Dental caries in three-year-old preschool children in Lima, Peru assessed according to the CAST instrument / Caries dental en niños prescolares de 3 años en Lima-Perú evaluados con el instrumento CAST

ABSTRACT The aim of this study was to determine the caries situation of three-year-old preschool children residing in low socioeconomic status districts in Lima, Peru. The study is a crosssectional analysis of the caries situation of suburban areas of Lima. A stratified sampling procedure by geographical distribution, considering healthcare centers with a motherand- child health clinic and surrounding preschools as factors, identified 45 randomly selected preschools, of which 17 accepted to participate. Children from 3-year-old classrooms were examined by two independent calibrated dentists using the Caries Assessment Spectrum and Treatment (CAST) instrument at their premises using artificial light, sterile examination mirrors and gauze for drying each tooth before evaluation. ANOVA and the Tamhane method were used to analyze the data. 308 children, mean age 3.4 years (min: 3 years; max: 3 years, 7 months), were examined. The sample prevalence of enamel and dentine carious lesions (CAST code 3-7) was 91.2% while the prevalence of dentine carious lesions (CAST code 4-7) was 58.8%. The mean number of teeth with cavities that had reached the pulp and those that had an abscess or fistula were 2.0% and 0.5% respectively. The majority of enamel and dentine carious lesions were observed in molars. The CAST severity score was 7.0. Mean examination time was 57 seconds. The burden of dental caries of the children at this young age was high.

RESUMEN El objetivo del presente estudio fue determinar la prevalencia de caries dental en niños en edad preescolar de 3 años residentes en áreas suburbanas de Lima, Perú. Se trata de un análisis transversal de la situación de caries de áreas periféricas de Lima. Un procedimiento de muestreo estratificado por distribución geográfica consideraba a los centros de salud materno-infantiles y centros educativos preescolares de la jurisdicción como factores, identificando 45 centros prescolares aleatoriamente, de los cuales 17 aceptaron la invitación para participar del presente estudio. Dos odontólogas independientes, calibradas examinaron a los niños de las aulas de 3 años utilizando el instrumento Caries Assessment Spectrum and Treatment (CAST) en las instalaciones de cada jardín de infancia, utilizando luz artificial, instrumental estéril y gasas para el secado de las superficies a evaluar. Los datos fueron analizados utilizando ANOVA y el método Tamhane. Se evaluaron 308 niños, quienes tenían una edad media de 3.4 años (min: 3 años; max: 3 años, 7 meses). La prevalencia de lesiones de caries de esmalte y dentina (código CAST 3-7) fue del 91,2%, mientras que la prevalencia de lesiones de caries en dentina (código CAST 4-7) fue de 58,8%. El número promedio de dientes afectados por caries dental con compromiso pulpar y que tenían un absceso o fístula fue de 2.0% y 0.5% respectivamente. La mayoría de las lesiones de caries en esmalte y dentina se observaron en los molares. La valoración de severidad CAST fue 7.0. El tiempo promedio de examinación fue de 57 segundos. La carga de la enfermedad caries dental a estas edades tan tempranas ya es alta en la infancia suburbana de Lima.

Radiation-related caries assessment through the International Caries Detection and Assessment System and the Post-Radiation Dental Index.

OBJECTIVE: Although radiation-related caries (RRC) are a well-known toxicity of head and neck radiotherapy, a clinical classification system for RRC has not yet been clinically validated. Therefore, the aim of this study was to assess whether the International Caries Detection and Assessment System (ICDAS) and the Post-Radiation Dental Index (PRDI) were viable methods for the assessment of RRC. STUDY DESIGN: Clinicopathologic data and intraoral digital photographs of 60 patients (833 teeth) affected by RRC were assessed and classified according to the ICDAS and PRDI criteria. RESULTS: A total of 814 (97.7%) teeth presented RRC lesions ranging from early stage to complete tooth destruction. Mean scores for the whole sample were 5 for ICDAS and 3 for PRDI, indicating that RRC were diagnosed predominately in late stages. ICDAS and PRDI criteria underestimate the clinical expressivity of RRC by not including the whole qualitative clinical spectrum of RRC, such as enamel cracks, delamination, dental crown amputation, surface color alterations, and atypical lesions topography (incisal/cuspal caries). CONCLUSIONS: ICDAS and PRDI may not be considered viable for the assessment of RRC. The development of a specific clinical classification system is urgently needed to help clinicians recognize the peculiar patterns of RRC, particularly in incipient cases.

Índice de riesgo de caries dental / Dental caries risk index

Introducción: el desarrollo de índices para identificar el riesgo a padecer caries dental, permite focalizar intervenciones preventivas y optimizar los recursos sanitarios, lo que propicia mejores resultados en la atención a la población. Objetivo: evaluar la capacidad discriminatoria de un índice de riesgo de caries dental. Métodos: se realizó la investigación en dos etapas correspondientes al desarrollo y validación del índice, durante los cursos 2012-2013 y 2013-2014, respectivamente. La primera fue un estudio de casos y controles con niños entre 6 y 12 años de tres escuelas primarias de Santa Clara, Cuba. Se descartó en un inicio la presencia de caries y se recogió información sobre un grupo de variables; luego de diez meses se seleccionaron como casos a los 120 niños detectados con caries y del resto, 240 controles elegidos al azar. Se elaboró un índice mediante un procedimiento basado en la V de Cramer, y un modelo predictivo de caries mediante regresión logística. La segunda etapa fue un estudio transversal con 360 niños, para validar el índice y contrastarlo con el modelo predictivo mediante: área bajo la curva características operativas del receptor y otras medidas calculadas a partir de tablas de 2 x 2. Resultados: el índice obtenido tuvo valores de sensibilidad, especificidad e índice de validez de 87,5 por ciento, 82,5 por ciento y 84,2 por ciento respectivamente. El modelo de la regresión presentó cifras porcentuales de 80,8 por ciento, 81,3 por ciento y 81,1 por ciento. El área bajo la curva del primero fue 0,889 y del segundo 0,870(AU) Conclusiones: los resultados avalan al índice obtenido mediante los valores de V de Cramer como un instrumento importante para la identificación del riesgo y, por consiguiente, la prevención y control de la caries dental de los niños de 6 a 12 años que residen en Santa Clara.

Introduction: dental caries risk indices make it possible to focus on preventive actions and optimize health resources, leading to better results in dental care. Objective: evaluate the discriminating capacity of a dental caries risk index. Methods: the study was conducted in two stages, corresponding to development and validation of the index. These took place during school years 2012-2013 and 2013-2014, respectively. The first stage was a case-control study with children aged 6-12 from three elementary schools in Santa Clara, Cuba. At the outset, the presence of caries was discarded and information was collected about a number of variables. Ten months later the 120 children with detected caries were selected as cases, and 240 controls were randomly chosen from among the remaining children. An index was developed applying a procedure based on Cramér's V and a caries prediction model based on logistic regression. The second stage was a cross-sectional study with 360 children to validate the index and contrast it with the prediction model on the basis of the area under the curve, recipient's operative characteristics, and other measures estimated with 2 x 2 tables. Results: the index showed sensitivity, specificity and validity values of 87.5 percent, 82.5 percent y 84.2 percent respectively. The regression model obtained percentage values of 80.8 percent, 81.3 percent and 81.1 percent. The area under the curve was 0.889 for the former and 0.870 for the latter. Conclusions: results attest to the validity of the index obtained through Cramér's V values as an important tool to identify the risk for, and therefore the prevention and control of dental caries in children aged 6-12 resident in Santa Clara(AU)

Adolescência e sua relação com a cárie dentária, binge drinking, capital social e fatores associados / Adolescence and your relationship with tooth decay, binge drinking, social capital and associated factors

O objetivo deste estudo foi investigar as relações entre binge drinking - consumo de 5 ou mais doses de bebidas alcoólicas em uma ocasião -, cárie dentária, capital social e condição socioeconômica entre os estudantes de 12 anos de escolas públicas e privadas da área urbana da cidade de Diamantina-MG. A coleta de dados ocorreu em duas etapas: na primeira etapa foi realizado um censo envolvendo todos os 633 alunos de 12 anos de idade, matriculados nas 13 escolas. Na segunda etapa do estudo foi desenvolvido um estudo longitudinal de prevalência de período com os alunos que fizeram parte da primeira fase desta pesquisa. Na primeira etapa foram avaliados a prevalência da cárie dentária e sua associação com capital social e condições socioeconômicas, bem como, o consumo em ¿binge¿ por adolescentes e sua associação com o consumo de álcool por amigos, familiares, condições socioeconômicas e religiosidade. Na segunda etapa o objetivo foi investigar a associação entre capital social e a frequência de beber em "binge" entre adolescentes escolares. Os dados foram coletados por meio de exames clínicos e questionários autoaplicados. A frequência de consumo de álcool na vida e o binge drinking foram determinadas usando as Teste de Identificação de Desordens Devido ao Uso de Álcool (AUDIT-C). Para cárie dental foi adotado o Índice de dentes "cariados, perdidos e obturados" (CPO-D). O capital social foi medido pelo Questionário de Capital Social para Alunos Adolescentes (QCS-AE) desenvolvido e validado para os adolescentes escolares. Os indicadores socioeconômicos utilizados foram tipo de escola, renda familiar mensal, ABA-ABIPEME e escolaridade materna. Foram realizadas análise descritiva e bivariada e regressão binomial no estudo de prevalência de período. O nível de significância foi de 5%. Como principais resultados, observou-se que um total de 269 (45,7%) adolescentes tiveram pelo menos uma lesão cariada cavitada. A análise múltipla revelou que nem o gênero nem o capital social estiveram estatisticamente associados com a presença de lesões cavitadas (p > 0.05). Adolescentes que estudam em escolas públicas e com renda familiar inferior a 3 salários mínimos foram mais propensos a ter lesões cariosas cavitadas. Em relação ao consumo excessivo de álcool, a prevalência foi de 23,1%. A idade média de início do consumo de álcool foi de 10,8 anos. O binge drinking foi mais prevalente entre adolescentes cujo melhor amigo [RP = 4,72 (95% IC 2,78-8,03)] e irmão [RP = 1,46 (IC 95% 1,10-1,92)] consumiam álcool. A religiosidade [RP = 0,40 (IC 95% 0,27-0,62)] apareceu como um possível fator de proteção. No estudo longitudinal, adolescentes que relataram um aumento na coesão social na subescala comunidade/vizinhança foram 3,4 vezes mais propensos (95% IC 1,96-6,10) a consumir álcool excessivamente. Os achados desse estudo destacam os determinantes sociais do binge drinking e do comportamento de beber entre os adolescentes e a não associação entre o capital social e a cárie dentária. Além disso, os resultados fornecem novas evidências sobre o "lado negro" da coesão social na promoção do consumo excessivo de álcool entre os adolescentes.

The objetive of this study was to investigate the relationship between binge drinking - consumption of 5 or more doses of alcoholic beverages on one occasion - dental caries, social capital, and socioeconomic status among students of- 12-years-old of public and private schools in the urban area of the city of Diamantina-MG. Data collection took place in two stages: in the first stage, a census was carried out involving all 633 12-year-old students enrolled in the 13 scholls. In the second phase of the study a longitudinal period prevalence study was developed with students who were part of the first phase of this research. The first stage evaluated the prevalence of dental caries and its association with social capital and socioeconomic conditions, as well as the consumtion of alcoholic beverages by adolescents and their association with alcohol consumption by friends, family members, socioeconomic condition and religiosity...

Differential Impacts of Caries Classification in Children and Adults: A Comparison of ICDAS and DMF-T

Abstract The aim of this study was to describe and compare findings regarding the prevalence and severity of dental caries when using ICDAS and DMFT/dmft in an epidemiological study with children and their mothers. This cross-sectional study evaluated 150 preschoolers and their mothers. Data were collected with ICDAS and then transformed into DMFT/dmft. ICDAS scores related to caries were analyzed according to three different cut-off-points: CP1 (0-healthy/1-6-caries), CP2 (0-1-healthy/2-6-caries) and CP3 (0-2-healthy/3-6-caries), representing the D/d of DMFT/dmft. ICDAS codes regarding restorations, except sealants, were considered the F/f and the code 97 as the M/m of DMFT/dmft index. Prevalence of caries and its severity with ICDAS were 92%, 84% and 31.3% in children and 97.3%, 96.6% and 80% in adults according to CP1/CP2/CP3, respectively. Admitting CP3 as the standard for data transformation of ICDAS in DMFT/dmft, it was observed that DMFT/dmft index would underestimate 60% of non-cavitated lesions in children and 16.6% in adults. The DMFT/dmft underestimated the presence of disease to disregard non-cavitated lesions for the pediatric population evaluated. The choice of which is the best index for epidemiological surveys will depend on the purpose of the research and the target population: if it is to estimate the needs of the population to determine clinical care in children and adults, the DMFT/dmft may be sufficient. However, if the objective is to have a more comprehensive diagnosis of caries at the population level in order to develop preventive strategies, to halt and reverse the disease, the detection of non-cavitated-lesions becomes important, mainly in young children.

Resumo O objetivo deste estudo foi descrever e comparar os achados sobre a prevalência e severidade da cárie dentária ao utilizar ICDAS e CPOD/ceod em um estudo epidemiológico com crianças e suas mães. Este estudo transversal avaliou 150 pré-escolares e suas mães. Os dados foram coletados utilizando-se o ICDAS e depois transformados em CPOD/ceod. Os códigos do ICDAS relacionados à cárie foram analisados de acordo com três diferentes pontos de corte: CP1 (0-hígido/1-6-cárie), CP2 (0-1 hígido/2-6-cárie) e CP3 (0-2 hígido/3-6-cárie), representando o D/d do índice CPOD/ceod. Os códigos do ICDAS referentes às restaurações, exceto selantes, foram considerados o O/o e o código 97 do ICDAS como o P/e do índice CPOD/ceod. A prevalência de cárie e sua severidade com o ICDAS foram de 92%, 84% e 31,3% em crianças e 97,3%, 96,6% e 80% em adultos de acordo com o CP1 / CP2 / CP3, respectivamente. Admitindo o ponto de corte CP3 como o padrão para a transformação de achados do ICDAS em CPOD/ceod, foi observado que o índice CPOD/ceod subestimaria 60% das lesões não cavitadas em crianças e 16,6% em adultos. O CPOD/ceod subestima a presença da doença ao desconsiderar as lesões não cavitadas na população pediátrica avaliada. A escolha de qual é o melhor índice para levantamentos epidemiológicos vai depender do propósito da pesquisa e da população-alvo: se o objetivo for estimar as necessidades da população para determinar cuidados clínicos em crianças e adultos, o CPOD/ceod pode ser suficiente. No entanto, se o objetivo for ter um diagnóstico mais abrangente da doença ao nível da população, a fim de desenvolver estratégias preventivas, para paralisar e reverter a doença, a detecção de lesões não cavitadas torna-se importante, principalmente em crianças pequenas.

Efeito anticárie do flúor associado ao trimetafosfato de sódio / Anticaries effect of fluoride associated with sodium trimetaphosphate

Objetivo: Estudar o efeito anticárie da adição de trimetafosfato de sódio (TMP) aos compostos fluoretados (dentifrícios, vernizes e soluções) para prevenção e tratamento de lesões de cárie através de uma revisão de literatura. Materiais e Métodos: Foram selecionados artigos de pesquisa e revisões sistemáticas da literatura mais relevantes sobre o assunto publicados na língua inglesa, desde 1968 até 2015, pesquisados no PubMed. As palavras-chave utilizadas foram: trimetafosfato de sódio, cárie dentária e fluoretos.Resultados: Foram apresentados os principais resultados de trabalhos de pesquisa sobre o TMP quando associado aos dentifrícios, vernizes e soluções para bochechos e estudos clínicos longitudinais. Conclusão: Os estudos in vitro e in situ mostram que o trimetafosfato de sódio pode potencializar a eficácia do flúor na prevenção e tratamento da cárie dentária, porém ainda faltam estudos para entender o mecanismo de ação do TMP, além de estudos clínicos para comprovar sua eficácia e indicação.

Objective: The aim of this work was to study the anticaries effect of adding sodium trimeta phosphate (TMP) to fluoride compounds (tooth pastes, varnishes and mouthrinse)for prevention and treatment of caries lesions with a review of the literature. Materials and Methods: The most relevant research articles and systematic reviews on the subject published in English, were selected from 1968 to 2015, browsed on Pubmed. The key words used were: sodium trimetaphosphate, dental caries and fluorides. Results: Themain results of research articles on the TMP associated with dentifrices, varnishes and mouthrinses and longitudinal clinical studies were presented. Conclusion: In situ and in vitro studies have shown that TMP might increase the effectiveness of fluoride in the prevention and treatment of caries, but there are few studies that explain its mechanism of action, as well as clinical studies to demonstrate its anticaries effect and indication.

Infiltrante resinoso vs Microabrasão no manejo de lesões de mancha branca: relato de caso / Resin infiltration vs microabrasion in white-spot lesions treatment: case report

Objetivo: Apresentar caso clínico de tratamento estético das lesões de mancha branca após tratamento ortodôntico nos dentes superiores anteriores através de duas técnicas minimamente invasivas usando o sistema de infiltração de resina e microabrasão. Relato de caso: Paciente com 18 anos de idade apresentava lesões de manchas brancas inativas nos dentes 11, 12, 13, 21, 22, 23. O sistema de infiltrante de resina Icon (DMG, Hamburgo, Alemanha) foi utilizado nos dentes 11, 12, 13, enquanto os dentes 21, 22, 23 foram submetidos à microabrasão com Whiteness RM (FGM, Joinville, Santa Catarina, Brasil).Ambos os protocolos foram utilizados de acordo com as recomendações do fabricante.Nos dentes 21 e 22, o produto para microabrasão foi aplicado com espátula que acompanha o kit, enquanto que no dente 23 utilizou-se o mesmo produto aplicado com taça de borracha em baixa rotação, todos os procedimentos executados por um único operador. A microabrasão com taça de borracha proporcionou uma superfície mais lisa e homogênea.Ambos os produtos tiveram resultados satisfatórios na resolução estética das lesões de mancha branca após um ano de acompanhamento. Conclusão: Os dois produtos apresentam bom desempenho e resolutividade para os problemas estéticos de lesões de manchas brancas inativas, entretanto deve-se levar em conta o tempo clínico, toxicidade, a atividade da lesão e a possibilidade de desgaste da estrutura dentária.

Objective: To present a case report of aesthetic treatment of post orthodontic white--spot lesions in the anterior superior teeth through two minimally invasive technique susing resin infiltration system or microabrasion. Case report: Patient 17 years of age had inactive white-spots lesions on teeth 11, 12, 13, 21, 22, 23. The teeth 11, 12, 13 received the resin infiltrating system Icon (DMG, Hamburg, Germany) while the teeth 21, 22, 23were submitted to microabrasion with Whiteness RM (FGM, Joinville, Santa Catarina, Brazil). Both protocols were used according to manufacturer’s recommendations. In the teeth 21 and 22, the product of the microabrasion was applied with a spatula that accompanied the kit, while the tooth 23 received the same product applied with a rubbercup at low speed turbine, all by a single operator. The microabrasion with rubber cupoccasioned a more smooth and homogeneous surface. Both products had satisfactory results in aesthetic resolution of the white-spots lesions, for a 1-year follow-up. Conclusion:Although both products are able to resolve aesthetic problems of inactive white-spots lesions, it should be taken into account the clinical time, toxicity, the activity ofthe lesion and the possibility of wear of the tooth structure.

Reabilitação odontológica multidisciplinar em paciente pediátrico com hemofilia: relato de caso / Multidisciplinary rehabilitation of pediatric dentistry in patients with hemophilia: case report

A hemofilia é uma coagulopatia congênita autossômica recessiva ligada ao cromossomo X, isso é devido à deficiência do fator VIII (hemofilia A) ou do fator IX (hemofilia B) afetando apenas os homens.Os transtornos hemorrágicos constituem um dos problemas de maior interesse a serem considerados pelo cirurgião-dentista na prática odontológica. O tratamento odontológico de pacientes com hemofilia deve ser realizado sob cuidados especiais com uma equipe multidisciplinar, nos quais os profissionais da saúde devem ter experiência médica e apoio hematológico adequados. O Objetivo deste trabalho foi relatar a reabilitação odontológica de maneira multidisciplinar de um paciente pediátrico com diagnóstico de hemofilia B grave, a qual é tratada e controlada por médicos hematologos do Hospital Geral de Zona (HGZ). O diagnóstico odontológico foi de acúmulo de placa bacteriana nas superfícies dentais por má higiene bucal, lesões de cárie e hipoplasia de esmalte. Para reabilitação bucal foram realizadas extrações de alguns elementos dentais, profilaxia, flúor terapia, orientação emotivação de higiene bucal, remoção de tecido cariado com auxílio de ultrassom, restaurações com resina composta, ionômero de vidro e restaurações indiretas cerômeros. Concluiu-se que para um adequado manejo odontológico é imprescindível o conhecimento de diversas patologias sistêmicas como a hemofilia, o atendimento multidisciplinar, além do conhecimento de técnicas de mínima intervenção em Odontopediatria para assim poder oferecer ao paciente melhores alternativas de tratamento com a mínima invasão e resultados favoráveis.

Hemophilia is an autosomal recessive congenital blood coagulation desorder to X chromosome, this is due to deficiency of factor VIII (hemophilia A) or factor IX (hemophilia B) affects only men. Bleeding disorders are one of the issues of greatest interest to be considered by the dentist in the dental practice. Dental treatment of patients with hemophilia should be done under special care bya multidisciplinary team in which health professionals must have medical experience and adequate hematologic support. The objective of this study was to report the dental rehabilitation in a multidisciplinary team to a pediatric patient with severe haemophilia B, which is treated and controlled by medical hematologists in Zone General Hospital (HGZ). The dental diagnosis was accumulation ofplaque on dental surfaces by poor oral hygiene, dental caries and enamel hypoplasia. For oral rehabilitation extractions were performed in some dental elements, prophylaxis, fluoride therapy, guidance and motivation of oral hygiene, caries removal with ultrasound assistance restorations with compositeres in, glass ionomer and indirect restorations with cerômics. It was concluded that for properdental management is essential knowledge of various systemic diseases such as hemophilia, multidisciplinary care, in addition to knowledge of minimal intervention techniques in pediatric dentistry so as to offer the best treatment alternatives patient with minimal invasion and favorable results.

Comparison of simple screening criteria with the International Caries Detection and Assessment System classification in determining restorative treatment need.

INTRODUCTION: The Finnish Defence Forces' unique oral health-screening protocol (FDFsp) has been in use for decades. In FDFsp, restorative treatment need is determined based on the World Health Organization (WHO) criteria. The aim of this study was to compare the outcome of screening restorative treatment need with the outcome of using the International Caries Detection and Assessment System (ICDAS) classification at both individual and tooth levels. Our hypothesis was that the outcome of screening with FDFsp agrees with the outcome of using the ICDAS classification. METHODS: In this study, a trained, calibrated examiner estimated, in a visual-tactile manner the restorative treatment need of 337 young healthy adults using the FDFsp. During the screening, 74 conscripts were selected for a thorough inspection. The inclusion criteria for those selected were: having no, having one to five, or having six or more caries lesions needing restorative treatment. In the thorough inspection, the participants were inspected in a visual-tactile manner using the ICDAS classification. The association of the outcomes achieved using the two different methods was analysed at individual and tooth levels. Sensitivity, specificity, and kappa values were calculated. Wisdom teeth were excluded. RESULTS: At the individual level, the agreement between the outcomes of using FDFsp and ICDAS ≥4 was excellent: sensitivity, 94.1%; specificity, 97.5%; and kappa = 0.92. When ICDAS ≥3 was used, the values were 72.7%, 96.7%, and 0.66%, respectively. CONCLUSION: Screening performed by a trained examiner using specific criteria is a reliable method for detecting individuals with restorative treatment need. The outcome of screening agrees strongly with results using the ICDAS classification.

A practical method for use in epidemiological studies on enamel hypomineralisation.

With the development of the European Academy of Paediatric Dentistry (EAPD) judgment criteria, there has been increasing interest worldwide in investigation of the prevalence of demarcated opacities in tooth enamel substance, known as molar-incisor hypomineralisation (MIH). However, the lack of a standardised system for the purpose of recording MIH data in epidemiological surveys has contributed greatly to the wide variations in the reported prevalence between studies. The present publication describes the rationale, development, and content of a scoring method for MIH diagnosis in epidemiological studies as well as clinic- and hospital-based studies. The proposed grading method allows separate classification of demarcated hypomineralisation lesions and other enamel defects identical to MIH. It yields an informative description of the severity of MIH-affected teeth in terms of the stage of visible enamel destruction and the area of tooth surface affected (i.e. lesion clinical status and extent, respectively). In order to preserve the maximum amount of information from a clinical examination consistent with the need to permit direct comparisons between prevalence studies, two forms of the charting are proposed, a short form for simple screening surveys and a long form desirable for prospective, longitudinal observational research where aetiological factors in demarcated lesions are to be investigated in tandem with lesions distribution. Validation of the grading method is required, and its reliability and usefulness need to be tested in different age groups and different populations.

Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort.

BACKGROUND: To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated. METHODS: From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site ("Yes"/"No") was analyzed with logistic regression analysis. RESULTS: Mean age of subjects was 46.4 (range 20-77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis. CONCLUSIONS: Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist.

The effect of lifetime fluoridation exposure on dental caries experience of younger rural adults.

BACKGROUND: The aim of this study was to confirm whether the level of lifetime fluoridation exposure is associated with lower dental caries experience in younger adults (15-46 years). METHODS: Data of the cohort born between 1960 and 1990 residing outside Australia's capital cities from the 2004-2006 Australian National Survey of Adult Oral Health were analysed. Residential history questionnaires were used to determine the percentage of each person's lifetime exposure to fluoridated water (<50%/50+%). Examiners recorded decayed, missing and filled permanent teeth (DMFT). Socio-demographic variables, periodontal risk factors, and access to dental care were included in multivariable least-squares regression models. RESULTS: In bivariate analysis, the higher level of fluoridation category had significantly lower DMFT (mean 6.01 [SE=0.62]) than the lower level of fluoridation group (9.14 [SE=0.73] p<0.01) and lower numbers of filled teeth (4.08 [SE=0.43], 7.06 [SE=0.62], p<0.01). In multivariate analysis, the higher number of full-time equivalent dentists per 100,000 people was associated with a lower mean number of missing teeth (regression coefficient estimate=-1.75, p=0.03), and the higher level of water fluoridation with a lower mean DMFT (-2.45, p<0.01) and mean number of filled teeth (-2.52, p<0.01). CONCLUSIONS: The higher level of lifetime fluoridation exposure was associated with substantially lower caries experience in younger rural adults, largely due to a lower number of filled teeth.

Reabilitação estética e funcional na primeira infância: relato de caso / Aesthetic and functional rehabilitation in infancy: a case report

A perda precoce dos dentes decíduos pode ocorrer pela falta de diagnóstico e tratamento na fase inicial da cárie dentária. O objetivo foi relatar o tratamento reabilitador estético e funcional de uma criança de 4 anos e 5 meses de idade, do gênero feminino, com cárie precoce da infância severa. Durante a anamnese, além da queixa de dor nos dentes, notou-se apatia da criança e constrangimento da mesma ao falar e sorrir. Ao exame clínico inicial, a paciente apresentou ausência dos dentes 55, 54, 75, 84 e 85; lesões de cárie ativa do 73 ao 83; lesões cariosas ativas extensas (53, 52, 51, 61, 62, 63, 64, 65, 74) e presença de fístula na região dos dentes 51 e 52. Após o exame radiográfico, o tratamento proposto foi a realização da exodontia dos elementos dentários não passíveis de receber tratamento restaurador (53, 52, 51, 61, 62, 63, 64, 65, 74); restauração com resina composta do 73 ao 83; e posterior colocação de prótese total superior e prótese parcial inferior. Orientações sobre higiene bucal e dieta não-cariogênica foram realizadas em todas as etapas do tratamento para incentivar a criança e familiares à prática de hábitos saudáveis. Diante do tratamento realizado, concluiu-se que a reabilitação estética-funcional recuperou as funções estéticas, fonéticas e mastigatórias da paciente; colaborando para a melhora da autoestima da criança o que gerou satisfação dos familiares. O trabalho educativo em estimular a criança e os cuidadores foi essencial para o sucesso do tratamento e manutenção da saúde bucal...

Dental caries is a disease related with sucrose rich diet and poor oral hygiene. During childhood, if caries disease is misdiagnosed, it can lead to early loss of primary teeth. This study aimed to report the aesthetic and functional rehabilitation treatment in a female child aged 4 years and 5 months, with severe early childhood caries. In the case history, as well as complaints of toothache, the child showed apathy and embarrassment to talk and smile. In initial clinical examination, it was noticed lack of teeth 55, 54, 85, 84 and 75; active caries lesion on teeth 71, 73, 81, 82 and 83; the dental elements 51, 52, 53, 61, 62, 63, 64, 65 and 74 presented with extensive coronary destruction bellow the gingival margins, and the teeth 51 and 52 with the presence of fistula. After radiographic evaluation, the treatment proposed was comprised by destroyed teeth extraction, resin composite restoration of all cavities and subsequent placement of upper denture and lower partial denture. Oral hygiene and non-cariogenic diet orientations were accomplished since the initial treatment to encourage the child and her family to practice healthy habits. After accomplished the treatment, it could be concluded that aesthetic and functional rehabilitation recovered the patient aesthetic, phonetic and mastication functions. This fact contributed to improve the child’s self-esteem and it promoted satisfaction of her family. The dentist educational work and the stimulus of child and her caregivers were essential for treatment successful and for patient oral health maintenance...

Uso de seringas para inserção no ART: ensaio clínico randomizado / Use of syringes for insertion in ART: randomized clinical trial

O ART é considerado uma das abordagens minimamente invasivas no conceito de Odontologia de Mínima Intervenção, e se baseia principalmente na remoção de tecido cariado com os instrumentos manuais e restauração da cavidade com cimento de ionômero de vidro de alta viscosidade. O objetivo deste estudo foi avaliar a influência da técnica de inserção do material restaurador no sucesso das restaurações atraumáticas em superfícies proximais, em dentes decíduos. A amostra foi composta por 90 pacientes, com idades entre 6 a 10 anos (8,7 ± 1,51). Um total de 90 restaurações foram realizadas por único operador treinado, de acordo com o manual da Organização Mundial de Saúde (OMS). O material restaurador utilizado foi o cimento de ionômero de vidro de alta viscosidade (KetacTM Molar Easy Mix, 3M ESPE), o qual foi inserido através de uma espátula de inserção (G1); seringa Centrix e ponta Accudose Agulha (G2); e seringa modificada (G3). As restaurações foram avaliadas após 6 e 12 por dois examinadores treinados e calibrados (Kappa=0,74), através de fotografias padronizadas, de acordo com os critérios de Roeleveld et al., 2006. Foi aplicado o teste estatístico Qui-quadrado para avaliação de possíveis diferenças entre os tempos e as técnicas de inserção. Não houve diferença estatisticamente significativa quanto aos critérios de sucesso/insucesso clínico entre os métodos de inserção testados, nos dois tempos (p>0,05). Conclui-se que a utilização de técnicas alternativas de inserção do ionômero de vidro não aumenta a taxa de sucesso de restaurações proximais em dentes decíduos.

ART is considered one of the minimally invasive operative approaches in the concept of Minimal Intervention Dentistry, once it involves the removal of soft dentin with hand instruments, followed by filling the cavity with a high viscous glass ionomer cement. The aim of this study was to evaluate the influence of insertion technique on the success rate of proximal atraumatic restorative restorations in primary teeth. The sample comprised of 90 children with ages ranging from 6 to 10 (mean age 8.7±1.51 years). A total of 90 ART restorations were placed by one trained dentist according to World Health Organization (WHO) manual. The restorative material used was a high-viscosity glass-ionomer (KetacTM Molar Easy Mix, 3M ESPE) which was placed into the cavities in a using an insertion spatula (G1); a Centrix syringe injector and Accudose needle (G2); and a modified syringe (G3). The restorations were assessed 6 and 12 months after placement by two calibrated examiners (Kappa=0.74), through standard photographs, according Roeleveld et al. (2006) criteria. The chi-square test was used to evaluate differences between the insertion techniques and the periods tested. There was no difference between the insertion techniques tested, over the two periods evaluated, considering the clinical criteria for success/failure. It was concluded that using alternative insertion methods of glass ionomer cement did not improve success rate of proximal atraumatic restorative restorations in primary teeth.

Dental caries and childhood obesity: analysis of food intakes, lifestyle.

AIM: The aims of this cross-sectional statistical study were to evaluate the association between obesity and dental caries and to assess the impact of food intake, oral hygiene and lifestyle on the incidence of dental caries in obese paediatric patients, analysed by Dual X-ray Absorptiometry (DXA). MATERIALS AND METHODS: A sample of 96 healthy patients, aged between 6 and 11 years (mean age 8.58±1.43) was classified in relation to body composition assessment and McCarthy growth charts and cut- offs. Body composition analysis, to obtain body fat mass (FM) and body fat free mass (FFM) measurements, was determined by means of a DXA fan beam scanner. The subjects underwent dental examination to assess the dmft/DMFT, and completed a questionnaire on food intake, oral hygiene habits and lifestyle. The sample was subsequently subdivided into four groups: Group A (normal weight - caries-free), Group B (normal weight with caries), Group C (pre-obese/obese - caries-free), Group D (pre-obese/obese with caries). STATISTICS: The statistical analysis was performed using SPSS software (version 16; SPSS Inc., Chicago IL, USA). Spearman's correlation was performed to evaluate the correlation between dmft/DMFT and FM%. The chi-square test was performed to assess the categorical variables, while the non-parametric Kruskal Wallis test and the Mann Whitney test were employed for the quantitive variables. Statististical significance was set at a P-value of 0.05. RESULTS: The preobese-obese children had higher indexes of dental caries than normal weight subjects, both for deciduous teeth (dmft 2.5 ± 0.54 vs 1.4 ± 0.38; p=0.030) and permanent teeth (DMFT 2.8 ± 0.24 vs 1.93 ± 1.79; p=0.039). The correlations between dmft/DMFT indexes and body composition parameters were analysed and a significant correlation between dmft/DMFT indexes and FM% was observed (p=0.031 for dmft, p=0.022 for DMFT). According to the data recorded, there was no statistically significant difference between Groups A, B, C and D in terms of food intake between meals (p=0.436), frequency of starch intake limited to the main meals (p=0.867), home oral hygiene (p=0.905), dental hygiene performed at school (p=0.389), habit of eating after brushing teeth (p=0.196), participation in extracurricular sport activities (p=0.442) and educational level of parents: father (p=0.454), mother (p=0.978). In contrast, there was a statistically significant difference between Groups A, B, C and D in terms of intake of sugar-sweetened drinks (p=0.005), frequency of sugar intake limited to the main meals (p<0.001), frequency of food intake between meals (p=0.038) and sedentary lifestyle (p=0.012). Successive analysis revealed a statistically significant difference between Group A and D in terms of intake of sugar-sweetened drinks (p=0.001), frequency of sugar intake limited to the main meals (p=0.008), and frequency of food intake between meals (p=0.018), and between Group C and D in terms of frequency of sugar intake limited to the main meals (p<0.001), and frequency of food intake between meals (p=0.040). CONCLUSION: This study shows a direct association between dental caries and obesity evident from a correlation between prevalence of dental caries and FM%. The analysis of food intake, dmft/DMFT, FM%, measured by DXA, demonstrates that specific dietary habits (intake of sugar-sweetened drinks, frequency of sugar intake limited to main meals, frequency of food intake between meals) may be considered risk factors that are common to both dental caries and childhood obesity.

Caries de infancia temprana: diagnóstico e identificación de factores de riesgo / Early childhood caries: diagnosis and identification of risk factors

La caries de infancia temprana ha sido definida con múltiples denominaciones; en las últimas décadas se ha descrito como una enfermedad de origen multifactorial presente en infantes hasta los 71 meses de edad. El objetivo de esta revisión es describir la clasificación, características clínicas, epidemiología, etiología y factores condicionantes externos de la caries de infancia temprana, a través de una extensa revisión bibliográfica, realizada por un grupo de estudio de la Sociedad Peruana de Odontopediatría, durante seis meses (2013-2014); con el fin de brindar in- formación y herramientas, a los trabajadores de la salud en el Perú, útiles en el diagnóstico de la enfermedad y en la identificación de factores de riesgo asociados. La característica de la etiología de la caries de infancia temprana, radica en la influencia de factores únicos en los infantes, relacionados a la implantación temprana de los microorganismos cariogénicos, a la inmadurez del sistema de defensa del huésped, así como a los patrones del comportamiento asociados a la alimentación y la deficiente higiene oral en los infantes. De acuerdo a lo estudiado, la prevalencia de caries de infancia temprana en el Perú oscila entre 31.5% y 93%. Los factores socio culturales presentan una marcada influencia en la instauración, progresión y severidad de la enfermedad; adicionalmente, ciertos condicionan te s externos, como la conducta del niño, el nivel de conocimiento y actitud de los padres, malnutrición y la presencia de enfermedades crónicas o procesos infecciosos específicos como la otitis, se han relacionado con un mayor riesgo de caries dental en infantes...

Early childhood caries has been defined with multiple names; in recent decades has been described as a multifactorial origin disease, present in infants up to 71 months. The aim of this review is to describe the classification, clinical features, epidemiology, etiology and determinants external factors of early childhood caries, through an extensive literature review, conducted by a group of study of the Peruvian Society of Dentistry for six months (2013-2014); in order to provide information and tools to health workers in Peru, useful in the diagnosis of disease and identification of associated risk factors. The characteristic of the etiology of early childhood caries, lies in the influence of unique factors in infants, related to the early implementation of cariogenic microorganisms, to the immaturity of the host defense system, as well as behavioral patterns associated with food and poor oral hygiene in children. According to the study, the prevalence of early childhood caries in Peru varies between 31.5% and 93%. Socio- cultural factors have a marked influence on the onset, progression and severity of disease; additionally, certain external factors such as the child's behavior, the level of knowledge and parents attitude, malnutrition and the presence of chronic diseases or specific infectious conditions such as ear infections, have been associated with an increased risk of dental caries in infants...

Early intervention with probiotic Lactobacillus paracasei F19 has no long-term effect on caries experience.

The aim of the study was to evaluate possible long-term effects of a cereal diet supplemented with Lactobacillus paracasei F19 (LF19) during weaning on caries experience, mutans streptococci (MS) and lactobacilli (LBC) in a group of 9-year-old children. A secondary aim was to evaluate if the intervention resulted in the permanent integration of LF19 as part of the oral microbiota. The study followed up on a double-blind placebo-controlled randomised trial. Among 179 infants that were randomised to a daily diet that included cereals with or without LF19 from 4 to 13 months of age, 56 from the probiotic group and 62 from the placebo group participated in the follow-up at 9 years. Data were collected by oral clinical examination and questionnaires. MS and LBC levels were assessed with conventional cultivation; LF19 was detected by using randomly amplified polymerase chain reactions (RAPD-PCR). At the follow-up, neither decayed, missing and filled surfaces for primary teeth (dmfs) nor decayed, missing and filled surfaces for permanent teeth (DMFS) differed significantly between the probiotic and placebo groups (p > 0.05). MS and LBC levels were similar in both groups (p > 0.05). RAPD-PCR showed no evidence of oral colonisation with LF19 in the study group. It is concluded that an early intervention with LF19 did not affect the frequency of dental caries, MS or LBC. LF19 did not establish itself as a permanent facet of the oral microbiota in any of the subjects included in this study.

Cluster Effects in a National Dental PBRN restorative study.

Items in clusters, such as patients of the same clinician or teeth within the same patient, tend to be more similar than items from different groups. This within-group similarity, represented by the intraclass correlation coefficient (ICC), reduces precision, yielding less statistical power and wider confidence intervals, compared with non-clustered samples of the same size. This must be considered in the design of studies including clusters. We present ICC estimates from a study of 7,826 restorations placed in previously unrestored tooth surfaces of 4,672 patients by 222 clinicians in the National Dental Practice-Based Research Network, as a resource for sample size planning in restorative studies. Our findings suggest that magnitudes of ICCs in practice-based research can be substantial. These can have large effects on precision and the power to detect treatment effects. Generally, we found relatively large ICCs for characteristics that are influenced by clinician choice (e.g., 0.36 for rubber dam use). ICCs for outcomes within individual patients, such as tooth surfaces affected by a caries lesion, tended to be smaller (from 0.03 to 0.15), but were still sufficiently large to substantially affect statistical power. Clustering should be taken into account in the design of oral health studies and derivation of statistical power estimates for these studies (ClinicalTrials.gov, NCT00847470).

Using electronic dental record data for research: a data-mapping study.

Anecdotal evidence suggests that, during the clinical care process, many dental practices record some data that are also collected in dental practice based research network (PBRN) studies. Since the use of existing, electronically stored data for research has multiple benefits, we investigated the overlap between research data fields used in dental PBRN studies and clinical data fields typically found in general dental records. We mapped 734 unique data elements from the Dental Information Model (DIM) to 2,487 Common Data Elements (CDE) curated by the NIDCR's PBRNs in the Cancer Data Standards Registry and Repository (caDSR). Thirty-three percent of the DIM data elements matched at least one CDE completely and 9% partially, translating to about 9% and 2%, respectively, of all data elements used in PBRN studies. The most frequently used CDEs found in the DIM included data about dental anatomy, medications, and items such as oral biopsy and caries. Our study shows that a non-trivial number of data elements in general dental records can be mapped either completely or partially to data fields in research studies. Further studies should investigate the feasibility of electronic clinical data for research purposes.

Genome-wide association studies of pit-and-fissure- and smooth-surface caries in permanent dentition.

While genetics clearly influences dental caries risk, few caries genes have been discovered and validated. Recent studies have suggested differential genetic factors for primary dentition caries and permanent dentition caries, as well as for pit-and-fissure- (PF) and smooth- (SM) surface caries. We performed separate GWAS for caries in permanent-dentition PF surfaces (1,017 participants, adjusted for age, sex, and the presence of Streptococcus mutans) and SM surfaces (1,004 participants, adjusted for age, education group, and the presence of Streptococcus mutans) in self-reported whites (ages 14 to 56 yrs). Caries scores were derived based on visual assessment of each surface of each tooth; more than 1.2 million SNPs were either successfully genotyped or imputed and were tested for association. Two homologous genes were suggestively associated: BCOR (Xp11.4) in PF-surface caries (p value = 1.8E-7), and BCORL1 (Xq26.1) in SM-surface caries (p value = 1.0E-5). BCOR mutations cause oculofaciocardiodental syndrome, a Mendelian disease involving multiple dental anomalies. Associations of other plausible cariogenesis genes were also observed for PF-surface caries (e.g., INHBA, p value = 6.5E-6) and for SM-surface caries (e.g., CXCR1 and CXCR2, p value = 1.9E-6). This study supports the notion that genes differentially affect cariogenesis across the surfaces of the permanent dentition, and nominates several novel genes for investigation.