Reciprocating instrumentation for endodontic treatment of primary molars: 24-month randomized clinical trial.

BACKGROUND: Although reciprocating instrumentation has been extensively studied for permanent teeth, stronger evidence for its use in primary teeth is lacking. AIM: The aim of this randomized clinical trial was to compare the efficacy of endodontic treatment in primary molars using reciprocating (RECIP) and manual (MAN) instrumentation techniques after 24 months. DESIGN: Primary molars with indication of endodontic treatment were randomly divided into two groups: MAN and RECIP. Treatments were performed, and root canals were filled with calcium hydroxide and iodoform paste. Teeth were later restored with bulk-fill composite resin and re-evaluated after 6, 12, 18, and 24 months. The primary outcome was the success of the endodontic treatment evaluated by Cox regression analysis adjusted by cluster and success rate after 24 months in the intention-to-treat (ITT) population. Instrumentation time, discomfort, postoperative pain, and quality of root canal filling were also evaluated as secondary endpoints. RESULTS: A total of 151 primary win 107 children were included, and 137 were followed up for 24 months. Success rate of teeth allocated to the MAN group was 57.3% and 55.3% for RECIP (p = .792); MAN instrumentation, however, was more time-consuming (p = .005). CONCLUSION: The efficacy of endodontic treatment in primary molars using reciprocating and manual instrumentation is similar after 24 months.

Stainless steel crown vs bulk fill composites for the restoration of primary molars post-pulpectomy: 1-year survival and acceptance results of a randomized clinical trial.

BACKGROUND: A key factor for the success and longevity of the endodontic treatment is sealing of the cavity after restorative treatment. AIM: The aim of this randomised clinical trial was to evaluate the 1-year survival of endodontic treatment in primary molars restored with stainless steel crowns (SSCs) and bulk fill composite resin (BF). As a secondary outcome, the acceptance of both children and parents was evaluated. DESIGN: Ninety-one 3- to 8-year-old children with at least one primary molar requiring endodontic treatment were selected. Participants were randomized to SSC or BF and evaluated after 1, 3, 6, and 12 months. An acceptance questionnaire was completed immediately after the treatment. The primary outcome was the endodontic treatment success, evaluated in the intention-to-treat (ITT) population using the Kaplan-Meier and non-inferiority Cox regression analyses, with a non-inferiority limit of 15%. Sensitivity analysis between the success rates after 1 year was performed using Miettinen-Nurminen's method. The Mann-Whitney test was used to compare the treatment acceptance (α = 5%). RESULTS: The survival rate after 1 year was BF = 75% and SSC = 88% (HR = 1.41; 90% CI 0.57-3.43). ITT analysis showed a success rate of BF = 86.7% and SSC = 82.6% (RR = 0.95; 0.78-1.16). The non-inferiority hypothesis between the survival of endodontic treatment could not be proved in both analyses (P > .05). The overall acceptance scores did not differ between the restorative groups (P > .05). CONCLUSION: This study failed to show non-inferiority of BF compared with the SSC. The materials were well accepted by both children and their parents.

The influence of normative and subjective oral health status on schoolchildren's happiness.

BACKGROUND: Traditional methods to measure oral health based on clinical standards are limited because they do not consider psychosocial and functional aspects of oral health. It has been recommended that these measures need to be supplemented by data obtained from patients regarding their individual perceptions on oral health-related quality of life (OHRQoL). Happiness is a multidimensional construct comprising both emotional and cognitive domains, and has been defined as "the degree to which an individual judges the overall quality of his or her life as a whole favorably". It has been associated with several health outcomes, including oral health. The aim of this study was to assess the impact of oral health conditions, oral health-related quality of life (OHRQoL), and socioeconomic factors on the subjective happiness of Brazilian adolescents. METHODS: A cross-sectional study was conducted in 2012 on a representative sample of 12-year-old schoolchildren in Santa Maria-RS, Brazil. The data were collected through dental examinations and structured interviews. The participants underwent an evaluation aimed at detecting dental caries, traumatic dental injuries, malocclusion, and gingival bleeding. They also completed the Brazilian versions of the Child Perceptions Questionnaire-short form (CPQ11-14-ISF: 16) and the Subjective Happiness Scale (SHS), which was our outcome variable. Socioeconomic conditions were evaluated through a questionnaire that was completed by the participants' parents. Poisson regression analysis was used to determine the association between the explanatory variables and the outcome. Moreover, a correlation analysis was performed to determine the relationship between the SHS scores and the overall and domain scores of the CPQ11-14-ISF: 16. RESULTS: A total of 1,134 children were evaluated. Unadjusted analyses showed that happiness was associated with socioeconomic indicators, the use of dental services, clinical status, and scores on the OHRQoL measure. After adjustment, household overcrowding (RR: 0.96; 95% CI: 0.93-0.98), dental caries (RR: 0.98; 95% CI: 0.97-0.99), malocclusion (RR: 0.98; 95% CI: 0.96-0.99), and the severity associated with the CPQ11-14 (RR: 0.95; 95% CI: 0.93-0.97) still showed a significant association with lower levels of the mean SHS score. CONCLUSIONS: Happiness is influenced by oral conditions, socioeconomic status, and OHRQoL.

Photodynamic therapy associated final irrigation in root canals of the primary teeth.

The aim of this study was to analyze, in vitro, the reduction of Enterococcus faecalis in root canals of primary teeth after final irrigation and photodynamic therapy (PDT) use. Twenty primary molars were contaminated with Enterococcus faecalis. The teeth were randomly distributed into four groups according to the irrigation solutions and PDT use: G1 (Saline solution and no PDT use), G2 (17 % EDTA and no PDT use), G3 (Saline solution and PDT use) and G4 (17 % EDTA and PDT use). For PDT, 0.005 % toluidine blue was chosen as the photosensitizer, which was inserted in the canals with sterile paper cones. Bacterial counts were performed with a BHI test in blood agar plate, where bacteria were collected inside the canal for 30 s using sterile paper cones. The collection took place before and after the irrigation and PDT protocols. The samples were diluted, spread onto a blood agar plate and then incubated at 37 °C for 24 h. There was a reduction of the microbiota from the irrigation solutions before and after the final irrigation for all groups. It was observed a statistically significant reduction (p < 0,05) when PDT was used (97.6 % at the saline solution and 89.8 % at the 17 % EDTA) when compared to the groups with no PDT use. Our data demonstrated that PDT, according to the parameters used, increased the disinfection performance of the solutions tested in the root canals of primary teeth.

Physicochemical properties and filling capacity of an experimental iodoform-based paste in primary teeth.

In this study, we evaluated the physicochemical properties (PCP; radiopacity, flow, pH, and solubility) and the quality of root canal filling provided by an experimental industrialized paste (EP), with the same active ingredients as those of the Guedes Pinto paste, compared with the Vitapex® paste. PCP were analyzed according to the ANSI/ADA laboratory testing methods for endodontic filling and sealing materials. To analyze filling capacity, 120 artificial primary teeth (60 maxillary incisors [MIs] and 60 mandibulary molars [MMs]) were endodontically treated. The teeth were divided into eight groups based on the dental group (MIs or MMs), filling material (Vitapex® or EP), and insertion method (syringe or lentulo). The Image J® software was used to analyze the initial an final digital radiographies of each tooth, measuring and comparing root canal and void areas. The percentage of filling failure areas was obtained. Data were submitted to ANOVA and Tukey test of mean comparison. Regarding PCP, both pastes presented results according the ANSI/ADA standards. Flow capacity: Vitapex: 19.6 mm, EP: 25 mm (p < 0.01); radiopacity: Vitapex: 4.47 mmAl, EP: 6.06 mmAl (p < 0.01); pH after 28 days: Vitapex: 7.79, EP: 8.19 (p = 0.12); and solubility after 28 days: Vitapex: 2.68%, EP: 2.89% (p > 0.05). Regarding filling capacity analysis, EP demonstrated 12.5% of failure against 31.5% of Vitapex (p < 0.01). Compared to Vitapex, EP presented statistically significantly better results in flow, radiopacity, pH, and filling capacity. Molars presented more filling failures than incisors. The insertion method using a syringe and a thin tip was significantly better than that using Lentulo spiral carriers.

Endemic dental fluorosis in children from a brazilian slave-descendent community: a cross-sectional study / Fluorose dentária endêmica em crianças de uma comunidade quilombola brasileira: um estudo transversal

Although fluoride (F) is required for the normal growth and development of several human organs and tissues, excessive exposure to it may be potentially toxic. Groundwater may present ranging levels of F; however, the appearance, taste, and smell are not altered. Thus, the present study aimed to evaluate dental fluorosis in children from a Brazilian slave-descendent community, as well as to assess F levels in the drinking water supplies available in that area. For that, 21 children aged from 6 to 14 years living in Rincão dos Martimianos were invited to participate. Thylstrup and Fejerskov index (a 0­9 scale) was used to assess dental fluorosis on permanent teeth. Furthermore, the F concentration of two water samples (from the artesian well and a tank) was determined by using a potentiometric method. All children presented dental fluorosis to some degree, ranging from score 2 to 9. About 81% of them had dental fluorosis scores equal to or over 5. Scores lower than 5 were observed only in children younger than 8 years; on the other hand, all children older than 8 years presented scores higher than 5. Moreover, artesian well water had an F concentration of 5 mg/L and tank water 0.8 mg/L. It is suggested that the F-rich groundwater supply was most probably responsible for dental fluorosis in that area. Brazilian slave-descendent communities, therefore, should receive constant attention from their local authorities in order to guarantee a proper water supply for consumption, as well as to provide public health education(AU)

Embora o flúor (F) seja necessário para o crescimento e desenvolvimento normal de vários órgãos e tecidos humanos, a exposição excessiva pode ser potencialmente tóxica. As águas subterrâneas podem apresentar níveis variados de F; no entanto, a aparência, o sabor e o cheiro não são alterados. Desta forma, o presente estudo teve como objetivo avaliar a fluorose dentária em crianças de uma comunidade brasileira descendente de escravos, bem como avaliar os níveis de F na água potável disponível nessa área. Para isso, 21 crianças de 6 a 14 anos residentes no Rincão dos Martimianos foram convidadas a participar da pesquisa. O índice de Thylstrup e Fejerskov (uma escala de 0 a 9) foi usado para avaliar a fluorose dentária em dentes permanentes. Além disso, a concentração de F de duas amostras de água (do poço artesiano e de um tanque) foi determinada pelo método potenciométrico. Todas as crianças apresentaram algum grau de fluorose dentária, variando de 2 a 9. Cerca de 81% delas apresentaram escores de fluorose dentária iguais ou superiores a 5. Escores inferiores a 5 foram observados apenas em crianças menores de 8 anos; por outro lado, todas as crianças maiores de 8 anos apresentaram escores superiores a 5. Além disso, a água do poço artesiano tinha concentração de F de 5 mg/L e a água do tanque 0,8 mg/L. Desta forma, acredita-se que a fonte de água subterrânea rica em F foi provavelmente responsável pela fluorose dentária na região avaliada. As comunidades quilombolas brasileiras, portanto, devem receber atenção constante de suas autoridades locais, a fim de garantir o abastecimento adequado de água para consumo, bem como proporcionar educação em saúde pública(AU)

Antimicrobial activity of different filling pastes for deciduous tooth treatment.

Guedes-Pinto paste is the filling material most employed in Brazil for endodontic treatment of deciduous teeth; however, the Rifocort® ointment has been removed. Thus, the aim of this study was to investigate the antimicrobial potential of filling pastes, by proposing three new pharmacological associations to replace Rifocort® ointment with drugs of already established antimicrobial power: Nebacetin® ointment, 2% Chlorhexidine Gluconate gel, and Maxitrol® ointment. A paste composed of Iodoform, Rifocort® ointment and Camphorated Paramonochlorophenol (CPC) was employed as the gold standard (G1). The other associations were: Iodoform, Nebacetin® ointment and CPC (G2); Iodoform, 2% Chlorhexidine Digluconate gel and CPC (G3); Iodoform, Maxitrol® ointment and CPC (G4). The associations were tested for Staphylococcus aureus (S. aureus), Streptococcus mutans (S. mutans), Streptococcus oralis (S. oralis), Enterococcus faecalis (E. faecalis), Escherichia coli (E. coli), and Bacillus subtilis (B. subtilis), using the methods of dilution on solid medium - orifice agar - and broth dilution. The results were tested using statistical analysis ANOVA and Kruskal-Wallis. They showed that all the pastes had a bacteriostatic effect on all the microorganisms, without any statistically significant difference, compared with G1. S. aureus was statistically significant (multiple comparison test of Tukey), insofar as G2 and G3 presented the worst and the best performance, respectively. All associations were bactericidal for E. coli, S. aureus, S. mutans and S. oralis. Only G3 and G4 were bactericidal for E. faecalis, whereas no product was bactericidal for B. subtilis. Thus, the tested pastes have antimicrobial potential and have proved acceptable for endodontic treatment of primary teeth.

Physicochemical properties and filling capacity of an experimental iodoform-based paste in primary teeth

Abstract In this study, we evaluated the physicochemical properties (PCP; radiopacity, flow, pH, and solubility) and the quality of root canal filling provided by an experimental industrialized paste (EP), with the same active ingredients as those of the Guedes Pinto paste, compared with the Vitapex® paste. PCP were analyzed according to the ANSI/ADA laboratory testing methods for endodontic filling and sealing materials. To analyze filling capacity, 120 artificial primary teeth (60 maxillary incisors [MIs] and 60 mandibulary molars [MMs]) were endodontically treated. The teeth were divided into eight groups based on the dental group (MIs or MMs), filling material (Vitapex® or EP), and insertion method (syringe or lentulo). The Image J® software was used to analyze the initial an final digital radiographies of each tooth, measuring and comparing root canal and void areas. The percentage of filling failure areas was obtained. Data were submitted to ANOVA and Tukey test of mean comparison. Regarding PCP, both pastes presented results according the ANSI/ADA standards. Flow capacity: Vitapex: 19.6 mm, EP: 25 mm (p < 0.01); radiopacity: Vitapex: 4.47 mmAl, EP: 6.06 mmAl (p < 0.01); pH after 28 days: Vitapex: 7.79, EP: 8.19 (p = 0.12); and solubility after 28 days: Vitapex: 2.68%, EP: 2.89% (p > 0.05). Regarding filling capacity analysis, EP demonstrated 12.5% of failure against 31.5% of Vitapex (p < 0.01). Compared to Vitapex, EP presented statistically significantly better results in flow, radiopacity, pH, and filling capacity. Molars presented more filling failures than incisors. The insertion method using a syringe and a thin tip was significantly better than that using Lentulo spiral carriers.

Self-perceived oral health influences tooth brushing in preschool children.

This study assessed the influence of socioeconomic and clinical factors, as well as parent's perception of child's oral health on the toothbrushing frequency of 0-5-year-old children. The study was carried out in Santa Maria, RS, Brazil, during the National Children's Vaccination Day, and 478 children aged 0-5 years were included. Data were collected by clinical examinations and a structured questionnaire, conducted by 15 calibrated examiners and 30 supports. A questionnaire was filled out by the parents with information about several socioeconomic indicators, perception of child's oral health and frequency of tooth brushing. The main outcome was collected by the question: "How many times a day do you brush your child's teeth?". Multivariable Poisson regression model taking into account the cluster sample was performed to assess the association between the predictors and outcome. Children whose parents related worse perception of child's oral health showed less tooth brushing frequency (PR 1.23; 1.06 - 1.43). Young children brush their teeth less than the older ones (PR 0.90; 0.84 - 0.96); and lack of visit to a dentist was predictor for less tooth brushing frequency (PR 1.29; 1.05 - 1.59). Parent's perception of child oral health influence children's healthy behaviors, supporting the evidence that psychosocial factors are strong predictors of children's oral health.

Antimicrobial activity of different filling pastes for deciduous tooth treatment

Guedes-Pinto paste is the filling material most employed in Brazil for endodontic treatment of deciduous teeth; however, the Rifocort® ointment has been removed. Thus, the aim of this study was to investigate the antimicrobial potential of filling pastes, by proposing three new pharmacological associations to replace Rifocort® ointment with drugs of already established antimicrobial power: Nebacetin® ointment, 2% Chlorhexidine Gluconate gel, and Maxitrol® ointment. A paste composed of Iodoform, Rifocort® ointment and Camphorated Paramonochlorophenol (CPC) was employed as the gold standard (G1). The other associations were: Iodoform, Nebacetin® ointment and CPC (G2); Iodoform, 2% Chlorhexidine Digluconate gel and CPC (G3); Iodoform, Maxitrol® ointment and CPC (G4). The associations were tested for Staphylococcus aureus (S. aureus), Streptococcus mutans (S. mutans), Streptococcus oralis (S. oralis), Enterococcus faecalis (E. faecalis), Escherichia coli (E. coli), and Bacillus subtilis (B. subtilis), using the methods of dilution on solid medium – orifice agar – and broth dilution. The results were tested using statistical analysis ANOVA and Kruskal-Wallis. They showed that all the pastes had a bacteriostatic effect on all the microorganisms, without any statistically significant difference, compared with G1. S. aureus was statistically significant (multiple comparison test of Tukey), insofar as G2 and G3 presented the worst and the best performance, respectively. All associations were bactericidal for E. coli, S. aureus, S. mutans and S. oralis. Only G3 and G4 were bactericidal for E. faecalis, whereas no product was bactericidal for B. subtilis. Thus, the tested pastes have antimicrobial potential and have proved acceptable for endodontic treatment of primary teeth.

Self-Perceived Oral Health Influences Tooth Brushing in Preschool Children

This study assessed the influence of socioeconomic and clinical factors, as well as parent's perception of child's oral health on the toothbrushing frequency of 0-5-year-old children. The study was carried out in Santa Maria, RS, Brazil, during the National Children's Vaccination Day, and 478 children aged 0 - 5 years were included. Data were collected by clinical examinations and a structured questionnaire, conducted by 15 calibrated examiners and 30 supports. A questionnaire was filled out by the parents with information about several socioeconomic indicators, perception of child's oral health and frequency of tooth brushing. The main outcome was collected by the question: "How many times a day do you brush your child's teeth?". Multivariable Poisson regression model taking into account the cluster sample was performed to assess the association between the predictors and outcome. Children whose parents related worse perception of child's oral health showed less tooth brushing frequency (PR 1.23; 1.06 - 1.43). Young children brush their teeth less than the older ones (PR 0.90; 0.84 - 0.96); and lack of visit to a dentist was predictor for less tooth brushing frequency (PR 1.29; 1.05 - 1.59). Parent's perception of child oral health influence children's healthy behaviors, supporting the evidence that psychosocial factors are strong predictors of children's oral health.

O estudo avaliou a influência de fatores socioeconômicos, clínicos e a percepção dos pais quanto à saúde de seus filhos na frequência de escovação de pré-escolares de 0 a 5 anos de Santa Maria-RS, Brasil. O estudo foi realizado em Santa Maria, Brasil, durante o Dia Nacional de Vacinação das Crianças e 478 crianças de 0 - 5 anos foram incluídas. Os dados foram coletados por meio de exames clínicos e por um questionário estruturado, realizados por 15 examinadores calibrados e 30 auxiliares. Os responsáveis forneceram informações sobre diversos indicadores socioeconômicos, auto-percepção de saúde bucal e frequência de escovação dentária. O principal desfecho foi coletado pela pergunta "Quantas vezes por dia você escova os dentes de seu filho?". Os dados foram analisados utilizando modelo de regressão de Poisson, considerando pesos relativos à amostragem complexa. Pais que relataram pior percepção de saúde bucal dos seus filhos em relação às outras crianças apresentavam uma menor frequência de escovação (RP 0,23; IC: 1,06 - 1,43). Crianças mais novas escovavam menos os dentes que as de idade mais elevada (RP 0,90; IC: 0,84 - 0,96) e a não-procura pelo dentista foi preditor para menor frequência de escovação (RP 1,29; IC: 1,05 - 1,59). A percepção dos pais influencia hábitos saudáveis da criança, suportando a evidência de que aspectos psicossociais são fortes preditores de saúde bucal na infância.

Perfil dos pacientes da Clínica de Odontologia para Bebês da Universidade Federal de Santa Maria / Profile of babies assisted in a oral health university program

Objetivo: Traçar o perfil dos pacientes atendidos na Clínica de Bebêsda UFSM.Materiais e métodos: A partir de um senso realizado entre março ejulho de 2012, os dados foram retirados dos prontuários clínicos esocioeconômicos, totalizando uma amostra de 51 bebês (0 a 47meses), residentes em Santa Maria – RS e região central do estado.A estatística empregada foi descritiva.Resultados: Os bebês envolvidos na pesquisa são em sua maioriameninos da raça branca, estão sob responsabilidade dos pais emoram com os mesmos, em residências de cinco cômodos, contendotrês moradores, e cujo abastecimento é o de água tratada. As mãestrabalham fora do ambiente familiar em metade dos casos, tendo, emsua maioria, segundo grau completo. A renda familiar mais frequentefoi entre um e dois salários mínimos. Os pais realizam a escovaçãopara seus filhos, duas vezes ao dia, utilizando creme dental. Houvepredominância de bebês amamentados e que nunca haviam ido aodentista. Com relação aos hábitos orais deletérios, 77,6% utilizammamadeira, e destes, 59,2% utiliza dia e noite; 47,9% dos bebêsfazem uso de chupeta e 25,5% sucção digital. No exame clínico,96,8% dos bebês possuem dentição da série normal, 21,4%apresentam oclusopatias e 57,1% das crianças apresentam lesõescariosas.Conclusão: A partir do perfil da população atendida, será possíveldirecionar os procedimentos que visam à manutenção erestabelecimento da saúde e definir os recursos necessários para sua execução.

Objective: To describe the profile of patients treated at the ClinicBabies UFSM.Materials and methods: A sense was conducted between March andJuly 2012, data were collected from the medical records andsocioeconomic factors, resulting in a sample of 51 infants (0-47months), all residents in Santa Maria or central region - RS. Thestatistic used was descriptive.Results: The infants involved in the study are mostly children of thewhite race, are under the responsibility of parents and live with themin the homes of five rooms, mostly with three residents with treatedwater supply. Half the cases mothers work outside, and, mostly weregraduated at high school. The family income was usually between oneand two minimum wages. Parents held their children brushing twiceday using toothpaste. Predominated and breastfed babies who hadnever been to the dentist. With regards to deleterious oral habits,77.6% use a bottle, and of these, 59.2% used day and night, 47.9% ofbabies are pacifier use and thumb sucking 25.5%. On clinicalexamination, 96.8% of babies have teeth of the normal series, 21.4%had malocclusion and 57.1% of children have caries.Conclusion: From the profile of the population served, you can directthe procedures that aim at maintaining and restoring the health anddefine the resources needed for its execution.