Proteomic profile of the acquired enamel pellicle of children with early childhood caries and caries-free children.

Acquired enamel pellicle plays an important role in the pathogenesis of early childhood caries (ECC), working as a protective interface between the tooth and the oral cavity. The aim of this cross-sectional in vivo proteomic study was to compare the acquired enamel pellicle protein profile of 3-5-year-old children with ECC (n = 10) and caries-free children (n = 10). Acquired enamel pellicle samples were collected and processed for proteomic analysis (nLC-ESI-MS/MS). In total, 241 proteins were identified. Basic salivary proline-rich protein 1 and 2, Cystatin-B, and SA were found only in the caries free group. When comparing caries free and ECC groups, lower protein levels were found in the caries free group for hemoglobin subunit beta, delta, epsilon, gamma-2, globin domain-containing protein and gamma-1, neutrophil defensin 3, serum albumin, protein S100-A8, and S100-A9. The proteins histatin-1, statherin, salivary acidic proline-rich phosphoprotein ½, proline-rich protein 4, submaxillary gland androgen-regulated protein 3B, alpha-amylase 1 and 2B were found at higher levels in the caries free group. The exclusive and the proteins found at higher levels in the caries free group might have protective functions that play a role in the prevention of caries, besides providing important insights to be evaluated in future studies for the possible development of new therapeutic strategies for ECC.

Saliva proteomic profile of early childhood caries and caries-free children.

OBJECTIVE: Saliva plays an important antimicrobial role and it is related to the pathogenesis of early childhood caries (ECC). The aim of this study was to compare the proteomic profile of unstimulated saliva of children aged 3-5 years who had ECC and caries-free (CF) children. MATERIALS AND METHODS: After the saliva collection from 20 children (ECC: n = 10; CF: n = 10), the samples were processed for proteomic analysis on a mass spectrometer. RESULTS: 1638 proteins were identified, of which 355 were present in both groups. A total of 579 proteins were exclusively identified in the CF group and included Leucine-rich alpha-2-glycoprotein, Protein S100-A5, Protein S100-A8 and Mucin-2. Moreover, 704 proteins were exclusively identified in the ECC group, including Enamelin. The differential expression analysis revealed that 112 proteins were up-regulated in the CF group. Among these proteins, we highlighted Hemoglobin subunit gamma-1 (343-fold increase), gamma-2 (336-fold increase) and alpha (40-fold increase). CONCLUSIONS: The proteomic profile of the saliva varied substantially between the groups. Hemoglobin subunit gamma-1, gamma-2 and alpha may play a protective role in children with ECC. These proteins should be evaluated in future studies, because they may be possible good candidates to be included in anti-caries dental products.

Augmented Vision for Dental Students' Education in Detecting Proximal Carious Lesions on Bitewing Radiographs: A Randomized Controlled Trial.

This two-arm, parallel, randomized controlled trial aimed to assess the effect of augmented vision (AV, using interactive color overlays) on the education of dental students in detecting proximal carious lesions on bitewing radiographs compared to black-and-white textbook-like illustrations. Forty-eight preclinical third-year dental students were randomized using a random number generator into two learning groups: test (AV, allowing interaction with color-highlighted carious lesions, n = 24) and control (showing the native radiograph and a black-and-white illustration displaying the carious lesion, n = 24). First, students had 2 weeks to assess 50 bitewings (lesion prevalence on the tooth level: 54.5%) in the test or control. Due to the nature of the intervention, participants could not be blinded toward the intervention. After that, they were asked to detect lesions on 10 independent bitewings and to assess lesion extent (outer/inner enamel; outer/middle/inner dentin). The reference test was constituted by two experienced dentists. No significant differences in accuracy (test 0.84 [95% CI: 0.79, 0.88]; control 0.83 [0.78, 0.87]), AUC (test 0.82 [0.81, 0.84]; control 0.81 [0.80, 0.83]) and F1 score (test 0.79 [0.75, 0.82]; control 0.77 [0.72, 0.81]) were observed between groups. Students of both groups showed difficulties in differentiating enamel from dentin carious lesions. While AV was reported to be motivating by students, it did not increase their accuracy.

Sealing of cavitated occlusal carious lesions in the dentine of deciduous molars: a two-year randomised controlled clinical trial.

OBJECTIVES: This two-arm, parallel-group, tooth-randomised, controlled noninferiority clinical trial aimed to compare survival rates between the sealing and restoring of cavitated occlusal carious lesions in dentine [International Caries Detection and Assessment System (ICDAS) 5] of deciduous molars using resin-modified glass-ionomer cement (RMGIC) and to assess caries progression radiographically. MATERIALS AND METHODS: A total of 68 molars with ICDAS 5 occlusal lesions were randomly allocated into two groups, a sealing group (n = 31), in which RMGIC was placed directly over the carious lesion, and a restoration group (n = 37), in which a restoration with the same material was placed after selective caries removal. During the baseline and follow-up visits, dental caries was registered and caries activity was assessed according to a visuotactile criterion. At baseline, patient caries status (dmf-t) and cavity depth and extent (mesiodistal and buccolingual) were measured before RMGIC placement. An independent and blinded examiner evaluated the treated teeth using the USPHS criteria after one and two years. Standardised interproximal radiographs were taken for caries progression assessments. RESULTS: During the follow-up period, no lesion progression was observed radiographically. After one year (n = 60; 27 sealed and 33 restored) and two years (n = 48; 23 sealed and 25 restored) of follow-up, the treatment success rates were 78.8% and 76.0% in the restoration group and 59.3% and 47.8% in the sealing group, respectively. Multivariate Cox regression showed that lesions smaller than 2 mm in the mesiodistal extent were less prone to fail after one year (p = 0.03). However, survival curves (log-rank test) were statistically significantly different only after two years (p < 0.001). CONCLUSIONS: Sealing ICDAS 5 occlusal lesions of deciduous molars using RMGIC achieved lower survival rates than restorations. Both sealing and restoration effectively arrested caries progression for two years. Clinical relevance Sealing dentine carious lesions can be effective for treating lesions involving the inner and outer half of the dentine. Ultraconservative treatments can arrest carious lesions presenting obvious cavitation in primary molars. TRIAL REGISTRATION: ReBEC Register no. RBR-225n35.

Proteomic profile of the acquired enamel pellicle of professional wine tasters with erosive tooth wear.

The aim of this study was to compare the acquired enamel pellicle protein profile of professional wine tasters with mild and moderate erosive tooth wear. Twelve professional wine tasters participated (3 from a low tooth wear group; 9 from a high tooth wear group). Acquired enamel pellicle samples were collected and processed for proteomic analysis (nLC-ESI-MS/MS). The acquired enamel pellicle proteomic profile was different between the groups. The proteins found exclusively in the low tooth wear group were histatins 1 and 3 and mucins 7 and 21. When comparing the wear groups, proteins with higher levels in the low tooth wear group included neutrophil defensins (1 and 3), lysozyme C, lysozyme, myeloperoxidase, and squalene monooxygenase. In conclusion, the findings indicate that the proteins found at higher levels in the low tooth wear group and proteins exclusively found in the low tooth wear group might be protective and, therefore, could be good candidates for further studies regarding their potential to be added to dental products to protect professional wine tasters from extrinsic erosive tooth wear.

Sleep bruxism and oral health-related quality of life in children: A systematic review.

Sleep bruxism (SB) is a masticatory muscle activity during sleep that can cause several consequences to the stomatognathic system. This systematic review investigated the impact of SB on oral health-related quality of life (OHRQoL) of 0- to 6-year-old children. Literature search was undertaken through PubMed/MEDLINE, LILACS, Scopus, TRIP, Livivo databases, and grey literature. The search was conducted with no publication year or language limits. Two reviewers independently selected the studies, extracted the data and assessed the risk of bias. The quality of evidence was assessed using GRADE. From 185 potentially eligible studies, three were included in the review. All studies were conducted in Brazil, published between 2015 and 2017, and used the B-ECOHIS instrument to evaluate OHRQoL. Two studies found no association between SB and OHRQoL, whereas one showed a significant negative impact of SB on the OHRQoL of children. SB was associated with respiratory problems, presence of tooth wear, dental caries, malocclusion as well as income and pacifier use. Risk of bias ranged from moderate to high, and the quality of evidence was judged as very low. The evidence is currently insufficient for definitive conclusions about the impact of SB on OHRQoL of children.

Efficacy of toothpastes in the prevention of erosive tooth wear in permanent and deciduous teeth.

AIM: To evaluate the erosive preventive effect of toothpastes in permanent (PT) and deciduous teeth (dt). DESIGN: Enamel samples were divided into five groups (n = 20): G1: placebo toothpaste; G2: NaF toothpaste; G3: AmF-NaF-SnCl2 anti-erosion toothpaste; G4: SnF2-toothpaste; and G5: NaF anti-erosion toothpaste for children. The samples were exposed to five erosion-abrasion cycles (artificial saliva incubation; 3 min in 1% citric acid; 2 min in slurry, toothbrush abrasion, 50 strokes, 200 g). Surface microhardness (SMH), surface specular reflection intensity (SRI), and cumulative surface loss (CSL) were measured. Comparisons among toothpastes were evaluated using Kruskal-Wallis tests and comparisons between PT and dt were evaluated using Wilcoxon's rank sum test. RESULTS: G1 exhibited significantly lower SMH values in PT than the other toothpastes (p < 0.05), with no significant differences among the others groups. In dt, G1 and G4 exhibited significantly different values than the other groups (p < 0.05). G4 exhibited lower values of SRI in both types of teeth. Deciduous teeth presented significantly higher SRI than PT (p < 0.05), except for G3. Deciduous teeth generally presented higher CSL than PT, except for G3. CONCLUSIONS: Deciduous teeth were more prone to mineral loss than permanent teeth. G5 exhibited better efficacy for both teeth, while G3 exhibited a better preventive effect only for deciduous teeth. CLINICAL RELEVANCE: Erosive tooth wear prevalence in children is growing and deciduous teeth are more susceptible than permanent teeth. Considering this, it is important to know the preventive effect of different toothpastes in an initial erosion-abrasion model.

Pediatric Dentistry in Primary Healthcare: Creation, Development, and Evaluation of a Distance Education Course.

BACKGROUND: Oral health in childhood is a major problem for global public health. In Brazil, the prevalence of childhood tooth decay varies from 12% to 46%. Dental care treatment in Brazil is almost the exclusive responsibility of primary healthcare (PHC). Therefore, it is essential these professionals are prepared to conduct restorative, endodontic, and exodontic treatments and preventive care in children. INTRODUCTION: Children make up a large proportion of the population in territories requiring advanced dental care provided by PHC in Brazil. To care for these patients, it is necessary to have both manual dexterity and technical knowledge of pediatric dentistry. Accordingly, this study aimed to develop a distance course on pediatric dentistry. MATERIALS AND METHODS: A pretest questionnaire consisting of 15 questions was used to assess initial dental knowledge of participants. After completion of a five-module course, participants retook the same initial dental knowledge questionnaire (post-test). Descriptive statistic and paired t test, one-way analysis of variance, and Pearson and Spearman correlation were used, and a significance level of 5% was set. RESULTS: The majority of participants completing the five-module course were women who earned specialty degrees beyond undergraduate studies and currently worked in PHC (>5 years). Participant performance on the dental knowledge questionnaire after completion of the five-module course improved pre- to post-test. CONCLUSIONS: These data suggest that completion of a distance course on pediatric dentistry can be an effective tool for improving knowledge of pediatric dentistry in PHC professionals.

Do fluoride toothpastes have similar preventive effect in permanent and primary teeth against erosive tooth wear?

BACKGROUND: Little is known about fluoride toothpastes effect on primary teeth submitted to erosive tooth wear. OBJECTIVES: To evaluate the preventive effect of different toothpastes on surface loss (SL) after severe erosion/abrasion model and to compare this effect between permanent (PT) and primary teeth (pt). DESIGN: Enamel samples were randomly divided according toothpastes groups (n = 17). G1: placebo; G2: NaF; G3: AmF-NaF-SnCl2 anti-erosion; G4: SnF2 ; and G5: NaF anti-erosion for children. Samples were incubated in artificial saliva (1 hour), submitted to erosive challenge (3 minutes; 1% citric acid; pH3.6; at 25°C) and to toothbrush abrasion (2 minutes slurry immersion; 50 strokes; 200 g) during 30 cycles. Surface loss (µm; mean ± SD) was quantified by contactless profilometry. The effects of the two covariables "tooth" and "toothpaste" were analysed by non-parametric ANOVA, variables with significant effects were tested by Wilcoxon tests. RESULTS: pt showed significantly higher surface loss than PT in all groups (P < 0.001). The mean values of SL of each group were: G1 PT 18.18(±3.98), pt 25.65(±9.21); G2 PT 14.76(±2.82), pt 18.11(±3.92); G3 PT 12.62(±5.29), pt 15.61(±6.70); G4 PT 17.12(±2.24), pt 23.41(±7.9); G5 PT 13.24(±1.29), pt 18.28(±8.96). CONCLUSIONS: In permanent teeth, G3 showed the best preventive effect. In primary teeth, G1, G3, and G5 showed similar effect.

In vitro validation of a hand-held optical reflectometer to measure clinically observed erosive tooth wear.

In this study, we analyzed a newly developed optical reflectometer for measuring erosive tooth wear (ETW) in vitro. Three examiners independently assessed the labial surface of 80 deciduous canines and 75 permanent incisors. One examiner performed visual examinations (BEWE), and the other two used the optical pen-size reflectometer to measure surface reflection intensity (SRI) on the same labial surfaces. The examinations were made in duplicate with at least 1 week interval. Intra- and inter-rater agreements were calculated using weighted kappa analysis for BEWE, and intra-class correlation coefficients (ICC) as well as Bland-Altman plots for SRI. The teeth were separated into without (BEWE 0) or with (BEWE 1-3) ETW, and SRI cut-off points were calculated. Intra-rater agreement for the visual examination was 0.46 and 0.82 for deciduous and permanent teeth, respectively. Inter-rater and intra-rater agreement for SRI were good (ICC > 0.7; p < 0.001). SRI measurements produced high specificity values for deciduous and permanent teeth (≥0.74 and ≥ 0.84, respectively), and lower sensitivity values (≥0.37 and ≥ 0.64, respectively), but permanent teeth had generally higher SRI values (p < 0.05). We observed a significant association between BEWE and SRI (p < 0.05). The optical pen-size reflectometer was able to adequately differentiate ETW on permanent teeth, with highly reliable and reproducible measurements, but ETW on deciduous teeth was less accurately differentiated. The reflectometer is a good candidate for clinical research.

Gingivitis and salivary osmolality in children with cerebral palsy.

AIM: To investigate the influence of salivary osmolality on the occurrence of gingivitis in children with cerebral palsy (CP). DESIGN: A total of 82 children with spastic CP were included in this cross-sectional study. Oral motor performance and gingival conditions were evaluated. Unstimulated saliva was collected using cotton swabs, and salivary osmolality was measured using a freezing point depression osmometer. Spearman's coefficient, receiver operating characteristic (ROC), and multiple logistic regression analyses were performed. RESULTS: Strong correlation (r > 0.7) was determined among salivary osmolality, salivary flow rate, visible plaque, dental calculus, and the occurrence of gingivitis. The area under the ROC to predict the influence of salivary osmolality on the occurrence of gingivitis was 0.88 (95% CI 0.81-0.96; P < 0.001). The cutoff value of 84.5 for salivary osmolality presented good sensitivity and specificity, both higher than 77%. The proportion of children presenting salivary osmolality ≤84.5 mOsm/kgH2 O and gingivitis was 22.5%, whereas for the group presenting osmolality >84.5 mOsm/kgH2 O, the proportion of children with gingivitis was 77.5%. Salivary osmolality above 84.5 increased the likelihood of gingivitis fivefold, whereas each additional 0.1 mL of salivary flow reduced the likelihood of gingivitis by 97%. CONCLUSION: Gingivitis occurs more frequently in children with CP showing increased values of salivary osmolality.

Diagnostic performance of a new red light LED device for approximal caries detection.

The aim of this study was to test a newly developed LED-based fluorescence device for approximal caries detection in vitro. We assembled 120 extracted molars without frank cavitations or fillings pairwise in order to create contact areas. The teeth were independently assessed by two examiners using visual caries detection (International Caries Detection and Assessment System, ICDAS), bitewing radiography (BW), laser fluorescence (LFpen), and LED fluorescence (Midwest Caries I.D., MW). The measurements were repeated at least 1 week later. The diagnostic performance was calculated with Bayesian analyses. Post-test probabilities were calculated in order to judge the diagnostic performance of combined methods. Reliability analyses were performed using kappa statistics for nominal data and intraclass correlation (ICC) for absolute data. Histology served as the gold standard. Sensitivities/specificities at the enamel threshold were 0.33/0.84 for ICDAS, 0.23/0.86 for BW, 0.47/0.78 for LFpen, and 0.32/0.87 for MW. Sensitivities/specificities at the dentine threshold were 0.04/0.89 for ICDAS, 0.27/0.94 for BW, 0.39/0.84 for LFpen, and 0.07/0.96 for MW. Reliability data were fair to moderate for MW and good for BW and LFpen. The combination of ICDAS and radiography yielded the best diagnostic performance (post-test probability of 0.73 at the dentine threshold). The newly developed LED device is not able to be recommended for approximal caries detection. There might be too much signal loss during signal transduction from the occlusal aspect to the proximal lesion site and the reverse.

Effectiveness of a standardized treatment protocol for children with active non-cavitated occlusal lesions on erupting permanent molars.

OBJECTIVE: To evaluate the effectiveness of a treatment for non-cavitated occlusal lesions on erupting permanent molars and to verify whether initial eruption stage and final biofilm accumulation are associated with lesions activity after the treatment. METHODS: Forty-eight patients aged from 5 to 13 years old were selected. Molars with active non-cavitated lesions on the occlusal surface were classified according to eruption stage. Patients received a treatment for 4 weeks based on oral health instructions and fluoride applications. Three weeks after the end of the treatment, 39 patients were reassessed and lesion activity status and biofilm accumulation were recorded. Odds ratios were obtained using generalized estimating equations with logistic link function. RESULTS: Partially erupted molars were more prone to remain caries-active than molars in full occlusion (E1: OR = 301.1; E2: OR = 49.0 and E3: OR = 1107.3). High biofilm accumulation was associated with the presence of active lesions. CONCLUSIONS: Biofilm accumulation and eruption stage strongly influenced the effectiveness of a treatment for dental caries.

Segmentation of Dental Restorations on Panoramic Radiographs Using Deep Learning.

Convolutional Neural Networks (CNNs) such as U-Net have been widely used for medical image segmentation. Dental restorations are prominent features of dental radiographs. Applying U-Net on the panoramic image is challenging, as the shape, size and frequency of different restoration types vary. We hypothesized that models trained on smaller, equally spaced rectangular image crops (tiles) of the panoramic would outperform models trained on the full image. A total of 1781 panoramic radiographs were annotated pixelwise for fillings, crowns, and root canal fillings by dental experts. We used different numbers of tiles for our experiments. Five-times-repeated three-fold cross-validation was used for model evaluation. Training with more tiles improved model performance and accelerated convergence. The F1-score for the full panoramic image was 0.7, compared to 0.83, 0.92 and 0.95 for 6, 10 and 20 tiles, respectively. For root canals fillings, which are small, cone-shaped features that appear less frequently on the radiographs, the performance improvement was even higher (+294%). Training on tiles and pooling the results thereafter improved pixelwise classification performance and reduced the time to model convergence for segmenting dental restorations. Segmentation of panoramic radiographs is biased towards more frequent and extended classes. Tiling may help to overcome this bias and increase accuracy.

Self-Supervised Learning Methods for Label-Efficient Dental Caries Classification.

High annotation costs are a substantial bottleneck in applying deep learning architectures to clinically relevant use cases, substantiating the need for algorithms to learn from unlabeled data. In this work, we propose employing self-supervised methods. To that end, we trained with three self-supervised algorithms on a large corpus of unlabeled dental images, which contained 38K bitewing radiographs (BWRs). We then applied the learned neural network representations on tooth-level dental caries classification, for which we utilized labels extracted from electronic health records (EHRs). Finally, a holdout test-set was established, which consisted of 343 BWRs and was annotated by three dental professionals and approved by a senior dentist. This test-set was used to evaluate the fine-tuned caries classification models. Our experimental results demonstrate the obtained gains by pretraining models using self-supervised algorithms. These include improved caries classification performance (6 p.p. increase in sensitivity) and, most importantly, improved label-efficiency. In other words, the resulting models can be fine-tuned using few labels (annotations). Our results show that using as few as 18 annotations can produce ≥45% sensitivity, which is comparable to human-level diagnostic performance. This study shows that self-supervision can provide gains in medical image analysis, particularly when obtaining labels is costly and expensive.

In situ and in vitro comparison of laser fluorescence with visual inspection in detecting occlusal caries lesions.

The aim of this study was to compare the in situ and in vitro performances of a laser fluorescence (LF) device (DIAGNOdent 2095) with visual inspection for the detection of occlusal caries in permanent teeth. Sixty-four sites were selected, and visual inspection and LF assessments were carried out, in vitro, three times by two independent examiners, with a 1-week interval between evaluations. Afterwards, the occlusal surfaces were mounted on the palatal portion of removable acrylic orthodontic appliances and placed in six volunteers. Assessments were repeated and validated by histological analysis of the tooth sections under a stereomicroscope. For both examiners, the highest intra-examiner values were observed for the visual inspection when in vitro and in situ evaluations were compared. The inter-examiner reproducibility varied from 0.61 to 0.64, except for the in vitro assessment using LF, which presented a lower value (0.43). The methods showed high specificity at the D(1) threshold (considering enamel and dentin caries as disease). In vitro evaluations showed the highest values of sensitivity for both methods when compared to the in situ evaluations at D(1) and D(2) (considering only dentinal caries as the disease) thresholds. For both methods, the results of sensitivity (at D(1) and D(2)) and accuracy (at D(1)) showed significant differences between in vitro and in situ conditions. However, the sensitivity (at D(1) and D(2)), specificity and accuracy (both at D(1)) of the methods were not significantly different when the same condition was considered. It can be concluded that visual inspection and LF showed better performance in vitro than in situ.

Performance of laser fluorescence devices, visual and radiographic examination for the detection of occlusal caries in primary molars.

The aim of this in vitro study was to compare the performance of two laser fluorescence devices (LF, LFpen), conventional visual criteria (VE), ICDAS and radiographic examination on occlusal surfaces of primary teeth. Thirty-seven primary human molars were selected from a pool of extracted teeth, which were stored frozen at -20 °C until use. Teeth were assessed twice by two experienced examiners using laser fluorescence devices (LF and LFpen), conventional visual criteria, ICDAS and bitewing radiographs, with a 2-week interval between measurements. After measurement, the teeth were histologically prepared and assessed for caries extension. The highest sensitivity was observed for ICDAS at D(1) and D(3) thresholds, with no statistically significant difference when compared to the LF devices, except at the D(3) threshold. Bitewing radiographs presented the lowest values of sensitivity. Specificity at D(1) was higher for LFpen (0.90) and for VE at D(3) (0.94). When VE was combined with LFpen the post-test probabilities were the highest (94.0% and 89.2% at D(1) and D(3) thresholds, respectively). High values were observed for the combination of ICDAS and LFpen (92.0% and 80.0%, respectively). LF and LFpen showed the highest values of ICC for interexaminer reproducibility. However, regarding ICDAS, BW and VE, intraexaminer reproducibility was not the same for the two examiners. After primary visual inspection using ICDAS or not, the use of LFpen may aid in the detection of occlusal caries in primary teeth. Bitewing radiographs may be indicated only for approximal caries detection.

Demystifying artificial intelligence and deep learning in dentistry.

Artificial intelligence (AI) is a general term used to describe the development of computer systems which can perform tasks that normally require human cognition. Machine learning (ML) is one subfield of AI, where computers learn rules from data, capturing its intrinsic statistical patterns and structures. Neural networks (NNs) have been increasingly employed for ML complex data. The application of multilayered NN is referred to as "deep learning", which has been recently investigated in dentistry. Convolutional neural networks (CNNs) are mainly used for processing large and complex imagery data, as they are able to extract image features like edges, corners, shapes, and macroscopic patterns using layers of filters. CNN algorithms allow to perform tasks like image classification, object detection and segmentation. The literature involving AI in dentistry has increased rapidly, so a methodological guidance for designing, conducting and reporting studies must be rigorously followed, including the improvement of datasets. The limited interaction between the dental field and the technical disciplines, however, remains a hurdle for applicable dental AI. Similarly, dental users must understand why and how AI applications work and decide to appraise their decisions critically. Generalizable and robust AI applications will eventually prove helpful for clinicians and patients alike.

Narratives about a stigma: attributing meaning to the early loss of deciduous teeth on children's caregivers.

Qualitative approach about the implications that occur succeeding the premature loss teeth is still insufficient. This study aimed to understand the experience of early loss of deciduous teeth in children's lives, from the perspective of their caregivers. Qualitative case study included 52 caregivers of children from an outpatient service of a public university in the south of Brazil. Early loss of deciduous teeth to trauma or caries was identified through analysis of health records, and afterwards, semi-structured interviews were performed. Textual material was interpreted through the content analysis proposed by Bardin, supported by the ATLAS.ti software. The theoretical perspective of stigma was guided according to the principles of the phenomenology of Maurice Merleau-Ponty, centred on the experience of early loss of deciduous teeth as a historic-cultural expression of a social group. According to caregivers, premature loss of deciduous teeth due to trauma or decay brings functional limitations with chewing and speaking, and impairments related to social interaction with other children. The repercussions of missing teeth were not limited to the child's image, but also brought changes in families' daily lives. However, when early tooth loss was due to extraction because of pain and suffering, caregivers perceived the loss as 'commonplace' in children's lives. The understanding of how children see themselves without teeth in their social world for their caregivers, which also includes their family and friends, determines how much experiencing tooth loss affects their lives. Besides, caregivers' perceptions related to early loss of deciduous teeth should be included in strategies of oral health promotion programs.

Non-invasive and micro-invasive treatments to arrest active occlusal carious lesions in erupting permanent molars: A randomized clinical trial.

This study aimed to evaluate the efficacy of non-invasive and micro-invasive treatments on the arrest of occlusal enamel carious lesions in erupting permanent molars. This two-arm randomized clinical trial included 27 subjects, aged 5-11 years, with 64 erupting permanent molars presenting active occlusal enamel carious lesions (as assessed by the International Caries Detection and Assessment System [ICDAS]; scores 1-3). The sample was randomly assigned into two treatment groups: 1) resin-modified glass ionomer cement sealant (Clinpro XT Varnish; 3M ESPE) and 2) 4-week topical fluoride varnish application (Duraphat; Colgate). All children and parents received oral hygiene and dietary instructions. Teeth were evaluated at baseline and 3, 6, 9, and 12 months regarding the eruption stage, biofilm accumulation, as well as severity and activity of the carious lesions. The Kaplan-Meier method was used to evaluate the survival estimates for inactivation of the carious lesions for both treatment groups. Multivariate Cox regression models with shared frailty were performed to identify factors associated with the outcome (p < 0.05). After 12 months, 22% and 3% of the lesions treated with topical fluoride varnish and sealant, respectively remained active. The adjusted model demonstrated that younger children had a higher probability of active enamel carious lesions arresting (hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.22-0.78; p=0.01). However, the probability of active enamel carious lesions arresting after sealant application was 8.85 times higher compared with fluoride varnish applications (p=0.01). Sealing is a more effective approach than fluoride varnish for arresting occlusal enamel carious lesions in erupting permanent molars.