Associated factors and treatment options for sleep bruxism in children: an umbrella review

Abstract Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options.

Survival rate of the Hall technique compared with resin composite restoration in multi-surface cavities in primary teeth: a 1-year randomized clinical trial

Abstract Background Hall technique (HT) has been indicated for teeth with dentinal caries lesion; however, extensive cavities, with more than two surfaces still seem challenging for restorative treatment in pediatric dentistry, resulting in a higher failure rate and an increased need for retreatment. Objectives To compare the survival rate of the Hall technique preformed metal crown (HT) with resin composite restoration (RC) for multi-surface cavitated caries lesions in primary molars. Methodology In this multicenter two-arm randomized clinical trial, children between 4 and 9 years of age with at least one primary molar with cavitated caries lesion involving more than two surfaces, including one buccal or palatal/lingual surface, were selected from 17 Brazilian cities. A total of 364 teeth were allocated into two groups: (1) teeth treated with selective caries removal and RC and (2) treated with the HT. The survival rate was assessed at 6 and 12 months after the interventions. Survival analysis was performed with the Kaplan‒Meier method. Cox regression was used to determine the influence of explanatory variables on the survival rate (α=5%). Results After 12 months, 292 teeth were re-evaluated. A total of 358 teeth were re-evaluated at least once during the study and included in the survival analysis. The HT (87.8%) resulted in a higher survival rate than RC restoration (75.7%) (p=0.004). Conclusion HT has a higher survival rate than RC as a treatment for multi-surface cavitated caries lesions in primary teeth. ClinicalTrials.gov: NCT02782390

Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT

Abstract: The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Manejo dental de paciente con Síndrome de Hallervorden-Spatz: reporte de caso / Manejo odontológico de paciente com síndrome de Hallervorden-Spatz: relato de caso / Dental management of a patient with Hallervorden-Spatz syndrome: case report

El Síndrome de Hallervorden-Spatz es una afección neurodegenerativa rara, autosómica recesiva, caracterizada por depósitos en gran cantidad de hierro en los ganglios de base, lo que ocasiona gran pérdida motora y mental. Presenta dos formas de manifestación: la clásica, que aparece en la infancia a lo largo de la primera década de vida, y la atípica, cuyas manifestaciones clínicas aparecen de forma tardía, entre la segunda y tercera décadas de vida. El objetivo del presente estudio es describir un caso clínico de tratamiento endodóntico, en ambulatorio, de una paciente del sexo femenino, de 28 años, con manifestaciones clásicas de dicho síndrome, con cambio de color en el elemento 11 y lesión periapical, que justifica la indicación de endodoncia. La atención odontológica de una enfermedad neurodegenerativa rara, realizada en forma ambulatoria, requiere el conocimiento del dentista para que se conduzca de forma eficiente y segura

A síndrome de Hallervorden-Spatz é uma afecção neurodegenerativa rara, autossômica recessiva, caracterizada por depósitos em grande quantidade de ferro nos gânglios de base, o que ocasiona grande perda motora e mental. Apresenta duas formas de manifestações: a clássica, que surge na infância na primeira década de vida; e a atípica, cujas manifestações clínicas surgem mais tardiamente, entre a segunda e terceira décadas de vida. O objetivo desse estudo foi descrever um caso clínico de tratamento endodôntico, ambulatorial, de uma paciente do sexo feminino, 28 anos, com manifestações clássicas da síndrome, apresentando mudança de cor no elemento 11 com lesão periapical, justificando a indicação para endodontia. O atendimento odontológico de uma doença neurodegenerativa rara; realizado em ambiente ambulatorial, requer o conhecimento do dentista para que seja conduzido de forma eficiente e segura.

Hallervorden-Spatz syndrome is a rare, autosomal recessive neurodegenerative disorder characterized by large deposits of iron in the basal ganglia, which causes great motor and mental loss. It presents two forms of manifestations: the classic, which arises in childhood in the first decade of life; and the atypical, whose clinical manifestations appear later, between the second and third decades of life. The objective of this study was to describe a clinical case of endodontic outpatient treatment of a female patient, 28 years old, with classic manifestations of the syndrome, showing color change in element 11 with periapical lesion, justifying the indication for endodontics. The dental care of a rare neurodegenerative disease in an outpatient setting requires the dental surgeon's knowledge so that it is conducted efficiently and safely.

Lesion sterilization and tissue repair of primary molar to the eruption of its permanent successor: a case report / Esterilização da lesão e reparação de tecidos de molar decíduo: relato de caso clínico até a erupção do permanente sucessor

The aim of this study is to report a clinical case of lesion sterilization and tissue repair in primary molar, with follow-up until the eruption of the permanent successor. A 6-year-old male patient came to the Pediatric Dentistry Clinic at Faculdade Sao Leopoldo Mandic in Campinas-SP, with his mother, complaining of "caries in several teeth". On clinical examination, it was found that tooth 85 had a severe carious lesion with pulp involvement and fistula. Radiographically, radiolucency was observed in the furcation region. It was then decided to perform lesion sterilization and tissue repair of the tooth with CTZ paste. After 6 months of the procedure, the tooth was clinically and radiographically normal and after 3 years it was observed that tooth 85 was in complete root resorption. After extraction, the permanent successor erupted naturally without clinical or radiographic alterations. It can be concluded that the present clinical case demonstrated success in the use of CTZ paste in the lesion sterilization and tissue repair of primary molars, until the complete eruption of the permanent successor. (AU)

O objetivo desse estudo é relatar o caso clínico de esterilização da lesão e reparação de tecidos em molar decíduo com pasta CTZ, com acompanhamento até a erupção do pré-molar sucessor. Paciente do sexo masculino, 6 anos de idade, apresentou-se à Clínica de Odontopediatria da Faculdade São Leopoldo Mandic em Campinas-SP, acompanhado de sua mãe, queixando-se de "cárie em vários dentes". Ao exame clínico, verificou-se que o dente 85 apresentava lesão de cárie severa com envolvimento pulpar e fístula. Radiograficamente, observou-se radiolucidez na região de furca. Optou-se, então, por realizar a esterilização da lesão e reparação de tecidos do dente com pasta CTZ. Após 6 meses da realização do procedimento, o dente apresentava-se clinica e radiograficamente normal e após 3 anos observou-se que o elemento 85 estava em rizólise completa. Feita a extração, o permanente sucessor erupcionou naturalmente sem alterações clínicas ou radiográficas. Pode-se concluir que o presente caso clínico demonstrou sucesso do emprego da pasta CTZ na esterilização da lesão e reparação de tecidos de molar decíduo, até completa erupção do permanente sucessor. (AU)

Impact of mesiodens management on the oral health-related quality of life of a child: a case report

Introduction: Mesiodens is a supernumerary tooth present in the anterior maxilla. Children with teeth alterations that could affect their facial features may experience harassment and teasing, leading to difficulties in social interaction. Objective: To report a clinical case of treatment in a pediatric patient with mesiodens. Additionally, we aimed to correlate the mesiodens to the quality of life and happiness through the Child Perceptions Questionnaire (CPQ8-10) and the Subjective Happiness Scale (SHS). Case report: A 7-year-old patient complaining about a tooth between the upper central incisors and esthetical problems his tooth caused, according to his grandmother. In the initial session, the CPQ8-10 and the SHS were applied. The treatment performed was mesiodent extraction and follow-up. Four months after extraction, teeth 11 and 21 spontaneously repositioned, without the need for orthodontic intervention. The initial results (22 points in CPQ8-10 and mean 2.5 in the ESF) showed a negative impact on quality of life. Six months after the initial session, the questionnaires were reapplied and an improvement in the results was observed (7 points in CPQ8-10 and mean 5.25 in SHS). Conclusion: The correct diagnosis and the best moment for treatment were keys for preventing occlusal problems in a patient with mesiodens. Additionally, mesiodens treatment significantly improved the child's quality of life and perceived happiness.

Introdução: Mesiodente é um dente supranumerário presente na maxila anterior. Crianças com alterações nos dentes que podem afetar suas características faciais podem sofrer bullying e dificuldades de interação social. Objetivo: Relatar um caso clínico de tratamento em um paciente com mesiodente. Adicionalmente, correlacionar o tratamento do mesiodente ao impacto na qualidade de vida e felicidade por meio do Child Perceptions Questionnaire (CPQ8-10) e da Escala Subjetiva de Felicidade (ESF). Relato do caso: Paciente de 7 anos tinha como queixa um dente entre os incisivos centrais superiores e diagnóstico de mesiodente. O paciente relatou sofrer bullying por conta disso. Na consulta inicial foram aplicados o CPQ8-10 e o ESF. O tratamento realizado foi exodontia do mesiodente e acompanhamento. Quatro meses após a exodontia houve aproximação espontânea dos dentes 11 e 21, sem a necessidade de intervenção ortodôntica. Os resultados iniciais (22 pontos no CPQ8-10 e média 2,5 no ESF) mostraram impacto negativo na qualidade de vida. Seis meses após a consulta inicial os questionários foram reaplicados e uma melhora nos resultados foi percebida (7 pontos no CPQ8-10 e média 5,25 no SHS). Conclusão: O diagnóstico correto e o melhor momento para o tratamento foram fundamentais para prevenir problemas oclusais. Além disso, o tratamento melhorou significativamente a qualidade de vida da criança e a felicidade percebida.

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial

Abstract: This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

Management of deep caries lesions with or without pulp involvement in primary teeth: a systematic review and network meta-analysis

Abstract: There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21-2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insufficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.

Severe trauma in young permanent tooth: a case report / Trauma severo em dente permanente jovem: relato de caso

ABSTRACT Dentoalveolar trauma is a severe traumatic injury involving alveolar bone and dental structures. Like any trauma, it can leave irreparable sequelae and even cause tooth loss. The aim of this study is to report on the case of a dentoalveolar trauma in a 10-year-old male patient and the treatment performed with 12-month follow-up. The child had lateral luxation and displacement of teeth 11 and 21 in labial direction after a fall from his own height. The patient was examined at a hospital, received medication and was referred to a dental clinic. At the dental office, the teeth were repositioned, as well as received endodontic treatment and dental reanatomization. Two months after the trauma, root resorption was observed externally, which remained stable for 12 months. It was concluded that post-trauma treatment should be immediate and that follow-up sessions should be done carefully to minimize sequelae and to receive better prognosis.

RESUMO Traumatismo dentoalveolar é uma lesão traumática grave envolvendo osso alveolar e estruturas dentárias. Como qualquer trauma, pode deixar sequelas irreparáveis e até causar perda dentária. O objetivo deste estudo é relatar o caso de um trauma dentoalveolar em um paciente de 10 anos e o tratamento realizado com 12 meses de acompanhamento. A criança apresentou luxação lateral e deslocamento dos dentes 11 e 21 na direção labial após uma queda da própria altura. O paciente foi examinado em um hospital, recebeu medicação e foi encaminhado a uma clínica odontológica. No consultório odontológico, os dentes foram reposicionados, posteriormente, tratados endodônticamente e realizado a reanatomização dentária. Dois meses após o trauma, a reabsorção radicular foi observada externamente, permanecendo estável por 12 meses. Concluiu-se que o tratamento pós-trauma deve ser imediato e que as sessões de acompanhamento devem ser realizadas com cuidado, a fim de minimizar sequelas e obter melhor prognóstico.

Perfil de problemas orales en infantes y preescolares atendidos en el servicio de urgencias odontológicas de un centro de salud infantil de Brasil / Perfil de problemas orais em infantes e pré-escolares tratados no serviço de urgências odontológicas de um centro de saúde infantil do Brasil / Oral health problems profile in infants and preschool children attended at the dental emergency service of a children ́s health centre of Brazil

Objetivo: Determinar el perfil de los problemas orales en lactantes y preescolares atendidos en el servicio de urgencias de la Clínica de Especialidades infantil/ Clínica de Bebés de la Universidad Estatal de Londrina, Brasil. Materiales y métodos:Estudio retrospectivo donde se analizaron 776 historias clínicas de pacientes en el rango de edad de 0 a 72 meses, atendidos entre abril de 2007 a abril de 2008. Los datos recolectados fueron: Género, edad, lugar de residencia, ocupación y grado de escolaridad de los padres, motivo de consulta, dientes involucrados e intervenciones realizadas. Se utilizó la prueba de Chi2(χ2) y un nivel de significancia de 5% para la asociación entre variables. Resultados: Se observó una mayor proporción de pacientes de género masculino en la búsqueda del servicio (55,5%) y la mayoría de pacientes se ubicaron en el rango de edad de 0 a 24 meses (27,3%). Se verificó que el 62,9% residían en la zona urbana y la mayoría de los padres/responsables habían cursado secundaria completa (30,5% padres, 33,8% madres). Los motivos de consulta más frecuentes en la atención fueron caries dental (38,9%) siendo el dolor la queja principal (42,0%) y trauma dental (28,9%). Los dientes más afectados por caries fueron los segundos molares inferiores primarios y, por trauma los incisivos centrales superiores primarios. Dentro de las intervenciones más comunes se encontraron el tratamiento endodóntico (16,0%) y la adecuación del medio bucal (15,1%). Se encontró una asociación estadísticamente significativa entre escolaridad de la madre y motivo de consulta en el servicio de urgencias (p=0,001). Conclusión: El servicio analizado es necesario y útil, sin embargo, la resolución de problemas orales en la población infantil de Londrina, ocurrirá por medio de una reorganización de los servicios odontológicos actuales.

Objective: To determine the profile of oral problems in infants and preschool children treated at an emergency service from Clinic of Infantile Specialities / Clinical Baby of the State University of Londrina, Brazil. Materials and method: Retrospective study where 776 clinical histories of patients aged 0 to 72 months, treated between April 2007 and April 2008 were analysed. Data collection included gender, age, place of residence, parental occupation and educational level, reason for consultation, involved teeth and performed intervention. Chi-square test (χ2) and a significance level of 5% were used for variables associations. Results:A greater proportion of male patients (55.5%) attended the service and the main age group was the 0-24 months (27.3%). It was found that 62.9% lived in urban areas and most parents/caregivers had completed secondary school (30.5% parents, 33.8% mothers). The main reason for consultation was caries (38.9%) - pain as main complaint (42.0%) and dental trauma (28.9%). The most affected tooth by caries was the lower second primary molar and, regarding trauma, the upper central primary incisors were the most injured. Interventions varied from endodontic treatment (16.0%) and adequacy of oral environment (15.1%). There was a statistically significant association between mother educational level and reason for consultation (p = 0.001). Conclusion:The assessed health service was necessary and useful. However, oral health problems resolution in the paediatric population in Londrina will only occur after the implementation of reorganised dental services from the currently available.

Objetivo: Determinar o perfil dos problemas bucais em lactantes e pré-escolares atendidos no pronto socorro da Clínica de Especialidades Infantis / Bebê Clínica da Universidade Estadual de Londrina, Brasil. Materiais e métodos: Estudo retrospec-tivo onde foram analisados 776 prontuários odontológicos de pacientes na faixa etária de 0 a 72 meses, atendidos entre abril de 2007 a abril de 2008. Os dados coletados foram: Gênero, idade, lugar de moradia, ocupação e grau de escolaridade dos pais, motivo da consulta, dentes envolvidos e intervenções realizadas. Foi usado o teste qui-quadrado (χ2) e estabeleceu-se um nível de significância de 5% para a associação entre variáveis. Resultados: Observou-se uma maior proporção de pacientes de sexo masculino na procura do atendimento (55,5%) e a maioria dos pacientes pertenciam à faixa etária de 0 a 24 meses (27,3%). Verificou-se que, 62,9% moravam na zona urbana e a maioria dos pais/responsáveis possuíam escolaridade de segundo grau completo (30,5% pais, 33,8% mães). Os motivos mais frequentes pelo atendimento foram cárie dentária (38,9%) sendo a dor a principal queixa 42,0%, e trauma dentário (28,9%). Os dentes mais acometidos pela cárie foram os segundos molares infe-riores e por trauma, os incisivos centrais superiores decíduos. As intervenções mais comuns foram o tratamento endodôntico (16,0%) e adequação do meio bucal (15,1%). Houve associação estatisticamente significante entre escolaridade da mãe e moti-vo da consulta do pronto socorro (p=0,001). Conclusão: O serviço de urgência é necessário e útil, porém, a resolução dos pro-blemas bucais na população infantil de Londrina, ocorrerá por meio de uma reorganização dos serviços odontológicos atuais.

Remoção de mucocele com laser diodo: relato de caso clínico em paciente infantil / Mucocele removal with laser diode: case report on child patient

A mucocele é uma das lesões benignas que mais afeta a cavidade bucal. O laser de diodo de alta potência é uma opção que substitui ou associa procedimentos complementares aos processos convencionais,tendo mais conforto pós-cirúrgico. O objetivo deste trabalho foi relatar o caso clínico de remoção de mucocele de lábio inferior em paciente infantil utilizando laser de diodo de alta potência. Paciente do sexo feminino, 8 anos de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia São Leopoldo Mandic, em Campinas, relatando incômodo no lábio inferior, com a presença de uma “bolinha”. Ao exame clínico observou-se tumefação de consistência mole, flutuante, translúcida, com coloração similar à mucosa bucal. Após diagnóstico, o tratamento baseou-se na remoção cirúrgica com auxílio de laser de diodo de alta potência. Inicialmente foi realizada a anestesia infiltrativa ao redor da lesão, e então a remoção cirúrgica foi conduzida, juntamente com as glândulas acessórias para evitar recidiva, com uso do laser de diodo de alta potência. Ao fim do procedimento foi possível observar que a paciente saiu satisfeita, sendo o prognóstico favorável. No retorno de 30 dias, observou-se que não houve recidiva da lesão. O laser dediodo de alta potência, uma vez que apresenta uma série de benefícios, como excelente hemostasia, sem a necessidade de sutura, redução do edema e dor, cicatrização mais rápida e redução do tempo para realizar o procedimento, parece ser uma opção para remoção de mucocele em Odontopediatria.

Mucocele is a benign lesion that affects the oral cavity. The high power diode laser is an option as anadditional method or as a substitute to conventional procedures, with more post-surgical comfort. The objective of this study was to report a case of lower lip mucocele removal in a child patient using highpower diode laser. A female patient, 8 years old, attended the Clinic of Pediatric Dentistry, São Leopoldo Mandic School of Dentistry in Campinas, reporting discomfort in the lower lip, with the presence of a“ball”. On clinical examination it was observed swelling of soft consistency, floating, translucent, with coloring similar to the buccal mucosa. After diagnosis, the treatment was based on surgical removal with high power diode laser assistance. Initially infiltration anesthesia around the lesion was performed,and then the surgical removal was conducted, along with the accessory glands to prevent recurrence,with high power diode laser use. At the end of the procedure it was observed that the patient leftsatisfied, with a favorable prognosis. At the 30-day post-operative return, it was observed that there was no recurrence. The high power diode laser, since it presents a series of benefits such as excellen the mostasis, without the need for sutures, reduction of swelling and pain, faster healing, reducing the time to perform the procedure, it seems to be an option for removal of mucocele in pediatric dentistry.