Relationship between tooth loss, nutritional status and consumption of macro and micronutrients in elderly people from southern Brazil

Maintaining a functional natural dentition plays an important role in keeping a satisfactory nutritional status. The aim of this study was to evaluate the relationship between oral health conditions determined by the presence of edentulism and the number of missing teeth, nutritional status and consumption of nutrients by the elderly. This cross-sectional study comprised 494 independent elderly of both genders, over 60 years of age, registered at the Brazilian public health service in Londrina, southern Brazil. The data collection included: oral examinations; anthropometric measurements by calculating the Body Mass Index (BMI); analysis of food consumption based on a multiple pass 24-hour dietary recall and a food intake frequency questionnaire; and structured interviews to obtain sociodemographic information. Multiple linear regression, the Fisher's Exact test, chi-square and Mann-Whitney tests, were applied at a 5% significance level. The prevalence of edentulism was 47.3%; this predominated in females, age group from 65 to 74 years, low education level and low/medium economic classification. A larger numberof underweight and fewer number of overweight elderly were recorded among the edentulous versus dentate participants (< 0.0001). Significantly lower consumption of several nutrients, as well as fruit, was recorded among the edentulous group. In particular, carbohydrates, vitamins (B1, B9 and C), and the majority of the minerals studied were associated with a larger number of missing teeth. In conclusion, tooth loss was associated with the food consumption pattern of some macro-and micronutrients and the nutritional status of the Brazilian elderly.

Associating the Presence of Structural Defects in Dental Enamel with Children's Health History / Associando a Presença de Alterações de Estrutura no Esmalte Dentário com Histórico de Saúde na Infância

The enamel defects, hypoplasia and hypo mineralization, are classified as dental anomalies of structure, being frequently found in deciduous and permanent dentitions, since the permanent teeth and second deciduous molars finish their total mineralization after the age of three. The aim of the present study was to identify the presence of hypo mineralization and/or enamel hypoplasia and to associate it with respiratory problems in infant patients. Of the 90 patients evaluated, it was found that 23 male children (57.5%) and 22 female children (44%) had defects in the structure of tooth enamel. Most children were born by cesarean operation (64.4%), with no complications during birth (90.0%), 12.2% of children had dental anomalies (agenesis, ectopic canine, ankylosis, fusion, conoid tooth, and macrodontia, only 7 children showed an association between dental anomalies and enamel defects. Regarding respiratory problems that occurred up to 3 years of age, 38.9% had an episode of asthma, bronchitis, sinusitis, rhinitis, or pneumonia, and 55% had similar results at the current age. There was a positive association (Chi-square tests) between the presence of changes in the structure of tooth enamel and the presence of respiratory problems up to 3 years of age (p <0.001). It is concluded, therefore, that the presence of respiratory problems in early childhood, can interfere in amelogenesis, providing disturbances for the formation of normal enamel, causing defects or irregularities in the surface of the dental enamel, such as hypoplasias and hypo mineralization. (AU)

Os defeitos de esmalte, hipoplasia e hipomineralização, são classificados como anomalias dentárias de estrutura, sendo encontrados com frequência nas dentições decídua e permanente, já que os dentes permanentes e segundos molares decíduos finalizam sua total mineralização após os três anos de idade. O objetivo do presente estudo foi identificar a presença de hipomineralização e/ou hipoplasia de esmalte, e associála com problemas respiratórios no paciente infantil. Dos 90 pacientes avaliados, constatou-se que 23 crianças do gênero masculino (57,5%) e 22 do gênero feminino (44%) apresentaram defeitos na estrutura do esmalte dentário. A maioria das crianças nasceu de parto cesária (64,4%), sem complicação no parto (90,0%), 12,2% das crianças apresentaram anomalias dentárias (agenesia, canino ectópico, anquilose, fusão, dente conóide e macrodontia), somente 7 crianças apresentaram associação entre anomalias dentárias e defeitos de esmalte. Em relação à problemas respiratórios ocorrido até aos 3 anos de idade 38,9% apresentaram algum episódio de asma, bronquite, sinusite, rinite ou pneumonia e 55% apresentaram resultados semelhantes na idade atual. Houve associação positiva (Testes Qui Quadrado) entre a presença de alterações na estrutura do esmalte dentário e presença de problemas respiratórios até os 3 anos de idade (p<0,001). Conclui-se, portanto, que a presença de problemas respiratórios na primeira infância, podem interferir na amelogênese, proporcionando distúrbios para formação do esmalte normal, causando defeitos ou irregularidades na superfície do esmalte dentário, como hipoplasias e hipomineralizações. (AU)

Estudo longitudinal dos traumatismos severos em dentes decíduos: complicações clínicas e radiográficas / Longitudinal study of severe traumatisms on primary teeth: clinical and radiographic complications

O objetivo é avaliar a frequência dos traumatismos em dentes decíduos, as sequelas advindas das injúrias envolvendo os tecidos de sustentação, bem como a associação destas injúrias às sequelas clínicas e radiográficas. Trata-se de um estudo clínico longitudinal, no qual foram avaliados 342 dentes traumatizados, atendidas no serviço odontológico de uma instituição pública, as avaliações foram realizadas após o traumatismo e decorrido 24 meses. Os dados foram submetidos a uma análise descritiva e ao teste Qui-quadrado (p≤0,05). A maior frequência de traumas acorreu na idade 24-35 meses, o principal fator etiológico à queda da própria altura (77,8 %), gênero masculino (59,5%), arco dentário o superior (96,5%), dente 51 (43,1%); 70,6% possuíam mais de um dente afetado e 8,2% histórico de trauma; a injúria mais prevalente foi a luxação lateral (33,6%). Na proservação, houve associação entre tipo de injúria ao tecido de suporte com a presença de sequelas radiográficas (p=0,02) e perda precoce (p=0,01). Conclui-se que as principais sequelas observadas foram a descoloração coronária e reabsorção radicular inflamatória e houve associação significante entre as variáveis tipo de injúria ao tecido de sustentação com a presença de sequelas radiográficas e a perda precoce do dente decíduo traumatizado.

The objective is to evaluate the frequency of trauma in primary teeth, the sequelae resulting from injuries involving the supporting tissues, as well as the association of these injuries with clinical and radiographic sequelae. This was a longitudinal clinical study, in which 342 traumatized teeth, assisted at the dental service of a public institution, were evaluated after the trauma and after 24 months. The data were submitted to a descriptive analysis and the Chi-square test (p≤0.05). The highest frequency of trauma occurred at age 24-35 months, the main etiological factor being the decrease of height (77.8%), male gender (59.5%), dental arch (96.5%), tooth 51 (43.1%); 70.6% had more than one affected tooth and 8.2% had a history of trauma; the most prevalent injury was lateral luxation (33.6%). In the proservation, there was an association between type of injury to the supporting tissue with the presence of radiographic sequelae (p = 0.02) and early loss (p = 0.01). In conclusion, the main sequelae observed were tooth crown discoloration and inflammatory root resorption and there was a significant association between the type of support tissue injury and the presence of radiographic sequelae and the early loss of the traumatized deciduous tooth.

Efficacy of fluoride associated with nano-hydroxyapatite in reducing enamel demineralization adjacent to orthodontic brackets: in situ study

ABSTRACT Objective: To assess in situ the effect of fluoride associated with nano-hydroxyapatite for the prevention of demineralization of the enamel adjacent to orthodontic brackets. Material and Methods: Eight volunteers wore palatal devices prepared with 6 bovine enamel blocks (5x5x2 mm) with bonded brackets. The volunteers used the devices in two different moments of 14 days each. During the first 14 days, a product containing fluoride + nano-hydroxyapatite was applied twice (experimental group, GNH, n = 48), and for the other 14 days no prevention product was applied (control group, CG, n = 48). In both groups, along the experiment, the blocks were dripped with 20% sucrose eight times daily. After the experiment, all the specimens were sectioned and examined for lesion depth analysis (µm) under polarized light microscopy, and for enamel longitudinal microhardness (measured under the bracket, at 30 µm and at 130 µm from the margin), at seven different depths (10, 20, 30, 50, 70, 90, and 110 µm). Results: Under polarized light, group GNH presented significantly less demineralization depth ( X ¯= 15.01 µm, SD = 33.65) in relation to CG ( X ¯= 76.43 µm, SD = 83.75). Enamel longitudinal microhardness demonstrated significantly higher microhardness for group GNH when compared to CG. Conclusion: Fluoride + nano-hydroxyapatite can be an alternative preventive procedure for demineralization of the enamel adjacent to orthodontic brackets.

RESUMO Objetivo: avaliar in situ o efeito da nano-hidroxiapatita associada ao fluoreto na prevenção da desmineralização do esmalte adjacente aos braquetes ortodônticos. Material e Métodos: oito voluntários utilizaram aparelhos palatinos preparados com seis blocos de esmalte bovino (5 x 5 x 2 mm) com braquetes colados unidos por um fio de NiTi 0,016" preso por ligaduras elásticas. Os voluntários utilizaram os dispositivos em dois tempos distintos de 14 dias. Durante os primeiros 14 dias, um produto contendo flúor + nano-hidroxiapatita foi aplicado duas vezes (grupo experimental, GNH, n = 48), e nos outros 14 dias não foi aplicado qualquer produto de prevenção (grupo controle, GC, n = 48). Em ambos os grupos, ao longo do experimento, os blocos foram gotejados com sacarose a 20%, 8 vezes ao dia. Após o experimento, todos os espécimes foram seccionados e examinados para análise de profundidade de lesão (µm), sob microscopia de luz polarizada, e para microdureza longitudinal do esmalte do braquete (a 30µm e a 130µm da margem), a 7 profundidades diferentes (10, 20, 30, 50, 70, 90 e 110µm) Resultados: sob luz polarizada, o grupo GNH apresentou significativamente menor profundidade de desmineralização ( X ¯= 15,01µm, D.P. = 33,65) em relação ao GC ( X ¯= 76,43µm, D.P. = 83,75) A microdureza longitudinal do esmalte demonstrou valor significativamente maior para o grupo GNH, quando comparado ao GC. Conclusão: a nano-hidroxiapatita associada ao fluoreto pode ser um procedimento alternativo para a prevenção da desmineralização do esmalte adjacente aos braquetes ortodônticos.

Conhecimento dos profissionais da saúde sobre o diagnóstico e conduta para anquiloglossia em bebês / Knowledge of health professionals on diagnosis and treatment of ankyloglossia in very young children

O estudo avaliou o conhecimento de profissionais da área de saúde, sobre o diagnóstico e conduta clínica para o tratamento da anquiloglossia em bebês. A amostra (n=84) foi dividida em: G1 (46 médicos da ESF); G2 (13 pediatras); G3 (5 fonoaudiólogas) e G4 (20 dentistas da ESF), que responderam ao questionário (dados pessoais e aplicação do protocolo de avaliação do freio lingual, preconizado por Martinelli et al. (2012)6. Um total de 21 profissionais responderam adequadamente o questionário sendo estes 66,6% do gênero feminino, com idade média de 46,4±12,5 anos de modo que 80,9% já receberam pacientes com queixa de anquiloglossia. Quanto à obrigatoriedade do teste da linguinha constatou-se que o Grupo 1 apresentou menor grau de informação (57,1%) comparado ao Grupo 4 (21,4%), no entanto 57,1% dos profissionais avaliados não o fazem rotineiramente. Referente ao protocolo, nos itens 1, 2 e 3, três profissionais (14,2%) assinalaram figuras com diagnóstico correto (G1 e G3); em relação ao item 4, dez profissionais (47,6%) pontuaram corretamente. Conclui-se que houve grande desconhecimento quanto à obrigatoriedade do teste da linguinha e dificuldade no correto diagnóstico de anquiloglossia em bebês.

Current study evaluates the knowledge of health professional on the clinical diagnosis and treatment of ankyloglossia in very young children. Samples (n=84) comprised G1 (46 physicians of ESF); G2 (13 pediatric physicians); G3 (5 phonoaudiologists) and G4 (20 dentists of ESF) who answered the questionnaire (personal data and application of protocol for assessment of the short lingual frenum, following Martinelli et al. (2012). Twenty-one professionals answered adequately the questionnaires, comprising females (66.6%), average age 46.4±12.5 years, of whom 80.9% have already received patients with tongue-tie. In the case of the mandatory stance of the tongue test, Group 1 had the lowest information rate (57.1%) when compared with Group 4 (21.4%). However, 57.1% of the professionals do not do it routinely. In the case of protocol, for items 1, 2 and 3, three professional (14.2%) marked pictures with the correct diagnosis (G1 and G3); in the case of item 4, ten professionals (47.6%) marked correctly. Results show lack of knowledge on the mandatory stance of the ankyloglossia test and the difficulty in its correct diagnosis in very young children.

Sweetness Taste Preference Levels and Their Relationship to the Nutritional and Dental Caries Patterns among Brazilian Preschool Children

Objective: To evaluate the sweetness taste preference levels and their relationship with the nutritional and dental caries patterns among preschool children. Material and Methods: The participants of this cross-sectional study were 191 children aged 4 to 5 years, who were regularly attending public Child Education Centers of a city southern Brazil. Children's preference for sugar was evaluated by the Sweet Preference Inventory; caries prevalence, according to the World Health Organization criteria, and nutritional status, by anthropometric weight and stature measurements, in accordance with child growth standards of the World Health Organization. Results: High levels of sweetness preference were identified. The majority of children (67.5%) opted for the most concentrated sucrose solutions. Excess weight was recorded in 27.7% of the preschoolers. The prevalence of caries was 51.8%, with the mean dmf-t equal to 1.92 (± 2.72) and the decayed (c) component responsible for 94.2% of the index. No significant association between sweetness preference and the nutritional or the oral health patterns could be established. In addition, no association between excess weight and dental caries was identified. The diseases studied were only associated with sociodemographic variables. Excess weight was associated with maternal age (p=0.004) and caries experience with family income (p=0.013). Conclusion: No significant associations could be stablished between the sweetness taste preference and the diseases studied, nor between excess weight and dental caries. However, the findings of high patterns of sweet preference, excess weight and untreated caries experience, highlight the need for the implementation of integrated public policies aimed at controlling both nutritional and of oral health problems in the studied population.

Relation of Dental Anomalies with Occlusal Alterations in the Pediatric Patients

Objective: To identify the dental anomalies that can modify the occlusal characteristics and their distribution in these occlusal alterations in the skeletal patterns of children. Material and Methods: We analyzed charts, panoramic and periapical radiographs of children aged 5 to 12 years from 2009 to 2012. The facial pattern was evaluated through subjective face analysis and cephalometric data, as well as the occlusion of patients with and without (control) dental anomalies. The relationship between the presence of dental anomalies and malocclusion was analyzed by the Chi-square test with significance level of 5%. Results: 73 children (27.8%) presented dental anomalies, being 49.3% in girls and 50.7% in boys in a total of 88 teeth involved. Anomalies observed in decreasing order were: enamel hypoplasias, eruptive ectopias, agenesis, supernumerary teeth, corono-radicular dilaceration, microdontia, transposition and imperfect amelogenesis. Of these, 22.2% presented associated dental anomalies, whose ectopic eruption with enamel hypoplasia were the most frequently encountered. When comparing the control group with children with dental abnormalities it was observed a significant relationship between the presence of dental anomalies and malocclusion (p<0.05). The most frequent alteration among patients with dental anomalies was deep overbite (24.6%), followed by crowding (23.3%), posterior crossbite (14.2%), anterior open bite (12.9%) and anterior crossbite (0.3%). Conclusion: Dental dysgenesis interferes with the development of occlusion and the resulting occlusal problems are distributed differently, taking into account the skeletal facial pattern in patients with and without dental anomalies.

Clinical and Radiographic Sequelae in Primary Teeth due to Dental Trauma

Objective: To evaluate the presence of clinical and radiographic sequelae in primary teeth affected by dental trauma and its association with age at the time of trauma in children attended at a Public Higher Education Institution. Material and Methods: This is a longitudinal clinical study, in which 229 patients with history of dental trauma in primary teeth were examined, totaling 390 traumatized teeth. Relative frequency analysis was used, and for associations, the Chi-square test was used to verify the relationship of age at the time of trauma with variables such as type of trauma. Results: The most prevalent age group was over 24 months, and fall from own height as the main etiological factor; 71.0% of traumas had involvement of 2 teeth, 9.5% had history of anterior trauma and 66.6% of traumas involved supporting tissues. Regarding the type of injury to dental tissue, the most prevalent was enamel fracture (58.3%) and to periodontium, lateral dislocation (30.8%). Children older than two years had less trauma related to dental tissue (p<0.01), higher number of injuries to the periodontium (p=0.03); and most of them did not present extra-oral changes associated with trauma (p=0.01). During the 12- month period, 325 teeth were examined, and the most frequent clinical sequelae observed was crown discoloration. In the radiographic evaluation, inflammatory root resorption was the most prevalent. Conclusion: Children older than two years presented more injuries to the periodontium. After 12 months, the main clinical sequelae observed was enamel discoloration and the main radiographic sequelae was inflammatory root resorption.

Oral health promotion in patients with morbid obesity after gastroplasty: a randomized clinical trial / Promoção de saúde bucal em pacientes com obesidade mórbida após gastroplastia: ensaio clínico randomizado

ABSTRACT Background: The bariatric surgery may have negative repercussions on oral conditions. Aim: To evaluate the impact of oral health educational/preventive program developed with patients submitted to gastroplasties. Method: The sample consisted of 109 patients randomly allocated to two groups: intervention group (IG), where they participated in the oral health promotion program that include multiple educational-preventive approaches; control group (CG), where they received usual care from the bariatric clinic staff, without participation in the program. The oral conditions investigated in the pre-operative and postoperative periods of one month (1M) and six months (6M) were: dental caries, periodontal disease, tooth wear, dental plaque and salivary flow. Results: After bariatric surgery, patients in IG presented: fewer changes in enamel (6M: p=0.004), dentin (6M: p=0.005) and gingival bleeding (6M: p<0.0001), reduction in plaque index (1M, 6M: p<0.0001) and increased salivary flow (6M: p=0.039), when compared with CG. Incipient tooth wear was recorded in both groups (6M: p=0.713). Conclusion: There was a positive impact of the implemented program in the prevention of the main oral health problems in patients who underwent gastroplasties, contributing to their quality of life.

RESUMO Racional: A cirurgia bariátrica pode repercutir negativamente nas condições bucais. Objetivo: Avaliar o impacto de um programa educativo/preventivo em saúde bucal desenvolvido em pacientes submetidos à gastroplastia. Método: A amostra foi constituída por 109 pacientes aleatoriamente alocados em dois grupos: grupo de intervenção (GI), onde participaram do programa de promoção de saúde bucal com abordagens educativo-preventivas; grupo controle (GC), onde receberam cuidado da equipe da clínica, sem participação no programa. As condições bucais investigadas nos períodos pré e pós-operatório de um mês (1M) e seis meses (6M) foram: cárie dentária, doença periodontal, desgaste dentário, placa dentária e fluxo salivar. Resultados: Após a gastroplastia, pacientes do GI apresentaram: menor alteração em esmalte (6M: p=0,004), dentina (6M: p=0,005) e sangramento gengival (6M: p<0,0001); redução no índice de placa (1M, 6M: p<0,0001) e aumento do fluxo salivar (6M: p=0,039), quando comparados aos do GC. Desgaste dentário incipiente foi registrado em ambos os grupos (6M: p=0,713). Conclusão: Houve impacto positivo do programa implementado na prevenção dos principais problemas de saúde bucal em pacientes submetidos à gastroplastia, contribuindo para sua qualidade de vida.

Performance of Preventive Methods Applied to the Occlusal Surface of Primary Teeth: A Randomized Clinical Study

Objective: To evaluate the clinical performance of three preventive materials on the occlusal surfaces of primary molars over a 36-month period. Material and Methods: The study was conducted with a split-mouth design involving four experimental groups: G1 ­ resin-modified glass ionomer cement (Vitremer®); G2 - resin sealant (Alpha Seal Light®); G3 - silver diamine fluoride (Cariostatic®); and G4 - control group without material. Thirty-two children aged 36 to 60 months, attending a pediatric clinic, with a deft index ≥ 1 and four primary second molars participated in the study. The material retention was evaluated in G1 and G2, and the presence of incipient caries was evaluated in all groups. Data were submitted to the Wilcoxon test and survival test (α = 5%). Results: At three, six, 12, 24 and 36 months, G2 exhibited greater material loss (maximum loss: 44%) in comparison to G1 (maximum loss: 35%), but this difference did not achieve statistical significance (p = 0.214). The highest incidence of incipient caries occurred in G3 (20%), but no significant differences were found between groups at any evaluation time (p = 0.154). Conclusion: There were no statistically significant differences between the evaluated products regarding material retention and dental caries, although there was more material loss in teeth that received the Alpha Seal® sealant resin, and a greater number of carious lesions in the Cariostatic® group (silver diamine fluoride).

Analysis of pH and release of calcium of association between melaleuca alternifolia oil and calcium hydroxide / Análise de pH e liberação de cálcio da associação entre óleo de melaleuca alternifólia e hidróxido de cálcio

Introduction: The use of intracanal medications with antimicrobial properties is essential for decontaminating root canals during endodontic treatment. Calcium hydroxide is used for this because of its excellent properties. Melaleuca alternifolia oil has shown medicinal importance by demonstrating antifungal and bactericidal action against proven human pathogens. Objective: To evaluate the physical and chemical aspects such as pH and calcium release, of Melaleuca alternifolia oil associated with calcium hydroxide, during different time intervals. Material and method: Calcium hydroxide powder was added to vehicles to reach a concentration of 72mg / 0.1mL. Three groups were formed: Group I: Calcium Hydroxide + Distilled Water; Group II: Calcium hydroxide + Propylene Glycol; Group III: Calcium hydroxide + Melaleuca oil. The pH of each group was measured after time intervals of 10 minutes; 24 and 48 hours; 7, 15 and 30 days after tooling by a pH meter. Calcium release was analyzed by atomic absorption spectrometry equipped with a calcium hollow cathode lamp. Data were statistically analyzed by using the Kruskall-Wallis and Dunn test. Result: Group II showed high pH, similar to group III that remained uniform at 15 and 30 days. Calcium release that began after 24 hours, was similar in Groups II and III, and showed a peak release in 48 hours. Conclusion: The association of Melaleuca oil with calcium hydroxide showed good results in the pH and calcium release analyses, and showed action similar to that of propylene glycol + calcium hydroxide.

Introdução: O uso de medicações intracanais com propriedades antimicrobianas é fundamental para descontaminação dos canais radiculares durante o tratamento endodôntico. O hidróxido de cálcio é utilizado como medicação intracanal por apresentar excelentes propriedades. O óleo de Melaleuca alternifólia apresenta importância medicinal demonstrando ação antifúngica e bactericida comprovada contra patógenos humanos. Objetivo: Avaliar aspectos físico-químicos da associação do óleo de Melaleuca Alternifólia com hidróxido de cálcio, como: pH e liberação de cálcio durante diferentes períodos. Material e método: O pó do hidróxido de cálcio foi adicionado aos veículos até a concentração de 72mg/0,1mL. Foram divididos três grupos: Grupo I: Hidróxido de Cálcio + Água Destilada; Grupo II: Hidróxido de Cálcio + Propilenoglicol; Grupo III: Hidróxido de Cálcio + Óleo de Melaleuca. O pH de cada grupo foi medido após 10 minutos, 24, 48 horas, 7, 15 e 30 dias após a espatulação por um pHmetro. A liberação de cálcio foi analisada através da espectrometria de absorção atômica equipada com uma lâmpada cátodo para cálcio. Os dados foram analisados estatisticamente pelos testes de Kruskall-Wallis e Dunn. Resultado: O grupo II apresentou pH elevado, semelhante ao grupo III, permanecendo uniforme aos 15 e 30 dias. A liberação de cálcio iniciou em 24 horas, de forma semelhante nos grupos II e III e seu pico de liberação deu-se em 48 horas. Conclusão: A associação do Óleo de Melaleuca com hidróxido de cálcio apresentou bons resultados quanto à análise de pH e liberação de cálcio, demonstrando ação semelhante ao propilenoglicol + hidróxido de cálcio.

Injúrias dentárias em dentes decíduos: estudo longitudinal / Dental injuries in deciduous teeth: a longitudinal study

O objetivo deste estudo foi avaliar 139 crianças, com histórico de traumatismo em dentes decíduos, verificando as sequelas e a associação com gênero e idade. 33,8% da amostra apresentavam entre 24 e 35 meses no momento do trauma e 61,2% do gênero masculino. Quanto ao tipo de injúria dental e tecido de suporte, as mais prevalentes foram a fratura de esmalte (28,1%) e a luxação lateral (17,3%). Na dentição decídua, diagnosticou-se descoloração da coroa (18%), reabsorção radicular inflamatória (7,9%) e lesão periapical (6,5%). 13,7% dos dentes permanentes estavam irrompidos, sendo 2,9% com hipoplasia de esmalte; radiograficamente, 2,2% apresentou atraso na erupção e 2,2% a posição anormal do dente. O Teste Qui-quadrado mostrou associação da idade no momento do trauma com injúria dentária (p=0,02); tipo de injúria dentária (p=0,01) e sequelas clínicas nos dentes decíduos (p=0,02). Conclui-se que é elevada a prevalência de sequelas diagnosticadas no acompanhamento, demonstrando a importância da preservação.

Current study analyzes 139 children with a history of traumatism in deciduous teeth through sequelae and the association between gender and age. Further, 33.8% of the sample showed that the trauma started between 24 and 35 months, with 61.2% involving males. Regarding to type of dental injury and tissue, enamel fracture (28,1%) and lateral dislocation (17,3%) were the most prevalent. De-coloration of the crown (18%), inflammatory radicular reabsorption (7,9%) and peri-apical lesion (6,5%) were diagnosed in deciduous dentition. Moreover, 13,7% of permanent teeth had emerged, with 2,9% featuring enamel hypoplasia, whereas 2,2% showed a radiographic delay in eruption and 2,2% revealed abnormal position of teeth. Chi-square test demonstrated a link at the moment of trauma with dental injury (p=0,02); type of dental injury (p=0,01) and clinical sequelae in deciduous teeth (p=0,02). Results show high prevalence of sequelae diagnosed in the follow-up and thus the importance of preservation.

Association between oral health status and central obesity among Brazilian independent-living elderly

Abstract The aim of this study was to investigate the association between oral health status and central obesity (CO) in Brazilian independent-living elderly. A cross-sectional study was carried out in a sample of 489 elderly, who were participants of the Study on Aging and Longevity, in Londrina, state of Parana. The number of natural teeth and use of prostheses were evaluated according to the World Health Organization criteria. The presence of CO was assessed using measures of waist circumference (WC) and waist-hip ratio (WHR). Information concerning sociodemographic profile and some systemic conditions was also collected. Data were analyzed using stepwise logistic regression, α=5%. According to WC and WHR measures, the prevalence of central obesity was 79.3% and 76.1%, respectively. CO according to WC was not associated with oral status. Considering the WHR measure, the following oral conditions were associated to CO: having fewer natural teeth (OR = 2.61; 95%CI = 1.17-5.80), being edentulous and wearing both upper and lower complete dentures (OR = 2.34; 95%CI = 1.11-4.93), and being edentulous wearing only the upper complete denture (OR = 2.64; 95%CI = 1.01-6.95). Traditional risk factors for CO such as gender, dyslipidemia, hypertension and diabetes were associated with both measures. A poor oral health due to extensive tooth loss, whether partial or complete, even if rehabilitated by removable prostheses, may be considered a good predictor of CO in Brazilian independent-living elderly.

Exploring the association between dental caries, obesity and sensory characteristics in students living in southern Brazil

Objective: to investigate possible associations between dental caries, obesity, sweet taste preference and sensitivity to bitter taste in children and adolescents. Material and Methods: this is a cross-sectional study with a sample of 462 schoolchildren aged 6-15 years enrolled in public schools of Pato Branco, PR. Their oral conditions were examined by adopting the criteria of the World Health Organization. Nutritional status was assessed using anthropometric criteria, adopting the reference standards of the Center for Disease Control and Prevention. To determine the taste sensitivity, sweet taste preference and sensitivity tophenylthiocarbamide (PTC) tests were applied. In the statistical analysis of data, Chi-square, Mann Whitney and Kruskal Wallis tests were used, adopting significance level of 5%. Results: low dental caries severity levels were observed among students. Overweight was diagnosed in 24.4% of students. The lowest DMFT index was recorded among obese individuals (p <0.05). High levels of sweet taste preference were identified. No statistically significant association was detected between the sensory characteristics assessed and the occurrence of dental caries and obesity in the study sample. Conclusion: the high levels of sweet taste preference, as well as the dental caries and overweight rates observed, although with no statistically significant associations, highlight the need or intersectoral interventions with a focus on healthy eating habits in order to reduce the risk and incidence of chronic diseases in this population.

Relação entre cárie dentária, edentulismo e autopercepção de saúde bucal em adolescentes, adultos e idosos de um município do nordeste brasileiro / Relationship between dental caries, edentulism and self-perception of oral health in adolescents, adults and elderly of a municipality in northeastern Brazil

O diagnóstico das condições e autopercepção da saúde bucal dos indivíduos é fundamental nas estratégias de planejamento e avaliação dos serviços de saúde. O objetivo deste estudo foi descrever a prevalência da cárie dentária, do edentulismo e a autopercepção em saúde bucal na população adolescente, adulta e idosa de um município de pequeno porte da região nordeste do Brasil. Adicionalmente, investigou-se a relação entre a autopercepção e as variáveis clínicas investigadas. Compuseram a amostra de estudo 139 indivíduos. Nos exames clínicos foi usado o índice CPO-D, segundo critérios da OMS e as informações sobre autopercepção foram obtidas por entrevistas. Na análise dos dados foram usados os testes Qui-quadrado, Mann Whitney e Exato de Fischer, com nível de significância de 5%. O índice CPO-D foi 6,57± 4,17 para adolescentes, 22,76±7,63 para adultos e 30,96±2,82 para idosos. Foi registrado predomínio da autopercepção negativa da saúde bucal entre adultos (58,6%) e positiva, entre idosos (57,7%). Autopercepções negativas da mastigação (p<0,001) e da fala (p=0,001) associaram-se ao aumento da idade. O índice CPO-D foi maior entre adolescentes com relato de dor (p=0,028). Nos adultos, a autopercepção negativa da saúde bucal (p=0,007), aparência de dentes/gengivas (p=0,003) e fala (p=0,046) associou-se ao maior número de dentes cariados presentes. Foi evidenciada a discrepância entre autopercepção positiva em saúde bucal e presença de edentulismo. Os resultados sugerem a necessidade do estabelecimento de políticas locais de saúde bucal, voltadas para a promoção da saúde, focadas na prevenção da cárie dentária e do edentulismo.

The diagnosis of conditions and self-perceived oral health status of individuals is fundamental in planning strategies and evaluation of health services. The aim of this study was to describe the prevalence of dental caries, edentulism and self-perception of oral health in adolescents, adults and elderly in a small city in northeastern Brazil. Additionally, we investigated the relationship between self-perception and the clinical variables studied. The study sample consisted of 139 subjects. In clinical examinations the DMFT index was used according to WHO criteria and information about self-perception was collected through interviews. The Chi-square, Mann Whitney and Fisher exact tests were used with 5% significance level . The DMFT index was 6.57 ± 4.17 for adolescents, 22.76 ± 7.63 for adults and 30.96 ± 2.82 for elderly. It was recorded predominance of negative self-perception of oral health among adults (58.6%) and positive self-perception among the elderly (57.7%). Negative self-perceptions of chewing (p <0.001) and speech (p = 0.001) were associated with increasing age. The DMFT index was higher among adolescents with a history of pain (p = 0.028). In adults, the negative self-perception of oral health (p = 0.007), appearance of teeth / gums (p = 0.003) and speech (p = 0.046) was associated with higher number of decayed teeth present. The discrepancy between positive self-perception of oral health and the presence of edentulism was highlighted. The results suggest the need to establish local policies for oral health aimed at promoting health and focused on preventing dental caries and edentulism.

Utilização de prótese parcial fixa modificada na primeira infância: relato de caso / The use of a modified fixed partial denture in childhood:clinical case reporting

A reposição do dente decíduo perdido prematuramente é indicada para que não haja conseqüências estéticas, funcionais (fala e mastigação) e psicológicas. Crianças na primeira infância não possuem maturidade e cooperação para o uso de próteses removíveis. Assim sendo, indica-se as próteses parciais fixas modificadas. O objetivo do presente estudo é relatar o caso clínico de uma paciente de 30 meses de idade, com história de traumatismo dentário, com perda precoce do elemento 51, cujo tratamento foi a colocação de uma prótese parcial fixa modificada. A principal característica desta prótese, que a diferencia de uma prótese utilizada em adultos é a presença de conectores com o sistema tubo-barra. A estrutura metálica de um dos dentes de apoio apresenta uma barra que se encaixa em um tubo presente no pôntico, este sistema não é fixo, o que permite o distanciamento lento entre o retentor e o pôntico, através do deslocamento da barra, caso ocorra crescimento da pré-maxila. Após a moldagem dos arcos superior e inferior da paciente, a prótese parcial fixa modificada foi confeccionada com um pôntico e dois retentores de metal nos elementos 52 e 62, os quais não receberam nenhum tipo de preparo. A cimentação da prótese foi realizada com cimento resinoso dual e resina composta para um melhor resultado estético. No caso clínico descrito, pôde ser observado um resultado estético e funcional satisfatório, o que propiciou melhora na saúde bucal da paciente.

The replacement of the prematurely lost deciduous tooth is indicated to avoid aesthetic, functional (speaking and chewing) and psychological consequences. Childhood does not have maturity and cooperation to collaborate with the use of removable partial denture. Therefore, on this situation, the modified fixed partial denture can be indicated. The aim of this study is to report a case of a 30 months patient with dental trauma's history and early loss of the element 51, whose treatment was the placement of a modified fixed partial denture. The main feature of this prosthesis, which differentiates it from adults prosthesis, is the presence of connectors with the tube-bar system. The steel structure of the supporting tooth has a bar that fits into a tube present in the pontic. This system is not fixed, allowing the slow displacement between the pontic and the bar, in case of premaxilla growths. After molding the upper and lower arches of the patient, the modified fixed partial denture was fabricated with a pontic and metal on the elements 52 and 62, which did not have any kind of preparation. Prosthesis cementation was performed with dual-resin cement and composite resin for a better aesthetic result. In the described clinical case, it was found a satisfactory functional and aesthetic result, which improved patient's oral health.

Utilização de gel de papaína associado à técnica de restauração atraumática em bebê: relato de caso clínico / The use of papain gel associated with the atraumatic restorative treatment in childhood: clinical case reporting

O tratamento odontológico curativo em bebês apresenta dificuldades que podem ser diminuídas por meio da utilização do método de remoção químico-mecânico da cárie, da necessidade da utilização de anestesia e de instrumentos rotatórios. O objetivo do presente estudo é relatar o caso clínico de um paciente de 27 meses de idade, submetido à remoção químico-mecânica do tecido cariado na oclusal do elemento 85 que apresentava lesão cariosa de profundidade média. O procedimento clínico restaurador foi realizado, utilizando-se o método químico-mecânico de remoção da cárie à base de gel de papaína (Papacarie®) e posterior restauração com cimento de ionômero de vidro por meio da técnica de restauração atraumática. Foram necessárias 6 aplicações de 1 minuto e 30 segundos do gel, sem anestesia, e foi preciso utilizar-se da alta rotação para acesso à cavidade, o que resultou em piora de comportamento. No caso clínico apresentado, a aplicação do gel de papaína associada à técnica de restauração atraumática se apresentou como uma boa alternativa para o tratamento restaurador em bebê, pois diminuiu o desconforto da criança, refletindo, positivamente, no comportamento. Por outro lado, foi necessário um longo tempo clínico, e a utilização de instrumentos rotatórios para acesso à cavidade interferiu negativamente no comportamento.

The childhood restorative dental treatment presents difficulties, which can be diminished by the use of chemomechanical caries removal method by reducing the use of anesthesia and rotatory instruments. The aim of this study is to report the clinical case of a 27 months patient subjected to chemomechanical caries removal method of 85 tooth 85, which presented medium lesion depth. The procedure was performed using papain gel chemomechanical caries removal method (Papacarie ®) and the cavities were restored using the atraumatic restorative treatment, with glass ionomer cement. It took 6 applications of 1 minute and 30 seconds of gel, without need for anesthesia. However the use of rotatory instruments was necessary for cavity assessment resulting in worst child behavior. Taking into consideration the presented clinical case the application of papain gel associated with atraumatic restorative treatment seems to be a good alternative for childhood restorative treatment, since children's discomfort decreased, resulting in positive behavior. On the other hand it took a long clinical time and the use of rotatory instruments was necessary for cavity access and these factors seem to negatively interfere on child's behavior.

Avaliacao clinica dos selantes realizados com cimento de ionomero de vidro modificado por resina (vitremer©) em molares deciduos / Clinical evaluation of a resin-modifi ed glass ionomer cement (Vitremer©) used as pit-and-fissure sealant in primary molars

Objetivo: Avaliar a eficacia preventiva do cimento de ionomero de vidro modificado por resina (Vitremer) utilizado como selante em molares deciduos, apos seis meses de sua aplicacao. Metodo: Foram selados o molar superior direito e inferior esquerdo com CIV-mr (G2) e os dentes antagonistas ficaram sem selamento (grupo controle G1) em uma amostra de 30 criancas com 24 a 60 meses de idade. Apos 6 meses os selantes foram avaliados por dois examinadores previamente calibrados, com isolamento relativo, apos profilaxia e sob a luz do refletor. Para avaliacao dos selantes empregou-se criterio quanto a retencao, presenca de carie secundaria, e descoloracao marginal. Alem disso, registrou-se o indice de higiene bucal medio (IHB) e o indice de carie (ceo-s). Os dados foram analisados pelo teste exato de Fisher com nivel de significancia de 5%. Resultados: De um total de 58 dentes, 96,55% permaneceram livres de carie dentaria, com retencao total e parcial de 94,64%, embora sem relacao evidente entre os grupos selante/controle e carie dentaria. Houve associacoes entre o ceo-s com a descoloracao marginal do selante e com o IHB, sendo que o IHB satisfatorio mostrou ausencia de carie dentaria. Houve efetividade do selamento oclusal quanto a prevencao da carie e uma satisfatoria retencao quando considerada a retencao parcial. Conclusao: O cimento de ionomero de vidro modificado por resina pode ser uma alternativa promissora como selante oclusal em molares deciduos, desde que incorporado a uma serie de medidas educativas e preventivas, considerando o fator de risco da crianca.

Objective: To evaluate the preventive efficacy of a resin modified glass ionomer cement (RMGIC) (Vitremer) used as a pit-and-fissure sealant in primary molars 6 months after placement. Method: In a sample of 30 children aged 24 to 60 months, the maxillary right and mandibular left primary molars were sealed with the RMGIC (G2) while their antagonists were not sealed (G1 - control group). Six months after sealant placement, the sealants were assessed by two previously calibrated examiners after professional prophylaxis and relative isolation, with the direct illumination of the dental chairs light reflector. The following criteria were considered for evaluation of the sealants: retention, presence of secondary caries, and marginal staining. In addition, the mean oral hygiene index (OHI) and the caries index (dmf-t) were assessed. Data were analyzed statistically bythe Fishers exact test at a significance level of 5%. Results: From a total of 58 teeth, 96.55% were caries free, with total or partial retention of 94.64% of the sealants, though without an evident relationship between the sealant/control groups and dental caries. There was association between dmf-t and sealers marginal staining and OHI; satisfactory OHI showed absence of dental caries. Occlusal sealing was effective with respect to caries prevention and showed satisfactory retention as far as partial retention is considered. Conclusion: The RMGIC can be a promising alternative as an occlusal sealant in primary molars, as far as a series of educative and preventive are adopted, according to the childs caries risk factor.

Conhecimento das gestantes sobre alterações bucais e tratamento odontológico durante a gravidez / Pregnant's knowledge about oral alterations and dental treatment during pregnancy

A manutenção da saúde bucal durante a gestação é extremamente importante, no entanto, grande parte da população não tem acesso a informações relacionadas às alterações bucais caracterísitcas deste período. Diante disso, o presente trabalho teve como objetivo avaliar o conhecimento de gestantes quanto à prevenção, consequências e oportunidade de tratamento de possíveis alterações bucais desenvolvidas na gravidez. Foram entrevistadas 80 gestantes de consultório médicos particulares e de Unidades Básicas de Saúde da cidade de Maringá-PR, utilizando-se um questionário com questões de múltipla escolha e abertas. Os principais resultados demonstraram que uma pequena parcela das gestantes (33%) recebeu orientação sobre como manter sua saúde bucal e, apesar de 68,75% das entrevistadas acreditarem que poderiam receber o tratamento odontológico preventivo ou curativo sem riscos para o bebê, apenas 40% procuraram por atendimento odontológico. Além disso, as mesmas não sabiam como evitar a gengivite (80%), associavam a cárie dentária ao período gestacional (48,75%) e a maioria desconhecia que seus problemas bucais poderiam ter influência sobre a saúde geral da criança (73,75%). Desta forma, pode-se concluir que persiste a necessidade de orientações frequentes sobre saúde bucal às gestantes, maior integração entre classe médica e odontológica e melhor esclarecimento sobre a seguridade do tratamento odontológico.

The oral health during the pregnancy is a very important issue, but the majority of the population does not have access to the information related to the oral alterations that might occur during this period. Based on this fact, the aim of this study was to evaluate the pregnant knowledge about prevention, consequences and treatment of the possible alterations developed during the pregnancy. A questionnaire composed by multiple-choice and discursive quentions was applied to 80 pregnant from private practices and Basic Health Units in Maringá-PR. The results show that few pregnant (33%) received information about how to to maintain their oral health and, although 68,75% of the interviewed believed that they coult receive the dental treatment without risaks for the baby, only 40% had looked for dental attendance. Moreover, they dont' know how to avoid gingivitis (80%), they associate dental caries occurrence with pregnancy (48,75%), and the majority demonstrated no knowledge about the influence of the oral disturbances on the baby's general health (73,75%). It could be concluded that persists the necessity of frequent information about oral health to the the pregnant, greater integration between doctors and dentists and better knowledge about the security of the dental treatment.

Incisivo permanente avulsionado - reimplante após dois dias do trauma: relato de um caso / Avulsed permanent incisor - replantation after two days of the trauma: report of a case

Tooth avulsion is a complex injury that affects the pulp tissue, periodontal ligament and alveolar bone. It is more frequent in children aged 7 to 11 years. The prognosis is directly related to the period during which the tooth is outside the socket; there is consensus in the literature that the shorter this period, the higher will be the possibility of pulp revascularization and reattachment of periodontal ligament fibers. The need of maintenance of the avulsed tooth in an adequate medium is also known. This study reports a case of complex replantation after avulsion, in which the care was provided 48 hours after the trauma and the tooth was kept dry by the patient, thus suggesting a treatment option for these cases. The avulsed tooth was cleaned and submitted to endodontic treatment; a rigid retainer was used for 7 days and the calcium hydroxide dressing was constantly replaced for 12 months. After 28 months, the tooth exhibited clinical aspect of normality and the radiographic examination revealed a slight alteration at the apical portion of the root. It was concluded that this treatment planning may be a good option in cases of tooth avulsion with late replantation; even though the conditions of care were unfavorable and contraindicated by the scientific literature and the prognosis was impaired, a considerable benefit was achieved for the patient, since the treatment allowed its immediate reintegration to the social relationships, as well as maintenance of facial growth and development.

A avulsão dentária é uma injúria complexa que afeta o tecido pulpar, ligamento periodontal e osso alveolar. É mais frequente em crianças com idade entre 7 a 11 anos. O prognóstico está diretamente relacionado ao período de tempo em que o dente avulsionado permanece fora do alvéolo. É consenso na literatura que, quanto menor esse período, maior probabilidade de revascularização pulpar e restabelecimento das fibras do ligamento periodontal. É necessária a manutenção do dente avulsionado em um meio adequado. O objetivo deste estudo é relatar um caso de um procedimento complexo de reimplante dentário tardio, em que o dentista somente foi procurado após 48 horas da avulsão e o dente foi mantido seco durante este período, assim como sugerir uma opção de tratamento para esses casos. O dente avulsionado foi limpo e submetido a tratamento endodôntico; uma contenção rígida foi usada durante 7 dias e trocas periódicas do hidróxido de cálcio foram mantidas durante 12 meses. Após 28 meses, o dente exibiu aspecto clínico de normalidade e o exame microscópico revelou uma ligeira alteração no ápice radicular. Conclui-se que esse plano de tratamento pode ser uma boa opção para casos de avulsão com reimplante tardio. Ainda que sob condições de manutenção do dente desfavoráveis e contraindicadas pela literatura científica, um considerável benefício foi alcançado para o paciente, uma vez que o tratamento permitiu uma reintegração imediata de seu relacionamento social, assim como permitiu a manutenção do crescimento e desenvolvimento facial.