Impact of Molar Incisor Hypomineralization on Oral Health-Related Quality of Life in Brazilian Schoolchildren Aged 8 to 10 Years

ABSTRACT Objective: To assess the impact of Molar Incisor Hypomineralization (MIH) and confounding factors on oral health-related quality of life (OHRQoL) according to the perception of 8 to 10-year-old children and their parents/caregivers. Material and Methods: A cross-sectional study including 403 students aged 8-10 years was carried out, in which OHRQoL was measured using the Child Perceptions Questionnaire administered to both children and parents/caregivers. The diagnosis of MIH was performed according to the previously proposed index. Dental caries experience, malocclusion, and sociodemographic factors were evaluated as confounders. Cluster analysis and Poisson regression with robust variance (p<0.05) were performed. Results: The prevalence of MIH was 13.4%. Parents/caregivers of children with MIH in incisors showed a higher impact prevalence in the emotional well-being domain (PR=1.92; 95%CI=1.16-3.19). Children with hypoplasia had a higher prevalence of negative impact on OHRQoL in the oral symptoms domain (PR=1.51; 95%CI=1.03-2.23). According to the perception of parents/caregivers, dental caries experience had a negative impact on the quality of life of students in the emotional well-being domain (PR=4.19; 95%CI=1.06-16.49) and in the total questionnaire score (PR=3.21; 95%CI=1.06-9.71). Conclusion: According to the perception of parents/caregivers, children with MIH in incisors showed a greater impact on OHRQoL. Additionally, the presence of hypoplasia affected the self-perception of OHRQoL in children, and caries experience influenced the OHRQoL of children, as perceived by parents/caregivers.

Identification of dental calcification stages as a predictor of skeletal development phase

ABSTRACT Objective: This study aimed to establish a correlation between the stages of tooth calcification of mandibular canines and second molars with the phases of skeletal development. Methods: In a consecutive series of panoramic, cephalometric and hand-wrist radiographs of 113 individuals (60 females and 53 males) with an average age of 12.24 ± 1.81 years, the stages of mandibular canine and second molar calcification, cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI) were classified. The variables were correlated by means of the Spearman's Rank test: chronological age, SMI, CVMI and tooth calcification stages. In order to assess whether the CVMI and tooth calcification stages were significant predictors of the SMI, an ordinal regression analysis was carried out. Results: The stages of CVMI (OR = 16.92; CI 95% = 6.45-44.39; p< 0.001) and calcification of the second molars (OR = 3.22; CI 95% = 1.50-6.92; p= 0.003) were significant predictors of SMI, however similar result was not observed for canines (OR = 0.52, CI 95% = 0.18-1.54; p= 0.239). Calcification stage E for boys, and E and F for girls corresponded to the pre-peak phase of pubertal growth. Stages G and H for boys, and F and G for girls coincided with peak of growth. In the final growth phase, the majority of second molars presented with root apex closure (stage H). Conclusion: The stages of calcification of the second molar may be considered predictors of the stage of skeletal development in the population studied.

RESUMO Objetivo: O presente estudo objetivou estabelecer uma correlação entre os estágios de calcificação dentária de caninos e segundos molares inferiores e as fases do desenvolvimento esquelético. Métodos: Em uma série consecutiva de radiografias panorâmicas, cefalométricas e de mão e punho de 113 indivíduos (60 meninas e 53 meninos) com idade média de 12,24 ± 1,81 anos, foram classificados os estágios de calcificação do canino e do segundo molar inferiores, indicadores de maturação das vértebras cervicais (IMVC) e indicadores de maturação esquelética (IME). As variáveis foram correlacionadas pelo teste de Correlação de Rank de Spearman: idade cronológica, IME, IMVC e estágios de calcificação dentária. A fim de avaliar se os estágios do IMVC e da calcificação dentária foram preditores significativos do IME, foi realizada uma análise de regressão ordinal. Resultados: Os estágios de IMVC (OR = 16,92; IC 95% = 6,45-44,39; p< 0,001) e calcificação dos segundos molares (OR = 3,22; IC 95% = 1,50-6,92; p= 0,003) foram preditores significativos de IME; no entanto, esse não foi o caso com dentes caninos (OR = 0,52, IC 95% = 0,18-1,54; p= 0,239). Os estágios de calcificação E para meninos e E e F para meninas corresponderam à fase pré-pico de crescimento puberal. Os estágios G e H para meninos e F e G para meninas coincidiram com o pico de crescimento. Na fase final de crescimento, a maioria dos segundos molares apresentou fechamento do ápice radicular (estágio H). Conclusão: Os estágios de calcificação do segundo molar podem ser considerados preditores do estágio de desenvolvimento esquelético na população estudada.

Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren

Abstract This study aimed to identify the prevalence of molar-incisor hypomineralization (MIH) in schoolchildren and its association with dental caries experience. This was a cross-sectional study with a sample of 471 children aged 8 to 10 years. Data were collected via a sociodemographic questionnaire. Intra-oral clinical examination was done to identify and diagnose MIH (EAPD Criteria) as well as dental caries (ICDAS Index). Statistical analyses were performed with Person's Chi-square, Fisher's exact, and Mann-Whitney tests, and Poisson regression models were built. Statistical significance was set at an alpha-level of 0.05. The prevalence of MIH in our participants was 9.8%, with lesions being mostly of the mild form (65.2%) and affecting the first permanent molars but not the incisors in 54.2% of the children. Dental caries was observed in 88.1% of subjects. We observed a significant association between dental caries and the following variables: presence of MIH (p < 0.01; PR = 1.13), dental visit (p < 0.02; PR=0.92), and parents or legal guardians' education level (p < 0.05; PR = 1.07). A MIH diagnosis was also significantly associated with family income (p < 0.05; PR = 4.09). Children with MIH had more caries lesions on molar surfaces (p < 0.01; PR = 4.05). The prevalence of MIH was found to be moderate, based on previous studies, and the presence of enamel defect was associated with dental caries. The teeth most affected by MIH lesions were the first permanent molars.

In Situ Effect of Intra-Oral Application of Pastes Containing CPP-ACP or CPP-ACPF Against Initial Enamel Erosion

Objective: To evaluate in situ the effect of toothpastes containing casein phosphopeptide - amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium phosphate associated to fluoride (CPP-ACPF) on initial erosion prevention. Material and Methods: Bovine enamel blocks (n = 192) were randomly assigned into 4 phases according to the baseline surface hardness: GI: CPP-ACP Paste (MI Paste™), GII: CPP-ACPF Paste (MI Paste Plus™), GIII: Fluoridated paste and GIV: Placebo Paste. In each of the 4 crossover phases, twelve volunteers wore intraoral palatal appliances containing 4 enamel blocks for 2 hours, then the tested treatments were applied intraorally (3 min) and the appliance was maintained in the mouth for another 3 hours. After, the appliances were removed and immersed in hydrochloric acid (0.01 M, pH 2.3) for 30 seconds to promote erosive demineralization. The final surface hardness was evaluated and percentage of surface hardness loss was calculated. The data were analyzed by ANOVA and Tukey's test (α = 5%). Results: The application of CPP-ACP paste, independent of fluoride content, resulted in significant lower enamel hardness loss (GI: 9.26% ±3.48 and GII: 9.14% ±1.73) compared to NaF (GIII: 15.5% ± 3.94) and placebo (GIV: 16.7% ± 4.07) pastes, which did not show difference between them. Conclusion: The CPP-ACP pastes were able to reduce initial erosive demineralization in relation to fluoride and placebo pastes. Nevertheless the formulation of CPP-ACP with fluoride did not provide an additional benefit.

Craniofacial trauma in older adults victims of road traffic accidents: a cross-sectional study

Introduction: Among the determinant factors for the implant-supported prosthesis longevity is the exact and comprehensive process of impression which results is the passive prosthesis fitting. Objective: To compare the accuracy of transfer coping impression techniques with or without splinting, after the isolation of the factors associated to the passive fitting. Method: Based on the control group composed by an edentulous mandibular master model (self-cured acrylic resin) with four external hexagon parallel implants splinting with a metallic bar, four customized open trays were constructed with self-cured acrylic. Ten impressions were made with condensation silicone ( Xantopren ®), poured with type IV plaster ( Durone ®), and then divided into two groups: Group 1 (n=5) ­ non-splinting multi unit transfer copings; and Group 2 (n=5) ­ splinting multi unit transfer copings with a bar constructed with self-cured acrylic resin ( Palavit G ®) and dental floss, with the aid of an addition silicon mold ( Elite Double ® Zhermack) . Next, the bar was cut and splinted again. The ten transfer molds were measured at the center of the labial surface of each implant with the aid of Stereoscopic Magnifying Glass ( Physis ®) with x60 magnification. The results were tabulated and submitted to non-parametric statistics through Kruskal-Wallis test (p<0.05). Results: The means were: 22.44 µm (±7) for control group, 26.86 µm (±10) for direct splinting, and 24.70 µm (±13) for direct non-splinting technique. Conclusion: No statistically significant differences were found between the tested techniques.

Introdução: Entre os fatores determinantes para a longevidade de uma prótese implanto suportada, está o processo exato e meticuloso de moldagem dos implantes osseointegrados, implicando diretamente no assentamento passivo da prótese. Objetivo: Comparar a precisão das técnicas de moldagem com e sem união dos transferentes isolando os fatores que podem estar associados ao ajuste passivo. Métodos: A partir de um grupo controle composto por um modelo mestre (em resina acrílica quimicamente ativada) mandibular desdentado com quatro implantes de conexão externa posicionados paralelamente e unidos por uma barra metálica. Foram confeccionadas dez moldeiras em resina acrílica quimicamente ativada (todas abertas). Dez impressões foram feitas com silicone de condensação Xantopren ®, e vertidas com gesso tipo IV, Durone ®, divididas em dois grupos: Grupo 1 (n=5) ­ Pilares multi unit não unidos e Grupo 2 (n=5) ­ Pilares multi unit unidos por uma barra confeccionada com fio dental e resina acrílica autopolimerizável, Palavit G ®, através de um molde de silicone de adição, Elite Double ® Zhermack . Em seguida, a barra foi seccionada e reunida. Os dez modelos de transferência foram mensurados no centro da face vestibular de cada um dos implantes através de uma lupa estereoscópica ( Physis ®) com ampliação de 60 vezes. Os resultados foram tabulados e submetidos à análise estatística não paramétrica, teste Kruskal-Wallis (p<0,05). Resultados: As médias aritméticas encontradas foram de 22,44 µm (±7) para grupo controle, 26,86 µm (±10) para técnica direta com esplintagem e 24,70 µm (±13) para técnica direta sem esplintagem. Conclusão: Não foi identificado diferenças estatísticas significantes entre as técnicas experimentadas.

Caracterização dos ensaios clínicos sobre cárie dentária desenvolvidos no Brasil e registrados no clinical trials: uma análise de 15 anos (2003-2017) / Characterization of clinical trials about caries developed in Brazil and registered on clinical trials: an analysis of 15 years (2003-2017)

Objetivo: Caracterizar os ensaios clínicos sobre cárie dentária desenvolvidos por pesquisadores brasileiros e registrados na plataforma Clinical Trials. Material e método: Tratou-se de estudo bibliográfico sobre a cárie dentária por meio da análise dos registros feitos na plataforma Clinical Trials. O período de busca compreendeu todos os estudos registrados entre os anos de 2003 a 2017. Para a estratégia de pesquisa foi utilizada a palavra-chave "Dental caries" na seção "Condition or disease" e "Brazil" na seção "Country". Os dados foram apresentados por meio de estatística descritiva. Resultados: Foram obtidos 55 ensaios clínicos, constituindo- se o Estado de São Paulo como principal local de execução (51,8%). A amostra variou de três a 800 indivíduos. Quanto à análise do período de registro, a maioria dos ensaios clínicos foram registrados nos últimos cinco anos (2013-2017) (63,6%). A maioria dos ensaios clínicos analisados recrutou crianças entre 0-12 anos (67,7%). Com relação à alocação dos grupos, apenas um estudo (1,8%) não se caracterizou como randomizado. O modelo de intervenção mais frequente foi o paralelo (70,9%). Quanto ao tipo de mascaramento, o estudo cego (34,5%) foi o mais prevalente e os estudos com finalidade terapêutica foram predominantes (67,3%). A maior parte dos estudos dividiu os participantes em dois grupos (67,3%) e não usou grupo placebo (80,0%). Conclusões: Os ensaios clínicos desenvolvidos por pesquisadores brasileiros voltados à temática da cárie dentária são majoritariamente desenvolvidos em crianças, predominando o desenho paralelo e a finalidade terapêutica. Existe grande variabilidade no número amostral, sendo baixo o uso de grupo placebo.

Objectives: To caracterize the clinical trials about dental caries developed by brazilian resourchers and registered on Clinical Trials Plataform. Methods: A bibliographic study about dental caries theme by means of the analysis of registries made at the Clinical Trials, an international plataform for registration of clinical trials. The search included all the registered studies between the years of 2003 and 2017. The search strategy used "dental caries" as key word on section "Condition or disease" and "Brazil" on section "Country". The data were presented through a descriptive statistics. Results: The search obtained 55 (fifty five) clinical trials, having the state of São Paulo as the principal execution place (51,8%). The sample varied between 3 (three) and 800 (eight hundred) individuals. In relation to the period of registry, most of the clinical trials belong to the last 5 (five) years - 2013-2017 (63,6%). Most of clinical trials analyzed had recruited children between 0-12 years (67,7%). With regard to allocation of groups, only 1 (one) study didn't caracterize as randomized. The most frequent intervation model was the parallel (70,9%). As the type of masking, the blind study prevailed and the studies with therapeutic purpose were predominant (67,3%). The most part of studies divided the participants into 2 (two) groups (67,3%) and didn't use a placebo group. Conclusion: The clinical trials developed by brazilian resourchers toward dental caries theme are mostly developed on children, predominating the parallel design and therapeutic purpose. There is large variability on sample numbers, with low use of placebo groups.

Hipomineralização molar-incisivo: etiologia, características clínicas e tratamento / Molar incisor hypomineralization: etiology, clinical characteristics and treatment

Introdução: a Hipomineralização Molar-Incisivo (HMI) é um defeito de desenvolvimento do esmalte dentário que afeta de um até todos os primeiros molares permanentes, podendo estar presente nos incisivos permanentes. Objetivo: revisar a literatura sobre a HMI objetivando proporcionar informações ao cirurgião-dentista que realiza atendimento infantil sobre o diagnóstico, características clínicas e tratamento. Metodologia: revisão integrativa da literatura, sendo utilizado as bases de dados LILACS, PubMed, Web of Science e Scopus. Foram usadas as palavras-chaves "Hipoplasia do Esmalte Dentário/Dental Enamel Hypoplasia" e " Hipomineralização Molar-Incisivo/Molar Incisor Hypomineralization". Resultados: fatores etiológicos associados a complicações pré, peri e pós-natais, ambientais e genéticos têm sido evidenciados e a prevalência de HMI mostra-se variada entre as populações. Apresenta-se como manchas opacas bem delimitadas e, com o aumento da gravidade, ocorre a perda do esmalte resultando em fratura, destruição coronária e indicação de exodontia. As fraturas pós-eruptivas atuam como áreas de retenção de biofilme, o que facilita seu acúmulo e aumenta a susceptibilidade à cárie dentária. A Academia Europeia de Odontopediatria (EAPD) estabeleceu critérios que facilitam o diagnóstico deste agravo por meio de pesquisas epidemiológicas. As medidas terapêuticas são direcionadas de acordo com a gravidade da lesão. Conclusão: a HMI deve receber adequada atenção do cirurgião-dentista em função das consequências clínicas e estéticas que acarreta ao paciente, interferindo negativamente na sua qualidade de vida nos casos mais graves. Novas pesquisas são necessárias com a finalidade de expandir o conhecimento acerca da HMI, objetivando ofertar ao paciente o correto diagnóstico e a melhor opção terapêutica.

ntroduction: molar Incisor Hypomineralization (HMI) is a developmental defects of enamel that affects from one to all first permanent molars and also permanent incisors. Aim: to review the literature with the aim of providing information to the pediatric dentist about the diagnosis, clinical characteristics and treatment of HMI. Methodology: integrative literature review, using the LILACS, PubMed, Web of Science and Scopus databases. The keywords "Hipoplasia do Esmalte Dentário/Dental Enamel Hypoplasia" and "Hipomineralização Molar-Incisivo/Molar Incisor Hypomineralization" were used. Results: etiologic factors are associated with prenatal and postnatal factors, environmental and genetic complications. The prevalence of HMI is varied among the populations. It's clinically characterized as delimited opaque spots. With increasing severity, can occurs enamel loss, fracture, coronary destruction and indication of exodontia. Post-eruptive fractures act as areas of biofilm retention, which facilitates their accumulation and increases susceptibility to dental caries. European Academy of Pediatric Dentistry (EAPD) has established criteria that facilitate diagnosis of HMI in epidemiological research. Therapeutic measures are indicated according to the severity of the lesion. Conclusion: MIH should receive adequate attention from the dentist due to its clinical and aesthetic consequences, interfering negatively in quality of life of patients in the most severe cases.

Effect of vegetable oils applied over acquired enamel pellicle on initial erosion

Abstract Objective The prevalence of dental erosion has been recently increasing, requiring new preventive and therapeutic approaches. Vegetable oils have been studied in preventive dentistry because they come from a natural, edible, low-cost, and worldwide accessible source. This study aimed to evaluate the protective effect of different vegetable oils, applied in two concentrations, on initial enamel erosion. Material and Methods Initially, the acquired pellicle was formed in situ for 2 hours. Subsequently, the enamel blocks were treated in vitro according to the study group (n=12/per group): GP5 and GP100 - 5% and pure palm oil, respectively; GC5 and GC100 - 5% and pure coconut oil; GSa5 and GSa100 - 5% and pure safflower oil; GSu5 and GSu100 - 5% and pure sunflower oil; GO5 and GO100 - 5% and pure olive oil; CON− - Deionized Water (negative control) and CON+ - Commercial Mouthwash (Elmex® Erosion Protection Dental Rinse, GABA/positive control). Then, the enamel blocks were immersed in artificial saliva for 2 minutes and subjected to short-term acid exposure in 0.5% citric acid, pH 2.4, for 30 seconds, to promote enamel surface softening. The response variable was the percentage of surface hardness loss [((SHi - SHf) / SHf )×100]. Data were analyzed by one-way ANOVA and Tukey's test (p<0.05). Results Enamel blocks of GP100 presented similar hardness loss to GSu100 (p>0.05) and less than the other groups (p<0.05). There was no difference between GP5, GC5, GC100, GSa5, GSu100, GSa100, GSu5, GO5, GO100, CON− and CON+. Conclusion Palm oil seems to be a promising alternative for preventing enamel erosion. However, further studies are necessary to evaluate a long-term erosive cycling.

In situ effect of CPP-ACP chewing gum upon erosive enamel loss

Abstract Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is able to increase salivary calcium and phosphate levels at an acidic pH. Previous studies demonstrated that a CPP-ACP chewing gum was able to enhance the re-hardening of erosion lesions, but could not diminish enamel hardness loss. Therefore, there is no consensus regarding the effectiveness of CPP-ACP on dental erosion. Objective This in situ study investigated the ability of a CPP-ACP chewing gum in preventing erosive enamel loss. Material and Methods: During three experimental crossover phases (one phase per group) of seven days each, eight volunteers wore palatal devices with human enamel blocks. The groups were: GI - Sugar free chewing gum with CPP-ACP; GII - Conventional sugar free chewing gum; and GIII - No chewing gum (control). Erosive challenge was extraorally performed by immersion of the enamel blocks in cola drink (5 min, 4x/day). After each challenge, in groups CPP and No CPP, volunteers chewed one unit of the corresponding chewing gum for 30 minutes. Quantitative analysis of enamel loss was performed by profilometry (µm). Data were analyzed by Repeated-Measures ANOVA and Tukey's test (p<0.05). Results The use of chewing gum (CPP and No CPP) resulted in lower erosive enamel loss compared with the control group (p<0.05). CPP-ACP chewing gum (CPP) did not improve the protection against erosive enamel loss compared with conventional chewing gum (No CPP) (p>0.05). Conclusion The CPP-ACP chewing gum was not able to enhance the anti-erosive effect of conventional chewing gum against enamel loss.

Strategies for control and treatment of carious lesions in deciduous molars: a review of the literature / Estratégias para o controle e tratamento das lesões de cárie em molares decíduos: Uma revisão de literatura

ABSTRACT In recent years, a reduction has been observed in the prevalence of dental caries in the global population. However, caries is still considered a public health problem. Currently, total removal of decayed tissue has been questioned and replaced by less invasive therapeutic approaches, which offer the possibility of incomplete removal of decayed tissue in one or two clinical sessions. Other techniques aim at sealing the carious lesion or use prefabricated metal crowns on the cavitated tooth without removal of the decayed tissue, preventing direct contact of the substrates with the carious lesion. Recently, ultra-conservative treatment has gained scientific prominence, and is able to control carious lesions through the disorganization of dental biofilm via supervised brushing. Each therapeutic approach has its advantages and limitations, and it is the responsibility of dental professionals to plan their patients' treatments according to their individual needs, allowing for better functional, aesthetic and psychological conditions for patients by preserving primary teeth until their physiological exfoliation.

RESUMO Nos últimos anos, foi perceptível a diminuição na prevalência da cárie dentária na população mundial. Entretanto, a doença cárie continua sendo considerada um problema de saúde pública. Atualmente, a remoção total do tecido cariado vem sendo questionada e substituída por abordagens terapêuticas menos invasivas, as quais oferecem a possibilidade de remoção incompleta do tecido cariado em uma ou duas sessões clínicas. Outras técnicas visam o selamento da lesão cariosa ou o emprego de coroas metálicas pré-fabricadas sobre o dente cavitado sem que haja remoção de tecido cariado, impedindo o contato direto dos substratos com a lesão cariosa. Recentemente, o tratamento ultraconservador tem ganhado destaque científico, o qual tem a capacidade de conduzir o controle da lesão de cárie através da desorganização do biofilme dentário pela escovação supervisionada. Cada abordagem terapêutica apresenta suas vantagens e limitações, sendo responsabilidade do profissional planejar o tratamento do seu paciente de acordo com as suas necessidades individuais, possibilitando melhores condições funcionais, estéticas e psicológicas para o paciente através da manutenção dos dentes decíduos até a sua esfoliação fisiológica.

Effect of different salivary exposure times on the rehardening of acid-softened enamel

Abstract This in situ study assessed the effect of different times of salivary exposure on the rehardening of acid-softened enamel. Bovine enamel blocks were subjected in vitro to a short-term acidic exposure by immersion in 0.05 M (pH 2.5) citric acid for 30 s, resulting in surface softening. Then, 40 selected eroded enamel blocks were randomly assigned to 10 volunteers. Intraoral palatal appliances containing 4 enamel blocks were constructed for each volunteer, who wore the appliance for 12 nonconsecutive hours: initial 30 min, followed by an additional 30, and then by an additional 1 hour. For the last additional 10 hours the appliances were used at night, during the volunteers' sleep. Surface hardness was analyzed in the same blocks at baseline, after erosion and after each period of salivary exposure, enabling percentage of surface hardness recovery calculation (%SHR). The data were tested using repeated measures ANOVA and Tukey's test (α = 0.05). Increasing periods of salivary action promoted a progressive increase in the surface hardness (p < 0.001). However a similar degree of enamel rehardening (p = 0.641) was observed between 2 hours (49.9%) and 12 hours (53.3%) of salivary exposure. Two hours of salivary exposure seems to be appropriate for partial rehardening of the softened enamel surface. The use of the intraoral appliance during sleep did not improve the enamel rehardening after erosion.

Changes in Oral Health-related Behavior of Infants following a Preventive Program of Continuing Education Directed to their Parents

To evaluate changes in oral health-related behavior of infants following preventive program of continuing education directed to their parents.Material and Methods:We analyzed 53 dental files of infants aged up to 36 months, who participated in the Prevention and Education Program of the Infants Clinic, School of Dentistry of Bauru (USP), and attended at least 2 visits with a maximum of 4 missing appointments. Initially an educational lecture was conducted, pointing issues related to diet and oral hygiene. At the following visit, the professional filled in a form with questions about diet and hygiene performed at home. The following information was extracted from dental files: reason of the first visit, age, number of teeth, number of visits, missing appointments, and dietary and oral hygiene risk factors. The data were tabulated and analyzed using descriptive statistics comparing the information obtained from the first visit to that of the last one.Results:The reason for the first visit was dental caries prevention (88.68%) followed by dental trauma (7.55%), and needed of curative treatment (3.77%). The mean age of the sample was 14.85 months, the tooth number mean was 12.64 at first visit, the mean number of visits was 7 and the mean missing appointments was 0.83. The percentage of infants with inadequate diet and hygiene habits was 88.68% and 62.26%, and only 12.762% and 57.57% of these have changed their habits, respectively.Conclusion:After the preventive program of continuing education, the dietary habits showed were more difficult to change in relation to hygiene ones...

Efeito in situ da utilização de uma goma de mascar com caseína fosfopeptídea fosfato de cálcio amorfo (CPP-ACP) previamente ao desafio erosivo inicial / Effect of CPP-ACP chewing gum previously to erosive demineralization

O efeito protetor da caseína fosfopeptídea fosfato de cálcio amorfo (CPP-ACP) contra a erosão dentária é controverso. Este estudo in situ teve como objetivo investigar a capacidade de uma goma de mascar com CPP-ACP em prevenir uma única desmineralização erosiva. Blocos de esmalte bovino (120) selecionados pela dureza superficial inicial foram divididos aleatoriamente entre os grupos: GI - goma de mascar com CPP-ACP, GII - goma de mascar sem CPP-ACP e GIII - controle negativo para avaliação do efeito protetor sem estimulação salivar (sem goma de mascar). Dezenove voluntários participaram do estudo durante três fases cruzadas de 2 h cada. Nas fases de GI e GII os voluntários usaram dispositivos intrabucais palatinos contendo 2 blocos de esmalte, durante 120 minutos e mascaram uma unidade da goma de mascar correspondente ao grupo nos últimos 30 minutos. No grupo controle os voluntários usaram o dispositivo intrabucal por 2h, sem uso de goma de mascar. Em cada fase, imediatamente após a utilização, os dispositivos intrabucais foram imersos em refrigerante tipo cola durante 5 minutos para promover a desmineralização erosiva. A dureza superficial final foi mensurada e os valores foram utilizados para o cálculo do percentual de perda de dureza. Os dados foram analisados por ANOVA de medidas repetidas e teste Tukey (α = 5%). Menor perda de dureza do esmalte foi encontrada após a utilização de goma de mascar com (GI - 32,7%) e sem (GII - 33,5%) CPP-ACP relação ao efeito salivar sem estimulação (GIII - 39,8%) (p <0,05). Não houve diferença entre GI e GII (p> 0,05). Os resultados sugerem que a utilização de goma de mascar imediatamente antes de uma desmineralização erosiva é capaz de diminuir a perda de dureza do esmalte. No entanto, a presença de CPP-ACP na goma de mascar não foi capaz de melhorar este efeito.

The erosion-protective effect of CPP-ACP is controversial. This in situ study aimed to investigate the ability of CPP-ACP chewing gum to prevent a single event of erosive demineralization. Bovine enamel blocks (120), after selection (initial surface hardness) were randomly assigned to groups: GI-chewing gum with CPP-ACP, GIIchewing gum without CPP-ACP and Control group-salivary effect without stimulation (no gum). Nineteen volunteers participated on this study during 3 crossover phases of 2 h. On GI and GII, the volunteers wore intraoral palatal devices for 120 min and chewed a unit of the corresponding chewing gum on the last 30 min. On Control group the volunteer wore the appliance for 2 h, without chewing gum. On each phase immediately after the intraoral use, devices were extra orally immersed in cola drink for 5 minutes to promote erosive demineralization. The percentage of surface hardness loss was calculated. The data were analyzed by Repeated Measures ANOVA and Turkeys test. Less enamel hardness loss was found after the use of chewing gum with (GI-32.7 %) and without (GII-33.5%) CPP-ACP when compared to salivary effect without stimulation (control- 39.8%) (p<0.05). There was no difference between GI and GII (p>0.05). The results suggest that the use of chewing gum immediately before an erosive demineralization is able to diminish the enamel hardness loss. However, the presence of CPP-ACP in the chewing gum cannot enhance this protective effect.

Efeito in situ da utilização de uma goma de mascar com caseína fosfopeptídea fosfato de cálcio amorfo (CPP-ACP) previamente ao desafio erosivo inicial / Effect of CPP-ACP chewing gum previously to erosive demineralization

O efeito protetor da caseína fosfopeptídea fosfato de cálcio amorfo (CPP-ACP) contra a erosão dentária é controverso. Este estudo in situ teve como objetivo investigar a capacidade de uma goma de mascar com CPP-ACP em prevenir uma única desmineralização erosiva. Blocos de esmalte bovino (120) selecionados pela dureza superficial inicial foram divididos aleatoriamente entre os grupos: GI - goma de mascar com CPP-ACP, GII - goma de mascar sem CPP-ACP e GIII - controle negativo para avaliação do efeito protetor sem estimulação salivar (sem goma de mascar). Dezenove voluntários participaram do estudo durante três fases cruzadas de 2 h cada. Nas fases de GI e GII os voluntários usaram dispositivos intrabucais palatinos contendo 2 blocos de esmalte, durante 120 minutos e mascaram uma unidade da goma de mascar correspondente ao grupo nos últimos 30 minutos. No grupo controle os voluntários usaram o dispositivo intrabucal por 2h, sem uso de goma de mascar. Em cada fase, imediatamente após a utilização, os dispositivos intrabucais foram imersos em refrigerante tipo cola durante 5 minutos para promover a desmineralização erosiva. A dureza superficial final foi mensurada e os valores foram utilizados para o cálculo do percentual de perda de dureza. Os dados foram analisados por ANOVA de medidas repetidas e teste Tukey (α = 5%). Menor perda de dureza do esmalte foi encontrada após a utilização de goma de mascar com (GI - 32,7%) e sem (GII - 33,5%) CPP-ACP relação ao efeito salivar sem estimulação (GIII - 39,8%) (p <0,05). Não houve diferença entre GI e GII (p> 0,05). Os resultados sugerem que a utilização de goma de mascar imediatamente antes de uma desmineralização erosiva é capaz de diminuir a perda de dureza do esmalte. No entanto, a presença de CPP-ACP na goma de mascar não foi capaz de melhorar este efeito...

The erosion-protective effect of CPP-ACP is controversial. This in situ study aimed to investigate the ability of CPP-ACP chewing gum to prevent a single event of erosive demineralization. Bovine enamel blocks (120), after selection (initial surface hardness) were randomly assigned to groups: GI-chewing gum with CPP-ACP, GIIchewing gum without CPP-ACP and Control group-salivary effect without stimulation (no gum). Nineteen volunteers participated on this study during 3 crossover phases of 2 h. On GI and GII, the volunteers wore intraoral palatal devices for 120 min and chewed a unit of the corresponding chewing gum on the last 30 min. On Control group the volunteer wore the appliance for 2 h, without chewing gum. On each phase immediately after the intraoral use, devices were extra orally immersed in cola drink for 5 minutes to promote erosive demineralization. The percentage of surface hardness loss was calculated. The data were analyzed by Repeated Measures ANOVA and Turkeys test. Less enamel hardness loss was found after the use of chewing gum with (GI-32.7 %) and without (GII-33.5%) CPP-ACP when compared to salivary effect without stimulation (control- 39.8%) (p<0.05). There was no difference between GI and GII (p>0.05). The results suggest that the use of chewing gum immediately before an erosive demineralization is able to diminish the enamel hardness loss. However, the presence of CPP-ACP in the chewing gum cannot enhance this protective effect...

Uso dos serviços odontológicos entre idosos residentes no município de Campina Grande, Paraíba / Use of Dental Services among Elderly Living in the City of Campina Grande, PB, Brazil

Objetivo: Investigar o uso dos serviços odontológicos por idosos cadastrados na Estratégia Saúde da Família no município de Campina Grande, Paraíba.Método: Estudo de base domiciliar, transversal, no qual foram entrevistados idosos com idade igual ou superior a 60 anos. A amostra do tipo probabilística foi composta por 283 indivíduos. O instrumento de pesquisa consistiu de um formulário semi-estruturado, composto por quatro dimensões: identificação, características demográficas, condições de moradia e consumo de serviços de saúde. Os dados foram processados usando-se o software Epi Info 3.5.1, sendo apresentados por meio da estatística descritiva.Resultados: Verificou-se maior frequência das mulheres (70,3%) e a idade variou de 60 a 104 anos (72,2 anos ± 9,3). A maioria dos idosos tem renda pessoal e familiar entre 1 e 2 salários mínimos (72,8% e65,7%, respectivamente), residindo em casa própria (90,5%). Apenas 4,2% dos idosos declararam jamais ter ido ao cirurgião-dentista e 67,2% haviam utilizado o serviço odontológico há mais de três anos. As principais razões que motivaram a busca pelo atendimento foram a exodontia (27,0%) e a necessidade de reparos ou manutenção nas próteses dentárias (26,6%). Quanto à autopercepção das necessidades de tratamento, 46,1% dos entrevistados informaram necessitar de tratamento odontológico.Conclusão: Apesar de a população idosa utilizar os serviços odontológicos de saúde, uma boa parte o fez há mais de três anos, sendo a exodontia o motivo principal da consulta, de modo que muitos afirmaram necessitar de tratamento odontológico.

Objective: To investigate the use of dental services by elderly registered in the Family Health Strategy in the city of Campina Grande, PB, Brazil.Method: In this cross-sectional, home-based study, elderly aged 60 years or older. The probabilistic sample was composed by 283 subjects. The data collection instrument was a semi-structured questionnaire composed by four dimensions: identification, demographics, living conditions and use of health services. Data were processed using the Epi Info 3.5.1 software and were presented by means of descriptive statistics.Results: There was higher frequency among females (70.3%) and the age ranged from 60 to 104 years (72.2 years ± 9.3). Most elderly have personal and family incomes between 1 and 2 minimum wages (72.8% and 65.7%, respectively) and live in their own property (90.5%). Only 4.2% of the elderly had never gone to the dentist and 67.2% affirmed to have used the dental service more than 3 years ago. The main reasons for visiting the dentist were extractions (27.0%) and need of repairs or maintenance of dentures (26.6%). Regarding the self-perception of treatment needs, 46.1% of the interviewees believed that they needed dental treatment.Conclusion: Although the elderly population use dental services, more than 3 years had elapsed since their last visit to the dentist, and extraction was the main reason for seeking dental care, in such a way that many of the interviewees affirmed to need dental treatment.

Comparação in vitro do efeito erosivo de refrigerantes zero ou light em relação à versão regular / In vitro erosive effect of light or zero versus regular soft drinks

Objetivo: Comparar o potencial erosivo de bebidas light e zero em relação a sua versão regular sobre o esmalte. Método: Blocos de esmalte bovino foram divididos em 7 grupos (n=10) e submetidos à ciclagem erosiva com a versão regular ou light/zero das seguintes bebidas: Coca-cola®, Guaraná® e Sprite®. Antes da imersão, metade da superfície dos blocos de esmalte foi protegida com esmalte cosmético para referência na análise perfilométrica. As imersões nas bebidas de acordo com os grupos em estudo foram realizadas 4 vezes ao dia durante 2 minutos. Entre os desafios erosivos os blocos foram imersos em saliva artificial por 2 horas. A cada dia, após as 4 ciclagens erosivas os blocos foram armazenados em saliva artificial. Ao final do 5º dia de ciclagem a alteração da superfície do esmalte foi analisada por perfilometria (µm). Os dados foram analisados com ANOVA e teste de Tukey (para as bebidas tipo cola) e teste t não pariado (para as outras bebidas) (p menor que 0.05). Resultados: A cola light (0.52±0.19) provocou um desgaste similar a cola zero (0.54±0.17) e ambas causaram menor desgaste quando comparadas a cola regular (2.15±0.65). A sprite regular (1.17±0.36) provocou menor desgaste do que a versão zero (2.25±0.75). Os guaranás regular (1.03±0.36) e light (1.02±0.26) resultaram em desgaste semelhante no esmalte. Conclusão: O presente estudo in vitro constatou que as colas light e zero apresentaram menor potencial erosivo, o que não foi observado para as versões zero da guaraná e da Sprite, as quais causaram desgaste semelhante e maior que a versão regular, respectivamente.

Objective: The aim of this study was to evaluate the erosive potential of light and zero soft drinks compared with the regular version on dental enamel. Method: Bovine enamel slabs were divided into 7 groups (n=10) and subjected to erosive challenge by immersion in the light, zero and regular versions of the following soft drinks: Coca-cola®, Guaraná® and Sprite®. Before immersion in the beverages, half of slab surface was protected with nail varnish for reference for the profilometry analysis. The enamel slabs were immersed in the beverages for 2 minutes, 4 times a day, at room temperature. Between challenges, the slabs were maintained in artificial saliva for 2 hours. Every day after completion of the four pH-cycles, the samples were stored in artificial saliva overnight. At the end of the 5th day of erosive challenge, the alterations on enamel surface were measured by profilometry (µm). Data were analyzed by ANOVA and Tukey's test (for cola drinks) and unpaired t test (for the other beverages) (p less than 0.05). Results: Light Coca-cola® (0.52±0.19) promoted similar enamel wear to zero Coca-cola® (0.54±0.17), and both resulted in less enamel loss compared with regular Coca-cola® (2.15±0.65). However, regular Sprite (1.17±0.36) caused lower enamel wear than its zero version (2.25±0.75). Regular (1.03±0.36) and light (1.02±0.26) Guaraná® caused similar wear in enamel. Conclusion: This in vitro study demonstrated that light and zero Coca-cola® had less erosive potential than the regular version of this soft drink. The same result, however, was not observed for the zero versions of Guaraná® and Sprite®, which caused similar and higher enamel wear, respectively, compared with their regular versions.

Cirurgia oral em pacientes idosos: considerações clínicas, cirúrgicas e avaliação de riscos / Oral surgery in elderly patients: clinical/surgical considerations and risk assessment

INTRODUÇÃO: A necessidade de cirurgia oral em idosos tem sido crescente no sentido de permitir o equilíbrio de suas funções mastigatórias, estéticas e fonéticas, por meio da adequação dos tecidos orais para o assentamento correto de aparelhos protéticos, repercutindo positivamente na saúde geral do indivíduo. OBJETIVO: Rever a literatura acerca das considerações clínicas e operatórias relevantes ao satisfatório atendimento de idosos na prática clínica rotineira, sobretudo nos casos em que o tratamento de escolha represente uma conduta cirúrgica. REVISÃO DE LITERATURA: Na atualidade, as exodontias, as cirurgias pré-protéticas e os implantes osteointegrados são as condutas operatórias mais realizadas em pessoas idosas. Para tanto, as particularidades fisiológicas de tais casos têm de ser consideradas, com destaque para o monitoramento da pressão arterial e dos níveis glicêmicos, osteoporose, uso de medicações, entre as mais variadas condições que tornam o idoso um paciente que requer atenção especial no consultório odontológico. CONCLUSÃO: Em virtude da fragilidade inerente aos indivíduos da terceira idade, o ato operatório nessa fase da vida reveste-se de cuidados em relação a um completo exame clínico e uma criteriosa avaliação dos riscos cirúrgicos, de maneira a analisar a conveniência da indicação cirúrgica a fim de primar pelo bem-estar do paciente.

INTRODUCTION: The need for oral surgery has been considerably increasing in elderly population in order to allow the balance of their masticatory, aesthetic, and phonetic functions through adapting the oral tissues for the appropriate placement of the prosthetic devices, thereby impacting positively on the subject's health. OBJECTIVE: This article aimed to review the literature on both clinical and surgical considerations required to the satisfactory treatment of elderly patients in clinical routine practice, focusing particularly on cases whose treatment choice is a surgical procedure. LITERATURE REVIEW: The most commonly performed surgeries in elderly patients, nowadays, are tooth extractions, pre-prosthetic surgeries and osseointegrated implants. Therefore, the physiological features inherent to such cases should be considered, especially those that involve the monitoring of glycemic and blood pressure levels, osteoporosis, medication use, and many other conditions demanding special attention for elderly patient treatment at dental office. CONCLUSION: Due to the fragility intrinsic to elderly individuals, the surgery at this stage of life requires caution in relation to a comprehensive clinical examination and also to a careful evaluation of the surgical risks in order to analyze the correct indication of the surgery and thereby to ensure patient's well-being.

Prevalência de Maloclusão em Escolares de 6 a 12 Anos de Idade em Campina Grande, PB, Brasil / Prevalence of Malocclusion in 6-12 Year-Old Schoolchildren in the City of Campina Grande, PB, Brazil

Objetivo: Avaliar a prevalência das maloclusões em escolares de 6 a 12 anos de idade do município de Campina Grande, Paraíba, Brasil.Método: Realizou-se um estudo transversal em 516 crianças, selecionadas de forma probabilística, de ambos os sexos. Dentre as características da oclusão, foram observadas: presença de mordida aberta anterior, de mordida cruzada anterior e/ou posterior, a relação incisal (sobressaliência e sobremordida) e a relação molar (Classe I, Classe II e Classe III). Na ocasião do exame, manipulou-se a mandíbula em relação cêntrica. Os dados foram coletados por um examinador calibrado (Kappa = 0,90), registradosem ficha padronizada, organizados com o Epi-Info 3.4.1 e submetidos à análise estatística através de Teste do Qui-quadrado. Resultados: A maloclusão foi diagnosticada em 80,6% das crianças, não havendo diferenças significativas entre os gêneros (p>0,05). A sobressaliência acentuada (48,0%) foi o tipo de maloclusão mais freqüente e a Mordida Aberta Anterior (MAA) apresentou-se com grau severo em 59,1% dos portadores. Conclusão: A elevada prevalência de alterações oclusais demonstra ser fundamental o reconhecimento das maloclusões como uma demanda importante que deva ser avaliada, não somente em relação à necessidade de tratamento, mas também no que se refere às ações preventivas e educativas, as quais devem ser contempladas na elaboração de um programa de saúde para estas comunidades.