Child Stress and Behaviour During Restorative Treatment under Non-Pharmacological Techniques and Sedation: A Case Series

ABSTRACT Objective: To evaluate the behaviour and stress of children undergoing restorative treatment with and without sedation. Material and Methods: Participants were 14 healthy children aged between 2.5 and 6 years and with a history of dental behavioural management problems. In the dental treatment visit, the child was treated with non-pharmacological techniques, and in the second, moderate sedation was added. The child received the same procedure performed by a paediatric dentist in both visits: composite resin restoration using local anaesthesia and rubber dam isolation. In both visits, saliva was collected at the children's arrival at the dental clinic, during local anaesthesia and at the end of treatment. The visits were filmed for later analysis of behaviour according to the Ohio State University Behavioural Rating Scale. Results: About 78.5% of children improved their behaviour from the first to the second visit. The salivary cortisol curve of the first visit was maintained in the second visit for 21.4% of children but varied in the remaining participants. Conclusion: Most children presented better behaviour and less stress when sedation was added to non-pharmacological techniques during dental care.

Religiosity is associated with caregivers' perception of preschool children's dental health

Abstract The aim of the study was to investigate the association between psychosocial factors and perception of caregivers about the dental health of their preschool children. A cross-sectional analysis was performed with 146 caregiver-child dyads attended at Pediatric Dentistry school clinics in Goiânia, Midwest Brazil. Data were collected through a structured interview and a questionnaire with the caregivers and the children's dental records. The study outcome was caregivers' perception of children's dental health (positive or negative). The independent psychosocial variables were religiosity (Duke University Religion Index - DUREL) and Sense of Coherence (Antonovsky's SOC-13 scale). Sociodemographic data and oral health-related variables were also collected as covariates. Bivariate analysis (Pearson's chi-square, T-test, and Mann-Whitney) and Poisson regression with robust variance were performed. The prevalence of negative perception was 54.8%. In bivariate analysis, negative perception was associated with caries experience and report of dental pain at any time in the child's life. In the adjusted regression model, prevalence of caregivers with negative perception of their children's dental health was 1.38 times higher in the group with low organizational religiosity (PR = 1.38; 95%CI 1.05-1.81) and 2.35 times higher in the group of children with high caries experience (PR = 2.35; 95%CI 1.54-3.60). In conclusion, religiosity was associated with caregivers' perception of dental health of their preschool children undergoing treatment in specialized dental clinics, regardless of their caries experience.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE

Abstract: There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

Impact of dental caries on oral health-related quality of life in children with dental behavior management problems

Abstract: The aim of this cross-sectional study was to evaluate the impact of dental caries and sociodemographic factors on the oral health-related quality of life (OHRQoL) of children with dental behavior management problems (DBMP) and their families. One hundred and thirty-four dyads of caregivers and children participated. The impact of OHRQoL was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Socioeconomic variables were obtained from an interview. Dental caries was assessed using the dmft index. The total B-ECOHIS score was categorized as low, medium, or high impact, and its association with the independent variables was determined based on bivariate tests and a multivariate model. The median score for B-ECOHIS was 13 (range: 1-40). The negative impact was reflected mainly by complaints of oral/dental pain, difficulty in eating and parental guilt. The number of teeth with caries was significantly higher among children who experienced a high negative impact on OHRQoL (mean 9.2 [standard deviation 3.5]; p = 0.003) than those who had a low negative impact (7.0 [3.3]). The final adjusted model showed that dental caries remained independently associated with poor OHRQoL (b = 0.100; x2 Wald 4.205; p = 0.040). A greater impact on OHRQoL was experienced by children with DBMP and greater caries experience.

Translation and Cultural Adaptation of the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese

Abstract Objective: To translate and culturally adapt the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese. Material and Methods: The MCDASf consists of eight questions about anxiety toward dental procedures that are answered on a five-point Likert scale ranging from "not worried" (1 point) to "very worried" (5 points). The answers correspond to a scale of face drawings ranging from extremely negative to extremely positive. The process consisted of initial translation, back-translation, expert committee review, and pretesting. Results: The first revised version was applied to 32 children aged 5 to 12 years, 16 from the city of Governador Valadares, Brazil (southeastern region) and 16 from the city of Pelotas, Brazil (southern region). In the first pretest, Item 5 was misunderstood by 6.25% of children in the southern region; Item 6 by 6.25% in both regions; Items 7 and 8 by 87.5% and 100% of those from the southeastern region, respectively, and by 12.5% and 25% of those from the southern region, respectively. Items 7 and 8 were modified by the expert committee, and the second revised version was applied to 32 children, 16 from each region. The only misunderstood items were 4 and 5, both by a 7-year-old boy in Governador Valadares. Conclusion: The Brazilian Portuguese version of the MCDASf was well understood by the sample of children (AU).

Is dental anxiety associated with the behavior of sedated children?

Abstract The aim of this cross-sectional study was to investigate factors associated with dental anxiety in children treated under moderate sedation. Prior to treatment, each child's dental anxiety was evaluated using the modified Venham Picture Test (VPT). Interviews were also conducted with parents/guardians to gather information on the child's dental anxiety (Corah's Dental Anxiety Scale [DAS]), age and sex, shyness or anxiety in the presence of strangers, and dental history, as well as socioeconomic factors. All the children were sedated, and had at least one tooth restored using the atraumatic restorative treatment technique. Child behavior was assessed using the Frankl scale. Data analysis involved descriptive statistics and bivariate tests. The median VPT score was 2.0 (range: 0 to 8). Children who were shy in the presence of strangers (yes: median 2.0 [0-8]; no: 0.5 [0-4]; p = 0.018), and those with negative behavior during dental care (negative: 3.0 [0-8]; positive: 1.0 [0-8]; p = 0.014) had greater anxiety. The child's dental anxiety was associated with the mother's education level (≤ 8 years: 4 [2-7]; > 8 years: 1 [0-8]; p = 0.016). The dental anxiety of children treated under sedation is associated with negative behavior, shyness, and the mother's education level.

Risk communication in the context of clinical research

Abstract Physicians and dentists usually make clinical decisions and recommendations without a clear understanding of the meaning of the numbers regarding the accuracy of diagnostic tests and the efficacy of treatments. This critical review aimed to identify problems in the communication of diagnostic test accuracy and treatment benefits and to suggest strategies to improve risk communication in these contexts. Most clinical decisions are taken under uncertainty. Health professionals cannot predict the outcome in one individual patient. This uncertainty invites these professionals to make decisions based on heuristics, which gives rise to several cognitive biases. Cognitive biases are automatic and unconscious, so how is it possible to mitigate their undesirable effects on risk interpretation in the context of clinical practice? Some forms of risk communication reinforce cognitive bias, while others weaken them. Maybe one of the most difficult obstacles to overcome is the difficulty to think with numbers. This difficulty probably arises from a mismatch of ancestral adaptations of the brain having to deal with modern environments, which are quite different from the ancestral ones. There are two quite common, but bad, forms of risk communication: the conditional probability and the relative risk reduction or efficacy. People, including physicians and dentists, are confused with this kind of information. The main methods discovered so far to facilitate a clearer understanding are to emphasize the base rates of the events and to use absolute numbers, that is to use natural frequencies, instead of percentages and conditional probabilities.

Crossover studies of pediatric dental sedation are inappropriate

Abstract Crossover studies continue to be published in spite of warnings about their inherent risks in relation to behavioral outcomes. This study took the opportunity of access to secondary data analysis in order to demonstrate the impact of a crossover design on the outcomes of randomized clinical trials aimed at the behavior of children during dental treatment. We evaluated the effect of the sequence of sedative administration, the sedative and the participant's age on the behavior of children undergoing two sequential dental visits. Eighteen uncooperative healthy young children were equally randomly assigned to: (G1) 1.0 mg/kg oral midazolam (first session) and oral placebo (second session); (G2) oral placebo (first) and 1.0 mg/kg oral midazolam (second). One trained observer assessed children's behavior. Data were analyzed by three-way mixed ANOVA. Both midazolam [mean(SD); 71.7%(16.5)] and placebo [48.6%(33.1)] produced more struggling behavior when they were administered in the first session compared to the second one (p=0.001). For the placebo, children aged 2-3 years exhibited more struggling behavior [G1 54.9%(36.2); G2 80.5%(8.3)] than those aged 4-5 years (p=0.04). Also, the reduction of percentage of struggling behavior was higher in G1 for older children (76.2%) and in G2 for younger children (32.9%). There were significant interactions between drug and sequence of administration, and between drug and age. The results of our study confirm the conventional wisdom that crossover study design is inappropriate to evaluate children's behavior/anxiety related-dental treatment under sedation and the results of crossover studies of dental sedation should be treated with extreme caution.

Resumo Pouco se sabe sobre o impacto de um delineamento cruzado nos desfechos de ensaios clínicos randomizados voltados ao comportamento de crianças durante tratamento odontológico. Este estudo objetivou avaliar o efeito da sequência de administração do sedativo, da droga em si e da idade dos participantes no comportamento de crianças que receberam duas consultas odontológicas consecutivas. Dezoito crianças saudáveis não colaboradoras, 2-5 anos de idade, foram randomizadas em dois grupos: G1 - 1,0 mg/kg midazolam oral (primeira sessão) e placebo oral (segunda sessão); G2 - placebo (primeira) e 1,0 mg/kg midazolam oral (segunda). Um observador treinado avaliou o comportamento infantil. Os dados foram analisados por ANOVA de três fatores (alfa=0,05). Midazolam [média(DP); 71,7%(16,5)] e placebo [48,6%(33,1)] resultaram em mais comportamento não cooperativo quando administrados na primeira sessão comparado com a segunda (p=0,001). Com o uso do placebo, crianças de 2-3 anos de idade exibiram mais comportamento não cooperativo [G1 54,9%(36,2); G2 80,5%(8,3)] que as de 4-5 anos de idade (p=0,04). Além disso, a porcentagem de redução do comportamento não cooperativo foi maior em crianças mais velhas em G1 (76,2%) e em crianças mais novas em G2 (32,9%). Considerando a avaliação do comportamento infantil sob sedação, a primeira sessão odontológica influenciou a segunda visita. Os resultados deste estudo confirmam a especulação de que o delineamento cruzado é inadequado para avaliar o comportamento odontológico relacionado à ansiedade/comportamento infantil; os resultados dos ensaios cruzados de sedação odontológica devem ser tratados com extrema cautela.

Tradução, adaptação transcultural e avaliação preliminar da pain catastrophizing scale-parents para uso no brasil / Translation, cross-cultural adaptation and preliminary evaluation of the brazilian versionof the pain catastrophizing scale-parents

RESUMO Objetivo: No Brasil, não há escala que avalie a catastrofização dos pais sobre a dor das crianças. O objetivo deste estudo foi traduzir e adaptar transculturalmente o Pain Catastrophizing Scale-Parents para a língua portuguesa do Brasil e avaliar preliminarmente as propriedades psicométricas de pais/outros parentes de crianças com e sem dor de dente. Métodos: Foi realizado um estudo transversal com 237 pais/outros parentes de 237 crianças. A adaptação transcultural da escala para o português brasileiro foi feita conforme a abordagem universalista. Para avaliar a confiabilidade e a validade da escala, os pais/outros parentes fizeram um relato sobre a dor de dente da criança e preencheram as versões brasileiras da Escala de Catastrofização da Dor-Pais e o Questionário de Desconforto Dentário. Resultados: Houve equivalência semântica com a versão original após pequenas modificações. O alfa de Cronbach para os 13 itens da escala foi 0,83 e os respectivos coeficientes de correlação intraclasse do teste-reteste variaram de 0,63 a 0,97. Os escores obtidos na Escala de Catastrofização da Dor-Pais e no Questionário de Desconforto Dentário apresentaram baixa correlação (rho=0,25; p<0,001). O escore total da Escala de Catastrofização da Dor-Pais diferiu significativamente (p<0,001) em crianças com dor de dente à noite (mediana: 30,0; percentil 25-75: 25,0-35,5) quando comparado com o daquelas sem dor de dente (25,5; 20,0-31,0). Conclusões: A versão brasileira da Escala de Catastrofização da Dor-Pais apresentou características aceitáveis nesta avaliação preliminar e pode ser utilizada no Brasil tanto na prática clínica quanto em pesquisas.

ABSTRACT Objective: In Brazil, there is no scale to assess parental catastrophizing about their child's pain. This study aimed to translate and cross-culturally adapt the Pain Catastrophizing Scale-Parents to the Brazilian Portuguese language, as well as to preliminarily evaluate its psychometric properties among parents/guardians of children with and without a toothache. Methods: A cross-sectional study was conducted with 237 parents/other relatives of 237 children. Across-cultural adaptation of the scale into Brazilian Portuguese was carried out according to the universalistic approach. To assess the reliability and validity of the scale, parents/other relatives reported on the child's toothache and filled out the Brazilian versions of the Pain Catastrophizing Scale-Parents and the Dental Discomfort Questionnaire. Results: There was semantic equivalence with the original version after minor modifications. TheCronbach's alpha for the 13 items of the scale was 0.83, and the respective test-retest intraclass correlation coefficients ranged from 0.63 to 0.97. The scores obtained from the Pain Catastrophizing Scale-Parents and the Dental Discomfort Questionnaire had a low correlation (rho=0.25; p<0.001). Thetotal score of the Pain Catastrophizing Scale-Parents differed significantly (p<0.001) in children with a toothache at night (median: 3.0, 25-75 percentile: 25.0-35.5) compared to those who did not have a toothache at night (25.5; 20.0-31.0). Conclusions: The Brazilian version of the Pain Catastrophizing Scale-Parents was acceptable in this preliminary evaluation and can be used in Brazilian clinical and research practice.

Divulgação de imagem de pacientes em redes sociais segundo docentes: curtir e compartilhar? / Publication of patients' image in social networks according to teachers: like and share?

A formação do cirurgião-dentista deve ser pautada pelo respeito aos princípios éticos e legais da profissão. A popularização das redes sociais potencializa a exposição irregular de imagem de pacientes ao público leigo. Este trabalho buscou investigar a percepção de docentes sobre o uso de redes sociais virtuais para divulgar imagem de pacientes no âmbito da Odontologia. Para a coleta de dados foi utilizado um questionário autoaplicável direcionado a docentes que lecionam disciplinas clínicas em um curso de Odontologia da cidade de Anápolis-GO. A taxa de resposta foi de 59,6% (31 de 52); média de idade de 42,6 anos; maioria do sexo masculino (17; 54,8%); 28 (90,3%) atendem pacientes fora da instituição com vínculo predominantemente de natureza privada, 20 (64,5%); maioria (22; 70,9%), declarou ter perfil de usuário em ao menos uma rede social, sendo o Facebook® a mais citada. É importante que os cursos de graduação insistam na formação ética, daí a importância do docente propor e executar um processo de avaliação que o permita aferir conhecimentos, habilidades e atitudes. É crucial que os profissionais formados reconheçam a extensão da responsabilidade de suas ações nas esferas ética/administrativa, cível e penal. Os docentes do curso de Odontologia investigado identificaram o uso de redes sociais, inclusive com a publicação da imagem de paciente, por cirurgião-dentista, estudantes de odontologia e outros docentes. Compreendem que estas veiculações podem ser entendidas como uma forma de publicidade e que, de modo geral, a exposição dos pacientes deve respeitar os princípios do anonimato e da privacidade.

The training of the dentist should be guided by respect for the ethical and legal principles of the profession. The popularization of social networks enhances the irregular image exposure of patients. This work aimed to investigate the perception of teachers about the use of virtual social networks as a tool to disseminate the image of dental patients. For data collection, a self-administered questionnaire was used directed to teachers who teach clinical subjects in a Dentistry course in the city of Anápolis-GO. The response rate was 59.6% (31 of 52); Mean age 42.6 years; Majority of males (17; 54.8%); 28 (90.3%) have other jobs with a predominantly private relationship, 20 (64.5%); Majority (22; 70.9%), declared to have user profile in at least one social network, being Facebook® the most cited. It is important that undergraduate courses insist on ethical training, hence the importance of teachers to propose and execute an evaluation process that allows them to measure knowledge, skills and attitudes. It is crucial that graduates recognize the extent of responsibility for their actions in the ethical / administrative, civil and criminal spheres. The teachers of the Dentistry course investigated identified the use of social networks, including the publication of the patient image, by dentists, dentistry students and other teachers. They understand that these placements can be understood as a form of advertising and that patient exposure should respect the principles of anonymity and privacy.

Effect of dental pain and caries on the quality of life of Brazilian preschool children

ABSTRACT OBJECTIVE To investigate the impact of dental pain on daily performances among five-year-old Brazilian children. METHODS The study used data of 7,280 five-year-old children participating in the 2010 Brazilian Oral Health Survey (SBBrasil 2010 Project). Children were clinically examined and their parents or carers were interviewed at their homes. The outcome was the prevalence of the oral impacts on daily performance, and the explanatory variable was dental pain in the last six months. Other independent variables were children's gender and skin color/race, family income, household overcrowding, and caries experience (dmft). Rao-Scott test and Poisson regression for complex samples were carried out. RESULTS The prevalence of impacts on daily performances was 26.1% (95%CI 22.3-30.2). Significant associations were found between the outcome and pain, caries experience, and sociodemographic variables. After adjusting for the independent variables, only pain and caries remained significant. Impacts on daily performances were more frequent among children with pain (PR = 1.14, 95%CI 1.06-1.23) compared to those without pain. Children with low dmft (PR = 1.90, 95%CI 1.39-2.60) and those with high dmft (PR = 3.53, 95%CI 2.78-4.49) had a higher prevalence of impact than those with no caries experience. CONCLUSIONS Dental pain and caries had strong negative impacts on the five-year-old children's daily performances regardless of their demographic and socioeconomic characteristics.

Is pain during pediatric dental sedation associated with children's pre-operative characteristics? An exploratory study / Dor durante sedação em odontopediatria associa-se a características pré-operatórias da criança? Estudo exploratório

Introduction: Little is known about the factors associated with the pain of children in dental treatment under conscious sedation. Objective: To investigate the association between preoperative characteristics and pain during pediatric dental treatment under sedation. Material and method: This exploratory study was conducted with 27 children in restorative treatment under sedation. Information on age, sex and experience of the children with previous dental treatment was obtained through interviews with parents. Oral health status, determined from the presence of dental caries, was verified using the dmf-t index. Pain was assessed by analyzing videos of the dental treatments by two previously calibrated examiners, using the items legs, activity and crying of the observational scale “face, legs, activity, consolability and crying (FLACC). Data were analyzed using bivariate tests. Result Most of the children (n=14, 51.8%) had no pain during dental treatment under sedation. Among the other children, lower or moderate pain scores (median 1.1; minimum 0 to 3.8) were observed. The FLACC scores did not vary according to sex (P=0.38), previous experience with dental treatment (P=0.32) and history with local anesthesia (P=0.96). The FLACC scores did not correlate significantly with age (Spearman rho= -0.08, P=0.67) and dmf-t (Spearman rho= -0.04, P=0.84). Conclusion In this group of children, pain during dental treatment under sedation was of low frequency and intensity and did not associate with age, sex, oral condition and previous dental experience.

Introdução: Pouco se sabe sobre os fatores associados à dor das crianças no tratamento odontológico sob sedação consciente. Objetivo: Verificar a associação entre as características pré-operatórias e a dor durante o tratamento odontopediátrico sob sedação. Material e método: Este estudo exploratório foi realizado com 27 crianças submetidas a tratamento restaurador sob sedação. As informações sobre idade, sexo e experiência de tratamento odontológico prévio da criança foram obtidas por meio de entrevista aos pais. A condição bucal, determinada a partir da presença de cárie dentária, foi verificada por meio do índice ceo-d. A dor foi avaliada por análise dos vídeos dos tratamentos, por dois examinadores previamente calibrados, utilizando-se os itens: pernas, atividade e choro da escala observacional . Face, pernas, atividade, consolabilidade e choro (FLACC). Os dados foram analisados por meio de testes bivariados. Resultado A maioria das crianças (n=14; 51,8%) não teve dor durante o tratamento odontológico sob sedação. Entre as demais crianças, observaram-se escores de dor baixos ou moderados (mediana 1,1; mínimo 0-3,8). Os escores FLACC não diferiram conforme sexo (P=0,38), experiência prévia de tratamento odontológico (P=0,32) e história de anestesia local (P=0,96). Os escores FLACC não se correlacionaram significativamente com idade (Spearman rho= -0,08; P=0,67) e ceo-d (Spearman rho= -0,04, P=0,84). Conclusão: Neste grupo de crianças, a dor durante tratamento odontológico sob sedação foi pouco observada, de baixa intensidade e não se associou a idade, sexo, condição bucal e experiência odontológica anterior.

Moderate sedation helps improve future behavior in pediatric dental patients - a prospective study

Abstract There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.

Mothers' perceptions about pediatric dental sedation as an alternative to dental general anesthesia / Percepção de mães sobre sedação em odontopediatria como uma alternativa à anestesia geral

Moderate sedation has limits in managing children's behavior. Existing literature lacks insight into parental perceptions about the topic. This study aimed to understand mothers' perceptions concerning sedation after their children undergone dental treatment under sedation.

Sedação moderada tem limites no gerenciamento do comportamento infantil. A literatura existente carece de estudos sobre as percepções dos pais a cerca do tema. Este estudo objetivou compreender a percepção das mães sobre sedação após o tratamento dentário de suas crianças sob sedação.

Evaluation of clinical and laboratory variables associated with anemia in pediatric patients on hemodialysis / Avaliação de variáveis clínicas e laboratoriais associadas à anemia em pacientes pediátricos em hemodiálise

OBJECTIVE: To identify the occurrence of anemia in pediatric patients on hemodialysis and the association between hemoglobin levels and anemia in CKD-related variables. METHODS: This was a retrospective study. Patients aged up to 18 years with chronic kidney disease undergoing hemodialysis at this service between January of 2009 and December of 2010 were selected. Clinical and laboratory data were obtained from medical records. Statistical analysis was performed with chi-squared test, Student's t-test and general estimating equations (GEE) using SPSS 20.0, assuming a significance level of 5%. RESULTS: A total of 357 medical records depicting the monthly evolution of 29 patients were analyzed. The most common etiology for chronic kidney disease was malformations of the genitourinary tract (28%). Hemoglobin showed a mean (standard deviation) value of 9.20 (1.8) g/dL, with the occurrence of anemia in 65.3% of cases. Anemia was associated with hospitalization; antibiotic use; transfusion; use of intravenous iron hydroxide; low values of creatinine, hematocrit, and albumin; and high values of ferritin, aluminum, and equilibrated Kt/V (p < 0.05). The odds ratio for anemia with the use of intravenous iron hydroxide was 0.36 (95% CI: 0.25 to 0.89), i.e., a 2.78-fold higher chance of developing anemia without the use of this medication. CONCLUSIONS: Anemia predominated in children and adolescents with chronic kidney disease; intravenous iron hydroxide use was a protective factor. .

OBJETIVO: Identificar a ocorrência de anemia entre pacientes pediátricos em hemodiálise e a associação entre os valores de hemoglobina e variáveis relacionadas à anemia na DRC. MÉTODOS: Estudo retrospectivo. Selecionados pacientes até 18 anos com doença renal crônica em hemodiálise no serviço entre janeiro de 2009 e dezembro de 2010. Verificados prontuários para coleta de dados clínicos e laboratoriais. Análise estatística com testes de qui-quadrado, t de Student e General Estimating Equations (GEE) em programa Statistical Package for the Social Sciences 20.0, assumindo-se nível de significância de 5%. RESULTADOS: Analisadas 357 fichas de evolução médica mensal de 29 pacientes. A etiologia mais frequente para a doença renal crônica foram as malformações do trato genito-urinário (28%). Hemoglobina apresentou valor médio (desvio padrão) de 9,20 (1,8) g/dL, com ocorrência de anemia em 65,3% das consultas. Anemia associou-se a internação, uso de antibiótico, transfusão, uso de hidróxido de ferro endovenoso, valores baixos de creatinina, hematócrito e albumina e valores altos de ferritina, alumínio e Kt/V equilibrado (p < 0,05). A odds ratio para anemia com uso de hidróxido de ferro endovenoso foi 0,36 (95% IC 0,25-0,89), ou seja, uma chance 2,78 vezes maior de desenvolver anemia sem o uso dessa medicação. CONCLUSÕES: A anemia predominou em crianças e adolescentes com doença renal crônica, tendo como fator protetor o uso de hidróxido de ferro endovenoso. .

Ineffectiveness of Antibiotic-Based Pulpotomy for Primary Molars: a Survival Analysis

To investigate the two-year survival rate of primary molars treated with non-instrumentation endodontic treatment with mixed antibiotic paste containing chloramphenicol, tetracycline, zinc oxide and eugenol (CTZ pulpotomy), and compare it to the conventional root canal treatment with calcium hydroxide paste. Material and Methods:Thirty-six children, mean age 6.2 years old (standard deviation, SD=1.5), presenting at least one primary molar with irreversible pulpitis or necrotic pulp, were included in this prospective clinical study. Teeth were assigned to CTZ pulpotomy (Group I) or calcium hydroxide pulpectomy (Group II) and assessed clinically and radiographically for up to 26 months. Data were analyzed using descriptive statistics, Chi-square test, Kaplan-Meier survival analysis and Log-rank test. Results:Fifty-three primary molars were treated in Group I (n=37) or Group II (n=16). Children were followed up for 1 to 26 months (mean=12.0; SD=7.1). Treatment failure rates were 73.0% in Group I and 31.3% in Group II. Overall, mean survival time was 15.2 months (95% confidence interval, CI 12.6û17.9); Group I (mean 13.2; 95% CI 10.2-16.3) had a lower survival rate than Group II (mean 18.9; 95% CI 14.5-23.2) (p=0.02). Necrotic pulp treatments had significantly lower survival rates (p=0.01) than pulpitis treatments. Conclusion:Non-instrumentation endodontic treatment of primary molars with CTZ paste resulted in a low survival rate in a two-year follow-up; its radiographic ineffectiveness discourages its use instead of conventional root canal endodontic treatment...

Oral midazolam reduces cortisol levels during local anaesthesia in children: a randomised controlled trial

Little is known about whether midazolam sedation can reduce salivary cortisol levels and consequently influence children’s behaviour during dental treatment. The aim of this study was to evaluate the effect of midazolam sedation on salivary cortisol and its correlation with children’s behaviour during restorative dental treatment. Eighteen healthy children, aged two to five years, were randomly assigned to two dental treatment appointments, both with physical restraint: oral midazolam 1 mg/kg (MS) and placebo (PS). An observer assessed the children’s behaviour (videos) using the Ohio State University Behavioral Rating Scale (OSUBRS). The children’s saliva was collected just after waking up, on arrival at the dental school, 25 minutes after local anaesthesia, and 25 minutes after the end of the procedure. Salivary cortisol levels were determined using the enzyme-linked immunoabsorbent assay. The data were analysed by bivariate tests and multivariate analysis of variance (5% level). Salivary cortisol levels were lower in the MS group than in the PS group at the time of anaesthesia (p = 0.004), but did not vary during the appointment within sedation (p = 0.319) or placebo (p = 0.080) groups. Children’s behaviour was negative most of the time and did not differ between MS and PS; however, the behaviour (OSUBRS) did not correlate with salivary cortisol levels. Oral midazolam is able to control salivary cortisol levels during dental treatment of pre-schoolers, which might not lead to better clinical behaviour.

Higiene oral e pneumonia em crianças em Unidade de Terapia Intensiva: revisão sistemática / Oral hygiene and pneumonia in children in Intensive Care Units: a systematic review

Objetivo: Pacientes internados em Unidades de Terapia Intensiva (UTI) podem apresentar pneumonia associada à ventilação mecânica (PAV), grave infecção relacionada à colonização bacteriana na orofaringe. O objetivo deste estudo foi identificar evidências sobre o efeito da higiene oral na prevenção da PAV em crianças internadas em UTI neonatal ou pediátrica. Materiais e métodos: Revisão sistemática de estudos indexados nas bases Embase, Medline e Lilacs, conduzidos em crianças sob ventilação mecânica. A intervenção de interesse foi higiene oral e, o desfecho, PAV. Utilizou-se as escalas de Jadad e Newcastle-Ottawa para classificação qualitativa dos artigos. Resultados: Dentre 113 artigos localizados, selecionou-se 5. Três estudos coorte avaliaram a higiene oral como parte de um pacote de cuidados e encontraram redução significativa na incidência de PAV. Dois ensaios clínicos investigaram a escovação dentária realizada com gel de gluconato de clorexidina 0,12% comparada a placebo, e não evidenciaram redução significativa na ocorrência de PAV. Conclusão: A higiene oral integrada a um protocolo de ações de prevenção de infecção hospitalar associa-se à redução da PAV em crianças internadas em UTI; não há evidências para a eficácia da limpeza oral com clorexidina em crianças internadas em UTI.

Objective: Patients in Intensive Care Units (ICU) may present ventilator-associated pneumonia (VAP), which is a severe infection related to bacterial colonization in the oropharynx. The objective of this study was to identify scientific evidences on the effect of oral hygiene in the prevention of VAP in children admitted to neonatal or pediatric ICU. Methods: Systematic review of studies indexed in Embase, Medline and Lilacs, conducted in children on mechanical ventilation. The intervention of interest was oral hygiene and the outcome, VAP. We used the Jadad and the Newcastle-Ottawa scales for the qualitative classification of the studies. Results: Five out of 113 papers were selected. Three cohort studies evaluated oral hygiene as part of a comprehensive care bundle and found a significant reduction in the incidence of VAP. Two clinical trials investigated toothbrushing performed with 0.12% chlorhexidine gluconate gel compared to placebo, and showed no significant reduction in the occurrence of VAP. onclusion: Oral hygiene integrated into a hospital infection prevention protocol associated with the reduction of VAP in children admitted to ICU; there is no evidence for the effectiveness of oral hygiene with chlorhexidine in children admitted to ICU.

Hábitos relacionados à saúde bucal em crianças nascidas prematuras: uma preocupação para equipes multiprofissionais de saúde / Oral health habits in pre-term children: a concern for healthcare professionals

Objetivo: Identificar hábitos alimentares, de sucção não nutritiva e de higiene bucal nos primeiros três anos de vida de crianças nascidas prematuras. Materiais e Métodos: Estudo descritivo retrospectivo baseado em dados secundários obtidos de prontuários odontológicos das 109 crianças com história de nascimento prematuro, acompanhadas no Ambulatório Odontológico de Prematuridade do Hospital das Clínicas da Universidade Federal de Goiás, de fevereiro de 2011 a julho de 2012. Consideraram-se informações da primeira consulta odontológica: idade atual, sexo, idade gestacional, hábitos alimentares (tipo de aleitamento, ingestão de açúcar extrínseco), hábitos bucais não nutritivos (sucção de chupeta e sucção digital) e hábitos de higiene bucal. Os dados foram analisados por estatística descritiva com auxílio do software IBM SPSS versão 20.0. Resultados: No primeiro exame odontológico, as crianças nascidas prematuras tinham de 1 a 33 meses de idade (média de 8,6±7,2), sendo 49 (45,0%) meninas e 60 (55,0%) meninos. A ocorrência de aleitamento natural em menores de 6 meses foi de 22,8%, com predominância de aleitamento artificial (45,6%). Do total de nascidos prematuros, 79,8% utilizavam mamadeira e 58,7% realizavam sucção de chupeta. Em relação à higiene bucal, 73,4% da amostra realizava higiene bucal e 44,4% utilizava a fralda como instrumento. Conclusão: Os percentuais de aleitamento materno exclusivo foram baixos. A maioria das crianças apresentou algum hábito de sucção não nutritiva. A prática de higiene bucal mostrou-se insatisfatória. Assim, o estabelecimento de programas educativo-preventivos é essencial no apoio às famílias para os cuidados bucais a essas crianças, visando à promoção de saúde e prevenção de alterações no sistema estomatognático.(AU)

Aim: This study aimed to identify dietary habits, non-nutritive sucking habits, and oral hygiene habits in the first three years of pre-term children. Materials and Methods: This work consists of an observational, retrospective, descriptive study in which secondary data were collected from the clinical records of 109 children attended to at the Dental Clinic for Pre-term Children at the University Hospital of the Federal University of Goias (UFG), from February 2011 to July 2012. This study considered information regarding the child's first dental visit: the child's current age, gender, gestational age, dietary habits (natural breast-feeding, bottle feeding, extrinsic sugar consumption), non-nutritive sucking habits (sucking a pacifier and finger sucking), and oral hygiene habits. Data were analyzed by descriptive statistics using the IBM Statistical Package for the Social Sciences (SPSS®), version 20.0. Results: In the first dental visit, the pre-term children were from 1 to 33 months old (8.6±7,2), with 49 (45.0%) girls and 60 (55.0%) boys. The occurrence of natural breastfeeding in children under 6 months of age was 22.8%, with a predominance of mixed bottle-breastfeeding (45.6%). Of the total number of pre-term children, 79.8% were bottle-fed and 58.7% used pacifiers. Mothers of 73.4% of these children performed their oral hygiene, while 44.4% used only a soft cloth diaper to perform oral hygiene. Conclusions: The percentage of exclusive breastfeeding was low. The majority of children presented some type of non-nutritive sucking habit. Most of the children received unsatisfactory oral hygiene. Thus, the establishment of educationalpreventive programs are essential in an attempt to provide support to the family regarding their babies' oral hygiene, geared toward the promotion of oral healthcare and the prevention of changes in the child's stomatognathic system.(AU)