Association of sociodemographic factors with the prescription pattern of opioids for dental patients: A systematic review protocol.

INTRODUCTION: Oral health practitioners are responsible for a significant share of opioid prescriptions that seem to be influenced by many aspects, including sociodemographic factors. However, there is no consensus on the factors associated with opioid prescription in Dentistry. OBJECTIVE: To identify whether patients' sociodemographic factors are associated with the prescription pattern of opioids in Dentistry. MATERIALS AND METHODS: This systematic review will include observational studies (cross-sectional, case-control, and cohort). Electronic searches will be conducted in MEDLINE (PubMed), EMBASE, Scopus, Web of science, LILACS, SciELO, and Google Scholar. Grey literature will also be consulted. Two independent reviewers will screen all retrieved articles for eligibility, extract data, and assess the methodological quality of the included studies. The results will be presented as a narrative synthesis and, where possible, a meta-analysis will be conducted. Certainty of the evidence will be assessed with the Grading of Recommendations, Assessment, Development, and Evaluation approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020211226.

Contextual and individual factors associated with dental pain in adolescents from Southeastern Brazil.

The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Carious lesions recurrence in children with developmental disabilities: a longitudinal study.

This study investigated the factors associated with new carious lesions in one-to five-year-old children with developmental disabilities. This was a retrospective cohort that evaluated 64 dental charts of individuals with caries or fillings in their first dental appointment. The dependent variable was the occurrence of a new carious lesion or restoration. Gender, age, mother's education, sugar consumption, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic drugs, use of asthma drugs, history of asthma, bronchitis, reflux or seizures and having at least one sibling were covariates. Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios with their respective 95% confidence interval. The average time that individuals remained free of dental caries/restoration was 79.49 months (95%CI: 64.37 to 92.61). Increase in sucrose consumption increased the rate of caries recurrence (HR = 1.16; 95%CI: 1.04 to 1.30). Individuals who had poor oral hygiene had higher rate of new dental caries (HR = 3.88; 95%CI: 1.22 to 12.37) compared to those with good oral hygiene. The presence of mouth breathing decreased the rate of recurrence of the disease when compared to the nasal breathing (HR = 0.32; 95%CI: 0.15 to 0.70). Oral health-related behaviors and nasal respiration influenced the rate of dental caries recurrence in individuals with developmental disabilities.

Prescriptions of analgesics and anti-inflammatory drugs in municipalities from a Brazilian Southeast state.

The objective of this study was to describe dental prescriptions of non-steroidal anti-inflammatory drugs (NSAID), opioids, and analgesics dispensed by the Brazilian National Health System (BNHS, SUS in Portuguese) of a Southeastern state from January to December 2017, and to analyze their association with socioeconomic and oral health care services' characteristics at municipal level. Data were collected from the Brazilian Integrated Pharmaceutical Care Management System. Medicines were grouped according to the Anatomical Therapeutic Chemical Classification System. The total number of Defined Daily Doses (DDD) and DDD per 1,000 inhabitants (inhab.) per year were presented and compared between groups of municipalities. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25.0. The total number of NSAID, opioids, and analgesics prescriptions was 70,747 and accounted for 354,221.13 DDD. The most frequently prescribed medicine was ibuprofen (n = 24,676; 34.88%). The number of dental practitioners in the BNHS per 1,000 inhab. (p < 0.001), first dental appointment coverage (p = 0.010), oral health teams per 1,000 inhab. (p=0.022), and the proportion of rural population (p = 0.014) were variables positively associated with the number of DDD of NSAID per 1,000 inhab. per year. Bolsa Família program coverage per 1,000 inhab. (p = 0.022) was negatively associated with NSAID prescription. Regarding analgesics, first dental appointment coverage (p=0.002) and Bolsa Família program coverage per 1,000 inhab. (p = 0.012) were positively associated with DDD per 1,000 inhab. per year. In conclusion, dental prescriptions of analgesics and NSAID in the BNHS were associated with socioeconomic and oral health care services' characteristics.

What Increases the Risk of Dental Traumatism in Patients with Developmental Disabilities?

This study investigated risk factors for tooth injuries in individuals from a dental clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 493 dental charts of individuals with or without tooth injuries at their first dental appointment. The dependent variable was the time of occurrence of new dental traumatic injuries and was measured in months. Gender, age, International Code of Diseases, mother's education, mouth breathing, hyperkinesis, pacifier use, thumb sucking, psychotropic drug use, tooth injuries at the first dental examination, involuntary movements, open bite, having one or more siblings and reports of seizures were the covariates. The Cox proportional hazards regression model was used to estimate the unadjusted and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental traumatism was 170.78 months (95% CI, 157.89-183.66) with median of 216 months. The incidence of new events was 11.88%. The covariate associated with an increased risk of dental traumatism was a history of tooth injuries at the first dental appointment. The increase in dental trauma risk was 3.59 (95% CI, 1.94-6.65). A history of traumatic dental injury was the risk factor for the dental trauma found in this group of individuals with developmental disabilities.

Risk factors for dental caries in children with developmental disabilities.

The aim of the present study was to investigate risk factors for dental caries in children with developmental disabilities who were treated at a clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 401 dental charts of individuals without dental caries or restorations in their first dental appointment. The dependent variable was the time of occurrence of new dental caries or restorations and was measured in months. Gender, age, International Code of Diseases (ICD), mother´s education, sugar consumption, use of fluoride toothpaste, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic or asthma drugs, and history of asthma were covariates. The Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental caries/restoration was equal to 107.46 months (95%CI 95.41 to 119.51), with a median of caries-free children up to 94 months. For each point increase in the scale of sucrose consumption, the increase in caries risk was 1.07 (95%CI 1.01 to 1.15). Sucrose consumption was the only risk factor for dental caries found in this group of individuals with developmental disabilities.

Carious lesions recurrence in children with developmental disabilities: a longitudinal study

Abstract This study investigated the factors associated with new carious lesions in one-to five-year-old children with developmental disabilities. This was a retrospective cohort that evaluated 64 dental charts of individuals with caries or fillings in their first dental appointment. The dependent variable was the occurrence of a new carious lesion or restoration. Gender, age, mother's education, sugar consumption, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic drugs, use of asthma drugs, history of asthma, bronchitis, reflux or seizures and having at least one sibling were covariates. Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios with their respective 95% confidence interval. The average time that individuals remained free of dental caries/restoration was 79.49 months (95%CI: 64.37 to 92.61). Increase in sucrose consumption increased the rate of caries recurrence (HR = 1.16; 95%CI: 1.04 to 1.30). Individuals who had poor oral hygiene had higher rate of new dental caries (HR = 3.88; 95%CI: 1.22 to 12.37) compared to those with good oral hygiene. The presence of mouth breathing decreased the rate of recurrence of the disease when compared to the nasal breathing (HR = 0.32; 95%CI: 0.15 to 0.70). Oral health-related behaviors and nasal respiration influenced the rate of dental caries recurrence in individuals with developmental disabilities.

Factors associated with edentulism in individuals with chronic kidney disease undergoing hemodialysis: a cross-sectional study / Fatores associados ao edentulismo em indivíduos com doença renal crônica em hemodiálise: um estudo transversa

Introduction: Chronic kidney disease (CKD) is a progres-sive condition characterized by structural or functional abnormalities of the kidney. CKD may be associated with several oral alterations, such as higher prevalence rate of dental caries, periodontal disease, xerostomia, candidiasis and burning mouth. The aim of the study was to identify risk factors associated with edentulism in adults with CKD undergoing hemodialysis. Methods: A cross-sec-tional study was conducted with 650 individuals aged 18 to 90 years undergoing hemodialysis in southeastern Brazil. Oral clinical examination and administration of a questionnaire addressing demographic characteristics and dental history were performed. The study received approval from the Human Research Ethics Committee of UFMG. Findings: A total of 183 participants were eden-tulous (28.2%). Individuals with less schooling (OR = 3.99; 95% CI: 2.34-6.79), those who had not been to a dentist in the previous six months (OR = 2.49; 95% CI: 1.52-4.08), those who rated their own smile as excellent or good (OR = 2.00; 95% CI: 1.35-2.97) and those with some mucosal alteration (OR = 4.17; 95% CI: 2.83-6.13) had a greater chance of belonging to the edentulous group. Discussion: The present findings can contribute to the establishment of public health policies aimed at guiding dental care programs for individuals with chronic kidney disease that take into account the specific needs of this population. Conclusion: Edentulism was associated with low schooling, a lack of dental care in the previous six months, a positive self-perception of one's smile and alterations in the oral mucosa.

Introdução: A doença renal crônica (DRC) é uma condição caracterizada por anormalidades estruturais ou funcionais do rim. A DRC pode estar associada a diversas alterações bucais, como maior prevalência de cárie dentária, doença periodontal, xerostomia, candidíase e queimação bucal. O objetivo deste estudo foi identificar os fatores de risco associados ao edentulismo em indivíduos com DRC em tratamento com hemodiálise. Materiais e Métodos: Foi realizado um estudo transversal com 650 indivíduos de 18 a 90 anos em hemodiálise no sudeste do Brasil. Foi realizado exame clínico oral e aplicação de questionário abordando características demográficas e histórico odontológico. O estudo foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos da UFMG. Resultados: Um total de 183 participantes eram edêntulos (28,2%). Indivíduos com menor escolaridade (OR = 3,99; IC 95%: 2,34-6,79), aqueles que não foram ao dentista nos últimos seis meses (OR = 2,49; IC 95%: 1,52-4,08), aqueles que avaliaram o seu próprio sorriso como excelente ou bom (OR = 2,00; IC 95%: 1,35-2,97) e aqueles com alguma alteração de mucosa (OR = 4,17; IC 95%: 2,83-6,13) tiveram maior chance de pertencer ao grupo de edêntulos. Discussão: Os presentes achados podem contribuir para o estabelecimento de políticas públicas de saúde voltadas a nortear programas de atenção odontológica à pessoa com doença renal crônica que atendam às necessidades específicas dessa população. Conclusão: O edentulismo esteve associado à baixa escolaridade, falta de atendimento odontológico nos últimos seis meses, sorriso autoavaliado positivo e alterações mucosas.

Prescriptions of analgesics and anti-inflammatory drugs in municipalities from a Brazilian Southeast state

Abstract The objective of this study was to describe dental prescriptions of non-steroidal anti-inflammatory drugs (NSAID), opioids, and analgesics dispensed by the Brazilian National Health System (BNHS, SUS in Portuguese) of a Southeastern state from January to December 2017, and to analyze their association with socioeconomic and oral health care services' characteristics at municipal level. Data were collected from the Brazilian Integrated Pharmaceutical Care Management System. Medicines were grouped according to the Anatomical Therapeutic Chemical Classification System. The total number of Defined Daily Doses (DDD) and DDD per 1,000 inhabitants (inhab.) per year were presented and compared between groups of municipalities. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25.0. The total number of NSAID, opioids, and analgesics prescriptions was 70,747 and accounted for 354,221.13 DDD. The most frequently prescribed medicine was ibuprofen (n = 24,676; 34.88%). The number of dental practitioners in the BNHS per 1,000 inhab. (p < 0.001), first dental appointment coverage (p = 0.010), oral health teams per 1,000 inhab. (p=0.022), and the proportion of rural population (p = 0.014) were variables positively associated with the number of DDD of NSAID per 1,000 inhab. per year. Bolsa Família program coverage per 1,000 inhab. (p = 0.022) was negatively associated with NSAID prescription. Regarding analgesics, first dental appointment coverage (p=0.002) and Bolsa Família program coverage per 1,000 inhab. (p = 0.012) were positively associated with DDD per 1,000 inhab. per year. In conclusion, dental prescriptions of analgesics and NSAID in the BNHS were associated with socioeconomic and oral health care services' characteristics.

Contextual and individual factors associated with dental pain in adolescents from Southeastern Brazil

Abstract The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Prescribing errors in antibiotic prophylaxis by dentists in a large Brazilian city.

Prescribing errors may contribute to antibiotic resistance and other drug-related problems. To investigate the quality of prescriptions involving antibiotic prophylaxis by dentists in a large Brazilian city, 366 dental prescriptions were randomly selected from 31,105. A prophylaxis indication represented 24.9% of the prescriptions, and only 12 (13.2%; 95% confidence interval, 7.7%-21.7%) were correct regarding the generic name, dose, and length of antibiotic use. Prescriptions for antibiotic prophylaxis by dentists are mostly inadequate in this city.

Availability of Analgesic and Anti-Inflammatory Medicines in Primary Health Care

Abstract Objective: To describe and analyze the availability and factors related to the presence of analgesics and non-steroidal anti-inflammatory drugs in the Brazilian public primary healthcare system. Material and Methods: This was a cross-sectional study that evaluated 17,903 health units that participated in the National Program for Primary Care Access and Quality Improvement (2013-2014). The dependent variable was defined as the presence of metamizole, ibuprofen, and acetaminophen in a sufficient amount. The independent variables included the type of primary health care unit, the presence of a medication disposal area, the number of physicians, nurses, and dental practitioners; and the number of primary care units with family and oral health teams. For statistical analysis, unadjusted and adjusted Odds Ratio (OR) (95% CI) were presented. Results: The three medicines were available in 62.4% of the units. Regarding Health Clinics, the Basic Health Units (OR= 1.31, CI95% 1.18-1.44), Polyclinic (OR= 2.00, 95% CI, 1.15 -3.48), and others (OR= 1.37; 95% CI 1.14-1.63) had higher chances of availability of all three drugs. The presence of a disposal area (OR = 1.64, 95% CI 1.51-1.77) and the number of physicians (OR= 1.04, 95% CI 1.00-1.08), nurses (OR= 1.08, 95% CI 1.03- 1.13), and dental practitioners (OR= 1.09, 95% CI 1.04-1.14) increased the availability odds of the analyzed drugs in the service. Conclusion: The structure of the healthcare units and the higher number of professionals were positively associated with the availability of these drugs.

Dental caries and endemic dental fluorosis in rural communities, Minas Gerais, Brazil.

It is observational, analytical and cross-sectional aimed to evaluate the association between severity and prevalence of fluorosis and dental caries in rural communities with endemic dental fluorosis in the north state of Minas Gerais, Brazil, with fluoride concentrations in water up to 4.8 mg/L. Data were collected by one examiner (intra-examiner kappa, 0.96 to 0,95 for caries and fluorosis) after toothbrushing. The study included 511 individuals aged 7 - 22 years, categorized according to age: 7 - 9 years (n = 227), 10 to 12 years (n = 153), 13 to 15 years (n = 92), 16 to 22 years (n = 39). For the diagnosis of dental caries used the criteria of the World Health Organization to measure indices DMFT. For fluorosis used the index Thylstrup and Fejerskov (TF), dichotomized according to prevalence (TF = 0 and TF > 0) and severity (TF < 4 and TF > 5). In the two younger groups, the DMFT and its decay component were higher in the group with more severe fluorosis (p < 0.001). This association was not found among adolescents and adults (p > 0.05). The association was found between the conditions more severe fluorosis and caries in individuals under 12 years.

What increases the risk of dental traumatism in patients with developmental disabilities?

Abstract This study investigated risk factors for tooth injuries in individuals from a dental clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 493 dental charts of individuals with or without tooth injuries at their first dental appointment. The dependent variable was the time of occurrence of new dental traumatic injuries and was measured in months. Gender, age, International Code of Diseases, mother's education, mouth breathing, hyperkinesis, pacifier use, thumb sucking, psychotropic drug use, tooth injuries at the first dental examination, involuntary movements, open bite, having one or more siblings and reports of seizures were the covariates. The Cox proportional hazards regression model was used to estimate the unadjusted and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental traumatism was 170.78 months (95% CI, 157.89-183.66) with median of 216 months. The incidence of new events was 11.88%. The covariate associated with an increased risk of dental traumatism was a history of tooth injuries at the first dental appointment. The increase in dental trauma risk was 3.59 (95% CI, 1.94-6.65). A history of traumatic dental injury was the risk factor for the dental trauma found in this group of individuals with developmental disabilities.

Resumo Este estudo investigou os fatores de risco para traumatismo dentário em indivíduos da clínica odontológica de um serviço de referência para pacientes com necessidades especiais em Belo Horizonte, Brasil. Este é um estudo de coorte retrospectivo que avaliou 493 prontuários de indivíduos com ou sem traumatismo dentário em sua primeira consulta odontológica. A variável dependente foi o tempo de ocorrência de novas lesões traumáticas e foi mensurada em meses. Sexo, idade, Código Internacional de Doenças, educação materna, respiração bucal, hipercinese, uso de chupeta, sucção digital, uso de medicação psicotrópica, lesões dentárias no primeiro exame odontológico, movimentação involuntária, mordida aberta, ter um ou mais irmãos e relatos de convulsões foram

Perfil dos pacientes com deficiências de desenvolvimento sob atendimento odontológico em um projeto de extensão intersetorial / Profile of patients with developmental disabilities under dental care in an intersectoral extension project

Objetivo: Descrever o perfil dos pacientes atendidos em uma instituição filantrópica onde funciona o projeto de extensão "Atendimento Odontológico a Pacientes com Necessidades Especiais". Métodos: A amostra foi composta por 581 prontuários de pacientes com necessidades especiais de 0 a 33 anos de idade. Foram coletadas informações sobre as prevalências de cárie nas dentições decídua e permanente, gengivite, xerostomia, bruxismo, refluxo gastroesofágico, sexo, uso de medicação de ação central, uso de chupeta, sucção digital, alimentação e higiene bucal. Os dados foram analisados por meio da estatística descritiva e teste do qui-quadrado para verificação de associação entre diagnóstico e sexo. Resultados: 51,93% dos pacientes eram meninos, 71,42% possuíam paralisia cerebral, 12,36% tinham refluxo gastroesofágico, 49,30% usavam medicação anticonvulsivante. O diagnóstico de paralisia cerebral quadriespástica esteve associado ao sexo masculino. Dentre as alterações bucais, 4,86% dos casos apresentaram xerostomia. O uso da chupeta foi encontrado em 26,93% dos indivíduos e 18,05% chupavam o dedo. Alterações gengivais foram detectadas em 15,61% das fichas. Em relação à alimentação, 56,97% dos indivíduos consumiam açúcar acima do aceitável, e com relação à higiene bucal, 14,48% foram classificados como ruim e 17,57% moderada. Em 20,57% dos prontuários havia registro de dentes decíduos cariados e em 4,29% de dentes obturados. Do total de pacientes que possuíam dentes permanentes, 13,17% tinha dentes cariados e 7,75% possuía dentes obturados. A prevalência de cárie dentária é moderada com pequena proporção de dentes restaurados. A alimentação é rica em sacarose para quase 60% destes pacientes. Conclusão: os hábitos parafuncionais apresentam um percentual preocupante de prevalência. Por isso, estes pacientes possuem um perfil de doenças bucais com gravidade moderada e que devem ter um acompanhamento odontológico sistemático para que a prevalência de doenças bucais não aumente com o passar dos anos.(AU)

Aim: The present study aimed to describe the profile of the patients who received dental care at a philanthropic institution, within the project "Dental Care for Patients with Special Needs". Methods: This study was carried out by evaluating 581 records of patients with special needs from 0 to 33 years of age. Data were collected on the prevalence of caries in deciduous and permanent dentitions, gingivitis, xerostomia, bruxism, gastroesophageal reflux, sex, use of central action medication, pacifier use, digital suction, feeding, and oral hygiene. Data were analyzed using descriptive statistics and the chi-square test to verify an association between diagnosis and sex. Results: The results showed that 51.93% were boys, 71.42% had cerebral palsy, 12.36% had gastroesophageal reflux, and 49.30% used anticonvulsant medication. The diagnosis of quadrispastic cerebral palsy was associated with males. Xerostomia was observed in 4.86% of the cases. The use of pacifiers was present in 26.93% of the individuals, while 18.05% of the patients used to suck their finger. Gingival changes were detected in 15.61% of the records. In relation to food, 56.97% of the individuals consumed sugar above the acceptable amount, and when oral hygiene was considered, 14.48% were classified as poor and 17.57% as moderate. This study also identified 20.57% of decayed and 4.29% of filled deciduos teeth. Among the patients who had permanent teeth, 13.17% had decayed teeth, while 7.75% had filled teeth. It could therefore be concluded that the prevalence of dental caries is moderate with a small proportion of treated teeth. Diet is rich in sucrose for almost 60% of these patients. Conclusion: The parafunctional habits present a worrisome percentage of prevalence. Therefore, these patients have a profile of oral diseases with moderate severity and should undergo systematic dental follow-up so that the prevalence of oral diseases does not increase over the years.(AU)

Root fracture in patient in the pre-liver transplantation phase / Fratura de raiz em paciente em fase pré-transplante de fígado

ABSTRACT Liver transplantation is the treatment of choice for end-stage liver disease patients, and offers them the possibility of returning to active and longer life. A dental evaluation before transplantation is a recommended prerequisite to avoid oral infections, which can worsen the patient's overall situation. This case report refers to the root fracture of an anterior tooth in a patient who was undergoing dental treatment prior to liver transplantation. On clinical examination, the maxillary right central incisor (11) presented without color change, but with mobility in the buccolingual direction, slight flaring and extrusion, and fistula in the attached gingiva on the distal side of tooth 11. The patient reported that he had suffered a trauma in that region 30 years before. The radiographic examination showed a horizontal fracture of the middle third of the root, associated with bone damage, indicated by a radiolucent area at the distal surface of 11. The proposed treatment consisted of: scraping procedure and straightening of the distal surface, radical endodontic treatment of the coronal portion of the root, subsequent filling with Mineral Trioxide Aggregate and dental immobilization. The clinical and radiographic follow-up at three-monthly intervals allowed us to observe gradual regression of the lesion with bone formation, contributing to maintenance of the patient's general and emotional health, preserving his smile and quality of life.

RESUMO O transplante de fígado é o tratamento de escolha para o estágio final da doença hepática e oferece a possibilidade ao paciente de retorno a uma vida ativa e longa. Uma avaliação dentária antes do transplante é recomendada como pre-requisito para a eliminação de infecções orais, as quais podem piorar o quadro do paciente. Este relato de caso se refere a uma fratura radicular de dente anterior em um paciente em tratamento odontológico prévio ao transplante de fígado. No exame clínico, o incisivo central superior direito (11) apresentava-se sem alteração na coloração mas com mobilidade no sentido vestíbulo-lingual, ligeira vestibularização e extrusão, e fístula na gengiva inserida na distal do 11. O paciente relatou ter sofrido traumatismo na região há mais de 30 anos. Ao exame radiográfico, foi identificada uma linha de fratura radicular horizontal no terço médio, associada à lesão óssea indicada por uma área radiolúcida na superfície distal do 11. O tratamento proposto para o caso envolveu procedimentos de raspagem e alisamento subgengival da superfície distal, o tratamento endodôntico radical da porção coronária radicular com posterior obturação com Agregado Trióxido Mineral e imobilização dental. O acompanhamento clínico e radiográfico, em intervalos de três meses, permitiu observar a regressão gradual da lesão, com formação de osso no local, contribuindo para manutenção do quadro de saúde geral e emocional do paciente, preservando seu sorriso e sua qualidade de vida.

Risk factors for dental caries in children with developmental disabilities

Abstract The aim of the present study was to investigate risk factors for dental caries in children with developmental disabilities who were treated at a clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 401 dental charts of individuals without dental caries or restorations in their first dental appointment. The dependent variable was the time of occurrence of new dental caries or restorations and was measured in months. Gender, age, International Code of Diseases (ICD), mother´s education, sugar consumption, use of fluoride toothpaste, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic or asthma drugs, and history of asthma were covariates. The Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental caries/restoration was equal to 107.46 months (95%CI 95.41 to 119.51), with a median of caries-free children up to 94 months. For each point increase in the scale of sucrose consumption, the increase in caries risk was 1.07 (95%CI 1.01 to 1.15). Sucrose consumption was the only risk factor for dental caries found in this group of individuals with developmental disabilities.

Factors Associated with Gingivitis in Children with Developmental Disabilities

Objective: To investigate factors associated with gingivitis in children aged one to 13 years with developmental disabilities. Material and Methods: A total of 408 dental records were used to recover the data. Gingivitis was measured based on the Modified Gingival Index. Other variables were also analysed: gender, age, International Classification of Diseases (ICD) code, mouth breathing, history of gastroesophageal reflux, use of psychotropic drugs, reports of dry mouth, history of asthma, use of medications to treat asthma, oral hygiene, dental caries, and filled or missing teeth in deciduous or permanent dentition. For the purposes of this analysis, the individuals were categorized as with and without gingivitis. Variables with a p-value < 0.25 in the bivariate analysis were incorporated into the logistic regression models (ICD, reflux, oral hygiene, primary tooth decay or filling, mouth breathing, dry mouth and use of psychotropic drugs). Results: We found a 14.67% prevalence of gingivitis. Individuals with mouth breathing had a 2.574-fold (95% CI: (1.113-5.950) greater chance of exhibiting gingivitis. Individuals with moderate oral hygiene had a 2.763-fold (95% CI: 1.066 to 7.160) greater chance of exhibiting gingivitis, and individuals with poor oral hygiene had a 15.029-fold (95% CI: 3.705-60.965) greater chance of exhibiting gingivitis than those with good oral hygiene. Conclusion: Moderate or poor oral hygiene and mouth breathing are factors associated with gingivitis in a group of patients with developmental disabilities at a dental service in Belo Horizonte.

Beliefs and attitudes about endemic dental fluorosis among adolescents in rural Brazil.

OBJECTIVE: To understand beliefs and attitudes about fluorosis among young people living in a rural area. METHODOLOGICAL PROCEDURES: Qualitative study consisting of semi-structured interviews with 23 adolescents with dental fluorosis, 14 teachers and three health authorities in the city of São Francisco, Southeastern Brazil, in 2002. Content analysis and social representation theory were applied. ANALYSIS OF RESULTS: The organoleptic characteristics of carbonates that affect groundwater (salty flavor, whitish coloration, and turbidity) associated with negative aspects of household use of this water are considered a cause of mottled enamel. Even after contact with researchers who investigated this phenomenon and helped find a solution for this condition, the local population is still unwilling to accept fluoride as the cause of the problem and does not fully agree to use water from other sources because they are afraid of the quality of water. CONCLUSIONS: Misperceptions of the causes of dental fluorosis and water treatment costs compromise the implementation of uncontaminated surface water supplies. Health education strategies are required in parallel with solutions for securing water supply in drought-ravaged areas.

Dental caries and endemic dental fluorosis in rural communities, Minas Gerais, Brazil / Carie dentaria e fluorose endemica em distritos rurais de Minas Gerais, Brasil

It is observational, analytical and cross-sectional aimed to evaluate the association between severity and prevalence of fluorosis and dental caries in rural communities with endemic dental fluorosis in the north state of Minas Gerais, Brazil, with fluoride concentrations in water up to 4.8 mg/L. Data were collected by one examiner (intra-examiner kappa, 0.96 to 0,95 for caries and fluorosis) after toothbrushing. The study included 511 individuals aged 7 - 22 years, categorized according to age: 7 - 9 years (n = 227), 10 to 12 years (n = 153), 13 to 15 years (n = 92), 16 to 22 years (n = 39). For the diagnosis of dental caries used the criteria of the World Health Organization to measure indices DMFT. For fluorosis used the index Thylstrup and Fejerskov (TF), dichotomized according to prevalence (TF = 0 and TF > 0) and severity (TF < 4 and TF > 5). In the two younger groups, the DMFT and its decay component were higher in the group with more severe fluorosis (p < 0.001). This association was not found among adolescents and adults (p > 0.05). The association was found between the conditions more severe fluorosis and caries in individuals under 12 years.

Trata-se de estudo transversal e analítico cujo objetivo foi avaliar a associação entre a prevalência e a gravidade da fluorose e da cárie dentária em municípios rurais com fluorose endêmica no norte do Estado de Minas Gerais, Brasil, com concentração de flúor nas águas de até 4,8 mg/L. Os dados foram coletados por um examinador (Kappa intra examinador, 0,96 para fluorose e 0,95 para cárie) após escovação dentária. Participaram do estudo 511 indivíduos, com idades de 7 a 22 anos, categorizados conforme faixa etária: 7 a 9 anos (n = 227), 10 a 12 anos (n = 153), 13 a 15 anos (n = 92), 16 a 22 anos (n = 39). Para o diagnóstico da cárie dentária, utilizaram-se os critérios da Organização Mundial da Saúde (OMS) para a mensuração do índice de Dentes Cariados, Perdidos e Obturados (CPO-D). Para a fluorose utilizou-se o índice de Thylstrup e Fejerskov (TF), dicotomizado segundo a prevalência (TF = 0 e TF > 0) e gravidade (TF < 4 e TF > 5).Nos dois grupos mais jovens, o CPO-D e seu componente cariado foram maiores no grupo com fluorose mais grave (p < 0,001). Essa associação não foi identificada entre os adolescentes e adultos (p > 0,05). A associação mais grave entre as condições cárie e fluorose foi encontrada em indivíduos com até 12 anos.