Did the Use of Minimum Interventions for Caries Management Change during the COVID-19 Pandemic? A Cross-Sectional Study.

The aim of this study was to evaluate changes in the frequency of use of minimum intervention (MI) techniques for caries management during the COVID-19 pandemic. A questionnaire was applied through the SurveyMonkeyTM platform to evaluate changes in the dentist's frequency of use of noninvasive, microinvasive, minimally invasive, and mixed interventions, nonaerosol or aerosol productive, to manage dental caries before and during COVID-19 pandemic. Differences in the use of MI techniques were analyzed by Wilcoxon test, and the effect size (ES) was calculated. An α = 0.05 was adopted. A total of 781 dentists answered the questionnaire; most of them were female (76.4%), with 30s (76.4%), graduated over 10-24 years ago (38%) in public dental schools (62%), graduated in southwest of Brazil (38%), that work in clinical environment (66.8%) and in private jobs (53.4%). During COVID-19, among the sample, 91 respondents were not working. In relation to the noninvasive techniques, only the use of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) decreased during the COVID-19 pandemic (p < 0.01; ES = 0.11). The frequency of sealants to repair defective restorations was the only microinvasive technique that increased during the pandemic (p < 0.01; ES = 0.03). Among the minimally invasive techniques, the use of atraumatic restorative treatment increased significantly (p < 0.01; ES = 0.06), while the use of air abrasion decreased (p = 0.02; ES = 0.04) during COVID-19 pandemic. Moreover, nonrestorative cavity control (mixed intervention) increased during pandemic period (p < 0.001; ES = 0.11). Although the results demonstrated differences in the use of some procedures, a very small magnitude of the effect was perceived, demonstrating that the influence of COVID-19 pandemic was very little, if any, in the use of MI techniques for caries management. Moreover, the use of MI strategies was already well established between Brazilian dentists before the pandemic period.

TRA associado ou não ao Brix3000, tendências mundiais e o conhecimento sobre técnicas de mínima intervenção para o controle da cárie dentária / ART associated or not with Brix3000, world trends and knowledge of minimal interventional dentistry for the control of dental caries

A presente dissertação foi dividida em três estudos: o primeiro avaliou o Tratamento Restaurador Atraumático (TRA) associado ou não ao Brix3000™ quanto ao tempo de tratamento, experiência de dor e aceitabilidade de crianças (n=20) de 3-9 anos em um ensaio clínico controlado e randomizado. O tempo foi cronometrado do início ao fim do tratamento. A experiência de dor foi avaliada pela versão revisada da escala "Face, Legs, Activity, Cry, Consolability" (FLACC-r) e a aceitabilidade por uma escala facial hedônica. O grupo TRA + Brix3000™ gastou 4 minutos a mais (13,14±4,0 min) que o grupo TRA (9,8±2,7 min) (p=0,03). Não houve diferença quanto à aceitabilidade e à dor (p>0,05). O segundo estudo caracterizou a literatura científica mundial sobre produtos de remoção químico-mecânica de tecido cariado (RQMTC), por meio de mineração de dados bibliométricos, metodológicos e dos resultados de 397 artigos. Houve maior número de publicações entre 2011-2020, no Journal of Dental Research, desenvolvidos no Brasil e Índia. Estudos in vitro foram mais prevalentes, seguidos dos estudos clínicos. Nestes últimos, Carisolv™e Papacarie™ foram os produtos mais utilizados, prescritos para uso isolado e comparados ao uso de brocas. Os produtos para RQMTC foram mais estudados em crianças, cujos dentes foram restaurados com o cimento de ionômero de vidro, nos quais o tempo gasto e dor foram os principais desfechos. Observou-se que a RQMTC demanda maior tempo, entretanto, promove redução de ansiedade, dor e necessidade de anestesia local. O estudo 3 avaliou o conhecimento de dentistas brasileiros sobre odontologia de mínima intervenção (OMI) pelo desenvolvimento, validação e aplicação de uma escala de conhecimento (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS), de 12 itens (0-12 pontos). Quanto maior a pontuação, maior o conhecimento do dentista. Dados sociodemográficos e de formação acadêmica foram coletados. A escala (α=0,72; ICC=0,85) foi aplicada por meio da plataforma Survey Monkey™ a 637 dentistas que demostraram ter conhecimento médio de 7,4±2,5 sobre OMI. As maiores pontuações foram alcançadas por mulheres (7,8±2,4; p=0,00); profissionais com mais de 10 anos de formados (7,6±2,6; p=0,02); emfaculdades públicas (7,8±2,4; p=0,00), atuando no setor público (7,9±2,3; p=0,00) ou acadêmico (8,8±2,3; p=0,04). Pontuações maiores foram alcançadas por especialistas em Odontopediatria (9,2±1,6) e menores por Cirurgiões buco-maxilo-faciais (3,1±2,1). Houve maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. Técnica de Hall, infiltrante resinoso e RQMTC foram as técnicas menos conhecidas. Com a presente dissertação, concluiu-se que o TRA associado ao Brix3000™ demandou mais tempo de tratamento, sem diferença quanto à aceitabilidade e à dor. Os estudos com produtos para RQMTC aumentaram ao longo dos anos, principalmente em países em desenvolvimento. Os estudos clínicos com crianças tendem a avaliar o tempo gasto e a dor em comparação ao uso de brocas e, a RQMTC reduz ansiedade, dor e necessidade de anestesia, embora aumente o tempo de tratamento. Foi constatada suficiente evidência psicométrica da escala MIDDeC-KS. As maiores pontuações foram alcançadas por profissionais do gênero feminino e especialistas em Odontopediatria, com maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. (AU)

This dissertation was divided into three studies: the first evaluated the Atraumatic Restorative Treatment (ART) associated or not with Brix3000 ™ in terms of treatment time, pain experience and acceptability of children (n=20) aged 3-9 years through a randomized controlled clinical trial. The time was calculated from the beginning to the end of the treatment. Pain experience was assessed by the revised version of the "Face, Legs, Activity, Chy, Consolability" (FLACC-r) scale and acceptability by a hedonic facial scale. The ART + Brix3000 ™ group spent 4 minutes longer (13.14±4.0 min) than the ART group (9.8±2.7 min) (p=0.03). There was no difference regarding acceptability and pain (p>0.05). The second study characterized the world scientific literature on chemical-mechanical carious tissue removal (CMCTR) products, through bibliometric, methodological and results data mining of the 397 articles. There was a greater number of publications between 2011-2020, in the Journal of Dental Research, which were developed in Brazil and India. In vitro studies were more prevalent, followed by clinical studies. In the latter, Carisolv ™ and Papacarie ™ were the most used products prescribed for isolated use and compared to the use of drills. CMCTR products have been most studied in children whose teeth were restored with glass ionomer cement, in which time spent and pain were the main outcomes. Clinical application of CMCTR takes more treatment time but can also reduce patient anxiety, pain and need for anesthesia Study 3 assessed the knowledge of Brazilian dentists about minimal intervention dentistry (MID) through the development, validation, and application of a 12-item (0-12 points) knowledge scale (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS). The higher the score, the greater the knowledge of the dentist. Gender, educational level, specialty, academic training institutions and workplace were collected. The final scale (α=0.72; ICC=0.85) was applied through the Survey Monkey™ platform to 637 dentists who demonstrated an average knowledge of 7.4±2.5 about MID. The highest scores were achieved by women (7.8±2.4; p=0.00); professionals with more than 10 years of graduation (7.6±2.6; p=0.02); in public colleges (7.8±2.4; p=0.00), working in the public sector (7.9±2.3; p=0.00) or academic (8.8±2.3; p =0.04). Higher scores were achieved by specialists in Pediatric Dentistry (9.2±1.6) and lowest by maxillofacial surgeons (3.1±2.1). There was greater knowledge about diet and biofilm control, as well as topical application of fluoride. Hall technique, resin infiltration and CMCTR were the least known MID techniques. With the present master thesis, it was concluded that ART associated with Brix3000™ required more treatment time, with no difference in terms of acceptability and pain. Studies with products for CMCTR have increased over the years, mainly in developing countries. The clinical studies with children tend to assess the time spent and pain compared to the use of drills. CMCR clinical application reduces anxiety, pain and need for anesthesia, despite increase treatments' time Sufficient psychometric evidence of the MIDDeC-KS scale was observed. The highest scores were achieved by women, specialists in Pediatric Dentistry, with more knowledge about diet control, biofilm, and topical fluoride application. (AU)

TRA associado ou não ao Brix3000, tendências mundiais e o conhecimento sobre técnicas de mínima intervenção para o controle da cárie dentária / ART associated or not with Brix3000, world trends and knowledge of minimal interventional dentistry for the control of dental caries

A presente dissertação foi dividida em três estudos: o primeiro avaliou o Tratamento Restaurador Atraumático (TRA) associado ou não ao Brix3000™ quanto ao tempo de tratamento, experiência de dor e aceitabilidade de crianças (n=20) de 3-9 anos em um ensaio clínico controlado e randomizado. O tempo foi cronometrado do início ao fim do tratamento. A experiência de dor foi avaliada pela versão revisada da escala "Face, Legs, Activity, Cry, Consolability" (FLACC-r) e a aceitabilidade por uma escala facial hedônica. O grupo TRA + Brix3000™ gastou 4 minutos a mais (13,14±4,0 min) que o grupo TRA (9,8±2,7 min) (p=0,03). Não houve diferença quanto à aceitabilidade e à dor (p>0,05). O segundo estudo caracterizou a literatura científica mundial sobre produtos de remoção químico-mecânica de tecido cariado (RQMTC), por meio de mineração de dados bibliométricos, metodológicos e dos resultados de 397 artigos. Houve maior número de publicações entre 2011- 2020, no Journal of Dental Research, desenvolvidos no Brasil e Índia. Estudos in vitro foram mais prevalentes, seguidos dos estudos clínicos. Nestes últimos, Carisolv™ e Papacarie™ foram os produtos mais utilizados, prescritos para uso isolado e comparados ao uso de brocas. Os produtos para RQMTC foram mais estudados em crianças, cujos dentes foram restaurados com o cimento de ionômero de vidro, nos quais o tempo gasto e dor foram os principais desfechos. Observou-se que a RQMTC demanda maior tempo, entretanto, promove redução de ansiedade, dor e necessidade de anestesia local. O estudo 3 avaliou o conhecimento de dentistas brasileiros sobre odontologia de mínima intervenção (OMI) pelo desenvolvimento, validação e aplicação de uma escala de conhecimento (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS), de 12 itens (0-12 pontos). Quanto maior a pontuação, maior o conhecimento do dentista. Dados sociodemográficos e de formação acadêmica foram coletados. A escala (α=0,72; ICC=0,85) foi aplicada por meio da plataforma Survey Monkey™ a 637 dentistas que demostraram ter conhecimento médio de 7,4±2,5 sobre OMI. As maiores pontuações foram alcançadas por mulheres (7,8±2,4; p=0,00); profissionais com mais de 10 anos de formados (7,6±2,6; p=0,02); em faculdades públicas (7,8±2,4; p=0,00), atuando no setor público (7,9±2,3; p=0,00) ou acadêmico (8,8±2,3; p=0,04). Pontuações maiores foram alcançadas por especialistas em Odontopediatria (9,2±1,6) e menores por Cirurgiões buco-maxilo-faciais (3,1±2,1). Houve maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. Técnica de Hall, infiltrante resinoso e RQMTC foram as técnicas menos conhecidas. Com a presente dissertação, concluiu-se que o TRA associado ao Brix3000™ demandou mais tempo de tratamento, sem diferença quanto à aceitabilidade e à dor. Os estudos com produtos para RQMTC aumentaram ao longo dos anos, principalmente em países em desenvolvimento. Os estudos clínicos com crianças tendem a avaliar o tempo gasto e a dor em comparação ao uso de brocas e, a RQMTC reduz ansiedade, dor e necessidade de anestesia, embora aumente o tempo de tratamento. Foi constatada suficiente evidência psicométrica da escala MIDDeC-KS. As maiores pontuações foram alcançadas por profissionais do gênero feminino e especialistas em Odontopediatria, com maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. (AU)

This dissertation was divided into three studies: the first evaluated the Atraumatic Restorative Treatment (ART) associated or not with Brix3000 ™ in terms of treatment time, pain experience and acceptability of children (n=20) aged 3-9 years through a randomized controlled clinical trial. The time was calculated from the beginning to the end of the treatment. Pain experience was assessed by the revised version of the "Face, Legs, Activity, Chy, Consolability" (FLACC-r) scale and acceptability by a hedonic facial scale. The ART + Brix3000 ™ group spent 4 minutes longer (13.14±4.0 min) than the ART group (9.8±2.7 min) (p=0.03). There was no difference regarding acceptability and pain (p>0.05). The second study characterized the world scientific literature on chemical-mechanical carious tissue removal (CMCTR) products, through bibliometric, methodological and results data mining of the 397 articles. There was a greater number of publications between 2011-2020, in the Journal of Dental Research, which were developed in Brazil and India. In vitro studies were more prevalent, followed by clinical studies. In the latter, Carisolv ™ and Papacarie ™ were the most used products prescribed for isolated use and compared to the use of drills. CMCTR products have been most studied in children whose teeth were restored with glass ionomer cement, in which time spent and pain were the main outcomes. Clinical application of CMCTR takes more treatment time but can also reduce patient anxiety, pain and need for anesthesia Study 3 assessed the knowledge of Brazilian dentists about minimal intervention dentistry (MID) through the development, validation, and application of a 12-item (0-12 points) knowledge scale (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS). The higher the score, the greater the knowledge of the dentist. Gender, educational level, specialty, academic training institutions and workplace were collected. The final scale (α=0.72; ICC=0.85) was applied through the Survey Monkey™ platform to 637 dentists who demonstrated an average knowledge of 7.4±2.5 about MID. The highest scores were achieved by women (7.8±2.4; p=0.00); professionals with more than 10 years of graduation (7.6±2.6; p=0.02); in public colleges (7.8±2.4; p=0.00), working in the public sector (7.9±2.3; p=0.00) or academic (8.8±2.3; p =0.04). Higher scores were achieved by specialists in Pediatric Dentistry (9.2±1.6) and lowest by maxillofacial surgeons (3.1±2.1). There was greater knowledge about diet and biofilm control, as well as topical application of fluoride. Hall technique, resin infiltration and CMCTR were the least known MID techniques. With the present master thesis, it was concluded that ART associated with Brix3000™ required more treatment time, with no difference in terms of acceptability and pain. Studies with products for CMCTR have increased over the years, mainly in developing countries. The clinical studies with children tend to assess the time spent and pain compared to the use of drills. CMCR clinical application reduces anxiety, pain and need for anesthesia, despite increase treatments' time Sufficient psychometric evidence of the MIDDeC-KS scale was observed. The highest scores were achieved by women, specialists in Pediatric Dentistry, with more knowledge about diet control, biofilm, and topical fluoride application. (AU)