Effect of therapeutic doses of radiotherapy on the organic and inorganic contents of the deciduous enamel: an in vitro study.

OBJECTIVES: This study evaluated the effects of radiotherapy on the composition of deciduous teeth enamel using micro-energy-dispersive X-ray fluorescence and Fourier transform Raman spectroscopy before and after a pH cycling process. MATERIALS AND METHODS: Ten deciduous molars were sectioned and divided into two groups (n = 10). The radiotherapy group (RT) was irradiated with 54 Gy at 2 Gy/day, 5 days per week for 5 weeks and 2 days, and the normal group (N) was not irradiated. The RT group was evaluated before radiotherapy (RTb), after radiotherapy (RTa), and after radiotherapy and pH cycling (RTc). The normal group was evaluated before (N) and after pH cycling (Nc). The weight percentage (wt%) of calcium (Ca), phosphorus (P), and organic content; the Ca/P ratio; and the integrated area of the Raman bands relative to the organic, carbonate, and phosphate contents were also evaluated. RESULTS: The exclusive use of RT reduced the organic content of the enamel (p = 0.000). The RTc group exhibited a decrease in P wt% (p = 0.016), an increase in the Ca/P ratio (p = 0.000), and a reduction in the integrated area of the phosphate band (p = 0.046). An increase in the Ca/P ratio (p = 0.000) and a reduction in the areas of the carbonate and phosphate bands were found in the RTb/RTc treatments. CONCLUSIONS: RT application at a therapeutic dose reduced the organic content of the deciduous enamel. CLINICAL RELEVANCE: Preventive measures should be included in the patient treatment protocol because of RT-induced chemical changes to the deciduous enamel.

Oral manifestations of systemic alterations in early childhood.

AIM: This study aimed to describe certain common oral manifestations during early childhood that should be known by the pediatric dental surgeon. BACKGROUND: The correct diagnosis and treatment of oral manifestations during early childhood is important for children's development. The pediatric dentist is responsible for maintaining oral health in children, since they change constantly during their development and growth. CASE REPORT: Four cases of oral lesions are described, in which the diagnosis and related approach for each one is reported. The first was an acute primary herpetic gingivostomatitis, the second, pseudomembranous candidiasis, the third, chickenpox and the last was molluscum. CONCLUSION: Professionals who treat children in this age group must be able to diagnose and treat common oral manifestations when necessary and should refer the child to a pediatrician for effective treatment if the presence of any systemic alteration is suspected. CLINICAL SIGNIFICANCE: Pathognomonic signs of the most common oral manifestations in early childhood should be known by dentists to improve early diagnosis and proper management.

Dental procedures cause stress in children with cerebral palsy?

BACKGROUND: To evaluate the level of stress during dental care in children and preadolescents with cerebral palsy through biological and psychological parameters. MATERIAL AND METHODS: A total of 38 children aged 7 to 12 years were divided into two groups: one with 18 children with cerebral palsy and the other with 20 healthy children (control group). Saliva was noninvasively collected before and after dental care to analyze salivary biomarkers. The Frankl Behavior Scale and the Facial Image Scale were applied. RESULTS: After the dental procedure, cortisol levels were significantly higher (p = 0.02) in the cerebral palsy group than in the control group. Salivary alpha-amylase was not significantly different between groups. Regarding psychological parameters, anxiety was significantly higher (p = 0.00012) in the cerebral palsy group than in the control group. CONCLUSIONS: There was a change in physiological parameters (salivary cortisol and salivary alpha-amylase) and in psychological parameters (Frankl Behavioral Scale and Facial Image Scale) in patients with cerebral palsy, who exhibited higher stress and anxiety levels than did children without cerebral palsy. Key words:Ortisol, physiological stress, dental care, cerebral palsy, dental treatment anxiety.

Surface morphology of sound deciduous tooth enamel after application of a photo-absorbing cream and infrared low-level laser irradiation: an in vitro scanning electron microscopy study.

OBJECTIVES: The purpose of this descriptive scanning electron microscopic study was to characterize surface alterations in deciduous tooth enamel after in vitro infrared diode laser irradiation, using a photo-absorbing agent alone and also combined with fluoride, before and after laser irradiation. BACKGROUND DATA: Previous investigations have demonstrated increased enamel caries resistance after laser irradiation. METHODS: Seven extracted or exfoliated primary molar teeth underwent soft tissue débridement and fluoride-free prophylaxis. Buccal surfaces were determined to be caries free by macroscopic examination. Sample groups were divided into: (1) control (no treatment); (2) infrared diode laser irradiation (lambda = 810 nm, 68 nm, 60 mW/mm(2), 30 W) using the photo-absorbing agent alone (IRDL + PA; 500 J/cm(2)); and (3) infrared diode laser irradiation using a photo-absorbing agent combined with 2% fluoride (IRDL + PFA; 500 J/cm(2)). Buccal surfaces were evaluated following standard scanning electron microscopy preparation techniques. Control samples of enamel surfaces were relatively smooth but presented occasional enamel prism ends. There were no areas with cavitations or surface defects. RESULTS: After the IRDL + PA treatment, irradiated surfaces became rough and mildly to moderately irregular with scarce enamel cavitations and without exposure of enamel prism ends. The surfaces had adherent granules and only occasional fine cracks and porosities in surface coatings were noted. After the IRDL + PFA treatment, there was a homogenous confluent surface that masked typical enamel surface markings. The surfaces had well-defined globules resulting from the IRDL + PFA treatment, that were not seen after IRDL + PA treatment. CONCLUSIONS: Treatment of deciduous tooth enamel with infrared diode laser irradiation using a photo-absorbing agent and a photo-absorbing agent combined with 2% fluoride created surface coatings that may act as reservoirs for mineral phases during cariogenic activity on enamel, and also provide a certain degree of protection against cariogenic challenge.

Compromised salivary parameters of children with juvenile idiopathic arthritis.

OBJECTIVE: To evaluate the salivary parameters of individuals with juvenile idiopathic arthritis (JIA) and determine if there is a correlation with the simplified oral hygiene index (OHI-S). STUDY DESIGN: Stimulated whole saliva was collected from children, aged 6 to 12 years, with JIA (n = 36) and compared with saliva from a control group (CG) composed of healthy children matched by demographic characteristics (n = 36). Salivary parameters evaluated were amylase and peroxidase activities, calcium, phosphate, and total sialic acid concentration. Data were compared by two-tailed Student's t test, and salivary parameters were evaluated for correlations with OHI-S by Spearman's correlation. RESULTS: The JIA group had a statistically significant reduction in all salivary parameters: α-amylase (20%) (CG, 9.84 ± 4.23; JIA 4.80 ± 3.10) and peroxidase (55%) (CG, 35.05 ± 14.97; JIA, 15.78 ± 6.44) activities, total sialic acid (25%) (CG, 0.024 ± 0.01; JIA, 0.010 ± 0.04), calcium (13%) (CG, 6.26 ± 2.26; JIA, 5.44 ± 2.26) and phosphate (50%) (CG, 10.88 ± 1.49; JIA, 5.45 ± 0.88) concentration compared with the CG (P ≤ .05). There were no significant correlations between the salivary parameters and OHI-S in either group. CONCLUSION: JIA patients showed a reduction of different salivary parameters involved in maintaining oral health.

Sports dentistry: buccal and salivary profile of a female soccer team.

Sports dentistry has been considered a prominent area of dentistry because dental health can limit the abilities of athletes, both professional and nonprofessional, in their training and competition. Dental decay is associated with the frequent use of carbohydrates, recommended as an energy source for exercise. Strong indications exist regarding the possibility to use saliva as a performance determinant and for evaluation and prescription of physical activity. This study evaluated the salivary profiles (pH, flow rate, mutans streptococci and Lactobacillus counts) and decayed, missing, and filled teeth of 18 female soccer players (13 to 19 years old) of the Olympic Training and Research Center of São Paulo, before and after a training session. The salivary flow rate presented a significant reduction after training; however, there was no significant alteration in pH. Fifty percent of the players presented 10(5) to 10(6) mutans streptococci, and 66% presented 10(3) Lactobacillus. Several salivary components protect against microorganisms that cause superior respiratory tract infections (common in athletes), as well as participating in the remineralization mechanism during cariogenic challenges. Thus, due to the salivary flow rate reduction in this population with a high number of cariogenic microorganisms, noncariogenic drink ingestion at regular intervals and maintenance of hydration levels during training, are suggested.

Fraser syndrome-oral manifestations and a dental care protocol.

Fraser syndrome is a rare genetic malformation with an autosomal recessive pattern of inheritance and an incidence of consanguinity ranging from 15% to 25%. A 5-year-old male patient who is a carrier of Fraser syndrome initiated treatment in the pediatric dentistry sector. The patient was fed parenterally since birth, experienced recurring bouts of chronic lung disease, and was referred to the pediatric dentistry sector by the medical team. Radiographic examination revealed the presence of all permanent teeth. Supragingival dental calculus, halitosis, and gingival inflammation were also observed. Dental calculus was removed by manual scraping, and chemotherapeutic agents were used, chlorhexidine 0,12%, chlorhexidine gel 2%, and PVP-I, to control the bacterial flora. The patient is still being monitored after an 8-year follow-up period, the complications associated with periodontal disease decreased, and since the initiation of treatment, the patient has not needed to be hospitalized because of chronic lung disease. This study reports the case of a patient diagnosed with Fraser syndrome and describes the clinical manifestations (general and oral).

Photodynamic therapy in pediatric dentistry.

Conservation of deciduous teeth with pulp alterations caused by caries and trauma is a major therapeutic challenge in pediatric dentistry as a result of the internal anatomy and life cycle characteristic. It is essential that the root canal procedures sanitizers have a performance in eliminating bacterial. In this context, antimicrobial photodynamic therapy (PAT) is promising and emerging as adjuvant therapy in an attempt to eliminate the microorganisms persistent to chemi-mechanical preparation. Since there is presence of oxygen in cells, photosensitizer activated by light can react with molecules in its vicinity by electrons' or hydrogen's transfer, leading to microorganism death. This paper reports the case of 4-year-old patient, female, with early childhood caries. The proposed endodontic treatment incuded chemomechanical treatment allied to PAT in the decontamination of root canals using methylene blue dye 50 µg/mL during 3-5 minutes and 40 J/cm(2) as energy density, taking into account the need for tissue penetration and effectiveness of PAT inside the dentinal tubules.

Effects of near infrared laser radiation associated with photoabsorbing cream in preventing white spot lesions around orthodontic brackets: an in vitro study.

OBJECTIVE: The present study aims to investigate the effect of a low-power infrared laser on the inhibition of bovine enamel demineralization around orthodontic brackets. BACKGROUND DATA: Near infrared lasers have been suggested as alternative approaches because they may produce an increase in resistance to dental caries. METHODS: Forty-eight blocks of enamel obtained from bovine incisor teeth were divided into six groups: Group 1 (control), without treatment; Group 2 (C), photoabsorbing cream; Group 3 (CF), photoabsorbing cream with fluoride; Group 4 (L), irradiation with low-level infrared laser (λ=830 nm) at an energy density of 4.47 J/cm2; Group 5 (L+C), photoabsorbing cream followed by low-level infrared laser irradiation; and Group 6 (L+CF), photoabsorbing cream with fluoride followed by low-level infrared laser irradiation. After these procedures, the enamel blocks received an assortment of orthodontic brackets and were then submitted to pH cycling to simulate a highly cariogenic challenge. The enamel surface demineralization around the orthodontic brackets, according to the different treatments, was quantified by fluorescence loss analysis by quantitative light-induced fluorescence (QLF). The fluorescence loss, expressed as ΔF (percentage of loss fluorescence), was statistically examined by analysis of variance and the Tukey test. RESULTS: The control group (-10.48±2.85) was statistically similar to Group C (-14.52±7.80), which presented the lowest values of ΔF when compared with Groups FC (-3.67±3.21), L (-2.79±1.68), CL (-1.05±0:50), and CFL (-0.60±0:43). However, Groups FC, L, CL, and CFL showed no statistically significant differences among them. CONCLUSIONS: It can be concluded that both the low-level infrared laser and photoabsorbing cream with fluoride were effective in inhibiting the development of caries in enamel around orthodontic brackets, even in situations of high cariogenic challenge.

Dental enamel irradiated with a low-intensity infrared laser and photoabsorbing cream: a study of microhardness, surface, and pulp temperature.

OBJECTIVE: The aim of this study was to assess the effect of low-intensity infrared laser light (λ=810 nm, 100 mW/cm(2), 90 sec, 4.47 J/cm(2), 9 J) with or without indocyanine green cream fluorinated or not fluorinated, using Knoop surface microhardness analysis. BACKGROUND DATA: Lasers can be used as tools for the prevention of tooth enamel demineralization. METHODS: The surface and pulp temperatures of the human deciduous tooth enamel were measured. For the analysis of surface hardness, a total of 48 specimens were prepared and randomly assigned into six groups (n=8/group): C (+), which received laser light; C(-), which received no treatment; cream (IV); cream and fluoride (IVF); cream and light (IVL); and cream and fluoride and light (IVFL). The specimens were subjected to treatment before demineralizing challenge by pH cycling. To analyze the surface and pulp temperatures, the samples were divided into the following groups (n=10): C(+), IVL, and IVFL. RESULTS: The hardness analysis indicated that the groups that received irradiation had less hardness reduction following the demineralizing challenge (p<0.001), with IVFL and IVL presenting the lowest percentages of surface microhardness loss at 3.98% and 9.3%, respectively. Surface temperature analysis indicated a maximum increase of 74°C and a mean of 45.25°C and 45.95°C for the IVL and IVFL groups, respectively. Pulp temperature analysis indicated a higher mean increase of 2.40°C±0.65 in the IVL group. CONCLUSIONS: These results suggest that the combination of cream and laser light possibly promoted protein denaturation of the tooth enamel organic matrix, which possibly decreased the loss of hardness without causing pulp damage.

Dental enamel irradiated with infrared diode laser and photoabsorbing cream: Part 1 -- FT-Raman Study.

OBJECTIVE: The aim of this FT-Raman study was to investigate laser-induced compositional changes in enamel after therapy with a low-level infrared diode laser and a photoabsorbing cream, in order to intensify the superficial light absorption before and after cariogenic challenge. BACKGROUND DATA: Dental caries remains the most prevalent disease during childhood and adolescence. Preventive modalities include the use of fluoride, reduction of dietary cariogenic refined carbohydrates, plaque removal and oral hygiene techniques, and antimicrobial prescriptions. A relatively simple and noninvasive caries preventive regimen is treating tooth enamel with laser irradiation, either alone or in combination with topical fluoride treatment, resulting in reduced enamel solubility and dissolution rates. Due to their high cost, high-powered lasers are still not widely employed in private practice in developing countries. Thus, low-power red and near-infrared lasers appear to be an appealing alternative. MATERIALS AND METHODS: Twenty-four extracted or exfoliated caries-free deciduous molars were divided into six groups: control group (no treatment; n = 8); infrared laser treatment (L; n = 8) (810 nm at 100 mW/cm(2) for 90 sec); infrared diode laser irradiation (810 nm at 100 mW/cm(2) for 90 sec) and photoabsorbing cream (IVL; n = 8); photoabsorbing cream alone (IV; n = 8); infrared diode laser irradiation (810 nm at 100 mW/cm(2) for 90 sec) and fluorinated photoabsorbing agent (IVLF; n = 8); and fluorinated photoabsorbing agent alone (IVF; n = 8). Samples were analyzed using FT-Raman spectroscopy before and after pH cycling cariogenic challenge. RESULTS: There was a significant laser-induced reduction and possible modification of the organic matrix content in enamel treated with the low-level diode laser (the L, IVL, and IVFL groups). CONCLUSION: The FT-Raman technique may be suitable for detecting compositional and structural changes occurring in mineral phases and organic phases of lased enamel under cariogenic challenge.

Dental enamel irradiated with infrared diode laser and photo-absorbing cream: part 2--EDX study.

OBJECTIVE: The effects of laser-induced compositional changes on the enamel were investigated by energy-dispersive X-ray fluorescence spectrometry (micro-EDX). After cariogenic challenge, we administered treatment of low-level infrared diode laser and a photo-absorbing cream (used to intensify the superficial light absorption). BACKGROUND DATA: Dental caries is considered the most prevalent oral disease. A simple and noninvasive caries preventive regimen is treating tooth enamel with a laser, either alone or in combination with fluoride, which reduces enamel solubility and dissolution rates. High power lasers are still not widely used in private practice. Low-power near-infrared lasers may be an alternative approach. Energy-dispersive micro-EDX is a versatile and nondestructive spectroscopic technique that allows for a qualitative and quantitative elemental analysis of inorganic enamel components, such as calcium and phosphorus. MATERIALS AND METHODS: Twenty-four extracted or exfoliated caries-free deciduous molars were divided into six groups: 1) control group (CTR-no treatment); 2) infrared laser treatment (L) (lambda = 810 nm, 100 mW/cm(2), 90 sec, 4.47 J/cm(2), 9 J); 3) infrared laser irradiation and photo-absorbing agent (CL); 4) photo-absorbing agent alone (C); 5) infrared laser irradiation and fluoridated photo-absorbing agent (FCL); and 6) fluoridated photo-absorbing agent alone (FC). Samples were analyzed using micro-EDX after two sets of treatments and pH cycling cariogenic challenges. RESULTS: The CL group showed statistically significant increases in calcium and phosphorus (wt%) compared with the CTR group. The Ca/P ratio was similar in the FCL and CTR groups. There was a significant laser-induced reduction compared with the CTR group, and there was a possible modification of the organic balance content in enamel treated with laser and cream. CONCLUSION: micro-EDX may be able to detect compositional changes in mineral phases of lased enamel under cariogenic challenge. Our results suggest that with a combined laser and photo-absorbing agent (CL) treatment, there was a possible disorganization of organic content in the tooth enamel with hydroxyapatite crystal reordering and reorganization.