Microcephaly as a risk factor for dental alterations: A case-control study.

OBJECTIVE: This study aimed to assess whether microcephaly is a risk factor for alterations in the chronology and sequence of tooth eruption and for developmental defects of enamel. MATHERIALS AND METHODS: In this case-control study, 81 children aged 30-36 months, including 40 normoreactive children and 41 with microcephaly, were submitted to oral clinical examination to determine the frequency of alterations in the chronology and sequence of tooth eruption and developmental enamel defects. The sample was matched for sex and age (1:1) and allocated to the case (presence of dental alterations) and control (absence of dental alterations) groups. Gestational age, birthweight and socioeconomic characteristics were also analyzed. Chi-square test and Fisher's exact test were applied (α = 0.05). RESULTS: Microcephaly was significantly associated with delayed tooth eruption, alterations in the sequence of tooth eruption, and defects in dental enamel (p < 0.001). Low birthweight also showed a significant association with this alterations (p < 0.005) and prematurity was associated with defects in enamel development (p < 0.005). CONCLUSION: Microcephaly is a risk factor for alterations in the tooth eruption process and enamel formation in primary teeth.

Prevalence of malocclusions in children with microcephaly associated with the Zika virus.

INTRODUCTION: The objectives of this study were to determine the prevalence of malocclusion among children with Zika virus-associated microcephaly (MZV) and to describe the most common malocclusion in this population. METHODS: This was a cross-sectional study including patients aged between 30 and 36 months diagnosed with MZV. Healthy children were randomly selected with the same sociodemographic characteristics as the control group. Information about arch-type, primate spaces, arch form, overbite, overjet, midline deviation, anterior crossbite, anterior open bite, and the posterior crossbite was recorded. The statistical analysis used descriptive analysis, Pearson chi-square test, and multivariate logistic regression. RESULTS: Forty children comprised the MZV group, and 40 comprised the control group. Our results demonstrated a significantly higher prevalence of malocclusions in children who had MZV than the control group (P <0.001). Patients with MZV were more likely to have late eruption (P <0.001), hypoplastic maxillary arch (P <0.001), hypoplastic mandibular arch (P <0.001), excessive overjet (P <0.001), and posterior crossbite (P = 0.004). CONCLUSIONS: The prevalence of malocclusion was higher among children with MZV. Late eruption, hypoplastic maxillary arch, hypoplastic mandibular arch, excessive overjet, and posterior crossbite were the most common characteristics for this population.

Monitoring Translation Activity of mRNA-Loaded Nanoparticles in Mice.

Targeting mRNA to eukaryotic cells is an emerging technology for basic research and provides broad applications in cancer immunotherapy, vaccine development, protein replacement, and in vivo genome editing. Although a plethora of nanoparticles for efficient mRNA delivery exists, in vivo mRNA targeting to specific organs, tissue compartments, and cells remains a major challenge. For this reason, methods for reporting the in vivo targeting specificity of different mRNA nanoparticle formats will be crucial. Here, we describe a straightforward method for monitoring the in vivo targeting efficiency of mRNA-loaded nanoparticles in mice. To achieve accurate mRNA delivery readouts, we loaded lipoplex nanoparticles with Cre-recombinase-encoding mRNA and injected these into commonly used Cre reporter mouse strains. Our results show that this approach provides readouts that accurately report the targeting efficacy of mRNA into organs, tissue structures, and single cells as a function of the used mRNA delivery system. The method described here establishes a versatile basis for determining in vivo mRNA targeting profiles and can be systematically applied for testing and improving mRNA packaging formats.

The treatment of multiple gingival recession defects with connective tissue grafting and enamel matrix derivative in a private practice setting: Two case reports.

BACKGROUND: Dentofacial esthetics has become a mainstay treatment in periodontics. For a periodontal private practice to succeed in a referral-based environment, predictability and stability in treatment results are crucial. The scientific literature provides a guide to successfully treating multiple recession defects with non-carious cervical lesions and lingual recession. These case reports show how the use of biologic mediators, proper case selection, and proper surgical technique may provide a better treatment outcome for our patients. METHODS: Two patients with multiple gingival recession defects were treated with autogenous tissue grafting in conjunction with the application of enamel matrix derivative (EMD) to attempt root coverage. Based on the Cairo classification, the recession defects were classified as type I in the maxillary buccal and lingual recession in the mandibular anterior. There were areas of no attached gingiva, loss of enamel, and the presence of non-carious cervical lesions. RESULTS: At 3-month post-treatment in case #1 and 6-month post-treatment in case #2, satisfactory esthetic results for the patients and clinician were achieved. These short-term follow-ups were favorable for root coverage and soft tissue healing, especially at the 1-week visit. There was noticeably less edema and erythema. Additionally, dental hypersensitivity was no longer reported for both patients. CONCLUSION: By using biologic mediators, such as an EMD combined with connective tissue grafting, both multiple recession defects with non-carious cervical lesions, and lingual recession cases, can be treated successfully in a private practice setting. Using an EMD provides no additional risks to patients, may result in faster healing, and would afford stability of long-term success by influencing true periodontal regeneration.

Association of congenital Zika syndrome with dental alterations in children with microcephaly.

The effects of congenital Zika syndrome (CZS) on the tooth development of infected children are not well known. The aim of this study was to analyze the association of CZS with dental alterations in children with microcephaly seen at a referral hospital in Rio Grande do Norte, Brazil. The chronology and sequence of tooth eruption and the presence of dental alterations were evaluated by a single calibrated examiner (kappa > 0.80) in 62 children aged 7 to 35 months with microcephaly associated with CZS and other congenital infections. Medical data of the mother and child were collected from the records and the parents responded to a socioeconomic questionnaire. Descriptive analysis and Fisher's exact test were used (5% significance level). The mean age of the children was 26.4 months (SD = 7.52). The mean weight and head circumference at birth were 2,593 g (SD = 0.60) and 29.6 cm (SD = 2.48), respectively. Microcephaly was associated with congenital Zika virus infection in 79% of cases and with other congenital infections in 21%. No significant association was found between CZS and alterations in the chronology (p = 1.00) or sequence of tooth eruption (p = 0.16) or changes in enamel development (p = 1.00). In conclusion, children with microcephaly exhibit a delay and alterations in the sequence of tooth eruption of primary teeth, as well as developmental defects of enamel, which are not associated with Zika virus infection.

The Importance of Integrated Healthcare in the Association Between Oral Health and Awareness of Periodontitis and Diabetes in Type 2 Diabetics.

PURPOSE: Purpose: To assess the association of various factors including education level and oral health with type 2 diabetics' awareness of periodontitis and periodontitis/diabetes relationship, and to evaluate the importance of integrated healthcare in this association. Materials and Methods: 288 type 2 diabetics were evaluated through a validated structured questionnaire about oral hygiene habits, access and attendance to dental treatment, the presence of periodontitis and previously received information of periodontitis and periodontitis/diabetes relationship. Descriptive data were explored and both simple and multiple logistic regressions were performed. Results: The average age of participants was 62.24 (±10.93) years, 81.6% were previously treated for periodontitis and approximately 70% have never received information on periodontitis and its relationship with diabetes. A higher chance of participants having previously received information regarding periodontitis was associated with more than 8 years of schooling, daily flossing habit, presence of periodontitis and prior treatment for periodontitis (p < 0.005). Regarding previously received information about periodontitis/diabetes relationship, statistically significant associations were observed for more than 12 years of schooling and diabetes diagnosed more than 8 years ago (p < 0.05). Conclusion: The vast majority of participants were previously treated for periodontitis without receiving proper oral health education, which means that access to costly dental treatment is provided while patient education is neglected. It was shown the influence of habits and living conditions on the previously received information about diseases, and therefore, particular attention to the population characteristics is important to make the information accessible to everyone.

Clinical, microbiological, and immunological effects of systemic probiotics in periodontal treatment: study protocol for a randomized controlled trial.

BACKGROUND: The association of scaling and root planing (SRP) with systemic metronidazole (MTZ) plus amoxicillin (AMX) has shown to be an effective treatment protocol, particularly for periodontitis stages III and IV, generalized. More recently, probiotics have also been suggested as a promising adjunctive treatment for periodontal diseases due to their antimicrobial and anti-inflammatory properties. Therefore, the aim of this randomized clinical trial (RCT) is to evaluate the clinical, microbiological, and immunological effects of probiotics as adjuncts to SRP alone or with MTZ+AMX in the treatment of periodontitis. METHODS: Subjects with periodontitis are being randomly assigned to receive (i) SRP alone, or with (ii) two probiotic lozenges/day for 90 days (Prob), (iii) MTZ (400 mg) and AMX (500 mg) thrice a day (TID) for 14 days (MTZ+AMX), or (iv) Prob and MTZ+AMX. Subjects are being monitored for up to 12 months post-treatment. Nine subgingival plaque samples per patient are being collected at baseline and at 3, 6, and 12 months post-therapy and analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Peripheral blood and gingival crevicular fluid (GCF) of four randomly selected periodontal sites will be analyzed by means of a multiplex fluorescent bead-based immunoassay for 17 cyto/chemokines. STATISTICAL ANALYSES: The significance of differences in each group (over the course of the study) will be sought using repeated measures ANOVA or Friedman tests and among groups (at each time point) using either ANOVA/ANCOVA or Kruskal-Wallis tests, depending on normality of the data. The chi-square test will be used to compare differences in the frequency of subjects achieving the clinical endpoint for treatment (≤ 4 sites with PD ≥ 5 mm) at 1 year and of self-perceived adverse effects. A stepwise forward logistic regression analysis will be performed in order to investigate the impact of different predictor variables on the percentage of patients achieving the clinical endpoint for treatment. The Number Needed to Treat (NNT) with different treatment protocols will be also calculated. Statistical significance will be set at 5%. TRIAL REGISTRATION: ClinicalTrials.gov NCT03733379. Registered on November 7, 2018.

Protective effect of guarana-loaded liposomes on hemolytic activity.

Paullinia cupana var. sorbilis (Mart.) Ducke, popularly known as guarana, is one of the most promising plants in Brazilian flora and has attracted considerable interest from the scientific community owing to its numerous therapeutic activities and less side effects. Hence, using nanotechnology is a viable alternative to primarily improve the physicochemical characteristics and bioavailability of guarana. The objective of the present study was to develop, characterize, and evaluate the stability of liposomes containing guarana powder and to evaluate their antioxidant and hemolytic activity in vitro. Three different concentrations of guarana powder and two methods of liposome preparation were tested. Liposomes were developed and characterized, and their stability was analyzed by evaluating physicochemical parameters. Hemolytic activity of guarana liposomal formulation (G-Lip) was compared with that of guarana in its free form (FG) and of liposome without guarana (W-Lip). Red blood cells from rats were exposed to these different formulations dissolved in phosphate buffer solution (PBS; pH 7.4). The best stability was achieved for the formulation containing 1 mg mL-1 guarana powder produced by the reverse phase evaporation method. FG showed dose-dependent antioxidant activity, which was maintained in G-Lip. W-Lip showed high hemolytic activity in PBS at pH 7.4 possibly because of the presence of polysorbate 80, and on addition of guarana to these structures, the hemolytic process was reversed. The same protective effect was observed for FG. It is believed that the complex structure of guarana, primarily the presence of polyphenols, exerts a powerful antioxidant action, helping to protect erythrocytes.

Does subgingival bacterial colonization differ between implants and teeth? A systematic review.

The aim was of this study was to determine the current weight of evidence for the existence of specific differences between the microbiota of healthy teeth and healthy implants, or of teeth with periodontitis and implants with peri-implantitis. A systematic review was conducted according to the PRISMA statement. The MEDLINE, EMBASE and Cochrane databases were searched up to February 2018 for studies comparing microbiological data of biofilm samples collected from healthy teeth and implants or from teeth with periodontitis and implants with peri-implantitis. The weight of evidence was defined in three categories (strong, moderate and mild/some), according to the difference in number of studies showing statistically significantly higher counts and/or proportions and/or abundance and/or prevalence of microorganisms in health or in disease. Of the 132 articles identified, 8 were included. A wide range of microorganisms were present in different conditions but no microorganisms showed strong, moderate or mild/some evidence for a specific association with either teeth or implants. The results of this systematic review indicated that there is insufficient evidence in the literature to support specific differences between microorganisms colonizing teeth and implants, either in health or in disease.

Nanoencapsulation of the flavonoid dihydromyricetin protects against the genotoxicity and cytotoxicity induced by cationic nanocapsules.

We evaluated the influence of nanoencapsulation of the flavonoid Dihydromyricetin (DMY) in reducing the genotoxicity and cytotoxicity induced by cationic nanocapsules. Assays were conducted in order to evaluate the potential of protein corona formation, cytotoxicity, genotoxicity and the antioxidant capacity. Nanocapsules containing DMY (NC-DMY) and free DMY (DMY-F) did not demonstrate cytotoxicity and genotoxicity. However, Eudragit RS100® nanocapsules (NC-E) increased cytotoxicity and DNA damage formation. NC-DMY and NC-E presented high interaction with the DNA in vitro, suggesting DNA sequestration. These results indicate that nanoencapsulated DMY does not induce cytotoxicity or genotoxicity, and demonstrates high antioxidant capacity. This antioxidant capacity is probably associated with DMY, and occurs due to its ability to avoid the formation of free radicals, thus preventing the toxicity caused by the nanostructure with the cationic polymer Eudragit RS100®. Therefore, NC-DMY can be considered an important formulation with significant antioxidant potential to be exploited by nanomedicine.

Microbiome of Deep Dentinal Caries Lesions in Teeth with Symptomatic Irreversible Pulpitis.

This study used a next-generation sequencing approach to identify the bacterial taxa occurring in the advanced front of caries biofilms associated with pulp exposure and irreversible pulpitis. Samples were taken from the deepest layer of dentinal caries lesions associated with pulp exposure in 10 teeth diagnosed with symptomatic irreversible pulpitis. DNA was extracted and the microbiome was characterized on the basis of the V4 hypervariable region of the 16S rRNA gene by using paired-end sequencing on Illumina MiSeq device. Bacterial taxa were mapped to 14 phyla and 101 genera composed by 706 different OTUs. Three phyla accounted for approximately 98% of the sequences: Firmicutes, Actinobacteria and Proteobacteria. These phyla were also the ones with most representatives at the species level. Firmicutes was the most abundant phylum in 9/10 samples. As for genera, Lactobacillus accounted for 42.3% of the sequences, followed by Olsenella (13.7%), Pseudoramibacter (10.7%) and Streptococcus (5.5%). Half of the samples were heavily dominated by Lactobacillus, while in the other half lactobacilli were in very low abundance and the most dominant genera were Pseudoramibacter, Olsenella, Streptococcus, and Stenotrophomonas. High bacterial diversity occurred in deep dentinal caries lesions associated with symptomatic irreversible pulpitis. The microbiome could be classified according to the relative abundance of Lactobacillus. Except for Lactobacillus species, most of the highly prevalent and abundant bacterial taxa identified in this study have been commonly detected in infected root canals. The detected taxa can be regarded as candidate pathogens for irreversible pulpitis and possibly the pioneers in pulp invasion to initiate endodontic infection.

Advanced Caries Microbiota in Teeth with Irreversible Pulpitis.

INTRODUCTION: Bacterial taxa in the forefront of caries biofilms are candidate pathogens for irreversible pulpitis and are possibly the first ones to invade the pulp and initiate endodontic infection. This study examined the microbiota of the most advanced layers of dentinal caries in teeth with irreversible pulpitis. METHODS: DNA extracted from samples taken from deep dentinal caries associated with pulp exposures was analyzed for the presence and relative levels of 33 oral bacterial taxa by using reverse-capture checkerboard hybridization assay. Quantification of total bacteria, streptococci, and lactobacilli was also performed by using real-time quantitative polymerase chain reaction. Associations between the target bacterial taxa and clinical signs/symptoms were also evaluated. RESULTS: The most frequently detected taxa in the checkerboard assay were Atopobium genomospecies C1 (53%), Pseudoramibacter alactolyticus (37%), Streptococcus species (33%), Streptococcus mutans (33%), Parvimonas micra (13%), Fusobacterium nucleatum (13%), and Veillonella species (13%). Streptococcus species, Dialister invisus, and P. micra were significantly associated with throbbing pain, S. mutans with pain to percussion, and Lactobacillus with continuous pain (P < .05). Quantitative polymerase chain reaction revealed a mean total bacterial load of 1 × 10(8) (range, 2.05 × 10(5) to 4.5 × 10(8)) cell equivalents per milligram (wet weight) of dentin. Streptococci and lactobacilli were very prevalent but comprised only 0.09% and 2% of the whole bacterial population, respectively. CONCLUSIONS: Several bacterial taxa were found in advanced caries lesions in teeth with exposed pulps, and some of them were significantly associated with symptoms. A role for these taxa in the etiology of irreversible pulpitis is suspected.

[Dental caries in Paulínia, São Paulo State, Brazil, and WHO goals for 2000 and 2010]. / Paulínia, São Paulo, Brasil: situação da cárie dentária com relação às metas OMS 2000 e 2010.

An epidemiological survey was conducted in Paulínia, São Paulo State, Brazil, in 2000, aimed at verifying the prevalence of principal oral health problems, using the DMFT index and WHO diagnostic criteria. The sample (1,151) was randomly selected. The dmft was 1.90 in 5-year-olds, with 54.2% caries-free. DMFT was 1.00 in 12-year-olds, with 46.4% caries-free in the permanent dentition. Fluorosis prevalence in 7 to 12-year-olds was 30.5%, mostly the very mild form (22.9%). Prevalence of opacities and hypoplasias was 9.1%. In adults, the dental care index was 55.4% and an average of 21.30 teeth presented caries experience. In the elderly, DMFT was 29.50, consisting predominantly of extracted teeth (93.0%).

Does subgingival bacterial colonization differ between implants and teeth? A systematic review

Abstract The aim was of this study was to determine the current weight of evidence for the existence of specific differences between the microbiota of healthy teeth and healthy implants, or of teeth with periodontitis and implants with peri-implantitis. A systematic review was conducted according to the PRISMA statement. The MEDLINE, EMBASE and Cochrane databases were searched up to February 2018 for studies comparing microbiological data of biofilm samples collected from healthy teeth and implants or from teeth with periodontitis and implants with peri-implantitis. The weight of evidence was defined in three categories (strong, moderate and mild/some), according to the difference in number of studies showing statistically significantly higher counts and/or proportions and/or abundance and/or prevalence of microorganisms in health or in disease. Of the 132 articles identified, 8 were included. A wide range of microorganisms were present in different conditions but no microorganisms showed strong, moderate or mild/some evidence for a specific association with either teeth or implants. The results of this systematic review indicated that there is insufficient evidence in the literature to support specific differences between microorganisms colonizing teeth and implants, either in health or in disease.

Comparison of the effectiveness of polyethylene glycol 4000 without electrolytes and magnesium hydroxide in the treatment of chronic functional constipation in children.

OBJECTIVE: To compare the effectiveness of two drugs, polyethylene glycol 4000 without electrolytes and magnesium hydroxide, in the treatment of chronic functional constipation in children. METHODS: Thirty-eight children were randomly assigned to either of two groups, polyethylene glycol 4000 without electrolytes or magnesium hydroxide. The children were followed through periodic appointments until they reached 6 months of treatment. In each medical appointment the following aspects were evaluated: stool consistency, frequency of bowel movements, fecal incontinence, abdominal pain, straining and acceptance of the drugs. RESULTS: Seventeen children made use of polyethylene glycol and twenty-one received magnesium hydroxide. All variables analyzed improved for both groups, with no statistically significant differences. All children accepted polyethylene glycol, while 42.9% refused magnesium hydroxide. CONCLUSION: The two laxatives showed no difference in effectiveness for the treatment of constipation. However, due to its better acceptance, because it is odorless and tasteless, polyethylene glycol proved to be a better option for treating chronic functional constipation.

Alterações dentárias em crianças com microcefalia associada à Síndrome Congênita do Zika Vírus e outras infecções congênitas / Dental changes in children with microcephaly associated with Congenital Zika Virus Syndrome and other congenital infections

As consequências da microcefalia associada à Síndrome Congênita do Zika Vírus (SCZ) e outras infecções congênitas no desenvolvimento dentário da criança afetada ainda não são bem conhecidas. Os objetivos deste estudo foram avaliar a frequência de alterações dentárias em crianças com microcefalia, analisar se há associação das alterações dentárias com a SCZ e verificar se a microcefalia é fator de risco para as alterações dentárias. Para isso, foram realizados dois estudos observacionais transversais e um estudo do tipo caso-controle. Um único examinador calibrado (Kappa > 0,8) avaliou a presença de alterações dentárias de número, forma e tamanho, alterações na cronologia e sequência de irrupção dentária e alterações no desenvolvimento do esmalte dentário em crianças com microcefalia, associada à SCZ e outras infecções congênitas, e em crianças normoreativas. Informações relacionadas à gestação da mãe e ao nascimento da criança foram coletadas e um questionário socioeconômico foi aplicado. Os dados foram avaliados descritivamente e, como testes de associação, foram utilizados o teste do Qui-quadrado e Exato de Fisher, considerando um nível de significância de 5% (estudos 2 e 3). A amostra do primeiro estudo foi composta por 49 crianças entre 7 e 35 meses de idade apresentando microcefalia associada à SCZ. As alterações mais prevalentes foram as relacionadas à cronologia de irrupção (93,9%; IC95%= 89­99%), às alterações no desenvolvimento do esmalte dentário (76,1%; IC95%= 64­88%) e sequência de irrupção dentária (71,7%; IC95%= 60­84%). No segundo estudo, 62 crianças, com idade entre 7 e 35 meses, portadoras de microcefalia associada à SCZ e outras infecções congênitas compuseram a amostra. Não houve associação estatisticamente significativa entre a SCZ e a presença de alteração na cronologia (p = 1,00) e sequência de irrupção dentária (p = 0,16) e de desenvolvimento do esmalte dentário (p = 1,00). No estudo de caso-controle, 81 crianças entre 30 e 35 meses de idade, normoreativas e portadoras de microcefalia, fizeram parte da amostra, a qual, após identificadas as frequências de cada uma das alterações dentárias, foi emparelhada pelo sexo e idade, na proporção 1:1, e alocadas nos grupos caso (presença de alterações dentárias) e controle (ausência de alterações dentárias). A presença de microcefalia mostrou-se estatisticamente associada ao atraso na irrupção dentária (p < 0,001), à presença de alterações na sequência de irrupção dentária (p < 0,001) e de defeitos no esmalte dentário (p < 0,001). Concluiu-se que as crianças com microcefalia associada à SCZ apresentaram atraso na irrupção dentária, alterações na sequência irruptiva e opacidade do esmalte dos dentes decíduos, no entanto, a infecção pelo vírus Zika não foi associada à ocorrência dessas alterações dentárias. A microcefalia, independente de sua etiologia, é fator de risco para alterações relacionadas ao processo de irrupção dentária e ao desenvolvimento do esmalte dos dentes decíduos (AU).

The consequences of microcephaly associated with Congenital Zika Virus Syndrome (CZS) and other congenital infections on the dental development of the affected child are not well known. The objectives of this study were to evaluate the frequency of dental alterations in children with microcephaly, to analyze if there is an association of dental alterations with CZS, and to verify if microcephaly is a risk factor for dental alterations. For this, two crosssectional observational studies and one case-control study were performed. A single calibrated examiner (Kappa > 0,8) evaluated the presence of dental alterations of number, shape and size, alterations in the chronology and sequence of tooth eruption, and alterations in the tooth enamel development in children with CZS and other congenital infections, as well as in normoreactive children. Information related to mothers' pregnancies and child births were collected and a socioeconomic questionnaire was applied. Data were descriptively evaluated and chi-square test and Fisher's exact test were used as association tests considering a significance level of 5% (studies 2 and 3). The first study sample consisted of 49 children between 7 and 35 months of age with CZS-associated microcephaly. The most prevalent alterations were related to the eruption chronology (93.9%), changes in the development of the enamel (76.1%) and the dental eruption sequence (71.7%). Next, 62 children aged 7 to 35 months with CZS-associated microcephaly and other congenital infections comprised the sample in the second study. There was no statistically significant association between CZS and the presence of changes in chronology (p = 1.00), sequence of tooth eruption (p = 0.16) and tooth enamel development (p = 1.00). In the case-control study, 81 normoreactive children and children with microcephaly between 30 and 35 months of age were part of the sample, which were then paired by gender and age at a 1:1 ratio after identifying the frequencies of each of the dental alterations, and then allocated to the case (presence of dental changes) or control (absence of dental changes) groups. The presence of microcephaly was statistically associated with delayed tooth eruption (p<0.001), the presence of changes in tooth eruption sequence (p<0.001) and dental enamel defects (p<0.001). It was concluded that children with CZS-associated microcephaly had delayed dental eruption, alterations in the eruptive sequence and hypomineralization of primary tooth enamel; however, a Zika virus infection was not associated with these dental changes. A microcephaly, regardless of its etiology, is a risk factor for changes related to the tooth eruption process and the development of primary tooth enamel. It is concluded that microcephaly associated with CZS and other congenital infections is a risk factor for delayed tooth eruption, alterations in the eruptive sequence and defects in dental enamel development occurring (AU).

Comparação da efetividade entre polietilenoglicol 4000 sem eletrólitos e hidróxido de magnésio no tratamento da constipação intestinal crônica funcional em crianças / Comparison of the effectiveness of polyethylene glycol 4000 without electrolytes and magnesium hydroxide in the treatment of chronic functional constipation in children

OBJETIVO: Comparar a efetividade de dois medicamentos: hidróxido de magnésio e polietilenoglicol 4000 sem eletrólitos no tratamento da constipação intestinal crônica funcional em crianças. MÉTODOS: Trinta e oito crianças foram divididas, por processo randômico, em dois grupos para uso de polietilenoglicol 4000 sem eletrólitos ou de hidróxido de magnésio. As crianças foram acompanhadas em consultas periódicas até completarem 6 meses de tratamento. Em todas as consultas, foram investigados: consistência das fezes, frequência evacuatória, presença de escape fecal, dor abdominal, esforço evacuatório e aceitação desses fármacos. RESULTADOS: Dezessete crianças fizeram uso de polietilenoglicol, e 21 utilizaram o hidróxido de magnésio. Houve melhora clínica de todas as variáveis nos dois grupos, sem diferenças com significância estatística. Todas as crianças aceitaram o polietilenoglicol, enquanto 42,9 por cento recusaram o hidróxido de magnésio. CONCLUSÃO: Não houve diferença de efetividade no tratamento da constipação intestinal entre esses dois laxantes. Entretanto, a melhor aceitação do polietilenoglicol, por ser inodoro e insípido, torna-o melhor opção no tratamento da constipação intestinal crônica funcional.

OBJECTIVE: To compare the effectiveness of two drugs, polyethylene glycol 4000 without electrolytes and magnesium hydroxide, in the treatment of chronic functional constipation in children. METHODS: Thirty-eight children were randomly assigned to either of two groups, polyethylene glycol 4000 without electrolytes or magnesium hydroxide. The children were followed through periodic appointments until they reached 6 months of treatment. In each medical appointment the following aspects were evaluated: stool consistency, frequency of bowel movements, fecal incontinence, abdominal pain, straining and acceptance of the drugs. RESULTS: Seventeen children made use of polyethylene glycol and twenty-one received magnesium hydroxide. All variables analyzed improved for both groups, with no statistically significant differences. All children accepted polyethylene glycol, while 42.9 percent refused magnesium hydroxide. CONCLUSION: The two laxatives showed no difference in effectiveness for the treatment of constipation. However, due to its better acceptance, because it is odorless and tasteless, polyethylene glycol proved to be a better option for treating chronic functional constipation.

Polietilenoglicol na constipação intestinal crônica funcional em crianças / Polyethylene glycol in the treatment of chronic functional constipation in children

OBJETIVO: Rever a literatura sobre o uso do polietile-noglicol no tratamento da constipação intestinal crônica funcional em crianças. FONTES DOS DADOS: Foram selecionadas publicações entre 1998 e 2009, utilizando as bases de dados Medline e SciELO. Foram incluídos estudos relevantes referentes à constipação, ao uso do polietilenoglicol em adultos, a diretriz recente da NASPGHAN e os critérios de ROMA III relativos às doenças intestinais funcionais. SÍNTESE DOS DADOS: O tratamento da constipação intestinal em crianças é dividido em várias etapas não consecutivas. O uso prolongado de laxativos é uma dessas etapas; no entanto, as opções terapêuticas são restritas. Os efeitos adversos e a dificuldade de aceitação pela criança são os principais problemas que surgem com o uso prolongado de laxativos. O polietilenoglicol é um laxativo osmótico utilizado para o tratamento da constipação, com absorção de 0,2 por cento, insípido e inodoro, disponível com os pesos moleculares 3350 e 4000 Dalton, com ou sem adição de eletrólitos. Estudos randomizados e controlados demonstraram ser o polietilenoglicol um agente efetivo na melhora dos sintomas, além de ser seguro, pois não foram relatados efeitos colaterais significativos. CONCLUSÕES: O polietilenoglicol é superior aos outros agentes osmóticos em relação ao sabor e à aceitação pelas crianças. O uso diário é seguro e efetivo e pode ser considerado uma opção terapêu-tica na constipação intestinal crônica funcional em pediatria.

OBJECTIVE: To review the literature about the use of the polyethylene glycol in the treatment of chronic functional constipation in children. DATA SOURCE: Articles published between 1998 and 2009 were selected from Medline and SciELO databases. Relevant articles concerning constipation, the use of polyethylene glycol in adults, the recent NASPGHAN guideline and the ROMA III criteria were also included. DATA SYNTHESIS: The treatment of functional constipa-tion in children is composed of several stages, among which is the long-term use of laxative drugs. The therapeutic options are limited and they carry problems related to long-term use, especially due to the adverse effects and child's low adherence to the treatment. Polyethylene glycol is an odorless, tasteless and minimally absorbed osmotic agent, available in 3350 and 4000 molecular weights, with or without electrolytes. Good results have been reported in controlled and randomized studies regarding the improve-ment of symptoms of constipation. It is considered safe, without significant side effects. CONCLUSIONS: Polyethylene glycol is superior to other osmotic agents as far as taste and children's acceptance are concerned. Low daily doses are safe and effective. It is a good treatment option for chronic functional constipation in children.

Dor de dente e sua relação com a experiência de cárie em adolescentes / Toothache and its relationship with caries experience in teenagers

Objetivo: Verificar a prevalência de dor de dente relatada por escolares e a sua relação com a experiência de cárie, bem como a necessidade de tratamento, em escolares de 12 anos de Paulínia, São Paulo. Métodos: Foram examinados 413 escolares de escolas públicas de Paulínia, São Paulo, em 2004, selecionados mediante processo amostral aleatório sistemático. Os selecionados responderam a um questionário sobre questões relacionadas a dor de dente e passaram por um exame bucal. Na análise estatística, utilizaram-se os testes Mann-Whitney e Qui-Quadrado, com nível de significância de 5%. Resultados: A prevalência de dor de origem bucal foi de 22,8% e o CPO-D no município foi de 0,9 (Intervalo de Confiança=0,8-1,1). Os estudantes que relataram dor apresentaram índice de CPO-D mais elevado e maior percentual de dentes cariados que os do grupo sem relato de dor (p<0,05). Além disto, os escolares com relato de dor apresentaram maior percentual de dentes com necessidade de tratamento curativo (p=0,033), apresentando mais indicação de restaurações com duas ou mais superfícies (p=0,017).Conclusão: Apesar de o município apresentar muito baixa experiência de cárie, um percentual considerável (22,8% dos adolescentes) relatou que sentiu dor de dente. O grupo que relatou dor teve piores condições de saúde bucal. Além disso, neste mesmo grupo, houve mais faltas à escola e um impacto negativo em relação à satisfação com a aparência dos dentes.

Objective: To verify the prevalence of toothache and its relationship with dental caries experience and treatment needs among schoolchildren aged 12 in the city of Paulínia, São Paulo, Brazil. Methods: The 413 schoolchildren chosen to participate in this survey were selected by systematic random sampling from public schools and were examined in 2004. The subjects answered a questionnaire and underwent an oral exam. For the statistical analysis, the Mann-Whitney and Chi-squared tests were used. Results: Prevalence of toothache was 22.8% and the DFMT was 0.9 (IC=0.8-1.1). The students that presented toothache showed a higher DFMT index and percentage of decayed teeth than the group that did not report pain (p <0.05). Moreover, schoolchildren who reported toothache had a higher percentage of teeth with restorative treatment needs (p=0.033). The most prevalent treatment needs were restorations in 2 or more surfaces (p=0.017). Conclusion: Although this city presented very low caries experience, a considerable percentage of the adolescents reported having toothache (22.8%), The group with toothache had the worst oral health conditions. Furthermore, in this same group, there were more absences from school and a negative impact on satisfaction with the appearance of the teeth.

Atividade de cárie em adolescentes de município com muito baixa prevalência de cárie: Paulínia, São Paulo, 2004 / Dental caries activity in adolescents of city with very low dental caries prevalence: Paulínia, São Paulo, 2004

Os objetivos deste trabalho foram verificar a atividade de cárie, além de conhecer a prevalência de cárie e fluorose e as necessidades de tratamento em escolares de 12 anos de idade do município de Paulínia. Foram examinadas 413 crianças, de escolas públicas e particulares de Paulínia, São Paulo, em 2004, selecionadas mediante processo amostral aleatório sistemático. Para medir a experiência de cárie, necessidades de tratamento e fluorose dentária adotou-se os critérios da OMS (1997). Para a atividade de cárie, optou-se por uma simplificação dos critérios de diagnóstico de Nyvad et al. (1999). Os índices utilizados para cárie dentária foram: CPOD e Significant Caries Index (SiC). Os livres de cárie representaram 60,8% dos escolares. O CPOD foi de 0,9 (IC95%=0,8-1,1). O maior componente do CPOD foi o obturado (52,3%) seguido pelo componente cariado (47,2%). Nas crianças que apresentaram atividade de cárie o CPOD foi de 1,37 (IC95%=1,1-1,7) e nas sem atividade de cárie o CPOD foi de 0,57 (IC95%=0,4-0,7) (p<0,01). 38,7% das necessidades de tratamento foram referentes à selantes e 35,1% de restaurações de uma superfície. Dentre as crianças que apresentaram fluorose, 36,6% (n=151) era o grau muito leve. O valor do índice SiC foi de 2,5. Paulínia já alcançou as metas da OMS para 2010 para a idade de 12 anos, assim sendo, recomenda-se que cuidados diferenciados sejam intensificados nos escolares que compõem o SiC, visando assim controlar a cárie dentária também neste grupo. Recomenda-se que novos estudos sejam realizados, com enfoque à atividade, com o intuito de se interferir em lesões de cárie incipientes, utilizando procedimentos não invasivos.

The objectives of this work were to verify the caries activity and to know the caries and fluorosis prevalence among 12-year-old schoolboys and girls in the municipality of Paulinia. Four hundred and thirteen children from public and private schools selected by means of systematic random sampling process were investigated. In order to assess the caries experience, treatment necessities and dental flourosis, the WHO criteria were adopted (1997). For caries activity, the Nyvad et al. (1999) simplified diagnosis criteria were adopted. The indexes used for dental caries were: CPOD and Significant caries Index (SiC). Those free from caries represented 60.8% of students. The CPOD index was of 0.9 (IC95% = 0.8-1.1). The obturated component (52.3%) was the first for CPOD, followed by the decayed component (47.2%). In children presenting caries activity, the COPD was of 1.37 (IC95%=1.1-1.7) and in those without caries activity, the COPD was of 0.57 (IC95%=0.4-0.7) (p<0.01). 38.7% of the treatment necessities referred to the application of fissure sealants and 35.1% to the restoration of 1 surface. Among children who presented fluorosis, 36.6% (n=151) were of very low intensity. The SiC index value was of 2.5. The municipality of Paulinia has already achieved the WHO goals for 2010 for 12-year-old children; therefore, it is recommended that differentiated cares should be intensified among students who compose the SiC with the objective of controlling the incidence of dental caries also within this group. Further studies should be conducted and aimed at caries activity with the objective of interfering in incipient caries lesions using non-invasive procedures.