Evaluation of primary headache associated with temporomandibular dysfunction in adolescents from Santos, SP, Brazil: an observational study.

[Purpose] Evaluate the association of primary headache and Temporomandibular Dysfunction in healthy adolescents from the Santos, SP, Brazil. [Participants and Methods] A total of 208 adolescents, aged 11 to 16 years old were randomly selected at the dentistry clinic at Universidade Metropolitana de Santos. For that, the Fonseca Anamnestic Index was applied, including information such as: limitation when opening the mouth and moving the jaw, headaches, pain in the temporomandibular joint, noises in the temporomandibular joint, and the habit of tightening or grinding the teeth. The data were submitted to descriptive statistical analysis and the χ2 test and Fisher's exact test were used to evaluate the association of categorical variables. [Results] The results were 63% of male participants, and 61% of female participants had Temporomandibular Dysfunction. In both genders headache was associated with the presence of Temporomandibular Dysfunction, with 93 participants with light headache and 39 with moderate headache. [Conclusion] There was an association between headache and the presence of Temporomandibular Dysfunction, and the percentage of affected males was slightly higher among this association. In the sample of adolescents who presented Temporomandibular Dysfunction, moderate headache was the main reported symptom of both genders.

Evaluation of muscle activity, bite force and salivary cortisol in children with bruxism before and after low level laser applied to acupoints: study protocol for a randomised controlled trial.

BACKGROUND: Bruxism is a repetitive activity that causes tooth wear, audible sounds, and discomfort. Preventive measures have been studied for conditions that can exert a negative influence on physiological development in children. Low-level laser therapy administered over acupoints is an effective, painless, low-cost treatment option that has achieved good results. Thus, the aim of the proposed study is to evaluate changes in muscle activity, bite force and salivary cortisol in children with bruxism after the application of low-level laser to accupoints. METHODS: The children will be randomly allocated to four groups of 19 individuals: G1 - low-level laser; G2 - occlusal splint; G3 - placebo laser; and G4 - control (without bruxism). The BTS TMJOINT electromyography will be used to determine muscle activity and a digital gnathodynamometer will be used to measure bite force. Salivary cortisol will be analysed at baseline as well as one and six months after treatment. Two-way ANOVA will be employed and complemented by Tukey's test. DISCUSSION: Bruxism is a repetitive activity of the masticatory muscles that can have negative consequences if not treated, such as tooth wear, noises, discomfort and anxiety. Thus, control and treatment measures should be taken. Although low-level laser therapy over acupoints has been indicated for children, the effects of this treatment modality have not yet been studied. TRIAL REGISTRATION: NCT02757261 on 8 April 2016. This study protocol received a grant from the Brazilian fostering agency São Paulo Research Foundation (FAPESP: #2015/24731-0).

The relationship between bruxism, sleep quality, and headaches in schoolchildren.

[Purpose] Present study aimed to evaluate the relationship between sleep bruxism and headache in school children. [Subjects and Methods] This study was conducted with 103 children aged 3-6 years. The exclusion criteria were early tooth loss, dental appliance was used, physical or psychological limitations, chronic disease and continuous medication. Sleep bruxism was diagnosed based on an indication by parents of the occurrence of teeth clenching/grinding and incisor/occlusal tooth wear, following the criteria of the American Academy of Sleep Medicine. Sleep quality was evaluated by a questionnarie, detailing the child's sleep characteristics. [Results] Forty-nine children (47.6%) were diagnosed with sleep bruxism. Those with sleep bruxism were 3.25-fold more likely to present headache. Children whose parents were separated had a significantly greater frequency of sleep bruxism and primary headache. The relative risk of exhibiting primary headache was 13.1 among children with sleep bruxism whose parents were separated. [Conclusion] Children with SB demonstrated a greater risk of having primary headache and those whose parents were separated had a greater chance of having headache. Only sleep bruxism was associated with headache, clenching the teeth during waking hours was not correlated with primary headache.

Evaluation of electromyographic signals in children with bruxism before and after therapy with Melissa Officinalis L-a randomized controlled clinical trial.

[Purpose] Bruxism is a repetitive muscle activity involving the clenching or grinding of one's teeth during sleep or waking hours. Melissa officinalis L. may be employed as a natural therapy due to the sedative, anxiolytic, anti-inflammatory, and anti-spasm properties of the chemical constituents of the essential oil obtained from its leaves. The aim of the present study was to evaluate electromyographic signals in the temporal muscle using the BiteStrip(®) test on children with sleep bruxism before and after therapy with Melissa officinalis L. [Subjects and Methods] The subjects were randomly allocated to two groups. Group 1 (n = 12) ingested a tincture containing Melissa officinalis L. for 30 days. Group 2 (n = 12) received a placebo solution with the same dose and frequency as Group 1. The Wilcoxon and Mann-Whitney tests were employed for statistical analysis. [Results] The sample was made up of 24 children aged 6 to 10 years. No statistically significant differences were found between initial and final muscle activity in either group or in an intergroup comparison. [Conclusion] Use of the Melissa officinalis L. tincture at the dose employed did not lead to a reduction in muscle activity in children with bruxism.

Effect of low-level laser therapy on adolescents with temporomandibular disorder: a blind randomized controlled pilot study.

PURPOSE: The aim of this pilot study was to evaluate the effect of low-level laser therapy on pain, mandibular movements, and occlusal contacts in adolescents and young adults with temporomandibular disorder. MATERIALS AND METHODS: Individuals aged 14 to 23 years were evaluated. The Research Diagnostic Criteria for Temporomandibular Disorders were used for the diagnosis of temporomandibular disorders. Pain was assessed with a visual analog scale. Occlusal contacts were recorded using the T-Scan III program (Tekscan, Boston, MA). The participants were randomly allocated to 2 groups: active or placebo laser treatment. The laser parameters were as follows: wavelength of 780 nm, energy density of 33.5 J/cm(2), power of 50 mW, power density of 1.67 W/cm(2), and 20-second exposure time. The Kolmogorov-Smirnov test was used to determine the normality of the data distribution. The paired t test was used for the comparisons of the pretreatment and post-treatment results. The SPSS program for Windows (version 15.0; SPSS, Chicago, IL) was used for all analyses, with the level of significance set at 5% (P < .05). RESULTS: No statistically significant differences between groups were found for the right and left anterior temporal muscles (P = .3801 and P = .5595, respectively), superior masseter muscles (P = .087 and P = .1969, respectively), medial masseter muscles (P = .2241 and P = .076, respectively), or inferior masseter muscles (P = .5589 and P = .3268, respectively) after treatment. CONCLUSIONS: No statistically significant differences were found regarding pain, mandibular range of motion, or the distribution of occlusal contacts after treatment with low-level laser therapy. These preliminary results need to be verified in a larger sample of patients to confirm the lack of response to low-level laser therapy.

Influence of temporomandibular disorder on temporal and masseter muscles and occlusal contacts in adolescents: an electromyographic study.

BACKGROUND: The aim of the present study was to analyse the influence of temporomandibular disorder (TMD) on electromyographic activity in the masseter and temporal muscles of adolescents and investigate a possible association with the number of occlusal contacts. METHODS: The Helkimo Index was administered for the diagnosis of TMD and classification of the adolescents into three groups: without TMD; with mild TMD; and with moderate/severe TMD. Carbon paper was used for the determination of occlusal contact points. A standardised electromyographic evaluation was performed on the masticatory muscles at rest, during habitual chewing and during maximum voluntary clenching. The readings were normalised to maximum voluntary clenching. Statistical analysis involved the chi-squared test and Fisher's exact test. The Kruskal-Wallis test and one-way analysis of variance with Dunn's post hoc test were used to compare differences between groups. Pearson's correlation coefficients (r) were calculated for the determination of correlations between the number of occlusal contacts and RMS values. RESULTS: Electromyography revealed significant differences in the right and left masseter and temporal muscles at rest and during chewing among the three groups. These differences were not observed during maximum voluntary clenching. No statistically significant differences were found between the groups with and without TMD regarding the number of occlusal contacts. CONCLUSION: Electromyographic activity in the masseter and temporal muscles was greater among adolescents with moderate to severe TMD.

Chemo-mechanical caries removal with Papacarie™: case series with 84 reports and 12 months of follow-up.

AIM: The aim of the present study was to determine the success rate after 12 months of follow-up in a series of cases in which chemo-mechanical caries removal (CMCR) was performed with Papacarie(TM), followed by restoration with glass ionomer cement. BACKGROUND: The development of conservative techniques for carious tissue removal and improvements in dental restoration materials have allowed better preservation of dental structures in the treatment of decayed teeth. Chemo-mechanical caries removal (CMCR) is a conservative atraumatic treatment option. Papacarie(TM) is a papain-based material developed to act only on the carious dentin, allowing its easy removal with a blunt curette. CASE REPORT: The study involved a total of 84 deciduous posterior teeth with occlusal dentinal caries. Only teeth without risk of pulp exposure were studied. After a period of 12 months, the restorations were evaluated based on criteria employed in previous studies. The radiographic evaluation revealed resorption and calcification of the affected teeth. The data were submitted to descriptive statistical analysis with the aid of the XLSTAT program. The success rate was 88.1% and 98.8% based on the clinical and radiographic evaluations, respectively. The difference between the success and failure rates was statistically significant (p < 0.0001). CONCLUSION: Papacarie(TM) is an effective product for CMCR on occlusal dentinal tissue in deciduous teeth, demonstrating a high clinical and radiographic success rate after 12 months of follow-up.

Use of photobiomodulation (880 nm) for anesthesia puncture pain reduction: A split-mouth case report.

The objective of this split-mouth case report is to evaluate the effect of photobiomodulation (PBM, 880 nm) on pain control during pterygomandibular puncture. A patient received anesthesia on both sides of the mouth in a randomized manner. On the right side, an 880-nm infrared laser was applied immediately before local anesthesia. On the left side, a sham laser was applied using the same technique. There was a 50% reduction in pain levels on the PBM-treated side compared to the PBM-sham side, as measured by the visual analog scale. Sensitivity tests revealed that anesthesia was more effective on the PBM side. There was no difference in blood pressure. This case report suggests that PBM (880 nm) before anesthesia may alleviate puncture pain associated with pterygomandibular anesthesia. Although these findings are based on a single case report, they can serve as the initial stepping stone for further randomized clinical trials.

A minimal interventive protocol using antimicrobial photodynamic therapy on teeth with molar incisor hypomineralization: A case report.

Molar incisor hypomineralization (MIH) is a qualitative developmental defect of enamel that occurs during the mineralization phase. Patients with MIH have increased risk of caries, hypersensitivity, and restoration failures. The present case report describes the treatment of a 10-year-old patient exhibiting two teeth with atypical carious lesions. A minimal interventive protocol was instituted combining antimicrobial photodynamic therapy and the selective chemical-mechanical removal of the carious tissue using the product Papacárie Duo®. This protocol is promising for the decontamination and control of hypersensitivity in teeth with MIH.

Assessment of the pre-emptive effect of photobiomodulation in the postoperative period of impacted lower third molar extractions: A randomized, controlled, double-blind study protocol.

Photobiomodulation is a safe option for controlling pain, edema, and trismus when applied postoperatively in third molar surgery. However, administration prior to surgery has been under-explored. This study aims to explore the effectiveness of pre-emptive photobiomodulation in reducing postoperative edema in impacted lower third molar extractions. Two groups of healthy individuals undergoing tooth extraction will be randomly assigned: Control group receiving pre-emptive corticosteroid and simulated photobiomodulation, and Photobiomodulation Group receiving intraoral low-intensity laser and extraoral LED cluster application. The primary outcome will be postoperative edema after 48 h. The secondary outcomes will be pain, trismus dysphagia, and analgesic intake (paracetamol). These outcomes will be assessed at baseline as well as two and seven days after surgery. Adverse effects will be recorded. Data will be presented as means ± SD and a p-value < 0.05 will be indicative of statistical significance.

Short term effect of antimicrobial photodynamic therapy and probiotic L. salivarius WB21 on halitosis: A controlled and randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) and the use of probiotics on the treatment of halitosis. METHODS: Fifty-two participants, aged from 18 to 25 years, exhaling sulfhydride (H2S) ≥ 112 ppb were selected. They were allocated into 4 groups (n = 13): Group 1: tongue scraper; Group 2: treated once with aPDT; Group 3: probiotic capsule containing Lactobacillus salivarius WB21 (6.7 x 108 CFU) and xylitol (280mg), 3 times a day after meals, for 14 days; Group 4: treated once with aPDT and with the probiotic capsule for 14 days. Halimetry with gas chromatography (clinical evaluation) and microbiological samples were collected from the dorsum of the tongue before and after aPDT, as well as after 7, 14, and 30 days. The clinical data failed to follow a normal distribution; therefore, comparisons were made using the Kruskal-Wallis test (independent measures) and Friedman ANOVA (dependent measures) followed by appropriate posthoc tests, when necessary. For the microbiological data, seeing as the data failed to follow a normal distribution, the Kruskal-Wallis rank sum test was performed with Dunn's post-test. The significance level was α = 0.05. RESULTS: Clinical results (halimetry) showed an immediate significant reduction in halitosis with aPDT (p = 0.0008) and/or tongue scraper (p = 0.0006). Probiotics showed no difference in relation to the initial levels (p = 0.7530). No significant differences were found in the control appointments. The amount of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were not altered throughout the analysis (p = 0.1616, p = 0.2829 and p = 0.2882, respectively). CONCLUSION: There was an immediate clinical reduction of halitosis with aPDT and tongue scraping, but there was no reduction in the number of bacteria throughout the study, or differences in the control times, both in the clinical and microbiological results. New clinical trials are necessary to better assess the tested therapies. TRIAL REGISTRATION: Clinical Trials NCT03996044.

Association between parafunctional habits and signs and symptoms of temporomandibular dysfunction among adolescents.

PURPOSE: To determine associations between signs and symptoms of temporomandibular disorder (TMD) and harmful oral habits. MATERIALS AND METHODS: Two hundred forty-four adolescents from a public school in the city of São Roque, Brazil, were evaluated. A screening questionnaire for orofacial pain and TMD recommended by the American Academy of Orofacial Pain was used to determine signs and symptoms of TMD. Patient histories and clinical exams were used to determine harmful oral habits. RESULTS: Eighty-three participants (34%) displayed no signs or symptoms of TMD, 161 (66%) responded affirmatively to at least one item on the questionnaire and 49 (20.1%) gave at least three affirmative responses. Headache was the most frequently reported sign or symptom of TMD (40.6%; n = 99). There was no statistically significant association between gender and signs or symptoms of TMD (P = 0.281). Twenty-five percent (n = 61) of the patients had no harmful oral habits, while 16.4% (n = 40) had only one habit, the most common of which was nail biting. A total of 20.1% (n = 49) reported two harmful oral habits and 38.5% (n = 94) reported three or more such habits. There was a statistically significant association between signs and symptoms of TMD and three or more habits. CONCLUSION: A statistically significant association was found between signs and/or symptoms of TMD and harmful oral habits in adolescents.

Pericoronitis treatment with antimicrobial photodynamic therapy using a new formula of methylene blue: A case report.

Pericoronitis is a common disease that impacts the quality of life of individuals during the eruption of the third molars. Among the main clinical signs and symptoms reported were the presence of gingival operculum, pain, difficulty swallowing, and trismus with functional impairment. The present study shows a case report of pericoronitis treated with antimicrobial photodynamic therapy (aPDT), using a new oral formulation (INPI BR 1020170253902) of methylene blue. A female patient, 27 years old, presenting initial pericoronitis, had her pain, mouth opening, and swelling evaluated. She was submitted to a protocol of irrigation with sterile saline and photodynamic therapy using the new MB at 0.005% concentration and irradiation with low-intensity laser λ = 660 nm, 9 J per point, and radiant exposure of 318 J/cm2. The variables were evaluated on 4th day after aPDT. There was a 100% improvement in pain and an increase of 1,3 cm in mouth opening. There was no difference in the edema before and after aPDT using the new MB formula. Although the results are based on a single case report, suggest the hypothesis that aPDT using the new MB formula is an efficient therapy in the treatment of pain and trismus caused by the early stage of pericoronitis. Well-conducted randomized clinical trials are needed to compare this new formulation with conventional aPDT for further generalization of results.

Efficacy of antibiotic and iodoform pastes in non-instrumental endodontic treatment of anterior primary teeth-Protocol for a randomized controlled clinical.

The maintenance of the deciduous tooth until its physiological exfoliation occurs is one of the main objectives of pediatric dentistry. Endodontic treatment in deciduous teeth resulting from carious or traumatic lesions with pulpal involvement is often necessary and we often find it difficult to perform it, due to the difficult control of the child, the internal anatomy of the root canals, and root resorptions. The non-instrumental endodontic treatment technique (NIET) associated with antimicrobial drugs has advantages such as shorter chair time and less complexity than the conventional technique in which root canal instrumentation is performed. The aim of this study is to carry out a controlled and randomized clinical trial to compare the effectiveness of (NIET) in primary teeth associated with the use of two obturator pastes. One hundred and twenty necrotic deciduous teeth of children aged between 3 and 6 years will be selected; and the teeth will be divided into two groups. In Group 1 and Group 2, root canals will not be instrumented, just irrigated and filled with the respective pastes, antibiotic (CTZ) and iodoform (Guedes-Pinto). Presence of fistula and mobility will be clinically evaluated. The evaluations will be carried out in both groups on the day of treatment and in periods of 1, 3 and 6 months after treatment. For the main outcome, the tooth will be the unit of analysis and the Kaplan-Meier test will be performed to estimate the survival rates of the included teeth. For comparison between the two groups, Student's t test or Mann-Whitney test will be performed, depending on the normality of the data. In addition, Poisson regression analyzes will be carried out, in order to allow the evaluation of the influence of some variables on the results. For all analyses, the significance value will be adjusted to 5%. Trial registration: NCT04587089 in ClinicalTrials.gov. Approval date: May 15, 2023.

Application of Photodynamic Therapy in Pediatric Dentistry: Literature Review.

Microbiological control of dental pathologies presents a significant clinical challenge for dental surgeons, particularly considering drug-resistant microorganisms. To address this issue, Antimicrobial Photodynamic Therapy (PDT) has emerged as an effective and complementary technique for microbial reduction. This therapy involves the application of a photosensitizer dye (PS) either topically or systemically, followed by exposure to low-power lasers with appropriate visible light wavelengths. PDT has found a valuable place in dentistry across various specialties, including surgery, periodontics, endodontics, dentistry, implantology, orthodontics, and pediatrics. In the realm of pediatric dentistry, managing microorganisms during dental treatments has become a major challenge. Considering its promising results and ease of application, Photodynamic Therapy presents an interesting alternative for clinical practice. However, it is important to note that specific protocols must be followed for each application, encompassing the type of photosensitizer, concentration, pre-irradiation time, light type, wavelength, energy, power, and mode of light delivery. Researchers have been steadily refining these protocols to facilitate PDT's integration into clinical practice. The objective of this review is to describe in which procedures and oral health problems in children PDT can be applied. In this sense, we list what the literature brings about the possibilities of applying PDT in a pediatric dentistry clinic.

Investigation on the effect of antimicrobial photodynamic therapy as an adjunct for management of deep caries lesions-study protocol for a randomized, parallel groups, controlled clinical trial.

BACKGROUND: Alternatively to conventional treatments, chemo-mechanical caries removal agents can be used. A modality of treatment that has been increasing in dentistry is antimicrobial photodynamic therapy (aPDT). Bixa orellana is being researched for application in aPDT. This protocol aims to determine the effectiveness of aPDT with Bixa orellana extract in deep caries lesions. METHODS: A total of 160 teeth with deep occlusal dental caries will be selected and divided into 4 groups: G1 - control group (Caries removal with a low-speed drill); G2 - Partial Caries Removal with Papacarie™ (Fórmula e Ação, São Paulo, SP, Brazil); G3 - Partial Caries Removal with Papacarie™ and application Bixa orellana extract (20%) (Fórmula e Ação, São Paulo, SP, Brazil); G4 - Partial Caries Removal with Papacarie™ and application Bixa orellana extract (20%) with LED (Valo Cordless Ultradent®, South Jordan, UT, USA) (aPDT). After treatment, all the teeth will be restored with glass ionomer cement and followed up clinically and radiographically, with evaluations at immediately, 1 week, and 1, 3, 6, and 12 months. Dentin samples before and after treatment will be analyzed microbiologically. The efficacy of treatments will be assessed with microbiological (colony-forming units, before and after carious tissue removal), radiographic (integrity of the periapical area and eventual changes in the radiolucent zones), and clinical examinations (retention of the restorative material in the cavity and occurrence of secondary caries), as well as with the time required for the procedures and the need for anesthesia during the procedures. In case data distribution is normal, analysis of variance (ANOVA) will be used for both the dependent and independent variables. In case the data distribution is not normal, the Friedman test will be used for the dependent variables. For independent variables, the Kruskal-Wallis test will be used. DISCUSSION: Procedures using aPDT have been developed for the treatment of dental caries, but there are few controlled clinical trials in the literature confirming its efficacy. TRIAL REGISTRATION: This protocol is registered at ClinicalTrials.gov under the number NCT05236205 and it was first posted on 01/21/2022 and last updated on 05/10/2022.

Photobiomodulation and glass ionomer sealant as complementary treatment for hypersensitivity in molar incisor hypomineralisation in children: protocol for a blinded randomised clinical trial.

INTRODUCTION: Photobiomodulation has been widely used as a complementary treatment for dentin hypersensitivity, with reports of clinical success. However, the literature offers only one study, in which photobiomodulation was used for the treatment of sensitivity in molars with molar incisor hypomineralisation (MIH). The aim of the proposed study is to determine whether photobiomodulation enhances the results of treatment with glass ionomer sealant on molars with MIH that present sensitivity. METHODS AND ANALYSIS: The study involves 50 patients from 6 to 12 years of age that will be randomly allocated in two groups. Group 1 (control group) (n=25): toothpaste with a concentration of fluoride ≤1000 ppm two times a day, glass ionomer sealant and sham low-level laser (LLL) and group 2 (n=25): toothpaste with a concentration of fluoride ≤1000 ppm two times a day, glass ionomer sealant and active LLL. The evaluations will involve MIH record, Simplified Oral Hygiene Index (OHI), Schiff Cold Air Sensitivity Scale (SCASS) and visual analogue scale (VAS) before the procedure. Immediately after the procedure, the hypersensitivity index (SCASS/VAS) will be registered. Records of OHI and SCASS/VAS will be registered after 48 hours as well as 1 month after the procedure. The persistence of the sealant will also be registered. It is expected that by the second consultation, a decrease in sensitivity will be observed due to the treatments received in the two groups. ETHICS AND DISSEMINATION: This protocol has been approved by the local medical ethical committee (certificate: CEUCU 220516). The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05370417.

Photobiomodulation increases uprighting tooth movement and modulates IL-1ß expression during orthodontically bone remodeling.

This study investigated the effects of photobiomodulation (PBM) in acceleration of orthodontic movement of inferior molar uprighting movement. Thirty-four individuals, with indication of molar uprighting movement for oral rehabilitation, were randomly divided in two groups: verticalization + PBM (808 nm, 100 mW, 1 J per point, 10 points and 25 J/cm2 ) or verticalization + PBM simulation. Elastomeric chain ligatures were changed every 30 days for 3 months. FBM was performed immediately, 24 h, 72 h, 1 and 2 months after activation. The primary outcome was the amount of uprighting movement. Secondary outcomes were pain, amount of medication, OHIP-14 questionnaire, and cytokine IL-1ß. PBM group increase uprighting movement when compared to control after 3 months and modulate IL-1ß expression. For pain control, the amount of medication and OHIP-14 no difference were found. This study suggests that PBM accelerates tooth movement during molar uprighting, due to modulation of IL-1ß during bone remodeling.

Comparative study between photodynamic therapy and the use of probiotics in the reduction of halitosis in mouth breathing children: Study protocol for a randomized controlled clinical trial.

INTRODUCTION: Halitosis is a term that defines any odor or foul smell the emanates from the oral cavity, the origin of which may be local or systemic. One of the causes of local or oral halitosis is low salivary flow and dry mouth, which is also one of the complaints of individuals with the mouth-breathing habit. The aim of this study is to determine the effectiveness of antimicrobial photodynamic therapy (aPDT) and the use of probiotics for the treatment of halitosis in mouth-breathing children. METHODS: Fifty-two children between 7 and 12 years of age with a diagnosis of mouth breathing and halitosis determined through an interview and clinical examination will be selected. The participants will be divided into 4 groups: Group 1-treatment with brushing, dental floss and tongue scraper; Group 2-brushing, dental floss and aPDT applied to the dorsum and middle third of the tongue; Group 3-brushing, dental floss and probiotics; Group 4-brushing, dental floss, aPDT and probiotics. The use of a breath meter and microbiological analysis of the tongue coating will be performed before, immediately after treatment and 7 days after treatment. The quantitative analysis will involve counts of colony-forming bacteria per milliliter and real-time polymerase chain reaction. The normality of the data will be determined using the Shapiro-Wilk test. Parametric data will be submitted to analysis of variance and nonparametric data will be compared using the Kruskal-Wallis test. The results of each treatment in the different periods of the study will be compared using the Wilcoxon test. DISCUSSION: Due to the low level of evidence, studies are needed to determine whether treatment with aPDT using annatto as the photosensitizer and blue led as the light source is effective at diminishing halitosis in mouth-breathing children.

Antimicrobial photodynamic therapy with erythrosine and blue light on dental biofilm bacteria: study protocol for randomised clinical trial.

INTRODUCTION: The objective is to investigate the effect of antimicrobial photodynamic therapy (aPDT) mediated by erythrosine and a blue light-emitting diode (LED) in the reduction of bacteria in dental biofilm. METHODS AND ANALYSIS: This clinical trial will be conducted with 30 patients who have biofilm, but without the presence of periodontal pockets, and who are being treated at the Dental Clinic of Universidade Metropolitana de Santos. A split-mouth model will be used (n=30), with group 1 control (conventional treatment) and group 2 (conventional treatment and aPDT). The bicarbonate jet will be used to remove dental biofilm in both groups. The treatment will be carried out in one session. aPDT will be performed before cleaning/prophylaxis, only in group 2. Participants will rinse with the photosensitiser erythrosine (diluted to 1 mM) for 1 min of pre-irradiation time, so that the drug can stain all the bacterial biofilm. Then, the D-2000 LED (DMC) will be applied, emitting at a wavelength of ʎ=470 nm, radiant power of 1000 mW, irradiance of 0.532 W/cm2 and radiant exposure of 63.8 J/cm2. Irradiation will be performed until the biofilm of the cervical region is illuminated for 2 min/point (4 cm2). The microbiological examination will be performed from samples of supragingival biofilm collected from the gingival sulcus. Collection will be performed in each experimental site before irradiation, immediately after the irradiation procedure and after the prophylaxis. Colony-forming units will be counted and the data will be submitted for statistical analysis for comparison of pretreatment and post-treatment results and between groups (conventional X aPDT). ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of Universidade Metropolitana de Santos under process number 66984123.0.0000.5509. Results will be published in peer-reviewed journals and will be presented at conferences. TRIAL REGISTRATION NUMBER: NCT05805761.