Paediatric head and neck malignant neoplasms: A brazilian retrospective study.

BACKGROUND: To assess the prevalence of oral and maxillofacial malignant neoplasias in children and adolescents diagnosed through biopsies sent to the Oral Pathology Laboratory at the University of Sao Paulo School of Dentistry. MATERIAL AND METHODS: A retrospective analysis of anatomopathological reports on patients between 1 and 18 years old issued by the oral and maxillofacial pathology laboratory between 1997 and 2021 was performed for demographic data, lesion site, type of biopsy, diagnostic hypothesis and final diagnosis. RESULTS: The laboratory issued 76,194 anatomopathological reports during this period, of which 10.77% were of children and adolescents. Of this total, only 32 biopsies (32/8.204; 0.39%) were neoplasias in children and adolescents. Sarcomas were the most prevalent malignant neoplasms (19/32; 59%), followed by carcinomas (7/32; 22%), lymphomas (5/32; 16%) and ganglioneuroblastomas (1/32; 3%). Of these 32 patients, the most affected individuals were aged between 4 and 11 years old (47%), 18 (56%) were male, and the mandible was the main anatomical site involved (28%). In 41% of the cases (13/32), the diagnostic hypothesis of the biopsied lesion was mistakenly considered benign and there was no diagnostic hypothesis in 18% of the cases. CONCLUSIONS: Oral and maxillofacial malignant neoplasms in children and adolescents are uncommon and the accuracy of provisional diagnoses is low in these cases. Better knowledge on oral and maxillofacial malignant lesions in this population would help professionals to reduce the diagnostic time and consequently improve the patient's prognosis.

Comparison of two behavior management techniques used during mandibular block anesthesia among preschool children: a randomized clinical trial.

PURPOSE: To compare the Tell-Show-Do Technique (TSD-T) with Hiding Dental-Needle Technique (HDN-T) based on children's anxiety, pain, and behavior during first-time mandibular block anesthesia. METHODS: A total of 52 children aged 3-5 years who had never received dental anesthesia and had at least one mandibular primary molar requiring extraction or pulpal therapy were included in the study. Children were randomly allocated into two groups: G1: TSD-T (n = 26) and G2: HDN-T (n = 26). This study included two sessions: intervention session (baseline) and control session (7 days after intervention). Facial Image Scale and Wong-Baker Pain Scale were used to evaluate anxiety and pain levels, respectively. Frankl Behavior Scale was used to assess children's behavior. RESULTS: Anxiety and pain levels were not statistically significant between G1 and G2 groups (p > 0.05). Similar results were observed for children's behavior rating (p > 0.05). Higher pain level was associated with younger children (rate ratios (RR) = 0.41; p = 0.016) and negative behavior (RR = 1.11; p < 0.001). On the other hand, in within-groups comparisons, there was a statistical difference in anxiety levels between intervention session and control session (p = 0.032) in G2. CONCLUSIONS: Even though there are no differences in the efficacy of TSD-T compared to HDN-T during first-time mandibular block anesthesia in preschool children in terms of children's anxiety, pain, and behavior, children from the HDN-T group can show reduced dental anxiety levels in the control sessions.

Unusual oral leiomyoma in a child: case report.

AIM: Very few oral leiomyomas have been reported in the literature, especially in children. The aim of this article was to present a very rare new case of leiomyoma in the chin, in a seven-year-old black male, and to explain its clinical and histological features. CASE REPORT: A seven-year-old black male patient presented with a swelling mass of diameter 2.5 x 3.0 cm in the lower anterior area of the chin. The tumor was firm, painless, non-fixed and well-defined, with normal mucosa overlying it. Fine-needle aspiration prior to surgery was negative. The surgical access was intraoral and the mass was located under the skin and below the periosteal bone, within the musculature. The histological and immunohistochemical studies diagnosed an oral leiomyoma. The clinical appearance of leiomyomas is very difficult to differentiate from other mesenchymal tumors. Histological and immunohistochemical studies were crucial for achieving a definitive diagnosis. Eighteen months after the excision of the lesion, no signs of recurrence were observed. The successful treatment had several objectives, including removing the lesion with success and providing the patient with an aesthetic appearance.

Actinic cheilitis among agricultural workers in Campinas, Brazil.

OBJECTIVE: To assess the prevalence of Actinic Cheilitis (AC) among agricultural workers and analyze its risk factors. DESIGN: A cross sectional epidemiological study. A lip lesion was defined as an abnormal change on the lip mucosa surface, such as erythematous pigmented, ulcerative or swelling (Cataldo and Doku, 1981). Data were gathered according to age group, gender, ethnicity-time and frequency of occupational sunlight exposure, smoking habits, drinking habits and socio-economic status. SETTING: Sugar-cane plantation farms in Brazil. PARTICIPANTS: Full-time workers of both genders employed at sugar-cane plantation farms for at least six months. OUTCOME MEASURES: Correlations between AC prevalence, demographic and socioeconomic risk factors. RESULTS: 202 people were examined and the prevalence of AC was 39.6%. Results revealed that being black (0.15-0.88- 95% CI; OR = 0.36; p = 0.025) or mulatto (0.21-0.82- 95% CI; OR = 0.42; p =0.011) decreased the risk for AC, while age and gender sex had no effect. In relation to socioeconomic variables, formal education and more than four years of education (0.07-0.68- 95% CI; OR = 0.22; p = 0.009) decreased the risk for AC. Moreover, drinking alcohol was a risk for AC (1.05-3.37- 95% CI; OR = 1.88; p = 0.034), while tobacco smoking was not (0.60-2.02- 95% CI; OR = 1.10; p = 0.763). CONCLUSIONS: The prevalence of AC is high in agricultural workers who were fairskinned, had low education and high alcohol intake. Prevention and early diagnosis are required for workers exposed to sunlight.

Feasibility of the International Caries Detection and Assessment System (ICDAS-II) in epidemiological surveys and comparability with standard World Health Organization criteria.

This study evaluated the feasibility of using the International Caries Detection and Assessment System (ICDAS-II) in epidemiological surveys and compared ICDAS with WHO criteria. Two hundred and fifty-two children (36-59 months old) in Amparo, Brazil, were each examined by 2 examiners using ICDAS-II or WHO criteria. Dmf-t, dmf-s, caries prevalence and examination time were calculated using both systems. ICDAS-II was comparable to standard criteria when the cut-off point was score 3. Examination by ICDAS-II took twice as long as by WHO criteria. In conclusion, ICDAS-II, besides providing information on non-cavitated caries lesions, can generate data comparable to previous surveys which used WHO criteria.

Absence of carious lesions at margins of glass-ionomer and amalgam restorations: a meta- analysis.

AIM: To report on the absence of carious lesions at margins of glass ionomer cement (GIC) and amalgam restorations. METHODS: Six Anglophone and 1 Lusophone databases were searched for articles up to 5 January 2008. Inclusion criteria for articles were: (i) titles/abstracts relevant to topic; (ii) published in English, Portuguese or Spanish language; (iii) reporting on a randomised control trial. Exclusion criteria were: (i) insufficient random allocation of study subjects (ii) operator and subject not blinded, where appropriate; (iii) not all entered subjects accounted for at trial conclusion; (iv) subjects of both groups not followed up the same way. Articles were accepted only if they complied with all the criteria. Ten articles complied with the inclusion criteria and were selected for review. From these 4 were rejected and 6 articles reporting on 8 separate studies accepted. Due to aspects of heterogeneity, studies were sub-grouped before meta- analysis. RESULTS: Significantly less carious lesions were observed on single-surface GIC restorations in permanent teeth after 6 years as compared to restorations with amalgam (OR 2.64 - CI 95% 1.39 - 5.03, p= 0.003). No studies investigating multiple-surface restorations on permanent teeth were identified. Studies investigating carious lesions at margins of restorations in primary teeth showed no difference between both materials after 3 and 8 years. CONCLUSIONS: Carious lesions at margins of single-surface GIC restorations are less common than with amalgam fillings after 6 years in permanent teeth. No difference was observed in primary teeth. More trials are needed in order to confirm these results.

Clinical, histological and microbiological study of hand-excavated carious dentine in extracted permanent teeth.

Changes in cultivable flora in dentine samples collected before and after hand excavation were examined in association with clinical status of the cavity surface, light microscopy and scanning electron microscopy (SEM). Thirty-five extracted permanent molar teeth with an occlusal caries lesion were excavated with hand instruments according to the atraumatic restorative treatment (ART) approach. Excavation pressure, dentine colour and consistency were recorded at the dentine-enamel junction (DEJ) prior to carious dentine removal and at the cavity floor after the final excavation; a microbiological sample of dentine was taken at both stages. Twelve restored teeth; six with positive and six with negative bacterial growth on the second sample, were selected for light microscopy and SEM. The hand-excavation removed tooth structure was soft, irreversibly damaged, dark and highly infected. Hand excavation reached dentine of increased hardness with a more normal colour to provide a sound structural base for restoration. Light and SEM examination of the cavity floor showed infected dentinal tubules in all 12 teeth examined. Linear logistic analysis showed a statistical association between light-yellow dentine on the cavity floor and an absence of bacterial growth (P = 0.006). This short-term in vitro study showed that caries-producing bacteria remained in dentine close to the cavity floor in 26/35 teeth despite clinical observations that indicated a suitably prepared cavity floor.

Mutans streptococci strains prevalence before and after cavity preparation during Atraumatic Restorative Treatment.

Critics argue that all carious dentine is not removed from the hand-prepared cavity during the Atraumatic Restorative Treatment (ART) procedure, and that the caries process is soon resumed. The aim of this study was to determine the effectiveness of ART in removing carious tissue, by investigating the numbers of mutans streptococci and lactobacilli, with emphasis on the prevalence of Streptococcus mutans and Streptococcus sobrinus strains before, and after ART treatment of dental caries. Two microbiology samples were collected. The first sample was removed from the centre of the carious lesion at the enamel-dentine junction, and the second was collected from the centre of the hard cavity wall above the pulp, after the soft infected dentine had been manually removed. A total of 71 mutans streptococci isolates from 31 children and 40 carious teeth were subcultured, biochemically characterised and genotyped by the arbitrarily primed polymerase chain reaction (AP-PCR). Results showed a significant decrease in TVC (P<0.0001), mutans streptococci (P < 0.0001) and lactobacilli (P = 0.0002) after cavity preparation. AP-PCR identified S. mutans strains that were undetectable during biotyping, and divided clinical isolates into two main clusters. In all, 63% (45/71) of isolates from the carious lesions comprised S. mutans strains. After cavity preparation, this was reduced to 35% (25/71), of which 30% (21/71) were S. mutans and the remaining 6% (4/71) S. sobrinus strains. The number of mutans streptococci strains was below detectable levels in 19 of the prepared cavities. The significant decrease in bacteria after manual cavity preparation demonstrates the reliability of a standardized ART technique, yet the presence of S. mutans strains shows that the effectiveness of the ART procedure can vary during treatment and between dental practitioners.

Caries reductions between 1995, 1997 and 1999 in preschool children in Diadema, Brazil.

AIMS: This study aimed to assess changes in caries prevalence and severity in preschool children in Diadema, Brazil. METHODS: Three cross-sectional surveys were conducted, using the same protocol, in 1995, 1997 and 1999. The first survey included children aged 5-35 months, and the second and third, children aged 5-59 months. Participants were selected from all children attending a National Day of Children's Vaccination; 548, 992 and 690 in 1995, 1997 and 1999, respectively. This approach was sound as uptake rates for all years studied were above 90% for children aged between 1 and 59 months in all three surveys. Caries experience was measured using the World Health Organization (WHO) def index. Time-lag and quasi-longitudinal analysis were carried out. RESULTS: Time-lag analysis showed a marked and statistically significant decline in the prevalence and severity of coronal and rampant caries between 1995 and 1999. There were reductions of 36.5% in the prevalence of caries in 2-year-olds between 1995 and 1997 (P < 0.002) and 36.0% between 1997 and 1999 (P = 0.041). The mean def-s at the same age decreased from 2.0 in 1995 to 1.1 in 1997 (P < 0.001) and to 1.0 in 1999 (P > 0.05). The quasi-longitudinal analysis showed a statistically significantly increase in the percentage of children with caries between 1995 and 1997 and 1997 and 1999 (P < 0.001), but not for 2-year-old children between 1995 and 1997 (P > 0.05). The same pattern was observed for severity of dental caries. CONCLUSION: Oral health in preschool children in Diadema improved markedly during 1995-99.