Oral Health Education for Children: Development of a Serious Game with a User-Centered Design Approach.

Background: Children can learn efficiently with well-designed serious games. The use of applications to promote health has proliferated, but there is a lack of scientific studies on educational games in oral health. Materials and Methods: We developed the Brazilian version of a British and Jordanian oral health education game for children from the perspectives of Brazilian specialists and users. This descriptive study, with a qualitative and quantitative approach, comprised three phases: I-Experts' discussion of the appropriateness of the previous version of the game to Brazil; II-Development of the first Brazilian version of the game; and III-Evaluation of the first version with 15 children from 4 to 8 years of age. Results: In Phase I, the specialists agreed with the development of the Brazilian version of the game, with minor adjustments on: advice on eating; advice on oral hygiene habits, users' age group, game characters, and game purpose. Phase II: a version with a few changes in images and recommendations, written and spoken in Brazilian Portuguese. Phase III: The global average of correct answers in the game's tasks was 75.3%, ranging from 50.0% to 100%. Children reported having fun with the game, and most understood the content and its interface; their parents found the information relevant and enjoyed the gameplay with their children. Conclusions: The Oral Health Education Game offered basic information for preventing dental caries to Brazilian children aged 4-8 years old in an interactive and fun way; it could support professionals in improving oral health education.

Impact of dental sedation treatment on the oral health-related quality of life of distressed young children: A secondary analysis of a randomized clinical trial.

INTRODUCTION: Little is known regarding the impact of dental treatment under sedation on distressed young children's oral health-related quality of life (OHRQoL). AIM: To evaluate the impact of dental treatment under sedation on the OHRQoL of children and their families. METHODS: Caregivers of two-to-six-year-old children answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS): (1) before treatment under sedation (T0), (2) two weeks (T1) and (3) 3 months after the completion of treatment (T2). A global transition judgment was included in the posttreatment evaluations to determine the perception of changes in OHRQoL after dental treatment. Bivariate analysis was performed. Changes in scores and effect sizes (ES) were calculated. RESULTS: Reductions were found at both posttreatment evaluations in the total B-ECOHIS scores (median [25th-75th percentile] at T0: 14 [9.8-21.7]; T1: 2.0 [0.0-5.1]; T2: 2.0 [0.0-6.7]); "child impact" section (T0: 8.8 [4.0-13.1]; T1: 0.0 [0.0-2.2]; T2: 0.0 [0.0-4.3]) and "family impact" section (T0: 6.0 [4.0-8.5]; T1: 0.0 [0.0-2.0]; T2: 0.0 [0.0-2.0]) (≤0.001; large ES). In 92.3% of cases at T1 and 88.3% at T2, caregivers reported that their child's oral health improved considerably. CONCLUSION: Dental treatment under sedation significantly improved the OHRQoL of the children and their families.

Child Stress and Behaviour During Restorative Treatment under Non-Pharmacological Techniques and Sedation: A Case Series

ABSTRACT Objective: To evaluate the behaviour and stress of children undergoing restorative treatment with and without sedation. Material and Methods: Participants were 14 healthy children aged between 2.5 and 6 years and with a history of dental behavioural management problems. In the dental treatment visit, the child was treated with non-pharmacological techniques, and in the second, moderate sedation was added. The child received the same procedure performed by a paediatric dentist in both visits: composite resin restoration using local anaesthesia and rubber dam isolation. In both visits, saliva was collected at the children's arrival at the dental clinic, during local anaesthesia and at the end of treatment. The visits were filmed for later analysis of behaviour according to the Ohio State University Behavioural Rating Scale. Results: About 78.5% of children improved their behaviour from the first to the second visit. The salivary cortisol curve of the first visit was maintained in the second visit for 21.4% of children but varied in the remaining participants. Conclusion: Most children presented better behaviour and less stress when sedation was added to non-pharmacological techniques during dental care.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE.

There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

Religiosity is associated with caregivers' perception of preschool children's dental health.

The aim of the study was to investigate the association between psychosocial factors and perception of caregivers about the dental health of their preschool children. A cross-sectional analysis was performed with 146 caregiver-child dyads attended at Pediatric Dentistry school clinics in Goiânia, Midwest Brazil. Data were collected through a structured interview and a questionnaire with the caregivers and the children's dental records. The study outcome was caregivers' perception of children's dental health (positive or negative). The independent psychosocial variables were religiosity (Duke University Religion Index - DUREL) and Sense of Coherence (Antonovsky's SOC-13 scale). Sociodemographic data and oral health-related variables were also collected as covariates. Bivariate analysis (Pearson's chi-square, T-test, and Mann-Whitney) and Poisson regression with robust variance were performed. The prevalence of negative perception was 54.8%. In bivariate analysis, negative perception was associated with caries experience and report of dental pain at any time in the child's life. In the adjusted regression model, prevalence of caregivers with negative perception of their children's dental health was 1.38 times higher in the group with low organizational religiosity (PR = 1.38; 95%CI 1.05-1.81) and 2.35 times higher in the group of children with high caries experience (PR = 2.35; 95%CI 1.54-3.60). In conclusion, religiosity was associated with caregivers' perception of dental health of their preschool children undergoing treatment in specialized dental clinics, regardless of their caries experience.

Impact of dental caries on oral health-related quality of life in children with dental behavior management problems.

The aim of this cross-sectional study was to evaluate the impact of dental caries and sociodemographic factors on the oral health-related quality of life (OHRQoL) of children with dental behavior management problems (DBMP) and their families. One hundred and thirty-four dyads of caregivers and children participated. The impact of OHRQoL was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Socioeconomic variables were obtained from an interview. Dental caries was assessed using the dmft index. The total B-ECOHIS score was categorized as low, medium, or high impact, and its association with the independent variables was determined based on bivariate tests and a multivariate model. The median score for B-ECOHIS was 13 (range: 1-40). The negative impact was reflected mainly by complaints of oral/dental pain, difficulty in eating and parental guilt. The number of teeth with caries was significantly higher among children who experienced a high negative impact on OHRQoL (mean 9.2 [standard deviation 3.5]; p = 0.003) than those who had a low negative impact (7.0 [3.3]). The final adjusted model showed that dental caries remained independently associated with poor OHRQoL (b = 0.100; x2 Wald 4.205; p = 0.040). A greater impact on OHRQoL was experienced by children with DBMP and greater caries experience.

Comparison between Analgesia Nociception Index (ANI) and self-reported measures for diagnosing pain in conscious individuals: a systematic review and meta-analysis.

The Analgesia Nociception Index (ANI), an objective measure of pain based on heart rate variability (HRV), has its usefulness in awake patients still unclear. This systematic review and meta-analysis aimed to assess ANI's accuracy compared to self-reported pain measures in conscious individuals undergoing medical procedures or painful stimuli. PubMed, Ovid, Web of Science, Scopus, Embase, and grey literature were searched until March 2021. Of the 832 identified citations, 16 studies complied with the eligibility criteria. A meta-analysis including nine studies demonstrated a weak negative correlation between ANI and NRS for pain assessment in individuals in the post-anesthetic recovery room (r = - 0.0984, 95% CI = - 0.397 to 0.220, I2 = 95.82%), or in those submitted to electrical stimulus (r = - 0.089; 95% CI = - 0.390 to 0.228, I2 = 0%). The evidence to use ANI in conscious individuals is weak compared to self-report measures of pain, yet ANI explains a part of self-report. Therefore, some individuals may be benefited from the use of ANI during procedures or in the immediate postoperative period.

Experiência de estudantes na divulgação da imagem de pacientes odontológicos / Student experience in the images' dissemination of dental patients

As implicações éticas do uso de redes sociais por profissionais da saúde têm ocupado espaço na agenda da Bioética quando se considera os direitos do paciente e o risco de exposição de sua imagem. Este estudo buscou conhecer a percepção de estudantesde Odontologia sobre a exposição da imagem de pacientes em redes sociais. Trata-se de estudo observacional transversal, quantitativo, com aplicação de questionário a estudantes de um curso de Odontologia. Os dados foram tabulados e analisados por meio de estatísticas descritivas. A taxa de resposta foi de 73,5% (n=247), todos utilizando redes sociais e 33,1% (n=82) declararam já ter realizado fotografia de paciente na clínica de ensino. Muitos estudantes ainda não têm clareza sobre as questões éticas que envolvem a divulgação de imagem de pacientes em rede social. Isso revela a importância de se ater a esse tópico nos cursos brasileiros de graduação em Odontologia (AU).

The ethical implications of social networks use by health professionals have occupied space on the Bioethics' agenda, when considering the rights of patients and the risk of exposing their image. This study aimed to understand the perception of dentistry students about the exposure of patients image in social networks. This is a cross-sectional, quantitative, observational study, with the application of a questionnaire to students of a Dentistry course. It was used the descriptive statistics for tabulating and analyzing the data. The response rate was 73.5% (n=247), all using social networks, and 33.1% (n=82) reported having already taken a patient photograph at the training clinic. Many students are still unclear about the ethical issues surrounding the dissemination of patient images on social media. The ethical implications of social networks use by health professionals haveoccupied space on the Bioethics' agenda, when considering the rights of patients and the risk of exposing their image (AU).

Evaluating the agreement between children and their parents on dental pain in children using the self-reported method.

BACKGROUND: Having preschool children evaluate their dental pain can provide an additional insight into pain diagnoses and improve patient-centered care. This study aimed to evaluate the agreement between self-reported dental pain by preschoolers and their parents' report (proxy measure). DESIGN: This cross-sectional study was conducted with children aged 4 to 6 years, and with one of their parents. Dental pain was reported using the Simplified Faces Pain Scale (S-FPS) and administered before the dental consultation. Dental pain was assessed using closed-ended questions, and a three-face scale was used to determine pain severity. The kappa and weighted kappa tests were used to evaluate the agreement between the children's self-report and their parents' report. RESULTS: A total of 198 child-parent dyads participated. Current child dental pain was reported by 44.4% of the children and 36.9% of the parents. Severe pain was reported most frequently between children (17.1%) and parents (16.2%). The agreement on the severity of dental pain ranged from substantial (children aged 6 years and parents: weighted kappa = 0.372) to moderate (4-year-olds: 0.412; 5-year-olds: 0.453). CONCLUSION: Children and parents agreed on the child's dental pain. The use of the S-FPS among younger children appears valid and feasible for assessing dental pain.

Impact of dental caries on oral health-related quality of life in children with dental behavior management problems

Abstract: The aim of this cross-sectional study was to evaluate the impact of dental caries and sociodemographic factors on the oral health-related quality of life (OHRQoL) of children with dental behavior management problems (DBMP) and their families. One hundred and thirty-four dyads of caregivers and children participated. The impact of OHRQoL was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Socioeconomic variables were obtained from an interview. Dental caries was assessed using the dmft index. The total B-ECOHIS score was categorized as low, medium, or high impact, and its association with the independent variables was determined based on bivariate tests and a multivariate model. The median score for B-ECOHIS was 13 (range: 1-40). The negative impact was reflected mainly by complaints of oral/dental pain, difficulty in eating and parental guilt. The number of teeth with caries was significantly higher among children who experienced a high negative impact on OHRQoL (mean 9.2 [standard deviation 3.5]; p = 0.003) than those who had a low negative impact (7.0 [3.3]). The final adjusted model showed that dental caries remained independently associated with poor OHRQoL (b = 0.100; x2 Wald 4.205; p = 0.040). A greater impact on OHRQoL was experienced by children with DBMP and greater caries experience.

Translation and Cultural Adaptation of the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese

Abstract Objective: To translate and culturally adapt the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese. Material and Methods: The MCDASf consists of eight questions about anxiety toward dental procedures that are answered on a five-point Likert scale ranging from "not worried" (1 point) to "very worried" (5 points). The answers correspond to a scale of face drawings ranging from extremely negative to extremely positive. The process consisted of initial translation, back-translation, expert committee review, and pretesting. Results: The first revised version was applied to 32 children aged 5 to 12 years, 16 from the city of Governador Valadares, Brazil (southeastern region) and 16 from the city of Pelotas, Brazil (southern region). In the first pretest, Item 5 was misunderstood by 6.25% of children in the southern region; Item 6 by 6.25% in both regions; Items 7 and 8 by 87.5% and 100% of those from the southeastern region, respectively, and by 12.5% and 25% of those from the southern region, respectively. Items 7 and 8 were modified by the expert committee, and the second revised version was applied to 32 children, 16 from each region. The only misunderstood items were 4 and 5, both by a 7-year-old boy in Governador Valadares. Conclusion: The Brazilian Portuguese version of the MCDASf was well understood by the sample of children (AU).

Religiosity is associated with caregivers' perception of preschool children's dental health

Abstract The aim of the study was to investigate the association between psychosocial factors and perception of caregivers about the dental health of their preschool children. A cross-sectional analysis was performed with 146 caregiver-child dyads attended at Pediatric Dentistry school clinics in Goiânia, Midwest Brazil. Data were collected through a structured interview and a questionnaire with the caregivers and the children's dental records. The study outcome was caregivers' perception of children's dental health (positive or negative). The independent psychosocial variables were religiosity (Duke University Religion Index - DUREL) and Sense of Coherence (Antonovsky's SOC-13 scale). Sociodemographic data and oral health-related variables were also collected as covariates. Bivariate analysis (Pearson's chi-square, T-test, and Mann-Whitney) and Poisson regression with robust variance were performed. The prevalence of negative perception was 54.8%. In bivariate analysis, negative perception was associated with caries experience and report of dental pain at any time in the child's life. In the adjusted regression model, prevalence of caregivers with negative perception of their children's dental health was 1.38 times higher in the group with low organizational religiosity (PR = 1.38; 95%CI 1.05-1.81) and 2.35 times higher in the group of children with high caries experience (PR = 2.35; 95%CI 1.54-3.60). In conclusion, religiosity was associated with caregivers' perception of dental health of their preschool children undergoing treatment in specialized dental clinics, regardless of their caries experience.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE

Abstract: There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

Is dental anxiety associated with the behavior of sedated children?

The aim of this cross-sectional study was to investigate factors associated with dental anxiety in children treated under moderate sedation. Prior to treatment, each child's dental anxiety was evaluated using the modified Venham Picture Test (VPT). Interviews were also conducted with parents/guardians to gather information on the child's dental anxiety (Corah's Dental Anxiety Scale [DAS]), age and sex, shyness or anxiety in the presence of strangers, and dental history, as well as socioeconomic factors. All the children were sedated, and had at least one tooth restored using the atraumatic restorative treatment technique. Child behavior was assessed using the Frankl scale. Data analysis involved descriptive statistics and bivariate tests. The median VPT score was 2.0 (range: 0 to 8). Children who were shy in the presence of strangers (yes: median 2.0 [0-8]; no: 0.5 [0-4]; p = 0.018), and those with negative behavior during dental care (negative: 3.0 [0-8]; positive: 1.0 [0-8]; p = 0.014) had greater anxiety. The child's dental anxiety was associated with the mother's education level (≤ 8 years: 4 [2-7]; > 8 years: 1 [0-8]; p = 0.016). The dental anxiety of children treated under sedation is associated with negative behavior, shyness, and the mother's education level.

Sedation versus protective stabilization for dental treatment of children with caries and challenging behavior at the dentist (CHOOSE): a study protocol for a non-randomized clinical trial.

BACKGROUND: There is a lack of evidence on the effectiveness of moderate sedation in pediatric dentistry, compared to protective stabilization, which remains routinely used in Brazil despite moral questions. This prospective non-randomized clinical trial's objective is to evaluate the effectiveness of moderate sedation, compared to the protective stabilization, in the dental care of children with dental behavior management problems. METHODS: Participants will be 152 children under seven years of age with early childhood caries (ECC) who need specialized dental treatment due to a history of challenging behavior during dental care. The interventions to be compared are moderate sedation with oral administration of ketamine and midazolam and protective stabilization. The primary endpoint will be the child's behavior during treatment assessed using the Ohio State University Behavioral Rating Scale (OSUBRS). The secondary outcomes are (A) child's - behavior according to the visual analogue scale, anxiety, pain, and physiological stress; (B) parent's - satisfaction and anxiety; (C) family and child - impact on oral health-related quality of life (OHRQoL); (D) dentist's - satisfaction and stress; (E) procedure - adverse events of the intervention and dental treatment longevity. A cost-effectiveness analysis will be performed from the perspective of the Brazilian Unified Health System (SUS). DISCUSSION: Considering the primary outcome, this study hypothesis is that sedated children have better behavior during dental treatment than children whose behavior was managed by protective stabilization without sedation. Additionally, at the end of 12 months, we expect to identify participants' reported outcomes and objective measures related to dental behavior in early childhood. Trial registration Clinicaltrials.gov registration NCT04119180 on October 8th, 2019. https://clinicaltrials.gov/ct2/show/NCT04119180.

Parents' satisfaction with paediatric dental treatment under sedation: A cross-sectional study.

BACKGROUND: Patient-reported outcomes are under-investigated in the field of paediatric dental sedation. AIM: To evaluate the satisfaction of parents/guardians with their children's dental sedation, compare it to the dentist's satisfaction, and identify associated factors. DESIGN: This study was performed with parents/guardians of young children treated under sedation and dentists. Participants' satisfaction was measured using the visual analogue scale (0-100). Child's behaviour was classified using the Ohio State Behavioural Rating Scale. Other information was collected during interviews and from patient charts. The Spearman's, Mann-Whitney and Kruskal-Wallis tests were performed (P < .05). RESULTS: A total of 167 parents/guardians and ten dentists participated in the study. Protective stabilisation and atraumatic restorative treatment (ART) were used in 69.9% and 51.5% appointments, respectively. The parents/guardians (median: 91 [25-75 percentile: 75-96]) and dentists (76 [23-98]) were satisfied. Parental/guardian satisfaction was higher than dentist satisfaction (P ≤ .001). Parental/guardian satisfaction was positively correlated with quiet child behaviour (r = 0.347, P ≤ .001) and was associated with the non-use of protective stabilisation (P ≤ .001), no previous toothache (P = .019), and the use of ART (P = .018). CONCLUSION: The participants were satisfied with treatment under sedation. Parents/guardians were more satisfied, especially, when the child had cooperative behaviour.

Is dental anxiety associated with the behavior of sedated children?

Abstract The aim of this cross-sectional study was to investigate factors associated with dental anxiety in children treated under moderate sedation. Prior to treatment, each child's dental anxiety was evaluated using the modified Venham Picture Test (VPT). Interviews were also conducted with parents/guardians to gather information on the child's dental anxiety (Corah's Dental Anxiety Scale [DAS]), age and sex, shyness or anxiety in the presence of strangers, and dental history, as well as socioeconomic factors. All the children were sedated, and had at least one tooth restored using the atraumatic restorative treatment technique. Child behavior was assessed using the Frankl scale. Data analysis involved descriptive statistics and bivariate tests. The median VPT score was 2.0 (range: 0 to 8). Children who were shy in the presence of strangers (yes: median 2.0 [0-8]; no: 0.5 [0-4]; p = 0.018), and those with negative behavior during dental care (negative: 3.0 [0-8]; positive: 1.0 [0-8]; p = 0.014) had greater anxiety. The child's dental anxiety was associated with the mother's education level (≤ 8 years: 4 [2-7]; > 8 years: 1 [0-8]; p = 0.016). The dental anxiety of children treated under sedation is associated with negative behavior, shyness, and the mother's education level.

Risk communication in the context of clinical research.

Physicians and dentists usually make clinical decisions and recommendations without a clear understanding of the meaning of the numbers regarding the accuracy of diagnostic tests and the efficacy of treatments. This critical review aimed to identify problems in the communication of diagnostic test accuracy and treatment benefits and to suggest strategies to improve risk communication in these contexts. Most clinical decisions are taken under uncertainty. Health professionals cannot predict the outcome in one individual patient. This uncertainty invites these professionals to make decisions based on heuristics, which gives rise to several cognitive biases. Cognitive biases are automatic and unconscious, so how is it possible to mitigate their undesirable effects on risk interpretation in the context of clinical practice? Some forms of risk communication reinforce cognitive bias, while others weaken them. Maybe one of the most difficult obstacles to overcome is the difficulty to think with numbers. This difficulty probably arises from a mismatch of ancestral adaptations of the brain having to deal with modern environments, which are quite different from the ancestral ones. There are two quite common, but bad, forms of risk communication: the conditional probability and the relative risk reduction or efficacy. People, including physicians and dentists, are confused with this kind of information. The main methods discovered so far to facilitate a clearer understanding are to emphasize the base rates of the events and to use absolute numbers, that is to use natural frequencies, instead of percentages and conditional probabilities.

Recommended procedures for the management of early childhood caries lesions - a scoping review by the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE).

BACKGROUND: Early childhood caries (ECC) affects millions of children up to 6 years old. Its treatment positively impacts the quality of life of children and their families. However, there is no consensus on how to treat ECC. Thus, we performed a scoping review to identify the recommended procedures for the management of ECC lesions. METHODS: A search was performed in PubMed, Scopus, The Cochrane Library, The International Guideline Library and pediatric dentistry associations around the world were contacted by email for unpublished search documents. ECC guidelines/guidance/policies were considered eligible regardless of language and publication date. RESULTS: From a total of 828 references, 52 full-text articles were assessed for eligibility and 22 included in the scoping review. We found different procedures recommendations for the management of ECC lesions. For incipient lesions, minimally invasive methods such as professional fluoride and cariostatic (silver diamine) applications, as well as surveillance were recommended. If restoration was required, the recommended materials were glass ionomer cement, composite resin, amalgam and stainless-steel crown. Interim restorations and Atraumatic Restorative Treatment (ART) were also recommended. Extractions have been suggested for teeth with lesions with pulpal involvement, depending on the child's behaviour and other clinical conditions. CONCLUSIONS: Non-operative procedures, restorative and extraction were recommended for the management of ECC, depending on the extent of the lesions. There is no difference between different management guidelines/guidance/policies for ECC lesions.

Determinants of parental report of dental pain and discomfort in preschool children-The Dental Discomfort Questionnaire.

BACKGROUND: Pain is a major consequence of caries, which negatively impacts the quality of life of children and their families. AIM: To analyse the parental report of dental pain and discomfort in preschool children, and to identify clinical and sociodemographic factors associated. DESIGN: This cross-sectional study involved 375 four- and five-year-old preschoolers enrolled in the city of Campo Magro public school system, along with their parents and caregivers. Parents/caregivers answered the Brazilian version of the Dental Discomfort Questionnaire (DDQ-B) and a sociodemographic questionnaire. Two examiners (kappa > 0.79) performed clinical examinations using dmf-t and pufa index. The associations were statistically analysed by univariate and multiple Poisson regression with robust variance (α = 0.05). RESULTS: The prevalence of dental pain and discomfort was 70.3% (66%-75% 95% CI). Children from non-nuclear families (PRa 1.33; 95% CI: 1.01-1.76) and whose parents presented a lower level of education (PRa 2.43; 95% CI 1.66-3.55) presented a higher prevalence of dental pain or discomfort. Considering the clinical determinants, after adjusting, only the presence of clinical consequences of untreated dental caries (pufa ≥ 1) (PRa 1.37; 95% CI 1.02-1.84) was significantly associated with higher dental pain or discomfort. CONCLUSIONS: Dental pain and discomfort were associated with socioeconomic factors and with the presence of clinical consequences of untreated dental caries.