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.

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.

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.

Intraoral findings in newborns: prevalence and associated factors

Aim: To investigate the prevalence of intraoral characteristics and associated factors with neonatal and parent variables in a group of Brazilian newborns. Methods: This cross-sectional study with a descriptive and inferential approach, whose data was obtained through clinical examination, interview and the collection of medical record information. The sample was selected from babies up to three days old, of both sexes, and born between January and December 2013 in the Ana Bezerra University Hospital, in the city of Santa Cruz-RN, Brazil. The exposure variables included neonatal (sex, weight, gestational age, type of delivery and Apgar score) and parent (presence of systemic disease(s), drug use and consanguinity between the parents) variables. Descriptive analysis and Poisson regression were performed to estimate the ratio of gross and adjusted prevalence of intraoral findings (Epstein pearls, Bohn's nodule, dental lamina cyst and ankyloglossia) with the neonatal and parent variables (p<0.05). Results: Of a total of 168 examined newborns, 56.5% (n=95) were male. The most prevalent intraoral feature was the fibrous cord of Magitot, 62.5% (n=105), and the most frequent alteration was Epstein pearls, 44.6% (n=75). Female gender was a factor for Bohn's nodule (OR=0.90; 95%CI:0.82-0.99), and no tobacco use by the father was a protective factor for Epstein pearls (OR=0.73;95%CI:0.55-0.97). Additionally, lower mother's age, between 20-34 years of age (OR=1.58;95%CI:1.07-2.35) and under 19 years of age (OR=1.61; 95%CI:1.03-2.52) increases the chance of having Epstein pearls. Conclusion: There was a high prevalence of alterations in the newborns' oral cavities and there were associations between neonatal and parent variables

Perception of dental care among children

Children that arrive at dental offices with fear and anxiety usually tend to resist conditioning mechanisms. The aim this study was to evaluate children's perception about dental treatment and to identify factors that influence this perception. Material and Methods: A random sample of 100 children of both genders aged 3 to 12, who were treated at the Department of Dentistry of a University (group I) and at a Children's Hospital (group II), was selected. A structured questionnaire about the child's perception about dental care was applied and the children were asked to draw a picture of this topic. Most of children expressed a positive perception in the questionnaire and in the drawings (93.8%). This positive perception was more pronounced in group I (94%) and in children aged 3 to 5 years (100%), particularly in girls (78%). The main cause of fear was the use of needles (42.4%). Many children (24.2%) reported to prefer the noninvasive procedures. A positive perception of dental treatment was observed in the majority of the sample. Therefore, dental pediatricians must be aware of the perception of children for better conditioning (Au)

Competências gerais e habilidades específicas: a realidade do ciclo básico / General Competencies and Specific Skills: the reality of the basic cycle

A formação em odontologia vem, ao longo dos anos, sofrendo significativas mudanças. A última alteração considerável foi a construção e implementação das Diretrizes Curriculares Nacionais (DCN), em 2002, para os cursos de graduação. Visando formar cirurgiões-dentistas dotados de conhecimento e pensamento crítico, reflexivo e humanístico, as DCN vêm para guiar a formação profissional para qualquer mercado de trabalho. Assim, esse estudo visou avaliar e discutir a estrutura curricular dos primeiros quatro períodos do curso de Odontologia da Universidade Federal do Rio Grande do Norte com base nas competências gerais e habilidades específicas propostas pelas DCN. Foi realizada a categorização das Habilidades Específicas tomando como base as competências gerais. Em seguida, com base nas categorias formadas, foram detectados os momentos nesses dois anos iniciais em que as mesmas eram desenvolvidas. Ao contrário do que se pensava, a primeira metade do curso, tida como "ciclo básico", que abrange as disciplinas comuns a toda a área da saúde, trabalha elementos importantes das DCN e ainda traz a perspectiva de educação permanente, uma das competências gerais para o futuro profissional. Conclui-se que o "ciclo básico" do curso de odontologia da UFRN contempla todas as competências gerais e habilidades específicas propostas pelas DCN para o curso de Odontologia (AU).

Training in Dentistry has, over the years, undergoing significant changes. The last major change was the construction and implementation of the National Curriculum Guidelines (DCN) in 2002 for undergraduate courses. In order to form dental surgeons endowed with knowledge and critical, reflective and humanistic thoughts, DCN is to guide the training for any job market. Thus, this study aimed to evaluate and discuss the curricular structure of the first four periods of the Dental course at Federal University of Rio Grande do Norte regarding general and specific skills proposed by DCN. The categorization of specific skills based on general skills was conducted. Then, on the basis of these categories, the moments in the early years they were developed. Unlike previously thought, the first half of the course, considered "basic cycle" which includes common disciplines to all health courses, works important elements of DCN and also brings the perspective of permanent education, one of the general competencies for the future professional. It was concluded that the "basic cycle" of Dental School at UFRN includes all general and specific skills proposed by DCN for the dental course (AU).

Quality of life of patients with cleft lip and / or cleft palate: perspective of parents/guardians

To evaluate the quality of life of children with oral cleft.Material and Methods:The ECOHIS questionnaire was used to assess the quality of life of 31 patients aged 02-05 years from the perception of their parents. Study's variables were divided into impact on children subscale, through the domain of symptoms, limitations, psychological and self-image; and impact on the family subscale, through the domain anguish of parents and family function. Descriptive analysis tests were used in Statistical Software Program -SPSS® version 18.0.Results:71% of sample subjects were male.There was prevalence of cleft lip -palate (38.7%), followed by cleft lip (32.3%) and cleft palate (29%). Cleft transforamen incisive (38.7%) was predominantand the most frequent location was unilateral left (58.3%) and the complete type was the most significant (75%). All participants mentioned some impact of the problem on the child's quality of life. In the impact on children subscale, limitations domain had the highest average (mean: 5.16; SD2.87) and in the impact on family subscale, family function domain was the most significant (mean: 2.29; SD: 1.82). As for difficulties faced by children, question on "difficulty in pronouncing words" was the most significant (61.3%). Conclusion:The presence of clefts impacts the quality of life of children and their families, thus requiring strategies for the reestablishment of aesthetics, function and psychological support for such individuals...

Efficacy and safety of midazolam for sedation in pediatric dentistry: a controlled clinical trial.

PURPOSE: Pharmacological management of uncooperative children is becoming increasingly common in the dental setting. The purpose of this study was to determine the efficacy and safety of 3 different doses of midazolam for sedation in 2- to 4- year-old children with multiple dental needs and negative behavior. METHODS: Ten children participated in this crossover, controlled, double-blinded clinical trial, which evaluated their behavior, appointment length and patient response after administration of 3 different doses of midazolam or placebo. Oxygen saturation, heart rate, respiratory rate, and blood pressure were monitored in all sessions. RESULTS: Sedated children exhibited a more positive behavior compared to the placebo group, both at the beginning of the appointment (sitting in the chair) and during administration of local anesthesia (P=.008 and P<.03, respectively). The use of midazolam allowed for longer appointments, and doses of at least 0.3 mg/kg produced a higher rate of positive behavior overall. No changes in oxygen saturation, heart rate, respiratory rate, and blood pressure were observed. CONCLUSION: Midazolam was effective and safe for pediatric sedation in the dosages studied.

Perfil odontológico de pacientes com necessidades especiais assistidos em hospital pediátrico de uma universidade pública brasileira / Dental Profile of Special Needs Patients in a Pediatric Hospital of a Brazilian Public University

Objetivo: Traçar o perfil odontológico dos pacientes com necessidades especiais que são assistidos no ambulatório odontológico em um hospital pediátrico de uma universidade pública. Método: Foi realizado estudo descritivo e retrospectivo, pela análise de 186 prontuários odontológicos dos pacientes com Necessidades Especiais, provenientes do Hospital de Pediatria Professor Heriberto Ferreira Bezerra, Natal/RN. Coletaram-se os dados relativos ao sexo, faixa etária, hábitos parafuncionais, forma de higiene oral, presença de cárie, mancha branca ativa, doença periodontal, e uso de medicação. Os dados foram analisados no programa SPSS por meio da estatística descritiva e analítica. Resultados: Observou-se maior prevalência do sexo masculino (55,9%) e da faixa etária de nove a 11 anos (26,9%). Das necessidades especiais, as mais registradas foram as anomalias congênitas (54,3%) e doenças sistêmicas crônicas (45,7%). Dentre eles, 53,8% usam medicamentos, sendo hormônio 15,6%, vitaminas 12,4%, antibiótico 9,1%, anti-hipertensivo 9,1% e anticonvulsivante 9,1%. Entre os hábitos deletérios, destacaram-se a respiração bucal (41,4%) e a onicofagia (31,2%). A higiene oral é realizada com escova e dentifrício em 96,8% dos pacientes, sendo que o dentifrício com flúor é usado por 78,5% da amostra. O uso do fio dental foi identificado em apenas 12,4% e a condição de higiene oral foi insatisfatória em 86% das PNEs. Constatou-se presença de mancha branca ativa (14%), necessidade de selamento dentário (31,7%) e exodontia (57%). 87,1% dos pacientes apresentam lesões cariosas, 35,5% gengivite, e 29,6% cálculo dentário.Conclusões: As necessidades especiais mais comuns foram fenda labial e/ou palatina, síndrome de Down, diabetes, epilepsia, doença renal crônica e cardiopatia. A respiração bucal é um hábito deletério recorrente. Apesar da utilização de escova dental regularmente e dentifrício fluoretado, a higiene oral é insatisfatória e há alta incidência de cárie, presença de gengivite e necessidade de exodontias múltiplas.

Objective: To outline the dental profile of special needs patients treated in the dental outpatient clinic in a pediatric hospital of a Brazilian public university.Method: A descriptive retrospective study of 186 dental charts of special needs patients referred from the Prof. Heriberto Ferreira Bezerra Pediatric Hospital in Natal, RN, Brazil. Data were collected on sex, age group, parafunctional habits, oral hygiene method, caries, active white spots, periodontal disease and use of medication. The collected data were analyzed by descriptive and analytical statistics using the SPSS software.Results: There was prevalence of males (55.9%) and the 9-11 year-old (26.9%) age group. Among the special needs, the most frequent were congenital anomalies (54.3%) and chronic systemic diseases (45.7%). Medication was used by 53.8% of the sample; 15.6% were hormones, 12.4% vitamins, 9.1% antibiotics, 9.1% anti-hypertensive drugs and 9.1% were anticonvulsant drugs. The main deleterious habits were mouth breathing (41.4%) and nail biting (31.2%). Oral hygiene was performed with dentifrice and toothbrushing by 96.8% of the patients and fluoridated dentifrice is used by 78.5% of the subjects. Dental floss was used only by 12.4% and poor oral hygiene conditions were observed in 86% of the special needs patients. The analyses also revealed active white spots (14%), need of restoration by 31.7% and extraction by 57%. As much as 87.1% presented carious lesions, 35.5% presented gingivitis, and 29.6% had dental calculi.Conclusions: The most common special needs were cleft lip/palate, Down syndrome, diabetes, epilepsy, chronic renal disease and cardiopathy. Mouth breathing was a recurrent deleterious habit. Despite regular toothbrushing and use of fluoridated dentifrice, poor oral hygiene was observed and there was a high incidence of caries, presence of gingivitis and need of multiple extractions.

Conduta terapêutica em portador da doença de von Willebrand: relato de caso clínico / Therapeutic management in carriers of von Willebrand disease: a case report

A doença de von Willebrand é a mais comum das doenças hereditárias de coagulação, caracterizada por uma anormalidade quantitativa ou qualitativa do fator von Willebrand, glicoproteína presente no plasma, plaquetas e células endoteliais. Resulta em duplo defeito hemorrágico, caracterizado por tempo de sangramento prolongado e níveis plasmáticos baixos do fator VIII de coagulação. É importante que o cirurgião-dentista conheça essa entidade e os riscos originários da mesma. O trabalho conjunto desse profissional e do hematologista é essencial para a segurança nas abordagens odontológicas em portadores dessa doença. Este artigo relata um caso clínico envolvendo a extração de molares permanentes em portador de von Willebrand do tipo 1, com ênfase na utilização de acetato de desmopressin e ácido tranexâmico para a prevenção de quadro hemorrágico.

von Willebrand's disease is the most commom of the coagulation hereditary disorders and it is characterized by a quantitative and a qualitative abnormality of the von Willebrand's factor, which is a glycoprotein found in plasma, platelets and endothelial cells. It has a double bleeding defect characterized by a prolonged bleeding time and lower plasmatic levels of the clotting VIII factor. It is important that the clinician knows this disease and the risks that it involves. It is essential that dentists and hematologists work together in order to give a secure treatment to von Willebrand carriers. This clinical case describes a dental treatment, which involved permanent molars extraction in a thirteen years old patient, with type 1 von Willebrand disease, emphasizing the use of desmopressin acetate and tranexamic acid in prevention of the hemorragic aspect.

Medidas preventivas em odontologia para pacientes portadores de necessidades especiais / Preventive dental procedures in handicapped patients

Este trabalho de revisão, buscou na literatura, identificar as medidas preventivas utilizadas para o controle e a manutenção da saúde bucal dos Pacientes Portadores de Necessidades Especiais (PPNE). Além disso, fez uma breve retrospectiva da forma de atenção que foi conferida a esses indivíduos ao longo dos anos, mostrando a evolução que houve em relação ao tratamento que lhes era atribuído, de maneira a fornecer uma visão geral de como a História contribuiu para o reconhecimento da necessidade de uma atenção especial voltada para estes pacientes. Ao final do estudo, foi possível constatar que os Pacientes Portadores de Necessidades Especiais precisam ser avaliados de modo integral por uma equipe multidisciplinar capacitada, mediante um acompanhamento precoce, de maneira que as medidas preventivas, sobretudo aquelas relacionadas com a educação em saúde, possam ser instituídas desde cedo, possibilitando-lhes maiores chances de qualidade de vida

Cárie dentária: uma doença transmissível / Dental caries: the communicable diseases

O objetivo deste trabalho foi buscar na literatura dados que reafirmem a transmissibilidade da doença cárie e, assim, propor alternativas que contribuam para o controle de um grande problema enfrentado, principalmente, pelos odontopediatras - a infecçäo precose nos pacientes infantis