Improving accuracy of early dental carious lesions detection using deep learning-based automated method.

OBJECTIVE: To investigate the effectiveness of a convolutional neural network (CNN) in detecting healthy teeth and early carious lesions on occlusal surfaces and to assess the applicability of this deep learning algorithm as an auxiliary aid. MATERIALS AND METHODS: A total of 2,481 posterior teeth (2,459 permanent and 22 deciduous teeth) with varying stages of carious lesions were classified according to the International Caries Detection and Assessment System (ICDAS). After clinical evaluation, ICDAS 0 and 2 occlusal surfaces were photographed with a professional digital camera. VGG-19 was chosen as the CNN and the findings were compared with those of a reference examiner to evaluate its detection efficiency. To verify the effectiveness of the CNN as an auxiliary detection aid, three examiners (an undergraduate student (US), a newly graduated dental surgeon (ND), and a specialist in pediatric dentistry (SP) assessed the acquired images (Phase I). In Phase II, the examiners reassessed the same images using the CNN-generated algorithms. RESULTS: The training dataset consisted of 8,749 images, whereas the test dataset included 140 images. VGG-19 achieved an accuracy of 0.879, positive agreement of 0.827, precision of 0.949, negative agreement 0.800, and an F1-score of 0.887. In Phase I, the accuracy rates for examiners US, ND, and SP were 0.543, 0.771, and 0.807, respectively. In Phase II, the accuracy rates improved to 0.679, 0.886, and 0.857 for the respective examiners. The number of correct answers was significantly higher in Phase II than in Phase I for all examiners (McNemar test;P<0.05). CONCLUSIONS: VGG-19 demonstrated satisfactory performance in the detection of early carious lesions, as well as an auxiliary detection aid. CLINICAL RELEVANCE: Automated detection using deep learning algorithms is an important aid in detecting early caries lesions and improves the accuracy of the disease detection, enabling quicker and more reliable clinical decision-making.

Temporomandibular Disorders at the Preoperative Time of Orthognathic Surgery.

Individuals seeking orthodontic treatment combined with orthognathic surgery (OS) have a high prevalence of temporomandibular disorders (TMDs), but the relationship between TMD diagnoses and dentofacial deformities (DFDs) is still controversial. Therefore, this cross-sectional study with a comparison group aimed to analyze the association between dentofacial deformities and TMDs. METHODOLOGY: Eighty patients undergoing OS were consecutively selected from the stomatology department of the Federal University of Paraná between July 2021 and July 2022. Forty patients who would undergo OS composed the group of participants with DFD, and forty who received other types of attention and did not present changes in the dental bone bases formed the group without DFDs (DFDs and no DFDs groups). The groups were matched for sex, age, and self-reported ethnicity. The diagnostic criteria for TMDs (DC/TMDs) were used to diagnose TMD based on the Axis I criteria. The psychosocial aspects, oral behaviors in wakefulness, and sleep bruxism were evaluated through the Axis II criteria. The data were analyzed with a 5% significance level. RESULTS: The presence of DFDs was significantly associated with arthralgia (p = 0.01). The other types of TMDs were not associated with DFDs. Comorbidities, habits, and psychosocial variables were not associated with DFDs at a level of 0.05. (p > 0.05). In analyzing the participants with arthralgia, the ones with this condition presented higher frequencies of sleep bruxism (p = 0.046). CONCLUSIONS: Participants with DFDs presented a significantly higher frequency of arthralgia when compared to no DFDs ones. Sleep bruxism was associated with the occurrence of joint TMDs in these participants.

How is the quality of the available evidence on molar-incisor hypomineralization treatment? An overview of systematic reviews.

OBJECTIVE: This overview analyzed the quality of the systematic reviews (SRs) available on treatments for molar-incisor hypomineralization (MIH). MATERIAL AND METHODS: Six electronic databases were searched (PubMed/MEDLINE, Scopus, Web of Science, LILACS, Brazilian Bibliography of Dentistry and Cochrane Library) until March 2022. Two reviewers independently performed the selection, the quality assessment (Assessment of Multiple Systematic Reviews 2 - AMSTAR-2), and the risk of bias assessment of the SR (Risk of Bias in Systematic Reviews - ROBIS). RESULTS: Two hundred nine records were retrieved; after removing duplicates and applying the inclusion/exclusion criteria, 5 SRs remained. Three SRs were rated as showing critically low methodological quality and high risk of bias, and two were rated as moderate methodological quality and low risk of bias. The identified treatments that may be suitable for MIH were classified as (1) non-invasive - casein incorporated into toothpaste and sugar-free chewing gum, toothpaste containing arginine, 0.4% stannous fluoride gel; fluoride varnish; (2) micro-invasive - resin sealants for pits and fissures, microabrasion, dental whitening, resin infiltration; (3) invasive - ART restorations, indirect restorations (metal, composite, or ceramic); and (4) mixed intervention - stainless steel crowns. CONCLUSION: Despite the considerable number of published papers included in this set of systematic reviews, the evidence supporting the effectiveness of treatments for treating MIH is limited due to the methodological quality and risk of bias of the systematic reviews, as well as the quality of the primary studies (PROSPERO: CRD42020144831). CLINICAL RELEVANCE: Different treatments have been purposed for MIH treatment, but there is still not enough scientific evidence of good quality for the establishment of a definitive clinical protocol for the treatment of MIH.

Restorative Techniques for Permanent First Molars Affected by Hypomineralization: A Systematic Review.

Purpose: There are several restorative modalities for molar hypomineralization, but there is no consensus on the best approach. The purpose of this review was to describe restorative approaches applied to permanent first molars (PFM) with molar hypomineralization (MH). Methods: This review was registered (PROSPERO database CRD42017078336). Searches were conducted in the PubMed, Scopus, Web of Science, LILACS, BBO, and Cochrane Library databases and grey literature. From a total of 1,751 studies, 12 that compared restorative treatments for PFM with MH were included. The risk of bias of the studies was assessed using the Cochrane Collaboration and the Newcastle-Ottawa Scale. The success rate was the primary outcome. Results: The restorative treatment options were direct restorations with amalgam, glass ionomer cement, and resin-based composite as well as indirect restorations with stainless steel, porcelain, ceromer, and gold crowns. The restorative techniques, considering the type of isolation and the removal of caries and hypomineralization, vary between the study. There was also a lack of standard clinical criteria for restorative evaluation. The follow-up period ranged from six to 216 months. The success of direct restorations ranged from 86.3 to 100 percent. For indirect restorations, success ranged from 91.3 to 100 percent. Conclusions: There were multiple clinical protocols for MH. The studies presented heterogeneity in the restoration technique, time, and clinical criteria for restorative follow-up. Direct restorations with glass ionomer cement and resin-based composite could be the first choices for restoration. Further randomized clinical trials on a restorative treatment for MH are needed.

Is there an association of genetic polymorphisms of the catechol-O-methyltransferase gene (rs165656 and rs174675) and the 5-hydroxytryptamine receptor 2A gene (rs4941573 and rs6313) with sleep bruxism in individuals with obstructive sleep apnea?

OBJECTIVE: To evaluate the association of single-nucleotide polymorphisms within the catechol-O-methyltransferase and 5-hydroxytryptamine receptor 2A genes with sleep bruxism in individuals diagnosed with obstructive sleep apnea. DESIGN: Sixty-nine individuals with suspected sleep-related problems were evaluated by polysomnography, following the recommendations of the American Academy of Sleep Medicine. Deoxyribonucleic acid (DNA) samples were collected only from 48 of the study participants because of missing polysomnographic data. DNA samples were collected and two single-nucleotide polymorphisms in the 5-hydroxytryptamine receptor 2A encoding HTR2A gene (rs4941573 and rs6313) and two in the catechol-O-methyltransferase gene (rs165656 and rs174675) were selected to be genotyped using real-time polymerase chain reaction. The association between sleep bruxism and genetic polymorphisms was investigated by recessive and dominant models. Association analyses were performed using a 95% confidence interval and the level of statistical significance was p < 0.05. RESULTS: From the 69 study participants, 48 were included in the polymorphism analysis and sleep bruxism was present in 35.4%. No significant differences were observed in the dominant and recessive models (p > 0.05). Haplotype and diplotype analyses revealed the predicted four haplotypes and two diplotypes were not associated with sleep bruxism. CONCLUSION: Polymorphisms rs174675 and rs165656 in the catechol-O-methyltransferase gene and rs4941573 and rs6313 in the 5-hydroxytryptamine receptor 2A gene were not significantly associated with sleep bruxism in individuals with obstructive sleep apnea.

Genetic polymorphisms are associated with alterations in anxiety levels and vital signs in patients undergoing third molar extractions.

OBJECTIVE: The objective of this study was to evaluate the association between SLC6A4 (rs1042173 and rs3813034), DRD2 (rs6275 and rs6276), ANKK1 (rs1800497), and COMT (rs174675) genetic polymorphisms and alterations in anxiety levels and vital signs in individuals undergoing third molar extractions. STUDY DESIGN: One hundred sixty-eight individuals were evaluated at the pre-, trans-, and postoperative periods by checking systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and body temperature. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI). Buccal mucosa cells were collected for genetic evaluation using real-time polymerase chain reaction. Statistical analysis was performed at a significance level of 5%. RESULTS: The level of anxiety was associated with rs1800497 for STAI-Trait (P = .031) and rs174675 for STAI-State (P = .007). Considering the vital signs, there was a significant difference between the values of respiratory rate and rs1042173 (P = .029), rs3813034 (P = .024), and rs6275 (P = .025). The diastolic blood pressure values differed significantly for rs1042173 (P = .042), and the body temperature values differed significantly for rs174675 (P = .016). CONCLUSIONS: Polymorphisms in SLC6A4, DRD2, ANKK1, and COMT genes could be associated with alterations in anxiety levels and vital signs in individuals undergoing third molar extractions.

Polymorphisms in COL2A1 gene in Adolescents with Temporomandibular Disorders.

OBJECTIVES: Temporomandibular disorder (TMD) is considered a functional disorder with multifactorial aspects. The goal of this study was to investigate if genetic polymorphisms in the COL2A1 gene could be associated with TMD in adolescents. STUDY DESIGN: The case group (TMD-affected) included individuals diagnosed with any of the following TMD subgroups according to the RDC/TMD criteria: myofascial pain, disc displacements and arthralgia. Genomic DNA for molecular analysis was extracted from buccal cells and genetic polymorphisms in COL2A1 were genotyped by real time polymerase chain reactions using the TaqMan assay. Data were analyzed using the Epi Info 3.5.7 and Stata software. RESULTS: 249 subjects were included in this study (148 subjects "affected" by TMD). There were no significant differences between the affected and unaffected individual (p>0.05), for TMD, arthralgia and myofascial pain however, rs2276454 was borderline in the genotype distribution (p=0.07) and was associated with disc displacement (p=0.03) in the allelic distribution. Recessive model showed significant differences between groups for with disc displacement (p=0.02). CONCLUSIONS: Genetic polymorphisms in COL2A1 are not associated with myofascial pain, arthralgia or TMD in adolescents but this study provides evidence that rs2276454 is involved in the disc displacement of the temporomandibular joint.

Alendronate disturbs femoral growth due to changes during immunolocalization of transforming growth factor-ß1 and bone morphogenetic protein-2 in epiphyseal plate.

BACKGROUND: The epiphyseal growth plate is an important anatomical segment localized on the ends of a long bone. Despite the abovementioned atractive reasons for alendronate's use, few data on the effect of alendronate during epiphyseal growth exist. AIM: Verify the effect of alendronate on the growth epiphyseal plate, and compare its effect with the size of the femur during the double-staining of the immunolocalization of transforming growth factor-ß1 (TGF-ß1) and bone morphogenetic protein-2 (BMP2) in endochondral ossifing in specimens that have received alendronate. METHODS: Forty newborn rats were randomly divided into two groups: a control group (were given applications of 1 mg/kg physiologic saline) and a group that received Alendronate (a dose of 2.5 mg/kg). These groups were then divided into two subgroups for euthanasia in two and 12 d of life. After euthanasia, the femurs were removed, and the femoral bones were measured linearly between the apex of the greater trochanter until the lower intercondylar midlle face to verify the probable bone growth between 3 and 12 d in control and alednroanto treated rats. Posteriorly, the surgical pieces were also sent to the histopathology laboratory to produce histological slides. The obtained slides were stained with hematoxylin and eosin to measure each of the cartilage zones in endochondral development. and other slides were immunohistochemically tested for anti- TGF-ß1 and BMP-2 antibodies to investigate the immunolocalization of these proteins in the epiphyseal plaque area. RESULTS: On the third day, some diferences between the control group and specimens treated with alendronate were verified. Macroscopiccaly, we found similarities in size between the femoral bones when we compared the control group with the specimens that received alendronate. On the 12th day, the bone size of the mice receiving the drug was significantly smaller than those of the control group. These results coincide with changes in the TGF-ß1 and BMP-2 expression. In the specimens that received alendronate, the TGF-ß1 was expressed in some sites of trabecular bone that was neoformed, peripherally to the bone marrow area. The BMP-2 was also positive in proliferative chondrocytes and hypertrofic chondrocytes. On the 12th day, all layers of chondrocytes exhibited positivity for BMP-2 in the specimens that received alendronate. In the interface between the trabecular bone and cartilage, an area of disorganized bone deposition was evident. Neoformed bone also appeared to be different at 12 d. In the control group, BMP-2 was positive in an intense area of bone trabeculae, whereas the alendronate-treated group showed TGF-ß1 positive trabeculae and a greater bone area. CONCLUSION: Alendronate alters the immunolocalization of TGF-ß1 and BMP-2 simultaneously, a condition that changes the usual histological aspects of the cartilage zone and impairs epiphysis growth and femur growth.

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.

Systemic Exposures Associated with Hypomineralized Primary Second Molars.

Purpose: Hypomineralized primary second molars (HPSMs) are clinically represented by demarcated opacities in the enamel, involving from one to four primary second molars. The purpose of this cross-sectional study was to investigate the systemic exposures associated with hypomineralized primary second molars. Methods: A representative population-based sample of 731 eight-year-old children was randomly selected. Data on systemic exposures were collected via a structured questionnaire given to the children's mothers. The HPSMs were clinically assessed by calibrated examiners according to the modified-DDE (developmental defects of enamel) index and European Academy of Paediatric Dentistry criteria. Associations were analyzed by Poisson multiple regression considering a temporal hierarchical approach. Results: The prevalence of HPSMs was 9.4 percent (95 percent confidence interval equals 7.0 to 12.0 percent). Children whose mothers presented with hypertension were found with an Adjusted Prevalence ratio (PRa) of 1.73 (P=0.044) and mothers who used tobacco (PRa equals 2.44; P=0.001) during pregnancy had a significantly higher prevalence of HPSMs. The presence of complications during delivery (PRa equals 1.83; P=0.032) and the occurrence of otitis media during early childhood (PRa equals 1.68; P=0.043) also presented a higher prevalence of HPSMs. Conclusion: The use of tobacco, presence of hypertension, complications during delivery, and otitis media during the first years of a child's life are associated with a higher prevalence of hypomineralized primary second molars. (Pediatr Dent 2019;41(5):364-70).

Dopamine receptor D2 and ankyrin repeat domain containing one in temporomandibular disorder of adolescents.

BACKGROUND: Temporomandibular disorder (TMD) is a multifactorial condition that combines environmental and genetic factors and its prevalence increases during adolescence. AIM: To investigate the association between TMD and genetic polymorphisms in the DRD2 and ANKK1 in a population of Brazilian adolescents. DESIGN: The TMD group included adolescents diagnosed with any of the following TMD subgroups according to the RDC/TMD criteria: myofascial pain, arthralgia and disc displacement and painful TMD. Genomic DNA for molecular analysis was extracted from buccal cells, and genetic polymorphism rs6275 in DRD2 and rs1800497 in ANKK1 were genotyped by real-time polymerase chain reactions using the TaqMan assay. Data were analysed using the Epi Info 3.5.7 and Stata software, with significance level of 0.05. RESULTS: Two hundred fifty-one individuals were included in this study, 148 subjects presented TMD. For disc displacement, the genetic polymorphisms rs6275 was associated in a recessive model (P = 0.04), whereas the rs6276 and rs1800497 presented only a borderline association in a recessive and dominant models, respectively (P = 0.07 and P = 0.06). CONCLUSION: The genetic polymorphism rs6275 in DRD2 was associated with disc displacement in Brazilian adolescents.

Dental anxiety in schoolchildren with molar incisor hypomineralization-A population-based cross-sectional study.

BACKGROUND: Identifying patients with high levels of DA helps to define the most adequate oral healthcare strategy, especially for pediatric patients. AIM: To investigate the association between parental reports of dental anxiety (DA) and molar incisor hypomineralization (MIH) in schoolchildren. DESIGN: A cross-sectional study was conducted in a representative sample of 731 8-year-old schoolchildren from the city of Curitiba, Brazil, who were clinically examined (k ≥ 0.75) for the diagnosis of MIH and dental caries using the EAPD criteria and dmft/DMFT index, respectively. Parents/guardians reported children's DA using the Dental Anxiety Question (DAQ) and answered a self-administered structured questionnaire addressing socioeconomic and demographic characteristics. Associations were evaluated using Poisson regression analysis with robust variance (P < 0.05). RESULTS: A significant association was found between DA and MIH (PR = 1.20; 95%CI: 1.01-1.42; P = 0.038), but this association lost its significance when adjusted for the other characteristics (PR = 1.13; 95%CI: 0.93-1.38; P = 0.215). Caries experience in primary teeth was associated with lower levels of DA (PR = 0.83; 95%CI: 0.71-0.96; P = 0.0013). The most recent visit to the dentist due to pain increased the levels of DA (PR = 1.18; 95%CI: 1.07-1.30; P = 0.001). CONCLUSIONS: The presence of MIH in schoolchildren was not associated with parental reports of DA.

Impact of molar incisor hypomineralization on quality of life in children with early mixed dentition: A hierarchical approach.

BACKGROUND: Molar incisor hypomineralization (MIH) is associated with unfavourable dental conditions such as dental caries and may consequently impact oral health-related quality of life (OHRQoL). OBJECTIVE: To assess the impact of MIH on OHRQoL in children with early mixed dentition. METHOD: A population-based cross-sectional study of 728 8-year-old children from the public school system in Curitiba, Brazil, was conducted. The Child Perception Questionnaire for 8- to 10-year-olds (CPQ8-10 ) was used to evaluate OHRQoL. MIH was diagnosed according to the European Academy of Paediatric Dentistry (EAPD) criteria. The assessments of MIH, dental caries, and malocclusion were performed by four calibrated examiners (κ ≥ 0.80). Demographic and socioeconomic data (DSE) were obtained from the children's parents/caregivers using a structured questionnaire. The analysis of OHRQoL determinants was performed through a three-level hierarchical approach: mesial (DSE), intermediate (clinical conditions), and distal (child's oral self-perception), using Poisson regression with robust variance (α = 0.05). RESULTS: The prevalence of MIH was 12.1% (95% CI: 10-15). An association was found between MIH and OHRQoL in the "oral symptoms" domain of the CPQ8-10 (PR: 1.07, 95% CI: 1.03-1.11, P < 0.001) after adjusting for other clinical variables and DSE. CONCLUSION: Molar incisor hypomineralization was associated with a greater impact on OHRQoL in children's oral symptoms.

The association of genetic polymorphisms in serotonin transporter and catechol-O-methyltransferase on temporomandibular disorders and anxiety in adolescents.

BACKGROUND: Temporomandibular disorder (TMD) is a multifactorial condition involving environmental, psychological and genetic factors. OBJECTIVE: The aim of this case-control study was to evaluate the influence of genetic polymorphisms in 5HTT and COMT on TMD and anxiety in adolescents. METHODS: TMD was diagnosed and classified according to the RDC/TMD criteria. For case group, the following TMD categories were used: myofascial pain, disc displacement, arthralgia and painful TMD (myofascial and arthralgia). Anxiety levels were assessed according to the State-Trait Anxiety Inventory. Genomic DNA was extracted, and genetic polymorphisms were genotyped by TaqMan chemistry and endpoint analysis. Logistic multivariate regression was used to analyse the associations between TMD types and genotypes, anxiety level and genotypes, using an adjusted odds ratio (ORa ; CI 95%) that considered the gender. RESULTS: In 5HTT, the rs1042173 was associated with painful TMD (arthralgia and myofascial pain) (ORc  = 1.97; CI 95%: 1.02-3.77; P = 0.04). Polymorphisms in COMT rs4818 were significantly associated with myofascial pain (ORc  = 2.15; CI 95%: 1.08-4.29; P = 0.02) and were borderline for painful TMD (ORc  = 1.85; CI 95%: 0.97-3.51; P = 0.06) and disc displacement (ORc  = 2.42; CI 95%: 1.00-5.87; P = 0.05). The rs6269 was borderline for myofascial pain (ORc  = 1.82; CI 95%: 0.92-3.59; P = 0.08) and disc displacement (ORc  = 2.38; CI 95% 0.95-5.97; P = 0.06) and also was associated with anxiety (ORa  = 2.34; CI 95% 1.04-5.25; P = 0.03). CONCLUSION: Polymorphisms in 5HTT and COMT are associated with TMD in adolescents. Moreover, polymorphism in COMT is associated with anxiety in adolescents.

Anxiety and malocclusion are associated with temporomandibular disorders in adolescents diagnosed by RDC/TMD. A cross-sectional study.

BACKGROUND: Temporomandibular Disorders (TMD) is a multifactorial condition, which could be associated to occlusal and psychological factors, such as anxiety. OBJECTIVE: Investigate if anxiety and malocclusion are associated with the prevalence of TMD in adolescents. METHODS: To ensure a population-based representative sample, 934 adolescents aged 10 to 14 years old from Curitiba-PR, Brazil were randomly selected and examined according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and malocclusion by a single-calibrated examiner (Kappa > 0.80). Anxiety was assessed according to trait anxiety (STAI-T), categorised as high, moderate and low levels. For occlusal exam, it was considered: Angel's molar relationship, anterior and posterior crossbite, excessive overjet, open and deep bite. The associations were analysed by the crude and adjusted prevalence ration (RPa ) of TMJ, calculated by a Poisson multivariate regression with robust variance (α = 0.05). RESULTS: The prevalence of at least one type of malocclusion was found in 52.3%. Anxiety was found in high level (12.2%), moderate (70.4%) and low (17.5%). Presence of high anxiety was significantly associated with the prevalence of TMD symptoms (RPa  = 4.06, P < 0.001), as well as the prevalence of myofascial pain (RPa  = 24.78; P < 0.001) and prevalence of disc displacement with reduction (RPa  = 11.08, P < 0.001). Adolescents Class II had higher prevalence of myofascial pain (Class II RPa  = 1.73; P < 0.015) than adolescents Class I. Adolescents Class III presented higher prevalence of myofascial pain (PRa 2.53; P = 0.004) than adolescents Class I. CONCLUSION: Anxiety is strongly associated with TMD in adolescents. Presence of Class II or III is associated with higher prevalence of myofascial pain in adolescentsPLESAE check and approve the edit made in the article title.

Does orthognathic surgery improve myofacial pain in individuals with skeletal class III? One-year follow-up.

OBJECTIVE: The objective of the study was to evaluate the effect of orthognathic surgery on temporomandibular disorder (TMD) in patients with skeletal class III malocclusion. STUDY DESIGN: Forty-seven patients undergoing surgery were evaluated by a trained examiner using Axis I of the Research Diagnostic Criteria/TMD index, consecutively, at 3 different periods: 1 week before operation (T0), 6 months after operation (T1), and 1 year after operation (T2). Bivariate analyses were performed to compare the evaluation periods (P < .05). RESULTS: The prevalence of TMD in the sampled patients from T0 to T1 decreased from 30 (63.8%) to 22 (46.8%) (P = .021). Even in T2, the prevalence of TMD remained lower than that in T0, at 21 (44.7%) diagnosed patients (P = .049). The reported frequencies of myofascial pain and headache were lower in T1 and T2 than in T0 (P < .001). Decrease in the frequency of joint pain and joint sounds was observed only from T0 to T1 (P = .039 and P = .021, respectively). The mean maximum of mouth opening decreased from T0 to T1 (P < .001) and increased again at T2 (P < .001). CONCLUSIONS: Orthognathic surgery promoted reduction in the frequencies of myofascial pain and headache reported by patients with skeletal class III malocclusion.

Evaluation of the erosive capacity of children's beverages on primary teeth enamel: An in vitro study.

BACKGROUND: The consumption of acidified beverages, associated with lower mineralization of primary enamel, is the ideal combination for the development and progression of dental erosion. The objective of this study is to analyze the erosive capacity and the surface roughness of primary teeth enamel after exposure to three different brands of grape juices. MATERIAL AND METHODS: Forty enamel blocks of primary teeth were obtained, attened and polished. They were submitted to initial surface roughness analysis (baseline), and randomly assigned into four groups (n = 10): NAT: natural grape juice (Campo Largo); IND: industrialized grape juice (Dell Vale Kapo); SOY: soy-based grape juice (Ades); and CONT (control): artificial saliva. Blocks were immersed for 2 min, 3 times per day, for 9 days. During the whole time of the experiment, the enamel blocks were stored in artificial saliva. After the 9 days, the roughness parameters were determined again. The beverages were analyzed for pH and titratable acidity. Data were statistically analyzed (α = 0.05). RESULTS: The surface roughness did not differ significantly among groups (p > 0.05). However, after the immersion in the different grape juices, the surface roughness values increased significantly (p< 0.05). The pH values were weakly correlated to acidity values; NAT showed the highest titratable acidity values than the other juices (p<0.05). CONCLUSIONS: Although the surface roughness values of the experimental groups did not differ from the control group, there was a difference in initial and final roughness in all groups. Grape juices, especially natural, may have an erosive capacity, changing the surface roughness of primary dental enamel. Key words:Dental erosion, beverages, enamel, roughness.

Prevalence of diagnosed temporomandibular disorders: A cross-sectional study in Brazilian adolescents.

BACKGROUND: The prevalence of signs and symptoms of temporomandibular disorders (TMD) increases during adolescence and adulthood. Few studies have examined TMD prevalence in Brazilian adolescents. AIM: To investigate the prevalence of TMD in Brazilian adolescents. METHODS: A representative population-based sample of 934 adolescents (10-14-years-old) was examined. TMD screening was performed using a questionnaire by the American Academy of Orofacial Pain. TMD diagnoses used research diagnostic criteria for temporomandibular disorders (RDC/TMD-Axis-I). Examinations were performed by a single calibrated examiner (kappa > 0.80). RESULTS: The prevalence of TMD symptoms was 34.9%; the most frequently reported symptoms were headache and neck ache (20.9%), followed by joint sounds (18.5%). Myofascial pain was the most prevalent type (10.3%), followed by disc displacement with reduction (8.0%) and arthralgia (3.5%). There was a significant association between sex and TMD symptoms; prevalence was significantly higher in girls (RP = 1.37; 95% CI = 1.14-1.65; p = 0.001). Myofascial pain of TMD and displacement with reduction were more prevalent in girls (RP = 1.76; p = 0.007 and RP = 2.06; p = 0.004, respectively). CONCLUSION: TMD symptoms were present in 34.9% of adolescents, with myofascial pain being the most prevalent type (10.3%). TMD was significantly more common in girls. Routine pediatric dental care should include a TMD screening.

Eighteen-month clinical performance of composite resin restorations with two different adhesive systems for molars affected by molar incisor hypomineralization.

INTRODUCTION: The restorative management of molars with molar incisor hypomineralization (MIH) represents a challenge in the clinical practice with high failure rate. OBJECTIVE: The aim of this study is to evaluate the clinical survival of direct composite resin restorations in first permanent molars (FPMs) that are affected by MIH, comparing two adhesive systems. MATERIAL AND METHODS: We selected 41 FPMs with MIH from children aged 6-8 years. FPM fully erupted and with restorative treatment needed were the inclusion criteria. We excluded FPMs with destroyed crowns. The FPMs were randomly assigned to two groups: self-etching adhesive (SEA) and total-etch adhesive (TEA). Clinical evaluation was performed by a blinded examiner during 18 months according to the modified US Public Health Service (USPHS) criteria. The actuarial method was used to evaluate survival of the restorations, and Chi-square and Fisher's exact tests were used to compare differences between the groups (α = 5 %). RESULTS: The cumulative survival rates were 100 % at 1 month, 89 % at 6 months, 73 % at 12 months, and 68 % at 18 months in SEA, and 95 % at 1 month, 72 % at 6 months, 59 % at 12 months, and 54 % at 18 months in TEA; there was no significant difference between groups. CONCLUSIONS: There was no difference in clinical survival of restorations in FPMs affected by MIH using TEA or SEA adhesives in the end of 18 months. CLINICAL RELEVANCE: It was suggested that SEAs as well as TEAs can be applied to restore molars affected by MIH, when it is performed a conservative cavity preparation. Once, cavosurface margins (cavity design) in hypomineralized enamel have less bonding capability.