Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management.

OBJECTIVES: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. METHODS: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. RESULTS: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. DISCUSSION: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

Effects of Orthodontic Functional Appliances in Relation to Skeletal Maturation of Cervical Vertebrae In Class II Malocclusion.

AIM: To evaluate the effects produced by functional orthodontic appliances at dental and skeletal level in relation to the level of skeletal maturation in class II patients Study design: Longitudinal and observational study Patients selected for the study had been wearing Sander Bite Jumping Appliance (SBJA) for at least 12 months; they were first diagnosed (T1) with skeletal class II according to Ricketts' cephalometric analysis, and had had lateral cephalograms taken before and after orthopaedic treatment (T2). Variables studied at T1 and T2 were: facial convexity, inclination of the upper and lower incisors, and facial depth. Results were compared between T1 and T2 for each variable and in relation to cervical maturation stage (CVS) according to the Lamparski analysis. Statistical analysis was performed using Shapiro-Wilk, t-student, Analysis of Variance (ANOVA) and multiple comparison tests, taking as statistically significant a p-value <0.05. RESULTS: A final sample of 235 patients was obtained. Statistically significant differences were found in the inclination of the mandibular incisors between T1 and T2 and among the different cervical stages when the functional appliances were placed in CVS1 (p = 0.000), CVS2 (p = 0.04) or CVS5 (p = 0.048). For the remaining variables, significant differences were also found between T1 and T2, but these differences were similar in all cervical stages. CONCLUSIONS: A significant proclination of the mandibular incisors was found when the functional appliance was placed during CVS1, CVS2, or CVS5. Time of placement of the functional appliances was not statistically significant for the remaining variables studied.

Effects of Orthodontic Functional Appliances in Relation to Skeletal Maturation of Cervical Vertebrae in Class II Malocclusion.

AIM: To evaluate the effects produced by functional orthodontic appliances at dental and skeletal level in relation to the level of skeletal maturation in class II patients. STUDY DESIGN: Longitudinal and observational study. Patients selected for the study had been wearing Sander Bite Jumping Appliance (SBJA) for at least 12 months; they were first diagnosed (T1) with skeletal class II according to Ricketts' cephalometric analysis, and had had lateral cephalograms taken before and after orthopaedic treatment (T2). Variables studied at T1 and T2 were: facial convexity, inclination of the upper and lower incisors, and facial depth. Results were compared between T1 and T2 for each variable and in relation to cervical maturation stage (CVS) according to the Lamparski analysis. Statistical analysis was performed using Shapiro-Wilk, t-student, Analysis of Variance (ANOVA) and multiple comparison tests, taking as statistically significant a p-value <0.05. RESULTS: A final sample of 235 patients was obtained. Statistically significant differences were found in the inclination of the mandibular incisors between T1 and T2 and among the different cervical stages when the functional appliances were placed in CVS1 (p = 0.000), CVS2 (p = 0.04) or CVS5 (p = 0.048). For the remaining variables, significant differences were also found between T1 and T2, but these differences were similar in all cervical stages. CONCLUSIONS: A significant proclination of the mandibular incisors was found when the functional appliance was placed during CVS1, CVS2, or CVS5. Time of placement of the functional appliances was not statistically significant for the remaining variables studied.

Oral Manifestations of Wolf-Hirschhorn Syndrome: Genotype-Phenotype Correlation Analysis.

BACKGROUND: Wolf-Hirschhorn syndrome (WHS) is a rare disease caused by deletion in the distal moiety of the short arm of chromosome 4. The objectives of this study were to report the most representative oral findings of WHS, relate them with other clinical characteristics of the disease, and establish possible phenotype-genotype correlation. METHODS: The study was conducted at 6 reference centers distributed throughout Spain during 2018-2019. The study group consisted of 31 patients with WHS who underwent a standardized oral examination. Due to behavioral reasons, imaging studies were performed on only 11 of the children 6 years of age or older. All participants had previously undergone a specific medical examination for WHS, during which anatomical, functional, epilepsy-related, and genetic variables were recorded. RESULTS: The most prevalent oral manifestations were delayed tooth eruption (74.1%), bruxism (64.5%), dental agenesis (63.6%), micrognathia (60.0%), oligodontia (45.5%), and downturned corners of the mouth (32.3%). We detected strong correlation between psychomotor delay and oligodontia (p = 0.008; Cramér's V coefficient, 0.75). The size of the deletion was correlated in a statistically significant manner with the presence of oligodontia (p = 0.009; point-biserial correlation coefficient, 0.75). CONCLUSION: Certain oral manifestations prevalent in WHS can form part of the syndrome's phenotypic variability. A number of the characteristics of WHS, such as psychomotor delay and epilepsy, are correlated with oral findings such as oligodontia and bruxism. Although most genotype-phenotype correlations are currently unknown, most of them seem to be associated with larger deletions, suggesting that some oral-facial candidate genes might be outside the critical WHS region, indicating that WHS is a contiguous gene syndrome.

El carbón activado y las condiciones de oscuridad en la micropropagación de banana variedad Nanicão / Activated Carbon and dark conditions in banana micropropagation Variety Nanicão

El objetivo del trabajo fue evaluar los efectos del carbón activado y las condiciones de oscuridad inicial sobre la propagación in vitro de banana (Musa spp.) variedad Nanicão. Fueron empleados 64 ápices provenientes de hijuelos de 20 - 30 cm. Los tratamientos consistieron en la combinación de dos concentraciones de carbón activado (2 y 3 g/l) y dos condiciones de oscuridad inicial (15 y 30 días). El diseño experimental utilizado fue completamente al azar con arreglo factorial 2 x 2 y cuatro repeticiones. Cada unidad experimental estuvo constituida por cuatro ápices. Las variables evaluadas fueron la tasa media de multiplicación, el porcentaje de supervivencia, oxidación, contaminación y aclimatización de plántulas. El análisis estadístico consistió en el ANAVA con un nivel de significancia del 5 %. Las medias fueron comparadas a través del test de Tukey al 5 % de probabilidad. Los resultados mostraron que la combinación de 2 g/l de carbón activado y 15 días de oscuridad inicial promovió el mayor porcentaje de supervivencia del primer subcultivo que alcanzo 57,30 %. En la fase de establecimiento el porcentaje de contaminación de los ápices de 39,06 % mientras que en el primer subcultivo de 22,39 %. La oxidación en la fase de establecimiento fue de 9,37 % y en el primer subcultivo fue de 8,85 %. Se concluye que la combinación entre la concentración de 2 g/l de carbón activado y 15 días de período de incubación inicial resulta efectiva en el aumento de la supervivencia de los ápices.

The objective of this work was to evaluate the effects of activated charcoal and the initial darkness conditions in the propagation in vitro of banana (Musa spp.) variety Nanicão. Were employed 64 apexes coming from shoots of approximately 20 to 30 cm. The treatments consisted in the combination of two concentrations of activated charcoal (2 and 3 g/l) and two initial dark conditions (15 and 30 days). The experimental design went completely randomized with 2 x 2 factorial arrangement and four replications. Each experimental unit consisted of four apexes. Statistical analysis consisted ANOVA with significance level of 5 %. The variables were the average rate of multiplication, survival percentage, oxidation, contamination and acclimatization of plantlets. Means were compared by Tukey test at 5 % of probability. The results showed significant difference in the interaction between the concentration of 2 g/l of activated charcoal and 15 days of initial darkness at the survival percentage from the first subculture which reached 57.30 %. In the establishment phase the percentage of contamination of the apexes was 39.06 % while that in the first subculture was 22.39 %. The oxidation in the establishment phase was 9.37 % and in the first subculture was 8.85 %. It is concluded the interaction between the concentration of 2 g/l of activated charcoal and 15 days of initial incubation period is effective in increasing survival.