The use of mouthwash containing trimetaphosphate as an adjunct therapy to fluoridated toothpaste reduces enamel demineralization.

INTRODUCTION: The decline in dental caries has been attributed to the widespread use of fluoride (F). Two forms of presentation are fluoridated toothpaste (FT) and mouthwash (MW), widely used by the population. MATERIALS AND METHODS: This study aimed to evaluate in vitro the effects of combining FT and MW, whether supplemented with sodium trimetaphosphate (TMP) or not, on dental enamel demineralization. Bovine enamel blocks (n = 60) were selected based on initial surface hardness (SHi) and divided into 5 experimental groups (n = 12 each): I) Placebo Toothpaste (without F/TMP); II) 1100 ppm F Toothpaste (FT); III) 1100F associated with a MW at 100 ppm F (FT + MW 100F); IV) 1100F associated with a MW at 225 ppm F (FT + MW 250F); and V) 1100F associated with a MW at 100 ppm F supplemented with 0.4 % TMP (FT + MW 100F-TMP). The blocks were treated twice a day, undergoing 5 pH cycles over 7 days. Thus, the percentage change in surface hardness (%SH), integrated subsurface hardness loss (ΔKHN), and the concentration of F, phosphorus (P), and calcium (Ca) in the enamel were determined. The data were submitted to ANOVA and Student-Newman-Keuls test (p < 0.001). RESULTS: The 1100F group was statistically inferior to the groups associated with MW for %SH, ΔKHN, and the concentration of P and Ca in the enamel (p < 0.001). Blocks treated with FT + MW 225F and FT + MW 100F-TMP showed significantly lower %SH compared to the other groups (p < 0.001). The FT + MW 100F - TMP group exhibited the lowest depth mineral loss (ΔKHN), and higher concentration de P in enamel (p < 0.001). CONCLUSION: The adjunct use of MW with FT produces a greater protective effect in inhibiting enamel demineralization, and the supplementation of TMP to the MW with 100F provides a superior effect compared to MW with 225F. CLINICAL SIGNIFICANCE: This combination of treatments could be regarded as one of several alternative fluoride supplements for subjects at elevated risk of caries.

Xylitol associated or not with fluoride: Is the action the same on de- and remineralization?

OBJECTIVES: This study evaluated the effect of xylitol combined or not with fluoride (F) on reduction of demineralization and increase of remineralization of shallow and deep artificial enamel lesions. METHODS: Bovine enamel samples were allocated to the following solutions groups: no xylitol (negative control), 5% xylitol, 10% xylitol, 20% xylitol, 500 ppm F (as NaF), 5% xylitol+F, 10% xylitol+F or 20% xylitol+F (n = 12-15). For the demin study, a pH-cycling model (demineralization-6 h, pH 4.7/remineralization 18 h, pH 7.0) was employed for 7 days. Treatments were applied 2 × 1 min. In the remin study, specimens were pre-demineralized for 2, 5 or 10 days. Afterwards, a pH-cycling protocol was conducted (2 h demineralizing and 22 h remineralizing solution/day for 8 days) and the same treatments were done. The response variables were percentage surface hardness loss (%SHL) and transverse microradiography. Data were analyzed by RM ANOVA/Tukey or Kruskal-Wallis/Dunn (p < 0.05) RESULTS: F and Xylitol combined with F reduced the %SHL (23-30%) compared to the negative control (61.5%). The integrated mineral loss and the lesion depth were not reduced by any treatment. Surface hardness recovery was seen only for shallow lesions in case of 20% xylitol+F compared to negative control. No lesion depth recovery, but significant mineral recovery was seen for F (2-days and 10-days lesion). CONCLUSIONS: All concentrations of xylitol+F reduced enamel surface demineralization, while only 20% xylitol+F improved surface remineralization of shallow lesions in vitro. CLINICAL SIGNIFICANCE: Our results suggest that while F or any concentration of xylitol + F reduces surface demineralization, only 20% xylitol+F improves surface remineralization of shallow lesions in vitro. Therefore, xylitol may be added into oral products, combined to F, to control dental caries.

Assessment of the developmental defects of the enamel in children and adolescents with sickle cell disease: A comparative study.

BACKGROUND: Sickle cell disease (SCD) is the most important hemoglobinopathy in terms of frequency and social impact and can affect the stomatognathic system. AIM: To assess and compare the developmental defects of the enamel (DDE) in children and adolescents with and without SCD. DESIGN: This was a cross-sectional, analytical, and comparative study of 210 children and adolescents aged 5-18 years, who visited the Hematology and Hemotherapy Hospital of Pernambuco. RESULTS: Developmental defects of the enamel were observed in 55.2% of the SCD patients and 35.2% of the non-SCD patients (healthy group; p < .05). In the SCD group, DDE were more common in females than in males (69.1% vs. 40.0%; p < .05). The incidence of DDE in the permanent teeth was higher in the upper arch than in the lower arch (SCD group, 13.1% vs. 4.6%; healthy group, 8.9% vs. 3.6%; p < .05). CONCLUSION: Compared with the healthy group, the SCD patients were almost twice as likely to develop DDE, mostly affecting females and the permanent teeth. These findings suggest that individuals with SCD need early dental care to avoid future oral problems.

Impact of Molar Incisor Hypomineralization on Oral Health-Related Quality of Life in Brazilian Schoolchildren Aged 8 to 10 Years

ABSTRACT Objective: To assess the impact of Molar Incisor Hypomineralization (MIH) and confounding factors on oral health-related quality of life (OHRQoL) according to the perception of 8 to 10-year-old children and their parents/caregivers. Material and Methods: A cross-sectional study including 403 students aged 8-10 years was carried out, in which OHRQoL was measured using the Child Perceptions Questionnaire administered to both children and parents/caregivers. The diagnosis of MIH was performed according to the previously proposed index. Dental caries experience, malocclusion, and sociodemographic factors were evaluated as confounders. Cluster analysis and Poisson regression with robust variance (p<0.05) were performed. Results: The prevalence of MIH was 13.4%. Parents/caregivers of children with MIH in incisors showed a higher impact prevalence in the emotional well-being domain (PR=1.92; 95%CI=1.16-3.19). Children with hypoplasia had a higher prevalence of negative impact on OHRQoL in the oral symptoms domain (PR=1.51; 95%CI=1.03-2.23). According to the perception of parents/caregivers, dental caries experience had a negative impact on the quality of life of students in the emotional well-being domain (PR=4.19; 95%CI=1.06-16.49) and in the total questionnaire score (PR=3.21; 95%CI=1.06-9.71). Conclusion: According to the perception of parents/caregivers, children with MIH in incisors showed a greater impact on OHRQoL. Additionally, the presence of hypoplasia affected the self-perception of OHRQoL in children, and caries experience influenced the OHRQoL of children, as perceived by parents/caregivers.

Inhibition of incipient caries lesion progression by different fluoridated varnishes

Abstract The aim of this in vitro study was to evaluate the potential of different fluoridated varnishes to inhibit the progression of incipient caries lesions after cariogenic challenge. Seventy-five enamel specimens of bovine teeth were prepared and selected based on the initial surface microhardness (SMH). The specimens were first subjected to artificial demineralization (in buffer solution) after which SMH was re-analyzed (SM1). They were then randomly assigned to five experimental groups: 1- CONTROL (pH cycling), 2 - MI VAR (MI Varnish with RECALDENTTM - CPP-ACP), 3 - PROFL (Profluorid®), 4 - CLIN (ClinproTM White Varnish with TCP), and 5 - DUR (Duraphat®) (n=15). The varnishes were applied in a thin layer and the specimens were then subjected to pH cycling for eight days. The SMH and cross-sectional microhardness (CSMH) were then analyzed (SM2). The fluoride and calcium ion concentrations in the solution were analyzed by the indirect method and atomic absorption spectrophotometry, respectively. Data were statistically analyzed by Student's t-test, ANOVA/Tukey-Kramer, or Kruskall-Wallis/Dunn tests for individual comparisons (p˂0.05). All varnishes led to significantly higher surface and subsurface remineralization compared with the control group but did not differ from each other. The varnishes with the highest fluoride release were: PROFL and CLIN, followed by MI VAR and DUR. The varnishes with significantly higher release of calcium were: DUR, CLIN, and PROFL. In conclusion, all commercial fluoridated varnishes tested have good potential to inhibit the progression of demineralization, regardless of the ion release mechanisms.

Resumo O objetivo deste estudo in vitro foi avaliar o potencial de diferentes vernizes fluoretados em inibir a progressão de lesões de cárie incipientes. Setenta e cinco espécimes de esmalte de dentes bovinos foram preparados e selecionados com base na microdureza superficial inicial (MDS/SM). Os espécimes foram submetidos à desmineralização artificial (em solução de Buskes), sendo então a MDS (SM1) reanalisada. Foram então distribuídos aleatoriamente em cinco grupos experimentais: 1- CONTROLE (pH cycling), 2 - MI VAR (MI Varnish with RECALDENTTM - CPP-ACP), 3 - PROFL (Profluorid®), 4 - CLIN (ClinproTM White Varnish with TCP), and 5 - DUR (Duraphat®). Os vernizes foram aplicados em camada fina e os espécimes foram então submetidos à ciclagem de pH por oito dias. A MDS final (SM2) e a microdureza transversal (CSMH) foram então analisadas. As concentrações de flúor e íons cálcio em solução foram analisadas pelo método indireto e espectrofotometria de absorção atômica, respectivamente. Os dados foram analisados estatisticamente pelo teste T de Student, ANOVA/Tukey-Kramer ou testes de Kruskall-Wallis/Dunn para comparações individuais (p˂0,05). Todos os vernizes levaram a uma remineralização superficial e subsuperficial significativamente maior em comparação com o grupo controle, não diferindo significativamente entre si. Os vernizes com maior liberação de flúor foram: PROFL e CLIN, seguidos de MI VAR e DUR. Os vernizes com liberação significativamente maior de cálcio foram: DUR, CLIN e PROFL. Pôde-se concluir que todos os vernizes fluoretados comerciais testados apresentam bom potencial de inibição da progressão da desmineralização, independentemente dos mecanismos de liberação de íons.

Acid challenge exacerbates activation of matrix metalloproteinases in permanent teeth undergoing radiotherapy

Abstract The aim of this study was to investigate the effect of acid challenge on the activation of matrix metalloproteinases (MMPs) in the Dentinoenamel junction of primary and permanent teeth submitted to radiotherapy. For this purpose, a total of 178 dental fragments obtained from molars were used, and randomly divided into 2 groups (primary and permanent teeth) / 4 experimental subgroups (irradiated and non-irradiated, demineralized and non-demineralized). The fragments were exposed to radiation, with a dose fraction of 2 Gy, for 5 consecutive days, until a total dose of 60 Gy was reached, with a total of 30 cycles, for 6 weeks. To determine the activity of MMPs on the dentinoenamel junction (DEJ), in situ zymography assays on 0.6mm dental fragments were performed. To assess whether MMP activity would be impacted by an acidic environment, the fragments were placed in a demineralizing solution (pH of 4.8). The finding was that irradiation activated MMPs in DEJ and these effects were more evident in permanent when compared with primary teeth. When the effect of an acid challenge on MMPs activity was investigated, demineralization was observed not to increase MMPs activity in non-irradiated teeth, but it did increase MMPs activity in irradiated teeth. In conclusion, an acid challenge was found to exacerbate activation of MMPs in DEJ of permanent teeth submitted to irradiation, but not in primary teeth.

Bioactive Restorative Materials Applied over Coronal Dentine-A Bibliometric and Critical Review.

The objective of the research was to examine the scientific literature concerning restorative materials with bioactive properties for the purpose of covering dentin. Searches were performed in various databases including MEDLINE, Scopus, Web of Science, Cochrane Library, Lilacs/BBO, and Embase. Inclusion criteria involved studies that utilized the terms "dentin" and "bioactive", along with "ion-releasing", "smart materials", "biomimetic materials" and "smart replacement for dentin". The information extracted included the title, authors, publication year, journal and the country of affiliation of the corresponding author. The studies were categorized based on their study design, type of material, substrate, analytical method, and bioactivity. A total of 7161 records were recovered and 159 were included for data extraction. Most of the publications were in vitro studies (n = 149), testing different types of materials in sound dentine (n = 115). Most studies were published in Dental Materials (n = 29), and an increase in publications could be observed after the year 2000. Most of the articles were from the USA (n = 34), followed by Brazil (n = 28). Interfacial analysis was the most investigated (n = 105), followed by bond strength (n = 86). Bioactivity potential was demonstrated for most tested materials (n = 148). This review presents insights into the current trends of bioactive materials development, clearly showing a severe lack of clinical studies.

Effect of Bioactive Filler Addition on the Mechanical and Biological Properties of Resin-Modified Glass Ionomer.

The maintenance of affected dentin can promote the greater conservation of tooth structure. The development of materials that have properties capable of reducing the demineralizing potential and/or even helping in dental remineralization is important for conservative dentistry. This study aimed to evaluate, in vitro, the alkalizing potential, fluoride as well as calcium ion release ability, antimicrobial activity, and dentin remineralization properties of resin-modified glass ionomer cement (RMGIC) incorporated with a bioactive filler (niobium phosphate (NbG) and bioglass (45S5)). The study samples were grouped into RMGIC, NbG, and 45S5. The materials' alkalizing potential, ability to release calcium as well as fluoride ions, and antimicrobial properties concerning Streptococcus mutans UA159 biofilms were analyzed. The remineralization potential was evaluated using the Knoop microhardness test, which was performed at different depths. The alkalizing and fluoride release potential was higher for the 45S5 group (p < 0.001) over time. An increase in the microhardness of demineralized dentin was observed in the 45S5 and NbG groups (p < 0.001). No differences in biofilm formation were observed between the bioactive materials, although 45S5 exhibited lower biofilm acidogenicity at different time points (p < 0.001) and greater calcium ion release in the microbial environment. A resin-modified glass ionomer cement enriched with bioactive glasses, particularly 45S5, is a promising alternative for the treatment of demineralized dentin.

Potencial protetor de dentifrícios contendo partículas S-PRG contra o desgaste dental erosivo / Potential protector of toothpastes containing S-PRG fillers against erosive dental wear

Novas alternativas de tratamento têm surgido para se reduzir a desmineralização dental, como o uso de materiais com propriedade bioativa. As partículas de vidro com superfície pré-reagida (S-PRG) tem o potencial de liberação de íons, alumínio, boro, flúor, sódio, silício e estrôncio, podendo representar uma proposta promissora contra a desmineralização ocasionada na erosão dental. Assim, neste trabalho, propusemo-nos avaliar se dentifrícios experimentais contendo diferentes concentrações de partículas S-PRG oferecem potencial protetor contra a erosão inicial e o desgaste dental erosivo/abrasivo do esmalte dentário. Espécimes em esmalte bovino foram preparados, polidos e alocados aleatoriamente em grupos (n = 10) conforme a concentração de S-PRG no dentifrício: 0% S-PRG; 1% S-PRG; 5% S-PRG; 10% S-PRG 20% S-PRG; 30% S-PRG. A água ultrapura e o dentifrício fluoretado (1450 ppm F-) foram controles negativo e positivo, respectivamente. Foram realizadas ciclagens erosivas/abrasivas, que consistiram na imersão em ácido cítrico a 0,3% (5 min ­ 4x/dia) seguidos por saliva humana. Os tratamentos com as suspensões de dentifrícios (1:3 com saliva artificial) foram realizados 2x/dia ­ 2 min. Os espécimes foram submetidos à abrasão em máquina de escovação (15 s ­ 200 g) durante a imersão nas suspensões de tratamento. As ciclagens foram repetidas por 5 dias. Inicialmente foram realizadas leituras de microdureza Knoop e perfilometria de contato. No primeiro dia do ciclo, a microdureza dos espécimes foi mensurada após o primeiro desafio ácido (E1), após os tratamentos para avaliar o potencial de reendurecimento (T) e após o segundo desafio ácido para avaliar o potencial protetor contra a desmineralização (E2). Após a finalização da ciclagem (5 dias), foi avaliada a perda de superfície do esmalte por meio de perfilometria. Os dados foram submetidos ao teste ANOVA a um fator e teste post hoc de Tukey (α = 0.05). Os dados de microdureza mostraram diferenças significantes para os diferentes grupos testados, tanto em relação potencial de reendurecimento (p<0,001) e de redução de alteração da dureza (p<0,001). Os valores médios de perda superficial do esmalte foram: Água (11,24±1,22a); NaF (6,43±0,83c); 0% (10,96±0,97a); 1% (10,26±1,01a); 5% (8,66±0,46b); 10% (6,62 ±0,64c); 20% (4,65±0,92d); 30% (4,05±0,74d); (letras diferentes significam diferença significante pelo teste de Tukey). Conclui-se que os dentifrícios contendo partículas de S-PRG em maiores concentrações (10% a 30%) tiveram resultados favoráveis no potencial de reendurecimento, na redução de alteração, e diminuição do desgaste dental erosivo, sendo que na concentração de 30%, o efeito foi superior ao observado pelo dentifrício fluoretado.(AU)

New treatment alternatives have emerged to reduce dental demineralization, such as the use of materials with bioactive properties. Glass particles with a pre-reacted surface (S-PRG) have the potential to release ions, aluminum, boron, fluorine, sodium, silicon and strontium, and may represent a promising proposal against demineralization caused by dental erosion. Thus, in this study, we aimed to evaluate whether experimental dentifrices containing different concentrations of S-PRG particles offer protective potential against initial erosion and erosive/abrasive tooth wear of dental enamel. Bovine enamel specimens were prepared, polished and randomly allocated into groups (n = 10) according to the concentration of S-PRG in the dentifrice: 0% S-PRG; 1% S-PRG; 5% S-PRG; 10% S-PRG 20% S-PRG; 30% SPRG. Ultrapure water and fluoridated dentifrice (1450 ppm F-) were negative and positive controls, respectively. Erosive/abrasive cycling was performed, consisting of immersion in 0.3% citric acid (5 min - 4x/day) followed by human saliva. Treatments with dentifrice suspensions (1:3 with artificial saliva) were performed 2x/day - 2 min. Specimens were subjected to abrasion in a brushing machine (15 s - 200 g) during immersion in the treatment suspensions. Cycling was repeated for 5 days. Initially, Knoop microhardness and contact profilometry readings were performed. On the first day of the cycle, the microhardness of the specimens was measured after the first acid challenge (E1), after the treatments to evaluate the re-hardening potential (T) and after the second acid challenge to evaluate the protective potential against demineralization (E2). After completion of cycling (5 days), enamel surface loss was assessed by means of profilometry. Data were submitted to one-way ANOVA and Tukey's post hoc test (α = 0.05). The microhardness data showed significant differences for the different groups tested, both in terms of re-hardening potential (p<0.001) and reduction in hardness change (p<0.001). The mean values of enamel surface loss were: Water (11.24±1.22a); NaF (6.43±0.83c); 0% (10.96±0.97a); 1% (10.26±1.01a); 5% (8.66±0.46b); 10% (6.62±0.64c); 20% (4.65±0.92d); 30% (4.05±0.74 d); (different letters mean significant difference by Tukey's test). It is concluded that dentifrices containing S-PRG particles in higher concentrations (10% to 30%) had favorable results in the re-hardening potential, in the reduction of alteration, and reduction of erosive tooth wear, and at the concentration of 30%, the effect was superior to that observed by fluoridated dentifrice (AU)

In vitro effect of low-fluoride toothpaste supplemented with sodium trimetaphosphate, xylitol, and erythritol on enamel demineralization

Abstract Regular use of toothpaste with fluoride (F) concentrations of ≥ 1000 ppm has been shown to contribute to reducing caries increment. However, when used by children during the period of dental development, it can lead to dental fluorosis. Objective: In this study, we aimed to evaluate the in vitro effect of a toothpaste formulation with reduced fluoride (F) concentration (200 ppm) supplemented with sodium trimetaphosphate (TMP: 0.2%), Xylitol (X:16%), and Erythritol (E: 4%) on dental enamel demineralization. Methodology: Bovine enamel blocks were selected according to initial surface hardness (SHi) and then divided into seven experimental toothpaste groups (n=12). These groups included 1) no F-TMP-X-E (Placebo); 2) 16% Xylitol and 4% Erythritol (X-E); 3) 16% Xylitol, 4% Erythritol and 0.2%TMP (X-E-TMP); 4) 200 ppm F (no X-E-TMP: (200F)); 5) 200 ppm F and 0.2% TMP (200F-TMP); 200 ppm F, 16% Xylitol, 4% Erythritol, and 0.2% TMP (200F-X-E-TMP); and 7) 1,100 ppm F (1100F). Blocks were individually treated 2×/day with slurries of toothpastes and subjected to a pH cycling regimen for five days (DES: 6 hours and RE: 18 hours). Then, the percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), fluoride (F), calcium (Ca), and phosphorus (P) in enamel were determined. The data were analyzed by ANOVA (1-criterion) and the Student-Newman-Keuls test (p<0.001). Results: We found that the 200F-X-E-TMP treatment reduced %SH by 43% compared to the 1100F treatments (p<0.001). The ΔKHN was ~ 65% higher with 200F-X-E-TMP compared to 1100F (p<0.001). The highest concentration of F in enamel was observed on the 1100F treatment (p<0.001). The 200F-X-E-TMP treatment promote higher increase of Ca and P concentration in the enamel (p<0.001). Conclusion: The association of 200F-X-E-TMP led to a significant increase of the protective effect on enamel demineralization compared to the 1100F toothpaste.

Ocorrência e severidade da hipomineralização molar-incisivo em crianças e adolescentes: um estudo de painéis seriados / Occurrence and severity of molar-incisor hypomineralization in children and adolescents: a serial panel study

Introdução: A Hipomineralização Molar-Incisivo (HMI) é um defeito de desenvolvimento do esmalte, de origem sistêmica, que afeta pelo menos um primeiro molar permanente, podendo estar associado aos incisivos permanentes. Clinicamente é caracterizada como opacidades demarcadas de esmalte que podem variar de coloração (branco-creme ou amarelo-marrom). Objetivo: Estimar a ocorrência e a severidade da HMI em crianças e adolescentes e identificar os possíveis fatores associados à ocorrência da HMI. Metodologia: Foi realizado um estudo transversal em painéis seriados (2002 a 2011) e (2012 a 2021) que utilizou 230 prontuários de pacientes na faixa etária entre 06 e 12 anos, submetidos ao tratamento ortodôntico na Associação Brasileira de Odontologia entre os anos de 2002 e 2021. Os critérios diagnósticos utilizados foram a presença ou a ausência de opacidades demarcadas, restaurações atípicas, fraturas pós-irruptivas e extração de molar devido à HMI. Os dados coletados digitados e processados no programa SPSS, tratados estatisticamente através do teste do Qui-Quadrado para um nível de confiança de 95%. Resultados: A ocorrência de HMI em todo o período estudado foi de 26 casos dentre os 230 prontuários avaliados (o que representa 11,3% com IC de 95% de 7,21 a 15,39%). Desses, 03 casos são severos, o que equivale a 11,5% (com IC 95% de 5,00 a 18,00%). Foi observada uma associação da ocorrência da HMI com as variáveis gênero (masculino), idade (06 a 10 anos) e ano em que a documentação foi realizada (2012 a 2021). Conclusão: Esse trabalho evidencia que embora a ocorrência de HMI seja baixa em crianças e adolescentes de 06 a 12 anos, ela vem aumentando nos últimos anos. O percentual de indivíduos do gênero masculino e mais jovens com HMI é maior, apontando uma tendência de aumento da ocorrência de HMI nos próximos anos. Além disso, a maioria dos casos são leves, com um envolvimento maior de dentes molares em relação aos incisivos e de molares e incisivos maxilares em relação aos mandibulares. Esses achados são importantes para ajudar a formular estratégias para prevenir ou reduzir as consequências da HMI (AU).

Introduction: Molar-Incisor Hypomineralization (MIH) is an enamel development defect of systemic origin that affects at least one permanent first molar and may be associated with permanent incisors. Clinically, it is characterized as demarcated enamel opacities that can vary in color (white-cream or yellow-brown). Objective: To estimate the occurrence and severity of MIH in children and adolescents and identify possible factors associated with the occurrence of MIH. Methodology: A crosssectional study was carried out in serial panels (2002 to 2011) and (2012 to 2021) using 230 medical records of patients aged between 6 and 12 years, undergoing orthodontic treatment at the Brazilian Dental Association between 2002 and 2021. The diagnostic criteria used were the presence or absence of demarcated opacities, atypical restorations, post-rupturing fractures and molar extraction due to HMI. The collected data were typed and processed in the SPSS program, statistically treated using the chi-square test at a confidence level of 95%. Results: The occurrence of MIH throughout the study period was 26 cases among the 230 medical records evaluated (which represents 11.3% with a 95% CI of 7.21 to 15.39%). Of these, 03 cases are severe, which is equivalent to 11.5% (with CI 95% from 5.00 to 18.00%). An association was observed between the occurrence of MIH with the variables gender (male), age (06 to 10 years old) and year in which the documentation was carried out (2012 to 2021). Conclusion: This work shows that although the occurrence of MIH is low in children and adolescents from 6 to 12 years old, it has been increasing in recent years. The percentage of male and younger individuals with HMI is higher, indicating an increasing trend in the occurrence of HMI in the coming years. In addition, most cases are mild, with greater involvement of molar teeth compared to incisors and maxillary molars and incisors compared to mandibular ones. These findings are important to help formulate strategies to prevent or reduce the consequences of HMI (AU).

Avaliação do conhecimento e condutas clínicas dos ortodontistas quanto à hipomineralização molar incisivo / Assessment of orthodontists' knowledge and clinical conduct regarding incisor molar hypomineralization

Introdução: A Hipomineralização Molar Incisivo (HMI) é um defeito qualitativo do esmalte dentário, que o torna frágil e poroso, podendo levar a interferências na prática ortodôntica. Assim, torna-se necessário que o ortodontista conheça essa alteração. Objetivo: Avaliar o nível de conhecimento e as condutas clínicas dos ortodontistas em relação à HMI. Metodologia: Foi realizado um estudo observacional transversal, entre ortodontistas brasileiros para avaliar suas práticas e seus conhecimentos prévios sobre a HMI. Para isso, foi desenvolvido um questionário que contemplava perguntas sobre o diagnóstico da HMI, experiência clínica e condutas ortodônticas frente à essa condição. O questionário foi validado por odontopediatras através do método Delphi, e enviado para ortodontistas de todas as regiões do Brasil. Foram excluídos desse estudo ortodontistas que residiam fora do país, e aqueles que estavam impedidos de exercer a especialidade temporariamente. No total, foram consideradas 351 respostas. Resultados: Apesar de 80,1% dos ortodontistas afirmarem conhecer a HMI, 44,2% assumiram não sentir segurança na realização de seu diagnóstico. Não houve associação significativa entre o nível de conhecimento desses profissionais e as variáveis sociodemográficas (p>0,05), com exceção da variável sexo, onde o feminino apresentou um conhecimento superior em relação a HMI, quando comparado ao masculino (p<0,05). A HMI tem sido notada por 74,4% dos participantes em seu dia-a-dia clínico, e 80,3% afirmaram que estas alterações afetam diretamente suas práticas ortodônticas. Conclusão: Apesar dos ortodontistas conhecerem a HMI, eles não possuem domínio total das suas características e peculiaridades. Não há na literatura protocolos ideais para a conduta de colagem, cimentação e descolagem de acessórios ortodônticos em dentes com HMI, o que evidencia a necessidade de mais estudos nesse sentido (AU).

Introduction: Molar Incisor Hypomineralization (MIH) is a qualitative defect of dental enamel, which makes it fragile and porous, and can interfere with orthodontic practice. Thus, it is necessary for the orthodontist to know this enamel change. Aim: To assess the level of knowledge and clinical practices of orthodontists in relation to MIH. Methodology: We performed a cross-sectional observational study among brazilian orthodontists to evaluate their practices and previous knowledge regarding MIH. We developed a questionnaire including questions about MIH diagnosis, clinical experience and orthodontic approaches regarding MIH. The questionnaire was validated by pediatric dentists (using the Delphi method) and sent to orthodontists acting in all brazilian regions. Orthodontists who did not reside in Brazil and those who were temporarily unable to practice the speciality were excluded from this study. At total, responses from 351 orthodontists were considered. Results: Although 80.1% orthodontists claimed to know the HMI, 44.2% said they did not feel confident in carrying out their diagnosis. There was no significant association between the level of knowledge of these professionals and the sociodemographic variables (p>0.05), with the exception of the gender variable, where females showed superior knowledge regarding MIH, when compared to males (p<0,05). The HMI has been noticed by 74.4% of the participants in their clinical routine, and 80.3% stated that these changes directly affect their orthodontic practices. Conclusion: Although orthodontists know the MIH, they do not fully master its characteristics and peculiarities. There are no ideal protocols in the literature for the conduct of bonding, cementing and debonding of orthodontic accessories in teeth with MIH, which highlights the need for further studies in this regard (AU).

Evaluation of bleaching efficacy, microhardness, and trans-amelodentinal diffusion of a novel bleaching agent for an in-office technique containing hexametaphosphate and fluoride.

OBJECTIVE: This study evaluated in vitro the effects of calcium gluconate (CaGlu), sodium fluoride (NaF), sodium hexametaphosphate (HMP), and NaF/TMP added to a 35% hydrogen peroxide (H2O2) bleaching gel on the color change, enamel hardness, and trans-amelodentinal diffusion. MATERIALS AND METHODS: Enamel discs/bovine dentin (n = 150) were divided according to the bleaching gel: 35% H2O2 (H2O2); 35% H2O2 + 0.1% NaF (H2O2/NaF); 35% H2O2 + 1% HMP (H2O2/HMP); 35% H2O2 + 0.1% NaF + 1% HMP (H2O2/NaF/HMP), and 35% H2O2 + 2% CaGlu (H2O2/Caglu). The bleaching gels were applied three times (40 min/session) at 7-day intervals between each application. Then, color alteration (ΔE), whitening index (ΔWID), percentage of surface hardness loss (% SH), cross-sectional hardness (ΔKHN), and trans-amelodentinal diffusion were determined. Data were submitted for analysis of variance (ANOVA), followed by the Student-Newman-Keuls test (p < 0.05). RESULTS: All bleaching gels showed significant color changes after treatment (p < 0.001). ΔE and ΔWID were similar among the evaluated gels. Mineral loss (% SH and ΔKHN) and trans-amelodentinal diffusion of hydrogen peroxide were lower for H2O2/NaF/HMP; the H2O2/CaGlu group presented the highest values about the other groups (p < 0.001). CONCLUSION: It is possible to conclude that the addition of NaF/HMP to the in-office bleaching agent did not interfere with the bleaching efficacy and reduced enamel demineralization and H2O2 diffusion. CLINICAL SIGNIFICANCE: The association of NaF/HMP to the bleaching gel can be used as a novel approach for minimizing the adverse effects of H2O2 by-products and with similar clinical efficacy.

Triacrylamide-Based Adhesives Stabilize Bonds in Physiologic Conditions.

In this study, an acrylamide-based adhesive was combined with a thiourethane-based composite to improve bond stability and reduce polymerization stress, respectively, of simulated composite restorations. The stability testing was conducted under physiologic conditions, combining mechanical and bacterial challenges. Urethane dimethacrylate was combined with a newly synthesized triacrylamide (TMAAEA) or HEMA (2-hydroxyethyl-methacrylate; control) to produce a 2-step total-etch adhesive system. Methacrylate-based composites (70 wt% silanized filler) were formulated, containing thiourethane oligomers at 0 (control) or 20 wt%. Standardized preparations in human third molars were restored; then, epoxy replicas were obtained from the occlusal surfaces before and after 7-d storage in water or with Streptococcus mutans biofilm, which was tested after storage in an incubator (static) or the bioreactor (mechanical challenge). Images were obtained from the replicas (scanning electron microscopy) and cross sections of the samples (confocal laser scanning microscopy) and then analyzed to obtain measurements of gap, bacterial infiltration, and demineralization. Microtensile bond strength of specimens stored in water or biofilm was assessed in 1-mm2 stick specimens. Data were analyzed with analysis of variance and Tukey's test (α = 0.05). HEMA-based materials had greater initial gap measurements, indicating more efficient bonding for the acrylamide materials. When tested in water, the triacrylamide-based adhesive had smaller gaps in the incubator or bioreactor. In the presence of biofilm, there was less difference among materials, but the acrylamide/thiourethane combination led to statistically lower gap formation in the bioreactor. HEMA and TMAAEA-based adhesives produced statistically similar microtensile bond strengths after being stored in water for 7 d, but after the same period with biofilm-challenged specimens, the TMAAEA-based adhesives were the only ones to retain the initial bond strength values. The use of a stable multiacrylamide-based adhesive led to the preservation of the resin-dentin bonded interface after a physiologically relevant challenge. Future studies will include a multispecies biofilm model.

Association between respiratory diseases and molar-incisor hypomineralization: A systematic review and meta-analysis.

The molar-incisor permineralização (MIH) is a qualitative enamel developing abnormality involving the occlusal and/or incisal third of one or more molars or permanent incisors, caused by systemic factors. Several systemic disorders and environmental factors, such as respiratory diseases, have been reported as probable causes of MIH. Thus, this work aimed to evaluate whether respiratory diseases and MIH are associated. The searches were carried out in electronic databases, including PubMed, Scopus, Web of Science, the Cochrane Library, LILACS, OpenGrey, and Google Scholar. The acronym PECO was used, in which the P (population) was humans in permanent dentition stage; (E-exposure) molar-incisor hypomineralization; (C-comparison) reference population and (O - outcome) respiratory diseases. After the search retrieval, the duplicates were removed, and the articles were evaluated by title and abstract; then, the papers were read and thoroughly assessed. After selection, the risk of bias assessment was performed using the Newcastle-Ottawa Scale (NOS) for observational studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess the level of evidence. Three thousand six hundred and sixty six were found through the searches. After exclusion by duplicates, title, abstract, and full-reading, 13 articles remained. The articles included in this review evaluated the association of MIH with asthma, tonsilitis, pneumonia, and bronchitis. Most reports showed a low risk of bias. When exploring through GRADE, a very low level of evidence was found. We observed that the included studies showed that children with MIH had more respiratory diseases than the group that did not have MIH. Systematic review registration: https://osf.io/un76d.

A conservative approach to rehabilitate a molar-incisor hypomineralization case / Uma abordagem conservadora para reabilitar um caso de hipomineralização molar-incisivo

ABSTRACT Molar incisor hypomineralization is an increasingly common condition in our population. This condition can have great impact on the esthetics, function, and well-being of the child. This paper reports a case of a young patient diagnosed with this condition affecting all the first permanent molars and lower incisors, particularly teeth 31 and 41. The molars were treated with direct resin restorations with cusp coating and the incisors aesthetic was restored with different techniques such as bleaching with sodium hypochlorite, micro-abrasion and resin restorations. This treatment plan aimed to restore the proper teeth function, treat the already existing hypersensitivity and algic complains and to improve the aesthetic of the anterior sector. The presented case shows a conservative approach to deal with the molar incisor hypomineralization condition with satisfactory results after 1-year follow-up.

RESUMO A hipomineralização incisivo-molar (HIM) é uma condição cada vez mais comum na nossa população. Esta condição pode ter um grande impacto na estética, função e bem-estar da criança. Este artigo relata um caso de um paciente jovem diagnosticado com esta condição afetando todos os primeiros molares permanentes e incisivos inferiores, principalmente os dentes 31 e 41. Os molares foram tratados com restaurações diretas em resina composta com recobrimento de cúspides e a estética dos incisivos foi restabelecida com diferentes técnicas, como branqueamento com hipoclorito de sódio, micro-abrasão e restaurações de resina composta. Este plano de tratamento teve como objetivo restaurar a função dos dentes, tratar a hipersensibilidade e as queixas álgicas já existentes e melhorar a estética do sector anterior. O caso apresentado mostra uma abordagem conservadora para lidar com casos de hipomineralização incisivo-molar com resultados satisfatórios após 1 ano de acompanhamento.

Effect of Xylitol Varnishes on the Inhibition of Demineralization in Vitro

Abstract Objective: To evaluate the efficacy of xylitol varnishes in the inhibition of enamel demineralization in vitro. Material and Methods: Bovine enamel blocks (n=120) were randomly allocated to four groups (n = 30), and the surface hardness (SH) was measured at baseline. The blocks were treated with the following varnishes: 20% xylitol, 20% xylitol plus F (5% NaF), Duraphat™ (5% NaF, positive control), and placebo (no-F/xylitol, negative control). The varnishes were applied and removed after 6 h of immersion in artificial saliva. The blocks were subjected to pH cycles (demineralization and remineralization for 2 and 22h/day, respectively, for 8 days). Surface and cross-sectional hardnesses were measured to calculate the percentage of SH loss (%SHL) and the integrated loss of the subsurface hardness (ΔKHN). Data were statistically analyzed using Kruskal-Wallis and Tukey's tests (p<0.05). Results: %SHL was significantly decreased by 20% xylitol plus F, Duraphat™, and 20% xylitol varnishes compared to placebo. The use of 20% xylitol plus F varnish led to a significantly lower percentage of SH loss compared to the use of 20% xylitol varnish without F. However, the experimental and commercial varnishes led to significantly lower subsurface demineralization compared to placebo and did not differ from each other. Conclusion: Xylitol varnishes, especially when combined with F, effectively prevent enamel demineralization (AU).

Prevalence and predisponent factors of molar-incisor hypomineralization in primary dentition

Aim: To evaluate the prevalence and predisposing factors for hypomineralization of second molars in children in primary dentition. Methods: A questionnaire was applied to parents to analyze predisposing factors and to assist in the diagnosis of hypomineralization in children between 2 and 6 years old, followed by an intraoral examination based on indices of non-fluorotic enamel defects in the primary dentition, according to the "Modified Index DDE" to determine demarcated opacity and HSPM presence / severity index to assess hypomineralization. Children from public and private schools were dived into two groups: if they presented HSPM-Group 1 (G1) and if they did not have HSPM-Control group (CG). Results: The most frequent predisposing factors associated with the child were Illness in the first year of life (X2= 6.49; p=0.01) and antibiotic use in the first year of life (X2= 41.82; p= 0.01). The factors associated with the mother were hypertension (X2= 9.36; p=0.01), infections during pregnancy (X2=14.80; p=0.01) and alcohol consumption during pregnancy (X2=97.33; p=0.01). There was a prevalence of 3.9% of HSPM in 14 children, with statistical difference regarding gender (X2 = 4.57; p <0.05), with boys presenting a higher frequency. In G1 hypomineralization was of the type with demarcated opacity, with more prevalent characteristics the yellowish spot, with moderate post-eruptive fracture and acceptable atypical restorations. All lesions were located in the labial region with 1/3 of extension. Conclusion: The prevalence of HSPM in children between 2 and 6 years old was 3.9%, with a predominance in males, with tooth 65 being the most affected. There was an association between HSPM and infection in the first year of life, as well as the use of antibiotics and sensitivity in the teeth affected by the lesion. There was an association between HSPM and hypertension, infection and mothers' alcohol use during pregnancy

In situ evaluation of 200 ppm fluoride toothpaste content trimetaphosphate, xylitol and erythritol on enamel demineralization and dental biofilm.

OBJECTIVE: To evaluate the effect of low-fluoride (F-) toothpaste and sodium trimetaphosphate (TMP) associated with xylitol and erythritol (XE) on enamel demineralization and biofilm composition. METHODS: This crossover double-blind in situ study consisted of five phases (seven days each), in which 14 volunteers wore oral appliances containing four enamel bovine blocks. The cariogenic challenge was performed by exposure to a 30% sucrose solution (6x/day). The toothpaste treatments (3x/day) were as follows: placebo (no F-/TMP/XE); 200 ppm F- (NaF) (200F); 1,100 ppm F- (1100F); 16% Xylitol and 4% Erythritol (XE); and 200 ppm F-, 0.2% TMP, 16% xylitol, and 4% erythritol (200F-TMP-XE). Percentage of surface hardness loss (%SH) and integrated loss of subsurface hardness (ΔKHN), and calcium (Ca2+), phosphate (PO43-), and F- on enamel and biofilm were determined; as well as insoluble extracellular polysaccharide (EPS). RESULTS: XE and 1100F groups showed no significant difference for %SH and ΔKHN values (p = 0.220 and p = 0.886), and the 200F-TMP-XE group had the lowest mineral loss (p < 0.001). Ca2+ and PO43- in the enamel showed the highest values (p < 0.001) for the 200F-TMP-XE group. Higher values of F- in the enamel and biofilm were observed for the 1100F group (p < 0.001). There was no difference for Ca2+ (p = 1.00) and EPS (p =0.918) values between XE and 200-TMP-XE groups in the biofilm, but their values were higher and lower than the 1100F (p = 0.002 and p = 0.029), respectively. CONCLUSIONS: 200F-TMP-XE promoted a greater protective effect against enamel demineralization and significantly affected the composition of biofilm formed in situ compared to 1100F toothpaste. CLINICAL SIGNIFICANCE: Low-F- toothpaste containing TMP and polyols can be considered an effective and safe measure to improve the oral health of individuals, especially patients with high caries activity.

Efficacy of silver diamine fluoride and sodium fluoride in inhibiting enamel erosion: an ex vivo study with primary teeth.

PURPOSE: To assess the efficacy of silver diamine fluoride (SDF) and sodium fluoride (NaF) in inhibiting enamel erosion in primary teeth. METHODS: 80 primary canine teeth were immersed for 24 h in 2% NaF, 10% SDF, or distilled water. Afterward, some of them underwent a 10-min acid challenge using either 1% or 10% citric acid while others did not. Specimens selected for negative controls were immersed in distilled water but not exposed to the acids, whereas those selected for positive controls were not only immersed in distilled water, but also exposed to the acids. Following, 3-mL samples were collected for calcium and phosphorus analysis by an atomic emission spectrometer. RESULTS: 1% acid caused higher phosphorus loss in the positive control group than in the others (no differences between them). Regarding 10% acid, the SDF group showed lower phosphorus loss compared to the positive control and NaF groups. From calcium loss analysis, SDF and NaF groups presented no significant difference when compared to the positive control groups after both acidic challenges. CONCLUSION: Considering phosphorus loss values, 10% SDF seems to be effective in inhibiting enamel erosion after 1% and 10% citric acid challenges, whereas 2% NaF only after 1% citric acid challenge. Regarding calcium loss values, both fluoride agents seem to have no impact on inhibiting enamel erosion after 1% and 10% citric acid challenges.