Knowledge, attitudes, and psychosocial impacts among Brazilian Pediatric Dentists during COVID-19 pandemic.

In this study, we evaluated the knowledge, attitudes, and psychosocial impacts among Brazilian pediatric dentists during the COVID-19 pandemic. A cross-sectional study with primary data collection was carried out using an online structured questionnaire. Data were submitted to descriptive analysis by using absolute and relative frequencies. A chi-square test was used for association analysis and log-linear regression models to estimate the prevalence ratio (5%). The population comprised mostly women and knowledge regarding COVID-19 was satisfactory (above 80% in most items). N95 masks and faceshields were used, albeit 64.22% reported difficulty in providing dental care to children due to the need for extra Personal Protective Equipment. Thirty eight percent provided urgency/emergency dental care, 59.78% performed invasive procedures, 59.56% used high speed handpieces, 8.44% started using cariostatics, and 6.22% introduced the use of chemomechanical caries removal agents. Fear for the future (PR = 1.21) and use of medications (for anxiety, depression, or insomnia) increased (PR = 1.16) among the ones who had wage losses. Brazilian pediatric dentists have knowledge about COVID-19, and attitudes in their clinical routines changed due the pandemic. Financial life was harmed and a negative impact of the pandemic in psychosocial aspects of workers was found.

Knowledge, attitudes, and psychosocial impacts among Brazilian Pediatric Dentists during COVID-19 pandemic

Abstract: In this study, we evaluated the knowledge, attitudes, and psychosocial impacts among Brazilian pediatric dentists during the COVID-19 pandemic. A cross-sectional study with primary data collection was carried out using an online structured questionnaire. Data were submitted to descriptive analysis by using absolute and relative frequencies. A chi-square test was used for association analysis and log-linear regression models to estimate the prevalence ratio (5%). The population comprised mostly women and knowledge regarding COVID-19 was satisfactory (above 80% in most items). N95 masks and faceshields were used, albeit 64.22% reported difficulty in providing dental care to children due to the need for extra Personal Protective Equipment. Thirty eight percent provided urgency/emergency dental care, 59.78% performed invasive procedures, 59.56% used high speed handpieces, 8.44% started using cariostatics, and 6.22% introduced the use of chemomechanical caries removal agents. Fear for the future (PR = 1.21) and use of medications (for anxiety, depression, or insomnia) increased (PR = 1.16) among the ones who had wage losses. Brazilian pediatric dentists have knowledge about COVID-19, and attitudes in their clinical routines changed due the pandemic. Financial life was harmed and a negative impact of the pandemic in psychosocial aspects of workers was found.

An Epigallocatechin-3-gallate Formulation Developed for Endodontic Use: A Physicochemical and Biological Evaluation.

INTRODUCTION: Although epigallocatechin-3-gallate (EGCG) from green tea has been successfully used in the prevention and treatment of several infectious and immunoinflammatory diseases because of its proven anti-inflammatory, antioxidant, antimicrobial, and antiresorptive role, its use as an intracanal dressing has not been proposed. The aim of this study was to develop a formulation based on EGCG for endodontic use by assessing its physicochemical and biological properties. METHODS: Initially, physicochemical characterization of EGCG was performed by ultraviolet-visible and fluorescence spectroscopy to evaluate if the properties were maintained in acidic pH and time (1-6, 24, and 27 hours). After that, biological studies evaluated the developed formulation of EGCG at different concentrations (1.25, 5, 10, and 20 mg/mL). The tissue compatibility with subcutaneous tissue of mice was evaluated by plasma leakage after 24 hours and the examination of macroscopic and microscopic features at 7, 21, and 63 days after the insertion of polyethylene tubes containing the formulations. The repair of experimentally induced periapical lesions in dog's teeth by radiographic and histopathologic analysis was also evaluated. The scores were statistically analyzed by the chi-square and Fisher exact test. Analysis of variance followed by the Tukey posttest were used for the quantitative analysis. The significance level was 5%. RESULTS: The physicochemical characterization performed under ultraviolet-visible spectrophotometry showed that the EGCG properties remained unaltered in acid pH and function of time, keeping its wavelength to 274 nm. Macroscopic parameters evaluated at 7, 21, and 63 days showed that all concentrations presented no epithelial ulceration or presence of mild superficial tissue necrosis, edema, or vascularization with no significant difference in the control group. During all periods of microscopic examination, all groups presented the absence of abscess foci and edema and the presence of fibrous capsule and neovascularization. The presence of reparative tissue with a gentle presence of neutrophilic inflammatory cells was also observed for all groups, except for the calcium hydroxide paste group, which presented a more pronounced inflammation and tissue necrosis at days 7 and 21 (P < .001). At day 63, all groups presented an absence of inflammatory infiltrate and necrosis. The evaluation of dog teeth showed that treatment with the EGCG formulation provided a reduction of the periapical radiolucent area and allowed the repair of apical and periapical tissues (P > .05). CONCLUSIONS: The developed formulation based on EGCG from green tea presented physicochemical stability and tissue compatibility and provided the repair of periapical lesions when used as an intracanal dressing.

Vitamin D deficiency is a risk factor for delayed tooth eruption associated with persistent primary tooth.

OBJECTIVE: To verify the association between 25(OH)D level and polymorphisms in the vitamin D receptor gene (VDR) with the disturbance in the dental development and eruption. DESIGN: A total of 183 children from two datasets were evaluated. The first dataset was a case-control (15:15) designed to assess if persistent primary tooth (PPT) is associate with serum 25(OH)D level and with genetic polymorphisms in VDR. The second dataset of genomic DNA samples from 54 children with delayed tooth eruption (DTE) and 99 controls were analysed to verify if genetic polymorphisms in VDR (rs2228570 and rs739837) are associated with DTE. The 25(OH)D and the genotyping/allele distribution were analysed using the T-test and chi-square test, respectively. RESULTS: The level of 25(OH)D in the PPT group (24.9 ± 6.4 mg/mL) was significantly lower than the control (30.0 ± 7.0 mg/mL) (p=.047). Our data show that children with 25(OH)D deficiency are more likely to present PPT (OR = 2.36; 95%CI: 1.51, 3.70). The rs739837 and rs2228570 polymorphisms were not associated with DTE (OR = 1.44; 95%CI: 0.87, 2.39 and OR = 0.80; 95%CI: 0.45, 1.44, respectively). CONCLUSIONS: Vitamin D deficiency is a risk factor for PPT.

GHR and IGF2R genes may contribute to normal variations in craniofacial dimensions: Insights from an admixed population.

INTRODUCTION: This study aimed to determine whether single nucleotide polymorphisms in the growth hormone receptor (GHR) and insulin-like growth factor 2 receptor (IGF2R) genes are associated with different craniofacial phenotypes. METHODS: A total of 596 orthodontic and 98 orthognathic patients from 4 cities in Brazil were included for analyses. Angular and linear cephalometric measurements were obtained, and phenotype characterizations were performed. Genomic DNA was collected from buccal cells and single nucleotide polymorphisms in GHR (rs2910875, rs2973015, rs1509460) and IGF2R (rs2277071, rs6909681, rs6920141) were genotyped by polymerase chain reactions using TaqMan assay. Genotype-phenotype associations were assessed in the total sample (statistical significance was set at P <8.333 × 10-3) and by a meta-analytic approach implemented to calculate the single effect size measurement for the different cohorts. RESULTS: Rare homozygotes for the GHR rs2973015 showed increased measurements for the lower anterior facial height (ANS-Me) and mandibular sagittal lengths (Co-Gn and Go-Pg). In contrast, common homozygotes for the IGF2R rs6920141 presented reduced measurements for these dimensions (ANS-Me and Go-Pg). Furthermore, the less common homozygotes for IGF2R rs2277071 had reduced maxillary sagittal length (Ptm'-A'). The meta-analytical approach replicated the associations of rs2973015 with ANS-Me, rs2277071 with Ptm'-A', and rs6920141 with Go-Pg. CONCLUSIONS: Our results provide further evidence that GHR contributes to the determination of mandibular morphology. In addition, we report that IGF2R is a possible gene associated with variations in craniofacial dimensions. Applying meta-analytical approaches to genetic variation data originating from likely underpowered samples may provide additional insight regarding genotype and/or phenotype associations.

Efficacy of green tea and its extract, epigallocatechin-3-gallate, in the reduction of cariogenic microbiota in children: a randomized clinical trial.

OBJECTIVE: This study was conducted to evaluate and compare the antimicrobial efficacy of green tea and its extract epigallocatechin-3-gallate (EGCG) as a mouthwash in children. DESIGN: The study group included 47 children aged 5-12 years at high caries risk and prevalence. Children selected were asked to rinse with one of the substances (EGCG, green tea, chlorhexidine and distilled water) for one min. A non-stimulated salivary sample (2 mL) was collected at baseline and after rinsing. The concentration of cariogenic microorganisms (mutans streptococci and lactobacilli) was determined before and after rinsing based on the count of colony-forming units (CFU). CFU were counted with the aid of a stereomicroscope through the perfunctory identification of the morphological characteristics of CFU. The microbial reduction percentage was then calculated. RESULTS: The analysis of the effectiveness of the treatments showed that there was a significant reduction in relation to the values obtained before and after the mouthwash, both for mutans streptococci (pCHX = 0.001; pEGCG = 0.001; pGreen Tea = 0.005; pDistilled Water = 0.018) and lactobacilli (pCHX = 0.001; pEGCG = 0.002; pGreen Tea = 0.008; pDistilled Water = 0.033). The percentage of microbial reduction of both cariogenic microorganisms caused by the EGCG solution was higher than green tea and distilled water, but less than CHX. The percentage of microbial reduction by the EGCG solution for mutans streptococci was 79.9%, green tea 68.3%, distilled water 50.6% and CHX 95.5%. For lactobacilli, the percentage reduction of all solutions was relatively lower when compared to mutans streptococci. For the EGCG solution it was 72.09%, followed by green tea 59.17% and distilled water 41.96%, but less than CHX 86.02%. CONCLUSION: Rinsing with EGCG solution reduced the levels of mutans streptococci and lactobacilli in the oral cavity of children. Although EGCG had better antimicrobial activity than green tea, this study supports the effectiveness of both as an antibacterial mouthwash option. Both EGCG and green tea could be used as alternatives to chlorhexidine-based mouthwashes.

Clinical, microbiological, and immunological evaluation of patients in corrective orthodontic treatment.

BACKGROUND: The objective was to analyze clinical, microbiological, and immunological periodontal parameters in patients in corrective orthodontic treatment. MATERIALS AND METHODS: Twenty-eight patients were selected. Plaque index (PI), bleeding on probing (BOP), width of keratinized gingiva, levels of 40 bacterial species, and of 3 cytokines (IL-1ß, MMP-8, and TNF-α) in gingival crevicular fluid (GCF) were evaluated at T0, before orthodontic treatment; T1, 6 months; and T2, 12 months post-treatment. Non-parametric, Friedman, Wilcoxon, ANOVA, and Spearman correlation coefficient tests were used for statistical analyses, with the significance level of 5%. RESULTS: No significant difference was found for the width of keratinized gingiva, but PI presented a significant increase at T1 and T2 (p < 0.05) when compared with T0. The percentage of sites with BOP increased significantly from T0 to T1 (p < 0.05); however, at T2, the values decreased and did not differ anymore from T0 (p > 0.05). In the microbiological analysis, red complex pathogens were in significantly greater proportions in T2 compared with T0 (p < 0.05). There was no statistically significant difference in the cytokine levels between the periods but there was a positive correlation between BOP and IL-1ß (r = 0.49 p = .01) and TNF-α (r = 0.39 and p = .05). CONCLUSION: In conclusion, corrective orthodontic treatment caused clinical periodontal alterations regarding biofilm accumulation and gingival bleeding, with alteration of periodontopathogens.

RANKL is associated with persistent primary teeth and delayed permanent tooth emergence.

BACKGROUND: Tooth eruption is a process that is not fully understood. AIM: To evaluate whether genetic polymorphisms for RANK/RANKL/OPG are associated with delayed tooth emergence. To evaluate whether the relative expression of this genes is associated with persistent primary teeth. DESIGN: To evaluate whether genetic polymorphisms for RANK/RANKL/OPG could be involved in delayed tooth emergence, saliva samples from 160 children, aged 6-13 years old, were analysed. To test if there is correlation between gene expression of RANK/RANKL/OPG in children with delayed tooth emergence and persistent primary teeth, periapical tissue from 15 children with persistent primary teeth and from 15 control subjects were collected for qPCR analysis. RESULTS: Fifty-six children with delayed tooth emergence (35%) had at least one permanent tooth with delayed emergence. The T allele in RANKL (rs9594738) increased the risk of delayed tooth emergence (P = 0.02; OR = 1.71, 95%CI 1.09-2.75). The relative gene expression for RANKL and the ratio RANKL/OPG in children with delayed tooth emergence and persistent primary teeth were lower compared to controls (P = 0.02 and P = 0.005, respectively). CONCLUSIONS: Data suggest that the polymorphism rs9594738 in RANKL is associated with delayed permanent tooth emergence. Moreover, reduced relative gene expression of RANKL in periapical tissue is associated with persistent primary teeth.

Strategies and dental care in the treatment of patients with myelomeningocele.

Myelomeningocele (MMC) is a congenital malformation that occurs in the embryonic period, characterized by failure in closure of the caudal portion of the neural tube during central nervous system formation. Alterations and complications can be associated with this condition, such as hydrocephalus, neurogenic bladder, orthopedic problems, and motor and cognitive impairment. This patients with MMC also have predisposition to develop latex allergy and high caries risk and activity due to deficient oral hygiene, fermentable carbon hydrate-rich diet and prolonged use of sugar-containing oral medications. This paper reports the oral findings and dental treatment in a 15-year-old female patient diagnosed with MMC and describes the strategies used to improve dental treatment conditions and reduce the impact of associated risks to her health. The measures and precautions adopted in this case could be useful to reduce the barriers for patients with the same condition to access oral health care: regular visits to the dentist, initiating as early as possible; frequent reinforcement of oral homecare instructions and diet counseling; minor adaptions to the dental chair and dental office to improve ease of access due to patients' mobility problems; prevention of latex-related allergic reactions; reduction of gag reflex during dental procedures.

Effects of Rosiglitazone on the Outcome of Experimental Periapical Lesions in Mice.

INTRODUCTION: The purpose of this study was to evaluate a protocol for systemic administration of rosiglitazone in mice in order to stimulate apoptosis of osteocytes in the jaws and to evaluate the effect of osteocyte apoptosis induced by rosiglitazone in the progression of periapical lesions in mice at 7, 21, and 42 days. METHODS: C57BL/6 mice at 4-5 weeks of age were used. In phase 1, mice (n = 24) were treated with rosiglitazone (gavage, 10 mg/kg dose) or without (phosphate-buffered saline + 10% dimethyl sulfoxide) for 1, 2, or 3 weeks. We used the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling and 4'-6-diamidino-2-phenylindole methods for quantification of apoptotic cells. In phase 2, mice (n = 30) received rosiglitazone for 2 weeks or just vehicle for 1 week (n = 30), and periapical lesions were induced for 7, 21, or 42 days. We performed the measurement of periapical lesions, tartrate-resistant acid phosphatase staining, dual-energy x-ray absorptiometry for the evaluation of bone mineral density (BMD) in long bone, and gene evaluation using real time quantitative polymerase chain reaction of osteocyte markers (Sost, Hyou1, and Dmp1) and receptor activator of nuclear factor kappa-B ligand (RANKL) (Tnfsf11). RESULTS: It was observed that systemic administration of rosiglitazone for 2 weeks showed apoptosis of osteocytes in a more expressive manner. In phase 2, in the groups that received rosiglitazone, a trend toward larger periapical lesions was observed (P > .05). Rosiglitazone also induced a greater number of osteoclasts and a greater expression of Sost and Hyou1 at 21 days of lesions. Moreover, there were no statistically significant differences in RANKL and Dmp1 expression or in the BMD of femurs. CONCLUSIONS: Rosiglitazone stimulated apoptosis of osteocytes, interfering in the progression of periapical lesions in mice.

Microleakage of Sealants after Phosphoric Acid, Er: YAG Laser and Air Abrasion Enamel Conditioning: Systematic Review and Meta-Analysis.

PURPOSE: The aim of this systematic review and meta-analysis is to answer the focused question: Does the application of phosphoric acid, Er:YAG laser and air abrasion enamel conditioning methods previous to the oclusal sealant application in human permanent molars influence the microleakage? STUDY DESIGN: A literature research was carried out in the Pubmed Medline, Web of Science, Scopus and Cochrane databases using with the MeSH terms and keyword search strategy. A supplemental hand search of the references of retrieved articles was also performed. Inclusion criteria comprised ex vivo studies (extracted teeth) with permanent human teeth that used chemical (phosphoric acid) or mechanical (Er:YAG laser and air abrasion) conditioning methods previous the sealant application. The studies should evaluate microleakage as an outcome. Meta-analysis pooled plot were obtained comparing the microleakage after pre-treatment with phosphoric acid, Er:YAG and air abrasion enamel conditioning for sealant application using RevMan software. RESULTS: The search resulted in 164 articles, 55 records were excluded because they were duplicated. The analysis of titles and abstracts resulted in the exclusion of 105 studies. Four studies were included in the systematic review and the meta-analysis. According to the risk of bias evaluation, the four studies were considered low risk of bias. The meta-analysis showed that phosphoric acid had lower microleakage than Er:YAG laser (p < 0.001) and air abrasion (p < 0.001), with heterogeinity of I2 = 0% and I2 = 71%, respectively. It was not found statistical difference when compared phosphoric acid and phosphoric acid combined with Er:YAG laser and air abrasion (p > 0.05). CONCLUSION: The evidence supports that the pretreatment with phosphoric acid leads lower microleakage in oclusal sealants than Er:YAG laser and air abrasion.

Odontología para bebés: una posibilidad práctica de promoción de salud bucal / Odontologia para bebês: uma possibilidade prática de promoção de saúde bucal / Dentistry for babies: a practical possibility of oral health promotion

Objetivo. Revisar la literatura sobre la filosofía en Odontología para Bebés. Síntesis de datos. A pesar de que la promoción de la salud es muy practicada en todas las áreas de la salud, la odontología se caracteriza por restar importancia a la prevención de enfermedades bucales y a los tratamientos preventivos, cuando estos son realizados, ya los dientes deciduos se encuentran altamente comprometidos por la caries dental. Los resultados alcanzados a través de la enseñanza de tratamiento odontológico a bebés, en diferentes partes del mundo, tienen un futuro promisorio, ya que enfatiza las particularidades de su crecimiento y desarrollo infantil, considera al bebé como un todo, y no solamente desde el punto de vista de salud bucal. Conclusiones. La buena práctica de la odontología para bebés brinda la posibilidad de fomentar la salud y prevenir la enfermedad, de una forma muy simple, eficaz y de bajo costo.

Objetivo: Revisar a literatura sobre a filosofia da Odontologia para Bebês. Síntese dos dados: Embora a promoção e a manutenção de saúde sejam muito preconizadas atualmente em todas as áreas da saúde, a Odontologia tem se caracterizado por uma prática que pouco privilegia a prevenção da ocorrência das doenças e as ações preventivas e quando são empregadas, ocorrem tardiamente, quase sempre quando a dentição decídua já se encontra em grande parte comprometida pela cárie dentária. Os resultados alcançados através da Odontologia para Bebês, em diversas partes do mundo, têm apontado para um futuro promissor, que enfatiza as particularidades do crescimento e desenvolvimento infantis e considera o bebê como um todo, e não apenas do ponto de vista de saúde bucal. Conclusões: Uma boa prática odontológica para bebês possibilita promover a saúde e prevenir a doença de uma forma simples, eficaz e de baixo custo.

Objective: To review the literature concerning the philosophy of Dentistry for Babies. Data synthesis: Although the promotion and maintenance of health have been very recommended currently in all areas of health, dentistry has been characterized by a practice with little focus on prevention of diseases and the preventive actions, when employed, often occur late, when the primary dentition is already largely compromised by tooth decay. The results achieved by Dentistry for Babies, in various parts of the world, have pointed to a promising future. That emphasize the particularities of children's growth and development and considered the baby as a whole, and not only by the point of view oral health. Conclusion: The practice of dentistry for babies allows the possibility to promote health and prevent disease, in a highly simple, effective and low cost manner.

Antibacterial efficacy of epigallocatechin -3 - gallate against streptococcus mutans: a systematic review / Eficacia antibacteriana de la epigalocatequina-3-galato contra el Streptococcus mutans: Revisión sistemática

Background: Green tea, obtained from the Camellia sinensis, is one of the most popular drinks worldwide and has recently been in the focus of scientific research due to its beneficial effects on general health. Several studies suggest that, among the polyphenols found on green tea, epigallocatechin-3-gallate (EGCG) is the most bioactive compound and is responsible for its antibacterial activity. Purpose: To conduct a qualitative systematic review of literature evaluating the antibacterial efficacy of EGCG against Streptococcus mutans (S. mutans). Methods: Relevant published studies included in the Pubmed (1966- June 2015), Scopus (1960- June 2015), Web of Science (1900- June 2015), and Google Scholar databases were identified. Publications of in vitro studies, which studied EGCG antibacterial efficacy against S. mutans, were extracted and pooled in a table. The evaluation included inhibition zone measures, reduction of the number of microorganisms, and biofilm formation. Results: Twelve studies were selected to compose this systematic review. Eleven of them showed that EGCG has antibacterial efficacy against S. mutans. Conclusions : In vitro evidence available confirms the antibacterial activity of EGCG against S. mutans.

Antecedentes: El té verde, obtenido de la Camellia sinensis, es una de las bebidas más populares en el mundo y ha estado recientemente en el foco de atención de la investigación científica por sus efectos benéficos en la salud general. Varios estudios sugieren que, entre los polifenoles encontrados en el té verde, la epigalocatequina-3-galato (EGCG) es el compuesto más bioactivo y es el responsable de su actividad antimicrobiana. Objetivo: Realizar una revisión sistemática cualitativa de la literatura donde se evalúe la actividad antibacteriana de la EGCG contra el Streptococcus mutans (S. mutans). Métodos: Se identificaron estudios relevantes incluidos en las bases de datos bibliográficas Pubmed (1966-junio del 2015), Scopus (1960-junio del 2015), Web of Science (1900- junio del 2015) y Google Académico. Los datos de estudios in vitro que investigaron la eficacia antibacterial de la EGCG contra el S. mutans se seleccionaron y organizaron en una tabla. La evaluación de los estudios incluyó los criterios: medidas de las zonas de inhibición, reducción del número de microorganismos y formación de biopelícula. Resultados: Se seleccionaron 12 estudios para la revisión sistemática. Once de ellos comprobaron la eficacia antibacteriana de la EGCG contra el S. mutans. Conclusiones: La evidencia in vitro disponible confirma que la EGCG tiene un efecto antibacteriano contra el S. mutans.

Cementocytes Express Receptor Activator of the Nuclear Factor Kappa-B Ligand in Response to Endodontic Infection in Mice.

INTRODUCTION: Although studies have recently shown that osteocytes embedded in mineralized bone matrix play an important role in bone diseases, the participation of cementocytes in apical periodontitis has not been evaluated. The aim of the present study was to evaluate the possible involvement of cementocytes in the development of apical periodontitis. METHODS: Apical periodontitis was experimentally induced in the lower first molars of wild-type mice by pulp exposure to the oral environment. At 0, 7, 21, and 42 days after pulp infection, the animals were euthanized, and the jaws were prepared for analysis under conventional and fluorescence microscopy (morphologic and morphometric analysis), immunohistochemistry and immunofluorescence (receptor activator of nuclear factor kappa-B [RANK], receptor activator of the nuclear factor kappa-B ligand [RANKL], and osteoprotegerin [OPG]), enzyme histochemistry (osteoclasts and cementoclasts), and real-time polymerase chain reaction (RANK, RANKL, OPG, and cathepsin K). RESULTS: At 7, 21, and 42 days after pulp exposure, there was a progressive increase in periodontal ligament, cementum and bone resorption areas, osteoclasts, and cementoclast counts as well as higher messenger RNA levels of RANK, RANKL, OPG, and cathepsin K. In intact teeth, cementocytes and osteocytes did not express RANKL. After infection, RANKL was strongly expressed in cementocytes, but not in osteocytes, and its expression increased with lesion progression. CONCLUSIONS: Our findings show that cementocytes express RANKL in response to endodontic infection and may be involved in the pathogenesis of apical periodontitis.

Solitary Median Maxillary Central Incisor Versus Agenesis of the Maxillary Central Incisor.

A solitary median maxillary central incisor (SMMCI) is rare and affected individuals may carry a potentially serious condition known as SMMCI syndrome. However, many of these cases do not receive proper attention because they are misdiagnosed as agenesis of the maxillary central incisor. The purpose of this manuscript is to report two cases of children with only one maxillary central incisor and draw diagnostic differences between the entities. A correct diagnosis is very important because if an SMMCI is confirmed, the patient should be referred for genetic counseling.

Expression of Mineralization Markers during Pulp Response to Biodentine and Mineral Trioxide Aggregate.

INTRODUCTION: The purpose of this study was to compare the cell viability of dental pulp cells treated with Biodentine (Septodont, Saint-Maur, France) and mineral trioxide aggregate (MTA) and the in vitro and in vivo expression of mineralization markers induced by the 2 materials. METHODS: Human dental pulp cells isolated from 6 permanent teeth were stimulated with Biodentine and MTA extracts. Cell viability was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay, and quantitative reverse-transcriptase polymerase chain reaction was used to determine the expression of mineralization markers. Specimens of teeth from dogs treated with Biodentine and MTA after pulpotomy were used to determine the presence of osteopontin and alkaline phosphatase by immunohistochemistry and runt-related transcription factor 2 by immunofluorescence. RESULTS: No significant differences in cell viability were found between MTA and Biodentine extracts and controls after 24 and 48 hours (P > .05). After 48 hours, osteopontin (SPP1), alkaline phosphatase (ALP), and runt-related transcription factor 2 (RUNX2) expression was higher in MTA and Biodentine than in controls (P < .05). Osteopontin staining was more intense and spread over a greater number of areas in Biodentine than in MTA samples (P < .0001). Alkaline phosphatase staining of a mineralized tissue bridge was significantly different between materials (P < .0001), but no difference in alkaline phosphatase staining of pulp tissue was found between MTA and Biodentine (P = .2). Also, no significant difference in the number of cells labeled for runt-related transcription factor 2 by immunofluorescence was observed between materials (P > .05). CONCLUSIONS: Biodentine stimulated similar markers as MTA, but staining was more intense and spread over a larger area of the pulp tissue.

Development of an intraoral device for social inclusion of a physically disabled patient.

The aim of this study is to describe the use of an intraoral assistive technology for a patient with idiopathic generalized muscular dystonia, presenting temporomandibular disorder and severe anterior tooth mobility and diastema. A multidisciplinary team developed an intraoral device to provide typing and painting functions, and promote relaxation of masticatory muscles without compromising the teeth and supporting tissue structures. The occlusal splint associated with the device promoted muscle relaxation and relief of the signs and symptoms of temporomandibular dysfunction, in this case with generalized muscle dystonia, allowing typing and painting with her mouth without causing tooth mobility or occlusal alteration. This intraoral device has low cost, easy adaptation and was efficient in TMD symptoms. Furthermore, the patient returned to her rehabilitation allowing performance of her duties without compromising dental structures, facilitating the social and the digital inclusion.

Latex and nonlatex orthodontic elastics: In vitro and in vivo evaluations of tissue compatibility and surface structure.

OBJECTIVE: To test the null hypothesis that there is no difference between latex and nonlatex orthodontic elastics with respect to tissue compatibility and surface structure. MATERIALS AND METHODS: Latex and nonlatex elastics were implanted in the subcutaneous connective tissue of 45 Wistar rats. In the control groups, no material was implanted (sham). After 24 hours, 3, 7, 14, and 21 days, the animals were euthanized; tissue samples were processed and analyzed by descriptive and semi-quantitative microscopic analysis and quantification of plasma extravasation. The surface structure of elastics was evaluated by scanning electron microscopy (SEM). The results were analyzed by analysis of variance (ANOVA), Tukey test and Kruskal-Wallis test at 5% significance level. RESULTS: Peri-implant plasma extravasation was significantly higher (P < .05) in the animals that received latex elastics compared with those with nonlatex elastics and those that were control animals. The microscopic analysis revealed a more intense inflammatory infiltrate in the initial periods without statistically significant difference (P > .05) between the experimental and control groups. The SEM analysis revealed that the latex elastics presented microspheres and porosities, while the nonlatex elastics exhibited crystals on their surface and absence of porosities. CONCLUSION: The null hypothesis was rejected since the latex elastics were more irritating to the connective tissue than the nonlatex elastics in the initial periods and presented a more porous surface.

Changes in caries risk and activity of a 9-year-old patient with niemann-pick disease type C.

Objective. This case report describes the changes in caries risk and activity and dental treatment of a 9-year-old patient who presented with signs and symptoms of Niemann-Pick disease type C (NPC). Treatment. The preventive dental treatment included instructions to caregivers for oral hygiene and diet. A calcium hydroxide pulpotomy and restorative dental treatments were performed in a dental office with desensitization techniques and behavioral management. The patient was attended every 3 months for the control of dental plaque biofilm, for topical fluoride application, and for observing the pulpotomized tooth. Results. The bacterial plaque biofilm was being adequately controlled by the caregiver. After 2 years, the clinical and radiographic examination of the pulpotomized tooth showed the absence of internal root resorption and bone rarefaction, and clinical examination showed tooth sensitivity, dental pain, and gingival swelling. Conclusion. The pulpotomy prevented clinical and radiographic success. Dentists must be aware of and be able to identify systemic and local aspects associated with caries risk of children with NPC disease. Furthermore, dentists must employ stringent preventive measures and provide instructions to caregivers to reduce caries risk.