Evaluating the Quality of Systematic Reviews on Pediatric Sedation in Dentistry: An Umbrella Review.

Sedation is a depression of a patient's state of consciousness, induced by medications, that can reach different levels of intensity during a medical procedure. Conscious sedation produces a minimally depressed level of consciousness without impairment of the ability to maintain an open airway, of protective reflexes or of responses to verbal and physical stimulation. This umbrella review is aimed at critically assessing the available systematic reviews (SRs) and meta-analyses (MA) on sedation in children/adolescents. An electronic database search was conducted that included Pubmed-Medline, Web of Science, Cochrane, Scopus, Scielo, Embase, LILACS and TRIP and the scope of which extended until January 2023. The risk of bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). Of 998 entries, 37 SRs were included. In terms of methodological quality, eight studies were assessed as having critically low quality, four studies had low quality, nine studies had moderate quality, and sixteen were considered to be of high quality. Based on the current guidelines, the most employed drugs in pediatric dentistry for sedation are nitrous oxide and midazolam; however, the available evidence supporting their use is insufficient and of low/critically low quality. The combined technique is recommended (nitrous oxide (30-50%) + midazolam). The optimal dose of oral midazolam is 0.75 mg/kg. The level of methodological quality of SRs is expected to increase according to the results and future directions of this umbrella review.

Evidence of Age Estimation Procedures in Forensic Dentistry: Results from an Umbrella Review.

Background and objective: Age estimation is an important tool when dealing with human remains or undocumented minors. Although the skull, the skeleton or the hand-wrist are used in age estimation as maturity indicators, they often present a lack of good conditions for a correct identification or estimation. Few systematic reviews (SRs) have been recently published; therefore, this umbrella review critically assesses their level of evidence and provides a general, comprehensive view. Materials and methods: Considering the review question "What is the current evidence on age determination approaches in Forensic Dentistry?" an electronic database search was conducted in four databases (PubMed, Cochrane, WoS, LILACS) up to December 2022, focusing on SRs of age estimation through forensic dentistry procedures. The methodological quality was analyzed using the measurement tool to assess SRs criteria (AMSTAR2). Results: Eighteen SRs were included: five of critically low quality, six of low quality, three of moderate quality and four of high quality. The SRs posited that Willems' method is more accurate and less prone to overestimation; most methods seem to be geographically sensitive; and 3D-imaging and artificial intelligence tools demonstrate high potential. Conclusions: The quality of evidence on age estimation using dental approaches was rated as low to moderate. Well-designed clinical trials and high-standard systematic reviews are essential to corroborate the accuracy of the different procedures for age estimation in forensic dentistry.

Knowledge, perception, and clinical experiences on molar incisor hypomineralization amongst Portuguese dentists.

AIM: Molar incisor hypomineralization (MIH) is a prevalent oral health condition whose knowledge by dentists is key to the best clinical outcome. This study aimed to evaluate the knowledge, perceptions and clinical experiences of MIH among Portuguese dentists. METHODS: A cross-sectional structured questionnaire was distributed nationally through a web-based survey platform. Data concerning demographic variables, years of experience, dental specialty, MIH prevalence, diagnosis, severity, training demands and clinical management of MIH were collected. We calculated a knowledge score (KS), and compared data between Pediatric Dentists (PDs), General Dental Practitioners (GDPs) and other dental specialties (ODS). RESULTS: Overall, 2.2% of Portuguese dentists (n = 257) answered the questionnaire. Most participants reported having identified MIH in their practice (82.5%), with PD reporting the prevalence appeared to have increased, and practically all (91.7%) considered it a public health problem. Resin composite was often the used material to restore MIH teeth (56.0%), however PDs indicated glass ionomer cements as the preferred and preformed crowns a better option. The average KS on MIH was 41.3 (± 5.7), with GDPs having a similar score than PDs. Most respondents (94.9%) reported a lack of information about MIH and were willing to receive appropriate clinical training. CONCLUSIONS: The average knowledge on MIH was considered low among Portuguese dentists. Respondents perceived an increased incidence of MIH, despite the lack of prevalence data in Portugal. The material of choice was Glass Ionomer and performed crowns, by PDs, while GDPs and ODS reported poor confidence to manage MIH. These results may serve future programs to increase knowledge, perceptions and clinical experiences towards MIH.

The prevalence of molar-incisor hypomineralization: a systematic review and meta-analysis.

Molar-Incisor Hypomineralization (MIH) is a qualitative defect of enamel of unknown etiology, affecting one or more permanent molars and may include incisors. This condition is a clinical challenge and its prevalence is still uncertain given the recent increase in research. Thus, we aimed to comprehensively estimate the overall prevalence of MIH and associated characteristics. This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, MEDLINE, CENTRAL, Web of Science, SciELO, LILACS and TRIP databases, until July 2021. Heterogeneity and publication bias were computed via I2 test statistics and Egger's significance test, respectively. Random-effects meta-analysis of prevalence were processed. We used the Strength of Recommendation Taxonomy [SORT] to grading the strength of evidence. Overall, 116 observational studies were included, with one study with moderate methodological quality and the remaining of high methodological quality. Subgroup analysis confirmed an influence of not using the 2003 MIH case definition (p = 0.0066). The pooled prevalence of MIH was 13.5% (95% CI 12.0-15.1, I2 = 98.0%). Affected incisors were seen in 36.6% (95% CI 30.0-43.7, I2 = 92.5%) of the cases. Lastly, the prevalence of hypomineralization of the second primary molars was observed in 3.6% of the MIH cases (95% CI 1.9-6.8, I2 = 96.3%). America was the continent with highest prevalence (15.3, 95% CI 12.8-18.3, p < 0.001, I2 = 96.3%) and Asia had the lowest prevalence (10.7, 95% CI 8.5-13.5, p < 0.001, I2 = 98.7%), however no continental differences were found. Sample size and year of publication were slight contributing factors to the heterogeneity in the analysis. Overall, these results were classified with a SORT A recommendation.

Association between Dietary Inflammatory Index and Periodontitis: A Cross-Sectional and Mediation Analysis.

Inflammation-modulating elements are recognized periodontitis (PD) risk factors, nevertheless, the association between dietary inflammatory index (DII) and PD has never been appraised. We aimed to assess the association between DII and PD and the mediation effect of DII in the association of PD with systemic inflammation. Using the National Health and Nutrition Examination Survey 2009-2010, 2011-2012 and 2013-2014, participants who received periodontal exam and provided dietary recall data were included. The inflammatory potential of diet was calculated via DII. PD was defined according to the 2012 case definition. White blood cells (WBC), segmented neutrophils and C-reactive protein (CRP) were used as proxies for systemic inflammation. The periodontal measures were regressed across DII values using adjusted multivariate linear regression and adjusted mediation analysis. Overall, 10,178 participants were included. DII was significantly correlated with mean periodontal probing depth (PPD), mean clinical attachment loss (CAL), thresholds of PPD and CAL, WBC, segmented neutrophils and DII (p < 0.01). A linear regression logistic adjusted for multiple confounding variables confirmed the association between DII and mean PPD (B = 0.02, Standard Error [SE]: 0.02, p < 0.001) and CAL (B = -0.02, SE: 0.01, p < 0.001). The association of mean PPD and mean CAL with both WBC and segmented neutrophils were mediated by DII (from 2.1 to 3.5%, p < 0.001). In the 2009-2010 subset, the association of mean CAL with serum CRP was mediated by DII (52.0%, p < 0.01). Inflammatory diet and PD may be associated. Also, the inflammatory diet significantly mediated the association of leukocyte counts and systemic inflammation with PD.

Children's Attitudes and Behaviors about Oral Health and Dental Practices.

The present study sought to contribute to a better understanding of children's attitudes and behaviors regarding oral health and dental practices. The sample was composed of 101 children (8-10 years), collected from several schools in the Lisbon metropolitan area. Our main goals were to collect a survey of information about the beliefs, attitudes, habits and knowledge of children about oral and dental issues in order to not only have an overview of them but also to serve as a basis and a starting point for the development of intervention programs to increase positive attitudes and behaviors related to oral health and promote greater knowledge about these subjects. In general, children reported positive behaviors regarding dental habits and oral hygiene practices. Children's opinions and beliefs about dentists were also globally positive; however, the results suggested that younger children reported more positive attitudes, emotions and previous experiences. Regarding children's knowledge about these dental issues, the results were quite negative and worrying, ruled by ignorance and incorrect beliefs and behaviors. In sum, all the results and conclusions of this study may contribute to the development of educational programs within the scope of the promotion of oral health and hygiene practices-"An Adventure about Oral Health."

Regenerative Endodontic Procedures: An Umbrella Review.

The Regenerative Endodontic Procedure (REP) is a biologically based method in which a damaged pulp-dentin complex is replaced by a new vital tissue. This umbrella review aimed to critically assess the available systematic reviews (SRs) on REP. An electronic database search was conducted (PubMed-Medline, CENTRAL, Scielo, Web of Science, and LILACS) until December 2020. Studies were included if they were an SR on REP. The Risk of Bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). The primary outcome was the methodological quality in each specific section of REP protocols and outcomes. From 403 entries, 29 SRs were included. Regarding the methodological quality, ten studies were of critically low, three of low, fourteen of moderate, and two were rated as high quality. The quality of evidence produced by the available SRs was not favorable. Future high standard SRs and well-designed clinical trials are warranted to better elucidate the clinical protocols and outcomes of REP.

Vital and Nonvital Pulp Therapy in Primary Dentition: An Umbrella Review.

Dental caries is the most common non-communicable disease in children with significant aesthetic, functional, and quality of life deterioration. Depending on the depth, two approaches may be considered in primary dentition: vital pulp therapy (VPT) or non-vital therapy (NPT). This umbrella review aimed to critically assess the available systematic reviews (SRs) on VPT and NPT. An electronic database search was conducted (PubMed, Embase, Scopus, Cochrane, Web of Science, and LILACS) until June 2021. The Risk of Bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). From 272 entries, 33 SRs were included. Regarding the methodological quality, three studies were critically low, nine low, seventeen moderate, and six were rated as high quality. The quality of evidence produced by the available SRs was moderate. Future high standard SRs and well-designed clinical trials are warranted to better elucidate the clinical protocols and outcomes of VPT and NPT.

Severe Case of Delayed Replantation of Avulsed Permanent Central Incisor: A Case Report with Four-Year Follow-Up.

Avulsion is one of the most serious dental traumatic injuries with a reserved prognosis. This case report describes multiple trauma lesions in permanent central incisors of an eight-year-old girl and a four-year follow-up. The right upper incisor suffered avulsion, remained 16 h extraorally, and was replanted after extraoral endodontic therapy. The left maxillary central incisor suffered a noncomplicated crown fracture with concomitant subluxation. The present case adds to the literature a rare occurrence of success in a severe case with poor prognosis. For this reason, the International Association for Dental Traumatology (IADT) guidelines should be followed and, even in extreme situations, replantation should always be considered.

Oral and Dental Abnormalities Caused by a Pediatric Rhabdomyosarcoma Tumor Treatment: A Clinical Case Report.

Rhabdomyosarcoma is one of the most common soft-tissue sarcomas in children. The therapy for this condition has evolved significantly over recent decades, as has survival rates. Nevertheless, multiagent chemotherapy, radiation therapy, surgical resection or a combination of these modalities still have to be performed. This case report presents a 16-year-old boy with oral and dental effects after rhabdomyosarcoma treatment, diagnosed at the age of 4 years old. This report highlights the key role of dentists in the clinical management of rhabdomyosarcoma cases before, during and after treatment, and its potential side effects.

Dental trauma in contact sports / Traumatismos dentários em esportes de contato

ABSTRACT Objective Investigate the prevalence of dental traumas in participants of two contact sports (Judo and Taekwondo) and characterise some related factors. Methods Cross-sectional pilot study of observational nature, conducted by observing and collecting data and information. The sample consisted of 60 individuals of both genders aged between 5 and 15 years old, participants of Judo or Taekwondo. The statistical analysis involved descriptive and inferential statistical measures. Results The prevalence of dental trauma in the studied sample was of 38,3%, with the majority occurring outside the practice of sport (82,6%). Only 4 children suffered trauma whilst playing their sport, corresponding to a prevalence of 6,67%. In addition, all 4 cases pertained to the practice of Judo. The most affected teeth were the primary maxillary central incisors followed by the permanent maxillary central incisors, with only one injured tooth in most cases. The lips were the soft tissue with greatest number of registered traumatic lesions. A statistically significant relationship was observed between risk factors and the occurrence of trauma. Conclusion A high prevalence of dental trauma in the studied population was found. Despite no record of traumatic lesions in Taekwondo, this prevalence was particularly noticeable in Judo.

RESUMO Objetivo Investigar a prevalência de traumatismos dentários na população praticante de dois esportes de contacto (Judo e Taekwondo) e caraterizar alguns fatores associados. Métodos Estudo piloto transversal com carácter observacional, realizado com recurso a observação e registo de dados e informações. A amostra foi de 60 indivíduos com idades compreendidas entre os 5 e os 15 anos, de ambos os sexos, praticantes de Judo ou Taekwondo no Parque de Jogos 1º de Maio - INATEL. A análise estatística envolveu medidas de estatística descritiva e estatística inferencial. Resultados A prevalência de traumatismos dentários na população em estudo foi de 38,3%, em que a maioria ocorreu fora da prática desportiva (82,6%). Apenas 4 crianças sofreram traumatismos durante a prática desportiva, correspondendo a uma prevalência de 6,67%. O único esporte predisponente para o trauma neste estudo foi o Judo. Os dentes mais atingidos foram os incisivos centrais superiores decíduos seguidos dos incisivos centrais superiores definitivos, e a maioria das situações afetou apenas um dente. O lábio foi o tecido mole com maior número de lesões traumáticas registadas. O hábito de utilização de protetor oral teve frequência nula. Verificou-se relação estatisticamente significativa entre a ocorrência de trauma e os fatores de risco estudados. Conclusão Foi encontrada uma alta prevalência de traumatismos dentários na população estudada. Esta mostrou-se alta no Judo, no entanto no Taekwondo não houve qualquer registo de lesões traumáticas.

Quantification of color variation of restorative materials used on pediatric dentistry after pigmentation / Quantificação da variação da cor de materiais restauradores utilizada em Odontopediatria após pigmentação

Objective: To quantify the color variation of two glass ionomer cements and a composite resin used in pediatric dentistry, after being immersed in different pigments agents. Methods: Using two glass ionomer cements (Ketac(tm) Molar and Photac(tm) Fil) and a microhybrid composite resin (Filtek(tm) z250), were produced 40 disks of each material (10 mm in diameter and 2 mm thick). The samples were soaked in artificial saliva (control group), coke, peach Ice Tea (r) and chocolate milk, for 72 hours in an oven at 37ºC. After this period, the samples were washed in 50 ml of distilled water. Finally, using the spectrophotometer, it was made the reading of results. The color change was measured according to the CIE L * a * b * system. Color changes were statistically analyzed using parametric one-way ANOVA and ANOVA with Welch correction, the nonparametric Kruskal-Wallis tests and post-hoc Tukey and Dunnet T3 with p≤ 0.05. Results: The immersion of restorative materials in different pigmentation agents caused a significant color variation on the samples. The agent who presented higher results was the Peach Ice Tea (r). The chocolate milk was the fluid with lowest pigmentation capacity of all restorative materials under study. The greater color variation was found on the Ketac(tm) Molar submerged in Coca-Cola (r) and the smallest on the Filtek(tm) z250 in chocolate milk. Conclusion: All restorative materials were shown to be susceptible to pigmentation by all agents. The Filtek(tm) z250 proved to have better color stability, followed by Photac(tm) Fil and finally by Ketac(tm) Molar.

Objetivo: Quantificar a variação da cor de materiais restauradores utilizados emodontopediatria, após serem imersos em agentes pigmentantes. Métodos: Recorrendo aos cimentos de ionómero de vidro Photac(tm) Fil e Ketac(tm) Molar, e à resina composta microhíbridaFiltek(tm) z250, foram efectuados 40 discos de cada material (10 milímetros de diâmetro e 2 milímetros de espessura). As amostras foram imersas em saliva artificial (grupo controlo), Coca-Cola(r), Ice Tea(r) de pêssego e Leite com chocolate, durante 72 horas, numa estufa a 37ºC. Decorrido este período, as amostras foram lavadas em 50 mililitros de água destilada. Por último, através da utilização do Espectrofotómetro, procedeu-se à leitura dos resultados. A variação da cor foi medida de acordo com o sistema CIE L* a* b* e analisada estatisticamente utilizando os testes paramétricos ANOVA one-way e ANOVA com correcção de Welch, o teste não paramétrico Kruskal-Wallis e os testes post-hoc Dunnet T3 e Tukey com p≤ 0,05. Resultados: A imersão das amostras nos fluidos, provocou uma variação de cor significativa das mesmas. O agente que apresentou resultados de pigmentação mais elevados foi o Ice Tea(r)de pêssego. O leite com chocolate foi o fluido que apresentou menor capacidade pigmentante em todos os materiais em estudo. A maior variação de cor verificou-se no Ketac(tm) Molar em Coca-Cola(r) e a menor no Filtek(tm) z250 em leite com chocolate. Conclusão: Todos os materiais restauradores demonstraram ser suscetíveis à pigmentação, por parte dos agentes. O Filtek(tm) z250 demonstrou ter uma melhor estabilidade de cor, seguido pelo Photac(tm) Fil e pelo Ketac(tm) Molar.