Accuracy of clinical and radiographic recording protocols for diagnosing periodontitis.

OBJECTIVE: To compare the accuracy of periodontal examination at 6-sites full-mouth protocol with clinical and radiographic partial-mouth recording protocols (PRPs) to diagnose periodontitis considering new 2018 case definition. METHODS: Periodontitis was diagnosed by full-mouth assessment of clinical attachment level (CAL) at 6-sites (n = 8529) according to 2018 case definition (standard reference). Three clinical and radiographic PRPs were considered: (i) 4 interproximal sites of all teeth (4-sites, full-mouth); (ii) 6-sites on Community Periodontal Index of Treatment Needs (CPITN) teeth (6-sites, CPITN teeth); (iii) 4-sites on CPITN teeth (4-sites, CPITN teeth); (iv) radiographic examination on interproximal sites of all teeth (rM-D, full-mouth); and (v) radiographic examination on interproximal sites of CPITN teeth (rM-D, CPITN teeth) using Image J®. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV), accuracy, and Κappa (k) were estimated (α = 0.05). RESULTS: The 4-sites, full-mouth protocol showed 100% sensitivity and NPV, 79.87% PPV, low specificity (38.32%), 69.30% accuracy, and poor agreement (k = 0.468). 6-sites and 4-sites CPITN teeth protocols showed 100% PPV and specificity, sensitivity and NPV of >60%, accuracy of >80%, and good agreement (k > 0.65). All clinical PRPs outperformed radiographic protocols. CONCLUSION: Clinical PRPs using index teeth are highly accurate in diagnosing periodontitis considering 2018 case definition.

Mechanisms underlying the adaptive pulp and jaw bone trabecular changes in sickle cell anemia.

OBJECTIVE: Mechanisms underlying the oral outcomes in sickle cell anemia (HbSS) have been less explored. This study aimed to investigate the association of morbimortality indicators and hydroxyurea use with adaptive pulp and jaw bone trabecular changes in HbSS. METHODS: This cross-sectional study included 123 individuals with HbSS. The exposures were the morbimortality indicators of HbSS (number of vaso-occlusive crises, organ damage, hemoglobin level, and leukocyte count) and the use of hydroxyurea for HbSS treatment. The outcomes were adaptive pulp and jaw bone trabecular changes confirmed by radiographic examination. Associations were estimated by Poisson regression in crude and adjusted analyses for sex, skin color, socioeconomic class, and age. RESULTS: The vaso-occlusive crises (mean ratio (MR) = 3.5, p = 0.045), lower hemoglobin (MR = 2.4, p = 0.037), and higher leukocyte count (MR = 2.17, p = 0.036) were risk factors, while the use of hydroxyurea was inversely associated with adaptive pulp changes (MR = 0.23, p = 0.024). The vaso-occlusive crises were associated with jaw bone trabecular changes (MR = 1.33, p = 0.02). CONCLUSION: Adaptive pulp changes may be a potential clinical marker of chronic vasculopathy in HbSS. The use of hydroxyurea may reduce the frequency of adaptive pulp changes.

Chronic oral diseases burden: The confluence of caries and periodontitis throughout life.

AIM: To investigate the confluence of caries and periodontitis indicators from adolescence to elderhood among Americans. MATERIALS AND METHODS: This cross-sectional study explored the grouping among a set of caries and periodontitis indicators (the proportion of sites with bleeding on probing, moderate probing pocket depth [PPD, 4-5 mm], severe PPD [≥6 mm], moderate clinical attachment level [CAL, 3-4 mm], severe CAL [≥5 mm], number of teeth with furcation involvement, number of decayed teeth, number of teeth with pulp involvement, and the number of missing teeth) in 14,421 Americans from the NHANES III study. Exploratory factorial analysis was used to determine the constructs between those indicators (factorial loading ≥0.3). These analyses were stratified by age and confirmed with a confirmatory factorial analysis. We also performed a sensitivity analysis using the NHANES 2011-2014. RESULTS: Two constructs were extracted. The first, Chronic Oral Diseases Burden, grouped caries indicators with moderate PPD and moderate CAL for the youngest subjects (13-39 years old), while for the subjects over 50 years, the Chronic Oral Disease Burden grouped caries indicators with severe CAL and PPD and furcation involvement. The second construct, Periodontal Destruction, grouped only periodontitis indicators. CONCLUSIONS: Caries and periodontitis indicators grouped consistently across the different age ranges in lapse times of 25 years.

A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Compressive strength of premolars restored with ceramic crowns and supported with a glass fiber post using different luting agents.

Objective: The retention of glass fiber post (GFP) is considered a key factor for the long-term success of restorations of endodontically treated teeth. This study aimed to compare the compressive strength of a ceramic crown supported by a GFP using different luting agents. Methods: Forty single-rooted premolars were randomly divided into four groups (n = 10 each): control group (teeth without a GFP), Ketac Cem group (glass ionomer), RelyX ARC group (conventional dual-curing resin), and RelyX U200 group (self-adhesive dual-curing resin). After luting of the posts and placement of all-ceramic crowns made using feldspathic porcelain (Noritake EX-3), they were exposed to thermocycling for 1000 cycles and compressive strength tests. Statistical analysis included Kruskal-Wallis test with Dunn's multi-comparison test. Results: The Ketac Cem group and RelyX U200 group showed significantly greater fracture resistance to compressive loading than the control group. Conclusion: This study indicates a possible role of the luting agent used with the GFP in influencing the compressive strength of the restored teeth. In this study, the self-adhesive dual-curing resin and glass ionomer both offered resistance to fractures.

Adverse pregnancy outcomes and occlusal traits in the primary dentition: A prospective cohort (BRISA).

OBJECTIVES: This study aimed to analyse the relationship between adverse pregnancy outcomes (APO) and occlusal traits in the primary dentition, checking for different mediation paths. SETTING AND SAMPLE POPULATION: Children evaluated at birth (T1), between 12 and 24 months (T2), and between 24 and 36 months (T3) were included. Two hundred and seventeen children who participated in T1 and T2 were randomly selected to perform the occlusion examination. MATERIALS AND METHODS: This is a prospective cohort study (BRISA). The theoretical model was tested by structural equation modelling (SEM), estimating standardized coefficients (Coeff.) (α = 0.05). The primary exposure was APO-a latent variable manifested from three health problems at birth: low birthweight (LBW), pre-term birth (PTB) and intrauterine growth restriction (IUGR), evaluated in T1. The outcomes were four different occlusal traits assessed in T3: overjet, anterior and posterior crossbite, and crowding. Each outcome's direct and indirect effects were tested, mediated by growth, breathing, breastfeeding, and pacifier use. RESULTS: There was no direct association between APO and any of the outcomes: overjet (Coeff. = -0.163, P = .241), anterior crossbite (Coeff. = -0.696, P = .065), posterior crossbite (Coeff. = -0.087, P = .589) and crowding (Coeff. = 0.400, P = .423). The indirect (total and specifics) effects tested also showed no association (P > .05). However, APO was associated with lower child growth in all models; breastfeeding was associated with higher child growth in all models, and pacifier use was associated with overjet (Coeff. = 0.184, P < .001) and posterior crossbite (Coeff. = 0.373, P = .011). CONCLUSION: APO was not a risk factor for overjet, crossbite and crowding in an early stage of the primary dentition by direct and indirect pathways. However, growth has been lower in children with APO and higher in children breastfed. Also, the harmful effects of using a pacifier in dental occlusion are highlighted.

Bioactive toothpastes in dentin hypersensitivity treatment: A systematic review.

The use of bioactive materials is a recent proposal in the treatment of dentin hypersensitivity (DH) due to the ability to stimulate the neoformation of a barrier on dentin surface. Questions have arisen about the effectiveness of the materials to reduce DH when compared to the control groups (placebo or non-bioactive substance). Thus, the aim of this systematic review was to evaluate the randomized controlled trials in adult patients for DH treatment with a dentifrice containing bioactive glass, applied either at-home or in-office. Methods: The study was registered in PROSPERO and followed PRISMA guidelines. Searches were carried out in four databases (Pubmed/Medline, CENTRAL, Wbb of Science, LILACS) spanning from February 2020 to March 2020, with no language or publication date restrictions. A supplementary hand-search was performed by checking the list of references. The so-called gray literature of the national and international databases for theses and dissertations, as well as unfinished, in progress and unpublished studies were also searched. Results: After reading the titles and abstracts, articles that were duplicated (74 records) or unrelated to the systematic review (76 records) were excluded. Fifteen studies were evaluated considering seven at low risk of bias, four at high risk and four at moderate risk. Conclusion: The bioactive compounds at low concentrations (2.5-7.5%) can be used as treatment of DH both at-home and in-office.

Low bone mineral density is associated with severe periodontitis at the end of the second decade of life: A population-based study.

AIM: To evaluate the association between low bone mineral density (BMD) and severe periodontitis at the end of the second decade of life. MATERIALS AND METHODS: This population-based study analysed 2032 youngers (18-19 years old) of the RPS cohort. BMD of lumbar spine (BMD-LS) and of the whole body (BMD-WB) were assessed by dual x-ray emission densitometry. Low BMD-LS (Z-score ≤ -2) and low BMD-WB (Z-score ≤ -1.5) were correlated with severe periodontitis. The extent of periodontal disease was also evaluated as the following outcomes: proportions of teeth affected by clinical attachment loss ≥5 mm and probing depth ≥5 mm. Multivariate models by sex, education, family income, risk of alcohol dependence, smoking, plaque, bleeding index, and body mass index were estimated through logistic regression (binary outcomes) and Poisson regression (continuous outcomes). RESULTS: The prevalence of severe periodontitis was 10.97%. Low BMD-LS (odds ratio [OR] = 2.08, confidence interval [CI] = 1.12-3.85, p = .01) and low BMD-WB (OR = 1.34, CI = 1.001-1.81, p = .04) were associated with severe periodontitis in the final multivariate models. Low BMD-LS and BMD-WB were also associated with a greater extent of periodontitis (p < .05). CONCLUSIONS: Low BMD was found to be associated with the severity and extent of periodontitis in adolescents. Adolescents at peak bone mass age presenting low BMD are more likely to be affected by severe periodontitis.

Biological factors associating pulp necrosis and sickle cell anemia.

BACKGROUND: This study was conducted to investigate the biological factors underlying the association between pulp necrosis (PN) in subjects with permanent teeth with intact crowns and sickle cell anemia (SCA). METHODS: This cohort study included 140 subjects: 125 without PN and 15 with PN. A theoretical model was built to explore the following biological factors involved in the association between PN and SCA, namely (a) increased number of sickle cell crises in the previous year (No. SCCs/year), (b) low percentage of blood oxygen saturation (SpO2 ) in the body, and (c) comorbidities (CoMs). The theoretical model for testing associations was analyzed by structural equation modeling. RESULTS: PN was associated with CoMs (SFL = 1.115; p = .032) but not with No. SCCs/year (SFL = .127; p = .596) or body SpO2 (SFL = -.102; p = .485). The prevalence rates of osteoarticular lesions (p = .009) and death (p<.001) were significantly higher in subjects with PN than in those without. CONCLUSIONS: Comorbidities, primarily osteoarticular lesions, are associated with PN in permanent teeth with intact crowns of patients with SCA. PN can be considered an indicator of the lethality of SCA.

Association Between Anaemia and Dental Caries in Brazilian Adolescents.

Purpose: The present study analysed the association between anaemia and dental caries in adolescents on the basis of predisposing factors and presence of severely decayed teeth.
Materials and Methods: This observational study included a complex probabilistic sample of adolescents (17-18 years old) enrolled at public schools in São Luís, Brazil (n = 363). Two hypothesis models were tested: (1) anaemia and dental caries are associated given that they share predisposing factors, such as socioeconomic and high sugar consumption, and (2) the presence of severely decayed teeth may increase the susceptibility of patients to anaemia. In the first model, the association between anaemia and the history of dental caries (the outcome number of affected teeth) was analysed by Poisson regression. In the second model, the association between the presence of severely decayed teeth with pulp exposure/necrosis and the outcome anaemia was analysed by logistic regression. Bivariate and multivariate analyses after adjusting for socioeconomic factors and sugar consumption were performed, considering 5% of statistical significance level and using STATA 115.0.
Results: Anaemia was associated with a higher number of affected teeth with a history of dental caries in bivariate (means ratio [MR]: 1.30; 95% confidence intervals [CI95%]: 1.10-1.52; p = 0.001) and multivariate (MR: 1.18; CI95%: 1.01-1.39; p = 0.046) analyses. Severely decayed teeth with pulp exposure/necrosis were associated with anaemia in bivariate (odds ratios [OR]: 5.75; CI95%: 1.97-16.8; p = 0.001)] and multivariate (OR 5.51; CI95%: 1.71-17.74; p = 0.004) analyses.
Conclusion: This study suggests that anaemia and dental caries are associated in a population-based sample of adolescents and that predisposing factors and severely decayed teeth seem to be involved in this association..

Oral manifestations of renal tubular acidosis associated with secondary rickets: case report / Manifestações bucais da acidose tubular renal associada ao raquitismo secundário: relato de caso

ABSTRACT This report describes the oral manifestations of renal tubular acidosis (RTA) associated with secondary rickets and discusses the biological plausibility of these findings. The characteristic electrolyte changes during RTA or genetic mutations that trigger RTA may be responsible for impaired amelogenesis, dental malocclusion, impacted teeth, and absent lamina dura. This report reinforces the possibility of an association between RTA and the oral manifestations described.

RESUMO Este relato de caso descreve as manifestações bucais da acidose tubular renal (ATR) associada ao raquitismo secundário e discute a plausibilidade biológica desses achados. As alterações eletrolíticas características da ATR ou as mutações genéticas que a desencadeiam podem ser responsáveis pela amelogênese imperfeita, maloclusão dentária, dentes impactados e ausência de lâmina dura. Este relato reforça a possibilidade de uma associação entre ATR e as manifestações bucais descritas.

Clorexidina melhora as propriedades mecânicas da dentina radicular / Chlorhexidine improves the mechanical properties of root dentin

Objetivo: avaliar a resistência máxima à flexão (MFS), módulo de elasticidade (E), microdureza Knoop (KHN) e rugosidade de superfície (Ra) da dentina radicular tratada com solução de clorexidina a 2% (CHX). Métodos: foram selecionados 50 incisivos bovinos com ápice fechado, e trinta raízes foram cortadas em barras de dentina (DB) e divididas em três grupos (n = 10): Controle (sem tratamento), G1 (NaOCl 2,5% + EDTA 17%) e G2 (CHX 2% + H2O). As DB foram submetidas ao ensaio de resistência flexural de três pontos, para se obter os valores de MFS e E. Vinte raízes foram cortadas longitudinalmente ao meio e inseridas em resina acrílica; as superfícies pulpares foram lixadas e polidas e, em seguida, irrigadas de acordo com o grupo (G1 ou G2; n = 20 metades por grupo) e submetidas aos testes de KHN e Ra. Foi realizada análise de MEV. Os dados foram analisados por meio dos testes de ANOVA de um e dois critérios, seguidos do teste de Tukey (α = 0,05). Resultados: os valores de MFS (p < 0,05) e E (p < 0,01) foram maiores para G2. A KHN foi reduzida após o tratamento com cada irrigante endodôntico (p < 0,001), sem diferenças entre eles (p = 0,115). A Ra foi maior para o G1 (p < 0,001). Conclusões: a solução de clorexidina a 2% melhora as propriedades mecânicas de MFS, E e Ra da dentina radicular. (AU)

Objective: To evaluate the maximum flexural strength (MFS), elastic modulus (E), Knoop microhardness (KHN), and surface roughness (Ra) of root dentin treated with 2% chlorhexidine (CHX) solution. Materials and methods: Fifty bovine incisors with closed apex were selected. Thirty roots were cut into dentin bars (DB) and divided into three groups (n=10): control (no treatment), G1 (2.5% NaOCl + 17% EDTA) and G2 (2% CHX + H2O). The DB were submitted to the three-point flexural strength test to obtain the MFS and E. Twenty roots were cut longitudinally into two half-halves and placed in acrylic resin. The pulp surfaces were sanded and polished. They were rinsed according to the group (G1 or G2; n = 20 per group) and subjected to the KHN and Ra tests. SEM analysis was made. Data were analysed by one- and two-way ANOVA and Tukey post hoc test (a = 0.05). Results: The values of MFS (P < 0.05) and E (P < 0.01) were higher for G2. The KHN reduced after both endodontic irrigation treatments (P < 0.001), with no differences between them (P = 0.115). Ra was higher for G1 (P < 0.001). Conclusions: 2% CHX improved the mechanical properties of MFS, E and Ra of root dentin (AU).

Oral manifestations of renal tubular acidosis associated with secondary rickets: case report.

This report describes the oral manifestations of renal tubular acidosis (RTA) associated with secondary rickets and discusses the biological plausibility of these findings. The characteristic electrolyte changes during RTA or genetic mutations that trigger RTA may be responsible for impaired amelogenesis, dental malocclusion, impacted teeth, and absent lamina dura. This report reinforces the possibility of an association between RTA and the oral manifestations described.

Management of atypical mucosal lesions from primary endodontic infection: two cases report

Aim/Case report: We have described here the diagnosis and treatment of two cases involving atypical mucosal lesions originating from primary endodontic infections in young patients. Differential diagnoses were established by clinical and radiographic examinations. In both the cases, a red-colored lesion was observed in the alveolar mucosa, with a soft consistency and a sessile-base without any drainage path in tooth 31 (case 1) and with a sinus tract in tooth 36 (case 2), as confirmed by X-ray. The cleaning and shaping of the root canals were performed, and camphorated paramonochlorofenol (CPMC)-enriched calcium hydroxide paste was used as an intracanal dressing for 6 months, with replacement every 60 days. Conclusion: Based on our experience, we thus conclude that long-term root canal maintenance with CPMC-enriched calcium hydroxide was an effective therapeutic protocol for promoting the healing of atypical mucosal lesions

Healthy Dental Pulp Oxygen Saturation Rates in Subjects with Homozygous Sickle Cell Anemia: A Cross-Sectional Study Nested in a Cohort.

INTRODUCTION: To compare the percentage of arterial oxygen saturation (SpO2) in healthy teeth with confirmed pulp vitality between individuals with sickle cell anemia (HbSS) and normal hemoglobin A (HbAA). METHODS: This is a cross-sectional study nested within a cohort. Samples (n = 2543) comprised teeth with intact crowns and pulp vitality confirmed by thermal sensitivity tests and no history of caries, periodontal disease, or dental trauma. A total of 728 teeth of 113 individuals with HbSS and 1815 teeth of 246 individuals with HbAA were evaluated. Data analysis was performed using the χ2 and Mann-Whitney tests and Spearman correlation analysis (α = 0.05). RESULTS: The study groups were comparable in terms of age, race, and sex (P > .05). Subjects with HbSS exhibited lower median SpO2 levels in the body and upper teeth, excluding canines, than subjects with HbAA (P < .05). There were no significant differences in the evaluated parameters between the 2 groups (P > .05). CONCLUSION: Compared with individuals with HbAA, those with HbSS exhibited lower SpO2 in maxillary teeth with confirmed pulp vitality, except in the canines. There was no correlation between SpO2 levels of the body and dental pulp in individuals with HbSS or HbAA.

Chlorhexidine Prevents Root Dentine Mineral Loss and Fracture Caused by Calcium Hydroxide over Time.

Purpose. To evaluate the mineral ion loss of root dentine after treatment with 2% chlorhexidine solution (CHX) and to compare its yield and flexural strength (fs) after exposure to calcium hydroxide [Ca(OH)2]. Materials and Methods. Dentine bars (DB) were made from 90 roots of bovine incisors and randomized into three groups: GControl: distilled/deionized water (DDW), GNaOCl: 2.5% sodium hypochlorite + 17% EDTA, and GCHX: CHX + DDW. The release of phosphate (PO4) and calcium (Ca) ions was measured by spectrophotometry. The DB were exposed to Ca(OH)2 paste for 0, 30, 90, and 180 days. DB were subjected to the three-point bending test to obtain yield and fs values. The fracture patterns were evaluated (20x). Data were analyzed using Kruskal-Wallis and Dunn's post hoc tests or one- and two-way ANOVA followed by Tukey's post hoc test (α = 0.05). Results. GCHX showed lower PO43- and Ca2+ ionic release than GNaOCl (p < 0.001). For yield and fs, GCHX > GNaOCl in all periods (p < 0.001), except for yield strength values on 90 days (p = 0.791). A larger frequency of vertical fractures was observed in GNaOCl and that of oblique fractures in GCHX (p < 0.05). Conclusions. CHX prevented PO43- and Ca2+ loss and showed a tendency to preserve the yield and fs of root dentine over time following exposure to Ca(OH)2 paste.

Are dental and jaw changes more prevalent in a Brazilian population with sickle cell anemia?

OBJECTIVE: The aim of this study was to analyze the prevalence of dental and jaw changes in individuals with sickle cell anemia (SCA) compared with a control group from a Brazilian population. STUDY DESIGN: This was a retrospective cross-sectional study. Participants were divided into 2 groups: SCA and control (123 patients per group). Intraoral periapical radiographs were taken. Changes in bone pattern and dental changes were investigated by using the following radiographic parameters: (1) trabecular bone (step-ladder or spider web); (2) integrity of the lamina dura (loss of sharpness and continuity, partial or complete absence, and increased thickness); and (3) dental changes (pulp chamber, root surface, periapex, dental form, number, and position). Fisher's exact and χ2 tests were used to compare frequencies and the Mann-Whitney test was used to compare medians (P < .05). RESULTS: Step-ladder (P < .001) and spider-web patterns (P < .001) in trabecular bone of the jaw were more common in individuals with SCA than in the control group. Loss of lamina dura was more frequent in those with SCA than in control individuals (P = .021). Dental changes were not different between groups (P > .05), even though the prevalence of hypotaurodontism was twice as high in the SCA group as in controls (P = .086). CONCLUSIONS: The prevalence of jaw changes is higher in individuals with SCA.

Dental care provided to sickle cell anemia patients stratified by age: A population-based study in Northeastern Brazil.

OBJECTIVE: To assess differences in the dental care provided to sickle cell anemia (SCA) patients depending on age. This retrospective study used secondary data from the dental records of the Center of Hematology and Hemotherapy in Maranhão (HEMOMAR). MATERIALS AND METHODS: Data were obtained from 574 dental records of patients with SCA treated or under treatment in the Dental Department of HEMOMAR from 2000 to 2011. Data on the gender, age, duration of dental treatment, number of patients submitted to periodontal treatment (PT), number of filled teeth (FT), teeth extracted (EX), endodontically treated teeth (ET), and reason for the dental procedures were collected. The Kruskal-Wallis test together with Dunn's post hoc test, Chi-square test, and Spearman's correlation was used for statistical analysis. An alpha error of 5% was considered acceptable. RESULTS: Significant differences were found for FT, EX (P < 0.05), ET and PT (P < 0.001) between the age groups. There were fewer FT in children compared to other age groups (P < 0.001). The most common reasons for restorations and endodontic treatment were dental caries (100%) and irreversible pulpitis (55.6%), respectively. The main reasons for teeth extractions were residual roots (21.3%), chronic apical periodontitis (19.7%), and crown destruction (19.3%). There were positive correlations between age and EX (r = 0.93; P = 0.025) and ET (r = 0.92; P = 0.028). CONCLUSIONS: FT, ET, EX, and PT procedures become more common in older patients. Tooth decay is the main reason for dental treatment in SCA patients.

Is sickle cell anemia a risk factor for severe dental malocclusion?

The aim of this study was to investigate possible associations between sickle cell anemia (SCA) and the severity of dental malocclusion (MO). This was a retrospective cohort study of 93 individuals with SCA (G1) and 186 individuals without the disease (G2). SCA patients were randomly selected by a simple draw from patients treated in the Centro de Hematologia e Hemoterapia do Maranhão (HEMOMAR) in northeastern Brazil. Patients aged between 16 and 60 were included after being tested for the hemoglobin S gene. G2 consisted of individuals living in the same residence as the patients. The Dental Aesthetic Index (DAI), as well as some morphological deviations not included in DAI, were used for the orthodontic evaluation of MO. Poisson regression with robust variance adjustment was employed to estimate relative risk (RR). In the multivariate analysis, SCA was associated with moderate (RR = 1.36) and very severe MO (RR = 8.0). SCA is correlated with anterior tooth loss (RR = 1.94), anterior spacing (RR = 1.66), overjet (RR = 1.87), anterior crossbite (RR = 1.94), and open bite (RR = 1.94). Thus, SCA is a risk factor for moderate and very severe MO.

Effect of Chlorhexidine Gel in Mentally Handicapped Children highly Infected with Streptococcus Mutans

Objective:To evaluate the effect of 1% chlorhexidine (CHX) gel on mentally handicapped children (n=11) highly infected with Streptococcus mutans (SM) and evaluate the re-colonization time of this bacterium after the treatment period.. Material and Methods:Before CHX treatment, saliva samples were collected to establish baseline saliva SM levels. CHX gel was daily applied for 5 min, for 7 consecutive days. Saliva samples were then collected after 7, 30, 60, 90 and 120 days to evaluate SM oral re-colonization. Data were analyzed by the Wilcoxon test (α=0.05).Results:When compared to baseline (5.7 / 3.0 x 105), the collection performed 7 days after CHX treatment (0.06 / 0.2 x 105) showed a significant reduction (P <0.05) in SM saliva levels (mean / s.d., CFU ml-1). In subsequent collections, a gradual SM re-colonization was observed, and after 60 days of treatment, the levels of this bacterium (0.8 / 0.9 x 105) no longer statistically differed from SM levels considered high risk to caries (105) (P> 0.05).Conclusion:Treatment with CHX gel for 7 days was effective in reducing the SM levels of mentally handicapped children and should be repeated after 60 days to control the risk of caries in these children...