Efficacy of a new light-cured anesthetic gel for clamp placement before rubber dam isolation in children: A triple-blinded randomized controlled clinical trial.

PURPOSE: To evaluate the efficacy of a new light-cured anesthetic gel for pain control associated with the clamp placement for rubber dam isolation in children. METHODS: 82 children in need of sealant placement on the first permanent mandibular molars were selected to take part in this randomized, split-mouth, triple-blinded study. Before rubber dam placement, the light-cured anesthetic gel (test) or a placebo gel (control) was applied on the gingival margins of the molars. The hemi-arches were isolated with cotton rolls and the gels were applied; the anesthetic gel was light-cured. After 30 seconds, clamp #26 was positioned on tooth 36 or 46. If there was pain, the clamp was removed and rescue anesthesia was applied. The absolute risk and intensity of pain were registered using three scales: facial expression (Wong-Baker), observational (FLACC) and numerical (NRS). Data were analyzed by McNemar's test and Wilcoxon Signed Rank (α= 5%). RESULTS: Differences were detected for the risk of pain between groups (P= 0.0002) and for the different intensity of pain scales used (P< 0.001) with positive results for the anesthetic gel. CLINICAL SIGNIFICANCE: The new developed light-cured topical anesthetic is an alternative to infiltrative anesthesia for pain control during clamp adaptation for rubber dam isolation. Its use helps to overcome the fear of needles, which can trigger pain, anxiety and discomfort for the majority of the patients, hampering the behavior management in children.

Intrapocket topical anesthetic versus injected anesthetic for pain control during scaling and root planing in adult patients: Systematic review and meta-analysis.

BACKGROUND: In this systematic review and meta-analysis, the authors evaluated the pain during scaling and root planing with use of topical anesthetic versus that with the use of injected anesthetic in adult patients. TYPES OF STUDIES REVIEWED: The authors searched 6 databases for randomized clinical trials in which the investigators compared the clinical effectiveness of intrapocket and injectable anesthetics. The primary outcome was the risk of developing pain or intensity of pain. Quality assessment followed the guidelines from the Cochrane Collaboration's risk-of-bias tool. The authors performed meta-analyses on studies considered at low and unclear risk of bias. RESULTS: From 976 articles identified, 6 remained in the qualitative synthesis (4 at low and 2 at unclear risk of bias). Injected anesthetic produced lower pain intensity than did anesthetic gel (P = .03) and required less rescue anesthetic than did topical anesthetic (P < .0001). There was no difference in patient preference (P = .09). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Injected anesthetic decreased the intensity of pain and the need for rescue anesthetic during scaling and root planing, but the risk of developing pain yielded similar results for injected and topical anesthetics.

Children using Day Nurseries' Facilities can be Associated with more Risk to Nonnutritive Sucking Habits.

INTRODUCTION: This study evaluated the expression of nonnutritive sucking habits and the presence of malocclusion in children using day nurseries' facilities. MATERIALS AND METHODS: The 195 children (7-40 months) attending 18 public day nurseries were evaluated clinically in Ponta Grossa, Brazil. Statistical package software was used for descriptive, univariate, bivariate, and multiple logistic regressions of the data about the socioeconomic condition, educational family status, malocclusions, and prevalence of nonnutritive sucking habits among the children. RESULTS: The pacifier users had a statistically significant, explanatory association with open bite [odds ratio (OR) = 10.97; 95% confidence interval (CI): 4.95, 24.31; p < 0.0001]. The children older than 25 months had more open bite than younger children (OR = 6.07; 95% CI: 2.81, 13.11; p < 0.0001). Of the children examined, 35.4% had an anterior open bite, 0.51% had posterior cross-bite, and 1.03% showed finger-sucking habits. A high frequency of pacifier-sucking habits was found (52%), with a significant association between this habit and anterior open bite (p < 0.0001, OR = 7.49; 95% CI: 3.71, 15.15). The 126 children without open bite (36.5%) were pacifier users. There was suggestive, though nonsignificant, evidence of a difference in pacifier use by gender (males, 34%; females, 46%; p = 0.07). The 69 children with open bite (81.16%) were pacifier users and (18.84%) nonusers. The boys showed a slightly greater association with open bite (OR = 21.33; 95% CI: 6.12, 74.40; p < 0.0001) than girls (OR = 5.03; 95% CI: 1.26, 20.00; p = 0.02) in the age group of 25 to 40 months; however, it was not observed in younger children. CONCLUSION: Pacifier use is a predictor for open bite in children from the lower socioeconomic classes using day nurseries' facilities. CLINICAL SIGNIFICANCE: The parents, guardians, and caregivers working in public day nurseries should be advised to monitor nonnutritive sucking habits in order to avoid or minimize the occurrence of malocclusion. It demonstrates that the permanence of the children in day nurseries may be linked with deleterious oral habits, and it discusses strategies to minimize the occurrence of alterations in the normal occlusion.

Intra-pocket anaesthesia and pain during probing, scaling and root planing: a systematic review and meta-analysis.

AIM: A systematic review/meta-analysis was performed to evaluate pain during probing, scaling and root planing using intra-pocket anaesthesia versus placebo in adult patients. METHODS: A search was performed in PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library and Grey literature. IADR abstracts, unpublished trials registries, dissertations and theses were also searched for randomized clinical trials comparing the clinical effectiveness of intra-pocket anaesthesia and placebo. Risk/intensity of pain was the primary outcome. The risk of bias tool from the Cochrane Collaboration was used for quality assessment. Meta-analysis was performed on studies considered at low risk of bias. RESULTS: A total of 1740 articles were identified. Eleven remained in the qualitative synthesis, and nine studies were considered at "low" risk of bias for meta-analysis. Standardized Hedge's g mean difference for pain intensity using visual analogue scale and Heft-Parker pain scales was -0.576 (95% confidence interval [CI] -0.94 to -0.22; p = 0.002) and for verbal rating scale pain scale it was -1.814 (95% CI -3.38 to -0.245; p = 0.023). The odds ratio for the risk of pain was 0.025 (95% CI 0.003 to 0.25; p = 0.002) and the odds ratio for the need for rescue anaesthesia it was 0.358 (95% CI 0.174 to 0.736; p = 0.005). CONCLUSIONS: The anaesthetic gel decreases the risk and intensity of pain during probing/SRP.

Evaluation of primary carious dentin after cavity sealing in deep lesions: a 10- to 13-month follow-up.

PURPOSE: This study's purpose was to describe the primary dentin reactions following restoration without complete removal of infected dentin. METHODS: Fragments of carious dentin from 43 teeth with acute deep lesions were removed at baseline and compared to samples of carious dentin removed 60 days later, using scanning electron microscopy (SEM) photographs. At the follow-up periods (60 days; 10-13 months), restorations were evaluated using US Public Health Service criteria and standardized radiographs. A postprocessing routine of radiographs was used to identify changes in radiographic density between periods. RESULTS: At baseline, SEM photographs showed disorganized tissue and bacterial invasion. After 60 days, the dentin exhibited a better organization and signs of remineralization. Differences in restoration characteristics were detected for cavosurface discoloration (P=.008), wear (P<.001), and surface texture (P<.001) after 10 to 13 months. Digital subtraction radiographs showed that mean gray levels of carious and sound dentin increased after 10 to 13 months (P<.001). Differences in mean gray levels were detected between carious and sound dentin only for the 60-day images (P=.03). CONCLUSIONS: Removal of infected dentin wasn't fundamental for caries arrestment. Carious dentin tended to reorganize in a short period when properly sealed, and the remineralization process continued for longer periods. Correct diagnosis of pulp vitality seems fundamental for the success of this protocol.

Effects of warm air drying on water sorption, solubility, and adhesive strength of simplified etch-and-rinse adhesives.

PURPOSE: To evaluate the effects of the temperature of air used for solvent evaporation on water sorption, solubility, and ultimate tensile strength (UTS) of simplified etch-and-rinse adhesives. MATERIALS AND METHODS: Four commercial simplified etch-and-rinse adhesives (Adper Single Bond 2 [SB]; Te Econom [TE]; XP Bond [XP] and Ambar [AM]) were selected. Disk-shaped specimens were prepared by dispensing the uncured resin into a mold (5.8 mm x 0.8 mm). Solvent evaporation was performed using a warm (60°C) or cold (20°C) air stream for 40 s. After desiccation, the cured specimens were weighed and then stored in distilled water for evaluation of the water diffusion kinetics over a 28-day period. For the UTS measurement, hourglass-shaped specimens of adhesives were prepared and tested in tension. The data from each test were evaluated with two-way ANOVA and Tukey's test at a confidence level of 95%. RESULTS: Water sorption and solubility varied significantly between materials, but no significant difference was observed between warm and cold conditions (p > 0.05). TE and AM showed the lowest water sorption and solubility (p < 0.05). For SB, TE, and XP, the use of a warm air stream resulted in higher ultimate tensile strength (p < 0.05) in both experimental conditions. CONCLUSIONS: The water sorption and solubility of the materials seem to be more influenced by their composition than by the temperature used for solvent evaporation. For some adhesives, the use of a warm air stream can yield higher ultimate tensile strength.

The role of dentin moisture in the degradation of resin-dentin interfaces under clinical and laboratory conditions.

BACKGROUND: The authors conducted a study to evaluate the influence of dentin moisture on the degradation of the resin-dentin interface in primary teeth under clinical and laboratory conditions. METHODS: The authors prepared 40 Class I restorations (five teeth per group) by using a cylindrical diamond bur, leaving a flat dentin surface on the pulpal floor. They vigorously rubbed two coats of a simplified etch-and-rinse adhesive on either dry or wet demineralized dentin under clinical or laboratory conditions. After performing restorative procedures, the authors extracted teeth prepared under clinical conditions after 20 minutes (immediately) or the teeth exfoliated after six months. The authors also tested the teeth prepared under laboratory conditions immediately or after six months of being stored in water. They sectioned the teeth to obtain resin-dentin bonded specimens for microtensile testing and for silver nitrate uptake (SNU) under scanning electron microscopy. They performed a three-way analysis of variance and Tukey test (α = .05) on the SNU bond strength data. RESULTS: Statistically higher bond strength values (megapascals [standard deviation]) were observed when bonding was performed under laboratory conditions (clinical = 25.2 [3.6] MPa versus laboratory = 28.5 [4.4] MPa; P < .05). Degradation occurred only in the wet dentin groups under both experimental conditions (immediately = 31.3 [4.5] MPa versus after six months = 21.3 [2.1] MPa; P < .05). SNU occurred in all groups and was statistically higher after six months of clinical function or water storage (immediately = 13.9 [4.9 SD] percent versus after six months = 34.1 [4.5 SD] percent; P < .05). CONCLUSIONS: The bonding of adhesives to dry demineralized dentin produces adhesive interfaces that are more resistant to degradation regardless of the bonding condition. CLINICAL IMPLICATIONS: Resin-dentin bond strengths produced under laboratory conditions in primary teeth may be higher than those obtained under clinical circumstances, although both conditions (clinical and laboratory) seemed to yield similar results. Bonding to dry demineralized primary tooth dentin produced resin-dentin interfaces that were more resistant to degradation.

In vitro and in vivo analyses of the effects of desensitizing agents on dentin permeability and dentinal tubule occlusion.

This study was done to assess the influence of the topical application of two different desensitizing agents on dentin permeability and dentinal tubule occlusion. Twenty-one rats provided 84 teeth: 36 for the in vitro and 48 for the in vivo investigation. The following agents were tested: Group 1, 2% potassium nitrate plus 2% sodium fluoride gel; Group 2, 5% sodium fluoride varnish; Group 3, 3% hydroxyethylcellulose gel (control). Cervical cavities were prepared and EDTA was applied to expose the dentinal tubules. After each treatment, Evans blue dye was applied to the teeth. Dentin permeability, scanning electron microscope (SEM) sections, and energy dispersive X-ray (EDX) were analyzed. One-way ANOVA was used to compare the data. There were significant differences (P < 0.05) among groups for dentin permeability, number of tubules/mm(2), tubule area and tubular diameter. Groups 1 and 2 (both in vitro and in vivo) showed open and partially occluded tubules. Group 3 had the most open tubules. EDX revealed similar composition for both experimental conditions. Within the limits of the study, 2% nitrate potassium plus 2% sodium fluoride gel and 5% fluoride varnish decreased the dentin permeability, resulting in partial tubular occlusion.