Eroded enamel rehardening using two intraoral appliances designs in different times of salivary exposure.

BACKGROUND: The aim of this study was evaluated the eroded enamel rehardening potential using upper palatal and lower buccal removable appliances in different times of salivary exposure (30 min, 1h, 2h, 12h) after a single erosive challenge event. MATERIAL AND METHODS: After initial surface hardness evaluation, bovine enamel blocks were eroded in vitro (0.01 M hydrochloric acid, pH 2.3, 30 seconds), selected (n = 160) and randomly assigned to the two appliance designs and twenty volunteers. Four enamel blocks were inserted in each removable appliance. On the in situ phase, the volunteers were instructed to use the upper palatal and lower buccal appliances simultaneously for 12 nonconsecutive hours. After each predetermined period of time of salivary exposure, the enamel blocks were removed from the appliances for immediate evaluation of surface hardness, enabling percentage of surface hardness recovery calculation (%SHR). The data were analyzed using two-way ANOVA and Tukey's test (α=5%). RESULTS: The results showed no difference in the degree of enamel rehardening by the upper palatal or lower buccal appliances (p >0.0001). Regarding the time of use of the appliances, it was demonstrated that 30 minutes (upper = 21.12%, lower = 19.84%) and 1 hour (upper = 35.69%, lower = 30.50%) promoted lower hardness recovery than two hours (upper = 44.65%, lower 40.80%) of salivary exposure (p<0.0001). The use of 12 hours (upper = 49.33%, lower = 49.00%), including the sleeping time of the volunteers did not increase the %SHR. CONCLUSIONS: The location of the appliance does not influence the re-hardening ability of saliva and the use of intraoral appliances for 2 hours seems to be appropriate for partial rehardening of the softened enamel surface. Key words:Tooth erosion, in situ, saliva, tooth remineralization.

Social determinants of health and maxillofacial injuries in children and adolescents victims of violence: A novel GIS-based modelling application.

BACKGROUND: Physical violence against children and adolescents comprises a serious public health problem and often results in oral and maxillofacial traumas. Social determinants may favour the occurrence of these events, but few studies have critically evaluated the interaction between social and geographical risk factors. AIMS: To investigate the spatiotemporal distribution of oral and maxillofacial traumas resulting from violence against children and adolescents through geostatistical techniques. METHODS: This study was an ecological analysis of cases of trauma caused by violence against Brazilian children and adolescents using aggregated data from victims attended at a Center of Forensic Medicine and Forensic Dentistry between January 2012 and December 2015. Data were analysed through modelling based on geographic information system (GIS). RESULTS: Two distinct patterns of longitudinal trajectory of oral and maxillofacial trauma related to violence against children and adolescents were identified (TP1 and TP2, P < 0.05). The spatial regression analysis revealed a statistically significant association between higher incidence of cases and areas with worse socioeconomic conditions (ß = 0.047, SE = 0.020, P < 0.05). CONCLUSION: Neighbourhoods with considerable socio-spatial vulnerability for violence against children and adolescents and maxillofacial traumas were identified.

Chronology of the First Deciduous Tooth Eruption in Brazilian Children with Microcephaly Associated with Zika Virus: A Longitudinal Study

Objective: To analyze the chronology of first deciduous tooth eruption in children with microcephaly associated with presumed or confirmed Zika virus. Material and Methods: A longitudinal study was developed with 74 children of both sexes. Data on prematurity, gestational age (in weeks), anthropometric characteristics at birth [length (cm), weight (g) and cephalic perimeter (cm)] and dental eruption (chronological age and corrected age for prematurity in months) were collected and presented through descriptive statistics. Data was analyzed using the Statistical Package for Social Sciences. Results: The majority of children were female (54.1%) and 14.9% were born premature. The mean gestational age was 38.2 (± 1.9) weeks, while length, weight and cephalic perimeter at birth were 45.6 (± 3.1) cm, 2750 (± 526.6) and 30 (± 2.3) cm, respectively. The eruption of the first tooth occurred on average at 12.3 (± 3.0) months of chronological age and at 11.1 (± 2.3) months of corrected age. The first erupted teeth were the lower deciduous central incisors (82.4%). The mean age for dental eruption in males was 12.5 months (± 3.0) and in females 12.0 months (± 3.1) among full-term children. For premature infants, the mean corrected age of dental eruption was 11.5 months (± 3.4) for boys and 11 months (± 1.7) for girls. Conclusion: In this group of children with microcephaly, the first tooth to erupt was the lower central incisor around the first year of life. Girls had lower average eruption time when compared to boys in both chronological age and age corrected for prematurity.

Delayed Treatment of Traumatized Primary Teeth with Distinct Pulp Response: Follow-Up until Permanent Successors Eruption.

Complicated crown fracture and crown-root fracture with pulp involvement expose dental pulp to the oral environment. The pulp outcome is often unpredictable because the patient and injury which are related to variables can influence the treatment of choice and the prognosis of the case. This report presents the case of a 4-year-old boy with complicated crown fracture with pulp polyp in the primary right maxillary central incisor (51) and crown-root fracture with pulp involvement in the primary left maxillary central incisor (61), which was treated only 3 months after the tooth injuries. The treatment of choice was extraction of tooth (61) due to a periapical lesion with disruption of the dental follicle of the permanent successor and pulpotomy (MTA) of the tooth (51), because the pulp presented signs of vitality. At the follow-up visits, no clinical, symptomalogical, and radiographic changes were observed until the primary tooth's exfoliation. However, at 3-year follow-up, the permanent successors showed hypocalcification and the position of the permanent right maxillary central incisors (11) was altered. Besides the conservative and adequate delayed treatment, the sequelae on the permanent successors could not be avoided.

Conservative management of external root resorption after tooth reimplantation: a 3-year follow-up.

The aim of this case report is to describe the treatment of a 9-year-old patient who suffered external root resorption of the permanent maxillary left lateral incisor following reimplantation of the avulsed left central and lateral incisors. Sixteen days after reimplantation and splinting of the incisors in a hospital emergency department, the patient was brought to the pediatric department of a dental school for further treatment. Root canal access was created in the maxillary left lateral and central incisors, and calcium hydroxide paste was used as intracanal dressing. At the 5-month follow-up, a radiograph revealed extensive external root resorption, a communicating root canal, and a periodontal lesion affecting the left lateral incisor. Management of the root resorption included obturation of the apical third of the canal with gutta percha and the middle third with mineral trioxide aggregate (MTA). At the 3-year recall examination, the patient was asymptomatic, and no mobility or soft tissue alterations were observed clinically. There was no radiographic sign that resorption had progressed. Despite the success of treatment, observation is still required. The use of MTA may be considered an alternative treatment for external root resorption after tooth reimplantation. The technique may allow tooth preservation in children until skeletal growth and development are completed and implant treatment may be considered.

Impact of Saliva and Intraoral Appliance on Erosion Lesions Rehardening Ability - A Pilot Study

Objective: To evaluate the ability of different periods of salivary exposure and two different removable appliances to rehardening initial erosive lesions. Material and Methods: This randomized, single blind in situ study was conducted with 2 crossover phases. The factors under study were: period of salivary exposure (15 minutes, 30 minutes, 1 hour and 2 hours) and type of oral appliance (maxillary or mandibular). Two hundred enamel blocks were selected by initial surface hardness (SHi). Enamel blocks were demineralized in vitro (0.05M citric acid; pH2.5 for 15 seconds), surface hardness (SHd) was remeasured and 160 blocks were selected and randomized among groups. Thus, there were 2 blocks per period of salivary exposure in each type of oral appliance for each one of the 10 volunteers. In each phase, one of the removable appliances was tested. The response variable was percentage of surface hardness recovery (%SHR=[(SHf-SHd)/SHi)]x100). Two-way ANOVA and Tukey's post hoc test were applied adopting 5% of significance. Results: No difference was found among oral appliances on enamel rehardening (p>0.01). Salivary exposure of 2 hours promoted similar enamel rehardening when compared to 1 hour (p>0.05), which showed similar rehardening to 30 min. All mentioned period of salivary exposure promoted superior rehardening than 15 min (p>0.01). Conclusion: The salivary time exposure between erosive attacks might be 2 hours to achieve a feasible maximum rehardening. In addition, both maxillary and the mandibular appliance have presented a similar rehardening ability.

Resin infiltration of early carious lesion in early childhood: a case report.

The treatment of white-spot lesions in infants and young children with early childhood caries is a challenge. The ideal management of the disease and subsequent remineralization of the lesions depend on the family's commitment to dietary behavior modifications to address the causes of the disease. If this proves ineffective or unlikely, resin infiltration has been developed to slow or arrest progression of white-spot lesions. In resin infiltration, the porous lesion body is penetrated by a special low-viscosity resin, blocking the diffusion of cariogenic acids into the lesion. This case report describes the use of a resin infiltrant to treat white-spot lesions in a 24-month-old boy with early childhood caries.

Posttraumatic displacement management: lateral luxation and alveolar bone fracture in young permanent teeth with 5 years of follow-up.

Dental trauma is an important public health problem due to high prevalence and associated limitations. The external impact accounting for trauma may result in different injury types to teeth and supporting structures. This paper describes a clinical case of tooth trauma in an 8-year-old patient exhibiting the displacement of three permanent teeth with open root apexes. Although the traumatic impact resulted in two injury types to teeth and supporting tissues (lateral luxation and alveolar bone fracture), the therapeutic approach was the same in both situations. The bone and teeth were repositioned by digital pressure, stabilized by semirigid splint, and followed up at every week. After six weeks, the splint was removed. At that moment, the clinical and radiographic findings indicated normal soft/hard tissues and absence of pulp/periodontal pathologies. At the fifth year of follow-up, the treatment success of the case was confirmed, although it has been observed that all lower incisors exhibited pulp obliteration as a consequence of the dental trauma.

In situ effect of a commercial CPP-ACP chewing gum on the human enamel initial erosion.

OBJECTIVE: This study evaluated the in situ rehardening effect of a commercial chewing gum containing casein phosphopeptide - amorphous calcium phosphate (CPP-ACP) on initial erosion lesions. METHODS: Seventy-two human enamel blocks, after selection (initial surface hardness - SHi) and in vitro short-term acidic exposure (cola drink for 3 min - SHd) were randomly assigned to three groups. The factors under study were treatment (3 levels: GI chewing gum with CPP-ACP, GII chewing gum without CPP-ACP and GIII control group without gum) and intraoral period (2 levels: 2 and 24h). Twelve volunteers wore intraoral palatal devices for 24h in 3 crossover phases. On each phase, after 2h the surface hardness was assessed (SHf1) and the blocks were reinserted and the devices were used for additional 22 h (SHf2). In phases of GI and GII volunteers chewed the respective gum during 30 min, for 4 times with an interval of 4h. Percentage of surface hardness recovery (%SHR) was calculated after 2 and 24 h. The data were analysed by repeated measures ANOVA and Tukey's test. RESULTS: Chewing gum with CPP-ACP (2h=50.0%<24h=95.9%) showed higher hardness recovery than chewing gum without CPP-ACP (2h=30.0%<24 h=71.1%) and control (2 h=15.7%<24 h=40.9%) (p<0.05). CONCLUSIONS: The results suggest that saliva increased hardness of softened enamel after the use of conventional chewing gum (GII) and this effect was enhanced by the prolonged intraoral period (24 h) and by the use of CPP-ACP chewing gum (GI). CLINICAL SIGNIFICANCE: Since chewing gum is an alternative to enhance salivary defenses after erosive challenges, CPP-ACP chewing gum might be a supplementary strategy to potentiate the mineral precipitation of initial erosion lesions.

In vitro assessment of artificial saliva formulations on initial enamel erosion remineralization.

OBJECTIVES: Various formulations of artificial saliva are present in the literature and little guidance is available on the standardization of type of saliva for use in in vitro protocols for erosive studies. The aim of this study was to evaluate the remineralizing capacity of different formulations of artificial saliva on initial enamel erosive lesion. METHODS: Bovine enamel blocks were subjected to short-term acidic exposure by immersion in citric acid 0.05 M (pH 2.5) for 15s, resulting in surface softening without tissue loss. Then 90 selected eroded enamel blocks were randomly and equally divided into 6 groups according to saliva formulation (n=15): Saliva 1 (contain mucin); Saliva 2 (Saliva 1 without mucin); Saliva 3; Saliva 4; Saliva 5 (contain sodium carboxymethyl cellulose) and control (C) (deionized water). After demineralization enamel blocks were subjected to remineralization by immersion in the saliva's formulations for 2h. Enamel remineralization was measured by superficial hardness test (% superficial hardness change). The data were tested using ANOVA and Tukey's test (p<0.05). RESULTS: All the tested formulations of artificial saliva resulted in significantly higher enamel remineralization compared to control (p<0.001). Saliva 3 showed higher percentage of enamel remineralization than Saliva 5 (p<0.05). CONCLUSIONS: Besides the variety of artificial saliva for erosion in vitro protocols, all the formulations tested were able to partially remineralize initial erosive lesions.

Bilateral maxillary and mandibular fourth molars: a case report and literature review.

Supernumerary teeth are those present in addition to the normal set of teeth. These teeth are found in both the primary and the permanent dentitions, and are most frequently seen in the maxillary anterior and molar regions. Supernumerary molars are divided into two types, depending on their location: distomolars and paramolars. Distomolars usually occur in the form of a fourth molar distal to the third molar, while paramolars are rudimentary supernumerary teeth that might develop buccally or lingually to the molar series. The management of a supernumerary tooth should be part of a comprehensive treatment plan. This paper reports a rare case of a male patient with bilateral maxillary and mandibular fourth molars, and reviews the literature on supernumerary teeth.

Traumatic anterior dental injuries in 7- to 12-year-old Brazilian children.

The aim of this study was to determine the prevalence and risk factors of dental trauma in the permanent anterior teeth of schoolchildren in Campina Grande, Brazil. A sample of 448 schoolchildren, 228 boys and 220 girls, aged 7-12 years, were randomly selected from 17 public schools in an urban area. The sample selection was carried out in two stages: first, schools were selected by simple sampling and then children were chosen using a proportionality coefficient. Data were collected through clinical examinations and interviews, after examiner calibration. Overjet (OJ) was considered a risk factor when it presented values higher than 3 mm, while lip coverage was classified as adequate or inadequate. Yates' chi-squared test verified the association between the variables and odds ratio. Significance level was set at 5%. The prevalence of dental injuries was 21%. Boys experienced more injuries than girls, 21.9% and 20%, respectively (P > 0.05). Falls and collisions were the main causes of dental trauma, 63.8% and 24.5%, respectively. There was a statistically significant difference between traumatic dental injuries (TDI) and OJ (95% CI 0.22-0.63) (P < 0.001) and between TDI and inadequate lip coverage (95% CI 9.16-34.93) (P < 0.001). Data indicated that boys presenting an OJ size >3 mm and inadequate lip coverage were more likely to have TDI in Campina Grande, Brazil.