Reciprocating instrumentation for endodontic treatment of primary molars: 24-month randomized clinical trial.

BACKGROUND: Although reciprocating instrumentation has been extensively studied for permanent teeth, stronger evidence for its use in primary teeth is lacking. AIM: The aim of this randomized clinical trial was to compare the efficacy of endodontic treatment in primary molars using reciprocating (RECIP) and manual (MAN) instrumentation techniques after 24 months. DESIGN: Primary molars with indication of endodontic treatment were randomly divided into two groups: MAN and RECIP. Treatments were performed, and root canals were filled with calcium hydroxide and iodoform paste. Teeth were later restored with bulk-fill composite resin and re-evaluated after 6, 12, 18, and 24 months. The primary outcome was the success of the endodontic treatment evaluated by Cox regression analysis adjusted by cluster and success rate after 24 months in the intention-to-treat (ITT) population. Instrumentation time, discomfort, postoperative pain, and quality of root canal filling were also evaluated as secondary endpoints. RESULTS: A total of 151 primary win 107 children were included, and 137 were followed up for 24 months. Success rate of teeth allocated to the MAN group was 57.3% and 55.3% for RECIP (p = .792); MAN instrumentation, however, was more time-consuming (p = .005). CONCLUSION: The efficacy of endodontic treatment in primary molars using reciprocating and manual instrumentation is similar after 24 months.

Influence of two caries detection strategies on the quality of life of preschool children: An analysis of secondary outcomes of a 2-Year randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to evaluate the influence of two caries diagnosis strategies, and subsequent management, on oral health-related quality of life (OHRQoL) of preschoolers. Additionally, the association of the OHRQoL outcomes with the clinician-centred primary outcome used in the main study was also explored. MATERIALS AND METHODS: This study refers to the OHRQoL secondary outcomes analyses of the so-called RCT 'CARDEC-1'. Three- to 6-year-old children were randomly allocated in two caries detection strategies in primary molars: visual inspection (VIS) or visual + radiographic (RAD) assessment. Participants were diagnosed and treated according to the allocated group and followed up for 2 years. Caregivers answered the Early Childhood Oral Health Impact Scale (ECOHIS) at baseline and after 2 years. Intention-to-treat analysis was performed. ECOHIS scores at baseline and 2 years later were compared using the Mann-Whitney test. Effect sizes, change scores and the minimally important difference (MID) were also compared between groups. Additional analysis was performed to assess if OHRQoL variables could reflect the primary clinical outcome (number of new operative interventions during the follow-up), observing if these met the Prentice criteria. RESULTS: Two hundred and five children had the ECOHIS answered in both period times (18.7% attrition rate). There was a decrease in total ECOHIS scores, as well as for different domains for both trial groups, with effect sizes varying from 0.43 to 0.77. Comparisons between groups, however, did not show significant differences. In the additional analysis, the OHRQoL variables met the Prentice criteria and presented the same trends observed with the clinician-centred primary endpoint. CONCLUSION: Caries detection performed by visual inspection alone or associated with radiographic method does not influence the long-term impact on OHRQoL. Furthermore, OHRQoL variables reflect clinical outcomes in this type of clinical trial. CLINICALTRIALS: gov NCT02078453.

Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT.

The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Tactile perception of roughness to assess activity in artificial initial caries lesions with a novel force-controlled probe.

Roughness-tactile perception is part of activity assessment in initial-caries-lesions. Hypothesizing that a probe's design influences this examiner's assessment, four probes were designed. The aims of this study were to select the probe with highest inter-/intra-examiners' roughness-assessment agreement and to determine its diagnostic accuracy on artificial initial-caries lesions. A pilot study was conducted with trained dentists to select one controlled-pressure probe design (n = 4) by assessing roughness on known-roughness metal plaques with 5-point Likert scale. Diagnostic accuracy of roughness assessment was conducted with the selected controlled-pressure probe and the WHO-probe on sound and artificial initial-caries-lesion (n = 20) human enamel blocks. Intra-class correlation coefficients (ICCs) and quadratic weighted-Kappa scores were used to assess examiners' reproducibility and Multilevel Poisson models to determine diagnostic accuracy between both probes controlling for confounding variables. The probe design with the highest inter/intra-examiner's agreement (ICC = 0.96) was selected for subsequent analyses. Unadjusted sensitivity, specificity and accuracy values were for the controlled-pressure and the WHO probes: 71.1%,90.6%,81.2%, and 67.4%,84.6%,75.8%, respectively (p > 0.05). Examiner remained the most important factor influencing diagnostic accuracy. While this study did not show significantly higher diagnostic accuracy of the designed controlled-pressure vs. the WHO-probe when used by trained dentists, all over roughness-assessment accuracy and reproducibility were high.

Caries risk assessment using different Cariogram models. A comparative study about concordance in different populations-Adults and children.

This methodological survey aimed to verify whether there is concordance among several Cariogram different risk models at different thresholds, comparing both children and adult populations and how each risk/protective factor weight on the overall caries risk profile. Three groups' data (two in children and one in adults) were obtained from previous studies, while a fourth, in young adults, was ad hoc enrolled. Different caries risk levels were assessed: a) three risk categories with two different thresholds as: "low risk" = 61-100% or 81-100% chance to avoid caries, "moderate risk" = 41-60% or 21-80% and "high risk" = 0-40% or 0-20%, named model 1 and 2; b) four risk categories with two different thresholds as: "low risk" = 61-100% or 76-100%, "moderate/low risk" = 41-60% or 51-75%; "moderate/high risk" = 21-40% or 26-50% and "high risk" = 0-20% or 0-25%, model 3 and 4; c) five risk categories as: "very low risk" = 81-100%; "low risk" = 61-80% "moderate risk" = 41-60%; "high risk" = 21-40% and "very high risk" = 0-20%, model 5. Concordance of the different Cariogram risk categories among the four groups was calculated using Cohen's kappa. The weight of the association between all Cariogram models toward the Cariogram risk variables was evaluated by ordinal logistic regression models. Considering Cariogram model 1 and 2, Cohen's Kappa values ranged from 0.40 (SE = 0.07) for the young adult group to 0.71 (SE = 0.05) for the adult one. Cohen's Kappa values ranged from 0.14 (SE = 0.03 p<0.01) for the adult group to 0.62 (SE = 0.02) for the two groups of children in models 3 and 4. Statistically significant associations were found for all Cariogram risk variables excepting Fluoride program in models 4 and 5 and the overall risk on children's samples. Caries experience showed a quite variable weight in the different models in both adult groups. In the regression analyses, adult groups' convergence was not always achievable since variations in associations between caries risk and different risk variables were narrower compared to other samples. Significant differences in caries risk stratification using different thresholds stands out from data analysis; consequently, risk assessments need to be carefully considered due to the risk of misleadingly choosing preventive and research actions.

Nonrestorative treatment of initial caries lesion in primary teeth: a systematic review and network meta-analysis.

OBJECTIVE: To identify the best available approach to avoid initial caries lesions progression in primary teeth. MATERIALS AND METHODS: Search was performed in MEDLINE/Pubmed, Web of Science, Embase and CENTRAL databases until March 2021. Studies compared treatment options to avoid the initial caries lesion progression with at least 12 months of follow-up were included. Network meta-analyses were conducted considering the non-progression of caries lesions as an outcome. RESULTS: Potentially eligible studies were screened (n = 2820) and eleven were included. Six studies evaluated the use of fluoride varnish, resin infiltration, sealing, and toothbrushing/flossing on proximal initial caries lesions. When considering occlusal surfaces, only two studies evaluating the ozone gas, fluoride varnish, resin infiltration, and sealants were included. For buccal/lingual surfaces, three studies evaluating toothbrushing, CPP-ACP paste, fluoride varnish, and resin infiltration were included. For all types of surfaces, the resin infiltration showed the best probability to avoid the progression of initial caries lesions. CONCLUSION: The limited number of included studies, most with a high risk of bias and lack of hard outcomes, such as frank cavitation, makes it not feasible to recommend a specific management approach for initial caries lesion control in primary teeth with a high certainty of evidence. PROSPERO: #CRD42016037781.

Impact of early childhood caries severity on oral health-related quality of life among preschool children in Mexico: A cross-sectional study.

BACKGROUND: Information is scarce on Early Childhood Caries (ECC) in Mexican preschool children and its impact on quality of life. AIM: To evaluate the ECC prevalence and its impact on OHRQoL in 3-5 years-old Mexican children according to disease severity. DESIGN: Caries was determined at two thresholds: (1) children with at least one caries lesion (ICDAS-1-6) and (2) children with at least one lesion in dentin (ICDAS-3-6). OHRQoL was assessed through the Mexican Early Childhood Oral Health Impact Scale (M-ECOHIS). Associations among caries severity, M-ECOHIS, and other variables were assessed by ordinal logistic regression. RESULTS: A total of 409 children participated (53.8% girls, 46.2% boys). Caries prevalence was 82.2% considering all lesions, and 45.0% for dentinal lesions. Significant linear trends (p < .05) among caries levels and categories of exposure were found for socioeconomic variables, dietary habits, and toothbrushing habits. Attending rural private schools (OR = 1.39, 95%CI = 1.11-1.72; p < .01), two main meals/day (OR = 2.75, 95%CI = 1.26-6.03; p = .01) and unsupervised toothbrushing (OR = 3.20, 95%CI = 1.96-5.24; p < .01) increased the risk to have high caries severity levels. M-ECOHIS scores were statistically significant associated with caries levels (χ2 (4)  = 175.85, p < .01; trend across groups z = 12.63 Prob > |z| < 0.01). CONCLUSIONS: M-ECOHIS was significantly associated with caries severity. Type of school, age groups, parents' educational level, family income, and living conditions were correlated with caries, showing how distinctive risk indicators were associated with different caries stages.

Tactile perception of roughness to assess activity in artificial initial caries lesions with a novel force-controlled probe

Abstract Roughness-tactile perception is part of activity assessment in initial-caries-lesions. Hypothesizing that a probe's design influences this examiner's assessment, four probes were designed. The aims of this study were to select the probe with highest inter-/intra-examiners' roughness-assessment agreement and to determine its diagnostic accuracy on artificial initial-caries lesions. A pilot study was conducted with trained dentists to select one controlled-pressure probe design (n = 4) by assessing roughness on known-roughness metal plaques with 5-point Likert scale. Diagnostic accuracy of roughness assessment was conducted with the selected controlled-pressure probe and the WHO-probe on sound and artificial initial-caries-lesion (n = 20) human enamel blocks. Intra-class correlation coefficients (ICCs) and quadratic weighted-Kappa scores were used to assess examiners' reproducibility and Multilevel Poisson models to determine diagnostic accuracy between both probes controlling for confounding variables. The probe design with the highest inter/intra-examiner's agreement (ICC = 0.96) was selected for subsequent analyses. Unadjusted sensitivity, specificity and accuracy values were for the controlled-pressure and the WHO probes: 71.1%,90.6%,81.2%, and 67.4%,84.6%,75.8%, respectively (p > 0.05). Examiner remained the most important factor influencing diagnostic accuracy. While this study did not show significantly higher diagnostic accuracy of the designed controlled-pressure vs. the WHO-probe when used by trained dentists, all over roughness-assessment accuracy and reproducibility were high.

Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT

Abstract: The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Negligible therapeutic impact, false-positives, overdiagnosis and lead-time are the reasons why radiographs bring more harm than benefits in the caries diagnosis of preschool children.

BACKGROUND: To evaluate the clinical course and interventions required during two years of follow-up of dental surfaces of deciduous molars diagnosed, and consequently treated, by two different strategies: diagnosis made by clinical examination alone or associated with radiographs. METHODS: This is a secondary analysis of a two-arm randomized clinical trial with parallel groups related to the diagnostic strategy for caries detection in preschool children. 216 children (3-6 years old) were followed-up for two years. All dental surfaces were diagnosed by visual inspection and later, through radiographic assessment. Baseline treatment was made in accordance with the results obtained by visual inspection performed alone or combined with radiographic method, considering the allocated group. Dental surfaces with no restoration needs, or those restored at the beginning of the study were followed-up for two years. The treatment decision was made according to the allocated group. The outcome was the occurrence of failure (a new caries lesion or a restoration replacement) during the follow-up. RESULTS: 4383 proximal and occlusal surfaces of deciduous molars in 216 preschool children were diagnosed and treated according to the abovementioned diagnostic strategies and followed-up for 24 months. The assessment of radiographs made change the initial decision reached by visual inspection in about 30% of the surfaces when all types of interventions were considered. However, most disagreements occurred for initial lesions, where radiographs tended to underestimate them. Discordances between methods occurred in less than 5% of all surfaces when considered lesions requiring operative treatment. For discrepancy cases, the placed interventions guided by following the radiographic results did not present less failures against those made following only visual inspection. As a matter of fact, the use of radiographs in the diagnostic strategy for caries detection in children brought more harms than benefits due to the occurrence of false-positives, overdiagnosis and lead-time bias. CONCLUSIONS: Simultaneous association of visual inspection and radiographic assessment for caries detection in preschool children causes more harms than benefits, and therefore, visual inspection should be conducted alone in the regular clinical practice. Trial registration Clinicaltrials.gov platform: NCT02078453, registered on 5th March 2014.

A Virtual 3D Dynamic Model of Caries Lesion Progression as a Learning Object for Caries Detection Training and Teaching: Video Development Study.

BACKGROUND: In the last decade, 3D virtual models have been used for educational purposes in the health sciences, specifically for teaching human anatomy and pathology. These models provide an opportunity to didactically visualize key spatial relations that can be poorly understood when taught by traditional educational approaches. Caries lesion detection is a crucial process in dentistry that has been reported to be difficult to learn. One especially difficult aspect is linking clinical characteristics of the different severity stages with their histological features, which is fundamental for treatment decision-making. OBJECTIVE: This project was designed to develop a virtual 3D digital model of caries lesion formation and progression to aid the detection of lesions at different severity stages as a potential complement to traditional lectures. METHODS: Pedagogical planning, including identification of objectives, exploration of the degree of difficulty of caries diagnosis-associated topics perceived by dental students and lecturers, review of the literature regarding key concepts, and consultation of experts, was performed prior to constructing the model. An educational script strategy was created based on the topics to be addressed (dental tissues, biofilm stagnation areas, the demineralization process, caries lesion progression on occlusal surfaces, clinical characteristics related to different stages of caries progression, and histological correlations). Virtual 3D models were developed using the Virtual Man Project and refined using multiple 3D software applications. In the next phase, computer graphic modelling and previsualization were executed. After that, the video was revised and edited based on suggestions. Finally, explanatory subtitles were generated, the models were textured and rendered, and voiceovers in 3 languages were implemented. RESULTS: We developed a 6-minute virtual 3D dynamic video in 3 languages (English, Spanish, and Brazilian Portuguese) intended for dentists and dental students to support teaching and learning of caries lesion detection. The videos were made available on YouTube; to date, they have received more than 100,000 views. CONCLUSIONS: Complementary pedagogical tools are valuable to support cariology education. This tool will be further tested in terms of utility and usability as well as user satisfaction in achieving the proposed objectives in specific contexts.

Recommendations and guidelines for dentists using the basic erosive wear examination index (BEWE).

This paper explains how to screen tooth wear in general practice using the Basic Erosive Wear Examination (BEWE) index. It explains how stakeholders in the UK acknowledged the convenience of the BEWE and that it could be recorded at the same time as the Basic Periodontal Examination (BPE). The article contains examples of anterior and posterior tooth wear for each BEWE score to help dentists in their evaluation.

Impact of a Tutored Theoretical-Practical Training to Develop Undergraduate Students' Skills for the Detection of Caries Lesions: Study Protocol for a Multicenter Controlled Randomized Study.

BACKGROUND: Tutored laboratorial activities could be a manner of improving the competency development of students. However, its impact over conventional theoretical classes has not yet been tested. Additionally, different university contexts could influence this issue and should be explored. OBJECTIVE: To assess the impact of a tutored theoretical-practical training for teaching undergraduate students to detect caries lesions as compared with theoretical teaching activities. The impact of these teaching/learning activities will be assessed in terms of efficacy, cost/benefit, retention of knowledge/acquired competences, and student acceptability. METHODS: Sixteen centers (7 centers from Brazil and 9 centers from other countries throughout the world) are involved in the inclusion of subjects for this protocol. A randomized controlled study with parallel groups will be conducted. One group (control) will be exposed to a 60- to 90-minute conventional theoretical class and the other group (test) will be exposed to the same theoretical class and also a 90-minute laboratory class, including exercises and discussions based on the evaluation of a pool of images and extracted teeth. The mentioned outcomes will be evaluated immediately after the teaching activities and also in medium- and long-term analyses. To compare the long-term outcomes, students who enrolled in the university before the participating students will be interviewed for data collection and these data will be used as a control and compared with the trained group. This stage will be a nonrandomized phase of this study, nested in the main study. Appropriate statistical analysis will be performed according to the aims of this study. Variables related to the centers will also be analyzed and used to model adjustment as possible sources of variability among results. RESULTS: This ongoing study is funded by a Brazilian national funding agency (CNPq- 400736/2014-4). We expect that the tutored theoretical-practical training will improve the undergraduate students' performance in the detection of caries lesions and subsequent treatment decisions, mainly in terms of long-term retention of knowledge. Our hypothesis is that tutored theoretical-practical training is a more cost-effective option for teaching undergraduate students to detect caries lesions. CONCLUSIONS: If our hypothesis is confirmed, the use of laboratory training in conjunction with theoretical classes could be used as an educational strategy in Cariology to improve the development of undergraduate students' skills in the detection of caries lesions and clinical decision-making.

E-learning Activities to Complement Education in Cariology for Undergraduate Students

Objective: To evaluate activities performed in an e-learning platform after 2-year of implementation in terms of contents and functionality. Material and Methods: Elearning courses were prepared and created by two lecturers. Contents were intended for last year undergraduate students attending the pediatric dentistry discipline, and included different topics considered as relevant to the area. Given tele-courses from 2010-2012 as well as statistics and contents, provided by the platform, were collected for analysis. Results: Five tele-courses were proposed and the total participation was 322 students (mean-per-course±SD=64.4±17.2). On average, 15 tutors/course accompanied the process. Caries lesion detection and fluoride therapy were discussed in all modules, but different activities were focused in various aspects. Other topics were also included: caries activity (60%), caries risk assessment, oral hygiene and clinical examination (40%). Two lecturers were responsible for preparing exercises and tutors helped in the creation, revision and correction. The main type of validation was open questions (83%). A High level of students' access was observed during the 2-year-period (mean-per-course±SD=21372±6775,2). More than 32000 external visits of the topics were also seen. On average, 14 tutor/student feedbacks were sent per student in each tele-course. Conclusion: The use of an e-learning system has been used especially to complementing teaching in caries detection and management using fluorides. Telecourses have been highly accessed by undergraduate students and also, external participants.

Oral health status of children and young adults with autism spectrum disorders: systematic review and meta-analysis.

BACKGROUND: Individuals with special needs are often affected by oral disorders such as dental caries and periodontal disease. Current data regarding prevalence of these conditions in individuals with autism spectrum disorders (ASD) are controversial. AIM: To conduct a systematic review and meta-analysis to verify the prevalence of dental caries and periodontal disease in individuals with ASD, especially children and young adults. DESIGN: Searches were conducted through MEDLINE/PubMed, Web of Science, and Scopus databases in December 2015. Studies were included if fulfilled the following eligibility criteria: to evaluate the oral health status of individuals with ASD; to be an observational study; and to assess the prevalence of dental caries and/or periodontal disease. Meta-analyses were conducted considering prevalence of dental caries and periodontal disease in individuals as outcome. RESULTS: Search strategy identified 928 potentially relevant articles and seven of them were included in this review. All included studies reported dental caries prevalence, and the pooled prevalence was 60.6% (95% CI: 44.0-75.1). Moreover, only three studies showed prevalence of periodontal disease, resulting in pooled prevalence of 69.4% (95% CI: 47.6-85.0). CONCLUSION: Prevalence of dental caries and periodontal disease in children and young adults with ASD can be considered as high, pointing to the need for oral health policies focused on these individuals.

Perfil de problemas orales en infantes y preescolares atendidos en el servicio de urgencias odontológicas de un centro de salud infantil de Brasil / Perfil de problemas orais em infantes e pré-escolares tratados no serviço de urgências odontológicas de um centro de saúde infantil do Brasil / Oral health problems profile in infants and preschool children attended at the dental emergency service of a children ́s health centre of Brazil

Objetivo: Determinar el perfil de los problemas orales en lactantes y preescolares atendidos en el servicio de urgencias de la Clínica de Especialidades infantil/ Clínica de Bebés de la Universidad Estatal de Londrina, Brasil. Materiales y métodos:Estudio retrospectivo donde se analizaron 776 historias clínicas de pacientes en el rango de edad de 0 a 72 meses, atendidos entre abril de 2007 a abril de 2008. Los datos recolectados fueron: Género, edad, lugar de residencia, ocupación y grado de escolaridad de los padres, motivo de consulta, dientes involucrados e intervenciones realizadas. Se utilizó la prueba de Chi2(χ2) y un nivel de significancia de 5% para la asociación entre variables. Resultados: Se observó una mayor proporción de pacientes de género masculino en la búsqueda del servicio (55,5%) y la mayoría de pacientes se ubicaron en el rango de edad de 0 a 24 meses (27,3%). Se verificó que el 62,9% residían en la zona urbana y la mayoría de los padres/responsables habían cursado secundaria completa (30,5% padres, 33,8% madres). Los motivos de consulta más frecuentes en la atención fueron caries dental (38,9%) siendo el dolor la queja principal (42,0%) y trauma dental (28,9%). Los dientes más afectados por caries fueron los segundos molares inferiores primarios y, por trauma los incisivos centrales superiores primarios. Dentro de las intervenciones más comunes se encontraron el tratamiento endodóntico (16,0%) y la adecuación del medio bucal (15,1%). Se encontró una asociación estadísticamente significativa entre escolaridad de la madre y motivo de consulta en el servicio de urgencias (p=0,001). Conclusión: El servicio analizado es necesario y útil, sin embargo, la resolución de problemas orales en la población infantil de Londrina, ocurrirá por medio de una reorganización de los servicios odontológicos actuales.

Objective: To determine the profile of oral problems in infants and preschool children treated at an emergency service from Clinic of Infantile Specialities / Clinical Baby of the State University of Londrina, Brazil. Materials and method: Retrospective study where 776 clinical histories of patients aged 0 to 72 months, treated between April 2007 and April 2008 were analysed. Data collection included gender, age, place of residence, parental occupation and educational level, reason for consultation, involved teeth and performed intervention. Chi-square test (χ2) and a significance level of 5% were used for variables associations. Results:A greater proportion of male patients (55.5%) attended the service and the main age group was the 0-24 months (27.3%). It was found that 62.9% lived in urban areas and most parents/caregivers had completed secondary school (30.5% parents, 33.8% mothers). The main reason for consultation was caries (38.9%) - pain as main complaint (42.0%) and dental trauma (28.9%). The most affected tooth by caries was the lower second primary molar and, regarding trauma, the upper central primary incisors were the most injured. Interventions varied from endodontic treatment (16.0%) and adequacy of oral environment (15.1%). There was a statistically significant association between mother educational level and reason for consultation (p = 0.001). Conclusion:The assessed health service was necessary and useful. However, oral health problems resolution in the paediatric population in Londrina will only occur after the implementation of reorganised dental services from the currently available.

Objetivo: Determinar o perfil dos problemas bucais em lactantes e pré-escolares atendidos no pronto socorro da Clínica de Especialidades Infantis / Bebê Clínica da Universidade Estadual de Londrina, Brasil. Materiais e métodos: Estudo retrospec-tivo onde foram analisados 776 prontuários odontológicos de pacientes na faixa etária de 0 a 72 meses, atendidos entre abril de 2007 a abril de 2008. Os dados coletados foram: Gênero, idade, lugar de moradia, ocupação e grau de escolaridade dos pais, motivo da consulta, dentes envolvidos e intervenções realizadas. Foi usado o teste qui-quadrado (χ2) e estabeleceu-se um nível de significância de 5% para a associação entre variáveis. Resultados: Observou-se uma maior proporção de pacientes de sexo masculino na procura do atendimento (55,5%) e a maioria dos pacientes pertenciam à faixa etária de 0 a 24 meses (27,3%). Verificou-se que, 62,9% moravam na zona urbana e a maioria dos pais/responsáveis possuíam escolaridade de segundo grau completo (30,5% pais, 33,8% mães). Os motivos mais frequentes pelo atendimento foram cárie dentária (38,9%) sendo a dor a principal queixa 42,0%, e trauma dentário (28,9%). Os dentes mais acometidos pela cárie foram os segundos molares infe-riores e por trauma, os incisivos centrais superiores decíduos. As intervenções mais comuns foram o tratamento endodôntico (16,0%) e adequação do meio bucal (15,1%). Houve associação estatisticamente significante entre escolaridade da mãe e moti-vo da consulta do pronto socorro (p=0,001). Conclusão: O serviço de urgência é necessário e útil, porém, a resolução dos pro-blemas bucais na população infantil de Londrina, ocorrerá por meio de uma reorganização dos serviços odontológicos atuais.

Impact of the radiographic examination on diagnosis and treatment decision of caries lesions in primary teeth--the Caries Detection in Children (CARDEC-01) trial: study protocol for a randomized controlled trial.

BACKGROUND: Although most clinical guidelines throughout the world indicate that clinicians take two bitewings for detecting caries lesions in primary molars of all children, evidence for this recommendation is essentially based on cross-sectional studies performed in laboratory settings or using convenience samples. The benefits and impact of performing radiographs on diagnosis and treatment decision of caries lesions in primary teeth, mainly considering relevant outcomes for patients, have not been evaluated yet. Thus, the aim of this randomized clinical trial will be to evaluate the impact of performing radiographic examination adjunct to the visual inspection for detecting and making treatment decision regarding caries lesions in primary teeth compared with visual inspection performed alone. We will consider different outcomes related to children's health and welfare. METHODS/DESIGN: To reach this objective, 250 children ages 3 to 6 years who sought dental treatment in our dental school will be randomly allocated in two groups according to the diagnostic strategy used for caries detection: visual inspection performed alone or visual inspection associated to radiographic examination. Two trained and calibrated examiners will carry out the examinations and elaborate the treatment decision plan. Then, children will be treated and followed up for 2 years, with evaluations after 12 and 24 months after the inclusion of children in the study. Children will also return after 6 and 18 months to reinforce the preventive orientations. Primary outcome will be the number of dental surfaces in need of dental treatment at the follow-up. Secondary outcomes will be the components of the primary outcome separately, as well as, proportion of false-positive results, the oral health-related quality of life, cost-efficacy, cost-adjusted life years, and number of new lesions in the first permanent molars. DISCUSSION: Our working hypothesis is that radiographic examination would actually exert little influence on patient-centered outcomes, and visual inspection would be enough as diagnostic strategy for caries detection in primary teeth. TRIAL REGISTRATION: NCT02078453. Registered 4 March 2015.

Assessment of Glass Ionomer Cements (GIC) Restorations after Acidic Erosive Challenges: An in vitro Study

Objective: To analyze the marginal adaptation of two different Glass Ionomer Cements (GIC) after erosive challenges. Material and Methods: Sixty sound extracted primary canines were selected and class V cavities were made. Teeth were allocated into 6 groups according to restorative material: 1) high-viscosity GIC (Ketac™Molar Easymix) and 2) resin-modified GIC with nanoparticles (Ketac™N100), low pH beverage erosive challenge (Orange juice and Coca-Cola) or distilled water as control. Thereafter the sample was restored and subjecting to thermocycling. The sample was immersed for a 10-days period for the erosive simulation and then embedded in methylene blue solution during 4 hours. Finally teeth were sectioned for further analysis. Marginal adaptation test was performed by two trained examiners using the Salama et al. criteria. Descriptive and Kruskal-Wallis test (α=5%) were used to analyze the data. Results: The groups treated with Ketac™Molar EasyMix were similar in terms of marginal sealing ability when submitted to Orange juice and Coca-Cola but significantly worse than water. For samples restored with the Ketac™N100 the worst results were found in the Coca-Cola group. Conclusion: Erosive challenges with acidic drinks affected the marginal adaptation of the tested GIC.

Dental students' and lecturers' perception of the degree of difficulty of caries detection associated learning topics in Brazil.

PURPOSE: It aimed to explore the degree of difficulty of caries-detection-associated-topics perceived by dental students and lecturers as pedagogical step in the development of learning objects for e-learning. METHODS: A convenience sample comprising ninety-eight subjects from different academic levels (undergraduate/graduate students and pediatric dentistry lecturers) participated. Two spreadsheets (isolated/relative) were created considering key topics in the caries detection process. The isolated evaluation intended to explore each topic in an isolated way, while the relative intended to classify, comparatively, the participants' perceived difficulty per topic. Afterwards, data were analyzed. All values on spreadsheets were combined obtaining the subject's final perception. Associations between the subjects' degree of the perceived difficulty and academic level were estimated. ANOVA was used to determine differences regarding the perception among evaluated topics in distinct groups. RESULTS: Caries histopathology and detection of proximal carious lesions were the topics perceived as the most difficult in the process of caries detection by both students and lecturers. Differentiation between an extrinsic pigmentation and a brown-spot (caries lesion) as well as differential diagnosis between caries and enamel developmental defects or non-carious lesions were considered as more difficult by undergraduates in comparison to graduates/lecturers (regression-coefficient=14.54; Standard Error=3.34; P<0.001 and 8.40, 3.31, and 0.01 respectively). CONCLUSION: Topics as histopathology and detection of proximal caries lesions were identified as the most difficult despite the academic level. However, some topics are differently perceived according to the group. These results are useful for developing pedagogical material, based on the students real learning needs/expectations.

Desenvolvimento de um objeto educacional para o uso do ICDAS na detecção de lesões de cárie oclusal primária e sua correlação histológica utilizando o Projeto Homem Virtual / Developing a learning object to the use of ICDAS in detecting occlusal caries lesions and their primary histologic correlation using the Virtual Human Project

O ICDAS (International Caries Detection and Assessment System) é um sistema de classificação de cárie atual que busca ser estandardizado e globalizado. No entanto este sistema ainda não abrange um alto número de pessoas envolvidas e enfrenta o desafio da ampliação da sua utilização. As ferramentas pedagógicas são importantes para conseguir divulgar eficazmente estes novos conceitos (Fejerskov O 2004). O objetivo desta dissertação foi a construção de um objeto educacional para capacitar cirurgiões-dentistas e estudantes de odontologia no uso do ICDAS para o diagnóstico de lesões de cárie em superfícies oclusais. O objeto foi desenvolvido usando o Projeto Homem Virtual e as tecnologias educacionais interativas relacionadas. Para exploração da percepção de dificuldade de alguns subtemas considerados importantes na elaboração e inclusão do objeto educacional, foram aplicadas 2 planilhas de conteúdos a alunos de graduação do diurno (n=36), noturno (n=31), alunos de pós-graduação (n=24) e, docentes da área (n=7). Os subtemas percebidos com maior grau de dificuldade para todos os grupos foram: Histopatologia da doença cárie e, detecção visual e tátil de lesões de cárie em superfícies proximais. O produto final produzido enfatizou nestes subtemas e pretende avaliar os conteúdos em termos de usabilidade e utilidade em uma etapa posterior.

The ICDAS (International Caries Detection and Assessment System) is a current caries classification system that seeks to be standardized and globalized. However the system still does not cover a large number of people involved and faces the challenge of expanding its use. The teaching tools are important then, to achieve effectively the dissemination of these new concepts (Fejerskov O, 2004). The aim of this project was the construction of a learning object to train dentists and dental students in the use of the ICDAS for the diagnosis of caries on occlusal surfaces. The object was developed using the Virtual Man Project and the related interactive educational technologies. To explore the perception on the difficulty of some subtopics considered as important in the development and inclusion of the learning object, two worksheets were applied to undergraduate students (n = 67), graduate students (n = 24) and teachers in the area (n = 7). The subthemes perceived with a greater degree of difficulty for all groups were: Histopathology of caries, and visual and tactile detection of caries on proximal surfaces. The final product here presented emphasized in those subtopics. In order to evaluate the usability and usefulness of the educational object a later estage of evaluation is under construction.