Minimum intervention oral care management of early childhood caries: a 17-year follow-up case report.

BACKGROUND: Early childhood caries (ECC) has a profound impact on a child's quality of life, and its management remains a challenge for the paediatric dentist, mainly because it depends on radical changes in the child/carers' daily behaviour and any dental treatment must be provided to very young child. CASE REPORT: This case report describes the on-going care of a 2-year-old child presenting with ECC and management until permanent dentition is complete. All patient-focused, teamdelivered care was delivered using the minimum intervention oral care framework, implementing non-invasive and minimally invasive preventive procedures. Throughout the care provided, oral and dental health education was reinforced in all visits. The child's mother was trained to perform effective biofilm control and dietary habits were adjusted, especially baby-bottle removal during sleep. The child was initially anxious and resistant towards any dental examination and clinical procedures. However, with effort from the oral healthcare team members, the patient became compliant, allowing the mother to perform suitable oral hygiene measures, as well as accepting the clinical procedures carried out by the paediatric dentist. The clinical procedures consisted of atraumatic restorations and fluoride varnish applications. During the subsequent years after the baseline treatment, follow-up visits included continued dietary and oral hygiene instruction with positive behavior reinforcement, fluoride topical applications and tooth-restoration complex maintenance with glass-ionomer cement where needed. Currently, the patient is 19 years old and has a stable, healthy permanent dentition. CONCLUSION: Understanding of the causes of oral diseases by the patients' caregivers, alongside with pragmatic practical guidance to maintain good oral health, can reduce the risk for acquiring future disease, since caries activity control is the basis for successful caries management.

Some Myths in Dentin Bonding: An Evidence-Based Perspective.

Laboratory investigations are essential models responsible for science development. However, laboratory discoveries must be confirmed in a clinical environment where many known and unknown variables and complex mechanisms are involved. Using conclusions from laboratory studies to make clinical recommendations can lead to widespread "unreliable truths" or so-called myths in any field of knowledge. These myths may increase the costs (financial and time) or even cause harm (side effects) that would be unnecessary, given that the current protocol or conduct was previously evaluated in a more complex and complete clinical setting. This article will discuss certain myths in dentin bonding that may influence clinical decision-making, bringing some principles of evidence-based practice to allow a more critical evaluation of the literature findings.

Tooth Sensitivity After Dental Bleaching With a Desensitizer-containing and a Desensitizer-free Bleaching Gel: A Systematic Review and Meta-analysis.

OBJECTIVES:: A systematic review and meta-analysis were performed to evaluate the risk and intensity of tooth sensitivity (TS) after dental bleaching with a desensitizer-containing and a desensitizer-free bleaching gel in adult patients. Color change and risk of gingival sensitivity was also evaluated. METHODS:: A comprehensive search was performed MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), EMBASE and Cochrane Library, and System for Information on Grey Literature in Europe (SIGLE) without restrictions to identify randomized clinical trials. Abstracts from the annual conference of the International Association for Dental Research (1990-2016), unpublished and ongoing trials registries, dissertations, and theses were also searched. The quality of the evidence was rated using the Grading of Recommendations: Assessment, Development and Evaluation (GRADE) approach. DATA:: After duplicates were removed, 1352 articles were identified. After title and abstract screening, only 47 studies remained for qualitative evaluation. Most of the studies had unclear risk of bias. No difference between groups were observed for the risk ratio of TS (risk ratio = 0.99; 95% confidence interval [CI] = 0.74-1.33); intensity of TS (standardized difference in means [SMD] = 0.04; 95% CI = 0.79-0.70); color change in shade guide units (SMD - 0.04; 95% CI = 0.50-0.42); color change in ΔE* (SMD = 0.41 (95% CI = 0.07-0.89); and risk ratio of gingival irritation (SMD = 1.05; 95% CI = 0.81-1.36). Except for the risk of TS, graded as moderate quality of evidence, all other outcomes were rated as low and very low quality. CONCLUSIONS:: Incorporating desensitizers in the bleaching gel did not reduce the risk of TS, and the quality of this evidence was considered moderate. On the other hand, the intensity of TS, color change, and risk of gingival irritation was similar between groups, but the quality of the evidence for these outcomes was graded as low or very low, thus reducing the level of confidence in these outcomes.

Three-Year Effects of Deproteinization on the In Vitro Durability of Resin/Dentin-Eroded Interfaces.

OBJECTIVE: To evaluate the effect of sodium hypochlorite on the immediate and three-year bonding properties of a resin-eroded dentin interface produced by one of two adhesive strategies. METHODS AND MATERIALS: Forty-eight molars were randomly assigned to six experimental groups, according to the combination of the adhesive strategy (etch-and-rinse and self-etch) and the dentin surface (control groups without erosion, eroded dentin surface [ED], and eroded dentin surface + NaOCl 5.2% [ED + NaOCl]). After completing restoration, specimens were stored in water (37°C) for 24 hours and then sectioned into resin-dentin beams (0.8 mm2) to be tested under tension (0.5 mm/min) immediately thereafter or after three years of water storage. To assess nanoleakage (NL), specimens were immersed in silver nitrate solution and examined by scanning electron microscopy at both time points. The dentin-etching pattern was examined under a scanning electron microscope. Data were subjected to appropriate statistical analysis (α=0.05) Results: In both strategies, a more pronounced and significant reduction of the microtensile bond strength (µTBS) values was observed for the ED groups ( p=0.0001) after three years. However, in the ED + NaOCl group, µTBS values were maintained after three years of water storage. Furthermore, application of NaOCl to eroded dentin significantly reduced the immediate NL values and also preserved these values after three years of water storage for both adhesive strategies ( p>0.05). When considering the ED group, a superficial removal of the smear layer and enlarged lumen tubules in comparison to control were present. However, for ED + NaOCl, there was a total removal of the smear layer and significant numbers of collagen fibrils were exposed. CONCLUSION: The use of NaOCl may maintain the long-term stability of a resin-eroded dentin interface formed by etch-and-rinse and self-etch adhesives.

Anaesthetic efficacy of 4% articaine compared with 2% mepivacaine: a randomized, double-blind, crossover clinical trial.

The aim of this study was to evaluate the clinical efficacy of 4% articaine (Ar4) compared to 2% mepivacaine (Me2), both in combination with 1:100,000 epinephrine, in a unique soft tissue model. This was a randomized, double-blind, crossover clinical trial. The anaesthetic was applied to the lower lip using a computerized local delivery system. The following were evaluated: blood flow, thermal sensation, pressure and proprioception, extent of anaesthesia, gradual elimination, and the final duration of the effect of the anaesthesia. Seventy-two volunteers completed all parts of the study. Significant differences, which indicated better effectiveness of Me2 compared to Ar4, were observed in the following tests: reduction in blood flow (larger in the Me2 group); anaesthetized area at 30min (larger in the Me2 group); pressure tests; temperature tests after 20min; fine and discriminatory proprioception tests after 20min. The volunteers' perception of anaesthesia at 30, 40, 50, and 60min was superior for Me2 at all recorded time points. The duration of anaesthesia was also superior for Me2. The overall performance of Me2 was superior to Ar4, implying that Me2 provides a more effective anaesthesia in terms of depth, extent, and duration.

Bone sialoprotein, matrix metalloproteinases and type I collagen expression after sealing infected caries dentin in primary teeth.

The objective of this in vivo study was to compare the expression of matrix metalloproteinases (MMP-2, MMP-8, MMP-9), type I collagen and bone sialoprotein (BSP) in infected dentin of primary teeth at baseline and after cavity sealing with glass ionomer cement. Dentin samples from 45 primary molars with deep and active carious lesions were collected before (baseline sample) and after cavity sealing (60-day sample). The samples were fixed, demineralized and processed for immunohistochemistry assays. Monoclonal antibodies were used for the localization of the cited antigens with an avidin-biotin method. Digital images of the sections were captured and analyzed with ImageJ software. The mean intensity of RGB channels in the images was obtained and compared using Student's t test (α = 0.05). The expression of the MMPs, type I collagen and BSP increased after sealing, but statistical differences were observed only for MMP-8, type I collagen and BSP. MMP-2 and MMP-9 were more concentrated around dentin tubules; MMP-8 and collagen showed strong expression throughout the organic matrix; BSP exhibited strong expression both in the matrix and around dentin tubules. The increased expression of the enzymes investigated 60 days after cavity sealing suggests that they are not related with disease progression but with the healing process of dentin.

Clinical evaluation of chlorhexidine for the control of dental biofilm in children with special needs.

OBJECTIVE: The aim of the present study was to assess two vehicles and forms of the in-home administration of chlorhexidine for the control of dental biofilm in children with special needs. BASIC RESEARCH DESIGN: Twenty-nine children aged seven to 12 years (mixed dentition phase) participated in the study. A double-blind, placebo-controlled, cross-over clinical trial was carried out with the following treatment groups: 1 - 0.12% chlorhexidine gel (CG); 2 - placebo gel (PG); 3 - 0.12% chlorhexidine spray (CS); 4 - placebo spray (PS). Ten-day experiment periods were separated by 15-day washout intervals. MAIN OUTCOME MEASURES: The parameters evaluated were plaque, gingival bleeding, and preferences of parents/caregivers. RESULTS: The initial conditions were similar in each phase of the experiment (p > 0.05). The treatments with chlorhexidine (gel and spray) achieved a significant reduction (p < 0.0001) in plaque and bleeding. The placebo treatments did not achieve significant differences (p > 0.05). The parents/caregivers preferred the administration of chlorhexidine in spray form. CONCLUSIONS: The topical administration of chlorhexidine associated to tooth brushing led to a reduction in dental biofilm and gingival bleeding in children with special needs. Administration in spray form proved easier and was preferred by parents/caregivers.

Clinical evaluation of three toothbrush models tested by schoolchildren.

AIM: The aim of this single-blind cross-over study was to compare the performance of three different toothbrush models in the control of dental biofilm and maintaining a healthy gingival condition. METHODS: Twenty-seven schoolchildren (aged 9-10 years) participated in the study. Three toothbrushes with different bristle arrangements were used: T1 - bristles on the same plane, straight arrangement; T2 - bristles on different planes, straight arrangement; T3 - bristles on different planes, straight and circular arrangement. The participants were then randomly divided into three groups for brushing with one of the three toothbrushes. Each experimental period lasted 15 days each, with three daily brushings and a 7-day washout interval was used between periods. The oral hygiene and gingival bleeding indices were recorded by a single, calibrated examiner blind to the brush used. Bristle wear was measured with a digital calliper at the end of each period. The data were analysed using parametric (anova and Student's t-test) and non-parametric (Cochran's Q and McNemar) tests. RESULTS: The toothbrushes achieved similar results (P>0.05) for the clinical parameters investigated. The three models exhibited a similar degree of bristle wear (P>0.05). CONCLUSION: The arrangement of the bristles had little influence over the removal of biofilm and gingival conditions. Thus, there is no clinical justification for replacing conventional toothbrushes with more expensive models.