Parental-oriented educational mobile messages to aid in the control of early childhood caries in low socioeconomic children: A randomized controlled trial.

OBJECTIVES: To evaluate the effectiveness of educational messages as an aid in the control of early childhood caries (ECC) in low socioeconomic children. METHODS: A single-blinded, randomized, and parallel-group study was conducted with 104 dyads of parents and children aged between 36-60 months, recruited in preschools from Bauru, Brazil. The participants were randomly allocated into control and intervention groups (1:1), stratified by parental eHealth literacy scores (eHEALS) and children's caries experience. Every 2 weeks, text messages were sent to parents of intervention group via WhatsApp. Visible plaque index (VPI) and the International Caries Detection and Assessment System (ICDAS) were assessed at baseline, 3- and 6-month follow-ups, while eHEALS and dietary habits were determined at baseline and 6-month follow-up. Statistical analysis was performed to intra and intergroup comparisons through Fischer's exact and McNemar tests, and Mann-Whitney U and Friedman tests, respectively (P < 0.05). RESULTS: Despite similarities between groups, intervention increased parental eHEALS scores, influencing the reports about the children's consumption of sugar-free sweets and controlling the severity of ECC. CONCLUSION: Therefore, mobile text messages were effective to control the severity of ECC in low socioeconomic preschoolers, improving parental eHealth literacy and changing children's dietary patterns. CLINICAL SIGNIFICANCE: These findings demonstrate that parental-oriented WhatsApp messages can contribute to oral health education of socioeconomic vulnerable parents towards risk behavior changes to control ECC.

Parental perspectives on early childhood caries: A qualitative study.

BACKGROUND: Early childhood caries (ECC) affects about 621 million children worldwide, causing chronic pain, infections, sleeping disorders, and tooth extraction. AIM: To determine perspectives of parents and caregivers of preschoolers regarding ECC. DESIGN: Three focus groups were conducted with attendees of the Clinics of Paediatric Dentistry from the Bauru School of Dentistry. The meetings were video- and audio-recorded, and the contents were transcribed verbatim. Then, textual passages were examined and coded using the software NVivo 12 Plus. RESULTS: The participants associated the presence of dental caries lesions with negative consequences for children, such as problems for permanent dentition, discrimination, and psychological damages. Although regular oral hygiene and healthy diet were recognized as important factors for the prevention of ECC, specific doubts about feeding, toothpaste usage, oral hygiene, and dental eruption were detected among parents. Additionally, they declared that their children brush teeth alone, intake fermentable carbohydrates frequently, and sleep during breastfeeding without dental plaque removal, because uncooperativeness, permissiveness, and convenience. CONCLUSIONS: Based on these results, parents and caregivers understand the unfavourable effects of ECC on children's quality of life; however, their attitudes against the disease seemed to be inaccurate, influenced by their daily routines, doubts, and beliefs.

Cytotoxic effect and apoptosis pathways activated by methylene blue-mediated photodynamic therapy in fibroblasts.

Antimicrobial photodynamic therapy (aPDT) has been used as an adjuvant treatment of oral infections as a minimal intervention clinical approach. Its antimicrobial efficacy was demonstrated in several studies; however, there is a lack of evidence on its cytotoxic effect on mouse fibroblasts (NIH/3T3). The aim of this study was to evaluate the cytotoxicity and apoptotic pathways of methylene blue-mediated aPDT on mouse fibroblasts. Cells were treated with 0.1 or 1.0 mg.L-1 methylene blue (MB), and 0.075 or 7.5 J.cm-² LED at 630 nm. Cell viability was examined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and crystal violet (CV) assays, while cDNA expression for Bax, Bad, Bcl-2, VDAC-1, cytochrome C and Fas-L was assessed by qRT-PCR (1, 3, 6 and 24 h). The differences between groups were detected by Kruskal-Wallis and post-hoc Dunn's tests for MTT and CV assays, and by ANOVA and post-hoc Tukey test for qPCR (P < 0.05). The combination of 1.0 mg.L-1 MB and 7.5 J.cm-² LED significantly reduced the cellular viability, whereas MB and LED alone were innocuous to fibroblasts. MB-mediated aPDT increased the expression of cytochrome C and Fas-L after 3 h, and Bax/Bcl-2, Bad/Bcl-2, and VDAC-1 after 6 h from treatment. Based on these results, MB-mediated aPDT induced cytotoxicity on mouse fibroblasts, with consequent activation of Bcl-2 apoptosis signaling pathways. Further studies are needed to determine the adequate parameters of aPDT to inactivate microorganisms without damaging fibroblasts.

The effectiveness of curcumin-mediated antimicrobial photodynamic therapy depends on pre-irradiation and biofilm growth times.

BACKGROUND: The aim of this study was to determine the influence of distinct pre-irradiation times (PIT) of curcumin on the effectiveness of antimicrobial photodynamic therapy (aPDT) against intact dentin caries biofilms grown for 3 or 5 days. METHODS: The microcosm biofilms grew on non-fluorescent glass blocks immersed in McBain medium with 1% sucrose, using microaerophilic conditions at 37 °C for 3 or 5 days. The biofilms were treated by the association of 600 µmol.L-1 curcumin using different pre-irradiation times (1, 2 or 5 min) combined with 0 or 75 J.cm-2 blue LED. Then, the vitality of biofilms was determined by confocal scanning laser microscopy (CSLM), after being stained with the mixture of ethidium bromide and fluorescein diacetate. Statistical analysis was performed by two-way ANOVA and post-hoc Tukey tests, after arcsine transformation (P < 0,05). RESULTS: In comparison to control, curcumin alone (PIT = 5 min) and all combinations of curcumin and LED reduced significantly the vitality of 3-day biofilms. Distinctly, only curcumin plus LED using PITs of 2 or 5 min were effective in reducing the vitality of 5-day biofilms. CONCLUSION: Curcumin-mediated aPDT significantly decreased the vitality of intact dentin caries microcosms grown during 3 or 5 days, although successful treatments of 5-day biofilms required longer PITs in comparison to their counterparts.

Curcumin-mediated antimicrobial photodynamic therapy reduces the viability and vitality of infected dentin caries microcosms.

BACKGROUND: To our knowledge, there is a lack of evidence on the effect of Antimicrobial Photodynamic Therapy (aPDT) by the application of curcumin against complex biofilms of dental caries lesions. This study aimed to evaluate the viability, vitality, and acid metabolism of infected dentin caries microcosms treated with curcumin-mediated aPDT. METHODS: After microcosm biofilms growing anaerobically on bovine dentin disks immersed in McBain medium with 1% sucrose at 37 °C for 5 days, the biofilms were treated by the association of DMSO water solution or 600 µmol L-1 curcumin with 0, 37.5 or 75 J cm-2 blue LED (455 nm). Then, the colony-forming units (CFU) counts of total microorganisms, total streptococci, mutans streptococci, and total lactobacilli were determined by plating. The lactic acid concentration was analyzed by enzymatic spectrophotometry method, while the vitality of intact biofilms was evaluated by confocal laser scanning microscope (CLSM). Statistical analysis was performed by Kruskal Wallis and post-hoc Dunn's tests (P < 0.05). RESULTS: Curcumin alone did not affect the viability of microorganisms and the vitality of intact biofilms. However, 75 J cm-2 LED alone decreased the total microorganisms and total lactobacilli counts. The combination of curcumin and LED reduced significantly the counts of all microorganism groups and the vitality of intact biofilms. Differences were not observed between the lactic acid concentrations of distinct groups. CONCLUSIONS: Therefore, curcumin-mediated aPDT was effective in reducing the viability and the vitality of infected dentin caries microcosms, without interfering in their acidogenicity.

Analysis of the interests of Google users on toothache information.

BACKGROUND: The knowledge on health interests of a given population of Internet users might contribute to the increase of evidence on community's dental needs, and consequently, to the improvement of public health planning. The frequency of searches for specific issues on Google can be analyzed by the application of Google Trends. AIM: In this study, we aimed to characterize the interests on toothache information of Google users from the United States, United Kingdom, Australia and Brazil. METHODS: The monthly variation of relative search volume (RSV) and the lists of main toothache-related queries were determined from January 2004 through April 2016 using Google Trends. Autoregressive Integrated Moving Average (ARIMA) forecasting models were developed to determine predictive RSV values for toothache for additional 12 months. Autocorrelation plots and general additive model (GAM) were applied to determine trends and seasonality in RSV curves. Through linear regression models, we assessed the association between the variation of annual means of RSV values and national statistics for toothache in the U.S. and U.K. Subsequently, the distribution of main queries according to the identification of endodontic pain, type of searching information, and the interest in self-management of toothache was evaluated for the four countries. RESULTS: The autocorrelation plots showed patterns of non-stationary time series. The monthly variation influenced the data of the U.S. and U.K., with the higher RSV values found respectively in January/July and December. Also, the interest on toothache in the U.K. increases in the second semester and in the fourth quarter, especially in December. Additionally, an annual variation affected significantly all time series, with the increment of RSV means over the years, varying from 265% in the U.S. to 745% in Brazil. In parallel, the increments in RSV values were also observed in all predictive curves. The annual variation of observed and fitted RSV values was directly associated with the increase of toothache visits in the U.S. and urgent dental treatments in the U.K. Moreover, the queries typed on Google were markedly linked to searches on endodontic pain information, especially in Brazil, where the residents usually searched for relief and/or self-management of pain. CONCLUSIONS: Therefore, these findings indicate an increasing interest of Google users on toothache-related topics, regardless of country and season. The Internet activity can be used by policy makers as a complementary source of data for the development and implementation of strategies to control and prevent toothache complications.

Comparison of two treatment protocols in children with unilateral complete cleft lip and palate: Tridimensional evaluation of the maxillary dental arch.

OBJECTIVE: The aim of this study was to evaluate the dimensional alterations of the maxillary dental arches after lip repair in children with unilateral complete cleft lip and palate of two different protocols. MATERIAL AND METHODS: The sample was composed of 94 digital models and divided in two groups: Group I - 23 children, (protocol 1) - with presurgical orthopedic intervention: Hotz plate; Group II - 24 children, (protocol 2) - without presurgical orthopedic intervention. The three dimensional images of the maxillary arch were obtained before lip repair (stage 1) and at approximately 1 year of age (stage 2). Interstages changes for each group were evaluated using dependent t test and Wilcoxon test, and in the intergroup were used independent t test, and Mann-Whitney test. RESULTS: The comparison of the dimensional alterations of dental arches between the two protocols exhibited differences: in the stage 1, the intercanine was smaller in Group II; in the stage 2, the anterior cleft width, the intercanine and the anteroposterior cleft were smaller in Group II. CONCLUSION: The results reported here suggest that the use of infant orthopedic plate as applied in protocol 1 may favor correct arch form establishment in infants with unilateral complete cleft lip and palate.

Influence of removing excess of resin-based materials applied to eroded enamel on the resistance to erosive challenge.

OBJECTIVES: The aim of this study was to evaluate the effect of removing excess of resin-based materials applied to eroded enamel, subjected to erosive challenge. METHODS: Bovine enamel blocks were immersed in HCl 0.01M, pH 2.3, for 30s under agitation at 50 rpm in room temperature, in order to form a softened erosion lesion. The blocks were then randomly divided into eight groups (n=12) and treated as follows: Cn- and Ce-control without treatment, Hn- and He-fissure resin sealant (Helioseal Clear(®)), An- and Ae-self-etch adhesive (Adhese(®)), In- and Ie-infiltrant (Icon(®)); being n-with excess removal and e-without excess removal of the material. After application of the materials, the blocks were immersed in HCl for 2 min, followed by immersion in artificial saliva for 120 min. This cycle was repeated four times a day for five days. Material thickness and enamel wear were assessed using profilometry. Data were analyzed by two-way ANOVA and Tukey's test (P<0.05). RESULTS: Groups He, Ae, and Ie resulted in the formation of a layer of material over enamel, being similar effective in inhibiting erosion progression (P>0.05). Groups Hn, An, and In (with excess removal) were similar to controls (Cn, Ce) and resulted in near enamel loss after application and after erosive challenge (P>0.05). CONCLUSIONS: Resin-based materials are able to protect enamel against erosion only when they are present over enamel, as a physical barrier. CLINICAL SIGNIFICANCE: The resin-based materials demonstrated potential to prevent the progression of erosion lesions when the material remains on the dental surface.

Clinical and radiographic outcomes of the use of Low-Level Laser Therapy in vital pulp of primary teeth.

AIM: This study aimed to compare the clinical and radiographic effectiveness of Low Level Laser Therapy in vital pulp of human primary teeth. METHODS: Sixty mandibular primary molars of children aged between 5-9 years were assigned into four groups: Diluted Formocresol (FC), Calcium Hydroxide (CH), Low Level Laser Therapy (LLLT) and Calcium Hydroxide preceded by Low Level Laser Therapy (LLLT + CH). The clinical and radiographic evaluations were performed at 6, 12 and 18 post-operative months. RESULTS: All the groups studied were successful in the clinical evaluation over the follow-up period. At 6 months, the radiographic success rate for FC group was 100%, 60% for CH group, 80% for LLLT group and 85.7% for LLLT + CH group. After 12 months, the radiographic success rate was 100% for FC group, 50% for CH group, 80% for LLLT group and 78.6% for LLLT + CH group. At the 18 months follow-up, 100% of the FC group, 66.7% of CH group, 73.3% of the LLLT group and 75% of the LLLT + CH group. CONCLUSION: These findings suggest that Low Level Laser Therapy may be considered as an adjuvant alternative for vital pulp therapy on human primary teeth. Low Level Laser Therapy preceding the use of calcium hydroxide showed satisfactory results.

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.

Photodynamic inactivation of Candida albicans mediated by a low density of light energy.

Shorter times and lower energies of application of light sources are desirable to use photodynamic antimicrobial chemotherapy (PACT) to the clinical control of candidiasis, especially among babies and children. Light energies ranging from 39.5 to 100 J/cm(2) were previously applied to kill Candida albicans by PACT. The present study evaluated the efficacy of a combination of 0.05 mg/mL toluidine blue O (TBO) and a short time of application (60 s) and a low density of light energy (18 J/cm(2)) of a red light-emitting diode (LED) in killing C. albicans planktonic cells. Standard suspensions of C. albicans were randomly assigned for four treatment groups: control (L-P-), LED alone (L+P-), TBO alone (L-P+), and PACT (L+P+). After treatments, serial dilutions of suspensions were prepared and streaked on Sabouraud dextrose agar to determine colony-forming units of C. albicans per milliliter (CFU/mL). The results were analyzed by ANOVA and Tukey's post-hoc test (P < 0.05). PACT significantly reduced CFUs of C. albicans in comparison to other three treatments. Our results demonstrated a fungicidal effect of PACT mediated by a shorter time of application of LED on C. albicans planktonic cells. Further in vivo studies are needed to elucidate the efficacy of PACT to treat human fungal infections.

An in situ/ex vivo comparison of the ability of regular and light colas to induce enamel wear when erosion is combined with abrasion.

OBJECTIVE: To evaluate whether the type of cola drink (regular or diet) could influence the wear of enamel subjected to erosion followed by brushing abrasion. METHOD AND MATERIALS: Ten volunteers wore intraoral devices that each had eight bovine enamel blocks divided into four groups: ER, erosion with regular cola; EAR, erosion with regular cola plus abrasion; EL, erosion with light cola; and EAL, erosion with light cola plus abrasion. Each day for 1 week, half of each device was immersed in regular cola for 5 minutes. Then, two blocks were brushed using a fluoridated toothpaste and electric toothbrush for 30 seconds four times daily. Immediately after, the other half of the device was subjected to the same procedure using a light cola. The pH, calcium, phosphorus, and fluoride concentrations of the colas were analyzed using standard procedures. Enamel alterations were measured by profilometry. Data were tested using two-way ANOVA and Bonferroni test (P<.05). RESULTS: Regarding chemical characteristics, light cola presented pH 3.0, 13.7 mg Ca/L, 15.5 mg P/L, and 0.31 mg F/L, while regular cola had pH 2.6, 32.1 mg Ca/L, 18.1 mg P/L, and 0.26 mg F/L. The light cola promoted less enamel loss (EL, 0.36 Μm; EAL, 0.39 Μm) than its regular counterpart (ER, 0.72 Μm; EAR, 0.95 Μm) for both conditions. There was not a significant difference (P>.05) between erosion and erosion plus abrasion for light cola. However, for regular cola, erosion plus abrasion resulted in higher enamel loss than erosion alone. CONCLUSION: The data suggest that light cola promoted less enamel wear even when erosion was followed by brushing abrasion.

Dental erosion in a group of 12- and 16-year-old Brazilian schoolchildren.

PURPOSE: This study's purpose was to assess the prevalence of dental erosion in adolescents and to investigate the association between erosion and sociodemographic characteristics. METHODS: This study consisted of a single center cluster random sample of 414 adolescents (12 and 16 years old) of both genders from private and public schools in Bauru, São Paulo, Brazil. Two previously calibrated examiners (kappa=0.85) used the O'Brien (1994) index for assessment of dental erosion on the buccal and palatal surfaces of the permanent maxillary incisors and on the occlusal surfaces of the permanent first molars. Data on gender, type of school, and mean family income were collected by a questionnaire completed by the adolescents. Descriptive statistics were applied to the data, and the associations between erosion and sociodemographic variables were investigated by chi-square test (P<0.05). RESULTS: The prevalence of dental erosion was 20% (N=83), with only enamel being involved (score 1). The labial surface was the most affected (16%). There were no significant differences between the presence of erosion and gender, type of school, and mean family income. CONCLUSIONS: The results indicate that dental erosion restricted to enamel was observed among adolescents in Bauru/Brazil, and there was no correlation between this condition and sociodemographic factors.

Light cola drink is less erosive than the regular one: an in situ/ex vivo study.

OBJECTIVE: This in situ/ex vivo study assessed the erosive potential of a light cola drink when compared to a regular one. METHODS: During 2 experimental 14-days crossover phases, eight volunteers wore palatal devices with 2 human enamel blocks. The groups under study were: group light, erosive challenge with light cola drink and group regular, erosive challenge with regular cola drink. During 14 days, erosive challenges were performed extraorally 3X/day. In each challenge, the device was immersed in 150ml of light cola (group light) or regular cola (group regular) for 5min. Erosion was analysed by surface profilometry (microm) and surface microhardness change (%SMH). The data were statistically analyzed using paired t test (p<0.05). RESULTS: Group light (0.6+/-0.2microm) showed significantly lesser wear than group regular (3.1+/-1.0microm). There was no significant difference between the groups for the %SMH (group light -63.9+/-13.9 and group regular -78.5+/-12.7). CONCLUSIONS: The data suggest that the light cola drink is less erosive than the regular one.

In situ effect of an erosive challenge on different restorative materials and on enamel adjacent to these materials.

OBJECTIVES: This in situ study evaluated the effect of an erosive challenge on different restorative materials and on enamel restored with these materials, as well as the ability of these materials to protect the adjacent enamel against erosion. METHODS: Ten volunteers wore palatal devices with eight bovine enamel blocks, randomly selected and distributed into two vertical rows, corresponding to the following groups: GI/GV, resin-modified glass ionomer; GII/GVI, conventional glass ionomer; GIII/GVII, composite resin; GIV/GVIII, amalgam. One row (corresponding to groups I-IV) was immersed in a cola drink and the other row (corresponding to groups V-VIII) was subjected to saliva only. The palatal device was continuously worn for 7 days and only half of the appliance (groups I-IV) was immersed in the soft drink (Coca-Cola), 150 mL) for 5 min, three times a day. The study variables comprised the wear (profilometry, microm) and the percentage of surface microhardness change (%SMHC). Data were tested for significant differences by two-way ANOVA and Tukey's tests (p<0.05). RESULTS: Considering the restorative materials, for %SMHC and wear, there were no differences among the materials and between the saliva and the erosive challenge. For enamel analyses, the erosive challenge promoted a higher wear and %SMHC of the enamel than did the saliva. There were no significant differences in wear and %SMHC of the enamel adjacent to the different restorative materials. CONCLUSION: This research data suggest that there is little %SMHC and wear of the studied restorative materials and none of them had a preventive effect against erosion on adjacent enamel, which showed a pronounced wear.

Evaluation of the erosive potential of soft drinks.

OBJECTIVES: This in vitro study evaluated the capability of different soft drinks (Coca-Cola(R)-C, Coca-Cola Light(R)-CL, Guaraná(R)-G, Pepsi Twist(R)-P and Sprite Light(R)-SL) to erode dental enamel, relating the percentage of superficial microhardness change (%SMHC) to concentrations of fluoride and phosphate, buffering capacity and pH of these drinks. METHODS: The soft drinks were evaluated in respect to concentration of phosphate and fluoride spectrophotometrically using Fiske, Subarrow method and by specific electrode (Orion 9609), respectively. The pH and the buffering capacity were determined by glass electrode and by estimating of the volume of NaOH necessary to change the pH of the drink in one unit, respectively. One hundred specimens of bovine enamel were randomly assigned to 5 groups of 20 each. They were exposed to 4 cycles of demineralisation in the beverage and remineralisation in artificial saliva. The softening of enamel was evaluated by %SMHC. RESULTS: The mean %SMHC was: C=77.27%, CL= 72.45%, SL=78.43%, G=66.65% and P=67.95%. Comparing the %SMHC promoted by 5 soft drinks, SL = C > CL > P = G (P<.05). There was not significant correlation between %SMHC and the other variables tested for the five drinks (P>.05). CONCLUSIONS: The five soft drinks caused surface softening of enamel (erosion). In respect to the chemical variables tested, despite not statistically significant, the pH seems to have more influence on the erosive potential of these drinks. (Eur J Dent 2007;1:10-13).