Incomplete caries removal and indirect pulp capping in primary molars: a randomized controlled trial.

PURPOSE: To compare the effect of incomplete caries removal (ICR) and indirect pulp capping (IPC) with calcium hydroxide (CH) or an inert material (wax) on color, consistency and contamination of the remaining dentin of primary molars. METHODS: This double-blind, parallel-design, randomized controlled trial included 30 children presenting one primary molar with deep caries lesion. Children were randomly assigned after ICR to receive IPC with CH or wax. All teeth were then restored with resin composite. Baseline dentin color and consistency were evaluated after ICR, and dentin samples were collected for contamination analyses using scanning electron microscopy. After 3 months, restorations were removed and the three parameters were re-evaluated. In both groups, dentin became significantly darker after 3 months. RESULTS: No cases of yellow dentin were observed after 3 months with CH compared to 33.3% of the wax cases (P < 0.05). A statistically significant difference over time was observed only for CH regarding consistency. CH stimulated a dentin hardening process in a statistically higher number of cases than wax (86.7% vs. 33.3%; P = 0.008). Contamination changed significantly over time in CH and wax without significant difference between groups. It was concluded that CH and wax arrested the carious process of the remaining carious dentin after indirect pulp capping, but CH showed superior dentin color and consistency after 3 months.

Professional flossing as a diagnostic method for gingivitis in the primary dentition.

The aim of this study was to evaluate flossing as a diagnostic method for interproximal gingival bleeding in children. For this crossover study, 23 pre-schoolchildren presenting neither restorations nor approximal carious cavities and with at least 15% of gingival bleeding sites were selected. Examinations were performed at three different moments (3-4 days interval). Examinations comprised repeated measurements of two gingival indices with a 10-minute interval in the following sequences: the Ainamo & Bay Gingival Bleeding Index (GBI) followed by the Carter & Barnes flossing index (CBI); CBI followed by GBI; and GBI followed by GBI. Data analysis was performed only for the interproximal sites, considering the GBI as the gold-standard. Agreement between indices, sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) were estimated. Percentage agreements in sequences GBI-CBI, CBI-GBI and GBI-GBI were 70.3%, 76.4% and 84.5%, respectively. Validation of flossing in the first sequence (GBI-CBI) resulted in values of 0.61 (95%CI 0.53 - 0.68), 0.72 (95%CI 0.69 - 0.76), 0.33 (95%CI 0.28 - 0.39) and 0.89 (95%CI 0.86 - 0.92) respectively for SE, SP, PPV and NPV. It can be concluded that professional flossing is a useful tool in the diagnosis of interproximal gingival inflammatory status in children, especially in conditions of gingival health.

Professional flossing as a diagnostic method for gingivitis in the primary dentition

The aim of this study was to evaluate flossing as a diagnostic method for interproximal gingival bleeding in children. For this crossover study, 23 pre-schoolchildren presenting neither restorations nor approximal carious cavities and with at least 15 percent of gingival bleeding sites were selected. Examinations were performed at three different moments (3-4 days interval). Examinations comprised repeated measurements of two gingival indices with a 10-minute interval in the following sequences: the Ainamo & Bay Gingival Bleeding Index (GBI) followed by the Carter & Barnes flossing index (CBI); CBI followed by GBI; and GBI followed by GBI. Data analysis was performed only for the interproximal sites, considering the GBI as the gold-standard. Agreement between indices, sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) were estimated. Percentage agreements in sequences GBI-CBI, CBI-GBI and GBI-GBI were 70.3 percent, 76.4 percent and 84.5 percent, respectively. Validation of flossing in the first sequence (GBI-CBI) resulted in values of 0.61 (95 percentCI 0.53 - 0.68), 0.72 (95 percentCI 0.69 - 0.76), 0.33 (95 percentCI 0.28 - 0.39) and 0.89 (95 percentCI 0.86 - 0.92) respectively for SE, SP, PPV and NPV. It can be concluded that professional flossing is a useful tool in the diagnosis of interproximal gingival inflammatory status in children, especially in conditions of gingival health.

Elastomeric impression as a diagnostic method of cavitation in proximal dentin caries in primary molars

The purpose of this study was to validate the elastomeric impression after temporary tooth separation as a method of cavitation detection in proximal caries lesions in primary molars with outer half dentin radiolucency. Fifty-one children (4-10 years old), presenting radiolucency in the outer half of the dentin at the proximal surfaces of primary molars and proximal anatomic contact with the adjacent tooth (without restoration/cavitated caries lesion) were enrolled in the study. Temporary tooth separation was performed with an orthodontic rubber ring placed around the contact point during 2-3 days. Thereafter, impression of the proximal surfaces was made. The elastomeric impressions were classified as "non-cavitated" or "cavitated" surfaces. Visual inspection after tooth separation was considered as the gold standard. Examiner reliability of visual inspection after tooth separation was determined (kappa 0.92). Impression examination was repeated every 5 participants to evaluate the reproducibility of the method. The frequency of cavitated lesions was 65 percent, and 67 percent of those were inactive. Sensitivity, specificity, positive and negative predictive values were 0.88 percent (95 percentCI 0.73-0.95), 0.89 percent (95 percentCI 0.67-0.97), 0.94 percent (95 percentCI 0.79-0.98) and 0.80 percent (95 percentCI 0.58-0.92), respectively. Impression examination showed total agreement regarding cavitation. The evaluation of elastomeric impression after tooth separation is a useful clinical resource in cavitation detection for clinicians and researchers when visual inspection is doubtful.

Elastomeric impression as a diagnostic method of cavitation in proximal dentin caries in primary molars.

The purpose of this study was to validate the elastomeric impression after temporary tooth separation as a method of cavitation detection in proximal caries lesions in primary molars with outer half dentin radiolucency. Fifty-one children (4-10 years old), presenting radiolucency in the outer half of the dentin at the proximal surfaces of primary molars and proximal anatomic contact with the adjacent tooth (without restoration/cavitated caries lesion) were enrolled in the study. Temporary tooth separation was performed with an orthodontic rubber ring placed around the contact point during 2-3 days. Thereafter, impression of the proximal surfaces was made. The elastomeric impressions were classified as "non-cavitated" or "cavitated" surfaces. Visual inspection after tooth separation was considered as the gold standard. Examiner reliability of visual inspection after tooth separation was determined (kappa 0.92). Impression examination was repeated every 5 participants to evaluate the reproducibility of the method. The frequency of cavitated lesions was 65%, and 67% of those were inactive. Sensitivity, specificity, positive and negative predictive values were 0.88% (95%CI 0.73-0.95), 0.89% (95%CI 0.67-0.97), 0.94% (95%CI 0.79-0.98) and 0.80% (95%CI 0.58-0.92), respectively. Impression examination showed total agreement regarding cavitation. The evaluation of elastomeric impression after tooth separation is a useful clinical resource in cavitation detection for clinicians and researchers when visual inspection is doubtful.

Lesões de cárie proximais na dentição decídua: freqüência de lesões homólogas / Approximal caries lesion on primary teeth: homologous lesions frequency

O objetivo deste estudo transversal observacional foi avaliar a experiência de cárie na superfície proximal de molares decíduos quanto à ocorrência de comportamento bilateral e ao envolvimento de superfícies adjacentes. A população estudada foi o arquivo de pacientes do Ambulatório de Odontopediatria (UFRGS). Das 670 fichas de pacientes avaliadas, 208 possuíam radiografias interproximais bilaterais. As fichas dos indivíduos que apresentaram lesão de cárie e/ou restauração proximal (kappa intra-examinador: 0,84), com adequado contraste e ausência de sobreposição foram selecionados para a análise. As imagens radiográficas foram avaliadas aleatoriamente de acordo com a presença de lesões proximais/restaurações e posteriormente foi analisada a freqüência de acometimento em superfícies homólogas e adjacentes. Assim, 64 pares de radiografias interproximais compuseram a amostra, com ocorrência de 81% de lesões cariosas em faces homólogas. Dentre estas, 58% apresentaram mais de um par de superfícies homólogas com lesão cariosa. Além disso, 48% dos indivíduos mostraram exclusivamente lesões de cárie em pares homólogos. As superfícies distais dos primeiros molares inferiores foram as mais acometidas pela ocorrência bilateral(41%). Outro aspecto analisado foi a ocorrência simultânea de lesões em faces proximais adjacentes: em 59% das crianças, ambas as faces de contato apresentaram lesão cariosa diagnosticada através da imagem radiográfica. A partir da metodologia utilizada, concluiu-se que lesões cariosas de molares decíduos apresentam comportamento bilateral em faces homólogas, o que representa uma informação útil durante a investigação de lesões em pacientes com experiência de cárie.

Prevalência de traumatismos alvéolo-dentários na clínica de urgência odontopediátrica de FO. UFRGS / Prevalence of dento-alveolar traumatisms in the urgency pediatric dental clinic of FO. UFRGS

O objetivo deste estudo foi avaliar a prevalência de traumatismos alvéolo-dentários em crianças que procuraram atendimento no Curso de Extensão Univesitária de Urgência em Odontopediatria da FO-UFRGS no período de abril de 1999 a dezembro de 2000. A amostra constituiu de 129 crianças, sendo 80 (62,01 por cento) do sexo masculino e 49 (37,99 por cento) do sexo feminino, com idade de 0 a 14 anos. A faixa etária mais acometida por traumatismo em dentes decíduos foi a de 2-4 anos, enquanto que, permanentes, foi a de 8-10 anos. Os traumatismos dos tecidos de sustentação fora os mais prevalentes na dentição decídua (79,64 por cento), predominando a intrusão (35,55 por cento) e a luxação lateral (27,77 por cento). Já com relação aos dentes permanentes, a prevalência maior foi de injúrias traumáticas aos tecidos duros (59,25 por cento), sendo de maior ocorrência a fratura coronária sem exposição pulpar (70,83 por cento), seguida da fratura coronária com exposição pulpar (22,91 por cento). Em relação aos procedimentos clínicos adotados para o atendimento emergencial, a conduta mais prevalente foi a orientação, tanto para dentes decíduos (72,56 por cento), quanto para permanentes (27,16 por cento). A restauração (25,92 por cento) foi o seguinte procedimento clínico mais prevalente para dentes permanentes e a exodontia (13,27 por cento) para os dentes decíduos traumatizados