Autistic spectrum disorder children and adolescents' oral health characteristics - scoping review.

This study aimed to conduct a scoping review to know children and adolescents' main oral health concerns with Autism Spectrum Disorder (ASD) and thus identify any oral characteristic that stands out, aiming at preventive and interceptive clinical conduct. A search was performed in the three electronic databases and the gray literature; in September 2021. A total of 562 studies were identified, and after applying the eligibility criteria, 73 articles were included in the synthesis of this scoping review. The mean decayed, lost, and restored teeth index (DMFT/dfmt) ranged from 0 to 12.37; the mean DMFT index (permanent dentition) from 0.06 to 6.2; and the average dmft index (deciduous dentition) ranged from 0.29 to 9.91. The mean simplified oral hygiene index (OHIS) ranged from 0 to 3.4; gingival index (GI) from 0.29 to 2; and plaque index (PI) from 0.005 to 3.15. Plaque prevalence was 25.9% to 90%; dental calculus from 4.7% to 59.41%; gingivitis from 36.7% to 100%. Bruxism was 10.3% to 73%, and dental trauma was 4.7% to 100%. This disparity in the results shows the heterogeneity of this population, with different degrees of socio-behavioral impairment, which can directly influence oral hygiene and the consequent accumulation of biofilm.

Oral Health and Behavioral Management of Children with Autistic Spectrum Disorder: A 30-year Retrospective Study.

PURPOSE: This article aims to determine the oral health status, the dental treatment, the behavioral management techniques, and the follow-up of pediatric autistic spectrum disorder (ASD) patients treated at the Clinic for Pediatric Patients with Disabilities (CPPD) at a public university in Brazil. METHODS: The medical records of all the patients seen between 1990 and 2020 were evaluated. Data were collected on the autistic patients' medical and dental conditions, treatments, behavior during dental visits, behavioral management techniques used, and the entire follow-up period at the clinic. The Student's t-test and chi-square tests were used to perform the statistical analysis (α = 0.05%). RESULTS: Sixty-six records of ASD children were analyzed from a total of 656 dental records. The majority were male (80.3%). The mean age was 7.39 ± 2.75 years. All the children had a cognitive deficit, and 62.5% used medication. Most of the children arrived with caries lesions (56.1%), and the mean number of decayed, missed and filled teeth in both the deciduous (dmft-d) and permanent dentition (DMFT) was 2.45 ± 3.13 and 0.87 ± 1.51, respectively. The restorative technique was the most commonly used procedure (54.5%), and protective stabilization was the most frequently used behavioral management technique (18.2%). Of the children who sought treatment, 86.4% were discharged, and 15.2% abandoned the procedure. The majority (those discharged) continued to undergo regular follow-up at the clinic (86%), and the incidence of new caries lesions observed was 33.33% Conclusions: Although our ASD patients had a high frequency of caries and dental treatment needs, we observed good adherence to the treatment, with a low dropout rate, and high discharge rate.

Gradual Deprogramming of Self-Inflicted Oral Trauma Habit in a Child with Cerebral Palsy.

The purpose of this paper is to report the successful noninvasive treatment of a self-inflicted traumatic lesion on the lower labial mucosa in a 22-month-old boy with cerebral palsy. An acrylic appliance was cemented on the anterior maxillary region to reduce repetitive self-injury by gradual deprogramming. The wound healed after a few weeks, but four weeks after the appliance was removed new trauma was observed at the site. The appliance was replaced by a new one on the anterior region of the mandibular arch, and complete remission of the habit was achieved after three weeks. In order to prevent relapse, the appliance was gradually reduced in size with carbide drills every two weeks and was removed three weeks after the final reduction. After 24 months of follow-up, the labial mucosa was completely healed and no recurrence of the traumatic habit has been observed.

Relationship between depression, alcohol and / or tobacco abuse of those responsible and children's oral health

Objective :To investigate the influence of parental depression and smoking and alcohol use by parents/caregivers use on oral health in children aged 5-11 years of both sexes. Methods: A cross-sectional study was conducted involving 85 children and their parents/caregivers. Adult respondents completed three questionnaires to assess depression and alcohol and tobacco use: two versions of the PHQ (PatientHealth Questionnaire; PHQ-2 and PHQ-9), AUDIT (Alcohol Use DisordersIdentification Test) for risk assessment of alcohol dependence and abuse, and the Fagerström Test for Nicotine Dependence (FTND). The PHQ-2 contained two questions requiring an affirmative or negative answer. Children underwent oral examinations to evaluate biofilm control, gingival bleeding and caries index, specifically DMFT index. Relationships among variables were evaluated using chi-squared tests and Fisher's exact test. Results: Only 10.6% of parents and caregivers consumed tobacco and 24,7% of parents or caregivers manifested depressive symptoms. Regarding alcohol consumption, 10.6% of caregivers presented risk consumption or dependence. A positive association was found between children'sgingival bleeding and their caregivers' risk of alcohol dependence (p=0.038). Conclusion: A positive association between caregivers' risk of alcohol dependence and the presence of gingival bleeding in children was found. Caregivers' depression and alcohol and tobacco use did not influence children's caries.

Objetivo: Investigar a influência da depressão parental e do uso de cigarro e álcool pelos pelos pais/cuidadores na saúde bucal de crianças de 5 a 11 anos de ambos os sexos. Métodos: Um estudo do tipo transversal foi conduzido com 85 crianças e seus respectivos cuidadores. Para detectar a presença de depressão, duas versões do PHQ (Pacient Health Questionnaire) foram aplicadas: o PHQ-2, contendo duas perguntas com opção de resposta afirmativa ou negativa e o segundo, PHQ-9. Para o uso de álcool foi aplicado o AUDIT (Alcohol Use Disorders Identification Test) para avaliação do risco de dependência e abuso de álcool; e o Fagerstrom para dependência de nicotina. As crianças foram submetidas a exames orais para avaliação do controle de biofilme, sangramento gengival e presença de cárie (índices CPO-D e ceo-d). Para verificar a associação entre as diferentes variáveis, foram utilizados os testes Qui-quadrado e Exato de Fisher. Resultados: Somente 10,6% dos responsáveis faziam uso de tabaco e 24,7% dos mesmos apresentavam sintomas de depressão. Em relação ao consumo de álcool, 10,6% apresentavam consumo de risco ou dependência. Verificou-se associação entre sangramento gengival nas crianças e o risco de dependência de álcool dos responsáveis (p=0,038). Conclusão: Concluiu-se que há uma associação positiva entre o risco de dependência de álcool dos responsáveis e a presença de sangramento gengival no paciente e que a depressão, o uso de álcool e de tabaco pelos cuidadores não influência na experiência de cárie das crianças.

Alagille syndrome: facial characteristics, rare oral manifestations, and management of the case

Introduction: Alagille syndrome (AGS) is an autosomal dominant disease with variable expressiveness that can affect the liver, heart, kidneys, blood vessels, eyes, face and skeleton. Objective: To describe a case of a pediatric patient with Alagille syndrome. Case report: The family history was negative for even the mildest manifestations of AGS. Clinically, the patient had a triangular face, hypertelorism, short philtrum and flat midface. Intraoral examination revealed the absence of the permanent upper lateral incisors, enamel hypoplasia and agreenish color in some teeth, gingival hyperplasia, retention of two primary lower incisors, presence of a supernumerary tooth, and a pediculated nodule of soft tissue on the lingual aspect of the left permanent mandibular first molar. Results: The dental treatment required the extraction of the retained primary teeth and the supernumerary tooth, excisional biopsy and histopathological examination of the lesion were performed and also application of topical fluoride. Also dietary and oral hygiene instructions were given. Conclusion: Currently, the patient makes frequent follow-up visits to monitor the dental development.

Introdução: A síndrome de Alagille (AGS) é uma doença autossômica dominante com expressividade variável que podem afetar o fígado, coração, rins, vasos sanguíneos, olhos, rosto e esqueleto. Objetivo: Descrever um caso de um paciente pediátrico com síndrome de Alagille. Relato do caso: A história familiar era negativa até mesmo para as manifestações mais leves de AGS. Clinicamente, o paciente apresentava face triangular, hipertelorismo, filtro curto e face média plana. O exame intraoral revelou ausência dos incisivos laterais superiores permanentes, hipoplasia de esmalte e aspecto esverdeado em alguns dentes, hiperplasia gengival, retenção de dois incisivos inferiores decíduos, presença de um dente supranumerário, e um nódulo de tecido mole pediculado na face lingual do primeiro molar inferior permanente esquerdo. Resultados: O tratamento odontológico exigiu a extração dos dentes decíduos retidos e do dente supranumerário, biópsia excisional e exame histopatológico da lesão além da aplicação de fluoreto tópico. Também foi realizada instrução dietética e de higiene oral. Conclusão: Atualmente, o paciente faz visitas de acompanhamento frequentes para monitorar o desenvolvimento dentário.

Management of an unerupted tooth and odontoma after trauma in predecessor

The purpose of this case report was to describe the surgical exposure and orthodontic management of an unerupted and ectopic maxillary right central incisor after trauma to the primary predecessor. Case report: An 11-year-old girl was referred to the Pediatric Dentistry Clinic due to eruption failure of the maxillary right central incisor. Radiographs showed the impacted central incisor located below the anterior nasal spine and its apex parallel to the palatal plane and the presence of an odontoma. General surgery was performed to remove the odontoma and two perforations in the crown of the impacted tooth were made to carry out orthodontic traction. Correct alignment was achieved after 18 months and no significant clinical or radiographic alterations were founded. Conclusion: The orthodontic management was performed successfully, and a positive esthetic outcome combined with adequate occlusion demonstrated the satisfactory results of this case.

Objetivo: O objetivo deste relato de caso foi descrever a exposição cirúrgica e o tratamento ortodôntico de um incisivo central superior direito ectópico e não irrompido após trauma do predecessor decíduo. Relato do caso: Uma menina de 11 anos de idade foi encaminhada à Clínica de Odontopediatria devido ao atraso na erupção do incisivo central superior direito. As radiografias mostraram o incisivo central impactado localizado abaixo da espinha nasal anterior e seu ápice paralelo ao plano palatino e a presença de um odontoma. A cirurgia para remoção do odontoma foi realizada sob anestesia geral e duas perfurações na coroa do dente impactado foram realizadas para a tração ortodôntica. O alinhamento correto foi alcançado após 18 meses e não foram encontradas alterações clínicas ou radiográficas significativas. Conclusão: O manejo ortodôntico foi realizado com sucesso, e um resultado estético positivo combinado à oclusão adequada demonstrou os resultados satisfatórios deste caso.

Impaction of mandibular canine associated with a dentigerous cyst: a 2. 5 - year follow-up report

Introduction: Dentigerous cyst is an odontogenic cyst lesion surrounding the crown of an unerupted or impacted tooth in the jaw. Objective: The aim of this case report is to describe the treatment planning and follow-up of a dentigerous cyst associated with the impaction of the permanent mandibular right canine tooth in an 11-year-old female. Case report: Radiographic assessment revealed a radiolucent unilocular round-shaped lesion localized in the mandibular symphysis. Enucleation was performed and the affected tooth was removed under general anesthesia. The patient is under follow-up due to orthodontic treatment. The affected area healed without complications. Conclusion: Two and a half years after the enucleation, the cyst had totally disappeared, and no recurrences were observed. Bone remodeling and neoformation were noticed.

Introdução: O cisto dentígero é uma lesão odontogênica ao redor da coroa de um dente não irrompido ou impactado na mandíbula. Objetivo: O objetivo deste relato de caso é descrever o plano do tratamento e o acompanhamento de um cisto dentígero associado à impactação do canino permanente inferior direito em uma criança do gênero feminino de 11 anos de idade. Relato do caso: A avaliação radiográfica revelou lesão unilocular radiolúcida de forma arredondada, localizada na sínfise mandibular. A enucleação foi realizada e o dente afetado foi removido sob anestesia geral. A paciente encontra-se em acompanhamento devido o tratamento ortodôntico. A área afetada curou sem complicações. Conclusão: Dois anos e meio após a enucleação, o cisto desapareceu totalmente e não houve recidivas. Remodelação óssea e neoformação foram observadas.

Types of Feeding and Presence of Harmful Oral Habits in Children with Cleft Lip and/or Palate: A Pilot Study

Abstract Objective: To verify the relationship between the types of feeding and presence of harmful oral habits (HOH) in children with cleft lip (CL), palate (CP) and cleft lip and palate (CLP), as well as to compare the different types of cleft to each other. Material and Methods: A form was applied to the parents of 162 children (3-5 years old), addressing the following variables: gender, cleft type, age, socioeconomic conditions, type of breastfeeding, presence of HOH, and the parents' knowledge about the consequences of oral habits. The data obtained were analyzed by chi-square test (p<0.05). Results: The majority of children (83.3%) were bottle-fed and 12.3% were exclusively maternal breastfed. The main reason for weaning was the presence of cleft (59.9%). Breastfeeding was significantly higher in children with CL (75%) in comparison with CP (20%) and CLP (5%) (p<0.001). Children with CLP were 12 times more likely to be bottle-fed than children with CL (OR=12.21; CI=4.09-36.45). The prevalence of HOH was 37%. Sociodemographic characteristics were not associated with the presence of HOH (p>0.05). The type of feeding and cleft were not decisive to present some type of HOH (p>0.05) and 87% of parents stated that HOH could lead to serious complications of tooth misalignment. Conclusion: The type of feeding and fissure did not determine the acquisition of harmful oral habits in children with cleft. However, the greater the fissure's complexity, the lesser the chance of children receiving exclusive breastfeeding.

Oral findings in Robinow Syndrome: a case report in pediatric patient

Objective: The aim of this article was to describe a case of Robinow syndrome in a pediatric patient. Case Report: Clinically, the patient had frontal bossing, flat facial profile with macrocephaly, midfacial hypoplasia, hypertelorism, wide palpebral fissures, triangular mouth, short upturned nose, short philtrum, ankyloglossia, prolonged retention of primary teeth and abnormal aligment of teeth. The radiographic exams indicated the presence of three impacted permanent supernumerary teeth, agenesis of eight permanent teeth and dental root shortening of all permanent teeth. The treatment proposed was the extraction of all retained primary teeth and the supernumerary teeth, dietary and oral hygiene instructions and orthodontic treatment. Also, important aspects to avoid complications associated with Robinow syndrome were discussed. Conclusion: This case describes uncommon oral findings and some important aspects to avoid complications associated with the Robinow syndrome. Early professional advice, treatment, and periodical follow-ups can improve the quality of life of these patients.

Objetivo: O objetivo deste artigo foi descrever um caso de síndrome de Robinow em um paciente pediátrico. Relato de Caso: Clinicamente, o paciente apresentava bossas frontais, perfil facial plano com macrocefalia, hipoplasia da face média, hipertelorismo, fissuras palpebrais amplas, boca triangular, nariz curto, filtro curto, anquiloglossia, retenção prolongada de dentes decíduos e dentes desalinhados. Os exames radiográficos indicaram a presença de três elementos supranumerários permanentes impactados, agenesia de oito dentes permanentes e encurtamento radicular de todos os dentes permanentes. O tratamento proposto foi a extração de todos os dentes decíduos retidos e os elementos supranumerários, instruções de higiene bucal e dietética e tratamento ortodôntico. Além disso, aspectos importantes para evitar complicações associadas à síndrome de Robinow são discutidos. Conclusão: Este caso descreve achados orais incomuns e alguns aspectos importantes para evitar complicações associadas à síndrome de Robinow. Aconselhamento profissional precoce, tratamento e acompanhamento periódico podem melhorar a qualidade de vida desses pacientes.

Dentomaxillofacial sequelae resulting from a chemoradiotherapy against rhabdomyosarcoma: 6-year follow-up

Introduction: Rhabdomyosarcoma is an aggressive malignant soft tissue neoplasm of immature mesenchymal cells treated with surgery and chemoradiotherapy. The effects of chemoradiotherapy in head induce a series of sequelae on oral cavity and growth development. Objectives: Report the case of a child undergoing treatment for rhabdomyosarcoma whose effects on the dento-maxillofacial development were cared for in order to safe guard the patient's quality of life. Case report: Describes a case of severe dento-maxillofacial defects resulting from chemoradiation therapy for embryonal rhabdomyosarcoma in a child as well as the dental management performed. Clinically, the patient had gingivitis, severe mobility of permanent teeth, hyposalivation, mucositis and severe trismus. The radiologic exams showed interruption of root formation of all permanent teeth and over-retention of primary teeth. Cephalometric analyses revealed mandibular and maxillary hypoplasia. Results: Was made extraction of the overretained primary teeth associated with a prophylactic program and use of artificial saliva due to hyposalivation in order to improve the quality of life of the patient. After 6 years of dental and phonoaudiologic follow-up her oral opening has increased and chewing and swallowing difficulties have decreased, there is no gingivitis or mucositis and she has remained free of recurrent or metastatic diseases 11 years after the initial diagnosis. Conclusion: Our report emphasizes the importance of dental treatment with a program of prevention and follow-up for patients undergoing anticancer therapies.

Introdução: O rabdomiossarcoma é uma neoplasia maligna agressiva de tecido mole de células mesenquimais imaturas tratadas com cirurgia e quimioradioterapia. Os efeitos da quimioradioterapia na cabeça induzem uma série de sequelas na cavidade oral e no desenvolvimento do crescimento. Objetivo: Relatar o caso de uma criança em tratamento de rabdomiossarcoma cujos efeitos no desenvolvimento dento-maxilofacial foram cuidados a fim de salvaguardar a qualidade de vida do paciente. Relato de caso: Descreve um caso de defeitos dento-maxilo-faciais graves resultante de quimioradioterapia para rabdomiossarcoma embrionário em uma criança, bem como o manejo realizado. Clinicamente, a paciente apresentava gengivite, severa mobilidade dos dentes permanentes, hipossalivação, mucosite e trismo severo. Os exames radiográficos mostraram interrupção da formação radicular de todos os dentes permanentes e retenção dos dentes decíduos. Análises cefalométricas revelaram hipoplasia mandibular e maxilar. Resultados: Foi realizada a extração dos dentes decíduos retidos associado a um programa profilático e uso de saliva artificial devido à hipossalivação, a fim de melhorar a qualidade de vida do paciente. Após 6 anos de acompanhamento odontológico e fonoaudiológico, sua abertura bucal aumentou e as dificuldades de mastigação e deglutição diminuíram, não há gengivite ou mucosite e ela permaneceu livre de doenças recorrentes ou metastáticas 11 anos após o diagnóstico inicial. Conclusão: Nosso relato enfatiza a importância do tratamento odontológico com um programa de prevenção e acompanhamento para pacientes submetidos a terapias antineoplásicas.

Unusual case of ankyloglossia recurrence after frenectomy in a child with cerebral palsy

Introduction: Frenectomy is the most indicated treatment for ankyloglossia in children and adolescents, with recurrence being extremely rare. Objective: Here, we report the unusual case of an 8-year-old boy with cerebral palsy presenting recurrence of ankyloglossia 2 years after undergoing lingual frenectomy. Case report: On physicalexamination, in a follow-up, 2 years after a lingual frenectomy, we observed a slightly elastic, short and adhered lingual frenulum and the presence of a heart-shaped tongue, with severe restriction of lateral and superior movements, and difficulties in speech and swallowing. A new frenectomy was performed under local anesthesia, restoring lingual mobility. The patient has been followed-up periodically and has undergone speech therapy; 2 years after the second surgery, firm insertion of the frenulum and the continuity of the bifid aspect of the tongue have been again verified, but the tongue movements and oral functions remain satisfactory. The patient will continue to be followed periodically and a new intervention will be performed if there are changes in oral functions. Conclusion: Beyond the need forperiodic clinical follow-up, the diagnosis and multidisciplinary treatment of ankyloglossia are fundamental for identifying possible cases of recurrence, which, although rare, can occur.

Introdução: A frenectomia é o tratamento mais indicado para os casos de anquiloglossia em crianças e jovens, sendo a recorrência extremamente rara. Objetivo: O objetivo é relatar o caso incomum de um menino de 8 anos, com paralisia cerebral, apresentando recidiva de anquiloglossia dois anos após a realização de frenectomia lingual. Relato de caso: Ao exame físico, em consulta de revisão, 2 anos após uma frenectomia lingual observou-se freio lingual levemente elástico, curto e aderido, presença de formato de coração na língua, restrição severa dos movimentos laterais e superiores, além de dificuldades na fala e deglutição. Uma nova frenectomia foi realizada após dois anos da primeira frenectomia , sob anestesia local, restaurando a mobilidade lingual. O paciente foi acompanhado periodicamente junto com a fonoaudiologia e após 2 anos da segunda cirurgia, a inserção firme do freio e a continuidade do aspecto bífido da língua foram novamente verificadas, porém, os movimentos da língua e as funções orais mantiveram-se satisfatórios. O paciente continuará a ser acompanhado periodicamente e, se houver alterações nas funções orais, uma nova intervenção será realizada. Conclusão: É fundamental o diagnóstico e tratamento multidisciplinar da anquiloglossia, além da necessidade de acompanhamento clínico periódico para identificar possíveis casos de recidiva, que, embora raros, podem ocorrer.

Oral healthcare management of a child with phakomatosis pigmentovascularis associated with bilateral Sturge-Weber syndrome.

The aim of this report was to describe an approach for a child with phakomatosis pigmentovascularis Type IIb associated with bilateral Sturge-Weber syndrome and autistic spectrum disorder. A 6-year-old boy was referred to the Special Care Dental Clinic with the main complaints of "damaged teeth and pain." The physical examination revealed bilateral port-wine staining on the face, neck, and upper and lower limbs, congenital dermal melanocytosis on the back, and dilated blood vessels in the sclera. Intraoral examination revealed hypertrophy of the maxillary bone, diffuse and intense redness of the oral mucosa, crowding, anterior open bite, and carious lesions in the left and right upper second primary molars. The medical team was consulted prior to dental treatment to assess the risk of bleeding, and anesthesia was contraindicated. Instruction about brushing technique and procedures for a suitable oral environment were then carried out using a minimally invasive restorative treatment. The patient did not exhibit collaborative behavior, and follow up continues with the patient receiving preventive treatments. Therefore, a multidisciplinary approach to these patients is fundamental to avoid complications during dental intervention. Moreover, regular visits to the dentist reduce the need for invasive treatments and improve the well-being of these individuals.

Candida spp. In Linear gingival erythema lesions in HIV-Infected children: report of six cases

Introduction: Linear gingival erythema (LGE), formally referred to as HIV-gingivitis, is the most common form of HIV-associated periodontal disease in HIV-infected individuals These lesions have been recently evaluated as a possible form of erythematous oral candidosis, mainly caused by Candida albicans. Other species such as C. tropicalis, C. stellatoidea, C. krusei, C. parapsilosis, C. glabrata and C. Dubliniensis, have also been identified in some HIV-infected subjects. Objective: This case report reveals the presence of typical LGE lesions in six HIV-infected children, and also investigates the etiologic agent through microbiological exams and correlates this oral manifestation with the patients' systemic conditions. Case report: Microbiological analyses showed growth for Candida spp in all patients; all of whom had severe immunosuppression. However, the regression of lesions was noted after antifungal medication. Conclusion: The presence of LGE in pediatric patients with AIDS may be a predictive marker in the progression of AIDS or it may be the first clinical manifestation of HIV infection in children. Hence it is important for dentists to be aware of such lesions.

Introdução: O eritema gengival linear (LGE), normalmente referido como gengivite do HIV, é a forma mais comum de doença periodontal presente em indivíduos infectados pelo HIV. Recentemente, estas lesões foram consideradas como uma possível forma de candidíase oral eritematosa causada por Candida. Albicans . Outras espécies, como C. tropicalis, C. stellatoidea,C. krusei, C. parapsilosis, C. glabrata e C. Dubliniensis também foram identificadas em indivíduos infectados pelo HIV associadas ao LGE. Objetivo: O presente artigo mostra a presença de lesões típicas de LGE em seis crianças infectadas pelo HIV e também investigou o agente etiológico das lesões orais através de exames microbiológicos, correlacionando o LGE com as condições sistêmicas dos pacientes. Case report: Análises microbiológicas mostraram crescimento positivo para Candida spp em todos os pacientes, os quais possuiam imunossupressão grave. Adicionalmente, a regressão total das lesões foi observada após medicação tópica antifúngica. Conclusão: A presença de LGE em pacientes pediátricos com AIDS pode ser um marcador preditivo da progressão.

A successful dental management in a child with Cornelia de Lange Syndrome: rare case of Cornelia de Lange Syndrome in child / O sucesso do manejo odontológico em criança com Síndrome Cornelia de Lange: um caso raro da Síndrome Cornelia de Lange em criança

Background: the Cornelia de Lange Syndrome (CDLs) is a rare and complex syndrome characterized, basically, by psychomotor retardation associated with a number of congenital malformations. Aims: this paper reports the case of an 11-year-old female child diagnosed with Cornelia de Lange Syndrome (CdLS) and her successful dental management. Case report: the patient had severe mental retardation, definite negative behavior and the clinical findings included oral and physical changes. The patient's oral hygiene was deficient with the presence of calculus and gingivitis, besides several active caries lesions in permanent and deciduous dental elements. The treatment consisted in guidance for caregivers about oral hygiene and diet, and the dental procedures were performed under general anesthesia. Currently, the patient is accompanied by monthly follow-ups. Conclusions: the lack of knowledge about oral hygiene and cariogenic diets was identified as a one of the reasons for the oral diseases present. Due to the need to care for the other more serious and complex health problems, the oral diseases had evolved faster than usual and thus were difficult to treat and maintain thereafter. Under such conditions, the dentist plays a key role within a multidisciplinary team. From the guidance and knowledge provided in the dental clinic, there was a significant improvement in the life quality of the child and her family

Aprendizagem Baseada em Problemas como ferramenta para o ensino da Odontopediatria em nível de especialização / Problem Based Learning as a teaching tool in Pediatric Dentistry specialization

O tema abordado neste estudo é o processo educacional na formação do cirurgião-dentista nos tempos atuais. O objetivo do trabalho foi implementar a Aprendizagem Baseada em Problemas (PBL - Problem Based Learning) como ferramenta de ensino no curso de especialização em Odontopediatria da Universidade Federal do Rio de Janeiro. A metodologia dividiu-se em duas etapas: a primeira, da elaboração e aplicação do método de ensino, que ocorreu durante o primeiro semestre de 2016, com a carga horária de duas horas semanais, na disciplina Temas em Odontopediatria. A segunda etapa correspondeu à avaliação da ferramenta pelos estudantes, para determinar a percepção dos mesmos quanto ao desenvolvimento do PBL como ferramenta de ensino na formação em Odontopediatria. O tratamento dos dados foi feito a partir da análise de conteúdo, numa abordagem metodológica qualitativa. Entre os resultados obtidos estão o desenvolvimento do pensamento crítico, maior autonomia, liberdade para questionar e maior participação discente. O reforço do vínculo entre os estudantes também se expressou promovendo uma rede de apoio e dando suporte ao protagonismo, tornando-os sujeitos ativos na construção do seu processo de aprendizagem (AU).

The subject of the present study was the current educational process for training dentists. The subject emerged from the need to reorient the teaching process in the Dental Pediatrics Specialization Course of the Federal University of Rio de Janeiro (UFRJ). The study aimed to implement problembased learning as a teaching tool in the Dental Pediatrics Specialization Course of UFRJ. The method was divided into two steps: initially the development and application of the method during the first semester of 2016, with a two-hour a week work load in the Topics on Dental Pediatrics discipline. The second step, the assessment of the tool, used a questionnaire answered by students of the discipline to determine their perception regarding the development of the problem-based learning method as a teaching tool in Dental Pediatrics training. Data were submitted to content analysis, using a qualitative methodological approach. Among results obtained were development of analytical thinking, greater autonomy, freedom to question, and more participation of students. Relations among students were also strengthened, promoting a support network and sustaining the empowerment of students, turning them into active participants in the construction of their learning process (AU).

Influence of Caregiver's Sociodemographic Background on the Oral Health Status and Care of HIV-infected Children.

PURPOSE: The purpose of this study was to evaluate the relationship between socio-demographic characteristics of caregivers and the oral health of their children infected with human immunodeficiency virus (HIV+) compared to a group of HIV-children and their caregivers. METHODS: One hundred forty HIV+ and 140 healthy two- to five-year-old children and their caregivers who sought care at hospitals in Rio de Janeiro, Brazil, participated. Caregivers were interviewed for sociodemographic characteristics, and knowledge and attitudes regarding oral health. The decayed, missing and filled primary teeth (dmft) index was obtained for the children. Chi-square and Mann-Whitney tests were used (five percent significance level). Content analysis method was used for qualitative evaluation. RESULTS: Most interviewees were mothers (83.6 percent), did no work outside the home (69.3 percent), had low educational status (47.1 percent), and were born in the South/Southeast regions of Brazil (83.6 percent). The mean dmft was 3.48±3.14 for the HIV+ group and 1.02±1.00 for the healthy children. Oral care was reported as important by 54.1 percent of the caregivers. Those who didn't consider oral care important had never received information about oral health (P<0.01). Caregivers born in the North/Northeast regions took their children to the dentist less frequently than mothers born in other areas (P=0.02). Low educational status influenced the attitudes about oral health (P<0.01), irregular dental visits for the children (P<0.01), and the dmft index (P<0.01). CONCLUSION: Caregivers' low educational status and birthplace influenced the importance given to HIV+ children's oral health as well as the oral health knowledge and practices for both HIV+ and healthy children.

Role of Candida species from HIV infected children in enamel caries lesions: an in vitro study.

OBJECTIVES: This study analyzed the capacity of Candida spp. from dental biofilm of HIV infected (HIV+) children to demineralize primary molar enamel in vitro by Transversal Microhardness (TMH), Polarized Light Microscopy (PLM) and the quantity of calcium ions (Ca2+) released from the enamel. MATERIAL AND METHODS: Candida spp. samples were isolated from the supragingival biofilm of HIV+ children. A hundred and forty (140) enamel blocks were randomly assigned to six groups: biofilm formed by C. albicans (Group 1); mixed biofilm formed by C. albicans and C. tropicalis (Group 2); mixed biofilm formed by C. albicans and C. parapsilosis (Group 3); mixed biofilm formed by C. albicans, C. parapsilosis and C. glabrata (Group 4); biofilm formed by C. albicans ATCC (Group 5) and medium without Candida (Group 6). Enamel blocks from each group were removed on days 3, 5, 8 and 15 after biofilm formation to evaluate the TMH and images of enamel were analyzed by PLM. The quantity of Ca2+ released, from Groups 1 and 6, was determined using an Atomic Absorption Spectrophotometer. The SPSS program was used for statistical analysis and the significance level was 5%. RESULTS: TMH showed a gradual reduction in enamel hardness (p<0.05) from the 1st to 15th day, but mainly five days after biofilm formation in all groups. The PLM showed superficial lesions indicating an increase in porosity. C. albicans caused the release of Ca2+ into suspension during biofilm formation. CONCLUSION: Candida species from dental biofilm of HIV+ children can cause demineralization of primary enamel in vitro.

Role of Candida species from HIV infected children in enamel caries lesions: an in vitro study

Abstract Objectives This study analyzed the capacity of Candida spp. from dental biofilm of HIV infected (HIV+) children to demineralize primary molar enamel in vitro by Transversal Microhardness (TMH), Polarized Light Microscopy (PLM) and the quantity of calcium ions (Ca2+) released from the enamel. Material and Methods Candida spp. samples were isolated from the supragingival biofilm of HIV+ children. A hundred and forty (140) enamel blocks were randomly assigned to six groups: biofilm formed by C. albicans (Group 1); mixed biofilm formed by C. albicans and C. tropicalis (Group 2); mixed biofilm formed by C. albicans and C. parapsilosis (Group 3); mixed biofilm formed by C. albicans, C. parapsilosis and C. glabrata (Group 4); biofilm formed by C. albicans ATCC (Group 5) and medium without Candida (Group 6). Enamel blocks from each group were removed on days 3, 5, 8 and 15 after biofilm formation to evaluate the TMH and images of enamel were analyzed by PLM. The quantity of Ca2+ released, from Groups 1 and 6, was determined using an Atomic Absorption Spectrophotometer. The SPSS program was used for statistical analysis and the significance level was 5%. Results TMH showed a gradual reduction in enamel hardness (p<0.05) from the 1st to 15th day, but mainly five days after biofilm formation in all groups. The PLM showed superficial lesions indicating an increase in porosity. C. albicans caused the release of Ca2+ into suspension during biofilm formation. Conclusion Candida species from dental biofilm of HIV+ children can cause demineralization of primary enamel in vitro.

Candida species from oral cavity of HIV-infected children exhibit reduced virulence factors in the HAART era.

This study aimed to assess, in vitro, the biofilm viability and the phospholipase and protease production of Candida spp. from the saliva of HIV infected children and healthy controls, and to correlate the results with the use of medical data. A total of 79 isolates were analyzed: 48 Candida albicans isolates (33/15) and 20 Candida parapsilosis sensu lato complex isolates (12/8) (from HIV/control patients, respectively), and 8 Candida krusei, 1 Candida tropicalis, 1 Candida dubliniensis and 1 Candida guilliermondii from HIV patients. The XTT (2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-Carboxanilide) reduction assay analyzed the biofilm viability. Phospholipase and protease assays were performed using the egg yolk and Bovine Serum Albumin agar plate methods, respectively. All isolates were able to form biofilm with cell viability. Quantitatively, Candida isolates from both groups presented a similar ability to form biofilm (p > 0.05). The biofilm viability activity was higher in C. albicans isolates than in non-albicans Candida isolates (p < 0.05) for both groups. Phospholipase activity was detected in 32 isolates (40.5%) and it was significantly higher in the HIV group (p = 0.006). Protease activity was detected in 66 isolates (84.8%) and most of them were relatively/very strong producers. No statistical association with medical data was found in the HIV group. Although Candida spp. isolates from HIV-positive children presented higher phospholipase production, in vitro they exhibited reduced virulence factors compared to isolates from healthy individuals. This finding may enlighten the role played by immunosuppression in the modulation of Candida virulence attributes.

Demineralizing potential of dental biofilm added with Candida albicans and Candida parapsilosis isolated from preschool children with and without caries.

This study aimed to investigate the demineralizing potential of dental biofilm added of Candida albicans (CA) and Candida parapsilosis (CP), isolated from preschoolers with and without caries. Bovine enamel blocks (n = 48), with initial hardness = 341.50 ± 21,83 kg/mm2 were fixed in 24 well plates containing culture media. A pool of children saliva (PHS) was the inoculum for biofilm formation in the presence or absence of isolated CA or CP in accordance with each group (G n = 8): G1 - PHS; G2 - PHS + CA isolated from children with caries; G3 - PHS + CP isolated from children with caries; G4 - PHS + CA isolated from children without caries; G5 - PHS + CP isolated from children without caries; and G6 - blank control. The plates were incubated at 37 °C for 5 days, with daily changes of culture media. The microhardness loss percentage (MHL%) of the blocks was calculated, taking in account the hardness values before and after the experiment. Dental biofilm became more cariogenic, independently of the isolated Candida species. The highest MHL% was observed in G4 (85.90 ± 8.72%) and G5 (86.13 ± 6.74%) compared to the others (p < 0.001): G1 (34.30 ± 14,30%) < G2 (59.40 ± 10.56%) and G3 (65.80 ± 6.36%) < G6 (13.68 ± 4.86%) (p < 0.001). C. albicans and C. parapsilosis isolates induced the demineralization of the dental enamel.