Impact of the COVID-19 pandemic on the gingival health of children and adolescents with cerebral palsy / Impacto da pandemia do COVID-19 na saúde gengival de crianças e adolescentes com paralisia cerebral

Objective: to evaluate the impact of the COVID-19 pandemic on children and adolescents with cerebral palsy, comparing the gingival condition and the type of dental treatment before and after the interruption of dental care. Material and Methods: the retrospective longitudinal study consisted of 273 participants undergoing Dental Clinic of the AACD (Disabled Child Assistance Association), divided into three groups according to age: Group 1 (G1: 0 to 5 years and 11 months; n=137), Group 2 (G2: 6 to 11 years and 11 months; n=85) and Group 3 (G3: 12 to 17 years and 11 months; n=51). Sociodemographic, data, clinical pattern of cerebral palsy and use of medication were collected, evaluating the gingival condition by the gingival index and the type of dental treatment before the pandemic and during, nine months after the interruption of dental care. Chi-square, Fisher Exact and Kruskal-Wallis (α=5%) tests were used. Results: the groups were homogeneous in terms of sex (p=0.4581), race (p=0.1725), clinical pattern (p=0.3482) and use of antiepileptic drugs (p=0.3509). Regarding the gingival condition, in the period during the pandemic, there was a reduction in the number of participants with Gingival Index scores 0 and 1 and an increase in participants with scores 2 and 3 (p<0.05). As for the procedures performed, the three groups showed a reduction in preventive procedures (p<0.05) and an increase in surgical, periodontal and restorative procedures (p<0.05). Conclusion: it is concluded that the interruption of dental care for nine months during the COVID-19 pandemic in children and adolescents with cerebral palsy had a negative impact on oral health (AU)

Objetivo: avaliar o impacto da pandemia da COVID-19 em crianças e adolescentes com Paralisia Cerebral, comparando a condição gengival e o tipo de tratamento odontológico antes e após a interrupção dos atendimentos odontológicos. Material e Métodos: o estudo longitudinal retrospectivo foi composto por 273 participantes atendidos na Clínica odontológica da AACD (Associação de Assistência à Criança Deficiente), reunidos em três grupos segundo a faixa etária: Grupo 1 (G1: 0 a 5 anos e 11 meses; n=137), Grupo 2 (G2: 6 a 11 anos e 11 meses; n=85) e Grupo 3 (G3: 12 a 17 anos e 11 meses; n=51). Foram coletados dados sociodemográficos, padrão clínico da Paralisia Cerebral e o uso de medicação, avaliando a condição gengival pelo índice gengival e o tipo de tratamento odontológico antes e durante a pandemia, nove meses após a interrupção dos atendimentos. Foram empregados os testes Qui-quadrado, Exato de Fisher e Kruskal-Wallis (α=5%). Resultados: os grupos eram homogêneos quanto ao sexo (p=0,4581), raça (p=0,1725), padrão clínico (p=0,3482) e uso de drogas antiepiléticas (p=0,3509). Com relação à condição gengival, no período Durante Pandemia, observou-se redução no número de participantes com escores Índice Gengival 0 e 1 e aumento de participantes com escores 2 e 3 (p<0,05). Quanto aos procedimentos realizados, os três grupos apresentaram redução de procedimentos preventivos (p<0,05) e aumento dos procedimentos cirúrgicos, periodontal e restaurador (p<0,05). Conclusão: conclui-se que a interrupção do acompanhamento odontológico por nove meses na pandemia da COVID-19 em crianças e adolescentes com PC acarretou impacto negativo na saúde bucal (AU)

Sinais clínicos do transtorno do espectro autista (TEA) para auxiliar o odontopediatra no diagnóstico precoce / Clinical signs of Autistic Spectrum Disorder (ASD) to assist pediatric dentists in early diagnosis

Introdução: O Transtorno do Espectro Autista (TEA) é um distúrbio de desenvolvimento que interfere nas áreas de interação social e comportamental, podendo ser classificado em níveis leve, moderado e severo. Objetivo: Realizar uma revisão de literatura para identificar os sinais presentes em pacientes com esse transtorno, e assim auxiliar os cirurgiões dentistas, principalmente o odontopediatra, no diagnóstico precoce. Revisão de literatura: As primeiras manifestações do TEA aparecem antes dos 36 meses de idade. Um dos sinais clínicos relacionados à interação social são crianças que preferem ficar sozinhas, não participando de brincadeiras. Costumam ser observados sinais de comportamentos repetitivos e interesses restritos, que podem dificultar o convívio social. Atrasos na fala são, frequentemente, o principal sinal observado pelos pais. Alguns questionários de rastreamento de TEA podem ser aplicados pelos profissionais da saúde. Discussão: O cirurgião-dentista, especialmente o odontopediatra, deve estar atento ao desenvolvimento do paciente infantil, verificando a presença de atraso na fala, característica importante do espectro, bem como de desvios de comportamento incompatíveis com a idade ou procedimento odontológico. Na presença de algum sinal do espectro o profissional não deve hesitar em encaminhar para outros profissionais para melhor avaliação. Conclusão: O conhecimento desses sinais por parte dos profissionais de saúde, em especial o odontopediatra, é de fundamental importância para auxiliar no diagnóstico precoce, a fim de minimizar os sintomas e contribuir para o desenvolvimento e integração da criança com TEA na sociedade.

Introduction: Autism Spectrum Disorder (ASD) is a de-velopmental disorder that interferes in the behavioral and social interaction areas, and can be classified into mild, moderate, and severe levels. Aim: To conduct a literature review to identify the signs present in patients with ASD, and thus assist dentists, especially pediatric dentists, in early diagnosis. Literature review: The first manifestations of ASD appear before 36 months of age. One of the clinical signs related to social interaction are children who prefer to be alone, not participating in games. Signs of repetitive behaviors and restricted interests are usually observed, which can hinder social interaction. Speech delays are often the main sign observed by parents. Some ASD screening questionnaires can be applied by healthcare professionals. Discussion:The dentist, especially the pediatric dentist, must be attentive to the development of the patient, verifying the presence of speech delay, an important characteristic of the spectrum, as well as behavioral deviations incom-patible with age or dental procedure. In the presence of some signs of the spectrum, the professional should not hesitate to refer the patient to other professionals for further evaluation. Conclusion: Knowledge of these signs by health professionals, especially pediatric dentists, is of fundamental importance to assist in early diagnosis in order to minimize symptoms and contribute to the development and integration of children with ASD in society.

Perfil dos endodontistas de uma metrópole brasileira quanto ao atendimento odontológico a pacientes com necessidades especiais / Profile of endodontists in a Brazilian metropolis regarding dental care for patients with special needs

O objetivo do estudo foi caracterizar o perfil dos endodontistas do estado de São Paulo, Brasil em relação ao tratamento odontológico depacientes com necessidades especiais (PNE). Um questionário onlinesobre capacitação do profissional e dados sobre o atendimento odontológico de PNEfoi enviado para 3.500 endodontistas registrados no Conselho Regional de Odontologia de São Paulo. Dentre os 138 profissionais que retornaram, 57,2% eram do sexo feminino; 34,8% estavam na faixa etária entre 31e 40 anos; 42,8% tinham entre 11 e20 anos de formados; e 38,4% possuíam 11 a 20 anos de especialidade. Apenas 22,5% eram capacitados para o atendimento de PNE, sendo que desses, 58,1% tiveram apenas aula teórica. Dos que não receberam capacitação na pós-graduação, 80,4% gostariam de ter recebido. Com relação ao interesse em cursos de atendimento a PNE após a especialização, observou-se que apenas 15,9% realizaram algum tipo de curso, a maioria apenas teórico. Em relação às dificuldades durante o atendimento de PNEa "falta de colaboração do paciente durante o atendimento" foi citada por 74,6%, a "insegurança devido àfalta de preparo profissional" por 55,0%. A análise da associação das variáveis pelo teste Qui-quadrado apontou que quanto maior o tempo de formação, menor essa dificuldade (p=0,0415). Os especialistas encontram mais dificuldades comparados aos que tem formação associada (mestrado e doutorado) (p=0,0369). Não houve associação significativa entre as dificuldades e o tipo de instituição de formação(pública ou privada) (p>0,05). O panorama atual da formação do endodontista não contempla o atendimento as pessoas com necessidades especiais (AU).

The aim of this study was to characterize the profile of endodontic professionals from the state of São Paulo, Brazil in relation to dental treatment for patients with special needs (PSN). An online questionnaire on professional training and data on PSN dental care was sent to 3,500 endodontic professionals registered with the São Paulo Regional Dental Council in 2017. Of the 138 returning professionals, 57.2% were female; 34.8% aged 31-40 years; 42.8% had 11-20 years since graduation; 38.4% had 11-20 years of endodontic specialization. Only 22.5% were trained to provide dental care to PSNs and of these, 58.1% had only theoretical classes. Of those who did not receive post-graduation training, 80.4% would like to have received it. Regarding the interest in PSN care courses after specialization, it was observed that only 15.9% performed some type of course, most of them theoretical only. Regarding difficulties during PSN care, "lack of patient collaboration during care" was mentioned by 74.6%, and "insecurity due to lack of professional preparation" by 55.0%. The analysis of the association of variables by the Chi-square test showed that the longer the training time, the lower the difficulty during PSN care (p=0.0415). Specialists find more difficulties compared to those with associated training (masters and doctorate) (p=0.0369). There was no significant association between difficulties in PSN care and typeof HEI (public or private) (p> 0.05). The current panorama of endodontic professional training does not seem to include care for patients with special needs (AU).

Epidemiological profile of patients with disabilities undergoing dental treatment under general anesthesia / Perfil epidemiológico de pacientes com deficiência submetidos a tratamento odontológico sob anestesia geral

Introduction General anesthesia is commonly used in the dental treatment of people with disabilities, anxious or difficult behavior, who need complex and/or extensive treatments. Objective The aim of this study was to evaluate the epidemiological profile of patients with disabilities undergoing dental treatment under general anesthesia by the team of the Dental Unit for Patients with Special Needs of the Federal University of Sergipe. Material and method Through the analysis of 371 dental records of patients assisted between August 2002 and March 2019. Result The analysis showed that 56.1% of patients were male, the most prevalent age group was 11-20 years, and the most frequent medical conditions were intellectual disability, followed by multiple disabilities. Relative to dental procedures, in 94.1% of the patients, it was observed that 4,056 dental extractions were performed and in 52.3% of patients, 1,156 restorations were performed. In 30.2% of patients, total multiple extractions were performed. Radiographic examination was performed in 51.8% of patients. As regards the origin of patients, 58.8% were from municipalities in the state, other than the capital. Return to the service for follow-up and prevention was observed in 38.5% of patients. Conclusion There is great need for early dental intervention, with specific preventive actions for this group of patients, focusing on those from interior regions of the state.

Introdução A anestesia geral é comumente utilizada no tratamento odontológico de pessoas com deficiência, ansiosos ou com difícil comportamento, que necessitem de tratamentos complexos e/ou extensos. Objetivo Avaliar o perfil epidemiológico da pessoa com deficiência submetida a tratamento odontológico sob anestesia geral pela equipe da Unidade de Odontologia para Pacientes com Necessidades Especiais da Universidade Federal de Sergipe. Material e método Através da análise de 371 prontuários de pacientes assistidos entre agosto de 2002 e março de 2019. Resultado Observou-se que 56,1% dos pacientes eram do sexo masculino, que a faixa etária mais prevalente foi de 11-20 anos de idade e que as condições médicas mais frequentes foram a deficiência intelectual, seguida pelas múltiplas deficiências. Quanto aos procedimentos odontológicos, observou-se que em 94,1% dos pacientes foram realizadas 4.056 extrações dentárias e em 52,3% dos pacientes 1.156 restaurações. Em 30,2% dos pacientes foram realizadas extrações múltiplas totais. O exame radiográfico foi realizado em 51,8% dos pacientes. Em relação a procedência dos pacientes, 58,8% eram provenientes de outros municípios do estado, distinto da capital. Os retornos ao serviço para acompanhamento e prevenção foi observado em 38,5% dos pacientes. Conclusão Há uma grande necessidade de intervenção precoce da odontologia, com ações preventivas específicas para esse grupo de pacientes, com enfoque no interior do estado de Sergipe.

Comparison of salivary cytokines levels among individuals with Down syndrome, cerebral palsy and normoactive.

BACKGROUND: Individuals with Down syndrome (DS) present increased susceptibility to infections and high prevalence of periodontal disease. The objective of this study is to evaluate the salivary concentrations of IL-1ß, IL-6, IL-8, IL-10, TNFα and IL-12p70 of DS individuals and compare to cerebral palsy (CP) and normoactive patients (all with gingivitis). MATERIAL AND METHODS: Twenty-two individuals with DS, 24 with CP and 22 normoactive participated in this cross-sectional study. Salivary flow rate, osmolality rate, Oral Hygiene Index, Gingival Index (GI) and salivary inflammatory markers IL-1ß, IL-6, IL-8, IL-10, TNFα and IL-12p70 were evaluated. Shapiro-Wilks, Chi-square, ANOVA One-Way and Kruskal Wallis tests were applied with significance level at 5%. RESULTS: The groups were homogenous for gender, age, and IL12p70 cytokine (p>0.05). GI was significantly higher in DS compared to CP and healthy (p<0.05). CP presented reduced salivary flow and increased osmolality rate. CP showed significantly higher values for TNFα, IL10, and IL6 compared to DS and normoactive (p<0.05). DS and CP presented significantly higher values of IL-1ß and IL8 compared to normoactive (p<0.05). CONCLUSIONS: Individuals with CP have higher risk to develop periodontal disease due to reduced salivary flow rate, increased salivary osmolality rate and elevated TNFα, IL-10, IL-6 compared to DS. Key words:Cytokines, biomarkers, gingivitis, periodontal diseases, Down syndrome, cerebral palsy, saliva.

Quality of life and burden of caregivers of children and adolescents with disabilities.

AIMS: To evaluate the quality of life (QoL) and burden of primary caregivers of children and young adults (PCCYAs) with and without disabilities. METHODS: A cross-sectional study was carried out with sample composed of 336 PCCYAs with cerebral palsy (CP; n = 84), Down syndrome (DS; n = 84), autism spectrum disorder (ASD; n = 84), and without disabilities (control group: CG n = 84), matched by gender and age. The burden of caregivers was assessed with the Zarit Burden Interview (ZBI), whereas QoL was assessed using the WHOQOL-BREF instrument. RESULTS: QoL and burden of CG presented better results compared to groups with disabilities, with the lowest environmental domain of all study groups (P <.001). The prevalence of burden was moderate for PCCAs of groups with disabilities. There was association between all WHOQOL-BREF and ZBI domains and variables age, schooling, occupation and per capita income (Spearman's correlation coefficient, P <.05). There is a negative impact on WHOQOL-BREF, with an increase in the level of burden of PCCAs with disabilities. CONCLUSION: The majority of PCCYAs were unemployed married mothers, with low schooling and health problems. Older caregivers experience even higher burden and greater impact on QoL.

Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy

Background: Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. Material and Methods: The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. Study design: A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1-anticholinergic drugs (n = 18), G2-botulinum toxin injection (n = 16), G3-salivary glands surgery (n = 16), G4-no treatment (n = 42), and G5-non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. Results: No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p < 0.001), lower values of salivary flow rate (p < 0.001), and higher values of osmolality (p < 0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p < 0.001). Conclusions: Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality

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Barriers to Access to Dental Treatment for People with Physical Disabilities in a Brazilian Metropolis

Objective: To evaluate the barriers for accessing dental care for people with physical disabilities. Material and Methods: A cross-sectional study with 191 caregivers of individuals with physical disabilities attending a rehabilitation center in São Paulo, who responded to a questionnaire about information related to barriers (user, caregiver, government and professional) found in dental treatment, visit to the dentist and age of the first dental appointment. Data were collected from medical records regarding age, sex, family income and medical diagnosis of patients. Statistical analysis was performed using the MedCalc for Windows software version 12.3.0. The Chi-square test was applied for heterogeneity, with significance level of 5%. Results: The main barriers identified by caregivers (p<0.0001) were patient fear/anxiety (66.8%), patient requiring accompaniment to access treatment (87.4%), treatment costs (82.7%), lack of treatment at primary health care units (73.3%) and professionals not specialized in dental care for people with physical disabilities (67.0%). It was observed that caregivers of individuals with cerebral palsy reported greater physical barriers for accessing dental treatment compared to caregivers of other diagnoses (p=0.0307). Conclusion: Individuals with physical disabilities face financial constraints, fear of dental treatment, lack of treatment options in public services and, perhaps most importantly, lack of qualified professionals interested in treating such individuals.

Inflammatory markers in saliva as indicators of gingival inflammation in cerebral palsy children with and without cervical motor control.

AIM: To evaluate the relation among gingival inflammation, salivary osmolality, levels of IL-1ß, IL-6, IL-8, TNF-α, and s-IgA concentrations in children with spastic CP with or without cervical motor control in a cross-sectional study. DESIGN: Unstimulated whole saliva and the gingival index were collected in 37 and 34 CP children with and without cervical motor control, respectively. The data were dichotomized as follows: (=0) absence of gingival inflammation and (≥0.1) presence of gingival inflammation. RESULTS: The group without cervical control presented statistically higher mean values of salivary osmolality, s-IgA, and cytokines. In addition, statistically positive correlation between the gingival index and salivary cytokines was observed in the group with cervical control. Salivary osmolality, salivary cytokines, and s-IgA from both groups presented a significant positive correlation. Significant differences (P = 0.00336) in the values of salivary osmolality were observed between the CP individuals with (93.9 ± 32.7) and without gingival inflammation (74.4 ± 16.6). ROC analysis was performed, and values of salivary osmolality >80 indicated a sensitivity of 0.54 and a specificity of 0.79. CONCLUSIONS: Children without cervical motor control presented a more pronounced oral inflammatory status that was characterized by higher levels of cytokines.