Issues of recruitment and rationale for conducting clinical trials on mutans streptococci suppression in mothers.

The aims of this study are (1) to describe issues related to recruitment of mothers participating in a clinical trial of transmission of mutans streptococci (MS) from mother to child in Bauru, Brazil and (2) to perform cross-cultural and temporal comparisons of levels of infection of the MS in mothers of Bauru. A total of 1422 mothers were visited at their domiciles. Cutoff levels for the MS were established at ≥10(5) CFU/mL saliva. The main reason for a mother not enrolling was not being highly infected by the MS, yet 76% of mothers presented with levels ≥10(5) CFU/mL saliva. Recent studies in industrialized countries showed a negative coefficient for linear tests indicating significant decline overtime in the levels of MS in mothers. Intercountry comparisons for mothers' salivary levels of the MS with the Bauru study as the reference revealed significant differences with studies conducted in the last two decades.

Early oral rehabilitation of a child with amelogenesis imperfecta / Reabilitação oral precoce de uma criança com amelogênese imperfeita

Amelogenesis imperfecta (AI) is an inherited disorder which results in enamel defects. The main clinical characteristics are extensive loss of tooth tissue, poor esthetics and tooth sensitivity. Early recognition followed by appropriate preventive care and oral rehabilitation is essential in the successful management of AI. This clinical report describes the management of a 3 year-old girl with a hypocalcified type of Al. The patient presented early extensive tissue loss of the superior incisors and molars, with general dentinal sensitivity. The first phase of the treatment was preventive measures to improve dental and periodontal health. On the second phase the anterior teeth were extracted and the molars were endodontic treated and covered with stainless steel crowns. A functional appliance was made to rehabilitate the anterior extracted teeth on the third phase. The performed treatment achieved satisfactory esthetic and function, which resulted in an improvement in the child's quality of life.

Amelogênese imperfeita (AI) é uma doença hereditária que resulta em defeitos no esmalte. As principais características clínicas são a extensa perda de tecido dentário, estética prejudicada devido a coloração acastanhada dos dentes e sensibilidade dentária. O reconhecimento precoce seguido de cuidados preventivos adequados e reabilitação oral é essencial para o êxito nos tratamentos de AI. Este relato de caso clínico descreve o tratamento de uma criança de 3 anos com Al do tipo hipocalcificada. A paciente apresentava inicialmente extensas perdas de tecido nos incisivos superiores e molares, e uma sensibilidade dentinária generalizada. O tratamento reabilitador foi dividido em duas fases, na primeira fase do tratamento foram passadas à mãe e a criança medidas preventivas para melhorar a saúde dental e periodontal. Na segunda fase do tratamento os dentes anteriores foram extraídos e os molares foram tratados endodonticamente e cobertos com coroas de aço. Um aparelho funcional, visando manter o espaço dentário e oferecer uma estética de sorriso à paciente foi feito para reabilitar o arco anterior devido as extrações dentárias. O tratamento realizado foi satisfatório tanto na estética quanto na função, o que resultou em uma melhora na qualidade de vida da criança.

Clinical management for epidermolysis bullosa dystrophica.

Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders in which patients frequently present fragile skin and mucosa that form blisters following minor trauma. More than 20 subtypes of EB have been recognized in the literature. Specific genetic mutations are well characterized for most the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters affecting all the oral surfaces. Dental treatment for patients with EB consists of palliative therapy for its oral manifestations along with typical restorative and periodontal procedures. The aim of this article is to describe two dental clinical treatments of recessive dystrophic EB cases and their specific clinical manifestations. The psychological intervention required during the dental treatment of these patients is also presented.

Surgical removal of an oral pyogenic granuloma and subsequent root coverage with a pedicle graft.

Pyogenic granuloma (PG) is a lesion characterized by non-neoplastic proliferation of endothelial cells, occurring in gingival tissue and representing an excessive reaction of the connective tissue to stimuli or injuries. The purpose of this report was to describe the treatment of an oral pyogenic granuloma, with emphasis on clinical, histopathological, and radiographic aspects. The surgical therapy comprised lesion excision followed by pedicle graft to cover the exposed root surface. The patient's pyogenic granuloma has been under control for a year, and recurrence has not been observed. The permanent teeth erupted correctly and the gingival tissue of both the receptor and donor sites shows a satisfactory clinical appearance.

The importance of radiographic diagnosis of incipient occlusal caries: case report / A importância do diagnóstico radiográfico de cárie oclusal incipiente: relato de caso

The treatment of a large dentine caries, which seemed to be a small pit-and-fissure carious lesion on the occlusal surface of the permanent mandibular right first molar in a 6-year-old boy, is presented. The treatment included the filling of the root canals and the sealing of the cavity with composite resin. Underlying periodontal tissue healing could be radiographically observed at the 14-month follow-up. It is possible that a better visual examination, with careful cleaning and drying of teeth, may improve occlusal caries detection. Dentists should examine bitewing radiographies carefully for occlusal demineralization. As radiographies are probably an effective method of lesions caries diagnosis, they should be recommended at appropriate ages to aid early detection of these lesions.

O tratamento de uma cárie grande do dentine, que pareça ser um lesion carious do poço-e-pit-and-fissure pequeno na superfície occlusal do primeiro molar da direita mandibular permanente em um menino de 6-year-old, é apresentado. O tratamento inclui o enchimento dos canais da raiz e do sealing da cavidade com resina composta. O tecido peridental subjacente que healing podia radiographically ser observado na continuação de 14 mês. É possível que uma examinação visual melhor, com limpeza cuidadosa e secagem dos dentes, pode melhorar a deteção occlusal da cárie. Os dentistas devem examinar radiographies do bitewing com cuidado para o demineralization occlusal. Porque as radiografias são provavelmente um método eficaz do diagnóstico da cárie dos lesions, devem ser recomendados em idades apropriadas ajudar à deteção adiantada desta lesão.

Clinical management for epidermolysis bullosa dystrophica

Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders in which patients frequently present fragile skin and mucosa that form blisters following minor trauma. More than 20 subtypes of EB have been recognized in the literature. Specific genetic mutations are well characterized for most the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters affecting all the oral surfaces. Dental treatment for patients with EB consists of palliative therapy for its oral manifestations along with typical restorative and periodontal procedures. The aim of this article is to describe two dental clinical treatments of recessive dystrophic EB cases and their specific clinical manifestations. The psychological intervention required during the dental treatment of these patients is also presented.

Fluoride concentrations in dental plaque and saliva after the use of a fluoride dentifrice preceded by a calcium lactate rinse.

Plaque fluoride concentrations ([F]) are directly related to plaque calcium concentrations [Ca]. Attempts to increase plaque F uptake from dentifrices or rinses have used methods designed to increase plaque [Ca] but with inconsistent results. This double-blind, double-crossover study tested the effect of a 150 mM calcium lactate rinse used prior to brushing with placebo or fluoridated dentifrices (1030 p.p.m. as NaF) on plaque and salivary [F] and [Ca]. Sixteen children (8-10 yr of age) were randomly assigned to four different groups according to the four treatments (placebo dentifrice or fluoridated dentifrice preceded by calcium lactate or deionized water prerinses). Plaque and saliva were collected 1 and 12 h after brushing on day 7 after starting to use the dentifrices. F was determined using the electrode and Ca was determined using atomic absorption spectrometry. Plaque and salivary [Ca] were not significantly increased after use of the calcium lactate prerinse, except for plaque [Ca] 1 h after the use of the placebo dentifrice. A significant increase in salivary [F] was associated with the calcium lactate prerinse only at 1 h after the use of the fluoridated dentifrice. The the calcium lactate prerinse did not significantly affect plaque [F] under any condition.

Compliance with Xylitol and Sorbitol Chewing Gum Regimens in Clinical Trials.

OBJECTIVE: The purpose of this study was to investigate compliance of long-term xylitol and sorbitol chewing gum regimens in adult women participating in a double-blind randomized controlled clinical trial. DESIGN: The participants included 122 mothers (age range: 16-35 years) residing in the city of Bauru, São Paulo, Brazil. Compliance with the xylitol and sorbitol chewing gum regimens was assessed by weighing, with a precision balance, all used gums returned in zip-lock bags during the study period of 33 months. The total number of returned bags in both chewing gum groups was computed and the differences between groups were determined by one-way ANOVA. Compliance was further categorized into excellent, good, fair or poor based on the distribution of the combined data for both groups by quartiles. These distributions for the xylitol and sorbitol groups were subjected to chi-square analysis. RESULTS: Compliance was always superior for the xylitol group in all categories. These distributions were, however, not significantly different in statistical terms. Average compliance in the xylitol chewing gum group was significantly higher when compared to the sorbitol chewing gum group (p=0.0481). CONCLUSIONS: The results suggest that compliance, and possibly acceptance in this population, was superior for xylitol chewing gum than for sorbitol chewing gum.

On the Acquisition of Periodontopathic Bacteria by Children from Mothers: A Randomized Double-Masked Placebo-Controlled Trial in Bauru, Brazil.

OBJECTIVE: The purpose of this study was two-fold: 1) to determine the effects of mechanical and chemical modalities treatments on periodontal clinical and microbiological parameters of mothers; and 2) to determine the subsequent colonization of periodontal pathogens in tongue samples from their infants. DESIGN: A total of 168 mothers met inclusion criteria to participate in a randomized double-masked placebo-controlled clinical trial. Of those, 121 mothers (and their infants) of 158 seen at baseline provided complete data during study protocols from when their infants were 3 months old until the infants were about 2 years old. Treatments consisted of a combination of xylitol chewing gum, fluoride and chlorhexidine varnishes. The control/placebo group received sorbitol chewing gum and placebo varnishes. The effect of these treatments on periodontal clinical and microbiological parameters of mothers and on microbiological parameters of their infants was assessed by generalized estimating equation models. RESULTS: Microbiological outcomes using the BANA Test were lower for the majority of the visits in the test group when compared to the control/placebo group. These differences, however, were not statistically significant. Similarly, mean PBS results were lower for all follow-up visits for test-group mothers when compared to the control/placebo group's mothers, but of no statistical significance. Colonization of the tongue in infants by periodontal pathogens as measured by the BANA Test showed no distinct patterns concerning the stability of colonization of periodontal pathogens throughout the study period, albeit slightly superior for the test group. CONCLUSIONS: We have demonstrated that a combined chemical modalities treatment consisting of xylitol chewing gum, fluoride varnish and chlorhexidine varnish was moderately superior to control/placebo treatments on periodontal clinical and microbiological parameters of mothers throughout the study period, but of no statistical significance. Similar results were found for the infants in the test group when compared to infants of the control/placebo groups.