Comparison of two behavior management techniques used during mandibular block anesthesia among preschool children: a randomized clinical trial.

PURPOSE: To compare the Tell-Show-Do Technique (TSD-T) with Hiding Dental-Needle Technique (HDN-T) based on children's anxiety, pain, and behavior during first-time mandibular block anesthesia. METHODS: A total of 52 children aged 3-5 years who had never received dental anesthesia and had at least one mandibular primary molar requiring extraction or pulpal therapy were included in the study. Children were randomly allocated into two groups: G1: TSD-T (n = 26) and G2: HDN-T (n = 26). This study included two sessions: intervention session (baseline) and control session (7 days after intervention). Facial Image Scale and Wong-Baker Pain Scale were used to evaluate anxiety and pain levels, respectively. Frankl Behavior Scale was used to assess children's behavior. RESULTS: Anxiety and pain levels were not statistically significant between G1 and G2 groups (p > 0.05). Similar results were observed for children's behavior rating (p > 0.05). Higher pain level was associated with younger children (rate ratios (RR) = 0.41; p = 0.016) and negative behavior (RR = 1.11; p < 0.001). On the other hand, in within-groups comparisons, there was a statistical difference in anxiety levels between intervention session and control session (p = 0.032) in G2. CONCLUSIONS: Even though there are no differences in the efficacy of TSD-T compared to HDN-T during first-time mandibular block anesthesia in preschool children in terms of children's anxiety, pain, and behavior, children from the HDN-T group can show reduced dental anxiety levels in the control sessions.

Does previous dental care experience make the child less anxious? An evaluation of anxiety and fear of pain.

PURPOSE: Evidence has shown an inverse correlation between previous dental care experience and anxiety levels in children. This study aimed to determine the prevalence of dental anxiety in Brazilian schoolchildren and to evaluate the association between previous experience with the dentist and anxiety and fear of pain. METHODS: This was a cross-sectional descriptive study carried out in two cities in Brazil with 1191 schoolchildren aged 6-12 years. The data were collected through interviews and clinical examination. The interviews followed the Dental Anxiety Question (DAQ), the Fear of Dental Pain Questionnaire Short Form (S-FDPQ) adapted to children, and some sociodemographic questions. RESULTS: Dental anxiety was more prevalent in the younger group, with a higher prevalence of moderate and severe anxiety. The group with extreme anxiety showed a higher prevalence of extreme fear, whereas the group who did not present anxiety showed a higher prevalence of children with moderate fear of pain. Children who had not visited the dentist showed a higher prevalence of fear and a lot of fear (33.5%) as compared to those who had already experienced dental care (13.9%). The prevalence of severe anxiety and extreme fear of pain was higher in the group of female children aged 6-9 years, and with caries experience (P < 0.001). CONCLUSIONS: The experience with the dentist was associated with less anxiety and fear of pain. The age of the child was a determining factor for changes in their anxiety level. Severe dental anxiety influences fear of pain experienced by the child.

Efficacy of silver diamine fluoride and sodium fluoride in inhibiting enamel erosion: an ex vivo study with primary teeth.

PURPOSE: To assess the efficacy of silver diamine fluoride (SDF) and sodium fluoride (NaF) in inhibiting enamel erosion in primary teeth. METHODS: 80 primary canine teeth were immersed for 24 h in 2% NaF, 10% SDF, or distilled water. Afterward, some of them underwent a 10-min acid challenge using either 1% or 10% citric acid while others did not. Specimens selected for negative controls were immersed in distilled water but not exposed to the acids, whereas those selected for positive controls were not only immersed in distilled water, but also exposed to the acids. Following, 3-mL samples were collected for calcium and phosphorus analysis by an atomic emission spectrometer. RESULTS: 1% acid caused higher phosphorus loss in the positive control group than in the others (no differences between them). Regarding 10% acid, the SDF group showed lower phosphorus loss compared to the positive control and NaF groups. From calcium loss analysis, SDF and NaF groups presented no significant difference when compared to the positive control groups after both acidic challenges. CONCLUSION: Considering phosphorus loss values, 10% SDF seems to be effective in inhibiting enamel erosion after 1% and 10% citric acid challenges, whereas 2% NaF only after 1% citric acid challenge. Regarding calcium loss values, both fluoride agents seem to have no impact on inhibiting enamel erosion after 1% and 10% citric acid challenges.

Psychophysiological correlates of cognitive deficits in family caregivers of patients with Alzheimer Disease.

BACKGROUND: The progressive loss of memory and autonomy of Alzheimer's Disease (AD) patients, together with their characteristic behavioral and psychological symptoms, subjects their family caregivers to chronic stress. Several studies indicate that these caregivers are predisposed to cognitive impairments, but the physiological correlates of these alterations remain to be elucidated. OBJECTIVE: Analyze the effects of chronic stress of family caregivers of AD patients on cognition, cortisol/DHEA ratios and BDNF levels and investigate the relation between these variables. EXPERIMENTAL PROCEDURE: Seventeen family caregivers (64.83 ± 3.64 years) of patients with AD and eighteen non-caregivers (58.29 ± 3.16 years) completed stress, depression and anxiety inventories. Exclusion criteria were current neurological disorders, major unstable medical illnesses, use of medications that could interfere with cognitive or HPA axis function and dementia. Attention, working memory and executive function were assessed with Digit Span and Trail Making tests, and declarative memory was analyzed with the Logical Memory test. Saliva was collected at 8 AM and 10 PM and its cortisol and DHEA levels determined by radioimmunoassay. Serum BDNF levels were measured by sandwich-ELISA. Results were analyzed with independent samples t test, covariance analysis and linear regressions. The statistical significance was set at p<0.05 and all p values were adjusted with Holm's Method. RESULTS: Caregivers showed more stress, depression and anxiety symptoms than non-caregivers, as well as significantly worse performances on attention, working memory and executive function tests. Caregivers also had higher cortisol/DHEA ratios and lower BDNF levels than non-caregivers. Cortisol/DHEA ratios, especially at 10 PM, were negatively related with all cognitive tasks in which caregivers showed impaired performance. On the other hand, the only cognitive task that related with the BDNF level was digit span. CONCLUSIONS: This study showed that caregivers' cognitive impairment is related with alterations on cortisol/DHEA ratios, and that chronic stress experienced by these subjects has the potential to alter their BDNF levels.

Treatment of supernumerary teeth.

AIM: The finding of supernumerary teeth in the oral cavity is a common occurrence, and they are interesting because of their potential to lead to aesthetic and functional alterations. When they are present in the anterior area of the maxilla, they may cause complications, such as late tooth eruption or impaction of the central incisors. They affect from 0.5 to 3.8% of the population, with men being more affected. CASE REPORTS: This article describes two cases of impaction of the permanent maxillary left central incisor, due to the presence of a supernumerary tooth in the parasagittal area of the pre-maxilla, as well as the surgical and orthodontic procedures adopted.

Mutans streptococci oral colonization in 12-30-month-old Brazilian children over a one-year follow-up period.

OBJECTIVES: The infection levels of mutans streptococci were investigated during a one-year follow-up in children aged 12 to 30 months attending school nurseries where a sucrose-rich diet was provided. METHODS: Oral levels of mutans streptococci obtained from 101 children at baseline and after a one-year follow-up were compared by age, number of teeth, feeding habits, and presence of visible plaque at baseline. Baseline predictors and changes in mutans streptococci levels during the study were compared to caries incidence after one year. RESULTS: Fluctuations in mutans streptococci levels during the follow-up period were not related to feeding habits or presence of visible plaque. Mutans streptococci levels increased after one year among children aged 12 to 24 months, while a significantly higher proportion of those aged 25-30 months showed a decrease in mutans streptococci levels during the study. Multiple logistic regression analysis suggested that high levels of mutans streptococci (> or = 100 cfu) at baseline were associated with a higher caries increment, while reduction in mutans streptococci was negatively associated with caries incidence. CONCLUSIONS: Our data suggest that despite early mutans streptococci infection and high exposure to sucrose, mutans streptococci may achieve relatively stable levels after 2 years of age. Heavy colonization by mutans streptococci in an early age was related to an extremely high caries incidence during childhood, while decreasing levels of mutans streptococci can be associated to the decrease in caries activity.

[Abortion among adolescents]. / O aborto entre adolescentes.

For some adolescents, pregnancy means happiness and fulfillment. However, for most of them, it means a sad moment, characterized by fear and despair, as this is an unplanned situation and the abortion seems the only alternative. This retrospective study aimed at finding out the epidemiological profile of the adolescents admitted at the Clériston Andrade General Hospital, in Feira de Santana, Bahia, that were submitted to a curettage from January 1995 to December 1997. The results showed the need for educative programs in order to prevent unplanned pregnancies.

The contribution of immunohistochemistry in the diagnosis of pediatric neoplastic lesions in the University of Puerto Rico, School of Medicine.

Immunohistochemistry has revolutionized the field of diagnostic pathology in the past fifteen years. Since then, it has been increasingly used as an adjunct to morphological diagnosis. The purpose of this retrospective analysis is to examine the value of this technique in the diagnosis of pediatric neoplasias in our laboratory. Forty eight pediatric cases, collected from January 1998 until May 1999, were reviewed, and classified in one of four categories: confirmed the morphological diagnosis, provided the definite diagnosis from a list of probable diagnoses, contributed by excluding other entities, and non-contributory. Immunohistochemistry confirmed the morphological diagnosis in 29 cases (60.4%), provided the definite diagnosis from a list of probable diagnoses in 13 cases (27.1%), was contributory by exclusion of other entities in 2 cases (4.2%), and was non-contributory in 4 cases (8.3%). In this preliminary study, we conclude that immunohistochemistry is being used in our laboratory mostly as a confirmatory tool for the definitive diagnosis of the lesions and once more exalts the utility of this technology in the field of diagnostic pathology.

[Care of women victims of spouse violence from the Heidegger's perspective of the technology world]. / Reflexões sobre o cuidar de mulheres que sofrem violência conjugal em uma perspectiva Heideggeriana do mundo da técnica.

This is concerned with a reflexive text that approaches the subject of the care to women that suffer conjugal violence in an analytic perspective of the world of the technique, developed from conceptions and concepts of Martin Heidegger, contemporary philosopher of phenomenology. The care of women that suffer conjugal violence appears as one that considers values, decision, trust to care, knowledge and care actions and its consequences.

Tratamento das hernias incisionais volumosas pela tecnica de Lazaro de Silva. / Therapy of large incisional hernias by the technic of Lazaro da Silva

Os autores analisam 20 casos de hernia incisional abdominal, tratados pela tecnica de superposicao peritonioaponeurotica proposta por Lazaro da Silva. Descrevem a tecnica e comentam seus resultados imediatos