Salivary Cortisol and Sustained Auditory Attention in Children with and without Cleft Lip and Palate

Abstract Introduction Cortisol is a hormone involved in the response to stress. Attention is a function that can change due to exposure to stress. Objectives To verify the correlation between the level of salivary cortisol and sustained auditory attention in children with cleft lip and palate, as well as to compare the results of the variables analyzed between female and male patients. Methods In total, 103 children aged 6 to 11 years, were divided into 2 groups: those with cleft lip and palate (experimental group, EG; n = 69) and the control group (CG; n = 34). The Sustained Auditory Attention Ability Test (SAAAT) and salivary cortisol levels, measured by an enzyme immunoassay kit (Salimetrics, Stage College, PA, US), were calculated and compared regarding the two groups. The statistical tests used were the Mann-Whitney test and the Spearman correlation. Results The median level of salivary cortisol was of 0.03615 μl/dL and 0.18000 μl/dL respectively for the EG and CG, with a significant difference between the groups (p =0.000). Absence of statistical significance (total error score = 0.656; vigilance decrement = 0.051) was observed the for SAAAT among the EG (median total error score = 12.00; 25th percentile [25%] = 7.00; 75th percentile [75%] = 21.00; and vigilance decrement = 1.00; 25% = 0.00; 75% = 2.50) and the CG (median total error score = 12.00; 25% = 6.00; 75% = 24.00; and vigilance decrement = 0.00; 25% = -1.00; 75% = 2.00). Conclusion All children had median levels of salivary cortisol and scores for sustained auditory attention within normal parameters. A significant correlation between the level of salivary cortisol and the ability to sustain auditory attention was observed in children without cleft lip and palate. There were no differences regarding the SAAAT and salivary cortisol between female and male patients.

Salivary Cortisol and Sustained Auditory Attention in Children with and without Cleft Lip and Palate.

Introduction Cortisol is a hormone involved in the response to stress. Attention is a function that can change due to exposure to stress. Objectives To verify the correlation between the level of salivary cortisol and sustained auditory attention in children with cleft lip and palate, as well as to compare the results of the variables analyzed between female and male patients. Methods In total, 103 children aged 6 to 11 years, were divided into 2 groups: those with cleft lip and palate (experimental group, EG; n = 69) and the control group (CG; n = 34). The Sustained Auditory Attention Ability Test (SAAAT) and salivary cortisol levels, measured by an enzyme immunoassay kit (Salimetrics, Stage College, PA, US), were calculated and compared regarding the two groups. The statistical tests used were the Mann-Whitney test and the Spearman correlation. Results The median level of salivary cortisol was of 0.03615 µl/dL and 0.18000 µl/dL respectively for the EG and CG, with a significant difference between the groups ( p = 0.000). Absence of statistical significance (total error score = 0.656; vigilance decrement = 0.051) was observed the for SAAAT among the EG (median total error score = 12.00; 25th percentile [25%] = 7.00; 75th percentile [75%] = 21.00; and vigilance decrement = 1.00; 25% = 0.00; 75% = 2.50) and the CG (median total error score = 12.00; 25% = 6.00; 75% = 24.00; and vigilance decrement = 0.00; 25% = -1.00; 75% = 2.00). Conclusion All children had median levels of salivary cortisol and scores for sustained auditory attention within normal parameters. A significant correlation between the level of salivary cortisol and the ability to sustain auditory attention was observed in children without cleft lip and palate. There were no differences regarding the SAAAT and salivary cortisol between female and male patients.

Dental anomalies in non-syndromic orofacial clefts: A clinical approach.

Orofacial clefts (OC) represent some of the most common congenital malformations and affect multiple structures in the craniofacial region. There are a wide range of morphological OC types within the spectrum of both non-syndromic OC (NSOC) and syndromic OC, including cleft lip (CL), cleft lip and palate, (CLP), and cleft palate (CP). Here, we describe the most frequent dental anomalies seen in the permanent dentition of individuals with NSOC, comparing them between the three main cleft types (CL, CLP, and CP). We present these findings from the perspective of prevalence relating to each anomaly, as well as the clinical characteristics and potential impact on the rehabilitation process. The investigation of dental anomalies associated with NSOC is important, helping to expand the phenotypic characterization of NSOC, improve the initial diagnostics, and establish appropriate rehabilitation and counseling.

Tooth Abnormalities and Occlusal Disorders in Individuals With Frontonasal Dysplasia.

OBJECTIVE: Frontonasal dysplasia is a rare developmental defect of the midface, and little is known about the dental involvement in individuals with this condition. This study investigated tooth abnormalities and occlusal disorders in individuals with frontonasal dysplasia. DESIGN: Cross-sectional. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil. INTERVENTIONS: Clinical oral examination, analysis of patient records, and panoramic radiographs. PARTICIPANTS: A total of 20 individuals with frontonasal dysplasia aged 7 to 17 years. MAIN OUTCOME MEASURES: Prevalence of the several tooth abnormalities and occlusal disorders analyzed. RESULTS: A total of 19 individuals presented at least one tooth abnormality, with highly variable findings. In radiographs, 20% of individuals (all presenting oral clefts) presented agenesis of lateral incisors and second premolars. No supernumerary teeth were observed; 65% of individuals exhibited occlusal alterations, especially anterior open bite in the two individuals with median cleft lip. CONCLUSIONS: Variable clinical and radiographic alterations were observed, probably due to the large variety of phenotypic characteristics. No specific dental alteration could be related with frontonasal dysplasia.

Aplicação do Nursing Activities Score em unidade semi-intensiva especializada: construção e validação de um tutorial / Application of the Nursing Cctivities Score in specialized semi-intensive unit: construction and validation of a tutorial

Objetivo: apresentar a validação de um tutorial referente à aplicação do Nursing Activities Score (NAS) emUnidade de Cuidado Semi-intensivo especializada. Método: estudo descritivo, de validação, realizado porjuízes por meio da Técnica Delphi quanto à abrangência, clareza e pertinência. Para avaliar a concordânciaentre os juízes foi utilizado o Índice de Validade de Conteúdo de 90%. Resultados: participaram sete juízes ea validação do tutorial compreendeu dois ciclos. Em relação à avaliação dos itens, os Índices de Validade deConteúdo referentes à abrangência, clareza e pertinência foram respectivamente de: primeira avaliação -0,78; 0,79 e 0,89; segunda avaliação - 0,98; 0,97 e 1,00. O percentual de concordância foi de 82% na primeiraavaliação e 98% na segunda avaliação. Conclusão: a construção e validação do tutorial contribuíram parauniformizar e facilitar a aplicação do instrumento, tornando mais fidedigna à mensuração da carga detrabalho de enfermagem.(AU)

Objective: to present the validation of a tutorial on the application of the Nursing Activities Score (NAS) in specialized Semi-Intensive Care Unit. Method: a descriptive study, of validation, conducted by judges through the Delphi Technique regarding the comprehensiveness, clarity and relevance. For evaluating the agreement among the judges, a 90% Content Validity Index was used. Results: seven judges participated and the tutorial validation comprised two cycles. Regarding the assessment of the items, the Content Validity Indices relating to the scope, clarity and relevance were respectively: first assessment - 0.78, 0.79 and 0.89; second evaluation - 0.98, 0.97 and 1.00. The percentage of agreement was 82% in the first evaluation and 98% in the second evaluation. Conclusion: the tutorial construction and validation contributed to standardize and facilitate the implementation of the instrument, making it more reliable to measure the nursing workload. (AU)

Objetivo: presentar la validación de un tutorial sobre la aplicación del Nursing Activities Score (NAS) en la Unidad de Cuidado Semi-Intensivo especializada. Método: estudio descriptivo, de validación, llevado a cabo por los jueces a través de la técnica Delphi cuanto al alcance, claridad y relevancia. Para evaluar el acuerdo entre los jueces se utilizó el Índice de Validez de Contenido de 90%. Resultados: participaron siete jueces y la validación del tutorial fue compuesto por dos ciclos. En cuanto a la evaluación de los artículos, los índices de validez de contenido relacionados con el alcance, claridad y relevancia fueron, respectivamente: primera evaluación - 0,78, 0,79 y 0,89; segunda evaluación - 0,98, 0.97 y 1.00. El porcentaje de acuerdo fue del 82% en la primera evaluación y el 98% en la segunda evaluación. Conclusión: la construcción y validación del tutorial contribuyeron a normalizar y facilitar la aplicación del instrumento, por lo que es más fiable para medir la carga de trabajo de enfermería.(AU)

Impact of promoting self-care in nursing workload.

OBJECTIVES: To assess the impact of promoting self-care in nursing workload and associate it to the variables: age, gender, socioeconomic status, education, marital status and number of children of caregivers. METHODS: Prospective study with 31 children and their caregivers. Participants were assessed at two moments, 1st and 2nd hospitalization, the nursing workload was measured by the Nursing Activities Score (NAS). RESULTS: The mean NAS in the 1st hospitalization was 60.9% and in the 2nd hospitalization was 41.6%, that is, 14.6 and 9.9 hours of nursing, respectively. The nursing workload on the first day of hospitalization was higher compared to the last day, both for the 1st (p<0.001) and for the 2nd hospitalization (p<0.001), and higher in the first (p<0.001) and in the last day (p=0.025) in the 1st hospitalization. Comparing the 1st hospitalization to the 2nd hospitalization, the first was higher (p<0.001), and NAS items related to the training of self-care was influenced (p<0.001). CONCLUSION: The nursing workload associated to self-care promotion corresponded to 14.6 hours and was higher than determined by the existing legislation. OBJETIVOS: Verificar o impacto da promoção do autocuidado na carga de trabalho de enfermagem e associá-la às variáveis: idade, gênero, classificação socioeconômica, escolaridade, estado civil e número de filhos dos cuidadores. MÉTODO: Estudo prospectivo, onde participaram 31 crianças e seus respectivos cuidadores. Os participantes foram avaliados em dois momentos, 1ª e 2ª internação, quanto à carga de trabalho de enfermagem mensurada por meio do Nursing Activities Score (NAS). RESULTADOS: A média NAS na 1ª internação foi de 60,9%, e na 2ª internação foi de 41,6%, ou seja, 14,6 e 9,9 horas de enfermagem, respectivamente. A carga de trabalho de enfermagem no primeiro dia de internação foi maior quando comparada ao último dia, tanto na 1ª (p<0,001) como na 2ª internação (p<0,001), e maior no primeiro (p<0,001) e último dia (p=0,025) na 1ª internação. Ainda, na 1ª internação, foi maior quando comparada à 2ª internação (p<0,001), e os itens NAS referentes à capacitação do autocuidado a influenciaram (p<0,001). CONCLUSÃO: A carga de trabalho de enfermagem referente à promoção do autocuidado correspondeu a 14,6 horas e foi superior ao determinado pela legislação existente.

Impact of promoting self-care in nursing workload / Impacto de la promoción del autocuidado en la carga laboral de enfermería / Impacto da promoção do autocuidado na carga de trabalho de enfermagem

Abstract OBJECTIVES To assess the impact of promoting self-care in nursing workload and associate it to the variables: age, gender, socioeconomic status, education, marital status and number of children of caregivers. METHODS Prospective study with 31 children and their caregivers. Participants were assessed at two moments, 1st and 2nd hospitalization, the nursing workload was measured by the Nursing Activities Score (NAS). RESULTS The mean NAS in the 1st hospitalization was 60.9% and in the 2nd hospitalization was 41.6%, that is, 14.6 and 9.9 hours of nursing, respectively. The nursing workload on the first day of hospitalization was higher compared to the last day, both for the 1st (p<0.001) and for the 2nd hospitalization (p<0.001), and higher in the first (p<0.001) and in the last day (p=0.025) in the 1st hospitalization. Comparing the 1st hospitalization to the 2nd hospitalization, the first was higher (p<0.001), and NAS items related to the training of self-care was influenced (p<0.001). CONCLUSION The nursing workload associated to self-care promotion corresponded to 14.6 hours and was higher than determined by the existing legislation.

Resumen OBJETIVOS Verificar el impacto de la promoción del autocuidado en la carga laboral de enfermería y asociarla con las variables: edad, género, clasificación socioeconómica, escolaridad, estado civil y número de hijos de los cuidadores. MÉTODO Estudio prospectivo, en el que participaron 31 niños y sus respectivos cuidadores. Los participantes fueron evaluados en dos momentos, 1ª y 2ª hospitalización, en cuanto a la carga laboral de enfermería medida por medio del Nursing Activities Score (NAS). RESULTADOS El promedio NAS en la 1ª hospitalización fue del 60,9% y, en la 2ª, fue del 41,6%, es decir, 14,6 y 9,9 horas de enfermería, respectivamente. La carga de trabajo de enfermería el primer día de hospitalización fue mayor cuando comparada con el último día, tanto en la 1ª (p<;0,001) como en la 2ª hospitalización (p<;0,001), y mayor el primero (p<;0,001) y último día (p=0,025) en la 1ª hospitalización. En la 1ª hospitalización fue aún mayor cuando comparada con la 2ª hospitalización (p<;0,001), y los ítems NAS referentes a la capacitación del autocuidado la influenciaron (p<;0,001). CONCLUSIÓN La carga laboral de enfermería referente a la promoción del autocuidado correspondió a 14,6 horas y fue superior a lo determinado por la legislación existente.

Resumo OBJETIVOS Verificar o impacto da promoção do autocuidado na carga de trabalho de enfermagem e associá-la às variáveis: idade, gênero, classificação socioeconômica, escolaridade, estado civil e número de filhos dos cuidadores. MÉTODO Estudo prospectivo, onde participaram 31 crianças e seus respectivos cuidadores. Os participantes foram avaliados em dois momentos, 1ª e 2ª internação, quanto à carga de trabalho de enfermagem mensurada por meio do Nursing Activities Score (NAS). RESULTADOS A média NAS na 1ª internação foi de 60,9%, e na 2ª internação foi de 41,6%, ou seja, 14,6 e 9,9 horas de enfermagem, respectivamente. A carga de trabalho de enfermagem no primeiro dia de internação foi maior quando comparada ao último dia, tanto na 1ª (p<0,001) como na 2ª internação (p<0,001), e maior no primeiro (p<0,001) e último dia (p=0,025) na 1ª internação. Ainda, na 1ª internação, foi maior quando comparada à 2ª internação (p<0,001), e os itens NAS referentes à capacitação do autocuidado a influenciaram (p<0,001). CONCLUSÃO A carga de trabalho de enfermagem referente à promoção do autocuidado correspondeu a 14,6 horas e foi superior ao determinado pela legislação existente.

Three-dimensional digital evaluation of dental arches in infants with cleft lip and/or palate.

The aim of this study was to measure and compare the dimensions of the dental arches on three-dimensional digital study models in children with and without cleft lip and palate before the primary surgery. The sample consisted of 223 digital models of children aged 3-9 months, divided into 5 groups: without craniofacial deformities, unilateral and bilateral incomplete cleft lip and alveolus, unilateral and bilateral complete cleft lip and alveolus, unilateral cleft lip and palate, and bilateral cleft lip and palate. Dental casts of the maxillary dental arches of the children were used. The dental casts underwent a process of scanning through 3D scanner and the measurements used for the correlation among groups were made on the scanned images. Statistical analysis was performed by t test and ANOVA followed by Tukey test. The results showed that the intercanine distance and anterior cleft width was wider in children with unilateral cleft lip and palate. The intertuberosity distances and posterior cleft width was wider in children with bilateral cleft lip and palate among the groups. Children with cleft lip and palate before the primary surgery had wider maxillary arch dimensions than the children without cleft lip and palate.

Three-dimensional Digital Evaluation of Dental Arches in Infants with Cleft Lip and/or Palate

The aim of this study was to measure and compare the dimensions of the dental arches on three-dimensional digital study models in children with and without cleft lip and palate before the primary surgery. The sample consisted of 223 digital models of children aged 3-9 months, divided into 5 groups: without craniofacial deformities, unilateral and bilateral incomplete cleft lip and alveolus, unilateral and bilateral complete cleft lip and alveolus, unilateral cleft lip and palate, and bilateral cleft lip and palate. Dental casts of the maxillary dental arches of the children were used. The dental casts underwent a process of scanning through 3D scanner and the measurements used for the correlation among groups were made on the scanned images. Statistical analysis was performed by t test and ANOVA followed by Tukey test. The results showed that the intercanine distance and anterior cleft width was wider in children with unilateral cleft lip and palate. The intertuberosity distances and posterior cleft width was wider in children with bilateral cleft lip and palate among the groups. Children with cleft lip and palate before the primary surgery had wider maxillary arch dimensions than the children without cleft lip and palate.

O propósito deste trabalho foi mensurar e comparar as dimensões dos arcos dentários em modelos digitais tridimensionais de crianças com ou sem fissuras de lábio e palato antes das cirurgias primárias. A amostra foi composta de 223 modelos de gesso de crianças, de 3 a 9 meses, divididas em 5 grupos: sem deformidades craniofaciais, fissura pré-forame incompleta, fissura pré-forame completa, fissura transforame unilateral e fissura transforame bilateral. Modelos de gesso dos arcos dentários superiores das crianças foram utilizados para avaliação. Os modelos passaram por um processo de digitalização, por meio de escâner 3D e as medidas utilizadas para a correlação entre os grupos foram realizadas diretamente nas imagens escaneadas. A análise estatística foi realizada por meio do teste t e ANOVA seguido pelo teste de Tukey. Os resultados mostraram que a distância intercaninos e a amplitude anterior da fissura foram maiores nas crianças com fissura transforame unilateral. A distância intertuberosidades e a amplitude posterior da fissura foi maior nas com fissura transforame bilateral entre os grupos estudados. As crianças com fissura de lábio e palato apresentam as dimensões dos arcos maxilares maiores que as crianças sem fissura labiopalatina antes das cirurgias primárias.

Doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty / Dúvidas de cuidadores de crianças com fissura labiopalatina sobre os cuidados pós-operatórios de queiloplastia e palatoplastia dudas de cuidadores de niños con fisura labiopalatina acerca de los cuidados posoperatorios de queiloplastia y palatoplastia / Dúvidas de cuidadores de crianças com fissura labiopalatina sobre os cuidados pós-operatórios de queiloplastia e palatoplastia

Objective To identify the main doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty. Method Cross-sectional study carried out in a reference hospital, between September and November 2012. The sample was composed of 50 individuals divided in two groups, of which 25 caregivers of children submitted to cheiloplasty, and 25 of children submitted to palatoplasty. The doubts were identified by an interview applied during the preoperative nursing consultation and were then categorized by similarity. Descriptive statistics was used for analysis of the outcomes. Results Concerning cheiloplasty, the doubts were related to feeding (36%), hygiene and healing (24% each), pain and infection (8% each). With regard to palatoplasty, the doubts were related to feeding (48%), hygiene (24%), pain (16%), bleeding (8%) and infection (4%). Conclusion The study evidenced the concern of caregivers in relation to feeding and care of the postoperative wound. .

Objetivo Identificar as principais dúvidas dos cuidadores de crianças com fissura labiopalatina sobre os cuidados pós-operatórios das cirurgias de queiloplastia e palatoplastia. Método Estudo transversal realizado em um hospital de referência, entre os meses de setembro a novembro de 2012. A amostra constou de 50 indivíduos divididos em dois grupos, sendo 25 cuidadores de crianças submetidas à queiloplastia e 25 crianças submetidas à palatoplastia. As dúvidas foram identificadas por meio de entrevista, realizada durante a consulta de Enfermagem pré-operatória, e, posteriormente, foram categorizadas por similaridade. Utilizou-se a análise estatística descritiva para construção dos resultados. Resultados Observou-se que, em relação à queiloplastia, as dúvidas foram sobre alimentação (36%), higienização e cicatrização (24% cada), e dor e infecção (8% cada). Quanto à palatoplastia, as dúvidas se relacionaram à: alimentação (48%), higienização (24%), dor (16%), sangramento (8%) e infecção (4%). Conclusão Evidenciou-se a preocupação dos cuidadores em relação à alimentação e aos cuidados com a ferida pós-operatória. .

Objetivo Identificar las principales dudas de los cuidadores de niños con fisura labiopalatina acerca de los cuidados posoperatorios de las cirugías de queiloplastia y palatoplastia. Método Estudio transversal llevado a cabo en un hospital de referencia, entre los meses de septiembre a noviembro de 2012. La muestra constó de 50 individuos divididos en dos grupos, siendo 25 cuidadores de niños sometidos a la queiloplastia y 25 niños sometidos a la palatoplastia. Las dudas fueron identificadas por medio de entrevista, realizada durante la consulta de Enfermería preoperatoria y, posteriormente, fueron categorizadas por similaridad. Se utilizó el análisis estadístico descriptivo para la construcción de los resultados. Resultados Se observó que, con respecto a la queiloplastia, las dudas fueron acerca de la alimentación (36%), higienización y cicatrización (24% cada), y dolor e infección (8% cada). En cuanto a la palatoplastia, las dudas estuvieron relacionadas con: la alimentación (48%), higienización (24%), dolor (16%), sangrado (8%) e infección (4%). Conclusión Se evidenció la preocupación de los cuidadores con respecto a la alimentación y los cuidados con la herida posoperatoria. .

[Doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty]. / Dúvidas de cuidadores de crianças com fissure labiopalatina sobre os cuidados pósoperatórios de queiloplastia e palatoplastia.

OBJECTIVE: To identify the main doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty. METHOD: Cross-sectional study carried out in a reference hospital, between September and November 2012. The sample was composed of 50 individuals divided in two groups, of which 25 caregivers of children submitted to cheiloplasty, and 25 of children submitted to palatoplasty. The doubts were identified by an interview applied during the preoperative nursing consultation and were then categorized by similarity. Descriptive statistics was used for analysis of the outcomes. RESULTS: Concerning cheiloplasty, the doubts were related to feeding (36%), hygiene and healing (24% each), pain and infection (8% each). With regard to palatoplasty, the doubts were related to feeding (48%), hygiene (24%), pain (16%), bleeding (8%) and infection (4%). CONCLUSION: The study evidenced the concern of caregivers in relation to feeding and care of the postoperative wound.

Prevalence, cause, and location of palatal fistula in operated complete unilateral cleft lip and palate: retrospective study.

OBJECTIVE: To evaluate the prevalence of fistulas after palate repair and analyze their location and association with possible causal factors. DESIGN: Retrospective analysis of patient records and evaluation of preoperative initial photographs. SETTING: Tertiary craniofacial center. PARTICIPANTS: Five hundred eighty-nine individuals with complete unilateral cleft lip and palate that underwent palate repair at the age of 12 to 36 months by the von Langenbeck technique, in a single stage, by the plastic surgery team of the hospital, from January 2003 to July 2007. INTERVENTIONS: The cleft width was visually classified by a single examiner as narrow, regular, or wide. The following regions of the palate were considered for the location: anterior, medium, transition (between hard and soft palate), and soft palate. MAIN OUTCOME MEASURES: Descriptive statistics and analysis of association between the occurrence of fistula and the different parameters were evaluated. RESULTS: Palatal fistulas were observed in 27% of the sample, with a greater proportion at the anterior region (37.11%). The chi-square statistical test revealed statistically significant association (P ≤ .05) between the fistulas and initial cleft width (P = .0003), intraoperative problems (P = .0037), and postoperative problems (P = .00002). CONCLUSIONS: The prevalence of palatal fistula was similar to mean values reported in the literature. Analysis of causal factors showed a positive association between palatal fistulas with wide and regular initial cleft width and intraoperative and postoperative problems. The anterior region presented the greatest occurrence of fistulas.

Tratamento de Brida Lateral Anômala na Síndrome de Pierre Robin: Relato de Caso / Abnormal Lateral Frenulum Treatment in the Pierre Robin Syndrome: Case Report

Apesar da controvérsia existente na literatura a respeito da necessidade de uma faixa mínima de mucosa ceratinizada ao redor de dentes naturais, muitos autores concordam que pelo menos 2mm desse tecido é um pré-requisito essencial para a saúde periodontal, aumentando a resistência do periodonto a danos externos e contribuindo para a estabilização da posição da margem gengival, além de auxiliar na dissipação de forças fisiológicas. O enxerto gengival autógeno livre continua a ser o método mais previsível para se obter aumento da dimensão ápice-coronal de mucosa ceratinizada. Outro fator que conduz à saúde periodontal é a eliminação de inserções musculares como freios ou bridas considerados anormais ou patológicos. Nesse contexto, descreve-se, nesse trabalho, um relato de caso de freio anormal e patológico em uma paciente com 13 anos de idade portadora de fissura pós-forame incisivo e Síndrome de Pirre Robin. O caso foi solucionado. O freio foi eliminado e uma grande quantidade de mucosa ceratinizada foi obtida. Não houve recorrência do freio e não houve perda de mucosa ceratinizada em um ano de acompanhamento. A partir desse caso, pode-se concluir que técnicas simples da Periodontia básica (como enxerto gengiva livre autógeno e frenectomia) podem ser usadas com sucesso na solução de casos complexos.

Despite the polemic about the need of a minimum quantity of attached gingiva around natural teeth, many authors agree that at least 2mm of this tissue is essential to achieve periodontal health. The attached gingiva increases the periodontal resistance to external damage, contributes to the stabilization of the gingival margin, and helps in the physiologic strength dissipation. The free gingival autograft is the most predictable method to gain attached gingiva. Another factor that leads to periodontal health is the elimination of muscle attachments, like frenulum, when they are considered abnormal or pathological. A case report of an abnormal and pathologic frenulum is described in a 13-year-old patient with post foramen cleft and Pierre-Robin Syndrome removed by using frenulectomy, free gingival autograft and deepening of the vestibular trough (vestibuloplasty). The case was solved. The frenulum was eliminated and a great amount of attached gingiva was obtained. There has been no recurrence of the frenulum and no attached gingiva has been lost in 1 year of follow-up. From this case it may be concluded that simple techniques of basic periodontology (Iike free gingival graft and frenulectomy) may be used with success in order to solve complex cases.

Timing and sequence of primary tooth eruption in children with cleft lip and palate.

OBJECTIVE: To determine the timing and sequence of eruption of primary teeth in children with complete bilateral cleft lip and palate. MATERIAL AND METHODS: This cross-sectional study was conducted at the Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo, Bauru, SP, Brazil, with a sample of 395 children (128 girls and 267 boys) aged 0 to 48 months, with complete bilateral cleft lip and palate. RESULTS: Children with complete bilateral clefts presented a higher mean age of eruption of all primary teeth for both arches and both genders, compared to children without clefts. This difference was statistically significant for all teeth, except for the maxillary first molar. Mean age of eruption of most teeth was lower for girls compared to boys. The greatest delay was found for the maxillary lateral incisor, which was the eighth tooth of children with clefts of both genders. Analyzing by gender, the maxillary lateral incisor was the eighth tooth to erupt in girls and the last in boys. CONCLUSION: The results suggest an interference of the cleft on the timing and sequence of eruption of primary teeth.

Timing and sequence of primary tooth eruption in children with cleft lip and palate

OBJECTIVE: To determine the timing and sequence of eruption of primary teeth in children with complete bilateral cleft lip and palate. MATERIAL AND METHODS: This cross-sectional study was conducted at the Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo, Bauru, SP, Brazil, with a sample of 395 children (128 girls and 267 boys) aged 0 to 48 months, with complete bilateral cleft lip and palate. RESULTS: Children with complete bilateral clefts presented a higher mean age of eruption of all primary teeth for both arches and both genders, compared to children without clefts. This difference was statistically signifcant for all teeth, except for the maxillary first molar. Mean age of eruption of most teeth was lower for girls compared to boys. The greatest delay was found for the maxillary lateral incisor, which was the eighth tooth of children with clefts of both genders. Analyzing by gender, the maxillary lateral incisor was the eighth tooth to erupt in girls and the last in boys. CONCLUSION: The results suggest an interference of the cleft on the timing and sequence of eruption of primary teeth.

Oral-facial-digital syndrome type 1: oral features in 12 patients submitted to clinical and radiographic examination.

OBJECTIVE: To evaluate the oral features in individuals with oral-facial-digital syndrome type 1 (OFD 1), previously diagnosed by the Genetic Sector of the Hospital of Rehabilitation of Craniofacial Anomalies of the University of São Paulo (HRAC-USP). DESIGN: Twelve patients with OFD 1 were examined clinically and radiographically; their medical files were also evaluated. RESULTS: Associated oral malformations were observed in all patients (100%). The most frequent findings were tongue hamartomas, multiple buccal frena, asymmetric lips, asymmetric tongue, and bilateral maxillary gingival swelling. Interestingly, atrophy of the maxillary midline frenum was also observed in all the individuals examined. CONCLUSIONS: Several extra and intraoral alterations were observed in patients with OFD 1. The authors suggest the inclusion of atrophy of the maxillary midline frenum as a commonly found characteristic of OFD 1.

Enamel defects in maxillary central incisors of infants with unilateral cleft lip.

OBJECTIVE: To evaluate the presence of enamel alterations in deciduous maxillary central incisors of infants with unilateral cleft lip and alveolar ridge, with or without cleft palate, and to compare the occurrence and location of these alterations between the central incisor adjacent to the cleft and the contralateral incisor. DESIGN: Intraoral clinical examination was performed after tooth cleaning and drying by a single examiner with the aid of a dental mirror, dental probe, and artificial light, with the child positioned on a dental chair. The defects were recorded in a standardized manner according to the criteria of the Modified Developmental Defects of Enamel Index. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies (HRAC) at Bauru, São Paulo, Brazil. PATIENTS: One hundred one infants were evaluated. All were white, of both genders, aged 12 to 36 months and had at least two thirds of the crowns of maxillary incisors erupted. RESULTS: Demarcated opacity was the most common defect at both cleft and noncleft sides, followed by diffuse opacity. The occurrence of hypoplasia at the cleft side was 11.8%. Most defects affected less than one third of the crown. CONCLUSION: The occurrence of enamel defects in deciduous maxillary central incisors of patients with unilateral cleft lip was 42.6%, mainly affecting the cleft side as to both number and severity.

Oral findings in patients with Apert Syndrome

INTRODUCTION: The Apert syndrome is a rare disorder of autosomal dominant inheritance caused by mutations in the FGFR2 gene at locus 10q26; patients with this syndrome present severe syndactyly, exophthalmia, ocular hypertelorism and hypoplastic midface with Class III malocclusion, besides systemic alterations. Most investigations available on the Apert syndrome address the genetic aspect or surgical management, with little emphasis on the oral aspects. OBJECTIVE: to investigate the oral findings, including dental anomalies, ectopic eruption of the maxillary permanent first molars and soft tissue alterations, in subjects with Apert syndrome. MATERIALS AND METHODS: clinical and radiographic examination of nine patients with Apert syndrome, aged 6 to 15 years, not previously submitted to orthodontic or orthognathic treatment. RESULTS: dental anomalies were present in all patients, with one to eight anomalies per individual. The most frequent anomalies were tooth agenesis, mainly affecting maxillary canines, and enamel opacities (44.4 percent for both). Ectopic eruption of maxillary first molars was found in 33.3 percent of patients; lateral palatal swellings were observed in 88.8 percent of patients. CONCLUSIONS: The occurrence of typical lateral palatal swellings agrees with the literature. The high prevalence of dental anomalies and ectopic eruption may suggest a possible etiologic relationship with the syndrome.

INTRODUÇÃO: A síndrome de Apert é um distúrbio raro de herança autossômica dominante causado por mutações no lócus 10q26 do gene FGFR2; pacientes com esta síndrome apresentam sindactilia severa, exoftalmia, hiperteleorbitismo e hipoplasia da face média com má oclusão de Classe III, além de alterações sistêmicas. A maior parte dos estudos disponíveis sobre a síndrome de Apert aborda o aspecto genético ou manejo cirúrgico, com pouca ênfase nos aspectos bucais. OBJETIVO: investigar os achados bucais, incluindo anomalias dentárias, irrupção ectópica dos primeiros molares permanentes superiores e alterações de tecido mole, em indivíduos com síndrome de Apert. MATERIAIS E MÉTODOS: exame clínico e radiográfico de nove pacientes com síndrome de Apert, de 6 a 15 anos de idade, não anteriormente submetidos a tratamento ortodôntico ou ortognático. RESULTADOS: anomalias dentárias estavam presentes em todos os pacientes, com uma a oito anomalias por indivíduo. As anomalias mais freqüentes foram agenesia dentária, principalmente afetando os caninos superiores, e opacidades de esmalte (44,4 por cento para ambos). Foi observada irrupção ectópica dos primeiros molares superiores em 33,3 por cento dos pacientes; foram observados aumentos volumétricos laterais da mucosa palatina em 88,8 por cento dos pacientes. CONCLUSÕES: a ocorrência de aumentos volumétricos laterais típicos da mucosa palatina concorda com a literatura. A alta prevalência de anomalias dentárias e irrupção ectópica pode sugerir uma possível relação etiológica com a síndrome.

Oral health status of children with syndromic craniosynostosis.

OBJECTIVE: To gain more information on the oral health status of subjects with syndromic craniosynostosis. DESIGN: A cross-sectional study. MATERIALS AND METHODS: The present study took place at the Hospital for Rehabilitation of Craniofacial Anomalies of University of São Paulo (HRAC-USP). The sample was 19 patients with syndromic craniosynostosis (10 Apert, 5 Crouzon, 2 Pfeiffer and 2 Saethre-Chotzen), aged 5 to 15 years. An assessment of plaque, caries and gingival indices, and evaluation of the efficacy of toothbrushing was carried out. The measurements included PHP index, dmft and DMFT indices, gingival index, comparison of PHP before and after non-supervised toothbrushing and between individuals with and without severe syndactyly. RESULTS: The patients displayed high plaque index and poor efficacy of toothbrushing, regardless of the presence of severe syndactyly; despite the plaque accumulation, the gingival index was not proportionally high. There was predominance of the D component for the DMFT index, which combined with the need for restorative treatment in 42.1% of the patients indicates poor access to dental care by these patients. CONCLUSIONS: The results show the need for a dental follow-up programme for these patients. Carers should be informed of the importance in aiding these patients during accomplishment of oral hygiene at home.