Utilização do diamino fluoreto de prata como estratégia para tratamento da cárie na primeira infância em paciente não colaborador: relato de caso / Use of silver diamine fluoride as a strategy for treating early childhood caries in a non-cooperative patient: case report

Objetivo: relatar o uso do diamino fluoreto de prata (DFP) para tratamento da cárie na primeira infância em paciente não colaboradora de 3 anos. Relato do caso: ao exame clínico inicial, realizado com auxílio da estabilização protetora, notou-se que a paciente estava na fase de dentição decídua, possuía excessivo acúmulo de biofilme visível, sem sensibilidade ou qualquer outro sintoma, porém apresentando múltiplas lesões de cárie ativas em todos os dentes, exceto nos incisivos inferiores. Optou-se pelo uso do DFP 30% (Cariestop®) para o tratamento das lesões de cárie e também como alternativa para o manejo do comportamento, que foi classificado usando a Escala Comportamental de Frankl. Já na consulta inicial foi realizada a primeira aplicação, durante 2 minutos, diretamente sobre as lesões cavitadas em dentina dos dentes do hemiarco superior esquerdo, após profilaxia dentária prévia. Na segunda consulta, foi realizada a aplicação do produto nas lesões do hemiarco superior direito, enquanto no terceiro atendimento foi aplicado o DFP nos molares e caninos inferiores. Em todas as consultas foi realizada instrução de higiene bucal e de dieta com a responsável. Resultados: no decorrer do tratamento a paciente apresentou expressiva melhora no comportamento, que havia sido definitivamente negativo na primeira consulta. Ela sentou-se sozinha na cadeira e não precisou da estabilização protetora na última consulta, apresentando comportamento positivo. Verificou-se também a paralisação das lesões de cárie em decorrência do uso do DFP. Conclusão: o uso de DFP para tratamento de lesões cavitadas de cárie em pacientes não colaboradores foi considerado uma estratégia eficaz tanto para paralisação das lesões quanto para auxílio no condicionamento do comportamento.

Objective: to report the use of silver diamine fluoride (SDF) for the treatment of caries in early childhood in a 3-year-old non-collaborating patient. Case report: at the initial clinical examination, performed with protective stabilization, it was verified that the patient was in the primary dentition period, had excessive accumulation of visible biofilm, no dental sensibility or any other symptom, but had multiple active caries lesions in all teeth except the lower incisors. It was decided to use SDF 30% (Cariestop®) for the treatment of caries lesions and also as an alternative for managing behavior, which was classified using the Frankl Behavioral Scale. In the initial consultation, the first application was performed, for 2 minutes, directly on the dentin cavitated lesions of the teeth of the upper left hemiarch, after previous dental prophylaxis. In the second appointment, the product was applied into the lesions on the upper right hemiarch, while in the third visit, the SDF was applied to the lower molars and canines. In all consultations, instructions on oral hygiene and diet were given to the guardian. Results: during the treatment, the patient showed a significant improvement in behavior, which had been definitely negative in the first consultation. She sat alone in the dental chair and did not need protective stabilization at her last visit, showing positive behavior. There was also an arrest of carious lesions due to the use of DFP. Conclusion: The use of SDF for the treatment of cavitated carious lesions in non- collaborating patients was considered an effective strategy both for arresting the lesions and for improving the condition behavior.

NMR-Based Metabolomics Demonstrates a Metabolic Change during Early Developmental Stages from Healthy Infants to Young Children.

The present study aims to identify the salivary metabolic profile of healthy infants and young children, and to correlate this with age, salivary gland maturation, and dentition. Forty-eight children were selected after clinical evaluation in which all intraoral structures were examined. Total unstimulated saliva was collected, and salivary metabolites were analyzed by 1H Nuclear Magnetic Resonance (NMR) at 25 °C. Partial least squares discriminant analysis (PLS-DA), orthogonal PLS-DA (O-PLS-DA), and univariate analysis were used, adopting a 95% confidence interval. The study showed a distinct salivary metabolomic profile related to age and developmental phase. The saliva of children in the pre-eruption teeth period showed a different metabolite profile than that of children after the eruption. However, more evident changes were observed in the saliva profile of children older than 30 months. Alanine, choline, ethanol, lactate, and sugar region were found in higher levels in the saliva of patients before 30 months old. Acetate, N-acetyl sugar, butyrate, caproate, creatinine, leucine, phenylalanine, propionate, valine, succinate, and valerate were found to be more abundant in the saliva of children after 30 months old. The saliva profile is a result of changes in age and dental eruption, and these findings can be useful for monitoring the physiological changes that occur in infancy.

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.

Multidisciplinary conservative management of dental fracture in young patient: case report

The management of fractured permanent teeth due to dental trauma in young patients is a challenge that requires an efficient approach. Objective: Describe a conservative and multidisciplinary treatment of a case of dental trauma in a 13 years-old boy. Case report: At clinical examination was verified enamel and dentin fracture in the left upper central incisor and a fracture with pulp exposure in the right upper lateral incisor, with subgingival extension of its margin at lingual surface, and no swelling or tooth displacement was observed. At radiographic evaluation, no pulp or periradicular disturbances were verified. It was proposed the surgical lengthening of the clinical crown of the right upper lateral incisor for later performing endodontic treatment. It was decided to make direct composite resin restorations in both fractured teeth, instead of doing a prosthetic treatment in the affected lateral incisor, such as the placement of a full ceramic crown, in an attempt to perform a less invasive treatment, mainly due to the age of the patient. At a two years follow-up visit was observed the maintenance of the health of periapical tissues and the absence of clinical alterations. Conclusion: The restorations were kept in good conditions and aesthetics was considered satisfactory by professionals, patient and parents.

Introdução: O manejo de dentes permanentes fraturados por traumatismo dentário em pacientes jovens é desafiador e requer uma abordagem eficiente. Objetivo: Descrever o tratamento conservador e multidisciplinar em um caso de traumatismo dentário de um menino de 13 anos de idade. Relato do caso: Ao exame clínico foi verificada uma fratura de esmalte e dentina no incisivo central superior esquerdo e uma fratura complicada no incisivo lateral superior direito, com extensão subgengival da margem na face palatina, e não foram observados edema ou deslocamento dentário. Ao exame radiográfico, não foram verificadas alterações pulpares ou perirradiculares. Foi proposta realização de aumento da coroa clínica do incisivo lateral superior direito para posterior realização do tratamento endodôntico. Para os dois dentes traumatizados foi proposta a realização de restauração direta com resina composta, proporcionando um tratamento menos invasivo ao incisivo lateral superior direito, ao invés de submetê-lo a um tratamento protético, como a colocação de uma coroa total cerâmica, principalmente devido à pouca idade do paciente. Na visita de dois anos de acompanhamento, observou-se a manutenção da saúde dos tecidos periapicais e ausência de alterações clínicas. Conclusão: As restaurações se mantiveram em boas condições e a estética foi considerada satisfatória pelos profissionais, paciente e pais.

Avaliações salivares em odontopediatria e perfil metabólico in vitro dos Streptococcus mutans / Salivary assessments in pediatric dentistry and in vitro metabolic profile of Streptococcus mutans

O objetivo da presente tese foi analisar características salivares e microbiológicas relacionadas com a cárie dentária em crianças. Para isso, foram realizados três estudos. O primeiro foi uma revisão crítica da literatura que objetivou avaliar se crianças e adolescentes com hiposalivação apresentam mais lesões de cárie do que pacientes com fluxo salivar normal. Através de busca sistemática da literatura, foram selecionados 9 estudos, sendo 5 transversais e 4 coortes. Apenas uma coorte encontrou associação entre baixo fluxo salivar e aumento da presença de cárie, enquanto os outros 8 estudos não observaram essa relação. No entanto, foi observada grande heterogeneidade entre as metodologias, além da ausência de um parâmetro único para definir a hiposalivação nos pacientes abaixo de 18 anos. Dessa forma, não foi encontrada evidência que permita avaliar a associação entre a presença de hiposalivação e aumento na experiência de cárie. O segundo estudo foi uma avaliação clínica objetivando comparar o perfil metabolômico da saliva de bebês no período prédental antes a após a realização de um protocolo de limpeza bucal. Foi feita coleta inicial de saliva total não estimulada, sendo repetida 5 minutos após a limpeza da mucosa bucal com gaze embebida em água filtrada, para posterior análise por Ressonância Magnética Nuclear (RMN). Foi encontrada menor concentração de componentes como lactose, açúcares, acetato e lactato nas amostras após a limpeza da cavidade bucal. Além disso, observou-se maior quantidade de lactose na saliva dos participantes que faziam amamentação exclusiva do que nos bebês que faziam aleitamento misto. Verificou-se que a higienização bucal prévia a coleta salivar foi efetiva na redução da concentração de alguns metabólitos extrínsecos. O terceiro estudo foi um ensaio laboratorial objetivando caracterizar o perfil dos metabólitos de baixo peso molecular secretados pelo crescimento e maturação do biofilme de uma cepa de Streptococcus mutans, usando blocos dentários bovinos selecionados a partir da sua microdureza superficial (354,9 ±8,6 kg/mm2). O crescimento em biofilme (B) foi comparado com a cultura em suspensão celular (SC) durante diferentes períodos (2, 4 e 6 dias). Foram realizadas análises em espectrômetro de RMN de 500 MHz, além da avaliação final da microdureza transversal dos blocos. Verificou-se que o principal metabólito consumido foi a sacarose, sendo o consumo estatisticamente menor em SC-2d do que em B-2d, e no grupo B-6d do que nos grupos B-2d e B-4d. Os principais compostos secretados foram lactato e frutose. Houve maior liberação de lactato no grupo SC-2d do que em B-2d, e em B-6d do que B-4d. A perda mineral dos blocos dentários foi semelhante entre os grupos experimentais (p>0,05). Desse modo, concluise que: (1) não há evidência científica disponível até o momento que permita verificar a associação entre a hiposalivação e a cárie dentária em crianças e adolescentes; (2) a realização de um protocolo de limpeza da mucosa bucal de bebês no período prédental previamente à coleta salivar é capaz de reduzir a concentração de metabólitos extrínsecos; e (3) a atividade metabólica do S. mutans promove o consumo de sacarose e a liberação principalmente de lactato e frutose. (AU)

The aim of this thesis was to analyze salivary and microbiological characteristics related to dental caries in children. For this, three different studies were carried out. The first one was a critical review of the literature that aimed to assess whether children and adolescents with hyposalivation have more dental caries lesions than patients with normal salivary flow. A systematic literature search was performed which 9 studies were selected, 5 cross-sectional and 4 cohorts. Only one cohort found an association between low salivary flow and an increasing in caries presence, while the other 8 studies did not observe this relationship. However, great heterogeneity was observed between the methodologies, in addition to the absence of a single parameter to define hyposalivation in patients under 18 years. Thus, no evidence was found to assess the association between the presence of hyposalivation and increased dental caries experience. The second study was a clinical evaluation aiming to compare the metabolomic profile of the saliva of babies in the pre-dental period before and after performing a mouth cleaning protocol. Initial collection of total unstimulated saliva was performed, being repeated 5 minutes after cleaning the oral mucosa with gauze soaked in filtered water, for further Nuclear Magnetic Resonance (NMR) analysis. The samples were analyzed by Nuclear Magnetic Resonance (NMR). Lower concentrations of components such as lactose, sugars, acetate, and lactate were found in the samples after cleaning the oral cavity. In addition, a higher amount of lactose was observed in the saliva of participants who were exclusively breastfeeding than in babies who were mixed breastfeeding. It was verified that oral hygiene prior to salivary collection was effective in reducing the concentration of some extrinsic metabolites. The third study was a laboratory test aiming to characterize the low molecular weight metabolites profile secreted by the growth and maturation of the biofilm of a strain of Streptococcus mutans, using bovine dental blocks selected from their surface microhardness (354.9 ± 8.6 kg / mm2). The growth in biofilm (B) was compared with that observed in cell suspension (CS) during different periods (2, 4 and 6 days). NMR analyzes were performed on a 500 MHz spectrometer, in addition to the final assessment of the crosssectional microhardness of the blocks. It was found that the main metabolite consumed was sucrose, with statistically lower consumption in CS-2d than in B-2d and in group B6d than in groups B-2d and B-4d. The two main secreted compounds were lactate and fructose. There was a higher lactate release in the CS-2d group than in B-2d and B-6d than in B-4d. The mineral loss of the dental blocks was similar between the experimental groups (p> 0.05). Therefore, it is concluded that: (1) there is no scientific evidence available so far that allows verifying the association between hyposalivation and dental caries in children and adolescents; (2) a protocol for cleaning the oral mucosa of babies in the pre-dental period prior to salivary collection is capable of reducing the concentration of extrinsic metabolites; and (3) the metabolic activity of S. mutans promotes the consumption of sucrose and the release mainly of lactate and fructose. (AU)

Adhesiveness of bulk-fill composite resin in permanent molars submitted to Streptococcus mutans biofilm.

The aim of the present study was to evaluate the microtensile bond strength and the microleakage of a bulk-fill composite resin compared with a conventional incremental composite resin, in permanent molars and under cariogenic challenge using a Streptococcus mutans model. Permanent human third molars (n = 60) with an occlusal cavity of 5×3×2 mm were randomly allocated into four subgroups of restorative treatments: conventional composite resin with (n = 15) and without (n = 15) cariogenic challenge (Z350-E and Z350-C experimental and control groups, respectively), and bulk-fill composite resin with (n = 15) and without (n = 15) cariogenic challenge (Bulk Fill-E and Bulk Fill-C, respectively). Ten specimens from each subgroup were submitted to microtensile strength, and 5, to microleakage. The cariogenic challenge was conducted using the Streptococcus mutans strain (ATCC) for 7 days. The stickers obtained (1 × 1 × 2 mm) were submitted to a microtensile strength test, followed by classification of the fracture mode. Microleakage was performed using a scoring system. The data were analyzed by Kruskal-Wallis and Mann-Whitney tests (p < 0.05). Filtek Z350 XT resin presented higher microtensile bond strength than Bulk Fill resin without (19.02 ± 4.90 and 8.76 ± 3.94MPa, respectively; p < 0.001) and with cariogenic challenge (22.69 ± 7.86 and 13.31 ± 3.38MPa, respectively; p < 0.02). Z350-C and Bulk Fill-C resins presented a higher prevalence of mixed fractures (23 and 14%, respectively) in the specimens submitted to cariogenic challenge than those of the control groups, whereas microleakage was similar (p = 0.85). The conventional composite resin had higher microtensile bond strength than the bulk-fill resin, but both resin types had similar adhesion quality and microfiltration scores.

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.

Longitudinal Evaluation of Salivary Iga-S in Children with Early Childhood Caries Before and After Restorative Treatment.

Background: Our aim was to compare salivary levels of secretory immunoglobulin A (s-IgA) in children with early childhood caries (ECCG) and those who are caries-free (CFG) and verify these levels in a follow-up period after restorative treatment. Materials and methods: We selected 46 systemically healthy children in the complete primary dentition period, who were allocated into two groups: CFG (n = 23) and ECCG (dmf-s > 0; n = 23). Unstimulated whole saliva was obtained at baseline from both groups and during the follow-up period (7 days, 1, 2 and 3 months) in the ECCG group. The s-IgA was measured using an ELISA assay, and total protein was assessed using the Bradford method. We also evaluated the flow rate (mL/min), Streptococcus mutans and Lactobacillus spp. counting using selective media plaques. The data were submitted to statistical analysis using the software SPSS 20.0 (SPSS Inc, IL, USA) with a confidence interval set at 95%. Results: Salivary s-IgA levels were higher in baseline of ECCG than in CFG (p<0.05). No statistically significant differences were observed between s-IgA salivary levels at baseline and the evaluations after dental treatment in ECCG (p>0.05). However, we observed two different changes in s-IgA levels among participants: one group presented s-IgA reduction, and the other group demonstrated its maintenance. It was shown that patients from the ECCG group who presented a reduction in s-IgA levels during follow-up also showed a decrease in Streptococcus mutans and Lactobacillus spp. count (p<0.05), in contrast to patients who did not present this reduction. The flow rate and total protein were similar between groups (p>0.05). Conclusions: The present data support the idea that children with early childhood caries present higher levels of s-IgA in saliva than caries-free children. The restorative dental treatment does not have a significant influence on salivary levels of this immunoglobulin during the follow-up period.

The use of hypnosis in dental care: a literature review

Introduction: Hypnosis is a technique that involves inducing a special state of consciousness in which the conscious mind relaxes while the unconscious mind manifests itself by working the imagination. Objective : To perform a literature review to evaluate the different techniques used to induce hypnosis and the need for its use in dental care, as well as, its results. Sources of data: A bibliographic search was performed in the Google Academic and PubMed databases to identify studies for review. There was no restriction on language or year. Inclusion criteria were studies that addressed the topic of interest. Synthesis of data : Hypnosis aims to improve care by controlling patients' anxiety, fear and phobias. However, its use is little known by patients and professionals in the context of dental treatment. There are two techniques of hypnosis, namely essential hypnosis and hypnosis by object fixation. The main indications are the need to control the patient's fear and anxiety during dental treatment and to prepare the patients before performing surgical procedures. It can be used in association with local anesthetics, but this combination is not essential. Conclusion : Hypnosis can be effective at controlling patients' feelings related to dental care, being the hypnosis by object fixation the most used technique with this purpose. It is considered easy, quick, painless, with low costs and accessible to any dentist who has completed specific training in this field.

Introdução: A hipnose é uma técnica que envolve a indução de um estado especial de consciência em que a mente consciente relaxa enquanto a mente inconsciente se manifesta trabalhando a imaginação. Objetivo : Realizar uma revisão de literatura para avaliar as diferentes técnicas utilizadas para induzir a hipnose e a necessidade de seu uso no atendimento odontológico, bem como, seus resultados. Fontes de dados : Uma pesquisa bibliográfica foi realizada nas bases de dados Google Acadêmico e PubMed para identificar estudos para revisão. Não houve restrição de idioma ou ano. Os critérios de inclusão foram os estudos que abordaram o tema de interesse. Síntese dos dados: A hipnose visa melhorar o atendimento, controlando a ansiedade, o medo e as fobias dos pacientes. Entretanto, seu uso é pouco conhecido pelos pacientes e profissionais no contexto do tratamento odontológico. Existem duas técnicas de hipnose, a saber, hipnose essencial e hipnose por fixação objetal. As principais indicações são a necessidade de controlar o medo e a ansiedade do paciente durante o tratamento odontológico e preparar os pacientes antes de realizar procedimentos cirúrgicos. Pode ser usado em associação com anestésicos locais, mas essa combinação não é essencial. Conclusão : A hipnose pode ser eficaz no controle dos sentimentos dos pacientes relacionados ao atendimento odontológico, sendo a hipnose pela fixação do objeto a técnica mais utilizada para esse fim. É considerado fácil, rápido, indolor, com baixos custos e acessível a qualquer dentista que tenha completado o treinamento específico neste campo.

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.

Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces.

The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.

Transient functional crossbite and lip biting caued by eruption of the first permanent molar: a case report

Introduction: Tooth eruption is a physiological phenomenon that typically causes local changes. Objective: The aim of this paper is to report an unusual functional crossbite and lip biting caused by eruption of the first permanent molar. Case report: A 5-year-old female sought dental treatment with the chief complaint of pain in the posterior region. At the clinical examination, swelling, accumulation of biofilm, local ulceration and severe traumatic tissue inflammation due to eruption of the first permanent lower left molar were observed. Furthermore, functional unilateral crossbite and lip biting were observed. Local hygiene associated with chlorhexidine 0.12% and topical analgesic/anti-inflammatory ointment (Triamcinolone Acetonide) were prescribed for 10 and 7 days, respectively. At 1-month follow up, resolution of local inflammation was observed as well as spontaneous correction of the crossbite and lip biting. Conclusion: Since functional occlusal deviations can be caused by tooth eruption, it is important that dentists are able to diagnose and treat this condition.

Introdução: A erupção dentária é um fenômeno fisiológico que costuma causar alterações locais. Objetivo: Relatar um caso incomum de mordida cruzada transitória e mordedura de lábio causadas pela erupção do primeiro molar permanente. Relato do caso: Uma garota de 5 anos buscou tratamento odontológico com a queixa principal de dor em região posterior inferior. No exame clínico, foram observados edema, acúmulo de biofilme, ulceração local e inflamação por trauma do tecido devido à erupção do primeiro molar permanente inferior esquerdo. Além disso, foram observadas mordida cruzada unilateral funcional e mordedura de lábio. Foi prescrita clorexidina a 0,12% e pomada analgésica/antiinflamatória (Triancinolona Acetonida) tópica por 10 e 7 dias, respectivamente, associada à higiene local na área afetada. No acompanhamento de 1 mês, observou-se a resolução da inflamação local, bem como a correção espontânea da mordida cruzada e da mordedura do lábio. Conclusão: Uma vez que os desvios oclusais funcionais podem ser causados pela erupção dentária, é importante que os profissionais saibam diagnosticar e tratar corretamente esta condição.

Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces

Abstract The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.

Avaliação longitudinal de imunoglobulina A secretória em crianças com cárie após tratamento restaurador / Longitudinal evaluation of secretory immunoglobulin A in children with caries after restorative treatment

A saliva atua diretamente na modulação da ocorrência e progressão da cárie dentária; entretanto a relação entre os níveis de alguns de seus componentes e a doença ainda permanece controversa. Logo, o objetivo do presente estudo foi avaliar os níveis salivares da imunoglobulina A secretória (IgA-s) em pacientes com cárie de acometimento precoce (GC) e livres de cárie (GLC), e verificar esses níveis em um período de acompanhamento após tratamento restaurador no GC. Foram selecionadas crianças sistemicamente saudáveis em período de dentição decídua completa, usando-se os seguintes critérios de exclusão: uso de antibióticos sistêmicos nos 3 meses anteriores, realização de tratamento odontológico restaurador prévio, uso de aparelhos ortodônticos, presença de dentes com necessidade de tratamento pulpar ou exodontia, sangramento gengival espontâneo ou lesão bucal. Os participantes foram alocados em dois grupos: GC (n = 23), com lesões cavitadas em dentina (ceo-s > 0); e GLC (n = 23), com ausência de histórico de doença (ceo-s = 0), inclusive sem presença de mancha branca. Foram obtidas amostras de 1 mL de saliva total não estimulada e o tempo requerido foi registrado para calcular o fluxo salivar. Foi realizada quantificação de proteínas totais, IgA-s, Lactobacillus sp e Streptococcus mutans. Os pacientes do GC receberam tratamento restaurador com resina composta, sendo realizadas coletas de acompanhamento em períodos de 7 dias, 1, 2 e 3 meses pós-tratamento. Observou-se que a média de idade e a distribuição dos gêneros foi similar entre os grupos (p > 0,05, teste Mann­Whitney). O fluxo salivar e a concentração de proteínas totais não diferiram entre os grupos nem durante o acompanhamento no GC (p > 0,05, testes Mann­Whitney e Wilcoxon). Os níveis de IgA-s foram estatisticamente mais elevados no GC (46,89 ± 41,94 µg/mL) do que no GLC (25,40 ± 15,44 µg/mL) (p = 0,03, teste Mann-Whitney). No GC, houve redução da IgA-s durante o acompanhamento, porém essa diferença não foi estatisticamente significativa (p > 0,05, teste Wilcoxon). Foram obtidas amostras de acompanhamento em alguns participantes do GLC, aonde foram observados níveis similares de IgA-s (p > 0,05, teste Wilcoxon). A concentração de Lactobacillus sp foi estatisticamente menor no GLC (p < 0,01, teste Mann-Whitney), havendo redução durante o acompanhamento no GC (p < 0,01, teste Wilcoxon). Houve grande variação interindividual nos níveis de Streptococcus mutans; entretanto, no acompanhamento no GC observou-se redução apenas nos indivíduos que apresentaram diminuição da concentração de IgA-s. Diante do exposto, conclui-se que crianças com cárie de acometimento precoce apresentam níveis mais elevados de IgA-s do que as livres de cárie. Além disso, verificou-se que a redução da IgA-s no período de acompanhamento pós-tratamento no grupo com cárie esteve associada à diminuição dos níveis de Streptococcus mutans (AU)

Saliva acts directly modulating the occurrence and progression of dental caries; however, the relationship between the levels of some components and the disease remains controversial. Therefore, the aim of this study was to evaluate the salivary levels of secretory immunoglobulin A (s-IgA) in children with early childhood caries (ECC) and caries-free (CF), and verify these levels in a followup period after restorative treatment in ECC participants. It were selected systemic health children in complete primary dentition period, with the following exclusion criteria: use of systemic antibiotics in the previous three months, previous restorative dental treatment, use of any orthodontic appliance, presence of tooth with need of pulp treatment or extraction, spontaneous gingival bleeding or oral lesion. The participants were divided into two groups: ECCG (n = 23), with cavitated lesions in dentin (dmf-s > 0); and CFG (n = 23), with no history of dental caries (dmf-s = 0), including without any whit spot. Samples of 1 mL of unstimulated whole saliva were obtained and the required time was recorded to calculate the salivary flow rate. It was quantified the total protein, s-IgA, Lactobacillus sp and Streptococcus mutans. Participants from ECCG received restorative treatment with composite resin, being conducted follow-up collections in 7 days, 1, 2 and 3 months after the treatment. It was observed that mean age and gender distribution were similar in both groups (p > 0.05, Mann-Whitney test). The flow rate and total protein concentration did not differ between groups or between follow-up samples in ECCG (p > 0.05, MannWhitney and Wilcoxon tests). It was found that the s-IgA levels were significantly higher in ECCG (46.89 ± 41.94 µg/mL) than in CFG (25.40 ± 15.44 µg/mL) (p = 0.03, Mann-Whitney test). In ECCG, s-IgA levels decreased during the follow-up, but it was not statistically significant (p > 0.05, Wilcoxon test). Follow-up samples from some patients of CFG were obtained and was verified similar levels of s-IgA (p > 0.05, Wilcoxon test). The concentration of Lactobacillus sp was statistically lower in CFG (p < 0.01, Mann-Whitney test), with a reduction during follow-up in the ECCG (p < 0.01, Wilcoxon test). There were wide interindividual variation in salivary levels of Streptococcus mutans; however, it was observed a reduction during follow-up only in ECC participants that showed a decrease in the concentrations of s-IgA. Thus, it is concluded that early childhood caries children have higher levels of s-IgA than caries-free. Furthermore, it was found that the reduction of s-IgA during follow-up in early childhood caries group was associated with the decrease of Streptococcus mutans levels (AU)

Avaliação de aderência dos estudantes de Odontologia em relação ao controle de infecções / Evaluation of infection control adherence in Dental school students

O objetivo deste estudo foi verificar a aderência às normas de controle de infecção pelo corpo discente da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro (FO/UFRJ). Foram aplicados questionários aos alunos com atividades clínicas, abrangendo: proteção pessoal, barreiras, esterilização, desinfecção, descarte de material, atitudes e conhecimentos. Os resultados foram analisados de forma descritiva. A amostra foi de 169 alunos, 31,4% homens e 68,6% mulheres, com média de idade de 22 anos (± 2,18). A maior parte dos procedimentos de controle de infecções foi executada pela maioria dos alunos. Não houve diferença significativa entre os períodos em relação às condutas. A falta de tempo foi apontada como a causa mais frequente para o não cumprimento das normas.

Métodos de identificação em próteses dentárias: uma revisão de literatura / Methods of denture identification: a review of literature

Sabe-se que a identificação de cadáveres por meio da arcada dentária é de extrema importância nas investigações. Entretanto, quando há ausências dentárias se torna mais complicado. Assim sendo, o presente artigo visa, através de uma revisão de literatura, expor diferentes materiais existentes para identificação de próteses removíveis e as técnicas para implantação desses materiais nas próteses, discutindo vantagens e desvantagens. Contudo, chegou-se a conclusão que, dependendo da prioridade do paciente e do dentista, pode-se escolher certo material, desde ele atenda as expectativas de resistência necessárias para caso de identificação através da prótese dentária.