Choking, gagging and complementary feeding methods in the first year of life: a randomized clinical trial.

OBJECTIVE: Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. METHODS: Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) - group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05). RESULTS: 130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). CONCLUSION: Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.

Choking, gagging and complementary feeding methods in the first year of life: a randomized clinical trial

Abstract Objective: Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. Methods: Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) — group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05). Results: 130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). Conclusion: Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.

Complementary feeding methods in the first year of life: a study protocol for a randomized clinical trial.

BACKGROUND: The traditional spoon-feeding approach to introduction of solid foods during the complementary feeding period is supported by consensus in the scientific literature. However, a method called Baby-Led Introduction to SolidS (BLISS) has been proposed as an alternative, allowing infants to self-feed with no adult interference. To date, there have been no trials in the Brazilian population to evaluate the effectiveness of BLISS in comparison to the traditional approach. METHODS/DESIGN: To evaluate and compare three different complementary feeding methods. Data on 144 mother-child pairs will be randomized into intervention groups by methods: (A) strict Parent-Led Weaning; (B) strict Baby-Led Introduction to SolidS; and (C) a mixed method. Prospective participants from Porto Alegre, Brazil, and nearby cities will be recruited through the Internet. The interventions will be performed by nutritionists and speech therapists, at 5.5 months of age of the child, at a private nutrition office equipped with a test kitchen where meals will be prepared according to the randomized method. The pairs will be followed up at 7, 9, and 12 months of age. Data will be collected through questionnaires designed especially for this study, which will include a 24h child food recall, questionnaires on the child's and parents' eating behavior, oral habits, eating difficulties, and choking prevalence. At 12 months of age, children will undergo blood collection to measure hemoglobin, ferritin, and C-reactive protein, saliva collection for analysis of genetic polymorphisms, and oral examination. Anthropometric parameters (child and maternal) will be measured at the baseline intervention, at a 9 month home visit, and at the end-of-study visit at the hospital. The primary outcome will be child growth and nutritional status z-scores at 12 months; secondary outcomes will include iron status, feeding behavior, acceptability of the methods, dietary variety, choking, eating behaviors, food preferences, acceptance of bitter and sweet flavors, suction, oral habits, oral hygiene behavior, dental caries, gingival health status, and functional constipation. DISCUSSION: The trial intends to ascertain whether there are potential advantages to the BLISS complementary feeding method in this specific population, generating data to support families and healthcare providers. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC): RBR- 229scm number U1111-1226-9516 . Registered on September 24, 2019.

Erosive tooth wear in an asthmatic child: a case report

Introduction: Erosive tooth wear (ETW) is defined as a mechanical chemical process that results in a cumulative loss of hard tissue without the involvement of bacteria. This process may occur in permanent and deciduous teeth and may also reach the dentin tissue. Patients who report chronic diseases, such as respiratory allergy and bronchial asthma, or recurrent acute diseases, such as tonsillitis, allergic rhinitis, sinusitis, and otitis, commonly use drugs for prolonged periods; thus, more attention should be given to the dental aspects since the drugs may cause undesirable effects. Objective: This paper aims to report and discuss a clinical case of a nine-year-old, male, Caucasian, asthmatic patient who continually uses anti-asthmatic medications and has developed ETW. Case report: According to the patient's needs, oral hygiene instructions (use of fluoride stannous dentifrice, dental floss, and topical fluoride applications), daily use of mouthwash solution containing 0.05% sodium fluoride, and dietary guidance were recommended. Conclusion: An early and accurate diagnosis of ETW lesions and recognition of specific etiological factors allow the professional to elaborate an individualized prevention and control program for ETW progression.

Introdução: O desgaste dentário erosivo é definido como um processo químico mecânico que resulta em uma perda cumulativa de tecido duro, sem o envolvimento de bactérias. Esse processo pode ocorrer em dentes permanentes e decíduos, podendo atingir o tecido dentinário. Pacientes que relatam doenças crônicas, como alergia respiratória e asma brônquica ou doenças agudas recorrentes como amigdalite, rinite alérgica, sinusite e otite, comumente usam medicamentos por períodos prolongados, portanto, mais atenção deve ser dada ao aspecto odontológico, uma vez que os medicamentos podem causar efeitos indesejáveis. Objetivo : Este trabalho tem como objetivo relatar e discutir um caso clínico de um paciente de nove anos, asmático, caucasiano, sexo masculino, que faz uso contínuo de medicamentos anti-asmáticos e desenvolveu o desgate erosivo dentário. Relato do caso: De acordo com as necessidades do paciente foi realizado instruções de higiene oral (uso de dentifrício contendo fluoreto estanhoso, fio dental e aplicações tópicas de flúor). Uso diário de enxaguatório bucal contendo 0,05% de fluoreto de sódio também foi recomendado e orientações dietéticas foram realizadas. Conclusão: O diagnóstico precoce e preciso das lesões de desgaste erosivo e o reconhecimento dos fatores etiológicos específicos permite o profissional elaborar um programa individualizado de prevenção e controle da progressão do desgaste erosivo dentário.

Survival and Factors Associated with Failure of Pulpectomies Performed in Primary Teeth by Dental Students.

Although endodontic treatment is widely recommended for compromised dental pulp, there is no information regarding the factors associated with failures in primary teeth. The aim of this study was to evaluate the survival and factors associated with failure of pulpectomies performed in primary teeth by dental students. The sample comprised patients treated at a University Dental Service and required endodontic treatment in primary teeth. The study investigated treatment-related variables and patient factors potentially associated with treatment failure. Pulpectomy survival was analyzed by Kaplan-Meier estimator followed by log-rank test (p<0.05). The analysis included 81 pulpectomies performed in 62 children (5.6±1.5 years). The survival reached 62.9% up to 12 months follow-up. Most failures occurred in the first 3 months (p<0.001). Teeth with carious lesions at the start of treatment presented more failures than those with restorations or history of trauma (p=0.002). The survival of endodontically treated teeth restored with composite was higher than the ones filled with GIC (p=0.006). Pulpectomy performed in two or more sessions resulted in more failures (p=0.028). Patients presenting gingivitis had more failures in the endodontic treatment (p=0.022). The failures of root canal treatment in primary teeth were more prone to occur in a short time and when the treatment was performed in teeth presenting carious lesions. The use of composite instead of GIC increased the survival of pulpectomies. Repeated sessions for endodontic treatment and lack of oral hygiene habits had a negative effect on the results.

Survival and Factors Associated with Failure of Pulpectomies Performed in Primary Teeth by Dental Students

Abstract Although endodontic treatment is widely recommended for compromised dental pulp, there is no information regarding the factors associated with failures in primary teeth. The aim of this study was to evaluate the survival and factors associated with failure of pulpectomies performed in primary teeth by dental students. The sample comprised patients treated at a University Dental Service and required endodontic treatment in primary teeth. The study investigated treatment-related variables and patient factors potentially associated with treatment failure. Pulpectomy survival was analyzed by Kaplan-Meier estimator followed by log-rank test (p<0.05). The analysis included 81 pulpectomies performed in 62 children (5.6±1.5 years). The survival reached 62.9% up to 12 months follow-up. Most failures occurred in the first 3 months (p<0.001). Teeth with carious lesions at the start of treatment presented more failures than those with restorations or history of trauma (p=0.002). The survival of endodontically treated teeth restored with composite was higher than the ones filled with GIC (p=0.006). Pulpectomy performed in two or more sessions resulted in more failures (p=0.028). Patients presenting gingivitis had more failures in the endodontic treatment (p=0.022). The failures of root canal treatment in primary teeth were more prone to occur in a short time and when the treatment was performed in teeth presenting carious lesions. The use of composite instead of GIC increased the survival of pulpectomies. Repeated sessions for endodontic treatment and lack of oral hygiene habits had a negative effect on the results.

Resumo Embora o tratamento endodôntico seja amplamente recomendado para polpa dentária comprometida, não há informações sobre os fatores associados ás falhas nos dentes decíduos. O objetivo do trabalho foi avaliar a sobrevida e os fatores associados à falha de pulpectomias realizadas em dentes decíduos por estudantes de odontologia. A amostra foi constituída por pacientes atendidos em um Serviço Odontológico Universitário e necessitaram de tratamento endodôntico em dentes decíduos. O estudo investigou variáveis relacionadas ao tratamento e fatores do paciente potencialmente associados à falha do tratamento. A sobrevivência das pulpectomias foi analisada pelas curvas de Kaplan-Meier seguido do teste de log-rank (p<0,05). A análise incluiu 81 pulpectomias realizadas em 62 crianças (5,6 ± 1,5 anos). A sobrevida atingiu 62,9% em até 12 meses de seguimento. A maioria das falhas ocorreu nos primeiros 3 meses (p<0,001). Os dentes com lesões cariosas no início do tratamento apresentaram mais falhas do que aqueles com restaurações ou história de trauma (p = 0,002). A sobrevida de dentes endodonticamente tratados restaurados com compósito foi maior do que os preenchidos com cimento de ionômero de vidro (p = 0,006). Pulpectomias realizadas em duas ou mais sessões apresentaram mais falhas (p = 0,028). Os pacientes com gengivite apresentaram mais falhas no tratamento endodôntico (p = 0,022). As falhas do tratamento do canal radicular em dentes decíduos foram mais propensas a ocorrer em um curto período de tempo e quando o tratamento foi realizado em dentes com lesões cariosas. O uso de compósito em vez de cimento de ionômero de vidro aumentou a sobrevivência pulpectomias. Sessões repetidas para o tratamento endodôntico e a falta de hábitos de higiene bucal tiveram um efeito negativo sobre os resultados.

Incomplete caries removal and indirect pulp capping in primary molars: a randomized controlled trial.

PURPOSE: To compare the effect of incomplete caries removal (ICR) and indirect pulp capping (IPC) with calcium hydroxide (CH) or an inert material (wax) on color, consistency and contamination of the remaining dentin of primary molars. METHODS: This double-blind, parallel-design, randomized controlled trial included 30 children presenting one primary molar with deep caries lesion. Children were randomly assigned after ICR to receive IPC with CH or wax. All teeth were then restored with resin composite. Baseline dentin color and consistency were evaluated after ICR, and dentin samples were collected for contamination analyses using scanning electron microscopy. After 3 months, restorations were removed and the three parameters were re-evaluated. In both groups, dentin became significantly darker after 3 months. RESULTS: No cases of yellow dentin were observed after 3 months with CH compared to 33.3% of the wax cases (P < 0.05). A statistically significant difference over time was observed only for CH regarding consistency. CH stimulated a dentin hardening process in a statistically higher number of cases than wax (86.7% vs. 33.3%; P = 0.008). Contamination changed significantly over time in CH and wax without significant difference between groups. It was concluded that CH and wax arrested the carious process of the remaining carious dentin after indirect pulp capping, but CH showed superior dentin color and consistency after 3 months.

Professional toothbrushing as a method for diagnosing gingivitis in 3- to 6-year-old preschool children.

PURPOSE: The aim of the present crossover study was to evaluate professional toothbrushing as a method for diagnosing gingivitis in children. MATERIALS AND METHODS: Thirty-four preschool children who had gingival bleeding > or = 10% and without proximal restorations/carious lesions were included in the study. Examinations comprised two gingival indices recorded at a 15-min interval, in the following sequences: the Ainamo and Bay gingival bleeding index (GBI1) followed by the brushing index (BI2) and vice versa (BI1-GBI2). Half of the children started the study in the first sequence and the other half in the second. After a 3- to 4-day washout period, the indices were again recorded with individuals changing the sequences. Data analysis considered GBI as the gold standard, and sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were also calculated. RESULTS: The overall mean value of gingival bleeding at the first examination was 18.85 +/- 9.24%. Validation of toothbrushing performed after GBI (BI2) resulted in values for SE, SP, PPV and NPV of 0.59 (95% CI, 0.55 to 0.63), 0.92 (95% CI, 0.91 to 0.93), 0.64 (95% CI, 0.60 to 0.69) and 0.90 (95% CI, 0.89 to 0.92), respectively. BI performed before GBI (BI1) resulted in similar SE, SP, PPV and NPV. Percentage agreement of GBI1-BI2 and BI1-GBI2 was 83.5% and 85.9%, respectively. CONCLUSIONS: Professional toothbrushing can be suggested as a method for the diagnosis of gingival inflammatory status in children, especially as an indicator of gingival health.

Dentifrício de baixa concentração de fluoreto: efeito em esmalte e dentina de dentes decíduos / Low-fluoride dentifrice: deciduos enamel and dentin effect

Esta tese constituiu-se de três artigos que tiveram como objetivo: identificar a evidência científica disponível quanto à eficácia dos dentifrícios de concentração reduzida de fluoreto (500µgF/g) comparados ao dentifrício convencional (1100µgF/g) no controle de cárie dentaria na infância; avaliar a desmineralização do esmalte e da dentina decídua frente ao desafio cariogênico na presença de dentifrício 500 F comparado ao 1100; avaliar a subtração radiográfica digital, comparada a microdureza transversa, como método de detecção de perda mineral em esmalte e dentina decíduos. Após a revisão sistemática da literatura (artigo 1), 177 publicações comparando dentifrícios de diferentes concentrações de flúor (F) foram identificadas e destas, apenas 10 foram selecionadas (4 experimentos in vitro; 1 in situ; 3 ensaios populacionais e 2 ensaios clínicos randomizados). Os estudos laboratoriais indicaram a superioridade do dentifrício 1100 em relação ao 500. Os estudos clínicos apontam para a equivalência de efeito entre 500 e 1100, exceto em crianças de diferentes perfis de atividade de cárie. Concluiu-se que não há evidência de superioridade de efeito do dentifrício 1100 em relação ao 500, exceto para crianças de alto risco ou com atividade cariosa. O artigo 2 constituiu-se de um experimento in situ cruzado randomizado no qual 15 voluntários utilizaram, em 3 fases de 14 dias, dispositivos palatinos contendo blocos de esmalte e dentina coronária decíduos. O desafio cariogênico (sacarose 20% 8x/dia) foi estabelecido concomitantemente ao uso de dentifrícios 500, 1100 e sem F. Após cada fase experimental, o biofilme foi analisado e os blocos seccionados para aferir a microdureza transversa. Para a análise dos dados, ANOVA e teste de Tuckey foram utilizados. A concentração de F no biofilme do grupo sem F foi significativamente inferior aos grupos 500 e 1100, tanto em esmalte quanto em dentina. Em esmalte, a perda mineral foi...

This thesis consisted of three articles that aimed to: identify the available scientific evidence regarding the efficacy of low fluoride (F) concentration dentifrice (500µgF/g) compared to conventional F-dentifrice (1100µgF/g) in infant caries; evaluate the demineralization of deciduous enamel and dentine during a cariogenic challenge in the presence of low-F dentifrice compared to conventional dentifrice; evaluate digital subtraction radiography compared to transversal microhardness as a method of mineral loss detection in deciduous enamel and dentine. A systematic review (article 1) identified 177 publications of which only 10 (4 in vitro and 1 in situ experiments, 3 field trials and 2 randomized clinical trials) compared different F-dentifrices concentrations were then selected. Laboratory studies indicated a superiority of the 1100 compared to the 500 F-dentifrices. Clinical studies pointed out for an equivalence effect between 500 and 1100 F-dentifrices, except in children with different profiles of caries activity. It was concluded that there is no evidence of superiority of the 1100 compared to the 500 F-dentifrices except for high-risk children. Article 2 was a randomized crossover in situ experiment, including 15 volunteers that used palatal devices containing deciduous enamel and coronal slabs for periods of 14-days. A cariogenic challenge (20% sucrose 8x/day) was established concomitantly to the use of 500, 1100 and non-F dentifrices slurries. After each phase, the dental biofilm formed was analyzed and the slabs were prepared for cross-sectional microhardness measurements. Tuckey's test was used for post-ANOVA comparisons. The effect of F-dentifrices in enamel was observed only at 10µm from the surface, but no significant difference was observed between 500 and 1100 F-dentifrices. In dentin, the effect of 1100-F dentifrice was observed deeper, presenting significantly less mineral loss than 500 and non-F...

Professional flossing as a diagnostic method for gingivitis in the primary dentition.

The aim of this study was to evaluate flossing as a diagnostic method for interproximal gingival bleeding in children. For this crossover study, 23 pre-schoolchildren presenting neither restorations nor approximal carious cavities and with at least 15% of gingival bleeding sites were selected. Examinations were performed at three different moments (3-4 days interval). Examinations comprised repeated measurements of two gingival indices with a 10-minute interval in the following sequences: the Ainamo & Bay Gingival Bleeding Index (GBI) followed by the Carter & Barnes flossing index (CBI); CBI followed by GBI; and GBI followed by GBI. Data analysis was performed only for the interproximal sites, considering the GBI as the gold-standard. Agreement between indices, sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) were estimated. Percentage agreements in sequences GBI-CBI, CBI-GBI and GBI-GBI were 70.3%, 76.4% and 84.5%, respectively. Validation of flossing in the first sequence (GBI-CBI) resulted in values of 0.61 (95%CI 0.53 - 0.68), 0.72 (95%CI 0.69 - 0.76), 0.33 (95%CI 0.28 - 0.39) and 0.89 (95%CI 0.86 - 0.92) respectively for SE, SP, PPV and NPV. It can be concluded that professional flossing is a useful tool in the diagnosis of interproximal gingival inflammatory status in children, especially in conditions of gingival health.

Professional flossing as a diagnostic method for gingivitis in the primary dentition

The aim of this study was to evaluate flossing as a diagnostic method for interproximal gingival bleeding in children. For this crossover study, 23 pre-schoolchildren presenting neither restorations nor approximal carious cavities and with at least 15 percent of gingival bleeding sites were selected. Examinations were performed at three different moments (3-4 days interval). Examinations comprised repeated measurements of two gingival indices with a 10-minute interval in the following sequences: the Ainamo & Bay Gingival Bleeding Index (GBI) followed by the Carter & Barnes flossing index (CBI); CBI followed by GBI; and GBI followed by GBI. Data analysis was performed only for the interproximal sites, considering the GBI as the gold-standard. Agreement between indices, sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) were estimated. Percentage agreements in sequences GBI-CBI, CBI-GBI and GBI-GBI were 70.3 percent, 76.4 percent and 84.5 percent, respectively. Validation of flossing in the first sequence (GBI-CBI) resulted in values of 0.61 (95 percentCI 0.53 - 0.68), 0.72 (95 percentCI 0.69 - 0.76), 0.33 (95 percentCI 0.28 - 0.39) and 0.89 (95 percentCI 0.86 - 0.92) respectively for SE, SP, PPV and NPV. It can be concluded that professional flossing is a useful tool in the diagnosis of interproximal gingival inflammatory status in children, especially in conditions of gingival health.

Elastomeric impression as a diagnostic method of cavitation in proximal dentin caries in primary molars

The purpose of this study was to validate the elastomeric impression after temporary tooth separation as a method of cavitation detection in proximal caries lesions in primary molars with outer half dentin radiolucency. Fifty-one children (4-10 years old), presenting radiolucency in the outer half of the dentin at the proximal surfaces of primary molars and proximal anatomic contact with the adjacent tooth (without restoration/cavitated caries lesion) were enrolled in the study. Temporary tooth separation was performed with an orthodontic rubber ring placed around the contact point during 2-3 days. Thereafter, impression of the proximal surfaces was made. The elastomeric impressions were classified as "non-cavitated" or "cavitated" surfaces. Visual inspection after tooth separation was considered as the gold standard. Examiner reliability of visual inspection after tooth separation was determined (kappa 0.92). Impression examination was repeated every 5 participants to evaluate the reproducibility of the method. The frequency of cavitated lesions was 65 percent, and 67 percent of those were inactive. Sensitivity, specificity, positive and negative predictive values were 0.88 percent (95 percentCI 0.73-0.95), 0.89 percent (95 percentCI 0.67-0.97), 0.94 percent (95 percentCI 0.79-0.98) and 0.80 percent (95 percentCI 0.58-0.92), respectively. Impression examination showed total agreement regarding cavitation. The evaluation of elastomeric impression after tooth separation is a useful clinical resource in cavitation detection for clinicians and researchers when visual inspection is doubtful.

Elastomeric impression as a diagnostic method of cavitation in proximal dentin caries in primary molars.

The purpose of this study was to validate the elastomeric impression after temporary tooth separation as a method of cavitation detection in proximal caries lesions in primary molars with outer half dentin radiolucency. Fifty-one children (4-10 years old), presenting radiolucency in the outer half of the dentin at the proximal surfaces of primary molars and proximal anatomic contact with the adjacent tooth (without restoration/cavitated caries lesion) were enrolled in the study. Temporary tooth separation was performed with an orthodontic rubber ring placed around the contact point during 2-3 days. Thereafter, impression of the proximal surfaces was made. The elastomeric impressions were classified as "non-cavitated" or "cavitated" surfaces. Visual inspection after tooth separation was considered as the gold standard. Examiner reliability of visual inspection after tooth separation was determined (kappa 0.92). Impression examination was repeated every 5 participants to evaluate the reproducibility of the method. The frequency of cavitated lesions was 65%, and 67% of those were inactive. Sensitivity, specificity, positive and negative predictive values were 0.88% (95%CI 0.73-0.95), 0.89% (95%CI 0.67-0.97), 0.94% (95%CI 0.79-0.98) and 0.80% (95%CI 0.58-0.92), respectively. Impression examination showed total agreement regarding cavitation. The evaluation of elastomeric impression after tooth separation is a useful clinical resource in cavitation detection for clinicians and researchers when visual inspection is doubtful.

Lesões de cárie proximais na dentição decídua: freqüência de lesões homólogas / Approximal caries lesion on primary teeth: homologous lesions frequency

O objetivo deste estudo transversal observacional foi avaliar a experiência de cárie na superfície proximal de molares decíduos quanto à ocorrência de comportamento bilateral e ao envolvimento de superfícies adjacentes. A população estudada foi o arquivo de pacientes do Ambulatório de Odontopediatria (UFRGS). Das 670 fichas de pacientes avaliadas, 208 possuíam radiografias interproximais bilaterais. As fichas dos indivíduos que apresentaram lesão de cárie e/ou restauração proximal (kappa intra-examinador: 0,84), com adequado contraste e ausência de sobreposição foram selecionados para a análise. As imagens radiográficas foram avaliadas aleatoriamente de acordo com a presença de lesões proximais/restaurações e posteriormente foi analisada a freqüência de acometimento em superfícies homólogas e adjacentes. Assim, 64 pares de radiografias interproximais compuseram a amostra, com ocorrência de 81% de lesões cariosas em faces homólogas. Dentre estas, 58% apresentaram mais de um par de superfícies homólogas com lesão cariosa. Além disso, 48% dos indivíduos mostraram exclusivamente lesões de cárie em pares homólogos. As superfícies distais dos primeiros molares inferiores foram as mais acometidas pela ocorrência bilateral(41%). Outro aspecto analisado foi a ocorrência simultânea de lesões em faces proximais adjacentes: em 59% das crianças, ambas as faces de contato apresentaram lesão cariosa diagnosticada através da imagem radiográfica. A partir da metodologia utilizada, concluiu-se que lesões cariosas de molares decíduos apresentam comportamento bilateral em faces homólogas, o que representa uma informação útil durante a investigação de lesões em pacientes com experiência de cárie.

Novas tendências na preservaçäo do complexo dentinopulpar: materiais indutores de tecido calcificado / New tendencies on dentinpulp complex preservation: mineralized tissue inductor materials

Recentemente, foram desenvolvidas as proteínas osteogênicas, as quais säo capazes de induzir a formaçäo de tecido mineralizado, como por exemplo, osso e dentina. Uma dessas proteínas, a Proteína Osteogênica-1 (OP-1), vem sendo estudada em modelos experimentais animais sobre exposiçöes pulpares, obtendo resultados satisfatórios. O presente artigo buscou, à luz da literatura, analisar a viabilidade terapêutica desta proteína, comparada ao uso de outros materiais capeadores pulpares diretos. Dentre estes, o hidróxido de cálcio e o MTA (Agragado Trióxido Mineral) apresentam mecanismos de açäo semelhantes, sendo o hidróxido de cálcio ainda reconhecido como o material de eleiçäo para o tratamento das exposiçöes pulpares, em funçäo da existência de dados histológicos e clínicos bem definidos na literatura. Já a OP-1 é um material promissor, mas ainda é necessário um maior conhecimento de suas propriedades biológicas e, a partir daí, de suas indicaçöes e limitaçöes para sustentá-la como alternativa terapêutica