Occlusion development after premature loss of deciduous anterior teeth: preliminary results of a 24-month prospective cohort study.

OBJECTIVE: This study aimed to evaluate occlusion development after premature loss or extraction of deciduous anterior teeth, by means of a prospective cohort study. METHODS: Fifteen infants and children aged 1 to 5 years old were longitudinally assessed (with loss or extraction of deciduous anterior teeth [n = 9], and without tooth losses [n = 6]). Photographs and dental casts at the baseline and after 24 months of follow-up were performed. Dental casts were scanned, and linear measurements were made on the digitalized models (missing tooth space, arch perimeter, arch length, arch width, intercanine length and intercanine width). The t-test was used for groups comparisons (α = 0.05). RESULTS: Individuals' mean age at baseline was 2.93 (± 1.18) years. No statistically significant differences were observed in the missing tooth space in the group with tooth loss during the 24 months of follow-up (p > 0.05). Arch perimeter, arch length, arch width, intercanine length and intercanine width did not show differences between the groups (p > 0.05). Qualitative photographic evaluation revealed other changes in the dental arches and occlusion, such as exfoliation and eruption of deciduous teeth, eruption of permanent teeth, self-correction or establishment of malocclusion, among others. CONCLUSION: The results suggest that the premature loss of deciduous anterior teeth does not affect the perimeter, length and width of the dental arches; however, other alterations that lead to malocclusion could be established.

Occlusion development after premature loss of deciduous anterior teeth: preliminary results of a 24-month prospective cohort study

ABSTRACT Objective: This study aimed to evaluate occlusion development after premature loss or extraction of deciduous anterior teeth, by means of a prospective cohort study. Methods: Fifteen infants and children aged 1 to 5 years old were longitudinally assessed (with loss or extraction of deciduous anterior teeth [n = 9], and without tooth losses [n = 6]). Photographs and dental casts at the baseline and after 24 months of follow-up were performed. Dental casts were scanned, and linear measurements were made on the digitalized models (missing tooth space, arch perimeter, arch length, arch width, intercanine length and intercanine width). The t-test was used for groups comparisons (α = 0.05). Results: Individuals' mean age at baseline was 2.93 (± 1.18) years. No statistically significant differences were observed in the missing tooth space in the group with tooth loss during the 24 months of follow-up (p > 0.05). Arch perimeter, arch length, arch width, intercanine length and intercanine width did not show differences between the groups (p > 0.05). Qualitative photographic evaluation revealed other changes in the dental arches and occlusion, such as exfoliation and eruption of deciduous teeth, eruption of permanent teeth, self-correction or establishment of malocclusion, among others. Conclusion: The results suggest that the premature loss of deciduous anterior teeth does not affect the perimeter, length and width of the dental arches; however, other alterations that lead to malocclusion could be established.

RESUMO Objetivo: Este estudo teve como objetivo avaliar o desenvolvimento da oclusão após perda prematura ou extração de dentes decíduos anteriores, por meio de um estudo de coorte prospectivo. Métodos: Quinze bebês e crianças de 1 a 5 anos foram avaliados longitudinalmente (com perda ou extração de dentes anteriores decíduos [n = 9] e sem perdas dentárias [n = 6]). Foram realizadas fotografias e modelos dentais no início e após 24 meses de acompanhamento. Os modelos dentários foram escaneados e medidas lineares foram feitas nos modelos digitalizados (espaço dentário perdido, perímetro da arcada, comprimento da arcada, largura da arcada, comprimento intercaninos e largura intercaninos). O teste t foi utilizado para comparações entre grupos (α = 0,05). Resultados: A média de idade dos indivíduos no início do estudo foi de 2,93 (± 1,18) anos. Não foram observadas diferenças estatisticamente significativas no espaço dentário perdido no grupo com perda dentária durante os 24 meses de acompanhamento (p > 0,05). O perímetro da arcada, comprimento da arcada, largura da arcada, comprimento intercaninos e largura intercaninos não apresentaram diferenças entre os grupos (p> 0,05). A avaliação fotográfica qualitativa revelou alterações nas arcadas dentárias e na oclusão, como: esfoliação e erupção de dentes decíduos, erupção de dentes permanentes, autocorreção ou estabelecimento de má oclusão, entre outras. Conclusão: Os resultados sugerem que a perda prematura de dentes anteriores decíduos não afeta o perímetro, comprimento e largura das arcadas dentárias; entretanto, outras alterações que levam à má oclusão poderiam ser estabelecidas.

Does the premature loss of primary anterior teeth cause morphological, functional and psychosocial consequences?

Premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence regarding the types and magnitudes of the consequences involved. Morphological, functional, and psychosocial problems may arise from untreated premature loss of primary incisors and canines. The morphological problems include impaction and eruption disturbances of permanent successors; inclination and/or extrusion of adjacent and antagonist teeth, respectively; midline deviation; and crowding. Functional complications, such as speech disorders, aesthetic problems, and development of non-nutritive habits may occur, resulting in psychosocial implications, including a decrease in self-esteem, and even being targeted for bullying. The current critical review aimed to present and discuss the evidence available in the literature about the etiology, characteristics, implications and interventions resulting from the premature loss of primary anterior teeth. It is of utmost importance that future studies be developed to support the clinical decisions made by dental professionals on this topic.

Dental arch perimeter changes as a result from premature loss of primary anterior teeth due to trauma: A case series in infant and pre-school children.

BACKGROUND: The premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence about the consequences in the arch perimeter space and magnitudes of the effects involved. AIM: Evaluate the association between premature loss of primary anterior teeth and dental arch perimeter changes, according to clinical variables as deciduous arch type, erupted primary canines, midline involvement and deleterious oral habits, on infants and pre-school children. DESIGN: Patients with avulsion or referral to extraction due to traumatic dental injuries (TDI) were evaluated. After the tooth loss, two trained operators measured the tooth/teeth space, both with a digital caliper and a dry tip compass. The clinical documentation included photographs and radiographs. Follow-up visits occurred from the baseline and every two months over a 12-month period. Chi-square test was used to evaluate the association between arch perimeter changes and clinical variables (α = 0.05). A descriptive statistic was performed to explore the magnitude of space changes, with 95% confidence intervals. RESULTS: Eighteen infants/children (mean, 2.78 ± 1.39 years) were included. Nine patients presented space loss (50.0%) (mean, -1.32 mm), six patients gained space (33.3%) (mean, +1.55 mm), and three patients presented space maintenance (16.7%). Clinical variables did not influence dental arch perimeter changes. CONCLUSIONS: Premature loss of primary anterior teeth, as well as deleterious oral habits, deciduous arch type, midline involvement and erupted primary canines, were not associated with dental arch perimeter changes.

Does the premature loss of primary anterior teeth cause morphological, functional and psychosocial consequences?

Abstract Premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence regarding the types and magnitudes of the consequences involved. Morphological, functional, and psychosocial problems may arise from untreated premature loss of primary incisors and canines. The morphological problems include impaction and eruption disturbances of permanent successors; inclination and/or extrusion of adjacent and antagonist teeth, respectively; midline deviation; and crowding. Functional complications, such as speech disorders, aesthetic problems, and development of non-nutritive habits may occur, resulting in psychosocial implications, including a decrease in self-esteem, and even being targeted for bullying. The current critical review aimed to present and discuss the evidence available in the literature about the etiology, characteristics, implications and interventions resulting from the premature loss of primary anterior teeth. It is of utmost importance that future studies be developed to support the clinical decisions made by dental professionals on this topic.

Associations and risk factors for dental trauma: A systematic review of systematic reviews.

OBJECTIVE: We sought to revise, qualify and summarize the body of evidence based on current information on the known associations and risk factors for traumatic dental injury (TDI) occurrence with an overview of systematic reviews. METHODS: Electronic searches were performed with no language nor date restrictions.According to the PECO strategy, systematic reviews that investigated participants (P) with (E) and without (O) the presentation of factors relating to TDI and these factors' association with TDI episodes (O) as primary or secondary outcomes were included. Quality assessment and bias control were carried out according to the AMSTAR 2 checklist. In cases of systematic review results of discordance, the Jadad decision algorithm was applied. RESULTS: After titles, abstracts and full texts were read, 19 systematic reviews were included in this overview. Four were classified with critically low, eleven with low and four with moderate methodological quality, respectively. In all studies, 249 cross-sectional, 34 epidemiological surveys, 22 cohort, 9 case-control, 4 longitudinal, 3 ecological and 30 unspecified studies were included. Male gender, child age, greater overjet, inadequate lip coverage, anterior open bite, caries in the permanent dentition, overweight, a previous history of TDI, tongue piercing, the use of alcoholic beverages and participation in sports were all associated with a greater chance of suffering TDI. CONCLUSIONS: Sociodemographic, clinical and environmental factors are associated with a greater chance of TDI occurrence. However, most of the systematic reviews included were of a low quality and may not provide an accurate and comprehensive summary of the available research that addresses the question of interest. Well-designed primary studies on different aspects of TDI are encouraged to provide higher quality scientific evidence.

Does Calcium Hydroxide Reduce Endotoxins in Infected Root Canals? Systematic Review and Meta-analysis.

INTRODUCTION: The purpose of this study was to evaluate the potential of endotoxin reduction by comparing the number of lipopolysaccharides (LPSs) before and after the use of calcium hydroxide (Ca[OH]2) as intracanal medication (ICM). METHODS: Searches were performed up to June 2020. Clinical and experimental studies comparing the amount of LPSs before and after the use of Ca(OH)2 as ICM in infected root canals were included. Risks of bias assessment and data extraction were performed. Meta-analysis was conducted by subgrouping according to Ca(OH)2, the presence of an antimicrobial substance (AS), irrigant solution during chemomechanical preparation (CMP), and the incidence of LPS reduction. The certainty of evidence was determined by the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Nine studies were included in the qualitative synthesis and 7 in the meta-analysis. Three articles had low risk of bias (RB), 1 had moderate RB, 2 had high RB, and 3 "some concerns." Overall, Ca(OH)2, with or without AS, reduced mean LPSs before CMP (standardized mean difference [SMD] = -1.087 [confidence interval {CI}, -1.453 to -0.721], P < .001, I2 = 58.7%) and after CMP (SMD = -0.919 [CI, -1.156 to -0.682], P < .001, I2 = 24.7%). Considering the irrigant solutions, the overall results showed a reduction before (SMD = -1.053 [CI, -1.311 to -0.795], P < .001, I2 = 58.7%) and after CMP (SMD = -0.938 [CI, -1.147 to -0.729], P < .001, I2 = 24,6%). Analyses presented very low certainty of evidence. The incidence of LPS reduction was 98.9% and 61.7% for Ca(OH)2 with and without AS, respectively. CONCLUSIONS: Ca(OH)2 reduces endotoxin levels when used as ICM but is unable to eliminate LPSs completely independent of the irrigating solution used with very low certainty of evidence.

Does dental trauma and its consequences influence the professional hiring process? Development, validation and application of an assessment tool.

OBJECTIVES: To develop and validate a questionnaire concerning the aspects evaluated during the hiring process by human resources professionals (HRPs); to apply the validated questionnaire; and to evaluate the perceptions and judgment of HRPs regarding different traumatic dental injuries (TDIs) and their consequences (TDI-Cs). MATERIALS AND METHODS: The acceptability, discriminative properties, internal consistency and test-retest reliability of the developed questionnaire were evaluated, using the same methodology as the main study and adopting a pilot sample. For both the validation process and the application phase, images of one male and one female were manipulated, or not (control), to create different types of TDI (enamel fracture, enamel and dentin fracture, avulsion) and TDI-Cs (crown discoloration, tooth loss due to avulsion). In the application phase, the images were analyzed by 100 HRPs using the validated questionnaire, and the results were analyzed using the Friedman, Wilcoxon and Mann-Whitney tests (P < 0.05). RESULTS: The developed questionnaire produced excellent acceptability, strong discriminative properties, satisfactory internal consistency and excellent to good test-retest reliability. The presence of TDIs and TDI-Cs had a negative effect on the evaluated aspects used during the hiring process (P < 0.001). Tooth loss provoked the worse level of judgment in all evaluated characteristics and in professional hiring. CONCLUSIONS: The developed questionnaire produced valid and reliable responses concerning the aspects evaluated during the hiring process by Brazilian HRPs. TDIs and TDI-Cs had a negative influence on the aspects evaluated during the HRP professional hiring process. CLINICAL SIGNIFICANCE: TDIs and TDI-Cs had a negative influence on the aspects evaluated during the HRP professional hiring process.

Premature loss of primary anterior teeth and its consequences to primary dental arch and speech pattern: A systematic review and meta-analysis.

BACKGROUND: Information about the functional and morphological consequences that occur following the premature loss of anterior teeth is still insufficient. AIM: To evaluate the consequences in children's speech and arch integrity following premature loss of primary anterior teeth compared to those without premature losses. DESIGN: Electronic searches were performed based on the PECO criteria. Observational studies in children (P) who suffered premature loss or extraction of primary anterior teeth (E) compared to children presenting normal occlusion development (C) and the consequences to speech and dental arch perimeter (O) were included. Risk of bias and data extraction were performed. The meta-analysis evaluated the influence of premature loss of primary anterior teeth in articulatory speech disorders (distortion, omission, and substitution) and space loss in the dental arches. Random- and fixed-effect models were used, and heterogeneity was tested. The certainty of evidence was estimated using the GRADE approach. RESULTS: From a total of 2.234 studies, six studies were included in the qualitative synthesis, and four in speech disorders meta-analysis. Despite it was not possible to perform space loss meta-analysis due to the absence of available data, qualitative analysis showed that there was no space loss after premature loss of mandibular primary incisors; a space loss, however, could be observed in children who lost primary canines at an early stage of dental development. For speech disorders results, children who lost anterior tooth presented higher chance of suffering speech distortion, than children without tooth loss (OR 5.466 [1.689, 17.692] P = .005) with low certainty of evidence. On the other hand, there were no statistically differences between premature loss of primary anterior teeth and omission (OR (a) 1.157 [0.439, 3.049] P = .767 and (OR (b) 1.393 [0.434, 4.70] P = .577) or substitution (OR (a) 1.071 [0.581, 1.974] P = .827 and OR (b) 1.218 [0.686, 2.163] P = .5), both with very low certainty of evidence. CONCLUSIONS: Premature loss of primary anterior teeth may affect children phonation causing speech distortion. Consequences of space loss to primary dental arch still need to be further studied. Despite the speech distortion results, included articles present low-level evidence-based quality, thus new studies should be performed.

Knowledge of dental students and professionals about the management of traumatic dental injuries: a critical literature review

Knowledge about the diagnosis and treatment of traumatic dental injuries (TDIs) is extremely important in improving the prognosis of such cases. Aim: To evaluate the knowledge of dental students and professionals about the management of TDIs, and the factors that influence this knowledge, through a literature review. Methods: An electronic search was performed in the PubMed database, with no language or date restrictions. Studies that evaluated the knowledge of dental students or professionals about the management of TDIs were considered eligible. Results: From a total of 1902 retrieved papers, 36 full-texts were assessed for eligibility, and 31 were included in this review. All studies evaluated TDI knowledge through questionnaires; 15 of them only concerned tooth avulsion. In general, knowledge about TDI treatment, both in deciduous and permanent dentition, was considered to be low or moderate. Individual factors (age and gender), professional factors (postgraduate degree, qualification time and place of work), and previous TDI knowledge (attendance frequency, previous education and self-judgment about the knowledge) influenced the knowledge and the frequency of correct answers. Conclusion: Dentistry student and professional knowledge about TDIs is not satisfactory

Are dairy products containing probiotics beneficial for oral health? A systematic review and meta-analysis.

OBJECTIVES: To evaluate the effect of probiotic containing in dairy products on oral and salivary parameters. MATERIAL AND METHODS: Electronic searches were performed based on the PICO criteria. Randomized controlled trials in adults/children (P) in which dairy products containing probiotics (I) were compared to controls (C) for establishment of oral health (O) were included. Risk of bias and data extraction were performed. The meta-analysis evaluated the influence of probiotics on Streptococcus mutans (SM), Lactobacillus spp. (LB), and yeast counts, plaque index, and salivary pH. Random or fixed effect models were used, and heterogeneity was tested. RESULTS: Thirty-two studies were included in the qualitative synthesis, and 24 in the meta-analysis. For dichotomous results, individuals who consumed probiotics exhibited decreased scores in SM concentrations (RD 0.15 [0.02, 0.28] p = 0.03, I2 = 70%), but no change was observed for LB (RD 0.10 [- 0.03, 0.23] p = 0.13, I2 = 94%), or yeast levels (RD 0.05 [- 0.02, 0.12] p = 0.7, I2 = 48%). For continuous analysis, both probiotic and control groups presented similar results for SM and LB (MD - 0.55 [- 1.16, 0.07] p = 0.08, I2 = 62%, and RD 0.10 [- 0.03, 0.23] p = 0.13, I2 = 94%, respectively). The consumption of probiotics increased salivary pH (MD 0.20 [0.04, 0.35] p = 0.01, I2 = 46%) and plaque index (MD 0.38 [0.11, 0.65] p = 0.005, I2 = 0%). The probiotic milk reduced SM (MD - 0.59 [- 0.96, - 0.22] p = 0.002, I2 = 0%), and the probiotic yogurt decreased LB counts (RD 0.35 [0.19, 0.51] p < 0.0001, I2 = 0%). CONCLUSIONS: In general, dairy probiotics were effective in reducing SM, increasing salivary pH, and promoting a higher plaque index. Liquid matrices, such as milk and yogurt, seem to be more effective in reducing SM and LB levels. CLINICAL RELEVANCE: Consumption of dairy products containing probiotics could be a supporting method in caries prevention.