Peripheral odontogenic fibroma in a child with Ellis-van Creveld syndrome: Case report.

INTRODUCTION: Ellis-van Creveld (EVC) syndrome is an autosomal recessive disorder predominantly characterized by a disproportionate dwarfism, ectodermal dysplasia, postaxial polydactyly, and congenital heart malformations and pulmonary hypoplasia. OBJECTIVE: In this article, we hereby present a case of a 6-year-old Brazilian boy with EVC syndrome who presented a rare oral lesion as well as a remarkable number of classical and uncommon oral and dental features. CASE REPORT: Clinical and radiographic examination revealed multiple enamel hypoplasia, teeth agenesis, conical teeth, lower canine rotation, bilateral posterior crossbite, taurodontism of deciduous and permanent molars and delayed tooth eruption, dental caries, and absent vestibular sulcus. Additionally, a whitish lobulated nodule located in the alveolar ridge in the anterior region of the mandible was noted. Anatomopathological examination was compatible with the diagnosis of peripheral odontogenic fibroma (POF). In a 10-month clinical follow-up, no signs of recurrence were observed. CONCLUSION: In view of the characteristic oral findings of EVC syndrome and the potential for recurrence of POF, the pediatric dentist plays an essential role in clinical follow-up, planning and preventive, and rehabilitative treatment.

Fluoride varnishes supplemented with nano-sized sodium trimetaphosphate reduce enamel erosive wear in vitro.

OBJECTIVE: To evaluate the effect of fluoride (F) varnishes with sodium trimetaphosphate (TMP) on erosive tooth wear (ETW) in vitro. METHODS: Enamel blocks (n = 100) were divided into 5 experimental groups (n = 20/group): Placebo (Pla - without F/TMP); 5 % NaF (NaF); 5 % NaF + 5 % micrometric TMP (NaF+5 %MICRO); 5 % NaF + 2.5 % nano-sized TMP (NaF+2.5 %NANO), and 5 % NaF + 5 % nano-sized TMP (NaF+5 %NANO). Blocks received a single varnish application (6 h contact), and were submitted to 4 daily erosive challenges (ERO, 0.05 M citric acid, pH 3.2, 90 s, under agitation), for 5 days. After ERO, half of the blocks (n = 10/group) were subjected to brushing abrasion (ERO+ABR). Profilometry, surface hardness (SH), and cross-sectional hardness (ΔKHN) were determined. The data were submitted to 2-way ANOVA and Fisher's LSD test (p < 0.05). RESULTS: Enamel wear was significantly lower for ERO compared with ERO+ABR for all varnishes tested (p < 0.001), following the pattern NaF+5 %NANO < NaF+5 %MICRO < NaF < NaF+2.5 %NANO < Pla (both for ERO and ERO+ABR). The highest SH loss was observed for Pla and the lowest for NaF (ERO) and NaF+2.5 %NANO (ERO+ABR), without significant differences among NaF+2.5 %NANO, NaF, and NaF+5 %MICRO. The highest ΔKHN values were observed for NaF+5 %MICRO and NaF+5 %NANO at 5-30 µm, with less marked differences among the groups at 30-70 µm (ERO and ERO+ABR). CONCLUSIONS: The addition of TMP to F varnishes significantly improves protection against ETW in vitro. The use of 5 % nano-sized TMP further enhances such effects. CLINICAL SIGNIFICANCE: F varnishes containing TMP can reduce enamel loss caused by ERO or ERO+ABR.

Maternal methylmercury exposure during early-life periods adversely affects mature enamel structure of offspring rats at human exposure levels: a concern for oral health.

Although there are many studies on the health effects of methylmercury (MeHg) toxicity during in utero and early development, little is known about its effects on mineralized tissues present in the oral cavity, such as enamel structure. Therefore, this study evaluated the effects of MeHg exposure on the physico-chemical, ultrastructural and functional properties of mature tooth enamel. Specifically, we studied offspring of mothers exposed to MeHg during the prenatal and postnatal periods which are the developmental stages associated with tooth enamel formation. Female rats were exposed to MeHg at a dose of 40 µg/kg/day for 42 days of pregnancy and lactation. The enamel of offspring was analyzed by (1) Fourier Transform Infrared Spectroscopy and Raman to assess physicochemical composition, (2) Scanning Electron Microscopy for ultrastructural evaluation, (3) Transmitted Polarizing Light Microscopy for analysis of the enamel extracellular matrix, and (4) resistance and hardness were evaluated by microhardness. The results showed that MeHg exposure during this sensitive enamel formation period induced changes in inorganic and organic content and enamel prisms ultrastructure alterations and disturbed the organic extracellular matrix due to a decreased enamel strength. These novel findings establish for the first time that maternal exposure to MeHg pre and postnatal promoted relevant changes in mature enamel of their offspring rats.

Amount of Dentifrice and Fluoride Concentration Influence Salivary Fluoride Concentrations and Fluoride Intake by Toddlers.

The present study evaluated fluoride (F) concentrations in saliva of toddlers after brushing with dentifrices containing different F concentrations, applied in different quantities, and estimated F intake from toothbrushing. The study comprised a double-blind, crossover protocol, in which toddlers (n = 18, 2-3 years old) were randomly assigned into six groups, according to possible combinations of dentifrices (0/550/1,100 ppm F, as NaF) and amounts (rice grain, pea size, and transverse technique). Volunteers used a F-free dentifrice during 1 week. On the 7th day, saliva samples were collected before (baseline), and at 5/15/30/60 min after toothbrushing. All dentifrice expectorated after brushing was collected. F concentrations (saliva and expectorate) were determined with an ion-specific electrode. Data were submitted to ANOVA or Kruskal-Wallis test, followed by Fisher's LSD or Student-Newman-Keuls' tests (p <0.05). Brushing with 550 ppm F dentifrice (pea size or transversal technique) increased the area under the curve (AUC) at similar levels compared to 1,100 ppm F (rice grain). The highest AUC and salivary F at 5 min after brushing were achieved by 1,100 ppm F (pea size), followed by 550 ppm F (transversal technique). Regarding F intake, the highest values were observed for 550 ppm F (transversal technique), followed by 1,100 ppm F (pea size). It is possible to conclude that the amount of dentifrice and F concentration in the product significantly affected both salivary F concentrations and F intake during toothbrushing.

Efeito de vernizes fluoretados suplementados com nanopartículas de trimetafosfato de sódio sobre o desgaste dental erosivo in vitro e in situ / Effect of fluoride varnishes supplemented with nanosized Sodium Trimetaphosphate on enamel erosive wear in vitro and in situ

O presente estudo avaliou o efeito de vernizes fluoretados suplementados com nanopartículas de Trimetafosfato de Sódio (TMP) sobre o desgaste erosivo do esmalte dental bovino, em protocolos in vitro e in situ. Para a 1ª fase, blocos de esmalte dental bovino (n=100) foram selecionados por meio de dureza de superfície (DS) e aleatoriamente divididos em 5 grupos experimentais (n=20/grupo), de acordo com os vernizes testados: (a) Placebo (Pla - sem F ou TMP), (b) 5% NaF, (c) 5% NaF + 5% TMP microparticulado (5% Micro), (d) 5% NaF + 2,5% TMP nanoparticulado (2,5% Nano), (e) 5% NaF + 5% TMP nanoparticulado (5% Nano). Os blocos receberam uma única aplicação dos vernizes e foram imersos em saliva artificial por 6 h. Em seguida, os vernizes foram removidos e todos os blocos, submetidos a 4 desafios erosivos diários durante 5 dias (ERO, imersão em ácido cítrico 0,05 M, pH 3,2, 90 s/ciclo, sob agitação). Após ERO, metade dos blocos foi submetida a abrasão por escovação (15 s/ciclo) com dentifrício placebo (ERO+ABR). Os blocos foram analisados por perfilometria, dureza de superfície (DS) e dureza em secção longitudinal (ΔKHN). Os dados foram submetidos a ANOVA a dois critérios e Teste de Fisher LSD (p< 0,05). O desgaste do esmalte foi significativamente menor para ERO comparado a ERO+ABR para todos os vernizes testados (p< 0,001), seguindo o padrão 5% Nano < 5% Micro < 5% NaF < 2,5% Nano < Pla (ERO e ERO+ABR). A maior perda de DS foi observada para o Pla e a menor para 5% NaF (ERO) e 2,5% Nano (ERO+ABR), sem diferenças significativas entre 2,5% Nano, 5% NaF e 5% Micro. Os maiores valores de ΔKHN foram observados para 5% Micro e 5% Nano a 5-30 µm, com diferenças menos acentuadas entre os grupos a 30-70 µm (ERO e ERO+ABR). Para a 2ª fase, blocos de esmalte bovino (n=224) foram selecionados por DS e distribuídos aleatoriamente entre os grupos: (a) Placebo (Pla - sem F ou TMP), (b) 5% NaF, (c) 5% NaF + 5% TMP microparticulado (5% Micro), e (d) 5% NaF + 5% TMP nanoparticulado (5% Nano). Os blocos foram inseridos em dispositivos acrílicos palatinos (n=4/dispositivo), e tratados com os vernizes uma única vez, permanecendo na cavidade bucal dos voluntários (n=14) por 6 h. Em seguida, os vernizes foram removidos e os blocos, submetidos à ERO (imersão ex vivo em ácido cítrico 0,05 M, pH 3,2, 90 s, 4x/dia), enquanto dois blocos foram adicionalmente submetidos a abrasão por escovação com dentifrício fluoretado (ERO+ABR), totalizando 5 dias em cada etapa experimental, seguindo um protocolo duplo-cego e cruzado. As análises dos blocos e dos dados foram idênticas às da 1ª fase. Os valores do desgaste seguiram um padrão similar em ambas as condições experimentais (ERO ou ERO+ABR), com 5% Nano < 5% Micro < 5% NaF < Pla. Um padrão similar foi observado para dureza em secção longitudinal (ΔKHN), apesar de não serem verificadas diferenças significativas entre 5% Micro×5% Nano (5-30 µm). Quanto à perda de DS, o maior valor foi observado para Pla e o menor para 5% Nano (ERO ou ERO+ABR), sem diferenças significativas entre Pla×5% NaF (ERO), 5% NaF×5% Micro (ERO+ABR), e 5% Micro×5% Nano (ERO+ABR). Diante dos resultados, conclui-se que a adição de TMP a vernizes fluoretados melhorou significativamente a proteção contra o desgaste erosivo do esmalte in vitro e in situ. O uso de 5% de TMP em escala nanométrica aumentou ainda mais esses efeitos(AU)

The present study evaluated the effect of fluoride (F) varnishes supplemented with sodium trimetaphosphate (TMP) nanoparticles on erosive tooth wear, using in vitro and in situ protocols. For the first phase, bovine enamel blocks (n=100) were selected by surface hardness (SH) and randomly divided into 5 experimental groups (n=20/group), according to the varnishes tested: (a) Placebo (Pla - without F or TMP), (b) 5% NaF, (c) 5% NaF + 5% micrometric TMP (5% Micro), (d) 5% NaF + 2.5% nano-sized TMP (2.5% Nano), (e) 5% NaF + 5% nano-sized TMP (5% Nano). Blocks received a single varnish application, and were immersed in artificial saliva for 6 h. Varnishes were then removed and all blocks, subjected to 4 daily erosive challenges during for 5 days (ERO, immersion in 0.05 M citric acid, pH 3.2, 90 s/cycle, under agitation). After ERO, half of the blocks were subjected to abrasion by brushing (15 s/cycle) with placebo dentifrice (ERO+ABR). Blocks were analyzed by profilometry, surface hardness (SH) and cross-sectional hardness (ΔKHN). The data were submitted to 2-way ANOVA and Fisher's LSD test (p< 0.05). Enamel wear was significantly lower for ERO compared to ERO+ABR for all varnishes tested (p< 0.001), following the pattern 5% Nano < 5% Micro < 5% NaF < 2.5% Nano < Pla (ERO and ERO+ABR). The highest SH loss was observed for Pla, and the lowest for 5% NaF (ERO) and 2.5% Nano (ERO+ABR), without significant differences between 2.5% Nano, 5% NaF and 5% Micro. The highest values of ΔKHN were observed for 5% Micro and 5% Nano at 5-30 µm, with less marked differences between the groups at 30-70 µm (ERO and ERO+ABR). In the second phase, bovine enamel blocks (n=224) were selected by SH and randomly distributed among the groups: (a) Placebo (Pla - without F or TMP), (b) 5% NaF, (c) 5% NaF + 5% micrometric TMP (5% Micro), and (d) 5% NaF + 5% nano-sized TMP (5% Nano). The blocks were inserted in acrylic palatal devices (n=4/device), and treated with the varnishes only once, remaining in the oral cavity of the volunteers (n=14) for 6 h. Then, the varnishes were removed and the blocks, subjected to ERO (ex vivo immersion in 0.05 M citric acid, pH 3.2, 90 s, 4x/ day), while two blocks were additionally subjected to abrasion by brushing with fluoride dentifrice (ERO+ABR), totaling 5 days in each experimental stage, following a double-blind, crossover protocol. The blocks and the data were analyzed as described for the first phase. The wear values followed a similar pattern under both experimental conditions (ERO or ERO+ABR), with 5% Nano < 5% Micro < 5% NaF < Pla. A similar pattern was observed for hardness in depth (ΔKHN), although no significant differences were found between 5% Micro×5% Nano (5-30 µm). As for SH loss, the highest value was observed for Pla, and the lowest for 5% Nano (ERO or ERO+ABR), without significant differences between Pla×5% NaF (ERO), 5% NaF×5% Micro (ERO+ABR), and 5% Micro×5% Nano (ERO + ABR). In view of the results, it was concluded that the addition of TMP to fluoride varnishes significantly improved protection against erosive enamel wear in vitro and in situ. The use of 5% nano-sized TMP further increased these effects(AU)

Concentração de fluoreto e quantidade de dentifrício influenciam a desmineralização do esmalte dental in situ / Fluoride concentration and amount of dentifrice influence enamel demineralization in situ

O presente estudo avaliou o efeito da escovação com dentifrício convencional (DC, 1100 ppm F) e com concentração reduzida de fluoreto (DCRF, 550 ppm F), aplicados em diferentes quantidades sobre a desmineralização do esmalte dental bovino, bem como sobre as concentrações de fluoreto (F) no biofilme dental (biomassa e fluido) formado in situ. O estudo compreendeu 5 etapas experimentais de 7 dias cada, nas quais foram testadas 5 combinações de dentifrícios e quantidades: dentifrício placebo (sem F) aplicado sobre todas as cerdas da escova (P); DCRF aplicado pela técnica transversal (0,3 g ­ T1) ou sobre todas as cerdas da escova (0,6 g ­ T2); e DC aplicado do tamanho de uma ervilha (0,15 g ­ T3) ou pela técnica transversal (0,3 g ­ T4), para se obter intensidades de tratamento comparáveis (concentração de F no dentifrício x quantidade aplicada na escova). Em cada fase, os voluntários (n=13, 20-36 anos de idade) utilizaram um dispositivo palatino contendo 4 blocos de esmalte dental bovino, selecionados por meio de dureza de superfície inicial (330 ­ 370 KHN) e realizaram um desafio cariogênico com solução de sacarose a 30%, 6x/dia. A escovação foi realizada 3x/dia com as combinações previamente descritas, seguindo um protocolo duplo-cego, cruzado e randomizado. Na manhã do 8º dia, o biofilme foi coletado 5 e 60 min após a escovação. Foram realizadas as análises de F no biofilme total e no fluido do biofilme, bem como análise da dureza de superfície final e cálculo da porcentagem de perda de dureza de superfície (%DS) e perda integrada da dureza de subsuperfície (ΔKHN). Os resultados foram analisados por ANOVA de medidas repetidas, teste de Student-Newman-Keuls e coeficiente de correlação de Pearson (p<0.05). Para %DS e ΔKHN, a escovação com DC e DCRF promoveu efeitos significativamente superiores aos do P, sendo que a %DS para T3 foi significativamente maior que T4. Para os dados de ΔKHN, os tratamentos de maior intensidade (T2 e T4) promoveram valores significativamente menores em relação aos de menor intensidade (T1 e T3), sem diferenças significativas entre DC e DCRF dentro de cada intensidade. A concentração de F no biofilme total apresentou uma tendência dose-resposta em relação à concentração de F nos dentifrícios. Entretanto, as concentrações de F no fluido do biofilme atingiram um plateau para todos os dentifrícios fluoretados, em ambos os tempos de coleta. Uma forte correlação foi observada entre ΔKHN e a concentração de F no biofilme total (r=-0,71) e no fluido do biofilme (r=-0,72) 5 min após a escovação, enquanto uma correlação moderada foi observada entre ΔKHN e %DS (r=0,60). Concluiu-se que a intensidade do tratamento apresenta influência significativa sobre o desenvolvimento de lesões de cárie, bem como sobre as concentrações de F no biofilme formado in situ(AU)

The present study evaluated the effect of brushing with conventional (CD, 1100 ppm F) and low-fluoride (LFD, 550 ppm F) dentifrices, applied in different quantities, on the demineralization of bovine dental enamel, as well as on fluoride (F) concentrations in the dental biofilm (solid and fluid phases) formed in situ. The study comprised 5 experimental phases of 7 days each, in which 5 combinations of dentifrices and quantities were tested: placebo dentifrice (Ffree) applied on all brush bristles (P); LFD applied by the transversal technique (0.3 g ­ T1) or on all bristles of the brush (0.6 g ­ T2); and CD applied in a peasized amount (0.15 g - T3) or transversal technique (0.3 g - T4), in order to produce comparable intensities (F concentration in the dentifrice x amount applied to the brush). At each experimental phase, volunteers (n=13, 20-36 years old) wore palatal devices containing 4 bovine enamel blocks, selected by initial surface hardness (330 ­ 370 KHN) and performed a cariogenic challenge using a 30% sucrose solution, 6x/day. Brushing was performed 3x/day, using the above-mentioned combinations, following a double-blind, cross-over and randomized protocol. On the morning of the 8th day, biofilm formed on the enamel blocks was collected at 5 and 60 min after brushing. Biofilm and biofilm fluid samples were analyzed for F concentrations. The analysis of final surface and cross-sectional hardness, and the calculation of the percentage of surface hardness loss (% SH) and integrated loss of subsurface hardness (ΔKHN) were determined for all enamel specimens. The results were analyzed by repeated measures ANOVA, Student-Newman-Keuls test, and by Pearson's correlation coefficient (p<0.05). For %SH and ΔKHN, brushing with CD or LFD promoted significantly superior effects than P; the %SH of T3 was significantly higher than of T4. For the ΔKHN data, the treatments with higher intensity (T2 and T4) promoted values significantly lower than those seen for the lower intensity (T1 and T3). F concentrations in the total biofilm showed a dose-response tendency in relation to F concentrations in the dentifrices. However, F concentrations in the fluid phase reached a plateau for all fluoridated dentifrices at both times of sample collection. A strong correlation was observed between ΔKHN and F concentrations in the total biofilm (r=-0.71) and biofilm fluid (r=-0.72) 5 min after brushing, while a moderate correlation was observed between ΔKHN and %SH (r=0.60). It was concluded that the intensity of treatment has a significant influence on the development of caries lesions, as well as on F concentrations of dental biofilm formed in situ(AU)