Dental Status of Firefighters of Rio de Janeiro State and Comparison with Brazilian Oral Health Surveys

ABSTRACT Objective: This cross-sectional study aimed to assess clinical dental status in military firefighters of Rio de Janeiro State and compare data with Brazilian National and Regional oral health surveys. Material and Methods: A sample of 926 military firefighters was examined using the visible biofilm index, the DMFT index and the Community Periodontal Index (CPI). Clinical exams were performed by 15 trained dentists. The Kruskal-Wallis test and Mann-Whitney test with Bonferroni correction were used. Results: Higher biofilm accumulation was associated with increased age. The mean DMFT index for the whole sample of this study was 12.74 (±7.03), and the 'filled' component was the most prevalent (69.9%), whereas the 'decayed' and 'missing' components were, respectively, 8.4% and 21.7%. There was a higher prevalence of periodontal diseases with increasing age, ranging from 57.1% in firefighters of 34 years or less to 70.5% in the ones between 35 and 44 years old and 75.4% in participants at age 45 years or older. Clinical dental status of the military firefighters who belonged to the age group 35-44 was better than the one observed for the Brazilian population at the same age range. However, pathological conditions that can be solved with health promotion strategies associated with dental procedures of low complexity still persist. Conclusion: These results suggest that the availability of dental health care services itself does not represent the most effective approach to the oral health problems found in the studied population.

Does the presence of sucrose in pediatric antibiotics influence the enamel mineral loss and the Streptococcus mutans counts in dental biofilm?

The role of antibiotics containing sucrose on the formation of dental caries is still controversial. This study aimed to investigate the effect of two antibiotics (amoxicillin and potassium clavulanate suspension), with and without sucrose, on human dental hardness and Streptococcus mutans counts in dental biofilm. Primary tooth fragments (n=72) were coated with nail varnish leaving a window of 2.25 mm diameter. Specimens were fixed in 24-well polystyrene plates, containing BHI medium. S. mutans (clinical strains) represented the inoculum to form biofilm on the fragments for 24 h. Twelve fragments were separated for the initial count of microorganisms (baseline). The other fragments were divided into 4 groups (n=12) of treatment: G1 (Clavulin(r)), G2 (Betamox(r)), G3 (chlorhexidine 0.12%), G4 (sucrose 10%). All specimens had their self-control area (covered area). The cross-sectional microhardness (CSMH) was evaluated for each specimen. All the treated groups had a loss of hardness compared to their self-controls (p<0.05). Both drugs inhibited the S. mutans growth and promoted no CSMH difference among them. Both antibiotics eliminated all formed biofilm and did not cause mineral loss from the enamel, regardless the presence of sucrose in its formulation.

Does the Presence of Sucrose in Pediatric Antibiotics Influence the Enamel Mineral Loss and the Streptococcus mutans Counts in Dental Biofilm?

The role of antibiotics containing sucrose on the formation of dental caries is still controversial. This study aimed to investigate the effect of two antibiotics (amoxicillin and potassium clavulanate suspension), with and without sucrose, on human dental hardness and Streptococcus mutans counts in dental biofilm. Primary tooth fragments (n=72) were coated with nail varnish leaving a window of 2.25 mm diameter. Specimens were fixed in 24-well polystyrene plates, containing BHI medium. S. mutans (clinical strains) represented the inoculum to form biofilm on the fragments for 24 h. Twelve fragments were separated for the initial count of microorganisms (baseline). The other fragments were divided into 4 groups (n=12) of treatment: G1 (Clavulin(r)), G2 (Betamox(r)), G3 (chlorhexidine 0.12%), G4 (sucrose 10%). All specimens had their self-control area (covered area). The cross-sectional microhardness (CSMH) was evaluated for each specimen. All the treated groups had a loss of hardness compared to their self-controls (p<0.05). Both drugs inhibited the S. mutans growth and promoted no CSMH difference among them. Both antibiotics eliminated all formed biofilm and did not cause mineral loss from the enamel, regardless the presence of sucrose in its formulation.

O papel dos antibióticos contendo sacarose na formação de cárie dentária é ainda controverso. Este estudo teve como objetivo investigar o efeito de dois antibióticos (amoxicilina / clavulanato de potássio suspensão oral), com e sem sacarose, na dureza do esmalte dental humano e na contagem de Streptococcus mutans no biofilme dental. Fragmentos de dentes decíduos (n = 72) foram revestidos com verniz deixando uma janela de exposição de 2,25mm de diâmetro. Os espécimes foram fixados em placas de poliestireno de 24 poços, contendo meio de cultura BHI. S. mutans (estirpes clínicas) representaram o inoculo para formar biofilmes sobre os fragmentos por 24 h. Doze fragmentos foram separados para a contagem inicial de microrganismos (baseline). Os restantes dos fragmentos foram divididos em 4 grupos (n = 12) de tratamento: G1 (Clavulin(r)), G2 (Betamox(r)), G3 (clorexidina 0,12%), G4 (sacarose a 10%). Todas as amostras tiveram sua área de controle (área coberta). A microdureza transversal (CSMH) foi avaliada para cada espécime. Todos os grupos tratados tiveram uma perda de dureza quando comparados com os seus respectivos controles (p <0,05). Ambos os fármacos inibiram o crescimento de S. mutans e não promoveram diferença da CSMH entre eles. Ambos os antibióticos eliminaram todo o biofilme formado, não promovendo assim, perda mineral do esmalte, independente da presença de sacarose na sua formulação.

Topical effect of a medically prescribed pediatric antibiotic on dental biofilm: a cross-over, in situ study.

OBJECTIVE: This study aimed to investigate the possible topical effect of a broad-spectrum antibiotic on dental biofilm formed in situ in the absence or presence of sucrose. METHODS: A crossover study was conducted in three phases of 14 days each, during which 11 volunteers wore palatal devices containing 6 enamel blocks covered with meshes to allow biofilm formation. Dental blocks were extraorally submitted to a 20% sucrose solution at three different frequencies of exposure (0, 3 and 8 times/day), and to a suspension of amoxicillin/clavulanate potassium (A/CP) or a placebo (P) suspension at an 8-hour time interval application regimen. On the 14(th) day of each phase, biofilms were collected for microbiological (conventional culture) and molecular (Denaturing Gradient Gel Electrophoresis--DGGE) analyses. RESULTS: In the absence of sucrose exposure (SE) and at the 3-time daily frequency, dental biofilms treated with A/CP showed lower total biofilm weight and lower counts of total microbiota than the ones treated with P (p>0.05). A/CP presented higher counts of Candida spp. when compared with P in the presence of SE, especially at the 8-time daily frequency (p<0.05). Considering the DGGE analysis, the mean number of bands was higher for P (p>0.05), regardless of SE. However, DGGE profiles demonstrated large interindividual variability. CONCLUSION: Both conventional culture and DGGE have demonstrated some differences on total microbiota of dental biofilms when exposed to the A/CP or P suspensions, mainly in the absence of sucrose, which suggests a possible topical effect of the sugar-free A/CP suspension on dental biofilm.

In vitro effect of paediatric liquid medicines on deciduous enamel exposed to biofilm.

OBJECTIVE: This study aimed to assess the in vitro effects of paediatric liquid medicines on deciduous enamel exposed to biofilms. METHODS: Fragments (n = 25) of first primary molars were covered by nail varnish, leaving a 22 mm(2) exposure area. Specimens were fixed in polystyrene plates containing BHI broth media. Pooled human saliva was added to form a mature biofilm on fragments over a 10-day period in microaerophilic conditions. Specimens were divided into groups (n = 5 per group) and treated (50 µL) daily for 1 min over 1 week as follows: G1 = 10% sucrose solution (positive control); G2 = Dimetapp Elixir® (antihistamine); G3 = Claritin® (antihistamine); and G4 = Klaricid® (antibiotic). Five other fragments, without treatment and inoculum represented the blank controls. The covered area for each specimen represented the negative control. Cross-sectional hardness of the enamel was used as a demineralization indicator. RESULTS: All treatment groups showed hardness loss compared to the corresponding negative controls (p < 0.05). Among the treatment groups, G2 exhibited the greatest demineralization pattern (p < 0.05) followed by G3, G1 and G4. CONCLUSION: All medicines caused deciduous enamel demineralization in the presence of biofilm. The greatest hardness loss was observed after treatment with Dimetapp Elixir®.

Caries preventive effects of xylitol-based candies and lozenges: a systematic review.

OBJECTIVE: A systematic review of published data was conducted with the aim of assessing the caries preventive effect of consuming xylitol-based candies and lozenges. METHODS: Electronic and hand searches were performed to find clinical trials concerning the consumption of products containing xylitol, published up to November 2009. The studies must have had the following characteristics: (a) a comparison of caries progression in subjects who either did or did not consume candies or lozenges containing xylitol during a minimum follow-up period of 1 year; and (b) a concurrent comparison of the percentage of caries progression according to the World Health Organization criteria. The caries preventive effect of xylitol was assessed by calculating the prevented fraction. RESULTS: The initial search identified 127 references. Six studies met the initial eligibility criteria, but three were excluded after thorough analysis. Two more articles were selected after hand searching, but they were excluded due to the presence of chewing gum in the experimental group. Of the three selected studies, two found a lower caries increment in the treatment groups. Although the findings of the analyzed studies suggest that the use of xylitol-based candies and lozenges could favor a reduction in caries increment, in general, their consumption did not seem to be effective on the proximal surfaces. Nevertheless, these findings are not supported by strong evidence. CONCLUSION: This research demonstrates the need for well-designed randomized clinical studies with adequate control groups and high compliance by the subjects.

In vitro alterations in dental enamel exposed to acidic medicines.

OBJECTIVE: To evaluate the effect of acidic medicines (Klaricid(®), Claritin(®), and Dimetapp(®)) on surface enamel in vitro. METHODS: Enamel blocks (n=104) were randomly distributed into two groups: G1 (pH-cycling simulating physiological oral conditions) and G2 (erosive conditions). Each group was divided into four subgroups, three to be immersed in the medicines and the control in deionized water. Specimen surfaces were evaluated for roughness and hardness at baseline and again after the in vitro experimental phase, which included 30 min immersions in the medicines twice daily for 12 days. Scanning electron microscopy (SEM) was also performed after the in vitro experimental phase. RESULTS: All medicines produced a significant reduction in hardness in G1 after 12 days (P<0.05). The three medicines promoted greater roughness after both pH-regimens - G1 and G2 (P<0.01), except for Claritin in G1. Scanning electron microscopy analysis showed erosive patterns in all subgroups. Dimetapp(®) showed the most erosion and Klaricid(®) the least, in both groups. CONCLUSION: Dimetapp(®) (lowest pH and viscosity) and deionized water (control) showed the most pronounced erosive patterns. Klaricid(®) (highest pH and viscosity) presented an in vitro protective effect against acid attacks perhaps due to its mineral content and viscosity.

An unusual accident during a primary molar extraction.

BACKGROUND: Special care must be taken during surgical procedures in children, especially primary tooth extractions. However, despite dentist's effort to perform tooth removal carefully, some accidents may be unavoidable when defective instruments are unknowingly used. CASE REPORT: This article presents a case of a pediatric dental elevator fracture during a primary mandibular right second molar extraction. CONCLUSION: Although uncommon, instruments breakage may occur during dental and surgical procedures. Therefore, dentists should always check the surgical instrument for signs of breakage and be prepared to solve a possible emergency.

Erosive effect of an antihistamine liquid formulation on bovine teeth: influence of exposure time

Aim: To evaluate, in vitro, the effect of an oral antihistamine liquid formulation on roughness and topography of bovine enamel and the influence of exposure time on its erosive effect. Methods: Forty-one bovine enamel blocks were prepared leaving an exposed window of 0.8 mm2 Thirtynine blocks were divided into three treatment groups according to media immersion: antihistamine. formulation (Histamin ®), 0.6% citric acid (positive control), and distilled water (negative control). Before immersion of the samples, pH, titratable acidity, calcium, phosphate and fluoride contents of all media were verified. Enamel roughness was evaluated at baseline, and after 5, 15, and 30 min of immersion (9 samples per group). Two specimens from each group and exposure time, and 2 additional specimens representing baseline, were analyzed by scanning electron microscopy (SEM). Data were analyzed by the Kruskal-Wallis test, and the Mann-Whitney test using the Bonferroni correction (á=0.017). Results: Specimens immersed in citric acid showed the highest roughness (P<.001). SEM images showed a progressive erosion pattern in samples immersed in citric acid and in antihistamine formulation. Conclusions: The antihistamine liquid formulation did not promote significant alterations of enamel roughness. Nevertheless, SEM demonstrated that the antihistamine eroded bovine enamel, and the erosion pattern was influenced by exposure time.

Influence of local factors on cementoenamel junction-alveolar bone crest distance in primary dentition.

OBJECTIVE: This study illustrated the influence of local factors (dental biofilm, gingival bleeding, probing depth, proximal contact and proximal caries/inadequate restorations) on the cementoenamel junction (CEJ)-alveolar bone crest (ABC) distance in primary canines and molars of healthy children with complete primary dentition. STUDY DESIGN: Two hundred and four patients have been examined clinically with regard to biofilm's presence, gingival status, probing depth, proximal contact and dental condition (carious lesions/restorations). Two bitewings of each patient were also taken. Eight dental surfaces (second molars mesial, first molars mesial and distal, and canines distal) could be analyzed per bitewing and the CEJ-ABC distance was measured using a digimatic caliper. Statistical analyses were controlled by dental arch, tooth type and surface. Mann-Whitney test was used to verify the association between CEJ-ABC distance and local factors. RESULTS: After stratifying the data according to those influencing factors, the only local factor associated with increased CEJ-ABC distances in most of the different analyzed dental surfaces was the increased probing depth (> 2mm), although only two dental surfaces showed statistical significance (p < 0.01). CONCLUSION: Among the analyzed local factors, increased probing depth was the only factor that proved to be relevant in children's alveolar bone loss screening.

Pediatric bitewing film holder: preschoolers' acceptance and radiographs' diagnostic quality.

PURPOSE: The purpose of this study was to evaluate a modified bitewing film holder based on preschoolers' acceptance and the diagnostic quality of radiographic images. METHODS: Sixty-six 3- to 5-year-old children were radiographed with the modified device. Acceptance was assessed according to their behavior during the radiographic examination and to their perception of the procedure. In only the 4- and 5-year-olds, the children's perception was assessed using a faces scale. Evaluation of the images' diagnostic quality for each quadrant (considering pairs of radiographs) was based on anatomic structures usually present on bitewing radiographs. RESULTS: During radiographic examination, 73% of the children were cooperative. As to the patients' perceptions (N = 43), 74% showed satisfaction with the radiographic examination. The diagnostic quality of radiographic images (N = 66) was adequate in more than 90% of the cases for all evaluated parameters, except for the visualization of alveolar bone crests (54%) and the absence of proximal overlapping (86%). CONCLUSIONS: The modified bitewing film holder produced adequate radiographs for almost all parameters and was well accepted by preschoolers.

Pediatricians' perceptions of the use of sweetened medications related to oral health.

OBJECTIVE: To evaluate pediatricians' perceptions and attitudes about the use of liquid pediatric medicines and their relationship with dental caries and dental erosion. STUDY DESIGN: A cross sectional study was conducted. Data was collected by questionnaires handed out in hospitals, medical clinics and offices. A convenience sample of 104 pediatricians was obtained. RESULTS: Most respondents (80.8%) stated that pediatric medicines could be related with dental disorders. Dental caries (64.70%) and tooth discoloration (43.7%) were the most frequent mentioned alterations, while only 3 (4.2%) respondents pointed out dental erosion. A considerable number of respondents (62.50%) recognized the presence of fermentable carbohydrates as a contributing factor to tooth decay, however not all of them recommended oral hygiene after their consumption (50.80%). Besides, 48 respondents (46.20) also believed that pediatric medicines could cause dental wear. CONCLUSIONS: Pediatricians in this study did not perceive the correct relationship between the presence of acidity in medicines and dental erosion; however, most of them presented a reasonable awareness about the relationship between sugared pediatric medicines and dental caries. Besides, they were unaware about the need of recommending oral hygiene after medicines' use.

Percepções e atitudes de responsáveis por crianças frente ao uso de medicamentos infantis e sua relação com cárie e erosão dentária / Perceptions and attitudes among parents and guardians on the use of pediatric medicines and their cariogenic and erosive potential

Este estudo avaliou as percepções e atitudes de responsáveis por crianças sobre os potenciais cariogênico e erosivo de medicamentos infantis. Foram realizadas entrevistas sobre a associação do uso de medicamentos infantis com cárie e erosão dentária, bem como os cuidados com a higiene bucal após sua ingestão. Do total de responsáveis com entrevista completa (n=86), 24 (27,9 por cento) consideraram os medicamentos infantis ácidos, 51 (59,3 por cento) amargos e 56 (65,1 por cento) doces; porém, apenas 16 (28,6 por cento) destes últimos realizavam higiene bucal das crianças após utilização (Exato de Fisher; p>0,05). Além disso, apenas 18 (20,9 por cento) responsáveis realizavam esta prática, dos quais 8 (44,4 por cento) haviam recebido orientação prévia sobre higiene bucal (Exato de Fisher; p<0,05). A associação entre uso de medicamentos e cárie dental ou defeitos na estrutura dos dentes foi apontada por 61 (70,9 por cento) entrevistados, dos quais 24 (39,3 por cento) justificaram tal associação em função da presença de açúcar nas formulações. Apesar dos responsáveis considerarem os medicamentos doces e relacionarem seu uso à presença de cárie e defeitos na estrutura dental, grande parte destes não realiza higiene bucal em seus filhos após o uso desses fármacos e não consegue estabelecer claramente a relação de causa e efeito existente em tal associação.

The study assesses the perceptions of parents/guardians on the use of pediatric medicines and their cariogenic/erosive potential, interviewing them on the relationship between the use of pediatric medicines and cavities/dental erosion, as well as oral hygiene procedures after the medication. Among the interviewed parents/guardians (n=86), 24 (27.9 percent) mentioned the sour taste of pediatric medication, 51 (59.3 percent) the bitter taste, and 56 (65.1 percent) considered them sweet, although only 16 (28.6 percent) of these parents/guardians brushed their children's teeth after the medication (Fisher's Exact; p>0.05). Moreover, only 18 (20.9 percent) of the parents/guardians performed oral hygiene practices after the medication, of whom 8 (44.4 percent) received previous instructions (Fisher's Exact; p<0.05). The association between taking medications and dental caries or structural dental defects was mentioned by 61 (70.9 percent) of the parents/guardians, with 24 (39.3 percent) of them justifying this association through the presence of sugar in the formulations. Although parents/guardians consider medicines to be sweet substances and relate their use to dental caries and tooth structure flaws, most of them do not brush their children's teeth after taking medications and are unable to establish a clear cause/effect relationship for this association.

[Perceptions and attitudes among parents and guardians on the use of pediatric medicines and their cariogenic and erosive potential]. / Percepções e atitudes de responsáveis por crianças frente ao uso de medicamentos infantis e sua relação com cárie e erosão dentária.

The study assesses the perceptions of parents/guardians on the use of pediatric medicines and their cariogenic/erosive potential, interviewing them on the relationship between the use of pediatric medicines and cavities/dental erosion, as well as oral hygiene procedures after the medication. Among the interviewed parents/guardians (n=86), 24 (27.9%) mentioned the sour taste of pediatric medication, 51 (59.3%) the bitter taste, and 56 (65.1%) considered them sweet, although only 16 (28.6%) of these parents/guardians brushed their children's teeth after the medication (Fisher's Exact; p>0.05). Moreover, only 18 (20.9%) of the parents/guardians performed oral hygiene practices after the medication, of whom 8 (44.4%) received previous instructions (Fisher's Exact; p<0.05). The association between taking medications and dental caries or structural dental defects was mentioned by 61 (70.9%) of the parents/guardians, with 24 (39.3%) of them justifying this association through the presence of sugar in the formulations. Although parents/guardians consider medicines to be sweet substances and relate their use to dental caries and tooth structure flaws, most of them do not brush their children's teeth after taking medications and are unable to establish a clear cause/effect relationship for this association.

O tratamento restaurador atraumático no contexto do Sistema Único de Saúde / Atraumatic restorative treatment regarding the context of Sistema Único de Saúde

Este trabalho tem por objetivo analisar o Tratamento Restaurador Atraumático - TRA como estratégia de ação clínica da Odontologia dentro do Sistema Único de Saúde - SUS. Além disto, alguns aspectos como o uso de tecnologia apropriada, o baixo custo e o amplo respaldo científico do TRA são salientados como seus principais pontos positivos. São também apontados os benefícios e as possibilidades de aplicação do TRA no contexto do Programa Saúde da Família, bem como nos diferentes espaços sociais, objetivando a universalização da atenção odontológica. Por fim, o artigo salienta a necessidade de implementação de políticas econômicas e sociais mais justas como fator essencial para a melhoria da saúde bucal da população brasileira.

This paper intends to both analyze the Atraumatic Restorative Treatment - ART as a strategy of clinical action of Dentistry in the Sistema Único de Saúde - SUS, and emphasize some of its aspects, such as appropriate technology usage, low cost and the vast scientific support, as its main positive characteristics. We also emphasize the benefits of the ART in the context of Programa Saúde da Familia (PSF) and its possibilities of application to the public in different social spaces, in order to achieve the universalization of the dental attention. ln conclusion, the paper stresses the necessity to implement fair social and economic policies as essential factors for the improvement of Brazilian population's oral health.

Bruxism in children: a warning sign for psychological problems.

Bruxism is nonfunctional clenching or grinding of the teeth. It is a destructive habit that may result in tooth wear. Although research on bruxism is extensive, its etiology remains debatable. The literature suggests that bruxism is correlated with both experienced and anticipated life stress. The purpose of this report is to describe 2 cases of severe bruxism in children of similar age with different life histories and to discuss the factors that could have triggered this parafunctional condition.

Free sugar concentration and pH of paediatric medicines in Brazil.

OBJECTIVE: This study aimed to determine free sugar concentration and pH of paediatric syrup medicines. Setting Ten paediatric syrup medicines most frequently prescribed in urban centres in Brazil were randomly chosen to be tested. OUTCOME MEASURES: Three different bottles from each type of syrup medicine were analysed (n = 30). Analysis of free sugars was performed using normal phase High-Performance Liquid Cromatography (HPLC). Quantification of free sugars was achieved by peak height comparison with standards of sucrose, fructose, glucose and sorbitol (Merck). The results were average of replicates from three bottles of each medicine. The pH of the three different bottles of each medicine was determined using a digital pHmeter (Analion - PM 600). RESULTS: Sucrose and glucose were detected in seven of the ten types of paediatric syrup medicines, with concentrations varying from 3.7 to 49.4% (w/w) (Median 32.7%) and 2.1 to 23.2% (w/w) (Median = 6.1%), respectively. Only two medicines contained fructose, and three, sorbitol, with respective medians of 12.8% (3.1-22.4%) and 24.6% (22.8-27.4%). The median of pH values was 4.9 (2.6-6.1). CONCLUSIONS: Most paediatric syrup medicines showed high concentration of free sugars and pH below the critical value (5.5), which can increase their cariogenic and erosive potentials.

Alveolar bone loss in the primary dentition: state of the art.

Alveolar bone loss has been reported in primary teeth of healthy young children with a variable prevalence. This study aimed to review the literature on alveolar bone loss in the primary teeth of children without systemic diseases and to discuss the controversies with regard to the prevalence of this pathology in the primary dentition.