Knowledge of Brazilian Dentists about Dentoalveolar Trauma Care and their Experiences during the COVID-19 Pandemic

ABSTRACT Objective: To assess dentists' knowledge from Minas Gerais, Brazil, about dentoalveolar trauma (DT) and their experiences during the COVID-19 pandemic. Material and Methods: An online questionnaire with 34 questions was applied to collect personal data, professional training, self-assessment of experience/knowledge about DT, experience in care provided during the social distancing, and knowledge/conduct. The specific responses were evaluated based on the guidelines of the International Association of Dental Traumatology (IADT). Descriptive analysis and Pearson's chi-square test were performed. The level of significance was set at p≤0.05. Results: Most professionals (97.7%) had received information on DT, and only 4.6% of the participants considered their knowledge poor or very poor. However, 92.7% felt the need for more information on the subject. Regarding experiences during the pandemic, 55.7% provided trauma care during that period. Forty percent of the consultations were performed in person, and 33.3% of the professionals noted an increase in cases during the pandemic; 56.6% reported that the frequency did not change. The overall mean number of correct answers about DT was 5.29±2.11, indicating an acceptable level of knowledge. The mean percentage of hits for the specific questions was 44.1%. Conclusion: Although the level of knowledge of the dentists evaluated was acceptable, some aspects were deficient, with the need for more information about the IADT guidelines.

Changes in Oral Health-Related Behaviors and Oral Health of Children in Early Childhood during Social Isolation Caused by COVID-19

ABSTRACT Objective: To assess changes in oral health-related behavior and oral health status in Brazilian children in early childhood perceived by their parents/caregivers during social isolation caused by COVID-19. Material and Methods: A cross-sectional study with parents/caregivers of children in southeastern Brazil aged 0-5 years who responded to an online questionnaire about sociodemographic data, dietary changes, oral hygiene, and oral health status of children during the COVID-19 pandemic. Results: Of the 119 parents/caregivers, 54.60% did not observe any changes in eating habits, and 81.50% maintained their children's oral hygiene. Associations were observed between the impact of the pandemic on the family income and changes in eating habits (p=0.02) and between lower family income and dental caries perceived by parents/caregivers (p=0.05). Z tests with Bonferroni correction showed that families with drastic income reduction were more likely to consume lower-cost foods (62.50%) than families with no impact or slight reduction on family income. Parents/caregivers did not identify dental caries (89.10%), toothache (92.40%), and dental trauma (92.40%) in their children. Conclusion: Parents/caregivers of children in southeastern Brazil aged 0-5 years observed behavioral changes in the dietary habits of families whose income was impacted by the pandemic, and their perception of dental caries was significantly associated with family income.

Perceptions of Parents/Caregivers About the Impact of Oral Conditions on the Quality of Life of Children and Adolescents with Autism Spectrum Disorder.

PURPOSE: To investigate the perceptions of parents/caregivers about the impact of oral conditions on the oral health-related quality of life (OHRQoL) of children/adolescents with autism spectrum disorder (ASD) compared to the perceptions of parents/caregivers of children/adolescents without ASD. METHODS: A comparative cross-sectional study was conducted involving 80 children/adolescents with ASD three to 16 years of age matched by sex and age with 80 children/adolescents without ASD and their parents/caregivers. Clinical examinations were performed for the diagnosis of dental caries experience (DMFT/dmft), clinical consequences of untreated dental caries (PUFA/pufa), visible plaque (VPI), bleeding on probing (BPI), malocclusion and traumatic dental injury (TDI). Parents/caregivers answered a questionnaire addressing sociodemographic characteristics and the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ), which measures OHRQoL from the perspective of parents/caregivers. Data analysis involved the Wilcoxon test, chi-squared test and Poisson regression. RESULTS: Dental caries experience impacted OHRQoL in the group with ASD regarding the total P-CPQ score (p < 0.001) as well as the "oral symptoms" (p = 0.011) and "wellbeing" (p < 0.011) domains. No differences were found between the perceptions of parents/caregivers of children/adolescents with ASD and perceptions of parents/caregivers of children/adolescents without ASD (p = 0.721). CONCLUSION: Dental caries experience can have a negative impact on the OHRQoL of children/adolescents with ASD.

Impacto de condições bucais na qualidade de vida de crianças/adolescentes com e sem transtorno do espectro autista e de seus familiares / Impact of oral conditions on the quality of life of children/adolescents with and without Autistic Spectrum Disorder and their family

O objetivo deste estudo foi avaliar o impacto dos fatores psicossociais familiares relacionados à saúde bucal de crianças/adolescentes com Transtorno do Espectro Autista (TEA) comparados com a percepção de pais/cuidadores de crianças/adolescentes sem TEA. Para avaliação da percepção do impacto de condições bucais na qualidade de vida relacionada a saúde bucal (QVRSB), 80 crianças/adolescentes com TEA e 80 sem TEA foram examinadas. Os pais/cuidadores responderam a versão curta do Parental-Caregiver Perceptions Questionnaire (P-CPQ). A avaliação da influência dos fatores comportamentais na experiência de cárie dentária foi avaliada em 80 mães de crianças/adolescentes com TEA comparada com 76 mães de crianças/adolescentes sem TEA por meio dos questionários Senso de Coerência e Lócus de Controle (LOC). Informações sociodemográficas das famílias foram coletadas por meio de um questionário estruturado autorrespondido pelos responsáveis. Um único examinador avaliou os seguintes indicadores clínicos: cárie dentária (CPO-D/ceo-d), consequências clínicas da cárie dentária não tratada (PUFA/pufa), presença de placa visível (IPV), sangramento à sondagem periodontal (ISS), má oclusão e traumatismos dentoalveolares (TD). O teste Wilcoxon comparou os domínios e o escore total do P- CPQ entre indivíduos com e sem TEA. O teste qui-quadrado de Pearson foi empregado para avaliar a associação entre o escore total do P-CPQ com os dados sociodemográficos, de saúde e com os indicadores clínicos. As variáveis que apresentaram um nível de significância (p<0,20) na análise bivariada foram incorporadas no modelo final da regressão de Poisson (IC 95%, p<0,05). Para a análise dos fatores comportamentais, os testes Qui-quadrado de Pearson, Teste-t de Student e Teste de Mann-Whitney foram realizados para avaliar as diferenças de experiência de cárie e variáveis independentes em ambos os grupos. As variáveis que apresentaram nível de significância (p<0,20) no modelo não-ajustado da Regressão Logística foram incorporadas no modelo final da regressão (IC 95%, p<0,05). Não foram encontradas diferenças estatisticamente significativas em relação à percepção de pais/cuidadores das crianças/adolescentes com TEA sobre as repercussões das condições bucais na qualidade de vida de seus filhos quando comparados à percepção dos pais/cuidadores dos indivíduos sem TEA (p=0,721). O modelo ajustado de crianças com TEA encontrou que crianças que já haviam realizado visita prévia ao dentista têm 3,682 (IC 95% = 1,007 ­ 13,462) vezes mais chance de apresentar experiência de cárie dentária que crianças que nunca foram ao dentista. Enquanto crianças com presença de placa visível têm 3,426 (IC 95% = 1,089 ­ 10,783) vezes mais chance de apresentar experiência de cárie dentária quando comparadas a crianças que não possuem placa visível. A presença de placa visível e a atribuição do acaso ao LOC materno foram determinantes para maior prevalência de experiência de cárie dentária em crianças/adolescentes sem TEA. O grupo com TEA apresentou os mesmos fatores, entretanto a visita prévia ao dentista também foi determinante. A experiência de cárie dentária ainda foi associada à percepção da ocorrência de repercussões negativas na qualidade de vida relacionada à saúde bucal das crianças/adolescentes com TEA.

The aim of this study was to evaluate the impact of family psychosocial factors related to the oral health of children/adolescents with Autism Spectrum Disorder (ASD) compared with the perception of parents/caregivers of children/adolescents without ASD. To assess the perception of the impact of oral conditions on oral health- related quality of life (QHRSB), 80 children/adolescents with ASD and 80 without ASD were examined. Parents/caregivers answered the short version of the Parental- Caregiver Perceptions Questionnaire (P-CPQ). The evaluation of the influence of behavioral factors on the experience of dental caries was evaluated in 80 mothers of children/adolescents with ASD compared with 76 mothers of children/adolescents without ASD using the Sense of Coherence and Locus of Control (LOC) questionnaires. Socio-demographic information of the families was collected through a structured questionnaire self-reported by the guardians. A single examiner evaluated the following clinical indicators: dental caries (DMFT/dmft), clinical consequences of untreated dental caries (PUFA/pufa), presence of visible plaque (IPV), bleeding on periodontal probing (ISS), malocclusion and dentoalveolar trauma (TD). The Wilcoxon test compared the domains and the total score of the P-CPQ between individuals with and without ASD. Pearson's chi-square test was used to assess the association between the total P-CPQ score and sociodemographic and health data and clinical indicators. Variables that showed a significance level (p<0.20) in the bivariate analysis were incorporated into the final Poisson regression model (95% CI, p<0.05). For the analysis of behavioral factors, Pearson's chi-square test, Student's t-test and Mann-Whitney test were performed to assess differences in caries experience and independent variables in both groups. The variables that showed a significance level (p<0.20) in the unadjusted logistic regression model were incorporated into the final regression model (95% CI, p<0.05). No statistically significant differences were found in relation to the perception of parents/caregivers of children/adolescents with ASD about the repercussions of oral conditions on their children's quality of life when compared to the perception of parents/caregivers of individuals without ASD (p=0.721). The adjusted model of children with ASD found that children who had already made a previous visit to the dentist are 3.682 (95% CI = 1.007 ­ 13.462) times more likely to experience dental caries than children who had never been to the dentist. While children with visible plaque are 3.426 (95% CI = 1.089 ­ 10.783) times more likely to experience dental caries when compared to children who do not have visible plaque. The presence of visible plaque and the attribution of chance to maternal LOC were determinants for a higher prevalence of dental caries in children/adolescents without ASD. The group with ASD presented the same factors, however the previous visit to the dentist was also decisive. The experience of dental caries was also associated with the perception of the occurrence of negative repercussions on the quality of life related to the oral health of children/adolescents with ASD.

Is the Oral Cavity of Intensive Care Unit Pediatric Patients More Susceptible to Methicillin-Resistant Staphylococcus aureus Infection?

Objective: The aim of this study was to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the oral cavity of pediatric patients hospitalized at an intensive care unit (ICU). Methodology: Thirty ICU patients (group 1) and 30 healthy patients (group 2), between 1 and 12 years of age, matched by sex and age, were selected from a public hospital in Brazil. After oral examinations, biological specimens (nostril swab, oral mucosa, and supragingival biofilm) were collected from both groups to verify the presence of Staphylococcus aureus. Identification occurred after growth in Tryptic Soy Broth with 7.5% of NaCl for 48 hours, growth in Mannitol Salt Agar, gram staining, catalase, and coagulase tests. S. aureus isolates were submitted to antibiotic sensitivity test. Results: Only 36.7% of patients in the ICU perform oral hygiene during the hospitalization period and 41.7% presented high level of dental biofilm accumulation. The presence of S. aureus was similar in patients from group 1 (43.3%, 13) and group 2 (50.0%, 15) (p = 0.60). Both groups presented 18 samples each that tested positive for S. aureus. However, when considering patients infected by MRSA, the prevalence was higher in group 1 (eight; 26.7%) than in group 2 (five; 16.7%) but no statistical difference was observed (p = 0.53). In group 1, nine MRSA samples were resistant to erythromycin and seven to clindamycin. In group 2, two MRSA samples were resistant to erythromycin and two to clindamycin. Conclusions: Although ICU children did not show a significant higher carriage of MRSA when compared with the healthy group in the population studied, the number of highly resistant strains in the oral cavity isolated from ICU patients adds an important risk factor to be considered by the medical team as possible source of systemic infections, extended hospital stay, and poor outcomes.

Occurrence of Dental Trauma in a Group of Children with Autistic Spectrum Disorder

ABSTRACT Objective: To assess the occurrence of dental trauma in a group of children with Autistic Spectrum Disorder (ASD) in comparison to children without the disorder. Material and Methods: This is a cross-sectional study conducted at the Department of Children and Adolescents Health in the Department of Health of Juiz de Fora, Brazil. The study included individuals with and without ASD, between three and 16 years old, and their parents/caregivers. Children/adolescents were assessed for dental trauma by clinical examination. All exams were performed by a trained and calibrated examiner (MCT), and intra-examiner reliability was previously established (Kappa=0.93). The Socio-demographic status was reported by parents/caregivers. Data analysis included descriptive statistics and generation of frequency distributions. Fisher's exact test was used to evaluate the association between groups of children/adolescents with and without ASD about the presence of dental trauma. The significance level was set at p < 0.05. Results: Sixty children of both sexes participated in the study, thirty with a diagnosis of ASD and thirty without. The age ranging from 3 to 13 years, with an average of 7.5 ± 3.2 years. Children with ASD had a higher frequency of dental trauma than children without ASD (p=0.02), and the most frequent type of trauma was enamel fracture (57.10%), followed by enamel/dentin fracture without pulp exposure (42.90%). Conclusion: Children with ASD, when compared to children who did not have ASD, had a higher occurrence of dental trauma.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis.

Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.

Development of a calcified odontogenic hamartoma following avulsion of a permanent central incisor.

The avulsion of a permanent immature tooth is a serious condition and a real emergency in dentistry. The management of a traumatized avulsed tooth is always a challenge to the clinician. This case report concerns the development of a calcified odontogenic hamartoma after the avulsion of an immature central incisor in an eight-year-old female. The patient presented for the treatment four months after the avulsion. Her intraoral examination showed complete healing of the area but an atypical appearance of the alveolar area of the missing tooth was observed in the periapical radiograph. A new radiographic scan performed six months later revealed the formation of a radiopaque irregular structure at the cervical level of the alveolar ridge at the site of the missing tooth. Surgical removal was performed, and the histopathological examination revealed a hamartomatous proliferation of odontogenic tissue with calcification. After healing, the lateral incisor was orthodontically moved mesially and restored to resemble the central incisor. An orthodontic device was installed to improve function and aesthetics of the patient.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis

Abstract Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.

Prevalência de Staphylococcus aureus em pacientes pediátricos hospitalizados / Prevalence of Staphylococcus aureus in pediatric patients hospitalized

O objetivo desse estudo foi avaliar a prevalência de Staphylococcus aureus e Staphylococcus aureus resistentes à meticilina (MRSA) na cavidade oral de pacientes hospitalizados em uma unidade de terapia intensiva (UTI). Foram selecionados 30 pacientes na UTI (grupo I) e 30 pacientes saudáveis (grupo II), com idade entre 1 e 12 anos, pareados por sexo e idade. Inicialmente, foram realizadas coletas de dados médicos e exames intra e extra-orais. Em seguida, foram coletados espécimes clínicos (swab bucal, swab de narina e biofilme supragengival) de ambos os grupos para verificar a presença de Staphylococcus aureus. A identificação ocorreu pelo crescimento no caldo de soja Tryptic com 7,5% de NaCl durante 48 h, crescimento em agar de sal de Mannitol, coloração de Gram, teste de catalase e coagulase. As amostras positivas de S.aureus foram submetidas ao antibiograma para avaliação da susceptibilidade a antibióticos. Os resultados foram analisados estatisticamente através do SPSS versão 20.0 e comparados por meio dos testes do Quiquadrado, Teste de Fisher e Mann-Whitney. O valor de 0,05 foi considerado estatisticamente significativo. Apenas 36,7% dos pacientes na UTI realizavam higiene bucal durante o período de hospitalização e mais de 40% dos pacientes hospitalizados em UTI apresentavam biofilme espesso. A prevalência de S. aureus foi de 22,5% e 20,4% para UTI e grupo controle, respectivamente. Nove amostras de boca (30%), 6 amostras de narina (20%) e 3 amostras de biofilme (15%) do grupo UTI foram consideradas S. aureus positivo. No grupo de controle, 6 amostras de boca (20%), 5 amostras de narina (16,7%) e 7 de biofilme (25%) foram positivas. Nas 36 amostras positivas de S. aureus, 44,4% (16) foram consideradas MRSA, sendo 62,5% (10) no grupo I e 37,5% (6) no grupo II. Essa diferença foi estatisticamente significante (p = 0.032, teste de Fisher). Não foram observadas correlações entre sua prevalência e razão e tempo de internação. Todas as amostras de MRSA dos dois grupos apresentaram resistência à penicilina G. No grupo I, duas amostras de MRSA foram resistentes a todos os antibióticos, inclusive a vancomicina, nove foram resistentes à eritromicina e sete à clindamicina. No grupo II, duas amostras de MRSA foram resistentes à eritromicina e duas à clindamicina. Dessa forma, conclui-se que os pacientes internados em UTI apresentam uma maior prevalência de MRSA, entretanto não houve correlação entre essa prevalência e a história médica dos pacientes. (AU)

The aim of this study was to evaluate the prevalence of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) in the oral cavity of patients in an intensive care unit (ICU). We selected 30 patients in the ICU (group I) and 30 healthy patients (group II), aged between 1 and 12 years, matched by sex and age. Initially, medical data collection and intra- and extraoral examinations were performed. Then, clinical specimens (buccal swab, nostril swab and supragingival biofilm) were collected from both groups to verify the presence of Staphylococcus aureus. Identification occurred by growth in Tryptic soy broth with 7.5% NaCl for 48 h, growth on Mannitol salt agar, Gram staining, catalase test and coagulase. The S.aureus positive samples were submitted to the antibiogram for evaluation of susceptibility to antibiotics. The results were analyzed statistically through SPSS version 20.0 and compared using the Chi-square test, Fisher's test and Mann-Whitney test. The value of 0.05 was considered statistically significant. Only 36.7% of the patients in the ICU performed oral hygiene during the hospitalization period and more than 40% of patients hospitalized in ICU had thick biofilm. The prevalence of S. aureus was 22.5% and 20.4% for ICU and control group, respectively. Nine mouth samples (30%), 6 nostril samples (20%) and 3 biofilm samples (15%) of the ICU group were considered S. aureus positive. In the control group, 6 mouth samples (20%), 5 nostril samples (16.7%) and 7 biofilm samples (25%) were positive. In the 36 positive S. aureus samples, 44.4% (16) were considered MRSA, 62.5% (10) in group I and 37.5% (6) in group II. This difference was statistically significant (p = 0.032, Fisher's test). No correlation was observed between its prevalence and reason and time of hospitalization. All MRSA samples from both groups showed resistance to penicillin G. In group I, two samples of MRSA were resistant to all antibiotics, including vancomycin, nine were resistant to erythromycin and seven to clindamycin. In group II, two samples of MRSA were resistant to erythromycin and two to clindamycin. Thus, we conclude that ICU patients present a higher prevalence of MRSA, but there was no correlation between this prevalence and the medical history of the patients. (AU)