Needle-free anesthetic polymeric device for dental anesthesia in children: A randomized clinical trial.

PURPOSE: To evaluate efficacy of an anesthetic mucoadhesive film with a polymeric device (PD) in promoting anesthesia compared to conventional local infiltration (LA) in children. METHODS: 50 children aged 6-10 years (both genders) needing similar procedures on homologous teeth on the maxilla were included. The parents and children were asked about perception of dental treatment. The child's heart rate per minute (bpm) and blood pressure were evaluated before and after each anesthetic technique (AT) procedure. Anesthesia efficacy was measured by reporting pain using Wong-Baker Faces Scale. Children's behavior and AT preferences were also evaluated. Paired T-test, chi-square and Wilcoxon test were used for statistical comparisons. RESULTS: Fear of anesthesia was reported by 50% of caregivers and by 66% of children. No difference was observed in systolic (P= 0.282) and diastolic (P= 0.251) blood pressure, comparing both AT. Difference was observed regarding the child's behavior when the PD was used (P= 0.0028). Evaluating the face scale, 74% of the children selected the "no pain" (face 0) (P< 0.0001) for PD, and 26% for LA. PD was preferred by 86% of children. Only 20% of the PD anesthesia needed to be complemented by LA. CLINICAL SIGNIFICANCE: The polymeric device presented promising results since most children did not report pain and dental procedures could be performed without local infiltration.

Radiotherapy Activates Matrix Metalloproteinases in the Dentinoenamel Junction of Primary Teeth.

Purpose: Radiation-related caries is characterized by enamel delamination near the dentinoenamel junction (DEJ). We investigated the activity and expression of the matrix metalloproteinases (MMPs) -2 and -9 in order to understand disease pathogenesis in teeth submitted or not to radiotherapy (RT).
Methods: In situ zymography and immunofluorescence assays were performed to evaluate the activity and expression of MMPs -2 and -9, respectively. Twelve primary second molars were randomly assigned into two experimental subgroups: irradiated and nonirradiated. Dental fragments were exposed to radiation at a dose fraction of two Gy for five consecutive days until reaching the total dose of 60 Gy. The percentage of fluorescence in the DEJ was evaluated in three distinct regions of the tooth (cervical, cusp, and pit). The regions were photographed under fluorescence microscopy at 1.25× and 5× magnification.
Results: The intensity of fluorescence per mm 2 in the DEJ was higher in the cervical region of irradiated primary teeth (P <0.05) versus nonirradiated ones. In these areas, immunofluorescence revealed expression of MMPs -2 and -9.
Conclusion: Radiotherapy can increase the activity of MMPs -2 and -9 in the cervical region of the DEJ of primary teeth.

Factors involved in the treatment sought immediately after traumatic dental injuries in Brazilian children.

AIM: The aim of this study was to evaluate demographic and clinical factors involved in the immediate seeking of care after traumatic dental injury (TDI) in Brazilian children. MATERIALS AND METHODS: Records from 74 patients, age ranged 1-11 years, who sought treatment at the School of Dentistry of Ribeirão Preto at University of São Paulo, Brazil, were collected. Data was analyzed using the Epi Info 7.0 software by t-test, odds ratio calculation, Chi-square, or Fisher's exact tests. RESULTS: Twenty-three (31.1%) sought dental treatment immediately and 51 (68.9%) did not seek dental treatment immediately. The most common type of trauma was lateral luxation (44.6%). In primary teeth, 31 cases (60.78%) involved the soft tissue and 16 (39.2%) involved hard tissue injuries. While in permanent teeth, 20 cases (40%) involved soft tissue and 24 (60%) involved hard tissue injuries had more traumas in the hard tissue (P = 0.04). The type of injury and dentition was not associated with the time that the guardians sought dental treatment (P > 0.05). None of the factors were involved in immediately seeking care after TDI. CONCLUSION: Moreover, the majority of parents/caregivers did not immediately seek dental treatment after TDI, regardless of the type of injury.

Effect of manual and electrical brushing on the enamel of sound primary teeth and teeth with induced white spot lesions.

PURPOSE: To evaluate the effect of different electrical brushing systems on the surface roughness and wear profile of the enamel of sound primary teeth and teeth with induced white spot lesions. METHODS: 45 specimens were obtained from sound primary incisors, and the buccal surface was divided into four parts: sound enamel; enamel with white spot lesions; sound enamel with brushing; and enamel with white spot lesions and brushing. Specimens were randomly divided into three groups (n =15), according to the different brushing systems: Group 1 - Electric rotating toothbrush (Kid's Power Toothbrush - Oral B); Group 2 - Sonic electric toothbrush (Baby Sonic Toothbrush); and Group 3 - Manual toothbrush (Curaprox infantil) (control). The specimens were analyzed for surface roughness and wear profile. Data were analyzed by appropriate statistical tests, with a significance level of 5%. RESULTS: Regarding the surface roughness, no significant difference was observed between the groups. However, with respect to the wear profile, Group 1 caused significantly higher wear in the sound tooth enamel and in the presence of white spot lesions, in comparison to the other brushing systems (2 and 3) (P< 0.05), which did not cause wear. Manual and electric brushing (rotational and sonic) did not increase surface roughness in primary tooth enamel. However, the electric rotational brushing caused significant wear of the sound and demineralized enamel surface of primary teeth. CLINICAL SIGNIFICANCE: None of the toothbrushing systems tested caused significant alterations on sound dental enamel. However, rotational toothbrushing on enamel of primary teeth with white spot lesion increased wear.

Oestrogen receptor alpha, growth hormone receptor, and developmental defect of enamel.

BACKGROUND: Oestrogen (ES) and growth hormone (GH) are hormones that may have a role in caries aetiology and developmental defects of enamel (DDE) since their receptors (ERs and GHR) are expressed during amelogenesis. AIM: To evaluate whether genetic polymorphisms in the genes that codify the ERα (ESR1) and GHR are associated with caries experience and DDE in children. DESIGN: Two hundred and sixteen children of both genders, aged 9-12 years, were examined and classified according to caries and DDE phenotype. Genomic DNA was extracted from buccal cells in saliva. Genetic polymorphisms in ERS1 (rs1884051 and rs12154178) and GHR (rs297305, rs2940913, rs2910875, and rs1509460) were genotyped using TaqMan chemistry. Data were analysed by PLINK, while the chi-square test was used to compare allele and genotype distributions (alpha of 5%). RESULTS: A total of 131 children (60.7%) had caries experience, and 43 (19.9%) presented DDE. Genotype and allele distributions were not associated with caries experience (P > 0.05). Genotype and allele distributions between DDE, affected and unaffected, were associated with the polymorphism rs12154178 in ESR1 (P = 0.01 and P = 0.001, respectively) and with the polymorphism rs1509460 in GHR (P = 0.05 and P = 0.02, respectively). CONCLUSIONS: Genetic polymorphisms in ERS1 (rs12154178) and GHR (rs1509460) are associated with DDE.

Effects of Rosiglitazone on the Outcome of Experimental Periapical Lesions in Mice.

INTRODUCTION: The purpose of this study was to evaluate a protocol for systemic administration of rosiglitazone in mice in order to stimulate apoptosis of osteocytes in the jaws and to evaluate the effect of osteocyte apoptosis induced by rosiglitazone in the progression of periapical lesions in mice at 7, 21, and 42 days. METHODS: C57BL/6 mice at 4-5 weeks of age were used. In phase 1, mice (n = 24) were treated with rosiglitazone (gavage, 10 mg/kg dose) or without (phosphate-buffered saline + 10% dimethyl sulfoxide) for 1, 2, or 3 weeks. We used the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling and 4'-6-diamidino-2-phenylindole methods for quantification of apoptotic cells. In phase 2, mice (n = 30) received rosiglitazone for 2 weeks or just vehicle for 1 week (n = 30), and periapical lesions were induced for 7, 21, or 42 days. We performed the measurement of periapical lesions, tartrate-resistant acid phosphatase staining, dual-energy x-ray absorptiometry for the evaluation of bone mineral density (BMD) in long bone, and gene evaluation using real time quantitative polymerase chain reaction of osteocyte markers (Sost, Hyou1, and Dmp1) and receptor activator of nuclear factor kappa-B ligand (RANKL) (Tnfsf11). RESULTS: It was observed that systemic administration of rosiglitazone for 2 weeks showed apoptosis of osteocytes in a more expressive manner. In phase 2, in the groups that received rosiglitazone, a trend toward larger periapical lesions was observed (P > .05). Rosiglitazone also induced a greater number of osteoclasts and a greater expression of Sost and Hyou1 at 21 days of lesions. Moreover, there were no statistically significant differences in RANKL and Dmp1 expression or in the BMD of femurs. CONCLUSIONS: Rosiglitazone stimulated apoptosis of osteocytes, interfering in the progression of periapical lesions in mice.

Single vs Two-session Root Canal Treatment: A Preliminary Randomized Clinical Study using Cone Beam Computed Tomography.

AIMS: To compare root canal treatment of teeth with apical periodontitis (AP) in a single or two visits, using cone beam computed tomography (CBCT). MATERIALS AND METHODS: Twenty-six pairs of teeth (13 patients) were assigned to two groups: Group single-session (GSS): Instrumentation and root canal filling in the same session; and group two-session (GTS): A calcium hydroxide intracanal medication (Calen(®) paste) was used for 14 days between two sessions. Cone beam computed tomography scans were obtained before and 12 months after treatment. The pre- and postoperative volume of the AP lesions was measured in mm(3). The percentages of volume reduction was compared using Student's t-test and the existence of significant difference between the groups for cases with ≤ 50% or > 50% lesion volume reduction was assessed by chi-squared test ratio likelihood test (α = 5%). RESULTS: The volume reduction was greater in GTS (79.25%) than GSS (68.35%), though without significant difference (p > 0.05). After 12 months, complete repair was not observed in any specimen. Lesion volume reduction > 50% was significantly greater with the use of an intracanal medication (p < 0.05). CONCLUSION: Twelve months posttreatment, CBCT did not show complete repair in any of the teeth, suggesting that this follow-up period is not sufficient for complete lesion regression. In both groups, similar AP lesion volume reduction was observed after 12 months, with a more advanced repair (> 50% volume reduction) in the teeth medicated with calcium hydroxide intracanal dressing. CLINICAL SIGNIFICANCE: Calcium hydroxide intracanal dressing provided clinical evidence to indicate its use in teeth with apical periodontitis prior to definitive root canal filling.

Sex Differences in Pediatric Dental Pain Perception.

PURPOSE: To evaluate sex-related differences in dental pain perception in children. METHODS: Fifty-two children who received a dental procedure with local anesthesia were selected to participate. Pain perception levels were assessed with the Wong-Baker FACES Pain Rating Scale. Twenty-four and 48 hours following the procedure, the parents were contacted by phone for a verbal survey to assess their child's postoperative pain. Age, type of dental procedure, and behavior were also evaluated as covariables. The data were analyzed using Epi Info 7.0 software and GraphPad Prism 5.0 software. Chi-square or t test were performed with a significance level of five percent. RESULTS: The mean age of the children was 6.7 (±2.4 [SD]) years. Twenty-seven (51.9 percent) were boys. None of the parents reported pain at 48 hours. None of the covariables were differentially distributed among the sexes (P>0.05). There was no statistical difference between sex and pain perception immediately after the procedure (P=0.64) and after 24 hours (P=0.41). However, when the analysis was performed according to age group, a borderline association was found. Female preschoolers reported more pain immediately after the procedure than male preschoolers (P=0.06). CONCLUSION: There was no statistical difference in pain perception between sexes.

Stress and anxiety in children after the use of computerized dental anesthesia.

The aim of this study was to evaluate the transitory stress levels and the anxiety state in children submitted to conventional and computerized dental anesthesia. Twenty children (7 to 12 years) were randomly assigned to receive conventional and computerized dental anesthesia. To investigate the hypothesis that transitory stress could be lower after using computerized anesthesia compared to conventional anesthesia, cortisol levels in saliva were measured before and after each technique. Anxiety was also evaluated individually by answering the State-Trait Anxiety Inventory for Children (STAIC). Numerical data were analyzed statistically by the Mann-Whitney non-parametric test (5% significance level). Salivary cortisol levels increased in 8 (40%) patients after conventional anesthesia and in 9 (45%) patients after computerized anesthesia, with no statistically significant difference between the two types (p=0.34). In the same way, no statistically significant difference was found between the techniques (p=0.39) related to the psychological analysis based on the STAIC scores. Local anesthesia using either conventional anesthesia or a computerized delivery system produced similar level of stress/anxiety in pediatric patients, using both quantitative and qualitative analyses.

Stress and Anxiety in Children After the Use of Computerized Dental Anesthesia

The aim of this study was to evaluate the transitory stress levels and the anxiety state in children submitted to conventional and computerized dental anesthesia. Twenty children (7 to 12 years) were randomly assigned to receive conventional and computerized dental anesthesia. To investigate the hypothesis that transitory stress could be lower after using computerized anesthesia compared to conventional anesthesia, cortisol levels in saliva were measured before and after each technique. Anxiety was also evaluated individually by answering the State-Trait Anxiety Inventory for Children (STAIC). Numerical data were analyzed statistically by the Mann-Whitney non-parametric test (5% significance level). Salivary cortisol levels increased in 8 (40%) patients after conventional anesthesia and in 9 (45%) patients after computerized anesthesia, with no statistically significant difference between the two types (p=0.34). In the same way, no statistically significant difference was found between the techniques (p=0.39) related to the psychological analysis based on the STAIC scores. Local anesthesia using either conventional anesthesia or a computerized delivery system produced similar level of stress/anxiety in pediatric patients, using both quantitative and qualitative analyses.

O objetivo deste estudo foi avaliar os níveis de estresse transitório e o estado de ansiedade em crianças submetidas à anestesia dental convencional e computadorizada. Vinte crianças (7 a 12 anos de idade) foram randomicamente designadas para receber anestesia dental convencional e computadorizada. Para investigar a hipótese que o estresse transitório poderia ser menor após a anestesia computadorizada, comparada à anestesia convencional, os níveis de cortisol na saliva foram medidos antes e depois de cada técnica. A ansiedade também foi avaliada individualmente por meio do State-Trait Anxiety Inventory for Children (STAIC). Os dados numéricos foram analisados estatisticamente pelo teste não paramétrico de Mann-Whitney (nível de significância de 5%). Os níveis salivares de cortisol aumentaram em 8 (40%) pacientes após anestesia convencional e em 9 (45%) pacientes após anestesia computadorizada, sem diferença estatisticamente significante entre os dois tipos (p=0,34). Da mesma maneira, não foi encontrada diferença estatisticamente significante entre as técnicas (p=0,39) com relação à análise psicológica baseada nos escores STAIC. Anestesia local usando tanto a anestesia convencional quanto o sistema de aplicação computadorizado produziu nível similar de estresse/ansiedade em pacientes infantis, utilizando análises quantitativa e qualitativa. .

Filtek™ Silorane and Filtek™ Supreme XT resins: tissue reaction after subcutaneous implantation in isogenic mice.

The aim of this study was to evaluate the tissue compatibility of a silorane-based resin system (Filtek™ Silorane) and a methacrylate-based nanoparticle resin (Filtek™ Supreme XT) after implantation in the subcutaneous connective tissue of isogenic mice. One hundred and thirty five male isogenic BALB/c mice were randomly assigned to 12 experimental and 3 control groups, according to the implanted material and the experimental period of 7, 21 and 63 days. At the end of each period, the animals were killed and the tubes with the surrounding tissues were removed and processed for microscopic analysis. Samples were subjected to a descriptive and a semi-quantitative analyses using a 4-point scoring system (0-3) to evaluate the collagen fiber formation and inflammatory infiltrate. Data were statistically analyzed using the Kruskal Wallis test (α=0.05). The results showed that there was no significant difference between the experimental and control groups considering the three evaluation periods (p>0.05). The silorane-based and the methacrylate-based nanoparticle resins presented similar tissue response to that of the empty tube (control group) after subcutaneous implantation in isogenic mice.

FiltekTM Silorane and FiltekTM Supreme XT resins: tissue reaction after subcutaneous implantation in isogenic mice

The aim of this study was to evaluate the tissue compatibility of a silorane-based resin system (FiltekTM Silorane) and a methacrylate-based nanoparticle resin (FiltekTM Supreme XT) after implantation in the subcutaneous connective tissue of isogenic mice. One hundred and thirty five male isogenic BALB/c mice were randomly assigned to 12 experimental and 3 control groups, according to the implanted material and the experimental period of 7, 21 and 63 days. At the end of each period, the animals were killed and the tubes with the surrounding tissues were removed and processed for microscopic analysis. Samples were subjected to a descriptive and a semi-quantitative analyses using a 4-point scoring system (0-3) to evaluate the collagen fiber formation and inflammatory infiltrate. Data were statistically analyzed using the Kruskal Wallis test (?=0.05). The results showed that there was no significant difference between the experimental and control groups considering the three evaluation periods (p>0.05). The silorane-based and the methacrylate-based nanoparticle resins presented similar tissue response to that of the empty tube (control group) after subcutaneous implantation in isogenic mice.

O objetivo do presente estudo foi avaliar a compatibilidade tecidual de um sistema resinoso à base de silorane (FiltekTM Silorane) e de uma resina nanoparticulada à base de metacrilato (FiltekTM Supreme XT), após implantação no tecido conjuntivo subcutâneo de camundongos isogênicos. Um total de 135 camundongos isogênicos BALB/c machos foram randomicamente divididos em 12 grupos experimentais e em 3 grupos controles, de acordo com o material implantado e com o período experimental (7, 21 e 63 dias). Ao final de cada período, os animais foram mortos, sendo os tubos removidos com o tecido circundante e processados para análise microscópica. As lâminas foram submetidas a análise descritiva e análise semi-quantitativa empregando um sistema de escores de 4 pontos (0-3), a fim de avaliar a formação de fibras colágenas e o infiltrado inflamatório. Os dados obtidos foram submetidos à análise estatística por meio do teste de Kruskal Wallis (?=0,05). Os resultados mostraram que não houve diferença estatisticamente significante entre os grupos experimentais e controles, considerando os três períodos de avaliação (p>0,05). As resinas à base de silorane e à base de metacrilato apresentaram resposta tecidual semelhante à do tubo vazio (controle), após implantação no tecido conjuntivo de camundongos isogênicos.

Direct pulp capping with a self-etching adhesive system: histopathologic evaluation in dogs' teeth.

OBJECTIVE: This study evaluated histopathologically the response of pulp and periradicular tissues after pulp capping with an all-in-one self-etching adhesive system in dogs' teeth. STUDY DESIGN: Forty teeth of 4 dogs were assigned to 3 groups according to the pulp capping material: G1 (n = 20): self-etching adhesive system; G2 (n = 10): Ca(OH)(2); G3 (n = 10): zinc oxide-eugenol. The animals were killed 7 and 70 days after pulp capping. The pieces containing the pulp-capped teeth were removed and processed for histologic analysis. RESULTS: At 7 days, no dentin bridge formation was observed; G1 and G3 exhibited inflammatory pulpal alterations, whereas G2 presented only mild inflammatory infiltrate in the pulp tissue adjacent to the capping material, the remainder being intact. At 70 days, no specimen in G1 or G3 presented dentin bridge formation. The remaining pulp tissue exhibited severe inflammatory alterations and areas of necrosis. In G2, all specimens showed dentin bridge formation and absence of inflammation and mineralized tissue resorption. No bacteria were identified using Brown and Brenn staining techniques in all 3 groups at any observation period. CONCLUSION: According to the conditions of this study, direct pulp capping with the self-etching adhesive system did not allow pulp tissue repair and failed histopathologically in 100% of the cases.

Dental findings and dental care management in trisomy 18: case report of a 13-year-old "long-term survivor".

Trisomy 18 is a disorder characterized by psychomotor disabilities, dysmorphic features and organ malformations, including mental disabilities, growth deficiency, poor motor ability, micrognathia, microcephaly, low-set and malformed ears, distinctively clenched fists with overlapping fingers, and congenital heart defects. The prognosis is poor: 90% of infants with trisomy 18 do not survive beyond the first year of life and 99% die before the age of 10. This paper reports on a 13-year-old child diagnosed with trisomy 18. The major clinical features are cleft lip/palate, high-arched narrow palate, micrognathia, anterior open bite, posterior crossbite and taurodontism. Dental care management of these patients with special needs is discussed and the dental treatment for this child with trisomy 18 is described.