Efficacy of 1.23% APF gel applications on incipient carious lesions: a double-blind randomized clinical trial.

The aim of this double-blind randomized clinical trial was to evaluate the efficacy of 1.23% APF gel application on the arrest of active incipient carious lesions in children. Sixty 7- to 12-year-old children, with active incipient lesions were included in the study. Children were divided randomly into 2 groups: 1.23% APF gel and placebo gel applications. Each group received 8 weekly applications of treatment. The lesions were re-evaluated at the 4th and 8th appointments. Poisson regression analysis was used to estimate relative risks of the presence of active white spot lesions. Groups showed similar results (PR = 1.67; CI 95% 0.69-3.98). The persistence of at least 1 active lesion was associated with a higher number of lesions in the baseline (PR = 2.67; CI 95% 1.19-6.03), but not with sugar intake (PR = 1.06; CI 95% 0.56-2.86) and previous exposure to fluoride dentifrice (PR = 1.26; CI 95% 0.49-2.29). The trial demonstrates the equivalence of the treatments. The use of the APF gel showed no additional benefits in this sample of children exposed to fluoridated water and dentifrice. The professional dental plaque removal in both groups may also account for the resulting equivalence of the treatments.

Efficacy of 1.23% APF gel applications on incipient carious lesions: a double-blind randomized clinical trial

The aim of this double-blind randomized clinical trial was to evaluate the efficacy of 1.23% APF gel application on the arrest of active incipient carious lesions in children. Sixty 7- to 12-year-old children, with active incipient lesions were included in the study. Children were divided randomly into 2 groups: 1.23% APF gel and placebo gel applications. Each group received 8 weekly applications of treatment. The lesions were re-evaluated at the 4th and 8th appointments. Poisson regression analysis was used to estimate relative risks of the presence of active white spot lesions. Groups showed similar results (PR = 1.67; CI 95% 0.69–3.98). The persistence of at least 1 active lesion was associated with a higher number of lesions in the baseline (PR = 2.67; CI 95% 1.19–6.03), but not with sugar intake (PR = 1.06; CI 95% 0.56–2.86) and previous exposure to fluoride dentifrice (PR = 1.26; CI 95% 0.49–2.29). The trial demonstrates the equivalence of the treatments. The use of the APF gel showed no additional benefits in this sample of children exposed to fluoridated water and dentifrice. The professional dental plaque removal in both groups may also account for the resulting equivalence of the treatments.

Eficácia da escova dental convencional e de cabeça tripla na remoção do biofilme dental em crianças / The cleaning efficiency of a conventional and a triple-headed toothbrush in children

Objetivo: Comparar a eficácia de duas escovas na remoção de biofilme dental utilizadas por crianças de quatro anos de idade. Métodos: As escovas dentais convencional (Bitufo® 22, Bitufo, Itupeva, Brasil) e de cabeça tripla (DenTrust®, Dental HealthWay Inc., Newport, EUA) foram utilizadas por 20 crianças previamente treinadas para realizarem a escovação pelo tempo de um minuto em cada arco. A eficácia de cada escova foi avaliada pela quantidade de biofilme dental presente nas superfícies dentárias antes e após a escovação, evidenciada com o uso do corante fluorescente (Plaque Test® Vivadent, Ivoclar Vivadent AG, Schaan, Principado de Liechtenstein) e categorizada pela utilização dos índices de Rodrigues et al.1 para superfícies lisas e de Greene & Vermillion2 para superfícies oclusais. Os dados foram submetidos à Análise de Variância, Teste de Tukey e Kruskal-Wallis (?=0,05).Resultados: Independente da escova utilizada houve redução dos escores na quantidade de biofilme presente nas superfícies dentárias (p=0,000). Considerando somente as superfícies oclusais, não foram encontradas diferenças estatísticas significativas entre as escovas. Entretanto, a escova tripla apresentou melhor desempenho na remoção de biofilme nas superfícies lisas (p<0,05) principalmente nas faces linguais/palatinas (p<0,0001). Na região anterior do arco não houve diferença entre as escovas e na região posterior a escova tripla também proporcionou maior redução de biofilme em comparação à escova convencional (p<0,0001). Conclusão: Com base nos resultados, concluiu-se que as duas escovas avaliadas foram efetivas na remoção de biofilme dental, contudo que a escova de cabeça tripla apresentou desempenho superior.

Objective: The objective of this study was to compare the efficacy of bacterial plaque removal with conventional (Bitufo® 22, Bitufo, Itupeva, Brazil) and triple-headed (DenTrust®, Dental HealthWay Inc., Newport, USA) toothbrushes. Methods: Twenty children aged 4 years old participated in this crossed study, with weekly intervals. The quantity of biofilm was evaluated before and after toothbrushing by children for 1 minute each arch. A fluorescent light-cured bacterial plaque revealer (Plaque Test® Vivadent, Ivoclar Vivadent AG, Schaan, Principality of Liechtenstein) was used to report Greene and Vermillion1 index for free smooth surfaces, and Rodrigues et al.2 index for occlusal surfaces. Data were submitted to ANOVA. Results: In spide of the employed toothbrush, there was statistically significant difference on plaque removal between smooth or occlusal surfaces (p=0.000). The triple-headed and the conventional type cleaned occlusal surfaces similarly. However, the triple-headed toothbrush removed more plaque on buccal surface than the conventional type (p<0.05). The triple-headed toothbrush removed more plaque on the buccal surface (p<0.0001). The conventional and the triple-headed promoted a similar plaque removal both in anterior buccal areas. The triple-headed toothbrush was more effective than the conventional type on the posterior area (p<0.0001). Conclusion: It was concluded that effective plaque removal was achieved by the children with both toothbrushes; however the triple-headed toothbrush had a better performance.

Use of chewing gum containing 15% of xylitol and reduction in mutans streptococci salivary levels.

Frequent use of Xylitol may decrease the S. mutans levels. However, very little is known about whether this effect on the levels of cariogenic bacteria is maintained after the interruption of short-term usage of xylitol. This study aimed at evaluating changes in mutans streptococci (MS) salivary levels after using a chewing gum containing xylitol. Twelve volunteers harboring > or = 10(5) CFU MS/ml saliva levels were asked to chew Happydent-xylit for 5 minutes, 5 X/day, for 30 days. Saliva samples were collected at baseline, at 30 days after xylitol usage began, and at 30 days beyond its interruption. MS salivary levels were estimated. The average salivary levels of MS in the ten subjects who completed the study were 13.17 (NL-CFU) at baseline (A). After the 30 days experimental period (B), this average decreased to 9.45 (NL-CFU). Nine of ten subjects studied showed a reduction in MS salivary levels in relation to baseline, whereas salivary levels were maintained in the remaining subject. At thirty days beyond the interruption of xylitol usage (C), the average levels of MS were still reduced to 10.31 (NL-CFU). Multiple sample comparison using the Bonferroni test revealed that the decrease in MS levels observed from baseline (A) to the time immediately after 30 days of xylitol usage (B) was statistically significant (p < 0.05), and those levels were still decreased between baseline and 30 days beyond the interruption of xylitol usage (C). So, the use of xylitol induced a reduction in MS salivary levels after a short period of usage which persisted beyond its interruption.

Use of chewing gum containing 15 percent of xylitol and reduction in mutans streptococci salivary levels

Frequent use of Xylitol may decrease the S. mutans levels. However, very little is known about whether this effect on the levels of cariogenic bacteria is maintained after the interruption of short-term usage of xylitol. This study aimed at evaluating changes in mutans streptococci (MS) salivary levels after using a chewing gum containing xylitol. Twelve volunteers harboring > 10(5) CFU MS/ml saliva levels were asked to chew Happydent-xylit® for 5 minutes, 5 X/day, for 30 days. Saliva samples were collected at baseline, at 30 days after xylitol usage began, and at 30 days beyond its interruption. MS salivary levels were estimated. The average salivary levels of MS in the ten subjects who completed the study were 13.17 (NL-CFU) at baseline (A). After the 30 days experimental period (B), this average decreased to 9.45 (NL-CFU). Nine of ten subjects studied showed a reduction in MS salivary levels in relation to baseline, whereas salivary levels were maintained in the remaining subject. At thirty days beyond the interruption of xylitol usage (C), the average levels of MS were still reduced to 10.31 (NL-CFU). Multiple sample comparison using the Bonferroni test revealed that the decrease in MS levels observed from baseline (A) to the time immediately after 30 days of xylitol usage (B) was statistically significant (p < 0.05), and those levels were still decreased between baseline and 30 days beyond the interruption of xylitol usage (C). So, the use of xylitol induced a reduction in MS salivary levels after a short period of usage which persisted beyond its interruption.

Uso da fluxometria laser doppler em dentes decíduos traumatizados / Use of laser Doppler flowmetry in traumatized primary teeth

A necrose pulpar apresenta-se como uma sequela de difícil diagnóstico em dentes decíduos traumatizados e, muitas vezes, somente é detectada após o aparecimento de sinais como fístula, lesão periapical e reabsorção inflamatória externa. Os dados provenientes da anamnese, dos exames clínicos intra-bucal e radiográfico são limitados. Para melhorar esse diagnóstico, sugere-se a utilização de testes objetivos e não invasivos que avaliem a circulação sanguínea. O objetivo deste artigo foi apresentar um caso clínico que utilizou a Fluxometria Laser Doppler para auxiliar no diagnóstico de necrose pulpar do dente 51, em uma criança de 4 anos e 2 meses de idade atendida no Centro de Atendimento e Pesquisa de Traumatismos em Dentes Decíduos da Disciplina de Odontopediatria da Faculdade de Odontologia da Universidade de São Paulo. O dente 51 não apresentava sinais clínicos de necrose pulpar. O aparelho utilizado foi o Fluxômetro Laser Doppler (Moor Instruments, Axminster, Inglaterra), modelo moorLAB, com diodo laser emitindo no comprimento de onda de 780nm, potência de 1mW, banda Doppler fixada em 15kHz. Para o dente 51, foi obtido valor de fluxo de 2,1UA e o valor da variação percentual entre o dente 51 e 52 foi de 40,4%. Estes valores classificam o dente como desvitalizado. Assim sendo, foi possível realizar o diagnóstico de necrose pulpar utilizando a Fluxometria Laser Doppler como método auxiliar sem que houvesse sinais clínicos evidentes dessa sequela.

The diagnosis of pulp necrosis in traumatized primary teeth is difficult. Pulp necrosis is usually detected after signs like fistula, periapical radiolucency and inflammatory root resorption appear. Data from anamnesis and clinical and radiographic examinations are limited. In order to improve diagnosis, the use of objective and noninvasive tests that assess blood flow has been suggested. The aim of this article was to present a clinical case where laser Doppler flowmetry was used to aid the diagnosis of pulp necrosis in the upper right central incisor (tooth 51) of a child aged 4 years and 2 months seen at the Pediatric Dental Trauma Research Center of the Pediatric Department of FOUSP. Tooth 51 presented no clinical sign of pulp necrosis. The laser Doppler flowmeter (Moor Instruments, Axminster, England) model moorLAB was used with a 780 nm diode laser, cut-off frequency of 15 kHz and intensity of 1mW. The flow value of tooth 51 was 2.1UA and the percentage variation between teeth 51 and 52 was 40.4%. These values classify the tooth as devitalized. Therefore, it was possible to obtain a diagnosis of pulp necrosis using laser Doppler flowmetry in a tooth without evident clinical signs of this sequela.

Características oclusais e miofuncionais orais das crianças atendidas na Clínica de Odontopediatria da Faculdade de Odontologia da USP / Occlusal and oral myofunctional characteristics of children treated in Pediatric Dentistry Clinic, School of Dentistry USP

Introdução - O objetivo deste trabalho foi avaliar e correlacionar características oclusais e miofuncionais orais em crianças. Material e Métodos - Oclusão e aspectos miofuncionais orais de 229 crianças, entre 3 e 14 anos de idade, pacientes da Clínica de Odontopediatria da Faculdade de Odontologia da USP foram avaliados em exame clínico realizado por cirurgião-dentista e fonoaudióloga. Utilizou-se teste das proporções (GMC) para investigar a associação entre a postura e tônus de lábios, postura de língua, deglutição, respiração e fala e a presença de mordida aberta anterior, mordida cruzada posterior e ausência dessas alterações oclusais. Resultados - Na dentição decídua houve maior prevalência de mordida aberta anterior (30,6%) enquanto nas dentições mista e permanente, houve maior prevalência de mordida cruzada posterior (11,6% e 6,7% respectivamente). Não foi encontrada associação significante entre presença de mordida aberta anterior ou mordida cruzada posterior e ocorrência de alterações miofuncionais orais, exceto pela alteração na fala, que foi mais frequente nas crianças com mordida aberta anterior (p< 0,05). A principal alteração na fala dessas crianças foi a interposição lingual anterior (55,6%), sendo que a interposição lingual anterior durante a deglutição também foi muito prevalente nas crianças com mordida aberta anterior (70,4%). Chamou atenção a elevada prevalência de alterações na deglutição e na respiração nas crianças avaliadas, em todos os grupos. Conclusão - Diante da elevada prevalência de alterações oclusais e miofuncionais orais nos pacientes avaliados, recomenda-se a atuação multiprofissional de cirurgiões-dentistas e fonoaudiólogos na Clínica Odontopediátrica. Novos estudos clínicos ainda são necessários para investigar a associação entre as características oclusais e miofuncionais orais nas crianças.

Introduction - This study aimed to evaluate and correlate occlusal and oral myofunctional characteristics in children. Material and Methods - Occlusion and oral myofunctional characteristics of 229 children, between 3 and 14 years of age, patients of the Pediatric Dentistry Clinic School of Dentistry USP, were evaluated in a clinical examination performed by dentist and speech therapist. Test of the proportions (GMC) was used to investigate the association between lips posture and tonus, tongue posture, deglutition, breathing and speech and occurrence of anterior open bite, posterior crossbite and abscense of these occlusal alterations. Results - In deciduous dentition, there was higher prevalence of anterior open bite (30,6%) while in mixed and permanent dentitions, there was higher prevalence of posterior crossbite (11,6% and 6,7% respectively). There was not statistically significant association between presence of anterior open bite or posterior crossbite and occurrence of oral myofunctional alterations, except for alteration in the speech, which was more frequent in children with anterior open bite (p< 0,05). The major speech alteration in these children was anterior tongue interposition (55,6%), and anterior tongue interposition during deglutition (70,4%) was also very prevalent in children with anterior open bite. It called attention the high prevalence of alterations in the deglutition and in the breathing in children, in all groups. Conclusion - Due to high prevalence of occlusal and oral myofunctional alterations in the patients, the multiprofessional acting of dentists and speech therapists is recommended in Pediatric Dentistry Clinic. New clinical trials are still necessary to investigate the association between the occlusal and oral myofunctional characteristics in children.

Effect of fluoride varnish and gel on dental erosion in primary and permanent teeth.

OBJECTIVE: To assess the effect of a fluoride varnish and gel on the erosive wear of primary and permanent teeth. DESIGN: Sixty human primary (n=30) and permanent (n=30) enamel specimens were randomly assigned to one of the following groups: APF gel (1.23% F), NaF varnish (2.26% F), and control (no treatment). Fluoride gel was applied for 4 min and fluoride varnish for 24 h. Six daily demineralisation-remineralization cycles of 5 min of immersion in a cola drink (pH 2.3) and 30 min in artificial saliva were conducted during 7 days. All specimens were stored in artificial saliva between and after cycles. Surface Knoop microhardness (%SMHC) readings were performed at baseline, 48 h and 7 days. Data were tested using ANOVA and Tukey's tests (p<0.05). RESULTS: For primary enamel, the mean %SMHC (+/-SD) after 48 h and 7 days was, respectively: gel (31.0+/-14.4 and 36.9+/-7.5), varnish (26.7+/-9.5 and 38.3+/-8.7), and control (35.8+/-8.6 and 45.0+/-8.6). For permanent enamel, such values were: gel (37.5+/-7.7 and 27.8+/-7.5), varnish (31.7+/-9.6 and 27.4+/-11.1) and control (48.6+/-6.4 and 43.1+/-6.4). In primary enamel, erosion inhibition by fluoride was not significant at 48 h (p=0.203) and 7 days (p=0.082). In permanent specimens, both products showed a significant effect (p<0.001). CONCLUSIONS: Both fluoride varnish and gel were able to inhibit erosive enamel loss but mainly in the permanent experimental groups. Primary and permanent enamel substrates reacted differently to both demineralization by a cola drink and remineralization by fluoridated compounds.

Laser fluorescence device does not perform well in detection of early caries lesions in primary teeth: an in vitro study.

PURPOSE: To evaluate if using the laser fluorescence (LF) device improves the detection of early or more advanced occlusal caries lesions in primary teeth. MATERIALS AND METHODS: A total of 181 occlusal sites in primary teeth were assessed by one examiner using DIAGNOdent. The same examiner and a second examiner evaluated 72 of the sites again to assess intra- and inter-examiner reproducibility. After histological validation, lesions were divided at three thresholds according to the lesion depth: outer half of the enamel (D1), inner half of the enamel (D2) and dentine (D3). The sensitivity, specificity, accuracy and area under ROC curve were calculated for cut-off points for the sample considering the aforementioned thresholds. The parameters were compared using chi-square test and by comparison between unpaired ROC curves. RESULTS: The overall LF performance was better at dentine threshold than at enamel threshold. The higher specificity was found at D3 and D2, and higher accuracy at D3 (P < 0.001). The intra- and inter-examiner agreements were classified as good or excellent for all thresholds. CONCLUSIONS: The LF device performs better at the dentine threshold than at the enamel threshold. This method does not perform well in detecting initial enamel caries lesions.

Early diagnosis and surgical treatment of the lower labial frenum in infancy: a case report.

The lower labial frenum attached to the free gingival margin can promote local tension, resulting in tissue ischemia, promoting the development of gingival recession, as well as complicating oral hygiene, resulting in a local biofilm accumulation and chronic inflammation. In such cases, periodontal surgery is recommended and the local anatomic characteristics will be improved as early as school age. In this case report, a 7 years old patient had the lower labial frenum repositioned. After this procedure, the suture of the mucosa to the periosteum was performed around the surgical wound to provide local healing by secondary intention. This case report suggests that early diagnosis and surgical treatment of the lower labial frenum in school age children is fundamental in eliminating etiological factors, reestablishing normal anatomic characteristics and preventing periodontal diseases.

Effect of chlorhexidine-thymol varnish on caries lesion development in first permanent molars.

OBJECTIVE: The aim of this study was to investigate the caries prevention efficacy of chlorhexidine-thymol (CHX-T) varnish on newly erupted permanent first molars. METHODS: Fifty-seven six- to eight-year-old school children were included in a program of sequential CHX-T varnish application. For inclusion, they had to have at least two homologous, newly erupted first permanent molars with visually sound occlusal surfaces. A clinical examination was used to determine the molar eruption stage, biofilm presence, and whole caries status. There were 99 pairs of molars in the study population. A split-mouth design was used where each child randomly had one first molar treated with six applications of CHX-T varnish, and the other with a placebo varnish, every 15 days for 75 days. The children were then revaluated for caries one year following the conclusion of treatment. RESULTS: Fourteen pairs of teeth presented incipient enamel caries lesions in both molars (one CHX-T and one placebo varnish), four developed lesions in the placebo-treated molars only, and eight developed lesions in CHX-T varnish-treated molar only. No significant statistical differences were found between the two groups with regard to caries increment (p = 0.20). CONCLUSION: Six applications of CHX-T varnish had no protective effect against caries development.

Evaluation of residual dentin after conventional and chemomechanical caries removal using SEM.

The purpose of this in vitro study was to analyze the residual dentinal surfaces following caries removal using rotatory instruments and two chemomechanical methods (Papacárie and Carisolv), by scanning electron microscopy (SEM). Thirty primary incisors were divided into three groups, according to the caries removal method used, and their residual dentin was examined under SEM (15). After caries removal, 15 of these teeth were restored with Single Bond (3M) adhesive system and Z100 Filtek composite resin (3M). The tags of the replicas were observed under SEM. The chemomechanical caries removal methods (Papacárie and Carisolv) formed an amorphous layer, similar to the smear layer and few exposed dentinal tubules; the conventional caries removal method produced a smooth and regular dentinal surface, with typical smear layer and exposed dentinal tubules. All groups showed abundant tag formation. Scanning electron microscopy analysis revealed a difference between dentin treated with rotatory instruments and that treated with chemomechanical methods in spite of the occurrence of a similar tag formation in both groups.

Microtensile bond strength of contemporary adhesives to primary enamel and dentin.

UNLABELLED: The purpose of this study was to assess bond strength of three self-etching and two total-etch adhesive systems bonded to primary tooth enamel and dentin. MATERIALS AND METHODS: Forty extracted primary human molars were selected and abraded in order to create flat buccal enamel and occlusal dentin surfaces. Teeth were assigned to one of the adhesive systems: Adper Scotch Bond Multi Purpose, Adper Single Bond 2, Adper Prompt L-Pop, Clearfil SE Bond and AdheSE. Immediately to adhesive application, a composite resin (Filtek Z250) block was built up. After 3 months of water storage, each sample was sequentially sectioned in order to obtain sticks with a square cross-sectional area of about 0.72 mm2. The specimens were fixed lengthways to a microtensile device and tested using a universal testing machine with a 50-N load cell at a crosshead speed of 0.5 mm/min. Microtensile bond strength values were recorded in MPa and compared by Analysis of Variance and the post hoc Tukey test (a = 0.05). RESULTS: In enamel, Clearfil SE Bond presented the highest values, followed by Adper Single Bond 2, AdheSE and Adper Scotch Bond Multi Purpose, without significant difference. The highest values in dentin were obtained with Adper Scotch Bond Multi Purpose and all other adhesives did not present significant different values from that, except Adper Prompt L-Pop that achieved the lowest bond strength in both substrates. Adper Scotch Bond Multi Purpose and Adper Single Bond 2 presented significantly lower values in enamel than in dentin although all other adhesives presented similar results in both substrates. CONCLUSIONS: contemporary adhesive systems present similar behaviors when bonded to primary teeth, with the exception of the one-step self-etching system; and self-etching systems can achieve bond strength values as good in enamel as in dentin of primary teeth.

Occlusal and orofacial myofunctional evaluation in children with anterior open bite before and after removal of pacifier sucking habit.

The aim of this study was to evaluate occlusal and orofacial myofunctional characteristics in children with primary dentition and anterior open bite, before and after removal of pacifier sucking habit. A dentist checked anterior open bite, overjet and upper intercanine distance and a speech therapist evaluated posture and tonus of lips and tongue, cheek tonus, swallowing, breathing and speech of twenty-seven 3-5 year-old children at baseline and 3 months later. Habit removal propitiated a mean reduction of 1.97 mm on anterior open bite (P < .001), promoted improvement of lip posture (P = .03), favored nasal breathing (P =. 008) and reduced the occurrence of tongue interposition during swallowing (P = .008). Lack of proper tongue rest posture was capable of preventing spontaneous correction of anterior open bite (odds ratio 17.50).

Entendendo as cores: parte II / Understanding colors: part II

Atualmente, a beleza física tem sido bastante valorizada e a procura por trabalhos estéticos na clínica odontológica cresceu muito. Para um bom desempenho clínico, o cirurgião-dentista, além do domínio da técnica para reproduzir a forma, tamanho e textura do elemento dentário, deve ter conhecimento teórico que facilite a determinação da escolha da cor, para que possa sempre melhorar a qualidade de seu trabalho. Diante das dificuldades de escolha de cor, uma vez que esta sofre influência de inúmeros fatores, a Odontologia tem se aprofundado em estudos sobre esta questão. Portanto, este trabalho tem como objetivo apresentar uma revisão de literatura sobre o estudo da cor na Odontologia.

Chemical versus conventional caries removal techniques in primary teeth: a microhardness study.

The aim of this in vitro study was to assess the remaining dentinal surface after carious tooth tissue removal with a low speed conventional bur and two chemomechanical methods, (Papacárie and Carisolv), using the microhardness test. It was concluded that the hardness of the remaining dentin after carious tissue removal was lower than that obtained on healthy dentin, without significance between the different means of carious tissue removal (p<0.05).

Entendendo as cores: parte I / Understanding colors: part I

Este trabalho tem como objetivo apresentar uma revisão de literatura sobre o estudo da cor, importante para colaborar com o cirurgião-dentista no conhecimento dos princípios que regem a determinação da sua escolha em trabalhos estéticos. Apresenta conceitos básicos sobre a formação das cores, de um modo geral e abrangente; faz um breve histórico de como foram criados os principais sistemas de padronização, classificação e aparelhos usados para sua aferição. A percepção de cor é uma tarefa difícil, porém a compreensão das regras básicas do processo do seu estabelecimento fornece bases ao profissional para um planejamento mais lógico, seguro e inteligente, direcionado a uma melhor aplicabilidade na clínica odontológica.

Microabrasão de esmalte: solução estética para dentes com fluorose / Enamel microabrasion: esthetic treatment for permanent teeth with dental fluorosis

A adição de flúor à água de abastecimento e a produtos odontológicos favoreceu o declínio da cárie dental; no entanto, observa-se o aumento da prevalência de fluorose dental. O tratamento da fluorose visa à melhora na estética. O objetivo deste trabalho é apresentar o caso clínico de uma paciente de nove anos de idade, atendida na clínica de graduação da Disciplina de Odontopediatria da Fousp, onde foi utilizada a técnica de microabrasão com a mistura de ácido fosfórico a 37% em gel e pedra-pomes para melhorar a estética dos dentes anteriores. A técnica de microabrasão do esmalte mostrou ser uma boa alternativa para a remoção de manchas fluoróticas do esmalte dental, deixando sua coloração mais uniforme, melhorando a estética, além de ser uma técnica de fácil execução, conservadora e de baixo custo.

The fluoride addition to the water of provisioning and dentistry products favored the decline of the dental decay bringing the increase of the fluorosis parallelly. The treatment seeks the improvement of the aesthetics. The aim of this study is to present a case report of a nine-years old patient, who showed dental fluorosis, assisted at the Children's Dentistry Clinic, of the Graduation course of Fousp. The enamel microabrasion technique using a mixture of pumice and 37% phosphoric acid proved to be efficient in this case. It has a satisfactory aesthetic and the procedure is easily performed, conservative and a law-cast alternative.

Clinical effectiveness of toothbrushes and toothbrushing methods of plaque removal on partially erupted occlusal surfaces.

PURPOSE: The aim of this crossover study was to compare the efficacy of conventional and end-tufted toothbrushes and two methods of plaque removal on partially erupted occlusal surfaces in schoolchildren. MATERIALS AND METHODS: Thirty-seven subjects, aged 5-7 years, with at least one partially erupted lower permanent first molar, were randomly divided into three groups. Occlusal plaque (baseline) was scored using a disclosing solution applied to the occlusal surface of an erupting molar. Subjects were instructed to use a conventional toothbrush with horizontal scrubbing (conventional group); a conventional toothbrush with transverse technique (modified group); or an end-tufted toothbrush (end-tufted group). Subjects returned after a one-week washout period and brushed with the alternate toothbrush or technique. Final plaque condition was evaluated again using the same scoring as at baseline. Occlusal plaque reduction (baseline to final) percentiles were compared using paired t-test. RESULTS: No statistically significant difference was found among transverse and end-tufted techniques (modified and end-tufted groups respectively) (p > 0.05). The conventional group was less effective on occlusal plaque removal in erupting first molars than the other groups (p < 0.05). CONCLUSION: The conventional toothbrushing technique was not satisfactory compared with other tested techniques on occlusal plaque removal. Moreover, the use of a conventional toothbrush with a modified technique was very effective on erupting first permanent molars without any additional costly device.

Inhibition of demineralization adjacent to tooth-colored restorations in primary teeth after 2 in vitro challenges.

PURPOSE: As clinical diagnosis of secondary caries is the most common reason for restoration replacement, fluoride-releasing restorative materials have been developed to address this problem. The purposes of this study were to verify demineralization inhibition produced by 5 restorative materials submitted to two methods of in vitro cariogenic challenge and verify whether these methods influence material behavior by means of polarized light microscopy and microhardness. METHODS: Class V cavities were prepared on buccal surfaces of 100 extracted primary molars and randomly restored with 1 of the 4 fluoride-releasing materials, Fuji IX, Vitremer, Dyract, Tetric Ceram, and Filtek Z250 as control material (N=10). Specimens were submitted to in vitro caries induction by two different methods, acid gel immersion, and pH cycling. Teeth submitted to gel were then sectioned and prepared for polarized light microscopy in water, while teeth cycled were prepared for microhardness evaluation. RESULTS: Polarized light microscopy: Means of demineralization areas (microm(2)) differed significantly, depending on the restorative material. Tukey's test revealed the smallest demineralization areas adjacent to Fuji IX and Vitremer restorations, with no difference between them (P>.05). The greatest demineralization area mean values were verified using Dyract and Filtek Z250, without differences between them (P>.05). Microhardness: Glass ionomer cements (GICs) performed better on the area of great cariogenic challenge, closer to the surface, than other materials indicating minor mineral loss during pH cycling. The compomer Dyract presented similar performance to GICs and composite resin Tetric Ceram, but it was better than Filtek Z250. CONCLUSION: The experimental model of caries lesion induction may influence material performance. GICs, however, are superior in preventing in vitro demineralization independently of the method.