Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis.

This review aimed to assess the association between overweight/obesity and dental caries in Brazilian children/adolescents. Searches were performed in the Web of Science, Scopus, Cochrane, PubMed, Embase and SciELO, Lilacs and Open Grey literature databases up to June 2022. The Joanna Briggs Institute checklist for analytical cross-sectional studies, the checklist for cohort studies, and the checklist for case-control studies were used. A total of 41 publications were included, and 15 meta-analyses were performed. The authors analyzed the differences in weighted mean difference (MD) and odds ratios (OR), and their corresponding confidence intervals (CI) (95%) for dental caries among eutrophic and obese and/or overweight children/adolescents. Meta-analyses showed that there was no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI (Body Mass Index). A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve (OR = 2.53, 95% CI;1.49-4.29; p = 0.0006; I2 = 0%) in dichotomous outcome studies, and (MD = 0.61, 95%CI: 0.08-1.15; p = 0.02; I2 = 0%) in continuous studies. The strength of the evidence of the results was classified as very low, low or moderate. It was concluded that there is no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI. A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve.

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.

Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis

Abstract This review aimed to assess the association between overweight/obesity and dental caries in Brazilian children/adolescents. Searches were performed in the Web of Science, Scopus, Cochrane, PubMed, Embase and SciELO, Lilacs and Open Grey literature databases up to June 2022. The Joanna Briggs Institute checklist for analytical cross-sectional studies, the checklist for cohort studies, and the checklist for case-control studies were used. A total of 41 publications were included, and 15 meta-analyses were performed. The authors analyzed the differences in weighted mean difference (MD) and odds ratios (OR), and their corresponding confidence intervals (CI) (95%) for dental caries among eutrophic and obese and/or overweight children/adolescents. Meta-analyses showed that there was no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI (Body Mass Index). A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve (OR = 2.53, 95% CI;1.49-4.29; p = 0.0006; I2 = 0%) in dichotomous outcome studies, and (MD = 0.61, 95%CI: 0.08-1.15; p = 0.02; I2 = 0%) in continuous studies. The strength of the evidence of the results was classified as very low, low or moderate. It was concluded that there is no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI. A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve.

Traumatic dental injuries in children: experience during the Covid-19 pandemic and parents' knowledge about their management.

The social isolation measures adopted during the critical phase of the COVID-19 pandemic led children to spend most of their time at home. Isolation may alter the pattern of traumatic dental injury occurrences, inasmuch as studies point out that most traumatic accidents occur at home. Considering this scenario and the influence of emergency management on the prognosis of the injury, the aim of this study was to evaluate the experience of traumatic dental injuries in children before and during the pandemic, and the knowledge of this topic by the children's guardians. This cross-sectional study was conducted with guardians of children aged 0 to 6 years, residing in Juiz de Fora, MG, Brazil. The guardians answered an online questionnaire addressing personal information, traumatic dental injury experience before and during the pandemic, and knowledge of this topic. Descriptive and statistical analyses were performed using Pearson's chi-square test at a 5% significance level. The total sample consisted of 343 volunteers. A total of 95 and 92 injuries were reported before and during the pandemic, respectively; the home was the place of greatest occurrence. Most volunteers (88.1%) agreed that traumatic dental injuries are emergency situations, and were aware that the tooth/fragment had to be taken to the dentist after a fracture or avulsion (97.4%). This study revealed that the traumatic dental injury experience was similar before and during the pandemic, and that the volunteers had satisfactory knowledge, especially in recognizing the importance of immediate attention for a more favorable prognosis of these injuries.

Elementary school teachers' knowledge and attitudes toward emergency management of traumatic dental injuries.

The consequences of traumatic dental injuries can be even more serious when their emergency management procedures are inadequate. Since traumatic accidents frequently occur at school, it is crucial that teachers be knowledgeable enough to assist an injured child. This study aimed to assess the knowledge and attitudes of the elementary school teachers of a Brazilian city toward dental trauma in permanent teeth, and its emergency practices. A combination of convenience and snowball sampling methods was used. An online questionnaire was distributed through social media, consisting of three parts: demographic characteristics and professional information; previous experiences and attitudes toward dental trauma; teachers' knowledge of this subject. Descriptive and statistical analyses were carried out. Pearson chi-squared test (p < 0.05) was used. A total of 217 teachers participated in the study. The power of the sample was 95%. Half of the teachers had already witnessed a dental trauma incident involving students, and 70.5% never received any information on the subject. The teachers who were provided previous information were the ones who opted to search for the tooth fragment (p=0.036) in cases of crown fracture, and for the lost tooth (p = 0.025) in cases of avulsion. They were also the ones who chose to wash the tooth in running water (p = 0.018), and look for a dentist in the first 30 or 60 minutes after the trauma (p = 0.026). Most of the teachers assessed did not have adequate knowledge of dental trauma. Having previous information was associated with more assertive practices in trauma management.

Oral health characteristics in children and adolescents with Down syndrome.

AIM: To compare oral health indicators of children/adolescents with Down syndrome (DS) with a group of children/adolescents without DS. METHODS AND RESULTS: This cross-sectional study included 144 individuals with DS, ages 4 to 18 years, matched for age and sex with a group of 144 individuals without DS, and their parents/caregivers. Parents/caregivers completed a questionnaire regarding sociodemographic information and habits related to their children's oral health. Clinical examination of the children/adolescents evaluated dental caries experience (DMFT/dmft), bleeding on periodontal probing, presence of visible plaque, clinical consequences of untreated dental caries (PUFA/pufa), and malocclusion (DAI). The chi-square test, linear by linear test, and Mann-Whitney test were used to compare the variables between the groups (p < .05). Children/adolescents without DS brushed their teeth more times per day (p < .001) and had a higher frequency of daily sugar intake (p < .001). The children/adolescents in the DS group had a greater presence of gingival bleeding (p < .001) and had a greater number of cases of "severe malocclusion" and "very severe malocclusion" (p = .001). No difference was found in the prevalence of dental caries between the two groups. CONCLUSION: The children/adolescents in the DS group had a greater presence of gingival bleeding during the clinical examination and had a greater need for orthodontic treatment.

Efeito da intervenção educativa sobre o nível de conhecimento de acadêmicos de medicina, participantes de uma equipe do Serviço de Atendimento Móvel de Urgência (SAMU), em relação a avulsão de dentes permanentes / Effect of educational intervention on the level of knowledge of participants in a mobile emergency care team (SAMU) in cases of avulsion of permanent teeth

Objetivo: Avaliar o efeito de uma intervenção educativa, sobre avulsão de dentes permanentes, no nível de conhecimento de participantes de uma equipe do SAMU. Métodos: Participaram acadêmicos de Medicina que compunham a equipe do SAMU de Juiz de Fora (MG). A intervenção educativa foi realizada por meio de uma palestra com duração de 15 minutos. Para coleta dos dados foi utilizado um questionário, contendo 13 perguntas sobre avulsão dentária, aplicado em três etapas: antes da palestra (T0), imediatamente após a palestra (T1) e quinze dias após a palestra (T2). Foi realizada análise descritiva e teste McNemar para análise estatística (p < 0,05). Resultados:A amostra foi composta por 36 indivíduos. Nenhum participante relatou ter prestado atendimento a um caso de avulsão dentária. Trinta e quatro acadêmicos informaram não ter recebido orientações anteriores sobre o que fazer diante desse episódio e 35 afirmaram que esse conhecimento é necessário para o médico do SAMU. Houve aumento na porcentagem de acertos após os acadêmicos assistirem a palestra educativa (T1), para sete questões avaliadas. As mesmas questões também apresentaram maior percentual de acertos quinze dias após a palestra educativa (T2). Não houve diferença na capacidade dos acadêmicos reimplantarem um dente avulsionado tanto imediatamente após a palestra educativa (T1), quanto quinze dias após as orientações (T2) (T0-T1: p = 0,999; T0-T2: p = 0,999). Conclusão:A palestra educativa influenciou de forma significativa à melhora do conhecimento sobre avulsão dentária dos acadêmicos de Medicina que fazem parte da equipe do SAMU-JF.

Aim: To evaluate the effect of an educational intervention concerning the avulsion of permanent teeth upon the level of knowledge of members of a SAMU (Ambulance) team. Methods:Medical students who were members of the SAMU team in Juiz de Fora (MG) participated in this study. The educational intervention on the theme was carried out by means of a 15-minute lecture. Data collection was conducted using a structured questionnaire containing 13 objective questions on tooth avulsion, applied to the medical students in three stages: before the lecture (T0), immediately after the lecture (T1), and fifteen days after the lecture (T2). Descriptive analysis and the McNemar test were performed (p < 0.05). Results: The sample consisted of 36 individuals. All participants reported never having attended a dental avulsion case. Thirty-four students reported that they had not received previous guidance on what to do when faced with this type of episode, and 35 stated that information about dental avulsion is necessary for SAMU doctors. For seven of the evaluated questions, an increase was identified in the percentage of correct answers after the students attended the educational lecture (T1). The same questions also showed a higher percentage of correct answers fifteen days after the educational lecture (T2). No difference was found in the students' ability to reimplant an avulsed tooth either immediately after the educational lecture (T1) or fifteen days after receiving guidance on the subject (T2) (T0-T1: p = 0.999; T0-T2: p = 0.999). Conclusion: The educational lecture significantly influenced the improvement of knowledge about dental avulsion among medical students who are members of the SAMU-JF team.

Traumatic dental injuries in children: experience during the Covid-19 pandemic and parents' knowledge about their management

Abstract The social isolation measures adopted during the critical phase of the COVID-19 pandemic led children to spend most of their time at home. Isolation may alter the pattern of traumatic dental injury occurrences, inasmuch as studies point out that most traumatic accidents occur at home. Considering this scenario and the influence of emergency management on the prognosis of the injury, the aim of this study was to evaluate the experience of traumatic dental injuries in children before and during the pandemic, and the knowledge of this topic by the children's guardians. This cross-sectional study was conducted with guardians of children aged 0 to 6 years, residing in Juiz de Fora, MG, Brazil. The guardians answered an online questionnaire addressing personal information, traumatic dental injury experience before and during the pandemic, and knowledge of this topic. Descriptive and statistical analyses were performed using Pearson's chi-square test at a 5% significance level. The total sample consisted of 343 volunteers. A total of 95 and 92 injuries were reported before and during the pandemic, respectively; the home was the place of greatest occurrence. Most volunteers (88.1%) agreed that traumatic dental injuries are emergency situations, and were aware that the tooth/fragment had to be taken to the dentist after a fracture or avulsion (97.4%). This study revealed that the traumatic dental injury experience was similar before and during the pandemic, and that the volunteers had satisfactory knowledge, especially in recognizing the importance of immediate attention for a more favorable prognosis of these injuries.

Elementary school teachers' knowledge and attitudes toward emergency management of traumatic dental injuries

Abstract The consequences of traumatic dental injuries can be even more serious when their emergency management procedures are inadequate. Since traumatic accidents frequently occur at school, it is crucial that teachers be knowledgeable enough to assist an injured child. This study aimed to assess the knowledge and attitudes of the elementary school teachers of a Brazilian city toward dental trauma in permanent teeth, and its emergency practices. A combination of convenience and snowball sampling methods was used. An online questionnaire was distributed through social media, consisting of three parts: demographic characteristics and professional information; previous experiences and attitudes toward dental trauma; teachers' knowledge of this subject. Descriptive and statistical analyses were carried out. Pearson chi-squared test (p < 0.05) was used. A total of 217 teachers participated in the study. The power of the sample was 95%. Half of the teachers had already witnessed a dental trauma incident involving students, and 70.5% never received any information on the subject. The teachers who were provided previous information were the ones who opted to search for the tooth fragment (p=0.036) in cases of crown fracture, and for the lost tooth (p = 0.025) in cases of avulsion. They were also the ones who chose to wash the tooth in running water (p = 0.018), and look for a dentist in the first 30 or 60 minutes after the trauma (p = 0.026). Most of the teachers assessed did not have adequate knowledge of dental trauma. Having previous information was associated with more assertive practices in trauma management.

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.

Association Between Dental Caries Experience and Socioeconomic Determinants on Oral Health-Related Quality of Life among Children and their Families

ABSTRACT Objective: To assess the association between dental caries experience, severe dental caries experience and socioeconomic determinants on oral health-related quality of life among children and their families. Material and Methods: This is a cross-sectional study whose sample was composed of children aged 4-12 years, who sought dental care in a dentistry school clinic, and their parents/caregivers. Dental caries experience and severe dental caries experience were assessed according to the DMF-T/dmf-t indexes. Parents/caregivers answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ), the Family Impact Scale (FIS) and a questionnaire on socioeconomic and demographic conditions. Data analysis included the chi-square test and Poisson regression (PR). Results: The sample was composed of 105 children and their parents/caregivers. Severe dental caries experience in children was determinant for negative perception of children's OHRQoL by parents/caregivers (PR = 1.22; CI = 1.05-1.41). Negative impact on OHRQoL perceived by family members was determined by severe dental caries experience in children (PR = 1.22; CI = 1.05-1.42) and family income <5 minimum wage (PR = 1.32; CI = 1.08-1.61). Conclusion: Severe dental caries experience was associated with a negative impact on OHRQoL perceived by children and their families. Low family income was associated with a negative impact on the OHRQoL perceived by children and their families.

Conhecimento dos pais e responsáveis sobre hábitos saudáveis de higiene bucal e dieta na infância / Knowledge of parents and caregivers about healthy oral hygiene habits and diet in childhood

Introdução: Para garantir que as instruções sobre saúde bucal para crianças sejam administradas assertivamente, deve-se conhecer o nível de conhecimento sobre saúde bucal infantil dos pais/responsáveis. Objetivo: Avaliar o conhecimento dos pais/responsáveis sobre hábitos saudáveis de higiene bucal e dieta na infância. Materiais e Métodos: Trata-se de um estudo observacional transversal. Foi aplicado um questionário estruturado aos pais/responsáveis contendo dados de identificação e 10 perguntas destinadas ao tema. Foi realizada análise descritiva dos dados obtidos. Resultados: O estudo incluiu uma amostra de 86 pais/responsáveis de escolares de duas escolas públicas em Minas Gerais. A maioria dos participantes já recebeu informações sobre a importância da saúde bucal e da alimentação saudável (93%) assim como também concordam que os dentes decíduos devem ser escovados todos os dias (91,9%). Todos os participantes acharam essas informações importantes para a manutenção da saúde bucal das crianças (100%). A quantidade de dentifrício fluoretado menor que a metade da extensão das cerdas da escova de dente foi recomendada por 23,3% dos participantes, 15,3% responderam que o fio dental deve ser utilizado durante a higiene bucal das crianças. Um total de 40,7% acredita que a ingestão de alimentos açucarados pela criança interfere no desenvolvimento da cárie. Conclusão: Embora a maioria dos participantes já tenha recebido informações sobre a importância da higiene bucal e da alimentação saudável e todos achem essas informações importantes para manutenção da saúde bucal das crianças, algumas questões sobre o assunto ainda não são de conhecimento da maioria dos pais/responsáveis. (AU)

Introduction: To ensure that instructions on oral health for children are administered assertively, you must know the level of knowledge about children's oral health of parents/caregivers. Objective: Assess the knowledge of parents/ caregivers about healthy hygiene and diet habits in childhood. Materials and Methods: This is a cross-sectional observational study. A structured questionnaire was applied to parents/caregivers containing identification data and 10 questions for the theme. Descriptive analysis was performed on the data obtained. Results: It included a sample of 86 parents/caregivers of schoolchildren from two public schools in Minas Gerais. Most participants have already received information about the importance of oral health and healthy eating (93%) as well as agreeing that primary teeth should be brushed every day (91.9%). All participants found this information important for maintaining children's oral health (100%). The amount of fluoride dentifrice less than half the length of the toothbrush bristles was recommended by 23.3% of the participants, 15.3% answered that dental floss should be used during children's oral hygiene. A total of 40.7% believe that the child's intake of sugary foods interferes with the development of caries. Conclusion: Although most of the participants have already received information about the importance of oral hygiene and healthy eating, and everyone thinks this information is important for maintaining the oral health of children, some questions on the subject are not yet known to most parents/caregivers. (AU)

Anatomical evaluation of the relationship between the maxillary posterior teeth and maxillary sinus.

Knowledge of the anatomical relationships between the maxillary sinus (MS) and posterior teeth is important to prevent complications when endodontic or oral surgical procedures are performed. The aim of this study was to evaluate the relationships between the root apices of maxillary posterior teeth and the MS floor. Three oral radiologists evaluated 851 posterior teeth (1969 roots) imaged with cone beam computed tomography. The roots were analyzed individually in parasagittal sections, on which the most superior point of the apex was observed. A qualitative evaluation was performed, and each root was assigned a proximity score: 1, root invaginating the MS; 2, root in close contact with the MS floor; 3, root with no relationship with the MS; and 4, root with a measurable proximity to the MS. For roots classified as score 4, the distance to the MS floor was measured (quantitative analysis). Student t tests, 1-way analysis of variance, and simple linear regression analysis were performed (P < 0.05). The qualitative analysis revealed that the mesiobuccal root of the second molar had a pronounced proximity to the MS. The quantitative analysis revealed no differences in distance to the MS between right and left posterior teeth or between the different roots of the same tooth. In relation to the MS, the second molar was positioned closest, followed by the first molar, second premolar, and first premolar. Except for the comparison between mean distances of the second premolar and first molar (P = 0.11), the differences between groups of teeth were statistically significant (P < 0.05). Simple linear regression analysis showed that the more posterior the tooth was in relation to the midline, the shorter the mean distance from the root apex to the MS floor (P < 0.05). The mesiobuccal roots of second molars were closest to the MS. Second molars exhibited the shortest distances between their root apices and the MS and the greatest number of roots that were invaginating or in close contact with the MS. Therefore, second molars require special attention when endodontic or oral surgical approaches involve those regions.

Impact of oral conditions of children/adolescents with Down syndrome on their families' quality of life.

AIMS: To assess the impact of oral conditions among children/adolescents with Down syndrome (DS) on the Oral Health-related Quality of Life (OHRQoL) of their families in comparison with a group without DS. METHODS AND RESULTS: Families of 144 children/adolescents with DS aged 4-18 years were compared with families of individuals without DS. Dental caries experience (DMFT/dmft), clinical consequences of untreated dental caries (PUFA/pufa), gingival bleeding (GBI), visible plaque (VPI), and malocclusion were evaluated. Parents/caregivers answered the Family Impact Scale (FIS) and questionnaires on sociodemographic conditions and the health of children/adolescents. Data analysis included chi-square test and Poisson regression. There was no difference between groups regarding the impact of the children's/adolescents' oral condition on their families' OHRQoL for all domains and the total FIS score (P > 0.05). A negative impact on the OHRQoL of families of children/adolescents with DS was determined by dental caries (PR = 3.95, CI = 2.09-7.46), clinical consequences of untreated dental caries (PR = 1.83, CI = 1.18-2.84), defined malocclusion (PR = 2.75, CI = 1.23-6.13), and severe malocclusion (PR = 2.82, CI = 1.02-7.74). CONCLUSION: There is no difference on the OHRQoL of families of children/adolescents with and without DS. Dental caries experience, clinical consequences of untreated dental caries, defined malocclusion, and severe malocclusion determined the negative impact on the OHRQoL of families of children/adolescents with DS.

Periodontal disease in patients with Down syndrome: A systematic review.

BACKGROUND: The authors systematically reviewed the scientific evidence of an association between periodontal disease and Down syndrome (DS). TYPES OF STUDIES REVIEWED: In this systematic review, the authors included observational studies in which the investigators assessed the prevalence, incidence, or experience of periodontal disease in patients with DS compared with that in healthy patients. The authors used the Population, Exposure, Comparison, Outcome structure. The population was patients of any age, the exposure was the presence of DS, the comparison was the absence of DS, and the outcome was the presence of periodontal disease. The authors conducted an electronic search in 5 databases through March 2017. Two independent reviewers assessed the risk of bias by using the Fowkes and Fulton scale. The authors performed a meta-analysis to compare periodontal disease among patients with DS and those without DS. The authors calculated a summary effect measure-standard mean difference-when evaluating the means of the oral hygiene index. The authors assessed the strength of evidence from the selected studies by using a modified Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The authors included 23 case-control studies in the systematic review and submitted 3 to meta-analysis. In the qualitative analysis, results from most studies showed that the prevalence of some periodontal parameters was higher among patients with DS than among those without DS. Evaluations of the Fowkes and Fulton scale point to many methodological problems in the studies evaluated. Results of the meta-analysis revealed no differences between groups with regard to the oral hygiene index (standard mean difference, 0.05; 95% confidence interval, -0.55 to 0.65; I2 = 0.0%). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Further research is required, in particular well-designed studies that avoid the deficiencies identified in the studies in this review.

Saúde bucal em crianças e adolescentes com Síndrome de Down: avaliação de indicadores clínicos e da escala de saúde bucal para pessoas com Síndrome de Down / Oral health in children and adolescents with Down syndrome: Evaluation of clinical indicators and the Oral Health Scale for People with Down's Syndrome

Avaliar a influência dos indicadores clínicos e das características sociodemográficas na percepção de saúde bucal dos cuidadores de indivíduos com SD, além de comparar aspectos relacionados à saúde bucal entre crianças e adolescentes com SD e um grupo de crianças e adolescentes sem a síndrome. Pais/cuidadores de 288 indivíduos com e sem SD com idade entre quatro e 18 anos e seus filhos, foram convidados a participar do estudo. Os pais/cuidadores preencheram um questionário contendo informações sociodemográficas e informações sobre as variáveis de comportamento relacionado à saúde bucal de seus filhos, e responderam a Escala de Saúde Bucal para Pessoas com Síndrome de Down. O exame físico intrabucal das crianças/adolescentes foi realizado para avaliar a experiência de cárie dentária, doença periodontal e má oclusão. Após a análise descritiva, o teste qui-quadrado foi empregado. As variáveis que apresentaram um nível de significância (p < 0,25) foram incorporadas no modelo final da regressão de Poisson. Os testes McNemar e Wilcoxon foram empregados para comparar as variáveis de comportamento de saúde bucal e variáveis clínicas entre os grupos. Dentre os cuidadores 55,1% apresentaram uma percepção positiva da saúde bucal do seu filho. Cuidadores de indivíduos entre 4 e 9 anos e com má oclusão definida apresentaram mais chances de relatar uma percepção mais negativa da saúde bucal do seu filho (OR = 1,13; CI = 1,04-1,23; p = 0,003 e OR = 1,14; CI = 1,00-1,31; p = 0,047, respectivamente). A comparação entre os grupos mostrou que crianças/adolescentes sem SD realizam a escovação dentária mais vezes ao dia (p < 0,001), assim como têm uma maior frequência de ingestão de açúcar diária (p = 0,048). As crianças/adolescentes do grupo SD tiveram maior presença de sangramento gengival durante o exame clínico (p < 0,001) e apresentaram maior número de casos de "má oclusão severa" e "má oclusão muito severa" (p = 0,045), porém não foi encontrada diferença na prevalência da doença cárie entre os dois grupos. A idade e a gravidade da má oclusão foram indicadores de uma percepção mais negativa dos cuidadores quanto à saúde bucal de seus filhos com SD. As crianças/adolescentes do grupo SD tiveram maior presença de sangramento gengival durante o exame clínico e apresentaram maior necessidade de tratamento ortodôntico quando comparadas com o grupo de crianças/adolescentes sem a síndrome.(AU)

To evaluate the influence of clinical indicators and sociodemographic characteristics on the caregivers' perception of oral health of individuals with DS through the Brazilian version of the Oral Health Scale for People with Down Syndrome and to compare aspects related to oral health among children and adolescents with DS and children and adolescents without the syndrome. Parents/caregivers of 288 individuals with and without SD aged 4 to 18 years and their children were invited to participate in the study. The parents/caregivers completed a questionnaire containing sociodemographic data and information on the behavioral variables related to the oral health of their children, and answered the Oral Health Scale for People with Down Syndrome. Intraoral oral examination of the children/adolescents was performed to evaluate the experience of dental caries, periodontal disease and malocclusion. After the descriptive analysis, the chi-square test was used to evaluate the association between the Scale of Oral Health for People with Down Syndrome, sociodemographic criteria and clinical indicators. The variables that presented a level of significance (p < 0.25) were incorporated into the final Poisson regression model. The McNemar and Wilcoxon tests were used to compare the variables of oral health behavior and clinical variables between the groups. Among that caregivers 55.1% presented a positive perception of their child's oral health. Caregivers of 4- to 9-yearolds with defined malocclusion were more likely to report a more negative perception of their child's oral health (p = 0.003 and p = 0.047, respectively). The comparison between the groups showed that children/adolescents without DS perform toothbrushing more times a day (p < 0.001), as well as have a higher frequency of daily sugar intake (p = 0.048). Children/adolescents with DS had a greater presence of gingival bleeding during the clinical examination (p <0.001) and presented a greater number of cases of "severe malocclusion" and "very severe malocclusion" (p = 0.045). There was no difference in the prevalence of dental caries disease between the groups. The age and the severity of malocclusion were indicators of a more negative perception of the caregivers regarding the oral health of their sons/daughters. Children/adolescents with DS had a greater presence of gingival bleeding during the clinical examination and presented greater need for orthodontic treatment when compared to children/adolescents without the syndrome.(AU)

Nível de cortisol salivar entre crianças em tratamento odontológico - Um estudo piloto / Salivary cortisol levels in children undergoing dental treatment - A pilot study

Objetivo: Situações capazes de induzir à ansiedade, como o tratamento odontológico, correlacionam-se com o aumento do cortisol livre circulante, o qual pode ser utilizado como indicador de estresse. O presente estudo determinou os níveis de cortisol salivar de crianças em tratamento odontológico.Métodos: Foram incluídas crianças com idade entre sete e dez anos atendidas em uma Faculdade de Odontologia no segundo semestre de 2010. Após preenchimento do prontuário clínico, duas amostras de saliva foram coletadas empregando o kit Salivettes®. As amostras foram coletadas em um dia de consulta odontológica, antes da realização do exame físico e imediatamente após o mesmo, enviadas para análise laboratorial por meio de ensaio de quimioluminescência. Os resultados obtidos foram expressos em µg/dL. O teste de Wilcoxon foi aplicado para verificar a diferença dos níveis de cortisol salivar antes e após a consulta na amostra total e entre crianças de mesmo sexo. O teste U de Mann-Whitney foi utilizado para análise da diferença entre grupos de crianças do sexo masculino e feminino. Adotou-se o nível de significância de 5%. Resultados: Dezenove crianças participaram da amostra final (9 meninos e 10 meninas). Para a amostra total, as médias de cortisol determinadas foram 0,14 µg/dL e 0,09 µg/dL, nas coletas antes e após a consulta, respectivamente, com diferença significativa (P=0.002). Observou-se redução significativa no nível de cortisol salivar após a realização da consulta (P=0.011) entre as meninas. Conclusão: O período anterior a uma consulta odontológica pode gerar maior ansiedade/estresse entre crianças do que a própria consulta...

Objective: Situations capable of inducing anxiety, such as dental treatment, are associated with an increase of circulating free cortisol, which may be used as a stress indicator. This study measured the salivary cortisol levels of children undergoing dental treatment. Method: Children aged 7 to 10 years undergoing dental treatment at a Dental School in the 2nd semester of 2010 were enrolled in the study. After filling dental chat, two samples of saliva were collected with a Salivettes® kit on the consultation day before and immediately after the physical examination. The samples were sent for laboratory analysis by the chemiluminescence assay. The obtained results were expressed in Ág/dL. The Wilcoxon test was used to verify the difference in the salivary cortisol levels before and after the dental consultation in the whole population and among children of the same gender. The Mann-Whitney U test was used to analyze the differences between the female and male children. The significance level was set at 5%. Results: Nineteen children (9 boys and 10 girls) comprised the final sample. The whole population exhibited cortisol levels of 0.14 Ág/dL and 0.09 Ág/dL before and after the consultation, respectively, with a statistically significant difference between them (p=0.002). Among the girls, there was a significant decrease of salivary cortisol levels after the consultation (p=0.011). Conclusion: The period that antecedes a dental consultation may produce greater anxiety/stress in children than the consultation itself...

Hábitos de dieta e cárie precoce da infância em crianças atendidas em faculdade de odontologia brasileira / Dietary habits and early childhood caries in children treated at a brazilian dental school

Objetivo: Avaliar a associação entre hábitos de dieta e a presença de Cárie Precoce da Infância (CPI) em um grupo de crianças atendidas em uma Universidade Pública, Minas Gerais - Brasil. Método: Foram incluídas 69 crianças (30 meninos; 39 meninas), com idade entre 13 e 60 meses. O índice ceo-d foi determinado por um único examinador treinado (coeficiente de kappa = 1), segundo critérios preconizados pela Organização Mundial da Saúde. Diário alimentar de três dias foi preenchido pelos pais e/ou responsáveis para obtenção dos dados sobre a dieta. A análise estatística incluiu os testes Qui-Quadrado e Exato de Fischer, seguidos por análise de regressão logística múltipla. Adotou-se o nível de significância de 5% (alfa = 0,05). Resultados: A CPI foi diagnosticada em 87% da amostra (60/69 crianças). Registrou-se um índice ceo-d médio igual a 9,20. A frequência média de ingestão de carboidratos foi alta (mais de cinco vezes por dia) para 82,6% das crianças (57/69). Não houve associação significativa entre frequência de ingestão de açúcar e presença de cárie (P = 0,183). O modelo de regressão logística múltipla demonstrou associação inversa entre consumo de "outros alimentos" e ausência de cárie (P = 0,02). Estes resultados sugerem a necessidade de aconselhamento de dieta com respeito ao consumo de certos alimentos associados à CPI na amostra estudada. Conclusão: A alta frequência média de ingestão de dieta cariogênica não se associou à presença de Cárie Precoce da Infância, assim como indicaram que o consumo de certos alimentos se associou à ausência da doença.

Objective: To evaluate the association between dietary habits and presence of early childhood caries (ECC) in a group of children treated at a public University in the state of Minas Gerais, Brazil. Method: Sixty-nine children (30 boys and 39 girls) aged 13 to 60 months were enrolled in the styudy. The dmf-t index was determined by a single trained examiner (kappa coefficient = 1), according to criteria preconized by the World Health Organization. A three-day diet journal was filled out by parents and/or caregivers to collect data from the children's diet. The statistical analysis included the chi-square and Fisher's exact tests, followed by multiple logistic regression analysis. A significance level of 5% was adopted (alpha = 0.05). Results: ECC was diagnosed in 87% of the sample (60/69 children). A mean dmf-t index of 9.20 was recorded. The mean frequency of ingestion of carbon hydrates was high (more than five times a day) for 82.6% of the children (57/69). There was no significant association between frequency of sugar ingestion and presence of caries (p=0.183). The multiple logistic regression model revealed an inverse association between consumption of "other foods" and absence of caries (p=0.02). These results suggest the need of dietary counseling with respect to the consumption of certain foods associated with ECC in the studied sample. Conclusion: The high mean frequency of ingestion of a cariogenic diet was not associated with the presence of ECC, and the consumption of certain foods was related to the absence of the disease.

Humanização na Odontologia: a Experiência da Disciplina Odontopediatria II do Curso de Graduação em Odontologia da UFJF / Humanizing Dentistry: the Experience of the Pediatric Dentistry II Discipline of the Dental Graduation Course of UFJF

Objetivo: Avaliar se a Disciplina Odontopediatria II permite oestabelecimento de uma relação aluno-paciente, pais e/ouresponsáveis satisfatória, bem como a satisfação do usuário.Método: O estudo foi conduzido na Faculdade de Odontologia daUniversidade Federal de Juiz de Fora (UFJF) no primeiro semestreletivo de 2007. A amostra incluiu 19 acadêmicos matriculados nodécimo período do Curso de Odontologia da UFJF (Grupo I) e 50usuários – pai, mãe ou responsável legal de pacientes atendidosna Clínica da Disciplina Odontopediatria II (Grupo II). Dois formuláriosestruturados foram elaborados e aplicados aos voluntários. Aanálise descritiva foi utilizada para os dados quantitativos obtidosdas questões fechadas. Para as questões abertas, utilizou-se umaabordagem quali-quantitativa.Resultados: A análise do formulário aplicado aos alunos demonstrouatitudes favoráveis ao estabelecimento de uma relação satisfatóriae humanizada com os pacientes e seus pais e/ou responsáveis,tendo como fator facilitador a presença e conhecimento dasprofessoras. Como fatores dificultadores, foram citados a nãoparticipação efetiva dos pais no controle de dieta e higiene e ocomparecimento às consultas. Entre os usuários, verificou-se umelevado grau de satisfação com o atendimento. A fala dos usuáriosapontou o forte reconhecimento da atuação dos acadêmicos,demonstrando o papel fundamental do aluno para a humanizaçãodo atendimento na disciplina. Os resultados alcançados permitirãoo aprimoramento da disciplina.Conclusão: A Disciplina Odontopediatria II do Curso de Graduaçãoem Odontologia da UFJF está contribuindo para formação de umprofissional humanizado, assim como está proporcionando asatisfação da comunidade assistida.