Treatment of Dental Caries with Diamine Silver Fluoride: Literature Review / Tratamento da Cárie Dentária com Diamino Fluoreto de Prata: Revisão da Literatura

Brazilian health care programs recommend the use of cariostatic solutions of silver diamine fluoride (SDF) or sodium fluoride varnishes for children 0 to 3 years old with high or moderate caries activity for the control of caries lesions. SDF is a safe, economical, efficient and non-invasive coadjuvant agent, exerting an antibacterial action capable of reducing superficial mineral loss of the enamel and can be used in the treatment of deciduous and permanent teeth. The objective of this literature review was to gather current information on describing the mechanism of SDF action' and its clinical application in young children in caries prevention and paralysis. The PubMed / Medline and Cochrane Library databases were accessed by identifying the relevant studies published in English from 1960 to May 2017. The search strategy employed the keywords: "Silver diamine fluoride" and "Children "or "Infant" and "Caries prevention". Data extraction was performed in: 19 in vitro studies; 10 review articles and 8 in vivo studies. It was possible to conclude that SDF is almost twice as effective compared to fluoride varnish in caries paralysis. However, the contact time of the solution and the optimal frequency of application of the SDF are still undefined, inducing new projects and clinical studies in the search for an adequate clinical protocol of this cariostatic.(AU)

Os programas de assistência à saúde brasileiros recomendam para o controle das lesões de cárie a utilização de soluções cariostáticas de diamino fluoreto de prata - DFP ou vernizes de fluoreto de sódio para crianças de 0 a 3 anos com atividade de cárie alta ou moderada. O DFP é agente coadjuvante seguro, econômico, eficiente e não invasivo, exercendo ação antibacteriana capaz de reduzir a perda mineral superficial do esmalte e, pode ser utilizado no tratamento de dentes decíduos e permanentes. O objetivo desta revisão de literatura foi reunir informações atuais sobre descrever o mecanismo de ação do DFP e sua aplicação clínica em crianças de pouca idade na prevenção e paralisação da cárie. As bases de dados PubMed/Medline e Cochane Library foram acessadas identificando os estudos relevantes publicados em inglês, no período de 1960 a maio de 2017. A estratégia de busca empregou as palavras-chave: "Silver diamine fluoride" and "Children" or "Infant" and "Caries prevention". A extração dos dados foi realizada em: 19 estudos in vitro; 10 artigos de revisão e 8 estudos in vivo. Foi possível concluir que o DFP apresenta-se quase duas vezes tão eficaz comparado ao verniz fluoretado na paralização de cárie. Porém, o tempo de contato da solução e a frequência ótima de aplicação do DFP ainda estão indefinidos, suscitando novos projetos e estudos clínicos na busca de adequado protocolo clínico deste cariostático.(AU).

In Vitro Evaluation of the Remineralizing Potential and Antimicrobial Activity of a Cariostatic Agent with Silver Nanoparticles.

Cariostatic treatment has been shown to successfully arrest caries. However, it blackens the carious tooth structure. This study evaluated the effects of an experimental cariostatic agent with silver nanoparticles (Ag-Nano) using microhardness (MH) and microbiological tests. The cariostatic agents tested were: Saforide®, Cariestop®, Ancarie® and Ag-Nano. Sixty-six samples from deciduous enamel were submitted to initial (after pH cycling to obtain initial caries-like lesion) and final (after cariostatic application) MH testing and %MH values were calculated. After longitudinal sectioning, internal (I) MH was evaluated. Strains of Streptococcus mutans, Escherichia coli, and Enterococcus faecalis in brain-heart infusion culture were treated with the cariostatic agents. Agar diffusion tests (ADTs) were performed and minimum inhibitory concentrations were determined. The statistical tests used were: Kruskal-Wallis and Dunn (%MD; ADT; MIC) and ANOVA followed by Tukey's test (I-MH) (p<0.05). The %MH of Saforide® was significantly greater than that of Ag-Nano (p<0.05). Internal MH showed progressive improvement in the enamel remineralization for all cariostatic tested. In ADTs showed greater inhibition of S. mutans, E. faecalis, and E. coli by Saforide® than by Ancarie® and Ag-Nano. Ag-Nano was able to inhibit 100% microorganism growth at a lower concentration than required for the other agents. It was concluded that Ag-Nano treatment promoted remineralization of deciduous tooth enamel with initial caries-like lesion and bactericidal activity.

In Vitro Evaluation of the Remineralizing Potential and Antimicrobial Activity of a Cariostatic Agent with Silver Nanoparticles

Abstract Cariostatic treatment has been shown to successfully arrest caries. However, it blackens the carious tooth structure. This study evaluated the effects of an experimental cariostatic agent with silver nanoparticles (Ag-Nano) using microhardness (MH) and microbiological tests. The cariostatic agents tested were: Saforide®, Cariestop®, Ancarie® and Ag-Nano. Sixty-six samples from deciduous enamel were submitted to initial (after pH cycling to obtain initial caries-like lesion) and final (after cariostatic application) MH testing and %MH values were calculated. After longitudinal sectioning, internal (I) MH was evaluated. Strains of Streptococcus mutans, Escherichia coli, and Enterococcus faecalis in brain-heart infusion culture were treated with the cariostatic agents. Agar diffusion tests (ADTs) were performed and minimum inhibitory concentrations were determined. The statistical tests used were: Kruskal-Wallis and Dunn (%MD; ADT; MIC) and ANOVA followed by Tukey's test (I-MH) (p<0.05). The %MH of Saforide® was significantly greater than that of Ag-Nano (p<0.05). Internal MH showed progressive improvement in the enamel remineralization for all cariostatic tested. In ADTs showed greater inhibition of S. mutans, E. faecalis, and E. coli by Saforide® than by Ancarie® and Ag-Nano. Ag-Nano was able to inhibit 100% microorganism growth at a lower concentration than required for the other agents. It was concluded that Ag-Nano treatment promoted remineralization of deciduous tooth enamel with initial caries-like lesion and bactericidal activity.

Resumo O tratamento com cariostático tem demostrado sucesso na paralização da cárie. No entanto, causa escurecimento da estrutura dental cariada. Este estudo avaliou os efeitos de um agente cariostático experimental com nanopartículas de prata (Ag-Nano) através de microdureza (MD) e testes microbiológicos. Os cariostáticos testados foram: Saforide®, Cariestop®, Ancarie® e Ag-Nano. Sessenta e seis amostras de esmalte decíduo foram submetidos a MD inicial (após ciclagem de pH para obtenção da lesão de cárie inicial) e final (após aplicação dos cariostáticos), e os valores da porcentagem (%) de MD foram calculados. Após secção longitudinal, a MD interna (I) foi avaliada. Cepas de Streptococcus mutans, Escherichia coli e E. faecalis foram cultivados em ágar infusão de cérebro e coração (BHI) e submetidos aos cariostáticos testados. Além disso, foram realizados teste de difusão em ágar (TDA) e avaliação da concentração mínima inibitória (CIM) dos cariostáticos. Os testes estatísticos usados foram: Kruskall-Wallis e Dunn (%MD; TDA; CIM) e ANOVA seguido de teste de Tukey (MD-I) (p<0.05). A %MD do Saforide® foi significativamente maior do que a de Ag-Nano (p<0,05). A MD interna apresentou melhora progressiva na remineralização do esmalte para todos os cariostático testados. Os resultados do TDA mostraram que S. mutans, E. faecalis e E. coli sofreram maior inibição pelo Saforide® (p<0,05), em relação ao Ancarie® e Ag-Nano. No entanto, para o teste de CIM o Ag-Nano foi capaz de inibir 100% dos microorganismos, em menor concentração do que os demais cariostaticos. Conclui-se que, o tratamento Ag-Nano foi capaz de promover remineralização do esmalte dental decíduo com lesão de cárie inicial e apresentou atividade bactericida.

Evaluation of a preventive educational program for malocclusions: 7-year study.

RESULTS: 506 of the 802 guardians/children referred to the PPM joined. As for the children, the most frequently assessed habits were: bottle (56.1%), bottle and pacifier (18.4%), finger (11.9%), bottle and finger (7.1%), pacifier (5.7%), pacifier and finger (0.6%), and bottle/pacifier/finger (0.2%). After parent participation in the meetings, 335 (66.2%) children abandoned their habits. There was a statistical difference between type of oral habit and time to abandonment (p = 0.0001). However, those with only one habit abandoned it more easily (72.6%) than those with two or more associated habits (48.1%) (p = 0.042). Presence or absence of breastfeeding and parents' level of education had no significant effect on habit abandonment. CONCLUSION: PPM was an important tool for spreading knowledge to guardians, greatly contributing to the abandonment of deleterious oral habits. Bottle sucking warrants special attention - mentioned by 81.8% of parents - either alone or associated with other habits. Thus, educational actions to implement the children's approach to oral health are fundamental to making behavioral changes and promoting education of healthy habits, thereby keeping malocclusions from developing.

Evaluation of a preventive educational program for malocclusions: 7-year study

Abstract This study aimed at evaluating the Protocol for the Prevention of Malocclusions (PPM), established in the preventive educational program developed by the Public Infant Oral Health Program of the State University of Londrina (PIOHP-UEL). Guardians of three-year-olds or older, maintaining nutritive (bottle) and/or non-nutritive (pacifier and finger) sucking habits, attended meetings designed to alert and guide them to eliminating these habits from their children. PPM patient records (2006-2013) were assessed and the data were described and evaluated by the Chi-square test, with a 5% significance level. Results 506 of the 802 guardians/children referred to the PPM joined. As for the children, the most frequently assessed habits were: bottle (56.1%), bottle and pacifier (18.4%), finger (11.9%), bottle and finger (7.1%), pacifier (5.7%), pacifier and finger (0.6%), and bottle/pacifier/finger (0.2%). After parent participation in the meetings, 335 (66.2%) children abandoned their habits. There was a statistical difference between type of oral habit and time to abandonment (p = 0.0001). However, those with only one habit abandoned it more easily (72.6%) than those with two or more associated habits (48.1%) (p = 0.042). Presence or absence of breastfeeding and parents' level of education had no significant effect on habit abandonment. Conclusion PPM was an important tool for spreading knowledge to guardians, greatly contributing to the abandonment of deleterious oral habits. Bottle sucking warrants special attention - mentioned by 81.8% of parents - either alone or associated with other habits. Thus, educational actions to implement the children's approach to oral health are fundamental to making behavioral changes and promoting education of healthy habits, thereby keeping malocclusions from developing.

Dispositivo de Dunn e de Chenet no tratamento do torcicolo congênito / Dunn and Chenet's devices in the treatment of congenital torticollis

O torcicolo congênito é caracterizado por fibrose e encurtamento do músculo esternocleidomastóideo. O diagnóstico é clínico e pode ser feito pela posição anômala da cabeça e presença de massa fibrosa fusiforme, pequena, indolor e dura à palpação, localizada na região central ou inferior do músculo afetado. O tratamento é fisioterápico, sendo a intervenção cirúrgica restrita aos casos que não respondem a fisioterapia. Se não tratado, pode levar a alterações permanentes na coluna e na musculatura ocular, além de assimetria facial, relacionada a subdesenvolvimento da mandíbula, com conseqüênte maloclusão. O objetivo do presente trabalho é enfatizar o papel do Odontopediatra no diagnóstico precoce e no tratamento multiprofissional da patologia, demonstrando, através de um caso clínico, os dispositivos de Dunn e de Chenet, que estimulam o desenvolvimento mandibular e são uma alternativa eficiente, segura, simples e prática para auxiliar no tratamento, reduzindo ou eliminado as seqüelas da patologia.