Salivary Metabolites in Patients with Mucopolysaccharidosis

ABSTRACT Objective: To identify the salivary metabolites profile of Mucopolysaccharidosis (MPS) types I, II, IV, and VI patients. Material and Methods: The participants were asked to refrain from eating and drinking for one hour before sampling, performed between 7:30 and 9:00 a.m. Samples were centrifuged at 10.000 × g for 60 min at 4°C, and the supernatants (500µl) were stored at −80°C until NMR analysis. The salivary proton nuclear magnetic resonance (1H-NMR) spectra were acquired in a 500 MHz spectrometer, and TOCSY experiments were used to confirm and assign metabolites. Data were analyzed descriptively. Results: Differences in salivary metabolites were found among MPS types and the control, such as lactate, propionate, alanine, and N-acetyl sugar. Understanding these metabolite changes may contribute to precision medicine and early detection of mucopolysaccharidosis and its monitoring. Conclusion: The composition of low molecular weight salivary metabolites of mucopolysaccharidosis subjects may present specific features compared to healthy controls.

NMR-Based Metabolomics Demonstrates a Metabolic Change during Early Developmental Stages from Healthy Infants to Young Children.

The present study aims to identify the salivary metabolic profile of healthy infants and young children, and to correlate this with age, salivary gland maturation, and dentition. Forty-eight children were selected after clinical evaluation in which all intraoral structures were examined. Total unstimulated saliva was collected, and salivary metabolites were analyzed by 1H Nuclear Magnetic Resonance (NMR) at 25 °C. Partial least squares discriminant analysis (PLS-DA), orthogonal PLS-DA (O-PLS-DA), and univariate analysis were used, adopting a 95% confidence interval. The study showed a distinct salivary metabolomic profile related to age and developmental phase. The saliva of children in the pre-eruption teeth period showed a different metabolite profile than that of children after the eruption. However, more evident changes were observed in the saliva profile of children older than 30 months. Alanine, choline, ethanol, lactate, and sugar region were found in higher levels in the saliva of patients before 30 months old. Acetate, N-acetyl sugar, butyrate, caproate, creatinine, leucine, phenylalanine, propionate, valine, succinate, and valerate were found to be more abundant in the saliva of children after 30 months old. The saliva profile is a result of changes in age and dental eruption, and these findings can be useful for monitoring the physiological changes that occur in infancy.

Comparison Between Radiographs, White and Fluorescent Images in the Diagnosis and Treatment Decisions for Occlusal Caries: An Ex Vivo Study

ABSTRACT Objective: To compare the agreement of images in white light (WL), fluorescence (FL), and digital radiographs (DR), on the diagnosis and treatment decisions for occlusal caries lesions against a micro-CT gold standard. Material and Methods: Ten extracted third molars, with enamel and/or dentin caries (ICDAS 2-4), were included. Occlusal surface images were acquired with an intraoral camera (SoproLife®) in WL and FL modes. DR was obtained using an intraoral X-ray and a semi-direct digital system. A total of 780 images were needed, organized in a template, to be later examined by twenty-six dentists invited to compose the study. The Generalized Estimation Equations model was used to compare the proportions of the correct answers between the three methods and the gold standard. When significant, Bonferroni post-hoc test was used to identify differences (α=5%). Results: Most of the examiners were specialists (76.9%) with 14.5 years of experience. All diagnostic methods were similar and showed low agreement (DR 12.7%, WL 16.5%, and FL 16.5%) compared with gold standard caries diagnostic scores. Regarding treatment decisions, mean agreement for all diagnostic methods was higher (43.2%; p<0.001), and among all methods, WL (48.1%) and FL (51.2%) modes performed better than DR (30.4%, p<0.001). Conclusion: SoproLife® images could help clinicians to propose rational, minimally invasive treatments for occlusal caries lesions.

Relationship between Malocclusion, Bullying, and Quality of Life in Students from Low Social Development Area: A Cross-Sectional Study

ABSTRACT Objective: To analyze the relationship between malocclusion and bullying and its impact on the well-being and quality of life of students from low social development areas. Material and Methods: This cross-sectional study included 243 schoolchildren between 10 and 17 years. Malocclusion was analyzed using Dental Aesthetic Index. Bullying and self-perception of the impact of one's oral condition on quality of life and interpersonal relationships were assessed by questions from National Survey of Schoolchildren's Health and Child Perceptions Questionnaire 11-14 (CPQ11-14). Data were analyzed using the Spearman correlation coefficient and Mann-Whitney tests, considering groups: 10-11, 12-14 and 15-17 years. Results: No correlation was observed between malocclusion and bullying. However, in the 12-14 group, poor correlations were found between malocclusion and the CPQ11-14 (0.226) and between malocclusion and being shy/embarrassed due to oral aspects (0.298). Positive correlations were observed between bullying and the impact on the quality of life in the 10-11 (0.420) and 12-14 (0.425) groups. In the older group, a positive correlation (0.724) was observed between the concern about what others think of their oral health and the impact on their quality of life. Conclusion: There was no evidence of a relationship between malocclusion and bullying. However, the oral conditions negatively affected the interpersonal relationships and the student's quality of life.

Association Between Caries Experience and School Performance in an Island Community: Full-Time versus Part-Time Public Schools

Abstract Objective: To investigate the association between caries experience and school performance among children and adolescents living in an island community without fluoridated water supply and to compare data according to the type of attended school (full-time or part-time). Material and Methods: A cross-sectional oral health survey in a convenience sample of students (n=147) attending four public schools was performed. Students were examined by one calibrated dentist in the school environment to the obtain prevalence of dental caries (DMFT/dmft) and its consequences using the PUFA/pufa index. Self-reported oral health behavior was also accessed. Data from each student's school performance and absenteeism were extracted from official sources and the school performance was classified into "good" and "fair". The final sample consisted of 120 students. Descriptive statistics, Mann-Whitney, Kruskal-Wallis, chi-square tests and binary logistic regression were performed to evaluate collected data. Results: Students´ age ranged between 5 to 19 years (10±4.3). DMFT/dmft mean were 1.3 (±2.3) and 3.05 (±3.4), respectively. Conclusion: Participants from the full-time school presented better oral health status than their peers in the part-time schools (p<0.05). A significant association was found between the prevalence of caries-free participants and good school performance when the factor age range was controlled (OR=2.87). Moreover, attendance to full-time schools appeared to be a protective factor for good oral health conditions (AU).

Effect of antihistamine-containing syrup on salivary metabolites: an in vitro and in vivo study.

This study tested the null hypothesis that antihistamine-containing syrup does not change salivary metabolites in vitro and in vivo. For the in vitro experiments, saliva from 10 volunteers was mixed with a syrup or pill suspension of loratadine (1 mg/ml Claritin®, Schering-Plough, Rio de Janeiro, Brazil). For the in vivo experiment, 10 volunteers performed a mouth rinse with 10 mL of antihistamine syrup (Claritin®; Schering-Plough, Rio de Janeiro, Brazil) for 20 seconds and then discarded the rinse water. After 20 seconds, 5 mL of unstimulated whole saliva was spit into a plastic tube kept on ice. The protein profile of in vitro and in vivo experiments was analyzed using 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The samples were also analyzed by nuclear magnetic resonance (NMR) spectroscopy, followed by Principal Component Analysis and Wilcoxon test (p < 0.05). There were differences in salivary metabolites after syrup interaction. The salivary concentrations of acetate, n-caproate, arginine, glutamate, and lysine among other metabolites were reduced with the syrup in both in vivo and in vitro experiments (p < 0.05), but no differences were observed when the pill suspension was used (p > 0.05). Similar changes in metabolite profiles were observed in both in vitro and in vivo experiments. Electrophoresis revealed no difference in the salivary protein pattern. The null hypothesis was rejected because the intake of syrup medicine changes the salivary composition and influences oral homeostasis and susceptibility to oral diseases.

Effect of antihistamine-containing syrup on salivary metabolites: an in vitro and in vivo study

Abstract This study tested the null hypothesis that antihistamine-containing syrup does not change salivary metabolites in vitro and in vivo. For the in vitro experiments, saliva from 10 volunteers was mixed with a syrup or pill suspension of loratadine (1 mg/ml Claritin®, Schering-Plough, Rio de Janeiro, Brazil). For the in vivo experiment, 10 volunteers performed a mouth rinse with 10 mL of antihistamine syrup (Claritin®; Schering-Plough, Rio de Janeiro, Brazil) for 20 seconds and then discarded the rinse water. After 20 seconds, 5 mL of unstimulated whole saliva was spit into a plastic tube kept on ice. The protein profile of in vitro and in vivo experiments was analyzed using 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The samples were also analyzed by nuclear magnetic resonance (NMR) spectroscopy, followed by Principal Component Analysis and Wilcoxon test (p < 0.05). There were differences in salivary metabolites after syrup interaction. The salivary concentrations of acetate, n-caproate, arginine, glutamate, and lysine among other metabolites were reduced with the syrup in both in vivo and in vitro experiments (p < 0.05), but no differences were observed when the pill suspension was used (p > 0.05). Similar changes in metabolite profiles were observed in both in vitro and in vivo experiments. Electrophoresis revealed no difference in the salivary protein pattern. The null hypothesis was rejected because the intake of syrup medicine changes the salivary composition and influences oral homeostasis and susceptibility to oral diseases.

Impact of oral health on the quality of life and personal satisfaction of adolescents from urban and rural areas from a city in brazil: a cross-sectional study

Objective: Evaluate the impact of oral health status on the quality of life and personal satisfaction among adolescents from urban and rural areas, in Nova Friburgo, Brazil. Methods: Adolescents between 11 and 14 years, enrolled in the schools participating in the Health in School Program (HSP) of rural and urban of this city (n = 509), received the consent form for the participation in this study, along with the economic questionnaire to be handed to the responsible. Adolescent´s oral health status was evaluated clinically, through the Decayed, Missing and Filled Teeth (DMFT); pulpal involvement, ulceration, fistula and abscess criteria (PUFA); and Dental Treatment Needs Index (DTNI). The quality of life was measured through the Child Perception Questionnaire (CPQ11-14), while personal satisfaction´s evaluation, through the Subjective Happiness Scale (SHS), both as interview. Statistical tests were performed (Chi-Square; Fisher's exact; Mann-Whitney) with level of significance of 5%. Results: The final sample comprised 161 adolescents. The impact of oral health status on the quality of life of adolescents from both areas was not significantly different, although the aggravation of the oral condition showed a tendency to worse the quality of life. Similarly, there was no relation of the oral status with personal satisfaction, without differences between the groups. It was observed that rural adolescents presented better quality of life (p<0.010), while the urban ones had higher degree of personal satisfaction (p<0.001). Conclusion: Oral health status had a negative impact on the quality of life, but had no relation to personal satisfaction, regardless of the demographic area.

Objetivo: Avaliar o impacto do estado de saúde bucal na qualidade de vida e na satisfação pessoal de adolescentes das áreas urbana e rural de Nova Friburgo, Brasil. Métodos: Adolescentes entre 11 e 14 anos, matriculados nas escolas participantes do Programa Saúde na Escola (PSE) da zona rural e urbana desta cidade (n = 509), receberam o Termo de Consentimento Livre e Esclarecido para a participação neste estudo,juntamente ao questionário econômico a ser entregue para o responsável. O estado de saúde bucal do adolescente foi avaliado clinicamente, por meio dos índices Cariados, Perdidos e Obturados (CPOD); critérios de envolvimento pulpar, ulceração, fístula e abscesso (PUFA); e Índice de Necessidades de Tratamento Odontológico (INTO). A qualidade de vida foi mensurada por meio do Child Perception Questionnaire (CPQ11- 14), enquanto a avaliação da satisfação pessoal, por meio da Subjective Happiness Scale (SHS), ambos na forma de entrevista. Foram realizados testes estatísticos (Qui-Quadrado; Exato de Fisher; Mann-Whitney) com nível de significância de 5%. Resultados: A amostra final foi de 161 adolescentes. O impacto do estado de saúde bucal na qualidade de vida dos adolescentes de ambas as áreas não foi significativamente diferente, embora o agravamento da condição bucal tenha apresentado tendência a piorar a qualidade de vida. Da mesma forma, não houve relação da condição oral com a satisfação pessoal, sem diferenças entre os grupos. Observou-se que os adolescentes rurais apresentaram melhor qualidade de vida (p<0,010), enquanto os urbanos apresentaram maior grau de satisfação pessoal (p<0,001). Conclusão: O estado de saúde bucal teve impacto negativo na qualidade de vida, mas não teve relação com a satisfação pessoal, independente da área demográfica.

Dentomaxillofacial sequelae resulting from a chemoradiotherapy against rhabdomyosarcoma: 6-year follow-up

Introduction: Rhabdomyosarcoma is an aggressive malignant soft tissue neoplasm of immature mesenchymal cells treated with surgery and chemoradiotherapy. The effects of chemoradiotherapy in head induce a series of sequelae on oral cavity and growth development. Objectives: Report the case of a child undergoing treatment for rhabdomyosarcoma whose effects on the dento-maxillofacial development were cared for in order to safe guard the patient's quality of life. Case report: Describes a case of severe dento-maxillofacial defects resulting from chemoradiation therapy for embryonal rhabdomyosarcoma in a child as well as the dental management performed. Clinically, the patient had gingivitis, severe mobility of permanent teeth, hyposalivation, mucositis and severe trismus. The radiologic exams showed interruption of root formation of all permanent teeth and over-retention of primary teeth. Cephalometric analyses revealed mandibular and maxillary hypoplasia. Results: Was made extraction of the overretained primary teeth associated with a prophylactic program and use of artificial saliva due to hyposalivation in order to improve the quality of life of the patient. After 6 years of dental and phonoaudiologic follow-up her oral opening has increased and chewing and swallowing difficulties have decreased, there is no gingivitis or mucositis and she has remained free of recurrent or metastatic diseases 11 years after the initial diagnosis. Conclusion: Our report emphasizes the importance of dental treatment with a program of prevention and follow-up for patients undergoing anticancer therapies.

Introdução: O rabdomiossarcoma é uma neoplasia maligna agressiva de tecido mole de células mesenquimais imaturas tratadas com cirurgia e quimioradioterapia. Os efeitos da quimioradioterapia na cabeça induzem uma série de sequelas na cavidade oral e no desenvolvimento do crescimento. Objetivo: Relatar o caso de uma criança em tratamento de rabdomiossarcoma cujos efeitos no desenvolvimento dento-maxilofacial foram cuidados a fim de salvaguardar a qualidade de vida do paciente. Relato de caso: Descreve um caso de defeitos dento-maxilo-faciais graves resultante de quimioradioterapia para rabdomiossarcoma embrionário em uma criança, bem como o manejo realizado. Clinicamente, a paciente apresentava gengivite, severa mobilidade dos dentes permanentes, hipossalivação, mucosite e trismo severo. Os exames radiográficos mostraram interrupção da formação radicular de todos os dentes permanentes e retenção dos dentes decíduos. Análises cefalométricas revelaram hipoplasia mandibular e maxilar. Resultados: Foi realizada a extração dos dentes decíduos retidos associado a um programa profilático e uso de saliva artificial devido à hipossalivação, a fim de melhorar a qualidade de vida do paciente. Após 6 anos de acompanhamento odontológico e fonoaudiológico, sua abertura bucal aumentou e as dificuldades de mastigação e deglutição diminuíram, não há gengivite ou mucosite e ela permaneceu livre de doenças recorrentes ou metastáticas 11 anos após o diagnóstico inicial. Conclusão: Nosso relato enfatiza a importância do tratamento odontológico com um programa de prevenção e acompanhamento para pacientes submetidos a terapias antineoplásicas.

Oral health condition and interpersonal relationship of scholars of a public institution

Objective: The aim of this study was to evaluate the oral health status and to analyze the self- erception of the impact of oral health statuson the interpersonal relationship of students from a local school in Rio de Janeiro, Brazil. Methods: A non-probabilistic sample was used, consisting of 260 children and adolescents aged 8 to 15 years. Oral health status was evaluated by clinical examination according to the World Health Organization criteria. The perception of the students of their oral health status was assessed by interview using a questionnaire developed from PeNSE (Brazilian National School Health survey) and CPQ 11-14 (Child Perception Questionnaire). Chi- quare and Fisher's exact test were used, with level of significance of 5% (p< 0.05). Results: A DMFT index equal to 0 was observed in 51.5% of the participants. The questionnaire revealed that most students were happy about their own smile (88.1%). However, 35.8% had already avoided smiling and 18.5% had refrained from some daily activities because of the appearance of their teeth. Conclusion: Although half of the students were free of dental caries and most were satisfied with their smile, a sizable number felt upset and embarrassed about their teeth, which may interfere in the relationship with their peers.

Objetivo: O objetivo desse trabalho foi avaliar a condição de saúde bucal e analisar a autopercepção do impacto da saúde bucal no relacionamento interpessoal de escolares de uma instituição da rede pública municipal do Rio de Janeiro, Brasil. Método: A amostra foi do tipo não probabilística, sendo composta por 260 crianças e adolescentes, de 8 a 15 anos. A condição bucal foi verificada através de exame clínico de acordo com os critérios da Organização Mundial da Saúde. A percepção dos escolares em relação a própria condição bucal foi avaliada através de entrevista, cujo instrumento foi desenvolvido a partir da Pesquisa Nacional de Saúde do Escolar, 2012 e do Child Perception Questionnaire ( CPQ). 11-14 Os testes qui-quadrado e Exato de Fisher foram utilizados com nível designificância de 5% (p<0,05). Resultados: 51,5% da amostra apresentou CPOD zero. A análise do questionário mostrou que a maioria está feliz com o próprio sorriso (88,1%). Porém, 35,8% relatou já ter evitado sorrir e 18,5% já deixou de realizar alguma atividade por causa dos dentes. Conclusão: Embora a metade dos escolares se apresente livre de cárie e a maioria goste dopróprio sorriso, uma parcela considerável demonstra sentimentos como chateação e vergonha, podendo interferir no relacionamento com seus pares.

Oral health and dental care related to diabetes status in young children

Objective: This study compares the oral health, dietary and oral hygiene habits and dental care experience of children with type 1 diabetes (DG) to healthy ones (HG) under six years old. Methods: The children were chosen matched by gender and age in each group. Diabetes status from G was determined using HbA1c criteria levels: <8.5% (69 mmol/mol) was considered controlled and >8.5% uncontrolled. Guardians were asked about oral hygiene, dietary habits and dental care experience. Oral examination was performed in order to assess dental caries (dmft), plaque and calculus indexes, as well as oral manifestations in soft tissues. Data were described and analyzed by SPSS 20.0 software through Chi-square and T-tests. Results: A total of 68 children were enrolled in this study. Children with diabetes differed from healthy ones in relation to geographic tongue, breath acetone and xerostomia (p<0.05). Only 23% (n=7) of DG were considered as presenting uncontrolled diabetes status. Statistical differences between controlled and uncontrolled diabetic status were observed among children, such as age at diagnosis, disease duration, sugar consumption, dental visits, type of experience during dental appointment, presence of geographic tongue, dental caries, reported breath acetone and xerostomia (p<0.05). Toothache was the main reason that DG children had been to a dentist before. Conclusion: Oral health and dietary habits of children with diabetes differed from healthy ones. Most children with diabetes had never been to a dentist before. Oral manifestation and oral habits diverged from children uncontrolled and controlled diabetes.

Objetivo: Este estudo compara a saúde bucal, os hábitos alimentares e higiene bucal e a experiência odontológica de crianças com diabetes tipo 1 (DG) e saudáveis (HG) com menos de seis anos de idade. Métodos: As crianças foram escolhidas pareadas por sexo e idade em cada grupo. O status de diabetes da DG foi determinado usando os níveis de HbA1c: <8,5% (69 mmol/mol) foi considerado controlado e >8,5% não controlado. Os responsáveis foram questionados sobre higiene bucal, hábitos alimentares e experiência em atendimento odontológico. O exame bucal foi realizado para avaliar índice de cárie (ceod), placa e cálculo, bem como manifestações orais em tecidos moles. Os dados foram descritos e analisados pelo software SPSS 20.0 por meio dos testes Qui-quadrado. Resultados: No total, 68 crianças foram incluídas neste estudo. Crianças com diabete diferiram das saudáveis em relação à língua geográfica, hálito cetônico e xerostomia (p<0,05). Apenas 23 % (n=7) dos GD foram considerados como apresentando estado de diabetes descontrolados. Diferenças estatísticas entre o estado diabético controlado e não controlado foram observadas em crianças, como idade no diagnóstico, duração da doença, consumo de açúcar, visitas ao dentista, tipo de experiencia durante a consulta, presença de língua geográfica, cárie dentária, pneumonia relatada e xerostomia (p<0,05). Odontalgia foi a principal razão da ida ao dentista para as crianças DG. Conclusão: A saúde bucal e os hábitos alimentares das crianças com diabetes diferiram dos saudáveis. A maioria das crianças com diabetes nunca haviam ido ao dentista antes. Manifestação bucal e hábitos bucais divergem entre crianças com diabetes descontrolados e controlados.

In situ effect of titanium tetrafluoride and sodium fluoride on artificially decayed human enamel.

This study compared in situ the application of 4% titanium tetrafluoride (TiF4) solution and 2% sodium fluoride (NaF) gel on artificial white-spot lesions in human enamel. A crossover, double-blind study using in situ caries models was carried out. Eleven volunteers used an intraoral appliance containing five demineralized human enamel blocks. The blocks (n=170) were randomly divided according to treatment into the following groups: TiF4 (n=55), NaF (n=55), positive control (n=55). A negative control group was composed of demineralized specimens (n=5). The microhardness test was performed using a Knoop penetrator. Energy dispersive spectrometer (EDS) was used to analyze the concentration of titanium, calcium, phosphate and oxygen. The enamel microhardness at different depths for TiF4, NaF and positive control samples was not statistically different (p>0.05). The samples from these three groups had statistically higher microhardness values than the negative control samples (p<0.05). EDS analysis did not provide conclusive results about the penetration of titanium in the TiF4 samples. While in some fragments it had substantial penetration, in other fragments it only had superficial penetration. It was possible to conclude that, under in situ conditions, 4% TiF4 solution and 2% NaF gel were able to remineralize artificial white-spot lesions in human enamel. However, the magnitude of the remineralization did not differ between groups.

In Situ Effect of Titanium Tetrafluoride and Sodium Fluoride on Artificially Decayed Human Enamel

This study compared in situ the application of 4% titanium tetrafluoride (TiF4) solution and 2% sodium fluoride (NaF) gel on artificial white-spot lesions in human enamel. A crossover, double-blind study using in situ caries models was carried out. Eleven volunteers used an intraoral appliance containing five demineralized human enamel blocks. The blocks (n=170) were randomly divided according to treatment into the following groups: TiF4 (n=55), NaF (n=55), positive control (n=55). A negative control group was composed of demineralized specimens (n=5). The microhardness test was performed using a Knoop penetrator. Energy dispersive spectrometer (EDS) was used to analyze the concentration of titanium, calcium, phosphate and oxygen. The enamel microhardness at different depths for TiF4, NaF and positive control samples was not statistically different (p>0.05). The samples from these three groups had statistically higher microhardness values than the negative control samples (p<0.05). EDS analysis did not provide conclusive results about the penetration of titanium in the TiF4 samples. While in some fragments it had substantial penetration, in other fragments it only had superficial penetration. It was possible to conclude that, under in situ conditions, 4% TiF4 solution and 2% NaF gel were able to remineralize artificial white-spot lesions in human enamel. However, the magnitude of the remineralization did not differ between groups.

Este estudo comparou in situ a aplicação de uma solução de tetrafluoreto de titânio (TiF4) a 4% e um gel de fluoreto de sódio (NaF) sobre lesões de mancha branca artificiais em esmalte dentário humano. Foi realizado um estudo cruzado, duplo-cego utilizando um modelo in situ de cárie. Onze voluntários usaram um aparelho intraoral contendo cinco blocos de esmalte humanos desmineralizados. Os blocos (n = 170) foram divididos aleatoriamente de acordo com o tratamento nos seguintes grupos: TiF4 (n = 55) , NaF (n = 55) , controle positivo (n = 55). Um grupo controle negativo foi composto de espécimes desmineralizados (n = 5). O teste de microdureza foi realizado utilizando um penetrador Knoop. Espectrômetro de energia dispersiva (EDS) foi utilizado para analisar a concentração de titânio, cálcio, fosfato e oxigênio. A microdureza do esmalte em diferentes profundidades para as amostras dos grupos TiF4, NaF e controle positivo não diferiram estatisticamente (p>0,05). As amostras destes três grupos apresentaram valores de microdureza estatisticamente maiores do que as amostras do controle negativo (p<0,05). A análise EDS não forneceu resultados conclusivos sobre a penetração de titânio nas amostras de TiF4. Apesar de apresentar, em alguns fragmentos, uma penetração substancial, em outros fragmentos apresentou apenas penetração superficial. Foi possível concluir que, sob as condições do estudo in situ, a solução de TiF4 a 4% e o gel de NaF a 2% foram capazes de remineralizar lesões de mancha branca em esmalte humano. No entanto, a magnitude da remineralização não diferiu entre os grupos.

Current status of herpesvirus identification in the oral cavity of HIV-infected children.

INTRODUCTION: Some viruses of the Herpesviridae family are frequently the etiologic agents of oral lesions associated with HIV. The aim of this study was to identify the presence of herpes simplex virus types 1 and 2 (HSV-1, HSV-2), Varicella Zoster virus (VZV), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus type 6, type 7 and type 8 (HHV-6, HHV-7 and HHV-8) in the oral cavity of HIV-infected children/adolescents and verify the association between viral subtypes and clinical factors. METHODS: The cells of oral mucosa were collected from 50 HIV infected children/adolescents, 3-13 years old (mean age 8.66). The majority (66%) of selected were girls, and they were all outpatients at the pediatric AIDS clinic of a public hospital in Rio de Janeiro. Nested-PCR was used to identify the viral types. RESULTS: Absence of immunosuppression was observed in 66% of the children. Highly active antiretroviral therapy (HAART) was used by 72.1% of selected and moderate viral load was observed in 56% of the children/adolescents. Viral types were found in 86% of the children and the subtypes were: HSV-1 (4%), HSV-2 (2%), VZV (4%), EBV (0%), HCMV (24%), HHV6 (18%), HHV-7 (68%), HHV8 (0%). CONCLUSIONS: The use of HAART has helped to reduce oral lesions, especially with herpes virus infections. The health professionals who work with these patients should be aware of such lesions because of their predictive value and the herpes virus can be found circulating in the oral cavity without causing lesions.

Current status of herpesvirus identification in the oral cavity of HIV-infected children

INTRODUCTION: Some viruses of the Herpesviridae family are frequently the etiologic agents of oral lesions associated with HIV. The aim of this study was to identify the presence of herpes simplex virus types 1 and 2 (HSV-1, HSV-2), Varicella Zoster virus (VZV), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus type 6, type 7 and type 8 (HHV-6, HHV-7 and HHV-8) in the oral cavity of HIV-infected children/adolescents and verify the association between viral subtypes and clinical factors. METHODS: The cells of oral mucosa were collected from 50 HIV infected children/adolescents, 3-13 years old (mean age 8.66). The majority (66%) of selected were girls, and they were all outpatients at the pediatric AIDS clinic of a public hospital in Rio de Janeiro. Nested-PCR was used to identify the viral types. RESULTS: Absence of immunosuppression was observed in 66% of the children. Highly active antiretroviral therapy (HAART) was used by 72.1% of selected and moderate viral load was observed in 56% of the children/adolescents. Viral types were found in 86% of the children and the subtypes were: HSV-1 (4%), HSV-2 (2%), VZV (4%), EBV (0%), HCMV (24%), HHV6 (18%), HHV-7 (68%), HHV8 (0%). CONCLUSIONS: The use of HAART has helped to reduce oral lesions, especially with herpes virus infections. The health professionals who work with these patients should be aware of such lesions because of their predictive value and the herpes virus can be found circulating in the oral cavity without causing lesions.

Dental needs and management of children with special health care needs according to type of disability.

PURPOSE: The purpose of this study was to investigate the dental needs and management of special health care needs children in Rio de Janeiro, Brazil, according to the type of disability. METHODS: Records of 428 0- to 19-year-old patients who received dental treatment at the Patients Special Care Needs Clinic (Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro) from 1996-2009 were analyzed. Information about the type of disability, use of medication, dental exam findings, management during treatment, dental treatment performed, and follow-up examinations were collected. Children were divided into 2 groups: those with medical conditions and those with intellectual disability. RESULTS: Patients with medical conditions used more medications and were older than those with intellectual disability. The most common dental treatments received were dental restorations (63%) and extractions (47%). There was no association between the type of disability and dental treatment needed. Children with intellectual disability were 3 times more likely to need general anesthesia and 7 times more likely to need physical restraint for dental care than the other group. CONCLUSIONS: Children with intellectual disability have a greater chance of requiring advanced management techniques during dental treatment. The development of effective oral health programs is recommended as well as a specific education program for their parents.

Atividade antifúngica da clorexidina em biofilmes de Candida spp / Antifungal activity of chlorhexidine on Candida spp. biofilm

Candidíase oral é a infecção oportunista mais comum em pacientes imunocomprometidos, sendo a clorexidina um importante antimicrobiano auxiliar no seu tratamento. O objetivo do presente estudo foi avaliar o efeito antifúngico de diferentes soluções de clorexidina (Periogard®, NoPlak Max®, Noplak®, Perioxidin®, Clorexidina 0.06%, Paradontax® e Clorexidina 1%) sobre biofilmes artificiais de Candida spp.: C. albicans (ATCC36801); C. parapsilosis (ATCC22019); C. krusei (ATCC6258); C. glabrata (ATCC2001) e C. tropicalis (ATCC750). As cepas foram cultivadas em meio de cultura BHI ágar sobre fragmentos de esmalte bovino por 72 horas a 37 °C. Após o crescimento, cada fragmento de esmalte bovino foi imerso nas diferentes soluções de Clorexidina por 3 minutos. Nistatina e solução salina foram utilizadas como controle negativo e positivo, respectivamente. Para remoção das células não aderidas, os fragmentos foram então imersos em solução salina por 10 minutos e agitados em vortex. Alíquotas de 100 µL foram inoculadas em placas contendo BHI ágar por 24 horas a 37 °C para contagem de unidades formadoras de colônias (UFC). Observamos que o número de UFC de C. albicans e C. parapsilosis, apresentou um percentual de redução variando de 79 a 99% quando do uso das diferentes soluções (p < 0,001), o mesmo não foi observado para o NoPlak Max® (2,94 e 1,3%, respectivamente); Para C. krusei e C. glabrata, a solução menos efetiva foi a Nistatina (23 e 3,4%, respectivamente) enquanto que para C. tropicalis, todas as soluções apresentaram um alto percentual de redução (99 a 100%). As soluções de clorexidina foram capazes de reduzir significativamente o número de UFC provenientes de biofilme de Candida spp. in vitro.

Oral candidiasis is the most common opportunistic infection in immunocompromised patients and chlorhexidine is an important antimicrobial for its treatment. The antifungal effect of different CHX solutions (Periogard®, NoPlak Max®, Noplak®, Perioxidin®, Chlorhexidine 0.06%, Paradontax® and Chlorhexidine 1%) was evaluated on artificial biofilms of Candida spps: C. albicans (ATCC36801), C. parapsilosis (ATCC22019), C. krusei (ATCC6258), C. glabrata (ATCC2001) and Candida tropicalis (ATCC750). The strains were grown, in a BHI agar medium on bovine teeth enamel for 72 hours at 37 °C. After growth, the fragments were immersed in the CHX solutions for 3 minutes. Nystatin and saline solutions were used as positive and negative controls respectively. To remove the non-adhered cells, the fragments were inoculated in saline solution for 10 minutes, transferred to Falcon tubes containing saline solution and mixed in a vortex. Aliquots of 100 µL were inoculated on BHI agar for 24 hours at 37 °C to count the number of colony forming units (CFU). We observed that the number of (CFU) of C. albicans and C. parapsilosis, showed a reduction rate ranging from 79 to 99% with the use of different solutions (p < 0.001), except for NoPlak Max® (2.94 and 1.3%, respectively). For C. krusei and C. glabrata, nystatin was the least effective solution (23 and 3.4%, respectively); and for C. tropicalis, all the substances presented a high reduction percentage (99-100%). The chlorhexidine solutions were able to reduce the colony forming units of Candida biofilm.

Risco e atividade de cárie em crianças com e sem infecção pelo HIV / Caries risk and activity in HIV infected children and their controls

Objetivo: Determinar os fatores de risco e a prevalência de cárie em um grupo de crianças infectadas pelo HIV (GI), e em crianças sem evidência clínica de imunossupressão (GII). Métodos: Foram avaliados 133 pacientes de um Ambulatório de AIDS Pediátrica do Rio de Janeiro e 85 pacientes da Clínica de Odontopediatria da mesma instituição. Os responsáveis foram entrevistados, respondendo a questões sobre higiene bucal, dieta e medicação. As crianças foram examinadas, para determinação do índice de cárie (ceo/CPOD). O teste de Mann-Withney verificou a associação entre as variáveis, com significância de 5%. Resultados: Os dois grupos (GI: 6,8 e GII: 8,1 anos de idade) não apresentaram diferença significante no ceo/CPOD (ceo: 6,4 e 8,0; CPOD: 1,0 e 1,4 para GI e GII respectivamente). O GII apresentou mais elementos restaurados (p<0,05), assim como maior frequência de escovação (p<0,05). Nos dois grupos verificou-se que a maioria das crianças realizava escovação sem a supervisão de um adulto. Observou-se associação significante entre o ceo e o hábito de ingestão de sacarose entre as refeições no GII, embora no GI o hábito de ingestão de sacarose entre as refeições tenha sido maior (p<0,05). Foi constatado que 78,9% das crianças do GI faziam uso da terapia antirretroviral combinada, e que a forma de administração da medicação apresentou alto potencial cariogênico (45,1%). Conclusão: Os dois grupos apresentaram exposição a fatores de risco e alta prevalência de cárie. O hábito de ingestão de sacarose entre as refeições, em crianças sem evidência clínica de imunossupressão, demonstrou-se importante, associado à alta prevalência de cárie na dentição decídua.

Objective: To determine the risk factors and prevalence of caries in HIV infected children (GI) and in children with no evidence of immunosupression (GII). Methods: One hundred and thirty-three patients of a Pediatric AIDS Ambulatorial Service in Rio de Janeiro and 85 patients of a Pediatric Dentistry Service were examined. The patient´s guardians were interviewed, and provided information about children´s oral higyene, use of medication and dietary habits. The children were examined to determine DMFT and dmft indexes. The Mann-Whitney test was performed ata level of significance of 5%. Results: The two groups (mean age: G1=6.8 years, GII=8.1 years) showed no significant difference in dmft/DMFT indexes (dmft: 6.4 and 8.0; DMFT: 1.0 and 1.4 for GI and GII), but GII showed a higher number of restored teeth (p<0.05). GII showed also a higher frequency of toothbrushing (p<0.05), and in both groups, most of the children brushed their teeth withouth any adult supervision. Sucrose ingestion between meals was higher for GI (p<0.05). In GI 78.9% had been using combined antiretroviral therapy and the cariogenic potential of thetherapy administration classified as high was the most frequently observed (45.1%). Significant association was observed only between dmft and sucrose ingestion in GII. Conclusion: GI and GII were exposed to risk factors for a high caries prevalence. The habit of sucrose ingestion between meals was considered an important factor associated with the high prevalence of caries in deciduous dentition in children with no clinical signs of immunosupression.

O impacto das imunoglobulinas salivares sobre Candida spp em pacientes pediátricos infectados pelo HIV / The impact of salivary immunoglobulins on Candida spp in HIV infected paediatric patients

Pacientes pediátricos imunodeprimidos, ou seja, aqueles que não têm a capacidade de responder adequadamente a um estímulo antigênico, estão mais sujeitos a desenvolver infecções oportunistas, tais como as infecções fúngicas. Dentre elas, pode-se citar a candidíase bucal, causada pelas Candida spp, comumente encontrada em crianças infectadas pelo HIV. Este trabalho teve como objetivo realizar uma revisão da literatura sobre a relação entre imunoglobulinas salivares, que constituem o principal agente na linha de defesa da mucosa bucal, com as Candida spp em pacientes pediátricos infectados pelo HIV, ressaltando a importância desses anticorpos.

O impacto da saúde bucal na qualidade de vida de crianças infectadas pelo HIV: revisão de literatura / The impact of oral health on the quality of life of HIV infected children: a literature review

Em busca de uma melhora da saúde de pacientes sistemicamente comprometidos e um maior entendimento do impacto de doenças nas suas vidas, grande interesse tem sido dado à qualidade de vida relacionada à saúde, principalmente em crianças com doenças crônicas. Neste sentido, a qualidade de vida relacionada à saúde bucal tem sua importância haja vista que a mesma é um componente indissociável da saúde geral e também pela relevância dos problemas orais na vida destes pacientes. Assim, a avaliação de qualidade de vida relacionada à saúde bucal em pacientes infantis infectados pelo HIV pode ser de grande relevância uma vez que estas apresentam alta prevalência de doença cárie e periodontal, além da presença de manifestações orais da própria infecção pelo vírus. Dessa forma, o objetivo deste artigo é, através de uma revisão de literatura, apresentar alguns conceitos relacionados à qualidade de vida e utilização de instrumentos de avaliação da mesma, bem como analisar o impacto da saúde bucal na qualidade de vida de crianças infectadas pelo HIV.

The search for improvement of the health of systemically compromised patients and for a better knowledge about the impact of diseases on their lives has brought great interest for health-related quality of life, mainly in children with chronic diseases. The quality of life related to oral health is thus relevant, not only for being an inseparable component of the general health but also due to the importance of oral problems in the lives of these patients. The evaluation of oral health-related quality of life in HIV infected children can be of great importance seen that these patients show high prevalence of caries and periodontal diseases besides the oral manifestations of the virus infection itself. The aim of this article is to present some concepts about quality of life and the use of instruments for its evaluation on the basis of a literature review as well as to analyze the impact of oral health on the quality of life of HIV infected children.