Dental caries severity and oral health-related quality-of-life in Brazilian preschool children.

The impact of dental caries on oral health-related quality-of-life (OHRQoL) may be influenced by disease severity. This study evaluated the impact of caries severity on OHRQoL in preschool children. A school-based, cross-sectional study was conducted with 205 children (aged 2-5 years) in Southern Brazil. Parents answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and provided sociodemographic information. The Caries Assessment Spectrum and Treatment criteria were used to evaluate caries severity, and Poisson regression with robust variance estimation conducted to determine the rate ratio (RR) and 95% confidence intervals (CIs) of the mean OHRQoL scores according to severity level. Most children had at least one tooth in the morbidity (37%) or pre-morbidity (35%) stages, and the prevalence of impacts on OHRQoL was 40%. Caries severity was associated with the impact scores: after adjustments, the mean B-ECOHIS scores were 6.31 (95% CI: 4.24-9.38) higher for children in the morbidity stage, and 10.84 (95% CI: 6.51-18.05) higher in the severe morbidity stage, than for healthy children [RR = 10.84 (95% CI: 6.51-18.05)]. Children with carious lesions into dentine or with pulpally-involved or abscessed teeth had poorer OHRQoL than children without such lesions.

Prognosis of primary teeth following intrusive luxation according to the degree of intrusion: A retrospective cohort study.

BACKGROUND/AIM: The degree of intrusion is an important aspect to be evaluated when treating children following intrusive luxation. The aim of this retrospective cohort study was to evaluate re-eruption rates and the occurrence of sequelae in intruded primary teeth according to the degree of intrusion. MATERIAL AND METHODS: A total of 238 teeth from 168 patients diagnosed with and treated for intrusion over a 16-year period at a specialized trauma center in South Brazil were included in this study. Patient details, including demographic characteristics, tooth affected, presence of sequelae of trauma during the follow up (pulp necrosis and infection, crown discoloration and abnormal mobility), and any effects on the permanent successors, were collected from their records. Photographs were analyzed to determine the degree of intrusion (Grade I, II, or III) and spontaneous re-eruption during follow up. Re-eruption and occurrence of sequelae according to the degree of intrusion were evaluated using the chi-squared test. The level of significance was set at 5%. RESULTS: Most teeth were maxillary central incisors (87.8%) with Grade I intrusion (32.8%). In the first 30 days, 13.1% had signs of re-eruption. After 3-6 months, the frequency of re-eruption increased to 58.7%. Of the teeth evaluated 6 months or more after intrusion, 68% had re-erupted. Total intrusion (Grade III) was associated with pulp necrosis and infection (p = .002), but the degree of intrusion was not associated with the presence of crown discoloration or abnormal mobility. Of the 78 permanent successors evaluated, 52.6% had developmental disturbances. CONCLUSION: Most intruded primary teeth re-erupted spontaneously, and the degree of intrusion was associated with a worse prognosis.

Association between malocclusion and the severity of dental trauma in primary teeth.

BACKGROUND/AIMS: The literature does not clearly state whether the type of malocclusion is associated with a specific type of trauma and the severity of the injury. Hence, the aim of this retrospective study was to assess the occlusal condition in children with traumatic dental injuries of the primary teeth, and the association between the occlusal characteristics and the type and severity of these injuries. MATERIAL AND METHODS: Data were collected from records of children treated at a dental trauma center in Brazil over a period of 16 years. The data included age, gender, etiology of the trauma, place of occurrence, number of affected teeth, type of trauma, and injury severity. The occlusal condition was assessed by a trained dentist using photographs of the patients from their first visit. Chi-square tests and Poisson regression were used for data analyses. RESULTS: This study included 209 patients, and most were aged between 2-4 years (50.55%). Multivariate regression analysis showed that children with an anterior open bite had a 47% higher prevalence of severe trauma than those who did not have an anterior open bite, and those with class II canines had a 56% higher prevalence of severe trauma than those with class I and III canines. Children with an anterior open bite had a 46% higher prevalence of injuries affecting multiple teeth than those without an anterior open bite. CONCLUSIONS: Anterior open bite and class II canine relationship were associated with a higher prevalence of severe traumatic dental injury in primary teeth, and anterior open bite was associated with trauma affecting multiple teeth.

Effectiveness of Virtual Reality Glasses as a Distraction for Children During Dental Care.

Purpose: The purpose of this review was to investigate the effect of virtual reality (VR) glasses as an audiovisual distraction technique on dental anxiety, pain perception, and behavior triggered during dental treatment in children up to 12 years old. The research question asked was: Can improvement be seen in the child's behavior, pain perception or anxiety when VR eyeglasses are used during dental treatment? Methods: Five databases were searched for studies published until September 2018. Studies were selected by titles and abstracts, followed by full-texts reading. Results: Meta-analysis was performed and combined results were presented as a pooled mean difference for each procedure, using random-effect models. Nine randomized clinical trials assessed the effect of VR glasses on children's behavior during dental care. No differences were observed in anxiety levels during local anesthesia, use of rubber dam, removal of caries and restorative procedures. Similar results were observed in children's behavior when local anesthesia and rubber dam were used. Conclusions: The use of virtual reality glasses is an effective tool for improving behavior and reducing pain perception during the dental treatment of children. Children who used VR eye-glasses behaved better during removal of caries and showed lower pain perception during restoration.

Incidence and prognosis of crown discoloration in traumatized primary teeth: A retrospective cohort study.

BACKGROUND/AIM: Knowledge of factors influencing the occurrence of crown discoloration following traumatic dental injuries in primary teeth and understanding its possible consequences can help dentists to provide appropriate care. The aim of this retrospective cohort study was to investigate the incidence of crown discoloration following trauma in primary teeth. This study also estimated the risk of pulp necrosis with subsequent infection of the root canal system and pulp canal obliteration in discolored teeth. MATERIAL AND METHODS: Records of children treated at the specialized trauma center of the Federal University of Pelotas during a period of 10 years were analyzed. Patient details including the type of injury, presence of crown discoloration, pulp necrosis, and pulp canal obliteration were collected. Photographs of teeth with crown discoloration were assessed to evaluate the color presented (yellow or dark). Chi-square tests and Poisson regression were used for data analyses (P < .05). RESULTS: A total of 355 children with 628 traumatized teeth were included in the study. The incidence of crown discoloration was 27.9%, and 20.5% of the teeth were affected. Discoloration was higher in children whose age at the time of trauma was 2-4 years (P = .020), and it was associated with the type of injury (P = .019). Discolored teeth had a twofold risk of pulp necrosis and subsequent infection of the root canal system (RR 1.98 95% CI 1.42-276; P < .001) and a higher risk of pulp canal obliteration (RR 8.47; 95% CI 4.95-14.51; P < .001) than did teeth without discoloration. Teeth with dark and yellow discoloration were significantly associated with pulp necrosis and pulp canal obliteration, respectively (P < .001). CONCLUSIONS: This study demonstrates the importance of monitoring traumatized primary teeth with crown discoloration, particularly those appearing darker, owing to their higher risk of pulp necrosis and subsequent infection of the root canal system.

Validity of the Brazilian version of the Dental Subscale of Children's Fear Survey Schedule.

BACKGROUND: Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) is a tool widely used to assess dental fear in children. AIM: To translate and to verify the psychometric properties, including factor analyses of the Brazilian version of the CFSS-DS (B-CFSS-DS) in two settings. DESIGN: The CFFS-DS was translated into the Portuguese language. In the first cross-sectional study (dental setting), 128 children (age: 4-12 years) participated. Mothers were interviewed; children's dental fear was assessed through the CFSS-DS and the Venham picture test; and child behaviour was assessed using the Frankl Scale. The second was a longitudinal study, with 103 schoolchildren (age: 4-12 years). Two receiver operating characteristic curves were drawn to establish the cut-off points. RESULTS: The B-CFSS-DS version showed good internal consistency in dental and school settings (Cronbach's α = 0.88 and 0.77 respectively) and a good test-retest reliability (Weighted Kappa = 0.767), as well as good criterion and discriminant validities. Factor analyses showed four factors. CONCLUSION: The Brazilian version of the CFSS-DS is a valid tool for dental fear assessment in children aged 4-12 years. Further studies with representative samples should be performed to strengthen the findings of this study, especially in the school setting.

Perinatal health and malocclusions in preschool children: Findings from a cohort of adolescent mothers in Southern Brazil.

INTRODUCTION: Pregnancy in adolescence has long-term consequences that can negatively influence oral conditions. In this study, we aimed to assess malocclusion in deciduous dentition and its association with prolonged breastfeeding, pacifier use, and perinatal health indicators pertaining to the periods immediately before and after birth. METHODS: This cross-sectional study was nested in a cohort of adolescent mothers who became pregnant from 13 to 19 years of age (mean age, 17.3 ± 1.6 years). A total of 509 mother-child dyads were included. Information on perinatal indicators, including Apgar score (0-10), which is a standardized assessment of the condition of the infant at birth (heart rate, breath rate, muscle tone, reflex irritability, and skin color), head circumference, birth weight, and need for intensive care unit admission were collected after delivery through interviews with the mothers. By the time the children were 24 to 36 months of age, malocclusion was assessed, and information on the use of pacifiers and breastfeeding was collected. Multivariate Poisson regression was used to assess the effect of independent variables on the outcome (malocclusion). RESULTS: The prevalence of malocclusion was 62.33%, and open bite was the most frequent one (47.45%). After adjustments, children with no need for intensive care unit admission had a lower risk of malocclusion (prevalence ratio [PR] = 0.75; 95% CI, 0.56-0.99), whereas those with an Apgar score less than 7 had a higher risk (PR = 1.32; 95% CI, 1.06-1.64). Children who had used a pacifier (PR = 1.82; 95% CI, 1.02-3.24) or were still using it (PR = 3.88; 95% CI, 2.65-5.68) had a higher chance of malocclusion compared with children who never used a pacifier. Children breastfeeding for 24 months or longer were less likely to have malocclusion (PR = 0.46; 95% CI, 0.34-0.73). CONCLUSIONS: Poor perinatal health and pacifier use may be risk factors for malocclusion development in deciduous teeth. Long duration of breastfeeding is associated with better occlusal conditions in children of adolescent mothers. Further studies are needed with other age groups.

Nonuse of dental service by schoolchildren in Southern Brazil: impact of socioeconomics, behavioral and clinical factors.

OBJECTIVES: To assess clinical, behavioral and socioeconomic factors associated with nonuse of dental services by schoolchildren. METHODS: A cross-sectional school-based study with 1211 children aged 8-12 years was carried out in Pelotas, Brazil. The outcome (never having had a dental appointment) and independent variables were collected through interview with parents and children, including sex, age, parent's schooling, family income, self-perception about oral health, and dental fear. Dental caries was assessed by clinical examination performed at schools. RESULTS: 291 (24.3 %; 95 % CI 22.0-26.9) of the children had never visited a dentist. Multivariate Poisson regression analysis showed that the outcome was associated with children from mothers with little education (≤0.001), from public schools (≤0.001), from crowded households (≤0.001), who had no caries (≤0.001), who had dental fear (≤0.001), and who started oral hygiene later (0.04). CONCLUSIONS: Despite the extensive increase in oral health coverage, especially in the public system in the last years in Brazil, there is still an unassisted portion of the population of schoolchildren. It was observed that socioeconomic, behavioral, and clinical factors influenced the nonuse of dental services.

Long-term clinical and radiographic follow up of subluxated and intruded maxillary primary anterior teeth.

AIMS: This study aimed to determine the kinds of sequelae resulting from intrusive luxation and subluxative injuries in primary anterior teeth as well as the timing of such sequelae. MATERIALS AND METHODS: In this longitudinal retrospective study, data were collected from dental records and radiographs of patients with traumatic dental injury (TDI) treated at the Centre for the Study and Treatment of Dental Trauma in Primary Dentition (Pelotas, RS, Brazil). Fifty-two children, with seventy intruded teeth, and 76 children, with 99 subluxated teeth, met the inclusion criteria. Sequelae, such as crown discoloration, fistula, pulp canal obliteration (PCO), inflammatory root resorption (IRR), and internal root resorption, were investigated. The data on the sequelae were distributed into eight follow-up periods: 0-30 days, 31-90 days, 91-180 days, 181-365 days, 1-2 years, 2-3 years, 3-4 years, and >4 years. RESULTS: The sample comprised 99 subluxation cases and 70 intruded teeth. Crown discoloration was the most prevalent sequelae. Among the subluxated teeth, <50% of IRR, fistula, crown discoloration, and PCO occurred within 180 days after TDI; however, the sequelae were also diagnosed after longer periods. Majority of sequelae of intrusion were diagnosed within the 181-365 days and 1-2 years periods but were also observed after more than 4 years of follow up. CONCLUSIONS: For both intrusion and subluxation, trauma sequelae were diagnosed even after the 3-4 years of follow-up.