Determinantes sociais de saúde de crianças em consulta de puericultura: das condições socioeconômicas aos aspectos relacionados à saúde bucal / Social determinants of health of children in child care consultation: from socioeconomic conditions to aspects related to oral health / Determinantes sociales de la salud de los niños en la consulta infantil: de las condiciones socioeconómicas a los aspectos relacionados con la salud bucal

A imaturidade do sistema imunológico, associado a Determinantes Sociais de Saúde (DSS), promove doenças na infância. Especificamente, na cavidade oral, os DSS, representados pelo consumo elevado de açúcar, limitado acesso aos serviços de saúde e deficiência na higiene bucal, favorecem transtornos locais e sistêmicos. Assim, o estudo objetivou associar os DSS, no contexto das condições socioeconômicas, do acompanhamento pelo serviço de saúde e dos aspectos relacionados à saúde bucal de crianças atendidas em Unidades Básicas de Saúde (UBS) de um município cearense. Trata-se de estudo observacional, analítico, transversal e de abordagem quantitativa, conduzido com crianças e suas mães em Acarape - CE. Após consentimento, essas preencheram um questionário. Os dados foram analisados. Das 70 mães, 87,14% e 90,00% tinham idade inferior ou igual a 30 anos e renda de até um salário mínimo, respectivamente. Das 70 crianças, 87,14% tinham seus dentes/gengiva higienizados por seus pais ou responsável. Do total, 94,29% nunca se submeteram a atendimento odontológico. Observou-se associação significativa entre a mãe ter escolaridade superior ao ensino fundamental incompleto e higienizar os dentes/gengiva do filho com escova dental e dentifrício. Constatou-se associação significativa entre a criança ingerir bolacha doce/recheada, não consumir refrigerante e usar escova dental e dentifrício na higienização oral. Conclui-se que as crianças eram acompanhadas nas UBS regularmente; no entanto, esse serviço não esteve relacionado ao atendimento odontológico. Apesar da ausência desse tipo de acompanhamento e do consumo de alimentos cariogênicos, as mães se preocupavam com a saúde bucal das crianças, higienizando a cavidade oral diariamente, com meios adequados.

The immaturity of the immune system, associated with Social Determi- nants of Health (SDH), promotes diseases in childhood. Specifically, in the oral cavity, SDH, represented by high sugar consumption, limited access to health services, and poor oral hygiene, favors local and systemic disorders. Thus, the study aimed to associate the SDH, in the context of socioeconomic conditions, monitoring by the health service and aspects related to children's oral health assisted in Basic Health Units (BHU) of a muni- cipality in Ceará. This is an observational, analytical, cross-sectional study with a quan- titative approach conducted with children and their mothers in Acarape - CE. After con- sent, they filled out a questionnaire. Data were analyzed. Of the 70 mothers, 87.14% and 90.00% were aged less than or equal to 30 years and had income up to one minimum wage, respectively. Of the 70 children, 87.14% had their teeth/gums cleaned by their pa- rents or guardian. Of the total, 94.29% never underwent dental care. There was a signifi- cant association between the mother having higher education than incomplete elementary school and cleaning the child's teeth/gums with a toothbrush and toothpaste. A significant association was found between the child eating sweet/stuffed biscuits, not consuming soft drink, and using a toothbrush and dentifrice for oral hygiene. It is concluded that the chil- dren were regularly monitored at the BHU; however, this service was not related to dental care. Despite the absence of this type of follow-up and the consumption of cariogenic foods, the mothers were concerned about their children's oral health, cleaning the oral cavity daily with adequate means.

La inmadurez del sistema inmunológico, asociada a los Determinantes So- ciales de la Salud (DSS), promueve enfermedades en la infancia. Específicamente, en la cavidad bucal, los DSS, representados por el alto consumo de azúcar, el acceso limitado a los servicios de salud y la mala higiene bucal, favorecen los trastornos locales y sisté- micos. Así, el estudio tuvo como objetivo asociar el DSS, en el contexto de las condicio- nes socioeconómicas, el seguimiento por el servicio de salud y los aspectos relacionados con la salud bucal de los niños atendidos en las Unidades Básicas de Salud (UBS) de un municipio de Ceará. Se trata de un estudio observacional, analítico, transversal con enfo- que cuantitativo, realizado con niños y sus madres en Acarape ­ CE. Después del consen- timiento, completaron un cuestionario. Los datos fueron analizados. De las 70 madres, 87,14% y 90,00% tenían edad menor o igual a 30 años e ingresos hasta un salario mínimo, respectivamente. De los 70 niños, al 87,14% se les limpió los dientes/encías por sus pa- dres o tutores. Del total, el 94,29% nunca realizó atención odontológica. Hubo una aso- ciación significativa entre la madre con educación superior a la primaria incompleta y la limpieza de los dientes/encías del niño con cepillo y pasta dental. Se encontró una asoci- ación significativa entre el niño que come galletas dulces/rellenas, no consume gaseosas y usa cepillo de dientes y dentífrico para la higiene bucal. Se concluyó que los niños eran monitoreados periódicamente en la UBS; sin embargo, este servicio no estaba relacionado con el cuidado dental. A pesar de la ausencia de este tipo de seguimiento y del consumo de alimentos cariogénicos, las madres se preocupan por la salud bucal de sus hijos, reali- zando la limpieza de la cavidad bucal diariamente, con medios adecuados.

Avaliação do crescimento e desenvolvimento infantil e fatores de risco de um município que integra uma universidade brasileira de cunho internacional / Evaluation of childhood growth and development and risk factors of a municipality that is part of an international brazilian university / Evaluación de los factores de crecimiento y desarrollo infantil y de riesgo de un municipio que forma parte de una universidad brasileña internacional

Fatores de risco, incluindo os de cunho materno, interferem no crescimento e desenvolvimento infantil. Nesse sentido, o conhecimento desses fatores e avaliação ade- quada desses processos são necessários para articulação de estratégias preventivas de transtornos futuros. Assim, o estudo visou investigar o crescimento e desenvolvimento de crianças atendidas em consulta de puericultura em unidades básicas de saúde de um mu- nicípio cearense, que integra uma universidade brasileira de cunho internacional, e seus fatores de risco. Trata-se de estudo observacional, analítico, transversal e de abordagem quantitativa, conduzido com crianças e suas mães no Centro de Saúde de Acarape e Posto de Saúde São Benedito (Acarape ­ CE), no período de fevereiro a julho de 2021. Após consentimento, as mães preencheram um questionário, seguido de avaliação do cresci- mento e desenvolvimento das crianças. Os dados obtidos foram analisados. Das 70 crian- ças, 50,00% (n = 17) e 51,43% (n = 18) dos meninos e meninas tinham baixa estatura para idade, respectivamente. Para o desenvolvimento psicossocial, dos 284 testes condu- zidos, 86,27% (n = 245) foram realizados em plenitude pelas crianças. Observou-se as- sociação significativa entre a gestante ter concebido o filho com, no mínimo, 9 meses de período gestacional e esse apresentar relação Peso/Idade adequada e Estatura/Idade ina- dequada. Houve associação significativa entre a criança não ingerir refresco em pó e apre- sentar relação Peso/Idade adequada. Conclui-se que as crianças tinham idade gestacional adequada e apresentavam estado nutricional apropriado, apesar da baixa estatura para idade. Manifestavam desenvolvimento psicossocial, de linguagem e físico normais. Sobre os fatores de risco, esses envolveram os de cunho materno e o consumo de alimentos cariogênicos.

Risk factors, including maternal ones, interfere with child growth and de- velopment. In this sense, knowledge of these factors and adequate evaluation of these processes are necessary to articulate preventive strategies for future disorders. Thus, the study aimed to investigate the growth and development of children seen in childcare con- sultations in primary health units in Ceará, part of a Brazilian university of international character, and their risk factors. This is an observational, analytical, cross-sectional study with a quantitative approach, conducted with children and their mothers at the Acarape Health Center and São Benedito Health Center (Acarape ­ CE), from February to July 2021. After consent, the mothers completed a questionnaire, followed by an assessment of the children's growth and development. The data obtained were analyzed. Of the 70 children, 50.00% (n = 17) and 51.43% (n = 18) of the boys and girls were short for their age, respectively. Of the 284 tests conducted for psychosocial development, 86.27% (n = 245) were entirely performed by the children. A significant association was observed between the pregnant woman having conceived her child at least nine months of gestation and having an adequate Weight/Age and Height/Age ratio. There was a significant asso- ciation between the child not ingesting powdered soft drinks and having an appropriate Weight/Age ratio. It was concluded that the children had an adequate gestational age and had an appropriate nutritional status, despite their low height for their age. They showed normal psychosocial, language, and physical development. The risk factors involved those of mother nature and the consumption of cariogenic foods.

Los factores de riesgo, incluidos los maternos, interfieren en el crecimiento y desarrollo infantil. En este sentido, el conocimiento de estos factores y la evaluación adecuada de estos procesos son necesarios para articular estrategias preventivas de futu- ros trastornos. Así, el estudio tuvo como objetivo investigar el crecimiento y desarrollo de niños atendidos en consultas de puericultura en unidades básicas de salud de un muni- cipio de Ceará, que forma parte de una universidad brasileña de carácter internacional, y sus factores de riesgo. Se trata de un estudio observacional, analítico, transversal, con enfoque cuantitativo, realizado con niños y sus madres en el Centro de Salud de Acarape y el Centro de Salud São Benedito (Acarape ­ CE), de febrero a julio de 2021. Después del consentimiento, las madres completaron un cuestionario, seguido de una evaluación del crecimiento y desarrollo de los niños. Los datos obtenidos fueron analizados. De los 70 niños, el 50,00% (n = 17) y el 51,43% (n = 18) de los niños y niñas eran bajos para su edad, respectivamente. Para el desarrollo psicosocial, de las 284 pruebas realizadas, el 86,27% (n = 245) fueron realizadas íntegramente por los niños. Se observó una asociación significativa entre la gestante haber concebido a su hijo con al menos 9 meses de gesta- ción y tener una adecuada relación Peso/Edad y Talla/Edad. Hubo asociación significativa entre el niño que no ingiere gaseosas en polvo y presentar una adecuada relación Peso/Edad. Se concluyó que los niños tenían una edad gestacional adecuada y un estado nutricional adecuado, a pesar de su baja talla para su edad. Presentaron un desarrollo psi- cosocial, lingüístico y físico normal. En cuanto a los factores de riesgo, estos involucraron los de naturaleza materna y el consumo de alimentos cariogénicos.

Riesgo cariogénico en pacientes pediátricos de la Universidad del Pacífico en el año 2021 / Cariogenic risk in pediatric patients of the Universidad del Pacífico in 2021

RESUMEN Introducción. El riesgo cariogénico es la probabilidad que tiene una persona de desarrollar caries y está determinado por la medición, en el individuo o en una comunidad, de factores como la susceptibilidad del huésped, el tiempo de exposición a los sustratos, la presencia de microorganismos específicos y los hábitos. Existen diferentes índices para la medición del riesgo cariogénico que han sido aplicados en diferentes contextos y en distintas muestras de poblaciones. Objetivo. Determinar el riesgo cariogénico en pacientes que acudieron a la clínica de Odontopediatría de la Facultad de Odontología de la Universidad del Pacífico en el año 2021. Metodología. Estudio observacional descriptivo de corte transversal en el que se aplicó la tabla de medición del riesgo cariogénico a 66 pacientes de 3 a 16 años. Los datos se registraron en una planilla creada con el programa Microsoft Excel® y fueron analizados mediante el programa Epi Info™. Resultados. En los pacientes examinados, el nivel de riesgo cariogénico alto fue el más frecuente (40,91%). En relación a la variable sexo, el nivel de riesgo cariogénico alto fue el más frecuente en el sexo femenino (59,26%), mientras que los niveles de riesgo moderado (63,64%) y riesgo bajo (58,82%) predominaron en el sexo masculino. Conclusión. La mayoría de los pacientes tienen un nivel alto de riesgo cariogénico, siendo el factor de exposición más predominante los momentos de azúcar mayor a tres veces al día, seguido por la presencia de manchas blancas o lesiones activas.

ABSTRACT Introduction. The cariogenic risk is the probability that a person has of developing caries and is determined by the measurement, in the individual or in a community, of factors such as the susceptibility of the host, the time of exposure to the substrates, the presence of specific microorganisms and the habits. There are different indices for measuring cariogenic risk that have been applied in different contexts and in different population samples. Objective: To determine the cariogenic risk in patients who attended the Pediatric Dentistry clinic of the Faculty of Dentistry of the Universidad del Pacífico in 2021. Methodology. Cross-sectional descriptive observational study in which the cariogenic risk measurement table was applied to 66 patients aged from 3 to 16 years old. The data was recorded in a spreadsheet created with the Microsoft Excel® program and analyzed using the Epi Info™ program. Results. In the examined patients, the level of high cariogenic risk was the most frequent (40.91%). In relation to the gender variable, the level of high cariogenic risk was the most frequent in the female sex (59.26%), while the levels of moderate risk (63.64%) and low risk (58.82%) predominated in the male sex. Conclusion. Most patients have a high level of cariogenic risk, with the most predominant exposure factor being moments of sugar greater than three times per day, followed by the presence of white spots or active lesions.

Biopelícula cariogénica de Streptococcus mutans y efecto hemostático de ácido tánico en la hemorragia post-exodoncia / Streptococcus mutans cariogenic biofilm and hemostatic effect of tannic acid in post-extraction hemorrhage

La caries dental y la placa dental se encuentran entre las enfermedades más comunes en todo el mundo y son causadas por una mezcla de microorganismos y restos de alimentos. Tipos específicos de bacterias productoras de ácido, especialmente Streptococcus mutans, colonizan la superficie dental y causan daño a la estructura dental dura en presencia de carbohidratos fermentables, por ejemplo, sacarosa y fructosa. Por otro lado, el sangrado posterior a la extracción es una complicación reconocida y frecuente en la práctica dental, que se define como la pérdida de sangre que continúa más allá de las 8 a 12 horas después de la exodoncia. Existe una amplia gama de técnicas sugeridas y sustancias para el tratamiento del sangrado post-extracción, que incluyen intervenciones dirigidas tanto a causas locales como sistémicas. El ácido tánico es una de las sustancias astringente que precipitan proteínas, pero no penetran en las células, por lo que inciden solo en la capa superficial. Su objetivo se enfoca a robustecer la superficie para acrecentar su resistencia mecánica y reducir la exudación. El objetivo de este estudio fue determinar la presencia de S. mutans en las biopelículas dentales y al mismo tiempo evaluar la actividad del ácido tánico como inhibidor del sangrado profuso en las extracciones dentales. S. mutans se aisló en el 92,5% de los pacientes evaluados. Los tiempos de hemostasia post-exodoncia fue significativamente menor en el grupo de pacientes a los que se les aplicó el ácido tánico en comparación a los que no se les aplicó(AU)

Tooth decay and dental plaque are among the most common diseases worldwide and are caused by a mix of microorganisms and food debris. Specific types of acid-producing bacteria, especially Streptococcus mutans, colonize the tooth surface and cause damage to hard tooth structure in the presence of fermentable carbohydrates, for example, sucrose and fructose. On the other hand, post-extraction bleeding is a recognized and frequent complication in dental practice, defined as blood loss that continues beyond 8 to 12 hours after extraction. There is a wide range of suggested techniques and substances for the treatment of post-extraction bleeding, including interventions targeting both local and systemic causes. Tannic acid is one of the astringent substances that precipitate proteins, but does not penetrate the cells, so it affects only the superficial layer. Its objective is focused on strengthening the surface to increase its mechanical resistance and reduce exudation. The objective of this study was to determine the presence of S. mutans in dental biofilms and at the same time to evaluate the activity of tannic acid as an inhibitor of profuse bleeding in dental extractions. S. mutans was isolated in 92.5% of the patients evaluated. Post-extraction hemostasis times were significantly shorter in the group of patients who received tannic acid compared to those who did not(AU)

The Effects of Nonnutritive Sweeteners on the Cariogenic Potential of Oral Microbiome.

Nonnutritive sweeteners (NNSs) are sugar substitutes widely used to reduce the negative health effects of excessive sugar consumption. Dental caries, one of the most prevalent chronic diseases globally, results from a pathogenic biofilm with microecological imbalance and frequent exposure to sugars. Some research has shown that certain NNSs possess less cariogenic potential than sucrose, indicating their putative effect on oral microbiome. To uncover the alterations of acidogenic pathogens and alkali-generating commensals, as well as the biofilm cariogenic potential under the influence of NNSs, we selected four common NNSs (acesulfame-K, aspartame, saccharin, and sucralose) and established single-, dual-, and multispecies in vitro culture model to assess their effects on Streptococcus mutans (S. mutans) and/or Streptococcus sanguinis (S. sanguinis) compared to sucrose with the same sweetness. The results showed that NNSs significantly suppressed the planktonic growth, acid production, and biofilm formation of S. mutans or S. sanguinis compared with sucrose in single-species cultures. Additionally, decreased S. mutans/S. sanguinis ratio, less EPS generation, and higher pH value were observed in dual-species and saliva-derived multispecies biofilms with supplementary NNSs. Collectively, this study demonstrates that NNSs inhibit the cariogenic potential of biofilms by maintaining microbial equilibrium, thus having a promising prospect as anticaries agents.

Investigação do potencial erosivo de gomas de mascar não convencionais / Investigation the erosive potential of unconventional chewing gums

Objetivo: mensurar o potencial erosivo de gomas de mascar não convencionais disponíveis no mercado brasileiro. Material e método: estudo experimental (in vitro) de caráter quantitativo. Foram adquiridos oito sabores de gomas de mascar: Poosh® (pinta língua); Plutonita® (abraço congelante, dentada ardente, baba de bruxa e língua ácida); e TNT® (sangue, lava e tumba). Para análise da acidez, foram realizadas leituras em triplicata do pH e acidez titulável (AT), utilizando um potenciômetro e eletrodo combinado de vidro em soluções obtidas após a maceração das gomas de mascar em água duplamente deionizada. Nas soluções com valores de pH inferiores a 5,5, foi mensurada a AT adicionando-se alíquotas de 100 µLNaOH 0,1 M, até alcançar pH 5,5. Os resultados foram submetidos à Análise de Variância (ANOVA). As comparações das médias de pH e acidez titulável foram realizadas pelo teste de Tukey, com um nível de 5% de significância (p<0,05). Resultados: os valores de pH variaram entre 2,4 (abraço congelante) e 3,5 (baba de bruxa), diferin-do significantemente do controle (água mineral/pH=6,2). Os valores de acidez titulável variaram entre 628µL de NaOH 0,1 M (sangue) e 10700µL de NaOH 0,1 M (abraço congelante). A goma de mascar sabor abraço congelante apresentou o pH mais baixo e a mais elevada acidez titulável, diferindo significantemente dos demais sabores. Conclusões: as gomas de mascar avaliadas são ácidas, mas diferem quanto ao seu potencial erosivo. Seu consumo abusivo pode constituir um fator de risco para erosão dental.(AU)

Objective: to measure the erosive potential of non- -conventional chewing gums available in the Brazilian market. Material and methods: this is an in vitro study using the following flavors of chewing gums from the Brazilian market: Poosh® (tongue cleaner); Plutonita® (freezing hug, burning bite, witch slime and acid tongue); TNT® (blood, lava and tomb). For acidity analysis, pH and titratable acidity (TA) readings were performed in triplicate using a potentiometer and combined glass electrode in solutions obtained after maceration of the chewing gums in double deionized water. In solutions with pH values below 5.5, the TA was measured by adding aliquots of 100 µL 0.1 M NaOH, until pH 5.5 was reached. The results were submitted to Analysis of Variance (ANOVA). Comparisons of pH and titratable acidity means were performed by Tukey test at a 5% significance level (p<0.05). Results: the pH values that ranged from 2.4 (freezing hug) to 3.5 (witch's slime) differed significantly from the control (mineral water/ pH=6.2). Titratable acidity values ranged from 628µL of 0.1 M NaOH (blood) to 10700µL of 0.1 M NaOH (freezing hug). The freezing hug flavor chewing gum had the lowest pH and the highest titratable acidity differing significantly from the other flavors. Conclusions: the evaluated chewing gums are acidic, but differ in their erosive potential. Their abusive consumption may constitute a risk factor for dental erosion.(AU)

Análise físico-química de balas duras e mastigáveis e o seu efeito desmineralizante em esmalte bovino / Physico-chemical analysis of hard and soft candies and their demineralizing effect in bovine enamel

Objetivo: avaliar o potencial cariogênico de balas duras e mastigáveis e seu potencial desmineralizante em esmalte bovino. Métodos: foram selecionadas 30 balas de diferentes marcas, divididas em balas duras (n=11), Tic Tac®, Halls® e IceKiss®, e balas mastigáveis (n=19), Lílith®, Azedinha®, Mentos Rainbow® e Dori Gomets®. As balas foram dissolvidas em água destilada (1:10) e foram avaliados pH, acidez titulável (ATT) e presença de sólidos solúveis totais (SST/°Brix). Na ciclagem erosiva, 40 espécimes de esmalte bovino foram divididos em quatro grupos (n=10): GCN ­ saliva artificial; GCP ­ ácido clorídrico; GT1 ­ solução da bala Lílith® maçã verde; GT2 ­ solução da bala IceKiss® extraforte. O desafio erosivo foi realizado por 2 minutos, 4x/dia, segui-do de 2 horas de imersão em saliva artificial durante cinco dias. Resultados: os valores de pH para as balas duras e mastigáveis variaram de 2,88 a 5,53 e de 2,73 a 4,16, respectivamente. ATT em pH 5,5 variou de 0,07 mL a 39,40 mL de NaOH 0,1 N, para as balas duras, e de 1,53 mL a 35,83 mL, para balas mastigáveis. ATT em pH 7,0 variou de 0,2 mL a 49,13 mL de NaOH, para balas duras, e de 2,37 mL a 49,97 mL, para as mastigáveis. O conteúdo de SST de todas as balas duras foi superior a 8,5°Brix, já entre as mastigáveis variou de 5,3 a 8,83°Brix. O GCP apresentou maior desmineralização que GCN e GT2 (p<0,05). Conclusão: a maioria das balas duras e mastigáveis dissolvidas em água destilada mostraram-se potencialmente erosivas e cariogênicas.(AU)

Objective: evaluate the cariogenic potential of hard and soft candies and their demineralizing potential in bovine enamel. Methods: 30 candies of different brands were selected, divided into hard candies (n=11): Tic Tac®, Halls® and IceKiss® and soft candies (n=19): Lílith®, Azedinha®, Mentos Rainbow® and Dori Gomets®. The candies were dissolved in distilled water (1:10) and pH, titratable acidity (TT) and presence of total soluble solids (SST/°Brix) were evaluated. In erosive cycling, 40 specimens of bovine enamel were divided into four groups (n=10): GCN - artificial saliva; GCP - hydrochloric acid; GT1 - Lilith® apple green candy solution; GT2 - IceKiss® Extra Strong candy Solution. The erosive challenge was performed for 2 minutes, 4X/day, followed by 2 hours of immersion in artificial saliva for five days. Results: pH values for hard and soft candies ranged from 2.88 to 5.53 and 2.73 to 4, respectively. ATT at pH 5.5 varied from 0.07 mL to 39.40 mL of 0.1 N NaOH for hard candies and 1.53 mL to 35.83 mL for soft candies. ATT at pH 7,0 varied from 0.2 mL to 49.13 mL of 0.1 N NaOH for hard candies and from 2.37 mL to 49.97 mL for soft candies. The content of SST of all hard candies was higher than 8.5 °Brix and for soft candies, varied between 5.3 to 8.83 °Brix. The GCP group showed greater demineralization than GCN and GT2 (p<0.05). Conclusion: most hard and soft candies dissolved in distilled water were potentially erosive and cariogenic.(AU)

Cariogenic potential of oral nutritional supplements measured by intraoral plaque pH telemetry.

BACKGROUND & AIMS: Oral nutritional supplements (ONS) administered to malnourished elders and other patients contain high-levels of carbohydrates that could be a potential risk factor for dental caries. This study aimed to evaluate the cariogenic potentials of ONS using intraoral plaque telemetry. METHODS: Ten ONS were tested on five healthy volunteers (mean age: 76.8 ± 9.15 years). Participants were requested to refrain from performing oral hygiene 3-7 days prior to testing. The pH-value below the dental plaque on the tooth was measured while the ONS was being consumed. After neutralizing the participant's saliva, a control solution (10% sucrose) was administered and telemetry measurements were repeated. Mean relative cariogenicity (RC) was calculated for each ONS. ANOVA and post hoc tests were used for statistical analyses (p < 0.05). RESULTS: All ten ONS were potentially cariogenic on enamel with an overall RC of 0.519 ± 0.35 (Range: Min = 0.31 ± 0.16; Max = 1.00 ± 0.34). RC differed significantly between the ONS (p = 0.002). RC was lower in ONS that contained high-protein (p = 0.018). RC was not influenced by other factors such as readily consumable (p = 0.102), flavor (p = 0.869), consistency (p = 0.126), fiber containing (p = 0.134), style (p = 0.112), and age of plaque (p = 0.339). CONCLUSIONS: The ONS administered to elders and malnourished patients are potentially cariogenic. It is imperative that the administration of ONS must be based on individual needs to potentiate a maximum benefit. Wherever possible, an attempt to limit the use of high-carbohydrate containing ONS must be practiced along with the adoption of suitable preventive measures to arrest the development and progression of caries.

Short-Chain N-Acylhomoserine Lactone Quorum-Sensing Molecules Promote Periodontal Pathogens in In Vitro Oral Biofilms.

Acylhomoserine lactones (AHLs), the quorum-sensing (QS) signals produced by a range of Gram-negative bacteria, are involved in biofilm formation in many pathogenic and environmental bacteria. Nevertheless, the current paradigm excludes a role of AHLs in dental plaque formation, while other QS signals, such as AI-2 and autoinducer peptides, have been demonstrated to play an important role in biofilm formation and virulence-related gene expression in oral pathogens. In the present work, we have explored the effect of externally added AHLs on in vitro oral biofilm models for commensal, cariogenic, and periodontal dental plaque. While little effect on bacterial growth was observed, some AHLs specifically affected the lactic acid production and protease activity of the biofilms. Most importantly, the analysis of bacterial diversity in the biofilms showed that the addition of C6-homoserine lactone (C6-HSL) results in a shift toward a periodontal bacterial composition profile by increasing the relative presence of the orange-complex bacteria Peptostreptococcus and Prevotella These results point to a relevant role of AHL-mediated QS in dental plaque formation and might be involved in the development of dysbiosis, the mechanism of which should be further investigated. This finding potentially opens new opportunities for the prevention or treatment of the periodontal disease.IMPORTANCE Dental plaque is omnipresent in healthy oral cavities and part of our commensal microbial colonization. At the same time, dental plaque is the cause of the most common human diseases, caries and gum disease. Dental plaque consists of billions of microbes attached to the surface of your teeth. Communication among these microbes is pivotal for development of these complex communities yet poorly studied in dental plaque. In the present study, we show that a specific communication molecule induces changes within the community related to the development of gum disease. This finding suggests that interfering with microbial communication may represent an interesting novel strategy to prevent gum disease that should be further investigated.

Adecuación del medio bucal: protocolo de odontopediatría de la UNIGRANRIO, RJ ­ Brasil / Adequação do meio bucal: protocolo da odontopediatria da UNIGRANRIO, RJ - Brasil / Adequacy of the buccal environment: Pediatric dentistry protocol used at UNIGRANRIO, RJ - Brazil

La adecuación del medio bucal consiste en un conjunto de medidas que apuntan a la disminución de los niveles de microorganismos cariogénicos presentes en la cavidad bucal, proporcionando la paralización del proceso carioso. Las medidas se aplican después del diagnóstico y antes del tratamiento restaurador definitivo, siendo considerada una etapa intermedia. El presente trabajo tiene como objetivo discutir la adecuación del medio bucal, sus etapas y presentar el protocolo utilizado en la Clínica de Odontopediatría de la UNIGRANRIO, RJ Brasil.

A adequação do meio bucal consiste em um conjunto de medidas que visam a diminuição dos níveis de microorganismos cariogênicos presentes na cavidade bucal, proporcionando a paralisação do processo da doença cárie. As medidas são aplicadas após o diagnóstico e anteriormente ao tratamento restaurador definitivo, sendo considerada uma etapa intermediária. O presente trabalho tem por objetivo discutir a adequação do meio bucal, suas etapas e apresentar o protocolo utilizado na Clínica de Odontopediatria da UNIGRANRIO, Brasil

The adequacy of the oral environment consists of a set of measures aimed at reducing the levels of cariogenic microorganisms present in the oral cavity and arresting the caries disease process. These measurements are applied after the diagnosis but before the definitive restorative treatment; hence, being considered an intermediate step. The aim of this study was to discuss the adequacy of the oral environment, its stages and present the related protocol used in the Pediatric Dentistry Clinic of UNIGRANRIO, Brazil

Caries de la temprana infancia y factores de riesgo en niños de nivel socioeconómico medio-bajo, Ecuador / Early childhood caries and risk factors in young children of medium-low socioeconomic status, Ecuador / Cárie na primeira infância e fatores de risco em crianças de nível socioeconômico médio-baixo, Equador

Introducción: La caries de la temprana infancia (CTI) es una de las enfermedades infecciosas más comunes en infantes y niños preescolares. Objetivo: Evaluar la caries de la temprana infancia y los factores de riesgo asociados con prácticas dietarías y el estado nutricional en niños de 10-48 meses de edad. Materiales y Métodos: Se realizó un estudio transversal en 142 niños de nivel socioeconómico medio-bajo de un centro infantil gubernamental en Cuenca, Ecuador. La salud dental, estado nutricional y patrones dietarios se evaluaron mediante exámenes clínicos, mediciones antropométricas y recordatorios de 24 horas, respectivamente. Resultados: La prevalencia de caries de la temprana infancia fue alta (95.8%) mayoritariamente en etapa avanzada (83.1%). No se observaron asociaciones con el estado nutricional. El consumo diario de alimentos cariogénicos fue significativamente mayor entre semana (11,1 ± 1,4) (p<0,001). La dieta fue categorizada como de bajo riesgo cariogénico (<34). La edad del niño (OR=1.1; IC 95%: 1.041, 1.160, p=0.001) y el índice de placa (OR=4.9; IC 95%: 1.331, 17.82; p=0.017) fueron determinantes positivos de caries avanzada. Conclusión: El deterioro de la salud dental de esta población se evidenció, empeorando a edades mayores sin asociación con los patrones dietarios.

Introduction. Early childhood caries (ECC) is one of the most common infectious diseases for infants and preschool children. Objective: To evaluate early childhood caries and risk factors associated with dietary practices and nutri- tional status in children of 10-48 months old. Materials and Methods: A cross-sectional study was performed on 142 children of medium-low so- cio-economic status from a governmental child-care center in Cuenca, Ecuador. Dental health, nutritional status and dietary patterns were assessed through clinical examination, anthropometric measurements and 24-hours dietary recalls, respectively. Results: Early childhood caries prevalence was high (95.8%) mostly of advanced stage (83.1%). No as- sociations with nutritional status. Daily consumption of cariogenic foods was significantly higher during weekdays (11.1 ± 1.4) (p<0.001). The diet was categorized as low cariogenic risk (<34). Child's age (OR=1.1; 95% CI: 1.041, 1.160, p=0.001) and the plaque index (OR=4.9; 95% CI: 1.331, 17.82; p=0.017) were positive determinants for advanced caries. Conclusions: The deteriorated dental health of this population was evidenced, being worse at older ages without any association with dietary patterns.

Introdução. A cárie da primeira infância (CPI) é uma das enfermidades infecciosas mais comuns em crianças pre-escolares. Objetivo: Avaliar a cárie da primeira infância e fatores de risco associados com práticas dietárias e estado nutricional de crianças de 10-48 meses. Materiais e métodos. Realizou-se um estudo transversal em 142 crianças de nível socioeconômico médio-baixo do centro infantil governamental em Cuenca, Equador. A saúde dental, estado nutricio- nal e patroes dietários se avaliaram mediante exames clínicos, medições antropométricas e lembretes de 24 horas respectivamente. Resultados: A prevalência de cárie da primeira infância foi alta (95.8%) principalmente em estágio avançado (83.1%). Não se observaram relações com o estado nutricional. O consumo diário de ali- mentos cariogênicos foi significativamente maior entre semana (11,1 ± 1,4) (p<0,001). A dieta foi categorizada como de baixo risco cariogênico (<34). A idade das crianças (OR=1.1; IC 95%: 1.041, 1.160, p=0.001) e o índice de placa (OR=4.9; IC 95%: 1.331, 17.82; p=0.017) foi determinante em cárie avançada positiva. Conclusão: O deterioro da saúde dental dessa população se evidenciou, piorando as idades mais velhas sem relação com os patroes dietários.

Effects of Norspermidine on Dual-Species Biofilms Composed of Streptococcus mutans and Streptococcus sanguinis.

The present study aimed at investigating the influence of norspermidine on the formation of dual-species biofilms composed of Streptococcus mutans (S. mutans) and Streptococcus sanguinis (S. sanguinis). Crystal violet assay was conducted to assess the formation of single-species biofilms of S. mutans and S. sanguinis, and the growth curve was carefully observed to monitor the growth of these two species of bacteria. Fluorescence in situ hybridization (FISH) and MTT array were used to analyze the composition and metabolic activity of the dual-species biofilms, respectively. Extracellular polysaccharides (EPS)/bacteria staining, anthrone method, and scanning electron microscopy (SEM) imaging were conducted to study the synthesis of EPS by dual-species biofilms. Lactic acid assay and pH were measured to detect dual-species biofilm acid production. We found that norspermidine had different effects on S. mutans and S. sanguinis including their growth and biofilm formation. Norspermidine regulated the composition of the dual-species biofilms, decreased the ratio of S. mutans in dual-species biofilms, and reduced the metabolic activity, EPS synthesis, and acid production of dual-species biofilms. Norspermidine regulated dual-species biofilms in an ecological way, suggesting that it may be a potent reagent for controlling dental biofilms and managing dental caries.

Surface morphologic evaluation of orthodontic bonding systems under conditions of cariogenic challenge.

Orthodontic bonding systems are submitted to demineralization and remineralization dynamics that might compromise their surface smoothness, and favor biofilm aggregation and caries development. The aim of the present study was to evaluate the effects of a cariogenic challenge model (in vitro pH-cycling model) on the surface roughness and topography of 3 bonding materials: Transbond™ XT (XT), Transbond™ Plus Color Change (PLUS) and Fuji Ortho™ LC (FUJI), by means of Atomic Force Microscopy (AFM). Six specimens with standardized dimensions and surface smoothness were fabricated per group, and the materials were manipulated in accordance with the manufacturers' instructions. No polishing was necessary. AFM tests were performed before and after pH-cycling, taking 3 readouts per specimen. The roughness results (Ra) were obtained at nanometric levels (nm) and surface records were acquired in two- and three-dimensional images of height and lock-in phase of the material components. The surfaces of all groups analyzed in the study were morphologically altered, presenting images suggestive of matrix degradation and loss of matrix-load integrity. FUJI presented the greatest increase in surface roughness, followed by XT and PLUS, respectively (p≤0.001). Nevertheless, the roughness values found did not present sufficient degradation to harbor bacteria. The surface roughness of all tested materials was increased by pH-cycling. The use of materials capable of resisting degradation in the oral environment is recommended, in order to conserve their integrity and of the surrounding tissues.

Cariogenic Potential of Infant Formulas-An In Vitro Study.

Objectives: To compare the in vitro cariogenic potential of two infant formulas (IF, for ages 6-12 months) processed with sterile distilled water with or without 1 ppm fluoride. Study design: Nine specimens in each water type were inoculated with Streptococcus mutans (SM) suspension. The specimens were then divided into one group of samples cultured immediately on Mitis salivarius (MS) agar plates (T0) and another group of specimens cultured on MS agar plates after incubation at 37°C for 4 hours in anaerobic conditions (T4). Six-fold dilutions of each sample were incubated for 48 hours, and colony-forming units (CFUs) of SM were numerated. The pH changes associated with bacterial fermentation of each of the suspensions were measured at T0 and at T4 following incubation. Results: The pH was lower at T4 than at T0 in both IF. The SM colonies increased significantly at T4 compared to T0 in both IF (P < 0.001). There was no significant difference between the CFUs of the mediums at T0 and T4 or relation between SM colonies of IF based on fluoridated and non-fluoridated distilled water. Conclusion: The cariogenic potential was not significantly different between two IF prepared with fluoridated or non-fluoridated distilled water.

Effect of Sweeteners on Root Dentine Demineralization Using a Microcosm Biofilm Model / Efecto de los Edulcorantes en la Desmineralización de la Dentina Radicular Utilizando un Modelo de Biofilm Microcosmo

ABSTRACT: The aim of the present study was to evaluate the effect of commercial sweeteners on root dentin demineralization using a microcosm biofilm model. Bovine dentin specimens with pre-determined surface hardness were randomized into six groups according to the studied sweeteners: sucralose, stevia, saccharin, aspartame. Sucrose was used as a positive control and an untreated group as a negative control. The specimens were submitted to biofilm development from one saliva donor and the cariogenic challenge occurred on subsequent five days, twice a day. At the end, the percentage of surface hardness loss (%SHL) and biomass was determined and submitted to ANOVA followed by Tukey's test. Sucrose presented the highest rate of demineralization, however, all sweeteners tested lead to a statistically higher root demineralization compared to the negative control (p <0.05). Sucrose caused greater demineralization in root dentin, however, the sweeteners were also able to induce it under this biofilm model.

RESUMEN: El objetivo del presente estudio fue evaluar el efecto de los edulcorantes comerciales en la desmineralización de la dentina radicular utilizando un modelo de biofilm microcosmo. Se asignaron al azar muestras de dentina bovina con una dureza de la superficie predeterminada de acuerdo con los edulcorantes estudiados: sucralosa, estevia, sacarina, aspartame. La sacarosa se utilizó como control positivo y un grupo no tratado como control negativo. Las muestras se enviaron al desarrollo de biopelículas de un donante de saliva y el desafío cariogénico se produjo en los siguientes cinco días, dos veces al día. Al final, se determinó el porcentaje de pérdida de dureza de la superficie (% PDS) y biomasa y se aplicó un estudio estadístico de ANOVA seguido de la prueba de Tukey. La sacarosa presentó la mayor tasa de desmineralización; sin embargo, todos los endulzantes probados condujeron a una desmineralización de la raíz estadísticamente mayor en comparación con el control negativo (p<0,05). La sacarosa causó una mayor desmineralización en la dentina de raíz, sin embargo, los edulcorantes también fueron capaces de inducirla bajo este modelo de biofilm.

Surface morphologic evaluation of orthodontic bonding systems under conditions of cariogenic challenge

Abstract: Orthodontic bonding systems are submitted to demineralization and remineralization dynamics that might compromise their surface smoothness, and favor biofilm aggregation and caries development. The aim of the present study was to evaluate the effects of a cariogenic challenge model (in vitro pH-cycling model) on the surface roughness and topography of 3 bonding materials: Transbond™ XT (XT), Transbond™ Plus Color Change (PLUS) and Fuji Ortho™ LC (FUJI), by means of Atomic Force Microscopy (AFM). Six specimens with standardized dimensions and surface smoothness were fabricated per group, and the materials were manipulated in accordance with the manufacturers' instructions. No polishing was necessary. AFM tests were performed before and after pH-cycling, taking 3 readouts per specimen. The roughness results (Ra) were obtained at nanometric levels (nm) and surface records were acquired in two- and three-dimensional images of height and lock-in phase of the material components. The surfaces of all groups analyzed in the study were morphologically altered, presenting images suggestive of matrix degradation and loss of matrix-load integrity. FUJI presented the greatest increase in surface roughness, followed by XT and PLUS, respectively (p≤0.001). Nevertheless, the roughness values found did not present sufficient degradation to harbor bacteria. The surface roughness of all tested materials was increased by pH-cycling. The use of materials capable of resisting degradation in the oral environment is recommended, in order to conserve their integrity and of the surrounding tissues.

Avaliação in vitro do potencial erosivo e cariogênico de antifúngicos tópicos / In vitro evaluation of erosive and cariogenic potential of topical antifungal agents

Introdução: a candidíase é uma infecção fúngica oportunista, causada pela proliferação e disseminação de espécies de Candida, que pode acometer a cavidade oral. Dentre os antifúngicos mais utilizados e de uso tópico, a nistatina é considerada o medicamento de primeira escolha. Objetivo: avaliar as propriedades físico-químicas de diferentes marcas de nistatina disponíveis no mercado, incluindo o pH, a acidez total titulável (ATT) e a determinação de sólidos solúveis totais (SST). Metodologia: trata-se de um estudo experimental in vitro, constituído por uma amostra de oito diferentes marcas de nistatina em suspensão oral de uso tópico. Foi analisado o potencial erosivo e cariogênico dessas soluções mediante a determinação de pH, ATT e SST (°Brix). Resultados: no tocante ao pH, verificou-se que a média obtida foi de 6,05 (± 0,66). Dois dos medicamentos analisados (marcas A e H) apresentaram pH abaixo do crítico para a dissolução do esmalte dental. Quanto à ATT das soluções, os valores variaram de 1,9 a 14,53 mL para atingir o pH neutro, indicando que as marcas B, C e E podem levar mais tempo para ser neutralizadas em razão da quantidade de solução necessária. A análise do °Brix revelou que a marca H apresentou o maior teor de açúcares em sua composição (44,9%). Conclusão: a formulação de nistatina da marca H apresentou pH endógeno mais crítico e percentual de sólidos solúveis totais elevado, sendo, portanto, a medicação com maior fator de risco para o desenvolvimento de cárie e erosão dentária, devendo ser consideradas as doses e frequências de uso, bem como os hábitos de higiene oral do paciente

Introduction: candidiasis is an opportunistic fungal infection caused by the proliferation and spread of Candida species that can affect the oral cavity. Among the most commonly used topical antifungal agents, nystatin is considered the first choice drug. Methodology: to evaluate the physical and chemical properties of different brands of nystatin available in the market, including pH, titratable acidity and determination of total soluble solids. Results: Regarding pH, it was verified that the mean obtained was 6.05 (± 0.66). Two of the analyzed drugs (A and H) presented pH below that considered critical for the dissolution of dental enamel. As for the titratable total acidity of the solutions, values ranged from 1.9 to 14.53 mL to reach neutral pH, indicating that the B, C and E marks may take longer to neutralize because of the amount of solution required. The analysis of ° Brix revealed that the H mark had the highest sugar content in its composition (44.9%). Conclusion: Nystatin brand H presented the worst indices in terms of endogenous pH and total sugar percentage, being therefore the medication with the highest risk factor for the development of caries and dental erosion.

Avaliação in vitro do potencial cariogênico e erosivo de corticosteroide de uso tópico / In vitro evaluation of cariogenic and erosive potential of topic corticosteroid

Introdução: o tratamento com bochechos de dexametasona elixir é bastante descrito na literatura para casos de lesões erosivas e ulceradas em mucosa bucal. Excipientes acrescentados aos medicamentos os tornam mais palatáveis e estáveis, embora possam resultar em efeitos adversos que comprometem a saúde bucal. Objetivo: este estudo propôs-se a avaliar, in vitro, o pH, a acidez total titulável (ATT) e o teor de sólidos solúveis totais (SST) de diferentes marcas de dexametasona elixir disponíveis no mercado da cidade de Salvador, correlacionando-os ao potencial erosivo e cariogênico do medicamento para os dentes. Metodologia: seis marcas (A, B, C, D, E e F) de laboratórios distintos foram incluídas neste estudo. O valor do pH foi aferido utilizando-se pHmetro e agitador magnético; a ATT foi determinada adicionando-se hidróxido de sódio (NaOH) 0,1 N e a aferição do SST foi através de refratômetro. Os dados foram expressos em valores médios e desvios padrão. Resultados: o pH de todas as marcas investigadas apresentou medidas abaixo de 5,5, logo, todas apresentaram potencial erosivo. Na avaliação da ATT, maior volume de NaOH 0,1N foi necessário pela marca D para alcançar pH 5,5 e 7,0. Dentre as marcas investigadas, a marca B foi a que apresentou maior teor de SST em sua composição. Conclusão: soluções para uso local de dexametasona elixir possuem potencial erosivo e alto teor de SST, tornando-se, então, importante a orientação de instrução de higiene oral dos pacientes que possuem maior risco de desenvolver alterações dentárias.

Introduction: treatment with mouthwash dexamethasone elixir is sufficiently described in the literature for cases of erosive and ulcerated lesions in oral mucosa. Excipients added to drugs make them more palatable and stable, however, may result in adverse effects that compromise the health of the oral cavity. Aim: this study sets out to evaluate in vitro pH, titratable total acidity (TTA) and the total soluble solids content (TSS) of different brands of dexamethasone elixir available on the market of Salvador city, correlating them to the potential of cariogenic and erosive medicine for the dental units. Methodology: six distinct laboratories brands (A, B, C, D, E and F) were included in this study. The pH value was assessed using a pH meter and magnetic stirrer, the TTA was determined by adding sodium hydroxide (NaOH) 0.1 N and measurement of TSS was made with refractometer. The data were expressed as average and standard deviations. Results: the pH of all brands investigated presented measures below 5.5, so, all presented erosive potential. In TTA, greater volume of NaOH 0, 1N was required by D brand to achieve pH 5.5 and 7.0. Among the brands investigated, brand B was the one that presented the highest content of TSS in its composition. Conclusion: solutions for local use of dexamethasone elixir have erosive potential and high content of TSS, becoming so important the guidance of oral hygiene instruction of patients who have higher risk of developing dental changes

The role of human milk and sucrose on cariogenicity of microcosm biofilms.

This study investigated the effect of human milk, alone and associated with sucrose, in the cariogenicity of biofilms in a microcosm biofilm model and compared with the cariogenicity of sucrose and bovine milk. Microcosm biofilms were grown in enamel discs in 24-well plates. Six growth conditions were studied: DMM (chemically defined artificial saliva - negative control), DMM with 1% of sucrose (DMM+s) (positive control), human milk with DMM, human milk with DMM+s, bovine milk with DMM, and bovine milk with DMM+s. After 5 days, the outcome variables surface hardness change (%SHC), microbiological composition of biofilms, and pH of supernatant were analyzed. All groups had significantly lower hardness loss compared to the DMM group with 1% of sucrose. Human and bovine milk associated with sucrose showed higher hardness loss. The supernatant pH values after 6 hours of different treatments were similar for the groups sucrose and human milk associated with sucrose (p>0.05). After 18 hours at rest in pure DMM, an increase in the pH of the supernatant was observed. Higher values of total microorganisms count were found for sucrose and bovine milk groups compared to the group supplemented only by DMM. Bovine milk group showed greater amount of total aciduric microorganisms in comparison to human milk group. Within the limits of this study, it can be infered that both human and cow milks have some cariogenic potential, although differing from sucrose in terms of mineral loss.

Effects of Antimicrobial Peptide GH12 on the Cariogenic Properties and Composition of a Cariogenic Multispecies Biofilm.

Dental caries is a biofilm-mediated disease that occurs when acidogenic/aciduric bacteria obtain an ecological advantage over commensal species. In previous studies, the effects of the antimicrobial peptide GH12 on planktonic bacteria and monospecies biofilms were confirmed. The objectives of this study were to investigate the effects of GH12 on a cariogenic multispecies biofilm and to preliminarily explain the mechanism. In this biofilm model, Streptococcus mutans ATCC 70061 was the representative of cariogenic bacteria, while Streptococcus gordonii ATCC 35105 and Streptococcus sanguinis JCM 5708 were selected as healthy microbiota. The results showed that GH12 was more effective in suppressing S. mutans than the other two species, with lower MIC and minimal bactericidal concentration (MBC) values among diverse type strains and clinical isolated strains. Therefore, GH12, at no more than 8 mg/liter, was used to selectively suppress S. mutans in the multispecies biofilm. GH12 at 4 mg/liter and 8 mg/liter reduced the cariogenic properties of the multispecies biofilm in biofilm formation, glucan synthesis, and lactic acid production. In addition, GH12 suppressed S. mutans within the multispecies biofilm and changed the bacterial composition. Furthermore, 8 mg/liter GH12 showed a selective bactericidal impact on S. mutans, and GH12 promoted hydrogen peroxide production in S. sanguinis and S. gordonii, which improved their ecological advantages. In conclusion, GH12 inhibited the cariogenic properties and changed the composition of the multispecies biofilm through a two-part mechanism by which GH12 directly suppressed the growth of S. mutans as well as enhanced the ecological competitiveness of S. sanguinis and S. gordoniiIMPORTANCE Dental caries is one of the most prevalent chronic infectious diseases worldwide, with substantial economic and quality-of-life impacts. Streptococcus mutans has been considered the principal pathogen of dental caries. To combat dental caries, an antimicrobial peptide, GH12, was designed, and its antibacterial effects on planktonic S. mutans and the monospecies biofilm were confirmed. As etiological concepts of dental caries evolved to include microecosystems, the homeostasis between pathogenic and commensal bacteria and a selective action on cariogenic virulence have increasingly become the focus. The novelty of this research was to study the effects of the antimicrobial peptides on a controlled cariogenic multispecies biofilm model. Notably, the role of an antimicrobial agent in regulating interspecific competition and composition shifts within this multispecies biofilm was investigated. With promising antibacterial and antibiofilm properties, the use of GH12 might be of importance in preventing and controlling caries and other dental infections.