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1.
Medicine (Baltimore) ; 99(41): e22508, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031289

RESUMO

RATIONALE: Vitamin D-dependent rickets type I (VDDR-I) is a rare form of rickets, which is an autosomal recessive disease caused by 1α-hydroxylase enzyme deficiency. However, long-term dental management and microscopic morphology of teeth remain largely unclear. PATIENT CONCERNS: We report the case of a 10-year-old Chinese boy complaining of yellowish-brown teeth with extensive caries. DIAGNOSES: Clinical and laboratory examinations were performed, and VDDR-I was confirmed. Scanning electron microscopy confirmed amelogenesis imperfecta. INTERVENTIONS: The patient had been taking drugs intervention for VDDR-I from the age of 3 years. The decayed teeth were treated, and metal-preformed crowns were placed to prevent further impairment. Sequence tooth extraction and remineralization therapy were also performed. OUTCOMES: After 3 years of follow-up, the patient exhibited normal tooth replacement and an acceptable oral hygiene status. However, the new erupted teeth had amelogenesis imperfecta. LESSONS: This case is the first to confirm amelogenesis imperfecta in a patient with VDDR-I that was not prevented by drug intervention. Importantly, it provides evidence that long-term dental intervention in patients with VDDR-I can result in an acceptable oral hygiene status. Therefore, early and long-term dental intervention is necessary in VDDR-I patients.


Assuntos
Amelogênese Imperfeita/terapia , Cárie Dentária/terapia , Raquitismo Hipofosfatêmico Familiar/complicações , Amelogênese Imperfeita/etiologia , Criança , Coroas , Cárie Dentária/etiologia , Restauração Dentária Permanente , Humanos , Masculino , Higiene Bucal , Extração Seriada
2.
Periodontol 2000 ; 84(1): 69-83, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32844424

RESUMO

As a result of aging populations, in the future, dental practitioners will be caring for more older adults than ever before. These older adults, especially in developed countries, will demand a greater number of dental services, driven by increased tooth retention and an expectation of excellent oral healthcare throughout the life course. Further, the global rise in the prevalence and incidence of chronic diseases will increase the risk and/or severity of oral diseases and add a layer of complexity to the management of oral diseases in older adults. More older adults will be at a higher risk of periodontal disease and root caries as a result of reduced tooth loss and edentulism. This article reviews information on periodontitis and root caries, oral diseases which reflect the cumulative risk of the individual, and which are best addressed through prevention. Oral healthcare providers must embrace the concept of lifelong emphasis on prevention, as well as participation as active members of a healthcare team which provides healthcare for older adults in various settings (eg, hospital/clinic-based care, community-based settings, and long-term care facilities). National guidelines that address oral health are being considered by some countries, and if these are implemented they will increase the accessibility to oral health for older adults. In parallel to this, revisions of existing older adult insurance schemes (eg, the inclusion of routine oral healthcare in the US Medicare program) would promote the maintenance of a functional dentition that is pain-free and conducive to general health. The opportunity exists to implement a holistic approach to oral health that will align oral health with general health and emphasize that true health can only be achieved with the inclusion of oral health.


Assuntos
Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Cárie Dentária/terapia , Doenças Periodontais/epidemiologia , Doenças Periodontais/prevenção & controle , Doenças Periodontais/terapia , Idoso , Odontólogos , Humanos , Medicare , Saúde Bucal , Papel Profissional , Estados Unidos
3.
J Oral Sci ; 62(4): 427-429, 2020 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-32830164

RESUMO

This study examined the effectiveness of resin infiltration in inhibiting microleakage from artificial white-spot lesions (AWL) in enamel. Fifty sound extracted premolars were selected and randomly divided into five groups (n = 10 each). Group 1 included sound teeth. In contrast, an AWL was created in all specimens in groups 2 to 5, as follows-Group 2: AWL with no treatment; Group 3: AWL treated with resin infiltration; Group 4: AWL treated with resin infiltration and 5,000 cycles of thermocycling; Group 5: AWL treated with resin infiltration and 10,000 cycles of thermocycling. All specimens were then coated with nail varnish, except for a 4 × 4 mm2 area on the buccal surface (the measurement area), immersed in 2% methylene blue solution, and sectioned buccolingually. Microleakage was evaluated with a stereomicroscope. Data were analyzed by using the Kruskal-Wallis test and Bonferroni post-hoc correction. Application of resin infiltrant reduced microleakage in AWL. No microleakage was seen in Group 3, and differences between Groups 3, 4, and 5 were not significant (P > 0.05). The resin infiltration technique appears to aid in sealing enamel AWL and may help provide long-term protection against microleakage in enamel AWL.


Assuntos
Cárie Dentária/terapia , Infiltração Dentária , Dente Pré-Molar , Resinas Compostas , Esmalte Dentário , Humanos
4.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(8): 551-554, 2020 Aug 09.
Artigo em Chinês | MEDLINE | ID: mdl-32842346

RESUMO

Deciduous caries and abnormal tooth development are common children's oral diseases which seriously harm the health of deciduous dentition, hinder the absorption of nutrients and affect the general growth and development. Caries of deciduous teeth progresses rapidly and can develop into rampant caries and other hard tissue diseases in a short time. The metal prefabricated crown is a stainless steel restoration for the treatment and repair of severe dental tissue damage in children. Its repair technique has certain operating procedures, requires specific equipments and materials, needs qualified dental clinicians to complete. The Society of Pediatric Dentistry, Chinese Stomatological Association organized experts to formulate the guideline of the clinical operation stainless steel crown restoration, so as to standardize the application of stainless steel crowns in the molar repair treatment of deciduous teeth such as caries in children and to further promote the application of the technique.


Assuntos
Cárie Dentária/terapia , Dente Decíduo , Criança , Coroas , Restauração Dentária Permanente , Humanos , Aço Inoxidável
5.
West Afr J Med ; 37(3): 253-259, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32476119

RESUMO

BACKGROUND: Stainless steel crown (SSC) restoration is one of the restorative treatment options in the management of carious primary molars. The Hall technique is a biologic method of managing carious primary teeth by sealing in the caries with SSCs without the routine local anaesthesia and tooth preparations. The objectives of this study was to compare the treatment assessments of the conventional stainless steel crown restoration with Hall technique using subjects' discomfort during treatments and parents' treatment perception, treatment acceptability and satisfaction with the treatment. METHODS: The study was a comparative analytical study involving the placement of 25 SSC restorations using the conventional method and 25 SSC restorations using the Hall technique in 25 subjects aged 3-8 years with a pair or pairs of unrestored enamel or dentinal carious primary molars matched for tooth type, dental arch and extent of caries. Discomfort during the placements of the SSCs was assessed by the subjects while treatment perception, acceptability and satisfaction were assessed by the parents with the use of questionnaires. RESULTS: There was statistically significant difference (p-value 0.00001) between the conventional method and the Hall technique for the discomfort outcomes. There was no statistically significant difference for treatment perception (p=0.73), acceptability (0.72) and satisfaction (0.60). CONCLUSION: The Hall Technique compared favourably well with the conventional method in treatment perception, acceptability and satisfaction but it gave higher level of discomfort in some of the subjects. The Hall Technique appears to be a good method for managing dental caries in primary molar teeth especially in a resource challenged environment where electricity and access to care are contending issues.


Assuntos
Coroas , Assistência Odontológica para Crianças/métodos , Cárie Dentária/terapia , Restauração Dentária Permanente/métodos , Cimentos de Resina/uso terapêutico , Aço Inoxidável , Criança , Pré-Escolar , Ligas Dentárias , Humanos , Dente Molar/patologia , Dente Decíduo/patologia , Resultado do Tratamento
6.
Artigo em Inglês | MEDLINE | ID: mdl-32575448

RESUMO

BACKGROUND: The effect of untreated dental caries and their treatment under general anesthesia (GA) on the quality of life, growth, and blood chemistry parameters in uncooperative pediatric patients has not been extensively elucidated. The aims are to evaluate the impact of dental treatment under GA on oral health-related quality of life (OHRQoL) in uncooperative pediatric patients with severe dental caries and to assess the effect of dental treatment under GA on children's weight (Wt), height (Ht), Body Mass Index (BMI), and blood chemistry parameters. METHODS: Forty-three uncooperative children aged 3-14 years were selected. OHRQoL, through ECOHIS (Early Childhood Oral Health Impact Scale) and COHRQoL (Child Oral Health-Related Quality of Life) questionnaires, Wt, Ht, BMI, and blood chemistry parameters were measured at baseline and eight months after dental treatment under GA. RESULTS: At follow up, the reductions in the ECHOIS and the COHRQoL components were statistically significant (p < 0.0001), there was significant improvement in the anthropometric measures: 76.5% of children increased the percentile curves for weight, 68.6% for height, and 51.4% for BMI; for the blood chemistry parameters: ferritin improved in 68.6% of the samples, PCR in 65.7%, ESR in 68.6%, Vitamin D in 68.6%, and IGF-1 in 65.7%. CONCLUSIONS: Oral health status significantly influences OHRQoL, growth, and blood chemistry parameters in uncooperative pediatric patients.


Assuntos
Anestesia Geral , Cárie Dentária , Saúde Bucal , Qualidade de Vida , Adolescente , Criança , Pré-Escolar , Cárie Dentária/terapia , Humanos , Projetos Piloto , Inquéritos e Questionários
7.
Eur Arch Paediatr Dent ; 21(5): 543-556, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32557183

RESUMO

PURPOSE: The first aim of this paper is to provide dental professionals caring for children and adolescents during and after the COVID-19 pandemic with a reference to international dental guidelines. The second aim is to suggest minimally invasive treatment alternatives for caries management, minimising the risk of viral cross-infection and offering a safer clinical environment. METHODS: An evidence-based pertinent literature search of different electronic databases was performed in addition to leading global dental authorities, royal colleges, and programmes. RESULTS: All guidelines released in response to COVID-19 centred around minimising Aerosol Generating Procedures (AGP) impacting the provision of regular dental treatment of paediatric patients. There was an emphasis on triaging and only treating emergency and urgent cases. Special attention was given to medically compromised children in the guidelines. Detailed guidelines for the dental environment and equipment were given. This paper also summarised the relevant evidence-based guidelines for the use of non-invasive and minimally invasive caries management techniques. CONCLUSION:  Specific recommendations for dental management of paediatric patients during and in the post-COVID-19 era are suggested. Minimisation of AGP procedures, and case-based selection of biological, non-invasive or minimally invasive methods are recommended.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Cárie Dentária/prevenção & controle , Cárie Dentária/terapia , Pandemias , Odontopediatria , Pneumonia Viral , Guias de Prática Clínica como Assunto , Adolescente , Criança , Humanos
8.
Recurso na Internet em Inglês, Espanhol, Português | LIS - Localizador de Informação em Saúde | ID: lis-47368

RESUMO

Este mapa apresenta uma visão geral das evidências sobre os efeitos da Ozonoterapia Bucal para várias condições clínicas e de saúde das pessoas a partir da caracterização de 15 estudos de revisão, distribuídos graficamente em uma matriz com 6 intervenções em uma série de resultados clínicos agrupados em 9 categorias. A maioria dos estudos concentra-se na intervenção com água ozonizada tópica e mistura gasosa oxigênio-ozônio tópica aplicada no tratamento de cárie, dor, cicatrização e inflamação. Este mapa proporciona una visión general de la evidencia sobre los efectos de la ozonoterapia oral para diversas afecciones clínicas y de salud de las personas a partir de la caracterización de 15 estudios de revisión, distribuidos gráficamente en una matriz con 6 intervenciones en una serie de resultados clínicos agrupados en 9 categorías. La mayoría de los estudios se centran en la intervención con agua ozonizada tópica y una mezcla tópica de gas oxígeno-ozono aplicada en el tratamiento de caries, dolor, cicatrices e inflamación. Investigadores del Centro de Excelencia Prótese Implante de la Facultad de Odontología de la Universidade de São Paulo (FOUSP) fueron colaboradores del mapa. This map displays an overview of the evidence on the effects of oral ozone therapy for various clinical and health conditions from the characterization of 15 review studies, graphically distributed in a matrix with 6 interventions in a series of clinical results grouped in 9 categories. Most studies focus on intervention with topical ozonized water and topical oxygen-ozone gas mixture applied in the treatment of caries, pain, scarring and inflammation. The Map had collaboration of researchers from "Centro de Excelencia Prótese Implante" of the Dentistry Faculty of the University of São Paulo (FOUSP) colaborated in this Map.


Assuntos
Ozônio/uso terapêutico , Medicina Baseada em Evidências/instrumentação , Revisões Sistemáticas como Assunto , Cárie Dentária/terapia , Saúde Bucal/tendências , Resultado do Tratamento
9.
Artigo em Inglês | MEDLINE | ID: covidwho-421883

RESUMO

Pending the availability of vaccines to contain the SARS-CoV-2 pandemic, the current solution is "social distancing" with a reduction of dental treatments to those assessed as urgent and emergency cases. These treatments also involve Early Childhood Caries (ECC) due to the fact that this disease affects preschool children (a vulnerable population) and, in addition, shows a propensity to evolve into more serious complications (dental pain, infections). A narrative review was carried out to support a protocol for treating ECC with efficacious and safe (in terms of SARS-CoV-2 transmission) procedures. Protocol involves criteria for patients' selection remotely (telemedicine), and well-detailed criteria/equipment and hygiene procedures to combat against SARS-CoV-2 transmission. Moreover, the protocol proposes innovative caries treatments, named Minimally Invasive Treatments (MITs), well known in pedodontics for their high level of children's acceptance during dental care. MITs allow for caries removal (particularly in primary teeth) without any high-speed rotating instrument cooled with nebulized air-water spray (with high risk of virus environmental diffusion), usually adopted during traditional treatments. For evaluating MITs effectiveness in caries management, only Systematic Review and Randomized Controlled Trials (RCTs) were included in our study, without any risk of bias assessment. The indications proposed in this protocol could support clinicians for the temporary management of ECC until the SARS-CoV-2 pandemic ends.


Assuntos
Infecções por Coronavirus/epidemiologia , Cárie Dentária/terapia , Pneumonia Viral/epidemiologia , Dente Decíduo , Betacoronavirus , Criança , Pré-Escolar , Protocolos Clínicos , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Pneumonia Viral/transmissão , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
10.
Artigo em Inglês | MEDLINE | ID: mdl-32466392

RESUMO

Pending the availability of vaccines to contain the SARS-CoV-2 pandemic, the current solution is "social distancing" with a reduction of dental treatments to those assessed as urgent and emergency cases. These treatments also involve Early Childhood Caries (ECC) due to the fact that this disease affects preschool children (a vulnerable population) and, in addition, shows a propensity to evolve into more serious complications (dental pain, infections). A narrative review was carried out to support a protocol for treating ECC with efficacious and safe (in terms of SARS-CoV-2 transmission) procedures. Protocol involves criteria for patients' selection remotely (telemedicine), and well-detailed criteria/equipment and hygiene procedures to combat against SARS-CoV-2 transmission. Moreover, the protocol proposes innovative caries treatments, named Minimally Invasive Treatments (MITs), well known in pedodontics for their high level of children's acceptance during dental care. MITs allow for caries removal (particularly in primary teeth) without any high-speed rotating instrument cooled with nebulized air-water spray (with high risk of virus environmental diffusion), usually adopted during traditional treatments. For evaluating MITs effectiveness in caries management, only Systematic Review and Randomized Controlled Trials (RCTs) were included in our study, without any risk of bias assessment. The indications proposed in this protocol could support clinicians for the temporary management of ECC until the SARS-CoV-2 pandemic ends.


Assuntos
Infecções por Coronavirus/epidemiologia , Cárie Dentária/terapia , Pneumonia Viral/epidemiologia , Dente Decíduo , Betacoronavirus , Criança , Pré-Escolar , Protocolos Clínicos , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Pneumonia Viral/transmissão , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
11.
Clin Oral Investig ; 24(5): 1869-1876, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32300980

RESUMO

OBJECTIVES: To assess how to control, detect, and treat secondary caries. This review serves to inform a joint ORCA/EFCD consensus process. METHODS: Systematic and non-systematic reviews were performed or consulted and narratively synthesized. RESULTS: Secondary (or recurrent) caries is defined as a lesion associated with restorations or sealants. While the restorative material itself has some influence on secondary caries, further factors like the presence and size of restoration gaps, patients' caries risk, and the placing dentist's experience seem more relevant. Current detection methods for secondary caries are only sparsely validated and likely prone for the risk of over-detection. In many patients, it might be prudent to prioritize specific detection methods to avoid invasive overtreatment. Detected secondary caries can be managed either by repair of the defective part of the restoration or its complete replacement. CONCLUSIONS: There is sparse data towards the nature of secondary caries and how to control, detect, and treat it. CLINICAL SIGNIFICANCE: Despite often claimed to be a major complication of restorations, there is surprisingly little data on secondary caries. Longer-term studies may be needed to identify differences in secondary caries risk between materials and to identify characteristic features of progressive lesions (i.e., those in need of treatment).


Assuntos
Cárie Dentária/diagnóstico , Cárie Dentária/prevenção & controle , Cárie Dentária/terapia , Restauração Dentária Permanente , Materiais Dentários , Humanos
12.
Clin Oral Investig ; 24(5): 1623-1636, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32306093

RESUMO

OBJECTIVES: For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults". MATERIAL AND METHODS: Separating between the management of initial and cavitated proximal caries lesions, Medline via PubMed was searched regarding non-operative/non-invasive, minimally/micro-invasive and restorative treatment. First priority was systematic reviews or randomized controlled trials (RCTs), otherwise cohort studies. After extraction of data, the potential risk of bias was estimated depending on the study type, and the emerging evidence for conclusions was graded. RESULTS: Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12) with a low level of evidence, NOC like biofilm management and fluoride was associated with a low proportion and slow speed of progression of initial proximal lesions. Minimally/micro-invasive (MI) treatments such as proximal sealants or resin infiltration (four systematic reviews/meta-analyses) were effective compared with a non-invasive/placebo control at a moderate level of evidence. Data on restorative treatment came with low evidence (5 systematic reviews, 13 RCTs); with the limitation of no direct comparative studies, sample size-weighted mean annual failure rates of class II restorations varied between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT, class II composite restorations may show a higher risk of failure compared with amalgam. CONCLUSIONS: Proximal caries lesions can be managed successfully with non-operative, micro-invasive and restorative treatment according to lesion stage and caries activity. CLINICAL RELEVANCE: Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.


Assuntos
Cárie Dentária/prevenção & controle , Cárie Dentária/terapia , Adolescente , Adulto , Biofilmes , Consenso , Materiais Dentários , Restauração Dentária Permanente , Fluoretos/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
13.
Clin Ter ; 171(3): e275-e282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32323718

RESUMO

PURPOSE: To investigate the prevalence of dental caries and periodontal disease in children with ASD, and to analyse the necessity of treatment and the prevalence of using general anaesthesia in order to perform it. MATERIALS AND METHODS: A search was performed covering the last 10 years utilising the following databases: Pubmed, Scopus, Medline, BASE, Science Citation Index, Science Direct, Web of Science. Four reviewers evaluated each study. Review findings were summarised using the PRISMA Statement for reporting. Thirteen articles were included in this systematic review. RESULTS: When analysing the articles selected, the evidence turned out did not show a common DFMT and dmft for the groups of children affected by Autism Spectrum Disorder considered. When compared to group of unaffected children, groups of ASD children not always showed a higher prevalence of caries but always higher Periodontal Indexes (PI and GI), resulting in higher prevalence of periodontal disease. Where the treatment was performed and taken into consideration, there was a high incidence of necessity of General Anaesthesia due to the lack of collaboration of the children. CONCLUSION: The high prevalence of treatment under general anaesthesia and the often-reported negative behaviour evidence how there is a lack of protocols specifically designed for these patients, in order to better improve their collaboration and subsequently their oral health and so additional strategies for a preventive care should be applied for these patients.


Assuntos
Transtorno do Espectro Autista/complicações , Cárie Dentária/epidemiologia , Criança , Pré-Escolar , Cárie Dentária/etiologia , Cárie Dentária/terapia , Humanos , Saúde Bucal , Prevalência
15.
Braz Oral Res ; 34: e017, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130364

RESUMO

Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children's decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.


Assuntos
Tratamento Dentário Restaurador sem Trauma/economia , Cárie Dentária/economia , Cárie Dentária/terapia , Análise de Sistemas , Brasil , Pré-Escolar , Índice CPO , Tratamento Dentário Restaurador sem Trauma/métodos , Materiais Dentários/economia , Feminino , Fluoretos Tópicos/economia , Humanos , Masculino , Software/normas , Fatores de Tempo
16.
BMC Oral Health ; 20(1): 64, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131801

RESUMO

BACKGROUND: The lack of evidence for the effective management of carious lesions in children's primary teeth has caused uncertainty for the dental profession and patients. Possible approaches include conventional and biological management alongside best practice prevention, and best practice prevention alone. The FiCTION trial assessed the effectiveness of these options, and included a qualitative study exploring dental professionals' (DPs) experiences of delivering the different treatment arms. This paper reports on how DPs managed children with carious lesions within FiCTION and how this related to their everyday experiences of doing dentistry. METHODS: Overall, 31 DPs from FiCTION-trained dental surgeries in four regions of the UK participated in semi-structured interviews about their experiences of the three treatment arms (conventional management of carious lesions and prevention (C + P), biological management of carious lesions and prevention (B + P) or prevention alone (PA)). A theoretical framework, drawing on social practice theory (SPT), was developed for analysis. RESULTS: Participants discussed perceived effectiveness of, and familiarity with, the three techniques. The C + P arm was familiar, but some participants questioned the effectiveness of conventional restorations. Attitudes towards the B + P arm varied in terms of familiarity, but once DPs were introduced to the techniques, this was seen as effective. While prevention was familiar, PA was described as ineffective. DPs manage children with carious lesions day-to-day, drawing on previous experience and knowledge of the child to provide what they view as the most appropriate treatment in the best interests of each child. Randomisation undermined these normal choices. Several DPs reported deviating from the trial arms in order to treat a patient in a particular way. Participants valued evidence-based dentistry, and expect to use the results of FiCTION to inform future practice. They anticipate continuing to use the full range of treatment options, and to personally select appropriate strategies for individual children. CONCLUSIONS: RCTs take place in the context of day-to-day practices of doing dentistry. DPs employ experiential and interpersonal knowledge to act in the best interests of their patients. Randomisation within a clinical trial can present a source of tension for DPs, which has implications for assuring individual equipoise in future trials.


Assuntos
Assistentes de Odontologia/psicologia , Assistência Odontológica para Crianças/métodos , Cárie Dentária/terapia , Odontólogos/psicologia , Dente Decíduo/patologia , Adulto , Criança , Cárie Dentária/patologia , Cárie Dentária/prevenção & controle , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Odontopediatria , Pesquisa Qualitativa , Reino Unido
17.
BMC Oral Health ; 20(1): 69, 2020 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164703

RESUMO

BACKGROUND: The Filling Children's Teeth: Indicated Or Not? (FiCTION) randomised controlled trial (RCT) aimed to explore the clinical- and cost-effectiveness of managing dental caries in children's primary teeth. The trial compared three management strategies: conventional caries management with best practice prevention (C + P), biological management with best practice prevention (B + P) and best practice prevention alone (PA)-based approaches. Recently, the concept of treatment acceptability has gained attention and attempts have been made to provide a conceptual definition, however this has mainly focused on adults. Recognising the importance of evaluating the acceptability of interventions in addition to their effectiveness, particularly for multi-component complex interventions, the trial design included a qualitative component. The aim of this component was to explore the acceptability of the three strategies from the perspectives of the child participants and their parents. METHODS: Qualitative exploration, based on the concept of acceptability. Participants were children already taking part in the FiCTION trial and their parents. Children were identified through purposive maximum variation sampling. The sample included children from the three management strategy arms who had been treated and followed up; median (IQR) follow-up was at 33.8 (23.8, 36.7) months. Semi-structured interviews with thirteen child-parent dyads. Interviews were transcribed verbatim and analysed using a framework approach. RESULTS: Data saturation was reached after thirteen interviews. Each child-parent dyad took part in one interview together. The participants were eight girls and five boys aged 5-11 years and their parents. The children's distribution across the trial arms was: C + P n = 4; B + P n = 5; PA n = 4. Three key factors influenced the acceptability of caries management in primary teeth to children and parents: i) experiences of specific procedures within management strategies; ii) experiences of anticipatory dental anxiety and; iii) perceptions of effectiveness (particularly whether pain was reduced). These factors were underpinned by a fourth key factor: the notion of trust in the dental professionals - this was pervasive across all arms. CONCLUSIONS: Overall children and parents found each of the three strategies for the management of dental caries in primary teeth acceptable, with trust in the dental professional playing an important role.


Assuntos
Cárie Dentária , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Criança , Pré-Escolar , Assistência Odontológica , Cárie Dentária/prevenção & controle , Cárie Dentária/terapia , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Dente Decíduo
18.
BMC Oral Health ; 20(1): 75, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183770

RESUMO

BACKGROUND: Early childhood caries (ECC) affects millions of children up to 6 years old. Its treatment positively impacts the quality of life of children and their families. However, there is no consensus on how to treat ECC. Thus, we performed a scoping review to identify the recommended procedures for the management of ECC lesions. METHODS: A search was performed in PubMed, Scopus, The Cochrane Library, The International Guideline Library and pediatric dentistry associations around the world were contacted by email for unpublished search documents. ECC guidelines/guidance/policies were considered eligible regardless of language and publication date. RESULTS: From a total of 828 references, 52 full-text articles were assessed for eligibility and 22 included in the scoping review. We found different procedures recommendations for the management of ECC lesions. For incipient lesions, minimally invasive methods such as professional fluoride and cariostatic (silver diamine) applications, as well as surveillance were recommended. If restoration was required, the recommended materials were glass ionomer cement, composite resin, amalgam and stainless-steel crown. Interim restorations and Atraumatic Restorative Treatment (ART) were also recommended. Extractions have been suggested for teeth with lesions with pulpal involvement, depending on the child's behaviour and other clinical conditions. CONCLUSIONS: Non-operative procedures, restorative and extraction were recommended for the management of ECC, depending on the extent of the lesions. There is no difference between different management guidelines/guidance/policies for ECC lesions.


Assuntos
Ansiedade ao Tratamento Odontológico/psicologia , Tratamento Dentário Restaurador sem Trauma , Cárie Dentária/terapia , Cimentos de Ionômeros de Vidro/uso terapêutico , Guias de Prática Clínica como Assunto , Criança , Pré-Escolar , Cárie Dentária/psicologia , Restauração Dentária Permanente , Humanos , Qualidade de Vida
19.
Health Qual Life Outcomes ; 18(1): 43, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32093749

RESUMO

BACKGROUND: The oral health of Indigenous children in remote communities is much worse than other population groups in Australia. Providing and maintaining an oral health service is challenging due to the remoteness of communities, the associated high cost, and the low retention of clinical staff. An annual preventive intervention delivered by fly-in clinicians may be a more cost-effective way to manage this problem. In this analysis we estimate the cost-effectiveness of an annual professional intervention for the prevention of dental caries in children of a remote Indigenous community in Far North Queensland. METHODS: A cost-effectiveness analysis was conducted based on an annual preventive intervention protocol. This included treating all dental decay in those with disease, applying fissure sealants, a disinfectant swab, fluoride varnish and providing oral hygiene instructions and dietary advice to all participating school children. This study included an intervention group and a natural comparison group and both groups were followed-up for 2 years after the initial preventive intervention. A Markov model was built to assess the cost-effectiveness of the intervention compared with the usual care. Costs of treatment from the Queensland Department of Health were used and effectiveness was measured as quality-adjusted life years (QALYs) with the CHU-9D. One-way and probabilistic sensitivity analyses were conducted to identify key drivers and quantify uncertainty. RESULTS: The preventive intervention was found to be highly cost-effective. The incremental cost per QALY gained was AU$3747. Probability of new caries and seeking treatment were identified as the main drivers of the model. In probabilistic sensitivity analysis intervention was cost effective in 100% of simulations. CONCLUSION: An annual preventive intervention for remote Indigenous communities in Australia is a highly cost-effective strategy to prevent dental caries and improve the quality of life of children.


Assuntos
Cárie Dentária/terapia , Serviços de Saúde do Indígena/economia , Saúde Bucal/economia , Anos de Vida Ajustados por Qualidade de Vida , Estudos de Casos e Controles , Criança , Análise Custo-Benefício , Cárie Dentária/epidemiologia , Feminino , Humanos , Masculino , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Queensland
20.
Medicine (Baltimore) ; 99(7): e19092, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049814

RESUMO

To determine the treatment needs and the care index for dental caries in the primary dentition and permanent dentition of schoolchildren and to quantify the cost of care that would represent the treatment of dental caries in Mexico.A secondary analysis of data from the First National Caries Survey was conducted, which was a cross-sectional study conducted in the 32 states of Mexico. Based on dmft (average number of decayed, extracted, and filled teeth in the primary dentition) and DMFT (average number of decayed, extracted, and filled teeth in permanent dentition) information, a treatment needs index (TNI) and a caries care index (CI) were calculated.At age 6, the TNI for the primary dentition ranged from 81.7% to 99.5% and the CI ranged from 0.5% to 17.6%. In the permanent dentition, the TNI ranged from 58.8% to 100%, and the CI ranged from 0.0% to 41.2%. At age 12, the TNI ranged from 55.4% to 93.4%, and the CI ranged from 6.5% to 43.4%. At age 15, the TNI ranged from 50.4% to 98.4%, and the CI ranged from 1.4% to 48.3%. The total cost of treatment at 6 years of age was estimated to range from a purchasing power parity (PPP) of USD $49.1 to 287.7 million in the primary dentition, and from a PPP of USD $3.7 to 24 million in the permanent dentition. For the treatment of the permanent dentition of 12-year-olds, the PPP ranged from USD $13.3 to 85.4 million. The estimated cost of treatment of the permanent dentition of the 15-year-olds ranged from a PPP of USD $10.9 to 70.3 million. The total estimated cost of caries treatment ranged from a PPP of USD $77.1 to 499.6 million, depending on the type of treatment and provider (public or private).High percentages of TNI for dental caries and low CI values were observed. The estimated costs associated with the treatment for caries have an impact because they represent a considerable percentage of the total health expenditure in Mexico.


Assuntos
Cárie Dentária/epidemiologia , Cárie Dentária/terapia , Adolescente , Criança , Custos e Análise de Custo , Estudos Transversais , Índice CPO , Cárie Dentária/economia , Feminino , Humanos , Masculino , México/epidemiologia , Prevalência
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