Oral rehabilitation in pediatric dentistry: a clinical case report / Reabilitação bucal em Odontopediatria: relato de caso clínico

ABSTRACT Despite the emphasis and effort devoted to preventive dentistry, massive coronal destruction caused by dental caries or trauma is still seen in pediatric dentistry practice today. The technical difficulties related to dental treatment are compounded by problems related to the behavior of young patients in these circumstances, which brings the need for a broader understanding of behavior management techniques and certain skills in dealing with patients by dental practitioners, aimed at ensuring the well-being of both patient and dentist during treatment. This case report presents and discusses the scientific rationale for the treatment options adopted, considering the techniques and materials already established for aesthetic rehabilitation of adult patients (such as resins, glass-fiber posts, and glass ionomers), and now employed and adapted for pediatric dental care, that would best suit the clinical situation described. At the end of treatment, the patient achieved full rehabilitation and a restored smile, through the use of modern techniques and materials, while the dental practitioner gained a better understanding of the optimal treatment possibilities and strategies for similar cases.

RESUMO Apesar da ênfase e esforço dedicados à Odontologia preventiva, as grandes destruições coronárias causadas por cárie ou traumatismos dentários ainda são hoje problemas que ocorrem na prática clínica da odontopediatria. Além das dificuldades técnicas relacionadas a tais tratamentos, soma-se a isso, os problemas inerentes ao controle da conduta de um paciente muito jovem, o que traz a necessidade de um maior conhecimento de técnicas de manejo comportamental e uma habilidade no trato odontológico por parte do profissional, visando o bem-estar de ambos nestas circunstâncias. O relato de caso a seguir tem como objetivo apresentar e discutir o embasamento científico da opção de tratamento adotada, considerando os materiais, pinos de fibra de vidro, ionômeros de vidro, resinas, e as técnicas disponíveis atualmente, ou seja, procedimentos já consagrados na reabilitação estética em adultos, agora aplicados e adaptados à odontologia de bebês, e que melhor solucionariam a situação clínica descrita, visando sua aplicabilidade em clínica. Ao final obtemos um paciente reabilitado, gozando de um tratamento com técnicas e materiais bastante modernos, com seu sorriso restabelecido, e um profissional informado das possibilidades e técnicas mais adequadas para o tratamento de pacientes em situações semelhantes.

A Two-Year Clinical Evaluation of Fluoride and Non-Fluoride Resin-Based Pit-and-Fissure Sealants

The aim of this study was to evaluate and compare for 24 months, the retention and surface characteristics of two pit-and-fissure sealants: Helioseal Clear and Helioseal F (Ivoclar Vivadent). The correlation between the different stages of eruption and sealant retention was also verified. Fifty children aged 6 to 8 years participated in the study, totalizing 153 teeth divided into two groups: HC (Helioseal Clear) and HF (Helioseal F). After 6, 12, 18 and 24 months, a clinical examination was performed by previously calibrated examiners. The surface characteristics and the retention of the sealants (modified RYGE & SNYDER criteria) were assessed. Analyzing the occlusal surface, HC exhibited a statistically significant higher retention at 12 (p=0.0345) and 24 months (p=0.0076). Concerning the surface characteristics, only the superficial discoloration of HC was smaller than HF, during the entire studied period. For all the other characteristics, the results of the Mann-Whitney test were highly significant at different periods (p=0.0000 to 0.0421). The frequency of air bubbles within the sealant surfaces, determined by Chi-square test, was significantly higher in HF (p=0.000:12 and 18 months to p=0.002: 6 and 24 months). HC sealant material exhibited the best performance regarding the retention and surface characteristics on the occlusal surface.

Resumo Os objetivos deste trabalho foram avaliar e comparar por 24 meses, a retenção e as características superficiais de dois diferentes materiais seladores, Helioseal Clear e Helioseal F(Ivoclar Vivadent). A correlação entre os diferentes graus de erupção e a retenção dos selantes também foram verificadas. Cinquenta crianças de 6 a 8 anos de idade participaram deste estudo, totalizando de 153 dentes divididos em dois grupos: HC (Helioseal Clear) e HF (Helioseal F). Após 6, 12, 18 e 24 meses, avaliação clínica foi realizada por dois examinadores calibrados. As caracterísiticas superficiais e a retenção (critério modificado de Ryge &Snyder) foram avaliadas. A análise da superfície oclusal, o HC demostrou retenção estatisticamente significante maior para os 12 meses (p=0,0345) e 24 meses (p=0,0076). Em relação às características superficiais, somente para descoloração superficial, o HC foi menor que do HF, durante o período estudado. Para as demais características, os resultados do teste de Mann-Whitney foram altamente significantes para HC em diferentes períodos (p=0,0000 a 0,0421). A frequência de bolhas nas superfícies seladas, determinada pelo teste do Qui-quadrado, foi maior e mais significante no HF (p=0,000:12 e 18 meses a p=0,002: 6 e 24 meses). O selante HC apresentou melhor desempenho à retenção e características superficiais.

Evaluation of superficial microhardness in dental enamel with different eruptive ages.

This study evaluated the superficial microhardness of enamel in teeth at different posteruptive ages (before eruption in the oral cavity, 2-3 years after eruption, 4-10 years after eruption and more than 10 years after eruption). The study sample was composed of 134 specimens of human enamel. One fragment of each tooth was obtained from the flattest central portion of the crown to produce specimens with 3 x 3 mm. The enamel blocks were minimally flattened out and polished in order to obtain a flat surface parallel to the base, which is fundamental for microhardness testing. Microhardness was measured with a microhardness tester and a Knoop diamond indenter, under a static load of 25 g applied for 5 seconds. Comparison between the superficial microhardness obtained for the different groups was performed by analysis of Student's t test. The results demonstrated that superficial microhardness values have a tendency to increase over the years, with statistically significant difference only between unerupted enamel and that with more than 10 years after eruption. According to the present conditions and methodology, it was concluded that there were differences between the superficial micro-hardness of specimens at different eruptive ages, revealing an increasing mineralization. However, this difference was significant only between unerupted specimens and those with more than 10 years after eruption.

Scanning electron microscopic study of the in situ effect of salivary stimulation on erosion and abrasion in human and bovine enamel.

This in situ study investigated, using scanning electron microscopy, the effect of stimulated saliva on the enamel surface of bovine and human substrates submitted to erosion followed by brushing abrasion immediately or after one hour. During 2 experimental 7-day crossover phases, 9 previously selected volunteers wore intraoral palatal devices, with 12 enamel specimens (6 human and 6 bovine). In the first phase, the volunteers immersed the device for 5 minutes in 150 ml of a cola drink, 4 times a day (8h00, 12h00, 16h00 and 20h00). Immediately after the immersions, no treatment was performed in 4 specimens (ERO), 4 other specimens were immediately brushed (0 min) using a fluoride dentifrice and the device was replaced into the mouth. After 60 min, the other 4 specimens were brushed. In the second phase, the procedures were repeated but, after the immersions, the volunteers stimulated the salivary flow rate by chewing a sugar-free gum for 30 min. Enamel superficial alterations of all specimens were then evaluated using a scanning electron microscope. Enamel prism core dissolution was seen on the surfaces submitted to erosion, while on those submitted to erosion and to abrasion (both at 0 and 60 min) a more homogeneous enamel surface was observed, probably due to the removal of the altered superficial prism layer. For all the other variables--enamel substrate and salivary stimulation -, the microscopic pattern of the enamel specimens was similar.

Avaliação clínica da saúde bucal de crianças dos municípios de Alfenas e Areado, Minas Gerais, Brasil / Clinical evaluation of the oral health of children in the Cities of Alfenas and Areado, MG, Brazil

Objetivo: Avaliar, clinicamente, a saúde bucal de 447 crianças, de 0 a 71 meses de idade, pertencentes a escolas públicas e privadas, com e sem assistência odontológica, de dois municípios brasileiros (Alfenas e Areado, Minas Gerais). Método: A experiência de cárie dentária (CPI) foi obtida através do índice ceos. Adicionalmente, determinou-se o índice de sangramento gengival (ISG), o índice de placa visível (IPV) e foi aplicado um questionário para avaliação de fatores indicadores de risco à cárie (FIRC). Os dados foram analisados pelos testes t-student e do Qui-quadrado e através de análise de regressão linear múltipla, com nível de significância pré-estabelecido de 5%. Resultados: Houve predomínio de lesões de cárie nos molares decíduos e um aumento da experiência de CPI com a idade, atingindo maiores valores aos 37-48 meses (ceos=1,09). O ISG foi igual a zero em todas as crianças estudadas. O ceos (P=0,0326) e o IPV (P=0,0000) entre os dois municípios foram significantes. O IPV foi significante entre as crianças com e sem assistência odontológica (P=0,0000) e entre as crianças de escolas públicas e privadas de Areado (P=0,023). Apenas o gênero masculino (P=0,00529) e a frequência de visitas ao Cirurgião Dentista (P=0,0000) influenciaram a experiência de CPI significantemente. A análise de regressão linear múltipla (P=0,0000 e R2=26%) mostrou significância somente entre a variável dependente (CPI) e as seguintes variáveis independentes: gênero masculino (P=0,0013), frequência de escovação (P=0,0000), uso de fio dental (P =0,0485), presença de fumante na residência (P =0,0020) e nível socioeconômico (P =0,0187). Conclusão: A cárie dentária afeta a população infantil de forma polarizada, numa idade muito precoce, com ênfase nos dentes posteriores e requer atenção preventiva profissional e dos pais/responsáveis.

Objective: The aim of this study was to evaluate clinically the oral health of 447 children aged 0-71 months old attending public and private schools, with and without dental assistance, in two Brazilian cities (Alfenas and Areado - MG). Method: Dental caries experience (early childhood caries - ECC) was based on the dmfs index. Additionally, the gingival bleeding index (GBI) and the visible plaque index (VPI) were determined, and a questionnaire was applied to assess the caries risk indicators. Data were analyzed statistically by the Student's t-test, chi-square test, and multiple linear regression analysis, with significance level set at 5%. Results: There was a predominance of caries lesions in the primary molars and an increase in ECC experience with age, reaching higher values at 37-48 months (dmfs=1.09). The GBI was equal to 0 for all children. The dmfs (p=0.0326) and the VPI (p=0.0000) were statistically significant between the two cities. The VPI was statistically significant between children from schools with and without dental assistance (p=0.0000) and between children from public and private schools in Areado (p=0.023). Only the male gender (p=0.00529) and the frequency of visits to the dentist (p=0.0000) influenced significantly the ECC experience. The multiple linear regression analysis (p=0.0000 and R2=26%) showed statistically significant association only between the dependent variable (ECC) and the following independent variables: male gender (p=0.0013), toothbrushing frequency (p=0.0000), use of dental floss (p=0.0485), presence of smokers at home (p=0.0020) and socioeconomic status (p=0.0187). Conclusion: ECC affects children at a very early age in a polarized manner, with emphasis on the posterior teeth, demanding preventive actions from dentists and parents/caregivers.

Reabilitação bucal em odontopediatria: relato de caso clínico / Oral rehabilitation in pediatric dentistry: clinical case report

A Odontologia moderna está voltada para os procedimentos preventivos, mesmo assim a cárie dentária constitui problema frequente na prática clínica odontopediátrica, sendo responsável por destruições coronárias extensas e tratamentos reabilitadores diversos. Nesses casos, o uso de aparelhos protéticos seria o tratamento indicado com a finalidade de restaurar a função mastigatória, normalizar a fonação, a estética, e possibilitar ajuste social e emocional do paciente. Este estudo relata um caso de reabilitação estético-funcional de um paciente de 5 anos de idade. Foi realizada exodontia do segundo molar decíduo superior direito, restauração de elementos superiores e inferiores remanescentes, confecção de coroas de aço nos molares inferiores, controle da cárie e um aparelho protético foi confeccionado para o paciente. O plano de tratamento permitiu restabelecer a função mastigatória, melhorar a fonética e estética da criança, bem como resultou na satisfação, demonstrada pelo paciente e seus familiares

The Modern dentistry is focused on the preventive procedures, even thus dental caries is a frequent problem in Pediatric Dentistry clinical practice, being responsible for extensive dental and coronal destructions and various rehabilitation treatments. In these cases, the use of prosthetic appliances on the treatment would be indicated in order to restore the masticatory function, normalize the speech, aesthetics, and provides social and emotional adjustment of the patient. This case reports a aesthetic-rehabilitation functioning of a 5 years-old patient. We performed extraction of the upper right second deciduous molar, upper and restoration less remaining, making steel crowns on molars, caries control and a prosthetic device was fabricated for the patient. The treatment plan allowed restore chewing function, improve phonetics and aesthetics of the child and resulted in satisfaction, demonstrated by patients and their relatives

Reabilitação bucal na primeira infância: relato de caso / Oral rehabilitation in childhood: case report

A perda precoce de dentes decíduos, com subsequente comprometimento estético, pode induzir a alterações comportamentais e de ajuste social, fatores estes que devem ser considerados no planejamento do tratamento. Este estudo apresenta uma breve revisão de literatura e um relato de caso clínico sobre a perda precoce de dentes decíduos, ocasionada pela cárie severa precoce da infância em um paciente de tenra idade com o objetivo de descrever a etiologia, as implicações clínicas e o tratamento desta condição. No caso clínico apresentado, próteses parciais removíveis superior e inferior foram necessárias para o tratamento reabilitador, além da realização da adequação do meio bucal e de exodontias. A colocação das próteses restabeleceu a estética e, consequentemente a auto-estima, além da mastigação e fonética. O diagnóstico e a intervenção no caso de perda precoce de dentes decíduos são de fundamental importância para evitar danos à saúde física e psicológica da criança

The premature loss of deciduous teeth, with subsequent aesthetic problems, may induce disturbances at the child social interactions, aspects that must be considered in the treatment planning. This study presents a brief review of the literature and a case report of the premature loss of deciduous teeth, caused by severe early childhood caries in a young child, with the objective of describing the etiology, clinical implications and treatment of this condition. In the presented case, upper and lower removable partial dentures were necessary for the rehabilitation treatment besides the adequacy of the oral environment and dental extractions. The placement of the removable partial dentures restored the aesthetic, and consequently the self-esteem, as the mastication and the phonetic. The diagnosis and early intervention are of fundamental importance to prevent physical and psychological harm of the child

In vitro evaluation of the marginal microleakage of amalgam restorations associated with dentin adhesive, glass ionomer cement and cavity varnish by means of different evaluation methods.

This in vitro study evaluated the marginal microleakage of amalgam restorations associated with the cavity varnish Copalite - Cooley & Cooley (GI-CP), dentin adhesive OptiBond Solo - Kerr (GII-OS) and the glass ionomer cement Vitremer - 3M (GIII-VT). Forty-five premolars were employed, which were submitted to independent class II preparations at the mesial and distal aspects comprising the marginal ridges and were restored with Dispersalloy - Dentsply. Afterwards, the teeth were thermocycled and stored in 0.5% basic fuchsine for 24 hours. The evaluations were conducted on a light microscope with 150x magnification and on the Sigma Scan software with employment of a single line and segmented lines. Data analysis allowed to establish that none of the materials was able to eliminate the marginal microleakage, having the GI - CP presented greater and statistically significant values in relation to the other groups in all evaluation methods (p<0.05). The lowest values were displayed by the GIII-VT, yet with no statistically significant difference when compared to GII-OS, except for the evaluation at the Sigma Scan in single line. The three evaluation methods showed a strong positive relationship to each other.

Urgency treatment profile of 0 to 15 year-old children assisted at urgency dental service from Bauru Dental School, University of São Paulo.

Dental recordings of 0 to 15-year-old patients assisted at Urgency Dental Service (UDS) from Bauru Dental School, University of São Paulo, in 2001 and 2002, were assessed in order to quantify the number of patients that used the service, to determine attendance patterns, and to record the frequency of different types of dental emergencies and their performed treatment. Data were plotted and submitted to a descriptive statistical analysis. Among the total of patients attended at UDS (6020), 1166 (19.37%) were children, with mean age of 9.24 years. Trauma was the cause for 199 (17.06%) of the recorded urgency visits. It occurred more frequently in children between 0 and 3 years of age (34.42%), and between 7 and 12 years of age (18.12%). The main treatments performed were temporary restoration (33.33%) for coronal fracture, and orientation (24.44%) for luxation. Nontraumatic events were the etiology for 967 (82.92%) of the total urgency diagnosis. The most commonly found nontraumatic diagnosis was dental caries lesions (61.75%), followed by problems of eruption or root resorption (14.27%) and bone or soft tissue lesions (6.51%), among others (17.47%). The most frequent treatments performed for caries lesions were: excavation and temporary restoration (39.39%) when there was no abscess, and coronal opening and dressing (40.95%) for caries lesions with abscess. There was an increasing trend in caries lesions prevalence according to the rising of the age, in contrast to trauma prevalence. Treatment for both situations was done according to the indicated protocol for each case.

Effect of professional cleaning and dental brushing with or without fluoridated dentifrice on enamel remineralization.

An in situ evaluation of the potential rehardening effect of fluoridated and non-fluoridated toothpastes with or without air polishing was conducted. Ten volunteers, using acrylic palatal appliances containing two bovine enamel blocks with artificial carious lesions, took part in this study. Four times a day, after the main meals and at night, the volunteers, in a habitual way, brushed their natural teeth with the dentifrice indicated to the experimental design and after that the appliances were put again into the mouth. They were divided into 4 different groups: G1 - control - non-fluoridated dentifrice; G2 - fluoridated dentifrice; G3 - non-fluoridated dentifrice, but having a previous prophylaxis using air polishing; G4 - fluoridated dentifrice and previous air polishing. The effects of treatments on enamel rehardening were evaluated in the blocks that were assessed by surface microhardness, and the percentage of surface microhardness change (%reh) was calculated in relation to the baseline values. The results showed that %reh was higher in the groups with fluoridated dentifrice, and professional prophylaxis did not have an additional effect in the groups of fluoridated dentifrices (p<0.05). The data suggested that, in the absence of fluoride, removal of dental plaque helped to increase the process of enamel rehardening.

Avaliação da microinfiltração marginal e profundidade de penetração dos cimentos de ionômero de vidro utilizados como selantes oclusais.

OBJECTIVE: the aim of this study was to conduct an in vitro comparison of marginal microleakage (MM) and the depth of penetration (DP) of glass ionomer cements (GIC) and a resin sealant (RS) into occlusal pit and fissures. METHODS: for that purpose, 60 intact third molars were equally distributed to 5 groups: G1 - 37% phosphoric acid / Delton; G2 - 40% polyacrylic acid / Ketac-Molar / nail varnish; G3 - Fuji Plus conditioner / Fuji Plus/ nail varnish; G4 -37% phosphoric acid / Vitremer / Finishing gloss; G5 -37% phosphoric acid / Vitremer prepared with a 1:4 ratio of powder / Finishing gloss. The teeth were submitted to a thermal treatment corresponding to 300 cycles (15 sec, 5/55(0)C), followed by complete coating with nail varnish, except for 1mm beyond the contour of the sealant. Afterwards, the teeth were immersed in 0.5% basic fuchsine for 24 hours. Thereafter, the teeth were sectioned in buccolingual direction and microscopically analyzed (150x magnification) by means of predetermined scores. The results were subject to the Kruskal-Wallis test. RESULTS: there was no statistical difference between the materials tested in relation to the DP, being that all groups displayed nearly complete filling of the fissures. No sealant material was able to prevent dye penetration; however, the GICs provided better results of MM, with significant difference when compared to the RS. CONCLUSION: all materials investigated presented a satisfactory degree of penetration into the fissures; however, the glass ionomer cements displayed better performance in the marginal microleakage test compared to the resin sealant.

Perfil de tratamento de urgência de crianças de 0 a 12 anos de idade, atendidas no Serviço de Urgência Odontológica da Faculdade de Odontologia de Bauru da Universidade de São Paulo / Urgency treatment profile of 0 to 12 year-old-children assisted at urgency dental service from Bauru Dental School, University of São Paulo

Foram avaliados os prontuários de atendimentos de crianças de 0 a 12 anos de idade, atendidas no Setor de Urgência Odontológica (SUO) da Faculdade de Odontologia de Bauru, da Universidade de São Paulo, no período compreendido entre os anos de 2004 a 2008 que continham informações completas sobre o paciente e o tipo de atendimento realizado. Os dados analisados foram: idade, gênero, motivo da visita, exames, tratamentos realizados e tipo de encaminhamento. As crianças foram divididas em dois grupos de acordo com a injúria sofrida: traumáticas e não-traumatícas. Os dados foram tabulados e submetidos a uma análise descritiva. Do total de pacientes atendidos no SUO, nesse intervalo de 60 meses, 1236 (9,05%) eram crianças, sendo que a maoria apresentava idade ente 7 e 12 anos (62,78%). Enquanto as lesões traumáticas foram responsáveis por 18,52% (229) dos atendimentos, as injúrias não-traumáticas foram responsáveis por 81,47% (1007). O tratamento para ambos estava de acordo com o preconizado para esse tipo de serviço. Por meio do presente estudo, pôde-se concluir que a cárie dentária foi a lesão que gerou a maior ocorrência dos atendimentos realizados pelo SUO, o que indica uma maior necessidade de orientação em saúde bucal da população, com ênfase nas ações preventivas.

The attendance's records of children between 0 to 12 years old assisted at Urgency Dental Service (UDS) from Bauru Dental School, University of São Paulo were assessed in the period among the years 2004 and 2008, which only the records that containing all information completed about the patient or type of treatment were analyzed. The analyzed data were age, gender, main complaint, exams, performed treatmente records and follow-up care. They were divided into two groups in relation to the involved injury: traumatic and non-traumatic. Data were plotted and submitted to a descriptive statistical analysis. Among the total of patients attended at UDS at this period of 60 months, 1236 (9.05%) were children the majority was between 7 and 12 years old (62.78%). While traumatic lesions were the cause of 229 (18.52%) of treatments, the non-traumatic injuries were the cause of 1007 (81.47%). The treatment performed in both situations was done according to the indicated protocol for each case. Through this study it was concluded that dental caries was the most frequent lesion of the treatments provided by UDS, which indicates a higher need for oral health orientation of the population with emphasis in preventive measures.

Evaluation of the total fluoride intake of 4-7-year-old children from diet and dentifrice.

This study measured the total daily fluoride (F) intake of 21 children, living in Bauru, a fluoridated community. F intake from diet (D) and dentifrice (B) was determined for 2 groups of children: A (4-5-year-old) and B (6-7-year-old). The method of 24-hour duplicate diet was used. F ingested from dentifrice was indirectly obtained, subtracting the amount expelled and the amount left on the toothbrush from the amount initially loaded onto the brush. F analysis was carried out with the ion specific electrode (Orion 9409), after hexamethyldisiloxane-facilitated diffusion. The amount of F intake from D and B was divided by the child weight and total intake (T) was calculated by adding D and B. Data were analyzed by Student’s "t" (p<0.05) test and by linear regression. Results (mean ± SD, mg F/Kg body weigh) of T, D and B were, respectively: 0.056±0.040; 0.018±0.12; 0.037±0.038 for all children; 0.055±0.026; 0.021±0.014; 0.034±0.027 for Group A and 0.057±0.052; 0.016±0.010; 0.041±0.046 for Group B. There was a strong positive correlation between the amount of dentifrice used and the amount of fluoride ingested (r = 0.92, p<0.0001). One-third of the children analyzed were exposed to a F dose above 0.07 mg / Kg body weight, which is recommended as the upper limit of daily F intake. Dentifrice was the main source of F ingested by children with percentages of 57.43 ± 29.02 for all children; 56.49 ± 31.82 for group A; and 58.29 ± 27.78 for group B. No significant differences were found between the 2 groups.

Aquisição de Estreptococos Mutans e Desenvolvimento de CárieDental em Primogênitos / Streptococcus mutans Acquisition and Dental Caries Development in First-Born Children

Objetivo: Avaliar o momento de aquisição de estreptococos mutans(EM), desenvolvimento de cárie dental e as variáveis a elesassociadas no decorrer de 23 meses, em primogênitos de famíliasde baixo nível socioeconômico, desde os sete meses de idade.Método: A amostra foi selecionada com base em mães densamentecolonizadas por EM, incluindo todos os membros de 14 famílias queconviviam na mesma casa. Foram envolvidos no estudo 14 mães,pais e primogênitos e 8 parentes, na maioria avós. Exames clínicose radiográficos iniciais determinaram os índices de cárie e condiçãoperiodontal dos adultos. Contagens de EM foram feitas em todosos adultos nas duas primeiras visitas. Nas crianças foram avaliadosos níveis de EM, o número de dentes e de cáries, em quatro visitas.Resultados: A prevalência de EM nos adultos foi alta, estandoausente em apenas um dos pais. EM foram detectados em 1, 2, 3 e10 crianças, respectivamente nas visitas #1, 2, 3 e 4. A cárie dentalfoi detectada em apenas três crianças na última visita (aos 30meses de idade), as quais apresentaram escores de EMsignificantemente maiores que as crianças sem cárie, na mesmavisita.Conclusão: Exclusivamente a condição social de baixa renda emães densamente colonizadas por EM não são sinônimo decolonização precoce e alta atividade de cárie em crianças cuidadasem casa. O desenvolvimento de cárie está significantementeassociado a escores elevados de EM nas crianças.

Evaluation of superficial microhardness in dental enamel with different eruptive ages

This study evaluated the superficial microhardness of enamel in teeth at different posteruptive ages (before eruption in the oral cavity, 2-3 years after eruption, 4-10 years after eruption and more than 10 years after eruption). The study sample was composed of 134 specimens of human enamel. One fragment of each tooth was obtained from the flattest central portion of the crown to produce specimens with 3 x 3 mm. The enamel blocks were minimally flattened out and polished in order to obtain a flat surface parallel to the base, which is fundamental for microhardness testing. Microhardness was measured with a microhardness tester and a Knoop diamond indenter, under a static load of 25 g applied for 5 seconds. Comparison between the superficial microhardness obtained for the different groups was performed by analysis of Student's t test. The results demonstrated that superficial microhardness values have a tendency to increase over the years, with statistically significant difference only between unerupted enamel and that with more than 10 years after eruption. According to the present conditions and methodology, it was concluded that there were differences between the superficial micro-hardness of specimens at different eruptive ages, revealing an increasing mineralization. However, this difference was significant only between unerupted specimens and those with more than 10 years after eruption.

Scanning electron microscopic study of the in situ effect of salivary stimulation on erosion and abrasion in human and bovine enamel

This in situ study investigated, using scanning electron microscopy, the effect of stimulated saliva on the enamel surface of bovine and human substrates submitted to erosion followed by brushing abrasion immediately or after one hour. During 2 experimental 7-day crossover phases, 9 previously selected volunteers wore intraoral palatal devices, with 12 enamel specimens (6 human and 6 bovine). In the first phase, the volunteers immersed the device for 5 minutes in 150 ml of a cola drink, 4 times a day (8h00, 12h00, 16h00 and 20h00). Immediately after the immersions, no treatment was performed in 4 specimens (ERO), 4 other specimens were immediately brushed (0 min) using a fluoride dentifrice and the device was replaced into the mouth. After 60 min, the other 4 specimens were brushed. In the second phase, the procedures were repeated but, after the immersions, the volunteers stimulated the salivary flow rate by chewing a sugar-free gum for 30 min. Enamel superficial alterations of all specimens were then evaluated using a scanning electron microscope. Enamel prism core dissolution was seen on the surfaces submitted to erosion, while on those submitted to erosion and to abrasion (both at 0 and 60 min) a more homogeneous enamel surface was observed, probably due to the removal of the altered superficial prism layer. For all the other variables - enamel substrate and salivary stimulation -, the microscopic pattern of the enamel specimens was similar.

Airpolishing effect on bovine enamel and the posterior remineralizing effect of saliva: estudo in vitro%Efeito do jato de bicarbonato de sódio sobre o esmalte bovino e posterior efeito remineralizador da saliva: estudo in vitro

OBJETIVO: A finalidade do trabalho foi avaliar as alterações da microdureza e o desgaste provocado pelo jato de bicarbonato de sódio em esmalte bovino e o posterior efeito remineralizador da saliva artificial. MÉTODOS: Utilizaram-se 15 espécimes de esmalte (4,0mm x 4,0mm) que constituíram os grupos: sem tratamento (MI); tratamento com jato de bicarbonato de sódio (MII e DI); tratamento com jato de bicarbonato de sódio e imersão em saliva artificial por uma hora (MIII e DII), 24 horas (MIV e DIII) e sete dias (MV e DIV). Foram realizados testes de microdureza com um microdurômetro nos grupos M e testes de desgaste com um rugosímetro nos grupos D. RESULTADOS: Os dados foram avaliados pela Análise de Variância a um critério e pelo Teste de Tukey. O valor das médias da microdureza, em KHN, nos grupos MI, MII, MIII, MIV e MV foram 359,80; 335,46; 369,20; 377,73 e 341,86; respectivamente, enquanto que os valores médios, em µm, do desgaste para o grupo DI, DII, DIII e DIV foram 0,564; 0,519; 0,441 e 0,428, respectivamente. CONCLUSÕES: o jato de bicarbonato de sódio causou desgaste e diminuição da microdureza superficial; a saliva promoveu o retorno da microdureza superficial à condição inicial e reduziu o desgaste; o efeito reparador da saliva sobre as alterações na microdureza superficial já ocorreu com uma hora de tratamento, não havendo diferença estatisticamente significante do efeito obtido com 24 horas; o melhor efeito reparador da saliva sobre o desgaste ocorreu com 24 horas de tratamento

Influence of toothbrushing on enamel softening and abrasive wear of eroded bovine enamel: an in situ study

Este estudo avaliou o amolecimento superficial e o desgaste do esmalte bovino erodido com ou sem influência da escovação. Cinco voluntários fizeram parte deste estudo in situ de 5 dias. Eles usaram aparelhos palatinos de acrílico contendo 6 blocos de esmalte bovino divididos em 2 fileiras com 3 blocos, cada fileira correspondeu a um grupo em estudo: erosão sem escovação dentária (GI) e erosão seguida de escovação dentária (GII). Os blocos foram submetidos à erosão por imersão do aparelho em uma bebida à base de cola por 10 minutos, 4 vezes ao dia. Depois disso, nenhum tratamento foi realizado em uma fileira (GI), enquanto a outra fileira foi escovada (GII). Em seguida, o aparelho foi recolocado na boca. Alterações do esmalte foram determinadas por teste de perfilometria e microdureza. Os dados foram analisados usando-se teste t de Student (p < 0,05). O valor médio de desgaste (µm) e da porcentagem de perda de microdureza superficial (%PDS) foi respectivamente: GI – 2,77 ± 1,21/91,61 ± 3,68 e GII – 3,80 ± 0,91/58,77 ± 11,47. Houve uma diferença estatisticamente significante no desgaste (p = 0,001) e na %PDS (p = 0,001) entre grupos. Conclui-se que o desgaste foi mais pronunciado quando associado à abrasão pela escovação. Entretanto, a escovação promoveu menor %PDS, devido à remoção da camada de esmalte superficial alterada.

Airpolishing effect on bovine enamel and the posterior remineralizing effect of saliva: estudo in vitro

PURPOSE: The aim of the present study was to evaluate the alterations of surface microhardness and wear caused by the sodium bicarbonate jet on bovine enamel and the further remineralizing effect of artificial saliva. METHODS: Fifteen enamel samples (4,0mm x 4,0mm) were used, which constituted the groups: no treatment (MI); treatment with sodium bicarbonate jet (MII and DI); treatment with sodium bicarbonate jet and immersion in saliva for one hour (MIII and DII), 24 hours (MIV and DIII) and 7 days (MV and DIV). Microhardness tests were carried out using a microdurometer in groups M and wear tests by a rugosimeter in groups D. The data were assessed by the one criterion variance analysis and Tukey test. RESULTS: The mean value of microhardness, in KHN, in groups MI, MII, MIII, MIV and MV were 359,80; 335,46; 369,20; 377,73 and 341,86, respectively, whereas the mean values in æm, of wear for group DI, DII, DIII and DIV were 0,564; 0,519; 0,441 and 0,428, respectively. CONCLUSIONS: The sodium bicarbonate jet caused a wear and a reduction in microhardness on the enamel surface; saliva promoted the recovery of initial condition surface microhardness and reduced the wear; the repairing effect of saliva on the surface microhardness alterations occurred within one hour of treatment, having no significant statistical difference from the effect obtained in 24 hours; the best saliva repairing effect on the wear occurred with treatment of 24 hours.

OBJETIVO: A finalidade do trabalho foi avaliar as alterações da microdureza e o desgaste provocado pelo jato de bicarbonato de sódio em esmalte bovino e o posterior efeito remineralizador da saliva artificial. MÉTODOS: Utilizaram-se 15 espécimes de esmalte (4,0mm x 4,0mm) que constituíram os grupos: sem tratamento (MI); tratamento com jato de bicarbonato de sódio (MII e DI); tratamento com jato de bicarbonato de sódio e imersão em saliva artificial por uma hora (MIII e DII), 24 horas (MIV e DIII) e sete dias (MV e DIV). Foram realizados testes de microdureza com um microdurômetro nos grupos M e testes de desgaste com um rugosímetro nos grupos D. RESULTADOS: Os dados foram avaliados pela Análise de Variância a um critério e pelo Teste de Tukey. O valor das médias da microdureza, em KHN, nos grupos MI, MII, MIII, MIV e MV foram 359,80; 335,46; 369,20; 377,73 e 341,86; respectivamente, enquanto que os valores médios, em æm, do desgaste para o grupo DI, DII, DIII e DIV foram 0,564; 0,519; 0,441 e 0,428, respectivamente. CONCLUSÕES: o jato de bicarbonato de sódio causou desgaste e diminuição da microdureza superficial; a saliva promoveu o retorno da microdureza superficial à condição inicial e reduziu o desgaste; o efeito reparador da saliva sobre as alterações na microdureza superficial já ocorreu com uma hora de tratamento, não havendo diferença estatisticamente significante do efeito obtido com 24 horas; o melhor efeito reparador da saliva sobre o desgaste ocorreu com 24 horas de tratamento.

Uso da tomografia computadorizada de feixe cônico em odontopediatria: relato de casos / Use of cone beam computed tomography in pediatric dentistry: case reports

Tomografia Computadorizada de Feixe Cônico é uma técnica de aquisição de imagens queoferece diversas vantagens na prática clínica odontológica por produzir imagens tridimensionais da região dentomaxilofacial. Em Odontopediatria, a avaliação de estruturas em diferentes planos é necessária especialmente em casos complexos, nos quais as radiografias convencionais não fornecem com exatidão informações importantes. O presente estudo tem como objetivo relatar três casos clínicos de diferentes alterações buco-dentárias em que a utilização da Tomografia Computadorizada de Feixe Cônico auxiliou na determinação de um correto diagnóstico e definição de um plano de tratamento adequado.

Cone Beam Computed Tomography is a technique that offers many advantages in dentistry because it produces three-dimensional imaging of the dentomaxillofacial structures. In pediatric dentistry, the need to evaluate structures in different planes is noticed especially in complex cases, in which conventional radiographs do not show, in an accurate way, some important information. Therefore, the purpose of this study is to report three cases of different alterations which the use of Cone Beam Computed Tomography helped us for correct diagnosis and adequate treatment planning.