Efficacy of resin infiltration of proximal caries in primary molars: 1-year follow-up of a split-mouth randomized controlled clinical trial.

OBJECTIVE: The main purpose of this split month, randomized, controlled clinical trial was evaluate the efficacy of caries infiltration in controlling the progression of non-cavitated proximal lesions in primary molars. Anxiety and time required for the caries infiltration was also evaluated. MATERIALS AND METHODS: Fifty healthy children, 5 to 9 years, presenting two primary molars with proximal caries lesions (1/2 of the enamel or outer 1/3 of dentin), were included. Lesions were randomly allocated to the test group (fluoridated toothpaste + flossing + infiltration) or to the control group (fluoridated toothpaste + flossing). Caries risk was based on the Cariogram model. The main outcome after 1-year radiographic follow up was assessed by an independent blinded examiner A facial image scale (FIS) was applied to assess dental anxiety and time required to perform the infiltration was recorded. RESULTS: Of the sample, 92.9% corresponded to high or medium caries risk. In 42 patients (1-year follow up), caries progression was observed in 11.9% (5/42) of the test lesions compared with 33.3% (14/42) of the control lesions (p < 0.05). Five control and three test lesions progressed to the middle 1/3 of dentin and were restored. No side effects were observed. Anxiety was both low before and after the treatment, and mean time required for the infiltration was 11.29 min (± 1.16 min). CONCLUSIONS: Caries infiltration of proximal caries lesions in primary molars is significantly more efficacious than standard therapy alone (fluoride toothpaste + flossing). CLINICAL RELEVANCE: Caries infiltration is an applicable and well-accepted method be used in children, representing a promising micro-invasive approach.

Energy dispersive x-ray spectroscopy evaluation of demineralized human enamel after titanium tetrafluoride application.

OBJECTIVE: Evaluate the presence of a titanium dioxide layer after application of titanium tetrafluoride on human permanent tooth enamel. STUDY DESIGN: The sample consisted of unerupted third molars. After the removal of the roots, each tooth was mesiodistally divided into 2 fragments, one reserved for the experimental group and the other for the control group. Before the treatments the fragments were artificially demineralized. The experimental group (n=5) received an application of 4% titanium tetrafluoride, for one minute and the control group (n=5) did not receive any treatment. The samples were sputter-coated with a 20-30nm gold layer as the energy dispersive x-ray spectrometer analysis was carried out in a scanning electron microscope and the results were descriptively analyzed. RESULTS: The titanium dioxide layer was present on all experimental samples with a titanium peak varying between 6.82 and 26.37%. This layer was not found in the control group. Fluoride and calcium fluoride precipitates were present in the samples treated with titanium tetrafluoride. CONCLUSION: Titanium dioxide layer was formed after one titanium tetrafluoride application, but it was not uniform. Further studies should be carried out so that both the morphology and thickness of such layers can be better understood.

Effects of ENSO events on the intensity, seasonality, and diversity of reproductive phenology of Miconia (Melastomataceae) species in tropical rainforest.

We evaluated the phenology and reproductive phenological diversity of three sympatric species of Miconia in a gallery forest in the Chapada Diamantina mountains, Bahia, Brazil. The reproductive phenophases (bud, flower, immature fruit, and mature fruit) of M. alborufescens (N=38), M. holosericea (N=46), and M. prasina (N=44) were evaluated monthly, between June/2008 and June/2015. The Fournier index was used to assess the intensities of the reproductive phenophases; synchrony and seasonality were analyzed using circular statistics and the Rayleigh (Z) test. The Frideman and Wilcoxon tests were used to verify interannual variations in phenological patterns. Reproductive phenological diversity was measured by calculating the Shannon-Wiener index; ANOVA tested possible differences in the means of diversity among the different years. The reproductive phenophases of the studied Miconia species occurred sequentially (M. alborufescens, then M. holoserica, followed by M. prasina), in the transition between the dry and rainy seasons, with little overlap between them. In general, the species showed seasonal and synchronic phenological patterns, with some variations that coincided with El Niño and/or La Niña events, e.g., demonstrating changes in the periodicity, synchrony, and intensity of their phenophases. The intensity of fruiting, for example, showed increases during La Niña years. Reproductive phenological diversity appears to respond to climate changes resulting from El Niño events and periods of prolonged drought, with high Shannon-Wiener index values. The results also suggest that the effects of global climatic phenomena (El Niño and La Niña) that alter regional climatic seasonality can also cause variations in the reproductive phenological rhythms of the Miconia species studied.

Impact of oral health on the quality of life of 3-6-years old HIV-infected children. Quality of life in HIV+ children.

AIM: The objective was to assess the impact of oral health on the quality of life of HIV-infected patients aged 3-6 years based on their caregivers' perceptions. METHODS: A questionnaire for measuring the perception and the instrument Early Childhood Oral Health Impact Scale (ECOHIS) were applied to 31 caregivers whose children were being treated in a public hospital. Results The mean age of the children was 4.52 years (SD 1.22). The total ECOHIS score ranged from 0 to 26, with a mean value of 4.13 (SD 6.66). Seventeen children (54.8%) were found to have at least one impact: toothache (64.7%), herpetic gingivostomatitis (23.5%) or both (11.8%). Statistically significant difference was found between the ECOHIS score and presence of restored teeth, prior dental treatment, AIDS, and viral load. With respect to the caregivers' perception, it resulted to be adequate, as those caregivers whose children had a greater number of decayed teeth and higher biofilm index also considered the oral health to be bad (P<0.001). However, the children's general health was found to be good despite the worse immunological classification (P<0.017).Conclusion The quality of life of the HIV- infected children has been negatively affected by the oral health.

Impact of oral problems on daily activities of HIV-infected children.

AIM: Oral manifestations are common in HIV+ children, but the impact of these diseases on their daily life is unknown. So the aim of this study was to assess the impact of oral problems on the daily activities of HIV+ children. METHODS: The Child-OIDP-B was used with 59 10-12 year-old HIV+ children, who were outpatients at two public hospitals for HIV treatment in Rio de Janeiro, Brazil. Caries, biofilm and gingival bleeding indexes were recorded. The Kruskall-Wallis and Mann-Whitney tests as well as the Spearman's correlation coefficient were used for analysis. Statistical evaluation: Replies were analysed using the Statgraphics ® Plus Version 5.0 statistics software system, in order to obtain comparative diagrams and graphs using the ANOVA multifactorial system. RESULTS: The Child-OIDP-B scores ranged from 0 to 30, (mean=6.09) and 71.2% of the children were affected by oral problems. Association was found between oral impact and number of caries (p=0.009). Children receiving HAART therapy had a Child-OIDP-B score (4.87), much lower than those who were not (8.87) (p=0.038). The most reported oral impact of the disease was eating (55.6%), but oral wounds were the most prevalent type of lesions (76.3%). As regards the level of intensity of the impact, moderate severity was prevalent in all 59 children and 66.1% reported that oral impacts affected 1-4 daily activities, 50.8% of all children were not satisfied with their appearance and oral health; 23.7% perceived the impact of HIV-infection on general health. CONCLUSION: Most children suffered the impact of oral problems on their daily activities, mainly functional impacts.

Ectophosphatase activity in Candida albicans influences fungal adhesion: study between HIV-positive and HIV-negative isolates.

OBJECTIVE: This study describes the expression of acidic ectophosphatase activity on twenty isolates of C. albicans from oral cavities of HIV-infected children (HIV+) and compares them with fifteen isolates from HIV-negative children (HIV-), as well as the fungal adhesion to epithelial cells and medical records. METHODS: The activities were measured in intact cells grown in BHI medium for 48 h at 37 degrees C. Phosphatase activity was assayed at pH 5.5 using 4-methylumbelliferyl phosphate. Yeast adhesion was measured using the MA 104 epithelial cell line. RESULTS: Mean values of ectophosphatase activity were 610.27 +/- 166.36 and 241.25 +/- 78.96 picomoles 4-methylumbelliferone/h/10(7) cells for HIV+ and HIV- group, respectively (P = 0.049). No correlation between C. albicans enzyme activity from HIV children with viral load and CD4 percentual was observed. Yeasts with high enzyme activity, isolated from HIV+ children showed greater adherence than yeasts with basal levels of ectophosphatases from HIV- (Spearman correlation, r = 0.8). Surface phosphatase activity was apparently involved in the adhesion to host cells, as the enhanced attachment of C. albicans to host epithelial cells was reversed by pretreatment of yeast with sodium orthovanadate (1 mM), an acid phosphatase inhibitor. CONCLUSION: These results show that C. albicans from HIV+ has an ectophosphatase activity significantly higher than the other isolates. Yeasts expressing higher levels of surface phosphatase activity showed greater adhesion to epithelial cells. So, the activity of acidic surface phosphatases on these cells may contribute to the early mechanisms required for disease establishment.

Randomized controlled clinical trial of resin infiltration in primary molars: 2 years follow-up.

OBJECTIVE: The aim of this split-mouth, randomized, controlled clinical trial was to evaluate the efficacy of resin infiltration in controlling the progression of non-cavitated proximal lesions in primary molars after two-years follow-up. METHODS: Fifty healthy children presenting at least two primary molars with proximal lesion detected radiographically (in the inner half of enamel or the outer third of dentin) were included in the study. The proximal lesions were randomly allocated into resin infltration + flossing (test group) or flossing (control group). All patients received oral hygiene instructions for daily brushing with fluoride toothpaste (1100 ppmF) and flossing. The proportion of caries progression was compared using the McNemar test. The main outcome after 2-years, caries progression in the radiography was assessed by pair-wise reading by an independent examiner who was blind regarding the treatment. RESULTS: The sample comprised 28 (56%) girls and 22 (44%) boys with a defs of 7,3 (SD = 6,5), mainly of moderate (46%) to high (48%) caries risk. Results after one year were published previously. After 2-years, 29 (58%) patients were assessed. Caries progression was observed in 24.1% (7/29) of the test lesions, compared with 55.2% (16/29) of the control lesions (p = 0.012). The therapeutic effect was 31.1% and the relative risk reduction (RRR) was 56.3%. Eigth lesions from the control group and two lesions from the test group progressed to the inner third of dentin and were restored. CONCLUSIONS: In conclusion, resin infiltration was more efficacious in controlling proximal caries lesions in primary molars than non-invasive approach alone. CLINICAL SIGNIFICANCE: The results indicate that resin infiltration was an efficacious method in controlling proximal caries lesions in primary molars after 2 years, even in patients with high caries risk, reaffirming the results of 1-year follow-up.

Bilateral Primary Obstructive Giant Megaureter in an Adult Dog.

A rare case of bilateral, primary, obstructive, giant megaureter was found during necropsy examination of an 11-year-old female German shepherd dog. On ultrasound examination and at necropsy examination, both ureters were tortuous and extensively dilated with diameter ranging from 1.86 to 4.8 cm. Both vesicoureteral junctions were obstructed by uroliths. A diagnosis of giant megaureter was established using human parameters since these values are not recognized in animals. The classification of obstructive and primary megaureter was determined because the obstruction was due to uroliths at the vesicoureteral junctions.

Cariogenic and erosive potential of the medication used by HIV-infected children: pH and sugar concentration.

OBJECTIVE: The aim of this work was to analyze pH and sugar concentration in seven antiretroviral and three antibacterial medications frequently prescribed to HIV infected paediatric patients. METHOD: Sugars (sucrose, glucose, lactose and fructose) and pH were measured from every one of ten medications with different serial numbers in two samples. The pH was determined by a previously calibrated digital pHmeter (Beckman). Analysis of free sugars was performed using thin-layer chromatography (TLC). The pH results and the amount of sugar originated from the two samples in each lot were added. The arithmetic mean of these results were computed. RESULTS: Two antiretrovirals (Zidovudin and Abacavir Sulphate) had pH below critical level (3.55 and 3.93, respectively). All three antibacterials analyzed had pH above 5.5, and one of them (Azithromycin) had the highest pH level of the ten medications examined (9.28). Sugar was present in seven out of 10 of the medications analyzed. The antibacterials contained the highest concentration of sucrose, ranging from 40% to 54%. Glucose was found in one of the ten, sucrose was present in seven of them and none showed lactose. Fructose was not observed with the technique used. CONCLUSIONS: A number of medications frequently used by HIV-infected children may cause a significant risk of both caries and dental erosion.

Sweetened medicines and hospitalization: caries risk factors in children with and without special needs.

AIM: This was to evaluate caries risk factors: medicine consumption level, oral hygiene frequency and oral hygiene habits during hospitalization of children with and without special needs. METHODS: A cross-sectional study was carried out using a pre-tested form, interviews were conducted with guardians of children with (G1-116) and without special needs (G2-86), from a public day nursery in Rio de Janeiro (Brazil). RESULTS: Average use of medications was at 21.8 months for G1--24.5 and G2--7.2 (Mann-Whitney: p-value = 0.0009). In the total sample, medicines were taken usually at night; 8.4% of parents sweetened them before ingestion and the majority of children did not brush their teeth after taking medicines. More than half (61.9%) had been hospitalized with an average duration of 21.8 days; 83 (66.4%) had had few hospitalizations; G1--62.8% and G2--77.4%. Some 81.6% of the sample reported no tooth brushing while in hospital. STATISTICS: The data were entered in the EPI INFO 6.04d program, and the tests used were Fisher Exact, Mann-Whitney, Kruskal-Wallis and Chi-square with a 5% significance level. CONCLUSIONS: Poor oral hygiene habits when taking medicines and during hospitalizations were observed, mainly among children with special needs.

Caudal vena cava collapsibility index in healthy cats by ultrasonography / [Índice de colapsibilidade da veia cava caudal em gatos domésticos Saudáveis, obtido por meio de ultrassonografia]

The objective of this study was to calculate the collapsibility index (CI) in a group of 15 healthy adult mixed breed cats via right hepatic intercostal ultrasound view. The minimal and the maximal diameters of the caudal vena cava (CVC) were obtained during inspiration and expiration, respectively, then CI was calculated. The mean diameter of the CVC was 0.5cm. The mean CI was 28±3% and CI was not significantly associated with gender. As in human medicine, there is a growing need for less invasive monitoring in small animal practice. The CI enables the assessment of estimated volemia without the need for a central venous catheter. This is the first reported study investigating CI in cats.(AU)

O objetivo deste estudo foi calcular o índice de colapsabilidade (IC) em um grupo de 15 gatos adultos, saudáveis e SRD, por meio da janela ultrassonográfica hepática intercostal direita. Os diâmetros mínimo e máximo da veia cava caudal (VCC) foram obtidos durante a inspiração e a expiração, respectivamente. O IC foi calculado, posteriormente. O diâmetro médio da VCC foi de 0,5cm. O diâmetro médio do IC foi de 28±3%, e o IC não foi significativamente associado ao gênero. Como na medicina humana, há uma necessidade crescente de monitoramento menos invasivo na prática de pequenos animais. O IC possibilita a avaliação da volemia estimada sem a necessidade de um cateter venoso central. Este é o primeiro estudo relatado sobre IC em gatos domésticos.(AU)

Fluoride uptake and release by composites and glass ionomers in a high caries challenge situation.

PURPOSE: To evaluate the behavior of composite resins and glass ionomer cements with regard to the uptake and release of fluoride, in a high caries challenge situation. MATERIALS AND METHODS: Standard test specimens of glass ionomer cement (Chelon Fil), a resin-modified glass ionomer (Vitremer), two polyacid-modified composite resins (VariGlass and Dyract) and a composite resin (Heliomolar), were submitted for 14 days to demineralization and remineralization cycles in order to simulate a high caries challenge, while from the eighth day onward, a fluoridated dentifrice solution was applied for 5 minutes twice a day and the daily fluoride release of those materials to the mediums was quantified and compared. Fifteen test specimens were prepared for each material, making up a total of 75. RESULTS: All materials studied, except for Heliomolar from day 4 to day 7 in the demineralizing solution, were capable of releasing fluoride in measurable quantities during the whole experiment. The fluoride amounts released by Chelon Fil, Vitremer, VariGlass and Dyract were significantly higher in the demineralizing solution (ANOVA, P < 0.05) than in the remineralizing solution, during almost the entire experiment. The fluoride amounts released by Heliomolar were significantly higher in the remineralizing solution (ANOVA, P < 0.05) than in the demineralizing solution, during almost the entire experiment. All materials studied were capable of uptaking fluoride from the dentifrice solution and of later releasing it to the solution, maintaining the release relatively constant and at a higher level than that seen between days 5 and 7.

Gingival status of HIV+ children and the correlation with caries incidence and immunologic profile.

PURPOSE: The aim of this study was to determine gingival health and caries levels in HIV-infected children. METHODS: The modified gingival index (GI) of 43 HIV+ children of both sexes, aged between 2 and 12 years, was measured and correlated with the DMFT/dmf. The children's immunodeficiency level was also established by means of the CD4:CD8 ratio. Pearson's product-moment correlation co-efficient and the Mann-Whitney U test were used. RESULTS: The GI was significantly related to the DMFT/dmf. The children with a GI = 0 presented significantly more DMFT/dmf than the children with a GI > or = 0.1, but there were no significant differences between the GIs of caries-free children and those with DMFT/dmf > or = 1. The children who presented a CD4:CD8 > or = 0.5 ratio presented less DMFT/dmf compared with children who presented a CD4:CD8 < 0.5 ratio. The children who presented a CD4:CD8 < 0.5 ratio presented a statistically significant correlation between their GI and their DMFT/dmf, unlike children who presented a CD4:CD8 > or = 0.5 ratio. Children with a CD4:CD8 < 0.5 who showed a greater DMFT/dmf index also showed greater gingival inflammation. CONCLUSIONS: In this study, children with greater caries experience showed more gingival inflammation. In addition, a greater immunological deficiency might indicate a greater caries experience in children.

Craniometaphyseal dysplasia: case report.

Craniometaphyseal dysplasia is a rare genetic bone remodeling disorder characterized by undertubulation of the long bones, especially in the lower extremities, causing deformities of the metaphyses of the long bones, and sclerosis of the skull base or cranial bone hyperostosis. The authors report a case of craniometaphyseal dysplasia in an 8-year-old Brazilian child, emphasizing the importance of precocious diagnosis of this rare genetic disorder.

Oral manifestations related to immunosuppression degree in HIV-positive children.

Oral manifestations often found in HIV-infected children are frequently the first clinical sign of the infection. This article aims to report the prevalence of oral manifestations in soft tissues and their relationship with the degree of immunosuppression in 80 HIV-infected patients (average age 6.30 +/- 3.32 years old) at the IPPMG-UFRJ. Thirty children (38%) presented some type of oral lesion and the percentage of CD4 was lower than that found in lesion-free children (p < 0.05); 22.5% presented candidiasis, 17.5% gingivitis, 8.8% enlargement of parotids, 1.3% herpes simplex and 1.3% hairy leukoplakia. Of the 30 children with lesions, 70% showed severe immunosuppression, 23.3% moderate immunosuppression and in only 6.7% was immunosuppression absent. Oral manifestations were directly related to the degree of immunosuppression and such lesions can be considered as indicators of the progression of the HIV infection in children.

[Prevalence of caries and its correlation with clinical and immunological classification in HIV-infected children]. / Prevalência de cárie e sua correlação com a classificação clínica e imunológica em crianças infectadas pelo HIV.

This research aims to determine the relationship between the prevalence of caries and clinical and immunological classification in HIV-infected children. Ninety-two outpatients (42 male and 50 female subjects) with definitive diagnosis of HIV infection took part in this research. The patients were examined in order to determine the prevalence of caries (dmf and DMFT indexes), and medical data were collected from their medical records. The mean age of the subjects was 5.77 years. Although no statistical differences were found, young patients (up to 5 years old) had more caries when they were more clinically and immunologically compromised. The same fact was observed regarding older children.

Reliability of two methods for measurement of alveolar bone level in children.

OBJECTIVES: To determine the intra- and interexaminer reliability of two methods (calliper and computerized images) for measuring the alveolar bone level on bitewing radiographs of pre-school children and to determine the extent to which one method can measure more sites. METHODS: Standardized paediatric bitewings were analysed with either an image analysis program (ImageTool) or a digital calliper (Digimatic Caliper). With each method, radiographs were measured three times by three trained examiners. The differences in the number of sites measured with the two methods were assessed with McNemar's tests and kappa statistics. Reliability was assessed with paired t-tests, intraclass correlation coefficients (ICCs), Bland-Altman and survival-agreement plots. RESULTS: The kappa statistics and McNemar's test indicated that examiners measured 14% fewer sites using ImageTool. Paired t-tests also demonstrated a statistically significant bias (range 0.11-0.23 mm) indicating larger measurements for this method, although these observed differences were considered clinically unimportant for the detection of 2 mm of bone loss (which was considered the threshold for periodontal disease). Intra- and interexaminer reliability (ICC range: 0.87-0.97) was considered good for both methods. CONCLUSIONS: Reliable methods to assess alveolar bone loss in primary teeth are important for the diagnosis of incipient periodontal diseases. Both studied methods proved to be reliable. With the Digimatic Caliper, however, more sites were measured.

Pyknodysostosis: oral findings and differential diagnosis.

Pyknodysostosis is a rare, genetic, autosomal recessive condition characterized by short stature, generalized bone sclerosis, and oral manifestations such as maxillary atresia and an increase of the mandibular angle. The main purpose of this article was to report a case of pyknodysostosis, describing the characteristic orofacial findings of the disease and discussing the differential diagnosis.

Knowledge, attitudes and status of oral health in children at risk for infective endocarditis.

AIM: The purpose of this study was to assess the oral health status of 104 children (2-17 years of age) at risk for infective endocarditis attending the Paediatric Cardiology Service of the Martagão Gesteira Institute of Child Care and Paediatrics, Rio de Janeiro, Brazil, and their guardians' attitudes towards and knowledge about endocarditis risks. METHODS: A structured interview was carried out with guardians and an oral examination was performed on each child to determine scores for the plaque index (PI), gingival index (GI) and dmft/DMFT index. RESULTS: The percentage of guardians who understood the meaning of 'heart infection' was 9.6%, who knew the possibility of heart disease caused by dental procedures was 60.6%, who understood the requirement for antibiotic cover before dental treatment was 72.1%, and who understood the importance of good oral health to prevent infective endocarditis was 41.3%. As regards oral health behaviours, 46.1% of children brushed their teeth three times or more a day, 28.8% had never visited a dentist before, and only 24.3% attended the dentist for prevention. There was visible plaque in 98% and gingival bleeding in 99% of children in this study. The caries experience for primary dentition (dmft) was 2.62%, and 3.97 for permanent dentition (DMFT). CONCLUSIONS: Based on these results, we can conclude that the guardians' knowledge and attitudes about oral health were not good. This group at risk has poor oral health, which may give rise to a frequent bacteraemia under physiological conditions.