Recommendations from Pediatric and Pediatric Dentistry Associations of the Americas Regarding Pacifier Use

ABSTRACT Objective: To identify online recommendations from pediatric and pediatric dentistry associations of the Americas regarding the pacifier habit. Material and Methods: A search was conducted on the associations' website (November/2021 to March/2023) to the questions: (1) Recommend using a pacifier?, (2) What care?, (3) Advantages and (4) disadvantages, (5) Ideal age, and (6) methods for habit removal. Results: Among the 36 American countries, 21 were represented on websites, social media, and official guides. The most significant portion of pediatric dentistry associations (23.81%) does not recommend the use of a pacifier if the infant is exclusively breastfeeding, and recommends avoiding the offer of a pacifier in the first days of life to facilitate the establishment of breastfeeding. Some pediatric (29.63%) associations suggested that use reduces the risk of sudden infant death syndrome. Most pediatric dentistry associations (85.71%) and some pediatric associations (22.22%) linked pacifier use to breastfeeding difficulties and the occurrence of orthodontics. Most of the 20 pediatric dentistry associations stated that the habit should be removed by a maximum of three years of age (90.48%). The most reported recommendations were behavior modification techniques and positive reinforcement. Conclusion: Most pediatric dentistry associations recommend the care and disadvantages of pacifiers and the ideal age to remove them. The few pediatric associations that provide information address indications, care, advantages and disadvantages of pacifiers, age, and methods for removing them.

Perfil dos pacientes atendidos na clínica de traumatismo dentário na dentição decídua em Belo Horizonte/MG / Profile of patients assisted at the dental traumatic clinic in the primary dentition in Belo Horizonte/MG

Objetivo: O presente estudo teve como objetivo avaliar o perfil dos pacientes atendidos em um centro de referência de traumatismos dentários na dentição decídua, identificando as características sociodemográficas, frequência, tipos de lesões traumáticas e tratamentos realizados. Métodos:Trata-se de um estudo retrospectivo com prontuários odontológicos de crianças de 6 a 60 meses de idade atendidas na Clínica de Traumatismo na Dentição Decídua da FAO/UFMG no período de 2007 a 2019. Foram analisadas características das lesões traumáticas, da criança, atendimento imediato (2h após o trauma) e condições socioeconômicas. A análise dos dados foi realizada de maneira descritiva e consistiu na distribuição de frequência das variáveis. Resultados:Entre os 610 prontuários odontológicos, 365 crianças (59,8%) eram do sexo masculino; 335 (54,9%) tinham 3 anos de idade ou menos, 446 (73,1%) eram de baixa renda e 335 (54,9%) das mães estudaram até o ensino médio. Lesões aos tecidos duros dentários apresentaram a maior frequência em crianças com 3 anos de idade ou menos (60,4%), entretanto, após os 3 anos de idade, as lesões mais frequentes foram lesões aos tecidos de sustentação (48,0%). Dentre a classificação de lesões aos tecidos duros dentários, a trinca e/ou fratura de esmalte foi a lesão mais frequente (15,0%). A luxação intrusiva foi o trauma mais frequente nos tecidos de sustentação (11,2%) e lesão em gengiva foi mais frequente dentre lesões nos tecidos moles (9,5%). Em geral, 212 crianças (34,8%) buscaram atendimento em um intervalo menor ou igual a duas horas após o trauma. A exodontia foi o tratamento mais realizado: em casos de lesões aos tecidos de sustentação (47,1%), seguido do mantenedor de espaço (24,3%). Em tecidos duros dentários a exodontia também foi o tratamento mais frequente (50,7%), seguido de restauração e mantenedor de espaço (18,0%). Conclusão: Conclui-se que a maioria dos traumatismos dentários na dentição decídua foram em meninos com menos de 3 anos e as lesões mais comuns foram trincas/fratura de esmalte, seguidas das luxações intrusivas.

Aim: The aim of the present study was to evaluate the profile and characteristics of patients treated at a dental trauma reference center, and identifying frequency, types of traumatic injuries and treatments performed. Methods: This retrospective study was carried out with dental records of children aged 6 to 60 months attended at the Primary Dental Trauma Clinic of FAO/UFMG between 2007 and 2019. Characteristics of the child and traumatic dental injuries, immediate care (2 hours after the trauma) and socioeconomic status were analyzed. Data analysis was performed descriptively using frequency distribution. Results:Of the total of 610 dental records, 365 children (59.8%) were male; 335 (54.9%) were up to 3 years old, 446 (73.1%) were low-income and 335 (54.9%) had mothers who studied up to high school. Dental hard tissue injuries were more frequent in children aged 3 years or less (60.4%), but after 3 years of age, the most frequent injuries were supporting tissue injuries (48.0%). Among dental hard tissue injuries, enamel crack and/or fracture was the most frequent injury (15.0%). Intrusive luxation was the most frequent lesion in supporting tissues injuries (11.2%) and gingival lesions was the most frequent soft tissue injuries (9.5%). Overall, 212 children (34.8%) sought care within two hours of the injury. Extraction was the most common treatment for supporting tissue injuries (44.3%), followed by space maintainers (22.8%). In dental hard tissues injuries, extraction was also the most frequent treatment (35.8%), followed by restoration (30.2%). Conclusion: In conclusion, most traumatic dental injuries in the primary dentition occurred in boys under 3 years of age, and the most common injuries were enamel cracks/fractures, followed by intrusive luxation.

A ansiedade odontológica materna influencia no relato da qualidade de vida relacionada à saúde bucal de pré-escolares? / Does maternal dental anxiety influence the report of oral health-related quality of life in preschool children?

Objetivo: O objetivo desse trabalho foi avaliar a associação entre a ansiedade odontológica materna e o impacto no relato da QVRSB de seus filhos pré-escolares. Métodos: Um estudo transversal foi conduzido com uma amostra de 150 crianças de 4 e 5 anos de idade residentes na cidade de Diamantina-MG. A ansiedade odontológica materna foi avaliada por meio da Escala de Ansiedade Odontológica (Dental Anxiety Scale - DAS) previamente à uma consulta de exame clínico para detecção de alterações bucais. As crianças também foram clinicamente avaliadas para verificar a presença de cárie dentária e traumatismo dentário. As avaliações clínicas foram conduzidas por examinadores treinados e calibrados para esses critérios. As mães responderam o Early Childhood Oral Health Impact Scale (ECOHIS) e preencheram um formulário com características sociodemográficas e econômicas. A análise de dados envolveu estatística descritiva e regressão de Poisson. Resultados: Ansiedade odontológica moderada à alta foi encontrada em 12% (n = 18) das mães e mostrou-se associada a uma pior qualidade de vida de pré-escolares na análise não ajustada. A análise ajustada mostrou uma associação significativa da idade da criança aos 5 anos (RP = 4,45; IC = 2,38-8,30; p≤ 0,001) e da cárie dentária não tratada (RP = 2,77; IC = 1,64-4,65; p ≤ 0,001) com um impacto negativo na qualidade de vida das crianças. A ansiedade materna moderada à alta foi associada a um impacto negativo no relato de qualidade de vida de pré-escolares na análise não ajustada, mas perdeu a associação após o ajuste para outras variáveis. Conclusão: Não foi encontrada associação entre a ansiedade odontológica materna e o relato de QVRSB de seus filhos.

Aim: This study aimed to evaluate the association between maternal dental anxiety and the impact on oral health-related quality of life (HRQoL) of preschool children. Methods: A cross-sectional study was conducted with a sample of 150 children, aged between 4 and 5 years, living in the city of Diamantina, MG, Brazil. Maternal dental anxiety was assessed using the Dental Anxiety Scale (DAS) prior to a clinical examination appointment to detect oral alterations. The children were also clinically evaluated for the presence of dental caries and dental trauma. Clinical assessments were conducted by examiners trained and calibrated to these criteria. Mothers answered the Early Childhood Oral Health Impact Scale (ECOHIS) and filled out a form to provide sociodemographic and economic characteristics. Data analysis involved descriptive statistics and Poisson regression. Results: Moderate to high dental anxiety was found in 12% (n=18) of the mothers and was associated with a poorer quality of life in preschoolers in the unadjusted analysis. The adjusted analysis showed a significant association between the child at 5 years of age (PR = 4.45; CI = 2.38-8.30; p ≤ 0.001) and untreated dental caries (PR = 2.77; CI = 1.64-4.65; p ≤ 0.001) with a negative impact on children's quality of life. Moderate to high maternal anxiety was associated with a negative impact on preschoolers' quality of life in the unadjusted analysis, but the association was lost after adjustment for other variables. Conclusion: No association was found between maternal dental anxiety and their children's HRQoL.

Mothers' sense of coherence and oral health-related quality of life of preschoolers: a 3-year cohort study

Abstract The aim of the present study was to assess whether mothers' sense of coherence (SOC) was a predictor of decline in oral health-related quality of life (OHRQoL) of preschoolers. A 3-year cohort study was conducted in Diamantina, Brazil. At baseline, 162 preschoolers aged one to three years were randomly selected from among children registered in local Primary Healthcare Units. In the first stage, mothers completed a sociodemographic questionnaire, the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS), and the Brazilian short version of the Sense of Coherence Scale (SOC-13). The total score obtained from the SOC-13 was used to select exposed and unexposed children. Clinical examinations were performed to detect the presence of dental caries, traumatic dental injury, and malocclusion. At follow-up, mothers completed the sociodemographic questionnaire and the B-ECOHIS again. The incidence of severe dental caries and adherence to the proposed treatment at baseline were evaluated. A decline in OHRQoL was considered if there was an increase in the B-ECOHIS score of at least one unit. The chi-square test and Poisson regression were performed. A total of 151 preschoolers participated in the study, among whom 37.7% showed a decline in OHRQoL. Mothers' SOC was not associated with a negative impact on OHRQoL (RR = 1.24; 95%CI = 0.81-1.88), while the incidence of severe dental caries had a greater impact on the decline in OHRQoL (RR = 2.02; 95%CI = 1.29-3.16). Mothers' low SOC was not a predictor of decline in the OHRQoL of preschoolers after a 3-year follow-up period.

Prevalence of unsatisfactory dental restorations in posterior primary teeth and associated factors

Abstract The aim of this study was to investigate the prevalence of unsatisfactory dental restorations on posterior primary teeth and associated factors in school children aged six to ten years. A cross-sectional study was conducted with children randomly selected from public schools in a small Brazilian town. Questionnaires were sent to the guardians addressing socioeconomic and behavioral aspects of the child. Oral examinations were performed at the schools to determine the quality of dental restorations, visible biofilm, and presence of moderate/extensive untreated caries (scores 3-6 ICDAS). This examination was performed by two previously trained and calibrated examiners. Associations were tested using multilevel logistic regression. Among the 400 children evaluated, 98 had restorations (217 teeth). The prevalence of unsatisfactory restorations was 34.6%. Restorations in amalgam were less likely to fail compared to those in glass ionomer cement (OR = 0.11; 95%CI: 0.02-0.49; p = 0.005). Children with moderate/extensive untreated caries were more likely to have unsatisfactory restorations (OR = 6.79; 95%CI: 2.20-20.93; p = 0.001). Children with a visible plaque index ≥ 20% were also more likely to have unsatisfactory restorations (OR = 2.28 95%CI: 1.05-4.92; p = 0.036). The prevalence of unsatisfactory restorations was high. The occurrence of this outcome was associated with restorative material, presence of caries, and visible plaque.

Avaliação comparativa entre terapia endodôntica convencional e técnica não instrumental: um relato de caso / Comparative evaluation between conventional endodontic therapy and a non-instrumental technique: a case report

Objetivo: A necrose da polpa dentária é uma complicação causada principalmente por cáries e lesões traumáticas. Não há consenso sobre a melhor técnica e materiais para o tratamento endodôntico na dentição decídua. O objetivo foi apresentar um relato de caso clínico em que foram realizadas diferentes abordagens endodônticas em dentes homólogos traumatizados e necróticos. Métodos: Um menino de um ano e oito meses sofreu traumatismo dento-alveolar após queda e procurou o projeto de extensão de traumatismos na dentição decídua da Faculdade de Odontologia da UFMG em outubro de 2018 para avaliação clínica e radiográfica. O incisivo central superior esquerdo apresentou fratura de esmalte e dentina sem exposição pulpar, enquanto o incisivo central superior direito apresentou luxação intrusiva leve. Ambos apresentaram o desenvolvimento de lesões periapicais. Resultados: Os dentes foram tratados respectivamente com a técnica não instrumental com pasta CTZ e com terapia endodôntica convencional com pasta Guedes-Pinto. Os acompanhamentos clínico e radiográfico após os tratamentos revelaram dentes assintomáticos e evidência de cicatrização periapical. Conclusão: O uso da pasta CTZ apresentou resultados satisfatórios e semelhantes à terapia tradicional em curto prazo no relato de caso apresentado.

Aim: Dental pulp necrosis is a complication caused mainly by dental caries and lesions. No consensus has been reached on the best technique and materials for endodontic treatment in the primary dentition. The objective was to present a clinical case report in which different endodontic approaches were performed in traumatized and necrotic homologous teeth. Methods: A one-year-and-eight-month-old boy suffered dentoalveolar trauma after a fall and sought out the Deciduous Trauma Dental Center of the Federal University of Minas Gerais in October 2018 for clinical and radiographic evaluation. The left maxillary central incisor presented enamel and dentin fracture without pulp exposure, while the right maxillary central incisor presented a small intrusive dislocation. Both presented the development of periapical lesions. Results: The teeth were treated respectively, using the non-instrumental technique with CTZ paste and the conventional endodontic therapy with Guedes-Pinto paste. Clinical and radiographic follow-ups after treatments revealed asymptomatic teeth and evidence of periapical healing. Conclusion: The use of CTZ paste in this case report presented satisfactory and similar results to traditional therapy in the short term.

Association between different stages of dental caries in preschoolers and familial socioeconomic factors

Abstract: This study evaluated the association between socioeconomic factors and stages of dental caries in children one to five years of age. A cross-sectional study was conducted involving 759 children enrolled in preschools in Diamantina, Brazil. The parents/caregivers filled out a form addressing socioeconomic factors. Add to the end of this sentence: and categorized in caries free (code 0 and 1), no obvious decay (code 2 and 3) and obvious decay (code 4, 5 and 6). Statistical analysis was performed using the Mann-Whitney test and multinomial regression. The prevalence of "no obvious decay" was higher among children from families with a larger number of income-dependent individuals (OR: 2.47; 95%CI: 1.41-4.31). The higher prevalence of "obvious decay" was associated with the child's age (OR: 1.36; 95%CI: 1.16-1.58), attending a public preschool (OR: 2.38; 95%CI: 1.31-4.34), a larger number of income-dependent individuals (four to five individuals: OR: 1.71; 95%CI: 1.09-2.74; more than five individuals: OR: 3.41; 95%CI: 1.95-5.94), no access to a dentist (OR: 2.14; 95%CI: 1.48-3.09), and lower income (OR: 1.72; 95%CI: 1.19--2.49). It was concluded that the variable of a larger number of income-dependent individuals was associated with both no obvious decay and obvious decay. Child's age, type of preschool, access to a dentist, and income were associated with obvious decay.

Influence of breastfeeding duration on the incidence of dental caries in preschoolers: a cohort study / Influência da duração da amamentação na incidência de cárie dentária em pré-escolares: um estudo de coorte

Abstract Objectives: investigate the association between breastfeeding duration and the incidence of severe caries in preschoolers. Methods: a cohort study was conducted with 132 pairs of mothers and children in the city of Diamantina, Brazil. Data collection was performed in 2 moments: when the children were between two and three years of age (baseline- 2013/2014) and after three years (T1-2016/2017). In both moments, children were evaluated for dental caries (International Caries Detection and Assessment System - ICDAS) and a questionnaire was administered to the mothers addressing socioeconomic aspects and thee habits of children. The outcome evaluated was the incidence of severe caries (Dentin caries - ICDAS Codes 5 and 6). Data analysis involved descriptive statistics, chi-squared test and Poisson hierarchical regression with robust variance. Results: children who breastfed for more than 24 months (RR = 2.24 CI95%= 1.23-4.08), those whose parents were separated (RR = 1.73 CI95%= 1.11-2.69), and those with estab-lished/severe caries (RR = 2.74 CI95%= 1.37-5.49) at baseline were at greater risk of incidence of severe caries after three years. Conclusion: breastfeeding for more than 24 months is a risk factor for incidence of severe caries. In addition, family structure and established or severe baseline caries were associated.

Resumo Objetivos: investigar a associação entre a duração da amamentação e a incidência de cárie grave em pré-escolares. Métodos: foi realizado um estudo de coorte com 132 pares de mães e crianças de Diamantina, Minas Gerais, Brasil. As crianças foram avaliadas em dois momentos: dois e três anos de idade (baseline-2013/2014) e após três anos (T1- 2016/2017). Dados socioeconómicos e relativos aos hábitos das criançasforam obtidos por meio de entrevistas com as mães e a presença de cárie dentária foi diagnosticada segundo o protocolo "International Caries Detection and Assessment System - ICDAS". O desfecho foi a incidência de cárie grave (cárie em dentina - códigos ICDAS 5 e 6). Para análise dos dados empregou-se regressão hierárquica de Poisson com variância robusta. Resultados: crianças que amamentaram por mais de 24 meses (RR = 2,24 IC95%= 1,234,08), cujos pais viviam separados no baseline (RR = 1,73 IC95%= 1,11-2,69) e aquelas com cárie estabelecida ou grave no baseline (RR = 2, 74 IC950%= 1,37-5,49) estavam em maior risco de incidência de cárie grave após 3 anos. Conclusão: a amamentação por mais de 24 meses foi um fator de risco para a incidência de cárie dentária grave em pré-escolares. Além disso, estrutura familiar e cárie estabelecida ou grave no baseline estiveram associados.

Impaction of mandibular third molars after orthodontic treatment by the edgewise method: a retrospective study

Abstract This study aimed to determine the incidence of mandibular third molar (M3) impaction after orthodontic treatment by edgewise appliances, and identify possible determinant factors of M3 impaction. A retrospective cohort study was conducted with 1154 patients. Complete orthodontic records were analyzed pretreatment and posttreatment, considering the following variables: type of Angle malocclusion, treatment with or without extraction of first premolars, overbite, stage of dentition, M3 prior angulation and duration of orthodontic treatment. Impaction was determined after radiographic evidence of total closure of the root apex. The chi-square test and Poisson regression (p < 0.05) were used for statistical analysis with a hierarchical approach. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. Mandibular M3 impaction incidence was 17%. Overbite equal to or greater than 4 mm (RR = 1.23, 95%CI: 1.11-1.26, p < 0.001), prior mesial angulation of M3 (RR = 0.59, 95%CI: 0.52-0.68, p < 0.001), non-extraction of first premolars (RR=1.06, 95%CI: 1.01-1.12, P=0.019) and orthodontic treatment time equal to or less than three years (RR = 0.94. 95%CI: 0.90-0.99, p < 0.014) were significantly associated with impacted M3. There was no correlation between the type of Angle malocclusion and the risk of impaction. In conclusion, the incidence of mandibular M3 impaction was considered low. The main pretreatment factors directly involved in impaction were mesioangulation of M3 and overbite equal to or greater than 4 mm. Orthodontic treatment with extraction of first premolars and treatment time greater than 3 years reduce the risk of impaction.

Relationship Between Mother's Sense of Coherence and Oral Health of Babies aged 6-36 Months: A Pilot Study

Objective: To evaluate the association between oral health of babies aged 6-36 months and the Mother's Sense of Coherence (SOC). Material and Methods: A cross-sectional pilot study was conducted in the city of Diamantina -MG with a convenience sample of 32 mothers and their babies, attended at the Dental Clinic for Babies at the Federal University of the Vales do Jequitinhonha and Mucuri. The survey included the filling of dental records of babies, a questionnaire given to the mothers about sociodemographic and oral hygiene of their babies, and self-administered SOC-13. Babies were submitted to a clinical intra-oral examination for the detection of dental caries and initial lesions according to World Health Organization (WHO) criteria. Data were analyzed by the t test and Pearson's correlation (p<0.05). The size effect calculation proposed by Cohen was used to test the clinical significance of results. Results: The prevalence of dental caries was 40.0%. Maternal SOC had a variation between 35 and 59, with mean score of 47.7 (SD = 6.09). The monthly family income was more than two minimum wages for 51.6% of families. There was no statistically significant association between dental caries and maternal SOC (p = 0.646). Regarding monthly family income, there was a statistically significant association with maternal SOC (p = 0.005). Maternal SOC was also significantly associated with nocturnal oral hygiene of babies (p = 0.008). Conclusion: The mother's sense of coherence was not associated with dental caries and was associated with nocturnal oral hygiene of babies and with family monthly income.

Hábitos parafuncionais em crianças de 36 a 71 meses de idade: prevalência e fatores associados / Parafunctional habits in children between 36 and 71 months of age: prevalence and associated factors

Objetivo: Avaliar a prevalência de hábitos parafuncionais em crianças e verificar se o aleitamento materno, o uso de mamadeira, a renda e a escolaridade materna estão associados a estes hábitos. Materiais e Métodos: Um estudo transversal foi realizado com 592 crianças de 36 a 71 meses de idade e suas mães. Os dados foram coletados por meio de entrevista com as mães durante as campanhas de vacinação infantil realizadas na cidade de Diamantina, Minas Gerais, em 2010. A variável dependente (presença de hábitos parafuncionais) foi obtida por meio de relato das mães, considerando-se os hábitos (sucção, morder objetos e outros) presentes no momento do estudo. Por esta entrevista foram obtidas também as informações sobre as variáveis independentes (sexo, idade da criança, problema de saúde, aleitamento materno, uso de mamadeira, renda mensal e escolaridade materna). A análise estatística foi realizada utilizando-se o programa SPSS for Windows e envolveu análise descritiva, teste qui-quadrado (p<0,05) e regressão de Poisson com variância robusta. Resultados: A prevalência de hábitos parafuncionais foi de 42,2% (n=250), sendo a sucção o tipo de hábito mais frequente (17,6%). Os hábitos parafuncionais foram mais frequentes entre as crianças que não foram amamentadas no peito (p=0,004) e que usaram mamadeira (p<0,001). Associação estatisticamente significativa também foi observada entre estes hábitos e escolaridade materna (p=0,006) e número de filhos (p=0,009). A análise multivariada mostrou que as crianças que usaram mamadeira (RP: 1,40; IC95%: 0,5-0,8), aquelas que não foram amamentadas no peito (RP: 1,41; IC95%: 1,1-1,8) e cujas mães tinham escolaridade superior a oito anos (RP: 1,32; IC95%: 1,0-1,6) apresentaram maior prevalência de hábitos parafuncionais. Conclusão: A prevalência de hábitos parafuncionais foi alta e associou-se à ausência de aleitamento materno, ao uso de mamadeira e ao maior nível de escolaridade das mães.(AU)

Aim: The present study aimed to determine the prevalence of parafunctional habits in children and evaluate possible associations with breastfeeding, bottle feeding, income, and mother's educational level. Materials and Methods: A cross-sectional study was carried out involving 592 children from 36 to 71 months of age of age and their mothers. Data were collected through interviews with mothers during child vaccination campaigns in 2010 in the city of Diamantina, Brazil. The dependent variable (parafunctional habits) was determined through mothers' reports considering nonnutritive sucking, biting on objects, and other habits at the time of the interview. The independent variables included gender, child's age, health problems, breastfeeding, bottle feeding, monthly income, and mother's educational level. Statistical analysis was carried out using the SPSS program for Windows and involved descriptive statistics, the chi-square test (p < 0.05), and Poisson regression with robust variance. Results: The prevalence of parafunctional habits was 42.2% (n = 250), the most frequent of which were nonnutritive sucking habits (17.6%). Parafunctional habits were more frequent among children who had not been breastfed (p = 0.004) and those who had been bottle fed (p < 0.001). Parafunctional habits were significantly associated with the mother's educational level (p = 0.006) and the number of children in the family (p = 0.009). The multivariate analysis revealed a greater prevalence rate of parafunctional habits among children who had been bottle fed (PR: 1.40; 95% CI: 0.5-0.8), those who had not been breastfed (PR: 1.41; 95% CI: 1.1-1.8), and those whose mothers had more than eight years of schooling (PR: 1.32; 95% CI: 1.0-1.6). Conclusion: The prevalence of parafunctional habits was high in the present study and was associated with a lack of breastfeeding, the use of bottle feeding, and a higher educational level among the mothers.(AU)