Impact of Wearing Palatal Expanders on the Quality of Life of Children Aged 8 to 10 Years

ABSTRACT Objective: To assess the impact of wearing palatal expanders on the oral health-related quality of life (OHRQoL) of children aged 8 to 10 years. Material and Methods: The sample consisted of 35 children aged 8 to 10 years treated at the orthodontics and pediatric dentistry outpatient clinics affiliated with the Dental School. Children were divided in two groups: 17 were submitted to palatal expansion treatment (Group 1), while 18 just received coronal polishing and topical fluoride application (Group 2). The Brazilian version of the Child Perceptions Questionnaire (CPQ8-10) was used to assess children's OHRQoL. The questionnaire was administered before the expander was placed, at the end of its activation, and before its removal. Intervals between the interviews were similar in the two groups. Descriptive statistics and ANOVA were used for data analyses. Results: The overall CPQ8-10 score was not significantly different between the groups. The results show statistically significant differences between the two groups only for the functional limitations domain after activation of the appliance (p=0.001). Conclusion: Palatal expanders may negatively affect children's functions only during the initial wearing period.

O cuidado no atendimento às crianças no consultório odontológico frente à pandemia da COVID-19 / Dental care for children in dental clinics faced with the COVID-19 pandemic

Objetivo: O presente trabalho visa orientar o odontólogo sobre as novas regras de uso de EPIs, normas de biossegurança, técnicas odontológicas utilizadas no atendimento da criança, para que possamos realizar os procedimentos odontológicos com segurança antes, durante e após a pandemia da COVID-19. Métodos: Após busca em diversos bancos de dados (Google, SciELO, Bireme, Portal de Periódicos da CAPES, PubMed), em 30/03/2020, 21 artigos relacionados ao atendimento odontológico durante a pandemia foram selecionados. O critério de inclusão dos artigos foi se relacionar às normas específicas de biossegurança para o atendimento odontológico durante a pandemia, especialmente em crianças. Resultados: Vinte e um artigos foram incluídos no trabalho sendo sete deles, específicos do atendimento odontopediátrico. As consultas odontopediátricas devem ser marcadas de forma espaçada, evitando o encontro de pessoas na sala de espera. A criança deve vir acompanhada de apenas um acompanhante. Algumas barreiras devem ser usadas nas crianças como máscara, gorro e óculos. O odontólogo deve usar máscara N95 e protetor facial, além dos outros EPI's. Previamente ao atendimento, bochecho de peróxido de hidrogênio a 1% deve ser realizado pela criança. Técnicas operatórias (ART, aplicação de diamino fluoreto de prata e técnica Hall) que gerem menos aerossóis dever ser priorizadas. Se necessário o uso de baixa e alta rotação, estas deverão ser com sistema anti-reflexo e esterilizadas a cada paciente. Um intervalo de 1 a 2 horas deve ser dado entre pacientes, permitindo a ventilação da sala, diminuição dos aerossóis e desinfecção de todo o ambiente clínico. Conclusão: A pandemia do COVID-19 se tornou um risco ocupacional para odontólogos, crianças e responsáveis. Para evitar contágio e transmissão da doença, os odontólogos devem se capacitar por meio de informações seguras e cumprir as normas de biossegurança sugeridas.

Aim: The present work aims to guide the dentist as regards the new rules for the use of PPEs, biosafety standards, and dental techniques used in pediatric dental care, so that we can safely perform dental procedures before, during, and after the COVID-19 pandemic. Methods:After searching several databases (Google, SciELO, Bireme, Portal de Periódicos da CAPES, PubMed), on March 30, 2020, 21 articles related to dental care during the pandemic were selected. The inclusion criteria for the articles was to relate to specific biosafety standards for dental care during the pandemic, especially in children. Results: Twenty-one articles were included in the work, with seven of these specifically treating pediatric dental care. Dental appointments should be scheduled in a staggered manner, avoiding the meeting of people in the waiting room. The child must be accompanied by only one family member or guardian. Some barriers should be used with children, such as a mask, hat, and glasses. The dentist must wear an N95 mask and face shield, in addition to the other PPEs. Before attending, 1% hydrogen peroxide mouthwash must be used by the child. Operative techniques (ART, application of silver diamine fluoride and Hall technique), which generate less aerosols, should be given priority. If the use of low and high speed is necessary, they must be with an anti-reflective system and sterilized for each patient. An interval of 1 to 2 hours must be given between patients, allowing for the ventilation of the room, a reduction in aerosols, and the disinfection of the entire clinical environment. Conclusion: The COVID-19 pandemic has become an occupational hazard for dentists, children, and guardians. To avoid contagion and transmission of the disease, dentists must train themselves through secure information and comply with the suggested biosafety rules.

Apoptosis in pulp elimination during physiological root resorption in human primary teeth

Pulp samples of 50 healthy human teeth with indication for extraction were examined to evaluate the role of apoptosis in pulp elimination during physiological root resorption. Two groups were formed: a test group (n=30) composed of pulp samples of primary teeth with physiological root resorption and a control group (n=20) composed of pulp samples of permanent maxillary third molars. Morphological evidence of apoptosis as well as in situ detection of cellular DNA fragmentation by TUNEL assay and detection of internucleosomal pattern of fragmentation of the genomic DNA by electrophoresis were observed. The apoptotic index of the primary tooth group was significantly higher than that of the permanent tooth group (51.01 ± 0.52 versus 25.32 ± 0.68) (p<0.001). TUNEL reaction showed intense and diffuse labeling in the pulp samples of primary teeth, which were discrete in the controls. Intense DNA internucleosomal fragmentation, a specific pattern for apoptosis, was observed in primary tooth pulps DNA by electrophoresis, in the permanent tooth pulps this pattern fragmentation of the genomic DNA for apoptosis were not present. These results seem to indicate a role of apoptosis in pulp elimination during the physiological root resorption of human primary teeth.

Cinqüenta amostras de polpas de dentes humanos hígidos com indicação para extração foram estudadas a fim de verificar a participação da apoptose na eliminação pulpar durante a reabsorção radicular fisiológica. As amostras foram divididas em 2 grupos: um grupo de estudo composto por 30 polpas de dentes decíduos hígidos com reabsorção radicular fisiológica, e um grupo controle composto por 20 polpas de terceiros molares superiores hígidos. Evidências morfológicas de apoptose, bem como detecção in situ da fragmentação do DNA genômico via reação de TUNEL e também a detecção do padrão internucleossômico de fragmentação do DNA genômico via eletroforese foram observados. O índice apoptótico foi maior no grupo de dentes decíduos (51,01 ± 0,52) quando comparado ao grupo de dentes permanentes (25,32 ± 0,68) (p<0,001). Quanto à reação de TUNEL, houve intensa marcação positiva para fragmentação do genoma no grupo de estudo, o que ocorreu de maneira discreta nos controle. A eletroforese do DNA genômico mostrou fragmentação internucleossômica, em um padrão específico de apoptose nas amostras de dentes decíduos o que não ocorreu no grupo de dentes permanentes. Estes achados parecem indicar a apoptose como um mecanismo importante na eliminação do tecido pulpar durante a reabsorção radicular fisiológica de dentes decíduos humanos.