Dental treatment of a child with oral cleft: a case report

Introduction:The cleft lip and palate are the most common facial congenital malformations, developing in the early embryonic stages between the fourth and eighth week of intrauterine life. Objective: To present the dental treatment of a child with cleft lip and palate under general anesthesia. Case report: Patient, aged four years, with cleft lip and palate, living in an indigenous village in the city of Vilhena, Rondônia, Brazil, with poor hygienic conditions and with dental caries, needed dental treatment under general anesthesia. The clinical examination revealed that the child had impaired general health by the presence of several wounds in the feet and nails, low weight, and many carious lesions. Discussion: In addition to parents' instructions and monitoring of multidisciplinary team, it is important to know the life of the patients with oral cleft, to target the most appropriate treatment to be successful in their rehabilitation process. Conclusion:Children with cleft lip and palate can have their quality of life improved through adequate care.

Evaluation of oral hygiene index, monitoring and oral hygiene instruction in visually impaired people

Introduction: Eyesight can be considered a major human interaction promoter in motor, perceptual and mental activities and its loss can cause social environment changes. Objective: To evaluate and determine Simplified Oral Hygiene Index (OHI-S) in visually impaired individuals, as well as to provide information to promote oral health, to verify the effectiveness of educational activities for index change and to promote the social inclusion of visually impaired people. Material and methods: Study population was constituted by 28 visually impaired people of both genders, aged from 14 to 75 years old, residents and students at the Parana Institute for the Blind (IPC), Curitiba (PR, Brazil). The study was conducted in three stages. At first, the participants individually answered a questionnaire, performed tooth brushing and then the disclosure of oral biofilm was made, as well as the evaluation of Simplified Oral Hygiene Index, oral hygiene instruction and supervised toothbrushing. The second step was performed after seven days and the third after thirty days to reassess the Simplified Oral Hygiene Index to check whether there would a change in their values. Participants were divided into two groups according to Simplified Oral Hygiene Index: those who had only bacterial plaque and those who had plaque and calculus. Results: At the first day, patients with plaque and calculus had initial OHI-S mean of 2.3 (regular), 2.1 (regular) after seven days, and 2.4 (regular) after one month. Patients with only plaque at the first day had an average OHI-S of 0.71 (regular), 0.74 (regular) after seven days, and 0.78 (regular) after one month. Conclusion: Within this context, it is possible to understand that it is necessary to implement frequent supervised toothbrushing, oral instruction and motivation activities to promote wellness and health for these patients.

Oral rehabilitation of patient with severe early childhood caries: a case report

Introduction: Severe early childhood caries (S-ECC) is very common in pre-school children and shows a pattern of development which is defined and symmetrical, beginning on the cervical third of labial surface of maxillary anterior teeth. Accordingly, it can damage speech, swallowing, feeding, development, esthetics and self-esteem of the child. Objective: To report a case of a 5-year-old female patient with S-ECC on teeth #51, #52, #61 and #62. Case report: The patient came to dental clinic of the university with her mother for dental care. During the interview, the mother reported that her daughter used to drink milk in baby bottle at day and night with sugar content. Moreover, oral hygiene was not performed after bottle feeding at night. On clinical examination, the teeth #51, #52, #61 and #62 presented coronal destruction, and the mucosa associated at these teeth was very inflamed. Radiographically, it was found that carious lesions were limited to inner dentin. The treatment plan included education on oral hygiene and diet guidance. Rehabilitation with acetate matrixes was the treatment chosen for teeth destroyed by caries. Conclusion: This study demonstrated that the use of acetate matrixes is an effective alternative to return aesthetics and functionality to teeth of patients with severe early childhood caries.

Mecanismos e fatores fisiológicos e patológicos no processo de reabsorção radicular de dentes decíduos / Physiological and pathological factors and mechanisms in the process of root resorption in primary teeth

Introdução: A reabsorção dentária é fundamental no processo de rizólise (reabsorção radicular fisiológica) dos dentes decíduos, entretanto as reabsorções dentárias patológicas, especialmente a do tipo inflamatória, caracterizam-se em consequência e/ou complicação de várias situações clínicas, como traumatismos dentários e lesões periapicais inflamatórias provenientes da doença cárie, constituindo causa comum de perda de dentes. Objetivo: Procurou-se apresentar e discutir uma revisão de literatura acerca do mecanismo das reabsorções radiculares fisiológica e patológica inflamatória em dentes decíduos, enfatizando seus eventos bioquímicos e celulares. Revisão de literatura: As células responsáveis pela reabsorção dos tecidos dentais são os odontoclastos, sob a influência de inúmeros estímulos e sinalizações moleculares oriundos de citocinas, neuropeptídeos, hormônios e produtos de degradação liberados quando o tecido é lesado. Porém até hoje não se sabe exatamente o que leva à diferenciação das células precursoras dos odontoclastos, o que lhes dá o sinal para iniciar a reabsorção em local e momento específicos (principalmente nos dentes decíduos) e por que eles são prematuramente ativados em algumas condições patológicas, mas não em outras. Conclusão: O conhecimento sobre o mecanismo molecular e os fatores que regulam o processo de reabsorção radicular ainda é escasso. A pesquisa nessa área mostra-se de grande relevância, uma vez que novos conhecimentos sobre a(s) via(s) molecular(es) da reabsorção dental podem permitir o desenvolvimento de terapias diferenciadas, mais biológicas, que controlem ou impeçam a reabsorção, evitando assim a extração do dente acometido e suas consequências.

Introduction: Tooth resorption is essential in the process of root resorption in primary teeth. However, pathological root resorption, mainly the inflammatory one, is a consequence and/or complication of several clinical conditions, such as dental trauma and periapical inflammatory lesions from dental caries, thus becoming a common cause of tooth loss. Objective: To present and discuss a literature review regarding the mechanisms of physiological and inflammatory pathological root resorption in primary teeth, emphasizing their biochemical and cellular events. Literature review: The odontoclasts cells are responsible for resorption of dental tissues, and they are influenced by several stimuli and molecular signals derived from cytokines, neuropeptides, hormones and degradation products released when tissue is injured. However, so far it is not clear what leads to the differentiation of the precursor cells of odontoclasts, what gives them the signal to start the resorption in a specific place and time (especially in primary teeth) and why they are activated in some pathological conditions, but not in others. Conclusion: The knowledge regarding molecular mechanisms and factors that regulate the process of root resorption is still meager. Research in this area is of great relevance, since new knowledge about the molecular pathway(s) involved in root resorption may allow the development of different therapies, more biological ones, in order to control or prevent resorption, thus preventing tooth loss and its consequences.

Injúrias não Intencionais na Infância: Estudo Piloto com Mães que Frequentam a Clínica de Bebês da Universidade Federal de Santa Catarina, Brasil / Non-intentional injuries in childhood: pilot-study with mothers attending the baby clinic of the Federal University of Santa Catarina, Brazil

Objetivo: Identificar a ocorrencia de injurias nao intencionais entre criancas de ate 3 anos de idade, que frequentam a Clinica de Bebes da Universidade Federal de Santa Catarina, junto a suas maes. Metodo: Estudo piloto transversal descritivo, com eixo temporal contemporaneo, realizado a partir de entrevistas guiadas por um questionario, com questoes abertas e fechadas, aplicadas a 28 maes de criancas que frequentaram a Clinica de Bebes da disciplina de Odontopediatria da Universidade Federal de Santa Catarina (UFSC), durante o ulti mo trimestre do ano de 2007. Resultados: Entre as maes entrevistadas 10 (35,7%) referiram a ocorrencia de injuria(s) nao intencional(is) no seu filho, perfazendo um total de 21 casos. A residencia das criancas foi o local onde ocorreram 12 (57,1%) das 21 injurias citadas, e 15 (71,4%) delas foram causadas por quedas. Em 18 (85,7%) casos a mae ou o pai acompanhavam a crianca no momento do agravo, e 12 (57,1%) das injurias tiveram gravidade moderada, exigindo atendimento hospitalar sem internacao. Em relacao ao recebimento de informacoes sobre a prevencao de injurias nao intencionais, 10 (35,7%) maes declararam nunca terem sido orientadas a respeito. Conclusao: A incidencia de injurias nao intencionais foi alta na amostra estudada, havendo a necessidade de estudos a nivel populacional, que possam orientar acoes praticas de prevencao deste agravo. Ainda, cirurgioes-dentistas, especialmente odontopediatras, tem contato regular com criancas e suas familias, portanto e de grande valia sua participacao em acoes conjuntas entre governo, profissionais da saude e sociedade civil, visando a promocao da seguranca infantil.

Objective: To identify the occurrence of non-intentional injuries in children under the age of 3 att ending the Baby Clinic of the Federal University of Santa Catarina, SC, Brazil, with their mothers. Method: This investigation was a descriptive cross-sectional pilot-study with a contemporaneous temporal axis, which conducted from interviews guided by a questionnaire with open and multiple-choice questions applied to 28 mothers of children who attended the Baby Clinic of the Discipline of Pediatric Dentistry of the Federal University of Santa Catarina during the last trimester of 2007. Results: Among the interviewed mothers, 10 (35.7%) reported that their children had suffered non-intentional injuries, totalizing 21 cases. Home was the site of accident of 12 (57.1%) of the 21 injuries, and 15 (71.4%) of them were caused by falls. In 18 (85.7%) cases, either the mother or the father was with the child at the moment of the accident, and 12 (57.1%) injuries had moderate severity, requiring in-hospital treatment without need of admission. Ten (35.7%) mothers affirmed that they had never received information about prevention of non-intentional injuries. Conclusion: The incidence of non-intentional injuries was high in the surveyed population, showing the need of studies with a national sample that may guide practical actions to prevent this type of injury. In addition, as dentists ? especially pediatric dentists - have regular contact with children and their families, their engagement in collective actions with the government, health professionals and civil society, is very important to promote childrens safety.

Desigualdade em saúde / Health inequalities

higher educational level have easily access to health information and treatment. Oral diseases have also their origin and clinical evolution determined by social factors, getting easily to harmful stages that can lead to oral health damage. Conclusion: Social inclusion policies should be developed with effective participation of society in order to provide better living conditions for the population, thus better health conditions, aiming at solving inequalities.

Introduction and objective: The aim of this study is to describe aspects of health inequalities in Brazil, correlating theory and practice, as well as emphasizing these aspects in dentistry. Literature review: According to recent studies, economically privileged classes with higher educational level have easily access to health information and treatment. Oral diseases have also their origin and clinical evolution determined by social factors, getting easily to harmful stages that can lead to oral health damage. Conclusion: Social inclusion policies should be developed with effective participation of society in order to provide better living conditions for the population, thus better health conditions, aiming at solving inequalities.

Participação dos pais na tomada de decisões no atendimento odontológico de seus filhos / Parent?s role On the decision taking Of their children?s dental treatment

Introdução: Segundo o Código de Ética Odontológica, é considerada infração o atendimento de pacientesinfantis sem o consentimento dos pais ou responsáveis, salvo em situações de urgência. No tratamentoodontopediátrico, é indispensável o esclarecimento dos pais em relação aos procedimentos a que seus filhos serão submetidos, as opções de tratamento existentes e seus custos, para que eles possam emitir um consentimentorealmente esclarecido. O objetivo deste estudo é analisar se e de que forma os pais participam da tomada de decisões no atendimento odontológico de seus filhos. Para tanto, realizou-se uma pesquisa, utilizando-se um questionário, junto a 122 pais, cujos filhos tinham idades entre 0 e 6 anos e encontravamsematriculados em uma escola pública no município de Florianópolis. Verificou-se que 70,2% dos paisautorizaram o tratamento de seus filhos de forma verbal, apenas 5,3% deles assinaram um Termo de Consentimento Livre e Esclarecido e 61,6% não receberam opções de tratamento. Concluiu-se que a postura paternalista do profissional, tem imperado também nos consultórios odontopediátricos, onde as decisões deveriam ser compartilhadas com os responsáveis legais pela criança

Introduction: According to the Brazilian Dental Ethical Code it is considered an infration to treat childrenwithout parents or guardians consent except in emergencial needs. On pediatric dental treatment it ismandatory that parents should be informed about the procedures that their children will receive as wellas treatment options and their costs to allow them to emit a clarified consent. The aim of this study is toanalyse if and how parents participate on decisions about their children?s dental treatment. It was used aquestionnaire to 122 parents or guardians, of children between 0 and 6 years of age, attending a publicschool in Florianópolis. 70,2% of parents did authorize orally dental treatment of their children, only 5,3%signed a written consent and 61,6% did not receive treatment options. It was concluded that paternalistposture is still present nowadays in dental pediatric office, where children?s treatment choices should beshared with parents

Mudanças do pH salivar em crianças após a ingestão de suco de frutas industrializado / Salivary pH changes in children after industrialized fruit juice consumption

Introdução: As crianças apresentam erosão dentária e cáries precoces na infância associadas a uma dieta rica em carboidratos, a qual incluia ingestão freqüente de sucos industrializados em caixa. A ingestão de bebidas com pH inferior a 5,5 pode causar erosão principalmente se o ataque for de longa duração e freqüente. A proteção natural dos dentes é a saliva, por intermédio de seu tamponamento salivar. Objetivo: Medir o pH salivar em crianças antes e após a ingestão de suco de uva (DelValle Kids). Material e métodos: Participaram do trabalho 31 crianças com idade entre 6 e 12 anos, de ambos os sexos. A variação do pH foi medida com uma fita colorimétrica. Aferiu-se o pH antes, imediatamente após a ingestão do suco, 5, 10 e 15 minutos após a ingestão. Resultados:Houve diferença estatisticamente significante entre os grupos. Observou-se uma redução imediatamente 5 e 10 minutos após a ingestão do suco em relação ao basal. No tempo imediato o valor do pH de 16 crianças foi acima de 5,5, e 15 apresentaram pH igual ou abaixo de 5,5. No tempo de 5 minutos, 3 crianças mantiveram esse pH, e após10 minutos todas as crianças apresentaram pH acima de 5,5.Conclusão: Pode-se concluir que o suco de fruta apresenta pH baixo eque após 10 minutos da ingestão do suco o pH salivar de todos os participantes tinha valor acima de 5,5, elevando-se próximo aos valores normais com o tempo de 15 minutos.

Introduction: The children presented dental erosion and caries in early infancy that were associated to a rich diet in sugars, including the frequent ingestion of industrialized fruit juice (conditioned in boxes).The drink ingestion with pH lower than 5.5 can cause teeth erosionmainly if it is associated with frequent and prolonged teeth contact.The natural protection of teeth is the saliva through its buffering capacity. Objective: Measure the children salivary pH before and after the grape fruit juice (Del Valle Kids) ingestion. Material and methods: Thirty one children with age between 6 and 12 years of both sexes participated in the study. The pH was measured with pH paper indicator. The salivary pH was measured before, immediately after, and at the 5, 10 and 15min following the ingestion of the juice. Results: There was a significant difference of the pH at different time measurement. A reduction was observed immediately, 5 and 10 minutes after juice ingestion in relation to the basal one. Immediately after fruit ingestion the pH measurementof 16 children was above 5.5 while 15 children presented a pH equalor below of 5.5. At 5 minutes, 3 children still had a pH equal or below5.5. At 10 minutes, all the children had pH above 5.5. Conclusion: It was concluded that, in children, immediately after the ingestion of fruitjuice, there is a clinically significant pH decrease, which can reduce the salivary buffer capacity, but after 10 minutes this ingestion salivarypH reached values above 5.5, raising to next to the normal values atthe time of 15 minutes.

Tooth ankylosis in deciduous teeth of children with cleft lip and/or palate

Este estudo avaliou a prevalência de anquilose dentária em molares decíduos de portadores de fissura de lábio e/ou palato, brancos, de ambos os sexos, com idade entre 5 e 12 anos. Um total de 330 pacientes atendidos no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo para tratamento de rotina foi clinicamente avaliado. A prevalência de anquilose foi analisada em relação a gênero, idade (5-7; 8-10; 11-12 anos), tipo de fissura, dente e arco afetados. O grupo total demonstrou prevalência de 18%, sem diferença estatística entre gêneros e tipos de fissura, sendo mais acometido o arco mandibular, o primeiro molar inferior e as faixas etárias de 8 a 10 e de 11 a 12 anos. Os resultados estão de acordo com aqueles observados na literatura para pacientes sem fissuras, destacando a ausência da influência das fissuras na prevalência de anquilose. Isso reforça a importância do diagnóstico precoce dessa anomalia e do tratamento de escolha, que são similares aos de pacientes sem fissuras.