Occlusion development after premature loss of deciduous anterior teeth: preliminary results of a 24-month prospective cohort study

ABSTRACT Objective: This study aimed to evaluate occlusion development after premature loss or extraction of deciduous anterior teeth, by means of a prospective cohort study. Methods: Fifteen infants and children aged 1 to 5 years old were longitudinally assessed (with loss or extraction of deciduous anterior teeth [n = 9], and without tooth losses [n = 6]). Photographs and dental casts at the baseline and after 24 months of follow-up were performed. Dental casts were scanned, and linear measurements were made on the digitalized models (missing tooth space, arch perimeter, arch length, arch width, intercanine length and intercanine width). The t-test was used for groups comparisons (α = 0.05). Results: Individuals' mean age at baseline was 2.93 (± 1.18) years. No statistically significant differences were observed in the missing tooth space in the group with tooth loss during the 24 months of follow-up (p > 0.05). Arch perimeter, arch length, arch width, intercanine length and intercanine width did not show differences between the groups (p > 0.05). Qualitative photographic evaluation revealed other changes in the dental arches and occlusion, such as exfoliation and eruption of deciduous teeth, eruption of permanent teeth, self-correction or establishment of malocclusion, among others. Conclusion: The results suggest that the premature loss of deciduous anterior teeth does not affect the perimeter, length and width of the dental arches; however, other alterations that lead to malocclusion could be established.

RESUMO Objetivo: Este estudo teve como objetivo avaliar o desenvolvimento da oclusão após perda prematura ou extração de dentes decíduos anteriores, por meio de um estudo de coorte prospectivo. Métodos: Quinze bebês e crianças de 1 a 5 anos foram avaliados longitudinalmente (com perda ou extração de dentes anteriores decíduos [n = 9] e sem perdas dentárias [n = 6]). Foram realizadas fotografias e modelos dentais no início e após 24 meses de acompanhamento. Os modelos dentários foram escaneados e medidas lineares foram feitas nos modelos digitalizados (espaço dentário perdido, perímetro da arcada, comprimento da arcada, largura da arcada, comprimento intercaninos e largura intercaninos). O teste t foi utilizado para comparações entre grupos (α = 0,05). Resultados: A média de idade dos indivíduos no início do estudo foi de 2,93 (± 1,18) anos. Não foram observadas diferenças estatisticamente significativas no espaço dentário perdido no grupo com perda dentária durante os 24 meses de acompanhamento (p > 0,05). O perímetro da arcada, comprimento da arcada, largura da arcada, comprimento intercaninos e largura intercaninos não apresentaram diferenças entre os grupos (p> 0,05). A avaliação fotográfica qualitativa revelou alterações nas arcadas dentárias e na oclusão, como: esfoliação e erupção de dentes decíduos, erupção de dentes permanentes, autocorreção ou estabelecimento de má oclusão, entre outras. Conclusão: Os resultados sugerem que a perda prematura de dentes anteriores decíduos não afeta o perímetro, comprimento e largura das arcadas dentárias; entretanto, outras alterações que levam à má oclusão poderiam ser estabelecidas.

Fatores comportamentais e socioeconômicos são fortes preditores de cárie dentária em pré- escolares: um estudo transversal / Behavioral and socioeconomic factors are strong predictors of dental caries in preschoolers: a cross-sectional study

Avaliaram-se possíveis preditores para a cárie dentária em pré-escolares sem experiência odontológica prévia, que buscaram a clínica de odontopediatria de uma universidade pública. Analisaram-se 191 prontuários, dos quais 87 foram incluídos. Coletaram-se dados demográficos, socioeconômicos, histórico de cárie da mãe, orientação prévia sobre cárie, frequência de escovação, uso de dentifrício fluoretado, consumo de doces/biscoitos e/ou líquidos açucarados, ceo-d e a presença ou ausência de defeitos de desenvolvimento do esmalte. Análises descritivas e de regressão logística binária foram realizadas para investigar quais variáveis prediziam um ceod>0. O modelo múltiplo incluiu consumo de doces/biscoitos, dados socioeconômicos, histórico de cárie na mãe e orientação prévia sobre cárie. Das crianças (2,69±1,18 anos), a maioria (67,8%) apresentava ceod>0 (3,78±3,82), sendo 50,6% meninas e 73,3% da classe baixa. A maioria (56,5%) das mães tinha 12 anos de estudos completos, histórico de cárie (78,6%) e receberam orientação prévia sobre cárie (52,9%). A maior parte (80,6%) escova os dentes pelo menos 2 vezes ao dia, utiliza dentifrício fluoretado (75,9%) e consome líquidos açucarados (90,8%), além de doces/biscoitos (86,9%) entre as refeições. Pertencer à classe baixa aumentou em 7 vezes a chance de ceod>0 (OR=7,354; IC 95%=1,951-27,723), histórico de cárie na mãe em 4 vezes (OR=4,131; IC 95%=1,042-16,369) e consumo de doces/biscoitos em quase 2 vezes (OR=1,786; IC 95%=1,072-2,976). Classe econômica baixa, histórico de cárie da mãe e consumo de doces/biscoitos entre as refeições mostraram-se fatores associados ao ceod>0 nos pacientes sem experiência prévia odontológica de uma clínica de odontopediatria de uma universidade pública.

Possible predictors of dental caries in preschool children without previous dental experience, who sought a pediatric dentistry clinic at a public university, were evaluated. Medical records (n=191) were analyzed; 87 were included. Demographic, socioeconomic data, mother's history of caries, previous orientation on caries, brushing frequency, use of fluoridated toothpaste, consumption of sweets/cookies and/or sugary liquids, dmft and the presence or absence of enamel development defects were collected. Descriptive and binary logistic regression analyzes were performed to investigate which variables predicted a dmft>0. The multiple model included consumption of sweets/cookies, socioeconomic data, mother's history of caries and previous orientation on caries. Of the children (2.69±1.18 years), most (67.8%) had dmft>0 (3.78±3.82), with 50.6% girls and 73.3% from the lower class. Most mothers had completed 12 years of schooling (56.5%), reported history of caries (78.6%) and received previous orientation on caries (52.9%). Most of children brush their teeth at least twice a day (80.6%), use fluoridated toothpaste (75.9%) and consume sugary liquids (90.8%), in addition to consumption of sweets/cookies (86 .9%) among the meals. Belonging to the lower class increased the chance of having dmft>0 by 7 times (OR=7,354; 95% CI=1,951-27,723), mother's history of caries by 4 times (OR=4,131;95% CI=1,042-16,369) and consumption of sweets/cookies by almost twice (OR=1,786;95% CI=1,072-2,976). Low economic class, mother's history of caries and consumption of sweets/cookies between meals were factors associated with dmft>0 in the patients without previous dental experience in a pediatric dentistry clinic at a public university.

Efficacy of 30% and 38% Silver Diamine Fluoride in Arresting Caries Lesions After Different Application Times: An in Vitro Study

Abstract Objective: To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions when applied under different concentrations and times. Material and Methods: Forty-two bovine blocks were selected and fixed in 24-well plates. Each well received a mixed bacterial inoculum added to the culture medium with 5% sucrose. The plates were incubated in microaerophilia (7 days) for caries formation, confirmed by micro-CT (M1). SDF was applied over the carious lesions for different times and concentrations (n=6): SDF 30% - immediate removal, 1 minute and 3 minutes; SDF 38%, - immediate removal, 1 minute and 3 minutes. The group without treatment was the control. Then, the samples were again scanned by micro-CT (M2) and submitted to a second cariogenic challenge for 21 days. Then, a final scan was performed (M3). Results: Mean pH at the culture medium and lesion depth were compared using Kruskal-Wallis and Wilcoxon tests. 38% SDF showed the lowest metabolic activity of the biofilm. All 38% groups and 30% 1 and 3 minutes did not show an increase in mean lesion depth comparing M3 with M1. However, only 30% 3 minutes and 38% 1 and 3 minutes showed a significant reduction of lesion depth. Conclusion: The minimum application time of 30% SDF to arrest dentin caries lesion was 1 minute, while 38% SDF arrested with application and immediate removal.

Survey of Knowledge, Attitudes and Practices of Brazilian Dentists Regarding Silver Diamine Fluoride

Abstract Objective: Current acceptability, barriers to use, and clinical/teaching practices of Silver Diamine Fluoride (SDF) among Brazilian dentists were investigated. Material and Methods: A Google forms questionnaire was sent to dentists (n=10,500) to collect information about the use of SDF and the dentists' workplace, experience, specialty, and city of practice. A logistic regression model was performed. Results: From 409 respondents, 13.2% used SDF. Working at universities increased the use of SDF by 2.29 times (p=0.018) compared to private offices. Each training year, the chance of SDF usage increased by 3% (p=0.008). Pediatric dentists are more likely to use SDF (OR=6.76, p<0.001). There is no association between SDF usage and the city of practice. The majority (75.9%) indicated SDF for noncompliant patients. Dentists (75.9%) reported the exclusive use in deciduous teeth, while 24.1% also use in permanent teeth. The main barrier for non-users was a lack of knowledge (58.3%), while for users, tooth staining (90.7%) and parental acceptance (64.8%) were the complaints. Conclusion: The Silver Diamine Fluoride is not a common product used by the dentists from RJ. Its clinical applicability should be further disseminated; thus, lack of scientific knowledge would cease to be a problem in the use of SDF to arrest caries lesions.

The dentist as a child abuse informer: a case report

Introducition: Domestic violence against children interferes in their psychological development, leading to sequels that manifest and persist up to adulthood. Physical evidence of domestic violence is easily observed in the orofacial complex and eventually becomes detected by dentists. Case Report: We report the case of a 9-year-old victim of maltreatment who was diagnosed during dental treatment. The existence of physical injuries (a hematoma in the left orbit and burns on the left hand and in the lips) aroused the attention of the pediatric dentistry, whose brought the case to the responsible authorities. Custody of the child was granted to the grandmother by a court decision, which enabled the recovery of health and quality of life. Conclusion: Professionals must properly conduct cases through complaints in order to protect children from future occurrences.

Introdução: A violência doméstica contra as crianças interfere no seu desenvolvimento psicológico, levando a sequelas que se manifestam e persistem até a idade adulta. A evidência física da violência doméstica é facilmente observada no complexo orofacial e, eventualmente, é detectada pelos dentistas. Relato do Caso: Relatamos o caso de uma vítima de maus-tratos, de 9 anos de idade, que foi diagnosticada durante o tratamento odontológico. Um odontopediatra, durante as consultas de rotina, após identificar injúrias físicas (hematoma na órbita esquerda e queimaduras na mão esquerda e lábios), suspeitou tratar-se de maus tratos, levando o caso às autoridades responsáveis. A custódia da criança foi concedida à avó por uma decisão judicial, o que permitiu a recuperação da saúde e qualidade de vida. Conclusão: Os profissionais devem conduzir adequadamente os casos de abuso, a fim de proteger as crianças de ocorrências futuras.