Influence of genetic polymorphisms on oral health-related quality of life after root canal treatment

Abstract To evaluate the impact of genetic polymorphisms in interleukins (IL1A rs17561, rs1304037; IL10 rs1800871; IL1RN rs9005), nitric oxide (NOS2 rs2779249, rs2897518) and suppressor of cytokine signaling (SOCS1 rs243327, rs33977706) on oral health-related quality of life (OHRQoL) of patients under-going root canal treatment (RCT). Methods: The sample consisted of 108 participants, presenting single-rooted teeth with asymptomatic periapical periodontitis. The impact of the OHRQoL was recorded using the Oral Health Impact Profile (OHIP-14) before, seven, and 30 days after RCT. Saliva samples were collected as a source of genomic DNA. Genetic polymorphisms were genotyped by Real-Time PCR using the Taqman method. Univariate and Multivariate analyses were used (p<0.05). Results: A significant difference was observed for the polymorphism rs2297518 in the NOS2 gene in functional limitation in the codominant (p=0.037) and recessive (p=0.001) models; in the physical pain (p<0.001 in both models); in psychological discomfort (p<0.001 in both models); in physical disability (p<0.001 in both models) and in psychological disability (p<0.001 in both models). Polymorphisms in the SOCS1 gene, in the recessive model, rs33977706 (p=0.045) and rs243327 (p=0.019), influenced the OHRQoL in the psychological discomfort domain. Conclusions: Polymorphisms in NOS2 and SOCS1 genes influenced the OHRQoL of patients undergoing RCT.

Resumo Avaliar o impacto de polimorfismos genéticos em interleucinas (IL1A rs17561, rs1304037; IL10 rs1800871; IL1RN rs9005), óxido nítrico (NOS2 rs2779249, rs2897518) e supressor da sinalização de citocinas (SOCS1 rs243327, rs33977706) na qualidade de vida relacionada à saúde bucal (QVRSB) de pacientes submetidos a tratamento endodôntico (TE). Métodos: A amostra foi composta por 108 participantes, que apresentavam dentes unirradiculares com lesão periapical assintomática. O impacto da QVRSB foi registrado usando o Oral Health Impact Profile (OHIP-14) antes, sete e 30 dias após o TE. Amostras de saliva foram coletadas como fonte de DNA genômico. Os polimorfismos genéticos foram genotipados por PCR em tempo real usando o método Taqman. Análises univariadas e multivariadas foram utilizadas (p<0,05). Resultados: Observou-se diferença significativa para o polimorfismo rs2297518 no gene NOS2 na limitação funcional nos modelos codominante (p=0,037) e recessivo (p=0,001); na dor física (p<0,001 em ambos os modelos); no desconforto psicológico (p<0,001 em ambos os modelos); na deficiência física (p<0,001 em ambos os modelos) e na deficiência psicológica (p<0,001 em ambos os modelos). Polimorfismos no gene SOCS1, no modelo recessivo, rs33977706 (p=0,045) e rs243327 (p=0,019), influenciaram a QVRSB no domínio desconforto psicológico. Conclusões: Polimorfismos nos genes NOS2 e SOCS1 influenciaram a QVRSB de pacientes submetidos a TE.

Association between nutritional status and children and adolescents' dental caries experiences: an overview of systematic reviews

Abstract An increasing number of systematic reviews (SR) has investigated the association between dental caries and nutritional status in children and adolescents, thus requiring an overview to compile the information in a single piece of evidence. Therefore, this study aimed to evaluate and summarize evidence from published SR on the association between dental caries and nutritional status in children and adolescents. A wide search was conducted on May 29, 2023, in six databases (Medline via PubMed, Scopus, Web of Science, Cochrane library, Embase, and the Virtual Health Library - VHL). An additional search was performed in the gray literature (Open grey and Google Scholar), SR registration databases, and the list of references of the included SR. Our inclusion criteria were based on acronym PECOS. Overall, two reviewers independently extracted the data, evaluated the risk of bias (ROBIS), and assessed the quality of the chosen studies (AMSTAR-2). Data from the included meta-analysis were summarized and certainty of evidence using the GRADE approach was performed. After removing duplicates and applying our eligibility criteria, 19 SR from 2006-2022 were included. We found that 17 SR showed high risk of bias and critically low methodological quality. We observed an association between dental caries experiences and nutritional status since seven SR found an association between obesity/overweight and dental caries; one, an association between underweight and dental caries; and eleven, no associations. The meta-analysis showed divergent results according to the study designs, used indices, and participants' age group, and were scored as having a very low certainty of evidence. Therefore, based on the high risk of bias, low methodological quality, and very low certainty of evidence of the chosen SR, most studies found no association between children and adolescents' nutritional status and dental caries experience.

Do irrigation solutions used during root canal instrumentation influence the adhesion of glass fiber posts? A systematic review / As soluções de irrigação usadas durante a instrumentação do canal radicular influenciam a adesão de pinos de fibra de vidro? Uma revisão sistemática

Statement of problem: the bond strength between adhesive cement and root dentin can be affected by irrigation protocols. Purpose: therefore, the objective of this systematic review was to answer the following question: Do irrigation solutions used during root canal instrumentation influence the adhesion of glass fiber posts to root dentin? Material and Methods: this study followed the recommendations of PRISMA 2020 for writing. PubMed, Scopus, Web of Science, and LILACS databases were searched for articles published until 26 January, 2022. Grey literature and a manual search were also performed. The inclusion criteria were based on the PICO strategy: permanent human or animal teeth (P), which were irrigated during root canal instrumentation with endodontic substances (I) and compared to irrigation with sodium hypochlorite at various concentrations (C) to analyze the bond strength of glass fiber posts (O). Two authors independently performed data extraction and the risk of bias. Results: eight articles were included. Four articles were classified as having a high risk of bias, where the others as medium risk. Studies have reported conflicting results regarding the influence of irrigating solutions and the different concentrations of sodium hypochlorite on the adhesion of glass fiber posts to root dentin. Conclusion: the heterogeneity between studies did not allow the conclusion of a true estimate regarding this topic, and further well-designed studies are needed to clarify this issue. Register: CRD42020221835. (AU)

Definição do problema: a resistência de união entre o cimento adesivo e a dentina radicular pode ser afetada pelos protocolos de irrigação. Objetivo: portanto, o objetivo desta revisão sistemática foi responder à seguinte questão: As soluções de irrigação usadas durante a instrumentação do canal radicular influenciam a adesão de pinos de fibra de vidro à dentina radicular? Material e Métodos: este estudo seguiu as recomendações do PRISMA 2020 para sua redação. As bases de dados PubMed, Scopus, Web of Science e LILACS foram pesquisadas para artigos publicados até 26 de janeiro de 2022. A literatura cinza e uma pesquisa manual também foram realizadas. Os critérios de inclusão foram baseados na estratégia PICO: dentes humanos ou animais permanentes (P), que foram irrigados durante a instrumentação do canal radicular com substâncias endodônticas (I) e comparados à irrigação com hipoclorito de sódio em várias concentrações (C) para analisar a resistência de união de pinos de fibra de vidro (O). Dois autores realizaram independentemente a extração de dados e o risco de viés. Resultados:oito artigos foram incluídos. Quatro artigos foram classificados como de alto riscode viés, enquanto os demais como de médio risco. Estudos relataram resultados conflitantes sobre a influência de soluções irrigadoras e as diferentes concentrações de hipoclorito de sódio na adesão de pinos de fibra de vidro à dentina radicular. Conclusão: a heterogeneidade entre os estudos não permitiu a conclusão de uma estimativa verdadeira sobre este tópico, sendo necessários mais estudos bem delineados para esclarecer esta questão. Registo: CRD42020221835 (AU)

Association of MTR and MTRR genes and oral health-related quality of life in children with dental caries

Abstract This study aimed to assess whether genetic polymorphisms in MTR and MTRR are potential biomarkers of oral health-related quality of life (OHRQoL) in children with caries. A cross-sectional study was designed wherein pairs of parents/caregivers and children (aged two-five years) were selected. Clinical examination was used to detect dental caries, which were classified as low-severity and high-severity caries. The Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire was used to assess OHRQoL. Genomic DNA extracted from the saliva was used to analyze two missense genetic polymorphisms: MTR (rs1805087) and MTRR (rs1801394). Mann-Whitney non-parametric test was used to analyze candidate genes with OHRQoL scale and domain, with a significance level of p≤0.05. MTR (rs1805087) was found associated (p = 0.05) with children's OHRQoL subscale scores in the dominant model (GG + AG). Genetic polymorphisms in MTR may increase the risk of poor OHRQoL in children with caries. Further studies are needed to investigate genetics, molecular factors, and OHRQoL.

Factors associated with postoperative signs and symptoms in teeth with periapical lesion: a longitudinal study

Abstract This study aimed to evaluate the association of the variables age, gender, arch position, tooth length, root canal amplitude, and periapical lesion size with the occurrence of postoperative signs and symptoms (pain, tenderness, and edema) and the use of postoperative analgesics following root canal treatment with foraminal enlargement in single-rooted teeth with apical periodontitis. This prospective longitudinal study included 105 patients requiring root canal treatment of maxillary or mandibular single-rooted teeth with periapical lesion. After root canal treatment in a single session, pain intensity and tenderness were recorded daily for 7 days and on days 14 and 30. Edema was evaluated by two independent evaluators within 48 h, 72 h, and 7 days after treatment. Ordinal and logistic regressions were performed (p < 0.05). Female gender (beta = 1.02; p < 0.01), mandibular teeth (beta = 25.50; p < 0.01), medium root canal amplitude (beta = 0.93; p = 0.03), and edema (beta = 1.88; p < 0.01) were associated with increased postoperative pain and tenderness, while the use of analgesics (beta = -1.82; p < 0.01) and time in days (beta = -0.23; p < 0.01) were associated with a decrease in these signs and symptoms. Edema was considered a risk factor for analgesic requirement (Odds Ratio [OR] = 61.46; p < 0.01). Factors such as gender, arch position, and root canal amplitude were associated with postoperative signs and symptoms. The use of analgesics was more required in edema and was associated with decreased pain.

Resumo Este estudo teve como objetivo avaliar a associação das variáveis idade, sexo, posição no arco, comprimento do dente, amplitude do canal radicular e tamanho da lesão periapical com a ocorrência de sinais e sintomas pós-operatórios (dor, dor ao toque e edema) e o uso de analgésicos após o tratamento endodôntico com alargamento foraminal em dentes uniradiculares com lesão periapical. Este estudo longitudinal prospectivo incluiu 105 pacientes que necessitavam de tratamento endodôntico em dentes uniradiculares superiores ou inferiores com lesão periapical. Após o tratamento do canal radicular em uma sessão, a intensidade da dor e a dor ao toque foram registradas diariamente por 7 dias e nos dias 14 e 30. O edema foi avaliado por dois avaliadores independentes dentro de 48 h, 72 h e 7 dias após o tratamento. Foram realizadas regressões ordinal e logística, e a significância estatística foi fixada em um valor de p < 0,05. Gênero feminino (beta = 1,02; p < 0.01), dentes inferiores (beta = 25,50; p < 0.01), amplitude média do canal radicular (beta = 0,93; p = 0,03) e edema (beta = 1,88; p < 0.01) foram associados ao aumento da dor e dor ao toque pós-operatória, enquanto o uso de analgésicos (beta = -1,82; p < 0.01) e o tempo em dias (beta = -0,23; p < 0.01) foram associados à diminuição desses sinais e sintomas. O edema foi considerado fator de risco para necessidade de analgésico (Odds Ratio [OR] = 61,46; p < 0.01). Fatores como sexo, posição do arco e amplitude do canal radicular foram associados aos sinais e sintomas pós-operatórios. O uso de analgésicos foi mais necessário no edema e foi associado à diminuição da dor.

Genetic polymorphisms in TNF-α as a potential biomarker for oral health-related quality of life in children

Abstract: This cross-sectional study aimed to assess if genetic polymorphisms in TNF- α are associated with a negative impact on Oral Health-Related Quality of Life (OHRQoL) in children with dental caries. A total of 307 pairs of parents/caregivers and children aged two to five years were selected. The children were clinically evaluated and classified according to caries experience and severity of active caries. The Brazilian Portuguese version of the Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess OHRQoL. Genotyping analysis of genetic polymorphisms in TNF- α (rs1799724, rs1799964, and rs1800629) was performed using real-time polymerase chain reaction. In the recessive model, children with the CC genotype of TNF-α (rs1799964) had a significantly high chance of poor OHRQoL in the symptom domain (pain), in both the caries experience (p = 0.045) and the high-severity active caries phenotypes (p = 0.033) (Mann-Whitney U test). It was concluded that genetic polymorphisms in TNF-α are associated with OHRQoL related to the symptom domain (pain), suggesting that TNF-α could be used as a potential biomarker for OHRQoL. Understanding the genetic aspects associated with OHRQoL will allow the early identification of patients with OHRQoL disparities and provide personalized healthcare.

Protocolo clínico-laboratorial para a confecção de protetor bucal personalizado ao alcance do clínico / Clinical-laboratory protocol for the manufacture of personalized mouthguard within the reach of the clinician

O procedimento de pulpectomia em dentes decíduos consiste na remoção total do tecido pulpar com inflamação irreversível ou com necrose, preparo químicomecânico e obturação com material reabsorvível, com o intuito de manter o dente o maior tempo possível na cavidade bucal, devolvendo função e saúde para o paciente infantil. Existem vários protocolos descritos na literatura, no entanto, não há consenso entre eles e poucos possuem acesso livre. Sendo assim, observa-se carência de um guia clínico e prático para nortear o cirurgião-dentista na realização desse procedimento durante o atendimento odontopediátrico. Portanto, o intuito deste trabalho é apresentar aos clínicos um protocolo de pulpectomia com altas frequências de sucesso clínico e radiográfico, baseado em evidências científicas, desenvolvido e aplicado pelo Grupo de Pesquisa de Endodontia em Odontopediatria da Universidade Federal do Rio de Janeiro (GEDOPED-UFRJ). O presente protocolo contempla indicações, contraindicações, tática operatória, materiais necessários e orientações para acompanhamento. Com esta publicação de maneira gratuita, de acesso livre e no idioma dominante do país, espera-se ampliar o alcance de odontopediatras e clínicos gerais que atendem crianças a um tratamento eficaz.

Pulpectomy in primary teeth consists of the complete removal of the irreversibly affected pulp or necrotic pulp tissue, chemical-mechanical preparation of the root dentin and filling root canals with a resorbable material, to keep the tooth as long as possible in the oral cavity, restoring function and health. There are several pulpectomy protocols described in the literature, however, there is no consensus among them and only few of them are open access. Therefore, there is a lack of clinical and practical guides to the practitioner in performing this procedure during pediatric dental care. The aim of this article is to present a clinically and radiographically successful pulpectomy protocol, based on scientific evidence, developed, and applied by the Research Group on Endodontics in Pediatric Dentistry at the Universidade Federal do Rio de Janeiro. This protocol includes indications, contraindications, operative techniques, materials, and guidelines for follow-up appointments. With this open access publication in Portuguese, we hope to disseminate an effective treatment and expand the outreach of a pulpectomy technique protocol to pediatric dentists and clinicians who treat children.

Association of taste receptor gene polymorphisms with dental caries

Abstract This study was performed to evaluate the interplay between dental caries, nutritional status, and genetic polymorphisms in TAS1R1 and TAS1R2 (taste receptor, type 1, member 1 and 2) in preschool children and pre-adolescents. We included 525 subjects (306 preschool children and 219 pre-adolescents). Parents/caregivers answered a self-administered questionnaire about their children's systemic health, characteristics, oral hygiene habits, and diet. Clinical examination was performed to evaluate dental caries and nutritional status. Saliva samples were collected for DNA extraction. The genotyping of rs17492553 ( TAS1R1 ), rs3935570, and rs4920566 ( TAS1R2 ) polymorphisms was performed using real-time PCR with Taqman Genotyping Master Mix and SNP assay. Both univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis. In preschool children, consumption of sweets between meals increased the prevalence of dental caries by 85% (PR c = 1.85; 95%CI 1.39-2.46; p < 0.001), whereas in pre-adolescents, this prevalence increased by 34% (PR a = 1.34; 95%CI 1.11-1.62; p = 0.002), regardless of genetic polymorphisms . Moreover, individuals carrying at least one allele C in rs17492553 presented 23% more prevalence of dental caries (PR a = 1.23; 95%CI 1.02-1.49 p = 0.030). Nutritional status was not associated with dental caries, neither with genetic polymorphisms . Consumption of sweets between meals increased the prevalence of dental caries. In pre-adolescents, rs17492553 genetic polymorphism in TAS1R1 was associated with dental caries.

Risk Factors for Different Types of Traumatic Injuries in Primary Teeth

Abstract Objective: To evaluate traumatic dental injuries (TDI) in primary teeth and the association of gender and age with different injuries. Material and Methods: Records of patients with TDI in primary teeth were included. The following parameters were registered: gender and age, place of trauma, cause of trauma, affected tissue and tooth, number of injured teeth, type of injury, and gingival and bone damage. A logistic regression analysis was performed to explore the interaction between gender and age on the occurrence of types of injuries (p≤0.05). Results: The total of 721 records were evaluated and 370 records were included, being 61.6% boys and 60.5% children aged 0-3 years old, with 658 primary teeth affected. The support tissue was most affected (496/658), followed by dental tissue (139/658). Enamel/dentine fracture with pulp exposure (n=51) and intrusion (n=131) were the most common injuries of dental and support tissues, respectively. In general, boys suffered more traumas than girls, regardless of the age range. As for concussion, logistic regression confirms that gender and age are also influencers. Girls (OR=1.822, CI = 1.050-3.164, p=0.033) in the 4-6 year age group (OR=2.15, CI = 1.239-3.747, p=0.007) are more likely to have concussions. Children age 4-6 years were less likely to suffer an intrusion (OR=0.496; CI = 0.278-0.886; p=0.018). Conclusion: Gender and age influence concussion and intrusion in the primary teeth.

Oral health-related quality of life of 8-10 year-old children with traumatic dental injury

Introduction: Children presents high prevalence of traumatic dental injury (TDI). Objective: It is very important to detect the impact on oral health related to quality of life (OHRQoL) in this age group. Methods: Based on this, a cross sectional study was carried out using a convenience sample. Children from 8-10 years with TDI in permanent teeth were recruited over an 18 month period, from a public University. Data about OHRQoL using the Brazilian version of CPQ 8-10 (B-CPQ 8- 0 ) were collected. TDI were classified according to Andreasen criteria and grouped according to its severity. Variations in the scores and impact of TDI on OHRQoL according to age, gender and TDI severity were examined using nonparametric statistical tests (Kruskall-Wallis and Mann-Whitney test, p<0.05). Results: From a sample of 255 children, 41 healthy children that suffered TDI in permanent were included in the study. The mean B-CPQ 8-10 scores were 29.7 (SD 14.3). Emotional and social wellbeing domais had the highest negative score impact average 8.8 (SD 5.9) and 9.8 (SD 6.3), respectively. Gender or TDI severity did not present relation to impact on OHRQoL. In relation to age, 10-year-old children had more impact on their OHRQoL on the overall scale (p<0.05) and for the functional limitation subscale (p<0.05). Conclusion: TDI impacts negatively on OHRQoL of children aged from 8-10 years old.

Introdução: Crianças apresentam alta prevalência de traumatismo dentário (TD).Objetivo: Detectar o impacto do TD na qualidade de vida relacionada à saúde bucal (QVRSB) nessa faixa etária. Métodos: Um estudo transversal foi realizado com amostra de conveniência recrutando-se crianças de 8-10 anos com TD em dente permanente por um período de 18 meses em clínica pública. Dados sobre a QVRSB foram coletados através da versão brasileira do CPQ 8-10 (B-CPQ 8-10 ). O TD foi classificado de acordo com os critérios de Andreasen e agrupado de acordo com sua gravidade. As variações nos escores e o impacto do TD na QVRSB, de acordo com idade, gênero e gravidade do TD foram examinados por meio de testes estatísticos não paramétricos (teste de Kruskall-Wallis e Mann-Whitney, p <0,05). Resultados: De uma amostra de 255 crianças, 41 crianças saudáveis que sofreram TD em dentes permanentes foram incluídas no estudo. O escore médio do B-CPQ 8-10 foi 29,7 (DP 14,3). Os domínios bem-estar emocional e social apresentaram maior impacto negativo com média de 8,8 (DP 5,9) e 9,8 (DP 6,3), respectivamente. A diferença de gênero e a gravidade do TD não apresentaram relação de impacto na QVRSB. Em relação a idade, crianças de 10 anos tiveram maior impacto na escala global da QVRSB (p <0,05) e na subescala de limitação funcional (p <0,05). Conclusão: O TD impacta negativamente a QVRSB de crianças de 8 a 10 anos de idade.

Determination of tnf-a gene polymorphisms on skeletal pattern in class ii malocclusion

Abstract Bone development and growth is a non-going, life-long process, varying greatly among individuals and much of this variation could be modulated by genetic factors. The purpose of this study was to evaluate the association between the polymorphisms in the TNF-a gene and skeletal class II malocclusion. Single nucleotide polymorphisms in TNF-a (rs1799724; rs1800629) gene were studied in 79 skeletal class II malocclusion and 102 skeletal class I malocclusion subjects from Straight Wire Group of Studies on Orthodontics and Functional Orthopedics for Maxillary from Rio de Janeiro, Brazil. The Genotyping of these selected polymorphisms was carried out by TaqMan real-time PCR using genomic DNA extracted from buccal cells. All allele and genotype frequencies were compared between the groups using the PLINK® software in a free, in a dominant and in a recessive model using a chi-square test (p≤0.05). There was no significant association of TNF-a (rs1799724; rs1800629) genotype and allele distribution with skeletal class II malocclusion. Regardless of the dominant or recessive genetic model, the preferential genotype associations for rs1799724 and rs1800629 was insignificant. In conclusion, no evidence of association is apparent between genetic polymorphisms involving TNF-a and skeletal class II malocclusion or the position of the maxilla and mandible in the postero-anterior direction.

Resumo O desenvolvimento e crescimento ósseo é um processo contínuo, que dura toda a vida, variando muito entre os indivíduos e grande parte dessa variação pode ser modulada por fatores genéticos. O objetivo deste estudo foi avaliar a associação entre os polimorfismos no gene TNF-a e a má oclusão da classe II esquelética. Polimorfismos no gene TNF-a (rs1799724; rs1800629) foram estudados em 79 indivíduos com má oclusão esquelética de classe II e 102 indivíduos com má oclusão esquelética classe I do Grupo de Estudos em Ortodontia e Ortopedia Funcional dos Maxilares do Rio de Janeiro, Brasil. A genotipagem destes polimorfismos foi realizada por PCR em tempo real, através de DNA genômico extraído de células bucais. Todas as frequências alélicas e genotípicas foram comparadas entre os grupos utilizando o software PLINK® em um modelo livre, dominante e recessivo. Foi aplicado o teste do qui-quadrado (p≤0,05). Não houve associação significativa na distribuição genotipica e alélica do gene TNF-a (rs1799724; rs1800629) com a má oclusão de classe II esquelética. Independentemente do modelo genético dominante ou recessivo, as associações genotípicas preferenciais para rs1799724 e rs1800629 foram insignificantes. Pode-se concluir que, não existe evidência de associação entre polimorfismos genéticos envolvendo TNF-a e má oclusão esquelética de classe II ou a posição da maxila e mandíbula na direção póstero-anterior.

Influence of genetic polymorphisms in genes of bone remodeling and angiogenesis process in the apical periodontitis

Abstract Persistent apical periodontitis (AP) is a situation involving an inflammatory and immune response caused mainly by anaerobic polymicrobial infection of the root canal system and the outcome and follow-up of the root canal treatment has been reported as intimately related to host response. The apical periodontitis repair might be associated with genetic polymorphisms. This study aimed to evaluate the association between HIF1A genetic polymorphisms (rs2301113 and rs2057482) with PAP in Brazilian patients. Subjects with at least 1 year of follow-up after root canal therapy (RCT) were recalled. Sixty-four subjects with signs/symptoms of PAP and 84 subjects with root canal-treated teeth exhibiting healthy perirradicular tissues (healed) were included. Genomic DNA was extracted from saliva and used for HIF1A genotyping by real-time PCR. Genotype and allele frequencies were compared by c2 or Fisher's exact tests and odds ratio was implemented, using Epi Info 3.5.2. All tests were performed with an established alpha of 0.05. There was no association between allele and genotype distribution for HIF1As polymorphisms and PAP (p>0.05). The genetic polymorphisms in HIF1A were not associated with persistent apical periodontitis.

Resumo A periodontite apical persistente (PAP) é uma condição que envolve uma resposta inflamatória e imunológica causada principalmente por infecções polimicrobianas de origem anaeróbia no sistema de canais radiculares, tornando o resultado e o acompanhamento do tratamento do canal radicular intimamente relacionados à resposta do hospedeiro. O reparo da periodontite apical pode estar associado a polimorfismos genéticos. Este estudo teve como objetivo avaliar a associação entre os polimorfismos genéticos do HIF1A (rs2301113 e rs2057482) com a PAP em pacientes brasileiros. Indivíduos com pelo menos 1 ano de acompanhamento após o tratamento do canal radicular (TCR) foram agendados para consulta de acompanhamento. Sessenta e quatro indivíduos com sinais/sintomas de PAP e 84 indivíduos com dentes tratados endodonticamente e tecidos perirradiculares saudáveis (cicatrizados) foram incluídos no presente estudo. O DNA genômico foi extraído da saliva e utilizado para a genotipagem do HIF1A por PCR em tempo real. O genótipo e as frequências alélicas foram comparados por teste c2 ou exato de Fisher e odds-ratio foi implementado por meio do software Epi Info 3.5.2. Todos os testes realizados foram estabelecidos com a=0,05. Não houve associação entre alelo e distribuição genotípica para polimorfismos do HIF1A e PAP (p> 0,05). Os polimorfismos genéticos em HIF1A não foram associados à periodontite apical persistente.

Oral health outcomes: the association of clinical and socio-dental indicators to evaluate dental caries in preschool children / Desfechos em saúde bucal: associação de indicadores clínicos e sociodentais para avaliar cárie dentária em pré-escolares

Abstract Dental caries is a public health problem that impacts oral health related to quality of life (OHRQoL). This study aimed to evaluate the outcome of dental caries in children by associating clinical and socio-dental indicators. A cross-sectional study was carried out with 2 to 6-year-old children who attended public day care centers in a city in the Southeast Region of Brazil. After sample calculation, 446 children were randomly selected by eligibility criteria. Two professionals evaluated dental caries using WHO (2013) criteria and classified subjects according to early childhood caries (ECC) severity. Parents/care- givers answered a characterization questionnaire and self-reported socio-dental indicator (B-ECO-HIS). The prevalence of dental caries was 33.7%. The children with high severity of ECC had 5 times higher chance of suffering an impact on OHRQoL. The one way ANOVA test showed that the impact on OHRQoL (ECOHIS scores) was associated with ECC. The outcome dental caries in oral health presented high prevalence as clinical indicator and high impact on OHRQoL as socio dental indicator. Clinical and socio-dental indicators should be evaluated together.

Resumo A cárie dentária é um problema de saúde pública com impacto na qualidade de vida relacionada à saúde bucal (QVRSB). Este estudo teve como objetivo avaliar a cárie dentária como desfecho em saúde bucal em pré-escolares, por meio da associação de indicadores clínicos e sociodentais que avaliam a QVRSB. Um estudo transversal foi realizado com crianças de 2 a 6 anos de idade que frequentavam creches públicas de um município do sudeste do Brasil. Após o cálculo da amostra, 446 crianças foram selecionadas aleatoriamente por critérios de elegibilidade. A avaliação foi feita por dois profissionais, usando critérios da OMS, que classificaram os sujeitos de acordo com a gravidade de cárie precoce na infância (CPI). Os pais/cuidadores responderam um questionário auto- aplicado de caracterização da amostra e um indicador sociodental (B-ECOHIS). A prevalência de cárie dentária foi de 33,7%. As crianças com alta gravidade de CPI tinha cinco vezes mais chance de sofrer impacto sobre QVRSB. O teste one way ANOVA apresentou associação entre impacto na QVRSB (ECOHIS escores) e CPI. O desfecho cárie em saúde bucal apresentou alta prevalência como indicador clínico e alto impacto sobre a QVRSB como o indicador sociodental. Indicadores clínicos e sociodentais devem ser avaliados em conjunto.

Association Between Apical Periodontitis and TNF- alpha -308 G>A Gene Polymorphism: A Systematic Review and Meta-Analysis

Abstract Currently, investigations have focused on the identification of Single Nucleotide Polymorphisms (SNP) involved in host response and its ability to generate an immunity deficiency. The aim of this study was to perform a systematic review (SR) and meta-analysis to evaluate the association between TNF-α -308 G>A polymorphism and apical periodontitis (AP) phenotypes. A broad search for studies was conducted. The following databases were used: PubMed, Scopus, Web of Science, and VHL (Medline, SciELO, Ibecs, and Lilacs). The MeSH terms "Periapical Periodontitis," "Periapical Abscess," "Polymorphism, Genetic," and "Polymorphism, Single Nucleotide" were used. MeSH synonyms, related terms, and free terms were included. Clinical investigations of individuals with different AP phenotypes in permanent teeth were selected. After application of the eligibility criteria, selected studies were qualified by assessing their methodological quality. A fixed effect model was used for the meta-analysis. The initial search identified 71 references. After excluding duplicate abstracts, 33 were selected. From these, two were eligible for quality assessment and were classified as being of moderate evidence. The included studies did not demonstrate association between AP and TNF-α -308 G>A SNP. However, the meta-analysis demonstrated an association between the genotype distribution and AP phenotype (OR= 0.49; confidence interval= 0.25, 0.96; p=0.04). The role of TNF-α -308 G>A SNP in AP phenotypes is debatable. Further studies are needed to confirm and understand the underlying mechanisms of the identified association.

Resumo Atualmente as investigações têm focado na identificação de Polimorfismos de Núcleo Único (SNP) envolvidos na resposta do hospedeiro e sua capacidade de gerar uma deficiência de imunidade. O objetivo deste estudo foi realizar uma revisão sistemática (RS) e uma meta-análise para avaliar a associação entre o polimorfismo do gene TNF-α (-308 G> A) e os fenótipos de periodontite apical (PA). Esta RS foi registrada na base de dados PROSPERO, CRD42016035688, e foi conduzida seguindo o método PRISMA. Foi realizada uma ampla pesquisa de estudos. Foram utilizadas as seguintes bases de dados: PubMed, Scopus, Web of Science e BVS (Medline, SciELO, Ibecs e Lilacs). Foram utilizados os seguintes descritores (MeSH) "Periapical Periodontitis," "Periapical Abscess," "Polymorphism, Genetic," and "Polymorphism, Single Nucleotide". Sinônimos, termos relacionados e termos livres foram incluídos. Foram selecionadas investigações clínicas de indivíduos com diferentes fenótipos de PA em dentes permanentes. Após a aplicação dos critérios de elegibilidade, os estudos selecionados foram classificados através da avaliação da qualidade metodológica. Foi utilizado um modelo de efeito fixo para a metanálise. A pesquisa inicial identificou 71 referências. Após a exclusão de resumos duplicados, 33 foram selecionados. Destes, dois eram elegíveis para a avaliação da qualidade e foram classificados como sendo de evidência moderada. Os estudos incluídos não demonstraram associação entre PA e o TNF-α-308 G>A. No entanto, a metanálise demonstrou associação entre a distribuição do genótipo e os fenótipos da PA (OR = 0,49, intervalo de confiança=0,25, 0,96; p=0,04). O papel do TNF-α-308 G>A em fenótipos da PA é discutível. São necessários mais estudos para confirmar e compreender os mecanismos subjacentes à associação identificada.

Genetic Polymorphism in MMP9 May Be Associated With Anterior Open Bite in Children

Abstract Anterior open bite (AOB) has a multifactorial etiology caused by the interaction of sucking habits and genetic factors. The aim of this study was to evaluate the association between AOB and polymorphisms in genes that encode Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Four hundred and seventy-two children that presented at least one sucking habit were evaluated. Children were examined clinically for the presence of AOB. Genomic DNA was extracted from saliva. Genotyping of the selected polymorphisms in MMP2, MMP3, MMP9, TIMP1 and TIMP2 was carried out by real-time PCR using the TaqMan method. Allele and genotype frequencies were compared between the groups with and without AOB using the PLINK® software in a free and in a recessive model using a chi-square test. Logistic regression analysis was implemented (p≤0.05). Two hundred nineteen children had AOB while 253 did not. The polymorphism rs17576 in MMP9 was significantly associated with AOB (p=0.009). In a recessive model GG genotype was a protective factor for AOB (p=0.014; OR 4.6, 95%CI 1.3-16.2). In the logistic regression analysis, none of the genes was associated with AOB. In conclusion, the polymorphism rs17576 (glutamine for arginine substitution) in MMP9 was a protective factor for AOB.

Resumo A mordida aberta anterior apresenta uma etiologia multifatorial causada pela interação entre hábitos de sucção e fatores genéticos. O objetivo deste estudo foi avaliar a associação entre mordida aberta anterior e polimorfismo nos genes que codificam as metaloproteinases da matriz (MMPs) e seus inibidores teciduais (TIMPs). Foram avaliadas 472 crianças que apresentvam pelo menos um hábito de sucção. As crianças foram clinicamente examinadas para avaliar a presença de mordida aberta anterior. DNA genômico foi extraído da saliva. A genotipagem dos polimorfismos selecionados em MMP2, MMP3, MMP9, TIMP1 e TIMP2 foi realizada por PCR em tempo real, usando o método de TaqMan. As frequências alélicas e genotípicas foram comparadas entre os grupos com e sem mordida aberta anterior usando o software PLINK®. Duzentas e dezenove crianças apresentavam mordida aberta anterior enquanto 253 não a apresentavam. O polimorfismo rs17576 em MMP9 estava significativamente associado com mordida aberta anterior (p=0,009). No modelo recessivo (GG versus AG+AA) o genótipo GG foi um fator protetor para mordida aberta anterior (p=0,014; OR 4,6; 95%CI 1,3- 16,2). Concluindo, o polimorfismo rs17576 (substituição de glutamina por arginina) em MMP9 está associado com mordida aberta anterior. Os resultados obtidos suportam a hipótese de que fatores genéticos estão envolvidos com a etiologia da mordida aberta anterior.

Trauma dental e protetor bucal: conhecimento e atitudes em estudantes de graduação em Educação Física / Dental trauma and mouthguard: knowledge and attitudes in Physical Education undergraduates

Resumo Este estudo objetivou avaliar o conhecimento e as atitudes de estudantes de Educação Física de Universidades públicas do Estado do Rio de Janeiro, Brasil, em relação ao traumatismo dentário e uso de protetor bucal. Foram entrevistados 373 graduandos de três universidades públicas do Rio de Janeiro, através de questionário semiestruturado e padronizado. Os dados foram tabulados e analisados (SPSS 16.0), sendo obtida a frequência (%) e a relação dos mesmos (Teste qui-quadrado, p < 0,05). Apenas 3,21% dos entrevistados haviam recebido informação sobre traumatismo dentário e utilização do protetor bucal durante a graduação. Com relação à atitude dos graduandos, responderam corretamente apenas 19,83% a conduta frente a uma avulsão; 54,69% ao manuseio do dente avulsionado e 7,77% ao transporte do dente avulsionado. Ao se comparar essas atitudes em razão do período de graduação (< 5º período ou ≥ 5º período), informações prévias de trauma e experiências prévias de trauma, não se observou diferença significativa (p > 0,05). Tratando de prevenção, 89,81% conheciam o protetor bucal, embora apenas 17,96% o utilizavam durante atividades esportivas. Conclui-se que os alunos não recebem tais informações durante a graduação, mesmo possuindo em sua grade curricular a disciplina de primeiros socorros. Cabe aos cirurgiões dentistas desenvolver ações para que este conhecimento supra as necessidades dos futuros profissionais de educação física.(AU)

Abstract To evaluate the knowledge and attitudes in a group of Brazilian physical education undergraduate students, relative to dental trauma and use of mouthguard. A total of 373 undergraduates from three public universities of Rio de Janeiro were interviewed by means of a semi-structured standardised questionnaire. The data were tabulated and analyzed using the statistical program SPSS, 17.0. Frequency was performed and it was also applied the qui-quadrado (p < 0.05) test, to establish a relation between variables of interest. Only 3.21% of the interviewees had been given information on dental trauma and use of mouth protector during their undergraduate course. With regard to their attitudes, only 19.83% responded correctly about how to act towards a tooth avulsion; 54.69% about how to manage the avulsed tooth, and 7.77% about how to transport the avulsed tooth. By comparing these attitudes in relation to the undergraduate period (before or after the 5th semester), previous information and experience on dental trauma, it was observed no significant difference (p > 0.05). With regard to prevention, 89.81% knew mouthguard although only 17.96% wore it during sport activities. The students were given no information during their undergraduation course, even though the curriculum has the discipline of first aid. The dentist are supposed to develop actions so that such knowledge meets the needs of the future physical education practitioners.(AU)

Conhecimento e Atitudes com Relação ao Atendimento Emergencial das Injúrias Dentárias Traumáticas / Knowledge and Attitudes Regarding Emergency Care of Traumatic Dental Injuries

Injúrias dentárias traumáticas ­ IDT apresentam elevada prevalência e estão entre os principais agravos à saúde de crianças e adolescentes. A adoção de medidas adequadas no momento do acidente é fundamental para a manutenção do elemento dentário. Assim, o objetivo do presente estudo foi avaliar o nível de conhecimento e atitudes de pessoas leigas frente às IDT. Um estudo transversal foi realizado, coletando-se dados a partir de um questionário estruturado. Os dados foram tabulados (SPSS 16.0), obtidas as frequências e a relação das atitudes com idade, nível de escolaridade, experiência com IDT (teste exato de Fisher, p<0,05). Dos 455 indivíduos entrevistados, 76,3% relataram não ter conhecimento sobre IDT, 55,2% não se sentiam preparados para realizar o atendimento emergencial e 89,5% demonstraram-se receptivos a novos conhecimentos. Apenas 27,3% reconheceram a gravidade do IDT em ambas as dentições. Não foi observada associação entre experiência prévia de IDT e atitudes (p<0,05). Em relação à escolaridade, pessoas com menor grau de escolaridade apresentaram maior índice de acerto quanto ao tempo de procura para o atendimento (p=0,01). Quanto à idade, os mais jovens obtiveram um maior percentual de acerto quanto ao procedimento de reimplante de dentes permanentes (p=0,01). Concluiu-se que o conhecimento e atitude em relação ao atendimento emergencial das IDT não é o adequado, sendo importante a implementação de ações de conscientização.(AU)

Traumatic dental injury (TDI) has high prevalence, and is considered one of the major health problems of children and adolescents. The adoption of appropriate measures at the time of the accident is critical for maintaining the tooth. The objective of this study was to evaluate the level of knowledge and attitudes of lay people in the face of TDI. A cross-sectional study was conducted by collecting data from a structured questionnaire. Data were tabulated (SPSS 16.0), obtaining the frequencies and the relationship of attitudes to age, education level, experience with TI (Fisher exact test, p <0.05). Of the 455 individuals interviewed, 76.3% reported not having knowledge on TDI, 55.2% did not feel prepared to carry out emergency care, and 89.5% proved to be receptive to new knowledge. Only 27.3% recognized the seriousness of TDI in both dentitions. There was no association between prior experience on TDI and attitudes (p <0.05). Regarding education, people with less education had a higher rate of success on the search of time for care (p = 0.01). Regarding age, younger had the highest percentage of success as the reimplantation procedure of permanent teeth (p = 0.01). It was concluded that the level of knowledge and attitude toward the emergency care of TDI is not appropriate, this it is important to implement awareness actions.(AU)

Orthodontic treatment reduces the impact on children and adolescents’ oral health‑related quality of life.

Context: Malocclusion is a chronic disability that is usually remedied by orthodontic treatment which can provide the patient with a satisfactory state of oral health. Aim: To assess the current evidence in the literature concerning the impact of malocclusion treatment on the oral health related quality of life (OHRQoL) of children and adolescents. Settings and Design: Systematic review. Materials and Methods: Four databases (PubMed, Web of Science, Scopus and Virtual Health Library) were searched using specified indexing terms, including a manual search for of the references listed in the studies. The articles that met the inclusion criteria were classified regarding methodological quality and risk of bias in categories of high, moderate, or low. Results: The electronic search produced 426 titles and abstracts, and the manual search of their references detected another 1 article. After excluding duplicate abstracts and applying the inclusion and exclusion criteria, 3 studies were eligible for quality assessment. Among these, 1 was classified as high methodological quality/low risk of bias and 2 as moderate methodological quality/moderate risk of bias. These 3 articles were included in the final qualitative synthesis. Conclusions: Malocclusions treatment reduces the impact on children and adolescents’ OHRQoL based on evidence assessed in the literature. The level of evidence was moderate to high to detect changes in the impact after orthodontic treatment.

Abrasão ultrassônica: uma alternativa de preparo cavitário para o paciente infantil / Ultrasonic abrasion: an alternative in the performance of cavity preparation in childhood

A técnica da abrasão ultrassônica é realizada com o uso de pontas CVD (Chemical Vapor Deposition), que são formadas através da união química da peça única do diamante à haste metálica, acopladas ao aparelho de ultrassom. Assim, o corte do esmalte e da dentina é feito por oscilação dessas pontas diamantadas e não por ação mecânica, o que promove um desgaste preciso e um preparo conservador da cavidade. Essa técnica proporciona inúmeras vantagens para o profissional e para o paciente, pois diminui a sensação de barulho, pressão, vibração e calor, além de possibilitar um tratamento sem anestesia local e apenas com uso de isolamento relativo, tendo uma boa aceitação pelos pacientes, destacando-se, assim, como aspecto de grande relevância na odontopediatria, para o preparo cavitário. O presente trabalho tem por objetivo descrever um caso clínico utilizando a técnica de abrasão ultrassônica para o preparo cavitário nos dentes 51 e 61 acometidos por lesão cariosa, de um paciente de 04 anos, abordando os aspectos positivos e negativos relacionados a essa técnica

The technique of ultrasonic abrasion is carried out using tips CVD (Chemical Vapor Deposition), which areformed by the chemical union of one piece of diamond to metal rod coupled to the ultrasonic device. Thus, the cut enamel and dentin is done by oscillation of these diamond burs and not by mechanical action, which promotes an accurate wear and a conservative cavity preparation. This technique provides numerous advantages for the professional and the patient, because it reduces the sensation of noise, pressure, vibration and heat, besides enabling a treatment without local anesthesia and only with the use of relative isolation, with good acceptance by patients, highlighting was thus as an aspect of great relevance in pediatric dentistry for cavity preparation. This paper aims to describe a clinical case using the technique of ultrasonic abrasion for cavity preparation in teeth 51 and 61 affected by carious lesion of a patient of 04 years, addressing the positive and negative aspects to this technique

Perfil Epidemiológico dos Traumatismos Dentários em Crianças e Adolescentes no Brasil / Epidemiological Profile of Dental Trauma in Children and Adolescents in Brazil

O traumatismo dentário - TD é considerado, pela Organização Mundial de Saúde ? OMS um problema de saúde pública que apresenta alta prevalência e gera impacto negativo na qualidade de vida relacionada à saúde bucal de crianças/adolescentes e familiares com sequelas biológicas, socioeconômicas, psicológicas e comportamentais. Assim, o presente estudo objetivou realizar uma revisão critica da literatura sobre os estudos que avaliam o perfil epidemiológico do TD em crianças e adolescentes, mapeando a distribuição desses estudos no Brasil. A busca na literatura foi feita utilizando os descritores: traumatismos dentários, criança, adolescente, e epidemiologia, nas Bases Medline, Lilacs, SciELO, BBO e no Google Acadêmico. Os mesmos termos em inglês foram utilizados no Pubmed. De 248 artigos encontrados inicialmente, foram removidas as duplicatas e aplicados os critérios de inclusão e exclusão, selecionando-se 53 artigos. Observou-se que há muitos estudos sobre a prevalência dos TD desenvolvidos no Brasil durante os últimos anos. No entanto, os estudos estão concentrados em algumas regiões específicas como Rio Grande do Sul, Santa Catarina, Minas Gerais e São Paulo. A prevalência de TD em dentição decídua foi de 9,4% e 62,1%, e permanente variou de 8,0% a 58,6%. Os fatores como gênero, sobressaliência acentuada e cobertura labial inadequada foram frequentemente associados ao TD em crianças e adolescentes. Baseado nos levantamentos epidemiológicos dos artigos selecionados neste trabalho, conclui-se que, devido à concentração das pesquisas em alguns centros, não há um perfil representativo da população brasileira e os dados compilados dos estudos devem ser comparados com cautela, devido à grande diferença metodológica existente nos estudos.

Traumatic dental injury (TDI) is considered by the World Health Organization as a public health problem with high prevalence, which generates negative impact on oral health related to quality of life of children / adolescents and their families, causing biological, socioeconomic, psychological and behavioral sequelae. The present study aimed to conduct a critical review of the literature on studies assessing the epidemiological profile of the TDI in children and adolescents, mapping the distribution of these studies in Brazil. The search was performed using the descriptors ?dental trauma, children, adolescents, epidemiology and Brazil?, in the Medline, Lilacs, SCiELO, BBO, Google Scholar, and Pubmed. Initially, 248 articles were found. After removing the duplicates and applying the inclusion and exclusion criteria, 53 articles were selected. It has been observed that there are many studies of prevalence of TDI developed in recent years in Brazil. However, these studies are concentrated in some specific areas such as Rio Grande do Sul, Santa Catarina, Minas Gerais, and São Paulo. The prevalence of TDI in the primary dentition was 9.4% and 62.1%, ranging from 8.0% to 58.6% in the permanent dentition. Factors such as gender, increased overjet and inadequate lip coverage were often associated with TDI in children and adolescents. Based on the epidemiological surveys of the articles selected in this study, we concluded that there is no representative profile of the Brazilian population due to the concentration of research in some centers, thus data should be compared with caution due to the large methodological difference between the studies.