Toothpaste-related interests of Google users from different countries

Abstract The Internet is a growing source of knowledge and can provide information about oral health. This ecological study aimed to characterize the interests in toothpaste among Google users from different countries. Our hypothesis was that there would be an increase in Google users' interest in information about toothpaste. This retrospective longitudinal ecological study analyzed the toothpaste-related interest of Google users from 10 countries between January 2004 and December 2020. The monthly variation in relative search volume (RSV) and the main related queries were determined using Google Trends. Autoregressive integrated moving average (ARIMA) forecasting models were built to establish the predictive RSV values for toothpaste for an additional 12 months. Autocorrelation plots and the generalized additive model (GAM) were used to diagnose trends and seasonality in RSV curves. Additionally, the influence of social isolation related to the outbreak of COVID-19 was analyzed. Although not detected by autocorrelation function (ACF) and partial autocorrelation function (PACF) analyses, the heuristic analysis showed an increase in the interest in toothpaste-related information in all countries, with a stable trend observed in the 12-month forecasts, except for the increases in the United Kingdom and South Africa. Also, GAM analyses demonstrated a non-significant monthly or quarterly seasonal influence on data. In addition, social isolation during the COVID-19 pandemic did not influence the online information-seeking behavior of Google Search users linked to this topic. We confirmed the hypothesis that the interest of Google Search users in information about toothpaste increased in all of the 10 assessed countries.

Influence of the FDI criteria in the restorations' evaluation and treatment decision in primary molars / Influência dos critérios da FDI na avaliação de restaurações e decisão de tratamento em molares decíduos

Objective: This study investigated the impact of FDI criteria for evaluating restorations on examiners' decision-making compared with their previous personal judgment in primary teeth. Secondly, the possible factors related to changes when using the criteria, including the examiners' experience were explored. Material and Methods: A cross-sectional study in a dental office setting was conducted selecting 27 resin composite restorations placed in primary molars in 11 children. Examinations of the restorations were performed by five undergraduate and five graduate dental students. First, the evaluations were performed based on personal judgment, and 2 weeks later, with FDI criteria. All examiners underwent training to use the FDI criteria after the first evaluation. The consensus of two benchmark examiners was considered to be the reference standard. Initially, a descriptive analysis was performed. Multiple Poisson regressions analyses were used to identify possible associated factors with outcomes - to be less or more invasive based on the FDI criteria than personal judgment. Results: The use of the FDI criteria changed the examiners' decisions in approximately 15% of the cases. Irrespective of examiners' experience, there was a trend of false results (compared to the reference examiners) when a change in the treatment decision was registered by using the FDI criteria. Examiners chose a less invasive option when assessing multi surface restorations with FDI criteria (PR=2.04, 95%CI=1.03-4.05; p=0.04). Examiners who spent more time for evaluation with FDI criteria were more invasive (PR=1.001, 95%CI=1.0001-1.002; p=0.03). Students were more invasive with the FDI criteria when examined children with higher dmf-t (PR=1.16, 95%CI=1.01-1.32; p=0.03). Conclusion: The use of the FDI criteria negatively influenced the restorations' evaluation and treatment decision in primary molars by undergraduate and graduate students.(AU)

Objetivo: Este estudo investigou o impacto dos critérios da FDI para avaliar restaurações na tomade de decisão feita pelos examinadores em comparação ao seu julgamento pessoal prévio em dentes decíduos. Secundariamente, foram explorados os possíveis fatores relacionados com mudanças causadas pelo uso dos critérios, incluindo a experiência dos examinadores. Material e Métodos: Um estudo transversal em ambiente de consultório odontológico foi conduzido selecionando 27 restaurações de resina composta realizado em molares decíduos em 11 crianças. As avaliações das restaurações foram realizadas por cinco estudantes de Graduação e cinco de Pós-graduação em Odontologia. As avaliações foram realizadas com base no julgamento pessoal e, duas semanas depois, com os critérios da FDI. Todos os examinadores foram treinados para utilizar os critérios da FDI após a primeira avaliação. O consenso de dois examinadores "padrão-ouro" foi considerado o padrão de referência. Inicialmente, uma análise descritiva foi realizada. Análises de regressão múltipla de Poisson foram utilizadas para identificar possíveis fatores associados com os desfechos ­ ser mais ou menos invasivo com o uso dos critérios da FDI em relação ao julgamento pessoal. Resultados: A utilização dos critérios do FDI alterou as decisões dos examinadores em aproximadamente 15% dos casos. Independente da experiência dos examinadores, houve uma tendência de resultados falsos (em comparação com os examinadores de referência) quando uma mudança na decisão de tratamento foi registrada usando os critérios da FDI. Os examinadores escolheram uma opção menos invasiva quando avaliaram restaurações envolvendo múltiplas superfícies com os critérios da FDI (RP = 2,04, IC 95% = 1,03-4,05; p = 0,04). Os examinadores que levaram mais tempo para avaliação das restaurações foram mais invasivos com o uso dos critérios da FDI (RP = 1,001, IC 95% = 1,0001-1,0002; p = 0,03). Os alunos foram mais invasivos com o uso dos critérios da FDI quando examinaram crianças com maior experiência de cárie (RP = 1,16, IC 95% = 1,01-1,32; p = 0,03). Conclusão: O uso dos critérios da FDI influenciou negativamente a avaliação das restaurações e decisão de tratamento em dentes decíduos realizada por estudantes de graduação e pós-graduação. (AU)

Early childhood caries management using fluoride varnish and neutral fluoride gel: a randomized clinical trial

Abstract The aim of this study was to evaluate the clinical efficacy of varnish and neutral fluoride gel in the management of early childhood caries (ECC). A randomized clinical trial was conducted to compare two strategies for ECC management: topical application of neutral fluoride gel (NFG group) and varnish (FV group) every four months for a period of one year. The sample consisted of children between the ages of three and four years, enrolled in public daycare centers. The incidence of ECC between the groups was compared by assessing values (new dmfs) at two levels: d2 when enamel/dentin were affected and d3 when dentin affected. Pearson's Chi-square, Fisher's Exact, Kolmogorov-Smirnov and Mann-Whitney tests were used to compare the incidence and increment of caries between the NFG and FV groups (p<0.05). A total of 240 children were included in this study and 213 children (88.7%) were followed up for 12 months. The incidence of ECC was 24.1% in the GF and 21.0% in the FV groups (p=0.586). The increment of caries in d2mfs was 1.36 (95% CI = 0.83 - 1.89) in the NFG and 1.33 (95% CI = 0.75 - 1.89) in FV (p=0.756) groups. Increment of caries in d3mfs was 1.60 (95% CI = 0.95 - 2.25) in NFG and 1.40 (95% CI = 0.75 - 2.04) in FV (p=0.468). Neutral fluoride gel and fluoride varnish exhibited similar efficacy in the management of ECC after 12 months of follow-up.

How can we associate an economic evaluation with a clinical trial?

Abstract Economic evaluations in Dentistry have been increasing in recent years. They are a relevant contribution if an economic issue exists. Knowing if a new intervention is an efficient way of allocating available (and scarce) resources (the concept of opportunity costs), a well-designed economic evaluation may be helpful. One option is to conduct a trial-based economic analysis, which extracts a considerable board of information from a trial. This approach produces a more controlled result since many sources of variations might be reduced. On the other hand, some aspects could not be predicted directly from the trial or even extrapolated. Thus, combining model-based analysis may be an idea. In this paper, we intended to discuss important aspects to be considered by researchers in further economic evaluations. This paper will be systematically divided into sessions related to the study design as time horizon and perspective, health effects, costs, and data analysis. In the end, we expect the reader could be able to plan a trial-based economic evaluation, which should be a careful, meticulous, quite laborious and especially transparent process.

Choosing the Criteria for Clinical Evaluation of Composite Restorations: An Analysis of Impact on Reliabilty and Treatment Decision

Abstract Objective: To assess the reproducibility of two clinical criteria for the evaluation of restorations in primary teeth and the impact on treatment decision. Material and Methods: A cross-sectional study was performed selecting 71 resin-based composite restorations placed in primary molars of children who had sought dental treatment at a dental school. Two trained examiners evaluated independently the restorations using modified FDI and USPHS criteria. All restorations were assessed separately with each system in random order to avoid memory bias. Kappa statistics were used to determine inter-examiner reliability considering each parameter of both criteria and score final about treatment decision. McNemar test was used to compare the treatment decision with two criteria. The significance level was set at 5%. Results: Kappa values ranged from 0.28 to 0.93 with USPHS and 0.28 to 0.88 with FDI, considering each parameter separately. Inter-examiner agreement for treatment decision was excellent for both criteria (Kappa: 0.85-0.90). For clinical decision-making, no difference between criteria was found, irrespective of examiner. Conclusion: Low inter-examiner agreement for evaluation of each parameter of USPHS and FDI criteria does not reflect on reproducibility for treatment decision. Both criteria may be suitable for evaluation of composite restorations in primary teeth.

Efficacy of Sealing with Glass Ionomer Cement and Transversal Brushing Technique in Erupting First Molars: 18-Month Clinical Follow-Up

Objective: To verify the effectiveness of sealing with glass ionomer cement and transversal brushing in the prevention and treatment of initial caries lesions in erupting permanent molars of children aged 5-7 years. Material and Methods: Healthy teeth with ICDAS scores 1 or 2 were selected. One hundred and thirty-one children (79 teeth in the control group - 75 teeth in the test group) were randomly assigned into the two experimental groups: (1) transversal brushing technique for plaque control with conventional flat bristles and fluoridated dentifrice or (2) sealing the occlusal surfaces with glass ionomer cement (Vitro Molar®). Follow-up was performed for 18 months and the survival analysis was applied to test the occurrence of lesion progression. Results: The mean age of children was 5.4 years and it was verified that, by examining the initial tooth condition, the probability of progression was 66% lower when the tooth had initial caries lesions than when it was healthy; the probability of molar progression was about 74% lower in the test group compared to the control group. The mean time for lesion development in the test group (16.8 months; SD = 0.5) was greater than that in the control group (16.5 months; SD = 0.5; p=0.008). Conclusion: Sealing reduces the progression of caries disease in initial lesions when compared to the transversal brushing technique.

E-learning Activities to Complement Education in Cariology for Undergraduate Students

Objective: To evaluate activities performed in an e-learning platform after 2-year of implementation in terms of contents and functionality. Material and Methods: Elearning courses were prepared and created by two lecturers. Contents were intended for last year undergraduate students attending the pediatric dentistry discipline, and included different topics considered as relevant to the area. Given tele-courses from 2010-2012 as well as statistics and contents, provided by the platform, were collected for analysis. Results: Five tele-courses were proposed and the total participation was 322 students (mean-per-course±SD=64.4±17.2). On average, 15 tutors/course accompanied the process. Caries lesion detection and fluoride therapy were discussed in all modules, but different activities were focused in various aspects. Other topics were also included: caries activity (60%), caries risk assessment, oral hygiene and clinical examination (40%). Two lecturers were responsible for preparing exercises and tutors helped in the creation, revision and correction. The main type of validation was open questions (83%). A High level of students' access was observed during the 2-year-period (mean-per-course±SD=21372±6775,2). More than 32000 external visits of the topics were also seen. On average, 14 tutor/student feedbacks were sent per student in each tele-course. Conclusion: The use of an e-learning system has been used especially to complementing teaching in caries detection and management using fluorides. Telecourses have been highly accessed by undergraduate students and also, external participants.

Clinical performance of fluorescence-based methods for detection of occlusal caries lesions in primary teeth

Abstract We aimed to investigate the performance of fluorescence-based methods (FBMs), compared to visual inspection after histological validation, in detecting and assessing the activity status of occlusal carious lesions in primary teeth. One examiner evaluated 50 primary molars close to exfoliation in 24 children. Teeth were assessed using quantitative light-induced fluorescence (QLF) and pen-type laser fluorescence (LFpen). After exfoliation, histological validation was performed. Teeth were cut and sections were evaluated for lesion depth and activity status (after utilization of a pH indicator) under a stereomicroscope. Parameters related to the performance of the methods in detecting caries lesions at two thresholds (initial and dentin lesions) were calculated. Regarding the activity status, lesions were classified into sound+inactive or active, and the area under the ROC curve and the diagnostic odds ratio values of the methods were calculated and compared. Evaluation of red fluorescence using QLF presented higher sensitivity but lower specificity than visual inspection in detecting dentin caries lesions. However, QLF considering different parameters and LFpen had similar performance to that obtained with visual inspection. Regarding activity assessment, all FBMs and visual inspection also presented similar performance. In conclusion, FBMs did not prove advantageous for the detection and activity assessment of occlusal caries lesions in primary molars when compared to visual inspection.

Evaluation of the relationship between the cost and properties of glass ionomer cements indicated for atraumatic restorative treatment

The aim of this study was to evaluate microshear bond strength (μSBS), water sorption and solubility of glass ionomer cements (GIC) indicated for atraumatic restorative treatment (ART). Cylindrical specimens (6x2.4 mm) were used to test the sorption and solubility of each GIC (n = 5). The specimens were weighed before and after immersion in water and desiccation. For the μSBS test, 60 primary molars were ground to obtain flat surfaces from both enamel and dentin. The teeth were then assigned to the tested GIC (n = 10) groups, namely Fuji IX - FIX, Ketac Molar - KM and Maxxion R – MX. The exposed surfaces were pre-treated with GIC liquid. Polyethylene tubes were placed on the pre-treated surface and filled with one of the GIC. After 24 h, the specimens were submitted to the μSBS test. The failure mode was assessed using a stereomicroscope (400x magnification). The powder to liquid ratio and cost of material were also determined (n = 3). The data were analyzed by ANOVA and Tukey's post hoc test. Linear regression was used to determine the relation between cost and the other variables. Overall, MX showed lower μSBS values (enamel: 3.93 ± 0.38; dentin: 5.04 ± 0.70) than FIX (enamel: 5.95 ± 0.85; dentin: 7.01 ± 1.06) and KM (enamel: 5.91 ± 0.78; dentin: 6.88 ± 1.35), as well as higher sorption and solubility. The regression analyses showed a significant and positive correlation between cost and μSBS in enamel (R2 = 0.62; p < 0.001) and dentin (R2 = 0.43; p < 0.001); and a negative correlation between cost and water sorption (R2 = 0.93; p < 0.001) and solubility (R2 = 0.79; p < 0.001). In conclusion, the materials indicated for ART exhibit distinct physical and mechanical properties; in addition, low-priced materials may interfere with GIC properties.

Detecção de lesões de cane usando o método de inspeção visual: iniciativas para aprimoramento do ensino no curso de graduação / Caries detection using visual inspection: initiatives for improving the pre­ graduate education

O desenvolvimento e avaliação de metodologias de ensino voltadas para alunos de graduação é essencial e deve ser estimulada em todas as áreas do conhecimento. Nesse sentido, propostas de metodologias ativas de ensino/aprendizagem vêm sendo propostas para auxiliar o desenvolvimento de habilidades dos alunos de graduação para detecção de lesões de cárie. Treinamentos teóricos laboratoriais mediado por tutores têm sido utilizados para ensinar os alunos a utilizar o método de inspeção visual e também pratica-Io em atividades pré-clínicas que simulem as condições clínicas que enfrentarão no futuro. Essa tese de livre docência é composta por uma série de trabalhos, que têm por objetivo coletar evidências científicas, bem como descrever novas ossibilidades e testar o impacto das mesmas no ensino e treinamento de alunos do curso de graduação em Odontologia. Para isso, esse exemplar será dividido em capítulos, nos quais serão discutidos os seguintes tópicos em relação ao ensino do método visual com a finalidade de detecção de lesões de cárie: bases conceituais para o uso do método de inspeção visual na prática clínica (revisão crítica narrativa), estágio atual das evidências sobre métodos de ensino voltados para Cariologia (revisão sistemática), nova proposta/insights para treinamento teórico-Iaboratorial mediado por tutores em detecção de lesões de cárie pelo método visual (descrição do método de ensino e sua aplicação), efeito do treinamento prático dos alunos de graduação utilizando fotografias clínicas (estudo antes-depois), efeito do treinamento prático dos alunos de graduação utilizando dentes extraídos (estudo controlado randomizado) e proposta de um estudo multicêntrico focado no impacto a curto e longo prazo da implementação dessa prática de ensino nos cursos de graduação em Odontologia...

The development and evaluation of learning strategies directed to undergraduate students is essential and should be estimulated in ali fields. In this sense, active learning methodologies have been devised to aid the development of undergraduate students' abilities in detecting caries lesions. Tutored-Iaboratorial training has been used to teach students in using the visual inspection and practicing it in pre-clinical activities that simulate further clinical situations. This habilitation thesis comprised a series of studies that aimed to collect scientific evidences, as well to describe new possibilities to be used and their effect in teaching dental undergraduate students. This issue was written divided in chapters which are focused on the following topics related to the training to use of visual inspection for detecting caries lesions: conceptual basis to use the visual inspection in clinical practice (critical appraisal of the literatute), available scientific evidences about educational strategies in Cariology (systematic review), a novel proposal /insights tutored-based laboratorial training for detection of caries lesions using visual inspection and its implementation), effect of practical training using clinical photographs (before-and-after study), effect of practical training using extracted teeth (randomized controlled study) and a proposal of a multicentre study aiming to assess the short-term and long-term impact of this learning strategies in pre-graduation courses...

Tratamento pulpar indireto sem reabertura em dente permanente: acompanhamento de 36 meses / Indirect pulp treatment without re-entry in a permanent tooth: 36 months of follow-up

An alternative approach in the management of deep caries lesions is the indirect pulp treatment, without re-entry in the cavity. It has been shown that the complete removal of the carious dentin became unnecessary after the total tooth sealing, because the remaining microorganisms of the affected dentin would stop proliferating and/or die. This case report describes the management of a deep caries lesion of an 11-year-old girl with great coronary destruction in the left mandibular permanent first molar. Infected dentinal walls were excavated with manual instruments and the remainder affected dentin was filled with ionomer glass cement and composite resin. After 36 months of followup, no clinical and radiographic signs and symptoms of pulp damage were observed. In conclusion, the indirect pulp treatment was considered a good alternative for the treatment of deep caries lesions as it reduced the risk of pulp exposure by not reopening the cavity, saved the patient and the dentist clinical time and arrested the lesion progression with radiographic density increase and absence of any pain symptoms.

Um novo conceito cl?nico no tratamento de les?es de c?rie profunda ? o tratamento pulpar indireto sem reabertura da cavidade. Tem sido demonstrado que a remo??o completa da dentina cariada tornou-se desnecess?ria ap?s selamento total do dente, pois os microorganismosremanescentes da dentina afetada n?o se proliferariam ou morreriam. Este relato de caso descreve o tratamento de les?es de c?rie profunda de uma menina de 11 anos de idade com grande destrui??o coron?ria no primeiro molar permanente mandibular. As paredes dentin?rias infectadas foram removidas com instrumentos manuais e a dentina afetada remanescente foi preenchida com cimento de ion?mero de vidro e resina composta. Ap?s 36 meses de acompanhamento, n?o se observou nenhum sinal e sintoma cl?nico e radiogr?fico de dano pulpar. Em conclus?o, o tratamento pulpar indireto foi considerado uma boa alternativa para o tratamento de les?es de carie profunda, j? que reduziu o risco de exposi??o pulpar, devido a n?o reabertura da cavidade, economizou tempo cl?nico para o paciente e o dentista e paralisou a progress?o da les?o com aumento da densidade radiogr?fica e aus?ncia de qualquer sintomatologia dolorosa.

Métodos complementares na detecção de lesões de cárie em dentes decíduos são realmente necessários? / Are adjunct methods for the detection of caries lesions in primary teeth really necessary?

O presente estudo teve como objetivo avaliar, em termos de probabilidade, o impacto da realização de métodos complementares para a detecção de lesões de cárie em superfícies proximais e oclusais de dentes decíduos, comparado à inspeção visual. Para isso, 1.213 superfícies proximais de 126 crianças e 407 superfícies oclusais de 68 crianças foram examinadas através dos métodos de inspeção visual, exame radiográfico e fluorescência a laser. A validação das superfícies proximais foi realizada após separação temporária. Nas superfícies oclusais, o padrão de referência foi a confirmação da presença de lesão após tratamento operatório. Utilizando análise bayesiana, foram calculadas as probabilidades pós-teste com a aplicação da inspeção visual, e depois com a utilização dos métodos complementares. A probabilidade pré-teste foi de 4,2% e 5,2% para superfícies proximais e oclusais, respectivamente. Um resultado negativo obtido com a inspeção visual levou a probabilidade de ter uma lesão para porcentagens bem baixas, principalmente na superfície oclusal. Nesses casos, mesmo com resultados positivos obtidos com os métodos complementares, a probabilidade de haver uma lesão ainda foi baixa (em torno de 50%, no caso do exame radiográfico positivo em superfícies proximais). A realização da radiografia para confirmar lesões detectadas pelo exame visual em superfície oclusal poderia aumentar a certeza da presença da lesão, evitando tratamento operatório desnecessário. Portanto, pode-se concluir que os métodos complementares não possuem grande utilidade na detecção de lesões de cárie em dentes decíduos, e o exame visual realizado isoladamente já seria suficiente para um diagnóstico acurado.

The present study aimed to evaluate, in terms of probability, the impact of performing adjunct methods of caries lesions detection in proximal and occl usa I surfaces of primary teeth, cornpared to the visual inspection. For this, 1,213 proximalsurfaces of 126 children and 407 occlusalsurfaces of 68 children were examined through visual inspection, radiographic and laser fluorescence methods. The validation for proximalsurfaces was performed after temporary separation.ln the occlusal surfaces the reference standard was the confirmation of the presence of the lesion after operative treatment. Using Bayesian analysis post -test probabilities after performing the visual inspection were calculated. After that, these figures were computed after performing the adjunct caries detection methods. Pre-test probability was 4.2% and 5.2% for proximal and occl usa I surfaces, respectivelv A negative result obtained with visual inspection reduced the post-test probability to very low values, mainly at occlusal surfaces. On these occasions, even with positive results obtained by adjunct methods, the post-test probability of having a carieslesion was stilllow (around 50% in case of a positive result obtained by radiographic method in proximalsurfaces). Performing radiography to confirm carieslesions detected by visual inspection could increase the confidence concerned the presence of the lesion, avoiding unnecessary operative treatment. Therefore, it was concluded thal the adjunct methods do not have great utility in detecting caries lesions in primary teeth, and that the visual inspection performed alone is enough to reach an accurate diagnosis.

Poder discriminatório de métodos de avaliação de placa quanto à remoção do biofilme na superfície oclusal de dentes em erupção / Discriminatory efficiency of biofilm evaluation methods regarding biofilm removal on oclusal surface of erupting teeth

Objetivo: Comparar dois índices visuais de placa e a fluorescência a laser (FL) na discriminação da remoção de placa entre o método de escovação transversal e a utilização da escova unitufo quanto à remoção de biofilme em superfícies oclusais de molares permanentes em erupção. Método: Foram selecionadas 25 crianças entre cinco e sete anos com pelo menos um primeiro molar permanente em erupção presente na cavidade bucal, totalizando 42 dentes. As crianças foram alocadas aleatoriamente em dois grupos de acordo com a técnica de escovação a ser empregada em primeiro lugar. Elas utilizaram a primeira técnica e iniciaram a utilização da segunda após 15 dias de uso da primeira e um período de wash-out. Antes e após cada período de escovação, foi avaliado o biofilme sobre a superfície oclusal por dois examinadores independentes pelos métodos acima descritos. Para comparação entre as técnicas de escovação, foi utilizado o teste de Mann-Whitney. O teste de Wilcoxon foi realizado para comparar as condições antes e depois da técnica de escovação aplicada.Resultados: Não houve diferença, em média, nos índices de placa entre o os períodos de escovação com ambas as técnicas, nem antes e após a utilização das mesmas. As leituras da FL ao final da escovação transversal, nas superfícies evidenciadas ou não, foram maiores que das leituras realizadas no grupo da escova unitufo (p menor que 0,05). Conclusão: Os índices de placa visuais não apresentam poder de discriminar a efetividade das técnicas de escovação testadas direcionadas para molares em erupção na remoção de biofilme, nem períodos de escovação, mas a FL pode ser uma alternativa a ser estudada com essa finalidade.

Objective: To compare two visual plaque indices and laser fluorescence (LF) in the discrimination of biofilm removal using the transversal toothbrushing method and single tufted brush considering biofilm removal from occlusal surfaces of erupting permanent molars. Method: Twenty-five children aged 5 to 7 with at least one first permanent molar in eruption in the oral cavity, totalizing 42 teeth. The children were randomly assigned to two groups according to the toothbrushing technique to be used firstly. They used the first technique and started using the second technique after 15 days using the first followed by a wash-out period. Before and after each toothbrushing period, the biofilm on the occlusal surface was examined by two independent examiners using the methods described above. The Mann-Whitney test was used for comparison between the toothbrushing techniques and the Wilcoxon test was used to compare the conditions before and after the applied toothbrushing technique. Results: There was no statistically significant difference, on average, in the plaque indices between the toothbrushing periods with both techniques, neither before nor after their use. LF readings at the end of the transversal toothbrushing period, on the surfaces evidenced or not, were higher compared with the readings of the single tufted brush group (p less than 0.05). Conclusion: The visual plaque indices was not able to determine the effectiveness of the toothbrushing techniques directed to erupting molars on biofilm removal, nor toothbrushing periods, but LF can be an alternative to be evaluated with this purpose.

The influence of interdental spacing on the detection of proximal caries lesions in primary teeth

The aim of this study was to investigate the influence of interdental spacing on the performance of proximal caries detection methods in primary molars. In addition, aspects related to temporary tooth separation with orthodontic separators were evaluated. The proximal spaces between the posterior primary teeth (n = 344) of 76 children (4-12 years old) were evaluated before and after temporary separation. Stainless steel strips with different standardized thicknesses were used to measure the presence of biological spacing and the spacing obtained after temporary separation with orthodontic rubber rings. First, the presence of proximal caries lesions was assessed by visual inspection, bitewing radiographs and a pen-type laser fluorescence device (DIAGNOdent pen). Visual inspection after temporary separation with separators was the reference standard method in checking the actual presence of caries. Multilevel analyses were performed considering different outcomes: the performance of the methods in detecting caries lesions and the spacing after temporary separation. The spacing did not influence the performance of the caries detection methods. The maximum spacing obtained with temporary tooth separation was 0.80 mm (mean ± standard deviation = 0.46 ± 0.13 mm). The temporary separation was more effective in the upper arch and less effective when an initial biological interdental spacing was present. The biological interdental spacing does not influence the performance of proximal caries detection methods in primary molars, and temporary tooth separation provides spacing narrower than 1.0 mm.

Children's discomfort in assessments using different methods for approximal caries detection

Because discomfort caused by different approximal caries detection methods can influence their performance, the assessment of this discomfort is important. Thus, this study aimed to evaluate the discomfort reported by children after the use of different diagnostic methods to detect approximal caries lesions in primary teeth: visual inspection, bitewing radiography, laser fluorescence (DIAGNOdent pen - LFpen) and temporary separation with orthodontic rubbers. Seventy-six children aged 4 to 12 years were examined using these methods. Their discomfort was assessed using the Wong-Baker scale and compared among the methods. Visual inspection caused less discomfort than did other methods. Radiography and the LFpen presented similar levels of discomfort. Older children reported higher discomfort using temporary separation, whereas younger children reported less discomfort with the LFpen. In conclusion, radiographic, temporary separation and LFpen methods provoke higher discomfort than visual inspection.

Reabilitação estético-funcional de paciente com displasia ectodérmica em idade precoce / Early aesthetic functional rehabilitation of patient with ectodermal dysplasia

A displasia ectodérmica representa um complexo grupo de doenças com características clínicasrelacionadas principalmente às estruturas do ectoderma, como pele, anexos cutâneos,cabelos, unhas, glândulas sudoríparas e dentes. Dentre as alterações dentais, as anomalias denúmero e forma são bastante comuns, tanto na dentição decídua como na permanente, levandoao comprometimento bucal estético e funcional. Este trabalho visa apresentar um casoclínico de displasia ectodérmica em paciente odontopediátrico, descrevendo as anormalidadesdentais e a conduta de reabilitação oral adotada para estabelecimento da função, estética eequilíbrio psicológico.

Ectodermal dysplasia is a complex group of diseases with clinical features related mainlywith ectodermal structures such as skin, skin appendages, hair, nails, sweat glands and teeth.Among the dental alterations, the absence of some teeth and morphologic anomalies are extremelycommon, both in the primary and permanent teeth resulting in esthetical and functionalcompromise. This report aims to present teeth abnormalities and the clinical procedures involvedin the child's oral rehabilitation carried out in order to restore the function, the estheticaland the psychological equilibrium.

Avaliação de periódicos nacionais quanto aos aspectos éticos / Evaluation of national scientific journals on ethical aspects

A experimentação científica surgiu no século 16 com o físico Galileu-Galilei (1564-1642). Ao longo dos anos, o número de experimentos com humanos teve um grande aumento e a preocupação com a valorização dos seres humanos foi manifestada pelo público. O termo bioética foi criado em 1970 nos Estados Unidos, e um novo estilo ético foi proposto por meio do Relatório de Belmont em 1978. Esse modelo ético tem como princípios o respeito pelas pessoas (autonomia), a obrigação de não causar dano, maximizar os benefícios e minimizar os riscos (beneficência) e a imparcialidade na distribuição dos riscos e benefícios (justiça). No Brasil, o Conselho Nacional da Saúde (CNS) estabeleceu a Resolução 196/1996 para guiar as normas sobre ética em pesquisa, a qual tem grande preocupação no controle social. Este trabalho teve como propósito verificar se os periódicos nacionais estão garantindo que a ética seja aplicada de maneira rigorosa em experimentos com seres humanos

Aspecto emocional dos bebês envolvidos no Tratamento Restaurador Atraumático (ART): estudo clínico piloto / Emotional aspects in todlers involved in the Atraumatic Restorative Treatment (ART): pilot study

Objetivo - Estudos clínicos que envolvem bebês e Tratamento Restaurador Atraumático (ART) são necessários para a construção da evidência científica no que se refere à busca por tratamento odontológico eficiente que envolva níveis reduzidos de estresse para esta faixa etária. O propósito deste estudo piloto foi avaliar o grau de desconforto envolvido no atendimento odontológico em bebês comparando a técnica do ART com a abordagem convencional que envolve utilização de técnicas anestésicas e isolamento absoluto. Métodos - Foram selecionadas 2 crianças com aproximadamente 30 meses apresentando, pelo menos, dois molares com lesão de cárie oclusal em dentina. Dois dentes, um de cada criança, foram tratados segundo o ART e os outros dois dentes foram tratados de maneira convencional, caracterizando um estudo do tipo split-mouth. A extensão do desconforto foi avaliada por meio da medição da frequência cardíaca e registrando o comportamento geral do bebê de acordo com escala modificada de Venham10 (1980). Resultados - Foi constatado que na maior parte do tempo os bebês apresentaram frequência cardíaca superior ao considerado normal para esta faixa etária, evidenciando a ansiedade relacionada ao tratamento odontológico. Além disso, observaram-se valores de batimento cardíaco semelhantes ou inferiores para as sessões nas quais o tratamento utilizado foi o ART e os valores da escala modificada de Venham foram semelhantes ou inferiores para o tratamento convencional. Conclusão - Considerando a frequência cardíaca como critério de avaliação de estresse menos subjetivo, conclui-se que os bebês submetidos ao ART apresentam menor desconforto emocional quando comparado ao tratamento convencional.

Objective - Clinical studies involving babies and Atraumatic Restorative Treatment (ART) is needed for the scientific evidence construction regarding an efficient dental treatment involving low levels of stress on this special age. The purpose of this pilot study was to evaluate the degree of discomfort involved in dental care in babies comparing ART with conventional approach. Methods - Two children about 30 months with at least two molars with occlusal caries in dentin were selected. Two teeth, one for each child, were treated according to ART and the other two teeth were treated in the conventional manner, featuring a split-mouth study. The extent of discomfort was assessed by measuring heart rate and recording the general behavior of the baby according to the Venham's10 (1980) scale modified. The records of heart rate and behavior of the child were performed by the same researcher who did not participate actively in clinical procedures. Results - It was found that most of the time the babies heart rate had exceeded normal levels for this age group, highlighting the anxiety related to dental treatment. In addition, we observed heart rate values similar or inferior to the sessions when ART was used and Venham's scale values similar or inferior to conventional treatment. Conclusion - Considering the heart rate as a criterion for evaluation of stress less subjective, it was concluded that babies undergoing Atraumatic Restorative Treatment have less emotional distress when compared to conventional treatment.

Reliability and discriminatory power of methods for dental plaque quantification

OBJECTIVE: This in situ study evaluated the discriminatory power and reliability of methods of dental plaque quantification and the relationship between visual indices (VI) and fluorescence camera (FC) to detect plaque. MATERIAL AND METHODS: Six volunteers used palatal appliances with six bovine enamel blocks presenting different stages of plaque accumulation. The presence of plaque with and without disclosing was assessed using VI. Images were obtained with FC and digital camera in both conditions. The area covered by plaque was assessed. Examinations were done by two independent examiners. Data were analyzed by Kruskal-Wallis and Kappa tests to compare different conditions of samples and to assess the inter-examiner reproducibility. RESULTS: Some methods presented adequate reproducibility. The Turesky index and the assessment of area covered by disclosed plaque in the FC images presented the highest discriminatory powers. CONCLUSION: The Turesky index and images with FC with disclosing present good reliability and discriminatory power in quantifying dental plaque.

Avaliação da presença de defeitos de esmalte pelo índice visual DDE modificado e por aparelho de fluorescência a laser (DIAGNOdent) / Presence of developmental defects of enamel (DDE) by the modified DDE visual index and laser fluorescence (DIAGNOdent)

Objetivo: Avaliar os defeitos de desenvolvimento de esmalte em dentes permanentes através da avaliação com o Índice Development Defects of Enamel (DDE) modificado e do aparelho DIAGNOdent, visando avaliar se as leituras do DIAGNOdent apresentavam interferência em dentes com defeitos de desenvolvimento de esmalte e correlacionar os resultados obtidos pelo Índice DDE modificado e pelo DIAGNOdent. Método: Vinte indivíduos (6-17 anos) tiveram alguns de seus dentes permanentes avaliados pelo DIAGNOdent, tanto na sua face vestibular quanto na face lingual. As medidas obtidas pelo DIAGNOdent em dentes com defeitos de desenvolvimento de esmalte foram comparados com dentes contra-laterais sem os defeitos pelo teste de Mann-Whitney. As medidas do aparelho também foram comparadas em dentes classificados como sem defeitos de desenvolvimento de esmalte, dentes com hipocalcificação e dentes com hipoplasia, classsificados pelo DDE, utilizando o teste de Kruskal-Wallis. Foi investigada também a correlação da presença desses defeitos com a classificação pelo DDE modificado e com experiência de cárie desses pacientes (teste de correlação de Spearman). Resultados: Observou-se que os valores do DIAGNOdent foram em média maiores para os dentes com defeitos de esmalte que para dentes normais (p<0,001). Entretanto, o coeficiente de correlação entre as medidas com o DIAGNOdent e a ocorrência de alterações de esmalte foi considerada baixa (rSp=0,31- p<0,001). Houve diferença estatisticamente significante entre os diferentes tipos de alterações de esmalte (p<0,001). Não foi encontrada correlação entre as alterações de esmalte e cárie dentária (p>0,05). Conclusão: As medidas com o DIAGNOdent podem ser alteradas pela presença de alterações no esmalte, podendo levar a diagnóstico equivocado, se considerado isoladamente.

Objective: To evaluate the presence of developmental defects of enamel (DDE) in permanent teeth by the analysis of the modified DDE index and the use of a laser fluorescence system (DIAGNOdent), aiming at determining whether the presence of DDE interfere in the DIAGNOdent readings, and correlating the results obtained by the modified DDE index and DIAGNOdent. Method: Twenty individuals (age range: 6-17 years) had the buccal and lingual faces of some of their permanent teeth evaluated using the DIAGNOdent system. The DIAGNOdent measurements obtained from teeth with DDE were compared to those of their contra-lateral teeth without defects by the Mann-Whitney test. The DIAGNOdent measurements were also compared in teeth classified as without DDE, teeth with hypocalcification and teeth with hypoplasia, classified by the DDE index, using the Kruskal-Wallis test. The correlation of the presence of these defects with the classification by the modified DDE index and the patients' caries experience (Spearman's correlation test) was also investigated. Results: In general, higher DIAGNOdent values were obtained for teeth with DDE compared to teeth without enamel alterations (p<0.001). However, the correlation coefficient between the DIAGNOdent readings and the occurrence of enamel alterations was considered low (rSp=0.31-p<0.001). There was statistically significant difference among the different types of enamel alterations (p<0.001). There was no correlation between the enamel alterations and dental caries (p>0.05). Conclusion: The DIAGNOdent readings may be altered by the presence of DDE, possibly leading to misdiagnosis if they are considered alone.