Prevalencia de papiloma oral en niños brasileños: un estudio retrospectivo de lesiones biopsiadas / Prevalência de papiloma oral em crianças brasileiras: um estudo retrospectivo de lesões biopsiadas / Prevalence of oral papillomas in Brazilian children: a retrospective study of biopsied lesions

Introducción: El virus del papiloma humano (VPH) es un factor etiológico de diversas enfermedades de la mucosa oral y de la piel que pueden derivar en neoplasias malignas. La vacunación es la principal forma de prevención, inmunizando a las niñas de 9 a 13 años y a los niños de 11 a 13 años. Todavía no hay consenso sobre la prevalencia del virus VPH en niños. Objetivo: Verificar la prevalencia del VPH en niños de 1 a 13 años a partir de una base de datos de informes de biopsias de lesiones diagnosticadas de papiloma analizadas en un laboratorio nacional de referencia. Material y métodos: Se analizaron los informes anatomopatológicos de biopsias recibidas por el Laboratorio de Patología Oral y Maxilofacial de la Facultad de Odontología de la Universidad de São Paulo en un período de 20 años, de 2002 a 2022. También se recogieron informaciones sobre sexo, localización de la lesión e hipótesis diagnóstica. Resultados: En una base de datos de 93.950 informes, 4.203 comprendían el grupo de edad analizado y 99 (2,3%) tenían diagnóstico de papiloma. El porcentaje de varones y mujeres fue similar, 50,5% y 49,5% respectivamente. La localización más frecuente fueron los labios (48%). Las hipótesis diagnósticas más citadas fueron epulides y verruga vulgar. Conclusión: La prevalencia del papiloma en niños brasileños de 1 a 13 años fue del 2,3%. El reconocimiento de las características clínicas de las lesiones es esencial para el diagnóstico correcto y la intervención precoz, así como la orientación.

Introdução: O papiloma vírus humano (HPV) é fator etiológico para diversas doenças na mucosa oral e na pele que podem sofrer processo de malignização. A vacinação é a principal forma de prevenção, imunizando meninas de 9 a 13 anos e meninos de 11 a 13 anos. Ainda não há um consenso sobre a prevalência do vírus HPV em crianças. Objetivo: Verificar a prevalência de HPV em crianças de 1 a 13 anos de idade com base em um banco de laudos de lesões biopsiadas com diagnóstico de papiloma analisadas em um laboratório de referência nacional. Material e Métodos: Foi feita a análise de laudos anatomopatológicos de biópsias recebidas pelo Laboratório de Patologia Bucal e Maxilofacial da Faculdade de Odontologia da Universidade de São Paulo em um período de 20 anos, compreendido entre ao anos 2002 a 2022. Informações de sexo, localização da lesão e hipóteses diagnósticas também foram coletadas. Resultados: Em um banco de 93.950 laudos, 4.203 compreendiam a faixa etária analisada e 99 (2,3%) tinham o diagnóstico de papiloma. A porcentagem de laudos do sexo masculino e feminino foi similar, sendo 50,5% e 49,5%, respectivamente. A localização da lesão mais frequente encontrada foi a região dos lábios (48%). Hipóteses diagnósticas mais citadas foram epúlide e verruga vulgar. Conclusão: A prevalência de papiloma em crianças brasileiras de 1 a 13 anos foi de 2,3%. Reconhecer características clínicas das lesões é essencial para um correto diagnóstico e intervenção precoce bem como para evitar o agravamento da doença.

Introduction: Human papillomavirus (HPV) is an etiologic factor for several diseases of the oral mucosa and skin that can undergo a malignant process. Vaccination is the most important form of prevention, with girls being vaccinated between the ages of 9 and 13 and boys between the ages of 11 and 13. There is still no consensus on the prevalence of the HPV virus in children. Aim: To review the prevalence of HPV in children aged 1 to 13 years based on a database of reports of biopsied lesions diagnosed with papilloma analyzed in a national reference laboratory. Material and methods: Anatomic-pathologic reports of biopsies received at the Oral and Maxillofacial Pathology Laboratory of the Faculty of Dentistry of the College of São Paulo were analyzed over a 20-year period, between 2002 and 2022. Information on gender, lesion location and diagnostic hypotheses was also collected. Results: In a database of 93,950 reports, the age group analyzed accounted for 4,203 and 99 (2.3%) were diagnosed with papilloma. The proportion of male and female reports was similar at 50.5% and 49.5% respectively. The most common location of the lesion found was the lip region (48%). The most frequently cited diagnostic hypotheses were epulis and verruca vulgaris. Conclusion: The prevalence of papillomas in Brazilian children aged 1 to 13 years was 2.3%. Early diagnosis and advice on HPV vaccination can prevent and avoid exacerbation of the disease. Recognizing the clinical features of lesions is essential for correct diagnosis and early intervention and counseling

Adverse oral conditions associated with worse emotional and social well-being of Brazilian teenagers: a population-based study in a deprived rural-urban boundary / Condições bucais adversas associadas a pior bem-estar emocional e social de adolescentes brasileiros: um estudo de base populacional em uma periferia rural-urbana negligenciada

Abstract Background The relationship between dental appearance and emotional/social well-being in underprivileged areas undergoing rapid urbanization is unknown. Objective To assess if the emotional and social well-being of teenagers living in urban areas might be more affected by unfavorable dental appearance determined by oral conditions. Method A population-based cross-sectional exploratory study with 12-year-old Brazilian schoolchildren was carried out in two poor, underserviced districts of Sao Paulo City, Brazil. Outcome was severity of oral health-related quality of life (QHRQoL) due to the emotional and social well-being and exposures were oral conditions and residence district (rural or urban). Results The impact on severity of QHRQoL due to emotional well-being and due to social well-being, respectively, were 14% and 16% higher for those presenting at least one untreated decayed tooth; 36% and 54% higher for those with unfavorable dental appearance and 25% and 39% higher for those from the urban district. No association between malocclusion and district was observed. Conclusion Despite higher prevalence of untreated dental caries in the rural district, teenagers from the urban district felt that their OHRQoL, adjusted by oral conditions investigated, was more negatively affected. This suggests that urban environmental influences can lead to stressful social pressures stemming from dental appearance, leading to diminished emotional and social well-being.

Resumo Introdução A relação entre aparência dentária e bem-estar emocional/social em áreas carentes com urbanização acelerada é desconhecida. Objetivo Avaliar se o bem-estar emocional e social de adolescentes residentes em área urbana pode ser mais impactado pela aparência dentária desfavorável controlada pelas condições bucais. Método Um estudo exploratório transversal de base populacional envolvendo escolares brasileiros de 12 anos foi realizado em dois bairros carentes foi realizado, na cidade de São Paulo, Brasil. O desfecho foi a gravidade da qualidade de vida relacionada à saúde bucal (QVRSB) devido ao bem-estar emocional e social, e as exposições foram condições bucais e distrito de residência (rural e urbano). Resultados O impacto sobre a gravidade da QVRSB em decorrência do bem-estar emocional e do bem-estar social, respectivamente, foi 14% e 16% maior para aqueles que apresentavam pelo menos um dente cariado não tratado; 36% e 54% maior para aqueles com aparência dentária desfavorável e 25% e 39% maior para aqueles moradores em distrito urbano. Nenhuma associação entre má oclusão e distrito foi observada. Conclusão Apesar da maior prevalência de cárie dentária não tratada no distrito rural, os adolescentes do distrito urbano sentiram-se mais afetados negativamente em sua qualidade de vida relacionada à saúde bucal ajustada pelas condições bucais, sugerindo que as possíveis influências do ambiente urbano podem trazer experiências sociais estressantes devido à aparência dentária impactando no bem-estar emocional e social.

Retención del conocimiento de estudiantes después de una capacitación teórico-laboratorial para detección de caries / Retenção de conhecimento de graduandos após 1. 5 ano de treinamento teórico-laboratorial para detecção de cárie / Students' knowledge retention after theoretical-laboratory training for caries detection in pediatric dentistry. 1. 5 Year-assessment

Este estudio evaluó la retención de conocimientos, de estudiantes de pregrado expuestos a una actividad educativa de detección de lesiones de caries. Estudiantes de Odontología de los últimos años fueron invitados a participar del estudio. Ellos recibieron la capacitación 1 año y medio antes. Para evaluar su retención de conocimientos se realizaron evaluaciones teóricas y prácticas para dimensionar los conocimientos, habilidades y actitudes de los estudiantes. Cada prueba se valoró entre 0 a 10. Análisis de regresión multinivel se usaron para ver la asociación entre el desempeño de los estudiantes y su percepción sobre la importancia de la actividad. Otras peculiaridades relacionadas al desempeño en temas específicos y diferentes tipos de evaluación también fueron estudiadas. 302 estudiantes fueron evaluados. En promedio, los estudiantes tuvieron una nota 6.68 para la teórica y 5.5 para la práctica, con desviación estándar de 1.88 y de 2.27, respectivamente. La percepción de los estudiantes sobre la actividad didáctica fue asociada a su desempeño. En la evaluación teórica, los estudiantes fueron peores al relacionar la condición clínica con la histológica (21% de aciertos) y al justificar su conducta frente a lesiones inactivas (36% de aciertos). En la evaluación práctica, el 70-90% de los estudiantes demostraron tener capacidad para detectar, valorar la actividad y tomar decisiones clínicas sobre lesiones iniciales y severas. Solo 50% detectó correctamente lesiones moderadas y 32% sabe su manejo. Concluimos que la retención de conocimientos de los alumnos en mediano plazo es moderada está dentro de lo esperado.

Este estudo avaliou a retenção de conhecimento, em médio prazo, de graduandos expostos a uma atividade educativa de detecção de cárie. Esta é uma parte do estudo multicêntrico IuSTC. Alunos dos últimos anos foram convidados a participar e passaram pela atividade. Foram avaliados quanto à retenção do conhecimento após 1,5 ano. Avaliações teóricas e práticas (pontuadas de 0 a 10) foram preparadas para avaliar conhecimento, habilidades e atitudes. Os escores foram definidos como desfechos. Análises de regressão multinível testaram a associação entre a performance dos alunos e sua percepção sobre a importância da atividade dentro do seu currículo. Particularidades relacionadas à performance em tópicos específicos e diferentes tipos de avaliação também foram explorados. 302 alunos participaram das avaliações. Em média, os alunos tiveram medias (desvio-padrão (DP), de 6,68 (1,88) teórica e 5,5 (2,27) prática. A percepção dos alunos esteve associada com sua performance. Na avaliação teórica, os alunos tiveram pior performance ao relacionar a condição clínica com a histológica (21% de acertos) ou em justificar a conduta frente a lesões inativas (36% de acertos). Na avaliação prática, 70-90% dos alunos demonstraram habilidade de detectar, avaliar atividade e tomar decisões clínicas frente a lesões iniciais e severas, enquanto 50% avaliaram adequadamente as lesões moderadas e apenas 32% demonstrou atitude correta do manejo. Em conclusão, a retenção do conhecimento dos alunos está dentro do esperado em uma análise de médio prazo. Para alguns tópicos (por exemplo, relacionados a prática e justificativa de atitudes), a performance dos alunos tende a ser pior.

This study aimed to evaluate undergraduate students' medium-term knowledge retention after a learning activity related to caries lesions detection. This study is part of the IuSTC multicenter study. Last-years dental students were invited to participate and were exposed to the teaching activity. Their knowledge retention after 1.5 year was assessed. Theoretical and practical tests (scored 0 to 10) were prepared to evaluate knowledge, abilities and attitudes The scores were set as outcomes. Multilevel regression analyses were used to assess the association between students' performance and his/her perception about the importance of such learning activity in curriculum. Particularities related to students' performance in specific topics and types of evaluations were also explored. 302 students participated. On average, students achieved 6.68 (SD=1.88) in theoretical and 5.5 (SD=2.27) in practical assessment. Student's perception was associated with their performance. In theoretical test, students performed worse (21% of correct answers) in linking clinical and histological condition or justifying clinical decision-making for inactive lesions (36% of correct answers). In the practical test, 70-90% demonstrated ability to detect, assess activity and make the decision about management of initial or severe lesions, while 50% of students could assess adequately moderate caries lesions and only 32% demonstrated correct attitude related to their management. Undergraduate students' knowledge retention related to the detection of caries lesions is moderate in a medium-term analysis. It is noted that for some topics (e.g. not related to practice/justification of attitudes), the students' performance tends to be worse.

A scoping review about LGBTQIAP+ people in oral health research

Abstract Oral health personnel must acknowledge the health needs of sexual and gender minorities. They should consult scientific literature to deepen their knowledge about sexuality, gender identity, general and oral health status, and treatment disparities among LGBTQIA+ people. The aim of this scoping review was to portray the development and current stage of internationally indexed literature approaching the oral health of this population. In this study, the search strategy used consisted of combinations of subject descriptors (MeSH terms), in two concept blocks: LGBTQIAP+ people and oral health. Global literature was searched through Medline (PUBMED), Web of Science, Embase, Lilacs, and Scopus electronic databases, with no language or date restrictions. Records were selected and evaluated by two independent reviewers, under the supervision of three senior reviewers and the inclusion criteria resulted in 189 eligible papers. Since the first study was published in 1974, numbers increased over the decades, reaching 67 (35.4%) in 2010-2019. The most frequently studied populations were North American (42.9%) and European (19.0%) and the most frequent language of publication was English (99.0%). There were 38 open access papers (20.1%). Medical (57.7%) and dental journals (20.1%) predominated. Cross-sectional studies were found more frequently (65.1%), followed by the cohort type (11.1%). Oral manifestation of STI (58.7%) was the topic most frequently addressed. The search for literature approaching the oral health of LGBTQIAP+ people showed evidence of the need to encourage research reported in papers made easily available, with more robust scientific evidence, and on a broader scope of topics, including oral health needs and treatment, and planning of oral health services.

Consensus for teaching dental caries in the Portuguese Language at Brazilian dental schools

Abstract The aim of this paper was to present a summary of the process of developing and preparing the final documents of the national consensus for teaching undergraduate Brazilian dental students the dental caries curriculum in the Portuguese language. The final document was developed in three steps: a) The ABENO and LAOHA cariology group invited experts from all five regions of Brazil to participate in the discussion. The theoretical support for crafting the first draft of the consensus was based on two publications: National Curriculum Guidelines of the Dentistry graduation in Brazil, Ministry of Education (2021) and the competences described in the European Core Curriculum for Cariology (ORCA-ADEE, 2011); b) The group of experts was divided into 5 working groups: G1-Domain, Main and Specific Competences, G2-Essential knowledge, G3-Life course perspective, G4-Social determinants and dental caries, G5- Glossary. The document was finalized by thoroughly reviewing the process using Delphi methodology; c) The 5-chapter document (one from each working group) was submitted to three open public consultations in 2022 (May-June, August, and October) using Google-forms. The suggestions (content/wording) were discussed within the group as: totally accepted, partially accepted, and rejected. A total of 192 suggestions were registered from 31 dental schools in all regions of Brazil. The number of suggestions received per Group were: 84, 28, 26, 24, 30 suggestions for G1, G2, G3, G4 and G5, respectively. The majority of suggestions were totally accepted by the group of experts (n = 172, 89.6%), 15 were partially accepted (7.8%), and 5 were rejected. Conclusion The final document could be considered to be the first national consensus for teaching the dental caries curriculum in Brazil.

Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption

Abstract Policy evaluation and guidance on fluoride use and sugar consumption in Latin American and Caribbean countries (LACC) may provide a scientific evidence basis for policymakers, dental professionals, civil society organizations and individuals committed to improving public oral health. A cross-sectional study was conducted to evaluate the extent of implementation of policies/guidelines on fluoride use, and sugar consumption in LACC. The study had two stages. First a questionnaire covering four major areas was developed: fluoridation of public water supplies; salt fluoridation; fluoride dentifrices, and sugar consumption. Then, the questionnaire was applied to collect data among representative participants in public oral health from LACC. Ninety-six participants from 18 LACC answered the questionnaire. One-hundred seventy documents were attached, and 285 links of websites were provided by the respondents. Implementation of policies and guidelines on water and table salt fluoridation and processed and ultra-processed food consumption were found in most countries, with some issues in the consensus and coverage. Thus, differences were identified in the extent of implementation of public oral health strategies on sugar consumption and fluoridation among the countries. There is no consensus on the policies in LACC to reduce sugar consumption and for the use of fluoride. A few policies and guidelines were applied in isolated countries, with a variety of strategies and standards. For future actions, it will be important to encourage the development of strategies and public policies within countries, and to evaluate the effectiveness of existing policies in reducing dental caries and in improving oral health in LACC.

Oral findings in children on liver transplantation programming: a scoping review / Achados odontológicos em crianças em programação para o transplante hepático: revisão de escopo

Abstract Objective: To identify oral characteristics found in children with liver disease in programming for liver transplantation. Data source: The methodology was written according to PRISMA-ScR. We adopted the methodological framework and recommendations for this type of review by Arksey and O'Malley and the Joanna Briggs Institute. The protocol was registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/QCU4W). A systematic search (Medline/PubMed, Scopus, Web of Science, and ProQuest) was conducted to identify studies that met the inclusion criteria: systematic reviews; prospective clinical trials (parallel or crossover group designs); observational studies (cohort, case-control, and cross-sectional studies); clinical case series; and case reports evaluating children with liver disease in preparation for transplantation. The last search was conducted in July 2021, and no restrictions were imposed as to language or year of publication. Studies presenting mixed data with post-transplant evaluation, and studies evaluating not only liver transplantation but also other solid organs were excluded. Screening, inclusion, and data extraction were performed by two reviewers independently. A narrative synthesis was conducted to describe the findings of the study. Data synthesis: The bibliographic search identified 830 references. A total of 21 articles were read in their entirety after the inclusion criteria assessment. Finally, after evaluating the exclusion criteria, only 3 studies were considered for the qualitative analysis. Conclusions: Children with liver disease in preparation for transplantation may present enamel defects, tooth pigmentation, caries, gingivitis, and opportunistic infections such as candidiasis.

RESUMO Objetivo: Identificar características bucais em crianças hepatopatas em programação para o transplante hepático. Fontes de dados: A metodologia foi descrita de acordo com o PRISMA-ScR. Adotamos a estrutura metodológica e recomendações para este tipo de revisão por Arksey e O'Malley e o Instituto Joanna Briggs. O protocolo foi registrado no Open Science Framework (https://doi.org/10.17605/OSF.IO/QCU4W). Uma pesquisa sistemática (Medline/PubMed, Scopus, Web of Science e ProQuest) foi conduzida para identificar estudos que preenchessem os critérios de inclusão: revisões sistemáticas; ensaios clínicos prospectivos (desenhos de grupos paralelos ou cruzados); estudos observacionais (coorte, caso-controle e estudos transversais); séries de casos clínicos; e relatos de casos que avaliam crianças com doenças hepáticas em preparação para o transplante. A última busca foi conduzida em julho de 2021, e não foram impostas restrições quanto ao idioma ou ano de publicação. Foram excluídos estudos que apresentavam dados mistos com avaliação pós-transplante e estudos que avaliavam não só o transplante de fígado, mas também de outros órgãos sólidos. O rastreio, inclusão e extração de dados foram realizados por dois revisores independentemente. Foi conduzida uma síntese narrativa para identificar os resultados do estudo. Síntese dos dados: A pesquisa bibliográfica identificou 830 referências. Foram lidos 21 artigos na íntegra após avaliação dos critérios de inclusão. Finalmente, após a avaliação dos critérios de exclusão, apenas três estudos foram considerados para análise. Conclusões Crianças com doença hepática em preparação para o transplante podem apresentar defeitos de esmalte, pigmentação dentária, cárie, gengivite além de infecções oportunistas como a candidíase.

Impact of the first thousand days of life on dental caries through the life course: a transdisciplinary approach

Abstract This review aimed to describe the importance of the first 1000 days of a child's life as a golden period for interventions and actions to prevent dental caries and other chronic non-communicable diseases (NCDs) throughout the life course and highlight that the first 450 days of life could be even more important for oral health. During the first 1000 days of life (pregnancy and first two years of life), health care providers can identify unhealthy lifestyles, behaviors, and their determinants. Bearing in mind contextual factors like socioeconomic conditions and cultural aspects, this is a unique period to work together with the family and identify opportunities for adopting healthy habits that might last throughout the life of the expected or newborn child. This is a "window of opportunity" for the prevention of chronic NCDs of both systemic and oral origin, such as overweight, obesity, diabetes, cardiovascular diseases, and dental caries. In fact, to effectively prevent dental caries, pregnancy and the first 6 months of a child's life (first 450 days) should be considered the critical period to work together with families to facilitate the adoption of healthy habits. Knowledge about the first thousand days of life is essential and represents a crucial period for the implementation of actions and interventions that will guarantee good oral and general health development that can persist throughout life.

How oral health literacy and parental behavior during the meals relate to dental caries in children

Abstract This cross-sectional study aimed to verify the influence of parental behavior on the development of dental caries in children by assessing parents' behavior during their children's meals and their parental level of oral health literacy. This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred and thirty children were examined to assess the prevalence of dental caries (dmft index). Parents answered a questionnaire related to socio-demographic conditions, oral health literacy (OHL), and the parents' behavior during the meal - Parent Mealtime Action Scale - (PMAS). The analysis fitted zero-inflated negative binomial regression (ZINB) models to assess unadjusted and adjusted associations between the study outcome and covariates. In the unadjusted analysis, the child's age, the number of siblings, household crowding, family income, socioeconomic status and OHL were associated with the outcome (p <0.05). In the adjusted model, dental caries was more prevalent among 3- (PR: 1.85, 95%CI: 1.19-2.87) and 4-year-old children (PR: 2.43, 95%CI: 1.60-3.71), those with at least one sibling (PR: 1.66, 95%CI:1.18-2.33). Poor children were more likely to have dental caries (PR: 0.66, 95%CI: 0.48-0.91); the Use of Rewards dimension of the PMAS was associated positively with dental caries severity (RR: 0.90, 95%CI: 0.84-0.97). Although OHL was not associated with caries, parents' mealtime behaviors were related to dental caries. This suggested that communication between parents and children related to good eating practices could play a protective role against dental caries in children.

Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus

Abstract Dental caries can be effectively managed and prevented from developing into cavitated lesions while preserving tooth structure at all levels. However, the strong correlation between caries and socioeconomic factors may compromise the efficacy of preventive strategies. The high prevalence of persistent inequalities in dental caries in Latin American and Caribbean countries (LACC) is a matter of concern. The estimates of the burden of disease in some countries in this region are outdated or absent. This paper aims to summarize and present the final recommendations of a regional Consensus for Dental Caries Prevalence, Prospects, and Challenges for LACC. This consensus is based on four articles that were written by a team of Latin American experts, reviewed by dental associations, and presented and discussed in two consensus events. The following domains were explored: epidemiology, risk factors, prevention strategies, and management of dental caries with a focus on restorative procedures. Dental caries can manifest throughout the lifespan of an individual, making it a matter of concern for infants, children, adults, and older people alike. The prevalence rates of untreated caries in deciduous and permanent teeth are high in many parts of the world, including LACCs. Previous evidence suggests that the prevalence of dental caries in 12-year-olds is moderate to high in most Latin American countries. Moreover, the prevalence of treatment needs and dental caries in the adult and elderly population can also be regarded as high in this region. The risk/protective factors (e.g., sugar consumption, exposure to fluoride, and oral hygiene) probably operate similarly in all LACCs, although variations in the interplay of these factors in some countries and within the same country cannot be ruled out. Although salt and water fluoridation programs are implemented in many countries, there is a need for implementation of a surveillance policy. There is also room for improvement with regard to the introduction of minimal intervention techniques in practice and public health programs. Dental caries is a marker of social disadvantage, and oral health promotion programs and interventions aimed at reducing the burden of dental caries in LACCs must consider the complexity of the socioeconomic dynamics in this region. There is an urgent need to promote engagement of stakeholders, policymakers, medical personnel, universities, dental associations, community members, and industries to develop regional plans that enhance the oral health agenda for LACCs. A list of recommendations has been presented to underpin strategies aimed at reducing the prevalence and severity of dental caries and improving the quality of life of the impacted LACC population in the near future.

Follow-up interval for dental appointments: a randomized clinical trial with children with low caries risk

Abstract The objective of this study was to evaluate the effect of different follow-up consultation intervals on caries incidence in children with low caries risk. The study was composed of 224 children aged between 3 and 5 years and with low risk of caries. The children were randomly allocated into two groups, according to two different follow-up consultation intervals: Group 1 (G1) - 12-month follow-up interval; Group 2 (G2) - 18-month follow-up interval. All oral clinical examinations were performed by a single examiner who was previously calibrated and blinded in relation to the study groups. An external dentist provided the advice on oral hygiene and diet and evaluated the children's socioeconomic conditions. The Chi-square and Mann-Whitney tests were used to evaluate the differences between groups. Poisson regression analyses were performed to assess the association of caries incidence with the other variables. At the end of the study there was a significant difference between the groups regarding initial active lesions (p = 0.012), and children in G2 were at a higher risk of developing initial active lesions than those in G1 (p = 0.047). Children who had a higher number of teeth with initial active lesions in the follow-up consultations were at a higher risk of developing cavitated dentin caries (p = 0.001). Both follow-up intervals are justifiable. Although significant results have been observed for initial active caries lesions within the 18-month follow-up interval, it should be noted that these lesions can be treated using just preventive measures. Besides, different return interval had no effect in cavitated dentin lesions.

Expression of the of STRO-1 and HSP-25 markers during odontogenesis / Expressão dos marcadores STRO-1 e HSP-25 durante a odontogênese

ABSTRACT Objective: Therefore, the purpose of the currently study was to analyze the expression of the STRO-1 stem cell marker and the marker related to Hsp25 differentiation and dental development during odontogenesis in rats. Methods: Eighteen-day Wistar rat embryos and 7-day-old animals were analyzed morphologically via Hematoxylin and Eosin (HE) staining and via immunohistochemical marking for Stro-1 and Hsp25 in 5uM serial sections. Results: In the HE morphological analysis in 18-day embryos, the stage of tooth development was in the cap phase, while in the 7-day old animals it was in the bell phase. Conclusion: The expression of STRO-1 in the embryos was not found in the region of the dental papilla or enamel organ, however, in the 7-day-old animals, STRO-1-positive cells were found in the region of the dental follicle and dental papilla. As for the Hsp25, this exhibited weak marking in the cap phase while in the bell phase, there was a reaction, mainly in the odontoblasts. The expressions in the site of these markers vary according to the stage of tooth development.

RESUMO Objetivo: Analisar a expressão do marcador de células-tronco STRO-1 e o marcador relacionado à diferenciação da Hsp25 e ao desenvolvimento dental durante a odontogênese em ratos. Métodos: Embriões de ratos Wistar de dezoito dias e animais de sete dias de idade foram analisados morfologicamente através da coloração com Hematoxilina e Eosina (HE) e através de marcação imuno-histoquímica para STRO-1 e Hsp25 em seções seriais de 5uM. Resultados: Na análise morfológica da HE em embriões de 18 dias, o estágio de desenvolvimento dos dentes estava na fase capuz, enquanto nos animais de 7 dias estava na fase de campânula. Conclusão: Nos embriões, a expressão de STRO-1 não foi encontrada na região da papila dentária ou no órgão do esmalte; no entanto, nos animais de sete dias de idade, células positivas para STRO-1 estava presente na região do folículo e papila dentária. Quanto ao Hsp25, este apresentou fraca marcação na fase capuz, enquanto na fase campânula houve reação, principalmente nos odontoblastos. As expressões no local desses marcadores variam de acordo com o estágio do desenvolvimento dentário.

Survival rate of pulpectomy in primary teeth using Feapex® paste: a clinical study in infants / Sobrevida de pulpectomia em dentes decíduos utilizando pasta Feapex®: um estudo clínico em bebês

Objective: The aim of this clinical study was to evaluate the survival rate of a new pulpectomy protocol using 2% chlorhexidine digluconate gel and Feapex® paste for endodontic treatment in primary teeth. Material and Methods: A total of 105 pulpectomies were performed in anterior and posterior teeth of 48 infants (1-3 years old) with high caries experience with irreversible pulpitis or pulp necrosis. All treatments were performed by dental surgeons with no specialization in Pediatric Dentistry, under local anesthesia and rubberdam isolation. Manual files were used in conjunction with 2% chlorherixidine gel for root canal instrumentation, and Feapex® paste was used as a obturation material. The clinical and radiographic outcomes were collected by one trained independent evaluator with a follow-up period of 24months. Success was determined by the absence of pain, pathological mobility, pathologic bone rarefaction, pathological root resorption and soft tissue pathology around the affected tooth Survival of the endodontic treatment was evaluated by estimating survival rates through Kaplan-Meier curves. Cox Regression analysis with shared fragility were performed to evaluate the association between the independent variables to endodontic treatment failure (α=5%). Results: After 24 months, the treatment survival was 86% (SE=0.03). Root resorption at baseline was associated with a higher risk of failure (HR=2.81; CI=1.12-7.08; p=0.027). The survival rate of the endodontic treated teeth due to dental trauma was 100%, while teeth with dental caries had lower survival rate (85.05%; p<0.001*). Other variables analyzed included gender, age of the child, tooth position (incisor/molar), restoration type, obturation quality, and caries experience were not associated with treatment failure (p>0.05). Conclusion: The new protocol using 2% chlorhexidine digluconate and Feapex® presented a high survival rate and can be considered as a suitable protocol for pulpectomy in primary teeth.Trial Registration: REBEC (RBR-282s2f) (AU)

Objetivo: Avaliar a sobrevida de um novo protocolo para tratamento endodôntico (pulpectomia) em dentes decíduos utilizando gel de digluconato de clorexidina 2% e pasta Feapex®. Material e Métodos: Um total de 105 pulpectomias foram realizadas em dentes anteriores e posteriores diagnosticados com pulpite irreversível ou necrose pulpar em 48 crianças (1-3 anos de idade) com alta experiência de cárie. Todos os tratamentos foram realizados por cirurgiões-dentistas clínicos gerais, sob anestesia local e isolamento absoluto. Limas manuais foram utilizadas em conjunto com cloroherixidina 2% gel para instrumentação dos canais radiculares e pasta Feapex® foi utilizada como material de obturação. Os resultados clínicos e radiográficos foram coletados por um avaliador independente treinado com um período de acompanhamento de 24 meses. O sucesso foi determinado pela ausência de dor, mobilidade patológica, rarefação óssea patológica, reabsorção radicular patológica e ausência de fístula/abscesso ao redor do dente tratado. A sobrevida do tratamento endodôntico foi estimativa utilizando curvas de Kaplan-Meier. Análise de regressão de Cox com fragilidade compartilhada foi realizada para avaliar a associação entre as variáveis independentes com a falha do tratamento endodôntico (α = 5%). Resultados: Após 24 meses, a sobrevida do tratamento foi de 86% (EP = 0,03). A reabsorção radicular no início do estudo foi associada a um maior risco de falha (HR= 2,81; IC= 1,12-7,08; p= 0,027). Dentes tratados endodonticamente devido ao traumatismo dentário na dentição decídua apresentaram taxa de sobrevida de 100%, enquanto dentes com comprometimento pulpar devido à cárie dentária tiveram menor sobrevida (85,05%; p<0,001 *). Todas as outras variáveis analisadas como sexo, idade da criança, dente (incisivo/molar), tipo de restauração, qualidade da obturação e experiência de cárie não foram associadas à falha do tratamento (p> 0,05). Conclusão: O novo protocolo utilizando digluconato de clorexidina 2% e Feapex® apresentou alta sobrevida e pode ser considerado um protocolo adequado para pulpectomia em dentes decíduos.Registro do estudo clínico: REBEC (RBR-282s2f). (AU)

Oral health-related quality of life among pediatric liver transplant candidates

Abstract To assess the impact of oral conditions on the oral health-related quality of life (OHRQoL) of pediatric liver transplant candidates. This cross-sectional study included 60 children aged 13 to 48 months who were liver transplant candidates that attended the AC Camargo Cancer Center, São Paulo, Brazil. On the day of oral examinations, the children's mothers were invited to answer two questionnaires; one related to children's OHRQoL using the B-ECOHIS and another related to socioeconomic/demographic characteristics. Thereafter, a single, adequately trained dentist carried out children's oral examinations for gingival inflammation (Silness-Löe index), dental plaque (Green-Vermillion Simplified index), dental caries (dmft index), developmental defects of enamel (DDE index), tooth discoloration, oral mucosal/lip alterations. The data collected also included socioeconomic/demographic characteristics and liver disease. The adjusted Poisson regression model was used to associate children's socioeconomic/demographic characteristics and clinical conditions to the outcome. The adjusted regression model showed that children with untreated caries lesions (RR = 3.35, p < 0.0001) and tooth discoloration (RR = 1.74, p = 0.04) had poorer total B-ECOHIS scores. Dental discoloration and untreated caries lesions had a negative impact on the OHRQoL in pediatric liver transplant candidates.

Cariology education for undergraduate Brazilian dental students / Ensino da cariologia para estudantes de graduação em odontologia no Brasil

ABSTRACT This study sought to provide an overview of current cariology education for undergraduate Brazilian dental students. Data collection was via a Portuguese version of a 12-item questionnaire (Schulte et al., 2011) that was sent to all Brazilian dental schools (n = 219). The response rate was 57.0% (n = 125). Of the schools that returned the questionnaire, 84.8% supported the development of a Brazilian cariology curriculum. The units responsible for teaching cariology were predominantly operative dentistry (49.6%), pediatric dentistry (49.6%), dental public health (44.8%), and cariology (32%). Theoretical teaching of cariology (74.4%) and pre-clinical exercises (63.2%) were cited to occur mainly during the second year of the course, while clinical activities were placed in the third (71.2%) and fourth (64.8%) years. Among respondents, 76.8% of the schools included dental erosion and 86.4% included defects of dental hard tissues, such as abrasion, in teaching cariology. This survey was able to determine the panorama of cariology education in Brazil and to detect some differences among Brazilian geographic areas. The promotion of a workshop to discuss the topics that should be taught to undergraduate dental students and the development of a Brazilian core curriculum in cariology would be likely to reduce the differences in teaching cariology in Brazil.

RESUMO Este estudo teve como objetivo apresentar um panorama do ensino de cariologia nos cursos de graduação em Odontologia no Brasil. A coleta de dados foi realizada por meio de uma versão em Português Brasileiro de um questionário de 12 itens (Schulte et al., 2011) que foi enviado a todas as faculdades de Odontologia brasileiras (n = 219). A taxa de resposta foi de 57,0% (n = 125). Dentre as faculdades que responderam o questionário, 84,8% apoiam o desenvolvimento de um currículo brasileiro de cariologia. As disciplinas responsáveis por lecionar os conteúdos de cariologia são principalmente dentística (49,6%), odontopediatria (49,6%), saúde bucal coletiva (44,8%), e cariologia (32%). O ensino teórico de cariologia (74,4%) e os exercícios de pré-clínica (63,2%) são abordados principalmente durante o segundo ano do curso, enquanto as atividades clínicas ocorrem, em geral, no terceiro (71,2%) e quarto (64,8%) anos. Dentre os respondentes, 76,8% das faculdades incluem erosão dentária e 86,4% incluem defeitos dos tecidos dentários duros, como abrasão, no ensino da cariologia. Essa pesquisa foi capaz de determinar o panorama do ensino da cariologia no Brasil e detectar algumas diferenças de currículo entre as regiões do país. A promoção de um workshop para discutir os assuntos que devem ser ministrados aos estudantes de graduação em Odontologia e para desenvolver um currículo brasileiro de cariologia seria válida para reduzir as diferenças no ensino de cariologia no Brasil.

Assessment of oxidative stress in saliva of children with dental erosion / Avaliação do estresse oxidativo da saliva de crianças com erosão dentária

ABSTRACT Objective To evaluate oxidative stress in saliva of children with dental erosion as compared to children with no erosion. Methods One single examiner, trained and prepared to make diagnosis of dental erosion according to the Basic Erosive Wear Examination index, selected 40 children aged 4 to 6 years, who attended a pediatric dentistry prevention clinic. Two groups were formed - one comprising children with dental erosion (n=22), and another with no dental erosion (n=18). The quantity of dental biofilm was verified using the Simplified Index of Oral Hygiene, and unstimulated saliva was collected for biochemical analyses. The following were assessed in saliva: flow rate, buffering capacity, pH, and total protein concentration. Malondialdehyde levels were also verified to determine oxidative stress and total antioxidant status. Results The quantity of biofilm was smaller in children with mean dental erosion±standard deviation (0.76±0.25), as compared to those with no dental erosion (1.18±0.28). There was no statistical difference in saliva parameters of oxidative stress in children with dental erosion. Conclusion The activity of oxidative stress in saliva did not influence dental erosion process when in its early stages.

RESUMO Objetivo Avaliar o estresse oxidativo da saliva de crianças que possuíam erosão dentária, comparadas àquelas que não apresentavam esta situação. Métodos Um único examinador, treinado e calibrado para o diagnóstico de erosão dentária, segundo o índice de Basic Erosive Wear Examination, selecionou 40 crianças de 4 a 6 anos de idade que frequentavam uma clínica de prevenção de odontopediatria. Dois grupos foram formados - um com aquelas que apresentavam erosão (n=22) e outro sem erosão (n=18). A quantidade do biofilme dental foi obtida utilizando o Índice de Higiene Oral Simplificado, tendo sido feita a coleta de saliva não estimulada para as análises bioquímicas. O fluxo salivar, a capacidade tampão da saliva, o pH salivar e a proteína total da saliva foram avaliados. Também foi verificado o valor do malondialdeído para determinação do estresse oxidativo e o total antioxidante. Resultados A quantidade de biofilme foi menor nas crianças, com erosão dentária média±desvio padrão (0,76±0,25) comparadas àquelas sem erosão dentária (1,18±0,28). Não houve diferença estatística nos parâmetros salivares de estresse oxidativo em crianças com erosão dentária. Conclusão A ação do estresse oxidativo na saliva não influenciou na erosão dentária, quando ainda nos estágios iniciais.

Parental perceptions of impact of oral disorders on Colombian preschoolers´oral health-related quality of life / Percepción de padres del impacto de desórdenes orales de preescolares Colombianos sobre calidad de vida relacionada con la salud oral

There is no study assessing the impact of dental caries (DC), traumatic dental injuries (TDI) and dental malocclusions (DM) on the oral healthrelated quality of life (OHRQoL) of preschool children from Spanishspeaking countries in populationbased samples. The purpose of this study was to assess the impact of DC, TDI and DM, on Colombian preschool children's OHRQoL through a crosssectional study. The clinical setting included private and public preschools in Cartagena,Colombia. The sample included 643 preschool children aged 15 years and their parents, who answered the Colombian version of the Early Childhood Oral Health Impact Scale (CECOHIS) and socioeconomic questionnaire. Three calibrated examiners performed clinical assessment of severity of DC according to decayed, missing and filled primary teeth index, TDI and DM. Poisson regression associated clinical and socio economic conditions to the outcome. Overall, 48.2% of parents reported children's oral impacts (total CECOHIS score ≥1). The mean (standard deviation) CECOHIS scores were 2.20 (0.15). The multivariate adjusted model showed that children from nonnuclear families (RR=1.51; p=0.003),with low and high DC severity (RR=1.51, p=0.003; RR=1.53, p=0.009) and TDI (RR=1.56, p=0.003), were more likely to experience negative impact on total CECOHIS scores. DC and TDI have negative impact on Colombian preschool children's OHRQoL. Children from nonnuclear families have worse OHRQoL at this age, independently of the presence of oral conditions (AU)

No existen estudios que evalúen el impacto de la caries dental (CD), el trauma dentoalveolar (TDA) y las maloclusiones dentales (MD) sobre la calidad de vida relacionada con la salud bucal (CVRSB) en niños preescolares en muestras de poblaciones de países hispanohablantes. El propósito de este estudio fue evaluar el impacto de CD, TDA y MD sobre la CVRSB en niños colombianos en edad preescolar a través de un estudio transversal. Las evaluaciones clínicas se realizaron en colegios privados y públicos de Cartagena, Colombia, en una muestra de 643 niños en edad de 15 años y sus padres quienes respondieron la versión colombiana de la Escala Early Childhood Oral Health Impact Scale (CECOHIS) y un cuestionario socioeconómico. Tres examinadores calibrados realizaron la evaluación clínica de la severidad de CD acorde con el Indice ceod para dentición decidua, TDA y MD. La regresión de Poisson asoció las condiciones clínicas y socioeconómicas al puntaje total del CECOHIS y sus dominios. En general, el 48,2% de los padres reportaron impactos orales de los niños (puntuación CECOHIS total ≥1). La media (DE) del CECOHIS fué de 2,20 (0,15). El modelo multivariado ajustado mostró que los niños de familias no nucleares (RR = 1,51; p = 0,003), que tienen baja y alta severidad de CD (RR = 1,51, p = 0,003; RR = 1,53, p = 0,009) y TDA(RR = 1,56, p = 0,003) tuvieron mayor probabilidad de experimentar un impacto negativo en las puntuaciones totales de CECOHIS. La CD y la TDA tienen un impacto negativo sobre la CVRSB en niños preescolares colombianos. Los niños de familias no nucleares tienen peor CVRSB a esta edad, independientemente de la presencia de las condiciones orales (AU)

Parental perceptions of impact of oral disorders on Colombian schoolchildren´s oral health-related quality of life

There is no study assessing the impact of dental caries (DC), dental fluorosis (DF) and traumatic dental injuries (TDI) on oral healthrelated quality of life (OHRQoL) in school children from Colombia. The purpose of this study was to assess the impact of DC, DF and TDI on Colombian schoolchildren´s OHRQoL using their parents as proxies. The parents of 338 children aged 6 to 14 years from public and private schools of Cartagena, Colombia answered the ParentalCaregiver Perception Questionnaire (PCPQ) on child's OHRQoL adapted to Colombian Spanish language and a socioeconomic questionnaire. Three calibrated examiners performed the clinical assessment for DC, DF and TDI. Poisson regression associated clinical and socioeconomic conditions to the outcome. Overall, 90.24% of parents reported children's oral impact (total PCPQ score ≥ 1). The mean (standard deviation) PCPQ scores were 12.49 (14.04). The multivariate adjusted model showed that children from public schools and who have dental caries experience (RR= 1.28; p=0.04 and RR= 1.37; p= 0.018, respectively) were more likely to experience negative impact on total PCPQ scores. DC was found to be associated to parentalcaregiver perception of impact on their children's oral healthrelated quality of life, but DF and TDI were not (AU)

No existen estudios que evalúen el impacto de la caries dental (CD), la fluorosis dental (FD) y el trauma dentoalveolar (TDA) sobre la calidad de vida relacionada con la salud bucal (CVRSB) de escolares de Colombia que pertenece a países de habla hispana. El propósito de este estudio fue evaluar el impacto de la caries dental (CD), la fluorosis dental (FD) y el trauma dentoalveolar (TDA) sobre la calidad de vida relacionada con la salud bucal de escolares colombianos usando sus padres como proxies. Los padres de 338 niños y niñas de 6 a 14 años de escuelas públicas y privadas de Cartagena, Colombia, contestaron el ParentalCaregivers Perception Questionnaire (PCPQ) on child's OHRQoL adaptado al español colombiano y un cuestionario socioeconómico. Tres examinadores calibra dos realizaron la evaluación clínica para CD, FD y TDA. La regresión de Poisson asoció las condiciones clínicas y socioeconómicas al puntaje total del PCPQ y sus dominios. En general, el 90,24% de los padres reportaron el impacto oral de los niños sobre la calidad de vida (puntaje PCPQ total ≥ 1). La media (DE) del PCPQ fue de 12,49 (14,04). El modelo multivariado ajustado mostró que los niños de escuelas públicas que tenían experiencia de caries dental (RR = 1,28, p = 0,04 y RR = 1,37, p = 0,018, respectivamente) tuvieron mayor probabi lidad de experimentar un impacto negativo en las puntuaciones totales del PCPQ. La CD mostró asociación con la percepción del impacto de los padrescuidadores sobre la salud oral de sus hijos en relación con la calidad de vida. Sin embargo, FD y TDA no se encontraron asociados (AU)