Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review

Abstract: The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.

Comparative effect of calcium mesoporous silica versus calcium and/or fluoride products against dental erosion

Abstract The aim of this study was to compare the effects of a single application of a new calcium mesoporous silica nanoparticle (Ca2+-MSN) versus other calcium and/or fluoride products against dental erosion. Enamel blocks were half-covered and assigned to six groups (n = 10): Ca2+-MSNs; casein phosphopeptide-amorphous calcium phosphate mousse (CPP-ACP); CPP-ACP/F− (900 ppm F−); titanium tetrafluoride (TiF4 1%); sodium fluoride (NaF 1.36%); and Milli-Q® water (negative control). A single application for each product was completed on the exposed areas of the blocks and were submitted to an erosive challenge. Differences in volumetric roughness (Sa), and tooth structure loss (TSL) by use of three-dimensional noncontact optical profilometry were evaluate. Scanning electron microscopy (SEM) was performed. Analysis of variance and Tukey's test for Sa and the Kruskal-Wallis and Mann-Whitney U tests (p< 0.05) for TSL, respectively. Results: When evaluating Sa, all products presented differences in roughness when compared with the control group (p< 0.05) but not with each other (p > 0.05). However, when analyzing the TSL, it was observed that Ca2+-MSNs, TiF4, and NaF were more effective in preventing dental erosion versus CPP-ACP, CPP-ACP/F−, and Milli-Q® water (p< 0.05). In the SEM images, the negative control presented the worst loss of dental structure, with more porous enamel. Ca2+-MSNs were as effective as TiF4 and NaF to reduce the tooth structure loss.

Resumo O objetivo deste estudo foi comparar os efeitos de uma única aplicação de uma nova nanopartícula de sílica mesoporosa de cálcio (Ca2+ -MSN) versus outros produtos à base de cálcio e / ou fluoreto contra a erosão dentária. Blocos de esmalte foram parcialmente cobertos e distribuídos em seis grupos (n = 10): Ca2+ -MSNs; fosfopeptídeos de caseína/fosfato de cálcio amorfo (CPP-ACP); CPP-ACP / F- (900 ppm F-); tetrafluoreto de titânio (TiF4 1%); fluoreto de sódio (NaF 1,36%); e água Milli-Q® (controle negativo). Uma única aplicação para cada produto foi realizada nas áreas expostas dos blocos e submetida a desafio erosivo. Diferenças na rugosidade volumétrica (Sa) e na perda de estrutura dentária (TSL) por meio de perfilometria tridimensional de não contato foram avaliadas. Microscopia eletrônica de varredura (MEV) foi realizada. Foram realizadas análise de variância e teste de Tukey para os testes Sa e Kruskal-Wallis e Mann-Whitney (p<0,05) para TSL, respectivamente. Na avaliação de Sa, todos os produtos apresentaram diferenças de rugosidade quando comparados ao grupo controle (p<0,05), mas não entre si (p> 0,05). No entanto, ao analisar o TSL, observou-se que Ca2+ -MSNs, TiF4 e NaF foram mais eficazes na prevenção da erosão dental versus CPP-ACP, CPP-ACP / F- e Milli-Q® (p<0,05). Nas imagens de MEV, o controle negativo apresentou a pior perda de estrutura dentária, com o esmalte mais poroso. A Ca2+ -MSNs foi tão eficaz quanto o TiF4 e o NaF para reduzir a perda da estrutura dentária.

The use of a new calcium mesoporous silica nanoparticle versus calcium and/or fluoride products in reducing the progression of dental erosion

Abstract Objective There is increasingly common the consumption more times a day of foods and acidic drinks in the diet of the population. The present study aimed to evaluate and compare the effects of a calcium mesoporous silica nanoparticle single application of other calcium and/or fluoride products in reducing the progression of dental erosion. Methodology Half of the eroded area was covered of 60 blocks of enamel, after which the block was submitted to the following treatments: (Ca2+-MSN), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP); CPP-ACP/F-(900 ppm F−); titanium tetrafluoride (TiF4 1%) (positive control); sodium fluoride (NaF 1.36%) (positive control); and Milli-Q® water (negative control) before being submitted to a second erosive challenge. A surface analysis was performed via a three-dimensional (3D) noncontact optical profilometry to assess the volumetric roughness (Sa) and tooth structure loss (TSL) and and through scanning electron microscopy (MEV). An analysis of variance (ANOVA) and Tukey's test were performed. Results Regarding Sa, all experimental groups exhibited less roughness than the control (p<0.05). The TSL analysis revealed that the Ca2+-MSN and NaF groups were similar (p>0.05) and more effective in minimizing tooth loss compared with the other groups (p<0.05). Conclusions The Ca2+-MSN and NaF treatments were superior compared with the others and the negative control.

Comparative Effect of Calcium Mesoporous Silica Versus Calcium and/or Fluoride Products on the Reduction of Erosive Tooth Wear and Abrasive Enamel Lesion

Abstract Objective: To evaluate the effect of a calcium nanocompound on the reduction of erosive tooth wear and abrasion. Material and Methods: Bovine enamel specimens (BE), were randomly assigned to the following groups (n = 10): G1 = Calcium mesoporous silica nanoparticles (Ca2+MSNs); G2 = casein phosphopeptide-amorphous calcium phosphate (CPP-ACP, 2% CPP-ACP, GC®); G3 = casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP, 2% CPP-ACP + 900 ppm F-, GC®); G4 = sodium fluoride NaF (900 ppm F-, positive control); and G5 = distilled and deionized water (negative control). Each product was applied to the exposed area for one minute, three times per day for three consecutive days, and followed by the immersion of the specimens in Sprite Zero™ - a low-pH solution (2.58) for five minutes (Coca-Cola™). After the first and last erosive challenges of the day, the specimens were submitted to abrasion in a toothbrush machine for 15 seconds (200 g/BE). The specimens were analysed using 3D non-contact optical profilometry, with tooth structure loss (TSL) measurements and scanning electron microscopy (SEM). TSL values were analysed by Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: There were no significant differences between G1 (10.95 µm) and G3 (10.80 µm) treatments for TSL values; however both resulted in significantly reduced TSL values compared with the G5 (16.00 µm) (p<0.05). The G4 (12.26 µm) showed no statistically significant difference when compared to the G5 (16.00 µm). The groups G1 and G3 presented higher surface preservation than the G5. Conclusion: Ca2+MSNs was effective for reducing tooth surface loss caused by erosive tooth wear and abrasion.

Topography and Microhardness Changes of Nanofilled Resin Composite Restorations Submitted to Different Finishing and Polishing Systems and Erosive Challenge

Abstract Objective: To evaluate the topography and microhardness of composite resin restorations submitted to different finishing and polishing systems before and after erosive challenge. Material and Methods: Thirty standardized cavities prepared in enamel-dentin blocks of bovine incisors were restored with Z350 composite resin, and randomly distributed into three groups (n=10) according to the finishing and polishing systems: G1 = Soflex 4 steps, G2 = Soflex Spiral 2 steps and G3 = PoGo (single step). The specimens were half protected with nail varnish and submitted to five immersions in Pepsi Twist®, for 10 minutes each, five times/day during six consecutive days. The initial and final challenge surface microhardness (SMHinitial and SMHfinal) of the composite resin was evaluated and the percentage of SMH loss (%SMHL) was calculated. After protection removal, the topographic change linear (Ra) and volumetric (Sa) roughness was evaluated in initial and final areas by using 3D non-contact optical profilometry and scanning electron microscopy (SEM). Data were analyzed by paired Student's t-test, Kruskal-Wallis test, and by ANOVA and Tukey's test. Results: There was significant intra-group %SMHL in composite resin (p<0.05). Differences among groups in %SMHL, Ra/Sa in resin composite were not observed (p>0.05). SEM images revealed structural changes between the initial and final surfaces for all groups. Conclusion: The three types of finishing and polishing systems had a similar influence on %SMHL, Ra and Sa in the nanofilled composite resin.

Unusual case of ankyloglossia recurrence after frenectomy in a child with cerebral palsy

Introduction: Frenectomy is the most indicated treatment for ankyloglossia in children and adolescents, with recurrence being extremely rare. Objective: Here, we report the unusual case of an 8-year-old boy with cerebral palsy presenting recurrence of ankyloglossia 2 years after undergoing lingual frenectomy. Case report: On physicalexamination, in a follow-up, 2 years after a lingual frenectomy, we observed a slightly elastic, short and adhered lingual frenulum and the presence of a heart-shaped tongue, with severe restriction of lateral and superior movements, and difficulties in speech and swallowing. A new frenectomy was performed under local anesthesia, restoring lingual mobility. The patient has been followed-up periodically and has undergone speech therapy; 2 years after the second surgery, firm insertion of the frenulum and the continuity of the bifid aspect of the tongue have been again verified, but the tongue movements and oral functions remain satisfactory. The patient will continue to be followed periodically and a new intervention will be performed if there are changes in oral functions. Conclusion: Beyond the need forperiodic clinical follow-up, the diagnosis and multidisciplinary treatment of ankyloglossia are fundamental for identifying possible cases of recurrence, which, although rare, can occur.

Introdução: A frenectomia é o tratamento mais indicado para os casos de anquiloglossia em crianças e jovens, sendo a recorrência extremamente rara. Objetivo: O objetivo é relatar o caso incomum de um menino de 8 anos, com paralisia cerebral, apresentando recidiva de anquiloglossia dois anos após a realização de frenectomia lingual. Relato de caso: Ao exame físico, em consulta de revisão, 2 anos após uma frenectomia lingual observou-se freio lingual levemente elástico, curto e aderido, presença de formato de coração na língua, restrição severa dos movimentos laterais e superiores, além de dificuldades na fala e deglutição. Uma nova frenectomia foi realizada após dois anos da primeira frenectomia , sob anestesia local, restaurando a mobilidade lingual. O paciente foi acompanhado periodicamente junto com a fonoaudiologia e após 2 anos da segunda cirurgia, a inserção firme do freio e a continuidade do aspecto bífido da língua foram novamente verificadas, porém, os movimentos da língua e as funções orais mantiveram-se satisfatórios. O paciente continuará a ser acompanhado periodicamente e, se houver alterações nas funções orais, uma nova intervenção será realizada. Conclusão: É fundamental o diagnóstico e tratamento multidisciplinar da anquiloglossia, além da necessidade de acompanhamento clínico periódico para identificar possíveis casos de recidiva, que, embora raros, podem ocorrer.