Acquired enamel pellicle protects gastroesophageal reflux disease patients against erosive tooth wear

Abstract The objective of this study was to compare the protein profile of the acquired enamel pellicle (AEP) formed in vivo in patients with or without gastroesophageal reflux disease (GERD), and with or without erosive tooth wear (ETW). Twenty-four volunteers were divided into 3 groups: 1) GERD and ETW; 2) GERD without ETW; and 3) control (without GERD). The AEP formed 120 min after prophylaxis was collected from the lingual/palatal surfaces. The samples were subjected to mass spectrometry (nLC-ESI-MS/MS) and label-free quantification by Protein Lynx Global Service software. A total of 213 proteins were identified, or 119, 92 and 106 from each group, respectively. Group 2 showed a high number of phosphorylated and calcium-binding proteins. Twenty-three proteins were found in all the groups, including 14-3-3 protein zeta/delta and 1-phosphatidylinositol. Several intracellular proteins that join saliva after the exfoliation of oral mucosa cells might have the potential to bind hydroxyapatite, or participate in forming supramolecular aggregates that bind to precursor proteins in the AEP. Proteins might play a central role in protecting the dental surface against acid dissolution.

Rinsing solutions containing natural extracts and fluoride prevent enamel erosion in vitro

Abstract Polyphenols interact with salivary proteins and thus can improve the pellicle's erosion protective properties. This effect could be exploited to create rinsing solutions with polyphenols as active ingredients for erosion prevention. Different from the current gold standard for erosion protective rinsing solutions, these rinses would not rely on stannous ions. This would offer alternatives for patients with concerns regarding the composition of rinsing solutions and preferring bio-products. Objective To develop an erosion-preventive rinsing solution containing natural polyphenol-rich extracts. Methodology Solutions were prepared with polyphenols from either grapeseed extract or cranberry extract, 500 ppm fluoride added, and additionally flavors and sweeteners. Controls were deionized water, 500 ppm fluoride solution, and the gold standard rinse in the field (Sn2+/F-). In total, 135 enamel specimens (n=15/group) were subjected to five cycles of salivary pellicle formation (30 min, 37°C), modification with the solutions (2 min, 25°C), further salivary pellicle formation (60 min, 37°C), and erosive challenge (1 min, 1% citric acid, pH 3.6). Relative surface microhardness (rSMH), surface reflection intensity (rSRI), and amount of calcium release (CaR) were investigated. Data were analyzed with Kruskal-Wallis and Wilcoxon rank sum tests (α=0.05). Results The polyphenol solutions containing fluoride, as well as additional flavors, protected enamel better than fluoride alone, and similar to the Sn2+/F- solution, when investigating both rSMH and CaR. When measuring rSRI, Sn2+/F- showed the best protection, while the polyphenol solutions were similar to fluoride. Conclusion For two of the three assessed parameters (rSMH and CaR), both developed polyphenol-rich rinsing solutions were able to protect enamel from erosion, improving/potentializing the effect of fluoride and matching the protection offered by the current gold standard rinsing solution.

Factors for determining dental anxiety in preschool children with severe dental caries

Abstract The aim of this study was to assess the clinical and socioeconomic indicators associated with dental anxiety in preschool children with severe dental caries. A total of 100 children between 3 and 5 years of age were selected during a dental screening procedure. The selection criteria were having at least one tooth with dental caries and a visible pulpal involvement, ulceration, fistula, and abscess (PUFA) index of ≥1 in primary teeth. Before the clinical examination or any treatment procedure was performed, we evaluated the children’s dental anxiety using the Facial Image Scale (FIS). Parents completed a questionnaire on socioeconomic conditions, which included the family structure, number of siblings, parental level of education, and family income. A dentist blinded to FIS and socioeconomic data performed the clinical examination. Poisson regressions associate clinical and socioeconomic conditions with the outcome. Most of the children (53%) experienced extensive dental caries (dmf-t ≥ 6), and all children had severe caries lesions, with a PUFA index of ≥1 in 41% and that of ≥2 in 59%. The multivariate adjusted model showed that older children (4–5-year old) experienced lower dental anxiety levels compared with younger children (3-year old) (RR = 0.35; 95%CI: 0.17–0.72 and RR = 0.18; 95%CI: 0.04–0.76, respectively), and children with three or more siblings were associated with higher levels of dental anxiety (RR = 2.27; 95%CI: 1.06–4.87). Older age is associated with low dental anxiety, and more number of siblings is associated with high dental anxiety in preschool children, whereas the severity or extent of dental caries is not associated with dental anxiety.

Fluoride varnishes with calcium glycerophosphate: fluoride release and effect on in vitro enamel demineralization

The aims of this study were (1) to assess the amount of fluoride (F) released from varnishes containing calcium glycerophosphate (CaGP) and (2) to assess the effect of the experimental varnishes on in vitrodemineralization. Six test groups using 5 varnishes: base varnish (no active ingredients); Duraphat® (2.26% NaF); Duofluorid® (5.63% NaF/CaF2); experimental varnish 1 (1% CaGP/5.63% NaF/CaF2); experimental varnish 2 (5% CaGP/5.63% NaF/CaF2); and no varnish were set up. In stage 1, 60 acrylic blocks were randomly distributed into 6 groups (n = 10). Then 300 µg of each varnish was applied to each block. The blocks were immersed in deionized water, which was changed after 1, 8, 12, 24, 48 and 72 hours. Fluoride concentration in the water was analyzed using a fluoride electrode. In stage 2, 60 bovine enamel samples were distributed into 6 groups (n = 10), and treated with 300 µg of the respective varnish. After 6 h the varnish was removed and the samples were subjected to a 7-day in vitro pH cycle (6 h demineralization/18 h remineralization per day). The demineralization was measured using surface hardness. The results showed that both experimental varnishes released more fluoride than Duofluorid® and Duraphat® (p < 0.05), but Duraphat® showed the best preventive effect by decreasing enamel hardness loss (p < 0.05). Therefore, we conclude that even though (1) the experimental varnishes containing CaGP released greater amounts of F, (2) they did not increase in the preventive effect against enamel demineralization.

Association between parental guilt and oral health problems in preschool children

Parents may feel guilty about their children's oral problems, which can affect their quality of life. The aim of this study was to assess the presence of parental guilt and its association with early childhood caries (ECC), traumatic dental injuries (TDI) and malocclusion (AMT) in preschool children. All 2 to 5 year-old children (N = 305), and their parents, seeking dental care at the University of São Paulo Dental School one-week Screening Programme, were asked to participate in the study, and 260 agreed. Children were examined by two calibrated dentists, and their parents answered a socioeconomic and ECOHIS questionnaire; the question on guilt was used as the dependent variable. Regression analyses examined the association between parental guilt and ECC, TDI, AMT and socioeconomic factors. A total of 35.8% of parents felt guilty. This was only associated with caries severity. No association was found between guilt and TDI, AMT or socioeconomic factors. ECC was present in 63.8% of the children; the mean (± sd) dmf-t score was 7.29 (± 2.78). Thus, the number of parents feeling guilty increases with the increase of their children's dental caries severity. Parental guilt is related to caries but is not associated with TDI or AMT.

Diagnóstico, prevenção e tratamento clínico da erosão dentária / Clinical diagnasis, preventian and treatment af dental erosian

Estudos epidemiológicos recentes evidenciam um aumento na prevalência de erosão dentária em vários países, principalmente entre crianças e adolescentes. O diagnóstico precoce das lesões erosivas viabiliza a instituição de medidas preventivas logo no início do processo de perda de estrutura dentária, evitando procedimentos reabilitadores extensos. Porém, o diagnóstico diferencial entre a abrasão, a atrição e a erosão dentárias ainda é um assunto controverso entre os clínicos e os pesquisadores, sendo necessário estabelecer critérios claros para distinção entre as características destes tipos de lesões. Uma vez diagnosticada a erosão dentária, terapias preventivas e restauradoras são necessárias e diversas pesquisas têm sido geradas com este propósito nos últimos anos. Portanto, o presente trabalho se propõe a apresentar uma revisão baseada nas evidências científicas encontradas na literatura sobre o diagnóstico e o tratamento da erosão dentária.

Recent epidemiological studies revealed an increase in the prevalence of dental ero- sion around the world, mainly among children and teenagers. Early diagnosis of erosive lesions enables the implementation of preventive measures at the beginning of process of dental structure loss, thus avoiding the need for extensive rehabilitation procedures. However, differential diagnosis of dental abrasion, attrition and erosion remains a con- troversial issue among clinicians and researchers. Therefore, there is a need to establish clear criteria to make it possible to distinguish between the different characteristics of each type of tooth wear lesion. Once dental erosion is diagnosed, preventive and res- torative procedures are needed and a variety of researches have been published on this subject. Thus, the present paper aims to review concepts of dental erosion diagnosis and treatment, based on the scientific evidence found in literature.

Tipo de aleitamento e presença de açúcar nas bebidas das mamadeiras dos bebês / Type of breastfeeding and presence of sugar in the content of baby bottles

This study aims at analyzing the feeding of babies, either by breastfeeding or using a baby bottle, time until weaning, as well as the presence of sugar in the content of baby bottles. Data from 305 babies, aged 0 to 36 months, were collected using questionnaires answered by their mothers. Information on age, gender, feeding habits and the presence of sugar containing substances in the baby bottles was collected. Most mothers used baby bottles (70.2%), and this rate increased with the babies? age. During the babies' first six months of life, 46.2% of mothers fed their babies exclusively on breast, whereas 38.5% of the babies were fed from baby bottles since birth, together with breastfeeding, and 15.3% of the babies at this age range were exclusively fed from baby bottles. Weaning occurred in 20.0%. 82.6% of the babies fed from baby bottles received sugar in their diet. Feeding from a baby bottle was found to be present since the first month of a baby's life, and its use was predominant until the age of 3 years. Sugar is present in the diet of the majority of the babies fed from bottles.

El estudio se propone analizar el tipo de leche utilizada, materno y/o artificial, sus periodos de uso y la presencia de azúcar en los biberones. Participaron 305 infantes de 0 a 36 meses, cuyos datos fueron obtenidos por medio de un cuestionario aplicado a las madres. Éste contenía informaciones sobre edad y sexo de los niños, tipo de alimentación que recibían y presencia o no de azúcar en los biberones. El tipo de alimentación más utilizada era artificial (70,2%), porcentaje que aumentó junto con la edad de los niños. La lactancia materna exclusiva durante los primeros seis meses de vida correspondía a 46,2% del grupo. Para 38,5% el biberón fue introducido conjuntamente con la lactancia materna desde el nacimiento y para 15,3% la lactancia artificial fue exclusiva (biberón). El desmame ocurrió en 20,0%. La dieta de 82,6% de los bebés presentaba azúcar en las bebidas del biberón. La leche artificial está presente desde el primer mes de vida y su uso predomina hasta los 3 años de edad.El azúcar está presente en la dieta de la mayoría de los bebés alimentados con biberón

O estudo propõe analisar o tipo de aleitamento utilizado, seja materno e/ou artificial, o seu tempo de uso, assim como a presença de açúcar na mamadeira dos bebês. Participaram 305 bebês de 0 a 36 meses, cujos dados foram obtidos através de um questionário junto às mães. Este continha informações sobre idade e gênero dos bebês, tipo de aleitamento e substâncias açucaradas introduzidas nas mamadeiras destes. O tipo de aleitamento mais utilizado foi o artificial (70,2%), sendo que aumentou com o decorrer da idade. Nos seis primeiros meses de vida, o aleitamento materno exclusivo foi realizado por 46,2% das mães, sendo que a mamadeira foi introduzida conjuntamente ao aleitamento materno desde o nascimento em 38,5% dos bebês e 15,3% destes receberam aleitamento artificial exclusivo (mamadeira). O desmame ocorreu em 20,0%. A dieta de 82,6% dos bebês continha açúcar nas bebidas da mamadeira. O aleitamento artificial está presente desde o primeiro mês de vida e seu uso é predominante até os três anos de idade. O açúcar está presente na dieta da maioria dos bebês amamentados com mamadeira.

Patrones de lactancia en bebés, su primer contacto con el azúcar y el dentista / Patterns of breastfeeding in infants, their first contact with the sugar and the dentist

El objetivo de esta investigación fue evaluar el patrón de lactancia, primer contacto con el azúcar y primera visita al dentista de los bebés con relación al estado socioeconómico familiar. Participaron 129 niños de 0 a 36 meses, cuyos datos fueron obtenidos por medio de un cuestionario realizado a las madres y exámenes clínicos bucales de los bebés en ambulatorios públicos y privados. La forma de lactancia más utilizada fue artificial (59%), siendo empleada desde el inicio de la vida y volviéndose más prevalente con el aumento de la edad. El primer contacto con el azúcar ocurrió principalmente después de los 3 meses de edad, sin embargo, 20% de las madres ofrecieron azúcar a sus hijos antes de los tres primeros meses de vida. El mayor número de bebés acudieron durante el primer año de vida al dentista (43%) siendo la prevención su principal motivo (65%). La prevalencia de actividad de caries para la muestra fue de 17%. Estos resultados correspondieron a madres que poseían grado escolar secundario y superior completo y recibían de 1 a 3 salarios mínimos. Conclusión: el patrón de amamantamiento en bebés es esencialmente artificial en los primeros meses de vida, lo que contribuye para que ocurra el primer contacto con el azúcar muy precozmente. La primera visita al dentista ocurre generalmente durante el primer año de vida del bebé

To analyze the pattern of feeding, first contact with sugar and first babies visit to the dentist with respect to family socioeconomic status. One hundred and twenty nine children, from 0 to 36 months, participated in the study. The data was obtained through a questionnaire conducted for their mothers and clinical oral exams of the babies in public and private outpatient departments. Results: bottle feeding was most widely used (59%), being employed since the beginning of the life and becoming more prevalent with the increasing age. The first contact with sugar occurred mostly after 3 months of life; however, 20% of mothers offered sugar for their children before the first three months of life. Most of the babies visited the dentist within their first year of life (43%) and the main reason was prevention (65%). All these results corresponded to mothers who had completed high school and higher education, as well as perceive 1 to 3 minimum wages. The pattern of breastfeeding in babies is essentially artificial in the first months of life, which contributes to appear the first contact with the sugar very early. The first visit to the dentist occurs during the first year of life of the baby

Avaliação dos hábitos alimentares de interesse odontológico em crianças com paralisia cerebral / Assessment of dietary habits of dental interest in children with cerebral palsy

Introdução - As dificuldades na mastigação e deglutição em crianças com Paralisia Cerebral (PC) são identificadas como fatores de risco para hábitos alimentares inadequados podendo estar associada a presença da doença cárie. O objetivo do estudo foi avaliar os hábitos alimentares de interesse odontológico em crianças com PC em comparação a crianças normoreativas (grupo controle). Material e Métodos - Participaram do estudo 60 crianças pareadas pela idade, 30 com diagnóstico médico de PC e 30 normoreativas. Foram incluídas crianças de ambos os gêneros, na faixa etária de 5 a 11 anos de idade (média = 7,45). Avaliou-se a presença visível de biofilme nos dentes anteriores, e um questionário foi aplicado ao responsável referente à preferência da consistência dos alimentos, necessidade de auxilio na alimentação, utensílio utilizado para alimentação e o conteúdo da dieta. Um diário alimentar foi entregue ao responsável, para ser preenchido durante 5 dias. A avaliação clínica visual da presença de biofilme e a análise dos diários foram realizadas por um único examinador. Resultados - As crianças com PC apresentaram uma frequência significantemente mais alta de alimentos líquidos ou pastosos, assim como maior uso de colher, maior necessidade de auxilio durante a alimentação e maiores índices de biofilme, em comparação ao grupo controle (p < 0,01). A frequência de ingestão de sacarose foi mais alta em crianças com PC, mas sem associação à presença de biofilme dentário. Conclusões - As crianças com PC são mais dependentes no momento da alimentação, possuem uma dieta de consistência mais líquida a pastosa e apresentam maior quantidade de biofilme dentário em comparação com as crianças normoreativas.

Introduction - The difficulties in chewing and swallowing in children with Cerebral Palsy (CP) are possible risk factors for an inadequate nutritional state. The objective of the study was to evaluate the dietary habits of dental interest in children with CP compared to normoreactive children(control group). Material and Methods - Sixty children matched by age participated; 30 with medical diagnosis of CP and 30 normoreactive. Children of both genders were included, aged 5 to 11years (mean = 7.45). The presence of biofilm in anterior teeth was evaluated, and a questionnaire was applied to the guardian regarding the consistency of food, need for assistance during feeding, utensil used for feeding and content of the diet. A food diary was given to the guardian to be completed for 5 days. Visual clinical evaluation of the presence of biofilm and the food diary analysis were performed by a single examiner. Results - Children with CP had a significantly higher frequency of liquid or paste foods, as well as a greater use of spoon, greater need for help during feeding and higher rates of biofilm compared to the control group (p < 0.01). The frequency of sucrose intake was higher in children with CP, but no association with the presence of dental biofilm was found. Conclusions - Children with CP are more dependent during feeding, they have a diet of liquid to paste consistency and they have a greater amount of dental biofilm compared to normoreactive children.

Avaliação do hábitos alimentares de interesse odontológico em crianças com paralisia cerebral / Assesment of dietary habits of dental interest in children with cerebral palsy

Introdução - As dificuldades na mastigação e deglutição em crianças com Paralisia Cerebral (PC) são identificadas como fatores de risco para hábitos alimentares inadequados podendo estar associada a presença da doença cárie. O objetivo do estudo foi avaliar os hábitos alimentares de interesse odontológico em crianças com PC em comparação a crianças normoreativas (grupo controle). Material e Métodos - Participaram do estudo 60 crianças pareadas pela idade, 30 com diagnóstico médico de PC e 30 normoreativas. foram incluídas crianças de ambos os gêneros, na faixa etária de 5 a 11 anos de idade (média= 7,45). Avaliou-se a presença visível de biofilme nos dentes anteriores, e um questionário foi aplicado ao responsável referente à preferência da consistência dos alimentos, necessidade de auxílio na alimentação, utensílio utilizado para alimentação e o conteúdo da dieta. Um diário alimentar foi entregue ao responsável, para ser preenchido durante 5 dias. A avaliação clínica visual da presença de biofilme e a análise dos diários foram realizadas por um único examinador. Resultados - As crianças com PC apresentaram uma frequência significantemente mais alta de alimentos líquidos ou pastosos, assim como maior uso de colher, maior necessidade de auxílio durante a alimentação e maiores índices de biofilme, em comparação ao grupo controle (p < 0,01). A frequência de ingestão de sacarose foi mais alta em crianças com PC, mas sem associação à presença de biofilme dentário. Conclusões - As crianças com PC são mais dependentes no momento da alimentação, possuem uma dieta de consistência mais líquida a pastosa e apresentam maior quantidade de biofilme dentário em comparação com as crianças normoreativas

Prevalence and severity of dental fluorosis among students from João Pessoa, PB, Brazil

The aim of this study was to determine the prevalence and severity of dental fluorosis among 12-15-year-old students from João Pessoa, PB, Brazil before starting a program of artificial fluoridation of drinking water. The use of fluoridated dentifrice was also surveyed. A sample of 1,402 students was randomly selected. However, 31 students refused to participate and 257 were not permanent residents in João Pessoa, thus leaving a final sample of 1,114 students. Clinical exams were carried out by two calibrated dentists (Kappa = 0.78) under natural indirect light. Upper and lower front teeth were cleaned with gauze and dried, and then examined using the TF index for fluorosis. A questionnaire on dentifrice ingestion and oral hygiene habits was applied to the students. The results revealed that fluorosis prevalence in this age group was higher than expected (29.2 percent). Most fluorosis cases were TF = 1 (66.8 percent), and the most severe cases were TF = 4 (2.2 percent). The majority of the students reported that they had been using fluoridated dentifrices since childhood; 95 percent of the participants preferred brands with a 1,500 ppm F concentration, and 40 percent remembered that they usually ingested or still ingest dentifrice during brushing. It was concluded that dental fluorosis prevalence among students in João Pessoa is higher than expected for an area with non-fluoridated water. However, although most students use fluoridated dentifrices, and almost half ingest slurry while brushing, the majority of cases had little aesthetic relevance from the professionals' point of view, thus suggesting that fluorosis is not a public health problem in the locality.

O objetivo deste estudo foi determinar a prevalência e severidade de fluorose dentária em escolares de 12 a 15 anos de idade de João Pessoa, PB, Brasil antes da implantação de um programa de fluoretação de águas. O uso de dentifrício fluoretado também foi investigado. De 1.402 escolares aleatoriamente selecionados, 31 recusaram-se a participar, 257 não eram residentes permanentes na cidade, resultando em uma amostra final de 1.114 escolares. Dois cirurgiões-dentistas calibrados (Kappa = 0,78) realizaram exames clínicos sob luz natural indireta nos dentes anteriores superiores e inferiores limpos com gaze e secos, aplicando-se o índice TF para fluorose. Um questionário sobre ingestão de dentifrício e hábitos de higiene oral foi aplicado. Os resultados demonstram uma prevalência de fluorose acima do esperado (29,2 por cento). A maioria dos casos foi TF = 1 (66,8 por cento), e os mais severos foram TF = 4 (2,2 por cento). A maioria dos estudantes informou que faz uso de dentifrícios desde a infância; 95 por cento dos participantes preferiam marcas com 1.500 ppm F e 40 por cento confirmaram que usualmente ingeriam ou ainda ingerem dentifrício durante a escovação. Conclui-se que a prevalência de fluorose entre estudantes de João Pessoa é acima do esperado para uma cidade sem fluoretação de águas. No entanto, apesar de a maioria dos estudantes usar dentifrícios fluoretados, e quase a metade deles ingerir dentifrício quando escova, a maioria dos casos foi de pouco comprometimento estético sob o ponto de vista dos profissionais, o que sugere que a fluorose não se constitui em um problema de saúde pública nesta localidade.