Systemic Manifestations, Tooth Eruption and Enamel Defects in Children with Congenital Zika Virus Syndrome: 36-Month Follow-up Case Series

Abstract Objective: To describe systemic manifestations, the characteristics related to tooth eruption, and the occurrence of enamel defects in children with Congenital Zika Virus Syndrome (CZS). Material and Methods: Prospective case series based on nine children with confirmed CZS diagnosis assisted at a reference center in a municipality in the Northeast Region of Brazil. Through a structured interview directed to mothers, information related to prenatal, delivery, and postpartum periods was collected. Tooth eruption was monitored through clinical examinations for 36 months. The modified developmental defect of enamel index (DDE) was used to identify opacities and hypoplasia. Data were presented using descriptive statistics. Results: A high proportion (77.8%) had microcephaly, and 55.5% had low birth weight. Musculoskeletal disorders, swallowing difficulty, and self-injury practices were present in all children. Among the systemic findings, visual impairment (77.8%) and seizures (77.8%) were widely reported. Concerning disorders related to the stomatognathic system, bruxism (66.7%) and difficulty in sucking (33.3%) were present. For most children (77.8%), the deciduous right lower central incisor was the first tooth to erupt (minimum 8 months and maximum 17 months). Enamel defects were diagnosed in only two children (22.2%). Conclusion: A wide range of systemic manifestations was observed in children with CZS, including visual impairment and musculoskeletal disorders. Delayed eruption of the first deciduous tooth was also observed. Enamel defects were present in a small proportion of children.

Maxillofacial Injuries in Brazilian Children and Adolescents Victims of Physical Violence: A Single Forensic Center Analysis

Abstract Objective: To identify the prevalence of maxillofacial injuries resulting from interpersonal violence in Brazilian children and adolescents. Material and Methods: This is a retrospective study conducted at a Center of Forensic Medicine and Forensic Dentistry with a sample of 335 medical reports of victims aged up to 19 years. Variables involved sex and age group, perpetrator, occurrence of the event, characterization of injuries, presence of maxillofacial injuries, type of tissue involvement, and injuries in the oral cavity. Data were analyzed using descriptive, and the Chi-square was used for categorical data. Results: Most victims were female (60.3%) and aged 15-19 years (57.6%). Aggressions occurred at home (50.6%), in the evening (39.5%) and involved perpetrators known to the victim (91.5%). Most victims had multiple injuries (75.8%), involving up to three regions of the body (93.4%). Injuries with blunt objects were the most frequent (86.2%). The prevalence of maxillofacial injuries was 36.7%, with low involvement of the oral cavity (8.4%). A significant association between the presence of injuries on the face and variables "perpetrator" (p=0.015) and "number of injuries" (p=0.006) was observed. Conclusion: Female adolescents were the main victims of physical violence, with repercussions in different regions of the body. The prevalence of maxillofacial injuries was high, although with little involvement of oral cavity structures.

Use of Medicines by Infants with Microcephaly Caused by Congenital Zika Virus Infection and Implications to Oral Health

Abstract Objective: To analyze the use of continued-use medications by Brazilian children with microcephaly caused by Congenital Zika Virus Infection. Material and Methods: Cross-sectional study with 76 children of both genders. Information on age, use of continued-use medications, number and type of drugs used was collected. Data were analyzed using descriptive statistics. Results: Continued-use medications were used by 89.4% of the children, anticonvulsants / antiepileptics (88.1%), and those indicated for behavioral disorders (27.1%) were the most frequent. Sodium saccharin, sucrose, and sorbitol are the most common sugars in the composition of these drugs. Conclusion: The use of medicines is high, predominantly anticonvulsants and antiepileptics, which contain sugars in their composition. These drugs can lead to irreversible dental problems, such as tooth decay if proper oral hygiene is not present. Therefore, parents/guardians should be advised about adopting healthy oral hygiene habits after the administration of these drugs.

Craniofacial trauma in older adults victims of road traffic accidents: a cross-sectional study

Introduction: Among the determinant factors for the implant-supported prosthesis longevity is the exact and comprehensive process of impression which results is the passive prosthesis fitting. Objective: To compare the accuracy of transfer coping impression techniques with or without splinting, after the isolation of the factors associated to the passive fitting. Method: Based on the control group composed by an edentulous mandibular master model (self-cured acrylic resin) with four external hexagon parallel implants splinting with a metallic bar, four customized open trays were constructed with self-cured acrylic. Ten impressions were made with condensation silicone ( Xantopren ®), poured with type IV plaster ( Durone ®), and then divided into two groups: Group 1 (n=5) ­ non-splinting multi unit transfer copings; and Group 2 (n=5) ­ splinting multi unit transfer copings with a bar constructed with self-cured acrylic resin ( Palavit G ®) and dental floss, with the aid of an addition silicon mold ( Elite Double ® Zhermack) . Next, the bar was cut and splinted again. The ten transfer molds were measured at the center of the labial surface of each implant with the aid of Stereoscopic Magnifying Glass ( Physis ®) with x60 magnification. The results were tabulated and submitted to non-parametric statistics through Kruskal-Wallis test (p<0.05). Results: The means were: 22.44 µm (±7) for control group, 26.86 µm (±10) for direct splinting, and 24.70 µm (±13) for direct non-splinting technique. Conclusion: No statistically significant differences were found between the tested techniques.

Introdução: Entre os fatores determinantes para a longevidade de uma prótese implanto suportada, está o processo exato e meticuloso de moldagem dos implantes osseointegrados, implicando diretamente no assentamento passivo da prótese. Objetivo: Comparar a precisão das técnicas de moldagem com e sem união dos transferentes isolando os fatores que podem estar associados ao ajuste passivo. Métodos: A partir de um grupo controle composto por um modelo mestre (em resina acrílica quimicamente ativada) mandibular desdentado com quatro implantes de conexão externa posicionados paralelamente e unidos por uma barra metálica. Foram confeccionadas dez moldeiras em resina acrílica quimicamente ativada (todas abertas). Dez impressões foram feitas com silicone de condensação Xantopren ®, e vertidas com gesso tipo IV, Durone ®, divididas em dois grupos: Grupo 1 (n=5) ­ Pilares multi unit não unidos e Grupo 2 (n=5) ­ Pilares multi unit unidos por uma barra confeccionada com fio dental e resina acrílica autopolimerizável, Palavit G ®, através de um molde de silicone de adição, Elite Double ® Zhermack . Em seguida, a barra foi seccionada e reunida. Os dez modelos de transferência foram mensurados no centro da face vestibular de cada um dos implantes através de uma lupa estereoscópica ( Physis ®) com ampliação de 60 vezes. Os resultados foram tabulados e submetidos à análise estatística não paramétrica, teste Kruskal-Wallis (p<0,05). Resultados: As médias aritméticas encontradas foram de 22,44 µm (±7) para grupo controle, 26,86 µm (±10) para técnica direta com esplintagem e 24,70 µm (±13) para técnica direta sem esplintagem. Conclusão: Não foi identificado diferenças estatísticas significantes entre as técnicas experimentadas.

Unnatural deaths in brazilian children and adolescents / Mortes não naturais em crianças e adolescentes brasileiros

Accidents and violence are considered an important public health problem for being the main cause of mortality among children and adolescents. Assuming the hypothesis that the deaths predominantly affect men, victims of traffic accidents, the aim of this study was to assess unnatural deaths in Brazilian children and adolescents in a city in northeastern Brazil. A cross-sectional study was carried out with analysis of 584 forensic medical reports from the Legal Medicine Institute of Campina Grande, Brazil, between January 2008 and December 2011. Descriptive and inferential statistical analysis was conducted using the chi-square test (a = 0.05). Victims were mostly males (82.4 %) and adolescents aged from 15 to 19 years (70.0 %). The main causes of unnatural deaths were aggressions (39.2 %), followed by traffic accidents (32.7 %). Significant associations between etiology and age group were observed (p< 0.001). With regard to traffic accidents, there were more records of accidents involving motorcyclists (46.7 %), followed by vehicle occupants (29.8 %) and pedestrians (15.7%). Our hypothesis was confirmed, and the aggressions and traffic accidents were the most common causes of unnatural deaths, primarily affecting males aged from 15 to 19 years. Most deaths from traffic accidents involved motorcycle accidents

Acidentes e violência são considerados um importante problema de saúde pública por ser a principal causa de mortalidade entre crianças e adolescentes. Assumindo-se a hipótese de que as mortes acometem predominantemente homens, vítimas de acidentes de trânsito, o objetivo deste trabalho foi avaliar as mortes não-naturais em crianças e adolescentes brasileiros em um município da região nordeste do Brasil. Um estudo transversal foi realizado através da análise de 584 laudos medico-legais do Instituto de Medicina Legal de Campina Grande, Paraíba, ocorridos entre janeiro de 2008 e dezembro de 2011. Os resultados são apresentados por meio da estatística descritiva e inferencial com o uso do teste do Qui-quadrado (a = 0,05). As vítimas foram predominantemente do sexo masculino (82,4%) com idade entre 15 e 19 anos (70%). As principais etiologias foram as agressões (39,2 %), seguidas pelos acidentes de trânsito (32,7%). Observou-se associação estatisticamente significante entre a etiologia e a faixa etária (p < 0,001), indicando elevado percentual de mortes devido às agressões (34,9%) e acidentes de trânsito (22,9%) dentro da faixa etária de 15 a 19 anos, etiologia e gênero da vítima (p < 0,001) e tipo de acidente de trânsito e idade da vítima (p < 0,001). Com relação aos acidentes de trânsito, foram mais frequentes aqueles envolvendo motociclistas (46,7%), seguidos pelos ocupantes de veículos (29,8%) e pedestres (15,7%). Agressões e acidentes de trânsito foram as causas mais comuns das mortes não-naturais, afetando predominantemente homens com idades entre 15 e 19 anos. A maioria das mortes foi devido aos acidentes envolvendo motociclistas

Born in Chains: Perceptions of Brazilian Mothers Deprived of Freedom about Breastfeeding

Objective: To analyze the perception of mothers deprived of freedom about breastfeeding. Material and Methods: This cross-sectional study was developed in four prison units in the state of Paraíba, Brazil. The non-probabilistic type sample was composed of inmates who were breastfeeding. Information regarding mother, infant, prenatal care, breastfeeding and sucking habits were collected. Data were analyzed through the Statistical Package for Social Sciences and presented through descriptive statistics. Results: Of the 496 women under closed prison system, only 13 (2.6%) were breastfeeding their children in the prison environment. The age of mothers ranged from 19 to 35 years, and the most frequent age group was 19-23 years (46.2%). The majority had no partner (84.6%), low schooling (60%) and had other children (84.6%). All were pregnant when they were arrested and 76.9% underwent cesarean delivery. Infants aged 1-5 months and 61.5% were female. The majority of inmates performed prenatal care (76.9%), with prison being the referred site (60%). Participation in educational activities on breastfeeding was reported by 90.9%, and nurses were the health professionals who provided these guidelines (66.6%). Exclusive breastfeeding was reported by 69.2%, but the maximum period was two months (33.3%). All mothers complemented breastfeeding (100%). Nocturnal breastfeeding was reported by 15.4%, being used for the child to sleep. All children started bottle-feeding from the first trimester of life. Pacifier use was observed in all infants. Conclusion: Inmates are predominantly young, single, of low schooling and underwent cesarean delivery. Prenatal care was carried out at the prison and mothers participated in educational activities about breastfeeding. Exclusive breastfeeding was reported by the majority; however, the maximum time was two months. All infants used bottle and pacifier use was reported from birth.

Chronology of the First Deciduous Tooth Eruption in Brazilian Children with Microcephaly Associated with Zika Virus: A Longitudinal Study

Objective: To analyze the chronology of first deciduous tooth eruption in children with microcephaly associated with presumed or confirmed Zika virus. Material and Methods: A longitudinal study was developed with 74 children of both sexes. Data on prematurity, gestational age (in weeks), anthropometric characteristics at birth [length (cm), weight (g) and cephalic perimeter (cm)] and dental eruption (chronological age and corrected age for prematurity in months) were collected and presented through descriptive statistics. Data was analyzed using the Statistical Package for Social Sciences. Results: The majority of children were female (54.1%) and 14.9% were born premature. The mean gestational age was 38.2 (± 1.9) weeks, while length, weight and cephalic perimeter at birth were 45.6 (± 3.1) cm, 2750 (± 526.6) and 30 (± 2.3) cm, respectively. The eruption of the first tooth occurred on average at 12.3 (± 3.0) months of chronological age and at 11.1 (± 2.3) months of corrected age. The first erupted teeth were the lower deciduous central incisors (82.4%). The mean age for dental eruption in males was 12.5 months (± 3.0) and in females 12.0 months (± 3.1) among full-term children. For premature infants, the mean corrected age of dental eruption was 11.5 months (± 3.4) for boys and 11 months (± 1.7) for girls. Conclusion: In this group of children with microcephaly, the first tooth to erupt was the lower central incisor around the first year of life. Girls had lower average eruption time when compared to boys in both chronological age and age corrected for prematurity.

Oral Health Status of Brazilian Workers of a Textile Industry

Objective: To evaluate the oral health status of Brazilian workers of a textile industry. Material and Methods: A cross-sectional study including 489 individuals of both sexes was performed. Data on gender, age, schooling, frequency of dentist visits and caries experience (DMFT) were collected by a single trained and calibrated examiner. Data were organized using the Statistical Package for Social Sciences (SPSS) software and presented through descriptive and inferential statistics (Poisson Regression Analysis). The significance level was 5%. Results: There was predominance of female workers (57.7%) aged 30-39 years (44.6%) and with 9-11 years of schooling (79.7%). Almost all of them had visited the dentist at least once in their lifetime (99.6%), and 66.8% had done so in the last 12 months. The mean DMFT value was 11.14 (± 5.64), with higher participation of filled (6.21) and missing components (4.03). There was a statistically significant association between DMFT values (≤ 11 and ≥ 12) and age group (p <0.001), as well as between schooling and number of missing (p <0.001) and decayed teeth (p < 0.001). Conclusion: The mean DMFT of Brazilian workers is high, with a tendency to increase the number of missing teeth as age increases. Schooling was associated with the number of missing and filled teeth.

Head and Face Injuries in Automobile Accidents and Associated Factors in a city in Northeastern Brazil

Objective: To evaluate the occurrence of head and face injuries and associated factors among victims of automobile accidents in a trauma center. Material and Methods: A cross-sectional study was developed through the analysis of 9,734 medical records of children and adults hospitalized due to external causes in the Regional Hospital of Emergency and Trauma at Campina Grande, Brazil. Data were analyzed with the SPSS software version 15, also using the Pearson's chi-square test. The significance level adopted was 5 %. Results: Cases of automobile accidents accounted for 25.9% (n = 463) of hospitalizations due to external causes, and 83.8 % of victims were male and 16.2 % were female, representing a sex ratio of 5.1:1. As for age group, most had between 20 and 29 years (38.1%) and with respect to the day of the week, 40.8 % of incidents occurred over the weekend. The occurrence of injury was greater on the face (17.4%) than on the head (7.8%) and most victims had a single injury (58.5%). The existence of bone fractures was observed in 76.9 % of victims and 14.7 % had functional impairment. There was association between variables age (p < 0.001), sex (p < 0.001), day of the week (p < 0.001), presence of bone fractures (p < 0.001) and functional impairment (p = 0.002) with the occurrence of automobile accidents. Conclusion: The most automobile accidents occur on weekends and affect young male individuals, with frequent presence of fractures among victims. The occurrence of injury was greater on the face than on the head. Factors such as age, sex, presence of bone fractures and functional impairment was associated with automobile accidents.

Assessment of Oral Hygiene Level and Periodontal Condition in Brazilian Adolescents

Objective: To evaluate the oral hygiene level and periodontal condition of adolescents aged 15-19 years and socioeconomic factors. Material and Methods: Cross-sectional study with 630 adolescents from public schools randomly selected in the city of Campina Grande, Brazil. For data collection, a form containing socioeconomic variables and those related to oral hygiene was used. The oral hygiene level was measured through the Simplified Oral Hygiene Index (OHI-S) and periodontal condition was evaluated by the Community Periodontal Index (CPI). Data were descriptively and inferentially analyzed using the chi-square test, adopting significance level of 5%. Results: Adolescents were mostly females (59.5%), aged 16 years (32.4%), non-white (77.8%), with family income lower than US $ 612.00 (55.1%), with parental schooling of up to high school (50%). Periodontal condition showed no significant association with any of the socioeconomic factors (p> 0.05). All participants reported using toothbrush; however, the control of interproximal plaque with flossing was reported by only 44.1%, being higher among females (p = 0.028), and its use has been associated with periodontal status (p = 0.026). The oral hygiene level was satisfactory for 59.7% of adolescents, while CPI showed that only 1.6% of them had healthy periodontium and gingival bleeding (34.4%) and presence of dental calculus (37, 8%) were the most prevalent alterations. Conclusion: Adolescents showed satisfactory oral hygiene condition; however, there was a high prevalence of gingival bleeding and dental calculus. Periodontal condition was associated with flossing; however, association with socioeconomic factors was not observed.