Effect of thermo mechanical stimulation duringlocal anesthesia in pediatric dentistry: a pilot randomized clinical trial / Efeito de estimulação termomecânica durante anestesia local em odontopediatria: um ensaio clínico randomizado piloto

Objetivo: Avaliar a eficácia de um dispositivo de estimulação termomecânica (Buzzy®) em relação à dor, medo e ansiedade durante anestesia local em crianças. Materiais e métodos: Estudo realizado no período de maio de 2018 a julho de 2019, com crianças de 7 a 11 anos, sem experiência prévia envolvendo anestesia nos últimos 2 anos e que necessitassem de tratamento odontológico (extração, restauração ou endodontia) sob anestesia local em molares decíduos. A amostra foi randomizada em grupo controle, que recebeu anestesia convencional, e grupo intervenção, que recebeu anestesia com Buzzy®. Os níveis de ansiedade, medo e percepção de dor de ambos os grupos foram verificados por meio de: Venham Modified Picture Test (VPTM); frequência cardíaca; Escala Comportamental Venham; Faces Pain Scale ­ Revised (FPS-R) e Face, Legs, Activity, Cry, Consolability (FLACC). Resultados: A maioria das crianças (55%) apresentou baixa ansiedade antes e depois do tratamento (P<0,05). A aceitabilidade das crianças ao Buzzy® foi de 100% e a maioria (90%) gostaria de usar novamente. Discussão: O aparelho testado é uma ferramenta interessante para complementar as técnicas de manejo durante as consultas, tendo em vista a excelente aceitabilidade e interesse por parte dos pacientes e familiares. Conclusão: Este estudo demonstrou que o uso da estimulação termomecânica é viável na clínica odontológica, devido ao seu fácil uso e boa aceitabilidade no meio clínico, além de não apresentar riscos em seu uso.

Aim: To evaluate the effectiveness of a thermo mechanical stimulation device (Buzzy®) in relation to pain, fear and anxiety during local anesthesia in children. Materials and methods: Study carried out from May 2018 to July 2019, with children aged 7 to 11 years, without previous experience involving anesthesia in the last 2 years and who needed dental treatment (extraction, restoration or endodontic) under local anesthesia in deciduous molars. The sample was randomized into a control group, which received conventional anesthesia, and an intervention group, which received anesthesia with Buzzy®. The levels of anxiety, fear and pain perception of both groups were verified using: Come Modified Picture Test (VPTM); heart rate; Behavioral Scale Come; Faces Pain Scale ­ Revised (FPS-R) and Face, Legs, Activity, Cry, Consolability (FLACC). Results: Most children (55%) had low anxiety before and after treatment (P<0.05). The acceptability of the children to Buzzy® was 100% and the majority (90%) would like to use it again. Discussion: The tested device is an interesting tool to complement management techniques during consultations, in view of the excellent acceptability and interest on the part of patients and family members. Conclusion: This study demonstrated that the use of thermo mechanical stimulation is feasible in the dental clinic, due to its easy use and good acceptability in the clinical environment, in addition to not presenting risks in its use.

Translation and cultural adaptation of the Illness Perception Questionnaire-Revised for Dental to Brazil

Abstract This study aimed to translate and to perform the cultural adaptation of the instrument Illness Perception Questionnaire-Revised for Dental (IPQ-RD) into Brazilian Portuguese. The IPQ-RD consists of 34 items that assess the cognitive and emotional representation/perception of parents/caregivers of children with dental caries, with response options on a 5-point Likert scale, ranging from "Strongly agree" (score 1) to "Strongly disagree" (score 5). The higher the score, the lower the perception of the disease. The protocol consists of translation into Brazilian Portuguese, back-translation into English, revision by an Expert Review Committee, and pre-test (application in parents/caregivers of children in dental care). For some questions, the translated versions were identical (T1 = T2); for others, one version was preferred (T1 or T2); for still others, it was decided to modify terms to obtain greater clarity on the item (T3). In the first pre-test, three questions were misunderstood by more than 15% of the sample, after which the items were reviewed by the Expert Review Committee. In the second pre-test, the adapted version was applied to a new sample of parents/caregivers (n = 15) and the questions were understood by more than 85% of the participants. The Brazilian Portuguese version of the IPQ-RD was well understood by the evaluated population.

Impact of dental caries severity and activity on oral health-related quality of life among children aged 8-11 years

Abstract Caries disease can lead to strong impact in terms of pain and suffering, to functional impairment, and to negative effects on quality of life. Studies have demonstrated that the impact on quality of life increases with dental caries severity, and few studies have assessed the relationship between caries activity and children's oral health-related quality of life (OHRQoL). This cross-sectional study aimed to assess the impact of dental caries severity and activity on the OHRQoL of schoolchildren. The study was conducted with a sample of children aged 8 to 11 years from Pelotas, southern Brazil. Children answered the Child Perceptions Questionnaire 8-10, and socioeconomic data were collected. Children's dental caries (Kappa value of 0.95), PUFA, traumatic dental injuries, and malocclusion were examined. The Mann-Whitney, Kruskal-Wallis, and Poisson regression tests were performed. A total of 119 children were included. Children with initial (mean ratio (MR) of 1.92; 95% confidence interval (95% CI) of 1.05-3.48), moderate (MR: 2.66; 95%CI: 1.44-4.90), and severe carious lesions (MR: 2.65; 95%CI: 1.46-4.79) had a greater impact on OHRQoL compared with those without carious lesions (p =0 .047). Children with active carious lesions exhibited a greater impact on OHRQoL (MR:1.53 and 95%CI: 1.11-2.11) when compared to those without active lesions (p = 0.019). The findings demonstrate an association between dental caries severity and activity and the OHRQoL of school-aged children.

Translation and Cross-Cultural Adaptation of the "Child Drawing: Hospital" (CD:H) Scale for Paediatric Dentistry in Brazil

Abstract Objective: To translate and perform the cross-cultural adaption of the CD:H scale for use in Paediatric Dentistry in Brazilian Portuguese language. Material and Methods: The translation and cross-cultural adaptation of the CD: H was carried out in four stages: 1) translation of the instrument; 2) reverse translation (back translation); 3) cross-cultural adaptation, and 4) face validation. Face validation consisted of the evaluation of 30 subjects from the target population. A pilot study was conducted with 15 children aged 5-10 years treated at a university dental clinic and their drawings were analysed by two dentists. Data were analysed using Stata 12.0. Results: In the face validation, most items were understood; however, some words were changed, and terms were included to identify the dental environment. Good reproducibility was obtained: inter-examiner reliability was 0.9647 and intra-examiner reliability was 0.9619 for examiner A and 0.8260 for examiner B. Conclusion: The Brazilian version of the CD:H scale is a useful tool for dentists, helping identify children's emotions and being enjoyable for them.

Dental Fear/Anxiety in Children and Child Emotional and Behavioural Problems

ABSTRACT Objective: To investigate the association between emotional and behavioural problems and dental fear/anxiety (DFA) in children aged four to 12 years treated at a clinic in southern Brazil. Material and Methods: In this cross-sectional study where mother-child dyads were interviewed, emotional and behavioural problems were investigated using the Strengths and Difficulties Questionnaire (SDQ) (considering five subscales). Children's DFA was evaluated through the Venham Picture Test. For each SDQ subscale, Poisson regression model was explored. Prevalence ratios (PR) were estimated, considering a significant level of p ≤ 0.05. Results: Overall, 128 children participated in this study. Most children were female (54.7%) and aged between 7 and 9 years (39.8%). The prevalence of emotional problems was 47.7% and behavioural problems were 46.1%. The prevalence of DFA was 18.8%. Children with emotional problems had a 2.3 higher prevalence of DFA (95%CI 1.06-5.04). In general, behavioural problems were not associated with DFA (95%CI 0.84-3.34) only when conduct problems were considered (2.20; 95%CI 1.02-4.70). Conclusion: Children aged between 4 and 12 years who present emotional and conduct problems tend to show higher DFA.

Mediating effect of eating pattern on the relationship between television exposure and caries in children

Abstract Behavioral characteristics may also take part in the etiology of dental caries. Sedentary behavior, especially watching television, is associated with increased intake of foods high in fat or free sugar, which could influence the occurrence of dental caries. The aim of this study was to assess the mediating effect of eating pattern on the relationship between television exposure time and the presence of dental caries in children. A cross-sectional study was conducted with a representative sample of 580 parent-child dyads with children aged 7 to 8 years in 20 public schools in Pelotas, Brazil. Parents or legal guardians were interviewed and provided information on demographic/socioeconomic data, children's daily television exposure time, and answered the Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K-eating pattern domain). Caries was evaluated through clinical examination. The mediating effect of eating pattern on the relationship between television exposure and presence of dental caries was estimated using the parametric g-formula. Prevalence of dental caries was 63%, and 22% of children watched TV 4 or more hours per day. Television exposure had no direct effect on the dental caries experience [odds ratio (OR): 1.05 (95% confidence interval (95%CI): 0.92-1.19)]. Nevertheless, difficulty maintaining regular eating pattern mediated the natural indirect effect of television exposure time (≥ 4 hours/day) on dental caries experience [OR: 1.07 (95%CI): 1.01-1.14)]. The results of this study confirm the indirect pathway between television viewing and dental caries and the role of disordered eating patterns in this association.

Agreement between schoolchildren and their parents on rating the child's oral health-related quality of life

Abstract The perceptions of parents/caregivers regarding their children's oral health can influence the standard of care and decision-making regarding oral health. The children's perspective on their own oral health-related quality of life (OHRQoL) may differ from the parents/caregivers' views. This cross-sectional study aimed to analyze the agreement between the perceptions of parents/caregivers and schoolchildren regarding OHRQoL. It was conducted with a sample of children between 8 and 11 years old and their parents/caregivers from Pelotas. Children answered the Child Perceptions Questionnaire 8-10 (CPQ), and parents/caregivers answered the short form of the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Socioeconomic data were also collected. Children's dental caries, traumatic dental injuries, and malocclusions were examined. The Spearman's correlation test was performed. A total of 119 parents/caregivers-children pairs were included. There was an agreement between the total scores of parents/caregivers and children (0.2770; p = 0.003), in the oral symptoms (0.1907; p = 0.038), and functional limitations (0.2233; p=0.015) domains. The Bland-Altman graph showed an agreement between children's and parents/caregivers' OHRQoL total score, but there was an underestimation of approximately two points in the parents/caregivers' perception compared to the children's score. There was an agreement between the reports of parents/caregivers and children regarding children's OHRQoL.

Eficácia de distrações audiovisuais em crianças no comportamento, controle da dor e da ansiedade durante procedimentos odontológicos: um estudo transversal / Effectiveness of audiovisual distractions in children on behavior, pain and anxiety control during dental procedures: a cross-sectional study

Objetivo: Avaliar se distrações audiovisuais em crianças são eficazes a fim de manejar comportamento, dor e ansiedade em atendimentos odontopediátricos. Materiais e Métodos: Este estudo transversal foi derivado de um ensaio clínico randomizado, realizado entre março e dezembro de 2019 com 48 crianças de 6 a 10 anos que necessitavam de tratamento restaurador, endodôntico ou exodôntico, na Clínica Infantil da Faculdade de Odontologia da Universidade Federal de Pelotas (UFPEL). Foi aprovado pelo Comitê de Ética em Pesquisa da UFPel, sob número 3700062. As crianças foram alocadas em dois grupos: controle e intervenção (óculos de realidade virtual e tablet). O comportamento da criança foi avaliado a partir da Versão Brasileira da Escala de Venham e a ansiedade através da Venham Picture Test Modified (VPTM). A partir das escalas Face, Legs, Activity, Cry and Consolability (FLACC) e Faces Pain Scale-Revised (FPS-R) foi realizada a avaliação da dor. Resultado: Observou-se que o grupo óculos possuiu melhores resultados do que o grupo tablet, porém sem diferença significativa, já que os dois obtiveram melhores resultados se comparados ao controle. Ademais, o comportamento apresentou diferença significativa (p=0,035) em relação às outras variáveis. Discussão: Um ensaio clínico que analisou uso dos óculos em crianças entre 6 e 9 anos, concluiu que não houve diferença estatística importante entre os grupos em relação ao comportamento. Assim, o presente estudo demonstrou resultados mais relevantes se comparados aos achados na literatura. Conclusão: O uso das distrações audiovisuais por crianças durante procedimentos odontológicos foram eficazes no manejo da dor, comportamento e ansiedade.

Aim: To assess whether audiovisual distractions in chil-dren are effective in managing behavior, pain and anxiety in pediatric dental care. Materials and Methods: This cross-sectional study was derived from a randomized clinical trial, carried out between March and December 2019 with 48 children aged 6 to 10 years who required restorative, endodontic or exodontic treatment, at the Children's Clinic of the Faculty of Dentistry of the Federal University of Pelotas (UFPEL). It was approved by the Re-search Ethics Committee at UFPel, under number 3700062. The children were allocated into two groups: control and intervention (virtual reality glasses and tablet). The child's behavior was assessed using the Brazilian Version of the Venham Scale and anxiety using the Venham Picture Test Modified (VPTM). Pain assessment was performed using the Face, Legs, Activity, Cry and Consolability (FLACC) and Faces Pain Scale-Revised (FPS-R) scales. Result: It was observed that the glasses group had better results than the tablet group, but without significant difference, since the two obtained better results compared to the control. Furthermore, the behavior showed a significant difference (p=0.035) in relation to the other variables. Discussion: A clinical trial that analyzed the use of glasses in children between 6 and 9 years old concluded that there was no significant statistical difference between the groups in relation to behavior. Thus, the present study showed more relevant results when compared to findings in the literature. Conclusion: The use of audiovisual distractions by children during den-tal procedures was effective in managing pain, behavior and anxiety.

Associação entre características infantis e estresse de alunos de graduação durante atendimento odontopediátrico / Association between childhood characteristics and stress in undergraduate students during pediatric dental care

Objetivo: O objetivo desse trabalho foi avaliar a associação entre as características das crianças com o estresse apresentado por estudantes de graduação em Odontologia durante o atendimento odontopediátrico. Materiais e métodos: Participaram 48 crianças com idade entre 6 e 10 anos e 37 alunos voluntários do 7º, 8º e 9º semestres de um curso de Odontologia. Foi realizado um questionário sobre aspectos socioeconômicos e também coletados dados sobre comportamento, percepção de dor e ansiedade da criança e do responsável. Ainda, foram coletados dados relacionados aos alunos da graduação: sexo, semestre, nível de estresse, tipo de procedimento realizado. Foram obtidas as frequências absolutas e relativas por meio da análise descritiva dos dados. As comparações nos desfechos de interesse foram feitas utilizando o teste quiquadrado para variáveis dicotômicas e categóricas, teste linear por linear para variável ordinal e teste exato de Fischer para contagens menor do que 5. Foi adotado um nível de significância de 5%. Resultados: Os resultados mostraram que a maioria dos operadores que atenderam crianças não colaboradoras relataram nível de estresse alto (83,33%) (p<0,001). Os operadores que atenderam crianças com nível de ansiedade médio ou alto relataram nível de estresse alto (p= 0,043) e em pacientes com dor, o nível de estresse da maioria dos operadores foi considerado alto (75%) (p=0,001). Conclusão: as características das crianças influenciaram no estresse apresentado pelo aluno operador durante o atendimento odontológico infantil. Crianças ansiosas, não colaboradoras e que estavam sentindo dor durante o atendimento deixaram o operador mais estressado.

Objective: The aim of this study was to evaluate the association between the characteristics of children and the stress presented by undergraduate dentistry students during pediatric dental care. Materials and Methods: Participants were 48 children aged between 6 to 10 years old and 37 volunteer students from the 7th, 8th and 9th semesters of a Dentistry course. A questionnaire on socioeconomic aspects was carried out and data on behavior, perception of pain and anxiety of the child and the guardian were also collected. Also, data related to undergraduate students were collected: sex, semester, stress level, type of procedure performed. Absolute and relative frequencies were obtained through descriptive data analysis. Comparisons in the outcomes of interest were made using the chi-square test for dichotomous and categorical variables, linear by linear test for ordinal variable, and Fisher's exact test for counts less than 5. A significance level of 5% was adopted. Results: The results showed that students who assisted non-cooperative children reported a high level of stress (83.33%) (p<0.001). Students who assisted children with medium or high levels of anxiety reported high levels of stress. (p=0.043) and in patients with pain, the students' stress level was considered high (75%) (p=0.001). Conclusion: The characteristics of the children influenced the stress presented by the student during child dental care. Anxious children, noncooperative and who were in pain during care left the student more stressed.

Translation and Cultural Adaptation of the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese

Abstract Objective: To translate and culturally adapt the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese. Material and Methods: The MCDASf consists of eight questions about anxiety toward dental procedures that are answered on a five-point Likert scale ranging from "not worried" (1 point) to "very worried" (5 points). The answers correspond to a scale of face drawings ranging from extremely negative to extremely positive. The process consisted of initial translation, back-translation, expert committee review, and pretesting. Results: The first revised version was applied to 32 children aged 5 to 12 years, 16 from the city of Governador Valadares, Brazil (southeastern region) and 16 from the city of Pelotas, Brazil (southern region). In the first pretest, Item 5 was misunderstood by 6.25% of children in the southern region; Item 6 by 6.25% in both regions; Items 7 and 8 by 87.5% and 100% of those from the southeastern region, respectively, and by 12.5% and 25% of those from the southern region, respectively. Items 7 and 8 were modified by the expert committee, and the second revised version was applied to 32 children, 16 from each region. The only misunderstood items were 4 and 5, both by a 7-year-old boy in Governador Valadares. Conclusion: The Brazilian Portuguese version of the MCDASf was well understood by the sample of children (AU).

Comportamento da criança durante o atendimento odontológico nas clínicas de uma instituição de ensino pública / Child behavior during dentistry treatment

Objetivo: avaliar o comportamento de crianças de 3 a 7 anos durante o atendimento odontológico nas clínicas de uma instituição de ensino pública e sua relação com características demográficas e relacionadas aos procedimentos realizados. Metodologia: foram avaliados os prontuários odontológicos de crianças entre 3 e 7 anos de idade para coleta de dados demográficos, socioeconômicos, histórico de internação hospitalar e de atendimento odontológico prévio, tipo de procedimento executado e comportamento. Os dados foram tabulados no Microsoft Excel® e analisados por meio de estatística descritiva no Programa Stata versão 12.0. Resultados: foram incluídos no estudo 81 prontuários odontológicos (40,9%). A maioria das crianças pertencia ao sexo masculino (50,6%), raça branca (77,3%), com renda familiar de até 2 salários-mínimos (73%), as mães apresentavam mais de 9 anos de estudo (54,6%) e a criança não tinha histórico de internação hospitalar (61,3%). A maioria apresentou comportamento colaborador nas consultas com procedimentos pouco invasivos e invasivos, percebendo-se, de uma maneira geral, um aumento gradativo da colaboração com o passar da idade, independentemente do tipo de procedimento. Nas consultas com procedimentos muito invasivos constatou-se que a maioria tende a ser colaboradora (66,4%), porém em proporção menor que nos pouco invasivos (83,3%) e invasivos (78,0%). Conclusão: As crianças apresentaram, em sua maioria, comportamento colaborador frente aos procedimentos odontológicos executados por estudantes e empregando técnicas de manejo do comportamento não farmacológicas. A frequência de comportamento colaborador foi maior em crianças de 5 anos ou mais e que realizaram procedimentos pouco invasivos.(AU)

Objective: to evaluate the behavior of children aged 3 to 7 years during dental care at the clinics of a public educational institution and its relationship with demographic characteristics and those related to the procedures performed. Methodology: the dental records of children between 3 and 7 years of age were evaluated to collect demographic and socioeconomic data, history of hospitalization and previous dental care, type of procedure performed and behavior. Data were tabulated in Microsoft Excel® and analyzed using descriptive statistics in Stata version 12.0. Results: 81 dental records (40.9%) were included in the study. Most children were male (50.6%), white (77.3%), with family income of up to 2 minimum wages (73%), mothers had more than 9 years of study (54, 6%) and the child had no history of hospitalization (61.3%). Most showed a collaborative behavior in consultations with minimally invasive and invasive procedures, with a general increase in collaboration being observed with age, regardless of the type of procedure. In consultations with very invasive procedures, it was found that the majority tend to be collaborative (66.4%), but in a smaller proportion than in the slightly invasive (83.3%) and invasive (78.0%). Conclusion: Most of the children showed collaborative behavior when faced with dental procedures performed by students and using non-pharmacological behavior management techniques. The frequency of collaborative behavior was higher in children aged 5 years or older who underwent minimally invasive procedures.(AU)

Relação da condição de cárie da criança com experiência de cárie da mãe / Relationship between the child's caries status and the mother's caries experience

Objetivo: verificar a relação da condição de cárie da criança com a experiência autopercebida de cárie da mãe através de um estudo observacional transversal. Métodos: O estudo foi realizado na Faculdade de Odontologia da Universidade Federal de Pelotas com crianças entre 8 e 11 anos e suas mães. A amostra contou com 105 pares mãe-filho. Os responsáveis responderam um questionário relacionado à situação socioeconômica e demográfica, a mãe respondeu sobre sua saúde bucal: experiência de cárie (restauração ou dente cariado e perda dentária por cárie). Nas crianças os desfechos foram avaliados através de exame clínico com a soma de dentes decíduos e permanentes cariados, perdidos e obturados (ceod/CPOD) e para severidade de cárie foi utilizado Significant Caries Index (SiC), ceod/CPOD≥3. Para testar a associação entre as variáveis relacionadas à mãe e o desfecho severidade de cárie foi realizado o teste Qui-quadrado, para média de cárie na criança (ceod/CPOD) foi utilizado o Teste Mann-Whitney. Resultados: Com relação à severidade de cárie não foi encontrada associação estatisticamente significante. A média do ceod/CPOD foi quase três vezes maior nas crianças cujas mães relataram que haviam tido ou estavam com algum dente cariado ou restaurado em função da cárie em comparação àquelas que não relataram esta experiência. As mães mais jovens apresentaram filhos com maior média de cárie do que as mães mais velhas. Conclusão: Entre as crianças atendidas neste serviço existe uma relação de uma maior média de cárie nas crianças com cujas mães tem ou tiveram experiência de cárie e mais jovens.(AU)

Objective: to verify the relationship between the child's caries condition and the mother's self-perceived caries experience through a cross-sectional observational study. Methods: The study was carried out at the Faculty of Dentistry of the Federal University of Pelotas with children between 8 and 11 years old and their mothers. The sample had 105 mother-child pairs. The guardians answered a questionnaire related to the socioeconomic and demographic situation, the mother answered about her oral health: caries experience (restoration or decayed tooth and tooth loss due to caries). In children, the outcomes were evaluated through clinical examination with the sum of decayed, missing and filled deciduous and permanent teeth (DMFT/DMFT) and for caries severity we used the Significant Caries Index (SiC), DMFT/DMFT≥3. To test the association between the variables related to the mother and the outcome of caries severity, the Chi-square test was performed, for mean caries in children (dmft/DMFT) the Mann-Whitney Test was used. Results: Regarding caries severity, no statistically significant association was found. The mean dmft/DMFT was almost three times higher in children whose mothers reported that they had had or had a decayed or restored tooth due to caries compared to those who did not report this experience. Younger mothers had children with a higher average of caries than older mothers. Conclusion: Among the children assisted in this service, there is a relation of a higher average of caries in children whose mothers have or had caries experience and younger.(AU)

Efficacy of audiovisual distraction using eyeglasses during dental care: a randomized clinical trial

Abstract This randomized parallel-group control trial tested the efficacy of distraction using audiovisual eyeglasses (AVE) during dental procedures [NCT03902158]. Forty-four 6-9 year-old children with low/moderate anxiety and who needed restorative treatment or exodontia of the primary molars were randomly allocated into two groups: the AVE (experimental) and the conventional behavior management techniques (control) groups. Motion sensors were used to measure the participants' body movements. Dental visits were video recorded, and their pain levels and behavior were assessed using the Faces, Legs, Activity, Cry, and Consolability Behavioral Pain Assessment Scale and the Venham Behavioral Scale, respectively. Anxiety was assessed via heart rate measurements. After treatment, the children scored their pain using the Faces Pain Scale. Mann-Whitney U and chi-square tests were used to compare the groups. The mean score on the behavioral scale was 0.59 in the experimental group and 0.72 in the control group under local anesthesia (p = 0.73). During the procedure, the mean score was 0.41 in the experimental group and 1.32 in the control group (p = 0.07). The mean heart rate was similar in both groups (p = 0.47), but a significant increase during treatment was observed in the control group. There was no difference between the groups in terms of pain, behavior, and self-reported pain scores (p = 0.08). Children aged 6-7 who used the AVE had fewer wrist movements (435.6) than that of children in the control group (1170.4) (p = 0.04). The AVE achieved similar results to the basic behavior management techniques, with good acceptance by the children.

Prevention and Management of Dental Trauma in Primary Teeth in the Context of the COVID-19: A Critical Literature Review

ABSTRACT Objective: To evaluate and discuss the prevention and management of dental trauma in primary teeth during the COVID-19 pandemic. Material and Methods: Critic literature review, searching electronic databases and Google for articles and guidelines published in English that described prevention and management of dental trauma in primary dentition during the pandemic of COVID-19. Results: 5 publications regarding management and 1 leaflet about prevention for parents were identified. Urgent care is required when the child presents tooth fracture resulting in pain or causing soft tissue trauma and luxation affecting bite. Avulsed teeth should not be replanted and advice and self-help may be sufficient in some situations. Instructions about soft diet and hygiene must be provided. Remote consults are recommended for non-urgent situations and during follow-up to evaluate the presence of sequelae. Aerosol generating procedures should be avoided and, in cases of poor prognosis, extraction is recommended to prevent recurring visits to the dental office. Conclusion: During COVID-19 pandemic, remote consults should be recommended to evaluate traumatic dental injuries in primary dentition. Follow-up should not be neglected and may be performed through remote consultation.

Discriminant validity of the CAST instrument compared to the dmf index in the deciduous dentition: a cross sectional study

Abstract This study aimed to assess the discriminant validity of the Caries Assessment Spectrum and Treatment (CAST) at different thresholds, compared with the Decayed, Missing, and Filled Teeth Index (dmf) instrument, to discriminate caries risk factors. A cross-sectional study was conducted including children aged 2-5 years from preschools in Southern Brazil. Parents answered a questionnaire, and children were clinically examined using the CAST instrument and, in the following weeks, using the dmf index. Two caries thresholds were adopted for CAST: caries in dentin (CAST4-7/CAST2,4-8) and enamel caries (CAST3-7/CAST2-8). Poisson regression was used in the analysis (p < 0.05). A total of 200 children were included. The prevalence of caries was 47.0% with dmf, 42.5% with CAST4-7, and 77.5% with CAST3-7. When the outcome was caries prevalence, CAST4-7 discriminated between sexes, household crowding, and dental pain, and CAST3-7 discriminated age and family income, while the dmf was associated with dental pain. When experience of caries was the outcome, all the criteria discriminated between sexes, age, family income, household overcrowding, visible dental plaque, and dental pain, while dmf and CAST2-8 also discriminated maternal schooling. The CAST discriminated caries risk factors similar to the dmf index when caries experience was the outcome. When prevalence was considered, CAST was able to discriminate for more individual characteristics than dmf.

Ansiedade materna odontológica e experiência de cárie dentária em crianças de 7 a 13 anos de idade: um estudo transversal / Maternal dental anxiety and dental caries experience in children aged 7 to 13 years: a cross-sectional study

Objetivo: o objetivo deste estudo foi investigar se a ansiedade materna odontológica está associada à experiência de cárie dentária da criança. Métodos: este estudo transversal foi realizado com crianças entre 7 a 13 anos de idade. A coleta de dados consistiu na aplicação de um questionário às mães e exame clínico nas crianças. A ansiedade odontológica materna foi avaliada pela Modified Dental Anxiety Scale. A experiência de cárie dentária foi avaliada por meio do índice CPO-D/CEO-D. A análise multivariada, bruta e ajustada, foi realizada pelo teste de Regressão de Poisson com variância robusta para testar o efeito das variáveis independentes no desfecho (Razão de Prevalência, Intervalo de Confiança de 95%). Um nível de significância de 5% foi adotado. Resultados: participaram 85 díades mãe/criança. Em torno de 32% das mães apresentaram moderado/alto grau de ansiedade odontológica. A experiência de cárie foi associada à idade da criança (p = 0,001), à percepção materna da saúde bucal da criança (p = 0,017) e à ansiedade materna odontológica (p = 0,001). Após os ajustes, a ansiedade materna odontológica permaneceu associada à experiência de cárie da criança. Crianças filhas de mães ansiosas apresentaram 23% maior prevalência de experiência de cárie dentária quando comparadas aquelas crianças filhas de mães não ansiosas. Conclusão: em crianças de 7 a 13 anos de idade, a ansiedade materna odontológica foi associada à experiência de cárie da criança.(AU)

Aim: to investigate if maternal dental anxiety is associated eith dental caries experience in children. Methods: this cross-sectional study was performed in children aged 7-13 years. Data collection included in a questionnaire applied to mothers and in a clinical examination in children. Maternal dental anxiety was measured using the Modified Dental Anxiety Scale. Dental caries was assessed through dmft/DMFT Index. Multivariate analyses, crude and adjusted, using Poisson Regression model with robust variance in order to test asssociation between maternal dental anxiety and dental caries experience (Prevalence Ratio, 95% Confidence Interval). A significance level of 5% was adopted. Results: na overall of 85 dyades mothers/ children particpated. About 32% of mothers presented moderate/high level of dental anxiety. Dental caries was associated to child's age (p = 0,001), maternal perception abut oral health of children (p = 0,017) and to maternal dental anxiety (p = 0,001). After adjustments, maternal dental anxiety was associated to dental caries experience. Children from anxious mothers presented 23% higher prevalence of dental caries experience than those whose mothers did not present anxiety. Conclusion: in children aged 7 to 13 years, maternal dental anxiety was associated to dental caries experience.(AU)

Association of Dental Anxiety with Psychosocial Characteristics among Children Aged 7-13 Years

Abstract Objective: To identify psychosocial characteristics associated with dental anxiety in children aged 7-13 years in the dental setting. Material and Methods: This cross-sectional study was conducted with children aged 7-13 years attended at the Dentistry School of Pelotas, Brazil. Data collection was based on a questionnaire administered to mothers and children, and the behavior of children during dental treatment was evaluated using the Frankl' Scale. Data were analyzed using Chi-square and Fisher's exact tests in order to analyze the association between independent variables and dental anxiety. The effect of variables on the outcome was assessed by the Poisson regression model with robust variance (Prevalence Ratio; 95% Confidence interval). Results: A total of 187 children were included. Dental anxiety prevalence was 40.11%. After adjustments, younger children (p=0.046), only child (p=0.019), and children with negative previous dental experience (p=0.046) showed higher dental anxiety prevalence. Children with uncooperative behavior in previous (p=0.033) and current (p≤0.001) dental appointments showed higher dental anxiety prevalence. Conclusion: In this sample of children treated at a dentistry school, a report of dental anxiety was associated with age, birth order, previous dental experience and behavior in dental settings.

Methods and logistics of an oral health cohort of university students from Pelotas, a Brazilian Southern city

Aim: This paper aimed to describe the methodological aspects in the baseline of university students' cohort in a public university in southern Brazil. Methods: A multidisciplinary study was carried out assessing the psychosocial and oral health conditions of university students at the Federal University of Pelotas (UFPel). All new university students who have entered in in UFPel in the first semester of 2016 year were invited to participate. Two self-administered questionnaires were applied in classrooms. Descriptive analysis was performed using Stata 14.0. Results: A total of 3,237 students were eligible. Of these, 2,089 (64.5%) signed the consent form to participate of the study and answered the general questionnaires, and 2,052 (63.4%) students answered the confidential questionnaire. Refuses represented only 1.4% (n=29) of the total sample. Overall, most of the sample was female (52.2%), with age ranging from 18 to 24 years (66.1%), with white skin color (74.1%) and with mothers with educational level at university course (32.4%). A total, 62% reported a family income between 1001.00 and 5000.00 BRL, while only 16.3% reported being from low-income family (≤ 1000.00 BRL). The UFPel offers 63 classroom-based courses classified in nine areas of knowledge. The Applied Social Sciences area comprised 19% of the sample followed by the Linguistics, Letters and Arts (17%) area and the Health sciences area (13%). Conclusion: To the knowledge of researchers, this was the first cohort study of university students in the South of Brazil including more than two thousand participants. This paper described strategies adopted to optimize and to allow data collection in the baseline and in the next follow-ups

Dental fluorosis treatment can improve the individuals' ohrqol? results from a randomized clinical trial

Abstract This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito na qualidade de vida relacionada à saúde bucal (QVRSB) de dois protocolos de tratamento para fluorose dentária, em indivíduos incluídos em um ensaio clínico randomizado. Setenta voluntários, os quais viviam em uma área de fluorose endêmica no Brasil, e que possuíam pelo menos quatro dentes ântero-superiores com índice de Thylstrup e Fejerskov de 1 a 7, foram randomizados em dois grupos de tratamento (n= 35): GI- microabrasão de esmalte; ou GII- microabrasão associada com clareamento caseiro. A microabrasão foi realizada com ácido fosfórico 37% e pedra pomes e, o clareamento caseiro com peróxido de carbamida 10% e uso de moldeira. Os voluntários responderam um questionário antes e 1 mês após o tratamento, visando avaliar mudanças na QVRSB através do instrumento Oral Impact on Daily Performance (OIDP). Diferenças nos escores de impacto geral entre e nos mesmos grupos de tratamento foram analisadas através dos testes Wilcoxon (mesmo grupo) e Mann-Whitney (entre grupos), respectivamente. Alterações no escores dos domínios foram analisadas usando o teste Wilcoxon (a<0.05). Um mês após o tratamento, os indivíduos relataram melhora na QVRSB. Ambos os grupos apresentaram menores escores do OIDP (p<0,001), sem diferença entre eles. Os escores dos domínios comer, limpar os dentes, sorrir e estado emocioal diminuíram após o tratamento para toda a amostra. Concluiu-se que o tratamento com microabrasão melhorou a QVRSB de indivíduos vivendo em uma área de fluorose endêmica independentemente da associação com o clareamento caseiro.

Pacifier use modifies the association between breastfeeding and malocclusion: a cross-sectional study

Abstract This study aimed to evaluate the influence of breastfeeding and pacifier use on the occlusal status of preschool children. A cross-sectional study was conducted with children (n = 489) aged 2-5 years in private and public schools in Pelotas, South Brazil. Mothers answered a questionnaire on demographic, socioeconomic and behavioral variables, including breastfeeding and non-nutritive sucking habits. Malocclusion was classified as normal/mild and moderate/severe, according to WHO criteria. The association between breastfeeding and pacifier use with malocclusion was tested using multivariate logistic regression. The prevalence of malocclusion was 37.83% (95%CI 33.52-42.14), and 57.87% of the children used a pacifier. A total of 46.01% of the sample was exclusively breastfed for 6 months, and 24.74% were never breastfed. Malocclusion was associated with pacifier use, and with both non-exclusively breastfed and never breastfed. After adjustments for demographic and socioeconomic variables, the children who used a pacifier and were never breastfed (OR = 19.08; 95%CI 8.54-42.63), or who used a pacifier and were not exclusively breastfed (OR = 13.74; 95%CI 6.11-30.92), showed worse occlusal conditions, compared with the children who were exclusively breastfed and never used a pacifier. Pacifier use modifies the relationship between breastfeeding and occlusal status.