Efficacy and Safety of Oral Midazolam Sedation Compared with its Combination with Hydroxyzine Use in Pediatric Dentistry: A Systematic Review

ABSTRACT Objective: To assess the efficacy and safety of the use of midazolam as monotherapy, compared to the associated use of midazolam and hydroxyzine for minimum and moderate sedation of children in dental offices, using data obtained from clinical trials. Material and Methods: A systematic review protocol was developed and registered on PROSPERO (CR42020208633). An electronic search was carried out in Pubmed, Lilacs, Science Direct, Open Gray, Web of Science, and central Cochrane Library. No language restrictions were included. Clinical trials were carried out with children aged 0-12 years, using midazolam as monotherapy compared to the use of midazolam associated with hydroxyzine to verify the effectiveness and safety of oral sedation. The quality of the studies was individually assessed and grouped using the RoB 2 (Revised Cochrane risk-of-bias tool for randomized trials) and GRADE (Grading of Recommendations Assessment, Development and Evaluation) systems, respectively. Results: A total of 749 studies were found. After analyzing the inclusion and removal of duplicates, two studies were analyzed for the quality of evidence. Through this analysis, it was possible to verify the very low level of scientific evidence on the superiority of the efficacy and safety of the combined use of midazolam and hydroxyzine for oral sedation in children in dental offices. Conclusion: The conflicting results and limitations of the studies enabled to establish that there is insufficient evidence to support the use of these drugs combined. There is only evidence for the use of midazolam as monotherapy.

Non-Invasive Methods and the Use of Infiltrating Resins for the Control of Caries Progression in Deciduous Teeth: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To evaluate the influence of non-invasive treatment associated with the use of infiltrating resin for managing caries lesions in primary teeth. Material and Methods: A systematic review was performed by selecting articles from 6 online databases, using a search algorithm and eligibility criteria for data extraction and data synthesis for the papers included. Clinical trials involving primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the outer dentin) were included, presenting full text and answering the study's guiding question. This study used the RoB 2 tool for the risk of bias assessment and GRADE for certainty of evidence. Random effects meta-analyses were implemented, and lesion progression treatment effects were estimated through relative risk (RR) and associated 95% confidence intervals. Results: A total of 440 studies were found. After analyzing the inclusion criteria and removal of duplicates, eight studies were analyzed for quality evidence. Five of the eight studies included in this review contributed to the meta-analysis, all with some reflections regarding the risk of bias. Overall, the results of the meta-analysis showed that non-invasive treatment, when associated with the use of infiltrating resins, significantly reduced the risk of caries progression in relation to the treatment without this addition for follow-up periods ranging from 12 months to 2 years (RR 0.51 [0.40-0.65]). Conclusion: There is moderate certainty of evidence that the use of infiltrating resins associated with non-invasive treatments decreases the risk of caries progression in primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the dentin outer) when combined with non-invasive control methods alone.

Development of a Mobile Application for Acquiring Clinical and Laboratorial Skills and Abilities in Pediatric Dentistry and Orthodontics

Abstract Objective: To develop an educational mobile application as a dynamic platform provided free of charge, including several clinical and laboratory protocols for a wider range of skills and greater knowledge on the strategic axes of child dental care: Pediatric Dentistry and Orthodontics. Material and Methods: The prototype tool was structured as follows: development of clinical and laboratory contents to be addressed, software selection, layout format, inclusion of features, applicability and acceptability tests of the operational system, and indexation on the Play Store® application store (free of charge). Results: The mobile application has shown to be a tool capable of storing and providing data through various audiovisual media formats on clinical and laboratory contents of child dental care. Media resources were developed for the following themes: restorative dentistry in pediatric dentistry, radiographic techniques with pediatric patients, pulp therapy in deciduous teeth, traumatic injuries in the primary dentition, and preventive and interceptive orthodontics. The short-duration multimedia content, with different audiovisual formats, proved to be coherent with the peculiarities of each procedure, enabling to better visualize and understand the techniques. Moreover, the rewind, fast forward, and pause features were included in the mobile application, as well as the possibility of saving print screens, as well as highlighting and searching for contents of interest. Conclusion: The OdontoPed-Helpbox® demonstrated to be able to reach new strategies for the dynamic teaching-learning process, through operational efficiency. It proved to be a useful and instant tool for providing information to support clinical decision making in Dentistry.

Development of odontoma in the permanent dentition after intrusion of primary incisors: case report

Introduction: Dental trauma in childhood is a serious and high incidence complication, mostly due to the discovery phase. This is when the first steps begin, without adequate motor coordination, making children more prone to falls. Trauma to a deciduous tooth can leave sequelae owing to the anatomical proximity to the permanent successor tooth germ. Objective: This study aimed to report a case of severe intrusion in a 10-month-old baby with the emergence of odontoma after dental trauma. Case Report: A 9-year-old patient, accompanied by the guardian, sought attendance for delayed primary teeth exfoliation. During anamnesis, the trauma to the deciduous dentition was found in a 10-month old child, followed by clinical and radiographic examination, showing the presence of odontoma in teeth 11 and 21. The multidisciplinary treatment plan included surgery to remove the odontoma, with subsequent rehabilitation. Conclusion: Trauma to primary dentition can have several consequences for permanent dentition. Thus, dental care is required soon after the incident, besides careful follow-up to evaluate possible sequelae.

Introdução: O traumatismo dentário na infância é uma intercorrência grave, de incidência alta devido principalmente a fase de descobertas, com o início dos primeiros passos, sem ter coordenação motora adequada, tornando as crianças mais propensas a quedas. Um trauma em um dente decíduo pode deixar sequelas em razão da proximidade anatômica ao germe do dente sucessor permanente. Objetivo: O objetivo deste trabalho foi relatar um caso de intrusão grave em bebê de 10 meses, com surgimento de Odontoma após trauma dentário. Relatode Caso: Paciente de 9 anos de idade, acompanhada pela responsável, procurou atendimento pelo atraso na esfoliação dos dentes decíduos. Durante a anamneses foi constatado traumatismo na dentição decídua aos 10 meses de idade, e em seguida realizado o exame clínico e radiográfico, demostrando a presença de odontoma nos dentes 11 e 21. O plano de tratamento multidisciplinar compreedeu a cirurgia para remoção do odontoma, com posterior tratamento ortodôntico reabilitador. Conclusão: O trauma na dentição decídua pode gerar diversas consequências para a dentição permanente. Desse modo é necessário um atendimento odontológico logo após o incidente e um proservação do caso, para avaliar possíveis sequelas.

Análise da confiabilidade de fórmulas para o cálculo de dose de antibacterianos em odontopediatria / Analysis of the reliability of formulas for calculating antibacterial doses in pediatric dentistry

Objetivo: avaliar a confiabilidade de fórmulas para o cálculo da dose dos principais antibacterianos em crianças de diferentes idades e pesos, tendo como padrão-ouro as dosagens fornecidas em bulas. Sujeitos e método: 45 crianças, com idades de 3, 6 e 9 anos, constituíram três grupos independentes. Os dados antropométricos foram obtidos por meio da análise de prontuários da Clínica de Odontologia Infantil da Faculdade Integrada de Pernambuco. As dosagens foram calculadas através das fórmulas estabelecidas a partir de parâmetros de peso, idade e superfície corporal. Os antibacterianos selecionados para a análise foram: Amoxicilina, Amoxicilina com clavulonato de potássio, Clindamicina, Claritromicina, Eritromicina e Azitromicina. Os dados foram submetidos ao teste paramétrico de análise de variância. Para verificar se houve diferença entre as dosagens estabelecidas por fórmulas e a dose estabelecida pela bula (padrão-ouro), foi aplicado o teste post-hoc de Tukey. Os testes estatísticos foram realizados com uma margem de erro de 5%. Resultados: nenhuma fórmula foi válida para todos os antibacterianos quando se comparou com a dose padrão estabelecida em bula. Os resultados apresentaram maiores variabilidades no grupo de crianças com menor idade, podendo ser considerado um risco clínico. Conclusão: as dosagens pediátricas dos antibacterianos obtidas por meio de fórmulas não são confiáveis para os grupos etários analisados e, portanto, não devem ser utilizadas para fins de prescrição medicamentosa. (AU)

Objective: This cross-sectional study evaluated the reliability of formulas for calculating the dose of the main antibacterials in children of different ages and weight, and the gold standard were the dosages provided in package inserts. Subjects and method: Forty-five children aged 3, 6, and 9 years constituted three independent groups. The anthropometric data were obtained through the analysis of medical records of the Child Dentistry Clinic of Faculdade Integrada de Pernambuco, Brazil. The dosages were calculated using the formulas established from parameters of weight, age, and body surface. The antibacterials selected for this analysis were amoxicillin, amoxicillin with potassium clavulanate, clindamycin, clarithromycin, erythromycin, and azithromycin. The data were subjected to parametric analysis of variance. In order to verify whether there was a difference between the dosages established in the formulas and the dose established in the package insert (gold standard), Tukey's post-hoc test was applied. The statistical tests were performed with a 5% margin of error. Results: No formula was valid for all antibacterials when compared to the standard dose established in package inserts. The results showed greater variability in the group of younger children, which may be considered a clinical risk. Conclusion: The pediatric dosages of antibacterials obtained in formulas are not reliable for the age groups analyzed and therefore should not be used for drug prescription purposes. (AU)

Ameloblastic fibrodentinoma in a baby maxilla: case report

Introduction: Ameloblastic fibrodentinoma (AFD) is a rare, asymptomatic, slow-growing mixed odontogenic tumor, usually affecting children and young peoplein their first or second decade of life. This lesion usually causes bone expansion ofthe involved region and makes tooth eruption difficult. Objective: the aim of thisstudy is to report a case of AFD in the anterior maxilla of a 3-year-old baby and itstreatment, highlighting the importance of early dental care and treatment forthis type of injury. Casereport: A 3-year-old female patient attended the dentalcare clinic at Cesmac University Center (Maceió- AL, Brazil), accompanied by hermother, reporting a swollen gum for approximately 6 months. Clinical examinationrevealed an increase in volume in the right central and lateral incisor region,discreetly reddish in color, smooth surface, spherical shape, sessile insertion, nomobility and firm consistency. Radiographic examination revealed a mixed lesionwith radiolucent area compatible with bone resorption and radiopaque areascompatible with calcified material within the lesion. An incisional biopsy wasperformed, confirming the diagnosis of Ameloblastic Fibrodentinoma. Conclusion:Treating this anomaly requires an early approach to improve the quality of life ofthese patients. Parents or guardians should be advised of the need for periodicfollow-up after treatment.

Introdução: O Fibrodentinoma Ameloblástico (FDA) é um tumor odontogênicomisto, raro, assintomático e de crescimento lento, acometendo normalmentecrianças e jovens em sua primeira ou segunda década de vida. Essa lesãogeralmente provoca expansão óssea da região envolvida e dificulta a erupçãodentária. Objetivo: O objetivo deste trabalho é relatar um caso de FDA em maxilaanterior de bebê de 3 anos de idade e seu tratamento, ressaltando a importânciado atendimento odontológico precoce e o tratamento para este tipo de lesão.Relatodecaso: Paciente do gênero feminino, 3 anos, compareceu à clínicaodontológica de atendimento a bebês do Centro Universitário Cesmac (Maceió ­AL, Brasil), acompanhada de sua mãe, relatando uma gengiva inchada háaproximadamente 6 meses. Ao exame clínico, observou-se um aumento de volumena região do incisivo central e lateral direito, com coloração discretamenteavermelhada, superfície lisa, formato esférico, com inserção séssil, sem mobilidadee de consistência firme. Ao exame radiográfico constatou-se uma lesão mistacom área radiolúcida compatível com reabsorção óssea e áreas radiopacascompatíveis com material calcificado no interior da lesão. Foi realizado umabiopsia incisional, confirmando o diagnóstico de Fibrodentinoma Ameloblástico.Conclusão: O tratamento desta anomalia requer uma abordagem precoce como objetivo de melhorar a qualidade de vida desses pacientes, devendo-se aconselharos pais ou responsáveis quanto à necessidade do acompanhamento periódicoapós a realização do tratamento.

Análise clínica e radiográfica de dentes decíduos traumatizados e dos permanentes sucessores: estudo longitudinal / Clinical and radiographic evaluation in traumatic primary teeth and the permanent sucessors

A incidência de traumas dentários na infância é alta, já que esta é uma fase de descobertas em que as crianças estão aprendendo a andar e a correr sem ainda possuírem coordenação motora adequada, tornando-as mais sujeitas a quedas. O traumatismo dentário pode determinar a ocorrência de seqüelas no dente decíduo e em decorrência da proximidade anatômica com o germe do dente permanente sucessor, provoca freqüentemente alterações aos dentes em desenvolvimento. Dessa maneira objetivou-se analisar clinica e radiograficamente dentes decíduos traumatizados e os permanentes sucessores em crianças de 0 a 8 anos de idade, assistidas na Bebê Clínica e na Clínica de Prevenção da Faculdade de Odontologia de Araçatuba - UNESP. Foram analisados 247 pacientes, totalizando 379 dentes decíduos traumatizados e 162 dentes permanentes sucessores. A freqüência de injúrias traumáticas foi de 17%, sendo as crianças do gênero masculino as mais acometidas (53%). A faixa etária entre 13 e 24 meses foi a mais prevalente (45,3%). Os dentes mais afetados foram os incisivos centrais superiores (91%), sendo mais freqüente o envolvimento de apenas um dente por trauma dentário (54,6%). As injúrias ao tecido duro prevaleceram (57%), destacando-se a fratura coronária de esmalte (49,1%). Após a realização dos exames clínico e radiográfico, 78% dos dentes decíduos traumatizados mantiveram a vitalidade pulpar, sendo que as complicações mais comuns nestes dentes foram a descoloração coronária (53,8%) e a reabsorção radicular (30,1%). À avaliação clínica, a freqüência de distúrbios de desenvolvimento observada nos permanentes sucessores foi de 10,5%, sendo a hipocalcificação do esmalte a seqüela encontrada. 17,3% das alterações clínicas nos dentes permanentes sucessores foram causadas por traumas ao tecido de sustentação, sendo que a luxação intrusiva foi responsável pelo maior número de danos...