Impact of Malocclusion on Oral Health-Related Quality of Life of 8-12 Years Old Schoolchildren in Southern Brazil

Abstract The aim of this study was to estimate the impact of malocclusion on the oral health-related quality of life (OHRQoL) of schoolchildren aged 8-12 years old in Southern Brazil. A two-stage cluster procedure was used to select 1,199 children in 20 public and private schools in Pelotas/Brazil. Cross-sectional data was collected, consisting of a socioeconomic questionnaire to parents, children’s interview and clinical oral examination. The clinical variables were obtained from clinical examination, and the Child Perceptions Questionnaire (CPQ) was assessed during children’s interview. To measure malocclusion and orthodontic treatment need the Dental Aesthetic Index was used. For data analysis multiple Poisson regression models estimating the rate ratios (RR) and their respective confidence intervals (95%CI) were used. Among 1,206 participants, 789 were aged 8-10 years and 417 between 11-12 years. The orthodontic treatment need was higher among the younger children (44.6%) than in the older ones (35.0%) (p value ≤0.05). There was a significant association in the CPQ social and emotional domains with malocclusion in the older schoolchildren. In the adjusted analysis (for socioeconomics and clinical variables) the effect of very severe malocclusion on OHRQoL was confirmed in both 8-10 and 11-12 age groups (RR(95%CI) of 1.24(1.02;1.51) and 1.28(1.01;1.62), respectively). The findings demonstrated that children with very severe malocclusion experienced greater negative impact on OHRQoL compared to those with mild or no malocclusion. The results suggest that malocclusion impacts the quality of life. The higher impact occurs in the social and emotional well-being domains.

Resumo O ojetivo desse estudo foi ostimar o impacto da maloclusão na qualidade de vida relacionada à saúde bucal (QVRSB) de escolares de 8 a 12 anos de idade em Pelotas/ RS. Seleção amostral foi realizada através da técnica de conglomerado em duplo estágio, selecionando 1.199 crianças de 20 escolas públicas e privadas em Pelotas/Brasil. A coleta de dados foi realizada com uma abordagem transversal e consistiu em um questionário socioeconômico aos pais, entrevista com as crianças e exame clínico de saúde bucal. As variáveis clínicas foram obtidas através do exame clínico, e o Child Perceptions Questionnaire (CPQ) foi respondido através da entrevista com a criança. Para mensurar maloclusão e necessidade de tratamento ortodôntico, o Índice de Estética Dental foi usado. Para análise dos dados foram utilizados modelos de regressão de Poisson multivariados, a fim de estimar as razões de taxa e seus intervalos de confiança (95%). De 1.206 participantes, 789 tinham entre 8 e 10 anos de idade e 417 entre 11 e 12 anos. A necessidade de tratamento ortodôntico foi maior entre crianças mais jovens (44.6%) do que em mais velhas (35.0%) (p ≤0.05). Uma associação estatisticamente significante foi observada entre os domínios social e emocional do CPQ e a maloclusão em crianças mais velhas. Na análise ajustada (para variáveis socioeconômicas e clínicas), o efeito de maloclusão muito severa na QVRSB foi confirmado nos grupos etários de 8 a 10 e 11 a 12 (RR (IC95%) de 1,24(1,02;1,51) e 1,28(1,01;1,62), respectivamente . Os achados demostraram que crianças com maloclusão muito severa experienciaram maior impacto negativo na QVRSB comparadas com aquelas sem maloclusão ou com maloclusão leve. Os resultados sugerem que a maloclusão impacta na qualidade de vida. Um maior impacto acontece nos domínios de bem estar social e emocional.

Epidemiology of malocclusions in primary dentition and associated factors

This study aimed to evaluate malocclusion occurrence in children with complete primary dentition, describing the most frequent one and verifying potential associations with demographic, socioeconomic, and behavioral variables. Subjects and method: 502 children with complete primary dentition from primary schools in the city of Pelotas, RS, Brazil, were examined. Data was collected based on questionnaires distributed to the mothers, as well as on physical examinations of the oral cavity. The children with malocclusion presented at least one of the following changes: anterior open bite, deep overbite, posterior crossbite, and overjet. Chi-square tests for heterogeneity and linear trend were used to verify associations with demographic, socioeconomic, and behavioral variables. Results: the occurrence of malocclusions in the population studied was 67.5%. From them, 33.6% presented anterior open bite, 22.3% presented deep overbite, 9.8% presented posterior crossbite, and overjet was present in 1.8%. The most frequent malocclusion was anterior open bite, which was directly associated with the use of pacifier (p<0.001), duration of use (p<0.001), and frequency use (p<0.001). There was also an inverse association with children's age (p=0.007) and maternal level of education (p=0.016). An association was found between the number of children and anterior open bite (p=0.039). Conclusion: the population studied presented high prevalence of malocclusions, and anterior open bite was the most frequent one, which was associated with the use of pacifier, as well as the duration and frequency of use.

Clinical and radiographic sequelae to primary teeth affected by dental trauma: a 9-year retrospective study

Abstract This retrospective study aimed at determining the predicted risks of clinical and radiographic complications in primary teeth following traumatic dental injuries, according to injury type, severity and child's age. Data were collected from records of children treated at a Dental Trauma Center in Brazil for nine years. Records of 576 children were included; clinical sequelae were assessed in 774 teeth, and radiographic sequelae, in 566 teeth. A total of 408 teeth (52.7%) had clinical sequelae and 185 teeth (32.7%), radiographic sequelae. The type of injury with the highest number of clinical sequelae was the crown-root fracture (86.4%). Clinical sequelae increased with injury severity (p < 0.001), whereas radiographic sequelae did not (0.236). The predicted risk of color change was 29.0% (95%CI 19-41) for teeth with enamel fracture, and 26.0% (95%CI 14-40) for teeth with enamel dentin fracture as well as enamel dentin pulp fracture. Risk of periapical radiolucency was higher for teeth with enameldentinpulp fracture (61.1% 95%CI 35-82) and those with subluxation (15.8% 95%CI 10-22). Risk of premature loss was 27.3% (95%CI 13-45) for teeth with extrusive luxation, and 10.2% (95%CI 5-17) for those with intrusive luxation. The assessment of predicted risks of sequelae showed that teeth with hard tissue trauma tended to present color change, periapical radiolucency and premature loss, whereas teeth with supporting tissue trauma showed color change, abnormal position, premature loss and periapical radiolucency as the most common sequelae. Knowledge about the predicted risks of complications may help clinicians establish appropriate treatment plans.

Atitudes e conhecimento dos pais quanto ao uso de dentifrícios fluoretados em crianças de um a 65 meses de idade / Attitudes and knowledge of parents regarding the use of fluoride dentifrices in children aged one to sixty-five months

Objetivo: analisar o conhecimento dos pais sobre o flúor, os dentifrícios, seu uso e o motivo da escolha. Sujeitos e método: estudo transversal com dados coletados em entrevistas com pais de crianças de um a 65 meses de idade, sobre questões socioeconômicas, conhecimento sobre flúor, motivo pela escolha do dentifrício, quantidade utilizada e hábitos de higiene bucal da criança. Os dados foram analisados por meio de estatística descritiva. Resultados: foram entrevistados 202 pais. A média de idade das crianças participantes do estudo foi de 35,6 meses (±15,06). Os pais citaram os seguintes critérios para a compra do dentifrício: ausência de flúor (20,3%), preço (6,9%), sabor (11,4%), marca (10,9%), e 20,8% dos pais responderam não haver critério. Com relação ao início da administração do dentifrício fluoretado para as crianças, 43,1% dos paisrelataram que ocorreu até um ano, 21,8% mais de um ano, e 35,1% não lembravam. Sobre a quantidade utilizada de dentifrício, 32,2% dos pais apontaram usar a técnica longitudinal, 41,1% a transversal, 26,2% a dogrão de arroz, e 5% não responderam. Com relação à higiene bucal ser realizada sozinha ou com ajuda, em 12,2% ela é realizada somente pela criança, em 47,7% dos casos é a criança com a ajuda de um adulto, e em40,1% é feita somente pelo adulto. Conclusão: Os pais têm conhecimentos sobre o flúor e sua finalidade, porém não utilizam a dose recomendada para a idade e não há uma conscientização quanto à motivação para a escolha do dentifrício. Assim, há necessidade de investir em educação a respeito dos dentifrícios para a escolha consciente e o uso adequado.

Oral health-related quality of life of preschool children assisted at a University Dental Clinic / Oral health-related quality of life of preschool children assisted at a University Dental Clinic

Objective: This study assessed parental perception on children?s oral health-related quality of life (OHRQoL), and children?s views on their own teeth. Subjects and method: The sample included in this cross-sectional study consisted of 106 parents and their children, aged 0-6 years, who were assisted at a School of Dentistry. The Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess OHRQoL. Socioeconomic information and reasons for seeking dental care were asked and obtained from parents, while clinical information were collected from files. Children expressed the views on their teeth through an instrument with drawings. Data was analyzed by the Fisher?s exact test and Poisson regression. Results: The mean ECOHIS score was 8.31. Higher impacts on OHRQoL were observed in older children (RR=1.75; 95% CI=1.21-2.54), children referred to the clinic due to either dental trauma (RR=2.44; 95% CI=1.28-4.66) or caries (RR=2.64; 95% CI=1.39-5.05), children who have hadcaries (RR=2.15; 95% CI=1.50-3.08), and children whose parents perceived their own oral health as poor (RR=1.45; 95% CI=1.02-2.05). Twenty-three (31%) children expressed dissatisfaction with their oral health. Conclusions: The impact of oral diseases was high for this population. Children whose parents considered their own oral healthas regular/poor presented higher impact on quality of life. Moreover, older children, taken to the dentist due to caries or dental trauma, and with previous dental caries experience, presented negative impact on OHRQoL.

Educação Em Saúde Bucal Direcionada Aos Deficientes Visuais / Oral Health Education Targeting People With Visual Impairments

O objetivo deste estudo foi revisar na literatura estudos que abordem formas de realização de promoção de saúde e prevenção de doenças bucais para pacientes com deficiência visual. Foi realizada revisão sistemática da literatura nas bases de dados PubMed Central, Biblioteca Virtual de Saúde (BVS) e Scopus, sem limite de data de publicação. Foram incluídos ensaios clínicos nas línguas inglesa, portuguesa e espanhola, com algum tipo de intervenção de promoção de saúde bucal voltada para deficientes visuais totais ou parciais. Os artigos foram selecionados e os dados extraídos pelos autores. A busca resultou em 688 artigos dos sites PubMed,BVS e Scopus. Foram eliminados 303 artigos repetidos e, dentre os demais, selecionados nove que abordavam o tema desta revisão. As datas de publicação dos estudos variaram de 1991 a 2013. O total de deficientes visuais participantes destes estudos foi de 431 com idades entre seis e 49 anos. Todas as intervenções educativas foram efetivas e realizadas por odontólogos. A orientação verbal foi o recurso educativo mais utilizado Os resultados encontrados nos estudos deixam clara a necessidade e importância da implantação de estratégias de educação em saúde bucal para essa população. Programas de orientação de higiene bucal envolvendo recursos adaptados e comunicação verbal são efetivos no estabelecimento de uma rotina de higiene adequada, agregando conhecimento aos pacientes e seus familiares e resultando em melhora nos índices de saúde bucal.

The aim of this study was to review the literature about oral health promotion and oral disease prevention for patients with visual impairment. A systematic literature review was conducted using PubMed Central, BVS (Virtual Health Library) and Scopus without restriction for publication date. Clinical trials in English, Portuguese and Spanish that presented any oral health promotion intervention targeting people with visual impairments were included. The articles were selected and data extracted by author. The search resulted in 688 articles from the PubMed, BVS and Scopus websites. Three hundred and three repeated items were eliminated and, among the others, 9 that addressed the topic of this review were selected. The publication dates of the studies ranged from 1991 to 2013. The total number of visually impaired participants of these studies was 431, aged 6 to 49 years. All educational interventions were effective and performed by dentists. The verbal guidance was the most used educational resource. The results demonstrated the need and importance of implementing strategies for oral health education for this population. Oral hygiene orientation programs involving tailored resources and verbal communication are effective in establishing a routine for proper hygiene, providing knowledge to patients and their families, with improvement in oral health indices.

Tooth erosion and dental caries in schoolchildren: is there a relationship between them?

AIM: To identify a possible association between the occurrence of dental caries and tooth erosion and to correlate the dietary factor with an increased risk of dental caries. METHODS: A cross-sectional study in a multistage random sample of 1,211, 8 to 12-years-old Brazilian schoolchildren in private and public schools was conducted in Pelotas, Brazil. The prevalence of dental caries and tooth erosion was assessed. Dietary habits data were collected by a structured questionnaire. Data were analyzed using Poisson regression model taking into account the cluster sample (Prevalence ratio - PR; 95% Confidence Interval - CI). RESULTS: The prevalence of dental caries and tooth erosion was 32.4% (95% CI: 30.0; 35.2) and 25.0% (95% CI: 23.4; 29.0), respectively. Most children had high consumption of sweets (65%). Consumption of fruits, such as oranges (31%), strawberries (23.6%), pineapple (12%), and natural fruit juices (oranges, lemon) was low. Soft drinks consumption, 3 or more times a week was observed in 40% of the children. CONCLUSIONS: Dental caries was not statistically associated with tooth erosion. The consumption of acidic fruits/drinks was not associated with dental caries. Dental caries and dental erosion were not associated with each other and with acidic fruits or drinks consumption.

Iniquidades em saúde bucal: escolares beneficiários do Bolsa Família são mais vulneráveis? / Inequalities in oral health: are schoolchildren receiving the Bolsa Família more vulnerable? / Inequidades en salud bucal: escolares beneficiarios de la Beca Familia son más vulnerables?

OBJECTIVE: To evaluate the association between being a recipient of the Bolsa Família program and oral health conditions in Brazilian schoolchildren.METHODS: A cross-sectional study was conducted with 1,107 schoolchildren aged between eight and 12 years from 20 public and private schools in Pelotas, RS, Southern Brazil. A list of all children receiving the Bolsa Família program was provided by the participant schools. Demographic, socioeconomic and oral hygiene information were assessed using a questionnaire completed by the schoolchildren and their parents. Dental exams were performed to assess the presence of dental plaque and prevalence of dental caries. Data were analyzed by Chi-square test, Chi-square test for linear trend and multivariate Poisson Regression (prevalence ratio; 95% confidence interval).RESULTS: Schoolchildren from non-nuclear families, with a DMFT ≥ 1 and who had never visited a dentist were associated with receiving the Bolsa Família. Final model showed that caries prevalence was twice as high (PR 2.00; 95%CI 1.47;2.69) in schoolchildren benefiting from the Bolsa Família . It was also showed that schoolchildren benefiting from the program presented greater severity of dental caries compared to school children from private schools (RR 1.53; 95%CI 1.18;2.00). After final adjustments, the prevalence of schoolchildren who have never visited a dentist was six times higher in children who received the government benefit (PR 6.18; 95%CI 3.07;12.45) compared to those from private schools.CONCLUSIONS: Schoolchildren benefiting from the Bolsa Família program experienced more caries lesions and have less frequently accessed dental care services, which suggest the need to include oral health in the program.

OBJETIVO: Analisar a associação entre ser beneficiário do Programa Bolsa Família e condições de saúde bucal entre escolares.MÉTODOS: Estudo transversal com 1.107 escolares entre oito e 12 anos de idade, provenientes de 20 escolas públicas e particulares da cidade de Pelotas, RS, em 2010. Os beneficiários do Programa Bolsa Família foram verificados por meio de lista fornecida pelas escolas participantes do estudo. Informações demográficas, socioeconômicas, de uso de serviço odontológico e de higiene bucal foram obtidas por meio de questionários respondidos pelos escolares e por seus pais. O exame clínico avaliou a presença de placa dental e experiência de cárie. Os dados foram analisados por meio dos testes do Qui-quadrado e Qui-quadrado de tendência linear e por regressão de Poisson (razão de prevalência; intervalo de confiança de 95%).RESULTADOS: Crianças de família não nuclear, que apresentavam CPOD ≥ 1 e que nunca haviam feito uso de serviço odontológico na vida estiveram associadas ao recebimento do Programa Bolsa Família. O modelo final mostrou que a prevalência de cárie foi duas vezes maior (RP 2,00; IC95% 1,47;2,69) em alunos beneficiários do Programa que também apresentaram maior severidade da doença, quando comparados aos alunos de escolas particulares (RM 1,53; IC95% 1,18;2,00). A prevalência de escolares que nunca haviam ido ao dentista foi mais de seis vezes maior em beneficiários do Programa Bolsa Família (RP 6,18; IC95% 3,07;12,45), em comparação com aqueles das escolas privadas, após ajustes.CONCLUSÕES: Escolares beneficiários do Programa Bolsa Família possuem maior carga de cárie e são os que menos acessam os serviços odontológicos. Esses achados sugerem a necessidade de incorporação da saúde bucal nas condicionalidades do Programa Bolsa Família.

OBJETIVO: Analizar la asociación entre ser beneficiario del Programa Beca Familia y condiciones de salud bucal entre escolares.MÉTODOS: Estudio transversal con 1.107 escolares entre ocho y 12 años de edad, provenientes de 20 escuelas públicas y privadas de la ciudad de Pelotas, RS, Brasil, en 2010. El beneficiario del Programa Beca Familia fue verificado por medio de lista suministrada por las escuelas participantes del estudio. Informaciones demográficas, socioeconómicas, de uso de servicio odontológico y de higiene bucal fueron obtenidas por medio de cuestionarios respondidos por los escolares y por sus padres. El examen clínico evaluó la presencia de placa dental y experiencia de caries. Los datos fueron analizados por medio de las pruebas de Chi-cuadrado y Chi-cuadrado de tendencia linear y por regresión de Poisson (cociente de prevalencia; intervalo de confianza de 95%).RESULTADOS: Niños de familia no nuclear, que presentaban COPD ≥1 y que nunca habían hecho uso de servicio odontológico en la vida estuvieron asociados al recibimiento en el Programa Beca Familia. El modelo final mostró que la prevalencia de caries fue dos veces mayor (RP 2,00; IC95% 1,47;2,69) en alumnos beneficiarios del Programa que también presentaron mayor severidad de la enfermedad, al ser comparados con los alumnos de escuelas privadas (RR 1,53; IC95% 1,18;2,00). La prevalencia de escolares que nunca habían ido al dentista fue más de seis veces mayor en beneficiarios del Programa Beca Familia (RP 6,18; IC95% 3,07;12,45), en comparación con aquellos de escuelas privadas, posterior a los ajustes.CONCLUSIONES: Escolares beneficiarios del Programa Beca Familia poseen mayor carga de caries y son los que menos tienen hacen uso de los servicios odontológicos. Estos resultados sugieren la necesidad de incorporar salud bucal en las condiciones del Programa Beca Familia.

Amelogênese imperfeita: aspectos clínicos e tratamento / Amelogenesis imperfecta: clinical aspects and treatment

O objetivo deste trabalho foi apresentar uma revisão de literatura, avaliando aspectos clínicos e opções de tratamento da amelogênese imperfeita, com a intenção de fornecer ao cirurgião-dentista subsídios para o diagnóstico e escolha de tratamento mais apropriado, levando em consideração a individualidade de cada caso. Apesar de a amelogênese imperfeita ser uma doença rara, em que a formação do esmalte é afetada, o profissional deve estar preparado para lidar com a situação e fornecer o suporte, tanto clínico quanto emocional, necessário para esses pacientes. Historicamente, pacientes com essa condição eram tratados com extrações e a confecção de próteses totais. Entretanto, atualmente é possível restaurar estética e função a níveis aceitáveis e como consequência interferir positivamente no comportamento e autoestima do paciente. Estudos com maior tempo de acompanhamento ainda são necessários, com o intuito de verificar a durabilidade dos diferentes materiais e técnicas restauradoras em casos de amelogênese imperfeita.

The purpose of this article is to present a review regarding clinical aspects and treatment alternatives for AmelogenesisImperfecta with the intention of facilitating dentists? diagnosis and most appropriate treatment choices, taking into account the peculiarities of each case. Although AmelogenesisImperfecta is a rare disease that affects enamel formation, professionals must be prepared to deal with this condition to give the clinical and emotional support needed by patients. Historically, patients with AmelogenesisImperfecta were treated by means of extractions and by the use of fully removable dentures. However, it is possible to restore esthetics and function to an acceptable level that can positively affect the patient?s self-confidence and behavior nowadays. Patient long-term follow up studies are still needed in order to verify the durability of the different materials and restorative techniques in AmelogenesisImperfecta cases.

Methods and logistics of a multidisciplinary survey of schoolchildren from Pelotas, in the Southern Region of Brazil / Métodos e logística de um estudo multidisciplinar com escolares de Pelotas, Sul do Brasil / Métodos y logística de un estudio multidisciplinar con escolares de Pelotas, sur de Brasil

This paper describes the methods of a multidisciplinary epidemiological survey conducted in schools in Pelotas, in the Southern Region of Brazil. This cross-sectional study evaluated a representative sample (n = 1,211) of eight to 12-year-old children attending public (15) and private (5) schools. Questionnaires were applied to parents to obtain information about socioeconomic and sociocultural characteristics. Children were interviewed to provide information on demographic characteristics, oral health behavior and physical activity habits. Oral health examinations were performed on the children and anthropometric data was collected to assess nutritional status. School principals responded a questionnaire about the social and physical environment of the school. A total of 1,744 children were eligible for the study; a response rate of 69.4% was achieved, with no significant differences between schools. The method used allowed investigators to obtain data on several health outcomes as well as on possible risk factors. This strategy optimizes the use of financial resources for research and promotes interprofessional collaboration.

O artigo detalha os métodos de um estudo epidemiológico multidisciplinar conduzido em escolas em Pelotas, Sul do Brasil. O estudo transversal incluiu uma amostra representativa (n = 1.211) de crianças de 8 a 12 anos, em escolas públicas (15) e privadas (5). Questionários foram aplicados aos pais para obter informações socioeconômicas e culturais. As crianças foram entrevistadas, fornecendo informações demográficas, comportamentos de saúde bucal e prática de atividade física. Exame de saúde bucal foi realizado e medidas antropométricas aferidas para avaliação da condição nutricional. Diretores das escolas forneceram informações sobre o ambiente físico e social das escolas. Das 1.744 crianças elegíveis, a taxa de resposta foi 69,4% sem diferenças entre escolas. A metodologia proposta permitiu a obtenção de dados sobre diversos desfechos de saúde bem como sobre possíveis fatores de risco. Esta estratégia otimiza recursos financeiros de pesquisa e favorece a colaboração interprofissional.

El artículo detalla los métodos de un estudio epidemiológico multidisciplinar llevado a cabo en escuelas en Pelotas, sur de Brasil. El estudio transversal incluyó una muestra representativa (n = 1.211) de niños de 8 a 12 años, en escuelas públicas (15) y privadas (5). Los cuestionarios fueron administrados a los padres para obtener información socioeconómica y cultural. Los niños fueron entrevistados, proporcionando información demográfica, comportamientos de salud bucal y práctica de actividad física. Se realizaron un examen de salud bucal y medidas antropométricas para la evaluación de la condición nutricional. Directores de escuelas proporcionaron información sobre el ambiente físico y social de las escuelas. De los 1.744 niños elegibles, la tasa de respuesta fue de un 69,4% sin diferencias entre escuelas. La metodología propuesta permitió la obtención de datos sobre diversas soluciones de salud, así como sobre posibles factores de riesgo. Esta estrategia optimiza recursos financieros de investigación y favorece la colaboración interprofesional.

Child maltreatment: a survey of dentists in southern Brazil

Child abuse is a serious public health problem and affects the victims' physical and mental health and development. The aims of this study were two-fold: to assess the attitudes and perceptions of dentists regarding child abuse, and to investigate professional characteristics associated with the identification of suspected child abuse. A questionnaire was sent to the 276 dentists of Pelotas, RS, Brazil , and 187 (68.0%) were returned. Demographic characteristics and profiles of the dentists, and information about their knowledge and attitudes regarding child abuse were collected. Descriptive analysis was performed, and associations were tested by chi-square and Fisher's exact tests. From all dentists surveyed, 123 (71.9%) reported providing treatment for children. Most dentists believed they could detect cases of child abuse (78.7%), but 85.7% had never suspected it. Among those who did suspect, 76.0% did not report the cases to authorities. No differences were observed between sexes, years of graduation, types of licenses, and the frequency at which children were treated. A higher proportion of dentists working at university had suspected child abuse. Even though dentists considered themselves able to identify suspicious cases, only a small percentage reported those suspicions, indicating a lack of awareness by these professionals in the adoption of protective measures for victims of aggression. It is necessary that dental professionals receive interdisciplinary training to enhance their ability to care for and protect children.

Dental emergencies in a university pediatric dentistry clinic: a retrospective study

A significant number of children visit a dentist for the first time due to emergency situations. However, little is known regarding the prevalence, etiology, and treatment provided for children at emergency dental visits. This study aimed to evaluate the profile of children attending a dental school emergency clinic, the reasons for seeking dental care, and the treatment provided. Records of 270 patients who attended an emergency clinic during 2010 were analyzed, and 253 were selected. Demographic, diagnostic, and procedural information was collected. The mean child age was 7.8 years. For 208 children (82%), pain was the main reason for the emergency visit. Nearly 79% of the visits were due to caries, and the most frequently required treatment was endodontic intervention (31.22%). Of the decayed teeth, 61.70% were primary posterior teeth and 31.9% permanent posterior teeth. Pain caused by dental decay was the most frequent chief complaint. A large number of children were brought to the dentist with complaints that had started long before, for which over-the-counter medications had been used.

Direct composite veneer to treat primary teeth with sequela of dental trauma: a case report / Faceta direta de resina composta para tratamento de dente decíduo com sequela de traumatismo dentário: relato de caso

Introduction: Tooth discoloration can be one of the main reasons for parents to seek treatment after dental trauma. When this sequela occurs with no other clinical or radiographic symptoms, a conservative approach is recommended. However, when such alterations can compromise the patient's esthetics and his/her interaction in a social environment, an esthetic treatment may be required. Case report: Here we report the esthetic rehabilitation of a primary maxillary left central incisor presenting coronal darkening in a 5-year-old girl that had been monitored clinically and radiographically due to dental trauma in the maxillary anterior teeth since she was 1 year old. Because of the esthetic complaint, a direct composite resin veneer was performed. Final considerations: After the treatment, a good esthetic result was achieved making the patient and her parents pleased. The esthetic improvement was maintained at the six-month follow-up with no negative impact on the child's social life.

Integração entre pediatria e odontopediatria: uma abordagem transdisciplinar na saúde bucal infantil / Integration between pediatrics and pediatric dentistry:a transdisciplinary approach to children’s oral health

Introdução: Embora os levantamentos epidemiológicos venham demonstrando redução significativa, ainda é possível observar, entre a população infantil, alta prevalência da doença cárie, a qual é responsável pelo desenvolvimento de morbidades além do comprometimento da saúde sistêmica da criança. O objetivo deste estudo foi avaliar a conduta dos pediatras relacionada à saúde bucal infantil e a viabilidade de integração entre a pediatria e a odontopediatria. Métodos: Foi aplicado um questionário semiestruturado, previamente submetido a teste-piloto, aos pediatras da cidade de Pelotas, RS. Todos os profissionais foram registrados, obtendo-se uma taxa de resposta de 81,25% (n=53). Através de análise bivariada, foi realizado teste qui-quadrado, com nível de significância de p<0,05. Resultados: Observou-se associação significativa entre o tempo de atuação do profissional e o conhecimento sobre saúde bucal (p=0,024) e o interesse em receber maiores informações (p<0,001). Entre os participantes, 82,69% responderam incorretamente alguma das questões e 88,67% desejavam receber maiores orientações. Os assuntos de maior interesse foram sobre cárie, flúor, oclusão, técnicas de higiene e idade da primeira consulta odontológica. Um Guia de Orientação para Saúde Bucal da Criança, baseado nos resultados da pesquisa, foi distribuído aos pediatras. Conclusões: Detectou-se que os profissionais com formação acadêmica mais recente apresentaram um conhecimento e conduta mais adequados quando comparados aos demais, sendo possível inferir que existe a necessidade de métodos de educação continuada. Os pediatras concordam com a importância da condição bucal para o desenvolvimento de uma boa saúde sistêmica, sentem-se parcialmente responsáveis nesta questão e avalizam o desenvolvimento de ações integradas com a odontopediatria para execução de medidas promotoras de saúde bucal.

Introduction: Although epidemiological surveys have been showing a significant reduction, there still is a high prevalence of dental caries among children. Dental caries are responsible for the development of morbidities as well as impairment of the systemic health. The aim of this study was to evaluate pediatricians’ approach to children’s oral health and the feasibility of integrating pediatrics with pediatric dentistry. Methods: We applied a semi-structured, previously piloted questionnaire to pediatricians in the city of Pelotas, RS. All of the physicians were included, and we obtained a response rate of 81.25% (n = 53). Through bivariate analysis, a chi-square test was performed with a significance level of p <0.05. Results: There was a significant association between time working as a physician and knowledge about oral health (p = 0.024) and an interest in receiving more information (p <0.001). Among participants 82.69% answered some questions incorrectly, and 88.67% wanted to receive further guidance. The subjects that raised most interest were caries, fluorine, occlusion, oral hygiene techniques, and age at the first dental visit. A Guideline for Children’s Oral Health based on the results of the survey was distributed to pediatricians. Conclusions: More recently graduated physicians were found to show a more appropriate knowledge and approach as compared to the others, and it is possible to infer that there is a need for methods of continuing education. Pediatricians agree on the importance of oral health conditions for the development of good systemic health, feel partially responsible for this issue, and endorse the development of integrated actions with pediatric dentistry in order to implement measures to promote oral health.

Avaliação clínica e radiográfica de dentes decíduos intruídos por traumatismo alvéolo-dentário / Clinical and radiographic evaluation of intrusion in primary teeth by the dental trauma

A luxação intrusiva é causada por um impacto no sentido axial, no qual o dente é deslocado para dentro do osso alveolar, afetando comumente a dentição decídua e podendo gerar sequelas. O seu tratamento é definido por sinais clínicos e radiográficos. Objetivo: acompanhar dentes decíduos intruídos e observar a ocorrência de sequelas. Método: Avaliaram-se prontuários de pacientes com história de traumatismo alveolodentário na dentição decídua e selecionaram-se os prontuários de pacientes que sofreram intrusão com, no mínimo, dois anos de acompanhamento, verificando-se: graus de intrusão e de reerupção; presença de mobilidade dentária; coloração e posição do dente após reerupção; presença de fístula; condição do canal pulpar e da região periapical; presença de reabsorção radicular; e tratamento executado. Resultados: Dentre os 435 pacientes atendidos, foram encontrados 83 casos de intrusão e 29 desses foram incluídos na amostra, totalizando 39 dentes decíduos traumatizados. Assim, as intrusões representaram 19,1% dos traumatismos observados. Embora o sexo feminino fosse o mais acometido (55,2%), não existiu correlação entre sexo e prevalência de dentes decíduos traumatizados. Em relação aos dentes atingidos, o mais acometido foi o 61 (34,4%), seguido pelo 51 (31,0%). Ainda, em 31,0% dos casos, os dois incisivos centrais superiores foram acometidos. O estudo aponta, ainda, que queda da própria altura foi a etiologia prevalente, com 58,6% dos casos. Do total de dentes, 27 tiveram reerupção total, três reerupção de 2/3 da coroa e nove esfoliaram ou foram extraídos. Observando-se as sequelas, discoloração dentária foi a mais frequente, sendo encontrada em 23 dentes (79,3%). Quanto ao tratamento, dos 39 dentes, 28 foram apenas acompanhados (71,8%), nove necessitaram de endodontia (23,1%) e dois de extração (5,1%). Conclusão: o monitoramento da reerupção espontânea dos dentes intruídos e a observação cuidadosa do aparecimento de sequelas são as melhores alternativas, pois algumas complicações podem aparecer vários meses após o traumatismo. As sequelas e o grau de intrusão apresentam grande relação, visto que quanto maior o grau de intrusão, maior será a gravidade das sequelas e mais importante torna-se o acompanhamento por um profissional.

Intrusive luxation is caused by an impact in the axial direction by which the tooth is displaced into the alveolar bone. It usually affects the primary dentition and can generate sequalae. Its treatment is defined by clinical and radiographic signs. Objective: to follow intrusive primary teeth and observe sequela occurrence. Methods: Dental records of patients with a history of alveolodental trauma were evaluated and records from patients that had suffered intrusion with at least a two-year follow-up period were selected. Intrusion and reeruption degrees, dental mobility occurrence, coloration and tooth position after reeruption, fistula occurrence, pulp canal and periapical region condition, root resorption occurrence and treatment performed were checked. Results: Out of 435 treated patients, 83 intrusion cases were found, 29 of which were included in the sample, totaling 39 traumatized primary teeth. Thus, intrusion represented 19.1% of the analyzed traumas. Although females were more affected (55.2%) than males, a correlation between sex and traumatized primary teeth was not found. With reference to affected teeth, the most affected was tooth 61 (34.4%), followed by tooth 51 (31.0%). Also, in 31.0% of the cases, the two central upper incisives were affected. The study showed that fall from height was the prevailing etiology, encompassing 58.6 % of the cases. Out of the total, 27 teeth showed total reeruption, 3 presented a 2/3 reeruption of the crown, and 9 either exfoliated or were extracted. Upon observing sequelae, dental discoloration was most frequent, having been encountered in 23 teeth (79.3%). As to treatment, 28 out of 39 teeth were only followed up (71.8%), 9 needed endodontic treatment (23.1%) and 2 extraction (5.1%). Conclusion: the monitoring of the spontaneous reeruption of intruded teeth and the careful observation to determine sequela occurrence are the best choices, once complications might arise several months after trauma. Sequelae and inclusion degree are closely related, inasmuch as the higher the intrusion degree, the greater the sequela severity; thus, professional follow-up is indispensable.

Management of root dilaceration in a central incisor after avulsion of primary tooth: a case report with a 6-year follow-up / Manejo de dilação radicular em incisivo central permanente após avulsão do decíduo: relato de 6 anos de acompanhamento

PURPOSE: To describe the management and six-year follow-up of a patient who suffered trauma in primary dentition and, as a consequence, presented root malformation in permanent tooth. CASE DESCRIPTION: A 5-years-old boy sustained trauma in primary maxillary anterior teeth due to a bicycle fall. As consequence of avulsion of left central incisor, the boy presented root dilaceration of the permanent successor. Radiography and clinical monitoring of the case were regularly performed. The tooth completed its eruption one year after sequel was detected and is currently successfully functional in the arch, despite the malformation. CONCLUSION: This case reinforces the need of long term follow-up in order to avoid any risks of further tooth damage, intervening only when necessary.

OBJETIVO: Descrever o acompanhamento de seis anos de um paciente que sofreu trauma na dentição decídua e, como conseqüência, apresentou malformação radicular do sucessor permanente. DESCRIÇÃO DO CASO: Um menino de 5 anos traumatizou o incisivo central superior durante queda de bicicleta. Como consequência da avulsão do incisivo esquerdo, houve a dilaceração radicular do sucessor permanente. Foi realizado o acompanhamento periódico clínico e radiográfico. O dente completou sua erupção um ano após a seqüela foi detectada e apresenta-se funcional no arco, apesar da malformação. CONCLUSÃO: Esta caso reforça a necessidade do acompanhamento a longo prazo e de intervir-se apenas quando realmente necessário, visando evitar danos ao dente permanente.

Traumatismos Dentários e Ambiente Físico Escolar, Pelotas, RS, Brasil / Dental Trauma and Physical Environment of Schools of the City of Pelotas, RS, Brazil

Objetivo: Avaliar as condições físico-ambientais das escolas públicas e privadas do município de Pelotas, Rio Grande do Sul, Brasil.Método: As escolas foram visitas por um único avaliador, o qual coletou dados a respeito das condições do piso, de janelas, escadas, área do pátio e tipo de superfície no mesmo, número de alunos por recreio e número de supervisores presentes no recreio. Foi feita análise descritiva dos dados e as escolas foram classificadas a partir da pontuação obtida. A associação entre o tipo de escola e a condição do ambiente foi testada usando teste exato de Fischer (α = 5%).Resultados: Oitenta e cinco escolas foram visitadas. Encontrou-se que a maior parte das escolas avaliadas apresentava deficiências quanto à segurança do espaço físico, sendo que 76,5% possuíam janelas ruins ou regulares e 16,5% apresentavam piso de superfície inadequada. Foram encontradas em várias instituições situações de risco a ocorrência de acidentes, como presença de buracos, obstáculos ou vidros de janela quebrados. O ambiente físico escolar foi classificado como ruim em 40,7% das escolas, como regular em 30,9% e como bom em 28,4%. Escolas particulares apresentaram melhores condições físicas do que as escolas públicas (p<0,03). Conclusão: A maioria das escolas apresenta condições físicas desfavoráveis, principalmente as públicas. Estudos que relacionem as condições físico-ambientais das escolas com a prevalência de traumatismos dentários ocorridos nestes locais devem ser realizados com o objetivo de melhor esclarecer a influência do ambiente no risco de ocorrência de traumatismos dentários

Objective: To evaluate as physical-environmental conditions of public and privates schools of the city of Pelotas, RS, Brazil.Method: The schools were visited by a single examiner, who collected data relative to the conditions of the floor, windows, stairs, area and type of the floor of the playground, number of students during the playtime and number of supervisors present during the playtime. A descriptive analysis of data was performed and the schools were classified according to the obtained score. The association between the type of school and the environmental conditions was tested using FischerÆs exact test (α = 5%).Results: Eighty-five schools were visited. Most of the schools had deficiencies with respect to the safety of the physical space; 76.5% presented poor or fair windows and 16.5% presented inadequate type of floor. Several institutions presented situations that offered risk to the occurrence of accidents, such as presence of wholes, obstacles or windows with broken glasses. The physical environment was classified as poor in 40.7% of the schools, fair in 30.9% and good in 28.4%. Private schools presented better physical conditions than public schools (p<0.03). Conclusion: The majority of the schools, especially the public ones, presented unfavorable physical conditions. Studies relating the physical-environmental conditions of schools with the prevalence of traumatic dental injuries in these placed should be performed in order to clarify the influence of the environment on the risk of occurrence of dental trauma

Survey on the occurrence of dental trauma and preventive strategies among Brazilian professional soccer players

OBJECTIVES: The aims of this study were to verify the occurrence of dental injuries in professional Brazilian soccer players, the level of knowledge of the teams' medical departments about mouthguards, and the conducts adopted in cases of dental trauma during the match. MATERIAL AND METHODS: Closed questionnaires were sent to the physicians in charge of the medical departments of the 40 teams enrolled in the first and second divisions of the Brazilian professional soccer league in 2007. The data obtained were subjected to descriptive analysis to determine absolute and relative frequencies of answers for each one of the questions. RESULTS: Physicians from 38 (95 percent) of the 40 teams in the first and second divisions answered the questionnaires and 71.1 percent reported the occurrence of some type of dental injury during soccer practice, dental fractures (74.1 percent) and avulsions (59.3 percent) being the most prevalent ones. Regarding emergency conducts, approximately 50 percent answered that a successful replantation could be obtained in periods from 6 to 24 h after injury, and 27.8 percent were not able to answer this question. Regarding mouthguard use, 48.6 percent of the physicians did not know about mouthguards, and only 21.6 percent usually recommended their use by the soccer players. Among the physicians who do not recommend the use of mouthguards, 50 percent justified that it was not necessary. Almost 50 percent of the medical departments do not have a dentist as part of the health professional staff. CONCLUSIONS: It was possible to conclude that dental injuries are common during professional soccer practice and that there is a lack of information in the medical departments related to the emergency conducts and prevention of dental trauma.

Radiographic analysis of traumatized primary teeth / Análise radiográfica da dentição decídua após traumatismo alveolodentário

This study aimed to evaluate the frequency of radiographic findings in primary teeth, as well as theirsupporting tissues, following dental trauma, and the occurrence of sequelae according to the trauma type.One radiograph was taken soon after the trauma, and two follow-up radiographs, with approximately sixmonth intervals between each, were taken of 116 traumatized teeth from 65 patients at the Pelotas DentistrySchool in Pelotas, Santa Catarina, Brazil. One hundred and ninety-five radiographs were analyzed to evaluate:tooth position, periodontal ligament space, root integrity, alveolar bone, and root canal aspects. Data wereshown in the form of absolute and percentage frequencies. The Wilcoxon test (p<0.05) was used to detectdifferences in the images. The widening of the periodontal ligament and pathological root resorption, althoughwith different evolutions, represented the most frequent findings. In the first radiograph, 35.6% of the teethwere diagnosed as presenting a widening of the periodontal ligament, as compared to 15.1% in the finalradiograph. Pathological root resorption varied from 9.6% in the first radiograph to 35.8% in the final exam.Whereas alveolar bone resorption prevailed in intrusion cases and root canal obliteration in concussion/subluxation cases, tooth displacement occurred most often in intrusion and lateral luxation/extrusion cases.Concussion, subluxation, and intrusion were the conditions which were most often associated with sequelaeduring this sample’s period of analysis. Radiographic sequelae resulting from alveolodental trauma in theprimary dentition tend to vary. Identifying radiographic findings and relating them to the type of trauma canaid the professional in defining the prognosis and a proper treatment plan.

Fratura dentária em crianças no Rio Grande do Sul: análise dos dados do levantamento SB-Gaúcho 2002/2003 / Crown fractures in children in Rio Grande do Sul: data analysis of Survey SB-Gaúcho 2002/2003

Dental trauma is recognized as a public health problem due to the high frequency that occurs and the costs involved in treatment. Among the injuries, the crown fractures are one of the most frequent. The aim of this study was to describe the prevalence of crown fractures in children in the primary and permanent dentition in the state of Rio Grande do Sul. Secondary data from the Survey SB-Gaucho 2002/2003, of the State Department of Health were used. Data of 11,904 children were included, obtained with the diagnostic criteria of the World Health Organization. The prevalence of crown fracture at 18 to 36 months was 1.5%, at 5 years was 1.8% and at 12 years was 2.7%. It was found that dental trauma tended to increase with age, indicating that it would benefit from measures aimed at prevention of oral diseases. The index used possess limitations, which minimize dental trauma occurrence. Criteria including other types of dental trauma should be used by national surveys to obtain a more reliable estimate of its prevalence.

Os traumatismos dentários são reconhecidos como um problema de saúde pública devido à alta freqüência com que ocorrem e aos custos envolvidos no seu tratamento. Dentre os traumatismos, as fraturas dentárias são um dos tipos de maior ocorrência. O objetivo desse trabalho foi descrever a prevalência encontrada de fraturas dentárias em crianças na dentição decídua e permanente no estado do Rio Grande do Sul. Foram utilizados dados secundários de 11.904 crianças, avaliadas com os critérios de diagnóstico da Organização Mundial da Saúde, no levantamento SB-Gaúcho 2002/2003, da Secretaria Estadual de Saúde. Observou-se que dos 18 aos 36 meses a prevalência de fratura dentária foi de 1,5%, aos 5 anos de 1,8% e aos 12 anos de 2,7%. Apesar da limitação do critério diagnóstico utilizado, o qual minimiza a ocorrência do agravo, evidenciou-se que traumatismo dentário apresenta tendência de aumento com idade, indicando que se beneficiaria de medidas destinadas à prevenção. É importante que sejam utilizados nos levantamentos nacionais critérios que inclúam outros tipos de traumatismos dentários, visando obter-se uma estimativa mais confiável de sua ocorrência.