Sense of coherence and oral health-related quality of life among southern Brazilian male adolescents

Abstract This study evaluated the association between sense of coherence (SoC) and oral health-related quality of life (OHRQoL) among conscripts of the Brazilian Army, in two cities of southern Brazil. A cross-sectional study included all 18-19-year-old adolescents who joined the Brazilian Army as draftees for mandatory military service in the cities of Itaqui, RS, and Santiago, RS (n = 505). Data collection was conducted from 2019 to 2021, and included the application of questionnaires and a clinical oral examination to record gingivitis, malocclusion, and dental caries. OHRQoL was collected through the Brazilian short version of the Oral Health Impact Profile (OHIP), composed of 14 questions. The adolescents' SoC was assessed using the validated Brazilian version of the SOC-13 scale. The primary outcome of this study was OHRQoL, modeled as a discrete variable (OHIP-14 scores). The main predictor variable was SoC, categorized as low, moderate, or high. The association between predictor variables and OHRQoL was assessed by Poisson regression models using a hierarchical approach. Unadjusted and adjusted rate ratios (RR), and 95% confidence intervals (CI) were estimated. All the analyses were performed using STATA software version 14.2. Adolescents with a moderate and high SoC had 27% (RR = 0.73, 95%CI = 0.64-0.84) and 51% (RR = 0.49, 95%CI = 0.41-0.58) lower mean OHIP-14 scores, respectively, than those with a low SoC score, after the inclusion of behavioral and clinical variables. This study showed a significant association between SoC and OHRQoL among 18-19-year-old southern Brazilian adolescents. Strengthening the SoC as a psychosocial resource may improve the well-being and OHRQoL of adolescents.

Association between the city region and traumatic dental injuries among adolescents from Santa Maria, South Brazil

Abstract This study investigated the association between the city region and traumatic dental injury (TDI) among adolescents from Santa Maria, Rio Grande do Sul, Brazil. A population-based cross-sectional survey was conducted from March to November 2018, which included a representative sample of adolescents (15-19-year-old) attending public and private high schools. A questionnaire on sociodemographic information was sent to the parents/legal guardians of the selected adolescents. TDI in the upper and lower permanent incisors and canines was recorded based on the O'Brien classification. Environmental variables (sociodemographic and structural characteristics of the neighborhoods) were obtained from official publications. Multilevel Poisson regression models were used, and prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. A total of 1,146 adolescents participated in this study. The overall prevalence of TDI was 17.3%, mild trauma was 12.7%, and severe trauma was 5.8%. Adolescents living in the southern region had a prevalence of TDI of 25.3%, compared with 13.6% in the northern region. After adjusting for important cofactors, adolescents living in the southern region were more likely to have TDI than their counterparts in the northern region (PR, 1.91; 95%CI: 1.18-3.11; p = 0.009). Analyzing the number of environmental risk indicators in different regions, the southern region presented a higher mean and median than all other regions. In conclusion, living in the southern region was associated with a higher prevalence and severity of TDI among adolescents from Santa Maria, southern Brazil. Our findings suggest the role of the environment in the epidemiology of TDI.

Efficacy of fluoride gel in arresting active non-cavitated caries lesions: a randomized clinical trial

Abstract: This study evaluated the efficacy of fluoride gel in arresting active non-cavitated caries lesions in permanent teeth. This randomized, triple-blind, placebo-controlled clinical trial randomized 100 schoolchildren aged 10.7 ± 2.2 years to test treatment (1.23% acidulated phosphate fluoride [APF] gel) or control treatment (placebo gel) for 4-6 applications at weekly intervals. Data collection included the visible plaque index, gingival bleeding index, visible plaque accumulation on the occlusal surfaces, eruption stage, and dental caries. The association between group and lesion arrestment was assessed using logistic regression, and estimates were adjusted for plaque accumulation over the lesion at baseline, surface type, and tooth type. Models were fitted using generalized estimating equations for accounting for the clustering of data (i.e., the same individual contributed > 1 lesion). Ninety-eight children completed the study (48 fluoride and 50 placebo). When all dental surfaces were analyzed, the likelihood of lesion arrestment was similar between both groups (p > 0.05). A secondary analysis including only the occlusal lesions in molars showed that for teeth under eruption, lesions receiving the 1.23% APF gel were about 3-fold more likely to become arrested than lesions receiving the placebo gel (OR = 2.85; 95%CI = 1.23-6.61; p = 0.01). No significant difference was detected for molars with complete eruption (p > 0.05). The benefit of fluoride gel for arresting non-cavitated caries lesions could not be identified by clinical assessment in this short-term trial. Notwithstanding, when the cariogenic challenge was greater (as on the occlusal surfaces of erupting molars), 1.23% APF gel treatment was an important tool for caries control.

Self-perceived neighborhood factors and OHRQoL among adolescents: a population-based study in southern Brazil

Abstract This study aimed to assess the relationship between self-perceived neighborhood factors and oral health-related quality of life (OHRQoL) among adolescents from southern Brazil. A representative sample of 15-19-year-old students from Santa Maria, Brazil, was included. The Oral Health Impact Profile (OHIP-14) was used to assess the OHRQoL. Self-perceived neighborhood factors were assessed through a structured questionnaire and included characteristics of the neighborhood where the adolescents lived, such as the presence of paved streets, tap water, community social networks, and availability of dental services and the Family Health Strategy (FHS). In addition, socioeconomic, behavioral, and clinical variables (dental caries and malocclusion) were also evaluated. Multilevel Poisson regression analysis with a hierarchical approach was used to assess the association between predictors and OHIP-14. The rate ratio (RR) and 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included in this study (participation rate: 72.3%). The mean OHIP-14 score was 8.4 (standard error = 0.2), ranging from 0 to 49. Living in residences with unpaved streets (RR = 1.11, 95%CI:1.06−1.17), no tap water (RR = 1.11, 95%CI: 1.02−1.20), absence of the FHS services (RR = 1.15, 95%CI: 1.09−1.20), and the availability of dental services (RR = 1.08, 95%CI: 1.03−1.14) were associated with higher OHIP-14 scores, indicating a poorer OHRQoL. In addition, lower socioeconomic status, visiting the dentist for curative reasons, lower frequency of brushing teeth, and higher sugar consumption were also associated with higher OHIP-14 scores. In conclusion, self-perceived neighborhood characteristics were associated with OHRQoL in adolescents. Adolescents who perceived their neighborhood as deprived had poorer OHRQoL.

Prevalence and risk indicators for underlying dentin shadows among 12-year-old southern Brazilian schoolchildren

Abstract This study aimed to assess the prevalence, extent, and associated factors of underlying dentin shadows (UDS) in the occlusal surfaces of permanent posterior teeth among 12-year-old schoolchildren from southern Brazil. A population-based cross-sectional study that included a representative sample of 1,528 schoolchildren was conducted in Porto Alegre, southern Brazil (participation rate: 83.2%). A questionnaire on sociodemographic characteristics, behavioral habits, and access to dental services was sent to parents/legal guardians of each student selected. Caries examination included the recording of non-cavitated and cavitated lesions, including the presence of UDS, as defined by the ICDAS Group (i.e., a shadow of discolored dentin visible through an apparently intact enamel surface that may or may not show signs of localized breakdown - ICDAS Code 4). The association between predictor variables and UDS prevalence was assessed using survey Poisson regression models. The prevalence of UDS was 6.3% (95%CI = 1.2 -11.3). The mean number of affected teeth among the schoolchildren presenting UDS was 1.51 (95%CI = 1.40 -1.61), ranging from 1 to 6. Type of school (public, PR = 2.23, 95%CI = 1.22 -4.07) and caries experience (DMFT 1-2, PR = 2.41, 95%CI = 1.15 -5.04; DMFT ≥ 3, PR = 3.09, 95%CI = 1.52 -6.27) were significantly associated with UDS prevalence. In conclusion, this population-based cross-sectional study found a low prevalence of UDS in the occlusal surfaces of the permanent posterior teeth of 12-year-old southern Brazilian schoolchildren. Overall caries experience and type of school were associated with UDS in this population.

Oral health status of schoolchildren living in rural and urban areas in southern Brazil

Abstract This study assessed the effect of area of residence (rural vs. urban) on dental caries experience among southern Brazilian schoolchildren. This cross-sectional survey was conducted in Rosário do Sul, southern Brazil, and included 373 9-14-year-old schoolchildren attending public municipal schools (122 living in the rural area, and 251, in the urban area). Data collection included a questionnaire and a clinical examination. Clinical examination of the permanent dentition involved visible plaque index, gingival bleeding index and dental caries experience (non-cavitated and cavitated, inactive and active lesions). Samples of water were collected to check the fluoride concentration. Caries prevalence and extent using different criteria were compared between rural and urban schoolchildren using the chi-square test and the Mann-Whitney test, respectively. The association between explanatory variables and the extent of caries activity (number of active caries lesions) was assessed using Poisson regression. When caries was recorded at the cavity level (WHO criterion), no difference was observed between rural and urban populations (p ≥ 0.05). Conversely, higher caries prevalence and extent were found among urban schoolchildren when active non-cavitated lesions were also computed (p < 0.05). In the adjusted Poisson regression model, urban schoolchildren were 57% more likely to present more active lesions than rural students (RR = 1.57; 95%CI = 1.29-1.92). Rural communities did not have sufficient fluoride in the water supply, whereas ideal concentrations were detected in the urban areas. In conclusion, this cross-sectional study found that urban schoolchildren showed greater caries experience than rural students, and that this increment was related to active non-cavitated lesions.

Sombreamento da dentina subjacente: relato de opção terapêutica baseada em evidências científicas / Shading from hidden caries lesions in adjacent dentin: report of a therapeutic option based on scientific evidences

A técnica da réplica oclusal é indicada nos casos em que há evidências, principalmente radiográficas, de comprometimento dentário sob o esmalte parcialmente íntegro. O objetivo deste estudo foi descrever um caso clínico de tratamento de lesão de cárie em dentina, ICDAS 4, por meio da técnica da réplica oclusal e remoção parcial do tecido cariado. Após 2 anos de acompanhamento clínico e radiográfico não foi observada progressão da lesão de cárie, e os detalhes anatômicos foram preservados, indicando sucesso da terapêutica...

The occlusal replica technique is indicated in cases where there are evidences, mainly radiographic, of dentinal involvement under partially intact enamel. The aim of this study was to describe a clinical case of treatment of “hidden” caries lesion in dentin, ICDAS 4, by occlusal replica technique and partial removal of the carious tissue. After 2 years of clinical and radiographic follow-up, it was not observed progression of the caries lesion and anatomical details were preserved, indicating success of the therapy...

Dentes fluoróticos tratados e não tratados: aspecto clínico após 21 anos / Treated and untreated fluorotic teeth: clinical aspect after 21 years

O aumento na ocorrência de fluorose dentária, observado nos últimos anos, tende a promover maior procura pela resolução estética dos manchamentos, o que é geralmente feito com a aplicação de técnicas de erosão-abrasão. Pode-se supor que a abrasão fisiológica e a erosão ácida que ocorrem ao longo da vida atuem no sentido de atenuar a severidade das manchas de fluorose. O presente artigo apresenta um caso de atenuação de manchamentos por fluorose dentária nos dentes anteriores de um paciente de 36 anos que aos 15 havia recebido tratamento erosivo-abrasivo apenas em seus incisivos 11 e 21. Isso permitiu que, após duas décadas, fosse possível comparar os dentes tratados com aqueles que sofreram apenas desgaste fisiológico e a constatação de que, embora as manchas ainda permaneçam, o aspecto de ambos é estético e socialmente aceitável.

The increased prevalence of dental fluorosis observed in recent years tends to promote an increased demand for esthetic resolution of tooth staining, which is usually made by erosion-abrasion techniques. It can be assumed that the physiological abrasion and acid erosion that occur throughout life act to mitigate the severity of fluorosis. This article presents a case of mitigation of fluorosis stains in the anterior teeth of a 36-year-old patient who had received, at 15 years, erosive/abrasive treatment only on his incisors 11 and 21. After two decades, it was possible to compare the treated teeth with those who suffered only physiological wear. It was possible to find that in spite the stains were still present, their clinical aspect is esthetic and socially acceptable.

Indicação de tratamento restaurador para lesões cariosas: uma reflexão / Indicating restorative treatment for carious lesions: some thoughts

O presente artigo discute a indicação do tratamento restaurador para lesões cariosas, utilizando como exemplo o caso de uma paciente com atividade de doença cárie durante o período de erupção dos molares permanentes. O diagnóstico precoce da lesão permitiu sua inativação, por meio de abordagem não invasiva. O controle longitudinal do caso foi possível por 18 meses. Após 10 anos sem contato com a paciente, ela retornou com o dente em questão restaurado. O “selamento biológico”, o estabelecimento da oclusão funcional e a superficialidade e amplitude da restauração permitem questionar a indicação do procedimento restaurador executado

This paper discusses the indication of restorative treatment for carious lesions considering a young patient with caries active disease, treated during the period of eruption of permanent molars. Early diagnosis led to caries inactivation by means of a non-invasive approach. Longitudinal control of the disease was possible for 18 months. After 10 years without contact, the patient returned and it was possible to observe that the tooth has been restored. The quality of the “biological sealing”, the occlusal function and the thinness and extension of the restoration led us to question the indication of the restorative procedure executed

Cárie dentária em incisivos permanentes jovens: diagnóstico e manejo clínico / Dental caries in young permanent incisors: diagnostic and clinical management

A cárie dentária é uma doença multifatorial, mediada por um biofilme oportunista que, para se manifestar clinicamente, necessita da interação de vários fatores em condições críticas. Atualmente, sua lenta evolução propicia manejo clínico mais voltado para a detecção de lesões incipientes. Assim, torna-se possível controlar a progressão da doença antes que ela atinja uma fase irreversível. Este trabalho relata um caso clínico de diagnóstico e tratamento de lesões cariosas incipientes em dentes anteriores e seu manejo clínico e discute as evidências disponíveis...

Dental caries is a multifactorial disease produced by an opportunistic biofilm that needs the interaction of several factors at specific conditions to occur. Currently, the slow progression trend provides allows for the clinical management more focused on the detection of incipient lesions. This makes possible to control the progression of the disease before reaching an irreversible stage. This article is a case report of the diagnostic and treatment of incipient carious lesion in permanent incisors discussing the available evidence...

Resolução estética de manchamentos por fluorose dentária grau TF-4 / Esthetic resolution for TF-4 grade staining from dental fluorosis

Com o uso disseminado dos dentifrícios fluoretados, tem-se observado aumento na prevalência da fluorose dentária, e são mais comuns casos de pacientes que buscam solução estética para manchamentos do esmalte dentário. Estudos recentes mostram que a percepção da perda estética causada pela fluorose acorre apenas nos graus mais severos da patologia. Este artigo relata o caso de uma jovem de 22 anos que buscou solução para manchas de fluorose de grau quatro de Thylstrup e Fejerskov, o que foi realizado por meio de uma técnica simplificada de erosão-abrasão (microabrasão)...

The widespread use of fluoride-containing dentifrices led to an increased prevalence of dental fluorosis. Patients seeking for esthetic solutions for enamel staining are more frequent. Recent studies show that the perception of esthetic impairment caused by fluorosis occur only in patients with most severe cases. This article is a case report of a 22 year-old female that was seeking for the solution for her severely stained enamel (dental fluorosis, Thylstrup & Fejerskov scale, TF-4 degree). The case was adequately treated with a simplified microabrasion technique...

Sistema estomatognático postura e equilíbrio corporal / Stomatognathic system posture and body balance

O sistema estomatognático está intimamente ligado à postura e ao equilíbrio corporal, porém essa relação é pouco enfatizada na literatura cientifica. Diante disso, esse estudo buscou analisar as influências e as relações das disfunções do sistema estomatognático com a postura e o equilíbrio corporal dos indivíduos, por meio de uma revisão de literatura. Para isso, foi realizada uma busca em base de dados, livros e demais produções cientificas da área de biomecânica e odontológica. Foi priorizado a inclusão de artigos que tivessem sido publicados nos últimos 10 anos, sendo assim, obteve-se 54 estudos relacionados ao tema, selecionando-se os 36 estudos mais relevantes.Os resultados dessa pesquisa mostram que muitas modificações posturais são influenciadas pela articulação temporomandibular e por conseqüência, a postura e o equilíbrio corporal são também alterados. Conclui-se que a relação específica do sistema estomatognático com a postura e equilíbrio, é uma abordagem pouco estudada e necessita ainda ser bem desenvolvida.

The stomatognathic system is intimately connected with the posture and with the musculoskeletal equilibrium. However this relationis little emphasized in the scientific literature. In the presence of this, the study tried to analyze the influences and the relations of the stomatognathic system dysfunctions with the posture and the musculoskeletal equilibrium of the individuals, through a review of literature. For this, it was realized a literature search data bank, books and in many scientific productions of the biomechanical and odontologic area. It was prioritized articles published in the last 10 years, thus obtaining 54 studies related to the subject and selecting the 36 most relevant studies. Results show that many posture modifications are influenced by the temporomandibular articulation and consequently, the posture and musculoskeletal equilibrium are altered, too. It is concluded that the specific relation between the stomatognathic system and the posture and balance has not been enough studied and there is still need to be better developed.

Assessment of the frequency of routine removal of dental plaque prior to caries diagnosis by dentists in three cities in southern Brazil

The aim of this study was to assess the frequency of routine use of dental prophylaxis prior to visual inspection, in order to diagnose caries, by dentists with different lapses of time after graduating time. One hundred and fifty one Brazilian dentists were interviewed in 3 Brazilian cities to determine if they usually remove dental plaque prior to visual inspection for caries diagnosis. The dentists were stratified according to year of graduation. The association between the lapse of time after graduating and the practice of routinely removing dental plaque before clinical examination was tested using the chi-square test with a significance level of 5 percent. Only 28.5 percent of the dentists reported that they usually remove dental plaque prior to clinical examination. The dentists who graduated in the last 15 years presented the lowest percentages of plaque removal prior to clinical examination (15.1 percent), whereas the more experienced dentists reported that they perform prophylaxis more frequently. Of the professionals who graduated from 1960-1975, 23.9 percent reported that they performed dental plaque removal prior to diagnosis, whereas the figure for those graduating from 1976-1990 was 46.2 percent. Most of the dentists interviewed reported that they did not remove dental plaque prior to performing visual diagnosis of caries.

Restabelecendo anatomia, função e estética mediante a técnica da réplica oclusal / Reestablishing the anatomy, function and esthetics using an occlusal replica technique

A superfície oclusal dos dentes posteriores apresenta características anatômicas complexas, o que dificulta sua reprodução em restaurações diretas de resina composta. A técnica da réplica oclusal aparece como alternativa conservadora para o restabelecimento da anatomia, função e estética em molares acometidos por “cárie oculta”, um padrão distinto de cárie oclusal caracterizado pela preservação das características oclusais. Essa técnica prevê a cópia fiel da anatomia oclusal por meio de moldagem prévia da superfície com resina acrílica autopolimerizável. A técnica demonstrou ser de fácil execução, simplifica etapas restauradoras, minimiza o desgaste inadvertido de tecido sadio e privilegia a harmonia oclusal, por permitir fiel reprodução dos detalhes anatômicos perdidos durante o preparo cavitário.

Alternativa para remoção de manchamentos por fluorose / An alternative for removing stains from fluorosis

Por ser procedimento conservador para a correção da estética, a microabrasão ou erosão-abrasão do esmalte vem sendo utilizada há alguns anos. Ácido clorídrico a 18% e materiais comerciais que têm em sua constituição esse ácido são atualmente os produtos mais utilizados na microabrasão. No entanto, esse ácido é agressivo, o que representa risco ao paciente e ao operador, caso ocorra contato desse material com tecidos orais, pele ou olhos. Assim, este artigo, mediante exposição de um caso clínico, demonstra a eficácia e preconiza o uso de uma pasta de ácido fosfórico a 37% mais pedra-pomes para o procedimento de microabrasão, visto que esse ácido é menos nocivo aos tecidos orais do paciente e apresenta maior disponibilidade nos consultórios odontológicos do que o ácido clorídrico a 18%.