Fluorosis dental en adolescentes de instituciones educativas de Lima, Perú / Dental fluorosis in adolescents from Educational Institutions in Lima, Peru

Introducción: La fluorosis dental es una patología endémica causada por la ingestión excesiva de fluoruros que pueden producir una alteración durante el desarrollo del esmalte, y es considerado un importante problema de salud pública porque afecta la salud bucal y sistémica de la población. Objetivo: Este estudio tuvo como idea principal determinar la frecuencia y los niveles de fluorosis dental en escolares de 12 a 15 años pertenecientes a dos instituciones educativas de Lima - Perú. Método: Se realizó un estudio descriptivo de tipo transversal, la muestra estuvo conformada por 252 estudiantes, entre 12 y 15 años de dos centros educativos de Lima. El muestreo fue por selección sistemática de elementos muestrales. La fluorosis dental se evalúo mediante el Índice de Dean. Para determinar la frecuencia y los niveles de fluorosis dental, se realizó un examen clínico bucal y se desarrolló un cuestionario validado previamente. Resultados: La frecuencia de fluorosis dental fue de 44,8% (n=113) afectando más a los varones en un 27,39% (n=69) y a los adolescentes de 13 años (15,1%). En relación con los niveles de fluorosis, predominó el tipo "muy leve" (34,9%). También se encontró una asociación entre la presencia y el nivel de fluorosis con el número de aplicaciones de flúor (p<0,05). Además, se dijo que el índice comunitario de fluorosis de Dean fue de 0,43. Conclusiones: En la población escolar evaluada, la frecuencia de fluorosis fue de 44,8% y el nivel predominante de fluorosis fue muy leve. Además, el índice comunitario fue de 0,43, el cual mostró un nivel límite de importancia para la salud pública. Por lo que se puede considerar que el número de aplicaciones tópicas de flúor recibido por la población sin una planificación adecuada se podría convertir en un factor de riesgo para causar fluorosis dental.

Introduction: Dental fluorosis is an endemic pathology caused by the excessive ingestion of fluorides that can produce an alteration during the development of the enamel and is considered an important public health problema because it affects the oral and systemic health of the population. Objective: The objective of this study was to determine the frequency and levels of dental fluorosis in school children between 12 and 15 years of age belonging to two educational institutions in Lima, Peru. Method: A descriptive cross-sectional study was carried out, the sample consisted of 252 students between 12 and 15 years of age from two educational centers in Lima. Sampling was by systematic selection of sample elements. Dental fluorosis was evaluated using the Dean Index. To determine the frequency and levels of dental fluorosis a clinical oral examination was carried out and a previously validated questionnaire was developed. Results: The frequency of dental fluorosis was 44.8% (n=113) affecting more males by 27.39% (n=69) and adolescents aged 13 years (15.1%). In relation to the levels of fluorosis, the "very mild" type predominated (34.9%). An association was also found between the presence and level of fluorosis with the number of fluoride applications (p<0.05). In addition, Dean's community fluorosis index was reported to be 0.43. Conclusions: In the school population evaluated, the frequency of fluorosis was 44.8% and the predominant level of fluorosis was very mild. In addition, the community index was 0.43, which indicated a borderline level of public health importance. Therefore, it can be considered that the number of topical fluoride applications received by the population without adequate planning could become a risk factor for causing dental fluorosis.

Fluorosis dental en la primera infancia: estado del arte

La fluorosis dental se caracteriza por una hipomineralización de la estructura dental causada por ingesta excesiva de flúor sistémico. En la dentición decidua, su diagnóstico precoz es importante, dado que será un predictor para la aparición de lesiones en la dentición permanente. El objetivo de esta revisión fue describir la evidencia científica sobre la fluorosis dental en dentición decidua reportando su etiología y factores relacionados, prevalencia, diagnóstico y tratamiento. Se realizaron búsquedas electrónicas en las bases de datos Pub-Med/Medline, EbscoHost y ScienceDirect (noviembre/2020), utilizando las palabras clave "dental fluorosis", "deciduous teeth", "primary tooth", "primary teeth". El desarrollo de fluorosis dental en dentición decidua se relacionó con la ingesta de múltiples fuentes de flúor principalmente, agua potable, alimentos de la dieta, fórmulas infantiles, suplementos y uso de dentífricos fluorados en dosis inadecuadas. Algunos factores prenatales, como vivir en terrenos montañosos o de gran altitud y habitar en lugares cercanos a minas de combustión de carbón, también fueron asociados. La prevalencia de fluorosis dental reportada en los estudios varió entre 6,2 y 96,6 %, dependiendo principalmente de la concentración de flúor en agua potable. Para el diagnóstico de la fluorosis dental en la dentición decidua se deben considerar características como la localización, aspecto, extensión y color de la lesión, realizando diagnóstico diferencial con otro tipo de defectos en esmalte y dentina. Así mismo, el tratamiento de las lesiones dependerá de la severidad del defecto y condiciones individuales del paciente.

Dental fluorosis is characterized by a hypomineralization of the tooth structure caused by excessive intake of systemic fluoride. In the deciduous dentition, its early diagnosis is important since it will be a predictor for the appearance of lesions in the permanent dentition. The objective of this review was to describe the scientific evidence on dental fluorosis in deciduous dentition, reporting its etiology and related factors, prevalence, diagnosis and treatment. Electronic searches were conducted PubMed / Medline, EbscoHost and ScienceDirect (November / 2020) databases, using the keywords "dental fluorosis", "deciduous teeth", "primary tooth", "primary teeth". The development of Dental fluorosis in deciduous dentition was related to the intake of multiple sources of fluoride mainly; drinking water, diet foods, infant formulas, supplements and the use of luoridated toothpastes in inadequate doses. Some prenatal factors such as living in mountainous or high altitude terrain and living in places near coal-burning mines were also associated. The prevalence of dental fluorosis in early childhood reported in the studies varied between 6.2% and 96.6%, depending mainly on the concentration of fluoride in drinking water. For the diagnosis of dental fluorosis in the deciduous dentition, characteristics such as the location, appearance, extension and color of the lesion must be considered, making a differential diagnosis with other types of enamel and dentin defects. Evenly, the treatment of lesions will depend on the severity defects and individual patient conditions.

Effects of different toothpaste formulations on erosive tooth wear prevention: systematic review / Efeitos de diferentes dentifrícios na prevenção do desgaste dentário erosivo: revisão sistemática de literatura

Objective: erosive tooth wear is a multifactorial condition that results in loss of dental hard tissue, caused by a chemical and mechanical process. This paper aims to carry out a systematic review presenting the effects of different toothpaste formulations on the loss of dental enamel surface in vitro. Material and Methods: the searches were performed in the databases PubMed, Web of Science, LILACS and Scielo. Articles published from 2010 to 2020 were filtered, without language restriction. Articles that included abrasion and erosion protocols were searched, as they were more similar to clinical reality, since toothpaste is applied through tooth brushing. The searches with descriptors and free terms on the topic resulted in 992 articles, however only 12 were within the search criteria. Results: the selected studies appointed that association of conventional fluorides (NaF) with metallic fluorides can be a promising strategy for the reduction of surface loss by erosive tooth wear. Toothpastes containing sodium fluoride, as well as tin without chitosan, showed a reduction in surface loss, considered sufficient for individuals with medium exposure to acids. In children's toothpastes, the one containing sodium fluoride showed a reduction in surface loss when compared to non-fluoride dentifrices. Conclusion: different protocols may result in less or greater loss of enamel surface, and methodological differences should be considered. To clarify the effects of dentifrices on erosive tooth wear, other properties of dentifrices should be investigated. (AU)

Objetivo: o desgaste erosivo é uma condição multifatorial que resulta em perda de tecido duro dentário, causado por um processo químico e mecânico. Este trabalho tem como objetivo realizar uma revisão sistemática de literatura apresentando os efeitos de diferentes formulações de dentifrícios na perda de superfície de esmalte dentário in vitro. Material e Métodos: a busca foi realizada nas bases de dados PubMed, Web of Science, LILACS e Scielo. Foram filtrados artigos publicados no intervalo de 2010 a 2020, sem restrição de idioma. Buscou-se artigos que incluíssem protocolos de abrasão e erosão, por mais se assemelhar a realidade clínica, uma vez que o dentifrício é aplicado através da escovação dentária. A busca com descritores e termos livres sobre o tema encontrou 992 artigos, entretanto somente 12 estavam dentro dos critérios da pesquisa. Resultados: os estudos selecionados apontaram que associação dos fluoretos convencionais (NaF) com os metálicos pode ser uma estratégia promissora para a redução de perda de superfície pelo desgaste dentário erosivo. Dentifrícios contendo fluoreto de sódio, assim como estanho sem quitosana, apresentaram redução na perda de superfície, sendo considerada suficiente para indivíduos com exposição média aos ácidos. Em dentifrícios infantis, aquele que continha fluoreto de sódio apresentou uma redução de perda de superfície quando comparado com dentifrícios sem fluoreto. Conclusão:diferentes protocolos podem resultar em menor ou maior perda de superfície de esmalte e as diferenças (AU)

Fluoride in Mozambique: retrospective study / Flúor em Moçambique: estudo retrospectivo

ABSTRACT Objective: The study aims to analyse the fluoride concentration in the water supply of the capital of each province of Mozambique, 2019 and compare with previous data 1978 and 2008. Methods: The water supply in cities of Mozambique were analysed in 1978, 2008 and 2019 and water from Tete's River in 1978 and 2019. The fluoride concentration of the water samples was determined in duplicate, using the ion-sensitive electrode (Orion 9609), coupled to a potentiometer (Procyon, model 720), adopting a significance level of 5%. Results: The average fluoride concentration found in the years 1978, 2008 and 2019 was 0.31, 0.33 and 0.14 mg F/L, respectively. The fluoride concentrations collected from household taps in 1978, 2008 and 2019 were: Cabo Delgado/Pemba (0.62, 0.28 and 0.07 mg F/L), Niassa/Lichinga (0.18, 0.98 and 0.07 mg F/L), Nampula/Nampula (0.18, 0.01 and 0.06 mg F/L), Zambézia/Quelimane (0.81, 0.37 and 0.15 mg F/L), Tete/Tete (1.00, 0.97 and 0 .46 mg F/L), Sofala/Beira (0.00, 0.01 and 0.10mg F/L), Manica/Chimoio (0.04, 0.01 and 0.07 mg F/L), Inhambane/Inhambane (0.00, 0.05 and 0.19 mg F/L), Gaza/Xai-Xai (0.01, 0.06 and 0.06 mg F/L) and Maputo (0.23, 0.36 and 0.23 mg F/L), respectively. In the waters of the Zambeze River was 5.5 mg F/L in 1978 and 0.12 mg F/L in 2019. There was no significant change between the fluoride concentrations in the water collected from the taps during the periods studied (p=0.83), however there was a significant difference in the water collected from the river (p<0.05). Conclusion: Tete' River showed a significant reduction in fluoride concentration, and in the piped water collected in all municipalities, the fluoride content was below optimum.

RESUMO Objetivo: O estudo visa analisar a concentração de flúor no abastecimento de água da capital de cada província de Moçambique, 2019 e comparar com dados anteriores de 1978 e 2008. Métodos: A água de abastecimento das cidades de Moçambique foi analisada em 1978, 2008 e 2019 e a água do Rio Tete em 1978 e 2019. A concentração de flúor das amostras de água foi determinada em duplicata, utilizando o eletrodo íon-sensível (Orion 9609), acoplado a um potenciômetro (Procyon, modelo 720), adotando-se nível de significância de 5%. Resultados: A concentração média de flúor encontrada nos anos de 1978, 2008 e 2019 foi de 0,31, 0,33 e 0,14 mg F/L, respectivamente. As concentrações de flúor recolhidas nas torneiras das casas em 1978, 2008 e 2019 foram: Cabo Delgado/Pemba (0,62, 0,28 e 0,07 mg F/L), Niassa/Lichinga (0,18, 0,98 e 0,07 mg F/L), Nampula/Nampula (0,18, 0,01 e 0,06 mg F/L), Zambézia /Quelimane (0,81, 0,37 e 0,15 mg F/L), Tete/Tete (1,00, 0,97 e 0,46 mg F/L), Sofala/Beira (0,00, 0,01 e 0,10 mg F/L), Manica/Chimoio (0,04, 0,01 e 0,07 mg F/L), Inhambane/Inhambane (0,00 , 0,05 e 0,19 mg F/L), Gaza/Xai-Xai (0,01, 0,06 e 0,06 mg F/L) e Maputo (0,23, 0,36 e 0,23 mg F/L), respectivamente. Nas águas do rio Zambeze foi de 5,5 mg F/L em 1978 e 0,12 mg F/L em 2019. Não houve alteração significativa entre as concentrações de flúor na água coletada das torneiras durante os períodos estudados (p=0,83), porém houve diferença significativa na água captada no Rio (p<0,05). Conclusão: O Rio Tete apresentou redução significativa na concentração de flúor, e na água das torneiras coletada em todas as cidades, o teor de flúor estava abaixo do ideal.

Análisis curricular de la enseñanza aprendizaje del flúor en la disciplina Estomatología General

Introducción: La enseñanza-aprendizaje de los métodos de prevención y control de la caries dental en estomatología requiere de una formación académica que implique el conocimiento y desarrollo de habilidades del uso del flúor. Objetivo: Analizar la contribución de los programas de las asignaturas de la disciplina Estomatología General del plan de estudio E de la carrera Estomatología a la sistematización en la enseñanza-aprendizaje del flúor. Métodos: Se realizó una investigación cualitativa mediante revisión de documentos curriculares de la carrera y programas de las asignaturas de la disciplina Estomatología General del plan de estudio E. Se analizaron los temas, contenidos, objetivos y sistemas de habilidades, orientaciones metodológicas y estrategias curriculares de los programas y su relación con la enseñanza aprendizaje del flúor. Resultados: Las ocho asignaturas que contribuyen al aprendizaje del flúor abarcan todos los años de la carrera, más de la mitad abordan de manera directa este contenido, en tres sus vínculos son indirectos y no se aborda dentro de los contenidos o habilidades en el programa. El sistema de conocimientos y sistema de habilidades, seguido de los objetivos, resultó ser donde más se plantea la enseñanza del flúor. Solo dos asignaturas lo abordan en las orientaciones metodológicas. Conclusiones: La estructura del diseño curricular posibilita el enfoque en sistema de la enseñanza-aprendizaje del flúor, sin embargo, no existe una estrategia de la disciplina que garantice la sistematización del conocimiento de las acciones preventivas y curativas.

Introduction: The teaching-learning process of methods for the prevention and control of dental caries in dentistry requires academic training that involves knowledge and development of skills in the use of fluoride. Objective: To analyze the contribution of the programs of the subjects of General Dentistry discipline in the Plan E of Dentistry career to the systematic teaching and learning process of the use of fluoride. Methods: A qualitative research was carried out by revising curricular documents of the studies and programs of the subjects of General Dentistry discipline of Plan E. Themes, contents, objectives and systems of abilities, methodological orientations and curricular strategies of the programs were analyzed as well as their relationship with the teaching-learning process of the use of fluoride. Results: The eight subjects that contribute to the leaning of the use of fluoride cover all the academic years of the dental studies. More than half of the subjects directly considers this topic in their programs. Three of the subjects has indirect approach of the topic in question, and it is not taught in the content or abilities in the program. The teaching of the use of fluoride was emphasized in the knowledge system and system of abilities, followed by the objective. It was only covered in two subjects, in the methodological orientations. Conclusions: The structure of the curricular design makes possible the system approach of the teaching-learning process of the use of fluoride. Unfortunately, there is no a strategy of the discipline that guarantees systematization of the knowledge of preventive and healing actions.

Control de la caries no restaurativa en incisivos centrales primarios, a los 36 meses de seguimiento / Controle cavitário não restaurador em incisivos centrais decíduos com 36 meses de acompanhamento / Non-restorative cavity control in deciduous central incisors at 36-month follow-up

La mínima intervención ha ido ganando cada vez más notoriedad en la Odontología, reflejando una creciente demanda por parte de los profesionales que buscan técnicas que promuevan tratamientos eficientes y que preserven la estructura dentaria. Objetivo: El presente estudio tuvo como objetivo promover el control de caries no restaurador (CCNR) en un paciente infantil, mediante una regularización de la cavidad de la lesión cariosa para permitir una mejor limpieza del área, junto con un protocolo complementario de fluoración. Presentación de caso: Paciente masculino de 4 años de edad con higiene bucal satisfactoria, sin embargo con acumulación de biopelícula entre los incisivos centrales superiores y sin síntomas ni quejas estéticas. Se alisaron las caras mesiales de los incisivos centrales con tiras abrasivas para eliminar zonas socavadas y facilitar el acceso para mejorar la higiene bucal, y se aplicó el barniz de flúor en 4 sesiones, con un intervalo de una semana entre cada aplicación. La madre de la paciente fue instruida sobre cuidados de higiene y alimentación. Durante 36 meses se realizó seguimiento clínico y radiográfico del paciente con retornos cada 12 meses. También se reevaluaron el índice de placa visible y los resultados de la guía de higiene y dieta. Conclusión; En este caso clínico, la fluorterapia asociada a la regularización superficial demostró ser una alternativa de tratamiento exitosa a largo plazo, permitiendo la preservación del tejido dentario y previniendo la progresión de las lesiones cariosas. El concepto ultraconservador puede ser una alternativa válida por su eficacia, sencillez, bajo coste y buena aceptación por parte de los niños y sus padres

A mínima intervenção vem ganhando cada vez mais notoriedade na Odontologia, refletindo uma crescente demanda de profissionais que buscam por técnicas que promovam tratamentos eficientes e preservem a estrutura dental. Objetivo: O presente estudo teve como objetivo promover um controle cavitário não restaurador (CCNR) em um paciente infantil, por meio de uma regularização da cavidade da lesão de cárie para permitir uma melhor higienização da área, associado a um protocolo complementar de flúor. Caso clinico: Paciente do sexo masculino, 4 anos de idade, com higiene bucal regular, entretanto com acúmulo de biofilme entre os incisivos centrais superiores e sem sintomatologia ou queixa estética. As superfícies mesiais dos incisivos centrais foram regularizadas com tiras abrasivas para remover áreas retentivas e facilitar o acesso para melhorar a higiene bucal. O verniz fluoretado foi aplicado em 4 sessões, com intervalo de uma semana entre cada aplicação. A mãe do paciente foi orientada quanto à higiene e cuidados com a dieta. Durante 36 meses, houve o acompanhamento clínico e radiográfico do paciente com retornos a cada 12 meses. O índice de placa visível e os resultados da orientação de higiene e dieta também foram reavaliados. Conclusão: Neste caso clínico, a regularização de superfícies associada a fluorterapia, mostrou-se uma alternativa de tratamento de sucesso a longo prazo, permitindo a preservação do tecido dentário e impedindo a progressão das lesões de cárie. O conceito ultraconservador pode ser uma alternativa válida devido à sua eficácia, simplicidade, baixo custo e boa aceitação pelas crianças e seus pais.

The minimal intervention has been gaining more notoriety in Dentistry, reflecting growing demand from professionals looking for techniques that promote efficient treatments and preserve the dental structure. Objective: The present study aimed to promote non-restorative cavity control (CCNR) in a child patient through regularization of the cavity of the carious lesion to allow better cleaning of the area, together with a complimentary fluoride protocol. Case presentation: Male patient, 4 years old, presenting adequate oral hygiene. However, biofilm accumulation occurs between the upper central incisors without symptoms or aesthetic complaints. Therefore, the mesial surfaces of the central incisors were smoothed with abrasive strips to remove undercut areas and facilitate access to improve oral hygiene. The fluoride varnish was applied in 4 sessions, with an interval of one week between each application. The patient's mother was instructed on hygiene and diet care. During 36 months, there was a clinical and radiographic follow-up of the patient with returns every 12 months. The visible plaque index and the hygiene and diet guidance results were also re-evaluated. Conclusion: In this clinical case, surface regularization associated fluortherapy proved to be a successful long-term treatment alternative, allowing the preservation of dental tissue and preventing the progression of caries lesions. The ultra-conservative concept can be a valid alternative due to its effectiveness, simplicity, low cost, and good acceptance by children and their parents.

Análise do teor de fluoretos nas águas de abastecimento público em um município da região metropolitana de Curitiba/PR: doze meses de heterocontrole / Analysis of fluoride content in the public water supply in a city of the metropolitan region of Curitiba/PR: twelve months of external control

Resumo Introdução A fluoretação das águas de abastecimento tem sido apontada em estudos nacionais e internacionais como a mais eficiente e equânime forma de acesso a fluoretos na prevenção da cárie dentária. Objetivo Relatar os resultados do heterocontrole nas águas de abastecimento público do município de Colombo/PR, no período de dezembro de 2013 a novembro de 2014. Método Foram coletadas amostras mensais em 15 Unidades Básicas de Saúde, em dias da semana aleatórios, no período de 12/2013 a 11/2014. As amostras foram analisadas pelo método eletrométrico na Faculdade de Odontologia da Universidade Federal Fluminense. Resultados Foram analisadas 180 amostras, que variaram de <0,001 a 1,480 mg/L (média 0,715±0,232 mg/L). De acordo com o critério estabelecido pelo Centro Colaborador do Ministério da Saúde em Vigilância da Saúde Bucal, 51,11% das amostras apresentavam níveis de fluoretos adequados, 13,34% concentrações de flúor acima do ideal, e 35,56% abaixo do ideal. Conclusão O heterocontrole representa uma das principais estratégias de vigilância em saúde bucal, e, dessa forma, deve ser implementado e efetuado em todas as regiões que utilizam água fluoretada, a fim de garantir a manutenção de níveis ótimos de fluoretos.

Abstract Background The fluoridation of water supply has been pointed out in national and international studies as the most efficient and equal way of accessing fluorides in the prevention of dental caries. Objective To report the results of heterocontrol in public water supply in the municipality of Colombo/PR, from December 2013 to November 2014. Method The samples were monthly collected in 15 Basic Health Units, on random days of the week, from 12/2013 to 11/2014. The samples were analyzed by the electrometric method at the Faculty of Dentistry of Fluminense Federal University. Results 180 samples were analyzed, ranging from <0.001 to 1.480 mg/L (mean 0.715 ± 0.232 mg/L). According to the criteria established by the Collaborating Center of the Ministry of Health in Oral Health Surveillance, 51.11% of the samples had adequate fluoride levels, 13.34% above ideal fluoride levels, and 35.56% below ideal levels. Conclusion Heterocontrol could represent one of the main strategies of oral health surveillance, and, therefore, it should be implemented and carried out in all regions that use fluoridated water, in order to guarantee the maintenance of optimal fluoride levels.

Endemic dental fluorosis in children from a brazilian slave-descendent community: a cross-sectional study / Fluorose dentária endêmica em crianças de uma comunidade quilombola brasileira: um estudo transversal

Although fluoride (F) is required for the normal growth and development of several human organs and tissues, excessive exposure to it may be potentially toxic. Groundwater may present ranging levels of F; however, the appearance, taste, and smell are not altered. Thus, the present study aimed to evaluate dental fluorosis in children from a Brazilian slave-descendent community, as well as to assess F levels in the drinking water supplies available in that area. For that, 21 children aged from 6 to 14 years living in Rincão dos Martimianos were invited to participate. Thylstrup and Fejerskov index (a 0­9 scale) was used to assess dental fluorosis on permanent teeth. Furthermore, the F concentration of two water samples (from the artesian well and a tank) was determined by using a potentiometric method. All children presented dental fluorosis to some degree, ranging from score 2 to 9. About 81% of them had dental fluorosis scores equal to or over 5. Scores lower than 5 were observed only in children younger than 8 years; on the other hand, all children older than 8 years presented scores higher than 5. Moreover, artesian well water had an F concentration of 5 mg/L and tank water 0.8 mg/L. It is suggested that the F-rich groundwater supply was most probably responsible for dental fluorosis in that area. Brazilian slave-descendent communities, therefore, should receive constant attention from their local authorities in order to guarantee a proper water supply for consumption, as well as to provide public health education(AU)

Embora o flúor (F) seja necessário para o crescimento e desenvolvimento normal de vários órgãos e tecidos humanos, a exposição excessiva pode ser potencialmente tóxica. As águas subterrâneas podem apresentar níveis variados de F; no entanto, a aparência, o sabor e o cheiro não são alterados. Desta forma, o presente estudo teve como objetivo avaliar a fluorose dentária em crianças de uma comunidade brasileira descendente de escravos, bem como avaliar os níveis de F na água potável disponível nessa área. Para isso, 21 crianças de 6 a 14 anos residentes no Rincão dos Martimianos foram convidadas a participar da pesquisa. O índice de Thylstrup e Fejerskov (uma escala de 0 a 9) foi usado para avaliar a fluorose dentária em dentes permanentes. Além disso, a concentração de F de duas amostras de água (do poço artesiano e de um tanque) foi determinada pelo método potenciométrico. Todas as crianças apresentaram algum grau de fluorose dentária, variando de 2 a 9. Cerca de 81% delas apresentaram escores de fluorose dentária iguais ou superiores a 5. Escores inferiores a 5 foram observados apenas em crianças menores de 8 anos; por outro lado, todas as crianças maiores de 8 anos apresentaram escores superiores a 5. Além disso, a água do poço artesiano tinha concentração de F de 5 mg/L e a água do tanque 0,8 mg/L. Desta forma, acredita-se que a fonte de água subterrânea rica em F foi provavelmente responsável pela fluorose dentária na região avaliada. As comunidades quilombolas brasileiras, portanto, devem receber atenção constante de suas autoridades locais, a fim de garantir o abastecimento adequado de água para consumo, bem como proporcionar educação em saúde pública(AU)

Geographical barriers to the use of toothpaste containing ≥1000 ppm fluoride in peruvian children / Barreras geográficas para el uso de pasta dental con fluoruro ≥1000 ppm en niños peruanos

Objective: The aim of this was to determine the geographical barriers for the use of equal or more than 1000 (≥1000) parts per million (ppm) of toothpaste with fluorine (F) in children aged 1 to 11 years in Peru in 2018. Material and Methods: This is a cross-sectional study, the database of Demographic and Family Health Survey (ENDES, for its Spanish acronym) of Peru in 2018 was used; the final sample was 25660 records of children between 1 and 11 years old. The variables evaluated were the use of ≥1000 ppm fluoride toothpaste, place of residence, natural region, area of residence, region, wealth index, access to dental service, whether information was received about oral hygiene, daily tooth brushing, age and sex. A descriptive, bivariate (Chi square) and multivariate (log-linear Poisson regression) analysis was performed. Results: An association was found between the use of toothpaste ≥1000 ppm F with place of residence: small city vs capital-large city with an adjusted prevalence ratio (RPa): 0.94; 95% confidence interval (95% IC): 0.90-0.98, town and country vs. capital-large city both with an RPa: 0.95; 95% CI: 0.91-0.99. With natural region: rest of the Coast vs Lima with RPa: 0.94; 95% CI: 0.91-0.98, Sierra vs Lima with RPa: 0.95; 95% CI: 0.92-0.99 and Jungle vs Lima with RPa: 0.94; 95% CI: 0.90-0.98). Conclusion: The place of residence and the natural region are geographic barriers to the use ≥1000 ppm fluoride toothpaste in children aged between 1 and 11 years in Peru in 2018.

Objetivo: El objetivo de este fue determinar las barreras geográficas para el uso de igual o más de 1000 (≥1000) partes por millón (ppm) de pasta dental con flúor (F) en niños de 1 a 11 años en Perú en 2018. Material y Métodos: Se trata de un estudio transversal, la base de datos de la Encuesta Demográfica y de Salud Familiar (ENDES) del Perú en 2018 fue usada con una muestra de 25 660 registros de niños entre 1 y 11 años. Las variables evaluadas fueron el uso de pasta dental ≥1000 ppm F, lugar de residencia, región natural, área de residencia, región, índice de riqueza, acceso al servicio odontológico, si se recibió información sobre higiene bucal, cepillado diario de dientes, edad y sexo. Se realizó un análisis descriptivo, bivariado (Chi cuadrado) y multivariado (regresión loglineal de Poisson). Resultados: Se encontró una asociación entre el uso de pasta dental ≥1000 ppm F con el lugar de residencia: ciudad pequeña vs ciudad capital-grande con una razón de prevalencia ajustada (RPa): 0,94; intervalo de confianza de 95% (IC 95%): 0,90-0,98, ciudad y campo vs. capital-grande ciudad ambos con un RPa: 0,95; IC 95%: 0,91-0,99. Con región natural: resto de la Costa vs Lima con RPa: 0,94; IC 95%: 0,91-0,98, Sierra vs Lima con RPa: 0,95; IC 95%: 0,92-0,99 y Selva vs Lima con RPa: 0,94; 95% % CI: 0,90-0,98. Conclusión: El lugar de residencia y la región natural son barreras geográficas para el uso de pasta dental fluorada ≥1000 ppm en niños de 1 a 11 años en Perú en 2018.

Prevalencia de mancha blanca en dentición temporaria en el Hospital de Odontología Infantil Don Benito Quinquela Martín / Prevalence of white spot in temporary dentition at Don Benito Quinquela Martin Children's Dentistry Hospital

Introducción: La caries dental es una enfermedad infecciosa y multifactorial, que co- mienza por una desmineralización del esmalte producida por la acción de ácidos generados por bacterias presentes en el biofilm dental. Estas lesiones se inician como manchas blancas (MB) y es el único estadio de la caries dental capaz de ser revertido mediante la aplicación profesional de agentes remineralizantes, por lo que es fundamental la detección y tratamiento temprano de las mismas. Objetivo: Determinar la prevalencia de manchas blancas en la dentición temporaria de los niños atendidos en el Servicio de Clínica y Orientación del Hospital de Odontología Infantil (HOI) «Don Benito Quinquela Martín¼. Materiales y métodos: Se evaluó una muestra de 94 niños con dentición temporaria, en el Servicio de Clínica y Orientación del HOI, teniendo en cuenta los ingresos y reingresos, durante el período comprendido entre septiembre de 2019 y febrero de 2020. Resultados: La prevalencia de manchas blancas de un total de 94 niños evaluados fue del 55 %. De los pacientes que presentaron MB, el 59 % fue de sexo masculino y el 41 % de sexo femenino. La media de edad fue de 4.77 años. De los pacientes atendidos, 73 concurrieron por primera vez y 21 pacientes fueron reingresos. Conclusión: La prevalencia de manchas blancas en la muestra evaluada de niños atendidos en el Servicio de Clínica y Orientación del HOI fue del 55 %. Este resultado sugiere la necesidad de continuar y potenciar la promoción de la salud bucal, no solo como herramienta estratégica para brindar conocimientos acerca de los beneficios de una correcta higiene oral y una dieta saludable, sino también como factor de prevención en cuanto a la aparición de lesiones de caries y posteriores consecuencias adversas (AU)

Introduction: Dental caries is an infectious and multifactorial disease that begins with the demineralization of the enamel produced by the action of acids generated by bacteria in the dental biofilm. These lesions start as white spots (WS), and it's the only stage of dental caries capable of being reverted by the professional application of remineralizing agents. Hence, its early detection and treatment are essential. Objective: To determine the prevalence of white spots in the temporary dentition of children treated at the Clinical and Orientation Service of "Don Benito Quinquela Martin" Children's Dentistry Hospital (CDH). Materials and methods: A sample of 94 children with temporary dentition was evaluated on admission and readmission at CDH's Clinical and Orientation Service between September 2019 and February 2020. Results: The prevalence of WS in 94 children evaluated was 55%: 59% of patients who presented WS were males, and 41% were females. The mean age was 4.77 years. Seventy-three patients seen attended for the first time, and the other 21 were readmissions. Conclusion: The prevalence of WS in children who attended CDH's Clinical and Orientation Service was relevant. This result indicates that we must continue and enhance oral health promotion as a strategy to give knowledge about good oral hygiene benefits, a healthy diet, and to prevent the appearance of caries lesions and subsequent consequences (AU)

Nivel de conocimiento de los padres sobre el uso de pastas dentales en asociación con la ingesta estimada de fluoruro en niños / Level of knowledge in parents about the use of toothpaste in association with estimated fluoride intake in children

Resumen Introducción: Diversos estudios han demostrado que los padres aún no cuentan con el conocimiento suficiente sobre el uso de pastas dentales que deben consumir sus hijos. Muchos de ellos desconocen desde que edad se debe empezar con el uso de pastas dentales, la cantidad exacta que se debe colocar en el cepillo y sobre todo con qué frecuencia se deben cepillar. Objetivo: Asociar el nivel de conocimiento de los padres sobre el uso de pastas dentales con las características asociadas a la ingesta estimada de fluoruro en niños entre los 6 meses a 8 años de Lima Metropolitana y Callao. Materiales y métodos: Estudio de tipo observacional, descriptivo y transversal. Se realizó el cuestionario a 264 padres de familia residentes en Lima Metropolitana y Callao durante los meses de julio a septiembre del 2020. Se calcularon las frecuencias absolutas y relativas. Para el análisis bivariado, se utilizó la prueba de Chi cuadrado de El nivel de significancia estadística fue de 0.05. Resultados: Se observa que el 52.94% de los padres, así como el 60.41% de las madres presentan un nivel medio de conocimiento sobre el uso de pastas dentales con flúor. Además, se obtuvo que el 56.25% de los padres que afirmaron que sus hijos no se enjuagan con agua después del cepillado presentan un nivel alto de conocimiento sobre el uso de pastas dentales con flúor. Conclusión: Se obtuvo que el 57.58% de los padres tenían un nivel medio de conocimiento sobre el uso de pastas dentales con flúor. Se encontró asociación entre el nivel de conocimiento sobre el uso de pastas dentales con flúor y las características asociadas a la ingesta estimada de fluoruro.

Abstract Introduction: Various studies have shown that parents still do not have sufficient knowledge about the use of toothpastes that their children should consume. Many of them do not know from what age to start using toothpastes, the exact amount to be placed on the brush and especially how often they should be brushed. Aim: To associate the level of knowledge of parents about the use of toothpastes with the characteristics associated with the estimated intake of fluoride in children between 6 months to 8 years of Metropolitan Lima and Callao. Materials and methods: An observational, descriptive, and crosssectional study. The questionnaire was carried out on 264 parents residing in Metropolitan Lima and Callao during the months of July to September 2020. The absolute and relative frequencies were calculated. For the bivariate analysis, the Chi-square test of the level of statistical significance was used was 0.05. Results: It is observed that 52.94% of the fathers, as well as 60.41% of the mothers present a medium level of knowledge about the use of fluoride toothpastes. In addition, it was found that 56.25% of parents who stated that their children do not rinse with water after brushing have a high level of knowledge about the use of fluoride toothpastes. Conclusion: It was found that the 57.58% of parents had a median level of knowledge about the use of fluoride toothpastes. An association was found between the level of knowledge about the use of fluoride toothpastes and the characteristics associated with the estimated fluoride intake.

Efecto de una pasta dental con xilitol sobre Streptcococcos mutans en pacientes con ortodoncia fija / Effect of a toothpaste with xylitol on Streptcococcus mutans in patients with fixed orthodontics / Efeito de um creme dental xilitol sobre Streptcococcus mutans em pacientes com ortodontia fixa

La terapia ortodóntica produce una mayor acumulación de placa bacteriana en los pacientes, observándose cambios ecológicos orales que causan aumento del número de estreptococos mutans, por lo que es importante una adecuada higiene bucal que ayude a disminuir las bacterias y prevenir la caries. Objetivo. El propósito fue comparar el efecto del uso de una pasta dental con xilitol, en el recuento de Streptcococcos mutans en pacientes con aparatología ortodóntica fija. Material y métodos. Se realizó un estudio cuasiexperimental de cegamiento simple. La muestra estuvo constituida por 34 pacientes adolescentes con aparatología ortodontica fija de ambo sexos que cumplieron los criterios establecidos, todos fueron instruidos en una técnica de cepillado y designados al azar a uno de los dos grupos: grupo experimental 17 pacientes que usaron una pasta dental con xilitol y 17 pacientes en el grupo control que utilizaron una pasta dental convencional con flúor. A ambos grupos se les tomó y procesó microbiológicamente placa bacteriana al inicio del estudio y a las 3 y 5 semanas para evaluar el recuento de streptococos mutans. Resultados. La prueba T-Student demostró que hubo menos unidades formadoras de colonias en los pacientes que utilizaron pasta dental con xilitol siendo significativa la diferencia en la quinta semana de uso (˂ 0.0001). Conclusiones. Existe mayor efectividad de la pasta dental con xilitol, en relación a la pasta dental solo con flúor en el recuento de Streptococos mutans, sin embargo, los pacientes de ambos grupos tuvieron menos unidades formadoras de colonias.

Orthodontic therapy produces a greater accumulation of bacterial plaque in patients, with oral ecological changes that cause an increase in the number of mutans streptococci, so it is important to have an adequate oral hygiene that helps to reduce bacteria and prevent caries. Objective. The purpose was to compare the effect of the use of a toothpaste with xylitol on the Streptococcus mutans count in patients with fixed orthodontic appliances. Material and methods. A single-blinded quasi-experimental study was carried out. The sample consisted of 34 adolescent patients with fixed orthodontic appliances of both sexes who met the established criteria. All were instructed in a brushing technique and randomly assigned to one of two groups: 17 patients in the experimental group used a toothpaste with xylitol and 17 patients in the control group used a conventional toothpaste with fluoride. Both groups had bacterial plaque taken and processed microbiologically at the beginning of the study and at 3 and 5 weeks to evaluate the streptococcus mutans count. Results. The T-Student test showed that there were fewer colony-forming units in patients who used xylitol toothpaste with the difference being significant at the fifth week of use (˂ 0.0001). Conclusions. There is greater effectiveness of toothpaste with xylitol in relation to toothpaste with fluoride alone in the Streptococcus mutans count; however, patients in both groups had fewer colony-forming units.

A terapia ortodôntica produz um maior acúmulo de placa bacteriana nos pacientes, com alterações ecológicas orais causando um aumento no número de estreptococos mutantes, razão pela qual uma higiene oral adequada é importante para ajudar a reduzir as bactérias e prevenir cáries. Objetivo. O propósito era comparar o efeito do uso de uma pasta de dentes com xilitol na contagem de Streptococcus mutans em pacientes com aparelhos ortodônticos fixos. Material e métodos. Foi realizado um estudo quase-experimental mono-cego. A amostra consistiu de 34 pacientes adolescentes com aparelhos ortodônticos fixos de ambos os sexos que preenchiam os critérios estabelecidos. Todos foram instruídos em uma técnica de escovação e distribuídos aleatoriamente em um dos dois grupos: 17 pacientes do grupo experimental que usaram uma pasta de dentes com xilitol e 17 pacientes do grupo controle que usaram uma pasta de dentes convencional com flúor. Ambos os grupos tiveram a placa bacteriana retirada e processada microbiologicamente na linha de base e com 3 e 5 semanas para avaliar a contagem de estreptococos mutantes. Resultados. O teste T-Student mostrou que havia menos unidades formadoras de colônias em pacientes que usavam pasta de dentes de xilitol, sendo a diferença significativa na quinta semana de uso (˂ 0,0001). Conclusões. A pasta de dente com xilitol é mais eficaz do que a pasta de dente com flúor apenas no Streptococcus mutans, entretanto, os pacientes de ambos os grupos tinham menos unidades formadoras de colônias.

Produção científica sobre fluorose em regiões endêmicas: estudo bibliométrico de Anais das Reuniões da Sociedade Brasileira de Pesquisa Odontológica / Scientific production on fluorosis in endemic regions: bibliometric study of Meeting Annals of the Brazilian Society of Dental Research

Objetivo: Identificar os resumos publicados nas Reuniões Anuais da Sociedade Brasileira de Pesquisa Odontológica sobre fluorose em regiões endêmicas e verificar a contribuição da Ciência Brasileira para o assunto. Métodos: Este estudo descritivo foi realizado com dados secundários do período entre 2005 e 2020; os estudos elegíveis foram identificados a partir dos descritores presentes no título e/ou resumo: flúor, fluorose, fluorose dental, fluorose dentária, fluoretação, intoxicação por flúor. Critérios de inclusão: estudos em regiões declaradas como de fluorose endêmica ou que citassem o teor de flúor acima de 0,8 mg F/L. Foram excluídos estudos que não declarassem estudar fluorose em regiões endêmicas ou não citassem o teor de flúor na água. Os dados foram coletados por dois examinadores de modo independente e a distribuição de frequências dos dados foi realizada (Microsoft Excel para Mac v.16.16.12). Resultados: Observou-se que de 41.953 resumos publicados durante esses 15 anos, 1190 (2,83%) foram elegíveis; 426 (1,01%) abordaram especificamente o tema fluorose e24 (0,06%) a fluorose em regiões endêmicas. Os assuntos abordados envolveram tratamento (n = 4; 14,81%); desenvolvimento de programas de promoção de saúde bucal (n = 2; 7,69%);avaliação da potabilidade da água (n = 2; 7,41%); implementação de sistemas de desfluoretação (n = 2; 7,41%); prevalência e severidade (n = 2; 7,41%); distribuição da fluorose na dentição (n = 1, 3,70%); impacto na qualidade de vida (n = 2; 7,41%); percepçãoestética(n = 5; 18,52%); uso e ingestão de flúor (n = 3; 11,11%); fluorose óssea (n = 2; 7,41%); análise da possibilidade de alteração no padrão cognitivo (n = 1; 3,70%), nas funções motoras e no equilíbrio (n=1; 3,70%).Conclusão: Diferentes aspectos relacionados à fluorose em região endêmica foram abordados. A Ciência Brasileira tem se dedicado ao tema ao longo dos anos. Entretanto, há um número restrito de estudos, em especial sobre a relação dose-reposta.

Aim: Identify the abstracts published at the Brazilian Society for Dental Research's Annual Meetings regarding Fluorosis in endemic regions, as well as verify the contribution of Brazilian science to the subject. Methods:This descriptive study was conducted using secondary data from the period between 2005 and 2020; the eligible studies were identified from the descriptors present in the title and/or abstract, as follows: fluoride, fluorosis, dental fluorosis, dental fluorosis, fluoridation, fluoride poisoning. Inclusion criteria: studies in regions with endemic fluorosis were included. Studies that did not address fluorosis in endemic regions were excluded. Data were collected by two independent examiners and the distribution frequency of the data was performed (Microsoft Excel for Mac v.16.16.12). Results: It was observed that of the 41,953 abstracts published during these 15 years, 1,190 (2.83%) were eligible; 426 (1.01%) specifically addressed the theme of fluorosis, and of these, 24 (0.06%) reported on fluorosis in endemic regions. The subjects addressed involved treatment (n = 4; 14.41%), the development of oral health promotion programs (n = 2; 7.41%), the evaluation of water potability (n = 2; 7.41%), the implementation of defluoridation systems (n = 2; 7.41%), prevalence and severity (n = 2; 7.41%), the distribution of fluorosis in dentition (n = 1, 3.70%), impacts on the quality of life (n = 2; 7.41%), esthetic perceptions (n = 4; 18.52%), fluoride use and ingestion (n = 3; 11.11%), bone fluorosis (n = 2; 7.41%), the analysis of alterations in the cognitive pattern (n = 1; 3.70%) and change in motor functions and balance (n=1; 3,70%).Conclusion: Different aspects related to fluorosis in an endemic region were addressed. Brazilian Science has been devoted to the theme over the years; however, there have been a limited number of studies published in the literature concerning the dose-response ratio.

Factores demográficos asociados a fluorósis dental en niños y adolescentes en el departamento de La Paz / Demographic factors associated with dental fluorosis in children and adolescents in the department of La Paz

La ingesta de flúor por períodos prolongados durante la formación del esmalte produce fluorósis dental. OBJETIVO: el objetivo del presente trabajo es determinar factores demográficos asociados a fluorósis dental en niños y adolescentes en el departamento de La Paz. MATERIAL Y MÉTODO: el estudio es transversal analítico, los participantes fueron 1393 estudiantes que fueron seleccionados aleatoriamente para ello se tomaron en cuenta 36 unidades educativas de 7 regiones del departamento de La Paz. Se realizó un levantamiento epidemiológico aplicando el índice de Dean. RESULTADOS: la prevalencia de fluorósis dental fue del 13,6% (188), los más afectados fueron los adolescentes con un 10,7% (149), el sexo femenino tenía una prevalencia de 7,4% (103). Un 8% (112) de fluorósis dental se observó en el área rural. Según severidad, con 8 % (113) fue fluorósis discutible, muy leve 4% (51), leve 1,3% (18), moderada 0,4% (5) y severa se observó en un estudiante. Se observa una asociación estadísticamente significativa (p=0,000) entre edad y fluorósis dental. CONCLUSION: la fluorósis dental se considera como un problema estético y el controlarlo es una medida preventiva muy buena.

The ingestion of fluoride for prolonged periods during enamel formation produces dental fluorosis OBJETIVE: the objective of this study was to determine demographic factors associated with dental fluorosis in children and adolescents in the La Paz department. MATERIAL AND METHODS: the study is an analytical crosssectional study, the participants were 1393 students who were randomly selected from 36 educational units of 7 regions of the La Paz department. An epidemiological survey was carried out by applying the Dean index. RESULTS: the prevalence of dental fluorosis was 13.6% (188), the most affected were adolescents with 10.7% (149), and the female sex had a prevalence of 7.4% (103). Eight percent (112) of dental fluorosis was observed in rural areas. According to severity, with 8 % (113) was debatable fluorosis, very mild 4% (51), mild 1.3% (18), moderate 0.4% (5) and severe was observed in one student. A statistically significant association (p=0.000) was observed between age and dental fluorosis. CONCLUSION: dental fluorosis is considered an esthetic problem and controlling it is a very good preventive measure.

Natural exosome-like nanovesicles from edible tea flowers suppress metastatic breast cancer via ROS generation and microbiota modulation

Although several artificial nanotherapeutics have been approved for practical treatment of metastatic breast cancer, their inefficient therapeutic outcomes, serious adverse effects, and high cost of mass production remain crucial challenges. Herein, we developed an alternative strategy to specifically trigger apoptosis of breast tumors and inhibit their lung metastasis by using natural nanovehicles from tea flowers (TFENs). These nanovehicles had desirable particle sizes (131 nm), exosome-like morphology, and negative zeta potentials. Furthermore, TFENs were found to contain large amounts of polyphenols, flavonoids, functional proteins, and lipids. Cell experiments revealed that TFENs showed strong cytotoxicities against cancer cells due to the stimulation of reactive oxygen species (ROS) amplification. The increased intracellular ROS amounts could not only trigger mitochondrial damage, but also arrest cell cycle, resulting in the in vitro anti-proliferation, anti-migration, and anti-invasion activities against breast cancer cells. Further mice investigations demonstrated that TFENs after intravenous (i.v.) injection or oral administration could accumulate in breast tumors and lung metastatic sites, inhibit the growth and metastasis of breast cancer, and modulate gut microbiota. This study brings new insights to the green production of natural exosome-like nanoplatform for the inhibition of breast cancer and its lung metastasis via i.v. and oral routes.

Prevalencia de fluorosis en menores de 4 a 15 años, según índice de Dean y su asociación con el nivel de flúor presente en el agua de consumo / Prevalence of fluorosis in children between 4 and 15 years of age according to Dean's index and its association with the level of fluoride present in drinking

Resumen Objetivo. Identificar la prevalencia de fluorosis en menores de 4 a 15 años de edad, según índice de Dean y su asociación con el nivel de flúor presente en el agua de consumo en la provincia de Cotopaxi. Previa una autorización de participación por parte de sus padres y aprobación del comité de la Universidad Central del Ecuador. Métodos. Fueron examinados 115 participantes en las edades de 4 a 15 años, siguiendo protocolos de registro fotográfico validados tras verificar y cumplimiento de criterios de inclusión. A su vez, se evaluaron muestras de agua de abastecimiento que fueron recolectadas según los protocolos adecuados y examinadas según la presencia de flúor. Las fotografías obtenidas fueron analizadas por tres evaluadores certificados y entrenados en la diferenciación de los grados de fluorosis según Dean mediante índice Kappa. Resultados. Los valores emitidos por cada evaluador fueron recolectados tabulados y procesados mediante el programa SPSS, y la prueba estadística de Chi cuadrado y correlación de Spearman, evidenciando ausencia de una relación estadísticamente significativa, entre las variables analizadas. Conclusión. La presencia de fluorosis de leve a moderada en la población analizada no guarda relación con el porcentaje de flúor presente en las aguas de consumo.

Abstract Objective. Identify the prevalence of fluorosis in children between 4 and 15 years of age according to the Dean's index, and determine its association with the level of fluoride present in drinking water from Cotopaxi province. Subsequent to the authorization by their parents and approval by the committee of the Central University of Ecuador Methods. 115 participants between the ages of 4 to 15 years old were examined following validated photographic registration protocols, after verifying and fulfilling the inclusion criteria, along with the supply water samples were collected following the adequate protocols and examined for the presence of fluoride. The obtained photographs were analyzed by three certified evaluators, who were trained in the differentiation of the degrees of fluorosis according to Dean by means of the Kappa index. Results. The values emitted by each evaluator were tabulated and processed through the SPSS program, using the statistical test of Chi-square and Spearman's correlation. The absence of a statistically significant relationship between the variables was observed. Conclusion: The presence of mild to moderate fluorosis in the analyzed population is not related to the percentage of fluoride present in drinking water.

Uso do fluoreto de sódio como dessensibilizante no clareamento dental: uma revisão de literatura / Use of sodium fluoride as a desensibilizer in dental bleaching: a literature review

Objetivo: Verificar, por meio de uma revisão de literatura, a efetividade do uso do fluoreto de sódio como dessensibilizante para casos de sensibilidade induzida por clareamento dental. Resultados: O clareamento dentário tornou-se um dos procedimentos estéticos mais procurados na odontologia. Atualmente, existem duas técnicas supervisionadas por dentistas: o clareamento caseiro e o de consultório. Os materiais mais utilizados são o peróxido de carbamida e o de hidrogênio, respectivamente. O clareamento dental baseia-se na premissa de que o peróxido de hidrogênio penetra na estrutura dentária para interagir com os cromóforos orgânicos. Embora o protocolo de clareamento exija o uso de agentes oxidantes de baixa concentração, a sensibilidade dentária ainda está presente e pode ser considerado o principal efeito adverso da técnica de clareamento. Para minimizar este problema, a aplicação tópica de dessensibilizantes antes e após o clareamento dentário tem mostrado bons resultados na redução da intensidade de sensibilidade. Considerações finais: Mediante revisão apresentada, constatou-se que fluoreto de sódio quando utilizado após o protocolo clareador, como dessensibilizante, não elimina a sensibilidade, mas diminui a intensidade da dor. Quando utilizado antes do clareamento dental, não apresenta resultados positivos. Ademais, salienta-se que quando o fluoreto é incorporado no gel clareador, resulta em menor desmineralização do esmalte dentário.(AU)

Objective: To verify, through a literature review, the effectiveness of using sodium fluoride as a desensitizer for cases of sensitivity induced by tooth whitening. Literature review: Teeth whitening has become one of the most desired aesthetic procedures in dentistry. Currently, there are two techniques supervised by dentists: home whitening and office whitening. The most used materials are carbamide peroxide and hydrogen peroxide, respectively. Teeth whitening is based on the premise that hydrogen peroxide penetrates the tooth structure to interact with organic chromophores. Although the whitening protocol requires the use of low concentration oxidizing agents, tooth sensitivity is still present and can be considered the main adverse effect of the whitening technique. To minimize this problem, the topical application of desensitizers before and after tooth whitening has shown good results in reducing the intensity of sensitivity. Final considerations: Upon the review presented, it was found that sodium fluoride, when used after the whitening protocol, as a desensitizer, does not eliminate sensitivity, but reduces the intensity of pain. When used before tooth whitening, it has no positive results. Furthermore, it should be noted that when fluoride is incorporated into the whitening gel, less enamel demineralization is induced.(AU)

Infiltración de resina y barniz de flúor para el tratamiento de caries interproximales no cavitadas en dentición temporal / Resin infiltration plus fluoride varnish for non-cavitated proximal caries in primary dentition

RESUMEN: Introducción: Con el fin de prevenir la progresión de la caries interproximal no cavitada en dientes temporales, se ha generalizado el uso de estrategias mínimamente invasivas como la aplicación de sellantes, barniz de flúor o la resina infiltrante, ya sea combinadas o como monoterapia. Pese a lo anterior, hay incertidumbre con relación al efecto de la infiltración de resina en combinación con el barniz de flúor en dientes temporales. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Se identificaron nueve revisiones sistemáticas que en conjunto incluyeron tres estudios primarios que corresponden a ensayos clínicos aleatorizados. Se concluye que la infiltración de resina probablemente reduce el riesgo de la progresión de la caries interproximal no cavitada en dientes temporales. No se encontraron estudios que evaluaran los eventos adversos. Palabras claves: caries, infiltración de resina, caries interproximal, barniz de flúor, tratamiento mínimamente invasivo, Epistemonikos, GRADE.

ABSTRACT: Introduction: Minimally invasive techniques are widely used in non-cavitated interproximal caries treatment in primary dentition. Sealants, fluoride varnish, or resin infiltration can be applied in conjunction or as monotherapy. There is uncertainty regarding the effect of resin infiltration in conjunction with fluoride varnish in primary dentition. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 9 systematic reviews including three studies overall, of which all were randomized trials. We conclude that resin infiltration plus fluoride varnish probably decreases the risk of progression of non-cavitated interproximal caries in primary dentition. No studies were found that looked at adverse effects.

¿Cómo Intervenir el Proceso de Caries en Adultos? Adaptación del Consenso de ORCA/EFCD/DGZ / How to Intervene the Caries Process in Adults? Adaptation of the ORCA/EFCD/DGZ Consensus

RESUMEN: El manejo terapéutico de lesiones de caries primarias y secundarias concentra gran parte del quehacer de los dentistas en el mundo. Recientes cambios en la concepción de la enfermedad de caries llevaron a un panel de expertos de la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ) a analizar la evidencia y consensuar recomendaciones sobre manejo de caries en adultos. Mediante una reunión en Berlín, Alemania en 2019 y con metodología e-Delphi, los expertos analizaron la evidencia y propusieron recomendaciones clínicas. El propósito de este artículo es presentar una adaptación idiomática de las principales recomendaciones, que incluyen terapias no invasivas (higiene, uso de fluoruros y control de dieta), terapias microinvasiva (sellantes e infiltrantes), terapias necesariamente invasivas y la reparación de restauraciones. Todas las recomendaciones se basan en un enfoque mínimamente invasivo, con un adecuado manejo restaurador. Los dentistas de países hispanoparlantes podrán encontrar recomendaciones basadas en evidencia, provenientes de un consenso de expertos a nivel global, que orienten sus decisiones clínicas, apoyándose en los principios de la odontología de mínima intervención.

ABSTRACT: Therapeutic management of primary and secondary caries lesions concentrates much of the work of dentists throughout the world. Recent changes in caries disease conception and therapeutic management led a panel of experts from the European Organisation for Caries Research (ORCA), the European Federation for Conservative Dentistry (EFCD) and the German Federation for Conservative Dentistry (DGZ) to analyze the evidence and reach consensus on recommendations for caries management in adults. Through a meeting held in Berlin, Germany in 2019 and using an e-Delphi methodology, the experts analyzed the evidence and proposed clinical recommendations. The purpose of this article is to present an idiomatic adaptation to Spanish of the main recommendations, which include non-invasive therapies (hygiene, use of fluoride and diet control), microinvasive therapies (sealants and infiltrants), invasive therapies and repair of restorations. All recommendations are based on a minimally invasive dentistry approach, with a technically adequate restorative management. Spanish-speaking dentists may use these consensus recommendations to guide their clinical decisions, based on the most recent evidence and experts opinions, under the principles of minimal intervention dentistry.

Liberación del ion flúor de un cemento de ionómero vítreo modificado con extracto etanólico de propóleo / Liberation of the fluoride ion from a vitreous ion cement modified with ethanol extract of propolis

Objetivo. El objetivo de este estudio fue cuantificar la liberación de flavonoides y flúor en probetas de ionómero vítreo convencional tipo II modificado con extracto de propóleo. Métodos. Fueron utilizadas 60 unidades de análisis. El extracto etanólico de propóleo al 2% fue incorporado a un ionómero vítreo tipo II. Para la determinación de la liberación de flavonoides el laboratorio analizó la concentración de quercetina por ml de solución, sea agua destilada o solución fisiológica durante un periodo de 5 días. Resultados. Hubo liberación inicial de 0,40 mg/ml de flúor en solución fisiológica y de 0,35 mg/ml de flúor en agua destilada, y una liberación final de 0 mg/ml de flavonoides y de flúor en solución fisiológica y de 0,18 mg/ml de flúor en solución de agua destilada. Conclusiones. La liberación de flúor y flavonoides se produce en mayor concentración en las primeras horas, decreciendo a medida que pasan las horas.

Objective. The objective of this study was to quantify the release of flavonoids and fluoride in test tubes of conventional type II vitreous ionomer modified with propolis extract. Methods. Sixty units of analysis were used. The 2% propolis ethanolic extract was incor- porated into a type II glass ionomer. To determine the release of flavonoids, the laboratory analyzed the concentration of quercetin per ml of solution, either distilled water or physiological solution, during a period of 5 days. Results. There was an initial release of 0.40 mg/ml of fluorine in physiological solution and 0.35 mg / ml of fluorine in distilled water, and a final release of 0 mg/ml of flavonoids and fluorine in physiological solution and of 0,18 mg/ml of fluorine in distilled water solution. Conclusions. The release of fluoride and flavonoids occurs in greater concentration in the first hours, decreasing as the hours go by.