Child Stress and Behaviour During Restorative Treatment under Non-Pharmacological Techniques and Sedation: A Case Series

ABSTRACT Objective: To evaluate the behaviour and stress of children undergoing restorative treatment with and without sedation. Material and Methods: Participants were 14 healthy children aged between 2.5 and 6 years and with a history of dental behavioural management problems. In the dental treatment visit, the child was treated with non-pharmacological techniques, and in the second, moderate sedation was added. The child received the same procedure performed by a paediatric dentist in both visits: composite resin restoration using local anaesthesia and rubber dam isolation. In both visits, saliva was collected at the children's arrival at the dental clinic, during local anaesthesia and at the end of treatment. The visits were filmed for later analysis of behaviour according to the Ohio State University Behavioural Rating Scale. Results: About 78.5% of children improved their behaviour from the first to the second visit. The salivary cortisol curve of the first visit was maintained in the second visit for 21.4% of children but varied in the remaining participants. Conclusion: Most children presented better behaviour and less stress when sedation was added to non-pharmacological techniques during dental care.

Parental oral health literacy influences preschool children's utilization of dental services

Abstract: Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03-1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09-1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03-1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level.

Absceso dentoalveolar agudo en escolares de Tuinucú / Acute dentoalveolar abscess in pupils from Tuinucú

RESUMEN Fundamento: Los abscesos dentoalveolares agudos constituyen causa frecuente de las visitas de los niños a la consulta estomatológica. Objetivo: Identificar los dientes afectados por absceso dentoalveolar agudo y sus factores de riesgo en escolares de en la Escuela Primaria Melanio Hernández de Tuinucú. Metodología: Se realizó un estudio descriptivo, transversal en la Escuela Primaria de Tuinucú en el período comprendido entre septiembre de 2020 y abril de 2021. Se seleccionaron 30 escolares de 2do grado con absceso dentoalveolar agudo. Se utilizaron métodos del nivel teórico, empírico y estadístico. Se estudiaron las variables: sexo, diente afectado y factores de riesgos del absceso dentoalveolar agudo. Resultados: El 53.3 % de los escolares presentó absceso dentoalveolar agudo en los primeros molares temporales y el 43.3 % en los segundos. El 97 % tiene desconocimiento del absceso alveolar agudo y el 70 % estuvo afectado por caries dental. Conclusiones: Los primeros y segundos molares temporales fueron los dientes con mayor afectación por absceso alveolar agudo, sobre todo los inferiores, con predominio de la caries dental y el desconocimiento sobre el absceso dentoalveolar agudo como principales factores de riesgo.

ABSTRACT Background: Acute dentoalveolar abscesses are a frequent cause for children to visit the dentist. Objective: To identify the teeth affected by acute dentoalveolar abscess and their risk factors in pupils at the Melanio Hernández Elementary School in Tuinucú. Methodology: A descriptive, cross-sectional study was conducted at the Primary School in Tuinucú from September 2020 to April 2021. 30 2nd grade pupils with acute dentoalveolar abscess were selected. Methods of the theoretical, empirical and statistical level were used. The variables studied were: sex, affected tooth and risk factors for acute dentoalveolar abscess. Results: 53.3 % of pupils presented acute dentoalveolar abscess in the first primary molars and 43.3 % in the second. 97 % are unconscious of the acute alveolar abscess and 70 % were affected by dental caries. Conclusions: The first and second primary molars were the teeth mostly affected by acute alveolar abscess, especially those lower part, with prevalence of dental caries and lack of knowledge about acute dentoalveolar abscess as the main risk factors.

Diagnóstico educativo sobre salud bucal en escolares de Trinidad / Educational diagnosis on oral health in schoolchildren from Trinidad city

RESUMEN Fundamento: En escolares de 4.to grado están presentes enfermedades bucales y se realizan acciones curativas, mientras que las educativas precedidas de un diagnóstico educativo, son deficientes e insuficientes. Objetivo: Identificar los conocimientos, actitudes, prácticas sobre salud bucal y la eficiencia del cepillado bucodental en los escolares de 4.to grado. Metodología: Se realizó un estudio observacional, descriptivo y transversal durante el curso 2020-2021 de la Escuela Primaria Pepito Tey del municipio Trinidad, provincia Sancti Spíritus, con la totalidad (71) de los escolares de 4.to grado. Las variables estudiadas fueron: conocimientos, prácticas, actitudes sobre salud bucal y eficiencia del cepillado bucodental. Se utilizaron métodos del nivel teórico, empírico y estadístico-matemático con la aplicación de un cuestionario y una guía de entrevista, para la eficiencia del cepillado se determinó el Índice de Love. Resultados: Se constató el 71.8 % de los escolares con conocimientos insuficientes, el 74.6 % con actitud desfavorable y el 81.7 % con prácticas insuficientes sobre salud bucal, así como el 93 % con cepillado bucodental no eficiente. Conclusiones: Más de la tercera parte de los escolares tuvo conocimientos insuficientes, actitudes no favorables y prácticas insuficientes de salud bucal y la mayoría un cepillado no eficiente.

ABSTRACT Background: Oral diseases and curative actions are present in 4th grade schoolchildren while educational actions preceded by an educational diagnosis are deficient and insufficient. Objective: To identify the knowledge, attitudes, practices on oral health and the efficiency of Oral brushing in 4th grade schoolchildren. Methodology: An observational, descriptive and cross-sectional study was carried out during the 2020-2021 academic course at Pepito Tey primary school in Trinidad city, in Sancti Spíritus province, with all (71) of the 4th grade students. The variables studied were: knowledge, practices, attitudes about oral health and efficiency of oral brushing. Some methods from the theoretical, empirical and statistical-mathematical level were used with the application of a questionnaire and an interview guide, for brushing efficiency. Results: 71.8 % of schoolchildren with insufficient knowledge were found, 74.6 % with an unfavorable attitude and 81.7 % with insufficient practices on oral health, as well as the 93 % with inefficient oral brushing. Conclusions: More than a third of the schoolchildren had insufficient knowledge, unfavorable attitudes and insufficient practices of oral health and most brushing is not efficient.

Differences in Early Childhood Caries Status on Parental Stress Levels and Socioeconomic Status in Makassar City, Indonesia, During the COVID-19 Pandemic

Abstract Objective: To analyze the differences in early childhood caries status on parental stress levels and socioeconomic status in Makassar City, Indonesia, during the COVID-19 pandemic. Material and Methods: This type of analytical observational study with a cross-sectional design was conducted in North Rantepao, Toraja City, South Sulawesi Province, Indonesia. The research subjects of this study were parents who met the criteria, were willing to participate in the study, and had children aged 6-17 years. The questionnaire instrument with the criteria for assessing children's dental and oral health was assessed based on parents' perceptions. Each item is rated on a scale from 1 (never) to 5 (always). Then the total score was divided into three categories, namely low (score 3-6), moderate (score 7-10), and high (score 11-15). Comparative test analysis using Chi-Square test. Results: Parents with high-stress levels had more children with poor oral health. There is a significant difference according to the level of stress and socioeconomic status of the parents. Conclusion: There is a significant difference between caries status in early childhood based on socioeconomic status and parental stress level (AU).

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE

Abstract: There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

Acciones educativas sobre salud bucal en estudiantes de la Escuela «René Fraga« / Educational actions on oral health in students from «René Fraga¼ School

RESUMEN Introducción: la mayoría de la población acepta como inevitable la pérdida de los dientes con la edad, pero si estuviera mejor informada y adoptara actitudes y prácticas favorables con relación a su salud bucal, la prevalencia y gravedad de estas afecciones se reduciría considerablemente; esto motiva a buscar soluciones a través de políticas de salud que implementen planes especialmente diseñados a tal efecto. Objetivos: identificar el nivel de información sobre salud bucodental, diseñar y aplicar acciones educativas en escolares de preescolar a tercer grado de la Escuela «René Fraga». Métodos: se realizó una investigación, con metodología cualitativa y cuantitativa, en el período comprendido entre marzo 2017 a mayo 2018. Se utilizaron varios métodos e instrumentos para la obtención de la información entre los que se destacan: la observación y la entrevista. La muestra estuvo conformada por 248 infantes, y fue seleccionada por criterios. La información se obtuvo a través de: la observación, la aplicación de una entrevista para explorar información sobre salud bucal en los niños y niñas, todo esto con previo consentimiento informado de instituciones y padres. Resultados: los resultados obtenidos señalan entre otros aspectos: dificultades en la forma, frecuencia y orientación del cepillado, así como el nivel de información sobre salud bucodental; se diseñaron y aplicaron acciones en correspondencia con las necesidades educativas identificadas. Conclusiones: las niñas y niños mostraron un nivel de información sobre salud bucodental no adecuado durante el diagnóstico; este mejoró considerablemente después de aplicadas las acciones educativas diseñadas.

ABSTRACT Introduction: the majority of the population accepts tooth loss as inevitable as they age, but if they were better informed and adopted favourable attitudes and practices regarding their oral health, the prevalence and severity of these conditions would be considerably reduced; this motivates us to look for solutions through health policies that implement plans specially designed for this purpose. Objectives: identifying the level of information on oral health, as well as designing and applying educational actions in schoolchildren from preschool age to third grade belonging to "René Fraga" School. Methods: a qualitative and quantitative research was carried out from March 2017 to May 2018. Several methods and instruments were used to obtain information, among which observation and interview stand out. The sample consisted of 248 infants, and was selected by criteria. The information was obtained through observation and the application of an interview to explore information on oral health in children; all this with the prior informed consent of institutions and parents. Results: the obtained results indicate, among other aspects: difficulties in shape, frequency and orientation of brushing, as well as in the level of information on oral health; actions were designed and applied in correspondence with the educational needs identified. Conclusions: girls and boys showed an inadequate level of information on oral health during the diagnosis; this improved considerably after applying the designed educational actions.

Análise do perfil da manifestação e tratamento de lesões de cárie em crianças de 0 a 10 anos, participantes de um programa de prevenção / Analysis of the profile of the manifestation and treatment of caries lesions in children from 0 to 10 years old, participating in a prevention program

O objetivo dessa pesquisa foi analisar o perfil da manifestação de lesões de cárie em pacientes de 0 a 10 anos de idade atendidos em um Programa Odontológico Educativo Preventivo (POEP). Neste projeto as crianças foram atendidas dos 0 aos 5 anos de idade na Bebê-Clínica (BC) e dos 5 aos 10 anos na Clínica de Prevenção (CP). Foram analisados 754 prontuários e destes, selecionados 381, cujas crianças apresentaram lesão de cárie dentária. Dados como sexo, dente acometido, tipo de lesão, tratamento realizado e data da ocorrência foram registrados em planilha do Microsoft Excel 2010. Análises estatísticas descritivas e inferenciais foram realizadas pelo programa Sigma Plot 12.0. Foram utilizados os testes Qui-Quadrado e de Mann-Whitney, ambos com nível de significância de 5%. Dos prontuários selecionados, 178 (47%) eram de crianças do sexo masculino e 203 (53%) do sexo feminino. Um total de 1375 lesões foram registradas e o grupo de dentes mais acometido foi o de molares decíduos inferiores (31,4%). O dente 55 foi o mais frequente (10,1%) e a superfície oclusal, a mais envolvida (41%). Na BC o grupo de dentes mais acometido foi o de molares inferiores (37%), sendo os dentes 75 e 51 os mais frequentes, ambos com 9,7%, e a superfície vestibular, a mais afetada, com um total de 172 (45%) ocorrências. Na CP prevaleceram os molares decíduos superiores com 33% do total, sendo o dente 55 o mais afetado (11,8%) e a face oclusal, a mais acometida, com 447 (45%) ocorrências. Em relação ao tipo de lesão, tanto na BC quanto na CP prevaleceu a cárie cavitada em esmalte com 47% e 71%, respectivamente. O tipo de tratamento mais realizado foi o tratamento restaurador na BC (50,6%) e na CP (90,5%). Conclui-se durante o POEP que a lesão de cárie ocorreu com maior frequência em dentes posteriores, sendo o dente 55 o mais afetado (10,1%) e a superfície oclusal a mais acometida (41%). Entretanto, considerando separadamente as fases BC e CP, os resultados diferiram para o dente e superfície mais afetados(AU)

The aim of this research was to analyze the profile of the manifestation of caries lesions in patients aged 0 to 10 years old treated in a Preventive Dental Education Program (POEP). In this project, children were assisted from 0 to 5 years of age at the Baby-Clinic (BC) and from 5 to 10 years at the Prevention Clinic (CP). A total of 754 medical records were analyzed, and of these, 381 were selected, whose children had dental caries lesions. Data such as sex, affected tooth, type of injury, treatment performed and date of occurrence were recorded in a Microsoft Excel 2010 spreadsheet. Descriptive and inferential statistical analyzes were performed using the Sigma Plot 12.0 program. The Chi-Square and Mann-Whitney tests were used, both with a significance level of 5%. Of the selected records, 178 (47%) were from male children and 203 (53%) were female. A total of 1375 injuries were recorded and the group of teeth most affected was the lower primary molars (31.4%). Tooth 55 was the most frequent (10.1%) and the occlusal surface was the most involved (41%). In BC, the group of teeth most affected was the lower molars (37%), with teeth 75 and 51 being the most frequent, both with 9.7%, and the buccal surface, the most affected, with a total of 172 (45%) occurrences. In PC, the upper primary molars prevailed with 33% of the total, with tooth 55 being the most affected (11.8%) and the occlusal surface being the most affected, with 447 (45%) occurrences. Regarding the type of lesion, both in BC and PC, cavitated enamel caries prevailed with 47% and 71%, respectively. The most common type of treatment was restorative treatment in BC (50.6%) and CP (90.5%). It was concluded during the POEP that dental caries lesions occurred more frequently in posterior teeth, with tooth 55 being the most affected (10.1%) and the occlusal surface being the most affected (41%). However, considering BC and CP phases separately, the results differed for the most affected tooth and surfasse(AU)

Early Childhood Caries Experience of Children from Poor Families Living Below and Above Poverty Line

ABSTRACT Objective: To evaluate the role of poverty and its related factors on early childhood caries (ECC) experience among deprived children. Material and Methods: This population-based cross-sectional study surveyed 418 children aged one to six years enrolled in Brazilian public preschools from an area of the country known for its high social deprivation. Intraoral examination of children evaluated dental caries experience (dmft). Parents/caregivers answered a questionnaire with sociodemographic indicators. Family income was dichotomized into below or above poverty line. Data analysis used Chi-square test, Mann-Whitney test, and Multivariate Logistic Regression analysis (p<0.05). Results: Predisposing variables for an increased chance of ECC were: age group 3-4 years (OR: 4.89; 95% CI: 2.32-10.31), age group 5-6-years (OR: 5.60; 95% CI: 2.60-12.04), being part of families living below poverty line (OR: 1.88; 95% CI: 1.04-3.38) and having mothers with less than nine years of schooling (OR: 2.86; 95% CI: 2.77-7.14). Children from families living below poverty line presented higher dmft (2.9 +3.8; p=0.001) and untreated dental caries (d component) (2.7 +3.7; p=0.002). Conclusion: ECC in a poor population was influenced by indicators of social deprivation. The poorest of poor children from mothers with less years of schooling were at higher risk.

Children's Primary Dental Treatment Needs According to Their Parents

ABSTRACT Objective: To determine the children's primary dental treatment needs reported by the parents and pediatric dentists. Material and Methods: 125 children (36 girls and 89 boys) and their parents participated in this study. The children's decayed-missing-filled teeth/teeth surfaces scores were recorded. A questionnaire about their children's primary dental treatment needs was conducted with the parents. Shapiro-Wilk test was used to test the normality of the data. Kruskal-Wallis test was used to compare the clinical findings according to the categorical variables. The Chi-Square test was used to compare the categorical data. Also, multiple linear regression analysis was performed to determine the effect of some variables on children's dmft/DMFT scores. The significance level was accepted as p<0.05. Results: The average age of the children who participated in the study was 7.59 ± 2.36 years. The main reason for applying to the paedodontics clinic was dental caries (38.4%), followed by dental pain (33.6%). As for the primary dental treatment needs, 28% of the parents said they needed dental filling, while 19.2% said they needed orthodontic treatment. According to the pediatric dentists, while the treatment rate of dental caries was 47.2% as the primary treatment need, it was only 4.8% for the orthodontic treatments. Conclusion: Turkish children who were admitted to paedodontics clinics were too old and dental caries and dental pain were the most common reasons for these visits to the clinics. The children's needs for primary treatment varied according to parents and pediatric dentists. There is a need for more comprehensive studies about the subject.

Programa de Salud Bucodental en escolares de la Comunidad del Bajo Boulogne / Oral Health Program in children from Bajo Boulogne Community

Las afecciones bucodentales constituyen un problema de salud pública por su alta prevalencia y su fuerte impacto individual y colectivo en términos de dolor, malestar y discapacidad social y funcional. El Centro de Medicina Familiar y Comunitaria San Pantaleón, ubicado en la provincia de Buenos Aires, brinda asistencia sanitaria gratuita a la comunidad. Un relevamiento documentó que el 97% de los concurrentes presentaba caries y no se lavaban los dientes por falta de cepillo y pasta dental. Se decidió llevar adelante un programa de promoción de la salud bucodental. El objetivo fue evaluar su implementación; que incluyó: a) rastreo de caries y problemas odontológicos; b) coordinación interinstitucional; c) entrega de cepillos y pasta dental; d) intervención educativa; e) extensión comunitaria. Participaron en forma irregular 120 niñas, niños y adolescentes entre 5 y 18 años del Centro de Apoyo Escolar Fundación Bajo Boulogne. Se realizaron dos encuentros educativos y entrega de cepillos y pasta dental. En la revisión odontológica inicial sobre 60 participantes se detectaron caries en 43 (71,6%), que fueron derivados para tratamiento odontológico, pero concurrieron solo 26 (60,4%). El conocimiento sobre salud bucodental mostró cambios entre los más pequeños luego de las intervenciones educativas. Se logró implementar el programa, cumplimentando las actividades propuestas. Pero surgieron barreras que dificultaron la cobertura. En cuanto a la eficacia de la intervención educativa, no se logró mostrar cambios en el conocimiento. Se consiguió la detección oportuna, la incorporación de hábitos como el cepillado dentro de la institución educativa, la articulación para mejorar el acceso a la atención y la vinculación entre los diferentes actores comunitarios. (AU)

Oral disorders are a public health problem due to their high prevalence and their strong individual and collective impact in terms of pain, discomfort, and social and functional disability. The San Pantaleón Family and Community Medicine Center, located in the province of Buenos Aires, provides free healthcare to the community. A survey documented that 97% of those present had cavities and did not brush their teeth due to a lack of brush and toothpaste. It was decided to carry out an oral health promotion program. The objective was to evaluate its implementation; which included: a) tracking of caries and dental problems; b) inter-institutional coordination; c) delivery of brushes and toothpaste; d) educational intervention; e) community extension. 120 girls and boys and adolescents between 5 and 18 years of age from the Bajo Boulogne Foundation School Support Center irregularly participated. Two educational meetings were held, handing out brushes and toothpaste. In the initial dental review of 60 participants, caries was detected in 43 (71.6%), who were referred for dental treatment, with only 26 (60.4%) concurring. Oral health knowledge showed changes among the youngest after educational interventions. It was possible to implement the program, completing the proposed activities. Barriers arose that made coverage difficult. Regarding the effectiveness of the educational intervention, it was not possible to show changes in knowledge. Timely detection was achieved, the incorporation of habits such as brushing within the educational institution, articulation to improve access to care and the link between the different community actors. (AU)

Assessment of Caries Spectrum of First Permanent Molars in 7- to 8-Year-Old School Children in Northern Saudi Arabia: A Cross-Sectional Study

Abstract Objective: To estimate caries spectrum in first permanent molars (FPMs) of 7- to 8-year-old children in Saudi Arabia using Caries Assessment Spectrum and Treatment (CAST) index, and examine the correlation between distributions of CAST codes among contralateral and opposite arches. Material and Methods: A cross-sectional survey was conducted of 7- to 8-year-old Saudi school children in Sakaka, Aljouf, Saudi Arabia. A total of 385 children were examined. CAST codes were determined for FPMs, and their distribution was analyzed using Spearman's rank correlation coefficient. Statistical significance was set as p<0.05. Intra-examiner reliability was determined using the unweighted kappa coefficient. Results: The results indicated most of the FPMs were scored as code 3 (enamel lesions) such as upper contralateral FPM 44.40% for right, 53.50% for left, respectively, and lower contralateral molars were 61.30% for right and 64.90% for left, respectively. It was also observed that upper FPMs had scored code 0 (sound teeth) more than that of lower FPMs. Serious morbidity (codes 6 and 7) and mortality (code 8) showed a low prevalence in FPMs. Strong correlations were observed between upper contralateral FPMs (r=0.586) and lower contralateral FPMs (r=0.567, p<0.001). Conclusion: A high prevalence of enamel caries lesions (code 3) was observed in FPMs; in addition, a strong correlation was present between upper contralateral FPMs and between lower contralateral FPMs.

Clinical Evaluation of Pit and Fissure Sealants Placed by Undergraduate Dental Students in 5-15 Years-old Children in Iraq

Abstract Objective: To clinically evaluate the retention and marginal discoloration of pit and fissure sealants applied to primary and permanent teeth. Material and Methods: The study population encompassed of 5-15 years-old children. After consenting, a light-curing sealant was applied to etched pits and fissures of occlusal surfaces of selected sound teeth. The retention rate and marginal discoloration were assessed, 3 months after application of the sealants based on the criteria proposed by Simonsen's criteria (total retention: score 0, partial loss: score 1, and total loss: score 2). Each tooth was considered as an independent sample during analysis. Results: The achieved sample size was 43 children aged 5-15 years (mean age=10.0 years). Therefore, data of 100 teeth from 43 children were used for the final analysis. The percentage of completely retained sealants (59%) was higher than the percentage of partially retained sealants (23%) and completely missing sealants (18%) after 3 months follow up. Out of 100 sealed teeth, 60% were either had marginal discoloration or completely missing. Using the Mann-Whitney test, there was a statistically significant difference (p<0.05) between primary and permanent teeth in terms of retention. However, there was no statistical difference (p>0.05) between upper and lower teeth in terms of retention. Conclusion: The success rate of fissure sealants after 3 months follow-up was satisfactory.

Crossover studies of pediatric dental sedation are inappropriate

Abstract Crossover studies continue to be published in spite of warnings about their inherent risks in relation to behavioral outcomes. This study took the opportunity of access to secondary data analysis in order to demonstrate the impact of a crossover design on the outcomes of randomized clinical trials aimed at the behavior of children during dental treatment. We evaluated the effect of the sequence of sedative administration, the sedative and the participant's age on the behavior of children undergoing two sequential dental visits. Eighteen uncooperative healthy young children were equally randomly assigned to: (G1) 1.0 mg/kg oral midazolam (first session) and oral placebo (second session); (G2) oral placebo (first) and 1.0 mg/kg oral midazolam (second). One trained observer assessed children's behavior. Data were analyzed by three-way mixed ANOVA. Both midazolam [mean(SD); 71.7%(16.5)] and placebo [48.6%(33.1)] produced more struggling behavior when they were administered in the first session compared to the second one (p=0.001). For the placebo, children aged 2-3 years exhibited more struggling behavior [G1 54.9%(36.2); G2 80.5%(8.3)] than those aged 4-5 years (p=0.04). Also, the reduction of percentage of struggling behavior was higher in G1 for older children (76.2%) and in G2 for younger children (32.9%). There were significant interactions between drug and sequence of administration, and between drug and age. The results of our study confirm the conventional wisdom that crossover study design is inappropriate to evaluate children's behavior/anxiety related-dental treatment under sedation and the results of crossover studies of dental sedation should be treated with extreme caution.

Resumo Pouco se sabe sobre o impacto de um delineamento cruzado nos desfechos de ensaios clínicos randomizados voltados ao comportamento de crianças durante tratamento odontológico. Este estudo objetivou avaliar o efeito da sequência de administração do sedativo, da droga em si e da idade dos participantes no comportamento de crianças que receberam duas consultas odontológicas consecutivas. Dezoito crianças saudáveis não colaboradoras, 2-5 anos de idade, foram randomizadas em dois grupos: G1 - 1,0 mg/kg midazolam oral (primeira sessão) e placebo oral (segunda sessão); G2 - placebo (primeira) e 1,0 mg/kg midazolam oral (segunda). Um observador treinado avaliou o comportamento infantil. Os dados foram analisados por ANOVA de três fatores (alfa=0,05). Midazolam [média(DP); 71,7%(16,5)] e placebo [48,6%(33,1)] resultaram em mais comportamento não cooperativo quando administrados na primeira sessão comparado com a segunda (p=0,001). Com o uso do placebo, crianças de 2-3 anos de idade exibiram mais comportamento não cooperativo [G1 54,9%(36,2); G2 80,5%(8,3)] que as de 4-5 anos de idade (p=0,04). Além disso, a porcentagem de redução do comportamento não cooperativo foi maior em crianças mais velhas em G1 (76,2%) e em crianças mais novas em G2 (32,9%). Considerando a avaliação do comportamento infantil sob sedação, a primeira sessão odontológica influenciou a segunda visita. Os resultados deste estudo confirmam a especulação de que o delineamento cruzado é inadequado para avaliar o comportamento odontológico relacionado à ansiedade/comportamento infantil; os resultados dos ensaios cruzados de sedação odontológica devem ser tratados com extrema cautela.

Factores asociados a fluorosis dental en niños de 10 a 12 años del cantón Pimampiro, provincia de Imbabura, Ecuador 2016-2017 / Associated factors to dental fluorosis in children between 10 and 12 years in the canton of Pimampiro, province of Imbabura, Ecuador 2016- 2017

Resumen Introducción: Determinar la prevalencia de fluorosis dental y los factores asociados a su presencia, en escolares de 10 a 12 años del cantón Pimampiro, provincia de Imbabura, Ecuador. Metodología: Muestra de 302 alumnos de centros educativos del cantón Pimampiro, provincia de Imbabura que cumplieron con criterios de inclusión, previo consentimiento de sus padres o representantes, y que fueron evaluados en cuanto a su alimentación y hábitos de higiene oral, acompañado de un registro fotográfico de los dientes anteriores definitivos de cada participante, las fotografías obtenidas analizadas por tres evaluadores calibrados en la detección de fluorosis mediante el índice de Thylstrup y Fejerskov. Resultados: La prevalencia de la fluorosis dental fue de 81,4 %, el grado 2 fue el más frecuente en un 32,6%. Al relacionar las variables establecidas en la encuesta y la presencia de fluorosis se encontró relación de la patología con el consumo de bebidas envasadas, con la cantidad de dentífrico usado y con su ingesta accidental (p = 0,000). Conclusión: La prevalencia de fluorosis en la población de estudio se considera alta, el grado 2 según TF fue el más frecuente, y se encontró una relación con el consumo de bebidas envasadas, la cantidad de dentífrico usado y con la ingesta accidental.

Abstract Introduction: We aimed to determine the prevalence of dental fluorosis and its associated factors, in children from 10 to 12 years old from Pimampiro, province of Imbabura, Ecuador. Methodology: 302 school children from Pimampiro, province of Imbabura who complied inclusion criteria, with the prior consent of their parents and /or representatives were evaluated in terms of their diet and oral hygiene habits, accompanied by a photographic record of the final anterior teeth of each participant, the photographs obtained were analyzed by three calibrated evaluators in the detection of fluorosis using the Thylstrup and Fejerskov index. Results: The prevalence of dental fluorosis was 81.4%, grade 2 was the most frequent with 32.6%. When relating the variables established in the survey and the presence of fluorosis, a relationship was found between the pathology and the consumption of bottled beverages, with the amount of toothpaste used and with accidental intake (p = 0.000). Discussion and Conclusion: The prevalence of fluorosis in the study population is considered high; grade 2 according to TF was the most frequent, finding a relationship with the consumption of bottled beverages, the amount of toothpaste used and with accidental intake.

A peer-led dental education program for modifying oral self-care in Mexican children / Un programa de educación para la salud guiado por pares dirigido al autocuidado bucal en niños mexicanos

Abstract: Objective: To compare peer-led dental education (PLDE) versus conventional dental instruction (CDI) in modifying children's oral self-care. Materials and methods: The intervention group (two schools) received PLDE and the control group (two schools) received CDI. The quality of oral self-care practice (OSC-P) and oral self-care skills (OSC-S) were indicated by dental plaque levels (%) and compared before and after dental education. Results: There were no baseline OSC-P differences between the control (55.8 ± 12.8%) and intervention (55.5 ± 14.6%) groups or OSC-S differences between the intervention (38.5 ± 13.2%) and control (38.1 ± 12.5%) groups. At the three-month follow-up we observed OSC-P deterioration in the control group (63.2 ± 15.0%) and OSC-P improvement in the intervention group (52.2 ± 15.6%). The OSC-P/OSC-S regression models found these predictors: baseline oral self-care, group affiliation, and mother's education (p<0.05). Conclusion: The hypothesis was confirmed and significant predictors were baseline oral self-care levels, group affiliation, and mother's education.

Resumen: Objetivo: Comparar un programa educativo guiado por pares (PEGP) versus un programa basado en educación convencional (EC) dirigido al autocuidado bucal en niños. Material y métodos: El grupo de intervención recibió un PEGP y el grupo control recibió EC. La calidad de prácticas de autocuidado (OSC-P) y habilidades de autocuidado (OSC-S) fueron indicadas por los niveles de placa dental (5) y comparadas antes y después de la intervención. Resultados: No se observaron diferencias en los datos de línea base del OSC-P entre el grupo control (55.8 ± 12.8%) y el de intervención (55.5 ± 14.6%) o en el OSC-S entre el grupo de intervención (38.5± 13.2%) y el control (38.1 ± 12.5%). En el seguimiento a tres meses, se observó un deterioro en las OSC-P en el grupo control (63.2 ± 15.0%) y un mejoramiento en las OSC-P en el grupo de intervención (52.2 ± 15.6%). Los modelos de regresión lineal para las OSC-P/OSC-S encontraron como significativos los siguientes predictores: autocuidado bucal de línea base, el grupo de afiliación y la educación materna (p<0.05). Conclusión: La hipótesis fue confirmada y los predictores significativos fueron los niveles de autocuidado bucal de línea base, el grupo de afiliación y la educación materna.

Acesso à saúde bucal na primeira infância no município de Porto Alegre, Brasil / Access to oral health in early childhood in the city of Porto Alegre, Brazil

Resumo O objetivo foi avaliar o acesso e fatores associados à consulta odontológica em crianças de até 5 anos no município de Porto Alegre, Brasil. Estudo transversal realizado em 10 Unidades Básicas de Saúde, através de questionário e exame clínico em 560 crianças. Foram avaliadas variáveis clínicas (placa visível, sangramento gengival e ceo-s), sociodemográficas, e de acesso à consulta. Regressão de Poisson foi utilizada para cálculo de Razões de Prevalência (RP), com intervalo de confiança de 95%. Os resultados mostraram que 68,2% das crianças nunca haviam ido ao dentista. O principal motivo relatado para a não realização de consulta odontológica foi não ter sentido necessidade (48,7%) e dificuldade de acesso ao posto de saúde (15,8%). A procura pelo dentista teve como propósito a prevenção/revisão (55,8%) e os locais mais procurados para consultas foi o consultório particular (43,9%) e o posto de saúde (39,5%). O modelo multivariado final mostrou que a idade da criança (IC95%, RP = 1,03 (1,02-1,05)), a renda familiar (RP = 1,05; (1,01-1,08)) e a mãe ter concluído o ensino médio (RP = 1,69 (1,15-2,56)) estiveram associados com a procura por consulta odontológica. Assim, torna-se fundamental reconhecer a importância do contexto familiar durante os primeiros anos de vida.

Abstract The goal was to assess the access and factors connected to dental visits in children up to age five in the city of Porto Alegre, Brazil. The cross-sectional study was conducted in 10 Basic Health Units through a questionnaire and clinical examination on 560 children. Clinical (visible plaque, gingival bleeding and defs), socio-demographic, and visit access variables were assessed. Poisson Regression was used to calculate the Prevalence Ratios (PR), with a 95% confidence interval. Results showed that 68.2% of children had never gone to a dentist. The main reason reported for not visiting a dentist was not feeling the need (48.7%) and difficult access to a health clinic (15.8%). The purpose of going to the dentist was for prevention/revision (55.8%), and the most sought-after places for visits were the private office (43.9%) and health clinic (39.5%). The final multivariate model showed that age of the child (95%CI, PR = 1.03 (1.02-1.05)), household income (PR = 1.05; (1.01-1.08)), and the mother having completed high school (PR = 1.69 (1.15-2.56)) were associated with seeking dental consultation. Thus, it is crucial to recognize the importance of the family setting during the first years of life.

Parental Presence in Dental Operatory as a Behaviour Management Tool on Children in Bhubaneswar, Odisha, India

Objective: To interpret the change in child's behaviour in presence/absence of parents during dental care. Material and Methods: Sixty children were examined till the age of 12 years visiting the out patient department of pediatric dentistry where parents along with the child were allowed in the operatory. After sometime parents were asked to leave and behavioural changes were noted. During revisit again the behaviour was noted according to Frankl scale. McNemar test was applied to test the behaviour response of children with parental absence/presence. The significance level was set at 5 %. Results: In 1st visit, 78.3% showed positive behaviour and 21.7% showed negative behaviour in parental absence, indicating that the child has more likelihood of showing positive behaviour in the presence of parents (p<0.001). More positive behaviour of the children is noticed, when the parents are present in 3 -5 year age group. In other 6-8 and 9-12 year age group, no difference was noticed in the presence or absence of the parents (p>0.05). In second visit, the negative behaviour reduced. When parents were absent 21.7% showed negative behaviour (p=0.000). This indicated that the child has more likelihood of showing positive behaviour in the presence of parents. Age group-wise analysis revealed that in the 3-5 years age group presence or absence of parents is a significant factor for child's behaviour. This factor is a non-issue in the elder age group like 6-8 years and 9-12 years. When the parents are absent, no significant difference was observed (p>0.05). Conclusion: There was no significant difference in parental presence/absence in elder children while the same can't be said for younger children.

Pattern and Severity of Early Childhood Caries among Preschool Children in Northern Region, Saudi Arabia: A Cross-Sectional Study

Objective: To investigate the pattern and severity of early childhood caries (ECC) by using the decayed and filled surface (dfs) index in preschool children in Al-Jouf, Saudi Arabia. Material and Methods: A convenience sample of 270 preschool children below 5 years of age (144 boys, 126 girls) attending outpatient pediatric dental clinics was selected for the study. World Health Organization criteria were used to diagnose caries through assessment of the dfs index. Information regarding oral hygiene practices, socio-economic status, and educational status of the mother was obtained through a structured questionnaire given to mothers. The data were statistically analyzed with the Chi-square test and Student's t-test. Results: 73% of children were not brushing regularly; 74.4% of them were using fluoridated toothpaste. In the maxillary teeth, boys had a higher mean dfs index (10.25), as well as a higher number of decayed surfaces (ds), than girls. In the mandibular teeth, boys and girls had similar mean dfs indices. Significant differences were observed between boys and girls regarding filled buccal surfaces (p=0.001) and occlusal surfaces (p=0.001) in maxillary teeth. The mandibular first molar was the most commonly affected tooth (93.3%); lower anterior teeth were the least affected teeth (2-4%) among the primary dentition. Conclusion: The ECC pattern in the northern region of Saudi Arabia follows the typical pattern of nursing caries.

Caries Prevalence in Preschool Children in a City of Southern Brazil According to Two Diagnostic Criteria: dmf-t and ICDAS II

Objective: This cross-sectional research evaluated caries prevalence and treatment need in preschool children using different indexes. Material and Methods: A sample of 931 children (3-5 years old) attending public schools were examined by two calibrated researchers, who recorded the caries prevalence using dmf-t and ICDAS II. The clinical records obtained directed the decision regarding the treatment needs, which were divided into non-invasive and invasive procedures according to the scores registered in the different caries indexes. Descriptive statistics were used to present the data related to each index; qui-square test was used to compare the need of invasive and non-invasive treatment in the different ages. Results: The mean dmf-t was 1.8 ± 2.9, with a 42.9% caries prevalence. Using cut-off points of ICDAS II (≥1, ≥3 and ≥4), the caries prevalence values found were 50.7%, 40.8% and 30.7%, respectively. Fiveyear- old children exhibited the highest caries prevalence, assessed with dmf-t or ≥3 and ≥4 cutoff points of ICDAS II (≥3: p=0.032; ≥4: p=0.015). The percentages of caries-free children were 49.1% and 57.1%, respectively for ICDAS II and dmf-t. Restorative treatment in at least one tooth was required by 30.7% and 40% of the children for ICDAS II and dmf-t. Only ICDAS II could establish the percentage of non-invasive treatments (20%). Both indices pointed out the expressive need of restorative treatment. Conclusion: The use of dmf-t in epidemiological surveys may underestimate caries prevalence whereas the ICDAS II allowed the identification of early carious lesions and the viability of the use of non-invasive procedures as caries control measures in a child population.