O uso de desenhos como técnica projetiva em odontopediatria / The use of drawings as a projective technique in pediatric dentistry

The dental environment can be considered a stressor for children, and can trigger unwanted behaviors. Pediatric Dentistry is a specialty that requires professionals to know preventive measures and restorative skills to perform dental treatment in children or adolescents. In addition, it is especially important that the professional is concerned with the child's feelings and reactions, allowing the pediatric dentist to identify situations that may generate stress for the patient during the care, and manage the presented behaviors. Recent studies have measured children's reactions and feelings during dental treatments using projective techniques. Given the importance of drawing to identify children's emotions, the objective of this study was to search the literature about the use of drawings as a projective technique in Pediatric Dentistry. Therefore, projective techniques, with an emphasis on drawing, have proved to be an effective instrument to be used in clinical practice to better understand the reactions presented by children during dental care and their relationship with dentists. Thus, avoiding unexpected situations in the office and allowing greater chances of obtaining a positive return from the patient.

O ambiente odontológico pode ser considerado um estressor para o público infantil, capaz de desencadear comportamentos indesejados. A Odontopediatria é uma especialidade que exige do profissional o conhecimento de medidas preventivas e de habilidades restauradoras para a realização do tratamento odontológico na criança ou no adolescente. Além disso, é muito importante que o profissional se atente aos sentimentos e às reações da criança, e identifique situações que possam desencadear estresse para o paciente durante o atendimento odontopediátrico, e maneje os comportamentos apresentados. Estudos recentes têm mensurado as reações das crianças e seus sentimentos durante tratamentos odontológicos por meio de técnicas projetivas. Diante da importância do desenho como meio para identificar as emoções das crianças, o objetivo deste estudo foi fazer uma busca na literatura acerca do uso de desenhos como técnica projetiva em Odontopediatria. As técnicas projetivas, com ênfase no desenho, revelaram-se um instrumento eficaz a ser utilizado na prática clínica a fim de melhor compreender as reações apresentadas pelas crianças durante o atendimento odontológico e seu relacionamento com os dentistas. Elas evitam situações inesperadas no consultório e possibilitam maiores chances de se obter um retorno positivo do paciente.

Usos del láser terapéutico en Odontopediatría: Revisión de la literatura. Reporte de casos / Uses of Therapeutic Laser in Pediatric Dentistry: Review of the Literature. Case Reports

RESUMEN El término "LÁSER" es un acrónimo de "Light Amplification by the Stimulated Emission of Radiation" (en español "Amplificación de Luz por Emisión Estimulada de Radiación"). La utilización de la tecnología láser en Odontología ha tenido una constante evolución y desarrollo en los últimos 30 años. Se deben distinguir dos grandes grupos de láseres: De alta potencia o quirúrgicos y de baja potencia o terapéuticos. El más empleado en odontología pediátrica es el terapéutico o LLLT (o "blando"). El láser terapéutico está indicado para diversas anomalías tales como la hipersensibilidad, gingivitis, herpes, parestesias, neuralgias del trigémino, trismus, disfunción ATM, implantes, activación de químicos de blanqueamiento dental, entre otros. Este artículo pretende realizar una actualización de las aplicaciones del láser de baja potencia en el ámbito de la Odontología Pediátrica, así como la presentación de 4 casos clínicos representativos.

ABSTRACT The term "LASER" is an acronym for "Light Amplification by the Stimulated Emission of Radiation" (in Spanish "Amplificación de Luz por Emisión Estimulada de Radiación"). The use of laser technology in dentistry has had a constant evolution and development in the last 30 years. Two large groups of lasers should be distinguished: high-power or surgical and low-power or therapeutic. The most used in pediatric dentistry is the therapeutic or LLLT (or "soft"). The therapeutic laser is indicated for various anomalies such as hypersensitivity, gingivitis, herpes, paresthesias, trigeminal neuralgias, trismus, TMJ dysfunction, implants, activation of teeth whitening chemicals, among others. This article intends to perform an update of the applications of low power laser in the field of Pediatric Dentistry, as well as the presentation of 4 representative clinical cases.

Aplicación del Láser de Baja Potencia (LLLT) en Pacientes Pediátricos: Revisión de Literatura a Propósito de una Serie de Casos / Application of Low Power Laser (LLLT) in Pediatric Patients: Review of the Literature in a Series of Cases

RESUMEN: El uso del láser de baja potencia en odontología está siendo cada vez más frecuente y con excelentes resultados, los equipos más modernos traen pre-establecidos la dosimetría de los parámetros para las diferentes acciones clínicas. El objetivo de esta revisión fue encontrar evidencia científica que permita al clínico tener como una alternativa de tratamiento el uso del láser de baja potencia en patologías orales de tejidos blandos y duros en pacientes pediátricos. Se realizó una revisión de la literatura por medio de buscadores como PubMed, LILACS y SciELO. Después de leer a texto completo todos los trabajos es posible señalar que el láser de baja frecuencia es una buena alternativa terapéutica en la resolución de signos y síntomas en patologías orales que aquejan al paciente pediátrico, puesto que, presenta un rápido control del dolor, la inflamación, el sangrado y acelera los procesos de reparación celular.

ABSTRACT: Low Level Laser Therapy in dentistry is becoming more frequent and has had excellent results, with state of the art equipment having pre-established dosimetry parameters for the various clinical actions. The objective of this review was to find scientific evidence that allows the clinician to have the use of low power laser as treatment alternative, in oral soft tissue and hard pathologies in pediatric patients. A review of the literature was performed through search engines such as PubMed, LILACS and SciELO. After reading the texts, it was possible to point out that low frequency laser is a good therapeutic alternative in the resolution of signs and symptoms in oral pathologies of the pediatric patient. This alternative allows for rapid pain control, reduces inflammation and bleeding, and accelerates cellular repair processes.

Remoção de mucocele com laser diodo: relato de caso clínico em paciente infantil / Mucocele removal with laser diode: case report on child patient

A mucocele é uma das lesões benignas que mais afeta a cavidade bucal. O laser de diodo de alta potência é uma opção que substitui ou associa procedimentos complementares aos processos convencionais,tendo mais conforto pós-cirúrgico. O objetivo deste trabalho foi relatar o caso clínico de remoção de mucocele de lábio inferior em paciente infantil utilizando laser de diodo de alta potência. Paciente do sexo feminino, 8 anos de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia São Leopoldo Mandic, em Campinas, relatando incômodo no lábio inferior, com a presença de uma “bolinha”. Ao exame clínico observou-se tumefação de consistência mole, flutuante, translúcida, com coloração similar à mucosa bucal. Após diagnóstico, o tratamento baseou-se na remoção cirúrgica com auxílio de laser de diodo de alta potência. Inicialmente foi realizada a anestesia infiltrativa ao redor da lesão, e então a remoção cirúrgica foi conduzida, juntamente com as glândulas acessórias para evitar recidiva, com uso do laser de diodo de alta potência. Ao fim do procedimento foi possível observar que a paciente saiu satisfeita, sendo o prognóstico favorável. No retorno de 30 dias, observou-se que não houve recidiva da lesão. O laser dediodo de alta potência, uma vez que apresenta uma série de benefícios, como excelente hemostasia, sem a necessidade de sutura, redução do edema e dor, cicatrização mais rápida e redução do tempo para realizar o procedimento, parece ser uma opção para remoção de mucocele em Odontopediatria.

Mucocele is a benign lesion that affects the oral cavity. The high power diode laser is an option as anadditional method or as a substitute to conventional procedures, with more post-surgical comfort. The objective of this study was to report a case of lower lip mucocele removal in a child patient using highpower diode laser. A female patient, 8 years old, attended the Clinic of Pediatric Dentistry, São Leopoldo Mandic School of Dentistry in Campinas, reporting discomfort in the lower lip, with the presence of a“ball”. On clinical examination it was observed swelling of soft consistency, floating, translucent, with coloring similar to the buccal mucosa. After diagnosis, the treatment was based on surgical removal with high power diode laser assistance. Initially infiltration anesthesia around the lesion was performed,and then the surgical removal was conducted, along with the accessory glands to prevent recurrence,with high power diode laser use. At the end of the procedure it was observed that the patient leftsatisfied, with a favorable prognosis. At the 30-day post-operative return, it was observed that there was no recurrence. The high power diode laser, since it presents a series of benefits such as excellen the mostasis, without the need for sutures, reduction of swelling and pain, faster healing, reducing the time to perform the procedure, it seems to be an option for removal of mucocele in pediatric dentistry.

Hemangioma: descrição de um caso clínico e sua importância no diagnóstico diferencial / Hemangioma: description of a clinical case and the importance in the differential diagnosis

O hemangioma infantil é um tumor vascular benigno que ocorre devido a uma proliferação anormal dos vasos sanguíneos. O quadro clínico apresenta três fases bem definidas: proliferativa, involutiva e involuída. O diagnóstico é realizado basicamente por meio da anamnese e do exame físico, e quando necessário preconiza-se avaliação histopatológica. O presente trabalho, descreve um caso clínico de um hemangioma presente em um bebê de 3 meses de idade que foi, de principio, diagnosticado como mucocele ou fibroma. A cirurgia excisional foi realizada eo material encaminhado para análise histopatológica, confirmando o diagnóstico de hemangioma. Nessas situações, vale ressaltar a importância do diagnostico diferencial, manobra cirúrgica adequada e a avaliação das características clínicas da lesão para evitar possíveis complicações cirurgicas.

The infantile hemangioma is a benign vascular tumor which occurs due to an abnormal proliferation of blood vessels. The clinical features three well-defined phases: proliferative, involution,and involuted. The diagnosis is made primarily by clinical history and physical examination, but when necessary, help to close the histopathological diagnosis. This paper describes a clinical case of a gift hemangioma in a baby three months old who was, in principle, diagnosed as mucocele or fibroma. The excisional surgery was performed and material sent for histopathological confirmation hemangioma. It is worth emphasizing the importance of differential diagnosis, appropriate surgical maneuver, assessment of clinical characteristics of the lesion to prevent potential surgical complications possible.

Cárie dentária e presença de placa visível em dentes ântero-superiores em crianças de 0 a 5 anos / Dental caries and presence of visible plaque on anterior teeth on 0 to 5 years old children

Objetivo: Identificar a associação entre cárie dentária e placa dental em função do estágio da primeira infância. Materiais e Métodos: Foram examinadas clinicamente 183 crianças de 8 a 69 meses de idade em dois Centros Municipais de Educação Infantil de Curitiba. As crianças foram divididas em dois grupos, de acordo com o estágio da primeira infância, G1 (até 36 meses)e G2 (37 a 69 meses). Experiência de cárie (ceo-d > 0) e presença de placa visível (em pelo menos um incisivo superior) foram avaliadas por um único pesquisador previamente calibrado (Kappainter e intraexaminador> 0,80). As mães responderam a um questionário sobre condições socioeconômicas, hábitos de higiene e alimentação. Os dados foram submetidos à análise bivariada,por meio dos testes de Qui-quadrado de Pearson e Exato de Fisher. Resultados: No grupo G1houve tendência de associação entre experiência de cárie e placa visível (p = 0,053), enquanto no grupo G2 esta associação apresentou-se significativa (p = 0,006). Houve associações entre o padrão de higienização após a alimentação durante a noite e placa visível (p= 0,026) no grupoG1; e entre estado civil das mães e placa visível no grupo G2 (p= 0,043). Conclusão: Dentro da primeira infância, a relação entre cárie dentária e placa visível em dentes anteriores torna-semais evidente com o aumento da idade.

Objective: To identify the association between dental caries and plaque in the different stages of the early childhood. Materials and Methods: 183 children 8-69 months of age from two Municipal Centers of Children Education, in Curitiba, were clinically examined for cariesand visible plaque. Children were divided in two groups according to the different stages ofthe early childhood, G1 (up to 36 months), G2 (37 to 69 months). Caries experience (ceo-d>0)and visible plaque on at least one upper incisor were evaluated by one previously calibrated examiner (kappa>0,80). Mothers were invited to answer a questionnaire about socioeconomic aspects, dental hygiene and feeding habits. Data were submitted to bivariate analysis using Pearson´s chi-square and Fisher´s exact tests. Results:G1 showed a tendency of association between caries experience and visible plaque (p=0,053), while in G2 a significant association wasfound (p=0,006).Association was found in G1 between dental hygiene after feeding during thenight and visible plaque (p=0,026), and between mother´s marital status and visible plaque onG2 (p=0,043). Conclusion: The association between dental caries and visible plaque on anteriorteeth becomes more evident on the late stages of early childhood.

Abordagem de pacientes com ansiedade ao tratamento odontológico no ambiente clínico / Management of patients with dental anxiety at clinical environment

Objetivos: Discutir a ansiedade frente ao tratamento odontológico e apresentar as principais escalas disponíveis para a sua mensuração nas crianças e nos adultos. Materiais e métodos: para esta revisão de literatura os artigos foram selecionados na base de dados online PubMed, dentre os publicados entre 1979 até julho de 2015, e que estavam de acordo com os critérios STROBE e CONSORT. Resultados: Foram selecionados 30 artigos e a revisão destes mostrou que a escolha das escalas depende da idade do paciente, de sua capacidade cognitiva, bem como do tempo disponível para a aplicação dos instrumentos. A ansiedade odontológica e a condição em saúde bucal dos pais e dos filhos estão diretamente relacionadas. Conclusão: o Cirurgião-Dentista deve estar atento para diagnosticar e quantificar a ansiedade adequadamente, visando o estabelecimento de estratégias de abordagem comportamental e clínica individualizadas, tornando a consulta odontológica mais eficaz e menos estressante, tanto para o profissional quanto para os seus pacientes.

Objectives: to present the main dental anxiety scales available for children and adults, explainits association between parents and siblings. Methodology: the articles were selected in PubMed, from 1979 until July 2015, chosen studies were according to STROBE and CONSORT. Results: Thirty articles were selected, after their review it was found that the choice of scales depends on patients’ age, cognitive ability, and available time to implement the instruments. Parents’ dental anxiety and oral health conditions interfere directly with those in children. Conclusion: Is mandatory for professionals to diagnose and quantify oral health literacy levels and anxiety, in order to establish clinical and behavioral approach strategies, making a most effective and less stressful dental appointment, for both, the professional and patients.

Anxiety in Children submitted to Dental Appointment

Objective: To determine anxiety in children undergoing dental treatment and to evaluate associated factors. Material and Methods: The sample consisted of 48 children during dental appointment in dental clinics of the Franciscano University Center, 48 caregivers, and 46 dentistry students. The modified Venham Picture Test was used to determine anxiety of children during dental appointment, before and after treatment. For determining anxiety related to dental care among caregivers, the modified Corah's dental anxiety scale was used. The Lipp`s stress symptoms inventory for adults was applied to determine the stress level of dentistry students. In addition, the individual characteristics of participants were recorded to determine their association with the presence of anxiety. Results: Anxiety was observed in 60.4% of children, and it was related to invasive dental procedures (p = 0.021), history of dental pain (p = 0.002), presence of bruxism (p = 0.028), anxious caregivers (p = 0.023), and stress of the dental student that conducted the appointment (p = 0.005). Conclusion: Overall, the majority of pediatric patients showed anxiety, which was directly related to misbehavior during dental care. Moreover, anxiety was related to individual characteristics of children and was influenced by the anxiety level of caregivers, as well as the emotional state of dentistry students during the dental appointment.

Síndrome Gorlin-Goltz asociado a fisura labiopalatina bilateral / Gorlin-Goltz syndrome associated with bilateral cleft lip and palate

El síndrome de Gorlin-Goltz corresponde a un trastorno de herencia autosómica dominante. Uno de los criterios menores de este síndrome es la fisura labiopalatina. Si bien esta corresponde a la anomalía congénita maxilofacial más prevalente, un porcentaje variable está asociado a síndromes. Presentar un caso de un paciente con síndrome de Gorlin-Goltz y fisura labiopalatina bilateral asociada constituye el propósito de esta presentación. Se trata de un paciente de 12 años de edad, con diagnóstico de síndrome de Gorlin-Goltz remitido por genetista. Clínicamente presenta anomalías cutáneas, óseas, dentarias, neurológicas, tumores, hoyuelos palmoplantares, prognatismo mandibular y fisura labiopalatina bilateral operada. Es importante reconocer las características asociadas no solo al área craneofacial, sino también a otras partes del cuerpo. Se requiere de la atención de un equipo multidisciplinario en el que el odontólogo también debe participar. La mayoría de las publicaciones se enfocan solo en el manejo quirúrgico de los quistes y no en el de otras secuelas asociadas, como lo es la fisura labiopalatina(AU)

Gorlin-Goltz syndrome is an autosomal dominant inheritance disorder. Cleft lip and palate is one of the minor criteria for this syndrome. Cleft lip and palate is the most prevalent congenital maxillofacial anomaly, and a varying percentage is associated with syndromes. Present the case of a patient with Gorlin-Goltz syndrome and associated bilateral cleft lip and palate. A 12-year-old male patient was referred by the geneticist with a diagnosis of Gorlin-Goltz syndrome. Clinical examination revealed skin, bone, dental and neurological anomalies, as well as tumors, palmoplantar pits, mandibular prognathism and operated bilateral cleft lip and palate. It is important to examine not only features associated with the craniofacial region, but also with other parts of the body. An interdisciplinary team is required of which the odontologist should be a member. Most publications only refer to the surgical management of cysts and not to associated sequels, such as cleft lip and palate(AU)

Dentes supranumerários impactados: relato de caso clínico / Supernumerary impacted teeth: case report

Dentes supranumerários impactados representam um desafio para os Odontopediatras. Estes dentes podem causar atraso na erupção do dente permanente, alteração do crescimento ósseo e posicionamento ectópico do dente permanente. O presente artigo relata a resolução de um caso de dois dentes supra numerários, em ambiente de consultório odontológico, sob sedação e com excelente sucesso clínico radiográfico.

Supernumerary impacted teeth represent a challenge to pediatric dentists. Their presence can cause failure of eruption of permanent teeth, growth and development alterations and displacement of teeth. The case reported in this paper presents the resolution of a case of two supernumerary impacted teeth in a dental office environment, under sedation and with excellent radiographic clinical success.

Ansiedade do responsável em relação ao atendimento odontopediátrico / Anxiety of guardian in relation to pediatric dentistry

Visto que, a influência dos responsáveis sobre a ansiedade da criança é notória, o objetivo da presente pesquisa foi verificar o nível de ansiedade odontológica do responsável pela criança em tratamento odontológico e quais fatores a influenciam. O estudo foi aprovado pelo comitê de ética local. A amostra foi de conveniência, com participação de 72 pais e/ou responsáveis por crianças na faixa etária de 6 a 13 anos de idade, presentes para atendimento odontológico nas instituições participantes: UAPS Jardim América/Serrinha de Várzea da Palma-MG, UAPS de Moema-MG e UninCor de Belo Horizonte-MG, selecionadas também por conveniência. Para a coleta de dados, foram utilizadas entrevista semiestruturada e a Dental Anxiety Scale (DAS), antes do atendimento da criança. Os dados foram registrados no programa SPSS versão 17.0. A maior parte dos responsáveis, que apresentaram maior valor na DAS, relataram ansiedade quando suas crianças vão ao Cirurgião-Dentista (p=0,002). O DAS dos responsáveis também se mostrou associado a características do consultório (p=0,009) e do profissional (p=0,009), à percepção sobre a ansiedade da criança (p=0,032) e à sua própria escolaridade (p=0,011). Pode-se concluir que, geralmente os responsáveis mais ansiosos também acham que suas crianças ficam ansiosas ao ir ao Cirurgião-Dentista. Portanto, o odontopediatra deve atuar de forma conjunta, abordando pais e/ou responsáveis para um tratamento tranquilo e resolutivo.

Since the influence of the guardians on the anxiety of the child is notorious, the aim of this research was to determine the level of dental anxiety of the guardian in dental treatment and which factors influence it. The study was approved by the local ethics committee. The convenience sample comprised 72 parents and/or guardians of children aged 6-13 years old, present at participating institutions for dental treatment: UAPS Jardim América/Serrinha of Várzea da Palma-MG, UAPS of Moema-MG and UNINCOR of Belo Horizonte-MG, also conveniently selected. In order to collect data, a semi-structured interview and the Dental Anxiety Scale (DAS) were used before the child’s treatment. Data were recorded using SPSS version 17.0. Most guardians, who showed the highest value in the DAS, reported anxiety when their children go to the dentist (p=0.002). The guardians DAS was also associated with both office (p=0.009) and professional (p=0.009) features, the perception of the child’s anxiety (p=0.032) and their own education (p=0.011). It can be concluded that generally the most eager guardians also find that their children are anxious to go to the dentist. Therefore, the pediatric dentist must act jointly, approaching parents and/or guardians for a tranquil and decisive treatment.

Diente natal / Natal teeth

INTRODUCCIÓN: se denominan dientes natales a aquellos dientes que se encuentran presentes en la cavidad bucal en el momento del nacimiento. Estos constituyen una alteración de erupción precoz y se presenta con más frecuencia en la región de los incisivos centrales inferiores. Dichos dientes pueden ocasionar trastornos en la alimentación, ulceraciones traumáticas sublinguales llamada entonces enfermedad de Riga-Fede y preocupaciones en cuanto a la posible aspiración de los mismos. OBJETIVO: describir las características de una niña con diente natal y los aspectos más relevantes del diagnóstico y tratamiento. PRESENTACIÓN DEL CASO: a la consulta de odontopediatría se presentó una madre con una niña de un mes de nacida, remitida del Servicio de Pediatría debido a la sospecha de presencia de un diente en el momento de su nacimiento. Dada la dificultad para la lactancia, la gran movilidad del diente y el alto riesgo de desprendimiento, el tratamiento aplicado fue la EXODONCIA. CONCLUSIONES: el caso presentó un diente natal pequeño y con ningún desarrollo radicular. El tratamiento aplicado fue exodoncia por el grado de movilidad del diente y forma cónica y puntiforme que tenía riesgo de desprendimiento. Por tener un mes de nacida no existía peligro de deficiencia de la coagulación resultante de la síntesis insuficiente de vitamina K que ocurre en los primeros días de vida. Aunque la presencia de diente natal es infrecuente es de gran importancia el conocimiento del diagnóstico y tratamiento del diente natal para el estomatólogo(AU)

INTRODUCTION: natal teeth are defined as those teeth that are present in the mouth at the time of birth. Natal teeth form an alteration of early eruption; generally the lower temporary central incisors are the most common tooth affected. These teeth are rare anomalies in newborns that can cause feed disturbances, tongue ulceration (Riga-Fede disease) and risk of aspiration of them. OBJECTIVE: the aim of this paper is to present a case report of a newborn girl with neonatal tooth and the most relevant aspects concerning the diagnosis and treatment. CLINIC CASE: a30 -day-old female baby was brought to our department, because she had one tooth at birth. Due to the great mobility it was decided to extract the mobile natal teeth. COMMENT: natal teeth, in most cases are small and with poor root development. The treatment of these teeth will depend on the degree of tooth mobility and presence of sharp incisal edge.The extraction must do after of the first weeks, because the vitamin K levels are low in the first days after birth and this is very important for the clot formation(AU)

Celulitis facial en niños con criterio de hospitalización / Children with facial cellulitis and hospitalization criterion

La celulitis facial puede convertirse en un grave riesgo vital cuando no se tiene en cuenta el tratamiento adecuado. Constituye un problema de salud en la población de edades pediátricas, pues es la segunda causa más frecuente de ingreso hospitalario en la cirugía maxilofacial, luego de los traumatismos maxilofaciales. Objetivo: describir el comportamiento y el manejo terapéutico por la Atención Primaria de Salud en los municipios de Playa, Marianao y Lisa de La Habana. Métodos: se realizó un estudio observacional retrospectivo en 53 pacientes que fueron ingresados en el Servicio de Cirugía Máxilo Facial del Hospital Pediátrico Docente Juan Manuel Márquez, desde enero de 2001 a enero de 2007. Resultados: hubo ausencia de significación estadística entre sexos y entre los grupos de edades. La media de la edad fue de 8 años, con una desviación estándar de 4. La celulitis más frecuente fue la odontógena (60,4 por ciento). El 60,3 por ciento de los pacientes fueron mal manejados por la atención primaria. Los grupos dentarios más afectados sugieren que las acciones preventivas deben encaminarse mayormente a la población con dentición temporal y mixta. Conclusiones: hubo mayor representación del sexo masculino y del grupo de 1 a 5 años. El tipo de celulitis facial predominante fue la odontógena. En más de la mitad de los casos el tratamiento antimicrobiano aplicado en la atención primaria de salud fue inadecuado. Al momento del ingreso predominó la evaluación clínica severa(AU)

Facial cellulitis can become a serious vital risk when doctors don't keep in mind the appropriate treatment. It constitutes a health problem in pediatric population, because it is the second more frequent cause of hospital admittance in the Maxillofacial Surgery Service, followed by maxillofacial traumatisms. Objective: to understand facial cellulitis behavior and to describe the therapeutic handling in Primary Health Care (PHC) in Playa, Marianao, and Lisa municipalities in Havana. Method: a retrospective observational study was performed on 53 patients who were admitted to the Maxillofacial Surgery Pediatric Teaching Hospital "Juan Manuel Marquez", from January 2001 to January 2007. Results: there was no statistical significance between genders and age groups, the mean age was 8 years with a standard deviation of 4. The most frequent was odontogenic cellulitis (60.4 per cent). 60.3 per cent of patients were poorly handled by the primary care service. The most affected dental groups suggest that preventive measures should be directed mostly to people with temporary and mixed teething Conclusions: there was higher representation in male patients and the 1 to 5 age group. Odontogenic facial cellulitis was the predominant type. Antimicrobial treatment was inadequate in more than half of cases at the primary health care. At admission severe clinical evaluation prevailed(AU)

Morfologia craniofacial e sua associação com o comprometimento funcional em adolescentes com paralisia cerebral / Craniofacial morphology and its association with functional impairment in adolescents with cerebral palsy

Este estudo objetivou aprofundar o conhecimento sobre a morfologia óssea craniofacial de jovens com Paralisia Cerebral, e associá-la ao comprometimento funcional geral e a função motora orofacial. Utilizamos uma amostra pareada por gênero e idade, constituída de 21 adolescentes com Paralisia Cerebral (GE) com idade média de 14,7(2,6) anos para o gênero feminino e 13,9(2,8) anos para o gênero masculino, e 22 adolescentes normorreativos (GC) com idade média de 14,6(2,6) anos para o gênero feminino e 14,8 (3,8) anos para o gênero masculino. Foram realizadas análises das imagens obtidas por Tomografia Computadorizada Feixe Cônico e software OsiriX, através da mensuração de medidas lineares e angulares. A avaliação da função motora geral foi dada pela aplicação do instrumento Gross Motor Functional Classification System (GMFCS). O instrumento para avaliação da motricidade oral aplicado neste estudo foi o OMAS (Oral Motor Assessment Scale). Quando comparado os grupos estudo e controle, as medidas que exibiram valores estatisticamente significantes foram Co-Pg (p=0,060), ENA-N (p=0,2), N-Me (p=0,088), N.A.Pg (p=0,04) e S.N.B (p=0,11). O GE apresentou uma tendência de perfil mais convexo, indicado pelo ângulo N.A.Pg, menor do que no GC (GE:168,48 (8,05)/GC:172,77(5,21)).

A medida Co-Pg menor (GE:106,36(6,08)/GC:107,94(9,45)), analisada juntamente com o ângulo S.N.B menor (GE:79,69(4,24)/GC:81,21(6,33)), indicam a mandíbula ligeiramente menor e mais retruída nos adolescentes com PC em relação ao GC. A medida N-B (p=0,035) foi estatisticamente significante e inversamente proporcional ao OMAS. Não houve relação estatisticamente significante entre o comprometimento motor geral e qualquer uma das medidas angulares e lineares no GE. Podemos concluir que a morfologia craniofacial em adolescentes com PC é diversa à de adolescentes normorreativos em algumas medidas, que não houve associação entre comprometimento motor geral e crescimento craniofacial de adolescentes com a PC e que a função motora orofacial de menor score está associada a um rosto mais longo.

This study aimed to deepen understanding of the craniofacial bone morphology of young people with cerebral palsy, and associate it to the general functional impairment and the orofacial motor function. We use a matched sample by gender and age , consisting of 21 adolescents with cerebral palsy (SG) , with a mean age of 14.7 years (2.6) for females and 13.9 years (2.8) for males , and a control group (CG), composed of 23 normoreactive adolescents with a mean age of 14.6 years (2.6) for females and 14.8 years (3.8) for males . Analysis of images obtained by CT Cone Beam and OsiriX software were performed, through the measurement of some linear and angular measurements. The evaluation of overall motor function was given by application of the instrument Gross Motor Functional Classification System (GMFCS). The instrument to evaluate oral motor applied in this study was the OMAS (Oral Motor Assessment Scale). When comparing the study and control groups, the measures showed statistically significant values were Co - Pg (p=0.060), ENA - N (p=0.2), N -Me (p=0.088), NAPg (p=0 04) and SNB (p= 0.11). The SG showed a tendency to a more convex profile, indicated by lower NAPg angle (GE: 168.48 (8.05) / GC: 172.77 (5.21)). The smaller linear measure Co - Pg (GE: 106.36 (6.08) / GC : 107.94 (9.45)) , analyzed along with smaller SNB angle (GE : 79.69 (4.24) / GC : 81.21 (6.33)), indicates a slightly smaller and more retruded mandible in adolescents with CP compared to the CG . NB (p=0,035) was statistically significantly and inversely proportional to the OMAS

There was no statistically significant relationship between generalized motor impairment and any of the angular and linear measurements in SG. We can conclude that the craniofacial morphology in adolescents with CP is different to the normoreactive teens in some measurements , that there was no overall association between motor impairment and craniofacial growth of adolescents with CP and orofacial motor function is associated with a longer face.

Dentistry for babies: caries experience vs. assiduity in clinical care

Aim: This study analyzed and compared the experience of dental caries in 300 children aged 0 to 48 months, who were participants and non-participants of a preventive program ‘Dentistry for babies’, as well as the correlation between assiduity of dental visits and experience of dental caries. Methods: The subjects were randomly selected and divided into two groups: G1 ‘Nonparticipant children of the Program’ (n=100) and G2 ‘Participant Children of the Program’ (n=200). Each group was subdivided in two subgroups: 0-24 months and 25-48 months. The collecteddata from G2 were analyzed, relating the variation of the dmft index (dmft refers to primary teeth: d = decayed, m = missing/extracted due to caries, f = filled, t = teeth) (C) and dental caries prevalence (P) with the influence of assiduity factor in each subgroup. To collect data, clinical examinations were performed using tactile and visual criteria by a single calibrated examiner.The data were statistically analyzed using the ‘paired t-test’, ‘Mann-Whitney’ and ’Chi-Squared’ tests (p<0.05). Results: It was found that prevalence and dmft index were statistically significant (P=0.0001) with the greatest values observed in G1 (p=0.0001). The values were: PG1 (73%), PG2 (22%), CG1 (3.45±3.84), CG2 (0.66±1.57). Assiduity was significant in G2 (p=0.0001). The values observed were: P-Assiduous (2%), P-Non-assiduous (42%), C-Assiduous (0.04±0.31), and C-Non-assiduous (1.29±2.01). Conclusions: The participation in the program had a positive influence on the oral health of babies. Complete assiduity to the program resulted in the lowest rates and prevalence of dental caries.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Traumatismo de tercio medio facial en pacientes pediátricos y adolescentes / Midface trauma in pediatric and adolescents patients

El objetivo de este estudio fue realizar un análisis retrospectivo de la etiología, incidencia, uso de dispositivos de seguridad, tipo y severidad de las fracturas, tratamiento y complicaciones de los traumatismos del tercio medio facial en una población pediátrica e adolescente del Estado de São Paulo. La muestra fue seleccionada a partir del análisis de historias clínicas de 2986 pacientes víctimas de traumatismos faciales atendidos entre 1999 y 2008 por el Área de Cirugía Buco-Maxilo-Facial de la Facultad de Odontología de Piracicaba, Universidad Estatal de Campinas, Estado de São Paulo-Brasil. Durante este periodo, 757 pacientes menores de 18 años fueron víctimas de traumatismos maxilofaciales. De éstos, 138 pacientes presentaron 148 fracturas nasales y de tercio medio. Los adolescentes fueron el grupo etario más afectado, mientras que el género masculino fue el de mayor prevalencia. Los accidentes ciclísticos se constituyeron en la principal etiología (21.7%). El tratamiento conservador fue utilizado en la gran mayoría de los casos (118 pacientes, 85.5%). Veinte pacientes (14.5%) recibieron tratamiento quirúrgico y solo un caso de complicación pos-operatoria fue reportado. La incidencia de traumatismos y fracturas del tercio medio fue alta en la región de estudio. Los accidentes ciclísticos y las agresiones físicas fueron los principales factores etiológicos, siendo el género masculino predominante en todos los grupos etarios evaluados. Las fracturas nasales y del complejo zigomático orbitario fueron las más prevalentes, mientras que el tratamiento conservador fue instituido en la gran mayoría de los casos

This study showed a retrospective analysis of the etiology, incidence, use of safety devices, type and severity of fractures, treatment and complications of midface trauma in a pediatric and adolescent population of São Paulo - Brazil. We analyzed 2986 medical records of facial trauma patients treated by the Division of Oral and Maxillofacial Surgery Piracicaba Dental School, State University of Campinas, São Paulo - Brazil between 1999 and 2008. During this period, 757 patients under 18 were identified and 138 had 148 nasal and midface fractures. The adolescents were the most affected age group, male gender being the most prevalent. The most common injury causes were bicycle accident (21.74%) and violence (19.6%). Conservative treatment was used in the majority of cases (118 patients, 85.5%). Twenty patients (14.5%) received surgical treatment and only one case of postoperative complication was reported. The incidence of trauma and middle third fractures in pediatric and adolescents patients was high in the study area, being the main etiological factors the bicycle accidents and violence. The male were most affected in all age groups tested. Nasal fractures and zygomatic complex were most prevalent, while conservative treatment was instituted in most cases

La prevalencia de caries dental y evaluación de los factores de riesgo en niños que participaron o no / Prevalence of dental caries and evaluation of risk factors in children participating or not of a preventive program

El objetivo de este estudio fue comparar la prevalencia de la caries dental y evaluar los factores de riesgo en los niños que presentaron o no caries dental en el Programa de Atención Odontológica a partir de la Primera Infancia (PAOPI) y en la Clínica de Atención Primaria (CAP), ambos pertenecientes la Clínica del Bebé de UNIGRANRIO. Este estudio fue retrospectivo, observacional y transversal. Se evaluaron 330 niños entre 12 y 36 meses, que fueron divididos en dos grupos: G1- PAOPI(n = 108) y G2- CAP(n = 222). CEP: 032/2005. Los datos fueron extraídos de las historias clínicas de los pacientes entre los meses de febrero y novienbre de 2008, por un único investigador. Los niños del G1, debían iniciar el PAOPI hasta los 12 meses de edad, sin perder las consultas de examen; los niños del G2 debían ser niños que nunca participaron de programas de prevención y que estaban iniciando el tratamiento en la CAP. Los datos fueron tabulados utilizando el EPI-Info 6.04, evaluados a través de los tests del "Chi-cuadrado" y "t-Student", p<0,05. Hubo datos significativos en cuanto a: los años de estudio de los padres o tutores, frecuencia de lactancia y limpieza posterior, y contaminación salival. La prevalencia de la caries dental para el G1 fue de 4,6% y 45,0% en el G2. El PAOPI fue capaz de prevenir y/o controlar el desarrollo de caries en la edad estudiada, en comparación a CAP

The objective of this study was to compare the dental caries prevalence and to evaluate the risk factors in children that presented or not carious lesions at the Program of Odontological Attention from First Infancy (PAOPI) and at the Clinic of Primary Attention (CAP), both belonging to the Baby-Clinic of UNIGRANRIO. This study had a retrospective, observational and transversal character. A total of 330 children between 12 and 36 months old were evaluated and divided into two groups: G1- PAOPI (n=108) and G2- CAP (n=222). CEP:032/2005. The data were collected from prontuaries between February 2008 and Novenber 2008 by a single researcher. The G1 children should have initiated the PAOPI program under the age of 12 months old and should not have missed the dental revision examinations. The G2 children should have been those that had never taken part of prevention programs and that were initiating the treatment at CAP. The data were tabulated at EPI-Info 6.04 and evaluated using both the Chi-square and t-Student tests, p<0.05. There was significance regarding the years of study of the father, the frequency of breast-feeding and later cleanness and salivary contamination. The caries prevalence was 4.6% and 45.0% for G1 and G2, respectively. The PAOPI was capable of preventing and/or controlling the development of carious lesions within the studied age range, when compared to CAP

Confecção de anteparo para restauração estética de dente permanente traumatizado / Mock-up for esthetics restorative treatment in traumatized permanent teeth

Lesões traumáticas em dentes anteriores se apresentam na clínica odontológica com frequência podendo, muitas vezes, gerar necessidade de tratamento restaurador. O pre- sente trabalho apresenta um caso clínico de trauma em criança de dez anos de idade com fratura de esmalte e dentina no dente 11. Foi realizada a confecção de um anteparo para auxiliar na restauração direta deste dente, posteriormente à moldagem da arcada superior. O anteparo proporcionou resultado final satisfatório e com melhor estética. Portanto, conclui-se que a confecção de anteparo para restauração direta em dentes anteriores traz vantagens no tempo gasto para realização do procedimento clínico, além de resultado satisfatório e estético.

Traumatic injuries are common in dental clinic and usually require restorative treatment. This paper presents a case of trauma with enamel-dentin fracture without pulpal involvement of permanent central incisor (11) in a ten years old patient. After taking im- pression of upper arch, we performed the construction of a mock-up to assist the direct restorative treatment. The mock-up provided satisfactory result with better aesthetics. Therefore, we conclude that the mock-up construction for direct restorative treatment to dental fractures of anterior teeth provides advantages such as reduction in clinical time and satisfactory aesthetics results.

Estado y salud buco-dental del paciente pediátrico con daño neurológico / Status and health oral-dental pediatric patient with neurological damage

Este documento describe a groso modo las características bucales que presentan los pacientes con daño neurológico, además de las consideraciones y el manejo en la atención estomatológica de este grupo de población infantil que puede variar de daño neurológico leve hasta severo, incluyendo a los de atención intrahospitalaria. Este tipo de pacientes sufre de severos problemas bucales especialmente la alta incidencia de caries dental y enfermedades que afectan el periodonto debido a las características propias de su diagnóstico que contribuye y dificulta el cuidado bucal por parte de sus cuidadores y por déficit en la atención estomatológica de los profesionales de la salud bucal, quienes desconocen en su mayoría las consideraciones a tomar en la atención de este grupo de pacientes

This document describes the characteristics of oral that presenting patients with neurological damage, in addition to the considerations and the handling in the stomatological care of this group of children which can vary from mild to severe neurological damage, including those for inpatient care. This type of patients suffering from severe oral problems especially the high incidence of dental caries and diseases which affect the periodont because of the specificity characteristics of her diagnosis that helps and hinders the oral care by their caregivers and deficits in attention stomatological of oral health professionals those who are unaware of the considerations to take care of this patient group