Comparison of Efficacy and Safety of Midazolam versus Nitrous Oxide as Sedative Agents during Paediatric Dental Treatment: A Systematic Review

ABSTRACT Objective: To identify and study the existing literature on the efficacy and safety of midazolam compared to inhalation of nitrous oxide in children undergoing dental treatment. Material and Methods: Electronic resources such as PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, and SIGLE were thoroughly searched. The title scan was used to find randomised controlled trials reviewed for inclusion by reading the abstract. Studies comparing the sedative, behavioural, and anxiolytic effects and safety in children undergoing dental treatment under midazolam and nitrous oxide inhalation were included. The Cochrane Reviews system software, Revman 5.4.1, was used to assess the quality of the included studies. Results: 11328 articles were identified by screening the electronic databases, of which 10906 were eliminated after titles were read and duplicates were removed. Ten full-text articles were examined, of which three were excluded as they did not match the eligibility criteria. Hence, a total of 7 studies were included. Midazolam and nitrous oxide inhalation were not statistically different in terms of the success of treatment and behaviour modification. However, midazolam showed a deeper level of sedation and resulted in amnesia in more children when compared to nitrous oxide sedation. All of the included studies were found to have a high risk of bias. Conclusion: Though all the studies included showed an increased risk of bias, midazolam and nitrous oxide inhalation seem equally effective sedative agents for controlling behaviour in children undergoing dental treatment. Midazolam shows a deeper sedation level when given orally and produces a higher rate of anterograde amnesia.

Dental age estimation by assessing the pulp volume of five teeth in a peruvian population using cone beam computed tomography images / Estimación de la edad dental evaluando el volumen pulpar de cinco dientes utilizando imágenes de tomografías computarizadas de haz cónico en una población peruana

Abstract Dental age estimation is very important for individual identification in criminal and civil forensic investigations. One of the methods for age estimation is studying age related changes in pulp volume of teeth. The objective of the current study was to estimate dental age from the pulp volume of five different categories of teeth of a Peruvian sample using cone beam computed tomography (CBCT). Retrospective CBCT records of 231 patients (females (134), males (97), age: 12-60 years) were included in the study, categorized into five different age groups (12-19, 20-29, 30-39, 40-49, 50-59, 60 years and older). Dental pulp volume of five categories of teeth(upper canines, left upper central incisors, left upper first molars, lower left first premolars, first molars) were analyzed using Romexis® 5.3.3.5 software for each patient. There was a reduction in the pulp volume of upper right and left canine with age. The Pulp volume was lowest in people aged 60 years and over. Linear regression analysis of the pulp volume and chronological age showed a coefficient of determination of 30%, suggesting a weak correlation. A weak correlation between dental pulp and age is derived. But, a robust large homogenous sample of teeth in future for different age groups may establish a reliable regression equation.

Resumen La estimación de la edad dental en personas vivas y cadáveres es muy importante para la Odontología Forense, sobre todo en casos de identificación en investigaciones legales y sociales. El objetivo del estudio fue estimación de la edad dental mediante la medición del volumen pulpar de imágenes dentales en tomografía computarizada de haz cónico (TCHC) de pacientes peruanos. Fueron analizadas 231 TCHC de pacientes entre 12 a 60 años a más. (Mujeres (134), hombres (97)) se dividieron en seis grupos de edad (12-19, 20-29, 30-39, 40-49, 50-59, 60 años a más). El análisis volumétrico de la pulpa dental se realizó en un total de 1155 dientes (caninos superiores, incisivos centrales superiores izquierdos, primeros molares superiores izquierdos y primeros premolares inferiores izquierdos), mediante el software Romexis® 5.3.3.5. El análisis de regresión lineal mostró un coeficiente de determinación del 30% que sugiere una correlación débil entre la relación del volumen pulpar de los dientes y la edad. El volumen pulpar de los caninos superiores derecho e izquierdo disminuyó a medida que aumentaba la edad y el volumen pulpar en dientes de personas de 60 años a más fue el más bajo. Sin embargo, se pueden proponer estudios futuros para incluir una gran muestra homogénea de dientes en diferentes categorías y grupos de edad para confirmar la correlación y establecer una ecuación de regresión confiable.

Manejo odontológico en paciente con síndrome de Cornelia de Lange / Dental treatment of a patient with Cornelia de Lange syndrome

El síndrome de Cornelia de Lange (SCdL) es un trastorno genético poco frecuente y se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Sus principales características clínicas son múltiples anomalías congénitas, dimorfismo facial, hirsutismo, hipertricosis, retraso psicomotor, discapacidad intelectual, restricción del crecimiento prenatal y postnatal, anomalías de manos y pies, así como malformaciones congénitas que afectan a distintos órganos. En pacientes con SCdL es necesario hacer hincapié en la higiene oral debido a la discapacidad intelectual que puede presentarse y asegurarse de que se realiza una adecuada valoración y saneamiento dental de forma periódica con el fin de prevenir enfermedades bucodentales. El objetivo de este reporte de caso es describir el manejo odontológico de un paciente de 10 años con SCdL y revisar las características clínicas y hallazgos radiológicos presentes en la cavidad oral (AU)

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder and is principally attributed to mutations in the NIPBL, SMC3 and SMC1A genes. The main clinical characteristics are multiple congenital anomalies, facial dimorphism, hirsutism, hypertrichosis, psychomotor retardation, intellectual disability, prenatal and postnatal growth restriction, hand and foot anomalies, as well as congenital malformations affecting different organs. In patients with CDLS, it is necessary to focus on oral hygiene due to the intellectual disability that may be present and to ensure that adequate dental valuation and hygiene is routinely performed in order to prevent oral diseases. The aim of this case report is to describe the dental management of a 10-year-old patient with CDLS and review the clinical characteristics and radiological findings that are present in the oral cavity (AU)

Periodontitis en niños sanos de 3 años: dos casos con seguimiento a 5 años / Periodontitis in healthy 3-year-old children: two cases with 5-year follow-up

Objetivo: La periodontitis en dentición primaria es ex- cepcional en niños sin enfermedades sistémicas. El objetivo de este informe es describir las características clínicas y ra- diográficas de dos casos de niños de 3 años sistémicamente sanos con periodontitis, y su tratamiento con seguimiento a 5 años. Casos clínicos: En ambos casos, a los 3 años de edad los niños fueron derivados al especialista en periodoncia por su odontopediatra debido a la pérdida muy temprana de inci- sivos inferiores. El examen clínico y radiográfico mostró pér- dida de inserción clínica, pérdida ósea y movilidad dental en otros incisivos superiores e inferiores. Se realizó la intercon- sulta médica y se descartó que los niños padecieran enferme- dades relacionadas con el diagnóstico de periodontitis como manifestación de una enfermedad sistémica. El tratamiento consistió en la instrucción de medidas de higiene bucal que debían ser ejecutadas por los padres, ins- trumentación subgingival, antisépticos locales, medicación antibiótica sistémica y mantenimiento periodontal. No se rea- lizaron extracciones como parte del tratamiento. En ambos casos uno de los incisivos presentes al momento de la con- sulta se perdió prematuramente, antes de los 4 años. El resto de los incisivos primarios cumplieron su ciclo normal. Luego de 5 años de seguimiento, a la edad de 8 años, ambos niños presentaban los incisivos y los primeros molares permanentes periodontalmente sanos y el resto de los dientes primarios sin signos de periodontitis (AU)

Aim: Periodontitis in primary dentition is exceptional in children without systemic diseases. The objective of this article is to describe the clinical and radiographic charac- teristics of two cases of systemically healthy 3-year-old chil- dren with periodontitis, and their treatment, with a 5-year follow-up. Clinical cases: In both cases, at 3 years of age, the chil- dren were referred to a periodontic specialist by their pediat- ric dentist, due to the very early loss of lower incisors. Clin- ical and radiographic examination showed loss of clinical attachment, bone loss and dental mobility in other upper and lower incisors. A medical consultation was carried out and diseases related to the diagnosis of periodontitis as a mani- festation of a systemic disease were ruled out. The treatment consisted of instruction on oral hygiene measures that had to be carried out by the parents, subgingival instrumentation, local antiseptics, systemic antibiotic medication, and perio- dontal maintenance. No extractions were performed as part of the treatment. In both cases, one of the incisors present at the time of consultation was lost prematurely, before the age of 4 years. The rest of the primary incisors completed their normal cycle. After 5 years of follow-up, at the age of 8 years, both children showed periodontally healthy incisors and first permanent molars, and the rest of the primary teeth without signs of periodontitis (AU)

Tratamiento integral de una adolescente con dentinogénesis imperfecta tipo I / Comprehensive treatment of an adolescent with type I dentinogenesis imperfecta

La dentinogénesis imperfecta (DI) es un desorden hereditario de carácter autosómico dominante, que se origina durante la etapa de histodiferenciación en el desarrollo dental y altera la formación de la denti-na. Se considera una displasia dentinaria que puede afectar ambas denticiones con una incidencia de 1 en 6000 a 8000 nacimientos. El tratamiento del pa-ciente con DI es complejo y multidisciplinario, supone un desafío para el odontólogo, ya que por lo general están involucradas todas las piezas dentarias y afec-ta no solo la salud buco dental sino el aspecto emo-cional y psicológico de los pacientes. Objetivo: des-cribir el tratamiento integral y rehabilitador realiza-do en una paciente adolescente con diagnóstico de DI tipo I. Relato del caso: Paciente de sexo femenino de 14 años, que concurrió en demanda de atención a la Cátedra de Odontología Integral Niños de la FOU-BA derivada del Hospital "Prof. Dr. Juan P. Garrahan" con diagnóstico de osteogénesis imperfecta tipo III (OI). Nunca recibió atención odontológica y el motivo de consulta fue la apariencia estética de sus piezas dentarias. Se realizó el examen clínico y radiográfico arrojando el diagnóstico de DI tipo I asociada a OI. Conclusión: El tratamiento rehabilitador de la DI tipo I en los pacientes en crecimiento y desarrollo debe estar dirigido a intervenir de manera integral y tem-prana para resolver la apariencia estética y funcio-nal, evitar las repercusiones sociales y emocionales y acompañar a los pacientes y sus familias (AU)

Dentinogenesis imperfecta (DI) is an autosomal dominant inherited disorder that originates during the histodifferentiation stage of tooth development and alters dentin formation. It is considered a den-tin dysplasia that can affect both dentitions with an incidence of 1 in 6000 to 8000 births. The treatment of patients with DI is complex and multidisciplinary, it is a challenge for the dentist, since in general all the teeth are involved and it affects not only oral health but also the emotional and psychological aspect of the patients. Objective: To describe the comprehen-sive and rehabilitative treatment carried out in an adolescent patient with a diagnosis of DI type I. Case report: A 14-year-old female patient, who required dental attention at the Department of Pediatric Den-tistry of FOUBA and was referred from the Hospital "Prof. Dr. Juan P. Garrahan" with a diagnosis of os-teogenesis imperfecta type III (OI). The patient never received dental care and the reason for consultation was esthetic appearance of her teeth. A clinical and radiographic examination was performed, resulting in a diagnosis of DI type I associated with OI. Conclu-sion: Rehabilitative treatment of DI in growing and developing patients will be aimed at early and com-prehensive intervention to resolve esthetic and func-tional appearance, avoid social and emotional reper-cussions and accompany patients and their families (AU)

Pulpectomía mecanizada en molares primarios: caso clínico / Mechanized pulpectomy in primary molars: a clinical case

Las pulpectomías en molares primarios están indica-das en casos de diagnóstico de pulpitis irreversible o necrosis y reabsorción radicular mínima o nula. Son tratamientos laboriosos y extensos, que sólo pueden ser llevados a cabo en pacientes colaboradores. En búsqueda de simplificar esta terapéutica y mejorar su eficacia, se propone la mecanización de la pre-paración de los conductos de molares primarios. Diversos autores aseguran que esta técnica opti-miza el tiempo clínico y mejora la calidad del trata-miento, obteniendo gran aceptación en la literatura actual. Se presenta la secuencia de procedimientos, resolución y controles de dos tratamientos de pul-pectomía con instrumentación mecanizada en mola-res primarios (AU)

Pulpectomies in primary molars are indicated in cases of irreversible pulpitis or necrosis with mini-mal or no root resorption. They are laborious and ex-tensive treatments, which only can be carried out in cooperative patients. In order to simplify this therapy and improve its effectiveness, the mechanization of root canal preparation is proposed. Several authors assume that this technique optimizes preparation time and improves the quality of treatment, obtaining great acceptance in the current literature. We report the sequence of procedures, resolution, and controls of two pulpectomies with mechanized instrumenta-tion in primary molars (AU)

Dental Fear/Anxiety in Children and Child Emotional and Behavioural Problems

ABSTRACT Objective: To investigate the association between emotional and behavioural problems and dental fear/anxiety (DFA) in children aged four to 12 years treated at a clinic in southern Brazil. Material and Methods: In this cross-sectional study where mother-child dyads were interviewed, emotional and behavioural problems were investigated using the Strengths and Difficulties Questionnaire (SDQ) (considering five subscales). Children's DFA was evaluated through the Venham Picture Test. For each SDQ subscale, Poisson regression model was explored. Prevalence ratios (PR) were estimated, considering a significant level of p ≤ 0.05. Results: Overall, 128 children participated in this study. Most children were female (54.7%) and aged between 7 and 9 years (39.8%). The prevalence of emotional problems was 47.7% and behavioural problems were 46.1%. The prevalence of DFA was 18.8%. Children with emotional problems had a 2.3 higher prevalence of DFA (95%CI 1.06-5.04). In general, behavioural problems were not associated with DFA (95%CI 0.84-3.34) only when conduct problems were considered (2.20; 95%CI 1.02-4.70). Conclusion: Children aged between 4 and 12 years who present emotional and conduct problems tend to show higher DFA.

Impact of Mobile Dental Clinics on the Quality of Life of Children

ABSTRACT Objective: To evaluate the impact of mobile dental clinics on the oral health-related quality of life (OHRQL) of children. Material and Methods: A longitudinal epidemiological study was conducted with participants from seven mobile dental clinics carried out between May 2019 and January 2020 by the NGO Missão Sorrisos. Parents and children who attended the program had their sociodemographic data collected. Both completed the Scale of Oral Health 5 (SOHO-5) self-reported questionnaire before treatment and again 30 days after treatment. Results: The improvement in the children's oral health after treatment at the mobile clinics is reflected in the pre-and post-treatment medians measured by the SOHO-5 total score from the children's own reports from the parents' reports. The procedures performed were effective in reducing pain and difficulties in eating, drinking, and sleeping. An improvement in the perception of the children's appearance and self-confidence was reported, both from the perspective of the parents/guardians and the children themselves. The chance of improvement in the perception of the children's oral health was greater for parents (OR=5.96; CI95%: 1.32-26.84) and children (OR=5.76; CI95%: 1.28-25.95) from families whose main caregiver was not professionally active at the time of the study. Conclusion: The mobile dental clinics had a positive impact on the OHRQL of children from the perspective of the participants of the study.

Cárie na primeira infância, má oclusão, fatores psicossociais e qualidade de vida relacionada à saúde bucal de crianças e suas famílias / Early childhood caries, malocclusion, psychosocial factors and oral health-related quality of life in children and their families

Cárie na primeira infância (CPI) e má oclusão podem afetar a qualidade de vida relacionada à saúde bucal (QVRSB) de crianças e suas famílias. Fatores psicossociais relacionados às crianças, suas famílias e comunidade na qual estão inseridas devem ser estudados. Diante disso, os objetivos desta tese foram: 1) verificar a associação entre fatores psicossociais associados à CPI e à QVRSB em pré-escolares e suas famílias (Artigo 1); 2) avaliar o impacto da mordida aberta anterior (MAA) e da mordida profunda (MP) na QVRSB de préescolares, e verificar o papel da resiliência parental como um fator moderador nessa associação (Artigo 2). Foi realizado um estudo transversal representativo com pré-escolares de 4-6 anos de idade e seus pais/responsáveis em Ribeirão das Neves, MG, Brasil. Os pais/responsáveis responderam às versões brasileiras do Early Childhood Oral Health Impact Scale (ECOHIS) e Escala de Resiliência, e um questionário com dados socioeconômicos e de comportamento de saúde bucal da criança. Os pré-escolares foram examinados por duas dentistas treinadas e calibradas para o diagnóstico de CPI e consequências pulpares de lesões cariosas não tratadas (Kappa>0,95), utilizando-se a versão epidemiológica do International Caries Detection and Assessment System (ICDASepi) combinado com o índice pufa e, assim categorizados: sem cárie, estágio inicial (opacidade notável/pigmentação retida em fundo de fóssulas e fissuras), estágio moderado (cavitação em esmalte/sombreamento em dentina subjacente), estágio extenso sem consequências pulpares (cavitação com exposição dentinária) e estágio extenso com consequências pulpares (cavitação com exposição dentinária, com envolvimento pulpar e/ou presença de fístulas/abscessos). A presença de MAA e MP foi avaliada através do índice de Foster e Hamilton. Os dados foram analisados por meio da modelagem por equações estruturais, utilizando-se o software Mplus, versão 8.6 (Artigo 1) e por meio da análise de moderação, utilizando-se o PROCESS (PROCESS for SPSS, version 3.4) (Artigo 2). Os resultados do artigo 1 demonstraram que menor status socioeconômico (ß =-0,250; p<0,001) e maior frequência de consumo de açúcares livres (ß=0,122; p=0,033) foram associados diretamente com estágio extenso de cárie com consequência pulpar, enquanto menor resiliência dos pais impactou indiretamente estágios mais avançados da CPI, por meio da variável frequência de consumo de açúcares livres (ß =-0,089; p=0,048). Além disso, CPI foi associada com piores escores tanto da QVRSB da criança (b=0,587; p<0,001) quanto da família (ß =0,506; p<0,001). Os resultados do artigo 2 demonstraram que préescolares filhos de pais com baixa resiliência, e que possuíam MAA apresentaram impacto negativo na QVRSB (ß:3,95;p=0,025) em comparação àqueles que apresentaram oclusão normal. A resiliência parental não atuou como fator moderador na associação entre MP e QVRSB (p>0,05). Conclui-se que quanto maior a gravidade da CPI, maior o impacto negativo na QVRSB de pré-escolares e suas famílias. Os principais fatores associados à CPI mais grave foram menor nível socioeconômico, maior frequência de consumo de açúcar livre e menor resiliência parental (Artigo 1). MAA interferiu negativamente na QVRSB dos pré-escolares, sendo essa associação mais forte quando a resiliência parental era baixa. Portanto, a resiliência dos pais atuou como fator moderador na relação entre MAA e QVRSB (Artigo 2).

Early childhood caries (ECC) and malocclusion can affect the oral health-related quality of life (OHRQoL) of children and families. Psychosocial factors related to children, their families and the community in which they are inserted must be studied. Therefore, the objectives of this thesis were: 1) to verify the association between psychosocial factors with ECC and OHRQoL in preschoolers and their families (Manuscript #1); 2) to evaluate the impact of anterior open bite (AOB) and deep bite (DB) on the OHRQoL of preschool children and the role of parental resilience as a moderating factor in such association (Manuscript #2). A representative crosssectional study was carried out with 4-to-6-year-old preschoolers and their parents/caregivers from Ribeirão das Neves, MG, Brazil. Parents/caregivers selfadministered the Brazilian versions of the Early Childhood Oral Health Impact Scale (ECOHIS) and the Resilience Scale, as well as a questionnaire about socioeconomic and child's oral health behavior data. Preschoolers were examined by two trained and calibrated dentists for the diagnosis of ECC and pulpal consequences of untreated carious lesions (Kappa>0.95), using the epidemiological version of the International Caries Detection and Assessment System (ICDASepi) index combined with the pufa index: no caries, early stage (notable opacity/retained pigmentation in the background of pits and fissures), moderate stage (cavitation in enamel/shading in underlying dentin), extensive stage without pulpal consequences (cavitation with dentin exposure) and extensive stage with pulpal consequences (cavitation with dentin exposure, and pulp involvement and/or fistulas/abscesses). The presence of AOB and DB were evaluated using the Foster and Hamilton index. Data were analysed through Structural Equation Model (SEM), using the Mplus software, version 8.6 (Manuscript #1) and through moderation analysis, using PROCESS (PROCESS for SPSS, version 3.4) (Manuscript #2). The results of the Manuscript #1 demonstrated that lower socioeconomic status (b=-0.250; p<0.001) and higher frequency of consumption of free sugars (ß=0.122; p=0.033) were directly associated with an extensive stage of caries with pulpal consequences, while lower parental resilience indirectly impacted more advanced stages of ECC, through the variable frequency of consumption of free sugars (b=-0.089; p=0.048). In addition, ECC was associated with worse scores in both the child's (ß=0.587; p<0.001) and the family's (ß=0.506; p<0.001) OHRQoL. The results of the Manuscript #2 demonstrated that preschoolers whose parents presented low resilience, and preschoolers who presented OAB, had a negative impact on OHRQoL (ß:3.95; p=0.025) compared to those who had normal occlusion. Parental resilience did not act as a moderating factor in the association between DB and OHRQoL (p>0.005). It is concluded that the severity of ECC negatively impacted the OHRQoL of preschoolers and their families, and the main factors associated with the severity of ECC were lower socioeconomic status, higher frequency of free sugar consumption and lower parental resilience (Manuscript #1). OAB negatively interfered with the OHRQoL of preschoolers, with this association being stronger when parental resilience was low. Therefore, parental resilience acted as a moderating factor in the relationship between OAB and OHRQoL (Manuscript # 2).

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.

Guía diagnóstica de hábitos lesivos orales para pediatras / Diagnostic guide of oral injurious habits for pediatricians / Guia de diagnóstico para pediatras sobre hábitos lesivos orais

Introducción: la etiología de las maloclusiones se encuentra relacionada a factores genéticos y ambientales, siendo relevantes los hábitos lesivos orales en ella; por lo que en un concepto de Salud Integral de los niños, debemos contar no solo con el rol activo preventivo del odontólogo sino también de pediatra. Método: crear guía clínico práctica para médicos pediatras, que permitan identificar sistemáticamente hábitos no fisiológicos vinculados a maloclusiones. Resultado: el pediatra con los conocimientos básicos podrá elaborar revisiones preventivas durante los controles periódicos de rutina. Discusión: considerar la atención en equipo multidisciplinario, con énfasis en la prevención, punto donde todo el equipo de salud debe contribuir. Conclusiones: consideramos que los efectos sobre el crecimiento y desarrollo provocados por hábitos lesivos orales/funciones no fisiológicas tendrán mayor o menor repercusión según la edad en que se inicia el hábito. Si actuamos de manera temprana tendremos más posibilidades de modificar el patrón de crecimiento de los maxilares y el desarrollo de los arcos dentarios. Se impone entonces un interrogatorio y examen funcional precoz y sistemático para la detección de desviaciones y trastornos funcionales en niños, así como enfocar los tratamientos desde equipos multidisciplinarios (odontólogo, pediatra, fonoaudiólogo, otorrinolaringólogo, psicólogo) y alcanzar resultados de excelencia.

Introduction: the etiology of malocclusions is related to genetic and environmental factors, and oral injurious habits are relevant in it; therefore, in a concept of integral health of children, we should count not only on the active preventive role of the dentist but also of the pediatrician. Method: to create a practical clinical guide for pediatricians that will allow the systematic identification of non-physiological habits linked to malocclusions. Result: the pediatrician with basic knowledge will be able to elaborate preventive check-ups during routine periodic check-ups. Discussion: consider multidisciplinary team care, with emphasis on prevention, a point to which the entire health team should contribute. Conclusions: we consider that the effects on growth and development caused by harmful oral habits/non-physiological functions will have greater or lesser repercussions depending on the age at which the habit begins. If we act early we will have more possibilities of modifying the growth pattern of the jaws and the development of the dental arches. Therefore, an early and systematic interrogation and functional examination is necessary to detect deviations and functional disorders in children, as well as to focus the treatments from multidisciplinary teams (dentist, pediatrician, speech therapist, otorhinolaryngologist, psychologist) and achieve excellent results.

Introdução: a etiologia das más oclusões está relacionada a fatores genéticos e ambientais, e hábitos orais nocivos são relevantes para ela; portanto, em um conceito de saúde integral das crianças, devemos confiar não apenas no papel ativo preventivo do dentista, mas também no do pediatra. Método: criar um guia clínico prático para que os pediatras identifiquem sistematicamente os hábitos não fisiológicos ligados às más oclusões. Resultado: o pediatra com conhecimentos básicos será capaz de desenvolver check-ups preventivos durante check-ups periódicos de rotina. Discussão: considerar os cuidados de equipe multidisciplinar, com ênfase na prevenção, um ponto para o qual toda a equipe de saúde deve contribuir. Conclusões: consideramos que os efeitos no crescimento e desenvolvimento causados por hábitos orais nocivos/ funções não-fisiológicas terão maiores ou menores repercussões dependendo da idade em que o hábito começa. Se agirmos cedo, teremos mais chances de modificar o padrão de crescimento das mandíbulas e o desenvolvimento dos arcos dentários. O questionamento precoce e sistemático e o exame funcional são, portanto, necessários para a detecção de desvios e distúrbios funcionais em crianças, assim como a aproximação de tratamento de equipes multidisciplinares (dentista, pediatra, fonoaudiólogo, otorrinolaringologista, psicólogo) e a obtenção de excelentes resultados.

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.

Nanopartículas de plata contra bacterias presentes en biofilm dental de pacientes pediátricos / Silver nanoparticles against bacteria present in dental biofilm of pediatric patients

Introducción: el biofilm dental microbiano es el precursor de diversas enfermedades orales, una de ellas la caries, ésta representa la enferme- dad oral más significativa a nivel mundial, con una incidencia de 1.76 billones de niños afectados. Las nanopartículas de plata (AgNPs) se están usando como alternativa para el control y prevención del biofilm dental, ya que poseen propiedades antimicrobianas contra bacterias relacionadas a estas enfermedades. Sin embargo, no hay estudios que evalúen este comportamiento en pacientes pediátricos. Objetivo: eva- luar la actividad antimicrobiana de las AgNPs en bacterias de aislados clínicos tomados de pacientes pediátricos. Material y métodos: se tomó muestra del biofilm dental de 22 pacientes pediátricos, el efecto micro- biológico se evaluó mediante ensayos microbiológicos estandarizados internacionalmente por triplicado, usando dos diferentes tamaños de AgNPs. Resultados: los dos tamaños de AgNPs mostraron inhibición bacteriana, sin embargo, sólo se vio una diferencia estadísticamente significativa entre el género (p < 0.05), además, en general, hubo una correlación positiva significativa en relación a la concentración de las AgNPs y la velocidad del crecimiento bacteriano (p < 0.05). Conclusión: las AgNPs se pueden considerar como una alternativa para la prevención del biofilm dental y de esta manera para el control de diferentes enfermedades orales (AU))

Introduction: dental biofilm is the precursor of oral diseases, one of them dental caries, this represents the most significant oral disease worldwide with an incidence of 1.76 billion affected children. Silver nanoparticles (AgNPs) are being used as an alternative for the control and prevention of dental biofilm since they have antimicrobial properties against bacteria related to these diseases. However, there are no studies evaluating this behavior in pediatric patients. Objective: to evaluate the antimicrobial activity of AgNPs in bacteria from clinical isolates taken from pediatric patients. Material and methods: a sample of dental biofilm was taken from 22 pediatric patients, the microbiological effect was evaluated by international standardized microbiological tests in triplicate, using two different sizes of AgNPs. Results: the two sizes of AgNPs showed bacterial inhibition, however, only a statistically significant difference was seen between gender (p < 0.05), in addition, in general, there was a significant positive correlation in relation to the concentration of AgNPs and the speed bacterial growth (p < 0.05). Conclusion: AgNPs can be considered as an alternative for the prevention of dental biofilm and thus for the control of different oral diseases (AU)

Associação entre características infantis e estresse de alunos de graduação durante atendimento odontopediátrico / Association between childhood characteristics and stress in undergraduate students during pediatric dental care

Objetivo: O objetivo desse trabalho foi avaliar a associação entre as características das crianças com o estresse apresentado por estudantes de graduação em Odontologia durante o atendimento odontopediátrico. Materiais e métodos: Participaram 48 crianças com idade entre 6 e 10 anos e 37 alunos voluntários do 7º, 8º e 9º semestres de um curso de Odontologia. Foi realizado um questionário sobre aspectos socioeconômicos e também coletados dados sobre comportamento, percepção de dor e ansiedade da criança e do responsável. Ainda, foram coletados dados relacionados aos alunos da graduação: sexo, semestre, nível de estresse, tipo de procedimento realizado. Foram obtidas as frequências absolutas e relativas por meio da análise descritiva dos dados. As comparações nos desfechos de interesse foram feitas utilizando o teste quiquadrado para variáveis dicotômicas e categóricas, teste linear por linear para variável ordinal e teste exato de Fischer para contagens menor do que 5. Foi adotado um nível de significância de 5%. Resultados: Os resultados mostraram que a maioria dos operadores que atenderam crianças não colaboradoras relataram nível de estresse alto (83,33%) (p<0,001). Os operadores que atenderam crianças com nível de ansiedade médio ou alto relataram nível de estresse alto (p= 0,043) e em pacientes com dor, o nível de estresse da maioria dos operadores foi considerado alto (75%) (p=0,001). Conclusão: as características das crianças influenciaram no estresse apresentado pelo aluno operador durante o atendimento odontológico infantil. Crianças ansiosas, não colaboradoras e que estavam sentindo dor durante o atendimento deixaram o operador mais estressado.

Objective: The aim of this study was to evaluate the association between the characteristics of children and the stress presented by undergraduate dentistry students during pediatric dental care. Materials and Methods: Participants were 48 children aged between 6 to 10 years old and 37 volunteer students from the 7th, 8th and 9th semesters of a Dentistry course. A questionnaire on socioeconomic aspects was carried out and data on behavior, perception of pain and anxiety of the child and the guardian were also collected. Also, data related to undergraduate students were collected: sex, semester, stress level, type of procedure performed. Absolute and relative frequencies were obtained through descriptive data analysis. Comparisons in the outcomes of interest were made using the chi-square test for dichotomous and categorical variables, linear by linear test for ordinal variable, and Fisher's exact test for counts less than 5. A significance level of 5% was adopted. Results: The results showed that students who assisted non-cooperative children reported a high level of stress (83.33%) (p<0.001). Students who assisted children with medium or high levels of anxiety reported high levels of stress. (p=0.043) and in patients with pain, the students' stress level was considered high (75%) (p=0.001). Conclusion: The characteristics of the children influenced the stress presented by the student during child dental care. Anxious children, noncooperative and who were in pain during care left the student more stressed.

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

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

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

Cárie na primeira infância: um problema de saúde pública global e suas consequências à saúde da criança / Caries in early childhood: a global public health problem and its consequences to children's health

Esse estudo tem como objetivo realizar uma revisão de literatura para apresentar os efeitos da doença cárie em crianças e ressaltar a importância do acompanhamento familiar. Foram selecionados artigos de 2011-2021, publicados nas bases de dados PubMed e SciELO utilizando os descritores: Doença cárie, Prevenção, Odontopediatria, foram incluídos artigos que estavam disponíveis na íntegra em português e inglês. A cárie dental continua a ser um problema de saúde pública, com maior prevalência em crianças e caracterizada por ser uma doença de etiologia multifatorial, biofilme-açúcar dependente não transmissível. A cárie de primeira infância (CPI) é capaz de afetar negativamente a qualidade de vida, por se apresentar como rápido desgaste da estrutura dental e presença de sintomatologia dolorosa. Isso pode resultar em um quadro de perda precoce, má oclusão, prejudicando a mastigação, dentição permanente, sono, rendimento escolar, favorecendo a desnutrição e afetando desenvolvimento. A Declaração de Bangkok recomenda aumento de conscientização sobre essa doença através da educação dos pais, limitação na ingestão de açúcar até os 2 anos de idade e escovação dos dentes de pelo menos 2x/ dia com dentifrício fluoretado. Diante do exposto, se torna essencial o acompanhamento da saúde odontológica da criança desde a erupção do primeiro dente na cavidade bucal, visando reduzir a CPI e contribuir para uma melhor qualidade de vida.

This study aims to carry out a literature review to present the effects of caries disease in children and emphasize the importance of family monitoring. Articles from 2011-2021 were selected, published in the PubMed and SciELO databases using the descriptors: Caries Disease, Prevention, Pediatric Dentistry, articles that were available in full in Portuguese and English were included. Dental caries continues to be a public health problem, with greater prevalence in children and characterized by being a disease of multifactorial etiology, non-transmissible biofilm-sugar dependent. Early childhood caries (CPI) is capable of negatively affecting the quality of life, as it presents itself as a rapid wear of the tooth structure and the presence of painful symptoms. This can result in early loss, malocclusion, impairing chewing, permanent dentition, sleep, school performance, favoring malnutrition and affecting development. The Bangkok Declaration recommends raising awareness of this disease through parent education, limiting sugar intake until age 2, and brushing teeth at least twice a day with fluoride toothpaste. Given the above, it is essential to monitor the child's dental health from the eruption of the first tooth in the oral cavity, in order to reduce CPI and contribute to a better quality of life.

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.

Patterns of Paediatric Dental Treatment Under General Anaesthesia: A Retrospective Study

ABSTRACT@#This retrospective study aimed to evaluate patterns of comprehensive dental treatment under general anaesthesia (GA) for healthy children in Universiti Teknologi MARA, Malaysia. The treatment records of healthy paediatric patients who received dental treatment under GA from February 2017 to January 2021 were reviewed. The patients were divided into two groups: (1) less than 6 years old and (2) 6 to 16 years old. Patients’ characteristics were summarised using descriptive statistics while an independent t-test was applied to investigate the influence of “age group” on treatment duration, number of procedures and use of various restorative materials. A total of 125 paediatric patients (67 boys and 58 girls) were included. The patients’ mean age at the time they underwent GA was 5.77 ± 1.94 years old and the average duration of dental treatment was 62.58 minutes. There was a significant difference in the duration of treatment between the two age groups (p < 0.05). Tooth extraction was the most dental procedure performed (63.31%). The 6 to 16 years old group had a significantly shorter treatment duration (p < 0.05). However, no significant differences were found in all procedures (extraction, restoration, preventive and pulp therapy) and the utilisation of composite, glass ionomer cement (GIC) and compomer in both groups. The use of stainless steel crown (SSC) restorations was significantly higher in the less than six years old group (p < 0.05). Most of the dental procedures performed under GA on healthy children were extraction procedures. Children less than six years of old had a longer treatment duration under GA. Composite restorations and SSC were more frequently used in primary dentition.

Enfoque de Tratamiento de una Adolescente con Amelogénesis Imperfecta / Treatment Approach for an Adolescent with Amelogenesis Imperfecta

La amelogénesis imperfecta (AI) es un grupo de tras-tornos hereditarios, clínica y etiológicamente hete-rogéneos, derivados de mutaciones genéticas, que se caracterizan por anomalías cualitativas y cuanti-tativas del desarrollo del esmalte, pudiendo afectar la dentición primaria y/o permanente. El tratamiento del paciente con AI es complejo y multidiscliplinario; supone un desafío para el odontólogo, ya que por lo general están involucradas todas las piezas dentarias y afecta no solo la salud buco dental sino el aspecto emocional y psicológico de los pacientes. Con el obje-tivo de describir el tratamiento integral y rehabilita-dor realizado en una paciente con diagnóstico de AI tipo III, se reporta el caso de un adolescente de sexo femenino de 13 años, que concurrió en demanda de atención a la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), cuyo motivo de consulta fue la apariencia estética y la hipersensibilidad de sus pie-zas dentarias. Durante el examen clínico intraoral, se observó que todas las piezas dentarias presentaban un esmalte rugoso, blando, con irregularidades y una coloración amarronada, compatible con diagnóstico de Amelogénesis Imperfecta tipo III hipomineralizada. Conclusión: El tratamiento rehabilitador de la AI en los pacientes en crecimiento y desarrollo estará diri-gido a intervenir de manera integral y temprana para resolver la apariencia estética y funcional, evitar las repercusiones sociales y emocionales, y acompañar a los pacientes y sus familias (AU)

Amelogenesis imperfecta (AI) is a group of clinically and etiologically heterogeneous hereditary disorders, derived from genetic mutations, characterized by qualitative and quantitative anomalies of enamel development, which can affect primary and/or permanent dentition. The treatment of patients with AI is complex and multidisciplinary, it is a challenge for the dentist, since in general all the teeth are involved and it affects not only oral health but also the emotional and psychological aspect of the patients. Objective: To describe the comprehensive and rehabilitative treatment carried out in an adolescent patient with a diagnosis of type III AI. Case report: The case of a 13-year-old female patient, who required dental attention at the Department of Dentistry for Children of the School of Dentistry of the University of Buenos Aires, whose reason for consultation was esthetic appearance and hypersensitivity of her teeth. In the intraoral clinical examination, it was observed that all the teeth had rough, soft enamel, with irregularities and a brownish color, compatible with the diagnosis of type III hypomineralized Amelogenesis Imperfecta. Conclusion: Rehabilitative treatment of AI in growing and developing patients will be aimed at early and comprehensive intervention to resolve esthetic and functional appearance, avoid social and emotional repercussions and accompany patients and their families (AU)