Validación de un Cuestionario para Evaluar Riesgo de Caries en Preescolares en Santiago, Chile / Validation of a Questionnaire to Assess Risk of Caries in Preschool-Age Children in Santiago, Chile

RESUMEN: La Caries Temprana de la Infancia (CTI) es una forma de caries dental agresiva que afecta a niños, y en el último reporte nacional reveló una prevalencia de caries del 50 % en niños de 4 años de edad de la Región Metropolitana de Santiago (Soto et al., 2007). El objetivo de este estudio es validar un cuestionario que permita recolectar información relacionada con diversos factores de riesgo de caries en niños preescolares. Para la validación del cuestionario se determinó la validez de convergencia y discriminación, la consistencia interna y la confiabilidad test retest del instrumento en dos muestras independientes. Se aplicó el instrumento al cuidador principal de 118 preescolares entre 24 a 71 meses de edad, que asisten a jardines infantiles de dependencia particular (bajo riesgo de caries) y la Fundación INTEGRA (alto riesgo de caries) en la Región Metropolitana de Santiago, Chile. Se realizaron exámenes clínicos dentales por 2 odontólogos calibrados utilizando en el criterio OMS e ICDAS II. Se estimó un modelo de regresión logística y se evalúo la capacidad de discriminación del puntaje a través de una curva ROC. El cuestionario mostró una validez de discriminación de 0,95 entre ambos grupos y de la pregunta global 0,61 y una consistencia interna del cuestionario de 0,72. En la validez de convergencia se encontró que no existe asociación estadísticamente significativa entre el puntaje del cuestionario y la pregunta global dicotomizada (OD) 1,061. No obstante, se evidenció que si existe asociación estadísticamente significativa entre el puntaje del cuestionario y el grupo riesgo de caries (bajo y alto) (OD) 1,961. La estabilidad temporal mediante comparaciones Test - Retest calculado con el índice de Kappa osciló entre 0,37 a 1. Por lo tanto, se puede concluir que el presente cuestionario es un instrumento válido para discriminar riesgo de caries, permitiendo un mejor análisis de los determinantes de la caries dental en la población preescolar chilena.

ABSTRACT: Early Childhood Caries (ECC) is an aggressive form of tooth decay, and the last national unpublished reports reveal a caries prevalence of 50 % at 4 years of age in children, in the Santiago Metropolitan Region (Soto et al., 2007). The objective of this study is to validate a questionnaire that allows the collection of information related to several caries risk factors in preschoolchildren. For the validation of the questionnaire, the convergence and discrimination validity, the internal consistency and the retest, test reliability of the instrument were determined in two independent samples. The instrument was applied to the main caregiver of 118 preschoolers between 24 and 71 months of age, who attend private childcare centers (low caries risk) and the INTEGRA Foundation childcare (high caries risk) in the Metropolitan Region of Santiago, Chile. Dental clinical examinations were performed by two calibrated dentists using the OMS and ICDAS II criteria. A logistic regression model was estimated and the ability to discriminate the score through an ROC curve was evaluated. The questionnaire showed a validity of discrimination of 0.95 between both groups and of the global question 0.61 and an internal consistency of the questionnaire of 0.72. In the convergence validity, it was found that there is no statistically significant association between the questionnaire score and the dichotomized global question (RE) 1.061. However, it was evidenced that there is a statistically significant association between the questionnaire score and the caries risk group (low and high) (OD) 1.961. Temporal stability by means of Test - Retest comparisons calculated with the Kappa index ranged from 0.37 to 1. Therefore, it can be concluded that the present questionnaire is a valid instrument for discriminating caries risk, allowing a better analysis of the determinants of dental caries in the Chilean preschool population.

Effects of oral environment stabilization procedures on Streptococcus mutans counts in pregnant women

The aim of this study was to determine the effect of oral environment stabilization (OES) on the counting of Streptococcus mutans in high-caries-risk pregnant women participants of a prevention program in a public teaching institution. The sample was composed of 30 pregnant women aged 18 to 43 years, who looked for treatment at the Preventive Dentistry Clinic of the Araraquara Dental School, UNESP. Saliva samples were collected before and after the OES procedures and were forwarded to the pathology for observation and quantification of S. mutans CFU. There was a decrease in the number of S. mutans CFU, which was significantly different (p<0.0001) between samples. Considering the age group, 70.0 percent were between 18 to 30 years old and 30.0 percent belonged to the 31-43-year-old age group. Data related to the pregnancy period showed that 73.4 percent were in the second trimester, 13.3 percent in the first and 13.3 percent in third trimester. OES showed to be an effective clinical procedure in diminishing the number of S. mutans CFU in the saliva of high-caries-risk pregnant women. This management is simple and effective, corresponding to the basic treatment needs of pregnant women that search dental care in this public service.

O objetivo desta pesquisa foi determinar o efeito da adequação do meio bucal sobre a contagem de Streptococcus mutans em gestantes de alto risco à cárie, participantes de um programa de prevenção em uma instituição de ensino público, antes e após adequação do meio bucal. Amostras de saliva de 30 gestantes (18 a 43 anos) que procuraram atendimento na Clínica de Odontologia Preventiva da FOAr-UNESP foram coletadas antes e após procedimentos de adequação do meio bucal, e examinadas para observação e contagem das UFCs de S. mutans. Foi demonstrado que houve diminuição na quantidade das UFCs (p<0,0001) entre as amostras. Em relação à faixa etária, 70,0 por cento das gestantes tinham entre 18 e 30 anos de idade e 30,0 por cento pertenciam à faixa etária de 31 a 43 anos. Dados relativos ao período da gestação revelaram que 73,4 por cento estavam no 2º trimestre e 13,3 por cento estavam igualitariamente no 1º e 3º trimestres. A adequação do meio bucal se mostrou eficaz na diminuição das UFCs de S. mutans presentes na saliva de gestantes de alto risco de cárie. Este procedimento é simples e extremamente efetivo, atendendo às necessidades de tratamento básico de gestantes que procuram atendimento odontológico no serviço público de saúde.

Hydrophobicity test in mutans Streptococci

Kinetic hydrophobic measurements were performed by confronting 40 mutans streptococci from thirty 10- to 20-year-old patients with 200 ml hexadecane (Sigma). Fourteen patients had high dental caries risk (Group A), dmft + DMFT >5 with 3 or more active caries, and 16 had low dental caries risk (Group B), dmft + DMFT <3 without active caries. Twenty bacteria from Group A and 20 bacteria from Group B were typed using De La Higuera's procedure and confirmed by API strip (bio- Merieux). From the 14 patients in Group A we obtained 12 S. mutans (8 hydrophobic/ 4 non-hydrophobic), 5 S. sobrinus (4 hydrophobic/ 1 non-hydrophobic) and 3 S. rattus (hydrophobic). From the 16 patients in Group B we obtained 11 Streptococcus mutans (10 non-hydrophobic/ 1 hydrophobic), 7 Streptococcus sobrinus (6 non-hydrophobic/ 1 hydrophobic) and 2 Streptococcus rattus (hydrophobic). Patients with high dental caries risk have a higher prevalence of hydrophobic bacteria than patients with low dental caries risk (p=0.0003). All typed S. rattus were hydrophobic.

Con el objeto de evaluar una posible relacion entre hidrofobicidad y caries dental, se estudiaron 40 cepas de Streptococcus grupo mutans provenientes de 30 pacientes de entre 10 y 20 anos, 14 pacientes con tres o mas caries activas e indice ceod mas CPOD > 5 (Grupo A) y 16 pacientes sin caries activas, con ceod mas CPOD < 3 (Grupo B). Las cepas fueron aisladas a partir de muestras de saliva en AMS-BT y tipificadas por pruebas bioquimicas y API-strep realizandose la medicion cinetica de hidrofobicidad, enfrentandolas con 200 ml de hexadecano (Sigma). En el grupo A se caracterizaron 12 cepas Streptococcus mutans: 8 hidrofobicas y 4 no hidrofobicas, 5 cepas de Streptococcus sobrinus: 4 hidrofobicas y 1 no hidrofobica y 3 cepas Streptococcus rattus hidrofobicas. En el grupo B, se caracterizaron 11 cepas de S. mutans, 10 no hidrofobicas y 1 hidrofobica, 7 cepas de S. sobrinus: 6 no hidrofobicas y 1 hidrofobica y 2 cepas de S. rattus hidrofobicas. Todos los pacientes del grupo A presentaron al menos 1 cepa hidrofobica. En las cepas aisladas de estos pacientes se demostro la existencia de una alta prevalencia de Streptococcus grupo mutans con caracteristicas hidrofobicas p=0,0003. Estos resultados indicarian la relacion entre la capacidad de adherencia a hexadecano y caries activa. Todas las cepas tipificadas como S. rattus fueron hidrofobicas independientemente del grupo de origen.

Physicochemical salivary properties, Lactobacillus, Mutans Streptococci counts and early childhood caries in preschool children of Colombia

Dental caries is a multifactorial disease, in which saliva has an important role. Saliva properties affect the growth of cariogenic microorganisms, so variations below threshold levels are considered risk factors for the development of dental caries. Salivary tests and microbiological counts of cariogenic bacteria are often used for clinical purposes in order to reveal problems that could explain caries development and have been evaluated in multiple studies, but these studies have mainly been carried out on adults. Thus, the aim of this study was to identify physicochemical salivary properties, mutans streptococci and Lactobacillus counts among preschool children, and their relationship with ECC in a cross-sectional study in Medellin, Colombia. Caries was determined using ICDAS criteria for a sample of 201 preschool children. Stimulated saliva samples were processed for bacterial detection, mean flow rate, pH and buffer capacity calculation. Risk variables for ECC were assessed individually and adjusted using a binary logistic regression model. The results showed that 71.14% of study subjects had ECC. Flow rate, final pH and Buffer capacity increased with age, but none of them were related to the presence of ECC. Although OR analysis detected correlations between ECC, gender, age, dental eruption stage and Lactobacillus presence, binary logistic regression analysis only showed gender and Lactobacillus as strongly associated with ECC. It can be concluded that gender and Lactobacillus presence are key variables for the presence of ECC in these children; whilst age and dental eruption stage play a minor role. Further studies are required to clarify the role of mutans streptococci counts in this population and to establish normal salivary parameters as well as threshold levels for hyposalivation in preschool children, as results showed differences with normal parameters used for adults.

La caries dental es una enfermedad multifactorial en la cual la saliva tiene un impacto importante. Las propiedades de la saliva afectan el crecimiento de microorganismos cariogenicos y por lo tanto las variaciones por debajo de los niveles umbral son consideradas factor de riesgo para el desarrollo de caries. Las pruebas salivares y los recuentos de microorganismos cariogenicos son utilizadas con frecuencia en la clinica para identificar factores que puedan explicar el desarrollo de lesiones cariosas y han sido evaluados en multiples estudios, pero estos han sido desarrollados principalmente en adultos. El objetivo de este trabajo fue identificar propiedades fisicoquimicas de la saliva y recuentos de estreptococos del grupo mutans y Lactobacillus, en relacion con la Caries de la Infancia Temprana (CIT). Para esto, se realizo un estudio descriptivo transversal. Se registraron las lesiones de caries dental con el sistema ICDAS en 201 ninos pre-escolares de hogares infantiles de estrato socioeconomico medio-bajo. Se obtuvieron muestras de saliva estimulada, que fueron procesadas para detectar estreptococos del grupo mutans y Lactobacillus; se calculo la tasa de secrecion salivar, pH y capacidad Buffer. Se analizaron posibles variables indicadoras de riesgo para CIT, mediante el calculo de OR individuales por variable y OR ajustadas mediante un modelo de regresion logistica binario. Los resultados indicaron que el 71.14% de los ninos presentaban CIT. Las propiedades de la saliva mostraron un mejor comportamiento con la edad, con valores diferentes a los parametros definidos para poblaciones adultas, pero ninguna tuvo relacion con la enfermedad. El genero y la presencia de Lactobacillus mostraron asociacion fuerte en el analisis de regresion sugiriendolos como principales indicadores de riesgo para CIT en esta poblacion. Se requieren estudios prospectivos y analizar variaciones biologicas, para clarificar el papel de los estreptococos del grupo mutans y revisar los valores umbral para la evaluacion de la secrecion salivar en preescolares.

Risk indicators and risk predictors of dental caries in schoolchildren

The purpose of this study was to identify risk indicators of high caries level at baseline (HCLB) based on cross-sectional data and predictors of high caries increment (HCI) based on a 7-year-follow-up examination in 6-8-year-old schoolchildren. Two hundred and six schoolchildren were examined in 1997 and in 2004 by the same two calibrated dentists, in Piracicaba, Brazil. At baseline, dental caries, presence of sealants, fluorosis, and oral hygiene status were recorded. The children's parents completed a questionnaire concerning socioeconomic level, fluoride use, dental service utilization, dietary and oral hygiene habits. HCLB and HCI were defined considering the upper quartile of the total caries experience distribution (dmfs+DMFS) and caries increment distribution, respectively. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals and p-values. Having white spot lesions (OR=5.25) was found to be a risk indicator of HCLB. Schoolchildren with dental fluorosis (OR=0.17) or those who brushed the teeth more than two times a day (OR=0.37) presented less probability of HCLB. The predictors of HCI were: dmfs>0 (OR=2.68) and mothers' educational level up to 8 years of schooling (OR=2.87). Clinical and socioeconomic variables were found to be risk indicators and/or predictors of dental caries in schoolchildren.

Adhesion of Streptococcus mutans to salivary proteins in caries-free and caries susceptible individuals

La adhesión de los microorganismos a las superficies dentales, es el paso inicial en la formación de la placa dentobacteriana, Streptococcus mutans (S. mutans) es uno de los encontrados en ésta y está asociado como el principal agente causal de una delas enfermedades más comunes en los humanos, la caries dental. La adherencia de esta bacteria se da por la interacción de adhesinas que la constituyen con los componentes salivales, específicamente con los que están formando parte de la película adquirida. La complejidad de esta interacción ha sido motivo deestudio durante los últimos años, hasta el punto de identificar algunos componentes salivales relacionados con la unión a las superficies del esmalte, tales como Proteínas ricas en prolina(PRPs), staterinas,Histatinas,Cistatinas, etc. En el presente trabajo se buscó determinar la capacidad de adhesión de S. mutans a hidroxilapatita sintética incubada con muestras de salivade personas con y sin experiencia de caries. Para estos ensayos se utilizó tanto la muestra de saliva completa como extractos de proteínas salivales, obtenidos por medio de la separaciónde las proteínas contenidas en la muestra por SDS-PAGE, en tres rangos de peso molecular seleccionados de acuerdo con el perfil electroforético que fue comúnmente encontrado. Losresultados indican que la adhesión de este microorganismo es mayor en las personas sin experiencia de caries cuando se ensayó con saliva completa y con las proteínas separadas en el rangode peso molecular de 120-159 kDa. Sugiriendo que la adhesión por sí sola no tiene un efecto determinante en los mecanismos que producen la enfermedad en algunas personas. Sin embargo estos hallazgos son interesantes ya que pueden contribuir en el diseño de estrategias para intervenir en la adhesión de S. mutanssobre las superficies dentales

Adhesion of microorganisms to dental surfaces is the initial step in the formation of dental bacterial plaque. Streptococcus mutans (S. mutans) is considered the main causal agent of one of the most common diseases in humans: dental caries. Adherence of these bacteria results from the interaction of adhesins that form part of their structure with salivary components, specifically those that compose the acquired pellicle. The complexity of this interaction has been the subject of studies in past years, to the extent of identifying certain salivary components related to adhesion to enamel surfaces, such as proline-rich proteins (PRSs), Staherins, Histatins, Cystatins, etc. One of the objectives of this study was to determine the adhesion capacity of S. mutans to synthetic hydroxyapatite incubated with saliva samples of caries-active and caries-inactive individuals. For the purpose of these assays, both the whole saliva samples and the salivary protein extracts were used. They were obtained by separating the proteins contained in the simple SDS-PAGE, in three ranges of molecular weight, selected in accordance with the electrophoresis profile that was usually found. The results indicated that the adhesion of this microorganism was greater in caries-inactive patients, when tested with whole saliva and proteins in the 120-159 kDa molecular weight range. This suggests that adhesion, per se, does not have a definite effect on the mechanisms that cause the disease in some individuals. However, these are interesting findings that may contribute to the design of strategies to control the adhesion of S. mutans to the tooth’s surface.

Xilitol: edulcorante com efeitos benéficos para a saúde humana / Xilitol: a sweetner with benefits for human health

Ao empregar adoçantes na produção de bebidas e alimentos, as indústrias atualmente levam em conta a quantidade de calorias do edulcorante, a possibilidade de seu uso em dietas para redução ou controle de peso e o grau de semelhança entre o seu sabor e o do açúcar. Nesse sentido, um produto que vem atraindo a atenção dos fabricantes de bebidas e alimentos é o xilitol, adoçante que se destaca das demais substâncias do gênero, não só pelo fato de poder ser obtido por via biotecnológica, mas também por possuir importantes propriedades físico-químicas e fisiológicas. Graças a essas propriedades, o xilitol tem um grande potencial de aplicação nas áreas odontológica e médica, tendo-se mostrado eficaz no...

Alteraçöes da cavidade bucal em crianças asmática / Oral alterations in asthmatic children

Objetivo: Descrever as alteraçöes da cavidade bucal relacionadas à asma, descritas na literatura médica e odontológica no período dos últimos dez anos. Método:Revisäo de literatura através de levantamento sobre o tema proposto. Resultados: Os pacientes asmáticos apresentam maior índice de cárie, gengivite, cálculo gengival e alteraçöes oclusais devido à ingestäo de medicamentos líquidos ou inalatórios e por sua respiraçäo preferencialmente bucal. Conclusäo: Os médicos que tratam de pacientes asmáticos podem auxiliar na prevençäo das afecçöes bucais através de medidas dietéticas e higiene bucal, educando os pacientes e estabelecendo uma parceria com cirurgiöes dentistas no atendimento destes pacientes.

Influencia de la prótesis parcial removible en la incidencia de caries de las piezas dentarias naturales remanentes / Influence of partial removable dentures in increase of caries of remanent natural tooth

Se estudió en un grupo de 102 pacientes portadores de prótesis parciales removibles los efectos producidos por éstas en el aumento de la incidencia de caries, después de 4 a 5 años de uso. Encontrándose un aumento de lesiones en las piezas pilares directas en relación al resto de las piezas que presentaban un índice de placa similar, se plantea hipótesis al respecto

Indice CPO-D de 196 excepcionais de 06 a 20 anos de idade, de ambos os sexos, submetidos a anestesia geral para tratamento odontologico / DMF index in 196 mentally retaded children, ages 06 to 20, both sexes, submitted to general anaesthesia for dental treatment

Como resultado de pesquisa foi constatado que ha prevalencia da carie dentaria em 196 excepcionais, de 06 a 20 anos de idade, 98 do sexo masculino e 98 do sexo feminino, submetidos a anestesia geral para tratamento odontologico. A carie dentaria ocorreu em 96,43 por cento do total de excepcionais examinados, apresentando-se o valor do indice CPO-D medio final com 9,06, maior no sexo feminino (9,83) que no sexo masculino (8,28) e o indice CPO-D aumentando com o avanco das idades em ambos os sexos ate a idade de 14 anos e com variacoes a partir desta idade. Nestes pacientes as necessidades de tratamento atingiram 91,55 por cento dos dentes permanentes com historia de carie.