Impact of Early Childhood Caries and Parental Oral Health Literacy on the Use of Oral Health Care Services by Children. Caries, Health Literacy and Health Care / Impacto de la Caries de la Primera Infancia y la Alfabetización en Salud Bucal de los Padres en el Uso de los Servicios de Atención de la Salud Oral por Parte de los Niños Caries, Alfabetización en Salud y Cuidado de la Salud

The objective of this study was to verify the impact of early childhood caries (ECC) and parental oral health literacy (OHL) on the use of oral health care services by preschool children. A population-based study was conducted with 449 dyads of preschool children aged 4-6 years and their parents/caregivers in the city of Ribeirão das Neves, Brazil. Two examiners performed the diagnosis of ECC using the International Caries Detection and Assessment System (ICDAS- Epi). The Brazilian version of the Hong Kong Oral Health Literacy Assessment Task for Pediatric Dentistry was administered to measure parents' OHL. Parents/caregivers answered the question "When was your child's last visit to the dentist?" to measure the use of oral health care services by the preschool children. The multiple logistic regression (p<0.05) revealed that children with presence of cavitated caries lesions were 1.82-fold more likely to use oral health care services (OR=1.82; 95%CI: 1.23-2.70) compared to those with absence of cavitated caries lesions. Children whose parents/caregivers had lower OHL were 34 % less likely to use oral health care services compared to those whose parents had higher OHL (OR=0.66; 95%CI: 0.45-0.99). Preschool children Dental services are used more by preschool children with presence of cavitated caries lesions and whose parents/caregivers have higher scores of OHL.

El objetivo de este estudio fue verificar el impacto de la caries de la primera infancia (CPI) y la alfabetización en salud oral de los padres (ASB) en el uso de los servicios de salud oral por parte de los niños en edad preescolar. Se realizó un estudio de base poblacional con 449 díadas de preescolares de 4 a 6 años y sus padres/cuidadores en la ciudad de Ribeirão das Neves, Brasil. Dos examinadores realizaron el diagnóstico de CPI utilizando el Sistema Internacional de Evaluación y Detección de Caries (ICDAS-Epi). Se administró la versión brasileña de Hong Kong Oral Health Literacy Assessment Task for Pediatric Dentistry para medir la ASB de los padres. Los padres/cuidadores respondieron la pregunta "¿Cuándo fue la última visita de su hijo al dentista?" medir la utilización de los servicios de salud oral por parte de los preescolares. La regresión logística múltiple (p<0,05) reveló que los niños con presencia de lesiones de caries cavitadas tenían 1,82 veces más probabilidades de utilizar los servicios de salud oral (OR=1,82; IC95%: 1,23-2,70) en comparación con aquellos con ausencia de lesiones de caries cavitadas. Los niños cuyos padres/cuidadores tenían un ASB más bajo tenían un 34 % menos de probabilidades de utilizar los servicios de atención de la salud bucodental en comparación con aquellos cuyos padres tenían un ASB más alto (OR = 0,66; IC del 95%: 0,45-0,99). Los servicios dentales para niños en edad preescolar son utilizados con mayor frecuencia por niños preescolares con presencia de lesiones cariosas cavitadas y cuyos padres/cuidadores tienen puntuaciones más altas de ASB.

Desenvolvimento e caracterização fisico-química de um selante resinoso com propriedades antimicrobianas associadas à incorporação do extrato do caule de Schinopsis brasiliensis (Braúna) / Development and physicochemical characterization of a resinous sealant with antimicrobial properties associated with the incorporation of Schinopsis brasiliensis (Braúna) stem extract

Introdução: os selantes resinosos possuem atividade preventiva e terapêutica da cárie dentária oclusal através da criação de uma barreira física que impede a adesão de biofilme. Não existem relatos destes materiais com propriedades antimicrobianas e, neste ensejo, a adição de princípios ativos obtidos de fitoterápicos configura como uma opção possível para resolver esta limitação. Objetivos: avaliar o potencial antimicrobiano do selante Fluroshield® enriquecido com o extrato do caule de Schinopsis brasiliensis (Braúna), bem como, a liberação do princípio ativo, grau de conversão, resistência de união imediata ao esmalte e padrão de falha dos materiais experimentais. Metodologia: trata-se de um estudo experimental in vitro. As cascas da Braúna foram secas a 40 ± 1 °C e o extrato etanólico foi obtido por percolação do pó da casca da Schinopsis brasiliensis. O selante comercial Fluroshield® (Dentsply) foi enriquecido com as proporções em massa (g) [0% (Controle), 20%, 10%, 5%, 2,5% e 1,25%]. Foi realizada a avaliação da Atividade antimicrobiana, a liberação do princípio ativo foi aferida através de Ultra Cromatografia Líquida de Alta Performance (UHPLC), o grau de conversão (GC) através do Micro-Raman, a resistência de união (RU) imediata ao esmalte foi avaliada através do microcisalhamento e padrão de fratura através de análise em estereomicroscópio. Os valores finais foram submetidos aos testes de normalidade Shapiro-Wilky (p > 0,05) e Levene. Os dados paramétricos foram submetidos a análise de variância (ANOVA one-way) com pós-teste de Tukey (p <0,05) e os não paramétricos através do teste de Kruskal-Wallis com pós-teste de Dunn's através do software GraphPad Prism 8 e Microsoft Excel 2018. Resultados: materiais com maior % de extrato apresentaram menor GC, não houve diferença estatisticamente significativa para RU entre os diferentes grupos, o padrão de fratura predominante foi adesiva, houve liberação do princípio ativo em meio aquoso em todos os materiais e os grupos com 20% e 10% de extrato em massa foram capazes de inibir a formação de biofilme de maneira semelhante ao controle positivo (clorexidina 0,12%). Conclusão: a adição do extrato de Schinopsis brasiliensis em concentrações entre 10% e 20% apresenta-se como uma alternativa promissora para a obtenção de propriedades antimicrobianas em selantes resinosos (AU).

Introduction: dental sealants have a preventive and therapeutic activity in the prevention and treatment of dental caries. However, there are no reports of these materials with antimicrobial properties and the addition of phytotherapy molecules would be an option to solve this limitation. Objectives: to evaluate the antimicrobial properties of the Fluroshield™ sealant with the addition of the stem extract of Schinopsis brasiliensis (Braúna), as well as the potential for releasing the active ingredient, degree of conversion and immediate enamel bond strength. Methodology: this is an experimental in vitro study. Braúna barks were dried at 40 ± 1 °C and the ethanolic extract was obtained by percolation of Schinopsis brasiliensis bark powder. The commercial sealant Fluroshield™ was enriched with the proportions by mass (g) [0% (Control), 20%, 10%, 5%, 2.5% and 1.25%]. The evaluation of the Inhibition of Biofilm Formation was carried out, the release of the active principle was measured with Ultra High Performance Liquid Chromatography (UHPLC), the immediate bond strength (BS) to the dental tissue was evaluated with microshear and the degree of conversion (DC) with Micro-Raman. Final values were submitted to Shapiro-Wilky (p > 0.05) and Levene normality tests. Parametric data were submitted to analysis of variance (one-way ANOVA) with Tukey's post-test (p <0.05) and nonparametric data through the Kruskal-Wallis test with Dunn's post-test using the GraphPad Prism software 8 and Microsoft Excel 2018. Results: materials with a higher % of extract had a lower DC, there was no statistically significant difference for BS between the different groups, there was release of the active principle in all materials and groups with 20% and 10 % of extract by mass were able to inhibit biofilm formation similarly to the positive control (0.12% chlorhexidine). Conclusion: the addition of Schinopsis brasiliensis extract in concentrations between 10% and 20% is a promising alternative for obtaining antimicrobial properties in resin sealants (AU).

Use of Restorative Materials in Primary Teeth - A Retrospective University-Based Study

ABSTRACT Objective: To investigate the types of restorative materials used for restorative treatment in primary teeth through a retrospective university-based study. Material and Methods: The sample consisted of all clinical records of children attended at the Pediatric Dentistry Clinic at the School of Dentistry of Ribeirão Preto at the University of São Paulo in Brazil. Inclusion criteria were primary anterior and posterior teeth that received dental restorations for treatment of dental caries lesions, dental trauma or dental development defects from 2013 to 2018. Restoration repairs and interim restorations during this period were also recorded. Descriptive analyzes were performed to assess the distribution according to the type of restorative material used over the years. Results: A total of 5,236 restorative procedures were performed in primary teeth, including restoration repair and interim restorations. Of those, 69% were done in posterior teeth and 31% in anterior teeth. Sixty percent of the procedures performed during this period were made of composite resin and a lower percentage of glass ionomer cement (18%) followed by silver amalgam (1%). The number of interim restorations was smaller but proportional to those of composite resin over the years. Conclusion: A tendency to carry out restorative treatment of primary teeth with composite resin during the 6 years of follow-up was observed.

Non-Invasive Methods and the Use of Infiltrating Resins for the Control of Caries Progression in Deciduous Teeth: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To evaluate the influence of non-invasive treatment associated with the use of infiltrating resin for managing caries lesions in primary teeth. Material and Methods: A systematic review was performed by selecting articles from 6 online databases, using a search algorithm and eligibility criteria for data extraction and data synthesis for the papers included. Clinical trials involving primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the outer dentin) were included, presenting full text and answering the study's guiding question. This study used the RoB 2 tool for the risk of bias assessment and GRADE for certainty of evidence. Random effects meta-analyses were implemented, and lesion progression treatment effects were estimated through relative risk (RR) and associated 95% confidence intervals. Results: A total of 440 studies were found. After analyzing the inclusion criteria and removal of duplicates, eight studies were analyzed for quality evidence. Five of the eight studies included in this review contributed to the meta-analysis, all with some reflections regarding the risk of bias. Overall, the results of the meta-analysis showed that non-invasive treatment, when associated with the use of infiltrating resins, significantly reduced the risk of caries progression in relation to the treatment without this addition for follow-up periods ranging from 12 months to 2 years (RR 0.51 [0.40-0.65]). Conclusion: There is moderate certainty of evidence that the use of infiltrating resins associated with non-invasive treatments decreases the risk of caries progression in primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the dentin outer) when combined with non-invasive control methods alone.

Antibacterial Efficacy of Silver Diamine Fluoride Compared to Casein Phosphopeptide-Amorphous Calcium Phosphate Against Streptococcus mutans in a Biofilm Caries Model

ABSTRACT Objective: To compare the antibacterial efficacy of silver diamine fluoride (SDF) with a product containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) against Streptococcus mutans using a biofilm caries model. Material and Methods: Twenty-seven saliva-coated dentine blocks obtained from extracted human teeth were inoculated with Streptococcus mutans monospecies biofilm in this in vitro study. The biofilms were then exposed to 10% sucrose in brain heart infusion broth eight times daily for seven days. After the biofilm growth period, the dentine blocks (n=9 per group) were treated with one of the following substances: 1) sterile saline (control), 2) 38% SDF, and 3) a product containing CPP-ACP. Then, the samples were incubated at 37ºC for 48 hours, and the numbers of viable microorganisms in the biofilms were counted and compared. ANOVA and Tukey's HSD tests were used to analyze the data (p<0.05). Results: The number of viable bacteria, as determined by the number of colony-forming units (CFU mL-1) of Streptococcus mutans, was significantly reduced following treatment with SDF and the CPP-ACP product (p<0.05). However, SDF showed superior antibacterial activity compared to the CPP-ACP product (mean CFU mL-1 =zero compared to 96 x106) (p<0.05). Conclusion: SDF has higher antibacterial activity against cariogenic Streptococcus mutans biofilm than the CPP-ACP product. The CPP-ACP product showed antibacterial activity, but it was limited.

Relationship of Dental Caries and Body Mass Index amongst School Children in Hail, Saudi Arabia: A Cross-Sectional Study

ABSTRACT Objective: To determine caries prevalence and its association with body mass index in school children between 9-12 years of age in Hail, Saudi Arabia. Material and Methods: This descriptive cross-sectional study included 524 school children 9-12 years of age. These children were selected from 9 Public schools in Hail Province. Dental caries was recorded as per criteria established by the World Health Organization using assessment form for children 2013. Children were weighed using an electronic scale nearest to 0.1 kg with children attired in light clothing and wearing no shoes. The height was measured using a stadiometer to the nearest full centimeter with the children in a standing position. Body Mass Index (BMI) was determined using the formula BMI = kg/m2. Results: Caries prevalence in the population was 86%. The comparisons of mean DMFT between the groups demonstrate higher scores in the overweight group (mean=2.43) compared to normal weight (mean=1.85) and underweight children (mean=1.56) which is statistically significant (p=0.000). Bonferroni Post hoc test to compare the underweight and overweight group (p=0.000) and overweight and normal weight (p=0.000) were highly significant. Conclusion: A positive correlation of caries severity, namely DMFT, with BMI is established.

Caregivers' Sense of Coherence and Untreated Dental Caries in Children and Adolescents: A Cross-Sectional Study

ABSTRACT Objective: To associate caregivers' sense of coherence (SOC) and untreated caries with oral health status in children covered by a dental public health system. Material and Methods: A convenience sample of caregivers/children in Angra dos Reis, Brazil, was surveyed. Caregivers' SOC was evaluated using the 13-question version questionnaire. For both caregivers/children, sociodemographic information was acquired and caries experience was evaluated by DMFT/dmft and PUFA/pufa index. Statistical associations between children's untreated carious teeth and interest variables from the caregivers were evaluated by binary logistic regression assessed by generalized linear modeling. Results: A total of 233 pairs of caregivers-children were included. Children's untreated permanent and primary carious teeth represented 34.8% and 62.2% of the caries experience, respectively and at least one PUFA/pufa scored tooth was detected in 22.7% of them. Caregivers' DMFT was 13.5±7.0, while 33.6% scored on PUFA. A total of 62.1% of them presented untreated carious lesions. Results from the univariate model, correlating children's untreated caries and caregivers' attributes showed a statistical significance for SOC values (p<0.015), untreated decayed teeth (p<0.035), self-perception of oral health (p<0.022) and oral impact on daily performance (p<0.010). The multivariate logistic first model kept the statistical significance only for the caregiver's untreated decayed teeth. Conclusion: Caregivers' SOC and untreated carious teeth could be used as indicators of dental treatment needs in their offspring.

A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Oral Condition of Adolescents who Participated in an Oral Health Program During the First Decade of Life

ABSTRACT Objective: To evaluate the oral health of adolescents who participated in an oral health preventive program during the first decade of life. Material and Methods: For the evaluation of dental caries and gingival condition, DMFT and Community Periodontal Index were used, both recommended by the World Health Organization. To verify the occurrence of dental fluorosis, the Dean index was used. Results: Data collection was obtained from 252 patients aged 12 to 16 years. The average DMFT index was 1.14; in relation to the gingival condition, the index of healthy gingival tissue prevailed and the average of this value was 84%, with code 0 being more registered in tooth 11, code 1, more frequently in teeth 16/17 and 36/37 and for last, code 2, in tooth 31 most frequently. Dean's index showed a percentage of 89% of patients without clinical signs of dental fluorosis. Conclusion: Adolescents participating in an oral health preventive program in the first decade of life exhibited very satisfactory results regarding the prevention of caries disease, healthy periodontal condition and reduced prevalence of dental fluorosis.

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.

Importância da abordagem integral da cárie na primeira infância / Importance of integral approach of caries in early childhood

Introdução: a cárie na primeira infância (CPI), refere-se à patologia encontrada na dentição decídua em crianças com idade inferior a 71 meses. Apesar de avanços significativos na educação em saúde bucal, a CPI continua a afetar um número exacerbado de crianças em todo o mundo. Objetivo: revisar a literatura ressaltando a abordagem integral da lesão de cárie em crianças na primeira infância, levantando e discutindo a etiologia, os principais fatores de risco interrelacionados no surgimento da cárie, buscando informações necessárias para orientação aos cuidadores. Fonte dos dados: foram captados dados da Organização Mundial da Saúde e artigos em português e inglês que abordassem a cárie na primeira infância levando em consideração toda sua abordagem, nas bases de dados Biblioteca Virtual em Saúde, Scielo e PubMed, no período de 2009 a 2020. Síntese dos dados: verificou-se que a cárie na primeira infância é uma doença evitável, caso haja priorização da promoção de saúde e meios de prevenção desde os primeiros anos da criança. Os principais fatores de risco da doença são: a dieta cariogênica, o nível socioeconômico, escolaridade dos responsáveis, baixo contato com fluoretos e falta de higienização bucal correta. Conclusão: o estudo dos fatores envolvidos no surgimento da CPI é relevante, uma vez que reconhecendo-os pode-se buscar meios estratégicos de diminuir a incidência dessa doença que causa tantas consequências. Percebeu-se que a orientação dos cuidadores é um dos principais meios de preveni-la ou trata-la precocemente evitando maiores danos na dentição.

Introduction: early childhood caries (ECC) refers to the pathology found in primary dentition in children under 71 months of age. Despite significant advances in oral health education, ECC continues to affect an exacerbated number of children around the world. Objective: to review the literature emphasizing the integral approach of caries lesions in children in early childhood, pointing and discussing the etiology, the main interrelated risk factors in the onset of caries, pursuing necessary information to guide caregivers. Sources of data: were collected data from World Health Organization and articles in Portuguese and English that approached entirely the caries in early childhood, in the Virtual Health Library, Scielo and PubMed databases, from 2009 to 2020. Synthesis of data: caries in early childhood, as verified is a preventable disease if health promotion and ways of prevention are taking as a priority since the child's early years of old. The main risk factors of the disease are: the cariogenic diet, the socioeconomic level, education of those responsible for the child, low contact with fluorides and lack of correct oral hygiene. Conclusion: the study of the factors involved in the development of ECC is relevant, since recognizing it, is possible to seek strategic ways to reduce the incidence of this disease that causes so many consequences. It was noticed that the guidance of caregivers is one of the main ways to prevent or treat it early, avoiding further damage to the dentition.

Dental caries in 12-Year-Old schoolchildren who participate in a preventive and restorative dentistry program / Caries dental en escolares de 12 años que participan en un programa de odontología preventiva y rehabilitación oral

Abstract Since 2013, the Faculty of Dentistry of the University of Costa Rica has provided a preventive and restorative oral health program at Carmen Lyra Public School. The first generation of students that received dental care from this project were examined in 2019 for caries status. A total of 62 twelve-year-old schoolchildren were examined (31 boys and 31 girls). First, all teeth surfaces were cleaned with a brush and then rinsed. Subsequently, examination was performed in each person by a calibrated examiner using the International Caries Detection and Assessment System (ICDAS). Prevalence of dental caries was 59.7%. ICDAS code 2 was the most prevalent (68.8%), followed by 1 (19.3%), 5 (4.5%), 3 (3.5%), 6 (2.5%), and 4 (1.4%). Regarding number of carious surfaces, the highest prevalence was observed in the occlusal surfaces (77.3%), followed by the vestibular (13.9%), mesial (4.2%), palatal/ lingual (4,1%) and distal (0.5%). Of these carious surfaces, 7% were caries associated with restorations and were present only on the occlusal surfaces. Boys had more cavities than girls (54.1% compared to 45.9%), however, this difference was not significant. Regarding the condition of restorations in teeth, 92 dental restorations (resin or amalgam) were found in the population studied and were well adjusted. Most of these restorations were found on the occlusal surfaces (82.6%), followed by vestibular surfaces (8.7%,) palatal/lingual (5.4%) surfaces, mesial surfaces (3.3%), and no restorations were detected on the distal surfaces. Sealants were identified in 11.3% schoolchildren; 98% were identified on the occlusal surfaces and the other 2% were found on the palatal/lingual surfaces. DMFT Index was 1.6±0.71. The prevalence of dental caries in this sample was low compared to other studies in twelve-year-old schoolchildren in Costa Rica. This may suggest that the oral health program had a positive impact in the studied population.

Resumen Desde el año 2013, la Facultad de Odontología de la Universidad de Costa Rica ha brindado un programa de prevención y rehabilitación oral en la Escuela Carmen Lyra. La primera generación de estudiantes que recibieron atención dental por parte de este programa, fueron examinados en el año 2019 para determinar la prevalencia de caries. Se examinó a 62 escolares de 12 años (31 niños y 31 niñas). Primero, todas las superficies de los dientes se limpiaron con un cepillo y luego se enjuagaron. Posteriormente, el examen fue realizado en cada participante por un examinador calibrado utilizando el Sistema Internacional de Detección y Evaluación de Caries (ICDAS). La prevalencia de caries dental fue del 59,7%. El código ICDAS 2 fue el más prevalente (68,8%), seguido de 1 (19,3%), 5 (4,5%), 3 (3,5%), 6 (2,5%) y 4 (1,4%). En cuanto al número de superficies cariadas, la mayor prevalencia se observó en las superficies oclusales (77,3%), seguidas de las vestibulares (13,9%), mesiales (4,2%), palatinas/linguales (4,1%) y distales (0,5%). De estas superficies cariadas, el 7% eran caries asociadas con restauraciones y estaban presentes solo en las superficies oclusales. Los niños tenían más caries que las niñas (54,1% en comparación con el 45,9%), sin embargo, esta diferencia no fue significativa. En cuanto al estado de las restauraciones dentales, se encontraron 92 restauraciones dentales (resina o amalgama) en la población estudiada y se encontraban bien ajustadas. La mayoría de estas restauraciones se encontraron en las superficies oclusales (82,6%), seguidas de las superficies vestibulares (8,7%), superficies palatinas/linguales (5,4%), superficies mesiales (3,3%) y no se detectaron restauraciones en las superficies distales. Se identificaron sellantes de fosas y fisuras en el 11,3% de los escolares. El 98% de estos sellantes se identificó en las superficies oclusales y el otro 2% se encontró en las superficies palatino/lingual. El índice CPOD fue de 1,6±0.71. La prevalencia de caries dental en esta muestra fue baja en comparación con otros estudios en escolares de doce años en Costa Rica. Esto sugiere que el programa de salud bucal tuvo un impacto positivo en la población estudiada.

Association between subjects with newly Diagnosed rheumatoid arthritis and dental caries / Asociación entre sujetos con artritis reumatoide recientemente diagnosticada y caries dental

Abstract Alterations in saliva, temporomandibular joint disorders, dysphagia, Sjogrens syndrome, dental caries, periodontal disease, and tooth loss have been identified in patients with Rheumatoid Arthritis. The aims of this research were 1) to study the association between newly diagnosed rheumatoid arthritis and dental caries and 2) to identify most frequent teeth with caries in study groups. A descriptive pilot study was performed. A total of 620 participants were evaluated, 29 met the selection criteria. The subjects were divided into 2 groups: 13 subjects with newly diagnosed rheumatoid arthritis and 16 subjects without rheumatoid arthritis. Salivary parameters, DMFT index, care index, FS-T index and Treatment Needs Index were evaluated in all participants. The Fishers Exact test and Mann-Whitney U test we used to establish the differences between groups. Low mean in all salivary parameters and a high caries frequency were observed in subjects with newly diagnosed rheumatoid arthritis compared to a control group (p<0.01). The right maxillary second premolar (n=6, 46%, p=0.0100); right mandibular second premolar (n=7,54%, p=0.0462) and left mandibular second molar (n=10,77%, p=0.0001) were the most frequent teeth with caries. Early diagnosis and early treatment of rheumatoid arthritis can improve the prognosis in most of patients. The development of new public health policies and care based on the prevention are necessary to improve the quality of patients lives.

Resumen Alteraciones en la saliva, trastornos de la articulación temporomandibular, disfagia, síndrome de Sjogren, caries dental, enfermedad periodontal y pérdida de dientes son algunas patologías que se han identificado en pacientes con artritis reumatoide. Los objetivos de este estudio fueron (1) Asociar la artritis reumatoide recientemente diagnosticada con la caries dentales e (2) Identificar los dientes más frecuentes con caries en los grupos de estudio. Se realizó un estudio piloto descriptivo. 620 participantes fueron evaluados, 29 sujetos cumplieron con los criterios de selección. Los sujetos se dividieron en 2 grupos: 13 sujetos con artritis reumatoide recién diagnosticados y 16 sujetos sin artritis reumatoide. En todos los participantes se evaluaron parámetros salivales, el índice CPOD, el índice IC, el índice FS-T y el índice INT. La prueba exacta de Fisher y U de Mann-Whitney se utilizaron para establecer diferencias entre grupos. En los resultados se observó un bajo promedio de los parámetros salivales y una alta frecuencia de caries en sujetos con artritis reumatoide recién diagnosticados comparados con un grupo control (p<0.01). El segundo premolar superior derecho (n=6,46%, p=0,0100); el segundo premolar mandibular derecho (n=7,54%, p=0.0462) y el segundo molar mandibular izquierdo (n=10,77%, p=0.0001) fueron los dientes más frecuentes con caries dental. El diagnóstico y el tratamiento temprano de la artritis reumatoide pueden mejorar el pronóstico en la mayoría de los pacientes. El desarrollo de nuevas políticas de salud pública basadas en la prevención de la cavidad bucal son necesarias para mejorar la calidad de vida de los pacientes.

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)

Self-perception of oral health among tertiary-care users: quanti-qualitative analysis with chronic kidney disease patients

Chronic kidney disease (CKD) has become a global public health challenge. The objective of this study was to analyze the relationship between self-perception of oral health and clinical condition among patients with CKD. This isa quanti-qualitative survey conducted in a CKD specialized service. The sample consisted of 60 patients who underwent oral examinations to have their severity of caries (DMFT) and need for dental prosthesis checked. Age, sex, time on dialysis, marital status, skin color, education and pre-existing diseases were also analyzed. Among the kidney patients who agreed to undergo the clinical examinations and showed communication skills, some were selected, and three focus groups were created, with the participation of a moderator and six to 10 kidney patients in each group. Their speeches were processed in the IRAMUTEQ software and analyzed through the similarity analysis and word cloud techniques. As for profile, the patients were aged 60.23 ± 10.87 years old; were male (73.33%); were on dialysis for 41.90 ± 56.57 months; were married (61.67%); were white (76.67%); had incomplete primary education (41.66%); had arterial hypertension (76.67%); had a DMFT index of 22.55 ± 8.39; 43.33% needed an upper complete denture; and 30.00% needed a lower complete denture. The similarity analysis revealed many doubts and uncertainties about current health services, which can be proven by the words 'no' and 'treatment'. The quanti-qualitative analysis showed a high rate of dental loss and the need for complete dentures and suggests inequities in oral health care for chronic kidney disease patients, especially in tertiary care. There was a positive representation regarding oral health, but the lexicographical analyses of the textual corpusconfirmed the self-perception of lack of dental care.

Qualidade da fluoretação da água: o modelo de regulação e o arranjo institucional em três países selecionados / Quality of water fluoridation: the regulatory model and institutional arrangement in three selected countries

A cárie dentária não tratada é uma das doenças mais prevalentes afetando os dentes permanentes de aproximadamente 2,3 bilhões de pessoas no mundo. Cerca de 370 milhões de pessoas (5% da população mundial) tem acesso à água fluoretada (usualmente entre 0,5 a 1,0 mgF/L), que é considerada a maneira mais eficiente de prevenção da cárie. No entanto, concentrações acima de 1,5 mg/L de fluoreto acarretam um risco crescente de fluorose dentária e níveis muito mais altos levam à fluorose esquelética. Por isso, mecanismos regulatórios devem ser implementados para assegurar o monitoramento e o nível de qualidade da água em relação ao parâmetro fluoreto com a finalidade de alcançar o máximo de prevenção da cárie com o mínimo de fluorose dentária. Investigar o desenho e o tipo de arranjo institucional adotado em cada contexto pode auxiliar a compreender os diferentes efeitos produzidos por esses mecanismos e identificar limitações e oportunidades de aprimoramento. O objetivo foi descrever e comparar o modelo de regulação e o arranjo institucional para assegurar a qualidade da água a fim de garantir a segurança e efetividade do ajuste da concentração do fluoreto em três países selecionados. Foi realizado um estudo descritivo por meio de pesquisa documental utilizando fontes oficiais do Brasil, Estados Unidos da América (EUA) e Inglaterra. Foram elaborados quadros síntese comparando-se as agências e organizações, as missões, as funções, os mecanismos regulatórios, os dispositivos normativos e os instrumentos de disseminação da informação adotados em cada um dos países selecionados. Embora em todos os países sejam adotados dispositivos normativos para o controle da qualidade da fluoretação da água, os modelos regulatórios, os arranjos institucionais e as formas de vigilância e divulgação eram distintos. O valor máximo permitido para fluoreto de ocorrência natural era 4,0 mgF/L nos EUA enquanto nos demais países era 1,5 mgF/L. Os procedimentos de controle operacional eram definidos centralmente nos três países, mas sua aplicação podia variar entre as unidades federativas dos EUA. Inglaterra e EUA preconizam a coleta de amostras na rede de abastecimento, enquanto o Brasil apenas na saída do tratamento. Do ponto de vista da vigilância, Inglaterra e EUA utilizam dados que dependem das empresas responsáveis pelo tratamento da água, enquanto o Brasil, embora ainda em processo de implementação, adota um sistema vigilância independente que utiliza dados coletados na rede de distribuição pela autoridade sanitária local. Um ponto em comum entre EUA e Brasil é a construção de um sistema de informação que, sob os princípios da vigilância em saúde, propicie a produção de informações e sua divulgação a fim de atender as exigências para assegurar um elevado nível de qualidade da fluoretação da água. Embora os dispositivos normativos e as medidas regulatórias possuam diferentes abordagens e graus de centralização/descentralização nos países pesquisados, observou-se que há importante espaço para troca de informações e intercâmbio de tecnologias a fim de elevar o desempenho dos serviços, a efetividade da vigilância da qualidade da água para que os benefícios máximos de redução dos índices de cárie dentária em nível populacional sejam atingidos.

Untreated tooth decay is one of the most prevalent diseases affecting the permanent teeth of approximately 2.3 billion people worldwide. About 370 million people (5% of the world population) have access to fluoridated water (usually between 0.5 to 1.0 mgF/L), which is considered the most efficient way of preventing caries. However, concentrations above 1.5 mg/L of fluoride carry an increased risk of dental fluorosis, and much higher levels lead to skeletal fluorosis. Therefore, regulatory mechanisms must be implemented to ensure monitoring and the level of water quality in relation to the fluoride parameter in order to achieve maximum caries prevention with minimum dental fluorosis. Investigating the design and type of institutional arrangement adopted in each context can help to understand the different effects produced by these mechanisms and identify limitations and opportunities for improvement. The objective was to describe and compare the regulatory model and the institutional arrangement to ensure water quality in order to guarantee the safety and effectiveness of fluoride concentration adjustment in three selected countries. A descriptive study was carried out through documentary research using official sources from Brazil, the United States and England. Summary tables were prepared comparing agencies and organizations, missions, functions, regulatory mechanisms, regulatory provisions and information dissemination instruments adopted in each of the selected countries. Although regulatory provisions are adopted in all countries to control the quality of water fluoridation, the regulatory models, institutional arrangements and forms of surveillance and disclosure were different. The maximum allowable value for naturally occurring fluoride was 4.0 mgF/L in the US while in other countries it was 1.5 mgF/L. Operational control procedures were centrally defined in the three countries, but their application could vary across US states. England and the USA advocate the collection of samples in the supply network, while Brazil only at the end of the treatment. From a surveillance point of view, England and the USA use data that depend on the companies responsible for water treatment, while Brazil, although still in the process of implementation, adopts an independent surveillance system that uses data collected in the distribution network by the local health authority. A common point between the USA and Brazil is the construction of an information system that, under the principles of health surveillance, promotes the production of information and its dissemination in order to meet the requirements to ensure a high level of quality in the fluoridation of Water. Although normative provisions and regulatory measures have different approaches and degrees of centralization/decentralization in the countries surveyed, it was observed that there is important space for exchanging information and exchanging technologies in order to increase the performance of services, the effectiveness of surveillance of the water quality so that the maximum benefits of reducing dental caries rates at the population level are achieved.

Expert consensus on dental caries management / 国际口腔科学杂志·英文版

Dental Caries is a kind of chronic oral disease that greatly threaten human being's health. Though dentists and researchers struggled for decades to combat this oral disease, the incidence and prevalence of dental caries remain quite high. Therefore, improving the disease management is a key issue for the whole population and life cycle management of dental caries. So clinical difficulty assessment system of caries prevention and management is established based on dental caries diagnosis and classification. Dentists should perform oral examination and establish dental records at each visit. When treatment plan is made on the base of caries risk assessment and carious lesion activity, we need to work out patient‑centered and personalized treatment planning to regain oral microecological balance, to control caries progression and to restore the structure and function of the carious teeth. And the follow-up visits are made based on personalized caries management. This expert consensus mainly discusses caries risk assessment, caries treatment difficulty assessment and dental caries treatment plan, which are the most important parts of caries management in the whole life cycle.

Research progress in ecological prevention of dental caries / 中华口腔医学杂志

Dental caries is one of the most common oral diseases around the world. Dental plaque attached to the surfaces of teeth is the main biological factor leading to caries. Although fluoride is still one of the most commonly used methods to prevent caries, with the change of epidemiological characteristics of caries and the update of the understanding of caries etiology, it is necessary to use other ecological methods such as antimicrobial peptides, arginine, probiotics and natural products, etc. to enhance the effect of fluoride in preventing dental caries. The present article reviews the research progress on the ecological approaches for caries prevention in recent years.

Expert consensus on early childhood caries management / 国际口腔科学杂志·英文版

Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.

Research Trends on Preventive and Therapeutic Use of TIF4 for Dental Caries and Erosion

Abstract Objective: To evaluate TIF4 preventive and therapeutic use in caries and erosive lesions. Material and Methods: Searches were performed in six databases. Studies evaluating TiF4 use in vitro, in situ, and in vivo in caries and erosive lesions were included and imported into VantagePoint™ (VP). Data about publication year, authors, country, journal, study design, outcomes, TIF4 vehicles, application and intervention time, cariogenic challenge, erosive cycles, effects (positive/ negative /null) and approach (preventive/therapeutic) were analyzed through VP and Excel. Results: 93 published studies were included and an increase in publications was observed between 2010 and 2021. Forty-three authors published three or more articles, of which 67.4% were developed in Brazil and published in Caries Research (22.6%). 69.9% were in vitro studies with erosion assays (59.1%) and with preventive approaches (67.4%). The principal vehicle was a solution (69.9%) with a 1-min single application (58.0%) and with an intervention time of 5-7 days (22.6%). The principal cariogenic challenge in vitro was pH cycling (11.8%); in situ was sucrose + biofilm (6.2%); and in vivo, biofilm (6.2%). The most used erosive cycle was 4× per day in in vitro studies (20.4%) and 1× in vivo (2.1%). A positive effect was observed in prevention (41.9%) and treatment (24.7%) studies. Conclusion: TIF4 has shown a positive effect in prevention and therapeutic treatments for dental caries and erosion (AU).