Bond strength comparison among 10-MDP-containing and non-10-MDP-Containing adhesives in different degrees of dental fluorosis / Comparación de fuerza de unión entre adhesivos que contienen y no contienen 10-MDP en diferentes grados de fluorosis dental

Dental fluorosis can cause changes in the enamel surface, conditioning its functionality and esthetics. The application of dental adhesives is a treatment option; however, their use on fluorotic teeth can result in limitations. The aim of this study was to compare the shear bond strength of two different adhesives, one with 10-MDP and one without 10-MDP, in different degrees of dental fluorosis.This is an in vitro study on dental enamel samples, a total of 180 samples with the inclusion criteria were treated, randomly divided into two groups of 90, according to the type of dental adhesive, where each group was again divided into three groups of 30 samples, representing different degrees of dental fluorosis according to the Thylstrup-Fejerskov index (Group I: TF1 and TF2; Group II: TF3; Group III: TF4). Normality tests, two-factor ANOVA, and post-hoc tests were used to determine differences between the groups, with a significance level of 95%. As results, a statistically significant difference was shown between the use of dental adhesive with 10-MDP and the three groups of dental fluorosis (p=0.011), in addition, a Tukey post-hoc test on the groups treated with 10-MDP adhesive revealed a statistically significant difference between group I versus group II, and group I versus group III, (p=<0.05). It is concluded that the use of adhesive systems with 10-MDP presents a better shear bond strength on enamel with dental fluorosis grades I and II in the Thylstrup-Fejerskov index.

La fluorosis dental puede ocasionar cambios en la superficie del esmalte, condicionando su funcionalidad y estética, la aplicación de adhesivos dentales es una opción de tratamiento, sin embargo, su uso en dientes fluoroticos puede resultar en limitaciones. El objetivo de este estudio consistió en comparar la fuerza de adhesión a la cizalladura de dos diferentes adhesivos, uno con 10-MDP y otro sin 10-MDP, en diferentes grados de fluorosis dental. Se trata de un estudio in vitro en muestras de esmalte dental, un total de 180 muestras con los criterios de inclusión fueron tratadas, aleatoriamente divididas en dos grupos de 90, de acuerdo al tipo de adhesivo dental, donde cada grupo fue dividido nuevamente en tres grupos de 30 muestras, representando diferentes grados de fluorosis dental según el índice de Thylstrup- Fejerskov (Grupo I: TF1 y TF2; Grupo II: TF3; Grupo III: TF4). Para determinar diferencias entre los grupos se utilizaron pruebas de normalidad, ANOVA de dos factores, y pruebas post-hoc, con un nivel de significancia de 95%. Como resultados, se mostró una diferencia estadísticamente significativa entre el uso de adhesivo dental con 10- MDP y los tres grupos de fluorosis dental (p=0.011), además, una prueba post hoc de Tukey sobre los grupos tratados con adhesivo 10-MDP revelaron una diferencia estadísticamente significativa entre el grupo I frente al grupo II, y el grupo I frente al grupo III, (p=<0.05) Se concluye que el uso de sistemas adhesivos con 10-MDP presentan una mejor resistencia de adhesión al cizallamiento en esmalte con grados de fluorosis dental I y II en el índice de Thylstrup-Fejerskov

Solução estética conservadora em paciente jovem com fluorose: clareamento e microabrasão: relato de caso / Conservative aesthetic solution in a young patient with fluorosis: whitening and microabrasion: case report

Introdução: a fluorose constitui uma patologia que afeta os dentes desencadeada pelo excesso de ingestão de flúor. Sua manifestação ocorre a nível de esmalte na presença de manchas ou defeitos anatômicos. Objetivo: relatar o manejo clínico de um paciente com fluorose tratado com procedimento minimamente invasivo. Relato do caso: paciente do sexo feminino, 18 anos, apresentando queixas estéticas clinicamente observadas na vestibular dos dentes, com diagnóstico de lesões fluoróticas. Foi executado protocolo de dessensibilização com Ultra EZ por 5 min e aplicação do Verniz (Enamelast Fluoride) previamente ao tratamento clareador. Foram realizados duas sessões de clareamento com peróxido de hidrogenio 35% (DMC) por 45 min com intervalo de sete dias entre elas. Imediatamente após a segunda sessão de clareamento, foi realizado microabrasão com pasta abrasiva Whitness RM (FGM) e taça de borracha com fricção por 20 segundos. Resultados: o tratamento clareador associado a técnica da microabrasão do esmalte demonstrou resultado estético favorável, microinvasivo e eficaz no tratamento da fluorose. Conclusão: a associação dos tratamentos resolveu o problema estético da paciente de forma rápida e segura, conservando a estrutura dentária.

Introduction: fluorosis is a pathology that affects teeth triggered by excess fluoride intake. Its manifestation occurs at the enamel level in the presence of stains or anatomical defects. Objective: to report the clinical management of a patient with fluorosis treated with a minimally invasive procedure. Case report: female patient, 18 years old, presenting aesthetic complaints clinically observed in the buccal of the teeth, with a diagnosis of fluorotic lesions. A desensitization protocol was performed with Ultra EZ for 5 min and Varnish (Enamelast Fluoride) was applied prior to the bleaching treatment. Two bleaching sessions were performed with 35% hydrogen peroxide (DMC) for 45 min, with an interval of seven days between them. Immediately after the second bleaching session, microabrasion was performed with Whitness RM abrasive paste (FGM) and a rubber cup with friction for 20 seconds. Results: The bleaching treatment associated with the enamel microabrasion technique demonstrated a favorable, microinvasive and effective esthetic result in the treatment of fluorosis. Conclusion: the combination of treatments solved the patient's aesthetic problem quickly and safely, preserving the dental structure.

Infiltrantes para tratamiento estético de lesiones de manchas blancas por fluorosis: Reporte de caso / Infiltrants for Aesthetic Treatment of White Spots Lesions by Fluorosis: Case Report

Resumen La fluorosis dental es una anomalía en el desarrollo del esmalte debido a la excesiva ingesta de flúor durante la formación de los tejidos dentales, y se caracteriza principalmente por la hipomineralización y mayor porosidad de la estructura del esmalte. Muchas veces las manchas ocasionadas por la fluorosis dental pueden comprometer la estética del paciente y afectar su autoestima. En años recientes ha sido desarrollado una nueva generación de materiales odontológicos conocida como infiltrantes resinosos, que básicamente son resinas de baja viscosidad que infiltran y paralizan la progresión de las lesiones cariosas incipientes no cavitadas. Cuando infiltrantes resinosos han sido utilizados para detener las lesiones cariosas se ha verificado que también producen cambios en la apariencia de la mancha blanca, atenuándola o tornándola imperceptible. El presente artículo describe un reporte de caso del uso de infiltrantes resinosos para tratamiento estético de lesiones de manchas blancas ocasionadas por fluorosis.

Abstract Dental fluorosis is an abnormality in the development of enamel due to the excessive intake of fluoride during formation of dental tissues, mainly characterized by hypomineralization and increased porosity of the enamel structure. Oftenly the spots caused by dental fluorosis can compromise the aesthetics of the patient and affect their self-esteem. In recent years a new generation of dental materials has been developed, known as resin infiltrants, which are basically low viscosity resins that infiltrate and paralyze the progression of incipient non cavitated carious lesions. When resin infiltrants have been used to stop carious lesions it has been verified that they also produce changes in the appearance of white spots, masking or making them imperceptible. The present article describes a case report of the use of resin infiltrants for aesthetic treatment of white spot lesions caused by fluorosis.

Impacto de la fluorosis dental en la calidad de vida de adolescentes ecuatorianos de entre 11 a 14 años / Impact of dental fluorosis over the quality of life of ecuadorian teenagers between 11 and 14 years

Resumen El propósito de este estudio fue determinar el impacto de la fluorosis dental (FD) en la calidad de vida (CV) de adolescentes entre 11 a 14 años del cantón Latacunga, Cotopaxi, Ecuador. Materiales y métodos: Se plantea un estudio descriptivo, en una muestra de 128 adolescentes entre 11 a 14 años y sus respectivos padres, empleando como instrumentos de recolección de información, la encuesta INEN para determinar el nivel socioeconómico, el cuestionario CPQ11-14 para precisar calidad de vida, y un registro fotográfico intraoral de cada adolescente, analizado posteriormente por tres investigadores según el índice de Thylstrup y Fejerskov (TF). Un análisis químico sobre la concentración de flúor en las fuentes de abastecimiento de agua de consumo, fue ejecutado complementariamente. Resultados: La prevalencia de FD fue de 70,3% en los grados TF 1, 2,3. El análisis químico del agua mostró una media de flúor de 1,06 mg/l. Las pruebas estadísticas revelaron una relación de la CV con FD (p = 0,000) y con el nivel socioeconómico (p = 0,001). Conclusiones: La CV se ve afectada con la presencia de FD y el nivel socioeconómico, sin relación con la edad, sexo o la presencia de flúor en el agua de consumo.

Abstract The purpose of this study was to determine the impact of dental fluorosis (DF) over the quality of life (QoL) of adolescents between 11 and 14 years old, of Latacunga, Cotopaxi, Ecuador. Materials and methods: This descriptive study had a sample of 128 adolescents between 11 to 14 years old and their respective parents. The information was collected through, the INEN survey to determine socioeconomic status and the CPQ11-14 survey to determine adolescents' QoL. In addition, intraoral photographic records were obtained for DF detection according Thylstrup and Fejerskov index (TF) and the public water company accomplished chemical analysis of fluoride concentration in water sources. Results: The prevalence of DF was 70.3% corresponding to TF 1, 2, 3 index. Chemical analyzes of water showed an average of 1.06 mg / l on Fluoride levels. Statistical analysis showed correlation between QoL and Fluorosis presence (p = 0.000) and QoL to socio-economic level (p = 0.001). Conclusions: QoL relates to DF and the socio-economic level. However, it is not to age, sex or fluoride levels in consumption water. Key words: Teenagers, dental fluorosis, oral health, life quality, water fluoridation, epidemiology, dental health survey, public health dentistry.

La exposición prenatal a fluoruro induce cambios en la porción coronal de la cripta ósea y altera la erupción dental en crías lactantes / Prenatal fluoride exposure induces changes in the coronal portion of bony crypt and alters dental eruption in suckling rats

La erupción dental es un proceso estrictamente regulado y programado espacial y temporalmente. El objetivo del trabajo fue estudiar el efecto de la exposición prenatal a fluoruro de sodio (NaF) sobre los eventos morfológicos y celulares que ocurren en el hueso supracoronal del primer molar de crías de rata durante la etapa preeruptiva. Se emplearon crías (n=6-8 por grupo) provenientes de madres que bebieron crónicamente agua con diferentes concentraciones de F- en forma de NaF durante la gestación y lactancia: control y NaF (50 mg/L). En cortes histológicos de la mandíbula de crías de 3 y 10 días se analizaron parámetros de histomorfometría estática en la zona supracoronal de la canastilla ósea a la altura del primer molar inferior: volumen óseo trabecular [BV/TV (%)], número de osteoclastos por milímetro (N.Oc/mm) y las variables indirectas: número de trabéculas [Tb.N (1/mm)], espesor [Tb.Th (µm)] y separación trabecular [Tb.Sp (µm)]. En crías de 15 días se midió el grado de erupción [TED (µm)] del primer molar inferior. Los resultados se analizaron con el test "t" de Student considerando diferencias significativas a p<0,05. El análisis histomorfométrico demostró un incremento en el BV/TV (%) del hueso supracoronal (p<0,01) asociado con disminución del N.Oc/mm (p<0,01) en crías de 3 y 10 días expuestas prenatalmente al F-. El grado de erupción dental fue menor en animales expuestos prenatalmente al F- en comparación con los controles (p<0,01). En conclusión, los resultados observados en la mandíbula de crías expuestas durante la etapa prenatal y posnatal temprana al F- sugieren un efecto disruptivo sobre la actividad resortiva necesaria para formación del canal eruptivo. (AU)

Tooth eruption is a tightly regulated and spatially and temporally programmed process. The aim of this study was to examine the effect of prenatal NaF exposure on the morphological and cellular events that occur in the supracoronal area of bony crypt of the first rat molar during the preeruptive stage. Offspring from two groups of rats were used (6-8 per group): Control and 50 mg/L NaF. The treatment was performed during pregnancy and lactation. Suckling pups were euthanized at 3-, 10- and 15-days-old by cervical dislocation. Mandibles were removed and histologically processed to obtain buccolingual sections stained with H&E. In sections of first mandibular molar of 3- and 10-days-old pups, the following static histomorphometric parameters were evaluated: trabecular bone volume [BV/TV (%)] and number of osteoclasts (N.Oc/mm). Also, indirect parameters were obtained: trabecular number [Tb.N (1/mm)], trabecular thickness [Tb.Th (µm)], and trabecular separation [Tb.Sp (µm)]. The degree of tooth eruption [TED (µm)] was determined. Results are expressed as mean ± SE and analyzed by Student t-test. Histomorphometric analysis showed an increase in the BV/TV (%) of the bone crypt of 3- and 10- days-old pups exposed to NaF (p <0.01); this increase was associated with a decrease in the N.Oc/mm (p <0.01). TED of mandibular first molar was lower in prenatal NaF exposed group than in control group (p<0.01). In conclusion, the increased BV/TV and the lower N.Oc observed in the bone crypt of 3- and 10- days-old pups from mothers treated with NaF suggested a disruptive effect triggered by F- on the formation events of the eruptive pathway in the offspring. (AU)

Differential diagnosis of dental fluorosis made by undergraduate dental students / Diagnóstico diferencial de fluorose dentária por discentes de odontologia

ABSTRACT Objective To check knowledge of undergraduate dental students to make diagnosis of dental fluorosis with varying degrees of severity and choose its appropriate treatment. Methods Data were collected using a semi-structured questionnaire addressing knowledge of undergraduates based on ten images of mouths presenting enamel changes. Results Only three images were correctly diagnosed by most undergraduates; the major difficulty was in establishing dental fluorosis severity degree. Conclusion Despite much information about fluorosis conveyed during the Dentistry training, as defined in the course syllabus, a significant part of the students was not able to differentiate it from other lesions; they did not demonstrate expertise as to defining severity of fluorosis and indications for treatment, and could not make the correct diagnosis of enamel surface changes.

RESUMO Objetivo Verificar o conhecimento de discentes de um curso de graduação em Odontologia ao diagnosticar casos de fluorose dentária nos diversos graus de severidade, bem como escolher seu tratamento adequado. Métodos O levantamento dos dados foi realizado por meio um questionário semiestruturado, que abordou o conhecimento dos acadêmicos sobre as imagens de bocas contendo alterações do esmalte dentário. Resultados Apenas três imagens foram diagnosticadas corretamente pela maioria dos acadêmicos; a maior dificuldade foi o diagnóstico da severidade da fluorose dentária. Conclusão Apesar das informações sobre fluorose repassadas no decorrer do curso de Odontologia, definidas pelos conteúdos abordados na matriz curricular, expressiva parte dos alunos ainda não soube diferenciá-la de outras lesões, não demonstrando domínio sobre a severidade e as indicações de tratamento, o que indicou desconhecimento no diagnóstico correto das alterações de superfície de esmalte.

Evaluation of young s knowledgeand behavior about dental fluorosis

AIM: This study has evaluated the knowledge about dental fluorosis and the behavior of young people regarding to the use of Fluor. MATERIAL AND METHODS: 313 students from High School of Tabatinga/SP, from 15 to 21 years old have answered a questionnaire with pre-encoded questions in which was approached the variables: gender, age, schooling level, dwelling, water consumption, oral hygiene habits, frequency of consults to the dentist and perception about clinical characteristics of fluorosis. Data obtained were analyzed by means of descriptive statistics. RESULTS: There was female prevalence (56.0%). Most of respondents (81.0%) answered brushing the teeth 3 times or more a day. About dentifrice use and quantity on the toothbrush, from 97% who has asserted using them, 58% cover all the bristles; 88% of participants know Fluor; however, regarding to its function or effect on the teeth, 17% and 32%, respectively, have not known how to answer. About water consumption, most of them consume from 1 to 2 liters a day, and the main source is the “faucet” (47%). It was observed that 49% of interviewees have visited the surgeon dentist less than one month ago; 93% have answered that the topic application of Fluor was carried out during the dentist consultation, and 32% have asserted that the application was performed in all the visits. Regarding the surface stains on tooth enamel, 59% have reported that they did not notice them; however, 21% have noticed white stains on the enamel. Regarding to the use of tooth paste in the childhood, 52% have reported that they used to ingest it. CONCLUSION: Young s knowledge about function and effect of Fluor on dental structures were mistaken, once the concept of dental cleaning was prevalent about prevention of caries, and the behavior about fluoridated toothpaste was inappropriate because they use it excessively, and they also asserted its ingestion in the childhood.

Agreement between parents and adolescents on dental fluorosis: a population-based study

This study evaluated the prevalence and severity of dental fluorosis and compared the reports from adolescents aged 12 to 18 years with those of their parents regarding the perceptions and concerns arising from this disease. The study was conducted in the cities of Viçosa and Sobral and the District of Rafael Arruda (Sobral), Ceará. A cross-sectional study was conducted from October 2010 to March 2011, with 891 students examined and 780 parents or guardians interviewed. Dental fluorosis was measured using the Dean's Index, and the Child's and Parent's Questionnaire about Teeth Appearance was used to assess the reports from parents and adolescents. A chi-squared test for trends was used to compare the opinions of parents and adolescents about fluorosis, and the agreement was measured using the weighted kappa. For the dichotomous variables, we used the unweighted kappa coefficient. The prevalence of fluorosis was 29.7%, but in the District of Rafael Arruda, evidence of very mild and mild fluorosis was found in 32.5% of the subjects, and moderate and severe fluorosis was found in 28.7%. There was poor agreement between the data reported by the adolescents and their parents or guardians regarding areas of concern and their perceived satisfaction with the appearance and color of their teeth. The prevalence of dental fluorosis was high in one of the communities studied, but the clinical diagnosis of this condition should not necessarily equate with concern and dissatisfaction with aesthetic appearances among teenagers and their parents.

Percepção da fluorose dentária e avaliação da concordância entre pais e filhos: validação de um instrumento / Perceptions of dental fluorosis and evaluation of agreement between parents and children: validation of a questionnaire

Objetivou-se validar o Child's and Parent's Questionnaire about Teeth Appearance, avaliando as preocupações relacionadas à fluorose em 213 pares de pais/crianças (12 anos) de duas regiões brasileiras. A confiabilidade foi avaliada pelo alfa de Cronbach e pelo coeficiente de correlação intraclasse; e a validade de constructo e de critério, pela correlação de Spearman. Para comparar as duas regiões e avaliar a concordância pais/filhos, foi utilizado o teste t de Student. A consistência interna foi aceitável, e a confiabilidade teste-reteste, moderada a excelente. Houve correlação significativa entre percepção da fluorose moderada e severa e os dados clínicos e entre percepção da fluorose e preocupações dos indivíduos. Embora os pais de Rafael Arruda, Ceará, Brasil, tenham tido maior percepção da fluorose, o incômodo e a preocupação com a aparência foram maiores em Piracicaba, São Paulo. Os pais se mostraram mais incomodados, preocupados e insatisfeitos com a aparência dentária das crianças do que elas mesmas. Essa versão é válida e confiável para avaliar a percepção da estética dentária em crianças e em seus pais.

This study aimed to validate the Child's and Parent's Questionnaire about Teeth Appearance and to evaluate concerns relative to fluorosis among 213 pairs of parents and 12-year-old children from two regions of Brazil. Reliability was assessed by Cronbach's alpha and intraclass correlation coefficient, and construct and criterion validity by Spearman's correlations. Student t-test was used to compare the two regions and to assess parent/child agreement. Internal consistency was acceptable, and test-retest reliability was moderate to excellent. Perception of moderate to severe fluorosis and clinical data were significantly correlated, as were perception of fluorosis and subjects' concerns. Although parents from Rafael Arruda, Ceará State, showed a higher perception of fluorosis, parental concern was greater in Piracicaba, São Paulo State. Parents were more worried and dissatisfied with their children's dental appearance than the children themselves. This version of the questionnaire proved to be valid and reliable for assessing children's and parents' perceptions of dental fluorosis.

Prevalencia de caries dental y fluorosis en áreas de fluorosis endémica en el Estado Portuguesa, Venezuela / Prevalence of dental caries and flurosis endemic fluorosis areas of Portuguesa State, Venezuela

Determinar la prevalencia y severidad de caries y fluorosis dental en una zona de fluorosis endémica en Portuguesa. 187 individuos entre 2-62 años de edad de cuatro comunidades del Municipio Santa Rosalía fueron evaluados para caries dental según el índice CPOD/ceo (OMS) y para fluorosis dental de acuerdo al Índice de Dean. Todos los participantes en la presente investigación firmaron un consentimiento informado. Cada paciente respondió un cuestionario estructurado a tal fin y los datos fueron registrados. El examen clínico fue realizado por un examinador calibrado y se utilizó sonda WHO, espejo plano #5 y luz natural. Según el género, de los 187 pacientes, 96 fueron masculino (51%) y 91 femeninos (49%) y 90,9% de la población estudiada pertenecía a los estratos 4 y 5 de Graffar. El 69% de pacientes estaban libres de caries dental y los índices promedio CPOD y ceo fueron 1,7±3,62 y 0,41±1,15, respectivamente siendo el índice CPOD en Cogote significativamente menor (p<0,05) al compararlos con los observados en San Pablo y Playón (p>0,05), pero sin diferencias significativas al compararlo con el de Punto Fijo. El 76,9% de los individuos evaluados presentaban fluorosis dental siendo el grado de severidad promedio la categoría de moderado (Grado 4). Se le debe dar una alta prioridad a la defluoruración del agua, y en caso de que no sea posible, se debe proveer a la población de agua con concentraciones de fluoruro óptimas. No se observó asociación entre el grado de severidad de fluorosis dental y los niveles de fluoruro en el agua. Estudio parcialmente financiado por la Facultad de Odontología, UCV.

The purpose of this study was to determine the prevalence and severity of dental caries and fluorosis in an endemic area of Portuguesa State. One hundred eighty seven individuals, age ranging between 2-62 years, from four communities of Santa Rosalía Municipality were evaluated for dental caries index DMFT/dmf according to the WHO criteria and dental fluorosis using the Dean index. All participants signed the written consent to be enrolled for the study. The clinical examination was done by a calibrated examiner using the WHO probe, mirror #5 and natural light. The results from the study showed that 96/187 (51%) were male and 91/187 (49%) were female. According to socioeconomic status 90.9% of the studied population was level 4 and 5 according to Graffar criteria. Sixty nine percent of the patient was dental caries free and the mean indexes DMFT/dmf were 1.7±3.62 and 0.41±1.15, respectively. The lower DMFT scores were observed in Cogote (p<0.05) with statistical significant differences when compared to San Pablo and Playón but without differences when compares to Punto Fijo community (p>0.05). When analyzing the presence of dental fluorosis, 76.9% of the subjects had the condition being moderate (Grade 4). We may conclude that water defluoridation is of high priority in these communities, as well as to provide the population with optimal fluoride concentration in water. Our results indicate the absence of association between the fluoride concentration for water consumption and the dental fluorosis severity in endemic areas. Study partially supported by the Faculty of Dentistry, UCV.

Quality of drinking water fluoridation of Capão Bonito, SP, Brazil, evaluated by operational and external controls / Qualidade da fluoretação da água de Capão Bonito, SP, Brasil, avaliada pelos controles operacional e heterocontrole

PURPOSE: To evaluate the quality of drinking water fluoridation of Capão Bonito, SP, Brazil, whose optimal fluoride concentration should be between 0.6 to 0.8 ppm F, considering the balance benefits/risks. METHODS: Historical records (n=1,964) from 2005 to 2009 of the water treatment plant (operational control) were evaluated. Also, from July 2009 to June 2010, 120 samples of the network water were collected for analysis and the fluoride concentrations found (external control) were compared with records of operational control of the same period. RESULTS: According to the historical records, 76.3% of the samples had acceptable fluoride concentration and this value was confirmed by the external control done during one year, which found that 80.8% of samples were within the optimal range. However, considering the samples out the optimal range, while the records of the operational control showed values below the minimum, the results of the external control found higher percentage of samples above the maximum. CONCLUSION: The data show the relevance to have a quality control of drinking water fluoridation because at same time the operational control analysis suggests that certain percentage of the population would not be receiving anticaries benefits, the external control indicates that it would be in increased risk of fluorosis.

OBJETIVO: Avaliar a qualidade da fluoretação da água de Capão Bonito, SP, Brasil, cuja concentração de fluoreto deveria estar entre os limites de 0,6 e 0,8 ppm F, considerando o equilíbrio benefícios/riscos. METODOLOGIA: Foram consultados 1964 registros feitos de 2005 a 2009 pela empresa responsável pelo tratamento da água (controle operacional). De 07/2009 a 06/2010, 120 amostras de água foram coletadas e as concentrações de fluoreto encontradas (heterocontrole) foram comparadas com as registradas pelo controle operacional do mesmo período. RESULTADOS: De acordo com os registros históricos, 76% das amostras tinham concentrações aceitáveis de fluoreto e este valor médio foi confirmado pelo heterocontrole feito, o qual encontrou um valor de 81%. Entretanto, considerando as amostras abaixo e acima dos limites aceitáveis, enquanto os registros do controle operacional mostraram maior porcentagem de valores abaixo do mínimo, os resultados do heterocontrole detectaram maior porcentagem acima do limite máximo. CONCLUSÃO: O relatado mostra a importância de haver um controle de qualidade da fluoretação da água de abastecimento publico, porque enquanto as análises feitas pelo controle operacional sugerem que uma porcentagem da população não estaria recebendo os benefícios da fluoretação, o heterocontrole aponta que ela estaria sob risco aumentado de fluorose dentária.

Fluorosis dental en escolares de 6 a 13 años de instituciones educativas públicas de Medellín, Colombia, 2006 / Dental fluorosis in 6-13-year-old children attending public schools in Medellín, Colombia

Objetivo El propósito de este estudio fue determinar la prevalencia y severidad de la fluorosis dental en escolares entre los 6 y 13 años de edad de la ciudad de Medellín, Colombia. Métodos Se realizó un estudio descriptivo en 1 330 niños matriculados en 34 instituciones educativas públicas. Los exámenes clínicos fueron realizados por dos odontólogas entrenadas y calibradas en el diagnóstico de fluorosis dental. Después de aislar con rollos de algodón y secar con gasa, se examinaron las superficies vestibulares de los dientes superiores mediante inspección visual con luz natural. Se utilizó el índice de Thylstrup y Fejerskov (TFI) Resultados La prevalencia de fluorosis dental fue 81 por ciento (TFI>1). El 46,4 por ciento tenían grados leves de fluorosis, TFI1 y TFI2 y el 8,8 por ciento tenían grados severos, TFI >5. El 21 por ciento de los niños tenían TFI>1 en al menos el 50 por ciento de sus dientes examinados. Conclusión La prevalencia fluorosis dental encontrada en los escolares de colegios públicos de Medellín fue alta. Las autoridades de salud deberán enfocar su atención en la prevención de este problema.

ObjectiveThis study was aimed at determining dental fluorosis prevalence and severity amongst 6-13-year-old students residing in Medellin, Colombia. Methods A descriptive study was carried out on 1,330 students attending 34 public schools in the city of Medellin. Two dentists trained in dental fluorosis diagnosis performed the examinations were after the teeth had been brushed. Teeth were dried with gauze, isolated with cotton pellets and visually examined in natural light. The Thylstrup and Fejerskov index (TFI) was used for rating fluorosis. Results Dental fluorosis prevalence was 81 percent (TFI>1); 46.4 percent was related to mild dental fluorosis (TFI1 and TFI2) and 8.8 percent to severe dental fluorosis (TFI >5). TFI > or = 1 was found in 21 percent of the children being examined in at least 50 percent of their teeth. Conclusion Dental fluorosis prevalence level was found to be high in Medellín, Colombia; health authorities should thus focus their attention on preventing this problem.

Agreement in the diagnosis of dental fluorosis in central incisors performed by a standardized photographic method and clinical examination / Concordância no diagnóstico da fluorose dentária em incisivos centrais realizado por um método fotográfico padronizado e pelo exame clínico

The aim of this study was to assess agreement in the diagnosis of dental fluorosis performed by a standardized digital photographic method and a clinical examination (gold standard). 49 children (aged 7-9 years) were clinically evaluated by a trained examiner for the assessment of dentalfluorosis. Central incisors were evaluated for the presence or absence of dental fluorosis and were photographed with a digital camera. Photographs were presented to three pediatric dentists, who examined the images. Data were analyzed using Cohen’s kappa and validity values. Agreement in the diagnosis performed by the photographic method and clinical examination was good (0.67) and accuracy was 83.7%. The prevalence ofdental fluorosis was reported to be higher in the clinical examination (49%) compared with the photographic method (36.7%). The photographic method presented higher specificity (96%) thansensitivity (70.8%), a positive predictive value (PPV) of 94.4% and a negative predictive value (NPV) of 77.4%. The diagnosis of dental fluorosisperformed using the photographic method presented high specificity and PPV, which indicates that the method is reproducible and reliable for recording dental fluorosis.

O objetivo do estudo foi comparar o diagnóstico de fluorose dentária realizado por um método fotográficocom o exame clínico (padrão ouro). Quarenta e nove crianças, de 7 e 9 anos, foram clinicamente examinadas por um examinador calibrado para fluorose dentária. Os incisivos foram fotografados com câmera digital e as fotografias foram apresentadas a três odontopediatras, que examinaram as imagens. A concordância por kappa entre o método fotográfico e o padrão ouro foi boa (0,67) e a acurácia foi de 83,67%. A prevalência de fluorose dentária foi levemente maior pelo método clínico (49%) do que pelo fotográfico (36,7%). O método fotográfico apresentou maior especificidade (96%) que sensibilidade (70,83%), valor de predição positivo (VPP) de 94,44% e valor de prediçãonegativo (VPN) de 77,42%, com poucos casos de falsos positivos (6%). O diagnóstico de fluorose dentária usando-se o método fotográfico apresentou altaespecificidade e VPP, indicando que é adequado para registrar fluorose dentária, com poucos casos de falsospositivos. O método é reprodutível e confiável quando comparado com o diagnóstico clínico e pode ser usado para o diagnóstico da fluorose dentária.

Alterações na amelogênese e suas implicações clínicas: relatos de casos / Alterations in amelogenesis and its clinical implications: cases reports

Alterações durante a amelogênese podem acarretar distúrbios no desenvolvimento do esmalte dentário. Em consequência a estas alterações o esmalte dentário pode apresentar modificação de cor e/ou que podem ocorrer isoladamente ou de forma simultânea, envolvendo, apenas um ou mais dentes. A intensidade, a extensão e a quantidade de elementos dentários envolvidos pelas alterações no esmalte podem estar relacionadas ao estágio de desenvolvimento do órgão do esmalte dentário. As causas podem ser de origem local, sistêmica, genética ou idiopática. Após a constatação de uma alteração da amelogênese evidenciada por meio da modificação de cor e/ou estrutura do esmalte dentário pelo dentista é importante que haja um diagnóstico preciso para se proceder à terapêutica adequada, seja ela preventiva, interceptativa ou o acompanhamento clínico do caso. Os casos clínicos relatados neste estudo ilustram algumas das alterações da amelogênese no esmalte dentário humano e suas prováveis causas com base na história clínica apresentada pelo paciente e na literatura consultada.

Alterations in amelogenesis can promote disturbances on the development of dental enamel. These alterations during amelogenesis will result in different color and/or structure of dental enamel that may occur isolated or simultaneously. These alterations may involve one tooth or more, yet the causal factors may be local, systemic, genetic or idiopathic. The intensity, extension and the number of teeth presenting alterations in the dental enamel are related to the developmental stage of the enamel dental organ. After the dentist has evidenced a color and/or structural alteration due to developmental defect in amelogenesis it is very important to make a precise diagnosis so that he can proceed with an adequate therapeutic either if it is only a matter of recall appointments, preventive or interceptive approaches. The clinical cases in this study illustrates some of human dental enamel’s alterations during amelogenesis and their probable causes based on the patient’s clinical history and in the dental literature.

Percepção estética das manchas de fluorose dentária: relato de caso de gêmeas dizigóticas / Aesthetic perception of dental fluorosis: a case report of dizygotic twins

Objetivo: O objetivo deste trabalho foi apresentar o caso clínico de duas irmãs gêmeas dizigóticas de 8 anos de idade, com fluorose dentária em graus diferentes, avaliar as fontes de flúor a que elas tiveram acesso e analisar a percepção estética das manchas de fluorose. Descrição do caso: O exame clínico foi feito na residência das pacientes, no período diurno, sob luz artificial, utilizando-se o Índice Thylstrup & Fejerskov (ITF). Foi diagnosticado o grau 2 em uma das irmãs (P(1)) e o grau 4 na outra (P(2)) em incisivos centrais superiores. De acordo com o relato da mãe, P(2) ingeriu mais flúor através da escovação com dentifrícios fluoretados que sua irmã P(1) até os três anos de idade. A mãe das crianças percebeu os dentes classificados com grau 4 como esteticamente mais satisfatórios que os dentes classificados com grau 2. Conclusão: O odontopediatra deve ser capaz de realizar um diagnóstico preciso da fluorose dentária e dominar as técnicas de remoção das manchas. Porém, deve-se considerar a percepção individual dos pacientes quanto à estética, seus anseios e suas expectativas com relação a um possível tratamento.

Purpose: The aim of this study was to present a case report of two 8-year-old female patients, dizygotics twins, with different degrees of dental fluorosis, investigate the fluoride sources they were exposed to, and assess the esthetic perception of dental fluorosis. Case description: Clinical examination was performed at home, during day-time, under artificial light, using the Thylstrup & Fejerskov Index (TFI). One twin presented fluorosis degree 2 (P(1)) and her sister presented degree 4 (P(2)) in the central incisors. Their mother reported that P(2) used to swallow more fluoridated dentifrice during tooth brushing than P(1) under the age of 3 year-old. In relation to the esthetic perception of fluorosis, the mother considered that the teeth with degree 4 were more esthetic than the teeth with degree 2. Conclusion: The pediatric dentist should be able to correctly diagnose dental fluorosis and have knowledge on appropriate treatment techniques. However, it is necessary to consider and respect the patients' perception on esthetics and their own desires.

Anomalías, lesiones adquiridas y modificaciones intencionales dentarias como variables de identificación forense / Abnormalities, acquired lesions and intentional tooth modifications as forensic identification variables

Establecer en ciencias forenses la identidad del daváver es determinar características que le distingan individualmente, siendo en ocasiones necesario el auxilio de la odontología. Algunos rasgos ya han sido estudiados para la determinación de raza, sexo, talla y edad. Aún cuando cada individuo posee 16 superficies dentarias que pueden presentar anomalías, lesiones adquiridas y restauraciones de diferentes tipos, características de innegable ayuda en la identificación erróneamente no son registradas actualmente en ninguna ficha odontológica. Se proponen los términos de expresiones dentarias para todas aquellas manifestaciones morfológicas externas susceptibles de ser indicio de identificación y perfil identificatorio al resultado del entrecruzamiento de estas expresiones.

Estudio de salud bucodental en estudiantes de la carrera de cirujano dentista de la FES Iztacala / A study on orodental health in students of the oral surgery specialty at the FES Iztacala

Objetivo: conocer el estado de salud bucal y las necesidades de tratamiento de los estudiantes de primer ingreso de la carrera de cirujano dentista de los peíodos escolares 2003-1 y 2004-1. Material: guantes, juego 1 x 5, encuesta de salud bucodental (OMS de 1997). Resultados: se obtuvo una media de cpo de 3.8 en el grupo 1 y de 3.2 en el grupo 2. La mitad de la población del grupo 1 se aplicó flúor y más de la mitad del 2; 37 por ciento presenta chasquido de ATM; 1 por ciento movilidad reducida de mandíbula en el grupo 1; 70 alumnos presentaron movilidad reducida y 126 chasquido del grupo 2; en el grupo 1 0.2 por ciento presenta ligera fluorosis, mientras que en 2.3 por ciento del grupo 2. En el grupo 1 se observa dientes con hemorragia 16 y 31, el 32 presentó cálculo, el 16 presentó bolsa de 4-5mm y 0.3 por ciento presentó bolsa periodontal de más de 6mm. Conclusión: los alumnos del grupo 2 tuvieron mayor acceso a tratamientos preventivos y hoy se traducen en bienestar físico, estético y psicosocial

Microabrasão como alternativa estética: relato de caso clínico / Microabrasion like a esthetic option: report of case

A microabrasão tem se mostrado um procedimento capaz de remover manchas e irregularidades encontradas na superfície do esmalte. Os autores apontam os resultados obtidos com a técnica de microabrasão, bem como a fácil execução, comentando as suas qualidades encontradas aqui e confirmada por outros autores.

Ingestão de bebidas por crianças de 0 a 3 anos e a sua relação com os graus de fluorose dentária / Beverage consumption by 0-3 year-old children and its relation with dental fluorisis dental severity

Objetivo: Avaliar as bebidas ingeridas pelas crianças na idadede 0 a 3 anos e a sua relação com os diferentes graus defluorose dentária. Método: Foi realizado exame clínico em 429crianças, de 6 a 12 anos, da Escola Municipal Levindo Lopes,Belo Horizonte-MG (0,74 ppm F). Cento e trinta e quatrocrianças foram diagnosticadas como portadoras de fluorosedentária em graus variando do questionável ao moderado. Ospais destas crianças responderam um questionário, abordandoa ingestão de leite, chás e sucos pelas crianças na idade de 0 a3 anos. Para as análises estatísticas foi utilizado o programaSPSS 9.0.0 e teste exato de Fisher (p=0,05). Resultados: Foicomum a ingestão de leite materno, leite bovino, sucos e chásna idade de 0 a 3 anos, embora nenhum destes fatores tenhatido associação significativa com os graus de fluorose dentária.Conclusão: A maior freqüência de ingestão de sucos estevesignificativamente associada com maiores graus de fluorose(p=0,046). Os pais devem ser informados sobre o papel dasbebidas industrializadas na ingestão de fluoretos