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

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

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

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

Necesidades educativas sobre salud bucodental en el grado prescolar / Educational needs related to oral health in the preschool grade

Introducción: La caries dental y la enfermedad periodontal son las enfermedades bucodentales más prevalentes, con una tendencia al aumento de las maloclusiones. Se considera la promoción de salud como un proceso educativo a través del cual la comunidad logra ejercer control de su salud. Objetivo: Identificar las necesidades educativas sobre salud bucodental en el grado prescolar, en Sagua la Grande, Villa Clara, durante el curso escolar 2017-2018. Método: Investigación descriptiva transversal en Sagua la Grande, durante el curso 2017-2018. La población quedó constituida por 326 niños, 24 docentes y 326 familias. La variable estudiada fue necesidades educativas sobre salud bucodental en el grado preescolar. Resultados: Se evidenció que no se realizan acciones educativas sobre salud bucodental. No existen proyectos ni un programa de capacitación sobre salud bucodental para los docentes que la sustente. No es concebida la salud bucal dentro del sistema de trabajo metodológico del sector. No se analizan contenidos de salud bucodental en consejos de dirección y preparaciones metodológicas Los docentes realizan escasas acciones educativas sobre salud bucodental. El nivel de conocimientos sobre salud bucodental fue evaluado de mal en los niños (74,23 por ciento), en docentes (41,67 por ciento) y familias (47,24 por ciento). Conclusiones: Se evidenció que no se realizan acciones educativas sobre salud bucodental y predominó el nivel de conocimientos sobre salud bucodental evaluado de mal en niños, docentes y familias(AU)

Introduction: Dental caries and periodontal disease are the most prevalent oral conditions, with a tendency to an increase in malocclusions. Health promotion is considered to be an educational process by which the community gains control of their health. Objective: Identify the educational needs related to oral health in the preschool grade. Method: A descriptive cross-sectional study was conducted in Sagua la Grande during the school year 2017-2018. The study population was 326 children, 24 teachers and 326 families. The variable analyzed was educational needs related to oral health in the preschool grade. Results: It was found that educational actions related to oral health are not performed, nor is there an oral health training program for teachers or projects supporting it. Oral health is not included in the system of methodological work for the sector. Oral health contents are not discussed in management meetings or methodological preparation sessions. Teachers conduct a scant number of oral health educational actions. Knowledge about oral health was evaluated as poor in 74.23 percent of the children, 41.67 percent of the teachers and 47.24 percent of the families. Conclusions: It was found that oral health educational actions are not performed and knowledge about oral health is poor among children, teachers and families(AU)

In Vitro Study of Tooth Surfaces After Interproximal Enamel Reduction: Extraoral Scanner and SEM Analysis

ABSTRACT Objective To perform a morphological evaluation concerning the extent of interproximal enamel reduction (IPR) with different manual instruments in different types of teeth and a qualitative analysis of enamel surface characteristics at the contact point before and after IPR. Material and Methods 40 freshly extracted, caries-free, and intact human teeth were used for the study (20 bicuspids and 20 incisors) and performed IPR just on the mesial surface. The morphological variation of contact point was evaluated by superimposed the stl file, obtained thanks to an extraoral scanner, at T0 and T1 for each tooth. Two types of strip were used, Intensiv Manual Ortho Strips Coarse/Medium and Steelcarbo Horico Strips. Teeth were then cut lengthwise, removed the most apical root portion and the mesial and distal halves were gilded and observed at different magnifications. Results The morphological variation following stripping mainly depends on the extent of the stripping, while the diameter, the type of strip and the shape of the tooth itself do not appear to be relevant. The 500X and 1500X magnifications allowed to appreciate better the characteristics of the surface of the stripped enamel and the differences with the intact enamel. All teeth treated, independently from the kind of strip used, shows deep marks and grooves in the direction of stripping. In both cases, the enamel appears significantly damaged at great magnifications. Conclusion Stripping always and inevitably leads to a change in the shape of the contact point and is directly correlated to the amount of stripping performed. The use of polishing after the removal of enamel interproximal is necessary in all cases.

Impact of Wearing Palatal Expanders on the Quality of Life of Children Aged 8 to 10 Years

ABSTRACT Objective: To assess the impact of wearing palatal expanders on the oral health-related quality of life (OHRQoL) of children aged 8 to 10 years. Material and Methods: The sample consisted of 35 children aged 8 to 10 years treated at the orthodontics and pediatric dentistry outpatient clinics affiliated with the Dental School. Children were divided in two groups: 17 were submitted to palatal expansion treatment (Group 1), while 18 just received coronal polishing and topical fluoride application (Group 2). The Brazilian version of the Child Perceptions Questionnaire (CPQ8-10) was used to assess children's OHRQoL. The questionnaire was administered before the expander was placed, at the end of its activation, and before its removal. Intervals between the interviews were similar in the two groups. Descriptive statistics and ANOVA were used for data analyses. Results: The overall CPQ8-10 score was not significantly different between the groups. The results show statistically significant differences between the two groups only for the functional limitations domain after activation of the appliance (p=0.001). Conclusion: Palatal expanders may negatively affect children's functions only during the initial wearing period.

Effect of Conventional Versus Passive Self-Ligating Vestibular Appliances on Torque, Tip and Transverse Dental Changes in Patients Affected by Class I Malocclusion: A Retrospective Study

ABSTRACT Objective: To evaluate the effects of passive self-ligating appliances (PSLAs) and conventional ligating appliances (CLAs) during orthodontic treatment regarding torque, tip, and transversal dental changes. Material and Methods: Dental parameters were digitally acquired from pre- and post-treatment models of each subject belonging to two groups of patients treated with PSLAs (23 patients; 11 females and 12 males with a mean age of 14.2 ± 1.6 years) and CLAs (18 patients; 10 females and 8 males with a mean age of 14.3 ± 1.9 years), respectively. All subjects had Class I or slight Class II malocclusion (= 2mm), permanent dentition and no previous orthodontic treatment. After normality of data was assumed, a paired sample t-test rejected any side differences at T0 and, therefore, the data were grouped by tooth group. Statistical analyses were performed using a linear mixed-effect framework, assuming the appliance, time, and interactions as fixed effects and the tooth type as random effects. Finally, post-hoc effect analysis was used to contrast modeled marginal effects (p<0.05). Results: For both appliances, there is a general increase of both torque and transverse values at T1, especially for PSLAs. Tip shows a general reduction in the lateral sectors for both appliances is registered. The only significant statistical difference referred to appliances' efficacy is located to mandibular intermolar width. Conclusion: Both appliances have an expansive potential for both torque and transverse dental changes. No evident differences are detectable between appliances except for the rate of the mandibular intermolar width increase.

Correlation Between Mesio-Distal Teeth Diameters and Arch Width

ABSTRACT Objective: To verify the existence of a correlation between the mesio-distal size of teeth and the arch width by analyzing the data separately for maxillary and mandibular arch in patients with ideal occlusion Material and Methods: 58 patients with ideal occlusion were studied, for a total of 276 files analyzed. Dental casts were then scanned using a professional scanner (Epson Perfection v 330) and images were obtained in TIFF format at 600 dpi. All single teeth measurements were carried out for all teeth of both arches using the VAM software (Vectra, Canfield Scientific, Fairfield, NJ, USA). The repeatability and reproducibility of the measurement method were evaluated using the Gauge R&R method. In case a correlation between tooth size and arch size is found to be significant, a linear regression analysis can be applied through the following statistical relationship: y=a+b*x, where y is the result (inter-molar distance "AvgB66" or inter-canine distance "Cusp 33"), and x the specific tooth. The a and b respectively represent the intercept (point of intersection between the line and the y axis) and the slope of the line that describes the regression ratio. Results: The statistical analysis highlights a significant correlation (p<1%) between the results of the mesio-distal measurements of each tooth and the two variables considered to define the size of each arch ("AvgB66" and "Cusp 33"). Based on these results, a numerical relationship "y=a+b*x" has been extrapolated. Thus, it is possible to calculate the estimated inter-molar or inter canine distance necessary to have the teeth aligned. Conclusion: The inter-canine and inter-molar distances can be estimated starting from measuring the mesio-distal diameter of a single tooth.

Prevalence of malocclusion and non-physiological oral habits in primary school children from Ercilla, Chile / Prevalencia de maloclusión y hábitos bucales no fisiológicos en niños de primaria de Ercilla, Chile

Introduction: Dentomaxillary Anomalies (DMA) affect the growth and morphology of the stomatognathic system of individuals, representing a public health problem. Few studies have described its prevalence among vulnerable populations in Chile. The aim of the study was to explore the prevalence of DMA and its association to non-physiological habits (NFH) and sociodemographic characteristics among primary school children living in Ercilla, Chile. Material and Methods: A convenience sample of 327 primary school students from six schools in Ercilla, were assessed through an intraoral and extraoral evaluation. Overjet, overbite, molar relationship, presence of DMAs, and NFHs were measured. Descriptive statistics, analysis of association between DMAs and studied factors, and logistic regression models were done and odds ratio with 95% confidence intervals presented. Results: A total of 61.5% of students presented at least one DMA. Chi-square test showed no significant association between DMA prevalence and NHFs, however, after adjusting for sociodemographic factors, children with NFH were 1.69 (95%CI 1.02-2.78) times more likely to have DMAs. Gender and area of residence were not significantly associated with DMAs. Conclusion: In children from Ercilla, DMAs were associated with NFHs, however, sociodemographic characteristics did not have a significant role in the presence of DMA, suggesting that sociodemographic factors might not strongly influence orthodontic needs among children from this geographical area.

Introducción: Las anomalías dentomaxilares (ADM) afectan el crecimiento y la morfología del sistema estomatognático de los individuos, lo que representa un problema de salud pública. Pocos estudios han descrito su prevalencia en poblaciones vulnerables en Chile. El objetivo del estudio fue explorar la prevalencia de ADM y su asociación con hábitos no fisiológicos (HNF) y características sociodemográficas en niños de escuela primaria que viven en Ercilla, Chile. Material y Métodos:Se evaluó una muestra de conveniencia de 327 estudiantes de educación básica de seis escuelas de Ercilla mediante una evaluación intraoral y extraoral. Se midieron el resalte, la sobremordida, la relación molar, la presencia de DMA y HNF. Se realizó estadística descriptiva, análisis de asociación entre ADMs y los factores estudiados, y modelos de regresión logística y se presentaron odds ratio con intervalos de confianza del 95%. Resultados: El 61,5% de los alumnos presentó al menos una ADM. La prueba de chi-cuadrado no mostróuna asociación significativa entre la prevalencia de ADM y HNF, sin embargo, después de ajustar de acuerdo a factores sociodemográficos, los niños con HNF tenían 1,69 (IC del 95%: 1,02 a 2,78) veces más probabilidades de tener ADMs. El género y el área de residencia no se asociaron significativamente con las ADMs. Conclusión: En los niños de Ercilla, las DMA se asociaron con NFH, sin embargo, las características sociodemográficas no tuvieron un papel significativo en la presencia de DMA, lo que sugiere que los factores sociodemográficos podrían no influir fuertemente en las necesidades de ortodoncia entre los niños de esta área geográfica.

Prevalence of malocclusions and dysfunctional oral habits in preschool children of municipal establishments in Viña del Mar / Prevalencia de maloclusiones y hábitos orales parafuncionales en preescolares de establecimientos municipales de Viña del Mar

Introduction: Malocclusions are a public health problem at national and global level, being third in the ranking of the most prevalent oral pathologies.Its origin is multifactorial, with dysfunctional oral habits being a risk factor. The objective of this study was to determine the prevalence of malocclusions and dysfunctional oral habits in students aged between 4 and 6 years in state-run public schools in Viña del Mar, Chile. Material and methods: A prevalence study was carried out in 184 students selected by random cluster sampling. Malocclusions were assessed by clinical examination, while dysfunctional oral habits were assessed by questionnaires and clinical examination. The data were analyzed using Fisher's exact test, Chi-square test and the PHI correlation coefficient. Results: The prevalence of malocclusions was 54.35% (95% CI [47.04% - 61.47%]), with dental crowding being the most frequent, while prevalence of dysfunctional oral habits was 95.11% (95% CI [90.82% - 97.45%]), led by lingual interposition. In none of the cases statistically significant differences of age, gender or class were noticed. The evidence provided by this study indicates that the presence of malocclusions is independent of the presence of dysfunctional oral habits, except between open bite and interposition of objects, whose magnitude of dependence was minor (0.2). Conclusion: There is a high prevalence of malocclusions and dysfunctional oral habits in preschool children, with dental crowding and lingual interposition being the most frequent, respectively. The presence of malocclusions is independent of the presence of dysfunctional oral habits.

Introducción: Las maloclusiones constituyen un problema de salud pública a nivel nacional y mundial, ocupando el tercer lugar en el ranking de patologías bucodentales más prevalentes. Su origen es multifactorial, siendo algunos de sus factores de riesgo los hábitos orales disfuncionales. El objetivo fue determinar la prevalencia de maloclusiones y hábitos orales disfuncionales en alumnos entre 4 y 6 años pertenecientes a establecimientos municipales de Viña del Mar. Material y Métodos: Se realizó un estudio de prevalencia en 184 alumnos seleccionados por muestreo aleatorio por conglomerados. Las maloclusiones fueron evaluadas mediante examen clínico, mientras que los hábitos orales disfuncionales a través de cuestionarios y examen clínico. Los datos fueron analizados utilizando el test Chi2, prueba exacta de Fisher y el coeficiente de correlación Phi. Resultados: La prevalencia de maloclusiones fue de 54.35% (IC 95% [47,04% - 61,47%]), siendo el apiñamiento la más frecuente, mientras que la de hábitos orales disfuncionales fue de 95.11% (IC 95% [90,82% - 97,45%]), liderada por la interposición lingual. Para ambos casos no se observaron diferencias estadísticamente significativas con edad, género y curso. La evidencia aportada por este estudio señala que la presencia de maloclusiones es independiente de la presencia de hábitos orales disfuncionales, excepto entre mordida abierta e interposición de objetos, cuya magnitud de dependencia fue leve (0.2). Conclusión: Existe una alta prevalencia de maloclusiones y hábitos orales disfuncionales en pre-escolares, siendo los más frecuentes el apiñamiento y la interposición lingual, respectivamente. La presencia de maloclusiones es independiente de la presencia de hábitos orales disfuncionales.

Arch parameters and dental discrepancy (crowding and spacing) in a sample of an Afro-Colombian population / Parámetros de arco y discrepancia dental (apiñamiento y espaciamiento) en una muestra de población Afrocolombiana

The aim of this study was to determine the differences in arch length, inter-canine distance, inter-premolar distance, intermolar distance and arch shape between dental discrepancies (crowding and spacing) in a sample of dental casts from the Afro-Colombian population of San Basilio de Palenque. An analytical, cross-sectional study was conducted on a convenience sample of 63 subjects aged 11 to 57years, of Afro-Colombian origin, with full dentition from first molar to first molar, without extensive caries or restorations, and excluding casts with defects due to loss. The differences between arch (upper and lower) variables were analyzed according to dental discrepancies. Plaster models digitalized with a TR1OS3 Mono scanner with exactitude (6.9 ± 0.9 pm) and precision (4.5 ± 0.9 pm) were analyzed with Orthonalyzer software. Statistical analyses were done on SPSS software (Version 20 for Windows) and Real Statistics. Spacing discrepancy of68.25% was found for upper arch and 66.66% for lower arch; crowding discrepancy of 19.04% for upper arch and 20.63% for lower arch, and an adequate ratio of 12.69% for both arches. No statistically significant difference (p>0.05) was found between arch parameters except for inter-premolar distance on the lower arch. The most frequent arch shape in the population was oval for both upper arch, with 76.19%, and lower arch, with 71.42%. Tooth size was larger in males than females but the difference was not statistically significant.

El objetivo de este estudio fue determinar las diferencias en longitud de arco, distancia intercanina, interpremolar, intermolar y la forma de arco entre discrepancias dentales (apiñamiento y espaciamiento), en una muestra de modelos dentales de la población afrocolombiana de San Basilio de Palenque. Se realizó un estudio analítico transversal, en una muestra por conveniencia de 63 sujetos con un rango de edad entre 11 y 57 años, de origen afrocolombiano, quienes tuvieron dentición completa de primer molar a primer molar, sin caries extensas, ni restauraciones; se excluyeron los modelos con defectos por el vaciado. Se analizaron las diferencias entre las variables de los maxilares (superior e inferior) con las discrepancias dentales. Se utilizaron modelos de yeso que fueron digitalizados con el escánerTR1OS3 Mono con una exactitud de (6.9 ± 0.9 pm) y una precisión de (4.5 ± 0.9 pm)y analizados con el software Orthonalyzer. Los análisis estadísticos se llevaron a cabo utilizando el software SPSS (Versión 20 para Windows) y Real Statistics. Se encontró una discrepancia de espaciamiento de un 68,25% para el arco superior y 66,66% en el arco inferior; y una discrepancia de apiñamiento en el arco superior de 19,04% e inferior de 20,63% y una relación adecuada de 12,69% para los dos arcos. No se encontraron diferencias estadísticamente significativas (p>0.05) en los parámetros de arco a excepción de la distancia interpremolar del arco inferior. La forma de arco más frecuente en la población fue ovalada tanto en el arco superior con un 76,19% como en el arco inferior con un 71,42%. En cuanto al tamaño dental, se presentó mayor tamaño en los hombres que en las mujeres, pero este no fue estadísticamente significativo.

Mandibular anterior crowding: normal or pathological?

ABSTRACT The teeth become very close to each other when they are crowded, but their structures remain individualized and, in this situation, the role of the epithelial rests of Malassez is fundamental to release the EGF. The concept of tensegrity is fundamental to understand the responses of tissues submitted to forces in body movements, including teeth and their stability in this process. The factors of tooth position stability in the arch - or dental tensegrity - should be considered when one plans and perform an orthodontic treatment. The direct causes of the mandibular anterior crowding are decisive to decide about the correct retainer indication: Should they be applied and indicated throughout life? Should they really be permanently used for lifetime? These aspects of the mandibular anterior crowding and their implication at the orthodontic practice will be discussed here to induct reflections and insights for new researches, as well as advances in knowledge and technology on this subject.

RESUMO Os dentes ficam muito próximos quando estão apinhados, mas suas estruturas permanecem individualizadas e, nessa situação, o papel dos restos epiteliais de Malassez é fundamental para liberar o EGF. A tensigridade é um conceito chave para compreender as respostas dos tecidos submetidos às forças nos movimentos corporais, incluindo os dentes e sua estabilidade nesse processo. Os fatores da estabilidade de posição de um dente na arcada dentária — ou tensigridade dentária — devem ser considerados quando se planeja e finaliza um caso na prática clínica ortodôntica. As causas diretas do apinhamento dentário anteroinferior são determinantes para se refletir se a contenção deve ser mesmo indicada e aplicada por toda a vida e se, necessariamente, deve ser usada de forma permanente. Esses aspectos do apinhamento dentário anteroinferior e suas implicações na prática clínica serão aqui abordados para induzir reflexões e insights de novas pesquisas, bem como avanços no conhecimento e tecnologia sobre esse assunto.

Influence of head and linear growth on the development of malocclusion at six years of age: a cohort study

Abstract The aim of this article was to evaluate the influence of biological and sociobehavioral factors on the development of malocclusions in children. This is a cross-sectional study nested in a cohort of 350 children who participated in a community intervention study. After six years, an active search identified 290 children with occlusal abnormalities. Socioeconomic status, linear growth, and nutritional status of the child at birth and at the time of measurement, as well as dietary and sucking habits, were investigated. Malocclusions were evaluated across three spatial planes - anteroposterior, vertical, and transverse. The prevalence of these anomalies was 64.5%, primarily in the anteroposterior plane. The logistic regression analysis revealed that pacifier use for 60 months or more, stunting as measured at age six, and reduced gain in head circumference from birth to six years of age, were significantly associated with the development of malocclusion in childhood. Head circumference and linear growth are associated with occlusal anomalies in infants, independent of pacifier sucking.

Pacifier use modifies the association between breastfeeding and malocclusion: a cross-sectional study

Abstract This study aimed to evaluate the influence of breastfeeding and pacifier use on the occlusal status of preschool children. A cross-sectional study was conducted with children (n = 489) aged 2-5 years in private and public schools in Pelotas, South Brazil. Mothers answered a questionnaire on demographic, socioeconomic and behavioral variables, including breastfeeding and non-nutritive sucking habits. Malocclusion was classified as normal/mild and moderate/severe, according to WHO criteria. The association between breastfeeding and pacifier use with malocclusion was tested using multivariate logistic regression. The prevalence of malocclusion was 37.83% (95%CI 33.52-42.14), and 57.87% of the children used a pacifier. A total of 46.01% of the sample was exclusively breastfed for 6 months, and 24.74% were never breastfed. Malocclusion was associated with pacifier use, and with both non-exclusively breastfed and never breastfed. After adjustments for demographic and socioeconomic variables, the children who used a pacifier and were never breastfed (OR = 19.08; 95%CI 8.54-42.63), or who used a pacifier and were not exclusively breastfed (OR = 13.74; 95%CI 6.11-30.92), showed worse occlusal conditions, compared with the children who were exclusively breastfed and never used a pacifier. Pacifier use modifies the relationship between breastfeeding and occlusal status.

Fatores individuais associados à má oclusão em adolescentes / Individual factors associated to malocclusion in adolescents

Resumo O objetivo deste artigo foi identificar a severidade da má oclusão e fatores associados em adolescentes brasileiros. Foram analisados dados dos 5.445 adolescentes que participaram do inquérito nacional de saúde bucal (SB Brasil 2010), sendo que destes, 4276 permaneceram no estudo com base nos critérios de inclusão. A variável dependente foi má oclusão severa e muito severa, classificada pelo índice de estética dentária (DAI > 30). As variáveis independentes foram: local de moradia, macrorregião, cor da pele autorreferida, renda, sexo, escolaridade, acesso a serviço de saúde bucal, presença de cárie não tratada e dentes perdidos por cárie, anteriores e posteriores. Foi realizada analise de regressão logística múltipla hierarquizada considerando o plano amostral complexo de conglomerados. A prevalência de má oclusão severa e muito severa foi de 17,5%. Após ajustes, o grupo preto/pardo (OR1,59 IC95%1,09-2,34), a menor renda familiar (OR0,67 IC95%0,55-0,82), a perda por cárie de dentes anteriores (OR2,32 IC95%1,14-4,76) e posteriores (OR1,45 IC95%1,14-1,84) mostraram associação com o desfecho. Concluiu-se que o grupo pretos/pardos, os que possuem menor a renda familiar e os que têm mais dentes anteriores e posteriores perdidos por carie, apresentam maior a chance de ter má oclusão severa/muito severa.

Abstract The study aimed to identify the severity of malocclusions and associated factors among Brazilian adolescents. Data from 5,445 adolescents participating in the Brazilian Oral Health Survey (SBBrasil 2010) were evaluated, of which 4,276 were included in the study based on the inclusion criteria. The dependent variable was severe and very severe malocclusion, according to the Dental Aesthetic Index (DAI > 30). The independent variables were place of residence, macro-region, self-reported ethnicity, income, gender, schooling, access to dental care, untreated caries and front and back teeth loss due to caries. A hierarchical multiple logistical regression analysis was performed, considering the complex cluster sampling plan. Prevalence of severe/very severe malocclusions was 17.5%. After adjustments, black/brown ethnicity group (OR = 1.59, 95% CI: 1.09-2.34), lower household income (OR = 0.67, 95% CI: 0.55-0-82), front (OR = 2.32, 95% CI: 1.14-4.76) and back teeth (OR = 1.45, 95% CI: 1.14-1.84) loss due to caries were associated with the outcome. Therefore, we conclude that black/brown ethnicity, lower household income and greater number of front and back teeth loss due to caries increased the odds for severe/very severe malocclusion.

Oral manifestations in children with mucopolysaccharidosis / Manifestações orais de mucopolissacaridose em crianças

BACKGROUND: Patients with mucopolysaccharidosis have several changes of the stomatognathic complex, representing a challenge for dentists. OBJECTIVE: The study aimed to evaluate and characterize oral health in patients with mucopolysaccharidosis in a reference center of Portugal. METHOD: The sample consisted of twelve participants with mucopolysaccharidosis followed in Metabolic Diseases Unit of the S. João Hospital Centre and twelve healthy participants followed at Faculty of Dental Medicine, University of Porto. The clinical oral evaluation was performed by a complete extra-oral and intra-oral examination to assess the presence of oral pathologies, gingival index and occlusion status. RESULTS: Mucoplysaccaridosis patients and controls presented similar age ranges and sex distribution. In comparison to controls, children with mucopolysaccharidosis presented a higher prevalence of tooth decay, gingival bleeding, macroglossia, dental hypoplasia, lingual interposition, delayed tooth eruption, anterior open bite, right and left posterior cross-bite, limitation of mouth opening, alteration on the size and shape of the teeth, diastemata and maxillary compression. CONCLUSIONS: Patients with mucopolysaccharidosis have a high prevalence eruption delay, teeth morphology alterations, occlusal problems, dental caries and bleeding gums, highlighting the need of oral health care providers to improve diagnostics and preventive protocols to overcome the factors that limit the oral health of these patients and promote together with parent/caregiver efficient oral care strategies.

INFORMAÇÕES GERAIS: Os pacientes com mucopolissacaridose apresentam diversas alterações do complexo estomatognático, representando um desafio para os médicos dentistas. OBJETIVO: O estudo pretendeu avaliar e caracterizar a saúde oral em pacientes com mucopolissacaridose num centro de referência em Portugal. MÉTODO: A amostra foi constituída por doze pacientes com mucopolissacaridose (MPS) seguidos na Unidade de Doenças Metabólicas do Centro Hospitalar de São João e doze participantes saudáveis seguidos na Faculdade de Medicina Dentária da Universidade do Porto. A avaliação clínica oral consistiu num completo exame extra-oral e intra-oral para avaliação de patologias orais, índice gengival e perfil oclusal. RESULTADOS: Pacientes com MPS e controlos apresentaram médias similares de idade e de distribuição de género. Em comparação com os controlos, crianças com mucopolissacaridose apresentam maior prevalência de dentes cariados, sangramento gengival, macroglossia, hipoplasia dentária, interposição lingual, erupção dentária atrasada, mordida aberta anterior, mordida cruzada posterior direita e esquerda, limitação da abertura da boca, alteração do tamanho e forma dentária, diastemas e compressão maxilar. CONCLUSÃO: Pacientes com mucopolissacaridose apresentam maior prevalência de erupção dentária atrasada, alterações morfológicas dentárias, problemas oclusais, cáries dentárias e gengivas inflamadas, reforçando a necessidade de prestadores de saúde oral para melhorar diagnósticos e protocolos preventivos para ultrapassar os fatores que limitam a saúde oral destes pacientes e promover em conjunto com pais/cuidadores estratégias de saúde oral eficientes.

Incidence of Lower Anterior Third Molars on Dental Crowding. A New Approach / Incidencia de Terceros Molares Inferiores en el Apiñamiento Dental. Un Nuevo Enfoque

ABSTRACT: This paper main objective is to estimate the level of association between lower anterior crowding and the presence of lower third molars on study models and panoramic dental radiographs of patients treated by the Orthodontics Postgraduate Students at the Dentistry Faculty at the University of Cartagena (Cartagena de Indias, Colombia) and also other dental and radiographs care centers in Cartagena de Indias. It was made using a cross-sectional study at the Dentistry Faculty at the University of Cartagena and others dental care centers in the city. There were 366 study models and panoramic dental radiographs selected by strict inclusion/exclusion criteria for patients. An instrument that includes age, gender, presence or absence of third molars, position of third molars according to Winter's classification, stage of formation of the third molars according to Nolla's classification, and crowding magnitude according to Harfin's classification was used. Data were analyzed based on frequency distributions and proportions; inferential analysis was performed through proportional odds model using the software package IBM SPSS Statistics v23. It was found that the patients with Nolla 6 from the right side are more likely to have mild-moderate crowding magnitude than patients with Nolla 10 on that same side. In conclusion, this research provides as main result the implication of the eruption of the lower third molars and particularly those erupting in mesioangular and horizontal positions in the anterior crowding (AA).

RESUMEN: El objetivo de este trabajo fue estimar el nivel de asociación entre el apiñamiento dentario anteroinferior y la presencia de terceros molares inferiores en modelos de estudio y radiografías panorámicas de los pacientes atendidos por estudiantes del posgrado de ortodoncia de laFacultad de Odontología de Cartagena de Indias, Colombia y también otros centros dentales y de radiografías en Cartagena de Indias. Se realizó un estudio transversal en la Facultad de Odontología de la Universidad de Cartagena y otros centros de atención odontológica de la ciudad. Se utilizaron 366 modelos de estudio y radiografías dentales panorámicas seleccionadas por estrictos criterios de inclusión / exclusión para los pacientes. Se utilizó un instrumento que incluía edad, sexo, presencia o ausencia de terceros molares, posición de los terceros molares de acuerdo con la clasificación de Winter, etapa de formación de los terceros molares de acuerdo con la clasificación de Nolla y magnitud de apiñamiento según la clasificación de Harfin. Los datos se analizaron en base a las distribuciones y proporciones de frecuencia; el análisis inferencial se realizó a través del modelo de probabilidades proporcional utilizando el software IBM SPSS Statistics v23. Se encontró que los pacientes con Nolla 6 en el lado derecho son más propensos a tener una magnitud de apiñamiento de leve a moderada en comparación a los pacientes con Nolla 10 en ese mismo lado. En conclusión, esta investigación proporciona como resultado principal la implicación de la erupción de los terceros molares inferiores y particularmente aquellos que erupcionan en posiciones mesioangulares y horizontales en el apiñamiento dentario anterior (AA).

Prevalencia de Anomalías Dentomaxilares y Necesidad de Tratamiento en Adolescentes / Prevalence of Dentomaxillary Anomalies and Treatment Needs in Adolescents

RESUMEN: Las anomalías dentomaxilares (ADM) constituyen un problema de salud pública en Chile, lo que genera la necesidad de un diagnóstico sistemático y la asignación de prioridades de tratamiento. Las ADM que afectan la estética pueden constituir una barrera para la inserción social de los adolescentes. El Dental Aesthetic Index (IED), es un instrumento que permite jerarquizar la necesidad de tratamiento de las ADM. El propósito de esta investigación fue caracterizar las ADM, necesidad de tratamiento a través de IED y auto-percepción estética en escolares de 12 a 15 años. Estudio de Prevalencia en adolescentes de 12 a 15 años, de la ciudad de Viña del Mar. El criterio de exclusión fue tratamiento ortodóncico previo. Se seleccionaron 204 sujetos mediante asignación uniforme con un nivel de confianza de 95 %. Variables recogidas: Edad, tipo de establecimiento educacional, sexo, percepción estética y IED por componentes. La prevalencia según IED fue de 63 % [56 % - 70 %]. La necesidad de tratamiento fue 44,2 % electivo, 31,01 % altamente deseable y 24,81 % obligatorio y prioritario. El IED Comunitario dio 29.5. Se encontró una relación significativa entre IED y percepción estética con un p-valor: 0,006 (Rho: 0,343). La prevalencia de anomalías dentomaxilares medido a través del indicador IED alcanza el 63 % y el IED comunitario de 29,54 % afirmando que el grupo "requiere tratamiento electivo por ADM definida"; en los establecimientos particulares está subestimado pues algunos casos ya han sido tratados con anterioridad a esta investigación.

ABSTRACT: Dentomaxillary anomalies are a public health problem in Chile, resulting in the need for screening and prioritization of treatment. Dentomaxillary anomalies affecting the aesthetics can be a barrier to social integration of adolescents. The Dental Aesthetic Index (DAI) is an instrument to prioritize the need for treatment of malocclusions. The purpose of this research was to characterize the malocclusions, orthodontic treatment needs and esthetic self-perception in schoolchildren from 12 to 15 years through DAI. Prevalence Study in 12 to 15 year-old adolescents from Viña del Mar. The exclusion criteria was previous orthodontic treatment. The sample was 204 subjects selected by uniform allocation with a confidence level of 95 %. Variables included age, type of educational establishment, sex, aesthetic perception and DAI by component. Prevalence of dentomaxillary anomalies by DAI was 63 % [56 % - 70 %], Treatment needs were 44.2 % treatment elective, 31.01 % highly desirable and 24.81 % mandatory. The Community's DAI was 29.5. The relationship between DAI and aesthetic perception was significant (p-value: 0.006; Rho: 0.343). The prevalence of dento-maxillary anomalies measured by DAI reaches 63 % and the communal DAI was 29.54 stating that the group "requires elective treatment for definite malocclusion"; in private schools, it is underestimated because some cases had already been treated prior to this investigation.

Ação odontológica na triagem neonatal direcionada ao hipotireoidismo congênito / Dental action in the neonatal screening directed to congenital hypothyroidism

O hipotireoidismo congênito é um distúrbio endócrino caracterizado pela diminuição dos níveis séricos dos hormônio da glândula tireóide. Este afeta o metabolismo do cálcio, e, portanto, a formação dos ossos e dentes. É comum nestes pacientes anomalias de formação dentária, atraso na erupção dentária, hipodesenvolvimento do côndilo mandibular e macroglossia. Somados, estes fatores podem ainda levar a uma má-oclusão e ao desenvolvimento inadequado das funções orais. Diante do exposto, Avaliou-se através deste estudo as condições clínicas orais e promoveu-se o atendimento odontológico dos pacientes com esta disfunção endócrina vinculados ao serviço de triagem neonatal do Hospital Universitário da Universidade Federal de Sergipe. Trata-se de um projeto de extensão em que foram atendidos 205 pacientes com idade entre 01 mês e 14 anos, no período de fevereiro à novembro de 2016, os quais passaram por uma avaliação clínica e receberam orientações preventivas. A partir do exame clínico, observou-se que 20% dos pacientes apresentavam alguma necessidade de tratamento odontológico, sendo esses, agendados e encaminhados para a realização do procedimento clínico odontológico. Com os dados obtidos foi possível concluir que é essencial dar aos responsáveis e pacientes as informações necessárias para a prevenção de doenças bucais, estando elas correlacionadas ou não com o Hipotireoidismo Congênito. Além disto, a realização de tratamento clínico, preventivo e curativo nesses pacientes, agregou a Odontologia ao plano multiprofissional já existente representado pelo programa de triagem neonatal do HU ­ UFS.(AU)

Congenital hypothyroidism is an endocrine disorder characterized by a decrease in the serum levels of thyroid gland hormones. This affects the metabolism of calcium, and therefore the formation of bones and teeth. It is common on those patients dental formation anomalies, delayed dental eruption, hypo development of the mandibular condyle and macroglossia. In addition, these factors may also lead to malocclusion and inadequate development of oral functions.In view of the above, this study was chosen as oral clinical conditions and it was promoted in the dental care of patients with this endocrine dysfunction linked to the neonatal screening service of the University Hospital of the Federal University of Sergipe. It is an extension project in which 205 patients aged between 1 month and 14 years were attended, in the period of February to November of 2016, who underwent a clinical evaluation and received preventive guidance. From the clinical examination, it was observed that 20% of the patients had a need for dental treatment, and they were scheduled and sent to perform a dental procedure. With the obtained data, it was possible to conclude that it is essential to give the responsible ones and patients the necessary information for the prevention of oral diseases, being they correlated or not with Congenital Hypothyroidism. In addition, performing clinical, preventive and curative treatment in these patients, added the Dentistry to the existing multiprofessional plan represented by the neonatal screening program of the HU ­ UFS.(AU)

Influência da hipermobilidade articular generalizada sobre a articulação temporomandibular e a oclusão dentária: estudo transversal / Influence of generalized joint hypermobility on temporomandibular joint and dental occlusion: a cross-sectional study

RESUMO Objetivo Avaliar a oclusão dentária e a articulação temporomandibular de mulheres com e sem hipermobilidade articular generalizada. Método A hipermobilidade foi avaliada pelo Escore de Beighton, e as voluntárias foram distribuídas, conforme o escore obtido, em dois grupos: com e sem hipermobilidade. A articulação temporomandibular foi avaliada por meio do instrumento Critérios de Diagnóstico para Pesquisa de Desordens Temporomandibulares, e a avaliação oclusal compreendeu a classificação de Angle, presença de sobremordida, sobressaliência e mordida cruzada, padrão de desoclusão e interferências oclusais. Resultados 43 mulheres participaram voluntariamente da pesquisa, 17 no grupo com hipermobilidade e 26 no grupo sem hipermobilidade. A frequência de ruídos articulares e de desvio na abertura da boca foi maior no grupo com hipermobilidade (52,9% versus 38,5% e 76,5% versus 50%, respectivamente), sem diferença significante. Quanto à oclusão, nenhuma voluntária apresentou uma oclusão ideal e não se verificou diferença significativa na Classe de Angle entre os grupos. As alterações na oclusão obtiveram percentual maior no grupo com hipermobilidade (29,4% de sobremordida, 47,1% de sobressaliência e 17,6% de mordida cruzada), sendo que a mordida cruzada apresentou diferença estatística entre os grupos. Conclusão A hipermobilidade não influenciou a oclusão e as amplitudes de movimentos mandibulares nas mulheres avaliadas. Contudo, o maior percentual de ruídos articulares e de desvio não corrigido apresentado pelo grupo com hipermobilidade, mesmo sem diferença entre os grupos, pode constituir um indício de relação entre hipermobilidade e disfunção temporomandibular.

ABSTRACT Purpose To evaluate the dental occlusion and temporomandibular joint in women with and without generalized joint hypermobility. Methods Generalized joint hypermobility was assessed by the Beighton score. Individuals were divided into two groups: with and without hypermobility. The Research Diagnostic Criteria for Temporomandibular Disorders was used to evaluate the temporomandibular joint. Dental occlusion was assessed according to Angle classification, overjet and overbite measures, presence of open bite or crossbite, pattern of disocclusion, and occlusal interference. Results Forty-three women participated voluntarily in the study: 17 in the group with hypermobility and 26 in the group without hypermobility. The frequencies of joint noise and deviation during mouth opening were greater in the hypermobility group (52.9% vs. 38.5% and 76.5% vs. 50%, respectively), but without statistical significance. None of the volunteers presented ideal occlusion and no significant difference was found in Angle Class between the groups. The hypermobility group presented a higher percentage of changes in occlusion (29.4% of overbite, 47.1% of overjet, and 17.6% of crossbite), with crossbite showing statistical difference between the groups. Conclusion Hypermobility does not influence occlusion and range of mandibular motion in the women assessed. Nevertheless, the higher percentage of articular noise and uncorrected deviation during mouth opening shown by the group with hypermobility, even without statistical difference, may constitute evidence of correlation between hypermobility and temporomandibular disorder.

Occlusal changes secondary to temporomandibular joint conditions: a critical review and implications for clinical practice

ABSTRACT The relationship between Temporomandibular Disorders (TMD) and malocclusion is an extremely critical issue in dentistry. Contrary to the old concept that malocclusion causes TMD, occlusal changes, especially those observed as sudden, may be secondary and reflect joint or muscle disorders due to the obvious connection between these structures and the dental occlusion. Objectives The aim of this article is to present the most commonly occlusal changes secondary to TMD. Methods The clinical presentation of these conditions is discussed. Details regarding diagnosis, treatment, and follow-up of patients presenting TMD prior or during treatment are also presented. Conclusions All plans for irreversible therapy should be preceded by a meticulous analysis of TMD signs and symptoms in such a way that patients are not submitted to irreversible treatment, based on an untrue occlusal relationship, secondary to articular and/or muscular disorders. When present, TMD symptoms must always be controlled to reestablish a “normal” occlusion and allow proper treatment strategy.