Experiência de c rie e doen‡a periodontal em crian‡as e adolescentes com paralisia cerebral / Dental caries and periodontal disease in children and adolescents with cerebral palsy

O objetivo deste estudo foi identificar os fatores associados … experiˆncia de c rie e doen‡a periodontal em crian‡as e adolescentes com paralisia cerebral (PC). Foram inclu¡dos neste estudo 70 crian‡as e adolescentes com PC, de ambos os sexos, na faixa et ria de 6 a 19 anos de idade. As vari veis estudadas foram idade, sexo, escolaridade, classifica‡ães da PC, GMFCS, uso de medicamentos, motricidade oral e consistˆncia da dieta. A experiˆncia de c rie foi avaliada pelo ¡ndice CPO-D, as condi‡ães periodontais pelo ¡ndice de higiene oral simplificado (IHO-S) e sangramento gengival … sondagem. Os exames epidemiol¢gicos foram realizados por uma £nica examinadora calibrada (Kappa = 0,97). Foram realizadas an lises univariada e multivariada, com n¡vel de significƒncia de 5%. A maioria dos participantes deste estudo era do sexo masculino (n=40, 57,1%), com PC do tipo esp stica (n=56, 80%), tetrapl‚gicos (n=50, 71,4%), GMFCS n¡vel V (n=41, 58,5%), com motricidade oral funcional (n=28, 40%). Faziam uso de anticonvulsivantes (n=31, 44,2%) e consumiam dieta s¢lida (n=38, 54,2%). O ¡ndice m‚dio de CPO-D = 3,8, sendo que a maioria dos participantes apresentava CPO-D=0 (n=45, 64,3%) e a presen‡a de sangramento gengival observada em 48 dos avaliados foi de 68,6%. O aumento da idade e a ingestÆo de dieta semi-s¢lida aumentam as chances desses indiv¡duos apresentarem maiores valores de experiˆncia de c rie. A presen‡a de maior comprometimento motor expresso pelo GMFCS foi n¡vel V, motricidade oral semifuncional e uso de anticonvulsivantes aumentam a frequˆncia de sangramento gengival em crian‡as e adolescentes com PC.

The aim of this study was to identify factors associated with dental caries and periodontal disease in children and adolescents with CP. The study included 70 children and adolescents with CP, of both sexes aged from 6 to 19 years old. The studied variables were age, sex, education, and ratings of PC, GMFCS, medications, oral motor, and consistency of the diet. Caries were assessed by the decayed, missing and filled teeth (DMFT); and periodontal conditions by the simplified oral hygiene index (OHI-S) and bleeding on probing. The epidemiological exam was performed by a single calibrated researcher (kappa = .97). We performed univariate and multivariate analyzes, with a significance level of 5%. Most participants of the study were male (n = 40, 57.1%), with CP spastic type (n = 56, 80%), tetraplegia (n = 50, 71.4%), GMFCS level V (n = 41, 58.5%) with oral motor function (n = 28, 40%). Patients of anticonvulsants (n = 31, 44.2%) and were on a solid diet (n = 38, 54.2%). The average DMFT = 3.8, the majority of the patients t had DMFT = 0 (n = 45, 64.3%) gingival bleeding was observed in 48 patients (68.6%). Increasing age and intake of semisolid increase the chances of these individuals presenting higher values of caries experience. Greater motor impairment expressed by GMFCS was level V, oral motor semi-functional, and anticonvulsants increase the frequency of gingival bleeding in children and adolescents with CP.

Tratamento pulpar indireto sem reabertura em dente permanente: acompanhamento de 36 meses / Indirect pulp treatment without re-entry in a permanent tooth: 36 months of follow-up

An alternative approach in the management of deep caries lesions is the indirect pulp treatment, without re-entry in the cavity. It has been shown that the complete removal of the carious dentin became unnecessary after the total tooth sealing, because the remaining microorganisms of the affected dentin would stop proliferating and/or die. This case report describes the management of a deep caries lesion of an 11-year-old girl with great coronary destruction in the left mandibular permanent first molar. Infected dentinal walls were excavated with manual instruments and the remainder affected dentin was filled with ionomer glass cement and composite resin. After 36 months of followup, no clinical and radiographic signs and symptoms of pulp damage were observed. In conclusion, the indirect pulp treatment was considered a good alternative for the treatment of deep caries lesions as it reduced the risk of pulp exposure by not reopening the cavity, saved the patient and the dentist clinical time and arrested the lesion progression with radiographic density increase and absence of any pain symptoms.

Um novo conceito cl?nico no tratamento de les?es de c?rie profunda ? o tratamento pulpar indireto sem reabertura da cavidade. Tem sido demonstrado que a remo??o completa da dentina cariada tornou-se desnecess?ria ap?s selamento total do dente, pois os microorganismosremanescentes da dentina afetada n?o se proliferariam ou morreriam. Este relato de caso descreve o tratamento de les?es de c?rie profunda de uma menina de 11 anos de idade com grande destrui??o coron?ria no primeiro molar permanente mandibular. As paredes dentin?rias infectadas foram removidas com instrumentos manuais e a dentina afetada remanescente foi preenchida com cimento de ion?mero de vidro e resina composta. Ap?s 36 meses de acompanhamento, n?o se observou nenhum sinal e sintoma cl?nico e radiogr?fico de dano pulpar. Em conclus?o, o tratamento pulpar indireto foi considerado uma boa alternativa para o tratamento de les?es de carie profunda, j? que reduziu o risco de exposi??o pulpar, devido a n?o reabertura da cavidade, economizou tempo cl?nico para o paciente e o dentista e paralisou a progress?o da les?o com aumento da densidade radiogr?fica e aus?ncia de qualquer sintomatologia dolorosa.