Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis

Abstract This review aimed to assess the association between overweight/obesity and dental caries in Brazilian children/adolescents. Searches were performed in the Web of Science, Scopus, Cochrane, PubMed, Embase and SciELO, Lilacs and Open Grey literature databases up to June 2022. The Joanna Briggs Institute checklist for analytical cross-sectional studies, the checklist for cohort studies, and the checklist for case-control studies were used. A total of 41 publications were included, and 15 meta-analyses were performed. The authors analyzed the differences in weighted mean difference (MD) and odds ratios (OR), and their corresponding confidence intervals (CI) (95%) for dental caries among eutrophic and obese and/or overweight children/adolescents. Meta-analyses showed that there was no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI (Body Mass Index). A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve (OR = 2.53, 95% CI;1.49-4.29; p = 0.0006; I2 = 0%) in dichotomous outcome studies, and (MD = 0.61, 95%CI: 0.08-1.15; p = 0.02; I2 = 0%) in continuous studies. The strength of the evidence of the results was classified as very low, low or moderate. It was concluded that there is no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI. A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve.

Mast cells in oral lichen planus and oral lichenoid lesions related to dental amalgam contact

Abstract The aim of this study was to analyze the expression of mast cell markers toluidine blue, c-kit, and tryptase and presence of mononuclear inflammatory cells in oral lichen planus (OLP) and oral lichenoid lesions related to dental amalgam. Nineteen specimens of OLP, OLLC, and healthy oral mucosa were selected. Mononuclear inflammatory cells were analyzed. Histochemical and immunohistochemical analyses were performed using toluidine blue, anti-c-kit and anti-tryptase reagents, and the results were quantified in areas A and B of connective tissue. Mast cells of all OLP and OLLC samples were positive for toluidine blue, c-kit, and tryptase. The density of toluidine blue+, c-kit+ and tryptase+ mast cells was higher in tissue with OLP and OLLC compared with healthy controls (p < 0.05). No difference was noted in mast cells density between OLP and OLLC (p > 0.05). The density of tryptase+ mast cells was higher in the subepithelial region (area A) than the region below it (Area B) in OLLC (p = 0.047). The mononuclear inflammatory cell density was higher in OLLC compared to OLP, but without statistical significance (p > 0.05). A positive statistical correlation was found between mononuclear immune cells and density of c-kit+ and tryptase+ mast cells in OLP (r = 0.943 and r = 0.886, respectively). Our data demonstrate that the etiopathogenesis process of OLP and OLLC modulates the expansion and degranulation of mast cells; mast cells density, however, was similar between OLP and OLLC. The distribution of mast cells appears to vary along the lamina propria.

Diagnosis and prevalence of probable awake and sleep bruxism in adolescents: an exploratory analysis

Abstract The aims of this study were to perform an exploratory analysis of probable awake (AB) and sleep bruxism (SB) prevalence using of different diagnosis criteria based on the International Consensus; evaluate the associations between self-report and clinical signs/symptoms in adolescents. Participated in this cross-sectional study 403 adolescents aged 12- to 19-years-old enrolled in public and private schools from Belo Horizonte, Brazil. Parents/caregivers answered a questionnaire about sociodemographic status and adolescents' health status. Adolescents answered a questionnaire evaluating AB (e.g., grinding and clenching) and SB (e.g., grinding, bracing, and thrusting) activities and frequent headaches. A clinical examination was performed on adolescents to evaluate bruxism clinical signs/symptoms (pain upon palpation on masseter and temporal, linea alba, indentation on the tongue and attrition wear severity). Descriptive statistics and Pearson's Qui-square test were performed (P≤0.05). Adolescents mean age was 14.3±1.5 years, and 58.1% were female. Self-report of SB was identified in 31% of participants and self-report of AB in 51.6%. Almost all adolescents (99%) presented at least one tooth with attrition wear (98.5% on enamel and 0.5% on dentin), with a mean number of 12.4±5.7 teeth. Depending on the diagnosis criteria, the prevalence of probable SB and AB varied from 0- 99% and 0.2- 99%, respectively. A high inconsistency was found for the prevalence of probable AB and SB in adolescents, which were influenced by the different clinical sings/symptoms used as diagnosis criteria. Frequent headaches and pain upon palpation on masseter and temporal muscle were associated to self-report of AB and SB among adolescents.

Resumo Os objetivos deste estudo foram realizar uma análise exploratória da prevalência de provável bruxismo em vigília (BV)e do sono (BS) utilizando diferentes critérios de diagnóstico baseados no Consenso Internacional; avaliar a associação entre o autorrelato e os sinais/sintomas clínicos em adolescentes. Participaram deste estudo transversal 403 adolescentes de 12 a 19 anos de idade matriculados em escolas públicas e privadas de Belo Horizonte, Brasil. Os pais/responsáveis responderam um questionário sobre dados sociodemográficos e estado de saúde dos adolescentes. Os adolescentes relataram atividades do BV (ranger e apertar) e BS (ranger, bracing e thrusting) e dores de cabeça frequentes. Um exame clínico foi realizado nos adolescentes para avaliar os sinais/sintomas clínicos do bruxismo (dor à palpação nos músculos masseter e temporal, marcas de endentação na língua e linha alba, desgaste dentário por atrição). Análises descritiva e teste Qui-quadrado de Pearson foram realizados (P≤0,05). A média de idade dos adolescentes foi de 14,3±1,5 anos e 58,1% eram do sexo feminino. O autorrelato de BS foi identificado em 31% dos participantes e o autorrelato do BV em 51,6%. Quase a totalidade dos adolescentes (99%) apresentaram pelo menos um dente com desgaste dentário (98,5% em esmalte; 0,5% em dentina), com média de 12,4±5,7 dentes acometidos. Dependendo do critério de diagnóstico, a prevalência do provável BS e BV variou de 0- 99% e 0,2- 99%, respectivamente. Uma grande inconsistência foi identificada na prevalência de provável BV e BS em adolescentes, que foram influenciadas pelos diferentes sinais/sintomas usados como critério de diagnóstico. Dores de cabeça frequentes e dor à palpação no masseter e temporal foram associados ao autorrelato de bruxismo em crianças e adolescentes.

Effectiveness of lip repositioning in the treatment of excessive gingival display: systematic review and meta-analysis / Eficacia del reposicionamiento de labios en el tratamiento de la exposición gingival excesiva: revisión sistemática y metanálisis

Background: The objective of this systematic review and meta-analysis was to answer the questions ''Does lip repositioning surgery reduce the amount of gingiva exposed in the smile in individuals with excessive gingival display EGD (excessive gingival display)?'' and ''Is the reduction of the amount of gingiva exposed when smiling obtained with lip repositioning surgery stable over time?'' to evaluate the effectiveness of lip repositioning surgery for correcting EGD on smiling. Materials and Methods: A systematic structured search was carried out in five databases without data restriction. Studies reporting the degree of reduction in gingival ex-posure after lip repositioning surgery were included. Study selection, data extraction, and risk of bias assessment were performed in duplicate Results: One hundred sixty-four references were retrieved and eleven studies met the eligibility criteria. Meta-analysis demonstrated that lip repositioning surgery results in a significant reduction in the amount of exposed gingival tissue (mean difference = -3.03; confidence interval = -3.55; -2.52). In addition, the results remained stable in the evaluated follow-up periods (1, 3, 6 and 12 months). Included studies had a low risk of bias. Conclusions: Lip repositioning surgery is effective for the treatment of EGD on smiling and exhibits stable results in the evaluated periods. The study was registered (CRD42020184866) in the international prospective register of systematic reviews (PROSPERO)

Antecedentes: el objetivo de esta revisión sistemática y metanálisis fue responder a las preguntas "¿La cirugía de reposicionamiento de labios reduce la cantidad de encía expuesta en la sonrisa en personas con exposición gingival excesiva (EGE)?" y "¿La reducción de la cantidad de encía expuesto al sonreír obtenido con cirugía de reposicionamiento de labios estable en el tiempo?" para evaluar la efectividad de la cirugía de reposicionamiento de labios para corregir la EGE al sonreír. Materiales y Métodos: Se realizó una búsqueda sistemática estructurada en cinco bases de datos sin restricción de datos. Se incluyeron los estudios que informaron el grado de reducción de la exposición gingival después de la cirugía de reposición de labios. La selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo se realizaron por duplicado. Resultados: Se recuperaron ciento sesenta y cuatro referencias y once estudios cumplieron con los criterios de elegibilidad. El metanálisis demostró que la cirugía de reposicionamiento de labios da como resultado una reducción significativa en la cantidad de tejido gingival expuesto (diferencia de medias = -3,03; intervalo de confianza = -3,55; -2,52). Además, los resultados se mantuvieron estables en los periodos de seguimiento evaluados (1, 3, 6 y 12 meses). Los estudios incluidos tenían un bajo riesgo de sesgo. Conclusión: La cirugía de reposicionamiento de labios es efectiva para el tratamiento de la EGE al sonreír y presenta resultados estables en los períodos evaluados. El estudio fue registrado (CRD42020184866) en el registro prospectivo internacional de revisiones sistemáticas (PROSPERO).

Semantic equivalence of the Brazilian version of the Patient Satisfaction Questionnaire (B-PSQ)

Abstract The Patient Satisfaction Questionnaire (PSQ) is a self-administered instrument to assess adolescent patients' satisfaction with orthodontic treatment. A pre-existing North American instrument was further explored in the Netherlands. Semantic equivalence is part of cross-cultural adaptation and is necessary to achieve a valid and reliable instrument for a specific culture. The present study aimed to evaluate the semantic equivalence of the items, subscales, and overall PSQ between the original English version and the Brazilian Portuguese language version (B-PSQ). The PSQ has 58 items, distributed across 6 subscales: doctor-patient relationship, situational aspects of the clinic, dentofacial improvement, psychosocial improvement, dental function, and a residual category. Semantic equivalence was evaluated according to the following methods: (1) independent translations to Portuguese by two translators, both native in Brazilian Portuguese and fluent in English; (2) an expert committee drafted the first summarized version in Portuguese; (3) two independent back-translations into English by two native English-speaking translators fluent in Portuguese; (4) committee review; (5) committee drafted a summarized version of the back-translations; (6) expert committee drafted the second summarized version in Portuguese; (7) pre-test of the instrument using individual semi-structured interviews with 10 adolescents; (8) review and final version of the B-PSQ. Semantic equivalence between the original and the Brazilian versions of the questionnaire was achieved through diligent and rigorous methods, with effective translation and expert evaluations, incorporating the opinions of the target population.

Resumo O Patient Satisfaction Questionnaire (PSQ) é um instrumento autorrelatado específico para avaliar a satisfação de pacientes adolescentes com o tratamento ortodôntico. Um instrumento norte-americano pré-existente foi mais explorado na Holanda. A equivalência semântica faz parte da adaptação transcultural e é necessária para se obter um instrumento válido e confiável para uma cultura específica. O presente estudo teve como objetivo avaliar a equivalência semântica dos itens, subescalas e escore geral do PSQ entre a versão original em inglês e a versão em português do Brasil (B-PSQ). O PSQ possui 58 itens, distribuídos em 6 subescalas; relação médico-paciente, aspectos situacionais da clínica, melhora dentofacial, melhora psicossocial, função dentária e uma categoria residual. A equivalência semântica foi avaliada de acordo com o seguinte método: 1) traduções independentes para o português por dois tradutores, ambos nativos em português brasileiro e fluentes em inglês; 2) um comitê de experts elaborou a primeira versão síntese em português; 3) duas retro-traduções independentes para o inglês por dois tradutores nativos de língua inglesa fluentes em português; 4) revisão do comitê; 5) o comitê elaborou uma versão síntese das retro-traduções; 6) comitê de experts redigiu a segunda versão síntese em português; 7) pré-teste do instrumento por meio de entrevistas individuais semiestruturadas com 10 adolescentes; 8) revisão e versão final do B-PSQ. A equivalência semântica entre as versões original e brasileira do questionário foi alcançada por meio de métodos cuidadosos e rigorosos, com tradução eficaz e avaliações de experts, incorporando as opiniões da população-alvo.

Pathways that explain racial differences on edentulism among older adults: 2019 Brazil National Health Survey

Abstract This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3-52.6), and 36.8% (95%CI: 35.7-37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

Efetividade do uso de instruções digitais (apps e mensagens de telefone) comparadas às instruções convencionais (verbais e escritas) na melhora da higiene bucal em pacientes ortodônticos: uma revisão sistemática e meta-análise / Effectiveness of using digital instructions (apps and phone messages) compared to conventional instructions (verbal and written) in improving oral hygiene in orthodontic patients: a systematic review and meta-analysis

Objetivo: Comparar o efeito do uso de instruções convencionais (verbais ou escritas) e instruções digitais (apps e mensagens de telefone) na cooperação e melhora da higiene oral dos pacientes ortodônticos.Métodos: Foram conduzidas buscas em seis bases de dados. Seleção dos estudos, extração de dados e análise do risco de viés dos artigos com a ferramenta Cochrane foram realizadas. Resultados de meta-análises foram apresentados em diferença média (DM) e intervalo de confiança (IC). Resultados: Seis estudos foram incluídos. No geral, os estudos mostraram que indivíduos que recebem instruções convencionais e digitais de higiene bucal apresentam uma melhora do índice de placa e índice gengival ao longo do tratamento ortodôntico (p < 0,05). Os indivíduos que só recebem instruções convencionais não apresentam melhora dos índices (p > 0,05). Os resultados são confirmados por duas meta-análises, sendo o índice de placa (DM = -1,30, IC = -2,52 - -0,08) e o índice gengival (DM = -0,27, IC = -0,42 - -0,12) melhor entre indivíduos que receberam instruções convencionais e digitais em comparação a indivíduos que receberam somente instruções convencionais. Meta-análises mostraram que não há diferença para índice de placa (DM = 0,57, IC = -0,61 ­ 1,74) e índice gengival (DM = -0,46, IC = -1,52 - 0,59) durante o tratamento entre indivíduos que somente receberam instruções de higiene convencionais e aqueles que só receberam instruções digitais. Indivíduos que só receberam instruções convencionais apresentam um aumento de lesões de mancha branca ao longo do tratamento (p < 0,05). O risco de viés variou de baixo a alto. Conclusão: Instruções digitais junto às convencionais são eficientes na melhora da higiene bucal dos pacientes em tratamento ortodôntico.

Aim: To compare the effects of the use of conventional instructions (verbal or written) and digital instructions (apps and phone messages) for the cooperation and improvement of oral hygiene in orthodontic patients. Methods: Searches were conducted in six databases. Selection of studies, data extraction, and risk of bias analysis of articles were performed using the Cochrane tool. For meta-analysis results, mean difference (MD) and confidence interval (CI) were provided. Results: Six studies were included. Overall, studies demonstrated that individuals who received conventional and digital oral hygiene instructions show an improvement in both the plaque and gingival indices over the course of orthodontic treatment (p < 0.05). By contrast, individuals who only received conventional instructions showed no improvement in the indices (p > 0.05). The results were confirmed in two meta-analyses, with the plaque index (MD = -1.30, CI = -2.52 - -0.08) and the gingival index (MD = -0.27, CI = -0.42 - -0.12) presenting better outcomes among individuals who received conventional and digital instructions, as compared to individuals who received only conventional instructions. Meta-analyses showed that there is no difference between the plaque index (MD = 0.57, CI = -0.61 ­ 1.74) and the gingival index (MD = -0.46, CI = -1.52 ­ 0.59) concerning the course of treatment between individuals who only received conventional hygiene instructions and those who only received digital instructions. Individuals who only received conventional instructions showed an increase in white spot lesions throughout the treatment (p < 0.05). The risk of bias ranged from low to high. Conclusion: Both digital instructions and the conventional instructions are efficient in improving the oral hygiene of patients during orthodontic treatment.

Effects of tobacco on the DNA of smokers and non-smokers affected by OSCC: systematic review and meta-analysis

Abstract Scientific evidence about genetic and molecular changes in oral squamous cell carcinoma (OSCC) among smokers and non-smokers is inconclusive. This systematic review and meta-analysis assessed the effects of tobacco on the DNA of individuals with OSCC based on protein mutations. Electronic searches were conducted on PubMed, Ovid, Web of Science, and Scopus to identify observational studies published up to January/2022. The Joanna Briggs Institute tool was used for the critical appraisal of studies. The certainty of the evidence was evaluated. Twenty-three studies assessing 4,060 individuals (2,967 smokers vs. 1,093 non-smokers) were included in this review. Fifteen groups of proteins/genes were investigated. Analysis of the quality of articles revealed low risk of bias in most studies. The certainty of the evidence was very low. The meta-analysis confirmed no significant difference between smokers and non-smokers with respect to damage to GSTM1 (OR: 0.60; 95%CI: 0.30-1.18), GSTT1 (OR: 1.18; 95%CI:0.49-2.83), hydrolase proteins (Ku70 and Ku80) (OR: 0.74; 95%CI: 0.18-3.05), and transferase proteins (GSTM1, GSTT1, GSTM3) (OR: 0.74; 95%CI: 0.47-1.18). Most of the studies included showed that smokers are more likely to exhibit genetic instability. However, the meta-analysis revealed that smokers do not necessarily have more genetic alterations in the DNA than non-smokers.

Tooth wear due to dental attrition among 12-year-old adolescents / Desgaste dentário por atrição entre adolescentes de 12 anos de idade

Aim: To evaluate the prevalence and distribution of tooth wear due to dental attrition among 12-year-old adolescents according to their gender, reports of tooth grinding during sleep/while awake (bruxism), and sleep features related to sleep-disordered breathing. Methods: A cross-sectional study was conducted with 172 adolescents from southeast Brazil. Parents/caregivers answered questions about sociodemographic characteristics; reports of adolescents' tooth grinding during sleep, and sleep features (e.g. sleep duration and position, snoring, drooling on the pillow) in the previous two weeks. Adolescents self-reported the occurrence of tooth clenching/grinding while awake in the previous two weeks. Tooth wear due to dental attrition was assessed by a previously calibrated researcher, using a validated 5-point analogical ordinal occlusal/incisal tooth wear grading scale, with scores ranging from 0 (no wear) to 4 (loss of crown height ≥ 2/3), depending on tooth wear severity. Descriptive statistics and the Mann-Whitney test (p < 0.05) were performed to identify differences in tooth wear due to the distribution of dental attrition, according to adolescents' characteristics. Results: Most adolescents were female (58.0%) and 81.6% of the participants presented tooth wear due to dental attrition within the enamel. Adolescents who snored had a higher number of incisors with tooth wear due to dental attrition (p = 0.035). Females showed a higher number of canines with tooth wear due to dental attrition (p = 0.020). Adolescents whose parents reported tooth grinding during sleep presented a higher number of bicuspids with tooth wear due to dental attrition (p = 0.001). Conclusion:Tooth wear due to dental attrition within the enamel was observed in most adolescents. The distribution, depending on specific groups of teeth, was higher among female adolescents, adolescents' whose parents reported tooth grinding, and adolescents who snored during sleep.

Objetivos: Avaliar a prevalência e distribuição de DDA entre adolescentes de 12 anos de acordo com o sexo, relato de ranger de dentes durante o sono e vigília (bruxismo) e características relacionadas a desordens respiratórias do sono.Método: Desenvolveu-se um estudo transversal com 172 adolescentes do sudeste do Brasil. Seus pais/responsáveis responderam um questionário contendo informações sociodemográficas, relato sobre os filhos rangerem os dentes durante o sono e hábitos do sono dos filhos (duração do sono, posição que dorme, roncar, babar no travesseiro) nas duas últimas semanas. Adolescentes relataram ocorrência de ranger/apertar de dentes durante a vigília nas duas últimas semanas. DDA foi avaliado por um pesquisador previamente calibrado através de uma escala analógica ordinal de cinco pontos de desgaste dentário para faces oclusal/incisal previamente validada, com escores variando de 0 (sem desgaste) a 4 (perda da coroa em altura ≥ 2/3), dependendo da gravidade do desgaste. Análises descritivas e teste de Mann-Whitney (p < 0,05) foram realizados para identificar as diferenças na distribuição de DDA de acordo com as características dos adolescentes.Resultados: A maioria dos adolescentes eram meninas (58,0%) e 81,6% dos participantes apresentaram DDA em esmalte em algum elemento dentário. Adolescentes que rocavam apresentavam mais incisivos com DDA (p = 0.035). Meninas apresentaram maior número de caninos com DDA (p = 0.020). Adolescentes que rangiam os dentes durante a noite apresentaram maior número de pré-molares com DDA (p = 0.001).Conclusão: Desgaste dentário por atrição em esmalte foi observado na maioria dos adolescentes. A distribuição, dependendo de grupos de dentes específicos, foi maior entre meninas, adolescentes que roncavam durante o sono e que rangiam os dentes durante o sono.

Dental anomalies in individuals with osteogenesis imperfecta: a systematic review and meta-analysis of prevalence and comparative studies

Abstract Background Osteogenesis imperfecta (OI) is a rare genetic disorder primarily caused by mutations in the genes involved in the production of type 1 collagen. OI is also known as brittle bone disease. Objective This study aims to describe the prevalence of dental anomalies (except dentinogenesis imperfecta) in individuals with OI, and compare the prevalence of dental anomalies between individuals with and without OI and between individuals with different types of OI. Search methods Searches in PubMed, Web of Science, Scopus, Ovid, and gray literature were performed in October 2022. Selection criteria Observational studies (with or without a comparison group) that evaluated the prevalence of dental anomalies in individuals with OI. Data collection and analysis: Data items were extracted by two authors. Quality assessment employing the Joanna Briggs Institute checklists and meta-analyses was conducted. Results were provided in prevalence values and odds ratio (OR) / 95% confidence interval (CI). Strength of evidence was determined. Results Eighteen studies were included. Most prevalent dental anomalies in individuals with OI included pulp obliteration (46.4%), dental impaction (33.5%), dental impaction of second molars (27%), and tooth agenesis (23.9%). Individuals with OI type III/IV had 20.16-fold greater chance of exhibiting tooth discoloration in comparison with individuals with OI type I (CI: 1.10-370.98). In comparison with the group without OI, the individuals with OI had 6.90-fold greater chance of exhibiting dental impaction (CI: 1.54-31.00). High methodological quality was found in 47% of the studies. Strength of evidence was low or very low. Conclusions Pulp obliteration, dental impaction, and tooth agenesis were the most prevalent dental anomalies in the OI group. Individuals with OI were more likely to have dental impaction than individuals without OI. Individuals with OI type III/IV (severe-moderate) are more likely to have tooth discoloration than individuals with OI type I (mild).

Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil

Abstract This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Influence of risedronate on orthodontic tooth movement in rodents: a systematic review and case report

ABSTRACT Introduction: Bisphosphonates have an inhibitory impact on osteoclastic activity, reducing bone resorption. However, the influence of risedronate on tooth movement is not well-defined. Objective: This systematic review assessed the effect of risedronate intake on orthodontic tooth movement. A case report was also provided. Methods: Two independent reviewers searched six databases (PubMed, Web of Science, Ovid, Lilacs, Scopus, and Open Grey). The searches were carried out in April/2020, and an update was set in place in June/2023. Therefore, the searches considered a timeline from the databases' inception date until June/2023, with no publication date and/or language restrictions. The clinical question focused on evaluating the orthodontic tooth movement and relapse movement (Outcome) in animals (Population) exposed to risedronate (Exposure), compared to control groups (Comparison). The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were applied, and the protocol was registered in PROSPERO (CRD42020168581). The risk of bias was determined using the Systematic Review Centre for Laboratory Animal Experimentation protocol (SYRCLE). Results: Two studies in rats and one in guinea pigs were included in the systematic review. The studies reported a decrease in orthodontic tooth movement, a reduction in the relapse movement, and a reduced number of positive tartrate-resistant acid phosphatase (TRAP) cells, with a significantly reduced number of bone gaps after the administration of risedronate in rats. A case report illustrated the effects of risedronate administration in one patient. Conclusion: Based on the systematic review, risedronate seems to impair orthodontic tooth movement and relapse due to a decrease in bone resorption cells.

RESUMO Introdução: Os bifosfonatos têm um impacto inibitório na atividade osteoclástica, reduzindo a reabsorção óssea. No entanto, a influência do risedronato no movimento dentário não está bem definida. Objetivo: Esta revisão sistemática avaliou o efeito do uso de risedronato no movimento ortodôntico dos dentes. Um relato de caso também é apresentado. Métodos: Dois revisores independentes pesquisaram seis bases de dados (PubMed, Web of Science, Ovid, Lilacs, Scopus e Open Grey), considerando o período de abril de 2020 até junho de 2023, sem restrições de data e/ou idioma de publicação. A questão clínica focou em avaliar o movimento ortodôntico dos dentes e movimento de recidiva (resultado) em animais (população) expostos ao risedronato (exposição) em comparação com grupos de controle (comparação). Foram aplicadas as Diretrizes Preferenciais para Revisão Sistemática e Metanálise (PRISMA) e um protocolo foi registrado no PROSPERO (CRD42020168581). O risco de viés foi determinado utilizando o protocolo do Centro de Revisão Sistemática para Experimentação em Animais de Laboratório (SYRCLE). Resultados: Dois estudos em ratos e um em porquinhos-da-índia foram incluídos na revisão sistemática. Os estudos relataram uma diminuição no movimento ortodôntico dos dentes, uma redução no movimento de recidiva e um número reduzido de células positivas à fosfatase ácida tartarato-resistente (TRAP) com um número significativamente reduzido de falhas ósseas após a administração de risedronato em ratos. Um relato de caso ilustrou os efeitos da administração de risedronato em uma paciente. Conclusão: Com base na revisão sistemática, o risedronato parece interferir no movimento ortodôntico dos dentes e na recidiva devido a uma diminuição nas células de reabsorção óssea.

Estudo da acurácia de dispositivos de indução da fluorescência e do método radiográfico para o diagnóstico de lesões de cárie em dentes decíduos: uma revisão sistemática e meta-análise / Assessment of the accuracy of the fluorescence devices and radiography for the diagnosis of caries in primary teeth: a systematic review and meta-analysis

Objetivo: O objetivo dessa revisão sistemática e meta-análise foi avaliar a acurácia de dispositivos de indução de fluorescência e do método radiográfico para diagnóstico da cárie dentária em dentes decíduos. Métodos: Buscas no PubMed, Web of Science, Scopus, Embase, Open Grey e Google Scholar foram realizadas em agosto de 2021. Referências que preenchiam os critérios de elegibilidade foram incluídas. O risco de viés dos artigos incluídos foi avaliado com a ferramenta QUADAS-2. Foram realizadas meta-analises com o MedCalc. Resultados fornecidos em área sob a curva (ASC), intervalo de confiança (IC) e erro padrão (EP). Resultados: Títulos/resumos de 619 referências foram avaliados por dois revisores calibrados de forma independente. Cinquenta e seis artigos foram selecionados para leitura do texto completo. Onze artigos foram incluídos na revisão-sistemática e meta-análise. Os artigos incluídos apresentaram baixo risco de viés. A ASC para diagnóstico de cárie em esmalte com o laser DIAGNOdent foi de 75,8% (IC = 68,1% - 83,6% / EP = 3,9% / I2 = 67,95%) e para o diagnóstico de cárie em dentina foi de 80,6% (ASC = 80,6% / IC = 65,7% - 95,6% / EP = 7,6% / I2 = 89,24%). A ASC para o diagnóstico de cárie em esmalte com a radiografia interproximal foi de 61,7% (IC = 51,4% - 72,1% / EP = 5,3% / I2 = 44,51%) e a ASC para diagnóstico de cárie em dentina com a radiografia interproximal foi de 73,7% (IC = 45,1% - 100% / EP = 14,6% / I2 = 96,97%). Conclusão: O método radiográfico e os dispositivos de indução de fluorescência são boas opções para diagnóstico de cárie em dentes decíduos. Ambos apresentam melhores resultados em lesões em dentina. Os métodos que utilizam fluorescência tiveram melhores resultados em esmalte quando comparados à radiografia.

Aim: This systematic review and meta-analysis aimed to evaluate the accuracy of the fluorescence induction devices and radiographic method for diagnosing dental caries in primary teeth. Methods: Searches in PubMed, Web of Science, Scopus, Embase, Open Grey, and Google Scholar were conducted in August 2021. References that met the eligibility criteria were included. The risk of bias of the included articles was assessed with QUADAS-2. Meta-analyses were performed with MedCalc. Results were provided as area under the curve (AUC), confidence interval (CI), and standard error (SE). Results: Titles/abstracts of 619 references were evaluated by two trained reviewers independently. Fifty-six articles were selected for full-text reading. Eleven articles were included in the systematic review and meta-analysis. The included articles showed a low risk of bias. The AUC for the diagnosis of caries on enamel with the DIAGNOdent laser was 75.8% (CI = 68.1% - 83.6% / SE = 3.9% / I2 = 67.95%), whereas for the diagnosis of caries on dentin, it was 80.6% (AUC = 80.6% / CI = 65.7% - 95.6% / SE = 7.6% / I2 = 89.24%). The AUC for the diagnosis of enamel caries with the interproximal radiograph was 61.7% (CI = 51.4% - 72.1% / SE = 5.3% / I2 = 44.51%) and the AUC for the diagnosis of dentin caries with the interproximal radiograph was 73.7% (CI = 45.1% - 100% / SE = 14.6% / I2 = 96.97%). Conclusion: Radiography and fluorescence devices are useful tools for the diagnosis of caries in deciduous teeth. Both showed better results in dentin lesions. The methods using fluorescence had better results in enamel when compared to radiography.

Incidence and mortality rates of lip, oral cavity, and pharynx cancers in Brazil: time-trend and age-period-cohort analysis from the last 30 years, Global Burden of Disease Study

Abstract INTRODUCTION: Cancers are the second main cause of morbidity worldwide, but robust information on lip, oral cavity, and pharynx cancers in Brazil is lacking. This study aimed to analyze the trends of incidence and mortality caused by lip, oral cavity, and pharynx cancers and age-period-cohort effects in the Brazilian population of 30 years of age and over, in the period of 1990 to 2019. METHODS: A time series study of the incidence and mortality rates for oral cavity and pharynx cancer ("Lip and oral cavity cancer", "Nasopharynx cancer", and "Other pharynx cancer") was conducted, with corrected data from the Global Burden of Disease Study (GBD) 2019. Age-standardized rates per 100,000 inhabitants, for the global population, were gathered according to the individuals' sex. The annual average percentage change (AAPC) was estimated, as was the age-period-cohort effects. RESULTS: The incidence and mortality rates were higher for men in the studied anatomical regions. The cancers tended to decrease for men, except for nasopharynx cancer, which increased in individuals of both sexes. Mortality tended to present a decline in most of the groups studied. For men and women, the age-period-cohort model presented a better adjustment for both incidence and mortality. CONCLUSIONS: Incidence and mortality caused by the main head and neck cancers showed a tendency to decline over the past 30 years in Brazil, except for nasopharynx cancer, which showed an increase in incidence and mortality in some segments of the population. Higher rates were found for lip and oral cavity cancers in men.

Prevalence, incidence, and years-lived with disability due to oral disorders in Brazil: an analysis of the Global Burden of Disease Study 2019

Abstract INTRODUCTION Epidemiological surveys revealed that Brazil has a high burden of oral diseases. However, no prior study has reported estimates of untreated dental caries, periodontitis, and edentulism over a three-decade period. The objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries in primary and permanent teeth, periodontitis, and edentulism in Brazil between 1990 and 2019. METHODS Estimates of prevalence, incidence, and YLDs due to dental caries in primary and permanent teeth, periodontitis, and edentulism were produced for Brazil, by sex and age, between 1990 and 2019, using Dismod-MR 2.1, as part of the Global Burden of Disease Study 2019 (GBD 2019). Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. RESULTS Almost 100 million Brazilians presented at least one oral disorder in 2019, which was equivalent to a prevalence of 45.3%. All oral diseases combined ranked eighth among all causes of disability, causing more than 970,000 YLDs. Untreated dental caries in primary teeth were estimated to affect 13.5 million children, and untreated dental caries in permanent teeth affected more than 52 million people. Periodontitis affected 29.5 million people, and edentulism affected almost 22 million. The generalized linear regression models revealed a trend of stability of oral disorders between 1990 and 2019. CONCLUSIONS The burden of oral diseases in Brazil is extremely high. Oral disorders, edentulism in particular, caused disability at levels that are comparable to other important chronic diseases.

Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users

Abstract We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

Anatomical evaluation of the medial lingual foramen using cone-beam computed tomography: a retrospective study / Avaliação anatômica do forame lingual medial usando tomografia computadorizada de feixe cônico: um estudo retrospectivo

ABSTRACT Objective: To evaluate the frequency of medial lingual foramina present in the cortex of the mandible using cone beam computed tomography (CBCT). Methods: A total of 953 CBTC exams of the mandible were evaluated to determine the presence of canals in the mandibular midline, canal location in relation to the mental spine, canal diameter, distance to the base and alveolar crest of the mandible, trajectory of the canal, and coincidence measurements of the panoramic image containing the location of the canal in relation to the mental spine. Results: Foramina were located in three positions: above the mental spine (FSS) 89.2%, below the mental spine (FIS) 67.9%, and other positions (FOP) 21.3%. Non-edentulous individuals had a significantly higher number of FSS than did edentulous individuals (P<0.001). Male individuals presented a significantly greater distance from the FSS (P=0.001), FIS (P=0.045) and FOP (p=0.002) to the base of the mandible than female individuals. Younger individuals presented a significantly higher distance from the FSS (P=0.001) and FIS (P=0.001) to the alveolar crest of the mandible. Male individuals had a significantly greater FIS (P=0.002) and FOP (P=0.001) diameter than female individuals. Male individuals had a significantly higher number of bifurcations in FOP than female individuals (P=0.017). Conclusion: CBCT supplies the provider with a detailed assessment of the foramina and canals, which improves the quality of surgical planning and mitigates the chances of surgical intercurrences.

RESUMO Objetivo: Avaliar a frequência dos forames linguais mediais presentes na cortical da mandíbula por meio da tomografia computadorizada de feixe cônico (TCFC). Métodos: Um total de 953 exames de TCFC da mandíbula foram avaliados para determinar a presença de canais na linha média mandibular, localização do canal em relação ao tubérculo geniano, diâmetro do canal, distância à base e crista alveolar da mandíbula, trajetória da canal e medidas de coincidência da imagem panorâmica contendo a localização do canal em relação ao tubérculo geniano. Resultados: Os forames localizaram-se em três posições: acima do tubérculo (FSS) 89,2%, abaixo do tubérculo (FIS) 67,9% e outras posições (FOP) 21,3%. Indivíduos não edêntulos apresentaram um número significativamente maior de FSS do que indivíduos edêntulos (P <0,001). Indivíduos do sexo masculino apresentaram distâncias significativamente maior do FSS (P = 0,001), FIS (P = 0,045) e FOP (p = 0,002) até a base da mandíbula do que indivíduos do sexo feminino. Os indivíduos mais jovens apresentaram uma distância significativamente maior do FSS (P = 0,001) e FIS (P = 0,001) até a crista alveolar da mandíbula. Indivíduos do sexo masculino tiveram um diâmetro de FIS (P = 0,002) e FOP (P = 0,001) significativamente maior do que indivíduos do sexo feminino. Indivíduos do sexo masculino tiveram um número significativamente maior de bifurcações no FOP do que indivíduos do sexo feminino (P = 0,017). Conclusão: a TCFC fornece ao profissional uma avaliação detalhada dos forames e canais, o que melhora a qualidade do planejamento cirúrgico e diminui as chances de intercorrências.

Satisfaction with orthodontic treatment: cross-cultural adaptation and validation of an instrument for the Brazilian Portuguese language

ABSTRACT Objective: To cross-culturally adapt into the Brazilian Portuguese and evaluate the psychometric properties of an instrument for assessing the satisfaction of parents/guardians regarding their sons'/daughters' orthodontic treatment. Methods: Translations of the instrument from English, pre-test and evaluation of validity and reliability of the Brazilian Portuguese version were performed. The questionnaire has 25 items distributed across 3 subscales (process, psychosocial effect and outcome). Eighty-three parents/guardians of children/adolescents who had completed orthodontic treatment participated. Descriptive statistics and floor and ceiling effects were calculated. Internal consistency, stability (interval of three weeks), convergent construct validity and discriminant construct validity were determined. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed dimensionality. Results: Among the 83 parents/guardians, 58 (69.9%) were mothers and 25 (30.1%) were fathers of children/adolescents. In the questionnaire's total score and the three subscales scores, an acceptable percentage (≤15%) of participants achieved the maximum score (ceiling effect). In the total questionnaire score and in the three subscales scores, no participant achieved the minimum score (floor effect). Cronbach's α coefficient for the total score was 0.72 (internal consistency). Intra-class correlation coefficient for the total score was 0.71 (stability). The questionnaire's total score presented large Pearson correlation coefficient (>0.50) with the three subscales too (construct validity). Female parents/guardians had significantly higher scores in the psychosocial effect (p=0.013) and in the treatment outcome (p=0.037) subscales, compared to male parents/guardians (discriminant validity). EFA and CFA confirmed dimensionality in a three-factor solution. Conclusions: The final obtained version is valid and reliable to be used in Brazilian populations.

RESUMO Objetivo: Adaptar transculturalmente para a língua portuguesa do Brasil e avaliar as propriedades psicométricas de um questionário que avalia a satisfação de pais e responsáveis com relação ao tratamento ortodôntico recebido por seus filhos. Métodos: Tradução do questionário em inglês, pré-teste e avaliação da validade e confiabilidade da versão em português obtida. O questionário consistiu de 25 itens distribuídos em três subescalas (processo durante o tratamento, efeito psicossocial e resultado geral do tratamento). Participaram 83 pais/responsáveis de crianças/adolescentes que concluíram o tratamento ortodôntico. Estatística descritiva foi realizada e foi calculado valor máximo e valor mínimo. Foram determinadas a consistência interna, a estabilidade (intervalo de três semanas), a validade de constructo convergente e a validade de constructo discriminante. A análise fatorial exploratória (AFE) e a análise fatorial confirmatória (AFC) avaliaram a dimensionalidade. Resultados: dos 83 pais/responsáveis que participaram do estudo, 58 (69,9%) eram mães e 25 (30,1%) eram pais das crianças/adolescentes. No escore total do questionário e no escore das três subescalas, uma porcentagem aceitável (≤15%) dos participantes atingiu o escore máximo (ceiling effect). No escore total do questionário e no escore das três subescalas, nenhum participante atingiu o escore mínimo (floor effect). O coeficiente α de Cronbach para o escore total foi 0,72 (consistência interna). O coeficiente de correlação intraclasse para o escore total foi 0,71 (estabilidade). O escore total do questionário apresentou um coeficiente de correlação de Person alto (>0,50) com as três subescalas (validade de constructo). Pais/responsáveis do sexo feminino apresentaram escores significativamente maiores nas subescalas efeito psicossocial (p=0,013) e desfecho do tratamento (p=0,037), em comparação aos pais/responsáveis do sexo masculino (validade discriminante). AFE e AFC confirmaram a dimensionalidade em uma solução de três fatores. Conclusões: A versão do questionário obtida no presente estudo mostrou-se válida e confiável para o uso na população brasileira.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE

Abstract: There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

Dental visits and depression mediating the association of socioeconomic status with oral health behaviors

Abstract Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the "Patient Health Questionnaire-9") and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.