Effectiveness of the use of xylitol chewing gum in prevention of dental caries A systematic review

This systematic review of the literature assessed the effectiveness of using chewing gum containing only xylitol compared to prevention strategies or placebo in reducing the incidence of carious lesions in children using data obtained from randomized controlled trials. Electronic search was carried out in PubMed MEDLINE, Latin American and Caribbean Literature on the Health Science, Web of Science, Scopus, Science Direct, and Scientific Electronic Library Online through the period between 2000 and 2020. Included clinical studies were done in children when the xylitol was dispensed in gum and the preventive effect of xylitol on tooth decay was compared to other preventive strategies or control groups. The studies were evaluated for their quality to obtain the level of evidence. The preventive fraction of each study was extracted. Two hundred studies were found. After analyzing the inclusion and removal of duplicates, only five studies were analyzed for the quality of evidence. With the analysis through the Grading of Recommendations Assessment, Development, and Evaluation system, it was possible to verify the very low level of scientific evidence on the effectiveness of gums containing only xylitol for the prevention of caries in children. The preventive fraction obtained varied between ? 0.31 and 0.57 depending on the compared prevention strategy. The conflicting results, limitations, and inconsistencies of the studies allow us to establish that there is insufficient evidence to support the use of gums containing only xylitol for the prevention of caries in children. Other properly designed clinical trials need to be carried out.

Clinical and Molecular Disorders Caused by COVID-19 During Pregnancy as a Potential Risk for Enamel Defects

ABSTRACT This paper discusses the potential risk that COVID-19 generates for the development of enamel defects. This hypothesis was built based on the etiopathogenesis of enamel defects and the relationship with the symptom's characteristic of COVID-19. Pregnancy is a critical period for the child's development; exposure to pathological agents can cause systemic imbalances and risks of adverse perinatal and prenatal outcomes. The main clinical symptoms of this disease and its association with that dental outcome were considered. Fever, breathing, cardiovascular disorders, and diarrhea were related as potential etiological factors of ameloblast metabolism imbalance, which can interfere qualitatively and quantitatively in the development, maturation and mineralization of the tooth enamel. Molecular disorders derived from COVID-19, as well as their clinical symptoms, can be considered potential risk factors for the development of enamel defects. Individuals with enamel defects experienced high stress levels during pregnancy or early childhood. The approach adopted may help build new research to ensure understanding of the etiology of the development of dental enamel defects and its relationship with COVID-19. However, longitudinal studies need to be conducted to confirm the association between COVID-19 and adverse events during pregnancy.

Clinical attachment loss and molecular profile of inflamed sites before treatment

Abstract Objective: To monitor early periodontal disease progression and to investigate clinical and molecular profile of inflamed sites by means of crevicular fluid and gingival biopsy analysis. Methodology: Eighty-one samples of twenty-seven periodontitis subjects and periodontally healthy individuals were collected for the study. Measurements of clinical parameters were recorded at day −15, baseline and 2 months after basic periodontal treatment aiming at monitoring early variations ofthe clinical attachment level. Saliva, crevicular fluid and gingival biopsies were harvested from clinically inflamed and non-inflamed sites from periodontal patients and from control sites of healthy patients for the assessment of IL-10, MMP-8, VEGF, RANKL, OPG and TGF-β1 protein and gene expression levels. Results: Baseline IL-10 protein levels from inflamed sites were higher in comparison to both non-inflamed and control sites (p<0.05). Higher expression of mRNA for IL-10, RANK-L, OPG, e TGF-β1 were also observed in inflamed sites at day −15 prior treatment (p<0.05). After the periodontal treatment and the resolution of inflammation, seventeen percent of evaluated sites still showed clinically detectable attachment loss without significant differences in the molecular profile. Conclusions: Clinical attachment loss is a negative event that may occur even after successful basic periodontal therapy, but it is small and limited to a small percentage of sites. Elevated inflammation markers of inflamed sites from disease patients reduced to the mean levels of those observed in healthy subjects after successful basic periodontal therapy. Significantly elevated both gene and protein levels of IL-10 in inflamed sites prior treatment confirms its modulatory role in the disease status.

Tratamento de retrações gengivais múltiplas / Treatment of multiple gingival recessions

A retração gengival é o deslocamento da gengiva marginal apicalmente à junção amelocementária, sendo uma queixa frequente na rotina do consultório, pois geralmente apresenta aspecto antiestético e pode contribuir para a hipersensibilidade dentinária e cárie. Miller (1985) propôs a classificação das recessões gengivais em classes I, II, III e IV, em que os melhores prognósticos de recobrimento estão associados às classes I e II. A escolha do procedimento cirúrgico apropriado irá depender de fatores como: altura da recessão, perda óssea interproximal, quantidade e qualidade de gengiva queratinizada, número de dentes envolvidos e largura de tecido interdental. Quando a gengiva é fina, o biotipo delgado associa-se o enxerto de tecido conjuntivo ao retalho posicionado coronalmente. O enxerto de tecido conjuntivo tem por objetivo aumentar a espessura do tecido queratinizado e o prognóstico do recobrimento radicular. Porém, na técnica convencional de retalho posicionado coronalmente pode ocorrer prejuízo de tecido queratinizado interdental. Diante disso, Zucchelli e De Sanctis (2000) propuseram uma técnica alternativa para os casos de recessões múltiplas em que papilas cirúrgicas são criadas através de incisões oblíquas, evitando a perda de tecido queratinizado interdental. O objetivo deste trabalho foi relatar um caso clínico bem-sucedido de tratamento de recessões gengivais múltiplas classe I e II de Miller, utilizando a técnica de Zucchelli e De Sanctis associada a enxerto de tecido conjuntivo, sendo o dente 13 eleito como referência para iniciar as incisões. Após 90 dias, pôde-se perceber o total recobrimento e melhor qualidade do tecido periodontal.

Gingival recession is a displacement of the marginal gingiva apical to the cemento enamel junction and a common complaint in clinical practice, because it usually is unaesthetic and can lead to dentin hypersensitive and caries. Miller (1985) proposed the classification of gingival recession in class I, II, III and IV, and better outcomes are associated to classes I and II. Selection of the appropriate surgical technique will depend on the factors: recession height, interdental bone loss, quantity and quality of keratinized gingiva, number of teeth, and width of interdental tissue. In cases of thin gingiva biotype, connective tissue graft associated with coronally positioned flap is indicated. The use of connective tissue graft aim to increase keratinized tissue thickness and the prognosis of root coverage. Nevertheless, in the traditional technique of coronally positioned flap may occur interdental keratinized tissue loss. Therefore, Zucchelli and De Sanctis (2000) proposed a technique for the treatment of multiple recessions, witch surgical papilla are perfomal through oblique incisions to avoid loss of interdental keratinized tissue. The aim of this paper is report a clinical case of Miller class I and II gingival recession treatment, using Zuchelli e De Sanctis technique associated with connective tissue graft, initial incisions was made as a reference in the upper right canine. After 90 days, complete root coverage and periodontal tissue improvement were visible.