Como avaliar a dor sentida por crianças pré-escolares durante os procedimentos odontológicos? revisão de escopo / How to evaluate the pain felt by preschool children during dental procedures? scope review

Introdução: o diagnóstico da dor sentida pela criança é um passo importante para orientar o cirurgião-dentista sobre o uso de técnicas farmacológicas e não farmacológicas que minimizem a sensação desagradável. Objetivo: identificar os instrumentos usados para a avaliação da dor de crianças pré-escolares durante procedimentos odontológicos. Fontes dos dados: busca por artigos foi realizada no PubMed, Scopus, The Cochrane Library e Google Schoolar, em abril/2022. Estudos observacionais e de intervenção que avaliaram a dor de crianças pré- escolares em atendimento odontológico, publicados em português, inglês ou espanhol foram incluídos. Estudos que avaliaram a dor de crianças tratadas sob sedação ou anestesia geral, bem como a dor pós-operatória, foram excluídos. Síntese dos dados: um total de 767 artigos foram identificados; 133 artigos foram lidos integralmente e 62 incluídos. Em 48 estudos, a dor foi avaliada por meio de autorrelato, usando instrumentos como a Wong-Baker FACES Pain Rating Scale e outras escalas de faces como a Faces Pain Scale-Revised e a Faces Pain Scale. Quando a dor foi avaliada a partir do comportamento infantil, foram usadas escalas como a Face, Legs, Activity, Cry, Consolability Scale (FLACC) e a Sound, Eye and Motor scale (SEM). Conclusão: a dor processual das crianças foi avaliada por meio de autorrelato e da observação do seu comportamento. Tanto as escalas de autorrelato quanto as observacionais têm limitações. A combinação dos instrumentos pode ser uma estratégia na avaliação da dor de pré-escolares.

Introduction: the diagnosis of the pain felt by the child is an important step to guide the dentist on the use of pharmacological and non-pharmacological techniques that minimize unpleasant sensation. Objective: to identify the instruments used to assess the pain of preschool children during dental procedures. Sources of Data: search for articles was conducted at PubMed, Scopus, The Cochrane Library and Google Schoolar in April/2022. Observational and interventional studies that evaluated the pain of preschool children in dental care, published in Portuguese, English or Spanish were included. Studies evaluating the pain of children treated under sedation or general anesthesia, as well as postoperative pain, were excluded. Synthesis of data: a total of 767 articles were identified; 133 articles were read in full and 62 included. In 48 studies, pain was evaluated by self-report, using instruments such as the Wong-Baker FACES Pain Rating Scale and other face scales such as the Faces Pain Scale-Revised and the Faces Pain Scale. When pain was evaluated from child behavior, scales such as Face, Legs, Activity, Cry, Consolability Scale (FLACC) and Sound, Eye and Motor scale (SEM) were used. Conclusion: the procedural pain of the children was evaluated by self-report and the observation of their behavior. Both self-report and observational scales have limitations. The combination of the instruments can be a strategy in the evaluation of the pain of preschoolers.

Impact of dental caries on oral health-related quality of life in children with dental behavior management problems

Abstract: The aim of this cross-sectional study was to evaluate the impact of dental caries and sociodemographic factors on the oral health-related quality of life (OHRQoL) of children with dental behavior management problems (DBMP) and their families. One hundred and thirty-four dyads of caregivers and children participated. The impact of OHRQoL was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Socioeconomic variables were obtained from an interview. Dental caries was assessed using the dmft index. The total B-ECOHIS score was categorized as low, medium, or high impact, and its association with the independent variables was determined based on bivariate tests and a multivariate model. The median score for B-ECOHIS was 13 (range: 1-40). The negative impact was reflected mainly by complaints of oral/dental pain, difficulty in eating and parental guilt. The number of teeth with caries was significantly higher among children who experienced a high negative impact on OHRQoL (mean 9.2 [standard deviation 3.5]; p = 0.003) than those who had a low negative impact (7.0 [3.3]). The final adjusted model showed that dental caries remained independently associated with poor OHRQoL (b = 0.100; x2 Wald 4.205; p = 0.040). A greater impact on OHRQoL was experienced by children with DBMP and greater caries experience.

Minimal intervention procedures: evaluating how much pediatric dentists really know about this field

Abstract The aim of this cross-sectional study was to evaluate how much pediatric dentists know about the noninvasive, micro, and minimally invasive strategies for managing caries lesions in deciduous teeth. An electronic questionnaire was sent to pediatric dentists enrolled in the Regional Board of Dentistry. Information was collected concerning: 1) characteristics of the participants; 2) level of updated knowledge of noninvasive, micro and minimally invasive procedures for caries management in children; 3) agreement to sentences on the indicated procedures. The data were analyzed descriptively and with bivariate tests. Seventy pediatric dentists participated. Results showed high frequency of agreement with sentences on strategies for lesion caries management: 92.8% with the sentence on selective removal of decayed tissue; 90.0% on fluoridated toothpaste (≥1,000 ppm); 84.3% on silver diamine fluoride (SDF); 80.0% on the Hall technique; and 76.9% on the sealing of small dentine lesions. Level of agreement with sentences was not significantly related to variables of time since graduation, degree of updatedness, area of employment, or higher education degree (p > 0.05). A higher score on agreement toward SDF use was accompanied by a greater degree of self-declared updatedness on noninvasive, micro and minimally invasive procedures for caries management in children (rho 0.259; p = 0.031). Pediatric dentists consider themselves updated and agree with the sentences on recommended use of fluoridated toothpaste as of eruption of the first tooth, and on the selective removal of decayed tissue. Disagreement still continues regarding application of SDF to arrest lesion progression, sealing of small dentin lesions, and the Hall technique.

Técnicas básicas para manejo do comportamento infantil no atendimento odontológico: scoping review / Basic techniques for managing child behavior in dental care: scoping review

Introdução: Para tornar o atendimento odontopediátrico mais confortável e reduzir a ansiedade, o dentista pode usar as técnicas básicas e avançadas de manejo do comportamento infantil. Objetivo: Identificar as técnicas básicas de manejo de comportamento investigadas nos últimos dez anos e sintetizar os resultados sobre a eficácia na redução do medo/ansiedade, melhora do comportamento e aceitabilidade. Fontes de dados: Uma busca foi realizada no PubMed, Scielo, Lilacs e Grey Literature Report, em outubro/2021. Estudos observacionais e de intervenção sobre o uso de técnicas básicas de manejo de comportamento no atendimento de crianças com até 6 anos, e publicados nos últimos dez anos, foram incluídos. Síntese dos dados: De um total de 756 referências, 63 foram lidas integralmente e 15 incluídas na scoping review. Distração, reforço positivo, controle de voz, falar-mostrar-fazer, modelagem e presença/ausência dos pais foram investigadas em ensaios clínicos e em estudos transversais. As técnicas foram eficazes na redução da ansiedade odontológica e, a maioria, bem aceita pelos pais/cuidadores. Controle de voz e presença/ausência dos pais foram as menos aceitas. Resultados controversos sobre o efeito no comportamento foram observados nos estudos sobre a presença/ausência dos pais. Conclusões: Distração foi a técnica investigada com maior frequência nos estudos selecionados, seguida por reforço positivo, presença dos pais, controle de voz e falar-mostrar-fazer. As técnicas básicas tiveram resultados positivos na redução da ansiedade infantil e na aceitabilidade dos pais. Controle de voz e presença/ausência dos pais devem ser recomendadas com cautela.

Introduction: To make pediatric dental care more comfortable and reduce anxiety, the dentist can use basic and advanced techniques for managing child behavior. Objective: Identify the basic behavior management techniques investigated in the last ten years and synthesize the results on efficacy in reducing dental fear/anxiety, improving behavior and acceptability. Sources of data: A search was conducted in PubMed, Scielo, Lilacs and Grey Literature Report, in October/2021. Observational and interventional studies on the use of basic behavior management techniques in the care of children up to 6 years old, and published in the last ten years, were included. Synthesis of data: Of a total of 756 references, 63 were read in full and 15 included in the scoping review. Distraction, positive reinforcement, voice control, tell-show-do, modeling, and presence/absence of parents were investigated in clinical trials and cross-sectional studies. The techniques were effective in reducing dental anxiety and, most, well accepted by parents/caregivers. Voice control and presence/absence of parents were the least accepted. Controversial results on the effect on behavior were observed in studies on the presence/absence of parents. Conclusions: Distraction was the most frequently investigated technique in the selected studies, following by positive reinforcement, presence of parents, voice control and tellshow-do. The basic techniques had positive results in reducing childhood anxiety and accepting parents. Voice control and presence/absence of parents should be recommended with caution.

Is dental anxiety associated with the behavior of sedated children?

Abstract The aim of this cross-sectional study was to investigate factors associated with dental anxiety in children treated under moderate sedation. Prior to treatment, each child's dental anxiety was evaluated using the modified Venham Picture Test (VPT). Interviews were also conducted with parents/guardians to gather information on the child's dental anxiety (Corah's Dental Anxiety Scale [DAS]), age and sex, shyness or anxiety in the presence of strangers, and dental history, as well as socioeconomic factors. All the children were sedated, and had at least one tooth restored using the atraumatic restorative treatment technique. Child behavior was assessed using the Frankl scale. Data analysis involved descriptive statistics and bivariate tests. The median VPT score was 2.0 (range: 0 to 8). Children who were shy in the presence of strangers (yes: median 2.0 [0-8]; no: 0.5 [0-4]; p = 0.018), and those with negative behavior during dental care (negative: 3.0 [0-8]; positive: 1.0 [0-8]; p = 0.014) had greater anxiety. The child's dental anxiety was associated with the mother's education level (≤ 8 years: 4 [2-7]; > 8 years: 1 [0-8]; p = 0.016). The dental anxiety of children treated under sedation is associated with negative behavior, shyness, and the mother's education level.

Prevalence and factors associated with enamel defects among preschool children from a southeastern city in Brazil / Prevalência e fatores associados aos defeitos de desenvolvimento de esmalte em crianças pré-escolares de uma cidade do sudeste do Brasil

Abstract This study sought to determine the prevalence of developmental defects of enamel (DDE) among preschool children and investigate associations with sociodemographic and socioeconomic factors and weight status. A cross-sectional study was conducted with 118 children aged 3 to 5 years. Data were collected via clinical examinations and a self-administered questionnaire completed by the parents. The diagnosis of DDE was performed using the modified DDE Index. Information on socioeconomic indicators (mother's schooling, monthly income per capita), child's sex and age, and age of mother at the birth of the child were obtained by questionnaire. The children's weight status was determined based on weight-for-age at the time of the exam. Statistical analysis involved the chi-squared test and Poisson regression with robust variance. The prevalence of DDE was 50.0%. DDE were more frequent in males (p = 0.025) and children whose families were classified as being at poverty line (p = 0.040). In the Poisson model controlled for child's sex and mother's schooling, children whose families were classified as being at the poverty line had a greater prevalence rate of DDE. In conclusion, the prevalence of DDE was high in the present sample and associated with lower household income. Weight status was not associated with DDE.

Resumo Objetivou-se avaliar a prevalência de defeitos de desenvolvimento de esmalte (DDE) em pré-escolares e investigar a associação com fatores sociodemográficos e socioeconômicos e peso da criança. Foi realizado um estudo transversal com 118 crianças de três a cinco anos de idade. Os dados foram coletados por meio de exame clínico e questionário autoaplicável respondido pelos pais. Para o diagnóstico de DDE utilizou-se o Developmental Defects of Enamel Index. Informações sobre indicadores socioeconômicos (escolaridade da mãe e renda familiar per capita), gênero e idade da criança e idade da mãe ao nascimento da criança foram obtidas do questionário. O status de peso foi determinado baseando-se no peso e idade da criança no momento do exame. A análise estatística incluiu teste do qui-quadrado e regressão de Poisson. A prevalência de DDE foi 50.0%, sendo mais frequente em crianças do sexo masculino (p = 0.025) e provenientes de famílias incluídas na linha de pobreza (p = 0.040). No modelo de regressão de Poisson ajustado para gênero e escolaridade da mãe, observou-se que as crianças provenientes de famílias incluídas na linha de pobreza apresentaram maior prevalência de DDE. Conclui-se que a prevalência de DDE foi alta e associada com renda familiar per capita. O peso da criança não foi associado com DDE.

Effect of dental pain and caries on the quality of life of Brazilian preschool children

ABSTRACT OBJECTIVE To investigate the impact of dental pain on daily performances among five-year-old Brazilian children. METHODS The study used data of 7,280 five-year-old children participating in the 2010 Brazilian Oral Health Survey (SBBrasil 2010 Project). Children were clinically examined and their parents or carers were interviewed at their homes. The outcome was the prevalence of the oral impacts on daily performance, and the explanatory variable was dental pain in the last six months. Other independent variables were children's gender and skin color/race, family income, household overcrowding, and caries experience (dmft). Rao-Scott test and Poisson regression for complex samples were carried out. RESULTS The prevalence of impacts on daily performances was 26.1% (95%CI 22.3-30.2). Significant associations were found between the outcome and pain, caries experience, and sociodemographic variables. After adjusting for the independent variables, only pain and caries remained significant. Impacts on daily performances were more frequent among children with pain (PR = 1.14, 95%CI 1.06-1.23) compared to those without pain. Children with low dmft (PR = 1.90, 95%CI 1.39-2.60) and those with high dmft (PR = 3.53, 95%CI 2.78-4.49) had a higher prevalence of impact than those with no caries experience. CONCLUSIONS Dental pain and caries had strong negative impacts on the five-year-old children's daily performances regardless of their demographic and socioeconomic characteristics.

Produtos lácteos podem contribuir com a prevenção da cárie dentária? Scoping review / Can milk and dairy products help with dental caries prevention? Scoping review

Objetivo: A associação entre leite e cárie dentária ainda é objeto de debate. Nesta scoping review, verificou-se a relação entre ingestão de leite e laticínios e a prevenção da cárie dentária. Material e método: Foi realizada pesquisa bibliográfica, a partir de consulta a artigos indexados nas bases de dados PubMed, Scielo e Lilacs publicados entre 2006 e janeiro/2016, incluindo estudos clínicos e laboratoriais, publicados nas línguas inglês, português e espanhol. Resultados: Dentre as 96 publicações inicialmente identificadas, apenas seis contemplaram os critérios de inclusão e exclusão. Os artigos apresentaram metodologias diversas que investigaram o efeito do leite, caseína, proteína do soro e compostos à base de fosfopeptídeos da caseína e fosfato de cálcio amorfo. O efeito preventivo dessas substâncias foi mais observado em crianças e em amostras de dentes extraídos. Conclusão: A diversidade metodológica dificultou comparações e conclusões, mas apontou para o potencial do uso do leite e laticínios no controle da cárie.

Aim: The association between milk and dental caries remains controversial. In this scoping review, we checked the relation between intake of milk and dairy products with the prevention of dental caries. Material and Methods: The literature search followed the protocol based on papers indexed in the databases PubMed, Scielo and Lilacs, published between 2006 and January/2016, including clinical studies and laboratories, published in English, Portuguese and Spanish. Results: Among the 96 publications initially identified, only six contemplated the inclusion and exclusion criteria. The papers showed diversities of methodologies that investigate the effect of milk, casein, whey protein and protein compounds of casein phosphopeotidies and amorphous calcium phosphate. The preventive effect of those substances was more observed in children and in samples of extracted teeth. Conclusion: The methodological diversity of studies hampers the comparisons and conclusions, but pointed out to a potential use of milk and dairy products in the control of dental caries.

Oral health-related quality of life of children and teens with sickle cell disease

BACKGROUND: Children with sickle cell disease may have their quality of life affected by oral alterations. However, there is still little data on oral health-related quality of life in these children. The aim of this study was to investigate the influence of sickle cell disease, socioeconomic characteristics, and oral conditions on oral health-related quality of life of children and teens. METHOD: One hundred and six children and teens with sickle cell disease were compared to a similar sample of 385 healthy peers. Data were collected through oral examinations, interviews to assess quality of life (Child Perceptions Questionnaire for children aged 8-10 and 11-14) and questionnaires containing questions on socioeconomic status. RESULTS: There were no statistically significant differences in the total scores of the Child Perceptions Questionnaires or domain scores comparing sickle cell disease patients to control subjects. When sub-scales were compared, oral symptoms and functional limitations had a greater negative impact on the quality of life of adolescents with sickle cell disease (p-value <0.001 and p-value <0.01, respectively) when compared to healthy controls. The only statistically significant determinants of negative impact on oral health-related quality of life in the overall sample was home overcrowding (more than two people/room) in the younger children's group, and dental malocclusion among teens. CONCLUSION: There was no significant difference in the negative impact on the oral health-related quality of life between the group with sickle cell disease and the control group. Of the oral alterations, there was a significant difference in the oral health-related quality of life between adolescents with sickle cell disease and controls only in relation to malocclusion. Among the socioeconomic characteristics, only overcrowding was significantly associated with a negative impact on oral health-related quality of life.

Incidence of dental caries in primary dentition and risk factors: a longitudinal study

Abstract The objectives of this prospective, longitudinal, population-based study were to estimate the incidence of dental caries in the primary dentition, identify risk factors and determine the proportion of children receiving dental treatment, through a two-year follow up. The first dental exam was conducted with 381 children aged one to five years, at health centers during immunization campaigns; 184 of them had dental caries and 197 had no caries experience. The second exam was carried out two years later at a nursery or at home with the same individuals who participated in the first exam. The diagnosis of dental caries was performed using the dmft criteria. Parents were interviewed regarding socioeconomic indicators. Descriptive, bivariate and adjusted Poisson regression analyses were performed. Among the 381 children, 234 were reexamined after two years (non-exposed: 139; exposed: 95). The overall incidence of dental caries was 46.6%. The greatest incidence of dental caries was found in the group of children with previous caries experience (61.1%). Among the children without dental caries in the first exam, 36.7% exhibited caries in the second exam. The majority of children (72.6%) received no treatment for carious lesions in the two-year interval between examinations. Children with previous dental caries (RR: 1.52, 95%CI: 1.12-2.05) had a greater risk of developing new lesions, compared with the children without previous dental caries. The incidence of dental caries was high and most of children's caries were untreated. Previous caries experience is a risk factor for developing new carious lesions in children.

The impact of the oral condition of children with sickle cell disease on family quality of life

Abstract The aim of this study was to assess the impact of oral conditions of children with sickle cell disease (SCD) on their parents' quality of life (QoL). A cross-sectional study was performed with parents of outpatients suffering from SCD at a hematology referral center in Belo Horizonte, MG. A qualified dentist performed an intraoral exam. The Family Impact Scale (FIS) was used to assess the parents' perception of QoL. The parents answered some questions regarding sociodemographic and medical information about their children. The dmft/DMFT score, DAI, gum bleeding and SCD severity were evaluated in terms of their impacts on the overall mean FIS scores and subscale scores. The chance of more frequent impacts was greater in parents of adolescents (OR = 2.04; 95%CI = 1.2, 3.4) than of younger children. Dental caries (dmft/DMFT ≥ 1) had a negative impact on the QoL of parents of younger children and adolescents (p < 0.05 and p < 0.01, respectively). Among the parents of younger children, dental caries and SCD severity significantly affected the subscales for parental activities (PA) and parental emotions (PE) (p < 0.01, p < 0.05, respectively). Among parents of adolescents, dental caries (DMFT) and severe malocclusion adversely affected the PE and PA subscales (p < 0.01, p < 0.05, respectively). SCD severity affected the overall FIS score among young children's parents (p < 0.05). In conclusion, dental caries, age and SCD severity were associated with a negative impact on the QoL of parents of children with SCD

Case-control study on factors associated with crown fractures in the primary dentition

The purpose of the present study was to identify the factors associated with dental trauma in preschool children. This case-control study was nested in a population-based cross-sectional study involving a random sample of 301 children one to five years of age in the city of Diamantina, Brazil. The case group was made up of children with at least one fractured deciduous tooth, and the control group was made up of children with no deciduous tooth fracture. The two groups were matched for age in a proportion of one control for every case. The dependent variable was “dental trauma,” diagnosed according to the criteria proposed by Andreasen and Andreasen. The independent variables were overjet, measured and considered accentuated when surpassing 3 mm, and lip coverage, classified as adequate or inadequate. Clinical oral examinations were performed by calibrated dentists. The parents provided information on the socioeconomic indicators. Statistical analysis involved the McNemar test and logistic regression. Each group (case and control) was composed of 92 children. In the bivariate analysis, traumatic dental injury (TDI) was associated with overjet > 3 mm (p = 0.001), inadequate lip coverage (p < 0.001), mother's schooling (p = 0.028) and household income (p < 0.001). In the multivariate analysis, only inadequate lip coverage was associated with TDI (OR: 5.35; 95% CI: 1.37-20.85). In conclusion, the case group children had a 5.3 - fold more likely chance of presenting inadequate lip coverage, compared with the control children.

Oral midazolam reduces cortisol levels during local anaesthesia in children: a randomised controlled trial

Little is known about whether midazolam sedation can reduce salivary cortisol levels and consequently influence children’s behaviour during dental treatment. The aim of this study was to evaluate the effect of midazolam sedation on salivary cortisol and its correlation with children’s behaviour during restorative dental treatment. Eighteen healthy children, aged two to five years, were randomly assigned to two dental treatment appointments, both with physical restraint: oral midazolam 1 mg/kg (MS) and placebo (PS). An observer assessed the children’s behaviour (videos) using the Ohio State University Behavioral Rating Scale (OSUBRS). The children’s saliva was collected just after waking up, on arrival at the dental school, 25 minutes after local anaesthesia, and 25 minutes after the end of the procedure. Salivary cortisol levels were determined using the enzyme-linked immunoabsorbent assay. The data were analysed by bivariate tests and multivariate analysis of variance (5% level). Salivary cortisol levels were lower in the MS group than in the PS group at the time of anaesthesia (p = 0.004), but did not vary during the appointment within sedation (p = 0.319) or placebo (p = 0.080) groups. Children’s behaviour was negative most of the time and did not differ between MS and PS; however, the behaviour (OSUBRS) did not correlate with salivary cortisol levels. Oral midazolam is able to control salivary cortisol levels during dental treatment of pre-schoolers, which might not lead to better clinical behaviour.

Influence of clinical and socioeconomic indicators on dental trauma in preschool children

The aim of the present study was to determine the prevalence of traumatic dental injury (TDI) in the primary dentition and investigate associations with clinical and socioeconomic indicators. A population-based, cross-sectional study was carried out with a randomly selected sample of 301 children aged one to five years. Data were collected through clinical oral examinations and interviews with parents/guardians during immunization campaigns. Statistical analysis involved Pearson’s Chi-squared test and Poisson regression with robust variance. The prevalence of TDI was 33.9%. TDI was more prevalent in children with overjet > 3 mm (p < 0.001) and those with inadequate lip coverage (p < 0.001). A statistically significant association was also found between TDI and household income (p = 0.024). According to the adjusted Poisson regression model, greater prevalence rates of TDI were found for children from families with a monthly income ≥ twice the Brazilian minimum monthly wage (PR: 1.52; 95%CI: 1.10-2.12), those with accentuated overjet (PR: 1.53; 95%CI: 1.05-2.22) and those with inadequate lip coverage (PR: 2.00; 95%CI: 1.41-2.84). The prevalence of TDI was high in the present study and was associated with a higher family income, accentuated overjet and inadequate lip coverage.

Hábitos parafuncionais em crianças de 36 a 71 meses de idade: prevalência e fatores associados / Parafunctional habits in children between 36 and 71 months of age: prevalence and associated factors

Objetivo: Avaliar a prevalência de hábitos parafuncionais em crianças e verificar se o aleitamento materno, o uso de mamadeira, a renda e a escolaridade materna estão associados a estes hábitos. Materiais e Métodos: Um estudo transversal foi realizado com 592 crianças de 36 a 71 meses de idade e suas mães. Os dados foram coletados por meio de entrevista com as mães durante as campanhas de vacinação infantil realizadas na cidade de Diamantina, Minas Gerais, em 2010. A variável dependente (presença de hábitos parafuncionais) foi obtida por meio de relato das mães, considerando-se os hábitos (sucção, morder objetos e outros) presentes no momento do estudo. Por esta entrevista foram obtidas também as informações sobre as variáveis independentes (sexo, idade da criança, problema de saúde, aleitamento materno, uso de mamadeira, renda mensal e escolaridade materna). A análise estatística foi realizada utilizando-se o programa SPSS for Windows e envolveu análise descritiva, teste qui-quadrado (p<0,05) e regressão de Poisson com variância robusta. Resultados: A prevalência de hábitos parafuncionais foi de 42,2% (n=250), sendo a sucção o tipo de hábito mais frequente (17,6%). Os hábitos parafuncionais foram mais frequentes entre as crianças que não foram amamentadas no peito (p=0,004) e que usaram mamadeira (p<0,001). Associação estatisticamente significativa também foi observada entre estes hábitos e escolaridade materna (p=0,006) e número de filhos (p=0,009). A análise multivariada mostrou que as crianças que usaram mamadeira (RP: 1,40; IC95%: 0,5-0,8), aquelas que não foram amamentadas no peito (RP: 1,41; IC95%: 1,1-1,8) e cujas mães tinham escolaridade superior a oito anos (RP: 1,32; IC95%: 1,0-1,6) apresentaram maior prevalência de hábitos parafuncionais. Conclusão: A prevalência de hábitos parafuncionais foi alta e associou-se à ausência de aleitamento materno, ao uso de mamadeira e ao maior nível de escolaridade das mães.(AU)

Aim: The present study aimed to determine the prevalence of parafunctional habits in children and evaluate possible associations with breastfeeding, bottle feeding, income, and mother's educational level. Materials and Methods: A cross-sectional study was carried out involving 592 children from 36 to 71 months of age of age and their mothers. Data were collected through interviews with mothers during child vaccination campaigns in 2010 in the city of Diamantina, Brazil. The dependent variable (parafunctional habits) was determined through mothers' reports considering nonnutritive sucking, biting on objects, and other habits at the time of the interview. The independent variables included gender, child's age, health problems, breastfeeding, bottle feeding, monthly income, and mother's educational level. Statistical analysis was carried out using the SPSS program for Windows and involved descriptive statistics, the chi-square test (p < 0.05), and Poisson regression with robust variance. Results: The prevalence of parafunctional habits was 42.2% (n = 250), the most frequent of which were nonnutritive sucking habits (17.6%). Parafunctional habits were more frequent among children who had not been breastfed (p = 0.004) and those who had been bottle fed (p < 0.001). Parafunctional habits were significantly associated with the mother's educational level (p = 0.006) and the number of children in the family (p = 0.009). The multivariate analysis revealed a greater prevalence rate of parafunctional habits among children who had been bottle fed (PR: 1.40; 95% CI: 0.5-0.8), those who had not been breastfed (PR: 1.41; 95% CI: 1.1-1.8), and those whose mothers had more than eight years of schooling (PR: 1.32; 95% CI: 1.0-1.6). Conclusion: The prevalence of parafunctional habits was high in the present study and was associated with a lack of breastfeeding, the use of bottle feeding, and a higher educational level among the mothers.(AU)

Perinatal factors associated with developmental defects of enamel in primary teeth: a case-control study

The present study was designed to evaluate associations between developmental defects of enamel (DDE) in the primary dentition and aspects related to mothers and preschoolers in the city of Diamantina, Brazil. A case-control study was carried out involving children aged three to five years. The case group was composed of 104 children with at least one dental surface affected by DDE. The control group comprised 105 children without DDE, matched for gender and age. The diagnosis of enamel defects was performed using the Developmental Defects of Enamel Index. Information was collected through interviews investigating socio-demographic aspects, gestation, birth weight, prematurity and breastfeeding. Simple and multiple regression analyses were performed, providing unadjusted and adjusted prevalence ratios (Poisson regression). DDE were more prevalent among children who had not been breastfed (PR = 1.57; 95% CI: 1.1-2.2) and those whose mothers were under 24 years of age at the birth of the child (PR = 1.41; 95% CI: 1.1-1.9). The prevalence of DDE in the primary dentition was higher among children who had not been breastfed and those whose mothers were under 24 years of age at the birth of the child.

Factors associated with the development of early childhood caries among Brazilian preschoolers

The aim of this study was to assess the prevalence of early childhood caries (ECC) in children and investigate the influence of sociodemographic variables, quality of oral hygiene and child-related aspects. A cross-sectional study was carried out with 593 children aged three to five years. Data were collected through clinical examinations and interviews with parents. Interviews with parents of the children were conducted to acquire information on sociodemographic aspects, breastfeeding, bottle feeding and harmful oral habits. Statistical analysis involved the chi-square test and the Poisson regression. The prevalence of ECC was 53.6%. The occurrence of ECC was greater among children with unsatisfactory oral hygiene (PR: 2.95; 95% CI: 2.42-3.60) and those from a family with a lower monthly household income (PR: 1.62; 95% CI: 1.24-2.10). In conclusion, unsatisfactory oral hygiene and monthly income exerted an influence on the occurrence of ECC among preschoolers.

Cárie dentária e necessidade de tratamento ortodôntico: impacto na qualidade de vida de escolares / Dental caries and need of orthodontic treatment: impact on the quality of life of schoolchildren

Objetivo: Avaliar o impacto da cárie e da maloclusão (necessidade etratamento ortodôntico) na qualidade de vida de escolares de oito a 14 anos de idade residentes em Belo Horizonte, Minas Gerais. Métodos: Realizou-se um estudo transversal com amostra deconveniência (n=75), dividida em dois grupos de acordo com a idade dos escolares: grupo 1 – oito a dez anos e grupo 2- 11 a 14 anos. Os dados foram coletados pelo exame clínico para diagnóstico da cárie dentária (CPOD) e avaliação da necessidade de tratamento ortodôntico (IED) e aplicação dos instrumentos CPQ8-10 e CPQ11-14, para avaliação do impacto na qualidade de vida. Realizou-se análise descritiva, teste qui-quadrado e Mann-Whitney.Resultados: No grupo de estudantes com idade entre oito e dez anos, observou-se associação estatisticamente significativa entre necessidade de tratamento ortodôntico (IED > 30) e impacto negativo na qualidade de vida (p = 0,004), principalmente nos domínios limitação funcional (p<0,001), bem-estar emocional (p=0,001) e bem-estar social (p=0,008). Não foi observada associação entre a cárie dentária e impacto negativo na qualidade de vida neste grupo (p=0,66). Entre as crianças com idade entre 11 e 14 anos, verificou-se associação estatisticamente significativa entre impacto na qualidade de vida, cárie (p=0,004) e necessidade de tratamento ortodôntico (p=0,001). Considerando-se a cárie, a associação foi observada com os domínios bem-estar emocional (p=0,006) e social (p=0,02). A necessidade de tratamento ortodôntico mostrou associação significativa com limitação funcional (p=0,02), bemestar emocional (p=0,05) e social (p=0,03). Conclusão: A maloclusão (necessidade de tratamento ortodôntico) mostrou associação com impacto negativo na qualidade e vida de estudantes na faixa etária entre oito e 14 anos. Impacto negativo também foi observado entre estudantes de 11 a 14 anos queapresentavam cárie dentária

Objective: To evaluate the impact of dental caries and malocclusion(need of orthodontic treatment) on the quality of life of schoolchildrenaged 8 to 14 years living in the city of Belo Horizonte, MG, Brazil.Method: This study was a cross-sectional investigation with aconvenience sample (n=75) divided into two groups, according to theage of schoolchildren: Group 1: 8 to 10 years and Group 2: 11 to 14years. Data were collected by clinical examination for diagnosis ofdental caries (DMFT index) and determination of orthodontic treatmentneed (DAI - dental aesthetic index), and through application of CPQ8-10and CPQ11-14 instruments to assess the influence on the quality of life.Descriptive analysis, Chi-square and Mann-Whitney tests wereperformed.Results: In the group of schoolchildren aged 8 to 10 years, there was astatistically significant association between the need of orthodontictreatment (DAI>30) and negative impact on the quality of life (p=0.004),especially for the domains “functional limitation” (p<0.001), “emotionalwell being” (p=0.001) and “social well being” (p=0.008).

No associationwas found between dental caries and negative impact on quality of lifein this group (p=0.66). In the group of schoolchildren aged 11 to 14years there was a statistically significant association between impact on the quality of life and dental caries (p=0.004) and need of orthodontictreatment (p<0.001). Regarding dental caries, there was significantassociation between the domains “emotional well being” (p=0.006) and“social well being” (p=0.02). The need of orthodontic treatmentshowed a significant association with “functional limitation” (p=0.02),“emotional well being” (p=0.05) and “social well being” (p=0.03).Conclusion: Malocclusion (need of orthodontic treatment) wasassociated with negative impact on the quality of life of schoolchildrenin the age range between 8 and 14 years. There was also negativeimpact on the quality of life of 11-14 children with dental caries

Prevalência de cárie dentária em crianças de seis a 60 meses e fatores associados, Diamantina, Minas Gerais, Brasil / Prevalence of dental caries in children aged 6 to 60 months and associated factors in Diamantina, Minas Gerais, Brazil

Objetivo: Verificar a prevalência e os fatores associados à cárie dentária em crianças de seis a 60 meses de idade em Diamantina, Minas Gerais, Brasil. Método: Foi realizado um estudo transversal com amostra representativa (n=233) da população pré-escolar (06-60 meses) de Diamantina, Minas Gerais, Brasil. A cárie dentária (variável dependente) foi avaliada por meio de exame clínico bucal e as variáveis independentes (gênero, idade, nível socioeconômico, estado nutricional, higiene e alimentação da criança) foram obtidas pelo exame das medidas antropométricas (peso e altura) e entrevistas com os pais ou responsáveis. A análise estatística foi realizada por meio de análise descritiva, teste qui-quadrado e regressão logística múltipla. Resultados: A prevalência de cárie dentária foi 44,8% (n=104). As variáveis idade da criança, higiene bucal, tempo e frequência de uso de mamadeira foram significativamente associadas à cárie dentária. Os pacientes com idade superior a 36 meses (OR [95%CI]=10,4 [3,7-29,5]), frequência de consumo de mamadeira igual ou superior a três vezes por dia (OR [95%CI]=3,3 [1,1-10,0]), tempo de uso de mamadeira superior a cinco meses (OR [95%CI]=6,2 [1,8-21,2]) e higienização bucal insatisfatória (OR [95%CI]=3,7 [1,2-11,5]) apresentaram maior chance de desenvolver cárie dentária. Conclusão: A prevalência de cárie dentária entre crianças de seis a 60 meses de idade foi alta. Os principais fatores diretamente envolvidos no desenvolvimento de cárie dentária foram: a idade do paciente, a frequência de consumo e tempo de uso de mamadeira e a higienização bucal insatisfatória.

Objective: The aim of this study was to assess the prevalence of dental caries and associated factors among children aged 6 to 60 months in Diamantina, MG, Brazil. Methods: A cross-sectional study was performed with a representative sample (n = 233) of the preschool population (6 to 60 months) of Diamantina, MG, Brazil. Dental caries (dependent variable) was evaluated by clinical examination and the independent variables (gender, age, socioeconomic status, nutritional status, oral hygiene and diet) were assessed by the determination of anthropometric measurements (weight and height) and interviews with parents/caregivers. Statistical analysis was performed using descriptive analysis, chi-square test and univariate and multivariate logistic regression model. Results: The prevalence of dental caries was 44.8% (n = 104). Child's age, oral hygiene and duration and frequency of bottle feeding were significantly associated with dental caries. Patients older than 36 months (OR [95% CI] = 10.4 [3.7 to 29.5]), those bottle-fed three or more times a day (OR [95% CI] = 3.3 [1.1 to 10.0]), those bottle-fed for more than five months (OR [95% CI] = 6.2 [1.8 to 21.2]) and those with poor oral hygiene (OR [ 95% CI] = 3.7 [1.2 to 11.5]) had greater chances of developing dental caries. Conclusion: The prevalence of caries among children aged 6 to 60 months was high. The main factors directly involved in the development of dental caries were the patient's age, frequency and duration of bottle feeding, and poor oral hygiene.

Allergic reactions and nickel-free braces: a systematic review

Nickel-free braces have gained popularity as a viable alternative for patients who are allergic to nickel. The purpose of this systematic review was to determine whether evidence exists to justify the use of nickel-free brackets in orthodontic patients who are allergic to nickel. An electronic search was performed using 7 databases (MEDLINE, BBO, LILACS, Web of Science, EMBASE, BIREME and Cochrane Library), without restriction regarding year or language, with supplemental manual searching of the references of retrieved articles. The search strategy produced 89 papers. The data extraction and quality score of each paper were evaluated independently by two reviewers, once each. After selection based on the eligibility criteria, four papers, including 2 controlled clinical trials and 2 clinical trials, qualified for the final analysis. Quality assessment of the included articles was also performed. Nickel-free braces (Ni content - 2 percent max.) seem to represent a viable alternative for orthodontic patients who are allergic to nickel. However, further in vivo studies, considering the immunology characteristics of patients, are needed to determine the clinical implications of the findings of this study.