Banda ortodôntica como alternativa de tratamento conservador provisório para primeiros molares permanentes com hipomineralização molar incisivo (HMI): relato de caso / Orthodontic banding as an alternative provisional conservative treatment for permanent first molars with incisor molar hypomineralization (IMH): case report

Introdução: a Hipomineralização Molar Incisivo (HMI) é um defeito qualitativo de desenvolvimento de esmalte que pode ocasionar fraturas pós-eruptivas (FPE), lesões de cárie e sensibilidade. Objetivo: relatar o tratamento de HMI severa através da cimentação de bandas ortodônticas para preservação da estrutura dentária em primeiros molares permanentes inferiores com FPE. Relato do caso: criança do sexo feminino, 10 anos de idade, apresentou-se com queixa de hipersensibilidade e fratura dentária associada à restauração prévia. Clinicamente, observou-se presença de HMI severa, com FPE associada à lesão de cárie em dentina nas superfícies oclusal e vestibular do dente 36 e restauração insatisfatória com cimento de ionômero de vidro (CIV) na superfície vestibular do dente 46 que apresentava opacidades demarcadas branco-creme. Radiograficamente, observou-se ausência de comprometimento pulpar. Após manejo por meio de abordagens não-invasivas (controle de biofilme e dieta e aplicação de verniz fluoretado), o tratamento proposto foi a cimentação de banda ortodôntica com CIV modificado por resina (Riva Light Cure®, SDI) nos dentes 36 e 46 para maior longevidade das restaurações. O tratamento restaurador atraumático (TRA) foi realizado no dente 36 previamente à cimentação da banda ortodôntica. Resultados: após o tratamento, a criança não relatou dor ou desconforto e as restaurações mantiveram-se intactas. A mãe da criança foi orientada quanto à importância de acompanhamento periódico a cada 4 meses. Conclusão: a cimentação das bandas ortodônticas com CIV possibilitou o manejo conservador de molares permanentes com HMI severa, com manutenção de sua funcionalidade oclusal, saúde pulpar e gengival, proporcionando melhor qualidade de vida à paciente.

Introduction: molar Incisor Hypomineralization (MIH) is a qualitative developmental enamel defect that can cause posteruptive enamel breakdown (PEB), caries lesions, and sensitivity. Objective: to report the treatment of a child with severe MIH through the cementation of orthodontic bands in lower first permanent molars with PEB to preserve tooth structure. Case report: female child, 10 years old, presenting hypersensitivity complaints and tooth fracture associated with previous restoration. Severe MIH was observed, with PEB associated with dentin caries on the occlusal and buccal surfaces of tooth #36 and unsatisfactory glass ionomer cement (GIC) restoration on the buccal surface of tooth #46 which had creamy-white marked opacities. There was no pulp involvement radiographically. After management through non-invasive approaches (biofilm and diet control and application of fluoride varnish), the proposed treatment was the cementation of an orthodontic band with resin-modified GIC (Riva Light Cure®, SDI) on teeth #36 and #46 to long-term lifespan restorations. Atraumatic restorative treatment (ART) was performed on tooth #36 prior to the cementation of the orthodontic band. Results: after treatment, the child did not report pain or discomfort and the restorations remained intact. The child's mother was instructed about the importance of periodic follow-up visits every 4 months. Conclusion: the cementation of orthodontic bands with GIC allowed the conservative management of permanent molars with severe MIH, maintaining their functional occlusion, pulpal and gingival health, providing a better quality of life to the patient.

Impact of the COVID-19 pandemic on the gingival health of children and adolescents with cerebral palsy / Impacto da pandemia do COVID-19 na saúde gengival de crianças e adolescentes com paralisia cerebral

Objective: to evaluate the impact of the COVID-19 pandemic on children and adolescents with cerebral palsy, comparing the gingival condition and the type of dental treatment before and after the interruption of dental care. Material and Methods: the retrospective longitudinal study consisted of 273 participants undergoing Dental Clinic of the AACD (Disabled Child Assistance Association), divided into three groups according to age: Group 1 (G1: 0 to 5 years and 11 months; n=137), Group 2 (G2: 6 to 11 years and 11 months; n=85) and Group 3 (G3: 12 to 17 years and 11 months; n=51). Sociodemographic, data, clinical pattern of cerebral palsy and use of medication were collected, evaluating the gingival condition by the gingival index and the type of dental treatment before the pandemic and during, nine months after the interruption of dental care. Chi-square, Fisher Exact and Kruskal-Wallis (α=5%) tests were used. Results: the groups were homogeneous in terms of sex (p=0.4581), race (p=0.1725), clinical pattern (p=0.3482) and use of antiepileptic drugs (p=0.3509). Regarding the gingival condition, in the period during the pandemic, there was a reduction in the number of participants with Gingival Index scores 0 and 1 and an increase in participants with scores 2 and 3 (p<0.05). As for the procedures performed, the three groups showed a reduction in preventive procedures (p<0.05) and an increase in surgical, periodontal and restorative procedures (p<0.05). Conclusion: it is concluded that the interruption of dental care for nine months during the COVID-19 pandemic in children and adolescents with cerebral palsy had a negative impact on oral health (AU)

Objetivo: avaliar o impacto da pandemia da COVID-19 em crianças e adolescentes com Paralisia Cerebral, comparando a condição gengival e o tipo de tratamento odontológico antes e após a interrupção dos atendimentos odontológicos. Material e Métodos: o estudo longitudinal retrospectivo foi composto por 273 participantes atendidos na Clínica odontológica da AACD (Associação de Assistência à Criança Deficiente), reunidos em três grupos segundo a faixa etária: Grupo 1 (G1: 0 a 5 anos e 11 meses; n=137), Grupo 2 (G2: 6 a 11 anos e 11 meses; n=85) e Grupo 3 (G3: 12 a 17 anos e 11 meses; n=51). Foram coletados dados sociodemográficos, padrão clínico da Paralisia Cerebral e o uso de medicação, avaliando a condição gengival pelo índice gengival e o tipo de tratamento odontológico antes e durante a pandemia, nove meses após a interrupção dos atendimentos. Foram empregados os testes Qui-quadrado, Exato de Fisher e Kruskal-Wallis (α=5%). Resultados: os grupos eram homogêneos quanto ao sexo (p=0,4581), raça (p=0,1725), padrão clínico (p=0,3482) e uso de drogas antiepiléticas (p=0,3509). Com relação à condição gengival, no período Durante Pandemia, observou-se redução no número de participantes com escores Índice Gengival 0 e 1 e aumento de participantes com escores 2 e 3 (p<0,05). Quanto aos procedimentos realizados, os três grupos apresentaram redução de procedimentos preventivos (p<0,05) e aumento dos procedimentos cirúrgicos, periodontal e restaurador (p<0,05). Conclusão: conclui-se que a interrupção do acompanhamento odontológico por nove meses na pandemia da COVID-19 em crianças e adolescentes com PC acarretou impacto negativo na saúde bucal (AU)

Association of salivary parameters and erosive tooth wear in preschool children

Abstract The aims of this study were to 1) assess the association between erosive tooth wear (ETW) according to the BEWE (Basic Erosive Wear Examination) scoring system and salivary parameters and 2) compare salivary parameters according to ETW severity in the subgroup of children with ETW. This cross-sectional study included 52 preschool children aged 5 years paired by sex. A calibrated examiner assessed ETW using BEWE criteria, and stimulated saliva was collected to determine salivary flow, osmolality, pH, and buffering capacity. The children were divided into two groups: without ETW (n=26; BEWE score 0) and with ETW (n=26; BEWE scores 1 and 2). Logistic regression analysis was used to determine the magnitude of the association between ETW and salivary parameters and estimates of odds ratios (OR). In the unadjusted analysis, the ETW group was more likely to have lower salivary flow (OR = 0.079; 95%CI = 0.013-0.469; p = 0.005) and lower osmolality (OR = 0.993; 95%CI = 0.985-1.000; p = 0.049). In the adjusted analysis, salivary flow remained significantly associated with ETW (OR = 0.087; 95%CI = 0.014-0.533; p = 0.008). Lower salivary osmolality values were observed in ETW, especially in preschool children with more severe ETW (BEWE score 2). Receiver operating characteristic (ROC) determined a salivary osmolality cutoff point of < 201 for the presence of ETW. In conclusion, salivary flow rate was significantly associated with ETW prevalence. Lower values of salivary osmolality were observed in preschool children with distinct erosive lesions with significant loss of tooth structure (BEWE 2).

Effect of Xylitol Varnishes on the Inhibition of Demineralization in Vitro

Abstract Objective: To evaluate the efficacy of xylitol varnishes in the inhibition of enamel demineralization in vitro. Material and Methods: Bovine enamel blocks (n=120) were randomly allocated to four groups (n = 30), and the surface hardness (SH) was measured at baseline. The blocks were treated with the following varnishes: 20% xylitol, 20% xylitol plus F (5% NaF), Duraphat™ (5% NaF, positive control), and placebo (no-F/xylitol, negative control). The varnishes were applied and removed after 6 h of immersion in artificial saliva. The blocks were subjected to pH cycles (demineralization and remineralization for 2 and 22h/day, respectively, for 8 days). Surface and cross-sectional hardnesses were measured to calculate the percentage of SH loss (%SHL) and the integrated loss of the subsurface hardness (ΔKHN). Data were statistically analyzed using Kruskal-Wallis and Tukey's tests (p<0.05). Results: %SHL was significantly decreased by 20% xylitol plus F, Duraphat™, and 20% xylitol varnishes compared to placebo. The use of 20% xylitol plus F varnish led to a significantly lower percentage of SH loss compared to the use of 20% xylitol varnish without F. However, the experimental and commercial varnishes led to significantly lower subsurface demineralization compared to placebo and did not differ from each other. Conclusion: Xylitol varnishes, especially when combined with F, effectively prevent enamel demineralization (AU).

Shame from Smiling and Speaking Due to Oral Health Problems in Brazilian Adolescents: A Nationwide Population-Based Study

Abstract Objective: To investigate the association between oral health problems and being ashamed of smiling or speaking among Brazilian adolescents. Material and Methods: This was a population-based cross-sectional study carried out with secondary data from 7,328 12-year-old Brazilian adolescents from the latest Brazilian national oral health survey (SB Brasil 2010). The question "In the previous 6 months, have you been ashamed of smiling or speaking due to your teeth?" was the outcome variable. Calibrated examiners performed clinical examinations on adolescents for the diagnosis of dental caries (DMF-T), dental trauma, dental fluorosis and occlusal alterations. Data were analyzed descriptively and by Poisson unadjusted and adjusted Poisson regression analysis (p<0.05). The final model was controlled by family income. Results: The prevalence of being ashamed of smiling or speaking was 13.6%. The following variables were associated with the outcome: female sex (PR= 1.33; 95% CI: 1.17-1.53), cavitated dental caries on upper incisors (PR= 1.81; 95% CI: 1.51-2.15), dental trauma (PR= 1.36; 95% CI:1.16-1.60), increased maxillary overjet (PR= 1.36; 95% CI:1.18-1.57), dental crowding (PR= 1.60; 95% CI:1.40-1.83), midline diastema (PR= 1.30; 95% CI:1.11-1.44), tooth loss (PR= 1.45; 95% CI:1.16-1.80), mild/questionable dental fluorosis (PR= 1.23; 95% CI:1.06-1.44) and moderate/severe dental fluorosis (PR= 1.67; 95% CI:1.15-2.44). Conclusion: Oral health problems that impact dental aesthetics were predisposing factors for being ashamed of smiling or speaking in Brazilian adolescents (AU).

Shprintzen-goldberg craniosynostosis: craniofacial and oral characteristics, diagnosis, and clinical management of a very rare syndrome / Craniossinostose de shprintzen-goldberg: características craniofaciais e orais, diagnóstico e manejo clínico de uma síndrome muito rara

ABSTRACT Shprintzen-Goldberg craniosynostosis syndrome, characterized by craniosynostosis and marfanoid habitus, is a very rare entity described in 75 individuals worldwide. This study aimed to present a case report of a 6-year-old female Brazilian child with Shprintzen-Goldberg's craniosynostosis syndrome. We described the craniofacial and oral characteristics and its clinical management, comparing to the existing literature. The patient presented with intellectual disability, craniosynostosis, ocular proptosis, low-set anomalous ears, and other skeletal and connective tissue defects. Oral features included malocclusion, micrognathia, pseudo-cleft palate, dental caries, and inefficient biofilm control. The treatment started with guidance on cariogenic foods, oral hygiene, and an indication to discontinue bottle feeding. Subsequently, the carious lesions were restored with composite resins, and the patient was referred for orthopedic surgery, orthodontic treatment, speech therapy, and nutritional counseling. The patient was followed for 5 years. This case report emphasizes the importance of knowing the craniofacial and oral characteristics for the diagnosis and clinical management of a female child with a rare Shprintzen-Goldberg's craniosynostosis syndrome. The case also highlights the need for oral health care in individuals with intellectual disabilities.

RESUMO A síndrome Shprintzen-Goldberg é uma entidade muito rara descrita em 75 pessoas, caracterizada por craniossinostose e habitus marfanóide. O objetivo deste estudo é apresentar o relato de um caso clínico de uma criança brasileira de 6 anos com síndrome da craniossinostose de Shprintzen-Goldberg, apresentando as características craniofaciais e orais e seu manejo clínico, comparando com a literatura. O paciente apresentava deficiência intelectual, craniossinostose, proptose ocular, orelhas anômalas de implantação baixa e outros defeitos esqueléticos e do tecido conjuntivo. As características orais incluíram má oclusão, micrognatia, pseudo fenda palatina, atividade de cárie e controle ineficiente do biofilme. O tratamento foi iniciado com orientações sobre alimentos cariogênicos, higiene oral e indicação de suspensão do uso de mamadeira. Em seguida, as lesões cariosas foram restauradas com resina composta e o paciente encaminhado para cirurgia ortopédica, tratamento ortodôntico, fonoaudiologia e nutricionista. O paciente foi acompanhado periodicamente por 5 anos. Este relato de caso enfatiza a importância do conhecimento das características craniofaciais e orais para o diagnóstico e manejo clínico de uma criança do sexo feminino com síndrome de craniossinostose de Shprintzen-Goldberg rara, destacando a necessidade de cuidados com a saúde bucal em indivíduos com deficiência intelectual.

Initial Mechanical Stabilization of Conventional Glass Ionomer Cements with Different Active Principles

ABSTRACT Objective: To determine the initial mechanical stabilization of conventional glass ionomer cements (GICs) indicated for the atraumatic restorative treatment (ART) in different storage periods. Material and Methods: Specimens were divided according to the GIC (n=12): IZ - Ion-Z, KM - Ketac Molar Easymix, RS - Riva Self Cure, and GL - Gold Label 9. They were prepared and stored in distilled water. Superficial microhardness (SMH) was evaluated (KHN) in three phases: (A) after 1, (B) 3, and (C) 7 days of storage. Data were submitted to 2-way ANOVA and Tukey tests (α = 5%). Results: The average KHN values for phases A, B, and C were, respectively, 33.05 ± 9.74; 33.21 ± 10.31 and 52.07 ± 11.75 (IZ); 50.35 ± 11.39; 66.05 ± 10.48 and 67.77 ± 13.80 (KM); 89.63 ± 15.59; 71.31 ± 23.86 and 57.70 ± 16.89 (RS); 42.18 ± 9.03; 68.54 ± 6.83 and 57.95 ± 8.24 (GL). Significant differences were observed: GIC, time, and interaction of both (p<0.05). KHN values differed between the groups, except in the GIC parameter for KM and GL. The time parameter values of phase A were lower than those of B and C, except for IZ and RS. Conclusion: The initial mechanical stabilization differed between the types of GIC tested and the storage time, and after the final period, all had similar SMH.

Social Representations of Children in Relation to the Image of the Dentist

Objective: To identify the social representations of children in relation to the image of the dentist. Material and Methods: This is a descriptive cross-sectional study with quantitativequalitative approach. The sample consisted of 80 children of both sexes aged 7-10 years attended at a clinic-school of a university in eastern Minas Gerais, Brazil. For data collection, the Test of Free Words Association (TALP) was used, with the word "dentist" as its inducing theme. The four items included in the research instrument were: 1) evoke up to five words or expressions related to the dentist; 2) to order each of them numerically, with number one being the most important and number five being the least important; 3) to conceptualize the one elected as number one; and 4) to justify the reason for that choice. The EVOC software was used to carry out quantitative analyses and the Analysis of Content of Bardin for qualitative analyses. Results: The words that composed the central nucleus of social representations were "tooth", "pain", "brushing" and "treats". This grouping of ideas points to the following conceptual formulation: "The dentist is someone who 'brushes' and 'treats' teeth, but sometimes performs procedures that cause 'pain'. The categories abstracted from participants' discourse were "oral health", "personal characteristics of the dentist" and "child-dentist interaction". Conclusion: Children presented predominantly positive image regarding the dentist.

Correlation of salivary immunoglobulin A with Body Mass Index and fat percentage in overweight/obese children

Abstract Obesity is considered a risk factor for periodontal health due to the low- grade inflammation promoted by the increased adipose tissue. Objective: This study aimed to determine correlations and associations between gingival inflammation (Simplified Oral Hygiene Index, and Gingival Index), salivary immunoglobulin A (s-IgA), and salivary parameters (salivary flow and osmolality) in normal-weight and overweight/obese children. Material and Methods: Ninety-one children, aged 6 to 12 years old (8.6±1.9 years), were divided into two groups according to their body mass index (BMI), circumferences, skinfold measurements and body fat percentage: normal- weight group (NWG; n =50) and overweight/obese group (OG; n =41). A calibrated examiner performed the clinical examination using the Simplified Oral Hygiene Index, Gingival Index, and salivary collection. Data analysis included descriptive statistics and association tests ( p <0.05). Results: OG presented statistically higher s-IgA values compared with NWG, especially among the obese children ( p <0.05). Significant positive correlations between s-IgA and salivary osmolality in OG ( p <0.05), and between s-IgA and BMI values ( p <0.05) and body fat percentage ( p <0.05) were observed among all the children. Effect size varied from moderate for s-IgA values ( d =0.57) to large for BMI ( d =2.60). Conclusion: Gingival inflammation and salivary parameters were similar for NWG and OG; however, s-IgA presented higher values in OG, with correlations between BMI and body fat percentage.

Barriers to Access to Dental Treatment for People with Physical Disabilities in a Brazilian Metropolis

Objective: To evaluate the barriers for accessing dental care for people with physical disabilities. Material and Methods: A cross-sectional study with 191 caregivers of individuals with physical disabilities attending a rehabilitation center in São Paulo, who responded to a questionnaire about information related to barriers (user, caregiver, government and professional) found in dental treatment, visit to the dentist and age of the first dental appointment. Data were collected from medical records regarding age, sex, family income and medical diagnosis of patients. Statistical analysis was performed using the MedCalc for Windows software version 12.3.0. The Chi-square test was applied for heterogeneity, with significance level of 5%. Results: The main barriers identified by caregivers (p<0.0001) were patient fear/anxiety (66.8%), patient requiring accompaniment to access treatment (87.4%), treatment costs (82.7%), lack of treatment at primary health care units (73.3%) and professionals not specialized in dental care for people with physical disabilities (67.0%). It was observed that caregivers of individuals with cerebral palsy reported greater physical barriers for accessing dental treatment compared to caregivers of other diagnoses (p=0.0307). Conclusion: Individuals with physical disabilities face financial constraints, fear of dental treatment, lack of treatment options in public services and, perhaps most importantly, lack of qualified professionals interested in treating such individuals.

Normative need for orthodontic treatment and perception of the need for such treatment among Brazilian adolescents

ABSTRACT Objective: The aim of the present study was to evaluate the normative need for orthodontic treatment and the perception of such need among students aged 11-14 years. Methods: A cross-sectional study was conducted with a sample of 346 students, randomly selected from public and private schools. The Dental Aesthetic Index (DAI) was used to evaluate the normative need for orthodontic treatment (NNOT). The perceived need for treatment among students was assessed by a previously validated questionnaire. Data was analyzed by Pearson's Chi-squared test (α = 5%). Results: The prevalence of malocclusion and NNOT was 65.6%. Of the sample, 73.7% felt they needed treatment, 66.2% wanted orthodontic treatment and 62.7% were satisfied with their dental aesthetics. A statistically significant association was observed between NNOT and the perception of the need for treatment among the students (p < 0.001). Conclusion: The present study demonstrated a high prevalence of malocclusion, which was reflected in the high normative need for orthodontic treatment. The opinion of patients regarding their expectations of orthodontic treatment should be valued. The students perceived a need for orthodontic treatment.

RESUMO Objetivo: o objetivo do presente estudo foi avaliar a necessidade normativa de tratamento ortodôntico e a percepção dessa necessidade entre alunos de 11-14 anos de idade. Métodos: realizou-se um estudo transversal com uma amostra de 346 alunos selecionados aleatoriamente de escolas públicas e privadas. O Índice de Estética Dental (DAI) foi utilizado para avaliar a necessidade normativa de tratamento ortodôntico (NNTO). A percepção da necessidade de tratamento entre os estudantes foi avaliada por meio de um questionário previamente validado. Os dados foram analisados pelo teste qui-quadrado de Pearson (α = 5%). Resultados: a prevalência de má oclusão e NNTO foi de 65,6%. Da amostra, 73,7% relataram que precisavam de tratamento, 66,2% queriam tratamento ortodôntico e 62,7% estavam satisfeitos com sua estética dentária. Observou-se associação estatisticamente significativa entre o NNTO e a percepção da necessidade de tratamento entre os alunos (p < 0,001). Conclusão: o presente estudo demonstrou alta prevalência de má oclusão, o que se refletiu na alta necessidade normativa de tratamento ortodôntico. A opinião dos pacientes sobre suas expectativas de tratamento ortodôntico deve ser valorizada. Os alunos perceberam a necessidade de tratamento ortodôntico.

Dental Erosion in Pediatric Dentistry: What is the Clinical Relevance?

The Dental erosion is not a new phenomenon and should be used to refer to the chemical process ­­ tooth demineralization without the involvement of bacteria. Dental erosion has for many years been a condition of little interest to clinical dental practice or dental public health. The relevance of dental erosion has increased substantially over recent years since dental caries has been decreasing in many societies, although it is still much more spread compared to erosive tooth wear. This fact is supported not only by daily observation in dental practice, but also by the large number of academic publications on the subject. In the 1970s, fewer than five publications per year addressed dental erosion, whereas this had doubled to approximately 10 a year in the 1980s. In the late 2000s, there were more than 100 publications on the topic every year.

Child's Behavior and its Relationship with the Level of Maternal-Child Anxiety During Dental Care

Objective: To evaluate the association between child's behavior and level of maternal and child anxiety during dental care. Material and Methods: The sample consisted of 100 children aged 6-11 years of both gender, scheduled for the first dental appointment at the dental clinic in a private school of Salvador, Brazil. The emotional reactions of patients were evaluated before the dental visit through the Venham Picture Test (VPT) instrument of anxiety evaluation. Mothers completed a specific questionnaire (Corah anxiety scale) to assess their anxiety about dental treatment. During dental care, prophylaxis and clinical examination by DMF-T and dmf-t indexes were performed. The child's behavior during the dental treatment was evaluated by the Frankl's Behavior Rating Scale. Fisher's exact test and chi-square were used to evaluate the association between variables (α = 5%). Results: It was observed that 24.0% of children presented anxiety according to VPT. There was a significant association between level of anxiety and pain and dental caries as the main dental complaint (p <0.001), and between child's behavior and variables maternal anxiety (p = 0.01) and childhood anxiety (p <0.001). Conclusion: It could be concluded that there was a positive association between child's non-cooperative behavior during dental care and maternal and child anxiety.

Is pomegranate peels infusion effective for disinfection of toothbrushes? / A infusão de cascas de romã é efetiva na desinfecção de escovas dentais?

Introduction: Methods of decontamination or sanitization of toothbrushes have been questioned. Objective: This study assessed the effectiveness of pomegranate peels infusion as a disinfectant of toothbrushes against Streptococcus mutans. Material and method: A sample of 16 schoolchildren aged between 7 and 9 years performed brushing 5 days/week, with a careful brushing once a day. After each day of brushing, the toothbrushes were washed and sprayed with one disinfectant solution. This procedure was repeated for 4 weeks using one of the different solutions per week: distilled water (G1; negative control), pomegranate (Punica granatum Linn) peels infusion (G2), 1% sodium hypochlorite (G3) and 0.12% chlorhexidine digluconate (G4). After the fifth day, toothbrushes were collected for laboratory analysis. Toothbrushes heads were subjected to agitation in saline dilution of 10–1, 10–2,10–3, and 25 μL of each dilution were seeded in mitis salivarius agar culture medium for S. mutans colony-forming unit (CFU) counting. One calibrated examiner (Kappa = 0.91) performed the CFU (mL–1 × 104) counts. Kruskal-Wallis and Dunn Multiple Comparison tests were used at a significance level of 5%. Result: G1 presented the highest number of CFU (3.9 ± 8.4), followed by G2 (3.2 ± 4.0). No S. mutans growth was observed in G3 and G4. There was no statistically significant difference between G1 and G2 and between G3 and G4 (p>0.05). Conclusion: Pomegranate infusion was completely ineffective for the disinfection of toothbrushes against S. mutans when compared with 1% sodium hypochlorite and 0.12% chlorhexidine digluconate solutions.

Introdução: Os métodos de descontaminação ou desinfecção de escovas dentais têm sido questionados. Objetivo: Este estudo avaliou a eficácia da infusão de cascas de romã como um desinfetante de escovas dentais contra Streptococcus mutans. Material e método: Uma amostra de 16 escolares com idade entre 7 e 9 anos realizou escovação dentária cuidadosa, uma vez ao dia por 5 dias/semana durante 4 semanas. Após cada dia de escovação, as escovas foram lavadas e pulverizadas com uma solução desinfetante. Este procedimento foi repetido por 4 semanas utilizando uma das diferentes soluções por semana: água destilada (G1; grupo controle), infusão de casca de romã (Punica granatum Linn) (G2), hipoclorito de sódio a 1% (G3) e digluconato de clorexidina a 0,12% (G4). Após o quinto dia, as escovas foram coletadas para análise laboratorial. As cabeças das escovas foram agitadas em solução salina diluída em 10–1, 10–2,10–3, e 25μL de cada diluição foi semeada em meio de cultura agar mitis salivarius para contagem de unidade formadora de colônias (UFC) de S. mutans. Um examinador calibrado (Kappa = 0,91) realizou a contagem de UFC mL–1 × 104. Os testes de Kruskal-Wallis e de Comparações Múltiplas de Dunn foram usados em um nível de significância de 5%. Resultado: G1 apresentou o maior número de UFC (3,9 ± 8,4), seguido de G2 (3,2 ± 4,0). Não foi observado crescimento de S. mutans em G3 e G4. Não houve diferença estatisticamente significante entre G1 e G2 e entre G3 e G4 (p>0,05). Conclusão: A infusão de romã foi completamente ineficaz para a desinfecção de escovas dentais contra S. mutans quando comparada às soluções de hipoclorito de sódio a 1% e digluconato de clorexidina a 0,12%.

Efeito anticárie do flúor associado ao trimetafosfato de sódio / Anticaries effect of fluoride associated with sodium trimetaphosphate

Objetivo: Estudar o efeito anticárie da adição de trimetafosfato de sódio (TMP) aos compostos fluoretados (dentifrícios, vernizes e soluções) para prevenção e tratamento de lesões de cárie através de uma revisão de literatura. Materiais e Métodos: Foram selecionados artigos de pesquisa e revisões sistemáticas da literatura mais relevantes sobre o assunto publicados na língua inglesa, desde 1968 até 2015, pesquisados no PubMed. As palavras-chave utilizadas foram: trimetafosfato de sódio, cárie dentária e fluoretos.Resultados: Foram apresentados os principais resultados de trabalhos de pesquisa sobre o TMP quando associado aos dentifrícios, vernizes e soluções para bochechos e estudos clínicos longitudinais. Conclusão: Os estudos in vitro e in situ mostram que o trimetafosfato de sódio pode potencializar a eficácia do flúor na prevenção e tratamento da cárie dentária, porém ainda faltam estudos para entender o mecanismo de ação do TMP, além de estudos clínicos para comprovar sua eficácia e indicação.

Objective: The aim of this work was to study the anticaries effect of adding sodium trimeta phosphate (TMP) to fluoride compounds (tooth pastes, varnishes and mouthrinse)for prevention and treatment of caries lesions with a review of the literature. Materials and Methods: The most relevant research articles and systematic reviews on the subject published in English, were selected from 1968 to 2015, browsed on Pubmed. The key words used were: sodium trimetaphosphate, dental caries and fluorides. Results: Themain results of research articles on the TMP associated with dentifrices, varnishes and mouthrinses and longitudinal clinical studies were presented. Conclusion: In situ and in vitro studies have shown that TMP might increase the effectiveness of fluoride in the prevention and treatment of caries, but there are few studies that explain its mechanism of action, as well as clinical studies to demonstrate its anticaries effect and indication.

Manifestações bucais e uso de serviços odontológicos por indivíduos com doença renal crônica / Oral manifestations and use of dental care assistance by individuals with chronic kidney disease

Objetivo: Avaliar as manifestações bucais e o uso de serviços odontológicos de indivíduos com Doença Renal Crônica (DRC) em tratamento hemodialítico. Materiais e Métodos: Participaram doestudo 130 indivíduos, de ambos os sexos e com idade superior a 18 anos em atendimento no Serviço de Hemodiálise de referência da cidade de João Pessoa-PB. Foram coletados dados socioeconômicos,saúde geral, higiene bucal, autopercepção dos problemas bucais e acesso ao serviço odontológico. Um único examinador realizou o exame clínico intrabucal. Resultados: A maioria dos participantes era do sexo masculino (60,8%), com baixos níveis de escolaridade (56,9%) e renda(61,5%). Houve o predomínio da hipertensão arterial sistêmica (86,2%) na doença de base. Em relação à autopercepção dos problemas bucais, os participantes relataram com maior frequência axerostomia (51,5%), seguida de mau hálito (30,0%). Dentre as manifestações bucais, a gengivite e a presença de cálculo dentário foram as mais prevalentes, com 66,2% e 56,2%, respectivamente.A maioria dos indivíduos buscava atendimento odontológico na rede pública de saúde e afirmava que o cirurgião-dentista não estava preparado para atender e explicar o tratamento que seria realizado. Conclusão: As principais alterações bucais identificadas foram xerostomia, mau hálito,cálculo dentário e gengivite, e que a maioria dos indivíduos tinha dificuldade no acesso ao serviço odontológico público de saúde.

Objective: To assess oral manifestations and use of dental care assistance by individuals with Chronic Kidney Disease (CKD) in hemodialysis treatment. Materials and Methods: Participated inthe study 130 individuals of both genders and aged over 18 years old attending the Hemodilalysis Reference Service in João Pessoa - PB. Data collection for socioeconomic status, oral hygiene, self--awareness of oral problems and access to dental care was carried out. A single examiner ran a clinical intraoral exam. Results: Most participants were male (60.8%) with low levels of education(56.9%) and income (61.5%). There was a predominance of systemic arterial hypertension (86.2%)as the underlying disease. In relation to the self-awareness of oral problems, participants reporteddry mouth most frequently (51.5%) followed by bad breath (30.0%). Among oral manifestations, gingivitis and the presence of tartar were the most prevalent, 66.2% and 56.2%, respectively. Mostindividuals sought dental care in the public health system and stated that the dental surgeon wasnot prepared to attend and explain the treatment to be provided. Conclusion: The main oral alterationsidentified were dry mouth, bad breath, tartar as well as gingivitis, and that most participantsfound it difficult to have access to dental care assistance in the public health system.

Desempenho de métodos baseados em indução de fluorescência na avaliação da remoção de dentina cariada / Performance of fluorescence-based methods in evaluating dentin caries removal

Introdução: Critérios clínicos vêm sendo utilizados para determinação da presença de tecido cariado remanescente, mas geram dúvidas, tornando-se relevante a utilização de métodos que auxiliem na determinação da presença de cárie dentária remanescente. Objetivo: Avaliar in vitro a eficácia de métodos de indução de fluorescência no diagnóstico da remoção de tecido cariado artificial dentinário. Material e método: O esmalte oclusal de 94 terceiros molares humanos hígidos foi removido, expondo a dentina subjacente, para indução microbiológica de lesão de cárie artificial. Após a remoção do tecido cariado induzido, o remanescente dentinário foi avaliado por dois examinadores com DIAGNOdent, DIAGNOdent pen e Quantitative Light-Induced Fluorescence (QLF). Após todas as avaliações, secções dos dentes foram observadas e fotografadas em lupa estereoscópica com 30× de aumento por um examinador independente. As imagens foram analisadas no software Image J, permitindo a quantificação de tecido remanescente em milímetros quadrados. Foi calculada a reprodutibilidade interexaminador através de coeficiente intraclasse, sensibilidade, especificidade e área sob a curva ROC, e o teste de McNemar (p< 0,05) foi aplicado para comparação dos diferentes métodos. Resultado: Dos 94 dentes, 51 (54,2%) apresentaram remanescente de tecido cariado. Os valores de sensibilidade, especificidade e área sobre a curva ROC foram semelhantes para os três grupos (p> 0,05). Os valores de reprodutibilidade variaram entre 0,952 e 0,978. Conclusão: Dentre os métodos utilizados, o DIAGNOdent e o DIAGNOdent pen apresentaram melhor desempenho na avaliação da presença de cárie artificial remanescente quando comparados ao QLF.

Introduction: Clinical criteria have been used for the determination of the presence of residual caries, however in a subjective manner. Then the use of auxiliary methods that assist in determination of the remaining presence of caries can be considered for this purpose. Objective: Evaluate the in in vitro efficacy fluorescence induction methods in the diagnosis of removing artificial dentinal caries. Material and method: Ninety-four thirds sound human molars without occlusal enamel were used for microbiological artificial caries lesion induction. The decayed tissue was removed and the remaining dentin evaluated by two examiners with DIAGNOdent, DIAGNOdent pen and Quantitative Light-Induced Fluorescence - QLF. After all assessments, sections of the specimens were observed and photographed in stereoscopic lens with 30× increase by an independent examiner. These images were analyzed with Image J software, allowing quantitation of remaining caries tissue in mm2. The inter-examiner reliability, sensitivity, specificity, and area under the ROC curve was calculated and the McNemar test (p< 0.05) was used to compare the different among methods. Result: Of the 94 teeth, 51 (54.2%) had residual caries. The sensitivity, specificity, and area under the ROC curve were similar for the three methods (p> 0.05). The inter-examiner agreement ranged between 0.952 and 0.978. Conclusion: Among the methods used, the DIAGNOdent, DIAGNOdent pen showed better performance in residual caries detection after dentin caries removal when compared to QLF.

Caries Risk Assessment by CAMBRA in Children Attending a Basic Health Unit

Objective: To determine the caries risk by Caries Management by Risk Assessment (CAMBRA) for children with mixed dentition attending a Basic Health Unit (BHU), identifying the main dental caries disease indicators, risk factors and protective factors. Material and Methods: The sample consisted of 89 children of both genders aged 8-12 years. Clinical and bitewing radiographic examinations were performed by a calibrated examiner, as well as the filling of the adapted CAMBRA form. Dental caries disease indicators, risk factors and protective factors of all subjects were determined. Chi-square test and multivariate logistic regression analysis for all CAMBRA variables were applied (p<0.05). Results: Caries risk was considered high in 38.2% of patients, moderate in 32.6% and low in 29.6%. The most frequent disease indicator was white spot lesion on smooth surfaces (73.0%), the most common risk factor was visible biofilm (78.7%) and protective factor was fluoridated water (100.0%). Children with "moderate risk" and "high risk" had risk of visible cavities or radiographic penetration of the dentin (OR=14.689; OR=574.363, respectively) compared to patients with "low risk". Conclusion: Caries risk determined as "high" and "moderate" were classifications most observed among children attending BHU. White spot lesions on smooth surfaces were the most frequent dental caries disease indicators and visible plaque on tooth surface and community water fluoridation were the most significant risk factors and protective factors, respectively.

Complications in adolescent pregnancy: systematic review of the literature / Complicações da gravidez na adolescência: revisão sistemática da literatura

Sexual activity during adolescence can lead to unwanted pregnancy, which in turn can result in serious maternal and fetal complications. The present study aimed to evaluate the complications related to adolescent pregnancy, through a systematic review using the Medical Subject Headings: “pregnancy complication” AND “adolescent” OR “pregnancy in adolescence”. Only full original articles in English or Portuguese with a clearly described methodology, were included. No qualitative studies, reviews or meta-analyses, editorials, case series, or case reports were included. The sample consisted of 15 articles; in that 10 were cross-sectional and 5 were cohort studies. The overall prevalence of adolescent pregnancy was 10%, and among the Brazilian studies, the adolescent pregnancy rate was 26%. The cesarean delivery rate was lower than that reported in the general population. The main maternal and neonatal complications were hypertensive disorders of pregnancy, prematurity and low birth weight, respectively. Adolescent pregnancy is related to increased frequency of neonatal and maternal complications and lower prevalence of cesarean delivery.

A atividade sexual na adolescência pode levar a uma gravidez indesejável que por sua vez pode trazer sérias complicações maternais e fetais. O presente estudo teve por objetivo avaliar as complicações relacionadas à gravidez na adolescência, por meio de uma revisão sistemática, utilizando como descritores do Medical Subject Headings: “pregnancy complication” AND “adolescent”OR “pregnancy in adolescence”. Foram considerados os artigos originais completos em inglês ou português, na íntegra, que apresentassem descrição clara da metodologia. Não foram incluídos estudos qualitativos, revisões ou metanálises, editoriais, série de casos e relatos de caso. A amostra foi constituída por 15 publicações, sendo 10 com delineamento transversal e 5 com delineamento coorte. A prevalência geral de gestação na adolescência foi de 10% e, entre os trabalhos nacionais, de 26%. A prevalência de parto cesárea foi menor que a descrita na população geral. As principais complicações maternas e neonatais de mães adolescentes foram doença hipertensiva específica da gestação, prematuridade e baixo peso ao nascer respectivamente. A gestação na adolescência se relacionou a maior frequência de complicações neonatais e maternas e à menor prevalência de parto cesariana.

Dente hipoplásico de Turner: relatode casos clínicos / Turner´s Hypoplasia Tooth: Clinical Case Reports

Objetivo: demonstrar as características do dente hipoplásico de Turner e suas possíveis causas por meio de relato de casos, ressaltando a importância da sua detecção precoce e o diagnóstico diferencial com outros defeitos de desenvolvimento do esmalte dentário. O dente de Turner é uma hipoplasia de esmalte localizada, caracterizada por um defeito na qualidade e na espessura do esmalte. Os dentes mais acometidos são os pré-molares superiores e inferiores. A etiologia mais provável é decorrente de uma infecção periapical que estava presente no dente decíduo predecessor, afetando o desenvolvimento do dente permanente. A severidade da hipoplasia pode variar desde manchas esbranquiçadas e de coloração pardo-acastanhada até a perda de estrutura dentária, que influenciará na conduta clínica apropriada, além do grau de sensibilidade dentinária, comportamento do paciente e risco de cárie. Relato de caso: apresentar dois casos clínicos de pacientes infantis com dente hipoplásico de Tunner em pré-molar, com diferentes graus de severidade e condutas clínicas. Considerações finais: o conhecimento dos aspectos patognomônicos do dente hipoplásico de Turner é fundamental para um correto diagnóstico e a elaboração de um plano de tratamento adequado, visando preservar a estrutura dentária, facilitar a higiene bucal e diminuir a sensibilidade.