Child abuse: perception and knowledge by Public Health Dentistry teams in Brazil

Abstract Aim: To evaluate the experience, knowledge and attitudes of dentists and oral health technicians (OHTs) who work in Basic Health Units in the city of Curitiba, PR, Brazil, regarding cases of abuse against children and adolescents. Methods: In this observational study, three hundred eighty-three questionnaires (validated for Brazilian Portuguese) were sent to dentists and OHTs who work in public health units. The response rate was 38.12% (n = 146) for dentists and 40% (n = 77) for OHTs. Results: The mean age of the dentists was 40±8.29 years, and 53.43% treated more than 10 children per week. The OHTs' mean age was 45.39±9.71 years, and 62.35% attended to more than 10 children per week. Although the dentists perceived 185 suspected cases of maltreatment, only 35.67% were reported to authorities. In the OHT group, 22.08% were reported to authorities. Sixty-eight dentists (47%) and 11 OHTs (14.28%) reported having treated at least one case of orofacial trauma in the previous 6 months, totalizing 166 orofacial traumas. About the mechanism for reporting suspected cases, 83% of the respondents knew how to report. Over 50% of the responses concerning why the professionals did not report cases of physical violence against children included fear of retaliation and difficulties in diagnosis. Conclusions: Suspected cases of maltreatment against children and adolescents are underreported. More information is required to recognize suspected maltreatment cases and notify authorities.

Shear bond strength of brackets bonded with nanofilled flowable resins

Introduction and Objective : To evaluate the shear bond strength of brackets fixed with different materials (two light-cured nanofilled low-viscosity resins - Transbond Supreme LV and Flow Tain LV and two light-cured traditional resins - Transbond XT and Transbond Plus Color Change) after 10 min and 24 h, and to evaluate the type of failure. Material and methods : Eighty bovine incisors were selected and randomly divided into groups (n = 10) according to the material and fixation period. The brackets were bonded following the manufacturer's instructions and stored in deionized water at 37oC for 10 min or 24 h. After, the specimens were submitted to shear bond strength test at 0.5 mm/min and evaluated for adhesive remnant index (ARI). The data were submitted to Kruskal Wallis and Wilcoxon tests (p < 0.05) and the ARI scores to Chi-Square test. Results: There was a significant difference among the materials (p < 0.05) (after 10 min - Transbond XT > Transbond Plus Color Change > Transbond Supreme LV = Flow Tain LV and after 24 h - Transbond XT > Transbond Plus Color Change = Transbond Supreme LV = Flow Tain LV). There was no significant difference in resistance values between 10 min and 24 h, except for Transbond Plus Color Change. Most groups showed adhesive remaining adhered to the enamel (scores 2 and 3) without statistical significant difference (p > 0.05). Conclusion: The light-cured traditional resins showed higher resistance than the nanofilled materials. The period of fixation had no influence on the resistance for different materials, except for Transbond Plus Color Change.

Mesiodens surgery at deciduous and permanent dentition

Introduction and Objective:To report a rare case of a patient who presented two mesiodens and the treatment performed at two moments. Case report: A 7 year-old male patient reported a supernumerary tooth extracted at age 4. The dental clinical exam revealed giroversion of permanent maxillary right central incisor. Cone-beam computed tomography (CBTC) revealed a presence of a mesiodens located at the buccal surface mesially to the permanent maxillary left central incisor and also indicated that the mesiodens was located close to the f loor of the nasal cavity. The surgery was performed with a conservative intervention and osteotomy by preserving the adjacent structure. The one-year following-up postoperative x-ray indicated new bone deposition and a more favorable eruption position of the right permanent maxillary lateral incisor. Conclusion: It can be concluded that an early diagnosis by CBTC allowed an adequate treatment planning, which avoid the formation of cysts and a prolonged retention of permanent tooth.

Effect of Different Surface Treatments for Ceramic Bracket Base on Bond Strength of Rebonded Brackets

The aim of this study was to evaluate the shear bond strength of rebonded ceramic brackets after subjecting the bracket base to different treatments. Seventy-five premolars were selected and randomly distributed into five groups (n=15), according to the type of the bracket surface treatment: I, no treatment, first bonding (control); II, sandblasting with aluminum oxide; III, sandblasting + silane; IV, silica coating + silane; and V, silicatization performed in a laboratory (Rocatec system). The brackets were fixed on an enamel surface with Transbond XT resin without acid etching. The brackets were then removed and their bases were subjected to different treatments. Thereafter, the brackets were fixed again to the enamel surface and the specimens were subjected to shear bond strength (SBS) test. The adhesive remnant index (ARI) was then evaluated for each specimen. Data were subjected to ANOVA and Tukey's tests (α=0.05). A statistically significant difference was observed only between Rocatec and the other groups; the Rocatec group showed the lowest SBS values. The highest SBS values were observed for group 1, without any significant difference from the values for groups II, III and IV. Most groups had a higher percentage of failures at the enamel-resin interface (score 1). It was concluded that the surface treatments of rebonded ceramic brackets were effective, with SBS values similar to that of the control group, except Rocatec group.

O objetivo do estudo foi avaliar o efeito de tratamentos da base de bráquetes cerâmicos monocristalinos na resistência de união ao esmalte após recolagem. Setenta e cinco pré-molares foram selecionados e aleatoriamente distribuídos em 5 grupos (n=15) de acordo com o tratamento da base do bráquete: I - sem tratamento, primeira colagem (controle), II - jateamento com óxido de alumínio, III - jateamento seguido da aplicação de silano, IV - jateamento com partículas de dióxido de sílica (silicatização) seguido de silano, V - silicatização realizada em laboratório (Sistema Rocatec). Os bráquetes foram colados no esmalte com Transbond XT sem condicionamento ácido. Em seguida, os bráquetes foram removidos e suas bases foram submetidas aos diferentes tratamentos. Os bráquetes foram recolados, armazenados por 24 h e submetidos ao ensaio mecânico de cisalhamento com velocidade de 0,5 mm/min. Após, o índice de remanescente adesivo (IRA) foi avaliado em cada espécime. Os dados foram submetidos à análise de variância e teste de Tukey (α=0,05). Pode-se observar que houve diferença significativa apenas entre o sistema Rocatec e os demais grupos, o qual apresentou os menores valores de resistência. Os maiores valores de resistência foram observados para o grupo I (controle), sem diferença significativa dos grupos II, III e IV. A maioria dos grupos apresentou maior porcentagem de falhas na interface esmalte/resina (escore 1). Pode-se concluir que os tratamentos da base do bráquete cerâmico foram efetivos, apresentando valores similares ao grupo controle, exceto para o grupo em que foi usado Rocatec.

Domestic Violence Against Children and Adolescents: Prevalence of Physical Injuries in a Southern Brazilian Metropolis

Violence against children and adolescents is a public health issue worldwide that threatens physical and mental wellbeing and causes irreparable harm. Reports on this violence are an essential way to prevent it and to protect the children and adolescents. Thus, the objective of the present study was to evaluate the prevalence of physical injuries that occur in domestic environments and reported to the Child and Adolescent Protection Network. This retrospective study was conducted at the Epidemiology Center of the Municipality of Curitiba. A total of 10,483 reports for the years 2010 (5,112) and 2011 (5,371) were analyzed and from them were selected reports of physical injuries that occurred in the family environment. The children and adolescents were 0-17 years old, comprising 322 cases of physical abuse within the family in 2010. Out of these, 57.1% were male and 42.9% were female, and 58% (187) presented head and neck injuries. There were 342 reports in 2011, 49% were male and 51% were female; head and neck injuries corresponded to 65% (222) of the reported cases. The prevalence of injuries increased by 6% and head and neck injury increased by 19% between 2010 and 2011. It may be concluded that physical abuse is associated with a high prevalence of head and neck injury, which is easily observed by the health and education professionals. Notification organs should be created in Brazilian hospitals and health centers, which is essential to conduct epidemiological surveillance and appropriate policies.

A violência contra crianças e adolescentes é um grave problema mundial e de saúde pública, que ameaça o bem estar físico e mental, deixando sequelas irreparáveis. A notificação desta violência permite sua prevenção e proteção das crianças e adolescentes. Assim, o objetivo desse estudo foi avaliar a prevalência de lesões na região de cabeça e pescoço contra crianças e adolescentes, bem como caracterizar o tipo das lesões, o agressor e unidades notificadoras. Essa pesquisa retrospectiva foi realizada no Centro de Epidemiologia da Prefeitura Municipal de Curitiba. Um total de 10.483 notificações dos anos de 2010 (5.112) e 2011 (5.371) foi analisado, para compor a amostra das lesões físicas ocorridas no ambiente intrafamiliar, na faixa etária de 0 a 17 anos de idade. Em 2010, a frequência de abuso físico intrafamiliar foi de 322 casos. Destas, 57,1% eram do sexo masculino e 42,9% do sexo feminino, e 58% (187) delas tiveram lesões em cabeça e pescoço. No ano de 2011 foram 342 notificações, sendo que 49% eram do sexo masculino e 51% do sexo feminino e as lesões em cabeça e pescoço corresponderam a 65% (222) dos casos notificados. Houve aumento na prevalência de 6% das lesões físicas e 19% das lesões na região de cabeça e pescoço, do ano de 2010 para 2011. Conclui-se que é alta a prevalência de lesões na região de cabeça e pescoço, áreas facilmente observadas pelo profissional de saúde e da educação. A criação de órgãos notificadores em hospitais e unidades de saúde é fundamental para a vigilância epidemiológica e para definição de políticas adequadas.

Aesthetic management of molar-incisor hypomineralization

Introduction: Molar-incisor hypomineralization (MIH) has been challenging for clinical practice. The term refers to an enamel defect that affects permanent molars and often permanent incisors. This defect may result in high sensibility, coronal destruction of the molars, aesthetic problem when incisors are affected, which can jeopardize the child`s emotional and psychological development. Objective: The aim of this paper is to report two cases in which a conservative approach was adopted using new technologies for direct restorative treatment of incisor with MIH opacities. Case report: Patients aged 11 and 12 years-old attended to the clinics of the School of Dentistry (Sao Paulo State University - Unesp) complaining about the appearance of incisors due to the presence of opacities on the labial surface. The cases were diagnosed as MIH, presenting enamel defects on the permanent molars and incisors. Direct restorations were carried out with minimal removal of the opacities using CVD diamond tip (CVDentus, São José dos Campos, São Paulo, Brazil) coupled to an ultrasonic device (CVDentus, São José dos Campos, São Paulo, Brazil) and direct restorations with composite resin. The result of the restorative treatment was satisfactory in both cases, with children showing immediate satisfaction. Conclusion: The incisors affected by MIH should be treated to improve the child`s self-esteem and avoid negative effects on their psychology development. The aesthetic treatment of the incisors should be conservative, since the replacements of restorations are needed throughout life.

In vitro analysis of ph and titratable acidity of yoghurts and milk beverages

Objective:To analyze pH, titratable acidity and carbohydrate and calcium amounts in yoghurts and milk beverages. Materials and Methods:twelve types of yoghurts and eight milk beverages were analyzed. The beverages’ pH was measured and samples were divided into two groups: Group 1: samples with pH<4.0; Group 2 samples with pH>4.0. The acidity of each drink was determined by titration. Calcium and carbohydrate rates were obtained from label information. pH, acidity, calcium and carbohydrates were compared in two groups of beverages (G1: pH<4.0; G2: pH>4.0) and analyzed according to the distribution pattern according to Shapiro-Wilk ́s test, whereas homogeneity of variances was performed by Levene's test at 0.05 significance level. Results:Overall analysis of the variables classified the beverages in 4 groups: A, B, C and D. Samples in group A had the best results: high pH, low acidity, high calcium amounts and few carbohydrates. On the other hand, samples in group D had low pH, high acidity, low calcium amounts and high carbohydrate rates. Conclusion:The three samples under analysis, two yoghurts and one milk beverage, join factors that may lead to the development of dental erosion

Clinical setting influences physiological responses in dental implant patients

AIM: To evaluate changes in blood pressure and heart rate in patients undergoing dental implant procedures, considering the dental setting as the main variable. METHODS: Fifty-five patients who underwent dental implant surgery were evaluated. Thirty-seven were treated at a university clinic and 18 were treated at a private office. Blood pressure and heart rate were measured at the following time-points: at the appointment prior to surgery (T0), immediately before the surgical procedure (T1), during anesthesia (T2), during implant installation (T3), immediately after the surgical procedure (T4) and at the first follow-up appointment after surgery (T5). The data were analyzed by two-way analysis of variance and Student's t-test. RESULTS : The university clinic patients had an increase in heart rate at T5 (t53=2.62, p<0.05) compared with private office patients. Systolic blood pressure in university clinic patients was higher at T2 (t53=2.86, p<0.01), T3 (t53=2.64, p<0.05), and T4 (t53=3.15, p<0.01). Diastolic blood pressure at T2 (t53=3.15, p<0.01) and T3 (t53=3.86, p<0.01) were also higher in university clinic patients. CONCLUSIONS : These results suggest that the dental setting is a relevant factor when planning dental implant surgery...

Hidden caries' challenge diagnosis: case report

Introduction: Hidden caries is a term used to describe occlusal dentine caries that is missed on a visual examination, but is large and demineralised enough to be detected by another exam for example, radiographs. Case report: This article reports a case of large dentine caries, which presented as to be a small pit-and-fissure carious lesion on the occlusal surface of the right mandibular permanent first molar in a 10-year-old girl. The treatment included root canal treatment and the sealing of the cavity with composite resin. Conclusion: Careful visual examination, with cleaning and drying of teeth, associated to bitewing radiographs may improve occlusal caries detection. Dentists should examine bitewing radiographs carefully for proximal caries and occlusal demineralization. Radiographs are an effective method of caries diagnosis that can avoid large destruction and allows less invasive treatment.

Child abuse: validation of a questionnaire translated into Brazilian Portuguese

This study sought to validate the Portuguese translation of a questionnaire on maltreatment of children and adolescents, developed by Russell et al. and to test its psychometric properties for use in Brazil. The original questionnaire was translated into Portuguese using a standardized forward-backward linguistic translation method. Both face and content validity were tested in a small pilot study (n = 8). In the main study, a convenience sample of 80 graduate dentistry students with different specialties, from Curitiba, PR, Brazil, were invited to complete the final Brazilian version of the questionnaire. Discriminant validity was assessed by comparing the results obtained from the questionnaire for different specialties (pediatric dentistry, for example). The respondents completed the questionnaire again after 4 weeks to evaluate test-retest reliability. The comparison of test versus retest questionnaire answers showed good agreement (kappa > 0.53, intraclass correlation > 0.84) for most questions. In regard to discriminant validity, a statistically significant difference was observed only in the experience and interest domains, in which pediatric dentists showed more experience with and interest in child abuse compared with dentists of other specialties (Mann-Whitney test, p < 0.05). The Brazilian version of the questionnaire was valid and reliable for assessing knowledge regarding child abuse by Portuguese-speaking dentists.

Avaliação tomográfica da região dos incisivos inferiores após tratamento com o aparelho de Herbst / Tomographic evaluation of lower incisors after treatment using Herbst Appliance

O objetivo deste estudo piloto foi avaliar a perda óssea na região dos incisivos inferiores, bem como a inclinação e a protrusão incisal inferior após o uso do aparelho de Herbst para o tratamento da Classe II. Foram selecionados 10 pacientes do grupo controle (G1) com idade média, inicial e final, de 8,9 a 10,4 anos, acompanhados por um período de 18 meses sem o uso do aparelho. E para o grupo tratado (G2) foram selecionados 6 pacientes, com idade média, inicial e final, de 10,8 a 11,4 anos, tratados com aparelho de Herbst com cantilever por um período de 6 meses. Para cada grupo foram realizados dois exames de tomografia computadorizada de feixe cônico (TCFC), T1 inicial e T2 final. Nas TCFC foram avaliadas, na região dos incisivos inferiores, a espessura do osso medular, a espessura das corticais vestibular e lingual, e a protrusão e a inclinação dos incisivos inferiores, utilizando o software InVivo 5.0. Os dados foram submetidos à análise estatística (análise de covariância e test t) com nível de significância de 5%. Como resultado, observou-se que a cortical vestibular na região entre os dentes 41 e 42 mostrou um aumento significativo no grupo controle (0,30 mm). A espessura da cortical lingual mostrou uma alteração significativa apenas no grupo controle na região entre os dentes 32 e 31 (0,46 mm). Para a medição da protrusão do incisivo inferior, houve uma diminuição dos valores, que foi significativa apenas para o grupo controle (-0,79 mm). Pode-se concluir que o aparelho de Herbst com cantilever não provocou perda óssea nas corticais vestibular e lingual. Durante os 6 meses iniciais de utilização do aparelho houve uma pequena vestibularização e protrusão anterior dos incisivos inferiores, sem implicações clínicas relevantes.

The aim of this pilot study was to evaluate bone loss in the region of the lower incisors and the incisal inclination and protrusion after Class II treatment with Herbst appliance.10 patients from the control group (G1)with initial and final mean ages of 8.9 to 10.4 years were selected and followed by a period of 18 months with out the use of the device. For the treated group (G2), 6 patients with initial and final mean ages of 10.8 to 11.4 years were treated with Herbst appliance with cantilever for a period of 6 months. Two cone beam computed tomography (CBCT) exams were carried out for each group, before treatment (T1- initial) and after 6 months (T2 - final). Through CBCT images from the region of the lower incisors, were evaluated the thickness of the bone marrow, the thickness of vestibular and lingual cortical, and protrusion and inclination of lower incisors, using the software In Vivo 5.0. Data were submitted to statistical analysis (analysis of covariance and T test) with a significance level of 5%. As a result it was observed that the cortical bone in the region between the teeth 41and 42 showed a significant in crease on the control group patients (0.30 mm). The thickness of the lingual cortical presented a significant change only in the control group on the are a between teeth 32 and 31 (0.46 mm). Regarding the protrusi on of the lower incisors, there was a decrease of values which was significant only for the control group (-0.79 mm). It can be concluded that the Herbst appliance with cantilever does not cause bone lossin vestibular and lingual cortical. During the initial 6 months of treatment, there was a small vestibular inclination and anterior protrusion of the lower incisors with out relevant clinical implications.

Alterações dentárias transversais em pacientes submetidos à expansão rápida da maxila com ancoragem esquelética / Tranversal dental changes in patients submitted to rapid maxillary expansion with skeletal anchorage

O objetivo desse trabalho foi verificar as possíveis variações nas distâncias interdentárias entre caninos, primeiros pré-molares e primeiros molares superiores em modelos de gesso e em tomografias computadorizadas de feixe cônico (TCFC) antes e após a expansão rápida da maxila (ERM) com ancoragem esquelética, correlacionando essas medidas com a abertura da sutura palatina mediana. A amostra consistiu de 13 pacientes com idade média de 16 anos que se submeteram à ERM com um aparelho do tipo Haas ancorado no palato com parafusos de titânio. Para a comparação entre os momentos de avaliação (inicial e final) e entre os métodos (modelos de gesso e TCFC) foi utilizado o teste t de Student para amostras pareadas (p<0,05). Para avaliar a associação entre as variáveis foi estimado o coeficiente de correlação de Pearson. Na comparação entre os momentos estudados houve diferença estatística significante em todas as distâncias interdentárias avaliadas nos dois métodos utilizados, bem como na abertura da sutura. Na comparação entre os métodos não houve diferença estatística significante. Também não houve correlação entre a diferença das distâncias interdentárias e a abertura da sutura. Concluiu-se que houve um aumento significante na largura do arco dentário superior, mas que não correspondeu a um aumento proporcional da abertura da sutura palatina mediana aos níveis dos elementos dentários analisados.

The purpose of this study was to verify possible differences of interdental distances between upper canines, first premolars and first molars in plaster casts and in cone-beam computed tomography (CBCT) before and after rapid maxillary expansion (RME) with skeletal anchorage and correlating these distances with the opening of midpalatal suture. The sample was composed of 13 patients, mean age of 16 years old, that were submitted to RME with Haas appliance anchored to the palatal plate with titanium screws. To compare the stages of evaluation (beginning and ending) and the methods (plaster casts and CBCT) Student t test for paired samples was used (p<0.05). To evaluate the association among measurements Pearson´s correlation was estimated. When comparing moments of measurements, there was significant statistical difference in all interdental distances evaluated in both methods as well as in the suture opening. There was no statistical difference in the comparison of both methods. There was no correlation between interdental differences and suture opening either. It was concluded that there was a significant increase in the width of the maxillary dental arch that however did not correspond to a proportional augmentation of the opening of midpalatal suture at the level of the studied dental elements.

O conhecimento do aluno de Odontologia sobre maus tratos na infância antes e após o recebimento de uma cartilha informativa / Dental student’s knowledge about child abuse before and after receiving an informative booklet

Objetivo: avaliar o conhecimento dos alunos do curso de Odontologia sobre a violência contra a criança e o adolescente. Metodologia: é um estudo descritivo e transversal, desenvolvido com 96 graduandos em Odontologia. Para a coleta de dados, utilizou-se um questionário com questões estruturadas e semiestruturadas que foi aplicado em dois momentos, antese após a entrega da cartilha “Enfrentamento dos maus tratos contra a criança e o adolescente” elaborada pelo Hospital Pequeno Príncipe, Curitiba, PR, Brasil. Resultados: apenas 25% dos alunos julgaram-se capazes de identificar os casos suspeitos de maus tratos, e, após a entrega da cartilha, houve um aumento para 36%.Em relação à instituição correta que deveriam notificar os casos suspeitos houve um aumento de 10%. Os sinais mais citados para o diagnóstico de maus tratos foram hematomas e mudança de comportamento. Todos os alunos afirmaram que é importante o conhecimento do assunto na graduação, apesar de apenas 36% deles afirmarem que leram ou participaram de palestras ou cursos relacionados ao tema. Conclusão: somente a entrega da cartilha não foi suficiente para despertar totalmente o interesse do grupo pelo assunto.

Aim: to evaluate the students' knowledge of the dentistry course on child abuse against children and adolescents. Methodology: this is a descriptive study, developed with 96 graduates in dentistry. For data collection, it was used a questionnaire with structured and semi-structured questions wich was applied in two moments, before and after distribution of the booklet "Combating of abuse against children and adolescents" prepared by the Hospital Pequeno Príncipe, Curitiba, PR, Brazil. Results: only 25% of students found themselves able to identify suspected cases of child abuse, and after distribution of the booklet, there was an increase to 36%. In relation to the institution that should properly notify suspected cases increased by 10%. The signs most often cited for the diagnosis of child abuse were bruises and behavior change before and after distribution of the booklet. All students said that it is important to examine the subjetc at graduation, although only 36% said they have read or attended a lecture or course related topic. Conclusion: only the distribution of the booklet was not enough to fully awaken the group's interest in the subject.

Child abuse: perception and management of the Brazilian endodontists

Introduction: In Brazil, dentists have a legal, moral, and ethical obligation to notify competent authorities of suspected cases of maltreatment. Studies conducted in several countries reported the difficulties of dentists in the diagnosis, documentation, and reporting of suspected abuse cases to authorities. Objective: The aim of this study was to investigate the perception, diagnosis and attitudes of Brazilian endodontists towards child abuse. Material and methods: Data were collected from 56 questionnaires, considering a total of 248 sent by mail (response rate = 23%) to the endodontists (female = 73%). Results: Forty-one percent (n = 23) of the professionals answered that they were able to identify cases of abuse, while 59% (n = 33) answered that they were unable. Considering their graduation years, 93% (n = 52) stated that they had received little information on this issue, and only 5% (n = 3) attended seminars on this subject during the year before the questionnaire's application. Although 61% (n = 34) of the professionals affirmed that suspicious cases must be reported, only 30% (n = 17) knew to whom. Eighteen percent (n = 10) of the endodontists reported they had already treated suspicious cases, although only 3.5% (n = 2) reported the case to the authorities. The most cited signs of abuse were: body bruises (48%; n = 27), change in behavior (48%; n = 27) and burn marks (12.5%; n = 7). Lesions presented in the face, mouth, and teeth were reported by 27% (n = 15) of the professionals. There were no statistically differences regarding the number of notifications in relation to either the number of years since graduation or the workplace. Conclusion: It was concluded that it is necessary to improve endodontists' formation concerning to child abuse identification, in order to modify their behavior, therefore, increasing the number of suspicious cases' notifications.

Effects of a motivational program for caregivers on the oral hygiene quality of 10-to-36-month-old children: a pilot study

Introduction: Dental caries is the most common chronic disease in childhood and a major problem for world public healthcare. For dental caries onset, the presence of dental plaque is primordial, being plaque removal one of caries preventive measures. Children younger than 3 years old depend on adults for dental plaque controlling. Objective: To assess the quality of oral hygiene of children before and after a motivational program conducted with their caregivers. Material and methods: Twelve caregivers and 16 children (from 10 to 36 months old) entered the study. The children's oral hygiene quality was assessed with the Oral Hygiene Index (OHI) of upper and lower incisors at baseline, 1 and 3 months after the instructional lecture on oral health given to the caregivers. Results: It was verified a statistical difference in OHI of upper/lower incisors between baseline and 3 months after the lecture. At 1-month assessment after the lecture, there was an improvement in OHI of the upper incisors. There was no statiscally significant difference between upper and lower incisors. All incisors OHI for the three assessments showed a statiscally significant difference between the groups at baseline and 1 month after the lecture, returning to the initial indexes after 3 months. Conclusion: Punctual health education activities are not effective. They need to be continuous to institute changes in behavior regarding oral health.

Analysis of fluoride concentration in solutions prepared at dispensing pharmacies

Introduction: Fluoride plays an important role in oral health promotion and is considered important in dental caries prevention both in children and adults. Fluoride is widely used at high-risk conditions of caries, when the use of fluoride-containing mouthwashes is recommended, considering that fluoride itself reduces the risk of dental caries. Objective: To evaluate the fluoride concentration in solutions prepared at different dispensing pharmacies in the city of Curitiba - PR, Brazil. Material and methods: The analysis of fluoride concentration was preformed through Ion Chromatography method (DIONEX). Results: The results obtained through this analysis showed that all solutions presented fluoride concentration above that required in the dentist's prescription, varying between 5.48% and 24.02% more fluoride, at absolute concentration. Conclusion: This finding highlights the increasing risk of fluoride acute intoxication in cases of accidental ingestion of the solution.

Severidade de fluorose dental em um grupo de escolares / Dental fluorosis severity in a group of school children

INTRODUÇÃO E OBJETIVO: O presente estudo teve como objetivo avaliar a prevalência e a severidade de fluorose dental em um grupo de escolares do município de Campo do Tenente (PR), de modo a comparar o teor médio de flúor presente na água de abastecimento público e discutir acerca dos valores efetivos para fluoretação das águas de abastecimento e da necessidade de um controle da concentração de flúor na água de que a população dispõe. MATERIAL E MÉTODOS: Foram examinadas 362 crianças, todas matriculadas em escolas públicas de ensino fundamental, procedimento feito por uma única examinadora previamente calibrada para aplicação do índice de Dean. Das crianças analisadas, 90 estavam acometidas por algum grau de fluorose; dessas 90, 40 retornaram com o termo de consentimento livre e esclarecido assinado pelos pais/responsáveis para assim participar da pesquisa. RESULTADOS: Das crianças que consentiram em fazer parte da investigação, 42,5 por cento apresentaram grau leve de fluorose e 32,5 por cento tinham grau moderado. Observou-se ainda que a média dos teores de flúor das águas de abastecimento público de 2004 foi de 1,7 ppm. CONCLUSÃO: Tais resultados demonstram que é preciso maior atenção para a situação na referida cidade, com a inclusão de heterocontrole e monitoramento constante das condições de saúde bucal da população.

INTRODUCTION AND OBJECTIVE: This study aimed to assess the prevalence and severity of dental fluorosis in a group of school children in the city of Campo do Tenente (Parana, Brazil) in order to compare the mean fluoride concentration in public water supply and discuss the effective values for fluoridation of water supply, as well as, the need of control of fluoride concentration within the water consumed by population. MATERIAL AND METHODS: Firstly, 362 children enrolled in regular public schools, at elementary level, were examined by a single researcher, previously calibrated for Dean's index application. From these, 90 children were affected by some degree of fluorosis, but only 40 returned the signed free and clarified consent form for participating in the research. RESULTS: It was found that 42.5 percent of the children presented mild fluorosis and 32.5 percent moderate fluorosis. Moreover, it was observed that the average fluoride concentration in public water supply, in 2004, was 1.7 ppm of fluoride. CONCLUSION: These results demonstrate the need of a closer supervision of the city situation, by the inclusion of fluoridation external control and constant monitoring of the oral health status of the population.

Traumatismo dentoalveolar na dentição decídua / Dentoalveolar trauma in the primary dentition

O atendimento a crianças com traumatismos na dentição decídua requer uma abordagem diferente daquela utilizada na dentição permanente, isso porque existe uma relação muito próxima entre o ápice do dente decíduo afetado pelo trauma e o germe do dente permanente sucessor. As possíveis repercussões sobre o dente permanente devem ser consideradas ao se realizar o tratamento imediato, de modo a evitar danos adicionais. também precisam ser levadas em conta as prováveis seqüelas tardias do trauma, tanto para a própria dentição decídua como para a permanente. Diante da importância do assunto, este capítulo procurou abordar tal tema de maneira ampla, desde a anamnese até os exames gerais, intrabucal e radiográfico, com vistas a analisar integralmente o paciente. Além da classificação das lesões traumáticas nos tecidos dentários e de sustentação, enfatizam-se o diagnóstico, o tratamento indicado, o prognóstico e a proservação de cada situação clínica. Um tópico sobre lesão em tecido mole foi incluído, pois esta tem grande impacto para a criança e sua família e pode estar associada a outros tipos de traumatismos. Como a análise da situação vacinal da criança é sugerida, ante a existência de casos que exigem que a vacina antitetânica esteja na sua validade, acrescentou-se a recomendação do Ministério da Saúde quanto á imunização antitetânica. Há também um item sobre contenção, orientação aos pais e repercussões do trauma para os dentes decíduos e os permanentes sucessores. Ao final do capítulo, duas tabelas resumem o tratamento das lesões traumáticas em tecidos dentários e polpa e o tratamento das lesões em tecidos de sustentação na dentição decídua em situações de tratamento imediato e tardio.

The treatment of children presenting dental trauma in the primary dentition requires a different approach from that used in the permanent dentition, because there is a very close relation between the apex of the traumatized primary tooth and the successor permanent bud. The possible consequences on the permanent teeth should be considered when performing early treatment in order to prevent further damage. Also, the probable trauma?s late sequelae should be taken into account both for primary and permanent dentition. Given the subject?s importance, this chapter aimed to report this issue broadly. This comprises the anamnesis, general, intraoral, and radiographic examination and the comprehensive treatment of the patient. Additionally to the classification of dental injuries, we highlighted the diagnosis, required treatment, prognosis, and follow-up of each clinical situation. A topic on soft tissue lesion was included, because it has a great impact on both the child and family. Moreover, it could be associated with other trauma types. Since the analysis of the child?s vaccination status is suggested, in face of cases demanding that tetanus vaccine be valid, the recommendation of the Brazilian Ministry of Health was also informed. Furthermore, there is an item on dental splinting, parenting advice, and trauma consequences on primary and successor permanent teeth. At the end of the chapter, two tables summarize the early and delayed treatment of trauma involving primary tooth?s enamel, dentin, pulp, and supportive tissues.

Antidepressivos e anestésicos locais: interaçõesmedicamentosas de interesse odontológico / Antidepressants and local anesthetics: druginteractions of interest to dentistry

Introdução: Em virtude da ampla variedade de tratamentosfarmacológicos de transtornos mentais, é cada vez mais comumpacientes que procuram tratamento odontológico fazerem uso contínuode psicofármacos. O número de pessoas que utilizam antidepressivostem crescido, e isso exige dos cirurgiões-dentistas atualização a respeitoda interação entre essa classe de medicamentos e os fármacos usadosna clínica odontológica, como anestésicos locais e vasoconstritores.Objetivo: Efetuar uma revisão de literatura sobre o tema. Revisãode literatura e conclusão: Os dados sugerem que vasoconstritoressimpatomiméticos (adrenalina, noradrenalina e fenilefrina) associadosa anestésicos locais podem potencializar os efeitos colaterais dosantidepressivos, principalmente tricíclicos e inibidores da MAO, sobreo sistema cardiovascular. Porém poucos são os estudos clínicos epré-clínicos sobre o assunto; na sua maioria foram realizados entre as décadas de 1960 e 1980. Pesquisas atuais são necessárias, já quemuitas drogas antidepressivas novas, com diferentes mecanismos deação, foram lançadas no mercado e estão sendo usadas atualmente.

Introduction: Since there is a vast variety of pharmacologicaltreatments for mental conditions, it has been increasingly morecommon that patients seeking dentistry treatment are continuallyusing psychoactive drugs as antidepressants. The number of peopletaking antidepressants is increasing; consequently, dentists shouldupdate their knowledge on the interaction between this drug classand those used in dental daily practice, such as local anesthetics andvasoconstrictors. Objective: To conduct a literature review on thissubject. Literature review and conclusion: Literature data suggestthat sympathomimetic vasoconstrictors (epinephrine, norepinephrine,and phenylephrine) associated with local anesthetics may potentiatethe side effects of antidepressants, particularly tricyclics and MAOinhibitors, on the cardiovascular system. There are few clinical trialsand preclinical studies on this subject, and most of them were carriedout between the 60s and 80s. Current studies are needed, since manynew antidepressant drugs with different

Determinação do pH, capacidade de tamponamento, carboidratos totais e sacarose em sucos de fruta industrializados ?zero açúcar? e light / Determination of pH, buffering capacity, total carbohydrates and sucrose in sugar-free and light processed fruit juices

Introdução: Erosão dentária é a perda irreversível dos tecidos dentários duros causada por ácidos e/ou quelação química sem envolvimento bacteriano. Vários estudos mostraram que há um aumento de sua prevalência em crianças, jovens e adultos e associam a erosão dentária ao consumo de bebidas ácidas, incluindo sucos de fruta industrializados. Objetivo: O objetivo deste estudo foi avaliar o pH, a capacidade de tamponamento (CT) e a quantidade de carboidratos totais e de sacarose em 15 sucos de fruta light ou ?zero açúcar?. Material e métodos: O pH foi verificado com auxílio de um potenciômetro Mettler Toledo 320. A CT foi estipulada por titulometria, gotejando-se NaOH 0,1 N em amostras de cada suco até que o pH delas atingisse 7,0. Os carboidratos totais foram determinados pelo método do fenolsulfúrico, e a sacarose, incubando-se cada amostra de bebida com a enzima invertase. Resultados: O valor médio de pH encontrado foi de 2,61 (±0,29). Os sucos analisados necessitaram, em média, de 6,2 mL (±1,9) de NaOH 0,1N para elevar o pH até 7,0. Os carboidratos totais observados nas análises foram condizentes com os valores descritos nas embalagens. O conteúdo de sacarose verificado em cada bebida foi muito pequeno e variou de 0,60 a 0,93 g / 200 mL. Conclusão: Este estudo mostrou que as 15 bebidas avaliadas tinham pH extremamente baixo e potencial erosivo, uma vez que a maioria dos sucos apresentou alta capacidade de tamponamento. A quantidade de sacarose presente em cada bebida é muito pequena, sugerindo que não são cariogênicas. Entretanto são necessários estudos futuros que demonstrem a ação dessas bebidas sobre a superfície dentária.

Introduction: Tooth erosion is the irreversible loss of dental hard tissues caused by acids and/or chelation without bacterial involvement. Many studies showed that there is an increase of tooth erosion in population and that it is related to the consumption of soft drinks, including processed fruit juices. Objective: The aim of this study was to evaluate the pH, buffering capacity (BC), total carbohydrates and sucrose in 15 sugar-free and light processed fruit juices. Material and methods: The pH was determined with a Mettler Toledo 320 pH meter. The BC was determined by titration, adding 0.1 N NaOH in 10 mL of each drink until reaching a pH level of 7.0. The total carbohydrates were determined using the phenol sulfuric method, while the sucrose was determined through the incubation of each sample with the invertase enzyme. Results: The average value of pH was 2.61 (±0.29). The processed fruit juices analyzed needed, in average, 6.2 mL (±1.9) of NaOH in order to increase the pH to 7.0. The total carbohydrates showed to be according to the values presented in the labels. The sucrose content verified in each drink was very low and varied from 0.60 to 0.93 g / 200 mL. Conclusion: This study showed that the 15 drinks analyzed had low pH and erosive potential, once most juices presented high BC. The sucrose presented in each drink was very low, suggesting that they are not cariogenic. Nevertheless, further studies that demonstrate the action of these juices in the dental surface are required.