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

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

Changes in Oral Health-Related Behaviors and Oral Health of Children in Early Childhood during Social Isolation Caused by COVID-19

ABSTRACT Objective: To assess changes in oral health-related behavior and oral health status in Brazilian children in early childhood perceived by their parents/caregivers during social isolation caused by COVID-19. Material and Methods: A cross-sectional study with parents/caregivers of children in southeastern Brazil aged 0-5 years who responded to an online questionnaire about sociodemographic data, dietary changes, oral hygiene, and oral health status of children during the COVID-19 pandemic. Results: Of the 119 parents/caregivers, 54.60% did not observe any changes in eating habits, and 81.50% maintained their children's oral hygiene. Associations were observed between the impact of the pandemic on the family income and changes in eating habits (p=0.02) and between lower family income and dental caries perceived by parents/caregivers (p=0.05). Z tests with Bonferroni correction showed that families with drastic income reduction were more likely to consume lower-cost foods (62.50%) than families with no impact or slight reduction on family income. Parents/caregivers did not identify dental caries (89.10%), toothache (92.40%), and dental trauma (92.40%) in their children. Conclusion: Parents/caregivers of children in southeastern Brazil aged 0-5 years observed behavioral changes in the dietary habits of families whose income was impacted by the pandemic, and their perception of dental caries was significantly associated with family income.

Traumatic dental injuries in children: experience during the Covid-19 pandemic and parents' knowledge about their management

Abstract The social isolation measures adopted during the critical phase of the COVID-19 pandemic led children to spend most of their time at home. Isolation may alter the pattern of traumatic dental injury occurrences, inasmuch as studies point out that most traumatic accidents occur at home. Considering this scenario and the influence of emergency management on the prognosis of the injury, the aim of this study was to evaluate the experience of traumatic dental injuries in children before and during the pandemic, and the knowledge of this topic by the children's guardians. This cross-sectional study was conducted with guardians of children aged 0 to 6 years, residing in Juiz de Fora, MG, Brazil. The guardians answered an online questionnaire addressing personal information, traumatic dental injury experience before and during the pandemic, and knowledge of this topic. Descriptive and statistical analyses were performed using Pearson's chi-square test at a 5% significance level. The total sample consisted of 343 volunteers. A total of 95 and 92 injuries were reported before and during the pandemic, respectively; the home was the place of greatest occurrence. Most volunteers (88.1%) agreed that traumatic dental injuries are emergency situations, and were aware that the tooth/fragment had to be taken to the dentist after a fracture or avulsion (97.4%). This study revealed that the traumatic dental injury experience was similar before and during the pandemic, and that the volunteers had satisfactory knowledge, especially in recognizing the importance of immediate attention for a more favorable prognosis of these injuries.

Association Between Dental Caries Experience and Socioeconomic Determinants on Oral Health-Related Quality of Life among Children and their Families

ABSTRACT Objective: To assess the association between dental caries experience, severe dental caries experience and socioeconomic determinants on oral health-related quality of life among children and their families. Material and Methods: This is a cross-sectional study whose sample was composed of children aged 4-12 years, who sought dental care in a dentistry school clinic, and their parents/caregivers. Dental caries experience and severe dental caries experience were assessed according to the DMF-T/dmf-t indexes. Parents/caregivers answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ), the Family Impact Scale (FIS) and a questionnaire on socioeconomic and demographic conditions. Data analysis included the chi-square test and Poisson regression (PR). Results: The sample was composed of 105 children and their parents/caregivers. Severe dental caries experience in children was determinant for negative perception of children's OHRQoL by parents/caregivers (PR = 1.22; CI = 1.05-1.41). Negative impact on OHRQoL perceived by family members was determined by severe dental caries experience in children (PR = 1.22; CI = 1.05-1.42) and family income <5 minimum wage (PR = 1.32; CI = 1.08-1.61). Conclusion: Severe dental caries experience was associated with a negative impact on OHRQoL perceived by children and their families. Low family income was associated with a negative impact on the OHRQoL perceived by children and their families.

Occurrence of Dental Trauma in a Group of Children with Autistic Spectrum Disorder

ABSTRACT Objective: To assess the occurrence of dental trauma in a group of children with Autistic Spectrum Disorder (ASD) in comparison to children without the disorder. Material and Methods: This is a cross-sectional study conducted at the Department of Children and Adolescents Health in the Department of Health of Juiz de Fora, Brazil. The study included individuals with and without ASD, between three and 16 years old, and their parents/caregivers. Children/adolescents were assessed for dental trauma by clinical examination. All exams were performed by a trained and calibrated examiner (MCT), and intra-examiner reliability was previously established (Kappa=0.93). The Socio-demographic status was reported by parents/caregivers. Data analysis included descriptive statistics and generation of frequency distributions. Fisher's exact test was used to evaluate the association between groups of children/adolescents with and without ASD about the presence of dental trauma. The significance level was set at p < 0.05. Results: Sixty children of both sexes participated in the study, thirty with a diagnosis of ASD and thirty without. The age ranging from 3 to 13 years, with an average of 7.5 ± 3.2 years. Children with ASD had a higher frequency of dental trauma than children without ASD (p=0.02), and the most frequent type of trauma was enamel fracture (57.10%), followed by enamel/dentin fracture without pulp exposure (42.90%). Conclusion: Children with ASD, when compared to children who did not have ASD, had a higher occurrence of dental trauma.

Early Childhood Caries Experience of Children from Poor Families Living Below and Above Poverty Line

ABSTRACT Objective: To evaluate the role of poverty and its related factors on early childhood caries (ECC) experience among deprived children. Material and Methods: This population-based cross-sectional study surveyed 418 children aged one to six years enrolled in Brazilian public preschools from an area of the country known for its high social deprivation. Intraoral examination of children evaluated dental caries experience (dmft). Parents/caregivers answered a questionnaire with sociodemographic indicators. Family income was dichotomized into below or above poverty line. Data analysis used Chi-square test, Mann-Whitney test, and Multivariate Logistic Regression analysis (p<0.05). Results: Predisposing variables for an increased chance of ECC were: age group 3-4 years (OR: 4.89; 95% CI: 2.32-10.31), age group 5-6-years (OR: 5.60; 95% CI: 2.60-12.04), being part of families living below poverty line (OR: 1.88; 95% CI: 1.04-3.38) and having mothers with less than nine years of schooling (OR: 2.86; 95% CI: 2.77-7.14). Children from families living below poverty line presented higher dmft (2.9 +3.8; p=0.001) and untreated dental caries (d component) (2.7 +3.7; p=0.002). Conclusion: ECC in a poor population was influenced by indicators of social deprivation. The poorest of poor children from mothers with less years of schooling were at higher risk.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis

Abstract Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.

Longitudinal study on clinical and microbial analysis of periodontal status in pregnancy

Abstract This study was aimed to provide a longitudinal overview of the subgingival bacterial microbiome using fluorescence in situ hybridization (FISH) technique, in women in the second trimester of pregnancy (between 14 and 24 weeks), and 48 h and 8 weeks postpartum. Of 31 women evaluated during pregnancy, 24 returned for the 48-h and 18 for their 8-week exams postpartum. Probing depth (PD), bleeding on probing, clinical attachment level, and presence of calculus were recorded. Subgingival plaque samples were collected, and FISH was used to identify the numbers of eight periodontal pathogens. Friedman test was used to compare differences between follow-up examinations, followed by a multiple comparison test for a post hoc pairwise comparison. Clinically, a significantly greater number of teeth with PD = 4-5 mm were found during pregnancy than on postpartum examinations. Microbial analysis showed a statistically significant decrease in cell count over the study period for Prevotella nigrescens. P. intermedia, Campylobacter rectus, and Porphyromonas gingivalis also decrease, although not significantly, and Aggregatibacter actinomycetemcomitans increased. No significant changes were found for Fusobacterium nucleatum, Treponema denticola, or Tannerella forsythia. Our data demonstrate a change in the subgingival microbiota during pregnancy, at least for P. nigrescens.

Clinical Effectiveness of Two Commercial Fluoride Varnish Formulations on the Control of White Spot Lesion in Primary Teeth: A Pilot Study

To evaluate the in vivo clinical effectiveness of two commercial fluoride varnish formulations.Material and Methods:The sample consisted of seven children aged 2-5 years for a total of 24 active white spot lesions (WSL) in primary teeth. Children were randomly divided into two groups in accordance with the varnish used: G1 -Duraphat® -DR (n = 14 WSL); and G2 -Duofluorid XII® -DF (n = 10 WSL). Children were submitted to treatment with varnishes applied once a week for four consecutive weeks. Maximum mesiodistal and incisogengival dimensions were measured with a periodontal probe at the beginning of treatment and on the fifth week of treatment. The average between the two dimensions represented the value of the WSL dimension. The comparison of the mean final values of WSL dimensions between groups of fluoride varnishes tested was analyzed by the Mann-Whitney U test. The significance level adopted was 5%. Results:After five weeks, most WSL were ranked as inactive (G1 = 71.4% and G2 = 40%). No significant difference between G1 and G2 in relation to lesion activity was observed (p = 0.124). There was a significant decrease of 24% between initial (3.12 mm ± 1.49 mm) and final WSL dimension (2.35 mm ± 1.06 mm) (p = 0.012) in G1. In G2, there was a significant reduction of 40% in lesion dimension with initial value of 5.7 mm (± 3.82 mm) and final value of 3.4 mm (± 3.35 mm) (p = 0.013). Regarding the reduction in the WSL dimension, no significant difference between groups was observed (p = 0.931). Conclusion:Both fluoride varnish formulations tested had similar effect on the control of active white spot lesions in primary teeth...

Nível de cortisol salivar entre crianças em tratamento odontológico - Um estudo piloto / Salivary cortisol levels in children undergoing dental treatment - A pilot study

Objetivo: Situações capazes de induzir à ansiedade, como o tratamento odontológico, correlacionam-se com o aumento do cortisol livre circulante, o qual pode ser utilizado como indicador de estresse. O presente estudo determinou os níveis de cortisol salivar de crianças em tratamento odontológico.Métodos: Foram incluídas crianças com idade entre sete e dez anos atendidas em uma Faculdade de Odontologia no segundo semestre de 2010. Após preenchimento do prontuário clínico, duas amostras de saliva foram coletadas empregando o kit Salivettes®. As amostras foram coletadas em um dia de consulta odontológica, antes da realização do exame físico e imediatamente após o mesmo, enviadas para análise laboratorial por meio de ensaio de quimioluminescência. Os resultados obtidos foram expressos em µg/dL. O teste de Wilcoxon foi aplicado para verificar a diferença dos níveis de cortisol salivar antes e após a consulta na amostra total e entre crianças de mesmo sexo. O teste U de Mann-Whitney foi utilizado para análise da diferença entre grupos de crianças do sexo masculino e feminino. Adotou-se o nível de significância de 5%. Resultados: Dezenove crianças participaram da amostra final (9 meninos e 10 meninas). Para a amostra total, as médias de cortisol determinadas foram 0,14 µg/dL e 0,09 µg/dL, nas coletas antes e após a consulta, respectivamente, com diferença significativa (P=0.002). Observou-se redução significativa no nível de cortisol salivar após a realização da consulta (P=0.011) entre as meninas. Conclusão: O período anterior a uma consulta odontológica pode gerar maior ansiedade/estresse entre crianças do que a própria consulta...

Objective: Situations capable of inducing anxiety, such as dental treatment, are associated with an increase of circulating free cortisol, which may be used as a stress indicator. This study measured the salivary cortisol levels of children undergoing dental treatment. Method: Children aged 7 to 10 years undergoing dental treatment at a Dental School in the 2nd semester of 2010 were enrolled in the study. After filling dental chat, two samples of saliva were collected with a Salivettes® kit on the consultation day before and immediately after the physical examination. The samples were sent for laboratory analysis by the chemiluminescence assay. The obtained results were expressed in Ág/dL. The Wilcoxon test was used to verify the difference in the salivary cortisol levels before and after the dental consultation in the whole population and among children of the same gender. The Mann-Whitney U test was used to analyze the differences between the female and male children. The significance level was set at 5%. Results: Nineteen children (9 boys and 10 girls) comprised the final sample. The whole population exhibited cortisol levels of 0.14 Ág/dL and 0.09 Ág/dL before and after the consultation, respectively, with a statistically significant difference between them (p=0.002). Among the girls, there was a significant decrease of salivary cortisol levels after the consultation (p=0.011). Conclusion: The period that antecedes a dental consultation may produce greater anxiety/stress in children than the consultation itself...

Detection and enumeration of periodontopathogenic bacteria in subgingival biofilm of pregnant women

The aim of this study was to use the fluorescence in situ hybridization (FISH) technique to test the hypothesis of qualitative and quantitative differences of 8 periodontopathogens between pregnant and non-pregnant women. This cross-sectional study included 20 pregnant women in their second trimester of pregnancy and 20 non-pregnant women. Probing depth, bleeding on probing, clinical attachment level, and presence of calculus were recorded. Subgingival plaque samples were collected and the FISH technique identified the presence and numbers of Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Campylobacter rectus, Porphyromonas gingivalis, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia and Prevotella nigrescens. The Mann-Whitney U-test was applied to compare the data between the two groups. The mean age, ethnicity, marital status, education, and economic level in both groups were similar. The clinical parameters showed no significant differences between pregnant and non-pregnant women. The numbers of subgingival periodontopathogens were not found to be significantly different between groups, despite the higher mean counts of P. intermedia in pregnant women. Colonization patterns of the different bacteria most commonly associated with periodontal disease were not different in the subgingival plaque of pregnant and non-pregnant women.

Hábitos de dieta e cárie precoce da infância em crianças atendidas em faculdade de odontologia brasileira / Dietary habits and early childhood caries in children treated at a brazilian dental school

Objetivo: Avaliar a associação entre hábitos de dieta e a presença de Cárie Precoce da Infância (CPI) em um grupo de crianças atendidas em uma Universidade Pública, Minas Gerais - Brasil. Método: Foram incluídas 69 crianças (30 meninos; 39 meninas), com idade entre 13 e 60 meses. O índice ceo-d foi determinado por um único examinador treinado (coeficiente de kappa = 1), segundo critérios preconizados pela Organização Mundial da Saúde. Diário alimentar de três dias foi preenchido pelos pais e/ou responsáveis para obtenção dos dados sobre a dieta. A análise estatística incluiu os testes Qui-Quadrado e Exato de Fischer, seguidos por análise de regressão logística múltipla. Adotou-se o nível de significância de 5% (alfa = 0,05). Resultados: A CPI foi diagnosticada em 87% da amostra (60/69 crianças). Registrou-se um índice ceo-d médio igual a 9,20. A frequência média de ingestão de carboidratos foi alta (mais de cinco vezes por dia) para 82,6% das crianças (57/69). Não houve associação significativa entre frequência de ingestão de açúcar e presença de cárie (P = 0,183). O modelo de regressão logística múltipla demonstrou associação inversa entre consumo de "outros alimentos" e ausência de cárie (P = 0,02). Estes resultados sugerem a necessidade de aconselhamento de dieta com respeito ao consumo de certos alimentos associados à CPI na amostra estudada. Conclusão: A alta frequência média de ingestão de dieta cariogênica não se associou à presença de Cárie Precoce da Infância, assim como indicaram que o consumo de certos alimentos se associou à ausência da doença.

Objective: To evaluate the association between dietary habits and presence of early childhood caries (ECC) in a group of children treated at a public University in the state of Minas Gerais, Brazil. Method: Sixty-nine children (30 boys and 39 girls) aged 13 to 60 months were enrolled in the styudy. The dmf-t index was determined by a single trained examiner (kappa coefficient = 1), according to criteria preconized by the World Health Organization. A three-day diet journal was filled out by parents and/or caregivers to collect data from the children's diet. The statistical analysis included the chi-square and Fisher's exact tests, followed by multiple logistic regression analysis. A significance level of 5% was adopted (alpha = 0.05). Results: ECC was diagnosed in 87% of the sample (60/69 children). A mean dmf-t index of 9.20 was recorded. The mean frequency of ingestion of carbon hydrates was high (more than five times a day) for 82.6% of the children (57/69). There was no significant association between frequency of sugar ingestion and presence of caries (p=0.183). The multiple logistic regression model revealed an inverse association between consumption of "other foods" and absence of caries (p=0.02). These results suggest the need of dietary counseling with respect to the consumption of certain foods associated with ECC in the studied sample. Conclusion: The high mean frequency of ingestion of a cariogenic diet was not associated with the presence of ECC, and the consumption of certain foods was related to the absence of the disease.

Effect of bovine hydroxyapatite on early stages of bone formation / Efeito da hidroxiapatita bovina no período inicial de formação óssea

PURPOSE: This study aimed to characterize the effect of bovine hydroxyapatite particles (HA) on the early stages of bone repairing in a rat femur defect model. METHODS: A non-critical 2 mm diameter bone defect was made in both femurs of 25 male albino Wistar rats. The left femurs defects were filled with HA and the right femurs defects were just let to fill with blood. Five animals were sacrificed at the 1st, 3rd, 5th, 7th or 14th post-surgery day and bone tissue sections were stained with hematoxylin and eosin for comparison of inflammatory response by light microscopy. Histomorphometrical analysis of the newly formed bone was evaluated at the three last periods, using independent t-student test to compare both groups at each period (a=0.05). RESULTS: Histological analyses showed same standard of bone repair on first and third day; however, from the fifth post-surgery day there was a higher deposit of collagen fibers surrounding the hydroxyapatite particles and a greater thickness of the opposite side periosteum. There was no significant histomorphometrical difference between groups at all periods. CONCLUSION: It can be concluded that hydroxyapatite does not accelerate the early-stage of bone repairing, despite of induction of a higher deposit of collagen fibers.

OBJETIVO: O objetivo deste estudo foi caracterizar o efeito das partículas de hidroxiapatita bovina (HA) nos estágios iniciais da reparação óssea em modelo de defeito ósseo em fêmur de ratos. METDOLOGIA: Defeito ósseo não crítico de 2 mm de diâmetro foi feito em cada fêmur de 25 ratos Wistar albinos. O defeito do fêmur esquerdo foi preenchido com HA enquanto a cavidade direita foi preenchida apenas com sangue. Cinco animais foram sacrificados no 1º, 3º, 5º, 7º e 14º dia pós-cirúrgico. Os cortes histológicos do tecido ósseo foram corados com hematoxicilina e eosina para comparação da resposta inflamatória por microscopia óptica. Análise histomorfométrica do tecido ósseo neoformado foi avaliado nos três últimos períodos utilizando o teste t de Student para comparação de ambos os grupos em cada período de avaliação (a=0,05). RESULTADOS: A análise histológica mostrou o mesmo padrão de reparação óssea no 1º e 3º dia; entretanto, no 5º dia pós-cirúrgico houve um maior depósito de fibras de colágeno ao redor dos cristais de hidroxiapatita e uma maior espessura do perióstio oposto. Não houve diferença histomorfométrica significativa entre os grupos em todos os períodos avaliados. CONCLUSÃO: Pode ser concluído que a hidroxiapatita não acelera os estágios inicias da reparação óssea, apesar de induzir a um maior depósito de fibras de colágeno.

A experiência de um programa de atenção à saúde bucal no atendimento às gestantes / Experience of an oral health attention program in attendance of pregnant women

O Projeto Só-Riso - Atenção Materno-Infantil é um projeto de extensão no qual alunos da Faculdade de Odontologia da Universidade Federal de Juiz de Fora, MG, realizam tratamento de gestantes visando a preservação da sanidade gestacional e promoção de saúde ao binômio mãe-filho. O objetivo deste estudo foi relatar a experiência da instituição no atendimento às gestantes. Foi coletado do prontuário dados sociodemográficos, distúrbios sistêmicos, condição de saúde bucal, tratamentos executados e encaminhamentos necessários. Utilizou-se análise descritiva da frequência absoluta e relativa. Foram atendidas 78 gestantes, com média de idade de 27,9 anos. Infecção geniturinária foi o distúrbio sistêmico mais comum (11/78). Todas as gestantes receberam orientação sobre saúde geral e bucal e foram submetidas à profilaxia antes do exame clínico. Selamento provisório de lesões cavitadas (66/78) e raspagem periodontal (60/78) representaram a maioria dos procedimentos executados. A alta prevalência de cárie dentária e doença periodontal encontrada demonstra a necessidade de atenção a esta população. Demonstrou-se que é possível o tratamento e a desmistificação do atendimento à gestante, principalmente em nível de atenção básica.

“Só-Riso – Atenção Materno-Infantil” is a extension project where students of the Dental School of Federal University of Juiz de Fora, Brazil, accomplish treatment of pregnant women in order to achieve preservation of the gestational sanity and health promotion of mother and child. The purpose of this study was to relate the experience of this institution in the assistance of these women. It was registered from the records information about socio-demographic data, systemic disturbances, condition of oral health, preventive and curative procedures performed and directions to other levels of attention. Descriptive analysis, which registered absolute and relative frequency were used. Seventy eight pregnant women, mean age 27.9 years, were assisted. Urinary tract infections were the most common (11/78) systemic disturbance. All women received guidance on general and oral health and were submitted to dental prophylaxis before oral examination. Temporary cavity sealing (66/78) and periodontal scaling (60/78) represented most of procedures carried out. The high prevalence of dental caries and periodontal disease has shown the need of continuing attention. It was also demonstrated that it is possible the treatment and demystification of pregnant women’s assistance, mainly at basic assistance.

Condição bucal de gestantes: implicações na idade gestacional e peso do recém-nascido / The oral condition of pregnant women: implications on the gestational age and weight of new born babies

Este estudo retrospectivo verificou a associação entre condição bucal de gestantes e idade gestacional e peso ao nascimento de seus filhos. Os dados foram coletados dos prontuários clínicos das díades (gestantes/bebês) assistidas em Instituição de Ensino Superior. Para as gestantes, foram registrados dados demográficos, socioeconômicos, história gestacional, índice de dentes permanentes cariados, perdidos e obturados e índice periodontal comunitário de necessidade de tratamento. Para os bebês, os registros incluíram idade gestacional e peso ao nascimento. Utilizou-se análise estatística descritiva e cálculo da razão de chance (Odds-Ratio) para expressar a associação entre condição bucal e idade gestacional e/ou peso ao nascimento. A amostra de 83 gestantes/bebês foi dividida em dois grupos. O Grupo 1 incluiu 59 gestantes/bebês a termo com peso normal. O Grupo 2 incluiu 24 gestantes/bebês prematuros e/ou de baixo peso. Maiores frequências foram encontradas para a alta gravidade de cárie dentária (31%) e grau leve de doença periodontal (65%). A presença de cárie ativa (P=0,167) e de bolsa periodontal (P=0,677) não se associou à prematuridade e/ou baixo peso ao nascer. A alta prevalência de cárie dentária e doença periodontal determinada neste grupo de gestantes não se associou ao nascimento prematuro e/ou de baixo peso.

This retrospective study evaluated the association between oral condition of pregnant women and gestational age and birth weight of their children. Data were collected from medical records of the groups (pregnant women/babies) assisted in a School of Dentistry. Demographic, socio-economic and history of pregnancy data, as well as index of decayed, missing and filled permanent teeth and Community Periodontal Index of Treatment Needs were registered for pregnant women. For the babies, reports included gestational age and weight at birth. Odds-Ratio and Descriptive Statistical Analysis were used to express the association between oral condition and gestational age and/or birth weight. The sample of 83 pregnant women/babies was divided into two groups. Group 1 included 59 pregnant women/term babies with normal weight. Group 2 included 24 pregnant women/preterm and/or low weight babies. High frequency was found for high dental caries severity (31%) and low level of mild periodontal disease (65%). The presence of active lesions of dental caries (P=0.167) and periodontal pocket (P=0.167) did not associate with premature and/or low birth weight babies. The high prevalence of dental caries and periodontal disease determined in this group of pregnant women was not associated with pre-term birth and low birth weight.

Pacientes hipertensos e a anestesia na Odontologia: devemos utilizar anestésicos locais associados ou não com vasoconstritores? / Hypertensive patients and anesthesia in Dentistry: we should use local anesthetics associates or not with vasoconstrictors agents?

Anestésicos locais associados a alguns vasoconstritores podem ser utilizados em pacientes hipertensos na odontologia. A felipressina ou a epinefrina são os mais indicados no atendimento a pacientes com hipertensão controlada no estágio I ou II. Quando utilizada em doses terapêuticas e, evitando-se a administração intravascular, as alterações pressóricas que podem ocorrer com os vasoconstritores adrenérgicos como a elevação na pressão sistólica, são compensadas por uma diminuição na resistência vascular periférica e, consequentemente,uma diminuição da pressão diastólica. Portanto, a preocupação deve ser com o aumento na concentração sanguínea de catecolaminas, em função de uma sobredosagem e/ou administração intravascular inadvertida,principalmente, se associados a um elevado grau de estresse e de ansiedade. A potencialização dos seus efeitos sistêmicos pode ainda estar relacionada a interações medicamentosas em pacientes que fazem uso de antihipertensivos do tipo beta-bloqueadores não-seletivos ou diuréticos não caliuréticos, que poderiam estar mais susceptíveis a possíveis precipitações de episódios hipertensivos motivados por estes vasoconstritores. Uma anamnese bem detalhada, uma anestesia mais eficaz com a associação de um vasoconstritor, bem como o controle da ansiedade e do medo frente a um tratamento odontológico são benéficos no atendimento aos hipertensos.

Local anesthetics associates with vasoconstrictors agents should be used in the hypertensive patients in Dentistry. Felypressin or epinephrine are the most indicated for the treatment of patients with controlledhypertension in stages I or II. When adrenergic vasoconstrictors agents are used in therapeutic doses and avoiding intravascular injection, the pressure alterations that may occur, such as an increase systolic pressure, are compensated by a reduction in peripheral vascular resistance and consequently, a reduced diastolic pressure. Therefore, attention must be paid to the decrease in blood catecholamine as a result of an overdose and/or unintentional intravascular injection, especially if associated with a high degree of stress and anxiety. The strengthening of its systemic effects may still be related to medical interactions in patients using non-specific beta-blocking anti-hypertension drugs or non-caliuretics diuretics, who might be more susceptible to possible occurrences of hypertension episodes motivated by vasoconstrictors agents. A detailed examination, a more effective anesthesia associated with vasoconstrictor, as well as anxiety and fear control when facing dental treatment are beneficial when treating hypertensive patients.

Reabilitação estético-funcional em odontopediatria: relato de um caso clínico / Aesthetic and functional rehabilitation in pediatric dentistry: a case report

Apesar de todos os procedimentos preventivos utilizados em Odontopediatria, ainda são frequentes os casos de crianças com necessidade de reabilitação estético-funcional, devido à perda de dentes decíduos por cárie precoce da infância. As alterações estéticas e funcionais causadas por estas perdas podem influenciar no desenvolvimento biopsicossocial da criança. Nestes casos, a prótese total é o último recurso a ser utilizado com a finalidade de restaurar a função mastigatória, normalizar a fonação, a estética, e possibilitar um ajuste social e emocional do paciente. Este estudo relata um caso de reabilitação estético-funcional de uma paciente de 5 anos de idade, portadora de cárie precoce da infância, em quem foi necessário utilizar a confecção de uma prótese total superior. Após exodontia de todos os dentes decíduos superiores, controle da doença (cárie) e restauração dos elementos inferiores comprometidos, uma prótese total superior foi confeccionada para a paciente, por meio de uma técnica semelhante à utilizada para adultos. A técnica proposta permitiu restabelecer a função mastigatória, melhorar a fonação e a estética da criança bem como resultou na satisfação com o tratamento, demonstrada pela paciente, sua mãe e seus familiares.

In spite of all preventive procedures used in Pediatric Dentistry, cases of children in the need of aesthetic and functional rehabilitation are still frequent due to the loss of deciduous teeth caused by early childhood caries. The aesthetic and functional changes caused by such losses may influence the child's bio-psychosocial development. In such cases, the total prosthesis is the last resource used in order to restore the masticatory function, normalize speech and aesthetics, and allow social and emotional adjustment. This article reports a case of aesthetic and functional rehabilitation of a five year old patient carrying early childhood caries. Therefore, an upper total prosthesis was made. After exodontia of all upper deciduous teeth, caries control and restoration of compromised lower teeth, an upper total prosthesis was made, similar to the one used for adults. The proposed technique allowed recovering of the masticatory function, improvement of speech and aesthetics, and the results of the treatment were considered satisfactory by the patient, the mother and relatives.

Humanização na Odontologia: a Experiência da Disciplina Odontopediatria II do Curso de Graduação em Odontologia da UFJF / Humanizing Dentistry: the Experience of the Pediatric Dentistry II Discipline of the Dental Graduation Course of UFJF

Objetivo: Avaliar se a Disciplina Odontopediatria II permite oestabelecimento de uma relação aluno-paciente, pais e/ouresponsáveis satisfatória, bem como a satisfação do usuário.Método: O estudo foi conduzido na Faculdade de Odontologia daUniversidade Federal de Juiz de Fora (UFJF) no primeiro semestreletivo de 2007. A amostra incluiu 19 acadêmicos matriculados nodécimo período do Curso de Odontologia da UFJF (Grupo I) e 50usuários – pai, mãe ou responsável legal de pacientes atendidosna Clínica da Disciplina Odontopediatria II (Grupo II). Dois formuláriosestruturados foram elaborados e aplicados aos voluntários. Aanálise descritiva foi utilizada para os dados quantitativos obtidosdas questões fechadas. Para as questões abertas, utilizou-se umaabordagem quali-quantitativa.Resultados: A análise do formulário aplicado aos alunos demonstrouatitudes favoráveis ao estabelecimento de uma relação satisfatóriae humanizada com os pacientes e seus pais e/ou responsáveis,tendo como fator facilitador a presença e conhecimento dasprofessoras. Como fatores dificultadores, foram citados a nãoparticipação efetiva dos pais no controle de dieta e higiene e ocomparecimento às consultas. Entre os usuários, verificou-se umelevado grau de satisfação com o atendimento. A fala dos usuáriosapontou o forte reconhecimento da atuação dos acadêmicos,demonstrando o papel fundamental do aluno para a humanizaçãodo atendimento na disciplina. Os resultados alcançados permitirãoo aprimoramento da disciplina.Conclusão: A Disciplina Odontopediatria II do Curso de Graduaçãoem Odontologia da UFJF está contribuindo para formação de umprofissional humanizado, assim como está proporcionando asatisfação da comunidade assistida.

Associação entre doença periodontal em gestantes e nascimentos prematuros e/ou de baixo peso: um estudo de revisão / Association between periodontal disease in pregnant women and preterm and/or low weight births: a review study

O nascimento de bebês prematuros (menos de 37 semanas de gestação) e de baixo peso (menos que 2.500g) está associado à elevada taxa de mortalidade no período pós-natal. Além do efeito significante na taxa de mortalidade infantil, há evidência crescente para ligar esses nascimentos a outros problemas de saúde que podem incapacitar estas crianças total ou parcialmente pelo resto da vida. Nos últimos anos, a hipótese de que a doença periodontal (DP) está associada ao nascimento de bebês prematuros e/ou de baixo peso tem recebido atenção considerável. Dessa forma, o objetivo deste estudo foi verificar, na literatura, se há evidência da associação entre DP na gestante e resultados adversos na evolução e desfecho da gestação e os possíveis mecanismos envolvidos nesta associação. Os estudos revisados parecem indicar que existe uma evidência de associação entre a DP em gestantes e um risco aumentado para nascimentos de bebês prematuros e/ou de baixo peso. A plausibilidade biológica da associação fundamenta-se na indução, pelos patógenos periodontais, da produção de mediadores inflamatórios (prostaglandinas e interleucinas) capazes de levar ao trabalho de parto e afetar o desenvolvimento fetal a distância. São necessários estudos de intervenção controlados para esclarecer a associação entre a doença e resultados adversos na gestação e estabelecer o benefício potencial do tratamento periodontal em reduzir estes nascimentos. Novos estudos poderiam, ainda, investigar os fatores locais e sistêmicos que podem predispor as gestantes ao estabelecimento e/ou agravamento da DP, bem como avaliar o impacto da prematuridade e/ou baixo peso ao nascimento em seus bebês.

Preterm (under 37 weeks of gestational age) and low weight infants (under 2.55g) have an elevated mortality rate in the postnatal period. Besides the significant effect on infant mortality rate, there is increasing evidence linking these births to other health problems that may disable a child totally or partially for the rest of his/her life. In the last years, the hypothesis that periodontal disease (PD) is related to preterm and/or low weight births has received considerable attention. According to this hypothesis, the objective of this study was to assess, the literature, for evidence of the association between PD in pregnant women and adverse results on the development and closing of the gestational period and possible mechanisms involved in this association. The revised studies seem to indicate that there is evidence of an association between PD in pregnant women and an increasing risk for preterm and/or low weight births. The biological rationale for this association is based on induction, periodontal pathogens, production of inflammatory mediators(prostaglandins and interleukins) able to induce labor and affect fetal development in the long run. Controlled intervention studies are necessary to clarify the association between the disease and adverse results during gestation and establish the beneficial potential of periodontal treatment at reducing these births. New studies could, still, investigate the local and systemic factors that may predispose the pregnant women to the establishment and/or severity of PD as well as evaluate the impact of preterm and/or low weight births of their infants.

Relationship between maternal periodontal disease and birth of preterm low weight babies

It has been recently suggested that periodontal disease is an associated factor for prematurity and low birth weight. The aim of this work was to assess the periodontal status of puerperae and determine its possible relationship with preterm low birth weight (PLBW) delivery. The sample included 59 women seen at two maternity hospitals in Juiz de Fora, MG, Brazil. Nineteen mothers had premature and low birth weight babies (gestational age below 37 weeks and birth weight below 2,500 g - group I), and 40 had mature, normal weight babies (gestational age over 37 weeks and birth weight over 2,500 g - group II). The mothers' data were obtained from medical files, interview, and periodontal clinical examination carried out up to 48 hours after delivery. The Periodontal Screening and Recording (PSR) was used for periodontal assessment. The association between periodontal disease and PLBW was expressed as odds ratio (OR). There was a higher rate of periodontal disease in group I (84.21 percent - 16/19) as compared with group II (37.5 percent - 15/40). The data also showed a significant association between periodontal disease and PLBW (OR = 8.9 - 95 percent CI: 2.22-35.65 - p = 0.001). It was concluded that maternal periodontal disease was an associated factor for prematurity and low birth weight in this sample.

Estudos recentes sugerem que a doença periodontal é um fator associado para prematuridade e baixo peso ao nascimento. O objetivo deste trabalho foi avaliar a condição periodontal de puérperas e determinar sua possível associação com nascimentos prematuros e de baixo peso (NPBP). A amostra incluiu 59 mães atendidas em duas maternidades de Juiz de Fora, MG. Dentre essas, 19 tiveram bebês prematuros e de baixo peso (idade gestacional menor que 37 semanas e peso ao nascimento menor que 2.500 g - grupo I) e 40 tiveram bebês a termo e de peso normal (idade gestacional maior que 37 semanas e peso ao nascimento maior que 2.500 g - grupo II). Os dados das mães foram obtidos através de prontuário médico, entrevista e exame clínico periodontal, realizado até 48 horas após o parto. O Registro Periodontal Simplificado (RPS) foi utilizado para avaliar a condição periodontal. A associação entre doença periodontal e NPBP foi expressa em "odds ratio" (OR). Os resultados demonstraram uma freqüência maior de doença periodontal no grupo I (84,21 por cento - 16/19) em comparação ao grupo II (37,5 por cento - 15/40). Os dados demonstraram ainda uma associação significante entre a presença de doença periodontal e NPBP (OR = 8,9 - IC de 95 por cento: 2,22-35,65 - p = 0,001). Concluiu-se que a doença periodontal materna atuou como fator associado para a prematuridade e o baixo peso ao nascimento nesta amostra.