Prevalence of malocclusion in public school students in the mixed dentition phase and its association with early loss of deciduous teeth

ABSTRACT Objective: To determine the prevalence of malocclusion and its association with the early loss of deciduous teeth and other factors in children in the mixed dentition phase, aged six to eight years, enrolled in public schools in southern Brazil. Methods: A cross-sectional study was conducted with a representative sample of 528 children from municipal public schools in 2009. Data collection involved a clinical examination for the determination of early tooth loss, dental caries, tongue pressure and malocclusion (outcome), as well as the administration of a questionnaire. Poisson regression analysis with robust variance was used to model the association between malocclusion and the independent variables. Results: The prevalence of malocclusion and early tooth loss was 69.1% and 21.8%, respectively. In the raw data analysis, malocclusion was associated with age, early tooth loss, dental caries and tongue pressure. After the adjustment, the likelihood of malocclusion was greater among children older than eight years, those who exerted tongue pressure on the teeth and those with early tooth loss. The likelihood of malocclusion was 24% greater among children with early tooth loss, compared to those without tooth loss. Conclusion: The early loss of deciduous teeth was associated with the occurrence of malocclusion in the children studied.

RESUMO Objetivo: Determinar a prevalência de má oclusão em crianças de seis a oito anos de idade no município de Florianópolis (Santa Catarina, Brasil), e a sua associação com a perda precoce de dentes decíduos. Métodos: Esse estudo transversal avaliou uma amostra representativa de 528 crianças de escolas públicas municipais de Florianópolis, no ano de 2009. Os dados foram coletados por meio de exame clínico (perda dentária precoce, cárie dentária, interposição lingual e má oclusão - que foi o desfecho do estudo) e de um questionário. A regressão de Poisson com variância robusta foi utilizada para modelar a associação entre má oclusão e as variáveis independentes. Resultados: A prevalência de má oclusão e de perda dentária precoce foi, respectivamente, de 66,7% e 21,8%. Na análise dos dados brutos, a má oclusão foi associada com a idade, perda dentária precoce e cárie dentária. Após ser feito o ajuste, crianças com mais de 7 anos, com interposição lingual e perda dentária precoce apresentaram maior probabilidade de ter má oclusão. Crianças com perda dentária precoce apresentaram probabilidade 24% maior de ter má oclusão do que aquelas sem perda dentária. Conclusões: A perda precoce de dentes decíduos foi associada à ocorrência de má oclusão nas crianças estudadas.

Immunohistochemistry of resorption and inflammation factors in the periodontal ligament of human deciduous teeth

Abstract: The understanding of the biological mechanisms involved in root resorption in deciduous teeth is important to the future development of preventive measures and treatments of this condition. The aim of the present study was to compare the expression and immunostaining of iNOS, MMP-9, OPG and RANKL in the periodontal ligament (PDL) of deciduous teeth with physiologic root resorption (GI), inflammatory pathological root resorption (GII) and permanent teeth (GIII), the negative control. Teeth in GI (n = 10), GII (n = 10) and (GIII) (n = 10) were submitted to immunohistochemical analysis to determine the expression of iNOS, MMP-9, OPG, and RANKL. The immunostaining was analysed by optical density. Statistical analysis included one-way ANOVA, followed by Student-Newman-Keuls post hoc test (p < 0.05). The results showed that iNOS, MMP-9 and RANKL expression in the PDL was higher in GII compared to GI and GIII (p < 0.05). Moreover, RANKL expression was higher in GI compared to GIII (p < 0.001), while OPG immunolabelling was lower in GII compared to GI and GIII (p < 0.001). The PDL of deciduous teeth bearing inflammatory processed exhibited upregulation of resorption-associated factors as well as enzymes related to tissue degradation which, in turn explains the exacerbation and greater susceptibility of those teeth to root resorption process.

Nível socioeconômico, saúde bucal e fatores associados no suporte social de gestantes: estudo transversal / Socioeconomic level, oral health, and associated factors in the social support of pregnant women: a cross-sectional study

Avaliar a associação entre variáveis socioeconômicas e relacionadas a saúde bucal no suporte social percebido por gestantes. Esse estudo transversal incluiu uma amostra obtida em conglomerados de gestantes atendidas no serviço público de saúde no sul do Brasil. As gestantes responderam questionários acerca de características demográficas, socioeconômicas e relacionadas à saúde bucal. O suporte social foi avaliado através da escala Medical Outcomes Study. As variáveis clínicas incluíram cárie dentária não tratada e sangramento gengival. Análise de Regressão de Poisson em multinível foram utilizados para avaliar a influência dos preditores no suporte social. A amostra foi composta por254 gestantes. Gestantes com pior autopercepção de saúde bucal, níveis extensivos de sangramento gengival e com menor nível socioeconômico apresentaram um pior suporte social. Fatores socioeconômicos e relacionados à saúde bucal exerceram impacto no suporte social percebido por gestantes.

To evaluate the association between socioeconomic and oral health-related variables in the social support perceived by pregnant women. This cross-sectional study included a sample obtained from clusters of pregnant women who attended public health services in southern Brazil. The pregnant women answered questionnaires about demographic, socioeconomic, and oral health characteristics. Social support was assessed using the Medical Outcomes Study scale. Clinical variables included untreated dental caries and gingival bleeding. Multilevel Poisson regression analysis was used to assess the influence of predictors on social support. The sample consisted of 254 pregnant women. Those with poorer self-perceived oral health, extensive levels of gingival bleeding, and lower socioeconomic status, presented poor social support. Socioeconomic factors and factors related to oral health had an impact on the social support perceived by pregnant women.

Acesso e utilização de serviços odontológicos por gestantes: revisão integrativa de literatura / Access and use of dental services by pregnant women: an integrative literature review

Resumo O objetivo deste artigo é identificar as produções científicas sobre o acesso e utilização de serviços odontológicos por gestantes. Foi realizada uma revisão integrativa de literatura com busca nas bases de dados BVS e MEDLINE/PubMed. Na base BVS os descritores foram: "acesso aos serviços de saúde", "saúde bucal" e "gestantes", e na PubMed: "Health services accessibility", "oral health" e "pregnant women", associados entre si pelo operador booleano AND. Foram encontrados cinco estudos que preencheram os critérios de inclusão e exclusão, sendo sistematizados em duas categorias empiricas e co-relacionadas: número expressivo de gestantes que não realizam o pré-natal odontológico e importância de medidas educativas que sinalizem a necessidade de receberem acompanhamento odontológico durante as consultas de pré-natal. Existe a necessidade de mais estudos, para embasar políticas de saúde pública que contemplem esta temática. As pesquisas existentes demonstram baixa adesão ao pré-natal odontológico e que os principais fatores observados como complicadores do acesso e utilização dos serviços odontológicos foram os relacionados aos aspectos socioeconômicos, culturais e educacionais.

Abstract The objective of this article is to identify the scientific productions on the access and use of dental services by pregnant women. A search was carried out on the BVS and MEDLINE/PubMed online databases to produce this integrative literature review. In the BVS database, the Portuguese descriptors were: "acesso aos serviços de saúde", "saúde bucal" and "gestantes", and in PubMed: "Health services accessibility", "oral health" and "pregnant women", all associated with each other by the Boolean operator "AND". We identified five studies that met the inclusion and exclusion criteria and were systematized into two empirical and co-related categories: the significant number of pregnant women who do not perform prenatal dental care and the importance of educational measures that signal the need to receive dental care during prenatal visits. Further studies on the subject are required to support public health policies that consider this theme. Existing research shows low adherence to prenatal dental care and that the main factors hindering the access to and use of dental services were related to socioeconomic, cultural and educational aspects.

Posições verticalizadas no parto e a prevenção de lacerações perineais: revisão sistemática e metanálise / Posiciones verticales en el parto y prevención de laceraciones perineales: revisión sistemática y metaanálisis / Upright positions in childbirth and the prevention of perineal lacerations: a systematic review and meta-analysis

RESUMO Objetivo Investigar se a adoção de posições verticalizadas pela mulher, no parto, comparada à posição litotômica, previne lacerações perineais. Método Revisão sistemática com metanálise. As buscas foram realizada nas bases de dados: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct e Scopus. As buscas na literatura cinzenta foram conduzidas nas bases Google Scholar e OpenGrey. Também foram consideradas as listas de referências dos artigos incluídos. Para análise da qualidade metodológica dos artigos, utilizou-se a ferramenta da colaboração Cochrane e a ACROBAT-NRSI. Resultados Foram elencados 26 estudos e 8 foram selecionados para a metanálise. O nível de evidência científica foi classificado pelo Sistema GRADE e considerado alto. Não houve diferença estatística significativa entre posições verticalizadas em relação as posições horizontais. Apesar dessa constatação, as posições verticalizadas apresentaram índices reduzidos de lacerações perineais graves. Conclusão A adoção de posições verticalizadas, no parto normal, pode ser encorajada pelos profissionais, pois pode evitar lacerações perineais graves, porém, não é possível afirmar com precisão a eficácia destas em detrimento das posições horizontais para o desfecho períneo íntegro.

RESUMEN Objetivo Investigar si la adopción de posiciones verticales por parte de la mujer en el parto, en comparación con la posición de litotomía, previene las laceraciones perineales. Método Revisión sistemática con metaanálisis. Se realizaron búsquedas en las siguientes bases de datos: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct y Scopus. Se realizaron búsquedas en la literatura gris en las bases de datos Google Scholar y Opengray. También se examinaron las listas de referencia de los artículos incluidos. La herramienta de colaboración Cochrane y el ACROBAT-NRSI se utilizaron para analizar la calidad metodológica de los artículos. Resultados Se enumeraron 26 estudios y se seleccionaron 8 para el metaanálisis. El nivel de evidencia científica fue clasificado por el Sistema GRADE y considerado alto. No hubo una diferencia estadística significativa entre las posiciones verticales y las horizontales. A pesar de este hallazgo, las posiciones verticales presentaban bajas tasas de laceraciones perineales graves. Conclusión La adopción de posiciones verticales en el parto normal puede ser fomentada por los profesionales, ya que puede evitar desgarros perineales severos, sin embargo, no es posible afirmar con exactitud su eficacia en detrimento de las posiciones horizontales para el resultado perineal completo.

ABSTRACT Objective To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position. Method A systematic review with meta-analysis. The searches were carried out in the databases: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct and Scopus. Searches in the gray literature were conducted on Google Scholar and OpenGrey databases. Reference lists of included articles were also considered. The Cochrane collaboration tool and ACROBAT-NRSI were used to analyze the methodological quality of the articles. Results There were 26 studies listed and 8 were selected for the meta-analysis. The level of scientific evidence was classified by the GRADE System and considered high. There was no statistically significant difference between upright positions in relation to horizontal positions. Despite this finding, the upright positions showed reduced rates of severe perineal lacerations. Conclusion Adopting upright positions in normal delivery can be encouraged by professionals as it can prevent severe perineal lacerations; however, it is not possible to accurately affirm their effectiveness to the detriment of horizontal positions for an intact perineum outcome.

Dental care utilization among children in Brazil: an exploratory study based on data from national household surveys / Utilização de serviços odontológicos entre crianças no Brasil: estudo exploratório a partir das pesquisas nacionais por amostra de domicílios

Abstract Wide availability of access to dental services can be considered a predictor of better oral health outcomes in a population. This article aims to compare data from the Brazilian National Household Sample Surveys (PNAD) on dental services utilization among children aged 4 to 12 years. This cross-sectional study was carried out using data from the 1998, 2003, and 2008 National Household Sample Surveys, involving a total of 61.438, 64.659 and 59.561 children, respectively. Ninety-nine percent confidence intervals were considered for the prevalence of each outcome of interest. In 1998, 60.8% (99%CI: 59.4;62.1) of children had been to a dentist; this prevalence was 65.5% (99%CI: 64.4;66.7) in 2003 and 73.8% (99%CI: 72.1;74.2) in 2008. In 1998, 41.2% (99%CI: 39.1;43.3) of children in the lowest household income quartile had been to a dentist; this value was 61.4% (99%CI: 59.5;63.2) in 2008. Among children from families whose head of household had 4 years of formal education or fewer, 49.5% and 63% had been to a dentist in 1998 and 2008, respectively. The lifetime prevalence of dentist attendance among Brazilian children increased between 1998 and 2008, especially among those from low-income families and those whose head of household had a low educational level.

Resumo A ampla disponibilidade de acesso aos serviços odontológicos pode ser considerada um fator preditor de melhores resultados na saúde bucal da população. O objetivo deste artigo é comparar os dados obtidos das Pesquisas Nacionais por Amostras de Domicílios (PNADs), em relação a utilização de serviços odontológicos, entre crianças de 4 a 12 anos. Estudo transversal, com dados obtidos a partir das PNADs realizadas em 1998, 2003 e 2008, envolvendo um total de 61.438, 64.659 e 59.561crianças, respectivamente. Considerou-se intervalos de confiança de 99% para os desfechos. No ano de 1998, 60,8% (IC99%: 59,4;62,1) das crianças haviam ido ao dentista, em 2003, 65,5% (IC99%: 64,4;66,7), e em 2008, 73,8% (IC99%: 72,1;74,2). Com relação à renda domiciliar, em 1998, 41,2% (IC99%: 39,1;43,3) das crianças inseridas nas famílias na menor faixa de renda foram ao cirurgião-dentista, em 2003 49,9% (IC99%: 48;51,9) o fizeram e, em 2008, 61,4% (IC99%: 59,5;63,2). Entre as que pertenciam a famílias onde o chefe possuía até 4 anos de estudo, 49,5% e 63%, em 1998 e 2008, foram às consultas odontológicas. A prevalência de crianças brasileiras que já haviam ido ao dentista aumentou entre 1998 e 2008, especialmente entre aquelas pertencentes a famílias com renda domiciliar menor e com chefes possuindo menor escolaridade.

Teaching and Learning Regarding the Dentist-Pediatric Patient Relationship: A Qualitative Study

Objective: To investigate the perceptions of dental students on the learning process regarding the dentist-pediatric patient relationship. Material and Methods: A qualitative study with an exploratory approach was conducted involving semistructured interviews with sixteen dental undergraduate students randomly selected from the thirty-two students in the last semester of the dentistry course. The transcribed interviews were submitted to content analysis. Results: The sample was composed of nine female (56.3%) and seven male (43.7%) students (median age: 23 years). The factors perceived as most influential with regard to learning the dentistpediatric patient relationship were observations of professors, other dentists or colleagues and the regular practice of dental procedures. While half of the participants considered lectures on the subject satisfactory, the other half reported a need for more instruction on how to deal with specific clinical situations. Most of the participants would like to have learned more about the dentist-pediatric patient relationship. Conclusion: The majority of students recognized that the teaching and learning process regarding the dentist-pediatric patient relationship is not easy. They reported having little counseling on the how to develop this relationship. The students suggested that the dentist-patient relationship should be addressed more during the course through the inclusion of lectures or classes on this issue as well as the demonstration of specific clinical situations.

Use of Dental Services Among Brazilian Children Aged Zero to Three Years: Analysis of National Household Surveys

Objective: To describe the use of dental services among children aged zero to three years in Brazil according to socio-demographic characteristics. Material and Methods: A cross-sectional study was carried out using data from the 1998, 2003 and 2008 Brazilian National Household Surveys involving a total of 25,769, 25,644 and 22,237 children, respectively. Prevalence rates and 99% confidence intervals (CI) were calculated. Results: : In 1998, 10.4% (99%CI: 9.7-11.1) of the children had been to the dentist. This figure was 13.4% (99%CI: 12.6-14.3) in 2003 and 16.2% (99%CI: 15.2-17.1) in 2008. In 2008, the prevalence rates of dental appointments in lifetime were respectively 10.2% (99%CI: 9.2-11.4) and 30.6% (99%CI: 27.7-33.6) for children in the lowest and highest income quartiles, 10.2% (99%CI: 8.9-11.7) and 22.4% (99%CI: 20.9- 23.9) for children from families whose head of household had up to four and nine or more years of schooling, 9.6% (99%CI: 2.2-11.1) and 27.5% (99%CI: 24.5-30.8) for those living in the northeast and central west regions of the country. Conclusion: Statistically significant increases in the prevalence rates of the use of dental services among Brazilian children aged zero to three years occurred between 1998 and 2008. The rates were lower among children belonging to socially and ethnically disadvantaged groups.

Anxiety in Children submitted to Dental Appointment

Objective: To determine anxiety in children undergoing dental treatment and to evaluate associated factors. Material and Methods: The sample consisted of 48 children during dental appointment in dental clinics of the Franciscano University Center, 48 caregivers, and 46 dentistry students. The modified Venham Picture Test was used to determine anxiety of children during dental appointment, before and after treatment. For determining anxiety related to dental care among caregivers, the modified Corah's dental anxiety scale was used. The Lipp`s stress symptoms inventory for adults was applied to determine the stress level of dentistry students. In addition, the individual characteristics of participants were recorded to determine their association with the presence of anxiety. Results: Anxiety was observed in 60.4% of children, and it was related to invasive dental procedures (p = 0.021), history of dental pain (p = 0.002), presence of bruxism (p = 0.028), anxious caregivers (p = 0.023), and stress of the dental student that conducted the appointment (p = 0.005). Conclusion: Overall, the majority of pediatric patients showed anxiety, which was directly related to misbehavior during dental care. Moreover, anxiety was related to individual characteristics of children and was influenced by the anxiety level of caregivers, as well as the emotional state of dentistry students during the dental appointment.

Levels of Anxiety and Salivary Alpha-Amylase in Children During Restorative Dental Treatment

Objective: To assess levels of anxiety and salivary alpha-amylase in children and its association with the use of informative or aversive behavioral management techniques during restorative dental procedures. Material and Methods: A cross-sectional study was performed with 69 children aged 4-12 years submitted to restorative dental treatment. The level of anxiety of patients was verified by means of the Modified Venham Picture Test and levels of salivary alpha-amylase were measured before and after the restorative procedure. The behavioral management techniques used during the dental procedure were registered. Associations between variables were analyzed using the chi-square test, considering statistically significant associations with p ≤ 0.05. Results: Salivary alpha-amylase showed high and moderate levels prior to dental procedure in 47 children (68.1%). Variables gender and behavioral management techniques were not associated with anxiety, as measured by VPT and salivary alphaamylase activity. However, younger children showed higher levels of alpha-amylase (p = 0.001). Conclusion: The sample revealed that the visit to the dentist has generated anxiety, manifested by behavioral and physiological changes, especially in children under 72 months; thus, no association between anxiety and the different management techniques was observed.

Eficácia de dois métodos de degermação das mãos / Effectiveness of two methods of hands degermation

A lavagem das mãos reduz as bactérias da pele, diminuindo as taxas de infecções. Há várias técnicas de higienização das mãos, devendo o profissional escolher a mais adequada. OBJETIVOS: este trabalho avaliou a eficácia da lavagem cirúrgica das mãos e antebraços com escova impregnada com clorexidina a 2%, comparando com o método de fricção das mãos e antebraço com sabonete líquido contendo clorexidina a 2%. MATERIAIS E MÉTODOS: foram analisadas amostras das pontas dos dedos polegar e indicador, palma da mão e antebraço, de 40 alunos do curso de Odontologia da UNIFRA. A primeira degermação realizada foi com a escova impregnada com clorexidina a 2%, e, sete dias após, os mesmos participantes degermaram as mãos com sabonete contendo clorexidina a 2%. As amostras foram coletadas em placas contendo meio Ágar Base Sangue, identificadas e levadas ao laboratório de microbiologia. RESULTADOS:os mostraram que o método de fricção com sabonete contendo clorexidina a 2% apresentou melhores resultados. CONCLUSÃO: a higienização das mãos pelo método de fricção com sabonete contendo clorexidina a 2% foi mais eficaz quando comparada à realizada com escova impregnada com clorexidina a 2%, sugerindo um método de preparo pré-cirúrgico das mãos mais rápido, eficaz e menos oneroso... (AU)

ABSTRACT Hand washing reduces the amount of skin bacteria, thus contributing to reducing infection rates. There are several techniques for hand washing and the health professional should choose the most appropriate one. OBJECTIVES: This study evaluated the effectiveness of surgical hands and forearms washing made with brush impregnated with 2% chlorhexidine, compared with the friction method of hands and forearms with liquid soap containing 2% chlorhexidine. MATERIALS AND METHODS: We analyzed tip of the thumb and index finger, palm and forearm from 40 students of Dentistry from UNIFRA. The first protocol antisepsis was performed with a brush impregnated with 2% chlorhexidine, and seven days later, the same participants washed their hands with soap containing 2% chlorhexidine. The samples were collected in plates containing Blood Agar Base, identified and taken to the microbiology laboratory. RESULTS:The method of rubbing the soap containing 2% chlorhexidine performed better. CONCLUSION: Hand hygiene by friction method with soap containing 2% chlorhexidine is more effective than the one performed with brush impregnated with 2% chlorhexidine, suggesting a faster, effective and less costly presurgical hand preparation... (AU)

Anxiety in the pediatric dental clinic: use of informative and aversive behavior management techniques

To measure dental anxiety in children, determine its association with behavior exhibited during treatment and evaluate the use of informative and aversive behavior management techniques.Material and Methods:Across-sectional study was carried out with 51 children aged 6-12 years submitted to restorative dental procedures at the pediatric dental clinic of the Franciscano University Center (Brazil) between May and December 2013. Anxiety was measured using the Venham Picture Test and behavior during treatment was analyzed using the Frankl Behavior Scale. Variables were submitted to descriptive statistics. The chi-square test was used to determine associations between anxiety and categorical variables, considering associations with p-value p ≤ 0.05 to be statistically significant.Results:Twelve children (23.5%) exhibited anxiety prior to dental procedure. Anxiety was not significantly associated with age (p=0.669), gender (p=0.478), behavior during treatment (p=0.915) or behavioral management techniques (p=0.701). Moreover, no significant association was found between changes in the level of anxiety after procedure and the behavior management techniques used during treatment (p=0.828).Conclusion:A high percentage of children exhibited dental anxiety. However, anxiety prior to dental procedure was not associated with any of the variables analyzed and no association was found between changes in the level of anxiety after procedure and the informative or aversive behavior management techniques used during treatment...

Expectativas de escolares de uma comunidade vulnerável: qualidade de vida e esperança sobre profissionais/governantes / Expectations of students of a vulnerable community: quality of life and hope in professional/rulers

Objetivou-se conhecer as expectativas/anseios de escolares sobre mudanças pessoais que possibilitariam melhorias na sua qualidade de vida e o que esperam dos profissionais da saúde e governantes. Estudo transversal, realizado com 435 escolares, de dez anos ou mais, matriculados do quinto ano do ensino fundamental até o último ano do ensino médio. Utilizou-se um questionário com questões fechadas e após a análise estatística descritiva. 45,3% dos pesquisados responderam que gostariam de estudar mais; 26,7%, de valorizar mais os pais. Praticamente metade dos sujeitos gostaria que os profissionais de saúde lhes dessem mais atenção e orientações. Destes, 19,7% consideravam importante o profissional de saúde na escola. 40% dos estudantes esperam honestidade dos governantes e 34,9%, que estes pensem mais no povo. Os escolares têm noção dos seus direitos de cidadania, expressam de forma consciente as expectativas/anseios em relação às mudanças pessoais e o que esperam de profissionais da saúde e governantes.

This study aimed to describe students’ expectations about personal changes that would bring improvements to their quality of life and also about their hope in health professionals and governments. Cross-sectional study, conducted with 435 students, ten years old or more, enrolled in the fifth year of elementary school to the last year of high school. We used a questionnaire with closed questions and after the descriptive statistical analysis. 45.3% of respondents said they would like to study more; 26.7% would like to give parents more value. Nearly half of the subjects would like health professionals to give them more attention and guidance. Among them, 19.7% considered important the presence of health professional in school. 40% of students expect honesty from rulers and 34.9% expect they think more in people. The students are aware of their rights of citizenship, they have conscience to express the expectations / aspirations regarding personal changes and what they expect from health professionals and government.

Este estudio tuvo como objetivo conocer expectativas/aspiraciones de estudiantes acerca de los cambios personales que permitan la mejora de su calidad de vida y lo que esperan de los profesionales de la salud y responsables políticos. Estudio transversal con 435 estudiantes, de diez años de edad o más, en el quinto año de la escuela primaria hasta el último año de la escuela secundaria. Se utilizó un cuestionario con preguntas cerradas y después del análisis estadístico descriptivo. El 45,3% de los encuestados dijo que les gustaría estudiar más; el 26,7% de dar más valor a los padres. A casi la mitad de los sujetos les gustaría que profesionales de la salud les dieran más atención y orientación. De éstos, el 19,7% considera que es importante tener en la escuela el profesional de la salud. El 40% de los estudiantes espera honestidad de los gobernantes y el 34,9% espera que pensaran más en las personas. Los estudiantes son conscientes de sus derechos de ciudadanía, expresan conscientemente expectativas/aspiraciones con respecto a los cambios personales y lo que esperan de los profesionales de la salud y responsables políticos.

Access to dental services among 6-to-12-year-old children in Brazil: an exploratory study based on the national household sample survey, 2008

Objective:To analyze the access and use of dental services among 6-to-12-year-old childrenin Brazil. Material and Methods:A cross-sectional study was conducted based on micro-data from the National Household Sample Survey carried out by the Brazilian Institute of Geography and Statistics in 2008. A total of 48,854 children were included and confidence intervals of 99% (CI 99%) were considered for the prevalence rates of the outcomes. The statistical significance of differences was analyzed using these intervals, level of 1%.Results:A total of 79.3% (CI 99%: 79.3%-79.3%) of children had been to the dentist at least once in their lives. A total of 62.1% (99% CI: 62.1%-62.1%) of children from families earning up to one quarter the monthly per capita household income and 95.5% (99% CI: 95.4-95.5) of those from families earning two or more times the minimum wage were among the 25,161 children that had been to the dentist in the previous year. Regarding region of residence, 68.2% (CI 99%: 68.2%-68.2%) of children from the northeastern region of the country and 89.5% (CI 99%: 89.5%-89.6%) of those from the southern region had been to the dentist. Conclusion:A considerable number of Brazilian children had never been to the dentist by the year 2008. In addition, individuals living in the southern region and from families with greater monthly household income were among those who had already been to the dentist. These data provide evidence for guiding public policies and actions aimed at minimizing the lack of dental follow up among Brazilian children

Oral rehabilitation of patient with severe early childhood caries: a case report

Introduction: Severe early childhood caries (S-ECC) is very common in pre-school children and shows a pattern of development which is defined and symmetrical, beginning on the cervical third of labial surface of maxillary anterior teeth. Accordingly, it can damage speech, swallowing, feeding, development, esthetics and self-esteem of the child. Objective: To report a case of a 5-year-old female patient with S-ECC on teeth #51, #52, #61 and #62. Case report: The patient came to dental clinic of the university with her mother for dental care. During the interview, the mother reported that her daughter used to drink milk in baby bottle at day and night with sugar content. Moreover, oral hygiene was not performed after bottle feeding at night. On clinical examination, the teeth #51, #52, #61 and #62 presented coronal destruction, and the mucosa associated at these teeth was very inflamed. Radiographically, it was found that carious lesions were limited to inner dentin. The treatment plan included education on oral hygiene and diet guidance. Rehabilitation with acetate matrixes was the treatment chosen for teeth destroyed by caries. Conclusion: This study demonstrated that the use of acetate matrixes is an effective alternative to return aesthetics and functionality to teeth of patients with severe early childhood caries.

O início do desmame precoce: motivos das mães assistidas por serviços de puericultura de Florianópolis/SC para esta prática / Early weaning: motives for this practice of mothers attending an infant welfare service in Florianopolis/SC, Brazil

Objetivo: Identificar as razões das mães de crianças de 6 a 12 meses de idade, em acompanhamento de puericultura na cidade de Florianópolis/SC, para a interrupção do aleitamento materno exclusivo (AME) antes do sexto mês pós-parto (início do desmame precoce). Método: Estudo transversal de características descritivas, realizado a partir de entrevistas guiadas por um questionário, aplicado a 100 mães que realizaram consultas de puericultura no Hospital Universitário da Universidade Federal de Santa Catarina (HU - UFSC) e em outras 100 mulheres que o fizeram na Unidade de Saúde do Saco Grande II (USSGII), entre janeiro e abril de 2005, totalizando uma amostra de 200 mães. Os dados foram analisados e as variáveis classificadas em categorias através da análise do significado e redução das respostas. Em seguida foram organizados com o programa Epi Info 3.5 e apresentados por meio da estatística descritiva (distribuições absolutas e percentuais). Resultados: O aleitamento materno foi realizado por 98% da amostra; entre as mães que amamentaram, 18,4% realizaram aleitamento materno exclusivo até o sexto mês de vida do seu filho. O desmame foi iniciado de forma precoce por 81,6% das participantes, sendo que 46,2% dessas mães o fizeram motivadas por conceitos pessoais, 35,6% relataram algum problema relacionado à saúde do bebê, 27,5% em função dos múltiplos papéis desempenhados pela mulher-mãe, 19,4% alegaram algum problema orgânico pessoal e 18,7% o realizaram por orientação de alguém. Conclusão: A influência cultural e familiar, o trabalho materno e problemas de saúde da mãe e do bebê foram determinantes para o início do desmame precoce.

Objective: To identify the reasons why mothers of children aged 6 to 12 months attending an infant welfare service in Florianopolis/SC, Brazil interrupted the exclusive breastfeeding (EBF) before the sixth month postpartum (beginning of early weaning). Methods: A cross-sectional study with descriptive and analytical characteristics was conducted based on questionnaire-guided interviews proposed to 100 mothers who had routine infant welfare visits at the University Hospital of the Federal University of Santa Catarina (HU - UFSC) and other 100 mothers who did so at the Saco Grande II Public Health Unit (USSGII), between January and April 2005, a total sample of 200 mothers. Data were analyzed and the variables were classified into categories by examining the meaning and the reduction of responses. The data were organized by EpiData version 3.1 and processed electronically by public domain software Epi Info - version 3.5. Results: Breastfeeding was reported by 98% of the sample. Among the mothers that breastfed, 18.4% did it exclusively until the infant reached six months. Early weaning was reported by 81.6% of the sample; 46.2% of them were motivated by their own concepts, 35.6% reported infant-related problems, 27.5% attributed to the multiple tasks assigned to a woman-mother, 19.4% reported a personal systemic problem, and 18.7% followed an advice from someone else. Conclusion: Cultural and familial influence, maternal work and maternal and infant health problems were determinant factors for early weaning.

Prevalência do Início do Desmame Precoce em duas Populações Assistidas por Serviços de Puericultura de Florianópolis, SC, Brasil / Prevalence of the Early Weaning in Two Populations Assisted at Infant Services of the City of Florianópolis, SC, Brazil

Objetivo: Verificar a prevalência de aleitamento materno (AM), aleitamento materno exclusivo (AME) e AM predominante (AMP) até 6 meses e, do início do desmame precoce (AME<6 meses), em mães de crianças de 6 a 12 meses de idade, em acompanhamento de puericultura no Hospital Universitário da Universidade Federal de Santa Catarina (HU - UFSC) e na Unidade de Saúde do Saco Grande II (USSGII) na cidade de Florianópolis/SC. Método: Estudo transversal de características descritivas e analíticas, realizado a partir de entrevistas guiadas por um questionário, aplicado a 100 mães que realizaram consultas de puericultura no Hospital Universitário da Universidade Federal de Santa Catarina (HU - UFSC) e em outras 100 mulheres que o fizeram na Unidade de Saúde do Saco Grande II (USSGII), entre janeiro e abril de 2005, totalizando uma amostra de 200 mães. Resultados: O aleitamento materno foi realizado por 98% da amostra; entre as que amamentaram 18,4% realizaram aleitamento materno exclusivo até o sexto mês de vida do seu filho. O início do desmame precoce foi realizado por 81,6% das participantes sendo que, destas, 15% realizaram aleitamento materno predominante nos 6 meses após a gestação.Conclusão: O aleitamento materno tem sido iniciado pela maioria das mulheres, mas poucas conseguem fazer o aleitamento materno exclusivo até o sexto mês de idade do bebê. A introdução de água, chá ou suco e o desmame completo, antes dos seis meses, vem sendo bastante praticados pelas mães. É relevante a participação do cirurgião dentista, na orientação às mães para a realização do aleitamento materno de forma adequada

Objective: To evaluate the prevalence of maternal breastfeeding (MB), exclusive maternal breastfeeding (EMB) and predominant MB (PMB) up to 6 months of age, and early weaning (EMB <6 months) among mothers of children aged 6 to 12 months asisted at the Infant Servicesof the University Hospital of the Federal University of Santa Catarina (HU - UFSC) and the Public Health Unit æSaco Grande IIÆ (USSGII) in the city of Florianópolis, SC, Brazil. Method: This investigation was a cross-sectional study with descriptive and analytical characteristics, which was conducted based on interviews guided by a questionnaire applied to 100 mothers that attended infant welfare visits at the University Hospital of the Federal University of Santa Catarina (HU - UFSC) and in other 100 women that attended these visits at the Saco Grande II Public Health Unit (USSGII), between January and April 2005, composing a sample of 200 mothers. Results: Maternal breastfeeding was performed by 98% of the women; among these, 18.4% reported exclusive breastfeeding until up to the 6th month of life of their children. Early weaning was performed by 81.6% of the participants and 15% of them used predominant breastfeeding during the first 6 months of life of their babies. Conclusion: Maternal breastfeeding was initiated by most women, but only few of them maintained exclusive breastfeeding until their babies were 6 months old. Introduction of water, tea or juice and complete weaning before 6 months of age was a frequent practice among the interviewed mothers. It is relevant the engagement of dentists for instructing pregnant women and mothers of newborns on how maternal breastfeeding should done in an adequate manner

Fatores Associados ao Desmame Precoce em Mães Assistidas por Serviços de Puericultura de Florianópolis/SC / Associated Factors in the Early Weaning in Mothers Assisted by Infantile Nursing Service in Florianopolis/SC

Objetivo: identificar a prevalência do desmame precoce (aleitamento materno exclusivo <6 meses) entre mães de crianças de seis a 12 meses de idade, em acompanhamento de puericultura no Hospital Universitário da Universidade Federal de Santa Catarina (HU - UFSC) e na Unidade de Saúde do Saco Grande II (USSGII) em Florianópolis/SC e verificar sua associação com variáveis maternas e do lactente.Método: estudo transversal de características descritivas e analíticas, realizado a partir de entrevistas aplicadas a 200 mães que realizaram consultas de puericultura nestas duas unidades de serviço público de saúde de Florianópolis, entre janeiro e abril de 2005. Utilizou- se o teste exato de Fisher ou qui-quadrado para análise univariada, e as variáveis que apresentaram p<0,20 foram incluídas num modelo de regressão logística múltipla para testar a independência entre elas, considerando estatisticamente significativo um valor de p≤0,05.Resultados: o aleitamento materno (AM) foi realizado por 196 (98%) mulheres e o desmame foi precoce em 160 (81,6%) delas. As variáveis: mãe ter até 26 anos de idade (OR: 2,9; 95% IC: 1,2-6,9; p=0,015), realizar pré-natal na USSG II (OR: 3,3; 95% IC: 1,1-9,5; p=0,029), o bebê não mamar no peito na primeira hora de vida (OR: 3,6; 95% IC: 1,4-9,5; p=0,008) bem como, o trabalho materno nos primeiros seis meses após o parto (OR: 6,0; 95% IC: 2,3-15,8; p<0,001), mostraram-se associadas ao início do desmame precoce independentemente das outras variáveis estudadas.Conclusão: a taxa de amamentação exclusiva na amostra estudada está aquém do preconizado pela Organização Mundial da Saúde. Houve associação, independentemente de outras variáveis, entre o desmame precoce com trabalho e idade maternos, local de pré-natal e tempo decorrido para a primeira mamada

Objective: To identify the prevalence of the early weaning (exclusive breast-feeding <6months), in mothers of children aged 6 to 12 months of age, in monitoring of child care at Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC) and the Unidade de Saúde do Saco Grande II (USSGII) in the city of Florianopolis/SC and to determined its association with maternal and infant variables.Method: The transversal study of descriptive and analytical characteristics was conducted through interviews guided by a questionnaire answered by 200 mothers who had routine visits in these two units of public health in Florianopolis, between january and april 2005. We used Fisher's exact test or chi-square test for univariate analysis and variables with p<0.20 were included in a multiple logistic regression model to test the independence between them, considering statistically significant p value ≤0.05.Results: The breastfeeding (BF) was accomplished by 98% of women and the weaning was early in 81.6% of cases. The variables, mother has until 26 years of age (OR: 2,9; 95% IC: 1,2-6,9; p=0,015), conduct antenatal in USSG II (OR: 3,3; 95% IC: 1,1-9,5; p=0,029), the baby not to breastfeed in the first hour of life (OR: 3,6; 95% IC: 1,4-9,5; p=0,008) and as the maternal employment during the first six months postpartum (OR: 6,0; 95% IC: 2,3-15,8; p<0,001) were related to the initiation of early weaning regardless of other variables.Conclusion: The rate of exclusive breastfeeding in this sample is lower than those recommended by the World Health Organization. Occurred association independent of other variables, from the early weaning with, maternal labor and age, place of antenatal care and time taken to first feeding

Mecanismos e fatores fisiológicos e patológicos no processo de reabsorção radicular de dentes decíduos / Physiological and pathological factors and mechanisms in the process of root resorption in primary teeth

Introdução: A reabsorção dentária é fundamental no processo de rizólise (reabsorção radicular fisiológica) dos dentes decíduos, entretanto as reabsorções dentárias patológicas, especialmente a do tipo inflamatória, caracterizam-se em consequência e/ou complicação de várias situações clínicas, como traumatismos dentários e lesões periapicais inflamatórias provenientes da doença cárie, constituindo causa comum de perda de dentes. Objetivo: Procurou-se apresentar e discutir uma revisão de literatura acerca do mecanismo das reabsorções radiculares fisiológica e patológica inflamatória em dentes decíduos, enfatizando seus eventos bioquímicos e celulares. Revisão de literatura: As células responsáveis pela reabsorção dos tecidos dentais são os odontoclastos, sob a influência de inúmeros estímulos e sinalizações moleculares oriundos de citocinas, neuropeptídeos, hormônios e produtos de degradação liberados quando o tecido é lesado. Porém até hoje não se sabe exatamente o que leva à diferenciação das células precursoras dos odontoclastos, o que lhes dá o sinal para iniciar a reabsorção em local e momento específicos (principalmente nos dentes decíduos) e por que eles são prematuramente ativados em algumas condições patológicas, mas não em outras. Conclusão: O conhecimento sobre o mecanismo molecular e os fatores que regulam o processo de reabsorção radicular ainda é escasso. A pesquisa nessa área mostra-se de grande relevância, uma vez que novos conhecimentos sobre a(s) via(s) molecular(es) da reabsorção dental podem permitir o desenvolvimento de terapias diferenciadas, mais biológicas, que controlem ou impeçam a reabsorção, evitando assim a extração do dente acometido e suas consequências.

Introduction: Tooth resorption is essential in the process of root resorption in primary teeth. However, pathological root resorption, mainly the inflammatory one, is a consequence and/or complication of several clinical conditions, such as dental trauma and periapical inflammatory lesions from dental caries, thus becoming a common cause of tooth loss. Objective: To present and discuss a literature review regarding the mechanisms of physiological and inflammatory pathological root resorption in primary teeth, emphasizing their biochemical and cellular events. Literature review: The odontoclasts cells are responsible for resorption of dental tissues, and they are influenced by several stimuli and molecular signals derived from cytokines, neuropeptides, hormones and degradation products released when tissue is injured. However, so far it is not clear what leads to the differentiation of the precursor cells of odontoclasts, what gives them the signal to start the resorption in a specific place and time (especially in primary teeth) and why they are activated in some pathological conditions, but not in others. Conclusion: The knowledge regarding molecular mechanisms and factors that regulate the process of root resorption is still meager. Research in this area is of great relevance, since new knowledge about the molecular pathway(s) involved in root resorption may allow the development of different therapies, more biological ones, in order to control or prevent resorption, thus preventing tooth loss and its consequences.

Praticas alimentares cariogenicas e fatores associados em criancas do sul do Brasil / Cariogenic feeding habits and associated factors in children from the southern Brazil

Objetivo: Identificar praticas alimentares cariogenicas e estimar os fatores associados ao consumo de guloseimas entre as refeicoes em pre-escolares de Ijui-RS. Metodo: A amostra consisti u em 481 criancas de 0 a 6 anos pertencentes a 12 pre-escolas deste municipio, sorteadas aleatoriamente. O instrumento de pesquisa foi questionario estruturado respondido pelos pais, que avaliou variaveis demograficas, socioeconomicas e as seguintes praticas alimentares: idade de introducao do acucar e o comportamento de consumir guloseimas (doces ou salgadinhos) entre as refeicoes. Foi utilizada regressao de Poisson com variancia robusta para identificar e quantificar os fatores associados ao consumo de guloseimas entre as refeicoes. Resultados: Aproximadamente 90% das criancas da amostra tiveram o acucar introduzido na dieta antes de completar o primeiro ano de vida. Alem disso, 3/4 dos pre-escolares consomem guloseimas entre as refeicoes, nao havendo diferenca entre os sexos, categorias de renda e estruturacao familiar. O modelo multivariavel mostrou que a probabilidade de consumir guloseimas entre as refeicoes foi 16% maior em criancas de 5 a 6 anos em relacao as criancas de ate 2 anos (RP=1,16; IC 95%= 1,00?1,34) e 14% maior quando a mae tinha 4 anos ou menos de escolaridade (RP=1,14; IC 95%= 1,01-1,29) em relacao as maes com mais de 8 anos de estudo. Fazer chantagem para receber guloseimas aumentou em 72% a probabilidade deste comportamento (RP= 1,72; IC 95%= 1,46-2,03). Conclusao: A introducao de acucar e precoce nesta populacao e um percentual elevado dos pre-escolares consome guloseimas entre as refeicoes, estando este desfecho associado a maior idade da crianca, menor escolaridade materna e comportamento da crianca. Programas preventivos devem incluir orientacao para praticas alimentares desde o primeiro ano de vida, especialmente para maes com menor escolaridade.

Objective: To identify cariogenic feeding habits and estimate the factors associated with the consumption of snacks between meals in preschoolers from the city of Ijui, RS, Brazil. Method: The sample was composed of 481 children aged 0 to 6 years attending 12 preschools of this city, chosen at random. The research instrument was a structured questionnaire filled out by the parents, which assessed demographic and socioeconomic data and information on feeding habits (age of introduction of sugar in the diet and consumption of sweet and salty snacks between meals). Poisson's regression with robust variance was used to identify and quantify the factors associated with the consumption of snacks between meals. Results: Approximately 90% of the children had sugar introduced in their diet before 1 year of age. In addition, ó of the preschoolers consume sweets between meals, without statistically significant difference between genders, income levels and family structure. The multi variable model showed that the probability of consuming snacks between meals was 16% higher in 5-6-year-old children compared to those up to the age of 2 (PR=1.16; 95% CI= 1.00-1.34), and 14% higher when the mother's educational level was up to 4 years (PR=1.14; 95% CI= 1.01-1.29) compared to those with more than 8 years of school education. Blackmailing to receive snacks increased in 72% the probability of this behavior (PR= 1.72; 95% CI= 1.46-2.03). Conclusion: The introduction of sugar was premature in the studied population, and a high percentage of the preschoolers were found to eat snacks between meals. This outcome is associated with older children, low maternal educational level, and child's behavior. Preventive programs must include diet counseling since the first year of life, especially for mothers with low educational level.