Oral conditions of children with microcephaly associated with congenital Zika syndrome: a cross-sectional study

Abstract The aim of the present study was to compare the oral conditions of children with congenital Zika syndrome (CZS)-associated microcephaly, non-CZS-associated microcephaly, and normotypical children, as well as to characterize their sociodemographic aspects and medical history. A paired cross-sectional study was carried out on 14 children with CZS-associated microcephaly and 24 age-matched controls, in Belo Horizonte, in southeastern Brazil. Children's oral conditions were assessed: dental caries experience (dmft/DMFT indices); developmental defects of enamel (DDE) index; dental anomalies; mucosal changes; lip sealing, and malocclusion (overjet, overbite, and/or posterior crossbite alterations). The quality of oral hygiene was analyzed by the simplified oral hygiene index. The children's mothers also answered a questionnaire about sociodemographic and medical history data. The variables were analyzed descriptively. Female participants were more prevalent (60.5%), and the mean age of the participants was 4.9 years (±1.4) (range: 2-8 years) and 92.1% of their exhibited some oral condition. All participants with CZS-associated microcephaly showed absence of lip sealing and had malocclusion (100.0%). When compared to the other groups, children with CZS had a higher percentage of dental anomalies (35.7%), mucosal changes (71.4%), and unsatisfactory oral hygiene (64.3%). In a sample composed mainly of female participants aged less than 5 years, the prevalence of oral conditions and unsatisfactory oral hygiene was higher in the group with CZS-associated microcephaly, followed by the group with non-CZS-associated microcephaly. Normotypical children had the highest percentage of dental caries experience.

Condição clínica e imunológica da cavidade bucal de crianças com síndrome congênita associada à infecção pelo vírus Zika / Clinical and immunologic condition of the oral cavity of children with congenital syndrome associated to Zika virus infection

O objetivo deste estudo foi comparar a condição bucal e parâmetros imunológicos de crianças com Síndrome Congênita associada à infecção pelo vírus Zika (SCZ), com microcefalia não associada à SCZ e normotípicas em um estudo transversal. Além disso, objetivou-se sintetizar, por meio de uma revisão sistemática da literatura, as alterações orais observadas em crianças com SCZ e comparar com crianças normotípicas. No artigo de revisão sistemática, buscas eletrônicas foram realizadas em cinco bases de dados, complementadas por escrutínio manual e pesquisas na literatura cinzenta. Os dados foram agrupados para análise quantitativa com intervalos de confiança de 95%. A qualidade metodológica dos estudos incluídos foi avaliada por meio das ferramentas de avaliação do Joanna Briggs Institute e a certeza da evidência, pela abordagem GRADE. Doze estudos observacionais foram incluídos. A prevalência bruta combinada mostrou 88% de aumento de salivação (IC 95%: 82%- 94%) e 52% de inserção anormal do freio labial superior (IC 95%: 43%-61%). Em comparação com controles normotípicos, crianças com SCZ tiveram maior chance de ter dificuldade de selamento labial (OR: 18,28; IC 95%: 1,42-235,91) e inadequada postura lingual em repouso (OR: 13,57; IC 95%: 4,24-43,44), com certeza muito baixa. Diversas alterações orais foram encontradas e as crianças com SCZ se mostraram mais propensas a desenvolver algumas delas, entretanto, entretanto, a certeza dessas evidências ainda é muito baixa. O estudo transversal foi desenvolvido com dois grupos de comparação, pareados por idade e sexo. Foram convidadas a participar da pesquisa mães e crianças com microcefalia, associada ou não à SCZ, e crianças normotípicas atendidas na Faculdade de Odontologia (FAO) da UFMG. Amostragem do tipo snowball foi utilizada para expandir a amostra inicial. Para a coleta de dados, as mães responderam a um questionário estruturado sobre informações sociodemográficas, história médica e odontológica das crianças. Também foi realizado um exame bucal para investigação das seguintes condições: experiência de cárie dentária, qualidade da higiene bucal, alterações de mucosa, presença de má oclusão, selamento labial, anomalias dentárias e defeitos de desenvolvimento de esmalte. A coleta de saliva para avaliação dos parâmetros imunológicos/inflamatórios da cavidade bucal das crianças foi realizada através do uso de um rolete de algodão. Os dados coletados foram armazenados e analisados pelo software Statistical Package for Social Science (SPSS®). Um total de 38 crianças (14 com SCZ, oito com microcefalia não associada à SCZ e 16 normotípicas) foram avaliadas. O sexo feminino foi o mais frequente (60,5%, n=23) e a média de idade entre eles foi de 4,9 (±1,4; 2-8) anos. Ausência de selamento labial e má oclusão foram os achados mais comuns nas crianças com SCZ, quando comparadas aos grupos controle. Em conjunto, os dados deste estudo contribuirão para a compreensão das condições bucais que crianças com SCZ possuem ou podem desenvolver, a fim de direcionar práticas clínicas e reforçar o incentivo aos cuidados de saúde bucal possibilitando uma melhora na qualidade de vida dessa população.

The objective of this study was to compare the oral condition and immunological parameters of children with congenital syndrome associated with Zika virus infection (CZS), with children with microcephaly non-CZS-associated and normotypic children in a cross-sectional study. In addition, it was intended to synthesize, through a systematic review of the literature, the oral alterations observed in children with CZS and compare with normotypic children. In the systematic review article, electronic searches were performed in five databases, complemented by manual scrutiny and research in gray literature. The data were grouped for quantitative analysis with 95%confidence intervals. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist tools, and the certainty of evidence was assessed using GRADE approach. Twelve observational studies were included. The pooled crude prevalence showed 88% of increased salivation (95%CI: 82%-94%), 52% of abnormal insertion of the upper labial frenum (95%CI: 43%-61%), and 50% of delayed tooth eruption (95%CI: 34%-66%). Compared to normotypic controls, children with CZS-associated microcephaly had a higher chance to have difficulty in lip sealing (OR: 18.28; 95%CI: 1.42-235.91), inadequate lingual posture at rest (OR: 13.57; 95%CI: 4.24-43.44), and delayed eruption (OR: 9.37; 95%CI: 2.03-43.21) with very low certainty. Several oral alterations were found and children with CZS-associated microcephaly were more likely to develop some of them, however, the certainty of this evidence is still very low. The cross-sectional study was carried out with two comparison groups, matched for age and sex. Mothers and children with microcephaly, associated or not with CZS, and normotypic children attended at the School of Dentistry of the UFMG were invited to participate in the research. Snowball sampling was used to expand the initial sample. For data collection, mothers responded to a structured questionnaire on sociodemographic information, medical and dental history of children. An oral examination was also performed to investigate the following conditions: experience of dental caries (dmft/DMFT), quality of oral hygiene (simplified oral hygiene index-SOHI), mucosa alterations, lip sealing, presence of malocclusion, dental anomalies and developmental defects of dental enamel (DDE). Saliva collection to evaluate the immunological/inflammatory parameters of the children's oral cavity was performed using a cotton roller. The collected data will be stored and analyzed using the Statistical Package for Social Science software (SPSS®). A total of 38 children (14 with CZS, eight with non-CZS-associated microcephaly and 16 normotypic) were evaluated. The female was the most frequent (60.5%, n=23) and the average age among them was 4.9 (±1.4; 2-8) years. Absence of lip sealing and malocclusion were the most common findings in children with SCZ when compared to control groups. Together, the data in this study will contribute to the understanding of the oral conditions that children with CZS have or can develop, in order to direct clinical practices and reinforce the incentive to oral health care enabling an improvement in the quality of life of this population.

A multicenter study of biopsied oral and maxillofacial lesions in a Brazilian pediatric population

Abstract The aim of this study was to investigate the prevalence of oral and maxillofacial lesions among children from representative regions of Brazil. A retrospective descriptive study was conducted. Biopsy records comprising the period from 2000 to 2015 were obtained from the archives of three Brazilian oral pathology referral centers. A total of 32,506 biopsy specimens were analyzed, and specimens from 1,706 children aged 0-12 years were selected. Gender, age, anatomical location and histopathological diagnosis were evaluated. Descriptive statistics was carried out. Likelihood ratio tests were used to evaluate the association between the categorical variables. The level of significance was set at 0.05. The post-hoc test was used to identify the subgroups that significantly differed from one another, and the Bonferroni correction was applied. A total of 1,706 oral and maxillofacial lesions were diagnosed in pediatric patients, including 51.9% girls. Oral mucocele was the most prevalent reactive/inflammatory lesion (64%). The most commonly affected sites were the lips (34.5%) and mandible (19.9%). A significant association was observed between age and the group of lesions of the oral cavity (p < 0.001), and between age and anatomical location (p < 0.001). Pediatric oral and maxillofacial lesions were frequent and showed wide diversity, with the prevalence of mucocele. Knowledge of oral lesions is important for pediatric dentists worldwide, since it provides accurate data for the diagnosis and oral health of children.