Dental caries in three-year-old preschool children in Lima, Peru assessed according to the CAST instrument / Caries dental en niños prescolares de 3 años en Lima-Perú evaluados con el instrumento CAST

ABSTRACT The aim of this study was to determine the caries situation of three-year-old preschool children residing in low socioeconomic status districts in Lima, Peru. The study is a crosssectional analysis of the caries situation of suburban areas of Lima. A stratified sampling procedure by geographical distribution, considering healthcare centers with a motherand- child health clinic and surrounding preschools as factors, identified 45 randomly selected preschools, of which 17 accepted to participate. Children from 3-year-old classrooms were examined by two independent calibrated dentists using the Caries Assessment Spectrum and Treatment (CAST) instrument at their premises using artificial light, sterile examination mirrors and gauze for drying each tooth before evaluation. ANOVA and the Tamhane method were used to analyze the data. 308 children, mean age 3.4 years (min: 3 years; max: 3 years, 7 months), were examined. The sample prevalence of enamel and dentine carious lesions (CAST code 3-7) was 91.2% while the prevalence of dentine carious lesions (CAST code 4-7) was 58.8%. The mean number of teeth with cavities that had reached the pulp and those that had an abscess or fistula were 2.0% and 0.5% respectively. The majority of enamel and dentine carious lesions were observed in molars. The CAST severity score was 7.0. Mean examination time was 57 seconds. The burden of dental caries of the children at this young age was high.

RESUMEN El objetivo del presente estudio fue determinar la prevalencia de caries dental en niños en edad preescolar de 3 años residentes en áreas suburbanas de Lima, Perú. Se trata de un análisis transversal de la situación de caries de áreas periféricas de Lima. Un procedimiento de muestreo estratificado por distribución geográfica consideraba a los centros de salud materno-infantiles y centros educativos preescolares de la jurisdicción como factores, identificando 45 centros prescolares aleatoriamente, de los cuales 17 aceptaron la invitación para participar del presente estudio. Dos odontólogas independientes, calibradas examinaron a los niños de las aulas de 3 años utilizando el instrumento Caries Assessment Spectrum and Treatment (CAST) en las instalaciones de cada jardín de infancia, utilizando luz artificial, instrumental estéril y gasas para el secado de las superficies a evaluar. Los datos fueron analizados utilizando ANOVA y el método Tamhane. Se evaluaron 308 niños, quienes tenían una edad media de 3.4 años (min: 3 años; max: 3 años, 7 meses). La prevalencia de lesiones de caries de esmalte y dentina (código CAST 3-7) fue del 91,2%, mientras que la prevalencia de lesiones de caries en dentina (código CAST 4-7) fue de 58,8%. El número promedio de dientes afectados por caries dental con compromiso pulpar y que tenían un absceso o fístula fue de 2.0% y 0.5% respectivamente. La mayoría de las lesiones de caries en esmalte y dentina se observaron en los molares. La valoración de severidad CAST fue 7.0. El tiempo promedio de examinación fue de 57 segundos. La carga de la enfermedad caries dental a estas edades tan tempranas ya es alta en la infancia suburbana de Lima.

Índice de riesgo de caries dental / Dental caries risk index

Introducción: el desarrollo de índices para identificar el riesgo a padecer caries dental, permite focalizar intervenciones preventivas y optimizar los recursos sanitarios, lo que propicia mejores resultados en la atención a la población. Objetivo: evaluar la capacidad discriminatoria de un índice de riesgo de caries dental. Métodos: se realizó la investigación en dos etapas correspondientes al desarrollo y validación del índice, durante los cursos 2012-2013 y 2013-2014, respectivamente. La primera fue un estudio de casos y controles con niños entre 6 y 12 años de tres escuelas primarias de Santa Clara, Cuba. Se descartó en un inicio la presencia de caries y se recogió información sobre un grupo de variables; luego de diez meses se seleccionaron como casos a los 120 niños detectados con caries y del resto, 240 controles elegidos al azar. Se elaboró un índice mediante un procedimiento basado en la V de Cramer, y un modelo predictivo de caries mediante regresión logística. La segunda etapa fue un estudio transversal con 360 niños, para validar el índice y contrastarlo con el modelo predictivo mediante: área bajo la curva características operativas del receptor y otras medidas calculadas a partir de tablas de 2 x 2. Resultados: el índice obtenido tuvo valores de sensibilidad, especificidad e índice de validez de 87,5 por ciento, 82,5 por ciento y 84,2 por ciento respectivamente. El modelo de la regresión presentó cifras porcentuales de 80,8 por ciento, 81,3 por ciento y 81,1 por ciento. El área bajo la curva del primero fue 0,889 y del segundo 0,870(AU) Conclusiones: los resultados avalan al índice obtenido mediante los valores de V de Cramer como un instrumento importante para la identificación del riesgo y, por consiguiente, la prevención y control de la caries dental de los niños de 6 a 12 años que residen en Santa Clara.

Introduction: dental caries risk indices make it possible to focus on preventive actions and optimize health resources, leading to better results in dental care. Objective: evaluate the discriminating capacity of a dental caries risk index. Methods: the study was conducted in two stages, corresponding to development and validation of the index. These took place during school years 2012-2013 and 2013-2014, respectively. The first stage was a case-control study with children aged 6-12 from three elementary schools in Santa Clara, Cuba. At the outset, the presence of caries was discarded and information was collected about a number of variables. Ten months later the 120 children with detected caries were selected as cases, and 240 controls were randomly chosen from among the remaining children. An index was developed applying a procedure based on Cramér's V and a caries prediction model based on logistic regression. The second stage was a cross-sectional study with 360 children to validate the index and contrast it with the prediction model on the basis of the area under the curve, recipient's operative characteristics, and other measures estimated with 2 x 2 tables. Results: the index showed sensitivity, specificity and validity values of 87.5 percent, 82.5 percent y 84.2 percent respectively. The regression model obtained percentage values of 80.8 percent, 81.3 percent and 81.1 percent. The area under the curve was 0.889 for the former and 0.870 for the latter. Conclusions: results attest to the validity of the index obtained through Cramér's V values as an important tool to identify the risk for, and therefore the prevention and control of dental caries in children aged 6-12 resident in Santa Clara(AU)

Adolescência e sua relação com a cárie dentária, binge drinking, capital social e fatores associados / Adolescence and your relationship with tooth decay, binge drinking, social capital and associated factors

O objetivo deste estudo foi investigar as relações entre binge drinking - consumo de 5 ou mais doses de bebidas alcoólicas em uma ocasião -, cárie dentária, capital social e condição socioeconômica entre os estudantes de 12 anos de escolas públicas e privadas da área urbana da cidade de Diamantina-MG. A coleta de dados ocorreu em duas etapas: na primeira etapa foi realizado um censo envolvendo todos os 633 alunos de 12 anos de idade, matriculados nas 13 escolas. Na segunda etapa do estudo foi desenvolvido um estudo longitudinal de prevalência de período com os alunos que fizeram parte da primeira fase desta pesquisa. Na primeira etapa foram avaliados a prevalência da cárie dentária e sua associação com capital social e condições socioeconômicas, bem como, o consumo em ¿binge¿ por adolescentes e sua associação com o consumo de álcool por amigos, familiares, condições socioeconômicas e religiosidade. Na segunda etapa o objetivo foi investigar a associação entre capital social e a frequência de beber em "binge" entre adolescentes escolares. Os dados foram coletados por meio de exames clínicos e questionários autoaplicados. A frequência de consumo de álcool na vida e o binge drinking foram determinadas usando as Teste de Identificação de Desordens Devido ao Uso de Álcool (AUDIT-C). Para cárie dental foi adotado o Índice de dentes "cariados, perdidos e obturados" (CPO-D). O capital social foi medido pelo Questionário de Capital Social para Alunos Adolescentes (QCS-AE) desenvolvido e validado para os adolescentes escolares. Os indicadores socioeconômicos utilizados foram tipo de escola, renda familiar mensal, ABA-ABIPEME e escolaridade materna. Foram realizadas análise descritiva e bivariada e regressão binomial no estudo de prevalência de período. O nível de significância foi de 5%. Como principais resultados, observou-se que um total de 269 (45,7%) adolescentes tiveram pelo menos uma lesão cariada cavitada. A análise múltipla revelou que nem o gênero nem o capital social estiveram estatisticamente associados com a presença de lesões cavitadas (p > 0.05). Adolescentes que estudam em escolas públicas e com renda familiar inferior a 3 salários mínimos foram mais propensos a ter lesões cariosas cavitadas. Em relação ao consumo excessivo de álcool, a prevalência foi de 23,1%. A idade média de início do consumo de álcool foi de 10,8 anos. O binge drinking foi mais prevalente entre adolescentes cujo melhor amigo [RP = 4,72 (95% IC 2,78-8,03)] e irmão [RP = 1,46 (IC 95% 1,10-1,92)] consumiam álcool. A religiosidade [RP = 0,40 (IC 95% 0,27-0,62)] apareceu como um possível fator de proteção. No estudo longitudinal, adolescentes que relataram um aumento na coesão social na subescala comunidade/vizinhança foram 3,4 vezes mais propensos (95% IC 1,96-6,10) a consumir álcool excessivamente. Os achados desse estudo destacam os determinantes sociais do binge drinking e do comportamento de beber entre os adolescentes e a não associação entre o capital social e a cárie dentária. Além disso, os resultados fornecem novas evidências sobre o "lado negro" da coesão social na promoção do consumo excessivo de álcool entre os adolescentes.

The objetive of this study was to investigate the relationship between binge drinking - consumption of 5 or more doses of alcoholic beverages on one occasion - dental caries, social capital, and socioeconomic status among students of- 12-years-old of public and private schools in the urban area of the city of Diamantina-MG. Data collection took place in two stages: in the first stage, a census was carried out involving all 633 12-year-old students enrolled in the 13 scholls. In the second phase of the study a longitudinal period prevalence study was developed with students who were part of the first phase of this research. The first stage evaluated the prevalence of dental caries and its association with social capital and socioeconomic conditions, as well as the consumtion of alcoholic beverages by adolescents and their association with alcohol consumption by friends, family members, socioeconomic condition and religiosity...

Differential Impacts of Caries Classification in Children and Adults: A Comparison of ICDAS and DMF-T

Abstract The aim of this study was to describe and compare findings regarding the prevalence and severity of dental caries when using ICDAS and DMFT/dmft in an epidemiological study with children and their mothers. This cross-sectional study evaluated 150 preschoolers and their mothers. Data were collected with ICDAS and then transformed into DMFT/dmft. ICDAS scores related to caries were analyzed according to three different cut-off-points: CP1 (0-healthy/1-6-caries), CP2 (0-1-healthy/2-6-caries) and CP3 (0-2-healthy/3-6-caries), representing the D/d of DMFT/dmft. ICDAS codes regarding restorations, except sealants, were considered the F/f and the code 97 as the M/m of DMFT/dmft index. Prevalence of caries and its severity with ICDAS were 92%, 84% and 31.3% in children and 97.3%, 96.6% and 80% in adults according to CP1/CP2/CP3, respectively. Admitting CP3 as the standard for data transformation of ICDAS in DMFT/dmft, it was observed that DMFT/dmft index would underestimate 60% of non-cavitated lesions in children and 16.6% in adults. The DMFT/dmft underestimated the presence of disease to disregard non-cavitated lesions for the pediatric population evaluated. The choice of which is the best index for epidemiological surveys will depend on the purpose of the research and the target population: if it is to estimate the needs of the population to determine clinical care in children and adults, the DMFT/dmft may be sufficient. However, if the objective is to have a more comprehensive diagnosis of caries at the population level in order to develop preventive strategies, to halt and reverse the disease, the detection of non-cavitated-lesions becomes important, mainly in young children.

Resumo O objetivo deste estudo foi descrever e comparar os achados sobre a prevalência e severidade da cárie dentária ao utilizar ICDAS e CPOD/ceod em um estudo epidemiológico com crianças e suas mães. Este estudo transversal avaliou 150 pré-escolares e suas mães. Os dados foram coletados utilizando-se o ICDAS e depois transformados em CPOD/ceod. Os códigos do ICDAS relacionados à cárie foram analisados de acordo com três diferentes pontos de corte: CP1 (0-hígido/1-6-cárie), CP2 (0-1 hígido/2-6-cárie) e CP3 (0-2 hígido/3-6-cárie), representando o D/d do índice CPOD/ceod. Os códigos do ICDAS referentes às restaurações, exceto selantes, foram considerados o O/o e o código 97 do ICDAS como o P/e do índice CPOD/ceod. A prevalência de cárie e sua severidade com o ICDAS foram de 92%, 84% e 31,3% em crianças e 97,3%, 96,6% e 80% em adultos de acordo com o CP1 / CP2 / CP3, respectivamente. Admitindo o ponto de corte CP3 como o padrão para a transformação de achados do ICDAS em CPOD/ceod, foi observado que o índice CPOD/ceod subestimaria 60% das lesões não cavitadas em crianças e 16,6% em adultos. O CPOD/ceod subestima a presença da doença ao desconsiderar as lesões não cavitadas na população pediátrica avaliada. A escolha de qual é o melhor índice para levantamentos epidemiológicos vai depender do propósito da pesquisa e da população-alvo: se o objetivo for estimar as necessidades da população para determinar cuidados clínicos em crianças e adultos, o CPOD/ceod pode ser suficiente. No entanto, se o objetivo for ter um diagnóstico mais abrangente da doença ao nível da população, a fim de desenvolver estratégias preventivas, para paralisar e reverter a doença, a detecção de lesões não cavitadas torna-se importante, principalmente em crianças pequenas.

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

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

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

Infiltrante resinoso vs Microabrasão no manejo de lesões de mancha branca: relato de caso / Resin infiltration vs microabrasion in white-spot lesions treatment: case report

Objetivo: Apresentar caso clínico de tratamento estético das lesões de mancha branca após tratamento ortodôntico nos dentes superiores anteriores através de duas técnicas minimamente invasivas usando o sistema de infiltração de resina e microabrasão. Relato de caso: Paciente com 18 anos de idade apresentava lesões de manchas brancas inativas nos dentes 11, 12, 13, 21, 22, 23. O sistema de infiltrante de resina Icon (DMG, Hamburgo, Alemanha) foi utilizado nos dentes 11, 12, 13, enquanto os dentes 21, 22, 23 foram submetidos à microabrasão com Whiteness RM (FGM, Joinville, Santa Catarina, Brasil).Ambos os protocolos foram utilizados de acordo com as recomendações do fabricante.Nos dentes 21 e 22, o produto para microabrasão foi aplicado com espátula que acompanha o kit, enquanto que no dente 23 utilizou-se o mesmo produto aplicado com taça de borracha em baixa rotação, todos os procedimentos executados por um único operador. A microabrasão com taça de borracha proporcionou uma superfície mais lisa e homogênea.Ambos os produtos tiveram resultados satisfatórios na resolução estética das lesões de mancha branca após um ano de acompanhamento. Conclusão: Os dois produtos apresentam bom desempenho e resolutividade para os problemas estéticos de lesões de manchas brancas inativas, entretanto deve-se levar em conta o tempo clínico, toxicidade, a atividade da lesão e a possibilidade de desgaste da estrutura dentária.

Objective: To present a case report of aesthetic treatment of post orthodontic white--spot lesions in the anterior superior teeth through two minimally invasive technique susing resin infiltration system or microabrasion. Case report: Patient 17 years of age had inactive white-spots lesions on teeth 11, 12, 13, 21, 22, 23. The teeth 11, 12, 13 received the resin infiltrating system Icon (DMG, Hamburg, Germany) while the teeth 21, 22, 23were submitted to microabrasion with Whiteness RM (FGM, Joinville, Santa Catarina, Brazil). Both protocols were used according to manufacturer’s recommendations. In the teeth 21 and 22, the product of the microabrasion was applied with a spatula that accompanied the kit, while the tooth 23 received the same product applied with a rubbercup at low speed turbine, all by a single operator. The microabrasion with rubber cupoccasioned a more smooth and homogeneous surface. Both products had satisfactory results in aesthetic resolution of the white-spots lesions, for a 1-year follow-up. Conclusion:Although both products are able to resolve aesthetic problems of inactive white-spots lesions, it should be taken into account the clinical time, toxicity, the activity ofthe lesion and the possibility of wear of the tooth structure.

Reabilitação odontológica multidisciplinar em paciente pediátrico com hemofilia: relato de caso / Multidisciplinary rehabilitation of pediatric dentistry in patients with hemophilia: case report

A hemofilia é uma coagulopatia congênita autossômica recessiva ligada ao cromossomo X, isso é devido à deficiência do fator VIII (hemofilia A) ou do fator IX (hemofilia B) afetando apenas os homens.Os transtornos hemorrágicos constituem um dos problemas de maior interesse a serem considerados pelo cirurgião-dentista na prática odontológica. O tratamento odontológico de pacientes com hemofilia deve ser realizado sob cuidados especiais com uma equipe multidisciplinar, nos quais os profissionais da saúde devem ter experiência médica e apoio hematológico adequados. O Objetivo deste trabalho foi relatar a reabilitação odontológica de maneira multidisciplinar de um paciente pediátrico com diagnóstico de hemofilia B grave, a qual é tratada e controlada por médicos hematologos do Hospital Geral de Zona (HGZ). O diagnóstico odontológico foi de acúmulo de placa bacteriana nas superfícies dentais por má higiene bucal, lesões de cárie e hipoplasia de esmalte. Para reabilitação bucal foram realizadas extrações de alguns elementos dentais, profilaxia, flúor terapia, orientação emotivação de higiene bucal, remoção de tecido cariado com auxílio de ultrassom, restaurações com resina composta, ionômero de vidro e restaurações indiretas cerômeros. Concluiu-se que para um adequado manejo odontológico é imprescindível o conhecimento de diversas patologias sistêmicas como a hemofilia, o atendimento multidisciplinar, além do conhecimento de técnicas de mínima intervenção em Odontopediatria para assim poder oferecer ao paciente melhores alternativas de tratamento com a mínima invasão e resultados favoráveis.

Hemophilia is an autosomal recessive congenital blood coagulation desorder to X chromosome, this is due to deficiency of factor VIII (hemophilia A) or factor IX (hemophilia B) affects only men. Bleeding disorders are one of the issues of greatest interest to be considered by the dentist in the dental practice. Dental treatment of patients with hemophilia should be done under special care bya multidisciplinary team in which health professionals must have medical experience and adequate hematologic support. The objective of this study was to report the dental rehabilitation in a multidisciplinary team to a pediatric patient with severe haemophilia B, which is treated and controlled by medical hematologists in Zone General Hospital (HGZ). The dental diagnosis was accumulation ofplaque on dental surfaces by poor oral hygiene, dental caries and enamel hypoplasia. For oral rehabilitation extractions were performed in some dental elements, prophylaxis, fluoride therapy, guidance and motivation of oral hygiene, caries removal with ultrasound assistance restorations with compositeres in, glass ionomer and indirect restorations with cerômics. It was concluded that for properdental management is essential knowledge of various systemic diseases such as hemophilia, multidisciplinary care, in addition to knowledge of minimal intervention techniques in pediatric dentistry so as to offer the best treatment alternatives patient with minimal invasion and favorable results.

Reabilitação estética e funcional na primeira infância: relato de caso / Aesthetic and functional rehabilitation in infancy: a case report

A perda precoce dos dentes decíduos pode ocorrer pela falta de diagnóstico e tratamento na fase inicial da cárie dentária. O objetivo foi relatar o tratamento reabilitador estético e funcional de uma criança de 4 anos e 5 meses de idade, do gênero feminino, com cárie precoce da infância severa. Durante a anamnese, além da queixa de dor nos dentes, notou-se apatia da criança e constrangimento da mesma ao falar e sorrir. Ao exame clínico inicial, a paciente apresentou ausência dos dentes 55, 54, 75, 84 e 85; lesões de cárie ativa do 73 ao 83; lesões cariosas ativas extensas (53, 52, 51, 61, 62, 63, 64, 65, 74) e presença de fístula na região dos dentes 51 e 52. Após o exame radiográfico, o tratamento proposto foi a realização da exodontia dos elementos dentários não passíveis de receber tratamento restaurador (53, 52, 51, 61, 62, 63, 64, 65, 74); restauração com resina composta do 73 ao 83; e posterior colocação de prótese total superior e prótese parcial inferior. Orientações sobre higiene bucal e dieta não-cariogênica foram realizadas em todas as etapas do tratamento para incentivar a criança e familiares à prática de hábitos saudáveis. Diante do tratamento realizado, concluiu-se que a reabilitação estética-funcional recuperou as funções estéticas, fonéticas e mastigatórias da paciente; colaborando para a melhora da autoestima da criança o que gerou satisfação dos familiares. O trabalho educativo em estimular a criança e os cuidadores foi essencial para o sucesso do tratamento e manutenção da saúde bucal...

Dental caries is a disease related with sucrose rich diet and poor oral hygiene. During childhood, if caries disease is misdiagnosed, it can lead to early loss of primary teeth. This study aimed to report the aesthetic and functional rehabilitation treatment in a female child aged 4 years and 5 months, with severe early childhood caries. In the case history, as well as complaints of toothache, the child showed apathy and embarrassment to talk and smile. In initial clinical examination, it was noticed lack of teeth 55, 54, 85, 84 and 75; active caries lesion on teeth 71, 73, 81, 82 and 83; the dental elements 51, 52, 53, 61, 62, 63, 64, 65 and 74 presented with extensive coronary destruction bellow the gingival margins, and the teeth 51 and 52 with the presence of fistula. After radiographic evaluation, the treatment proposed was comprised by destroyed teeth extraction, resin composite restoration of all cavities and subsequent placement of upper denture and lower partial denture. Oral hygiene and non-cariogenic diet orientations were accomplished since the initial treatment to encourage the child and her family to practice healthy habits. After accomplished the treatment, it could be concluded that aesthetic and functional rehabilitation recovered the patient aesthetic, phonetic and mastication functions. This fact contributed to improve the child’s self-esteem and it promoted satisfaction of her family. The dentist educational work and the stimulus of child and her caregivers were essential for treatment successful and for patient oral health maintenance...

Uso de seringas para inserção no ART: ensaio clínico randomizado / Use of syringes for insertion in ART: randomized clinical trial

O ART é considerado uma das abordagens minimamente invasivas no conceito de Odontologia de Mínima Intervenção, e se baseia principalmente na remoção de tecido cariado com os instrumentos manuais e restauração da cavidade com cimento de ionômero de vidro de alta viscosidade. O objetivo deste estudo foi avaliar a influência da técnica de inserção do material restaurador no sucesso das restaurações atraumáticas em superfícies proximais, em dentes decíduos. A amostra foi composta por 90 pacientes, com idades entre 6 a 10 anos (8,7 ± 1,51). Um total de 90 restaurações foram realizadas por único operador treinado, de acordo com o manual da Organização Mundial de Saúde (OMS). O material restaurador utilizado foi o cimento de ionômero de vidro de alta viscosidade (KetacTM Molar Easy Mix, 3M ESPE), o qual foi inserido através de uma espátula de inserção (G1); seringa Centrix e ponta Accudose Agulha (G2); e seringa modificada (G3). As restaurações foram avaliadas após 6 e 12 por dois examinadores treinados e calibrados (Kappa=0,74), através de fotografias padronizadas, de acordo com os critérios de Roeleveld et al., 2006. Foi aplicado o teste estatístico Qui-quadrado para avaliação de possíveis diferenças entre os tempos e as técnicas de inserção. Não houve diferença estatisticamente significativa quanto aos critérios de sucesso/insucesso clínico entre os métodos de inserção testados, nos dois tempos (p>0,05). Conclui-se que a utilização de técnicas alternativas de inserção do ionômero de vidro não aumenta a taxa de sucesso de restaurações proximais em dentes decíduos.

ART is considered one of the minimally invasive operative approaches in the concept of Minimal Intervention Dentistry, once it involves the removal of soft dentin with hand instruments, followed by filling the cavity with a high viscous glass ionomer cement. The aim of this study was to evaluate the influence of insertion technique on the success rate of proximal atraumatic restorative restorations in primary teeth. The sample comprised of 90 children with ages ranging from 6 to 10 (mean age 8.7±1.51 years). A total of 90 ART restorations were placed by one trained dentist according to World Health Organization (WHO) manual. The restorative material used was a high-viscosity glass-ionomer (KetacTM Molar Easy Mix, 3M ESPE) which was placed into the cavities in a using an insertion spatula (G1); a Centrix syringe injector and Accudose needle (G2); and a modified syringe (G3). The restorations were assessed 6 and 12 months after placement by two calibrated examiners (Kappa=0.74), through standard photographs, according Roeleveld et al. (2006) criteria. The chi-square test was used to evaluate differences between the insertion techniques and the periods tested. There was no difference between the insertion techniques tested, over the two periods evaluated, considering the clinical criteria for success/failure. It was concluded that using alternative insertion methods of glass ionomer cement did not improve success rate of proximal atraumatic restorative restorations in primary teeth.

Caries de infancia temprana: diagnóstico e identificación de factores de riesgo / Early childhood caries: diagnosis and identification of risk factors

La caries de infancia temprana ha sido definida con múltiples denominaciones; en las últimas décadas se ha descrito como una enfermedad de origen multifactorial presente en infantes hasta los 71 meses de edad. El objetivo de esta revisión es describir la clasificación, características clínicas, epidemiología, etiología y factores condicionantes externos de la caries de infancia temprana, a través de una extensa revisión bibliográfica, realizada por un grupo de estudio de la Sociedad Peruana de Odontopediatría, durante seis meses (2013-2014); con el fin de brindar in- formación y herramientas, a los trabajadores de la salud en el Perú, útiles en el diagnóstico de la enfermedad y en la identificación de factores de riesgo asociados. La característica de la etiología de la caries de infancia temprana, radica en la influencia de factores únicos en los infantes, relacionados a la implantación temprana de los microorganismos cariogénicos, a la inmadurez del sistema de defensa del huésped, así como a los patrones del comportamiento asociados a la alimentación y la deficiente higiene oral en los infantes. De acuerdo a lo estudiado, la prevalencia de caries de infancia temprana en el Perú oscila entre 31.5% y 93%. Los factores socio culturales presentan una marcada influencia en la instauración, progresión y severidad de la enfermedad; adicionalmente, ciertos condicionan te s externos, como la conducta del niño, el nivel de conocimiento y actitud de los padres, malnutrición y la presencia de enfermedades crónicas o procesos infecciosos específicos como la otitis, se han relacionado con un mayor riesgo de caries dental en infantes...

Early childhood caries has been defined with multiple names; in recent decades has been described as a multifactorial origin disease, present in infants up to 71 months. The aim of this review is to describe the classification, clinical features, epidemiology, etiology and determinants external factors of early childhood caries, through an extensive literature review, conducted by a group of study of the Peruvian Society of Dentistry for six months (2013-2014); in order to provide information and tools to health workers in Peru, useful in the diagnosis of disease and identification of associated risk factors. The characteristic of the etiology of early childhood caries, lies in the influence of unique factors in infants, related to the early implementation of cariogenic microorganisms, to the immaturity of the host defense system, as well as behavioral patterns associated with food and poor oral hygiene in children. According to the study, the prevalence of early childhood caries in Peru varies between 31.5% and 93%. Socio- cultural factors have a marked influence on the onset, progression and severity of disease; additionally, certain external factors such as the child's behavior, the level of knowledge and parents attitude, malnutrition and the presence of chronic diseases or specific infectious conditions such as ear infections, have been associated with an increased risk of dental caries in infants...

Impacto da cárie dentária na qualidade de vida de crianças pré-escolares e de suas famílias / Impact of dental caries on quality of life of preschoolers and their families

As consequências da cárie dentária na vida das cirnaças incluem dor, diminuição do apetite, dificuldades de mastigação, perda de peso, dificuldades para dormir, mudanças de comportamento e baixo rendimento escolar. O objetivo deste estudo transversal de base populacional foi avaliar o impacto de diferentes estágios de progressão, de atividade de cárie dentária e da distribuição das lesões na cavidade bucal e qualidade de vida de crianças pré-escolares e seus pais/cuidadores na cidade de Diamantina, Minas Gerais. Uma amostra aleatória de 451 crianças de 3 a 5 anos de idade fio submetida a um exame clínico para avaliar a cárie dentária usando um sistema internacional de avaliação e detecção de cárie...

Comparison of def index with Nyvad's new caries diagnostic criteria among three to six years old children in a school at Bangalore city

Background: Dental caries is a multifactorial disease with varying clinical picture and its diagnostic criteria is complicated, when initial lesion is considered. Hence, there is a need for an index which measures cavitated, non-cavitated, and initial lesion in dental caries. So, the purpose of this study was to compare the of def index with Nyvad's new diagnostic criteria. Materials and Methods: A total of 249 school children in the age group of three to six years were selected for the study from Sajjan Rao School at Bangalore city. Children teeth were cleaned and dried with cotton rolls and chip blower. The dental caries examinations were conducted under standardized conditions using plane mouth mirrors and explorers with the help of artificial illumination. The diagnostic criteria used were deft and d, e, and f component of Nyvad's new caries diagnostic criteria. Mann Whitney 'U' test was used to compare the two indexes at five percent significant level. Results: The mean value for deft was 2.48 and the mean for d, e, and f component of Nyvad's new caries diagnostic criteria was 3.18 which shows statistically significant difference with P value of <0.05. Conclusion: The result obtained by Nyvad's new caries diagnostic criteria produces values much higher than those with def caries index system. Hence, Nyvad's new caries diagnostic criteria can be used to diagnose dental caries at the initial stages, which in turn will reflect exact prevalence of caries.

Therapeutic potential of Brazilian fluoride varnishes: an in vivo study

The aim of this study was to assess in vivo the therapeutic effect of three fluoride varnishes available in the Brazilian market on the performance of white spot lesions (WSL). The sample included 36 children aged 7 to 13 years old, with a total of 67 active WSL in permanent anterior teeth. The children were randomly divided into 3 groups, according to fluoride varnish used: FL- Fluorniz (n=24), DUO - Duofluorid XII (n=22) and DF - Durafluor (n=21). Maximum WSL dimensions (mesiodistal and incisogingival) were measured in millimeters by a previously calibrated single examiner using a periodontal probe. WSL were also assessed regarding lesion activity. Initial and final S-OHI (Simplified Oral Hygiene Index) scores were recorded. Pearson's chi-square test revealed no statistically significant differences (p>0.05) in the performance of the varnishes. At the end of the 5th week, FL had 6 active and 18 inactive WSL; DUO had 7 active and 15 inactive WSL; and DL had 6 active and 15 inactive WSL. Taking into account all lesions, there was a 45.7 percent reduction in WSL dimensions. Paired Student's t-test revealed a statistically significant difference (p<0.05) between the initial size (1.88) and final size (1.02). After four applications, all varnishes obtained similar clinical results.

O propósito do presente estudo foi avaliar in vivo o efeito terapêutico de 3 vernizes fluoretados disponíveis no mercado brasileiro em lesões de mancha branca (MB). A amostra foi composta de 36 crianças entre 7 e 13 anos, portadoras de 67 MB ativas em elementos dentários permanentes anteriores. As crianças foram divididas aleatoriamente em 3 grupos FL - Fluorniz (n=24), DUO - Duofluorid XII (n=22) e DF - Durafluor (n=21). A dimensão máxima da MB (mésio-distal e cérvico-incisal) foi mensurada em milímetros por um único examinador previamente calibrado através de uma sonda periodontal. Em adição, foi verificada a atividade da MB. O IHO-S (Índice de Higiene Oral Simplificado) inicial e final foi registrado. O teste do qui-quadrado de Pearson mostrou não existir diferença estatisticamente significante (p>0,05) no comportamento dos vernizes estudados. No final da 5ª semana o FL apresentava 6 MB ativas e 18 inativas, DUO 7 MB ativas e 15 inativas e DF 6 MB ativas e 15 inativas. Levando em consideração o grupo total, houve uma redução de 45,7 por cento da dimensão das manchas brancas. O teste T pareado revelou uma diferença estatisticamente significante (p<0,05) entre o tamanho inicial (1,88) e final (1,02). Após 4 aplicações, todos os vernizes apresentaram resultados clínicos semelhantes.

Preparaciones conservadoras para el tratamiento de lesiones cariosas clase III / Conservative preparations for the treatment of Class III carious lesions

La evolución de los materiales dentales revolucionó la indicación de procedimientos restauradores estéticos; así mejoraron la práctica odontológica, modificando los conceptos de preparaciones cavitarias yd permitiendo una mayor conservación de estructura dental sana. La instrumentación y preparación cavitaria están tradicionalmente relacionadas a la alta velocidad y a fresas convencionales de diamante. Estos procedimientos representan un proceso incómodo y muchas veces doloroso para el paciente, debido a las vibraciones mecánicas, al elevado nivel de ruido y el calor generado. Además de remover una gran cantidad de estructura dental, pudiendo ocasionar alteraciones al complejo dentinopulpar. Surgieron nuevas alternativas, como la instrumentación ultrasónica asociada a fresas de diamante CVDentus, las cuales permiten una mayor preservación de estructura dental, buena preparación cavitaria y ausencia de lesiones cuando entra en contacto con tejidos blandos, realizando procedimientos indoloros pra el pacientes, además de presentar un mayor tiempo de vida útil y un menor nivel de ruido. El objetivo de este trabajo fue presentar un caso clínico en el que se asoció instrumentación ultrasónica con fresas CVDentus para la confección de preparaciones cavitarias conservadoras y posterior técnica restauradora con resina compuesta de inserción directa.

Frequency of class II type carious lesions in first permanent molars and their association with pulp

The objective of the present study was to determine the frequency of class II type carious lesions in first permanent molars and its possible association with the pulp when examined clinically and radiographically. Two hundred and forty two subjects were examined in the Dept. of Operative Dentistry, Khyber College of Dentistry, Peshawar for the presence of Class II type carious lesions in the period of two months. This study showed that 62% subjects had a Class II type carious lesion. In the maxilla, unilateral call II carious lesions were 19% and bilateral 2.5%, while in the mandible, unilateral 36.4% and bilateral 4.1% respectively. The occurrence of class II carious lesion was more in females and in mandibular molars. Regarding pulp exposure, a significant relationship was present between clinical and radiographic examination

Risk indicators and risk predictors of dental caries in schoolchildren

The purpose of this study was to identify risk indicators of high caries level at baseline (HCLB) based on cross-sectional data and predictors of high caries increment (HCI) based on a 7-year-follow-up examination in 6-8-year-old schoolchildren. Two hundred and six schoolchildren were examined in 1997 and in 2004 by the same two calibrated dentists, in Piracicaba, Brazil. At baseline, dental caries, presence of sealants, fluorosis, and oral hygiene status were recorded. The children's parents completed a questionnaire concerning socioeconomic level, fluoride use, dental service utilization, dietary and oral hygiene habits. HCLB and HCI were defined considering the upper quartile of the total caries experience distribution (dmfs+DMFS) and caries increment distribution, respectively. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals and p-values. Having white spot lesions (OR=5.25) was found to be a risk indicator of HCLB. Schoolchildren with dental fluorosis (OR=0.17) or those who brushed the teeth more than two times a day (OR=0.37) presented less probability of HCLB. The predictors of HCI were: dmfs>0 (OR=2.68) and mothers' educational level up to 8 years of schooling (OR=2.87). Clinical and socioeconomic variables were found to be risk indicators and/or predictors of dental caries in schoolchildren.

Estimation and comparison of significant caries index and the pattern of sugar consumption among 12-year-old school going children of two different socioeconomic strata.

The purpose of this study was to estimate and compare the Significant Caries Index (SiC), the pattern of sugar consumption, and to know the oral hygiene practices in a sample of 200, 12-year-old school going children of two different social classes residing in both urban and rural areas. The subjects were divided into two social classes based on the per capita monthly income. Twenty-four hour dietary records of five consecutive days were obtained from each subject. The results showed that all the subjects brushed daily. More number of children belonging to social class I and urban area brushed twice a day. While there were no significant differences in DMFT among the study groups, SiC index was higher in males, subjects of social class I, and urban residents. Sweet score, Total sugar exposure and Between-meal sugar exposure were more in males, subjects of social class I, and urban residents, whereas At-meal sugar exposure was more in females, subjects of social class II, and rural residents. From a preventive point of view, males, subjects of higher socioeconomic background, and urban residents seem to be the most important target groups for dental health communication programs focusing on the frequency of sugar consumption and dietary counselling.

Results after two years of non-operative treatment of occlusal surface in children with high caries prevalence

The aim of this study was to describe the 2-year results of an individualized treatment program designed to control occlusal caries in erupting first permanent molars. The sample consisted of 145 five-to-six-year-old students divided into a control group (n=71) and a test group (n=74). All test children received a biannual basic preventive program and a recall system according to individual disease activity. The basic program consisted of 3 (March) and 2 (August) sessions of oral hygiene orientation and toothbrushing with fluoride gel. The analysis of the baseline and 1-2-year data showed a significant reduction in the number of active lesions in the test group. In the control group, there were initially 70 active lesions and after two years 68 surfaces remained with disease and 24 surfaces had been filled. The children in the test group had 80 surfaces with active lesions initially and after two years only 3 surfaces with disease remained. From the 15 cavitated lesions, only 5 surfaces needed to be filled. This program showed that care of erupting teeth on an individualized basis can control occlusal caries