The effect of a chemomechanical protocol to eliminate microorganisms from pulpectomized primary teeth: three case reports

Introduction: Description of the bacterial community before and after chemomechanical preparation (CP) with the removal of a smear layer (SL) in pulpectomized primary teeth has been little reported. Objective: These case reports describe the presence of total microorganisms and Enterococcus faecalis in root canals of primary incisors before and after CP with SL removal. Case Reports: Microbiological samples were collected from the root canals of three children (3.66±0.58 years old) with necrosis (n=2) and irreversible pulpal inflammation (n=1) in maxillary primary incisors. After teeth isolation with a rubber dam and antisepsis of the operative field, the sample collections were performed with sterile absorbent paper cones before and after the CP, which included irrigation with 2.5% sodium hypochlorite followed by 6% citric acid to remove the SL. The collected samples were analysed immediately at the end of the clinical procedures. The plates were incubated anaerobically for 48 hours at 37°C. The results were expressed as colony forming units (CFU)/mL. Results: Two of the three teeth showed total microorganisms before the CP. One incisor had no microorganisms in the initial collection. No CFU was counted in the samples collected after CP. Moreover, E. faecalis was not observed any time, either before or after the CP. Conclusions: E. faecalis was not detected in any sample, yet two of the three root canals had microorganisms before CP. In cases where microorganisms were initially found, 100% elimination was observed after the applied protocol.

Introdução: A descrição da comunidade bacteriana antes e após o preparo químico-mecânico (PQM) com remoção da smear layer (SL) em dentes decíduos pulpectomizados tem sido pouco relatada. Objetivo: Esses relatos de casos descrevem a presença de microrganismos totais e Enterococcus faecalis em canais radiculares de incisivos decíduos antes e após PQM com remoção de SL. Relatos dos Casos: Amostras microbiológicas foram coletadas do canal radicular de três crianças (3,66 ± 0,58 anos) com necrose (n = 2) e inflamação pulpar irreversível (n= 1) em incisivos decíduos superiores. Após o isolamento dos dentes com dique de borracha e antissepsia do campo operatório, as coletas das amostras foram realizadas com cones de papel absorvente estéril antes e após o PQM, que incluiu irrigação com hipoclorito de sódio 2,5% seguido de ácido cítrico 6% para retirada do SL. As amostras coletadas foram analisadas imediatamente ao final dos procedimentos clínicos. As placas foram incubadas em anaerobiose durante 48 horas a 37°C. Os resultados foram expressos em unidades formadoras de colônias (UFC)/mL. Resultados: Dois dos três dentes apresentaram microrganismos totais antes do PQM. Um incisivo não apresentava microrganismos na coleta inicial. Nenhuma UFC foi contada nas amostras coletadas após o PQM. Além disso, o E. faecalis não foi observado nenhum momento, nem antes, nem depois do PQM. Conclusão: Não foi detectado E. faecalis em nenhuma amostra, porém dois dos três canais radiculares apresentavam microrganismos antes do PQM. Nos casos em que foram encontrados microrganismos inicialmente, observou-se 100% de eliminação após o protocolo aplicado.

Efficacy of sealing occlusal caries with a flowable composite in primary molars: A 2-year randomized controlled clinical trial.

OBJECTIVES: This randomized controlled clinical trial evaluated the efficacy of sealing carious dentin in controlling the progression of lesions in primary molars for 2-year follow-up. MATERIALS AND METHODS: Children (6.79 ±â€¯1.81 years, n = 28) presenting primary molars with occlusal caries in the outer half of dentine were randomized and allocated into 2 groups: test (sealing caries with a flowable resin - SC) and control (partial removal of caries followed by restoration - PRC). The primary outcomes were: the clinical success of restorations evaluated by USPHS criteria and the radiographic analysis of caries progression. The children anxiety was evaluated by a Facial Image Scale; and the time required to perform the treatments was registered. RESULTS: In 21 patients evaluated after 2 years, 48 primary molars were analyzed. Clinically, there was no difference between the groups. There was no difference between treatments (p = 0.848) considering lesion progression. The anxiety level did not change after the two interventions (p = 0.650). The treatment time of SC (9.03 ±â€¯1.91 min) was lower (p = 0.002) than the PRC time (17.13 ±â€¯5.26 min). CONCLUSION: Sealing carious dentin may be used in dentistry since it did not alter the children anxiety, reduced the chair time and demonstrated clinical success rate and no radiographic difference in relation to the partial caries removal followed by restoration.

Influence of the microbiological component of Cariogram® for evaluating the risk of caries in children.

OBJECTIVE: To compare the risk for caries in children as determined by Cariogram® software (CS; Stockholm, Sweden) with and without its microbiological component and by a form based on Cariogram® (FBC). METHODS: Children (n = 28) aged 3-9 years were included. Data were collected clinically and from anamnesis. The salivary levels of Streptococcus mutans (SM) were evaluated. A linear regression model was used to determine which variables were predictive for each type of risk analysis. Caries risk was the dependent variable and the independent variables were caries experience, related disease, plaque amount, diet frequency, salivary levels of SM, fluoride sources and clinical judgment. A paired Student t-test was used for the following comparisons: (a) CS with and without SM; (b) CS without SM and FBC; (c) CS with SM and FBC. RESULTS: The mean dmft/DMFT was 5.56 ± 2.51. There was no difference between the methods (p < .05). Regardless of caries risk, the children presented the same levels of SM (p = .889). Caries experience, plaque amount, diet frequency and fluoride sources were predictors of caries risk in all assessment methods. Clinical judgment was a significant predictor in CS. CONCLUSIONS: Caries experience, plaque amount, diet frequency and fluoride sources are valuable predictors of caries risk; microbiological tests are not necessary for evaluating caries risk in children, which can be assessed similarly by CS without SM and FBC.

Conhecimento de pais/responsáveis sobre a cárie dentária na primeira infância / Knowledge of the parents/guardians about dental caries in early childhood

Objetivo: Objetivou-se avaliar o conhecimento dos pais/responsáveis (P/R) de crianças atendidas na Clínica de Bebês da Faculdade de Odontologia da UFRJ, a respeito da cárie precoce na infância (CPI). Método: Um questionário relacionado à CPI foi aplicado na sala de espera, aos P/R (n=150) de pacientes entre 0 e 5 anos de idade com diagnóstico de presença ou ausência de lesões de cárie. Os dados foram analisados descritivamente e o teste χ2 foi utilizado para associação entre o conhecimento sobre CPI e variáveis relacionadas à: higiene bucal, grau de parentesco dos P/R, amamentação e sentimento de culpa dos P/R. O Coeficiente alfa de Cronbach (α) demonstrou consistência interna satisfatória do instrumento (α=0,878). Resultados: A média de idade dos P/R foi de 34,11±9,26 anos e das crianças, 3,63±1,26 anos. A maioria dos entrevistados (68,7%) foi representada por mães. Dentre os P/R, 88,7% apresentam lesões de cárie e 74% das crianças são acometidas. A maioria das crianças (72,0%) não é amamentada, assim não houve associação entre o tipo de aleitamento e o relato de cárie (p=0,125). A frequência da escovação (65,8% escovam 3 ou mais vezes ao dia) também não apresentou associação com a doença (p=0,352). Entre os participantes, 47,2% afirmaram realizar a escovação da criança e 36,7% a supervisionam. Somente 30,0% relataram ter conhecimento sobre cárie e 36,7% afirmaram que a doença é causada por escovação deficiente e dieta rica em açúcar. Dos entrevistados, 96,0% afirmaram saber que a cárie traz prejuízo à saúde. Destes, 22,0% indicam que a principal alteração é o prejuízo estético. A maioria dos responsáveis (70,0%) declarou sentir culpa pela cárie de seu filho (p=0,009). Conclusão: Conclui-se que novas estratégias que abordem a educação em saúde devam ser elaboradas, visando o maior esclarecimento aos pais/responsáveis sobre CPI, o que consequentemente auxiliará na prevenção da doença.(AU)