Impact of Pediatric Hematopoietic Stem-Cell Transplantation on Craniofacial Growth.

OBJECTIVES: To assess the craniofacial skeletal growth in pediatric hematopoietic stem-cell transplantation (HSCT) survivors in comparison with age-sex matched-paired controls. METHODS: A case-controlled retrospective comparison of the craniofacial growth in 25 HSCT children and 25 matched-paired controls was conducted. Craniofacial growth was quantitatively assessed by linear and angular measurements in panoramic radiographic images using ImageJ¯. Stature growth and body weight were obtained through physical examination. Cancer diagnosis, myeloablative conditioning, and HSCT were retrieved from medical records. RESULTS: Patients aged 12.2 years (±3.8; 16 male, 9 female). Radiographic images were obtained on an average of 2.43 (±2.0) years after HSCT. The main malignant diagnosis was acute lymphoblastic leukemia (56%), followed by acute myeloid leukemia (36%) and myelodysplastic syndromes (8%). Total body irradiation was associated with chemotherapy at 80%. Mean age at transplantation was 10 (±4.7) years. HSCT survivors showed reduced a vertical growth of the mandibular ramus (p=0.003). This persisted among individuals below 12 years of age (p=0.017). The HSCT group showed delayed dental eruption, though there was no statistically significant difference (p=0.3668). The HSCT group showed stature deficit, increased weight, and body mass index (Z-score stature: -0.28; Z-score weight: 0.38, respectively). CONCLUSIONS: Pediatric HSCT has decreased vertical craniofacial growth compared to their matched controls. There might be an association between reduced craniofacial vertical growth and reduced estature growth. Further studies to quantitatively investigate the impact of different myeloablative regimens in craniofacial skeletal growth and development.

Impact of pediatric hematopoietic stem-cell transplantation on craniofacial growth

OBJECTIVES: To assess the craniofacial skeletal growth in pediatric hematopoietic stem-cell transplantation (HSCT) survivors in comparison with age-sex matched-paired controls. METHODS: A case-controlled retrospective comparison of the craniofacial growth in 25 HSCT children and 25 matched-paired controls was conducted. Craniofacial growth was quantitatively assessed by linear and angular measurements in panoramic radiographic images using ImageJ¯. Stature growth and body weight were obtained through physical examination. Cancer diagnosis, myeloablative conditioning, and HSCT were retrieved from medical records. RESULTS: Patients aged 12.2 years (±3.8; 16 male, 9 female). Radiographic images were obtained on an average of 2.43 (±2.0) years after HSCT. The main malignant diagnosis was acute lymphoblastic leukemia (56%), followed by acute myeloid leukemia (36%) and myelodysplastic syndromes (8%). Total body irradiation was associated with chemotherapy at 80%. Mean age at transplantation was 10 (±4.7) years. HSCT survivors showed reduced a vertical growth of the mandibular ramus (p=0.003). This persisted among individuals below 12 years of age (p=0.017). The HSCT group showed delayed dental eruption, though there was no statistically significant difference (p=0.3668). The HSCT group showed stature deficit, increased weight, and body mass index (Z-score stature: -0.28; Z-score weight: 0.38, respectively). CONCLUSIONS: Pediatric HSCT has decreased vertical craniofacial growth compared to their matched controls. There might be an association between reduced craniofacial vertical growth and reduced estature growth. Further studies to quantitatively investigate the impact of different myeloablative regimens in craniofacial skeletal growth and development.

Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplantation.

OBJECTIVE: Hematopoietic stem-cell transplantation (HSCT) childhood survivors of hematologic malignancies are prone to develop late osteopenia and osteoporosis. The purpose of this retrospective study was to quantitatively and qualitatively assess bone mineral density (BMD) in HSCT childhood survivors and to compare the effectiveness of both qualitative and quantitative assessment methods. METHODS: DESIGN BMD assessment using panoramic radiographs of childhood HSCT survivors aged 3.69-18.88 years using two radiomorphometric indexes. Case-control double-blinded comparison of panoramic radiographic images from childhood HSCT survivors and age- and sex-matched healthy controls. Quantitative assessment was performed by measuring the cortical bone width bilaterally at the mental foramen level. Qualitative assessment was performed using the mandibular cortical index bilaterally on all panoramic images. RESULTS: Radiographs were taken 6.59-83.95 months after bone marrow transplantation [median±SD=25.92±24.9 months]. Fifty-two panoramic radiographic images were analyzed: 21 from HSCT survivors and 31 from healthy controls aged 3.69-25.1 years [mean±SD=11.89±5.28 years]. The mandibular cortical bone width was 17% smaller in childhood HSCT survivors than in healthy controls (case group: 2.420, control group: 3.307; p=0.00617). Qualitative analysis revealed an increased frequency of severe mandibular cortical erosion in childhood HSCT survivors, although no significant difference was observed (case group: 1.540, control group: 1.490; p=0.32). The interobserver agreement was 85% (Kappa index). CONCLUSIONS: HSCT childhood survivors exhibit quantitative and qualitative mandibular bone impairments. Further studies are needed to establish an association between mandibular cortical bone impairment and osteoporosis.

Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplantation

OBJECTIVE: Hematopoietic stem-cell transplantation (HSCT) childhood survivors of hematologic malignancies are prone to develop late osteopenia and osteoporosis. The purpose of this retrospective study was to quantitatively and qualitatively assess bone mineral density (BMD) in HSCT childhood survivors and to compare the effectiveness of both qualitative and quantitative assessment methods. METHODS: DESIGN BMD assessment using panoramic radiographs of childhood HSCT survivors aged 3.69-18.88 years using two radiomorphometric indexes. Case-control double-blinded comparison of panoramic radiographic images from childhood HSCT survivors and age- and sex-matched healthy controls. Quantitative assessment was performed by measuring the cortical bone width bilaterally at the mental foramen level. Qualitative assessment was performed using the mandibular cortical index bilaterally on all panoramic images. RESULTS: Radiographs were taken 6.59-83.95 months after bone marrow transplantation [median±SD=25.92±24.9 months]. Fifty-two panoramic radiographic images were analyzed: 21 from HSCT survivors and 31 from healthy controls aged 3.69-25.1 years [mean±SD=11.89±5.28 years]. The mandibular cortical bone width was 17% smaller in childhood HSCT survivors than in healthy controls (case group: 2.420, control group: 3.307; p=0.00617). Qualitative analysis revealed an increased frequency of severe mandibular cortical erosion in childhood HSCT survivors, although no significant difference was observed (case group: 1.540, control group: 1.490; p=0.32). The interobserver agreement was 85% (Kappa index). CONCLUSIONS: HSCT childhood survivors exhibit quantitative and qualitative mandibular bone impairments. Further studies are needed to establish an association between mandibular cortical bone impairment and osteoporosis.

Review of a three-year study on the dental care of onco-hematological pediatric patients.

The aim of this study was to provide an updated review of dental procedures undertaken at the dental unit of the Onco-hematology service of the Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (ICr/HC-FMUSP). We retrospectively reviewed 565 of 1902 medical and dental records of patients diagnosed with onco-hematological diseases who were seen in a 3-year study (January 2015 to December 2017). We assessed data regarding population characteristics, onco-hematological diagnosis and dental procedures performed. Of the selected medical records, preventive dentistry was the most common procedure undertaken in this population, followed by oral maxillofacial surgeries, restorative dentistry and oral mucositis treatment. The most prevalent malignant diagnosis was acute lymphocytic leukemia, and the most prevalent nonmalignant diagnosis was sickle-cell anemia. Preventive dental procedures represent most of the dental procedures undertaken in hospitalized onco-hematological pediatric patients.

Comparative analysis of different prophylactic methods for roughness of primary tooth enamel / Análise comparativa de diferentes métodos profiláticos sobre a rugosidade do esmalte em dentes decíduos

Objective: The purpose of this study was to comparatively evaluate quantitative effects of three different prophylactic methods of surface polishing treatments for primary teeth compared to a standardized control group. Material and Methods: 48 naturally exfoliated primary teeth were selected and randomly assigned into four groups: Control Group ­ teeth receiving only enamel standardization treatment with polishing disc to reduce natural enamel; Group I ­ teeth receiving superficial enamel standardization treatment followed by polishing with a mixture of water and pumice; Group II ­ teeth receiving enamel standardization treatment followed by prophylaxis with paste (Herjos-F, Vigodent S/A Indústria e Comércio, Rio de Janeiro, Brazil); and Group III ­ teeth receiving enamel standardization treatment followed by sodium bicarbonate spray (Profi II Ceramic, Dabi Atlante Indústrias Médico-Odontológicas Ltda, Ribeirão Preto, Brazil). All the procedures were performed by the same operator and the samples were rinsed and stored in distilled water. Comparative assessment of the enamel surface roughness between experimental groups and control group was performed by using a surface profilometer (Mitutoyo SJ400). Results: The results of this study were statistically analysed by using Minitab statistical software (version 17.1.0, 2013). The use of pumice and water led to significantly rougher surfaces than in other groups (i.e. Group I: 1.22 Ra; Group II 0.38 Ra; Group III: 1.01 Ra). Conclusion: Based on this study, one can conclude that use of pumice and water resulted in increased enamel surface roughness in comparison to the surface treatment with bicarbonate spray and prophylaxis paste. (AU)

Objetivos: O objetivo deste estudo foi quantificar e comparar a rugosidade do esmalte dentário após de três diferentes tratamentos profiláticos para polimento de superfície de esmalte em dentes decíduos, em relação a um grupo controle. Material e Métodos: 48 dentes decíduos naturalmente esfoliados foram selecionados e alocados aleatoriamente em quatro grupos. Grupo Controle: recebeu apenas padronização do esmalte através do disco de polimento para redução de dentes naturais. O grupo I recebeu padronização superficial do esmalte seguido de polimento por mistura de água e pedra-pomes; o grupo II recebeu padronização do esmalte seguido da pasta de profilaxia Herjos-F (Vigodent S / A Indústria e Comércio, Rio de Janeiro, Brasil); e o grupo III recebeu padronização da superfície do esmalte seguido de spray de bicarbonato de sódio Profi II Ceramic (Dabi Atlante Indústrias Médico Odontológicas Ltda., Ribeirão Preto, Brasil). Todos os tratamentos de superfície foram realizados pelo mesmo operador, por dez segundos e as amostras foram lavadas e armazenadas em água destilada. A avaliação comparativa da rugosidade superficial do esmalte entre os grupos experimentais e controle foi realizada utilizando-se um perfilômetro de superfície Mitutoyo SJ400. Resultados: Os resultados deste estudo foram analisados estatisticamente com o software estatístico Minitab (versão 17.1.0, 2013). A pedra-pomes e a água geraram significativamente maior aspereza na superfície de esmalte, em comparação aos outros grupos, quando empregado o teste estatístico de Tukey (Grupo I: 1,22 Ra; Grupo II: 0,38 Ra; Grupo III: 1,01 Ra). Conclusão: Com base neste estudo, pode-se concluir que a pedra-pomes e a água resultaram em aumento da rugosidade superficial do esmalte em comparação ao tratamento superficial com spray de bicarbonato e pasta profilática.(AU)

Review of a three-year study on the dental care of onco-hematological pediatric patients

The aim of this study was to provide an updated review of dental procedures undertaken at the dental unit of the Onco-hematology service of the Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (ICr/HC-FMUSP). We retrospectively reviewed 565 of 1902 medical and dental records of patients diagnosed with onco-hematological diseases who were seen in a 3-year study (January 2015 to December 2017). We assessed data regarding population characteristics, onco-hematological diagnosis and dental procedures performed. Of the selected medical records, preventive dentistry was the most common procedure undertaken in this population, followed by oral maxillofacial surgeries, restorative dentistry and oral mucositis treatment. The most prevalent malignant diagnosis was acute lymphocytic leukemia, and the most prevalent nonmalignant diagnosis was sickle-cell anemia. Preventive dental procedures represent most of the dental procedures undertaken in hospitalized onco-hematological pediatric patients.

Avaliação do nível de conhecimento de alunos de pós-graduação em radiologia e imaginologia sobre mucosite oral / Knowledge, attitude and profile of post-graduate students about oral mucositis

Objetivo: este estudo observacional transversal objetivou avaliar o nível de conhecimento dos cirurgiões-dentistas, alunos de pósgraduação em Radiologia e Imaginologia da Faculdade São Leopoldo Mandic ­ Campinas sobre diagnóstico, prevenção e tratamento de mucosite oral induzida pelo tratamento do câncer, por meio da aplicação um questionário. Metodologia: participaram da pesquisa 54 voluntários, cirurgiões dentistas, alunos de especialização e mestrado, que responderam um questionário desenvolvido para esta pesquisa, composto de questões para caracterização do entrevistado e questões para avaliar os conhecimentos sobre mucosite. Após a coleta, os dados obtidos foram tabulados no editor de planilhas Microsoft Office Excel e submetidos a uma análise estatística descritiva e analítica das variáveis coletadas. Resultados: revelaram que quanto à autoavaliação do conhecimento específico sobre mucosite oral foi "Regular" (44,6%) a resposta mais prevalente, seguida de "Bom" com 30,4%, "Insuficiente" com 17,9% e "Ótimo", com 7,1%. Questionados sobre o contato com a mucosite oral na prática clínica, 62,5% dos voluntários (n:35) responderam não ter tido contato e 35,7% responderam ter tido contato com a mucosite oral (n:20). O local de conhecimento da condição foi na graduação (75%); e quanto à conduta 12,5% realizaria o tratamento e 64,3% encaminharia para um estomatologista; e 50% dos investigados relataram não ter tido orientação de prevenção e tratamento da mucosite oral durante o curso de Graduação. Conclusão: pode se concluir que os entrevistados têm conhecimento teórico em nível médio (54,97%) sobre os conceitos mais gerais de mucosite oral; e a grande maioria (62,5%) não teve experiência clínica com esta patologia.

Objective: this cross-sectional observational study aimed to evaluate the level of knowledge of dentists, graduate students in Radiology and Imaging of Faculdade São Leopoldo Mandic ­ Campinas on diagnosis, prevention and treatment of oral mucositis induced by cancer treatment, through the application of an questionnaire. Methodology: the participants were 54 volunteers, dentists, specialization and master's students, who answered a questionnaire developed for this study, consisting of questions to characterize the interviewee and questions to assess the knowledge of mucositis. The data were tabulated and submitted to a descriptive and analytical statistical analysis of the collected variables.Results: the results revealed that the self-assessment of specific knowledge about oral mucositis was "Regular" (44.6%) the most prevalent response, followed by "Good" with 30.4%, "Not Enough" with 17.9% and "Great", with 7.1%. When asked about contact with oral mucositis in clinical practice, 62.5% of the volunteers (n = 35) responded have had contact and 35.7% reported having had contact with oral mucositis (n: 20). The knowledge of the condition site was graduation (75%); and how to conduct 12.5% undergo the treatment and 64.3% thereafter forward for Stomatological; and 50% of surveyed reported not having guidance for prevention and treatment of oral mucositis during the course of graduation.Conclusion: It can be concluded that the respondents have theoretical knowledge average level (54.97%) of the more general concepts of oral mucositis; and the vast majority (62.5%) had no clinical experience with this disease.

Tooth abnormalities in pediatric patients submitted to antineoplastic treatment for central nervous system neoplasms / Anormalidades dentárias em pacientes pediátricos submetidos a tratamento antineoplásico para neoplasias do sistema nervoso central

Objective: The aim of this study was to evaluate the frequency of tooth abnormalities in pediatric patients treated for central nervous system neoplasms. Material and methods: This crosssectional study assessed thirty-one patients, median age 14.2 years (range 5 - 25), who were off therapy for at least one year, comparatively with a control group of thirty-one healthy patients matched for age with the study group. Tooth abnormalities were evaluated by panoramic radiographs. Results: There was no statistical significant evidence that patients of the study group (age range 5 - 25 years) have more frequency of tooth abnormalities comparatively with controls. However, in children who were diagnosed before five years of age, microdontia was the most common abnormality with statistically significant difference (P = 0.037). Root shortening grade III was observed in patients over 10 years of age at the time of radiographic examination, also with statistical significance (P = 0.046). Conclusions: There was no difference in the frequency of tooth abnormalities in pediatric patients treated for central nervous system neoplasms, comparatively with the control group. However, the findings of this study highlight the importance of giving parents and patients orientation about maintenance of good oral hygiene and proper treatment.

Objetivo: O objetivo deste estudo foi avaliar a frequência de anormalidades dentárias em pacientes pediátricos tratados para neoplasias do sistema nervoso central. Material e Métodos: Este estudo transversal avaliou trinta e um pacientes, com média de idade de 14,2 anos (entre 5 – 25 anos), que estavam fora de terapia há pelo menos um ano, comparativamente com um grupo controle composto por 31 pacientes saudáveis pareados por idade com o grupo de estudo. As anormalidades dentárias foram avaliadas por meio de radiografias panorâmicas. Resultados: Não houve evidência estatisticamente significante de que pacientes do grupo de estudo (entre 5 – 25 anos) apresentam maior frequência de anormalidades dentárias quando comparados aos pacientes do grupo controle. No entanto, em crianças diagnosticadas antes dos cinco anos de idade, microdontia foi a anormalidade mais comumente encontrada, com diferença estatisticamente significante (P=0.037). Encurtamento radicular grau III foi observado em pacientes com mais de 10 anos de idade ao exame radiográfico, também com significância estatística (P=0.046). Conclusão: Não houve diferença na frequência de anormalidades dentárias em pacientes pediátricos submetidos a tratamento antineoplásico para neoplasias do sistema nervoso central, comparativamente ao grupo controle. No entanto, os achados deste estudo ressaltam a importância de reconhecer os efeitos dentários tardios do tratamento antineoplásico em crianças com câncer e deste modo orientar pacientes e responsáveis sobre cuidados de higiene bucal e sobre opções de tratamento apropriado.

Long-term dental follow-up in hematological stem cells transplantation children / Acompanhametnto a longo prazo das alterações dentárias em pacientes pediátricos submetidos ao transplante de celulas tronco hematopoieticas

The aim of this paper is to update the current published content about the craniofacial long-term development disturbances of childhood hematopoietic stem-cell transplantation (HSCT) and the preparative regimens for the onco-hematological malignancies treatments. Methods: Two author sindependently reviewed the published articles about long-term effects of childhood HSCT that fitted into predetermined inclusion/exclusion criteria: clear definition of exposure or intervention, standard outcomes measurement and appropriate statistical analysis. Results: Twelve papers matched all the previous established eligibility criteria and were included in this review. The children’s age at HSCT were related to a higher risk of dental development disturbances, such as agenesis, dental hypoplasia, root stunting, crown-root proportion alterations, and microdontia. Craniofacial vertical growth was impaired in the irradiated patients without antero-posterior or latero-lateral impairment. Temporomandibular joint dysfunction was found to be more prevalent in the patients diagnosed withgraft-versus-host disease. Conclusion: The late effects of craniofacial development disturbances lead to several aesthetic and functional impairment, periodontal bone resorption with consequent impairment of chewing ability, and risk of early tooth loss often associated with life’s quality impairment. Further investigations should be performed to provide accurate information for patients, parent sand health care professionals...

Este artigo visa revisar o conteúdo publicado sobre as alterações tardias em crianças submetidas ao transplante de células-tronco hematopoiéticas(TCTH) e o regime pré-transplante para tratamento das doenças onco-hematológicas. Método: Dois autores independentes conduziram uma revisão simples dos artigos recentemente publicados sobre o tema, utilizando os critérios de exclusão/inclusão pré determinados: definição clara da intervenção clínica realizada, mensuração dos resultados padronizada e análise estatística adequada. Resultados: Doze artigos enquadraram-se em todos os critérios de avaliação pré-determinados para esta revisão. Houve correlação entre a idade da criança no momento do TCTH e maior risco de distúrbios de desenvolvimento dentário, como agenesia, hipoplasia dentária, encurtamento radicular,alterações da proporção coroa-raiz e microdontia.Houve alteração do crescimento craniofacial no sentido vertical sem, no entanto, alterar o crescimento anteroposterior e latero-lateral. Disfunção da articulação temporomandibular foi mais prevalente entre os pacientes com diagnostico de Doença do Enxerto contra o Hospedeiro. Conclusão: Os efeitos tardios do desenvolvimento craniofacial podem levara diversas alterações estéticas e funcionais, reabsorção óssea periodontal, diminuição da capacidade de mastigação e perda dentária precoce com possíveis impactos negativos sobre a qualidade de vida. Mais estudos são necessários para fornecer informações precisas aos pacientes, cuidadores e profissionais de saúde...

Effects of thermomechanical and thermocycling on the shear bond strength of brackets to bovine enamel bonded with conventional and self-etching adhesive systems / Efeito da ciclagem térmica e térmico-mecânica na resistência adesiva ao cisalhamento de bráquetes aderidos ao esmalte bovino com sistema adesivo convencional e auto-condicionante

Muitos sistemas adesivos foram desenvolvidos na última década. O objetivo desse estudo foi avaliara resistência adesiva ao cisalhamaneto (RAC)de bráquetes ortodônticos aderidos com primer convencional (PC) ou primer auto-condicionante (PAC), submetidos à ciclagem térmica (CT) e ciclagem térmico-mecânica (CTM). Incisivos bovinos (n =90)foram randomicamente divididos em 2 grupos (n =45) para a colagem dos bráquetes: XT (Transbond XT, 3M-Unitek, CA, USA); SEP (Transbond Plus SEP,3M-Unitek, CA, USA). Após o procedimento adesivo os grupos forma subdivididos em 3 sub-grupos: SC(sem ciclagem) – 1 e 4 (n =15 cada); CTM (ciclagem térmico-mecânica)- 2 e 5 (n = 15 cada); CT (ciclagem térmica)- 3 e 6 (n = 15 cada). Um simulador de fadiga térmica foi usado para os subgrupos 3 e 6, que fioram submetidos a 500 ciclos térmicos entre 5 and 55 C (ISO 11405). Os subgrupos 2 e 5 foram submetidos à ciclagem térmico-mecânica em um simulador de fadiga. Os espécimes foram colocados em uma basede metal num ângulo de 45 e os braquetes receberam impulsos de 1 bar e 4 Hz de frequência, por uma agulha de metal de 2.5 mm de diâmetro fixada na haste superior do equipamento. Foram submetidos a 100.000 ciclos mecânicos e 500 ciclos térmicos entre 5 and 55 C. O teste de RAC foi realizado emuma máquina universal de testes (1mm/min). Após orompimento da união foi realizada uma avaliação emmicroscopia óptica para avaliar a penetração adesivae o Índice de Permanência do Adesivo (IPA) sobreo esmalte. Os resultados mostraram maiores valores de RAC (14,70 ± 4,85 MPa) para o SEP. A CT não influenciou os resultados para o XT (NC- 11,44 MPa;TC - 11,20 MPa; TMC - 11,19 MPa), enquanto para oSEP, a CTM mostrou maiores valores (16,84 MPa)...

Several adhesive systems have been developed in the last decade. The aim of the current studywas to evaluate the shear bond strength (SBS) of orthodontic brackets bonded with conventional primers (XT) or self-etching primers (SEP), by means of thermocycling (TC) and thermomechanical(TM) procedures. 90 bovine incisors were randomly divided into 2 groups (45 specimens each) for brackets bonding: XT (Transbond XT, 3M-Unitek,CA, USA); SEP (Transbond Plus SEP, 3M-Unitek,CA, USA). After bonding, groups were divided into 3subgroups: NC (no cycling)- 1 and 4 (n = 15 each),TMC – 2 and 5 (n =15 each); and TC- 3 and 6 (n=15 each). The fatigue simulator was used for thethermal fatigue test of groups 3 and 6, which were submitted to thermal variation cycles - 500 cyles were carried out in between 5 and 55 C ( ISO 11405). Groups 2 and 5 were submitted to thermomechanicaltests by using the mechanical fatigue simulator. Thespecimens were placed at a metal base at an angleof 45, in a way that the 2.5 mm diameter metalneedle was fixed in the upper part of the cyclingmachine and could induce impulses of 1 bar loadintensity and 4 Hz frequency (4 cycles per second)on the bracket. The samples were submitted to 100000 mechanical cycles and 500 thermal cycles which varied from 5C to 55C. The SBS test was performed in a universal testing machine (1 mm/min). Afterdebonding, optic microscopic evaluation for adhesive penetration and Adhesive Remaining Index (ARI)analyses in the enamel surface were performed.The results showed higher SBS (14.70 ± 4.85 MPa)values for SEP. The SBS remained similar despitecycling (NC-11.44 MPa; TC-11.20 MPa; TMC-11.19MPa) for XT, meanwhile for SEP, ...

Dental anomalies in children submitted to antineoplastic therapy.

Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.

Dental anomalies in children submitted to antineoplastic therapy

Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.

Comparison of disinfection protocol of irreversible hydrocolloid (alginate) impressions through plastic and metallic trays / Comparação do protocolo de desinfecção de moldes com hidrocolóide irreversível (alginato) em moldeiras plásticas e metálicas

Introduction: Many studies have evaluated the disinfection of irreversible hydrocolloid impressions through different disinfecting agents. However, impression trays can be source of cross-infection requiring disinfection. This study aimed to determine which would be the most suitable tray (metallic or plastic), available in dental market, and the ideal time to achieve disinfection by using 1% sodium hypochlorite poured into the alginate impression. Material and method: Thirty dental impressions from the patients aged from 7-12 years and treated in the Discipline of Orthodontics of the institution were divided into two groups according to the impression tray type: 15 impressions through plastic tray (Morelli) and 15 impressions through metallic tray (Tecnodent). The material collection was performed before and after the application of 1% sodium hypochlorite for 3, 5 and 10 min. After the incubation period of 48 h at 37 ºC, the microorganism colonies were counted on the plates presenting from 30 to 300 colonies to determine the colony-forming unit (CFU) per mL. CFU/ mL results were transformed into logarithm and submitted to statistical analysis by applying ANOVA and Tukey test (p ≤ 0.05). Results: Greater CFU percentage reduction occurred in alginate after three min, in both tray types. Concerning to tray types, it could be observed that the plastic tray showed 100% of reduction after 5 min while the metallic tray exhibited 81.49% of reduction after 3 min. Conclusion: 1 – The plastic tray showed the most effective disinfection after 5 min, with 100% of CFU reduction; 2 – The most effective time of disinfection with 1% sodium hypochlorite poured into the impression was 5 min, for both tray types.

Introdução: Muitos são os trabalhos que avaliam a desinfecção das moldagens com hidrocolóide irreversível e com diferentes agentes desinfetantes, mas as moldeiras também podem ser vetores de infecção cruzada e é necessária a sua desinfecção. A proposta do trabalho foi determinar qual a melhor moldeira (metálica ou plástica), disponíveis no mercado para a utilização do cirurgião dentista, e o tempo ideal para se obter a desinfecção utilizando o hipoclorito de sódio a 1% vertido na moldagem de com alginato. Material e método: Foram obtidas 30 moldagens de pacientes em tratamento na Disciplina de Ortodontia, do Curso de Odontologia, do ICT-UNESP-SJC, com idades entre 7 e 12 anos, divididas em dois grupos de acordo com o tipo de moldeira empregada: 15 moldagens com moldeiras de plástico (Morelli) e 15 com moldeiras de metal (Tecnodent). A coleta de material foi realizada antes e após a aplicação do hipoclorito de sódio a 1% durante 3, 5 e 10 min. Após período de incubação de 48 h a 37 ºC foram contadas colônias de microorganismos nas placas que apresentaram de 30 a 300 colônias para determinação de Unidades Formadoras de Colônias (UFC) por mL. Os resultados em UFC/ mL foram transformados em logaritmo e submetidos à análise estatística Anova e teste de Tukey (p ≤ 0,05). Resultados: No alginato ocorreu uma maior redução percentual de UFC após 3 min, em ambas as moldeiras. Em relação a maior redução nas moldeiras, pudemos observar que a moldeira plástica ocorreu 100% de redução após 5 min e 81,49% de redução na moldeira metálica após 3 min. Conclusão: 1 - A moldeira plástica apresentou desinfecção mais eficiente, após 5 min, com redução de 100% de UFC; 2 - O tempo mais eficaz de desinfecção da moldagem com hipoclorito de sódio a 1% vertido na moldagem foi de 5 min, para moldeira de plástico e de metal.

Prevalence of dental anomalies in children analyzed byorthopantomography / Prevalência de anomalias dentárias em crianças analisadas por ortopantomografia

Objective: To determine the prevalence of dental anomalies in patients aged from 4-12 years-old through radiographic examination. Material and Methods: 523 panoramic radiographs and file records were selected and analyzed by 3 calibrated examiners. The material was selected from the Orthodontic and Pediatric Dentistry files of Child Clinics of the Science and Technology Institute of Sao Jose dos Campos of the Sao Paulo State University, including only those with high quality and contrast. Data were submitted to statistical analysis. Results: The tabulated data were statistically analyzed by Mann Whitney test and Fisher’s exact test. There was a higher incidence of abnormalities in females (56.72%). It was found 7 cases (1.34%) of supernumerary teeth, 47 cases (8.99%) of anodontia, 45 cases (8.60%) of impacted teeth, 28 cases (5.35%) of dilacerated teeth, and 7 cases (1.34%) of ankylosed deciduous teeth. Conclusion: According to the sample studied, dental anomalies were present in 25.62% of the children. Considering the number of supernumerary, ankylosed, impacted and dilacerated teeth, there were no statistical differences between genders. There was statistical difference between genders regarding to the number of anodontia, with higher predominance in females.

Objetivo: Determinar a prevalência de anomalias dentárias em pacientes de 4 a 12 anos de idade por meio de avaliação radiográfica. Material e Métodos: 523 radiografias panorâmicas foram selecionadas e analisadas por três examinadoras calibradas. Os dados foram submetidos à análise estatística. O material foi selecionado a partir dos arquivos e prontuários das Disciplinas de Ortodontia e Odontopediatria, da Faculdade de Odontologia do ICT/UNESP. Foram incluídas no estudo as radiografias que apresentavam qualidade e contraste adequados. Resultados: Os dados obtidos foram analisados estatisticamente pelos testes Mann Whitney e Teste exato de Fisher. Os resultados revelaram que foram verificadas anomalias em 82 radiografias (15,68%). Com relação ao sexo, houve maior incidência de anomalias no gênero feminino (56,72%). Foram encontrados 7 casos (1,34%) de dentes supranumerários, 47 casos (8,99%) de anodontias, 45 casos (8,60%) de dentes impactados, 28 casos (5,35%) de dentes dilacerados e 7 casos (1,34%) de dentes decíduos anquilosados. Conclusão: De acordo com o estudo, as anomalias estavam presentes em 25,62% da amostra. Com relação ao gênero, o sexo feminino apresentou uma maior prevalência de anomalias dentais. Em relação ao número de dentes supranumerários e dentes anquilosados, a proporção entre os gêneros feminino e masculino não diferiu estatisticamente, embora a proporção no gênero feminino tenha sido ligeiramente maior. Em relação ao número de dentes impactados e dentes dilacerados, a proporção entre os gêneros feminino e masculino não diferiu estatisticamente, embora a proporção no gênero masculino tenha sido maior. Em relação ao número de anodontias, a proporção entre os gêneros feminino e masculino diferiu estatisticamente, sendo que no gênero feminino a proporção foi maior.

In vitro evaluation of the microhardness of bovine enamel exposed to acid solutions after bleaching.

Acid erosion is a superficial loss of enamel caused by chemical processes that do not involve bacteria. Intrinsic and extrinsic factors, such as the presence of acid substances in the oral cavity, may cause a pH reduction, thus potentially increasing acid erosion. The aim of this study was to evaluate the microhardness of bleached and unbleached bovine enamel after immersion in a soda beverage, artificial powder juice and hydrochloric acid. The results obtained for the variables of exposure time, acid solution and substrate condition (bleached or unbleached enamel) were statistically analyzed by the ANOVA and Tukey tests. It was concluded that a decrease in microhardness renders dental structures more susceptible to erosion and mineral loss, and that teeth left unbleached show higher values of microhardness compared to bleached teeth.

In vitro evaluation of the microhardness of bovine enamel exposed to acid solutions after bleaching

Acid erosion is a superficial loss of enamel caused by chemical processes that do not involve bacteria. Intrinsic and extrinsic factors, such as the presence of acid substances in the oral cavity, may cause a pH reduction, thus potentially increasing acid erosion. The aim of this study was to evaluate the microhardness of bleached and unbleached bovine enamel after immersion in a soda beverage, artificial powder juice and hydrochloric acid. The results obtained for the variables of exposure time, acid solution and substrate condition (bleached or unbleached enamel) were statistically analyzed by the ANOVA and Tukey tests. It was concluded that a decrease in microhardness renders dental structures more susceptible to erosion and mineral loss, and that teeth left unbleached show higher values of microhardness compared to bleached teeth.

Evaluation of bond strength of self-adhesive cements to dentin with or without application of adhesive systems.

PURPOSE: To evaluate the bond strength of indirect restorations to dentin using self-adhesive cements with and without the application of adhesive systems. MATERIAL AND METHODS: Seventy-two bovine incisors were used, in which the buccal surfaces were ground down to expose an area of dentin measuring a minimum of 4 x 4 mm. The indirect resin composite Resilab was used to make 72 blocks, which were cemented onto the dentin surface of the teeth and divided into 4 groups (n = 18): group 1: self-adhesive resin cement BiFix SE, applied according to manufacturer's recommendations; group 2: self-adhesive resin cement RelyX Unicem, used according to manufacturer's recommendations; group 3: etch-and-rinse Solobond M adhesive system + BiFix SE; group 4: etch-and-rinse Single Bond 2 adhesive system + RelyX Unicem. The specimens were sectioned into sticks and subjected to microtensile testing in a universal testing machine (EMIC DL- 200 MF). Data were subjected to one-way ANOVA and Tukey's test (α = 5%). RESULTS: The mean values (± standard deviation) obtained for the groups were: group 1: 15.28 (± 8.17)a, group 2: 14.60 (± 5.21)a, group 3: 39.20 (± 9.98)c, group 4: 27.59 (± 6.57)b. Different letters indicate significant differences (ANOVA; p = 0.0000). CONCLUSION: The application of adhesive systems before self-adhesive cements significantly increased the bond strength to dentin. In group 2, RelyX Unicem associated with the adhesive system Single Bond 2 showed significantly lower mean tensile bond strengths than group 3 (BiFix SE associated with the etch-and-rinse Solobond M adhesive system).

Dental approach in the pediatric oncology patient: characteristics of the population treated at the dentistry unit in a pediatric oncology brazilian teaching hospital.

OBJECTIVES: The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. METHOD: Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures. RESULTS: Review of 1,236 visits indicated that 54% (n=100) of the patients had blood cancers, 46% (n=86) had solid tumors and 63% were undergoing anticancer therapy. The proportion of males (52.7%) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2%). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci. CONCLUSION: The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients' quality of life, which is critical to provide oral care and prevent future oral problems.

Dental approach in the pediatric oncology patient: characteristics of the population treated at the dentistry unit in a pediatric oncology brazilian teaching hospital

OBJECTIVES: The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. METHOD: Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures. RESULTS: Review of 1,236 visits indicated that 54 percent (n=100) of the patients had blood cancers, 46 percent (n=86) had solid tumors and 63 percent were undergoing anticancer therapy. The proportion of males (52.7 percent) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2 percent). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci. CONCLUSION: The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients' quality of life, which is critical to provide oral care and prevent future oral problems.