In-vitro effect of a single application of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets.

OBJECTIVE: To assess the in-vitro effect of single applications of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets. MATERIAL AND METHODS: Tooth/bracket sets (n=65) were immersed in artificial saliva (1h at 37ºC) and randomly subjected to single applications (100µL; 1min) of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP emulsion), CPP-ACP with fluoride (CPP-ACPF emulsion), solutions of titanium tetrafluoride (TiF4) or sodium fluoride (NaF), or no treatment (CG). Multispecies biofilm (5 x 105 CFU/mL) was formed in the presence of 2% sucrose. After 24 h, the pH and the concentration of total soluble fluoride (TSF) were analyzed by culture medium. The presence of active white spot lesions (WSL) evaluated by macroscopic examination and the percent surface mineral loss (%SML) were analyzed. Also, the topography of enamel was detected by analysis of scanning electron microscopy (SEM). The data was assessed by chi-square, Kruskal-Wallis, and Mann-Whitney tests (p < 0.05). RESULTS: Fluoride-containing compounds led to a smaller pH reduction than did CPP-ACP and CG (p<0.05). There was difference in TSF between the groups (p<0.05), denoted as TiF4> NaF > CPP-ACPF > CPP-ACP > CG. Regarding the presence of WSL and %SML, the NaF group obtained lower values (p<0.05), while TiF4 and CPP-ACPF were similar (p>0.05). SEM demonstrated that fluoride-free groups had a larger surface dissolution. CONCLUSION: Fluoridated groups including solutions and CPP-ACPF were more effective than CPP-ACP in reducing enamel demineralization around orthodontic brackets after a single application.

Clinical Findings Arising from the Use of Silver Diamine Fluoride to Prevent or Treat Caries Lesions and Dentinal Hypersensitivity: A Data Mining Analysis

Abstract Objective: To summarize data of clinical trials that used silver diamine fluoride (SDF) to prevent and treat caries lesions and dentinal hypersensitivity. Material and Methods: Six electronic databases were searched in May 2022. The concentration of SDF, type of usage (alone/combined), dentition, anterior/posterior teeth, tooth region, dental tissue, number of the treated surfaces, the intervention environment, participants' age, frequency and duration of SDF application, purpose, and outcome were the extracted variables. The type of study, year of publication, authors, journals, and country were also investigated. Results: From 8860 articles, S3 were selected. Most were randomized (n=38), that applied 38% SDF (n=43), alone (n=44), on multiple surfaces (n=44), only in dentin (n=36), of the crown (n=46) of anterior and posterior (n=36) primary teeth (n=39). The studies were preferably carried out outside the clinic (n=3l), only in children (n=33), with reapplication of SDF (n=30), but did not inform the duration of application (n= 19). SDF was most used to treat (n=46) only caries lesions (n=50). They were published between 2001 and 2022, mainly in the Journal of Dentistry (n=10). China (n=19) and Lo E.GM (n=19) were the countries and authors that published the most, respectively. Conclusion: The silver diamine fluoride 38% alone was most used to treat caries lesions in the dentin of the crown of all primary teeth, preferably applied on multiple surfaces, requiring re application, and outside the clinic.

Implications of Vitamin D Status for Children's Bone Health: A Data Mining Analyses of Observational Studies

ABSTRACT Objective: To investigate associations/correlations between bone alterations and vitamin D status in children through data mining analyses based on observational studies. Material and Methods: Searches in PubMed, Scopus, Web of Science, and Embase databases were performed to recover studies, published until October 2022, with healthy children, which investigated the vitamin D status, related or not to undesirable bone alterations linked to bone quality (bone mineral density and bone mineral content), fracture or anthropometry. Country, study design, area of expertise (medicine, nutrition, dentistry, others), bone outcome, 25-hydroxyvitamin D data (serum or intake levels), the exams for bone diagnosis, and the results were analyzed in the VantagePointTM software. Results: Of 20,583 studies, 27 were included. The USA (n=9; 33.3%) had the highest number of publications. Cross-sectional (n=11; 40.7%), case-control (n=9; 33.3%), and cohort studies (n=7; 25.9%) contemplated the medicine and nutritional areas without any study in dentistry. Studies about bone quality (n=21; 77.8%), analyzed through dual-energy X-ray absorptiometry (DXA; n=14; 51.8%), with association (n=16; 59.2%) between the low serum levels of 25-hydroxyvitamin D and undesirable bone alterations (n=14; 51.8%) were the most prevalent. Conclusion: Most studies were conducted in the medical area and showed an association between low bone quality and low levels of 25-hydroxyvitamin D, verified through DXA.

In vitro and in situ caries-preventive effect of a new combined fluoride and calcium experimental nanocomposite solution.

To assess the in vitro and in situ effect of experimental combined fluoride and calcium nanocomposite solutions on dental caries prevention. Nanocompound mesoporous silica (MS) with calcium (Ca) and sodium fluoride (NaF) - (MSCaNaF); MS with NaF (MSNaF), NaF solution (positive control), and deionized water (negative control - CG) were studied. The specimens (n=130) were submitted in vitro to a multispecies biofilm in the presence of 2% sucrose. After 24 h and 48 h, the culture medium pH, the percent of surface mineral loss (%SML), and lesion depth (ΔZ) were analyzed. In the in situ study, 10 volunteers participated in four phases of 7-days each. The products were applied on the specimens (n=240) before 20% sucrose solution drips. The polysaccharides (SEPS and IEPS), %SML and roughness (Sa) were evaluated. There was an in vitro decrease in pH values in 24h and 48h, compared to baseline. The MSCaNaF and MSNaF groups obtained lower values of %SML and ΔZ (p < 0.05) than CG and NaF after 24h and were similar to NaF after 48h (p<0.05). In situ results showed similar SEPS and IEPS among all groups after 48h. An after 7-days, the nanocomposites had similar values (p>0.05), while NaF was similar to CG (p>0.05). After 48h, the MSCaNaF and MSNaF reduced the %SML (p<0.05). After 7-days, both experimental nanocomposites were similar to NaF (p>0.05). Regarding Sa, MSCaNaF was better than NaF for both periods (p<0.05). The nanocomposites controlled the in vitro and in situ enamel demineralization, mainly in the initial periods.

In vitro and in situ caries-preventive effect of a new combined fluoride and calcium experimental nanocomposite solution

Abstract To assess the in vitro and in situ effect of experimental combined fluoride and calcium nanocomposite solutions on dental caries prevention. Nanocompound mesoporous silica (MS) with calcium (Ca) and sodium fluoride (NaF) - (MSCaNaF); MS with NaF (MSNaF), NaF solution (positive control), and deionized water (negative control - CG) were studied. The specimens (n=130) were submitted in vitro to a multispecies biofilm in the presence of 2% sucrose. After 24 h and 48 h, the culture medium pH, the percent of surface mineral loss (%SML), and lesion depth (ΔZ) were analyzed. In the in situ study, 10 volunteers participated in four phases of 7-days each. The products were applied on the specimens (n=240) before 20% sucrose solution drips. The polysaccharides (SEPS and IEPS), %SML and roughness (Sa) were evaluated. There was an in vitro decrease in pH values in 24h and 48h, compared to baseline. The MSCaNaF and MSNaF groups obtained lower values of %SML and ΔZ (p < 0.05) than CG and NaF after 24h and were similar to NaF after 48h (p<0.05). In situ results showed similar SEPS and IEPS among all groups after 48h. An after 7-days, the nanocomposites had similar values (p>0.05), while NaF was similar to CG (p>0.05). After 48h, the MSCaNaF and MSNaF reduced the %SML (p<0.05). After 7-days, both experimental nanocomposites were similar to NaF (p>0.05). Regarding Sa, MSCaNaF was better than NaF for both periods (p<0.05). The nanocomposites controlled the in vitro and in situ enamel demineralization, mainly in the initial periods.

Did the Use of Minimum Interventions for Caries Management Change during the COVID-19 Pandemic? A Cross-Sectional Study.

The aim of this study was to evaluate changes in the frequency of use of minimum intervention (MI) techniques for caries management during the COVID-19 pandemic. A questionnaire was applied through the SurveyMonkeyTM platform to evaluate changes in the dentist's frequency of use of noninvasive, microinvasive, minimally invasive, and mixed interventions, nonaerosol or aerosol productive, to manage dental caries before and during COVID-19 pandemic. Differences in the use of MI techniques were analyzed by Wilcoxon test, and the effect size (ES) was calculated. An α = 0.05 was adopted. A total of 781 dentists answered the questionnaire; most of them were female (76.4%), with 30s (76.4%), graduated over 10-24 years ago (38%) in public dental schools (62%), graduated in southwest of Brazil (38%), that work in clinical environment (66.8%) and in private jobs (53.4%). During COVID-19, among the sample, 91 respondents were not working. In relation to the noninvasive techniques, only the use of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) decreased during the COVID-19 pandemic (p < 0.01; ES = 0.11). The frequency of sealants to repair defective restorations was the only microinvasive technique that increased during the pandemic (p < 0.01; ES = 0.03). Among the minimally invasive techniques, the use of atraumatic restorative treatment increased significantly (p < 0.01; ES = 0.06), while the use of air abrasion decreased (p = 0.02; ES = 0.04) during COVID-19 pandemic. Moreover, nonrestorative cavity control (mixed intervention) increased during pandemic period (p < 0.001; ES = 0.11). Although the results demonstrated differences in the use of some procedures, a very small magnitude of the effect was perceived, demonstrating that the influence of COVID-19 pandemic was very little, if any, in the use of MI techniques for caries management. Moreover, the use of MI strategies was already well established between Brazilian dentists before the pandemic period.

In-vitro effect of a single application of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets

ABSTRACT Objective: To assess the in-vitro effect of single applications of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets. Material and Methods: Tooth/bracket sets (n=65) were immersed in artificial saliva (1h at 37ºC) and randomly subjected to single applications (100µL; 1min) of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP emulsion), CPP-ACP with fluoride (CPP-ACPF emulsion), solutions of titanium tetrafluoride (TiF4) or sodium fluoride (NaF), or no treatment (CG). Multispecies biofilm (5 x 105 CFU/mL) was formed in the presence of 2% sucrose. After 24 h, the pH and the concentration of total soluble fluoride (TSF) were analyzed by culture medium. The presence of active white spot lesions (WSL) evaluated by macroscopic examination and the percent surface mineral loss (%SML) were analyzed. Also, the topography of enamel was detected by analysis of scanning electron microscopy (SEM). The data was assessed by chi-square, Kruskal-Wallis, and Mann-Whitney tests (p < 0.05). Results: Fluoride-containing compounds led to a smaller pH reduction than did CPP-ACP and CG (p<0.05). There was difference in TSF between the groups (p<0.05), denoted as TiF4> NaF > CPP-ACPF > CPP-ACP > CG. Regarding the presence of WSL and %SML, the NaF group obtained lower values (p<0.05), while TiF4 and CPP-ACPF were similar (p>0.05). SEM demonstrated that fluoride-free groups had a larger surface dissolution. Conclusion: Fluoridated groups including solutions and CPP-ACPF were more effective than CPP-ACP in reducing enamel demineralization around orthodontic brackets after a single application.

RESUMO Objetivo: Avaliar in-vitro o efeito de uma aplicação única de cremes dentais de CPP-ACP e diferentes soluções fluoretadas na prevenção da cárie dentária ao redor de braquetes ortodônticos Material e Métodos: O conjunto dentes/braquetes (n=65) foi imerso em saliva artificial (1h em 37°C) randomizado e submetido a tratamento único (100µL; 1 min) de emulsão de fosfopeptídeo de caseína-fosfato de cálcio amorfo (CPP-ACP) e CPP-ACP associado ao flúor (CPP-ACPF); soluções de tetrafluoreto de titânio (TiF4) e fluoreto de sódio (NaF); e ausência de tratamento (GC). Biofilmes multiespécie (5 x 105 CFU/mL) foram formados na presença de sacarose a 2%. Após 24h, o pH e a concentração de fluoreto solúvel total (FST) foram analisados pelo meio de cultura. Foram avaliadas a presença de lesões de mancha branca (LMB), por meio da análise de macroscopia visual, e a porcentagem de perda de dureza (%PD). Também foi verificada a topografia do esmalte, usando microscopia eletrônica de varredura (MEV). Os dados foram analisados pelos testes Qui-quadrado, Kruskal-Wallis e Mann-Whitney (p < 0,05). Resultados: Os compostos contendo flúor levaram a uma redução do pH menor do que o CPP-ACP e GC (p<0,05). Houve diferença no FST entre os grupos (p <0,05), sendo TiF4> NaF > CPP-ACPF > CPP-ACP > GC. Quanto à presença de LMB e à %PD, o grupo NaF obteve os menores valores (p<0,05), enquanto TiF4 e CPP-ACPF foram semelhantes (p> 0,05). A MEV demonstrou que os grupos sem flúor tiveram uma dissolução superficial maior. Conclusão: Os grupos fluoretados, incluindo soluções e CPP-ACPF, foram mais eficazes do que o CPP-ACP sem flúor na redução da desmineralização do esmalte ao redor dos braquetes ortodônticos após uma única aplicação.

The Xylitol Applicability and its Effects in Health Area Worldwide: A Bibliometric Analysis Based on Randomized Controlled Trials

ABSTRACT Objective To describe and evaluate the xylitol products' applicability and its effects in the health area worldwide utilizing a bibliometric analysis from randomized controlled trials (RCT) with humans. Material and Methods Electronic searches were carried out in Medline/PubMed, Scopus, Cochrane Library, Web of Science, and VHL databases. The main data extracted were: year, area of applicability, type of treatment, country, journal, xylitol posology and concentration, presentation form, outcomes, and effects. Results From 1476 studies, 257 were included. These studies were published between 1973-2021. The majority was carried out in dentistry (73.9%) and under preventive treatment (67.4%). These studies were developed in the USA (15.4%) and published in Caries Research (6.6%). The posology and concentration ranged between 0.004-67 g/day and 0.002-100%, respectively. The xylitol is usually used in the chewing gum form (44.0%), and for antimicrobial activity evaluation (38.5%). A positive effect was observed in 204 studies (79.3%) and was associated with xylitol concentration ≥ 15(p=0.007). Side effects were reported in 8.2and were associated with posology ≥ 5 g/day (p=0.03). Conclusion Most studies with xylitol were conducted to prevent diseases in the dentistry field. The chewing gum form and antimicrobial activity evaluation were more frequent. Most xylitol products have a positive effect, and few studies report side effects.

Gradual Deprogramming of Self-Inflicted Oral Trauma Habit in a Child with Cerebral Palsy.

The purpose of this paper is to report the successful noninvasive treatment of a self-inflicted traumatic lesion on the lower labial mucosa in a 22-month-old boy with cerebral palsy. An acrylic appliance was cemented on the anterior maxillary region to reduce repetitive self-injury by gradual deprogramming. The wound healed after a few weeks, but four weeks after the appliance was removed new trauma was observed at the site. The appliance was replaced by a new one on the anterior region of the mandibular arch, and complete remission of the habit was achieved after three weeks. In order to prevent relapse, the appliance was gradually reduced in size with carbide drills every two weeks and was removed three weeks after the final reduction. After 24 months of follow-up, the labial mucosa was completely healed and no recurrence of the traumatic habit has been observed.

Efeitos de produtos naturais e da dieta sobre parâmetros salivares, biofilme dentário, cárie e doença periodontal em crianças e adolescentes / Effects of natural products and diet on salivary parameters, dental biofilm, caries and periodontal disease in children and adolescents

Objetivou-se avaliar a eficácia de antimicrobianos naturais (ANs) em comparação aos sintéticos (ASs) no controle do biofilme e contagem de microrganismos (MOs), por meio de uma revisão sistemática (RS) (artigo 1); realizar uma revisão de literatura sobre os benefícios da própolis na saúde bucal (capítulo de livro 1); investigar, por meio de revisões bibliométricas, a aplicabilidade e o efeito de produtos com xilitol na área da saúde (artigo 2) e a eficácia de dentifrícios com xilitol (DX) ou própolis (DP) frente a condições bucais (capítulo de livro 2); verificar, por meio de um ensaio clínico cruzado e randomizado (ECR), o efeito de pastilhas de xilitol com (PXP) e sem (PX) própolis vermelha, sobre parâmetros salivares, biofilme e aceitabilidade sensorial de adolescentes (artigo 3); além de avaliar a influência da dieta na saúde bucal de crianças e adolescentes por meio de uma revisão bibliométrica (artigo 4). Para os estudos de revisão, buscas eletrônicas foram feitas no PubMed, Scopus, Cochrane Library, Web of Science, BVS e EMBASE. Na RS, avaliaramse o risco de viés e o nível de evidência. Metanálises (MAs) foram realizadas de acordo com a influência dos ANs sobre o índice de placa (IP), a redução do biofilme ao longo do tempo e a contagem de MOs. Análises descritivas dos dados bibliométricos foram realizadas no VantagePoint® e SPSS. No ECR, indivíduos entre 10 e 19 anos (n=29), saudáveis, sem cavidades de cárie, foram alocados aleatoriamente nos grupos, PXP e PX, com 30 dias de washout, para consumo de 2 pastilhas/dia (às 10h e 17h) por 7 dias. A saliva foi coletada antes (t0), imediatamente (t1) e 7 dias (t2) após o consumo de PXP e PX, para análise do fluxo, pH e capacidade tampão. Analisaram-se as diferenças das médias, em t0 e t2, de polissacarídeos extracelulares (PEC), microrganismos totais (MT) e Streptococcus spp. (Ss) do biofilme. A variabilidade de MOs foi avaliada usando MALDITOF. O questionário de aceitabilidade sensorial/intenção de compra foi respondido em t2. Utilizaram-se os testes t pareado e Wilcoxon (α=0,05). Na RS, 16 estudos foram selecionados para síntese qualitativa, dos quais 12 foram incluídos nas MAs. Os ANs foram menos eficazes na melhora do IP (p<0,01, I2> 87%) e na redução do biofilme ao longo do tempo (p<0,01, I2>87%), mas foram semelhantes aos ASs na redução de MOs (p=0,3, I 2=0%). A qualidade da evidência variou de moderada a baixa. Relatou-se, por meio da revisão de literatura, que produtos com própolis podem apresentar atividade antimicrobiana, anti-inflamatória, antioxidante e anticâncer. Estudos sobre xilitol (n=257) foram realizados, em sua maioria, na área de odontologia (73,9%) e para avaliação da atividade antimicrobiana (38,5%). A posologia e a concentração variaram entre 0,004-67 g/dia e 0,002-100%, respectivamente. Efeito positivo foi observado em 79,3% dos estudos e foi associado à concentração de xilitol ≥15% (p=0,007). Efeitos adversos (8,2%) foram associados à posologia ≥5 g/dia (p=0,03). Estudos com DX (n=41) e DP (n=22) utilizaram os dentifrícios como tratamento principal (95,2%), para controle do biofilme (36,5%) e exibiram efeito positivo sobre a saúde bucal (85,7%). A concentração de xilitol e própolis variou de 1 a 49%. Náusea ou queimação gengival (3,2%) e coceira inicial (1,6%) foram relatadas para DP e DX, respectivamente. No ECR, observou-se aumento dos parâmetros salivares apenas em t1, sem diferença entre PXP e PX (p>0,05). Não houve diferença de MT entre os grupos (p=0,177), porém PX foi mais eficaz na redução de Ss (p=0,01). A variabilidade de MOs do biofilme diminuiu para ambos os grupos, mas não houve redução de PEC intra e intergrupos (p≥0,090). A aceitabilidade sensorial foi de 78,2% para PXP e 82,3% para PX (p=0,607), com maior intenção de compra para PX (p<0,001). Estudos sobre dieta e saúde bucal (n=214) foram em sua maioria transversais (60,3%), apenas com crianças (64%) e realizaram avaliação de cárie (95,8%). A consistência da dieta não influenciou na saúde bucal. Observou-se associação positiva entre cárie e açúcares (91,2%), lanches (82,9%), hábitos alimentares noturnos (75%) e exposições ≥3×/dia (7%). Conclui-se que, embora ANs sejam semelhantes aos ASs na redução de MOs, são menos eficazes na melhora do IP e na redução de biofilme ao longo do tempo. Produtos naturais, como o xilitol e a própolis, apresentam propriedades biológicas que favorecem sua utilização na manutenção da saúde bucal. Não houve diferença entre PXP e PX nos parâmetros salivares. Apenas PX reduziu o número de microrganismos do biofilme. PXP e PX apresentaram boa aceitabilidade sensorial, com maior intenção de compra para PX. A consistência da dieta não influenciou na saúde bucal, mas a composição e a frequência da dieta foram associadas à cárie dentária. (AU)

El objetivo fue evaluar la eficacia de los antimicrobianos naturales (ANs) frente a los sintéticos (ASs) en el control del biopelícula dental, mediante una revisión sistemática (RS) (artículo 1); realizar una revisión de la literatura sobre los beneficios del própolis en la salud bucal (capítulo de libro 1); investigar, a través de revisiones bibliométricas, la aplicabilidad y efecto de los productos con xilitol en el área de la salud (artículo 2) y la efectividad de dentífricos con xilitol (DX) o própolis (DP) contra las condiciones bucales (capítulo de libro 2); verificar, mediante un ensayo clínico cruzado y aleatorizado (ECA), el efecto de las tabletas de xilitol con (TXP) y sin (TX) própolis rojo, sobre los parámetros salivales, biopelícula y aceptabilidad sensorial de adolescentes (artículo 3), además de evaluar la influencia de la dieta en la salud bucal de niños y adolescentes (artículo 4). Para los estudios de revisión, se realizaron búsquedas electrónicas en PubMed, Scopus, Cochrane Library, Web of Science, VHL y EMBASE. En RS se evaluó el riesgo de sesgo y el nivel de evidencia. Los metanálisis (MAs) se realizaron de acuerdo con la influencia de los ANs sobre el índice de placa (IP), la reducción de biopelícula a lo largo del tiempo y el recuento de microorganismos (MOs). Se realizaron análisis descriptivos de datos bibliométricos utilizando VantagePoint® y SPSS. En el ECA, individuos sanos entre 10 y 19 años (n=29), sin caries, fueron asignados aleatoriamente a los grupos, TXP y TX, con 30 días de washout, para consumir 2 tabletas/día (a las 10 am y 5 pm) durante 7 días. La saliva se recogió antes (t0), inmediatamente (t1) y 7 días (t2) después del consumo de TXP y TX, para análisis de flujo, pH y capacidad amortiguadora. Se analizaron las diferencias en las medias, en t0 y t2, de polisacáridos extracelulares (PEC), microorganismos totales (MT) y Streptococcus spp. (Ss) de la biopelícula. La variabilidad de los MOs se evaluó mediante MALDI-TOF. El cuestionario sobre aceptabilidad sensorial / intención de compra fue respondido en t2. Se utilizaron pruebas t pareadas y Wilcoxon (α=0,05). En RS, se seleccionaron 16 estudios para síntesis cualitativa, de los cuales 12 se incluyeron en MAs. Los ANs fueron menos efectivos para mejorar el IP (p<0,01, I2>87%) y reducir la biopelícula con el tiempo (p<0,01, I2>87%), pero fueron similares a los ASs en la reducción de MOs (p=0,3, I2=0%). La calidad de la evidencia varió de moderada a baja. Se ha informado, a través de la revisión de la literatura, que los productos con própolis pueden tener actividad antimicrobiana, antiinflamatoria, antioxidante y anticancerígena. La mayoría de los estudios sobre xilitol (n=257) se realizaron en el área de la odontología (73,9%) y para evaluar la actividad antimicrobiana (38,5%). La dosis y la concentración variaron entre 0,004-67 g/día y 0,002-100%, respectivamente. Se observó un efecto positivo en el 79,3% de los estudios y se asoció con una concentración de xilitol ≥15% (p=0,007). Los efectos adversos (8,2%) se asociaron con una dosis ≥5 g/día (p=0,03). Los estudios con DX (n=41) y DP (n=22) utilizaron dentífricos como tratamiento principal (95,2%), para control del biofilm (36,5%) y mostraron un efecto positivo en la salud bucal (85,7%). La concentración de xilitol y própolis varió del 1 al 49%. Se informaron náuseas o encías ardientes (3,2%) y prurito inicial (1,6%) para DP y DX, respectivamente. Los estudios sobre dieta y salud bucal (n=214) fueron em su mayoría transversales (60,3%), solo con niños (64%) y realizaron evaluación de caries (95,8%). En el ECA, se observó un aumento de los parámetros salivales solo en t1, sin diferencia entre TXP y TX (p>0,05). No hubo diferencia en MT entre los grupos (p=0,177), pero TX fue más eficaz en la reducción de Ss (p=0,01). La variabilidad de los MOs en la biopelícula disminuyó para ambos grupos, pero no hubo reducción de PEC intra e intergrupal (p≥0,090). La aceptabilidad sensorial fue del 78,2% para TXP y del 82,3% para TX (p=0,607), con una mayor intención de compra para TX (p<0,001). La consistencia de la dieta no influyó en la salud bucal. Se observó asociación positiva entre caries y azúcares/dulces (91,2%), aperitivos (82,9%), hábitos de dieta nocturna (75%) y exposiciones ≥3×/día (7%). Se concluye que, aunque los ANs son similares a los ASs en la reducción de MOs, son menos efectivos para mejorar el IP y reducir la biopelícula con el tiempo. Los productos naturales, como el xilitol y el própolis, tienen propiedades biológicas que favorecen su uso en el mantenimiento de la salud bucal. No hubo diferencia entre TXP y TX en los parámetros salivales. Solo TX redujo el número de MOs en la biopelícula. TXP y TX mostraron una buena aceptabilidad sensorial, con mayor intención de compra para TX. La consistencia de la dieta no influyó en la salud bucal, pero los azúcares, los aperitivos, los hábitos de dieta nocturna y las exposiciones frecuentes a la dieta se asociaron con la caries dental. (AU)

Effect of xylitol tablets with and without red propolis on salivary parameters, dental biofilm and sensory acceptability of adolescents: a randomized crossover clinical trial.

The effect of xylitol tablets with (XPT) and without (XT) red propolis on salivary parameters, dental biofilm and acceptability of adolescents was evaluated through a blinded randomized crossover clinical trial. Healthy volunteers were allocated in the XPT and XT groups with a 30-day washout period for consumption of two tablets/dayfor seven days. An increase in salivary parameters was only observed immediately after tablet consumption, without differences between XPT and XT. The results for total microorganisms were similar, but XT was better in controlling Streptococcus spp. Rothia dentocariosa and Streptococcus salivarius were the most frequent in the biofilm and saliva, respectively. XPT and XT showed similar acceptability, with the highest purchase intention for XT. Although propolis did not enhance the properties of XT, further studies testing different protocols and follow-up are necessary; XT controlled Streptococcus spp. in biofilms, which demonstrate its potential for clinical application.

Red propolis hydroalcoholic extract inhibits the formation of Candida albicans biofilms on denture surface.

BACKGROUND: To evaluate the antifungal activity of the red propolis hydroalcoholic extract (RPHE) against Candida albicans biofilms. MATERIAL AND METHODS: The minimum inhibitory and fungicidal concentrations (MIC and MFC) of the RPHE were determined by the microdilution technique. C. albicans biofilms were formed on the surface of resin specimens preconditioned with artificial saliva (1h). The specimens (N=48) were equally divided according to the four solutions used for anti-biofilm evaluation (n=12 per group). After overnight incubation, biofilms were daily exposed (2x/day for 15 min) along 3 days with 3% RPHE, 0.12% chlorhexidine (CHX), 50,000 IU/mL nystatin (NYS) or saline (0.9% NaCl). Biofilms were analyzed regarding the number of viable microorganisms (CFU/mL), the metabolic activity (MTT assay) and the proportion of hyphae (optical microscopy). RESULTS: The MIC and MFC of RPHE were respectively 0.29 mg/mL (0.03%) and 1.17 mg/mL (0.12%). There was no difference in the microorganisms' viability (CFU/mL) among groups treated with RPHE (4.92×103), CHX (3.33×102) or NYS (6.8×104), being all of them different from NaCl (3.93×107) (p<0.05). The CHX (0.133) had the lowest metabolic activity (p<0.05), followed by RPHE (0.292) and NYS (0.302) (p>0.05). All experimental groups had a mean proportion of hyphae <10%, lower than NaCl (70%). CONCLUSIONS: RPHE has antifungal activity against C. albicans biofilms, suggesting its use for the biofilm control on denture surfaces. Key words:Propolis, Candida albicans, biofilm, dentures, antifungal agents.

Efficacy of natural antimicrobials derived from phenolic compounds in the control of biofilm in children and adolescents compared to synthetic antimicrobials: A systematic review and meta-analysis.

AIM: To evaluate the efficacy of natural antimicrobials derived from phenolic compounds (NAPs), compared to synthetic antimicrobials (SAs), in the biofilm control and microorganisms (MOs) count among children and adolescents at different intervention times through a systematic review and meta-analysis. METHODS: Electronic searches were carried out in PubMed, Scopus, Cochrane Library, Web of Science, VHL, and Grey Literature. Randomized and non-randomized clinical trials were included. Methodological quality and risk of bias were assessed using the tools ROBINS-I and RoB 2.0. Meta-analyses (MAs) were performed according to three parameters: the influence of NAPs on the plaque index (PI) mean; the period of NAPs administration (≤15 days/>15 days) on the biofilm reduction; and the influence of NAPs on the MOs count subgrouping according to the type of MO (total MOs, S. mutans, and Streptococcus spp.). The standard mean differences were calculated (p ≤ 0.05) for all analyses, and the heterogeneity was tested through the I2 index. The evidence was certainty-tested using the GRADE approach. RESULTS: Sixteen studies were selected for qualitative synthesis, and 12 studies were included in the MAs. NAPs were less efficacious in improving the PI (p < 0.0001, I2>87 %) and reducing biofilm over time (p < 0.01, I2>87 %) but presented a reduction in MOs count similar to that of SAs (p = 0.3, I2 = 0%). The quality of the evidence ranged from moderate to low. CONCLUSION: Although the use of NAPs is similar to the use of SAs in reducing MOs count, it is less effective than SAs in improving PI mean and for biofilm reduction over time.

Is there association between dental malocclusion and bruxism? A systematic review and meta-analysis.

OBJECTIVES: Given that current literature largely dissociates dental malocclusion and bruxism, the objective of this study was to gather, through a systematic review, scientific evidence to support their relationship. METHODOLOGY: This study was performed according to the PECO strategy (where P = general population; E = dental malocclusion; C = no dental malocclusion; and O = bruxism). Literature searches were conducted without language or date restrictions in the following databases: PubMed, Scopus, the Web of Science, the Cochrane Library, LILACS/BBO via VHL and the grey literature. The search strategy included Medical Subject Headings/DECs, synonyms and free terms relevant to each database, with no age restrictions applied. Once the relevant data were extracted from the articles, the Fowkes and Fulton guidelines were followed to assess the quality and risk of bias. For quantitative analysis, dental malocclusions were divided into groups according to their type in order to perform odds ratio (OR) meta-analyses with 95% confidence intervals (CI) using the Review Manager software program (Cochrane, London, UK). The level of certainty of evidence was demonstrated through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: After 1,502 studies found, 10 studies were included for qualitative analysis and nine for quantitative synthesis. Four studies presented high methodological quality. Five meta-analyses suggested a non-association between bruxism and Angle class I (OR: 1.05, 95% CI: 0.41-2.69; P = .92; I2  = 84%), Angle class II (OR: 1.49, 95% CI: 0.77-2.87; P = .23; I2  = 71%) or Angle class III (OR: 0.77, 95% CI: 0.31-1.93; P = .58; I2  = 0%). Bruxism was associated with children who did not present with a posterior crossbite (OR: 0.70, 95% CI: 0.51-0.96; P = .03; I2  = 27%) and present crowding (OR: 1.53, 95% CI: 1.03-2.26; P = .03; I2  = 0%). The GRADE analysis presented a very low quality of evidence. CONCLUSION: Individuals who present with bruxism have a greater chance of crowding. However, bruxism is not associated with the presence of any of the other malocclusions evaluated.

Types of Feeding and Presence of Harmful Oral Habits in Children with Cleft Lip and/or Palate: A Pilot Study

Abstract Objective: To verify the relationship between the types of feeding and presence of harmful oral habits (HOH) in children with cleft lip (CL), palate (CP) and cleft lip and palate (CLP), as well as to compare the different types of cleft to each other. Material and Methods: A form was applied to the parents of 162 children (3-5 years old), addressing the following variables: gender, cleft type, age, socioeconomic conditions, type of breastfeeding, presence of HOH, and the parents' knowledge about the consequences of oral habits. The data obtained were analyzed by chi-square test (p<0.05). Results: The majority of children (83.3%) were bottle-fed and 12.3% were exclusively maternal breastfed. The main reason for weaning was the presence of cleft (59.9%). Breastfeeding was significantly higher in children with CL (75%) in comparison with CP (20%) and CLP (5%) (p<0.001). Children with CLP were 12 times more likely to be bottle-fed than children with CL (OR=12.21; CI=4.09-36.45). The prevalence of HOH was 37%. Sociodemographic characteristics were not associated with the presence of HOH (p>0.05). The type of feeding and cleft were not decisive to present some type of HOH (p>0.05) and 87% of parents stated that HOH could lead to serious complications of tooth misalignment. Conclusion: The type of feeding and fissure did not determine the acquisition of harmful oral habits in children with cleft. However, the greater the fissure's complexity, the lesser the chance of children receiving exclusive breastfeeding.

Cytotoxic and antibacterial effect of a red propolis mouthwash, with or without fluoride, on the growth of a cariogenic biofilm.

OBJECTIVE: To evaluatein vitro the antibacterial activity, the antibiofilm effect and the cytotoxic potential of mouthwashes containing Brazilian red propolis with or without fluoride. METHODS: The minimum inhibitory and bactericidal concentrations (MIC and MBC) against S. mutans, S. sanguinis, S. salivarius and L. casei were determined for RPE mouthwashes. A cariogenic biofilm with the aforementioned bacteria was formed over cellulose membrane disks (N = 30, 13 mm), which were submitted for 1 min to the following mouthwashes: plain mouthwash base; 0.05% NaF; 0.8% RPE; 0.8% RPE + 0.05% NaF and 0.12% chlorhexidine (CHX). The bacterial viability and the production of extracellular polysaccharide (EPS) were measured. Cytotoxic potential of the mouthwashes was also evaluated. For bacterial viability and EPS production, Mann-Withney and one-way ANOVA tests were performed followed by Tukey, with results considered significant when p ≤ 0.05. RESULTS: MIC and MBC values of RPE mouthwashes ranged from 7.44 to 29.76 mg/mL and from 7.44 to ≥59.52 mg/mL, respectively, presenting better action against S. salivarius. RPE mouthwashes showed 44% of viable cells after 1 min of contact with fibroblasts. RPE (7.74) had the greatest reduction of viable total microorganisms and did not differ from the RPE + NaF (7.95) (p = 0.292). CHX (7.54) was the most effective in reducing Streptococcus spp, but did not differ from RPE (p = 0.521) and RPE + NaF (p = 0.238). There was no difference between the treatments regarding EPS production. CONCLUSION: RPE and RPE + NaF mouthwash showed similar antibacterial activity, toxicity level and antibiofilm effect compared to CHX.

Oral healthcare management of a child with phakomatosis pigmentovascularis associated with bilateral Sturge-Weber syndrome.

The aim of this report was to describe an approach for a child with phakomatosis pigmentovascularis Type IIb associated with bilateral Sturge-Weber syndrome and autistic spectrum disorder. A 6-year-old boy was referred to the Special Care Dental Clinic with the main complaints of "damaged teeth and pain." The physical examination revealed bilateral port-wine staining on the face, neck, and upper and lower limbs, congenital dermal melanocytosis on the back, and dilated blood vessels in the sclera. Intraoral examination revealed hypertrophy of the maxillary bone, diffuse and intense redness of the oral mucosa, crowding, anterior open bite, and carious lesions in the left and right upper second primary molars. The medical team was consulted prior to dental treatment to assess the risk of bleeding, and anesthesia was contraindicated. Instruction about brushing technique and procedures for a suitable oral environment were then carried out using a minimally invasive restorative treatment. The patient did not exhibit collaborative behavior, and follow up continues with the patient receiving preventive treatments. Therefore, a multidisciplinary approach to these patients is fundamental to avoid complications during dental intervention. Moreover, regular visits to the dentist reduce the need for invasive treatments and improve the well-being of these individuals.

In Vitro Evaluation of Fluoride in Saliva After Topical Application of Professional Use Products

Objective: To evaluate in vitro the presence of fluoride in saliva after applying professional use products on the surface of dental enamel. Material and Methods: Experimental groups were composed by: Cariostatic 12% (CA), Fluoridated Varnish 5% (FV), Fluorine Acidulate Gel 1.23% (AG) and Fluorine Neutral Gel 2% (NG). Fluoridated dentifrice (FD) and Artificial Saliva (AS) were used as controls. Products (10 µL) were applied to the surface of bovine enamel blocks (4×4×1 mm, n = 18) and immersed in 10 mL of artificial saliva at room temperature. Aliquots of artificial saliva (750 µL) of each sample were collected 1, 2, 4, 8, 24 and 48 hours after application of the products. Analyses were performed in triplicate, using a fluoride ion-specific electrode coupled to a potentiometer. The equipment was calibrated using a standard curve for fluoride analysis from 0.125 to 64 µgF-/mL. Results: Greater fluoride concentration (µgF-/mL) was observed after 1h application, as follows: 197.40 (NG), 172.21 (AG), 20.25 (CA), 14.49 (FV) e 11.81 (FD). Fluoride concentration increased overtime for all groups. After 48h, the following fluoride concentrations were assessed: 428.12 (AG), 267.25 (NG), 65.36 (FV), and 62.52 (CA). Conclusion: Greater fluoride release was observed for AG and NG groups, mostly after 1h application.

Antibacterial and Cytotoxic Potential of a Brazilian Red Propolis

Objective: To evaluate in vitro the effect of a red propolis ethanolic extract (RPE) in the prevention of growth of a cariogenic biofilm and its cytotoxic potential. Material and Methods: Minimum inhibitory and bactericidal concentrations (MIC and MBC) of RPE against Streptococcus mutans and Lactobacillus casei were determined. The cytotoxic potential of 0.4% RPE in oral fibroblasts was observed after 1, 3 and 5 min of contact. Cellulose membrane disks (13 mm, N=12) were used for biofilm formation (24 h) of S. mutans and L. casei, which were treated (1 min) with 0.4% RPE or 0.12% Chlorhexidine (CHX). The control group of biofilm formation was not submitted to any treatment. Serial dilutions were then made to evaluate microbial viability. Descriptive data analysis and, for microbial viability, Mann Whitney test were performed (p≤0.05). Results: RPE showed similar MIC and MBC (4.46 mg/mL) against S. mutans and, for L. casei, they were 8.92 mg/mL (MIC) and 17.85 mg/mL (MBC). CHX presented MIC and MBC <0.00002 mg/mL for S. mutans and 0.00047 mg/mL for L. casei. After 1, 3 and 5 min, the RPE exhibited, respectively, 69.38%, 43.91% and 40.36% of viable cells. The RPE (6.55) and CHX (6.87) presented similar efficacy to reduce the total number of viable bacteria (p>0.05). Regarding the total number of viable bacteria (Log10 CFU/mL), the RPE (6.55) and CHX (6.87) presented similar efficacy (p>0.05). Conclusion: Red propolis extract showed antibacterial activity against the tested strains, exhibited acceptable cytotoxicity and reduced the colonization of S. mutans and L. casei in a biofilm membrane model.

Factors Associated with the Caregivers' Perception of the Oral Health of Individuals with Cerebral Palsy

Abstract Objective: To evaluate factors associated with the caregivers' perception of the oral health of children and adolescents with cerebral palsy. Material and Methods: A cross-sectional study was carried out with 80 children and adolescents with cerebral palsy aged 2-18 years, registered at a reference institution and their respective caregivers. Caregivers provided socioeconomic, systemic and health perception and access to dental services data. A calibrated researcher (Kappa=0.75-0.98) performed oral examinations using DMF-T, dmf-t, dental trauma, gingival bleeding index, community periodontal index, malocclusion index and the dental aesthetic index. The Poisson Regression was used (α=0.05) Results: According to the caregivers' perception, the oral health reports of children and adolescents with cerebral palsy considered good and poor was 73.8% and 26.3%, respectively. The poor oral health perception is associated with the presence of dental caries in anterior teeth (PR 1.34, 95% CI=1.11-1.63) and bleeding during tooth brushing (PR 1.20, 95% CI=1.04-1.40) Conclusion: Children and adolescents with cerebral palsy who presented lesions of caries in the anterior teeth and gingival bleeding during tooth brushing, more frequently, had poor oral health by their caregivers.