The geography of femicide in Sergipe, Brazil: matriarchy, human development, and income distribution.

AIM: This research analyzed a joint spatial distribution and explored the possible associations between epidemiological aspects and feminicide rates, in towns of the Sergipe State in Northeastern Brazil. METHODOLOGY: An exploratory ecological study investigated the global spatial autocorrelation of epidemiological aspects with femicide rates from towns in Sergipe State, Brazil, (n = 75), in the 2013-2017 period, using the "global" and "local" Moran statistic method and a multiple spatial regression. The exposure variables included socioeconomic and demographic conditions, services and health condition, and femicide rates. We used the software Stata 11.0, SPSS 18.0 and GeoDa 0.95-i. RESULTS: The spatial distribution of femicide rates was not random and showed high spatial autocorrelation and predominance of significant spatial groupings of towns with the highest mortality rates due to femicide in the central region of Sergipe State. In the multiple regression analysis, the percentage of women in charge of families and the Municipal Human Development Index were positively associated with the femicide rates in towns in Sergipe's municipalities in the studied period (p < 0.05). The opposite situation occurred between the Income Concentration Index (GINI) and the femicide rates. CONCLUSION: This is the first study that has analyzed the factors associated with the spatial clusters of femicide rates in a geographical space where there is a predominance of patriarchal culture. There was a femicide increase in locations with the lowest social inequality, the highest human development and authority exercised by women in the family environment.

The geography of femicide in Sergipe, Brazil: matriarchy, human development, and income distribution / A geografia do feminicídio em Sergipe, Brasil: matriarcado, desenvolvimento humano e distribuição de renda

ABSTRACT: Aim: This research analyzed a joint spatial distribution and explored the possible associations between epidemiological aspects and feminicide rates, in towns of the Sergipe State in Northeastern Brazil. Methodology: An exploratory ecological study investigated the global spatial autocorrelation of epidemiological aspects with femicide rates from towns in Sergipe State, Brazil, (n = 75), in the 2013-2017 period, using the "global" and "local" Moran statistic method and a multiple spatial regression. The exposure variables included socioeconomic and demographic conditions, services and health condition, and femicide rates. We used the software Stata 11.0, SPSS 18.0 and GeoDa 0.95-i. Results: The spatial distribution of femicide rates was not random and showed high spatial autocorrelation and predominance of significant spatial groupings of towns with the highest mortality rates due to femicide in the central region of Sergipe State. In the multiple regression analysis, the percentage of women in charge of families and the Municipal Human Development Index were positively associated with the femicide rates in towns in Sergipe's municipalities in the studied period (p < 0.05). The opposite situation occurred between the Income Concentration Index (GINI) and the femicide rates. Conclusion: This is the first study that has analyzed the factors associated with the spatial clusters of femicide rates in a geographical space where there is a predominance of patriarchal culture. There was a femicide increase in locations with the lowest social inequality, the highest human development and authority exercised by women in the family environment.

RESUMO: Objetivo: Esta pesquisa analisou a distribuição espacial conjunta e explorou possíveis associações entre aspectos epidemiológicos e taxas de feminicídio, nos municípios do Estado de Sergipe, no nordeste brasileiro. Métodos: Um estudo ecológico exploratório investigou a autocorrelação espacial global de aspectos epidemiológicos com taxas de feminicídio em municípios do Estado de Sergipe, Brasil (n = 75), no período de 2013 a 2017, utilizando a estatística de Moran "global" e "local" e uma regressão espacial múltipla. As variáveis incluíram a condição socioeconômica, a situação demográfica, os serviços e estado de saúde e as taxas de feminicídio. Os softwares utilizados foram Stata 11.0, SPSS 18.0 e GeoDa 0.95-i. Resultados: A distribuição espacial das taxas de feminicídio não foi aleatória e apresentou elevada autocorrelação espacial e predomínio de agrupamentos espaciais significativos de municípios com as maiores taxas de mortalidade por feminicídio na região central do Estado de Sergipe. Na regressão múltipla, o percentual de mulheres chefes de família e o Índice de Desenvolvimento Humano Municipal associaram-se positivamente às taxas de feminicídio nos municípios sergipanos no período estudado (p < 0,05). Situação oposta ocorreu entre o Índice GINI e as taxas de feminicídio. Conclusão: Este é o primeiro estudo que analisou os fatores associados aos clusters espaciais das taxas de feminicídio em um espaço geográfico com predomínio da cultura patriarcal. Houve aumento do feminicídio em localidades em que há menor desigualdade social, maior desenvolvimento humano e maior autoridade exercida pelas mulheres no ambiente familiar.

Cárie dentária e fatores associados aos 12 anos na Região Centro-Oeste do Brasil em 2010: um estudo transversal / Dental caries and associated factors at age 12 in the Brazilian

Resumo O objetivo do estudo é analisar o índice de dentes cariados, perdidos e obturados (CPO-D) na idade de 12 anos da Região Centro-Oeste e identificar fatores associados, segundo a Pesquisa Nacional de Saúde Bucal, o SB Brasil 2010. É um estudo transversal de base populacional do banco de dados do SB Brasil 2010, realizado nas capitais de Mato Grosso, Mato Grosso do Sul, Goiás, Distrito Federal e uma amostra de municípios da região. Os dados foram analisados pelo teste de qui-quadrado e razões de prevalências com seus respectivos intervalos de confiança, a um nível de significância de 0,05. A regressão de Poisson foi empregada na análise múltipla para analisar a associação entre a variável desfecho e as variáveis explicativas. As variáveis independentes que se mostraram associadas ao CPO-D foram: o estado de moradia em Mato Grosso, Goiás e Mato Grosso do Sul; a renda per capita ≤ R$500,00; dificuldade para comer e dormir, e o motivo da consulta por Dor/Extração/Tratamento/Outros. A média do índice CPO-D foi de 2,14 e a prevalência da cárie dental foi de 41% dos adolescentes.

Abstract This study aims to analyze the index of decayed, missing and filled teeth (DMFT) at age 12 in the Midwest Region and to identify associated factors, according to the National Oral Health Survey "SB Brasil 2010". This is a cross-sectional population-based study from the SB Brasil 2010 database, conducted in the capitals of Mato Grosso, Mato Grosso do Sul, Goiás, Federal District and a sample of municipalities in the region. Data were analyzed by the chi-square test and prevalence ratios with their respective confidence intervals, at a significance level of 5%. The Poisson regression was used in the multiple analysis to study the association between the outcome variable and the explanatory variables. The independent variables that were associated with the DMFT were: the state of residence in Mato Grosso, Goiás and Mato Grosso do Sul; the per capita income ≤ R$500.00; difficulties eating and sleeping, and reason for the visit was Pain/Extraction/Treatment/Other. Mean DMFT was 2.14 and the prevalence of dental caries affected 41% of adolescents.

Dental caries and associated factors at age 12 in the Brazilian. / Cárie dentária e fatores associados aos 12 anos na Região Centro-Oeste do Brasil em 2010: um estudo transversal.

This study aims to analyze the index of decayed, missing and filled teeth (DMFT) at age 12 in the Midwest Region and to identify associated factors, according to the National Oral Health Survey "SB Brasil 2010". This is a cross-sectional population-based study from the SB Brasil 2010 database, conducted in the capitals of Mato Grosso, Mato Grosso do Sul, Goiás, Federal District and a sample of municipalities in the region. Data were analyzed by the chi-square test and prevalence ratios with their respective confidence intervals, at a significance level of 5%. The Poisson regression was used in the multiple analysis to study the association between the outcome variable and the explanatory variables. The independent variables that were associated with the DMFT were: the state of residence in Mato Grosso, Goiás and Mato Grosso do Sul; the per capita income ≤ R$500.00; difficulties eating and sleeping, and reason for the visit was Pain/Extraction/Treatment/Other. Mean DMFT was 2.14 and the prevalence of dental caries affected 41% of adolescents.

O objetivo do estudo é analisar o índice de dentes cariados, perdidos e obturados (CPO-D) na idade de 12 anos da Região Centro-Oeste e identificar fatores associados, segundo a Pesquisa Nacional de Saúde Bucal, o SB Brasil 2010. É um estudo transversal de base populacional do banco de dados do SB Brasil 2010, realizado nas capitais de Mato Grosso, Mato Grosso do Sul, Goiás, Distrito Federal e uma amostra de municípios da região. Os dados foram analisados pelo teste de qui-quadrado e razões de prevalências com seus respectivos intervalos de confiança, a um nível de significância de 0,05. A regressão de Poisson foi empregada na análise múltipla para analisar a associação entre a variável desfecho e as variáveis explicativas. As variáveis independentes que se mostraram associadas ao CPO-D foram: o estado de moradia em Mato Grosso, Goiás e Mato Grosso do Sul; a renda per capita ≤ R$500,00; dificuldade para comer e dormir, e o motivo da consulta por Dor/Extração/Tratamento/Outros. A média do índice CPO-D foi de 2,14 e a prevalência da cárie dental foi de 41% dos adolescentes.

Dental Bleaching, Microabrasion, and Resin Infiltration: Case Report of Minimally Invasive Treatment of Enamel Hypoplasia.

Enamel hypoplasia occurs because of a defect in formation of the organic matrix during the development of tooth enamel. Minimally invasive procedures of the slightly altered enamel contribute to a greater longevity of teeth and prevent them from relapsing into the repetitive restorative cycle. This case history report aimed to show a sequential technique of minimally invasive procedures for esthetic resolution in anterior teeth. Prior to microabrasion, anterior teeth were bleached in office with 37% hydrogen peroxide. Afterwards, hypoplastic spots on the buccal incisal thirds of the maxillary central incisors were treated with two sessions of microabrasion using phosphoric acid and pumice stone and one session using resin infiltrant. Besides a slight remaining white spot on tooth 21, the masking of spots was done with this sequence of treatments, re-establishing color harmony. Spot depth, diagnosis, and the most relevant treatment choice determined the clinical success.

Spatial analysis of the death associated factors due oral cancer in Brazil: an ecological study.

BACKGROUND: Oral cancer (OC) is among the ten most common cancers and the seventh most frequent cause of death worldwide. It has been reported that these incidence rates are higher in developed country and these mortality rates are higher in less developed areas. So, the objective of the present study was to analyze the spatial joint distribution and to explore possible associations of the epidemiological aspects with mortality rates due to OC in the Brazil. METHODS: An exploratory ecological study investigated the global spatial autocorrelation of epidemiological aspects with mortality rates due to OC from the Brazilian Federative Units (FUs) (n = 27) in the period 2005-2014, using the "global" and "local" Moran statistic method and a multiple spatial regression, having as variables of exposure the habits and lifestyle, sociodemographic indicators, the consumption of pesticides, the presence of comorbidities, the use of health services and food consumption; and, as a variable response, mortality rates due to OC. The software used was Stata 11.0, SPSS 18.0 and GeoDa 0.95-i. RESULTS: The spatial distribution of OC mortality rates to age-standard was not random and showed high spatial autocorrelation and predominance of significant spatial groupings in the Central-South region of Brazil. In the multiple regression, statistically negative associations were observed between the Human Development Index (HDI) and OC age-standardized in the studied period (p < 0.05) and positive associations among the proportion of the population with dental appointment within last year, percentage of consumption of oils and fats, percentage of consumption of ready-to-eat foods and industrial mixtures and percentage of overweight adults with this type of cancer (p < 0.05). CONCLUSION: This is the first study that analyzed the factors associated to the spatial clusters of mortality due to oral cancer in the Brazilian FUs. A fairly unequal distribution of OC mortality rates was found, being that these rates presented inverse association with HDI and direct association with dental appointment, consumption of oils and fats, ready-to-eat foods and industrial mixtures consumption and overweight these rates. It suggests the need to redirect Brazilian public policies aimed at combating them so that they cease to be temporary and become permanent.

Parenteral exposure to pesticides and occurence of congenital malformations: hospital-based case-control study.

BACKGROUND: Most fetal defects are associated with genetic and environmental causes, among them, exposure of pregnant women to intensive pesticide use. Agribusiness is the economic basis of the state of Mato Grosso, the largest consumer of pesticides of all Brazilian states. The objective of this study was to investigate the association between past parental exposure to pesticides and the occurrence of congenital malformations in children in Mato Grosso, Brazil. METHODS: This hospital-based case-control study was conducted in Cuiabá, the capital of Mato Grosso, from March to October 2011. Data was collected in all public, private, and health plan referral hospitals that provide care for pregnant women in the state of Mato Grosso and were situated in Cuiabá. Cases were children under 5 years of age with congenital malformations classified in Chapter XVIII of the International Classification of Diseases-10 and controls were children within the same age range, without congenital malformations, treated at the same hospitals. Malformation-related data was obtained from the patients' medical records. Socioeconomic data and information about parental exposure to pesticides were obtained in an interview with the mother using a standardized questionnaire. We conducted multivariate logistic regression to assess the relation between parent report of past pesticide use and congenital malformations. We also assessed effect modification to verify whether low maternal education level modified the association between exposure and our outcome. RESULTS: We observed positive effect modification of the association of paternal past exposure to pesticide and congenital malformation in the offspring by maternal education for mothers with low educational level (OR = 8.40, 95 % CI 2.17-32.52), father's work related to farming (OR = 4.65, 95 % CI 1.03-20.98) and paternal past exposure to pesticides (OR = 4.15, 95 % CI 1.24-13.66). CONCLUSION: These findings provide further evidence that paternal exposure to pesticides, especially when associated with a low maternal education level, may be related to higher rates of fetal malformation in Mato Grosso, Brazil.

Influence of passive smoking on learning in elementary school / Influência do tabagismo passivo na aprendizagem de escolares

Abstract Objective To analyze the association between household smoking and the development of learning in elementary schoolchildren. Methods Cross-sectional study with 785 students from the 2nd to the 5th year of elementary school. Students were evaluated by the School Literacy Screening Protocol to identify the presence of learning disabilities. Mothers/guardians were interviewed at home through a validated questionnaire. Descriptive and bivariate analysis, as well as multivariate Poisson regression, were performed. Results In the final model, the variables associated with learning difficulties were current smoking at the household in the presence of the child (PR = 6.10, 95% CI: 4.56 to 8.16), maternal passive smoking during pregnancy (PR = 1.46, 95% CI: 1.07 to 2.01), students attending the 2nd and 3rd years of Elementary School (PR = 1.44, 95% CI: 1.10 to 1.90), and being children of mothers with only elementary level education (PR = 1.36, 95% CI: 1.04 to 1.79). Conclusion The study demonstrated an association between passive exposure to tobacco smoke and learning difficulties at school.

Resumo Objetivo Analisar a associação entre o tabagismo domiciliar e o desenvolvimento da aprendizagem em escolares do ensino fundamental. Métodos Estudo transversal, com 785 escolares do 2° ao 5° ano do ensino fundamental. Os alunos foram avaliados por meio do Protocolo de Triagem de Letramento Escolar, para identificar a presença de dificuldades de aprendizagem. As mães/responsáveis foram entrevistadas no domicílio por meio de questionário validado. Foram feitas análises descritiva, bivariada e regressão múltipla de Poisson. Resultado No modelo final, as variáveis associadas às dificuldades de aprendizagem foram tabagismo atual domiciliar na presença do filho (RP = 6,10; IC 95% 4,56-8,16), tabagismo passivo materno durante a gestação (RP = 1,46; IC 95% 1,07-2,01), alunos pertencerem ao 2° e 3° ano do ensino fundamental (RP = 1,44; IC 95% 1,10-1,90) e serem filhos de mães com apenas o nível fundamental de escolaridade (RP = 1,36; IC 95% 1,04-1,79). Conclusão O estudo evidenciou associação entre a exposição passiva ao tabaco e as dificuldades de aprendizagem nos escolares.

Occupational accidents related to cattle slaughter in Mato Grosso, Brazil / Acidentes de trabalho relacionados ao abate de bovinos em Mato Grosso, Brasil

Resumo Introdução A criação de gado no sul da Amazônia tem crescido rapidamente, sendo que o Mato Grosso é um dos primeiros estados na produção de carne. Esse crescimento permitiu a contratação de mais trabalhadores para a atividade de refrigeração, trazendo um aumento de acidentes de trabalho nesse setor. Objetivo Analisar a influência de abate de gado nos acidentes de trabalho e sua distribuição espacial no estado de Mato Grosso, Brasil. Métodos Estudo ecológico que investigou a autocorrelação espacial global das taxas de acidentes de trabalho e o número de bovinos abatidos em municípios de Mato Grosso, usando a estatística Moran “global” pelo método LISA e, posteriormente, uma regressão múltipla espacial, tendo como variáveis de exposição o abate de cabeças de gado e, como variável resposta, a taxa de acidentes de trabalho. Resultados Foram encontrados padrões espaciais globais na distribuição do número de cabeças de gado abatidas. Na regressão múltipla, foram observadas correlações estatisticamente significantes entre o número de bovinos abatidos e a taxa de acidentes de trabalho. Conclusão O abate de gado está relacionado ao aumento do número de acidentes de trabalho no Estado de Mato Grosso, Brasil.

Abstract Introduction Cattle rising in the southern Amazon have grown rapidly, being Mato Grosso one of the top states in meat production. This growth led to the hiring of more workers to the chilling activity, increasing the number of workplace accidents in this sector. Objective To analyze the influence of slaughter cattle on occupational accidents and their spatial distribution in the state of Mato Grosso, Brazil. Methods This is the first ecological study investigating the global spatial autocorrelation of the occupational accident rate and the number of slaughtered cattle in Mato Grosso municipalities; this study used the statistic Moran “global” by LISA method and subsequently held a spatial linear regression, with cattle slaughter exposure variables and as an outcome it showed the rate of workplace accidents. Results The study showed a global spatial pattern of number of cattle slaughtered. Statistically significant correlations were observed, in multiple regression analysis, between the number of cattle slaughtered and rate of occupational accidents. Conclusion The cattle slaughter is related to the increase of industrial accidents in the State of Mato Grosso, Brazil.

Influence of passive smoking on learning in elementary school.

OBJECTIVE: To analyze the association between household smoking and the development of learning in elementary schoolchildren. METHODS: Cross-sectional study with 785 students from the 2nd to the 5th year of elementary school. Students were evaluated by the School Literacy Screening Protocol to identify the presence of learning disabilities. Mothers/guardians were interviewed at home through a validated questionnaire. Descriptive and bivariate analysis, as well as multivariate Poisson regression, were performed. RESULTS: In the final model, the variables associated with learning difficulties were current smoking at the household in the presence of the child (PR=6.10, 95% CI: 4.56 to 8.16), maternal passive smoking during pregnancy (PR=1.46, 95% CI: 1.07 to 2.01), students attending the 2nd and 3rd years of Elementary School (PR=1.44, 95% CI: 1.10 to 1.90), and being children of mothers with only elementary level education (PR=1.36, 95% CI: 1.04 to 1.79). CONCLUSION: The study demonstrated an association between passive exposure to tobacco smoke and learning difficulties at school.

[Congenital defects in the cities with high use of pesticides in the state of Mato Grosso, Brazil]. / Malformações congênitas em municípios de grande utilização de agrotóxicos em Mato Grosso, Brasil.

Mato Grosso is the largest agricultural producer and the largest national consumer of pesticides in Brazil. Maternal exposure to pesticides in the periconceptional period has been associated with increased risk of congenital malformations. This article aims to analyze the association between the use of pesticides and congenital malformations in cities with highest exposure to pesticides in Mato Grosso. It was a case-control study conducted with 219 live births with congenital malformations and 862 live births. The average use of pesticides was estimated in the prior and subsequent trimester to the date of fertilization and throughout the periconceptional period per city, month and year of use. Subsequently, these measures were quartilized and transformed into indicator-type (dummy) variables, attributing an exposure level for each interquartile interval. Bivariate and multivariate logistic regression analysis was conducted. Significant associations were observed (p < 0.05) in the third (OR = 1.66, 95% CI 0.98 to 2.79) and fourth quartile (OR = 1.88, 95% CI 1.09 to 3.24) of the post-fertilization period and the fourth quartile (OR = 2.04, 95% CI 1.17 to 3.56) throughout the periconceptional period. Maternal exposure to pesticides was associated with higher incidence of congenital malformations.

Malformações congênitas em municípios de grande utilização de agrotóxicos em Mato Grosso, Brasil / Congenital defects in the cities with high use of pesticides in the state of Mato Grosso, Brazil

Mato Grosso é o maior produtor agrícola e também o maior consumidor nacional de agrotóxicos. A exposição materna aos agrotóxicos no período periconcepcional tem sido associada com aumento no risco de malformações congênitas. O objetivo deste artigo é analisar a associação entre o uso de agrotóxicos e as malformações congênitas em municípios com maior exposição aos agrotóxicos em Mato Grosso. Estudo de caso-controle realizado com 219 nascidos vivos com malformação congênita e 862 nascidos vivos sadios. Estimou-se a média de utilização dos agrotóxicos nos trimestres anterior e posterior à data da fecundação e durante todo o período periconcepecional segundo município e mês e ano de sua utilização. Posteriormente, estas medidas foram quartilizadas e transformadas em variáveis do tipo indicadoras (dummy ), atribuindo-se um nível de exposição para cada intervalo interquartil. Foi realizada análise bivariada e regressão logística. Foram observadas associações significantes (p < 0,05) no terceiro (OR=1,66, IC95% 0,98 - 2,79) e quarto quartil (OR=1,88, IC95% 1,09 - 3,24) do período pós-fecundação e no quarto quartil (OR=2,04, IC95%1,17-3,56) durante todo o período periconcepecional. A exposição materna aos agrotóxicos foi associada à maior ocorrência de malformações congênitas.

Mato Grosso is the largest agricultural producer and the largest national consumer of pesticides in Brazil. Maternal exposure to pesticides in the periconceptional period has been associated with increased risk of congenital malformations. This article aims to analyze the association between the use of pesticides and congenital malformations in cities with highest exposure to pesticides in Mato Grosso. It was a case-control study conducted with 219 live births with congenital malformations and 862 live births. The average use of pesticides was estimated in the prior and subsequent trimester to the date of fertilization and throughout the periconceptional period per city, month and year of use. Subsequently, these measures were quartilized and transformed into indicator-type (dummy) variables, attributing an exposure level for each interquartile interval. Bivariate and multivariate logistic regression analysis was conducted. Significant associations were observed (p < 0.05) in the third (OR = 1.66, 95% CI 0.98 to 2.79) and fourth quartile (OR = 1.88, 95% CI 1.09 to 3.24) of the post-fertilization period and the fourth quartile (OR = 2.04, 95% CI 1.17 to 3.56) throughout the periconceptional period. Maternal exposure to pesticides was associated with higher incidence of congenital malformations.

Low birth weight at term and the presence of fine particulate matter and carbon monoxide in the Brazilian Amazon: a population-based retrospective cohort study.

BACKGROUND: Although studies have shown an association between air pollutants from anthropogenic sources and pregnancy outcomes, little is known regarding the association between low birth weight (LBW) and exposure to emissions of biomass burning. METHODS: This population-based retrospective cohort study assessed the effect of exposure to particulate matter and carbon monoxide (CO) from biomass burning in the Amazon and cerrado (Brazilian savanna) biomes on term LBW (<2500 g) in cities of Mato Grosso, Brazil. Data on births were obtained from the Information System on Live Births of the Ministry of Health. The exclusion criteria were a twin pregnancy, gestational age of less than 37 weeks, and congenital malformation diagnosed at birth. For exposure variables, we used a historical series of daily average concentrations of particulate matter with a diameter less than 2.5 µm (PM2.5) and CO provided by Coupled Aerosol and Trace Gases Transport Model for the Brazilian Development of the Regional Atmospheric Modeling System developed at the National Institute for Space National Center for Weather Forecasts and Climate Studies, National Institute for Space Research. Maternal exposure was estimated by the average amount of pollutants for each trimester and for the entire period of gestation. The association between air pollutants and LBW was analyzed by multiple logistic regression, adjusting for the newborn's sex, mother's age and education, and prenatal care. RESULTS: A total of 6147 full-term singleton live births were included in the study and 193 (3.1%) were LBW. In adjusted analysis, the number of prenatal visits and maternal education with 8 years or more were associated with LBW. The association between exposure to air pollutants and the risk of LBW was significant for the 4th quartile of PM2.5 concentrations in the 2nd trimester (OR = 1.51, 95% CI = 1.04 to 2.17) and in the 3rd trimester, and for the 4th quartile of CO concentrations in the 2nd trimester only, in adjusted analysis. CONCLUSIONS: This study provides further evidence of the effect of smoke from biomass burning on the occurrence of LBW in cities of the Brazilian Amazon.

Aesthetic and functional rehabilitation of a supernumerary peg-shaped tooth in the primary dentition / Reabilitação funcional e estética em dente supranumerário conóide na dentição decídua

Supernumerary teeth are common changes in the human dentition that can compromise a congruous dental and facial growth and development. Early diagnosis and proper treatment of these developmental changes are essential for establishing occlusal, functional, and aesthetic congruence. Thus, this article reports the functional and aesthetic rehabilitation of a supernumerary peg-shaped tooth located in the anterior maxillary region of a preschooler. The tooth was restored directly using nanocomposite resin system, a putty index of the incisal position, and modified cotton roll isolation. This minimally invasive procedure not only allows future adjustment but also perfect control of the rehabilitation and simultaneous reestablishment of the child's self-esteem and tooth aesthetics and function. However, treatment should not be limited to the restorative technique. Maintenance of oral health and arch integrity are essential for the correct transition between the primary and permanent dentitions, preventing the treatment from affecting the permanent dentition.

As anomalias dentárias de número são alterações comuns da dentição humana que podem interferir na harmonia do crescimento e desenvolvimento dento-facial. O diagnóstico precoce e o tratamento adequado destas alterações de desenvolvimento são essenciais para que uma harmonia oclusal, funcional e estética, possa ser estabelecida. Assim, este artigo relata a reabilitação funcional e estética um dente supranumerário conóide, localizado na região ântero-superior da maxila, de uma criança em idade pré-escolar. A reanatomização do elemento dental foi realizada através de restauração direta em resina composta nanoparticulada, uso do guia palatina de silicone de adição e isolamento relativo modificado. Este procedimento minimamente invasivo além de ser passível de ajustes posteriores, permite o perfeito controle da reabilitação realizada e possibilita o restabelecimento simultâneo estético-funcional e da auto-estima da criança. Entretanto, o tratamento não deve se limitar exclusivamente à técnica restauradora. Sendo fundamental a manutenção da saúde bucal e da integridade da forma do arco para que seja possível à transição correta da dentição decídua para a permanente, permitindo que o impacto do tratamento realizado contemple a ausência de alterações na dentição permanente.

Effect of a calcium glycerophosphate fluoride dentifrice formulation on enamel demineralization in situ.

PURPOSE: To evaluate in situ the effect and mechanisms involved in the anticariogenic effect of a calcium glycerophosphate fluoride dentifrice. METHODS: In a double-blind, crossover design, a non-F dentifrice (negative control), a F dentifrice and a F dentifrice containing 0.13% CaGP were compared regarding the inhibition of enamel demineralization. Both F dentifrices contained 1500 microg F/g (w/w) as sodium monofluorophosphate (MFP). Bovine enamel blocks were mounted in contact with a S. mutans test plaque, in palatal appliances worn by 10 volunteers. 30 minutes after treatment with the dentifrices, a sucrose rinse was performed and enamel demineralization was assessed after an additional 45 minutes. RESULTS: No significant difference was observed among groups in the calcium and inorganic phosphate concentrations in the fluid phase of the test plaque 30 minutes after the dentifrice use (P > 0.05), but F concentration was significantly higher for both F dentifrices (P < 0.05). Also, the dentifrices did not differ regarding the pH before or 5 minutes after the sugar challenge (P > 0.05). A higher mineral loss was observed for the non-F dentifrice group (P < 0.05), but no significant difference was observed between the F dentifrices containing CaGP or not (P > 0.05). Using this in situ model, the findings suggested that CaGP at the concentration tested did not enhance the inhibition of enamel demineralization promoted by F dentifrice.

Anticaries potential of a fluoride mouthrinse evaluated in vitro by validated protocols.

This blind and randomized study tested in vitro, using validated protocols, the anticaries potential of an experimental fluoride mouthrinse. One-hundred enamel slabs, half sound and half with caries-like lesions (carious), all with known surface microhardness (SMH), were submitted to 3 treatment groups: A) a placebo mouthrinse (negative control); B) a positive control mouthrinse containing 0.05% NaF; and C) an experimental formulation containing 0.05% NaF and cetylpyridinium chloride as an antibacterial substance. To evaluate the formation of F products on enamel, sound (n=10) and carious (n=10) slabs were treated with the formulations during 10 min and loosely and firmly-bound F formed in enamel were determined after extraction with alkali and acid, respectively. To evaluate the inhibition of enamel demineralization, sound enamel slabs (n=10) were treated with the mouthrinse formulations 2x/day during 1 min and subjected to a pH-cycling regimen simulating a cariogenic challenge (demineralization). To evaluate enamel remineralization, the carious slabs (n=10) were submitted to the treatments 3x/day and subjected to a pH-cycling model simulating a remineralizing condition. After 8 days, enamel SMH was determined again and the percentage of SMH loss or SMH recovery was calculated for the sound and carious slabs, respectively. The experimental formulation was superior to the negative control (p<0.05) and equivalent to the positive control (p>0.05) in the formation of F products in enamel, and in the inhibition of enamel demineralization and enhancement of remineralization. These data suggest that the tested experimental fluoride mouthrinse has anticaries potential.

Anticaries potential of a fluoride mouthrinse evaluated in vitro by validated protocols

This blind and randomized study tested in vitro, using validated protocols, the anticaries potential of an experimental fluoride mouthrinse. One-hundred enamel slabs, half sound and half with caries-like lesions (carious), all with known surface microhardness (SMH), were submitted to 3 treatment groups: A) a placebo mouthrinse (negative control); B) a positive control mouthrinse containing 0.05 percent NaF; and C) an experimental formulation containing 0.05 percent NaF and cetylpyridinium chloride as an antibacterial substance. To evaluate the formation of F products on enamel, sound (n=10) and carious (n=10) slabs were treated with the formulations during 10 min and loosely and firmly-bound F formed in enamel were determined after extraction with alkali and acid, respectively. To evaluate the inhibition of enamel demineralization, sound enamel slabs (n=10) were treated with the mouthrinse formulations 2x/day during 1 min and subjected to a pH-cycling regimen simulating a cariogenic challenge (demineralization). To evaluate enamel remineralization, the carious slabs (n=10) were submitted to the treatments 3x/day and subjected to a pH-cycling model simulating a remineralizing condition. After 8 days, enamel SMH was determined again and the percentage of SMH loss or SMH recovery was calculated for the sound and carious slabs, respectively. The experimental formulation was superior to the negative control (p<0.05) and equivalent to the positive control (p>0.05) in the formation of F products in enamel, and in the inhibition of enamel demineralization and enhancement of remineralization. These data suggest that the tested experimental fluoride mouthrinse has anticaries potential.

Este estudo in vitro, cego e randomizado avaliou o potencial anticárie de uma formulação experimental de enxaguatório fluoretado (F), usando protocolos previamente validados. Blocos de esmalte (120), 60 hígidos e 60 com lesão artificial de cárie, com microdureza de superfície (MDS) conhecida, foram submetidos a 3 grupos de tratamentos: A) Enxaguatório placebo (controle negativo); B) Controle positivo contendo NaF 0,05 por cento e C) Uma formulação experimental contendo NaF 0,05 por cento e cloreto de cloreto de cetil-piridínio como antibacteriano. Para testar a capacidade de formação de produtos fluoretados no esmalte, blocos hígidos (n=10) e cariados (n=10) foram tratados durante 10 min e os fluoretos fracamente e fortemente ligados formados foram determinados após extração com álcali e ácido, respectivamente. Para avaliar a inibição da desmineralização do esmalte, os blocos hígidos (n=10) foram tratados com as formulações 2 x/dia durante 1 min e submetidos a um modelo de ciclagem de pH, simulando o processo de desmineralização. Para avaliar a ativação da remineralização do esmalte, os blocos com lesões de cárie (n=10) foram tratados 3 x/dia e submetidos a um modelo de ciclagens de pH, simulando uma condição de remineralização. Após 8 dias, a MDS do esmalte foi novamente determinada e as porcentagens de sua redução ou aumento foram calculadas, respectivamente para os blocos hígidos ou com lesão de cárie. A formulação experimental foi superior ao controle negativo (p<0,05) e equivalente ao positivo (p>0,05), na formação de produtos fluoretados no esmalte e na inibição de sua desmineralização e ativação da remineralização. Conclui-se que o enxaguatório experimental apresenta fluoreto ativo com potencial para controlar cárie dental.

Abordagem contemporânea das lesões cariosas adjacentes às restaurações na clínica odontopediátrica / Contemporary approach of the carious injuries adjacent to restorations in the pedodontics clinical

A microinfiltração tem sido intensamente associada ao desenvolvimento de lesões de cárie secundária. Entretanto, sabe-se atualmente que estas são ocasionadas pelo desequilíbrio bucal entre os fatores desencadeadores da doença e não pela presença exclusiva de uma fendamarginal, o que faz com que, pela sua semelhança com uma lesão inicial de cárie, seja denominada de lesão adjacente a uma restauração. Estas lesões estão freqüentemente relacionadas com o elevado número de restaurações substituídas. Entretanto, antes de optar pela substituição de uma restauração que apresenta um comprometimento marginal, é importante avaliar se existe uma lesão adjacente à restauração, além de avaliar o estado de atividade cariosa no indivíduo. O tratamento da doença cárie com um enfoque estritamente restaurador, sem atenção necessária para a redução ou eliminação dos fatores etiológicos, terá seu sucesso limitado a curto prazo, uma vez que o ciclo de desmineralização estará predominando, provocando outras seqüelas além das existentes. Portanto, a abordagem da lesão cariosa adjacente às restaurações deve extrapolar um sítio específico e abranger os fatores etiológicos da doença cárie no indivíduo. Considerando às dificuldades envolvidas no diagnóstico e conseqüentemente na abordagem da lesão adjacente às restaurações, este estudo buscou fazer uma revisão, com base na literatura, dos aspectos relacionados à sua etiologia e ao seu tratamento na clínica odontopediátrica.

Avaliação in situ da composição do biofilme e da progressão de lesões cariosas em esmalte de dentes decíduos e permanentes humanos, na presença e na ausência de dentifrício fluoretado / In situ evaluation of the carious lesion progression in the deciduous and permanent enamel in the presence or absence of fluoride

Evidências na literatura sugerem que a velocidade de progressão de cárie pode ser influenciada por diversos fatores, entre eles as peculiaridades químicas, morfológicas e fisiológicas pertinentes aos dentes decíduos e permanentes. Estas informações são fundamentais para a correta abordagem clínica do paciente odontopediátrico, principalmente quando esta não for invasiva. Este estudo in situ avaliou a progressão de lesões cariosas em esmalte de dentes decíduos e permanentes, em um mesmo desenho experimental, na presença e na ausência de dentifrício fluoretado (1100 ppm NaF). Onze voluntários, em duas fases distintas, utilizaram um dispositivo palatino de acrílico contendo blocos de esmalte decíduos e permanentes. Estes blocos foram tratados com sacarose 20%, 8x/dia, por 7, 14 e 21 dias. O biofilme formado sobre os blocos dentários foi coletado para análise bioquímica e as perdas minerais dos mesmos foram acessadas através da inspeção visual (IV), microdureza transversa (ΔZ) e microscopia de luz polarizada (MLP). Os resultados foram submetidos ao teste de Tukey (p=0,05) e mostraram que o biofilme formado na presença de dentifrício fluoretado apresentou maiores (p<0,05) concentrações de Ca, Pi, F que o tratado com dentifrício placebo. A concentração de PI foi significativamente maior no biofilme tratado com dentifrício placebo. Os fatores substrato, dentifrício e tempo influenciaram de forma significativa nas perdas minerais mensuradas através da IV, ΔZ e MLP. Em todos os períodos e fases estudadas, a velocidade de progressão de cárie no esmalte do dente decíduo foi maior que no permanente (p<0,05).