Starting gastrointestinal endoscopy in a lower middle-income country in Africa: Training, creating an endoscopy facility and developing telemedicine.

Background and study aims The prevalence of digestive diseases seems to be high in African countries. Nonetheless, the human and material resources are scarce. The aim of the Portuguese volunteering project described in this report was to develop the specialty of digestive endoscopy in Sao Tome and Principe, a lower-middle-income country in Africa. Methods Beginning by assessing the local needs and available resources and managing immediate issues related to this field, we aimed to provide the tools necessary to improve gastroenterological and endoscopic care in the country. The first step included training of the local teams, through the development and accomplishment of an adapted curriculum for a 3-year medical gastroenterological fellowship and a short-term nursing fellowship, both in Portugal, and the organization of regular gastroenterological and endoscopic theoretical and practical sessions in Sao Tome and Principe. Second, the endoscopy facilities of the unit were significantly optimized. Third, a web platform was designed to provide telemedicine incorporating real-time endoscopic imaging available remotely. Results Through these sequential steps achieved in collaboration with Portuguese and local teams, this 5-year project provided the basis for gastroenterology care in this country. Conclusions At the present time, Sao Tome and Principe has an autonomous, efficient and skilled team and unit to provide care for patients with gastrointestinal diseases who need endoscopic procedures.

Use of high-power lasers in pediatric dental surgeries: case reports.

The use of high-power diode laser technology follows the principles of minimally invasive dentistry. Laser technology is used frequently in pediatric dentistry, especially in surgical procedures, because this approach favors hemostasis, eliminates the use of sutures, improves healing, minimizes treatment time, reduces the sensation of pressure and vibration experienced by the patient, and creates more comfortable postoperative conditions. This article describes the use of high-power diode lasers to perform 3 minor oral surgical procedures--biopsy, lingual frenectomy, and operculectomy--in 2 children. In all 3 treatments, the operative time did not exceed 5 minutes, no sutures were used, and no postoperative complications were reported. Thus, high-power diode lasers can be considered an alternative approach to minor oral surgery that decreases chair time, reduces postoperative complications, and minimizes stress and anxiety in pediatric patients.

Pathways in the association between added sugar consumption, obesity in mother-child dyads, and chronic oral disease burden in early childhood.

In this study, we modeled the pathways in the association of socioeconomic status, frequency of added sugar consumption, and obesity in mother-child dyads with chronic oral disease burden in early childhood using structural equation modeling. A population-based study was conducted on preschoolers from public daycare centers in São Luís, Brazil (n = 674) and their mothers. Chronic oral disease burden in early childhood was a latent variable, representing the shared variance of the following indicators: visible plaque index, gingivitis, and dental caries. A higher consumption frequency of added sugars by children [standardized regression coefficient (SC) = 0.219] explained the chronic oral disease burden. A higher consumption frequency of added sugars by mothers was associated with greater consumption of sugar by children (SC = 0.236), and indirectly with a greater chronic oral disease burden (SC = 0.052). Maternal obesity was associated with obesity in the offspring (SC = 0.130). The chronic oral disease burden is already present in early childhood and can be explained by the higher consumption of added sugars by the mother-child dyad. Approaches to preventing chronic oral diseases should focus on common risk factors, start early in life, and promote family involvement in this process.

Oral health care for people with disabilities in Brazil: Transition from the specialized dental services between 2014 and 2018.

OBJECTIVE: To identify changes in the dental service provision to people with disabilities (PD) in the Dental Specialties Centers (acronym CEO in Portuguese-Centro de Especialidades Odontológicas) between the first and second cycles of the Program for the Improvement of Access and Quality of CEO and analyse factors associated with any changes. METHODS: This nationwide ecological time series study adopted the CEO as the analysis unit. The 827 CEO who participated in the two program's cycles (2014 and 2018) were included. Data on the structure and the work process were considered to identify features of providing services to PD in both cycles. Latent transition analysis (LTA) was performed to identify latent status (LS) with similar features and model the transition between LS over time. Models with five variables and with two to five LS were tested, considered best conceptual interpretability and best model fit parameters: human resources structure (dentist working exclusively with PD) and work process that identified guarantee of PD treatment at the CEO, the CEO's interface with primary care, and the interface with tertiary care. Spatial analysis was performed to identify spatial patterns of LS in the Brazilian territory with choropleth maps. A multinomial logistic regression model was performed to identify factors associated with changes in the provision of CEO (improved, remained or worsened). FINDINGS: The best-fit model identified four LS: 'Better', 'Medium better', 'Medium worse' and 'Worse'. CEO remained in the LS 'Better' (94%), LS 'Medium' (5.3%) and LS 'Worse' (78.4%). It is noteworthy that the highest proportion of CEO, in both cycles, was in the LS 'Better', featured by the CEO, characterized by all the CEO guaranteeing treatment to users with PD, high proportions of professionals working exclusively with PD, and most CEO articulated with primary care and with tertiary care. However, there is a decrease in the number of postgraduate professionals specializing in this service profile (1.3%). The higher the population growth, the greater the likelihood of the CEO achieving 'improved' in the LS. Moreover, the higher the number of goals, the lower the likelihood of the CEO getting 'worse' in the LS. CONCLUSION: Advances in dental service provision were observed, with more significant transitions to the 'Better' class, with improvements mainly in the interface with primary and tertiary care. Disability will be an even more significant concern as the population ages. Initiatives that can remove barriers and empower PD are potent in the provision of oral health services.

Avaliação da experiência odontológica prévia, hábitos alimentares e de higiene bucal em pacientes com paralisia cerebral / Evaluation of previous dental experience, eating habits and oral hygiene in patients with cerebral palsy

Avaliar descritivamente a experiência odontológica prévia, práticas de higiene bucal e hábitos alimentares de pacientes com Paralisia Cerebral (PC). Foi realizado um estudo observacional, do tipo transversal, com pacientes diagnosticados com PC através uma amostra de conveniência (n=27), com idade entre 3 e 14 anos, de ambos os sexos, que buscaram atendimento no ambulatório de pediatria do Hospital Universitário Materno Infantil, em São Luís ­ MA, no período de julho a outubro de 2018. Foi aplicado um questionário estruturado ao cuidador contendo história médica e odontológica da criança, avaliando também as práticas de higiene bucal e hábitos alimentares. Verificou-se que 66.67% dos pacientes eram do sexo masculino, com média de idade de 8,5 anos. Todos os acompanhantes eram do sexo feminino e a maior parte apresentou baixa escolaridade. Dentro os participantes, 92,59% não apresentavam habilidade para realizar escovação dentária e 51,85% dos cuidadores nunca receberam orientação sobre os cuidados de higiene bucal; 70,37% dos participantes fazem o consumo de alimentos açucarados e pastosos, e mais da metade já tiveram experiência de cárie. O estudo mostrou deficiência na higienização e um alto consumo de açúcar. Nesse sentido, práticas de higiene bucal e instruções dietéticas devem ser reforçadas e orientadas aos cuidadores a fim de contribuir para melhor assistência e prevenção à saúde.

Descriptively evaluate the previous dental experience, oral hygiene practices and eating habits of patients with Cerebral Palsy (CP). An observational, cross-sectional study was carried out with patients diagnosed with CP through a convenience sample (n = 27), aged between 0 and 18 years, of both sexes, who sought care at the pediatric outpatient clinic of Materno Infantile University Hospital, at Federal University of Maranhão, in São Luís - MA, from July to October 2018. A structured questionnaire was applied to the caregiver containing the child's medical and dental history, also evaluating oral hygiene practices and eating habits. It was found that 66.67% of the patients were male, with a mean age of 8.5 years. All companions were female and most had low education. Within the participants, 92.59% did not have the ability to perform tooth brushing and 51.85% of the caregivers never received guidance on oral hygiene care; 70.37% of participants consume sugary and pasty foods, and more than half have had caries experience. The study showed poor hygiene and a high consumption of sugar. In this sense, oral hygiene practices and dietary instructions should be reinforced and oriented to caregivers in order to contribute to better health care and prevention.

Oral manifestations of renal tubular acidosis associated with secondary rickets: case report / Manifestações bucais da acidose tubular renal associada ao raquitismo secundário: relato de caso

ABSTRACT This report describes the oral manifestations of renal tubular acidosis (RTA) associated with secondary rickets and discusses the biological plausibility of these findings. The characteristic electrolyte changes during RTA or genetic mutations that trigger RTA may be responsible for impaired amelogenesis, dental malocclusion, impacted teeth, and absent lamina dura. This report reinforces the possibility of an association between RTA and the oral manifestations described.

RESUMO Este relato de caso descreve as manifestações bucais da acidose tubular renal (ATR) associada ao raquitismo secundário e discute a plausibilidade biológica desses achados. As alterações eletrolíticas características da ATR ou as mutações genéticas que a desencadeiam podem ser responsáveis pela amelogênese imperfeita, maloclusão dentária, dentes impactados e ausência de lâmina dura. Este relato reforça a possibilidade de uma associação entre ATR e as manifestações bucais descritas.

Oral manifestations of renal tubular acidosis associated with secondary rickets: case report.

This report describes the oral manifestations of renal tubular acidosis (RTA) associated with secondary rickets and discusses the biological plausibility of these findings. The characteristic electrolyte changes during RTA or genetic mutations that trigger RTA may be responsible for impaired amelogenesis, dental malocclusion, impacted teeth, and absent lamina dura. This report reinforces the possibility of an association between RTA and the oral manifestations described.

Overweight, obese, underweight, and frequency of sugar consumption as risk indicators for early childhood caries in Brazilian preschool children.

BACKGROUND: A possible association between being overweight or obese and early childhood caries (ECC) remains controversial. AIM: To investigated this association in a developing country testing the confounding effects of socioeconomic factors and frequency of sugar consumption. METHODS: Historical cohort study, 388 children (aged 24-71 months) living in São Luís, Brazil. A theoretical model adjusted according to income, birthweight, and nutritional status at twelve months and frequency of sugar consumption was generated with directed acyclic graphs to analyze this association. Caries were considered a discrete variable in the Poisson regression models; incidence density ratios (IRs) and 95% confidence intervals (95% CIs) were estimated. RESULTS: Being overweight or obese (IR = 1.52; 95% CI: 1.03-2.22) was independently associated with ECC. Being thin or very thin (IR = 1.97; 95% CI: 1.52-2.54), a high frequency of sugar consumption (IR = 1.83; 95% CI: 1.42-2.38), and age (IR = 3.62; 95% CI: 2.58-5.08) were associated with ECC. CONCLUSIONS: Children overweight or obese, as well as children exhibiting being thin/very thin, were associated with ECC independent of socioeconomic variables and a high frequency of sugar consumption.

Breastfeeding, Dental Biofilm Acidogenicity, and Early Childhood Caries.

AIM: This study evaluated the acidogenicity of human milk by the dental biofilms of children with and without early childhood caries (ECC). METHOD: Biofilms of 16 children (7 with ECC; 9 caries free) were exposed to human milk or 10% sucrose solution in the crossover design, and the biofilm pH was determined. RESULTS: Breastfeeding did not provoke a decrease in biofilm pH, irrespective of the children's caries status, whereas sucrose decreased the pH for both groups. In addition, higher x0394;pH5min (pH variation occurring at 5 min) was observed in the biofilms of ECC children (p < 0.05). The results suggest that breastfeeding may not contribute to ECC.

Factors underlying the polarization of early childhood caries within a high-risk population.

BACKGROUND: Early childhood caries (ECC) are particularly prevalent in disadvantaged populations, and socioeconomic factors are associated with the polarization of disease. A previous study showed that even within a homogenous low-income population disease is polarized, indicating that other factors apart from income may contribute to disease susceptibility. METHODS: This study used a hierarchical approach to identify factors associated with polarization of ECC in low-income subjects. This cross-sectional study was conducted retrospectively using a cohort of 244 children (aged 48-72 months) with family incomes not exceeding double the minimum wage (U.S. $8,208.00/year), living in neighborhoods on the outskirts of São Luís, Maranhão, Brazil. The sample was divided into three groups based on the Significant Caries (SiC) Index: no caries group, few caries group (mean 1.38 lesions), and a high caries group (mean 3.82 lesions). Hierarchical multinomial logistic regression analyses were performed based on a theoretical model. RESULTS: Twenty-eight (11.5%) of the 244 children presented with high caries. Age (p = 0.026; prevalence ratio (PR) = 1.10; 95% confidence interval (CI) 1.01-1.20) and frequency of sucrose consumption - p = 0.001; PR 4.65 (95% CI 1.83-11.84) were associated with increased risk of ECC. CONCLUSIONS: In the high caries group, greater consumption of sucrose between main meals may explain why, in a group of children with homogenous social and health conditions, some had more caries than others.

Association between prolonged breast-feeding and early childhood caries: a hierarchical approach.

OBJECTIVES: This study was conducted to investigate the association between prolonged breastfeeding and early childhood caries(ECC) with adjustment for important confounders, using hieraschical approach. METHODS: This retrospective cohort study involved 260 low-income children (18-42 months). The number of decayed teeth was used as a measure of caries. Following a theoretical framework, the hierarchical model was built in a forward fashion, by adding the following levels in succession: level 1: age; level 2: social variables; level 3: health variables; level 4: behavioral variables; level 5: oral hygiene-related variables; level 6: oral hygiene quality measured by visible plaque; and level 7: contamination by mutans streptococci. Sequential forward multiple Poisson regression analysis was employed. RESULTS: Breast-feeding was not a risk factor for ECC after adjustment for some confounders (incidence density ratio, 1.15; 95% confidence interval, 0.84-1.59, P = 0.363). CONCLUSION: Prolonged breast-feeding was not a risk factor for ECC while age, high sucrose comption between main meals and the quality of oral higiene were associated with disease in children.

Rationale for the partial removal of carious tissue in primary teeth.

No consensus exists regarding the need for a second clinical session to remove carious dentin that remains in the pulp wall after partial caries removal. The purpose of the present article was to review studies that evaluated the effect of partial caries removal as provisional or definitive treatment on the dentinal microflora, the pulp response, or the progression of carious lesions in primary teeth. The results showed that partial caries removal performed in 1 session is more advantageous than removal in stages over 2 visits. This treatment, in addition to permitting the inactivation of caries lesions and reducing cariogenic micro-organisms in dentin, reduces the risk of pulp exposure caused by cavity reopening and excavation of remnant carious dentin. The favorable outcomes of partial caries removal in a single session support the indication of this modality as a definitive alternative restorative treatment for the primary dentition.