Conservative approach for molar-incisor hypomineralization: a case report and 7-year follow-up.

Molar-incisor hypomineralization (MIH) can result in minor injuries or major structural loss, especially in incisors and molars. Patients with MIH seek dental treatment early, usually in childhood. Choosing the best treatment option during this stage can be a challenge. Because these patients still present a mixed dentition, the use of prosthetic appliances is not usually the best option. This case report with a 7-year follow-up presents an overview of a conservative approach for the restoration of teeth affected by MIH. A 10-year-old girl presented with permanent molars and incisors that exhibited qualitative defects of enamel characteristic of MIH. During the restoration phase, direct resin-modified glass ionomer cement (RMGIC) restorations were placed in all 4 first molars with the aid of acetate crowns, which were used to facilitate reconstruction of the tooth morphology. The maxillary incisors were previously treated by another dentist, and the mandibular incisors were treated later, since they were not the main complaint of the patient at the time. During 7 years of follow-up, the RMGIC restorations proved to be a good option, presenting greater longevity in a molar with minor structural defects and requiring repair or replacement in molars with larger structural defects. Despite some failures and the necessity for new restorations, the patient conveyed satisfaction with the treatment and reported no tooth sensitivity, and there was no recurrence of caries. During this follow-up period, the defective mandibular incisors were treated first with enamel microabrasion, which proved esthetically unsatisfactory, and then with direct composite resin veneers. The results in this patient suggest that use of RMGIC may be a feasible conservative option for tooth restoration in young patients with a mixed dentition when permanent molars exhibit extensive structural loss associated with MIH.

Association between quantitative measures obtained using fluorescence-based methods and activity status of occlusal caries lesions in primary molars.

BACKGROUND: Fluorescence-based methods (FBM) can add objectiveness to diagnosis strategy for caries. Few studies, however, have focused on the evaluation of caries activity. AIM: To evaluate the association between quantitative measures obtained with FBM, clinical parameters acquired from the patients, caries detection, and assessment of activity status in occlusal surfaces of primary molars. DESIGN: Six hundred and six teeth from 113 children (4-14 years) were evaluated. The presence of a biofilm, caries experience, and the number of active lesions were recorded. The teeth were assessed using FBM: DIAGNOdent pen (Lfpen) and Quantitative light-induced fluorescence (QLF). As reference standard, all teeth were evaluated using the ICDAS (International Caries Detection and Assessment System) associated with clinical activity assessments. Multilevel regressions compared the FBM values and evaluated the association between the FBM measures and clinical variables related to the caries activity. RESULTS: The measures from the FBM were higher in cavitated lesions. Only, ∆F values distinguished active and inactive lesions. The LFpen measures were higher in active lesions, at the cavitated threshold (56.95 ± 29.60). Following regression analyses, only the presence of visible biofilm on occlusal surfaces (adjusted prevalence ratio = 1.43) and ∆R values of the teeth (adjusted prevalence ratio = 1.02) were associated with caries activity. CONCLUSION: Some quantitative measures from FBM parameters are associated with caries activity evaluation, which is similar to the clinical evaluation of the presence of visible biofilm.

Hábitos bucais deletérios e suas consequências em Odontopediatria / Deleterious oral habits and its consequences in Pediatric Dentistry

Objetivo: O objetivo deste trabalho foi revisar a literatura vigente sobre os hábitos bucais deletérios e suas consequências em Odontopediatria. Material e Métodos: Para isso, foi realizada uma busca nas bases de dados Bireme e Pubmed/MEDLINE, utilizando como palavras-chave: sistema estomatognático, hábitos bucais e Odontopediatria. Resultados: Pode-se observar que os hábitos bucais (nutritivos e não nutritivos) encontram-se diretamente relacionados com as funções do sistema estomatognático, acarretando em inadequações no posicionamento dos maxilares, lábios, língua e palato, alterações no desenvolvimento e posição dos dentes, problemas de fala e na respiração e alterações nos movimentos necessários para mastigar e deglutir os alimentos. Conclusão: Conclui-se que é de extrema importância um diagnóstico precoce e um trabalho multidisciplinar para uma possível remoção do hábito bucal deletério e suas consequências.

Objective: The aim of this study was to review the current literature about the deleterious oral habits and their consequences in Pediatric Dentistry. Material and Methods: For that, a search was performed in the Bireme and Pubmed/MEDLINE databases, using the keywords: stomatognathic system, oral habit and pediatric dentistry. Results: It was observed that oral habits (nutritious and non-nutritious) are directly related to the functions of stomatognathic system, causing consequences such as inadequacy in the positioning of the jaws, lips, tongue and palate, changes in development and position of teeth, speech problems and breathing and changes in the necessary movements to chew and swallow food. Conclusion: It can be concluded that is extremely important an early diagnosis and multidisciplinary work for possible removal of deleterious oral habits and their consequences.

Custo-eficácia do uso de escova infantil com cerdas longas nas pontas associada à técnica de escovação anteroposterior comparada à escova de cerdas planas associada à técnica transversal no controle de lesões de cárie em molares permanentes em erupção - estudo clínico randomizado / Cost-efficacy of anteroposterior toothbrushing using a toothbrush with extra-long bristles in the tip vs. cross-toothbrushing using a toothbrush with bristles in the same plane- randomized and controlled clinical trial

Este estudo clínico randomizado teve por objetivo avaliar se a escovação anteroposterior com escova de cerdas longas nas pontas (modo teste) foi mais custo-eficaz do que a técnica de escovação transversal com escovas de cerdas retas (modo controle) no controle de lesões de cárie na superfície oclusal de molares permanentes em erupção. Cento e quarenta participantes (66 crianças e 74 adolescentes) foram aleatoriamente designados para os grupos teste e controle. Os participantes foram acompanhados por 24 meses. Para determinar as diferenças entre os grupos em termos de eficácia, foram utilizadas as análises por intenção de tratar (ITT) e por protocolo, além de análises de sobrevida. Foram considerados como desfecho: 1) qualquer tipo de progressão e 2) progressão para cavidade. A análise de viabilidade econômica foi determinada através do custo da escova e seu grau de deterioração. Para comparação da relação de custo-eficácia entre os grupos utilizou-se a razão de custo-eficácia incremental. O modo teste mostrou-se superior quando a progressão geral de lesões foi considerada. As análises por protocolo e de sobrevida mostraram tendências semelhantes. A análise por ITT para progressão geral das lesões, bem como todas as análises considerando a progressão ara cavidades, não mostraram diferença entre os grupos. A custo-eficácia incremental entre os modos de escovação foi superior aos valores recomendados pela Organização Mundial de Saúde para tratamentos custo-eficazes. Conclui-se que o modo teste apresenta um impacto reduzido em termos de eficácia na redução da progressão de lesões de cárie em molares em erupção comparado ao modo controle e não é mais custo-eficaz que este último a ponto de ser indicado para substituí-lo na prática clínica...

This single-blinded randomized clinical trial investigated if the anteroposterior toothbrushing using a toothbrush with extra-long bristles in the tip (test mode) was more cost-efficacious than cross-toothbrushing technique using toothbrush with bristles in the same plane (control mode) in controlling caries lesion progression on occlusal surfaces of erupting first permanent molars. One hundred and forty participants (66 children and 74 adolescents) were randomly assigned for test and control modes of toothbrushing (technique + toothbrush). They were followed-up for 24 months. For assessing differences between groups in terms of efficacy, per protocol, intention to treat (ITT) and survival analyses were used. The outcomes set were: 1) overall caries lesions progression; 2) caries lesions progression for cavity threshold. Toothbrush cost and deterioration were considered for economic feasibility. The cost-efficacy between groups was compared using the incremental cost-efficacy ratio. The test mode was superior regarding overall caries lesion progression. Per protocol and survival analyses showed similar trends. ITT analysis for the previously mentioned outcome, as well as all analyses considering progression for cavitation threshold, did not show differences between groups. Incremental cost-efficacy ratio was superior to the thresholds determined by World Health Organization for being cost-efficacious treatments. In conclusion, the test mode has reduced impact on caries lesions progression compared to the control mode and is not most cost-efficacious than that. Therefore, the replacing the control mode for the test mode in clinical practice is not recommended...

New proposal of silver diamine fluoride use in arresting approximal caries: study protocol for a randomized controlled trial.

BACKGROUND: Approximal surfaces are a challenge to caries lesions control. Silver diamine fluoride (SDF) is a simple,low-cost and promisor intervention for arresting caries lesions, but it has never been tested on approximal surfaces. Our aim is to evaluate the efficacy and cost-efficacy of SDF in arresting initial lesions compared to resin infiltration and exclusively flossing (control group). Our second aim is to assess discomfort and satisfaction regarding interventions. METHODS/DESIGN: This is a randomized clinical trial, double-blinded, placebo-controlled study. Children/adolescents presenting at least one approximal initial caries lesion in primary molars/permanent premolars and molars will be included. Surfaces with advanced dentine lesions identified by radiography and participants who refuse to participate or present negative behaviors will be excluded. A minimum sample size of 504 surfaces will be required for each subgroup. Individuals will be randomly allocated in three groups of interventions: SDF, resin infiltration, and control group. Depending on the allocation, the patients will receive the active treatment and respective placebo therapies. All patients will be oriented to daily flossing the included surfaces. Our primary outcome will be caries progression by clinical and radiographic examinations. Appointments will be timed and costs of materials will be considered to calculate cost-efficacy. Patient discomfort will be assessed after interventions. Parent and patient satisfaction with the treatment will be collected after treatment and in the last follow-up visit. Individuals will be assessed at 1 and 3 months after treatment to evaluate dental biofilm and at 6, 12, and 24 months to assess caries progression by visual examination and/or radiography. Multilevel analyses will be used to verify if the type of treatment influenced on the tested outcomes. Costs will be compared and analyses of cost-efficacy will be performed. Poisson analysis will test the association between intervention and reported discomfort and satisfaction. DISCUSSION: Our hypothesis is that SDF is the most cost-efficacious option from all tested interventions. If our hypothesis is confirmed, the use of SDF in private and public contexts could represent an easier and effective option in the treatment of enamel approximal caries in children/adolescents. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01477385), Initial release: 11/16/2011: last update: 06/02/2014.

Influence of cross-infection control methods on performance of pen-type laser fluorescence in detecting occlusal caries lesions in primary teeth.

The aim of this in vitro study was to determine the influence of cross-infection control methods, as probe tip autoclaving and polyvinyl chloride (PVC) wrapping, on the performance of laser fluorescence device (DIAGNOdent pen--LFpen) on occlusal surfaces of primary molars. One experienced examiner carried out all examinations (n = 78). For the probe tip autoclaving study, 62 sites (sample A, 40 teeth) were used. The sites were assessed with LFpen using tips in six different conditions: without autoclaving and after autoclaving for 10, 20, 30, 40, and 50 cycles of 10 min. For the PVC wrapping study, we selected other 58 sites (sample B, 38 teeth). The sites were assessed with the LFpen device in two conditions: with and without PVC wrapping. The teeth were sectioned and histologically assessed for caries depth. LFpen values, sensitivity, and specificity were compared among the different conditions. The LF readings were slightly higher after successive examinations, independently of autoclaving. In both studies, no statistical differences in the sensitivity and specificity were observed for all conditions. In conclusion, probe tip autoclaving and PVC wrapping do not influence the performance of LFpen device on occlusal surfaces of primary molars.

Can the individual calibration be modified when laser fluorescence method is used for caries detection?

BACKGROUND: Individual calibration (IC) for caries detection methods based on fluorescence is time-consuming, especially for paediatric dentists, if the calibration has to be performed tooth-by-tooth. However, it is not clear how this calibration actually interfere in laser fluorescence (LF) readings. AIM: This in vivo study was to verify the influence of different modes of IC on laser fluorescence (LF) readings. DESIGN: Ninety six occlusal and 95 buccal surfaces of 1st permanent molars were examined using LF device after IC performed on control (no IC), the examined teeth, a permanent incisor, a 1st primary molar or a 2nd primary molar. All modes of IC were performed in the same child. Wilcoxon test and Bland-Altman analysis were used to compare the readings. Intraclass correlation coefficients (ICC) were calculated. RESULTS: Laser fluorescence readings without prior calibration were higher than readings performed after any mode of IC and resulted in different values of ICC. After other IC modes, the LF readings were statistically similar. CONCLUSION: The absence of IC influences LF readings and LF reproducibility, but different IC methods can be considered in clinical practice.

Fatores associados ao excesso de peso entre mulheres / Factors associated to overweight among women / Factores asociados al exceso de peso entre mujeres

Objetivou-se caracterizar as usuárias e identificar os fatores associados ao excesso de peso em serviço público de Promoção à Saúde (SPS). Estudo transversal com todas as mulheres de SPS, denominado Academia da Cidade. Utilizaram-se variáveis antropométricas, consumo e hábitos alimentares, e relato de morbidades. Realizou-se análise descritiva e regressão linear múltipla (p<0,05). Verificou-se entre as 262 entrevistadas elevada prevalência de excesso de peso (78,7%) e hábitos alimentares inadequados. Foram associados ao aumento do índice de massa corporal: mastigação inadequada de alimentos (b=2,780; p<0,001), consumo insuficiente de vitamina C (b=-2,700; p=0,039), ter risco para doenças cardiovasculares (b=2,840; p<0,001) e dislipidemias (b=2,292; p=0,003), e realizar dieta nos últimos seis meses (b=2,216; p=0,006). A alta taxa de excesso de peso e seus fatores associados apontam para a necessidade de realizar estratégias de promoção e recuperação da saúde, focadas no cuidado integral dos indivíduos e comunidades, ainda que em SPS.

The objective is to characterize the users of a public health promotion service (HPS) and identify factors associated with excess weight among these users. It's cross-sectional study among all women in a HPS. It was used anthropometric variables, food consumption and dietary habits, and reports of morbidity. Descriptive analysis and multiple linear regressions were performed (p<0,05). A high prevalence of excess weight (78,7%) and inadequate dietary characteristics were found among the 262 interviewees. The increase of body mass index correlated with inadequate food mastication (b=2,780; p<0,001); insufficient vitamin C intake (b=-2,700; p=0,039); risk of cardiovascular diseases (b=2,840; p<0,001) and dyslipidemia (b=2,292; p=0,003); and doing diets over the last six months (b=2,216; p=0,006). Conclusion: The high rates of excess weight and associated factors show that there is a need to implement strategies for health promotion and recovery, focusing on comprehensive care for individuals and communities, even if at HPS.

Se objetivó caracterizar las usuarias e identificar los factores asociados al exceso de peso en el Servicio de Promoción a la Salud (SPS) Pública. Estudio transversal con todas las mujeres de SPS, denominado Academia da Cidade. Se utilizaron variables antropométricas, consumo y hábitos alimentarios, e informe de morbilidades. Se realizó regresión lineal múltiple (p<0,05). Se comprobó entre las 262 entrevistadas elevada prevalencia de exceso de peso (78,7%) e erróneos hábitos alimentarios. Fueron asociados al aumento del índice de masa corporal (IMC): masticación inadecuada de alimentos (b=2,780; p<0,001), consumo insuficiente de vitamina C (b=-2,700; p=0,039), tener riesgo para enfermedades cardiovasculares (b=2,840; p<0,001) y dislipidemías (=2,292; p=0,003), y seguir dieta en los últimos seis meses (b=2,216; p=0,006). Las altas tasas de exceso de peso y sus factores asociados indican la necesidad de crear estrategias de promoción y recuperación de la salud, dirigidas al cuidado integral de los individuos y comunidades, aunque sea en SPS.

Efetividade do uso de escova infantil com cerdas multinível associada à técnica de escovação anteroposterior na remoção de biofilme em primeiros molares permanentes em erupção / Effectiveness of using childrens toothbrush with multilevel filaments associated with anteroposterior toothbrushing in removing dental plaque from occlusal surfasse of erupting permanente molars

O presente trabalho objetivou: 1) comparar a efetividade da técnica de escovação anteroposterior com escovas de design modificado e cerdas multinível com a técnica de escovação transversal com escova infantil convencional de cerdas retas com, quanto à remoção de biofilme em superfícies oclusais de molares permanentes em erupção, em curto e longo prazo; 2) comparar diferentes métodos de avaliação de biofilme para superfícies oclusais e 3) verificar fatores clínicos associados com a redução de biofilme nas superfícies oclusais de dentes em erupção. Foram determinados diferentes desfechos: presença de placa visível, presença de placa madura, área de placa corada e fluorescência da placa medida pelo aparelho de fluorescência induzida por luz (QLF). Dois examinadores, calibrados e cegos quanto ao grupo de tratamento que as crianças seriam alocadas, realizaram os exames com os índices e o exame com o QLF foi realizado apenas por um examinador. Um terceiro avaliador externo ficou encarregado de orientar e avaliar as técnicas e o grau de deteriorização das escovas. Foram selecionadas 33 crianças (92 dentes), que compareceram a triagem da disciplina de Odontopediatria da FOUSP, com idade entre 5-7 anos (Média±DP=6,23±0,56), com pelo menos um molar permanente em erupção presente na cavidade bucal. Essas crianças foram alocadas aleatoriamente em dois grupos de acordo com a técnica de escovação a ser empregada. Os dentes foram avaliados pelos métodos acima citados no início do estudo e após 15 dias, 1 mês e 3 meses. Alguns parâmetros clínicos foram analisados quanto à associação com redução de biofilme. Análises multinível foram realizadas buscando verificar qual a técnica mais efetiva na remoção de biofilme em superfícies oclusais de molares permanentes em erupção e as possíveis associações entre parâmetros clínicos e redução de biofilme. Foram também verificadas a reprodutibilidade e a correlação entre os métodos usados para avaliação do biofilme

Até os 15 dias de seguimento, não houve diferença entre os grupos. Após 1 mês de seguimento das crianças houve maior redução no biofilme visível e no biofilme maduro quando utilizada a escova modificada de cerdas multinível. Nenhuma alteração foi notada quando avaliado os desfechos de fluorescência da placa e área de placa corada. Os índices visuais mostraram fraca correlação entre si e a fluorescência da placa não mostrou correlação com os demais métodos. Diferentes fatores são associados com a redução de biofilme maduro e biofilme visível pelas técnicas de escovação. Conclui-se que, em longo prazo, a escova de cerdas multinível consegue desorganizar melhor o biofilme maduro e o biofilme visível e que os métodos de avaliação do biofilme avaliam o biofilme de forma diferente. A redução de placa madura e placa visível foram associadas a diferentes fatores clínicos testados, sugerindo que esses desfechos avaliam aspectos discretamente diferentes do biofilme acumulado em superfícies oclusais de dentes em erupção

The present study aimed 1) to evaluate the effectiveness of anteroposterior toothbrushing using a children`s toothbrush with multilevel filaments vs. cross-toothbrushing technique using straight bristles in short and long-term analysis; 2) to compare different methods assessing dental plaque in occlusal surfaces and 3) to verify the association between clinical parameters and the removal of biofilm on the occlusal surfaces of erupting permanent molars. Different outcomes concerning dental plaque were chosen: presence of visible plaque, presence of mature plaque, area of disclosed plaque and plaque fluorescence measured by a quantitative light fluorescence device (QLF). Two calibrated and blinded examiners performed the examinations using indices and only one assessed the biofilm using the QLF. Another examiner was responsible for explaining the techniques and evaluating the degree of deterioration of the toothbrushes. Thirty-three children aged 5-7 years (mean=6.23, SD=0.56), who attended the screening of the discipline of Pediatric Dentistry FOUSP, were select. In those children 92 erupting molars are included. These children were randomly assigned into two groups according to the toothbrushing technique Teeth were evaluated by the methods at baseline and after 15 days, 1 month and 3 month. Some clinical parameters were also analyzed regarding their association with plaque reduction. Multilevel analysis were performed to determine which technique is the most effective in removing plaque on occlusal surfaces of erupting permanent molars. Reproducibility and correlation of methods for plaque measuring were also tested

After 15 days, no difference was observed between groups. However, after 1 month of following-up, higher reduction in mature and visible plaque were found using the toothbrushes with multilevel filaments. Visual indexes for plaque evaluation presented poor correlation between themselves and the plaque fluorescence measured by QLF did not show correlation with visual them. Different clinical parameters were associated with biofilm removal by toothbrusing techniques. In conclusion, in a long-term analysis, the toothbrishing with multilevel filaments is able to disorganize the plaque on occlusal surfasse of erupting molares more efficiently and the methods for plaque assessement evaluate different parameters related to plaque. Finally, the reduction in mature plaque and in visible plaque are differently associated with clinical parameters, suggesting they measure slight different aspects related to de dental plaque on occlusal surface of erupting teeth

Complicações decorrentes da utilização do piercing bucal: avaliação e conduta clínica / Complications due use of oral piercing: clinical evaluation and management

Objetivo: apresentar três casos clínicos de pacientes portadores de piercing bucal, nos quais foram motivados a remover os adornos e, quando não admitiram a remoção, foram orientados preventivamente para evitar maiores complicações. Descrição do caso: a conduta do Cirurgião-dentista frente ao paciente portador do piercing na cavidade bucal foi descrita. O estudo ainda enalteceu a importância da intervenção do Cirurgião-dentista no esclarecimento dos possíveis prejuízos à saúde ocasionados pelo piercing bucal. Conclusão: o Cirurgião-dentista e particularmente o periodontista desempenham papel relevante na orientação evitando a instalação do piercing bucal, ou na recomendação de cuidados quando o paciente não aceita a remoção do adorno.

Aim: present 3 clinical cases of patients with oral piercing, who was guided to remove the ornaments, and when the patient did not admit the piercing removal, the patient was preventively warned to avoid more complications. Case description: the dentist management on the patient with oral piercing was described. This study also enhances the importance of the dentist intervention in the explanation of possible health injury occasioned by oral piercing. Conclusion: the dentist and particularly the periodontist play relevant role in guiding avoiding the installation of oral piercing, or the recommendation of care when the patient does not accept the removal of adornment.