A utilização do tratamento restaurador atraumático modificado na clínica de odontopediatria / Use of modified atraumatic restorative treatment in paediatric dentistry clinic

Apesar da redução dos índices epidemiológicos ao longo dos anos, a cárie dentária é uma doença que até hoje acomete populações do mundo inteiro, podendo causar infecção, dor e perda dentária prematura. O propósito desse trabalho foi relatar o caso clínico de uma criança portadora de múltiplas lesões extensas de cárie por meio da estruturação do tratamento em quatro fases, visando à promoção de saúde bucal. O tratamento restaurador atraumático modificado (ARTm) foi a técnica utilizada na reabilitação oral do paciente, o que proporcionou redução da ansiedade frente ao tratamento odontológico e maior colaboração por parte da criança, bem como melhora da qualidade de vida de toda a família envolvida.

Despite the reduction on epidemiological rates over the years, dental caries is a disease that still affects populations worldwide and causes infection, pain and premature tooth loss. The main purpose of this study was to report the clinical case of a child with multiple extensive carious lesions by using a four-step treatment organization, aimed at oral health promotion. The atraumatic restorative treatment modified (ARTm) was the technique that was applied at the pacient´s oral rehabilitation and was able to reduce the child´s anxiety and increase it´s colaboration during dental treatment, as well as improve the life quality levels of the whole family involved.

Oral Microbial Colonization in Pediatric Intensive Care Unit Patients.

PURPOSE: The purpose of this study was to assess oral microbial colonization before and after the implementation of an oral hygiene protocol in children admitted to a pediatric intensive care unit (PICU) using nonhospitalized healthy children as a control group. METHODS: Two groups were analyzed in this clinical study: Group G1 (dentate children admitted to the PICU); and Group G2 (nonhospitalized, healthy, dentate children). The G1 group underwent oral assessments before (G1i) and after (G1f) a three-day oral hygiene protocol using 0.12 percent chlorhexidine applied at 12-hour intervals. RESULTS: Several pathogenic bacteria were identified in group G1i, which was significantly higher than in group G2 (P<.001). There were significant differences between groups G1i and G1f regarding the presence of pathogenic bacteria (P<.001) and a tongue coat (P<.001). The G1f and G2 groups were comparable concerning the presence of pathogenic bacteria (P=.14). CONCLUSIONS: Pathogenic bacteria were present in the oral cavity of almost all hospitalized children and were significantly decreased after an appropriate oral hygiene protocol was incorporated in their daily care. Therefore, regular oral hygiene protocols are warranted in PICUs.

Efeito remineralizador da caseína fosfato de cálcio fosfopeptídeo amorfo em dentes decíduos e permanentes in vivo / Remineralizing effect of casein fosfopeptideo amorphous calcium phosphate in primary and permanent teeth in vivo

O presente estudo in vivo avaliou o efeito remineralizador da caseína fosfato de cálcio fosfopeptídeo amorfo (CPP-ACP) tooth mousse em lesões de mancha branca em dentes decíduos e permanentes. Dezoito crianças de 4 a 8 anos apresentaram 81 lesões de mancha branca, as quais foram divididas de maneira randômica. Estas foram tratadas com verniz de flúor 2,26% (controle) e CPP-ACP mousse (teste), duas vezes por semana, durante seis e quatro semanas, respectivamente. Um examinador cego avaliou as lesões de mancha branca no período inicial (T0) e após 3 (T1) e 12 (T2) semanas de tratamento. Os dados de índice de placa visível, índice de sangramento gengival, índice ICDAS foram coletados. Em adição, foram realizadas tomadas fotográficas das lesões em todos os períodos analisados. Os dados foram analisados por testes qui-quadrado e t de Student. Resultados não demonstraram diferença entre os grupos controle e teste durante os períodos, a partir do índice ICDAS (p>0,05). No entanto, a partir do mesmo índice, o grupo teste demonstrou diferença significante entre os períodos analisados (p<0,05). A área das manchas brancas, em pixels, dos grupos controle e teste não demonstrou diferença estatística de cada grupo, em qualquer dos períodos analisados (p>0,05). Dessa forma, concluiu- se que a terapia de remineralização de lesões de manchas brancas foi efetiva em ambos os grupos. No entanto, devido ao número amostral reduzido e o curto período de análise do presente estudo, são necessários maiores esclarecimentos em relação a este efeito.

This in vivo study was conducted to evaluate the remineralization effects of CPP-ACP Tooth Mousse on white-spot lesion in primary and permanent teeth. Eighteen children (age from 4-8) exhibiting 81 white-spot lesions sites were randomly divided into two different treatments protocols: test group received applications of the remineralizing mousse twice a week for six weeks; control group received applications of a 2.26% fluoridated coating once a week for four weeks. A blind examiner evaluated the children at baseline, 3 and 12 weeks after the first visit, recorded visible plaque, gingival bleeding, ICDAS index and photographed the lesions. Data was analyzed with chi-square and Student t-test. According to ICDAS index, the control group was not statistically different from the treated group (p>0.05), in each time. However, results from treated group demonstrated that ICDAS index was statistically different from times (p<0.05). The area of the white spots (in pixels) of samples from control and treated groups were not statistically different from each group in any time (p>0.05). It was concluded that the remineralizing therapy of white spot lesions was efficient in the two groups. Nevertheless, due to the small sample size and the brief time for conducting the study, new research is necessary to increase the findings.

Caries Diagnosis in the Mixed Dentition Using ICDAS II

To assess the dental caries prevalence with ICDAS II in the mixed dentition, 40 children aged 7 to 11 years old, participating in a social program, whose parents and/or guardians signed a informed consent form.Material and Methods:Clinical examination was carried out after brushing. A single researcher performed the examination and the diagnosis consistency was obtained by Kappa coefficient in 12% of the sample. All dental surfaces were examined receiving a two-digit code. The first one refers to the presence of restoration/sealant and the second, the severity of carious lesions. The data was processed at SPSS software version 10.0 and analyzed using descriptive statistics (absolute distribution, percentage, mean and standard deviation). Results:The coefficient intra-examiner agreement was 0,83.Caries prevalence was considered high because 100% of the children had some surface with non-cavitated caries lesion. ICDAS II can be easily transformed to dmf-s or DMF-S without compromising its integrity. For dmf-s/DMF-S decayed surfaces were consideredICDAS codes 3 to 6, resulting in a dmf-s = 6,57 where 11 children (27,5%) presented no decayed deciduous teeth surface. DMF-S = 2,0 showed that 15 children (37,5%) had none decayed permanent surface, determining a underestimation of the caries disease when using dmf-d/dmf-s and DMF-S indexes.Conclusion:A careful viewing of initial caries lesions makes ICDAS II usefull in evaluating the health promotion actions impact, supporting the planning process, implementation and evaluation of program activities...

Evaluation of therapeutic decision for treatment of carious lesions by dental students

Objective: to evaluate the therapeutic decision making for the academic of the last year of dentistry at the universities of the Distrito Federal, on dental caries in deciduous teeth and permanent young. Material and Methods: the evaluation was obtained through the application of a questionnaire containing a diagram representing five different stages of deep carious lesions on interproximal radiographs. Were selected through census of students enrolled last semester of each institution and concluded that the theoretical discipline of pediatric dentistry in accordance with the curriculum offered by the University. Data were analyzed statistically by the chi-square test the 5% level of significance. Results: we analyzed 132 questionnaires of which 30.3% of respondents opted for immediate restorative treatment for the injuries to deciduous teeth in the dentin-enamel junction to the permanent tooth, the percentage rose to 31.1%, revealing that there was similarity between universities about which strategy to use. Regarding caries removal there was a discrepancy in an institution compared the other in choosing the more invasive treatment (p = 0.0014). Conclusion: we see the need to implement teaching strategies for the training of a professional within the philosophy of minimum intervention.

Prevalence of enamel defects and associated risk factors in both dentitions in preterm and full term born children.

OBJECTIVES: The aim of this study was to evaluate the prevalence of enamel defects and their risk factors on primary and permanent dentitions of prematurely born children and full-term born children born at Regional Hospital of Asa Sul, Brasília, DF, Brazil. MATERIAL AND METHODS: Eighty 5-10-year-old children of both genders were examined, being 40 born prematurely (G1) and 40 born full term (G2). The demographic variables, medical history and oral health behaviors were retrieved using a questionnaire and data obtained from clinical examination were recorded. The teeth were examined and the presence of enamel defects was diagnosed according to the DDE Index and registered in odontograms. Subsequently, the defects were categorized in four groups according to one of the criteria proposed in 1992 by the FDI Commission on Oral Health, Research and Epidemiology. Kruskal-Wallis, Chi-square, Kappa, Mann-Whitney tests and logistic regression were used for statistical analysis. RESULTS: 75% of total sample had enamel defects. There was a major prevalence of hypoplasia of the enamel in G1 (p<0.001). There was a significant relationship between low weight and presence of the imperfections on the enamel in G1 on the primary dentition. The logistic regression model showed that the other risk factors such as monthly per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases were not associated with enamel defects and caries. CONCLUSIONS: Pre-term labor can be a predisposing factor for the presence of the enamel hypoplasia in the primary dentition.

Prevalence of enamel defects and associated risk factors in both dentitions in preterm and full term born children

OBJECTIVES: The aim of this study was to evaluate the prevalence of enamel defects and their risk factors on primary and permanent dentitions of prematurely born children and full-term born children born at Regional Hospital of Asa Sul, Brasília, DF, Brazil. MATERIAL AND METHODS: Eighty 5-10-year-old children of both genders were examined, being 40 born prematurely (G1) and 40 born full term (G2). The demographic variables, medical history and oral health behaviors were retrieved using a questionnaire and data obtained from clinical examination were recorded. The teeth were examined and the presence of enamel defects was diagnosed according to the DDE Index and registered in odontograms. Subsequently, the defects were categorized in four groups according to one of the criteria proposed in 1992 by the FDI Commission on Oral Health, Research and Epidemiology. Kruskal-Wallis, Chi-square, Kappa, Mann-Whitney tests and logistic regression were used for statistical analysis. RESULTS: 75% of total sample had enamel defects. There was a major prevalence of hypoplasia of the enamel in G1 (p<0.001). There was a significant relationship between low weight and presence of the imperfections on the enamel in G1 on the primary dentition. The logistic regression model showed that the other risk factors such as monthly per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases were not associated with enamel defects and caries. CONCLUSIONS: Pre-term labor can be a predisposing factor for the presence of the enamel hypoplasia in the primary dentition.

Prevalence of dental caries and caries-related risk factors in premature and term children.

This study evaluated the prevalence of enamel defects and dental caries and their risk factors on primary and permanent dentitions of prematurely-born children and term children. Eighty children were examined, 40 born prematurely (G1) and 40 born term (G2), in the age group between 5 and 10 years. The demographic variables, medical history and oral health behaviors were recorded on a questionnaire. The teeth were examined for presence of deficiencies of the enamel and caries that were registered. The caries were registered, focusing on the indices dmft (decayed, missing, and filled primary teeth) and DMFT (decayed, missing, and filled permanent teeth). The results showed that 75% of the total sample had enamel defects. The logistic regression model showed that other risk factors such as per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases had no correlation with enamel defects and caries. A smaller value of total DMFT (0.95) was found in the group of premature children in comparison to the term children (2.07) p = 0.0164. There was no difference concerning the permanent dentition between the two groups (p = 0.9926). One concludes that prematurity can't be a predisposing factor for the presence of dental caries.

Prevalence of dental caries and caries-related risk factors in premature and term children

This study evaluated the prevalence of enamel defects and dental caries and their risk factors on primary and permanent dentitions of prematurely-born children and term children. Eighty children were examined, 40 born prematurely (G1) and 40 born term (G2), in the age group between 5 and 10 years. The demographic variables, medical history and oral health behaviors were recorded on a questionnaire. The teeth were examined for presence of deficiencies of the enamel and caries that were registered. The caries were registered, focusing on the indices dmft (decayed, missing, and filled primary teeth) and DMFT (decayed, missing, and filled permanent teeth). The results showed that 75 percent of the total sample had enamel defects. The logistic regression model showed that other risk factors such as per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases had no correlation with enamel defects and caries. A smaller value of total DMFT (0.95) was found in the group of premature children in comparison to the term children (2.07) p = 0.0164. There was no difference concerning the permanent dentition between the two groups (p = 0.9926). One concludes that prematurity can't be a predisposing factor for the presence of dental caries.

Evaluation of chlorhexidine on the quality of the hybrid layer in noncarious primary teeth: an in vitro study.

It has recently been observed that chlorhexidine has the capacity to inhibit matrix metalloproteinase. Therefore, the object of this study was to assess the effect of chlorhexidine on the quality of the hybrid layer of noncarious primary teeth. In group 1, the teeth were subjected to acid-etching, chlorhexidine application, Single Bond adhesive insertion, and restoration with resin composite Z250. Group 2 received the same procedures, without the application of the antimicrobial agent. Twenty-five regions were examined by scanning electronic microscopy by blind examiners. The data obtained were statistically analyzed by the chi-square and student t tests at a 5% level of significance. The groups presented few interfacial gaps without statistically significant differences. Group 1 presented a larger number of areas with a visible hybrid layer (68%) vs group 2 (52%). The layer's thickness was 3.33 microm and 3.28 microm for groups 1 and 2, respectively (P=.94). The results showed that the clinical restorative protocol with the use of chlorhexidine application does not interfere significantly in the morphological characteristics of the hybrid layer.

Prevalence of dental caries in children born prematurely or at full term

The objective of this study was to evaluate the prevalence of dental caries in 192 children, 96 born prematurely and 96 at full term, in a regional hospital in Brazil. Mean age at clinical examination was 40.72 months in the full-term group (G1) and 30.44 months in the premature group (G2). The children were divided in two age subgroups: 0 to 3 and 4 to 6 years. Statistical results (Student's t and Kruskal-Wallis tests) showed that dmft was 0.43 for G1 and 0.01 for G2 in the 0-3 age subgroup, and 1.7 for G1 and 1.1 for G2 in the 4-6 age subgroup. Differences were significant between G1 and G2 only in the 0-3 age subgroup (p = 0.047). Caries evaluation showed that, of the 96 children in G1, 75 were caries free, while in G2, 84 did not have the disease. These differences were not significant (p = 0.088). The lower mean dmft found in the 0-3 age subgroup in G2 may be attributed to routines established by the hospital's neonatology staff, such as frequent dental visits and preventive instructions about oral habits, oral hygiene and diet. After this age, with the completion of the primary dentition, values increased and became similar between the G1 and G2 groups. Results also suggested a highly skewed distribution since most caries were found in only a small number of children.

O objetivo deste estudo foi avaliar a prevalência da cárie dentária em 192 crianças, 96 nascidas prematuramente e 96 a termo, em um hospital regional no Brasil. A média de idade ao exame clínico foi de 40,72 meses e 30,44 meses para os grupos a termo (G1) e prematuro (G2), respectivamente. As crianças foram divididas em faixas etárias de 0 a 3 e 4 a 6 anos. Os resultados estatísticos (testes t de Student e Kruskal-Wallis) mostraram que, entre 0 a 3 anos, o ceo-d foi 0,43 para o G1 e 0,01 para o G2. Entre 4 e 6 anos, o ceo-d foi 1,7 e 1,1 para G1 e G2, respectivamente. Os resultados foram significativos entre G1 e G2 apenas na faixa etária entre 0 e 3 anos (p = 0,047). A experiência de cárie mostrou que, das 96 crianças do G1, 75 estavam livres de cárie, enquanto que no G2, 84 não haviam tido a doença. Essas diferenças não foram significativas (p = 0,088). Conclui-se que o ceo-d médio menor encontrado no G2 entre 0 e 3 anos pode ser atribuído às freqüentes visitas de rotina e orientações sobre hábitos de higiene oral e dieta, oferecidos pela equipe de neonatologia. Após esta idade, com a dentição decídua completa, os valores aumentaram e se equipararam entre os grupos. Parece que o fenômeno de polarização esteve presente, visto que a experiência de cárie concentrou-se em um reduzido número de crianças.

Defeitos de desenvolvimento do esmalte dentário: relato de casos clínicos / Developmental defects of enamel: cases report

Os desvios da aparência normal do esmalte dentário são, em geral, resultantes de defeitos estruturais oriundos da disfunção de constituintes do órgão do esmalte, em particular das células formadoras do esmalte, ou seja, os ameloblastos. Assim sendo, o aparecimento desses defeitos está relacionado a distúrbios da amelogênese. A formação do esmalte passa por várias fases, iniciando-se por uma fase secretora, em que as células produzem principalmente amelogeninas simutaneamente ao inicio da mineralização, ou seja, a deposição orientada de cristais de hidroxiapatita. Esta fase é seguida pela reabsorção das amelogeninas, criando-se dessa maneira os espaços necessários para o crescimento das longas fitas de hidroxiapatita. Outras proteinas aparecem em seguida, havendo intensa reabsorção de água, fase em que os ameloblastos se modificam e tornam-se especializadas na reabsorção. Esses eventos levam, finalmente, a formação do esmalte maduro, constituído por aproxidamente 96% de minera.

Abnormalities of dental enamel are developmental defects arising from dysfunction of constituents of the enamel organ, in particular of ameloblasts, during amelogenesis. Enamel defects are observed in deciduous and permanent dentitions and are associated with a variety of local factors and systemic diseases. The purpose of this study was to review recent literature on the subject and to present two clinical cases. Thus, our observations, together with the literature, confirm that infections, nutritional problems, genetic factors, and preterm babies are more likely to be associated with enamel defects. The general dental practioner must therefore be aware of all the possibilities for a correct diagnosis and treatment.

Presence of developmental defects of enamel in cystic fibrosis patients.

PURPOSES: Cystic fibrosis (CF) is an autosomal recessive hereditary disease and is the frequently common lethal genetic pathology. The purposes of this study were to: (1) determine the presence of 3 different types of enamel defects: (a) demarcated opacities; (b) diffuse opacities; and (c) hypoplasia in the deciduous and permanent dentition of CF patients; and (2) compare with a control group. METHODS: The case group was defined as 13 patients who were diagnosed with CF and enrolled in a multiprofessional project of the Catholic University of Brasília (CUB), Brasilia, Brazil. All CF subjects were compared with control subjects selected from patients at the CUB. Each CF subject was individually paired with a control subject of similar sex and age. A full-mouth examination was carried out for the developmental defects of enamel (DDE) index. RESULTS: The most prevalent enamel defect in deciduous teeth was demarcated opacities present in 16% of the case group and in 7% of the control group. Although the defects were more prevalent in the case group, the difference was not statistically significant (P=0.57). The frequency of demarcated opacities was more prevalent in permanent teeth of the case group: 39% compared to 11% in the control group. For the control group, diffuse opacities were the more prevalent defects: 17% compared to 15% in the case group. The case group had more enamel defects in permanent teeth compared to the control (P=0.0003). CONCLUSIONS: In this study, enamel defects were frequently found in the permanent teeth of CF patients. Therefore, professionals who treat children should be alerted to promoting oral health among these patients.

Prevalence of dental caries in children born prematurely or at full term.

The objective of this study was to evaluate the prevalence of dental caries in 192 children, 96 born prematurely and 96 at full term, in a regional hospital in Brazil. Mean age at clinical examination was 40.72 months in the full-term group (G1) and 30.44 months in the premature group (G2). The children were divided in two age subgroups: 0 to 3 and 4 to 6 years. Statistical results (Student's t and Kruskal-Wallis tests) showed that dmft was 0.43 for G1 and 0.01 for G2 in the 0-3 age subgroup, and 1.7 for G1 and 1.1 for G2 in the 4-6 age subgroup. Differences were significant between G1 and G2 only in the 0-3 age subgroup (p = 0.047). Caries evaluation showed that, of the 96 children in G1, 75 were caries free, while in G2, 84 did not have the disease. These differences were not significant (p = 0.088). The lower mean dmft found in the 0-3 age subgroup in G2 may be attributed to routines established by the hospital's neonatology staff, such as frequent dental visits and preventive instructions about oral habits, oral hygiene and diet. After this age, with the completion of the primary dentition, values increased and became similar between the G1 and G2 groups. Results also suggested a highly skewed distribution since most caries were found in only a small number of children.

Feeding habits and severe early childhood caries in Brazilian preschool children.

PURPOSE: The objective of this study was to analyze the association between the feeding practice and presence or absence of SECC (Severe Early Childhood Caries) in Brazilian preschool children. METHODS: This cross-sectional study was conducted with male and female preschool children, aged 36 to 71 months, randomly selected from a low-income population. A 24-hour recall diary was used to assess data about infant feeding practices and dietary habits. The data were statistically analyzed using the chi-square test with a significance level of 5%. RESULTS: SECC was observed in 36% of the children examined. Infant feeding practices showed the association between SECC and night-time breast-feeding (P = .02) or breast-feeding (P = .0004) in children older than 12 months of age. The use of a bottle at night as a substitute for the pacifier and its use on demand during the day were also correlated with SECC (P < .0001). CONCLUSIONS: It was concluded that night-time breast-feeding in children older than 12 months of age, the use of a bottle at night as a substitute for the pacifier, and use of the bottle on demand during the day are feeding practices correlated with the etiology of SECC.

O uso da microabrasão do esmalte para remoção de manchas brancas sugestivas de fluorose dentária: caso clínico / The use of microabrasion enamel to remove fluorotic-like white spoots: a case report

A microabrasão do esmalte, empregando ácido hidroclorídrico a 18% e pedra pomes é um eficiente método para remover mancha superficial no esmalte dentário, especialmente àquelas sugestivas de fluorose dentária. Este trabalho relata o caso clínico de uma criança de 8 anos de idade presentando manchas brancas sugestivas de fluorose dentária de grau leve principalmente nos dentes anteriores superiorespermanentes, a qual procurou tratamento odontológico devido a preocupação estética. Foi realizada uma sessão inicial com microabrasão com ácido hidroclorídrico a 18% associada à pedra pomes executada com instrumento rotatório. Ao final da segunda e última sessão de microabrasão, o paciente e seu responsável mostraram-se extremamente satisfeitos com o resultado estético alcançado por esta técnica

Cárie severa da infância: discussão sobre a nomenclatura / Severe early childhood caries: discussion about terminology

A cárie severa da infância é um tipo especial de cárie que acomete um grande percentual da população pré-escolar. Nesta patologia, os quatro incisivos superiores são severamente afetados. Os outros dentes decíduos podem estar envolvidos, dependendo do tempo em que o processo carioso permanecer ativo. Na literatura, vários são os nomes utilizados para designá-la. Dentro deste contexto, o objetivo deste trabalho foi descrever, mediante revisão de literatura, a nomenclatura encontrada em publicações nacionais e internacionais, e promover um consenso sobre o termo que melhor defina essa patologia. Em publicações de outros países em língua inglesa, definiu-se que o termo "severe early childhood caries" deva ser o de eleição. No Brasil, este consenso não existe, mas acredita-se que essa doença seja melhor caracterizada como cárie severa da infância e, portanto, esta expressão deve ser a recomendada