Malocclusion characteristics amongst individuals with autism spectrum disorder: a systematic review and meta-analysis.

BACKGROUND: To estimate the prevalence of malocclusion in individuals with autism spectrum disorders (ASD) and to assess the relationship between ASD and malocclusion. METHODS: We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane, Embase, SciELO LILACS, Proquest, OpenGrey and Google Scholar. There were no language or publication dates restrictions. Two researchers independently performed selection, data extraction and quality assessment. Quality assessment and risk of bias were evaluated through the Newcastle-Ottawa scale and ROBINS-E tool. Meta-analyses using random effect models were used to estimate pooled measures of prevalence of malocclusion characteristics in individuals with ASD and pooled odds ratio (OR) on the relationship between ASD and malocclusion characteristics. Subgroup meta-analyses were conducted according to children and adolescents, history of orthodontic treatment, and occurrence of other syndromes and medical conditions. RESULTS: Searching identified 5549 papers with 238 were selected for full assessment. Eighteen cross-sectional studies were included according to inclusion criteria. Of them, eleven studies were considered of moderate quality. A judgement of critical risk of bias occurred for thirteen studies. The most prevalent malocclusion characteristics in individuals with ASD were crowding (33%; 95% CI 22 to 44%) and increased maxillary overjet (39%; 95% CI 23 to 54%). Individuals with ASD had higher odds of Angle's Class II (OR 1.92; 95% CI 1.36 to 2.72), Angle's Class III (OR 2.33; 95% CI 1.29 to 4.23), open bite (OR 1.96; 95% CI 1.21 to 3.16), and increased maxillary overjet (OR 1.53; 95% CI 1.06 to 2.21) than individuals without ASD. CONCLUSIONS: Angle's Class II, Angle's Class III, anterior open bite and increased maxillary overjet were more prevalent in individuals with ASD than those without ASD. Further high-quality studies are needed.

Má oclusão em indivíduos com Transtorno do Espectro Autista (TEA): revisão sistemática e meta-análise / Malocclusion in individuals with Autism Spectrum Disorder (ASD): review systematic and meta-analysis

Má-oclusão é a terceira condição bucal mais prevalente no mundo. Indivíduos com transtorno do espectro autista (TEA) podem apresentar hábitos orais parafuncionais que podem atuar como importantes fatores causais para oclusopatias. A literatura ainda é controversa sobre a maior ocorrência da má oclusão em indivíduos com TEA comparados aos sem TEA. O objetivo desta revisão sistemática e meta-análise foi avaliar a prevalência de má oclusão em indivíduos com TEA e comparar as características de má oclusão entre indivíduos com e sem TEA. Esta revisão sistemática foi registrada no PROSPERO (CRD42019151794). Foram incluídos estudos epidemiológicos que avaliaram clinicamente a má oclusão em indivíduos com TEA e/ou mensuraram a má oclusão em indivíduos com e sem TEA. A busca foi realizada nas bases eletrônicas PubMed, Scopus, Web of Science, Cochrane, Scielo and Lilacs. Os estudos identificados foram selecionados e avaliados por dois pesquisadores de forma independente. O risco de viés foi analisado com a escala Newcastle-Ottawa conforme o desenho do estudo. A meta-análise incluiu a prevalência agregada e o intervalo de confiança de 95% (IC 95%) das características de má-oclusão de indivíduos com TEA. A Odds Ratio (OR) agrupada e o IC 95% foram obtidos para estimar a associação entre TEA e má oclusão. Dentre os 2522 artigos identificados, 15 estudos foram incluídos. Em relação à qualidade dos estudos, nenhum estudo foi considerado de alta qualidade.. As meta-análises de prevalência e de associação incluíram 12 e 6 artigos, respectivamente. A prevalência de Classe I, II e III em indivíduos com TEA foi 39%, 22% e 8%, respectivamente. A característica de má oclusão mais prevalente foi a sobressaliência maxilar aumentada (39%, IC95% 23-54) e apinhamento (38%, IC95% 22-53%). Indivíduos com TEA apresentaram uma chance 53% maior (OR 1,53; IC95% 1,06-2,21) de ter sobressaliência maxilar aumentada e uma chance 73% maior (OR 1,73; IC95% 1,03-2,90) de ter mordida profunda quando comparados a indivíduos sem TEA. Além disso, indivíduos com TEA apresentaram uma chance 20% maior (OR 1,20; IC95% 1,03-1,39) de ter ao menos um tipo de má oclusão em relação a indivíduos sem TEA. As evidências disponíveis sugerem que indivíduos com TEA apresentaram uma maior chance de ter má oclusão do que indivíduos sem TEA. Estes achados indicam a importância de uma equipe multidisciplinar no cuidado em saúde aos indivíduos com TEA e também a necessidade de uma maior orientação para estes indivíduos para a prevenção e redução de hábitos bucais deletérios, com o objetivo de prevenir má oclusão.

Malocclusion is the third most prevalent oral condition worldwide. Individuals with autism spectrum disorder (ASD) may have parafunctional oral habits that may act as important causal factors for malocclusions. Literature is still controversial about the higher occurrence of malocclusion in individuals with ASD compared to those without ASD. The aim of this systematic review and meta-analysis was to assess the prevalence of malocclusion in individuals with ASD and to compare malocclusion characteristics between individuals with and without ASD. This systematic review was registered in PROSPERO (CRD42019151794). Epidemiologic studies that evaluated malocclusion clinically in individuals with ASD and/or measured malocclusion in individuals with or without ASD were included. The search was conducted on PubMed, Scopus, Web of Science, Cochrane, Scielo and Lilacs electronic databases. The identified studies were selected and assessed by two researchers independently. The risk of bias was analyzed using the Newcastle Ottawa scale according to the study design. The meta-analysis included the pooled prevalence and 95% confidence interval (CI 95%) of malocclusion characteristics among individuals with ASD. The pooled odds ratio (OR) and 95% CI were estimated to assess the relationship between ASD and malocclusion. Of the 2522 articles identified, 15 studies were included. Regarding the quality of studies, no articles were considered to be of high quality.. The meta-analyses of prevalence and association included 12 and 6 articles, respectively. The prevalence of Class I, II and III in individuals with ASD was 39%, 22% and 8%, respectively. The most prevalent malocclusion characteristic was increased maxillary overjet (39%, 95%CI 23-54) and crowding (38%, 95%CI 22-53%). Individuals with ASD had a 53% greater odds (OR 1.53; 95%CI 1.06-2.21) of increased maxillary overjet, and had 73% higher odds (OR 1.73; 95%CI 1.03 -2.90) of deep bite than those without ASD. Furthermore, individuals with ASD had 20% greater odds (OR 1.20; 95%CI 1.03-1.39) of having at least one type of malocclusion when compared with those without ASD. The available evidence suggests that individuals with ASD are more likely to have malocclusion than individuals without ASD. These findings indicate the importance of a multidisciplinary team in the health care of individuals with ASD as well as the need of providing more guidance for these individuals to prevent and reduce harmful oral habits, with the aim of preventing malocclusion.

Association between anterior open bite and impact on quality of life of preschool children.

The aim of this study was to evaluate the association between different types of malocclusion and the impact on quality of life among preschoolers and their families. A cross-sectional study was carried out involving 451 children 3-5 years of age. A clinical exam was performed to evaluate the malocclusions according to criteria proposed by Foster and Hamilton. This examination was conducted by a calibrated dentist. Parents/caregivers answered the Early Childhood Oral Health Impact Scale (ECOHIS) for the assessment of Oral Health-Related Quality of Life (OHRQoL) and the questionnaire on socioeconomic and demographic characteristics. Data analysis involved descriptive statistics, chi-square, Mann-Whitney and hierarchically adjusted Poisson regression. The prevalence of malocclusion was 28.4%. The most frequent conditions were posterior crossbite (20.4%), anterior open bite (9.5%) and increased overjet (8.4%). A significant association was found between anterior open bite and OHRQoL (p < 0.001). The adjusted analysis confirmed the association between anterior open bite and a negative impact on quality of life (PR = 2.55; 95%CI: 1.87 to 3.47; p < 0.001). Anterior open bite was associated with a negative impact on the quality of life of preschoolers.

Estudo sobre a ocorrência de fungos e aflatoxina B1 na dieta de bovinos leiteiros em São Paulo / Study on the occurrence of fungi and aflatoxina B1 in the diet of dairy cattle in São Paulo, Brazil

A qualidade da dieta ofertada às vacas em lactação é uma preocupação dos agentes de saúde devido à possibilidade da detecção de micotoxinas prejudiciais a saúde humana e animal. Os objetivos do trabalho foram avaliar o perfil da micobiota, determinar a atividade de água (Aa) e a ocorrência natural de aflatoxina B1 (AFB1) em dietas ofertadas a vacas em lactação de fazendas leiteiras no estado de São Paulo, Brasil. As amostragens das dietas foram realizadas diretamente dos cochos de lote de 15 vacas, em dois dias consecutivos com intervalos de 24h e a cada 15 dias, perfazendo um período de 45 dias de amostragens por fazenda. A purificação e determinação de AFB1 foram realizadas em colunas de imunoafinidade e Cromatografia Líquida de Alta Eficiência (CLAE). O estudo da micobiota presente nas amostras das dietas (288) revelou que as leveduras foram predominantes em todas as dietas (83,97 a 99,98%). Foram isolados 15 gêneros de fungos filamentosos, com os gêneros Aspergillus spp (20,09%), Fusarium spp (14,16%) e Penicillium spp (11,48%) os mais prevalentes. As contagens de Unidades Formadoras de Colônias por grama de alimento (UFC. g-1) variaram de 102 a 1011. A atividade de água das amostras variou entre 0,91 a 0,98. Foi detectada a presença de AFB1 em 31,44% das amostras com teores entre 1,68 a 194,51μg.kg-1. Medidas de boas práticas de produção, estocagem e utilização devem ser tomadas para diminuir a ocorrência de AFB1 nas dietas ofertadas às vacas em lactação...

The quality of the diet offered to lactating cows is a concern to health officials the possibility of detecting mycotoxins harmful to human and animal health. The objectives were to evaluate the profile of mycoflora, determine the water activity (Aw) and the natural occurrence of aflatoxin B1 (AFB1) in diets offered to lactating cows from dairy farms in the state of São Paulo, Brazil. Samples of the diets were taken directly from the troughs batch of 15 cows, on two consecutive days at intervals of 24 hours and every 15 days with a period of 45 sampling days per farm. Purification and determination of AFB1 were performed on immunoaffinity columns and High Performance Liquid Chromatography (HPLC). The study of mycobiota present in samples of diets (288) revealed that yeast cells were predominant in all diets (83.97 to 99.98%). 15 genera were isolated from filamentous fungi, with Aspergillus spp (20.09%), Fusarium spp. (14.16%) and Penicillium spp. (11.48%) the most prevalent. The counts of colony forming units per gram of food (UFC.g-1) ranged from 102 a1011. The water activity of the samples ranged from 0.91 to 0.98. We have detected the presence of AFB1 in 31.44% of samples with levels between 1.68 a 194.51μg.kg-1. Measures of good production, storage and use should be taken to reduce the occurrence of aflatoxin B1 in the diet offered to lactating cow...

Association between anterior open bite and impact on quality of life of preschool children

The aim of this study was to evaluate the association between different types of malocclusion and the impact on quality of life among preschoolers and their families. A cross-sectional study was carried out involving 451 children 3-5 years of age. A clinical exam was performed to evaluate the malocclusions according to criteria proposed by Foster and Hamilton. This examination was conducted by a calibrated dentist. Parents/caregivers answered the Early Childhood Oral Health Impact Scale (ECOHIS) for the assessment of Oral Health-Related Quality of Life (OHRQoL) and the questionnaire on socioeconomic and demographic characteristics. Data analysis involved descriptive statistics, chi-square, Mann-Whitney and hierarchically adjusted Poisson regression. The prevalence of malocclusion was 28.4%. The most frequent conditions were posterior crossbite (20.4%), anterior open bite (9.5%) and increased overjet (8.4%). A significant association was found between anterior open bite and OHRQoL (p< 0.001). The adjusted analysis confirmed the association between anterior open bite and a negative impact on quality of life (PR = 2.55; 95%CI: 1.87 to 3.47; p< 0.001). Anterior open bite was associated with a negative impact on the quality of life of preschoolers.

'Biological restoration': total crown anterior.

Restorative odontology is in constant evolution and is constantly seeking more aesthetic solutions to attend to demands from patients in search of the perfect smile. The case study presented herein refers to the aesthetic and functional recuperation of dental element 21, through the use of a dental fragment obtained through an extracted tooth, a technique known as 'Biological Restoration'. The results obtained, which were highly satisfactory, lead one to conclude that this technique can be considered as an alternative to all others and can be carried out successfully, quickly, and inexpensively.