Nivel de ansiedad y dolor dental en diferentes momentos en el tratamiento de conductos durante la pandemia por COVID-19 / Level of anxiety and dental pain at different times in root canal treatment during the COVID-19 pandemic / Nível de ansiedade e dor dentária em diferentes momentos do tratamento de canal durante a pandemia de COVID-19

RESUMEN Objetivo : Evaluar el nivel de ansiedad dental (AD) y dolor dental (DD) en diferentes momentos en el tratamiento de conductos durante la pandemia por COVID-19. Materiales y métodos : Estudio observacional, descriptivo y longitudinal. La muestra estuvo constituida por 68 participantes de la Clínica Estomatológica del Hospital Militar Central (HMC), que cumplieron con los criterios de inclusión y exclusión. El procedimiento consistió en el registro del nivel de AD y DD de los pacientes en distintos momentos del tratamiento de conductos mediante una escala visual analógica (EVA). Resultados : Antes del procedimiento, los participantes mostraron 3,66 ± 1,83 de AD y 4,54 ± 1,79 de DD; durante el procedimiento, obtuvieron valores de 3,13 ± 1,96 y 2,09 ± 1,39 de AD y 2,96 ± 1,57 y 1,82 ± 1,09 de DD; y al culminar el procedimiento, tuvieron 0,75 ± 0,74 de AD y 0,53 ± 0,72 de DD. Conclusiones : La AD y el DD estuvieron presentes antes de iniciar el tratamiento, pero, conforme se avanzaba con el procedimiento, sus niveles fueron disminuyendo.

ABSTRACT Objective : To evaluate the level of dental anxiety (DA) and dental pain (DD) at different times in root canal treatment during the COVID-19 pandemic. Materials and methods : Observational, descriptive, and longitudinal study. The sample consisted of 68 participants from the Stomatology Clinic of the Hospital Militar Central (HMC), who met the inclusion and exclusion criteria. The procedure consisted of recording the level of AD and DD of the patients at different times during root canal treatment using a visual analog scale (VAS). Results : Before the procedure, participants showed 3.66±1.83 of AD and 4.54±1.79 of DD; during the procedure, they obtained values of 3.13±1.96 and 2.09±1.39 of AD and 2.96±1.57 and 1.82±1.09 of DD; and at the end of the procedure, they had 0.75±0.74 of AD and 0.53±0.72 of DD. Conclusions : AD and DD were found to be present before starting treatment, but as the procedure progressed their levels decreased.

RESUMO Objetivo : avaliar o nível de ansiedade dentária (AD) e dor dentária (DD) em diferentes momentos do tratamento de canal durante a pandemia da COVID-19. Materiais e métodos : Estudo observacional, descritivo e longitudinal. A amostra foi composta por 68 participantes da Clínica de Estomatologia do Hospital Militar Central (HMC), que atenderam aos critérios de inclusão e exclusão. O procedimento consistiu em registar o nível de DA e DD dos pacientes em diferentes momentos durante o tratamento do canal radicular, utilizando uma escala visual analógica (EVA). Resultados : antes do procedimento, os participantes apresentavam 3,66±1,83 de DA e 4,54±1,79 de DD; durante o procedimento, obtiveram valores de 3,13±1,96 e 2,09±1,39 de DA e 2,96±1,57 e 1,82±1,09 de DD; e, no final do procedimento, apresentavam 0,75±0,74 de DA e 0,53±0,72 de DD. Conclusões : A DA e a DD estavam presentes antes do início do tratamento, mas à medida que o procedimento avançava, os seus níveis diminuíram.

Brazilian special olympics athletes: Oral health problems.

AIMS: The people with intellectual disabilities have been reported to be a vulnerable population in terms of oral health. This study was carried out to determine the oral health condition and treatment needs of Special Olympics athletes in Brazil. METHODS: This study is a retrospective review of oral health data collected from athletes participating in Healthy Athletes Program Special Olympics in Brazil, between the years 2015 and 2019. About 1241 athletes from the Brazil Special Olympics program were screened in the cities of São Paulo, Jundiai and Belo Horizonte (located in southeastern Brazil) and Recife (in northeastern Brazil). At each of these events, volunteer dental professionals performed an oral health screening for each athlete, All oral health assessments were done visually; and extra lighting were available if needed. The examinations were performed with the aid of a wooden spatula of the tongue depressor type and under natural light. The following parameters were recorded: mouth pain, untreated tooth decay, missing teeth, gingival signs, urgency and mouth hygiene habits. Data was analyzed using the STATA 14.0 program. Frequency tables were used for descriptive analyses. Categorical variables were compared between the different years of the event using the Chi-Square or Fisher's Exact test. Continuous variables were compared between different event years using the Kruskal-Wallis test followed by Dunn's post-hoc analyses. Simple logistic regression was used to assess the effect of age on dental assessment results. For all tests, a p-value was considered significant when less than or equal to .05. RESULTS: No statistically significant differences were observed in the frequencies of Mouth Pain and Missing Teeth over the years (p > .05). In relation to Untreated Tooth Decay, there is a higher frequency in the years 2016 and 2018 and a lower frequency in the year 2015 (p = .048). Regarding Gingival Signs of inflammation, there is a higher frequency in the years 2016 and 2018 and a lower frequency in the year 2017 (p < .001). In relation to cases of urgency (in need of treatment (Urgent treatment need, Non-Urgent or Maintenance)), there was a higher frequency (no urgency) in 2016 (p = .007). Finally, in relation to mouth hygiene habits, there is a higher frequency of participants with irregular habits in the years 2017 and 2019 (p < .001). CONCLUSION: The dental condition of Brazilian athletes Special Olympycs Brazil reported in this study from 2015 to 2019 showed us that athletes have a high prevalence of dental diseases and these needs could contribute to health damage. The athletes have many unmet dental treatment needs and these needs are similar in different regions of the country and in the years reported.

Manejo odontológico en paciente con síndrome de Cornelia de Lange / Dental treatment of a patient with Cornelia de Lange syndrome

El síndrome de Cornelia de Lange (SCdL) es un trastorno genético poco frecuente y se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Sus principales características clínicas son múltiples anomalías congénitas, dimorfismo facial, hirsutismo, hipertricosis, retraso psicomotor, discapacidad intelectual, restricción del crecimiento prenatal y postnatal, anomalías de manos y pies, así como malformaciones congénitas que afectan a distintos órganos. En pacientes con SCdL es necesario hacer hincapié en la higiene oral debido a la discapacidad intelectual que puede presentarse y asegurarse de que se realiza una adecuada valoración y saneamiento dental de forma periódica con el fin de prevenir enfermedades bucodentales. El objetivo de este reporte de caso es describir el manejo odontológico de un paciente de 10 años con SCdL y revisar las características clínicas y hallazgos radiológicos presentes en la cavidad oral (AU)

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder and is principally attributed to mutations in the NIPBL, SMC3 and SMC1A genes. The main clinical characteristics are multiple congenital anomalies, facial dimorphism, hirsutism, hypertrichosis, psychomotor retardation, intellectual disability, prenatal and postnatal growth restriction, hand and foot anomalies, as well as congenital malformations affecting different organs. In patients with CDLS, it is necessary to focus on oral hygiene due to the intellectual disability that may be present and to ensure that adequate dental valuation and hygiene is routinely performed in order to prevent oral diseases. The aim of this case report is to describe the dental management of a 10-year-old patient with CDLS and review the clinical characteristics and radiological findings that are present in the oral cavity (AU)

Dental anxiety and oral health-related quality of life before and after non-surgical periodontal treatment.

OBJECTIVES: To (1) investigate dental anxiety (DA) and oral health-related quality of life (OHRQOL) before and after non-surgical periodontal treatment (NSPT) and (2) determine correlations between these patient-reported measures. MATERIALS AND METHODS: Demographics, smoking habits, dental pain, Modified Corah's Dental Anxiety Scale (MDAS), and Oral Health Impact Profile (OHIP-14) were assessed in eighty-two participants. RESULTS: Mean age was 48.3 years ± 11.5. At baseline, 8.5% reported being active smokers. Of non-smokers, 11% reported being an ex-smoker. After NSPT, 11.0% reported smoking. Patients' maximal pain in the last month decreased after therapy. Before treatment, participants reported higher DA. Extreme DA was observed in 8.5% of participants before therapy. Afterwards, 2.4% of participants reported extreme DA. Fear of having a foreign object in the mouth decreased after NSPT. All OHIP-14 scores, except functional limitation, improved post-treatment. Higher DA was associated with worse OHRQoL before treatment. After treatment, total MDAS score was associated with OHIP-14 global score, physical pain, psychological disability, and social disability. Worse MDAS sub-scores were associated with a higher OHIP-14 global score. Individuals with "normal/slight anxiety" had a significant improvement in OHRQoL, whereas people in the "moderate and extreme anxiety" group did not report a significant improvement. Patients diagnosed with generalized periodontitis (GP) stage III grade B and GP stage IV grade B reported less anxiety after NSPT. CONCLUSIONS: Associations of MDAS subcategories with OHIP-14 domain scores were found before and after therapy. DA decreases and OHRQoL enhances after NSPT in patients with "normal/slight" anxiety to dental treatment. Dental practitioners should plan strategies to cope with anxiety to dental treatment and prevent decreases in OHRQoL. CLINICAL RELEVANCE: Within the limitations of this study, DA and OHRQoL were positively correlated in patients with periodontitis, before and after NSPT, using the MDAS and OHIP-14 questionnaires. The results of our study suggest that treatment is effective in terms of alleviating DA and improving oral health, along with quality of life, in patients that report "normal/slight" anxiety to dental treatment. Nonetheless, results must be interpreted with caution since patients are generally anxious before any type of dental treatment. DA may not just be confined to NSPT per se. According to our results, evaluation of both outcomes should be an integral part of routine periodontal clinical evaluation and periodontal reevaluation of initial therapy. It is important that clinicians learn to identify patients that suffer from anxiety and take time to explain the treatment procedures to the patient, to strive for patient's emotional well-being before, during, and after dental care services. The use of specific questionnaires for both DA and OHRQoL may be more appropriate to demonstrate the psychological and quality of life differences due to periodontal disease and NSPT.

Tratamento Restaurador Atraumático (ART): uma alternativa de mínima intervenção para lesões de cárie / Atraumatic Restorative Treatment (ART): a minimal intervention alternative for caries injuries

Este trabalho teve como objetivo demonstrar a importância do Tratamento Restaurador Atraumático (ART) na Odontologia, assim como compreender sua contextualização histórica, descrever suas vantagens e desvantagens, conhecer suas indicações e limitações e seu protocolo. Foram selecionados artigos científicos publicados em português e inglês, disponíveis nas bases de dados MEDLINE, SciELO e Google Acadêmico, tendo sido incluídos artigos dos últimos dez anos, utilizando os descritores: "Tratamento Dentário Restaurador sem Trauma", "Cárie dentária", "Cimento de Ionômero de Vidro" e "Avaliação da Promoção de Saúde". O tratamento restaurador Atraumático (ART), consiste na empregabilidade de uma técnica que tem como finalidade combater a doença cárie e promover saúde. Resume-se em uma abordagem de gerenciamento para lesões de cárie com mínimos preparos, sendo utilizados apenas instrumentos manuais para remoção da dentina infectada, a exemplo a colher de dentina, sendo finalizada posteriormente com cimento de ionômero de vidro para selar a cavidade. As principais vantagens estão relacionadas a sua aplicação, sendo pregada como uma técnica de fácil execução, procedimento rápido, apresenta baixo custo, devido à necessidade mínima de materiais que são utilizados, dispensa a utilização da energia elétrica, pode ser feita em diversos ambientes. Diante da literatura compreende-se que ART é uma técnica de grande importância para o gerenciamento e declínio da doença cárie em diversos âmbitos odontológico, capaz de proporcionar grandes vantagens positiva para abordagem odontológica, tornando o atendimento menos estressante, mais colaborativo e rápido.

This study aimed to demonstrate the importance of Atraumatic Restorative Treatment (ART) in Dentistry, as well as to understand its historical context, describe its advantages and disadvantages, know its indications and limitations and its protocol. Scientific articles published in Portuguese and English, available in the MEDLINE, SciELO and Google Scholar databases were selected, including articles from the last ten years, using the descriptors: "Restorative Dental Treatment without Trauma", "Dental Caries", "Glass Ionomer Cement" and "Evaluation of Health Promotion". The Atraumatic Restorative Treatment (ART) consists of the employability of a technique that aims to combat caries and promote health. It is summarized in a management approach for caries lesions with minimal preparations, using only manual instruments to remove the infected dentin, such as the dentin spoon, being finished later with glass ionomer cement to seal the cavity. The main advantages are related to its application, being preached as a technique of easy execution, quick procedure, low cost, due to the minimum need for materials that are used, it does not require the use of electricity, it can be performed in different environments. In view of the literature, it is understood that ART is a technique of great importance for the management and decline of caries in various dental areas, capable of providing great positive advantages for the dental approach, making care less stressful, more collaborative and faster.

Nociception associated with pain/distress in young children sedated for dental treatment: a clinical study with objective and subjective measures.

PURPOSE: To evaluate the association between children's pain/distress levels and patient characteristics (age, sex, history of dental pain), sedation type (level of sedation, sedative regimen), nociception and pain intensity reported by the parents in sedated children undergoing minimally invasive dental treatment. METHODS: This clinical study evaluated secondary outcomes of an RCT that evaluated the efficacy of dexmedetomidine sedation with or without ketamine. Only children who had nociception levels recorded using the Analgesia Nociception Index (ANI) were included (0-100; 0 = highest nociception). FLACC scale (Face, Legs, Activity, Cry and Consolability) was used to assess children's pain/distress (0-10; 0 = no pain/distress). Parental proxy report of the child's pain intensity during the treatment was performed using the Visual Analogue Scale (VAS; 0-100; 0 = no pain). The association between ANI, children's age and sex, dental pain history, sedation level, sedative regimen, and VAS with the FLACC was verified using the generalised estimation equation analysis (alpha 0.05). RESULTS: Participants were 31 children (51.6% boys) and their parents (90.3% mothers). Median FLACC was 3.3 (25th-75th percentiles 1.7-8.2), ANI 80.9 (74.7-85.8), and VAS 10 (1-23). FLACC associated with ANI (OR 0.96; 95% CI 0.93-0.99; p = 0.02), moderate sedation (0.13; 0.03-0.50; p = 0.003), and VAS (1.05; 1.01-1.10; p = 0.01). CONCLUSION: Pain/distress was generally low and more prominent with minimal (versus moderate) sedation and higher nociception.

Manejo de pacientes oncológicos na prática odontológica: uma revisão de literatura / Management of cancer patients in dental practice: a literature review / Manejo de pacientes con cáncer en la práctica odontológica: una revisión de la literatura

O manejo odontológico adaptado ao paciente que é diagnosticado com câncer é fundamental para a melhoria e manutenção da qualidade de vida dos mesmos. Esses indivíduos devem ser submetidos a uma avaliação odontológica prévia ao tratamento anticancerígeno, a fim de estabelecer as etapas necessárias às intervenções e o que pode ser realizado antes, durante e pós-tratamento, sendo essas fases executadas na clínica diária ou até mesmo no ambiente hospitalar, exercendo um trabalho multidisciplinar. A presente revisão de literatura tem como objetivo direcionar a atenção dos cirurgiões dentistas para o planejamento e atendimento personalizado dos pacientes oncológicos, de acordo com suas necessidades e particularidades.

Dental management adapted to patients diagnosed with cancer is essential for improving and maintaining their quality of life. These individuals must undergo a dental evaluation prior to anticancer treatment, in order to establish the necessary steps for interventions and what can be done before, during and after treatment, these phases being performed in the daily clinic or even in the hospital environment, exercising multidisciplinary work. This literature review aims to direct the attention of dentists to the planning and personalized care of cancer patients, according to their needs and particularities.

El manejo odontológico adaptado a los pacientes diagnosticados de cáncer es esencial para mejorar y mantener su calidad de vida. Estas personas deben someterse a una evaluación odontológica previa al tratamiento anticanceroso, con el fin de establecer los pasos necesarios para las intervenciones y lo que se puede hacer antes, durante y después del tratamiento, siendo estas fases realizadas en la clínica diaria o incluso en el ámbito hospitalario, ejerciendo un trabajo multidisciplinar. Esta revisión bibliográfica pretende dirigir la atención de los odontólogos a la planificación y atención personalizada de los pacientes con cáncer, de acuerdo con sus necesidades y particularidades.

Impact of oral health literacy and psychoactive substances on tooth loss in adolescents.

The aim of the present study was to investigate associations between tooth loss, and oral health literacy, the use of multiple psychoactive substances, and the reason for the last dental appointment in adolescents. A cross-sectional study was conducted with a representative sample of 746 adolescents aged 15-19 years in Campina Grande, Brazil. Parents/guardians answered a sociodemographic questionnaire. The adolescents answered the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), the alcohol, smoking, and substance involvement screening test, and an oral health questionnaire from the National Oral Health Survey. The adolescents were then examined by two examiners who had undergone training and calibration exercises for the diagnosis of tooth loss due to caries (K > 0.80). Associations between variables were investigated using robust logistic regression analysis for complex samples (α = 5%). The prevalence of tooth loss was 17.4%. Oral health literacy (OR = 0.93; 95% CI: 0.89-0.97) was inversely associated with tooth loss, while multiple psychoactive substance use (OR = 2.01; 95% CI: 1.09-3.69) and last dental visit for treatment/symptoms (OR = 3.05; 95% CI: 1.73-5.36) were directly associated with tooth loss. Oral health literacy, multiple psychoactive substance use, and reason for last dental appointment exerted an influence on tooth loss among adolescents.

Nivel de conocimiento sobre atención estomatológica de pacientes gestantes en estudiantes de Estomatología

Introducción: Los estomatólogos deben tener conocimientos específicos para la atención de pacientes con condiciones sistémicas. Durante la gestación ocurren cambios a nivel sistémico y estomatognático en la paciente gestante, por lo que, si no se brinda un manejo adecuado, podría afectarse la salud de la madre y/o del bebé. Es importante conocer el nivel de conocimiento sobre atención estomatológica de pacientes gestantes en estudiantes de Estomatología para, de ser necesario, proponer reformas en los planes de estudio de la carrera. Objetivo: Evaluar el nivel de conocimiento sobre la atención estomatológica de pacientes gestantes en estudiantes de Estomatología de dos universidades latinoamericanas. Material y métodos: Estudio analítico, descriptivo y transversal, cuya muestra fue de 103 estudiantes del 7mo al 9no semestre de la carrera de Estomatología de la Universidad Científica del Sur (UCSUR) de Perú y la Universidad Popular Autónoma del Estado de Puebla (UPAEP) de México. El instrumento de evaluación fue un cuestionario de 30 preguntas cerradas sobre mitos y creencias, adaptación de la fisiología femenina, patología bucal, empleo de medicamentos y tratamiento odontológico durante la gestación. Los posibles resultados fueron catalogados en deficiente, regular y bueno. Resultados: El 44,66 % de los estudiantes presentó un nivel de conocimiento regular, mientras que 28,16 % obtuvo un resultado bueno y 27,18 %, deficiente. No hubo una diferencia significativa entre ambas instituciones (p=0,458). Conclusiones: El nivel de conocimiento sobre atención estomatológica de pacientes gestantes fue predominantemente regular en ambas universidades.

Introduction: Dentists must have specific knowledge for the care of patients with systemic conditions. During gestation, changes occur at the systemic and stomatognathic levels in the pregnant patient, therefore, if proper management is not provided, the health of the mother and / or the product could be affected. It is important to know the level of knowledge about dental care to pregnant patients in dental students to, if necessary, propose reforms in the study plans. Objective: To evaluate the level of knowledge about dental care to pregnant patients in dental students from two Latin American universities. Material and Methods: Analytical, descriptive and cross-sectional study, whose sample was made up of 103 students from the 7th to the 9th semester of the dental studies of the Scientific University of the South (UCSUR) in Peru and the Popular Autonomous University of the State of Puebla (UPAEP) in Mexico. The evaluation instrument was a questionnaire of 30 closed questions about myths and beliefs, adaptation of female physiology, oral pathology, use of medications and dental treatment during pregnancy. The possible results were classified as poor, regular and good. Results: The results show that 44.66 % of the students presented a regular level of knowledge, while 28.16 % and 27.18 % obtained good and poor results, respectively. There was no significant difference between both institutions (p =0,458). Conclusions: The level of knowledge about dental care to pregnant patients was predominantly regular in both universities.

Interventions to Improve the Oral Hygiene of Individuals with Alzheimer's Disease: A Systematic Review.

This systematic review evaluates published evidence on oral hygiene interventions conducted in Alzheimer's disease (AD) patients. PubMed, Embase, Cochrane Library, CINAHL, Dentistry & Oral Sciences Source, and Web of Science were searched for articles published up to 19 April 2021. The main outcomes of interest were the Plaque index score (PI), oral health knowledge of participants or their caregivers, and behaviors and attitudes towards oral hygiene. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Institutes of Health. The study was conducted under PROSPERO registration code CRD42021247733. Two studies met the inclusion criteria. One was a pre-post study conducted in Brazil, and the other was a prospective cohort study carried out in China. The sample sizes of these studies were 29 and 168, respectively. Both studies were carried out in institutionalized patients and presented a significant loss to follow-up. The PI and gingival index scores both improved after the application of the respective interventions, yet the differing methodologies used precluded further comparisons. The studies were deemed to be of good and regular quality, respectively. Despite the need for more comprehensive interventions to ensure a better oral health status and a higher quality of life for AD patients, an alarming lack of studies have been conducted in this population.

Association of Age and Temperamental Traits with Children's Behaviour during Dental Treatment.

During paediatric dental treatment, cooperation by children is essential, and temperament can determine their behaviour style. This study aimed to associate temperamental traits and age with behaviour during paediatric dental treatment. This was an observational and cross-sectional study of patients aged 3-10 years. To determine the temperamental traits, an Emotionality Activity and Sociability Temperament Survey (EAS) was performed with the children's parents. The type of behaviour was determined with Frankl's criteria. The total scores for temperamental traits, means, and standard deviations were obtained. The chi-squared test, one-way ANOVA and Student's t-test were applied. A total of 140 patients, who were 5 ± 2.1 years old, participated in the study. Age was determinant for negative behaviour, with a greater frequency in children ≤5 years old (p < 0.05), and a significant negative correlation between age and behaviour (rho = -0.245, p = 0.001). Patients with higher emotionality and activity presented negative and definitely negative behaviours more frequently (p < 0.01). The values for sociability and shyness were similar for positive or negative behaviours. In conclusion, the temperamental traits of emotionality and activity were more frequent in children with disruptive behaviours; therefore, conducting a survey on temperamental traits can be useful for planning behavioural approaches in paediatric dentistry.

Future Perspectives in Pediatric Dentistry: Where are We Now and where are We Heading?

Oral diseases in children are still a major public health problem that can negatively impact parents and their children's quality of life. Even though oral diseases are largely preventable, initial signs of them can be detected in the 1st year of life, and its severity might increase with time if no preventive measures are taken. Based on this, we aim to discuss "where is pediatric dentistry now?" and "where is pediatric dentistry heading?" Early life oral health conditions are a good predictor of oral health status in adolescence, adulthood, and elderly people. A healthy childhood provides the foundation and opportunities for life; therefore, pediatric dentists have the unique opportunity to identify the presence of unhealthy habits in the 1st year of life and educate the parents and family members to change them for life. If all educational and preventive strategies fail or are not put into practice, the child might present oral health problems, such as dental caries, erosive tooth wear (ETW), hypomineralization, and malocclusion, that could have a great impact on other stages of life. At the moment, in pediatric dentistry, there are many alternatives to prevent and treat these oral health problems. However, if prevention fails, minimally invasive approaches, and new dental materials and technologies have been developed recently and will be important tools available in the near future in order to enhance children's oral health. How to cite this article: Rodrigues JA, Olegario I, Assunção CM, et al. Future Perspectives in Pediatric Dentistry: Where are We Now and where are We Heading? Int J Clin Pediatr Dent 2022;15(6):793-797.

Does outpatient dental treatment have impact on the quality of life of children with early childhood caries?

AIM: To assess the impact of outpatient dental treatment on oral health-related quality of life (OHRQoL) of children and their families. MATERIALS AND METHODS: This prospective observational study was conducted with children with untreated dental caries, recruited from a public university/the pediatric dentistry clinic of a public university in the northeastern Brazil. Sociodemographic data were collected, a clinical examination was carried out before and after dental treatment, and the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire was applied to those responsible for the children, before and after dental treatment. Descriptive and bivariate statistics were used, and the Wilcoxon and Student's t tests were applied (p < 0.05). RESULTS: The study included 64 children, of both sexes, aged between 3 and 5 years old. The majority had a dmft index higher than or equal to 6 (60.9%), with a mean value of 7.11 (± 4.11). Sociodemographic conditions such as sex, age, and socioeconomic status had no impact on their OHRQoL (p > 0.05). The mean total ECOHIS questionnaire scores and those of its domains decreased after completion of the treatments (p < 0.05), except for scores in the self-image and distress domains of the parents (p > 0.05). This study reinforces the relevance of adopting oral health policies aimed at the prevention and treatment of ECC. CONCLUSION: Outpatient dental treatment had a positive impact on the OHRQoL of children and their families. CLINICAL RELEVANCE: The possibility of evaluating the services provided by the pediatric dentistry clinic.

Avaliação longitudinal do índice de massa corporal antes e após restauração de lesões cavitadas de cárie em pré-escolares / Longitudinal assessment of the body mass index before and after restoration of cavitated cavity lesions in preschool children

O Índice de Massa Corporal (IMC) indicando desnutrição ou sobrepeso/obesidade pode ter fatores de risco comuns com a cárie dentária. A cárie dentária pode representar um dos múltiplos fatores que podem culminar em desnutrição ou sobrepeso/obesidade. Crianças obesas tendem a consumir alimentos ricos em carboidratos fermentáveis com maior frequência. Crianças com cárie dentária severa ou dor de dente podem evitar se alimentar e tendem a engolir o alimento sem uma trituração adequada, levando a alterações de peso. Nesse sentido, é possível que o tratamento restaurador de lesões de cárie, melhorando a função mastigatória, promova mudança no IMC. O objetivo deste estudo foi avaliar o efeito do tratamento restaurador de lesões cariosas cavitadas em dentes posteriores na mudança de IMC de pré-escolares. Um estudo longitudinal com crianças de 3 a 4 anos, acompanhadas por um período entre três e seis meses, selecionadas em pré-escolas e creches públicas e privadas, foi conduzido na cidade de Diamantina, MG, Brasil. A população de estudo foi composta por 132 crianças distribuídas em dois grupos. Um grupo foi composto por crianças com cárie dentária cavitada não tratada, sem envolvimento pulpar, em dentes posteriores (Grupo Intervenção - GI) e o outro grupo foi composto por crianças sem cárie dentária (Grupo Controle - GC). Para composição do GC as crianças foram pareadas por idade, sexo e escola com as crianças do GI. Todos os instrumentos de avaliação foram aplicados em dois momentos para ambos os grupos. Para o grupo que recebeu a intervenção, as avaliações foram realizadas antes do tratamento (M1) e após um intervalo mínimo de 3 meses e máximo de 6 meses posteriores à conclusão do tratamento (M2). As avaliações das crianças do GC foram realizadas no mesmo dia que das crianças do GI. Antes do exame clínico e das consultas para realização do tratamento odontológico restaurador, pais/responsáveis preencheram um formulário sociodemográfico. As crianças passaram por exame clínico bucal e avaliação antropométrica para cálculo do Índice de Massa Corporal (IMC). A cárie dentária foi avaliada através do International Caries Detection and Assessment System (ICDAS II). Aquelas crianças que, no exame clínico inicial, apresentaram lesões óbvias de cárie (códigos 3, 4, 5 e 6 do ICDAS) em dentes posteriores foram incluídas no GI. A presença de má-oclusão foi definida de acordo com os critérios propostos por Foster e Hamilton (1969). O tratamento restaurador foi realizado usando os princípios de remoção seletiva de cárie. Cimento de ionômero de vidro modificado por resina foi o material de escolha para as restaurações, seguindo as recomendações do fabricante. Foi realizada análise descritiva dos dados e regressão logística uni e multivariada. O desfecho foi dicotomizado em manutenção do IMC, entre o M1 e o M2, e mudança do IMC para o IMC normal, ou seja, crianças que tinham o IMC baixo ou alto na primeira avaliação e normal na segunda avaliação. A análise multivariada mostrou que a chance de mudança para o IMC normal foi maior em crianças de 4 anos (RC= 17,6; IC95% 2,2-24,8) e que pertenciam ao grupo que recebeu tratamento restaurador (RC=5,1; IC95% 1,6-16,2). Um maior número de dentes restaurados esteve associado com a mudança para o IMC normal na análise não ajustada, mas perdeu a associação após o ajuste. Nenhuma variável socioeconômica foi associada à mudança para o IMC normal. Concluiu-se que o tratamento restaurador dos dentes posteriores exerceu um efeito positivo na mudança de IMC de crianças pré-escolares.

Body Mass Index (BMI) non ideal may have risk factors in common with dental caries, but it can also be considered an outcome of this disorder. Obese children tend to consume foods with fermentable carbohydrates more often. On the other hand, children with dental caries may avoid eating or tend to swallow food without adequate mastication, leading to weight loss and weight gain, respectively. Thus, it is possible that the restorative treatment of dental caries, improving masticatory function, promotes some change in BMI. The aim of this study was to assess whether restorative treatment influences changing the BMI of preschool children with cavitated dental caries in posterior teeth. A longitudinal study with children aged 3 to 4 years, accompanied by a period of between three and six months, was carried out in the city of Diamantina, Minas Gerais. The sample was composed by 132 children distributed into two groups. One group was composed by children with untreated cavitated dental caries, without pulp involvement, in posterior teeth (intervention group) and the other group was composed by children without dental caries (control group). For the composition of the control group, children from the group that received the intervention were paired with children of the same age, sex and school who did not have cavitated dental caries. All assessment instruments were applied in two moments for both groups. For the group that received the intervention, evaluations were performed before treatment (M1) and after a minimum interval of 3 months and a maximum of 6 months after its completion (M2). For the control group, the assessments were performed on the same day as the pair in the intervention group. Before the clinical examination and restorative dental treatment, parents/guardians, the parents/caregivers filled out a form addressing socioeconomic characteristics. The children underwent clinical oral examination and anthropometric assessment to calculate the Body Mass Index (BMI). Dental caries was assessed using the International Caries Detection and Assessment System (ICDAS II). Those children with obvious caries lesions (ICDAS codes 3, 4, 5 and 6) in their posterior teeth were included in the intervention group. The presence of malocclusion was defined according to the criteria proposed by Foster and Hamilton (1969). The calculation of BMI was performed using the formula that divides weight (kg) by height (m) squared (BMI = weight/height2). Restorative treatment was carried out using the principles of selective caries removal. Resin-modified glass ionomer cement (it was the material of choice, following the manufacturer's recommendations. Descriptive analysis and uni- and multivariate logistic regression were performed. The outcome was dichotomized into maintenance of BMI, between baseline and follow-up, and change from BMI to normal BMI, that is, children who had low or high BMI in the first assessment and normal in the second assessment. Children aged 4 years (OR= 17.6; 95%CI= 2.2-24.8; p=0.006) and who belonged to the group that received restorative treatment (OR=5.0; 95%CI 1.6-16.2; p=0.004) had a greater chance of change to normal BMI. The number of restored teeth was associated with a change to normal BMI in the unadjusted analysis but lost the association after adjustment. Restorative treatment had a positive effect on change of BMI of preschool children.

Urgencias médicas durante la práctica estomatológica / Medical emergencies during dental practice

Introducción: Las urgencias médicas pueden ocurrir durante la práctica estomatológica. Objetivo: Abordar elementos actuales sobre la epidemiología, prevención, cuadro clínico y tratamiento de las urgencias médicas más frecuentes durante la atención estomatológica. Material y Métodos: Se realizó una revisión bibliográfica en septiembre de 2021. Se evaluaron revistas de impacto de Web of Science (19 revistas). Se consultaron bases de datos de MEDLINE, Google Académico, PubMed y SciELO con los descriptores: "medical emergency", "odontology treatment", "epidemiology". Se incluyeron artículos en idioma español e inglés, mayoritariamente de los últimos 5 años. Los que mejor cumplieron los criterios de revisión fueron 31 artículos y fueron incluidos como referencias en este artículo. Desarrollo: Las urgencias más frecuentes son las lipotimias y los síncopes vaso vágales. El diagnóstico basado en los antecedentes patológicos y hallazgos clínicos permite tomar conductas adecuadas. La terapéutica actual aboga por la protocolización de la atención y el uso justificado, sustentado por el conocimiento, de un botiquín de medicamentos de urgencia. Conclusiones: Las urgencias médicas pueden ocurrir durante la práctica estomatológica y poner en riesgo la vida de los pacientes. Su incidencia es variable, el riesgo para la vida no es frecuente y la sobrevida es elevada. Confeccionar una adecuada historia clínica y preparar al personal evitará complicaciones posteriores(AU)

Introduction: Medical emergencies can occur during dental practice. Objective: To address current issues in the epidemiology, prevention, clinical picture and treatment of the most frequent medical emergencies during dental treatment. Material and Methods: A literature review was conducted in September 2021. Web of science impact journals (19 journals) were evaluated. Medline, PubMed, Google Scholar, and SciELO databases were consulted using the following descriptors: "medical emergency", "odontology treatment", and "epidemiology". Articles in Spanish and English were included, preferably those published within the last 5 years. A total of 31 articles were obtained and included as references in this article. Development: Lipothymia and vasovagal syncope are the most frequent emergencies. The diagnosis based on pathological antecedents and clinical findings allows us to take appropriate behaviors. The current therapy advocates for the protocolization of care and justified use, supported by knowledge about a first-aid kit. Conclusions: Medical emergencies can occur during dental practice, putting patients´ lives at risk. The incidence is changeable and the survival rate is high. The development of an adequate clinical history and training of the staff will prevent further complications(AU)

Accidental ingestion of a three-way (air-water-spray) syringe tip during dental procedure recovered by gastroscopy: casereport / Ingestión accidental de la punta de una jeringa de tres vías (aire-agua-rociador) durante procedimiento recuperado por gastroscopia: reporte de caso

Abstract The ingestion or aspiration of dental material or instruments is one of the most feared complications in clinical dental practice, it can occur in both children and adults. The mouth is a moist, dark, small area; where the involuntary movements of the patient during the procedures and the small dimensions of the materials and instruments turn dental care into a challenge. A swallowed or aspirated foreign body during dental treatment can result in serious complications and even death, these depend largely on the shape, size and anatomical pathway through which it passes. This article describes an uncommon complication of which there is only one report in the literature worldwide, the ingestion of the tip of a triple syringe during a routine dental procedure that was recovered by esophagogastroduodenoscopy. It also highlights the importance of knowing the protocols for handling aspirated or swallowed foreign bodies where a fast and adequate approach during the first minutes can make the difference between life and death.

Tratamento odontológico em portador da Doença de Huntington: relato de caso / Dental treatment in Huntington's Disease: a case report / Tratamiento dental en la Enfermedad de Huntington: reporte de un caso

Caracterizada por um distúrbio neurodegenerativo progressivo autossômico dominante, a doença de Huntington interfere na capacidade de movimento, interação cognitiva além de causar transtornos comportamentais nos indivíduos diagnosticados com a enfermidade. Dependendo do estadiamento e do grau de comprometimento neuromotor a adesão voluntária à propostas terapêuticas como o tratamento odontológico fica comprometida. Este estudo relata o caso raro de um portador da doença de Huntington do sexo masculino com 23 anos, diagnosticado com a doença desde 2017. A abordagem em âmbito hospitalar sob sedação foi adotada considerando as limitações físicas e segurança para o paciente bem como a complexidade e extensão dos procedimentos odontológicos necessários(AU)

Characterized by a progressive autosomal dominant neurodegenerative disorder, Huntington's disease interferes in the ability to move, cognitive interaction and causes behavioral disorders in individuals diagnosed with the disease. Depending on the staging and the degree of neuromotor damage, willingly adhesion to therapeutic procedures such as a dental treatment could be compromised. This study reports the rare case of a 23-year-old male with Huntington's disease diagnosed since 2017. A hospital approach under sedation was required considering the physical limitations and safety for the patient as well as the complexity and extension of the necessary dental procedures(AU)

Caracterizada por un trastorno neurodegenerativo progresivo autosómico dominante, la enfermedad de Huntington interfiere con la capacidad para moverse, la interacción cognitiva y causa trastornos del comportamiento en individuos diagnosticados con la enfermedad. Según la estadificación y el grado de afectación neuromotora, se compromete la adherencia voluntaria a propuestas terapéuticas como el tratamiento odontológico. Este estudio reporta el caso raro de un varón de 23 años con enfermedad de Huntington diagnosticado con la enfermedad desde 2017. Se adoptó el abordaje hospitalario bajo sedación considerando las limitaciones físicas y la seguridad del paciente, así como la complejidad y extensión de los procedimientos dentales necessários(AU)

Necesidad social de atención estomatológica al adulto mayor con dismovilidad / Social need of stomatological attention to the senior citizen with dysmobility

RESUMEN Como consecuencia del alargamiento de la vida, aumenta también el número de adultos con discapacidades y enfermedades crónicas degenerativas, que pueden causarlas. El objetivo de esta revisión es conducir un análisis de las evidencias disponibles sobre la importancia de la atención estomatológica al paciente geriátrico con dismovilidad. Se tuvo en cuenta las características del adulto mayor dependiente, la atención domiciliaria como actividad asistencial y la atención odontológica domiciliaria que arrojó como conclusiones que para garantizar una buena salud bucodental de los adultos mayores con dismovilidad, se requiere de una correcta valoración geriátrica y un trabajo en equipo donde los estomatólogos juegan un papel importante ya que la atención estomatológica demanda de una asistencia odontológica domiciliaria provista de los elementos necesarios para su funcionamiento.

ABSTRACT As a result of the lengthening of life, the number of adults with disabilities and chronic degenerative diseases, which can cause them, also increases. The objective of this review is to conduct an analysis of available evidence on the importance of stomatological care to the geriatric patient with dysmobility. The characteristics of the dependent elderly were taken into account, the home care as a health care activity and the home dental care that was given as conclusions to ensure good oral health in the elderly with dismobility, proper geriatric assessment and teamwork are required where stomatologists play an important role as stomatological care requires home dental care provided with the necessary elements for its operation.

Tratamento expectante, tratamento expectante modificado e técnica ART: indicações, contraindicações, técnicas e relevância clínica / Expectant treatment, modified expectant treatment, and ART technique: indications, contraindications, techniques, and clinical relevance

Introdução: A doença cárie possui uma etiologia multifatorial que pode atingir toda a estrutura dentária. Em cavidades profundas, o tratamento expectante pode ser realizado com a finalidade de evitar danos à polpa. Já em lesões iniciais, a técnica ART é uma alternativa aceitável para o caso. Objetivo: Discutir sobre as indicações, contraindicações, técnicas e relevâncias clínicas do tratamento expectante (convencional e modificado) e da técnica restauradora atraumática (ART) no tratamento das lesões cariosas. Métodos: Foi realizada uma revisão da literatura de artigos científicos publicados nas bases de dados PubMED/Medline e Scielo, entre 2009 e 2020, e de livros considerados relevantes para este estudo. Resultados: No tratamento expectante, a remoção da dentina cariada é realizada em duas etapas: remoção da lesão cariosa de forma superficial, na primeira consulta, e remoção final após diferentes intervalos de tempo. No entanto, alguns autores defendem que não é necessária a realização da segunda etapa, basta apenas rebaixar o cimento de ionômero de vidro restaurador e, em seguida, realizar a restauração definitiva, técnica nomeada como tratamento expectante modificado. Com relação à técnica ART, o manejo da lesão é feito com a mínima intervenção possível, utilizando apenas instrumentos manuais. É confiável e bem aceita, principalmente na clínica de Odontopediatria. Ambas culminam em resultados terapêuticos favoráveis. Conclusão: Inicialmente, o dentista deve sempre realizar um diagnóstico minucioso das lesões de cárie, visando a máxima prevenção da estrutura dental. Devemos optar pelo tratamento restaurador convencional somente quando outros métodos não forem mais suficientes para interromper a progressão da lesão.

Introduction: Caries disease has a multifactorial etiology and can affect the entire tooth structure. In deep cavities, expectant treatment can avoid damage to the pulp. In early lesions, the ART technique is an acceptable alternative. Objective: To discuss indications, contraindications, techniques, and clinical relevance of the expectant treatment (conven-tional and modified) and the ART technique in the treatment of carious lesions. Methods: A literature review of scientific articles (published in PubMED/Medline and Scielo data-bases, between 2009 and 2020) and books considered relevant to this study. Results: In the expectant treatment, carious dentin is removed in two stages: a superficial removal of the carious lesion at the first visit, and a final removal after different time intervals. However, some authors argue that it is not necessary to perform the second step. Just lower the glass-ionomer cements and then perform the definitive restoration, a technique known as modified expectant treatment, is necessary. Regarding the ART technique, the management of the lesion is conducted with the least possible intervention, using only manual instruments. It is reliable and well accepted especially in the Pediatric Dentistry clinic. Both culminate in favorable therapeutic results. Conclusion: Initially, the dentist must always carry out a thorough diagnosis of caries lesions aiming at the maximum prevention of the dental structure. You should opt for conventional restorative treatment only when other methods are no longer sufficient to stop the progression of the lesion.

Study protocol for a diagnostic randomized clinical trial to evaluate the effect of the use of two clinical criteria in the assessment of caries lesions around restorations in adults: the Caries Cognition and Identification in Adults (CaCIA) trial.

BACKGROUND: The assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists' diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults. METHODS: The design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria-FDI group; and patients who will receive diagnosis and treatment decision according to the "Caries Associated with Restorations or Sealants" criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%. DISCUSSION: This is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth. Trial registration NCT03108586 (registered 11 April 2017).