Oral status, sense of coherence, religious-spiritual coping, socio-economic characteristics, and quality of life in young patients

BACKGROUND

Several factors can influence the oral health.

AIM

To explore the clinical factors, individual characteristics, and environmental factors (religious-spiritual coping-RSC, sense of coherence [SOC], and socio-economic status) related to oral status and impact on oral health-related quality of life (OHRQoL) of children/adolescents (C/A).

DESIGN

This study evaluated C/A up to 15 years old and their caregivers. Number of decayed (NDT) and missing teeth (NMT); history of dental trauma; caregiver's RSC and SOC, socio-economic factors, and OHRQoL were evaluated. Theoretical model exploring the direct and indirect effects was tested using a structural equation analysis.

RESULTS

For younger group (0-6 years), having more NDT or more NMT had a greater impact on the OHRQoL (β = 0.382, β = 0.203, respectively). In the oldest group (7-15 years), a higher SOC had an inverse relationship with the impact on the family OHRQoL (β=-0.201). The higher the age of the C/A, the lower the NDT (β=-0.235), and the higher the family income the lower, the need for social benefit (β = 0.275). Indirect relationships were observed between schooling with social benefit and OHRQoL in younger group. The family income indirectly influenced the OHRQoL in oldest group.

CONCLUSIONS

Quality of life is affected directly and indirectly by environmental characteristics, oral status, and the age of patients.

Prosthetic rehabilitation of a child with X-linked hypohidrotic ectodermal dysplasia: a case report and 12-month follow-up

The hereditary condition known as ectodermal dysplasia (ED) is characterized by the absence of or a defect in 2 or more ectodermally derived structures such as skin, nails, hair, sweat glands, or teeth. Patients with this disorder usually present with reduced salivary gland function and absence of some or all teeth, which compromises orofacial function and development. In addition, children with ED usually experience difficulty in social interactions because of their appearance. This article reviews previously published case reports pertaining to ED and describes oral rehabilitation with removable partial dentures (RPDs) in a 5-year-old girl diagnosed with X-linked hypohidrotic ED, which presented as hypodontia. An orthodontic expander screw was inserted in the maxillary prosthesis to correct the patient's crossbite, and periodic recall examinations were scheduled to monitor the effects of the patient's growth on occlusion and fit of the prosthesis. The child was monitored for 12 months, during which she exhibited significant improvement in physiologic function, appearance, and social behavior. Because negative esthetic, functional, and psychological consequences are associated with this condition, dentists must be knowledgeable about its common oral manifestations.

Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces

The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.

Effect of the Inclusion Nanocomplex Formed of Titanium Tetrafluoride and β-Cyclodextrin on Enamel Remineralization

OBJECTIVE

Titanium tetrafluoride (TiF₄) is a topical agent used in the control of dental caries; however, it is highly acidic. To minimize this effect, cyclodextrins (CDs) are used. This study evaluated the in vitro potential of TiF₄ and β-CD on remineralization.

METHODS

Forty bovine enamel blocks were selected by microhardness and randomly assigned to four groups (n = 10 per group): control (distilled and deionized water), 1% β-CD solution, 1% TiF₄ solution, and TiF₄: β-CD solution. The blocks were subjected to a pH cycling regimen for 8 days. After that, samples were evaluated by cross-sectional microhardness (CSMH), scanning electron microscopy (SEM), and energy dispersive spectrometry (EDS). Data were assessed for normality and analyzed using ANOVA and Tukey's tests (α = 0.05).

RESULTS

Regarding CSMH, TiF₄: β-CD was statistically superior to the control (P = 0.033), β-CD (P = 0.022), and TiF₄ (P = 0.006). SEM photomicrography revealed the titanium dioxide coating on slabs treated with TiF₄ and TiF₄: β-CD. EDS assessment demonstrated the presence of titanium on the surface of slabs treated with TiF₄ and TiF₄: β-CD.

CONCLUSION

The solution containing the inclusion nanocomplex formed of TiF₄ and β-CD was able to reharden the enamel subsurface.

Effect of highly active antiretroviral therapy use on oral manifestations in pediatric patients infected with HIV

AIMS

The aim was to assess the prevalence of oral lesions in HIV-infected children undergoing highly active anti-retroviral therapy (HAART), and the association between the duration of HAART usage and oral lesions.

SUBJECTS AND METHODS

Totally, 111 medical and dental records of HIV-infected children, aged from 2 to 16 years old were reviewed for medical data, presence of oral lesions, and caries prevalence. According to the type of medication, the children were grouped as follows: 51 were under HAART (G1), 46 were using anti-retroviral medication (G2), and 14 were using no medication (G3).

RESULTS

The majority of the HIV children had AIDS (65.8%), of which 86.3% were in G1, 63% in G2, and 0% in G3. The mean length of therapy was 34.4 months, with no difference between groups (Kruskal-Wallis; P = 0.917). The prevalence of the oral lesions was 23.4%, namely, G1 was 27.5%, G2 was 21.7%, and G3 was 14.3% (P > 0.05). Gingivitis was the most common oral manifestation (15.3%) seen in the three groups, followed by gingival linear erythema and pseudomembranous candidiasis in G1 and G2. The mean values regarding deft and DMFT indexes were, respectively, 3.2 and 1.9 (G1), 2.8 and 1.6 (G2), and 3.8 and 3.0 (G3). For the patients without AIDS (n = 38), oral manifestations were seen in 29.4% of G2 compared to G1, with 0% (Chi-square; P > 0.05). In terms of therapy duration, 47.65% of the patients who had been under HAART for 18 months or less had oral manifestations, compared to 13.3% of those who had been treated for a longer time (Chi-square; P = 0.007).

CONCLUSIONS

Although the prevalence of oral lesions was similar between the groups, it was less in patients without AIDS and those under HAART. The duration of HAART usage had a significant influence on the prevalence of these lesions.

Reliability analysis of two methods for measuring active enamel demineralization: An in vitro study

OBJECTIVE

The aim was to evaluate the intra- and inter-examiner reliability of two methods, namely, digital caliper [DC] and computerized image analysis software (Image Tool [IT] version 4.1) for measuring the area of an active enamel demineralization lesion. The effect on that measurement of a window that delimits the lesion was also assessed.

MATERIALS AND METHODS

Thirty-eight circular artificial enamel demineralization lesions (r = 2 mm) were produced on bovine teeth in vitro, which were then measured three times by three examiners, with and without the presence of a window delimiting the area to be measured. The data were analyzed by the intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and by the Altman and Bland analysis.

RESULTS

The intra-examiner correlation using the IT method showed excellent reproducibility (mean ICC values 0.922-0.970 with the delimiting window and 0.915-0.990 without the window). However, the intra-examiner correlation using the DC method showed comparatively less reproducibility in the measurements (mean ICC values 0.458-0.648 with the delimiting window and 0.378-0.665 without the window). The inter-examiner correlations showed very good reproducibility of the measurements regardless of the presence or absence of the window for both the DC method (0.811-0.846) and IT method (0.953-0.994). However, the latter method showed less variability within the measurements.

CONCLUSION

However, statistically no significant difference was found between both methodologies. Nevertheless, computerized image analysis with the Image Tool software demonstrated higher intra- and inter-examiner reliability than the digital caliper method, in estimating the area of the enamel demineralization lesion, regardless of the delimiting window.

In vivo effect of titanium tetrafluoride and sodium monofluorophosphate dentifrice on remineralization: a preliminary split-mouth clinical trial

The aim of this preliminary, split-mouth clinical trial was to evaluate how incipient carious lesions on permanent tooth enamel were affected by 4% titanium tetrafluoride (TiF4) when used with a sodium monofluorophosphate (MFP) dentifrice. Eight children were selected for this study, providing 18 pairs of permanent anterior teeth with incipient carious lesions. TiF4 was applied once to half of the sample teeth, while all teeth were brushed with the MFP dentifrice for four weeks. Clinical (texture, size, and brightness) and illustrative (photos and scanning electronic microscope replica) evaluations were performed. Descriptive-statistical analysis of the data was performed by analyzing pairs of teeth, using statistical software. Remineralization occurred in 13 of the 18 pairs of teeth that received both forms of treatment; seven pairs were partially remineralized while six pairs showed total remineralization (McNemar test: p = 0.375). Teeth treated with both TiF4 and MFP showed a 74.5% reduction in lesion size, compared to a 67% reduction in teeth treated with the MFP dentifrice only. The results indicate that a single application of TiF4 in conjunction with toothbrushing with a fluoride-containing dentifrice was no more effective than the use of dentifrice alone for treating incipient carious lesions.

Adverse effects associated with the clinical use of 4% TiF₄ on teeth enamel: case report

Titanium tetrafluoride (TiF₄) has been studied in dentistry as a promissory alternative for prevention and treatment of carious lesions. However, there are few in vivo studies concerning the consequences of its use on tooth enamel. The goal of this study was to report the effects of a 4% TiF₄ application on the remineralization of an incipient carious lesion of a permanent tooth. This research found an unexpected clinical outcome. A patient with active white spots had two of these lesions treated with 4% TiF₄ associated with fluoridated dentifrice and another lesion treated with fluoridated dentifrice only, thus the remineralization of the two kinds of treatment administered could be observed and compared. An extrinsic pigment appeared in the regions that received the TiF₄ treatment, which was partially removed by professional prophylaxis. Also, regular recidivists of this pigmentation in the review consultations were noted. The authors concluded that although the use of 4% TiF₄ was effective in treating incipient carious lesions on enamel, it was also responsible for an undesired pigmented layer on the tooth to which it was applied. Beyond the varied fluoridated materials used in dentistry, titanium tetrafluoride (TiF₄) deserves attention. This compound has the common properties of fluorides, and researchers are exploring its role in carious lesion prevention, fissure sealing, and tooth erosion prevention in in vitro and in situ studies. Research is also exploring its use for microinfiltration prevention in tooth restoration and hypersensitivity treatment. However, when compared to other fluoridated products TiF₄ demonstrates additional, specific particularities, such as the formation of a titanium dioxide (TiO₂) layer, which is tough, hydrophobic, and resistant in acidic environments. Nevertheless, there are insufficient in vivo studies concerning the consequences of TiF₄-containing products affecting tooth enamel. Thus, the goals of this study were to report the effects of a 4% TiF₄ application on the remineralization of an incipient carious lesion of a permanent tooth and to show the results of a backscattered scanning electron (BSE) analysis that was performed on the primary tooth. The clinical outcome was unexpected.

Levels of salivary IgA antibodies to Candida spp. in HIV-infected adult patients: a systematic review

OBJECTIVE

To perform a systematic review of published data with the aim of evaluating the levels of IgA antibodies to Candida albicans in HIV-infected adult patients.

METHODS

The search strategy was based on PubMed, Web of Science, Google Scholar, Cochrane and EMBASE databases. Also, the reference lists of included studies were searched. All abstracts found by electronic searches were independently scrutinized by two reviewers. To be eligible for review, the controlled studies had to present the following characteristics: samples of both HIV-infected adults and noninfected adults; appropriate HIV-diagnostic tests for both patient groups (case and control); IgA-diagnostic test applied to a similar population sample.

RESULTS

Of 144 studies found, only six met the initial eligibility criteria, but three were excluded after a thorough analysis. To assess the methodological quality of the three remaining studies, they were categorized according the risk of bias. The three selected studies revealed that the levels of C. albicans-specific IgA antibody were higher in HIV-infected individuals compared with the control group.

CONCLUSION

Adequate IgA antibody responses to C. albicans appear to be maintained, since the levels of these antibodies were higher in all studies selected. Although the findings of this systematic review are encouraging, the scientific evidence should be interpreted carefully because there are only a few reports in the literature, mostly because of the lack of important methodological details or the varying methodologies employed.

Associations among the use of highly active antiretroviral therapy, oral candidiasis, oral Candida species and salivary immunoglobulin A in HIV-infected children

OBJECTIVES

The aim was to examine the impact of antiretroviral therapy on the prevalence of oral candidiasis, recovery of oral Candida spp. , and salivary levels of total secretory immunoglobulin A (SIgA) and Candida-specific SIgA in human immunodeficiency virus (HIV)-infected children.

STUDY DESIGN

Sixty-six HIV+ and 40 HIV- children were cross-sectionally examined for the presence of oral lesions. Whole stimulated saliva samples were collected for the identification of Candida spp. using culture and measurement of total and specific SIgA using enzyme-linked immunosorbent assay (ELISA).

RESULTS

The HIV+ children had a higher prevalence of oral candidiasis (P < .05), higher frequency of detection of Candida spp. (P < .05), and higher levels of total (P < .05) and Candida-specific SIgA (P < .001) than the HIV- children. Among the HIV+ subjects, antiretroviral users had lower viral loads (P < .001) and lower levels of Candida spp. (P < .05) and total SIgA (P < .05) compared with antiretroviral nonusers.

CONCLUSIONS

The use of antiretroviral therapy was associated with decreases in the prevalence of oral candidiasis. This diminished exposure to Candida spp. was accompanied by decreases in levels of total and Candida-specific SIgA.

Cessation of dental development in a child with idiopathic hypoparathyroidism: a 5-year follow-up

Idiopathic hypoparathyroidism is a rare endocrinopathy whose origin is unknown, and which is characterized by a deficiency of parathyroid hormone causing low serum calcium and high serum phosphorus concentrations. Disorders of ectodermal tissues are common in this pathology, and enamel hypoplasia is the most frequently found dental pathology. This article describes the case of a 9-year-old child with hypoparathyroidism that had gone undiagnosed for 6 years. The permanent dentition showed enamel hypoplasia, delayed eruption, and cessation of root formation (i.e., shortened roots), resulting from nontreated hypocalcemia during the developmental phase of the dentition.

Cariogenic and erosive potential of the medication used by HIV-infected children: pH and sugar concentration

OBJECTIVE

The aim of this work was to analyze pH and sugar concentration in seven antiretroviral and three antibacterial medications frequently prescribed to HIV infected paediatric patients.

METHOD

Sugars (sucrose, glucose, lactose and fructose) and pH were measured from every one of ten medications with different serial numbers in two samples. The pH was determined by a previously calibrated digital pHmeter (Beckman). Analysis of free sugars was performed using thin-layer chromatography (TLC). The pH results and the amount of sugar originated from the two samples in each lot were added. The arithmetic mean of these results were computed.

RESULTS

Two antiretrovirals (Zidovudin and Abacavir Sulphate) had pH below critical level (3.55 and 3.93, respectively). All three antibacterials analyzed had pH above 5.5, and one of them (Azithromycin) had the highest pH level of the ten medications examined (9.28). Sugar was present in seven out of 10 of the medications analyzed. The antibacterials contained the highest concentration of sucrose, ranging from 40% to 54%. Glucose was found in one of the ten, sucrose was present in seven of them and none showed lactose. Fructose was not observed with the technique used.

CONCLUSIONS

A number of medications frequently used by HIV-infected children may cause a significant risk of both caries and dental erosion.

Pyknodysostosis: oral findings and differential diagnosis

Pyknodysostosis is a rare, genetic, autosomal recessive condition characterized by short stature, generalized bone sclerosis, and oral manifestations such as maxillary atresia and an increase of the mandibular angle. The main purpose of this article was to report a case of pyknodysostosis, describing the characteristic orofacial findings of the disease and discussing the differential diagnosis.

Examining dentinal carious lesions as a predisposing factor for the oral prevalence of Candida spp in HIV-infected children

PURPOSE

The aims of this study were to verify the oral prevalence of Candida spp in HIV-infected children, and investigate the association between Candida colonization and dentinal caries lesions.

METHODS

Whole stimulated saliva was collected from 62 HIV-infected children (group 1) and 40 seronegative siblings (group 2), followed by oral examination to determine: dmft/dmfs scores, DMFT/DMFS scores, the number of dentinal carious teeth (D+) and the presence of oral candidiasis. The salivary samples were cultured, and plates with positive isolation (G+) were classified as mild growth, moderate growth, and strong growth. Data was analyzed using chi-square, Mann-Whitney, and Spearman tests for correlations.

RESULTS

The patients' mean age was 8.8 for group 1 and 8.0 years for group 2. In group 1, 61% of the subjects had AIDS. Eighty percent of HIV-infected children (N=50) were positive for Candida growth, having a mean CD4% of 22, those who were Candida-free (N=12) presented a mean CD4% of 21. Correlation was observed between the mean D+ and G+ in groups 1 and 2 (P<.05, Mann-Whitney test), but not between the mean dmft/dmfs-DMFT/DMFS in group 1 (P>.05, Mann-Whitney test). Association of G+ and the D+ was noted in group 1 (P<.05; chi-square test). Positive correlation between high Candida counts and an increase in D+ was demonstrated in groups 1 and 2 (P<.05).

CONCLUSIONS

Dentinal carious lesions may be associated with Candida spp colonization in HIV-infected children.

Ectopic eruption of the maxillary central permanent incisors and mandibular first permanent molars: report of an unusual case

Ectopic eruption is a disturbance in which the tooth does not follow its usual course. Among its more important etiologic factors are macrodontism, shortened arch length, posterior positioning of the maxilla, atypical eruption angle, and genetic factors. This article reports a rare case of ectopic eruption of 4 permanent teeth, maxillary central incisors and mandibular first molars, in a child aged 7 years and 11 months, in which the treatment consisted of extracting the maxillary primary central incisors and making an orthodontic intervention on the mandibular arch. A bilateral fixed appliance containing 2 hooks with loops, 1 buccal and the other lingual, was placed on the mandibular primary first molars. The hooks were activated in a niche made of light-curing resin on the occlusal surface of the mandibular permanent molars, to bring about the distal drift of these teeth. After 6 months, complete eruption of the mandibular permanent molars occurred, and a slight displacement of the maxillary permanent central incisors toward the median line was noted. The importance of early, adequate treatment is discussed.

Sweetened medicines and hospitalization: caries risk factors in children with and without special needs

AIM

This was to evaluate caries risk factors: medicine consumption level, oral hygiene frequency and oral hygiene habits during hospitalization of children with and without special needs.

METHODS

A cross-sectional study was carried out using a pre-tested form, interviews were conducted with guardians of children with (G1-116) and without special needs (G2-86), from a public day nursery in Rio de Janeiro (Brazil).

RESULTS

Average use of medications was at 21.8 months for G1--24.5 and G2--7.2 (Mann-Whitney: p-value = 0.0009). In the total sample, medicines were taken usually at night; 8.4% of parents sweetened them before ingestion and the majority of children did not brush their teeth after taking medicines. More than half (61.9%) had been hospitalized with an average duration of 21.8 days; 83 (66.4%) had had few hospitalizations; G1--62.8% and G2--77.4%. Some 81.6% of the sample reported no tooth brushing while in hospital.

STATISTICS

The data were entered in the EPI INFO 6.04d program, and the tests used were Fisher Exact, Mann-Whitney, Kruskal-Wallis and Chi-square with a 5% significance level.

CONCLUSIONS

Poor oral hygiene habits when taking medicines and during hospitalizations were observed, mainly among children with special needs.

Multidisciplinary therapy for treating sequelae of trauma in primary teeth: 11 years of follow-up and maintenance

This article reports a case of root dilaceration and enamel hypoplasia in permanent maxillary incisors resulting from acute trauma in the primary dentition and the multidisciplinary treatment provided during 11 years of follow-up.

Green pigmentation of deciduous teeth: report of two cases

The purpose of this paper was to present 2 cases of green pigmentation in primary teeth caused by hyperbilirubinemia, from different pathologies during the neonatal period. Medical history revealed systemic problems during the neonatal period of an infectious, neurological, renal, respiratory, and cardiological nature, as well as a high amount of bilirubin in both cases and hepatitis in the first. The staining in the teeth was due to hyperbilirubinemia, caused by these systemic conditions. The clinical characteristics of teeth may help in the diagnosis of present current or past systemic diseases. The reported cases confirm the relevance of past medical history in establishing the diagnosis of the etiology of green pigmentation as a result of high levels of bilirubin serum.

Oral health profile of education and health professionals attending handicapped children

The purpose of this study was to evaluate the knowledge and attitudes toward oral health of education and health professionals working in a children care program for handicapped children from 0 to 6 years of age, run by a public municipal institution in Rio de Janeiro. Using a printed questionnaire, 67 professionals (teachers, attendants and health professionals) were interviewed. The results were compared to the children's oral hygiene habits, by directly observing their daily nursery routine. Although 97.0% said that oral health could play a part in general health, only 37.3% of the professionals answered correctly on this matter. As for methods for preventing caries, although 92.5% said that they were aware of them, only 17.9% went to the dentist for preventive treatment. Although the majority (81.3%) indicated oral hygiene as a way of preventing caries, observation showed that this practice is not always put into effect in the program's day nursery. Regarding when to start toothbrushing in children, 75.0% of the teachers and 94.4% of the health professionals said that they were aware of the need to begin brushing before one year of age, although this reply was given by only 52.5% of the attendants (chi-square, p = 0.006). In view of these results, it was concluded that attitudes toward oral health were not always coherent with the knowledge that these professionals express.