Cytotoxicity evaluation, antibacterial effect, and degree of conversion of QAM-containing adhesives

The aim of this study was to evaluate the influence of adding quaternary ammonium methacrylates (QAMs) to experimental adhesives by assessing the degree of conversion (DC), cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. Two QAMs were added to an experimental adhesive: dimethylaminododecyl methacrylate bromododecane (DMADDM) or dimethylaminododecyl methacrylate bromohexadecane (DMAHDM) at three concentrations each: 1, 2.5, and 5 wt.%. Experimental adhesive without QAMs (control group) and commercially available Transbond XT Primer (3M Unitek, Monrovia, California, USA) were used for comparisons. The adhesives were tested for DC, cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. DC, cytotoxicity against fibroblasts, and antibacterial activity were analyzed using one-way ANOVA and Tukey's multiple comparisons. Cytotoxicity against keratinocytes was evaluated using the Kruskal Wallis and Dunn's post-hoc (α = 5%) tests. Transbond showed lower DC as compared to 5% DMAHDM, 1% DMADDM, and 5% DMADDM (p < 0.05). However, all groups presented proper DC when compared to commercial adhesives in the literature. In the evaluation of cytotoxicity against keratinocytes, Transbond induced higher viability than 2.5 wt.% groups (p < 0.05). Against fibroblasts, Transbond induced higher viability as compared to 5 wt.% groups (p < 0.05). DMAHDM at 5 wt.% reduced biofilm formation when compared to all the other groups (p < 0.05). Despite their cytotoxic effect against keratinocytes, gingival fibroblasts showed higher viability. DMAHDM at 5 wt.% decreased Streptococcus mutans viability. The incorporation of DMAHDM at 5 wt.% may be a strategy for reducing the development of white spot lesions.

Responsiveness of the B-ECOHIS to detect changes in OHRQoL following dental treatment of children with autism spectrum disorder

The Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) is an oral health-related quality of life (OHRQoL) questionnaire. This paper aims to investigate the responsiveness of the B-ECOHIS to dental treatment in individuals diagnosed with autism spectrum disorder (ASD) and determine if dental treatment has an impact on OHRQoL. The survey targeted 27 ASD individuals aged 4 to 14 years attending the Acolher Project of the University Federal Fluminense. This project provides children and adolescents with disabilities with oral health services. A group of randomly selected caregivers self-completed the B-ECOHIS before and 14 days after their children's dental treatment. The dental treatment included meticulous screening, preventive treatment, and restorative treatment. Responsiveness was assessed by investigating the effect size (ES) and standardized response mean (SRM). Wilcoxon test was used to evaluate internal responsiveness (distribution-based approach). The B-ECOHIS showed significant changes in the total score (p<0.001) and in all domains. The ES of the total B-ECOHIS after treatment was 1.28 and ranged between 0.70 and 1.14 for the domains. The SRM for each of the domains was large, except for the symptom domain. The B-ECOHIS is sensitive and responsive to ASD individuals undergoing dental treatment. Individuals with ASD showed improvement in their OHRQoL score after dental treatment.

Effectiveness of CPP-ACP and Fluoride Products in Tooth Remineralization

OBJECTIVES

To compare the effectiveness of the casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) in the in situ remineralization of enamel exposed to two different degrees of preformed enamel lesions.

METHODS

One hundred and sixty 3x3x2 mm human enamel slabs were demineralized and divided into two subgroups according to baseline surface hardness (SH=B1≤150 and B2 >150). During each of four 10-day experimental periods, 10 participants wore intraoral removable acrylic palatal expanders with four human enamel slabs with preformed lesions (B1 and B2): CO1 and CO2 - Control: silica dentifrice without fluoride; MP1 and MP2: MI Paste; MPP1 and MPP2: MI Paste Plus; and FD1 and FD2: Fluoride dentifrice. The Knoop hardness test (50/15s Micromet 2001, Buehler, IL, USA) was performed after demineralization (B1 and B2) and after treatment (T1 and T2).

RESULTS

SH was higher in all treatment groups when compared with the controls, except for CO2 (Mann Whitney Wilcoxon Test; p <0.05). %SH was similar between MPP2 and FD2 and between MPP2 and MP2; however, FD2 and MPP2 products were more effective in microhardness recovery. In B1, all treatment groups were similar.

CONCLUSION

MPP and FD are more effective in preventing demineralization in enamel subsurface lesions.

Effect of CPP-ACP on remineralization of artificial caries-like lesion: an in situ study

The purpose of this double-blind, randomized, crossover in situ study is to compare remineralization of preformed enamel lesions by casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) and fluoride dentifrice products. During each of four 10-day experimental legs, 10 participants wore intraoral removable palatal acrylic appliances with four human enamel slabs with preformed lesions. A 0.03-mL treatment paste was dripped extraorally onto the enamel blocks once a day for 3 min. The four randomly allocated treatments were as follows: CO- Control: silica dentifrice without fluoride; MP: MI Paste; MPP: MI Paste Plus and FD: Fluoride dentifrice - 1100 ppm F as NaF). Knoop surface hardness (SH) test was performed in three stages (T0 - sound enamel, T1 - after preformed lesion, and T2 - after treatment) and the cross-sectional hardness (CSH) test was performed after treatment using a 50-gram Knoop load for 15 s. Knoop hardness number (KHN) was similar between treatments. %SHr was significantly higher in the MP, FD, and MPP when compared to CO group (Kruskal-Wallis and Mann-Whitney tests, p < 0.05). Harder enamel was found in MP (75 μm) and FD groups at 75 to 175 μm. Treatment with DF, MP, and MPP promoted an increase of 20.27%, 19.24%, and 14.71%, respectively, in Integral Hardness Change (ΔIHC) when compared to CO (p<0.05). Remineralizing agents (MP, MPP, and DF) were able to inhibit demineralization of human enamel subjected to high cariogenic challenge in situ. DF had the greatest preventive potential against the progression of carious lesions.

Parental perceptions of oral health-related quality of life of Brazilian children and adolescents with autism spectrum disorder

Objective:This paper aimed to assess the oral health-related quality of life (OHRQoL) of children and adolescents with autism spectrum disorder (ASD) using the parental/caregiver perceptions questionnaire (PCPQ). Materials and methods: Children aged 2 to 14 years, enrolled in the ACOLHER/PNE project at the Fluminense Federal University, RJ, Brazil, were assessed. The main independent variable was dental caries experience, diagnosed according to the World Health Organization (WHO) criteria. The variable was categorized as caries-free when dmft/DMFT=0 and caries experience when dmft/DMFT ? 1. Caregiver schooling, age, sex, and socioeconomic factors (Brazilian minimum wage – BMW) were the other independent variables. Quality of life (QoL) was measured using PCPQ subscales and total score. Mann-Whitney U, Kruskal-Wallis, and multivariate Poisson regression correlation analysis were performed. Results: The median age of patients was 8 (SD= 3.76). The study group consisted of 57 (76.0%) males and 18 (24.0%) females. Fifty parents (66.7%) have more than eight years of education and 35 (46.7%) earn less than 2 BWM. The impact values were significantly higher in male individuals in the oral symptoms (OS) domain and in individuals without caries experience in the social well-being (SW) domain (p<0.05). Conclusions: these results seem to suggest that individuals with ADS without caries experience in permanent dentitions in the SW domain and males in the OS domain had a higher impact quality of life. 

Ectodermal Dysplasia in child: multidisciplinary management

Ectodermal Dysplasia (ED) represents a group of hereditary conditions in which anatomical structures derived from the ectoderm show defects in its development. It is observed aplasia or hypoplasia of the tissues, among them the changes of dental relevance, as the anomalies regarding the number and morphology of the teeth. Due to the particularity of the cases, the dental surgeon must adapt the operative techniques and the choice of dental materials to each individual, according to the perceived need and condition. The objective of the present study is to report the clinical case of a 10 - year old male patient with ectodermal dysplasia who was attended in the discipline of Patients with Special Needs of Dentistry of the Federal University of Fluminense and its multidisciplinary aspects.KeywordsChildren with disabilities; Dental care for disabled; Ectodermal dysplasia; Oral rehabilitation.

Oral conditions of pediatric patients with Williams-Beuren syndrome: two case reports

Objective: The objective of this paper was to describe the oral conditions of two children accompanied by their mothers who reported to the Department of Pediatric Dentistry of Fluminense Federal University with Williams-Beuren syndrome (WBS). Case report: The 9-year-old female patient had a family and medical history significant for placental abruption, caesarean section, delayed psychomotor development, learning disabilities, tendency to selfdistract and congenital heart disease. In contrast, the 7-year-old male patient had a normal birth and no gestational intercurrences. Discussion: Clinically, the female presented with mixed dentition, crowding in the maxillary and mandibular arches, prolonged retention of deciduous teeth, anterior and posterior cross-bite and Angle Class I malocclusion, while the male had mixed dentition and retarded psychomotor development. Due to the patients having congenital heart disease, a prophylactic antibiotic regimen was prescribed prior to the dental procedures in both of them. Conclusion: These patients had been followed up for 2 years and this case report underscores the importance of early dental evaluation and counselling for parents of WBS patients.KeywordsWilliams Beuren syndrome; Oral manifestations; Child.

Síndrome da imunodeficiência adquirida na criança e no adolescente: conduta odontológica

A Síndrome da Imunodeficiência Adquirida (SIDA/AIDS) foi relatada inicialmente em 1981 nos Estados Unidos. Esta doença ataca o sistema imunológico do paciente deixando-o vulnerável às infecções oportunistas e neoplasias malignas. O cirurgião-dentista tem um papel muito importante no curso desta doença, visto que algumas lesões bucais aparecem na fase inicial, e o profissional pode fazer um diagnóstico precoce tornando o tratamento mais benéfico. É preciso fazer a avaliação do bem-estar do paciente, avaliações clínicas e laboratoriais, principalmente em crianças e adolescentes. Dentre as diversas doenças que acometem o paciente com a SIDA/AIDS, podem-se citar a fúngica, a bacteriana ou a viral sendo a candidíase oral, herpes simples e xerostomia as principais manifestações clínicas. Existem três vias diferentes de transmissão pelo vírus HIV: a Peri natal, a Transplacentária e a Pós-natal, e os exames mais utilizados para o diagnóstico da doença são o ELISA e o WESTERN BLOT. Sendo assim, o objetivo deste estudo é apresentar maiores conhecimento sobre o assunto, vias de transmissão, principais manifestações bucais em crianças e adolescentes com AIDS e a importância do cirurgião dentista.

Imperfect osteogenese: child case report

Osteogenesis Imperfecta leads to alterations in type 1 collagen fiber, apart from causing bone fracture, blue sclera and other related deformities. As few medical records are available in the field of dentistry regarding these alterations, having a better understanding of this medical disorder and its dental management has become a matter of extreme relevance if one is to provide adequate treatment for patients suffering from this medical condition. This paper reports the case of a 2-year old patient with Osteogenesis Imperfecta who received treatment as part of the Acolher Project – PNE run by the Federal Fluminense University in Rio de Janeiro, Brazil.

Accuracy of pen-type laser fluorescence device and radiographic methods in detecting approximal carious lesions in primary teeth - an in vivo study

BACKGROUND

The diagnosis of approximal lesions is limited due to the difficulty of direct examination of these areas.

AIM

To determine the accuracy of pen-type laser fluorescence (LFpen) device, compared to digital bitewing (BW) radiography, in diagnosing approximal carious lesions in posterior primary teeth at cavitation and non-cavitation thresholds.

DESIGN

A total of 46 children (aged 3-9 years) were assessed and 195 approximal surfaces of 184 primary molars were examined by digital BW and LFpen. Visual-tactile inspection based on the International Caries Detection and Assessment System (ICDAS-II) was used as the reference standard. All examinations were performed by the same examiner. Sensitivity, specificity, and accuracy were calculated. Spearman's correlation coefficients were calculated between LFpen and BW readings and the reference standard.

RESULTS

Sensitivity, specificity and AUC were 81.8, 86.7, and 0.84 for BW and 49.1, 87.9, and 0.69 for LFpen both at non-cavitation thresholds. At cavitation thresholds, BW showed higher specificity (96.0), sensitivity (93.0), and AUC (0.98) than did LFpen (72.0, 86.9, and 0.82, respectively), but a lower correlation was indicated by LFpen readings.

CONCLUSION

Bitewing had a better diagnostic accuracy and significantly outperformed LFpen in the detection of non-cavitated lesions. Similar results were obtained by the two methods at the cavitation threshold.

Effect of dentifrice containing fTCP, CPP-ACP and fluoride in the prevention of enamel demineralization

OBJECTIVE

To evaluate the effect of different fluoride- and calcium- and/or phosphate-containing products on their ability to prevent enamel demineralization under pH cycling conditions.

MATERIAL AND METHODS

Enamel bovine specimens were assigned to the following groups: G1-MPP (MI Paste Plus, 0.2% NaF, Recaldent™, GC Corporation Tokyo, Japan); G2-FD (Crest™ Cavity Protection, 0.243% NaF, Procter & Gamble, USA); G3-CLP (Clinpro™ 5000, 1.1% NaF, 3M ESPE, USA); and G4-CO (Control without fluoride, Silica-based dentifrice; Daudt Ltda, Brazil). The specimens were soaked in demineralizing solution for 6 h and remineralizing solution for 18 h alternatively for 10 days. The toothpaste was prepared with deionized water in a 1:3 ratio (w/v) for three minutes daily. The solutions were renewed every 48 h. After cycling, enamel changes were analysed by percentage change of SMH (%SMH) and energy-dispersive X-ray spectroscopy (EDS). The %SMH value observed for G3-CLP (2.9 ± 39.2) was higher than that found in G4-CO (-13.0 ± 20.7), G1-MPP (-8.9 ± 20.9) and G2-FD (-3.9 ± 27.1). The %SMH was similar for all treatment groups (one-way ANOVA and Tukey's HSD; p < .05). The pH, Ca²⁺ and P_total in the remineralization solutions were not different among all groups (Kruskal-Wallis; p < .05). At 24 h, the Ca²⁺ concentration in the demineralization solution was significantly lower in G1-MPP. Ca²⁺ concentration increased in all groups after 48 h, except for G3-CLP. The EDX quantitative analysis showed that the atomic % of elements is lower level at G4-CO.

CONCLUSIONS

The Clinpro™ 5000 demonstrated having the most protective effect against demineralization; however, the % SMH was similar for all groups.

Influence of biofilm formation on the mechanical properties of enamel after treatment with CPP-ACP crème

The study aimed to investigate the effects of bacterial biofilms on changes in the surface microhardness of enamel treated with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) with and without fluoride. Human enamel blocks with incipient caries-like lesions were divided into four groups of 13: G1: Saliva (Control); G2: fluoride dentifrice (Crest™, 1100 ppm as NaF); G3: CPP-ACP (MI Paste; Recaldent™); and G4: CPP-ACPF (MI Paste Plus; Recaldent™ 900 ppm as NaF). The specimens were soaked in demineralizing solution for 6 h and remineralized in artificial saliva for 18 h alternately for 10 days. The dentifrice was prepared with deionized water in a 1 : 3 ratio (w/w) or applied undiluted in the case of the CPP-ACP group. The surface microhardness (SMH) was evaluated at baseline, after artificial caries, after pH cycling and treatment with dentifrices, and after incubation in media with Streptococcus mutans for biofilm formation. The biofilms were exposed once a day to 2% sucrose and the biofilm viability was measured by MTT reduction. The percentage of change in surface microhardness (%SMHC) was calculated for each block. The data were analyzed by nonparametric test comparisons (α = 0.05). The %SMHC values observed in G2 were different from those of G1, G3, and G4 (p < 0.05). After biofilm formation, %SMHC was positive in G2 and G4 when compared to G1 and G3, but resistance to demineralization after biofilm formation was similar in all groups. In conclusion, the presence of biofilms did not influence the treatment outcomes of anticaries products.

Ectodermal dysplasia: case report of aesthetic and functional rehabilitation

Objective: The aim of this study is to report a case of aesthetic and prosthetic rehabilitation of a male 6-year-old patient diagnosed with Hipohidrotic Ectodermal Dysplasia, attended at the clinic of special patients held in the extension project of the Federal Fluminense University. Methods: This is a clinical, observational and descriptive study where the restorative and rehabilitative treatment was conducted and reported corresponding to the functional and aesthetic needs of the patient. Results: It was  realized the reconstruction of the anatomical shape of the teeth 51 and 61 and also was made a partial removable prosthesis to cover the absence of the teeth 71, 72, 74, 81 and 82, offering function, aesthetics and satisfaction reported by the patient. Conclusion: This case reports contributed to the increase of knowledge about the forms of Ectodermal Dysplasia on the importance of the differential diagnosis of the same, as well as to the teaching of the extension project of undergraduate students.

Profile of special needs patients assisted in a dental project

Objective: The aim of this paper was to outline the profile of patients with special needs who sought treatment at School of Dentistry, Universidade Federal Fluminense (FO-UFF). Material and Methods: We evaluated the charts of 17 patients who sought care during the survey period. The variables were gender, age, reason for consultation, continuous use of psychotropic drugs, socioeconomic status, consumption of sugar, toothbrushing frequency, dental occlusion dental care and length of treatment. All patients were treated by two undergraduate students linked to the project under supervision. Results: The mean age of the patients was 9.65 years old and males were the most prevalent (52.94%). Individuals with mental retardation and Down´s syndrome were the predominant group seeking dental care (35,3%) and pain was cited as the main reason (58,82%). The average dmft 0.9 (±1,4) and DMFT was 3.29 (±7,07) among patients and restorative treatment was provided for 25% of the patients. Conclusions: In conclusion the greatest demand was for curative and not preventive procedures and that the prevalence of caries is high in this group of patients.Keywords: Dental caries; DMFT index; Intellectual disability.

Remineralizing potential of CPP-ACP creams with and without fluoride in artificial enamel lesions

BACKGROUND

This study evaluated the effect of pastes containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) with and without fluoride on enamel demineralization.

METHODS

Human enamel blocks were used and after incipient caries-like lesions were formed, they were assigned to four groups: G1 - saliva; G2 - MI Paste (Recaldent^TM ); G3 - MI Paste Plus (Recaldent^TM 900 ppm as NaF); and G4 - Crest^™ (1.100 ppm as NaF). The specimens were soaked in demineralizing solution for 6 hours and remineralized in artificial saliva for 18 hours alternatively for 10 days. The dentifrice was prepared with deionized water in a 1:3 proportion (w/w) or applied undiluted in the case of the CPP-ACP formula. Demineralized enamel changes were analysed by surface microhardness (SMH), 3D-profilometry and SEM. Data were analysed by non-parametric Kruskal-Wallis and Mann-Whitney test comparisons and one-way ANOVA and Tukey's HSD post hoc test (α = 0.05).

RESULTS

The SMH values observed in the G2 (47.8 ± 28.5) and G3 (53.6 ± 27.6) groups were different from that of G4 (90.2 ± 17.1), which were significantly higher than that found in G1 (39.4 ± 14.2). The %SMH was significantly lower in G4 when compared to G1 (p < 0.001) and G3 (p < 0.05).

CONCLUSIONS

MI Paste Plus demonstrated a greater protective effect against demineralization than MI Paste and showed smoother surfaces.

Effect of resin infiltration on the nanomechanical properties of demineralized bovine enamel

Objective:

The aim of the present study was to evaluate the efficacy of resin infiltration in preventing in vitro lesion progression.

Materials and Methods:

Buccal surfaces of bovine incisors were divided into mesial and distal regions and, at the center, nail varnish was applied (1.0 mm width) to protect the enamel surface against any further treatment. In order to create artificial enamel lesions in the unprotected areas, each specimen was soaked in a demineralizing solution. After that, specimens had two enamel lesions. One lesion in each sample was etched with 15% HCl for 120 s and infiltrated with a commercial infiltrating resin for 3 min, while the other lesion was not treated (control). Each specimen was cross-sectionally halved and randomly allocated to two groups: Group 1 was immediately processed and Group 2 was submitted to a new demineralization process. The samples were analyzed by means of cross-sectional hardness measurements using a nanoindenter equipment. Hardness data were statistically analyzed by non-parametric Kruskal-Wallis and MannWhitney tests (α = 0.05).

Results:

The findings showed statistical difference between treatments at the same analyzed distance range from the outer surface of the enamel (P < 0.05).

Conclusion:

The untreated lesion showed lower hardness values for distances near the outer surface of the enamel. The resin infiltration was efficient in preventing further in vitro demineralization of bovine enamel lesions.

The quality of life of HIV-infected women is associated with psychiatric morbidity

This study evaluated the effect of clinical, demographic and psychiatric factors on the health-related quality of life of 76 women with HIV infection seen in two HIV reference centres in Brazil. The generic questionnaire for evaluation of Health-Related Quality of Life (SF-36), the Hospital Anxiety and Depression Scale (HAD) and the Clinical Interview Schedule (CIS-R) were used. The statistical tests included the covariance analysis. The patients' mean age was 37.4 years; 44.7% had less than 8 years of schooling. A total of 44.8% were asymptomatic, 28.9% symptomatic non-AIDS and 26.3% had AIDS. Most (77.6%) used two or three kinds of antiretrovirals; 36.8 and 30.3% achieved scores for anxiety and depression, respectively (HAD); and 48.7% for conspicuous psychiatric morbidity (CIS-R). The sub-group of the non-AIDS symptoms (clinical stage B) showed the worst quality of life. The variables which better explained the scoring variation on both the mental and physical components of the SF-36 were related to mental health. The more mental symptoms present, the worse the health-related quality of life. We must rethink care strategies in the area of mental health which are directed toward HIV+ patients, by virtue of the levels of mental symptoms found and the request for care which the research revealed.