Is there an association between dental caries and genetics? Systematic review and meta-analysis of studies with twins

OBJECTIVE

This review aimed to assess the agreement of dental caries experience between monozygotic (MZ) and dizygotic (DZ) twins.

DATA RESOURCES

This systematic review was performed by reviewers in the databases Embase, MEDLINE-PubMed, Scopus, Web of Science and manual searches and gray literature Google Scholar® and Opengray. Observational studies that evaluated dental caries in twins were included. The risk of bias was analyzed using the Joanna Briggs checklist. Meta-analyses were performed to assess the pooled Odds Ratio to estimate the agreement values of dental caries experience and DMF index between pairs of twins (p < 0.05). To assess the certainty of evidence, the GRADE scale was used.

STUDY SELECTION

2533 studies were identified, of which 19 were included in the qualitative analysis, six in the quantitative synthesis, with two meta-analyses being carried out. Association between genetics and the development of the disease was observed in most studies. In the risk of bias analysis, 47.4% had moderate risk. Higher agreement of dental caries experience was observed in MZ twins than DZ in both dentitions (OR: 5.94; 95% CI: 2.00-17.57). However, there was no difference between the MZ and DZ twin groups in the analysis comparing DMF index agreement (OR: 2.86; 95%CI: 0.25-32.79). The certainty of evidence was considered low and very low for all studies included in meta-analyses.

CONCLUSION

With very low certainty of the evidence, the genetic factor seems to influence the agreement of the caries experience.

CLINICAL RELEVANCE

Understanding the genetic influence on the disease has the potential to contribute to the development of studies that may use biotechnologies for prevention and treatment as well as guide future research involving gene therapies aiming to prevent the occurrence of dental caries.

Association between genetic factors and molar-incisor hypomineralisation or hypomineralised second primary molar: A systematic review

OBJECTIVE

To determine the association between genetic factors and molar-incisor hypomineralisation (MIH) and/or hypomineralised second primary molars by means of a systematic review.

DESIGN

A search was performed in Medline-PubMed, Scopus, Embase and Web of Science databases; manual search and search in gray literature were also performed. Selection of articles was performed independently by two researchers. A third examiner was involved in cases of disagreement. Data extraction was performed using an Excel® spreadsheet and independent analysis was performed for each outcome.

RESULTS

Sixteen studies were included. There was an association between MIH and genetic variants related to amelogenesis, immune response, xenobiotic detoxification and other genes. Moreover, interactions between amelogenesis and immune response genes, and SNPs in the aquaporin gene and vitamin D receptors were associated with MIH. Greater agreement of MIH was found in pairs of monozygotic twins than dizygotic twins. The heritability of MIH was 20 %. Hypomineralised second primary molars was associated with SNPs in the hypoxia-related HIF-1 gene and methylation in genes related to amelogenesis.

CONCLUSION

With very low or low certainty of evidence, an association was observed between MIH and SNPs in genes associated with amelogenesis, immune response, xenobiotic detox and ion transport. Interactions between genes related to amelogenesis and immune response as well as aquaporin genes were associated to MIH. With very low certainty of evidence, hypomineralised second primary molars was associated to a hypoxia-related gene and to methylation in genes related to amelogenesis. Moreover, higher agreement of MIH in pairs of monozygotic twins than dizygotic twins was observed.

Early childhood caries management using fluoride varnish and neutral fluoride gel: a randomized clinical trial

The aim of this study was to evaluate the clinical efficacy of varnish and neutral fluoride gel in the management of early childhood caries (ECC). A randomized clinical trial was conducted to compare two strategies for ECC management: topical application of neutral fluoride gel (NFG group) and varnish (FV group) every four months for a period of one year. The sample consisted of children between the ages of three and four years, enrolled in public daycare centers. The incidence of ECC between the groups was compared by assessing values (new dmfs) at two levels: d2 when enamel/dentin were affected and d3 when dentin affected. Pearson's Chi-square, Fisher's Exact, Kolmogorov-Smirnov and Mann-Whitney tests were used to compare the incidence and increment of caries between the NFG and FV groups (p<0.05). A total of 240 children were included in this study and 213 children (88.7%) were followed up for 12 months. The incidence of ECC was 24.1% in the GF and 21.0% in the FV groups (p=0.586). The increment of caries in d2mfs was 1.36 (95% CI = 0.83 - 1.89) in the NFG and 1.33 (95% CI = 0.75 - 1.89) in FV (p=0.756) groups. Increment of caries in d3mfs was 1.60 (95% CI = 0.95 - 2.25) in NFG and 1.40 (95% CI = 0.75 - 2.04) in FV (p=0.468). Neutral fluoride gel and fluoride varnish exhibited similar efficacy in the management of ECC after 12 months of follow-up.

Impact of hypomineralised second primary molar on preschoolers' oral health-related quality of life-A hierarchical approach

BACKGROUND

Hypomineralised second primary molar (HSPM) is a developmental enamel defect associated with dental caries.

AIM

To evaluate the impact of HSPM on oral health-related quality of life (OHRQoL) in preschoolers through hierarchical analysis.

DESIGN

This population-based cross-sectional study assessed 834 5-year-old preschoolers, in Teresina, Piauí, Brazil, using sociodemographic questionnaires and Early Childhood Oral Health Impact Scale (ECOHIS). Dental examination was performed by two calibrated examiners (κ ≥ 0.80) for the diagnosis of HSPM (EAPD), dental caries (dmft and pufa indices), and malocclusion (Foster and Hamilton criteria). Analysis of the determinants of OHRQoL was stratified at three levels (P < .05).

RESULTS

Severe HSPM was associated with OHRQoL in bivariate analysis (P < .05). In adjusted final multivariate analysis (model 1), the presence of dental caries with or without clinical consequences was associated with worse OHRQoL (P < .05). In model 2, after the removal of dental caries, preschoolers with severe HSPM had greater probability of having a negative impact on OHRQoL in the child impact section (RR = 2.14; 95% CI = 1.26-3.65), family impact section (RR = 1.99; 95% CI = 1.16-3.42), and total score (RR = 2.09; 95% CI = 1.25-3.49) of the ECOHIS.

CONCLUSION

Severe HSPM had a negative impact on the OHRQoL of preschoolers and their families, but the presence of dental caries neutralised this impact.

Impact of Pulp Necrosis on Oral Health-Related Quality of Life of Children with Early Childhood Caries

Purpose: To assess the impact of pulp necrosis on the oral health-related quality of life (OHRQoL) of children with early childhood caries and their caregivers.<br/>Methods: A cross-sectional study was performed with a consecutive sample of children who were divided into three groups: (1) caries-free children; (2) with untreated carious lesions and without pulp necrosis; and (3) with untreated carious lesions and at least one tooth with pulp necrosis. Data were collected using a sociodemographic questionnaire, the Early Childhood Oral Health Impact Scale (ECOHIS) and a dental clinical examination using the International Caries Detection and Assessment System index. Descriptive statistics, Kruskal-Wallis tests, Mann-Whitney tests and Poisson regression were performed (P <0.05).<br/>Results: A total of 532 children and their legal guardians participated in the study. Children with pulp necrosis had a greater negative impact on the OHRQoL versus those with untreated carious lesions without pulp necrosis (ratio of unadjusted and adjusted rates [RR] = 1.59; 95 percent confidence interval [95% CI] = 1.36 to 1.86; P <0.001), as measured by the total ECOHIS score. in Group 3, four- and five-year-old children had a greater negative impact on the OHRQoL than two- and three-year-old peers (RR = 1.36; 95% CI = 1.08 to 1.72; P <0,001).<br/>Conclusion: The presence of pulp necrosis increased the negative impact on OHRQoL of children with untreated carious lesions and their guardians.

Effect of fluoridated water on dental caries and fluorosis in schoolchildren who use fluoridated dentifrice

This cross-sectional study evaluated the prevalence and severity of dental caries and fluorosis in children and adolescents using fluoridated toothpaste, from areas with and without fluoridated water. Parents of 5-year-old children and 12-year-old adolescents from neighbourhoods that are supplied with and without fluoridated water answered questionnaires for determining socio-economic and demographic characteristics and habits related to oral health. The individuals were examined, and dental caries and fluorosis were measured by dmft/DMFT and TF indexes, respectively. Descriptive, bivariate and logistic regression analyses were performed (p < 0.05). Of 692 participants, 47.7% were 5-year-olds and 52.3% were 12-year-olds. The mean dmft/DMFT in the 5-year-olds/ 12-year-olds from Exposed and Not Exposed fluoridated water groups was 1.53 (± 2.47) and 3.54 (± 4.10) / 1.53 (± 1.81) and 3.54 (± 3.82), respectively. Children (OR = 2.86, 95% CI = 1.71-4.75) and adolescents (OR = 1.95, 95% CI = 1.24-3.05), who did not consume fluoridated water, had greater caries experience. Among adolescents, there was an association between fluoridated water and the prevalence of very mild/mild fluorosis (OR = 5.45, 95% CI: 3.23-9.19) and moderate fluorosis (OR = 11.11, 95% CI = 4.43-27.87). Children and adolescents, who consumed fluoridated water, presented lower prevalence and severity of dental caries compared to those who used only fluoridated toothpaste as the source of fluoride. There is an association between water fluoridation and very mild/mild and moderate fluorosis in adolescents.

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.

Fluoridated water impact on tooth decay and fluorosis in 17-20-year-olds exposed to fluoride toothpaste

OBJECTIVE

To determine the impact of water fluoridation on the prevalence and severity of dental caries and fluorosis in individuals aged 17-20 years exposed to fluoride toothpaste.

METHODS

The study population consisted of 660 students from public schools, residents of areas supplied with fluoridated water (exposed group) or not (not exposed group). Students from both groups had access to fluoride toothpaste throughout life. A questionnaire about socioeconomic demographic aspects, conditions related to access and exposure to fluoridated water, and habits related to oral health was applied. Dental caries was measured by the DMFT index and dental fluorosis by the TF index. The chi-square test, t test, and subsequently logistic regression were applied for data analysis.

RESULTS

Caries experience (DMFT≠0) was significantly higher in students from areas not exposed to fluoridated water, after adjustments to clinical conditions, demographic socioeconomic profile, and hygiene habits. The DMFT mean (±SD) was significantly higher in students from areas not exposed to fluoridated water than exposed (3.83 [±3.28] and 2.48 [±2.71] respectively). The prevalence of very mild/mild and moderate fluorosis was 41.1% and 21% for students either exposed to fluoridated water or not, respectively.

CONCLUSION

Exposure to fluoridated water was associated with a lower prevalence and severity of tooth decay, in spite of the use of fluoridated toothpaste. The prevalence of dental fluorosis at all levels was higher in fluoridated areas, however, in both groups, there were few cases with esthetic implications.

Hypomineralized Teeth Have a Higher Frequency of Dental Hypersensitivity

Purpose: The purposes of this study were to: (1) compare dental hypersensitivity (DH) between hypomineralized permanent first molars and unaffected controls molars in patients with molar-incisor hypomineralization (MIH); and (2) assess the influence of opacity, color, and subject age on DH. Methods: This cross-sectional study identified 40 children/adolescents, who were attending a children's dental clinic and had one to three first permanent molars hypomineralized (demarcated opacities). The severity and color of the hypomineralized lesions were also evaluated. The assessment of DH was made using evaporative stimulus using a jet of compressed air applied by a dental syringe for one second, perpendicular to the occlusal surface employing the visual analogue scale (VAS) and the Schiff cold air sensitivity scale (SCASS). To verify the association between the presence or absence of DH and MIH, Pearson's chi-square and Fisher's exact test (P<0.05) were performed. Results: The frequency of DH was 28.0 percent in hypomineralized teeth and 9.4 percent in normal controls (by VAS; P=0.002). A higher frequency of opacities was observed (P<0.001). Older individuals had DH more frequently (P<0.05). Conclusions: Hypomineralized molars presented a higher frequency of dental hypersensitivity than control teeth, and dental hypersensitivity was associated with darker opacities of the lesion and older-aged subjects.

Breathing problems, being an only child and having parents with possible sleep bruxism are associated with probable sleep bruxism in preschoolers: a population-based study

PURPOSE

To determine the prevalence of probable sleep bruxism (SB) in preschoolers and associated factors.

METHODS

A cross-sectional, population-based study was carried out with 862 dyads of parents/preschoolers aged 5 from Teresina, Brazil. Data collection was performed through a questionnaire answered by parents/guardians about socioeconomic, demographic, and health condition data. Each child was examined for diagnosis of probable SB based on the presence of dental wear associated or not with the report of teeth grinding by parents/guardians. The analysis of independent variables was stratified into four levels of determinants: demographic characteristics of the child (distal), characteristics of the family, environmental factors (intermediate), and health conditions (proximal). Descriptive analysis and bivariate and multivariate Poisson's regression were performed using a hierarchical approach (p < 0.05).

RESULTS

The prevalence of probable SB was 36%. In the final adjusted multivariate hierarchical model, a preschooler who was the only child (PR = 1.25; 95%CI = 1.02-1.51), with breathing problems (PR = 1.43; 95%CI = 1.19-1.73), and having parents/guardians with possible sleep bruxism (PR = 1.65; 95%CI = 1.32-2.07) had a higher prevalence of probable SB.

CONCLUSION

The prevalence of probable SB in preschoolers was high and associated with the condition of being an only child, the presence of breathing problems, and having parents/guardians with possible sleep bruxism.

Consumption of Acidic Beverages is a Predisposing Factor for Erosive Tooth Wear in Preschool Children: A Population-based Study

Purpose: In a cross-sectional population-based study of 888 5-year-old preschoolers from Teresina, Brazil, to determine the prevalence and factors associated with erosive tooth wear (ETW).
Materials and Methods: In a questionnaire, parents provided information on sociodemographic factors, their children's eating/drinking habits, and oral health. Dental examination was performed at the schools by two calibrated examiners for the diagnosis of ETW, following the criteria of the modified O'Brien Index.
Results: The prevalence of ETW was 3.3%. The maxillary incisors were the most highly affected teeth, followed by the mandibular and maxillary molars. The majority of the lesions reached only the enamel (72.1%) and up to 1/3 of the dental surface (63.1%). The occlusal surface was the most affected (47.8%). Preschoolers who had an acidic food-consumption profile had a 2.74 times (95% CI = 1.03-7.30) higher chance of having ETW than children without this profile.
Conclusion: The prevalence of erosive tooth wear on the deciduous teeth was low and associated with the consumption of acidic beverages.

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Oromandibular Limb Hypogenesis Syndrome: Overlap of Moebius and Ankyloglossia Superior With Severe Limb Defects

The oromandibular limb hypogenesis syndromes (OLHS) represent a group of rare conditions characterized by congenital malformations involving the tongue, mandible, and limbs. In this report, we describe a newborn girl with paralysis of abducens and facial nerves, transverse agenesis of the distal segments of the limbs, micrognathia, cleft lip and palate, and ankyloglossia superior. This observation confirms an overlap between Moebius syndrome and ankyloglossia superior syndrome with severe limb defects. The etiology of the OLHS is not clearly understood. The intriguing link between facial and limb anomalies can result from their simultaneous development from the fourth to eighth week of gestation, making both areas susceptible to the same teratogenic stimuli. There is an overlap between OLHS conditions, supporting a clustering, rather than a divided nosology and requiring an appropriate classification of these conditions. Patients with OLHS can be successfully managed using a multidisciplinary approach.

Prevalence of Enamel Defects in Premolars Whose Predecessors Were Treated with Extractions or Antibiotic Paste

PURPOSE

To determine the prevalence of developmental defects of the enamel (DDE) in premolars whose infected predecessors were submitted to pulp therapy with antibiotic paste or extractions due to pulp necrosis.

MATERIALS AND METHODS

A cross-sectional study with a consecutive sample consisting of children and adolescents who presented with fully erupted premolars, was evaluated. Data were collected by dental examinations, in which the modified DDE index was applied. Dental records were evaluated and three groups of premolars were determined according to the clinical history of predecessors: GCTZ: with pulp necrosis and treated with CTZ (chloramphenicol, tetracycline, zinc oxide and eugenol) paste; GE: with pulp necrosis and treated by extraction; GH: healthy and physiologically exfoliated. Descriptive analysis and a logistic regression (p <0.05) were performed.

RESULTS

The study included 1017 premolars, DDE was present in 22.5%. Premolars belonging to the GE group presented higher odds of DDE (odds ratio (OR) = 3.52, 95% CI:2.29-5.40) than those of GCTZ group (OR = 2.43, 95% CI:1.51-3.91) and GH group (p <0.01). Enamel defects were more frequent in maxillary premolars (OR = 3.22, 95% CI:1.65-6.27, OR = 3.39, 95% CI:1.67-6.90, OR = 2.90, 95% CI:1.48-5.66 and OR = 3.10, 95% CI:1.54-6.23).

CONCLUSIONS

The prevalence of enamel defects was higher in premolars whose predecessors were removed because of necrosis, followed by those treated with CTZ paste and those that were healthy by the time exfoliation occurred.

Pre-term birth and asthma is associated with hypomineralized second primary molars in pre-schoolers: A population-based study

BACKGROUND

Hypomineralized second primary molar (HSPM) is a developmental enamel defect that represents a caries-risk factor. There are few studies about HSPM epidemiology in representative populations.

AIM

To determine the prevalence and factors associated with HSPM in pre-schoolers.

DESIGN

This is a cross-sectional population-based study of 5-year-old pre-schoolers from Teresina, Brazil. The sample was randomly selected and stratified by geographic region of the city, type of school (public and private), and sex of the pre-schoolers (n = 811). Sociodemographic status and pre-, peri-, and post-natal conditions were collected by structured questionnaires. Two calibrated examiners diagnosed HSPM using the criteria of the European Academy of Paediatric Dentistry for molar-incisor hypomineralization. Severity, colour, location, and extent of lesions were also evaluated. Descriptive analysis of the data and a Poisson regression analysis were performed (P < .05).

RESULTS

The prevalence of HSPM was 14.9. Demarcated opacities (75.6%) and white/cream colour were the most prevalent (71.4%). Pre-term pre-schoolers had 66% (PR = 1.66, 95% CI = 1.07-2.58), and those who reported asthma in the first year of life had 69% (PR = 1.69, 95% CI = 1.01-2.85) higher prevalence of HSPM.

CONCLUSIONS

Pre-term birth and reported asthma in the first year of life were associated with HSPM. The prevalence of HSPM in pre-schoolers aged 5 years old in Teresina was high.

Does low-cost GIC have the same survival rate as high-viscosity GIC in atraumatic restorative treatments? A RCT

Atraumatic Restorative Treatment (ART) is one of the strategies used to control dental caries; it involves hand instruments for removal of carious tissue, and restorations using high-viscosity Glass Ionomer Cement (GIC). The present controlled clinical trial aimed to evaluate the performance of low-cost GIC indicated for ART in primary teeth, compared with high-viscosity GIC, after one year of follow-up. Two-to six-year-old children with dentin caries lesions on one or two surfaces of anterior and posterior teeth were selected. The children were randomly assigned to 2 groups according to the restorative material used: G1 (control) - Ketac Molar®; G2 (experimental) - Vitro Molar®. Treatments were performed in a school setting, following the guidelines of the ART. A total of 728 restorations were performed in 243 children. Descriptive analysis and Poisson regression were applied, with a significance level of p < 0.05. After 12 months, 559 (76.8%) restorations were re-evaluated. The success rate was evaluated by the prevalence ratio (PR), associated with restorations performed in primary second molars (PR = 1.21; 95%CI = 1.03-1.42), and with small (PR = 1.35; 95%CI = 1.14-1.60) or medium cavities (PR = 1.29; 95%CI = 1.08-1.55), using Ketac Molar® material (PR= 1.07; 95%CI = 1.01-1.15), considering p < 0.05. Small or medium restorations in primary second molars performed with high-viscosity GIC (Ketac Molar®) were more successful than restorations performed with low-cost GIC indicated for ART.

Impact of Developmental enamel defects on quality of life in 5-year-old children

BACKGROUND

Developmental enamel defects (DDE) represent one of the prevalent oral problems in childhood; however, few studies have evaluated its impact on quality of life in the children's own perception.

AIM

To evaluate the DDE impact on quality of life of 5-year-old children.

METHODS

This cross-sectional observational study assessed 566 children aged 5 years old, in Teresina, Piauí, Brazil, according to their self-perceptions. Children answered the Pediatric Quality of Life Inventory^™ Version 4.0 and Oral Health Scale. The dmft index, modified DDE index and Foster and Hamilton criteria were used to diagnose dental caries, DDE and malocclusion, respectively. A single examiner performed the clinical examination. Descriptive analyses and Poisson regression with robust variance were performed.

RESULTS

The prevalence of DDE was 33.7%. For children's self-reports, the presence of DDE had a negative association with oral health-related quality of life (OHRQoL; PR 1.09, 95% CI 1.02-1.15). Enamel hypoplasia had a negative impact on the physical function (PR 1.05; 95% CI 1.01-1.10) and oral health (PR 1.06, 95% CI 1.01-1.11) domains. Diffuse opacity had a negative impact on the social aspect (PR 1.09, 95% CI 1.02-1.18).

CONCLUSIONS

Enamel defects had a negative impact on OHRQoL according to the self-reports of the children.

Quilombola children and adolescents show high prevalence of developmental defects of enamel

Teeth with developmental defects of enamel (DDE) have porous and/or uneven enamel, making them more susceptible to the build-up of oral biofilm and development of caries and periodontal diseases. The aim of this cross-sectional study was to determine the prevalence of DDE and associated factors among children and adolescents living in a Quilombola community in the Northeast of Brazil. The study population was census-based and comprised individuals aged three to 14 years. The children's parents/guardians answered a questionnaire devised to collect information on socioeconomic and demographic characteristics, health problems during pregnancy and illnesses during early childhood. DDE was diagnosed using the modified DDE index. The data were analyzed using descriptive statistics and Poisson regression with robust standard errors (p<0.05). A total of 406 individuals were examined. DDE prevalence was 80.5%: 42.2% in deciduous teeth and 61.1% in permanent teeth. There was an association between presence of DDE and age (PR=1.09, 95% CI=1.01-1.17), use of antibiotics during pregnancy (PR=1.14, 95% CI=1.07-1.22) and reported malnutrition during early childhood (PR=1.12; 95% CI=1.03-1.22). The findings reveal high prevalence of DDE among children and adolescents living in the Quilombola community. Associated factors were older age, use of antibiotics during pregnancy and malnutrition during early childhood.

Attention to Oral Health of Children: Report of Experience in the Context of Implementation of the Vale Sorriso Project / Atenção à Saúde Bucal de Crianças: Relato de Experiência no contexto da Implantação do Projeto Vale Sorriso / Atención a la Salud Bucal de Niños: Relato de Experiencia en el Contexto de la Implantación

Objetivo: Relatar a experiência de implantação de um projeto de atenção integral à saúde bucal de crianças em uma comunidade do nordeste brasileiro. Metodologia: Trata-se de um estudo descritivo, do tipo relato de experiência, elaborado a partir de reflexões dos autores sobre implantação de ações voltadas à promoção da saúde bucal de crianças de 0 a 36 meses, desenvolvidas desde 2011 em uma Unidade Básica de Saúde, Piauí, Brasil. As atividades priorizam o diálogo com o cuidador favorecendo o fortalecimento da corresponsabilização, e são desenvolvidas como rotina das ações da equipe, propiciando a construção da integralidade. Resultados: O método utilizado convida o cuidador a ser disseminador e participante ativo do processo de promoção da saúde, fortalecendo a autonomia e também o vínculo com a criança. Considerações finais: Essa vivência tem um valor significativo, uma vez que mostra ser possível, dentro da Atenção Básica, o desenvolvimento de uma proposta que produz efeitos na saúde bucal dessas crianças contribuindo para melhoria da sua saúde geral.Descritores: Saúde bucal. Atenção integral à saúde da criança. Atenção básica. Estratégia da Saúde da Família. Pesquisa qualitativa.

Oral health children´s workshop: a report of experience / Oficina saúde bucal da criança: relato de experiência / Taller salud bucal del niño: um relato de experiencia

Objetivo: apresentar relato de experiência sobre a atividade educativa relacionada à atenção integral e à saúde bucal de crianças em uma comunidade do nordeste brasileiro. Metodologia: Trata-se de um estudo descritivo, do tipo relato de experiência, elaborado a partir de reflexões diante de práticas da equipe de Saúde da Família do município de Barras, Piauí. Diz respeito ao desenvolvimento da Oficina Saúde da Criança, realizada no período de novembro de 2017 a fevereiro de 2018. A ação foi planejada em três etapas: diagnostico situacional em saúde; elaboração do plano de ação; e, monitoramento e avaliação. Resultados e Discussão: a experiência identificou baixo nível sócio econômico; condições sanitárias precárias; alto índice de cárie e gengivite acometendo crianças de três a sete anos. A Oficina da criança estimulou a percepção do autocuidado e da saúde bucal de cuidadores e crianças que participaram da ação. O monitoramento apontou para a necessidade de continuidade e ampliação das ações de promoção e prevenção em saúde bucal. Conclusão: Essa oficina constituiu uma estratégia importante para disparar boas práticas de saúde de crianças e cuidadores, além de provocar a participação de toda a equipe de saúde e equipe pedagógica na construção de ações de saúde.Descritores: Promoção da saúde. Educação em Saúde. Saúde Bucal. Atenção Integral à Saúde da Criança.

Cellular profile of primary molars with pulp necrosis after treatment with antibiotic paste

The interradicular region of primary molars is permeated by many foramina, channels and accessories that connect the pulp cavity with the periapical tissues anatomically. Thus, pulp decomposition products or drugs used in endodontic treatment can trigger inflammatory reactions. The aim of this study was to evaluate the blood cell profile of the alveolar region after extraction of primary molars treated with CTZ paste. Forty-eight primary molars were selected with clinical and radiographic signs of extraction. The sample was divided into three groups with 16 teeth each: Group 1-healthy teeth; Group 2-untreated decayed teeth; and Group 3-teeth treated with CTZ paste. Immediately after the extraction, blood from the interface of the tooth socket was collected and smears were performed for further evaluation. The slides were stained by the Fast Panoptic® method and analysed by two previously trained examiners who counted the leucocytes in sets of 100 cells/slide, differentiating them into neutrophils, lymphocytes, monocytes, eosinophils and basophils. The data were analysed statistically by the MANOVA test. The blood samples from Group 2 differed significantly from Group 1 samples for all classes of leucocytes, except basophils, with higher average for lymphocytes (62.56), monocytes (7.81) and eosinophils (2.31). For Group 3, there was a relative difference (P < 0.05) to Group 2, of monocytes and eosinophils values. The blood cellularity interface in the tooth socket of primary teeth treated with CTZ paste is similar to those of healthy, exfoliated teeth and physiologically different from untreated decayed teeth.

Prevalence and associated factors to sleep bruxism in adolescents from Teresina, Piauí

INTRODUCTION

Sleep bruxism (SB) is defined as a repetitive jaw muscle activity whose epidemiology in adolescents has been little studied. This cross-sectional study aimed to determine the prevalence of sleep bruxism and associated factors in adolescents.

METHODOLOGY

The sample consisted of 594 students aged 11 to 14 years old from Teresina, Piauí, Brazil. Self-administered questionnaire was answered by parents/caregivers and dental clinical examination was performed. Pearson's chi-squared test was used to assess the association between SB and independent variables. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio (PR).

RESULTS

The prevalence of SB in adolescents was 22.2%. Multivariate analysis showed a higher prevalence of SB in male gender adolescents (PR = 1.41; 95%CI 1.04 - 1.89), presenting snoring (PR = 1.39; 95%CI 1.02 - 1.89) and difficulty falling asleep (PR = 1.92; 95%CI 1.38 - 2.66).

CONCLUSION

SB is a frequent condition in adolescents, and the factors associated with its prevalence were: male sex, snoring and difficulty falling asleep.

Molar incisor hypomineralization in HIV-infected children and adolescents

The objective was to determine the prevalence of molar incisor hypomineralization (MIH) among individuals between 7 and 15 years old infected or noninfected with human immunodeficiency virus (HIV). The study was conducted with 33 HIV-infected individuals (study group; SG) and 66 non-HIV-infected schoolchildren (control group; CG), paired by gender and age. Data collection was based on medical records (SG), a questionnaire for caregivers and oral examination for diagnosis of MIH (European Academy of Pediatric Dentistry criteria) and caries (DMFT index and ICDAS). Data were analyzed with Mann-Whitney, chi-square, and Fisher's exact tests and logistic regression. In SG, MIH (45.5%) and caries (87.9%) had higher prevalence. MIH was associated with use of protease inhibitors in SG (OR: 2.14; 95% CI: 1.21 to 3.77) and incubator need in CG (OR: 2.80; 95% CI: 1.71 to 9.10). HIV-infected patients had a higher prevalence of MIH and dental caries in the permanent dentition.

Dental enamel development defects in children and adolescents with HIV infection: case-control study

To determine the frequency of Enamel Development Defects (DDE) and associated factors in children and adolescents infected with HIV. A case-control study was conducted in HIV-infected patients (n = 52), aged 3 to 15, and a control group formed by preschool and schoolchildren (n = 104) matched according to gender, age and household income. Data on medical history, neonatal and maternal conditions were obtained. For diagnosis of enamel defects was used modified DDE Index. DDE frequency was 61.5% in the case group and 58.7% in the control group (p = 0.569). Infection of the genitourinary tract and maternal hemorrhage were factors associated with DDE in the case and control groups, respectively. An association was observed between the use of antiretroviral regimens with protease inhibitors or efavirenz and DDE in the permanent dentition. Children and adolescents HIV-infected showed a DDE frequency similar to healthy patients, but factors associated with this condition were different between the groups.

Vigilância epidemiológica da fluorose dentária em município de clima tropical com água de abastecimento público fluoretada

Resumo O objetivo deste estudo foi avaliar a prevalência e a severidade de fluorose dentária em escolares de 11 a 14 anos de idade em Teresina (PI) Brasil, município de clima tropical com água de abastecimento público fluoretada. Estudo do tipo observacional transversal no qual foram avaliadas 571 crianças distribuídas nas redes pública e particular de ensino. A coleta de dados foi realizada nas unidades escolares, após recolhimento do Termo de Consentimento Livre e Esclarecido (TCLE) e questionário respondido pelos pais referentes às condições socioeconômicas e demográficas e aos hábitos de higiene bucal. O exame dentário foi realizado por um cirurgião-dentista calibrado. O índice aplicado foi o Thylstrup e Fejerskov (TF). A prevalência de fluorose foi de 77,9%, e apenas 12,5% das crianças acometidas apresentaram TF ≥ 3, grau com comprometimento estético. Os pré-molares foram os dentes mais afetados pela fluorose. Dentre os escolares com maior severidade de fluorose, 98,6% dos pertenciam à classe social mais baixa (>B2), 91,5% nasceram e sempre moraram em Teresina, 94,4% consumiam água de abastecimento fluoretada, 76% usaram dentifrício infantil e 64% as mães relataram que engoliam dentifrício. A prevalência de fluorose foi elevada, mas com baixa severidade, em indivíduos expostos à fluoretação desde o nascimento.

Caries, Toothbrushing Habits, and Fluoride Intake From Toothpaste by Brazilian Children According to Socioeconomic Status

PURPOSE

The purpose of this study was to evaluate the prevalence of dental caries, toothbrushing habits, fluoride intake, and factors associated with the use of toothpaste in Brazilian children according to socioeconomic status (SES).

METHODS

A cross-sectional observational study was conducted with 148 three- to four-year-olds of both low and high socioeconomic status. Data collection consisted of administering a questionnaire to guardians, brushing to determine fluoride intake, and examining the children's teeth to evaluate dental caries.

RESULTS

In this study, 42 percent of children from high SES and 2.7 percent of children from low SES used toothpaste without fluoride or with a concentration below 1,000 ppm F. Fluoride intake was associated with SES, frequency of brushing, the amount of toothpaste used, and the concentration of fluoride present in toothpastes (P<0.05). Low SES children had a higher fluoride intake during brushing (0.045 mg F/kg body weight/day), compared to high SES children (0.023 mg F/kg body weight/day). Unlike low SES children (68.9 percent), all high SES children were caries free.

CONCLUSIONS

A lower socioeconomic status was associated with a higher prevalence of dental caries and a higher intake of fluoride from toothpaste.

Total Fluoride Intake by Children from a Tropical Brazilian City

The main sources of fluoride intake by children are fluoridated water and toothpaste. Little has been studied regarding fluoride intake from these sources in regions with tropical climates and high temperatures throughout the year. This study aimed to determine the amount of fluoride ingested from diet and tooth brushing by children who live in a city with a tropical climate. Sixty-seven children from Teresina, Piauí, Brazil, took part in this study. The city's water supply was optimally fluoridated. The duplicate-diet method was used to determine the fluoride intake from diet. The intake of fluoride from dentifrice was determined by subtracting the amount of fluoride placed on the toothbrush and that recovered after brushing. The concentration of fluoride was measured using an ion-specific electrode and is expressed as milligrams/kilogram of body weight/day. The mean (±SD) total amount was 0.071 ± 0.036 mg F/kg body weight/day, and the relative contributions of diet and toothpaste were 0.025 ± 0.010 and 0.046 ± 0.035, respectively. The factors associated with fluoride intake from toothpaste were: use of children's toothpaste (p = 0.003), use of large amounts of toothpaste (p < 0.001), and a high frequency of tooth brushing (p = 0.003). Sixty-four percent of children had an intake of less than 0.07 mg F/kg body weight/day, which is considered the upper limit for an aesthetically tolerable fluorosis risk. The results suggest that the amount of fluoride ingested by most children who live in a Brazilian city with a tropical climate is considered safe in terms of the risk of dental fluorosis.

Epidemiologic Study of Molar-incisor Hypomineralization in Schoolchildren in North-eastern Brazil

PURPOSE

To determine the prevalence of molar-incisor hypomineralization (MIH) in children and possible factors associated with this disorder.

METHODS

This was a cross-sectional observational study of 594 11- to 14-year-olds from Teresina, Piauí, Brazil. The diagnosis of MIH was made based on criteria set by the European Academy of Pediatric Dentistry. To investigate possible associated factors, mothers completed a questionnaire. A descriptive analysis of the data, chi-square, Mann-Whitney, and Fisher tests and Poisson regression (PR) were performed.

RESULTS

The prevalence of MIH was 18.4 percent (95 percent confidence interval [CI] equals 15.20 to 21.50). The maxillary molars were the teeth most affected by MIH (36.1 percent). MIH patients showed a higher number of mean DMF-T (PR equals 2.18; 95 percent CI equals 1.46 to 2.85) than those not affected by the condition. There was an association between MIH and preterm birth (PR equals 1.76; 95 percent CI equals 1.22 to 2.12) and between MIH and respiratory distress at birth (PR equals 1.83; 95 percent CI equals 1.25 to 2.18).

CONCLUSIONS

The prevalence of MIH in schoolchildren was 18.4 percent. Those with MIH had a greater mean DMF-T than those without MIH. Preterm birth and respiratory distress were associated with MIH.

Anomalias dentárias de número em pacientes ortodônticos

ResumoIntroduçãoA prevalência e a distribuição das anomalias dentárias de número variam de acordo com a população estudada.ObjetivoDeterminar a prevalência de anomalias dentárias de número, verificando-se a frequência com relação a gênero, localização e dentes mais acometidos.MétodoForam avaliadas 1.054 radiografias panorâmicas de pacientes com idade entre 5 e 30 anos, realizadas no período de janeiro a março de 2010, em uma clínica particular de diagnóstico por imagem de Teresina-PI. Foram registrados dados relativos a gênero, idade, presença ou ausência de anomalia, dente acometido e localização. Foram realizados os testes estatísticos Qui-quadrado de Pearson e Teste Binominal, para duas proporções.ResultadoA hipodontia, com prevalência de 4,9%, foi encontrada com mais frequência na maxila, não apresentando diferença entre os lados e os gêneros. Os dentes mais ausentes foram: incisivos laterais superiores e segundo pré-molar inferior. Em relação à hiperdontia, com prevalência de 4,0%, não foram observadas diferenças entre gêneros, lados e maxilares. As regiões com maior presença de supranumerários foram: distal dos terceiros molares e entre pré-molares inferiores.ConclusãoFoi observada prevalência de hipodontia de 4,9%, sendo mais comum na maxila, e de hiperdontia de 4%, não apresentando diferença entre maxilares, lados e gêneros.

Crown-root fracture with pulp exposure: a case report with 16-year follow-up

A 12-year-old boy presented for dental care 35 days after he fell from his bicycle. Clinical and radiographic examinations revealed a longitudinal crown-root fracture with pulp exposure in the maxillary left central incisor. The radiograph also suggested necrosis of the maxillary right central incisor. Urgent treatment of the left central incisor involved gingivectomy followed by autogenous bonding of the tooth fragment with self-curing composite resin. Immediately after bonding, coronal access was prepared, chemical and mechanical preparation was completed, and a calcium hydroxide intracanal dressing was placed. One week after the initial appointment, endodontic treatment was initiated in the right central incisor. The root canal of the maxillary left central incisor was maintained with calcium hydroxide paste (replaced at 45-day intervals) for 1 year and then definitively obturated. At the 16-year follow-up, satisfactory periodontal, esthetic, and clinical conditions were observed, and a radiograph revealed no resorption or periapical changes.

Restorative management of severely ankylosed primary molars

Severe dentoalveolar ankylosis is an etiological factor for malocclusion. When infraocclusion occurs early, it progresses with time, leading to severe consequences in young children because of compensatory supra-eruption of the antagonist tooth and mesialization of adjacent teeth. Early diagnosis allows for interception of the problem and may prevent orthodontic treatment. The purpose of this manuscript is to report two cases of infraocclusion of primary mandibular second molars that were diagnosed early and were treated with composite resin crowns. The use of indirect composite restorations for ankylosed teeth is a good option for primary teeth with a moderate/ severe degree of ankylosis.

[Oral health in the family health strategy in a regional management territory of the state of Piaui]

The objective of this cross-sectional study was to assess the professional profile of dental-surgeons (DS) who work in the Family Health Strategy (FHS), and on the basis of this reflect upon aspects of the development of dental actions in primary health care in municipalities of a health region of the state of Piauí (Brazil) The study covered the nineteen municipalities of the region. The sample consisted of 111 dentists and data was collected using a questionnaire from August to December 2008. An Excel Ò database was created for the statistical analysis. The dentists were predominantly female, aged 20-39 years, with one to five years of professional experience. Most of them are specialists in a clinical field of dentistry and make home care visits. However, these visits are infrequent and without a health team and they rarely meet with the health team to compare notes. The results indicate that the problems that were detected are likely to be the same in other regions of the country. The lack of an interdisciplinary professional approach among DS is an issue to be properly addressed when examining the role of dentistry and its potentially unquestionable participation in the family health strategy.

Conduct of pediatricians in relation to the oral health of children

OBJECTIVE: Pediatricians are health professionals who treat the child during the first years of their life. The purpose of this study was to evaluate the conduct adopted by pediatricians regarding the oral health of children. METHOD: This was a descriptive cross-sectional observational study with a sample of 100 physicians specialized in pediatrics, working in the public and private sectors. A questionnaire was used for data collection, and the pediatricians were approached in their workplaces. RESULT: Most pediatricians (69%) belong to the female gender, with an average age of 48 years, and work in both the public and private sectors of health and have over 20 years of professional experience. Regarding their level of knowledge on oral health, 59% consider it to be good and 59% said that they had not been approached about this issue during their training in pediatrics. Ninety-two percent routinely examine the oral cavity of the baby; 64% recommend the use of fluoridated toothpaste, and 66.7% direct patients to a dental appointment in the first year of life. Regarding breastfeeding at night, 55.6% do not make the association between breastfeeding and the onset of early childhood caries. Furthermore, 74.7% do not justify the associations between the eruption of the first primary teeth and systemic manifestations, and 93% contraindicate the use of a dummy. CONCLUSION: It was concluded that pediatricians have proactive attitudes with regards to oral health. However, they need more information on the importance of fluoride for the control of dental caries

The impact of a dental program for maternal and infant health on the prevalence of dental fluorosis

PURPOSE

This study's purpose was to investigate the prevalence of dental fluorosis in children, whose parents had participated in an oral health program when the children were between zero and three years old, residing in a city with fluoridated water.

METHODS

Group 1 consisted of 128 eight- to 12-year-olds whose parents had visited a program on at least five occasions when the children were zero to three years old and received education about tooth-brushing and the proper use of fluoridated toothpaste in this young age group. The prevalence of dental fluorosis in the permanent maxillary incisors, using the Thylstrup-Fejerskov index, in Group 1 was compared to that of an age-matched group of children (n=128) whose parents had not participated in the program (Group 2).

RESULTS

Group 1 mothers reported higher education levels (P<.05). Group 1 children had a significantly lower prevalence (∼42 percent) and severity (P<.05) of dental fluorosis than those in the control group (∼61 percent).

CONCLUSION

Children whose parents participated in a dental program that included counselling on the proper amount of fluoridated toothpaste when their children were between zero and three years old presented less frequently with dental fluorosis than a control group when examined at eight to 12 years old.

Correlação entre saúde periodontal e idade gestacional

INTRODUÇÃO: O baixo peso de recém-nascidos (RN) é considerado um problema de saúde pública e, geralmente, é associado à prematuridade. A etiologia do parto prematuro é bastante complexa e, frequentemente, está relacionada a vários fatores. Diversas teorias têm correlacionado a saúde periodontal de gestantes com o nascimento de bebês prematuros (idade gestacional) e/ou com baixo peso ao nascer. OBJETIVO: O objetivo do presente estudo foi avaliar a possível correlação de saúde periodontal com idade gestacional e/ou com nascimento de bebês com baixo peso. MATERIAL E MÉTODO: Estudo observacional longitudinal prospectivo com gestantes que foram atendidas em um projeto de extensão da Universidade Federal do Piauí - Programa Preventivo para Gestantes e Bebês - PPGB. A coleta dos dados foi estruturada em dois momentos: 1º- Preenchimento de ficha contendo dados relativos à saúde geral e exame periodontal completo, e 2º- Coleta de dados referentes a tipo de parto, duração da gestação, peso e condição de saúde do bebê. RESULTADO: De 62 gestantes atendidas, 43 participaram do segundo momento do estudo. Ocorreu uma predominância de gestantes com idade entre 25 e 35 anos (55,81%). O índice de sangramento gengival variou de 1,19% a 92,50%. A média do peso dos bebês foi 3.365,33 g e do tempo gestacional foi 39,33 semanas. CONCLUSÃO: Os resultados deste estudo não deram suporte à hipótese de que a doença periodontal está associada à idade gestacional.

Impacto de um projeto de extensão universitária na formação profissional de egressos de uma universidade pública

INTRODUÇÃO: Dentre as competências necessárias à formação profissional em Odontologia no Brasil, está aquela destinada à atuação nos serviços de saúde. Nesse processo de formação, a participação em programas de extensão universitária amplia as possibilidades de aprendizado por permitir a vivência entre os ambientes acadêmico e comunitário. OBJETIVO: Determinar o impacto que as informações e ações desenvolvidas em um programa de extensão universitária exerceram na formação profissional de egressos de uma universidade pública. MATERIAL E MÉTODO: Foi realizado um estudo observacional transversal descritivo. A população do estudo foi composta por 268 cirurgiões-dentistas, que participaram do projeto de extensão universitária do curso de Odontologia da Universidade Federal do Piauí - Programa Preventivo para Gestantes e Bebês, no período de 1997 a 2011. Foi utilizado questionário enviado por e-mail como instrumento de coleta de dados, incluindo perguntas relativas à importância que o programa exerceu na qualificação profissional dos ex-estagiários. RESULTADO: O percentual de resposta foi de 52,6%, ou seja, 141 cirurgiões-dentistas responderam ao questionário. Os resultados apontaram que 98,6% dos sujeitos classificaram o Programa Preventivo para Gestantes e Bebês como ótimo; 91,5% declararam aplicar os conhecimentos adquiridos no projeto em sua rotina profissional; 28,4% implantaram programas semelhantes; 85,8% atendem gestantes em suas rotinas de trabalho e, destes, 19,8% relataram dificuldade nos atendimentos; 69,5% atendem bebês em suas rotinas de trabalho e, destes, 63,3% se sentem capacitados para executar procedimentos clínicos. CONCLUSÃO: As informações e ações desenvolvidas no Programa Preventivo para Gestantes e Bebês apresentaram impacto positivo na qualificação profissional de egressos, contribuindo para que os mesmos atuem com segurança nos atendimentos de gestantes e bebês.

Crown-root fracture of fused primary teeth--a case report

In the primary dentition, traumatic injuries affecting the tooth-supporting structures are common due to increased bone resilience in children. Crown-root fracture, defined as a fracture involving enamel, dentin, and cementum, is uncommon in the primary dentition, comprising only 2% of dental traumas. This article reports the treatment and follow-up of a 2-year-old boy who suffered a traumatic crown-root fracture involving a primary anterior incisor that was fused to a supernumerary tooth.

Reattachment of fractured fragment of an anterior tooth: case report and nine-year follow-up

This article reports the treatment and follow-up of a 10-year-old boy who had a politraumatic accident that resulted in severe displacement and fracture of the maxillary right central incisor. After clinical and radiographic examination, the tooth fragment was bonded with adhesive and the tooth crown underwent nonrigid splinting. Follow-up appointments were scheduled once a week during the first month, once during the second month, and every three months thereafter. Each follow-up appointment included a clinical examination, followed by radiographic and pulp sensitivity tests. After the fifth year, pulp necrosis was diagnosed following a sensitivity test and a periapical radiograph. Endodontic treatment was performed; the chemical-mechanical preparation and root canal fillings used calcium hydroxide paste manipulated with saline solution. The abovementioned paste was replaced twice during the first month; after that, propylenoglycol was used as the vehicle for manipulating the calcium hydroxide. The filling paste was replaced whenever the radiographic image showed resorption of the paste. The root canals were filled definitively seven years postaccident. Nine years postaccident, clinical and radiographic examination revealed a normal aspect.

[Profile and procedures of the community health agents regarding oral health in the countryside of Piauí State, Brazil]

The aim of this survey was to draw the demographic profile and the actions concerning oral health carried out by the communitarian agents of health, in small towns of Piauí State, Brazil. Four towns were chosen: Agua Branca, Piracuruca, Queimada Nova e Simões. The method used was observational descriptive cross-sectional. One hundred and nine agents were assessed through questionnaires, with 28 multiples choice questions. Data was analyzed in Excel. It was possible to conclude that: the communitarian agents on the countryside of Piauí are predominantly females, married, age between 20-39, with one to three children, nine years of formal education, monthly income of one minimum salary, and has been living in their community for 24 years in average; the large majority of the agents has not received specific qualification to carry out their job, has not attended lectures on oral health, although almost half of them works on activities related to oral health, despite not registering them properly; they perceive themselves as having a fair knowledge of oral health, which coincided with the assessment collected by the questionnaire.

Interdisciplinary approach to traumatized permanent anterior teeth: case report and 10-year follow-up

This article presents a case report (including the 10-year follow-up) of a 10-year-old patient who suffered displacement of the maxillary right central incisor, intrusion of the maxillary left central incisor, and crown fractures to the mesial angles of these teeth as a result of dental trauma. Treatment involved an interdisciplinary approach that utilized a pediatric dentist, an endodontist, and an orthodontist.

Dental caries in children that participated in a dental program providing mother and child care

The main goal of this study was to evaluate the prevalence of caries in children that participate in a dental program attending mothers and children in Teresina, Piauí, Brazil. A selection was made of 343 children of both genders, from 3 to 6 years of age. The mothers answered questionnaires and children were examined at the Infant Dental Clinic of the Federal University of Piauí. The epidemiological index dmft was applied and active white spot lesions were included. The SPSS for Windows program, version 11.1 was used and non-parametric tests carried out (Friedman and Kruskal-Wallis). An alpha error of 5% (0.05) was considered for the null hypothesis of false rejection, with a confidence interval of 95%. The results showed that 57.5% (197) of the children were breast-fed for a period longer than 12 months. The mean dmft index and percentages of caries-free children at the age of 3 was 1.86 (58.82%); at 4 years of age 1.94 (57.60%); at 5 years of age 1.98 (56.86%) and at 6 years of age 2.42 (42.55%). The decay component (d) was prevalent at all ages. When active white spot lesions were added to the dmft index, there was an increase of 7.2% for children who had caries activity and/or previous caries experience and 2.61% for those with dmft equal to zero. The daily consumption of fermentable carbohydrates and free demand breast-feeding were factors increasing caries activity. Dental follow-up after the program and the number of daily brushings were shown to be factors providing protection against caries. Based on the results, the authors were able to conclude that the program caused a positive impact on caries disease control, as the number of dental appointments kept influenced the dmft index values in a statistically significant manner.

Conhecimentos e práticas em saúde bucal de mães que freqüentaram um programa odontológico de atenção materno-infantil

O objetivo do presente estudo foi avaliar a assimilação e as práticas preventivas em saúde bucal adotadas por mães de crianças que freqüentaram um programa odontológico de atenção materno infantil. O Programa Preventivo para Gestantes e Bebês (PPGB) é um programa de extensão vinculado à Universidade Federal do Piauí (UFPI), que tem como meta a conscientização de gestantes e mães de crianças de zero a 36 meses para a adoção de hábitos favoráveis à obtenção de saúde bucal. Realizou-se uma seleção aleatória de fichas clínicas de crianças que haviam participado do PPGB e, através destas fichas, foram enviadas cartas às mães. Houve um retorno de 281 mães, as quais foram submetidas a entrevistas envolvendo os temas abordados pelo programa. Pelos resultados obtidos, pôde-se concluir que as mães freqüentadoras do PPGB detêm um bom nível de informação e adotam, no âmbito familiar, práticas de saúde favoráveis ao controle e prevenção de doenças bucais.

Heterocontrole da fluoretação das águas em três cidades no Piauí, Brasil

O objetivo deste trabalho foi monitorar as concentrações de flúor na água de abastecimento público de Teresina, Floriano e Parnaíba, municípios do Piauí, Brasil. A coleta das amostras foi mensal por um período de um ano entre 2004 e 2005. Selecionaram-se aleatoriamente seis pontos de coleta de amostras de água em cada um dos três municípios, totalizando 576 amostras, sendo 192 por cidade. As análises de flúor foram realizadas em duplicata, utilizando-se um eletrodo específico. Os resultados demonstraram que a maioria da amostras ficou abaixo da concentração de flúor ideal e apenas 4,3% (n = 25) das amostras coletadas apresentaram valores aceitáveis de flúor (0,60 a 0,80ppm). Por cidade, o percentual de amostras aceitáveis foi de 7,8% (n = 15), 4,7% (n = 9) e 0,5% (n = 1) para Teresina, Floriano e Parnaíba, respectivamente. Conclui-se que as concentrações de flúor na água de abastecimento público das cidades avaliadas estão abaixo do ideal e que existe a necessidade de implantar medidas de controle e heterocontrole permanentes para garantir a eficácia da fluoretação de águas no Estado do Piauí.

In-vivo effects of fluoridated antiplaque dentifrice and bonding material on enamel demineralization adjacent to orthodontic appliances

INTRODUCTION

The effect of a fluoridated antiplaque dentifrice on the development of caries lesions adjacent to dental appliances bonded with ionomeric material is unknown.

METHODS

Fourteen orthodontic patients were randomly divided into 2 groups of 7. One group brushed 3 times a day with a fluoridated dentifrice, and the other used an experimental antiplaque fluoridated formulation. Bracket bases were randomly bonded with either resin-modified glass ionomer cement or composite resin to the buccal surfaces of either the maxillary left or right premolars in each subject. The teeth were banded, leaving a space on the buccal surface to allow dental plaque accumulation. After 28 days of dentifrice use, the teeth were extracted, and mineral loss in the enamel adjacent to the bonded material was assessed by cross-sectional microhardness.

RESULTS

Mineral loss in the enamel surrounding the bond with the resin-modified glass ionomer cement was lower (P <.05) than around the composite bond. Enamel demineralization was lower (P <.05) in subjects who used the experimental antiplaque fluoridated formulation than in those who used the fluoridated one.

CONCLUSIONS

The data suggest that an antiplaque fluoridated dentifrice is superior to one that is only fluoridated for reducing enamel demineralization adjacent to dental material bonded with composite, but the effect seems irrelevant when bonding is done with the ionomeric material.