Abstract Caries disease can lead to strong impact in terms of pain and suffering, to functional impairment, and to negative effects on quality of life. Studies have demonstrated that the impact on quality of life increases with dental caries severity, and few studies have assessed the relationship between caries activity and children’s oral health-related quality of life (OHRQoL). This cross-sectional study aimed to assess the impact of dental caries severity and activity on the OHRQoL of schoolchildren. The study was conducted with a sample of children aged 8 to 11 years from Pelotas, southern Brazil. Children answered the Child Perceptions Questionnaire 8–10, and socioeconomic data were collected. Children’s dental caries (Kappa value of 0.95), PUFA, traumatic dental injuries, and malocclusion were examined. The Mann-Whitney, Kruskal-Wallis, and Poisson regression tests were performed. A total of 119 children were included. Children with initial (mean ratio (MR) of 1.92; 95% confidence interval (95% CI) of 1.05–3.48), moderate (MR: 2.66; 95%CI: 1.44–4.90), and severe carious lesions (MR: 2.65; 95%CI: 1.46–4.79) had a greater impact on OHRQoL compared with those without carious lesions (p =0 .047). Children with active carious lesions exhibited a greater impact on OHRQoL (MR:1.53 and 95%CI: 1.11–2.11) when compared to those without active lesions (p = 0.019). The findings demonstrate an association between dental caries severity and activity and the OHRQoL of school-aged children.

RESUMO O objetivo deste trabalho é fornecer embasamento científico para condução do tratamento endodôntico em gestantes através de uma revisão de literatura e série de casos clínicos conduzidos em sessão única no projeto de extensão Atenção Odontológica Materno-infantil da Faculdade de Odontologia da Universidade Federal de Pelotas. As bases científicas abordam as principais dúvidas do profissional na condução do pré-natal odontológico: uso do exame radiográfico, anestésico local, prescrição de medicamentos, entre outros fatores essenciais no atendimento da gestante. As gestantes assistidas procuraram atendimento apresentando dor de origem dentária. Em dois casos foi diagnosticado pulpite irreversível sintomática, enquanto um terceiro se travava de periodontite apical aguda. Os procedimentos endodônticos foram realizados sob condições controladas e padronizadas, sob supervisão de um professor de Endodontia. O preparo dos canais radiculares foi realizado em sessão única, através de instrumentação mecanizada de cinemática reciprocante (Wave One® Gold Primary (Dentsply Sirona), sendo o comprimento dos canais determinado por meio de localizador foraminal FinePex (Schuster). A obturação dos canais foi realizada pela técnica do cone único com cones do sistema Wave One®. Após o tratamento endodôntico foi realizada blindagem coronária com resina composta cor A2 Z350 XT (3M ESPE). Os cuidados relacionados à condição gestacional estão destacados, sendo que as pacientes permanecem em acompanhamento no projeto. Conclui-se que o uso de localizadores foraminais e da instrumentação mecanizada, utilizando limas reciprocantes associadas à técnica de obturação com cone único padronizado para cada sistema representam avanços para a realização do tratamento endodôntico em pacientes gestantes devido ao menor tempo clínico e maior conforto do procedimento.

ABSTRACT The aim of this paper is to provide a scientific basis for conducting safe root canal treatment in pregnant women, illustrating with case reports treated in the extension project Maternal-Child Dental Care at the Federal University of Pelotas. The scientific bases address the main doubts of professionals when performing prenatal dental care: use of radiographic examination, local anesthetics, prescription of medications, among other essential factors in the care of pregnant women. The assisted pregnant women sought care with dental pain. In two cases symptomatic irreversible pulpitis was diagnosed, while a third was experiencing acute apical periodontitis. Endodontic procedures were performed under controlled and standardized conditions. The root canals were prepared in a single session, using mechanical instrumentation with reciprocating kinematics (Wave One® Gold Primary - Dentsply Sirona), and the root canal length was determined by an electronic apex locator FinePex (Schuster). Root canal filling was performed by the single cone technique with Wave One® gutta-percha points. After endodontic treatment, coronal sealing was performed with composite resin A2 Z350 XT (3M ESPE). The care related to the gestational condition is highlighted, and the patients remain under monitoring. It is concluded that the use of apical locators and mechanical instrumentation, using reciprocating files associated with the single cone obturation technique with a standardized cone for each system, represents advances for the accomplishment of endodontic treatment in pregnant patients due to the shorter clinical time and greater comfort of the procedure.

Resumo O objetivo deste estudo foi avaliar o processo inflamatório do tecido pulpar após o capeamento pulpar direto, realizado durante a gestação. Este estudo experimental envolveu 48 primeiros molares superiores de ratos Wistar fêmeas. Os procedimentos foram realizados em animais prenhes e não prenhes (n=20). Após as exposições pulpares, o capeamento pulpar direto foi efetuado com agregado trióxido mineral (MTA) ou restauração direta com resina composta. Nos grupos controle (n=4), nenhuma intervenção foi realizada. Os animais foram submetidos à eutanásia após 3 e 7 dias. Todos os cortes foram avaliados através de um microscópio ótico. Um patologista previamente calibrado realizou analise histológica descritiva e estabeleceu escores para intensidade da resposta inflamatória e para o grau de organização tecidual na região adjacente à exposição pulpar. O valor de Kappa intra-examinador foi 0,91. No período experimental de 3 dias, nos animais tratados com MTA, o infiltrado inflamatório estava ausente nos não prenhes, enquanto infiltrado inflamatório moderado estava presente nos animais prenhes. A resposta inflamatória variou de moderada a severa em ambos os grupos tratados apenas com resina composta. Após o periodo experimental de 7 dias, a resposta inflamatória foi mais intensa nos animais prenhes que nos não prenhes do grupo do MTA, enquanto esta diferença não foi tão evidente nos animais que receberam capeamento pulpar direto com resina composta. Pode-se concluir, que a gestação pode não exercer influência no processo inflamatório do tecido pulpar após proteção pulpar direta com resina composta; a qual foi sempre danosa aos tecidos pulpares. No entanto, a resposta tecidual ao capeamento pulpar com MTA foi mais favorável nos animais não prenhes.

Abstract The purpose of this study was to evaluate the inflammatory process following direct pulp capping during pregnancy. This experimental study involved 48 maxillary first molars of female Wistar rats. The procedures were performed in pregnant and non-pregnant animals (n =20 each). Direct pulp capping with mineral trioxide aggregate (MTA) and restoration with a light-cured resin composite was performed in half of exposed pulp specimens. In the other half of specimens, light-cured composite was placed directly on the exposed pulp. In the control groups (n=4 each), no intervention was performed. Animals were euthanized at 3 and 7 days. All sections (three per slide) were viewed under an optical microscope. One previously calibrated pathologist performed descriptive analysis and assigned scores for inflammatory response and tissue organization adjacent to the pulp exposure. The Kappa value for intra-examiner variability was 0.91. At 3 days, in animals treated with MTA, inflammatory infiltrate was absent in non-pregnant animals while mild inflammatory infiltrate was observed in some pregnant animals. The inflammatory response ranged from mild to severe in both groups treated with composite alone. At 7 days, the inflammatory response was more intense in pregnant than in non-pregnant animals treated with MTA; while this difference were not evident in animals treated with composite alone. In conclusion, pregnancy may not influence the inflammatory process following direct pulp capping with light-cured resin composite, which was always harmful to the pulp; while the tissue response after the direct pulp with MTA were more favorable in non-pregnant animals.

Abstract This study aimed to evaluate the influence of breastfeeding and pacifier use on the occlusal status of preschool children. A cross-sectional study was conducted with children (n = 489) aged 2–5 years in private and public schools in Pelotas, South Brazil. Mothers answered a questionnaire on demographic, socioeconomic and behavioral variables, including breastfeeding and non-nutritive sucking habits. Malocclusion was classified as normal/mild and moderate/severe, according to WHO criteria. The association between breastfeeding and pacifier use with malocclusion was tested using multivariate logistic regression. The prevalence of malocclusion was 37.83% (95%CI 33.52–42.14), and 57.87% of the children used a pacifier. A total of 46.01% of the sample was exclusively breastfed for 6 months, and 24.74% were never breastfed. Malocclusion was associated with pacifier use, and with both non-exclusively breastfed and never breastfed. After adjustments for demographic and socioeconomic variables, the children who used a pacifier and were never breastfed (OR = 19.08; 95%CI 8.54–42.63), or who used a pacifier and were not exclusively breastfed (OR = 13.74; 95%CI 6.11–30.92), showed worse occlusal conditions, compared with the children who were exclusively breastfed and never used a pacifier. Pacifier use modifies the relationship between breastfeeding and occlusal status.

Resumo Este estudo avaliou o pH, radiopacidade, efeito antimicrobiano, citotoxicidade e biocompatibilidae de materiais obturadores de dentes decíduos. Foram avaliados o cimento de óxido de zinco e eugenol (OZE), Vitapex e pasta Calen espessada com óxido de zinco (OZ), comparativamente a um material experimental à base de MTA. A radiopacidade foi testada usando uma escala milimetrada de alumínio, com um sensor digital. O pH dos materiais também foi avaliado nos períodos de 1, 4, 12 h; 1, 3, 7, 15, e 30 dias (n=5). O teste de contato direto foi utilizado para avaliação da atividade antimicrobiana dos materiais conta uma cepa de Enterococcus faecalis após incubação por 1, 4, 12, e 24 h (n=5). Para avaliação da citotoxicidade foi utilizado o teste de MTT para avaliação da viabilidade celular. No teste de biocompatibilidade, ratos Wistar receberam implantes subcutâneos contendo cada material obturador (n=5). Após biópsia, os tecidos foram submetidos à avaliação histológica em períodos de 15, 30 e 60 dias. Os resultados de radiopacidade, pH, ação antimicrobiana e citotoxicidade foram analisados usando os testes ANOVA e Tukey. Os dados histológicos foram submetidos ao teste de Kruskal-Wallis. O material experimental apresentou a menor radiopacidade (3.28 mm Al) e apresentou um pH superior a 12,0 durante todo o período experimental. O material experimental apresentou o maior efeito antimicrobiano, eliminando mais de 99,97% das bactérias em um período de 4 h. O Vitapex permitiu uma maior viabilidade celular em comparação aos demais materiais avaliados. Inicialmente, os testes de biocompatibilidade demonstraram inflamação de moderada a severa em todos os grupos. Após 60 dias, apenas o grupo Calen+ OZ apresentou inflamação moderada, enquanto os outros materiais demonstraram predominantemente a indução de inflamação leve. Os resultados demonstraram que o material experimental à base de MTA exibiu comportamento satisfatório com relação às propriedades avaliadas. Estudos adicionais, in vivo, são necessários para uma melhor avaliação do material.

Abstract This study assessed the pH, radiopacity, antimicrobial effect, cytotoxicity and biocompatibility of endodontic filling materials for primary teeth. Zinc oxide eugenol (ZOE), Vitapex and Calen paste thickened with zinc oxide (ZO) were evaluated in comparison to an experimental MTA-based material. Radiopacity was tested using a graduated aluminum stepwedge with a digital sensor (n=5). The materials pH was recorded at 1, 4, 12 h; 1, 3, 7, 15 and 30 days (n=5). Direct contact test was used to assess the antimicrobial efficacy against Enterococcus faecalis after 1, 4, 12, 24 h (n=5). Cytotoxicity assay used MTT test for cell viability after incubation for 1, 3 and 7 days (n=5). For biocompatibility test, Wistar rats had received implants containing each material (n=5). The biopsied tissues were histologically analyzed after 15, 30 and 60 days. The results of radiopacity, pH, antimicrobial capacity and cytotoxicity were analyzed using ANOVA and Tukey tests. The histological data were submitted to Kruskal-Wallis test. The experimental material presented the lowest radiopacity (3.28 mm Al) and had a pH>12.0 throughout the test period. The experimental material showed the highest antibacterial effect, killing over 99.97% bacteria in 4 h. Vitapex presented the highest cell viability. Initially, biocompatibility test showed moderate to severe inflammation in all groups. After 60 days, Calen+ZO group showed moderate inflammation, while the others showed predominantly mild inflammatory reaction. The present results demonstrated that the experimental MTA-based material exhibited satisfactory behavior regarding the studied properties. Additional in vivo studies are necessary for a better evaluation of the material.

Abstract The aim of this study was to assess the prevalence of black stains (BS) and factors associated with their occurrence and to investigate the association of BS with caries experience after adjusting for other risk indicators. A school-based, cross-sectional study using multistage sampling of children aged 10–12 years from 20 private and public schools in Pelotas/Southern Brazil was conducted (n = 706). Children were evaluated for BS and dental caries (DMFT/dmft index) and socioeconomic information was collected by questionnaire. Univariate and multivariate Poisson regressions were used to assess variables associated with the prevalence of BS and with caries experience. The prevalence of BS was 5.81%. The mean DMFT/dmft was 1.54 (±1.91), with a maximum value of 10. Among the children with BS, mean dmft/DMFT was 1.22 (SD 1.68), with a maximum value of 6. After adjustments for demographics and socioeconomic variables, dental plaque and tooth brushing habits, prevalence of BS was associated with lower caries experience (RR 0.67; 95%CI 0.49–0.92). In conclusion, the presence of BS showed an association with lower dental caries experience in the evaluated population. Future studies should investigate the mechanisms behind this association.

Early childhood caries (ECC) in the primary dentition of preschoolers remains high. Young children have limited access to oral healthcare, and oral health education (OHE) measures can be a valuable tool to prevent caries in this population. The aim of this study was to evaluate the impact of an early educational intervention on ECC prevention. The study group (SG) comprised 271 children aged 0-12 months and their mothers, who attended 12 selected public health centers (PHC). The SG received oral health instructions from a pamphlet and by verbal explanation of some topics. One year later, a similar sample of children from another 12 PHCs were selected to serve as the control (CG; n = 251). The children were examined to determine their caries status: decayed = cavitated and/or white spot lesion (maxillary anterior surface); missing; and filled surface index > 0. There was a one-year follow-up. Socioeconomic and demographic information was collected. Logistic regression was used to estimate the effects of the educational intervention on the ECC odds. A sample of 445 (SG = 194 and CG = 251) children remained to the end of the study and were examined. The prevalence of caries was 12.9% in the SG and 17.9% in the CG. The odds of caries were 80% higher in the CG than in the SG (p = 0.037). The strategy of providing OHE from a pamphlet and with a brief verbal instruction to mothers during their child’s first year of life can constitute a valuable tool for ECC prevention.

A significant number of children visit a dentist for the first time due to emergency situations. However, little is known regarding the prevalence, etiology, and treatment provided for children at emergency dental visits. This study aimed to evaluate the profile of children attending a dental school emergency clinic, the reasons for seeking dental care, and the treatment provided. Records of 270 patients who attended an emergency clinic during 2010 were analyzed, and 253 were selected. Demographic, diagnostic, and procedural information was collected. The mean child age was 7.8 years. For 208 children (82%), pain was the main reason for the emergency visit. Nearly 79% of the visits were due to caries, and the most frequently required treatment was endodontic intervention (31.22%). Of the decayed teeth, 61.70% were primary posterior teeth and 31.9% permanent posterior teeth. Pain caused by dental decay was the most frequent chief complaint. A large number of children were brought to the dentist with complaints that had started long before, for which over-the-counter medications had been used.

Este estudo retrospectivo avaliou o comportamento clínico e as razões de falhas de restaurações de resina composta em dentes anteriores e posteriores, realizadas por alunos de graduação em odontologia, após 3 anos de acompanhamento. Cento e dois pacientes que tiveram restaurações de resina composta colocadas por alunos do terceiro ou quarto ano foram rechamados e examinados para analisar a qualidade das restaurações. Todas as cavidades foram restauradas utilizando Prime & Bond 2.1 e TPH (Dentsply), de acordo com as orientações do fabricante. As restaurações foram avaliadas utilizando o sistema USPHS modificado. Duzentas e cinquenta e seis restaurações de resina composta, 170 em dentes anteriores e 86 em posteriores foram avaliadas. Destas restaurações, 85% foram consideradas satisfatórias após 3 anos. Cavidades de classe II e classe IV apresentaram maior prevalência de falhas. Perda de restaurações e adaptação marginal deficiente foram as maiores causas de falhas. Nenhuma restauração falhou em decorrência de cárie secundária. Em conclusão, restaurações de resina composta feitas por estudantes de odontologia foram na sua maioria consideradas satisfatórias após 3 anos. Falhas das restaurações foram mais prevalentes em restaurações maiores e não esteve associada com cárie secundária.

This retrospective study evaluated the clinical performance and the reasons for failure of anterior and posterior composite restorations placed by undergraduate dental students over a 3-year period. All cavities were restored using Prime & Bond 2.1 and TPH (Dentsply), according to the manufacturer's indications. One hundred and two patients who had received composite restorations by third and forth year undergraduate students were recalled and examined to analyze the quality of the restorations. The restorations were evaluated using the modified USPHS system. Two hundred and fifty-six composite restorations, 170 in anterior teeth and 86 in posterior teeth, were evaluated. Eighty-five percent of the restorations were considered satisfactory after 3 years. Class II and class IV restorations presented the highest prevalence of failure. Loss of the restoration and deficient marginal adaptation were the main causes of failure. No restoration failed due to secondary caries. Most restorations placed by dental students were considered satisfactory after long-term evaluation. Failure was more prevalent in larger restorations and was not associated with secondary caries.

Glass Ionomer Cements (GICs) have a wide range of uses in Dentistry, and the manipulation technique used can influence the results obtained. This study aimed at assessing the knowledge held by Dental School students from a city in Southern Brazil regarding the use of GIC, and the clinical technique chosen for its use and its applications. A structured questionnaire was applied to 60 advanced dental students. Descriptive statistics was used to analyze the quantitative data. All students had already used the material. Regarding the purpose for which the material was used, all students (100%) had used it as a dental cavity liner, 83.3% had used it as a temporary restorative material after endodontic treatment, and 73.3% had used it as a permanent restoration in primary teeth. Regarding the clinical technique used, 86.7% said that they insert the material while it still has a shiny surface, 33% said that they finish and polish the restoration in a following session, and only 28.3% said that they apply a surface protection immediately after the restoration is placed. Although students generally seem to be acquainted with the fundamental knowledge and main techniques involved in GIC use, they occasionally fail to follow all the technical steps required during clinical application, which may affect treatment outcome. Therefore, professors should stress that all the clinical procedures required during GIC application must be followed strictly to improve the performance of this material.

This study was carried out to evaluate in situ the influence of microleakage, surface roughness and biofilm control on caries formation around composite resin restorations. During 28 days, 12 volunteers wore palatal devices containing bovine enamel slabs restored with composite resin. Restorations were made without leakage, when the adhesive system was applied, or with leakage, when adhesive system was omitted. Half of the restorations in each group were finished and the remaining were finished and polished. In one side of the palatal device, biofilm was left to accumulate over the restored slabs, and in the other side dental slabs were brushed, to allow biofilm removal. There was an extraoral application of 20% sucrose solution (8x/day) over the enamel slabs. The formation of caries lesions (white spots) was evaluated by visual inspection under stereomicroscopy. Additionally, the dental slabs were sectioned and observed under polarized light microscopy. Data were submitted to Kruskal-Wallis test and Spearman's correlation test at 5% significance level. Polishing and bonding were not significant factors regarding white spot formation (p>0.05). Biofilm control (brushing) was associated with reduction of caries formation close to the restorations (p<0.01). Polarized light microscopy confirmed the visual inspection findings. These results suggest that while microleakage and surface roughness did not influence caries lesion formation, biofilm control may prevent the enamel demineralization.

OBJETIVO: O objetivo deste estudo foi investigar os determinantes sociais e biológicos, medidos no período perinatal e na infância, sobre a ocorrência de cárie dentária em crianças de 6 anos de idade. MÉTODOS: Foi realizado um estudo transversal de cárie dentária em 1999, em uma subamostra de 400 crianças pertencentes a uma coorte de nascidos vivos iniciada em 1993, em Pelotas, RS. Os índices e critérios de diagnóstico adotados foram os preconizados pela Organização Mundial da Saúde (1997). Os resultados do estudo de cárie foram inseridos no banco de dados da coorte, que continha informações sobre as condições sociais e de saúde coletadas ao nascimento, no primeiro, terceiro, sexto e décimo segundo meses e no sexto ano de vida da criança. O índice de cárie (ceo-d = 0 ou > 1) foi a variável dependente. Foram realizadas análises univariada e de regressão logística múltipla não condicional, tendo como base um modelo teórico hierárquico de determinação. RESULTADOS: Escolaridade materna abaixo ou igual a 8 anos, renda familiar menor que 6 salários mínimos, não freqüentar pré-escola e consumo de doces pelo menos uma vez ao dia aos 6 anos de idade foram fatores de risco à cárie. CONCLUSÕES: Os fatores de risco sociais, como baixa escolaridade materna e baixa renda familiar, não freqüentar a pré-escola e dieta inadequada são comuns à cárie dentária e outras doenças e agravos infantis, sugerindo que medidas de intervenção dirigidas a estes fatores seriam mais adequadas à prevenção da cárie do que medidas específicas.

OBJECTIVE: The aim of this study was to investigate the relationship between the social and biological conditions experienced in early life and dental caries in 6-year-old children, using a life course approach. METHODS: An oral health cross-sectional study was nested in a birth cohort study initiated in Pelotas, Brazil in 1993. In 1999, a sample of 400 6-year-old children was selected from the cohort. The criteria of the World Health Organization (1997) were used for dental caries. The results from the dental caries study were analyzed in relation to the socioeconomic and morbidity data collected at birth, and at 1, 3, 6 and 12 months, and the sixth year of life. Dental caries were measured through the decayed, missing and filled index (dmft). Unconditional univariate and multiple logistic regression analyses were performed according to a conceptual model. RESULTS: Risk factors for the occurrence of dental caries included maternal education equal or less than 8 years, family income lower than six minimum wages, not attending day care, and consumption of sweets at least once a day at age 6. CONCLUSIONS: Strategies for oral health care should include inter-sector approaches for health promotion based on a population strategy and a common risk approach.

OBJETIVO: O objetivo deste estudo foi investigar os determinantes sociais e biológicos, medidos no período perinatal e na infância, sobre a ocorrência de cárie dentária em crianças de 6 anos de idade. MÉTODOS: Foi realizado um estudo transversal de cárie dentária em 1999, em uma subamostra de 400 crianças pertencentes a uma coorte de nascidos vivos iniciada em 1993, em Pelotas, RS. Os índices e critérios de diagnóstico adotados foram os preconizados pela Organização Mundial da Saúde (1997). Os resultados do estudo de cárie foram inseridos no banco de dados da coorte, que continha informações sobre as condições sociais e de saúde coletadas ao nascimento, no primeiro, terceiro, sexto e décimo segundo meses e no sexto ano de vida da criança. O índice de cárie (ceo-d = 0 ou > 1) foi a variável dependente. Foram realizadas análises univariada e de regressão logística múltipla não condicional, tendo como base um modelo teórico hierárquico de determinação. RESULTADOS: Escolaridade materna abaixo ou igual a 8 anos, renda familiar menor que 6 salários mínimos, não freqüentar pré-escola e consumo de doces pelo menos uma vez ao dia aos 6 anos de idade foram fatores de risco à cárie. CONCLUSÕES: Os fatores de risco sociais, como baixa escolaridade materna e baixa renda familiar, não freqüentar a pré-escola e dieta inadequada são comuns à cárie dentária e outras doenças e agravos infantis, sugerindo que medidas de intervenção dirigidas a estes fatores seriam mais adequadas à prevenção da cárie do que medidas específicas.

OBJECTIVE: The aim of this study was to investigate the relationship between the social and biological conditions experienced in early life and dental caries in 6-year-old children, using a life course approach. METHODS: An oral health cross-sectional study was nested in a birth cohort study initiated in Pelotas, Brazil in 1993. In 1999, a sample of 400 6-year-old children was selected from the cohort. The criteria of the World Health Organization (1997) were used for dental caries. The results from the dental caries study were analyzed in relation to the socioeconomic and morbidity data collected at birth, and at 1, 3, 6 and 12 months, and the sixth year of life. Dental caries were measured through the decayed, missing and filled index (dmft). Unconditional univariate and multiple logistic regression analyses were performed according to a conceptual model. RESULTS: Risk factors for the occurrence of dental caries included maternal education equal or less than 8 years, family income lower than six minimum wages, not attending day care, and consumption of sweets at least once a day at age 6. CONCLUSIONS: Strategies for oral health care should include inter-sector approaches for health promotion based on a population strategy and a common risk approach.