ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Abstract This systematic review aimed to investigate if there is a better interceptive treatment for palatally displaced canines (PDC) in the mixed dentition stage. The PubMed/MEDLINE, CENTRAL, Scopus, and EMBASE databases were searched for randomized clinical trials related to the research topic. The gray literature and reference lists were also assessed. Network meta-analysis was conducted to analyze the effects of different approaches on PDC eruption. The surface under the cumulative ranking area was calculated to rank the treatments. The certainty of the evidence was evaluated using the GRADE approach. Of the 892 eligible studies, 18 were selected for full-text analysis and 9 for meta-analysis, involving 506 participants and 730 PDC, to compare 9 approaches. The proportion of erupted PDC was significantly higher for all interceptive treatments compared with control (no intervention). Furthermore, the proportion of erupted PDC was higher in patients subjected to rapid maxillary expansion (RME) than those who underwent double extraction of primary canine and primary molar (relative risk (RR) = 2.68 ICr95%: 1.12–9.35). A higher proportion of erupted PDC was found for RME (RR = 3.07 ICr95%: 1.31–10.67), RME plus use of transpalatal arch (TA) plus extraction of primary canine(s) (EC) (RR = 1.43 ICr95%: 1.09–1.95), EC plus use of cervical pull headgear (RR = 1.38 ICr95%: 1.11–1.79), and EC plus use of TA (RR = 1.36 ICr95%: 1.00–1.9) than for EC. RME was most likely to be considered as the best interceptive treatment. Overall, the certainty of the evidence was considered low due to imprecision and indirectness. In conclusion, no intervention in the mixed dentition stage is the worst choice for PDC.

Abstract Dentifrices containing different active agents may be helpful to allow rehardening and to increase the resistance of the eroded surface to further acids or mechanical impacts. This study aimed to compare the effects of conventional (sodium fluoride [NaF]) and stannous fluoride (SnF2)-containing dentifrices on reducing erosive tooth wear (ETW). The PubMed/MEDLINE, Scopus, LILACS, BBO, EMBASE, TRIP electronic databases, and grey literature were searched until January 2021 to retrieve relevant in vitro and in situ studies related to research question. There were no restrictions on publication year or language. Two authors independently selected the studies, extracted the data, and assessed the risk of bias. ETW data were pooled to calculate and compare both dentifrices (overall analysis) and in vitro and in situ studies separately (subgroup analysis). Statistical analyses were performed using RevMan5.3 with a random effects model. Of 820 potentially eligible studies, 101 were selected for full-text analysis, and 8 were included in the systematic review and meta-analysis. There was a significant difference between SnF2-containing dentifrices and NaF dentifrices only for in vitro studies (p=0.04), showing a higher effect of the SnF2-containing dentifrices against the erosion/abrasion (effect size: -6.80 95%CI: -13.42; -0.19). Most in vitro and in situ studies had high and low risk of bias, respectively. In vitro literature suggests that the ETW reduction is greater when using SnF2-containing dentifrices instead NaF-containing dentifrices. However, the evidence level is insufficient for definitive conclusions. Clinical trials are necessary for a better understanding of the effect of these compounds on ETW.

Abstract Objective: To evaluate the impact of early childhood caries, maternal behaviors and associated factors on the oral health-related quality of life (OHRQoL) of preschool children. Material and Methods: This cross-sectional study was conducted with 163 preschool children aged 3-4 old from Porto Alegre, Southern Brazil. Mothers completed the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) and answered questions about sociodemographic and maternal behaviors characteristics. The severity of dental caries was assessed by ICDAS criteria for evaluated early childhood caries (ECC). A Poisson regression model was used to investigate the association of ECC and associated factors on OHRQoL. Results: A total of 91.4% of preschooler children was ECC (ICDAS ≥ 1). Mean ECOHIS function domain and parental anxiety domain scores were significantly higher in children with dental caries (p<0.05). The adjusted Poisson regression model showed that household income, maternal education, mother’s job status and breastfeeding time was significantly associated with ECOHIS scores. Regarding oral conditions, child caries experience was associated with worsening child and family quality of life (RR 2.21; 95% IC: 1.43-3.41). Conclusion: Our findings suggest that ECC, socioeconomic and maternal behaviors characteristics influence children’s OHRQoL.

Resumo A cárie precoce na infância (CPI) acomete crianças em todo o mundo e apresenta alta prevalência e severidade em pré-escolares. Diferentes fatores sociais, biológicos e comportamentais constituem uma rede de fatores causais da CPI. O objetivo deste estudo foi avaliar a associação entre as variáveis socioeconômicas e presença de cárie na linha de base e a presença de Streptococcus mutans e Lactobacillus spp. com a progressão de lesões de cárie após dois anos de acompanhamento em um grupo de crianças. Na avaliação inicial, foram avaliadas 163 crianças (3-4 anos de idade) pertencentes a 12 unidades básicas de saúde do Grupo Hospitalar Conceição (GHC, Porto Alegre, RS, Brasil). Após dois anos, foram reavaliadas 119 crianças. Os exames clínicos foram realizados por examinadores calibrados usando os critérios ICDAS. Um questionário sociodemográfico foi aplicado aos pais das crianças e amostras de saliva foram coletadas de crianças para análise microbiológica. Foram realizadas estatísticas descritivas e regressão multivariada de Poisson na análise estatística. Os fatores associados com a progressão de cárie foram o estado marital das mães (p=0,040) e a presença de lesões cavitadas no início do estudo e uma maior contagem de S. mutans (p=0,031) após dois anos de acompanhamento. A progressão de cárie em pré-escolares pertencentes às unidades de atenção primária em saúde foi diretamente associada com o estado marital das mães, presença de lesões cavitadas na linha de base e maior contagem de S. mutans após dois anos de acompanhamento.

Abstract Early childhood caries (ECC) affects children all over the world and has high prevalence and severity in preschool children. Different social, biological and behavioral factors compose a network of causal factors for ECC. The aim was to evaluate the association between socioeconomic variables and caries at baseline, and the presence of Streptococcus mutans and Lactobacillus spp. microorganisms with the progression of caries lesions after two years of follow-up in a group of children. At baseline, 163 children (3-4 years old) living in the areas of 12 primary care services of the Hospital Group Conceição (GHC, Porto Alegre, RS, Brazil) were evaluated. After two years, 119 children were re-evaluated. Clinical examinations were conducted by calibrated examiners using the ICDAS criteria. A sociodemographic questionnaire was applied to the children’s parents and saliva samples were collected from the children for microbiological analysis. Descriptive statistics and multivariate Poisson regression analysis were performed in the statistical analysis. The factors associated with the caries progression were marital status of mothers (p=0.040), higher S. mutans counts (p=0.031) and the presence of cavitated lesions at baseline (p<0.001). The caries lesions progression in preschool children enrolled in primary health care was directly associated with marital status, presence of cavitated lesions at baseline and higher S. mutans counts at two-year follow-up.

Resumo O objetivo deste estudo foi descrever e comparar os achados sobre a prevalência e severidade da cárie dentária ao utilizar ICDAS e CPOD/ceod em um estudo epidemiológico com crianças e suas mães. Este estudo transversal avaliou 150 pré-escolares e suas mães. Os dados foram coletados utilizando-se o ICDAS e depois transformados em CPOD/ceod. Os códigos do ICDAS relacionados à cárie foram analisados de acordo com três diferentes pontos de corte: CP1 (0-hígido/1-6-cárie), CP2 (0-1 hígido/2-6-cárie) e CP3 (0-2 hígido/3-6-cárie), representando o D/d do índice CPOD/ceod. Os códigos do ICDAS referentes às restaurações, exceto selantes, foram considerados o O/o e o código 97 do ICDAS como o P/e do índice CPOD/ceod. A prevalência de cárie e sua severidade com o ICDAS foram de 92%, 84% e 31,3% em crianças e 97,3%, 96,6% e 80% em adultos de acordo com o CP1 / CP2 / CP3, respectivamente. Admitindo o ponto de corte CP3 como o padrão para a transformação de achados do ICDAS em CPOD/ceod, foi observado que o índice CPOD/ceod subestimaria 60% das lesões não cavitadas em crianças e 16,6% em adultos. O CPOD/ceod subestima a presença da doença ao desconsiderar as lesões não cavitadas na população pediátrica avaliada. A escolha de qual é o melhor índice para levantamentos epidemiológicos vai depender do propósito da pesquisa e da população-alvo: se o objetivo for estimar as necessidades da população para determinar cuidados clínicos em crianças e adultos, o CPOD/ceod pode ser suficiente. No entanto, se o objetivo for ter um diagnóstico mais abrangente da doença ao nível da população, a fim de desenvolver estratégias preventivas, para paralisar e reverter a doença, a detecção de lesões não cavitadas torna-se importante, principalmente em crianças pequenas.

Abstract The aim of this study was to describe and compare findings regarding the prevalence and severity of dental caries when using ICDAS and DMFT/dmft in an epidemiological study with children and their mothers. This cross-sectional study evaluated 150 preschoolers and their mothers. Data were collected with ICDAS and then transformed into DMFT/dmft. ICDAS scores related to caries were analyzed according to three different cut-off-points: CP1 (0-healthy/1-6-caries), CP2 (0-1-healthy/2-6-caries) and CP3 (0-2-healthy/3-6-caries), representing the D/d of DMFT/dmft. ICDAS codes regarding restorations, except sealants, were considered the F/f and the code 97 as the M/m of DMFT/dmft index. Prevalence of caries and its severity with ICDAS were 92%, 84% and 31.3% in children and 97.3%, 96.6% and 80% in adults according to CP1/CP2/CP3, respectively. Admitting CP3 as the standard for data transformation of ICDAS in DMFT/dmft, it was observed that DMFT/dmft index would underestimate 60% of non-cavitated lesions in children and 16.6% in adults. The DMFT/dmft underestimated the presence of disease to disregard non-cavitated lesions for the pediatric population evaluated. The choice of which is the best index for epidemiological surveys will depend on the purpose of the research and the target population: if it is to estimate the needs of the population to determine clinical care in children and adults, the DMFT/dmft may be sufficient. However, if the objective is to have a more comprehensive diagnosis of caries at the population level in order to develop preventive strategies, to halt and reverse the disease, the detection of non-cavitated-lesions becomes important, mainly in young children.

As anomalias dentárias de número são alterações comuns da dentição humana que podem interferir na harmonia do crescimento e desenvolvimento dento-facial. O diagnóstico precoce e o tratamento adequado destas alterações de desenvolvimento são essenciais para que uma harmonia oclusal, funcional e estética, possa ser estabelecida. Assim, este artigo relata a reabilitação funcional e estética um dente supranumerário conóide, localizado na região ântero-superior da maxila, de uma criança em idade pré-escolar. A reanatomização do elemento dental foi realizada através de restauração direta em resina composta nanoparticulada, uso do guia palatina de silicone de adição e isolamento relativo modificado. Este procedimento minimamente invasivo além de ser passível de ajustes posteriores, permite o perfeito controle da reabilitação realizada e possibilita o restabelecimento simultâneo estético-funcional e da auto-estima da criança. Entretanto, o tratamento não deve se limitar exclusivamente à técnica restauradora. Sendo fundamental a manutenção da saúde bucal e da integridade da forma do arco para que seja possível à transição correta da dentição decídua para a permanente, permitindo que o impacto do tratamento realizado contemple a ausência de alterações na dentição permanente.

Supernumerary teeth are common changes in the human dentition that can compromise a congruous dental and facial growth and development. Early diagnosis and proper treatment of these developmental changes are essential for establishing occlusal, functional, and aesthetic congruence. Thus, this article reports the functional and aesthetic rehabilitation of a supernumerary peg-shaped tooth located in the anterior maxillary region of a preschooler. The tooth was restored directly using nanocomposite resin system, a putty index of the incisal position, and modified cotton roll isolation. This minimally invasive procedure not only allows future adjustment but also perfect control of the rehabilitation and simultaneous reestablishment of the child's self-esteem and tooth aesthetics and function. However, treatment should not be limited to the restorative technique. Maintenance of oral health and arch integrity are essential for the correct transition between the primary and permanent dentitions, preventing the treatment from affecting the permanent dentition.

The aim of this study was to evaluate flossing as a diagnostic method for interproximal gingival bleeding in children. For this crossover study, 23 pre-schoolchildren presenting neither restorations nor approximal carious cavities and with at least 15% of gingival bleeding sites were selected. Examinations were performed at three different moments (3-4 days interval). Examinations comprised repeated measurements of two gingival indices with a 10-minute interval in the following sequences: the Ainamo & Bay Gingival Bleeding Index (GBI) followed by the Carter & Barnes flossing index (CBI); CBI followed by GBI; and GBI followed by GBI. Data analysis was performed only for the interproximal sites, considering the GBI as the gold-standard. Agreement between indices, sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) were estimated. Percentage agreements in sequences GBI-CBI, CBI-GBI and GBI-GBI were 70.3%, 76.4% and 84.5%, respectively. Validation of flossing in the first sequence (GBI-CBI) resulted in values of 0.61 (95%CI 0.53 - 0.68), 0.72 (95%CI 0.69 - 0.76), 0.33 (95%CI 0.28 - 0.39) and 0.89 (95%CI 0.86 - 0.92) respectively for SE, SP, PPV and NPV. It can be concluded that professional flossing is a useful tool in the diagnosis of interproximal gingival inflammatory status in children, especially in conditions of gingival health.

The purpose of this study was to validate the elastomeric impression after temporary tooth separation as a method of cavitation detection in proximal caries lesions in primary molars with outer half dentin radiolucency. Fifty-one children (4-10 years old), presenting radiolucency in the outer half of the dentin at the proximal surfaces of primary molars and proximal anatomic contact with the adjacent tooth (without restoration/cavitated caries lesion) were enrolled in the study. Temporary tooth separation was performed with an orthodontic rubber ring placed around the contact point during 2-3 days. Thereafter, impression of the proximal surfaces was made. The elastomeric impressions were classified as "non-cavitated" or "cavitated" surfaces. Visual inspection after tooth separation was considered as the gold standard. Examiner reliability of visual inspection after tooth separation was determined (kappa 0.92). Impression examination was repeated every 5 participants to evaluate the reproducibility of the method. The frequency of cavitated lesions was 65%, and 67% of those were inactive. Sensitivity, specificity, positive and negative predictive values were 0.88% (95%CI 0.73-0.95), 0.89% (95%CI 0.67-0.97), 0.94% (95%CI 0.79-0.98) and 0.80% (95%CI 0.58-0.92), respectively. Impression examination showed total agreement regarding cavitation. The evaluation of elastomeric impression after tooth separation is a useful clinical resource in cavitation detection for clinicians and researchers when visual inspection is doubtful.