Abstract This study aimed to assess whether complementing atraumatic restorative treatment (ART) with oral health educational strategies (OHES) improves the perception of oral health-related quality of life (OHRQoL) and clinical oral outcomes. A controlled clinical trial included 93 six- to eight-year-old students from five public schools of Piracicaba, Saltinho, and Charqueada municipalities (State of São Paulo, Brazil) divided into 3 groups (31 children each) which received: OHES (caries-free), ART (dental caries), and ART plus OHES (dental caries). OHRQoL (CPQ8-10-ISF:16), dental caries, biofilm control, and gingivitis were assessed before and 1 month after interventions by one calibrated examiner. OHES consisted of an educational interactive activity performed once a week for four weeks. Data were analyzed using mixed model ANOVA, Chi-square, and Sign tests. After 1 month of follow-up, improvement in gingivitis status, OHRQoL total score, and Functional Limitations, Emotional Well-Being and Social Well-Being domains scores were found in all groups (p < 0.05). The improvement in biofilm control was observed only in the OHES group (p < 0.001; power = 0.98), while a decrease in Oral Symptoms scores was observed only in ART+OHES group (p <0.001; power = 0.99) and a significant change in the perception of oral health was observed in the two groups that received ART (p < 0.05). In conclusion, improvement in overall OHRQoL and oral status was observed in all children, although the effect of including health educational strategies in the treatment plan was determinant for the perception of an improved oral health after restorative treatment.

Abstract The etiology of temporomandibular disorders (TMD), which are considered as a heterogeneous group of psychophysiological disturbances, remains a controversial issue in clinical dentistry. This study aimed to evaluate whether the salivary alpha-amylase (sAA), cortisol levels, and anxiety symptoms differ between children with and without TMD. Initially, 316 young subjects were screened in public schools (nonreferred sample); 76 subjects aged 7–14 years were selected and comprised the TMD and control groups with 38 subjects each matched by sex, age, and the presence/absence of sleep bruxism. Four saliva samples were collected: upon waking, 30 min and 1 h after awakening (fasting), and at night (at 8 PM) on 2 alternate days to examine the diurnal profiles of cortisol and sAA. Anxiety symptoms were screened using the Multidimensional Anxiety Scale for Children (MASC-Brazilian version). Shapiro–Wilk test, Student’s t-test/Mann–Whitney U test, and correlation tests were used for data analysis. No significant differences were observed in the salivary cortisol area under the curve (AUCG mean ± SD = 90.22 ± 63.36 × 94.21 ± 63.13 µg/dL/min) and sAA AUCG (mean ± SD = 2544.52 ± 2142.00 × 2054.03 ± 1046.89 U/mL/min) between the TMD and control groups, respectively (p > 0.05); however, the clinical groups differed in social anxiety domain (t = 3.759; CI = 2.609, 8.496), separation/panic (t = 2.243; CI = 0.309, 5.217), physical symptoms (U = 433.500), and MASC total score (t = −3.527; CI = −23.062, −6.412), with a power of the test >80% and large effect size (d = 0.80), with no significant correlation between the MASC total score, cortisol, and sAA levels. Although children with TMD scored higher in anxiety symptoms, no difference was observed in the salivary stress biomarkers between children with and without TMD.

ABSTRACT Purpose proper chewing and swallowing functions have great importance in general health, since it potentially affects food’s digestion and the subject’s nutritional status. The aim was to assess the validity and reliability of the self-applied Quality of Masticatory Function Questionnaire (QMFQ) in a convenience (non-referred) sample of Brazilian adolescents divided into three groups: control (n=57), dental caries (n=51) and malocclusion (n=54). Methods caries and malocclusion were evaluated using DMF-S index (number of decayed, missing and filled primary and permanent surfaces) and Index of Orthodontic Treatment Need, respectively. The QMFQ comprises 26 items regarding frequency and intensity of chewing problems with five domains: Food-Mastication, Habits, Meat, Fruits and Vegetables. Data were submitted to descriptive statistics, Kolmogorov-Smirnov and Chi-square tests. Psychometric evaluation included measures of reliability (internal consistency - Cronbach's alpha and matrix of correlation) and discriminant validity (Kruskal-Wallis/Dunn post-test). Results the instrument showed satisfactory internal consistency, with significant positive correlations between the domains scores except between Habits and Vegetables. Total scale Cronbach's alpha coefficient was 0.87 and the coefficient did not increase significantly with the removal of each domain. Significant differences were found between controls and caries group in Food-Mastication, Meat and Fruits scores. Caries group also showed higher median values in Food-Mastication and Fruits than the malocclusion group. Conclusion the Quality of Masticatory Function Questionnaire showed acceptable properties regarding internal consistency, reliability, and discriminant validity in evaluating the impact of caries on the perception of the masticatory function quality of Brazilian adolescents.

RESUMO: Objetivo: traduzir o instrumento em língua francesa "Questionnaire D'Alimentation" para o português brasileiro e realizar a adaptação transcultural em adolescentes brasileiros. Métodos: a tradução foi realizada com base em protocolo que consistiu na tradução para o português brasileiro (por um professor formado em Letras e uma Cirurgiã Dentista fluentes em francês), tradução reversa para o francês (realizada por dois professores de francês), revisão por Comitê de especialistas (duas tradutoras, uma nativa e uma juramentada, e duas professoras universitárias, sendo uma Cirurgiã Dentista e uma Fonoaudióloga) e equivalência cultural (pré-teste). A versão utilizada no pré- teste consistiu de 26 questões com cinco respostas possíveis (5-Likert), distribuídas em cinco domínios (Alimentação- mastigação, Hábitos, Carnes, Frutas e Legumes). O pré-teste e teste-reteste foram realizados com uma amostra de 20 adolescentes (10 meninos/10 meninas) de escolas públicas de Piracicaba (Brasil). Nesta fase, a alternativa "não entendi" foi incluída a cada questão, a fim de identificar aquelas não compreendidas. A confiabilidade teste-reteste foi avaliada para cada domínio utilizando os coeficientes de correlação intra-classe (CCI). Resultados: no pré-teste, foi observada uma excelente compreensão do instrumento; no teste-reteste, os CCIs variaram entre 0,45-0,81 (moderada a excelente concordância). Conclusão: a versão em Português do Questionnaire D'Alimentationmostrou ser de fácil compreensão por parte dos adolescentes brasileiros e útil na avaliação da função mastigatória e dos distúrbios de alimentação e deglutição que podem alterar a ingestão de alimentos.

ABSTRACT: Purpose: to translate the French language instrument "Questionnaire D'Alimentation" to Brazilian Portuguese and culturally adapt it for adolescents. Methods: the translation was based on a protocol that consisted of translation to Brazilian Portuguese (by a professor with a Literary Arts degree and a Doctor of Dental Surgery, both fluent in French and Brazilian Portuguese); back-translation into French; revision by a Committee of specialists (two translators, one native and one sworn translator, and two university professors, one being a Doctor of Dental Surgery and a Speech Therapist) and cultural equivalence (pre-test). The version used in the pre-test consisted of 26 questions with five possible responses (5-Likert), distributed in five domains (Food-Mastication, Habits, Meats, Fruits and Vegetables). The pre-test and test-retest was performed with a sample of 20 adolescents (10 boys/10 girls) from public schools of Piracicaba (Brazil). At this stage, the alternative "I did not understand" was added to each question in order to identify those that were not understood. Test-retest reliability was assessed for each domain using intra-class correlation coefficients (ICCs). Results: in the pre-test, an excellent comprehension of the instrument was observed; in test-retest, ICCs ranged from 0.45 to 0.81 (moderate to excellent agreement). Conclusion: the Portuguese version of the Questionnaire D'Alimentationhas shown to be easy to understand by Brazilian adolescents and useful in the evaluation of the masticatory function and feeding or swallowing disorders that may affect food intake.

Objetivo avaliar o dimorfismo sexual e a relação entre as características morfológicas craniofaciais, dos arcos dentários e do músculo masseter na fase de dentição mista. Métodos 32 crianças, com idade entre 6-10 anos (14♀/18♂) com oclusão normal, compuseram a amostra. Características morfológicas craniofaciais, dos arcos dentários e espessura do masseter foram avaliadas por meio de radiografia cefalométrica posteroanterior, modelos em gesso e ultrassonografia, respectivamente. Os resultados foram analisados utilizando testes Shapiro-Wilk, Mann-Whitney/teste “t” e regressão linear múltipla para avaliar a relação entre a largura da face e idade, gênero, índice de massa corporal, espessura do masseter, distâncias intermolares e intercaninos (entre cúspides e pontos cervicais) e larguras nasal, maxilar, mandibular e intermolar. Resultados a espessura do masseter não diferiu significativamente entre os lados esquerdo e direito. A comparação entre os gêneros mostrou diferença significativa apenas na largura da face (maior em meninos). O modelo de regressão mostrou que a largura da face relacionou-se positivamente com o índice de massa corporal, espessura do masseter, distâncias intermolares (cúspides) e intercaninos (cervicais) inferiores e largura intermolar maxilar; e negativamente com a distância intermolares superiores (cúspides) e inferiores (cervicais) e intercaninos inferiores (cervicais). Ou seja, quando as demais variáveis foram adicionadas ao modelo, a variável explanatória gênero não alcançou valor significativo. Conclusão na amostra avaliada, a espessura do masseter e dimensões dos arcos dentários não diferiram entre gêneros; além disso, a largura da face mostrou relação significativa com o índice de massa corporal, espessura do masseter e dimensões dos arcos dentários, mas o gênero não contribuiu significativamente para sua variação.

Purpose to evaluate sexual dimorphism and the relationship between craniofacial characteristics, dental arch morphology and masseter muscle thickness in children in the mixed dentition stage. Methods the study sample comprised 32 children, aged 6-10 years (14♀/18♂) with normal occlusion. Craniofacial characteristics, dental morphology and masseter muscle thickness were evaluated by means of posteroanterior cephalometric radiographs, dental cast evaluation and ultrasound exam, respectively. The results were analyzed using Shapiro-Wilk test, Mann-Whitney/t-test and stepwise linear regression to assess the relation between face width and age, gender, body mass index, masseter thickness, distances between first molars and canines on dental casts (between cusps/cervical points), nasal, maxillary, mandibular and intermolar widths. Results masseter thickness showed no significant difference between the sides left/right. The comparison between genders showed significant difference only in face width, being larger in boys. The regression model showed that face width was positively related with body mass index, masseter thickness, mandibular first molar distances (cusps), mandibular canine distances (cervical points), and maxillary intermolar width; and negatively with maxillary (cusps) and mandibular molar distances (cervical points) and mandibular canine distances (cusps). That is, when the other studied variables were considered, the explanatory variable gender did not reach a significant value. Conclusion in the studied sample, the dimensions of the dental arches and masseter thickness did not differ between boys and girls; moreover, face width showed significant relationship with body mass index, masseter thickness, and dimensions of dental arches; but gender did not contribute significantly to face width variation.

OBJETIVO: Verificar a associação entre a espessura do orbicularis oris e as variáveis esqueléticas e dentárias em crianças com dentição mista. MATERIAL E MÉTODO: Foi selecionada uma amostra de conveniência de 22 crianças, de 7 a 12 anos, com maloclusões Classe I e Classe II esqueléticas e subdivisões. As espessuras dos fascículos superior e inferior do orbicularis oris foram mensuradas, em repouso e em contração, por um examinador treinado utilizando ultrassom. As medidas cefalométricas dos tecidos duros e moles foram calculadas por um examinador treinado. Os resultados foram analisados pelos coeficientes de Pearson e Spearman. RESULTADO: Houve correlação negativa entre os fascículos superior e inferior do orbicularis oris em contração e a distância entre a linha E de Ricketts e o lábio superior (E ┴ Ls). Houve correlação positiva entre a altura inferior da face e a distância entre o plano AB e o lábio superior (AB-Ls) e entre o ângulo ANB e a distância entre E ┴ Ls e a linha E de Ricketts e o lábio inferior (E ┴ Li). A distância do incisivo inferior do plano N-Pg correlacionou-se positivamente com a distância entre AB-Ls e a distância entre E ┴ Ls e E ┴ Li. A sobremordida e o ângulo interincisal correlacionaram-se negativamente com a distância entre o pogônio e o pogônio mole e a distância entre E ┴ Li, respectivamente. CONCLUSÃO: As variáveis esqueléticas e dentárias estiveram associadas à posição dos lábios superior e inferior e a espessura do pogônio, enquanto que as espessuras dos fascículos superior e inferior do orbicularis oris em contração estiveram associadas à retrusão do lábio superior.

AIM: To evaluate the association between orbicularis oris thickness and skeletal and dental variables in children with mixed dentition. MATERIAL AND METHOD: A convenience sample of 22 children, aged 7 to 12 years, with skeletal Class I and Class II malocclusion and subdivisions were selected. The upper and lower fascicles of the orbicularis oris thicknesses were measured using ultrasound (US) by one calibrated examiner, at rest and in the contracted state. Cephalometric radiograph measurements of the hard and soft tissues were calculated by one trained examiner. The results were analyzed by the Pearson and Spearman coefficients. RESULT: The upper and lower fascicles of the orbicularis oris in the contracted state showed a negative correlation with the distance between Ricketts' E-line and the labrale superius (E ┴ Ls). There were positive correlations between the lower face height and the distance between the AB plane and the labrale superius (AB-Ls) and between the ANB angle and the distance between E ┴ Ls and Ricketts' E-line and the labrale inferius (E ┴ Li). The lower-incisor distance from the N-Pg plane correlated positively with the distance between AB-Ls and the distance between the E ┴ Ls and E ┴ Li. Overbite and interincisal angle were negatively correlated with the distance between the pogonion and the soft tissue pogonion and the distance between E ┴ Li, respectively. CONCLUSION: Skeletal and dental variables were associated with upper and lower lip position and pogonion thickness, while the upper and lower fascicles of the orbicularis oris thicknesses in the contracted state were associated only with upper lip retrusion.

OBJETIVE: The maintenance of normal conditions of the masticatory function is determinant for the correct growth and development of its structures. Thus, the aims of this study were to evaluate the influence of sucking habits on the presence of crossbite and its relationship with maximal bite force, facial morphology and body variables in 67 children of both genders (3.5-7 years) with primary or early mixed dentition. MATERIAL AND METHODS: The children were divided in four groups: primary-normocclusion (PN, n=19), primary-crossbite (PC, n=19), mixed-normocclusion (MN, n=13), and mixed-crossbite (MC, n=16). Bite force was measured with a pressurized tube, and facial morphology was determined by standardized frontal photographs: AFH (anterior face height) and BFW (bizygomatic facial width). RESULTS: It was observed that MC group showed lower bite force than MN, and AFH/BFW was significantly smaller in PN than PC (t-test). Weight and height were only significantly correlated with bite force in PC group (Pearson's correlation test). In the primary dentition, AFH/BFW and breast-feeding (at least six months) were positive and negatively associated with crossbite, respectively (multiple logistic regression). In the mixed dentition, breast-feeding and bite force showed negative associations with crossbite (univariate regression), while nonnutritive sucking (up to 3 years) associated significantly with crossbite in all groups (multiple logistic regression). CONCLUSIONS: In the studied sample, sucking habits played an important role in the etiology of crossbite, which was associated with lower bite force and long-face tendency.

Posterior crossbite may affect craniofacial growth and development. Thus, this study aimed to associate facial dimensions (by standardized frontal photographs) to masseter and anterior portion of the temporal muscle thickness (by ultrasonography) and maximal bilateral bite force in 49 children with deciduous and early mixed dentitions. They were distributed in four groups: deciduous-normal occlusion (DNO, n = 15), deciduous-crossbite (DCB, n = 10), mixed-normal occlusion (MNO, n = 13) and mixed-crossbite (MCB, n = 11). Anterior facial height (AFH), bizygomatic width (FWB), and intergonial width (FWI) were determined and associated with muscle thickness and bite force, applying Pearson’s coefficients and multiple logistic regression, with age, gender, body weight and height as the covariates. FWB and FWI were correlated positively with the masseter thickness, whereas AFH/FWB and AFH/FWI ratios had negative correlation, except in the DNO group. The correlation between AFH/FWB and bite force in the MCB group was significantly negative. A higher AFH/FWB in MNO and MCB led to a significantly higher probability for functional crossbite development. In the studied sample, it was observed that children in the early mixed dentition with a long-face trend showed lower bite force and higher probability to present functional posterior crossbite, without significant influence of the covariates.

OBJETIVO: avaliar a espessura dos músculos masseter e porção anterior do temporal por meio da ultra-sonografia e as dimensões faciais de crianças com oclusão normal e mordida cruzada posterior unilateral, na dentição decídua e mista inicial. MÉTODOS: foram selecionadas 49 crianças, de ambos os gêneros, divididas em quatro grupos: decídua-oclusão normal, decídua-mordida cruzada, mista-oclusão normal e mista-mordida cruzada. A espessura muscular foi comparada entre os lados direito e esquerdo (oclusão normal); e normal e cruzado (mordida cruzada) (teste "t" Student), e relacionada às dimensões faciais e variáveis corporais (teste de correlação de Pearson e Spearman). As dimensões faciais foram mensuradas sobre fotografias frontais padronizadas: altura facial anterior (AFA), distância bizigomática (DB) e intergoniana (DI) e razões AFA/DB e AFA/DI. RESULTADOS: observou-se que o músculo temporal no repouso apresentou espessura maior no lado cruzado no grupo mista-cruzada (p=0,05). O masseter não apresentou diferença significativa entre os lados em todos os grupos. As variáveis peso e altura não apresentaram correlação com a espessura muscular; já DB e DI apresentaram correlação positiva e as razões AFA/DB e AFA/DI, correlação negativa, com a espessura do masseter em todos os grupos, indicando que crianças com faces mais longas possuem menor espessura deste músculo. CONCLUSÃO: na amostra estudada, os exames da espessura dos músculos mastigatórios e das dimensões faciais demonstraram que a influência das características funcionais sobre as estruturas craniofaciais pôde ser observada já em crianças de pouca idade.

PURPOSE: to evaluate the ultrasonographic thickness of masseter and anterior portion of the temporalis muscle and facial dimensions in children with normal occlusion and unilateral crossbite, in deciduous and early mixed dentition. METHODS: the sample comprised 49 children of both genders, divided into four groups: deciduous-normal occlusion, deciduous-crossbite, mixed_normal occlusion and mixed_crossbite. Muscle thickness was compared between the right and left sides (normal occlusion) and normal and crossbite-side (crossbite) (Student's "t" test) and related to facial dimensions and body variables (Pearson's and Spearman's correlation test). Facial dimensions were determined by measuring standardized frontal photographs: anterior facial height (AFH), bizygomatic (FWB) and intergonial width (FWI), and AFH/FWB and AFH/FWI ratios. RESULTS: the results showed that the anterior temporalis muscle at rest was significantly thicker in the crossbite side in the mixed-crossbite group (p=0.05). Masseter thickness did not show significant differences between the sides in all groups. Weight and height did not correlate with masticatory muscle thickness; but FWB and FWI showed being positive, and AFH/FWB and AFH/FWI ratios showed having negative correlation with masseter thickness, i.e. children with a long-face pattern showed smaller muscle thickness. CONCLUSION: in the sample studied, the influence of functional characteristics on craniofacial structures was observed in young children by masticatory muscles ultrasonography and facial dimensions exam.

O objetivo deste estudo foi verificar a prevalência de sinais e sintomas de disfunção temporomandibular (DTM) em adolescentes e sua relação com o gênero. A amostra foi constituída de 217 voluntários, com idade entre 12 e 18 anos. Os sintomas subjetivos e os sinais clínicos de DTM foram avaliados usando-se, respectivamente, um questionário e o "Craniomandibular Index", o qual possui 2 subescalas: "Dysfunction Index" e "Palpation Index". Os resultados para sensibilidade muscular mostraram grande variabilidade (0,9-32,25%). Com relação à articulação temporomandibular, a sensibilidade à palpação nas regiões superior, dorsal e lateral do côndilo ocorreu, respectivamente, em 10,6%, 10,6% e 7,83% da amostra. A prevalência do ruído articular no movimento de abertura foi de 19,8% e no fechamento, 14,7%. Os sintomas relatados mais prevalentes foram o ruído articular (26,72%) e dor de cabeça (21,65%). Nenhuma diferença estatística foi encontrada para a associação entre os gêneros (p > 0,05), exceto para a sensibilidade no músculo pterigóideo lateral, a qual se apresentou mais prevalente nas meninas. Os sinais clínicos e sintomas subjetivos de DTM foram observados em adolescentes, no entanto a influência do gênero não foi percebida nessa faixa etária.

The aim of this study was to verify the prevalence of signs and symptoms of temporomandibular disorders (TMD) in adolescents and its relationship to gender. The sample comprised 217 subjects, aged 12 to 18. The subjective symptoms and clinical signs of TMD were evaluated, using, respectively, a self-report questionnaire and the Craniomandibular Index, which has 2 subscales; the Dysfunction Index and the Palpation Index. The results of muscle tenderness showed great variability (0.9-32.25%). In relation to the temporomandibular joint, tenderness of the superior, dorsal and lateral condyle regions occurred in 10.6%, 10.6% and 7.83%, respectively, of the sample. Joint sound during opening was present in 19.8% of the sample and during closing in 14.7%. The most prevalent symptoms were joint sounds (26.72%) and headache (21.65%). There was no statistical difference between genders (p > 0.05), except for the tenderness of the lateral pterygoid muscles, which presented more prevalence in girls. In conclusion, clinical signs and symptoms of TMD can occur in adolescents; however, gender influence was not perceived.

O objetivo desta pesquisa foi avaliar a amplitude dos movimentos mandibulares em crianças portadoras ou não de sinais e sintomas de disfunção temporomandibular. A amostra consistiu de 99 crianças entre 3 e 5 anos distribuídas em 2 grupos: I - Ausência de sinais e sintomas de DTM (25 meninas/40 meninos) II - Presença de sinais e sintomas de DTM (16 meninas/18 meninos). Os sintomas foram avaliados através de um questionário respondido pelos pais ou responsáveis das crianças. Os sinais clínicos foram avaliados através de exame intra e extra-oral por dois examinadores calibrados. Os movimentos de abertura máxima e lateralidade direita e esquerda foram mensurados com o auxílio de um paquímetro digital. Para o movimento de protrusão foi utilizada régua milimetrada. A média e o desvio padrão para abertura bucal máxima para o grupo I foi de 40,82mm±4,18 e para o grupo II 40,46mm±6,66. Os valores encontrados para a lateralidade esquerda foram 6,96mm±1,66 para o grupo I e 6,74mm±1,55 para o grupo II e, para a direita, foram 6,46mm±1,53 e de 6,74mm±1,77, respectivamente. Durante a protrusão foram encontrados valores de 5,67mm±1,76 para o grupo I e 6,12mm±1,92 para grupo II. Pode-se concluir que na amostra avaliada a amplitude dos movimentos mandibulares não diferiu estatisticamente entre os grupos, bem como entre os gêneros. FAPESP Processo 96/0714-6.

This research aimed to evaluate mandibular movements in children with and without signs and symptoms of temporomandibular dysfunction. The sample taken consisted of 99 children aged 3 to 5 years distributed in two groups: I - Absence of signs and/or symptoms of TMD (25 girls/40 boys); II - Presence of signs and symptoms of TMD (16 girls/18 boys). The symptoms were evaluated through an anamnesis questionnaire answered by the child's parents/caretakers. The clinical signs were evaluated through intra- and extraoral examination. Maximum mouth opening and left/right lateral movements were measured using a digital caliper. The maximum protrusive movement was measured using a millimeter ruler. The means and standard deviations for maximum mouth opening in Group I and Group II were 40.82mm±4.18 and 40.46mm±6.66, respectively. The values found for the left lateral movement were 6.96mm±1.66 for Group I and 6.74mm±1.55 for Group II, while for the right lateral movement they were 6.46mm±1.53 and 6.74mm±1.77. The maximum protrusion movements were 5.67mm±1.76 and 6.12mm±1.92, in Groups I and II, respectively. The mandibular movement ranges neither differed statistically between groups nor between genders. FAPESP Process 96/0714-6.