Abstract It is not uncommon that oral healthcare professionals and researchers interchange the use of the terms minimum/minimal intervention and minimally invasive dentistry. However, these terms apply to two different, but related, concepts. Minimum intervention dentistry, to be more appropriately addressed in this paper as minimum intervention oral care (MIOC), is an oral healthcare delivery framework that encompasses four interlinked clinical domains. These domains are: identifying disease - detection, longitudinal risk/susceptibility assessment, investigation, diagnosis and the development of a personalized care plan; prevention of lesions/control of disease – patient behaviour management, non-invasive remineralisation of the enamel and dentine, biofilm and diet control, micro-invasive sealants and infiltration techniques to arrest and reverse incipient lesions; minimally invasive operative procedures including selective carious dentine removal, the “5Rs” management of the tooth-restoration complex (review, refurbish, re-seal, repair and replace) amongst other restorative interventions; and tailored recall/review/re-assessment consultations. This framework includes that minimally invasive operative dentistry (MID), that although a critical operative clinical domain, should be viewed as one of the pillars of minimum intervention oral healthcare (MIOC), applied across all disciplines of restorative dentistry, not just caries management. The aim of this review is to clarify these differences and emphasize the importance of minimally invasive operative dentistry (MID) within the context of minimum intervention oral care (MIOC). MIOC is applicable to all disciplines within restorative dentistry, including clinical caries management.

Abstract This study aimed to assess the discriminant validity of the Caries Assessment Spectrum and Treatment (CAST) at different thresholds, compared with the Decayed, Missing, and Filled Teeth Index (dmf) instrument, to discriminate caries risk factors. A cross-sectional study was conducted including children aged 2-5 years from preschools in Southern Brazil. Parents answered a questionnaire, and children were clinically examined using the CAST instrument and, in the following weeks, using the dmf index. Two caries thresholds were adopted for CAST: caries in dentin (CAST4-7/CAST2,4-8) and enamel caries (CAST3-7/CAST2-8). Poisson regression was used in the analysis (p < 0.05). A total of 200 children were included. The prevalence of caries was 47.0% with dmf, 42.5% with CAST4-7, and 77.5% with CAST3-7. When the outcome was caries prevalence, CAST4-7 discriminated between sexes, household crowding, and dental pain, and CAST3-7 discriminated age and family income, while the dmf was associated with dental pain. When experience of caries was the outcome, all the criteria discriminated between sexes, age, family income, household overcrowding, visible dental plaque, and dental pain, while dmf and CAST2-8 also discriminated maternal schooling. The CAST discriminated caries risk factors similar to the dmf index when caries experience was the outcome. When prevalence was considered, CAST was able to discriminate for more individual characteristics than dmf.

Abstract Objective: This cross-sectional study aimed to determine the prevalence of dental caries, dental fluorosis, and molar-incisor hypomineralization, and their associations in a group of Brazilian schoolchildren. Methodology: Adolescents (n=411) were evaluated by two calibrated examiners for dental caries (DC), dental fluorosis (DF), and molar-incisor hypomineralization (MIH) using the CAST (Caries Assessment Spectrum and Treatment) instrument, Thylstrup and Fejerskov (TF) index, and MIH Severity Scoring System (MIH-SSS), respectively. Descriptive statistics, chi-square tests, and logistic regression were used for statistical analysis. Results: The sample comprised 42.75% boys and 57.25% girls. The prevalence of DC in permanent dentition was 94.75%, of which 29% were represented by dentin lesions. For DF, a prevalence of 40.75% was observed, with 69.32% mild, 12.88% moderate, and 17.79% severe. A positive association between the source of water and fluorosis was detected (p=0.01). The prevalence of MIH was 18%. Thirty adolescents (41.7%) presented with severe MIH. No association was found between DF or MIH and dentin DC or between MIH and DF at the individual level. However, a significant negative relationship was detected between DF and dentin carious lesions ( p <0.005) and DF and MIH ( p <0.00001) at the tooth level, whereas a positive association was observed between MIH and dentin carious lesions ( p <0.00001). A positive association was also observed between the severity of both conditions ( p <0.00001). Mild DF was the most prevalent problem observed. Cases of teeth with mild MIH were the most predominant in MIH-affected teeth. Conclusions: No association was observed among the dentin carious lesions, MIH, and DF at the participant level. However, a positive association between MIH and dentin carious lesions was found at the tooth level, whereas MIH, DF, and DF and dentin carious lesions showed a negative relationship.

Abstract: This before-after experimental study evaluated the impact of dental treatment on the oral health-related quality of life (OHRQoL) in children aged 6–8 years from Paranoá, DF, considering the presence or absence of cavitated dentin carious lesions pre- and post-treatment. The responsiveness and sensitivity of the questionnaires were also investigated. Caries was detected by using the Caries Assessment Spectrum and Treatment (CAST) instrument, while the impact of oral health on the children's health-related quality of life was assessed using the Brazilian version of the Child Perceptions Questionnaire (CPQ8-10), which was completed by the children and the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS), which was completed by their parents. Sociodemographic characteristics were also assessed. After the examinations, the children were categorized into two groups according to the presence (treatment/n = 34) or absence (control/n = 34) of cavitated dentin carious lesions. Restorative/curative care was provided to the treatment group, while the control group received preventive measures. OHRQoL was assessed at baseline and at four weeks post-treatment. No significant sociodemographic differences were observed between the groups. In the treatment group, the children and their families reported a greater impact of oral health on their OHRQoL in both questionnaires (p < 0.05). However, there was a significant reduction in the impact of oral health, with differences between the pre-treatment and post-treatment phases (p = 0.001). Good sensitivity and responsiveness were observed for both questionnaires. Dental treatment was found to reduce the negative impact of dental caries on OHRQoL in 6–8-year-old children, which was detected by both questionnaires (B-ECOHIS and CPQ8-10).

Abstract The aim of this study was to evaluate whether dentists and dental undergraduate students know the terminology of the International Caries Consensus Collaboration (ICCC), and make their restorative treatment decisions regarding carious tissue removal accordingly. Data collection was performed using an electronic questionnaire, considering: a) profile of the respondent; b) analysis of four clinical cases with respect to possible management strategies; and c) questions on cariology field terminology. Sample size consisted of 175 dentists and 66 last semester dental students. Statistical analyses were performed comparing profile, type of institution and dental specialty of the participants. Results showed students were less conservative and agreed less with the ICCC than dentists, and private schools, less than public institutions. Private institutions were 12% (95%CI = 0.833–0.949; p = 0.000) more likely to be less updated with the ICCC recommendations than public institutions, and dentists were 20% more likely to agree with them than students (95%CI = 1.118–1.302; p = 0.000). Dentists were 66% more likely to be conservative than students (95%CI = 0.203–0.554; p = 0.000); dentists and students who graduated or were graduating from public universities were twice as likely to be conservative as those from private universities (95%CI = 1.336–3.333; p = 0.001). In conclusion, students in the last semester are less conservative than dentists, and respondents who graduated or were graduating from public dental schools were more aligned with the current concepts of the ICCC. Several answers were not aligned with ICCC directives, thus showing that management of deep carious lesions still causes restorative therapeutic insecurity.

Resumo O CAST (Caries Assessment Spectrum and Treatment) é um instrumento desenvolvido para a detecção de cárie a ser utilizado em levantamentos epidemiológicos. Foi validado e tem se mostrado efetivo, fornecendo um diagnóstico mais preciso do estado de saúde bucal do que o critério OMS, recomendado pela Organização Mundial da Saúde. O objetivo deste artigo é comparar a apresentação dos resultados de cárie dentária utilizando o instrumento CAST e o critério OMS, numa mesma população. Foram avaliados por dois examinadores treinados na utilização do instrumento CAST 680 escolares de 6 a 8 anos do Distrito Federal, Brasil. A avaliação constou do índice de placa visível (IPV) e do índice de sangramento gengival (ISG). Os escores CAST dente foram convertidos em componentes ceo/CPO e calculados os ceod/CPOD. Os pais responderam a um questionário sociodemográfico. A idade média foi 7,45 anos (± 0,91). A prevalência de cárie na dentição decídua foi de 65,44% e 61,61%, considerando o CAST e o critério da OMS, respectivamente; na dentição permanente: 38,19% e 10,2%, respectivamente. A média do ceod foi de 2.4 (± 2.7) e a média do CPOD 0.16 (± 0.53). o IPV foi associado a maiores CAST máximos p < 0,005. O instrumento CAST demonstrou maior sensibilidade em identificar a presença e gravidade de lesões cariosas quando comparado ao critério OMS.

Abstract Caries Assessment Spectrum and Treatment (CAST) is an instrument developed for caries detection to be used in epidemiological surveys; it has been validated and is believed to provide a clearer picture of the oral health status than the criteria provided by the World Health Organization (WHO). This article aims to compare the epidemiological survey results using the CAST instrument and the WHO criteria in the same population. 680 schoolchildren aged 6-8 years from Federal District, Brazil, were evaluated by two examiners trained to use the CAST. The visible plaque index (VPI) and gingival bleeding index (GBI) were also evaluated. The maximum CAST codes per tooth were converted into the dmf/DMF, the mean scores for primary and permanent dentition were calculated. The mean age was 7.45(± 0.91) years. The prevalence of caries differed when CAST and the WHO criteria were applied. In the primary dentition, it was 65.44% and 61.61%, and for the permanent dentition, 38.19% and 10.2%, respectively. It was possible to calculate the mean dmft [2.4(± 2.7)] and the DMFT [0.16(± 0.53)] using CAST. VPI was associated with higher maximum CAST scores p < 0,005. The way CAST results are presented showed a higher sensibility to identify the presence and severity of carious lesions in comparison to the WHO criteria.

Abstract Objectives To perform a systematic review of test methodologies on conventional restorative glass-ionomer cement (GIC) materials for mechanical and optical properties to compare the results between different GICs. Material and Methods Screening of titles and abstracts, data extraction, and quality assessments of full-texts were conducted in search for in vitro studies on conventional GICs that follow the relevant specifications of ISO standards regarding the following mechanical and optical properties: compressive strength, flexural strength, color, opacity and radiopacity. Sources The Latin American and Caribbean Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO) databases from Latin-American and Caribbean System on Health Sciences Information (BIREME) and PubMed/Medline (US National Library of Medicine - National Institutes of Health) databases were searched regardless of language. Altogether, 1146 in vitro studies were selected. Two reviewers independently selected and assessed the articles according to pre-established inclusion/exclusion criteria. Among all the properties investigated, only one study was classified as being of fair quality that tested compressive strength and was included. It was observed that many authors had not strictly followed ISO recommendations and that, for some properties (diametral tensile strength and microhardness), there are no guidelines provided. Conclusions It was not possible to compare the results for the mechanical and optical properties of conventional restorative GICs due to the lack of standardization of studies.

Resumo O CAST (Caries Assessment Spectrum and Treatment) é um instrumento desenvolvido para a detecção de cárie a ser utilizado em levantamentos epidemiológicos. Foi validado e tem se mostrado efetivo, fornecendo um diagnóstico mais preciso do estado de saúde bucal do que o critério OMS, recomendado pela Organização Mundial da Saúde. O objetivo deste artigo é comparar a apresentação dos resultados de cárie dentária utilizando o instrumento CAST e o critério OMS, numa mesma população. Foram avaliados por dois examinadores treinados na utilização do instrumento CAST 680 escolares de 6 a 8 anos do Distrito Federal, Brasil. A avaliação constou do índice de placa visível (IPV) e do índice de sangramento gengival (ISG). Os escores CAST dente foram convertidos em componentes ceo/CPO e calculados os ceod/CPOD. Os pais responderam a um questionário sociodemográfico. A idade média foi 7,45 anos (± 0,91). A prevalência de cárie na dentição decídua foi de 65,44% e 61,61%, considerando o CAST e o critério da OMS, respectivamente; na dentição permanente: 38,19% e 10,2%, respectivamente. A média do ceod foi de 2.4 (± 2.7) e a média do CPOD 0.16 (± 0.53). o IPV foi associado a maiores CAST máximos p < 0,005. O instrumento CAST demonstrou maior sensibilidade em identificar a presença e gravidade de lesões cariosas quando comparado ao critério OMS.

Abstract Caries Assessment Spectrum and Treatment (CAST) is an instrument developed for caries detection to be used in epidemiological surveys; it has been validated and is believed to provide a clearer picture of the oral health status than the criteria provided by the World Health Organization (WHO). This article aims to compare the epidemiological survey results using the CAST instrument and the WHO criteria in the same population. 680 schoolchildren aged 6-8 years from Federal District, Brazil, were evaluated by two examiners trained to use the CAST. The visible plaque index (VPI) and gingival bleeding index (GBI) were also evaluated. The maximum CAST codes per tooth were converted into the dmf/DMF, the mean scores for primary and permanent dentition were calculated. The mean age was 7.45(± 0.91) years. The prevalence of caries differed when CAST and the WHO criteria were applied. In the primary dentition, it was 65.44% and 61.61%, and for the permanent dentition, 38.19% and 10.2%, respectively. It was possible to calculate the mean dmft [2.4(± 2.7)] and the DMFT [0.16(± 0.53)] using CAST. VPI was associated with higher maximum CAST scores p < 0,005. The way CAST results are presented showed a higher sensibility to identify the presence and severity of carious lesions in comparison to the WHO criteria.

Resumo É importante ter uma compreensão epidemiológica das doenças orais entre as populações indígenas, a fim de contribuir com a organização dos serviços de saúde para essas populações. O banco de dados SB Brasil 2010 foi utilizado para comparar a prevalência de cárie entre os 308 autoidentificados indígenas e 37.211 indivíduos não indígenas de áreas urbanas, nas idades/grupos etários: 5, 12, 15-19, 35-44, 65-74. O estudo também analisou o efeito do desenho amostral complexo e o peso da amostra nos resultados. Kruskal-Wallis, Wilcoxon Scores (Rank Sums), regressão logística e linear múltipla foram utilizados para análise estatística. O índice ceo-d médio para crianças indígenas e não indígenas com idade de cinco foram 4,02 ± 4,01 e 2,41 ± 3,35, respectivamente, e 46% dos não nativos e 30,8% das crianças nativas estavam livres de cárie. A média CPOD para indígenas e não indígenas foram 10,90 ± 11,69 e 10,93 ± 11,58, respectivamente, para público em geral, quando não levando em conta o efeito do peso da amostra. Ao considerar o desenho amostral complexo e o efeito do peso da amostra, o estudo encontrou uma diferença estatisticamente significativa. Os resultados dão crédito às suspeitas de que no Brasil existem disparidades nos padrões de cárie entre indivíduos indígenas e não indígenas autoidentificados.

Abstract It is important to have an epidemiological understanding of oral diseases among indigenous persons, in order to contribute with the organization of health services for these populations. The SB Brasil 2010 database was used to compare the prevalence of dental caries among 308 self-identified indigenous and 37,211 non-indigenous individuals from urban areas, in the following age/age-groups: 5, 12, 15-19, 35-44, 65-74. The study also analyzed the effect of the complex sample design and the sample weight in the outcomes. Kruskal-Wallis, Wilcoxon Scores (Rank Sums), logistic and multiple linear regressions were used for statistical analysis. The mean dmft index for indigenous and non-indigenous children aged five were 4.02 ± 4.01 and 2.41 ± 3.35, respectively, and 46% of non-native and 30.8% of native children were caries-free. The mean DMFT for indigenous and non-indigenous were 10.90 ± 11.69 and 10.93 ± 11.58, respectively, for all age groups when not taking into account the sample weight effect. When considering the complex sample design and the sample weight effect, the study found a statistical significant difference. The results lend credence to suspicions that in Brazil there are disparities in the patterns of caries between self-identified indigenous and non-indigenous individuals.

Resumo É importante ter uma compreensão epidemiológica das doenças orais entre as populações indígenas, a fim de contribuir com a organização dos serviços de saúde para essas populações. O banco de dados SB Brasil 2010 foi utilizado para comparar a prevalência de cárie entre os 308 autoidentificados indígenas e 37.211 indivíduos não indígenas de áreas urbanas, nas idades/grupos etários: 5, 12, 15-19, 35-44, 65-74. O estudo também analisou o efeito do desenho amostral complexo e o peso da amostra nos resultados. Kruskal-Wallis, Wilcoxon Scores (Rank Sums), regressão logística e linear múltipla foram utilizados para análise estatística. O índice ceo-d médio para crianças indígenas e não indígenas com idade de cinco foram 4,02 ± 4,01 e 2,41 ± 3,35, respectivamente, e 46% dos não nativos e 30,8% das crianças nativas estavam livres de cárie. A média CPOD para indígenas e não indígenas foram 10,90 ± 11,69 e 10,93 ± 11,58, respectivamente, para público em geral, quando não levando em conta o efeito do peso da amostra. Ao considerar o desenho amostral complexo e o efeito do peso da amostra, o estudo encontrou uma diferença estatisticamente significativa. Os resultados dão crédito às suspeitas de que no Brasil existem disparidades nos padrões de cárie entre indivíduos indígenas e não indígenas autoidentificados.

Abstract It is important to have an epidemiological understanding of oral diseases among indigenous persons, in order to contribute with the organization of health services for these populations. The SB Brasil 2010 database was used to compare the prevalence of dental caries among 308 self-identified indigenous and 37,211 non-indigenous individuals from urban areas, in the following age/age-groups: 5, 12, 15-19, 35-44, 65-74. The study also analyzed the effect of the complex sample design and the sample weight in the outcomes. Kruskal-Wallis, Wilcoxon Scores (Rank Sums), logistic and multiple linear regressions were used for statistical analysis. The mean dmft index for indigenous and non-indigenous children aged five were 4.02 ± 4.01 and 2.41 ± 3.35, respectively, and 46% of non-native and 30.8% of native children were caries-free. The mean DMFT for indigenous and non-indigenous were 10.90 ± 11.69 and 10.93 ± 11.58, respectively, for all age groups when not taking into account the sample weight effect. When considering the complex sample design and the sample weight effect, the study found a statistical significant difference. The results lend credence to suspicions that in Brazil there are disparities in the patterns of caries between self-identified indigenous and non-indigenous individuals.

Abstract The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6–7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.

Identifying caries risk factors is an important measure which contributes to best understanding of the cariogenic profile of the patient. The Cariogram® software provides this analysis, and protocols simplifying the method were suggested. Objectives: The aim of this study was to determine whether a newly developed Caries Risk Assessment (CRA) form based on the Cariogram® software could classify schoolchildren according to their caries risk and to evaluate relationships between caries risk and the variables in the form. Material and Methods: 150 schoolchildren aged 5 to 7 years old were included in this survey. Caries prevalence was obtained according to International Caries Detection and Assessment System (ICDAS) II. Information for filling in the form based on Cariogram® was collected clinically and from questionnaires sent to parents. Linear regression and a forward stepwise multiple regression model were applied to correlate the variables included in the form with the caries risk. Results: Caries prevalence, in primary dentition, including enamel and dentine carious lesions was 98.6%, and 77.3% when only dentine lesions were considered. Eighty-six percent of the children were classified as at moderate caries risk. The forward stepwise multiple regression model result was significant (R2=0.904; p<0.00001), showing that the most significant factors influencing caries risk were caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources. Conclusion: The use of the form based on the Cariogram® software enabled classification of the schoolchildren at low, moderate and high caries risk. Caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources are the variables that were shown to be highly correlated with caries risk.

OBJETIVO: Foi conduzida revisão da literatura em busca de ensaios clínicos randomizados in situ e in vivo que avaliassem o papel do complexo de fosfopeptídeo de caseína - fosfato de cálcio amorfo na prevenção de lesões de cárie. MÉTODOS: Inicialmente, buscou-se identificar na base Pubmed revisões sistemáticas sobre o tema. Foram identificadas duas revisões sistemáticas, que concluíram que a quantidade e qualidade dos ensaios clínicos randomizados são insuficientes para recomendação do uso clínico do produto. Posteriormente, pesquisaram-se ensaios clínicos randomizados in situ e in vivo que não tivessem sido incluídos nas revisões identificadas. RESULTADOS: Os estudos in vivo e in situ tiveram resultados contraditórios. Os estudos in situ indicaram uma maior eficácia do complexo de fosfopeptídeo de caseína - fosfato de cálcio amorfo em relação ao placebo. Já os estudos in vivo demonstraram diferentes. CONCLUSÃO: Complexo de fosfopeptídeo de caseína - fosfato de cálcio amorfo apresentou desempenho ora superior, ora equivalente ao placebo; o flúor demonstrou maior eficácia que o complexo de caseína; o complexo de fosfopeptídeo de caseína - fosfato de cálcio amorfo associado ao flúor se mostrou ora melhor, ora equivalente ao placebo. Diante da evidência científica disponível, não se pode generalizar a indicação do complexo de fosfopeptídeo de caseína - fosfato de cálcio amorfo para prevenção de lesões cariosas.

OBJECTIVE: A literature review of systematic reviews and in situ and in vivo randomized controlled trials was conducted in order to assess the role of casein phosphopeptide - amorphous calcium phosphate in providing caries-preventive effect superior to any intervention or placebo. METHODS: Initially, Pubmed database was searched for systematic reviews. Two systematic reviews were identified, which concluded that the quantity and quality of randomized controlled trials were insufficient to recommend the clinical use of the product. After this, Pubmed database was searched for in situ and in vivo randomized controlled trials that were not included in the reviews identified. In vivo and in situ studies yielded mixed results. RESULTS: In situ studies indicated greater efficacy of casein phosphopeptide - amorphous calcium phosphate in comparison with placebo. Whereas, in vivo studies demonstrated different findings CONCLUSION: Casein phosphopeptide - amorphous calcium phosphate had a performance equivalent to or greater efficacy than placebo; fluoride was more effective than the casein complex; casein phosphopeptide - amorphous calcium phosphate associated with fluoride showed better or equivalent performance to that of placebo. In view of available evidence, it was not possible to generalize the indication of casein phosphopeptide - amorphous calcium phosphate for preventing dental caries. Further studies on the preventive effect and longer treatment applications are recommended.

OBJETIVO: Comparar os níveis de cortisol sérico e salivar, alfa-amilase salivar (sAA) e fluxo de saliva não estimulada (UWS) em gestantes e não gestantes. MÉTODOS: Trata-se de um estudo longitudinal realizado no centro de promoção da saúde de um hospital universitário. Nove gestantes e 12 não gestantes participaram do estudo. Foram coletados e analisados soro e UWS nos três trimestres gestacionais e duas vezes por mês durante o ciclo menstrual. A análise do cortisol salivar e sérico foi realizada com o uso de quimiluminescência e a atividade da sAA foi determinada por meio de analisador automático para bioquímica. RESULTADOS: Foi verificado que a mediana (intervalo interquartil) dos níveis de cortisol sérico no grupo de gestantes foi maior que 23,8 µL/dL (19,4-29,4) quando comparado ao grupo de não gestantes, que teve média de 12,3 (9,6-16,8; p<0,001). Os níveis de sAA seguiram o mesmo padrão, com médias de 56,7 U/L (30,9-82,2) e 31,8 (18,1-53,2; p<0,001), respectivamente. Foram observadas diferenças dos níveis de cortisol sérico e salivar (µL/dL) e de sAA entre a fase folicular versus a fase lútea (p<0,001). As medianas dos fluxos salivares (UWS) foram semelhantes em gestantes (0,26 [0,15-0,30] mL/min) e não gestantes (0,23 [0,20-0,32] mL/min). Foram encontradas correlações significativas entre o cortisol salivar e o sérico (p=0,02) e entre o cortisol salivar e a sAA (p=0,01). CONCLUSÕES: Os níveis de cortisol sérico de sAA durante a gestação elevam-se. Na fase lútea do ciclo ovariano, os níveis de cortisol salivar aumentam ao passo que os níveis de cortisol sérico e sAA diminuem.

PURPOSE: To compare salivary and serum cortisol levels, salivary alpha-amylase (sAA), and unstimulated whole saliva (UWS) flow rate in pregnant and non-pregnant women. METHOD: A longitudinal study was conducted at a health promotion center of a university hospital. Nine pregnant and 12 non-pregnant women participated in the study. Serum and UWS were collected and analyzed every trimester and twice a month during the menstrual cycle. The salivary and serum cortisol levels were determined by chemiluminescence assay and the sAA was processed in an automated biochemistry analyzer. RESULTS: Significant differences between the pregnant and non-pregnant groups were found in median [interquartile range] levels of serum cortisol (23.8 µL/dL [19.4-29.4] versus 12.3 [9.6-16.8], p<0.001) and sAA (56.7 U/L [30.9-82.2] versus 31.8 [18.1-53.2], p<0.001). Differences in salivary and serum cortisol (µL/dL) and sAA levels in the follicular versus luteal phase were observed (p<0.001). Median UWS flow rates were similar in pregnant (0.26 [0.15-0.30] mL/min) and non-pregnant subjects (0.23 [0.20-0.32] mL/min). Significant correlations were found between salivary and serum cortisol (p=0.02) and between salivary cortisol and sAA (p=0.01). CONCLUSIONS: Serum cortisol and sAA levels are increased during pregnancy. During the luteal phase of the ovarian cycle, salivary cortisol levels increase, whereas serum cortisol and sAA levels decline.

Confusion exists amongst dentists and scientists about the correct use of the caries management approach termed atraumatic restorative treatment (ART). Inconsistent use of the original definition of ART and suggested modifications (mART) have led to misunderstanding, misconception and miscommunication in the dental literature over the last decade. The aim of this paper is to contribute to a uniform understanding and use of the term ART. Adherence to its original description is suggested and two major aspects were addressed: the use of hand instruments only and the use of adhesive materials and systems.