Abstract Objective: To translate and perform the cross-cultural adaption of the CD:H scale for use in Paediatric Dentistry in Brazilian Portuguese language. Material and Methods: The translation and cross-cultural adaptation of the CD: H was carried out in four stages: 1) translation of the instrument; 2) reverse translation (back translation); 3) cross-cultural adaptation, and 4) face validation. Face validation consisted of the evaluation of 30 subjects from the target population. A pilot study was conducted with 15 children aged 5-10 years treated at a university dental clinic and their drawings were analysed by two dentists. Data were analysed using Stata 12.0. Results: In the face validation, most items were understood; however, some words were changed, and terms were included to identify the dental environment. Good reproducibility was obtained: inter-examiner reliability was 0.9647 and intra-examiner reliability was 0.9619 for examiner A and 0.8260 for examiner B. Conclusion: The Brazilian version of the CD:H scale is a useful tool for dentists, helping identify children's emotions and being enjoyable for them.

ABSTRACT Objective: To investigate the association between emotional and behavioural problems and dental fear/anxiety (DFA) in children aged four to 12 years treated at a clinic in southern Brazil. Material and Methods: In this cross-sectional study where mother-child dyads were interviewed, emotional and behavioural problems were investigated using the Strengths and Difficulties Questionnaire (SDQ) (considering five subscales). Children's DFA was evaluated through the Venham Picture Test. For each SDQ subscale, Poisson regression model was explored. Prevalence ratios (PR) were estimated, considering a significant level of p ≤ 0.05. Results: Overall, 128 children participated in this study. Most children were female (54.7%) and aged between 7 and 9 years (39.8%). The prevalence of emotional problems was 47.7% and behavioural problems were 46.1%. The prevalence of DFA was 18.8%. Children with emotional problems had a 2.3 higher prevalence of DFA (95%CI 1.06-5.04). In general, behavioural problems were not associated with DFA (95%CI 0.84-3.34) only when conduct problems were considered (2.20; 95%CI 1.02-4.70). Conclusion: Children aged between 4 and 12 years who present emotional and conduct problems tend to show higher DFA.

Abstract Although periodontal disease is common during pregnancy, little is known about socioeconomic, behavioral, or biological determinants related to clinically assessed periodontal condition during this period. We assessed the prevalence of periodontal disease and associated factors in pregnant women. This population-based survey used data used from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth between December 2014 and May 2016 were interviewed and clinically examined by trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Outcomes were periodontitis (using the 2012 Centers for Disease Control and Prevention and the American Academy of Periodontology criteria) and gingivitis (by the 2018 European Federation of Periodontology/ American Academy of Periodontology classification). Multivariate hierarchical Poisson regression was used to assess the associations between socioeconomic, systemic, and clinical oral factors and periodontal disease. A total of 2,474 pregnant women participated in the study. Prevalence of periodontitis and gingivitis was 14.63% and 21.67%, respectively. Lower educational level and calculus were associated with higher prevalence periodontitis and gingivitis (P<0.05). Smoking was also associated with periodontitis (P=0.05), and lower frequency of toothbrushing (P=0.005) with gingivitis. Periodontal disease, especially gingivitis, was prevalent in pregnant women and their determinants were socioeconomic, environmental, and clinical oral health factors.

Abstract The present systematic review aimed to investigate the effectiveness of professionally applied topical fluoride as therapeutic agent for incipient carious lesions in permanent teeth. Randomised clinical trials (RCTs) comparing the effectiveness of professionally applied topical fluoride (varnish or gel) with that of placebo, no intervention, and toothbrushing (control group) in the treatment of incipient carious lesions in permanent dentition were included. An electronic search was performed in the PubMed, Web of Science, Scopus, Virtual Health Library, Embase, and Cochrane databases, in the grey literature, and in clinical trials registered until January 2021. Two reviewers independently screened titles and abstracts and assessed the risk of bias using the Cochrane tool. The certainty of evidence was classified using GRADE. A total of 2,223 articles were screened using titles/abstracts. After full-text reading of the 22 selected studies, nine RCTs were included. Five RCTs found that topical fluoride may be effective in reversing incipient carious lesions in permanent teeth. Overall, five studies were classified as having a low risk of bias and four as having some concerns. Only descriptive analysis was performed because of the heterogeneity of the data. Studies comparing fluoride varnish with usual home care oral hygiene have demonstrated topical fluoride does not appear to be more effective in improving the appearance of incipient carious lesions. Therefore, usual home care oral hygiene with fluoride toothpaste may be sufficient to treat incipient carious lesions in permanent dentition. Further studies with greater methodological rigor are, however, required to reduce bias, to allow a meta-analysis, and to draw well-founded conclusions (CRD42019120406).

Abstract The purpose of this study was to investigate the association between maternal factors and dental visits of children within their first year of life. This study used data from the 2015 Pelotas Birth Cohort and included pregnant women and their children at 12 months of age, followed-up between May 2014 and December 2015. Socioeconomic and demographic data, information on the use of dental services during the last year, and information on dental fear were collected by interviewing the mothers. Information regarding dental caries and periodontal disease were collected during the mother’s clinical examination. The date of each child’s first visit to the dentist was recorded. Crude and adjusted Poisson regression models with robust variance were used. The sample comprised 2,287 mother-child dyads, of which 10.1% of children visited the dentist during the first year of life. Children whose mothers visited the dentist within the last year for preventive reasons (RR: 1.51; 95%CI: 1.12–2.03) or curative reasons (RR: 1.47; 95%CI: 1.08–2.01) were more likely to have visited the dentist during the first year of life compared to those whose mothers had not used dental services during this period. Maternal tooth loss was inversely associated with a child’s visit to the dentist during the first year of life (RR: 0.69; 95%CI: 0.54–0.89). Considering the mother’s history of using dental services, as well as their dental caries history, is necessary to understand and improve patterns of dental health care utilization and implement public oral health policies for young children.

Aim To verify the validity of maternal reports on the number of deciduous teeth erupted in their children. Methods This cross-sectional study was performed with children enrolled in a Birth Cohort at the age of 12 months in the first stage and 24 months in the second stage. At both stages, children were clinically examined, and mothers reported the number of teeth of their children. Comparison between groups was performed using the Mann-Whitney non-paired Wilcoxon test. Level of agreement between two methods were estimated by the Observed Agreement, Weighted Kappa and Intraclass Correlation coefficients. Results A total of 125 children were examined in the first stage, with mean number of reported teeth of 6.2. In the second stage, 149 children were examined, with mean number of reported teeth of 15.9. High level of agreement, kappa values and intraclass correlation coefficients were observed for both arches in both periods (p<0.001). Conclusions Maternal report on the number of teeth erupted in children was reliable and valid. Thus, it seems to be a useful instrument for collecting data in population-based epidemiological studies targeting young children.

Abstract This randomized parallel-group control trial tested the efficacy of distraction using audiovisual eyeglasses (AVE) during dental procedures [NCT03902158]. Forty-four 6–9 year-old children with low/moderate anxiety and who needed restorative treatment or exodontia of the primary molars were randomly allocated into two groups: the AVE (experimental) and the conventional behavior management techniques (control) groups. Motion sensors were used to measure the participants’ body movements. Dental visits were video recorded, and their pain levels and behavior were assessed using the Faces, Legs, Activity, Cry, and Consolability Behavioral Pain Assessment Scale and the Venham Behavioral Scale, respectively. Anxiety was assessed via heart rate measurements. After treatment, the children scored their pain using the Faces Pain Scale. Mann-Whitney U and chi-square tests were used to compare the groups. The mean score on the behavioral scale was 0.59 in the experimental group and 0.72 in the control group under local anesthesia (p = 0.73). During the procedure, the mean score was 0.41 in the experimental group and 1.32 in the control group (p = 0.07). The mean heart rate was similar in both groups (p = 0.47), but a significant increase during treatment was observed in the control group. There was no difference between the groups in terms of pain, behavior, and self-reported pain scores (p = 0.08). Children aged 6-7 who used the AVE had fewer wrist movements (435.6) than that of children in the control group (1170.4) (p = 0.04). The AVE achieved similar results to the basic behavior management techniques, with good acceptance by the children.

Abstract: This study aimed to verify, through a longitudinal follow-up, the pre-, peri- and postnatal factors associated with the eruption of deciduous teeth. The study was nested in a Birth Cohort Study conducted in Pelotas, a Southern Brazilian city. Mothers were followed prenatally and their children were followed-up perinatally, at 3 and 12 months of age. The outcome was the number of teeth at 12 months, and exploratory variables included maternal habits and characteristics, anthropometric measures of children and mothers, and socioeconomic and demographic information. Data were collected through interviews with the mother and children’s clinical exam. Poisson regression models were used for the analysis. Participants included 4,014 children with a mean number of erupted teeth at 12 months of 5.50. After adjustments, a lower mean number of teeth was observed in children from non-white mothers, early preterm children, and shorter children at birth and at 12 months. A higher number of teeth was observed for mothers with excessive weight gain during pregnancy, mothers who smoked during pregnancy, weightier children at birth and at 12 months, and for children with larger heads at birth and at 12 months. Our findings suggest that maternal and children characteristics influenced primary tooth eruption.

Abstract Objective: To identify psychosocial characteristics associated with dental anxiety in children aged 7-13 years in the dental setting. Material and Methods: This cross-sectional study was conducted with children aged 7-13 years attended at the Dentistry School of Pelotas, Brazil. Data collection was based on a questionnaire administered to mothers and children, and the behavior of children during dental treatment was evaluated using the Frankl’ Scale. Data were analyzed using Chi-square and Fisher’s exact tests in order to analyze the association between independent variables and dental anxiety. The effect of variables on the outcome was assessed by the Poisson regression model with robust variance (Prevalence Ratio; 95% Confidence interval). Results: A total of 187 children were included. Dental anxiety prevalence was 40.11%. After adjustments, younger children (p=0.046), only child (p=0.019), and children with negative previous dental experience (p=0.046) showed higher dental anxiety prevalence. Children with uncooperative behavior in previous (p=0.033) and current (p≤0.001) dental appointments showed higher dental anxiety prevalence. Conclusion: In this sample of children treated at a dentistry school, a report of dental anxiety was associated with age, birth order, previous dental experience and behavior in dental settings.

Resumo: O estudo teve como objetivo testar a acurácia e a confiabilidade de um protocolo parcial (PP) para exame oral, envolvendo os primeiros molares permanentes. O estudo transversal foi realizado em duas etapas. Primeiro, foi feito um estudo transversal em uma amostra representativa de 1.211 crianças, usando o índice CPOD com um protocolo de boca completa (BC). O PP foi simulado a partir de dados de BC, usando apenas os dados dos primeiros molares permanentes. A segunda etapa foi realizada em 202 crianças examinadas por um examinador de padrão de ouro (BC) e três odontólogos usando o PP para avaliar a confiabilidade do mesmo. A acurácia do PP foi avaliada pela sensibilidade, especificidade e valores preditivos positivos e negativos. A confiabilidade inter- examinador, comparada com o examinador de padrão de ouro, foi avaliada através do índice kappa ponderado. A prevalência de cárie dentária, medida pelo índice CPOD, foi 32,4%, comparado com 30,2% para o PP. O PP apresentou sensibilidade alta (93,1%; IC95%: 91,5-94,5), com magnitude semelhante nas medidas de associação dos fatores investigados. Quando comparados com o exame de BC (padrão de ouro), todos os examinadores obtiveram níveis altos de sensibilidade e especificidade (em torno de 90%). Os valores preditivos negativos foram mais altos do que os valores preditivos positivos para os examinadores. O estudo mostrou que o protocolo parcial envolvendo os primeiros molares permanentes é acurado e confiável enquanto ferramenta de triagem para avaliar a prevalência de cárie dentária e fatores associados em escolares.

Abstract: The aim of this study was to test accuracy and reliability of a partial protocol (PP) of oral examination involving the permanent first molars. This cross-sectional study was carried out in two stages. First, a cross-sectional study was performed in a representative sample of 1,211 children using DMFT-index in a full-mouth protocol (FM). A PP was simulated from FM data using only data from the permanent first molars. A second part was performed with 202 children examined by a gold standard examiner (FM) and three dentists using the PP to assess its reliability. Accuracy of PP was assessed by sensitivity/specificity/predictive positive and negative values. Inter-examiner reliability in comparison with gold standard examiner was assessed using weighted kappa. The prevalence of dental caries observed using DMFT index was 32.4% and was 30.2% for PP . The PP presented high sensitivity (93.1%; 95%CI: 91.5-94.5), showing similar magnitude of association’s measures for all associated factors investigated. When compared with the gold standard FM examination, all examiners obtained high parameters of sensitivity and specificity (around 90%). Predictive negative values were higher than predictive positive values for the examiners. This study showed that this partial protocol involving the permanent first molars is accurate and reliable as a screening tool to assess dental caries prevalence and associated factors in schoolchildren.

Resumen: El objetivo de este estudio fue probar la precisión y fiabilidad de un protocolo parcial (PP) de exámenes orales, incluyendo los primeros molares permanentes. Este estudio transversal se llevó a cabo en dos etapas. En primer lugar, se desarrolló un estudio transversal con una muestra representativa de 1.211 niños, usando el DMFT-index en un protocolo para toda la boca (FM por sus siglas en inglés). El PP se simuló con datos del FM, usando solo información de los primeros molares permanentes. La segunda parte se realizó con 202 niños examinados por un examinador ideal (FM) y tres dentistas, usando el PP para evaluar su fiabilidad. La precisión del PP se evaluaron por sensibilidad/especificidad/valores predictivos positivos y negativos. La fiabilidad interexaminadores, en comparación con el examinador ideal, fue evaluada usando un índice kappa ponderado. La prevalencia de caries dental observada, usando el índice DMFT fue de un 32,4% y un 30,2% respecto al PP. El PP presentó una alta sensibilidad (93,1%; IC95%: 91,5-94,5), mostrando una magnitud similar de medidas de asociación para todos los factores asociados investigados. Cuando se comparó con el estándar ideal de examen para la FM, todos los examinadores obtuvieron parámetros altos de sensibilidad y especificidad (sobre un 90%). Los valores predictivos negativos eran más altos que los valores predictivos positivos para los examinadores. Este estudio mostró que este protocolo parcial, incluyendo los primeros molares permanentes, es preciso y fiable como herramienta de detección para evaluar la prevalencia de caries dental y sus factores asociados en niños con edad escolar.

Resumo: O estudo teve como objetivo testar a acurácia e a confiabilidade de um protocolo parcial (PP) para exame oral, envolvendo os primeiros molares permanentes. O estudo transversal foi realizado em duas etapas. Primeiro, foi feito um estudo transversal em uma amostra representativa de 1.211 crianças, usando o índice CPOD com um protocolo de boca completa (BC). O PP foi simulado a partir de dados de BC, usando apenas os dados dos primeiros molares permanentes. A segunda etapa foi realizada em 202 crianças examinadas por um examinador de padrão de ouro (BC) e três odontólogos usando o PP para avaliar a confiabilidade do mesmo. A acurácia do PP foi avaliada pela sensibilidade, especificidade e valores preditivos positivos e negativos. A confiabilidade inter- examinador, comparada com o examinador de padrão de ouro, foi avaliada através do índice kappa ponderado. A prevalência de cárie dentária, medida pelo índice CPOD, foi 32,4%, comparado com 30,2% para o PP. O PP apresentou sensibilidade alta (93,1%; IC95%: 91,5-94,5), com magnitude semelhante nas medidas de associação dos fatores investigados. Quando comparados com o exame de BC (padrão de ouro), todos os examinadores obtiveram níveis altos de sensibilidade e especificidade (em torno de 90%). Os valores preditivos negativos foram mais altos do que os valores preditivos positivos para os examinadores. O estudo mostrou que o protocolo parcial envolvendo os primeiros molares permanentes é acurado e confiável enquanto ferramenta de triagem para avaliar a prevalência de cárie dentária e fatores associados em escolares.

Abstract: The aim of this study was to test accuracy and reliability of a partial protocol (PP) of oral examination involving the permanent first molars. This cross-sectional study was carried out in two stages. First, a cross-sectional study was performed in a representative sample of 1,211 children using DMFT-index in a full-mouth protocol (FM). A PP was simulated from FM data using only data from the permanent first molars. A second part was performed with 202 children examined by a gold standard examiner (FM) and three dentists using the PP to assess its reliability. Accuracy of PP was assessed by sensitivity/specificity/predictive positive and negative values. Inter-examiner reliability in comparison with gold standard examiner was assessed using weighted kappa. The prevalence of dental caries observed using DMFT index was 32.4% and was 30.2% for PP . The PP presented high sensitivity (93.1%; 95%CI: 91.5-94.5), showing similar magnitude of association’s measures for all associated factors investigated. When compared with the gold standard FM examination, all examiners obtained high parameters of sensitivity and specificity (around 90%). Predictive negative values were higher than predictive positive values for the examiners. This study showed that this partial protocol involving the permanent first molars is accurate and reliable as a screening tool to assess dental caries prevalence and associated factors in schoolchildren.

Resumen: El objetivo de este estudio fue probar la precisión y fiabilidad de un protocolo parcial (PP) de exámenes orales, incluyendo los primeros molares permanentes. Este estudio transversal se llevó a cabo en dos etapas. En primer lugar, se desarrolló un estudio transversal con una muestra representativa de 1.211 niños, usando el DMFT-index en un protocolo para toda la boca (FM por sus siglas en inglés). El PP se simuló con datos del FM, usando solo información de los primeros molares permanentes. La segunda parte se realizó con 202 niños examinados por un examinador ideal (FM) y tres dentistas, usando el PP para evaluar su fiabilidad. La precisión del PP se evaluaron por sensibilidad/especificidad/valores predictivos positivos y negativos. La fiabilidad interexaminadores, en comparación con el examinador ideal, fue evaluada usando un índice kappa ponderado. La prevalencia de caries dental observada, usando el índice DMFT fue de un 32,4% y un 30,2% respecto al PP. El PP presentó una alta sensibilidad (93,1%; IC95%: 91,5-94,5), mostrando una magnitud similar de medidas de asociación para todos los factores asociados investigados. Cuando se comparó con el estándar ideal de examen para la FM, todos los examinadores obtuvieron parámetros altos de sensibilidad y especificidad (sobre un 90%). Los valores predictivos negativos eran más altos que los valores predictivos positivos para los examinadores. Este estudio mostró que este protocolo parcial, incluyendo los primeros molares permanentes, es preciso y fiable como herramienta de detección para evaluar la prevalencia de caries dental y sus factores asociados en niños con edad escolar.

Resumo Fraturas coronorradiculares em dentes decíduos são raras, com uma ampla variação de padrões que dificultam o diagnóstico e tratamento. O objetivo deste estudo foi apresentar uma série de casos de fraturas coronorradiculares na dentição decídua de crianças atendidas em um centro de referência. O estudo acompanhou 28 casos de fratura coronorradicular em 26 crianças, representando 4% do número total de participantes ao longo de 11 anos no serviço de referência na Universidade Federal de Pelotas. Na maioria dos casos, o incisivo central superior (85,7%) foi o mais envolvido. Na coroa, 57,1% dos casos tiveram linha de fratura simples, e 42,9% tiveram múltiplas linhas. As linhas simples predominaram na raiz (89,3%). Nos casos com linhas de fratura simples na coroa, 37,6% foram submetidos à extração total, 31,2% necessitaram de extração parcial e 31,2% de pulpectomia. A maioria dos dentes com múltiplas linhas de fratura na coroa, a extração total foi realizada (91,7%). Todos os casos foram acompanhados até a erupção do dente permanente sucessor, e todos os pacientes tiveram resultados favoráveis.

Abstract Crown-root fractures in primary teeth are rare, with a wide variation of patterns that make diagnosis and treatment difficult. The aim of this study was to present a case series of crown-root fractures in primary teeth of children who attended a reference center. The study followed 28 cases of crown-root fractures in 26 children, representing 4% of the total number of attendees over 11 years of reference service at the Universidade Federal de Pelotas, Pelotas, Brazil. In most cases, the maxillary central incisors (85.7%) were involved. In the crown, 57.1% of the cases had a simple line of fracture, and 42.9% had multiple lines. Simple lines predominated in the root (89.3%). In cases with simple fracture lines in the crown, 37.6% underwent a total extraction, 31.2% required a partial extraction and 31.2% underwent pulpectomy. In most teeth with multiple lines of fractures in the crown, total extraction was performed (91.7%) All cases were followed-up until the eruption of the permanent successor tooth, and all patients had favorable outcomes.