ABSTRACT Objective: To assess children's self-reported distress during dental procedures and investigate risk factors. Material and Methods: A total of 163 children (3–10 years old) were included from a clinical trial on diagnostic strategies for evaluating restorations in primary teeth. Treatment plans were elaborated based on the clinical examination performed at the baseline of the study. Dentists performed 742 dental procedures, and an external evaluator collected children's self-reported distress through the Wong Backer Facial Scale (WBFS) and dentists' opinions about children's behavior during the treatment. Kruskal-Wallis Test was performed to compare the distress and the dentists' perception of the different dental procedures, and multilevel ordered logistic regression analysis was conducted to the evaluate association between explanatory variables and the outcomes. Results: More complex procedures caused more distress in children (p=0.017), with a 5.5 times higher risk than simple operative treatments. Similarly, dentists reported children's worse behavior (p<0.001). Older children (older than 7 years) reported less distress than younger children (OR 0.52; CI 0.30-0.87; p=0.014). Patients reported greater distress in the first consultations, reducing the chance of higher scores by 16% in the next interventions. Conclusion: Children experience higher levels of distress during their first treatment appointments. More complex operative procedures and the child's age below 7 years were risk factors associated with greater distress during dental treatment. Objective childrens s selfreported self Methods 16 3–10 310 3 10 (3–1 old teeth study 74 WBFS (WBFS KruskalWallis Kruskal Wallis outcomes Results p=0.017, p0017 p p=0.017 , 0 017 (p=0.017) 55 5 5. treatments Similarly p<0.001. p0001 p<0.001 . 001 (p<0.001) older OR 0.52 052 52 0.300.87 030087 0.30 0.87 30 87 0.30-0.87 p=0.014. p0014 p=0.014 014 p=0.014) consultations interventions Conclusion appointments childs child 1 3–1 31 (3– p001 p=0.01 01 (p=0.017 p000 p<0.00 00 (p<0.001 0.5 05 300 0.300.8 03008 030 0.3 087 0.8 8 0.30-0.8 3– (3 p00 p=0.0 (p=0.01 p<0.0 (p<0.00 0. 0.300. 0300 03 08 0.30-0. ( p0 p=0. (p=0.0 p<0. (p<0.0 0.300 0.30-0 p=0 (p=0. p<0 (p<0. 0.30- p= (p=0 p< (p<0 (p= (p< (p

Abstract This trial-based economic evaluation aimed to estimate the incremental cost of implementing an active learning strategy (theoretical-practical workshop) to substitute the didactic lecture as the sole method for students training in caries detection. We also provided a budget impact analysis and explored the composition of costs related to the activity. Data from the coordinating centre of a multicentre randomized and controlled study (IuSTC01) was analyzed as the first part of our main economic analysis plan. The perspective of the educational provider (the institution implementing the activity) was considered, and an immediate time horizon was adopted. All used resources were valued in Brazilian Real by adopting a microcosting strategy. Costs for each strategy were estimated and converted into international dollars. The incremental Cost per student and the total cost of implementing the complete teaching strategy for 80 students were calculated. Monte Carlo simulations were used to estimate the uncertainties. The incremental Cost estimated for the workshop implementation would be $7.93 per student (interquartile range (IQR): $7.8–8.1), and the total cost of the teaching activity would be $684 (IQR:672–696). The laboratory training comprised more than 50% of the total amount spent, and a higher percentage of this value was related to human resources costs (72%). Saving 40% of the costs could be expected for the next rounds of activities in the institution, assuming no need for additional preparation of didactic materials and tutor training. A modest incremental cost per student and an acceptable organizational budget impact should be expected for the institution when including active learning training in caries detection for undergraduate students, mainly related to the human resources involved. trialbased trial based theoreticalpractical theoretical practical IuSTC01 IuSTC (IuSTC01 plan considered adopted dollars 8 calculated uncertainties 793 7 93 $7.9 interquartile IQR (IQR) $7.8–8.1, 7881 $7.8–8.1 , 1 $7.8–8.1) 684 $68 IQR672–696. IQR672696 672–696 . 672 696 (IQR:672–696) 50 spent 72%. 72 72% (72%) 40 involved IuSTC0 (IuSTC0 79 9 $7. (IQR 788 $7.8–8. 68 $6 IQR672 IQR672–696 IQR67269 672696 672–69 67 69 (IQR:672–696 5 (72% 4 (IuSTC $7 78 $7.8–8 6 $ IQR67 IQR672–69 IQR6726 67269 672–6 (IQR:672–69 (72 $7.8– IQR6 IQR672–6 6726 672– (IQR:672–6 (7 $7.8 IQR672– (IQR:672– ( (IQR:672 (IQR:67 (IQR:6 (IQR:

Abstract Background: Silver diamine fluoride (SDF) is an option for controlling caries lesions in children. However, it is said to be ill-received by caregivers due to the staining it may cause when applied. Objective: This study aimed to assess caregivers’ perception of their children's dental health and aesthetics when treating with SDF compared to those treated with other available options (not directly related to staining). Method: The caregivers of children enrolled in three randomized clinical trials (RCT) testing SDF efficacy in treating non-frankly cavitated caries lesions answered a validated questionnaire six months after completion of the children's dental treatment. The questionnaire was focused on their perception of children's dental health and aesthetics. Multilevel Poisson regression models were used to test the association between a negative caregiver's perception and the use of SDF as treatment. The relative risk (RR), with 95% confidence interval (95%CI), was calculated. Results: The study included 308 caregivers. The SDF treatment was not associated with a negative perception among caregivers both regarding their children's dental health (RR=0.86; 95%CI 0.45–1.62) and aesthetics (RR=0.91; 95%CI 0.59–1.44). Conclusion: The use of SDF on non-frankly cavitated caries lesions in children does not lead to caregivers’ negative perception of their children's dental health and aesthetics. Background (SDF However illreceived ill received applied Objective childrens s staining. . staining) Method RCT (RCT nonfrankly non frankly caregiver RR, RR , (RR) 95 95%CI, 95CI CI (95%CI) calculated Results 30 RR=0.86 RR086 0 86 (RR=0.86 0.45–1.62 045162 45 1 62 RR=0.91 RR091 91 (RR=0.91 0.59–1.44. 059144 0.59–1.44 59 44 0.59–1.44) Conclusion (RR 9 (95%CI 3 RR=0.8 RR08 8 (RR=0.8 0.45–1.6 04516 4 6 RR=0.9 RR09 (RR=0.9 05914 0.59–1.4 5 RR=0. RR0 (RR=0. 0.45–1. 0451 0591 0.59–1. RR=0 (RR=0 0.45–1 045 059 0.59–1 RR= (RR= 0.45– 04 05 0.59– 0.45 0.59 0.4 0.5 0.

Resumo Introdução: O diamino fluoreto de prata (DFP) é uma opção no controle de lesões de cárie em crianças, mas alega-se não ser aceita pelos responsáveis por causar o escurecimento das lesões. Objetivo: Avaliar a percepção dos responsáveis quanto à saúde e estética dos dentes de crianças submetidas ao tratamento de lesões de cárie não francamente cavitadas utilizando DFP em comparação a tratamento não diretamente associado à pigmentação. Método: Após seis meses do tratamento, os responsáveis de crianças envolvidas em três estudos clínicos randomizados (ECR) sobre a eficácia do DFP responderam a um questionário validado para avaliar a percepção da estética e da saúde dos dentes das crianças. Modelos multinível de regressão de Poisson foram utilizados para testar a associação entre a percepção negativa dos responsáveis e o tratamento utilizando DFP. Então, o risco relativo (RR) (intervalo de confiança de 95% — IC95%) foi calculado. Resultados: Foram incluídos 308 responsáveis. Não se associou o tratamento com a percepção negativa dos responsáveis com relação à estética (RR=0,86; IC95% 0,45–1,62) nem à saúde (RR=0,91; IC95% 0,59–1,44) dos dentes de seus filhos. Conclusão: O uso do DFP em lesões não francamente cavitadas não leva à percepção negativa dos responsáveis quanto à saúde e estética dos dentes de seus filhos. Introdução (DFP alegase alega Objetivo pigmentação Método ECR (ECR Então RR (RR intervalo 95 IC95 IC calculado Resultados 30 RR=0,86 RR086 0 86 (RR=0,86 0,45–1,62 045162 45 1 62 RR=0,91 RR091 91 (RR=0,91 0,59–1,44 059144 59 44 filhos Conclusão 9 IC9 3 RR=0,8 RR08 8 (RR=0,8 0,45–1,6 04516 4 6 RR=0,9 RR09 (RR=0,9 0,59–1,4 05914 5 RR=0, RR0 (RR=0, 0,45–1, 0451 0,59–1, 0591 RR=0 (RR=0 0,45–1 045 0,59–1 059 RR= (RR= 0,45– 04 0,59– 05 0,45 0,59 0,4 0,5 0,

Abstract The Internet is a growing source of knowledge and can provide information about oral health. This ecological study aimed to characterize the interests in toothpaste among Google users from different countries. Our hypothesis was that there would be an increase in Google users’ interest in information about toothpaste. This retrospective longitudinal ecological study analyzed the toothpaste-related interest of Google users from 10 countries between January 2004 and December 2020. The monthly variation in relative search volume (RSV) and the main related queries were determined using Google Trends. Autoregressive integrated moving average (ARIMA) forecasting models were built to establish the predictive RSV values for toothpaste for an additional 12 months. Autocorrelation plots and the generalized additive model (GAM) were used to diagnose trends and seasonality in RSV curves. Additionally, the influence of social isolation related to the outbreak of COVID-19 was analyzed. Although not detected by autocorrelation function (ACF) and partial autocorrelation function (PACF) analyses, the heuristic analysis showed an increase in the interest in toothpaste-related information in all countries, with a stable trend observed in the 12-month forecasts, except for the increases in the United Kingdom and South Africa. Also, GAM analyses demonstrated a non-significant monthly or quarterly seasonal influence on data. In addition, social isolation during the COVID-19 pandemic did not influence the online information-seeking behavior of Google Search users linked to this topic. We confirmed the hypothesis that the interest of Google Search users in information about toothpaste increased in all of the 10 assessed countries.

Abstract The aim of this study was to evaluate the clinical efficacy of varnish and neutral fluoride gel in the management of early childhood caries (ECC). A randomized clinical trial was conducted to compare two strategies for ECC management: topical application of neutral fluoride gel (NFG group) and varnish (FV group) every four months for a period of one year. The sample consisted of children between the ages of three and four years, enrolled in public daycare centers. The incidence of ECC between the groups was compared by assessing values (new dmfs) at two levels: d2 when enamel/dentin were affected and d3 when dentin affected. Pearson’s Chi-square, Fisher’s Exact, Kolmogorov-Smirnov and Mann-Whitney tests were used to compare the incidence and increment of caries between the NFG and FV groups (p<0.05). A total of 240 children were included in this study and 213 children (88.7%) were followed up for 12 months. The incidence of ECC was 24.1% in the GF and 21.0% in the FV groups (p=0.586). The increment of caries in d2mfs was 1.36 (95% CI = 0.83 – 1.89) in the NFG and 1.33 (95% CI = 0.75 – 1.89) in FV (p=0.756) groups. Increment of caries in d3mfs was 1.60 (95% CI = 0.95 – 2.25) in NFG and 1.40 (95% CI = 0.75 – 2.04) in FV (p=0.468). Neutral fluoride gel and fluoride varnish exhibited similar efficacy in the management of ECC after 12 months of follow-up.

Abstract Objective: To assess the reproducibility of two clinical criteria for the evaluation of restorations in primary teeth and the impact on treatment decision. Material and Methods: A cross-sectional study was performed selecting 71 resin-based composite restorations placed in primary molars of children who had sought dental treatment at a dental school. Two trained examiners evaluated independently the restorations using modified FDI and USPHS criteria. All restorations were assessed separately with each system in random order to avoid memory bias. Kappa statistics were used to determine inter-examiner reliability considering each parameter of both criteria and score final about treatment decision. McNemar test was used to compare the treatment decision with two criteria. The significance level was set at 5%. Results: Kappa values ranged from 0.28 to 0.93 with USPHS and 0.28 to 0.88 with FDI, considering each parameter separately. Inter-examiner agreement for treatment decision was excellent for both criteria (Kappa: 0.85-0.90). For clinical decision-making, no difference between criteria was found, irrespective of examiner. Conclusion: Low inter-examiner agreement for evaluation of each parameter of USPHS and FDI criteria does not reflect on reproducibility for treatment decision. Both criteria may be suitable for evaluation of composite restorations in primary teeth.

Abstract Economic evaluations in Dentistry have been increasing in recent years. They are a relevant contribution if an economic issue exists. Knowing if a new intervention is an efficient way of allocating available (and scarce) resources (the concept of opportunity costs), a well-designed economic evaluation may be helpful. One option is to conduct a trial-based economic analysis, which extracts a considerable board of information from a trial. This approach produces a more controlled result since many sources of variations might be reduced. On the other hand, some aspects could not be predicted directly from the trial or even extrapolated. Thus, combining model-based analysis may be an idea. In this paper, we intended to discuss important aspects to be considered by researchers in further economic evaluations. This paper will be systematically divided into sessions related to the study design as time horizon and perspective, health effects, costs, and data analysis. In the end, we expect the reader could be able to plan a trial-based economic evaluation, which should be a careful, meticulous, quite laborious and especially transparent process.

Abstract: This study aimed to systematically review the literature to address the question regarding the influence of different materials in the clinical and radiographic success of indirect pulp treatment in primary teeth. A literature search was carried out for articles published prior to January 2017 in PubMed/MEDLINE, CENTRAL, Scopus, TRIP and ClinicalTrials databases; relevant articles included randomized clinical trials that compared materials used for indirect pulp treatment in primary teeth. Two reviewers independently selected the studies and extracted the data. The effects of each material on the outcome (clinical and radiographic failures) were analyzed using a mixed treatment comparisons meta-analysis. The ranking of treatments according to their probability of being the best choice was also calculated. From 1,088 potentially eligible studies, 11 were selected for full-text analysis, and 4 were included in the meta-analysis. In all papers, calcium hydroxide liner was used as the control group versus an adhesive system, resin-modified glass ionomer cement or placebo. The follow-up period ranged from 24 to 48 months, with dropout rates of 0-25.7%. The material type did not significantly affect the risk of failure of the indirect pulp treatment. However, calcium hydroxide presented a higher probability of failure. In conclusion, there is no scientific evidence showing the superiority of any material used for indirect pulp treatment in primary teeth.

Abstract We aimed to investigate the performance of fluorescence-based methods (FBMs), compared to visual inspection after histological validation, in detecting and assessing the activity status of occlusal carious lesions in primary teeth. One examiner evaluated 50 primary molars close to exfoliation in 24 children. Teeth were assessed using quantitative light-induced fluorescence (QLF) and pen-type laser fluorescence (LFpen). After exfoliation, histological validation was performed. Teeth were cut and sections were evaluated for lesion depth and activity status (after utilization of a pH indicator) under a stereomicroscope. Parameters related to the performance of the methods in detecting caries lesions at two thresholds (initial and dentin lesions) were calculated. Regarding the activity status, lesions were classified into sound+inactive or active, and the area under the ROC curve and the diagnostic odds ratio values of the methods were calculated and compared. Evaluation of red fluorescence using QLF presented higher sensitivity but lower specificity than visual inspection in detecting dentin caries lesions. However, QLF considering different parameters and LFpen had similar performance to that obtained with visual inspection. Regarding activity assessment, all FBMs and visual inspection also presented similar performance. In conclusion, FBMs did not prove advantageous for the detection and activity assessment of occlusal caries lesions in primary molars when compared to visual inspection.

The aim of this study was to evaluate microshear bond strength (μSBS), water sorption and solubility of glass ionomer cements (GIC) indicated for atraumatic restorative treatment (ART). Cylindrical specimens (6x2.4 mm) were used to test the sorption and solubility of each GIC (n = 5). The specimens were weighed before and after immersion in water and desiccation. For the μSBS test, 60 primary molars were ground to obtain flat surfaces from both enamel and dentin. The teeth were then assigned to the tested GIC (n = 10) groups, namely Fuji IX - FIX, Ketac Molar - KM and Maxxion R – MX. The exposed surfaces were pre-treated with GIC liquid. Polyethylene tubes were placed on the pre-treated surface and filled with one of the GIC. After 24 h, the specimens were submitted to the μSBS test. The failure mode was assessed using a stereomicroscope (400x magnification). The powder to liquid ratio and cost of material were also determined (n = 3). The data were analyzed by ANOVA and Tukey's post hoc test. Linear regression was used to determine the relation between cost and the other variables. Overall, MX showed lower μSBS values (enamel: 3.93 ± 0.38; dentin: 5.04 ± 0.70) than FIX (enamel: 5.95 ± 0.85; dentin: 7.01 ± 1.06) and KM (enamel: 5.91 ± 0.78; dentin: 6.88 ± 1.35), as well as higher sorption and solubility. The regression analyses showed a significant and positive correlation between cost and μSBS in enamel (R2 = 0.62; p < 0.001) and dentin (R2 = 0.43; p < 0.001); and a negative correlation between cost and water sorption (R2 = 0.93; p < 0.001) and solubility (R2 = 0.79; p < 0.001). In conclusion, the materials indicated for ART exhibit distinct physical and mechanical properties; in addition, low-priced materials may interfere with GIC properties.

Um novo conceito clínico no tratamento de lesões de cárie profunda é o tratamento pulpar indireto sem reabertura da cavidade. Tem sido demonstrado que a remoção completa da dentina cariada tornou-se desnecessária após selamento total do dente, pois os microorganismos remanescentes da dentina afetada não se proliferariam ou morreriam. Este relato de caso descreve o tratamento de lesões de cárie profunda de uma menina de 11 anos de idade com grande destruição coronária no primeiro molar permanente mandibular. As paredes dentinárias infectadas foram removidas com instrumentos manuais e a dentina afetada remanescente foi preenchida com cimento de ionômero de vidro e resina composta. Após 36 meses de acompanhamento, não se observou nenhum sinal e sintoma clínico e radiográfico de dano pulpar. Em conclusão, o tratamento pulpar indireto foi considerado uma boa alternativa para o tratamento de lesões de carie profunda, já que reduziu o risco de exposição pulpar, devido a não reabertura da cavidade, economizou tempo clínico para o paciente e o dentista e paralisou a progressão da lesão com aumento da densidade radiográfica e ausência de qualquer sintomatologia dolorosa.

An alternative approach in the management of deep caries lesions is the indirect pulp treatment, without re-entry in the cavity. It has been shown that the complete removal of the carious dentin became unnecessary after the total tooth sealing, because the remaining microorganisms of the affected dentin would stop proliferating and/or die. This case report describes the management of a deep caries lesion of an 11-year-old girl with great coronary destruction in the left mandibular permanent first molar. Infected dentinal walls were excavated with manual instruments and the remainder affected dentin was filled with ionomer glass cement and composite resin. After 36 months of follow-up, no clinical and radiographic signs and symptoms of pulp damage were observed. In conclusion, the indirect pulp treatment was considered a good alternative for the treatment of deep caries lesions as it reduced the risk of pulp exposure by not reopening the cavity, saved the patient and the dentist clinical time and arrested the lesion progression with radiographic density increase and absence of any pain symptoms.

The aim of this study was to investigate the influence of interdental spacing on the performance of proximal caries detection methods in primary molars. In addition, aspects related to temporary tooth separation with orthodontic separators were evaluated. The proximal spaces between the posterior primary teeth (n = 344) of 76 children (4-12 years old) were evaluated before and after temporary separation. Stainless steel strips with different standardized thicknesses were used to measure the presence of biological spacing and the spacing obtained after temporary separation with orthodontic rubber rings. First, the presence of proximal caries lesions was assessed by visual inspection, bitewing radiographs and a pen-type laser fluorescence device (DIAGNOdent pen). Visual inspection after temporary separation with separators was the reference standard method in checking the actual presence of caries. Multilevel analyses were performed considering different outcomes: the performance of the methods in detecting caries lesions and the spacing after temporary separation. The spacing did not influence the performance of the caries detection methods. The maximum spacing obtained with temporary tooth separation was 0.80 mm (mean ± standard deviation = 0.46 ± 0.13 mm). The temporary separation was more effective in the upper arch and less effective when an initial biological interdental spacing was present. The biological interdental spacing does not influence the performance of proximal caries detection methods in primary molars, and temporary tooth separation provides spacing narrower than 1.0 mm.

Because discomfort caused by different approximal caries detection methods can influence their performance, the assessment of this discomfort is important. Thus, this study aimed to evaluate the discomfort reported by children after the use of different diagnostic methods to detect approximal caries lesions in primary teeth: visual inspection, bitewing radiography, laser fluorescence (DIAGNOdent pen - LFpen) and temporary separation with orthodontic rubbers. Seventy-six children aged 4 to 12 years were examined using these methods. Their discomfort was assessed using the Wong-Baker scale and compared among the methods. Visual inspection caused less discomfort than did other methods. Radiography and the LFpen presented similar levels of discomfort. Older children reported higher discomfort using temporary separation, whereas younger children reported less discomfort with the LFpen. In conclusion, radiographic, temporary separation and LFpen methods provoke higher discomfort than visual inspection.

OBJECTIVE: This in situ study evaluated the discriminatory power and reliability of methods of dental plaque quantification and the relationship between visual indices (VI) and fluorescence camera (FC) to detect plaque. MATERIAL AND METHODS: Six volunteers used palatal appliances with six bovine enamel blocks presenting different stages of plaque accumulation. The presence of plaque with and without disclosing was assessed using VI. Images were obtained with FC and digital camera in both conditions. The area covered by plaque was assessed. Examinations were done by two independent examiners. Data were analyzed by Kruskal-Wallis and Kappa tests to compare different conditions of samples and to assess the inter-examiner reproducibility. RESULTS: Some methods presented adequate reproducibility. The Turesky index and the assessment of area covered by disclosed plaque in the FC images presented the highest discriminatory powers. CONCLUSION: The Turesky index and images with FC with disclosing present good reliability and discriminatory power in quantifying dental plaque.

Secondary caries has been reported as the main reason for restoration replacement. The aim of this in vitro study was to evaluate the performance of different methods - visual inspection, laser fluorescence (DIAGNOdent), radiography and tactile examination - for secondary caries detection in primary molars restored with amalgam. Fifty-four primary molars were photographed and 73 suspect sites adjacent to amalgam restorations were selected. Two examiners evaluated independently these sites using all methods. Agreement between examiners was assessed by the Kappa test. To validate the methods, a caries-detector dye was used after restoration removal. The best cut-off points for the sample were found by a Receiver Operator Characteristic (ROC) analysis, and the area under the ROC curve (Az), and the sensitivity, specificity and accuracy of the methods were calculated for enamel (D2) and dentine (D3) thresholds. These parameters were found for each method and then compared by the McNemar test. The tactile examination and visual inspection presented the highest inter-examiner agreement for the D2 and D3 thresholds, respectively. The visual inspection also showed better performance than the other methods for both thresholds (Az = 0.861 and Az = 0.841, respectively). In conclusion, the visual inspection presented the best performance for detecting enamel and dentin secondary caries in primary teeth restored with amalgam.