Ana Cristina Barreto Bezerra

A new method to assess and measure palatal masticatory mucosa by cone-beam computerized tomography.

AIM The aim of this study was to apply a novel method to obtain high-quality images by cone-beam computerized tomography (CBCT) that consistently allowed the determination of the dimensions of the palatal mucosa. MATERIALS AND METHODS Thirty-one patients participated in this study. At the time of the CBCT scanning, the patients wore a plastic lip retractor and wooden spatulas to retract soft tissues away from the teeth and gingiva. The thickness of the palatal mucosa was obtained at forty different locations on each patient. RESULTS Retraction of the lips and cheek allowed a clear observation and measurements of the thickness of the palatal masticatory mucosa. The average thickness of the palatal mucosa was 2.92 mm in the canine area, 3.11 mm at the first pre-molar, 3.28 mm at the second pre-molar, 2.89 mm at the first molar and 3.15 mm at the second molar. Statistical differences were observed at different ages and heights of measurements. CONCLUSIONS A new non-invasive method to consistently obtain high-quality images of the palatal masticatory mucosa is described. Measurements of this mucosa could be obtained at different locations on the palate.

Efficacy and Safety of an Intraoral Electrostimulation Device for Xerostomia Relief: A Multicenter, Randomized Trial

OBJECTIVE To evaluate the efficacy and safety of an intraoral electrostimulation device, consisting of stimulating electrodes, an electronic circuit, and a power source, in treating xerostomia. The device delivers electrostimulation through the oral mucosa to the lingual nerve in order to enhance the salivary reflex. METHODS The device was tested on a sample of patients with xerostomia due to Sjögrens syndrome and other sicca conditions in a 2-stage prospective, randomized, multicenter trial. Stage I was a double-blind, crossover stage designed to compare the effects of the electrically active device with the sham device, each used for 1 month, and stage II was a 3-month open-label stage designed to assess the long-term effects of the active device. Improvement in xerostomia severity from baseline was the primary outcome measure. RESULTS A total of 114 patients were randomized. In stage I, the active device performed better than the sham device for patient-reported xerostomia severity (P<0.002), xerostomia frequency (P<0.05), quality of life impairment (P<0.01), and swallowing difficulty (P<0.02). At the end of stage II, statistically significant improvements were verified for patient-reported xerostomia severity (P<0.0001), xerostomia frequency (P<0.0001), oral discomfort (P<0.001), speech difficulty (P<0.02), sleeping difficulty (P<0.001), and resting salivary flow rate (P<0.01). CONCLUSION Our findings indicate that daily use of the device alleviated oral dryness, discomfort, and some complications of xerostomia, such as speech and sleeping difficulties, and increased salivary output. The results show a cumulative positive effect of the device over the period of the study, from baseline to the end of the trial.

Sugar-free chewing gum and dental caries: a systematic review

Objective: To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients. Method: 9 English and 2 Portuguese databases were searched using English and Portuguese keywords. Relevant articles in English, German, Portuguese and Spanish were included for review. Trials were excluded on lack of randomisation, control group, blinding and baseline data, drop out rate >33%, no statistical adjustment of baseline differences and no assessment of clinically important outcomes. Reviews were excluded on lack of information, article selection criteria, search strategy followed, search keywords, searched databases or lack of study-by-study critique tables. In cases of multiple reports from the same study, the report covering the longest period was included. Two reviewers independently reviewed and assessed the quality of accepted articles. Results: Thirty-nine articles were included for review. Thirty were excluded and 9 accepted. Of the 9 accepted, 2 trials of reasonable and good evidence value did not demonstrate any anti-cariogenic effect of sugar-free chewing gum. However, 7 articles, with 1 of strong, and 6 of good evidence value, demonstrated anti-cariogenic effects of chewing Sorbitol, Xylitol or Sorbitol/Xylitol gum. This effect can be ascribed to saliva stimulation through the chewing process, particularly when gum is used immediately after meals; the lack of sucrose and the inability of bacteria to metabolize polyols into acids. Conclusion: The evidence suggests that sugar-free chewing gum has a caries-reducing effect. Further well-designed randomised trials are needed to confirm these findings.

USE OF DIAGNODENT® FOR DIAGNOSIS OF NON- CAVITATED OCCLUSAL DENTIN CARIES

The purpose of this study was to evaluate the use of a laser fluorescence device for detection of occlusal caries in permanent teeth. One hundred and ninety-nine non-cavitated teeth from 26 patients aged 10 to 13 years were selected. After dental prophylaxis, two previously calibrated dentists examined the teeth. Visual inspection, radiographic examination and laser measurements were performed under standardized conditions. The validation method was cavity preparation with a small cone-shaped diamond bur, when the two examiners agreed about the presence of dentin caries. It was found that the laser detection method produced high values of sensitivity (0.93) and specificity (0.75) and a moderate positive predictive value (0.63). The laser device showed the lowest value of likelihood ratio (3.68). Kappa coefficient showed good repeatability for all methods. Although the laser device had an acceptable performance, this equipment should be used as an adjunct method to visual inspection to avoid false positive results.

Effectiveness of teaching methods for toothbrushing in preschool children.

Three different methods of instruction and motivation were used to assess the learning process and ability of preschool children in performing toothbrushing. Forty children from a private nursery of Brasília, DF, Brazil, were divided into 2 groups according to age (3-4 years old and 5-6 years old). The following methods of instruction and reinforcement were applied: I--audiovisual; II--child as a model; III--individual instruction. Professional prophylaxis was then performed and the children remained 48 hours without any kind of oral hygiene. Plaque disclosing and plaque index were carried out and recorded. The children subsequently brushed their teeth according to each method of instruction and a new plaque index was recorded. The data were analyzed statistically using the Student t-test and the comparison of two proportions. The results showed that the children of both groups reduced plaque index and that the individual instruction method was superior (p<0.05) to the others at all ages. Children older than 5 years of age were able to learn and accomplish toothbrushing better than younger children.

Association of chlorhexidine and fluoride for plaque control and white spot lesion remineralization in primary dentition.

BACKGROUND Plaque control and caries arrest still remain a challenge for dentists. OBJECTIVE This study was conducted to assess the effect of the combined use of chlorhexidine varnish and fluoride varnish on the visible plaque index (VPI) and white spot lesion (WS) remineralization in primary dentition. METHODS A total of 80 caries-active preschool children (3-5 years) were randomly divided into four groups. Group 1 received a chlorhexidine varnish application every week during 4 weeks. Group 2 received a fluoride varnish application every week during 4 weeks. Group 3 received alternated applications of chlorhexidine and fluoride varnish during 4 weeks. Group 4 served as control (without any type of cariostatic agent). RESULTS There was no statistically significant difference in the VPI and WS remineralization among the groups after 1 month. However, 3 months follow-up demonstrated that group 3 (chlorhexidine + fluoride) showed significantly better results for both VPI and WS remineralization. CONCLUSION The combined application of chlorhexidine and fluoride varnishes is more effective on plaque and remineralization of incipient caries after 3 months than the same agents applied separately.

Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial

OBJECTIVE A previous sham-controlled multinational study demonstrated the short-term efficacy and safety for xerostomia treatment of an intraoral device that delivers electrostimulation to the lingual nerve. The objective of this study was to test the hypothesis that those beneficial effects would be sustained over an 11-month period. STUDY DESIGN The device was tested on a mixed sample of 94 patients with xerostomia in an open-label, uncontrolled, prospective multicenter trial. Statutory outcome assessments were done at 5th, 8th, and 11th months and analyzed by multiple comparisons. RESULTS Improvements achieved at month 5 from baseline were sustained throughout the follow-up period for the primary outcome, xerostomia severity, and the secondary outcomes resting whole salivary flow rate, xerostomia frequency, oral discomfort, and difficulties in speech, swallowing, and sleeping. No significant side effects were detected. CONCLUSIONS The beneficial effects of a removable intraoral electrostimulating device were sustained for an 11-month period.

Prevalência de fluorose dentária em escolares de Brasília - Distrito Federal

An epidemiologic study was conducted to evaluate the prevalence of dental fluorosis in Brasilia - Federal District, a community where fluoride concentration is 0.8 ppm in drinking water. The sample consisted of 833 school children of both sexes, aged between 8 and 12, who have been living in Brasilia since birth. The anterior upper permanent teeth were examined and HOROWITZ fluorosis index was applied to evaluate pathological occurrences. No sex differences were observed in dental fluorosis prevalence. The authors found a high number of dental fluorosis free children (85.36%) and 14.64% of the sample showed light and moderate levels of fluorosis.

Prevalence of dental caries in children born prematurely or at full term

The objective of this study was to evaluate the prevalence of dental caries in 192 children, 96 born prematurely and 96 at full term, in a regional hospital in Brazil. Mean age at clinical examination was 40.72 months in the full-term group (G1) and 30.44 months in the premature group (G2). The children were divided in two age subgroups: 0 to 3 and 4 to 6 years. Statistical results (Students t and Kruskal-Wallis tests) showed that dmft was 0.43 for G1 and 0.01 for G2 in the 0-3 age subgroup, and 1.7 for G1 and 1.1 for G2 in the 4-6 age subgroup. Differences were significant between G1 and G2 only in the 0-3 age subgroup (p = 0.047). Caries evaluation showed that, of the 96 children in G1, 75 were caries free, while in G2, 84 did not have the disease. These differences were not significant (p = 0.088). The lower mean dmft found in the 0-3 age subgroup in G2 may be attributed to routines established by the hospitals neonatology staff, such as frequent dental visits and preventive instructions about oral habits, oral hygiene and diet. After this age, with the completion of the primary dentition, values increased and became similar between the G1 and G2 groups. Results also suggested a highly skewed distribution since most caries were found in only a small number of children.

Sialometria: aspectos de interesse clínico

Whole saliva is a multiglandular secretion complex consisting of gingival fluid, desquamated epithelial cells, microorganisms, products of bacterial metabolism, food debris, leukocytes mucus from the nasal cavity and the pharynx. Saliva has many functions, including tissue repair, tamponage, protection, digestion, taste, antimicrobial action, maintaining tooth integrity and antioxidant defense system. A decrease in salivary flow (hyposalivation) is a common disorder and it is estimated that approximately 20% of the general population have this alteration. Hyposalivation may be due to diabetes mellitus, hypothyroidism, dehydration, impaired glandular parenchyma by infectious processes, granulomatous diseases or autoimmune and inflammatory conditions (such as Sjogrens syndrome and rheumatoid arthritis), radiotherapy of head and/or neck region, or it may be associated with mood disorders, adverse effects caused by the use of some medications or even be idiopathic. Conventional therapies for the treatment of reduced saliva flow with the use of chemical and gustatory secretagogues are still limited. However, new alternatives have shown great perspective in the treatment of this disorder. To diagnose a patient as having chronic hyposalivation is a challenge in clinical practice and methods of salivary flow assessment are little known by rheumatologists. The serial evaluation of salivary flow is important for the diagnosis and prognosis of certain oral and systemic conditions. This review addresses some aspects related to the role of saliva, the consequences of hyposalivation and methods of salivary flow rate measurement, useful concepts in the daily practice of rheumatology.