Ana Paula Pires dos Santos

Caries prevalence and risk factors among children aged 0 to 36 months

The aim of this study was to assess the prevalence of caries and risk factors in outpatients of the Pediatric Ambulatory of the Pedro Ernesto University Hospital aging up to 36 months. After signing informed consent forms, the parents answered a structured questionnaire in order to evaluate risk factors for dental caries, including socioeconomic status, oral hygiene and dietary habits. A single investigator carried out the dental examination which assessed the presence of caries, biofilm and gingival bleeding. The data were analyzed by means of the Epi Info program, utilizing the chi-squared test. The childrens mean age was 22.9 months. The prevalence of caries, including white spot lesions, was 41.6%, and the mean def-s was 1.7 (+/- 2.5). The most affected teeth were the maxillary incisors, and the most common lesion was the white spot. No significant associations were found between the prevalence of caries and socioeconomic status, frequency of oral hygiene, nocturnal bottle- and breast-feeding or cariogenic food and beverage intake during the day. However, the association between caries and oral hygiene quality (dental biofilm) was statistically significant (p < 0.001). The results suggest that the presence of a thick biofilm was the most important factor for the occurrence of early childhood caries in the evaluated sample.

Inconsistencies in recommendations on oral hygiene practices for children by professional dental and paediatric organisations in ten countries.

BACKGROUND Some of the basic dental health practices that are recommended to the public by professionals are not evidence based. Incorrect oral health messages may adversely affect childrens oral health behaviours. AIM To identify and list the recommendations concerning childrens oral hygiene practices provided by dental and paediatric organisations, and to assess how these recommendations relate to the scientific evidence currently available. DESIGN Cross-sectional. The authors contacted professional organisations in ten countries requesting items (brochures, leaflets or folders) containing messages on childrens oral hygiene practices. They then listed these recommendations and assessed how they related to scientific evidence obtained from systematic reviews available at PubMed and the Cochrane Library. RESULTS Fifty-two of 59 (88%) organisations responded to our request and 24 dental health education materials were submitted to the authors. They mentioned recommendations on oral hygiene practices for children, such as toothbrushing frequency, supervision and technique; when to start and how long toothbrushing should last; toothbrush design and replacement; flossing; gums/teeth wiping; tongue cleaning; type and amount of toothpaste and advice on toothpaste ingestion. The search at PubMed and the Cochrane Library resulted in 11 systematic reviews addressing these topics. CONCLUSIONS Several oral hygiene messages delivered by professional organisations showed inconsistencies and lacked scientific support.

Are fluoride releasing dental materials clinically effective on caries control

OBJECTIVES (1) To describe caries lesions development and the role of fluoride in controlling disease progression; (2) to evaluate whether the use of fluoride-releasing pit and fissure sealants, bonding orthodontic agents and restorative materials, in comparison to a non-fluoride releasing material, reduces caries incidence in children or adults, and (3) to discuss how the anti-caries properties of these materials have been evaluated in vitro and in situ. METHODS The search was performed on the Cochrane Database of Systematic Reviews and on Medline via Pubmed. RESULTS Caries is a biofilm-sugar dependent disease and as such it provokes progressive destruction of mineral structure of any dental surface - intact, sealed or restored - where biofilm remains accumulated and is regularly exposed to sugar. The mechanism of action of fluoride released from dental materials on caries is similar to that of fluoride found in dentifrices or other vehicles of fluoride delivery. Fluoride-releasing materials are unable to interfere with the formation of biofilm on dental surfaces adjacent to them or to inhibit acid production by dental biofilms. However, the fluoride released slows down the progression of caries lesions in tooth surfaces adjacent to dental materials. This effect has been clearly shown by in vitro and in situ studies but not in randomized clinical trials. SIGNIFICANCE The anti-caries effect of fluoride releasing materials is still not based on clinical evidence, and, in addition, it can be overwhelmed by fluoride delivered from dentifrices.

Survey of Brazilian governmental health agencies shows conflicting recommendations concerning oral hygiene practices for children

The aims of this study were to detect whether recommendations concerning oral hygiene practices for children among Brazilian health agencies are consistent and to verify whether possible inconsistencies in these recommendations might be associated with an apparent gap in the scientific evidence. Fifty-four Brazilian health agencies were contacted by mail or electronic mail and were asked to send any material containing recommendations on oral hygiene practices aimed at children. A search was subsequently carried out on the Cochrane Oral Health Review Group and PubMed-Clinical Queries websites in order to assess the scientific evidence available on this subject. Forty (74%) agencies answered and 21 materials containing oral hygiene recommendations were obtained. Eleven pertinent systematic reviews were identified. This preliminary study detected some conflicting and not evidence-based oral hygiene messages, which emphasizes the need to carry out and disseminate systematic reviews on these controversial issues in order to bridge the gap between knowledge and practice.

Oral hygiene frequency and presence of visible biofilm in the primary dentition

The purpose of this study was to associate oral hygiene frequency and presence of visible biofilm in the primary dentition. The sample consisted of 90 children, aged up to 4 years old, outpatients of the University Hospital of the Rio de Janeiro State University. The examinations were carried out in a dental office by a single trained examiner who was aided by an assistant. The parents answered a structured questionnaire about oral hygiene methods and frequency. Two biofilm indices, one simplified (BF1) and the other conventional (BF2), were used. BF1 classifies biofilm as absent, thin or thick, in anterior and/or posterior teeth, and provides a score for the patient, whereas BF2 classifies biofilm as absent or present, provides scores for three surfaces of each tooth and the final score is the percentage of tooth surfaces with biofilm. More than half of the parents (51 - 56.7%) reported they cleaned their childs teeth at least twice a day, while 7 (7.8%) had never cleaned their childs teeth. BF1 revealed that 12.2% (11) of the children had no visible biofilm, 37.8% (34) had thin biofilm in anterior and/or posterior teeth, 27.8% (25) had thick biofilm in anterior or posterior teeth and 22.2% (20) had thick biofilm in both anterior and posterior teeth. BF2 revealed a mean value of 21.8% (s.d. 16.5). No statistically significant correlations were found between oral hygiene frequency and the two biofilm indices (p > 0.05), indicating that oral hygiene frequency was not associated to oral hygiene quality in the evaluated sample.

Systemic Antibiotics in Periodontal Treatment of Diabetic Patients: A Systematic Review.

Aim To evaluate the effects of systemic antibiotics in combination with scaling and root planing (SRP) on periodontal parameters, tooth loss and oral health-related quality of life in diabetes patients. Materials and Methods Two independent reviewers screened for controlled clinical trials with at least 6-month follow-up in six electronic databases, registers of clinical trials, meeting abstracts and four major dental journals. After duplicates removal, electronic and hand searches yielded 1,878 records; 18 full-text articles were independently read by two reviewers. To evaluate the additional effect of antibiotic usage, pooled weighted mean differences and 95% confidence intervals were calculated using a fixed effects model. Results Five studies met the inclusion criteria, four of which were included in meta-analyses. The meta-analyses showed a significant effect favouring SRP plus antibiotic for reductions in mean probing depth (PD) (-0.22 mm [-0.34, -0.11]) and mean percentage of bleeding on probing (BoP) (4% [-7, -1]). There was no significant effect for clinical attachment level gain and plaque index reduction. No study reported on tooth loss and oral health-related quality of life. Conclusion Adjunctive systemic antibiotic use in diabetic patients provides a small additional benefit in terms of reductions in mean PD and mean percentage of BoP. Registration PROSPERO: CRD42013006389.

Searching and selecting the best evidence efficiently: a tool for clinicians, professors and dental students

The aim of this article was to offer an efficient systematic search strategy appropriate for clinicians, professors and dental students, for when they have a question regarding the effectiveness of clinical intervention. We adapted the “6-S System” proposed for Medicine in order to build a search strategy focused on oral health, which is speedy, easy to use and arrives at the appropriate evidence. With a focus on validity and search efficiency, the following searching sequence is proposed: critical abstracts of systematic reviews (SR) of randomized controlled trials (RCTs), SR of RCTs, critical abstracts of RCTs, and RCTs. These can be searched in the Cochrane library; evidence-based journals; websites and blogs; and in Pubmed using the tool Clinical Queries. This strategy can enhance the ability to quickly retrieve evidence that is important to dental education, clinical practice and delivery of oral health care. The adoption of strategies such as the one proposed in this paper is likely to increase evidence based dental practice. Indexing terms: Education, dental. Evidence-based dentistry. Evidence-based practice.

A systematic review of the effects of supervised toothbrushing on caries incidence in children and adolescents

BACKGROUND The anticaries effect of supervised toothbrushing, irrespective of the effect of fluoride toothpaste, has not been clearly determined yet. AIM To assess the effects of supervised toothbrushing on caries incidence in children and adolescents. DESIGN A systematic review of controlled trials was performed (CRD42014013879). Electronic and hand searches retrieved 2046 records, 112 of which were read in full and independently assessed by two reviewers, who collected data regarding characteristics of participants, interventions, outcomes, length of follow-up and risk of bias. RESULTS Four trials were included and none of them had low risk of bias. They were all carried out in schools, but there was great variation regarding childrens age, fluoride content of the toothpaste, baseline caries levels and the way caries incidence was reported. Among the four trials, two found statistically significant differences favouring supervised toothbrushing, but information about the magnitude and/or the precision of the effect estimate was lacking and in one trial clustering effect was not taken into consideration. No meta-analysis was performed due to the clinical heterogeneity among the included studies and differences in the reporting of data. CONCLUSIONS There is no conclusive evidence regarding the effectiveness of supervised toothbrushing on caries incidence.

Effects on HbA1c in diabetic patients of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment: A systematic review

OBJECTIVE To assess the effects of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment compared to nonsurgical periodontal treatment alone, on mean glycated hemoglobin (HbA1c) reductions in patients with diabetes. DATA Two independent reviewers screened six electronic databases, registers of clinical trials, meeting abstracts and four major dental journals for controlled clinical trials with at least 3-month follow-up. SOURCES After duplicates removal, electronic and hand searches yielded 2136 records; 32 full-text articles were independently read by two reviewers. To evaluate the additional effect of antibiotic usage, pooled weighted mean differences and 95% confidence intervals were calculated using fixed and random effects models. STUDY SELECTION Twelve studies met the inclusion criteria, nine of which provided data that allowed their inclusion in meta-analyses. The meta-analyses showed no significant effect favouring scaling and root planing (SRP) plus antibiotic for reductions in mean HbA1c (-0.11% [-0.35, 0.13]; 6 studies), and an estimated prediction interval varying from -0.45 to 0.23. There was also no significant effect favouring the adjunctive usage of sub-antimicrobial doxycycline in HbA1c mean reduction (-0.19% [-1.04, 0.67]; 2 studies). CONCLUSION Adjunctive use of systemic antibiotic provides no statistically significant benefit in terms of HbA1c improvement in periodontal treatment of patients with diabetes. CLINICAL SIGNIFICANCE Adjunctive use of systemic antibiotics associated with nonsurgical periodontal treatment provides no additional benefit in terms of HbA1c of diabetic patients. Clinicians should weigh the trade-off between risks and benefits provided by the use of systemic antibiotics before prescribing them for periodontal disease treatment.

Semiannual Fluoride Applications in Low-Risk Toddlers May Not Be More Effective Than Toothbrushing Instruction and Dietary Counseling in Controlling Dental Caries

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Effectiveness of early preventive intervention with semiannual fluoride varnish application in toddlers living in high-risk areas: A stratified cluster-randomized controlled trial. Anderson M, Dahlöf G, Twetman S, Jansson L, Bergenlid AC, Grindefjord M. Caries Res 2016;50(1):17-23. SOURCE OF FUNDING The study was commissioned and supported by Stockholm County Council and Karolinska Institutet. TYPE OF STUDY/DESIGN Non-blinded, cluster-randomized controlled field trial with two parallel arms.