Ana Regina Romano

Children's use of dental services: influence of maternal dental anxiety, attendance pattern, and perception of children's quality of life

OBJECTIVES The purpose of the study was to investigate the influence of a childs clinical condition; maternal characteristics such as dental anxiety and dental visit pattern; socioeconomic conditions; and maternal perception of the childs oral health-related quality of life (OHRQoL) on a childs use of dental care services. METHODS A cross-sectional study of 608 mother-child dyads was conducted during the Childrens Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire regarding their use of dental services, dental anxiety (Dental Anxiety Scale), socioeconomic status, and perception of their childrens OHRQoL (the Early Childhood Oral Health Impact Scale). Clinical examination of the children was performed to assess dental caries (dmf-t). Associations between the above-mentioned factors and child use of dental services were assessed using Poisson regression models (prevalence ratio [PR]; 95% CI; P ≤ 0.05). RESULTS The majority of children (79.3%) had never had a dental appointment and of the children who had visited a dentist, 55 (43.65%) presented with untreated dental caries at the time of examination. More than half the mothers (60.2%) did not visit a dentist regularly. In the final model, low schooling level of mothers (PR, 0.64) and irregular visits to a dentist by the mother (PR, 0.48) were factors because of which a child did not have a dental appointment. Children who had experienced pain (PR, 1.56), those who had poor OHRQoL (PR, 1.49), and older children (PR, 2.14) visited a dentist with higher frequency. CONCLUSIONS Use of dental care services by preschool children was low, and treatment was neglected even among children who had visited a dentist. Children of mothers with low schooling level who do not visit a dentist regularly were at greater risk of not receiving dental care. Maternal perception of their childs oral health motivated visits to the dentist.

Traumatic dental injuries in primary dentition: epidemiological study among preschool children in South Brazil

AIM To estimate the prevalence of traumatic injury in primary dentition among children aged 12-71 months old, as well as to evaluate the distribution of traumatic injuries, type of trauma and associated factors. MATERIAL AND METHODS After the research project approval by the Ethics Research Committee, a cross-sectional study was carried out including 571 preschool children--both from public and private schools--in the city of Pelotas, Southern Brazil. Data were collected by means of anterior teeth examination, and by the administration of a structured questionnaire to parents. The classification proposed by Andreasen & Andreasen was used, and crown discoloration and fistula were added to this criterion. RESULTS AND CONCLUSIONS The prevalence of dental trauma was 36.6% (95% CI 32.7-40.5), with no significant differences between boys and girls. Trauma were more frequent among older children (P = 0.001). No associations were found for maternal schooling, income and type of school. The most frequent trauma was enamel fracture, and the most affected tooth was number 61. A significant statistical association was observed between the presence of dental trauma during clinical examination and parental report of trauma occurrence. The percentage of parents who looked for dental treatment was higher among children from private schools (P = 0.001). The most frequent place of occurrence was home, and the most frequently reported etiology was childs own-height fall. CONCLUSIONS Dental trauma in primary teeth is characterized as an accident that occurs due to the childrens development stage, even when they are cared for by mothers of higher schooling and income. Parents should search for assistance right after trauma occurrence to minimize sequelae.

Influence of microleakage, surface roughness and biofilm control on secondary caries formation around composite resin restorations: an in situ evaluation

This study was carried out to evaluate in situ the influence of microleakage, surface roughness and biofilm control on caries formation around composite resin restorations. During 28 days, 12 volunteers wore palatal devices containing bovine enamel slabs restored with composite resin. Restorations were made without leakage, when the adhesive system was applied, or with leakage, when adhesive system was omitted. Half of the restorations in each group were finished and the remaining were finished and polished. In one side of the palatal device, biofilm was left to accumulate over the restored slabs, and in the other side dental slabs were brushed, to allow biofilm removal. There was an extraoral application of 20% sucrose solution (8x/day) over the enamel slabs. The formation of caries lesions (white spots) was evaluated by visual inspection under stereomicroscopy. Additionally, the dental slabs were sectioned and observed under polarized light microscopy. Data were submitted to Kruskal-Wallis test and Spearmans correlation test at 5% significance level. Polishing and bonding were not significant factors regarding white spot formation (p>0.05). Biofilm control (brushing) was associated with reduction of caries formation close to the restorations (p<0.01). Polarized light microscopy confirmed the visual inspection findings. These results suggest that while microleakage and surface roughness did not influence caries lesion formation, biofilm control may prevent the enamel demineralization.

Determinantes sociais e biológicos da cárie dentária em crianças de 6 anos de idade: um estudo transversal aninhado numa coorte de nascidos vivos no Sul do Brasil

OBJETIVO: O objetivo deste estudo foi investigar os determinantes sociais e biologicos, medidos no periodo perinatal e na infância, sobre a ocorrencia de carie dentaria em criancas de 6 anos de idade. METODOS: Foi realizado um estudo transversal de carie dentaria em 1999, em uma subamostra de 400 criancas pertencentes a uma coorte de nascidos vivos iniciada em 1993, em Pelotas, RS. Os indices e criterios de diagnostico adotados foram os preconizados pela Organizacao Mundial da Saude (1997). Os resultados do estudo de carie foram inseridos no banco de dados da coorte, que continha informacoes sobre as condicoes sociais e de saude coletadas ao nascimento, no primeiro, terceiro, sexto e decimo segundo meses e no sexto ano de vida da crianca. O indice de carie (ceo-d = 0 ou > 1) foi a variavel dependente. Foram realizadas analises univariada e de regressao logistica multipla nao condicional, tendo como base um modelo teorico hierarquico de determinacao. RESULTADOS: Escolaridade materna abaixo ou igual a 8 anos, renda familiar menor que 6 salarios minimos, nao frequentar pre-escola e consumo de doces pelo menos uma vez ao dia aos 6 anos de idade foram fatores de risco a carie. CONCLUSOES: Os fatores de risco sociais, como baixa escolaridade materna e baixa renda familiar, nao frequentar a pre-escola e dieta inadequada sao comuns a carie dentaria e outras doencas e agravos infantis, sugerindo que medidas de intervencao dirigidas a estes fatores seriam mais adequadas a prevencao da carie do que medidas especificas.

Three-Year Clinical Performance of Composite Restorations Placed by Undergraduate Dental Students

This retrospective study evaluated the clinical performance and the reasons for failure of anterior and posterior composite restorations placed by undergraduate dental students over a 3-year period. All cavities were restored using Prime & Bond 2.1 and TPH (Dentsply), according to the manufacturers indications. One hundred and two patients who had received composite restorations by third and forth year undergraduate students were recalled and examined to analyze the quality of the restorations. The restorations were evaluated using the modified USPHS system. Two hundred and fifty-six composite restorations, 170 in anterior teeth and 86 in posterior teeth, were evaluated. Eighty-five percent of the restorations were considered satisfactory after 3 years. Class II and class IV restorations presented the highest prevalence of failure. Loss of the restoration and deficient marginal adaptation were the main causes of failure. No restoration failed due to secondary caries. Most restorations placed by dental students were considered satisfactory after long-term evaluation. Failure was more prevalent in larger restorations and was not associated with secondary caries.

Association between Black Stains and Dental Caries in Primary Teeth: Findings from a Brazilian Population-Based Birth Cohort

Lower dental caries experience has been observed in children and teenagers with the presence of black stains on dental structures. However, none of the previous investigations were population-based studies or adjusted the analysis for potential confounders. This study assessed the prevalence of black stains at the age of 5 in a population-based birth cohort from Pelotas, Brazil and investigated the association between black stains and dental caries. A total of 1,129 children from the 2004 Pelotas birth cohort were examined at age 5, and their mothers were interviewed at their households. Dental examinations included a search for black stains and dental caries on the primary dentition through the dmf-s index. The mothers’ questionnaire comprised data on demographic, social, and behavior aspects. Prevalence of black stains was 3.5% (95% CI 2.5–4.7) and the prevalence of dental caries was 48.4% (95% CI 45.4–51.4). Multivariable logistic regression analysis was performed to assess the association between black stains and dental caries. Adjusted analysis revealed that the presence of black stains was associated with lower levels of dental caries (OR = 0.51; 95% CI 0.26–0.99). The results of the present study suggest that black stains are a protective factor for dental caries development.

Influence of Maternal Dental Anxiety on the Child’s Dental Caries Experience

This study assessed the influence of maternal dental anxiety-related behavior on the child’s caries experience. A cross-sectional study with 608 mother-child dyads during the Children’s National Immunization Campaign in Pelotas, Brazil was performed. Mothers were asked to answer a questionnaire and dental examination of the children was performed (dmft). The association assessment used Poisson regression. Children from anxious mothers were more likely to present untreated caries even after covariate adjustment. Boys, older children and low-income family children presented a higher dmft mean. Preventive strategies should focus not only on child and family characteristics, but also on maternal dental anxiety-related behaviors.

Longevity of posterior restorations in primary teeth: Results from a paediatric dental clinic

OBJECTIVES The aim of this retrospective study was to evaluate the longevity of restorations in the posterior primary teeth of children attending to a public paediatric dental clinic and to test the factors associated with failures. METHODS Patient records of 329 children (162 boys and 166 girls) were used for collecting and analyzing data. A total of 565 restorations in primary teeth were included in the study. All children enrolled in the study were classified as high caries risk. The longevity of restorations from their placement until failure (up to 4 years of follow-up) was assessed using the Kaplan-Meier survival curves with log-rank test. Multivariate Cox regression analysis with shared frailty (p<0.05) was used to assess the factors associated with failures. RESULTS Up to 4 years of follow-up, the annual failure rates were 9.5% for composite fillings, 12.2% for light-cured glass ionomer restorations, and 12.9% for conventional glass ionomer restorations with statistical difference between the materials (p=0.014). Glass ionomer restorations had a higher risk of failure over time compared with composites (HR 1.86, 95% CI 1.17-2.97). In crude analysis, Class II restorations showed lower survival rate than Class I restorations (p=0.031) but lost significance after adjustments. CONCLUSIONS Our findings suggested that the material influenced the survival rate of primary posterior restorations, with composite presenting the best performance. CLINICAL SIGNIFICANCE Differences were observed between restorative materials with different properties in primary teeth up to 4 years of follow-up. This study provides valuable information regarding the primary teeth posterior restoration longevity in a paediatric population with restorations performed under daily life clinical environment.

Dental emergencies in a university pediatric dentistry clinic: a retrospective study

A significant number of children visit a dentist for the first time due to emergency situations. However, little is known regarding the prevalence, etiology, and treatment provided for children at emergency dental visits. This study aimed to evaluate the profile of children attending a dental school emergency clinic, the reasons for seeking dental care, and the treatment provided. Records of 270 patients who attended an emergency clinic during 2010 were analyzed, and 253 were selected. Demographic, diagnostic, and procedural information was collected. The mean child age was 7.8 years. For 208 children (82%), pain was the main reason for the emergency visit. Nearly 79% of the visits were due to caries, and the most frequently required treatment was endodontic intervention (31.22%). Of the decayed teeth, 61.70% were primary posterior teeth and 31.9% permanent posterior teeth. Pain caused by dental decay was the most frequent chief complaint. A large number of children were brought to the dentist with complaints that had started long before, for which over-the-counter medications had been used.

Where and how are Brazilian dental students using Glass lonomer Cement

Glass Ionomer Cements (GICs) have a wide range of uses in Dentistry, and the manipulation technique used can influence the results obtained. This study aimed at assessing the knowledge held by Dental School students from a city in Southern Brazil regarding the use of GIC, and the clinical technique chosen for its use and its applications. A structured questionnaire was applied to 60 advanced dental students. Descriptive statistics was used to analyze the quantitative data. All students had already used the material. Regarding the purpose for which the material was used, all students (100%) had used it as a dental cavity liner, 83.3% had used it as a temporary restorative material after endodontic treatment, and 73.3% had used it as a permanent restoration in primary teeth. Regarding the clinical technique used, 86.7% said that they insert the material while it still has a shiny surface, 33% said that they finish and polish the restoration in a following session, and only 28.3% said that they apply a surface protection immediately after the restoration is placed. Although students generally seem to be acquainted with the fundamental knowledge and main techniques involved in GIC use, they occasionally fail to follow all the technical steps required during clinical application, which may affect treatment outcome. Therefore, professors should stress that all the clinical procedures required during GIC application must be followed strictly to improve the performance of this material.