Andréa Gadelha Ribeiro Targino

A New “Silver-Bullet” to treat caries in children – Nano Silver Fluoride: A randomised clinical trial

BACKGROUND Untreated dental caries in children remains a public health challenge in poor communities. OBJECTIVES This prospective controlled clinical trial investigated the effectiveness of a new anti-caries agent, Nano Silver Fluoride (NSF), applied once a year to arrest caries in children. METHODS One hundred thirty decayed primary teeth were randomly divided into two groups: NSF as the experimental agent and water as the control group. Teeth were clinically diagnosed and treated by one masked examiner and followed up at seven days and five and 12 months by another calibrated examiner who was blinded to the type of treatment. The criteria of the ICDAS II were followed to determine the activity of lesion and the diagnosis of caries. The Pearsons chi-square test was used to compare the groups during different follow-up exams. RESULTS At seven days, 81% of teeth in the NSF group exhibited arrested caries, whereas in controls, no teeth had arrested decay (p<0.001) [PF, prevented fraction=81%]. After five months, the NSF group had 72.7% with arrested decay, and the control group had 27.4% (p<0.001) [PF=62.5%]. At 12 months, 66.7% of the lesions treated with NSF were still arrested, while the control group had 34.7% remaining arrested (p=0.003) [PF=50%]. The number need to treat (NNT) at five months was two, and at 12 months, the number was three. CLINICAL SIGNIFICANCE The NSF formulation is effective to arrest active dentine caries and not stain teeth. CONCLUSIONS NSF was demonstrated to be effective in arresting caries in children in poor communities.

Estudo do Traumatismo Dentário em Escolares do Município de João Pessoa, PB, Brasil

Objective: To determine the prevalence of dental trauma to permanent incisors in children attending elementary schools in the city of Joao Pessoa, PB, Brazil...

Effects of a New Nano-Silver Fluoride-Containing Dentifrice on Demineralization of Enamel and Streptococcus mutans Adhesion and Acidogenicity

An experimental dentifrice containing nano-silver fluoride (NSF) and a sodium fluoride (NaF) toothpaste were tested in vitro, against S. mutans, to evaluate the minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), antiadherence, antiacid, enamel microhardness, and OCT. The microdilution technique was used to determine the MIC and MBC. Fragments of deciduous enamel were treated with dentifrice slurries, containing bacterial suspension and PBS-treated saliva. The quantification of the microorganisms that adhered to the enamel was determined after 24 hours of incubation, and media pH readings were performed after 2 hours and 24 hours. Deciduous teeth were evaluated for microhardness and OCT during 14 days of pH cycling. Data were statistically analyzed using Students t-test, Mann–Whitney U test, ANOVA, and Tukey tests at 5% of significance. Dentifrices containing NSF presented a lower MIC and higher statistically significant results compared to NaF dentifrices with respect to preventing bacterial adhesion and pH decreases. NSF and NaF dentifrices showed the same ability to avoid enamel demineralization corroborated by the OCT images. The NSF formulation had a better antibacterial effect compared to NaF dentifrices and similar action on the demineralization of enamel indicating their potential effectiveness to prevent caries.

MANEJO CLÍNICO DA CÁRIE OCULTA - RELATO DE CASO

Hidden caries is a lesion radiographically found to affect the dentin, in which occlusal enamel appears to be clinically healthy or minimally demineralized. Objective: Given the difficulty in diagnosing hidden caries lesions, and due to the possibility of its silent progression, the aim of this study was to present and discuss the characteristics and treatment modalities for such injury by means of a case report. Case report: Patient complaining of pain to cold stimuli in her first lower right molar underwent detailed visual inspection, which showed no cavitation and color changes in the occlusal surface. However, a radiolucent area in the dentin was observed radiographically. After opening the cavity, it was decided to perform the technique of partial removal of dentin – due to the depth of the cavity and risk of pulp exposure – followed by indirect pulp capping and restoration with composite resin. Periapical radiographs were taken throughout the procedures, and it was verified formation of secondary dentine. Conclusion: Hidden caries is a condition that can progress to total destruction of the tooth without visible clinical manifestations. The choice for its treatment should be, where appropriate, conducted by minimally invasive dentistry such as partial removal of carious dentin. DESCRIPTORS Dental Caries. Clinical Diagnosis. Dental Pulp Capping.

Distinção entre Dois Tipos de Lesão Dentinária na Superfície Oclusal sob Esmalte sem Cavitação

Introducao: Embora a prevalencia de carie tenha diminuido consideravelmente, as superficies oclusais ainda representam as areas com maior proporcao de experiencia dessa lesao. Por outro lado, atualmente os clinicos e a comunidade cientifica tem detectado uma grande ocorrencia de lesoes dentinarias oclusais sob esmalte aparentemente higido. Essas lesoes tem sido denominadas de carie oculta porque se mostram clinicamente com superficie oclusal sem cavitacao e com evidente manifestacao em dentina, quando da execucao do exame radiografico. Objetivo: O objetivo desse trabalho e distinguir dois tipos de lesao dentinaria, sob esmalte sem cavitacao, apresentando uma nova denominacao, carie semioculta, para todas as lesoes dentinarias sob esmalte nao cavitado, porem com mudanca de coloracao, visivel atraves da inspecao visual detalhada, classificando as duas entidades distintas de carie escondida, carie oculta e semioculta, baseando-se no metodo de diagnostico. A diferenciacao entre as lesoes sera ilustrada atraves de fotografias, ressaltando os aspectos clinicos de ambas as situacoes.Conclusao: A introducao no meio cientifico dessa nova denominacao e bastante relevante tendo em vista que as pesquisas mostram uma taxa relativamente alta da prevalencia da carie oculta porque consideram apenas a ausencia da cavitacao no esmalte, sem a observacao da mudanca na sua configuracao e coloracao. Entretanto, se verifica que a maioria dessas lesoes e carie semioculta, portanto detectaveis pela inspecao visual detalhada, e que a carie oculta, encontrada em menor percentual, nao e perceptivel atraves da inspecao visual detalhada, mas plenamente visivel atraves da radiografia. As evidencias clinicas impoem a necessidade da constante evolucao e modificacao de conceitos e tecnicas operatorias Introduction: Although caries prevalence has decreased considerably, the occlusal surfaces still represent areas with higher proportion of experience of this injury. Moreover, currently the clinical and scientific community have found a high occurrence of occlusal dentin lesions in apparently healthy enamel. These lesions have been called hidden caries because they show clinically the occlusal surface without cavitation and with evident manifestation in dentin when executing radiographic examination. Objective: The aim of this work is to distinguish two types of dentinlesion, no cavitation in enamel, with a new name, almost hidden caries, for all lesions in enamel dentin cavitated not, but with color change, visible through the detailed visual inspection, classifying the twoseparate entities hidden caries, hidden caries and almost hidden caries, based on the method of diagnosis. The differentiation between the lesions will be illustrated by photographs, emphasizing the clinical aspects of both situations.Conclusion: The introduction of this new in the scientific name is very relevant given that polls show a relatively high prevalence of hidden caries because they take into account only the absence of cavitation inenamel without notice of the change in shape and color . However, it appears that the majority of these injuries is almost hidden cariestherefore detectable by detailed visual inspection, and that the hidden caries, found at a lower rate is not noticeable through visual detail, but fully visible by radiography. The clinical evidence imposes the need for constant evolution and change of concepts and surgical techniques