Aronita Rosenblatt

The Influence of Enamel Defects on the Development of Early Childhood Caries in a Population with Low Socioeconomic Status: A Longitudinal Study

The purpose of this study was to evaluate the influence of enamel defects in the development of dental caries and their association with feeding practices and oral health behaviors in a cohort study of low-socioeconomic children from birth to 36 months of age in northeastern Brazil. Subjects were registered at birth and examined from 12 to 36 months of age. At baseline, 246 children were examined and at follow-up 228. The teeth were clinically examined and dried with gauze under natural light. Enamel defects were determined using the Developmental Defects of Enamel (DDE) index. Dental caries was determined using WHO criteria. Data were analyzed using descriptive and analytical techniques. At 36 months 78.9% infants presented at least one tooth with enamel defects and 25% of the children had at least one decayed tooth. A total of 16.9% teeth with enamel defects had become decayed (p = 0.0001). Opacity with enamel hypoplasia was the defect most frequently associated with dental caries (p = 0.001). Only 0.9% of the teeth without enamel defects developed caries. Multivariate analyses revealed that enamel defects, night breast-feeding and poor oral hygiene habits were predictors of dental caries at 18 and 24 months (p < 0.05). Considering the risk factors evaluated at 30 months of age, the presence of enamel defects was the single predictor of caries development at 36 months (p = 0.0001). Enamel defects are strongly associated with early childhood caries and, therefore, this correlation must be considered when focussing on low-socioeconomic communities.

Non-nutritive sucking habits, dental malocclusions, and facial morphology in Brazilian children: a longitudinal study.

The aim of this longitudinal study was to assess the relationship between non-nutritive sucking habits and the presence of anterior open bites (AOBs) and posterior crossbites and their association with facial morphology among 4- to 6-year-old children attending state schools in the city of Recife, Brazil. The sample comprised 287 children, both males and females. The proportion of boys to girls was approximately 50 per cent. The average age was 4 years 5 months at the beginning and 6 years 6 months at the end of the study. Data were collected from interviews with mothers or carers, and the clinical examination was carried out by two calibrated examiners. Statistical analysis was undertaken using bivariate analysis, Pearsons chi-square, McNemar, and Stuart-Maxwell tests. The results revealed a significant reduction in AOB (P < 0.001) and a slight increase in the prevalence of posterior crossbites. Both occlusal traits were associated with a previous history of sucking habits. The most prevalent morphological facial type, assessed using the morphological facial index, was high (> or =88 mm) and a statistically significant (P = 0.02) association was found between facial morphology and an AOB. Children with an average or high facial morphology measurement exhibited a greater prevalence of AOB when compared with those with lower measurements. Self-correction of AOB was associated with cessation of sucking habits but facial morphology remained unaltered.

Prevalence of dental trauma in deciduous teeth of Brazilian children

The aim of this study was to assess the prevalence of dental trauma as compared to the prevalence of dental caries in children aged 3-59 months. A cross-sectional study was carried out during the National Immunization Day for Polio in Recife, northeast Brazil. The sample comprised 3489 children under the age of 5. The clinical examination was performed by 123 previously trained dental students. The inter-examiner agreement for crown fracture was 90.32% and for tooth discoloration it was 83.87%. The prevalence of dental caries was assessed using the dmf-t index. The statistical methods included descriptive analysis and the chi-square test with a margin of error of 5%. A total of 56 142 teeth were examined and the prevalence of dental trauma was 14.9%. Dental fracture was the most prevalent injury observed in 516 teeth (0.9%), followed by discoloration in 191 (0.9%), intrusion in 12 (0.02%) and extrusion in five (0.008%). The most affected teeth were the upper central incisors. The prevalence of dental trauma increased significantly with age and family income (P < 0.0001). Dental trauma was most prevalent from 2 to 5 years of age. The prevalence of dental caries was 14.3%. This prevalence increased significantly with age (P < 0.0001) and with the reduction in family income (P < 0.0001). The results showed that the prevalence of dental caries and dental trauma was similar, and that both caused the same amount of damage to dental health for the target population.

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.

Cárie precoce na infância: prevalência e fatores de risco em pré-escolares, aos 48 meses, na cidade de João Pessoa, Paraíba, Brasil

The purpose of the present study was to evaluate the prevalence of early childhood caries (ECC), in a cohort of children of low socioeconomic status at 48 months of age in João Pessoa, Paraíba, Brazil, in relation to feeding practices, oral health behaviors, fluoride exposure, and enamel defects. 224 children were clinically examined in the Knee-Knee position at the childrens home under natural light. Teeth were dried and cleaned with gauze, and caries (WHO index) and defect (DDE Index) were determined. Questionnaires on childrens oral hygiene and dietary history were completed by parents or guardians. The SAS statistical program was used with the Mantel-Haenszel tests. The results showed a prevalence of 10.7% and 33.0% for ECC and SECC, respectively. Of all the children examined, 79.9% had at least one tooth with enamel defects, which was the only statistically significant factor (p < 0.001) for ECC. The association between enamel defects and ECC indicates that alterations in the enamel surface may cause progression of dental caries.

Non-nutritive sucking habits, anterior open bite and associated factors in Brazilian children aged 30-59 months.

The aim of the present study was to investigate the prevalence of non-nutritive sucking habits and anterior open bite as well as their main causes (associated factors) in Brazilian children aged 30-59 months. A cross-sectional study was carried out during the National Immunization Day for polio in the city of Recife in the northeastern region of Brazil. The sample was made up of 1,308 children. Data were collected from interviews with mothers or guardians as well as from clinical examinations carried out by previously trained dental students. The chi-square test was used for statistical analysis at 5% significance level. The prevalence of non-nutritive sucking habits was 40%, and the habits were associated with gender (p=0.001), age (p=0.003) and feeding type (p<0.001). Anterior open bite was detected in 30.4% of children, and it was significantly associated with feeding type (p<0.001) and non-nutritive sucking habits (p<0.001). The variables found to be associated factors in the present study for the occurrence of non-nutritive sucking habits and anterior open bite emphasize the need to establish strategies that include orientation regarding health promotion based on the “common determining factors” approach. Public health policies should be adopted to encourage a longer duration of breastfeeding, thereby contributing towards reducing the prevalence of non-nutritive sucking habits and anterior open bite.

Paradigm shift in the effective treatment of caries in schoolchildren at risk

BACKGROUND  Silver diamine fluoride (SDF) is an effective agent for the arrest of caries in children, is easy to apply and can be used outside the clinical environment. Interim restorative treatment (IRT) using glass ionomer cement has also been claimed to be a simple and effective method to arrest caries in deciduous teeth. OBJECTIVE  To examine whether, for underprivileged schoolchildren with cavities, treatment with 30% SDF gives better results than IRT for carries arrest. METHOD  This randomised controlled study compares the effect of IRT (FUJI IX) with 30% SDF in 91 children aged 5-6 years. RESULTS  After 1 year, treatment with SDF was more effective [relative risk (RR) = 66.9%] than IRT (RR = 38.6%) for the arrest of caries; this was statistically significant (P < 0.05). CONCLUSION  The SDF technique showed better results than IRT for the arrest of cavities in deciduous teeth, indicating that its use for underprivileged communities may justify a paradigm shift in paediatric dentistry.

Prevalence of a posterior crossbite and sucking habits in Brazilian children aged 18–59 months

This cross-sectional study aimed to assess the prevalence of posterior crossbites and non-nutritive sucking habits in 2750 Brazilian children aged from 18 to 59 months. The data were collected by 123 previously trained dental students and recorded on a response card according to the model developed by the Forsyth Institute, Boston, Maryland, USA, for optical reading. Information concerning sucking habits and family income was obtained during an interview with a parent or guardian. A clinical examination was also undertaken. Statistical analysis included chi-square and Fishers exact tests. A posterior crossbite was observed as early as 18 months of age. The prevalence of a posterior crossbite was 10.4 per cent and was associated with age (P = 0.00) and with sucking habits (P = 0.01). The prevalence of sucking habits was 43.5 per cent. A posterior crossbite was not associated with socio-economic status (P = 0.38). While sucking habits were common among the age group studied (43.5 per cent), only a small percentage exhibited a posterior crossbite. These results suggest that further investigations into other aetiological factors, in particular genetics and respiratory problems, are necessary to provide more evidence that could clarify this issue.

Early childhood caries and its relationship with perinatal, socioeconomic and nutritional risks: a cross-sectional study

BackgroundSocioeconomic, perinatal and other life cycle events can be important determinants of the health status of the individual and populations. This study aimed to assess the prevalence of early childhood caries (ECC), perinatal factors (gestational age, teenage pregnancy and birth weight), family income and nutritional risk in children.MethodsA cross-sectional study in which 320 children were examined according to the criteria established by the World Health Organization. A previously validated questionnaire was used to obtain information from parents and guardians about family income, gestational age and birth weight. To check the nutritional risk, we used the criteria provided by the CDC (Center for Disease Control). For Statistics, Pearson’s, chi-square and the multivariate Poisson analyses were used to determine the association among variables.ResultsApproximately 20% of children had ECC, and the Poisson multivariate analyses indicated that family income (p = 0.009), birth weight (p < 0.001) and infant obesity (p < 0.001) were related to the increase of ECC, and gestational age was not significantly associated with ECC (p = 0.149). Pregnancy in adolescence was not included in the regression analyses model because it was not statistically significant in the chi-square test (p > 0.05).ConclusionThe prevalence of ECC was related to low family income, premature birth and infant obesity.

Action of silver nanoparticles towards biological systems: cytotoxicity evaluation using hen's egg test and inhibition of Streptococcus mutans biofilm formation

This study aimed to evaluate the cytotoxicity and bactericidal properties of four silver nanoparticle (AgNP) colloids and their ability to inhibit Streptococcus mutans biofilm formation on dental enamel. The cytotoxicity of AgNPs was evaluated based on signs of vascular change on the chorioallantoic membrane using the hens egg test (HET-CAM). Bactericidal properties and inhibition of S. mutans biofilm formation were determined using a parallel-flow cell system and a dichromatic fluorescent stain. The percentage of viable cells was calculated from regression data generated from a viability standard. AgNP colloids proved to be non-irritating, as they were unable to promote vasoconstriction, haemorrhage or coagulation. AgNP colloids inhibited S. mutans biofilm formation on dental enamel, and cell viability measured by fluorescence was 0% for samples S1, S2, S3 and S4 and 36.5% for the positive control (diluted 30% silver diamine fluoride). AgNPs are new products with a low production cost because they have a lower concentration of silver, with low toxicity and an effective bactericidal effect against a cariogenic oral bacterium. Moreover, they do not promote colour change in dental enamel, which is an aesthetic advantage compared with traditional silver products.