Fabian Calixto Fraiz

Study of the factors associated with dental caries in children who receive early dental care

The present study investigated the factors associated with the development of dental caries in preschool children who receive regular dental care and follow-up. The research was carried out at the Baby Clinic, Londrina State University, and comprised two hundred preschool children, whose ages ranged from 24 to 48 months, as well as their mothers, who had already taken part in a dental program at the Baby Clinic during, at least, the previous twelve months. Regarding oral hygiene habits, there was no significant difference between the preschool children who presented with caries and those who did not present with caries. However, the presence of visible bacterial plaque on the upper incisors was strongly associated with the presence of dental caries. Other factors associated with the presence of caries were: period of formal education of the father or of both parents equal or inferior to 8 years, high sugar consumption and bottle-feeding during sleep. In the studied population, the dietary pattern is still the main cause of carious lesions. In addition, the presence of visible bacterial plaque on the labial surface of the upper incisors must be considered as an important clinical sign, often associated with inadequate patterns of diet and oral hygiene.

Analysis of the in vitro adherence of Streptococcus mutans and Candida albicans

The objective of the present study was to investigate the in vitro adherence capacity of Streptococcus mutans and Candida albicans. Adherence assays were conducted on dental surfaces and analyzed by scanning electron microscopy (SEM). Extracted human teeth were inoculated with Streptococcus mutans or Candida albicans and with both species simultaneously, and incubated at 37oC for 21 days. Bacterial inocula had been obtained from saliva samples of children that had been colonized by both organisms. ATCC reference strains were used as controls. SEM analyses showed that the biofilm that covered the entire analyzed dental surface was more homogeneous inoculated with the two microorganisms simultaneously than with each species separately. In a second experiment, carried out with isolates that had shown the highest adherence the isolates were tested for adherence to high-density polyethylene substrates. The potentialization of the adherence capacity of Streptococcus mutans and Candida albicans when in association was confirmed.

The influence of gestational age and birth weight of the newborn on tooth eruption.

Objective: The aim of the present study was to compare the beginning of eruption of the first deciduous tooth in preterm infants (<38 weeks) with full-term infants (38 and 42 weeks) of normal birth weight (32.500g), low birth weight (< 2.500g) and very low birth weight (<1.500g), in order to evaluate if premature birth and low birth weight would affect tooth eruption. Methods: The neonatal records and the moment of eruption of the first deciduous tooth of 146 infants - 77 preterm infants and 69 full-term infants, ranging from 5 to 36 months old, of both genders – were recorded. All of them were under care at the Pediatric Ambulatory of Hospital Universitário Evangélico at Curitiba – Parana. Data were analyzed considering biological age and post-conception, or corrected, age – which is the gestational age plus the infants chronological age at the month of eruption of the first deciduous tooth. Results: Results showed that when chronological age is considered, tooth eruption in preterm and very low birth weight infants is importantly delayed. However, when corrected age is considered, no statistically significant differences were found among groups. Conclusion: The delayed eruption may be related to the premature birth and not to a delay in dental development.

Evaluation of fermented milk containing probiotic on dental enamel and biofilm: in situ study.

OBJECTIVES The aim of this study was to in situ evaluate the pH before and after the application of the fermented milk product; the fluoride (F), calcium (Ca), phosphate (P), and insoluble extracellular polysaccharides (EPS) concentration on the dental biofilm; the demineralisation of the bovine dental enamel. DESIGN Ten volunteers wore palatine devices containing four blocks of bovine dental enamel during three phases of 14 days each. In each phase, the treatment was accomplished with either fermented milk A (Yakult), or 20% sucrose solution (control) or fermented milk B (Batavito). Then, dental biofilm was collected, processed and the ionic concentration and insoluble extracellular polysaccharides appraised. For evaluation of the mineral loss, both the initial and final microhardness were determined. RESULTS The results showed that the ionic concentration (F, Ca and P) was significantly higher in the fermented milk B in comparison with both the fermented milk A and the 20% sucrose solution. There was no significant difference amongst these last two. With regarding EPS was significantly lower in fermented milk B compared to fermented milk A and sucrose (P<0.05), without significant difference amongst these last two. The two experimental groups did not differ significantly but had smaller mineral losses than control group. CONCLUSION It was concluded that all treatment decreased the pH of dental biofilm and promoted demineralisation of the enamel, although fermented milk B presented the lowest EPS content and percentage change and integrated loss of surface hardness. More studies should be developed to evaluate the action of probiotics on the bacterial activity and its interference on demineralisation, once the literature has been showing probiotics as a promissory caries reducing agent.

The influence of glycemic control on the oral health of children and adolescents with diabetes mellitus type 1.

OBJECTIVE To evaluate the influence of disease control, expressed by the mean values of glycated hemoglobin (HbA1c), in the oral health of children and adolescents with diabetes mellitus type 1 (T1DM). SUBJECTS AND METHODS A cross sectional study involving 87 children and adolescents (59 girls), 10 ± 2.6 years old. The participants were divided into three groups: HbA1c ≤ 8%, 8% < HbA1c ≤ 10% and HbA1c > 10%. The duration of the disease, age and average HbA1c were obtained from their medical records. Oral health was evaluated according to the following indexes: Simplified Oral Hygiene Index (OHI-S); Community Periodontal Index (CPI); Decayed, Missing or Filled Teeth Index (DMFT/dmft) for permanent and deciduous teeth; and the stimulated salivary flow rate (SSFR). RESULTS The median SSFR was 1.1 mL/min in the group with HbA1c ≤ 8%, 0.7 mL/min in the intermediary group and 0.6 mL/min in the HbA1c > 10% group. A significant decrease in salivary flow was observed with an increase in HbA1c (p = 0.007). The DMFT/dmft and CPI indexes were higher in individuals with higher HbA1c values. More caries-free individuals were found in the group with HbA1c ≤ 8% compared to those with HbA1c > 10%. The group with HbA1c > 10% exhibited more caries and bleeding gums than the other groups. HbA1c values in girls were higher than in boys. CONCLUSION Children and adolescents with unsatisfactory glycemic control, represented by higher HbA1c concentrations, exhibited a higher frequency of caries and gingivitis, and a reduction in salivary flow.

Validity and Reliability of the Brazilian Version of the Rapid Estimate of Adult Literacy in Dentistry – BREALD-30

Objective The aim of the present study was to translate, perform the cross-cultural adaptation of the Rapid Estimate of Adult Literacy in Dentistry to Brazilian-Portuguese language and test the reliability and validity of this version. Methods After translation and cross-cultural adaptation, interviews were conducted with 258 parents/caregivers of children in treatment at the pediatric dentistry clinics and health units in Curitiba, Brazil. To test the instruments validity, the scores of Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) were compared based on occupation, monthly household income, educational attainment, general literacy, use of dental services and three dental outcomes. Results The BREALD-30 demonstrated good internal reliability. Cronbach’s alpha ranged from 0.88 to 0.89 when words were deleted individually. The analysis of test-retest reliability revealed excellent reproducibility (intraclass correlation coefficient = 0.983 and Kappa coefficient ranging from moderate to nearly perfect). In the bivariate analysis, BREALD-30 scores were significantly correlated with the level of general literacy (rs = 0.593) and income (rs = 0.327) and significantly associated with occupation, educational attainment, use of dental services, self-rated oral health and the respondent’s perception regarding his/her childs oral health. However, only the association between the BREALD-30 score and the respondent’s perception regarding his/her childs oral health remained significant in the multivariate analysis. Conclusion The BREALD-30 demonstrated satisfactory psychometric properties and is therefore applicable to adults in Brazil.

Impact of Oral Health Status on the Oral Health-Related Quality of Life of Brazilian Male Incarcerated Adolescents.

PURPOSE To assess the impact of oral health status on the oral health-related quality of life (OHRQoL) of incarcerated Brazilian male adolescents. MATERIALS AND METHODS A cross-sectional survey with 102 male adolescents incarcerated at the São Francisco Juvenile Detention Facility, Piraquara, Brazil in 2010 was carried out. Dental caries, oral hygiene, periodontal status, malocclusion, dental fluorosis and dental trauma were analysed. The Oral Health Impact Profile (OHIP-14) was administered to measure OHRQoL, along with a questionnaire addressing sociodemographic variables, health-related aspects and dental experience. Descriptive statistical analysis and univariate and multiple Poisson regression with robust variance were performed. RESULTS The prevalence of adolescents who reported an impact on OHRQoL was 64% (95% CI: 54-73) and the mean OHIP-14 score was 6.69 (SD = 8.79; median = 3.00). In the multiple regression model, the prevalence of a negative impact on OHRQoL was significantly higher among individuals with untreated caries (PR = 1.74; 95% CI: 1.10-2.77), those who reported having discomfort in the teeth or mouth (PR = 1.33; 95% CI: 1.03-1.73), using tobacco prior to internment (PR = 1.53; 95% CI: 1.04-2.24) and maintaining a stable relationship (PR = 1.31; 95% CI: 1.01-1.70) in comparison to individuals who did not exhibit these conditions. Moreover, each month of internment represented an increase in the prevalence of an impact on OHRQoL (PR = 1.03; 95% CI: 1.01-1.06). CONCLUSION Incarcerated male adolescents reported that oral health problems exerted an influence on quality of life, with untreated caries exhibiting the greatest impact.

Reliability of self-reported toothbrushing frequency as an indicator for the assessment of oral hygiene in epidemiological research on caries in adolescents: a cross-sectional study

BackgroundIn the present state of knowledge regarding the etiology of dental caries, it is unacceptable for studies addressing factors associated with this outcome to disregard oral hygiene. Simple, valid methods are needed for the assessment of oral hygiene in adolescents to allow this condition to be properly investigated in epidemiological studies on caries and assist in the establishment of health promotion measures. The aim of the present study was to test the hypothesis that the self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices in epidemiological studies on dental caries in adolescents.MethodsA cross-sectional study was conducted with a representative sample (n = 589) of 12-year-old school children in a medium-sized city in southern Brazil. A detailed questionnaire addressing socio-demographic and economic characteristics was sent to primary caregivers. Adolescents answered a brief self-administered questionnaire on behavioral characteristics, including toothbrushing frequency and sugar intake. Samples of stimulated saliva were collected from the adolescents and evaluated for levels of mutans streptococci and lactobacilli using Dentacult kits I and II, respectively. Examiners who had undergone a training and calibration exercise (kappa > 0.81) performed the clinical examination of the adolescents. Caries experience was assessed using the decayed, missing and filled teeth index. Oral hygiene was determined using the Simplified Oral Hygiene Index and the Visible Plaque Index.ResultsWhen the oral hygiene variables were used alone in the multiple models, significant associations with dental caries were found. When Simplified Oral Hygiene Index and/or Plaque Index were used together with toothbrushing frequency in the same model, only the latter was significantly associated with dental caries. A significant association was also found between self-reported toothbrushing frequency and the clinical indices.ConclusionBased on the present findings, self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices, which facilitates data collection in epidemiological studies addressing dental caries in adolescents.

Impacto Relatado das Alterações Bucais na Qualidade de Vida de Adolescentes: Revisão Sistemática

Introducao: Alteracoes no estado de saude bucal tem o potencial de comprometer a funcao e o bem estar dos individuos. Objetivo: Buscar evidencia cientifica de que problemas bucais provocam repercussoes na qualidade de vida de adolescentes. Metodos: Foi realizada uma busca bibliografica eletronica em 4 bases de dados (MEDLINE, LILACS, BVS Adolec e Cochrane Library), abrangendo o periodo de janeiro de 2000 a outubro de 2011, sem restricao de lingua e com complementacao de busca realizada manualmente nas referencias dos artigos recuperados. Os descritores utilizados foram: “adolescen*”, “oral health” e “quality of life”. Resultados: A estrategia de busca adotada gerou 593 artigos. A partir da analise dos titulos e resumos, foram selecionados, com concordância de 100% entre dois examinadores, 29 artigos, os quais foram obtidos e avaliados na integra. Destes, 13 atenderam aos criterios de elegibilidade, tendo sido a decisao final tomada em consenso, sendo quatro estudos com desenho caso-controle e nove transversais. Nao foram identificados ensaios clinicos controlados sobre o tema. Os artigos incluidos foram avaliados quanto a sua qualidade metodologica. Dentre os artigos selecionados, a ma oclusao foi a condicao clinica que teve seu potencial de provocar repercussoes na qualidade de vida estudado com mais frequencia, seguida de traumatismo, carie e erosao dentaria. Conclusao: Com excecao da erosao dentaria, as alteracoes bucais estudadas apresentaram impacto relatado negativo na qualidade de vida associada a saude bucal de adolescentes. Contudo, estudos longitudinais, com especial atencao para aqueles com controle de fatores de confusao, sao necessarios para esclarecer o nivel de evidencia desta conclusao.

Tratamento ortodôntico em pacientes com dentes reimplantados após avulsão traumática: relato de caso

introduction: The high prevalence of individuals with dental trauma prior to orthodontic treatment justifies the precautions that should be followed before and during treatment, considering all possible effects of orthodontic movement on traumatized teeth. Among the major traumatic dental injuries, avulsion with subsequent tooth reimplantation entails a higher than average risk of complications, such as pulp necrosis, root resorption and ankylosis. Therefore, it gives orthodontists several reasons for concern. o bjective: This case report sought to analyze the implications of tooth reimplantation after traumatic avulsion in patients requiring orthodontic treatment. conclusions: Tooth movement of a reimplanted tooth after traumatic avulsion is viable provided no signs of abnormality are present. Ankylosed teeth, however, are not amenable to orthodontic movement but should be preserved as space maintainers until root resorption is completed, provided that the teeth do not present with severe infraocclusion. Should an ankylosed tooth be in severe infraocclusion, crown amputation and root burial are indicated as a means to preserve the alveolar bone in the region, since resorption will occur by replacement of the buried root, as was the case in this report. Abstract