Gustavo G. Nascimento

Estimated prevalence of erosive tooth wear in permanent teeth of children and adolescents: an epidemiological systematic review and meta-regression analysis

OBJECTIVES The main purpose of this systematic review was to estimate the prevalence of dental erosion in permanent teeth of children and adolescents. METHODS An electronic search was performed up to and including March 2014. Eligibility criteria included population-based studies in permanent teeth of children and adolescents aged 8-19-year-old reporting the prevalence or data that allowed the calculation of prevalence rates of tooth erosion. Data collection assessed information regarding geographic location, type of index used for clinical examination, sample size, year of publication, age, examined teeth and tissue exposure. The estimated prevalence of erosive wear was determined, followed by a meta-regression analysis. RESULTS Twenty-two papers were included in the systematic review. The overall estimated prevalence of tooth erosion was 30.4% (95%IC 23.8-37.0). In the multivariate meta-regression model use of the Tooth Wear Index for clinical examination, studies with sample smaller than 1000 subjects and those conducted in the Middle East and Africa remained associated with higher dental erosion prevalence rates. CONCLUSIONS Our results demonstrated that the estimated prevalence of erosive wear in permanent teeth of children and adolescents is 30.4% with high heterogeneity between studies. Additionally, the correct choice of a clinical index for dental erosion detection and the geographic location play an important role for the large variability of erosive tooth wear in permanent teeth of children and adolescents. CLINICAL SIGNIFICANCE The prevalence of tooth erosion observed in permanent teeth of children and adolescents was considerable high. Our results demonstrated that prevalence rate of erosive wear was influenced by methodological and diagnosis factors. When tooth erosion is assessed, the clinical index should be considered.

Is weight gain associated with the incidence of periodontitis? A systematic review and meta-analysis

AIM This study aimed to conduct a systematic review assessing the effects of weight gain on the incidence of periodontitis in adults. METHODS Electronic searches in four databases were performed up to and including February 2015. Only prospective longitudinal studies assessing the association between weight gain and the incidence of periodontitis in adults were eligible to be included in this study. All studies should state a clear description of nutritional status (Body Mass Index; Waist Circumference) as well as the case definition of periodontitis. Pooled relative risks (RR) for becoming overweight and obese on the incidence of periodontitis were estimated by meta-analysis. Quality was assessed with the Newcastle-Ottawa scale for cohort studies. RESULTS Five articles were included in this review and meta-analysis with 42,198 subjects enrolled. Subjects who became overweight and obese presented higher risk to develop new cases of periodontitis (RR 1.13; 95%CI 1.06-1.20 and RR 1.33 95%CI 1.21-1.47 respectively) compared with counterparts who stayed in normal weight. CONCLUSIONS A clear positive association between weight gain and new cases of periodontitis was found. However, these results are originated from limited evidence. Thus, more studies with longitudinal prospective design are needed.

Effect of breastfeeding on malocclusions: a systematic review and meta-analysis.

The objective of this systematic review was to investigate whether breastfeeding decreases the risk of malocclusions.

Diet influenced tooth erosion prevalence in children and adolescents: Results of a meta-analysis and meta-regression

OBJECTIVE The aim of the present study was to assess the influence of diet in tooth erosion presence in children and adolescents by meta-analysis and meta-regression. DATA Two reviewers independently performed the selection process and the quality of studies was assessed. SOURCES Studies published until May 2014 were identified in electronic databases: Pubmed, EBSHost, Scopus, Science direct, Web of Science and Scielo, using keywords. STUDY SELECTION Criteria used included: observational studies, tooth erosion and diet, subject age range 8-19 years old, permanent dentition and index. Meta-analysis was performed and in case of heterogeneity a random-effects model was used. Thirteen studies that fulfilled the inclusion criteria were selected. Higher consumption of carbonated drinks (p=0.001) or acid snacks/sweets (p=0.01 and for acid fruit juices (p=0.03)) increased the odds for tooth erosion, while higher intake of milk (p=0.028) and yogurt (p=0.002) reduced the erosion occurrence. Heterogeneity was observed in soft drinks, confectionary and snacks and acidic fruit juices models. Methodological issues regarding the questionnaires administration and the inclusion of other variables, such as food groups and tooth brushing, explained partially the heterogeneity observed. CONCLUSIONS Some dietary components (carbonated drinks, acid snacks/sweets and natural acidic fruits juice) increased erosion occurrence while milk and yogurt had a protective effect. Methods to assess diet could influence the homogeneity of the studies and should be considered during the study design. CLINICAL SIGNIFICANCE The method to assess diet should be carefully considered and well conducted as part of the clinical assessment of tooth erosion, since diet could influence the occurrence of tooth erosion.

Are there universal restorative composites for anterior and posterior teeth

OBJECTIVE This retrospective, longitudinal clinical study investigated the longevity up to 20 years of posterior restorations placed with 3 universal composites (Charisma, Herculite XR, Z100) and of anterior restorations placed with 2 universal composites (Charisma, Herculite XR). METHODS Records from 90 patients were retrieved from a private practice (374 posterior, 219 anterior restorations). Clinical evaluation was performed by the FDI criteria. Survival analysis was assessed using Kaplan-Meier method and Log-Rank test, and factors associated with failure by multivariate Cox regression with shared frailty. RESULTS In the first 10 years, almost 95% of the restorations were satisfactory, showing increased failure thereafter. Charisma showed the most failures in anterior and posterior areas. Annual failure rates varied between 0.3% and 2.5%, with slightly better performance for anterior restorations. Fracture (posterior) and aesthetics (anterior) were the main reasons for failure. CLINICAL SIGNIFICANCE Differences were observed between restorative materials with different properties, but these became apparent only after more than 10 years of clinical service. The present study provides evidence that in a patient group with low caries risk, anterior and posterior restorations placed with universal composites may have excellent long-term clinical performance.

Quantification of Endotoxins in Infected Root Canals and Acute Apical Abscess Exudates: Monitoring the Effectiveness of Root Canal Procedures in the Reduction of Endotoxins

INTRODUCTION This clinical study was conducted to measure the endotoxin levels in infected root canals (RCs) and exudates related to acute apical abscesses (AAAs). In addition, the effectiveness of RC procedures in reducing the endotoxin levels in RCs was monitored. METHODS Paired samples of infected RCs and exudates from AAAs were collected from 10 subjects by using paper points. RCs samples were collected before (RCS1) and after chemomechanical preparation (CMP) (RCS2), after 17% EDTA (RCS3), and after 30 days of intracanal medication (Ca[OH]2 + chlorhexidine) (RCS4). A turbidimetric kinetic limulus amebocyte lysate assay was used for the measurement of endotoxins. RESULTS Endotoxins were detected in 100% of the baseline samples of AAAs and RCs (RCS1) with median values of 175 EU/mL and 41.5 EU/mL, respectively (P < .05). After CMP (RCS2), endotoxins were reduced to a median value of 0.54 EU/mL (P < .05). Subsequent irrigation with EDTA (RCS3) failed to present a significant effectiveness in reducing the endotoxin levels (median= 0.37 EU/mL) (P = .07). However, intracanal medication for 30 days (RCS4) reduced endotoxins to median values of 0.03 EU/mL (P < .01). CONCLUSIONS The present study revealed a strong association between the high levels of endotoxins found in AAAs and RCs collected from the same tooth. Moreover, the effectiveness of CMP in reducing the endotoxin levels from RCs in acute endodontic infection was improved by the use of RC medication.

Are obesity and overweight associated with gingivitis occurrence in Brazilian schoolchildren

AIM This cross-sectional study aimed to assess the relationship between weight status and gingival inflammation in Brazilian schoolchildren aged 8- to 12-year old, when controlling for potential confounders. METHODS Overall, 1211 children aged 8- to 12-year old from public and private schools in Southern Brazil were selected by a two-stage cluster method. Questionnaires were used to assess socio-demographic data and oral hygiene habits. Oral examination evaluated presence of plaque and gingival bleeding. Anthropometric measures were collected to obtain body mass index. Multivariate Poisson regression was used for data analysis (Prevalence Ratio/95% Confidence Interval). RESULTS Prevalence of gingivitis was 44.0%. Mean and median values of gingival bleeding sites were 3.10 and 2.0 respectively. Obese/overweight children totalized 34.6%. In multivariate adjusted analysis, sex (PR 0.86; 95%CI 0.75;0.98), maternal schooling (PR 1.09; 95% CI 1.01;1.18), plaque (PR 1.37; 95% CI 1.26;1.50), dental caries experience (PR 1.16; 95% CI 1.01;1.36) and bleeding during tooth brushing (PR 1.27; 95% CI 1.11;1.48) were associated with the outcome. In the sex-stratified analysis, overweight/obese boys presented a greater risk for gingivitis (PR 1.22 95% CI 1.01;1.48). CONCLUSIONS Gingivitis was not associated with obesity/overweight in the total sample. Gender differences seem to influence the relationship between gingivitis and obesity/overweight; a stronger association was noted among boys than girls.

Tooth loss in adults and income: Systematic review and meta-analysis

OBJECTIVE To systematically review the literature in order to identify an association between income and tooth loss in adults. METHODS An electronic search was conducted on PubMed, Scopus, Embase, Web of Knowledge, Scielo and LILACS. Studies were included if they reported the relationship between socioeconomic status (assessed by income) and tooth loss (clinical examination or self-reported) among adults aged from 18 to 60-years-old. RESULTS We, found 1007 articles through March 2014; 11 studies were then included. The results of meta-analyses with random-effects model that subjects of lower levels of income presented greater chance of tooth loss (OR 2.52; 95%CI 2.11-3.01). This association also remained significant when only adjusted results were pooled; however, attenuation in the magnitude of such association was noted (OR 1.66; 95%CI 1.48-1.86) as well as no heterogeneity. Meta-regression analysis revealed that the sample size explained about 9% of heterogeneity in the crude model. CONCLUSION Our results evidenced a relationship between income and tooth loss in adults. Longitudinal studies with broader socioeconomic measures are encouraged.

Can Peri-Implant Crevicular Fluid Assist in the Diagnosis of Peri-Implantitis? A Systematic Review and Meta-Analysis

BACKGROUND A broader understanding of the immune inflammatory profile of peri-implant diseases could be helpful in the development of host-targeted preventive and therapeutic strategies. The aim of this study is to answer two clinical questions: 1) whether patients with peri-implantitis (PP) present higher prevalence of any specific inflammatory cytokine in peri-implant crevicular fluid (PICF) compared with healthy patients; and 2) whether local inflammation measured in PICF can be used as a predictor for incipient PP. METHODS A systematic review of the literature on the most common cytokines released in PICF in healthy and PP-affected sites was conducted from 1996 up to and including October 2013 using predefined search strategies. Cross-sectional and prospective longitudinal studies were considered. Meta-analyses were done separately for healthy, mucositis (MU), and PP outcomes. RESULTS Interleukin (IL)-1β was the most studied cytokine (n = 12), followed by tumor necrosis factor (TNF)-α (n = 10). Other cytokines were also linked to PP, such as IL-4, IL-6, IL-8, IL-10, IL-12, and IL-17. Statistical differences were revealed when IL-1β release was compared between healthy implant sites and PP (P = 0.001) or MU sites (P = 0.002), respectively; when PP and MU were compared, no statistical differences could be detected (P = 0.80). For TNF-α release, significant differences were found between healthy and PP implants (P = 0.02). CONCLUSIONS PICF containing inflammatory mediators, such as IL-1β and TNF-α, can be used as additional criteria for a more robust diagnosis of peri-implant infection. Additionally, once the inflammatory process is installed, no differences were found between peri-implant MU and PP.

Impact of Prolonged Breastfeeding on Dental Caries: A Population-Based Birth Cohort Study

Rigorous methodology and sophisticated statistical analysis improve the evidence of prolonged breastfeeding as a risk factor for primary dental caries. BACKGROUND: Few studies have assessed the effect of breastfeeding, bottle feeding, and sugar consumption on children’s dental caries. We investigated whether the duration of breastfeeding is a risk factor for dental caries in the primary dentition, independently of sugar consumption. METHODS: An oral health study (n = 1303) nested in a birth cohort study was carried out in southern Brazil. The average number of decayed, missing, and filled primary tooth surfaces (dmfs) and severe early childhood caries (S-ECC: dmfs ≥6) were investigated at age 5 years. Breastfeeding was the main exposure collected at birth and at 3, 12, and 24 months of age. Data on sugar consumption were collected at 24, 48, and 60 months of age. Marginal structural modeling was used to estimate the controlled direct effect of breastfeeding (0–12, 13–23, and ≥24 months) on dmfs and on S-ECC. RESULTS: The prevalence of S-ECC was 23.9%. The mean number of dmfs was 4.05. Children who were breastfed for ≥24 months had a higher number of dmfs (mean ratio: 1.9; 95% confidence interval: 1.5–2.4) and a 2.4 times higher risk of having S-ECC (risk ratio: 2.4; 95% confidence interval: 1.7–3.3) than those who were breastfed up to 12 months of age. Breastfeeding between 13 and 23 months had no effect on dental caries. CONCLUSIONS: Prolonged breastfeeding increases the risk of having dental caries. Preventive interventions for dental caries should be established as early as possible because breastfeeding is beneficial for children’s health. Mechanisms underlying this process should be investigated more deeply.