Lilian Marly de Paula

USE OF DIAGNODENT® FOR DIAGNOSIS OF NON- CAVITATED OCCLUSAL DENTIN CARIES

The purpose of this study was to evaluate the use of a laser fluorescence device for detection of occlusal caries in permanent teeth. One hundred and ninety-nine non-cavitated teeth from 26 patients aged 10 to 13 years were selected. After dental prophylaxis, two previously calibrated dentists examined the teeth. Visual inspection, radiographic examination and laser measurements were performed under standardized conditions. The validation method was cavity preparation with a small cone-shaped diamond bur, when the two examiners agreed about the presence of dentin caries. It was found that the laser detection method produced high values of sensitivity (0.93) and specificity (0.75) and a moderate positive predictive value (0.63). The laser device showed the lowest value of likelihood ratio (3.68). Kappa coefficient showed good repeatability for all methods. Although the laser device had an acceptable performance, this equipment should be used as an adjunct method to visual inspection to avoid false positive results.

Dental panoramic indices and fractal dimension measurements in osteogenesis imperfecta children under pamidronate treatment.

OBJECTIVES To verify radiomorphometric indices and fractal dimension (FD) in dental panoramic radiographs (DPRs) of children with different types of osteogenesis imperfecta (OI) and also to verify the effect of pamidronate (PAM) treatment in such panoramic analyses. METHODS In this retrospective study, 197 DPRs of 62 children with OI Types I, III and IV who were in treatment with a comparable dosage of intravenous PAM were selected. The mandibular cortical width (MCW), mandibular cortical index, visual estimation of the cortical width and FD of three standardized trabecular and cortical mandibular regions of interest were obtained from the radiographs. Factorial analysis of variance and Fisher test were used to compare FD and MCW measurements in children with different types of OI for different PAM cycles. RESULTS Children with all types of OI have thinner and more porous mandibular cortices at the beginning of treatment. There were significant differences between MCW and FD of the cortical bone, regarding different types of OI and number of PAM cycles (p = 0.037 and p = 0.044, respectively). FD measurements of the trabecular bone were not statistically different among OI types nor were PAM cycles (p > 0.05). CONCLUSIONS Children with OI presented cortical bone alterations after PAM treatment. Both MCW and the FD of the cortical bone were higher in children with OI after PAM treatment. It is argued that cortical bone should be considered for analyzing patients with OI, as well as to monitor the progress of PAM treatment.

Pamidronate Affects the Mandibular Cortex of Children with Osteogenesis Imperfecta

We hypothesized that mandibular cortical width (MCW) is smaller in children with osteogenesis imperfecta (OI) than in healthy children and that pamidronate can improve the cortical mandibular thickness. The aim of this study was to assess changes in the MCW on dental panoramic radiographs (DPRs) of children with normal bone mineral density (BMD) and with OI. We also compared the MCW of children with different types of OI regarding the number of pamidronate cycles and age at the beginning of treatment. MCW measurements were retrospectively obtained from 197 DPRs of 66 children with OI types I, III, and IV who were in treatment with a comparable dosage of cyclical intravenous pamidronate between 2007 and 2013. The control group had 92 DPRs from normal BMD children. Factorial analysis of variance was used to compare MCW measurements among different age groups and between sexes and also to compare MCW measurements of children with different types of OI among different pamidronate cycles and age at the beginning of treatment. No significant differences in results were found between male and female subjects in both OI and healthy children, so they were evaluated altogether (P > 0.05). There was an increase of MCW values related to aging in all normal BMD and OI children but on a smaller scale in children with OI types I and III. Children with OI presented lower mean MCW values than did children with normal BMD at the beginning of treatment (P < 0.05). A linear model estimated the number of pamidronate cycles necessary to achieve mean MCW values equivalent to those of healthy children. The thinning of the mandibular cortex depended on the number of pamidronate cycles, the type of OI, and the age at the beginning of treatment. DPRs could thus provide a way to identify cyclic pamidronate treatment outcomes in patients with OI.

Oral health promotion: expanding the boundaries of knowledge

The following professors participated in the symposium discussions as panelists: Maria Fidela de Lima Navarro (Univ de São Paulo, Bauru, SP, Brazil); Joana Carvalho (Univ de Louvain, Louvain, Belgium); Alexandre Rezende Vieira (Univ of Pittsburgh, Pittsburgh, PA, USA); Mário Taba Júnior (Univ de São Paulo, Ribeirão Preto, SP, Brazil); Tiago Sousa Coelho (Univ de Brasília, Brasília, DF, Brazil); and the following professors participated as moderators: Jaime Aparecido Cury (Univ de Campinas, Piracicaba, SP, Brazil); Nilce Tomita (Univ de São Paulo, Bauru, SP, Brazil); Lilian Marly de Paula (Univ de Brasília, Brasília, DF, Brazil). Jaime Cury: The analysis of the “SB Brazil 2010” National Oral Health Survey shows a steady reduction in the number of caries in our country. Nevertheless, there are still regional disparities, especially when we consider the Northern and Northeastern regions of the country, where the indicators are worse. What solutions, whether genetic, behavioral or political in nature, do the panelists propose to reduce this imbalance? Alexandre Vieira: The disparity problem is mainly related to the unequal allocation of resources and access to services, among other things. Unfortunately, the underlying genetic component does not provide immediate answers to this issue. My studies analyzing individual susceptibility as a risk factor for dental caries are still at an early stage and cannot yet be translated into clinical practice. Joana Carvalho: In my opinion, we have to work together with other health areas, as well as with the families, in order to reduce dental caries and to promote better healthcare in these regions. I think this is the simplest way of working with primary care, i.e., through education and basic oral healthcare measures. These simple actions have proven very effective in promoting long-term qualitative and quantitative improvements in this area. I believe the best thing we can do, practically speaking, is to educate people about the importance of tooth brushing and the use of toothpaste. This would be my recommendation. Maria Fidela: Social determinants are complex. There is no single factor that can determine how people will react. If the population lacks basic understanding about this matter, even the simplest educational actions may be hard to assimilate. It’s a known fact that the low-income populations are more vulnerable to a larger number of diseases, including oral diseases. Oral health cannot be analyzed as an isolated element. It is a part of a person’s overall health condition. In order to change this complex situation, we need sound public policies. In that sense, our country has created the Prouni (University for All Program) and the Bolsa Familia cash transfer program. These initiatives are enabling changes to be Lilian Marly de Paula Nilce Santos de Melo Heliana Dantas Mestrinho (organizers)

Promotion of Oral Health in the public and private context

Summary of the discussions held at the ABOPREV National Symposium 56 Braz Oral Res. 2010;24(Spec Iss 1):55-66Gilberto Pucca: We currently do not have any agreement upon oral health indicators. In 2003, when the Smiling Brazil (“Brasil Sorridente”) pro-gram was launched, we agreed upon two indica-tors: supervised brushing and the first appointment. It is worth noting that the purpose of indicators is to monitor the impact of the implemented measures and to follow up on the results achieved, the out-puts and effects. In dentistry, however, there is no single indicator that is capable of summing up the care actions (those performed directly between the professional and the patient) and promotion actions (those with an educational character). That is why we have chosen the indicator of supervised brushing in order to monitor the health promotion actions. With the second indicator, our purpose was to mea-sure the care provided, the clinical act itself, as well as the behavior inside the office, and that is why we chose the first appointment. This indicator was cho-sen based on the rationale that the patient would be registered in our system every time they came in on a planned basis. This same patient would not be registered, therefore, if the appointment was an emergency one. We have invested in planned actions that must be interdependent in order to have an epi-demiological impact. It is critical that the service be planned, rather than be based on the model in which the dentist waits for the patient in his office. There is a need for the professional to be part of a team effort. The first appointment indicator is intended to reflect entry in a planned manner. In Brazil, we have a long tradition of providing pre-natal care and in-dividual care in an unplanned way. There are a myr-iad of indicators for the health fields in which the in-dicators are agreed upon in a tripartite way (Unified Health System – SUS, State and Municipalities) and there is a movement within the Ministry of Health to clean them up because, with so many indicators, we have lost sight of quality control. Thus, in the negotiation process, it was decided that there would be only one indicator for the oral health field. Since the Ministry of Health was investing in the imple-mentation of new services and in setting up a care network, we made the decision to include the care indicator in order to measure the pace at which the network was growing. The logic behind the orga-nization of the services emphasizes the Oral Health Teams, but they should work within the basic care guidelines and that is not always the case. Setting up an Oral Health Team (OHT) is the responsi-bility of the municipality. The Ministry of Health transfers the funds, and the municipality then de-cides whether or not they will set up an OHT, but this does not imply the reorganization of basic care, which is the most important aspect. The fact that OHTs are implemented in the sphere of the family health strategies does not automatically entail plan-ning; that is to say, the municipalities have the au-tonomy to reorganize the basic care system. In the view of the National Council of the Health Secre-tariats (CONASS) and the National Council of Mu-nicipal Health Secretariats (CONASEMS), the oral health indicator should be the number of OHTs, but I do not share that view. Given the salutary tension that took root, it was not possible to include the oral health indicator, but we will renegotiate this aspect and we will probably include the number of teams, but I believe we still have to further discuss what it means to promote health.Nilce Tomita: In regard to the issue of social control, we need to understand what the people per-ceive to be their needs, their own view on their oral health and what responses the health system must provide in light of these. Another important issue is to understand the historical reasons that led to the discrepancy between the number of professionals in a certain sector – medicine – and that observed in another sector – dentistry. There are historical rea-sons why the Oral Health Teams turned to a tradi-tional care model without incorporating the precepts of Oral Health Care. However, more important than statistics is the issue of work organization. I can imagine that there is a corresponding number of OHAs (oral health auxiliaries) and OHTCs (oral health technicians) working alongside these dentists and that they operate according to the logic of the Oral Health Teams by reorganizing the care provid-ed, offering high-quality services and with a cover-age in proportion to the number of professionals. In regard to formal social control, the role of the coun-cils is critical. It is important to make sure dentists participate in these councils in order to advocate for