Lívia Azeredo Alves Antunes

Initial assessment of responsiveness of the P‐CPQ (Brazilian Version) to describe the changes in quality of life after treatment for traumatic dental injury

This study aimed to assess the responsiveness of the Brazilian version of the Parental-Caregiver Perception Questionnaire (B-P-CPQ) to describe changes in quality of life (QoL) after treatment for traumatic dental injury (TDI). After eligibility criteria were applied, 42 of 255 patients who went to a dental trauma center for TDI treatment were included. QoL was evaluated in two different appointments: A1 (after TDI) and A2 (after TDI treatment). The B-P-CPQ scores were calculated using the additive method. Psychometric properties like internal consistency (Cronbachs Alpha), test-retest reliability, intraclass correlation coefficient (ICC), and construct validity (Spearmans correlations) were assessed, and, mainly, the responsiveness was analyzed by standardized response means (SRM). Mean B-P-CPQ scores were 30.05 (1.74 SD) and 2.67 (4.05 SD), while the median scores were 17.39 and 2.00 (P < 0.01), respectively in A1 and A2. Cronbachs Alpha was 0.87 in A1 and 0.66 in A2. ICC was 0.90. B-P-CPQ scores were correlated with overall well-being (P < 0.01; rho: 0.71). The B-P-CPQ responsiveness scores declined 27.38 points, and a perfect SRM of 1.76 was achieved. The B-P-CPQ scores indicated changes in QoL following TDI. The change was observed as an impact decrease after TDI treatment, demonstrating positive reduction and improvement on QoL. The responsiveness of the P-CPQ (Brazilian version) in detecting change on QoL after TDI treatment was confirmed by SRM assessment. The findings represent an evidence of the importance of professional care and treatment of TDI.

Impacto do traumatismo dentário na qualidade de vida de crianças e adolescentes: revisão crítica e instrumentos de medida

Dental trauma constitutes a public health problem with a marked prevalence among Brazilian children and adolescents. Furthermore, it can lead to irreparable dental loss, which makes it important to evaluate this condition using instruments of oral health related to quality of life (OHRQoL). Based on this, a review of the literature sought to expose indices that may assess the evaluation of quality of life among Brazilians with dental trauma, as well as discuss the state of the art of publications about this condition on their OHRQoL followed by a discussion of the output encountered on the subject. With this in mind the articles published from 1980 to June/2011 located on databases (Pubmed, VHL, Google Scholar) or manually in the references of selected publications were prioritized. It was revealed that there is no specific instrument for dental trauma. It is therefore necessary to assess the OHRQoL in children and adolescents with indices found in the literature. Once this has been done, as yet unresolved questions about the impact of dental trauma on OHRQoL can be answered.

Genetic mapping of high caries experience on human chromosome 13.

BackgroundOur previous genome-wide linkage scan mapped five loci for caries experience. The purpose of this study was to fine map one of these loci, the locus 13q31.1, in order to identify genetic contributors to caries.MethodsSeventy-two pedigrees from the Philippines were studied. Caries experience was recorded and DNA was extracted from blood samples obtained from all subjects. Sixty-one single nucleotide polymorphisms (SNPs) in 13q31.1 were genotyped. Association between caries experience and alleles was tested. We also studied 1,481 DNA samples obtained from saliva of subjects from the USA, 918 children from Brazil, and 275 children from Turkey, in order to follow up the results found in the Filipino families. We used the AliBaba2.1 software to determine if the nucleotide changes of the associated SNPs changed the prediction of the presence of transcription-binding site sequences and we also analyzed the gene expression of the genes selected based on binding predictions. Mutation analysis was also performed in 33 Filipino individuals of a segment of 13q31.1 that is highly conserved in mammals.ResultsStatistically significant association with high caries experience was found for 11 markers in 13q31.1 in the Filipino families. Haplotype analysis also confirmed these results. In the populations used for follow-up purposes, associations were found between high caries experience and a subset of these markers. Regarding the prediction of the transcription-binding site, the base change of the SNP rs17074565 was found to change the predicted-binding of genes that could be involved in the pathogenesis of caries. When the sequence has the allele C of rs17074565, the potential transcription factors binding the sequence are GR and GATA1. When the subject carries the G allele of rs17074565, the potential transcription factor predicted to bind to the sequence is GATA3. The expression of GR in whole saliva was higher in individuals with low caries experience when compared to individuals with high caries experience (p = 0.046). No mutations were found in the highly conserved sequence.ConclusionsGenetic factors contributing to caries experience may exist in 13q31.1. The rs17074565 is located in an intergenic region and is predicted to disrupt the binding sites of two different transcription factors that might be involved with caries experience. GR expression in saliva may be a biomarker for caries risk and should be further explored.

Role of estrogen related receptor beta (ESRRB) in DFN35B hearing impairment and dental decay.

BackgroundCongenital forms of hearing impairment can be caused by mutations in the estrogen related receptor beta (ESRRB) gene. Our initial linkage studies suggested the ESRRB locus is linked to high caries experience in humans.MethodsWe tested for association between the ESRRB locus and dental caries in 1,731 subjects, if ESRRB was expressed in whole saliva, if ESRRB was associated with the microhardness of the dental enamel, and if ESRRB was expressed during enamel development of mice.ResultsTwo families with recessive ESRRB mutations and DFNB35 hearing impairment showed more extensive dental destruction by caries. Expression levels of ESRRB in whole saliva samples showed differences depending on sex and dental caries experience.ConclusionsThe common etiology of dental caries and hearing impairment provides a venue to assist in the identification of individuals at risk to either condition and provides options for the development of new caries prevention strategies, if the associated ESRRB genetic variants are correlated with efficacy.

Lower dental caries prevalence associated to chronic kidney disease: a systematic review.

BackgroundThe aim of this systematic review was to determine whether there is any evidence in the literature referring to a lower prevalence of dental caries in children and adolescents with chronic kidney disease (CKD) compared to healthy individuals.MethodsA search of the PubMed Medline, Ovid Medline and Cochrane Library databases was performed using the MeSH terms “dental caries” and “chronic renal failure”. To be eligible for entry in our study, controlled observational studies had to present a decayed, missing and filled index for primary teeth (dmft) and/or for permanent teeth (DMFT) in children and adolescents with CKD.ResultsAfter evaluation of title, keywords and abstracts of the articles selected, six articles met the inclusion criteria. Three of these six articles included studies which showed susceptibility to bias and possible confounding factors. A subsequent assessment of the six studies revealed that the mean caries indices in both primary (dmf) and permanent (DMF) teeth were lower in the children and adolescents with CKD compared with healthy individuals.ConclusionData in the literature weakly support a lower prevalence of caries in children and adolescents with CKD than in their healthy counterparts. There is still a lack of well-designed studies that provide better scientific evidence in support of this conclusion.

Effectiveness of high speed instrument and air abrasion on different dental substrates

The aim of this study was to compare the effectiveness of high speed (HS) and air abrasion (AA) instruments on groups of teeth (deciduous, permanent, bovine), in terms of preparation time, topography and presence of smear layer. Each group consisted of 5 teeth that had their buccal/lingual surfaces prepared by using either HS or AA. All procedures were standardized and timed. The teeth were then sectioned and prepared for evaluation of both the topography and the presence of smear layer by scanning electron microscopy. As regards preparation time, HS yielded preparations 1.5 times quicker than AA did on the three types of dental substrates (Wilcoxon test, p < 0.05). In both techniques (Kruskal-Wallis Test, p < 0.05) the preparation time was influenced by the dental substrate, particularly in deciduous teeth (Mann-Whitney test with Bonferonis correction, p < 0.017), which required a longer preparation time. In the descriptive analysis of the topography, no difference was found between the substrates. Nonetheless, the different instruments used determined distinctive topographies. Both techniques produced a smear layer (chi2 McNemar, p > 0.05) in all substrates, but with different formations. In conclusion, the HS instrument was found to be more rapid than the AA. No difference was found between the three dental substrates as regards both the topography and the presence of smear layer. The differences found in the present study were only in relation to the effects of each instrument used.

Fine mapping of locus Xq25.1-27-2 for a low caries experience phenotype

OBJECTIVE The purpose of this study was to fine map the locus Xq25.1-27-2 in order to identify genetic contributors involved in low caries experience. DESIGN Seventy-two families from the Philippines were studied. Caries experience was recorded and genomic DNA extracted from peripheral blood was obtained from all subjects. One hundred and twenty-eight polymorphisms in the locus Xq25.1-27-2, a region that contains 24 genes, were genotyped. Association between caries experience and alleles was tested using the transmission disequilibrium test (TDT). This initial analysis was followed by experiments with DNA samples from 1481 subjects from Pittsburgh, 918 children from Brazil, and 275 children from Turkey in order to follow up the results found in the Filipino families. Chi-square or Fishers exact tests were used. Sequencing of the coding regions and exon-intron boundaries of MST4 and FGF13 were also performed on 91 women from Pittsburgh. RESULTS Statistically significant association with low caries experience was found for 11 markers in Xq25.1-27-2 in the Filipino families. One marker was in MST4, another marker was in FGF13, and the remaining markers were in intergenic regions. Haplotype analysis also confirmed these results, but the follow up studies with DNA samples from Pittsburgh, Brazil, and Turkey showed associations for a subset of the 11 markers. No coding mutations were identified by sequencing. CONCLUSIONS Our study failed to conclusively demonstrate that genetic factors in Xq25.1-27-2 contribute to caries experience in multiple populations.

Analysis of the association between polymorphisms in MMP2, MMP3, MMP9, MMP20, TIMP1, and TIMP2 genes with white spot lesions and early childhood caries

BACKGROUND Matrix metalloproteinases and their inhibitors might be involved in enamel formation. AIM This study aimed to evaluate the association between polymorphisms in MMP2, MMP3, MMP9, MMP20, TIMP1, and TIMP2 with white spot lesions (WSL) and early childhood caries (ECC). DESIGN A cross-sectional study was performed on 786 children aged from 2 to 6 years in Brazil. After clinical evaluation, they were classified into groups with disease (the presence of WSL and/or ECC) and without disease (the absence of WSL or ECC). Genotyping of the selected polymorphisms was carried out with TaqMan real-time PCR, using genomic DNA extracted from buccal cells. Allele and genotype frequencies were compared between groups. Chi-square test, odds ratio (OR), and logistic regression were used (P ≤ 0.05). RESULTS The dmft score was 1.3 (SD: 2.4), and 41.34% of the children have at least one caries lesion. In MMP9, the GG genotype was more frequent in the group without disease (P = 0.006). In a recessive model, WSL was associated with the marker rs1711437 in MMP20 (P = 0.019; OR = 1.20, 95% CI 1.02-1.42). The marker rs1784418 in MMP20 showed an association between the allele G distribution for the WSL group (P = 0.020; OR = 0.73, 95% CI 0.55-0.96). CONCLUSION MMP9 and MMP20 are involved in WSL and ECC development.

BMP2 Is Associated with Caries Experience in Primary Teeth

Bone morphogenetic proteins (BMPs) play an important role during the initial process of enamel development and therefore may play a role in caries susceptibility. The purpose of this study was to evaluate the association between the polymorphisms in the BMP2, BMP4 and BMP7 genes and their association with caries experience and primary enamel microhardness characteristics. DNA from buccal cells as well as clinical and demographic information from 1,731 subjects from three different data sets from Brazil were included. Polymorphisms in BMP2, BMP4 and BMP7 were analyzed by real-time polymerase chain reaction from genomic DNA. Association between caries experience, genotype, and allele distribution in both cohorts was evaluated using χ2 and logistic regression analyses. In the family-based set, the association between caries experience and alleles was tested using the transmission disequilibrium test. In the Rio de Janeiro cohort, microhardness data on 108 exfoliated primary teeth before and after demineralization and remineralization challenges was included. Associations between microhardness values and genotype and allele distribution were evaluated using χ2 and logistic regression analyses. Differences between caries experience and some risk factors were statistically significant. In the cohort from Nova Friburgo, BMP2 was associated with caries experience in primary dentition during logistic regression analysis (p = 0.023; OR = 2.58; 95% CI 1.13-5.86). There was no association between genotype and allele distribution for BMP polymorphisms and primary enamel microhardness alterations. Our result suggests that BMP2 may be involved in caries experience in primary dentition from a Nova Friburgo cohort.

Dental findings and oral health status in patients with mucopolysaccharidosis: a case series

OBJECTIVE To present a mucopolysaccharidosis (MPS) case series evaluating oral manifestations (clinical and radiographic), oral health status and discussing its implications. PATIENTS AND METHODS All patients with MPS attending the Genetics clinic/Brazil were evaluated by means of anamnesis, clinical and radiographic examinations. RESULTS The final sample consisted of 12 subjects (nine males and three females), with ages ranging from 3-31 years old. Concerning oral health, it was observed high levels of caries and periodontal problems. About oral manifestations, this study clinically observed more cases of delayed tooth eruption, thickness of alveolar process and thick lips. Radiographically, it was observed alterations on condyle, mandibular ramus and joint fossa. CONCLUSION The dental changes in MPS population are high and consequently it is important to know them for differential diagnoses, early treatment intervention, prevention and education of both patients and parents/caregivers about oral health.