Luana Severo Alves

Influence of Eruption Stage and Biofilm Accumulation on Occlusal Caries in Permanent Molars: A Generalized Estimating Equations Logistic Approach

The aim of this study was to estimate the independent effects of biofilm accumulation and eruption stage on the occurrence of active caries lesions on occlusal surfaces of permanent molars. The sample consisted of 298 schoolchildren (6–15 years) who were examined by a calibrated examiner at a dental unit, using artificial light, a dental mirror and a WHO probe. The occurrence of visible biofilm on occlusal surfaces and the eruption stage of each permanent molar were recorded. After professional prophylaxis and air drying, the occlusal surfaces were classified as sound, caries-inactive or caries-active. To evaluate the association of eruption stage and biofilm accumulation with active caries lesions, a logistic regression model was used. Since data were clustered, odds ratios were obtained using generalized estimating equations with a logistic link function. 1,779 permanent molars were examined. All eruption stages were associated with active caries lesions. After adjustment for biofilm accumulation and type of molar, molars with occlusal surfaces partially exposed to the oral cavity were 63.6 times more susceptible to caries activity than molars with full occlusion (95% CI = 22.0–183.7). After adjustment for eruption stage and type of molar, teeth with a high degree of biofilm accumulation were 14.5 times more susceptible to caries activity than those without visible biofilm accumulation (95% CI = 6.5–32.4). No association between active caries and hardly detectable biofilm was found in this population. The present study found that the eruption stage of permanent molars is strongly associated with active caries lesions, adjusted for biofilm accumulation and type of molar.

Dental erosion among 12-year-old schoolchildren: a population-based cross-sectional study in South Brazil.

OBJECTIVEnTo assess the epidemiology and risk indicators for dental erosion among 12-year-old schoolchildren in South Brazil.nnnMETHODSnA population-based cross-sectional survey was conducted in Porto Alegre, Brazil, using a representative sample of 12-year-old schoolchildren (n = 1,528). Dental erosion was recorded according to the Basic Erosive Wear Examination (BEWE) index. Parents answered questions on socio-economic status, brushing frequency and general health. Schoolchildren answered questions on dietary habits. Anthropometric data were collected. Statistical analysis included logistic and Poisson regression models.nnnRESULTSnThe prevalence of dental erosion was 15% [95% confidence interval (95% CI): 13.6-16.5], being mainly mild erosion. Boys [odds ratio (OR) = 1.57, 95% CI: 1.17-2.10], private school attendees (OR = 1.45, 95% CI: 1.01-2.06) and schoolchildren reporting the daily consumption of soft drinks (OR = 5.04, 95% CI: 1.17-21.71) were more likely to have at least one tooth with dental erosion. Gender [boys, rate ratio (RR) = 1.66, 95% CI: 1.28-2.17], type of school (private, RR = 1.89, 95% CI: 1.53-2.35), the consumption of soft drinks (sometimes: RR = 5.27, 95% CI: 1.46-19.05; daily: RR = 6.82, 95% CI: 1.39-33.50) and the daily consumption of lemon (RR = 1.49, 95% CI: 1.11-2.00) were significantly associated with the number of affected surfaces.nnnCONCLUSIONSnThe present study found a moderate prevalence of dental erosion among young schoolchildren, with mild erosion being the most prevalent condition. Socio demographic variables and dietary habits were associated with dental erosion in this population.

Comparative scanning electron microscopic study of the effect of different dental conditioners on dentin micromorphology

This study evaluated comparatively by scanning electron microscopy (SEM) the effect of different dental conditioners on dentin micromorphology, when used according to the same protocol. Forty dentin sticks were obtained from 20 caries-free third human molars and were assigned to 4 groups corresponding to 3 conditioners (phosphoric acid 37%, Clearfil SE Bond and iBond) and an untreated control group. After application of the conditioners, the specimens were immersed in 50% ethanol solution during 10 s, chemically fixed and dehydrated to prepare them to SEM analysis. In the control group, dentin surface was completely covered by smear layer and all dentinal tubules were occluded. In the phosphoric acid-etched group, dentin surface was completely clean and presented exposed dentinal tubule openings; this was the only group in which the tubules exhibited the funnel-shaped aspect. In the groups conditioned with Clearfil SE Bond primer and iBond, which are less acidic than phosphoric acid, tubule openings were occluded or partially occluded, though smear layer removal was observed. SE Bond was more efficient in removing the smear layer than iBond. In the Clearfil SE Bond group, the cuff-like aspect of peritubular dentin was more evident. It may be concluded all tested conditioners were able to change dentin morphology. However, it cannot be stated that the agent aggressiveness was the only cause of the micromorphological alterations because a single morphological pattern was not established for each group, but rather an association of different aspects, according to the aggressiveness of the tested conditioner.

Association of malocclusion, happiness, and oral health-related quality of life (OHRQoL) in schoolchildren.

OBJECTIVEnThe aim of this study was to assess the impact of malocclusion on childrens oral health-related quality of life (COHRQoL) and self-reported happiness.nnnMETHODSnA cross-sectional study was conducted in a representative sample of 12-year-old schoolchildren from Santa Maria, South Brazil. Four calibrated examiners carried out clinical exams to evaluate malocclusion [Dental Aesthetic Index (DAI)], dental caries (DMFT), and dental trauma (OBrien classification, used in the Childrens dental health survey in the UK, 1994). Participants answered the Brazilian versions of the Child Perceptions Questionnaire (CPQ11-14 ) and the Subjective Happiness Scale (SHS). Parents completed a structured questionnaire regarding socioeconomic status. Data analysis was conducted using multilevel Poisson regression models.nnnRESULTSnA total of 1,134 adolescents (boys: 45.8 percent; girls: 54.1 percent) were enrolled in the study. The DAI overall score ranged from 13 to 63 (mean: 25.19, standard error: 0.19); 57.6 percent of the subjects had minor or no malocclusion and 24.4 percent had definite malocclusion. Severe malocclusion and handicapping malocclusion were found in 10.4 percent and 7.4 percent of the subjects, respectively. After adjustment, the severity of malocclusion was associated with high mean values of the CPQ11-14 overall score, and the emotional well-being and social well-being domains were the most affected. Lower levels of happiness were also associated with the severity of malocclusion: those with definite malocclusion presented lower scores on the SHS scale (Rate Ratio 0.97; 95 percent CI 0.94-0.99).nnnCONCLUSIONnMalocclusion had a negative impact on COHRQoL and happiness, mainly on the emotional and social domains.

One-year evaluation of inactive occlusal enamel lesions in children and adolescents

ObjectivesThe aims of this study were to compare caries incidence and progression on sound occlusal surfaces and on surfaces presenting inactive enamel lesions in children and adolescents over 1xa0year and to estimate the risk of caries incidence and progression on these surfaces.MethodsThis prospective cohort study followed 200 7-15-year-old caries-inactive schoolchildren over 1xa0year. Stage of eruption, occlusal plaque, and occlusal caries were recorded on permanent molars. Statistical analysis was performed using generalized estimating equations with a logistic link function.ResultsTwenty-two children (11xa0%) presented “caries progression” (at least one active lesion on molar teeth). At site level, no difference was observed in caries incidence and progression between sites classified either sound (2.6xa0%) or with inactive enamel lesion (3.9xa0%) at the baseline examination (χ2 test, pu2009=u20090.48). Adjusted for plaque, stage of eruption, type of molar and dental arch, inactive enamel lesions presented a similar risk for caries progression than sound occlusal surfaces (ORu2009=u20090.98, 95xa0% CIu2009=u20090.40–2.38).ConclusionWithin the limitations of this study, no difference was observed in caries incidence, progression, and risk on sound occlusal sites in comparison with sites presenting inactive enamel lesions.Clinical relevanceOcclusal surfaces harboring inactive caries lesions did not require additional attention than the one normally given to sound occlusal surfaces over a 1-year period.

Eruption Stage of Permanent Molars and Occlusal Caries Activity/Arrest

This study assessed the association between the eruption stage of permanent second molars and occlusal caries activity among 12-year-old schoolchildren from South Brazil. A cross-sectional study was performed in Porto Alegre using a multistage probability sampling strategy to select a representative sample. Clinical examination was conducted to assess the eruption stage of permanent molars, Gingival Bleeding Index, and, after tooth cleaning and drying, caries experience (noncavitated and cavitated lesions, including caries activity assessment). Data were collected on sex, socioeconomic status, mother’s education, brushing frequency, and consumption of soft drinks. Generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 983 schoolchildren with 3,071 second molars were available for analysis. Whereas active caries was observed in 6.6% of fully erupted permanent second molars, caries affected 26.2%, 29.6%, and 18.2% of erupting molars classified as stages 1, 2, and 3, respectively: stage 1, partially erupted occlusal surface; stage 2, fully erupted occlusal surface, <1/2 crown exposed; and stage 3, fully erupted occlusal surface, >1/2 crown exposed. After adjusting for socioeconomic and behavioral variables, partially erupted molars were significantly more likely to present active caries lesions than molars in full occlusion: stage 1, OR = 4.99 (95% CI = 3.38, 7.38); stage 2, OR = 5.18 (95% CI = 3.14, 8.53); stage 3, OR = 3.20 (95% CI = 2.21, 4.64). Similar results were found when clinical variables were included in the adjusted model. In conclusion, most occlusal caries lesions tend to arrest/revert when teeth reach the occlusal plan; however, an important proportion of these lesions remains active and in need of proper management. Children at risk should be targeted with preventive and minimally invasive strategies.

Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial

ObjectiveThis multicenter randomized controlled clinical trial aimed to compare the outcomes of stepwise excavation (SW) and partial caries removal (PCR) regarding the maintenance of pulp vitality in deep caries lesions over 5xa0years.MethodsAt baseline, 299 permanent molars with deep caries lesions were randomly assigned to control or test groups. The control group received the stepwise excavation treatment (SW), while the test group received partial caries removal from the pulpal wall followed by restoration in a single session (PCR). Treatments were conducted in two centers located in the cities of Porto Alegre (South Brazil) and Brasília (Midwest Brazil). Survival analysis was performed to compare PCR and SW over time (Weibull regression models). The primary outcome of this study was pulp vitality, determined by the combination of the following characteristics: positive response to cold test, negative response to percussion, absence of spontaneous pain, and absence of periapical lesion (radiographic examination).ResultsThis 5-year study includes data pertaining to 229 teeth: 121 teeth actually examined at the 5-year appointment, and 108 teeth contributed with data collected in previous follow-ups (18xa0months or 3xa0years). Survival analysis showed success rates of 80% in PCR group and 56% in SW group (pxa0<xa00.001). Failure was significantly associated with treatment [PCR, HR=0.38; 95%CI=0.23–0.63)] and region [South, HR=2.22; 95%CI=1.21–4.08].ConclusionPCR significantly reduced the occurrence of pulp necrosis when compared with SW.Clinical relevanceThis study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.

Dental erosion among South Brazilian adolescents: A 2.5‐year longitudinal study

OBJECTIVESnThis population-based longitudinal study investigated the incidence, progression and risk factors for dental erosion among South Brazilian adolescents.nnnMETHODSnEight hundred and one schoolchildren attending 42 public and private schools were clinically examined at 12 years of age; clinical examinations were repeated after 2.5 years (SD=0.3). After tooth cleaning and drying, permanent incisors and first molars were classified using the Basic Erosive Wear Examination (BEWE) scoring criteria. Questionnaires were used to collect data on socio-demographic characteristics, dietary habits, toothbrushing frequency and general health. Poisson regression analysis was used to assess the association between dental erosion incidence and explanatory variables, with adjusted incidence risk ratios (IRR) and 95% CI estimated.nnnRESULTSnAmong those who did not have dental erosion at baseline, 49 of 680 schoolchildren (7.1%; 95% CI=5.2-9.1) developed erosive lesions over the follow-up period. Among schoolchildren who had dental erosion at baseline, 31 of 121 (25.4%; 95% CI=17.6-33.3) had new or more severe lesions. Boys were more likely to develop dental erosion than girls (IRR=1.88; 95% CI=1.06-3.32).nnnCONCLUSIONSnA moderate incidence of dental erosion was observed among South Brazilian adolescents, with boys being at higher risk. The high progression rate of 25% observed here is very concerning, and it should be taken in consideration when designing preventive strategies for dental erosion.

The effect of dental treatment on oral health-related quality of life in adolescents

ObjectivesThe objective of the study is to assess the effect of dental treatment on the oral health-related quality of life (OHRQoL) of adolescents from a city in South Brazil.Materials and methodsThis longitudinal study included 129 adolescents aged 10 to 15xa0years who received dental caries treatment in a university clinic in Santa Maria, Brazil. The OHRQoL was measured using the Brazilian version of the Child Perceptions Questionnaire for children aged 11 to 14xa0years (CPQ11–14). The questionnaire was administered through face-to-face interviews before treatment and 1xa0month after its completion. Paired t tests and effect sizes were used to evaluate changes in CPQ11–14 scores after completion of treatment.ResultsIn total, 43.4% of the study participants received solely restorations, 15.5% received endodontic treatment, and 44.2% underwent tooth extractions. The mean CPQ11–14 score before treatment was 15.9u2009±u200910.3, which decreased to 6.3u2009±u20096.5 after treatment (Pu2009<u20090.001). The same pattern was observed in the four domains of CPQ11–14 (oral symptoms, functional limitation, emotional well-being, and social well-being). The effect sizes varied from 0.4 to 1.1, with oral symptoms and emotional well-being domains showing the greatest changes.ConclusionsDental treatment resulted in a significant improvement in the OHRQoL of the evaluated adolescents.Clinical relevanceProviding dental treatment has beneficial effects on the quality of life of adolescents, especially for oral symptoms and emotional well-being.

Proximal carious lesions infiltration—a 3-year follow-up study of a randomized controlled clinical trial

IntroductionInfiltration of carious lesion has been claimed as a promising approach for the management of non-cavitated proximal lesions (NCPL). Clinical studies have suggested that this approach may reduce NCPL progression in individuals whose caries risk was not change over the studied period.ObjectiveThis study aimed to assess the additional benefit of infiltration of NCPL over a 3-year period in a group of individuals who received treatment and control of carious activity.Materials and methodsTwenty-two caries-active subjects that possessed at least a pair of NCPL in posterior teeth were selected for this study totalizing 36 pairs of lesion. In a split-mouth design, lesions were randomly allocated to test (infiltration) or placebo treatments. At follow-up, lesions were radiographically analyzed, progression was determined by radiographic pair-wise comparison and differences in number of progressing lesions between test, and placebo-treated surfaces were compared.ResultsSeventeen subjects (27 pairs of lesions) were followed up. Only four subjects were caries-active at the follow-up. In the test group, 2/27 (7.4%) lesions and in the placebo group 5/27 (18.5%) lesions had progressed. No statistical difference was observed between the studied groups (pxa0=xa00.453).ConclusionSubjects under treatment focusing on controlling caries activity presented low progression rates in both infiltrated and non-infiltrated NCPL. As only very few lesions progressed in both groups, no significant additional effect could be found. Further studies with larger sample sizes are necessary.Clinical relevanceInfiltration of NCPL may have limited additional effect if other treatments focused on controlling caries activity are successful.