Maria Laura Menezes Bonow

Traumatic dental injuries in primary dentition: epidemiological study among preschool children in South Brazil

AIM To estimate the prevalence of traumatic injury in primary dentition among children aged 12-71 months old, as well as to evaluate the distribution of traumatic injuries, type of trauma and associated factors. MATERIAL AND METHODS After the research project approval by the Ethics Research Committee, a cross-sectional study was carried out including 571 preschool children--both from public and private schools--in the city of Pelotas, Southern Brazil. Data were collected by means of anterior teeth examination, and by the administration of a structured questionnaire to parents. The classification proposed by Andreasen & Andreasen was used, and crown discoloration and fistula were added to this criterion. RESULTS AND CONCLUSIONS The prevalence of dental trauma was 36.6% (95% CI 32.7-40.5), with no significant differences between boys and girls. Trauma were more frequent among older children (P = 0.001). No associations were found for maternal schooling, income and type of school. The most frequent trauma was enamel fracture, and the most affected tooth was number 61. A significant statistical association was observed between the presence of dental trauma during clinical examination and parental report of trauma occurrence. The percentage of parents who looked for dental treatment was higher among children from private schools (P = 0.001). The most frequent place of occurrence was home, and the most frequently reported etiology was childs own-height fall. CONCLUSIONS Dental trauma in primary teeth is characterized as an accident that occurs due to the childrens development stage, even when they are cared for by mothers of higher schooling and income. Parents should search for assistance right after trauma occurrence to minimize sequelae.

Longevity of posterior restorations in primary teeth: Results from a paediatric dental clinic

OBJECTIVES The aim of this retrospective study was to evaluate the longevity of restorations in the posterior primary teeth of children attending to a public paediatric dental clinic and to test the factors associated with failures. METHODS Patient records of 329 children (162 boys and 166 girls) were used for collecting and analyzing data. A total of 565 restorations in primary teeth were included in the study. All children enrolled in the study were classified as high caries risk. The longevity of restorations from their placement until failure (up to 4 years of follow-up) was assessed using the Kaplan-Meier survival curves with log-rank test. Multivariate Cox regression analysis with shared frailty (p<0.05) was used to assess the factors associated with failures. RESULTS Up to 4 years of follow-up, the annual failure rates were 9.5% for composite fillings, 12.2% for light-cured glass ionomer restorations, and 12.9% for conventional glass ionomer restorations with statistical difference between the materials (p=0.014). Glass ionomer restorations had a higher risk of failure over time compared with composites (HR 1.86, 95% CI 1.17-2.97). In crude analysis, Class II restorations showed lower survival rate than Class I restorations (p=0.031) but lost significance after adjustments. CONCLUSIONS Our findings suggested that the material influenced the survival rate of primary posterior restorations, with composite presenting the best performance. CLINICAL SIGNIFICANCE Differences were observed between restorative materials with different properties in primary teeth up to 4 years of follow-up. This study provides valuable information regarding the primary teeth posterior restoration longevity in a paediatric population with restorations performed under daily life clinical environment.

Dental emergencies in a university pediatric dentistry clinic: a retrospective study

A significant number of children visit a dentist for the first time due to emergency situations. However, little is known regarding the prevalence, etiology, and treatment provided for children at emergency dental visits. This study aimed to evaluate the profile of children attending a dental school emergency clinic, the reasons for seeking dental care, and the treatment provided. Records of 270 patients who attended an emergency clinic during 2010 were analyzed, and 253 were selected. Demographic, diagnostic, and procedural information was collected. The mean child age was 7.8 years. For 208 children (82%), pain was the main reason for the emergency visit. Nearly 79% of the visits were due to caries, and the most frequently required treatment was endodontic intervention (31.22%). Of the decayed teeth, 61.70% were primary posterior teeth and 31.9% permanent posterior teeth. Pain caused by dental decay was the most frequent chief complaint. A large number of children were brought to the dentist with complaints that had started long before, for which over-the-counter medications had been used.

Efficacy of 1.23% APF gel applications on incipient carious lesions: a double-blind randomized clinical trial

The aim of this double-blind randomized clinical trial was to evaluate the efficacy of 1.23% APF gel application on the arrest of active incipient carious lesions in children. Sixty 7- to 12-year-old children, with active incipient lesions were included in the study. Children were divided randomly into 2 groups: 1.23% APF gel and placebo gel applications. Each group received 8 weekly applications of treatment. The lesions were re-evaluated at the 4th and 8th appointments. Poisson regression analysis was used to estimate relative risks of the presence of active white spot lesions. Groups showed similar results (PR = 1.67; CI 95% 0.69-3.98). The persistence of at least 1 active lesion was associated with a higher number of lesions in the baseline (PR = 2.67; CI 95% 1.19-6.03), but not with sugar intake (PR = 1.06; CI 95% 0.56-2.86) and previous exposure to fluoride dentifrice (PR = 1.26; CI 95% 0.49-2.29). The trial demonstrates the equivalence of the treatments. The use of the APF gel showed no additional benefits in this sample of children exposed to fluoridated water and dentifrice. The professional dental plaque removal in both groups may also account for the resulting equivalence of the treatments.

Traumatic intrusion of primary tooth: follow up until eruption of permanent successor tooth

This paper presents a clinical case of a 2(1/2)-year-old boy who suffered dental trauma because of a fall from a bike. His father thought that the boys central upper left incisor had been fractured. The clinical exam showed laceration of the upper maxillary frenum and a possible intrusion of the tooth, as the area was swollen. An upper maxillary occlusal X-ray confirmed the intrusion of the incisor. The procedure adopted was to wait for the re-eruption of the tooth. It was recommended that the boy stop using a pacifier and feeding bottle. The necessity of keeping the affected area clean was also emphasized. The patient was observed and, within 6 months, the central upper left incisor was found in occlusion. The successor permanent tooth was normal after 6 years.

Traumatic intrusion of permanent teeth: 10 years follow-up of 2 cases

Intrusive luxation is a kind of traumatic injury characterized by an axial displacement of the tooth toward the alveolar bone. Its main causes are bicycle accidents, sports/recreational activities, and falls or collisions. Treatment strategies include waiting for the tooth to return to its position, immediate surgical repositioning, and repositioning through dental traction by orthodontic devices. In order to decide which treatment to follow, the degree of root formation, the patients age, and intrusion severity should be taken into consideration. This study aimed to report a 10-year follow-up of two patients that suffered permanent incisor (PI) traumatic injury who had a similar root development (incomplete rooting) but different results. In the first case, the treatment of choice was follow-up. The patient showed gingival alteration and root resorption of tooth 21. Calcium hydroxide therapy and root canal filling were performed twice because of not attending callback. After finishing the endodontic treatment, follow-up visits showed no abnormalities. In the second case, the treatment of choice was watch and wait to the teeth 11 and 21. After 7 months spontaneous eruption of both teeth was detected. Radiographic examination showed atypical root formation and almost completely pulp canal obliteration, 8 years later. In the follow-up, visit after 10 years was observed complete crow and pulp canal obliteration. It was concluded that PI intrusion treatments are good intervention alternatives, as they proved to be successful after a 10-year follow-up period.

Pacifier use modifies the association between breastfeeding and malocclusion: a cross-sectional study

This study aimed to evaluate the influence of breastfeeding and pacifier use on the occlusal status of preschool children. A cross-sectional study was conducted with children (n = 489) aged 2-5 years in private and public schools in Pelotas, South Brazil. Mothers answered a questionnaire on demographic, socioeconomic and behavioral variables, including breastfeeding and non-nutritive sucking habits. Malocclusion was classified as normal/mild and moderate/severe, according to WHO criteria. The association between breastfeeding and pacifier use with malocclusion was tested using multivariate logistic regression. The prevalence of malocclusion was 37.83% (95%CI 33.52-42.14), and 57.87% of the children used a pacifier. A total of 46.01% of the sample was exclusively breastfed for 6 months, and 24.74% were never breastfed. Malocclusion was associated with pacifier use, and with both non-exclusively breastfed and never breastfed. After adjustments for demographic and socioeconomic variables, the children who used a pacifier and were never breastfed (OR = 19.08; 95%CI 8.54-42.63), or who used a pacifier and were not exclusively breastfed (OR = 13.74; 95%CI 6.11-30.92), showed worse occlusal conditions, compared with the children who were exclusively breastfed and never used a pacifier. Pacifier use modifies the relationship between breastfeeding and occlusal status.