Paulo Antônio Martins-Júnior

Validations of the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS)

This study aimed to evaluate the psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A total of 247 children aged 2 to 5 years and their parents/guardians participated in this study. A clinical oral examination was performed and the parents/guardians completed the ECOHIS questionnaire. Within a period of four-weeks, 20% of the participants repeated the ECOHIS questionnaire. Construct validity was determined using Spearmans rank correlation. Discriminant validity, internal consistency and test-retest reliability were also evaluated. The children were divided into 2 groups: group 1 (with dental caries) and group 2 (caries-free). Children with caries showed higher mean ECOHIS scores than the caries-free children. The child impact section (p < 0.01), family impact section (p < 0.01) and total ECOHIS scores (p < 0.01) were significantly correlated with tooth decay. Cronbachs alpha coefficients demonstrated satisfactory internal consistency. The Brazilian version of the ECOHIS is a valid instrument for assessing oral health-related quality of life in preschool children with Brazilian Portuguese-speaking primary caregivers.

Carbon Nanotubes Directions and Perspectives in Oral Regenerative Medicine

One of the main goals of bone tissue engineering is to identify and develop new biomaterials and scaffolds for structural support and controlled cell growth, which allow for formation or replacement of bone tissue. Recently, carbon nanotubes (CNT) have emerged as a potential candidate for bone tissue engineering. CNT present remarkable mechanical, thermal, and electrical properties with easy functionalization capability and biocompatibility. In oral regenerative medicine, bone reconstruction is an essential requirement for functional rehabilitation of the stomatognathic system. Autologous bone still represents the gold standard graft material for bone reconstruction. However, the small amounts of bone available in donor regions, together with the high costs of surgeries, are critical aspects that hinder the selection of this procedure. Thus, CNT alone or combined with biopolymers have promise to be used as novel potential biomaterials for the restoration of bone defects. Indeed, recent evidence demonstrates CNT to be a feasible material that can increase the formation of bone in tooth sockets of rats. The purpose of this review is to summarize the recent developments in bone repair/regeneration with CNT or CNT-based composites. We further provide an overview of bone tissue engineering and current applications of biomaterials, especially of CNT, to enhance bone regeneration.

Factors associated with the development of early childhood caries among Brazilian preschoolers.

The aim of this study was to assess the prevalence of early childhood caries (ECC) in children and investigate the influence of sociodemographic variables, quality of oral hygiene and child-related aspects. A cross-sectional study was carried out with 593 children aged three to five years. Data were collected through clinical examinations and interviews with parents. Interviews with parents of the children were conducted to acquire information on sociodemographic aspects, breastfeeding, bottle feeding and harmful oral habits. Statistical analysis involved the chi-square test and the Poisson regression. The prevalence of ECC was 53.6%. The occurrence of ECC was greater among children with unsatisfactory oral hygiene (PR: 2.95; 95% CI: 2.42-3.60) and those from a family with a lower monthly household income (PR: 1.62; 95% CI: 1.24-2.10). In conclusion, unsatisfactory oral hygiene and monthly income exerted an influence on the occurrence of ECC among preschoolers.

Developmental defects of enamel in primary teeth: prevalence and associated factors.

BACKGROUND   Studies on the prevalence of enamel defects in the primary dentition as a whole are scarce, as most investigations examine specific population groups. OBJECTIVES   The aim of this study was to evaluate the prevalence of enamel defects in primary teeth and determine whether prematurity, birthweight, and socio-demographic variables are associated with such defects. DESIGN   A cross-sectional study was carried out with 381 children aged 3-5 years. Data were collected through clinical examinations and interviews with parents during the National Immunisation Day. The diagnosis of enamel defects was performed using the Developmental Defects of Enamel (DDE) Index. Through interviews, information was collected on socio-demographic aspects, pregnancy, birthweight, prematurity, and breastfeeding. Statistical analysis was performed using the SPSS program for Windows and involved descriptive analysis, Fishers exact test, the chi-square test, and Poisson regression. RESULTS   The prevalence of developmental defects of enamel was 29.9%. Demarcated opacity was the most frequent type of defect. Children with a history of very low birthweight had a greater prevalence of enamels defects (PR, 2.7; 95% CI, 1.66-4.61). Prematurity and socio-demographic variables were not associated with enamel defects. CONCLUSION   Children with a history of very low birthweight had a greater frequency of enamel defects in primary teeth.

Level of agreement between self-administered and interviewer-administered CPQ8–10 and CPQ11–14

OBJECTIVES The aim of the present study was to assess the psychometric properties and level of agreement between the self-administered and interviewer-administered Child Perceptions Questionnaire (CPQ) for children between 8 and 10 years of age (CPQ(8-10) ) and between 11 and 14 (CPQ(11-14) ) years of age. METHODS A randomized cross-over study was carried out, involving 180 children (Group 1 - 90 children between 8 and 10; Group 2 - 90 children between 11 and 14 years of age) in the state of Minas Gerais, Brazil. All children completed both administration modes of the CPQ; half of each group received interviewer-administered mode first [Subgroup A (CPQ(8-10) n = 45) and Subgroup C (CPQ(11-14) n = 45)], and the other half performed the self-administered mode first [Subgroup B (CPQ(8-10) n = 45) and Subgroup D (CPQ(11-14) n = 45)]. Test-retest reliability of each mode of administration was tested on 60 children (30 for CPQ(8-10) ; 30 for CPQ(11-14) ), who were not included in the other analyses. The level of agreement between scores on the self-administered and interviewer-administered versions of the CPQ(8-10) and CPQ(11-14) was established using the intraclass correlation coefficient (ICC). The order of presentation of both instruments was tested considering the four subgroups (A, B, C and D). The calculation of effect size proposed by Cohen (1992) was used to test the clinical significance of the findings. RESULTS Both the self-administered and interviewer-administered versions of CPQ(8-10) and CPQ(11-14) demonstrated acceptable psychometric properties. Agreement between the administration modes for the CPQ(8-10) and CPQ(11-14) was 0.90 and 0.88 (ICC), respectively. With the exception of the functional limitation subscale, the scores of the subscales and overall score on the CPQ(8-10) were significantly higher in the group of children who responded to the interviewer-administered measure first. With the CPQ(11-14) , statistically significant differences were found only for the emotional well-being subscale. CONCLUSIONS Both administration modes of the CPQ(8-10) and CPQ(11-14) demonstrated satisfactory psychometric properties and a high level of agreement. Although statistically significant differences were observed for oral symptoms, emotional well-being and social well-being, with the first administration of the interviewer-administered version, the effect of the order of administration had small to medium effects on the CPQ scores.

Dental caries, but not malocclusion or developmental defects, negatively impacts preschoolers' quality of life.

BACKGROUND Oral diseases can negatively influence the quality of life causing harm in the development of routine activities, child development and their well-being. AIM To investigate the impact of dental caries, malocclusion and developmental defects of enamel (DDE) on the oral health-related quality of life of preschool children and their parents. DESIGN A cross-sectional study was carried out with 646 children aged 2-6 years in Diamantina, Brazil. Calibrated dental examiners performed the oral examinations. Parents answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and a questionnaire on socio-economic indicators. Statistical analyses involved the chi-square test and Poisson regression. RESULTS Malocclusion and DDE did not cause a negative impact on the childrens quality of life. Children with dental caries (PR: 1.92; 95%CI: 1.56-2.35) and those aged 5 (PR: 1.51; 95%CI: 1.13-2.02) and 6 years (PR: 1.51; 95%CI: 1.02-2.23) were more likely to have a negative quality of life impact on the total B-ECOHIS. CONCLUSIONS Dental caries was associated with a negative impact on the quality of life of children. Malocclusion and DDE did not cause a negative impact on the childrens quality of life. Older children had higher frequency of negative impact on OHRQoL.

Impact of oral mucosal conditions on oral health-related quality of life in preschool children: a hierarchical approach

OBJECTIVE To determine the impact of oral mucosal conditions on OHRQoL in preschool children. METHODS A cross-sectional study was carried out with a selected representative sample of 724 children aged 2-5 years and their parents/caregivers. Data were collected through interviews with parents/caregivers, who also answered the B-ECOHIS. A clinical oral examination was performed to determine oral mucosal conditions, dental caries, dental trauma, and malocclusion. Data analysis involved descriptive statistics, the Kolmogorov-Smirnov normality test, the Mann-Whitney U-test and hierarchically adjusted Poisson regression models (P < 0.05, 95% CI). RESULTS The prevalence of oral mucosal conditions was 50.7%, the most prevalent of which were melanotic macules (17.8%), oral ulcers (11.0%), Fordyces spots (9.4%), geographic tongue (5.2%), fissured tongue (1.9%), median rhomboid glossitis (1.8%), and fistula (1.4%). In the final multivariate model, child with 5 years of age (RR = 1.60; 95% CI: 1.08-2.38; P = 0.020), with presence of fistula (RR = 1.94; 95% CI: 1.27-2.95; P = 0.002), and with dental caries (RR = 2.58; 95% CI: 2.00-3.35; P < 0.001) had a negative impact on childrens OHRQoL. CONCLUSION Child with 5 years of age, presence of fistula, and dental caries were associated with a negative impact on the quality of life of preschool children.

Replantation of avulsed primary teeth: a systematic review.

BACKGROUND There is little evidence regarding the risks and benefits of replantation of avulsed primary teeth. AIM The aim of this study was to perform a systematic review of the literature on the replantation of avulsed primary teeth, analysing the risks and benefits to help guide dentists regarding the best clinical decision-making in such cases. DESIGN The Medline/Pubmed, LILACS, and SciELO databases were searched for articles published in English, Portuguese, German or Spanish on the replantation of avulsed primary teeth in dental journals dating from the inception of the databases through to May 2013. RESULTS Among the 891 papers identified in the search, nineteen fulfilled the inclusion criteria. All 19 studies were case reports involving a total of 41 replanted primary teeth. No negative consequences to either the primary tooth or permanent successor were observed in 15 cases. Among the other 26 cases, there were negative consequences to only the replanted primary tooth in 16 cases, only the permanent successor in three cases and both the replanted primary tooth and permanent successor in seven cases. CONCLUSION There is a lack of high-quality studies that can help guide clinicians regarding the best approach in cases of primary tooth avulsion.

A novel 3D bone-mimetic scaffold composed of collagen/MTA/MWCNT modulates cell migration and osteogenesis.

AIMS This study characterized a three-dimensional (3D) biocomposite scaffolds produced using type I collagen, mineral trioxide aggregate (MTA) and multi-walled carbon nanotubes (MWCNT) to be used in bone tissue regeneration. MAIN METHODS The scaffolds were analyzed via scanning (SEM) and transmission (TEM) electron microscopy, as well as the viability and migration of osteoblasts and mineralization of the scaffolds. KEY FINDINGS SEM and TEM analyses showed that MTA and MWCNT were distributed as both large agglomerates entrapped within the collagen network and as smaller accumulations or individual molecules dispersed throughout the scaffold. Ultrastructural analysis revealed that osteoblastic MC3T3-E1 cells grown in the biocomposite endocytosed MWCNT, which were localized in the cytoplasm and in vesicles. Analysis of cells grown in the 3D scaffolds demonstrated that >95% of the cells remained viable in all tested combinations and concentrations of the biocomposite. MC3T3-E1 osteoblasts migrated into scaffolds formed with concentrations of type I collagen between 1.75 and 3.0mg/mL. Cells displayed increased migration into scaffolds formed with collagen and a range of low to high concentrations of MTA. In contrast, the presence of MWCNT in the biocomposite had a slight negative effect on migration. Collagen gels containing specific concentrations of MTA, or MWCNT, or combinations of MTA/MWCNT, caused an increase in mineralization of scaffolds. SIGNIFICANCE Scaffolds composed of defined concentrations of type I collagen, MTA and MWCNT are biocompatible, promote migration and mineralization of osteoblasts, and hence may be useful as bone tissue mimetics.

Single-walled carbon nanotubes functionalized with sodium hyaluronate enhance bone mineralization

The aim of this study was to evaluate the effects of sodium hyaluronate (HY), single-walled carbon nanotubes (SWCNTs) and HY-functionalized SWCNTs (HY-SWCNTs) on the behavior of primary osteoblasts, as well as to investigate the deposition of inorganic crystals on titanium surfaces coated with these biocomposites. Primary osteoblasts were obtained from the calvarial bones of male newborn Wistar rats (5 rats for each cell extraction). We assessed cell viability using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay and by double-staining with propidium iodide and Hoechst. We also assessed the formation of mineralized bone nodules by von Kossa staining, the mRNA expression of bone repair proteins, and the deposition of inorganic crystals on titanium surfaces coated with HY, SWCNTs, or HY-SWCNTs. The results showed that treatment with these biocomposites did not alter the viability of primary osteoblasts. Furthermore, deposition of mineralized bone nodules was significantly increased by cells treated with HY and HY-SWCNTs. This can be partly explained by an increase in the mRNA expression of type I and III collagen, osteocalcin, and bone morphogenetic proteins 2 and 4. Additionally, the titanium surface treated with HY-SWCNTs showed a significant increase in the deposition of inorganic crystals. Thus, our data indicate that HY, SWCNTs, and HY-SWCNTs are potentially useful for the development of new strategies for bone tissue engineering.