Thays Almeida Alfaya

Accuracy study of the main screening tools for temporomandibular disorder in children and adolescents

The aims of the present study were to assess the degree of sensitivity and specificity of the screening questionnaire recommended by the American Academy of Orofacial Pain (AAOP) and the patient-history index proposed by Helkimo (modified by Fonseca) and correlate the findings with a clinical exam. All participants answered the questionnaires and were submitted to a clinical exam by a dentist who had undergone calibration training. Both the AAOP questionnaire and Helkimo index achieved low degrees of sensitivity for the detection of temporomandibular disorder (TMD), but exhibited a high degree of specificity. With regard to concordance, the AAOP questionnaire and Helkimo index both achieved low levels of agreement with the clinical exam. The different instruments available in the literature for the assessment of TMD and examined herein exhibit low sensitivity and high specificity when administered to children and adolescents stemming from difficulties in comprehension due to the age group studied and the language used in the self-explanatory questions.

Myofascial Trigger Point Therapy: Laser Therapy and Dry Needling

The aim of the present review is to discuss two forms of treatment for myofascial pain: laser therapy and dry needling. Although studies have reported the deactivation of myofascial trigger points with these two methods, clinical trials demonstrating their efficacy are scarce. The literature reports greater efficacy with the use of laser over dry needling. It has been suggested that improvements in microcirculation through the administration of laser therapy may favor the supply of oxygen to the cells under conditions of hypoxia and help remove the waste products of cell metabolism, thereby breaking the vicious cycle of pain, muscle spasm and further pain. While laser therapy is the method of choice for patients with a fear of needles and healthcare professionals inexperienced with the dry needling technique, further controlled studies are still needed to prove the greater efficacy of this method.

Assessment of chemomechanical removal of carious lesions using Papacarie Duo™: randomized longitudinal clinical trial.

BACKGROUND Chemomechanical removal of carious lesions consists of the dissolution of carious tissue by the application of a natural or synthetic agent, followed by atraumatic mechanical removal. AIM The aim of the present study was to assess the effectiveness of Papacarie Duo ® gel in the chemomechanical removal of carious lesions in primary teeth in comparison to the traditional method (low-speed bur). SETTINGS AND DESIGN A randomized clinical trial was conducted with 20 children between 5 and 8 years of age. MATERIALS AND METHODS Two teeth were treated in each child (split-mouth design), with the randomization of two methods: Group 1 - chemomechanical caries removal with Papacarie Duo™; and Group 2 - removal of carious dentin tissue using a low-speed bur. Both methods involved restoration with glass ionomer cement and follow up. The following aspects were evaluated: time required for the procedure; pain (face evaluation scale); retention of the restorative material in the cavity; and the presence of secondary caries after 30 days. STATISTICAL ANALYSIS USED Chi-squared test, Students t-test, and Wilcoxon test. RESULTS No statistically significant differences between methods were found regarding time required for the procedure (P = 0.13), the occurrence of pain (P = 0.585), or restoration status at the 30-day clinical evaluation (P = 0.713). CONCLUSION The findings of the present study demonstrate that the two methods achieve similar results. The advantages of minimally invasive treatment, such as chemomechanical caries removal with Papacarie Duo™, are its ease of use, patient comfort, and the fact that it causes less damage to dental tissue.

Effect of a rapid maxillary expansion on snoring and sleep in children: a pilot study

Abstract Aim: The aim of this study was to assess the efficacy of the McNamara rapid palatal expansion device for the treatment of sleep disorders in children. Methods: The sample enrolled 12 children aged 4–11 years. Children with snoring and bruxism whose parents did not agree to tonsil surgery were included in the study. During the initial evaluation, a questionnaire addressing sleep was administered, and plaster models were made for the construction of the McNamara rapid maxillary expansion device. The expansion period was 7–15 days, and the McNamara device was removed after 6–8 months. The same questionnaire was administered again after 30 days of use of the orthopedic appliance. The data were analyzed using the McNemar test, with the level of significance set to 5% (P<0·05). Results: Significant improvements were found in tiredness upon waking (P = 0·002), mood (P = 0·008), lip seal (P = 0·031), drooling during sleep (P = 0·031), snoring (P = 0·001), and bruxism (P = 0·0062). Conclusion: The use of non-invasive methods, such as rapid maxillary expansion, can be an effective treatment for snoring and other undesirable sleep behaviors in children.

Efficacy of Papacarie® in reduction of residual bacteria in deciduous teeth: a randomized, controlled clinical trial

OBJECTIVES: The aim of the present study was to analyze the efficacy of Papacarie® gel compared with the traditional method (low-speed bur) in reducing the counts of total bacteria, Lactobacillus, total Streptococcus and Streptococcus mutans group. METHODS: A randomized, controlled clinical trial with a split-mouth design was performed. The sample comprised 40 deciduous teeth in 20 children (10 males and 10 females) aged four to seven years. The teeth were randomly allocated to two groups: G1, or chemomechanical caries removal with Papacarie Duo®, and G2, or the removal of carious dentin tissue with a low-speed bur. Infected dentin was collected prior to the procedure, and the remaining dentin was collected immediately following the removal of the carious tissue. Initial and final counts of bacterial colonies were performed to determine whether there was a reduction in the number of colony-forming units (CFUs) of each microorganism studied. ClinicalTrials.gov: NCT01811420. RESULTS: Reductions were found in the numbers of total bacteria, total Streptococcus and Streptococcus mutans group following either of the caries removal methods (p<0.05). A reduction was also noted in the number of Lactobacillus CFUs; however, this difference did not achieve statistical significance (p>0.05). CONCLUSION: Papacarie® is an excellent option for the minimally invasive removal of carious tissue, achieving significant reductions in total bacteria, total Streptococcus and S. mutans with the same effectiveness as the traditional caries removal method.

Pain during Removal of Carious Lesions in Children: A Randomized Controlled Clinical Trial

The aim of the present study was to assess pain and the need for anesthesia during chemomechanical caries removal with Papacarie gel and the traditional method (low-speed bur) in pediatric patients. A randomized, controlled, clinical trial with a “split-mouth” design was carried out involving 20 children (10 girls and 10 boys) aged four to seven years. Forty primary teeth (two per child) were randomly allocated to either Group 1 (G1: chemomechanical caries removal with Papacarie gel) or Group 2 (G2: removal of carious dentin with low-speed bur). A face scale was used to classify the sensation of pain during the procedure (1: absence of pain; 2: mild pain; 3: moderate pain; 4: moderately intense pain; 5: intense pain; and 6: extremely intense pain). Statistical analysis of the data was performed using the Wilcoxon-Mann-Whitney (U) test. Pain scores were higher in G2, with statistically significant differences in comparison to G1 (U = 148.0; W = 358.0; P = 0.041). Chemomechanical caries removal with Papacarie provides a lesser degree of pain in comparison to conventional caries removal and does not require the use of local anesthesia. The clinical trial registration number is NCT01811420.

Assessment of type of bite and vertical dimension of occlusion in children and adolescents with temporomandibular disorder

The aim of the present study was determine the type of bite and abnormalities in the vertical dimension of occlusion (VDO) among children and adolescents with temporomandibular disorder (TMD). The Helkimo index was employed for the diagnostic investigation of TMD. A clinical examination was performed for the determination of occlusion. The VDO was measured using a digital caliper. Fishers exact text was used to determine associations between type of bite, gender and TMD. The Students t-test was used to compare age and VDO by gender. The significance level was set to 5% or corresponding p-value. Children and adolescents with anterior open bite were 1.2-fold more likely to develop TMD in comparison to those without any type of malocclusion. The same was found for those with posterior crossbite and mixed malocclusion. A statistically significant association was found between the VDO and age in both genders. TMD affected 68.85% of the sample. No correlation was found between malocclusion, VDO and TMD in the sample. The present findings suggest that individuals with malocclusion are more prone to TMD. Therefore, it is important to evaluate all variables capable of influencing the harmony of the stomatognathic system for an effective diagnosis of TMD and malocclusion.

Randomized controlled clinical trial of long-term chemo-mechanical caries removal using PapacarieTM gel

Objectives Compare the effectiveness of PapacarieTM gel for the chemo-mechanical removal of carious lesions on primary teeth to conventional caries removal with a low-speed bur with regard to execution time, clinical aspects and radiographic findings. Material and Methods A randomized controlled clinical trial with a split-mouth design was carried out. The sample was composed of 20 children aged four to seven years, in whom 40 deciduous teeth were randomly divided into two groups: chemo-mechanical caries removal with PapacarieTM and removal of carious dentin with a low-speed bur. Each child underwent both procedures and served as his/her own control. Restorations were performed with glass ionomer cement. The time required to perform the procedure was also analyzed. The patients underwent longitudinal clinical and radiographic follow-up of the restorations. Results No statistically significant difference between groups was found regarding the time required to perform the procedures and the radiographic follow up. Statistically significant differences between groups were found in the clinical evaluation at 6 and 18 months after treatment. Conclusion PapacarieTM is as effective as the traditional method for the removal of carious dentin on deciduous teeth, but offers the advantages of the preservation of sound dental tissue as well as the avoidance of sharp rotary instruments and local anesthesia.

Impacto da terapia de suporte nas alterações otológicas em pacientes com desordem temporomandibular

BACKGROUND AND OBJECTIVES: Otological symptoms complaints may be associated to temporomandibular joint disorders (TMJD). Occlusal splint is an alternative to treat TMJD because it provides ideal occlusion to patients, acting on painful symptoms. Considering the conservative and reversible characteristics of supportive therapy with occlusal splints, this study aimed at evaluating its impact on the frequency of otological changes in TMJD patients. METHOD: An intervention study was carried out with 35 patients with TMJD-associated otological symptoms. TMJD patients were considered those with at least three signs and three symptoms of morbidity, being one of them earache, tinnitus, sensation of hypoacusis, ear fullness or dizziness. Patients were submitted to clinical evaluation, orientations and fabrication of maxillary occlusal splint in thermoplastic acrylic resin. Splint adjustments and symptoms evaluation were performed fortnightly. Fisher Exact test was used for statistical analysis of the prevalence of signs and symptoms before (BE) and after (AF) therapy with significance level of 5% (p < 0.05). RESULTS: Nineteen patients have finished the treatment. There has been decrease in the prevalence of otological signs and symptoms: tinnitus (BE = 14; AF = 6; p = 0.009), earache (BE = 13; AF = 4; p = 0.003), ear fullness (BE =12; AF = 4; p = 0.006), dizziness (BE = 11; AF = 4; p = 0.009) and hypoacusis (BE = 10; AF = 2; p = 0.001). CONCLUSION: Occlusal splint is a conservative and reversible therapy able to improve TMJD-related otological symptoms.

Clinical status of permanent first molars in children aged seven to ten years in a Brazilian rural community

Aim: To evaluate the clinical status of permanent first molars and associations with dental caries, gingival bleeding, dental fluorosis and malocclusion. Methods: An observational study was carried out in a rural community denominated Morro do Saboo in the city of Sao Roque, state of Sao Paulo, Brazil. A total of 194 children aged seven to ten years were examined for dental caries using the index proposed by the World Health Organization. Other conditions were determined using the Gingival Alterations Index, Dean’s Index and Dental Aesthetic Index. The chi-squared test was used for the statistical analysis of the data. Results: A total of 85.5% of the sample exhibited gingival bleeding and 69.9% exhibited malocclusion. A total of 53.6% had a clinical aspect of normality with regard to dental fluorosis. There was a predominance of sound teeth in the upper arch and teeth with carious lesions in the lower arch. No significant differences were found between sexes regarding gingival bleeding, dental fluorosis or malocclusion. Significant associations were found between tooth status and oral alterations (gingival bleeding, malocclusion and fluorosis) in teeth 16, 26 and 46 and between tooth status and gingival bleeding in tooth 36 (p<0.001). Conclusions: Caries activity in the permanent first molars was mainly associated with dental fluorosis and malocclusion. Strategies aimed at health promotion should be adopted on a large scale to minimize the prevalence of oral diseases.