Vera Mendes Soviero

Prevalence and distribution of demarcated opacities and their sequelae in permanent 1st molars and incisors in 7 to 13-year-old Brazilian children

Objective. To determine the prevalence of demarcated opacities in permanent 1st molars and incisors in 7 to 13-year-old Brazilian children. Material and methods. The study population comprised 292 children from a middle social class public school in Rio de Janeiro, Brazil. Children with all 1st permanent molars erupted were eligible for participation. Clinical examination was performed by two calibrated examiners who recorded demarcated opacities, post-eruptive breakdown, atypical restorations, and extractions due to demarcated opacities. Forty-three children had at least one molar that could not be examined, which left 249 children for the data analysis. Results. One hundred children (40.2%) had one or more 1st molars with demarcated opacities with a mean number of 1.98 (SD 1.09) affected molars. The number of affected incisors increased with increasing number of affected molars. Twenty-two (18.6%) of 118 children with unaffected 1st molars had affected incisors. Demarcated opacities were the most frequent defect, and 1st molars and upper central incisors were the most frequently affected teeth. Among children with demarcated opacities in 1st molars, 20 (20%) had post-eruptive breakdown. Conclusions. A high prevalence of demarcated opacities, possibly resulting in disintegration of the tooth crown, has been found in Brazilian children.

Validity of MicroCT for in vitro detection of proximal carious lesions in primary molars

OBJECTIVE This study aimed to validate the MicroCT for detection of proximal carious lesions in primary molars, using histology as the gold standard. METHODS Forty-eight proximal surfaces of primary molars were examined. Two calibrated examiners conducted the examinations independently. Proximal surfaces were visually scored, using ICDAS. Bitewing radiographs, Micro-CT and histological analyses used caries scores: 0=sound; 1=outer enamel; 2=inner enamel; 3=not spread dentine; 4=outer dentine; 5=inner dentine. Axial and sagital images were used for Micro-CT analysis, whilst for histology, tooth sections (400μm) were analyzed stereomicroscopically (×15). RESULTS Inter-examiner agreement ranged from 0.87 to 0.93 kappa coefficient (k). Histological analysis revealed a frequency of sound tooth surfaces (18.8%) enamel carious lesions (E1) (48%) and dentine carious lesions (D1) (33.3%). MicroCT showed high correlation with histology (r(s)0.88). At both diagnostic thresholds (E1 and D1), sensitivity and accuracy were higher for MicroCT. Inter-device agreement between MicroCT and histology was k=0.81. No difference was found between MicroCT and histology as gold standards for detecting carious lesions using ICDAS. CONCLUSION MicroCT can be used as a gold standard for detecting carious lesions in proximal surfaces in primary molars.

A systematic review on the association between molar incisor hypomineralization and dental caries

BACKGROUND Molar incisor hypomineralization (MIH) is a defect of enamel. The lower strength of the enamel can lead to fractures that predispose for plaque accumulation and caries. AIM This systematic review aimed to assess the association between MIH and caries. DESIGN Studies involving children of all ages, which reported results on MIH and caries in the permanent dentition, were considered eligible. A search was performed in PubMed and was limited to the period from January 2003 to November 2015, and to studies written in English. Reviews, meta-analyses, and case reports were excluded. The studies were evaluated by use of the Newcastle-Ottawa Quality Assessment Scale (NOS). RESULTS Seventeen publications were compiled in the review. Most publications reported that children with MIH have higher caries experience. One study did not observe a difference in DMF values among children affected or not by MIH. Three studies reported that children with MIH were 2.1 to 4.6 times more likely to have caries in the permanent dentition than children without MIH. CONCLUSIONS A significant association between MIH and caries was found. The results should, however, be interpreted cautiously due to the lack of high-quality studies. The present systematic review confirms the need for further well-designed studies.

Penetration depths of an infiltrant into proximal caries lesions in primary molars after different application times in vitro

BACKGROUND Caries infiltration aims to inhibit lesion progression, by occluding the porosities within the lesion body with low-viscosity resins. The ability in hampering lesion progression is correlated with the penetration depth (PD) of the infiltrant. AIM This study aimed to compare the infiltration depths into proximal lesions in primary molars after different application times. DESIGN Noncavitated natural caries lesions (n = 83) were etched with 15% HCl for 2 min and infiltrated for 0.5, 1, 3, or 5 min. Specimens were sectioned and PD at the maximum lesion depth (LD(max)) were analysed using dual fluorescence confocal microscopy. RESULTS Percentage penetrations (PD/LD(max)) were significantly higher after 3 or 5 min compared with 0.5-min application (P < 0.05; Mann-Whitney test). For LD(max) <400 μm, no significant differences were observed between application times (P > 0.05). For LD(max) ≥400 μm, 3- and 5-min application resulted in significantly deeper infiltration compared with 0.5 min (P < 0.05). After 1-min application, PD was significantly lower than 5 min (P < 0.05), PD/LD(max) did not differ from all other groups (P > 0.05). CONCLUSIONS Natural noncavitated proximal lesions in primary molars were deeply infiltrated after 1-min application in vitro. For deeper lesions, however, more consistent results were obtained after 3 min.

Oral hygiene frequency and presence of visible biofilm in the primary dentition

The purpose of this study was to associate oral hygiene frequency and presence of visible biofilm in the primary dentition. The sample consisted of 90 children, aged up to 4 years old, outpatients of the University Hospital of the Rio de Janeiro State University. The examinations were carried out in a dental office by a single trained examiner who was aided by an assistant. The parents answered a structured questionnaire about oral hygiene methods and frequency. Two biofilm indices, one simplified (BF1) and the other conventional (BF2), were used. BF1 classifies biofilm as absent, thin or thick, in anterior and/or posterior teeth, and provides a score for the patient, whereas BF2 classifies biofilm as absent or present, provides scores for three surfaces of each tooth and the final score is the percentage of tooth surfaces with biofilm. More than half of the parents (51 - 56.7%) reported they cleaned their childs teeth at least twice a day, while 7 (7.8%) had never cleaned their childs teeth. BF1 revealed that 12.2% (11) of the children had no visible biofilm, 37.8% (34) had thin biofilm in anterior and/or posterior teeth, 27.8% (25) had thick biofilm in anterior or posterior teeth and 22.2% (20) had thick biofilm in both anterior and posterior teeth. BF2 revealed a mean value of 21.8% (s.d. 16.5). No statistically significant correlations were found between oral hygiene frequency and the two biofilm indices (p > 0.05), indicating that oral hygiene frequency was not associated to oral hygiene quality in the evaluated sample.

Ex vivo Evaluation of Caries Infiltration after Different Application Times in Primary Molars

Low viscosity resins (infiltrants) have been shown to penetrate the lesion body of natural caries lesions almost completely in vitro. However, penetration depths (PD) have not been evaluated in vivo. Therefore, the aim of the present study was to evaluate the penetration of an infiltrant into proximal caries lesions in primary molars after different application times using an ex vivo model. 59 proximal lesions from 34 children were randomly allocated to one of the application times and were infiltrated under clinical conditions for 1, 3, or 5 min. After extraction or exfoliation (n = 48), teeth were sectioned perpendicular to their surfaces and lesion depths (LD) as well as lesion areas (LA) were evaluated using polarized light microscopy. PD and penetration areas (PA) were measured on scanning electron microscopic images. Percentage penetration depth (PPD) and percentage penetration area (PPA) were calculated. The mean (±SD) LD and LA were 596 ± 203 µm and 4.03 ± 2.75 × 105 µm2, respectively. PPD ranged from 70 to 80% and PPA from 54 to 60%. Longer application times did not result in significantly deeper or more complete penetration (p > 0.05; ANOVA). In conclusion, proximal caries lesions in primary molars can be infiltrated in vivo to a similar extent as observed previously in vitro. Moreover, 1-min application of the infiltrant led to PD and homogeneity similar to those observed with longer application times up to 5 min.

Reliability of the Nyvad criteria for caries assessment in primary teeth

This study assessed the interexaminer and intra-examiner reliability of the Nyvad caries classification system in primary teeth and calculated the mean examination time. The criteria were based on visual and tactile examinations to differentiate active and inactive lesions at cavitated and non-cavitated levels. Eighty children (3-7 yr of age) were examined under standardized conditions by calibrated examiners. At the tooth surface level, reliability was expressed as percentage agreement and kappa coefficient, using four diagnostic thresholds: sound vs. diseased; sound or inactive lesion vs. active lesion; intact surface vs. surface discontinuity; and sound or non-cavitated lesion vs. cavitated lesion. Interexaminer and intra-examiner kappa values were, respectively: 0.82/0.86; 0.80/0.86; 0.90/0.94; and 0.95/0.98. At the individual level, reliability of estimates of the caries prevalence and of the decayed or filled surface (dfs) counts were assessed at three diagnostic thresholds: sound vs. diseased; sound or inactive lesion vs. active lesion; and sound or non-cavitated lesion vs. cavitated lesion. For caries prevalence, interexaminer and intra-examiner kappa values were, respectively: 0.84/0.94; 0.69/0.74; and 0.95/0.97. The mean examination time was 226.5s (SD = 128.5). The use of the Nyvad caries diagnostic criteria in primary teeth showed reliable results. The examination time was acceptable.

Dentição decídua: estudo da prevalência dos espaços interproximais em crianças brasileiras

No intuito de conhecer mais sobre as caracteristicas da denticao decidua, apresentadas pelas criancas brasileiras, realizou-se um estudo de prevalencia do qual participaram 400 criancas, com denticao decidua completa e idade variando de 2 a 6 anos, na cidade de Petropolis - RJ. O arco tipo I foi o mais prevalente tanto no arco superior (93,2%) como no inferior (90,5%), sendo que o superior tipo II foi mais comum no sexo feminino (p < 0,01). Os espacos primatas foram os espacos interproximais mais encontrados em ambos os arcos. A associacao entre a presenca de espacos interproximais e idade foi estatisticamente significante para ambos os arcos (p < 0,05), sugerindo uma tendencia para o fechamento dos espacos com o aumento da idade.

Penetration of experimental infiltrants with different penetration coefficients and ethanol addition into natural caries lesions in primary molars.

This study evaluated the influence of the penetration coefficient (PC) and ethanol addition on the penetration depth (PD) of experimental infiltrants into proximal caries lesions in primary molars. Caries lesions (n = 45) were randomly treated with 1 of 4 experimental infiltrants (PC63; PC185; PC204; PC391) for 5 min. Lesion depths and PDs were analysed using dual fluorescence confocal microscopy. Lesions were almost completely infiltrated in all groups. Median PDs and percentage penetrations were not significantly different between groups (p > 0.05). When applied for 5 min, all tested infiltrants were able to infiltrate proximal caries in primary molars nearly completely.

Comparison between a simplified and a conventional biofilm index in relation to caries activity and gingivitis in the primary dentition

Aim: This was to compare a simplified biofilm index with a conventional one in relation to caries activity and gingivitis in the primary dentition. Study design: Observational, cross-sectional. Methods: The sample consisted of 90 children aged 10 to 57 months-old. A single examiner performed all examinations. Two visible biofilm indices, one simplified (BF1) and the other conventional (BF2), were used. Gingival bleeding was assessed after flossing all proximal surfaces and each tooth surface was classified for caries, including non-cavitated lesions. Results: According to BF1, half of the sample (45–50%) had thick biofilm. BF2 showed a mean value of 21.8% (SD±16.5); 12 (13.3%) children had gingival bleeding and the mean percentage of bleeding surfaces was 0.9% (SD±2.5). Caries was present in 36 (40.0%) children and the mean value of active lesions was 2.1 (SD±4.3). The ssociation between visible biofilm and gingival bleeding was significant (p = 0.01), except when BF1 was associated with the gingival index (p = 0.08). The association between BF1 and BF2 with caries activity was highly significant (p≤0.001). Conclusion: Both biofilm indices may be used when the outcome being measured is caries. In the primary dentition, though, the conventional index (BF2) is better suited for studies about gingivitis.