Educação e motivação em saúde bucal: prevenindo doenças e promovendo saúde em pacientes sob tratamento ortodôntico

Oral Health and Behavioral Management of Children with Autistic Spectrum Disorder: A 30-year Retrospective Study

PURPOSE

This article aims to determine the oral health status, the dental treatment, the behavioral management techniques, and the follow-up of pediatric autistic spectrum disorder (ASD) patients treated at the Clinic for Pediatric Patients with Disabilities (CPPD) at a public university in Brazil.

METHODS

The medical records of all the patients seen between 1990 and 2020 were evaluated. Data were collected on the autistic patients' medical and dental conditions, treatments, behavior during dental visits, behavioral management techniques used, and the entire follow-up period at the clinic. The Student's t-test and chi-square tests were used to perform the statistical analysis (α = 0.05%).

RESULTS

Sixty-six records of ASD children were analyzed from a total of 656 dental records. The majority were male (80.3%). The mean age was 7.39 ± 2.75 years. All the children had a cognitive deficit, and 62.5% used medication. Most of the children arrived with caries lesions (56.1%), and the mean number of decayed, missed and filled teeth in both the deciduous (dmft-d) and permanent dentition (DMFT) was 2.45 ± 3.13 and 0.87 ± 1.51, respectively. The restorative technique was the most commonly used procedure (54.5%), and protective stabilization was the most frequently used behavioral management technique (18.2%). Of the children who sought treatment, 86.4% were discharged, and 15.2% abandoned the procedure. The majority (those discharged) continued to undergo regular follow-up at the clinic (86%), and the incidence of new caries lesions observed was 33.33% Conclusions: Although our ASD patients had a high frequency of caries and dental treatment needs, we observed good adherence to the treatment, with a low dropout rate, and high discharge rate.

Intra-Oral Photograph Analysis for Gingivitis Screening in Orthodontic Patients

This study aimed to confirm the presence of gingival inflammation through image analysis of the papillary gingiva using intra-oral photographs (IOPs) before and after orthodontic treatment and to confirm the possibility of using gingival image analysis for gingivitis screening. Five hundred and eighty-eight (n  =  588) gingival sites from the IOPs of 98 patients were included. Twenty-five participants who had completed their orthodontic treatments and were aged between 20 and 37 were included. Six points on the papillary gingiva were selected in the maxillary and mandibular anterior incisors. The red/green (R/G) ratio values were obtained for the selected gingival images and the modified gingival index (GI) was compared. The change in the R/G values during the orthodontic treatment period appeared in the order of before orthodontic treatment (BO), mid-point of orthodontic treatment (MO), three-quarters of the way through orthodontic treatment (TO), and immediately after debonding (IDO), confirming that it was similar to the change in the GI. The R/G value of the gingiva in the image correlated with the GI. Therefore, it could be used as a major index for gingivitis diagnosis using images.

Prevalence of malocclusion in early childhood and its associated factors in a primary care service in Brazil

PURPOSE

to evaluate the prevalence of malocclusion and its associated factors of children cared for by a PHC Service in Porto Alegre, Brazil.

METHODS

a cross-sectional study nested in a cohort, carried out in 12 Health Care Practices. Of the 414 children in the cohort examined, 268 were assessed for malocclusion. The presence of anterior open bite, posterior and anterior crossbite was evaluated by the criteria of Foster and Hamilton. Socioeconomic variables, breastfeeding habits and pacifier use information were collected through a standardized questionnaire. Data analysis was performed using a hierarchical approach by Poisson Regression with robust variance.

RESULTS

out of the total 268 evaluated, 135 (50.4%) were boys, and the average age was 28.6 (± 11.9) months. Out of the 143 (53.4%) cases of malocclusion, 113 were anterior open bite, 16 were anterior crossbite, 27 were posterior crossbite, and 38 had increased overjet. In the final analysis, it was observed that there was a higher prevalence of malocclusion in children who never breastfed (PR = 1.44; 95%CI 1.00-2.08) and who always used a pacifier to sleep (PR = 1.81; 95%CI 1.14-2.86).

CONCLUSION

the prevalence of malocclusion in this population was high and was associated with behavioral habits, such as the use of pacifier and not breastfeeding.

Salivary Metalloproteinase-8 and Metalloproteinase-9 Evaluation in Patients Undergoing Fixed Orthodontic Treatment before and after Periodontal Therapy

(1) Background: Metalloproteinase-8 (MMP-8) and metalloproteinase-9 (MMP-9) are members of a family of proteases of major importance during orthodontic tooth movement. Their levels increase during orthodontic therapy and in periodontally affected tissues. Orthodontic fixed appliances retain dental plaque and can cause gingival inflammation. When gingival inflammation is present, the forces produced during orthodontic tooth movement can aggravate tissue reaction and cause the destruction of supportive periodontal tissue. This study aimed to identify biomarkers that facilitate the assessment of periodontal status during orthodontic treatment. (2) Methods: Our study was conducted on 111 patients who were about to receive fixed orthodontic treatment. We determined the salivary levels of MMP-8 and MMP-9 and bleeding on probing (BOP) before applying the orthodontic fixed appliance (T1), one week after appliance placement (T2), and during orthodontic treatment, one month after non-surgical periodontal treatment (T3). (3) Results: Patients undergoing orthodontic treatment show a significant increase in BOP, MMP-8, and MMP-9 levels one week after orthodontic appliance placement (T2) and a decrease in these parameters one month after periodontal treatment (T3). Statistically significant correlations were found between MMP-8 levels and BOP values at T1, T2, and T3. (4) Conclusion: In our study patients undergoing orthodontic treatment show a significant increase in BOP, MMP-8, and MMP-9 levels one week after orthodontic appliance placement and a decrease in these parameters one month after periodontal treatment. Strong positive statistically significant correlations were found between MMP-8 levels and BOP and medium positive statistically significant correlations between MMP-9 and BOP values before and after orthodontic treatment and periodontal treatment. MMP-8, MMP-9, and BOP could be used to assess the periodontal status of orthodontic patients.

A Comparative Clinical Study of the Self-Adhering Flowable Composite Resin Vertise Flow and the Traditional Flowable Composite Resin Premise Flowable

Background. The aim of this research was to carry out a comparative clinical study of a self-adhesive, light-curing composite material called Vertise Flow and a traditional flow material called Premise flowable used in combination with dedicated bonding systems. In order to standardize the clinical environment, the stability of oral hygiene (analyzed with the oral hygiene index and the approximal plaque index) was taken into consideration. Methods. The study involved 37 patients with 64 fillings. They were distributed into three groups: 22 fillings in Group I, 22 fillings in Group II and 20 fillings in Group III. In Group I (G I), Vertise Flow material was applied without the use of an etching agent or a bonding system; in Group II (G II), Premise flowable material was applied without the use of an etching agent, but with the use of the OptiBond All-In-One seventh-generation bonding system; in Group III (G III), Premise flowable material was applied after etching and treatment of the hard tooth tissues using a fifth-generation OptiBond Solo Plus bonding system. Then, at appropriate time intervals (0, i.e., right after filling and after 6, 12 and 24 months), the fillings were subjected to clinical evaluation, conducted according to the Ryge scale criteria with the use of registration by means of a fluorescent high-intensity visible light beam produced by a camera (Vista Proof). Results. The quality of fillings performed with the use of comparable materials was subjected to clinical evaluation using the Ryge scale of fillings after 6, 12, and 24 months; the examination showed significant differences between the tested materials. The Vertise Flow material used without an etching agent or a bonding system (G I) presented the weakest results with respect to marginal adaptation and smoothness among those evaluated in this study. The intensification of the degradation continued over time until the final clinical observation at 24 months. The results confirmed that the best quality was achieved with the Premise flowable material after etching and treatment of the hard tooth tissues using a fifth-generation OptiBond Solo Plus bonding system (G III) relative to others for all time points during the observation. Conclusions. The used preparation scheme and bonding system have an impact on the final quality of the composite filling. There is a need to carry out a qualitative clinical evaluation of dental restorative materials under uniform conditions using evaluation scales.

Prevalência e severidade da cárie dentária em escolares do Ensino Fundamental de um município vulnerável

Resumo Introdução A cárie dentária ainda é um problema de saúde pública na maioria dos países industrializados, com maior prevalência nas populações mais vulneráveis socioeconomicamente. Objetivo Avaliar a prevalência e a severidade da cárie dentária, e as ações curativas realizadas em escolares de 6 a 14 anos do Ensino Fundamental durante quatro meses de intervenção. Material e método Estudo transversal foi realizado com 130 escolares do município de Sarandi-PR. Para o diagnóstico da cárie dentária, foram utilizados os índices ceo-d, CPO-D e ICDAS II. Os escolares receberam atendimento curativo de acordo com as necessidades apresentadas, associado a atividades educativas preventivas. Resultado A prevalência de cárie dentária foi de 70% e 83%, segundo os índice ceo-d/CPO-D e ICDAS II, respectivamente. Os códigos referentes ao ICDAS II com maior prevalência foram ICDAS 5 e 6 (1,57% e 3,69%, respectivamente), enquanto o código 4 foi o de menor prevalência (0,30%). A maioria dos tratamentos restauradores foi realizada pela técnica de Tratamento Restaurador Atraumático (ART) (150 restaurações). Foram realizadas 90 aplicações de verniz fluoretado em lesões iniciais de cárie. Os tratamentos de maior complexidade foram encaminhados para a Unidade Básica de Saúde do município. Dos 32 escolares referenciados, 21 compareceram e nestes foram realizados tratamentos endodônticos e exodontias de dentes decíduos e permanentes. Conclusão A população estudada apresenta prevalência alta de cárie e, após quatro meses de intervenção, observou-se que o ART foi resolutivo para a maioria das necessidades de tratamento (59,2%), apresentando-se como uma estratégia eficiente que pode ser implementada em locais que não oferecem a estrutura de um consultório odontológico.

Effects of Reinforced Oral Hygiene Instruction Program With and Without Professional Tooth Cleaning on Plaque Control and Gingival Health of Orthodontic Patients Wearing Multibracket Appliances

Introduction: Fixed orthodontic therapy is considered to be one of the important risk factor for plaque accumulation, since various orthodontic components serves as the retentive areas for plaque accumulation and thus increasing the risk of caries and periodontitis. Therefore these patients must be encouraged to maintain good oral health throughout the treatment.

Objective: To investigate the effects of reinforced oral hygiene instruction programme with and without professional tooth cleaning on the plaque accumulation and gingival health of orthodontic patients wearing fixed multibracket appliances.

Material and Methods: Forty patients with fixed orthodontic appliances in the age range of 12–28 years were divided randomly into Group I (n=20) and Group II (n=20). Group I received oral hygiene instructions and Group II received similar instructions supplemented with one sitting of professional tooth cleaning. The plaque and gingival index were recorded at the baseline (before the instructions), after 4 and 8 weeks in both the groups. At each visit all the instructions were reinforced in both the groups.

Results: Intergroup comparison showed significant decrease in the mean plaque score at 4 weeks in Group II (p<0.01), but no significant difference in the mean plaque score at 8 weeks and mean gingival scores at 4 and 8 weeks between both the groups. Within the group comparison, showed that the mean values of both the indices showed significant decrease after 8 weeks in both the groups (p<0.01).

Conclusion: Reinforced oral hygiene instruction programme with or without professional prophylaxis can lead to efficient control of plaque accumulation as well as improvement in the gingival health of orthodontic patients wearing multibracket appliances. However, provision of professional tooth cleaning should be based on individual plaque control needs.