Randomised clinical trial of Class II ART restoration in primary teeth with and without retentive grooves after 12 months

AIM

The aim of the study was to evaluate the survival of Class II ART (Atraumatic Restorative Treatment) restorations in primary molars using encapsulated glass ionomer in cavities with and without retentive grooves. A total of 293 Class II restorations were performed on primary molars by three trained operators, using ART hand instruments (SS White/Duflex, Rio de Janeiro, Brazil) and restored with EQUIA Fil (GC Corporation, Tokyo, Japan). One hundred eighty-seven children aged 3 to 7 years (mean age = 5.5) from two public schools located in Lima, Peru, were included in the study. The restorations were performed following the ART protocol, randomising the presence or absence of proximal retentions. Cavity cleaning and restoration times were recorded by the assistant using a digital chronometer. After 6 and 12 months, evaluations occurred following the ART criteria. Data were analysed using the Mann-Whitney, Chisquare and Fisher's exact tests, Kaplan-Meier survival and logarithmic range. The mean dmf-s of the participants was 21.6 (S.D. = 10.2). The mean times to clean the cavity and apply the restorative material were 5.4 and 6.6 minutes, respectively. Success rates after 6 and 12 months for restorations without retentive grooves were 90.3% and 77.2%, respectively; and with retentive grooves 95.9% and 91.8%, respectively. Statistically significant differences were found at the 12-month follow-up (p = 0.001). The proximal retentive grooves increased the survival rate of ART Class II restorations in primary teeth after 12 months of follow-up.

Oral health and obesity in the SAYCARE study: reliability and internal validity of diagnostic methods

OBJECTIVE

The aim of this pilot study was to address the reliability, internal validity and viability of oral health methods used in the South American Youth/Child cARdiovascular and Environmental study.

METHODS

South American Youth/Child cARdiovascular and Environmental study was a multicentre feasibility observational study and conducted in seven South American cities. The training sessions were performed in two steps before data collection: the first verified the inter-rater reproducibility between the examiners of the six centres in relation to the gold standard, and the second one verified the inter-rater reproducibility between the examiners at each centre in relation to the main rater. The diagnostic methods used were International Caries Detection and Assessment System II and Pulpal Involvement, Ulceration, Fistula and Abscess for dental caries and Periodontal Screening and Recording and Index Plaque for periodontal disease. Anthropometric variables were measured and used to calculate the body mass index and were classified according to the cut-off points defined by the International Obesity Task Force. Cohen's kappa coefficient and proportions of agreement were calculated to report inter-rater and intra-rater reliability in the calibration process and pilot study.

RESULTS

The inter-rater weight kappa ranged from 0.78 to 0.88 and proportion of agreement from 96.07% to 98.10% for the International Caries Detection and Assessment System II and for the Periodontal Screening and Recording, 0.68 to 0.95 and 94.40% to 98.33%, respectively, in the calibration process. At the pilot study, a total of 490 children (40.8% overweight and 12.9% obese) and 364 adolescents (23.4% overweight and 4.3% obese) were examined. The prevalence of dental caries was 66% in children and 78% in adolescents, and gingival bleeding was 49% and 58.20%, respectively.

CONCLUSION

The results demonstrated good reliability and internal validity after the examiners were trained, as well as the feasibility of using the methods chosen for this multicentre study.

Biomarkers of fluoride in children exposed to different sources of systemic fluoride

There has been no comparison between fluoride concentrations in urine and nails of children exposed to different sources of systemic fluoride. The aim of this study was to compare the relationship between fluoride intake with urinary fluoride excretion and fluoride concentrations in fingernails and toenails of children receiving fluoride from artificially fluoridated water (0.6-0.8 mg F/L, n = 25), naturally fluoridated water (0.6-0.9 mg F/L, n = 21), fluoridated salt (180-200 mg F/Kg, n = 26), and fluoridated milk (0.25 mg F, n = 25). A control population was included (no systemic fluoride, n = 24). Fluoride intake from diet and dentifrice, urinary fluoride excretion, and fluoride concentrations in fingernails/toenails were evaluated. Fluoride was analyzed with an ion-selective electrode. Urinary fluoride excretion in the control community was significantly lower when compared with that in the fluoridated cities, except for the naturally fluoridated community. However, the same pattern was not as evident for nails. Both urinary fluoride output and fluoride concentrations in fingernails/toenails were significantly correlated to total fluoride intake. However, the correlation coefficients for fluoride intake and urinary fluoride output were lower (r = 0.28, p < 0.01) than those observed for fingernails/toenails (r = 0.36, p < 0.001), suggesting that nails might be slightly better indicators of fluoride intake at the individual level.

An investigation of the transverse technique of dentifrice application to reduce the amount of fluoride dentifrice for young children

PURPOSE

Recent studies have shown an increase in the prevalence of fluorosis. Consequently, recommendations for the use of a small quantity of fluoride dentifrice, 0.25 to 0.5 g or the equivalent of a "pea size" amount for children, have been made. This study evaluated a method of placing dentifrice in a transverse relation to the bristles (TT) and compares it to the standard technique used (ST) and to the "pea size" recommendation (PS).

METHODS

The study was conducted in three phases: the first was in a laboratory setting using 22 commercial brands of children's toothbrushes; the second evaluated various recommendations with 240 mothers (Brazilian and Peruvian); and the third evaluated these recommendations in 135 Peruvian children (ages 4 to 6).

RESULTS

The results showed that the mean quantity of dentifrice used with ST, PS, and TT was 0.58 g, 0.34 g, and 0.27 g for the mothers and 0.46 g, 0.29 g, and 0.24 g for the children, respectively. The average TT obtained through multiple weighing of 22 children's toothbrushes was 0.22 g. Both recommendations (PS and TT) reduced the amount of dentifrice used. However, TT also yielded a smaller variation range. Mothers and children learn easily and prefer TT.

CONCLUSION

This technique could be recommended for young children in order to decrease the amount of fluoride dentifrice used, hence minimizing the potential inadvertent ingestion of fluoride dentifrice.

Oral findings in pediatric AIDS: a case control study in Brazilian children

A cross-sectional study was performed to verify the oral status in forty-one-children, four months to twelve years old, with antibodies anti-HIV detected by ELISA and Western-blot, in comparison to children with no risk for AIDS. Intraoral and extraoral examinations were performed, and dental and medical history was also obtained. Representative oral findings in AIDS group were cervical lymphadenopathy (53.7 percent), pseudomembranous candidosis (22 percent), angular cheilitis (9.8 percent), parotid enlargement (7.3 percent), erythematous candidosis (4.9 percent), and ulcers (4.9 percent). Control group included only two children with cervical lymphadenopathy. Considering the mean values for dmft and DMFT, there were no statistically significant differences (Student's t test) between the two groups (p < 0.05). While oral soft-tissue lesions were frequently observed in HIV antibodies in seropositive children, dental caries could not be associated primarily with AIDS.

[Evaluation of fluoride content of bottled drinking waters in Brazil]

The utilization of a systemic fluoride method must be controlled in terms of risks and benefits. The reason for this is that while a small dose will not be effective in preventing dental caries, a larger dose may cause dental fluorosis. Therefore the knowledge of the fluoride concentration found in the bottled mineral waters sold throughout the Brazilian market the consumption of which has increased lately, is of great concern. The objective of the study was the analysis of the concentration of fluoride found in the bottled mineral waters. A hundred and four brands coming from different regions of Brazil were analysed using an Orion 96-09 ion specific electrode and an Orion EA 940 ionanalyser. previously calibrated with standard fluoride solutions. Different concentrations of fluoride ranging from 0.0 to 4.4 were found. It was discovered that specific bottled waters contained: 1) Significant concentrations of fluoride not reported by the producer; 2) Fluoride concentrations of no preventive effect, although the producer had advertised the water as a Fluoridated Mineral Water; 3) Fluoride concentrations high enough to cause dental fluorosis, although the producer did not alert the consumer to this fact. It is to be concluded, therefore, that a sanitary regulatory system for the control of the level of fluoride in the bottled mineral waters marketed is necessary. Such reputation should be formulated in terms of benefits as well as in terms of risks.