Clinical evaluation of two materials in the restoration of abfraction lesions

Aim: To evaluate the clinical performance of a composite resin (CR) and a resin-modified glassionomer cement (RMGIC) for the treatment of abfraction lesions. Methods: Thirty patients with abfraction lesions in at least two premolar teeth were selected and invited to participate in this study. All restorations were made within the same clinical time frame. One tooth was restored with CR Z100TM (3M, St. Paul, MN, USA), and the other was restored with RMGIC VitremerTM (3M). The restorations were assessed immediately and 1, 6 and 12 months after the restoration, using modified US Public Health Service (USPHS) criteria: marginal integrity, marginal discoloration, wear, retention, secondary caries and hypersensitivity. The statistical analysis was based on Friedman ANOVA test and Mann-Whitney test, considering p<0.05 for statistical significance. Results: Both materials demonstrated satisfactory clinical performance after one year. In the individual analysis of each material, there was a significant difference (p<0.05) in the criteria marginal integrity and wear, for both CR and RMGIC. RMGIC exhibited more damage one year after the restoration. Comparing both materials, it was found a significant difference only for marginal discoloration, while the RMGIC restorations showed the worst prognosis after a year of evaluation. There was no significant difference in the number of retentions, caries or hypersensitivity between CR and RMGIC. Conclusions: It was concluded that CR exhibited the best clinical performance according to the cost-effectiveness and evaluation criteria used in this study.

Impact of dental caries on quality of life of adolescents according to access to oral health services: a cross sectional study

Aim: This study presents the prevalence of dental caries and its relation to the quality of life of adolescents according to the access to dental health services. Methods: Two hundred and fifty-six adolescents between 15 and 19 years of age participated in the study; they were all enrolled in public schools in a countryside municipality of the São Paulo State. Data related to dental caries were evaluated by the DMFT Index, and OHIP-14 was used for evaluating the quality of life. Mann Whitney and Spearmann correlation tests were also used (p<0.05). Results: A DMFT of 3.09 (±3.30) was found with a higher prevalence among the adolescents who used public dental services (3.43±3.34) compared with those who used private services (2.94±3.28). A statistically significant relationship between the decay component of DMFT with physical pain (0.020), physical disability (0.002) and quality of life (0.017) was verified. Conclusions: A low prevalence of dental caries was observed, and it was higher in adolescents who used public oral health services rather than private ones, evidencing the low influence of oral health on the quality of life of the participants.

Does social vulnerability for caries predict caries status of children in sub-urban Nigeria?

It is important to identify groups of people vulnerable to a disease condition. Aim: To determine the association between social vulnerability to caries and caries status of children in Ile-Ife, Nigeria. Methods: A composite vulnerability index for caries was developed using data generated for 992 children. Wilks’ Lambda test to verify relationship between vulnerability and its variables. Logistic regression analysis was conducted to determine if the social vulnerability for caries index was a good predictor for caries status. Results: The social vulnerability to caries index could not predict caries status. The study found that sex, age and number of siblings were the significant predictors of caries status in the study population. Females (AOR: 1.63; 95%CI: 1.08 – 2.46; p=0.02) and children with more than two siblings had higher odds of having caries (AOR: 2.61; 95%CI: 1.61 – 4.24; p<0.001) while children below 5 years had lower odds of having caries (AOR: 0.62; 95%CI: 0.39 – 1.00; p=0.05) Conclusions: The social vulnerability index for caries could not predict the caries status of children in the study population. Sensitive tools to identify children with caries in the study population should be developed.

Evaluación de la eficacia de la remoción de caries en dientes temporales utilizando dos métodos químico-mecánicos.

La Odontología Pediátrica Contemporánea al igual que la Odontología de Mínima Intervención, comprende la máxima conservación de tejido dental subyacente con la finalidad de evitar la invasión a tejidos pulpares que derivan en tratamientos radicales tales como pulpotomías y pulpectomías; las técnicas de operatoria dental actuales comprenden en tratar el complejo dentino-pulpar lo más conservadoramente posible, con la finalidad de prevenir la extensión. Una de las propuestas del concepto de Mínima Intervención consiste en el uso de agentes químicos para la remoción de tejido cariado, auxiliado por instrumentos manuales que permitan remover solo la dentina infectada, sin necesidad de piezas rotatorias, reduciendo tiempos operatorios y costos. Objetivo: Evaluar cuál es el método más eficaz para eliminar la caries dental entre métodos químico-mecánicos para así establecer un protocolo de atención no invasivo para pacientes pediátricos y poder llevarlo a cabo en las campañas de brigadas Odontológicas, para que un mayor número de población sea beneficiada con éstas. Materiales y Métodos: Se evaluaron 10 piezas posteriores deciduas, extraídas de niños de 6 a 8 años que cumplían con los criterios de inclusión de la Maestría en Ciencias Odontológicas en el área de Odontopediatría de la UANL, Monterrey, Nuevo León, México. Las piezas a evaluar fueron seccionadas y tratadas con Carisolv y Papacárie, ambos productos de remoción químico mecánicos, mientras se medía el tiempo de trabajo y la calidad de dentina remanente tras la remoción de caries para posteriormente describir los hallazgos observados.

Prevalencia de caries en niños de 6 a 12 años de edad en relación con su índice de masa corporal

La caries dental es una enfermedad infecto-contagiosa que produce una desmineralización de la superficie del diente y que es causada por bacterias que se adhieren a la superficie dentaria. Es un proceso localizado que causa el reblandecimiento del tejido duro del diente y según estadísticas está presente en el 90% de la población. La etiología es multifactorial y uno de los factores más importantes relacionado con la caries es la dieta. Otro factor importante a estudiar es la obesidad infantil ya que en México es un problema de salud pública, debido a su alto porcentaje en la población. La obesidad es una enfermedad crónica de origen multifactorial prevenible, que se caracteriza por acumulación excesiva de grasa o hipertrofia general del tejido adiposo en el cuerpo. El sobrepeso y la obesidad son el quinto factor principal de riesgo de defunción humana en el mundo. Cada año fallecen por lo menos 2,8 millones de personas adultas como consecuencia del sobrepeso o la obesidad. Los pacientes con obesidad deben recibir un tratamiento integral para evitar que pueda surgir a futuro una enfermedad sistémica o problemas bucales. En el presente estudio se determinó si el estado nutricio es un determinante sobre el índice de caries, debido al aumento en la ingesta de alimentos ricos en carbohidratos y si la obesidad es un factor predisponente de caries. Se realizó un estudio comparativo y observacional en 166 niños de entre 6 a 12 años de edad de Ciudad Miguel Alemán, Tamaulipas. Se tomaron datos de los niños, se midieron y pesaron con una báscula calibrada, y mediante exploración clínica se revisó y registró la cantidad de dientes cariados, extraídos y obturados de los pacientes, encontrándose que no hay una relación entre la obesidad y la caries aunque se comprobó que la población tenían un alto índice de la misma.

Utilidad del fluoruro diamínico de plata en el diagnóstico precoz de la desmineralización del esmalte/caries incipiente en los primeros molares permanentes

El estudio se aplicó en niños escolares de 9-12 años de la parroquia urbano marginal de Narancay. La intervención se efectuó en dos meses y mediante las tres técnicas se evaluaron 120 molares con un total de 359 superficies examinadas. Resultados: el resultado global de la valoración de los diferentes índices de salud bucal presenta resultados positivos para calificarla como población de alto riesgo. El FDP detectó más lesiones de desmineralización del esmalte/caries incipientes que el examen clínico (311/359 vs. 168/359) p< 0.0001. El examen radiográfico detectó el menor número de lesiones incipientes (23/359 vs. 311/359) p< 0.00001. El FDP diagnostica más lesiones de desmineralización del esmalte y crisis incipiente que el examen clínico y radiográfico conjuntamente (311/359 vs. 191/359) p< 0.001 OR 5,70 (95% I C: 3,88 - 8,38). En cuanto a los costos, el diagnóstico clínico más Rx, por cada niño es de $4 y el diagnóstico clínico más FDP es de $1,50. Conclusiones: la localidad de Narancar de la parroquia Baños tiene una infraestructura sanitaria insuficiente, con baja escolaridad y con altos índices de enfermedad bucal. El diagnóstico dental de la población infantil que tanto los índices de CPOD-ceod, higiene buco dental, placa dental y los momentos de ingesta de azúcar, reflejan que el grupo de estudio tienen elevados factores de riesgo e indicadores de enfermedad buco denal

Charcot Marie Tooth disease (CMT4A) due to GDAP1 mutation: report of a colombian family

Background: Mutations of GDAP1 gene cause autosomal dominant and autosomal recessive Charcot-Marie-Tooth disease and more than 40 different mutations have been reported. The recessive Q163X mutation has been described in patients of Spanish ancestry, and a founder mutation in South American patients, originating in Spain has been demonstrated. Objective: We describe physical and histological features, and the molecular impact of mutation Q163X in a Colombian family. Methods: We report two female patients, daughters of consanguineous parents, with onset of symptoms within the first two years of life, developing severe functional impairment, without evidence of dysmorphic features, hoarseness or diaphragmatic paralysis. Electrophysiology tests showed a sensory and motor neuropathy with axonal pattern. Sequencing of GDAP1 gene was requested and the study identified a homozygous point mutation (c.487 C>T) in exon 4, resulting in a premature stop codon (p.Q163X). This result confirms the diagnosis of Charcot-Marie-Tooth disease, type 4A. Results: The patients were referred to Physical Medicine and Rehabilitation service, in order to be evaluated for ambulation assistance. They have been followed by Pulmonology service, for pulmonary function assessment and diaphragmatic paralysis evaluation. Genetic counseling was offered. The study of the genealogy of the patient, phenotypic features, and electrophysiological findings must be included as valuable tools in the clinical approach of the patient with Charcot-Marie-Tooth disease, in order to define a causative mutation. In patients of South American origin, the presence of GDAP1 gene mutations should be considered, especially the Q163X mutation, as the cause of CMT4A disease.

Charcot Marie Tooth disease (CMT4A) due to GDAP1 mutation: report of a colombian family

Background: Mutations of GDAP1 gene cause autosomal dominant and autosomal recessive Charcot-Marie-Tooth disease and more than 40 different mutations have been reported. The recessive Q163X mutation has been described in patients of Spanish ancestry, and a founder mutation in South American patients, originating in Spain has been demonstrated. Objective: we describe physical and histological features, and the molecular impact of mutation Q163X in a Colombian family. Methods: We report two female patients, daughters of consanguineous parents, with onset of symptoms within the first two years of life, developing severe functional impairment, without evidence of dysmorphic features, hoarseness or diaphragmatic paralysis. Electrophysiology tests showed a sensory and motor neuropathy with axonal pattern. Sequencing of GDAP1 gene was requested and the study identified a homozygous point mutation (c.487 C>T) in exon 4, resulting in a premature stop codon (p.Q163X). This result confirms the diagnosis of Charcot-Marie-Tooth disease, type 4A. Results: The patients were referred to Physical Medicine and Rehabilitation service, in order to be evaluated for ambulation assistance. They have been followed by Pulmonology service, for pulmonary function assessment and diaphragmatic paralysis evaluation. Genetic counseling was offered. The study of the genealogy of the patient, phenotypic features, and electrophysiological findings must be included as valuable tools in the clinical approach of the patient with Charcot-Marie-Tooth disease, in order to define a causative mutation. In patients of South American origin, the presence of GDAP1 gene mutations should be considered, especially the Q163X mutation, as the cause of CMT4A disease.

Colonización oral por Candida y su relación con la presencia de caries y/o enfermedad periodontal crónica en población adulta del País Vasco

250 p.

A preventative approach to oral health for children in a regional/rural community in south-west Victoria Australia

Abstract Dental caries is a major health problem in most industrialised countries. Childhood dental disease can cause acute pain, difficulty eating resulting in reduced self-esteem and sleep deprivation. The treatment of oral disease using traditional methods is costly and in industrialized countries currently rates the fourth most expensive disease to treat. Dental professionals are currently facing an unfathomable task of how to manage the large burden of consequences associated with caries progression across the world. The Barwon South-West Region of Victoria, Australia is a diverse regional/rural area. Some communities are quite remote. Barwon Health and Colac Area Health Oral Health Services developed an outreach program to improve access to dental services for children. A Minimal Intervention Dentistry approach was incorporated and includes early diagnosis, risk assessment, early detection of mineral loss, non-surgical treatment and preservation of the tooth structure. Kindergartens throughout the region and children in the first year of Primary School are visited by Oral Health Therapists. Teeth are scored according to the International Caries Detection Assessment System and any early 'white spot' lesions identified have fluoride varnish applied. Children receive up to three dental check-ups during the year and given a toothbrush and toothpaste at each visit. Parent engagement sessions are conducted during Visit 2. Examinations and fluoride application take only 3 - 6 minutes for each child, compared with the usual 30 minute appointments in dental clinics. Two virtual chairs have been created as two dental teams visit Kindergartens throughout the Barwon Region, significantly easing pressure at Community dental clinics. The Kinder Wide Smiles program successfully intervened in the oral health of 5,305 children in the region. Most importantly, one of the barriers for children not presenting to static dental clinics for screening has been eliminated.

Risk indicators associated with root caries in independently living older adults

Objective: To determine the risk indicators associated with root caries experience in a cohort of independently living older adults in Ireland. Methods: The data reported in the present study were obtained from a prospective longitudinal study conducted in a cohort of independently living older adults (n = 334). Each subject underwent an oral examination, performed by a single calibrated examiner, to determine the root caries index and other clinical variables. Questionnaires were used to collect data on oral hygiene habits, diet, smoking and alcohol habits and education level. A regression analysis with the outcome variable of root caries experience (no/yes) was conducted. Results: A total of 334 older dentate adults with a mean age of 69.1 years were examined. 53.3% had at least one filled or decayed root surface. The median root caries index was 3.13 (IQR 0.00, 13.92). The results from the multivariate regression analysis indicated that individuals with poor plaque control (OR 9.59, 95% CI 3.84–24.00), xerostomia (OR 18.49, 95% CI 2.00–172.80), two or more teeth with coronal decay (OR 4.50, 95% CI 2.02–10.02) and 37 or more exposed root surfaces (OR 5.48, 95% CI 2.49–12.01) were more likely to have been affected by root caries. Conclusions: The prevalence of root caries was high in this cohort. This study suggests a correlation between root caries and the variables poor plaque control, xerostomia, coronal decay (≥2 teeth affected) and exposed root surfaces (≥37). The significance of these risk indicators and the resulting prediction model should be further evaluated in a prospective study of root caries incidence. Clinical significance Identification of risk indicators for root caries in independently living older adults would facilitate dental practitioners to identify those who would benefit most from interventions aimed at prevention.

Oral Administration of Lactobacillus reuteri during the First Year of Life Reduces Caries Prevalence in the Primary Dentition at 9 Years of Age

The aim of this study was to evaluate the effect on oral health, at age 9 years, of daily oral supplementation with the probiotic Lactobacillus reuteri, strain ATCC 55730, to mothers during the last month of gestation and to children through the first year of life. The study was a single-blind, placebo-controlled, multicenter trial involving 113 children: 60 in the probiotic and 53 in the placebo group. The subjects underwent clinical and radiographic examination of the primary dentition and carious lesions, plaque and gingivitis were recorded. Saliva and plaque were sampled for determination of mutans streptococci (MS) and lactobacilli (LB) in saliva and plaque as well as salivary secretory IgA (SIgA). Forty-nine (82%) children in the probiotic group and 31 (58%) in the placebo group were caries-free (p < 0.01). The prevalence of approximal caries lesions was lower in the probiotic group (0.67 ± 1.61 vs. 1.53 ± 2.64; p < 0.05) and there were fewer sites with gingivitis compared to the placebo group (p < 0.05). There were no significant differences between the groups with respect to frequency of toothbrushing, plaque and dietary habits, but to intake of fluoride supplements (p < 0.05). There were no intergroup differences with respect to L. reuteri, MS, LB or SIgA in saliva. Within the limitation of this study it seems that daily supplementation with L. reuteri from birth and during the first year of life is associated with reduced caries prevalence and gingivitis score in the primary dentition at 9 years of age.

Etiologia da recessão gengival

Introdução: A Periodontologia é um ramo da Medicina Dentária que tem como objetivo manter o periodonto saudável. A recessão gengival tem vindo a ser estudada, tanto em populações com pobre controlo de placa bacteriana, quanto naquelas com boa Higiene Oral. Os médicos dentistas desconhecem ainda muitos dos aspetos da etiologia da recessão gengival e como tal, este assunto foi objeto de muitas conjeturas, nomeadamente a causa da mesma, sendo ainda mais importante, o controle deste problema. Sendo assim, persiste a confusão levantada por várias opiniões e pontos de vista contraditórios, sendo alvo desta dissertação. Objetivos: Esta dissertação tem como objetivo analisar, e verificar a Etiologia da Recessão Gengival, mais precisamente, a sua origem e os fatores que predispõem a mesma. Tendo sido assim, realizada uma revisão bibliográfica, de modo a verificar: quais as causas desta patologia e as suas limitações. Materiais e Métodos: Para a obtenção da informação necessária na realização da presente dissertação, foi efetuada uma pesquisa bibliográfica nas bases de dados da Pubmed, Scielo, o livro Tratado de Peridontia Clinica e Implantologia Oral, o Jornal da Associação Dentária Americana, o livro Peridontia Clinica, o livro de Histologia Básica e o livro Anatomia, Embriologia e Histologia Oral. Para tal, foi realizada a investigação através das seguintes palavras-chaves: “Etiology”, Gingival Recession”, “Periodontitis”, “Dental plaque”, e “Prevalence”. Conclusão: No trabalho realizado, é possível concluir que a Etiologia da recessão é multifatorial e raramente leva à perda do elemento dentário, embora, cause muitos danos por provocar a sensibilidade dentária, devido a perda e retração da gengiva. Esta etiologia leva a uma maior incidência de cáries radiculares, sacrificando o aspecto estético do paciente, e consequentemente, leva a um desconforto psicológico. Subsequentemente a recessão gengival e as suas múltiplas causas, existem atualmente métodos e técnicas, que nos permitem a resolução de alguns dos danos provocados por esta, com o objetivo de criar uma maior probabilidade de eliminação dos fatores causais da mesma.

Older patients request more information : a survey of use of written patient education materials in general practice

Objectives: To determine GPs' reported use of written education materials with older patients and older patients' reported receipt of these materials. To determine GPs' and older patients' perceptions of written materials.---------- Method: Using self-report questionnaires, two populations were surveyed; a randomised sample of 50 GPs (29 males and 21 females) practising in Brisbane's southern suburbs and a convenience sample of 188 older community-dwelling people (aged over 64 years).----------- Results: All GPs reported using written materials with patients, although 28% had not given any to the Last 10 patients. This increased to 46% when patients were older. Twenty percent of patients wanted more written information from their GP, while some GPs believed that older patients preferred verbal information and gave out written information only when they perceived patient interest. All GPs reported giving written materials at the time of consultation and over two thirds discussed the content with patients. Just over 50% of patients reported receiving written information from GPs in the Last six months and only hall of these again discussed it directly with their GP. Overall, patients were more positive than GPs about the value of written education materials.---------- Conclusions: Older patients' desire for written information may be better met if they are more assertive in requesting this of GPs and GPs may better serve their patients' needs if they make written information more readily available to them. Better access to materials and more financial incentives to give them out might also increase GPs' use of written materials.