Distúrbios alimentares em adolescentes em Belo Horizonte e sua associação com erosão e cárie dentária

Exportado OPUSMade available in DSpace on 2019-08-13T12:53:09Z (GMT). No. of bitstreams: 1 disserta__o_mestrado_ana_paula_brazileiro_vilar_hermont.pdf: 4197153 bytes, checksum: e42dcb80303abb02f721788aa430428d (MD5) Previous issue date: 29O cirurgião-dentista pode ser o primeiro profissional a suspeitar da ocorrência de distúrbios alimentares como a bulimia, devido aos sinais e sintomas da erosão e cárie dentária resultantes de um ambiente bucal cronicamente ácido e de uma dieta rica em carboidratos, respectivamente. Diante disso, realizou-se um estudo transversal controlado objetivando avaliar a ocorrência de erosão e cárie dentária em adolescentes em risco de estarem sofrendo de distúrbios alimentares e compará-la àquela de adolescentes saudáveis. Compuseram inicialmente a amostra, 1.287 escolares do gênero feminino, na faixa etária de 15 a 18 anos, oriundas de escolas da rede pública e particular de Belo Horizonte. A presença de risco para desenvolvimento de distúrbios alimentares foi avaliada através da versão brasileira do Bulimic Investigatory Test of Edinburgh (BITE). Hábitos alimentares e de higiene bucal também foram investigados através de um questionário auto-aplicável. A análise dos dados do BITE identificou 20 adolescentes com grave comportamento de risco para distúrbios alimentares, que foram pareadas por idade, escola e sala de aula, com 80 adolescentes nas quais não foi identificada a presença deste comportamento. As 100 adolescentes foram examinadas nas escolas para erosão e cárie dentária, através dos índices de OSullivan e ICDAS II, respectivamente. A examinadora, previamente calibrada (Kappa: 0,88 e 0,83, referentes à erosão e à cárie, respectivamente), não tinha conhecimento em relação à condição de cada adolescente. Os dados foram analisados de forma descritiva e inferencial através do software SPSS 17.0. A associação entre a ocorrência de erosão dentária e cárie dentária, e hábitos alimentares e de higiene oral, foi verificada através um processo de análise bivariada, utilizando os testes exatos do Quiquadrado de Pearson, Teste Exato de Fisher e Associação linear. Um modelo de regressão logística condicional foi utilizado para verificar a associação entre a presença de comportamento de risco para distúrbios alimentares e as demais variáveis (p< 0,05). A prevalência de comportamento de risco para distúrbios alimentares apontada pelo BITE na amostra de estudo foi de 6%, enquanto 1,7% foram identificados como um grupo com grave comportamento de risco. Este grupo apresentou maior experiência de erosão e cárie dentária quando comparado ao grupo controle (p< 0,001 e p= 0,024, respectivamente), bem como apresentou chances significativamente maiores de possuírem erosão dentária se comparadas ao grupo controle (OR, 10.04; 95% CI 2.539.4). No que se refere às adolescentes com erosão dentária, foi encontrada associação positiva entre essa condição dentária com o consumo de frutas cítricas e a presença do hábito de escovação dos dentes logo após as refeições (p=0,023 e p=0,049, respectivamente). Conclui-se que a ocorrência de erosão dentária foi associada ao comportamento de risco para distúrbios alimentares, mesmo em casos subclínicos, nos quais ainda não havia sido feito o diagnóstico.The dentist may be the first professional to suspect the occurrence of eating disorders, like bulimia, due to the signs and symptoms of tooth erosion and dental caries resulting from a chronically acidic oral environment and a diet rich in carbohydrates, respectively. Therefore, a controlled cross-sectional study was carried out in order to evaluate the occurrence of erosion and dental caries in adolescents at risk for being suffering from eating disorders and compare it to healthy adolescents. The target sample was composed by 1,287 female students, aged 15-18 years, from public and private schools in Belo Horizonte. The presence of risk for eating disorders was assessed using the Brazilian version of the Bulimic Investigatory Test of Edinburgh (BITE). Eating habits and oral hygiene were also investigated through a self-administered questionnaire. Data analysis of the BITE identified 20 adolescents with major risk behavior for eating disorders (case group), who were matched for age, school and classroom, with 80 adolescents without such risk (control group). All the 100 adolescents underwent dental examination for tooth erosion and dental caries diagnosis through the O'Sullivan index and the ICDAS-II index, respectively. The examiner, previously calibrated (Kappa: 0.88 and 0.83, relating to erosion and dental caries, respectively), was blinded regarding the case and control status of the participants. Data were analyzed using descriptive and inferential statistics by means of the statistical package SPSS 17.0. The association between the occurrence of tooth erosion, dental caries and dietary habits and oral hygiene was verified through a bivariate analysis process, using the Pearsons chi-square test, Fisher's exact test and linear association tests (p<0.05). A conditional logistic regression model was used to verify the association between the presence of risk behavior for eating disorders and the independent variables (p <0.05). The prevalence of risk behavior for eating disorders indicated by BITE in the study sample was 6%, while 1.7% were identified as a group with severe risk behavior. This group had a higher experience of tooth erosion and dental caries when compared to the control group (p <0.001 and p = 0.024, respectively) and had significantly higher chance of having tooth erosion when compared to thecontrol group (OR, 10.04, 95% CI 2.5 -39.4). Concerning those adolescents with tooth erosion, positive association was found between this dental condition and the consumption of citric fruits and the presence of the habit of brushing their teeth shortly after feeding (p=0.023 and p=0.049, respectively). It was concluded that the occurrence of tooth erosion was associated with risk behaviour for eating disorders, even relating to subclinical cases, which had not been diagnosed

Analgesia in newborns: a case-control study of the efficacy of nutritive and non-nutritive sucking stimuli

PURPOSE: To verify the nutritive and non-nutritive stimuli efficacy in the newborn's response to pain during venipuncture. METHODS: The main sample was composed of 64 newborns that were randomly divided into three groups. The first group (n=20) received nutritive sucking stimulus that was performed through maternal breastfeeding. The second group (n=21) received non-nutritive sucking stimulus that was performed through the introduction of the researcher little finger in the newborn's oral cavity. The third group or control group (n=23) did not receive any analgesia stimulus. The newborns were evaluated using the Neonatal Infant Pain Scale, and the responses to painful stimuli were compared. RESULTS: The nutritive as well as non-nutritive suction methods provided a comforting effect, resulting in lower pain response scores (p0.05). CONCLUSION: The nutritive and the non-nutritive sucking stimuli proved to be efficacious tools in relieving pain among newborns

Severe obstructive sleep apnea treatment with mandibular advancement device: A case report

Mandibular advancement device (MAD) has been described as an alternative treatment to the severe obstructive sleep apnea (OSA), once it is not as effective as the continuous positive airway pressure therapy (CPAP) in reducing the apnea and hypopnea index (AHI). The objective of this study is to report a case using a MAD in a CPAP-intolerant patient suffering from severe OSA. Polysomnography exams were performed before and after treatment. Five months after fitting and titrating the MAD, the AHI was reduced from 80.5 events/hour to 14.6 events/hour and the minimum oxyhemoglobin saturation (SpO2) increased from 46% to 83%. A two-year assessment of therapy revealed an AHI of 8 events/hour and SpO2 of 85%

Tooth Erosion and Eating Disorders: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Eating disorders are associated with the highest rates of morbidity and mortality of any mental disorders among adolescents. The failure to recognize their early signs can compromise a patient's recovery and long-term prognosis. Tooth erosion has been reported as an oral manifestation that might help in the early detection of eating disorders.</p><p>Objectives</p><p>The aim of this systematic review and meta-analysis was to search for scientific evidence regarding the following clinical question: Do eating disorders increase the risk of tooth erosion?</p><p>Methods</p><p>An electronic search addressing eating disorders and tooth erosion was conducted in eight databases. Two independent reviewers selected studies, abstracted information and assessed its quality. Data were abstracted for meta-analysis comparing tooth erosion in control patients (without eating disorders) vs. patients with eating disorders; and patients with eating disorder risk behavior vs. patients without such risk behavior. Combined odds ratios (ORs) and a 95% confidence interval (CI) were obtained.</p><p>Results</p><p>Twenty-three papers were included in the qualitative synthesis and assessed by a modified version of the Newcastle-Ottawa Scale. Fourteen papers were included in the meta-analysis. Patients with eating disorders had more risk of tooth erosion (OR = 12.4, 95%CI = 4.1–37.5). Patients with eating disorders who self-induced vomiting had more risk of tooth erosion than those patients who did not self-induce vomiting (OR = 19.6, 95%CI = 5.6–68.8). Patients with risk behavior of eating disorder had more risk of tooth erosion than patients without such risk behavior (Summary OR = 11.6, 95%CI = 3.2–41.7).</p><p>Conclusion</p><p>The scientific evidence suggests a causal relationship between tooth erosion and eating disorders and purging practices. Nevertheless, there is a lack of scientific evidence to fulfill the basic criteria of causation between the risk behavior for eating disorders and tooth erosion.</p></div

Quality assessment criteria used for cross-sectional studies through a modified version of Newcastle-Ottawa Scale for observational studies.

<p>Quality assessment criteria used for cross-sectional studies through a modified version of Newcastle-Ottawa Scale for observational studies.</p

Meta-analysis of nine case-control studies showing twelve different outcomes associating tooth erosion with types of eating disorders (EDs) with or without self-induced vomiting (SIV) vs. controls.

<p>Eating disorders were analyzed in subgroups according to each type of ED. Heterogeneity: I² = 0.0% (Anorexia subgroup), I² = 44.0% (Bulimia subgroup), I² = 0.0% (Bulimia with SIV subgroup), I² = 0.0% (Bulimia without SIV subgroup), I² = 0.0% (EDs subgroup), random effect model used.</p

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Screening of articles.

<p>Four-phase PRISMA flow-diagram for study collection <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111123#pone.0111123-Moher1" target="_blank">[38]</a>, showing the number of studies identified, screened, eligible, and included in the review and meta-analysis.</p

Meta-analysis of two cross-sectional studies associating tooth erosion with eating disorder risk behavior (EDs) vs. control groups (patients without eating disorder risk behavior), with statistical significance; I² = 11.3%, random effect model used.

<p>Meta-analysis of two cross-sectional studies associating tooth erosion with eating disorder risk behavior (EDs) vs. control groups (patients without eating disorder risk behavior), with statistical significance; I² = 11.3%, random effect model used.</p