Atraumatic restorative treatment-sealed versus nonsealed first permanent molars: a 3-year split-mouth clinical trial

To investigate the efficacy of atraumatic restorative treatment (ART) sealants vs. no sealant in preventing the development of dentine caries lesions in first permanent molars over a period of 3 years. A total of 187 schoolchildren (aged 6–8 years) from a low-income population presenting the 4 first permanent molars without clinically detectable dentine caries lesions were selected to be part of a split-mouth clinical trial. All 4 first permanent molars were investigated in this trial and the children’s mouth was split vertically into left and right sides; therefore, 2 molars were randomly allocated to receive ART sealants, while the other 2 molars remained nonsealed. All children received toothbrushing instructions and dietary advice every 6 months for a period of 3 years. Clinical evaluations were performed after 3, 6, 12, 18, 24, and 36 months and both sealant retention and dental caries were scored. Kaplan-Meier survival analysis, log-rank test, and Cox regression with shared frailty analysis were performed. A cavitated dentine caries lesion was considered a failure. The cumulative survival rates of dentine cavity-free first permanent molars were 90% for ART-sealed molars and 90.8% for nonsealed molars, with no statistically significantly difference between sealed and nonsealed molars (p = 0.70). The retention of sealants was not associated with the development of cavitated dentine caries and children presenting a higher baseline caries experience had greater chances of developing dentine lesions. In conclusion, the application of ART sealants was not more efficacious than nonsealing in reducing the development of dentine cavitated lesions in first permanent molars

Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan–Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 ± 3.4%; ART with Carisolv™, 46.0 ± 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth

Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students

Abstract Background The aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants—38 dental students and 38 pediatric dentistry students—in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course. Results A single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975–0.996). All students improved their performances after the e-learning course (Paired t-tests p < 0.001). The means of undergraduate students were 4.7 (initial) and 6.4 (final) and those of graduate students were 6.8 (initial) and 8.2 (final). The comparison of the final evaluation means showed a statistically significant difference (t-tests p < 0.0001). Conclusions The e-learning strategy has the potential of improving students’ knowledge in ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning

Saúde bucal em Diadema: da odontologia escolar à estratégia saúde da família Oral health in Diadema, Brazil: from schoolchildren dentistry to family health strategy

Embora a política de saúde bucal no Município de Diadema, SP, no período de 1972 a 2007, objeto deste artigo, tenha acompanhado o processo de transformação das práticas do setor no Brasil, sua evolução nesta cidade industrial na Região Metropolitana da Grande São Paulo foi marcada pela singularidade do processo histórico local. Neste artigo analisa-se essa evolução, relacionando-a com o processo de lutas sociais que levou à criação do Sistema Único de Saúde (SUS) e com as políticas nacionais, estaduais e municipais de saúde bucal. Trata-se de um estudo qualitativo do tipo exploratório. Os dados foram obtidos em documentos oficiais e fontes bibliográficas variadas e por meio de entrevistas semiestruturadas com prefeitos, secretários municipais de saúde, coordenadores de saúde bucal e cirurgiões dentistas que vivenciaram as diversas fases das políticas de saúde bucal no município. Identificam-se as características mais marcantes na organização das práticas assistenciais em saúde desenvolvidas na cidade, localizando-as no cenário estadual e nacional. Conclui-se que, não obstante a consolidação da inserção da saúde bucal no SUS e a experiência adquirida no Município com a gestão dessa modalidade assistencial, também em Diadema observam-se dificuldades para superar o modelo de atenção focado nos grupos populacionais tradicionalmente priorizados, com destaque para escolares, pré-escolares e bebês. Nesse sentido, Diadema compartilha com os demais municípios brasileiros o desafio de reestruturar a atenção básica em saúde bucal, superar o tradicional modelo da odontologia escolar e criar novas possibilidades, como a abordagem familiar, com a finalidade de assegurar a universalidade e a integralidade da atenção.<br>Although oral health policy in the city of Diadema, São Paulo, Brazil, from 1972 to 2007, the subject of this article, has accompanied the process of transformation of the sector's practices in Brazil, its evolution in this industrial city located in the metropolitan region of São Paulo has been marked by the singularity of the local history. This paper analyzes this evolution and relates it to the process of social struggles that led to the creation of the Sistema Único de Saúde (Brazil's National Health System) and to the national, state and local oral health policies. This is a qualitative exploratory study. Data were obtained from official documents and various literature sources and also through semi-structured interviews with mayors, municipal health secretaries, oral health coordinators and dentists who have undergone the various stages of the oral health policies in the municipality. The major features in the organization of health care practices developed in the city were identified, locating them in the state and national scenario. We conclude that, despite the consolidation of the integration of oral health in the SUS and the experience acquired in the city in managing this type of care, in Diadema we also observed difficulties to overcome the model of care focused on population groups which have been traditionally prioritized, with emphasis on school children, preschoolers and babies. In this sense, Diadema shares with other Brazilian cities the challenge of restructuring primary care in oral health, overcoming the traditional model of school dentistry and creating new possibilities, such as the family approach, in order to ensure the universality and comprehensiveness of care

Contribuição ao estudo da cárie dentária em crianças de 0-30 meses Contribution to the study of dental caries in 0-30-month-old infants

Este estudo avaliou as condições de saúde bucal de 340 crianças de 0-30 meses de idade (21,3 ± 5,6), sendo 54,4% meninos, 45,6% meninas, de 20 creches de Salvador, considerando lesões incipientes e relacionando-as a alguns fatores determinantes da cárie. Os exames foram realizados por um único examinador utilizando-se espelho, sonda e lanterna. Os dentes foram limpos, secos com gaze e as lesões classificadas de acordo com o grau de severidade em cinco níveis (C0-C4; ativa/inativa). Um questionário avaliou o conhecimento sobre a cárie, fatores de risco, instrução, renda familiar e uso de flúor. Foram incluídos 229 questionários (67,35%). A análise dos dados foi realizada no Epi-info 6.02. Observou-se uma prevalência de cárie de 55,3% quando todos os estágios da lesão foram considerados: 25% entre 0-12 meses; 51,18% entre 13-24 meses; 71,03% entre 25-30 meses (chi² = 25,31; p < 0,01). Avaliando-se apenas manchas brancas ativas, 49,7% das crianças mostraram-se afetadas e 17,6%, apenas com lesões cavitadas. Das crianças afetadas, 90,96% apresentavam apenas dentes anteriores afetados: 80% das lesões eram incipientes e 20%, cavitadas. Não foi observada diferença significante entre sexos. O aumento da quantidade de biofilme dental mostrou associação positiva com a cárie nesta faixa etária (chi² = 67,61; p < 0,01) e a porcentagem de crianças afetadas mostrou-se maior na presença de aleitamento noturno (chi² = 0,24; p = 0,62). Foi observado um aumento da prevalência de cárie com a idade (chi² = 25,31; p < 0,01) e com o número de dentes irrompidos (chi² = 122,95; p < 0,01). Sugere-se atenção precoce à saúde bucal para o diagnóstico de lesões incipientes e adoção de medidas educativas e preventivas, incentivando mudanças na higiene bucal e dieta.<br>This study evaluated the oral health conditions of 340 children, aged 0-30 months (21.3 ± 5.6) - 54.4% of girls and 45.6% of boys - from 20 public day nurseries of Salvador (Brazil), as to the presence of incipient carious lesions. The exam was carried out by a single examiner, who utilized a mirror, a probe and a penlight. The teeth were wiped with gauzes in order to remove the dental plaque. A questionnaire was answered by the children’s parents or caretakers in order to assess information regarding knowledge on caries, caries risk factors, socioeconomic status of the family and utilization of fluoride. Two hundred and twenty-nine answered questionnaires (67.35%) were obtained. The observed lesions were classified in five stages, according to their severity (C0-C4; active/inactive). The data were analyzed using the Epi-info 6.02. The prevalence of caries was 55.3% when all stages were registered: 25% for subjects aged 0-12 months, 51.18% for subjects aged 13-24 months and 71.03% for those aged 25-30 months (chi² = 25.31, p < 0.01). When only active white spots were considered, 49.7% of the children were affected; 17.6% of the children presented with cavitated lesions. Among the affected children, 90.96% had lesions only on anterior teeth: 80% of the lesions were white spots and 20%, cavities. No significant difference was observed between genders. The increased amount of biofilm was positively associated with dental decay in toddlers (chi² = 67.61, p < 0.01), and the number of affected children increased when the sleep-time nursing habit was present (chi² = 0.24, p = 0.62). The prevalence of lesions increased with age and with the number of erupted teeth (chi² = 25.31, p < 0.01; chi² = 122.95, p < 0.01). Early oral health attention, diagnosis of incipient lesions, as well as educative and preventive programs to change oral hygiene and dietary habits are suggested

Dental caries in the primary dentition in public nursery school children in Juiz de Fora, Minas Gerais, Brazil Cárie dentária na dentição decídua de crianças assistidas em algumas creches públicas em Juiz de Fora, Minas Gerais, Brasil

The aim of this study was to assess the prevalence of dental caries in the primary dentition and associated variables in low socioeconomic preschool children enrolled in public nursery schools in Juiz de Fora, Minas Gerais, Brazil. Four public institutions were selected by geographic criteria (two in the central region and two in the peripheral region). The study population comprised 338 children (181 boys; 157 girls) aged 2-6 years old. Dental caries was recorded using the decayed, missing, and filled teeth (dmf-t) index. Among the examined children, 50.6% were caries-free. The mean dmf-t index was 2.03. It was higher in the peripheral nursery schools (p < 0.01). A trend towards a difference between sexes (p = 0.06) was observed. Logistic regression analysis selected a previous child's visit to dentist (p < 0.001), geographic location of the public nursery school (p < 0.01), and age (p < 0.01) as predictive variables for the dmf-t index. The study showed the need for an oral health program for this population, including both curative and preventive measures in order to achieve the WHO/FDI goals for the year 2000, namely 50% of children free of caries at age 5-6 years.<br>O objetivo deste estudo foi avaliar a prevalência de cárie dentária em dentição decídua e variáveis a ela associadas em pré-escolares, de baixo nível sócio-econômico, assistidos em creches públicas da cidade de Juiz de Fora, Minas Gerais, Brasil. Quatro instituições públicas foram selecionadas por critérios geográficos (duas na região central e duas na região periférica). A população do estudo compreendeu 338 crianças (181 meninos; 157 meninas) com idade de dois a seis anos. A cárie dentária foi registrada usando o índice ceo-d. Dentre as crianças examinadas, 50,6% estavam livres de cárie. A média do índice ceo-d foi 2,03, que foi maior na creches periféricas (p < 0,01), e uma tendência de diferença entre sexos foi observada (p = 0,06). A análise de regressão logística selecionou as variáveis visita prévia da criança ao dentista (p < 0,001), localização geográfica da creche pública (p < 0,01) e idade (p < 0,01) como preditoras do índice ceo-d. O estudo mostrou a necessidade de um programa de saúde bucal para essa população, incluindo medidas tanto curativas, quanto preventivas, com o objetivo de alcançar as metas da OMS/FDI para o ano 2000 (50% de crianças livres de cárie na faixa etária de cinco a seis anos)

Study of the factors associated with dental caries in children who receive early dental care Estudo de fatores associados à cárie dental em crianças que recebem atendimento odontológico precoce

The present study investigated the factors associated with the development of dental caries in preschool children who receive regular dental care and follow-up. The research was carried out at the Baby Clinic, Londrina State University, and comprised two hundred preschool children, whose ages ranged from 24 to 48 months, as well as their mothers, who had already taken part in a dental program at the Baby Clinic during, at least, the previous twelve months. Regarding oral hygiene habits, there was no significant difference between the preschool children who presented with caries and those who did not present with caries. However, the presence of visible bacterial plaque on the upper incisors was strongly associated with the presence of dental caries. Other factors associated with the presence of caries were: period of formal education of the father or of both parents equal or inferior to 8 years, high sugar consumption and bottle-feeding during sleep. In the studied population, the dietary pattern is still the main cause of carious lesions. In addition, the presence of visible bacterial plaque on the labial surface of the upper incisors must be considered as an important clinical sign, often associated with inadequate patterns of diet and oral hygiene.<br>Esta pesquisa estudou os fatores associados com o desenvolvimento de cárie dentária em pré-escolares que recebem acompanhamento e intervenção odontológica. O estudo abrangeu 200 crianças, de 24 a 48 meses de idade, que participavam do programa da Bebê-Clínica (Universidade Estadual de Londrina) havia pelo menos 12 meses. A comparação entre as crianças com cárie e sem cárie não apresentou diferenças estatisticamente significantes com relação aos hábitos de higiene bucal. No entanto, a presença de placa visível nos incisivos superiores esteve fortemente associada com a presença de cárie dentária. Outros fatores relacionados à presença de cárie foram a educação formal paterna ou de ambos os pais igual ou menor do que 8 anos, alto consumo de açúcar e uso de mamadeira durante o sono. Na população estudada, o padrão dietético continua sendo o principal responsável pelo desenvolvimento de lesões de cárie. Além disso, a presença de placa bacteriana visível na superfície vestibular dos incisivos superiores deve ser considerada um importante sinal clínico, freqüentemente associado a padrões inadequados de higiene bucal e dieta