Oral findings and dental care in a patient with myelomeningocele: case report of a 3-year-old child

Myelomeningocele (MMC) is a congenital malformation of the neural tube that occurs in the first weeks of pregnancy. This malformation refers to the caudal non-closure of the neural tube and neural tissue exposure, which lead to neurological problems, such as hydrocephalus, motor disability, genitourinary tract and skeletal abnormalities and mental retardation. Patients with MMC have an acknowledged predisposition to latex allergy and are usually at a high caries risk and activity due to poor oral hygiene, fermentable carbon hydrate-rich diet and prolonged use of sugar-containing medications. This paper addresses the common oral findings in pediatric patients with MMC, discusses the strategies and precautions to deal with these individuals and reports the dental care to a young child diagnosed with this condition.Mielomeningocele (MMC) representa uma malformação congênita do tubo neural que acontece nas primeiras semanas de gestação. Esta malformação refere-se ao não fechamento da coluna vertebral expondo a medula espinhal, que levará a problemas neurológicos, como hidrocefalia, dificuldades motoras, anomalias esqueléticas e do trato genito-urinário, além de retardo mental. Pacientes com MMC apresentam uma reconhecida predisposição à alergia ao latex e geralmente apresentam um alto risco e atividade de cárie dental decorrente de uma higiene oral deficiente, de uma dieta rica em carboidratos e do uso prolongado de medicamentos contendo açúcares. Este trabalho discorre sobre os achados bucais em crianças com MMC, discute as estratégias e precauções no manejo destes pacientes e descreve o tratamento odontológico de uma criança diagnosticada com esta condição

Biofilm formation and corrosion in Haas expanders, with and without use of an antimicrobial agent: in situ study.

O objetivo do presente estudo foi avaliar, em aparelhos disjuntores de Haas, a contaminação in situ por estreptococos do grupo mutans, sob a forma de colônias/biofilmes, nas diferentes superfícies (acrílico, fios, bandas e parafusos), com e sem o uso de bochechos com gluconato de clorexidina a 0,12%, por meio de Cultura Microbiana e Microscopia Eletrônica de Varredura (MEV). Adicionalmente, a corrosão na área da união entre o fio, a solda de prata e a banda dos aparelhos foi avaliada por meio de Estereomicroscopia Ótica, MEV e análise em Espectrometria de Energia Dispersiva (EDS). Foram selecionados 34 pacientes de 7 a 12 anos de idade, que compareceram à clínica de Ortodontia Preventiva da FORP/USP, com necessidade de correção com aparelho disjuntor de Haas por problemas transversais da maxila (mordida cruzada posterior). Em seguida, utilizando uma tabela de números randômicos, os pacientes foram aleatoriamente divididos em dois grupos de 17 indivíduos cada (Grupos I e II). Durante todo o período de permanência dos aparelhos na cavidade bucal, no Grupo I (controle; n=17) os pacientes foram orientados a utilizar dentifrício fluoretado para escovação diária e não empregar bochechos com soluções antimicrobianas. Por outro lado, no Grupo II (experimental; n=17) os pacientes foram orientados a realizar, além da escovação diária com o uso de dentifrício fluoretado, 2 bochechos por semana com solução de gluconato de Clorexidina a 0,12% (Periogard®). Decorridos cerca de 4 meses da permanência na cavidade bucal, os aparelhos foram removidos. Sendo seccionadas, aleatoriamente, partes dos aparelhos constituídas de uma banda com fio soldado, para análise em estereomicroscopia ótica, MEV e EDS. Os resultados em estereomicroscopia foram submetidos à análise estatística por meio do teste de Fisher, com nível de significância de 5%. Em seguida, os aparelhos foram submetidos ao processamento microbiológico, em meio de cultura CaSa B, para contagem das colônias/biofilmes de estreptococos do grupo mutans. O teste estatístico não-paramétrico de Mann-Whitney foi aplicado para verificação de possíveis diferenças entre os grupos, com relação à formação de colônias/biofilmes sobre a superfície das diferentes áreas (parafuso, resina acrílica, bandas, fio vestibular e fio palatino), como também para verificar se havia diferença entre a formação de colônias/biofilmes sobre as superfícies livres (voltadas para a cavidade bucal) e as superfícies não-livres (em contato direto com a mucosa palatina e sulco gengival). O nível de significância adotado foi de 5%. Após cultura microbiana, partes dos aparelhos representativas de cada grupo foram submetidas ao processamento e análise em MEV. Os resultados obtidos evidenciaram que, com relação às colônias/biofilmes das superfícies nãolivres dos Grupos I e II, não houve diferença entre os grupos (p=0,009). No entanto, quando as superfícies livres dos Grupos I e II foram comparadas, evidenciou-se diferença significante entre os 2 grupos, em todas as áreas analisadas (parafuso, resina acrílica e bandas) (p<0,001). Os resultados da cultura microbiana foram confirmados em MEV. A análise em estereomicroscopia ótica evidenciou a presença de áreas de alteração de coloração sugestivas de corrosão na região de solda em contato com a banda e com o fio, em ambos os grupos (p=1). Os picos dos elementos químicos observados em EDS também foram semelhantes em ambos os grupos. Pôde-se concluir que o uso do gluconato de clorexidina a 0,12% (Periogard®), sob a forma de bochecho, apresentou eficácia na redução da formação de colônias/biofilmes nas superfícies livres dos aparelhos disjuntores de Haas, in situ, sem elevação nos níveis de corrosão.The purpose of this study was to evaluate, in situ, in Haas expanders, the contamination of different surfaces (acrylic resin, wires, bands and screws) by mutans group streptococci colonies/biofilms with and without prescription of 0.12% chlorhexidine gluconate mouthwashes, by means of microbial culture and scanning electron microscopy (SEM). Additionally, the corrosion in the area of union between the appliances wire, silver soldering and band was assessed by optical stereomicroscopy, SEM and energy dispersive spectroscopy (EDS). Thirty-four children aged 7 to 12 years were selected among the patients attending the Preventive Orthodontic Clinic at FORP/USP with need of corrective orthodontics with Haas expander due to transversal problems of the maxilla (posterior crossbite). Thereafter, using a table of random numbers, the patients were randomly assigned to two groups of 17 individuals each (Groups I and II). Throughout the time that the appliances remained in the oral cavity, the patients in Group I (control; n=17) were instructed to use a fluoridated dentifrice for daily toothbrushing and not to use antimicrobial mouthwash solutions. On the other hand, in Group II (experimental; n=17), in addition to daily toothbrushing with a fluoridated dentifrice, mouthwashes with an antimicrobial agent (0.12% chlorhexidine gluconate - Periogard®) were prescribed to the patients. After approximately 4 months of maintenance in the patients mouth, the appliances were retrieved. Thereafter, components of the appliances (consisting of a band with soldered wire) were sectioned at random for analysis under optical stereomicroscopy, SEM and EDS. The results of the optical stereomicroscopy were submitted to statistical analysis using Fisher\'s test at 5% significance level. The appliances were sent to microbiology processing, in CaSa B culture medium, for counting of the number of mutans streptococci colonies/biofilms. Mann-Whitney non-parametric statistical test was applied to verify possible differences between the groups with respect to the formation of colonies/biofilms on the surface of different areas (screw, acrylic resin, bands, buccal wire and palatal wire), as well as to determine whether there were differences between the formation of colonies/biofilms on free surfaces (facing the oral cavity) and non-free surfaces (in direct contact with the palatal mucosa and gingival sulcus). The level of significance was set at 5%. After microbial culture, components of the appliances that were representative of each group were submitted technical processing and SEM analysis. The obtained results showed that there was no statistically significant difference between Groups I and II (p=0.009) regarding the formation of colonies/biofilms on the non-free surfaces. However, when the free surfaces of Groups I and II were compared, statistically significant difference was observed between these groups in all analyzed areas (screw, acrylic resin and bands) (p<0.001). The results of the microbial culture were confirmed by the SEM analysis. The optical stereomicroscopic analysis showed the existence of color alteration suggestive of corrosion in the solder region in contact with the band and with the wire in both groups (p=1). The peaks of chemical elements observed in EDS were also similar in both groups. It may concluded that the use of 0.12% chlorhexidine gluconate mouthwashes (Periogard®) showed efficacy in reducing the formation of colonies/biofilms on the free surfaces of Haas expanders, in situ, without increasing the corrosion levels

Permeability and Resistance to Acid Challenges, after Systemic Use of Sodium Alendronate: a study in rat tooth enamel

Os bisfosfonatos representam uma classe de drogas que agem sobre o metabolismo ósseo e são amplamente utilizadas na prevenção e tratamento de estados osteopênicos e osteoporóticos. Tem sido demonstrado que alterações na estrutura dos tecidos dentais podem ocorrer como efeitos adversos à administração sistêmica do alendronato de sódio. No esmalte de dentes de ratos submetidos ou não ao uso sistêmico de alendronato de sódio, os objetivos do presente estudo foram: 1) avaliar a resistência do esmalte a desafios ácidos (indução artificial de lesões de cárie e indução artificial de lesões de erosão) por meio da mensuração da microdureza subsuperficial e da profundidade das lesões; 2) avaliar a permeabilidade do esmalte por meio de técnica histoquímica. Foi utilizada a porção coronária de 20 incisivos superiores de 10 animais submetidos à medicação com alendronato de sódio (grupo experimental) e 16 incisivos superiores de 8 animais que receberam apenas água destilada (grupo controle). Para os experimentos de indução artificial de lesão de cárie e de lesão de erosão, as porções coronárias de 18 incisivos superiores foram seccionadas ao meio, no sentido transversal, obtendo-se duas secções de aproximadamente 8 mm de comprimento de cada dente, num total de 36 secções que foram aleatoriamente divididas de acordo com o grupo experimental (n=10/grupo/experimento) e controle (n=8/grupo/experimento). Para a avaliação da permeabilidade, foram utilizados 18 incisivos superiores restantes, sendo 10 para o grupo experimental e 8 para o grupo controle. As variáveis de resposta quantitativa para o estudo foram a porcentagem da variação de perda de dureza subsuperficial (%VPD) na indução artificial de lesões de cárie e lesões de erosão, avaliadas em microdurômetro; e a profundidade das lesões de desmineralização de cárie/erosão e a permeabilidade do esmalte avaliadas em microscopia de luz. Os resultados foram submetidos à análise estatística por meio do teste ANOVA. O nível de significância adotado foi de 5%. De acordo com os resultados obtidos verificou-se que não houve diferença estatisticamente significante entre os grupos experimental e controle (p>0,05), tanto na porcentagem de VPD quanto na profundidade das lesões de cárie/erosão. Com relação à permeabilidade não foi observada diferença significante entre os grupos (p>0,05), mostrando penetração do agente traçador semelhante em ambos. Pôde-se concluir que, após o uso sistêmico do alendronato de sódio, o esmalte de dentes de ratos não apresentou maior resistência aos desafios ácidos (indução artificial de lesões de cárie e erosão) e não sofreu alteração em sua permeabilidade.Bisphosphonates represent a class of drugs that act on bone metabolism and are widely used in the prevention and treatment of osteopenic and osteoporotic states. It has been demonstrated that structural alterations on dental tissues might occur as adverse effects of systemic sodium alendronate administration. In the dental enamel of rats subjected or not to systemic use of sodium alendronate, the objectives of the present study were: 1) to evaluate enamel resistance to acid challenges (artificial induction of carious lesions and artificial induction of erosion lesions) by analysis of subsurface microhardness and lesion depth; 2) to evaluate enamel permeability by a histochemical coloring method. The crowns of 20 upper incisors of 10 animals, which received chemically pure sodium alendronate (experimental group), and 16 upper incisors of 8 animals, which received distilled water (control group) were used in the study. For the experiments of artificial induction of carious and erosion lesions, the coronal portions of 18 upper incisors were bisected transversally to produce two 8-mm-long sections per tooth, totalizing 36 sections, which were randomly assigned according to the experimental group (n=10/group/experiment) and the control group (n=8/group/experiment). For the permeability test, the remaining 18 upper incisors were used, being 10 of the experimental group and 8 of the control group. The quantitative response variables were the percent subsurface Knoop microhardness change (%SHC) assessed with a microhardness meter at different depths from enamel surface for the artificially induced carious/erosion lesions; and the carious/erosion lesions depth and enamel permeability, measured by light microscopy. The results were subjected to statistical analysis by ANOVA test with significance level set at 5%. There was no statistically significant difference between the experimental and control groups (p>0.05) for either %SHC or depth of the artificially induced carious/erosion lesions. Data from the permeability test revealed no statistically significant difference (p>0.05) between the groups, showing similar penetration of the tracer agent in both of them. Therefore, it may be concluded that after the systemic use of sodium alendronate, the enamel of rat teeth did not present higher resistance to acid challenges (artificially induced carious/erosion lesions) and did not suffer alteration of its permeability

Corrosion in Haas expanders with and without use of an antimicrobial agent: an in situ study

OBJECTIVES: The purpose of this study was to evaluate in situ the occurrence of corrosion in the soldering point areas between the wire, silver brazing and band in Haas expanders. MATERIAL AND METHODS: Thirty-four 7-12-year-old patients who needed maxillary expansion with a Haas expander were randomly assigned to two groups of 17 individuals each, according to the oral hygiene protocol adopted during the orthodontic treatment: Group I (control), toothbrushing with a fluoride dentifrice and Group II (experimental), toothbrushing with the same dentifrice plus 0.12% chlorhexidine gluconate (Periogard®) mouthrinses twice a week. The appliances were removed after approximately 4 months. Fragments of the appliances containing a metallic band with a soldered wire were sectioned at random for examination by stereomicroscopy, scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS). Data were analyzed statistically by Fisher's test at 5% significance level. RESULTS: The analysis by optical microscopy revealed areas with color change suggestive of corrosion in the soldering point areas joining the band and the wire in all specimens of both groups, with no statistically significant difference between the groups (p=1). The peaks of chemical elements (Ni, Fe, Cr, O, C and P) revealed by EDS were also similar in both groups. CONCLUSION: Color changes and peaks of chemical elements suggestive of corrosion were observed in the soldering point areas between the wire, silver brazing and band in both control and experimental groups, which indicate that the 0.12% chlorhexidine gluconate mouthrinses did not influence the occurrence of corrosion in situ

Corrosion in Haas expanders with and without use of an antimicrobial agent: an in situ study

OBJECTIVES: The purpose of this study was to evaluate in situ the occurrence of corrosion in the soldering point areas between the wire, silver brazing and band in Haas expanders. MATERIAL AND METHODS: Thirty-four 7-12-year-old patients who needed maxillary expansion with a Haas expander were randomly assigned to two groups of 17 individuals each, according to the oral hygiene protocol adopted during the orthodontic treatment: Group I (control), toothbrushing with a fluoride dentifrice and Group II (experimental), toothbrushing with the same dentifrice plus 0.12% chlorhexidine gluconate (Periogard®) mouthrinses twice a week. The appliances were removed after approximately 4 months. Fragments of the appliances containing a metallic band with a soldered wire were sectioned at random for examination by stereomicroscopy, scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS). Data were analyzed statistically by Fisher's test at 5% significance level. RESULTS: The analysis by optical microscopy revealed areas with color change suggestive of corrosion in the soldering point areas joining the band and the wire in all specimens of both groups, with no statistically significant difference between the groups (p=1). The peaks of chemical elements (Ni, Fe, Cr, O, C and P) revealed by EDS were also similar in both groups. CONCLUSION: Color changes and peaks of chemical elements suggestive of corrosion were observed in the soldering point areas between the wire, silver brazing and band in both control and experimental groups, which indicate that the 0.12% chlorhexidine gluconate mouthrinses did not influence the occurrence of corrosion in situ