Oral health education strategies for biofilm control in children with neurodevelopmental disorder – a case report/ Estratégias de educação em saúde bucal para o controle de biofilme em criança com transtorno de neurodesenvolvimento – um relato de caso

Objective: To report oral health education strategies for biofilm control in a child with a neurodevelopmental disorder. Case report: A 9-year-old boy with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) was presented at the dental clinic with extreme difficulties in the oral hygiene practice. The intraoral examination revealed a massive presence of dental biofilm, moderate gingivitis, and caries experience. An individualized educational strategy using visual pedagogy added an adapted toothbrush was implemented. The improvement in the simplified oral hygiene indexes and gingival bleeding index demonstrated the success of this intervention. Conclusion: The individualized educational strategies can be successful implemented in a child with ASD and ADHD

In vitro and in vivo assessment of a Bisphenol-A free resin restorative system, adapted for use in bonding of orthodontic brackets

O objetivo geral do presente trabalho foi comparar in vitro e in vivo a liberação de Bisfenol-A (BPA) de um sistema restaurador resinoso isento de BPA adaptado para uso na colagem de bráquetes ortodônticos (Adesivo Ambar APS e Resina Vittra APS), ao padrão-ouro Transbond XT. Os objetivos específicos incluíram a análise da Resistência ao Cisalhamento e Índice de Remanescente Adesivo (IRA) e parâmetros clínicos de quantificação de biofilme dentário, avaliação da saúde gengival e taxa de sobrevida (descolagem) dos bráquetes. Na etapa in vitro, discos fotopolimerizados de Transbond XT e Resina Vittra APS foram avaliados quanto à liberação de BPA por meio de cromatografia gasosa nos tempos de 30 minutos, 24 horas, 7 e 30 dias. Na análise de resistência ao cisalhamento e IRA, bráquetes foram fixados em pré-molares provenientes de biobanco com três protocolos de colagem (Transbond XT; e Adesivo Ambar APS associado à Resina Vittra APS pelas técnicas convencional e modificada) e analisados por máquina de ensaios universais e estereomicroscópio. A análise in vivo do BPA foi realizada em amostras salivares de 19 pacientes que tiveram bráquetes colados com Transbond XT ou com Adesivo Ambar APS e Resina Vittra APS (técnica modificada). A coleta foi realizada previamente à instalação do aparelho fixo, e após 30 minutos, 24 horas, 7 e 30 dias da colagem de bráquetes, sendo as amostras de saliva analisadas por cromatografia gasosa. Foi efetuada a quantificação de biofilme dentário e a avaliação da condição gengival, juntamente com a autopercepção de higiene bucal, com o uso do evidenciador de biofilme GC Tri Plaque ID GelTM. A taxa de sobrevida (descolagem) dos bráquetes foi avaliada por 12 meses. Os dados foram analisados por meio de testes estatísticos apropriados, com nível de significância de 5%. Verificou-se que apenas os discos de Transbond XT apresentaram traços de BPA no tempo de 30 dias, de acordo com o limite inferior da técnica. Nas análises in vitro de resistência ao cisalhamento e IRA, a técnica convencional (Adesivo Ambar APS e Resina Vittra APS) apresentou resultados inferiores, já técnica modificada e o Transbond XT não foram diferentes entre si. As maiores concentrações de BPA salivar encontraram-se no grupo controle (Transbond XT), em 30 minutos, 24 horas e 7 dias, retornando ao baseline em 30 dias. Por outro lado, não observou-se liberação adicional de BPA nos bráquetes colados pela técnica modificada. O biofilme dentário e o índice gengival foram menores no grupo experimental (Resina Vittra APS e adesivo Ambar APS) aos 7 dias da colagem de bráquetes. A autopercepção da higiene bucal dos pacientes apresentou diferença estatística pré e pós-utilização do GC Tri Plaque ID GelTM. A ausência de BPA não influenciou na taxa de sobrevida dos bráquetes. Conclui-se que o uso da Resina Vittra APS e do Adesivo Ambar APS pela técnica modificada não ocasionou a liberação de BPA, apresentou resistência ao cisalhamento e IRA adequados e menores índices clínicos de placa visível e saúde gengival. Ainda, demonstrou taxa de sobrevida semelhante ao controle após 12 meses, justificando sua indicação para uso clínico na colagem de bráquetes ortodônticos.The overall aim of this study was to compare in vitro and in vivo the release of Bisphenol-A (BPA) from a BPA-free restorative resin system adapted for use in bonding orthodontic brackets (Ambar APS Adhesive and Vittra APS Resin) to the gold standard Transbond XT. The specific aims included the analysis of the shear bond strength, Adhesive Remainder Index (ARI), and clinical parameters of dental biofilm quantification, assessment of gingival health and bracket survival rate (debonding). In the in vitro section, light-cured discs of Transbond XT and Vittra APS Resin were evaluated for the release of BPA by gas chromatography in 30 minutes, 24 hours, 7 and 30 days. In the analysis of shear bond strength and ARI, brackets were fixed in premolars from a biobank with three bonding protocols (Transbond XT; and Ambar APS Adhesive and Vittra APS Resin by conventional and modified techniques), and analyzed by universal testing machine and stereomicroscope. The in vivo analysis of BPA included salivary samples from 19 patients who had brackets bonded with Transbond XT or with Ambar APS Adhesive and Vittra APS Resin (modified technique). The sample was collected prior to the installation of the fixed appliance, and after 30 minutes, 24 hours, 7 and 30 days after bonding the brackets, and analyzed by gas chromatography. The quantification of dental biofilm and the evaluation of the gingival condition were carried out, together with the self-perception of oral hygiene, using the GC Tri Plaque ID GelTM biofilm disclosing agent. The bracket survival rate (debonding) was evaluated for 12 months. Data were analyzed using appropriate statistical tests, with a significance level of 5%. Only the Transbond XT discs showed traces of BPA within 30 days, according to the lower limit of the technique. In the in vitro analysis of shear bond strength and ARI, the conventional technique (Ambar APS Adhesive and Vittra APS Resin) showed inferior results, whereas the modified technique and the Transbond XT were not different from each other. The highest concentrations of salivary BPA were found in the control group (Transbond XT), at 30 minutes, 24 hours and 7 days, returning to baseline in 30 days. Moreover, there was no additional release of BPA in brackets bonded by the modified technique. Dental biofilm and gingival index were lower in the experimental group (Vittra APS Resin and Ambar APS adhesive) at 7 days after bracket bonding. The patients\' self-perception of oral hygiene showed a statistical difference before and after the use of the GC Tri Plaque ID GelTM. The absence of BPA did not influence the bracket survival rate. It is concluded that the use of Vittra APS Resin and Ambar APS Adhesive by the modified technique did not cause the release of BPA, showed adequate shear bond strength and ARI, and showed lower clinical indexes of visible plaque and gingival health. Furthermore, it showed a bracket survival rate similar to the control after 12 months, justifying its indication for clinical use in bonding of orthodontic brackets

Ellis-Van Creveld Syndrome, neonatal teeth and breastfeeding impairment: a case report

ABSTRACT Because of multisystemic impairment in patients with Ellis-van Creveld syndrome, multidisciplinary care may be demanded since birth to assure breastfeeding. This report presents a case of an Ellis-van Creveld infant that was facing breastfeeding difficulties because of maxillary neonatal teeth. A 3 months old male infant with Ellis-van Creveld syndrome was referred to Pediatric Dentistry Department because of two upper neonatal teeth causing breastfeeding difficulties. Clinical examination revealed that teeth position was compatible to 51 and 61, and both presented uncommon ectopic soft tissue placement, conical crown and hypoplastic enamel covered by a large amount of dental biofilm. Radiography indicated they were of normal series and had 2/3 of crown completion. Due to teeth mobility that impaired breastfeeding, treatment option was exodontia. Early tooth eruption, such as in natal and neonatal teeth, by itself can’t be considered a reason for exodontia. But exodontia must be considered when an early erupted tooth(s) impairs breastfeeding, especially in systemically compromised infants. In this present case report, after teeth extraction, the infant was able to breastfeed and gain weight properly