PCC31 - Cárie precoce da infância: uma alternativa de reabilitação oral com prótese tubo-barra modificada em bebê especial - relato de caso

A cárie precoce da infância é de rápida evolução e resulta em comprometimento estético e funcional em um curto intervalo de tempo, podendo interferir negativamente no comportamento, crescimento e desenvolvimento das crianças. Paciente do sexo feminino, de 3 anos de idade, com diagnóstico de TEA, procurou o atendimento na Clínica do Mestrado em Odontopediatria da São Leopoldo Mandic (Campinas - SP) com a queixa principal de dificuldades na alimentação, fonação e estética dos dentes anteriores

Survival rate of the Hall technique compared with resin composite restoration in multi-surface cavities in primary teeth: a 1-year randomized clinical trial

Background: Hall technique (HT) has been indicated for teeth with dentinal caries lesion; however, extensive cavities, with more than two surfaces still seem challenging for restorative treatment in pediatric dentistry, resulting in a higher failure rate and an increased need for retreatment. Objectives: To compare the survival rate of the Hall technique preformed metal crown (HT) with resin composite restoration (RC) for multi-surface cavitated caries lesions in primary molars. Methodology: In this multicenter two-arm randomized clinical trial, children between 4 and 9 years of age with at least one primary molar with cavitated caries lesion involving more than two surfaces, including one buccal or palatal/lingual surface, were selected from 17 Brazilian cities. A total of 364 teeth were allocated into two groups: (1) teeth treated with selective caries removal and RC and (2) treated with the HT. The survival rate was assessed at 6 and 12 months after the interventions. Survival analysis was performed with the Kaplan‒Meier method. Cox regression was used to determine the influence of explanatory variables on the survival rate (α=5%). Results: After 12 months, 292 teeth were re-evaluated. A total of 358 teeth were re-evaluated at least once during the study and included in the survival analysis. The HT (87.8%) resulted in a higher survival rate than RC restoration (75.7%) (p=0.004). Conclusion: HT has a higher survival rate than RC as a treatment for multi-surface cavitated caries lesions in primary teeth. ClinicalTrials.gov: NCT0278239

Management of deep caries lesions with or without pulp involvement in primary teeth: a systematic review and network meta-analysis

There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21–2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insuficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.info:eu-repo/semantics/publishedVersio

Children’s self-reported discomfort of restorative treatments for deep caries lesions in primary teeth: results from a randomized clinical trial

The aim of this study was to evaluate the impact of different restorative techniques to treat deep caries lesions of primary molars on children’s self-reported discomfort. A randomized clinical trial with two parallel arms (1:1) was conducted in São Paulo, Brazil. 4-8 years-old children with at least one occlusal or occlusoproximal deep caries lesion in primary molars were selected. Molars were randomly allocated into two groups: (1) restoration performed with calcium hydroxide cement followed by high-viscosity Glass Ionomer Cement (CHC+HVGIC), and (2) HVGIC restoration. Immediately after the intervention, children reported the experienced discomfort during restoration to an external examiner using a Wong-Baker face-scale. Children’s self-reported discomfort was analyzed using Poisson regression comparing both groups and assessing other variables’ influence (α=5%). One hundred and eight children fulfilled the eligibility criteria and were randomized in the two groups (n=54). Most of the children who received CHC+HVGIC restorations reported none or minimal discomfort (83.3%). Similar scores (92.6%) were reported for those treated with HVGIC (p=0.758). The mean reported discomfort in children with CHC+HVGIC restorations was 0.37(1.01), and 0.41(1.01) for those with HVGIC restorations. Children’s self-reported discomfort was associated with age, sex, children’s cooperation, and intervention duration. We can conclude that CHC+HVGIC or HVGIC restorations result in none or minimal discomfort in the management of deep caries lesions, being considered a reliable option

Associated factors and treatment options for sleep bruxism in children: an umbrella review

Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options

Comportamentos de proteção contra a infecção por SARS-CoV-2: um estudo de coorte

INTRODUÇÃO: Nós elaboramos um estudo prospectivo com o objetivo de avaliar fatores (adesão ao distanciamento social, uso de EPI’s, etc.) que poderiam ser determinantes no desenvolvimento da COVID-19 que poderá subsidiar o desenvolvimento de estratégias de saúde eficazes no combate da infecção no município de Passos - Minas Gerais, Brasil, seja em ambientes hospitalar ou não-hospitalar. MÉTODOS: Trata-se de um estudo coorte longitudinal onde foram incluídos 343 indivíduos da população que foram selecionados aleatoriamente por conglomerado. Os indivíduos selecionados responderam a um questionário relacionado às características clínicas, medidas preventivas, comorbidades e uso de medicamentos. Na ocasião foi realizado teste rápido nos indivíduos para detecção de anticorpos IgG e IgM. O tempo médio de acompanhamento foi de seis meses e, durante o acompanhamento, manteve-se contato telefônico a cada duas semanas. Ao final do seguimento, novo teste sorológico foi realizado e calculado o risco associado à presença de fatores de risco e à incidência da doença. RESULTADOS: Verificamos que 27,3% dos participantes que se infectaram no seguimento faziam uso ivermectina e hidroxicloroquina como forma de prevenção, enquanto nós não infectados, 11,3% usavam esses medicamentos. Para os indivíduos que apresentaram a doença durante o seguimento 21,2% relataram respeitar o isolamento social, 27,3% relataram que saíram para trabalhar e 42,14% relataram que frequentaram ambientes hospitalares. Entre os participantes que tiveram a infecção, 12,1% relataram contato apenas com familiares, 9,1% com familiares e colegas de trabalho e 75,8% com profissionais de saúde. CONCLUSÕES: Este estudo forneceu dados epidemiológicos de indivíduos infectados pelo COVID-19, que podem contribuir com o sistema de saúde no estabelecimento de medidas preventivas.INTRODUCTION: We designed a prospective study aiming to assess factors (adherence to social distancing, use of PPE, etc.) that could be determinants in the development of COVID-19 that may subsidize the development of effective health strategies to combat the infection in the municipality of Passos - Minas Gerais, Brazil, whether in the hospital or non-hospital settings. METHODS: This is a longitudinal cohort study where 343 individuals from the population were included and randomly selected by clusters. The selected individuals answered a questionnaire related to clinical characteristics, preventive measures, comorbidities, and medication use. A rapid test was performed on the individuals to detect IgG and IgM antibodies. The average follow-up period was six months, and during the follow-up, telephone contact was maintained every two weeks. At the end of the follow-up, a new serological test was performed, and the risk associated with risk factors and disease incidence was calculated. RESULTS: We found that 27.3% of patients who became infected during follow-up were using ivermectin and hydroxychloroquine as a means of prevention, while in non-infected patients, 11.3% used these drugs. (p = 0.024). For patients who had the disease during follow-up, 21.2% reported respecting social isolation, 27.3% reported leaving for work, and 42.14% reported having attended hospital environments (p = 0.004). Among the participants who had the infection, 12.1% reported contact only with family members, 9.1% with family members and co-workers, and 75.8% with health professionals (p = 0.001). CONCLUSIONS: This study provided epidemiological data on patients infected with COVID-19, which can contribute to the health system's establishment of preventive measures

New proposal of silver diamine fluoride use in arresting approximal caries: study protocol for a randomized controlled trial

Abstract\ud \ud Background\ud Approximal surfaces are a challenge to caries lesions control. Silver diamine fluoride (SDF) is a simple,low-cost and promisor intervention for arresting caries lesions, but it has never been tested on approximal surfaces. Our aim is to evaluate the efficacy and cost-efficacy of SDF in arresting initial lesions compared to resin infiltration and exclusively flossing (control group). Our second aim is to assess discomfort and satisfaction regarding interventions.\ud \ud \ud Methods/design\ud This is a randomized clinical trial, double-blinded, placebo-controlled study. Children/adolescents presenting at least one approximal initial caries lesion in primary molars/permanent premolars and molars will be included. Surfaces with advanced dentine lesions identified by radiography and participants who refuse to participate or present negative behaviors will be excluded. A minimum sample size of 504 surfaces will be required for each subgroup. Individuals will be randomly allocated in three groups of interventions: SDF, resin infiltration, and control group. Depending on the allocation, the patients will receive the active treatment and respective placebo therapies. All patients will be oriented to daily flossing the included surfaces. Our primary outcome will be caries progression by clinical and radiographic examinations. Appointments will be timed and costs of materials will be considered to calculate cost-efficacy. Patient discomfort will be assessed after interventions. Parent and patient satisfaction with the treatment will be collected after treatment and in the last follow-up visit. Individuals will be assessed at 1 and 3 months after treatment to evaluate dental biofilm and at 6, 12, and 24 months to assess caries progression by visual examination and/or radiography. Multilevel analyses will be used to verify if the type of treatment influenced on the tested outcomes. Costs will be compared and analyses of cost-efficacy will be performed. Poisson analysis will test the association between intervention and reported discomfort and satisfaction.\ud \ud \ud Discussion\ud Our hypothesis is that SDF is the most cost-efficacious option from all tested interventions. If our hypothesis is confirmed, the use of SDF in private and public contexts could represent an easier and effective option in the treatment of enamel approximal caries in children/adolescents.\ud \ud \ud Trial registration\ud ClinicalTrials.gov (\ud NCT01477385\ud \ud ), Initial release: 11/16/2011: last update: 06/02/2014.Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP (Protocols 2012/50716-0 and 2014/00271-7)CNPQCape

Hemofilia adquirida A e B principais apresentações clínicas da doença de Pott em crianças: Hemofilia adquirida A e B main clinical presentations of Pott disease in children

A hemofilia é uma doença sanguínea caracterizada por distúrbios nos mecanismos de coagulação do sangue, podendo ser de origem hereditária ou adquirida. A hemofilia adquirida ocorre devido à produção de autoanticorpos contra a atividade pró-coagulante dos fatores VIII (Hemofilia A) e IX (Hemofilia B). O objetivo desse trabalho é a realização de um estudo observacional e exploratório sobre os artigos publicados nos últimos 5 anos sobre a hemofilia adquirida A e B, uma vez que é uma enfermidade considerada rara. Dos 68 resultados obtidos na pesquisa, apenas 7 abordaram de forma objetiva sobre o tema, sendo utilizados na confecção do estudo. Segundo a literatura, as manifestações clínicas envolvem sangramento mucocutâneo, urogenital e gastrointestinal, e são mais prevalentes em idosos. Em crianças, o sangramento pode ser menos expressivo, provocando dúvidas quanto ao diagnóstico. O tratamento da hemofilia envolve a reposição dos fatores de coagulação deficientes e o uso de imunossupressores, ainda que nas obras analisadas apenas o tratamento hemostático tenha sido descrito, revelando uma carência de estudos sobre o uso de imunossupressores nos casos de hemofilia adquirida