Oral health profile of education and health professionals attending handicapped children

O objetivo deste estudo foi avaliar conhecimentos e atitudes em saúde bucal dos profissionais de educação e saúde, que atuam em um programa de atenção à criança de 0 a 6 anos de idade, portadora de necessidades especiais, em uma instituição municipal pública do Rio de Janeiro. Por meio de um formulário, foram entrevistados 67 profissionais (professoras, atendentes e profissionais de saúde). Os resultados foram comparados aos hábitos de higiene bucal das crianças, através da observação direta da rotina da creche. Embora 97,0% tenham afirmado que a saúde bucal pode interferir na saúde geral, somente 37,3% dos profissionais responderam corretamente a respeito dessa interferência. Quanto aos métodos de prevenção da cárie, 92,5% afirmaram conhecê-los, contudo somente 17,9% foram ao dentista para prevenção. A maioria (81,3%) indicou a higiene bucal como o modo de prevenir a cárie, porém a observação mostrou que nem sempre esta prática é realizada na creche. Quanto à época do início da escovação dos dentes das crianças, 75,0% das professoras e 94,4% dos profissionais de saúde afirmaram conhecer a necessidade de iniciar a escovação antes de um ano de vida, sendo essa resposta observada em somente 52,5% das atendentes (qui-quadrado, p = 0,006). Diante desses resultados, pôde-se concluir que as atitudes em saúde bucal nem sempre foram coerentes com os conhecimentos expressados por esses profissionais.The purpose of this study was to evaluate the knowledge and attitudes toward oral health of education and health professionals working in a children care program for handicapped children from 0 to 6 years of age, run by a public municipal institution in Rio de Janeiro. Using a printed questionnaire, 67 professionals (teachers, attendants and health professionals) were interviewed. The results were compared to the children's oral hygiene habits, by directly observing their daily nursery routine. Although 97.0% said that oral health could play a part in general health, only 37.3% of the professionals answered correctly on this matter. As for methods for preventing caries, although 92.5% said that they were aware of them, only 17.9% went to the dentist for preventive treatment. Although the majority (81.3%) indicated oral hygiene as a way of preventing caries, observation showed that this practice is not always put into effect in the program's day nursery. Regarding when to start toothbrushing in children, 75.0% of the teachers and 94.4% of the health professionals said that they were aware of the need to begin brushing before one year of age, although this reply was given by only 52.5% of the attendants (chi-square, p = 0.006). In view of these results, it was concluded that attitudes toward oral health were not always coherent with the knowledge that these professionals express

O impacto das imunoglobulinas salivares sobre Candida spp em pacientes pediátricos infectados pelo HIV

Immunodeficient paediatric patients, that is, those who lack the ability to respond adequately to an antigenic stimulus, are more liable to develop opportunistic infections, such as the fungal ones. Of these last, one can cite oral candidiasis, caused by Candida spp, and commonly found in HIV infected children. This study has had as its goal to make a revision of the literature about the relationship between salivary immunoglobulins, which constitute the first line of defence for oral mucosa, and Candida spp in HIV infected paediatric patients, emphasising the importance of these antibodies.Pacientes pediátricos imunodeprimidos, ou seja, aqueles que não têm a capacidade de responder adequadamente a um estímulo antigênico, estão mais sujeitos a desenvolver infecções oportunistas, tais como as infecções fúngicas. Dentre elas, pode-se citar a candidíase bucal, causada pelas Candida spp, comumente encontrada em crianças infectadas pelo HIV. Este trabalho teve como objetivo realizar uma revisão da literatura sobre a relação entre imunoglobulinas salivares, que constituem o principal agente na linha de defesa da mucosa bucal, com as Candida spp em pacientes pediátricos infectados pelo HIV, ressaltando a importância desses anticorpos

Relação entre biofilme, atividade de cárie e gengivite em crianças HIV+

The utilization of medicines to treat HIV-infected children has been promoting a decrease in the prevalence of soft-tissue oral lesions, as years pass by. In contrast, it has been observed that the experience of caries and gingivitis is constant in this population, mostly because of the chronic influence of some factors involved in the HIV-infection process, such as the chronic utilization of sweetened liquid medicines and carbohydrate-enriched diet, as well as frequent episodes of hospitalization. So, the purpose of this study was to evaluate if the quality and quantity of biofilm are important factors in the activity of dental caries and gingivitis, also in this special group. After examination of the biofilm (biofilm index - Ribeiro23, 2000), the activity of caries and gingivitis was assessed in 56 children, aging from 0 to 14 years, who were patients with definitive diagnosis of HIV infection. It was observed that only 7 subjects (12.5%) did not present with clinically visible biofilm, and 33 (58.9%) presented with gingivitis, with the average of 4.44 bleeding sites. As to dental caries, 73.2% of the patients presented with active carious lesions. A strong correlation was verified between Biofilm Index, gingival status and active carious lesions (Spearmans correlation test, r s = +0.57 and r s = +0.49, respectively). It was concluded that, also in HIV-infected children, the quality and quantity of biofilm over the dental surfaces are important etiologic factors related to the activity of caries and gingivitis. Biofilm should, thus, be controlled in order to reestablish the oral health of HIV-infected children.A utilização de terapia medicamentosa em crianças infectadas pelo HIV (HIV+) vem promovendo a diminuição na prevalência de manifestações bucais em tecidos moles ao longo dos anos. Entretanto, observa-se uma constância na experiência de cárie e gengivite desta população, sobretudo devido à influência crônica de alguns fatores envolvidos no processo da infecção pelo HIV, como uso prolongado de medicamentos líquidos açucarados, dieta rica em carboidratos e repetidos episódios de internação. Assim, o objetivo do presente estudo foi avaliar se a qualidade e quantidade de biofilme representam um fator importante na atividade da doença cárie e gengivite neste grupo em especial. Após exame do biofilme (índice de biofilme; Ribeiro23, 2000), da atividade de cárie e gengivite de 56 crianças, de 0 a 14 anos, pacientes com diagnóstico definitivo de infecção pelo HIV, observou-se que somente 7 (12,5%) não apresentavam biofilme visível clinicamente e 33 (58,9%) apresentavam gengivite, com, em média, 4,44 superfícies com sangramento. Quanto à doença cárie, 73,2% das crianças apresentavam lesões cariosas ativas. Verificou-se ainda a correlação entre o índice de biofilme, o estado gengival e a atividade das lesões cariosas (teste de correlação de Spearman, r s = +0,57 e r s = +0,49, respectivamente). Conclui-se, que nas crianças HIV+ avaliadas, a qualidade e quantidade de biofilme sobre a superfície dental representam um importante fator na etiologia da atividade das doenças cárie e gengivite, podendo e devendo este ser trabalhado para que seja possível restabelecer a saúde bucal destas crianças

An in situ study of human enamel after titanium tetrafluoride application

The purpose of this in situ, double blind, crossover study was to compare the effectiveness of an application of titanium tetrafluoride (TiF4) on deciduous and permanent enamel submitted to highly cariogenic conditions. Five volunteers used palatal appliances with 80 sections of teeth during two phases (TiF4 and Control) of 14 days each. They dropped 25% glucose on the sections, eight times per day. After that, the enamel was analyzed through scanning electron microscopy (SEM) and the Knoop Hardness Number (KHN) was determined at five different depths, up to 100 µm. The results revealed that differences between deciduous and permanent enamel were not significant. The KHN (Multiple Range Analysis) did not show a significant TiF4 effect, but SEM (Chi Square Test) results revealed differences between TiF4 and the Control group with p value = 0.027. There were equal numbers of incipient lesions in both groups, but there were 10 caries-free sections and 18 severe lesions in the Control group, against 20 and 8 in the TiF4 group, respectively. The findings suggested that lesions were less severe with TiF4 and that it changed the pattern of caries, but other studies are necessary to precisely define this effect, in terms of depth.O objetivo deste trabalho, cruzado, duplo-cego, realizado in situ, foi avaliar o esmalte dental humano submetido a um grande desafio cariogênico após aplicação de tetrafluoreto de titânio (TiF4) a 1%. Para isso, 5 voluntários utilizaram dispositivos intrabucais superiores contendo 80 fragmentos dentais durante 2 etapas (TiF4 e Controle) de 14 dias cada, gotejando 8 vezes ao dia glicose 25%. Após o uso, o esmalte foi submetido à análise através da MEV (microscopia eletrônica de varredura) e a MDT (microdureza em corte transversal) em 5 posições até a profundidade de 100 µm da superfície anatômica do dente. Os resultados não revelaram diferença significativa entre esmalte decíduo e permanente. Os dados da MDT, submetidos à análise de variância multifatorial também não revelaram efeito significativo do TiF4, porém, através da MEV, verificou-se diferença entre TiF4 e Controle com p = 0,027 (teste do qui-quadrado). O número de lesões brandas era igual para os dois grupos, porém no Controle haviam 10 fragmentos com esmalte sem cárie e 18 com lesões severas contra 20 e 8 respectivamente do grupo TiF4. Os dados permitem sugerir que o TiF4 modificou o padrão da lesão formada amenizando-a, sendo necessários novos estudos definindo esse efeito em termos de profundidade

Relationship between Malocclusion, Bullying, and Quality of Life in Students from Low Social Development Area: A Cross-Sectional Study

Objective: To analyze the relationship between malocclusion and bullying and its impact on the well-being and quality of life of students from low social development areas. Material and Methods: This cross-sectional study included 243 schoolchildren between 10 and 17 years. Malocclusion was analyzed using Dental Aesthetic Index. Bullying and self-perception of the impact of one’s oral condition on quality of life and interpersonal relationships were assessed by questions from National Survey of Schoolchildren\u27s Health and Child Perceptions Questionnaire 11-14 (CPQ11-14). Data were analyzed using the Spearman correlation coefficient and Mann-Whitney tests, considering groups: 10-11, 12-14 and 15-17 years. Results: No correlation was observed between malocclusion and bullying. However, in the 12-14 group, poor correlations were found between malocclusion and the CPQ11-14 (0.226) and between malocclusion and being shy/embarrassed due to oral aspects (0.298). Positive correlations were observed between bullying and the impact on the quality of life in the 10-11 (0.420) and 12-14 (0.425) groups. In the older group, a positive correlation (0.724) was observed between the concern about what others think of their oral health and the impact on their quality of life. Conclusion: There was no evidence of a relationship between malocclusion and bullying. However, the oral conditions negatively affected the interpersonal relationships and the student\u27s quality of life

Association Between Caries Experience and School Performance in an Island Community: Full-Time versus Part-Time Public Schools

Objective: To investigate the association between caries experience and school performance among children and adolescents living in an island community without fluoridated water supply and to compare data according to the type of attended school (full-time or part-time). Material and Methods: A cross-sectional oral health survey in a convenience sample of students (n=147) attending four public schools was performed. Students were examined by one calibrated dentist in the school environment to the obtain prevalence of dental caries (DMFT/dmft) and its consequences using the PUFA/pufa index. Self-reported oral health behavior was also accessed. Data from each student’s school performance and absenteeism were extracted from official sources and the school performance was classified into “good” and “fair”. The final sample consisted of 120 students. Descriptive statistics, Mann-Whitney, Kruskal-Wallis, chi-square tests and binary logistic regression were performed to evaluate collected data. Results: Students´ age ranged between 5 to 19 years (10±4.3). DMFT/dmft mean were 1.3 (±2.3) and 3.05 (±3.4), respectively. Conclusion:Participants from the full-time school presented better oral health status than their peers in the part-time schools (p<0.05). A significant association was found between the prevalence of caries-free participants and good school performance when the factor age range was controlled (OR=2.87). Moreover, attendance to full-time schools appeared to be a protective factor for good oral health conditions

Comparison Between Radiographs, White and Fluorescent Images in the Diagnosis and Treatment Decisions for Occlusal Caries: An Ex Vivo Study

Objective: To compare the agreement of images in white light (WL), fluorescence (FL), and digital radiographs (DR), on the diagnosis and treatment decisions for occlusal caries lesions against a micro-CT gold standard. Material and Methods: Ten extracted third molars, with enamel and/or dentin caries (ICDAS 2-4), were included. Occlusal surface images were acquired with an intraoral camera (SoproLife®) in WL and FL modes. DR was obtained using an intraoral X-ray and a semi-direct digital system. A total of 780 images were needed, organized in a template, to be later examined by twenty-six dentists invited to compose the study. The Generalized Estimation Equations model was used to compare the proportions of the correct answers between the three methods and the gold standard. When significant, Bonferroni post-hoc test was used to identify differences (α=5%). Results: Most of the examiners were specialists (76.9%) with 14.5 years of experience. All diagnostic methods were similar and showed low agreement (DR 12.7%, WL 16.5%, and FL 16.5%) compared with gold standard caries diagnostic scores. Regarding treatment decisions, mean agreement for all diagnostic methods was higher (43.2%; p<0.001), and among all methods, WL (48.1%) and FL (51.2%) modes performed better than DR (30.4%, p<0.001). Conclusion: SoproLife® images could help clinicians to propose rational, minimally invasive treatments for occlusal caries lesions

Relationship between Malocclusion, Bullying, and Quality of Life in Students from Low Social Development Area: A Cross-Sectional Study

Objective: To analyze the relationship between malocclusion and bullying and its impact on the well-being and quality of life of students from low social development areas. Material and Methods: This cross-sectional study included 243 schoolchildren between 10 and 17 years. Malocclusion was analyzed using Dental Aesthetic Index. Bullying and self-perception of the impact of one’s oral condition on quality of life and interpersonal relationships were assessed by questions from National Survey of Schoolchildren's Health and Child Perceptions Questionnaire 11-14 (CPQ11-14). Data were analyzed using the Spearman correlation coefficient and Mann-Whitney tests, considering groups: 10-11, 12-14 and 15-17 years. Results: No correlation was observed between malocclusion and bullying. However, in the 12-14 group, poor correlations were found between malocclusion and the CPQ11-14 (0.226) and between malocclusion and being shy/embarrassed due to oral aspects (0.298). Positive correlations were observed between bullying and the impact on the quality of life in the 10-11 (0.420) and 12-14 (0.425) groups. In the older group, a positive correlation (0.724) was observed between the concern about what others think of their oral health and the impact on their quality of life. Conclusion: There was no evidence of a relationship between malocclusion and bullying. However, the oral conditions negatively affected the interpersonal relationships and the student's quality of life

Salivary Metabolites in Patients with Mucopolysaccharidosis

Objective: To identify the salivary metabolites profile of Mucopolysaccharidosis (MPS) types I, II, IV, and VI patients. Material and Methods:The participants were asked to refrain from eating and drinking for one hour before sampling, performed between 7:30 and 9:00 a.m. Samples were centrifuged at 10.000 × g for 60 min at 4ºC, and the supernatants (500µl) were stored at -80ºC until NMR analysis. The salivary proton nuclear magnetic resonance (1H-NMR) spectra were acquired in a 500 MHz spectrometer, and TOCSY experiments were used to confirm and assign metabolites. Data were analyzed descriptively. Results: Differences in salivary metabolites were found among MPS types and the control, such as lactate, propionate, alanine, and N-acetyl sugar. Understanding these metabolite changes may contribute to precision medicine and early detection of mucopolysaccharidosis and its monitoring. Conclusion: The composition of low molecular weight salivary metabolites of mucopolysaccharidosis subjects may present specific features compared to healthy controls

Prevalence of caries and its correlation with clinical and immunological classification in HIV-infected children

Este estudo tem como objetivo determinar a experiência de cárie em crianças infectadas pelo HIV, correlacionada com a classificação clínica e imunológica (CDC³, 1994). Participaram da pesquisa 92 crianças (50 meninas e 42 meninos), com média de idade de 5,77 ± 3,31 anos (6 meses a 13 anos), com diagnóstico definitivo para o HIV, todos pacientes com atendimento ambulatorial. Foi realizado exame bucal para determinar os índices ceo/CPOD e os dados de história médica foram coletados dos prontuários médicos. Na dentição decídua de crianças mais jovens (até 5 anos), apesar de a prevalência de cárie ter apresentado valores maiores naquelas mais comprometidas clínica e imunologicamente, não houve diferença estatisticamente significante entre as diversas categorias de classificação. Nas crianças de maior idade, isto também foi observado, apesar de terem sido encontrados valores de CPOD maiores nas crianças mais doentes.This research aims to determine the relationship between the prevalence of caries and clinical and immunological classification in HIV-infected children. Ninety-two outpatients (42 male and 50 female subjects) with definitive diagnosis of HIV infection took part in this research. The patients were examined in order to determine the prevalence of caries (dmf and DMFT indexes), and medical data were collected from their medical records. The mean age of the subjects was 5.77 years. Although no statistical differences were found, young patients (up to 5 years old) had more caries when they were more clinically and immunologically compromised. The same fact was observed regarding older children