Child Stress and Behaviour During Restorative Treatment under Non-Pharmacological Techniques and Sedation: A Case Series

Objective: To evaluate the behaviour and stress of children undergoing restorative treatment with and without sedation. Material and Methods:Participants were 14 healthy children aged between 2.5 and 6 years and with a history of dental behavioural management problems. In the dental treatment visit, the child was treated with non-pharmacological techniques, and in the second, moderate sedation was added. The child received the same procedure performed by a paediatric dentist in both visits: composite resin restoration using local anaesthesia and rubber dam isolation. In both visits, saliva was collected at the children\u27s arrival at the dental clinic, during local anaesthesia and at the end of treatment. The visits were filmed for later analysis of behaviour according to the Ohio State University Behavioural Rating Scale. Results: About 78.5% of children improved their behaviour from the first to the second visit. The salivary cortisol curve of the first visit was maintained in the second visit for 21.4% of children but varied in the remaining participants. Conclusion: Most children presented better behaviour and less stress when sedation was added to non-pharmacological techniques during dental care

Effect of dental pain and caries on the quality of life of Brazilian preschool children

OBJECTIVE: To investigate the impact of dental pain on daily performances among five-year-old Brazilian children. METHODS: The study used data of 7,280 five-year-old children participating in the 2010 Brazilian Oral Health Survey (SBBrasil 2010 Project). Children were clinically examined and their parents or carers were interviewed at their homes. The outcome was the prevalence of the oral impacts on daily performance, and the explanatory variable was dental pain in the last six months. Other independent variables were children’s gender and skin color/race, family income, household overcrowding, and caries experience (dmft). Rao-Scott test and Poisson regression for complex samples were carried out. RESULTS: The prevalence of impacts on daily performances was 26.1% (95%CI 22.3–30.2). Significant associations were found between the outcome and pain, caries experience, and sociodemographic variables. After adjusting for the independent variables, only pain and caries remained significant. Impacts on daily performances were more frequent among children with pain (PR  =  1.14, 95%CI 1.06–1.23) compared to those without pain. Children with low dmft (PR = 1.90, 95%CI 1.39–2.60) and those with high dmft (PR = 3.53, 95%CI 2.78–4.49) had a higher prevalence of impact than those with no caries experience. CONCLUSIONS: Dental pain and caries had strong negative impacts on the five-year-old children’s daily performances regardless of their demographic and socioeconomic characteristics

Odontopediatria no alojamento conjunto: avaliação de um projeto inovador em promoção de saúde bucal

According to the current paradigm for promoting health, dental care should be a consideration from the first months of life, or even before birth. The aim of this paper is to evaluate mothers' knowledge of and attitude toward their babies' oral health after receiving guidance during the neonatal period. Forty-six mothers were contacted and asked about the advice they had received and how they felt about the information provided. The mothers recruited for the study were divided into two groups, A (n=25) and B (n=21), according to the time elapsed since their participation in the project, that is, less than or equal to three months and more than three months, respectively. A Wilcoxom rank sum test did not show any statistically significant difference between the two groups (p>;0.05). Guidance on the baby's oral hygiene, breastfeeding the baby exclusively until the sixth month, as well as the restrictions imposed on sugar intake were what the mothers remembered most. Recommendations concerning good arch development and the use of bottles were what mothers remembered least. Regarding infant oral health, it would be advisable to schedule prenatal and neonatal visits, with the second post-natal consultation no later than four months after childbirth.Segundo o paradigma atual de promoção de saúde, a atenção odontológica deve se iniciar ainda nos primeiros meses de vida ou então anteriormente ao nascimento, já que hábitos alimentares e de higiene bucal se estabelecem muito cedo. Avaliou-se o grau de conhecimento e as atitudes das mães com relação à saúde bucal do bebê, após as mesmas terem recebido orientações no período neonatal (projeto "Odontopediatria no alojamento conjunto"/ UFG). Quarenta e seis mães com idades de 15 a 38 anos foram questionadas a respeito das orientações recebidas, bem como seu comportamento em relação às mesmas. Dividiu-se a casuística em dois grupos, A (n=25) e B (n=21), de acordo com o tempo decorrido após a implementação do projeto, ou seja, menor ou igual a três meses e maior que três meses, respectivamente. Frente às orientações recebidas (transmissibilidade da cárie dentária, hábitos alimentares, desenvolvimento das arcadas e higiene bucal), a análise de variância não mostrou diferenças estatisticamente significantes entre os dois grupos (p >; 0,05), no que diz respeito ao conhecimento e atitudes das mães. As orientações de higiene bucal do bebê, de aleitamento materno exclusivo até seis meses e a restrição na ingestão de açúcar foram as mais lembradas pelas mães. Recomendações referentes à contribuição ao bom desenvolvimento das arcadas e às precauções quanto ao uso de mamadeiras foram menos recordadas. Considerando a saúde bucal do lactente, seria aconselhável que cuidadores sejam orientados nos períodos pré- e neonatal, sendo que a segunda consulta odontológica pós-nascimento deve idealmente ocorrer por volta do quarto mês de vida da criança

Sedação com midazolam e hidroxizina por via oral em Odontopediatria: ensaio clínico randomizado, controlado e cruzado

The effectiveness of oral midazolam in pediatric dentistry is controversial. This randomized, controlled, crossover, double blind clinical trial was conducted in order to study the effect of midazolam, used either alone or in association with hydroxyzine, during child dental treatment. Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old. In each appointment children were randomly assigned to groups: P - placebo, M - midazolam (1.0 mg/kg), or MH - midazolam (0.75 mg/kg) plus hydroxyzine (2.0 mg/kg). Vital signs (blood pressure, breathing rate, pulse and oxygen saturation) and behavior parameters (consciousness, crying, movement, overall behavior) were evaluated every 15 minutes. Friedman and Wilcoxon statistical tests were used to compare groups and different moments in the same group. Normal values of vital signs were usually registered. Heart rate increased in groups P and M as the session went on. Group M presented less crying and movement at the first 15 minutes of treatment. Group MH caused more drowsiness at the beginning of the session. Overall behavior was better in group M than in groups P or MH. Group M produced effective sedation in 77% of the cases, and group MH did so in 30.8%. It was concluded that midazolam was effective and safe, and its association with hydroxyzine did not lead to additional advantages in pediatric dental sedation.Há controvérsias quanto aos benefícios do midazolam na sedação de crianças durante a atenção odontológica. Conduziu-se um ensaio clínico controlado, cruzado e duplo-cego para comparar o efeito sedativo em Odontopediatria da administração oral do midazolam, associado ou não à hidroxizina. Trinta e sete sessões foram realizadas em 11 crianças menores de cinco anos, ASA I. Em cada atendimento, os pacientes receberam aleatoriamente o medicamento conforme os grupos: P - placebo, M - midazolam (1,0 mg/kg); MH - midazolam (0,75 mg/kg) associado à hidroxizina (2,0 mg/kg). Os sinais vitais (pressão arterial, freqüência respiratória, pulso e saturação de oxigênio) e os parâmetros comportamentais (consciência, choro, movimento, comportamento geral) foram avaliados a cada 15 minutos. As comparações entre grupos e entre momentos de atendimento num mesmo grupo foram estabelecidas estatisticamente através dos testes Friedman e Wilcoxon. Os grupos P, M e MH não diferiram quanto aos sinais vitais, os quais se mantiveram dentro de valores aceitáveis. A freqüência cardíaca aumentou nos grupos P e M com o transcorrer da sessão. O grupo M esteve associado a menos choro e movimento nos primeiros 15 minutos de tratamento. O grupo MH apresentou mais sonolência no início da sessão. O comportamento geral foi melhor em M do que em P e MH. M produziu sedação efetiva em 77% dos casos, e MH em 30,8%. Concluiu-se que o midazolam foi efetivo e seguro, e que sua associação à hidroxizina não repercutiu em vantagens adicionais na sedação odontopediátrica

Translation and Cultural Adaptation of the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese

Objective: To translate and culturally adapt the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese. Material and Methods: The MCDASf consists of eight questions about anxiety toward dental procedures that are answered on a five-point Likert scale ranging from “not worried” (1 point) to “very worried” (5 points). The answers correspond to a scale of face drawings ranging from extremely negative to extremely positive. The process consisted of initial translation, back-translation, expert committee review, and pretesting. Results: The first revised version was applied to 32 children aged 5 to 12 years, 16 from the city of Governador Valadares, Brazil (southeastern region) and 16 from the city of Pelotas, Brazil (southern region). In the first pretest, Item 5 was misunderstood by 6.25% of children in the southern region; Item 6 by 6.25% in both regions; Items 7 and 8 by 87.5% and 100% of those from the southeastern region, respectively, and by 12.5% and 25% of those from the southern region, respectively. Items 7 and 8 were modified by the expert committee, and the second revised version was applied to 32 children, 16 from each region. The only misunderstood items were 4 and 5, both by a 7-year-old boy in Governador Valadares. Conclusion: The Brazilian Portuguese version of the MCDASf was well understood by the sample of children.&nbsp

Percepção de cirurgiões-dentistas, acadêmicos de odontologia e público leigo sobre sedação em odontologia

Sedation is an option for controlling fear and anxiety related to a visit to the dentist. The goal of this study was to capture, by means of a questionnaire, the perceptions of twenty dentists, twenty dental students and twenty lay people concerning the use of sedatives in a dental environment. The responses were evaluated using the quantitative-interpretative method. Dentists: 75% had knowledge of sedatives in a dental setting, but their actual use was mentioned by only three. As far as the use of sedatives by dentists is concerned, one considered it "risky" and 19 were favorable. Two affirmed that sedation does not present risks. Eighteen said they would be able to react to a medical emergency. Dental students: 60% said they were aware of the topic, in theory. Nineteen expressed interest in the topic. Fifteen claimed there were risks associated with the technique. Twelve (60%) have the theoretical knowledge to deal with a medical emergency in the dental office. Lay public: Seven (35%) responded that they felt some discomfort during dental treatment, because of fear (n=6) and equipment noise (n=2). Five said they would go to the dentist more often if there was a way to reduce the discomfort. Half of those interviewed indicated that they knew what sedation was. Sixteen favored using it for dental treatment. Seven thought that there were no risks when sedation is carried out. It was concluded that few participants in any of the three categories felt confident about the topic, though they demonstrated interest. The population in general felt optimistic, while practicing dentists and dental students complained of a lack of exposure to the subject at dental school.A sedação constitui-se em opção no controle do medo e da ansiedade relacionados à visita ao dentista. Propôs-se captar a percepção de 20 cirurgiões-dentistas, 20 acadêmicos de odontologia e 20 leigos sobre a utilização de recursos sedativos em ambiente odontológico, através da aplicação de formulários. As respostas foram avaliadas através de método quantitativo-interpretativo. Cirurgiões-dentistas: 75% tinham conhecimento do uso de sedativos em consultório odontológico, sendo que sua prática efetiva foi mencionada por apenas três. Quanto ao uso de sedativos por dentistas, um considerou "arriscado" e 19 manifestaram-se favoráveis. Dois afirmaram que a sedação não oferece riscos. Dezoito disseram saber reagir frente a emergência médica. Acadêmicos de odontologia: 60% admitiam conhecer o tema, em teoria. Dezenove expressaram interesse no assunto. Quinze afirmaram haver riscos associados à técnica. Doze (60%) tinham o conhecimento teórico para conduta frente a uma emergência médica no consultório. Público leigo: Sete (35%) responderam que sentiam algum desconforto no tratamento odontológico, representado pelo medo (n=6) e o ruído dos equipamentos (n=2). Cinco disseram que iriam mais freqüentemente ao consultório odontológico se houvesse algum meio para reduzir o desconforto. Metade dos entrevistados relatou saber o que é sedação. Dezesseis foram favoráveis à sua realização para tratamento odontológico. Sete julgaram que não há riscos quando se faz sedação. Concluiu-se que poucos participantes, dentro das três categorias, estiveram seguros com relação ao assunto, embora tenham demonstrado interesse. A população em geral sentiu-se otimista, enquanto que CDs e acadêmicos queixaram-se da pouca vivência do tema nas faculdades

COVID-19 infodemic and impacts on the mental health of older people : cross-sectional multicenter survey study

Background: The COVID-19 pandemic received widespread media coverage due to its novelty, an early lack of data, and the rapid rise in deaths and cases. This excessive coverage created a secondary “infodemic” that was considered to be a serious public and mental health problem by the World Health Organization and the international scientific community. The infodemic particularly affected older individuals, specifically those who are vulnerable to misinformation due to political positions, low interpretive and critical analysis capacity, and limited technical-scientific knowledge. Thus, it is important to understand older people’s reaction to COVID-19 information disseminated by the media and the effect on their lives and mental health. Objective: We aimed to describe the profile of exposure to COVID-19 information among older Brazilian individuals and the impact on their mental health, perceived stress, and the presence of generalized anxiety disorder (GAD). Methods: This cross-sectional, exploratory study surveyed 3307 older Brazilians via the web, social networks, and email between July 2020 and March 2021. Descriptive analysis and bivariate analysis were performed to estimate associations of interest. Results: Major proportions of the 3307 participants were aged 60 to 64 years (n=1285, 38.9%), female (n=2250, 68.4%), and married (n=1835, 55.5%) and self-identified as White (n=2364, 71.5%). Only 295 (8.9%) had never started or completed a basic education. COVID-19 information was mainly accessed on television (n=2680, 81.1%) and social networks (n=1943, 58.8%). Television exposure was ≥3 hours in 1301 (39.3%) participants, social network use was 2 to 5 hours in 1084 (32.8%) participants, and radio exposure was ≥1 hour in 1223 (37%) participants. Frequency of exposure to social networks was significantly associated with perceived stress (P=.04) and GAD (P=.01). A Bonferroni post hoc test revealed significantly different perceived stress in participants who were exposed to social networks for 1 hour (P=.04) and those who had no exposure (P=.04). A crude linear regression showed that “some” social media use (P=.02) and 1 hour of exposure to social media (P<.001) were associated with perceived stress. Adjusting for sociodemographic variables revealed no associations with this outcome variable. In a crude logistic regression, some social media use (P<.001) and 2 to 5 hours of exposure to social media (P=.03) were associated with GAD. Adjusting for the indicated variables showed that some social network use (P<.001) and 1 hour (P=.04) and 2 to 5 hours (P=.03) of exposure to social media were associated with GAD. Conclusions: Older people, especially women, were often exposed to COVID-19–related information through television and social networks; this affected their mental health, specifically GAD and stress. Thus, the impact of the infodemic should be considered during anamnesis for older people, so that they can share their feelings about it and receive appropriate psychosocial care