Oral health status of children and adolescents victims of abuse: a literature review

Violence against minors can manifest in many forms and is considered a public health problem due to the physical and emotional consequences it produces. The dentist has a fundamental role in detecting victims of violence, as the face is often the most affected region. Objective: To review the national and international literature concerning injuries and most common oral conditions of children and adolescents victims of abuse. Literature review: The descriptors used were “child abuse”, “child violence”, “physical violence”, “psychological violence”, “dental caries”, and “oral health” for international databases and the corresponding terms in Portuguese for Brazilian databases, with no restriction of year of publication and language. Through the articles included in this review, it appears that children with maltreatment history presents not only high prevalence of head injuries and dental traumas, but may also have poor oral hygiene and low search for dental services and consequently higher rates of untreated caries compared with children who lived in contexts without violence. Conclusion: Although the literature suggested that children and adolescents who have suffered abuse may have worse oral health status than those who were not victims of violence, more studies are needed to understand whether there are actually significant differences in the prevalence trauma, soft tissue injuries, tooth decay, and periodontal disease among types of child abuse

Translation and Cross-Cultural Adaptation of the “Child Drawing: Hospital” (CD:H) Scale for Paediatric Dentistry in Brazil

Objective: To translate and perform the cross-cultural adaption of the CD:H scale for use in Paediatric Dentistry in Brazilian Portuguese language. Material and Methods: The translation and cross-cultural adaptation of the CD: H was carried out in four stages: 1) translation of the instrument; 2) reverse translation (back translation); 3) cross-cultural adaptation, and 4) face validation. Face validation consisted of the evaluation of 30 subjects from the target population. A pilot study was conducted with 15 children aged 5-10 years treated at a university dental clinic and their drawings were analysed by two dentists. Data were analysed using Stata 12.0. Results: In the face validation, most items were understood; however, some words were changed, and terms were included to identify the dental environment. Good reproducibility was obtained: inter-examiner reliability was 0.9647 and intra-examiner reliability was 0.9619 for examiner A and 0.8260 for examiner B. Conclusion: The Brazilian version of the CD:H scale is a useful tool for dentists, helping identify children's emotions and being enjoyable for them

Prevention and Management of Dental Trauma in Primary Teeth in the Context of the COVID-19: A Critical Literature Review

Objective: To evaluate and discuss the prevention and management of dental trauma in primary teeth during the COVID-19 pandemic. Material and Methods: Critic literature review, searching electronic databases and Google for articles and guidelines published in English that described prevention and management of dental trauma in primary dentition during the pandemic of COVID-19. Results: 5 publications regarding management and 1 leaflet about prevention for parents were identified. Urgent care is required when the child presents tooth fracture resulting in pain or causing soft tissue trauma and luxation affecting bite. Avulsed teeth should not be replanted and advice and self-help may be sufficient in some situations. Instructions about soft diet and hygiene must be provided. Remote consults are recommended for non-urgent situations and during follow-up to evaluate the presence of sequelae. Aerosol generating procedures should be avoided and, in cases of poor prognosis, extraction is recommended to prevent recurring visits to the dental office. Conclusion: During COVID-19 pandemic, remote consults should be recommended to evaluate traumatic dental injuries in primary dentition. Follow-up should not be neglected and may be performed through remote consultation

Prevention and Management of Dental Trauma in Primary Teeth in the Context of the COVID-19: A Critical Literature Review

Objective: To evaluate and discuss the prevention and management of dental trauma in primary teeth during the COVID-19 pandemic. Material and Methods: Critic literature review, searching electronic databases and Google for articles and guidelines published in English that described prevention and management of dental trauma in primary dentition during the pandemic of COVID-19. Results: 5 publications regarding management and 1 leaflet about prevention for parents were identified. Urgent care is required when the child presents tooth fracture resulting in pain or causing soft tissue trauma and luxation affecting bite. Avulsed teeth should not be replanted and advice and self-help may be sufficient in some situations. Instructions about soft diet and hygiene must be provided. Remote consults are recommended for non-urgent situations and during follow-up to evaluate the presence of sequelae. Aerosol generating procedures should be avoided and, in cases of poor prognosis, extraction is recommended to prevent recurring visits to the dental office. Conclusion: During COVID-19 pandemic, remote consults should be recommended to evaluate traumatic dental injuries in primary dentition. Follow-up should not be neglected and may be performed through remote consultation

Association of Dental Anxiety with Psychosocial Characteristics among Children Aged 7-13 Years

Objective: To identify psychosocial characteristics associated with dental anxiety in children aged 7-13 years in the dental setting. Material and Methods: This cross-sectional study was conducted with children aged 7-13 years attended at the Dentistry School of Pelotas, Brazil. Data collection was based on a questionnaire administered to mothers and children, and the behavior of children during dental treatment was evaluated using the Frankl’ Scale. Data were analyzed using Chi-square  and  Fisher’s exact tests in order to analyze the association between independent variables and dental anxiety. The effect of variables on the outcome was assessed by the Poisson regression model with robust variance (Prevalence Ratio; 95% Confidence interval). Results: A total of 187 children were included. Dental anxiety prevalence was 40.11%. After adjustments, younger children (p=0.046), only child (p=0.019), and children with negative previous dental experience (p=0.046) showed higher dental anxiety prevalence.  Children with uncooperative behavior in previous (p=0.033) and current (p≤0.001) dental appointments showed higher dental anxiety prevalence. Conclusion: In this sample of children treated at a dentistry school, a report of dental anxiety was associated with age, birth order, previous dental experience and behavior in dental settings

Efeito de estimulação termomecânica durante anestesia local em odontopediatria: um ensaio clínico randomizado piloto

Aim: To evaluate the effectiveness of a thermo mechanical stimulation device (Buzzy®) in relation to pain, fear and anxiety during local anesthesia in children. Materials and methods: Study carried out from May 2018 to July 2019, with children aged 7 to 11 years, without previous experience involving anesthesia in the last 2 years and who needed dental treatment (extraction, restoration or endodontic) under local anesthesia in deciduous molars. The sample was randomized into a control group, which received conventional anesthesia, and an intervention group, which received anesthesia with Buzzy®. The levels of anxiety, fear and pain perception of both groups were verified using: Come Modified Picture Test (VPTM); heart rate; Behavioral Scale Come; Faces Pain Scale – Revised (FPS-R) and Face, Legs, Activity, Cry, Consolability (FLACC). Results: Most children (55%) had low anxiety before and after treatment (P<0.05). The acceptability of the children to Buzzy® was 100% and the majority (90%) would like to use it again. Discussion: The tested device is an interesting tool to complement management techniques during consultations, in view of the excellent acceptability and interest on the part of patients and family members. Conclusion: This study demonstrated that the use of thermo mechanical stimulation is feasible in the dental clinic, due to its easy use and good acceptability in the clinical environment, in addition to not presenting risks in its use.Objetivo: Avaliar a eficácia de um dispositivo de estimulação termomecânica (Buzzy®) em relação à dor, medo e ansiedade durante anestesia local em crianças. Materiais e métodos: Estudo realizado no período de maio de 2018 a julho de 2019, com crianças de 7 a 11 anos, sem experiência prévia envolvendo anestesia nos últimos 2 anos e que necessitassem de tratamento odontológico (extração, restauração ou endodontia) sob anestesia local em molares decíduos. A amostra foi randomizada em grupo controle, que recebeu anestesia convencional, e grupo intervenção, que recebeu anestesia com Buzzy®. Os níveis de ansiedade, medo e percepção de dor de ambos os grupos foram verificados por meio de: Venham Modified Picture Test (VPTM); frequência cardíaca; Escala Comportamental Venham; Faces Pain Scale – Revised (FPS-R) e Face, Legs, Activity, Cry, Consolability (FLACC). Resultados: A maioria das crianças (55%) apresentou baixa ansiedade antes e depois do tratamento (P<0,05). A aceitabilidade das crianças ao Buzzy® foi de 100% e a maioria (90%) gostaria de usar novamente. Discussão: O aparelho testado é uma ferramenta interessante para complementar as técnicas de manejo durante as consultas, tendo em vista a excelente aceitabilidade e interesse por parte dos pacientes e familiares. Conclusão: Este estudo demonstrou que o uso da estimulação termomecânica é viável na clínica odontológica, devido ao seu fácil uso e boa aceitabilidade no meio clínico, além de não apresentar riscos em seu uso

Eficácia de distrações audiovisuais em crianças no comportamento, controle da dor e da ansiedade durante procedimentos odontológicos: um estudo transversal

Aim: To assess whether audiovisual distractions in children are effective in managing behavior, pain and anxiety in pediatric dental care. Materials and Methods: This cross-sectional study was derived from a randomized clinical trial, carried out between March and December 2019 with 48 children aged 6 to 10 years who required restorative, endodontic or exodontic treatment, at the Children's Clinic of the Faculty of Dentistry of the Federal University of Pelotas (UFPEL). It was approved by the Research Ethics Committee at UFPel, under number 3700062. The children were allocated into two groups: control and intervention (virtual reality glasses and tablet). The child's behavior was assessed using the Brazilian Version of the Venham Scale and anxiety using the Venham Picture Test Modified (VPTM). Pain assessment was performed using the Face, Legs, Activity, Cry and Consolability (FLACC) and Faces Pain Scale-Revised (FPS-R) scales. Result: It was observed that the glasses group had better results than the tablet group, but without significant difference, since the two obtained better results compared to the control. Furthermore, the behavior showed a significant difference (p=0.035) in relation to the other variables. Discussion: A clinical trial that analyzed the use of glasses in children between 6 and 9 years old concluded that there was no significant statistical difference between the groups in relation to behavior. Thus, the present study showed more relevant results when compared to findings in the literature. Conclusion: The use of audiovisual distractions by children during dental procedures was effective in managing pain, behavior and anxiety.Objetivo: Avaliar se distrações audiovisuais em crianças são eficazes a fim de manejar comportamento, dor e ansiedade em atendimentos odontopediátricos. Materiais e Métodos: Este estudo transversal foi derivado de um ensaio clínico randomizado, realizado entre março e dezembro de 2019 com 48 crianças de 6 a 10 anos que necessitavam de tratamento restaurador, endodôntico ou exodôntico, na Clínica Infantil da Faculdade de Odontologia da Universidade Federal de Pelotas (UFPEL). Foi aprovado pelo Comitê de Ética em Pesquisa da UFPel, sob número 3700062.  As crianças foram alocadas em dois grupos: controle e intervenção (óculos de realidade virtual e tablet). O comportamento da criança foi avaliado a partir da Versão Brasileira da Escala de Venham e a ansiedade através da Venham Picture Test Modified (VPTM). A partir das escalas Face, Legs, Activity, Cry and Consolability (FLACC) e Faces Pain Scale-Revised (FPS-R) foi realizada a avaliação da dor. Resultado: Observou-se que o grupo óculos possuiu melhores resultados do que o grupo tablet, porém sem diferença significativa, já que os dois obtiveram melhores resultados se comparados ao controle. Ademais, o comportamento apresentou diferença significativa (p=0,035) em relação às outras variáveis. Discussão: Um ensaio clínico que analisou uso dos óculos em crianças entre 6 e 9 anos, concluiu que não houve diferença estatística importante entre os grupos em relação ao comportamento. Assim, o presente estudo demonstrou resultados mais relevantes se comparados aos achados na literatura. Conclusão: O uso das distrações audiovisuais por crianças durante procedimentos odontológicos foram eficazes no manejo da dor, comportamento e ansiedade

Qualidade de vida relacionada à saúde bucal de crianças pré-escolares de acordo com as razões para procura por atendimento odontológico

Objetivo: avaliar a percepção dos pais sobre a qualidade de vida relacionada à saúde bucal (QVRSB) de crianças pré-escolares atendidas na clínica de uma faculdade de odontologia, de acordo com a razão que motivou a procura pelos cuidados. Método: Quarenta e cinco pais e crianças de 0 a 6 anos de idade foram incluídos. Vinte e cinco crianças foram à clínica odontológica devido a trauma dental (Grupo 1) e 20, devido a cárie ou dor (Grupo 2). Os cuidadores foram convidados a preencher um questionário sobre a qualidade de vida relacionada à saúde bucal (Early Childhood Oral Health Impact Scale - ECOHIS) para avaliar a QVRSB da criança. O ECOHIS inclui uma seção de impacto na criança e outra de impacto familiar, e a pontuação varia de 0 a 52. Quanto maior a pontuação, maior o impacto na qualidade de vida. Crianças com mais de 4 anos expressaram sentimentos sobre seus dentes por meio de um instrumento de avaliação com desenhos. Resultados: A média da pontuação do ECOHIS foi de 10,6 para toda a amostra e 10,1 e 11,6 para o grupo trauma e grupo cárie, respectivamente. As crianças que procuraram atendimento odontológico por cárie, bem como aquelas que haviam sido submetidas a tratamento restaurador, apresentaram maior impacto sobre o domínio sintomas (p < 0,05). No grupo 1, 36% (5) das crianças manifestaram sua insatisfação com a sua saúde oral, ao passo que, no grupo 2, o nível de insatisfação aumentou para 53% (8 crianças). Os resultados mostraram que o impacto sobre a QVRSB foi elevado na população estudada, e que cárie/ dor teve maior impacto sobre a criança, e trauma dental, sobre a família.Purpose: to evaluate parental perception on oral health-related quality of life (OHRQL) of preschool children attending a Dentistry School according to the reason care was sought. Method: 45 parents and their 0-6-year-old children were included. Twenty five children were taken to the dental clinic due to dental trauma (Group 1), and 20 due to caries or pain (Group 2). Caretakers were asked to complete the Early Childhood Oral Health Impact Scale (ECOHIS) to evaluate child’s OHRQoL. The ECOHIS includes a child impact section and a family impact section and varies from 0 to 52. Children over 4 years of age expressed their feelings on their teeth by an instrument with drawings. Results: mean ECOHIS score was 10.6 for the whole sample and 10.1 and 11.6 for the trauma and caries groups, respectively. Caries-bearing children had higher scores on the oral symptons and on the family function domain. Parent disstress was higher for the trauma-bearing child. In group 1, 36% (5) children expressed dissatisfaction with their oral health, whereas in group 2 the dissatisfaction level raised to 53% (8 children). The results showed that the impact on OHRQoL was high in the studied population. Caries/pain had more impact on the children, whereas dental trauma had a higher impact on the family

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

O método computadorizado de anestesia odontológica é mais efetivo que o método convencional em crianças e adolescentes? Uma revisão sistemática da literatura

Aim: To systematically review the literature on the effectiveness of the computerized method of dental anesthesia in relation to pain, non-collaborative behavior and fear/anxiety in children and adolescents compared to the conventional method. Materials and methods: An electronic search was performed in five databases (Virtual Health Library, Scopus, Embase, Pubmed and Web of Science) that included randomized clinical trials. The search was performed in October 2020 and updated in May 2021. The risk of bias assessment was performed using the RoB 2 and a qualitative analysis was also performed. Results: A total of 3,518 studies were found, and after removing duplicates, analyzing the title and abstract, and complete reading, 26 studies remained included. Of these, five assessed anxiety/fear, twelve assessed behavior during anesthesia, and twenty-two assessed pain perception. No significant difference was observed in most studies between the use of the computerized method compared to the traditional method for all outcomes analyzed. Discussion: Although there does not seem to be a significant difference in pain perception, fear/anxiety reports and behavior between the use of the computerized method and the traditional method, it is fundamental to evaluate the child's behavior during dental care, as their expressions may indicate some discomfort and pain. These findings should be interpreted with caution, considering that nearly three-quarters of the included studies were at high risk of bias. Conclusion: Even with the absence of difference, electronic devices are promising, as they promote slow and controlled administration and result in safe and effective anesthesia, which is an alternative to clinical practice.Objetivo: Revisar sistematicamente a literatura sobre a efetividade do método computadorizado de anestesia odontológica em relação à dor, comportamento não colaborador e o medo/ansiedade em crianças e adolescentes em comparação com o método convencional. Materiais e métodos: Uma busca eletrônica foi realizada em cinco base de dados (Biblioteca Virtual em Saúde, Scopus, Embase, Pubmed e Web of Science) e que incluiu ensaios clínicos randomizados. A busca foi realizada em outubro de 2020 e atualizada em maio de 2021 e, não houve restrição de data ou idioma. A avaliação de risco de viés foi realizada usando a RoB 2 e, também foi realizada uma análise qualitativa. Resultados: Foram encontrados 3.518 estudos, e após a remoção das duplicatas, análise do título e resumo e, leitura completa, restaram 26 estudos incluídos. Destes, cinco avaliaram ansiedade/medo, doze avaliaram o comportamento durante a anestesia, e vinte e dois avaliaram a percepção de dor. Não foi observado diferença significativa na maioria dos estudos entre o uso do método computadorizado em comparação ao método tradicional para todos os desfechos analisados. Discussão: Apesar de não parecer haver diferença significativa na percepção de dor, no relato de medo/ansiedade e no comportamento entre o uso do método computadorizado em comparação ao método tradicional, é fundamental avaliar o comportamento da criança durante o atendimento odontológico pois suas expressões podem indicar algum desconforto e dor. Esses achados devem ser interpretados com cautela, considerando que quase três quartos dos estudos incluídos apresentaram alto risco de viés. Conclusão: Mesmo com a ausência de diferença, os dispositivos eletrônicos são promissores, visto que promovem uma administração lenta e controlada e resultam em uma anestesia segura e eficaz que coloca-se como alternativa a prática clínica