Sinais e sintomas da erupção dos dentes decíduos : uma revisão sistemática e meta-análise

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, Florianópolis, 2015.O objetivo da pesquisa foi estimar a prevalência de sinais e sintomas locais e sistêmicos durante a erupção dos dentes decíduos. Realizou-se busca eletrônica nas bases de dados: LILACS, PubMed, ProQuest, Scopus e Web of Science e busca parcial da literatura cinzenta através do Google Scholar. As listas de referências dos estudos incluídos foram analisadas buscando artigos que inadvertidamente tenham sido excluídos nas buscas eletrônicas. Baseado na estratégia PECOS, foram incluídos estudos observacionais que verificaram a ocorrência de sinais e sintomas durante a erupção dos dentes decíduos através de relato de sintomas pelos pais e medida de temperatura corporal, além da análise clínica do dente em erupção, em crianças de 0-36 meses. A extração dos dados dos artigos selecionados foi realizada por dois revisores de forma independente. As informações foram conferidas para confirmar a precisão. O processo de seleção ocorreu em duas fases. Do total de 1.179 documentos identificados, 16 estudos foram incluídos. A análise qualitativa foi realizada através da avaliação do risco de viés dos estudos incluídos, enquanto a síntese quantitativa foi realizada através de meta-análise. A heterogeneidade encontrada entre os estudos nas meta-análises variou de 93,01 a 99,75% (pAbstract : Symptoms associated with the primary tooth eruption have been extensively studied but it is still controversial. The objective of the study was to to assess the occurrence of local and systemic signs and symptoms during primary tooth eruption through a systematic review. LILACS, PubMed, ProQuest, Scopus and Web of Science were searched. A partial grey literature search was taken using Google Scholar and the reference lists of the included studies were scanned. Observational studies assessing the association of eruption of primary teeth with local and systemic signs and symptoms in children aged 0-36 months were included. Two authors independently collected the information from the selected articles. Information was crosschecked and confirmed for its accuracy. A total of 1,179 papers were identified and after a 2-phase selection 16 studies were included. The qualitative analysis was performed by assessing the risk of bias of the included studies, while quantitative synthesis was performed by meta-analysis. The heterogeneity found among studies in the meta-analysis ranged from the 93.01 to 99.75% (p <0.0001), a random model was used. Overall prevalence of signs and symptoms occurring during primary tooth eruption in children between 0-36 months was 70.5% (total sample=3506 95% CI 54,19 a 84,62). Gingival inflammation (86.81%), irritability (68.19%) and drooling (55.72%) were the most frequent ones. As limitations, different general symptoms were considered among studies. Some studies presented: lack of confounding factors, use of subjective measures and examinations in long intervals. It was concluded that the prevalence of signs and symptoms during the eruption of primary teeth was high. There was no occurrence of fever during the eruption of primary teeth, but a slight increase of body temperature

Methodologic quality and risk-of-bias in systematic reviews of healthcare interventions: a review of methods

OBJECTIVE: To compare the characteristics of systematic reviews of healthcare interventions that assessed or did not methodologic quality/risk-of-bias of included studies. Additionally, to analyze methodologic features of those assessing the methodologic quality/risk-of-bias. METHODS: PubMed database was searched. From 25,571 systematic reviews retrieved, a random sample of 1,025 was screened. Frequencies were used to describe outcomes. Unadjusted and adjusted logistic regressions were performed to test the associations with methodologic quality/risk-of-bias results assessment. In a second analysis, systematic reviews that assessed methodologic quality/risk of bias were dichotomized according to the design of included studies (randomized clinical trials-only versus non-randomized studies of intervention or a combination of both). RESULTS: 303 systematic reviews were fully analyzed. Methodologic quality/risk of bias was assessed by 278 (92%). Methodologic quality/risk-of-bias assessment was associated with a higher number of databases searched (>4, P= 0.008), the presence of meta-analysis (P= 0.005), and the design of included studies (randomized clinical trials-only, P= 0.042). The chance of using a suitable tool and a tool designed for risk-of-bias assessment rather than methodologic quality was higher for randomized clinical trials-only systematic reviews (P4). The most used tool was Cochrane’s RoB Tool, with no clearly defined rating system. Methodologic quality/risk-of-bias assessment methods description, results, and impacts on meta-analysis, the certainty of evidence, and systematic reviews’ results are still to be consistently addressed.

Eficácia e eventos adversos da articaína 4% comparada à lidocaína 2% para exodontia de molares decíduos: ensaio clínico randomizado

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, Florianópolis, 2019.O objetivo desse trabalho foi verificar a eficácia e os eventos adversos da articaína a 4% com epinefrina 1:100 000 (teste) comparada à da lidocaína a 2% com epinefrina 1:100 000 (controle) na eficácia anestésica para exodontia de molares decíduos. Foi realizado um estudo clínico randomizado paralelo, triplo-cego, com geração da sequência de randomização dos grupos de tratamento feita por computador. Foram incluídas 43 crianças de 6 a 10 anos de idade com indicação clínica e radiográfica de extração de molar decíduo. As crianças incluídas no estudo foram distribuídas em 2 grupos: grupo teste (n=21) - exodontia de molar decíduo precedida por anestesia com solução anestésica articaína 4% 1:100 000 com epinefrina aplicada por técnica infiltrativa e grupo controle (n=22) - exodontia de molar decíduo precedida por anestesia com solução anestésica lidocaína 2% 1:100 000 epinefrina aplicada por técnica infiltrativa. O desfecho primário foi dor avaliada em dois momentos: durante a injeção anestésica e durante a extração dentária. O instrumento utilizado para avaliar a dor auto-relatada pela criança foi a Faces Pain Scale - Revised (FPS-R). Os desfechos secundários foram (a) o início do efeito anestésico (em minutos); (b) o tempo de duração do efeito anestésico (horas); (c) a presença de eventos adversos, e (d) a percepção da criança sobre a experiência de exodontia.. As crianças foram tratadas nas clínicas odontológicas da universidade entre dezembro de 2018 e junho de 2019. Nenhuma criança foi excluída da análise. A solução de articaína a 4% tem eficácia anestésica semelhante à de lidocaína a 2% na exodontia de molar decíduo quando aplicada pela técnica infiltrativa (ß - 0,47; IC95% -3,19 a 2,24; p = 0,76), porém as crianças relataram maior média de dor durante a injeção do líquido anestésico quando foi utilizada a articaína (ß 2,43; IC 95% 0,28 a 4,57; p = 0,02). Dor pós-operatória, edema e náusea foram observados sem diferenças entre os grupos. Concluiu-se que não há diferença na eficácia anestésica da articaína em comparação à lidocaína na extração de molares decíduos. A solução de articaína foi mais dolorosa durante a injeção. O protocolo do ensaio clínico pode ser acessado via REBEC (Registro Brasileiro de Ensaios Clínicos) sob número RBR-93djd9. Financiamento: UFSC, CAPES, FAPESC.Abstract: The aim of this study was to verify the efficacy and adverse events of 4% 1: 100,000 epinephrine articaine (test) compared to 2% 1: 100,000 epinephrine (control) lidocaine on anesthetic efficacy for primary molar extraction. We conducted a parallel; triple-blind randomized clinical trial with computer-generated randomization of treatment groups. We included 43 children aged 6 to 10 years with clinical and radiographic indications of primary molar extraction. The children included in the study were divided into 2 groups: test group - primary molar extraction preceded by anesthesia with 4% articaine anesthetic solution 1: 100 000 with epinephrine applied by infiltrative technique and control group - primary molar extraction followed by anesthesia with solution 2% lidocaine anesthetic 1: 100,000 epinephrine applied by buccal infiltrative technique. The primary outcome was pain assessed at two moments: during anesthetic injection and during tooth extraction. The instrument used to assess the child's self-reported pain was the Faces Pain Scale - Revised (FPS-R). Secondary outcomes were (a) the onset of anesthetic effect (in minutes); (b) the duration of anesthetic effect (hours); (c) the presence of adverse events; and (d) the child's perception of the extraction experience. The children were treated at the university dental clinics between December 2018 and June 2019. No children were excluded from the analysis. The 4% articaine solution has anesthetic efficacy similar to 2% lidocaine in primary molar extraction when applied by the infiltrative technique (ß -0.47; 95% CI -3.19 to 2.24; p = 0.76), however, children reported higher average pain during anesthetic fluid injection when articaine was used (ß 2.43; 95% CI 0.28 to 4.57; p = 0.02). Postoperative pain, edema, and nausea were observed without differences between the groups. It was concluded that there is no difference in anesthetic efficacy of articaine compared to lidocaine in primary molar extraction. Articaine solution is more painful during the injection. The clinical trial protocol can be accessed via REBEC (Brazilian Registry of Clinical Trials) under number RBR-93djd9. Financing: UFSC, CAPES, FAPESC

Prevalence of bruxism in children and adolescents with neurodevelopmental disabilities: a systematic review.

Bruxism is defined as a masticatory muscle activity during sleep or wakefulness and is not characterized as a disorder in otherwise healthy individuals. Its prevalence varies from 3.45% to 49.6% in children but appears to be more common in children with developmental disabilities than children without disabilities