Association among early childhood caries, microbiological composition of dental biofilm, diet, oral hygiene and socioeconomic factors in preschoolers aging 36 to 48 months

Orientador: Marines Nobre dos Santos UchoaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A prevalência da cárie precoce da infância (CPI) no Brasil é alta e sua severidade aumenta com a idade. Assim, métodos sensíveis para o diagnóstico precoce e a identificação de indicadores de risco são importantes para o controle desta doença. Essa dissertação, constituída por três artigos teve como objetivos: (1) revisar sistematicamente os trabalhos que evidenciaram associação entre os níveis de estreptococos do grupo mutans (SM) e a prevalência e progressão da CPI; (2) investigar a prevalência da CPI em pré-escolares após inclusão das lesões de mancha branca (LMB) no critério de diagnóstico e a influência destas lesões no perfil epidemiológico da população estudada; (3) identificar os principais indicadores de risco da CPI através da avaliação dos fatores microbiológicos, dietéticos, sociais e hábitos de higiene bucal, considerando os estágios de desenvolvimento da doença. No levantamento dos artigos da revisão (1951-2007) foram utilizadas as bases de dados: Pubmed, Scopus e Cochrane. Na realização dos estudos dois e três utilizou-se uma amostra constituída de 351 e 169 crianças, respectivamente. Estes pré-escolares, de 36-48 meses e ambos os gêneros, freqüentavam creches e pré-escolas municipais de Itatiba-SP. Os exames clínicos para determinação do índice de cárie foram realizados com auxílio de gaze, sonda e espelho sob luz artificial. No terceiro estudo as crianças foram divididas em 3 grupos experimentais (livres de cárie, LMB, lesões de cárie cavitadas). Para a avaliação da dieta foi empregado um diário, enquanto higiene bucal, renda familiar, etnia e escolaridade foram avaliados por questionário. A coleta do biofilme de todas as superfícies dentárias vestibulares e palatinas foi realizada com auxílio de alças esterilizadas (1 µl) para padronizar a quantidade removida. Técnicas quantitativas de cultura microbiológica foram empregadas para determinar o número de colônias de SM, microrganismos totais (MT) e lactobacilos (LB). Os dados da revisão foram avaliados qualitativamente, enquanto aqueles inerentes aos estudos dois e três foram analisados pelo teste t-pareado e pela regressão logística múltipla, respectivamente (_=0,05). Dos 119 artigos levantados na revisão, 16 foram avaliados e apenas 1 alcançou alto nível de evidência científica. No estudo dois, o índice de cárie aumentou significativamente (p<0,05) com a inclusão das LMB, que predominaram na maioria dos dentes, principalmente nas superfícies lisas livres. No terceiro estudo, dentre os indicadores de risco analisados, os mais significativos para o desenvolvimento de LMB foram: altos níveis de SM (OR=2,3, CI=1,01-5,14), alta freqüência diária de consumo de açúcar total (OR=5,4, CI=1,42-20,88) e presença de biofilme nos incisivos superiores (OR=2,3, CI=1,01-5,14). Os fatores significativos para a progressão da CPI foram: altos níveis de MT (OR=4,6, CI=1,56-13,74) e presença de LB (OR=20,3, CI=4,03-102,51). Através da revisão foi concluído que os níveis de SM são um forte indicador de risco para a CPI; entretanto, estudos longitudinais com maiores níveis de evidência científica são necessários para que os níveis de SM sejam apontados como fortes fatores de risco. As conclusões dos estudos dois e três revelaram que a inclusão das LMB no diagnóstico da cárie possibilitou a identificação precoce de pré-escolares de risco à cárie e o direcionamento de medidas preventivasAbstract: The prevalence of early childhood caries (ECC) in Brazil is high and its severity increases with age. This way, sensitive methods for the early caries diagnosis and risk indicators identification are important for the disease control. This thesis, comprised by three manuscripts, aimed: (1) to undertake a systematic review of studies which have evidenced the association between mutans streptococci (MS) levels and the prevalence and progression of the ECC; (2) to investigate the increase of caries prevalence in young children after the inclusion of early caries lesions (ECL) to WHO thresholds caries detection and the influence of these lesions in the epidemiological profile of the studied population; (3) to identify the main risk indicators of the ECC, with regards to the microbiological, dietary and social factors, as well as oral hygiene habits, considering the development stages of dental caries. In the review, Pubmed, Scopus and Cochrane Library databases were searched for papers (1951-2007). In studies two and three the sample comprised 351 and 169 children, respectively. These preschoolers, aging 36 to 48 months, from both genders, attended public nurseries and preschools in the city of Itatiba-SP. The clinical examinations for caries index determination were performed using gauze, probe and mirror under artificial light. In the third study, the children were divided in three experimental groups (caries free, ECL and cavitated lesions). A chart was employed for the diet evaluation whereas oral hygiene, family income, ethnicity and education level were assessed by a questionnaire. Dental biofilm was collected from all buccal and lingual surfaces with a sterilized handle (1 µl) in order to standardize the amount removed. Quantitative microbiological culture techniques were performed to determine the number of mutans streptococci (MS) colonies and total microorganisms (TM) and lactobacilli (LB) counts. The review data were appraised trough qualitative analyses; the data from studies two and three were statistically analyzed by paired t-test and multiple logistic regression, respectively (_=0.05). Out of the 119 articles yielded in the review, 16 were appraised and only one article has achieved high value as evidence. In study two, the caries index has significantly increased (p<0.05) when the ECL were included; these ECL were the predominant caries lesion in the majority of the teeth, particularly on smooth surfaces. In the third study, among all risk indicators studied, the statistically significant indicators associated with ECL development were: high levels of MS (OR=2.3, CI=1.01-5.14), high daily frequency of total sugar consumption (OR=5.4, CI=1.42-20.88) and biofilm presence on maxillary incisors (OR=2.3, CI=1.01-5.14). The significant factors associated with ECC progression were: high levels of TM (OR=4.6, CI=1.56-13.74) and lactobacilli presence (OR=20.3, CI=4.03-102.51). From the review it was concluded that MS levels are a strong risk indicator for early childhood caries; however, longitudinal studies with high levels of scientific evidence are required to point out MS levels as a remarkable ECC risk factor. From studies two and three it was concluded that the inclusion of ECL in the caries diagnosis allowed the earlier identification of caries risk preschoolers and targeting of preventive measuresMestradoOdontopediatriaMestre em Odontologi

Synthesis of Highly Functionalized Allylic Alcohols from Vinyl Oxiranes and N‑Tosylhydrazones via a Tsuji−Trost-Like “Palladium−Iodide” Catalyzed Coupling

An unprecedented efficient palladium(0)-catalyzed reaction of vinyl oxiranes with N-tosylhydrazones, affording “skipped” allylic alcohols in total regioselectivity and stereoselectivity, with excellent functional-group compatibility, is reported. In this Tsuji–Trost-like allylation, we propose the use of N-tosylhydrazones as a synthetic equivalent of α-styryl anions. More than 20 new products are described, including naturally occurring derivatives. A catalytic system involving an iodide (I–) source is necessary to sustain the catalytic cycle

Infant and child oral health risk status correlated to behavioral habits of parents or caregivers: a survey in central Italy

Aim: The aim of this survey was to evaluate the knowledge and awareness of parents and caregivers about potential oral health risk factors for their children in their first months of life (3–30 months). Materials and Methods: The participation to the survey was proposed to all parents or caregivers of children attending the public consulting service in Latina for mandatory vaccinations during the period of June to August 2014. A self-administered questionnaire was completed to obtain information regarding demographic variables, infant feeding practice, maternal oral health during and after pregnancy, children’s oral hygiene habits and risk behaviors (e.g., sharing cutlery, tasting of baby food, nightly using of baby bottles with sugared beverages, or sugared pacifier), and knowledge about caries and its transmission. The analysis of the data was performed using SPSS 14.0 for Windows (SPSS Inc., Chicago, IL, USA). The variance analysis and chi-square test were used to investigate the relationship between the variables. Results: Overall, the parents of 304 children consented to fill the questionnaire. Data analysis showed that about 50% of respondents considered dental caries an infectious disease, however, 53.6% was not aware of the potential vertical transmissibility of cariogenic bacteria through contaminated saliva. It is a common trend in the early stages of weaning to taste the baby food (53%) and sharing cutlery (38.5%). With regard to children oral health care, parents reported no toothbrushing for 53.1% of the children in their first 3 years of life. The relationship between the two variables concerning caries transmissibility and tools sharing carried out on through Pearson chi-square test identified P = 0.32. Conclusions: From this survey, the need for parental oral health promoting program emerged to control children oral health risk status