Impact of atraumatic restorative treatment associated with oral health educational strategy on dental anxiety of schoolchildren

Orientadores: Paula Midori Castelo, Taís de Souza BarbosaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Objetivo: Este estudo teve como objetivo avaliar o impacto do tratamento restaurador atraumático (ART, Atraumatic Restorative Treatment) associado à estratégia educativa em saúde bucal na ansiedade odontológica de escolares brasileiros. Material e Métodos: Setenta e oito estudantes com pelo menos um molar decíduo com cárie em dentina foram divididos em dois grupos: estratégia educativa em saúde bucal seguida do ART (GE+ART) e somente ART (GART). A estratégia educativa em saúde bucal consistiu de quatro sessões consecutivas, uma por semana. O ART foi realizado utilizando instrumentos manuais para abertura e limpeza da cavidade e ionômero de vidro de alta viscosidade para restauração. A ansiedade odontológica foi avaliada pelos aspectos cognitivo (versão modificada do Venham Picture Test, m-VPT), comportamental (versão modificada do Venham Anxiety Scale, m-VAS) e fisiológico (frequência cardíaca, FC; cortisol e alfa-amilase salivar, CS e AAS); no Dia 1 ¿ baseline, um dia antes do ART (Cs e AAS); Dia 2 ¿ no dia do tratamento, antes da estratégia (VPT-m), antes do ART (VPT-m, FC, CS e AAS), durante a explicação do procedimento (FC, VAS-m), no momento da escavação mais profunda (FC, m-VAS), no momento da restauração (FC, VAS-m) e após o ART (VPT-m, FC, CS e AAS). Os dados foram analisados utilizando os testes Shapiro-Wilk, Qui-quadrado independência/partição, Mann-Whitney/Kruskal-Wallis e Friedman/Wilcoxon. Resultados: As categorias "sem ansiedade" (VPT-m=0) e "comportamento relaxado" (VAS-m=0) foram as mais frequentes em todos os momentos para os grupos. Maior FC foi observada "antes do tratamento" do que nos outros momentos para os grupos. No GART, a FC média "durante a explicação do procedimento" foi similar ao primeiro registro, mas estisticamente maior que nas demais. O GART apresentou maior FC "durante a explicação do procedimento" e "no momento da escavação mais profunda" do que o GE+ART. No GART, foi observado maior concentração de AAS "antes do ART" do que "após o ART". Conclusões: Na amostra avaliada, a ansiedade odontológica no geral foi pequena e o ART foi bem aceito independente se precedido ou não pela estratégia em saúde bucal; entretanto certa antecipação ao tratamento foi observada em ambos os grupos, especialmente nas crianças que não foram submetidas à estratégiaAbstract: Aim: This study aimed to evaluate the impact of atraumatic restorative treatment (ART) associated with oral health educational strategy on dental anxiety of Brazilian schoolchildren. Material and Methods: Seventy-eight students with at least one primary molar with dentin caries lesion were divided in two treatment: oral health educational strategy followed by ART (GS+ART), and the other group was directly submitted to ART (GART). Oral health educational strategy consisted of four consecutive sessions, once a week. ART was performed using hand instruments for opening and cleaning the cavities and a high-viscosity glass-ionomer for restoration. Dental anxiety was assessed by measuring the cognitive (modified Venham Picture Test, m-VPT), behavioral (modified Venham Anxiety Scale, m-VAS) and physiological (heart rate, HR; salivary cortisol and alpha-amylase, SC and SAA), Day 1 ¿ baseline, a day preceding ART (SC and SAA); Day 2 ¿ day of treatment, before strategy (m-VPT), before ART (m-VPT, HR, SC, SAA), during the explanation of procedure (HR, m-VAS), at the moment of deepest excavation (HR, m-VAS), at the moment the restoration was applied (HR, m-VAS), after ART (m-VPT, HR, SC, SAA). Data were analyzed using Shapiro-Wilk, Chi-square independence/partition, Mann-Whitney/Kruskal-Wallis and Friedman/Wilcoxon tests. Results: The categories "without anxiety" (m-VPT=0) and "relaxed behavior" (m-VAS=0) were the most frequent in all moments for both groups. Higher HR was observed "before treatment" in comparison with the other moments for both groups. Moreover, in GART, mean of HR "during the explanation of procedure" was similar to the first record, but statistically higher than the others. GART had higher HR "during explanation of procedure" and "at the moment of deepest excavation" than their counterparts. In GART, SAA was significantly higher "before ART" than "after ART". Conclusions: Overall dental anxiety in the studied sample was found to be low and the ART was well accepted irrespective of preceded or not by OHES; however certain anticipation of the dental treatment was observed in both groups, especially in those children not submitted to OHESMestradoOdontopediatriaMestra em Odontologia162163/2014-22014/20464-4CNPQFAPES

Association of Oral Health-Related Quality of Life with the Longevity of ART-Restorations in Children

Objective: To evaluate the association of oral health-related quality of life (OHRQoL) with the longevity of ART-restorations in children after 18 months. Material and Methods: A longitudinal clinical study with 62 six- to seven-year-old children, both genders, 31 of whom underwent four weeks of oral health education strategy (OHES) followed by ART (GOHES+ART) and the others only ART (GART). The Brazilian short-version of the Child Perceptions Questionnaire (16-CPQ8-10) was used to evaluate the OHRQoL and the perception of change in oral health was assessed by a single question. Data was analyzed using Mann-Whitney, Wilcoxon and Friedman\u27s tests. Results: After 18 months, GOHES+ART reported a greater impairment on OHRQoL, mainly in oral symptoms domain (p<0.05). In this period, greater impairment of oral symptoms was reported in children with failed restorations and with treatment considered to have a minor failure (p<0.05). In inter-group analysis, the GOHES+ART, with 2 to 4 restorations, Class I, of small size, located in the upper arch and with a smaller failure, reported more oral symptoms than the GART. Conclusion: In the long-term, children submitted to OHES followed by ART reported more oral symptoms. Factors such as number, class, size and location of the restorations need to be considered for the implementation of an efficient and effective oral health program, as well as for greater longevity of ART-restorations

Association of Oral Health-Related Quality of Life with the Longevity of ART-Restorations in Children

Objective: To evaluate the association of oral health-related quality of life (OHRQoL) with the longevity of ART-restorations in children after 18 months. Material and Methods: A longitudinal clinical study with 62 six- to seven-year-old children, both genders, 31 of whom underwent four weeks of oral health education strategy (OHES) followed by ART (GOHES+ART) and the others only ART (GART). The Brazilian short-version of the Child Perceptions Questionnaire (16-CPQ8-10) was used to evaluate the OHRQoL and the perception of change in oral health was assessed by a single question. Data was analyzed using Mann-Whitney, Wilcoxon and Friedman's tests. Results: After 18 months, GOHES+ART reported a greater impairment on OHRQoL, mainly in oral symptoms domain (p<0.05). In this period, greater impairment of oral symptoms was reported in children with failed restorations and with treatment considered to have a minor failure (p<0.05). In inter-group analysis, the GOHES+ART, with 2 to 4 restorations, Class I, of small size, located in the upper arch and with a smaller failure, reported more oral symptoms than the GART. Conclusion: In the long-term, children submitted to OHES followed by ART reported more oral symptoms. Factors such as number, class, size and location of the restorations need to be considered for the implementation of an efficient and effective oral health program, as well as for greater longevity of ART-restorations