Aceitabilidade e conhecimento sobre remoção seletiva de tecido cariado de graduandos em odontologia e cirurgiões-dentistas

Aim: The aim of this study was to evaluate the acceptability and knowledge of undergraduate dental students and dentists on selective caries tissue removal (SCTR). Materials and Methods: Third- and fourth-year Dentistry undergraduates (Group 1) and graduates working in a Hospital Dentistry Center (Group 2) were included in the study. Participants anonymously and confidentially answered a validated questionnaire containing eleven questions on the diagnosis and management of deep caries lesions. Pearson’s Chi-square test and multivariate logistic regression compared the answers (p<0.05). Results: Total sample comprised 146 participants. Of these, 81.5% were female; 52.05% were graduates and the most prevalent age group was 18-29 years old (85.62%).  Sixty-nine participants chose stepwise caries removal (p=0.027). The logistic regression analysis showed statistically significant differences. The participants who considered pulp wall moist have approximately eight times more likelihood to choose an invasive treatment (p=0.028). Those who chose endodontic treatment as an option for two-year survival have three times more likelihood to choose an invasive treatment (p=0.032). Those who affirmed that the carious dentin close to the pulp should not be removed had almost three times more likelihood to choose minimally invasive treatments (p=0.031). Discussion: Studies with questionnaires can be useful tools to detect whether the students and dentists are following the most current evidences to treat deep carious lesions. Conclusion: The participants had certain level of knowledge on SCTR, but the technique acceptability lacked consensus.Objetivo: Avaliar a aceitabilidade e o conhecimento de estudantes de graduação em Odontologia e cirurgiões-dentistas sobre a remoção seletiva de tecido cariado (RSTC). Materiais e Métodos: Participaram do estudo graduandos do terceiro e quarto ano de Odontologia (Grupo 1) e egressos de um Centro Hospitalar de Odontologia (Grupo 2). Os participantes responderam de forma anônima e confidencial um questionário validado contendo onze questões sobre diagnóstico e manejo de lesões cariosas profundas. Teste qui-quadrado de Pearson e regressão logística multivariada foram aplicados (p<0.05). Resultados: A amostra total foi composta por 146 participantes. Destes, 81.5% eram do sexo feminino; 52.05% eram graduados e a faixa etária mais prevalente foi de 18 a 29 anos (85.62%). Sessenta e nove participantes escolheram o tratamento expectante (p=0.027). A análise de regressão logística mostrou diferenças estatisticamente significativas. Os participantes que consideraram a parede pulpar úmida têm aproximadamente oito vezes mais chances de escolha pelo tratamento invasivo (p=0.028). Aqueles que escolheram o tratamento endodôntico como opção de sobrevida em dois anos têm três vezes mais chances de optar pelo tratamento invasivo (p=0.032). Aqueles que afirmaram que a dentina cariada próxima à polpa não deveria ser removida tiveram quase três vezes mais chances de optar por tratamentos minimamente invasivos (p=0.031). Discussão: Estudos com questionários podem ser ferramentas úteis para detectar se estudantes e cirurgiões-dentistas estão seguindo as evidências mais atuais para o tratamento de lesões cariosas profundas. Conclusão: Os participantes tinham certo nível de conhecimento sobre RSTC, mas a aceitabilidade da técnica carecia de consenso

A randomized clinical trial of cavity liners after selective caries removal: one-year follow-up

Alternatives for the treatment of caries disease, such as minimally invasive approaches, have been developed in recent years. Objective: To carry out clinical and radiographic evaluations of three cavity liners after selective caries removal. Methodology: Thirty-six primary molars with deep occlusal caries lesions without pulp involvement (from children of both genders, aged between 5 and 8 years) were randomly divided into the following groups: calcium hydroxide cement (CHC) group; mineral trioxide aggregate (MTA) group and Portland cement with added zirconium oxide (PCZ) group. The following-up period was 6- and 12-month. The clinical and radiographic success rates were evaluated through chi-square test. The radiographic measurements were compared by ANOVA followed by Tukey's test (p<0.05). Results: Thirty-six patients were included, but thirty-four returned for 12-month follow-up. The overall success rate of the therapy for the three groups was 94.11% and no statistically significant differences occurred in the comparison among groups (p>0.05). Nineteen radiographs were selected to measure the dentin barrier thickness. The intragroup comparison presented a statistically significant increase of the dentin barrier for all groups, at 12-month follow-up. However, the MTA group showed increase of the dentin barrier, over time, 6- to 12-month follow-up. The intergroup comparison revealed no statistically significant differences (p>0.05). Conclusion: The clinical and radiographic data showed that all cavity liners provided effective treatment of primary teeth after selective caries removal

Oral health-related quality of life of children with oral clefts and their families

Abstract Oral health problems can influence people's Quality of Life (QoL) because of pain, discomfort, limitations, and other esthetics problems, affecting their social life, feeding, daily activities, and the individual's well-being. Objective: To compare oral health-related quality of life (OHRQoL) of children with and without oral clefts and their families. Materials and Methods: 121 children aged from 2 to 6 years, from both sexes, enrolled in the treatment routine of the Pediatric Dentistry Clinics of a Dental School and a Hospital for Cleft Treatment were divided into two groups: Group 1 - children with cleft lip and palate; Group 2 - children without cleft lip and palate. The OHRQoL was assessed using the validated Portuguese version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). The questionnaire was answered individually, only once, at a private place. Mann-Whitney U test was used to verify differences between groups. Spearman's Rho test was used to associate sex and age with quality of life. The level of significance was set at 5% (

Growth analysis of palatal shelves between pre-cheiloplasty and pre-palatoplasty stages

Introduction: The treatment of cleft lip and palate patient must be efficient with minimal damage to facial growth and satisfactory speech result, achieving the psychosocial rehabilitation of the patient. However, the cleft causes distinct levels of change on maxillary growth pattern either by the effect of the defect itself or the rehabilitative process. Generally, study casts, photographs and tridimensional images have been used to evaluate the growth. 3D scanner devices for digitizing study models allow the obtainment of the measurement of the deepness and inclination of palatal shelves and facilitate the study logistic with the reliability of the results. Objective: The aim of this study was to evaluate the size of palatal shelves at two distinct stages: prior to cheiloplasty (stage 1) and prior to palatoplasty (stage 2) in complete unilateral cleft lip and palate patients. Methods: Dental casts from 267 patients with unilateral cleft lip and palate. The palatal shelves were measured at two stages through the scanned images of the casts, by using Adobe Photoshop CS2 software. The measurements of palatal shelves were compared between stage 1 and stage 2. Results: There were an increase of size of palatal shelves in 159 patients (59.5%), a decrease of size of palatal shelves in 102 patients (38.2%), and in 6 patients (2.2%) there were no changes of the sizes. In average, the size of increase of palatal shelves was 0.21 cm; the decrease was 0.15 cm. Conclusion: Considering the small numeric difference, the results suggested that there were no clinical differences in the size of palatal shelves between stage 1 (prior to cheiloplasty) and 2 (prior to palatoplasty).FAPESP 2012/1465

Quality of life in children with cleft lip and palate: pilot study

Objects: The quality of life and oral health of cleft lip and palate children has gain increasingly interest because oral disorders may present negative effect on the quality of life of these individuals. Accordingly, questionnaires aiming to evaluate the impact of oral health on the well-being have been developed and adapted. The present study aimed to evaluate the quality of life and oral health (CPQ8-10) of cleft lip and palate children. Methods and results: Forty-two children were selected, aging from 8 to 10 years-old, at mixed dentition. The children selected were divided into groups according to the type of cleft: Group I - Cleft Lip (n = 7); Group II - Cleft Lip and Palate (n=28); Group III - Cleft Palate (n=7). Each child filled in a questionnaire about the impact of oral disease on quality of life (CPQ8-10). Generally, Group I children affirmed that their teeth are "very good" = 28.57%, and "good" = 42.85%. The participants of Group II and III reported "a little" = 42.5% and 57.14%, respectively, with a greater discomfort with their dental conditions. Concerning to the halitosis perception, Group III exhibited the highest percentage ("sometimes" = 42.85%), followed by Group II ("sometimes" = 32.14%) and Group I ("sometimes" = 14.28%). Conclusion: The pilot study conduction was satisfactorily and the methodology is recommended for a larger sample. To date, it is suggested that the cleft type did not influence on the perception of the patients regarding to the quality of life

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Operating microscope for caries diagnosis in children with cleft lip and palate

O presente estudo teve como objetivo comparar o microscópio operatório e um aparelho de fluorescência óptica como método de diagnóstico de lesões de cárie dentária em pacientes com fissura labiopalatina por meio da classificação do sistema ICDAS-II. Foram selecionadas para amostra 352 faces dentárias dos dentes localizados na região da fissura labiopalatina de 73 crianças entre 6 a 12 anos (média de 10 anos e 8 meses), em fase de dentadura mista, com fissura transforame unilateral (direita ou esquerda), fissura transforame bilateral, fissura pré-forame completa unilateral (direita ou esquerda), fissura pré-forame completa bilateral. Os dentes adjacentes à área da fissura labiopalatina foram observados de acordo com os seguintes grupos: exame clínico visual-tátil (Grupo 1), exame clínico visual-tátil em microscópio operatório (Grupo 2), exame visual com aparelho de fluorescência (Grupo 3). Antes dos exames, as superfícies dos dentes foram previamente limpas com uso de fio dental e profilaxia com pedra pomes, tergentol, escova de Robinson e auxílio de uma sonda tipo OMS. Primeiramente sob a luz de um refletor, após secagem de cinco segundos com seringa tríplice os dentes foram avaliados pelo exame clínico visual-tátil convencional (Grupo 1). Imediatamente após, o mesmo dente foi examinado por meio do exame visual-tátil em microscópio operatório (Grupo 2) e pelo exame com o aparelho de fluorescência (Grupo 3). Em todos os exames, os códigos do sistema ICDAS-II foram utilizados por dois examinadores previamente treinados e calibrados. Para análise da reprodutibilidade interexaminador foram obtidas as medidas de 103 faces por 2 avaliadores e realizado o teste Kappa. A comparação entre os métodos de diagnóstico e da porcentagem de cada escore do sistema ICDAS-II entre os métodos foi realizada utilizando-se, respectivamente, os testes de Friedman e Qui-quadrado com nível de significância de 5%. Não houve diferenças estatisticamente significativas entre os tipos (P=0,214) e eficácia (P=0,725) dos métodos de diagnóstico para os diferentes escores do sistema ICDAS-II. O exame por meio do microscópio operatório e do aparelho de fluorescência não foi mais eficaz que o exame clínico visual-tátil na detecção de lesões de cárie nos dentes próximos a área da fissura labiopalatina. Novos estudos envolvendo amostras com maiores prevalências de lesões de cárie dentária são necessários para verificar a eficácia das novas tecnologias.The aim of this study was to compare the operating microscope and optical fluorescence device as diagnosis methods of caries lesions in cleft and lip palate patients through ICDAS-II system. Three-hundred and fifty-two labial, palatal, mesial and distal surfaces of the teeth closest to the cleft area of children aging 6-12 years-old (mean of 10 years and 8 months-old) at mixed dentition, with complete unilateral cleft lip and palate (right or left), complete bilateral cleft lip and palate, unilateral cleft lip and alveolus (right or left) and bilateral cleft lip and alveolus were assessed. The teeth closest to cleft area were observed according to the following groups: visual-tactile examination (Group 1), visual-tactile examination with the aid of operating microscope (Group 2), visual examination with the aid of fluorescence device (Group 3).Prior to the assessments, dental surfaces were cleaned by dental floss and dental prophylaxis with pumice and tergentol with the aid of a rubber cup and a WHO dental probe. Firstly, under light and after 5-second air-drying, the surfaces were evaluated by unaided visual-tactile clinical examination (Group 1). Immediately after, the same surfaces were examined by visual-tactile clinical examination with the aid of operating microscope (Group 2) and optical fluorescence device (Group 3). In all assessments, ICDAS-II scores were used by two examiners previously calibrated and trained and inter-examiner agreement was obtained by Kappa test in 103 surfaces. The comparison among diagnosis methods and of the percentage of each ICDAS-II score among the methods was respectively performed by using Friedman and Chi-square tests with level of significance of 5%. No statistically significances were detected among the types (P=0.214) and effectiveness (P=0.725) of the different diagnosis methods for the different ICDAS-II scores. The operating microscope and optical fluorescence examinations were not more effective than unaided visual-tactile clinical examination of teeth closest to cleft area. Further studies comprising greater prevalence of caries lesions are necessary to verify the effectiveness of these new technologies