Reabilitação de paciente infantil com múltiplos dentes natais e oligodontia na dentição permanente

The objective of the present article is to report an uncommon case of a boy with history of 11 natal lost teeth, all belonging to the normal series of primary dentition, associated with absence of up to 21 permanent tooth germs. Such a condition resulted in the necessity for oral rehabilitation. Partial removable prostheses were used as a choice of treatment, and the patient will have to be constantly followed up so that new treatment approaches can be performed according to the patient’s development.O objetivo do presente artigo é reportar um caso incomum de um paciente infantil com história de 11 dentes natais extraídos, todos da série normal da dentição decídua, além de ausência de 21 germes da dentição permanente. Essa condição tornou necessária a reabilitação protética deste paciente. O tratamento de escolha foi a utilização de próteses parciais removíveis, e o paciente terá que ser constantemente acompanhado para que, conforme seu crescimento, novas alternativas de tratamento sejam utilizadas

Análise microestrutural do esmalte decíduo desmineralizado após escovação dentária in vitro

The aim of this study was to investigate, in vitro, the morphological characteristics of demineralized primary enamel subjected to brushing with a dentifrice with or without fluoride. In order to do so, 32 enamel blocks were divided in 4 different groups containing 8 blocks each. They were separately immersed in artificial saliva for 15 days. The experimental groups were: C - control; E - submitted to etching with 37% phosphoric acid gel (30 s); EB - submitted to etching and brushing 3 times a day with a non-fluoridated dentifrice; EBF = submitted to etching and brushing 3 times a day with a fluoridated dentifrice. The toothbrushing force was standardized at 0.2 kgf and 15 double strokes were performed on each block. After the experimental period, the samples were prepared and examined under SEM. The control group (C) showed a smooth surface, presenting scratches caused by habitual toothbrushing. The etched samples (E) exhibited different degrees of surface disintegration, but the pattern of acid etching was predominantly the type II dissolution. The brushed surfaces were smooth, with elevations which corresponded to the exposure of Tomes process pits and depressions which corresponded to interrod enamel. Particles resembling calcium carbonate were found in the most protected parts of the grooves. No morphological differences were observed between brushing with fluoridated (EBF) and non-fluoridated (EB) dentifrice. The results suggest that the mechanical abrasion caused by brushing demineralized enamel with dentifrice smoothes the rough etched surface, and the presence of fluoride does not cause morphological modifications in this pattern.O objetivo do estudo foi investigar as características morfológicas do esmalte decíduo desmineralizado submetido à escovação com dentifrício fluoretado ou não fluoretado. Para isto, 32 blocos de esmalte foram separados em 4 grupos diferentes, contendo 8 elementos cada que foram imersos em saliva artificial por 15 dias: C = controle; E = atacado com gel de ácido fosfórico a 37% por 30 segundos; EB = atacado e escovado 3 vezes ao dia com dentifrício não fluoretado; EBF = atacado e escovado 3 vezes ao dia com dentifrício fluoretado. A escovação foi padronizada em 0,2 kgf e 15 movimentos de vai-e-vem foram executados em cada bloco. Após o período experimental, as amostras foram preparadas e examinadas no MEV. O grupo controle (C) apresentou lisura superficial e riscos causados pela escovação habitual; as amostras atacadas (E) apresentaram diferentes graus de desintegração superficial, porém o padrão de ataque ácido foi predominantemente a dissolução do tipo II. As superfícies escovadas apresentaram-se alisadas, com exposição das elevações correspondentes aos processos de Tomes e as depressões de esmalte interprismático. Partículas semelhantes a carbonato de cálcio foram encontradas nas partes mais protegidas das depressões. Não houve diferença quando os grupos foram escovados com dentifrício fluoretado (EBF) e dentifrício sem fluoreto (EB). Os resultados sugerem que a abrasão mecânica da escovação com dentifrício sobre o esmalte desmineralizado alisa a superfície rugosa causada pelo condicionamento ácido e que a presença do fluoreto não altera morfologicamente este padrão

Pulpectomies with Iodoform Versus Calcium Hydroxide-Based Paste: A Preliminary Randomised Controlled Clinical Trial

Objective: To compare clinical and radiographical pulpectomy outcomes in primary teeth filled with different pastes. Material and Methods: The sample included thirty-eight teeth indicated for pulpectomy due to irreversible pulp inflammation or necrosis from thirty patients (2 to 9 years old). The first appointment comprised chemomechanical preparation (2.5% sodium hypochlorite), smear layer removal (6% citric acid), intracanal dressing and temporary restoration. Seven days later, teeth were randomly assigned to filling with iodoform (IP) or calcium hydroxide with zinc oxide (CHZO) based pastes and temporarily restored. Final restoration (composite resin) occurred at the 3rd appointment. Data from baseline, 6 and 12 months were analysed using descriptive and inferential statistics (p≤0.05). Results: The overall frequency of success was 63.6% (n=21), with no significant difference between groups (IP=62.5% n=10; CHZO=64.7% n=11, p=0.59). Multiradicular teeth, overfilled canals and teeth whose coronal restoration have been lost were significantly associated with failure (p=0.01, p=0.04 and p<0.001, respectively). Conclusion: After 12 months, both pastes showed similar outcomes and can be used as good options for pulpectomies in primary teeth. Moreover, tooth location, extent of the root canal filling, and integrity of final restoration during the follow-up influenced the outcome of pulpectomies

Knowledge of Dentists about Hypomineralization Enamel Defects: A Cross-Sectional Study

Objective: To evaluate a group of Brazilian dentists on their knowledge of Molar Incisor Hypomineralization (MIH) and Hypomineralized Second Primary Molars (HSPM) related to clinical aspects, consequences, and diagnostic criteria. Material and Methods: In this cross-sectional, the participants were invited by e-mail and Whatsapp® to answer a questionnaire about their knowledge of hypomineralization enamel defects (MIH/HSPM) on the Google Forms® platform. The questionnaire comprised eight questions about personal data and multiple-choice questions about their knowledge concerning clinical aspects, diagnostic criteria of MIH/HSPM and differential diagnosis through clinical images. Chi-square test was applied with the significance level set at 5%. Results: Most participants (n = 492; 91.1%) reported having knowledge about MIH/HSPM. The general dentists gave more incorrect answers (n = 40; 65.6 %;) about dental tissues affected by MIH/HSPM. Overall, 83.3% of the dentists gave the correct answer to which dentitions are associated with this condition. In addition, most dentists presented knowledge about the consequences related to possible fractures (n= 487; 90.2%) and about an increased risk of caries (n= 479; 88.9%) in the affected teeth.  Regarding the differential diagnosis performed through clinical images, most participants gave incorrect answers (p≤0.001). Conclusion: The participants presented knowledge about the dentition associated with this condition and possible consequences related to the teeth affected by MIH/HSPM; however, they showed difficulties concerning clinical diagnostic criteria

Pulpectomies with Iodoform Versus Calcium Hydroxide-Based Paste: A Preliminary Randomised Controlled Clinical Trial

Objective: To compare clinical and radiographical pulpectomy outcomes in primary teeth filled with different pastes. Material and Methods: The sample included thirty-eight teeth indicated for pulpectomy due to irreversible pulp inflammation or necrosis from thirty patients (2 to 9 years old). The first appointment comprised chemomechanical preparation (2.5% sodium hypochlorite), smear layer removal (6% citric acid), intracanal dressing and temporary restoration. Seven days later, teeth were randomly assigned to filling with iodoform (IP) or calcium hydroxide with zinc oxide (CHZO) based pastes and temporarily restored. Final restoration (composite resin) occurred at the 3rd appointment. Data from baseline, 6 and 12 months were analysed using descriptive and inferential statistics (p≤0.05). Results: The overall frequency of success was 63.6% (n=21), with no significant difference between groups (IP=62.5% n=10; CHZO=64.7% n=11, p=0.59). Multiradicular teeth, overfilled canals and teeth whose coronal restoration have been lost were significantly associated with failure (p=0.01, p=0.04 and p<0.001, respectively). Conclusion: After 12 months, both pastes showed similar outcomes and can be used as good options for pulpectomies in primary teeth. Moreover, tooth location, extent of the root canal filling, and integrity of final restoration during the follow-up influenced the outcome of pulpectomies

Proposal for the teaching of the chemical control of supragingival biofilm

The mechanical control of supragingival biofilm is accepted as one of the most important measures to treat and prevent dental caries and periodontal diseases. Nevertheless, maintaining dental surfaces biofilm-free is not an easy task. In this regard, chemical agents, mainly in the form of mouthwashes, have been studied to help overcome the difficulties involved in the mechanical control of biofilm. The aim of this paper was to discuss proposals for the teaching of supragingival chemical control (SCC) in order to improve dentists' knowledge regarding this clinical issue. Firstly, the literature regarding the efficacy of antiseptics is presented, clearly showing that chemical agents are clinically effective in the reduction of biofilm and gingival inflammation when used as adjuvant agents to mechanical control. Thus, it is suggested that the content related to SCC be included in the curricular grid of dental schools. Secondly, some essential topics are recommended to be included in the teaching of SCC as follows: skills and competencies expected of a graduate dentist regarding SCC; how to include this content in the curricular grid; teaching-learning tools and techniques to be employed; and program content

Reliability of Two Methods of Evaluation of the Apical Limit of Obturation of Root Canals of Primary Teeth: A Pilot Study

Objective: To verify the concordance in the evaluation of the apical limit of obturation (ALO) in filled root canals of primary teeth between digital and visual methods. Material and Methods: Twenty periapical radiographs of endodontically treated primary teeth were digitalized and evaluated by an endodontics specialist (E1), a PhD pediatric dentist (E2), and a MSc general dentist (E3). Calibrated evaluators (Kappa = 1.00) analysed the images in a light-isolated environment two times (D1 and D2) with a one-week interval between evaluations. ALO scores were categorized as overfilled, flush-filled and underfilled. Results: The intra-rater reliability between methods was 0.82 (D1) and 0.75 (D2) for E1, 0.93 (D1 and D2) for E2, and 0.94 (D1 and D2) for E3. Inter-rater reliability ranged from 0.71 (E1 × E3) and 1.00 (E1 × E2) for the visual method to 0.76 (E1 × E3) and 0.88 (E1 × E2) for the digital method. Spearman correlation coefficients showed a similar ranking among the evaluators. There was greater disagreement among the underfilled and ideal scores. For all evaluators, the digital method favoured the identification of the ideal score. Conclusion: Both methods are suitable for the determination of the ALO of filled primary teeth and can be used in clinical practice

Knowledge of Dentists about Hypomineralization Enamel Defects: A Cross-Sectional Study

Objective: To evaluate a group of Brazilian dentists on their knowledge of Molar Incisor Hypomineralization (MIH) and Hypomineralized Second Primary Molars (HSPM) related to clinical aspects, consequences, and diagnostic criteria. Material and Methods: In this cross-sectional, the participants were invited by e-mail and Whatsapp® to answer a questionnaire about their knowledge of hypomineralization enamel defects (MIH/HSPM) on the Google Forms® platform. The questionnaire comprised eight questions about personal data and multiple-choice questions about their knowledge concerning clinical aspects, diagnostic criteria of MIH/HSPM and differential diagnosis through clinical images. Chi-square test was applied with the significance level set at 5%. Results: Most participants (n = 492; 91.1%) reported having knowledge about MIH/HSPM. The general dentists gave more incorrect answers (n = 40; 65.6 %;) about dental tissues affected by MIH/HSPM. Overall, 83.3% of the dentists gave the correct answer to which dentitions are associated with this condition. In addition, most dentists presented knowledge about the consequences related to possible fractures (n= 487; 90.2%) and about an increased risk of caries (n= 479; 88.9%) in the affected teeth.  Regarding the differential diagnosis performed through clinical images, most participants gave incorrect answers (p≤0.001). Conclusion: The participants presented knowledge about the dentition associated with this condition and possible consequences related to the teeth affected by MIH/HSPM; however, they showed difficulties concerning clinical diagnostic criteria

Aspectos gerais da doença ulcerosa péptica - uma revisão sistemática da literatura: General aspects of peptic ulcerous disease - a systematic review of the literature

A doença ulcerosa péptica atinge cerca de 10% da população global e possui uma incidência anual de 0,1%-0,3%, com prevalência ao longo da vida chegando a 5%-10%. Os principais fatores de risco, apontados como etiologia da doença, são o uso abusivo e contínuo de anti-inflamatórios não esteroides (AINEs) e a infecção do trato gastrointestinal (TGI) pelo Helicobacter Pylori (HP). Em relação à fisiopatologia, o uso de AINEs está associado ao desenvolvimento de úlcera péptica devido à inibição da enzima COX-1 por estes fármacos, a qual é responsável pela produção basal de prostaglandinas, que são responsáveis pelo estímulo à produção de muco sobre a mucosa do TGI. Nesse sentido, a redução da produção de prostaglandinas resulta em queda da formação da barreira fisiológica do organismo frente ao ácido clorídrico, o que propicia a atuação do mesmo sobre o epitélio intestinal, predispondo-o à erosão e formação de úlceras. Por outro lado, a fisiopatologia envolvida na infecção por HP ainda não foi em elucidada; entretanto, acredita-se que a formação de úlceras estejam correlacionadas, principalmente devido ao quadro inflamatório causado pela infecção bacteriana. Dessa forma, o presente artigo objetiva reunir informações na literatura a respeito dos principais conceitos relacionados à doença ulcerosa péptica, abordando aspectos como epidemiologia, etiofisiopatologia, diagnóstico e tratamento