ABSTRACT Objective: The aim was evaluate the validity and reproducibility of the International Caries Detection and Assessment System (ICDAS) in detecting occlusal caries among graduate students ...after training using the e-learning program. Methods: A sample of forty-two primary teeth with different ranges of occlusal caries was selected. All teeth were mounted on a wax support and standardized photographs (EOS Rebel XTI, Canon, NY, USA) of the occlusal surfaces were taken. An experienced researcher randomly selected one specific site on the occlusal surface of each tooth to be examined later. Fifteen graduate students with no previous experience in the ICDAS scores completed the ICDAS e-learning program in Portuguese. After the training, visual examination of the occlusal surfaces was taken twice, independently, with a two-week interval. After visual examination, the teeth were longitudinally sectioned 1mm away from the previously selected occlusal site. The teeth were fixed on a wax support and photographed. Histological analysis was performed from these photographs by an experienced researcher to evaluate the depth of demineralization. Results: The Intraclass Correlation Coefficient (ICC) inter-examiner values among all participants varied from 0.54 to 0.96 and intra-examiner ICC reproducibility of the examiners ranges from 0.61 to 0.85, showing good to excellent reproducibility. For detection of enamel and dentine lesions (D1), ICDAS obtained sensitivity 0.835 and specificity 0.756. For dentine lesions (D3), the method revealed an increase in sensitivity but specificity was similar to D1. Conclusion: ICDAS e-learning training program was efficient for the training of caries lesions detection among graduate students.
RESUMO Objetivo: O objetivo foi avaliar a validade e a reprodutibilidade do Sistema Internacional de Detecção e Avaliação de Cárie (ICDAS) na detecção de cárie oclusal entre estudantes de pós-graduação após o treinamento usando o programa de e-learning. Métodos: Foi selecionada uma amostra de 42 dentes decíduos com diferentes faixas de cárie oclusal. Todos os dentes foram montados em um suporte de cera e foram tiradas fotografias padronizadas (EOS Rebel XTI, Canon, NY, EUA) das superfícies oclusais. Um pesquisador experiente selecionou aleatoriamente um local específico na superfície oclusal de cada dente para ser examinado posteriormente. Quinze estudantes de pós-graduação sem experiência anterior com o ICDAS concluíram o programa de e-learning em português. Após o treinamento, o exame visual das superfícies oclusais foi realizado duas vezes, independentemente, com intervalo de duas semanas. Após o exame visual, os dentes foram seccionados longitudinalmente a 1mm do local oclusal previamente selecionado. Os dentes foram fixados em um suporte de cera e fotografados. A análise histológica foi realizada a partir dessas fotografias por um pesquisador experiente para avaliar a profundidade da desmineralização. Resultados: Os valores interexaminadores do Coeficiente de Correlação Intraclasse (ICC) entre todos os participantes variaram de 0,54 a 0,96 e a reprodutibilidade intra-examinador do ICC dos examinadores variou de 0,61 a 0,85, mostrando reprodutibilidade boa a excelente. Para detecção de lesões de esmalte e dentina (D1), o ICDAS obteve sensibilidade 0,835 e especificidade 0,756. Para lesões de dentina (D3), o método revelou um aumento na sensibilidade, mas a especificidade foi semelhante ao D1. Conclusão: O programa de treinamento em e-learning do ICDAS foi eficiente no treinamento de detecção de lesões de cárie em estudantes de pós-graduação.
Abstract Background Polymorphisms in genes related to enamel formation and mineralization may increase the risk of developmental defects of enamel (DDE). Aim To evaluate the existing literature on ...genetic polymorphisms associated with DDE. Design This systematic review was registered in the PROSPERO (CRD42018115270). The literature search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and in the gray literature. Observational studies assessing the association between DDE and genetic polymorphism were included. The Newcastle–Ottawa Scale was used to assess the risk of bias. Results One thousand one hundred and forty‐six articles were identified, and 28 met the inclusion criteria. Five studies presented a low risk of bias. Ninety‐two genes related to enamel development, craniofacial patterning morphogenesis, immune response, and hormone transcription/reception were included. Molar–incisor hypomineralization (MIH) and/or hypomineralization of primary second molars (HPSM) were associated with 80 polymorphisms of genes responsible for enamel development, immune response, morphogenesis, and xenobiotic detoxication. A significant association was found between the different clinical manifestations of dental fluorosis (DF) with nine polymorphisms of genes responsible for enamel development, craniofacial development, hormonal transcription/reception, and oxidative stress. Hypoplasia was associated with polymorphisms located in intronic regions. Conclusion MIH, HPSM, DF, and hypoplasia reported as having a complex etiology are significantly associated with genetic polymorphisms of several genes.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract Objective: To identify the clinical and radiographic conditions associated with failure of pulp therapy in primary teeth through a survival analysis. Material and Methods: A total of 1000 ...records of children assisted at the pediatric dentistry clinic of the Federal University of Parana, Brazil, from the years 2000 to 2010, were analyzed. The mean evaluation time was 10.61 months (minimum/maximum: 1/28) from the report of pulp therapy. The different types of treatments analyzed included indirect pulp treatment (IPT), direct pulp treatment (DPT), pulpotomy and pulpectomy. The Kaplan-Meyer method and log-rank test were used for the survival analysis. Exodontia was considered as the outcome variable and censors included: traumatic tooth loss, presence of the tooth in the oral cavity and physiologic tooth exfoliation. Results: A total of 122 records reporting pulp therapy in the primary teeth were selected. From this, 16 teeth (13.12%) were extracted. Survival analysis showed that pulpectomy presented lower survival rates when compared to conservative therapies (p=0.0297). Teeth with furcal lesions and pathological root resorption before pulp therapy had lower survival rates when compared to those that did not present these conditions (P=0.006). Presence of fistula and abscess after pulp therapy were also associated with lower survival rates (P=0.0062 and 0.0143, respectively). Conclusion: Signals of pulp necrosis were associated to lower survival rates in primary teeth submitted to pulp therapy.
The aim of this study was to evaluate the prevalence evolution rate of MIH (molar-incisor hypomineralization) after a 6-year period in Araraquara/SP, Brazil. This population-based study evaluated MIH ...in 545 schoolchildren (6–12 years of age) and other associated alterations, dental caries and dental fluorosis (DF). A semistructured questionnaire was sent to the schoolchildren’s parents/guardians with the purpose of identifying the socioeconomic profile. Associations between MIH and the clinical characteristics were analyzed by the Poisson analysis of regression with robust variance, estimating the RPc (crude prevalence ratio) with CI 95%. The level of significance of 5% was adopted. The MIH prevalence in Araraquara/SP in 2016 was 14.3% (n = 78), and at this time, an increase of 2% was observed, in comparison with the data of the first prevalence study conducted in 2010 (12.3%). The mild degree compromise was the most prevalent diagnosis in the affected teeth (82.0%). Among children with MIH, the mean number of affected teeth was 2.78. Of the total number of children with MIH, 32.0% presented alterations in both first permanent molars and permanent incisors. There is no significant association between MIH and dental caries experience on permanent dentition (PRc = 1.141; CI 95% 0.709–1.835) or on primary dentition (PRc = 1.132; CI 95% 0.749–1.709). Children with MIH presented significantly less prevalence of dental fluorosis (PRc = 0.505; CI 95% 0.268–0.950). There is no association between MIH and monthly Brazilian minimal wage income (PRc = 1.130; CI 95% 0.655–1.949). It was concluded that the number of MIH cases had increased, revealing a greater need for defining the etiological factors and establishing a correct diagnosis to make it possible to institute early intervention.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
Temporomandibular disorder (TMD) is a condition, in which multiple factors act synergistically to determine the outcome of the disorder.
Aim
A systematic review and meta‐analysis was ...conducted to evaluate the association between genetic polymorphisms in catechol‐O‐methyltransferase (COMT) and TMD.
Design
Observational studies that investigated this association were included. The risk of bias and study quality were evaluated according to the Newcastle‐Ottawa tool. The meta‐analysis was performed for each polymorphism associated with TMD signs and symptoms.
Results
A total of 1903 articles were identified. Ten remained in the qualitative analysis: six were classified as low risk of bias and four with moderate risk of bias, and three were included in the meta‐analysis. The polymorphism rs6269, in the genotypic model (0.65; CI = 0.44‐0.97; P = .04) and in the allelic model (0.73; CI = 0.54‐0.98; P = .04), was associated with myofascial pain. The rs9332377 was associated with myofascial pain in the genotypic model (2.69; CI = 1.51‐4.76; P = .0007) and in the allelic model (1.46; CI = 1.01‐2.13; P = .05) and with painful TMD in the genotypic model (2.08; CI = 1.27‐3.40; P = .004) and in the allelic model (1.34 CI = 0.98‐1.82; P = .06).
Conclusion
The polymorphisms in COMT were significantly associated with TMD.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
This report describes the unexpected formation of root-like structures following the avulsion of immature permanent teeth without replantation. A 6-year-old female patient had avulsed the four ...permanent mandibular incisors and the two deciduous mandibular canines. The patient was seen in an emergency healthcare unit but did not receive specialized treatment for tooth replantation. As follow-up treatment, she received a removable prosthesis. After 4 years of follow-up, an image obtained by panoramic radiography showed formations similar to four root structures in the alveolus of the previously avulsed permanent teeth. This finding was confirmed by periapical radiography and computed tomography. This case report demonstrates that in teeth with incomplete root development, even after avulsion without replantation, cells from the pulp stump may have the capacity to form mineralized structures that appear radiographically comparable to root dentin.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective
This randomized clinical trial evaluated the survival of direct restorations on first permanent molars (FPMs) with molar incisor hypomineralization (MIH) and its impact on self-reported ...dental pain and dental anxiety.
Material and method
FPMs with MIH of 35 patients aged 7 to 16 years were included. The FPMs were randomized into the following two groups: total-etch (TE—37% phosphoric acid etching) and self-etch (SE—no prior etching). The FPMs were restored with universal adhesive and bulk-fill resin composites. The restoration survival was evaluated according to USPHS criteria modified by a blinded examiner. Dental anxiety (Venham picture test) and dental pain (Faces pain scale—revised) were evaluated before treatment and at 1, 6, and 12 months post-treatment. Survival rates were analyzed by the Kaplan-Meier method and the log-rank test. Nonparametric tests compared pain and anxiety in the follow-up periods.
Results
A total of 64 FPMs were restored (TE = 33; SE = 31). Survival rates were 96.9% (TE) and 96.7% (SE) after 1 month, 90.5% (TE) and 80.6% (SE) after 6 months, and 80.8% (TE) and 62.3% (SE) after 12 months (
p
> 0.05). Self-reported dental pain and anxiety level decreased after treatment in both groups (
p
< 0.05). Self-reported pain decreased after 1 month in SE, but it occurred at 6 months in TE.
Conclusion
Both restorative protocols presented similar longevity, decreasing self-reported pain and anxiety levels.
Clinical relevance
A universal adhesive could be appropriate for restoration of MIH-affected teeth, and the survival of restorations could be higher in the total-etch technique, reducing dental pain and anxiety.
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CMK, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. OBJECTIVETo assess the effect of amoxicillin and of the combination of amoxicillin and fluoride ...on enamel mineralization in rats. METHODOLOGYIn total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). RESULTSEnamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. CONCLUSIONThe rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.
Aim: To evaluate the performance of a pen-type laser fluorescence device (DIAGNOdent 2190; LFpen, KaVo, Germany) and bitewing radiographs (BW) for approximal caries detection in permanent and primary ...teeth. Materials and Methods: A total of 246 anterior approximal surfaces (102 permanent and 144 primary) were selected. Contact points were simulated using sound teeth. Two examiners assessed all approximal surfaces using LFpen and BW. The teeth were histologically assessed for the reference standard. Optimal cut-off limits were calculated for LFpen for primary and permanent teeth. Sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (Az) were calculated for D1 (enamel and dentin lesions) and D3 (dentin lesions) thresholds. The reproducibility was assessed by intraclass correlation coefficient (ICC) and Cohen's weighted kappa values. Results: For permanent teeth, the LFpen cut-off were 0- 27 (sound), 28- 33 (enamel caries) and >33 (dentin caries). For primary teeth, the LFpen cut-off were 0- 7 (sound), 8- 32 (enamelcaries) and >32 (dentin caries). The LFpen presented higher sensitivity values than BW for primary teeth (0.58 vs. 0.32 at D1 and 0.80 vs. 0.47 at D3) and permanent teeth (0.80 vs. 0.57 at D1 and 0.94 vs. 0.51 at D3). Specificity did not show a significant difference between the methods. Rank correlations with histology were 0.59 and 0.83 (LFpen) and 0.36 and 0.70 (BW) for primary and permanent teeth, respectively, considering all lesions. ICC values for LFpen were 0.71 (inter) and 0.86 (intra) for permanent teeth and 0.94 (inter) and 0.90/0.99 for primary teeth. Kappa values for BW were 0.69 (inter) and 0.68/0.90 (intra) for permanent teeth and 0.64 (inter) and 0.89/0.89 for primary teeth. Conclusion: LFpen presented better reproducibility for primary and permanent teeth and higher accuracy in detecting caries lesions at D1 threshold than BW for permanent teeth. LFpen should be used as an adjunct method for approximal caries detection.
Abstract The exposure to amoxicillin has been associated with molar incisor hypomineralization. This study aimed to determine if amoxicillin disturbs the enamel mineralization in in vivo experiments. ...Fifteen pregnant rats were randomly assigned into three groups to received daily phosphatase-buffered saline or amoxicillin as either 100 or 500 mg/kg. Mice received treatment from day 13 of pregnancy to day 40 postnatal. After birth, the offsprings from each litter continued to receive the same treatment according to their respective group. Calcium (Ca) and phosphorus (P) content in the dental hard tissues were analyzed from 60 upper first molars and 60 upper incisors by the complexometric titration method and colorimetric analysis using a spectrophotometer at 680 nm, respectively. Lower incisors were analyzed by X-ray microtomography, it was measured the electron density of lingual and buccal enamel, and the enamel and dentin thickness. Differences in Ca and P content and electron density among the groups were analyzed by one-way ANOVA. There was no significant difference on enamel electron density and thickness among the groups (p > 0.05). However, in incisors, the higher dose of amoxicillin decreased markedly the electron density in some rats. There were no statistically significant differences in Ca (p = 0.180) or P content (p = 0.054), although the higher dose of amoxicillin could affect the enamel in some animals. The amoxicillin did not significantly alter the enamel mineralization and thickness in rats.
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