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Background: Tuberous sclerosis complex (TSC) is a multisystem neurocutaneous syndrome with variable phenotypes. Recent updates of TSC diagnostic criteria reaffirmed the defined genetic diagnostic criterion as the finding of a pathogenic DNA alteration in either TSC1 or TSC2 genes. It also slightly modified definite clinical diagnostic criteria. TSC-associated skin lesions in infancy are important clinical signs to select individuals with possible TSC for a closer clinical follow-up and genetic testing., Objective: To raise awareness of the updated TSC diagnosis criteria; to assess the frequency of skin lesions in TSC patients as well as the first dermatological presentation; and to associate the findings with either TSC1 or TSC2 mutations., Methods: Observational cross-sectional study. Clinical and genetic data were retrospectively collected from 37 TSC patients from a Brazilian University Hospital. Patients with skin signs were examined and prospectively assessed for 12 months., Results: The earliest cutaneous lesions were hypomelanotic macules, which together with angiofibromas were the most frequent dermatological lesions. The total pathogenic DNA alteration ratio between TSC2 and TSC1 genes was 8:1. The frequency of a TSC2 pathogenic variant was 10-fold greater in the presence of ungual fibromas., Study Limitations: Small sample and a limited number of patients with TSC1 pathogenic variants., Conclusion: Clinicians should be knowledgeable about TSC updated diagnostic criteria. Patients need to be followed up by a multidisciplinary team and treated accordingly. Early detection of cutaneous lesions is important for TSC diagnosis. A significant association between TSC2 gene pathogenic alterations and ungual fibromas is described., (Copyright © 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

This study investigates the effect of daily consumption of a concentrated garlic and onion extract on COVID-19 symptoms among elderly nursing home residents. Volunteers consumed a daily capsule of the concentrated powder rich in organosulfur compounds over 36 weeks during lunch. The incidence and severity of COVID-19 symptoms between the treatment and control groups were compared, along with monitoring the safety of consumption, incidence of other diseases, and medicine usage. The treatment group showed a significant reduction in both the number and severity of COVID-19 symptoms compared to the control group, with no significant adverse effects observed. No significant reduction in symptom duration was detected. This study provides preliminary evidence that concentrated garlic and onion extract may aid in the treatment of COVID-19 among older adults. These findings suggest potential public health benefits, emphasizing the need for further research to explore the immunomodulatory properties of these natural compounds.

This prospective study aims to evaluate dental pain, anxiety, and catastrophizing levels in pregnant women undergoing root canal treatment. Sixty pregnant and non-pregnant women presenting dental pain and an indication for root canal treatment were included in the study. Dental anxiety and catastrophizing were investigated using validated questionnaires. The endodontic intervention was performed, and a numerical scale measured preoperative and postoperative dental pain. The results were analyzed using STATA software 12.0. Unadjusted analyses assessed the association between pregnancy and pain, anxiety, and catastrophizing levels. Multiple linear regression models using 'forward stepwise' entry procedures were used to assess the independent effects of variables on pain scores. The significance level was set at 0.05. Initially, most patients experienced intense dental pain. The levels of dental pain, dental anxiety, and catastrophizing did not differ between pregnant and non-pregnant women. Logistic regression showed that postoperative pain was associated with irreversible pulpitis diagnosis (OR = 4.78; 95%CI 1.55-13.55) and high catastrophizing levels (OR = 1.96; 95%CI 1.01-3.84). Preoperative and postoperative pain rates and anxiety and catastrophizing were similar between pregnant and non-pregnant patients. Postoperative pain was associated with irreversible pulpitis diagnosis and high catastrophizing levels. The similarity between pregnant and non-pregnant women regarding preoperative and postoperative dental pain and catastrophizing and anxiety levels supports the indication of root canal treatment during the gestational period whenever necessary.

Heart Failure is a significant public health problem leading to a high burden of physical and psychological symptoms despite optimized therapy. To evaluate primarily the impact of a Stress Reduction, Meditation, and Mindfulness Program on stress reduction of patients with Heart Failure. A randomized and controlled clinical trial assessed the effect of a stress reduction program compared to conventional multidisciplinary care in two specialized centers in Brazil. The data collection period took place between April and October 2019. Thirty-eight patients were included and allocated to the intervention or control groups. The intervention took place over 8 weeks. The protocol assessed the scales of perceived stress, depression, quality of life, anxiety, mindfulness, quality of sleep, a 6-minute walk test, and biomarkers analyzed by a blinded team, considering a p-value <0.05 statistically significant. The intervention resulted in a significant reduction in perceived stress from 22.8 ± 4.3 to 14.3 ± 3.8 points in the perceived stress scale-14 items in the intervention group vs. 23.9 ± 4.3 to 25.8 ± 5.4 in the control group (p-value<0.001). A significant improvement in quality of life (p-value=0.013), mindfulness (p-value=0.041), quality of sleep (p-value<0.001), and the 6-minute walk test (p-value=0.004) was also observed in the group under intervention in comparison with the control. The Stress Reduction, Meditation, and Mindfulness Program effectively reduced perceived stress and improved clinical outcomes in patients with chronic Heart Failure.

Introduction: The physiological changes in mother-infant pairs during pregnancy increase the susceptibility to a series of infections, including those of the oral cavity. Therefore, the oral and systemic health of pregnant women is related to adverse pregnancy outcomes., Objective: This cross-sectional study aimed to evaluate the systemic profile and periodontal status of women with a high-risk pregnancy., Methods: Eighty-nine pregnant women at risk of preterm labor admitted to a hospital in southern Brazil were interviewed and received a periodontal examination. Data related to obstetric complications during pregnancy (pre-eclampsia, infections, medication use, and gestational diabetes) and systemic diseases were collected from medical records. The periodontal parameters of probing pocket depth, bleeding on probing, and clinical attachment level were evaluated. The data were tabulated, and statistical analysis was performed (p < 0.05)., Results: The mean age of participants was 24 years (SD = 5.62). Gingival bleeding was recorded in 91% of the participants. The prevalence of gingivitis was 31.46%, and periodontitis was 29.21%. No association between systemic conditions and periodontal disease was observed., Conclusions and Implications for Practice: Periodontal inflammation was not associated with the systemic profile during pregnancy. However, women with high-risk pregnancies showed higher levels of gingival inflammation, emphasizing the importance of dental care during pregnancy., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Caries disease can lead to strong impact in terms of pain and suffering, to functional impairment, and to negative effects on quality of life. Studies have demonstrated that the impact on quality of life increases with dental caries severity, and few studies have assessed the relationship between caries activity and children's oral health-related quality of life (OHRQoL). This cross-sectional study aimed to assess the impact of dental caries severity and activity on the OHRQoL of schoolchildren. The study was conducted with a sample of children aged 8 to 11 years from Pelotas, southern Brazil. Children answered the Child Perceptions Questionnaire 8-10, and socioeconomic data were collected. Children's dental caries (Kappa value of 0.95), PUFA, traumatic dental injuries, and malocclusion were examined. The Mann-Whitney, Kruskal-Wallis, and Poisson regression tests were performed. A total of 119 children were included. Children with initial (mean ratio (MR) of 1.92; 95% confidence interval (95% CI) of 1.05-3.48), moderate (MR: 2.66; 95%CI: 1.44-4.90), and severe carious lesions (MR: 2.65; 95%CI: 1.46-4.79) had a greater impact on OHRQoL compared with those without carious lesions (p =0 .047). Children with active carious lesions exhibited a greater impact on OHRQoL (MR:1.53 and 95%CI: 1.11-2.11) when compared to those without active lesions (p = 0.019). The findings demonstrate an association between dental caries severity and activity and the OHRQoL of school-aged children.

Muscle tissue possess an innate regenerative potential that involves an extremely complicated and synchronized process on which resident muscle stem cells play a major role: activate after an injury, differentiate and fuse originating new myofibers for muscle repair. Considerable efforts have been made to design new approaches based on material systems to potentiate muscle repair by engineering muscle extracellular matrix and/or including soluble factors/cells in the media, trying to recapitulate the key biophysical and biochemical cues present in the muscle niche. This work proposes a different and simple approach to potentiate muscle regeneration exploiting the interplay between specific cell membrane receptors. The simultaneous stimulation of borate transporter, NaBC1 (encoded by SLC4A11gene), and fibronectin-binding integrins induced higher number and size of focal adhesions, major cell spreading and actin stress fibers, strengthening myoblast attachment and providing an enhanced response in terms of myotube fusion and maturation. The stimulated NaBC1 generated an adhesion-driven state through a mechanism that involves simultaneous NaBC1/α 5 β 1 /α v β 3 co-localization. We engineered and characterized borax-loaded alginate hydrogels for an effective activation of NaBC1 in vivo. After inducing an acute injury with cardiotoxin in mice, active-NaBC1 accelerated the muscle regeneration process. Our results put forward a new biomaterial approach for muscle repair., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: The association between maternal periodontal disease and adverse perinatal outcomes although extensively studied remains unclear. The aim of this study was to evaluate, by a case-control study, conducted in three hospitals the association between preterm birth and/or low birth weight (PTB/LBW) and clinical parameters of maternal periodontal disease. Material and methods: Postpartum women who gave birth to a newborn PTB/LBW (case group), and postpartum women who had babies at full term with normal weight (control group) were included, in 1:2 ratio. Data were collected through medical records, interview, and periodontal clinical parameters. Bivariate analysis was performed to assess the PTB/LBW proportion relative to independent variables and multiple logistic regression analysis to assess the association between adverse perinatal outcomes and independent variables. Results: The sample consisted of 148 cases and 296 controls. By the 148 postpartum women with PTB/LBW in case group, 126 (87.5%) had preterm birth, and 75 (50.7%) had PTB and LBW. The periodontal status and generalized periodontitis presence were not associated with any adverse pregnancy outcomes. Having made four or more prenatal visits was a protective factor for all outcomes. The history of previous PTB/LBW was a risk factor for new cases of PTB and PTB and/or LBW. The presence of systemic disease was associated with preterm and low birth weight (PTLBW). Preeclampsia and cesarean delivery were associated with all outcomes. Conclusions: The clinical parameters of maternal periodontitis were not considered as a risk factor for the studied adverse perinatal outcomes. Clinical relevance: The present study demonstrated no association between maternal periodontitis and PTB/LBW.

Purpose: To assess the association between long-term breastfeeding and dental caries in children during the third year of life., Study Design: This retrospective longitudinal study consisted of children who were followed-up by the Maternal and Child Public Oral Health Program. Information regarding socio-economic class, demographic status, daily frequency of sucrose intake, breastfeeding duration and oral hygiene were collected with the aid of a questionnaire. Information on dental caries in the children was collected from dental records. Negative binomial regression models were used to assess the association between breastfeeding duration and dental caries., Results: We included a total of 325 children in the study. The incidence of dental caries was found to be 12.92%. Even after adjustments, children who were breastfed for a period ≥24 months were more likely to have dental caries, when compared with children who were not breastfed or were breastfed for less than 6 months. Children who had a higher frequency of sucrose intake and those with dental plaque were more likely to have dental caries., Conclusion: In this study, a greater incidence of dental caries was found in children who were breastfed for a period ≥ 24 months..

The purpose of this study was to evaluate the inflammatory process following direct pulp capping during pregnancy. This experimental study involved 48 maxillary first molars of female Wistar rats. The procedures were performed in pregnant and non-pregnant animals (n =20 each). Direct pulp capping with mineral trioxide aggregate (MTA) and restoration with a light-cured resin composite was performed in half of exposed pulp specimens. In the other half of specimens, light-cured composite was placed directly on the exposed pulp. In the control groups (n=4 each), no intervention was performed. Animals were euthanized at 3 and 7 days. All sections (three per slide) were viewed under an optical microscope. One previously calibrated pathologist performed descriptive analysis and assigned scores for inflammatory response and tissue organization adjacent to the pulp exposure. The Kappa value for intra-examiner variability was 0.91. At 3 days, in animals treated with MTA, inflammatory infiltrate was absent in non-pregnant animals while mild inflammatory infiltrate was observed in some pregnant animals. The inflammatory response ranged from mild to severe in both groups treated with composite alone. At 7 days, the inflammatory response was more intense in pregnant than in non-pregnant animals treated with MTA; while this difference were not evident in animals treated with composite alone. In conclusion, pregnancy may not influence the inflammatory process following direct pulp capping with light-cured resin composite, which was always harmful to the pulp; while the tissue response after the direct pulp with MTA were more favorable in non-pregnant animals.

Objective: To evaluate endothelium-dependent microvascular reactivity during cardiopulmonary bypass (CPB) in surgery for the correction of cyanotic and acyanotic congenital heart disease (CHD) in children and infants using laser Doppler perfusion monitoring (LDPM)., Methods: This cross-sectional observational study included one hundred consecutive acyanotic (AC, n = 61) and cyanotic (C, n = 39) pediatric patients scheduled for cardiac surgery for correction of CHD. The endothelium-dependent microvascular vasodilation of the skin of the forehead was evaluated using a single-point LDPM coupled with local thermal hyperemia (LTH)., Results: LTH induced significant increases in microvascular conductance both in AC and C patients after the induction of anesthesia, during CPB and after weaning from CPB. Nevertheless, the vasodilation induced by LTH was significantly blunted during CPB when compared with values obtained after the induction of anesthesia both in AC and C patients. Microvascular endothelial reactivity nearly normalized after the discontinuation of CPB., Conclusion: The evaluation of systemic microvascular reactivity on the forehead skin of infants and children using LDPM appears to be a valuable tool for optimizing microvascular perfusion during CPB in pediatric cardiac surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This study aimed to evaluate the influence of breastfeeding and pacifier use on the occlusal status of preschool children. A cross-sectional study was conducted with children (n = 489) aged 2-5 years in private and public schools in Pelotas, South Brazil. Mothers answered a questionnaire on demographic, socioeconomic and behavioral variables, including breastfeeding and non-nutritive sucking habits. Malocclusion was classified as normal/mild and moderate/severe, according to WHO criteria. The association between breastfeeding and pacifier use with malocclusion was tested using multivariate logistic regression. The prevalence of malocclusion was 37.83% (95%CI 33.52-42.14), and 57.87% of the children used a pacifier. A total of 46.01% of the sample was exclusively breastfed for 6 months, and 24.74% were never breastfed. Malocclusion was associated with pacifier use, and with both non-exclusively breastfed and never breastfed. After adjustments for demographic and socioeconomic variables, the children who used a pacifier and were never breastfed (OR = 19.08; 95%CI 8.54-42.63), or who used a pacifier and were not exclusively breastfed (OR = 13.74; 95%CI 6.11-30.92), showed worse occlusal conditions, compared with the children who were exclusively breastfed and never used a pacifier. Pacifier use modifies the relationship between breastfeeding and occlusal status.

Objectives: The aim of this longitudinal study was to assess the likelihood of children suffering traumatic dental injuries in the permanent dentition subsequent to traumatic dental injuries in their primary dentition., Materials and Methods: A longitudinal study was conducted in Pelotas, Brazil. Children were assessed in 2007, when they were aged 2-5 years, and in 2013, at which time, they were aged 8-11 years. Data collection included interviews with parents and clinical oral examination for dental trauma and occlusion. The classification proposed by Andreasen and Andreasen was used, and crown discoloration and fistula were added to this criterion in order to assess pulp involvement. Child/parent report was used to aid in the diagnosis of both treated and untreated injuries. As a limitation, no radiographs were taken. Descriptive, univariate, and multivariate logistic regression analyses were performed., Results: A total of 110 children were included. Dental trauma frequency in the primary dentition was 38.2% and that in the permanent dentition was 30.9%. In the multivariate analyses, children with dental trauma in the primary dentition showed a higher likelihood of suffering dental trauma in the permanent dentition [odds ratio (OR) 2.97, 95% confidence interval (CI) 1.01-8.91, P = 0.05]., Conclusions: Individuals with previous trauma in the primary dentition are prone to further trauma in the permanent dentition. The history of dental trauma may be used to predict dental trauma in the permanent dentition and to establish preventive measures., Clinical Relevance: Behavioral characteristics may be related to the risk of a child suffering injuries. The results suggested that some children are accident-prone.

This study assessed the pH, radiopacity, antimicrobial effect, cytotoxicity and biocompatibility of endodontic filling materials for primary teeth. Zinc oxide eugenol (ZOE), Vitapex and Calen paste thickened with zinc oxide (ZO) were evaluated in comparison to an experimental MTA-based material. Radiopacity was tested using a graduated aluminum stepwedge with a digital sensor (n=5). The materials pH was recorded at 1, 4, 12 h; 1, 3, 7, 15 and 30 days (n=5). Direct contact test was used to assess the antimicrobial efficacy against Enterococcus faecalis after 1, 4, 12, 24 h (n=5). Cytotoxicity assay used MTT test for cell viability after incubation for 1, 3 and 7 days (n=5). For biocompatibility test, Wistar rats had received implants containing each material (n=5). The biopsied tissues were histologically analyzed after 15, 30 and 60 days. The results of radiopacity, pH, antimicrobial capacity and cytotoxicity were analyzed using ANOVA and Tukey tests. The histological data were submitted to Kruskal-Wallis test. The experimental material presented the lowest radiopacity (3.28 mm Al) and had a pH>12.0 throughout the test period. The experimental material showed the highest antibacterial effect, killing over 99.97% bacteria in 4 h. Vitapex presented the highest cell viability. Initially, biocompatibility test showed moderate to severe inflammation in all groups. After 60 days, Calen+ZO group showed moderate inflammation, while the others showed predominantly mild inflammatory reaction. The present results demonstrated that the experimental MTA-based material exhibited satisfactory behavior regarding the studied properties. Additional in vivo studies are necessary for a better evaluation of the material.

Introduction: The increase in telemedicine in the mental health field has led to psychometric instruments changing from paper-and-pencil administration to an electronic format. A study is performed to determine if both formats are equivalent for well-known questionnaires such as GHQ-12, WHO-5, and PHQ-9., Material and Methods: Forty-seven volunteers completed GHQ-12, WHO-5 and PHQ-9 questionnaires in paper-and-pencil format, and in the following 24h they completed their electronic versions via the web site www.memind.net. An electronic-Likert format was used by 24 participants, and 23 used an electronic-slider format. Internal consistency was measured by α-Cronbach index and omega coefficient, and test-retest was measured by the intraclass correlation coefficient (ICC). Agreement between individual items was compared using Weighted Kappa coefficients, and dimensional structure between formats using the Comparative Fit Index (CFI)., Results: Internal consistency was higher than 0.8 for GHQ-12 and WHO-5. The ICC ranged between 0.655 for PHQ-9 paper-and-pencil/electronic-slider and 0.901 for GHQ-12 paper-and-pencil/electronic- slider. Agreement for individual items in paper-and-pencil and electronic-Likert versions was variable, ranging from low agreement in PHQ-1 (weighted κ=0.143; P=.384) to high agreement in PHQ-5 (weighted κ=0.769; P=.000). The CFI results showed an adequate equivalence between formats., Conclusions: Except for the PHQ-9 electronic-Likert, questionnaires keep their structure in electronic formats. Discrepancies were found in items agreement. This study supports previous works indicating that the change from paper-and-pencil to electronic formats is not an immediate process, and needs a proper adaptation., (Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Tooth extractions are associated with anxiety-related situations that can cause behavioral problems in pediatric dental clinics., Aim: We aimed to describe the behavior of children during tooth extraction appointments, compare it to their behavior in preceding and subsequent dental appointments, and assess the behavioral differences according to gender, age, type of dentition, and reason for extraction., Settings and Design: This was a retrospective study based on information obtained from records of children between 6 and 13 years of age who were cared for at the Dentistry School in Pelotas, Brazil., Materials and Methods: Child behavior was assessed during the dental appointment that preceded the tooth extraction, during the tooth extraction appointment, and in the subsequent dental appointment using the Venham Behavior Rating Scale., Statistical Analysis: Results were analyzed using the Pearson Chi-square and McNemar tests., Results: Eighty-nine children were included. Cooperative behavior prevailed in all the dental appointments. The prevalence of "mild/intense protest" was higher in the tooth extraction appointments than in the previous or subsequent dental appointments (P < 0.001). No significant differences in behavior were detected between the type of dentition (primary or permanent teeth), reason for extraction or gender., Conclusion: In this sample of children treated at a dental school, the occurrence of uncooperative behavior was higher during the tooth extraction appointments than in the preceding and subsequent dental appointments.

Purpose: The purpose of this study was to evaluate the effect of five endodontic materials for primary teeth on in vitro mixed-species biofilms., Methods: Zinc oxide eugenol (ZOE) cement, Vitapex, Calen paste thickened with zinc oxide (ZO), pure calcium hydroxide (Ca(OH)2) paste, and iodoform were evaluated. Sterile water was used as a control. Mixed-species biofilm was incubated in anaerobic conditions for 21 days. The biofilm specimens were placed in contact with the endodontic materials for periods of seven and 30 days. The biofilm was studied by using confocal laser scanning microscopy. The cell viability ratio was calculated. The results were analyzed using analysis of variance and Tukey tests., Results: There was a statistically significant difference between groups at both seven and 30 days (F equals 73,073, P=0.00). After 30 days, 69 percent, 51 percent, and 35 percent of the biofilm volume fluoresced red, indicating the proportion of bacteria killed by iodoform, Vitapex, and ZOE cement, respectively. Calen plus ZO and pure Ca(OH)2 paste were the least effective materials against the biofilms., Conclusions: Pure iodoform paste and iodoform containing Vitapex were the most effective materials against the biofilms. Vitapex appears to be a suitable endodontic material for primary teeth.

Objective. The aims of this study were to evaluate the periodontal health of pregnant women and to investigate the association of periodontal status with demographic and socioeconomic characteristics, as well as medical and dental history. Materials and Methods. A total of 311 pregnant women were interviewed to obtain sociodemographic data along with medical and dental histories. Clinical examinations were performed to record the presence of visible plaque, gingival bleeding, and caries activity. The periodontal condition was evaluated by Community Periodontal Index of Treatment Needs (CPITN) in one tooth of each sextant (16, 11, 26, 36, 31, and 46). Results. After the adjustment analysis, the presence of visible plaque remained the main determinant of gingival bleeding (OR = 2.91, CI = 1.91-4.48). First-trimester pregnancy status was also a predictor, with a lower prevalence of gingival bleeding observed in the second (OR = 0.87, CI = 0.77-0.99) and third (OR = 0.82, CI = 0.73-0.93) trimesters. Conclusion. In pregnant women, the presence of dental plaque and first-trimester pregnancy status were the main implicated factors predicting gingival bleeding.

Objective. This study evaluated the discoloration potential of endodontic materials used in primary teeth. Material and Methods. Dentine-enamel blocks were prepared from 75 bovine teeth, assorted in five experimental groups ( n = 15). The tested materials included an MTA-based material; zinc oxide and eugenol cement (ZOE); Vitapex; and calcium hydroxide thickened with zinc oxide (Calen + ZO). The color measurements were performed using a spectrophotometer at the following intervals: prior to (T0) and after placement of the filling (T1) and after 1 week (T2), 1 month (T3), 3 months (T4), 6 months (T5), and 9 months (T6). Data were submitted to ANOVA with repeated measures and Tukey's test. Results. The time had a significant effect on the color variation (Δ E 00 ⁎ ) ( p < 0.0001). The effect of the materials on the color variation (Δ E 00 ⁎ ) was statistically significant ( p = 0.004). Interactions between time and materials demonstrated a significant effect on the values (Δ E 00 ⁎ ) ( p < 0.0001). The ZOE cement showed the highest darkening effect ( p = 0.018). Conclusion. The MTA-based material showed the smallest discoloration during the experimental time; however, it was similar to the other materials and to the control group. Zinc oxide and eugenol showed higher discoloration.

The aim of this study was to assess the prevalence of black stains (BS) and factors associated with their occurrence and to investigate the association of BS with caries experience after adjusting for other risk indicators. A school-based, cross-sectional study using multistage sampling of children aged 10-12 years from 20 private and public schools in Pelotas/Southern Brazil was conducted (n = 706). Children were evaluated for BS and dental caries (DMFT/dmft index) and socioeconomic information was collected by questionnaire. Univariate and multivariate Poisson regressions were used to assess variables associated with the prevalence of BS and with caries experience. The prevalence of BS was 5.81%. The mean DMFT/dmft was 1.54 (±1.91), with a maximum value of 10. Among the children with BS, mean dmft/DMFT was 1.22 (SD 1.68), with a maximum value of 6. After adjustments for demographics and socioeconomic variables, dental plaque and tooth brushing habits, prevalence of BS was associated with lower caries experience (RR 0.67; 95%CI 0.49-0.92). In conclusion, the presence of BS showed an association with lower dental caries experience in the evaluated population. Future studies should investigate the mechanisms behind this association.

Purpose: The purpose of this cross-sectional study was to assess the presence of dental plaque and associated factors in 12- to 18-month-old children., Methods: A clinical examination was performed to determine the presence of visible dental plaque on the maxillary incisors of 12- to 18-month-old children. Mothers were interviewed to collect demographic and socio-economic data, as well as oral hygiene habits. Univariate and multiple Poisson regression analysis (PR) with robust variance were performed., Results: Of the 249 children examined, 35 percent presented dental plaque. Tooth-brushing or cleaning their children's teeth was reported by 178 mothers (72 percent). Children whose maternal schooling was equal to or less than eight years showed higher risk to present dental plaque compared to children whose mothers had studied more than eight years (PR=1.41 [95 percent confidence interval=1.01 to 1.98]). Children with dental caries were associated with a higher risk of having dental plaque (PR=2.23 [95 percent confidence interval =1.63 to 3.04])., Conclusions: Visible dental plaque was a more reliable indicator of dental hygiene habits than the information provided by the mothers during the structured interviews. Therefore, preventive programs for young children are crucial, especially those at risk for dental caries and those with mothers with low educational levels.

The present study aimed to determine the prevalence of dental pain during pregnancy and its association with sociodemographic factors and oral health conditions among 315 pregnant women in South Brazil. Participants were interviewed to obtain sociodemographic data, such as age, educational level, employment status, family income, and marital and parity status. Medical and dental histories were also collected, including the occurrence of dental pain and the use of dental services during pregnancy. Clinical examinations were performed to assess the presence of visible plaque and gingival bleeding and to calculate the decayed, missing, and filled teeth index. Means and standard deviations of continuous variables and frequencies and percentages of categorical variables were calculated. Independent variables were included in a multivariate logistic regression analysis. A total of 173 (54.9 %) pregnant women reported dental pain during pregnancy. After adjustment of the analysis, caries activity remained the main determinant of dental pain (odds ratio 3.33, 95 % CI 1.67-6.65). The prevalence of dental pain during pregnancy was high and the presence of caries activity was a determinant of dental pain. Moreover, access to oral health care was low, despite pregnant women's increased need for dental assistance.

Early childhood caries (ECC) in the primary dentition of preschoolers remains high. Young children have limited access to oral healthcare, and oral health education (OHE) measures can be a valuable tool to prevent caries in this population. The aim of this study was to evaluate the impact of an early educational intervention on ECC prevention. The study group (SG) comprised 271 children aged 0-12 months and their mothers, who attended 12 selected public health centers (PHC). The SG received oral health instructions from a pamphlet and by verbal explanation of some topics. One year later, a similar sample of children from another 12 PHCs were selected to serve as the control (CG; n = 251). The children were examined to determine their caries status: decayed = cavitated and/or white spot lesion (maxillary anterior surface); missing; and filled surface index > 0. There was a one-year follow-up. Socioeconomic and demographic information was collected. Logistic regression was used to estimate the effects of the educational intervention on the ECC odds. A sample of 445 (SG = 194 and CG = 251) children remained to the end of the study and were examined. The prevalence of caries was 12.9% in the SG and 17.9% in the CG. The odds of caries were 80% higher in the CG than in the SG (p = 0.037). The strategy of providing OHE from a pamphlet and with a brief verbal instruction to mothers during their child's first year of life can constitute a valuable tool for ECC prevention.

Objectives: The aim of this retrospective study was to evaluate the longevity of restorations in the posterior primary teeth of children attending to a public paediatric dental clinic and to test the factors associated with failures., Methods: Patient records of 329 children (162 boys and 166 girls) were used for collecting and analyzing data. A total of 565 restorations in primary teeth were included in the study. All children enrolled in the study were classified as high caries risk. The longevity of restorations from their placement until failure (up to 4 years of follow-up) was assessed using the Kaplan-Meier survival curves with log-rank test. Multivariate Cox regression analysis with shared frailty (p<0.05) was used to assess the factors associated with failures., Results: Up to 4 years of follow-up, the annual failure rates were 9.5% for composite fillings, 12.2% for light-cured glass ionomer restorations, and 12.9% for conventional glass ionomer restorations with statistical difference between the materials (p=0.014). Glass ionomer restorations had a higher risk of failure over time compared with composites (HR 1.86, 95% CI 1.17-2.97). In crude analysis, Class II restorations showed lower survival rate than Class I restorations (p=0.031) but lost significance after adjustments., Conclusions: Our findings suggested that the material influenced the survival rate of primary posterior restorations, with composite presenting the best performance., Clinical Significance: Differences were observed between restorative materials with different properties in primary teeth up to 4 years of follow-up. This study provides valuable information regarding the primary teeth posterior restoration longevity in a paediatric population with restorations performed under daily life clinical environment., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose: This study's purpose was to assess mothers' knowledge and beliefs about early childhood caries (ECC) etiology and prevention., Methods: This cross-sectional study targeted mothers (N=277) of zero- to 12-month-olds visiting 12 public health care centers in Pelotas, Rio Grande do Sul, Brazil. Information on causes of and recommendations to prevent ECC, as well as socioeconomic and demographic variables, was collected. Chi-square, univariate, and multiple logistic regression analyses were performed (P<.05)., Results: Sugar intake and lack of oral hygiene were the most frequently mentioned causes of caries. Ninety percent of the mothers were aware of the need to begin tooth-brushing during their children's first year. Mothers who had more children and were in lower socioeconomic positions were more likely to not know the correct age for the first dental visit., Conclusions: Our findings showed that mothers do not know all the factors that can influence caries in their children. None reported the role of micro-organisms and lack of fluoride in the caries etiology. These findings highlight the importance of providing preventive orientation to the mothers regarding early childhood caries. Information on age of first dental visit should be emphasized, especially among mothers with more than one child and low-income families.

Purpose: This study's purpose was to assess mothers' knowledge and beliefs about early childhood caries (ECC) etiology and prevention., Methods: This cross-sectional study targeted mothers (N=277) of zero- to 12-month-olds visiting 12 public health care centers in Pelotas, Rio Grande do Sul, Brazil. Information on causes of and recommendations to prevent ECC, as well as socioeconomic and demographic variables, was collected. Chi-square, univariate, and multiple logistic regression analyses were performed (P<.05)., Results: Sugar intake and lack of oral hygiene were the most frequently mentioned causes of caries. Ninety percent of the mothers were aware of the need to begin tooth-brushing during their children's first year. Mothers who had more children and were in lower socioeconomic positions were more likely to not know the correct age for the first dental visit., Conclusions: Our findings showed that mothers do not know all the factors that can influence caries in their children. None reported the role of micro-organisms and lack of fluoride in the caries etiology. These findings highlight the importance of providing preventive orientation to the mothers regarding early childhood caries. Information on age of first dental visit should be emphasized, especially among mothers with more than one child and low-income families.

Objectives: The purpose of the study was to investigate the influence of a child's clinical condition; maternal characteristics such as dental anxiety and dental visit pattern; socioeconomic conditions; and maternal perception of the child's oral health-related quality of life (OHRQoL) on a child's use of dental care services., Methods: A cross-sectional study of 608 mother-child dyads was conducted during the Children's Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire regarding their use of dental services, dental anxiety (Dental Anxiety Scale), socioeconomic status, and perception of their children's OHRQoL (the Early Childhood Oral Health Impact Scale). Clinical examination of the children was performed to assess dental caries (dmf-t). Associations between the above-mentioned factors and child use of dental services were assessed using Poisson regression models (prevalence ratio [PR]; 95% CI; P ≤ 0.05)., Results: The majority of children (79.3%) had never had a dental appointment and of the children who had visited a dentist, 55 (43.65%) presented with untreated dental caries at the time of examination. More than half the mothers (60.2%) did not visit a dentist regularly. In the final model, low schooling level of mothers (PR, 0.64) and irregular visits to a dentist by the mother (PR, 0.48) were factors because of which a child did not have a dental appointment. Children who had experienced pain (PR, 1.56), those who had poor OHRQoL (PR, 1.49), and older children (PR, 2.14) visited a dentist with higher frequency., Conclusions: Use of dental care services by preschool children was low, and treatment was neglected even among children who had visited a dentist. Children of mothers with low schooling level who do not visit a dentist regularly were at greater risk of not receiving dental care. Maternal perception of their child's oral health motivated visits to the dentist., (© 2012 John Wiley & Sons A/S.)

Purpose: The purpose of this study was to analyze the association between dental trauma and occlusal traits in the primary dentition., Methods: Five hundred and one 24- to 71-month-old children, attending both private and public schools in Pelotas, Rio Grande do Sul, Brazil, were included. Clinical examinations were performed at each school. Occurrence of dental trauma was assessed using the Andreasen and Andreasen classification. Occlusal characteristics used in this study were: overjet; open bite; overbite; anterior crossbite; crowding and rotated teeth occurrence; and canine class. The occlusion type was classified according to the World Health Organization. A questionnaire was sent to parents to obtain socioeconomic data. Descriptive statistics were used, as well as chi-square tests (for heterogeneity or linear trend; P ≤ .05) and Fisher's exact test., Results: The prevalence of dental trauma was 40% (95% confidence interval=35-44). Of all children examined, 20% showed normal occlusion, 42% mild malocclusion, and 38% moderate/severe malocclusion. Dental trauma was associated with overjet ≥ 3 mm (P=.02), overbite ≥ 3 mm (P=.01), and canine class (P=.04). Children bearing mild or moderate/severe malocclusion presented greater dental trauma (P<.01)., Conclusion: The findings of this study emphasize the importance of preventing dental trauma, especially in children presenting increased overjet, overbite, or canine Class II.

A significant number of children visit a dentist for the first time due to emergency situations. However, little is known regarding the prevalence, etiology, and treatment provided for children at emergency dental visits. This study aimed to evaluate the profile of children attending a dental school emergency clinic, the reasons for seeking dental care, and the treatment provided. Records of 270 patients who attended an emergency clinic during 2010 were analyzed, and 253 were selected. Demographic, diagnostic, and procedural information was collected. The mean child age was 7.8 years. For 208 children (82%), pain was the main reason for the emergency visit. Nearly 79% of the visits were due to caries, and the most frequently required treatment was endodontic intervention (31.22%). Of the decayed teeth, 61.70% were primary posterior teeth and 31.9% permanent posterior teeth. Pain caused by dental decay was the most frequent chief complaint. A large number of children were brought to the dentist with complaints that had started long before, for which over-the-counter medications had been used.

Purpose: The aim of this study was to determine the influence of maternal dental anxiety on perceptions about oral health-related quality of life (OHRQoL) of preschool children., Methods: A cross-sectional study was conducted with 608 mother-child dyads during the Children's National Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire on dental anxiety (DAS), socioeconomic status, use of dental services, and perception of their child's OHRQoL (ECOHIS). The ECOHIS includes a child impact section (symptoms, function, psychological, self-image/social interaction domains) and a family impact section (parent distress and family function domains). Clinical examination of the children was performed to assess dental caries, dental trauma, and occlusal traits occurrence. The association assessment used Poisson regression models (RR; 95%CI, P ≤ 0.05)., Results: Anxious mothers presented higher scores in the parent distress domain. Higher impacts on OHRQoL were observed in children presenting untreated dental caries; children whose mothers had not completed primary education; and those who had non-regular use of dental services., Conclusions: Mean ECOHIS total score was not influenced by maternal dental anxiety. However, anxiety had a negative effect on the perception of the impact of the child's oral health problems in the family, affecting the parent distress domain.

This retrospective study evaluated the clinical performance and the reasons for failure of anterior and posterior composite restorations placed by undergraduate dental students over a 3-year period. All cavities were restored using Prime & Bond 2.1 and TPH (Dentsply), according to the manufacturer's indications. One hundred and two patients who had received composite restorations by third and forth year undergraduate students were recalled and examined to analyze the quality of the restorations. The restorations were evaluated using the modified USPHS system. Two hundred and fifty-six composite restorations, 170 in anterior teeth and 86 in posterior teeth, were evaluated. Eighty-five percent of the restorations were considered satisfactory after 3 years. Class II and class IV restorations presented the highest prevalence of failure. Loss of the restoration and deficient marginal adaptation were the main causes of failure. No restoration failed due to secondary caries. Most restorations placed by dental students were considered satisfactory after long-term evaluation. Failure was more prevalent in larger restorations and was not associated with secondary caries.

Attempts have been made to treat dentinal hypersensitivity by sealing exposed dentinal tubules, and the carbon dioxide (CO(2)) laser has been shown to have a sealing effect on dentinal surfaces. The purpose of this study was to analyze the morphological ultra-structure and temperature change after CO(2) laser irradiation of dentin. Fourteen human third molars were selected and cleaned. An area was delimited, and the samples were randomly divided into seven groups: Group 1 (G1): control; G2, calcium hydroxide paste (CA) + CO(2) laser (L) (0.5 W/63,69 W/cm(2)); G3, CA + L (1 W/125,38 W/cm(2)); G4, CA + L (1.5 W/191,08 W/cm(2)); G5, L (0.5 W); G6, L (1 W); G7, L (1.5 W). All irradiation was performed in unfocused mode. The electron micrographs were analyzed by three observers. For temperature analysis, a thermocouple was used. Data were subjected to statistical analysis. The Kruskal-Wallis non-parametric test showed statistical differences between the groups (P < 0.05). For the two by two comparisons, all groups treated with calcium hydroxide paste presented significantly higher mean scores. In the groups treated by CO(2) laser only, fusion, re-crystallization, cracks and carbonization were observed. A change of 1 ± 5°C was noted in the temperature. Under the limitation of an in vitro study, and with the protocols used, we concluded that CO(2) laser is safe to use for the establishment of partial fusion and re-solidification of the dentinal surface.

Glass Ionomer Cements (GICs) have a wide range of uses in Dentistry, and the manipulation technique used can influence the results obtained. This study aimed at assessing the knowledge held by Dental School students from a city in Southern Brazil regarding the use of GIC, and the clinical technique chosen for its use and its applications. A structured questionnaire was applied to 60 advanced dental students. Descriptive statistics was used to analyze the quantitative data. All students had already used the material. Regarding the purpose for which the material was used, all students (100%) had used it as a dental cavity liner, 83.3% had used it as a temporary restorative material after endodontic treatment, and 73.3% had used it as a permanent restoration in primary teeth. Regarding the clinical technique used, 86.7% said that they insert the material while it still has a shiny surface, 33% said that they finish and polish the restoration in a following session, and only 28.3% said that they apply a surface protection immediately after the restoration is placed. Although students generally seem to be acquainted with the fundamental knowledge and main techniques involved in GIC use, they occasionally fail to follow all the technical steps required during clinical application, which may affect treatment outcome. Therefore, professors should stress that all the clinical procedures required during GIC application must be followed strictly to improve the performance of this material.

Aim: To estimate the prevalence of traumatic injury in primary dentition among children aged 12-71 months old, as well as to evaluate the distribution of traumatic injuries, type of trauma and associated factors., Material and Methods: After the research project approval by the Ethics Research Committee, a cross-sectional study was carried out including 571 preschool children--both from public and private schools--in the city of Pelotas, Southern Brazil. Data were collected by means of anterior teeth examination, and by the administration of a structured questionnaire to parents. The classification proposed by Andreasen & Andreasen was used, and crown discoloration and fistula were added to this criterion., Results and Conclusions: The prevalence of dental trauma was 36.6% (95% CI 32.7-40.5), with no significant differences between boys and girls. Trauma were more frequent among older children (P = 0.001). No associations were found for maternal schooling, income and type of school. The most frequent trauma was enamel fracture, and the most affected tooth was number 61. A significant statistical association was observed between the presence of dental trauma during clinical examination and parental report of trauma occurrence. The percentage of parents who looked for dental treatment was higher among children from private schools (P = 0.001). The most frequent place of occurrence was home, and the most frequently reported etiology was child's own-height fall., Conclusions: Dental trauma in primary teeth is characterized as an accident that occurs due to the children's development stage, even when they are cared for by mothers of higher schooling and income. Parents should search for assistance right after trauma occurrence to minimize sequelae.

This study was carried out to evaluate in situ the influence of microleakage, surface roughness and biofilm control on caries formation around composite resin restorations. During 28 days, 12 volunteers wore palatal devices containing bovine enamel slabs restored with composite resin. Restorations were made without leakage, when the adhesive system was applied, or with leakage, when adhesive system was omitted. Half of the restorations in each group were finished and the remaining were finished and polished. In one side of the palatal device, biofilm was left to accumulate over the restored slabs, and in the other side dental slabs were brushed, to allow biofilm removal. There was an extraoral application of 20% sucrose solution (8x/day) over the enamel slabs. The formation of caries lesions (white spots) was evaluated by visual inspection under stereomicroscopy. Additionally, the dental slabs were sectioned and observed under polarized light microscopy. Data were submitted to Kruskal-Wallis test and Spearman's correlation test at 5% significance level. Polishing and bonding were not significant factors regarding white spot formation (p>0.05). Biofilm control (brushing) was associated with reduction of caries formation close to the restorations (p<0.01). Polarized light microscopy confirmed the visual inspection findings. These results suggest that while microleakage and surface roughness did not influence caries lesion formation, biofilm control may prevent the enamel demineralization.

This study investigated the association between several demographic, socio-economic, behavioural and clinical variables on caries activity. One hundred and two patients were randomly retrieved from the files of the Operative Dentistry Clinic (UFPel-Brazil). The patients gave written consent to participate in the study. They were interviewed reporting demographic (sex and age), socio-economic data (income, educaional level) and oral health behaviours (tooth-brushing frequency, dental floss usage and snacks frequency). Intraoral examination was performed to investigate the clinical variables (presence and quality of biofilm, DMFT and modified DMFT index and bleeding points). Patients were divided between caries-active (n=51) and caries-inactive (n=51), according to the presence of white spot lesions and/or active cavity lesions. Statistical analysis was carried tout using Chi-square or Fischer's exact test, with the confidence level at 95%. Results demonstrated that several conditions (younger subjects, lower educational or income levels, lower tooth-brushing frequency, higher snacks frequency, adherent biofilm, presence of bleeding points and higher modified DMFT index) were associated with caries activity in the studied population. Within the limitations of the experimental design, and considering the population under investigation, it was verified that demographic (age), socio-economic (income and educational levels), behavioural (tooth brushing and snacks frequencies) and clinical (modified DMFT index, presence and quality of biofilm, and bleeding points) variables were associated with caries-active patients.

Objective: To investigate the relationship between social and biological conditions experienced in very early life and dental caries in children aged 6 years., Methods: The design was a dental caries cross-sectional study nested in a birth cohort study started in Pelotas, Brazil, in 1993. The cross-sectional study was carried out in 1999. A random sample of 400 6-year-old children was selected from among 5249 live births in 1993. The World Health Organization (1997) criteria were used to diagnose dental caries. Results from the oral health study were linked to the data concerning perinatal and childhood health and illnesses and family social conditions collected at birth, 1, 3, 6 and 12 months, and in the sixth year of life. Dental caries was the outcome measured at two levels of severity (very low: dmft < or = 1; high: dmft > or = 4). Unconditional univariate and multiple logistic regression analysis were performed., Results: Self-employed and employees/unemployed, fathers with <8 years of education at time child was born, child's height deficit for age at 12 months; child who did not attend day care centre in sixth year of life; brushing teeth less than once a day, and children with sweet consumption of at least once a day at 6 years were risk factors for high dental caries after controlling for possible confounders., Conclusions: Harmful social and biological risk factors accumulated in early life contributed to the development of a high level of dental caries in childhood., (Copyright Blackwell Munksgaard, 2005.)