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BACKGROUND: Acrylic resins used in dental and biomedical applications do not have antimicrobial properties, their surface is susceptible to colonization of microorganisms. OBJECTIVE: The aim of this study was to evaluate the antibiofilm properties of silver nanoparticles (AgNPs) deposited in a polymethyl methacrylate (PMMA) surface against a Staphylococcus aureus biofilm. METHODS: The PMMA was impregnated with AgNPs by using the in-situ polymerization method. To determine the solubility of the incorporated silver (Ag+) atomic absorption spectrophotometry was used (AAS) at 24 h, 48 h, 7 days, and 30 days. Thirty specimens of PMMA with AgNPs and without NP (control group) were assembled in the CDC Biofilm Bioreactor system with a cell suspension of S. aureus. The specimens were removed at 6, 12, 24, 48, and 72 h to determine the viability profile and quantify the Arbitrary Fluorescence Units (AFU). RESULTS: The AgNPs showed an irregular and quasispherical shape with an average size of 25 nm. AAS analysis demonstrated a low solubility of Ag+. The formation of the S. aureus biofilm increased as the evaluation periods continued up to 72 h. The experimental group showed poor growth, and a decrease in the intensity of the fluorescence demonstrated a statistically significant inhibition of the formation of the biofilm (P < 0.05) in relation to the control group at 6, 12, 24, 48, and 72 h. CONCLUSION: AgNPs incorporated into PMMA decreased the growth and maturation of S. aureus biofilm.

PellGregory and Winter classifications are basic in third molar categorization; Sánchez-Torres classification is used in Mexico, but it has not been previously evaluated.To assess the degree of agreement in the radiographic evaluation of impacted mandibular third molar with the use of three classifications: PellGregory, Winter and Sánchez-Torres.Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sánchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss' kappa test.Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sánchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively.The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.Las clasificaciones de Pell y Gregory y de Winter son básicas en la categorización de terceros molares; la clasificación de Sánchez Torres es usada en México, pero no había sido evaluada previamente.Evaluar el grado de acuerdo en la valoración radiográfica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sánchez Torres.Estudio observacional, descriptivo, de concordancia interobservador, que incluyó a 10 cirujanos orales y maxilofaciales y 10 residentes en formación, quienes registraron la categorización radiográfica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sánchez Torres y Winter. Se evaluó el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss.La clasificación de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificación de Sánchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificación de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formación, respectivamente.La clasificación de Winter mostró un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formación.

The study aimed to perform a systematic scoping review with the need of exploring the actual clinical applications of the chloramphenicol-tetracycline-ZOE antibiotic paste (CTZ) as a lesion sterilization tissue repair (LSTR) therapy agent. Following a scoping framework suggested by Arksey and O’Malley, relevant articles (randomized controlled trials, literature reviews, observational studies, in vitro studies, and clinical case-series reports) published over the last 15 years (in English, Spanish, or Portuguese languages) were identified and retrieved from five internet databases: PubMed, Embase/Ovid, Cochrane Library, Google Scholar, and EBSCO. By title and abstract screening and after removing duplicates, 11 articles were finally included in the present scoping review: five randomized/non-randomized clinical trials, five in vitro studies, and one case-series report. According to the collected information, there were no differences between CTZ paste and conventional pulpectomy, antibiotic pastes, and intracanal filling materials, considering the clinical, radiographic, antimicrobial activity, and periapical tissue biocompatibility outcomes. CTZ has shown excellent rates of clinical success and good radiographic results, with adequate antimicrobial effects; however, its biocompatibility has been put into doubt. Contemporary pediatric dentists should carefully consider the CTZ paste as an alternative endodontic approach for pulpally involved primary molars, with the advantages of being simple and fast, and taking into account the limitations of instrumental pulpectomy such as the microbiological and morphological complexity of primary root canals.

Objective. This study sought to evaluate the biocompatibility of Neomineral Trioxide Aggregate (Neo-MTA), MTA Repair High Plasticity (MTA-HP), and Mineral Trioxide Aggregate-Angelus white (MTA-Ang) in fibroblasts of human dental pulp. Materials and Methods. Morphology was evaluated after 24 h of incubation. LIVE/DEAD assay and cell adhesion tests were performed at 24 h of treatment. Cell proliferation assays (MTSs) and Annexin V were performed at 48 h incubation with different treatments. The expression of Col-1 and TGF-β1 was tested by endpoint PCR at 5 days of treatment. Results. Morphological changes were observed in all groups. Neo-MTA and MTA-Ang were associated with increased cell viability, and all materials induced apoptosis, with a higher percentage in the MTA-HP group than in the other groups. In the LIVE/DEAD assay, there was more damage to the cell membrane in the group of cells treated with MTA-HP than in the other groups. Conclusion. Neo-MTA and MTA-Ang presented similar biocompatibility, and both showed greater biocompatibility than MTA-HP. MTA-HP and MTA-Ang increased Col-1A gene expression, and Neo-MTA and MTA-Ang increased TGF-β1 gene expression in a similar way.

OBJECTIVE This study sought to evaluate the effect of eugenol on the cell morphology and expression of genes involved in the apoptotic process in human dental pulp fibroblasts (hDPFs) from deciduous teeth. MATERIALS AND METHODS hDPFs were cultured with 4 concentrations of eugenol (0.06 nM, 0.6 nM, 6 nM, 12 nM) and compared with a control group. After a 72 h incubation period, the cytotoxic effect on cell morphology by optical microscopy and gene expression by RT-PCR were evaluated. RESULTS At 0.06 nM and 0.6 nM eugenol concentrations, vacuolisation of the cytoplasm was observed with atypical granulation of the hDPFs, and, at 6 nM and 12 nM cytoplasmic extensions disappeared almost completely. Casp-3, Casp-9, and telomerase genes were not expressed at the concentrations evaluated nor in the control group. The relative expression responses of Bcl-2 and TGF-β genes were overexpressed at the 4 concentrations. MAKP's 0.06 nM (p

Objective. The present study aimed to compare variations in quantified tumor necrosis factor-alpha (TNF-α) levels in patients with periodontitis stage 2 grade B (POD2B) and/or type 2 diabetes (T2D) and to identify any relationships between this cytokine and these diseases. Methods. Levels of the cytokine TNF-α in gingival crevicular fluid in patients with POD2B and/or T2D were evaluated. A total of 160 subjects were distributed into four groups: those with POD2B (n=44); those with T2D (n=37); those with POD2B/T2D (n=40); and healthy subjects (n=39). Glycosylated hemoglobin (HbA1c) and blood glucose (BG) levels were quantified in each subject. Data were collected on body mass index (BMI), loss of insertion (LI), and probe depth (PD). Gingival crevicular fluid samples were collected from the most acutely affected periodontal pocket and gingival sulcus in each subject, and TNF-α was quantified by multiplex analysis. Results. Kruskal Wallis tests was used to identify differences in TNF-α levels, LI, PD, BMI, BG, and HbA1c by group. Differences (pα levels and LI or PD identified a weak but significant negative correlation of TNF-α with LI (Rho=-0199; p=0.012), and a moderately positive correlation of LI with PD (Rho=0.509; p < 0.001). Conclusions. No variation was found between TNF-α levels and the presence of POD2B, POD2B/T2D, or T2D, suggesting the absence of any direct relationship between progression of these diseases and TNF-α levels. However, a correlation was present between low TNF-α concentrations and greater LI.

Dentinogenesis Imperfecta type II (DI2), also known as hereditary opalescent dentin, is one of the most common genetic disorders affecting the structure of dentin, not related with osteogenesis imperfecta, which involves both primary and permanent dentitions. The purpose of this article is to perform a scoping review of the published peer-reviewed literature (1986–2017) on DI2 management in children and to outline the most relevant clinical findings extracted from this review. Forty four articles were included in the present scoping review. According to the extracted data, the following are the most important tasks to be performed in clinical pediatric dentistry: to re-establish the oral mastication, esthetics, and speech, and the development of vertical growth of alveolar bone and facial muscles; to reduce the tendency to develop caries, periapical lesions and pain; to preserve vitality, form, and size of the dentition; to avoid interfering with the eruption process of permanent teeth; to decrease the risk of tooth fractures and occlusion disturbances; to return the facial profile to a more normal appearance; and to prevent or treat possible temporomandibular joint problems. Therefore, Pediatric Dentists should bear in mind that early diagnosis and treatment, together a long-term follow-up of DI2 in children, continue to be the best approaches for achieving enhanced patient psychological well-being and, in consequence, their quality of life.

Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

Dental caries can be effectively managed and prevented from developing into cavitated lesions while preserving tooth structure at all levels. However, the strong correlation between caries and socioeconomic factors may compromise the efficacy of preventive strategies. The high prevalence of persistent inequalities in dental caries in Latin American and Caribbean countries (LACC) is a matter of concern. The estimates of the burden of disease in some countries in this region are outdated or absent. This paper aims to summarize and present the final recommendations of a regional Consensus for Dental Caries Prevalence, Prospects, and Challenges for LACC. This consensus is based on four articles that were written by a team of Latin American experts, reviewed by dental associations, and presented and discussed in two consensus events. The following domains were explored: epidemiology, risk factors, prevention strategies, and management of dental caries with a focus on restorative procedures. Dental caries can manifest throughout the lifespan of an individual, making it a matter of concern for infants, children, adults, and older people alike. The prevalence rates of untreated caries in deciduous and permanent teeth are high in many parts of the world, including LACCs. Previous evidence suggests that the prevalence of dental caries in 12-year-olds is moderate to high in most Latin American countries. Moreover, the prevalence of treatment needs and dental caries in the adult and elderly population can also be regarded as high in this region. The risk/protective factors (e.g., sugar consumption, exposure to fluoride, and oral hygiene) probably operate similarly in all LACCs, although variations in the interplay of these factors in some countries and within the same country cannot be ruled out. Although salt and water fluoridation programs are implemented in many countries, there is a need for implementation of a surveillance policy. There is also room for improvement with regard to the introduction of minimal intervention techniques in practice and public health programs. Dental caries is a marker of social disadvantage, and oral health promotion programs and interventions aimed at reducing the burden of dental caries in LACCs must consider the complexity of the socioeconomic dynamics in this region. There is an urgent need to promote engagement of stakeholders, policymakers, medical personnel, universities, dental associations, community members, and industries to develop regional plans that enhance the oral health agenda for LACCs. A list of recommendations has been presented to underpin strategies aimed at reducing the prevalence and severity of dental caries and improving the quality of life of the impacted LACC population in the near future.

The objective of this systematic review and meta-analysis was to compare the pain/anxiety levels associated with the anesthetic process by conventional and computer-controlled delivery systems (CCDS) in children. Four electronic databases (PubMed, EMBASE, Scopus, Google Scholar, and Dentistry & Oral Science Source/EBSCO) were comprehensively explored for eligible studies, in English or Spanish, published from January 1995 to December 2019. A systematic literature review and meta-analysis were conducted according to the PRISMA statement, including only randomized controlled clinical trials. An exhaustive search was performed in different electronic databases under a specific PICO-posed question. Relevant studies were selected based on titles and abstracts, and the full texts were retrieved. From these articles, important information was extracted. Wand demonstrated significantly lower pain than the conventional injection did. In the subgroup by pain scale analysis, the Facial Image Scale and Wong-Baker Faces Pain Scale showed a significant difference in favor of the CCDS. In general, the reviewed evidence shows that less perceived pain and anxiety occur when the local anesthetic technique is performed with a CCDS than with the traditional technique.

Purpose: The objective was to evaluate the antagonistic effect of Lactobacillus and Bifidobacterium recovered from five commercial probiotics on the growth of C. albicans. Study design: The Lactobacillus and Bifidobacterium strains of five commercial probiotics were recovered and grown: Probio Hp+®, ProBiseis®, Lactipan®, Liolactil®, and Lacteol Fort®; 50 mg of each was hydrated and grown in Lactobacilli MRS (De Man, Rogosa and Sharpe) broth and incubated at 37°C with stirring (120 RPM) for 24 hours. Serial dilutions of 10−1 to 10−7 were made and viability was verified and quantified. For the antagonism tests, a suspension/inoculum of Lactobacillus strains recovered from each commercial preparation (4–30 × 109) and C. albicans ATCC 90028 (1.5–8 × 108) was prepared in MRS broth and incubated for 48 hours at 36°C, then plated on Dextrose Sabouraud Agar with Chloramphenicol and Rogosa Agar and the colony-forming units (CFU) were quantified. Additionally, viability was evaluated using the LIVE/DEAD® Yeast and Bacterial Viability kit. Results: The probiotic that produced the highest acidity of the medium was Lactipan®, followed by Probiseis® and Liolactil®, while Probio Hp+® showed the least change. Probiseis® was determined to have the highest growth of probiotic bacteria and the highest inhibition on C. albicans, followed by Lactipan®; Liolactil® and ProbioHp+® showed the least effect. In fluorescence tests, ProBiseis® showed the best effect, followed by Liolactil® and Lactipan®; Probio Hp+® had less of an effect. Conclusions: Two commercial products (ProBiseis and Lactipan) whose formulations have L. acidophilus, L. casei, L. rhamnosus, L. plantarum, B. infantis, and S. thermophilus have a greater inhibitory effect on C. albicans ATCC 90028

Dental treatment for anxious or fearful intellectually disabled children/adolescents (IDCA) may present great challenges, due to deficits in cognitive, intellectual, language, and social abilities, in conjunction with limited adaptive behavior. In many cases, it is necessary for the Dentist to implement advanced behavioral control techniques. Inclusive Dentistry (ID) considers profoundly each patient’s individual interests and likes, including the social and family situations, for choosing the respective personalized plan –contemplating potential risks and benefits– for the behavior control, in order to obtain the maximal possible cooperation of the patient in the dental chair. Through ID, the Pediatric Dental Practitioner aims to alleviate the anxiety and fear of IDCA in the clinical setting, in such a way that these patients are positively motivated, on a long-term basis, for current and future oral care, both at the dental office and at home. This management approach may be a time-consuming method or require more effort by the dentist, but it reaps benefits when applied for many mild-to-moderate (and some severe) IDCA. The Practitioner must possess the knowledge, in-depth understanding, and professional training for the adequate use of ID during the behavioral management of anxious or fearful IDCA. The aim of the present report was to describe four representative clinical cases of IDCA at our Clinic, managed under the philosophical principles of ID.

Root canal obturation needs to preserve optimal clinical conditions for achieving success in patients. The aim of the present study was to evaluate endodontic obturation performed by the lateral condensation technique with manual and rotary instruments. Thirty extracted incisors were divided into two groups according to instrumentation technique: group 1-RCSMA57 + Sealapex® and group 2-spreader iRace #30 + Sealapex®. All samples were decoronated and standardized at 10 mm, intraradicular instrumentation were performed with Gates-Glidden #3, and the protocols of irrigation that were employed were 5.25% NaOCl + 17% EDTA during instrumentation. Finally, the groups were obturated with the lateral condensation technique. The samples were observed with conventional X-ray, scanner X-ray, radiovisiography, and Cone Beam computed tomography techniques. For evaluation, a scale of canal obturation density (0 = suitable, 1 = acceptable, 2 = fair, and 3 = inadequate) was employed by blinded evaluator. A value of canal obturation density was assigned in each sample. A statistical analysis by the χ2 of Pearson with a significance level of 0.05% was employed. All groups showed different values according to the instrumentation technique employed. The rotary instrument gave better results than manual instruments according to the values expressed (p = 0.004). The both instruments can be used in the obturation lateral technique; however, the rotary instrument provides better conditions for this technique.

espanolIntroduccion: Las clasificaciones de Pell y Gregory y de Winter son basicas en la categorizacion de terceros molares; la clasificacion de Sanchez Torres es usada en Mexico, pero no habia sido evaluada previamente. Objetivo: Evaluar el grado de acuerdo en la valoracion radiografica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sanchez Torres. Metodo: Estudio observacional, descriptivo, de concordancia interobservador, que incluyo a 10 cirujanos orales y maxilofaciales y 10 residentes en formacion, quienes registraron la categorizacion radiografica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sanchez Torres y Winter. Se evaluo el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss. Resultados: La clasificacion de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificacion de Sanchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificacion de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formacion, respectivamente. Conclusion: La clasificacion de Winter mostro un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formacion. EnglishIntroduction: Pell & Gregory and Winter classifications are basic in third molar categorization; Sanchez-Torres classification is used in Mexico, but it has not been previously evaluated. Objective: To assess the degree of agreement in the radio- graphic evaluation of impacted mandibular third molar with the use of three classifications: Pell & Gregory, Winter and Sanchez- Torres. Method: Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sanchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss’ kappa test. Results: Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sanchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively. Conclusion: The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.

Pediatric clinical research on new drugs and biomaterials involves children in order to create valid and generalizable knowledge. Research on vulnerable populations, such as children, is necessary but only admissible when researchers strictly follow methodological and ethical standards, together with the respect to human rights; and very especially when the investigation cannot be conducted with other population or when the potential benefits are specifically for that age group. Clinical research in Pediatric Dentistry is not an exception. The aim of the present article was to provide the bioethical principles (with respect to the child/parents' autonomy, benefit/risk analysis, and distributive justice), and recommendations, including informed consent, research ethics committees, conflict of interest, and the “equipoise” concept. Current and future worldwide oral health research in children and adolescents must be conducted incorporating their perspectives in the decision-making process as completely as possible. This concept must be carefully considered when a dental clinical study research is going to be planned and conducted, especially in the case of randomized controlled trials, in which children will be recruited as participants.

Objective: The objective of this study was to evaluate the effects of pit and fissure sealant mixed with silver nanoparticles on dental caries, by means of monthly measurement of fluorescence with DIAGNOdent over six months. Study Design: This study was divided in two phases: experimental and clinical. In the experimental phase, the adhesion and microleakage of the pit and fissure sealant experiment were evaluated. Two groups of 10 teeth, without serious carious lesions, were included. Conventional (group A) and silver nanoparticles (group B) were added to the pit and fissure sealant. For the clinical phase, a split-mouth study was performed on 40 children aged 6-10 years old with healthy, erupted permanent first molars. A conventional pit and fissure sealant or a silver nanoparticle-mixed sealant was randomly placed. Repeated measures analysis was performed. Results: Conventional sealant presented an average microleakage of 30.6%, and the silver nanoparticle-mixed sealant showed 33.6% (P=NS). A three times greater reduction in fluorescence was found in the silver nanoparticles group compared to the conventional group (P

In order to include appropriate informed decisions on dental therapeutic or preventive procedures in children, Pediatric Dentists should apply the fundamentals of “Evidence-Based Dentistry” (EBD). This oral health approach assists clinicians in understanding and applying the most relevant research published on evidence in the clinical setting when treating their patients. One of the crucial steps of EBD is to critically appraise and use the primary articles about therapy or prevention, namely, Randomized Clinical Trials (RCT), the study design that best addresses the questions related with these clinical areas. The aim of the present paper was to provide the basic concepts and an example of how to critically read and understand articles on RCT studies in Pediatric Dentistry employing the CONSORT statement, a process that involves assessing the reliability of results, risk of bias (internal validity), and applicability of reported clinical findings (external validity).

Objective.The present study aimed to compare levels of matrix metalloproteinase-9 (MMP-9) and myeloperoxidase (MPO) in gingival crevicular fluid (GCF) from subjects with controlled and noncontrolled Type 2 Diabetes Mellitus (T2D), with and without stage 2 grade B periodontitis (POD2B) versus healthy (H) subjects.Methods.The levels of both enzymes, from 80 GCF samples collected with PerioPaper strips, were analyzed by a Multiplex/Luminex assay. Five groups were formed, all current patients at the Institutional Dentistry Service, and distributed as follows: two groups of diabetics (one controlled and one poorly controlled); two groups with the previous conditions and diagnosed with POD2B; and one H group.Results.The highest concentration of MMP-9 corresponded to the H group, while the lowest corresponded to the T2D controlled group. Regarding MPO levels, the highest levels were associated with the T2D controlled with POD2B group and the lowest with the T2D controlled group.Conclusions.No apparent relationship between the elevation of MMP-9 and MPO levels was observed among subjects with T2D, with and without POD2B, compared to H subjects.

A case report is a useful type of publication to describe information on unusual clinical diseases or syndromes, new management techniques, potential risk factors/oral disease associations, and uncommon side effects or responses to traditional dental treatments. In the practice of Dentistry and Medicine, the publication of case reports has the purpose of sharing new clinical experiences and knowledge with interested colleagues. Case reports in the field of Evidence-Based Pediatric Dentistry convey unique contributions to the clinical practice and help improve the process of clinical decision making in the form of a brief written communication. Additionally, case reports are potential resources of new hypotheses for more complex methodological designs in clinical research studies and are one of the best ways to get started in scholarly writing. The purposes of the present report were to comment on the role, relevance, and main limitations of case reports in Clinical Pediatric Dentistry, to describe the reasons for writing a case report and some recommendations for critically reviewing a published case report, and finally, to provide the fundamentals of preparing a case report, and finally, to provide the fundamentals of preparing a case report manuscript in a structured manner.

Objective: The aim of the study was to determine the eugenol concentrations at which toxicity occurs in human dental pulp fibroblasts of primary teeth. Study design: Samples of primary dental pulp tissue were taken. Tissue samples were seeded by means of explant technique and used in the 4th–5th pass. Single Cell Gel Electrophoresis (Comet), phenazine MeThoSulfate (MTS), LIVE/DEAD® Cell Viability/Toxicity and trypan blue assays for evaluation of the cytotoxicity of increasing concentrations of eugenol (0.06 to 810 μM) were performed. Results: The results of toxicity tests showed toxic effects on dental pulp fibroblasts, even at very low concentrations of eugenol (0.06 μM). Very low concentrations of eugenol produce high toxicity in human dental pulp fibroblasts. Conclusions: All of the concentrations of eugenol that we evaluated produced high toxicity in human dental pulp fibroblasts of primary teeth.

ResumenDebido a la gran problemática mundial de la resistencia bacteriana a los antibióticos, es necesaria la búsqueda continua de nuevas moléculas con características antimicrobianas. Este estudio evaluó el efecto antibacteriano y antifúngico de un extracto hexánico proveniente de la raíz de Salvia apiana. Los extractos de salvia a las concentraciones de 27; 13,5; 6,8 y 3,4mg/ml causaron inhibición del crecimiento de Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecalis y Candida albicans. Sin embargo, no presentaron efecto significativo sobre Escherichia coli y Candida tropicalis al compararse con los valores del vehículo en las valoraciones de difusión en pozo. Se demostró que S. apiana tiene un efecto antimicrobiano significativo sobre patógenos de gran importancia clínica, lo que abre el campo para continuar evaluando a esta lamiácea en vistas a su posible empleo en el futuro como un agente terapéutico.AbstractDue to the great global concern regarding bacterial resistance to antibiotics, an ongoing search for new molecules having antibacterial activity is necessary. This study evaluated the antibacterial and anticandidal effects of a hexane extract from the root of Salvia apiana. Salvia extracts at concentrations of 27, 13.5, 6.8 and 3.4mg/ml caused growth inhibition of Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecalis and Candida albicans. However, no significant effect was observed on Escherichia coli and Candida tropicalis in comparison to vehicle. It was here demonstrated for the first time that Salvia apiana has an important antimicrobial effect on human pathogens of great clinical value, thus opening the field to continue the evaluation of this lamiaceous plant for its future use as a therapeutic agent.

Objective: The purpose of the present study was to evaluate the clinical and radiographic effectiveness of zinc oxide–eugenol (ZOE) as the only pulp capping agent in pulpotomies carried out on decayed primary molars after a follow-up period of 24 months. Study design: In total, 60 pulpotomies were performed on 38 patients aged 3 to 11 years. Pulpotomy treatment consisted of the removal of the coronal pup tissue, subsequent hemostasis, irrigation with saline solution, drying and pressure with sterile cotton pellets, and placement of a thick regular ZOE base with a minimal amount of eugenol directly over the vital radicular pulp. Additionally, a histopathologic study was carried out on some of the molars treated. Results: After a 24-month follow-up, we considered 51 procedures to be successful and 9 failures using clinical and radiographic criteria; most of the failures occurred between the 12th and 18th month. Conclusions: Results suggest that the proposed pulpotomy treatment with ZOE as the only capping agent may be considered as an alternative technique in the pulp treatment of primary molars.

Early childhood caries: ¿neglect or ignorance? Report of a case

Background: Esophageal Atresia (EA) is defined as the congenital interruption of the continuity of the esophagus. Pediatric patients also have other congenital conditions, such as Tracheo-Esophageal Fistula (TEF). Case report: A 7-year-old male with TEF referred by a Pediatric Cardiologist, with the principal complaint of “severe and generalized tooth wearing”. Considering that the patient was systemically stable, it was decided to perform the oral procedures under local anesthesia and rubber-dam isolation with an antimicrobial prophylaxis regimen. The treatment consisted of the extraction of all maxillary primary incisors and canines and both first molars; in the mandibular arch, only the lower second right molar was extracted, and a distal shoe was placed. Pulpotomies were performed and preformed metallic crowns were placed on the remaining second primary molars, on both lower first molars, and on lower canines and lateral incisors. Finally, a fixed prosthesis was positioned in the upper arch, and cemented through orthodontic bands adapted to both crowned second molars. The patient has been maintained under close medical and dental control. The child showed satisfactory oral conditions, and the vomiting episodes had decreased significantly. Conclusions: Dentists can learn and then participate in the integral health management of infants and young children affected with EA/TEF, particularly those with dental erosion.

Aim: The objective of this study was to evaluate the efficacy of subcutaneous (SC) sedation using midazolam with and without ketamine in non-cooperative pediatric patients undergoing dental treatment. Study Design: A prospective, randomized, controlled, double-blind, crossover pilot clinical trial was carried out in 13 children, aged between 17–46 months, ASA l, Frankl 1. Two sedation schemes were administered SC: Midazolam alone (M), and a combination of Midazolam-Ketamine (MK). Both regimens were administered to the same patient in two consecutive treatment sessions, in accordance with a random assignment. Overall behavior, movement, and crying were assessed according to the modified Houpt scale. Heart rate, blood pressure, blood oxygen saturation, and possible side effects were also monitored. Results: The percentage of non-crying children was always higher in the treatment with MK compared with the treatment with M, but without a significant statistical difference. Regarding variable body movement, the percentage of children without movement was higher in the MK group, although only up to minute 10; no significant differences were found at 20, 30, and 40 minutes, and from minute 40, body movement was lower in the M group. Conclusions: Midazolam alone and the midazolam-ketamine combination administered subcutaneously resulted in a safe and efficient pharmacological method for providing moderate sedation to non-cooperative pediatric patients undergoing dental treatment.

The main purpose of the second part of this series was to provide the reader with some basic aspects of the most common biostatistical methods employed in health sciences, in order to better understand the validity, significance and reliability of the results from any article on Pediatric Dentistry. Currently, as mentioned in the first paper, Pediatric Dentists need basic biostatistical knowledge to be able to apply it when critically appraise a dental article during the Evidence-based Dentistry (EBD) process, or when participating in the development of a clinical study with dental pediatric patients. The EBD process provides a systematic approach of collecting, review and analyze current and relevant published evidence about oral health care in order to answer a particular clinical question; then this evidence should be applied in everyday practice. This second report describes the most commonly used statistical methods for analyzing and interpret collected data, and the methodological criteria to be considered when choosing the most appropriate tests for a specific study. These are available to Pediatric Dentistry practicants interested in reading or designing original clinical or epidemiological studies.

Objective: To investigate the possible association between maternal S. mutans levels and those of the infant during the period between birth and 5 months and evaluate possible risk factors in the S mutans colonization. Study Design: A prospective cohort study was carried out comprising 62 infants and their mothers, selected at the time of childbirth. For each infant, a sample swab was taken at 0, 15, 30, 90, and 150 days postpartum; on the same days, a sample was obtained from the mothers. TYCSB medium was employed for identifying the microorganism, which was later confirmed by Gram staining, the catalase activity test, and the API strep test. Results: The final total sample consisted of 60 infants, from which S. mutans was detected in only 2 (3%) at the 150th day of oral sample collection. Of the sample of 60 mothers, 54 exhibited colonization levels. Conclusions: In the studied sample pairs up to 150 days, it was not possible to demonstrate the presence of a direct relationship between maternal S. mutans oral levels.

Objective. The aim of this study was to evaluate the cytotoxicity and cellular adhesion of Mineral Trioxide Aggregate (MTA) and Biodentine (BD) on periodontal ligament fibroblasts (PDL).Methods. PDL cells were obtained from nonerupted third molars and cultured; MTS cellular profusion test was carried out in two groups: MTA and BD, with respective controls at different time periods. Also, the LIVE/DEAD assay was performed at 24 h. For evaluation of cellular adhesion, immunocytochemistry was conducted to discern the expression of Integrinβ1 and Vinculin at 12 h and 24 h. Statistical analysis was performed by the Kruskal-Wallis and Mann-WhitneyUtests.Results. MTA and BD exhibited living cells up to 7 days. More expressions of Integrinβ1 and Vinculin were demonstrated in the control group, followed by BD and MTA, which also showed cellular loss and morphological changes. There was a significant difference in the experimental groups cultured for 5 and 7 days compared with the control, but there was no significant statistical difference between both cements.Conclusions. Neither material was cytotoxic during the time evaluated. There was an increase of cell adhesion through the expression of focal contacts observed in the case of BD, followed by MTA, but not significantly.

HIV infection is a major global health problem affecting developing and developed countries alike. HIV infection is associated with multiple oral lesions, some of which are of value in diagnosing the disease. The aim of this report is to describe the clinical manifestations and their multidisciplinary management, in a 6- year-old girl with AIDS. The findings of this case report indicate that, it is essential to be familiar with the early oral manifestations of AIDS in order to understand the patient's dental health needs, apply preventive methods, control caries, and understand the value of oral lesions as diagnostic markers of disease progression in children with HIV infection. A multidisciplinary management is fundamental.

Objective: The aim of this study was to evaluate the effectiveness of oxidative potential water (OPW) as an irrigating solution in reducing bacterial loading in necrotic pulpectomized primary teeth. Study design: Forty necrotic teeth were included, 20 irrigated with OPW (experimental group) and 20 with 1% NaOCl (control group); in both groups, 2 microbiological samples from within the canals were taken with a sterile paper point, the first before irrigation (immediately before opening the crown), and the second after instrumentation and final irrigation (before filling). All samples were evaluated by McFarland's scale. Results: After the samples were analyzed before and after irrigation in the control group, there was a significant decrease in bacterial load, as in the experimental group (P < 0.0001). When both groups were compared post irrigation, no significant difference was observed (P = 0.1519). Conclusion: The OPW was as effective as the NaOCl and is suggested as an alternative for irrigating after pulpectomy of necrotic primary teeth.

Williams-Beuren syndrome is a rare congenital disorder involving the cardiovascular system, mental retardation, distinctive facial features, and tooth anomalies. The aim of the present report is to show a 10-year-old girl with Williams-Beuren syndrome, her general and orofacial clinical characteristics and the dental management.

A new system for sustained release of growth factors, such as osteogenic protein 1 (OP-1) and transforming growth factor β1 (TGF-β1), intended to repair and promote dental tissue regeneration in rats was designed and characterized in this work. The release system was made with microparticles of sodium alginate, produced by ionic gelling dripping technique. The release profiles of OP-1 and TGF-β1 from biopolymer matrix were determined by high-performance liquid chromatography (HPLC), and with this purpose, an HPLC-UV method was developed. About 80% of each growth factor was released in the first 24 h, reaching almost 100% in 168 h. The system was tested during the tissue repair in rat molars in comparison with calcium hydroxide and both growth factors not encapsulated. The dentin sialoprotein (DSP) was used as a repair marker. It was detected by immunohistochemistry, after 14- and 28-d post-treatment. X (2) test (p ≤ 0.001) and Fisher exact test (p ≤ 0.05) were applied for assessment of the amount of immunostaining. The treatment with encapsulated OP-1 showed an increased DSP immunostaining after 14 d and did not find any significant difference with the immunostaining observed for calcium hydroxide treatment. Treatment with TGF-β1 did not show significant difference with calcium hydroxide. Treatment with both factors OP-1 and TGF-β1 showed higher DSP immunostaining in comparison with calcium hydroxide treatment. In conclusion, the combination of both growth factors encapsulated showed more DSP immunostaining in comparison with each one separated, either encapsulated or not.

Silver nanoparticles (NNPs) are extensively used for all kinds of antimicrobial applications in medical research. Their efficacy has been demonstrated against Streptococcus mutans, which is associated with dental caries. However, their cytotoxic effects on human periodontal tissue are not completely understood.Objective: The aim of this study was to evaluate the possible toxic cellular effects of different concentrations and sizes of silver nanoparticles, less than 10 nm, 15–20 nm, and 80–100 nm, respectively, on human periodontal fibroblasts. Study design: Primary culture cells isolated from human periodontal tissue were exposed to 0–1,000 µM silver nanoparticles of each size for 24-, 72-, and 168-hour periods. Cytotoxicity was evaluated with a nonradioactive, soluble MTS/PMS assay. Results: The results demonstrated that silver nanoparticles of less than 20 nm increased cytotoxicity in human periodontal fibroblasts in a dose- and time-dependent manner. Conclusion: The 80–100-nm-sized nanoparticles did not modify the viability of human primary culture cells.

The purpose of this study was to determine the prevalence of oral manifestations in pediatric patients with acute lymphoblastic leukemia (ALL) receiving chemotherapy, and to evaluate the significance of independent risk factors (oral health, gender, age, time and type of treatment, and phase of chemotherapy). A crosssectional study was made in 49 children with ALL between 2 and 14 years of age. To describe oral manifestations,a clinical diagnosis was made and the following criteria were applied: the OHI-S index to describe oral health and the IMPA index to describe periodontal conditions and to differentiate gingivitis from periodontitis. The prevalence of oral manifestations was: gingivitis, 91.84%; caries, 81.63%; mucositis,38.77%; periodontitis, 16.32%; cheilitis, 18.36%; recurrent herpes, 12.24%; and primary herpetic gingivostomatitis,2.04%. Other oral manifestations were: dry lips, mucosal pallor, mucosal petechiae, ecchymoses,and induced ulcers. The prevalence of oral candidiasis was 6.12%. It was observed that high risk ALL and poor oral hygiene were important risk factors for the development of candidiasis and gingivitis. The type of leukemia, gender, and phase of chemotherapy were apparently associated with the presence of candidiasis, gingivitis, and periodontitis, and they could be considered risk factors for the development of oral manifestations.

Hypoglossia is referred to a small volume and/or size of the tongue. It is a rare congenital condition caused by failed embryogenesis of the lateral lingual swellings and tuberculum impar during the fourth to eighth weeks of gestation. The anomaly has often occurred in association with limb abnormalities and various syndromes, and it affects facial and mandibular growth. The present report describes a case of severe congenital hypoglossia in a female infant, her systemic and dentofacial features, and the initial management.

Isolated heterotopic lesions of neuroglial tissue may rarely present in the head and neck, or they may be associated with other congenital deviations. In this article we present the case of a 7–month-old patient with a central lesion that emerged through the anterior part of a bilateral palatine fissure.

Extracellular matrix (ECM) is a rich network of proteins and proteoglycans that has proved to be very useful in tissue regeneration. Porcine ECM has been proposed as a biological scaffold, and urinary bladder matrix (UBM) has demonstrated superior biological properties; however, its use in human treatment requires ensuring that it is DNA free. Several protocols have been used for decellularization and to demonstrate the absence of DNA, but until now, a porcine housekeeping gene for quantifying DNA by real-time quantitative PCR (qPCR) has been limiting. The aim of this study was to propose a protocol to quantify the DNA content of decellularized UBM by qPCR for the beta-actin gene (ACTB). A total of 20 porcine bladders were used, and each bladder was divided into three pieces: one as a control and the others decellularized with either SDS or Triton X-100 detergent. The presence of DNA was assessed by histology, spectrophotometry, conventional PCR, and qPCR for the ACTB. Histological analysis demonstrated the absence of nuclei using both protocols. Spectrophotometrical evaluation resulted in DNA concentrations of 1561.4 ± 357.1 and 1211.9 ± 635.2 ng of DNA/mg dry weight after the SDS and Triton X-100 protocols, respectively. DNA was not detected in any protocol by conventional PCR. In contrast, using qPCR, we found 3.9 ± 2.8 ng of DNA/mg dry weight in the Triton X-100 protocol. Therefore, the use of qPCR is a reliable method to quantify residual DNA content after decellularization procedures.

Tramadol is an atypical opioid with a complex mechanism of action including a synergistic interaction between the parent drug and an active metabolite. The local action of the parent drug is poorly documented. This study was designed to evaluate the site–site interaction of the antinociception produced by tramadol given by two different routes. The effects of individual and fixed-ratio combinations of intraplantar (i.pl.) and intraperitoneal (i.p.) tramadol were evaluated using the formalin test in rats. Isobolographic analysis was employed to identify the synergy produced by combinations. In both first and second phases of the formalin test, tramadol was active not only by the systemic (ED 50 10.2 ± 2.1 and 7.1 ± 0.5 mg/kg i.p.) but also by the local route (ED 50 171.0 ± 44.8 and 134.6 μg/paw i.pl.). The isobolographic analysis revealed a “self-synergism” in the antinociceptive effect between the two routes of administration, as the experimental ED 50 (211.1 ± 13.6 and 45.9 ± 3.9 “dose units” phase 1 and 2, respectively) of the combination was significantly lower than the theoretical ED 50 (422.2 ± 50.5 and 138.5 ± 9.2 “dose units”). The mechanism underlying this self-synergism appears to be partially opioid since systemic but not local naloxone reversed the potentiation. The observed dual-site interaction in the antinociceptive action of tramadol provides insights for alternatives in the management of pain.

Purpose.To evaluate a structurally matureE. faecalisbiofilm developed under anaerobic/dynamic conditions in anin vitrosystem.Methods.An experimental device was developed using a continuous drip flow system designed to develop biofilm under anaerobic conditions. The inoculum was replaced every 24 hours with a fresh growth medium for up to 10 days to feed the system. Gram staining was done every 24 hours to control the microorganism purity. Biofilms developed under the system were evaluated under the scanning electron microscope (SEM).Results.SEM micrographs demonstrated mushroom-shaped structures, corresponding to a matureE. faecalisbiofilm. In the mature biofilm bacterial cells are totally encased in a polymeric extracellular matrix.Conclusions.The proposedin vitrosystem model provides an additional useful tool to study the biofilm concept in endodontic microbiology, allowing for a better understanding of persistent root canal infections.

Dubowitz syndrome is a rare genetic condition characterized by microcephaly, dysmorphic facial features and delayed general growth. It is transmitted through autosomal recessive inheritance. The purpose of this report is to describe the oral, craniofacial and systemic characteristics of a 7-year 11-month-old boy with Dubowitz syndrome and the dental management provided. The pediatric dentist should possess the ability to recognize this rare alteration, to provide dental treatment and to refer for the necessary medical and multidisciplinary treatment.

En los últimos años se ha popularizado el uso de plasma rico en plaquetas y plasma rico en factores de crecimiento en la cirugía bucal y maxilofacial. Se reporta un caso de paciente femenino de 21 años de edad, con dolor moderado en zona de tercer molar inferior izquierdo y derecho. Se realiza remoción quirúrgica de ambos terceros molares inferiores. Se extraen 20 cc. de sangre del paciente para obtener plasma rico en factores de crecimiento el cuál fue colocado en zona de extracción de tercer molar inferior izquierdo. En zona de tercer molar inferior derecho se irrigo con suero fisiológico. Al tercer día post-operatorio se observa clínicamente menor inflamación extraoral del lado izquierdo comparado con lado derecho. Intraoralmente menor inflamación y eritema de la zona y mejor epitelización del lado izquierdo en relación con lado derecho. Al quinto día post-operatorio se retira sutura en ambos lados, observando mejor epitelización y menos eritema de la herida en lado izquierdo. Al séptimo día es clara la diferencia en la regeneración de tejidos blandos en el lado izquierdo comparado con el derecho. Se refería menos dolor del lado izquierdo en cada una de sus citas control. La experiencia en el presente caso nos hace sugerir que el uso de plasma rico en factores de crecimiento puede beneficiar el postoperatorio de los pacientes después de la remoción quirúrgica de terceros molares inferiores.

Objective: The aim of this study was to evaluate the reduction in bacterial loading using 2% chlorhexidine gluconate as an irrigating solution in pulpectomized primary teeth. Study design: A randomized, controlled clinical trial was performed that included primary teeth with pulp necrosis. Forty necrotic teeth were included, 20 irrigated with 2% chlorhexidine gluconate (experimental group) and 20 with sterile saline solution (control group); in all cases, 2 microbiological samples from within the canals were taken with sterile paper points, the first after the canal opening and before the first irrigation, and the second after instrumentation and final irrigation, before filling. All samples were evaluated by McFarland's scale. Results: The results were statistically analyzed by the Mann-Whitney U test. After analyzing samples before and after irrigation in the control group (saline), we found a significant decrease of bacterial load (P

Dental caries is a worldwide public health problem. S mutans plays an important role in the etiology of caries. There have been studies that showed the antimicrobial properties of silver nanoparticles are an effective agent to diminish S. mutans. The objective of this study was to evaluate the bactericidal and bacteriostatic effects of silver nanoparticles in addition to the Gantrez S-27 copolymer, on S mutans. Method:We performed an in vitro experimental study using the liquid microdilution method in order to find the minimum inhibitory concentrations (MICs) and the minimum bactericidal concentrations (MBCs) with the subcultures obtained. The mixture was obtained by preparing 98 µg/mL of silver nanoparticles (10-3mol)with Gantrez S-27 2%, in distilled water. The readings were performed 24 hours after incubation and on 3 consecutive days. The results showed an average MIC of 6.12 µg /mL and MBC of 6.12 µg /mL.Conclusion: The addition of Gantrez 2% to silver nanoparticles does not alter its antimicrobial effect.

Silver nanoparticles (NNPs), alone or in combination with the bioadhesive Gantrez S-97, have demonstrated their efficacy against Streptococcus mutans; however, it is not known if this combination changes the color of teeth. The aim of this work was to measure the color changes occurring after the use of a Gantrez-NNP combination on enamel tooth blocks. Two study groups were randomly formed: enamel blocks brushed with a) the Gantrez-NNP combination and b) conventional toothpaste, for 1 minute once daily for 4 weeks, then rinsed with distilled water and placed in thymol solution. Color changes in the enamel blocks were measured using a Minolta colorimeter CR300. Analysis of mixed models was performed with R 2.10.1 at a 95%confidence level, using the nonlinear mixed effects (NLME) package. The results showed that there were no color changes over time, only a high luminosity equal in both groups. Our study showed that the use of the Gantrez-NNP combination is safe with respect to dental esthetics in the control of S. mutans.

Enamel Matrix Derivative (EMD) is a rich amelogenin and amelin biomaterial that has been demonstrated to induce a reparative process similar to normal odontogenesis when placed in contact with pulp tissue. However, its effects in pulp capping on primary teeth has not been previously reported. The aim of the present case report is to present the favorable clinical and radiographic findings of a primary molar treated with direct pulp capping (DPC) and using EMD as capping material in a 6-year-old girl. Results: After 12 months, there was no sign or symptom indicative of treatment failure, such as pain, gingival swelling, sinus tract, sensitivity to percussion or palpation, abnormal mobility, widening of periodontal space, internal or external root resorption, or supporting bone or furcal area radiolucencies.

The objective of this study was to evaluate the clinical efficacy of 5% sodium hypochlorite solution for removal of stains caused by dental fluorosis in young patients. A clinical trial involved 33 patients with diffuse opacities on the enamel surfaces of maxillary incisors due to effects of dental fluorosis. The protocol of treatment 3 steps: (1) cleaning and enamel etching with 37% phosphoric acid in order to eliminate the layer that covers the fluorotic enamel surface and allow better penetration of the bleaching agent, (2) application of 5% sodium hypochlorite to remove stains caused by organic material, and (3) filling the opened micro-cavities with a light-cured, composite surface sealant to prevent restaining. The whiteness of the enamel lesions before and after treatment were expressed in L*, a*, and b* color space measurements using a Minolta Chroma Meter CR300. Analysis of parameters of [symbol:see text]E (L*, a*, b*) showed that changes were observed in the L* (brightness) and a* (redness), which paralleled the [symbol: see text]E differences. There was no significant difference in the b* (yellow) parameter. The technique described in this study appears to have advantages over other methods for improving the appearance of fluorotic lesions. It is simple, low cost, non invasive so the enamel keeps its structure, relatively rapid, and safe; it requires no special materials, and it can be used with safety on young permanent teeth.

The aim of this study was to compare the frequency of enamel hypoplasia in children with renal disease and healthy children, all of whom live in a fluoridated area. A cross-sectional study was made in 42 children divided into 2 groups. To describe enamel changes, 3 diagnostic criteria were applied: TSIF Index to describe dental fluorosis, Jackson-Al-Alousi Index to describe enamel hypoplasia, and Russell criteria to differentiate mild forms of dental fluorosis and enamel hypoplasia. The frequency of enamel hypoplasia in patients with renal disease was 38.09%. This frequency is smaller than that seen in other studies. There was no difference in the frequency of dental fluorosis between patients with renal disease and patients without renal disease. However, the patients with renal disease presented more severe dental fluorosis than children without renal disease.