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Cerebral palsy (CP) is one of the most severe childhood disabilities due to a lesion in the developing brain. Oral conditions often observed in this pathogenic are a tendency for the delayed eruption of permanent molars, higher percentages of malocclusion and parafunctional habits, including bruxism. The significance of oral conditions observed in CP patients demonstrates the need for intensive home and professional care for these individuals. This paper presents a 7-year-old boy, with cerebral palsy, severe mental retardation, who had high abrasion wear of the primary teeth related to bruxism. Dental care was carried out under oxide-induced sedation, and management of the bruxism was achieved after the use of a resin acrylic protective appliance fixed on both sides of the mandibula. The treatment performed offered efficiency advantages, was clinically viable, and should be a valuable option to practitioners considering appliance therapy to control parafunctional behavior. [ABSTRACT FROM AUTHOR]

Subclinical acute kidney injury (subAKI) is characterized by tubule-interstitial injury without significant changes in glomerular function. SubAKI is associated with the pathogenesis and progression of acute and chronic kidney diseases. Currently, therapeutic strategies to treat subAKI are limited. The use of gold nanoparticles (AuNPs) has shown promising benefits in different models of diseases. However, their possible effects on subAKI are still unknown. Here, we investigated the effects of AuNPs on a mouse model of subAKI. Animals with subAKI showed increased functional and histopathologic markers of tubular injury. There were no changes in glomerular function and structure. The animals with subAKI also presented an inflammatory profile demonstrated by activation of Th1 and Th17 cells in the renal cortex. This phenotype was associated with decreased megalin-mediated albumin endocytosis and expression of proximal tubular megalin. AuNP treatment prevented tubule-interstitial injury induced by subAKI. This effect was associated with a shift to an anti-inflammatory Th2 response. Furthermore, AuNP treatment preserved megalin-mediated albumin endocytosis in vivo and in vitro. AuNPs were not nephrotoxic in healthy mice. These results suggest that AuNPs have a protective effect in the tubule-interstitial injury observed in subAKI, highlighting a promising strategy as a future antiproteinuric treatment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: The purpose of this study was to evaluate the relationship between socio-demographic characteristics of caregivers and the oral health of their children infected with human immunodeficiency virus (HIV+) compared to a group of HIV-children and their caregivers., Methods: One hundred forty HIV+ and 140 healthy two- to five-year-old children and their caregivers who sought care at hospitals in Rio de Janeiro, Brazil, participated. Caregivers were interviewed for sociodemographic characteristics, and knowledge and attitudes regarding oral health. The decayed, missing and filled primary teeth (dmft) index was obtained for the children. Chi-square and Mann-Whitney tests were used (five percent significance level). Content analysis method was used for qualitative evaluation., Results: Most interviewees were mothers (83.6 percent), did no work outside the home (69.3 percent), had low educational status (47.1 percent), and were born in the South/Southeast regions of Brazil (83.6 percent). The mean dmft was 3.48±3.14 for the HIV+ group and 1.02±1.00 for the healthy children. Oral care was reported as important by 54.1 percent of the caregivers. Those who didn't consider oral care important had never received information about oral health (P<0.01). Caregivers born in the North/Northeast regions took their children to the dentist less frequently than mothers born in other areas (P=0.02). Low educational status influenced the attitudes about oral health (P<0.01), irregular dental visits for the children (P<0.01), and the dmft index (P<0.01)., Conclusion: Caregivers' low educational status and birthplace influenced the importance given to HIV+ children's oral health as well as the oral health knowledge and practices for both HIV+ and healthy children.

Objectives: This study analyzed the capacity of Candida spp. from dental biofilm of HIV infected (HIV+) children to demineralize primary molar enamel in vitro by Transversal Microhardness (TMH), Polarized Light Microscopy (PLM) and the quantity of calcium ions (Ca2+) released from the enamel., Material and Methods: Candida spp. samples were isolated from the supragingival biofilm of HIV+ children. A hundred and forty (140) enamel blocks were randomly assigned to six groups: biofilm formed by C. albicans (Group 1); mixed biofilm formed by C. albicans and C. tropicalis (Group 2); mixed biofilm formed by C. albicans and C. parapsilosis (Group 3); mixed biofilm formed by C. albicans, C. parapsilosis and C. glabrata (Group 4); biofilm formed by C. albicans ATCC (Group 5) and medium without Candida (Group 6). Enamel blocks from each group were removed on days 3, 5, 8 and 15 after biofilm formation to evaluate the TMH and images of enamel were analyzed by PLM. The quantity of Ca2+ released, from Groups 1 and 6, was determined using an Atomic Absorption Spectrophotometer. The SPSS program was used for statistical analysis and the significance level was 5%., Results: TMH showed a gradual reduction in enamel hardness (p<0.05) from the 1st to 15th day, but mainly five days after biofilm formation in all groups. The PLM showed superficial lesions indicating an increase in porosity. C. albicans caused the release of Ca2+ into suspension during biofilm formation., Conclusion: Candida species from dental biofilm of HIV+ children can cause demineralization of primary enamel in vitro.

This study aimed to assess, in vitro, the biofilm viability and the phospholipase and protease production of Candida spp. from the saliva of HIV infected children and healthy controls, and to correlate the results with the use of medical data. A total of 79 isolates were analyzed: 48 Candida albicans isolates (33/15) and 20 Candida parapsilosis sensu lato complex isolates (12/8) (from HIV/control patients, respectively), and 8 Candida krusei, 1 Candida tropicalis, 1 Candida dubliniensis and 1 Candida guilliermondii from HIV patients. The XTT (2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-Carboxanilide) reduction assay analyzed the biofilm viability. Phospholipase and protease assays were performed using the egg yolk and Bovine Serum Albumin agar plate methods, respectively. All isolates were able to form biofilm with cell viability. Quantitatively, Candida isolates from both groups presented a similar ability to form biofilm (p > 0.05). The biofilm viability activity was higher in C. albicans isolates than in non-albicans Candida isolates (p < 0.05) for both groups. Phospholipase activity was detected in 32 isolates (40.5%) and it was significantly higher in the HIV group (p = 0.006). Protease activity was detected in 66 isolates (84.8%) and most of them were relatively/very strong producers. No statistical association with medical data was found in the HIV group. Although Candida spp. isolates from HIV-positive children presented higher phospholipase production, in vitro they exhibited reduced virulence factors compared to isolates from healthy individuals. This finding may enlighten the role played by immunosuppression in the modulation of Candida virulence attributes., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: The purposes of this study were to: (1) quantify and identify Candida species (spp.) in the dental plaque of children infected with the human immunodeficiency virus (HIV) and compare with noninfected children; and (2) determine the association of Candida spp. with the presence of caries., Methods: Seventy HIV-infected and 55 non-HIV-infected three- to 12-year-old children were examined to determine caries prevalence. After a visual inspection, supragingival plaque was collected from the cervical region using standard dental curettes. The material was transferred to microtubes and submitted for analysis to identify and quantify the presence of Candida spp., Results: Candida spp. were more prevalent in the HIV-infected group (72.9 percent) than in the control group (20 percent), and the most prevalent specie was Candida albicans. Caries was found in 72.9 percent of the HIV-infected group and in 58.2 percent of the control group, but a significant difference was only found in the presence of active white spot lesions between the groups., Conclusions: The dental plaque of HIV-infected children was colonized by Candida species to a much greater extent than that of non-HIV-infected children, and this colonization was significantly associated with the prevalence of early carious lesions in enamel.

Background: Efforts have been made to establish sensitive diagnostic tools for malaria screening in blood banks in order to detect malaria asymptomatic carriers. Microscopy, the malaria reference test in Brazil, is time consuming and its sensitivity depends on microscopist experience. Although molecular tools are available, some aspects need to be considered for large-scale screening: accuracy and robustness for detecting low parasitemia, affordability for application to large number of samples and flexibility to perform on individual or pooled samples., Methodology: In this retrospective study, we evaluated four molecular assays for detection of malaria parasites in a set of 56 samples previously evaluated by expert microscopy. In addition, we evaluated the effect of pooling samples on the sensitivity and specificity of the molecular assays. A well-characterized cultured sample with 1 parasite/μL was included in all the tests evaluated. DNA was extracted with QIAamp DNA Blood Mini Kit and eluted in 50 μL to concentrate the DNA. Pools were assembled with 10 samples each. Molecular protocols targeting 18S rRNA, included one qPCR genus specific (Lima-genus), one duplex qPCR genus/Pf (PET-genus, PET-Pf) and one duplex qPCR specie-specific (Rougemont: Roug-Pf/Pv and Roug-Pm/Po). Additionally a nested PCR protocol specie-specific was used (Snou-Pf, Snou-Pv, Snou-Pm and Snou-Po)., Results: The limit of detection was 3.5 p/μL and 0.35p/μl for the PET-genus and Lima-genus assays, respectively. Considering the positive (n = 13) and negative (n = 39) unpooled individual samples according to microscopy, the sensitivity of the two genus qPCR assays was 76.9% (Lima-genus) and 72.7% (PET-genus). The Lima-genus and PET-genus showed both sensitivity of 86.7% in the pooled samples. The genus protocols yielded similar results (Kappa value of 1.000) in both individual and pooled samples., Conclusions: Efforts should be made to improve performance of molecular tests to enable the detection of low-density parasitemia if these tests are to be utilized for blood transfusion screening.

The aims of this study were to compare the detection of human herpesviruses (HHVs) in the saliva of HIV-infected and healthy control children, and to evaluate associations between viral infection and gingivitis and immunodeficiency. Saliva samples were collected from 48 HIV-infected and 48 healthy control children. Clinical and laboratory data were collected during dental visits and from medical records. A trained dentist determined gingival indices and extension of gingivitis. Saliva samples were tested for herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), varicella zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) by nested polymerase chain reaction assays. Thirty-five HIV-infected and 16 control children had gingivitis. Seventeen (35.4%) HIV-infected children and 13 (27%) control children were positive for HHVs. CMV was the most commonly detected HHV in both groups (HIV-infected, 25%; control, 12.5%), followed by HSV-1 (6.2% in both groups) and HSV-2 (HIV-infected, 4.2%; control, 8.3%). The presence of HHVs in saliva was not associated with the presence of gingivitis in HIV-1-infected children (p = 0.104) or healthy control children (p = 0.251), or with immunosuppression in HIV-infected individuals (p = 0.447). Gingivitis was correlated with HIV infection (p = 0.0001). These results suggest that asymptomatic salivary detection of HHVs is common in HIV-infected and healthy children, and that it is not associated with gingivitis.

Aims: The aim was to assess the prevalence of oral lesions in HIV-infected children undergoing highly active anti-retroviral therapy (HAART), and the association between the duration of HAART usage and oral lesions., Subjects and Methods: Totally, 111 medical and dental records of HIV-infected children, aged from 2 to 16 years old were reviewed for medical data, presence of oral lesions, and caries prevalence. According to the type of medication, the children were grouped as follows: 51 were under HAART (G1), 46 were using anti-retroviral medication (G2), and 14 were using no medication (G3)., Results: The majority of the HIV children had AIDS (65.8%), of which 86.3% were in G1, 63% in G2, and 0% in G3. The mean length of therapy was 34.4 months, with no difference between groups (Kruskal-Wallis; P = 0.917). The prevalence of the oral lesions was 23.4%, namely, G1 was 27.5%, G2 was 21.7%, and G3 was 14.3% (P > 0.05). Gingivitis was the most common oral manifestation (15.3%) seen in the three groups, followed by gingival linear erythema and pseudomembranous candidiasis in G1 and G2. The mean values regarding deft and DMFT indexes were, respectively, 3.2 and 1.9 (G1), 2.8 and 1.6 (G2), and 3.8 and 3.0 (G3). For the patients without AIDS (n = 38), oral manifestations were seen in 29.4% of G2 compared to G1, with 0% (Chi-square; P > 0.05). In terms of therapy duration, 47.65% of the patients who had been under HAART for 18 months or less had oral manifestations, compared to 13.3% of those who had been treated for a longer time (Chi-square; P = 0.007)., Conclusions: Although the prevalence of oral lesions was similar between the groups, it was less in patients without AIDS and those under HAART. The duration of HAART usage had a significant influence on the prevalence of these lesions.

Aims: This cross-sectional study investigated the association between eight herpesviruses and the bacterial community profiles from the oral cavity of children with and without leukaemia., Methods: Sixty participants (aged 3-13), divided into the leukaemia group (LG) and healthy group (HG), were evaluated. Collection of medical data, intraoral examination and collection of clinical specimens were carried out. Single PCR and nested-PCR techniques were used to identify the viral types; denaturing gradient gel electrophoresis (DGGE) and real-time PCR techniques were used to evaluate the profile and abundance of bacterial communities., Results: All the children with leukaemia were positive for at least one type of herpesvirus, compared with healthy participants (33.3%; p<0.000). Human cytomegalovirus (HCMV; 46.7%), human herpesvirus-7 (HHV-7; 20%) and HHV-8 (77.3%) were in higher prevalence in the LG (p ≤ 0.01). Children with leukaemia had positive associations with the presence of HCMV, HHV-7 and HHV-8 in the oral cavity when under chemotherapy (p<0.05). There was a qualitative (means of DGGE bands) and quantitative (means of 16S rRNA gene abundance) difference in relation to the bacterial community between the two groups (p<0.05)., Conclusions: Based on the results, the prevalence of herpesviruses and the qualitative bacterial profiles was higher in children with leukaemia and HCMV, HHV-7 and HHV-8 were related to the use of chemotherapy. Moreover, HHV-6 was correlated with an increased bacterial community profile in patients with leukaemia (p<0.05). More attention should be paid to the oral health of these individuals, mainly those under chemotherapy, in order to prevent infections by opportunistic pathogens., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: To undertake a systematic review to assess if HIV-infected children and adolescents have an increased dental caries experience., Methods: A search of MEDLINE, BIREME, EMBASE, GOOGLE SCHOLAR, SIGLE (Grey Literature) and reference lists of included studies was carried out. To be eligible the studies had to present HIV-infected and non-infected children/adolescents between 0-18 years old. To assess the methodological quality, the studies were categorized in scores from 'A' to 'C'. To perform a meta-analysis a random effect model was used with 95% confidence intervals and two distinct sub-group analyses were carried out in terms of caries progression: data for cavitated and non-cavitated lesions (sub-group 1) and data only for cavitated lesions (sub-group 2)., Results: Five studies fulfilled the selection criteria. Four studies (two ranked A and two B in the quality assessment) revealed higher caries scores in primary teeth in the HIV-infected patients with mean dmft/dmfs scores of 3.8-4.1/7.8-11.0 compared to the control group 1.5-2.4/3.4-5.1. No differences in caries index were found for permanent dentition. The meta-analysis excluded caries data of permanent teeth and showed a significant association between caries experience in primary dentition and HIV infection considering cavitated and non-cavitated lesions (OR = 2.33, 95% CI = 1.48-3.68) or only cavitated lesions (OR = 2.98, 95% CI = 1.59-5.59)., Conclusion: Evidence exists that suggests HIV-infected children/adolescents have an increased caries experience in primary dentition.

Studies on autochthonous malaria in low-transmission areas in Brazil have acquired epidemiological relevance because they suggest continued transmission in what remains of the Atlantic Forest. In the southeastern portion of the state of São Paulo, outbreaks in the municipality of Juquitiba have been the focus of studies on the prevalence of Plasmodium, including asymptomatic cases. Data on the occurrence of the disease or the presence of antiplasmodial antibodies in pregnant women from this region have not previously been described. Although Plasmodium falciparum in pregnant women has been widely addressed in the literature, the interaction of Plasmodium vivax and Plasmodium malariae with this cohort has been poorly explored to date. We monitored the circulation of Plasmodium in pregnant women in health facilities located in Juquitiba using thick blood film and molecular protocols, as well as immunological assays, to evaluate humoural immune parameters. Through real-time and nested polymerase chain reaction, P. vivax and P. malariae were detected for the first time in pregnant women, with a positivity of 5.6%. Immunoassays revealed the presence of IgG antibodies: 44% for ELISA-Pv, 38.4% for SD-Bioline-Pv and 18.4% for indirect immunofluorescence assay-Pm. The high prevalence of antibodies showed significant exposure of this population to Plasmodium. In regions with similar profiles, testing for a malaria diagnosis might be indicated in prenatal care.

Anopheles (Kerteszia) cruzii has been implicated as the primary vector of human and simian malarias out of the Brazilian Amazon and specifically in the Atlantic Forest regions. The presence of asymptomatic human cases, parasite-positive wild monkeys and the similarity between the parasites infecting them support the discussion whether these infections can be considered as a zoonosis. Although many aspects of the biology of An. cruzii have already been addressed, studies conducted during outbreaks of malaria transmission, aiming at the analysis of blood feeding and infectivity, are missing in the Atlantic Forest. This study was conducted in the location of Palestina, Juquitiba, where annually the majority of autochthonous human cases are notified in the Atlantic Forest of the state of São Paulo. Peridomiciliary sites were selected for collection of mosquitoes in a perimeter of up to 100 m around the residences of human malaria cases. The mosquitoes were analyzed with the purpose of molecular identification of blood-meal sources and to examine the prevalence of Plasmodium. A total of 13,441 females of An. (Ker.) cruzii were collected. The minimum infection rate was calculated at 0.03% and 0.01%, respectively, for P. vivax and P. malariae and only human blood was detected in the blood-fed mosquitoes analyzed. This data reinforce the hypothesis that asymptomatic human carriers are the main source of anopheline infection in the peridomiciliary area, making the probability of zoonotic transmission less likely to happen.

Objectives: This study aimed to evaluate the concentration of lactoferrin in the saliva of HIV infected and healthy children and analyze the associations between lactoferrin levels, Candida sp. colonization, oral manifestations and medical data. Also, the antifungal ability of lactoferrin to inhibit the growth of Candida albicans isolated from saliva of these children was investigated in vitro., Subjects and Methods: Saliva was collected from 70 HIV-infected and 50 healthy children, followed by oral manifestation assessments. The salivary lactoferrin was quantified using an ELISA Kit. The salivary samples were cultured and the Candida spp. colonies counted and then identified by sugar assimilation and fermentation. The antifungal activity of lactoferrin was analyzed in vitro with 10 isolates of C. albicans from each group., Results: The HIV infected children (mean age 9.8 ± 2.8) had higher lactoferrin levels (median 6.13 μg/ml (3.58-7.89)) and were colonized three times more by Candida sp. than the control group (mean age 9.4 ± 2.4) (median 5.74 μg/ml (3.12-6.86)) (p=0.003). Statistical associations were found considering the salivary lactoferrin levels and Candida sp. and oral manifestations between the groups. No associations between lactoferrin concentrations and oral manifestations, immunosuppression, presence of AIDS and use of HAART were observed in the HIV group. The percentage of dead C. albicans due to lactoferrin was inversely proportional to C. albicans cell density for both groups (p<0.001)., Conclusions: HIV-infected children have higher concentrations of lactoferrin and it was associated with Candida sp. colonization but no association with medical data was found. Also, both groups showed similar lactoferrin antifungal activity., (Copyright © 2014. Published by Elsevier Ltd.)

An oral ranula is a retention cyst that arises from the sublingual gland as a result of ductal obstruction and fluid retention. This report describes the successful management of a rare case of oral ranula in an infant. A 4-month-old male infant was referred for emergency treatment due to a 2-month history of a swelling in the right sublingual region. The examination revealed a lesion of approximately 3.5 cm in diameter, which was jeopardizing the infant's breastfeeding. The lesion's dimensions suggested a ranula. Surgical specimens were sent for histopathological analysis to confirm the diagnosis. Although there are many different ways to treat an oral ranula, the marsupialization method was followed in this case due to the serious consequences of the infant's restricted access to nourishment. The treatment proved to be successful and after 18 months of follow-up, there was no sign of recurrence.

Objective: The aim of this study was to analyze the effect of C. albicans on enamel microhardness in vitro., Study Design: Candida albicans was isolated from the oral mucosa (M) and dentin carious lesion (D) of an HIV+ child. Three groups of 12 enamel blocks each were placed in Petri plates (yeast carbon base agar/1% bovine serum albumin): G1, exposed to biofilm formed by C. albicans from M; G2, exposed to biofilm formed by C. albicans from D; G3, no biofilm. Three enamel blocks from each group were removed on days 3, 5, 8, and 10 after biofilm formation to measure the cross-sectional Knoop microhardness (CSMH) of the enamel areas, exposed and not exposed to biofilm., Results: CSMH decreased in G1 and G2: in G1 on day 5, and in G2 on day 3 (analysis of variance: P < .05; Mann-Whitney test: P < .05), with a similar mean percentage reduction for both groups., Conclusions: Candida albicans can reduce enamel microhardness in vitro., (Copyright © 2013 Elsevier Inc. All rights reserved.)

A dentigerous cyst is an odontogenic developmental cyst associated with the crown of an unerupted tooth. This article describes the case of a 7-year-old girl with painful swelling in the left facial region, prolonged retention of tooth No. 9d, and a displaced tooth No. 9 in eruption. Radiographic examination revealed an extensive radiolucent lesion of approximately 28 mm and displacement of teeth No. 10 and 11. Marsupialization was performed, teeth No. 8d and 9d were removed, and the swelling reduced immediately. At a 2-year follow-up, radiographs revealed that teeth No. 10 and 11 had erupted but were displaced. Routine radiographic examinations are important for children during the eruption phase to prevent and detect any alterations that could damage the permanent dentition and occlusion.

Objective: To present a mucopolysaccharidosis (MPS) case series evaluating oral manifestations (clinical and radiographic), oral health status and discussing its implications., Patients and Methods: All patients with MPS attending the Genetics clinic/Brazil were evaluated by means of anamnesis, clinical and radiographic examinations., Results: The final sample consisted of 12 subjects (nine males and three females), with ages ranging from 3-31 years old. Concerning oral health, it was observed high levels of caries and periodontal problems. About oral manifestations, this study clinically observed more cases of delayed tooth eruption, thickness of alveolar process and thick lips. Radiographically, it was observed alterations on condyle, mandibular ramus and joint fossa., Conclusion: The dental changes in MPS population are high and consequently it is important to know them for differential diagnoses, early treatment intervention, prevention and education of both patients and parents/caregivers about oral health.

Introduction: Some viruses of the Herpesviridae family are frequently the etiologic agents of oral lesions associated with HIV. The aim of this study was to identify the presence of herpes simplex virus types 1 and 2 (HSV-1, HSV-2), Varicella Zoster virus (VZV), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus type 6, type 7 and type 8 (HHV-6, HHV-7 and HHV-8) in the oral cavity of HIV-infected children/adolescents and verify the association between viral subtypes and clinical factors., Methods: The cells of oral mucosa were collected from 50 HIV infected children/adolescents, 3-13 years old (mean age 8.66). The majority (66%) of selected were girls, and they were all outpatients at the pediatric AIDS clinic of a public hospital in Rio de Janeiro. Nested-PCR was used to identify the viral types., Results: Absence of immunosuppression was observed in 66% of the children. Highly active antiretroviral therapy (HAART) was used by 72.1% of selected and moderate viral load was observed in 56% of the children/adolescents. Viral types were found in 86% of the children and the subtypes were: HSV-1 (4%), HSV-2 (2%), VZV (4%), EBV (0%), HCMV (24%), HHV6 (18%), HHV-7 (68%), HHV8 (0%)., Conclusions: The use of HAART has helped to reduce oral lesions, especially with herpes virus infections. The health professionals who work with these patients should be aware of such lesions because of their predictive value and the herpes virus can be found circulating in the oral cavity without causing lesions.

Background: Saliva is supersaturated with respect to calcium and phosphate ions. Salivary ions may well play a role in the subsequent adsorption of proteins and consequently in the formation of the acquired enamel pellicle. Among several biological functions, the enamel pellicle forms a selectively permeable barrier that regulates demineralization processes., Aim: The aim of this study was to evaluate the importance of salivary proteins when adsorbed on enamel surface and the resultant protective effect against demineralization without the presence of salivary ions., Methods: Enamel surfaces were coated with whole saliva, parotid saliva, dialyzed whole saliva or dialyzed parotid saliva (molecular weight cutoff 1 kDa). Adsorption was allowed to proceed for a period of 2 h. Enamel specimens were then washed with deionized water and immersed into a demineralization solution of pH 4.5 for 12 days. This solution was used to measure the amount of calcium and phosphate released from enamel specimens after the demineralization period., Results: All coated specimen groups showed a significantly higher protection than those not coated with any type of saliva. In addition, undialyzed saliva (whole saliva and parotid saliva) was more effective in protecting the enamel against demineralization than dialyzed saliva., Conclusion: The present investigation indicates that the ionic composition of saliva can amplify the demineralization protection effect by reducing acid-induced enamel demineralization. Moreover, a protective effect of salivary proteins without presence of ions was demonstrated in this study., (Copyright © 2012 S. Karger AG, Basel.)

Purpose: The purpose of this study was to investigate the dental needs and management of special health care needs children in Rio de Janeiro, Brazil, according to the type of disability., Methods: Records of 428 0- to 19-year-old patients who received dental treatment at the Patients Special Care Needs Clinic (Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro) from 1996-2009 were analyzed. Information about the type of disability, use of medication, dental exam findings, management during treatment, dental treatment performed, and follow-up examinations were collected. Children were divided into 2 groups: those with medical conditions and those with intellectual disability., Results: Patients with medical conditions used more medications and were older than those with intellectual disability. The most common dental treatments received were dental restorations (63%) and extractions (47%). There was no association between the type of disability and dental treatment needed. Children with intellectual disability were 3 times more likely to need general anesthesia and 7 times more likely to need physical restraint for dental care than the other group., Conclusions: Children with intellectual disability have a greater chance of requiring advanced management techniques during dental treatment. The development of effective oral health programs is recommended as well as a specific education program for their parents.

Objective: The aim of this study was to compare type I collagen degradation by Candida albicans isolated from oral mucosa (M) and cavitated active dentinal caries (CAD) of HIV-infected children., Study Design: To verify the proteolytic activity, the specimens were cultivated in brain-heart infusion medium and the supernatants were incubated in the presence or absence of type I collagen at 37°C for 12 hours and analyzed using 10% sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Intensity of the bands on the gels was assessed by densitometric analysis using a scanner and images analyzed with software from Kodak Digital Science EDAS 120., Results: Supernatants of all the C. albicans degraded type I collagen: that from M, on average, by 38.3% (SD 21.67) and that from CAD by 54% (SD 25.94; Wilcoxon test: P < .05). Predisposing factors had no association with the percentage of type I collagen degradation (Mann-Whitney test: P > .05)., Conclusions: Candida albicans from different sites of the oral cavity of HIV-infected children has proteolytic activity for type I collagen., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Aim: To identify the early presence of human papillomavirus (HPV) DNA in the oral cavity of HIV-infected children., Methods: The study group comprised 50 HIV-infected children and 50 healthy aged paired controls. Oral mucosa samples were collected by swab, and a 450 bp HPV DNA fragment was amplified by PCR, using degenerate consensus primers directed to the L1 gene. HPV typing was performed using specifics primers for types 6/16 and 11/18., Results: All HPV co-infected children had vertical transmission of HIV. HPV DNA was detected in 6/50 (12.0%) of HIV children and three control group individuals 3/50 (6.0%) (p>0.01). In the HIV group, one had type 11, in the control group one had co-infection of types 11/16, and the others had type 16 and 18., Conclusions: Based upon the results, it is concluded that HPV DNA may be present in HIV disease, but no association with immunosuppression, delivery, or medical records (CD4 cell count, viral load and use of highly active antiretroviral therapy) was observed, and no differences could be observed between the groups either.

This article reports the case of a boy born with 11 natal teeth who had many alterations in his permanent dentition. In this case, 22 teeth were missing and a shape anomaly was detected in eight teeth. The treatment consisted of prosthetic rehabilitation and follow-up of teeth eruption and jaw growth.

Aim: Oral manifestations are common in HIV+ children, but the impact of these diseases on their daily life is unknown. So the aim of this study was to assess the impact of oral problems on the daily activities of HIV+ children., Methods: The Child-OIDP-B was used with 59 10-12 year-old HIV+ children, who were outpatients at two public hospitals for HIV treatment in Rio de Janeiro, Brazil. Caries, biofilm and gingival bleeding indexes were recorded. The Kruskall-Wallis and Mann-Whitney tests as well as the Spearman's correlation coefficient were used for analysis. Statistical evaluation: Replies were analysed using the Statgraphics ® Plus Version 5.0 statistics software system, in order to obtain comparative diagrams and graphs using the ANOVA multifactorial system., Results: The Child-OIDP-B scores ranged from 0 to 30, (mean=6.09) and 71.2% of the children were affected by oral problems. Association was found between oral impact and number of caries (p=0.009). Children receiving HAART therapy had a Child-OIDP-B score (4.87), much lower than those who were not (8.87) (p=0.038). The most reported oral impact of the disease was eating (55.6%), but oral wounds were the most prevalent type of lesions (76.3%). As regards the level of intensity of the impact, moderate severity was prevalent in all 59 children and 66.1% reported that oral impacts affected 1-4 daily activities, 50.8% of all children were not satisfied with their appearance and oral health; 23.7% perceived the impact of HIV-infection on general health., Conclusion: Most children suffered the impact of oral problems on their daily activities, mainly functional impacts.

Aim: The objective was to assess the impact of oral health on the quality of life of HIV-infected patients aged 3-6 years based on their caregivers' perceptions., Methods: A questionnaire for measuring the perception and the instrument Early Childhood Oral Health Impact Scale (ECOHIS) were applied to 31 caregivers whose children were being treated in a public hospital. Results The mean age of the children was 4.52 years (SD 1.22). The total ECOHIS score ranged from 0 to 26, with a mean value of 4.13 (SD 6.66). Seventeen children (54.8%) were found to have at least one impact: toothache (64.7%), herpetic gingivostomatitis (23.5%) or both (11.8%). Statistically significant difference was found between the ECOHIS score and presence of restored teeth, prior dental treatment, AIDS, and viral load. With respect to the caregivers' perception, it resulted to be adequate, as those caregivers whose children had a greater number of decayed teeth and higher biofilm index also considered the oral health to be bad (P<0.001). However, the children's general health was found to be good despite the worse immunological classification (P<0.017).Conclusion The quality of life of the HIV- infected children has been negatively affected by the oral health.

Purpose: The purpose of this study was to evaluate chlorhexidine to control gingivitis and Candida species (spp.) in children infected with the human immunodeficiency virus (HIV) and their acceptance of the therapy., Methods: Twenty-six HIV+ children were selected, and oral exam-established biofilm, gingival indexes, and stimulated saliva were collected for Candida ssp. identification. The children brushed their teeth for 21 days with chlorhexidine gel (0.2%). Salivary samples, biofilm, and gingival indexes were collected after 21-days and again 35 days after ceasing gel use. The children answered a questionnaire about the therapy., Results: All children tested positive for Candida and gingivitis. After 21 days, Candida counts and gingivitis decreased in 25 and 26 children, respectively. Mean reduction was approximately 68% for Candida spp. and 74% for gingivitis. Thirty-five days after discontinuing gel use, gingivitis and Candida spp. increased in 13 and 16 patients, respectively. Considering the Candida spp., the heavy growth was lower in the first re-evaluation. Candida albicans was the most frequent species. Approximately 85% did not experience inconvenience with the gel, and approximately 48% thought it was good for tooth-brushing., Conclusion: Chlorhexidine therapy may be an option to treat and pre- vent gingivitis and reduce yeast counts in children infected with HIV.

Objective: The aim of this literature review was to identify studies conducted on the oral Human papillomavirus (HPV) infection in children., Methods: An electronic database search was performed using the terms 'oral HPV' and 'children'. The studies on the prevalence of oral HPV in children worldwide, descriptive studies, case reports, studies on the association of oral HPV and risk factors and transmission of HPV were included., Conclusion: The presence of HPV in oral mucosa of children should be investigated in virtue of the various forms of transmission, and the possibility of sexual abuse eliminated, and also of its possible relation with oral carcinoma pathogenesis in children., (© 2010 John Wiley & Sons A/S.)

Of the possible levels of amputation, transtibial amputations result in functionally excellent outcomes. However, in contrast to hind foot amputations, such as Syme and especially Boyd amputation, acute or late complications related to the amputated stump are frequent with the various described techniques. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) pedicled sensate flap with a surface that allowed full terminal weight-bearing in transtibial amputations in adults. One male patient, 66 years old with schizophrenia and chronic distal tibial osteomyelitis, underwent a leg amputation with sensate composite calcaneal flap construction. The stump was painless and able to bear total terminal weight at 12 weeks. Calcaneum tibial fusion was observed at 12-week postoperative follow-up. A below-knee prosthesis was adapted in 12 weeks, and at the 1-year follow-up, the patient was completely satisfied with the functional performance of his stump. The flap described provides proprioceptive feedback with the best bone and skin to support weight bearing. Another advantage is the possibility to use the same prosthesis commonly used in Boyd or Syme amputation due a longer arm leverage, which also allows full terminal weight-bearing. In the current study, a transtibial amputation covered with a pedicled sensate plantar flap preserving the calcaneum was proposed. In theory, the anatomic structures spared in this technique provide a strong full weight-bearing terminal surface of the stump that will last a lifetime., (© Thieme Medical Publishers.)

Malaria in Brazil is endemic in the Amazon region, but autochthonous cases with low parasitaemia occur in the Atlantic Forest area of the country. According to Brazilian legislation no test is mandatory for blood donors from non-endemic areas. However if they have traveled to malaria transmission regions they are deferred for six months before they can donate. This report describes a transfusion-transmitted malaria case in Sao Paulo, Brazil, where one recipient received infected blood and developed the disease. He lived in Sao Paulo and had no previous transfusion or trips to endemic areas, including those of low endemicity, such as Atlantic Forest. Thick blood smears confirmed Plasmodium malariae. All donors lived in Sao Paulo and one of them (Donor 045-0) showed positive hemoscopy and PCR. This asymptomatic donor had traveled to Juquia, in the Atlantic Forest area of S ao Paulo State, where sporadic cases of autochthonous malaria are described. DNA assay revealed P. malariae in the donor's (Donor 045-0) blood. Serum archives of the recipient and of all blood donors were analyzed by ELISA using both P. vivax and P. falciparum antigens, and IFAT with P. malariae. Donor 045-0's serum was P. malariae IFAT positive and the P. vivax ELISA was reactive. In addition, two out of 44 donors' archive sera were also P. vivax ELISA reactive. All sera were P. falciparum ELISA negative. This case suggests the need of reviewing donor selection criteria and deferral strategies to prevent possible cases of transfusion-transmitted malaria.

This study reports avian malaria caused by Plasmodium relictum in Magellanic Penguins (Spheniscus magellanicus) from São Paulo Zoo. The disease was highly infective among the birds and was clinically characterized by its acute course and high mortality. The penguins of São Paulo Zoo were housed for at least 2 years without malaria; however, they had always been maintained in an enclosure protected from mosquito exposure during the night period. When they presented pododermatitis, they were freed at night for a short period. São Paulo Zoo is located in one of the last forest remnants of the city, an area of original Atlantic forest. In the winter, the space destined for Zoo birds is shared with migratory species. Hence the possibility exists that the disease was transmitted to the penguins by mosquitoes that had previously bitten infected wild birds. Avian malaria parasites are transmitted mainly by mosquitoes of the genera Aedes and Culex, common vectors in the Atlantic forest. In this study, one Culex (Cux.) sp. was found, infected with P. relictum. There are diverse problems in housing distinct species of animals in captivity, principally when occupying the same enclosure, since it facilitates the transmission of diseases with indirect cycles, as is the case of Plasmodium spp., because certain species that cause discrete infections in some bird species can become a serious danger for others, especially penguins, which do not possess natural resistance. Thus, serious implications exist for periodically testing and administrating malaria therapy in captive penguins potentially exposed to mosquitoes during the night period, as well as other captive birds from São Paulo Zoo., (Copyright 2010 Elsevier B.V. All rights reserved.)

Malaria is an unusual complication after hematopoietic stem cell transplantation in non-endemic countries. However, transplant candidates, recipients and donors living in endemic regions frequently report previous episodes of malaria. This fact could represent an important risk for immunosuppressed recipients that could develop severe malaria cases. We report a case of hematopoietic stem cell transplant (HSCT) in which the donor had a history of previous malaria, and close monitoring was performed before and after procedure by parasitological and molecular tests. The donor presented Plasmodium vivax in thick blood smears one month after transplant and was treated according to Brazilian Health Ministry guidelines. The polymerase chain reaction (PCR) was able to detect malaria infection in the donor one week earlier than thick blood film. Even without positive results, the recipient was pre-emptively treated with chloroquine in order to prevent the disease. We highlight the importance of monitoring recipients and donors in transplant procedures with the aim of reducing the risk of malaria transmission.

Objectives: To evaluate predisposing factors such as orofacial manifestations, immunosuppression status and antiretroviral therapy in relation to oral colonization by Candida spp. in Brazilian HIV-infected children and their uninfected siblings in the era of highly active antiretroviral therapy (HAART)., Methods: Whole stimulated saliva was collected from 65 HIV-infected children (HIV+) and 40 uninfected siblings (HIV-), followed by assessment of orofacial manifestation, caries indexes and the number of cavitated dentinal carious teeth (CDT). The salivary samples were cultured and the colonies were counted. After which they were identified by sugar assimilation and fermentation (API 20C). Data was analyzed using chi-square, Mann-Whitney, Spearman tests and logistic regression., Results: Regarding positive growth, HIV+ presented 80% (52/65) and HIV- 57.5% (23/40) (P = 0.013). Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05). Mean CD4%, immune-status and history of recurrent oral candidiasis (OC) had no influence on Candida isolation. Mixed Candida spp. cultures were observed in HIV+ (40%) and HIV- (52%): C. albicans was more frequently found in both groups, with a higher prevalence in HIV+ (P = 0.05); other non-albicans species were isolated in HIV+ and HIV-. Low prevalence of orofacial manifestations was observed in HIV+ (10.7% of OC). There was an association between means of CDT and Candida growth (P < 0.05) and a positive correlation between number of CDT and Candida cfu-counts in HIV+ and HIV-. Mean CD4% and immune-status had no influence on Candida isolation. Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05)., Conclusions: The HIV infected children had a significantly higher prevalence of oral Candida spp. compared to their uninfected siblings. Absence of HAART and presence of dentinal carious teeth increased significantly Candida spp. colonization in these children.

Objective: To perform a systematic review of published data with the aim of evaluating the levels of IgA antibodies to Candida albicans in HIV-infected adult patients., Methods: The search strategy was based on PubMed, Web of Science, Google Scholar, Cochrane and EMBASE databases. Also, the reference lists of included studies were searched. All abstracts found by electronic searches were independently scrutinized by two reviewers. To be eligible for review, the controlled studies had to present the following characteristics: samples of both HIV-infected adults and noninfected adults; appropriate HIV-diagnostic tests for both patient groups (case and control); IgA-diagnostic test applied to a similar population sample., Results: Of 144 studies found, only six met the initial eligibility criteria, but three were excluded after a thorough analysis. To assess the methodological quality of the three remaining studies, they were categorized according the risk of bias. The three selected studies revealed that the levels of C. albicans-specific IgA antibody were higher in HIV-infected individuals compared with the control group., Conclusion: Adequate IgA antibody responses to C. albicans appear to be maintained, since the levels of these antibodies were higher in all studies selected. Although the findings of this systematic review are encouraging, the scientific evidence should be interpreted carefully because there are only a few reports in the literature, mostly because of the lack of important methodological details or the varying methodologies employed.

Congenital insensitivity to pain with anhidrosis is a rare autosomal-recessive disorder characterized by unexplained fever episodes, anhidrosis, pain insensitivity, self-mutilating behavior, and mental retardation. The lack of sensitivity to pain results in traumatic lesions, such as ulcers, fractures, burns, bites, scars, and digital amputations. Several methods have been suggested to treat these patients; however, appropriate management is difficult, especially when the mutilation is particularly severe. This report describes the case of a 2-year-old female patient who had severe self-mutilating injuries to her tongue, hands, lips, and oral mucosa caused by biting. The patient presented digital amputation and also a premature loss of a permanent tooth germ during the treatment. The dental management is described and discussed. It is important to include the dentist on the multidisciplinary team to reduce the frequency and severity of the self-inflicted lesions in these patients, also to prevent complications.

Objectives: The objective of this study was to evaluate Candida species in the oral mucosa before and after dental treatment in children infected with human immunodeficiency virus (HIV) and investigate the relation of these yeasts with cavitated carious lesions, immune suppression, and use of antiretroviral drugs., Methods: Specimens of oral mucosa (M1) and dentin were collected, using a swab and dental curette respectively, from 30 HIV-infected children. Dental treatment (tooth-brushing, fluoride application, restoration of all carious lesions and extractions, if needed) was performed, and at posttreatment (M2, mean 30 days after baseline) another sample of oral mucosa was collected., Results: Candida colony-forming unit (CFU) values were greater in dentin when compared with oral mucosa before dental treatment (M1), and a reduction of these fungi was observed in oral mucosa after dental treatment (M2) (P < .05). Cavitated carious lesions and caries in dentin were positively correlated with CFU in M1 (P < .05). C. albicans was the most prevalent of the Candida species. A relationship between the level of immune suppression and use of antiretroviral drugs with the prevalence of yeasts was not observed (P > .05)., Conclusion: The decrease in CFU at M2 and the high prevalence of these yeasts in dentin indicates that cavitated lesions in this population can serve as a niche for colonization and proliferation of Candida species in HIV-infected children.

Objective: Conducted a literature review to identify studies that reported on the oral manifestations in human immunodeficiency virus (HIV) infected children in highly active antiretrovial therapy (HAART) era., Methods: A search electronic data base were used and the terms used were 'oral lesions' and 'oral manifestations'. The studies of prevalence of oral manifestation in children with HIV worldwide, descriptive studies, case reports, studies on the association of oral lesions and levels of immune suppression, use of HAART and transmission of HIV were included., Results: There have been substantial changes in the management of HIV disease, especially in the past decade because of the use of HAART. However, children are still being infected and present some peculiarities when compared with adults. Molecular epidemiology, transmission and therapy of the common opportunistic oral infections of HIV disease need to be better understood as a consequence of improved anti-HIV strategies. Treatment with HAART improves the immune function and decreases mortality, morbidity, and opportunistic infections in HIV-infected persons., Conclusion: The frequency and severity of oral disease associated with HIV infection have reduced considerably, although the use of HAART may be associated with an increased appearance of oral lesions associated with human papillomavirus and potentially increase the risk of later oral squamous cell carcinoma.

Objectives: The aim was to examine the impact of antiretroviral therapy on the prevalence of oral candidiasis, recovery of oral Candida spp. , and salivary levels of total secretory immunoglobulin A (SIgA) and Candida-specific SIgA in human immunodeficiency virus (HIV)-infected children., Study Design: Sixty-six HIV+ and 40 HIV- children were cross-sectionally examined for the presence of oral lesions. Whole stimulated saliva samples were collected for the identification of Candida spp. using culture and measurement of total and specific SIgA using enzyme-linked immunosorbent assay (ELISA)., Results: The HIV+ children had a higher prevalence of oral candidiasis (P < .05), higher frequency of detection of Candida spp. (P < .05), and higher levels of total (P < .05) and Candida-specific SIgA (P < .001) than the HIV- children. Among the HIV+ subjects, antiretroviral users had lower viral loads (P < .001) and lower levels of Candida spp. (P < .05) and total SIgA (P < .05) compared with antiretroviral nonusers., Conclusions: The use of antiretroviral therapy was associated with decreases in the prevalence of oral candidiasis. This diminished exposure to Candida spp. was accompanied by decreases in levels of total and Candida-specific SIgA.

This preliminary study assessed the knowledge and practices of dentists in the prevention of infective endocarditis (IE). The study included 21 dentists working at two public hospitals in Brazil who cared for children with special needs who also have cardiac conditions. The data from a semistructured interview were processed for qualitative and quantitative analysis. All subjects defined IE correctly. Most subjects (81%) said they had treated patients with a previous history of IE and 7 (33%) stated that many guardians seemed to be afraid to mention that their child had a previous history of IE. The main risk of infectivity was the oral cavity according to 16 subjects (76%). Nine subjects (43%) considered a dental procedure involving any amount of bleeding as being a risk, and periodontal/endodontic treatments were mentioned by 5 (24%) as procedures that needed antibiotic prophylaxis. As for prophylactic treatment, only 7 subjects (33%) said they followed the American Heart Association guidelines. The authors concluded that the subjects' knowledge and practices in preventing IE were inadequate.

This study sought to compare techniques used to make a quantified evaluation of Candida spp. in children infected with HIV. Twenty-four HIV-infected children (age 3 to 13) were selected. Three sterilized swabs were used for each child: one for the dorsum of the tongue, one for the hard palate mucosa, and one for the right jugal mucosa; each swab was rubbed for 10 seconds and transferred to sterilized test tubes containing 1 mL of 0.9% saline solution. Candida spp. growth was observed in 95.8% of all samples, including 95.7% of tongue samples (Group T), 87.0% of saliva samples, 56.6% of hard palate mucosa samples (Group P), and 47.8% of right jugal mucosa samples (Group J). There was no statistical difference in Candida spp. growth between saliva samples and Group T samples, although both had higher growth compared to Groups P and J (p < 0.05; chi(2)). Regarding the sensitivity of each site for positive Candida spp. growth, Group T samples showed 69.5%, while saliva samples showed 52.2%, Group P samples showed 21.7%, and Group J samples showed 13.04%, with no significant statistical difference between Group T and saliva; however, both were more sensitive than Groups J and P (p < 0.05, chi(2)). It was concluded that whole stimulated saliva and swabbing the tongue were considered satisfactory for measuring Candida spp. in HIV-infected children.