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Objectives: This systematic review investigated the prevalence of tooth wear between patients with and without Down syndrome. Methods: Six databases (Embase, LILACS, Livivo, PubMed, Scopus and Web of Science) and grey literature (Google Scholar, OpenGrey and ProQuest) were searched until March 7, 2022. Observational studies were included to assess the differences in tooth wear prevalence and/or severity in Down syndrome and non-syndromic controls. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations were followed. Three reviewers independently screened studies, extracted data, assessed the methodological quality (Joanna Briggs Institute) and graded the certainty of evidence through the Grading of Recommendations, Assessment, Development, Evaluation (GRADE) approach. Results were summarized through meta-analyses using a random-effects model. The protocol was registered at PROSPERO (CRD42021266997). Results: Of the 1382 records identified, six cross-sectional studies were included. Individuals with Down syndrome had a higher prevalence and were more likely to have tooth wear than individuals without Down syndrome (44% × 15%; OR = 4.43; 95% CI 3.17–6.18; p < 0.00001; I2 = 8%). Also, the severity of tooth wear was higher in the Down syndrome group (n = 275) compared with the controls (n = 294). The certainty of evidence analysis was very low. Conclusions: Based on very low certainty of the evidence, patients with Down syndrome had a higher prevalence and likelihood and severity of tooth wear when compared to those without Down syndrome. Clinical relevance: Screening early tooth wear lesions should be carefully done in the Down syndrome population since its occurrence is remarkable compared to the general population.

PURPOSE The aim of this study was to systematically review the literature to answer the question: Can children's drawings represent a helping tool so the dentist can better understand the children's pain, fear, anxiety or stress/distress and their perception concerning the dentist and/or dental treatment? METHODS A scoping review was done. Cochrane Library, EMBASE, LILACS, LIVIVO, PsycINFO, PubMed, Scopus, Web of Science, and Grey literature was searched. Cross-sectional, quasi-experimental and qualitative studies in which patients were children and adolescents were included. Two authors independently selected studies to extract data and evaluate methodological quality by using Joanna Briggs Institute tools. Data collected included: characteristics of the studies, drawing evaluation/scales, main results and conclusion. RESULTS Out of 1037 papers were identified in search, 25 studies verified the emotional state and the children's perceptions regarding dental environment and the dentist and were included in the narrative synthesis. The spontaneous drawings were useful to identify the children's emotions. Drawings might be considered a helping tool to identify children and adolescents' perception in relation to dental treatment. Few studies used validated instruments. There were methodological disparities among studies. CONCLUSIONS The drawings can be considered a useful tool in identifying children's pain, fear, anxiety or stress/distress and perceptions about the dentist and/or dental treatment. Future studies with standardized analysis of the drawings are recommended. Code https://doi.org/10.17605/OSF.IO/U5BJH . "Retrospectively registered".

BACKGROUND The presence of parents during the dental appointment can affect the child's behaviour and, consequently, the success of the treatment. AIM This systematic review aimed to evaluate whether parents' presence in the operatory room influences children's behaviour, anxiety and fear during dental treatment. DESIGN EMBASE, Cochrane Library, LILACS, PubMed, PsycINFO, Scopus, Web of Science, Google Scholar, OpenGrey and ProQuest Dissertations and Theses Databases were searched. Randomized and non-randomized clinical trials in which some measure assessing children's behaviour and/or anxiety and fear during dental treatment with the presence and absence of parents were included. Two reviewers assessed studies for selection, extracted data, evaluated bias (Joanna Briggs Institute) and graded the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation). Random-effects meta-analyses using mean difference (MD) and narrative synthesis were performed. RESULTS A total of 2846 papers were identified, and after a 2-phase selection, sixteen studies were included (five in meta-analyses). There was no difference in children's behaviour in the presence or absence of parents (P = .23, P = .40, P = .60 and P = .89, respectively). The presence or absence of parents did not influence children's anxiety (P = .94 and P = .97) or fear (DM: -0.08; CI:-0.34-0.19, P = .24). All included studies presented a high risk of bias, and the certainty of evidence was considered to be very low. CONCLUSION It is concluded that parents' presence in the operation room does not influence children's (up to 12 years old) behaviour, anxiety and fear during dental treatment with very low certainty of evidence. Methodological limitations of included studies, however, suggest that better designed trials are needed to adequately understand this issue.

To assess the effectiveness of different anesthetic solutions for pain control immediately after the extraction of lower third molars. Nine databases were used to identify randomized clinical trials, without restriction of language or year of publication. The “JBI Critical Appraisal Tools for Systematic Reviews” was used to assess the risk of bias in the studies. The network meta-analysis was performed to compare the effectiveness of different anesthetics to control the pain immediately after the surgery of lower third molars, using the standardized mean difference (SMD) as the effect estimate. The GRADE approach was used to assess the certainty of evidence. The search presented 13,739 initial results, from which 45 met the eligibility criteria and presented low to moderate risk of bias. Thirteen studies were included in the meta-analysis. The 2% lidocaine + clonidine presented the lowest pain scores (SMD = − 1.44; − 2.72 to − 0.16) compared to 4% articaine + adrenaline, followed by 0.5% bupivacaine + adrenaline (SMD = − 1.36; − 2.13 to − 0.59). The certainty of evidence varied between very low to moderate. 2% lidocaine + clonidine and 0.5% bupivacaine + adrenaline were the anesthetics with the highest probability for pain control immediately after the surgical procedure of removing impacted lower third molars. The use of an adequate anesthetic with effective pain control can contribute to a more comfortable postoperative period.

To evaluate the perception of parents and children and the impact of molar and incisor hypomineralization (MIH) on the oral health-related quality of life (OHRQoL). A cross-sectional study was conducted with a group of 253 children aged 6–12 years presenting MIH and their parents or guardians who initially answered an interview containing socioeconomic and demographic questions as well as the Parental–Caregiver’s Perceptions Questionnaire (P-CPQ). The children answered the Child Perceptions Questionnaire (CPQ8-10) and Child Perceptions Questionnaire (CPQ11–14) and the clinical evaluation of MIH was performed. Poisson regression with robust variance was used in the data analysis. The parent’s perception showed that the impact felt by the children regarding caries leads to a higher oral symptom impact, functional limitation, emotional well-being and total PCPQ score domains, as well. For children with severe MIH, a higher prevalence of impact was felt regarding the functional limitation and emotional well-being. For CPQ8–10, the oral symptoms domain presented the highest mean score, while CPQ11–14 showed the functional limitations domain and P-CPQ the emotional well-being domain. Considering the perception of parents or guardians, it was concluded that MIH promotes a negative impact on the OHRQoL. MIH had no significant impact on OHRQoL according to children’s perceptions.

INTRODUCTION Education in oral imaging diagnosis is provided early in most dental curricula worldwide. Stressing the importance of clinical and radiographic information for oral diagnosis is of utmost importance for dental students. In this context, active learning methods, such as case-based learning (CBL), represent contemporary tools in the armamentarium of dental education. This study aimed to investigate (a) dental students' perceptions on CBL and (b) the importance of clinical data for image-based diagnosis. METHODS Fifteen cases of bone lesions were presented to 56 undergraduate students; group 1 (n = 24) was provided with the imaging data alone from each case, while group 2 (n = 32) received clinical information followed by the imaging data. Students' performance and perception on the teaching approach were assessed using a structured questionnaire. Their differential diagnoses for each of the lesions figured as variables to be compared with the known diagnosis. RESULTS All the students reported a positive experience with the case-based teaching method and confirmed this approach as a valuable tool in dental education. The diagnosis of a simple bone cyst, a periapical cyst or an ameloblastoma improved when they were provided with clinical data prior to the complementary images. No significant difference was detected, however, when the total amount of correct diagnoses were combined together and compared between groups (P > .05). CONCLUSION Case-based learning was corroborated as an optimal method for educating undergraduate dental students. Clinical data might contribute to diagnostic imaging, especially regarding lesions with multiple differential diagnoses.

Burnout syndrome has negative consequences on the dentist's health and performance during work. This systematic review aimed to assess the prevalence of Burnout syndrome in dentists.Searches were carried out in Medline, Scopus, Web of Science, PsycINFO, EMBASE, LILACS databases, and searches in the gray literature on January 27, 2021. There were no restrictions on language and search period. For the diagnosis of Burnout, only studies that used the Maslach burnout inventory questionnaire and its subscales emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA) were included. Proportion meta-analyses were performed using the Stata 13.0 software.A total of 37 articles were included in the narrative and 31 in quantitative syntheses. The overall prevalence of Burnout syndrome in dentists was 13% (95% confidence interval [CI]: 0.006-0.21; I²: 97.07%) and the total prevalence in the subscales EE, DP, and PA, were, respectively: 28% (95% CI: 0.24-0.32; I²: 20.70%), 18% (95% CI: 0.08-0.28; I²: 85.61%) and 10% (95% CI: 0.08-0.13; I²: 0%). About the levels of Burnout syndrome in the subscales, 25% (95% CI: 0.19-0.31; I² 92.58%) presented high EE, 18% (95% CI: 0.10-0.26; I² 96.62%) high DP and 32% (95% 0.20-0.45; I² 97.86%) low PA. About continuous data, the mean of EE, DP and PA was respectively 17.90 (95% CI: 9.36-26.43; I² 94.8), 6.93 (95% CI: 3.41-10.45; I² 80.2) and, 34.69 (95% CI: 23.82-45.55; I² 98.8). No study presented all the positive criteria of the Joanna Briggs Institute Critical Appraisal checklist.In conclusion, there was a considerable prevalence of burnout syndrome in dentists, mainly in the subscale of emotional exhaustion.

There is great variability in methodological quality assessment (MQ) systematic reviews (SRs). We identified how MQ assessment in SRs that included observational studies in Health Science is applied and explored associated characteristics. A search was conducted in PubMed and five trained reviewers randomly selected 1,025 references after sample size calculation. Only SR published in English (September 2019/2020) were included. Selection and data extraction were conducted in two phases. Data were analyzed descriptively and using logistic regressions. After eligibility criteria application, 205 SRs were included. Only 27.8% informed the protocol registration and 80.0% described having followed a reporting guideline. Proportion’ SRs did not seem to present MQ assessment (OR 4.22; 95% CI: 1.38-12.87; P =0.01). SRs that did not register the study protocol (9.70; 95% CI: 1.95-48.27; P 0.001), those that did not inform the included study design (5.96; 95% CI: 1.63-21.77; P 0.001) and those without MA (OR 8.90; 95% CI: 2.79-28.43; p0.001) increased the odds of not evaluating MQ. Newcastle-Ottawa (47.5%), Joanna Briggs Institute (8.2%) and National Institute of Health (7.1%) were the most commonly used MQ tools. Lack of protocol registration, absence of information about the design of included studies, absence of MA, and proportion’ SRs were associated with lack of MQ assessment.

Objective: To review the literature about children’s and parent’s perceptions on surgical attire. Data source: A systematic search was conducted in the databases EMBASE, Latin American and Caribbean Health Sciences (LILACS), PubMed, PsycINFO, Scopus and Web of Science. Grey literature was searched on Google Scholar, Open Grey and ProQuest Dissertations, and Theses Database. Data synthesis: A total of 2,567 papers were identified. After a two-phase selection, 15 studies were included in narrative synthesis. Children favored wearing white coats in five of the nine included studies (55.5% [95%CI 48.3-62.7]; p=1.00). With respect to parents’ preferences, results of vote counting showed that in 11 of 15 included studies, they favored physicians wearing white coats (73.3% [95%CI 67.9-78.6]; p=0.11). Conclusions: Children and parents have preferred physicians to wear a white coat with a very low certainty of evidence. RESUMO Objetivo: Revisar a literatura sobre as percepções de crianças e seus pais a respeito de trajes médicos. Fontes de dados: Buscas sistemáticas foram conduzidas nas bases de dados EMBASE, Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), PubMed, PsycINFO, Scopus e Web of Science. A literatura cinzenta foi pesquisada no Google Scholar, Open Grey e ProQuest Dissertations e Theses Database. Síntese dos dados: Foram identificadas 2.567 publicações e, após uma seleção de duas fases, foram incluídos 15 estudos na síntese qualitativa. As crianças tinham preferência pelo uso de jaleco branco em cinco dos nove estudos incluídos (55,5% [IC95% 48,3-62,7]; p=1,00). Em 11 dos 15 estudos incluídos, os pais tinham preferência pelos médicos que utilizavam jaleco (73,3% [IC95% 67,9-78,6]; p=0,11). Conclusões: Com uma qualidade baixa de evidência, crianças e pais preferem os médicos que usam jaleco branco.

Cleft lip and palate are the most frequent anomalies of the face, which can compromise normal functions in addition to interfering with the patient's quality of life. Oral health problems can impact daily life, being more striking for these patients due to their functional and aesthetic changes. The aim of the study was to evaluate the oral health-related quality of life of patients with cleft lip and/or palate at the Center for Attention to Face Defects (CADEFI/IMIP-PE). The sample consisted of 348 patients, 174 aged 8 to 12 years and 174 aged 13 to 18 years. The collection instrument used to measure quality of life was PedsQL 4.0. Data analysis was performed using the STATA 9.0 software, descriptive, observing the absolute and relative frequencies in relation to the demographic and clinical characteristics of the sample and measures of central tendency for the PedsQL 4.0 score and domains. Poisson regression with robust variance was performed to associate the total scores and individual domains of the PedsQL 4.0 with the types of cravings, their prevalence and demographic conditions. Subsequently, the selected variables were tested in the adjusted multivariate model, which could only be maintained if the variables presented p≤ 0.05. Robust rate ratios (RTR) and 95% confidence intervals (95% CI) were calculated. Practically all respondents (99.9%) reported some impact in at least one of the instrument's domains. Children aged 13 to 18 years had a positive impact, better quality of life, compared to those aged 8 to 12 years. Multidisciplinary treatment protocols for the rehabilitation of patients with cleft lip and palate seek to restore function and aesthetics, helping to overcome stigma and integrating into social life, which can justify the favorable results of the assessment of the quality of life of these patients Cleft lip and palate are the most frequent anomalies of the face, which can compromise normal functions in addition to interfering with the patient's quality of life. Oral health problems can impact daily life, being more striking for these patients due to their functional and aesthetic changes. The aim of the study was to evaluate the oral health-related quality of life of patients with cleft lip and/or palate at the Center for Attention to Face Defects (CADEFI/IMIP-PE). The sample consisted of 348 patients, 174 aged 8 to 12 years and 174 aged 13 to 18 years. The collection instrument used to measure quality of life was PedsQL 4.0. Data analysis was performed using the STATA 9.0 software, descriptive, observing the absolute and relative frequencies in relation to the demographic and clinical characteristics of the sample and measures of central tendency for the PedsQL 4.0 score and domains. Poisson regression with robust variance was performed to associate the total scores and individual domains of the PedsQL 4.0 with the types of cravings, their prevalence and demographic conditions. Subsequently, the selected variables were tested in the adjusted multivariate model, which could only be maintained if the variables presented p≤ 0.05. Robust rate ratios (RTR) and 95% confidence intervals (95% CI) were calculated. Practically all respondents (99.9%) reported some impact in at least one of the instrument's domains. Children aged 13 to 18 years had a positive impact, better quality of life, compared to those aged 8 to 12 years. Multidisciplinary treatment protocols for the rehabilitation of patients with cleft lip and palate seek to restore function and aesthetics, helping to overcome stigma and integrating into social life, which can justify the favorable results of the assessment of the quality of life of these patients

Objective: To investigate whether the use of cone beam CT (CBCT) changes the diagnosis of external root resorption (ERR) or marginal bone loss (MBL) involving a second molar adjacent to an impacted third molar. Methods: A systematic search was applied in PubMed, EMBASE, Scopus, Web of Science, LILACS, Google Scholar, OpenGrey, and ProQuest. Studies assessing the detection of ERR or MBL in a second molar adjacent to an impacted third molar through CBCT and panoramic radiography (PAN) were included. Prevalence and agreement between PAN and CBCT on the detection of ERR and MBL were collected. The risk of bias was assessed using the MAStARI. Results: A total of 593 papers were identified, and after a 2-phase selection, 5 studies were included in the narrative synthesis. Regarding ERR, its prevalence in PAN was reported from 5.31 to 19.5% and from 22.8 to 62.0% in CBCT. The percentage of agreement varied from 28.5 to 74.0%. The prevalence of MBL varied from 21.9 to 62.9% in PAN, while those values varied from 21.6 to 80% in CBCT images. The percentage of agreement between PAN and CBCT for the detection of MBL ranged from 66.0 to 85.0%. Four studies presented low risk of bias and one had moderate risk. Conclusions: More ERR and MBL are assessed in CBCT compared to PAN. There is a considerable agreement between PAN and CBCT assessment of ERR and MBL, however, mostly related to the absence of the pathology rather its presence.

Aim To assess the children's perceptions of the dentist's attire and environment. The protocol is available in the PROSPERO database. Search strategies Systematic searches in the databases were performed in Cochrane, Latin American and Caribbean Health Sciences, PubMed, PsycINFO, Scopus, and Web of Science from their inception to December 12, 2019, Google Scholar, Open Grey, and ProQuest Dissertations. Selection criteria Criteria consisted of descriptive studies regarding the above matter while two authors assessed the information. The risk of bias was also performed. Results Databases showed 1,544 papers and a two-phase assessment selected 21 studies in narrative and 9 in the quantitative synthesis. A meta-analysis demonstrated no difference between white coat and child-friendly attire (OR = 0.63; 95% CI 0.16-2.49; n = 3,706) and a decorated vs plain dental clinic was the preference of the children's majority (OR = 8.75; 95% CI 1.21-63.37; n = 150). Conclusion It can be concluded that there is no difference in the children's perception, white coat vs child-friendly attire; however, children prefer a decorated dental clinic. How to cite this article Oliveira LB, Massignan C, De Carvalho RM, et al. Children's Perceptions of Dentist's Attire and Environment: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2020;13(6):700-716.

Oral manifestations may be the first sign of Langerhans Cell Histiocytosis. Due to diversity in the clinical findings of LCH, this disease has been a diagnostic dilemma to the clinicians, dentists and pathologist, as well. The pediatrician plays a crucial role in the diagnosis and multidisciplinary approach. This paper reports a case of LCH involving the mandible in a 2-year-old girl, highlight the difficulties involved in LCH diagnosis and the utmost importance of a multidisciplinary treatment approach involving pediatricians and pediatric dentists. A 2-year-old girl was referred to the Stomatology Department for evaluation of a lesion in her mandible. Her mother reported that when the baby was 7 months old, the mother noticed the presence of a small red nodule in the baby's mandible. Clinical examination revealed markedly reddened and swollen gingiva around mandibular primary incisors, which was painless to palpation presenting slight bleeding. The child has no other health problem, without allergies and familial history of tumors. Our initial diagnosis hypotheses were Melanotic Neuroectodermal Tumor of infancy and Central Giant Cell Granuloma. The treatment consisted of surgical removal of lesion under general anesthesia. The diagnosis of Langerhans cell histiocytosis was confirmed. The patient is currently under regular review and there has been no evidence of recurrence after 3 years of surgery.

Background/aims Very few studies have been performed to evaluate cranio-maxillofacial trauma diagnosed in hospitals in children and adolescents. The aim of this study was to perform an analysis of oral and cranio-maxillofacial trauma in the aforementioned population. Materials and methods A hospital-based retrospective study, which reviewed 1438 patient records, was conducted at the "Teresina Emergency Hospital", Brazil. Data regarding demographics, day of the week on which trauma occurred, type of injury, etiology, anatomic trauma site, time of hospital admission, and associated comorbidities (or injuries) were collected. Results There were 1092 (75.9%) males and 346 (24.1%) females. The largest group was adolescents aged between 13 and 18 years (956, 66.5%). The majority lived in urban areas (69%). Trauma occurred most frequently during the week. The most prevalent etiology was road traffic accidents involving motorcycles (771, 53.6%) causing facial and skull fractures (598, 41%). The most prevalent soft tissue lesions were facial abrasions (49%), followed by injuries to the cheek (16.7%). Comorbidities associated with craniofacial trauma were present in 82%, with complications from traumatic brain injuries being the most prevalent (65.6%) Dental trauma was recorded in only 81 cases (5.6%). Conclusion Male adolescents living in urban areas were most affected by craniofacial trauma. The most common cause was road traffic accidents involving motorcycles, resulting in facial and skull fractures. Complications from traumatic brain injuries were the most common associated injuries.

O objetivo deste estudo foi avaliar diferentes estratégias para o aprimoramento de graduandos de Odontologia sobre normas de prescrição medicamentosa. Foram avaliados 72 estudantes, os quais foram divididos aleatoriamente em 3 grupos (n=24): Grupo 1 – em cada etapa de avaliação foi apresentado um vídeo explicativo sobre normas de prescrição com duração de 15 minutos; Grupo 2 – o mesmo vídeo foi disponibilizado em uma plataforma virtual (com acesso ilimitado); Grupo 3 – controle: os estudantes não tiveram atividades adicionais sobre o tema. Foram realizadas 4 avaliações e os voluntários receberam um caso clínico diferente em cada avaliação, realizando uma prescrição para a situação clínica proposta. Para cada prescrição realizada foi atribuída uma pontuação considerando diferentes itens: identificação do profissional e do paciente, concentração, dose e quantidade do medicamento, instruções, dentre outros. Os resultados obtidos foram submetidos à análise estatística, com nível de significância de 5%. Não foram observadas diferenças significativas na avaliação basal entre os grupos (p>0,05). Após o uso das diferentes estratégias foram observados melhores resultados para G1 quando comparados a G2 e G3 (p

Considering the role of epidemiological information in planning and effective interventions, the purpose of this study was to systematically review the epidemiology of squamous cell carcinoma in Brazil. We searched the PubMed, LILACS, BBO and Cochrane databases using keywords "oral squamous cell carcinoma", "oral squamous cell carcinoma", "oral squamous cell carcinoma" and their equivalents in English and Spanish, in combination with epidemiology, prevalence, frequency, and Brazil by 2018, excluding studies that did not address the epidemiology of this neoplasm or those conducted in other countries. The mean age of the patients was 56.6 years, with a higher prevalence in males 3.29: 1, mainly located in tongue, 42% and mouth floor 22%. Associated risk factors are tobacco (72.85%) and alcohol (66.65%). It was observed that 47% of patients present with regional metastases at the time of cancer discovery. According to the observed observational studies it can be concluded that the epidemiological data of Brazil are high in comparison to other countries, especially the number of metastases, indicating the late diagnosis of the disease

This study revisited three oral radiology centers (ORC) and screened the main clinical indications that justified the request for cone-beam computed tomography (CBCT) examination in Endodontics. The databases of three ORCs were searched for requests of CBCT exams taken for Endodontic purposes over the last two years. The extracted data consisted of the total number of CBCT exams, the clinical indication in the endodontic field that justified the CBCT exam, the outcome of each exam (from the report of Oral Radiologists), and demographic data of the patients. From the total CBCT exams (n = 4,583), nearly 13% (n = 611) were taken for Endodontic purposes. Most of the clinical indications were related to root fractures (65%) and periapical lesions/disease (24.1%). Radiologists’ reports hypothesized more often toward periapical lesion/disease (70.5%), root fracture (51.4%) and accidents/complications (25.2%). Some clinical indications significantly varied based on age. In particular, post-traumatic imaging and the investigation of root resorption were more common in young patients, while the prevalence of exams for the investigation of pulpal calcifications and root fractures increased with age. More interestingly, there was a significant disagreement between the clinical indication that justified the CBCT examinations and the outcomes retrieved from radiologists’ reports (p < 0.005). This study illustrates the broad spectrum of CBCT applications for the diagnosis, treatment planning and follow-up in Endodontics. Attention is necessary to the disagreements between clinical indications and imaging outcomes, especially because certain conditions in the routine Endodontics are only visible with the aid of advanced tools. Este estudio revisitó tres centros de radiología oral (CRO) y cribo las principales indicaciones clínicas que justificaron la solicitud de examen por tomografía computarizada de haz cónico (CBCT) en endodoncia. Se realizaron búsquedas en las bases de datos de tres CRO en busca de solicitudes de exámenes CBCT realizados con fines endodónticos durante los últimos dos años. Los datos extraídos consistieron en el número total de exámenes CBCT, la indicación clínica en el campo endodóntico que justificó el examen CBCT, el resultado de cada examen (del informe de los radiólogos orales) y los datos demográficos de los pacientes. Del total de exámenes CBCT (n = 4583), casi el 13% (n = 611) se tomaron con fines de endodoncia. La mayoría de las indicaciones clínicas se relacionaron con fracturas radiculares (65%) y lesiones / enfermedades periapicales (24,1%). Los informes de los radiólogos plantearon con mayor frecuencia la hipótesis de lesión / enfermedad periapical (70,5%), fractura de raíz (51,4%) y accidentes / complicaciones (25,2%). Algunas indicaciones clínicas variaron significativamente según la edad. En particular, las imágenes postraumáticas y la investigación de la reabsorción radicular fueron más comunes en pacientes jóvenes, mientras que la prevalencia de exámenes para la investigación de calcificaciones pulpares y fracturas radiculares aumentó con la edad. Más interesante aún, hubo un desacuerdo significativo entre la indicación clínica que justificaba los exámenes CBCT y los resultados obtenidos de los informes de los radiólogos (p

INTRODUCTION The use of teaching resources and digital objects has gradually been incorporated into dental schools. This study aimed to evaluate the digital anatomy table in teaching-learning process of the temporomandibular joint (TMJ) anatomy and the student's perception regarding this resource. MATERIALS AND METHODS A cross-sectional study was conducted on 41 undergraduate dental students. Knowledge assessment tests were applied at different time intervals: before and after the TMJ theoretical class, after the practical class on prosected specimens and after the use of digital anatomy table. The medians of the scores obtained in the three groups (theoretical class, practical class and digital table) were descriptively analysed and submitted to Wilcoxon, Kruskal-Wallis and Student-Newman-Keuls statistical tests. The perception survey was conducted at the end of the study. RESULTS When the teaching strategies were compared amongst each other, the medians of the scores with the digital anatomy table were significantly higher than after the theoretical and practical classes. At the end of the research, there were no differences amongst the three groups (theoretical class, practical class and digital table). Regarding the perception, the majority of the students reported that the digital anatomy table helped them to understand the content of the theoretical class. CONCLUSION It was concluded that learning with the use of the digital anatomy table did not increase the knowledge of dental students with respect to the TMJ anatomy. The students' perceptions of the digital anatomy table were positive and that it could be used as an additional resource in the teaching-learning process.

This study aims to perform a systematic review and meta-analysis of clinical trials in order to evaluate the clinical and radiographic success rates of primary teeth pulpotomy performed with biodentine, when compared to MTA. Search strategies were conducted in nine databases on August 5th, 2017, update on February 14th, 2018. Clinical articles were selected, which were in accordance with the inclusion and exclusion criteria and the research objective. They were analyzed by meta-analysis at three time points (6, 12, and 18 months). Out of the 233 publications initially identified, only 9 studies that fulfilled the inclusion criteria were included in the review. The 6-month overall clinical (RR = 0.99; 95% CI = 0.96–1.02, p = 0.92) and radiographic success rates (RR = 0.96; 95% CI = 0.92–1.00, p = 0.28) showed that biodentine vs. MTA did not differ statistically. The 12 and 18-month overall clinical success rates, respectively (RR = 1.01; 95% CI = 0.97–1.04, p = 0.77; RR = 0.98; 95% CI = 0.92–1.05, p = 0.74) and radiographic success rates, respectively (RR = 0.97; 95% CI = 0.92–1.02, p = 0.11; RR = 1.00; 95% CI = 0.91–1.10, p = 0.56) also showed that biodentine vs. MTA did not differ statistically. There is no superiority of one material over the other, MTA versus biodentine. This systematic review comparing the performance of biodentine in relation to the MTA when used in the pulpotomy technique in primary teeth. Although MTA is considered the gold standard material for pulpotomy procedures, it has some drawbacks (poor handling, staining potential, long setting time); thus, it is important to evaluate the clinical performance of other calcium silicate-based cements like biodentine that overcome this drawbacks.

Dentists should be prepared to manage eventual medical emergencies that occur in the dental practice. However, many dentists are not fully prepared to manage these situations and have insufficient experience training in medical emergencies. The aim of this paper is to report the experience of educational activities using a high-fidelity simulator in different scenarios in order to prepare dental professionals for medical emergencies in the dental clinic. This methodology allows discussion in the debriefing room regarding the main techniques and procedures to be performed in clinical practice in cases of emergencies and training of dentists to meet these situations. It can be concluded that high-fidelity simulation represents an innovative learning scenario and it is an effective educational method to prepare dental professionals for medical emergencies.

Objective: To test the standard protocols of a CBCT unit in order to find lower-dose alternatives with diagnostically acceptable image quality for the maxillary sinuses visualization. Study design: An observational study was performed. Two dry skulls were used to simulate four conditions of the maxillary sinuses: normality, mucous retention pseudocyst, membrane thickening and bone graft. Cone beam computed tomography scans were obtained with an i-CAT classic unit using different acquisition protocols and a box of polystyrene to simulate soft tissue attenuation. All the protocols were established by the manufacturer, combining different energy parameters, fields of view and voxel sizes. Multiplanar reconstructions were presented to three Oral Radiologists through blind and randomized distribution. The specialists judged general image quality, sharpness, contrast, and the presence of noise and artifacts based on a 4-points scale. Results: Protocols with higher energy parameters had significant association with higher scores for general quality, sharpness and contrast (p

This study aimed to assess the reproducibility of linear measurements performed in dental models produced via intraoral scanning and three-dimensional (3D) printing using digital light processing (DLP) and fused deposition modeling (FDM). A sample of 22 participants was selected for this study. Intraoral scanning was performed in each participant with TRIOS™ (3Shape A/S™, Copenhagen, Denmark) device. The digital models were 3D printed using DLP and FDM techniques. Using a caliper, intraoral linear measurements were performed in situ (on the surface of participant’s teeth) and on the 3D printed models. The measurements taken intraoral and on the models were compared using the Intraclass Correlation Coefficient (ICC). The correlation between measurements taken in situ and on DLP models was poor (0.05). According to Bland-Altman approach, the size of measurements did not bias the outcomes. The intraoral scanning and 3D printing techniques used in this study enabled the reproducibility of linear measurements, however, discrete distortions that might be clinically significant occurred. El objetivo fue evaluar la reproducibilidad de las mediciones lineales realizadas en modelos dentales producidos mediante escaneo intraoral e impresión tridimensional (3D) utilizando procesamiento de luz digital (DLP) y modelado de deposición fundida (FDM). Se seleccionó una muestra de 22 participantes para este estudio. Se realizó una exploración intraoral en cada participante con el dispositivo TRIOS ™ (3Shape A / S ™, Copenhague, Dinamarca). Los modelos digitales se imprimieron en 3D utilizando técnicas DLP y FDM. Con un calibre, se realizaron mediciones lineales intraorales in situ (en la superficie de los dientes de los participantes) y en los modelos impresos en 3D. Las medidas tomadas intraoralmente y en los modelos se compararon utilizando el coeficiente de correlación intraclase (ICC). La correlación entre las medidas tomadas in situ y en los modelos DLP fue pobre ( 0.05). Según el enfoque de Bland-Altman, el tamaño de las mediciones no sesgó los resultados. Las técnicas de escaneo intraoral e impresión 3D utilizadas en este estudio permitieron la reproducibilidad de las mediciones lineales, sin embargo, se produjeron distorsiones discretas que podrían ser clínicamente significativas. O objetivo deste estudo foi avaliar a reprodutibilidade de medidas lineares realizadas em modelos dentais produzidos por escaneamento intraoral e impressão tridimensional (3D) utilizando processamento digital de luz (DLP) e modelagem por deposição fundida (FDM). Uma amostra de 22 participantes foi selecionada para este estudo. A varredura intraoral foi realizada em cada participante com o dispositivo TRIOS ™ (3Shape A / S ™, Copenhagen, Dinamarca). Os modelos digitais foram impressos em 3D usando técnicas DLP e FDM. Usando um calibrador, medições lineares intraorais foram realizadas in situ (na superfície dos dentes do participante) e nos modelos impressos em 3D. As medições feitas intraoral e nos modelos foram comparadas usando o coeficiente de correlação intraclasse (ICC). A correlação entre as medições feitas in situ e nos modelos DLP foi fraca ( 0,05). De acordo com a abordagem de Bland-Altman, o tamanho das medidas não influenciou os resultados. As técnicas de digitalização intraoral e impressão 3D utilizadas neste estudo possibilitaram a reprodutibilidade das medidas lineares, porém, ocorreram discretas distorções que podem ser clinicamente significativas.

Objective: The aim of this study was to investigate the impact of erosive tooth wear on the Oral Health-Related Quality of life (OHRQoL) of preschool children. Methods: Dental examinations were conducted on 815 children aged 3-4 years during the Children’s Vaccination National Day when their parents were also invited to answer the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS). ETW prevalence and severity were measured using a modified version of the O’Brien index (1994). Data collected included socioeconomic factors and child's variables. OHRQoL was measured through B-ECOHIS domains and total score. Poisson regression was used to associate ETW to the outcome and this association was adjusted for dental caries and dental trauma. Results: The proportion of children who had at least 1 ETW tooth was 51.2%. Most erosive lesions were confined to enamel (42.7%). The multivariate adjusted model showed that child's age (children aged 4year-old) was associated to a negative impact on the symptom domain (RR=1.70; p=0.010), functional limitation domain (RR=1.85; p=0.005) and total B-ECOHIS score (RR= 1.63; p=0.006). Families with 2 or more children in the house have a negative impact on the self-image/social interaction domain (RR=5.41; p=0.043). ETW was not associated to total B-ECOHIS scores (RR= 0.79; p=0.163) and individual domains. Conclusion: Erosive tooth wear does not affect the OHRQoL in this sample of preschool children. RESUMO Objetivo: O objetivo deste estudo foi investigar o impacto das lesões de desgaste dentário erosivo na qualidade de vida relacionada à saúde bucal (QVRSB) de pré-escolares. Métodos: Exames clínicos foram conduzidos em 815 crianças de 3 e 4 anos de idade durante a Campanha Nacional de Multivacinação Infantil. Os pais ou responsáveis foram convidados a responderam a versão brasileira do Early Childhood Oral Health Impact Scale (B-ECOHIS). A prevalência e a gravidade das lesões de desgastes dentários erosivos foram avaliadas de acordo com o índice de O’Brien (1994). Também foram coletados dados socioeconômicos e variáveis da criança. A QVRSB foi mensurada por meio dos domínios e escore total do B-ECOHIS. A análise de regressão de Poisson foi adotada para associar as lesões de desgaste dentário erosivo ao desfecho e ajustada para cárie dentária e lesões dentárias traumáticas. Resultados: A proporção de crianças que apresentavam pelo menos 1 dente apresentando desgaste dentário erosivo foi 51,2%. A maioria das lesões de desgaste dentário erosivo estava confinada ao esmalte (42,7%). A análise ajustada multivariada revelou que apenas que a idade (crianças de 4 anos) foi associada a um impacto negativo nos domínios de sintomas (RR=1,70; p=0,010), limitação funcional (RR=1,85; p=0,005) e escore total do B-ECOHIS (RR= 1,63; p=0,006). Famílias com 2 ou mais filhos tiveram um impacto negativo nos dominíos de autoestima e interação social (RR=5,41; p=0,043). As lesões de desgaste dentário erosivo não foram associadas ao escore total de B-ECOHIS (RR= 0,79; p=0,163) e domínios individuais. Conclusão: As lesões de desgaste dentário erosivo não afetaram a qualidade de vida de pré-escolares da amostra estudada.

OBJECTIVE: To investigate the validity of micro-CT for in vitro caries detection in comparison with histology as the reference standard. METHODS: A systematic search was conducted in the databases Latin American and Caribbean Health Sciences (LILACS), LIVIVO, PubMed, Scopus and Web of Science from their inception to 16 January 2019. Grey literature was searched on Open Grey, ProQuest Dissertations and Theses Database and Google Scholar. In vitro studies assessing the validity of micro-CT for caries detection were included when compared with histology as the reference standard were included. Two authors independently collected the information and sensitivity, specificity, positive and negative likelihood ratios, as well as diagnostic odds ratios were calculated. The risk of bias of the included studies was assessed using the QUADAS-2 tool. Certainty of evidence was assessed with GRADE. RESULTS: A total of 270 papers were identified, and after a 2-phase selection, 12 studies were included in qualitative and three in quantitative synthesis. For enamel caries diagnostic, sensitivity values ranged from 29.0 to 84.0% indicating high variability while specificity varied from 88.0 to 95.0% indicating good to excellent micro-CT capability do identify the true negative. For dentine caries diagnostic, sensitivity values ranged from 61.0 to 77.0% indicating fair-to-good probability of micro-CT to identify the true positives, while specificity varied from 88.0 to 94.0%. The majority of the included studies presented low risk of bias and moderate certainty of evidence. CONCLUSIONS: This study demonstrated the validity of micro-CT for in vitro caries detection in comparison with histology.

The management of patients who undergo dental surgical procedures and receive oral anticoagulant therapy requires particular attention due to the risk of bleeding that may occur during the procedure. Bleeding rates in these trans- or post-operative patients tend to be unpredictable. The aim of this study was to conduct a systematic review in order to assess the risk of bleeding during and after performing oral surgery in patients administered oral anticoagulants compared with a group that discontinued anticoagulant therapy. For the purposes of this review, we searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), and the Virtual Health Library (VHL) from inception of the database to December 2018. The primary outcome was defined as the occurrence of local bleeding during and after oral surgical procedures. Four reviewers, independently and in pairs, screened titles and abstracts for full-text eligibility. Data regarding participant characteristics, interventions, and design and outcomes of the included studies were extracted. The data were pooled using random-effects meta-analyses and described as risk ratios (RRs) with a 95% confidence interval (95% CI). The confidence for the pooled estimates was ascertained through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and the protocol of this review was recorded in PROSPERO (CRD42017056986). A total of 58 eligible studies were identified, of which three randomized controlled trials were included in the meta-analysis, covering a total of 323 adult participants, among whom 167 were taking anticoagulants at the time they underwent dental surgery. Of these patients, 14.2% had reported bleeding. The risk of bleeding was found to be one to almost three times greater in patients taking warfarin compared with patients who discontinued the use of anticoagulant during the trans-operative period (RR = 1.67, 95% CI = 0.97 to 2.89) and in the post-operative period (RR = 1.44, 95% CI = 0.71 to 2.92), although the quality of evidence was very low. The results indicate that there is no evidence that the use of anticoagulants eliminates the risk of bleeding during surgical dental procedures.

Aim This study aimed to evaluate the effect of pseudocolor filter in micro-computed tomography (CT) images for the detection of proximal and occlusal caries lesions in primary molars. Materials and methods For this in vitro analysis, 26 extracted human primary teeth were scanned using a compact micro-CT device (Skyscan 1172, Bruker micro-CT, Kontich, Belgium) and the projection images were reconstructed into cross-sectional slices (NRecon v.1.6.9, Bruker micro-CT, Kontich, Belgium). The original and pseudocolor images were evaluated twice by three calibrated radiologists. The tooth surfaces were scored according to Mejare et al. criteria. The agreement was assessed by the Kappa coefficient, and the Chi-square test was used to evaluate the association between radiolucent lesion depth in enamel and dentin. Results There was a good intra-observer agreement for detecting proximal caries lesions with or without using pseudocolor filter (k >0.60). The inter-examiner agreement had similar results, and the agreement rates were good or moderate for the proximal surfaces. There were no statistically significant differences between the original and pseudocolor images (p >0.05). The pseudocolor filter showed high sensitivity and specificity when compared with the original image with the exception of the occlusal face in enamel. Conclusion The pseudocolor filter appears to be a promising enhancement tool for micro-CT images used for the detection of caries lesions in primary molars; even if it was not significantly different from the original images. Clinical significance The pseudocolor filter converts grey scale images into color images. It is present in micro-CT software and must increase the diagnostic capacity of detecting caries lesion in occlusal and proximal surfaces.

Evidence shows that acute symptoms of temporomandibular dysfunction (TMD) would eventually lead to chronicity and self‐medication would play a significant interfering role on such dynamics (Dias, Bastos, Alves, & Leite, 2019; Pastore, Goulart, Pastore, Prati, & de Moraes, 2018). Furthermore, some authors concluded that both propensity to catastrophize and depression contribute to the progression of chronic temporomandibular muscle and joint disorders (Velly et al., 2011). Hence, the aim of this study was to assess the relationship between the habit of self‐medicating and the propensity to catastrophize pain in a clinical population with myofascial pain (MP)., © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved

O presente estudo teve por objetivo verificar o não comparecimento dos pacientes com necessidades especiais em três Centros de Especialidades Odontológicas Regionais (CEO-R), localizados na região do Cariri. Os dados foram obtidos através do Sistema Integrado de Gestão em Saúde do Ceará. A fim de verificar associação entre distância e número de faltas foi realizada análise de correlação de Pearson e para descrever o padrão geográfico da ocorrência de faltas, foram construídos mapas temáticos baseados nas distribuições das taxas de faltas. Ao se correlacionar as variáveis, verifica-se correlação estatisticamente significativa para distância e percentual de faltas (p=0.003) distância e pacientes agendados (p=0.025), distância e pacientes confirmados (p=0.018) e distância e tratamentos concluídos (p=0.016). Pode-se concluir que a as faltas dos pacientes não ocorre de modo sazonal e que a distância até o CEO pode ser um preditor que apresentou correlação positiva e forte associação com o absenteísmo dos pacientes.

A Sindrome de Goldenhar e rara e suas principais manifestacoes fisicas incluem assimetria e desenvolvimento facial incompleto, tumores dermoides epibulbares, malformacoes na orelha e apendices auriculares, anomalias vertebrais, disturbios no sistema nervoso central, irregularidades oculares e anomalias viscerais. A etiologia desta condicao nao e claramente esclarecida e apresenta-se geneticamente variavel. A incidencia da Sindrome de Goldenhar pode variar de 1:3500 ate 1:5600 nascidos vivos e relacao por sexo de 3:2 (masculino: feminino), apresentando mais frequentemente em criancas com surdez congenita. O objetivo deste trabalho e apresentar um caso clinico de Sindrome de Goldenhar em paciente infantil de 5 anos de idade do sexo masculino, sem historia familiar relevante relacionada a sindrome e que apresenta caracteristicas claras desta condicao. Considerando o envolvimento das estruturas craniofaciais da Sindrome de Goldenhar, sua raridade e o amplo espectro de sintomas e anormalidades sistemicas associadas, o conhecimento desta condicao e primordial para o cirurgiao-dentista.

Objective: To investigate the validity of micro-CT for in vitro caries detection in comparison with histology as the reference standard. Methods: A systematic search was conducted in the databases Latin American and Caribbean Health Sciences (LILACS), LIVIVO, PubMed, Scopus and Web of Science from their inception to 16 January 2019. Grey literature was searched on Open Grey, ProQuest Dissertations and Theses Database and Google Scholar. In vitro studies assessing the validity of micro-CT for caries detection were included when compared with histology as the reference standard were included. Two authors independently collected the information and sensitivity, specificity, positive and negative likelihood ratios, as well as diagnostic odds ratios were calculated. The risk of bias of the included studies was assessed using the QUADAS-2 tool. Certainty of evidence was assessed with GRADE. Results: A total of 270 papers were identified, and after a 2-phase selection, 12 studies were included in qualitative and three in quantitative synthesis. For enamel caries diagnostic, sensitivity values ranged from 29.0 to 84.0% indicating high variability while specificity varied from 88.0 to 95.0% indicating good to excellent micro-CT capability do identify the true negative. For dentine caries diagnostic, sensitivity values ranged from 61.0 to 77.0% indicating fair-to-good probability of micro-CT to identify the true positives, while specificity varied from 88.0 to 94.0%. The majority of the included studies presented low risk of bias and moderate certainty of evidence. Conclusions: This study demonstrated the validity of micro-CT for in vitro caries detection in comparison with histology.

Los principales problemas de salud bucal que afectan a los niños menores de 5 años de edad son la Caries Dental (CD) Traumatismo Dentario (TD) e recientemente el Desgaste Dentario Erosivo (DDEr). Objetivo: Evaluar el impacto de la prevalencia y severidad de CD, TD y DDEr en la Calidad de Vida Relacionada a la Salud Bucal (CVRSB) de preescolares y de sus padres/cuidadores, asociadas con variables sociodemográficas. Materiales y Métodos: Fueron seleccionados sistemáticamente 617 niños de 3 y 4 años de edad durante la Campaña Nacional de Vacunación Infantil del Municipio de Diadema, São Paulo-Brasil. Los padres y/o cuidadores respondieron el cuestionario de la versión brasileña de calidad de vida (B-ECOHIS) y datos sociodemográficos relacionados al niño(a). Fue firmado el Consentimiento informado previo al examen clínico. Cirujanos Dentistas entrenados y calibrados realizaron los exámenes clínicos para CD, TD y DDEr. Para el análisis estadístico fue realizada la Regresión de Poisson con un intervalo de confianza de 95%. Resultados: Los valores de Kappa (Inter e intra-examinador) para todas las condiciones clínicas estudiadas fueron > 0.8. La prevalencia de CD, TD y DDEr del total de la muestra fue de 33.1%, 26.9% y 52.4% respectivamente. Fue observada una asociación del score total del B-ECOHIS con la edad del niño(a) (RP= 1.62 / p= 0.005), la presencia de CD (RP= 2.88 / p< 0.001) y la severidad de CD. Fue considerada como alta severidad cuando el niño(a) presentaba un ceo-d > 6 (RP= 4.76 / p< 0.001). La presencia y la severidad de TD y DDEr no mostraron un impacto negativo en la CVRSB de los preescolares. Conclusiones: La edad del niño, la presencia y severidad de la CD están asociadas con la peor CVRSB de preescolares y de sus padres/cuidadores. TD y DDEr no mostró impacto en la CVRSB.

Anatomical variations of mandibular canal have rarely been reported in the literature. The aim of this paper is to present three clinical cases of bifid mandibular canal diagnosed with cone-beam computed tomography (CBCT) as well as discuss its clinical implications. The first case is very interesting due to its anatomic variation verified in a panoramic radiograph during orthodontic planning, mimicking an odontogenic tumor. The second and the third cases were identified during tomographic evaluation for third molar exodontia. The diagnosis of bifid canals is extremely relevant in order to avoid complications during surgical procedures and implant placement as well as anesthesia failures which cause pain, paresthesia and bleeding. Furthermore, the shape of these anatomical variations can be confused with bone lesions. RESUMO O objetivo deste trabalho é apresentar três casos clínicos de canais mandibulares bífidos, diagnosticados em imagens de tomografia computadorizada de feixe cônico (TCFC) e discutir as possíveis implicações clínicas destas variações. O primeiro caso relatado é bastante interessante devido à variação anatômica diagnosticada em uma radiografia panorâmica, indicada para o planejamento ortodôntico. A ocorrência do canal bífido mimetiza o aspecto de um tumor odontogênico. A presença de canal bífido no segundo e no terceiro caso clínico foi identificada durante a avaliação tomográfica para a exodontia de terceiros molares. O diagnóstico de canais bífidos é de grande relevância para evitar possíveis complicações durante a realização de cirurgias, instalação de implantes dentários e falhas de anestesias durante os procedimentos cirúrgicos que podem provocar dor, parestesia e sangramento. Além disso, estas variações anatômicas podem ser confundidas com lesões ósseas.