Holistic approach of a child with cystic fibrosis: a case report

The Pediatric Dentistry Clinic staff of the Federal University of Santa Catarina (UFSC) treated a 5-year-old patient who had multiple dental treatment necessities. He also had cystic fibrosis (CF). As CF is an incurable disease that affects the mucous glands, especially the ones related to the lungs and digestive organs, the patient presented both chronic respiratory and intestinal problems. Such problems resulted in a severely compromised nutritional status. Patients who have CF may present problems in oral health because they receive food supplementation that is rich in carbohydrates. Behavioral changes of such patients when in contact with health professionals are also a point to consider because these changes may make the treatment difficult. That is the reason why oral complications imposed by the disease, as well as the psychological aspects related to it, need to be discussed so that treatment is given to the patient aiming at physical and emotional comfort.     

Enzymatic markers of salivary cell injury in saliva of type 1 diabetic children

To find evidence of salivary gland involvement in human type I diabetes, we explored the changes in aminotransferase and lactate dehydrogenase activities, as indices of cellular injury, in the whole saliva of diabetic children. Although no significant difference in these enzymatic activities was observed between control and diabetic children as a whole, a negative correlation was found between enzymatic activities and duration of the disease, the highest values being detected in the diabetic subgroup diagnosed for less than 4 years. This suggests that some cell damage could be present in salivary glands of recently diagnosed diabetic children, likely as a result of immune-mediated alterations. In conclusion, these results may support the hypothesis that, as in rodents, the salivary glands could be an additional target of the immunological attack mainly directed against pancreatic beta-cells and resulting in type 1 diabetes.     

Bone scintigraphy as an adjunct for the diagnosis of oral diseases

Bone scintigraphy is a very sensitive method for the detection of osteoblastic activity of the skeleton. The technique consists of imaging the uptake of bone-seeking radiopharmaceuticals, particularly technetium-99m labeled diphosphonates, in the mineral component of bone, which consists of hydroxyapatite crystals and calcium phosphate, as well as in the organic matrix such as collagen fibers. Plain radiographs, computed tomography, and magnetic resonance imaging are classified as structural imaging modalities, whereas bone scintigraphy is a functional method. In many cases, radionuclide imaging techniques are the only means by which early physiologic changes that are a direct result of biochemical alteration may be assessed, before significant bone mineral changes can be detected by other means. Since many oral diseases may cause metabolic changes in the oromaxillofacial complex, it would be of great value to use bone scintigraphy to evaluate more completely some conditions involving the bones in the region to formulate more appropriate treatment plans. Based upon the current literature, the authors discuss the possible applications of bone scintigraphy as a diagnostic and treatment planning adjunct for oral diseases. Bone scintigraphy has proven particularly useful in the study of malignant lesions and in the evaluation of vascularized bone grafts used for maxillofacial reconstructions.     

The effect of osteoporosis on periodontal status, alveolar bone and orthodontic tooth movement. A literature review

Osteoporosis, an age-related condition, is defined as a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration with a consequent increase in bone fragility and susceptibility to fracture. It is considered the most common bone metabolic disease and it constitutes a major public health problem. Several studies indicate that osteoporosis may be related to decreased oral bone density and alveolar bone loss. In osteoporotic patients, uncoupling of bone resorption and bone formation has taken place. Both bone resorption and bone formation are accelerated, and excessive bone resorption usually leads to loss of attachment. Osteoporosis could also affect the rate of tooth movement through the involvement of alveolar bone. In healthy individuals, bone is constantly being remodeled in the coupled sequence of bone resorption and formation. When a force is applied to a tooth, alveolar bone formation and resorption occur predominantly on the tension and pressure sides of the root, respectively, and the tooth moves with increased alveolar bone remodeling. Experimental studies suggest that systemic-osteoporotic hormone imbalance increases bone turnover and accelerates tooth movement while under orthodontic treatment. Based on these observations it can be concluded that deviations in bone turnover and consequent periodontal problems influence the response to orthodontic forces, and this should be taken into consideration when planning orthodontic treatment in adult patients with metabolic bone disease, especially postmenopausal females or those on chronic medication affecting bone metabolism.     

Dimensional alterations and solubility of new endodontic sealers

This study evaluated the dimensional alterations and the solubility of two experimental endodontic sealers based on Copaifera multijuga oil-resin (Biosealer) and castor oil bean cement (Poliquil), maintained in different storage solutions. Twenty specimens (3 mm diameter and 2 mm height) of each sealer were assigned to 2 groups (n=10) according to the storage solution: simulated tissue fluid (STF) or distilled water (DW). The specimens were stored in these solutions during 90 days, being removed every 30 days for weighting. The solutions were renewed every 15 days. The results were subjected to statistical analysis by Dunn's and Mann-Whitney tests (a=0.05). The solubility of Poliquil was higher in STF (38.4 ± 36.0) than in DW (28.4 ± 15.0), while Biosealer showed higher solubility in DW (34.61 ± 6.0) than in STF (18.59 ± 8.0). The storage solution influenced the behavior of sealers in relation to the weight variation (p=0.0001). Poliquil presented higher variation of weight independent of the solution (p=0.239). Biosealer also presented higher variation of weight regardless of the solution (p=0.0001). The solubility of Biosealer was different from that of Poliquil, but both sealers showed low solubility in STF. Under the tested conditions, neither of the materials were according to the ADA'S specification.     

Evaluation of the panoramic image formation in different anatomic positions

The aim of this study was to determine size, shape and position of the image layer by evaluation of the radiographic image formation in different anatomic positions. A customized phantom was made of a rectangular acrylic plate measuring 14 cm2 and 0.3 cm thick, with holes spaced 0.5 cm away and arranged in rows and columns. Each column was separately filled with 0.315 cm diameter metal spheres to acquire panoramic radiographs using the Orthopantomograph OP 100 unit. The customized phantom was placed on the mental support of the device, with its top surface kept parallel to the horizontal plane, and was radiographed at three different heights from the horizontal plane, i.e., the orbital, occlusal and mandibular symphysis levels. The images of the spheres were measured using a digital caliper to locate the image layer. The recorded data were analyzed statistically by the Student'-t test, ANOVA and Tukey' test (?=0.05). When the image size of spheres in horizontal and vertical axes were compared, statistically significant differences (p<0.05) were observed in all areas, portions of the image layer and heights of horizontal plane evaluated. In the middle portion of the image layer, differences in the image size of spheres were observed only along the horizontal axis (p<0.05), whereas no differences were observed along the vertical axis (p>0.05). The methodology used in this determined the precise size, shape and position of the image layer and differences in magnification were observed in both the horizontal and vertical axes.     

Measuring inequalities in the distribution of dental caries

Abstract – Objectives: To evaluate different measurements of prevalence and inequality in the distribution of dental caries as to their partial collinearity, and ability in expressing associations with the supply of fluoridated tap water, indices of socioeconomic status and provision of dental services. Methods: The DMFT, the Significant Caries (SiC) Index, the proportions of children with high- (DMFT ≥ 4) and rampant- (DMFT ≥ 7) caries experience, caries-free children (DMFT = 0), the Gini coefficient and the Dental Health Inequality Index (DHII) were the dental outcomes appraised in a sample comprising 18 718 oral examination records for 11- and 12-year-old schoolchildren in 131 towns of the state of São Paulo, Brazil. Spatial data analysis assessed the association between aggregate figures of dental indices and several covariates. Results: The DMFT, the SiC Index and the proportions of children with high- and rampant-caries experience presented strong linear associations (Pearson r near or higher than 0.95), and an analogous profile of correlation with indicators of socioeconomic status, dental services and access to fluoride tap water. The same was observed for the DHII, the Gini coefficient and the proportion of caries-free children. These observations involve the perception of variables in each set as interchangeable tools for ecological studies assessing factors influencing, respectively, prevalence levels and inequality in the distribution of dental disease. Conclusion: An improved characterization of the skewed distribution of caries experience demands the concurrent estimation of figures of prevalence and inequality in dental outcomes. This strategy may contribute to the design of socially appropriate programmes of oral health promotion.     

POLARIZATION OF DENTAL CARIES AMONG INDIVIDUALS AGED 15 TO 18 YEARS

Objective:

To evaluate the role of socioeconomic variables and self-perceived oral health in the polarization of caries among adolescents in Santa Bárbara D''Oeste, Brazil.

Material and Methods:

Cross-sectional study. Sampling was randomized and sample size was defined according to WHO criteria. Two hundred and seventy seven adolescents (15 to 18 year-old) were examined by five trained examiners that assessed DMFT index according to WHO criteria. Self-perceived oral health, access to dental services and socio-demographic variables were self-reported. Student''s t tests, chi-square tests, and multivariate logistic regression (with significant caries index (SiC) as the outcome), were performed.

Results:

Mean DMFT was 5.48 (±4.22) and the proportion of "caries free" subjects was 15.5%. Mean DMFT (9.71±2.85) and mean D (1.67±2.18) of SiC positive subjects were significantly higher than mean DMFT (2.88±2.17) and mean D (0.45±0.87) of SiC negative subjects (p<0.0001). Mean D of white (0.76±1.51) was significantly smaller than mean D of non-white subjects (1.32±2.01). The only variable independently associated with the "SiC positive" outcome was "report of toothache within six months prior to the study" [OR=1.83 (95%CI 1.08 to 3.12)], p<0.001.

Conclusion:

SiC was associated with "report of toothache" but not with sociodemographic variables in the studied population.     

Periodontal plastic surgery associated with treatment for the removal of gingival overgrowth

BACKGROUND: Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of hindering oral hygiene. METHODS: Two clinical cases are reported in which gingival overgrowths were removed by excisional biopsy, resulting in unsightly defects. The first clinical case presents an invasive approach for the treatment of a recurrent pyogenic granuloma in the anterior maxilla, and the second depicts a complete removal of a peripheral odontogenic fibroma in the posterior maxilla. In both situations, the soft-tissue defects were repaired by periodontal plastic surgery, including a laterally positioned flap and a coronally positioned flap, respectively. RESULTS: Periodontal plastic surgery successfully restored the defects that resulted from biopsies, and no recurrence has been noticed in the 5-year postoperative follow-up period. CONCLUSIONS: The combination of biopsy and periodontal plastic surgery in a one-step procedure seems to be suitable to remove gingival overgrowths in most areas of the mouth, regardless of esthetic significance. Such procedures seem to restore gingival health, encourage healing, and create both esthetics and function in the excised area.     

Effect of different finishing and polishing techniques on the surface roughness of microfilled, hybrid and packable composite resins

This study examined the average surface roughness (Ra, microm) of 2 microfilled (Durafill and Perfection), 1 hybrid (Filtek Z250) and 2 packable composite resins (Surefil and Fill Magic), before (baseline) and after eight different finishing and polishing treatments. The surface roughness was assessed using a profilometer. Ten specimens of each composite resin were randomly subjected to one of the following finishing/polishing techniques: A -- carbide burs; B -- fine/extrafine diamond burs; C -- Sof-Lex aluminum oxide discs; D -- Super-Snap aluminum oxide discs; E -- rubber polishing points + fine/extrafine polishing pastes; F -- diamond burs + rubber polishing points + fine/extrafine polishing pastes; G -- diamond burs + Sof-Lex system; H -- diamond burs + Super-Snap system. Data were analyzed using two-way ANOVA and Tukey's HSD test. Significant differences (p<0.05) were detected among both the resins and the finishing/polishing techniques. For all resins, the use of diamond burs resulted in the greatest surface roughness (Ra: 0.69 to 1.44 microm). The lowest Ra means were obtained for the specimens treated with Sof-Lex discs (Ra: 0.11 to 0.25 microm). The Ra values of Durafill were lower than those of Perfection and Filtek Z250, and these in turn had lower Ra than the packable composite resins. Overall, the smoothest surfaces were obtained with the use the complete sequence of Sof-Lex discs. In areas that could not be reached by the aluminum oxide discs, the carbide burs and the association between rubber points and polishing pastes produced satisfactory surface smoothness for the packable and hybrid composite resins, respectively.