ABSTRACT The aim of this study was to report the clinical case of an 8-year-old male patient seen at the Pediatric Dentistry outpatient clinic at the Universidade Federal do Paraná, Brazil, diagnosed with molar-incisor hypomineralization (MIH) after presenting with pain in teeth 16, 36, and 46, which had extensive atypical cavities and opacities on the adjacent enamel. A diagnostic wax-up of affected teeth was performed for manufacture of silicone occlusal matrix. Encapsulated high-viscosity glass ionomer cement was handled and inserted into the occlusal matrix which was fitted onto the teeth by slight finger pressure. After setting time, excess of material was removed, and occlusion was checked. A flowable resin coating material was applied, and the restorations were finished. Six months later, the restorations performed for treatment of the severe MIH lesions proved to be efficient, lowering the sensitivity reported by the patient, reshaping the teeth, improving their function, and refining dental esthetics.

RESUMO O objetivo deste estudo foi relatar um caso clínico de um paciente com diagnóstico de Hipomineralização de Molares e Incisivos (HMI). Paciente do sexo masculino, de 8 anos de idade, compareceu à clínica de Odontopediatria da Universidade Federal do Paraná com queixa de dor nos dentes 16, 36 e 46 - os quais apresentavam extensas cavitações atípicas com opacidades no esmalte adjacente. O enceramento diagnóstico dos dentes afetados foi realizado para a confecção das matrizes oclusais de silicone. Cimento ionômero de vidro de alta viscosidade encapsulado foi manipulado e inserido na matriz oclusal, a qual foi encaixada sobre os dentes, exercendo-se leve pressão digital. Após a presa do material os excessos foram removidos e a oclusão foi checada. Aplicou-se uma camada de resina fluída de cobertura e as restaurações foram finalizadas. Após seis meses, as restaurações realizadas para tratar as lesões severas de HMI mostraram-se eficazes, reduzindo a sensibilidade relatada pelo paciente, além de reestabelecerem a anatomia, função e estética dentária.

ABSTRACT Objective: To investigate whether children with premature birth (PB) and/or with low birth weight (LBW) have different tooth eruption patterns than those born at term or with normal weight. Material and Methods: Searches were performed in the PubMed, Cochrane Library, Sc1opus, Web of Science, LILACS, and BBO databases as well as the grey literature. Three independent reviewers were involved in study selection, data extraction, and bias assessment. The risk of bias was assessed using the Modified Newcastle-Ottawa Scale. Meta-analysis was conducted to compute the mean difference (MD) in mean chronological or adjusted age at the eruption of the first deciduous tooth between preterm children and those born at full term. The GRADE approach was used. Results: Among a total of 316 articles identified, 21 were eligible for inclusion and three were included in the meta-analysis. PB was associated with the delay in the first tooth deciduous eruption when chronological age was considered (MD: 1.36; 95%CI: 1.02–1.69) but not when considering adjusted age (MD: -0.30; 95%CI: -0.67–0.07). The evidence was graded as having very low quality. Conclusion: Based on a low certainty of evidence the PB is associated with the delayed eruption of the first deciduous tooth when considering chronological age but not when adjusted age is considered.

Abstract Objective: To evaluate the impact of daily toothbrushing frequency on parental reports of dental pain and discomfort in preschoolers. Material and Methods: An observational cross-sectional study was conducted involving 376 children between four and five years of age at public preschools in the city of Campo Magro, Brazil. Parents/guardians answered a socioeconomic questionnaire that contained a single question on the child's daily toothbrushing frequency and the Brazilian version of the Dental Discomfort Questionnaire (DDQ-B). Statistical analysis involved bivariate and multivariate Poisson regression analyses (α=0.05). Results: After the adjustments in the multivariate analysis, the prevalence of dental pain and discomfort was lower among children whose last visit to the dentist was for prevention (PR = 4.42; 95% CI: 1.75– 11.14; p=0.002) and those with a higher daily toothbrushing frequency (PR = 2.13; 95% CI: 1.12–4.05; p=0.021). Conclusion: A lower toothbrushing frequency is associated with parental reports of dental pain and discomfort in preschoolers. Educational and preventive measures that stimulate an increase in daily toothbrushing frequency can contribute to a better oral health status in preschoolers, consequently, less prevalence of dental pain and discomfort.

RESUMO Objetivo: O objetivo foi avaliar a validade e a reprodutibilidade do Sistema Internacional de Detecção e Avaliação de Cárie (ICDAS) na detecção de cárie oclusal entre estudantes de pós-graduação após o treinamento usando o programa de e-learning. Métodos: Foi selecionada uma amostra de 42 dentes decíduos com diferentes faixas de cárie oclusal. Todos os dentes foram montados em um suporte de cera e foram tiradas fotografias padronizadas (EOS Rebel XTI, Canon, NY, EUA) das superfícies oclusais. Um pesquisador experiente selecionou aleatoriamente um local específico na superfície oclusal de cada dente para ser examinado posteriormente. Quinze estudantes de pós-graduação sem experiência anterior com o ICDAS concluíram o programa de e-learning em português. Após o treinamento, o exame visual das superfícies oclusais foi realizado duas vezes, independentemente, com intervalo de duas semanas. Após o exame visual, os dentes foram seccionados longitudinalmente a 1mm do local oclusal previamente selecionado. Os dentes foram fixados em um suporte de cera e fotografados. A análise histológica foi realizada a partir dessas fotografias por um pesquisador experiente para avaliar a profundidade da desmineralização. Resultados: Os valores interexaminadores do Coeficiente de Correlação Intraclasse (ICC) entre todos os participantes variaram de 0,54 a 0,96 e a reprodutibilidade intra-examinador do ICC dos examinadores variou de 0,61 a 0,85, mostrando reprodutibilidade boa a excelente. Para detecção de lesões de esmalte e dentina (D1), o ICDAS obteve sensibilidade 0,835 e especificidade 0,756. Para lesões de dentina (D3), o método revelou um aumento na sensibilidade, mas a especificidade foi semelhante ao D1. Conclusão: O programa de treinamento em e-learning do ICDAS foi eficiente no treinamento de detecção de lesões de cárie em estudantes de pós-graduação.

ABSTRACT Objective: The aim was evaluate the validity and reproducibility of the International Caries Detection and Assessment System (ICDAS) in detecting occlusal caries among graduate students after training using the e-learning program. Methods: A sample of forty-two primary teeth with different ranges of occlusal caries was selected. All teeth were mounted on a wax support and standardized photographs (EOS Rebel XTI, Canon, NY, USA) of the occlusal surfaces were taken. An experienced researcher randomly selected one specific site on the occlusal surface of each tooth to be examined later. Fifteen graduate students with no previous experience in the ICDAS scores completed the ICDAS e-learning program in Portuguese. After the training, visual examination of the occlusal surfaces was taken twice, independently, with a two-week interval. After visual examination, the teeth were longitudinally sectioned 1mm away from the previously selected occlusal site. The teeth were fixed on a wax support and photographed. Histological analysis was performed from these photographs by an experienced researcher to evaluate the depth of demineralization. Results: The Intraclass Correlation Coefficient (ICC) inter-examiner values among all participants varied from 0.54 to 0.96 and intra-examiner ICC reproducibility of the examiners ranges from 0.61 to 0.85, showing good to excellent reproducibility. For detection of enamel and dentine lesions (D1), ICDAS obtained sensitivity 0.835 and specificity 0.756. For dentine lesions (D3), the method revealed an increase in sensitivity but specificity was similar to D1. Conclusion: ICDAS e-learning training program was efficient for the training of caries lesions detection among graduate students.

Abstract Objective: To analyze if the oral health conditions in children and adolescents are associated with hemophilia (PROSPERO-42020168192). Material and Methods: The search strategy was performed in PubMed, Scopus, Lilacs/BBO, Web of Science, Cochrane, and Grey literature databases. Two independent researchers assessed the risk of bias in these studies by the Newcastle-Ottawa Scale. For the meta-analysis, the clinical conditions data were extracted as numerical variables according to their indexes, such as dental caries experience (dmft/DMFT), gingival condition (Modified Gingival Index - IGM), and oral hygiene (Plaque Index - PI). The quality of the evidence of the meta-analysis was evaluated by the GRADE tool (GRADEproGDT). Results: From a total of 431 studies, 27 were included, and 10 were included in the meta-analysis. The studies presented a moderate risk of bias, ranging from 2 to 7 points. The dental caries experience in primary (-0.62; CI95%: -1.68–0.43) and permanent dentitions (-0.05; CI95%: -0.69–0.59), gingival condition (-0.12; CI95%: -0.27–0.03), and oral hygiene (0.36; CI95%: -0.06–0.77) did not differ between the groups. Conclusion: Based on studies with very weak evidence, there were no differences in the oral health conditions of children and adolescents with and without hemophilia.

Abstract Objective: To assess the knowledge of Brazilian dentists and final-year dental undergraduates concerning COVID-19. Material and Methods: We conducted a self-administered online questionnaire about the symptoms, incubation period, and transmission routes of COVID-19. In total, there were three questions addressing these topics and 15 correct answers, so each participant could score from 0 to 15 points. Besides that, data such as sex, age, education level, years of work experience and place of work were collected. All data were submitted to statistical analysis with a 5% significance level. Results: 476 participants were recruited. Regarding the respondents' perception of the most common symptoms of COVID-19, 99.4% responded fever, 95.2% cough, and 99.2% dyspnea. About the incubation period, 56.3% answered from 1 to 14 days. About the transmission routes, 98.3% recognized transmission through droplets, 80.3% through direct contact with infected persons, and 70.4% through indirect routes. The median knowledge score was 10 (4 – 14). Regarding the socio-demographic variables, participants aged 30 years or more had a higher score than those aged up to 29 years old (p=0.004). For education level, specialist dentists presented a higher score than undergraduates (p=0.006), general dentists (p=0.048) and Ph.D. (p=0.016). Participants with 15 years or more of work experience had a higher score than undergraduates (p=0.003). Concerning the workplace, participants working in the public sector had a higher score than those working in the private sector or universities (p=0.015). Conclusion: Participants recognized the main symptoms, incubation period, and transmission routes of the COVID-19 virus; however, the knowledge level of specialist dentists, older dentists, more experienced dentists, and dentists working in the public sector was higher than the other participants.

Abstract: The aim of this study was to evaluate patient perception of surgical discomfort in third molar surgery and the association with clinical variables and polymorphisms associated with the FKBP5, SLC6A4, and COMT genes. This cross-sectional observational study was carried out on 196 participants aged between 18 and 64 years at the Federal University of Paraná in 11 months. The intensity of surgical discomfort was assessed using the QCirDental questionnaire. Data on surgical and individual procedures were also cataloged. The oral health related quality of life was assessed by the Oral Health Impact Profile questionnaire (OHIP-14). The DNA sample was obtained from cells of the oral mucosa. Five markers of the FKBP5, SLC6A4, and COMT genes were genotyped. The data were submitted to statistical analysis with a significance level of 5%. Women reported greater intensity of discomfort associated with third molar surgery compared to men (p = 0.001). In the recessive model, the AA genotype of the rs3800373 marker was associated with greater surgical discomfort (p = 0.026). Therefore, women and individuals of the AA genotype for the rs3800373 marker in the FKBP5 gene reported greater surgical discomfort associated with third molar surgery.

Abstract The aim of this study was to investigate the segregation patterns of molar incisor hypomineralization (MIH) in families, given the evidence that its etiology is influenced by genetics. Clinically, MIH may be detected in parents and/or siblings of MIH-affected children. Our study included children with at least one first permanent molar affected by MIH (proband) and their first-degree relatives (parents and siblings). The participants were examined clinically to detect MIH, according to the European Academy of Paediatric Dentistry criteria (2003). A total of 101 nuclear families (391 individuals) were studied. Proband diagnosis was followed by MIH classification of the subject, his parents and siblings, as affected, unaffected, or unknown. Segregation analysis was performed using the multivariate logistic regression model of the Statistical Analysis for Genetic Epidemiology package, and segregation models (general transmission, environmental, major gene, dominant, codominant and recessive models). The Akaike information criterion (AIC) was used to evaluate the most parsimonious model. In all, 130 affected individuals, 165 unaffected individuals, and 96 unknown individuals were studied. Severe MIH was found in 50.7% of the cases. A segregation analysis performed for MIH revealed the following different models: environmental and dominance (p = 0.05), major gene (p = 0.04), codominant (p = 0.15) and recessive models (p = 0.03). According to the AIC values, the codominant model was the most parsimonious (AIC = 308.36). Our results suggest that the codominant model could be the most likely for inheriting MIH. This result strengthens the evidence that genetic factors, such as multifactorial complex defect, influence MIH.

Abstract Objective: To identify the clinical and radiographic conditions associated with failure of pulp therapy in primary teeth through a survival analysis. Material and Methods: A total of 1000 records of children assisted at the pediatric dentistry clinic of the Federal University of Parana, Brazil, from the years 2000 to 2010, were analyzed. The mean evaluation time was 10.61 months (minimum/maximum: 1/28) from the report of pulp therapy. The different types of treatments analyzed included indirect pulp treatment (IPT), direct pulp treatment (DPT), pulpotomy and pulpectomy. The Kaplan-Meyer method and log-rank test were used for the survival analysis. Exodontia was considered as the outcome variable and censors included: traumatic tooth loss, presence of the tooth in the oral cavity and physiologic tooth exfoliation. Results: A total of 122 records reporting pulp therapy in the primary teeth were selected. From this, 16 teeth (13.12%) were extracted. Survival analysis showed that pulpectomy presented lower survival rates when compared to conservative therapies (p=0.0297). Teeth with furcal lesions and pathological root resorption before pulp therapy had lower survival rates when compared to those that did not present these conditions (P=0.006). Presence of fistula and abscess after pulp therapy were also associated with lower survival rates (P=0.0062 and 0.0143, respectively). Conclusion: Signals of pulp necrosis were associated to lower survival rates in primary teeth submitted to pulp therapy.

Abstract This cross-sectional study aimed to assess the prevalence of molar incisor hypomineralization (MIH) and its relationship with the number of primary teeth with developmental defects of enamel (DDE). A representative population-based sample of 731 schoolchildren was randomly selected from the public school system in Curitiba, Brazil. Schoolchildren aged 8 years with fully erupted permanent first molars and incisors were eligible for the study. MIH and DDE were classified by four calibrated examiners (kappa > 0.75) according to EAPD criteria and to the FDI-modified DDE index. Clinical data were collected in a school environment. Socioeconomic information was collected through a self-administered semistructured questionnaire applied to the children’s caregivers. Statistical analyses were carried out using Poisson multiple regression with robust variance (α = 0.05). MIH prevalence was 12.1% (95%CI: 10–15), and opacities were the most prevalent defect. Socioeconomic factors were not associated with MIH. Children with demarcated opacity in primary teeth presented a higher prevalence of MIH than those without DDE in primary teeth. In the multiple analysis, the increase of one primary tooth affected by demarcated opacity increased the prevalence of MIH by 33% (PR = 1.33, 95%CI: 1.15–1.53, p < 0.001). Asian children had a higher prevalence of MIH (PR = 2.91, 95%CI: 1.08–8.09 p = 0.035) than did Caucasian children.Conclusion: Based on these findings, the prevalence of MIH in Curitiba was 12.1%. Demarcated opacity in primary teeth could be considered a predictor of MIH.

Abstract The objective of this study was to evaluate the clinical survival of sealants applied in first permanent molars (FPMs) affected by molar-incisor hypomineralization (MIH), at 18 months of follow-up. Forty-one first permanent molars were selected from 21 children, 6–8 years of age. MIH was classified by one calibrated examiner (kappa = 0.80) according to EAPD criteria. The inclusion criteria were fully erupted FPMs with MIH or sound FPMs (without MIH) for which sealant treatment was indicated. The FPMs were assigned to two groups: CG (control group) and HG (MIH group). Both groups were treated with sealant (FluroShield). Clinical follow-up was performed from baseline to 18 months to assess anatomical form, marginal adaptation, retention and presence of caries, according to criteria set by the United States Public Health Service-Modified, and was conducted by a blinded examiner (kappa = 0.80). The actuarial method was used to evaluate the survival of the sealants. The survival rates for the groups were compared using Fisher’s exact test (α = 5%). The cumulative survival rates were 81% at 1 month, 68.8% at 6 months, 68.8% at 12 months, and 62.6% at 18 months for CG, and 88% at 1 month, 84% at 6 months, 76% at 12 months, and 72% at 18 months for HG. No significant difference was found between the groups. The sealants in molars affected by MIH presented a survival rate similar to the sealants in the control, suggesting that sealants may be an adequate approach for preventing carious lesions in MIH-affected molars.

RESUMO Objetivo: Avaliar o desempenho in vitro de radiografia digital e de dois localizadores apicais eletrônicos, Propex II e Root ZX na determinação do comprimento de canal em molares decíduos. Métodos: Foram selecionados 25 molares decíduos divididos em dois grupos, G1, sem reabsorção radicular e G2 com reabsorção radicular. Os exames foram realizados utilizando todos os métodos por dois examinadores experientes, com intervalo de 1 semana. O padrão ouro foi determinada por exame visual. Os métodos foram analisados estatisticamente em relação aos valores de reprodutibilidade e correlacionada com o padrão ouro pelo coeficiente de correlação de Pearson. Resultados: A determinação de comprimento de canal coincidiu com padrão-ouro em 22,7% para o Root ZX, 17,5% para Propex II e 12,5% para a radiografia digital. valores de correlação foram maiores no G1, o Root ZX apresentou os maiores valores. Em G2 da radiografia digital apresentou a menor correlação. No G1, os valores de reprodutibilidade intra-examinador variou 0,925-0,523 e interexaminadores 0,863-0,670. No G2, os valores da reprodutibilidade intra-examinador varia 0,864-0,097, e inter era 0,774-0,379. Conclusão: Concluiu-se que o desempenho dos métodos varia de acordo com a experiência do examinador. O Root ZX apresentou maior reprodutibilidade e precisão.

ABSTRACT Objective: The aim of the study was to evaluate performance of digital radiographic and two electronic apex locators, Propex II and Root ZX in root canal length determination in primary molars. Methods: 25 primary molars were divided into two groups, G1 without root resorption and G2 with root resorption. The exams were performed using all methods by two experienced examiners, with 1-week interval. The gold standard was determined by visual examination. The methods were statistically analyzed regarding the values of reproducibility and correlated with the gold standard by Pearson´s correlation coefficient. Results: The root canal length determination coincided with gold standard in 22.7% for Root ZX, 17.5% for Propex II and 12.5% for digital radiography. Correlation values were higher in G1, the Root ZX presented the highest values. In G2 the digital radiography showed the lowest correlation. In G1, the intra-examiner reproducibility values ranged from 0.925 to 0.523, and interexaminer 0.863 to 0.670. In G2, the values of intra-examiner reproducibility ranges from 0.864 to 0.097, and inter was 0.774 to 0.379. Conclusion: It was concluded that the methods performance varying according to examiner's experience. The Root ZX presented the highest reproducibility and accuracy.

Abstract Aim: To evaluate the experience, knowledge and attitudes of dentists and oral health technicians (OHTs) who work in Basic Health Units in the city of Curitiba, PR, Brazil, regarding cases of abuse against children and adolescents. Methods: In this observational study, three hundred eighty-three questionnaires (validated for Brazilian Portuguese) were sent to dentists and OHTs who work in public health units. The response rate was 38.12% (n = 146) for dentists and 40% (n = 77) for OHTs. Results: The mean age of the dentists was 40±8.29 years, and 53.43% treated more than 10 children per week. The OHTs' mean age was 45.39±9.71 years, and 62.35% attended to more than 10 children per week. Although the dentists perceived 185 suspected cases of maltreatment, only 35.67% were reported to authorities. In the OHT group, 22.08% were reported to authorities. Sixty-eight dentists (47%) and 11 OHTs (14.28%) reported having treated at least one case of orofacial trauma in the previous 6 months, totalizing 166 orofacial traumas. About the mechanism for reporting suspected cases, 83% of the respondents knew how to report. Over 50% of the responses concerning why the professionals did not report cases of physical violence against children included fear of retaliation and difficulties in diagnosis. Conclusions: Suspected cases of maltreatment against children and adolescents are underreported. More information is required to recognize suspected maltreatment cases and notify authorities.

A violência contra crianças e adolescentes é um grave problema mundial e de saúde pública, que ameaça o bem estar físico e mental, deixando sequelas irreparáveis. A notificação desta violência permite sua prevenção e proteção das crianças e adolescentes. Assim, o objetivo desse estudo foi avaliar a prevalência de lesões na região de cabeça e pescoço contra crianças e adolescentes, bem como caracterizar o tipo das lesões, o agressor e unidades notificadoras. Essa pesquisa retrospectiva foi realizada no Centro de Epidemiologia da Prefeitura Municipal de Curitiba. Um total de 10.483 notificações dos anos de 2010 (5.112) e 2011 (5.371) foi analisado, para compor a amostra das lesões físicas ocorridas no ambiente intrafamiliar, na faixa etária de 0 a 17 anos de idade. Em 2010, a frequência de abuso físico intrafamiliar foi de 322 casos. Destas, 57,1% eram do sexo masculino e 42,9% do sexo feminino, e 58% (187) delas tiveram lesões em cabeça e pescoço. No ano de 2011 foram 342 notificações, sendo que 49% eram do sexo masculino e 51% do sexo feminino e as lesões em cabeça e pescoço corresponderam a 65% (222) dos casos notificados. Houve aumento na prevalência de 6% das lesões físicas e 19% das lesões na região de cabeça e pescoço, do ano de 2010 para 2011. Conclui-se que é alta a prevalência de lesões na região de cabeça e pescoço, áreas facilmente observadas pelo profissional de saúde e da educação. A criação de órgãos notificadores em hospitais e unidades de saúde é fundamental para a vigilância epidemiológica e para definição de políticas adequadas.

Violence against children and adolescents is a public health issue worldwide that threatens physical and mental wellbeing and causes irreparable harm. Reports on this violence are an essential way to prevent it and to protect the children and adolescents. Thus, the objective of the present study was to evaluate the prevalence of physical injuries that occur in domestic environments and reported to the Child and Adolescent Protection Network. This retrospective study was conducted at the Epidemiology Center of the Municipality of Curitiba. A total of 10,483 reports for the years 2010 (5,112) and 2011 (5,371) were analyzed and from them were selected reports of physical injuries that occurred in the family environment. The children and adolescents were 0-17 years old, comprising 322 cases of physical abuse within the family in 2010. Out of these, 57.1% were male and 42.9% were female, and 58% (187) presented head and neck injuries. There were 342 reports in 2011, 49% were male and 51% were female; head and neck injuries corresponded to 65% (222) of the reported cases. The prevalence of injuries increased by 6% and head and neck injury increased by 19% between 2010 and 2011. It may be concluded that physical abuse is associated with a high prevalence of head and neck injury, which is easily observed by the health and education professionals. Notification organs should be created in Brazilian hospitals and health centers, which is essential to conduct epidemiological surveillance and appropriate policies.

The purpose of this study was to evaluate the 12-month clinical performance of glass ionomer restorations in teeth with MIH. First permanent molars affected by MIH (48) were restored with glass ionomer cement (GIC) and evaluated at baseline, at 6 and at 12 months, by assessing tooth enamel breakdown, GIC breakdown and caries lesion associations. The data were analyzed using the chi-square test and actuarial survival analysis. The likelihood of a restored tooth remaining unchanged at the end of 12 months was 78%. No statistically significant difference was observed in the association between increased MIH severity and caries at baseline (p > 0.05) for a 6-month period, or between increased MIH severity and previous unsatisfactory treatment at baseline (p > 0.05) for both a 6- and 12-month period. A statistically significant difference was observed in the association between increased MIH severity and extension of the restoration, involving 2 or more surfaces (p < 0.05) at both periods, and between increased MIH severity and caries at baseline (p < 0.05) at a 12-month period. Because the likelihood of maintaining the tooth structures with GIC restorations is high, invasive treatment should be postponed until the child is sufficiently mature to cooperate with the treatment, mainly of teeth affected on just one face.