Oral Health and Preventive Dentistry, 06/2018

Purpose: To determine the prevalence of oral-maxillofacial trauma among Brazilian victims of physical aggression and identify its associated factors from a medico-legal and forensic perspective. Materials and Methods: A cross-sectional study was carried out involving the analysis of complete medico-legal and social reports of 3668 victims of physical aggression treated at a centre of legal medicine and forensic dentistry over the course of four years. The dependent variable was the occurrence of oral-maxillofacial trauma. The independent variables were sociodemographic status and characteristics of physical aggression. Statistical analyses included the chi-squared test (p < 0.05) as well as univariate and multivariate logistic regression analyses. Results: Oral-maxillofacial trauma occurred in 1655 cases (45.1%). Individuals who lived in suburban areas (OR = 1.32; 95%CI = 1.11-1.58) and those who were victims of community violence (OR = 1.20; 95%CI = 1.03-1.40) perpetrated by someone known to them (OR = 1.24; 95%CI = 1.03-1.40) using physical force (OR = 2.31; 95%CI = 1.96-2.72) on weekends (OR = 1.19; 95%CI = 1.04-1.37) and during nighttime hours (OR = 1.23; 95%CI = 1.08-1.41) were more likely to exhibit oral-maxillofacial trauma. Conclusion: The prevalence of oral-maxillofacial trauma was high and the associated factors were area of residence, type of violence, type of offender, mechanism of violence, day, and period of occurrence. Keywords: forensic sciences, maxillofacial injuries, violence

Purpose: To evaluate the 6-and 12-month performance of microrepairs of marginal occlusal microdefects of resin composite restorations in a group of patients with high caries risk. Materials and Methods: Thirty-five patients with at least three resin composite restorations with marginal occlusal defects were randomly distributed into three treatment groups: (1) sealed with flowable resin composite; (2) sealed with resin-based sealant; or (3) control. Restorations in all groups were assessed using World Dental Federation (FDI) criteria at three time points: baseline, and at 6 and 12 months after sealing. Results: After 1 year, 32 patients were examined. Of all the repaired restorations, those of the flowable resin composite (RC) group maintained an FDI value of 1 for marginal occlusal adaptation for 81.3% of the restorations at 6 and 78.1% at 12 months. The resin-based sealant group kept a value of 1 for the same parameter on 65.6% of restorations at 6 and 50% at 12 months with a statistically significant difference (p= 0.024) between the two time periods. There was a statistically significant difference between the two groups at the 12-month comparison (p = 0.015). Conclusions: Occlusal RC restorations that were sealed using either a resin-based sealant or a nanofilled flowable RC benefited from improved clinical status after 12 months. Use of the latter presented the better clinical performance of the two by providing a higher rate of total retention of sealing materials. Keywords: flowable resin composite, nanofilled, repair, sealing, universal adhesives

Purpose: Dysgeusia is an unpleasant alteration in taste. It can affect the nutritional and psychological status and decrease the quality of life of patients. It may be caused by nerve injury, head and neck trauma or surgery, infections, radiotherapy and drugs, but certain aetiological factors have not yet been identified. Understanding dysgeusia as a drug side effect is important for practitioners. The aim of this systematic review was to provide detailed information about dysgeusia in patients receiving different common medications. Materials and Methods: An electronic search was conducted in MEDLINE, Google Scholar and Scopus databases, and studies were selected according to our inclusion criteria. We included studies on human subjects that reported dysgeusia as a drug side effect. Results: Thirty-four eligible studies were included in the systematic review. Thirty-five drugs were found in the literature to be correlated to dysgeusia. The most commonly reported offending drugs were from keratolytic agents, chemotherapeutic and cancer medication, antihistamine, antibiotics and angiotensin-converting enzyme inhibitors. Conclusion: The quality of evidence was low in most reviewed studies. More studies with standard methodology are needed in this field. However, physicians and dental practitioners must consider the probability of dysgeusia as an adverse side effect when prescribing certain medications. Keywords: drug side effects, dysgeusia, taste alteration

Purpose: To compare the oral health of patients with bipolar disorder (BD) with a control group of subjects. Materials and Methods: The study sample comprised 242 patients with BD and a mean age of 35.8 years. The control group comprised 187 subjects and a mean age of 37.3 years. Oral health was assessed through clinical examination by the Decayed, Missing, and Filled Teeth (DMFT) Index, the Community Periodontal Index (CPI), and the Simplified Oral Hygiene Index (OHI-S). Results: Patients with BD had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than control group subjects. The average DMFT index score was 10.0 (SD = 5.7) in the BD group and 8.1 (SD = 5.2) in the control group (p = 0.002). The mean value of decayed teeth in patients with BD (4.5) was significantly higher than that of the control group (2.3) (p < 0.001). Periodontal diseases were significantly more prevalent among patients with BD (p < 0.001), particularly regarding shallow and deep pockets (47.1% vs. 16.6%). Oral dryness (xerostomia) and severe tooth wear were also more prevalent among patients with BD (p < 0.001). Statistically significant risk factors for higher DMFT scores were: older age and having BD; CPI scores of 3 or 4; having BD, male gender, older age, and lower educational level. Conclusion: Poorer oral health among patients with BD is represented mostly as caries and advanced periodontal disease. The results of this study highlight the necessity to intensify preventive dentistry in this vulnerable population. Keywords: bipolar disorder, dental caries, periodontal disease, oral dryness, oral hygiene

Purpose: To investigate the practices, attitudes, and confidence of nurses in the performance of oral health checkups in order to develop an educational oral health checkup training programme for nurses. Materials and Methods: A cross-sectional questionnaire survey was distributed to nurses (n = 184) who worked in a hospital and an affiliated long-term care facility in Japan from September to October in 2016. The questionnaire survey investigated their practices, attitudes and confidence in the performance of oral health checkups for elderly patients who were in their care and the factors that were associated with the performance of oral health checkups. Results: A total of 143 (77.7%) nurses participated in this study. Almost half (51.7%) performed oral health checkups for elderly patients. More than 60% examined the lip, tongue and tongue coating, gingiva and oral mucosa, and oral cleanliness; however only 32.4% examined the present teeth and 8.1% examined the saliva. Approximately 90% of the nurses felt that all health professionals should perform oral health checkups for elderly patients who were in their care. Their confidence of the oral examination was statistically significantly associated with their performance of oral health checkups for elderly patients. Conclusions: This is the first survey to investigate the practices, attitudes, and confidence of nurses in the performance of oral health checkups. These findings will contribute to the development of a training programme for nurses who perform oral health checkups in elderly patients. Keywords: dental examination, nurse, oral assessment, oral health checkup

Purpose: To qualitatively and quantitatively compare the cytotoxic potentials of five different one-step self-etching adhesives: Prime&Bond One-Select (PB-OS), Optibond All-in-One (OB-AIO), G-Bond (GB), Clearfil Universal Bond (CUB), Single Bond Universal (SBU). Materials and Methods: During the first stage of the study, the cytotoxic activities of the test materials were evaluated qualitatively using the direct contact method. In this method, the test materials were placed directly into a monkey kidney epithelial cell culture medium. Reaction zones which occurred in the culture medium were evaluated, in addition to the density and changes in the morphology of the cells. During the second stage, the cytotoxic potential of four different dilutions (1%, 0.1%, 0.01%, 0.001%) of the test materials on L929 rat fibroblast cells was quantitatively evaluated at three different time periods (24 h, 48 h, 72 h) with the MTT tetrazolium-based assay. Results: In the first stage, a zone exceeding 1 cm was observed around or below SBU, CUB, GB and OB-AIO. In PB-OS, the zone borders were approximately 1 cm. In the second stage after the MTT assay, CUB was the most cytotoxic after 24 h, GB and SBU after 48 h, and OB-AIO after 72 h. Conclusion: All adhesives tested showed different degrees of cytotoxicity, which statistically significantly increased with dose. Changes were seen related to time. Keywords: cytotoxicity, direct contact method, MTT, one-step adhesives, self-etching

Purpose: Inadequate gingival thickness (GT) may lead to gingival recession. Thus, early identification of patients/teeth at risk would be advantageous. In adults, the probe's visibility through the marginal gingiva (reference test) has been considered a reliable criterion to describe a thin gingiva. This study aimed to evaluate in children two more convenient methods: the whitening of the attached gingiva with coronal labial traction (GW test) and the visibility of the gingival blood supply (BS test). Materials and Methods: In 69 children, the GT of primary and/or permanent central and lateral incisors, first primary molars and/or first premolars was assessed with the three tests. The sensitivity and specificity of the GW and BS tests and their odds ratio with probing were calculated. Results: According to probing, 39% of children in the studied population had thin gingiva. The GW and BS tests reported different percentages of GT compared to probing, except for primary teeth, maxillary permanent incisors and mandibular first premolars, where the GW test exhibited a comparable percentage. The sensitivity of GW and BS tests was 37% and 19%, respectively, when compared to probing, while the specificity was 84% and 96%, respectively. Conclusion: The GW and BS tests could be used for first-line diagnosis of thin gingiva; if the results are negative, probing should be implemented. Keywords: gingival biotype, gingival thickness, paediatric dentistry, prevention

Purpose: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with first onset or diagnosis in pregnancy. This study evaluated clinical and biochemical parameters in a possible association between GDM and gingival inflammation. Materials and Methods: A total of 87 pregnant women - 44 with GDM and 43 without (NGDM) - were included. Subgroups were created according to gingival inflammation. Plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded. Results: Age, anthropometric variables and baby weight (g) were all statistically significantly higher in the GDM group (p < 0.0001). Systolic and diastolic blood pressure (mmHg), saliva, serum leptin and adiponectin levels were similar in the GDM and NGDM groups (p = 0.605, p = 0.662, p = 0.737, and p = 0.596, respectively). Salivary adiponectin levels were statistically significantly higher in the two subgroups with gingivitis compared to those with clinically healthy periodontium (p < 0.01). Serum adiponectin levels were statistically significantly higher in the NGDM subgroup with gingivitis than the NGDM group with clinically healthy periodontium (p < 0.05). Statistically significant positive correlations were found between PD, PI, BOP and saliva adiponectin levels in the GDM group (p < 0.05). Positive correlations were also found between clinical periodontal parameters and saliva, serum levels of adiponectin in the control group without GDM (p < 0.05). Conclusion: The higher salivary adiponectin levels in the gingivitis groups suggest that gingival inflammation is more likely to influence local inflammatory parameters both in the presence and absence of GDM. Further larger-scale studies are required to better clarify the possible interactions between gingival inflammation and GDM. Keywords: adiponectin, gestational diabetes, gingivitis, MeSH, leptin, saliva

Purpose: This study evaluated the efficacy of four methods to prevent chemotherapy-induced oral mucositis (OM) in patients with solid tumors (ST). In addition, the behaviour of OM was investigated in these oncological patients. Materials and Methods: Forty-eight patients, aged 27-84, were randomly allocated to different groups from the first day of chemotherapy (CT), in the following sequence: group 1: intensive oral care programme (IOCP); group 2: 0.12% chlorhexidine mouthrinse; group 3: 0.03% triclosan mouthrinse; group 4: low-level laser therapy (LLLT). Oral mucositis was evaluated on the 7th and 14th days by means of the Oral Mucositis Assessment Scale (OMAS). Results: Thirty-one (64.5%) patients developed OM in the first cycle of CT and the pain was significantly associated with OM severity (p < 0.0001). The statistically significantly worst OMAS score was found for the lips and buccal mucosa (p < 0.0001). Despite a lack of statistical significance, IOCP and LLLT notably demonstrated potential effects to prevent OM in patients who presented with only oral erythema (75%) and lower peak of severity during the follow up, respectively. Conclusions: Improved oral care awareness is needed in patients undergoing 5'fluorouracil and doxorubicin, mainly to avoid pain caused by oral mucositis. Oral mucositis was more prevalent and aggressive in oral sites exposed to chronic trauma. The IOCP and LLLT approaches showed positive results to prevent oral mucositis and should be further investigated in similar and larger samples. Keywords: cancer chemotherapy agents, low-level laser therapy, oral hygiene, oral mucositis, preventive dentistry

Purpose: To investigate the possible interaction between fluoride treatment time and concentration on enamel caries lesion de-/remineralisation. Materials and Methods: The study design followed a three (fluoride concentration: 0, 275, 1250 ppm as sodium fluoride) x four (treatment time: 10, 30, 60, 120 s) factorial design. Caries lesions were created in bovine enamel and the extent of demineralisation determined using Vickers surface microhardness (VHN). Lesions were pH cycled (18 days) with the daily schedule consisting of two fluoride treatments, a 4-h demineralisation period and exposure to artificial saliva at all other times. VHN was determined again after pH cycling and changes to baseline values calculated (∆VHN). Enamel fluoride uptake (EFU) was determined using the microbiopsy technique. Data were analyzed using two-way ANOVA. Results: The concentration x treatment time interaction was significant for ∆VHN (p < 0.0001) and EFU (p = 0.0298). Dose-response relationships were observed for both variables for fluoride concentration and treatment time. ∆VHN: higher fluoride concentration compensated for shorter treatment time (e.g. ∆VHN [mean ± SD] = 85.5 ± 60.6 for 30 s with 1250 ppm fluoride vs ∆VHN = 84.3 ± 26.9 for 120s with 275 ppm fluoride). EFU data were similar but highlighted a greater ability to discern between fluoride concentrations (e.g. EFU = 4364 ± 1166 ppm vs 8538 ± 9531 ppm; above examples). Although ∆VHN and EFU correlated well (r = 0.723; p < 0.001), lesion demonstrated a greater ability to acquire fluoride than to remineralise. Conclusions: Behavioural aspects relating to caries can be studied in vitro, although model limitations must be considered. Adequate exposure times to cariostatic concentrations of fluoride are important in maximising caries prevention. Keywords: caries, enamel, fluoride, pH cycling, remineralisation

Purpose: To evaluate the relationship between decayed, missing and filled teeth (DMF index) and body mass index (BMI). Materials and Methods: This was a cross-sectional, population-based study developed in 2015 at a primary health care (PHC) unit in the city of Sao Paulo, Brazil. Participants completed a form including sociodemographic and socioeconomic characteristics, nutritional, general health and oral health data. An anthropometric oral assessment was performed, and the association of DMFT and its components with not-categorised and categorised BMI was tested through simple and multiple logistic analysis, trend test and Spearman correlation. Results: The sample consisted of 239 individuals aged 18 to 70 years. The prevalence of caries was 84.5%, the mean DMFT was 14.6 and the mean BMI was 27.46. There was positive association for DMFT with BMI and age, sex, formal education, hypertension, diabetes and use of dental floss. A positive association is also suggested between BMI and missing teeth. Conclusion: A correlation was observed between DMFT (missing teeth) and BMI. This can help to identify at-risk groups, plan progammes and treatment of overweight and obese individuals in primary health care. Keywords: body mass index, DMF index, obesity, oral health, overweight, primary health care