Dental procedures may cause stress and increase the salivary cortisol levels. It is important to known if apparently simple procedures such as professional dental prophylaxis at low speed (DP) are stressful for children with dental behaviour management problems (DBMP) to help with behaviour guidance strategies. This longitudinal study aimed to evaluate if DP changes a physiological marker of stress (salivary cortisol) in children with DBMP who were referred to dental treatment under sedation. One paediatric dentist carried out a DP with rubber cup and pumice followed by dental examination in 39 children aged 2–5 years, prior to the dental sedation appointment. Children’s saliva was collected at three different moments: upon waking (UW), on arrival at the dental office reception area (RA) and 25 min after the dental prophylaxis (DP). The saliva samples were analysed using an enzyme immunoassay kit. The Wilcoxon test was used in paired comparison (P < 0.05). Salivary cortisol levels decreased from UW (0.34; 0.15–0.54) to RA (0.14; 0.08–0.56) (P = 0.019) and increased from RA to DP (0.25; 0.06–1.48) (P = 0.008). Higher salivary cortisol levels were observed at DP when compared to RA in children who did not have previous dental treatment (P = 0.007), had toothache (P = 0.006), presented some protest behaviour during DP (P = 0.008), or needed protective stabilisation by parents for the dental examination (P = 0.005). Paediatric dentists should be aware that even simple procedures such as professional dental prophylaxis are related to stress in young children.

Uncooperative children may need to receive dental treatment under sedation, which is indicated when nonpharmacological behavior guidance is unsuccessful. There are randomized controlled trials (RCTs) comparing different sedative protocols for dental procedures; however, the evidence for superiority of one form over another is weak. The primary aim of this study is to investigate the efficacy of intranasally administered ketamine plus midazolam for the dental treatment of children. We have designed a three-armed, parallel RCT to assess intranasal sedation using ketamine/midazolam in terms of the following measures: efficacy, safety, and cost-effectiveness. Two- to 6-year-old healthy children, referred for dental treatment in a dental sedation center in Brazil due to uncooperative behavior and requiring restorative dental procedures, will be recruited. Each child will be randomly assigned to one of the three groups: A – Intranasal administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.2 mg/kg, maximum 5.0 mg); B – Oral administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.5 mg/kg, maximum 20 mg); and C – Oral administration of midazolam (1.0 mg/kg, maximum 20 mg). The primary outcome is the child’s behavior assessed through an observational scale using digital videos of the restorative dental treatment under sedation. The secondary outcomes are as follows: acceptance of sedative administration; memory of intraoperative events; the child’s stress; adverse events; the child’s pain during the procedure; the parent’s, dentists’, and child’s perceptions of sedation; and economic analysis. Measures will be taken at baseline and drug administration and during and after the dental procedure. The necessary sample size was estimated to be 84 children after a blinded interim analysis of the first 30 cases. This study will provide data that can substantially add to science and pediatric dentistry as it examines the effect of sedative regimes from different perspectives (outcomes). ClinicalTrials.gov, identifier: NCT02447289 . Registered on 11 May 2015, named “Midazolam and Ketamine Effect Administered Through the Nose for Sedation of Children for Dental Treatment (NASO).”

There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

The diagnosis of irreversible pulpitis (IP) depends on clinical data, especially the chief complaint of the patient, visual inspection, response to the application of stimuli, and radiographic examination. The characterization of nerve fibers (NF) in IP may contribute to better interpret painful symptoms, but has been barely explored. This study sought to characterize the density and integrity of NF in 16 samples of IP and in five healthy pulps (HP) using S-100 and PGP 9.5 markers. Immunohistochemistry was performed to determine the density/mm2 of S-100+ and PGP 9.5+ in NF. The amount of degenerated NF was obtained by subtracting the total NF density from the amount of intact NF. Associations between NF density and integrity and symptomatology were calculated. All samples were positive for S-100 and PGP 9.5. Compared to HP samples (38.20/mm2), IP samples had a lower density of intact NF (6.24/mm2). A significantly higher density of degenerated NF was found in IP samples with spontaneous pain (39.59/mm2) compared to those with provoked pain (23.96/mm2) (p = 0.02). No association was observed between intensity of the inflammatory infiltrate and NF density and integrity (p > 0.05). The findings of this study suggest that pulpitis may involve different stages of degeneration and may be more advanced in cases with spontaneous pain. The symptoms reported by affected individuals do not appear to depend on the intensity of the inflammatory infiltrate, but rather on the integrity of NF.

Devido a sua etiologia multifatorial, a doença cárie está associada a diversos fatores, incluindo comportamentais, ambientais e socioeconômicos, hábitos alimentares, história odontológica e médica pregressa familiar, experiência prévia de cárie, bem como a carência de serviços odontológicos. Diante do grande número de fatores existentes nos dias atuais que podem estar relacionados com o surgimento da lesão e instalação da doença cárie, torna-se necessário a investigação das evidências científicas mais recentes sobre este tema. Portanto, o objetivo desta scoping review foi evidenciar a literatura científica sobre os fatores de risco relacionados atualmente com o desenvolvimento da doença cárie. Foi realizada uma pesquisa bibliográfica em Março de 2021 utilizando os descritores “Dental Caries”; ”Dental Care for Children”; “Health Education, Dental” e “Epidemiology”, em bases de dados eletrônicas. Após a seleção dos artigos, os dados extraídos dos artigos selecionados foram incluídos em uma tabela padronizada, e as informações obtidas, sintetizadas em quadro para melhor interpretação dos resultados disponíveis. Apesar de existirem variados fatores predisponentes, a maioria indica que a situação socioeconômica, falta de acesso odontológico e hábitos alimentares são as condições mais predominantes ao surgimento da doença. Devido à diversidade dos artigos e conclusões encontradas, comparações são difíceis de serem bem definidas. Porém, é notório o surgimento de novos fatores de risco associados a cárie dentária, por ser uma doença complexa, de etiologia multifatorial. Apesar da variedade de fatores associados, conclui-se que os principais fatores predisponentes associados à cárie dentária são os sociodemográficos e comportamentais.

Congenital heart diseases consist of structural defects of the heart and represent serious malformations, which manifest in newborns, contributing significantly to perinatal mortality. The dental management of patients with this condition may require caution by professionals, owing to the possibility of bleeding and the risk of causing an infectious endocarditis due to the variety of microorganisms residing in the oral cavity. The present case report aimed to detail dental care under general anesthesia in a hospital for a child with congenital heart disease. Female patient, 4 years old, was diagnosed with atrial and interventricular communication and hemodynamic repercussion 21 days after birth. The patient received dental treatment according to the proposed plan, which included dental restorations, conservative pulp therapy and extraction of lower anterior teeth. Posteriorly, a removable partial prosthesis was made for the patient for the purpose of functional aesthetic rehabilitation. The use of general anesthesia may reduce the risk of infective endocarditis and allows the performance of several dental procedures with a single antibiotic prophylaxis, since the cardiac pediatric patient needs a correct planning of the procedures to be performed.