Luciana Butini Oliveira

Objectives: The association between tooth wear (TW) and dentin hypersensitivity (DH) is not well understood. This systematic review investigated the role of TW (and etiological factors) as an associated factor for DH. Materials and Methods: Literature search was conducted in five databases with terms related to DH and TW, until April 2025. Three pairs of independent reviewers selected clinical studies reporting on DH and TW (and related etiology) in dentate adults, and performed data extraction. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. A structured narrative synthesis was performed. Results: Twenty‐one studies were included, with DH prevalence varying from 8.6% to 84.7%. Many indices were used for TW, the most common being BEWE ( n = 8); and for DH, the most common being Schiff ( n = 7). DH prevalence was higher in patients with (mean: 42.1%) versus without (18.7%) TW. Similar trends were observed when analyzing teeth with (34.6%) versus without (12.4%) TW. DH was associated with specific acidic diets, parafunctional behaviors, and health and lifestyle factors. There was conflicting evidence associating toothbrushing frequency and technique to DH. Conclusions: This review provides evidence for a consistent association between DH and TW and some etiological factors, observed across patient‐ and tooth‐level analyses. Clinical Relevance: Patients with TW and/or etiological factors—including dietary habits, oral hygiene practices, and parafunctional behaviors—should prompt a thorough evaluation for underlying DH, and vice‐versa. Identifying and addressing these factors will help explain the occurrence of DH and guide effective prevention strategies.

Background: Effective pain management is essential to high-quality dental care, and its inclusion in dental curricula is vital to ensure future professionals are adequately trained. In Brazil, however, little is known about how pain-related content is integrated into undergraduate dental education. This study aimed to¹ identify whether pain curricula are present in Brazilian undergraduate dentistry programs and² analyze the content covered in these curricula, using international recommendations as a benchmark. Methods: We examined all accredited dental education programs (DEPs) in Brazil and analyzed their curricular content based on guidelines from the International Association for the Study of Pain (IASP) and the American Dental Association (ADA). Results: Among 274 DEPs analyzed, only 50 (18.2%) included a dedicated pain curriculum. Regional distribution varied, with 91 programs (25.1%) in the Northeast, 141 (38.8%) in the Southeast, 43 (11.8%) in the Midwest, 26 (7.2%) in the North, and 62 (17.1%) in the South. Among the 17 programs with curricula fully available, the most frequently covered topics were related to pharmacological management, such as local anesthetics (70.6%), airway anatomy and physiology (64.7%), and drug administration routes, analgesics, and antagonists (52.9%). In contrast, topics such as pain definitions and orofacial pain conditions (23.5%), orofacial malignancies (41.2%), and pain and anxiety control (11.8%) were less frequent. Notably, non-pharmacological approaches and drug abuse prevention were almost entirely absent. Conclusion: Brazilian dental education programs fall short of meeting the IASP and ADA recommendations for pain education, particularly regarding non-pharmacological content and substance misuse. These findings highlight significant curricular gaps that may affect dental students' training and preparedness. Our results can support curriculum planners and academic leaders in identifying regional disparities and thematic omissions, ultimately guiding improvements in pain education within undergraduate dental programs.

Background: Clinical diagnosis of ankyloglossia and its therapeutic management through lingual frenotomy (LF) have increased in several countries. However, systematic reviews (SRs) and experts opinions show conflicting results on this topic. Aim: To synthesize the available knowledge with a critical evaluation of SRs on LF in infants up to 1 year of age on breastfeeding‐related outcomes. Design: An umbrella review was carried out. Searches were conducted (seven electronic databases, gray literature). SRs of clinical trials involving infants up to 1 year of age undergoing LF to treat maternal self‐efficacy related to breastfeeding, nipple pain, and/or weight gain were included. The articles were critically analyzed (AMSTAR 2). Results: We identified 272 studies; 15 SRs were included. Confidence was classified as critically low ( n = 14; 93.3%) and moderate ( n = 1; 6.7%). Fourteen SRs had more than two critical aspects, indicating that the studies were not conducted properly. Conclusion: The evidence on the efficacy of LF in infants remains inconclusive in relation to breastfeeding outcomes, especially maternal self‐efficacy related to breastfeeding and weight gain. Evidence of benefit for the treatment of breast pain is weak. Overdiagnosis of ankyloglossia may lead to overtreatment of the condition, without high‐quality evidence to support the benefits of this procedure.

The prevalence of early childhood caries (ECC) tends to increase in the first 5 years of life as children grow, and those affected by ECC are likely to experience caries throughout their lives. ECC negatively impacts the oral health-related quality of life of both children and their families. Although controlling sugar intake and the use of fluoride are well-known methods for managing dental caries, preventive and therapeutic interventions alone have not been sufficient to prevent the development of new caries lesions. This review aims to explore why ECC continues to occur despite the oral health team having the necessary knowledge to prevent it. Based on current scientific evidence, this article highlights the need for the oral health team to consider additional factors, such as implementing oral health prevention programs in the first 450 days of life, enhancing caregivers' oral health literacy, creating a supportive environment, and engaging in upstream actions (teledentistry, implementation science, health policies development etc.) to effectively manage and prevent dental caries. Otherwise we would be educating and treating children and sending them back to the conditions that made them sick. By addressing these factors, it might be possible to improve long-term oral health outcomes for children and reduce the burden of ECC on children and their families.

Objectives The aim of this study was to review the most effective topical anesthetic methods for reducing pain/discomfort prior to dental local anesthetic needle puncture for dental procedures in children and adolescents. Methods A scoping review was conducted. Individual search strategies were developed for each of the bibliographic databases (Cochrane, Embase, LILACS, LIVIVO, Pubmed, Scopus, PsyINFO, Web of Science), and in the gray literature (Google Scholar, Open Gray), comprehensively, without restrictions on language, publication data, or level of socioeconomic development of the country in which the study was conducted. The search was conducted on April 21, 2021 and the updates on May 24, 2024. Randomized controlled studies conducted in patients up to 18 years of age were included. Variables collected: characteristics of the included studies, topical anesthetics evaluated, time and the mode of application. Results Initially, 8579 studies were retrieved. Then 3127 were identified as eligible, of which (n = 3127), 52 studies were included in the narrative synthesis. The most commonly observed anesthetic methods with the most favorable outcomes were lidocaine, benzocaine, ice cooling, and EMLA. Spray, gel or patch were used, with application times ranging from 1 to 10 min. Mucosal cooling an ice stick was analyzed by eight studies. Only one showed a smaller reduction in pain perception scores than others. Conclusions Cooling is a technique with numerous clinical advantages from the clinical point of view, for reduction of pain/discomfort prior to needle puncture of dental local anesthesia in children and adolescents. It is an accessible, inexpensive and pleasant method that does not resemble needles or unpleasant tastes, nor involves systemic toxicity and complications that may be associated with others anesthetics agents. Future randomized controlled studies in accordance with the Consort Statement are needed to further investigate the topic.

Background: Parents believe that teething is associated with signs and symptoms, which may induce them to give medications that could harm their children. Some children may require alleviation of symptoms and overall attention.Aim: To assess parents' beliefs in and attitudes toward teething.Design: Through electronic databases and gray literature, this systematic review identified cross‐sectional studies reporting parents' beliefs in, knowledge about, and attitudes toward the signs and symptoms of primary tooth eruption in children aged between 0 and 36 months. Three reviewers independently selected the studies, collected the information, assessed methodological quality, and checked for accuracy with disagreements solved by a fourth reviewer. The Agency of Research and Quality in Health questionnaire for cross‐sectional studies was used for quality assessment. Descriptive analysis with median and interquartile ranges was adopted.Results: Twenty‐nine studies comprising 10 524 participants from all geographic regions were included. The methodological quality of the studies was moderate. Most parents have beliefs in signs and symptoms during dentition, the most reported symptom being the desire to bite. Oral rehydration was the most exposed attitude in the studies included. Only a small proportion of parents reported no attitude.Conclusions: The majority of parents believed in at least one sign or symptom associated with teething, and only few of them would do nothing or just wait for the signs or symptoms to pass, with no difference among countries (Protocol doi: 10.17605/OSF.IO/S2KZ3).

Purpose To evaluate the CBCT referrals in paediatric patients over a 24-month period. Methods A retrospective study was conducted in two radiological centers in Campinas, Brazil. Patients were divided into three age groups: G1: age under 10 years, G2: age between 10 and 12 years, and G3: age over 12 years. The following data were collected: patients’ age and sex, localisation, reasons for referral and dental specialty responsible for the request of CBCT exams. Results Data from 367 patients were assessed. CBCT was used more frequently in the Group 3 (58.9%). There was significant association between the region of the exam and age group (P < 0.05), with a higher percentage of exams in the maxilla for the age over 12 years (35.6%) than that of up to 10 years (50.9%) and between 10 and 12 years (51.1%). Alterations were observed in 79.3% of the exams and 47.4% showed impacted teeth with significant association with the increase in age group (P < 0.05). Of the total number of exams, (55.3%) were requested in Orthodontics followed by Oral Surgery (30.0%) and Paediatric Dentistry (9.5%). Conclusions It can be concluded that CBCT exams were indicated frequently for the age over 12 years. The presence of impacted teeth represented the main reason for referrals and Orthodontics was the dental specialty that indicated CBCT with higher frequency.

Background: Oral health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. However, scientific evidence about the oral health literacy of caregivers and the children’s oral health-related quality of life. The purpose of this study was to verify the relationship between the level of oral health literacy of caregivers and the children's oral health-related quality of life (OHRQOL).Methods: This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred thirty children were examined to assess the prevalence of dental caries (dmft index). Parents were interviewed to obtain sociodemographic status, oral conditions, and oral health literacy (OHL). The variable outcome was the children's OHRQOL as assessed by the Early Childhood Oral Health Impact Scale (ECOHIS). We fitted zero-inflated negative binomial regression (ZINB) models to evaluate associations between the study outcome and covariates in terms of PR (Prevalence Ratios), RR (Rate Ratios), and their respective Confidence Intervals (95% CI).Results: Children's OHRQOL was not associated with OHL. Dental caries had a negative impact on the children's quality of life (p < 0.05). A reduced impact on OHRQOL is also associated with having siblings (PR = 0.70, 95% CI 0.52–0.95). A higher age of the mother reduced OHRQOL impacts (PR = 0.72, 95% CI 0.52–0.98).Conclusions: The factors associated with children's OHRQOL were the number of siblings, the mothers' age, and dental caries. This study observed no association between parental OHL and children's OHRQOL.

OBJECTIVE: To compare the characteristics of systematic reviews of healthcare interventions that assessed or did not methodologic quality/risk-of-bias of included studies. Additionally, to analyze methodologic features of those assessing the methodologic quality/risk-of-bias. METHODS: PubMed database was searched. From 25,571 systematic reviews retrieved, a random sample of 1,025 was screened. Frequencies were used to describe outcomes. Unadjusted and adjusted logistic regressions were performed to test the associations with methodologic quality/risk-of-bias results assessment. In a second analysis, systematic reviews that assessed methodologic quality/risk of bias were dichotomized according to the design of included studies (randomized clinical trials-only versus non-randomized studies of intervention or a combination of both). RESULTS: 303 systematic reviews were fully analyzed. Methodologic quality/risk of bias was assessed by 278 (92%). Methodologic quality/risk-of-bias assessment was associated with a higher number of databases searched (>4, P= 0.008), the presence of meta-analysis (P= 0.005), and the design of included studies (randomized clinical trials-only, P= 0.042). The chance of using a suitable tool and a tool designed for risk-of-bias assessment rather than methodologic quality was higher for randomized clinical trials-only systematic reviews (P< 0.05). The most used tool was Cochrane’s RoB Tool without a clear studies’ overall risk classification system. CONCLUSION: methodologic quality/risk-of-bias assessment was associated with included studies’ design (randomized clinical trials-only), a meta-analysis of data, and the number of databases searched (>4). The most used tool was Cochrane’s RoB Tool, with no clearly defined rating system. Methodologic quality/risk-of-bias assessment methods description, results, and impacts on meta-analysis, the certainty of evidence, and systematic reviews’ results are still to be consistently addressed.

This review aimed to describe the importance of the first 1000 days of a child's life as a golden period for interventions and actions to prevent dental caries and other chronic non-communicable diseases (NCDs) throughout the life course and highlight that the first 450 days of life could be even more important for oral health. During the first 1000 days of life (pregnancy and first two years of life), health care providers can identify unhealthy lifestyles, behaviors, and their determinants. Bearing in mind contextual factors like socioeconomic conditions and cultural aspects, this is a unique period to work together with the family and identify opportunities for adopting healthy habits that might last throughout the life of the expected or newborn child. This is a "window of opportunity" for the prevention of chronic NCDs of both systemic and oral origin, such as overweight, obesity, diabetes, cardiovascular diseases, and dental caries. In fact, to effectively prevent dental caries, pregnancy and the first 6 months of a child's life (first 450 days) should be considered the critical period to work together with families to facilitate the adoption of healthy habits. Knowledge about the first thousand days of life is essential and represents a crucial period for the implementation of actions and interventions that will guarantee good oral and general health development that can persist throughout life.