Journal articles on the topic 'Dental Health Service, New York. Dental public health Teeth Dentistry Public health'

ABSTRACT Introduction The dental care must be driven by preventive and curative measures that can contribute to the population's oral health promotion. Objective To evaluate the impact of the actions proposed by a comprehensive dental care protocol (CDCP) on the oral health condition of primary care users. Materials and methods The sample consisted of 32 volunteers, assisted throughout the six phases proposed by the CDCP: diagnosis of dental needs; resolution of urgencies; restorative interventions; application of promotional measures; evaluation of the achieved health level; and periodic controls. Data were collected through clinical exams, which measured the simplified oral hygiene index (OHI-S), gingival bleeding index (GBI) and the decayed, missing and filled teeth (DMFT) Index, before and after the CDCP was implemented. Statistical analysis consisted of the Wilcoxon test, at 5% significance level (α = 0.05). Results The OHI-S and GBI indices showed a significant reduction (p < 0.05) from the initial (1.4 ± 0.6 and 46.3 ± 19.9) to final condition (0.9 ± 0.3 and 21.5 ± 7.5). The decayed, missing and filled teeth and the missing teeth component were not significantly altered (p > 0.05), showing final values equal to 12.7 ± 9.6 and 5.6 ± 7.8, respectively. Decayed elements were fully converted into filled elements, and the final values of the decayed and filled elements were, respectively, 0.0 ± 0.0 and 7.3 ± 5.7 (p < 0.05). Conclusions The enactment of the CDCP had a beneficial effect on the oral health of the population assisted by the dental services offered in primary care and this protocol seems to fit the public dental service demands. Clinical significance The CDCP can be useful to public dental service planning since it showed an efficient clinical outcome to the patients. We consider that this protocol should be employed in primary care oral health services in order to achieve overall upgrade, access enlargement and public oral health promotion. How to cite this article Cavalcanti YW, de Fátima Dantas de Almeida L, de Souza Barbosa A, Padilha WWN. Planning Oral Health and Clinical Discharge in Primary Care: The Comprehensive Dental Care Protocol Outcome. J Contemp Dent Pract 2015;16(3):172-177.

This study validates a case-based survey method and analyzes the extent to which Danish dental professionals apply current concepts and strategies for occlusal caries management in children, adolescents, and young adults. A case-based, precoded questionnaire consisting of 10 clinical cases/patients with 26 teeth/occlusal surfaces was developed. The cases were set up in a PowerPoint presentation and color printed as a booklet illustrating patients with different patterns of caries activity, severity, and risk. A total of 69 dental professionals participated. Content and face validity of the survey method was established using a panel of experts. The panel also assessed the reliability of the method using a test-retest procedure (κ ≥ 0.80) and acting as benchmark. Measurements of agreement between dental professional and benchmark assessments showed substantial agreement for overall caries activity and risk assessment of patients and for clinical and radiographic severity of occlusal lesions (κ = 0.61-0.67). For assessment of caries lesion activity on occlusal surfaces, the agreement was moderate (κ = 0.50). Regarding treatment decisions, dental professionals showed substantial agreement when indicating restorative treatments (κ = 0.68). Multivariate logistic regression analysis showed a significant influence of various patient-, lesion-, and participant-related variables in the assessment of caries risk, caries activity and severity, and treatment decision. In conclusion, Danish dental professionals participating in the study apply reasonably well current concepts on overall caries activity and risk assessment, clinical and radiographic severity of occlusal lesions, and, to a certain extent, assessment of caries lesion activity on occlusal surfaces. Nonoperative treatment decisions had a high priority among Danish professionals.

The first few months of the coronavirus disease 2019 (COVID-19) pandemic challenged health care facilities worldwide in many ways. Inpatient and intensive care unit (ICU) beds were at a premium, and personnel shortages occurred during the initial peak of the pandemic. New York State was the hardest hit of all US states, with a high concentration of cases in New York City and, in particular, Bronx County. The governor of New York and leadership of hospitals in New York City called upon all available personnel to provide support and patient care during this health care crisis. This case study highlights the efforts of Jacobi Medical Center, located in the northeast Bronx, from March 1 through May 31, 2020, and its use of nontraditional health care personnel, including Department of Dentistry/OMFS (Oral and Maxillofacial Surgery) staff members, to provide a wide range of health care services. Dental staff members including ancillary personnel, residents, and attendings were redeployed and functioned throughout the facility. Dental anesthesiology residents provided medical services in support of their colleagues in a step-down COVID-19–dedicated ICU, providing intubation, ventilator management, and critical and palliative care. (Step-down units provide an intermediate level of care between ICUs and the general medical–surgical wards.) Clear communication of an acute need, a well-articulated mission, creative use of personnel, and dedicated staff members were evident during this challenging time. Although not routinely called upon to provide support in the medical and surgical inpatient areas, dental staff members may provide additional health care personnel during times of need.

The scope was to analyze the perceptions of dentistry students at the State University of Montes Claros, Brazil, regarding dentistry, the job market and the public healthcare system. For this, a triangulation method was employed, using a self-administered questionnaire and interviews. The quantitative data were submitted to univariate and multivariate analysis, using Poisson regression, where p<0.05. Content analysis was used for the qualitative data. The majority reported expecting to obtain work in the public healthcare system, stated that the dentistry course prepares students for this market as the curriculum integrates both teaching and service, reported being in favor of greater experience in the public healthcare system and said they would not take classes in Public Health if they were optional. Contact with the social context through teaching/service integration in the advanced semesters of the dentistry course appears to contribute to the development of new professional skills for working in the public sector. However, the students' perceptions revealed contradictions, considering the low value they attributed to the classes on Public Health and their perception of the public system as a residual job option.

Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. The elderly are at greater risk for oral disease, since gains in longevity result in more medically compromising conditions or systemic disease with oral manifestations. Also, as edentulism decreases and as more teeth are retained by the elderly, the pattern of oral diseases and the treatment of dental conditions will be altered. Barriers to self-care and professional care must be removed, and prevention and early intervention strategies must be formulated to reduce the risk of oral diseases. Risk factors for oral diseases in the elderly can be reduced by personal home-care regimens, professionally provided preventive, diagnostic, and therapeutic care, changes in high-risk behavior, and a supportive environment. Generating new information about the prevention of oral diseases and conditions that have an impact on the elderly requires a substantial research effort. A research agenda for the elderly should include: epidemiologic studies of relevant oral diseases and related risk factors; investigations of patient and provider attitudes and behavior related to oral health; studies of the relationship between general health and oral health; development and testing of preventive and treatment strategies for conditions such as xerostomia, root caries, secondary caries, and gingival recession; and studies for the evaluation of the impact of the aging population on the dental delivery system. Public policy options to support geriatric oral health care and research are limited by the Government's pre-occupation with cost containment and the lack of visibility for dental programs. Many of the national health proposals for universal coverage and for elimination of financial barriers to health care do not include disease prevention or health promotion programs; dentistry is not mentioned even in those proposals that do include prevention. NIDR is gathering support for geriatric oral health research with its new initiative, entitled the "Research and Action Program to Improve the Oral Health of Older Americans and Other Adults at High Risk". Funding for this program may depend in part on changing national priorities and the dental profession's ability to become more intimately involved in the public debate regarding the future of the nation's health care system.

ABSTRACT Introduction: Although there has been an improvement in the oral health status of the population, tooth loss still aggravates the oral health of adults and is a matter of great relevance to dentistry. Aim: To determine the spatial distribution of tooth loss in adults and correlate this with the Social Exclusion Index and proximity to public dental services. Material and Method: This ecological study was based on epidemiological data of adults from Piracicaba municipality and from the Piracicaba Research and Planning Institute (IPPLAP). Data on dental evaluations were extracted from the Piracicaba epidemiological survey, which was a cross-sectional study with probabilistic sampling of 248 adults aged 20-64 years, representative of adults living in Piracicaba, Brazil. Oral examinations of the DMFT index were in accordance with the World Health Organization codes and criteria and were performed by a single examiner calibrated for this purpose. Data on social exclusion and the municipal health units that have dental services were extracted from IPPLAP. Georeferencing was performed of census tracts selected by draw, and the city health facilities that have dental services. For Spearman correlation analysis (p <0.05), we used the mean value of teeth lost per district, the Social Exclusion Index (IEX), and proximity to public dental service categorized according to radius: <500m, between 500-1000m, and >1000m the census tract. Result: There was a correlation between tooth loss and higher IEX, and r=−0.51 (p=0.01), but no correlation with proximity to public dental services (p=0.42). Conclusion: Tooth loss in adults was distributed according to social exclusion, however, it was unrelated to proximity to the public dental services.

This study aims to provide a comparative analysis of the Chronic Dental Disease Scheme (CDSS) and the Allied Health Profession (AHP) program as they related to the greater Enhanced Primary Care Scheme introduced by the Australian Government to manage patients with chronic and complex diseases. A retrospective analysis of data pertaining to Medicare items related to dentistry and the allied health professions were extracted from the Medicare Benefits Schedule database online, and formed the basis of this study. The highest proportion of services was provided in the state of New South Wales. There appears to be synergy in the utilisation of services with jurisdictions either overutilising or underutilising services. Costs to the Enhanced Primary Care Scheme under the CDSS model (fee for service) were up to 40 times more expensive compared with the AHP model (fee per visit). Costs and treatment associated with the CDSS experienced an increase of 13350% during the period 2007–08, coincident with an increase in subsidisation. Reconstructive dentistry accounted for the majority of the increase. Gender disparities in dentistry were less distinct when compared with AHPs and were postulated to be due to males presenting with conditions that were more progressive requiring more invasive treatment. A comparative analysis indicates significant differences in costs, nature of treatment and the manner of remuneration between dentistry and the AHPs. A fee for service schedule as evidenced by the CDSS is dependent on the degree of financial incentive as indicated by patterns in utilisation over time. The amount of treatment considered necessary may be influenced by the level of subsidy with treatment that may not reflect disease management. The AHP model, which is based around a fee for visit schedule, is not without its deficiencies but has not experienced significant rises in cost compared with the CDSS.

Objective: Dental professionals with proper training and integration into existing protocols for mobilization can be one additional re-source during catastrophic events. A pilot project on training of dental school faculty in telephone triage in the event of an avian flu pandemic is described. A partnership was established with a grant from the Department of Justice/Department of Homeland Security, between the New York City Department of Health and Mental Hygiene, and New York University to initiate a pilot program to increase the manpower resources available to the health agency should an overwhelming public health event be present in the New York City area.Methods: Eight faculties from New York University College of Dentistry were selected to receive telephone triage training consisting of 15 hours of formal presentations. This training was specifically designed to give participants a background in “outbreak investigations,” and included a mock influenza outbreak. Also, a “phone triaging” training during a surge event was practiced.Results: The training resulted in enabling alternative healthcare providers as capable personnel and one alternative source for a surge manpower pool. This was the innovative use of dental school faculty to bolster critically understaffed and overwhelmed areas in the NYCDOHMH infrastructure, such as call centers and for telephone triage, in their disaster scenarios, particularly in their response to avian flu.Conclusions: The established public health systems and medical community must understand the need to preplan for medical surge events and accept that a potential source of additional manpower could be the dental profession or other nontraditional healthcare personnel.

A leap of faith took Peter Thomson from years of service in the NHS to an Oral Health Alliance ‘down under’. Here, he talks about oral health and the organisation of dental services in Australia, as well as the drivers of change in academic dentistry that led to the formation of the Alliance between the University and a large public healthcare provider to deliver excellence in teaching, research and clinical practice.

SUMMARY Objective: The purpose of this study was to compare the clinical performance of two self-etch dental adhesives with Single Bond Plus, a traditional one-bottle total-etch dental adhesive, for the restoration of noncarious cervical lesions. Materials and Methods: A total of 156 restorations were placed in noncarious cervical lesions with a minimum depth of 1.5 mm. Patients had no chronic periodontal disease and had normal salivary function. Each patient received restorations on three teeth, each bonded with either Adper Single Bond Plus, Adper Easy Bond, or Adper Scotchbond SE dental adhesive. All lesions were restored with Filtek Supreme Plus composite resin. All teeth were isolated with a rubber dam, received a short enamel bevel, and were cleaned with flour of pumice. The adhesives and resin composite were applied following the manufacturers' instructions. Restorations were clinically evaluated at baseline, six months, one year, and two years using modified US Public Health Service criteria. Results: Two-year retention was recorded as 97.3%, 90.5%, and 95.2%, for Single Bond Plus, Scotchbond SE, and Easy Bond, respectively. Statistical analysis did not show a significant difference (p>0.05) in clinical performance between any of the three adhesives after a period of two years.

ABSTRACT Introduction Endodontic therapy is a specialized procedure more demanded by patients within public oral health care in the country. Then, single-visit endodontic therapy may offer advantages to the health care services, to the professionals, and to the patients by reducing access barriers. Materials and methods A meta-analysis was done and the variables evaluated were periapical repair, microbiological control, and postobturation pain in randomized clinical trials (RCTs) involving endodontic treatment of nonvital teeth at single- or multiple visits. Results About 17 RCTs were included. There were no differences found in periapical repair or microbiological control in single- and multiple-visit therapy. Single-visit endodontic therapy resulted in 21% less postobturation pain (relative risks = 0.79; 95%, confidence interval: 0.66-0.94). Conclusion There was less postobturation pain in the single-visit endodontic therapy group. In the public dental care, this analysis favors the adoption of this one therapy because it will be possible to increase the patient access and the supply of this therapy. Clinical significance It is possible to get a better cost-effectiveness for the patients and the health care service. This is very important because the reduction of the cost to the patient allows it to become a complete treatment. The health service, in turn, is able to be better used, with a greater supply of this service. How to cite this article Almeida DO, Chaves SCL, Souza RA, Soares FF. Outcome of Single- vs Multiple-visit Endodontic Therapy of Nonvital Teeth: A Meta-analysis. J Contemp Dent Pract 2017;18(4):330-336.

The aim of this study was to investigate potential differences in caries prevalence of children from ethnic minority groups compared to native Dutch children and the influence of socio-economic status (SES) and parent-reported oral health behaviour on this association. The study had a cross-sectional design, embedded in a population-based prospective multi-ethnic cohort study. 4,306 children with information on caries experience, belonging to 7 different ethnic groups, participated in this study. The decayed, missing, and filled teeth (dmft) index was assessed at the age of 6 and categorized in two ways for analysis: children without caries (dmft = 0) versus any caries experience (dmft >0) and children without caries (dmft = 0) versus children with mild caries (dmft = 1-3) or severe caries (dmft >3). Compared to native Dutch children, children with a Surinamese-Hindustani, Surinamese-Creole, Turkish, Moroccan, and Cape Verdean background had significantly higher odds for dental caries. Especially the Surinamese-Hindustani, Turkish, and Moroccan group had significantly higher odds for severe dental caries. Household income and educational level of the mother explained up to 43% of the association between ethnicity and dental caries, whereas parent-reported oral health behaviour did not mediate the association. Alarming disparities in caries prevalence between different ethnic (minority) groups exist, which cannot be fully explained by social inequalities. Public health strategies can apply this new knowledge and specifically focus on the reduction of ethnic disparities in oral health. More research is needed to explain the high caries prevalence among different ethnic minority groups.

OBJECTIVE: To diagnose the prevalence of amalgam and resin composite restorations performed by professionals in public service and university students in a municipality in the Northeast of the State of Paraná. METHODS: Ten basic health units were randomly selected, at which 500 clinical record charts of patients of both sexes aged from 18 to 50 years were consulted. To analyze the prevalence of restorations performed by students, a questionnaire was applied to 4th and 5th year students, containing questions relative to the number of restorations and type of material using in intramural clinical activities. RESULTS: In the basic health units, 66% of restorations were performed with amalgam, and 34% with resin composite. At the dental school, 4th year students responded that when they were in the 3rd year, out of a total of 367 restorations, 21.5% were performed with amalgam and 78.5% with resin composite. For the 5th year group of students, the percentage of teeth restored with amalgam was 14.3%, 12.0% and10.2%, when they were in the 3rd, 4the and 5th years of the course, respectively. The results obtained revealed that the indication of the restoration material differed in the two scenarios. CONCLUSION: In the basic health units, the majority of restorations were performed with amalgam, whereas at the dental school there was higher prevalence of resin composite restorations. One must reflect whether professional education has adequately developed the necessary competencies for decision making and meeting the needs of this population.

The aim of this study was to compare the longevity and cariostatic effects of everyday conventional glass-ionomer and amalgam restorations in primary teeth. The materials consisted of 515 Ketac-Fil glass-ionomer restorations and 543 Dispersalloy amalgam restorations prepared in 666 children, from 3 to 13 years of age, by 14 dentists within the Danish Public Dental Health Service in the municipalities of Vaerlose and Hillerød. The restorations, of which 79% were of the Class II type, were in contact with 593 unrestored surfaces in adjacent primary and permanent teeth. After 3 years, 6% of the patients had dropped out of the study, and 33% of the teeth were exfoliated with the restoration in situ. A further 37% of the glass-ionomer and 18% of the amalgam restorations were recorded as failed (p < 0.001). The frequency of failures was highest for Class II glass-ionomer restorations, which showed a 50% median survival time of only 34½ months, because of many fractures, while the 75% survival time for Class II amalgam restorations just exceeded the actual 36 months (p < 0.001). Caries progression was most often recorded in surfaces adjacent to amalgam restorations, and 21% of these surfaces needed restorative treatment vs. 12% of the surfaces adjacent to glass-ionomer restorations (p < 0.01). The three-year results indicated that conventional glass ionomer is not an appropriate alternative to amalgam for all types of restorations in primary teeth. In particular, the short longevity of Class II glass-ionomer restorations could not be compensated for by the reduced caries progression and need for restorative therapy of adjacent surfaces.

Objective: To evaluate fracture resistance and survival rate of IPS Empress CAD versus Polished Celtra Duo ceramic laminate veneers. Material and Methods: Thirty-six ceramic laminate veneers were fabricated for maxillary anterior teeth. The patients were divided into two groups according to the material Group 1(control group) fabricated from IPS Empress CAD laminate veneers and group 2(intervention group) fabricated from Polished Celtra Duo laminate veneers. Standardized the same preparation with butt joint design and chamfer finish line located supra gingival were performed for all the teeth. The fabrication of the veneers was performed using Cad\Cam (Ceramill motion) machine, with software (Exocad). The veneers surfaces were treated and silanated according to the manufacture instruction of each ceramic and enamel surfaces were etched where total etch adhesive protocol was obeyed using BISCO. Follow up sessions were done every two months up to one year for each patient using dental probe and operator vision to evaluate the fracture, survival rate, marginal adaptation, sensitivity and caries. according to USPHS criteria (United States Public Health Service). This was performed by an experienced, blinded investigator. Results: Fracture resistance, marginal adaptation, retention, caries and sensitivity were evaluated according to the criteria of USPHS and we found there is no significant difference as both groups scaled zero score. Conclusion: Both IPS Empress Cad and Polished Celtra Duo laminate veneers revealed successful clinical performance in terms of fracture resistance, marginal adaptation, retention, and sensitivity after one year follow up period. Keywords Ceramic laminate veneers; IPS Empress CAD; Celtra DUO; Clinical performance.

Replacement of dental restorations has been the traditional treatment for defective restorations. This five-year prospective clinical trial evaluated amalgam restorations with localized defects that were treated by means of repair or refurbishing. Fifty-two patients (50% female and 50% male, mean age28.3±18.1years, range 18–80) with 160 class I and class II defective restorations were included. The study focused on the application of two minimally invasive treatments for localized restoration defects and compared these with no treatment and total replacement as negative and positive controls, respectively. Restorations were assessed by two calibrated examiners according to modified U.S. Public Health Service criteria, including marginal adaptation, anatomic form, secondary caries, and roughness. At five years, recall was examined in 45 patients with 108 restorations (67.5%). The results suggest that repair treatment is as effective as total replacement of restorations with localized defects, reducing biological costs to the patient and providing new tools to the clinician. Refinishing restoration is a useful treatment for localized anatomic form defects.

SUMMARY Replacement of dental restorations has been the traditional treatment for restorations that are defective. In this five-year randomized clinical trial, restorations with localized marginal defects were treated with sealants. Thirty-two patients (mean age, 26.8 years) with 126 Class I and Class II restorations with defective margins (amalgam n=69 and resin-based composite n=57) were recruited. Treatment was seal with pit and fissure sealant on localized marginal defects (group A: n=43) and was compared with total restoration replacement (group B: n=40) and untreated restorations (group C: n=43) as negative and positive controls. Restorations were assessed by two examiners using the modified US Public Health Service criteria, observing five clinical parameters: marginal adaptation, roughness, marginal stain, teeth sensitivity, and secondary caries at baseline and at five years after treatment. At the five-year recall examination, 23 patients with 90 restorations (71.4% recall rate) were examined. A significant improvement was observed in the marginal adaptation of the restorations in group A compared with group B. None of the treated group showed trends to downgrade in any parameter. Tooth sensitivity and secondary caries showed a low frequency in all groups. No significant difference in marginal adaptation of the restorations was found between amalgam and resin-based composite restorations (p=0.191). This study demonstrated that marginal sealing of restorations is a minimally invasive treatment that may be used instead of the replacement of restorations with localized marginal defects.

SUMMARYThe aims of this retrospective clinical study were to compare the longevities of direct posterior amalgam restorations (AMs) and resin composite restorations (RCs) that were subjected to occlusal stresses and to investigate variables predictive of their outcome. A total of 269 AMs and RCs filled in Class I and II cavities of posterior teeth were evaluated with Kaplan-Meier survival estimator and multivariate Cox proportional hazard model. Seventy-one retreated restorations were reviewed from dental records. The other 198 restorations still in use were evaluated according to modified US Public Health Service (USPHS) criteria by two investigators. The longevity of RCs was significantly lower than that of AMs (AM = 8.7 years and RC = 5.0 years, p<0.05), especially in molars. The prognostic variables, such as age, restorative material, tooth type, operator group, diagnosis, cavity classification, and gender, affected the longevity of the restorations (multivariate Cox regression analysis, p<0.05). However, among the restorations working in oral cavities, their clinical performance evaluated with modified USPHS criteria showed no statistical difference between both restoratives. In contrast to the short longevity of RCs relative to AMs, the clinical performance of RCs working in oral cavities was observed to be not different from that of AMs. This suggests that once a RC starts to fail, it happens in a rapid progression. As posterior esthetic restorations, RCs must be observed carefully with periodic follow-ups for early detection and timely repair of failures.

SUMMARY Purpose: The objective of this double-blind, randomized clinical trial was to evaluate the six-month clinical performance of a new universal adhesive (Xeno Select, Dentsply) in noncarious cervical lesions (NCCLs) using two evaluation criteria: World Dental Federation (FDI) and the US Public Health Service (USPHS). Methods and Materials: A total of 124 restorations were randomly placed in 31 patients according to the following groups: ER-D = etch-and-rinse/dry dentin; ER-M = etch-and-rinse/moist dentin; SE-et = selective enamel etching; and SET = self-etch. The composite resin EVOLUX (Dentsply) was placed incrementally. The restorations were evaluated after one week (baseline) and at six months using the FDI and USPHS criteria. Statistical analyses were performed using appropriate tests (α=0.05). Results: Fifteen restorations were lost or fractured at six months (one for ER-D, three for ER-M, five for SE-et, and six for SET) (p>0.05 at six-month recall). When ER (ER-D and ER-M) was compared with SE (SE-et and SET) there was a significant difference in the retention rate after six months (p=0.001). Marginal staining and postoperative sensitivity to air were only observed in three (one for ER-M and two for SET) and two restorations (two for ER-D) in both evaluation criteria (p>0.05), respectively. Forty-seven restorations were considered to have minor discrepancies in marginal adaptation at the six-month recall using the FDI criteria (13 for ER-D, 10 for ER-M, 11 for SE-et, and 13 for SET; p>0.05 between groups). However, for all groups, a significant difference was detected when baseline and six-month data were compared (p<0.05). Conclusions: The six-month clinical behavior of Xeno Select Universal Adhesive depends on the bonding strategy used. The universal adhesive did not fulfill the American Dental Association criteria for full approval when used in the self-etch mode.

SUMMARY Purpose To evaluate the 18-month clinical performance of a multimode adhesive (Scotchbond Universal Adhesive, SU, 3M ESPE, St Paul, MN, USA) in noncarious cervical lesions (NCCLs) using two evaluation criteria. Materials and Methods Thirty-nine patients participated in this study. Two-hundred restorations were assigned to four groups: ERm, etch-and-rinse + moist dentin; ERd, etch-and-rinse + dry dentin; Set, selective enamel etching; and SE, self-etch. The composite resin, Filtek Supreme Ultra (3M ESPE), was placed incrementally. The restorations were evaluated at baseline, and at 18 months, using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Statistical analyses were performed using Friedman repeated-measures analysis of variance by rank and McNemar test for significance in each pair (α=0.05). Results Five restorations (SE: 3; Set: 1; and ERm: 1) were lost after 18 months (p>0.05 for either criteria). Marginal staining occurred in four and 10% of the restorations evaluated (p>0.05), respectively, for USPHS and FDI criteria. Nine restorations were scored as bravo for marginal adaptation using the USPHS criteria and 38%, 40%, 36%, and 44% for groups ERm, ERd, Set, and SE, respectively, when the FDI criteria were applied (p>0.05). However, when semiquantitative scores (or SQUACE) for marginal adaptation were used, SE resulted in a significantly greater number of restorations, with more than 30% of the total length of the interface showing marginal discrepancy (28%) in comparison with the other groups (8%, 6%, and 8%, respectively, for ERm, ERd, and Set). Conclusions The clinical retention of the multimode adhesive at 18 months does not depend on the bonding strategy. The only differences between strategies were found for the parameter marginal adaptation, for which the FDI criteria were more sensitive than the USPHS criteria.

Abstract Aim To determine the prevalence and risks of early childhood caries (ECC) among children less than 71 months of age in Toronto, Canada, and to evaluate the association between parental/ caregiver depression and ECC. Methods and Materials A secondary analysis of data previously collected by the Toronto Public Health as part of the 2003 Toronto Perinatal and Child Health Survey was performed. The 90-item survey was conducted over the telephone to 1,000 families with children from zero years (birth) to six years of age. Parents/caregivers were asked about factors related to the development and health of their children. For this study, only children younger than six years of age (less than 71 months) were included (n=833). The primary outcome of interest was self-reported and measured by the response to the question of whether a physician/dentist had ever told the parent/caregiver his/her child had ECC. Results The prevalence of ECC was 4.7 percent (37 of 791 children). The child's age, his/her history of dental visits, teeth brushing, the use of fluoridated toothpaste, the parent's/caregiver's depressive tendencies, the language spoken at home, and the household annual income were all significant in the bivariate analysis. Multiple logistic regression identified four factors associated with ECC: the child's age (being three years of age or older), having at least one parent/ caregiver with depression, not speaking English at home, and having an annual household income less than $40,000 in Canadian dollars (CAD). Conclusion While a child's age, home language, and household income are known risks for ECC, the finding that parental/caregiver depression may be related to ECC is new. Clinical Significance Multiple risk factors are involved in the development of early childhood caries. Of particular importance are demographic (e.g., child's age), social (e.g., annual household income), and psychosocial factors (e.g., parental/ caregiver depression) that are indirectly linked to ECC. More attention needs to be placed on understanding the role and process by which these factors influence the development of ECC. Citation Al-Jewair TS, Leake JL. The Prevalence and Risks of Early Childhood Caries (ECC) in Toronto, Canada. J Contemp Dent Pract [Internet]. 2010 October; 11(5):001-008. Available from: http://www.thejcdp.com/journal/view/ volume11-issue5-al-jewair

Background New dental graduates in England and Wales spend one year as vocational dental practitioners (VDPs) preparing for independent clinical practice. In recent years, they have entered a state-funded healthcare system undergoing the greatest period of change since the inception of the National Health Service (NHS) and a profession in which there has been a significant shift of care to the private sector. Against this background, the objectives of this study were to investigate VDPs’ vision of their future professional career and the influences that will impact on their choice of state-funded (NHS) and/or private dentistry, and to identify what factors may attract graduates to work for the NHS. Methods In 2004/2005, purposive sampling of a range of VDP training schemes across England and Wales was used to select the VDPs from ten schemes to take part in focus groups. To standardise data collection, a topic guide was used. Respondents’ views were recorded on tape and field notes. The data were transcribed and analysed using framework methodology. Results Ninety-nine VDPs from all parts of England and Wales participated in ten focus groups. They identified three main categories of future practice: private, state-funded (NHS), and mixed. Private practice was perceived as providing ‘professional independence’, ‘financial reward’, ‘time with patients’ and ‘clinical freedom’. NHS practice was associated with ‘providing access to specialist training’ and ‘gaining clinical experience’, often as preparation for private practice. Providing NHS care was attractive for VDPs who valued the ethos of public service. The VDPs considered that NHS practice could be made more attractive to young dentists by a range of factors, involving the funding, culture and philosophy of the system and the degree of fit with their personal and professional vision. They reported that they would welcome ‘incentives to work in areas of high need’, ‘assistance with debt’ and a ‘culture of valuing NHS dentists’. Conclusions The findings suggest that the commitment to healthcare systems of the VDPs who took part in this study was associated with being true to their values and being valued within the system. They perceived a tension between state-funded and private practice, considering the latter more likely to meet personal and professional expectations. However, they remained open to working in an enhanced and supportive state-funded system, should it correspond with their values, and demonstrate that they were valued healthcare professionals.

ABSTRACT Objective To analyze the spatial distribution of decayed and restored teeth in adults according to the Social Exclusion Index (SEI) and the proximity of public dental service. Methods: This ecological study used secondary data from an epidemiological survey of oral health and from the Piracicaba Research and Planning Institute (IPPLAP). The oral examinations of the DMFT index examined in households by a single examiner calibrated in 2011, by probability sampling, 248 adults (aged 20 to 64 years) representing the residents in Piracicaba-SP, Brazil. Data on social exclusion and health units with dental service were extracted from IPPLAP. We performed georeferencing of the census tracts selected by draw in the epidemiological survey and their respective districts, in addition to the health units with dental service in a radius of 500 m and 1000 m. Spearman’s rank correlation coefficient was analyzed (p<0.05). Results: The smallest value of SEI, that is, the highest social exclusion, showed no correlation with decayed teeth (p=0.09), but had strong positive correlation with restored teeth (r=0.79; p<0.0001). Presence of public dental service in the vicinity of 500 m and 1,000 m showed no correlation, respectively, with the average number of decayed (p=0.07 and p=0.58) and restored (p=0.26 and p=0.56) teeth. Conclusion: Although the correlation between social exclusion and caries in adults was not observed, its case management, namely, the restored teeth, showed correlation with social inequalities. Presence of public dental service showed no correlation with components of caries experience evaluated in this study.

ABSTRACT Introduction The demands of operational deployment mean that defense force personnel must be dentally fit. Although medical evacuation for dental causes should be avoided, dental emergencies are a major non-combat-related contributor to withdrawal from deployment. Information on the oral health status of recruits and officer cadets entering the New Zealand Defence Force (NZDF) is scarce, yet it is useful for service and workforce planning. We investigated oral health status and its associations in new recruits and officer cadets entering the NZDF over a 13-month period. Materials and Methods This study used data from recruits’ initial dental examination (including baseline forensic charting), posterior bitewing radiographs, orthopantomograph radiograph, and a socio-dental questionnaire. The impaction status of third molar teeth was evaluated. Ethical approval was obtained from the University of Otago Ethics Committee (reference number D18/200) and the NZDF Organisational Research Committee. Results Of the 874 (83%) of the 1,053 recruits (age range 17-59 years) who participated, one in five were Māori. Nearly two-thirds were Army recruits. Caries prevalence was almost 70%. Mean Decayed, Missing, and Filled Teeth (DMFT) (3.0 overall) was higher among females and Māori. Few teeth were missing due to caries. Third molars were common, seen in 745 (88.3%). One in four maxillary third molars (but only one in six mandibular ones) had fully erupted. The most common type of impaction among mandibular third molars was the mesioangular type, followed by vertical, horizontal, and distoangular. Almost 60% of recruits had one or more potentially problematic third molars. The prevalence was highest in the youngest age groups, those of medium or low socioeconomic status and in Army or Navy recruits. Conclusions Recruits’ oral health was acceptable, but potentially problematic third molars were common, indicating a need for careful assessment (and their possible removal) before operational deployment.

ABSTRACT Objective: Health services evaluation uses both general service monitoring indicators and evaluation research, with the aims of studying service performance and its enhancement through problem solving. This study aimed at analyzing the referral system between primary health care and the secondary level care in endodontics of the Dental Specialties Center in the city of Contagem, Minas Gerais, to seek enhancement of the existing referral protocol. Methods: Secondary data were collected from the municipal data systems as well as from services files, regarding all patients who were attended between 2009 and 2014. Results: Mean time between first appointment and treatment conclusion was 3.12 months. There was higher frequency of individuals from the administrative regions of cities with higher populations and more availability of primary health care units. Similar proportions of single and non-single rooted teeth were treated. High proportions of teeth reached the endodontics service of Dental Specialties Center without possible treatment. Conclusion: Data were generated to provide renovation of the service referral protocol.

Aim: To compare following the Cuban Revolution, Cuba’s economy and civil society was transformed by the initiation of a program of nationalization and political consolidation. The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the healthcare of its citizens. Other industrialized nations continue to surpass the US in health-related outcomes indicating areas of improvement in its healthcare system. Assessing the successes and failures as well as the advantages and disadvantages of other countries’ healthcare systems may be instrumental in the development of modifications to the organization and delivery system of healthcare in the US. This paper aims to report the information attained from previous literature as well as from first-hand observations from a public health trip to Cuba in order to compare the healthcare systems in Cuba and the United States. Materials and Methods: A group of New York University College of Dentistry faculty and students traveled to Cuba in April 2019 for professional research and professional meetings (CFR 515.564). While in Cuba, the researchers took written notes of the lecture-based material and conversations. Upon return to the United States, published literature was searched for the collection of any additional data and all qualitative data and quantitative data was compiled and organized. Since 1959, Cuba has made continuous adjustments and improvements to its universal, free and accessible healthcare system. Results: There have been notable improvements to the country’s public health status, such as the implementation of an immunization program and subsequent eradication of communicable diseases, such as polio and rubella. Additionally, the implementation of the National Program on Dentistry guarantees dental care to all Cuban children under the age of 19. Today, the Cuban National Health System (NHS) initiatives have evolved to combat the novel coronavirus (COVID-19) pandemic. Conclusion: Recognizing the advantages as well as the disadvantages of the Cuba’s National Health System (NHS) would be useful for future policymakers in the United States. Cuban approaches to health could be tailored to the United States environment to improve healthcare effectiveness and population health status in the future.

Abstract Background Since 2007, patients receiving oral health care within the Public Dental Service in Sweden have had the possibility to choose between the traditional fee-for-service (FFS) payment system or the new capitation payment system, ‘Dental Care for Health’ (DCH). Payment models are believed to involve different incentive structures for patients and caregivers. In theory, different incentives may lead to differences in health-related outcomes, and the research has been inconclusive. This 12-year longitudinal prospective cohort study of patients in regular dental care analyzes oral health development and self-reported oral health in relation to the patients’ level of education in the two payment systems, and compares with the results from an earlier 6-year follow-up. Methods Information was obtained through a questionnaire and from a register from n = 5877 individuals who kept their original choice of payment model for 12 years, 1650 patients in DCH and 4227 in FFS, in the Public Dental Service in Region Västra Götaland, Sweden. The data comprised manifest caries prevalence, levels of self-reported oral health and education, and choice of dental care payment model. Analyses were performed with chi square and multivariable regression analysis. Results The findings from the 6-year follow-up were essentially maintained at the 12-year examination, showing that the pre-baseline caries prevalence is the most influential factor for less favorable oral health development in terms of the resulting caries prevalence. Educational level (≥ university) showed an increased influence on the risk of higher caries prevalence after 12 years and differed between payment models with regard to the relation to self-rated oral health. Conclusions Differences in health and health-influencing properties between payment models were sustained from 6 to 12 years. Strategies for making use of potential compensatory mechanisms within the capitation payment system to increase oral health equality should be considered.

Abstract Background Capitation models of care in dentistry started around 1973 with varying degrees of success in meeting the needs of the individuals and expectations of the participating private practitioners. These studies mostly identified that capitation payments resulted in under treatment whilst fee-for-service models often led to over treatment. The objective of this study was to develop a new way of doing business using an outsourcing capitation model of care to meet population health needs and activity-based funding requirements of rural Local Health Districts with a local university dental school. This payment model is an alternate referral pathway for public oral health practitioners from the existing New South Wales Oral Health Fee-for-Service Scheme that focuses on urgent treatment to one that offers an all-inclusive preventive approach that concentrates on sustaining good long-term oral health for the individual. Method The reflective study analysed various adult age cohorts (18–24, 25–34, 35–44, 45–54, 55–64, 65–74 and 75 + years) based on 950 participants randomly selected from the Greater Southern adult public dental waiting lists. The study’s capitation formula was derived from NSW government adult treatment items (n = 447,625). Dental care was provided through the local university’s dental clinics utilising only dental students under clinical supervision. All data were sourced from NSW Oral Health Data Warehouse during 1 January 2012–30 June 2018 and analysed by using SAS 9.3 and Version 13 Microsoft Excel. Results There were 10,305 dental care items and 1129 capitation courses of care totalling A$599,026. This resulted in an average of 11 dental care items being provided to each participant. The capitation payment formula utilising the most provided dental care items of 100 individual patients proved to be economical and preventive focused. Conclusion The systematic reflection showed that this unique methodology in developing an adult capitation payment formula associated to diagnostic pathways that resulted in: (i) more efficient usage of government expenditure on public dental services, (ii) provision of person-centred courses of dental care, and (iii) utilisation of university dental education programs to best practice treatment and holistic care.

AbstractObjectives: The development of new information technology has significant effects on the health care system, and its implementation and the associated change management process can bring some positive changes and gains in understanding, but there are challenges with making the transition. These benefits and challenges are explored in the context of a hospital based dental department. Additionally, the concept of the integration of oral health to overall systemic health is explored in context with an Electronic Medical Records system implementation, and the American Dental Association’s recent recognition of dental anesthesiology as a clinical subspecialty.Method: Qualitative survey of attending dental faculty members of the department, who represent a broad range of dental specialties and experience in private practice, hospital based practice, teaching, and public health practice.Results: The faculty survey yielded some consistent themes, ranging from enhanced information to make better diagnoses, to challenges in transitioning to EMR, as well as concerns about data security and too much time and effort in front of a computer screen.Discussion: A brief summary of the history of the stand-alone development of dentistry is given, which contributed to the separate development of dental EMRs from hospital EMRs. The various modalities of clinical care provided by the Department of Dentistry at Advocate Illinois Masonic Medical Center, Chicago, IL are presented to give a scope of the areas of need a successful EMR solution must meet in a hospital based dental setting. Public health aspects are included in the discussion.Conclusion: Macro level health data sets (ie NHANES, state level datasets) have the potential to be expanded to include more thorough data, combining medical health data and oral health data in the same datasets.

Managing the oral health of children during the time of a health emergency linked to the current COVID-19 pandemic presents specific problems. A high number of non-specific effective infection control protocols are available in dental settings. It is of fundamental importance to implement specific protocols relating to those clinical situations that normally do not represent an emergency but which now fall into that category. The aim of this study was the comparison of data obtained from the Regional National Health Fund (NFZ) relating to the number and the type of procedures in the oral health management of children aged 0–18 years from the Wielkopolska region, with the months of March and April of 2019 being compared with those of the, respective, pandemic period of 2020. The results showed statistical differences in the number of performed procedures when comparing 2019 and 2020; especially in April (n = 53,077 in 2019 but only n = 2,287 in 2020), when lockdown restrictions reached their highest level and when only 30% of the dental clinics for children were open for patients in the Wielkopolska region of Poland. Regarding surgical cases, there were no differences in percentage frequency between April 2019 and 2020 in terms of extractions. However, an increase was observed in abscess incisions (3.5–17.8%) and surgical dressings (1.5–10.07%). There was a decrease in the total number of performed conservative dentistry procedures in April 2020, but temporary fillings in primary and permanent teeth showed a prominent increase: from 6.4% in 2019 to 19.3% in 2020; and 5.8–11.4%, respectively. Pulp treatment and mucosal lesions therapy fall into the dental emergency category during this COVID-19 pandemic. These cases have shown an increase from 3.2% in 2019 to 12.8% in 2020 for pulp treatment, and from 2.3 to 4.3% for the treatment of oral mucosal lesions. As suspected, after the lockdown was implemented, the number of pediatric dental cases were low. Moreover, the analysis revealed differences in the profile of clinical situations that represented the emergency cases and the pandemic treatment protocols. Future implications suggest that dental prophylactic procedures be included in pandemic protocols with even dental services being limited to a form of urgent treatment. New approaches and treatment models should be implemented in the control of the infectious spread of the disease in the management of the oral health of children in this pandemic period.

El conocimiento de la salud bucal de la población constituye una tarea fundamental desde la perspectiva de la salud pública, pues la caries es el padecimiento con mayor incidencia y prevalencia alrededor del mundo a pesar de los métodos de prevención. La salud bucodental es importante para el desarrollo físico y mental de las personas, desempeña un papel fundamental en la calidad de vida. El objetivo de esta investigación fue determinar el índice de dientes cariados, perdidos, obturados (CPOD) entre un grupo representativo de universitarios de ambos sexos de nuevo ingreso del área de la salud en las carreras de: nutrición, químico farmacobiólogo, medicina, odontología y cultura física, de una Universidad del estado de Nayarit. Dicho Sujetos se remitieron a la unidad académica de odontología para su atención, lo que permitió integrar resultados al macro-proyecto de investigación: Diagnóstico y seguimiento del estado integral de salud en estudiantes universitarios de nuevo ingreso. Este constituyó un estudio transversal, descriptivo, observacional, mediante la aplicación del examen de salud integral odontológica, se realizó una exploración clínica a partir de la cual se efectuó el registro en odontogramas. Se revisaron 200 alumnos con edad promedio de 18 años, 90% hombres y 10% mujeres. Se logró identificar que el porcentaje del índice CPOD fue de 2.2; con respecto al número de dientes cariados fueron: 195; dientes perdidos: 20; dientes obturados: 230; dientes sanos: 5155.Palabras clave: índice; caries; CPOD; OMS; salud dental AbstractThe knowledge of oral health of the population is a fundamental task from the perspective of public health, since caries is the disease with the highest incidence and prevalence around the world despite the prevention methods. Oral health is important for the physical and mental development of people since it plays a fundamental role in the quality of life. The objective of this research was to determine the index of teeth, decayed, lost, obturated (DMFT), among a representative group new university students of both sexes from the health area including the careers of: nutrition, chemical pharmacobiologist, medicine, dentistry and physical culture in the state of Nayarit and send them to the academic unit of dentistry for their attention, as well as append results a macro-research project entitled Diagnosis and monitoring of the comprehensive health status of new university students. Material and method: a cross-sectional, descriptive, observational study was carried out, through the application of the integral dental health examination, which consisted in a clinical exploration, the results were registered in odontograms. Being reviewed 200 students with an average age of 18.2. 90% men and 110% women. Results: The percentage of the DMFT index was 2.2. Regarding the number of teeth, decayed were: 195; lost teeth: 20; sealed teeth: 230; healthy teeth: 5155.Keywords: index; caries; CPOD; WHO; dental health

Dental caries is one of the major health problems in Indonesia. Data from Indonesian Basic Health Research in 2013, 2015 and 2018 showed a consistent increase in the prevalence of dental caries in 12-year-old schoolchildren: 43.4%, 53.2%, and 65.5%, respectively. More detailed results at 5 years of age show that 67.3% suffer from severe dental caries with a number (def-t) of more than 6, but only 10% get dental treatment. To overcome this problem, sufficient number of dentist is necessary. Data from the Indonesian Medical Council shows that one dentist serves about 9000 residents, therefore, every year a total of 1700 new dentists take the Hippocratic oath to carry out health services throughout Indonesia. Other than the number of dentists, dental caries prevention programs need to be developed.1
 High-tech dentistry for curative treatment such as CAD/CAM to support the installation of dental implants, veneers, root canal treatment technology, and orthodontic treatment are very attractive to dentists practicing in urban areas.2 Other than curative treatment is considered as an instant treatment, curative treatment also benefits both the patient and the dentist since it is supported by high technology and relatively easy to perform. Preventive treatment is becoming less popular and the short-term impact of the treatment is not felt.3The individual preventive treatment method is stuck to old technology that is slow to develop, while community empowerment method is stuck to conservative health education method. The advancement in information technology service is still not much help to preventive treatment.4
 If there is no preventive treatment innovation, then in 2023, the prevalence of dental caries in children aged 12 years old will reach to 79.2%. It means 80 out of 100 Indonesian children in their growth and development period will suffer from dental caries and bear all the consequences of other diseases due to dental caries, such as malnutrition, growth and development disorders, and other infectious diseases.5 Dental caries during mixed dentition stage can cause disruption in arrangement of the teeth (malocclusion) and will result in disturbances in masticatory and aesthetic functions. The more severe tooth and the oral disorder will reduce the immunity and increase the susceptibility to the disease.6,7
 Advances in artificial intelligence in the detection of dental caries in the oral cavity are not enough to suppress the growth of the prevalence of dental cariesVarious high technologies in the early detection of dental caries have been carried out, but the impact has not been significant. Fluorescence laser technology has been used to measure bacterial products in carious lesions (DIAGNOdent), whereas fiber-optic technology has been used to detect the initial area of demineralization, cracks, or fractures, and to provide a quantitative characterization of the caries process (Digital Imaging Trans Illumination Fiber-Optic (DIFOTI) ).8–10 Demineralization of human enamel can also be detected by quantitative light-induced fluorescence (QLF).11 Changes in electrical impedance between normal enamel and tooth structure and demineralized enamel can be measured by Electronic Caries Monitor (ECM).12In fact, high-tech tools have not been used optimally in everyday dental practice because dentists and patients are more interested in curative treatment. Surveys have shown that patients have no intention to maintain their dental health routinely and continuously. Dental caries is considered a temporary disease that can heal itself or with the help of a dentist. Dental caries is considered not a serious threat to general health.
 Technological advances in efforts to prevent dental disease have not been enough to suppress the growth of the prevalence of dental cariesFluoride is believed to be able to prevent dental caries by inhibiting the demineralization of the crystal structure in the teeth and increase remineralization. The enamel surfaces that are mineralized with fluoride are more resistant to acid attack.13,14 Topographic occlusal fissures of teeth are more susceptible to dental caries because of the contours that are more likely a place for plaque accumulation. This occlusal fissure conditions can be protected by filling the fissure with flowing composite material so that the surface of the occlusal becomes morphologically stronger. Xylitol and Sorbitol have been developed to be used as sugar substitutes to reduce the risk of caries. It prevents the sucrose molecule from binding to Streptococcus mutans, thus inhibiting metabolism.15 Sorbitol also reduces the ability of adhesion and the number of Streptococcus mutans. Since dental caries is an infectious microbiological disease, vaccine technology has also been applied in the prevention of dental caries. Experimental studies have succeeded in strengthening the effectiveness of vaccines against Streptococcus mutans.16 The form of the vaccines is protein, recombinant or synthetic peptides, protein-carbohydrate conjugates, as well as DNA-based vaccines. However, none of these vaccines appear on the market due to difficulties in inducing and maintaining high levels of antibodies in oral fluids. Current research is still ongoing for clinical applications.
 The prevention of dental caries is not possible to be done effectively if understanding the risks and benefits of dental caries prevention, the norm of dental maintenance in the community, and the ease of its implementation are still not integrated to raise the awareness of the community and dental service providers. Evidence-based dentistry regarding the prevention of dental and oral diseases in the community as well as in private clinic and hospital settings need to be socialized. Research that emphasizes the development of basic biological sciences in efforts to prevent dental caries is absolutely necessary, as well as clinical application research and evidence-based effectiveness of drugs or materials for dental caries prevention must be developed.17 Likewise, community empowerment research to improve the mindset of preventing oral and dental diseases, norms of dental prevention in the community, and the presence of facilities and methods need to be deepened and supported with adequate artificial intelligence technology.
 It can be concluded that: Research in Regenerative Dentistry, Clinical and Evidence-based Dentistry, and Dental Public Health and Primary Health Care will direct the promotion of promotive, preventive, curative and rehabilitative treatment for effective efforts to prevent dental caries and its consequences.
 Dr. Darmawan Setijanto, drg., M.Kes. (DDS., MPH)Dean of Faculty of Dental Medicine, Universitas Airlangga
 REFERENCES1. National Institute of Health Research and Development of Ministry of Health Indonesia. Main Result of Basic Health Research 2018.; 2018.2. Sriram S, Shankari V, Chacko Y. Computer Aided Designing / Computer Aided Manufacturing in Dentistry ( CAD / CAM ) – A Review. Int J Curr Res Rev. 2018;10(20):20-24.3. Bennadi D, Reddy V, Thummala NR. Preventive and curative measures adopted by dentists to combat occupational hazards – a cross sectional study Innovare Preventive And Curative Measures Adopted by Dentists to Combat Occupational Hazards – A Cross Sectional Study. Int J Pharm Pharm Sci. 2016;7(10):415-418.4. Janssens B, Vanobbergen J, Petrovic M, Jacquet W, Schols JMGA, Visschere L De. The impact of a preventive and curative oral healthcare program on the prevalence and incidence of oral health problems in nursing home residents. PLoS One. 2018:1-13.5. Sicca C, Bobbio E, Quartuccio N, Nicolò G, Cistaro A. Prevention of dental caries : A review of effective treatments. J Clin Exp Dent. 2016;8(5):604-610. doi:10.4317/jced.528906. Rapeepattana S, Thearmontree A, Suntornlohanakul S. Etiology of Malocclusion and Dominant Orthodontic Problems in Mixed Dentition: A Crosssectional Study in a Group of Thai Children Aged 8–9 Years. J Int Soc Prev Community Dent. 2019;9:383-389. doi:10.4103/jispcd.JISPCD7. Zou J, Meng M, Law CS, Rao Y, Zhou X. Common dental diseases in children and malocclusion. Int J Oral Sci. 2018;( January):1-7. doi:10.1038/s41368-018-0012-38. Ahlund K, Holbrook WP, Verdier B De, Tranæus S. Approximal Caries Detection by DIFOTI : In Vitro Comparison of Diagnostic Accuracy / Efficacy with Film and Digital Radiography. Int J Dent. 2012;2012:1-8. doi:10.1155/2012/3264019. Kouchaji C. Comparison between a laser fluorescence device and visual examination in the detection of occlusal caries in children. Saudi Dent J. 2012;24(3-4):169-174. doi:10.1016/j.sdentj.2012.07.00210. Gimenez T, Braga MM, Raggio DP, Deery C, Ricketts DN, Mendes FM. Fluorescence-Based Methods for Detecting Caries Lesions : Systematic Review , Meta-Analysis and Sources of Heterogeneity. PLoS One. 2013;8(4):1-14. doi:10.1371/journal.pone.006042111. Wu J, Donly ZR, Donly KJ, Hackmyer S. Demineralization Depth Using QLF and a Novel Image Processing Software. Int J Dent. 2010:1-7. doi:10.1155/2010/95826412. Bansode P V, Pathak SD, Wavdhane MB, Kale D. Diagnosing Dental Caries : An Insight. J Dent Med Sci. 2018;17(7):17-23. doi:10.9790/0853-170707172313. Kanduti D, Sterbenk P, Artnik B. Fluoride : A review of Use and Effects on Health. Mater Sociomed. 2016;28(2):133-137. doi:10.5455/msm.2016.28.133-13714. Chen F, Wang D. Novel technologies for the prevention and treatment of dental caries : a patent survey. Expert Opin Ther Pat. 2011;20(5):681-694. doi:10.1517/13543771003720491.Novel15. Shwetha R, Vivek S. Effect of dentifrices containing sorbitol , combination of xylitol and sorbitol on salivary Streptococcus mutans and Lactobacillus counts in 14-15 year old children : a randomized trial. Int J Clin Trials. 2017;4(4):184-190.16. Arora B, Setia V, Kaur A, Mahajan M, Sekhon HK, Singh H. Dental Caries Vaccine : An Overview. Indian J Dent Sci. 2018:121-125. doi:10.4103/IJDS.IJDS17. Santosh HN, Nagaraj T, Bose A, Sinha P, Mahalaksmi IP. Evidence-based dentistry : A new dimension in oral health. J Adv Clin Res Insights. 2014;1:114-119. doi:10.15713/ins.jcri.29

Dentre os causadores de impacto negativo na qualidade de vida, o traumatismo dentário alcança um caráter especial por estar, juntamente com a doença cárie e o câncer bucal, entre os principais problemas de saúde pública em todo o mundo. Este trabalho objetiva relatar a importância do tratamento de urgência do cirurgião-dentista frente às fraturas dento-alveolares. Paciente do gênero feminino, 7 anos de idade, vítima de acidente doméstico, apresentava inicialmente ao exame clínico intra-oral, ferimento corto-contuso em lábio superior e luxação lateral do elemento 11 e luxação extrusiva do elemento 21. Foi realizada sutura em região de ferimento corto-contuso e reposicionamento dos elementos traumatizados, devido a paciente ter sido encaminhada para um serviço público, improvisou-se com a utilização de uma agulha de injeção 27G e colagem com resina composta. Após 07 dias a paciente retornou para reavaliação clínica e realização do exame radiográfico, onde se constatou que as raízes dos elementos traumatizados 11 e 21 ainda estavam em processo de rizogênese, desse modo, sugeriu-se uma abordagem multidisciplinar em parceria com a equipe de endodontia para tratamento e condução do caso de modo a propiciar a completa formação radicular. Ao exame radiográfico final observou-se a completa formação radicular, a paciente encontra-se em proservação há 3 anos, sem indícios clínicos e radiográficos de reabsorção radicular. Traumatismos faciais são frequentes e requerem uma atuação rápida, principalmente em crianças e adolescentes. O papel do cirurgião-dentista frente a esses acidentes visa a melhoria no prognóstico das lesões físicas e o estado psicológico dos pacientes.Descritores: Traumatismos Dentários, Dentição Permanente, Avulsão Dentária.ReferênciasPetersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. 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BMC Oral Health. 2015;15(1):137.Guedes OA, Alencar AHG, Lopes LG, Pécora JD, Estrela C. A retrospective study of Traumatic Dental Injuries in a Brazilian dental urgency service. Braz Dent J. 2010;21(2):153-57.Díaz JA, Bustos L, Brandt AC, Fernández BE. Dental injuries among children and adolescents aged 1-15 years attending to public hospital in Temuco, Chile. Dent Traumatol. 2010;26(3):254-61.Cortes MI, Marcenes W, Sheiham A. Prevalence and correlates of traumatic injuries to the permanent teeth of schoolchildren aged 9-14 years in Belo Horizonte, Brazil. Dent Traumatol. 2001;17(1):22-6.Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol. 2012;28(2):88-96.Santos ME, Habecost AP, Gomes FV, Weber JB, de Oliveira MG. Parent and caretaker knowledge about avulsion of permanent teeth. Dent Traumatol. 2009;25(2):203-8.Poi WR, Sonoda CK, Martins CM, Melo ME, Pellizzer EP, Mendonça MR et al. Storage media for avulsed teeth: a literature review. Braz Dent J. 2013;24(5):437-45.Moura CC, Soares PB, de Paula Reis MV, Fernandes Neto AJ, Zanetta Barbosa D, Soares CJ. Potential of coconut water and soy milk for use as storage media to preserve the viability of periodontal ligament cells: an in vitro study. Dent Traumatol. 2014;30(1):22-6.von Arx T, Filippi A, Buser D. Splinting of traumatized teeth with a new device: TTS (Titanium Trauma Splint). Dent Traumatol. 2001;17(4):180-84. Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Manual de Traumatismo Dental. Porto Alegre: Artes Médicas Sul; 2000.Vasconcellos RJH, Oliveira DM, Nogueira RVB, Maciel AP, Cordeiro MC. Trauma na dentição decídua: enfoque atual. Rev cir traumatol buco-maxilo-fac. 2003;3(2):17-24.Andreasen JO, Andreasen FM, Andersson L. Textbook and color atlas of traumatic injuries to the teeth. 4th ed. Oxford: Blackwell 2007.p.337-71.Losso EM, Tavares MCR, Bertoli FMP, Baratto-Filho F. Traumatismo dentoalveolar na dentição decídua. RSBO. 2011;8(1):e1-20.Granville-Garcia AF, Menezes VA, Lira PI. Prevalence and sociodemographic factors associated with dental trauma in prescholers. Odontol Clín-Cient. 2006; 5(1):57-64.Panzarini SR, Saad Neto M, Sonoda CK, Poi WR, Carvalho AC. Avulsões dentárias em pacientes jovens e adultos na região de Araçatuba. Rev Assoc Paul Cir Dent. 2003;57(1):27-31.

Objetivo: O objetivo deste estudo foi compreender a percepção materna sobre a qualidade de vida de crianças, portadoras de cárie na primeira infância (CPI). Material e Método: O objeto de estudo foram seis mães de crianças em tratamento na Clínica de Odontologia da Universidade de Ribeirão Preto. Realizou-se entrevista semi-estruturada gravada. Os dados foram analisados segundo a técnica de Análise de Conteúdo proposta por Bardin e utilizando-se os conceitos teóricos oriundos de Bronfembrenner para avaliar aspectos da CPI que interferem no pleno desenvolvimento da pessoa desde a infância. Depreendeu-se dos dados, 03 categorias empíricas: 1ª - “o dente natural é tudo”; 2ª - “ Procura o dentista quando tem dor” e 3ª - “A mãe tem responsabilidade no aparecimento da cárie porque não limpa a boca da criança”. Resultados: Os resultados demonstraram que a influência dos aspectos sócio-econômicos e educacionais das mães tornam as crianças mais vulneráveis à CPI. As mães compreendem a importância dos dentes na saúde bucal, porém, não atribuem a presença da CPI a predispor as crianças ao desenvolvimento de problemas sistêmicos e afetar o desenvolvimento biopsicossocial. As mães apontaram falhas no atendimento das crianças e de acesso ao serviço público, assim como, o despreparo dos profissionais do serviço público e privado. Conclusão: Conclui-se que que existe necessidade de ampliação de medidas socioeducativas tanto para mães quanto crianças, assim como estratégias que visem formar e ampliar o conhecimento coletivo em saúde bucal e melhoria da Política Nacional da Saúde Bucal.Descritores: Comportamento Materno; Qualidade de Vida, Cárie Dentária; Saúde da Criança.ReferênciasCalcagnile F, Pietrunti D, Pranno N, Di Giorgio G, Ottolenghi L, Vozza I. Oral health knowledge in pre-school children: A survey among parents in central Italy. J Clin Exp Dent. 2019:11:e327-33.Chase I, Berkowitz RJ, Proskin HM, Weinstein P BR. Clinical outcomes for Early Childhood Caries (ECC): the influence of health locus of control. Eur J Paediatr Dent. 2004;2:76-80.Brasil Ministério da Saúde. Projeto SB Brasil 2003 Condições de saúde bucal da população brasileira2002-2003.http://cfo.org.br/wp-content/uploads /2009/10/04_0347_M.pdf. Published 2004. Accessed October 4, 2009.Brasil Ministério da Saúde. SB Brasil 2010: Pesquisa Nacional de Saúde Bucal. http://bvsms.saude.gov.br/bvs/publicacoes/pesquisa_nacional_saude_bucal.pdf. Published 2012. Accessed October 4, 2009.Guedes-Pinto AC. Odontopediatria. 9th ed. (Santos, ed.); 2016.Macedo LZ, Ammari MM. Cárie da primeira infância: conhecer para prevenir. Rev Rede Cuid em Saúde.2014;8:1-14.Minayo MC de S. O Desafio Do Conhecimento: Pesquisa Qualitativa Em Saúde. 1st ed. (Hucitec, ed.); 2012.Bardin L. Análise de Conteúdo. 70th ed. (France PU de, ed.). Lisboa; 1977.Alves PB. A ecologia do desenvolvimento humano: experimentos naturais e planejados. Psicol Reflexão e Crítica. 1997;10:369-73.Bronfenbrenner, U., Morris PA. The ecology of developmental processes. In: Inc. JW S, ed. Handbook of Child Psychology: Theoretical Models of Human Development. v. 1. New York; 1998:993-1028.Jiang M, Wong MCM, Chu CH, Dai L, Lo ECM. Effects of restoring SDF-treated and untreated dentine caries lesions on parental satisfaction and oral health related quality of life of preschool children. J Dent. 2019;88:103171.Vollú AL, da Costa M da EPR, Maia LC, Fonseca-Gonçalves A. Evaluation of Oral Health-Related Quality of Life to Assess Dental Treatment in Preschool Children with Early Childhood Caries: A Preliminary Study. J Clin Pediatr Dent.2018;42:37-44.Lai SHF, Wong MLW, Wong HM, McGrath CPJ, Yiu CKY. Factors influencing the oral health‐related quality of life among children with severe early childhood caries in Hong Kong.Int J Dent Hyg.2019;17:350-58.Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, Raggio DP. Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Community Dent Oral Epidemiol. 2011;39:105-14.American Academy of Pediatric Dentistry. Guidelines for Policy on Social Determinants of Children’s Oral Health and Health Disparities. Am Acad Pediatr Dent. 40:23-26.BaniHani A, Deery C, Toumba J, Munyombwe T, Duggal M. The impact of dental caries and its treatment by conventional or biological approaches on the oral health-related quality of life of children and carers. Int J Paediatr Dent. 2018;28:266-76.Knorst JK, Menegazzo GR, Emmanuelli B, Mendes FM, Ardenghi TM. Effect of neighborhood and individual social capital in early childhood on oral health-related quality of life: a 7-year cohort study. Qual Life Res.2019;28:1773-82.Marshman Z, Knapp R. Child oral health-related quality of life following treatment under dental general anaesthetic (DGA). Evid Based Dent. 2019;20:46-7.Phantumvanit P, Makino Y, Ogawa H, et al. WHO Global Consultation on Public Health Intervention against Early Childhood Caries. Community Dent Oral Epidemiol.2018;46:280-87.Zaror C, Atala-Acevedo C, Espinoza-Espinoza G, et al. Cross-cultural adaptation and psychometric evaluation of the early childhood oral health impact scale (ECOHIS) in chilean population. Health Qual Life Outcomes. 2018;16:232.Kidd E, Fejerskov O. Changing concepts in cariology: forty years on. Dent Update. 2013;40:277-86.Ferreira JMS, Silva FS, Aragão AKR, Duarte RC, Menezes VA. Conhecimento de pais sobre saúde bucal na primeira infância. Pediatr Mod.2010;46:224-30.Novaes TF, Pontes LRA, Freitas JG, et al. Responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS) is related to dental treatment complexity. Health Qual Life Outcomes.2017;15:182.Mansoori S, Mehta A, Ansari MI. Factors associated with Oral Health Related Quality of Life of children with severe -Early Childhood Caries. J Oral Biol Craniofacial Res.2019;9:222-225.Batliner T, Fehringer KA, Tiwari T, et al. Motivational interviewing with American Indian mothers to prevent early childhood caries: study design and methodology of a randomized control trial. Trials. 2014;15:125.

Introdução: A terapia fotodinâmica representa uma abordagem alternativa para a desinfecção do tecido cariado e tem apresentando resultados promissores no que diz respeito ao seu efeito deletério sobre os microrganismos envolvidos na progressão da cárie dentária. Objetivo: Investigar a produção científica brasileira sobre Terapia Fotodinâmica no manejo da Cárie dentária. Material e método: Tratou-se de uma pesquisa transversal, com abordagem quantitativa, a partir de dados secundários. Realizou-se uma análise bibliométrica dos resumos apresentados nas últimas dez Reuniões da Sociedade Brasileira de Pesquisa Odontológica. A pesquisa dos trabalhos procedeu-se através da seguinte estratégia: localização do fragmento “terapia fotodinâmica” e/ou “fotodinâmica” entre os resumos publicados nos anais do evento (1ª fase), em seguida foi realizada a busca pelo fragmento “cárie” e/ou “cardiologia” nos resumos selecionados na 1ª fase. Resultados: Foram selecionados 21 resumos, desses, 15 (71,43%) foram realizadas em universidades públicas, 13 (61,91%) receberam auxílio financeiro, 11 (52,38%) foram desenvolvidas na região Sudeste do Brasil, 9 (42,86%) eram do tipo in vitro, 6 (28,58%) utilizaram apenas o azul de toluidina como fotossensibilizante e 5 (23,81%) utilizaram apenas o LED vermelho como fonte de luz. Conclusão: Apesar dos resultados promissores da Terapia Fotodinâmica como terapia adjunta ao manejo da cárie, observou-se que poucas pesquisas abordando esse procedimento foram desenvolvidas nos últimos dez anos no Brasil.Descritores: Fotoquimioterapia; Cárie Dentária; Coleta de Dados.ReferênciasBradshaw DJ, lynch RJ. Diet and the microbial aetiology of dental caries: new paradigms. Int Dent J. 2013;63(Suppl 2):64-72.Hasan S, Singh K, Danisuddin M, Verma PK, Khan AU. Inhibition of major virulence pathways of Streptococcus mutansby quercitrin and deoxynojirimycin: a synergistic approach of infection control. PLoS one. 2014;9:1-12.Metwalli KH, Khan AS, Krom BP, Jabra-Rizk MA. Streptococcus mutans, Candida albicans, and the human mouth: a sticky situation. PLoS Pathog. 2013;9:1-5.Rouabhia M, Chmielewski W. Diseases associated with oral polymicrobial biofilms. Open Mycol J. 2012;6:27–32.Rozier RG, White BA, Slade GD. Trends in oral diseases in the U.S. population. J Dent Educ. 2017;81:98-109.Marcenes W, Kassebaum NJ, Bernabé E, Flaxman A, Naghavi M, Lopez A, et al. Global burden of oral conditions in 1990-2010: a systematic analysis. J Dent Res. 2013;9:592-97.Agnelli PB. Variação do índice CPOD do Brasil no período de 1980 a 2010. Rev bras odontol. 2015;72:10-5.Zaygorodniy AV, Rohanizadeh R, Swain MV. Ultrastructure of the dentine carious lesions. Arch Oral Biol. 2008; 53:124-32.Saffarpour M, Mohammadi M, Tahriri M, Zakerzaden A. Efficacy of modified bioactive glass for dentin remineralization and obstruction of dentinal tubules. J Dent. 2017;14:212-22.Leksell E, Ridell K, Cvek M, Mejàre I. Pulp exposure after stepwise excavation of deep carious lesions in young posterior permanent teeth. Endod Dent Traumatol. 1996;12:192-96.Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database Syst Rev. 2013;28:1-52.Griffin SO, Oong E, Kohn W, Vidakovic B, Gooch BF, Bader J, et al. The effectiveness of sealants in managing caries lesions. J Dent Res. 2008;87:169-74.Duque C, Negrini TC, Sacono NT, Boriollo MFG, Hofling JF, Hebling J et al. Genetic polymorphism of Streptococcus mutans strains associated with incomplete caries removal. Braz J Oral Sci. 2009;8:2-8.Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC. Microbiological analysis after complete or partial removal of carious dentin primary teeth: a randomized clinical trial. Caries Res. 2009;43:354-58.Williams JA, Pearson GJ, Colles MJ, Wilson M. The photoactivated antibacterial action of toluidine blue O in a collagen matrix and carious dentine. Caries Res. 2004;38:530-36.Pereira CA, Costa AC, Carreira CM, Junqueira JC, Jorge AO. Photodynamic inactivation of Streptococcus mutans and Streptococcus sanguinis biofilms in vitro. Lasers Med Sci. 2012;28:859-64.Melo MAS, Zanin ICJ, Rolim JPML, Rodrigues LKA. Characterization of Antimicrobial Photodynamic Therapy-Treated Streptococci mutans: An Atomic Force Microscopy Study. Photomed. Laser Surg. 2013;31:105-9.Steiner-Oliveira C, Ramalho, KM, Bello-Silva MS, Aranha ACC, Eduardo CP. The use of lasers in restorative dentistry: truths and myths. Braz Dent Sci.2012;15:40.Santin GC, Oliveira DBS, Galo R, Borsatto MC, Corona SAM. Antimicrobial photodynamic therapy and dental plaque: a systematic review of the literature. Scientific World Journal. 2014.Neves PA, Lima LA, Rodrigues FC, Leitão TJ, Ribeiro CC. Clinical effect of photodynamic therapy on primary carious dentin after partial caries removal. Braz. Oral Res. 2016;30:1-8.Melo MA. Photodynamic Antimicrobial Chemotherapy as a Strategy for Dental Caries: Building a More Conservative Therapy in Restorative Dentistry. Photomed Laser Surg. 2014;32:589-91.Soria-Lozano P, Gilaberte Y, Paz-Cristobal MP, Pérez-Artiaga L, Lampaya-Pérez V, Aporta et J, et al. In vitro effect photodynamic therapy with differents photosensitizers on cariogenic microorganisms. BMC Microbiology. 2015;15:2-8.Araújo PV, Correia-Silva F, Gomez RS, Massara L, Cortes ME, Poletto LT. Antimicrobial effect of photodynamic therapy in carious lesions in vivo, using culture and real time PCR methods. Photodiagnosis Photodyn Ther. 2015;12(3):401-7.Misba L, Kulshrestha S, Khan AU. Antibiofilm action of a toluidine blue O-silver nanoparticle conjugate on Streptococcus mutans: a mechanism of type I photodynamic therapy. Biofouling. 2016;32:313-28.Gursoy H, Ozcakir-Tomruk C, Tanalp J, Yilmaz S. Photodynamic therapy in dentistry: a literature review. Clin Oral Investig. 2013;17(4):1113-25.Melo MA, Rolim JP, Passos VF, Lima RA, Zanin IC, Codes BM, et al. Photodynamic antimicrobial chemotherapy and ultraconservative caries removal linked for management of deep caries lesions. Photodiagnosis Photodyn Ther. 2015;12(4):581-86.Feuerstein O. Light therapy: complementary antibacterial treatment of oral biofilm. Adv. Dent. Res. 2012;24:103-7.Longo JP, Leal SC, Simioni AR, Almeida-Santos FM, Tedesco AC, Azevedo RB. Photodynamic therapy disinfection of carious tissue mediated by aluminum-chloride-phthalocyanine entrapped in cationic liposomes: an in vitro and clinical study. Lasers Med. Sci. 2012;27:575-84.Araújo NC, Fontana CR, Bagnato VS, Gerbi ME. Photodynamic antimicrobial therapy of curcumin in biofilms and carious dentine. Lasers Med Sci. 2014;29(2):629-35.Teixeira AH, Pereira ES, Rodrigues LK, Saxena D, Duarte S, Zanin IC. Effect of photodynamic antimicrobial chemotherapy on in vitro and in situ biofilms. Caries Res. 2012;46(6):549-54.O'neill JF, Hope CK, Wilson M. Oral bacteria in multispecies biofilms can be killed by red light in the presence of toluidine blue. Lasers Surg Med. 2002;31(2):86-90.Dougherty TJ, Gomer CJ, Henderson BW, Jori G, Kessel D, Korbelik M et al. Photodynamic therapy. J Natl Cancer Inst. 1998;90(12);889-905.Dougherty TJ. An update on photodynamic therapy applications. J Clin Laser Med Surg. 2002;20(1):3-7.Bargrizan M, Fekrazad R, Goudarzi N, Goudarzi N. Effects of antibacterial photodynamic therapy on salivary mutans streptococci in 5- to 6-year-olds with severe early childhood caries. Lasers Med Sci. 2018;34(3):433-40.Hakimiha N. The susceptibility of Streptococcus mutans to antibacterial photodynamic therapy: a comparison of two diferente photosensitizers and light sources. J Appl Oral Sci. 2014;22:80-4.Baptista A, Kato IT, Prates RA, Suzuki LC, Raele MP, Freitas AZ et al. Antimicrobial photodynamic therapy as a strategy to arrest enamel demineralization: a short-term study on incipient caries in a rat model. Photochem Photobiol. 2012;88(3):584-89.Longo JPF, Azevedo RB. Efeito da terapia fotodinâmica mediada pelo azul de metileno sobre bactérias cariogênicas. Rev Clín Pesq Odontol. 2010;6(3):249-57.Guglielmi CA, Simionato MR, Ramalho KM, Imparato JC, Pinheiro SL, Luz MA et al. Clinical use of photodynamic antimicrobial chemotherapy for the treatment of deep carious lesions. J Biomed Opt. 2011;16(8):088003.Tonon CC, Paschoal MA, Correia M, Spolidório DM, Bagnato VS, Giusti JS et al. Comparative effects of protodynamic trerapy mediated by curcumin on standard and clinical isolate of streptococcus mutans. J Contemp Dental Pract. 2015;16(1):1-6.Araújo NC, Fontana CR, Bagnato VS, Gerbi ME. Photodynamic effects of curcumin against cariogenic pathogens. Photomed Laser Surg. 2012;30(7):393-99.Nagata JY, Hioka N, Kimura E, Batistela VR, Terada RS, Graciano AX, et al Antibacterial photodynamic therapy for dental caries: Evaluation of the photosensitizers used and light source properties. Photodiagnosis Photodyn Ther. 2012; 9: 122-31.Dias AA, Narvai PC, Rêgo DM. Tendências da produção científica em odontologia no Brasil. Rev Panam Salud Publica/Pan Am J Public Health. 2008;24(1):54-60.Baltazar LM, Ray A, Santos DA, Cisalpino PS, Friedman AJ, Nosanchuk JD. Antimicrobial photodynamic therapy: an effective alternative approach to control fungal infections Front Microbiol. 2015;6:202.Steiner-Oliveira C, Longo PL, Aranha AC, Ramalho KM, Mayer MP, Paula Eduardo C. Randomized in vivo evaluation of photodynamic antimicrobial chemotherapy on deciduous carious dentin. J Biomed Opt. 2015;20(10):108003.Martin ASS, Chisini LA, Martelli S, Sartori LRM, Ramos EC, Demarco FF. Distribuição dos cursos de Odontologia e de cirurgiões-dentistas no Brasil: uma visão do mercado de trabalho. Rev. ABENO. 2018;18(1):63-73.Scarpelli AC, Sadenberg F, Goursand D, Paiva SM, Pordeus IA. Academic trajectories of dental researchers receiving CNPq’s productivity grants. Braz Dent J. 2008;19(3):252-56.Oliveira Filho RS, Rochman B, Nahas FX, Ferreira LM. Fomento à publicação científica e proteção do conhecimento científico. Acta Cir Bras. 2005;20(Supl 2):35-9.Pinto GS, Nascimento GG, Mendes MS, Ogliari FA, Demarco FF, Correa MB. Scholarships for scientific initiation encourage post-graduation degree. Braz Dent J. 2014;25(1):63-8.Brasil. Ministério da Educação. Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. 2016. (Acesso em 01 de agosto de 2018). Disponível em: http://www.capes.gov.br/images/documentos/Documentos_de_area_2017/18_odon_docarea_2016.pdf.Allareddy V, Allareddy V, Rampa S, Nalliah RP, Elangovan S. 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 Perhaps nothing in media culture today makes clearer the connection between people’s bodies and their homes than the Emmy-winning reality TV program Extreme Makeover: Home Edition. Home Edition is a spin-off from the original Extreme Makeover, and that fact provides in fundamental form the strong connection that the show demonstrates between bodies and houses. The first EM, initially popular for its focus on cosmetic surgery, laser skin and hair treatments, dental work, cosmetics and wardrobe for mainly middle-aged and self-described unattractive participants, lagged after two full seasons and was finally cancelled entirely, whereas EMHE has continued to accrue viewers and sponsors, as well as accolades (Paulsen, Poniewozik, EMHE Website, Wilhelm). That viewers and the ABC network shifted their attention to the reconstruction of houses over the original version’s direct intervention in problematic bodies indicates that sites of personal transformation are not necessarily within our own physical or emotional beings, but in the larger surround of our environments and in our cultural ideals of home and body. One effect of this shift in the Extreme Makeover format is that a seemingly wider range of narrative problems can be solved relating to houses than to the particular bodies featured on the original show. Although Extreme Makeover featured a few people who’d had previously botched cleft palate surgeries or mastectomies, as Cressida Heyes points out, “the only kind of disability that interests the show is one that can be corrected to conform to able-bodied norms” (22). Most of the recipients were simply middle-aged folks who were ordinary or aged in appearance; many of them seemed self-obsessed and vain, and their children often seemed disturbed by the transformation (Heyes 24). However, children are happy to have a brand new TV and a toy-filled room decorated like their latest fantasy, and they thereby can be drawn into the process of identity transformation in the Home Edition version; in fact, children are required of virtually all recipients of the show’s largess. Because EMHE can do “major surgery” or simply bulldoze an old structure and start with a new building, it is also able to incorporate more variety in its stories—floods, fires, hurricanes, propane explosions, war, crime, immigration, car accidents, unscrupulous contractors, insurance problems, terrorist attacks—the list of traumas is seemingly endless. Home Edition can solve any problem, small or large. Houses are much easier things to repair or reconstruct than bodies. Perhaps partly for this reason, EMHE uses disability as one of its major tropes. Until Season 4, Episode 22, 46.9 percent of the episodes have had some content related to disability or illness of a disabling sort, and this number rises to 76.4 percent if the count includes families that have been traumatised by the (usually recent) death of a family member in childhood or the prime of life by illness, accident or violence. Considering that the percentage of people living with disabilities in the U.S. is defined at 18.1 percent (Steinmetz), EMHE obviously favours them considerably in the selection process. Even the disproportionate numbers of people with disabilities living in poverty and who therefore might be more likely to need help—20.9 percent as opposed to 7.7 percent of the able-bodied population (Steinmetz)—does not fully explain their dominance on the program. In fact, the program seeks out people with new and different physical disabilities and illnesses, sending out emails to local news stations looking for “Extraordinary Mom / Dad recently diagnosed with ALS,” “Family who has a child with PROGERIA (aka ‘little old man’s disease’)” and other particular situations (Simonian). A total of sixty-five ill or disabled people have been featured on the show over the past four years, and, even if one considers its methods maudlin or exploitive, the presence of that much disability and illness is very unusual for reality TV and for TV in general. What the show purports to do is to radically transform multiple aspects of individuals’ lives—and especially lives marred by what are perceived as physical setbacks—via the provision of a luxurious new house, albeit sometimes with the addition of automobiles, mortgage payments or college scholarships. In some ways the assumptions underpinning EMHE fit with a social constructionist body theory that posits an almost infinitely flexible physical matter, of which the definitions and capabilities are largely determined by social concepts and institutions. The social model within the disability studies field has used this theoretical perspective to emphasise the distinction between an impairment, “the physical fact of lacking an arm or a leg,” and disability, “the social process that turns an impairment into a negative by creating barriers to access” (Davis, Bending 12). Accessible housing has certainly been one emphasis of disability rights activists, and many of them have focused on how “design conceptions, in relation to floor plans and allocation of functions to specific spaces, do not conceive of impairment, disease and illness as part of domestic habitation or being” (Imrie 91). In this regard, EMHE appears as a paragon. In one of its most challenging and dramatic Season 1 episodes, the “Design Team” worked on the home of the Ziteks, whose twenty-two-year-old son had been restricted to a sub-floor of the three-level structure since a car accident had paralyzed him. The show refitted the house with an elevator, roll-in bathroom and shower, and wheelchair-accessible doors. Robert Zitek was also provided with sophisticated computer equipment that would help him produce music, a life-long interest that had been halted by his upper-vertebra paralysis. Such examples abound in the new EMHE houses, which have been constructed for families featuring situations such as both blind and deaf members, a child prone to bone breaks due to osteogenesis imperfecta, legs lost in Iraq warfare, allergies that make mold life-threatening, sun sensitivity due to melanoma or polymorphic light eruption or migraines, fragile immune systems (often due to organ transplants or chemotherapy), cerebral palsy, multiple sclerosis, Krabbe disease and autism. EMHE tries to set these lives right via the latest in technology and treatment—computer communication software and hardware, lock systems, wheelchair-friendly design, ventilation and air purification set-ups, the latest in care and mental health approaches for various disabilities and occasional consultations with disabled celebrities like Marlee Matlin. Even when individuals or familes are “[d]iscriminated against on a daily basis by ignorance and physical challenges,” as the program website notes, they “deserve to have a home that doesn’t discriminate against them” (EMHE website, Season 3, Episode 4). The relief that they will be able to inhabit accessible and pleasant environments is evident on the faces of many of these recipients. That physical ease, that ability to move and perform the intimate acts of domestic life, seems according to the show’s narrative to be the most basic element of home. Nonetheless, as Robert Imrie has pointed out, superficial accessibility may still veil “a static, singular conception of the body” (201) that prevents broader change in attitudes about people with disabilities, their activities and their spaces. Starting with the story of the child singing in an attempt at self-comforting from Deleuze and Guattari’s A Thousand Plateaus, J. MacGregor Wise defines home as a process of territorialisation through specific behaviours. “The markers of home … are not simply inanimate objects (a place with stuff),” he notes, “but the presence, habits, and effects of spouses, children, parents, and companions” (299). While Ty Pennington, EMHE’s boisterous host, implies changes for these families along the lines of access to higher education, creative possibilities provided by musical instruments and disability-appropriate art materials, help with home businesses in the way of equipment and licenses and so on, the families’ identity-producing habits are just as likely to be significantly changed by the structural and decorative arrangements made for them by the Design Team. The homes that are created for these families are highly conventional in their structure, layout, decoration, and expectations of use. More specifically, certain behavioural patterns are encouraged and others discouraged by the Design Team’s assumptions. Several themes run through the show’s episodes: Large dining rooms provide for the most common of Pennington’s comments: “You can finally sit down and eat meals together as a family.” A nostalgic value in an era where most families have schedules full of conflicts that prevent such Ozzie-and-Harriet scenarios, it nonetheless predominates. Large kitchens allow for cooking and eating at home, though featured food is usually frozen and instant. In addition, kitchens are not designed for the families’ disabled members; for wheelchair users, for instance, counters need to be lower than usual with open space underneath, so that a wheelchair can roll underneath the counter. Thus, all the wheelchair inhabitants depicted will still be dependent on family members, primarily mothers, to prepare food and clean up after them. (See Imrie, 95-96, for examples of adapted kitchens.) Pets, perhaps because they are inherently “dirty,” are downplayed or absent, even when the family has them when EMHE arrives (except one family that is featured for their animal rescue efforts); interestingly, there are no service dogs, which might obviate the need for some of the high-tech solutions for the disabled offered by the show. The previous example is one element of an emphasis on clutter-free cleanliness and tastefulness combined with a rampant consumerism. While “cultural” elements may be salvaged from exotic immigrant families, most of the houses are very similar and assume a certain kind of commodified style based on new furniture (not humble family hand-me-downs), appliances, toys and expensive, prefab yard gear. Sears is a sponsor of the program, and shopping trips for furniture and appliances form a regular part of the program. Most or all of the houses have large garages, and the families are often given large vehicles by Ford, maintaining a positive take on a reliance on private transportation and gas-guzzling vehicles, but rarely handicap-adapted vans. Living spaces are open, with high ceilings and arches rather than doorways, so that family members will have visual and aural contact. Bedrooms are by contrast presented as private domains of retreat, especially for parents who have demanding (often ill or disabled) children, from which they are considered to need an occasional break. All living and bedrooms are dominated by TVs and other electronica, sometimes presented as an aid to the disabled, but also dominating to the point of excluding other ways of being and interacting. As already mentioned, childless couples and elderly people without children are completely absent. Friends buying houses together and gay couples are also not represented. The ideal of the heterosexual nuclear family is thus perpetuated, even though some of the show’s craftspeople are gay. Likewise, even though “independence” is mentioned frequently in the context of families with disabled members, there are no recipients who are disabled adults living on their own without family caretakers. “Independence” is spoken of mostly in terms of bathing, dressing, using the bathroom and other bodily aspects of life, not in terms of work, friendship, community or self-concept. Perhaps most salient, the EMHE houses are usually created as though nothing about the family will ever again change. While a few of the projects have featured terminally ill parents seeking to leave their children secure after their death, for the most part the families are considered oddly in stasis. Single mothers will stay single mothers, even children with conditions with severe prognoses will continue to live, the five-year-old will sleep forever in a fire-truck bed or dollhouse room, the occasional grandparent installed in his or her own suite will never pass away, and teenagers and young adults (especially the disabled) will never grow up, marry, discover their homosexuality, have a falling out with their parents or leave home. A kind of timeless nostalgia, hearkening back to Gaston Bachelard’s The Poetics of Space, pervades the show. Like the body-modifying Extreme Makeover, the Home Edition version is haunted by the issue of normalisation. The word ‘normal’, in fact, floats through the program’s dialogue frequently, and it is made clear that the goal of the show is to restore, as much as possible, a somewhat glamourised, but status quo existence. The website, in describing the work of one deserving couple notes that “Camp Barnabas is a non-profit organisation that caters to the needs of critically and chronically ill children and gives them the opportunity to be ‘normal’ for one week” (EMHE website, Season 3, Episode 7). Someone at the network is sophisticated enough to put ‘normal’ in quotation marks, and the show demonstrates a relatively inclusive concept of ‘normal’, but the word dominates the show itself, and the concept remains largely unquestioned (See Canguilhem; Davis, Enforcing Normalcy; and Snyder and Mitchell, Narrative, for critiques of the process of normalization in regard to disability). In EMHE there is no sense that disability or illness ever produces anything positive, even though the show also notes repeatedly the inspirational attitudes that people have developed through their disability and illness experiences. Similarly, there is no sense that a little messiness can be creatively productive or even necessary. Wise makes a distinction between “home and the home, home and house, home and domus,” the latter of each pair being normative concepts, whereas the former “is a space of comfort (a never-ending process)” antithetical to oppressive norms, such as the association of the home with the enforced domesticity of women. In cases where the house or domus becomes a place of violence and discomfort, home becomes the process of coping with or resisting the negative aspects of the place (300). Certainly the disabled have experienced this in inaccessible homes, but they may also come to experience a different version in a new EMHE house. For, as Wise puts it, “home can also mean a process of rationalization or submission, a break with the reality of the situation, self-delusion, or falling under the delusion of others” (300). The show’s assumption that the construction of these new houses will to a great extent solve these families’ problems (and that disability itself is the problem, not the failure of our culture to accommodate its many forms) may in fact be a delusional spell under which the recipient families fall. In fact, the show demonstrates a triumphalist narrative prevalent today, in which individual happenstance and extreme circumstances are given responsibility for social ills. In this regard, EMHE acts out an ancient morality play, where the recipients of the show’s largesse are assessed and judged based on what they “deserve,” and the opening of each show, when the Design Team reviews the application video tape of the family, strongly emphasises what good people these are (they work with charities, they love each other, they help out their neighbours) and how their situation is caused by natural disaster, act of God or undeserved tragedy, not their own bad behaviour. Disabilities are viewed as terrible tragedies that befall the young and innocent—there is no lung cancer or emphysema from a former smoking habit, and the recipients paralyzed by gunshots have received them in drive-by shootings or in the line of duty as police officers and soldiers. In addition, one of the functions of large families is that the children veil any selfish motivation the adults may have—they are always seeking the show’s assistance on behalf of the children, not themselves. While the Design Team always notes that there are “so many other deserving people out there,” the implication is that some people’s poverty and need may be their own fault. (See Snyder and Mitchell, Locations 41-67; Blunt and Dowling 116-25; and Holliday.) In addition, the structure of the show—with the opening view of the family’s undeserved problems, their joyous greeting at the arrival of the Team, their departure for the first vacation they may ever have had and then the final exuberance when they return to the new house—creates a sense of complete, almost religious salvation. Such narratives fail to point out social support systems that fail large numbers of people who live in poverty and who struggle with issues of accessibility in terms of not only domestic spaces, but public buildings, educational opportunities and social acceptance. In this way, it echoes elements of the medical model, long criticised in disability studies, where each and every disabled body is conceptualised as a site of individual aberration in need of correction, not as something disabled by an ableist society. In fact, “the house does not shelter us from cosmic forces; at most it filters and selects them” (Deleuze and Guattari, What Is Philosophy?, qtd. in Frichot 61), and those outside forces will still apply to all these families. The normative assumptions inherent in the houses may also become oppressive in spite of their being accessible in a technical sense (a thing necessary but perhaps not sufficient for a sense of home). As Tobin Siebers points out, “[t]he debate in architecture has so far focused more on the fundamental problem of whether buildings and landscapes should be universally accessible than on the aesthetic symbolism by which the built environment mirrors its potential inhabitants” (“Culture” 183). Siebers argues that the Jamesonian “political unconscious” is a “social imaginary” based on a concept of perfection (186) that “enforces a mutual identification between forms of appearance, whether organic, aesthetic, or architectural, and ideal images of the body politic” (185). Able-bodied people are fearful of the disabled’s incurability and refusal of normalisation, and do not accept the statistical fact that, at least through the process of aging, most people will end up dependent, ill and/or disabled at some point in life. Mainstream society “prefers to think of people with disabilities as a small population, a stable population, that nevertheless makes enormous claims on the resources of everyone else” (“Theory” 742). Siebers notes that the use of euphemism and strategies of covering eventually harm efforts to create a society that is home to able-bodied and disabled alike (“Theory” 747) and calls for an exploration of “new modes of beauty that attack aesthetic and political standards that insist on uniformity, balance, hygiene, and formal integrity” (Culture 210). What such an architecture, particularly of an actually livable domestic nature, might look like is an open question, though there are already some examples of people trying to reframe many of the assumptions about housing design. For instance, cohousing, where families and individuals share communal space, yet have private accommodations, too, makes available a larger social group than the nuclear family for social and caretaking activities (Blunt and Dowling, 262-65). But how does one define a beauty-less aesthetic or a pleasant home that is not hygienic? Post-structuralist architects, working on different grounds and usually in a highly theoretical, imaginary framework, however, may offer another clue, as they have also tried to ‘liberate’ architecture from the nostalgic dictates of the aesthetic. Ironically, one of the most famous of these, Peter Eisenman, is well known for producing, in a strange reversal, buildings that render the able-bodied uncomfortable and even sometimes ill (see, in particular, Frank and Eisenman). Of several house designs he produced over the years, Eisenman notes that his intention was to dislocate the house from that comforting metaphysic and symbolism of shelter in order to initiate a search for those possibilities of dwelling that may have been repressed by that metaphysic. The house may once have been a true locus and symbol of nurturing shelter, but in a world of irresolvable anxiety, the meaning and form of shelter must be different. (Eisenman 172) Although Eisenman’s starting point is very different from that of Siebers, it nonetheless resonates with the latter’s desire for an aesthetic that incorporates the “ragged edge” of disabled bodies. Yet few would want to live in a home made less attractive or less comfortable, and the “illusion” of permanence is one of the things that provide rest within our homes. Could there be an architecture, or an aesthetic, of home that could create a new and different kind of comfort and beauty, one that is neither based on a denial of the importance of bodily comfort and pleasure nor based on an oppressively narrow and commercialised set of aesthetic values that implicitly value some people over others? For one thing, instead of viewing home as a place of (false) stasis and permanence, we might see it as a place of continual change and renewal, which any home always becomes in practice anyway. As architect Hélène Frichot suggests, “we must look toward the immanent conditions of architecture, the processes it employs, the serial deformations of its built forms, together with our quotidian spatio-temporal practices” (63) instead of settling into a deadening nostalgia like that seen on EMHE. If we define home as a process of continual territorialisation, if we understand that “[t]here is no fixed self, only the process of looking for one,” and likewise that “there is no home, only the process of forming one” (Wise 303), perhaps we can begin to imagine a different, yet lovely conception of “house” and its relation to the experience of “home.” Extreme Makeover: Home Edition should be lauded for its attempts to include families of a wide variety of ethnic and racial backgrounds, various religions, from different regions around the U.S., both rural and suburban, even occasionally urban, and especially for its bringing to the fore how, indeed, structures can be as disabling as any individual impairment. That it shows designers and builders working with the families of the disabled to create accessible homes may help to change wider attitudes and break down resistance to the building of inclusive housing. 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