Lesões de cárie incipientes em dentes decíduos: estudo clínico randomizado e revisão sistemática com metanálise

• Ano de defesa: 2019
• Autor(a) principal: Campos, Priscila Hernández de
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Cruzeiro do Sul; Brasil; Campus Liberdade; Doutorado em Odontologia; Cruzeiro do Sul
• Palavras-chave em Português: Cárie dentária; Ensaio clínico; Metanálise; CNPQ::CIENCIAS DA SAUDE::ODONTOLOGIA
• Link de acesso: https://repositorio.cruzeirodosul.edu.br/handle/123456789/359

The present study aimed to (1) evaluate the prevalence of white spot lesions (WSLs) in primary dentition through a systematic review and meta-analysis. The second aim was (2) to evaluate the efficacy of fluoride toothpastes with and without arginine in the remineralization of active WSLs in preschool children using a randomized controlled clinical trial (RCT). To this end, two studies were conducted. Research (1) evaluate systematically articles published before 2017 that investigated the prevalence of incipient caries lesions in primary teeth of children up to 5 years of age. A detailed search was conducted using the PubMed/MEDLINE, Scopus, Open Gray, and Web of Science databases based on the PECO strategy (Patient, Exposure, Control, and Outcome). Then, the evaluation of the titles and abstracts of the articles were carried out by two examiners. In cases of divergence, a discussion was held with a third experienced evaluator in the subject until a consensus was reached. Subsequently, selected articles were read in full to evaluate the exclusion criteria. Sixteen studies were included in the analysis. Qualitative evaluation was carried out using the Joanna Briggs Critical Appraisal Checklist. Meta-analysis was performed using a random effects model and the Higgins I2 statistical percentage and Cochran’s Q test to analyze the global prevalence of WSLs in primary teeth. Subsequent evaluation of subgroups aimed to elucidate the effects of mean preschool age, countries income and validation of evaluation instruments. It was observed a 14.0% global WSL prevalence in primary teeth, without publication bias (p=0.2668). While evaluating the subgroups, it was observed an increase in global prevalence (18.0%) as preschool age increased (>30 months), in countries classified as low-income economies (24.0%), and when validated criteria were used for lesion detection (20.0%). It can be concluded that the global WSL prevalence in preschool children's primary teeth is 14%, which rose as age increased, average income for the country decreased and when validated criteria were used for identification. Research (2) compared toothpaste containing 1.5% arginine and 1,450 ppm sodium monofluorophosphate (MFP), with a positive control toothpaste containing only 1,450 ppm MFP, in remineralizing active WSLs on primary teeth in children from 3 to 5 years of age. This double-blind RCT was conducted over 3 months in the east region of São Paulo, Brazil. Tooth brushing was performed 3 times a day under the supervision of parents/guardians and teachers/caregivers. WSLs were clinically evaluated using the ICDAS (International Caries Detection and Assessment System) visual criteria to determine their extent and to assess caries activity using staining and texture clinical criteria. Lesion area was evaluated by digital photography and measured in mm2 using ImageJ software. A DIAGNOdent pen laser fluorescence device was used to monitor the lesions. Analyses were performed by a single experienced, trained and calibrated examiner, at baseline and after 3 months of toothpaste use. Statistical analyses were performed using a two-factor repeated measures ANOVA for associations between the study phases and treatment type. Fisher's exact test, the Chi-square test and logistic regression were employed to analyze the regression or progression of lesions according to treatment type. A statistically significant difference was observed between the dmf-t index and the study phase, with an increase in dmf-t index after 3 months (p=0.005840). For lesion area (mm2) and DIAGNOdent pen fluorescence values, there was a statistically significant difference regarding the treatment type (p=0.024841 and p=0.038598, respectively); with larger lesions in the control group. Concerning WSLs activity and ICDAS scores, there were statistically significant differences for each treatment type (p<0.00001 and p= 0.005815). Regarding the transition of WSLs (progression and regression) there was no statistically significant difference between the two groups (p>0.05), regardless of the caries experience classification of the participating children (odds ratio [OR]=0.7953); low experience (OR=0.6667) or high experience (OR=0.9524). It can be concluded that the toothpaste containing arginine was not able to significantly improve enamel remineralization compared to the control toothpaste when treating active WSLs in primary teeth of preschool children after 3 months of follow-up.