Having an appropriate understanding of the behavioral and physiological impact of a disease requires thoroughly fielded tests and wide-ranging animal models to properly deduce generalized impacts of the disease under investigation. Through novel animal models, we acquire diverse insights into the mechanisms at play so that we may approach the problem at hand with fresh perspective and renewed vigor. Using the naked mole-rat (Heterocephalus glaber), a species becoming increasingly common in the medical sciences, my dissertation aimed to accomplish the aforementioned goals in two parts: 1) take the naked mole-rat through a battery of behavioral tasks to bolster our capabilities of using this animal model in medical research; and 2) introduce the naked mole-rat as an alternative model for the investigation of how loss of dental sensation alters behavior and neuroanatomy. Chapter two describes the many methods with which I tested the naked mole-rat across a variety of typical behavioral tasks for social dominance, learning and memory, anxiety, depression, and sociability. Included herein were tests to determine appropriate motivators for this subterranean species to perform such tasks. Additionally, due to the naked mole-rat’s unique disposition for biting, I measured their biting behaviors and compared them across rodent and other mammalian species. The results show that naked mole-rats exhibit large evolutionary divergence in their sensory capabilities and great consideration needs to be given to the proper behavioral tasks and subsequent evaluations of these behavioral paradigms. In chapter three, I evaluated the impact of tooth extraction on affective behaviors, learning and memory, and sociability. Chapter four sought to uncover underlying neuroplasticity associated with the behavioral tasks performed in chapter three. Additionally, in chapter four, I investigated plasticity of the traditional somatosensory pathway for tooth sensation. Tooth loss decreased neuronal density of contralateral ventral posteromedial nucleus of the thalamus and increased the neuronal density of the contralateral ventral dentate gyrus, indicating that tooth-loss induced neuronal plasticity may be more related to plasticity of pain circuitry or resultant from alterations in the muscles of mastication following tooth loss. Though no significant changes in the hippocampus arose from one year of living with no right incisor, I theorized as to which of the physiological idiosyncrasies exhibited by Heterocephalus glaber may have inhibited any observable plasticity due to tooth loss.

150 Schädel von Tieren verschiedener Altersgruppen einer geschlossenen Population des Berliner Miniaturschweines wurden bezüglich ihrer Dentition und der Okklusionsbeziehungen als Grundlage für den Einsatz dieser Modelltierart für zahnmedizinische Untersuchungen betrachtet. Die Population wurde anhand von 92 Reinzucht-, 28 Inzuchttieren sowie 30 Schädeln von Tieren der ersten und zweiten Rückkreuzungsgeneration an das Berliner Miniaturschwein nach Einkreuzung eines Ebers der Belgischen Landrasse sowie der Auswertung von Eberlinien und Sauenfamilien züchterisch untersucht. Angaben zum Zahndurchbruch und -wechsel, die anhand der Festlegung von drei Durchbruchstadien gewonnen wurden, standen bei möglicher Vergleichbarkeit im wesentlichen im Einklang mit den Literaturrecherchen. Die Untersuchung von Anomalien der Zahnzahl, die sich nur als Zahnunterzahl manifestierte, ergab neben dem vereinzelten Fehlen einiger Zähne eine Oligodontie des unteren P1 bei 88% der Tiere. Die in der Literatur dargestellte Rassenabhängigkeit dieses Merkmals konnte anhand von 30 untersuchten Tieren mit Anteilen der Belgischen Landrasse aufgezeigt werden. Die erstmals ausführliche Bestimmung der transversalen, vertikalen und sagittalen Okklusionsverhältnisse beim Schwein erfolgte vor allem im Hinblick auf eine Nutzung als Modelltier in der Zahnmedizin mit Hilfe der Begriffe der kieferorthopädischen Diagnostikmethoden des Menschen unter Beachtung der morphologischen Unterschiede. Die transversalen Okklusionsbeziehungen im Seitenzahngebiet, die im Gegensatz zum Menschen an zwei Zahnformen untersucht werden müssen, zeigten sich bei den älteren Tieren in einer großen Vielfalt, sowohl innerhalb der Population als auch an einem Schädel. Die Untersuchung der vertikalen Okklusionsbeziehungen erbrachte keine schweren Anomalien in der untersuchten Population des Berliner Miniaturschweines. Die Betrachtung der sagittalen Okklusionsbeziehungen erfolgte aufgrund der lückigen Anordnung der Zähne beim Schwein gesondert für den Front-, Eck- und Seitenzahnbereich. Das Überwiegen von beim Menschen als abweichende sagittale Frontzahnbeziehung bezeichneten progenen Formen beim Berliner Miniaturschwein, wird unter morphologischen, funktionellen und rassenspezifischen Aspekten diskutiert. Die Untersuchung der sagittalen Okklusionsbeziehungen im Eckzahngebiet auf der Grundlage der Bestimmung der Lage der Alveolen zueinander ergaben aufgrund der lückigen Anordnung der Zähne verschiedenen Lagen der Alveolen zueinander aber auch verschiedene Okklusionsbeziehungen. Die sagittalen Okklusionsbeziehungen im Seitenzahngebiet erwiesen sich in der untersuchten Population bei der Bestimmung anhand der beim Menschen geltenden Grundsätze als sehr ausgeglichen. / 150 skulls of Berlin miniaturpigs of several ages of a closed population were considerd in their dentition and occlusion to serve as a basis for the use as an experimental animal for dental research. The population was researched on 92 pure-breed animals, 28 inbreeding animals and 30 backcrossed animals of Berlin minaturpigs after having crossed a boar of the Belgian Landrace. Details about the eruption and change of teeth determined by three phases of eruption were corresponding with literature by possible comparability. The research of anomaly of the number of teeth only indicated by supernumery resulted besides missing of ocassional teeth in supernumery of the first lower premolar in 88% of the animals. The 30 animals with portions of Belgian Landrace have shown the race dependency of this characteristic. Because of the use as an experimental animal the first detailed definition of transversal, vertical and sagittal occlusal relationships of pigs were studied with guidelines used in human orthodontics in compliance with the morphological differences. The transversal occlusal relationships, determined at two different forms of teeth in the premolar and molar area of the pig have shown a great variety of older animals inside the population and of one skull. The vertical occlusal studies did not result in strong abnormal teeth positions. The studies of sagittal occlusal relationships were carried out separately in the area of front teeth, canine teeth and premolars and molars too. The predominated progenic positioning of front teeth of Berlin miniaturpig, in men called as malocclusion, is discussed under morphological and functional aspects and also specific for breeds. In the area of canine teeth, determined on the basis of the alveolar position of these teeth, several alveolar positions and also several occlusal positions were found because of the spaces between the teeth. The sagittal occlusal relationships in the area of premolars and molars, determined with guidelines used in orthodontics in men, were very homologous.

In den letzten Jahren kam es in den deutschsprachigen Ländern zu einem sprunghaften Anstieg forensischer Altersschätzungen bei lebenden Personen. Der strafrechtlich relevante Hintergrund dieser Altersschätzungen besteht in der Beurteilung der Strafmündigkeit bzw. der Anwendbarkeit des Erwachsenenstrafrechts bei Beschuldigten ohne gesicherte Altersangaben. Entsprechend den Empfehlungen der "Arbeitsgemeinschaft für Forensische Altersdiagnostik" sollten für eine Altersschätzung im Strafverfahren eine körperliche Untersuchung mit Erfassung anthropometrischer Maße, der sexuellen Reifezeichen sowie möglicher altersrelevanter Entwicklungsstörungen, eine Röntgenuntersuchung der linken Hand sowie eine zahnärztliche Untersuchung mit Erhebung des Zahnstatus und Auswertung eines Orthopantomogramms eingesetzt werden. Zur Frage der Vollendung des 21. Lebensjahrs wird eine zusätzliche Röntgen- bzw. CT-Untersuchung der Schlüsselbeine empfohlen. Da für die Herkunftsregionen der zu untersuchenden Personen in der Regel keine forensisch verwertbaren Referenzstudien vorliegen, stellt sich die Frage, ob es gravierende Entwicklungsunterschiede bei verschiedenen ethnischen Gruppen gibt, die eine Anwendung der einschlägigen Altersstandards bei Angehörigen anderer ethnischer Gruppen als der Referenzpopulation verbieten würden. Die Skelettreifung wird in der betreffenden Altersgruppe offenbar nicht relevant von der ethnischen Zugehörigkeit der untersuchten Personen beeinflusst. Da für Röntgenuntersuchungen zur forensischen Altersdiagnostik keine medizinische Indikation besteht, ist für deren Durchführung eine richterliche Anordnung auf der Grundlage des § 81a der Strafprozessordnung erforderlich. Gesundheitliche Nachteile für die untersuchten Personen aufgrund der Strahlenexposition der eingesetzten Röntgenuntersuchungen sind nicht zu befürchten. Forschungsdesiderate bestehen in der Angabe von statistisch gesicherten Streubreiten bei kombinierter Anwendung der empfohlenen Methoden, in der Frage des Einflusses der Ethnie auf die sexuelle Reifeentwicklung, die Weisheitszahneruption und die Weisheitszahnmineralisation sowie in der Überprüfung nicht ionisierender bildgebender Verfahren für die forensische Altersdiagnostik. / In the German-speaking area, recent years have seen a rapid growth of the need for forensic age estimations. If, for example, no verified information on the age of a person suspected of a criminal offence is available, the need arises to determine whether the suspect has reached the age of criminal responsibility and general criminal law in force for adults is to be applied. According to recommendations of the Study Group on Forensic Age Diagnostics, age estimations carried out for the purpose of criminal proceedings should consist of a physical examination which also records anthropometric data, signs of sexual maturation and potential age-relevant developmental disorders, as well as of an X-ray of the left hand and a dental examination which records dentition status and evaluates an orthopantomogram. In addition, a radiological or computed tomographic examination of the clavicles is recommended to establish whether a person has attained 21 years of age. Since reference studies that could be used for forensic purposes are generally not available for the areas of origin of the persons under examination, the question arises whether there are significant developmental differences between various ethnic groups which would contradict the application of relevant age standards to members of ethnic groups other than the reference population. As far as the relevant age group is concerned, ethnic origin apparently exerts no significant influence on skeletal maturation. Since there is no medical indication for X-ray examinations carried out for forensic age estimations, a court order under Section 81a of the Code of Criminal Procedure is required in Germany to authorize the necessary examinations. There is no reason to fear that the amount of radiation a person is exposed to during the X-ray examinations will have a detrimental effect on his/her health. Future research will have to provide statistically sound data on the ranges of scatter for combined use of the recommended methods, quantify the impact of ethnicity on sexual maturation, the eruption and mineralization of third molars, as well as review the suitability of non-ionizing imaging methods for forensic age estimation purposes.

Made available in DSpace on 2014-06-11T19:27:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-12-21Bitstream added on 2014-06-13T18:31:56Z : No. of bitstreams: 1 assuncao_lrs_me_araca.pdf: 464091 bytes, checksum: 39cdccddc9b32a15cb7ae244ad3645f3 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Estudos mostram que os traumatismos na dentição decídua são comuns, podendo trazer também comprometimentos aos dentes permanentes em desenvolvimento. O propósito desta pesquisa foi avaliar os traumatismos em dentes decíduos e as seqüelas nos dentes permanentes sucessores, em crianças atendidas no Pronto Atendimento da Bebê Clínica, da Universidade Estadual de Londrina, entre os anos de 1992 a 2002. Da análise de 1703 prontuários que apresentavam relato de traumatismos nos dentes decíduos, 864 atenderam os critérios de inclusão propostos para este estudo, sendo que 409 crianças foram localizadas e compareceram ao local de exame. Os prontuários destas crianças foram estudados a fim de se obter informações a respeito do trauma. O exame clínico e radiográfico foi realizado com o objetivo de verificar as seqüelas nos dentes permanentes em decorrência dos traumatismos nos antecessores decíduos. Para a análise destas seqüelas, a amostra foi dividida em 2 grupos, sendo o Grupo I constituindo as crianças com apenas uma ocorrência de traumatismo nos dentes decíduos e o Grupo II, aquelas com mais de uma ocorrência. A freqüência de injúrias traumáticas nos dentes decíduos foi de 31,9% no total dos 1703 prontuários avaliados. Das crianças examinadas, o gênero masculino foi o mais acometido (57%) e a idade da criança no momento do trauma entre 6 e 24 meses, a mais observada (38,4%). As quedas de uma forma geral, e entre estas, aquelas causadas pelo andar e correr foram os fatores etiológicos mais predominantes (37,8%). O tempo decorrido entre o trauma e a procura por atendimento foi mais averiguado no periodo de até 1 dia (43,5%). Dos 679 dentes decíduos avaliados, o incisivo central superior direito foi o mais afetado (42,0%) e a subluxação, o tipo de traumatismo mais prevalente... / Studies show dental trauma in primary teeth as common happening and the risk of compromising the permanent teeth in developing process. The purpose of this research was to evaluate the dental trauma in primary teeth and its sequelae in the successor permanent teeth in children attended at Pronto Atendimento da Bebê Clínica, State University of Londrina, from 1992 to 2002. From the analysis of 1703 children presenting cases of dental trauma in primary teeth, 864 attended the criteria of inclusion proposed to this study. From the total above 409 children were located and came to the examine place. The data of these children were studied in order to obtain precise information regarding trauma. The clinical and radiographic exams were carried out with the objective to verify sequelae in the permanent teeth due to traumas caused on the predecessor deciduous. For the analysis of these sequelae the sample was divided into 2 groups: Group I, consist of children with only one occurrence of trauma in the primary teeth and group II, of those with more occurrences. The frequency of traumatic injuries in the deciduous teeth was 31,9% in total of the 1703 cases evaluated. From the examined children, masculine gender was the most compromised (57%) and the age of the child in the moment of the trauma was between 6 and 24 moths (38,4%). Falls in general, among those caused by walking and runnings were the etiologic predominant factors (37,8%). The time between trauma and seeing the dentist was done in a period of a day (43,5%). From 679 deciduous teeth evaluated, the right maxillary central incisor was the most affected (42,0%) and the subluxation, type of trauma more frequent (32,5%). In regard to the treatment recommended to the primary teeth monitoring was the most used ...( Complete abstract click electronic address below)

Les poissons-perroquets, séparés en deux tribus les Scarini et les Sparisomatini, se sont diversifiés au sein des Labridae à partir d’ancêtres carnivores. L’un des facteurs essentiels pour expliquer cette diversification est leur exploitation d’une nouvelle niche trophique : les microorganismes. La plupart des Sparisomatini paissent des macroalgues pour y extraire les micro-organismes épiphytiques tandis que les poissons-perroquets brouteurs (tous les Scarini, certains Sparisoma) raclent ou creusent le substrat rocheux pour y récolter les microorganismes épilithiques et endolithiques. Ces changements de comportement alimentaire se sont accompagnés de nombreuses évolutions dentaires avec notamment la présence de plaques dentaires chez les brouteurs mais aussi certains paisseurs. Les phylogénies moléculaires ont contredit le précédent scénario évolutif sur la denture des poissons-perroquets qui stipulait l’apparition progressive de plaques dentaires à partir de dentures à dents non recouvertes d’os (dents libre s). Cette thèse se propose de réexaminer l’évolution de la denture chez les poissons -perroquets en se basant sur les progrès phylogénétiques mais aussi techniques (microtomographie 3D), tout en faisant le lien avec leur régime et leur fonction écologique. / Parrotfishes, divided into the tribes Scarini and Sparisomatini , are labrid fishes that arouse from carnivorous ancestors. One of the main factors that explain this radiation is the exploitation of microorganisms as a food source. While most Sparisomatini browse macroalgae to get epiphytic microorganisms, grazing parrotfishes (all Scarini and some Sparisoma) scrap or excavate hard substrate to obtain epilithic and endolithic microorganisms. Changes in feeding behaviour are associated with dentition specialization with notably dental plates in grazing but also some browsing parrotfishes. Gene-based phylogenies contradicted the previous evolutionary scenario about parrotfish dentition evolution, which states the progressive emergence of dental plates from non-coalesced dentitions. This thesis manuscript aims to re-examine the evolution of parrotfish dentitions in the light of the new phylogenies by using X-ray 3D microtomography, and to link this evolution with diet and ecology.

O propósito deste estudo foi contribuir para a análise da epidemiologia da oclusão dentária na infância e discutir a implicação para os sistemas de saúde, examinando dados de prevalência de uma amostra probabilística (n=985) da população de 5 e 12 anos de idade na cidade de São Paulo, Brasil (1996); e estudos epidemiológicos transversais publicados nos últimos 70 anos. A prevalência na cidade, cresceu de 49,0 ± 4,5 por cento na dentição decídua para 71,3 ± 3,9 por cento na dentição permanente (p<0,001), sendo que a chance de ocorrência de oclusopatia moderada/severa foi quase duas vezes maior na segunda dentição (OR=1,87; IC95 por cento =1,43-2,45; p<O,OOO). O ataque de cárie acima das metas da OMS para o ano 2000 mostrou associação positiva com a severidade do dano (OR=1,51; IC95s por cento =1,15-1,99; p<0,003). Análise de regressão logística múltipla mostrou que o risco estimado da população portadora de dentição permanente e com experiência de cárie acima dessas metas apresentar oclusopatia moderada/severa se elevou de 22 por cento para 50 por cento . Sexo, tipo de escola (pública e privada) e diferenças étnicas entre brancos e pardos não influenciaram essa distribuição. O exame da literatura através de meta-análise indicou que a prevalência dos problemas oclusais foi duas vezes maior na dentição permanente quando comparada às dentições decídua/mista. Tanto a realização de estudos longitudinais quanto de levantamentos e triagens para a identificação e o tratamento dos casos mais severos, não apenas no período da dentição permanente, mas também nas dentições decídua/mista, combinado à introdução de ações de proteção específica em programas materno-infantis direcionadas ao desenvolvimento oro-facial dos zero aos 6 anos são medidas que devem ser consideradas no planejamento estratégico e normativo dos sistemas de saúde. Métodos de intervenção em saúde pública devem ser pesquisados e implementados o mais precocemente possível para aumentar a proporção da população com oclusão normal e reduzir o percentual de oclusopatia moderada/severa. / The purpose of this study was to analyze some epidemiological aspects of dental occlusal problems at childhood and to discuss their implications for health systems. It were used prevalence data of a probabilistic sample (n=985) of five and twelve years old schoolchildren in São Paulo City, Brazil (1996); and cross-sectional data of studies published in the last 70 years. The results showed that the proportion of these problems in the city increased from 49.0 ± 4.5 per cent at deciduous dentition to 71.3 ± 3.9 per cent at permanent dentition (p<O,OO1), and the risk to severe/moderate malocclusion was closely twice higher at second dentition (OR= 1.87; CI95 per cent = 1.43-2.45; p<O,OOO). Caries experience above OMS goals for the year 2000 indicated positive association with severity of injury (OR= 1.51; CI95 per cent = 1.15-1.99; p<0,003). Multiple logistic regression analysis pointed out that risk estimative related to population carrier of permanent dentition and caries experience above these goals to present severe/moderate malocclusion growed up from 22 per cent to 50 per cent . Sex, kind of school (public and private) and ethnics diferences between whites and african-brazilians did not affect this distribution. The examination of literature through metanalysis showed that prevalence was twice higher at permanent dentition than deciduous/mixed. The realization of longitudinal studies as much as surveys and screenings to identify and care people with severe occlusal problems not only at permanent dentition but also at deciduous dentition, allied to especific protection measures on maternal-childhood programmes directed to orofacial development from O to 6 years old are aspects to be considering at estrategic and normative planning of health systems. Public health methods must be researched and introduced as earlier as possible in order to increase the proportion of population with normal occlusion and reduce the amount of severe/moderate malocclusion.

O propósito deste estudo foi contribuir para a análise da epidemiologia da oclusão dentária na infância e discutir a implicação para os sistemas de saúde, examinando dados de prevalência de uma amostra probabilística (n=985) da população de 5 e 12 anos de idade na cidade de São Paulo, Brasil (1996); e estudos epidemiológicos transversais publicados nos últimos 70 anos. A prevalência na cidade, cresceu de 49,0 ± 4,5 por cento na dentição decídua para 71,3 ± 3,9 por cento na dentição permanente (p<0,001), sendo que a chance de ocorrência de oclusopatia moderada/severa foi quase duas vezes maior na segunda dentição (OR=1,87; IC95 por cento =1,43-2,45; p<O,OOO). O ataque de cárie acima das metas da OMS para o ano 2000 mostrou associação positiva com a severidade do dano (OR=1,51; IC95s por cento =1,15-1,99; p<0,003). Análise de regressão logística múltipla mostrou que o risco estimado da população portadora de dentição permanente e com experiência de cárie acima dessas metas apresentar oclusopatia moderada/severa se elevou de 22 por cento para 50 por cento . Sexo, tipo de escola (pública e privada) e diferenças étnicas entre brancos e pardos não influenciaram essa distribuição. O exame da literatura através de meta-análise indicou que a prevalência dos problemas oclusais foi duas vezes maior na dentição permanente quando comparada às dentições decídua/mista. Tanto a realização de estudos longitudinais quanto de levantamentos e triagens para a identificação e o tratamento dos casos mais severos, não apenas no período da dentição permanente, mas também nas dentições decídua/mista, combinado à introdução de ações de proteção específica em programas materno-infantis direcionadas ao desenvolvimento oro-facial dos zero aos 6 anos são medidas que devem ser consideradas no planejamento estratégico e normativo dos sistemas de saúde. Métodos de intervenção em saúde pública devem ser pesquisados e implementados o mais precocemente possível para aumentar a proporção da população com oclusão normal e reduzir o percentual de oclusopatia moderada/severa. / The purpose of this study was to analyze some epidemiological aspects of dental occlusal problems at childhood and to discuss their implications for health systems. It were used prevalence data of a probabilistic sample (n=985) of five and twelve years old schoolchildren in São Paulo City, Brazil (1996); and cross-sectional data of studies published in the last 70 years. The results showed that the proportion of these problems in the city increased from 49.0 ± 4.5 per cent at deciduous dentition to 71.3 ± 3.9 per cent at permanent dentition (p<O,OO1), and the risk to severe/moderate malocclusion was closely twice higher at second dentition (OR= 1.87; CI95 per cent = 1.43-2.45; p<O,OOO). Caries experience above OMS goals for the year 2000 indicated positive association with severity of injury (OR= 1.51; CI95 per cent = 1.15-1.99; p<0,003). Multiple logistic regression analysis pointed out that risk estimative related to population carrier of permanent dentition and caries experience above these goals to present severe/moderate malocclusion growed up from 22 per cent to 50 per cent . Sex, kind of school (public and private) and ethnics diferences between whites and african-brazilians did not affect this distribution. The examination of literature through metanalysis showed that prevalence was twice higher at permanent dentition than deciduous/mixed. The realization of longitudinal studies as much as surveys and screenings to identify and care people with severe occlusal problems not only at permanent dentition but also at deciduous dentition, allied to especific protection measures on maternal-childhood programmes directed to orofacial development from O to 6 years old are aspects to be considering at estrategic and normative planning of health systems. Public health methods must be researched and introduced as earlier as possible in order to increase the proportion of population with normal occlusion and reduce the amount of severe/moderate malocclusion.

Universidade do Estado do Rio de Janeiro / Apesar do potencial anticárie do dentifrício fluoretado na dentição permanente estar bem estabelecido, existe uma lacuna no conhecimento em relação ao seu efeito na dentição decídua; não existe consenso quanto à concentração ideal de fluoreto no dentifrício capaz de maximizar o benefício anticárie na dentição decídua e simultaneamente minimizar o risco de desenvolver fluorose clinicamente importante na dentição permanente. O artigo 1 desta tese avaliou o efeito dos dentifrícios de concentração baixa (menos de 600 ppm) e padrão (1000 a 1500 ppm) de fluoreto comparados com placebo ou nenhuma intervenção e o artigo 2 comparou diretamente o efeito do dentifrício de concentração baixa de fluoreto com o de concentração padrão. Foi realizada uma revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados. Dois examinadores leram, de forma independente, 1932 resumos ou citações e 159 estudos na íntegra. As discordâncias foram resolvidas por um terceiro examinador. Oito estudos foram incluídos no artigo 1 e cinco no artigo 2. Para avaliar o efeito dos dentifrícios fluoretados sobre o número de dentes e superfícies dentárias cariadas, perdidas por cárie e obturadas, e sobre o número de crianças com cárie e fluorose, foram estimados frações prevenidas (FP) e riscos relativos (RR) combinados, respectivamente. Quando os dentifrícios de concentração padrão de fluoreto foram comparados com placebo ou nenhuma intervenção, houve reduções significativas de cárie no nível de superfície (FP= 31%; IC 95% 18 43), dente (FP= 16%; IC 95% 7 24) e indivíduo (RR= 0,86; IC 95% 0,81 0,93). Quando os dentifrícios de concentração baixa de fluoreto foram comparados com nenhuma intervenção, houve redução significativa de cárie apenas no nível de superfície (FP= 40%; IC 95% 5 75) (artigo 1). Os dentifrícios de concentração baixa de fluoreto, comparados diretamente com os de concentração padrão, aumentaram significativamente o risco de cárie na dentição decídua (RR= 1,13; IC 95% 1,07 1,20) e não reduziram significativamente o risco de fluorose clinicamente importante nos dentes permanentes anteriores superiores (RR= 0,32; IC 95% 0,03 2,97). Houve uma redução significativa de cárie no nível de dente quando o dentifrício com concentração padrão de fluoreto foi comparado com o de baixa concentração (FP=14%; IC 95% 6 21). Porém, não houve diferença no nível de superfície, apesar de ter havido uma tendência favorecendo os dentifrícios com concentração padrão de fluoreto e pH neutro (FP= 13%; IC 95% -4 30) e os de concentração baixa de fluoreto e pH ácido (FP= -5%; IC 95% -22 11) (artigo 2). Os dentifrícios de concentração padrão de fluoreto foram mais efetivos na redução de cárie na dentição decídua de pré-escolares do que os de concentração baixa, placebo ou nenhuma intervenção. Os dentifrícios de concentração padrão de fluoreto, em comparação com os de concentração baixa, não aumentaram significativamente o risco de fluorose clinicamente importante nos dentes permanentes anteriores superiores. São necessários mais estudos para confirmar se a redução do pH dos dentifrícios de concentração baixa de fluoreto pode ser considerada uma alternativa para aumentar o efeito anticárie e reduzir o risco de fluorose clinicamente importante. / Despite the well established anti-caries effect of fluoride toothpaste in the permanent dentition, there is a gap in the knowledge reagarding its effect on the primary dentition; there is no consensus on the optimal fluoride concentration in toothpaste capable of maximizing the anti-caries benefits in the primary dentition and simultaneously minimizing the risk of clinically relevant fluorosis in the permanent dentition. Paper 1 of this thesis assessed the effects of low (less than 600 ppm) and standard (1000 to 1500 ppm) fluoride toothpastes compared to placebo or no intervention, whereas paper 2 compared directly the effects of low and standard fluoride toothpastes. A systematic review of randomized or quasi-randomized clinical trials was carried out. Two examiners independently read 1932 abstracts or citations and 159 full-text articles. Disagreements were solved by a third examiner. Eight studies were included in paper 1 and five in paper 2. Pooled prevented fractions (PF) and relative risks (RR) were estimated in order to assess the effects of fluoride toothpastes on the number of decayed, missing due to caries and filled teeth and dental surfaces, and on the number of children developing caries and fluorosis, respectively. When standard fluoride toothpastes were compared to placebo or no intervention, significant caries reductions were observed at surface (PF= 31%; 95% CI 18 - 43), tooth (PF= 16%; 95% CI 7 - 24) and individual (RR= 0.86; 95% CI 0.81 - 0.93) level. When low fluoride toothpastes were compared to no intervention, significant caries reduction was observed only at surface level (PF= 40%; 95% CI 5 - 75) (paper 1). Low fluoride toothpastes, compared directly to standard fluoride toothpastes, significantly increased the risk of caries in primary dentition (RR= 1.13; 95% CI 1.07 - 1.20) and did not significantly reduce the risk of clinically relevant fluorosis in upper permanent anterior teeth (RR= 0.32; 95% CI 0.03 - 2.97). There was a significant caries reduction at tooth level when standard fluoride toothpastes were compared to low fluoride toothpastes (FP= 14%; 95% CI 6 - 21). However, at surface level, no significant difference was observed, even though there was a tendency favouring standard fluoride toothpastes with neutral pH (PF= 13%; 95% CI -4 - 30) and low fluoride toothpastes with acidic pH (PF= -5%; 95% CI -22 - 11) (paper 2). Standard fluoride toothpastes were more effective in reducing caries in the primary dentition of preschool children than low fluoride toothpastes, placebo or no intervention. Standard fluoride toothpastes, when compared to low fluoride toothpastes, did not significantly increase the risk of clinically relevant fluorosis in upper permanet anterior teeth. Further research is necessary to confirm whether the reduction in the pH of low fluoride toothpastes might be an alternative to increase the anti-caries effects and to reduce the risk of clinically relevant fluorosis.

Universidade do Estado do Rio de Janeiro / Apesar do potencial anticárie do dentifrício fluoretado na dentição permanente estar bem estabelecido, existe uma lacuna no conhecimento em relação ao seu efeito na dentição decídua; não existe consenso quanto à concentração ideal de fluoreto no dentifrício capaz de maximizar o benefício anticárie na dentição decídua e simultaneamente minimizar o risco de desenvolver fluorose clinicamente importante na dentição permanente. O artigo 1 desta tese avaliou o efeito dos dentifrícios de concentração baixa (menos de 600 ppm) e padrão (1000 a 1500 ppm) de fluoreto comparados com placebo ou nenhuma intervenção e o artigo 2 comparou diretamente o efeito do dentifrício de concentração baixa de fluoreto com o de concentração padrão. Foi realizada uma revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados. Dois examinadores leram, de forma independente, 1932 resumos ou citações e 159 estudos na íntegra. As discordâncias foram resolvidas por um terceiro examinador. Oito estudos foram incluídos no artigo 1 e cinco no artigo 2. Para avaliar o efeito dos dentifrícios fluoretados sobre o número de dentes e superfícies dentárias cariadas, perdidas por cárie e obturadas, e sobre o número de crianças com cárie e fluorose, foram estimados frações prevenidas (FP) e riscos relativos (RR) combinados, respectivamente. Quando os dentifrícios de concentração padrão de fluoreto foram comparados com placebo ou nenhuma intervenção, houve reduções significativas de cárie no nível de superfície (FP= 31%; IC 95% 18 43), dente (FP= 16%; IC 95% 7 24) e indivíduo (RR= 0,86; IC 95% 0,81 0,93). Quando os dentifrícios de concentração baixa de fluoreto foram comparados com nenhuma intervenção, houve redução significativa de cárie apenas no nível de superfície (FP= 40%; IC 95% 5 75) (artigo 1). Os dentifrícios de concentração baixa de fluoreto, comparados diretamente com os de concentração padrão, aumentaram significativamente o risco de cárie na dentição decídua (RR= 1,13; IC 95% 1,07 1,20) e não reduziram significativamente o risco de fluorose clinicamente importante nos dentes permanentes anteriores superiores (RR= 0,32; IC 95% 0,03 2,97). Houve uma redução significativa de cárie no nível de dente quando o dentifrício com concentração padrão de fluoreto foi comparado com o de baixa concentração (FP=14%; IC 95% 6 21). Porém, não houve diferença no nível de superfície, apesar de ter havido uma tendência favorecendo os dentifrícios com concentração padrão de fluoreto e pH neutro (FP= 13%; IC 95% -4 30) e os de concentração baixa de fluoreto e pH ácido (FP= -5%; IC 95% -22 11) (artigo 2). Os dentifrícios de concentração padrão de fluoreto foram mais efetivos na redução de cárie na dentição decídua de pré-escolares do que os de concentração baixa, placebo ou nenhuma intervenção. Os dentifrícios de concentração padrão de fluoreto, em comparação com os de concentração baixa, não aumentaram significativamente o risco de fluorose clinicamente importante nos dentes permanentes anteriores superiores. São necessários mais estudos para confirmar se a redução do pH dos dentifrícios de concentração baixa de fluoreto pode ser considerada uma alternativa para aumentar o efeito anticárie e reduzir o risco de fluorose clinicamente importante. / Despite the well established anti-caries effect of fluoride toothpaste in the permanent dentition, there is a gap in the knowledge reagarding its effect on the primary dentition; there is no consensus on the optimal fluoride concentration in toothpaste capable of maximizing the anti-caries benefits in the primary dentition and simultaneously minimizing the risk of clinically relevant fluorosis in the permanent dentition. Paper 1 of this thesis assessed the effects of low (less than 600 ppm) and standard (1000 to 1500 ppm) fluoride toothpastes compared to placebo or no intervention, whereas paper 2 compared directly the effects of low and standard fluoride toothpastes. A systematic review of randomized or quasi-randomized clinical trials was carried out. Two examiners independently read 1932 abstracts or citations and 159 full-text articles. Disagreements were solved by a third examiner. Eight studies were included in paper 1 and five in paper 2. Pooled prevented fractions (PF) and relative risks (RR) were estimated in order to assess the effects of fluoride toothpastes on the number of decayed, missing due to caries and filled teeth and dental surfaces, and on the number of children developing caries and fluorosis, respectively. When standard fluoride toothpastes were compared to placebo or no intervention, significant caries reductions were observed at surface (PF= 31%; 95% CI 18 - 43), tooth (PF= 16%; 95% CI 7 - 24) and individual (RR= 0.86; 95% CI 0.81 - 0.93) level. When low fluoride toothpastes were compared to no intervention, significant caries reduction was observed only at surface level (PF= 40%; 95% CI 5 - 75) (paper 1). Low fluoride toothpastes, compared directly to standard fluoride toothpastes, significantly increased the risk of caries in primary dentition (RR= 1.13; 95% CI 1.07 - 1.20) and did not significantly reduce the risk of clinically relevant fluorosis in upper permanent anterior teeth (RR= 0.32; 95% CI 0.03 - 2.97). There was a significant caries reduction at tooth level when standard fluoride toothpastes were compared to low fluoride toothpastes (FP= 14%; 95% CI 6 - 21). However, at surface level, no significant difference was observed, even though there was a tendency favouring standard fluoride toothpastes with neutral pH (PF= 13%; 95% CI -4 - 30) and low fluoride toothpastes with acidic pH (PF= -5%; 95% CI -22 - 11) (paper 2). Standard fluoride toothpastes were more effective in reducing caries in the primary dentition of preschool children than low fluoride toothpastes, placebo or no intervention. Standard fluoride toothpastes, when compared to low fluoride toothpastes, did not significantly increase the risk of clinically relevant fluorosis in upper permanet anterior teeth. Further research is necessary to confirm whether the reduction in the pH of low fluoride toothpastes might be an alternative to increase the anti-caries effects and to reduce the risk of clinically relevant fluorosis.

published_or_final_version / Dentistry / Master / Master of Dental Surgery