Experiência de cárie na síndrome congênita do Zika vírus: o papel protetor de alimentos ricos em fibra e proteínas

Abstract

Despite the recognized need for a multidisciplinary approach in the care of children with Congenital Zika Syndrome (CZS), the availability of robust scientific evidence guiding specific protocols for the dental management of this population remains limited, particularly regarding the understanding of caries prevalence and risk. The presente study aimed to monitor caries experience using the International Caries Detection and Assessment System (ICDAS), assess caries risk through the Caries Management by Risk Assessment (CAMBRA) method, and analyze the dietary records of children diagnosed with CZS who were followed at the Pediatric Dentistry Clinic of the Federal University of Ceará (UFC) and the Christus University Center (Unichristus). The sample consisted of children of both sexes, including 48 diagnosed with CZS and 24 healthy controls, matched by age and sex. A questionnaire was administered to collect information on general and oral health, as well as dietary habits. Subsequently, a clinical examination was performed by a trained and calibrated professional according to ICDAS criteria. The caries index (CI), as measured by ICDAS, showed a statistically significant difference between the CZS and Control groups (p = 0.033). Statistically significant differences were also observed for the following scores: D1-3 S (p = 0.021); D4-6 S (p = 0.002); ICDAS 1-3/4-6 T (p = 0.000); and ICDAS 4-6 LRS (p = 0.011). The analysis identified the following as caries risk factors: being in the CZS group (p = 0.002), use of medications (p = 0.024), need for assistance during toothbrushing (p = 0.030), presence of overbite (p = 0.015), crossbite (p = 0.026), bottle-feeding (p = 0.023), and higher consumption frequency of sandwich cookies (p = 0.006), sweetened yogurts (p = 0.001), and soft drinks (p = 0.040). Regarding dietary habits, protein intake showed a statistically significant difference between groups across all three food composition assessment methods: TACO (Brazilian Table of Food Composition) (p = 0.000), TBCA (Brazilian Food Composition Table) (p = 0.010), and TCA-IBGE (Brazilian Institute of Geography and Statistics Table) (p = 0.000). Fiber intake also revealed statistically significant differences using all three methods: TACO (p = 0.013), TBCA (p = 0.009), and TCA-IBGE (p = 0.006). No statistically significant diferences were found between the CZS and Control groups regarding caries risk and severity when analyzed by the TACO, TBCA, and TCA-IBGE methods. Spearman’s correlation analyses between nutritional parameters and caries indices showed a weak negative correlation between the Caries Index (CI) and protein intake across the three methods: TACO (r = -0.355; p = 0.002), TBCA (r = -0.371; p = 0.001), and TCA-IBGE (r = -0.264; p = 0.025). A moderate negative correlation was also observed between ICDAS 4-6 LRS and protein intake: TACO (r = -0.398; p = 0.001), TBCA (r = -0.388; p = 0.001), and TCA-IBGE (r = -0.386; p = 0.001). Conversely, a weak positive correlation was found between ICDAS D1-3 S and protein intake according to the TCA-IBGE method (r = 0.355; p = 0.002). The correlation between CI and fiber intake indicated a moderate negative association in all three methods: TACO (r = -0.394; p = 0.001), TBCA (r = - 0.385; p = 0.001), and TCA-IBGE (r = -0.383; p = 0.001). A similar result was identified between ICDAS 4-6 LRS and fiber intake: TACO (r = -0.275; p = 0.019), TBCA (r = - 0.277; p = 0.019), and TCA-IBGE (r = -0.315; p = 0.007).It is concluded that the sample of children with Congenital Zika Syndrome presented a higher prevalence of dental caries compared to the control group, with multiple risk factors identified. A negative correlation was also observed between the intake of proteins and fibers and caries indices, particularly for cavitated lesions, suggesting a potential protective effect of these macronutrients. On the other hand, a weak positive correlation was found between protein intake and initial caries lesions. No differences were observed between the groups in terms of caries risk and severity from the perspective of macronutrient analysis.