[Prevalence of dental caries in 12-year-old children in localities of the State of São Paulo, Brazil, in 1990-1995]

Oral health in the agenda of priorities in public health

This study describes the scientific production on oral health diffused in Revista de Saúde Pública, in the 50 years of its publication. A narrative review study was carried out using PubMed, as it is the search database that indexes all issues of the journal. From 1967 to 2015, 162 manuscripts specifically focused on oral health themes were published. This theme was present in all volumes of the journal, with increasing participation over the years. Dental caries was the most studied theme, constantly present in the journal since its first issue. Periodontal disease, fluorosis, malocclusions, and other themes emerged even before the decline of dental caries indicators. Oral health policy is the most recurring theme in the last two decades. Revista de Saúde Pública has been an important vehicle for dissemination, communication, and reflection on oral health, contributing in a relevant way to the technical-scientific interaction between professionals in this field.

Dental caries experience in 12-year-old schoolchildren in southeastern Brazil

The aim of this study was to evaluate the prevalence of caries-free children using DMFT and significant caries (SiC) indexes in different caries prevalence groups in cities of the region of Campinas, São Paulo State, Brazil. The methodology proposed by the World Health Organization (1997) was used for caries diagnosis in 2,378 individuals. According to the DMFT index obtained in each evaluated city, 3 prevalence groups with representative samples were formed, being classified as low, moderate and high. SiC index was used to classify the one third of the population with the highest caries prevalence. In the low prevalence group, 32.4% of the children were caries free (DMFT=0), with mean DMFT of 2.29 and SiC index of 4.93. In the moderate prevalence group, 21.8% of the children were caries free, with mean DMFT of 3.36 and SiC of 6.74. Only 6.9% of the children in the high prevalence group were caries free and the mean DMFT was 5.54 (SiC=9.62). There was a great heterogeneity in dental caries distribution within the studied population, as well as a high caries prevalence considering the 3 classifications. Other indexes besides DMFT could be used to improve oral health assessment during establishment of the treatment plan and intervention.

A inclusão da odontologia no Programa Saúde da Família no Estado do Paraná, Brasil

O objetivo deste estudo foi analisar o perfil de implantação da Odontologia no Programa Saúde da Família (PSF) no Estado do Paraná, Brasil, um ano após a entrada em vigor da Portaria n. 1.444 do Ministério da Saúde (MS). Para tanto, delineou-se um estudo quali-quantitativo que envolveu os 136 municípios que tinham implantado Equipes de Saúde Bucal no PSF até o início de 2002. Foram encaminhados questionários previamente testados, abordando aspectos administrativos e operacionais relacionados às equipes. Os resultados revelam que a média da população coberta por equipe corresponde ao mínimo estipulado pelo MS em 2000. Apesar disso, essas têm dificuldades em desempenhar todas as atividades pertinentes a elas. O encaminhamento dos casos de maior complexidade também foi referido como ponto crítico. A recepção favorável por parte da população e a participação dos dentistas entrevistados em cursos de capacitação foram pontos positivos relatados. Finalmente, verificou-se que o número de contratos temporários de dentistas não é pequeno (37,7%) e os relatos indicam que há necessidade de formação de profissionais generalistas com perfil adequado para o PSF.

[The current applicability of Viegas simplified indices to dental caries epidemiological surveys]

The aim of this study was to verify whether two simplified Viegas indices, "Method One" and "Method Two", could be recommended for epidemiological surveys. The sample was obtained from secondary data for 29 cities, totaling 2,378 epidemiological tests in 12-year-old schoolchildren. Considering mean DMFT in each city, three prevalence groups were obtained (low, moderate, and high), calculating the estimated value of simplified indices in each group. Moderate correlation in the three prevalence groups and similarity among the mean DMFT was found in "Method One", which describes first molar caries experience (p < 0.05). "Method Two", which in addition to first molar caries experience included upper central incisor caries experience, showed similarity in mean DMFT only in low caries prevalence. The results allow one to conclude that the "Method One" simplified index can be used with low, moderate, and high dental caries prevalence, showing the first molar as an important indicator of caries level in populations.

Paulínia, São Paulo, Brasil: situação da cárie dentária com relação às metas OMS 2000 e 2010

No ano de 2000, realizou-se um levantamento epidemiológico em Paulínia, São Paulo, Brasil, com o objetivo de verificar a prevalência dos principais problemas de saúde bucal, utilizando o índice CPOD e os critérios de diagnóstico da Organização Mundial da Saúde. A amostra foi probabilística e totalizou 1.151 indivíduos nas diferentes faixas etárias. Em crianças de cinco anos de idade, o índice ceod foi de 1,90, com 54,2% de crianças sem experiência de cárie. Aos 12 anos o CPOD foi de 1,0, com 46,4% de crianças livres de cárie. A prevalência de fluorose nos escolares foi de 30,5%, e a maioria dessas crianças apresentou fluorose muito leve (22,9%). A prevalência de opacidades e hipoplasias foi de 9,1%. Entre os adultos examinados, o índice de cuidados foi de 55,4 e em média 21,3 dentes apresentaram experiência de cárie. Nos idosos o CPOD foi ainda mais elevado (29,50), sendo composto predominantemente por dentes extraídos (93,0 %).

Precisão e validade de levantamentos epidemiológicos em saúde bucal: cárie dentária na Cidade de São Paulo, 2002

O presente estudo visa descrever o processo de avaliação da precisão e validade do levantamento de cárie dentária realizado na cidade de São Paulo em 2002, integrado ao Projeto SB2000 do Ministério da Saúde. Para essa finalidade, foi empregada metodologia padronizada internacionalmente pela Organização Mundial da Saúde. Durante o treinamento dos cirurgiões-dentistas que participaram do levantamento, foi realizado exercício de calibração envolvendo nove examinadores e dois grupos de 20 escolares, para a aferição de concordância interobservadores. A validação dos exames bucais usou como critério de "gold standard" a indicação do coordenador do levantamento como examinador padrão. Além disso, durante a coleta de dados, 58 escolares foram reexaminados pelos mesmos profissionais para o cálculo dos indicadores de precisão intra-observador. Foram estimados elevados indicadores sintéticos de precisão para o levantamento: respectivamente, 99,83% e 96,45% de porcentagem geral de concordância intra e interobservadores e 0,996 e 0,943 os correspondentes valores da estatística kappa. A validade do estudo também foi avaliada positivamente, com elevados indicadores globais de sensibilidade (0,972) e especificidade (0,978). A avaliação de precisão e validade para cada observador produziu indicadores igualmente elevados e satisfatórios. A descrição dos procedimentos adotados para avaliação de precisão e validade, bem como a apresentação dos resultados obtidos, podem fornecer indicações metodológicas para estudos subseqüentes dessa natureza.

Measuring inequalities in the distribution of dental caries

OBJECTIVES

To evaluate different measurements of prevalence and inequality in the distribution of dental caries as to their partial collinearity, and ability in expressing associations with the supply of fluoridated tap water, indices of socioeconomic status and provision of dental services.

METHODS

The DMFT, the Significant Caries (SiC) Index, the proportions of children with high- (DMFT > or = 4) and rampant- (DMFT > or = 7) caries experience, caries-free children (DMFT = 0), the Gini coefficient and the Dental Health Inequality Index (DHII) were the dental outcomes appraised in a sample comprising 18 718 oral examination records for 11- and 12-year-old schoolchildren in 131 towns of the state of São Paulo, Brazil. Spatial data analysis assessed the association between aggregate figures of dental indices and several covariates.

RESULTS

The DMFT, the SiC Index and the proportions of children with high- and rampant-caries experience presented strong linear associations (Pearson r near or higher than 0.95), and an analogous profile of correlation with indicators of socioeconomic status, dental services and access to fluoride tap water. The same was observed for the DHII, the Gini coefficient and the proportion of caries-free children. These observations involve the perception of variables in each set as interchangeable tools for ecological studies assessing factors influencing, respectively, prevalence levels and inequality in the distribution of dental disease.

CONCLUSION

An improved characterization of the skewed distribution of caries experience demands the concurrent estimation of figures of prevalence and inequality in dental outcomes. This strategy may contribute to the design of socially appropriate programmes of oral health promotion.

City-level gender differentials in the prevalence of dental caries and restorative dental treatment

This study assesses gender differentials in the distribution of dental caries and restorative treatment at the city level in order to discuss gender inequities in health. We retrieved data for caries prevalence and dental service utilisation by 11- and 12-year-old girls and boys in 131 towns in the state of São Paulo, Brazil, 1998. We also gathered aggregate population data for these towns, and information already held by the health authority regarding the provision of dental services. Results of data analysis indicated that girls presented higher caries indices in permanent teeth than boys of the same age, concurrent with a higher utilisation of dental care. When studying aggregate data at the city level, we gathered evidence reinforcing the hypothesis that the higher prevalence of caries in girls is attributable to their earlier eruption of permanent teeth, with no significant association between this excess and indices of socio-economic status at the city level. However, indices assessing the discrepant incorporation of dental services between genders were higher in towns with a poorer profile of socio-economic status. We also observed that towns whose public health service was more effective in providing dental care presented a more equitable gender distribution of dental services. Public resources destined to dental assistance contributed to reducing inequities in oral health by allowing an incorporation of restorative dental treatment more equitably distributed between girls and boys.

Trends in dental caries in Latin American and Caribbean 5-6- and 11-13-year-old children: a systematic review

OBJECTIVES

To determine trends in dental caries prevalence and severity in Latin America and Caribbean.

METHODS

A systematic review was done of studies published between 1970 and 2000 among 5-6- and 11-13-year-old children that used WHO caries diagnostic criteria.

RESULTS

Over the last 30 years, there has been a significant decrease in caries severity for children 5-6 years old and also a significant decrease in caries prevalence and severity for children 11-13 years old. The same broad trends were observed when caries prevalence and severity was analyzed for the last 20 and 10 years but these were not statistically significant.

CONCLUSIONS

Evidence of a decrease in dental caries in Latin American and Caribbean children has been shown, although the decrease was less prominent in the past few years.

Ethnic disparities in the prevalence of dental caries and restorative dental treatment in Brazilian children

AIM

This study assesses disparities in the oral health status of Brazilian black and white children.

PARTICIPANTS

11- and 12-year-old schoolchildren living in 131 cities of the State of São Paulo, Brazil.

METHODS

Spatial data analysis of city-level indexes of oral health, socio-economic status and provision of dental services.

MAIN OUTCOME MEASURES

Ethnic ratios of the DMFT and the care index.

RESULTS

White children had higher indexes of caries in permanent teeth than their black counterparts, concurrent with a higher utilisation of dental attendance. The gap of caries prevalence between black and white children was reduced in cities with a better profile of socio-economic status. Cities with higher per-capita yearly budget, expenditure in health, and provision of public dental services presented reduced indications of ethnic inequality in dental care.

CONCLUSION

The knowledge of conditions associated with a lower ethnic discrepancy in the risk of caries and in the incorporation of dental services can be used to design socially appropriate dental services. An improved community dental service, higher public expenditure in health and per-capita municipal yearly budget contribute effectively to reducing inequities in oral health by allowing an incorporation of restorative dental treatment more equitably distributed between black and white children.

Prevalência e severidade de cárie dentária e necessidade de tratamento odontológico em pequenos municípios brasileiros

O objetivo deste estudo foi conhecer a prevalência e severidade da cárie dental e necessidade de tratamento odontológico na população escolar de 6 a 12 anos de idade em dois pequenos municípios brasileiros. Utilizaram-se os critérios de diagnóstico da Organização Mundial de Saúde (1986) para se obter a prevalência e severidade da cárie, e realizou-se censo dos escolares de 6 a 12 anos de idade de São João do Sul (n = 803) e de Treviso (n = 382), ambas as cidades em Santa Catarina. As prevalências de cárie encontradas foram: 62,1% em São João do Sul e 63,6% em Treviso. Os índices CPO-Ds (número de dentes cariados, perdidos e restaurados) foram de 1,91 para São João do Sul e de 1,84 para Treviso, para a faixa etária de 6 a 12 anos. Em ambos os municípios a principal necessidade foi de tratamentos simples, principalmente o restaurador. Conclui-se que a prevalência de cárie em São João do Sul e Treviso é inferior a de outros pequenos municípios onde se realizaram estudos com metodologias semelhantes, com dados publicados na literatura, e que as necessidades de tratamento odontológico são de pequena magnitude.

[Why are children abused? A bibliographical review of the explanations for child abuse]

This article analyzes the factors related to child abuse that have been published in three of the main Brazilian pediatrics journals. The literature was assessed by content analysis. Fourteen studies were analyzed. The main explanatory factors were: (a) reproduction of violence; (b) family and psychological disorders and alcohol abuse; and (c) the structural or macro-social order. The authors conclude that prevention or intervention policies can be more successful if a theoretical/practical understanding is achieved, and that it is necessary to integrate each unique case with the knowledge based on care for thousands of families involved in child abuse both in Brazil and worldwide.

Spatial analysis to identify differentials in dental needs by area-based measures

OBJECTIVES

To examine the association between tooth decay and dental treatment needs in 5-12-year-old schoolchildren in São Paulo with area-level indicators of social development.

METHODS

The present study refers to a representative sample of children from the city of São Paulo, Brazil, comprising 2491 girls and boys attending public and private schools in different areas of the city. The assessment of caries and treatment needs followed the international methodological standards prescribed by the World Health Organization. We used spatial data analysis to describe epidemiological measures distributed by small areas, and to explore hypotheses of ecological association between caries indexes and indicators of social development.

RESULTS

Schoolchildren in central districts were less affected by tooth decay and presented fewer dental treatment needs when compared to those in peripheral deprived areas. At the spatial level, average family income, unemployment rate, household overcrowding, and an index of inequality of income distribution were significantly correlated with variables measuring children's caries experience.

CONCLUSIONS

The heterogeneous distribution of caries indexes by areas of the city indicates higher levels of dental decay in areas of social deprivation. The delimitation of areas with increased risk of caries and greater dental treatment needs should be helpful to public health services for the formulation of policies and the targeting of resources to address these problems.

[Dental caries prevalence in permanent teeth of schoolchildren in the Municipality of Sao Paulo, Brazil, 1970-1996]

OBJECTIVE

To assess the evolution of dental caries in permanent teeth of schoolchildren in S. Paulo City, Brazil, during the period of 1970-1996.

METHODS

The World Health Organization methodology for oral health surveys was applied in 2,491 schoolchildren, both male and female from 103 public and private schools. A probabilistic sample stratified by age, school category, and city zones was obtained by the Education State Service data system. Computational resources were used.

RESULTS

Data from the 1996 S. Paulo survey were compared with others data provided by studies such as the one conducted in the same city and the reference-population in the second half of the 20th century. In the 60s and 70s the DMF-T Index among 12-year-old schoolchildren was around 7.0. In 1986 it was 6.5 and in 1996 it was registered 2.1, a decline of 68%.

CONCLUSION

Dental caries in permanent teeth among S. Paulo City 12-year-old schoolchildren changed from a "very high" to "low" prevalence.

[Changes in caries prevalence in 7-12-year-old children from Araraquara, São Paulo, Brazil: 1989-1995]

The aim of this study was to compare the prevalence of caries in 7-12-year-old children from Araraquara, São Paulo, Brazil, in 1989 and 1995. Systematic random samples were drawn from the population of children enrolled in public schools. The surveys were carried out by trained examiners using the DMFT index and WHO diagnostic criteria. There was an increase in the percentage of children free of caries in the permanent dentition in all age groups (from 29 per cent in 1989 to 51 per cent in 1995). Amongst 12 year olds, the DMFT index was 3.8 in 1989 and 2.6 in 1995. Decreases were observed in the percentages of children classified in the 1-3 DMFT index category (from 40 per cent in 1989 to 31 per cent in 1995) and in the 4-6 DMFT index category (26.6 per cent in 1989 to 16.5 per cent in 1995). There was also a reduction in the percentage of children with a DMFT of 7 or more (4.4 per cent in 1989 to 1.5 in 1995). The WHO/FDI goal for the year 2000 of a mean DMFT index no more than 3 at the age of 12 years was achieved in this population, and on-going efforts should be made to reduce the percentage of children with caries in order to achieve the WHO/FDI goals for the year 2010.