Tamanho de amostra e estimativa de custo em levantamento epidemiológico de cárie dentária

Individual and contextual factors associated to the self-perception of oral health in Brazilian adults

OBJECTIVE

To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health.

METHODS

A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the “oral health perception” outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights.

RESULTS

Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis.

CONCLUSIONS

Biological factors, individual and contextual social determinants were associate synergistically with the population’s perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.

[Experimental model of tooth decay as an educational tool for school-age children]

Objective This work consisted of the construction of an educational in vitro model of dental caries that started with an adaptation of Miller's classic experiment. Methods In a sterilized and sealed glass jar, a sample paste of human saliva was collected and a substrate of manufactured sugar (sucrose) was added. In addition, a human tooth with healthy dental crown extracted in dental treatment but otherwise healthy was added. Research phase I had the negative control sample test (tooth + saliva without added) and the others were opened after 1, 2, 3 and 4 months of incubation. This phase was essential for the next experimental time development. In phase II, two saliva donors with poor levels of oral health habits were recruited. The incubation time (defined by phase I) was 2 and 3 months for each donor. Results This research data gives the possibility of building educational materials about the etiology of tooth decay and its clinical evolution. It also makes possible the production of an explanatory sheet about how to reproduce this experimental model to be used by school children in secondary education. Conclusions Doing this kind of work together at school can help reduce inequities in oral health, especially since there is an approximation toward the discourses, facilitating the process of information dissemination.

Estimated prevalence of erosive tooth wear in permanent teeth of children and adolescents: an epidemiological systematic review and meta-regression analysis

OBJECTIVES

The main purpose of this systematic review was to estimate the prevalence of dental erosion in permanent teeth of children and adolescents.

METHODS

An electronic search was performed up to and including March 2014. Eligibility criteria included population-based studies in permanent teeth of children and adolescents aged 8-19-year-old reporting the prevalence or data that allowed the calculation of prevalence rates of tooth erosion. Data collection assessed information regarding geographic location, type of index used for clinical examination, sample size, year of publication, age, examined teeth and tissue exposure. The estimated prevalence of erosive wear was determined, followed by a meta-regression analysis.

RESULTS

Twenty-two papers were included in the systematic review. The overall estimated prevalence of tooth erosion was 30.4% (95%IC 23.8-37.0). In the multivariate meta-regression model use of the Tooth Wear Index for clinical examination, studies with sample smaller than 1000 subjects and those conducted in the Middle East and Africa remained associated with higher dental erosion prevalence rates.

CONCLUSIONS

Our results demonstrated that the estimated prevalence of erosive wear in permanent teeth of children and adolescents is 30.4% with high heterogeneity between studies. Additionally, the correct choice of a clinical index for dental erosion detection and the geographic location play an important role for the large variability of erosive tooth wear in permanent teeth of children and adolescents.

CLINICAL SIGNIFICANCE

The prevalence of tooth erosion observed in permanent teeth of children and adolescents was considerable high. Our results demonstrated that prevalence rate of erosive wear was influenced by methodological and diagnosis factors. When tooth erosion is assessed, the clinical index should be considered.