Oral health-care practices and dental assistance management strategies for people with autism spectrum disorder: An integrative literature review

ABSTRACT

Autism spectrum disorder requires a careful approach from professionals and a favorable clinical environment for dental care and assistance. This article aims To perform a literature review about oral health among people with autism spectrum disorder and dental management strategies for this group. An integrative literature review was carried out in three databases, associating the descriptors: (autism or autism spectrum disorder) with (oral health or oral diseases) and (dental care or dental services). After identification and screening steps, 32 articles were included in the study. The most prevalent subjects were oral health conditions, parents’ understanding and practical attitudes about oral health, treatment and management strategies, and the use of technology. The principal barriers to dental care were the scarcity of specialized professionals, unpreparedness in the referral system, poor accessibility of the clinics, and lack of specific care protocols. The world literature on the subject is scarce, and there is still a need for investment and scientific production due to the incidence of autism in the world population and the maintenance of difficulties and barriers in offering quality health care to this group.

[The evolution of inequalities in the distribution of dentists in Brazil]

The scope of this article is to analyze the evolution of the distribution of dentists and undergraduate courses in Dentistry in Brazil between 1960 and 2022, based on institutional data and its correlation with economic and demographic data. The proportions between number of dentists and population were calculated for the federative units in different periods, and the Herfindahl-Hirschman Index (HHI) was used. to determine the concentration of dentists, population and undergraduate courses in Dentistry. The Pearson test was used, with a significance level of 95%, to test the correlation between variables. In the period from 1960 to 2022, the ratio of dentists per 10,000 inhabitants increased from 3.3 to 16.9. Moreover in 2022, the federative units with the highest average household income per capita were closely correlated with the highest concentration of dentists (R2= 0.90; p < 0.00). However, from 1975 to 2022, the concentration of dentists measured by the HHI dropped from 45.1 to 33.4. The decrease in the geographic concentration of Dentistry courses was even more pronounced, with the HHI rising from 39.3 in 1991, to 25.6 in 2022.

Expression and degranulation of mast cells in laser photobiomodulated mucositis chemo-induced: pilot study in hamsters

This study aimed to evaluate the influence of laser photobiomodulation on the expression and degranulation of mast cells in chemo-induced oral mucositis (OM) lesions in hamsters. Twelve adult male Syrian hamsters (Mesocricetus auratus), golden lineage, were submitted to OM induction. They were divided into three groups: control-OM without treatment (C), OM treated with red laser (RL), OM treated with infrared laser (IL) and analyzed in the experimental time of 7 days. Three and 4 days after the intraperitoneal injection of the chemotherapy drug fluorouracil, the OM lesions were induced by making grooves in the right cheek pouch. Immediately after chemoinduction, the hamsters were submitted to photobiomodulation every 48 h for 7 days. The specimens were processed and stained using the hematoxylin-eosin and toluidine blue techniques. There was a predominance of mild chronic inflammation in the experimental groups and a greater persistence of neutrophils in the control group (C), although not statistically significant. The group irradiated with red laser (RL) had the highest mean mast cell expression (38.28 ± 19.05) (p < 0.001). As for the degranulation activity in mast cells, the control group (C) showed a greater number of fields with more than 50% of degranulated cells, presenting statistical significance when comparing it with the RL (p < 0.009) and IL (p = 0.036) group. It can be concluded that photobiomodulation, at both wavelengths, decreased mast cell degranulation, accelerating the inflammatory process. The use of infrared laser provided, in addition to less degranulation, the quantitative reduction of mast cells.

Florid cemento-osseous dysplasia-related osteonecrosis: A series of cases

OBJECTIVE

The aim of this study was to assess the clinicopathological features of florid cemento-osseous dysplasia (FCOD)-related osteonecrosis highlighting their histopathological aspects and bone structure.

METHODS

Twenty-two FCOD-related osteonecrosis cases were evaluated retrospectively. Osteonecrosis, osteomyelitis, bacterial colonization, bone resorption, reactive bone, osteon-like structure, lamellar bone, and basophilic lines were analyzed. Specific staining and fluorescence and polarized light microscopy analyses were also performed.

RESULTS

The mandible was more affected by FCOD-related osteonecrosis. There was a predominance of African-Brazilian women in the fifth and seventh decades of life. Osteomyelitis was present in 82 % of cases whereas bone resorption and bacterial colonization were present in 100 % of FCOD-related osteonecrosis cases. Thick basophilic lines were seen in all cases (100 %). Actinomycosis and osteoclasts were not often.

CONCLUSIONS

This study showed female adult preference, mandibular location, and some findings such as osteomyelitis, bone resorption, and bacterial colonization were histopathological features more frequent in FCOD-related osteonecrosis. In the absence of a close clinical and radiographic correlation, the morphology of the necrotized bone similar to cementum could help to recognize FCOD.

Association between occupational exposure to domestic solid waste and dental caries: a cross-sectional study

Studies have shown that domestic waste collectors are exposed to toxicants including infectious pathogens, which may be linked to their oral health conditions. This cross-sectional study evaluated the dental caries and its associated factors among domestic waste collectors. A total of 301 adult men who worked for a waste collection corporation were included; 171 men worked in direct contact with domestic solid waste and 130 did not. Sociodemographic data, working, and medical history were assessed. The decayed, missing, and filled permanent teeth (DMFT) index was examined. Logistic regression analysis was used to identify factors associated with dental status with a significance level of 5%. The overall mean DMFT score was 8.36±5.64. The mean DMFT, missing teeth (MT), and filled teeth (FT) were significantly higher in workers who did not have any direct contact with waste (p≤0.04). In the logistic analysis, DMFT ≥8 was only associated with older age (OR=8.41 [95% confidence interval (95%CI), 5.01-14.12], p<0.001). Decayed teeth (DT) ≥2 was associated with no previous oral hygiene instruction (OR=2.70 [1.50-4.81], p=0.001) and no daily dental flossing (OR=4.26 [1.92-9.43], p<0.001). MT ≥9 was associated with lower education level (OR=3.33 [1.57-7.10], p= 0.002). FT≥3 had a negative association with low income (OR= 0.42 [0.25-0.70], p<0.001) and no daily flossing (OR=0.42 [0.23-0.76], p=0.004). In conclusion, occupational exposure to domestic solid waste was not associated with poor dental status. Instead, age, education, income level, and oral hygiene were associated with dental health status. Missing teeth constituted the major component of the DMFT index. Therefore, prevention and oral rehabilitation programs are necessary to improve dental health.

Saúde bucal e índice de desenvolvimento humano, Bahia, 2001-2014

Estudo ecológico de série histórica que avaliou indicadores de saúde bucal em relação a cobertura da Estratégia Saúde da Família (ESF), o porte populacional e Índice de Desenvolvimento Humano Municipal (IDH-M), entre 2001-2014, nos municípios da Bahia. As informações foram obtidas nas bases de dados do DATASUS e IBGE. Inicialmente, procedeu-se a compatibilização das informações das diferentes bases de dados e cálculo dos indicadores. A análise foi realizada através do Minitab 17, utilizando-se o teste de Pearson para correlação com um nível de significância de 5%. Observou-se consistência no registro de informações ambulatoriais e aumento das coberturas da ESF e de Equipes de Saúde Bucal (ESB), não proporcional à cobertura de 1ª consulta odontológica, que apresentou crescimento menor até 2012, seguido de declínio. A média de escovação supervisionada apresentou grande variação. Entre 2001 e 2007, a média de procedimentos básicos apresentou crescimento, enquanto as ações especializadas, apesar do aumento até 2005, caíram em 2006 e 2007. A análise de correlação evidenciou associação positiva entre porte populacional e coberturas da ESF e de ESB (menor porte populacional, maior cobertura), assim como entre IDH-M e estes indicadores (menor IDH-M, maior cobertura). Na Bahia, a implantação da ESF e das ESB tem representado um grande desafio para os municípios de grande porte populacional e melhor IDH.

Central giant cell granuloma: A clinicopathological and immunohistochemical study of macrophages, blood vessels, lymphatic vessels and regulatory proteins

OBJECTIVE

This study seeks to investigate immunohistochemical parameters that could distinguish non-aggressive Central giant cell granuloma (CGCG) from aggressive CGCG, two groups of lesions which differ in their clinical and radiographic features and prognosis.

MATERIAL AND METHODS

12 cases of non-aggressive CGCG and 11 cases of aggressive CGCG were investigated and associated the immunohistochemical expression of macrophages (CD68 and CD163), blood vessels (CD34 and CD105), lymphatic vessels (D2-40) and regulator proteins (p63 and Ki-67). Clinical and radiographic features were also studied.

RESULTS

Associations between all proteins in non-aggressive and aggressive CGCG were not significant (p > 0.05). With respect to non-aggressive CGCG, there were no significant correlations, while in aggressive CGCG there was a significant positive correlation between CD68 and CD163 (p = 0.031), between CD34 and D2-40 proteins (p = 0.04), whereas a significant negative correlation was observed between CD105 and CD68 (p = 0.040). However, regardless of aggressiveness of CGCG, there was a significant positive correlation between CD68 and CD163 (p = 0,04). Among the clinical and immunohistochemical aspects, only the symptomatology was a significant risk factor for the occurrence of aggressive CGCG (OR = 12.00/p = 0.016).

CONCLUSION

Macrophages and angiogenesis contribute to their maintenance and development of CGCG. In addition, immunohistochemistry used here was not able to differentiate their aggressiveness. However, symptomatology was proved to be a risk factor for the occurrence of aggressive CGCG. It is possible that clinical features, particularly symptomatology, represent the most appropriate parameter to attempt to distinguish GCCG.

Association between clinical manifestations of sickle cell anaemia in children and the occurrence of dental caries: A cross-sectional study

Objective: The aim of this study was to determine the association between clinical manifestations of sickle cell anemia (including hospitalization and pain crisis) and dental caries in children in Bahia. Material and Methods: The study design was crosssectional, and the population included children aged from 6 to 96 months from August 2007 to July 2008 (N = 686). Interviews were performed to identify the sociodemographic profiles of the participants, and oral examinations were conducted by three examiners who were previously trained and calibrated to identify the presence of dental caries according to World Health Organization (WHO) criteria. Logistic regression analysis was performed for confirmatory analysis and estimation of confidence intervals (CIs). Results: The results showed that pain crises and hospitalizations were positively associated with caries (crude odds ratio (OR) = 2.11 and adjusted OR = 1.24; crude OR = 2.50 and adjusted OR = 1.46, respectively), but these associations were not statistically significant. Conclusion: The severity of the sickle cell condition alone was not sufficient to aggravate the prevalence of caries; thus, there are no major differences in caries prevalence between children with and without sickle cell disease.KEYWORDSSickle cell anemia; Dental caries; Epidemiology; Paediatrics.

Chronology and sequence of deciduous teeth eruption in children with microcephaly associated to the Zika virus

INTRODUCTION

Deciduous teeth eruption is connected to children's growth and development. In Brazil, with the increase in the occurrence of children born with microcephaly associated to exposure to Zika virus, studies about orofacial alterations were necessary.

OBJECTIVE

Describe the chronology and sequence of deciduous teeth in children with microcephaly due to the fetal exposure to Zika virus.

METHODOLOGY

A cross-sectional study involving 74 children of a neuropediatric reference unit in Salvador, Bahia, in 2017 was conducted. Through use of secondary data, interviews with mothers and children's exam, the population was characterized, the chronology and sequence of deciduous teeth eruption was registered, and the analysis of the variables was proceeded.

RESULTS

The first eruption happened between 4 and 17 months of age and 52.70% had a delay in the eruption of incisors. The average eruption time for the maxilla varies from 17.92 (16.56-19.28; 95% CI) to 20.43 (19.35-21.51; 95% CI) months, and the jaw from 11.57 (6.85-18.99; 95% CI) to 20.20 (19.09-21.31; 95% CI) months. In 77.94% of population, the eruption of the first teeth was in the lower arch and in 33.82%, molars and/or canines erupted before the incisors.

CONCLUSIONS

There were alteration in the chronology and sequence of deciduous teeth eruption.

Does the vertical position of maxillary central incisors in men influence smile esthetics perception?

INTRODUCTION

The aim of this study was to investigate whether there is any influence on the perception of smile esthetics among orthodontists and laypersons, with regard to different vertical positions of the maxillary central incisors.

METHODS

Frontal smile photographs digitally altered at full-face view and close-up view of 2 adult men aged between 20 and 30 years were used. Six vertical positions of the central incisors were created, with changes of 0.5 mm. The images were randomly assembled in an album that was presented to 53 orthodontists and 53 laypersons, who evaluated the attractiveness of the images by using visual analog scales. Comparison among the images was performed using 1-way analysis of variance, with Tukey post-hoc test. To compare the distribution of the mean scores between the full-face and close-up smile views, and between orthodontists and laypersons, the Student t test was used. The level of significance was established at 5%.

RESULTS

The best evaluations presented the following: (a) the gingival margins of the central incisors corresponded to, or were up to, 1 mm below the line of the canine gingival margins, and (b) the incisal step between the central and lateral incisors was from 1.0 to 2.0 mm. The smiles considered least attractive showed (a) the central incisor gingival margins were 1.0 mm above or 1.5 mm below the canine gingival margins, and (b) no step, or a step of 2.5 mm, between the central and lateral incisors.

CONCLUSIONS

The results of this study suggested that, in men, slightly extruded central incisors were esthetically more attractive than intruded incisors.

Low birth weight and the delay on the eruption of deciduous teething in children

Abstract Objectives: To analyze the association between low birth weight (LBW) and the occurrence of the delay on the eruption of deciduous teething (DEDT) in children from 04 to 30 months, living in Salvador, Bahia. Methods: A cross-sectional study involved 520 children at four to thirty months of age, from public, private and philanthropic daycares from two districts in Salvador. A descriptive analysis and unconditional logistic regression were done to estimate the odds ratios (ORs), using the Confidence Interval of 95% as a criterion for accepting associations. Poisson regression was used as an analytical strategy to obtain the prevalence ratio. Results: the prevalence of the delay on the eruption was 10.29%. There was a positive association between LBW and occurrence of DEDT among children with less than 24 months, both in the unadjusted model (PR=2.07, 95%CI= 0.96 4.44) as in the adjusted (adjusted PR=2, 27, 95%CI= 1.02 5.07). Conclusions: the variables of development and nutritional at birth and during the early life may be important predictors of the chronology of eruption. Further investigations should be carried out towards the adequate evaluation of the LBW role in the occurrence of the delay on the eruption.

Actinomycosis is not Frequent in the Periapex But is a Persistent Lesion

Periapical actinomycosis caused by a gram-positive anaerobic pathogen characterizes a typical extra-radicular infection. This study determined the frequency and correlated the content of bacteria colonies with the of periapical actinomycosis size. The study comprised a total of 218 periapical lesions (PL) (cysts, granulomas or abscess). The specimens embedded in paraffin were sliced into 4-µm sections and stained with hematoxylin-eosin, Gram, Periodic Acid-Schiff (PAS) and Grocott's stain. The presence of bacterial colonies composed of filamentous structures labeled with the histochemical stains were described as Actinomyces, and for each case, the bacterial colonies were counted and measured. The correlation between the number and size of bacterial colonies and the size of PL was tested using Pearson's adjusted correlation coefficient. From 218 PL, bacterial colonies were identified in 64 biopsies. Seven cases (0.3%) fulfill the criteria for diagnosis of periapical actinomycosis. All of cases were therapy-resistant and did not showed periapical repair after 12 months of follow-up. Periapical surgery or dental extraction was performed. The correlation test indicated no correlation between the number of bacterial colonies and the lesion size (p=0.752, r=-0.148). However, a larger bacterial colony size generally resulted in a larger periapical lesion (P=0.000, r=0.657). The frequency of periapical actinomycosis was low, and this lesion should be included in the differential diagnosis of PL. The size of the Actinomyces colonies seemed to contribute to increase the size of the periapical lesion.

Risk factors for caries-free time: longitudinal study in early childhood

OBJECTIVE

To estimate time in days from the beginning of follow-up up to the development of dental caries in children under 30 months and to assess risk factors potentially affecting the development of the disease.

METHODS

The study population of the cohort study were children attending public, private, and charitable day care centers in Salvador, Northeastern Brazil, followed up for fourteen months. We used the multivariate Cox regression to estimate risk and Kaplan-Meier method to estimate the caries-free time.

RESULTS

Of the 495 children studied, 112 developed caries (22.6%). Mean caries-free time was 248.6 (SD = 96.2) days. The comparasion of curves by age group (> 24 months) and children attending public day care showed more caries in a shorter period (p < 0.00). The following variables were important risk factors for increased rate of caries: district of origin (HR = 1.88, 95%CI 1.27-2.77), category of day care (HR = 3.88, 95%CI 2.04-7.38), age (HR = 1.77, 95%CI 1.15-2.74), bottle-feeding before sleep time after the age of 12 months (HR = 1.62, 95%CI 1.04-2.51), presence of active white spots (HR = 2.70, 95%CI 1.07-6.80), and living in non-masonry house (HR = 1.68, 95%CI 1.02-2.76). The highest hazard ratio (HR = 4.60, 95%CI 2.80-7.42) was found for previous caries experience.

CONCLUSIONS

Social variables were considered as of high risk for the development of dental caries.

Evaluation of laser phototherapy (λ 780 nm) after dental replantation in rats

BACKGROUND/AIM

Tooth replantation is the treatment of choice in cases of avulsion although the outcomes are variable. The teeth can be lost due to external root resorption. The aim of this study was to histologically assess of the effect of laser phototherapy (λ780 nm) on replanted teeth in rats.

MATERIAL AND METHODS

Sixty Wistar Albinus rats had their maxillary right incisors extracted and were then divided into four groups: G1-absence of storage medium; G2-milk as storage medium; G3-milk as storage medium followed by a laser irradiation of the root surfaces and entrance of the alveolus (λ = 780 nm; P = 70 mW; CW; DE = 21 J/cm² ); G4-milk as storage medium, laser irradiation as in G3 before replantation. After this procedure, laser irradiation was performed on the buccal and palatal mucosa (8.4 J/cm² per session) every 48 h for 15 days. The animals were euthanized 15, 30, and 60 days after replantation.

RESULTS

The histological results showed that after 15 days, G4 exhibited intense chronic inflammation with the presence of clastic cells and moderate external inflammatory root resorption (P < 0.05) when compared with G3, in which these outcomes were not observed. At the 30th day, G1, G2, and G4 showed chronic inflammation varying from discrete to moderate, as well as intense external inflammatory root resorption. G3 remained without any inflammation and external inflammatory root resorption up to the 60th day.

CONCLUSIONS

The use of laser phototherapy on the root surface and at the entrance of the alveolus prior to replantation had a positive biomodulative effect on alveolar repair after tooth replantation in rats.

Interaction of stromal and microvascular components in keratocystic odontogenic tumors

OBJECTIVE

Little is known about the interaction of stromal components in odontogenic tumors. Thus, the aim of this study was to investigate mast cells (MCs), myofibroblasts, macrophages, and their possible association with angiogenesis and lymphangiogenesis in keratocystic odontogenic tumors (KCOTs).

MATERIAL AND METHODS

Thirty cases of KCOTs were included and analyzed by immunohistochemistry for mast cell tryptase, α-SMA, CD34, CD163, and D240. For comparative purpose, 15 radicular cysts (CRs) and 7 pericoronal follicles (PFs) were included.

RESULTS

There was an increase in MCs for RCs and this difference was significant when they were compared to KCOTS and PFs. A significant increase in the density of MFs was observed for KCOTs when compared to RCs and PFs (P = 0.00). No significant difference in CD163-positive macrophages (P = 0.084) and CD34-positive vessels (P = 0.244) densities was observed between KCOTs, RCs, and PFs, although KCOTs showed a higher density of all proteins. Significant difference in lymphatic vessel density was observed for KCOTs when compared to RCs and PFs (P = 0.00). Positive correlation was observed between mast cell tryptase and CD34 in KCOTs (P = 0.025).

CONCLUSIONS

A significant interaction between the MC population and CD34-positive vessels in KCOTs supported the hypothesis that MCs and blood vessels contribute to the stromal scaffold of KCOT.

Condições de saúde bucal de industriários participantes de Programa de Saúde Bucal na Empresa

Resumo Objetivo: verificar as condições de saúde bucal de trabalhadores de cinco indústrias da região metropolitana de Salvador, Bahia, que participavam do Programa de Saúde Bucal na Empresa (PSBE) entre os anos 2003 a 2008. Métodos: estudo transversal retrospectivo, com dados secundários do banco de dados do SESI/DR-BA. Participaram todos os funcionários que realizaram pelo menos dois exames odontológicos no período, totalizando 1.277 trabalhadores. Foram investigados dados sociodemográficos, incidência de cárie, atividade de cárie, urgência odontológica, uso e necessidade de prótese. Resultado: predominou o sexo masculino com média de idade de 38 anos (DP = 10,07). O índice CPO-D (dentes cariados, perdidos e obturados) apresentou variação da média de 15 a 19, com maior percentual para dentes obturados (de 58,5% a 70,2%). Observou-se menor incidência de cárie nos que possuíam maior número de exames – 35,03% com 2 exames e 21,88% com 4 exames (p<0,01). Destaca-se maior associação positiva entre atividade de cárie e ramo de metais (29,19%) em 2007. O ramo outros serviços apresentou os maiores percentuais de urgência odontológica (5,60% em 2007, 8,40% em 2008). Conclusão: a redução na incidência de cáries e na necessidade de próteses entre os que mais realizaram exames indica que programas de saúde bucal nas empresas podem contribuir para a melhor saúde bucal dos trabalhadores.

[Local government and public dental health services: an analysis of inequality in use]

The aim of this study was to identify factors associated with the use of primary and specialized public dental health services and private services. A population-based household survey was conducted in two cities of Bahia State, Brazil. Key informants provided data on socioeconomic variables and use of dental health services. Organization of the local public dental health service was ranked as worse versus better. Univariate and multivariate polytomous logistic regression was performed. Of the total of 1,290 individuals, 38.76% used private services, 33.80% used public primary care, and 17.29% used both primary care and the Center for Dental Specialties. Less use of both primary care and specialized public services was associated with lower education (OR = 1.47; 95%CI: 1.03-2.10) and worse organization of services (OR = 1.74; 95%CI: 1.22-2.48), when compared to the exclusive use of primary care. The study showed inequality in the use of dental services, even when comparing more homogeneous groups, namely users of public services.

Effect of laser (λ 660 nm) and LED (λ 630 nm) photobiomodulation on formocresol-induced oral ulcers: a clinical and histological study on rodents

The aim of this study was to evaluate, clinically and histologically, the influence of laser and LED photobiomodulation in the healing of formocresol-induced oral mucosa ulcers of rats. We used 60 Wistar rats in which oral ulcers were induced on the gingiva of the lower incisors. Forty-eight hours after inducing the ulcers, the animals were divided into three groups: laser, LED, and untreated. Animals from the laser group received irradiation with GaAlAs, 660 nm, CW, 40 mW, φ 4 mm(2), 4.8 J/cm(2). Animals from the LED group received irradiation with InGaAIP, 630 nm, 150 mW, 4.8 J/cm(2), 0.8 cm spot. Forty-eight hours after oral ulcer induction, both irradiations were applied in a punctuate manner in the center of the ulcer at 48-h interval until the end of the experimental period. The animals were killed at 3, 5, 7, and 11 days after day 0. The results of the clinical evaluation showed that the laser and LED phototherapies were able to accelerate the healing of formocresol-induced oral ulcers, which occurred first in the laser group (ANOVA, p < 0.05). Histologically, there was a slight variation between LED and laser therapy; therefore, the laser group proved to be effective in accelerating wound healing, especially at 5 days, whereas the LED group was more effective at the end of the experimental period. It was concluded that laser and LED photobiomodulation were effective in accelerating the healing of formocresol-induced oral ulcers in both clinical and histological aspects.

Effect of actions promoting healthy eating on students' lipid profile: A controlled trial

OBJECTIVE: To assess the effect of nutrition intervention actions on the lipid profile of children and adolescents enrolled in public elementary schools. METHODS: This nine-month, controlled, intervention study included 202 students aged 7 to 14 years attending two schools (intervention/control) located in a poor neighborhood of the municipality of Salvador, Bahia, Brazil. Actions were implemented in the intervention school to promote healthy eating habits, presented as "Ten steps to healthy eating". The effect of these actions was assessed by subjecting the students at baseline and end of the follow-up to biochemical, maturation, and anthropometric measurements and a produce intake survey. The dependent variables were the changes in the study biochemical parameters: total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, and triglycerides. Analysis of covariance assessed the changes that occurred over the study period. RESULTS: The mean total cholesterol, low-density lipoprotein-cholesterol, and triglycerides of the intervention students decreased 13.18 mg/dL (p=0.001), 7.41 mg/dL (p=0.038), and 12.37 mg/dL (p=0.029), respectively, compared with the control students. CONCLUSION: Actions of this nature have a positive impact on lipid profile. This study adds to those that use effective and viable public health strategies implementable at the primary care level.

Oral mucoceles: a clinical, histopathological and immunohistochemical study

The aim of study was to evaluate the clinicopathological features of oral mucoceles and the immunohistochemical expression of cellular and extracellular matrix components in these lesions. One hundred cases of oral mucoceles were examined for clinicopathological features. The expression of mast cell tryptase, CD68, MMP-1 (matrix metalloproteinase-1), MMP-9 (matrix metalloproteinase-9) and CD34 was investigated immunohistochemically in 32 cases. The lesions arose as nodules or blisters of variable color. The mean age was 23.2 years and a higher male frequency was observed. The most common locations were the lower lip (92%), followed by the floor of the mouth (7%), and palate (1%). The lesion size ranged from 0.4 to 3.0cm. Unusual histopathological findings as superficial mucoceles (n=16, 16%), pseudopapillary projections (n=3, 3%), epithelioid histiocytes (n=4, 4%), multinucleated giant cells (n=1, 1%) and myxoglobulosis (n=9, 9%) were also seen. Mast cells and CD68-positive macrophages, MMP-1, MMP-9 and CD34-positive blood vessels were seen in all cases. A significant association was seen between mast cells and MMP-1 (p=0.03) and between macrophages and MMP-1 (p=0.01). This study provided important insight into the demographic and histopathological occurrence of oral mucoceles. The tissue remodeling seen in these lesions mainly involved the migration and interaction of mast cells, macrophages and MMP-1.

[Inequalities in oral health care use in the primary care setting and associated factors in two Brazilian municipalities]

OBJECTIVE

To investigate the factors associated with inequality in the use of oral health services in the Brazilian Family Health Program (Estratégia Saúde da Família, ESF) as measured by dental extractions.

METHODS

A population-based household survey was carried out in two municipalities with full coverage by the ESF in the state of Bahia, Brazil. Ten census tracts were randomly selected. Households were selected by systematic sampling. To assess the use of public services by the population, a prevalence of 50%, sampling error of 4%, and confidence interval of 95% were considered. Trained community health workers conducted key informant interviews on use of oral health services and collected demographic data for all household members aged 15 years or older. Dental extraction was the main outcome. The association between dental extraction and predictive variables was assessed using prevalence ratio, and multivar logistic regression analysis was performed using odds ratio (OR).

RESULTS

Data from 2,539 people was collected. Of these, 682 (26.86%) had used primary oral health care services in the previous 12 months. Dental extraction was performed in 218 (31.96%) out of 682 primary care patients. Being assisted by social programs (OR = 1.43; IC95%: 1.02-2.01), being older than 35 years (OR = 1.59; IC95%: 1.12-2.27), and having lower education levels (OR = 1.81; IC95%: 1.27-2.56) were independently associated with the outcome.

CONCLUSIONS

The present results suggest that historical inequalities of access to oral health services persist. Intersectoral actions may play an important role in improving oral health conditions.

Effects of LED phototherapy on relative wound contraction and reepithelialization during tissue repair in hypothyroid rats: morphometric and histological study

The aim of this study was to assess morphometrically and histologically, the effects of light-emitting diode (LED) (λ630 ± 20 nm) phototherapy on reepithelialization and wound contraction during tissue repair in hypothyroid rats. Thyroid hormone deficiency has been associated with disorders of tissue repair. LED phototherapy has been studied using several healing models, but their usefulness in the improvement of hypothyroidism wound healing remains unknown. Under general anesthesia, a standard surgical wound (1 cm(2)) was produced on the dorsum of 48 male Wistar rats divided into four groups of 12 animals each: EC-control euthyroid, ED-euthyroid + LED, HC-control hypothyroid, and HD-Hypothyroid + LED. The irradiation started immediately after surgery and was repeated every other day for 7 and 14 days. Photographs of the wound were taken at the day of the surgical procedure and on days 8 and 15 after surgery, when animals' deaths occurred. The specimens were removed, routinely processed, and stained with hematoxylin/eosin. Seven days after the surgery, it was possible to observe statistically significant reductions in the wound area of the irradiated euthyroid group, in comparison to hypothyroid group, irradiated and non-irradiated (ANOVA, p < 0.05). The reepithelialization was significantly higher in the euthyroid and hypothyroid groups irradiated with LED than in the non-irradiated groups (Fisher's test, p < 0.05). No significant difference was found in the experimental period of 14 days among the groups. The hypothyroidism delayed wound healing and the LED phototherapy, at these specific parameters, improved the process of reepithelialization in the presence of hypothyroidism.

Effect of dental bleaching after bracket bonding and debonding using three different adhesive systems

OBJECTIVE

To evaluate the influence of bonding and debonding of orthodontic brackets on dental in-home bleaching, taking into account three different adhesive systems.

METHODS

Forty-four bovine incisors were divided into four groups according to the primer system used for orthodontic bracket bonding. Following the debonding of orthodontic brackets, the teeth were stored in staining solution for 96 hours. Then, teeth were whitened using 10% carbamide peroxide for two weeks at a 6-hour-a-day regime. Standardized digital photographs were taken at the following intervals: T₀ (initial); T₁ (after debonding); T₂ (after pigmentation); T₃, T₄ and T₅ representing 1, 7, and 14 days of bleaching. Repeatability and stability tests were carried out to check the method accuracy. Images were analyzed using Adobe Photoshop 7.0 software considering (L*a*b*) color coordinate values and a modified color difference total (ΔE').

RESULTS

The results of this study (ANOVA and Tukey; p < 0.01) demonstrated that after 7 days of bleaching, experimental groups showed significantly less teeth whitening compared to the control group. However, there were no significant color differences between the groups after 14 days, according to values of lightness (L*).

CONCLUSIONS

Regardless of the adhesive primer system applied, bonding and debonding of orthodontic brackets alters the outcome of tooth whitening in the first 7 days of bleaching, however it has no influence on the whitening of the dental structure after 14 days of in-home dental bleaching with 10% carbamide peroxide.

Occlusal characteristics and orthodontic treatment need in black adolescents in Salvador/BA (Brazil): an epidemiologic study using the Dental Aesthetics Index

OBJECTIVE

The objective of this article is to evaluate the need of orthodontic treatment, prevalence and severity of the malocclusions in individuals of black ethnicity in a representative sample of schoolchildren of the city of Salvador/Brazil, as well as to verify if the malocclusion was affected by socio-demographic conditions such as age and gender.

METHODS

The reference population was constituted of schoolchildren with age between 12 and 15 years, enrolled in public and private schools. The malocclusion was evaluated in 486 students of black ethnicity, with ages varying from 12 to 15 years, selected in random sample in multiple stages. The adopted significance level was 1% and the power of the test was 90%. A questionnaire registering demographic characteristics was filled out by each individual. The Dental Aesthetics Index (DAI) was used by previously calibrated examiners (kappa 0.89), according to criteria of the World Health Organization.

RESULTS

It was verified that most of the individuals (76%) had little or any need for orthodontic treatment. About 24% showed a condition of severe malocclusion, culminating in a vital need for orthodontic treatment. The main occlusal characteristics found in the group with high need of orthodontic treatment were dental crowding and accentuated overjet. The age was positively related to the improvement of the maxillary overjet and to the presence of crowding.

CONCLUSION

The development of public politics that aim the insertion of orthodontic treatment among the procedures of health programs, with the implementation and development of specialized centers, is fundamental.

Condição de urgência odontológica e fatores associados em trabalhadores da construção civil: Bahia, 2008

INTRODUÇÃO: O ramo da construção civil lidera as taxas de acidentes de trabalho e a sua força produtiva caracteriza-se por empregar, a baixo custo, um número significativo de força de trabalho masculina com reduzido nível de escolaridade. Em relação à saúde bucal, percebe-se que este grupo apresenta problemas bucais relevantes, que podem culminar em urgências odontológicas. OBJETIVO: O objetivo deste trabalho foi verificar a condição de urgência odontológica e os fatores sociodemográficos associados, em trabalhadores da construção civil de empresas de Salvador-BA e região metropolitana, atendidos pelo SESI-BA. MATERIAL E MÉTODO: Conduziu-se um estudo transversal com dados de 1057 trabalhadores, examinados no ano de 2008. Procedeu-se à análise descritiva de indicadores sociodemográficos e indicadores de saúde bucal, e ao teste de associação do qui-quadrado. A análise multivariada foi realizada e todas as variáveis que mostraram significância estatística com um p < 0,15 foram consideradas no modelo saturado da Análise de Regressão de Poisson Robusta. RESULTADO: Observou-se um percentual de 14% de condição de urgência e associação positiva com alta atividade de cárie (RP = 1,98 IC95% 1,32-2,64 p = 0,00) e menor grau de escolaridade (RP = 1,48 IC95% 1,01-1,95 p = 0,04). CONCLUSÃO: Os resultados mostram a necessidade do desenvolvimento de ações para tratamento dos problemas bucais instalados e ações de prevenção e promoção em saúde para melhorar a condição de saúde bucal de trabalhadores da construção civil.

Malocclusion and deleterious oral habits among adolescents in a developing area in northeastern Brazil

Although malocclusions represent a serious public health issue, there is insufficient information about this problem in adolescents in Brazil, especially in poorer areas. The purpose of this cross-sectional study was to estimate the prevalence of facial alterations, dental malocclusions, and deleterious oral habits (DOH) among adolescents in a developing area in northeastern Brazil and to test the hypothesis that the occurrence of DOH in infancy is associated with DOH during adolescence. The study included a probabilistic population-based sample of 2,060 Brazilian students aged 12-15 years. Facial characteristics (type of facial profile, facial symmetry, and passive lip sealing) and malocclusions (Angle and Dental Aesthetic Index, DAI) were evaluated. DOH in infancy and adolescence were evaluated by interviews with the parents and adolescents. Most adolescents presented with normal facial characteristics. The malocclusion prevalence (Angle) was 83%. The DAI ranged from 13 to 69 (mean ± SD: 25.9 ± 7.7). Orthodontic treatment was necessary in 45.1% of the sample. The most prevalent DOH in adolescents were nail biting, object biting, cheek/lip biting, and bruxism, which were associated with finger sucking during infancy (P < 0.05). We conclude that malocclusions and DOH are common among Brazilian adolescents and that finger sucking during infancy may be a good predictor of DOH occurrence during adolescence.

[Characteristics of the access and utilization of public dental services in medium-sized cities]

This cross-sectional study sought to describe the main characteristics of access and utilization of primary and specialized public dental services in two medium-sized cities in Bahia with 100% coverage of the Family Health Program. A survey of 952 households and 2.539 individuals aged over 15 years was conducted. The main variables analyzed were: perceived oral health needs, demand for the service, barriers of organizational access and the type of service and procedure utilized. The use of specialized public dental services was of 11.7% and primary care was 26%. In the city where there was greater use of public dental services, there was less use of private services. The main barrier to access remained in primary care (from 5.0% to 15.2%). There was little interface between secondary care a primary care, as only 16.6% of users returned to this level of care. In conclusion, the main barrier to access in cities with specific organizational and geographic realities appears to be in primary dental care. Individual preventive actions were little reported. It is recommended that barriers to access in primary care be eliminated, and also that a protocol (clinical guides) be established to foster the continuity and longitudinality of primary dental care.

[Impact of the Family Health Strategy: an analysis in cities in Northeast Brazil with more than 100,000 inhabitants]

This study aimed to analyze the impact of the Family Health Strategy (FHS) on oral health in Northeast Brazil, in 12 municipalities with more than 100 thousand inhabitants. The reference was 20 census tracts, 10 of which in areas with oral health covered by the FHS for at least a year, matched with 10 census tracts without oral health coverage. The total sample included 59,221 individuals. Three possible effects were considered: negative, positive, and absence of effect on the outcomes, based on the prevalence ratio adjusted by Poisson regression. The outcomes "access to collective preventive measures" and "treatment of toothache" indicate a positive effect in the FHS oral health model. However, the outcomes "coverage of tooth extraction" and "restorative treatment" showed either a negative effect or no effect in the majority of the municipalities in the sample. Evidence indicates that within the FHS, the results reflect the local organizational models for oral health care.

Prevalência e severidade de fluorose em escolares do município de São Francisco do Conde-BA, 2010

OBJETIVO: O presente estudo objetivou determinar a prevalência de fluorose em escolares do município de São Francisco do Conde, região metropolitana de Salvador-BA. METODOLOGIA: Todos os escolares do 1º ao 5º ano do Ensino Fundamental, que estudavam em escolas com mais de 150 alunos matriculados, foram selecionados, totalizando 1716 escolares. O índice de Dean foi usado para medir o grau de fluorose, conforme preconizado pela OMS. RESULTADO: Foram examinadas 1474 crianças com idade entre sete e 13 anos, sendo 54,61% do gênero masculino e 55,39% residentes na zona rural. Daqueles casos que apresentaram fluorose (39,80%), 37,02% foram classificados como muito leve, 1,97% leve e 0,81% moderada. Os escolares de dez anos de idade apresentaram maior prevalência de fluorose. Não houve diferença de prevalência entre a zona rural e a urbana. CONCLUSÃO: Em função da baixa prevalência encontrada, a fluorose não constitui um problema de saúde pública no município, mas sim uma questão de vigilância sanitária e epidemiológica.

Family context and incidence of dental caries in preschool children living in areas covered by the Family Health Strategy in Salvador, Bahia State, Brazil

Psychosocial factors influence family care and can jeopardize child development. This study aimed to analyze the association between maternal common mental disorders and incidence of early dental caries in preschool-age children living in areas covered by the Family Health Strategy in Salvador, Bahia State, Brazil, in a cohort design. A total of 472 children were examined and their mothers were interviewed from 2007 to 2008. Incidence of at least one tooth with caries was 21.19%, while 7.84% of the children showed high risk of caries. The results after adjusting for the child's age and maternal schooling showed that maternal common mental disorders were associated with high caries risk in deciduous teeth (adjusted RR = 2.41, 95%CI: 1.05-5.56, among children with 6 or fewer home appliances in the household; adjusted RR = 3.44, 95%CI: 1.06-11.17, among those that brushed twice or less per day). Maternal mental problems were associated with the development of caries in preschoolers.

Maternal breastfeeding, parafunctional oral habits and malocclusion in adolescents: a multivariate analysis

OBJECTIVE

Malocclusion may result in esthetic impairment and functional disorders such as bad chewing, speech and swallowing, with a negative impact on quality of life. There is uncertainty regarding the effects of breastfeeding on dentofacial malocclusions. The purpose of the study was to evaluate the relationship between maternal breastfeeding and dental malocclusions and facial characteristics in adolescents with permanent dentition.

METHODS

Probabilistic sampling of 2060 12- to 15-year-old students in a cross-sectional study was used. Malocclusion, as defined by Angle, and facial characteristics were the dependent variables. The duration of breastfeeding was the main independent variable. Other covariates were tested as effect modifiers or confounders. The associations were estimated using the odds ratio (OR) in multinomial logistic regression analysis (α=5%).

RESULTS

There was an association between a short duration of breastfeeding (less than 6 months) and Angle class II (OR=3.14; 95% CI: 1.28-7.66) and class III (OR=2.78; 95% CI: 1.21-6.36) malocclusion only in students with a prolonged history of bruxism. A higher occurrence of severe convex profile (OR=3.4; 95% CI: 0.63-18.26) and a lower occurrence of cancave profile (OR=0.43; 95% CI: 0.21-0.88) were also observed only among adolescents who had been breastfed for a short period and exposed to a long periods of mouth breathing.

CONCLUSIONS

These findings support the hypothesis that breastfeeding alone seems not to be directly associated with malocclusions, but it may have a synergetic effect with parafunctional oral habits on the development of occlusofacial problems. It is recommended that deleterious oral habits be avoided, especially by children who were breast-fed for less than 6 months.

Brazilian Oral Health Policy: factors associated with comprehensiveness in health care

OBJECTIVE

To analyze the factors associated with comprehensiveness in oral health care in Centers of Dental Specialists, according to the guiding principles of the Brazilian Oral Health Policy.

METHODS

An exploratory cross-sectional study, based on an interview with 611 users of four specialized dental care centers, was performed in the state of Bahia, Northeastern Brazil, in 2008. The dependent variable was described as "comprehensiveness in oral health care", corresponding to having a primary dental care performed before specialized treatment or concomitantly with it. The main covariables referred to the level of coverage of the family health strategy in the city, users' sociodemographic characteristics, and organizational and geographic accessibility to the service, in addition to the type of specialized care required.

RESULTS

Residents of the cities where the Family Healthcare Program had a coverage >50% were more likely to conclude their dental treatment (PR=2.03, 95% CI: 1.33;3.09), compared to those who lived in places with lower coverage. Individuals who sought endodontic treatment were more likely to receive comprehensive oral health care than users who were seeking other types of specialized care (PR=2.31, 95% CI: 1.67;3.19). Users with better geographic accessibility to specialized services (PR=1.22, 95% CI: 1.03;1.41), with a reference guide from primary care (PR=2.95, 95% CI: 1.82;4.78) and coming from primary health care services (PR=3.13, 95% CI: 1.70;5.77) were more likely to achieve comprehensiveness in oral health care than other users.

CONCLUSIONS

Users with better geographic accessibility, lower age and need of endodontic services were more likely to receive comprehensive health care. Implementation of Centers of Dental Specialists in cities where primary healthcare is not adequately structured is not recommended, because secondary health care would meet the free demand and perform basic procedures, thus not fulfilling the expected principle of comprehensiveness.

Caracterização do diagnóstico tardio do câncer de boca no estado de Alagoas

Oral cancer in Brazil still presents high levels of incidence and mortality bearing different traits throughout the national territory. In most of the cases the diagnosis is late; however there is a great possibility for cure when treated early on.

Aim

to assess factors associated with the late diagnosis of oral cancer in the state of Alagoas.

Material and Methods

a prospective cross-sectional study was carried out in 74 patients, all of them diagnosed with oral squamous cell carcinoma in a hospital of Alagoas, between July of 2007 and September of 2008. A semi-structured interview was given, obtaining socio-demographic data, the type of professional help sought, symptom onset, referrals and tumor clinical stage at the moment of diagnosis.

Results

According to the results obtained in this study, the patients usually sought professional medical help, rather than dental help when a lesion in the mouth appeared, being always referred to a specialist by the dentist, in advanced stages of the disease.

Conclusions

This study suggests the need for continued education programs for the population and professionals aiming at the early identification of symptoms of the illness; however needing further studies.

Condições de saúde bucal de crianças na faixa etária pré-escolar, residentes em áreas de abrangência do Programa Saúde da Família em Salvador, Bahia, Brasil

OBJETIVOS: determinar a prevalência e gravidade da cárie dentária, maloclusões, e alteração gengival em pré-escolares de cinco anos de idade residentes em áreas do Programa Saúde da Família (PSF). MÉTODOS: estudo de corte transversal, conduzido com crianças de cinco anos examinadas por equipes de saúde bucal do PSF e do programa de Procedimentos Coletivos do serviço municipal de saúde de Salvador, Bahia, Brasil, em 2005. Os critérios de diagnóstico da Organização Mundial da Saúde e do Projeto Saúde Bucal foram utilizados e os exames foram realizados em escolas, creches ou em domicílios. RESULTADOS: participaram deste inquérito 1374 crianças. A prevalência da cárie foi de 49,6% e o ceo-d (média de dentes cariados, extraídos e obturados) igual a 1,97, sendo que a maioria dos dentes encontrava-se cariados (85,78%). A prevalência de alteração gengival foi de 7,40% e maloclusões leve e moderada/severa de 24,90% e 12,70%, respectivamente. CONCLUSÕES: foram constatadas elevada prevalência e gravidade de problemas bucais passíveis de prevenção e controle mediante ações educativas, preventivas e curativas mais efetivas da atenção primária, em pré-escolares no município. A epidemiologia no serviço pode colaborar para o planejamento e acompanhamento de tais ações

Oral Cancer: Population Sample of the State of Alagoas at a Reference Hospital

The incidence and mortality of oral cancer in Brazil remains high; the disease manifests varying features throughout the country.

Aim

To analyze the epidemiology of oral cancer, including the prevalence, type and site of lesions, the distribution in the state of Alagoas, staging, treatment, and social and demographic aspects.

Materials and Methods

A descriptive retrospective study was carried out. Data were gathered from records of a hospital in Alagoas from January 2000 to December 2006.

Results

Of 396 cases (100% of the sample), 62.70% were male and 37.30% female. Most tumors were on the tongue. The mean age was 61.95 years (SD=14.56 years), and 95.2% of the sample were aged over 40 years. Most of lesions were stage II (57.04%). Radiotherapy was the most common treatment.

Conclusion

This study revealed the epidemiology of oral cancer patients at a reference hospital in the state of Alagoas. The results showed that oral cancer occurs mostly in males in the sixth decade of life; the most common site is the tongue, followed by the floor of the mouth.

Contexto familiar e alterações oclusais em pré-escolares no município de Salvador, Bahia, Brasil

OBJETIVOS: avaliar a prevalência e a associação entre variáveis sócio-ambientais e a maloclusão infantil. MÉTODOS: estudo transversal, em crianças de 1-5 anos, residentes em seis áreas do Programa de Saúde da Família, em Salvador, Bahia, Brasil. Foram sorteadas 360 famílias pré-estratificadas, pelo cadastro das famílias das Unidade de Saúde da Família (USF) (415 pré-escolares). Após a identificação, foram realizadas visitas domiciliares onde foram entrevistados os pais/responsáveis e as crianças examinadas. Foram utilizados como instrumentos a ficha A - Sistema de Atenção Básica, e o exame oclusal - presença ou ausência de alteração e tipo de desvio. A análise de regressão logística foi utilizada (p<0,05). RESULTADOS: 34,5 % das crianças apresentaram maloclusão; 77,2% residiam em habitações com mais de quatro cômodos e 64,8% das crianças foi aleitada naturalmente e destas, 50,6% por sete meses ou mais. Não tinham o hábito da sucção digital, 89,6% das crianças, mas uso da chupeta foi registrado em 47%. A análise de regressão logística identificou as associações: o número de indivíduos menores de 14 anos na residência (OR=1,44; IC95%: 1,02 - 2,26), sucção digital (OR=1,75; IC95%: 1,08-3,46) e ter adulto com uso abusivo de álcool (OR=1,22; IC95%: 1,04 - 2,02). CONCLUSÕES: ampliar o acesso à saúde oral pode refletir positivamente na saúde oral e qualidade de vida das crianças.

Disfunção familiar referida pela presença de depressão materna e/ou alcoolismo na família e ocorrência de cárie dentária em crianças de dois e três anos de idade

OBJETIVOS: identificar a associação entre disfunção familiar, referida pela presença de alcoolismo na família e/ou presença de sintomas de depressão materna e a cárie dentária em crianças de dois e três anos de idade. MÉTODOS: a população consistiu de 74 famílias de Salvador, Bahia. A coleta de dados compreendeu o exame bucal das crianças e a entrevista com suas mães no domicílio. Foram utilizados para o diagnóstico de cárie dentária os critérios adotados pela da Organização Mundial de Saúde, classificando posteriormente a prevalência da doença. Para a identificação de sintomas de depressão materna e/ou caso de alcoolismo na família foram utilizados o Self-Report Questionnaire (SRQ-20) e a escala CAGE adaptada, respectivamente. Procedeu-se a análise descritiva, e a razão de prevalência ajustada para as variáveis de confusão estimada por meio de regressão logística não-condicional. RESULTADOS: a população revelou-se homogênea no perfil socioeconômico. A prevalência de cárie em crianças foi de 20,2%. Observou-se uma associação positiva entre disfunção familiar e cárie (RPbruta= 3,06; IC95%: 1,07-8,75). Quando este modelo foi ajustado pelas covariáveis de confusão, chefia da família e situa-ção de trabalho materno nos últimos dois anos, detectou-se incremento da associação (RPajustada= 7,35; IC95%: 1,50-36,07). CONCLUSÕES: existe uma associação entre disfunção familiar e ocorrência de cárie dentária em crianças de dois e três anos de idade.

Fluorose dentária em escolares de 12 e 15 anos de idade. Salvador, Bahia, Brasil, nos anos 2001 e 2004

O objetivo deste trabalho foi comparar os resultados de dois estudos populacionais, conduzidos em Salvador, Bahia, Brasil, sobre a prevalência e severidade da fluorose dentária nas idades de 12 e 15 anos. Discutiram-se as metodologias dos estudos em relação ao processo amostral, calibração dos examinadores, sistemática de coleta, comparando-se as diferenças obtidas por meio do teste do qui-quadrado e intervalo de confiança (95%), obtidas pelo índice de Dean. Foram examinados 3.313 adolescentes de 12 e 15 anos, em 2001, e 1.032, em 2004. Nos dois períodos, procedeu-se à calibração dos examinadores, e as amostras foram de base populacional. No segundo estudo, houve maior proporção de alunos de escolas públicas nas duas idades em relação ao ano de 2001 (p < 0,001). Não existiu diferença na ocorrência da fluorose aos 12 anos, com uma prevalência de 32,64%, em 2004, e 31,4%, em 2001. Já aos 15 anos, em 2004 observou-se uma prevalência inferior a do ano de 2001 16,83% e 27,6%, respectivamente. Não pode se observar, neste período, tendência de incremento da prevalência ou severidade da fluorose em Salvador.

Prevalência de cárie dentária em escolares de 12 e 15 anos de Salvador, Bahia, 2001

OBJETIVOS: determinar a prevalência e severidade da cárie em escolares aos 12 e 15 anos de idade em Salvador, segundo distrito sanitário. MÉTODOS: desenvolveu-se um estudo transversal com uma amostra probabilística, pré-estratificada pelos 12 distritos. Equipes calibradas examinaram 3313 escolares (CPO-D). Dados sobre acesso e cobertura dos serviços de saúde foram obtidos através de questionário. Para a análise utilizaram-se: teste do qui-quadrado, t de Student, análise bivariada e de regressão logística com nível de significância de 5%. RESULTADOS: 49,6% da amostra teve acesso ao dentista no último ano e quase 40% aos 12 anos e 27,7% aos 15 anos relataram ter participado de programas coletivos nos últimos dois anos. Observou-se um CPO-D de 1,44 e 49% das crianças livres de cárie aos 12 anos, e um índice de 2,66 aos 15 anos. Os distritos com menor prevalência de cárie foram o de Pau da Lima, Cajazeiras e Subúrbio Ferroviário. CONCLUSÕES: foi baixa a prevalência de cárie, e são encontradas iniqüidades na distribuição da cárie em áreas geográficas distintas, reforçando a necessidade de vigilância à saúde.

Prevalência da fluorose dentária em escolares de 12 e 15 anos de idade em Salvador, Bahia, Brasil, 2001

O objetivo foi determinar a prevalência da fluorose dentária em uma amostra de 3.313 escolares de 12 e 15 anos em distrito sanitário em Salvador, Bahia, Brasil. Desenvolveu-se um estudo transversal e os dados foram coletados por sete examinadores (kappa = 0.69), segundo os critérios da OMS (índice de Dean). Informações adicionais como participação em programas, acesso ao dentista, local de moradia dos 0-5 anos de vida, sexo e etnia foram obtidos mediante questionário. Procedeu-se à análise descritiva para o município e para cada distrito. Resultou que 31,4% dos escolares aos 12 anos e 27,6% aos 15 anos apresentavam fluorose, predominando a categoria "muito leve". Foram encontradas diferenças entre os distritos (p < 0.05 X²). Os distritos de Pau da Lima e Brotas foram os com maior percentual de indivíduos sadios aos 12 anos 81,8% e 81,6%; e, aos 15 anos, Subúrbio Ferroviário, Pau da Lima e Cajazeiras foram as regiões com menor prevalência 13,0%, 14,6% e 13,5%. O distrito da Liberdade apresentou maior prevalência 72,4% e 57,3% aos 12 e 15 anos, respectivamente, atribuída às diferenças na calibração da equipe. Foram identificadas diferenças entre os distritos sanitários, reforçando a necessidade de vigilância à saúde.

[Dental caries in 12- and 15-year-old schoolchildren from public and private schools in Salvador, Bahia, Brazil, in 2001]

The aim of this paper was to assess the caries experience of 12- and 15-year-old schoolchildren from public and private schools in Salvador, Bahia, Brazil, and to identify the access of children to dental services and the coverage of such services, which might be related to differences between the groups. Cross-sectional data were obtained from 3,313 clinical exams, which followed the WHO (1997) criteria for the diagnosis of dental caries. The analysis was carried out by means of the Student's t test, the chi-square test and analysis of covariance. There were no differences regarding DMFT and frequency of caries-free individuals between public and private schools. However, while F (filled teeth) was the most prevalent component of the index in subjects from private schools, M (missing teeth) was the most common in those from public schools. The access to dental services in the last year was the only variable associated to the differences between both groups. Thus, the importance of access to dental services and social benefits must be pointed out in order to guarantee equity in oral health.

[Dental fluorosis in Brazil: a critical review]

This paper discusses dental fluorosis as a relevant public health problem, using a review of epidemiological studies published in the last 10 years on the disease's prevalence, severity, and risk factors. The results suggest that there are already more cases than expected, although few studies refer to major severity. Thus, measures are needed for the prevention and surveillance of dental fluorosis.