The relationship of children's dental clinical status with school performance and school attendance in the Kingdom of Bahrain: A life-course approach

OBJECTIVES

To examine the association between dental clinical status and school performance and school attendance in the Kingdom of Bahrain (KoB) using a life-course framework.

METHODS

This time-ordered cross-sectional study included 466 school children in Grade 2 (aged 7-8 years) and their parents in the KoB. Data were collected through parents' self-administered questionnaires, children's face-to-face interviews and dental clinical examinations. Data on children's school performance and school attendance were gathered from parents and school records. Structural equation modelling (SEM) examined the direct and indirect pathways between variables.

RESULTS

Children born in families with high socio-economic status (SES) were less likely to have dental caries and more likely to have better school performance at 7-8 years of age. Dentine caries was directly linked with poor school performance. Treated teeth directly predicted high school performance. The presence of dentine caries mediated the relationship of SES with school performance.

CONCLUSIONS

Birth and current socio-economic factors were significant predictors of dental clinical conditions and school performance. Dental caries and fewer treated teeth directly predicted poor school performance.

Development and psychometric validation of the gum health experience questionnaire

AIM

To develop and validate a new health-related quality of life measure to capture a wide range of gum-related impacts.

MATERIALS AND METHODS

The measure was developed using a multi-stage approach and a theoretical model. Development involved semi-structured interviews, pilot testing, cross-sectional analysis among a general population (n = 152) to assess psychometric properties and test-retest reliability among a subsample (n = 27).

RESULTS

Psychometric analysis supports the validity and reliability of the measure's impact scale. The measure has excellent internal reliability (nearly all item-total correlations above .4; Cronbach's alpha between .84 and .91 for subscales), with test-retest reliability also performing well (Intra-class correlation coefficient [ICC] of .91-.97 for subscales). Good content validity (indicated by large standard deviations for item and total scores) and construct validity (correlations of .54-.73 with global gum health rating for subscales, all p < .05) were also observed. Qualitative and quantitative data indicate that people with gum health-related symptoms experience different degrees of discomfort and impacts caused by their condition.

CONCLUSIONS

The gum health experience questionnaire holds substantial promise as a measure of gum-related quality of life in people across the gum health-disease continuum. Further face validity, refining and reducing the number of items and longitudinal studies to test evaluative properties are required before the measure can be used with confidence.

Social capital and oral health in children and adolescents: A systematic review and meta-analysis

OBJECTIVES

To systematically evaluate the association of individual and contextual social capital with oral health outcomes in children and adolescents.

METHODS

Electronic searches were performed in PubMed/Medline, Embase, Web of Science and Scopus databases for articles published from 1966 up to June 2021. Two calibrated reviewers screened and critically appraised the identified papers. Observational studies that evaluated the relationship of individual or/and contextual social capital or their proxies with oral health outcomes in children and adolescents using validated methods were included. Quality assessment was conducted using the Newcastle-Ottawa Scale. Data were extracted for narrative synthesis and meta-analysis followed by a meta-regression model. Meta-analysis using random effects method was used to estimate pooled prevalence ratio (PR) and 95% confidence intervals (CI).

RESULTS

Of the 3060 studies initially retrieved, 31 were included in the systematic review and 21 in the meta-analysis, totalling 81 241 individuals. The clinical outcomes included dental caries and gingival bleeding and subjective outcomes were oral health-related quality of life (OHRQoL) and self-rated oral health (SROH). Individuals with lower levels of individual social capital had a higher prevalence of poor clinical (PR 1.11; 95%CI 1.02-1.22) and subjective (PR 1.25; 95%CI 1.09-1.45) oral health conditions. The prevalence of worse clinical (PR 1.34; 95%CI 1.11-1.61) and subjective (PR 1.56; 95%CI 1.13-2.16) oral health outcomes were also associated with lower levels of contextual social capital. In general, the contextual level of social capital exerted more impact, and the subjective oral health outcomes were the more affected.

CONCLUSIONS

Contextual and individual social capital were positively related to oral health outcomes, such as dental caries, gingival bleeding, SROH and OHRQoL in children and adolescents.

Gum health and quality of life—subjective experiences from across the gum health-disease continuum in adults

Background

There has been a lack of qualitative work investigating the effects of the wide range of gum-related symptoms, and the perceived everyday impacts associated with these including on quality of life. While periodontal disease has been shown to have significant effects on quality of life, fewer studies have researched the perceived impacts of gingivitis and symptoms from across the entire gum health-disease continuum, despite evidence that these can also negatively affect quality of life. The aim of this study was to investigate perceived everyday impacts and explore the subjective experiences of adults with a variety of symptoms from across the self-reported gum health-disease continuum, and how these may affect quality of life.

Methods

Participants were recruited at a large UK University using purposive sampling, for self-reported symptoms ranging from mild gingivitis to severe periodontal disease. Semi-structured interviews gathered details on symptom history, changes occurring over time and associated beliefs, as well as perceived impacts on everyday life, and links between these experiences and identity. Interviews were analysed using framework analysis based on the Wilson and Cleary health-related quality of life model.

Results

Twenty-seven participants were recruited − 15 with symptoms of gingivitis, 12 with more severe periodontal symptoms. Prominent themes included description of symptoms, changes in daily life, social impacts, psychological impacts, identity, and overall impacts and quality of life. Differences were noted in severity, extent and frequency of symptoms and participant experiences, with greater perceived impacts often felt by those with periodontal disease. However, participants from across the gum health-disease continuum often expressed similar experiences and concerns.

Conclusion

Findings demonstrate the range of experiences from participants with a variety of gum-related symptoms; notably, gingivitis was reported to have a range of perceived impacts on quality of life alongside those reported by periodontal disease sufferers. Future work should look to include symptoms from across the entire gum health-disease continuum when considering quality of life, as well as considering a more patient-centred approach which could be valuable in both clinical and research settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02507-5.

Health-related behaviors during adolescence and subsequent anxiety and depression: the HUNT study

Background

Evidence on the predictors of common mental disorders using nationwide health registries are scarce in Norway. Identifying modifiable behaviours affecting mental health across the lifespan is paramount to develop tailored strategies to tackle mental illnesses. The aim of this study was to identify patterns of health-related behaviours in adolescence and their influence on anxiety and/or depression in adulthood.

Methods

This was a prospective study based on data from the Trøndelag Health Study (HUNT) and health register data (N = 2061). Patterns of health-related behaviours were assessed according to physical activity, consumption of wholegrain bread, fish, fruit, vegetables, and sugar sweetened beverages and insomnia. Participant’s use of healthcare system for anxiety and/or depression was recorded at least once in the health registries. The patterns of health-related behaviors were identified through latent class analysis. Multivariable logistic regression was used to test the association between patterns of health-related behaviors and depression or/and anxiety.

Results

Four classes of health-related behaviors were identified: class 1 (15.2%), class 2 (36.0%), class 3 (24.2%), class 4 (24.6%). Adolescents with unhealthy behaviors (classes 1, 2 and 3) had 82%, 34% and 84% higher odds of depression and/or anxiety during adolescence and early adulthood than those from the healthy-related behaviors group (class 4).

Conclusions

Our findings suggest that health-related behaviors are clustered among Norwegian adolescents. There was a meaningful association of the three patterns of unhealthy behaviors during adolescence with anxiety and depression in adulthood. Population strategies and policies aiming to tackle unhealthy behaviors among adolescents can positively impact on adult’s mental health.

Key messages

• Improving healthy behaviors during adolescence may reduce the burden of mental illness in adulthood.

• Population strategies and policies aiming to tackle unhealthy behaviors among adolescents can positively impact on adult’s mental health.

Making white spots disappear! Do minimally invasive treatments improve incisor opacities in children with molar-incisor hypomineralisation?

BACKGROUND

Children with molar-incisor hypomineralisation (MIH) frequently seek aesthetic treatment for incisor opacities. Surprisingly, few studies have evaluated the clinical success of such interventions.

AIM

To quantify the effectiveness of minimally invasive treatments in reducing enamel opacity visibility in children with MIH.

DESIGN

This in vitro study used digital clinical images of 23 children aged 8-16 years with MIH who underwent microabrasion and/or resin infiltration for the management of incisor opacities. Standard images were taken pre-treatment and 6 months post-treatment. Image software (Image-Pro Plus^® V7) was employed to convert 24-bit RGB images to 16-bit greyscale and 145× magnification. Measurement repeatability was assessed using intra-class correlation coefficients (ICCs). Post-treatment changes in visible opacity area (mm² ) and brightness (greyscale value) were tested using the Wilcoxon signed-rank test for related samples.

RESULTS

The mean total opacity surface area significantly reduced from 14.3 mm² (SD = 7.5) to 9.4 mm² (SD = 9.0) post-treatment. The proportion of tooth surface affected by the opacity also significantly reduced from 22.5% (SD = 10.5) to 14.7% (SD = 12.7). The mean maximum opacity brightness significantly reduced from 53 066 greyscale value (SD = 4740) to 49 040 (SD = 3796). ICC was good/excellent (0.75-1.0).

CONCLUSION

Minimally invasive treatment is effective in reducing the size and brightness of discrete incisor opacities. Future research should compare objective findings with patient-reported outcomes.

Association between sense of coherence and oral clinical conditions in adults and the elderly: systematic review and meta-analysis

OBJECTIVE

This study systematically reviews the evidence on the relationship between sense of coherence (SOC) and oral clinical conditions in adults and elderly people.

METHODS

PubMed, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences - Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Brazilian Dentistry Bibliography - Bibliografia Brasileira de Odontologia (BBO), Cochrane Library and grey literature were searched. Observational studies involving adults and elderly people that evaluated SOC with a valid instrument and investigated oral clinical measurements as outcomes were included. Two review authors independently assessed the studies for inclusion and extracted data. The quality of studies was assessed using the Downs and Black checklist. Meta-analysis used the random-effect inverse-variance method to obtain pooled odds ratios (OR) and 95% Confidence Intervals (CI) for each oral clinical condition.

RESULTS

From a total of 872 identified studies, ten observational cross-sectional and one longitudinal study were included. Nine studies were judged of medium or high risk of bias. Meta-analyses showed that adults and elderly people with higher SOC were less likely to present dental caries (OR 0.84; 95%CI = 0.73-0.96), periodontal disease (OR 0.58; 95%CI = 0.30-0.85), gingivitis (OR 0.54; 95%CI = 0.18-0.90) or dental biofilm (OR 0.65; 95%CI = 0.43-0.86).

CONCLUSIONS

Current evidence suggests that better SOC is positively related to better oral clinical status in adults and elderly people. Longitudinal and intervention studies are needed to confirm these findings.

Pathways between Social Capital and Oral Health from Childhood to Adolescence

This study aimed to evaluate the theoretical pathways by which social capital can influence dental caries and oral health-related quality of life (OHRQoL) of children over time. This 10-y prospective cohort started in 2010 with a sample of 639 preschoolers aged 1 to 5 y from the southern Brazil. Community and individual social capital were assessed at baseline through the presence of formal institutions in the neighborhood and social networks, respectively. In the 10-y follow-up, the individual social capital was evaluated by social trust and social networks. Dental caries was measured by the International Caries Detection and Assessment System (ICDAS), and the short version of the Child Perception Questionnaire (CPQ11-14) was used to assess OHRQoL. Demographic, socioeconomic, behavioral (frequency of toothbrushing and use of dental services), and psychosocial (sense of coherence) characteristics were also assessed. Structural equation modeling was used to evaluate the associations between variables over time. About 429 children were reassessed at 10-y follow-up (67.1% cohort retention rate). High community social capital at baseline directly predicted lower occurrence of dental caries and better OHRQoL after 10 y. Social capital at community level also indirectly predicted lower occurrence of dental caries through sense of coherence, frequency of toothbrushing, and use of dental services. Individual social capital at follow-up was indirectly linked to OHRQoL via the psychosocial pathway (sense of coherence). Community-level social capital was associated with dental caries and OHRQoL over time. The relationship between individual social capital and oral health was mediated through the psychosocial pathway.

Are oral health conditions associated with schoolchildren's performance and school attendance in the Kingdom of Bahrain? A life-course perspective

BACKGROUND

The link between oral diseases and school performance and school attendance remains unclear among Middle Eastern children.

AIM

To investigate the relationship of oral conditions with schoolchildren's school performance and attendance using the life-course approach.

DESIGN

A cross-sectional study was conducted with 466 schoolchildren aged 7-8 years from Kingdom of Bahrain (KoB) and their parents. Questionnaire data on children's current and at-birth environmental characteristics were completed by their parents. Children's oral health measures, including ICDAS (International Caries Detection and Assessment System), PUFA (pulp, ulcer, fistula, abscess), and DDE (developmental defects of enamel) indices, were the exposure variables. School performance and school attendance data obtained from the school register were the outcome variables. The data were analysed using multivariate ordinal logistic regression.

RESULTS

The odds of excellent school performance were significantly lower for children with untreated dentinal caries (OR = 0.98; 95% CI: 0.96-0.99). Children with caries-treated teeth showed greater odds of excellent school performance (OR = 1.41; 95% CI: 1.15-1.74). Disease Control and PreventionNone of the dental conditions were significantly associated with children's school attendance. A permissive parental style was associated with poor school attendance (OR = 2.63; 95% CI: 1.08-6.42).

CONCLUSION

Dental caries was associated with poor school performance but not with school attendance. Treated caries was associated with good school performance.

Do psychological factors predict changes in oral health-related quality of life and clinical status after periodontal treatment?

AIMS

To determine psychological factors predicting changes in OHRQoL and clinical status after periodontal treatment.

METHODS

Cohort of 140 patients with chronic periodontitis receiving non-surgical treatment consisting of scaling, root surface debridement and instruction in plaque control. Participants self-completed questionnaires enquiring about sense of coherence, locus of control, self-esteem and task-specific self-efficacy before treatment, and the Oral Health Impact Profile-14 before treatment, at oral hygiene review and end of study. Relationships among OHRQoL, clinical changes, individual factors (demographic and psychological) and environmental characteristics were analysed using latent growth curve modelling guided by the Wilson and Cleary model.

RESULTS

OHRQoL and periodontal status improved after treatment. Being male and having a greater sense of coherence predicted better OHRQoL before treatment. Stronger internal dimension of locus of control predicted a greater rate of improvement in OHRQoL, whereas greater external dimensions predicted a slower rate of improvement. Greater task-specific self-efficacy predicted less gains in probing attachment and reductions in probing depth.

CONCLUSIONS

Knowledge of psychological factors may be helpful in explaining individual differences in OHRQoL and clinical responses to periodontal treatment, and in identifying where health-promoting interventions may strengthen relevant factors to improve these outcomes.

Socioeconomic status and oral health-related quality of life: A systematic review and meta-analysis

OBJECTIVES

To systematically review observational studies assessing the association between socioeconomic status (SES) and oral health-related quality of life (OHRQoL) in children, adolescents and adults.

METHODS

Electronic searches were performed in the PubMed, Embase, Web of Science, LILACS and Scopus databases for articles published up to September 2020. Two independent reviewers performed the search and critical appraisal of the studies. The inclusion criteria were observational studies that evaluated the effect of SES on the OHRQoL in all age groups using validated methods. Quality assessment was conducted using the Newcastle-Ottawa Scale. Data were extracted for meta-analysis followed by a meta-regression analysis. A random-effects model was used to estimate the pooled calculate prevalence ratio (PR) and respective 95% confidence intervals (CI) for each study.

RESULTS

The search strategy retrieved 6114 publications. Some 139 articles met the eligibility criteria and were included in the systematic review. Of those, 75 were included in the general meta-analysis they represented a total sample of 109 269 individuals. People of lower SES had worse OHRQoL (PR 1.30; 95% CI 1.26-1.35). In the meta-analyses of different subgroups, an association was found between low SES and worse OHRQoL in countries of all economic classifications, in all age groups and irrespective of the socioeconomic indicator used. A socioeconomic gradient in OHRQoL was also observed, in which the lower the individuals' socioeconomic position, the poorer their OHRQoL.

CONCLUSIONS

Individuals of low SES had poorer OHRQoL, regardless of the country's economic classification, SES indicator and age group. Public policies aiming to reduce social inequalities are necessary for better OHRQoL throughout life.

Periodontal treatment, psychological factors and oral health-related quality of life

AIMS

To determine changes in OHRQoL and clinical status after periodontal treatment and the factors predicting these changes.

METHODS

Cohort of 140 patients with chronic periodontitis receiving non-surgical treatment. Participant self-completed questionnaires: Sense of Coherence, Locus of Control, Self-esteem and Task-specific Self-efficacy before treatment, and Oral Health Impact Profile at treatment, oral hygiene review and end of study. Relationships between OHRQoL, clinical data, individual and environmental characteristics were analysed with structural equation modelling guided by the Wilson and Cleary model.

RESULTS

OHRQoL and the periodontal status improved after treatment. Greater sense of coherence and age, better periodontal status, lower DMFT and being male predicted better OHRQoL after treatment. Better task-specific self-efficacy and self-esteem, but worse plaque score predicted better end periodontal status.

CONCLUSIONS

OHRQoL and periodontal status improved after periodontal treatment, and this was predicted by individual demographic and psychological factors. These factors may assist with case selection and as possible points for intervention to improve clinical and subjective outcomes of periodontal treatment.

How peoples’ ratings of dental implant treatment change over time?

Objectives

Dental implant treatment (DIT) improves peoples’ oral health-related quality of life (OHQoL). Assessment of longitudinal changes in OHRQoL may be undermined by response shift (RS). RS is the process by which quality of life changes, independent of health status as a result recalibration, reprioritization or reconceptualization. Thus, this study aimed to describe RS in the OHRQoL and perceived oral health of individuals receiving DIT and to compare the then-test, a self-anchored scale and the classification and regression trees (CRT) approaches for assessing RS.

Methods

OHRQoL was assessed in 100 patients receiving DIT using the OHIP-Edent (n = 100) and a self-anchored scale (n = 45) before placement of the final restoration and 3 to 6 months after treatment was completed. The OHIP-Edent was also used as a retrospective assessment at follow-up. CRT examined changes in the OHIP-Edent total score as a dependent variable with global changes in oral health and each OHIP-Edent subscale score as independent variables.

Results

OHRQoL and perceived oral health improved after treatment. The OHIP-Edent score decreased from 36.4 at baseline to 12.7 after treatment. On average, participants recalibrated their internal standard downwards (− 4.0 OHIP-Edent points). CRT detected downwards recalibration in 5% of participants and upwards in 15%. Reprioritization was observed in the social disability and psychological discomfort aspects of OHRQoL.

Conclusions

RS affects longitudinal assessments of OHRQoL in DIT, reducing the apparent magnitude of change. The then-test and CRT are valid and complementary methods to assess RS.

An investigation of the bidirectional link between osteoporosis and periodontitis

This study investigated whether periodontitis affects systemic bone status and whether FRAX® is a screening tool for periodontal disease in elderly women. The findings showed that bone density was not influenced by periodontitis and highlighted that women with FRAX® score above the intervention threshold had greater chance to present severe periodontitis.

PURPOSE

This study investigated whether periodontal disease is a predictor for systemic bone loss among elderly women. The utilization of FRAX® as a screening tool for severe periodontitis was also evaluated in this population.

METHODS

Current bone mineral density (BMD) for lumbar spine and proximal femur was used as an indicator of "bone status." Number of interdental sites with severe clinical attachment loss, frequency of bleeding on probing, and percentage of tooth loss due to periodontitis represented "periodontal disease" that was tested as a predictor of bone loss in a structural equation modeling analysis involving 110 participants. The intake of antiosteoporosis medication was considered in the analysis. Four other different criteria for periodontitis classification were also tested. FRAX® for major fracture was calculated without BMD, and with intervention threshold set by age. Longitudinally, BMD changes up to 10 years were also obtained and checked for possible association with periodontitis.

RESULTS

Periodontal disease was not a predictor for worse systemic bone status according to the different periodontal disease classifications, and was not associated with BMD changes. Antiosteoporosis medication directly predicted periodontal disease and systemic bone status. Women with FRAX® score above the intervention threshold had higher chance for periodontitis in more advanced stages: III/IV (OR = 1.13, 95% CI [1.04 to 1.22], p = 0.03).

CONCLUSION

Periodontal disease did not constitute a predictor for reduced systemic bone density in the studied population of elderly women. On the other hand, FRAX® demonstrated to be a useful tool to suggest periodontal evaluation. Antiresorptive medication showed benefits on periodontal and bone status.

What children say and clinicians hear: accounts relating to incisor hypomineralisation of cosmetic concern

AIM

To explore the range of impacts relating to incisor opacities as described by children, their general dental practitioners and paediatric dentists.

METHODS

Participants included 50 children, aged 7-16 years, referred to a UK hospital paediatric dentistry service for management of incisor opacities. All children were subsequently diagnosed with molar incisor hypomineralisation. Following ethical approval, data were recorded as follows: patient demographics, distance travelled, waiting times, nature of any impacts relating to incisor opacities documented in referral letters and/or in subsequent paediatric dentistry assessment records. Additionally, children completed the short form Child Oral Health Impact Profile questionnaire (COHIP-SF19) as a self-report measure of their oral health-related quality of life (OHRQoL).

RESULTS

Nearly, half (48%, n = 24) of the referral letters mentioned that the child was experiencing one or more negative social and/or functional impacts. Mean COHIP score was significantly lower (indicating poorer OHRQoL) for children whose referring dentist had identified a negative impact (COHIP = 42.9) compared to those with no documented impact (COHIP = 50.5; p = 0.018, independent t test). At the hospital consultation, negative impacts were elicited by a paediatric dentist in 86% (n = 43) of cases. Again, mean COHIP score was significantly lower for children whose assessment records noted a negative impact (COHIP = 44.5) compared to those with no recorded impact (COHIP = 60.2; p = 0.001). Families travelled a mean distance of 57 km (range 3-218 km) to the hospital service, with an average waiting time of 75 days from referral.

CONCLUSION

It is encouraging that dental professionals seem to be aware of the negative psychosocial impacts experienced by some children with enamel opacities, and that children feel able to describe them.

Effects of Bone Fragility and Antiresorptive Drugs on Periodontal Disease and Tooth Loss: A Longitudinal Study

This longitudinal study aimed to elucidate whether systemic bone fragility predicts severe periodontal clinical attachment loss (CAL) and tooth loss over the years and to test the influence of bone medication and periodontal maintenance in these relationships. Elderly women were evaluated for bone mineral density (BMD) and for fracture risk assessment (FRAX) in a cross-sectional analysis and retrospective follow-up (6- and 10-y periods). Data on BMD and FRAX were used as indicators of bone fragility in structural equation modeling. Periodontal examination and data on postmenopausal tooth loss were recorded. Multivariate Poisson regression models with robust covariance were used to estimate relative risk (RR) and 95% CI of BMD and FRAX for sites with CAL ≥6 mm and for tooth loss. The cross-sectional analysis included 134 women aged 65 to 80 y, and from them 71 and 49 women had available data for analysis in the 6- and 10-y follow-up periods, respectively. Bone fragility predicted severe CAL over 10 y (e.g., femoral neck: 10-y analysis, β = -0.389, P = 0.005; cross-sectional, β = -0.190, P = 0.004); however, this association did not remain significant when the use of bone medication was evaluated. Poisson regression showed that a better skeletal condition was associated with a lower risk of severe periodontal disease and tooth loss (cross-sectional femoral neck: RR = 0.08, P < 0.001; RR = 0.03, P < 0.001, respectively) when not adjusted for bone medication and periodontal maintenance. The receiver operating characteristic curve suggested that women with osteoporosis should be referred for periodontal assessment (sensitivity = 71.0%, specificity = 70.0%). Bone fragility is a relevant longitudinal predictor of severe periodontal disease and tooth loss among elderly women. The use of bisphosphonates improved the bone condition as well as the periodontal status. Periodontal maintenance also minimized the negative impact of low BMD on teeth-supportive tissues in the studied population. Knowledge Transfer Statement: The results of this study present evidence that the management of bone fragility and osteoporosis may be important in the prevention of periodontal attachment loss and future tooth loss. Besides the antiresorptive effects of the antiosteoporosis drugs on systemic bone conditions, these medications may protect periodontal tissues. The interaction of health care professionals such as dentists and physicians represents a key role for the approach to women's health, especially in an aging world.

Orthodontic treatment need, self-esteem, and oral health-related quality of life among 12-yr-old schoolchildren

The aim of this study was to investigate the association between orthodontic treatment need and oral health-related quality of life (OHRQoL) among 12-yr-old children. The study also assessed whether self-esteem modifies and/or moderates this relationship. Cross-sectional data on 406 schoolchildren aged 12 yr were analyzed. Data on socio-economic and demographic characteristics, dental pain, self-esteem, and OHRQoL were collected using validated questionnaires. Orthodontic treatment need was assessed, through dental examinations, using the dental aesthetic index (DAI). Multiple negative binomial regression and path analysis were used to estimate the association of orthodontic treatment need and self-esteem with OHRQoL. A modifying effect of self-esteem on the relationship between DAI and OHRQoL was observed. Self-esteem did not mediate the abovementioned relationship. Children with lower scores of self-esteem had worse OHRQoL among those with lower orthodontic treatment need (a DAI score of < 31). However, self-esteem did not influence the association between DAI and OHRQoL in children with greater orthodontic treatment need (a DAI score of ≥ 31). Self-esteem attenuated the impact of malocclusion on OHRQoL in children with minor or definite malocclusion, but not among those with severe or very severe malocclusion. Self-esteem appears to buffer the impact of malocclusion on OHRQoL in children with minor orthodontic treatment need.

Can a School-Based Intervention Improve the Oral Health-Related Quality of Life of Brazilian Children?

INTRODUCTION

Evidence of the effectiveness of oral health promotion strategies among children from different socioeconomic backgrounds is necessary to support the implementation of public health interventions.

OBJECTIVES

This study aimed to test the effectiveness of a school-based intervention to enhance the sense of coherence (SOC) and oral health-related quality of life (OHRQoL) of socially vulnerable Brazilian children. Furthermore, we explored the pathways by which the intervention may improve OHRQoL and SOC, assessing the direct and indirect pathways among demographic, clinical, socioeconomic, behavioral, and psychosocial variables.

METHODS

In this cluster-randomized trial, 5 primary schools in Brazil were randomly allocated into intervention and control groups. The intervention comprised 7 sessions of SOC-based activities over 2 mo, which focused on making the school environment a place to develop children's SOC through involving teachers, school staff, and children. Trained teachers delivered the intervention. OHRQoL and SOC data were collected at baseline, 2 wk after the intervention, and at 3-mo follow-up.

RESULTS

Information about oral clinical conditions, socioeconomic status, OHRQoL, and SOC was obtained from 356 children aged 8 to 14 y (165 in the intervention group and 191 in the control group). Children from the SOC-based intervention group reported fewer impacts of their oral health on their daily lives (Child Perceptions Questionnaire mean, 7.22) than those from the control group (9.14). The intervention group also reported greater improvement of SOC at 2 wk (SOC mean, 52.98) and 3 mo (52.75) than the control group (52.21 and 51.65, respectively).

CONCLUSION

The intervention was effective in improving SOC and OHRQoL among socially vulnerable Brazilian children. Moreover, SOC was a relevant predictor for oral symptom and functional status in this population (Brazilian Clinical Trials Registry RBR-2N9NHJ).

KNOWLEDGE TRANSFER STATEMENT

Clinicians and policy makers can use the results of this study to decide which approach to use when planning public health policy to improve the SOC and OHRQoL of socially vulnerable children. Our findings can assist policy makers in making more appropriate community health decisions in school environments that will improve community empowerment.

The Influence of Stress and Anxiety on the Expectation, Perception and Memory of Dental Pain in Schoolchildren

The aim of this study was to investigate the association of stress and anxiety with the expectation, perception and memory of dental pain among schoolchildren. A follow-up study involving 46 children aged 9 to 12 years was conducted in a public school in the city of Petropolis (RJ), Brazil. Demographic characteristics, stress (children's stress scale), and state and trait anxiety (state⁻trait anxiety inventory) were recorded before a dental procedure to restore the occlusal surface of a permanent first molar under local anaesthetic. Dental pain was assessed using the faces pain scale before (dental pain expectation), immediately after (dental pain perception) and six weeks after (memory of dental pain) the dental procedure. Dental pain expectation scores were significantly higher than dental pain perception, independent of the levels of stress, state anxiety and trait anxiety. Children with high scores of stress (OR 1.05 95%CI 1.02⁻1.09), state anxiety (OR 1.15 95%CI 1.05⁻1.27) and trait anxiety (OR 1.18 95%CI 1.07⁻1.30) were more likely to report greater scores of dental pain expectation. Children anticipated more dental pain than what was actually perceived after the dental restoration. Children with greater levels of stress and anxiety have a distorted evaluation of expected dental pain before the dental procedure.

Oral clinical status and oral health-related quality of life: is socioeconomic position a mediator or a moderator?

AIM

To evaluate whether socioeconomic position exerts a mediating and/or moderating effect on the association between oral clinical measures and oral health-related quality of life (OHRQoL) in adolescents.

MATERIALS AND METHODS

The study analysed data on 5,445 adolescents aged 15-19 years from the Brazilian Oral Health Survey (SBBrasil Project). The numbers of decayed and missing teeth, number of sextants with gingivitis and malocclusion were assessed through oral clinical examinations. Participant's age, sex, OHRQoL and socioeconomic position were also collected. Monthly family income was used to indicate the participant's socioeconomic position, and OHRQoL was assessed using the Oral Impacts on Daily Performance. Moderation was tested using Poisson regression models. Structural equation modelling and Sobel's test assessed the mediation effects.

RESULTS

Oral clinical measures, OHRQoL and socioeconomic position were significantly correlated (P < 0.001). The moderator effect of socioeconomic position on the association between all oral clinical measures and OHRQoL was observed. The impact of all oral clinical conditions on adolescents' OHRQoL was lower in the low-family-income groups compared with those with a better income. Socioeconomic position partially mediated the relationship between the four oral clinical measures and OHRQoL. Sobel's test confirmed these findings (P < 0.001).

CONCLUSIONS

The findings suggest the importance of socioeconomic position as a moderator and mediator factor between oral clinical measures and OHRQoL. Disadvantaged adolescents are likely to experience poor OHRQoL due to oral conditions. The reduction of the impact of oral conditions on quality of life in adolescents may be enhanced by addressing social inequalities related to oral health.

Subgroup identification in clinical trials: an overview of available methods and their implementations with R

Randomized controlled trials (RCTs) usually enroll heterogeneous study population, and thus it is interesting to identify subgroups of patients for whom the treatment may be beneficial or harmful. A variety of methods have been developed to do such kind of post hoc analyses. Conventional generalized linear model is able to include prognostic variables as a main effect and predictive variables in an interaction with treatment variable. A statistically significant and large interaction effect usually indicates potential subgroups that may have different responses to the treatment. However, the conventional regression method requires to specify the interaction term, which requires knowledge of predictive variables or becomes infeasible when there is a large number of feature variables. The Least Absolute Shrinkage and Selection Operator (LASSO) method does variable selection by shrinking less clear effects (including interaction effects) to zero and in this way selects only certain variables and interactions for the model. There are many tree-based methods for subgroup identification. For example, model-based recursive partitioning incorporates parametric models such as generalized linear models into trees. The model incorporated is usually a simple model with only the treatment as covariate. Predictive and prognostic variables are found and incorporated automatically via the tree. The present article gives an overview of these methods and explains how to perform them using the free software environment for statistical computing R (version 3.3.2). A simulated dataset is employed for illustrating the performance of these methods.

Multimorbidity patterns of oral clinical conditions, social position, and oral health-related quality of life in a population-based survey of 12-yr-old children

The aim of this study was to describe the patterns of multimorbidities of oral clinical conditions in children. The association between social position and number of oral clinical conditions, and the relationship of social position and number of oral clinical conditions with oral health-related quality of life [OHRQoL, measured using the Brazilian Child-Oral Impacts on Daily Performance (Child-OIDP)] were also investigated. The study analysed data on 7,208 children, 12 yr of age, from the Brazilian Oral Health Survey (SBBrasil Project). Cluster analysis based on the observed/expected (O/E) ratios identified six significant clusters of oral clinical conditions: (i) dental caries and missing teeth; (ii) dental caries and dental trauma; (iii) dental trauma and gingivitis; (iv) dental caries, missing teeth, and dental trauma; (v) dental caries, dental trauma, and gingivitis; and (vi) all oral clinical conditions. Ordinal regression showed that poor social position was associated with a large number of oral clinical conditions. Poisson regression demonstrated that low social position and greater number of oral clinical conditions increased the likelihood of poor OHRQoL (Child-OIDP extent). The four oral clinical conditions clustered into six distinct clusters among Brazilian children. Multimorbidity of oral clinical conditions predicted poor OHRQoL. Social position was of high relevance to multimorbidity of oral clinical conditions and children's OHRQoL.

Sense of coherence modifies the association between untreated dental caries and dental pain in low-social status women

Evidence of the link between sense of coherence (SOC), dental caries and dental pain is scarce.

OBJECTIVE

To explore the relationship of SOC and dental caries with dental pain prevalence in low-social status women.

BASIC RESEARCH DESIGN

A cross-sectional study.

PARTICIPANTS

A convenience sample of 190 women whose children attended a selected school in São João de Meriti, Brazil.

METHOD

Socioeconomic, demographic and oral health behaviour data were collected through interviews. SOC was assessed using the Antonovsky scale. Dental caries was evaluated through oral examinations. Multivariate logistic regression models were used to obtain Odds Ratio (OR) and 95% Confidence Intervals (CI).

MAIN OUTCOME VARIABLE

Dental pain in the past 6 months.

RESULTS

Dental pain prevalence was 26% (95% CI 20, 33). DMFT and decayed teeth means were 14.3 (SD 7.2) and 2.4 (SD 2.6), respectively. The odds of having dental pain was higher for women with moderate dental caries and low SOC (OR 3.3, 95%CI 1.1, 9.3) and women with high caries and low SOC (OR 4.0, 95% CI 1.7, 9.5) compared with women with low caries and high SOC.

CONCLUSIONS

Dental caries and lower SOC were factors associated with dental pain. SOC appeared to buffer the effect of dental caries on dental pain in women from low-socioeconomic status.

Gender differences in the association of perceived social support and social network with self-rated health status among older adults: a population-based study in Brazil

Background

Older adults are more likely to live alone, because they may have been predeceased by their spouse and friends. Social interaction could also be reduced in this age group due by limited mobility caused by chronic conditions. Therefore, aging is frequently accompanied by reduced social support, which might affect health status. Little is known about the role of gender in the relationship between social support and health in older adults. Hence, the present study tests the hypothesis that gender differences exist in the relationship between perceived social support, social network, and self-rated health (SRH) among older adults.

Methods

A cross-sectional study using two-stage probabilistic sampling recruited 3,649 individuals aged 60 years and above. Data were collected during the national influenza vaccination campaign in Rio de Janeiro, Brazil, in 2006. Individual interviews collected information on SRH, perceived social support, social network, and other covariates. Multivariate logistic regression analyses using nested models were conducted separately for males and females. Independent variables were organised into six blocks: (1) perceived social support and social network, (2) age group, (3) socioeconomic characteristics, (4) health-related behaviours, (5) use of health care services, (6) functional status measures and somatic health problems.

Results

Older men who did not participate in group activities were more likely to report poor SRH compared to those who did, (OR = 1.63; 95% CI = 1.16–2.30). Low perceived social support predicted the probability of poor SRH in women (OR = 1.64; 95% CI = 1.16–2.34). Poor SRH was associated with low age, low income, not working, poor functional capacity, and depression in both men and women. More somatic health problems were associated with poor SRH in women.

Conclusions

The association between social interactions and SRH varies between genders. Low social network involvement is associated with poor SRH in older men, whereas low perceived social support is associated with poor SRH in older women. The hypothesis that the relationship of perceived social support and social networks to SRH differs according to gender has been confirmed.

Oral health related quality of life in pregnant and post partum women in two social network domains; predominantly home-based and work-based networks

Background

Individuals connected to supportive social networks have better general and oral health quality of life. The objective of this study was to assess whether there were differences in oral health related quality of life (OHRQoL) between women connected to either predominantly home-based and work-based social networks.

Methods

A follow-up prevalence study was conducted on 1403 pregnant and post-partum women (mean age of 25.2 ± 6.3 years) living in two cities in the State of Rio de Janeiro, Brazil. Women were participants in an established cohort followed from pregnancy (baseline) to post-partum period (follow-up). All participants were allocated to two groups; 1. work-based social network group - employed women with paid work, and, 2. home-based social network group - women with no paid work, housewives or unemployed women. Measures of social support and social network were used as well as questions on sociodemographic characteristics and OHRQoL and health related behaviors. Multinomial logistic regression was performed to obtain OR of relationships between occupational contexts, affectionate support and positive social interaction on the one hand, and oral health quality of life, using the Oral Health Impacts Profile (OHIP) measure, adjusted for age, ethnicity, family income, schooling, marital status and social class.

Results

There was a modifying effect of positive social interaction on the odds of occupational context on OHRQoL. The odds of having a poorer OHIP score, ≥4, was significantly higher for women with home-based social networks and moderate levels of positive social interactions [OR 1.64 (95% CI: 1.08-2.48)], and for women with home-based social networks and low levels of positive social interactions [OR 2.15 (95% CI: 1.40-3.30)] compared with women with work-based social networks and high levels of positive social interactions. Black ethnicity was associated with OHIP scores ≥4 [OR 1.73 (95% CI: 1.23-2.42)].

Conclusions

Pregnant and post-partum Brazilian women in paid employment outside the home and having social supports had better OHRQoL than those with home-based social networks.

The relationship between periodontitis and preterm low birthweight

There is no consensus about the influence of periodontal disease on preterm low birthweight. The objective was to investigate the relationship between periodontal disease and preterm low birthweight. A case-control study with 542 post partum women aged over 30 yrs was conducted. Three groups of cases were compared with non-preterm and non-low-birthweight control individuals (n = 393): low birthweight (n = 96), preterm (n = 110), and preterm and low birthweight (n = 63). Periodontal clinical parameters and covariates were recorded. Periodontal disease levels were higher in control individuals than in cases. The extent of periodontal disease did not increase risk of preterm low birthweight according to 15 measures of periodontal disease. Mean periodontal pocket depth and frequency of periodontal sites with clinical attachment level > or = 3 mm in preterm low birthweight cases were lower than in control individuals. Periodontal disease was not more severe in women with preterm low birthweight babies.

The relationship of stress and anxiety with chronic periodontitis

AIM

This case-control study investigates the relationship of stress and anxiety with periodontal clinical characteristics.

METHOD

Seventy-nine selected patients (mean age 46.8+/-8 years) were assigned to three groups in accordance with their levels of probing pocket depth (PPD): control group (PPD< or =3 mm, n=22), test group 1 (at least four sites with PPD > or =4 mm and < or =6 mm, n=27) and test group 2 (at least four sites with PPD >6 mm, n=30). An inclusion criterion of the study required that patients presented a plaque index (PI) with a value equal to or larger than 2 in at least 50% of dental surfaces. All subjects were submitted to stress and anxiety evaluations. Stress was measured by the Stress Symptom Inventory (SSI) and the Social Readjustment Rating Scale (SRRS), while the State-Trait Anxiety Inventory (STAI) was used to assess anxiety. Clinical measures such as PI, gingival index (GI), PPD and clinical attachment level (CAL) were collected. Patient's medical history and socioeconomic data were also recorded.

RESULTS

The mean clinical measures (PI, GI, PPD and CAL) obtained for the three groups, were: control group, 1.56+/-0.32, 0.68+/-0.49, 1.72+/-0.54 and 2.04+/-0.64 mm; group 1, 1.56+/-0.39, 1.13+/-0.58, 2.67+/-0.67 and 3.10+/-0.76 mm, group 2, 1.65+/-0.37, 1.54+/-0.46, 4.14+/-1.23 and 5.01+/-1.60 mm. The three groups did not differ with respect to percentage of clinical stress, scores of the SRRS, trait and state anxiety. Frequency of moderate CAL (4-6 mm) and moderate PPD (4-6 mm) were found to be significantly associated with higher trait anxiety scores after adjusting for socioeconomic data and cigarette consumption (p<0.05).

CONCLUSIONS

Based on the obtained results, individuals with high levels of trait anxiety appeared to be more prone to periodontal disease.