Community and individual socioeconomic inequalities and dental caries from childhood to adolescence: A 10-year cohort study

PURPOSE

To evaluate the effect of individual and contextual socioeconomic inequalities in the occurrence of untreated dental caries during the transition from childhood to adolescence.

METHODS

This 10-year prospective cohort study followed up an initial sample of 639 1-5 years old schoolchildren from southern Brazil. After 7 and 10 years from the baseline (T1), two other reassessments were conducted (T2 and T3), respectively. Untreated dental caries was measured through the International Caries Detection and Assessment System (ICDAS- scores 3, 5 and 6) at T1 and T3. Socioeconomic status (SES) at the contextual and individual level was assessed at T1. At T2, socioeconomic, behavioural and psychosocial characteristics were evaluated as possible pathways of explanation. Structural equation modelling was used to estimate the direct and indirect effects among the variables over 10 years.

RESULTS

A total of 429 adolescents were reevaluated at 10-year follow-up (cohort retention rate of 67.1%). About 30.6% presented untreated dental caries at T3. Low individual SES at T1 directly impacted a higher occurrence of dental caries at T3. Non-white skin colour at T1 also indirectly impacted a higher occurrence of dental caries at T3 through low individual SES at T1 and lower household income at T2. Contextual SES did not predict, directly or indirectly, dental caries at T3.

CONCLUSION

There is strong evidence that socioeconomic inequalities at the individual level play an important role on the occurrence of dental caries from childhood to adolescence. On the other hand, there was no evidence that contextual SES influences the occurrence of dental caries over time.

Discriminant validity of the current gingivitis classification in adolescents: a cohort study

OBJECTIVES

To compare the prevalence of gingivitis estimated by the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification with the other case definitions and assess the ability of this classification system in discriminating sociodemographic and clinical factors associated with the presence of gingivitis in a cohort study.

MATERIALS AND METHODS

A multistage random sample of 1134 12-year-old adolescents was submitted to a full-mouth examination according to the Community Periodontal Index. Socioeconomic and clinical variables were collected at baseline. Gingivitis was considered according to the following criteria: (a) ≥ 10% of bleeding sites (the 2018 EFP/AAP criteria); (b) ≥ 15% of bleeding sites; and (c) the mean full-mouth bleeding sites. Adjusted multilevel Poisson regression assessed the association between independent variables at baseline and each definition of gingivitis at 2-year follow-up.

RESULTS

Seven hundred forty-two 14-year-old adolescents were re-revaluated at follow-up. The prevalence of gingivitis was 28.7% according to 10% of bleeding threshold. The 2018 EFP/AAP criteria and other definitions showed higher prevalence and mean of gingivitis for low-household income adolescents and for those with higher levels of dental plaque and untreated dental caries. Nonetheless, the highest strengths of association were observed for the threshold of ≥ 15% of bleeding sites.

CONCLUSION

The 2018 EFP/AAP case definition of gingivitis showed a similar discriminant validity compared to the 15% threshold and the mean full-mouth bleeding sites.

CLINICAL RELEVANCE

The 2018 EFP/AAP classification allows the discrimination of important risk factors and should be used for the establishment of priorities for large-scale therapeutic programs.

Early childhood factors in the development of oral health behaviours in adolescence: A structural equation modelling approach

OBJECTIVES

Oral health behaviour is a learning process that begins in the early years of an individual's life. The aim of this study was to evaluate the associations between demographic, socioeconomic, and psychosocial factors and oral health behaviours during the transition period from childhood to adolescence.

METHODS

This was a cohort study with a follow-up of 7 years. The baseline assessment occurred in 2010 with a random sample of 639 preschool children from southern Brazil. Demographic, socioeconomic and psychosocial oral health conditions were assessed at baseline. Oral health habit variables were collected at follow-up and included questions regarding dental care and oral hygiene behaviours. Structural equation modelling was performed to assess the direct and indirect relationships between predictors at baseline in oral health behaviours at follow-up.

RESULTS

A total of 449 children were re-examined at follow-up (70.3% cohort retention rate). Factors directly related to poorer oral health behaviours (lower use of dental services, dental visits for emergency reasons and lower frequency of toothbrushing) were lower household income, lower maternal education, lower frequency of visits to neighbours or friends, and male sex. Considering indirect pathways, the household income and maternal education at baseline influenced oral health behaviours at follow-up via visits to neighbours or friends.

CONCLUSIONS

Our findings suggest that household income, maternal education and social capital play an important role in the development of oral health behaviours during the transition from childhood to adolescence. Acquisition of healthy oral behaviours is an important factor to consider in childhood. With this knowledge, public health policies can be developed to intervene in specific causal factors and improve oral health during this transitional period.

Oral health-related quality of life in Brazilian children, adolescents, and young adults undergoing cancer treatment

Introduction

Cancer is considered a major public health problem worldwide and may have an important impact on oral health-related quality of life (OHRQoL). Thus, the present study aimed to assess OHRQoL in Brazilian patients aged 3 to 21 years undergoing cancer treatment.

Materials and Methods

In total, 121 patients receiving cancer treatment and 363 healthy individuals (control group) were evaluated. OHRQoL was assessed using an age-specific questionnaire, that is, the Brazilian versions of the Early Childhood Oral Health Impact Scale (ECOHIS), the Child Perceptions Questionnaire (CPQ) 11-14-short version, the CPQ 8-10-short version, and the short-form of Oral Health Impact Profile Questionnaire-14 (OHIP-14).

Results

Individuals from the control group who were evaluated by the ECOHIS presented more impact on the OHRQoL regarding the psychological and family function score, as well as those evaluated by CPQ 8-10, who presented more impact in general. However, considering CPQ 11-14, cancer patients had their OHRQoL more affected, as shown in both the total questionnaire score and oral symptoms score.

Conclusion

Within the limitations of this Brazilian study, cancer treatment seems to be associated with decreased OHRQoL only in patients aged between 11 and 14 years. However, children without cancer aged between 8 and 10 years seem to experience worse OHRQoL.

Early Childhood Predictors for Dental Caries: A Machine Learning Approach

We aimed to develop and validate caries prognosis models in primary and permanent teeth after 2 and 10 y of follow-up through a machine learning (ML) approach, using predictors collected in early childhood. Data from a 10-y prospective cohort study conducted in southern Brazil were analyzed. Children aged 1 to 5 y were first examined in 2010 and reassessed in 2012 and 2020 regarding caries development. Dental caries was assessed using the Caries Detection and Assessment System (ICDAS) criteria. Demographic, socioeconomic, psychosocial, behavioral, and clinical factors were collected. ML algorithms decision tree, random forest, and extreme gradient boosting (XGBoost) were employed, along with logistic regression. The discrimination and calibration of models were verified in independent sets. From 639 children included at the baseline, we reassessed 467 (73.3%) and 428 (66.9%) children in 2012 and 2020, respectively. For all models, the area under receiver operating characteristic curve (AUC) at training and testing was above 0.70 for predicting caries in primary teeth after 2-y follow-up, with caries severity at the baseline being the strongest predictor. After 10 y, the SHAP algorithm based on XGBoost achieved an AUC higher than 0.70 in the testing set and indicated caries experience, nonuse of fluoridated toothpaste, parent education, higher frequency of sugar consumption, low frequency of visits to the relatives, and poor parents' perception of their children's oral health as top predictors for caries in permanent teeth. In conclusion, the implementation of ML shows potential for determining caries development in both primary and permanent teeth using easy-to-collect predictors in early childhood.

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.

Association between malocclusion in the mixed dentition with breastfeeding and past nonnutritive sucking habits in school-age children

OBJECTIVES

To evaluate the association between malocclusion characteristics in the mixed dentition stage, breastfeeding, and past nonnutritive sucking habits in school-age children.

MATERIALS AND METHODS

A total of 547 school children in the mixed dentition, in the age range between 7 and 13 years, were evaluated by means of questionnaire and clinical examination. Binomial and multinomial logistic regression models were used to evaluate the associations between breastfeeding and finger and pacifier sucking habits, the malocclusion characteristics of posterior crossbite, and excessive or deficient overjet and overbite.

RESULTS

Individuals who had nonnutritive sucking habits had 2.16 times greater chance of having anterior open bite (odds ratio [OR] 2.16; 95% confidence interval [CI], 1.07-4.33) and 2.39 times greater chance of having posterior crossbite (OR 2.39; 95% CI, 1.56-5.49). Children who were exclusively breastfed up to at least 6 months of age had a higher frequency of normality for overjet and overbite and the lowest posterior crossbite index. However, in adjusted analysis, breastfeeding showed no association with malocclusion characteristics in the mixed dentition stage.

CONCLUSIONS

Breastfeeding was not associated with the presence of malocclusion in the mixed dentition, whereas past nonnutritive sucking habits were associated with the occurrence of malocclusion.

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.

Slow Spread of SARS-CoV-2 in Southern Brazil Over a 6-Month Period: Report on 8 Sequential Statewide Serological Surveys Including 35 611 Participants

Objectives. To evaluate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) over 6 months in the Brazilian State of Rio Grande do Sul (population 11.3 million), based on 8 serological surveys. Methods. In each survey, 4151 participants in round 1 and 4460 participants in round 2 were randomly sampled from all state regions. We assessed presence of antibodies against SARS-CoV-2 using a validated lateral flow point-of-care test; we adjusted figures for the time-dependent decay of antibodies. Results. The SARS-CoV-2 antibody prevalence increased from 0.03% (95% confidence interval [CI] = 0.00%, 0.34%; 1 in every 3333 individuals) in mid-April to 1.89% (95% CI = 1.36%, 2.54%; 1 in every 53 individuals) in early September. Prevalence was similar across gender and skin color categories. Older adults were less likely to be infected than younger participants. The proportion of the population who reported leaving home daily increased from 21.4% (95% CI = 20.2%, 22.7%) to 33.2% (95% CI = 31.8%, 34.5%). Conclusions. SARS-CoV-2 infection increased slowly during the first 6 months in the state, differently from what was observed in other Brazilian regions. Future survey rounds will continue to document the spread of the pandemic.

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.

The vicious cycle of dental fear at age 31 in a birth cohort in Southern Brazil

OBJECTIVES

This longitudinal study assessed the prevalence of dental fear in adulthood and the association with socio-economic, behavioural and clinical variables. Also, the existence of a vicious cycle of dental fear was tested.

METHODS

A random sample of adults (n = 535) from the 1982 Pelotas Birth Cohort, Brazil, was selected. Socio-economic data, behavioural characteristics and clinical variables were collected during different cohort waves. Oral health data were collected at ages 15, 24 and 31 years old, using questionnaires and oral examination. Dental fear (the outcome) was assessed by the question: 'Are you afraid of going to the dentist?', with possible responses: dichotomized into 'No' or 'A little/Yes/A lot'. Exposure variables were as follows: dental visit in the last years (at the ages 15 and 31); caries experience (DMFT ≥ mean) at the ages 15 and 31; the trajectory of caries prevalence from 15 to 31 years old; dental pain in the last six months in the two ages evaluated; and self-rated oral health at age 31. Several multivariable Poisson regression models were used to investigate the association between each of the exposure variables and dental fear.

RESULTS

Dental fear prevalence was 22.1%, and it was more prevalent among non-white individuals and females. After controlling for potential confounders, dental fear was more likely to be reported by those individuals who had dental pain or a higher prevalence of dental caries at the age 15. Dental fear was also associated with a worse trajectory of dental caries, negative self-rated oral health at age 31 and with not having visited the dentist in the last year (at the age 31). Results supported the proposed vicious cycle of dental fear.

CONCLUSIONS

Dental fear in adulthood was related to exposures occurring across the lifecourse. Also, it was possible to observe the occurrence of the vicious cycle of dental fear in the 1982 Pelotas Birth Cohort. Therefore, preventive measures during different periods of the life course are required to prevent dental fear and adulthood.

Oral health and happiness in adolescents: A cohort study

OBJECTIVES

To investigate the influence of oral health conditions, socioeconomic status and dental care utilization on subjective happiness and identify the factors associated with changes in happiness among adolescents.

METHODS

Data were collected in 2012 and 2014. Oral health conditions were evaluated by performing clinical examinations; socioeconomic status and dental care utilization were assessed by using a questionnaire. The participants answered the Child Perceptions Questionnaire 11-14 for the evaluation of the impact of these variables on oral health-related quality of life (OHRQoL). Happiness was assessed using the Brazilian version of the Subjective Happiness Scale. For longitudinal data analysis, a mixed-effect model of linear regression was used to assess the factors related to happiness and multinomial logistic regression to appraise prospective changes in happiness.

RESULTS

A total of 1134 12-year-old adolescents were examined at baseline (response rate: 93%), and 770 were reevaluated after 2 years (retention rate: 68%). The adolescents who lived in households with lower equivalized income and greater overcrowding, had not visited the dentist in the later 6 months, had a higher number of cavitated carious lesions, and reported a higher impact on OHRQoL in 2012 presented lower happiness levels. Additionally, the adolescents with a higher number of decayed, missing or filled teeth and who reported a higher impact on OHRQoL were more likely to belong to the most unfavourable happiness trajectory categories.

CONCLUSIONS

The presence of dental caries, socioeconomic conditions, dental care utilization and OHRQoL influence happiness in adolescents. Having more teeth affected by dental caries and worse self-perception in early adolescence can lead to a decrease in happiness.

Gingival inflammation influences oral health-related quality of life in individuals living in a rural area of southern Brazil

AIM

The aim of the present cross-sectional study was to evaluate whether the extent levels of gingival inflammation (GI) in whole mouth or restricted to the anterior region are independently associated with oral health-related quality of life (OHRQoL) in individuals living in a rural area of southern Brazil.

MATERIALS AND METHODS

A probability sample of 688 individuals was submitted to a full-mouth periodontal examination at six sites on each tooth. Extent levels of GI in whole mouth and restricted to anterior region were dichotomously considered when bleeding on probing (BoP) occurred at 20% or more of whole-mouth sites and at 10% or more of anterior region sites, respectively, in individuals with probing depths ≤3 mm, totalling 121 individuals analysed, aged 15-82 years. OHRQoL was assessed using the simplified version of the Oral Health Impact Profile (OHIP₁₄ ) questionnaire. Adjusted multilevel Poisson regression analysis was used with a conceptual hierarchical approach to calculate the rate ratio (RR) of OHIP₁₄ scores.

RESULTS

In the adjusted model, higher extent levels of full-mouth GI (RR = 1.23; 95% confidence interval [CI]: 1.06-1.44; p = .004) and GI restricted to the anterior region (RR = 1.29; 95% CI: 1.11-1.51; p ≤ .001) were significantly associated with poorer OHRQoL.

CONCLUSIONS

The extent of GI in whole mouth (≥20% of sites with BoP) and in the anterior region (≥10% of sites with BoP) was independently associated with OHRQoL in individuals living in a rural area.

The impact of cyberbullying on schoolchildren's dental anxiety in Brazil: A cross-sectional multi-level study

OBJECTIVES

This cross-sectional study assessed the correlation between individual and school-related social environment variables with dental anxiety in Brazilian schoolchildren aged 8-12 years.

METHODS

A sample of children from 20 private and public schools (n = 1211) from Pelotas, Brazil, were selected. Socioeconomic data were collected from parents, and data regarding children characteristics were collected using a questionnaire. Dental anxiety (the outcome) was assessed by the following question: 'Are you afraid of going to the dentist?' Dental examinations were performed to assess caries experience (DMFT ≥ 1). The social school environment was assessed by a questionnaire administered to schools' coordinators and considered: type of school, verbal violence between students, presence of gangs at school and cyberbullying episodes. Multilevel Poisson regression was used to investigate the association between school social environment and dental anxiety.

RESULTS

The prevalence of dental anxiety was 9.1% (95%CI 7.5-10.8). For the individual variables, anxiety was more prevalent in girls [1.85 (1.21-2.81)], in children with less-educated mothers [1.50 (1.00-2.27)] and in children who never attended to the dentist [2.48 (1.65-3.72)]. For contextual variables, episodes of cyberbullying in school increased the prevalence of dental anxiety by almost 80% [1.78 (1.14-2.78)].

CONCLUSIONS

The school social environment influences dental anxiety. The results suggest that it is important to establish strategies focused on promoting healthier environments and preventing cyberbullying in order to reduce the occurrence of dental anxiety.

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.

Sensitivity of an oral health-related quality-of-life questionnaire in detecting oral health impairment in preschool children

AIM

This two-year cohort study evaluated whether the Early Childhood Oral Health Impact Scale (ECOHIS) is responsive to detect changes related to dental caries.

DESIGN

Preschool children were examined in 2010 regarding dental caries, and their parents responded to the ECOHIS. After 2 years, 352 children (response rate = 73.6%) were re-examined and a new ECOHIS was responded. Children were categorized according to caries increment (no new caries, 1-3 surfaces with new lesions, and four or more decayed surfaces). The outcome variables were related to the decline of quality of life as determined via ECOHIS: decline, severe decline, and differences between baseline and follow-up scores. Effect sizes (ES) were calculated, and the associations were evaluated through Poisson regression.

RESULTS

ES was small for children with 1-3 new lesions (ES = 0.19) and moderate for children with four or more new carious lesions (ES = 0.61). Children who developed 1-3 new lesions were significantly associated with all outcome variables compared to children with no new lesions, but the associations were stronger for children with four or more new carious lesions.

CONCLUSIONS

The ECOHIS is sensitive to the deterioration of quality of life due to caries increments in preschool children.

Presence of Initial Caries Lesions as a Risk Factor for Caries in Preschool Children: A Cohort Study

The aim of this study was to evaluate the influence of initial noncavitated caries lesions on cavitated caries increment in preschool children. A 2-year cohort study was designed to include the participants of a survey on dental caries performed in 2010. Preschool children (12-59 months old) were examined for dental caries and classified as children with no caries lesions, with only initial lesions, with at least 1 moderate caries lesion, and with extensive lesions. Socioeconomic data were also collected. After 2 years, 466 children were re-examined (follow-up rate of 72.9%) only for cavitated lesions. Association between caries incidence at 2 levels of severity and caries experience and other variables was evaluated using hierarchical Poisson regression analysis. The children with moderate and extensive caries lesions at baseline presented a higher risk of presenting both outcomes than the children with no caries lesions. Nevertheless, the children with only initial lesions had a higher risk of developing at least 1 new cavitated carious lesion, but not for a more severe increment in caries. Subgroup analysis stratified by the children's age showed that the influence of the presence of initial caries lesions on cavitated caries increment was only observed in children aged 12-35 months. In conclusion, although the presence of moderate and extensive lesions at baseline is a significant predictor for cavitated caries increment after 2 years in preschool children at all ages, the presence of only initial caries lesions is also associated, but with less severe caries incidence.

Responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS) is related to dental treatment complexity

BACKGROUND

The responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS) has varied greatly across studies; hence, we hypothesized that this discrepancy could be related to the complexity of dental treatment received. Thus, we aimed to evaluate the responsiveness of the ECOHIS to changes in oral health-related quality of life (OHRQoL) following dental treatments of varying complexity in preschool children.

METHODS

Preschool children aged 3 to 6 years were selected; their parents responded to the ECOHIS at baseline. The parents responded to the ECOHIS again and a global transition question 30 days after the children were treated. The type of treatment received by the children was categorized according to complexity, as follows: 1) non-operative treatment only, 2) restorative treatment, and 3) endodontic treatment and/or tooth extraction. Change scores and effect sizes (ES) were calculated for total scores, as well as considering the different treatment types and global transition question responses.

RESULTS

Of the 152 children who completed the study, the ECOHIS yielded large ES for total scores (0.89). The children showed increasing ES values associated with better perception of improvement, assessed by the global transition question. The magnitude of ES after treatment was related to treatment complexity (0.53, 0.92 and 1.43, for children who received non-operative treatment only, restorative treatment, and endodontic treatment and/or tooth extraction, respectively).

CONCLUSIONS

Parents whose children required more complex dental treatment are more likely to perceive treatment-related changes to OHRQoL assessed with the ECOHIS.

Toothache, associated factors, and its impact on Oral Health-Related Quality of Life (OHRQoL) in preschool children

The aim of this study was to assess the prevalence of toothache, associated factors and impact of this condition on the Child Oral Health Related Quality of Life (COHRQoL) in preschoolers. The study was carried out in Santa Maria, Brazil, during the National Children's Vaccination Day, and 534 children aged 0 to 5 years were included. Clinical variables included dental caries and dental trauma. A questionnaire was responded by the parents and provided information about several socioeconomic indicators, dental service use and toothache. Toothache was collected by the question: "Has your child ever had a toothache - Yes or no?". Data on COHRQoL were assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Multivariable Logistic regression models were performed to assess the association between the predictor variables and outcomes. The prevalence of toothache was 10.11% (95% CI: 7.55% - 12.68%). Older children had a higher chance of presenting dental pain (OR 2.72; 95% CI: 1.01 - 7.56), as well as children with caries experience (OR 3.43; 95% CI: 1.81 - 6.52). Moreover, children who had not visited the dental service in the last 6 months were less likely to present toothache (OR 0.51; 95% CI: 0.28 - 0.95). The presence of dental pain negatively affects the COHRQoL; those with toothache presented a higher chance of having higher impact on the total scores of ECOHIS (OR 4.18; 95% CI: 1.76 - 9.95) than those without toothache. Similar observation was found for the child section of the questionnaire (OR 5.54; 95% CI: 2.15 - 14.24). Toothache negatively affects COHRQoL and is associated with caries experience, age and use of dental service.

Risk of initial and moderate caries lesions in primary teeth to progress to dentine cavitation: a 2-year cohort study

AIM

To investigate the risk of sound surfaces, and initial and moderate caries lesions to progress to dentine cavitation in preschool children.

DESIGN

A cohort study was designed with 639 children (12-59 months old) who had been examined by visual inspection during a survey in 2010. After 2 years, 469 children were re-examined regarding the presence of dentine cavitations. The probability of progression was calculated for sound and carious (initial and moderate lesions) surfaces. Relative risk of progression and 95% confidence intervals for each condition compared with sound surfaces were calculated using multilevel Poisson regression analysis. Association with explanatory variables, including caries experience of the children, was also investigated.

RESULTS

The higher the initial score attributed to the dental surface, the more likely was the progression. Moreover, children with severe lesions at baseline had higher risk of having a sound surface or a non-cavitated caries lesion progressing to cavitation when compared with caries-free children; however, this increased risk was not observed in children with only initial caries lesions.

CONCLUSIONS

Initial caries lesions present a low frequency of progression. Moreover, sound surfaces and initial caries lesions in children already presenting cavitations are more likely to progress to more severe conditions.

Influence of initial caries lesions on quality of life in preschool children: a 2-year cohort study

OBJECTIVES

We aimed to assess the impact of the presence of initial and other stages of dental caries on the impairment of oral health-related quality of life in preschool children (COHRQoL) through a cohort study.

METHODS

During an epidemiological survey, 478 children (12-59 months old) were examined for dental caries using the International Caries and Detection Assessment System (ICDAS), and their parents answered the Early Childhood Oral Health Impact Scale (ECOHIS). Children were categorized based on the presence of dental caries as follows: children with no caries lesions, children with only initial lesions (ICDAS scores 1 and 2), children with at least one moderate lesion (ICDAS scores 3 and 4) and children with extensive lesions (ICDAS scores 5 and 6). After 2 years, 352 children were re-examined for the presence of dentine cavitations, and their parents completed a new ECOHIS questionnaire. Multilevel Poisson regression analysis was performed to evaluate the impact of the presence of different stages of caries lesions at the baseline on COHRQoL impairment at the follow-up, considering two outcome variables: worsening and severe worsening of COHRQoL. Relative risk values (RR) and respective 95% confidence intervals (95% CI) were calculated.

RESULTS

Worsening or severe worsening of the COHRQoL at the follow-up were observed only in children with moderate lesions (RR = 2.00; 95% CI = 1.30-3.08 and RR = 2.38; 95% CI = 1.31-4.34, respectively) or children with extensive lesions (RR = 1.59; 95% CI = 1.10-2.30 for worsening and RR = 1.88; 95% CI = 1.13-3.12 for severe worsening). On the other hand, the presence of only initial caries lesions was not a significant predictor of COHRQoL impairment.

CONCLUSIONS

The presence of only initial caries lesions does not impair COHRQoL of preschool children; however, moderate and extensive lesions are risk factors for worsening of the COHRQoL.

Association between Dental Caries and Socioeconomic Factors in Schoolchildren - A Multilevel Analysis

Abstract This study aimed to assess the association between dental caries, socioeconomic individual and contextual factors in 12-years-old children. A representative sample of 1,134 children enrolled in public schools from Santa Maria, RS, Brazil, was obtained from a multistage random sampling. Four calibrated dentists examined participants at schools. Data about dental caries (DMF-T index) and dental plaque (present or absent) were assessed. Children's parents or guardians answered questions regarding their demographics and socioeconomic status. Context variables were also collected from official publications of the city. Data analyses were performed using multilevel logistic regression models. Caries prevalence in this sample (DMF-T≥1) was 49.9% (95%CI: 45.05% - 54.77%), and mean DMF-T was 1.15 (95%CI: 1.01-1.29) with 0.068 standard error. Children of the 3rd and 2nd tertile of income represented by the rich and intermediate categories, showed, respectively, a 50% (OR 0.50: CI95 % 0.35-0.71) and 39% (OR 0.61: CI95% 0.45-0.82) lower chance to present untreated caries compared with the poorest portion of the sample represented by the 1st tertile of income. Regarding the context covariates, children from lower income neighborhood presented a higher chance for having untreated dental caries compared with their counterpart (OR 1.70: CI95% 1.19 to 2.43). Inequalities in the distribution of dental caries continue affecting children from poorer socioeconomic profiles. There is need for planning public interventions for oral health promotion that take into account individual and contextual socioeconomic characteristics.

The Role of School Social Environment on Dental Caries Experience in 8- to 12-Year-Old Brazilian Children: A Multilevel Analysis

Aim: Although children spend most of their time involved in activities related to school, few studies have focused on the association between school social environment and oral health. This cross-sectional study assessed individual and school-related social environment correlates of dental caries in Brazilian schoolchildren aged 8-12 years. Methods: A sample of children from 20 private and public schools (n = 1,211) was selected. Socio-economic data were collected from parents, and data regarding children characteristics were collected from children using a questionnaire. Dental examinations were performed to assess the presence of dental plaque: dental caries experience (DMFT ≥1) and dental caries severity (mean dmf-t/DMF-T). The social school environment was assessed by a questionnaire administered to school coordinators. Multilevel Poisson regression was used to investigate the association between school social environment and dental caries prevalence and experience. Results: The dental caries prevalence was 32.4% (95% confidence interval: 29.7-35.2) and the mean dmf-t/DMF-T was 1.84 (standard deviation: 2.2). Multilevel models showed that the mean dmf-t/DMF-T and DMFT ≥1 were associated with lower maternal schooling and higher levels of dental plaque. For contextual variables, schools offering after-hours sports activities were associated with a lower prevalence of dental caries and a lower mean of dmf-t/DMF-T, while the occurrence of violence and theft episodes was positively associated with dental caries. Conclusions: The school social environment has an influence on dental caries in children. The results suggest that strategies focused on the promotion of healthier environments should be stimulated to reduce inequalities in dental caries.

Validation of Visual Caries Activity Assessment: A 2-yr Cohort Study

We evaluated the predictive and construct validity of a caries activity assessment system associated with the International Caries Detection and Assessment System (ICDAS) in primary teeth. A total of 469 children were reexamined: participants of a caries survey performed 2 yr before (follow-up rate of 73.4%). At baseline, children (12-59 mo old) were examined with the ICDAS and a caries activity assessment system. The predictive validity was assessed by evaluating the risk of active caries lesion progression to more severe conditions in the follow-up, compared with inactive lesions. We also assessed if children with a higher number of active caries lesions were more likely to develop new lesions (construct validity). Noncavitated active caries lesions at occlusal surfaces presented higher risk of progression than inactive ones. Children with a higher number of active lesions and with higher caries experience presented higher risk of developing new lesions. In conclusion, the caries activity system associated with the ICDAS presents predictive and construct validity in primary teeth in the assessment of occlusal caries lesions, but predictive validity was not observed in smooth surfaces.

Preliminary results of the survival and fracture load of roots restored with intracanal posts: weakened vs nonweakened roots

PURPOSE

To evaluate the fracture load and survival rate of weakened and non-weakened roots restored with different intracanal posts.

METHODS

Eighty teeth (16 mm) were prepared to a length of 10 mm with a custom drill. Fifty roots were weakened with a tapered diamond drill, and 30 roots were not. The specimens were embedded with acrylic resin up to 3 mm from the coronal aspect, and the periodontal ligament was simulated. The 50 weakened roots were restored with (n=10) CPC-gold (cast post and core made of gold alloy), CPC-Ni (cast post and core made of Ni-Cr alloy), FP (glass fiber posts), FP-W (glass fiber posts with a wider coronal diameter), and FP-CR (fiber posts relined with composite resin). The 30 nonweakened roots were restored with (n=10) CPC-gold, CPC-Ni, and FP. All of the posts were adhesively cemented. All of the specimens were mechanically cycled (37°C, 45°, 130 N, 2.2 Hz, and 1.5 million pulses) and evaluated after every 5 × 10(4) cycles to evaluate the presence of cracks as a primary outcome (event). The specimens that survived cycling were subjected to a fracture load test (load application on the palatal aspect at a 45° inclination). Failure mode was classified as favorable (above the simulated bone level) and catastrophic (below the simulated bone level). Survival rates were estimated using the Kaplan-Meier method. Fracture load data were analyzed using the Kruskal-Wallis test (α=0.05) for weakened roots, one-way analysis of variance, and Tukey test (p<0.05) for non-weakened roots, and Student t-test (p<0.05) compared nonweakened vs weakened roots for the same post system.

RESULTS

For the preliminary survival results, FP-W showed a higher survival rate when compared with CPC (gold/Ni). For the fracture load (N), the statistical analysis (p<0.0001) presented differences among the weakened groups: CPC-gold (541.4) = CPC-Ni (642.6) > FP (282.2) = FP-W (274.1) = FP-RC (216.6). No differences were observed for the groups that were nonweakened (majority of favorable failures): CPC-gold (459.3) = CPC-Ni (422.0) = FP (347.9). Weakened roots restored with CPC-gold promoted high values of load fracture and unfavorable failure rates.

CONCLUSION

Cast post and cores or fiber posts can be used for restoring nonweakened roots. However, for weakened roots, a fiber post with a wider cervical emerging diameter appears to be a better alternative when compared with cast post and cores.

Laboratorial training of examiners for using a visual caries detection system in epidemiological surveys

Background

In epidemiological surveys, a good reliability among the examiners regarding the caries detection method is essential. However, training and calibrating those examiners is an arduous task because it involves several patients who are examined many times. To facilitate this step, we aimed to propose a laboratory methodology to simulate the examinations performed to detect caries lesions using the International Caries Detection and Assessment System (ICDAS) in epidemiological surveys.

Methods

A benchmark examiner conducted all training sessions. A total of 67 exfoliated primary teeth, varying from sound to extensive cavitated, were set in seven arch models to simulate complete mouths in primary dentition. Sixteen examiners (graduate students) evaluated all surfaces of the teeth under illumination using buccal mirrors and ball-ended probe in two occasions, using only coronal primary caries scores of the ICDAS. As reference standard, two different examiners assessed the proximal surfaces by direct visual inspection, classifying them in sound, with non-cavitated or with cavitated lesions. After, teeth were sectioned in the bucco-lingual direction, and the examiners assessed the sections in stereomicroscope, classifying the occlusal and smooth surfaces according to lesion depth. Inter-examiner reproducibility was evaluated using weighted kappa. Sensitivities and specificities were calculated at two thresholds: all lesions and advanced lesions (cavitated lesions in proximal surfaces and lesions reaching the dentine in occlusal and smooth surfaces).

Results

Regarding the reproducibility, the mean (range) of kappa values was 0.781 (0.529–0.927) for occlusal surfaces, 0.568 (0.191–0.881) for smooth surfaces, and 0.844 (0.698–0.971) for proximal surfaces. Considering all lesions, sensitivity and specificity mean values were respectively 0.724 and 0.844 for occlusal, 0.635 and 0.943 for smooth and 0.658 and 0.927 for proximal surfaces. For detecting advanced lesions, sensitivities and specificities were 0.563 and 0.920 for occlusal, 0.670 and 0.985 for smooth, and 0.838 and 0.985 for proximal surfaces.

Conclusion

The methodology purposed for training and calibration of several examiners designated for epidemiological surveys of dental caries in preschool children using the ICDAS is feasible, permitting the assessment of reliability and accuracy of the examiners previously to the survey´s development.

Traumatic dental injury with treatment needs negatively affects the quality of life of Brazilian schoolchildren

BACKGROUND

Traumatic dental injury (TDI) has been considered a significant problem in youth, not only because of its consequences to the craniofacial structures but also for its potential impact on the quality of life of affected individuals.

AIM

The aim of this study was to investigate the impact of TDI with treatment needs on the oral health-related quality of life (OHRQoL) of South Brazilian schoolchildren.

DESIGN

A cross-sectional study was performed in Porto Alegre, Brazil, using a multistage probability sampling strategy. Of 1837 eligible 12-year-old schoolchildren attending public and private schools, 1528 were examined. OHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11-to 14-year-old children (CPQ11-14) - 16-item short form. Clinical examination was conducted to assess the presence of TDI in permanent incisors (Children's Dental Health Survey criteria), malocclusion, and dental caries. Parents/legal guardians answered questions on socioeconomic status. Statistical analyses were performed using Poisson regression models.

RESULTS

The overall CPQ11-14 score was not associated with TDI. In the functional limitations domain, individuals presenting TDIs with treatment needs experienced significantly higher mean CPQ11-14 than individuals with no TDI or without treatment needs (RR = 1.21; 95% CI = 1.05-1.39), after adjusting for malocclusion, dental caries, gender, and socioeconomic status. No other domains were associated with TDI.

CONCLUSIONS

This study revealed that TDI with treatment needs negatively affects the OHRQoL in this population of 12-year-old schoolchildren and that this impact is related to oral functions.

Children's use of dental services: influence of maternal dental anxiety, attendance pattern, and perception of children's quality of life

OBJECTIVES

The purpose of the study was to investigate the influence of a child's clinical condition; maternal characteristics such as dental anxiety and dental visit pattern; socioeconomic conditions; and maternal perception of the child's oral health-related quality of life (OHRQoL) on a child's use of dental care services.

METHODS

A cross-sectional study of 608 mother-child dyads was conducted during the Children's Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire regarding their use of dental services, dental anxiety (Dental Anxiety Scale), socioeconomic status, and perception of their children's OHRQoL (the Early Childhood Oral Health Impact Scale). Clinical examination of the children was performed to assess dental caries (dmf-t). Associations between the above-mentioned factors and child use of dental services were assessed using Poisson regression models (prevalence ratio [PR]; 95% CI; P ≤ 0.05).

RESULTS

The majority of children (79.3%) had never had a dental appointment and of the children who had visited a dentist, 55 (43.65%) presented with untreated dental caries at the time of examination. More than half the mothers (60.2%) did not visit a dentist regularly. In the final model, low schooling level of mothers (PR, 0.64) and irregular visits to a dentist by the mother (PR, 0.48) were factors because of which a child did not have a dental appointment. Children who had experienced pain (PR, 1.56), those who had poor OHRQoL (PR, 1.49), and older children (PR, 2.14) visited a dentist with higher frequency.

CONCLUSIONS

Use of dental care services by preschool children was low, and treatment was neglected even among children who had visited a dentist. Children of mothers with low schooling level who do not visit a dentist regularly were at greater risk of not receiving dental care. Maternal perception of their child's oral health motivated visits to the dentist.

Influence of maternal dental anxiety on the child's dental caries experience

This study assessed the influence of maternal dental anxiety-related behavior on the child's caries experience. A cross-sectional study with 608 mother-child dyads during the Children's National Immunization Campaign in Pelotas, Brazil was performed. Mothers were asked to answer a questionnaire and dental examination of the children was performed (dmft). The association assessment used Poisson regression. Children from anxious mothers were more likely to present untreated caries even after covariate adjustment. Boys, older children and low-income family children presented a higher dmft mean. Preventive strategies should focus not only on child and family characteristics, but also on maternal dental anxiety-related behaviors.

Socioeconomic inequalities in the distribution of dental caries in Brazilian preschool children

OBJECTIVES

This study assessed the inequality in caries distribution and the association between socioeconomic indicators and caries experience of preschool children in a city in Brazil.

METHODS

A cross-sectional study in a multistage random sample of 455, 1-5-year-old children was conducted on National Children's Vaccination Day in Santa Maria, Brazil. Calibrated examiners evaluated the prevalence of dental caries and parents provided information about several socioeconomic indicators by means of a semistructured questionnaire. Data were analyzed using Poisson regression model.

RESULTS

The caries prevalence was 23.5 percent and the means for the decayed, missing and filled primary teeth was 0.8. A high inequality in the caries distribution with Gini coefficient of 0.8 and Significant Caries Index of 2.8 was observed. The oldest children, non-white, with mothers having low level of education and from low household income had the highest prevalence of dental caries.

CONCLUSION

Socioeconomic factors are strong predictors for the inequality in caries distribution in Brazilian preschool children.

In vivo effectiveness of laser fluorescence compared to visual inspection and radiography for the detection of occlusal caries in primary teeth

The purpose of this study was to evaluate the in vivo effectiveness of laser fluorescence compared to visual inspection and radiography for the detection of occlusal caries in primary teeth. Fifty sites from 30 molars in 29 patients were selected and evaluated under standardized conditions by 2 previously trained examiners according to the 3 diagnostic methods. Histological examination served as gold standard after exfoliation or extraction. Values obtained for sensitivity, specificity and accuracy were 0.60, 0.90 and 0.73 for laser fluorescence, 0.82, 0.85 and 0.84 for visual inspection and 0.62, 0.73 and 0.67 for radiography, respectively. Considering only dentinal caries, values were 0.73, 0.95 and 0.90 for laser fluorescence, 0.61, 1.00 and 0.90 for visual inspection and 0.96, 0.81 and 0.85 for radiography, respectively. We conclude that for the detection of occlusal caries in primary molars laser fluorescence presents a similar accuracy when compared to visual inspection and radiography, although visual inspection showed better values for sensitivities for both enamel and dentin lesions.