Is tooth loss associated with oral health-related quality of life among young men? Findings from southern Brazil

OBJECTIVE

To determine the association between tooth loss and oral health-related quality of life (OHRQoL) among young men from southern Brazil.

METHODS

Cross-sectional study of 518 young men aged 18-19 years enlisted for mandatory military service in the Brazilian Army in two cities of southern Brazil in 2019-2021. Participants were clinically examined regarding gingivitis, dental caries experience (caries lesions, missing and filled surfaces), and malocclusion. A questionnaire collected socioeconomic information and the Oral Health Impact Profile 14 (OHIP-14). The outcome was OHRQoL, modeled as a discrete variable. The main explanatory variable was tooth loss due to caries (0 or ≥1). Negative binomial regression analysis was used; rate ratios (RR) and 95% confidence intervals (CI) were estimated.

RESULTS

Tooth loss prevalence was 22.2%. Associations were detected between tooth loss and OHRQoL in the physical pain and handicap domains. Individuals with at least one missing tooth had 17% higher OHIP-14 scores in the physical pain domain (adjusted RR=1.17; 95%CI=1.01, 1.35) and 49% higher in the handicap domain (adjusted RR=1.49; 95%CI=1.03, 2.15) than those with no tooth loss.

CONCLUSIONS

Tooth loss was negatively associated with OHRQoL among 18-19-year-old Brazilian Army conscripts, and this association was related to physical pain and handicap domains.

Sociodemographic disparities in oral health-related quality of life of schoolchildren in rural and urban areas

OBJECTIVE

To assess the association between residence place, socioeconomic conditions and oral health-related quality of life (OHRQoL) among schoolchildren from southern Brazil.

METHODS

Participants were 9-14-year-old schoolchildren from rural and urban municipal schools from Rosário do Sul, Brazil. The Child Perceptions Questionnaire (CPQ11-14) was used to assess OHRQoL. A structured questionnaire collected data on sociodemographic condition (family income), residence place (urban or rural), use of dental services, and behavioral variables. Clinical oral examination recorded the presence of missing teeth and the gingival bleeding index. Multilevel Poisson regression analysis with a hierarchical approach assessed the association between predictors and CPQ11-14 scores. Rate ratios (RR) and 95% confidence intervals (CI) were estimated.

RESULTS

A total of 373 schoolchildren were included (rural area=122; urban area=251), with a mean CPQ11-14 score of 11.83, ranging from 0 to 42. Low-income schoolchildren living in rural areas had 15% higher CPQ11-14 scores than high-income schoolchildren living in urban areas. In urban areas, family income predicted OHRQoL, with low-income schoolchildren having 9% higher CPQ11-14 scores than high-income children. In rural areas, schoolchildren with low household income had 19% higher CPQ11-14 scores than high-income children.

CONCLUSION

Schoolchildren from low-income families had a poorer OHRQoL irrespective of their area of residence (rural or urban). The association between family income and OHRQoL was more pronounced among children living in rural areas.

Exercise Training in Heart Failure With Reduced Ejection Fraction and Permanent Atrial Fibrillation: A Randomized Clinical Trial

BACKGROUND

Heart failure (HF) associated with atrial fibrillation (AF) increases patients' physical inactivity, worsening their clinical condition and mortality. Exercise training is safe and has clear benefits in HF. However, little is known about the effects of exercise training on heart failure patients with reduced ejection fraction and permanent atrial fibrillation (HFAF).

OBJECTIVE

To test the hypothesis that exercise training improves functional capacity, cardiac function, and quality of life in patients with HFAF.

METHODS

This randomized clinical trial was conducted at the Heart Institute. Patients with HFAF, LVEF ≤40% and resting HR ≤80 bpm were included in the study. Cardiopulmonary testing, echocardiography, autonomic, and quality of life assessment were performed before and after the 12-week protocol period.

RESULTS

Twenty-six patients, 58±1 years, were randomized to exercise training (HFAF-trained, n=13) or no training (HFAF-untrained, n=13). At baseline, no differences between groups were found. Exercise improved VO₂ peak, slope VE/VCO₂, and quality of life. HFAF-trained significantly decreased resting HR (from 73±2 to 69±2 bpm, P=.02) and recovery HR (from 148±11 to 128±9 bpm, P=.001). Concomitantly, LVEF increased (from 31±1 to 36±0.9 %, P=.01), LA decreased (from 52±1.2 to 47±1mm, P=.03), and LV-ESV and LV-EDV deceased (from 69±2 to 64±1.8 mL/m², and 99±2.1 to 91±2, P<.05, respectively). No changes were observed in the untrained group.

CONCLUSION

Exercise training can improve exercise capacity, quality of life, and cardiac function in patients with heart failure with reduced ejection fraction and permanent atrial fibrillation.

P331Effect of exercise stress test on platelet function in patients with recent acute myocardial infarction

Background

Exercise-based cardiac rehabilitation for coronary artery disease (CAD) is associated with lower cardiovascular mortality. On the other hand, acute strenuous exercise has been linked to cardiovascular complications such as acute myocardial infarction (AMI) and sudden cardiac death. One of the pathophysiological mechanisms involved in these outcomes might be an increase in platelet aggregability after exercise. Although previous studies showed higher platelet aggregability after exercise among stable CAD patients on aspirin treatment, there is no data regarding the effect of exercise on platelet activity in post-AMI patients on dual anti-platelet therapy (DAPT).

Purpose

To evaluate the effect of high-intensity exercise on platelet aggregability in sedentary post-AMI patients on DAPT.

Methods

Platelet function was analyzed immediately before and after maximal cardiopulmonary exercise test (CPET) on cycle ergometer utilizing a personalized ramp protocol and aiming to achieving peak exercise in around 10 min. The CPET was done within 31±4 days after uncomplicated AMI. Platelet aggregability was assessed by Multiplate®ADPtest (MP-ADP) and Multiplate® ASPItest (MP-ASPI) measured as area under the curve (AUC). Reticulated platelets were measured concomitantly to MP-ADP e MP-ASPI using a fully automated flow cytometer (Sysmex XN-2000®) to determine absolute immature platelet count (IPC) per 103/microliter. Continuous variables were expressed as means ±standard deviation or as median and 25th–75th percentiles if not Gaussian distributed. Comparisons between the pre- and post-CPET assessments were performed using Wilcoxon signed rank test.

Results

We analyzed 81 sedentary patients (mean age 58.3±10.1 years-old, 76.5% men) after AMI (50.6% with ST-elevation myocardial infarction, mean left ventricular ejection fraction after index event 55±11.7%, 98.8% on statin and 85.5% on beta-blocker treatment). Platelet aggregability, either by MP-ADP or MP-ASPI, and IPC were significantly increased after CPET (table).

Platelet function after CPET Before CPET After CPET p-value Multiplate® ADPtest (AUC) – median (25th–75th percentiles) 32.0 (22.0–48.5) 37.0 (26.0–55.2) 0.003 Multiplate® ASPItest (AUC) – median (25th–75th percentiles) 17.0 (12.7–22.0) 22.0 (16.7–28.0) <0.001 Immature platelet count (103/microliter) – median (25th–75th percentiles) 9.5 (6.8–13.8) 9.6 (6.6–16.5) 0.006 CPET: cardiopulmonary exercise test; AUC: area under the curve.

Conclusion

On this post-AMI population, platelet was hyperactivated after exercise stress test despite the use of DAPT. These findings suggest that, even when properly treated, post-AMI patients might be at higher risk of ischemic complications after high-intensity exercises, reinforcing the importance of tailoring exercise prescription in this population.

Acknowledgement/Funding

Sao Paulo Research Foundation, FAPESP

Dental erosion among South Brazilian adolescents: A 2.5-year longitudinal study

OBJECTIVES

This population-based longitudinal study investigated the incidence, progression and risk factors for dental erosion among South Brazilian adolescents.

METHODS

Eight hundred and one schoolchildren attending 42 public and private schools were clinically examined at 12 years of age; clinical examinations were repeated after 2.5 years (SD=0.3). After tooth cleaning and drying, permanent incisors and first molars were classified using the Basic Erosive Wear Examination (BEWE) scoring criteria. Questionnaires were used to collect data on socio-demographic characteristics, dietary habits, toothbrushing frequency and general health. Poisson regression analysis was used to assess the association between dental erosion incidence and explanatory variables, with adjusted incidence risk ratios (IRR) and 95% CI estimated.

RESULTS

Among those who did not have dental erosion at baseline, 49 of 680 schoolchildren (7.1%; 95% CI=5.2-9.1) developed erosive lesions over the follow-up period. Among schoolchildren who had dental erosion at baseline, 31 of 121 (25.4%; 95% CI=17.6-33.3) had new or more severe lesions. Boys were more likely to develop dental erosion than girls (IRR=1.88; 95% CI=1.06-3.32).

CONCLUSIONS

A moderate incidence of dental erosion was observed among South Brazilian adolescents, with boys being at higher risk. The high progression rate of 25% observed here is very concerning, and it should be taken in consideration when designing preventive strategies for dental erosion.

Gross Osteology, Radiographic and Computed Tomographic Morphology of the Axial Skeleton of the Nine-Banded Armadillo (Dasypus novemcinctus)

This study used 20 nine-banded armadillo, four in vivo and 16 cadavers, to describe the osteoarticular anatomy of the axial skeleton by means of digital radiography and computed tomography. Vertebral formula obtained in this sample specimens was seven cervical, 10 thoracic, five lumbar, nine vertebrae related to the synsacrum and 20-27 free caudal vertebrae. Peculiar features of this species were noted as the presence of xenarthrous processes in the caudal thoracic vertebra to the last lumbar vertebra, with prominent mammillary processes in the thoracolumbar segment, fused cervical vertebra from the second to fourth vertebra and the presence of synsacrum related to sacral and caudal vertebra fused to the pelvis. They are homodont animals presenting only molariform teeth with formula of 8/8, totalling 32 teeth. There was no complexity in the execution of radiographic and tomographic examinations, concluding that execution can be carried out in nine-banded armadillos during the clinical routine for wild animals.

Comparative effectiveness of water and salt community-based fluoridation methods in preventing dental caries among schoolchildren

OBJECTIVE

To compare the effectiveness of water and salt community-based fluoridation methods on caries experience among schoolchildren.

METHODS

Data derived from two population-based oral health surveys of 12-year-old schoolchildren exposed to different community-based fluoridation methods were compared: artificially fluoridated water in Porto Alegre, South Brazil and artificially fluoridated salt in Montevideo, Uruguay. Data on socio-demographic characteristics, maternal education and oral hygiene were collected. Dental caries was defined according to the WHO criteria (cavitated lesions) and to the modified WHO criteria (active noncavitated lesions and cavitated ones). The association between community-based fluoridation methods and dental caries was modelled using logistic (caries prevalence) and Poisson regression (DMFT). Odds ratios (OR), rate ratios (RR), and the 95% confidence intervals (CI) were estimated.

RESULTS

A total of 1528 in Porto Alegre and 1154 in Montevideo were examined (response rates: 83.2% and 69.6%, respectively). Adjusted estimates for caries prevalence and DMFT showed that schoolchildren from Porto Alegre were less affected by dental caries than their counterparts from Montevideo, irrespective of the criteria used. After adjusting for important characteristics, schoolchildren exposed to fluoridated salt had significantly higher likelihood of having caries (WHO criteria) than those exposed to fluoridated water (OR for prevalence=1.61, 95% CI=1.26-2.07; RR for DMFT=1.32, 95% CI=1.16-1.51). Similar differences were observed using the modified WHO criteria.

CONCLUSION

Fluoridated water appears to provide a better protective effect against dental caries than fluoridated household salt among schoolchildren from developing countries.

Tooth loss prevalence and risk indicators among 12-year-old schoolchildren from South Brazil

This population-based cross-sectional study aimed to assess the prevalence and risk indicators for tooth loss due to dental caries among 12-year-old schoolchildren from South Brazil. 1,528 out of 1,837 (participation rate = 83.17%) schoolchildren were included. Tooth loss prevalence was 5.81% (95% CI = 3.71-8.98) and 0.08 (95% CI = 0.04-0.12) teeth were missing. Schoolchildren with low socioeconomic status (OR = 2.28, 95% CI = 1.23-4.21), who repeated years in school (OR = 1.56, 95% CI = 1.01-2.42), and with gingivitis (OR = 1.81, 95% CI = 1.33-2.45) were more likely to have missing teeth. Schoolchildren brushing 2 times/day (OR = 0.78, 95% CI = 0.64-0.96) or more (OR = 0.49, 95% CI = 0.33-0.74), and those with dental insurance or private dentists (OR = 0.60, 95% CI = 0.39-0.93) were less likely to present missing teeth. © 2014 S. Karger AG, Basel.

Eruption stage of permanent molars and occlusal caries activity/arrest

This study assessed the association between the eruption stage of permanent second molars and occlusal caries activity among 12-year-old schoolchildren from South Brazil. A cross-sectional study was performed in Porto Alegre using a multistage probability sampling strategy to select a representative sample. Clinical examination was conducted to assess the eruption stage of permanent molars, Gingival Bleeding Index, and, after tooth cleaning and drying, caries experience (noncavitated and cavitated lesions, including caries activity assessment). Data were collected on sex, socioeconomic status, mother's education, brushing frequency, and consumption of soft drinks. Generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 983 schoolchildren with 3,071 second molars were available for analysis. Whereas active caries was observed in 6.6% of fully erupted permanent second molars, caries affected 26.2%, 29.6%, and 18.2% of erupting molars classified as stages 1, 2, and 3, respectively: stage 1, partially erupted occlusal surface; stage 2, fully erupted occlusal surface, <1/2 crown exposed; and stage 3, fully erupted occlusal surface, >1/2 crown exposed. After adjusting for socioeconomic and behavioral variables, partially erupted molars were significantly more likely to present active caries lesions than molars in full occlusion: stage 1, OR = 4.99 (95% CI = 3.38, 7.38); stage 2, OR = 5.18 (95% CI = 3.14, 8.53); stage 3, OR = 3.20 (95% CI = 2.21, 4.64). Similar results were found when clinical variables were included in the adjusted model. In conclusion, most occlusal caries lesions tend to arrest/revert when teeth reach the occlusal plan; however, an important proportion of these lesions remains active and in need of proper management. Children at risk should be targeted with preventive and minimally invasive strategies.

Yield, changes in proteolysis, and sensory quality of Prato cheese produced with different coagulants

The objective of this research was to compare the effect of 2 fungal proteases, one that is already commercially established as a milk-clotting agent and another produced at the laboratory scale, on Prato cheese composition, protein and fat recovery, yield, and sensory characteristics. Cheeses were produced according to the traditional protocol, using protease from the fungus Thermomucor indicae-seudaticae N31 and commercial coagulant from Rhizomucor spp. as clotting agents. A 2×6 factorial design with 3 replications was performed: 2 levels of coagulants and 6 levels of storage time. After 5, 12, 19, 33, 43, and 53d of refrigerated storage (12°C), cheeses were monitored for proteolysis, firmness, and casein degradation by capillary electrophoresis. Sensory acceptance was evaluated after 29d of manufacturing. The different coagulants did not statistically affect Prato cheese composition, protein and fat recovery, and yield. Both cheeses presented good sensory acceptance. Proteolysis increased and firmness decreased for both cheeses during the storage time, as expected for Prato cheese. Caseins were well separated by capillary electrophoresis and the results showed, with good resolution, that the cheeses exhibited similar protein hydrolysis profile. Both cheeses presented good sensory acceptance. The gathered data showed that the protease from T. indicae-seudaticae N31 presented similar action compared with the commercial enzyme, indicating its efficiency as clotting agent for Prato cheese manufacture.