Maternal perception of the impact of anterior caries and its treatment on children: A qualitative study

BACKGROUND

Qualitative studies could allow a more comprehensive understanding about the breadth of children's experiences and perspectives regarding the impact of dental caries treatment.

AIM

To assess parental perception about children's oral health-related quality of life (OHRQoL) following the rehabilitation of carious primary anterior teeth.

METHODS

A purposive sample of parents of preschool children attending a University Dental Clinic due to caries in primary anterior teeth was recruited. Qualitative individual interviews about parental perception regarding children's oral health were conducted, audio-recorded, and transcribed verbatim. An interview guide was used, based on the instrument ECOHIS. The responses were analysed using a thematic analysis approach.

RESULTS

Mothers of 10 children aged 4-8 years old participated. Four themes emerged during data analysis: (a) Perception about the presence and occurrence of caries; (b) Impact on the child's OHRQoL; (c) Impact on family's OHRQoL; and (d) Changes in OHRQoL following oral rehabilitation.

CONCLUSION

Mothers of children with dental caries in anterior teeth reported impact on children's and family's life. Also, mothers' reports demonstrated that oral rehabilitation caused positive changes in their children's well-being and everyday life.

Factors associated with children's perception of pain following dental treatment

PURPOSE

To assess children's perception of pain during routine dental procedures and associated factors.

METHODS

A cross-sectional study was performed including 192 children aged 6-13 years, who visited a university paediatric dental clinic. Mothers were interviewed to obtain information about demographic and socioeconomic data, and psychosocial characteristics. During dental treatment, children's behaviour was assessed using Frankl's Behaviour Scale. Dental procedures were recorded according to complexity of treatment from dental records. Immediately after the dental procedure, perception of pain was assessed using the Faces Pain Scale-Revised. Poisson regression analysis was used to assess the association between potential predictor variables and perception of pain (P  < 0.05 was considered significant).

RESULTS

Overall, the mean pain score was 1.5 (SD 2.4). Higher levels of pain were reported by children who demonstrated non-cooperative behaviour during the treatment (RR = 2.39, 95% CI = 1.23-4.64), who were administered local analgesia (RR = 2.36, 95% CI = 1.31-4.27), and who reported dental pain during the previous 4 weeks (RR = 1.60, 95% CI = 1.04-2.47).

CONCLUSION

Perception of pain may be influenced by pre-operative pain and use of local analgesia, and is associated with non-cooperative behaviour during treatment.

The influence of clinical and psychosocial characteristics on children behaviour during sequential dental visits: a longitudinal prospective assessment

PURPOSE

This is the first study to adopt a multilevel approach to assess the impact of the order of dental visits on child's behaviour. The aim was to investigate which factors directly interfere with child's behaviour regardless of the order of sequential dental visits.

METHODS

In this prospective longitudinal study, children aged 7-12 years were invited to participate. Child behaviour was assessed using the Frankl Scale during four sequential dental visits. Chi-square test was used to analyse the effect of dental fear on children's non-cooperative behaviour according to the presence of dental fear. Multilevel mixed logistic regression model was used to assess the association between predictor variables and the outcome (child behaviour) during the sequential dental visits.

RESULTS

Overall, 111 children participated in this study. Maternal dental anxiety, dental pain and complexity of the treatment were associated with the non-cooperative behaviour in children aged 7-12 years. When stratified by dental fear, the complexity of the treatment remained associated with non-cooperative behaviour.

CONCLUSIONS

The results provide evidence that, even with the familiarization of child with the dental environment, maternal dental anxiety, dental pain in the last month, and the complexity of dental treatment negatively affect the children's behaviour aged 7-12 years.

Is dental trauma more prevalent in maltreated children? A comparative Study in Southern Brazil

BACKGROUND

Although a high prevalence of head and neck trauma has been reported in maltreated children and adolescents, most of these studies focused on record-based analyses, and only a few used control groups.

AIM

To assess the presence of dental trauma in maltreated children in comparison with children without a history of maltreatment.

DESIGN

A cross-sectional study with 68 maltreated children and 204 age, sex-, and school-matched control participants was conducted in Pelotas, a Southern Brazilian city. Socioeconomic and demographic data were collected. Clinical examinations were performed to evaluate dental trauma (O'Brien Index) and dental caries (WHO criteria). Fisher's exact and chi-squared tests were used for intergroup comparisons of socioeconomic and clinical variables. Multivariate logistic regression analyses were conducted to obtain adjusted odds ratios (OR).

RESULTS

The prevalence of dental trauma was 23.53% (n = 16) among maltreated children and 14.22% (n = 29) in the comparative group. After adjustment, the occurrence of dental trauma showed association with child maltreatment, with an OR of 2.14 (95% confidence interval 1.03-4.44) for maltreated children in comparison with children in the comparative group (P = 0.04).

CONCLUSIONS

Maltreated children presented with more dental trauma than those with no history of maltreatment.

Methods and logistics of an oral health cohort of university students from Pelotas, a Brazilian Southern city

Aim: This paper aimed to describe the methodological aspects in the baseline of university students’ cohort in a public university in southern Brazil. Methods: A multidisciplinary study was carried out assessing the psychosocial and oral health conditions of university students at the Federal University of Pelotas (UFPel). All new university students who have entered in in UFPel in the first semester of 2016 year were invited to participate. Two self-administered questionnaires were applied in classrooms. Descriptive analysis was performed using Stata 14.0. Results: A total of 3,237 students were eligible. Of these, 2,089 (64.5%) signed the consent form to participate of the study and answered the general questionnaires, and 2,052 (63.4%) students answered the confidential questionnaire. Refuses represented only 1.4% (n=29) of the total sample. Overall, most of the sample was female (52.2%), with age ranging from 18 to 24 years (66.1%), with white skin color (74.1%) and with mothers with educational level at university course (32.4%). A total, 62% reported a family income between 1001.00 and 5000.00 BRL, while only 16.3% reported being from low-income family (≤ 1000.00 BRL).  The UFPel offers 63 classroom-based courses classified in nine areas of knowledge. The Applied Social Sciences area comprised 19% of the sample followed by the Linguistics, Letters and Arts (17%) area and the Health sciences area (13%). Conclusion: To the knowledge of researchers, this was the first cohort study of university students in the South of Brazil including more than two thousand participants. This paper described strategies adopted to optimize and to allow data collection in the baseline and in the next follow-ups.

Comparative Study of Dental Pain Between Children With and Without a History of Maltreatment

AIMS

To assess the presence of dental pain in child abuse victims and to compare the findings to children in the same age group with no history of abuse in a Southern Brazilian city.

METHODS

This cross-sectional comparative study was carried out in a convenience sample of 68 child abuse victims from a center for psychologic support and in a comparative group of 204 students from public and private schools, all aged between 8 and 12 years. Data for socioeconomic and demographic variables were collected, and information regarding dental pain in the last 6 months was obtained via interviews with the children. World Health Organization criteria were used to assess the presence of decayed, missing, or filled teeth in primary and permanent dentition. Dental trauma was measured using the O'Brien Index, and gingival bleeding was assessed. Crude and adjusted logistic regression analyses were performed to assess the association between dental pain and history of abuse.

RESULTS

Reporting of dental pain was higher among child abuse victims (54.41%) than in the comparative group (36.14%) (P < .01). After adjustment for clinical variables in the logistic regression analyses, the child abuse victims group had an odds ratio of 2.03 (95% confidence interval 1.13 to 3.64) for dental pain (P = .01).

CONCLUSION

Child abuse victims presented a higher prevalence of dental pain than children with no history of maltreatment, regardless of oral health status.

Salivary cortisol levels and biological rhythm in schoolchildren with sleep bruxism

OBJECTIVE

Salivary cortisol levels and biological rhythms could be hypothesized as part of the multifactorial framework that explains bruxism etiology. The objective of this study was to examine salivary cortisol levels and biological rhythms in schoolchildren with sleep bruxism (SB).

METHODS

This is a cross-sectional study with a school-based sample. The Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K) was used to evaluate biological rhythms. Salivary samples were collected by the spitting method. The salivary cortisol level was measured by electrochemiluminescence. The criteria proposed by the American Academy of Sleep Medicine (AASM) were used to evaluate SB.

RESULTS

The SB prevalence was 16%. The SB presence was associated with belonging to families of lower economic status (p = 0.003). In addition, children with SB showed greater difficulty in maintaining biological rhythm (p = 0.002) and had higher levels of salivary cortisol (p = 0.034) compared with children without SB.

CONCLUSIONS

Higher levels of cortisol and disruption of biological rhythm was associated with SB in schoolchildren.

Are Maternal Factors Predictors for Early Childhood Caries? Results from a Cohort in Southern Brazil

This study aimed to determine the influence of maternal factors on the early development of dental caries in Brazilian preschoolers. This cross-sectional study was nested in a cohort of adolescent mothers. The current wave was performed when the children were aged 24 to 42 months. The questionnaire-based survey targeted adolescent mothers and included demographic and socioeconomic variables as well as the maternal education level. In addition, clinical examinations were performed on the mothers and their children. Mothers were assessed for decayed, missing and filled teeth in the permanent dentition (DMFT index) and gingival assessment; their children were assessed for decayed, missing and filled teeth in the deciduous dentition (dmft index). Poisson regression with robust variance was used to estimate the prevalence ratio, risk ratio and 95% confidence intervals. This data was also used to identify the maternal risk factors associated with the outcomes (prevalence and severity of childhood caries). A total 538 mother-child dyads were evaluated; the prevalence of early childhood caries was 15.1% and maternal caries was 74.4%. After the adjustment, the children that exhibited a greater incidence of dental caries were from mothers of low socioeconomic status, or from those presenting decayed teeth and higher rates of gingival bleeding. The results of this study suggest that the oral health of mothers is a potentially important risk factor for the development of early childhood dental caries. Public health planners should consider this information when planning interventions in order to prevent the occurrence of early dental caries.

Oral health self-perception, dental caries, and pain: the role of dental fear underlying this association

BACKGROUND

Oral health perception has multidimensional nature and can be influenced not only by clinical conditions but also by psychosocial characteristics.

HYPOTHESIS

Dental fear could modify the association between dental caries and dental pain and the perception of negative impact.

DESIGN

A cross-sectional study was conducted with (n = 1,196) children aged 8-12 years attending public and private schools in Pelotas/Brazil. Children were interviewed and examined. Oral health perception was assessed using a global oral health impact item. Crude and adjusted multivariable regression models were built and effect modification of dental fear in the association between clinical indicators and perception of impact was tested.

RESULTS

Compared with children without fear and caries, children with fear and dental caries presented a 1.45 higher prevalence of negative impact (95% CI: 1.18-1.79) while those without fear and with dental caries had a 1.31 higher prevalence (95% CI: 1.11-1.54) after adjustments. Also, the prevalence of negative perception was higher for children with fear and dental pain (PR: 2.95; 95% CI: 1.59-2.39) and for children without fear and with pain (PR: 1.53; 95% CI: 1.29-1.80), compared to children without fear and pain.

CONCLUSION

The presence of fear increased the effect of pain and caries on children's oral health perception.

Early-life socioeconomic status and malocclusion in adolescents and young adults in Uruguay

This study aims to estimate orthodontic treatment need among 15-24 year-old individuals in Montevideo, Uruguay, and the association of occlusal traits with demographic, clinical and socioeconomic factors, considering a life course approach. A cross-sectional study using data from the First National Oral Health Survey in Uruguay was conducted. A two-stage cluster procedure was used to select a sample of 278 individuals in Montevideo. Household interviews and oral examinations were performed by six dentists. Dental Aesthetic (DAI) and Decayed Missing and Filled Teeth Indices (DMFT) were used to assess orthodontic treatment need and dental caries, respectively. Early life and current socioeconomic factors were obtained from the interview. Ordinal logistic regression was used to model the DAI index. Prevalence of definite malocclusion was 20.6%, followed by severe (8.2%) and very severe (7.6%). In the adjusted analysis, individuals with untreated dental caries (OR = 1.11; 95%CI: 1.03-1.20) and those who reported a lower socioeconomic level at 6 years of age (OR = 5.52; 95%CI: 1.06-28.62) had a higher chance of being a worse case of malocclusion. Current socioeconomic position was not associated with orthodontic treatment need. Individuals aged 22-24 years (OR = 1.59; 95%CI: 1.05-2.41) had a lower chance than those aged 14-17. This study shows that orthodontic treatment need is relatively high in Uruguayan adolescents and young adults. There is a potential relationship between early life socioeconomic status and the occurrence of malocclusion in adolescents and young adults under a life course approach.

Oral health-related quality of life in Brazilian child abuse victims: A comparative study

This study aims to assess and compare Oral Health-Related Quality of Life (OHRQoL) in child abuse victims and non-abused children in a Southern Brazilian city. The study compared two independent samples of children aged 8-10 years: 48 child abuse victims recruited from a centre for Child and Adolescent Psychological Support (NACA) for abused children, and 144 public and private school students. Data collection consisted of administration of the Child Perceptions Questionnaire 8-10 (CPQ_8-10) to measure OHRQoL (dependent variable), clinical examination (dental caries), and collection of socioeconomic and demographic information (age, sex, skin colour, family income, and type of school). Multiple linear regression models were used to assess the association between presence of abuse and OHRQoL and subscales. After adjustment for clinical and sociodemographic variables, child abuse victims were found to exhibit higher CPQ scores on the overall scale and on the oral symptoms and functional limitations subscales. In conclusion, child abuse victims have a higher impact on OHRQoL. Based on the results, it is possible to suggest that greater care should be taken of these children, not only in providing treatment for oral disorders, but also in providing interdisciplinary care.

Maternal depression and anxiety associated with dental fear in children: a cohort of adolescent mothers in Southern Brazil

Exposure to maternal symptoms of depression/anxiety has long-term negative consequences for child development, regardless of the contextual risk. The objective of this study was to investigate the relationship of the symptomatology of persistent maternal depression and anxiety with child dental fear. This study was nested in a cohort of adolescent mothers in southern Brazil. Symptomatology of maternal depression and anxiety was assessed during pregnancy and postpartum, when the mothers' children were 24-36 months old, using Beck Depression Inventory and Beck Anxiety Inventory. The mothers answered a questionnaire to assess dental fear in their children, and to obtain socioeconomic and demographic data. Both mothers and their children were submitted to clinical oral examination (n= 540 dyads) to obtain oral health data. Multivariate hierarchical Poisson regression analysis was used to determine associations (p < 0.05). At data collection, the prevalence of maternal depressive symptoms was 39.1%, and anxiety was observed in 27.8% of the mothers, whereas 21.6% of the children presented dental fear. In the adjusted analysis, children's dental fear was positively associated with mothers' presenting depressive symptomatology and caries experience. The depression symptomatology trajectory was not associated with dental fear, whereas mothers with persistent symptoms of anxiety reported higher prevalence of dental fear toward their offspring. The findings of symptomatology of maternal depression observed at data collection and persistence of anxiety may negatively impact the child's perception of dental fear. Mothers are the main caregivers and primary models responsible for transmitting health-related behaviors; consequently, mental disorders affecting mothers may negatively impact their children.

Clinical and Individual Variables in Children’s Dental Fear: A School-Based Investigation

Abstract This cross-sectional study evaluated the prevalence of dental fear and associated factors in schoolchildren aged 8 to 12 years old, in Pelotas, southern Brazil. Schoolchildren enrolled in 20 public and private schools were selected using a multi-stage sample design. Sociodemographic characteristics, children’s dental visit and oral hygiene habits were assessed by questionnaires. The Dental Anxiety Question was used to measure dental fear prevalence. Children’s clinical examination evaluated presence of dental caries (DMFT/dmft index) and gingival bleeding. Data were analyzed using Poisson regression with robust variance (prevalence ratio; 95% confidence interval). One thousand two hundred and two children were included. Dental fear prevalence was 24.6%. After the adjustment, girls [PR=1.71 (CI 95%: 1.31-2.22)], children from poorer families [PR=1.96 (CI 95%: 1.36-2.83)], those who had decayed teeth (D/d index>0)[PR=1.32 (CI 95%: 1.01-1.72), and who had never been at the dentist [PR=1.85 (CI 95%: 1.42-2.41) remained significantly associated with dental fear. The prevalence of dental fear indicates that it is a common problem among schoolchildren. Early dental care and dental caries prevention are important factors to prevent dental fear.

Validity of the Brazilian version of the Venham's behavior rating scale

BACKGROUND

Venham's Behavior Rating Scale (VBRS) is a measure of uncooperative behavior developed to assess children's responses to dental stress.

AIM

To evaluate the validity of the Brazilian version of the VBRS.

DESIGN

Children aged 7-13 years were invited to participate in this study. Child behavior was concurrently assessed with both the VBRS and the Frankl Scale. A receiver operating characteristic curve (ROC) was plotted to determine the cut-off points of the Brazilian version of the VBRS. Criterion validity was determined using Spearman's correlation coefficient. Discriminant validity was tested before and after scale dichotomization.

RESULTS

A total of 265 children participated in this study. According to the ROC curve, the ≥1 cut-off point was best for this population (SENS 97.4%; SPEC 94.7%). The Brazilian version of the VBRS was significantly correlated with the Frankl Scale (r -0.69; <0.001, r -0.72; <0.001). Child behavior assessed was related to complexity of treatment, type of procedure, use of local anesthesia, and dental fear.

CONCLUSIONS

The results provide strong evidence for the validity of Brazilian version of the VBRS in behavior assessment of children aged 7-13 years during dental care.

Nonpharmacologic Intervention on the Prevention of Pain and Anxiety During Pediatric Dental Care: A Systematic Review

BACKGROUND

Nonpharmacologic interventions may be used to reduce fear and anxiety during dental treatment.

OBJECTIVES

To systematically review trials on the effect of nonpharmacologic interventions in behavior, anxiety, and pain perception in children undergoing dental treatment.

DATA SOURCES

Medline, Scopus, Web of Science and CINAHL, Google Scholar, and studies' reference lists.

PARTICIPANTS AND INTERVENTIONS

Studies performed with children and adolescents that evaluated the effect of interventions on children's behavior, anxiety, and pain perception during dental treatment were included.

STUDY APPRAISAL METHODS

Independent quality assessment of the studies was carried out following the classification categories present on the Cochrane Handbook for Development of Systematic Reviews of Intervention.

RESULTS

Twenty-two articles, reporting 21 studies, were selected. Most studies tested distraction techniques. Eight studies presented bias and results were not considered. The remaining 13 studies had control groups with inactive controls, and 4 also included a variation of the intervention. Of the 4 studies assessing behavior, 3 found difference between intervention and control. Anxiety was evaluated by 10 studies: 4 found differences between intervention and control and 2 found differences between interventions. Five studies investigated pain perception: 3 found difference comparing active versus inactive interventions. In 1 of the 3, variations in the intervention decreased pain perception.

CONCLUSIONS

More research is needed to know whether the techniques are effective for improving behavior and reducing children's pain and distress during dental treatment. However, the majority of the techniques improved child's behavior, anxiety, and pain perception.

Impact of Malocclusion on Oral Health-Related Quality of Life of 8-12 Years Old Schoolchildren in Southern Brazil

Abstract The aim of this study was to estimate the impact of malocclusion on the oral health-related quality of life (OHRQoL) of schoolchildren aged 8-12 years old in Southern Brazil. A two-stage cluster procedure was used to select 1,199 children in 20 public and private schools in Pelotas/Brazil. Cross-sectional data was collected, consisting of a socioeconomic questionnaire to parents, children’s interview and clinical oral examination. The clinical variables were obtained from clinical examination, and the Child Perceptions Questionnaire (CPQ) was assessed during children’s interview. To measure malocclusion and orthodontic treatment need the Dental Aesthetic Index was used. For data analysis multiple Poisson regression models estimating the rate ratios (RR) and their respective confidence intervals (95%CI) were used. Among 1,206 participants, 789 were aged 8-10 years and 417 between 11-12 years. The orthodontic treatment need was higher among the younger children (44.6%) than in the older ones (35.0%) (p value ≤0.05). There was a significant association in the CPQ social and emotional domains with malocclusion in the older schoolchildren. In the adjusted analysis (for socioeconomics and clinical variables) the effect of very severe malocclusion on OHRQoL was confirmed in both 8-10 and 11-12 age groups (RR(95%CI) of 1.24(1.02;1.51) and 1.28(1.01;1.62), respectively). The findings demonstrated that children with very severe malocclusion experienced greater negative impact on OHRQoL compared to those with mild or no malocclusion. The results suggest that malocclusion impacts the quality of life. The higher impact occurs in the social and emotional well-being domains.

Maternal Depression Increases Childhood Dental Caries: A Cohort Study in Brazil

Aim: To investigate the relationship between maternal depression and childhood caries in a cohort of adolescent mothers. Methods: This cross-sectional study nested in a cohort evaluated a sample of 538 mother/child dyads. When the children were 24-36 months of age, data regarding oral health from children and mothers were collected by clinical dental examination. A mother's major depressive disorder was assessed by using the Mini International Neuropsychiatric Interview (MINI [Plus]), at the current moment. Independent variables were obtained by using questionnaires. The outcome on dental caries experience was dichotomized by using 2 cut points: dmfs ≥1 and dmfs ≥3. Poisson regression analysis, using a hierarchical approach, was applied to assess the association between major depressive disorder in mothers with and those without caries experience and the outcome. Results: The prevalence of dental caries in children was 15.1% (n = 82). The mean dmfs index was 1.12 (SD = 3.72). The prevalence of major depressive disorder was 32.6% (n = 168). An interaction between caries status and depressive disorder was found, and after adjusted analysis, children from mothers with major depressive disorder with negative caries experience presented a higher caries prevalence (prevalence ratio 4.00, 95% confidence interval 1.29-12.41). Conclusion: Our findings suggest that maternal psychiatric disorders could have a negative impact on children's oral health.