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Ribas-Perez D, Muñoz-Viveros C, Formoso-Veloso AL, Carrillo-Sanchez FJ, El Khoury-Moreno L, Torrejon-Martinez J, Castaño-Seiquer A. Oral Health-Related Quality of Life in a Paediatric Population in the Dominican Republic. J Clin Med 2024; 13:2449. [PMID: 38730978 PMCID: PMC11084811 DOI: 10.3390/jcm13092449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Introduction: During the summer of 2019 and within the framework of a social dentistry program carried out in the low-income town of San Francisco de Macorís (Dominican Republic), a descriptive study was carried out on oral health-related quality of life (OHRQoL), aiming to find out the oral health status of a population of children in the aforementioned Dominican city. Objective: The aim of this study was to describe the oral health status of a child population and its relationship with the quality of life perceived by these children in the aforementioned population of San Francisco de Macorís in order to develop an specific oral health program taking into account not only the existing oral health status but also the perceptions and feelings of the child population in this regard. Method: A descriptive cross-sectional study was carried out on a representative sample of children who were examined on their oral health status, following WHO guidelines, by professionals from the University of Seville (Spain) together with professionals from private practice (USA) and students from the Universidad Católica Nordestana (UCNE, Dominican Republic). Likewise, the children's parents voluntarily completed the Oral Quality of Life questionnaire COHIP-19 in its culturally adapted Spanish version. Results: For this purpose, 94 children with a mean age of 10.34 (SD 3.38) were observed in our study following WHO recommendations for oral health studies and evaluating OHQoL using the specific questionnaire validated in Spanish COHIP-19 in its short format (SF). The results show a state of oral health with a significant prevalence of caries (80.9%) and a DMFT of 1.70 (SD 1.90). The OHQoL perceived by these children shows that pain, bad breath or feeling sad because of the condition of their teeth were the factors with the worst evaluation score. Conclusions: The conclusion that mainly emerges from this study is that caries continues to be the main problem to be solved (more than other variables studied, such as malocclusion or fluorosis), and this ailment also causes pain, dysfunction, and bad breath and is therefore perceived as a problem to be solved in the children of this Dominican city.
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Affiliation(s)
- David Ribas-Perez
- Department of Stomatology, University of Seville, 41004 Seville, Spain (F.J.C.-S.); (L.E.K.-M.); (J.T.-M.); (A.C.-S.)
| | | | - Angel Luis Formoso-Veloso
- Department of Stomatology, University of Seville, 41004 Seville, Spain (F.J.C.-S.); (L.E.K.-M.); (J.T.-M.); (A.C.-S.)
| | | | - Luis El Khoury-Moreno
- Department of Stomatology, University of Seville, 41004 Seville, Spain (F.J.C.-S.); (L.E.K.-M.); (J.T.-M.); (A.C.-S.)
| | - Julio Torrejon-Martinez
- Department of Stomatology, University of Seville, 41004 Seville, Spain (F.J.C.-S.); (L.E.K.-M.); (J.T.-M.); (A.C.-S.)
| | - Antonio Castaño-Seiquer
- Department of Stomatology, University of Seville, 41004 Seville, Spain (F.J.C.-S.); (L.E.K.-M.); (J.T.-M.); (A.C.-S.)
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Herndon JB, Rubin MS, Reusch C, Edelstein BL. A scoping review of the economic impact of family oral health: Implications for public health, research, and policy. J Public Health Dent 2024; 84:43-99. [PMID: 38305646 DOI: 10.1111/jphd.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/07/2023] [Accepted: 11/25/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To summarize evidence on the impact of oral health on individual and family economic outcomes, describe trends in the literature, and identify areas for additional research to inform public health research and practice. METHODS Searches were conducted within PubMed, CINAHL, EconLit, Cochrane Library, PsycInfo, and Web of Science databases. Article review, selection, abstraction, and reporting processes were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS Of 2758 unduplicated records identified, 52 met inclusion criteria. Study outcomes included indicators of employment/employability (n = 9), earnings/earnings potential (n = 26), parent missed work and family financial impacts of child oral health (n = 19), and financial loss (n = 3). Dental caries-related variables were the most common predictors of poorer economic outcomes. Other oral health problems, such as poorer dental functioning or poorer self-reported oral health status, also were associated with adverse economic outcomes. Significant associations with employment were found among studies that assessed interventions designed to improve oral health. Only one study estimated the impact of oral health on earnings. One-third of studies conducted multivariable analyses, and 14% incorporated race and ethnicity variables. CONCLUSIONS Although existing evidence suggests associations between oral health problems and poorer economic outcomes, there is a substantial need for more rigorous research to better understand the extent of economic impact of oral health problems and which populations are most affected. Additional high-quality research is needed to inform which interventions are most likely to improve oral health, reduce adverse economic impacts, and promote health and economic equity.
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Affiliation(s)
| | - Marcie S Rubin
- Division of Socio-Behavioral Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| | - Colin Reusch
- Community Catalyst, Washington, District of Columbia, USA
| | - Burton L Edelstein
- Division of Pediatric Dentistry, College of Dental Medicine, Columbia University, New York, New York, USA
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Portella PD, de Oliveira LF, Ferreira MFDC, Dias BC, de Souza JF, Assunção LRDS. Improving accuracy of early dental carious lesions detection using deep learning-based automated method. Clin Oral Investig 2023; 27:7663-7670. [PMID: 37906303 DOI: 10.1007/s00784-023-05355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To investigate the effectiveness of a convolutional neural network (CNN) in detecting healthy teeth and early carious lesions on occlusal surfaces and to assess the applicability of this deep learning algorithm as an auxiliary aid. MATERIALS AND METHODS A total of 2,481 posterior teeth (2,459 permanent and 22 deciduous teeth) with varying stages of carious lesions were classified according to the International Caries Detection and Assessment System (ICDAS). After clinical evaluation, ICDAS 0 and 2 occlusal surfaces were photographed with a professional digital camera. VGG-19 was chosen as the CNN and the findings were compared with those of a reference examiner to evaluate its detection efficiency. To verify the effectiveness of the CNN as an auxiliary detection aid, three examiners (an undergraduate student (US), a newly graduated dental surgeon (ND), and a specialist in pediatric dentistry (SP) assessed the acquired images (Phase I). In Phase II, the examiners reassessed the same images using the CNN-generated algorithms. RESULTS The training dataset consisted of 8,749 images, whereas the test dataset included 140 images. VGG-19 achieved an accuracy of 0.879, positive agreement of 0.827, precision of 0.949, negative agreement 0.800, and an F1-score of 0.887. In Phase I, the accuracy rates for examiners US, ND, and SP were 0.543, 0.771, and 0.807, respectively. In Phase II, the accuracy rates improved to 0.679, 0.886, and 0.857 for the respective examiners. The number of correct answers was significantly higher in Phase II than in Phase I for all examiners (McNemar test;P<0.05). CONCLUSIONS VGG-19 demonstrated satisfactory performance in the detection of early carious lesions, as well as an auxiliary detection aid. CLINICAL RELEVANCE Automated detection using deep learning algorithms is an important aid in detecting early caries lesions and improves the accuracy of the disease detection, enabling quicker and more reliable clinical decision-making.
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Affiliation(s)
- Paula Dresch Portella
- Stomatology Department, Universidade Federal do Paraná, Avenida Prefeito Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, 80210-170, Brazil.
| | | | | | - Bruna Cristine Dias
- Stomatology Department, Universidade Federal do Paraná, Avenida Prefeito Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, 80210-170, Brazil
| | - Juliana Feltrin de Souza
- Stomatology Department, Universidade Federal do Paraná, Avenida Prefeito Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, 80210-170, Brazil
| | - Luciana Reichert da Silva Assunção
- Stomatology Department, Universidade Federal do Paraná, Avenida Prefeito Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, 80210-170, Brazil
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Alanzi A, Husain F, Husain H, Hanif A, Baskaradoss JK. Does the severity of untreated dental caries of preschool children influence the oral health-related quality of life? BMC Oral Health 2023; 23:552. [PMID: 37563589 PMCID: PMC10416462 DOI: 10.1186/s12903-023-03274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
AIM To assess the impact of untreated dental caries and its severity on the oral health-related quality of life (OHRQoL) of Kuwaiti preschool children and their caregivers. METHODS Participants were 4- and 5-year-old kindergarten children attending preselected public schools from one of the Governorates in Kuwait. Early childhood caries (ECC) was evaluated by clinical examinations and presented using decayed, missed, filled teeth/surface (dmft/dmfs). The clinical consequences of untreated dental caries were assessed using the pufa (pulp, ulcers, fistula, abscess) index for primary teeth. A structured questionnaire obtained demographic information of children and their caregivers. OHRQoL was assessed using the Arabic version of Early Childhood Oral Health Impact Scale (A-ECOHIS). RESULTS Among the 334 participants, 171 were kindergarten level-1 (KG1), and 163 were level-2 (KG2). The overall prevalence of dental caries was 78.9% for KG1 children and 67.4% for KG2 children. Decayed teeth were the main component for both dmft (84%) and dmfs (68%). The total mean (SD) pufa score was 0.54 (1.5), and about 19.2% of participants had at least one tooth with pufa > 0. A total of 207 A-ECOHIS were completed. Both family and child impact scores were significantly higher for children with a dmft score of 1 or more (p < 0.001) or with one or more pufa (p < 0.001). Child impact section scores were significantly higher with the increasing degrees of untreated caries (dt) (p = 0.004). CONCLUSION The severity of untreated dental caries and caries experience had a negative impact on the OHRQoL of Kuwaiti preschool children and their families. Using the pufa index had provided additional information about the effect of the caries severity on the OHRQoL than assessing the caries experience alone.
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Affiliation(s)
- A Alanzi
- College of Dentistry, Kuwait University, Jabriya, Kuwait.
| | - F Husain
- College of Dentistry, Kuwait University, Jabriya, Kuwait
| | - H Husain
- Ministry of Health, Kuwait City, Kuwait
| | - A Hanif
- College of Dentistry, Kuwait University, Jabriya, Kuwait
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Ramos BLM, Umemura AMB, Bruni O, de Souza JF, Menezes JVNB. Parental report of dental pain and discomfort in preschool children is associated with sleep disorders: a cross-sectional study in Brazilian families. Eur Arch Paediatr Dent 2023; 24:43-53. [PMID: 36125631 DOI: 10.1007/s40368-022-00747-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 08/28/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the prevalence of sleep disorders in Brazilian preschool children and its associations with parental report of dental pain and discomfort. METHODS This cross-sectional study involved 604 Brazilian preschoolers (4-5 years old). Sleep disorders (SD) and the parental report of dental pain and discomfort (DPD) were evaluated using the Brazilian versions of the Sleep Disturbance Scale for Children (SDSC) and the Dental Discomfort Questionnaire (DDQ-B), respectively. Bivariate and multivariate Poisson regression analyses with robust variance were performed to analyze the association between SDSC and DP. RESULTS Prevalence of SD ranged from 7 to 21%. 7.9% of the children had DPD indicating the need for more invasive dental procedures (DDQ-B ≥ 5). Significant associations were found between DPD and the following SDSC domains: sleep hyperhidrosis (p = 0.024; PRa = 1.38; 95% CI: 1.04-1.83), disorders of initiating and maintaining sleep (p < 0.001; PRa = 1.41; 95% CI: 1.15-1.73), parasomnias (p < 0.001; PRa = 1.82; 95% CI: 1.39-2.37), and sleep-wake transition disorders (p = 0.018; PRa = 1.28; 95% CI: 1.04-1.58). Children with higher prevalence of DPD presented 20% higher prevalence of SD than children lower prevalence of DPD (p = 0.039; PRa = 1.20; 95% CI: 1.01-1.44). CONCLUSION Preschool children with higher prevalence of DPD are more likely to have SD, such as hyperhidrosis, disorders of initiating and maintaining sleep, parasomnias, and sleep-wake transition.
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Affiliation(s)
- B L M Ramos
- Departament of Stomatology, Universidade Federal Do Paraná, Av. Prefeito Lothário Meissner, 632. Jardim Botânico, Curitiba, 80210-170, Brazil
| | - A M B Umemura
- Departament of Stomatology, Universidade Federal Do Paraná, Av. Prefeito Lothário Meissner, 632. Jardim Botânico, Curitiba, 80210-170, Brazil
| | - O Bruni
- Department of Developmental and Social Psychology, Sapienza University, Via dei Marsi 78, 00185, Rome, Italy
| | - J F de Souza
- Departament of Stomatology, Universidade Federal Do Paraná, Av. Prefeito Lothário Meissner, 632. Jardim Botânico, Curitiba, 80210-170, Brazil
| | - J V N B Menezes
- Departament of Stomatology, Universidade Federal Do Paraná, Av. Prefeito Lothário Meissner, 632. Jardim Botânico, Curitiba, 80210-170, Brazil.
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Oliveira TTDV, Menegaz AM, Rosário AMD, Romano AR, Schardosim LR, Mendes FM, Göettems ML, Azevedo MS. Impact of dental caries severity and activity on oral health-related quality of life among children aged 8-11 years. Braz Oral Res 2023; 37:e41. [PMID: 37132728 DOI: 10.1590/1807-3107bor-2023.vol37.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/15/2022] [Indexed: 05/04/2023] Open
Abstract
Caries disease can lead to strong impact in terms of pain and suffering, to functional impairment, and to negative effects on quality of life. Studies have demonstrated that the impact on quality of life increases with dental caries severity, and few studies have assessed the relationship between caries activity and children's oral health-related quality of life (OHRQoL). This cross-sectional study aimed to assess the impact of dental caries severity and activity on the OHRQoL of schoolchildren. The study was conducted with a sample of children aged 8 to 11 years from Pelotas, southern Brazil. Children answered the Child Perceptions Questionnaire 8-10, and socioeconomic data were collected. Children's dental caries (Kappa value of 0.95), PUFA, traumatic dental injuries, and malocclusion were examined. The Mann-Whitney, Kruskal-Wallis, and Poisson regression tests were performed. A total of 119 children were included. Children with initial (mean ratio (MR) of 1.92; 95% confidence interval (95% CI) of 1.05-3.48), moderate (MR: 2.66; 95%CI: 1.44-4.90), and severe carious lesions (MR: 2.65; 95%CI: 1.46-4.79) had a greater impact on OHRQoL compared with those without carious lesions (p =0 .047). Children with active carious lesions exhibited a greater impact on OHRQoL (MR:1.53 and 95%CI: 1.11-2.11) when compared to those without active lesions (p = 0.019). The findings demonstrate an association between dental caries severity and activity and the OHRQoL of school-aged children.
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Affiliation(s)
| | - Aryane Marques Menegaz
- Universidade Federal de Pelotas - UFPel, Graduate Program of Dentistry, Pelotas, RS, Brazil
| | - Andreza Montelli do Rosário
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Department of Social and Preventive Dentistry, Pelotas, RS, Brazil
| | - Ana Regina Romano
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Department of Social and Preventive Dentistry, Pelotas, RS, Brazil
| | - Lisandrea Rocha Schardosim
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Department of Social and Preventive Dentistry, Pelotas, RS, Brazil
| | - Fausto Medeiros Mendes
- Universidade Federal de Pelotas - UFPel, Graduate Program of Dentistry, Pelotas, RS, Brazil
| | - Marília Leão Göettems
- Universidade Federal de Pelotas - UFPel, Graduate Program of Dentistry, Pelotas, RS, Brazil
| | - Marina Sousa Azevedo
- Universidade Federal de Pelotas - UFPel, Graduate Program of Dentistry, Pelotas, RS, Brazil
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Tahani B, Asgari I, Golkar S, Ghorani A, Hasan Zadeh Tehrani N, Arezoo Moghadam F. Effectiveness of an integrated model of oral health-promoting schools in improving children's knowledge and the KAP of their parents, Iran. BMC Oral Health 2022; 22:599. [PMID: 36510207 PMCID: PMC9744048 DOI: 10.1186/s12903-022-02644-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The aim of our study was to investigate the effect of an Oral Health Promoting School (OHPS) model on children's oral health in Iran. METHODS This interventional quasi-experimental study was conducted in the academic year 2019-20 among 354 primary school students and their parents. A questionnaire including 17 questions was distributed among children before and 5 months after the program (The ranges of possible scores = 0-17). Training workshops for the parents based on the theoretical domains framework were designed. Using educational sessions, pamphlets, tooth brushing dairies, assignments to do at home, educational videos and messages as reminders in social networks, parents were educated about dental caries, its risk factors and prevention principles. Best recommended oral health behaviors including tooth brushing and the use of fluoridated tooth paste were also educated. A questionnaire consisting of 18 knowledge (The ranges of possible scores = 0-18), 13 attitude and 10 practice questions were distributed among parents before and after the workshops. The data were fed into SPSS and analyzed by descriptive and analytic statistics such as T-test, ANOVA and Correlation Coefficients (α = 0.05). RESULTS The mean pre-test knowledge (7.8 ± 1.7) was increased significantly in three schools after program, p < 0.001. In the post-test, girls gained significantly higher scores (9.61 ± 1.98 vs. 9.06 ± 1.4, p = 0.025). Among 147 parents, the mean knowledge was raised from 12.3 ± 3.1 (5-18) to 15 ± 3.03 (6-18), p < 0.001. Knowledge score of the parents attending both sessions was higher. Practice of the parents regarding the use of fluoridated tooth-paste was significantly improved (p < 0.001). Also, their attitude toward the ability of children to take care of their teeth was improved (p = 0.029). Based on the self-report of parents, 71.4% (n = 47) of mothers and 45.6% (n = 67) of their children used to brush once or two times daily and there was a correlation between their behaviors (p < 0.001, Spearman Correlation Coefficient = 0.4). CONCLUSION It seems that the education provided in OHPS had positive effects on increasing students' awareness and to some extent, the knowledge, attitude and practice of the parents.
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Affiliation(s)
- Bahareh Tahani
- grid.411036.10000 0001 1498 685XDepartment of Oral Public Health, Dental Research Center, Dental research Institute,School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Imaneh Asgari
- grid.411036.10000 0001 1498 685XDepartment of Oral Public Health, Dental Material Research Center, Dental Research Institute,School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shayan Golkar
- grid.411036.10000 0001 1498 685XDental Students Research Commiittee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Ghorani
- grid.411036.10000 0001 1498 685XDental Students Research Commiittee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nooshin Hasan Zadeh Tehrani
- grid.411036.10000 0001 1498 685XDental Students Research Commiittee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Arezoo Moghadam
- grid.411036.10000 0001 1498 685XDental Students Research Commiittee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Gomes MC, Perazzo MF, Neves ÉTB, Siqueira MBLD, Paiva SM, Granville-Garcia AF. Premature Primary Tooth Loss and Oral Health-Related Quality of Life in Preschool Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12163. [PMID: 36231465 PMCID: PMC9564822 DOI: 10.3390/ijerph191912163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The present study aimed to evaluate the association between premature primary tooth loss and oral health-related quality of life (OHRQoL) in preschool children. A cross-sectional study was conducted in 769 5-year-old preschool children. The children and their parents or guardians answered the Brazilian version of the Scale of Oral Health Outcomes for 5-Year-Old Children for the assessment of OHRQoL. Meanwhile, clinical examinations were performed for the assessment of premature primary tooth loss. Unadjusted and adjusted multilevel Poisson regression models were utilized to investigate the associations between the variables. In the parental version of the scale, premature posterior primary tooth loss (rate ratio [RR] = 2.65; 95% confidence interval [CI] = 1.51-4.68), weak sense of coherence (RR = 2.25; 95% CI = 1.62-3.11), and visit to a dentist (RR = 1.61; 95% CI = 1.04-2.52) were associated with OHRQoL. Based on the children's perceptions, only the preschool type was associated with OHRQoL (RR = 1.92; 95% CI = 1.21-3.05). Premature posterior primary tooth loss had a greater impact on OHRQoL based on the parents' perception, whereas only the preschool type was associated with OHRQoL based on the children's perception.
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Affiliation(s)
- Monalisa Cesarino Gomes
- Department of Dentistry, Unifacisa Centro Universitário, Campina Grande 58408-326, PB, Brazil
| | - Matheus França Perazzo
- Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Érick Tássio Barbosa Neves
- Department of Dentistry, Unifacisa Centro Universitário, Campina Grande 58408-326, PB, Brazil
- Department of Dentistry, State University of Paraíba, Campina Grande 58429-500, PB, Brazil
| | | | - Saul Martins Paiva
- Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
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Mahmoud SA, El Moshy S, Rady D, Radwan IA, Abbass MMS, Al Jawaldeh A. The effect of unhealthy dietary habits on the incidence of dental caries and overweight/obesity among Egyptian school children (A cross-sectional study). Front Public Health 2022; 10:953545. [PMID: 36052005 PMCID: PMC9424618 DOI: 10.3389/fpubh.2022.953545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/11/2022] [Indexed: 01/24/2023] Open
Abstract
Background Obesity and dental caries are public health problems in Egypt. Factors such as unhealthy diet, poor oral hygiene, and physical inactivity can play a major role in both problems. This study was carried out to illuminate the mutual unhealthy dietary risk factors associated with the incidence of both health conditions. Methods Between 1 October 2020 and 1 July 2021, 369 Egyptian children (5-10 years) were examined. Dental status was assessed using decayed, missing/extracted, and filled tooth indices (dmft, deft, and DMFT) for deciduous, mixed, and permanent dentitions, respectively. Moreover, the lifestyle, food habits, and body mass index (BMI) were recorded. Results A total of 342 (93.7%) of the included subjects suffered from caries, and only 27(7.3%) were caries-free. Based on BMI percentiles, 247 (66.9%) of the youngsters were overweight/obese, while 122 (33.1%) had normal weight. The mean dmft was 6.9 (±4.6), deft 4.2 (±3.3), and DMFT 0.1 (±1.7). In the primary dentition, a significant positive correlation was detected between dmft and BMI, legumes, sweetened milk and juice, soft drinks, and desserts, while a significant negative correlation was detected between dmft/deft, meat/poultry/fish, fresh fruits, and vegetables. A significant positive correlation was detected between deft and BMI, sweetened milk and juice, ice cream, candies, and crackers. In the permanent dentition, a significant positive correlation was detected between age, soft drinks, sweetened juice, desserts, and DMFT, while a significant negative correlation was detected with fresh fruits and vegetables. BMI was significantly negatively correlated with a healthy lifestyle, meat/poultry/fish consumption, and fresh fruits and vegetables while positively correlated with legumes, ice cream, soft drinks, granulated sugars, desserts, fast food, and caffeinated drinks. Conclusion Overweight/obesity was positively correlated with primary dentition dental caries. Desserts (sweetened snacks) and soft drinks could be the common risk factors associated with high caries and overweight/obesity incidence among Egyptian school children; conversely, consumption of fruits and vegetables could hinder both health conditions. Moreover, sweetened juices were associated with primary and permanent dental caries.
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Affiliation(s)
- Sara Ahmed Mahmoud
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Sara El Moshy
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Dina Rady
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Israa Ahmed Radwan
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Marwa M. S. Abbass
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt,*Correspondence: Marwa M. S. Abbass
| | - Ayoub Al Jawaldeh
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean (EMRO), Cairo, Egypt
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Velasco SRM, Moriyama CM, Bonecker M, Butini L, Abanto J, Antunes JLF. Relationship between oral health literacy of caregivers and the oral health-related quality of life of children: a cross-sectional study. Health Qual Life Outcomes 2022; 20:117. [PMID: 35907863 PMCID: PMC9338565 DOI: 10.1186/s12955-022-02019-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Oral health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. However, scientific evidence about the oral health literacy of caregivers and the children’s oral health-related quality of life. The purpose of this study was to verify the relationship between the level of oral health literacy of caregivers and the children's oral health-related quality of life (OHRQOL). Methods This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred thirty children were examined to assess the prevalence of dental caries (dmft index). Parents were interviewed to obtain sociodemographic status, oral conditions, and oral health literacy (OHL). The variable outcome was the children's OHRQOL as assessed by the Early Childhood Oral Health Impact Scale (ECOHIS). We fitted zero-inflated negative binomial regression (ZINB) models to evaluate associations between the study outcome and covariates in terms of PR (Prevalence Ratios), RR (Rate Ratios), and their respective Confidence Intervals (95% CI). Results Children's OHRQOL was not associated with OHL. Dental caries had a negative impact on the children's quality of life (p < 0.05). A reduced impact on OHRQOL is also associated with having siblings (PR = 0.70, 95% CI 0.52–0.95). A higher age of the mother reduced OHRQOL impacts (PR = 0.72, 95% CI 0.52–0.98). Conclusions The factors associated with children's OHRQOL were the number of siblings, the mothers' age, and dental caries. This study observed no association between parental OHL and children's OHRQOL.
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Affiliation(s)
- Sofia Rafaela Maito Velasco
- Public Health School, University of São Paulo, São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil.
| | - Caroline Moraes Moriyama
- Department of Paediatric and Orthodontic Dentistry, University of Sao Paulo, São Paulo, SP, Brazil.,Department of Postgraduation Program in Dentistry, Metropolitana de Santos University, Santos, SP, Brazil
| | - Marcelo Bonecker
- Department of Paediatric and Orthodontic Dentistry, University of Sao Paulo, São Paulo, SP, Brazil
| | - Luciane Butini
- Oral Radiology in the School of Dentistry, School of Dentistry, São Leopoldo Mandic, Campinas, SP, Brazil
| | - Jenny Abanto
- Public Health School, University of São Paulo, São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
| | - José Leopoldo Ferreira Antunes
- Public Health School, University of São Paulo, São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
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11
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Vieira-Andrade RG, Pordeus IA, Ramos-Jorge ML, Drumond CL, Silva-Freire LC, Ramos-Jorge J, Paiva SM. Risk indicators of untreated dental caries incidence among preschoolers: a prospective longitudinal study. Braz Oral Res 2022; 36:e064. [PMID: 36507751 DOI: 10.1590/1807-3107bor-2022.vol36.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/14/2022] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to evaluate the influence of socioeconomic factors, oral conditions and the impact of OHRQoL as possible risk indicators related to the incidence of untreated dental caries in preschool children two years after an initial examination. A prospective longitudinal study was performed with a sample of 288 preschool children allocated to two groups at baseline (T0): caries free (n = 144) and with untreated dental caries (n = 144). Untreated dental caries was determined through clinical examinations performed by a calibrated dentist at T0 (Kappa > 0,89) and T1 (two years after the baseline) (Kappa > 0,91) using the dmft criteria. Parents/caregivers answered a socioeconomic questionnaire and the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) at T0 and T1. Mann-Whitney test and hierarchically adjusted Poisson regression models were used (95%CI, p < 0,05). The incidence of untreated dental caries was 41.3%. Low (RR = 1.63; 95%CI:1.18-2.26; p < 0.001) and high severity of untreated dental caries (RR = 1.92; 95%CI:1.36-2.72; p < 0.001), monthly household income less than two times the Brazilian minimum salary (RR = 1.79; 95%CI:1.04-3.25; p = 0.042) and overall B-ECOHIS score (RR = 1.03; 95%CI:1.02-1.05; p < 0.001) at T0 were risk indicators for the incidence of untreated dental caries among the preschool children. In conclusion, the incidence of untreated dental caries was high and the higher severity of untreated dental caries, the lower monthly income and the higher the B-ECOHIS score (indicating a negative impact on quality of life) were risk indicators to the developing of new lesions of untreated dental caries after 2 years.
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Affiliation(s)
- Raquel Gonçalves Vieira-Andrade
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Health of Children and Adolescents, Belo Horizonte, MG, Brazil
| | - Isabela Almeida Pordeus
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Health of Children and Adolescents, Belo Horizonte, MG, Brazil
| | - Maria Letícia Ramos-Jorge
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, School of Dentistry, Department of Dentistry, Diamantina, MG, Brazil
| | - Clarissa Lopes Drumond
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Health of Children and Adolescents, Belo Horizonte, MG, Brazil
| | - Luíza Costa Silva-Freire
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Health of Children and Adolescents, Belo Horizonte, MG, Brazil
| | - Joana Ramos-Jorge
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Health of Children and Adolescents, Belo Horizonte, MG, Brazil
| | - Saul Martins Paiva
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Health of Children and Adolescents, Belo Horizonte, MG, Brazil
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12
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Feldens CA, Pinheiro LL, Cury JA, Mendonça F, Groisman M, Costa RAH, Pereira HC, Vieira AR. Added Sugar and Oral Health: A Position Paper of the Brazilian Academy of Dentistry. FRONTIERS IN ORAL HEALTH 2022; 3:869112. [PMID: 35464781 PMCID: PMC9020561 DOI: 10.3389/froh.2022.869112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Excessive sugar consumption is the main cause of dental caries. Dental caries is highly prevalent and negatively impacts the quality of life at all stages. Furthermore, sugar consumption is associated with other noncommunicable conditions and diseases, such as obesity, diabetes, and cardiovascular diseases. The aim of this paper is to propose recommendations at the individual and population levels for health professionals, families, educators, stakeholders, and public officials to reduce the burden of dental caries and other noncommunicable diseases that are caused by the excessive sugar intake. A systematic search was performed in PubMed and Cochrane databases to investigate the effectiveness of strategies and policies aiming to reduce sugar consumption as well as the impact of different patterns of sugar consumption on the occurrence of dental caries. Reference list of the identified papers and practice guidelines were manually reviewed as well. Based on the best evidence available, the Brazilian Academy of Dentistry recommends not to offer sugars to children younger than 2 years of age, and to limit total sugar consumption to <25 g per day after 2 years of age. Furthermore, families should be informed to limit sugar exposure, sugar-free areas should be available, content of food labels and advertisement should be regulated, taxation of products with sugar should be introduced, and reformulation of foods and drinks to reduce concentrations of sugars should be considered.
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Affiliation(s)
| | | | - Jaime A. Cury
- Piracicaba Dental School, Universidade de Campinas, Piracicaba, Brazil
| | | | | | - Rafael A. H. Costa
- National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Alexandre R. Vieira
- School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Alexandre R. Vieira
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13
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Fernandes IB, Ramos-Jorge J, Coelho VS, Pinto ACS, Pordeus IA, Paiva SM, Ramos-Jorge ML. Association between different stages of dental caries in preschoolers and familial socioeconomic factors. Braz Oral Res 2022; 36:e018. [DOI: 10.1590/1807-3107bor-2022.vol36.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
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14
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Alwattban RR, Alkhudhayr LS, Al-Haj Ali SN, Farah RI. Oral Health-Related Quality-of-Life According to Dental Caries Severity, Body Mass Index and Sociodemographic Indicators in Children with Special Health Care Needs. J Clin Med 2021; 10:jcm10214811. [PMID: 34768328 PMCID: PMC8584947 DOI: 10.3390/jcm10214811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/21/2022] Open
Abstract
This study aimed to assess the impact of dental caries’ severity, body mass index (BMI), and sociodemographic factors on oral health-related quality of life (OHRQoL) for special health care needs (SHCN) children and the suitability of their caregivers as proxies to determine OHRQoL. This cross-sectional study recruited 107 pairs of SHCN children and their caregivers and asked them to complete a questionnaire on sociodemographic issues as well as the Arabic version of the early childhood oral health impact scale (A-ECOHIS). This was followed by a dental examination. Dental caries was measured using the dmft/DMFT index, while caries’ severity was also determined. The children’s height and weight were measured, and BMI (kg/m2) was recorded. Data were analyzed statistically using t-test, one-way ANOVA, and Poisson regression models. Our results revealed that the A-ECOHIS score was 10.93, while the OHRQoL was affected in 95.3% of children. The most-reported item was ‘pain in the teeth, mouth, or jaws’ (48.7%). By regression analysis, caries-free children (Odds Ratio (OR): 0.650) or those who had moderate caries (OR: 0.551) were less likely to have a negative impact on their OHRQoL than those with severe caries. Additionally, those whose caregivers had a maximum primary education (OR: 0.656) or whose occupation was in the health sector (OR: 0.721) were less likely to have a negative impact on their OHRQoL. Those who were ≤ 6 years old (OR: 1.188) were more likely to have a negative impact. BMI did not have a significant impact on the OHRQoL of the children. Further, we detected a significant positive correlation between children’s dmft/DMFT scores and the A-ECOHIS scores reported by the mothers. Given these variables, which included dental caries’ severity, but not BMI, and caregivers’ education level and occupation, plus the child’s age group, we found a significant impact on the OHRQoL. However, we found that mothers were better proxies for their children’s OHRQoL.
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Affiliation(s)
- Rawan Rasheed Alwattban
- Dental Intern, College of Dentistry, Qassim University, Qassim 51452, Saudi Arabia; (R.R.A.); (L.S.A.)
| | - Lama Saleh Alkhudhayr
- Dental Intern, College of Dentistry, Qassim University, Qassim 51452, Saudi Arabia; (R.R.A.); (L.S.A.)
| | - Sanaa Najeh Al-Haj Ali
- Department of Orthodontic and Pediatric Dentistry, College of Dentistry, Qassim University, Qassim 51452, Saudi Arabia
- Correspondence: or ; Tel.: +966-504-603-339; Fax: +966-016-380-1762
| | - Ra’fat Ibrahim Farah
- Department of Prosthetic Dental Sciences, College of Dentistry, Qassim University, Qassim 51452, Saudi Arabia; or
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15
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Milani AJ, Castilho T, Assaf AV, Antunes LS, Antunes LAA. Impact of traumatic dental injury treatment on the Oral Health-Related Quality of Life of children, adolescents, and their family: Systematic review and meta-analysis. Dent Traumatol 2021; 37:735-748. [PMID: 34156753 DOI: 10.1111/edt.12697] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIM Measures of oral health-related quality of life (OHRQoL) are useful in clinical trials to evaluate treatment outcomes. To detect the treatment impact of traumatic dental injuries (TDI) on OHRQoL is extremely relevant. The aim of this study was to assess whether there is scientific evidence of the impact of TDI treatment on OHRQoL of children, adolescents, and their families. MATERIAL AND METHODS A systematic review and meta-analysis were conducted selecting articles from PubMed, Web of Science, Scopus, Cochrane Library, and Virtual Health Library until May 22nd, 2020. The gray literature, clinical trial registers, and a manual search were performed. Two independent reviewers selected the studies, extracted the data, and assessed the ROBINS-I risk of bias. A meta-analysis was performed using RevMan 5.4 program. The certainty of the evidence was evaluated using the GRADE system. RESULTS In the electronic search, 413 abstracts and one registered study were found. After removing the duplicates and eligibility application, six studies were included. Individually, the studies presented low to moderate risk of bias and they found that TDI treatment reduces the negative impact on OHRQoL. In the meta-analysis, TDI treatment improved OHRQoL for 8- to 10-year-old children (p = .03; CI 5.19 [0.62, 9.75]) (detected by CPQ 8-10 questionnaire). In the perception of parents, the children, and adolescents who had suffered TDI also had their OHRQoL improved (p = .04; CI 14.77 [0.95, 28.60]) (detected by PPQ and P-CPQ questionnaire) but both evaluations had very low certainty of evidence. CONCLUSION Treatment of traumatic dental injuries reduces the impact on the OHRQoL of children and adolescents. However, more studies are necessary to detect the TDI treatment influence on OHRQoL of preschoolers and in the family as well to estimate the effects due to outcomes that had a very low certainty of evidence (#CRD42018091210).
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Affiliation(s)
- Ana Júlia Milani
- Postgraduate Program in Dentistry of the Health Institute of Nova Friburgo (PPGO-ISNF), Fluminense Federal University, Nova Friburgo, Brazil
| | - Thuanny Castilho
- Postgraduate Program in Dentistry of Niterói Faculty of Dentistry, Federal Fluminense University (PPGO-FOUFF), Niterói, Brazil
| | - Andrea Videira Assaf
- Postgraduate Program in Dentistry of the Health Institute of Nova Friburgo (PPGO-ISNF), Fluminense Federal University, Nova Friburgo, Brazil.,Department of Specific Formation, School of Dentistry, Fluminense Federal University, Nova Friburgo, Brazil
| | - Leonardo Santos Antunes
- Postgraduate Program in Dentistry of the Health Institute of Nova Friburgo (PPGO-ISNF), Fluminense Federal University, Nova Friburgo, Brazil.,Postgraduate Program in Dentistry of Niterói Faculty of Dentistry, Federal Fluminense University (PPGO-FOUFF), Niterói, Brazil.,Department of Specific Formation, School of Dentistry, Fluminense Federal University, Nova Friburgo, Brazil
| | - Lívia Azeredo Alves Antunes
- Postgraduate Program in Dentistry of the Health Institute of Nova Friburgo (PPGO-ISNF), Fluminense Federal University, Nova Friburgo, Brazil.,Postgraduate Program in Dentistry of Niterói Faculty of Dentistry, Federal Fluminense University (PPGO-FOUFF), Niterói, Brazil.,Department of Specific Formation, School of Dentistry, Fluminense Federal University, Nova Friburgo, Brazil
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16
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Impact of oral diseases on oral health-related quality of life: A systematic review of studies conducted in Latin America and the Caribbean. PLoS One 2021; 16:e0252578. [PMID: 34077473 PMCID: PMC8171960 DOI: 10.1371/journal.pone.0252578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
Background We performed a systematic review of studies conducted in Latin America and the Caribbean (LAC) to assess the impact of oral diseases on oral health-related quality of life (OHRQoL). Materials and methods Searches were performed of the following PubMed, EMBASE, CINAHL, Scopus, and LILACS databases. Randomized clinical trials, quasi-experimental studies, cohort studies, case and control studies, and cross-sectional studies which included at least 100 participants evaluating the impact of oral diseases on OHRQoL were included. PROSPERO registry number: CRD42020156098. Results After exclusion of duplicates, 3310 articles were identified, 40 of which were included in this review. 90% of the studies were conducted in Brazil. The most commonly used OHRQoL measuring instruments were CPQ 11–14 (n = 9), ECOHIS (n-8) and B-ECOHIS (n = 8). The study designs included 32 cross-sectional, 2 cohort and 6 case and control studies. Most of the studies were conducted in children (n = 25) and adolescents (n = 9). Most studies identified an impact on OHRQoL in children, adolescents and adults with oral diseases. Moreover, greater oral disease severity had a greater impact on OHRQoL. Conclusions Most studies in LAC report a negative impact of diseases on OHRQoL. More longitudinal studies are required to confirm the results of these studies.
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17
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Bhatti A, Vinall-Collier K, Duara R, Owen J, Gray-Burrows KA, Day PF. Recommendations for delivering oral health advice: a qualitative supplementary analysis of dental teams, parents' and children's experiences. BMC Oral Health 2021; 21:210. [PMID: 33902541 PMCID: PMC8077708 DOI: 10.1186/s12903-021-01560-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tooth decay has a significant impact on children, their families and wider society. The dental consultation provides an opportunity to prevent tooth decay by engaging in an effective oral health conversation with parents and children. However, there is limited literature which explores how these oral health conversations are delivered, received, and understood. AIM To explore the common facilitators of delivering oral health advice from dental teams, parents' and children's experiences, to identify and inform practical recommendations for clinical practice. METHOD The current paper used a qualitative supplementary analysis to reanalyse data of existing published studies by applying a different research question. Qualitative focus groups were undertaken following a semi-structured interview guide with 27 dental team members (dentists, dental nurses, practice managers and receptionists), 37 parents and 120 children (aged 7-10 years old) in the northern region of England. Thematic analysis informed the identification of themes and aggregation of findings. RESULTS Three overarching themes were developed: (1) An engaging and personalised dental visit for parents and children; (2) Dental teams, parents and children working collaboratively to improve oral health habits; and (3) Recommending appropriate oral health products. Many parents and children had little recollection of any preventive oral health conversations when visiting the dentist. Practical solutions were identified by different stakeholders to facilitate three-way, personalised, non-judgemental and supportive oral health conversations. Adopting these innovative approaches will help to enable parents and their children to adopt and maintain appropriate oral health behaviours. CONCLUSION Understanding the context and triangulating the experiences of stakeholders involved in preventive oral health conversations for young children is an essential step in co-designing a complex oral health intervention. This study has provided recommendations for dental practices and wider paediatric health care services. Furthermore, the findings have informed the design of a complex oral health intervention called "Strong Teeth".
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Affiliation(s)
- Amrit Bhatti
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK.
- Bradford Community Dental Service, Bradford District Care NHS Trust, Bradford, UK.
| | - Karen Vinall-Collier
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
- Bradford Community Dental Service, Bradford District Care NHS Trust, Bradford, UK
| | - Raginie Duara
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
- Bradford Community Dental Service, Bradford District Care NHS Trust, Bradford, UK
| | - Jenny Owen
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
- Bradford Community Dental Service, Bradford District Care NHS Trust, Bradford, UK
| | - Kara A Gray-Burrows
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
- Bradford Community Dental Service, Bradford District Care NHS Trust, Bradford, UK
| | - Peter F Day
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
- Bradford Community Dental Service, Bradford District Care NHS Trust, Bradford, UK
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18
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Zaror C, Matamala-Santander A, Ferrer M, Rivera-Mendoza F, Espinoza-Espinoza G, Martínez-Zapata MJ. Impact of early childhood caries on oral health-related quality of life: A systematic review and meta-analysis. Int J Dent Hyg 2021; 20:120-135. [PMID: 33825317 DOI: 10.1111/idh.12494] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/22/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to conduct a systematic review in order to assess the impact of early childhood caries (ECC) and its severity on Oral health-related quality of life (OHRQoL). MATERIALS AND METHODS An electronic search was conducted in MEDLINE, EMBASE, Cochrane, SciELO and Lilacs databases. The study eligibility criteria were primary studies published in English, Spanish or Portuguese that assessed OHRQoL in preschool children with dental caries using validated instruments. Two researchers independently performed the selection process and data extraction. The Effective Public Health Practice Project's Quality Assessment Tool was used for the quality assessment. Random effects models were used to estimate the pooled effect for continuous and categorical data. RESULTS Of 2,037 identified articles, thirty-five studies (37 articles) met the inclusion criteria. The methodological quality was judged mainly as moderate. Children with ECC were more likely to report any impact on OHRQoL than children without caries (OR: 1.99; 95% CI: 1.51-2.62; 6 studies). Severe ECC (dmft > 5) presented a higher effect (OR: 5.00; 95% CI: 3.70-6.74; 8 studies). Sensitivity analysis including only population studies showed uncertain results on the impact of ECC on OHRQoL (OR: 1.67; 95% CI: 0.99-2.82; I2 = 95%). The symptom and psychological domains were the most affected (SMD: 0.60, 95% CI: 0.38-0.81 and SMD: 0.61, 95% CI: 0.37-0.85 respectively). CONCLUSIONS ECC has a negative impact on the OHRQoL of both preschoolers and their families. However, its impact on OHRQoL is diluted when it is evaluated at population level.
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Affiliation(s)
- Carlos Zaror
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.,Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Andrea Matamala-Santander
- Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.,Grupo de Investigación en Gestión y Docencia Odontológica (GIDGO), Universidad Autónoma de Chile, Temuco, Chile
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Fernando Rivera-Mendoza
- Forensic Dentistry Lab, Centro de Investigación en Odontología Legal y Forense -CIO-, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Gerardo Espinoza-Espinoza
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.,Department of Public Health, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - María José Martínez-Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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19
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Untreated dental caries and visible plaque of mothers are not determinant for the incidence of caries in dentin among children: evidence from a 3-year prospective cohort study. Clin Oral Investig 2021; 25:5431-5439. [PMID: 33704570 DOI: 10.1007/s00784-021-03851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate whether characteristics related to mother's oral health, trajectory of family income, and maternal education are associated with the incidence of caries in dentin in preschool children. MATERIALS AND METHODS One hundred fifty-eight mothers and their children were evaluated at baseline and re-evaluated after 3 years. Sociodemographic variables, dental caries, and biofilm of the mothers and children and daily sugar intake of the children were evaluated. Poisson regression was used to evaluate what factor represents risk for the incidence of caries in dentin at four to 6 years of age. RESULTS The risk of the incidence of caries in dentin was 54% higher in children whose mothers had a low level of education at both baseline and follow-up. Children from families with an income lower at baseline and follow-up (RR 2.49; 95% CI 1.62-3.83) and those whose families experienced a reduction in income in this period (RR 2.05; 95% CI 1.29-3.26) had a greater risk of the incidence of caries in dentin. Moreover, children who increased their daily sugar intake (RR 1.67; 95% CI 1.09-2.52), those that maintained high sugar intake (RR 1.81; 95% CI 1.14-2.87), and those with cavitated caries at baseline (RR 1.53; 95% CI 1.19-1.97) had a greater risk of the incidence of caries in dentin. CONCLUSIONS Low mother's education, a lower family income, a reduction in family income, a high frequency of daily sugar intake, and a history of cavitated caries were risk factors for the incidence of caries in dentin. CLINICAL RELEVANCE The results could help in the targeting of improved prevention and control strategies for dental caries.
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20
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Barasuol JC, Soares JP, Bolan M, Cardoso M. THE PERCEPTION OF CAREGIVERS OF POOR ORAL HEALTH OF THEIR CHILDREN AND ITS RELATED CLINICAL CONDITIONS. REVISTA PAULISTA DE PEDIATRIA 2021; 39:e2019381. [PMID: 33566986 PMCID: PMC7870097 DOI: 10.1590/1984-0462/2021/39/2019381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/19/2020] [Indexed: 11/21/2022]
Abstract
Objective: To determine the association between the perception of caregivers regarding the oral health of their children and socio-demographic characteristics, report of dental pain, and clinical oral conditions. Methods: A cross-sectional study was conducted with 570 children aged two to five years old, enrolled at public preschools, and with their caregivers. Data regarding perceptions of oral health status in children, socio-demographic characteristics, and dental pain were collected from a questionnaire. Three examiners (Kappa>0.7) evaluated children’s oral health status using the dmft index, pufa index, and the Andreasen classification for traumatic dental injury (TDI). The occurrence of open bite and overjet was also investigated. Descriptive analyses, and unadjusted and adjusted logistic regression were used, considering a 5% significance level. Results: A total of 24.7% of children had poor oral health status, which increased 4.92-fold (95% confidence interval [95%CI] 3.05-7.93) when children had dental caries, and 3.78-fold (95%CI 1.63-8.76) when there were consequences from dental caries. The perception of poor oral health was also associated to open bite (Odds Ratio [OR] 1.98; 95%CI 1.16-3.38) and TDI (OR 1.68; 95%CI 1.06-2.68). No associations were found between the perception of caregivers and socio-demographic variables or overjet. Conclusions: The perception of caregivers of poor oral health in their children was associated to dental caries, its consequences, TDI, and open bite.
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Affiliation(s)
| | | | - Michele Bolan
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Mariane Cardoso
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Mishu MP, Watt RG, Heilmann A, Tsakos G. Cross cultural adaptation and psychometric properties of the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). Health Qual Life Outcomes 2021; 19:46. [PMID: 33546712 PMCID: PMC7866745 DOI: 10.1186/s12955-021-01681-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The oral health related quality of life (OHRQoL) of children in Bangladesh has not yet been measured, as there is no validated OHRQoL measure for that population. The aim of this study was to cross-culturally adapt the child self-report and parental proxy report versions of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) into Bengali and test their psychometric properties: face validity, construct validity (convergent and discriminant validity) and reliability (internal consistency and test-retest reliability), among 5-9-year-old children and their parents in Bangladesh and assess associations between dental caries/sepsis and OHRQoL in this population. METHODS The forward-backward translated Bengali SOHO-5 was piloted among 272 children and their parents to test its face validity. The questionnaire was administered to 788 children and their parents to evaluate its psychometric properties. Internal consistency of Bengali SOHO-5 was assessed using Cronbach's alpha, and test-retest reliability was assessed using Kappa. Convergent and discriminant validity were assessed through nonparametric tests. The calculation of effect sizes and standard error of measurement facilitated the assessment of minimally important difference (MID) for SOHO-5. The associations of reporting an oral impact with caries and sepsis were assessed via logistic regression models. RESULTS Both child self-report and parental proxy report questionnaires showed good face validity. Cronbach's alpha scores were 0.79 and 0.87 for child and parental questionnaire, respectively. A weighted Kappa score of 0.85 demonstrated test-retest reliability of child questionnaire. SOHO-5 scores were significantly associated with subjective oral health outcomes and discriminated clearly between different caries severity and sepsis groups. These differences were considerably higher than the MID. After adjusting for child's age, sex, setting, maternal education and family income, the odds of reporting an oral impact were 2.25 (95% CI 1.98-2.56) and 4.44 (95% CI 3.14-6.28) times higher for each additional tooth with caries and sepsis, respectively. CONCLUSION This study provided strong evidence supporting the validity and reliability of both versions of Bengali SOHO-5 as OHRQoL measures. Dental caries and sepsis were associated with poor OHRQoL in this population. The Bengali SOHO-5 is expected to be a useful outcome measure for research and clinical purposes in Bengali speaking child populations.
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Affiliation(s)
- Masuma Pervin Mishu
- Department of Health Science, Faculty of Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Richard G Watt
- Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Anja Heilmann
- Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Georgios Tsakos
- Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 6BT, UK.
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Nepaul P, Mahomed O. Influence of Parents' Oral Health Knowledge and Attitudes on Oral Health Practices of Children (5-12 Years) in a Rural School in KwaZulu-Natal, South Africa. J Int Soc Prev Community Dent 2020; 10:605-612. [PMID: 33282770 PMCID: PMC7685284 DOI: 10.4103/jispcd.jispcd_273_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 11/04/2022] Open
Abstract
Context Oral health knowledge, beliefs, and attitudes of parents have a direct influence on their child's oral health maintenance, dietary habits, and oral health behaviors. Aim The aim of this study was to assess the knowledge, and attitude of parents with regard to the oral health practice of their children and its associated factors. Material and Methods A self-administered structured questionnaire was administered to parents or guardians of learners aged 5-12 years at a low socioeconomic rural primary school in the Ugu district, KwaZulu-Natal, South Africa. In addition to demographic variables, knowledge of dental health, use of toothbrush, use of toothpaste, dietary practices, and dental visits; practice with respect to dental care; and attitudes toward oral health were requested. Results One hundred and forty-four completed survey instruments were received with an 80% (118) representation of mothers. Ninety-five percent of the parents (136) had a positive attitude toward oral health with 86% (124) of the children brushed their tongue and 89% (128) of the children brushed their teeth happily. The mean knowledge score was 70%. Children were significantly more likely to brush their tongues (adjusted odds ratio [AOR]: 3.20 95% confidence interval [CI]: 1.06-9.66 P < 0.001), be happier when brushing their teeth (AOR: 4.65 95% CI: 1.41-15.38 P < 0.001) when the caregivers were their mothers, had an above-average knowledge score (AOR: 1.86 95% CI: 0.72-4.85) and positive attitudes (AOR: 3.20 95%CI: 0.46-22.00). Conclusion Parents in the rural community have satisfactory knowledge and a positive attitude toward oral health and children display good practices; however, there are a number of gaps noted in overall parental knowledge.
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Affiliation(s)
- Prenisha Nepaul
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Ozayr Mahomed
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Jackson DB, Testa A. Household food insecurity and children's oral health: Findings from the 2016-2018 National Survey of Children's Health. J Public Health Dent 2020; 81:150-161. [PMID: 33251647 DOI: 10.1111/jphd.12431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/28/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of the present study is to examine the association between household food insecurity and oral health problems among US children, and the role that socioeconomic, insurance, and oral health care utilization variables play in this association. METHODS A large, nationally representative sample of children from the 2016-2018 National Survey of Children's Health (NSCH) was employed in the present study (N = 99,962). Logistic regression and negative binomial regression were used to assess the influence of household food insecurity on diverse oral health problems and unmet oral health care needs. The Karlson-Holm-Breen (KHB) method was used to examine the attenuating roles of socioeconomic, insurance, and oral health care utilization variables. RESULTS Children in food-insecure households exhibited significantly greater odds of all examined oral health problems as well as unmet oral health care needs. These associations were a) most pronounced in the case of moderate-to-severe food insecurity and b) partly explained by a subset of socioeconomic and insurance-related variables. CONCLUSIONS Household food insecurity is a potent risk factor for oral health problems and unmet oral health care needs among US children. Programmatic efforts to address household food insecurity may yield collateral benefits for the oral health of children. Furthermore, because socioeconomic status and insurance-related variables explain part of the association, targeted interventions to improve these factors may improve oral health among at-risk children.
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Affiliation(s)
- Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexander Testa
- College for Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
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Ozsin Ozler C, Cocco P, Cakir B. Dental caries and quality of life among preschool children: a hospital-based nested case-control study. Br Dent J 2020:10.1038/s41415-020-2317-9. [PMID: 33244147 DOI: 10.1038/s41415-020-2317-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/31/2020] [Indexed: 11/08/2022]
Abstract
Introduction Oral health-related quality of life is a reflection of general health and wellbeing; related problems stand as major public health issues.Aim To investigate the potential association between dental caries and quality of life (QoL) among children aged 5-6 years old.Materials and methods Oral examination of 310 children admitted to a paediatric dentistry clinic was performed by using the International Caries Detection and Assessment System II (ICDAS-II) and the QoL was assessed using the Early Childhood Oral Health Impact Scale. A nested case-control study was conducted with all 104 QoL-unaffected children as the controls and a random sample of 104 QoL-affected children as the cases. Relative risk (RR) and its 95% confidence interval (CI) values were calculated to interpret potential associations.Results Gender distribution was similar by case controls (52.9% vs 51.0% were females, respectively). Early childhood caries (ECC) was detected in 78.8% of cases and 19.2% of controls. In binary analysis of the QoL (with a cutpoint of 2), low parental education, having a sibling, dental visit history for complaints and irregular/no toothbrushing were detected as significant predictors of poor QoL (p value <0.001). The RR of negative impact on QoL was fourfold (95% CI 2.64-5.69) among children having ECC, revealing a significant upward trend of impaired QoL with increasing ICDAS-II scores (t = 13.323; p value <0.001).Conclusion All patients should be evaluated thoroughly for social and psychological problems, besides functional and aesthetic in dental visits.
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Affiliation(s)
- Cansu Ozsin Ozler
- Hacettepe University, Faculty of Dentistry, Department of Paediatric Dentistry, Ankara, 06230, Turkey.
| | - Pierluigi Cocco
- University of Cagliari, Department of Medical Sciences and Public Health, Monserrato, 09042, Italy
| | - Banu Cakir
- Hacettepe University, Faculty of Medicine, Department of Public Health, Ankara, 06100, Turkey
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Nomura Y, Otsuka R, Wint WY, Okada A, Hasegawa R, Hanada N. Tooth-Level Analysis of Dental Caries in Primary Dentition in Myanmar Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207613. [PMID: 33086651 PMCID: PMC7589262 DOI: 10.3390/ijerph17207613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023]
Abstract
In developing countries, the prevalence of dental caries in children remains high, which means that implementing a simple and convenient classification is critical. The classification needs to be evidence-based and needs to reflect tooth-level information. In this study, the prevalence of dental caries in the primary dentition of 352 Myanmar school children at the ages of 5, 6, and 7 was analyzed at the tooth level to clarify the underlying data structure of the patterns of dental caries in the population. Ninety-three percent of subjects had caries in primary dentition and the mean number of decayed teeth in primary dentition was 7.54 ± 4.82. Based on the item response theory analysis, mixed-effect modeling, and Bayesian network analysis, we proposed the following classification: Group 1: No dental caries; Group 2: Dental caries in molar teeth or dental caries in maxillary anterior teeth; Group 3: Dental caries in both molar and maxillary anterior teeth; Group 4: Dental carries in mandibular anterior teeth. Dental caries (dmft) in the groups was different between groups. The results of characteristics of tooth-level information and classification presented in this study may be a useful instrument for the analysis of the data of dental caries prevalence in primary dentition.
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Affiliation(s)
- Yoshiaki Nomura
- Department of Translational Research, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan; (R.O.); (W.Y.W.); (R.H.); (N.H.)
- Correspondence:
| | - Ryoko Otsuka
- Department of Translational Research, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan; (R.O.); (W.Y.W.); (R.H.); (N.H.)
| | - Wit Yee Wint
- Department of Translational Research, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan; (R.O.); (W.Y.W.); (R.H.); (N.H.)
| | - Ayako Okada
- Department of Operative Dentistry, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan;
| | - Ryo Hasegawa
- Department of Translational Research, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan; (R.O.); (W.Y.W.); (R.H.); (N.H.)
| | - Nobuhiro Hanada
- Department of Translational Research, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan; (R.O.); (W.Y.W.); (R.H.); (N.H.)
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Vidigal EA, Abanto J, Haddad AE, Porta G, Alves FA, BÖnecker M. Oral health-related quality of life among pediatric liver transplant candidates. Braz Oral Res 2020; 34:e100. [PMID: 32876120 DOI: 10.1590/1807-3107bor-2020.vol34.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/16/2020] [Indexed: 11/22/2022] Open
Abstract
To assess the impact of oral conditions on the oral health-related quality of life (OHRQoL) of pediatric liver transplant candidates. This cross-sectional study included 60 children aged 13 to 48 months who were liver transplant candidates that attended the AC Camargo Cancer Center, São Paulo, Brazil. On the day of oral examinations, the children's mothers were invited to answer two questionnaires; one related to children's OHRQoL using the B-ECOHIS and another related to socioeconomic/demographic characteristics. Thereafter, a single, adequately trained dentist carried out children's oral examinations for gingival inflammation (Silness-Löe index), dental plaque (Green-Vermillion Simplified index), dental caries (dmft index), developmental defects of enamel (DDE index), tooth discoloration, oral mucosal/lip alterations. The data collected also included socioeconomic/demographic characteristics and liver disease. The adjusted Poisson regression model was used to associate children's socioeconomic/demographic characteristics and clinical conditions to the outcome. The adjusted regression model showed that children with untreated caries lesions (RR = 3.35, p < 0.0001) and tooth discoloration (RR = 1.74, p = 0.04) had poorer total B-ECOHIS scores. Dental discoloration and untreated caries lesions had a negative impact on the OHRQoL in pediatric liver transplant candidates.
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Affiliation(s)
- Evelyn Alvarez Vidigal
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jenny Abanto
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Estela Haddad
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gilda Porta
- Department of Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Fábio Abreu Alves
- Stomatology Department, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Marcelo BÖnecker
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade de São Paulo, São Paulo, SP, Brazil
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General dental practitioners' approach to caries prevention in high-caries-risk children. Eur Arch Paediatr Dent 2020; 22:187-193. [PMID: 32572857 DOI: 10.1007/s40368-020-00548-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
AIMS To evaluate the advice and preventive care provided by General Dental Practitioners (GDPs) to high-caries-risk children in Jordan. METHODS A cross-sectional study using an open-ended questionnaire. GDPs were presented with a high-caries-risk child scenario and asked regarding: (1) oral hygiene and dietary advice they would give; (2) preventive-care they would offer; (3) barriers they face in prevention delivery. Answers were compared to an evidence-based guideline. Data were input into SPSS-20 and analysed using descriptive statistics and frequencies. Chi-square test was used to compare results by age, gender, practice location and type. RESULTS One-hundred and sixty GDPs were approached and 128 agreed to participate (80%), of whom 87 (69%) were female. The average age was 31 years [range 22-50]. Sixty-nine percent practiced in the capital, Amman. Sixty-five percent gave advice on tooth-brushing frequency, but only 23% suggested brushing at bed-time and 24% recommended parental supervision. None provided advice on toothpaste fluoride content. Seventy-one percent advised reducing sugary-food amounts, but only 21% focused on frequency and 2% suggested using diet diaries. Most knew about fissure-sealants (77%) and fluoride-varnish (80%). Forty-two percent reported barriers to delivering preventive-care, including parental attitudes (36%), child cooperation (30%), financial reward (19%), and training (6%). Participants practicing outside of the capital were less likely to use fluoride-varnish [P = 0.002] and more likely to report barriers [P = 0.001]. CONCLUSIONS Advice delivered by GDPs to high-caries-risk children in Jordan does not meet the standards of an evidence-based guideline. Future initiatives for oral-health-promotion should aim to address the barriers reported, especially outside the capital.
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Duman C. YouTube™ quality as a source for parent education about the oral hygiene of children. Int J Dent Hyg 2020; 18:261-267. [DOI: 10.1111/idh.12445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Canan Duman
- Department of Pediatric Dentistry Faculty of Dentistry Atlas University Istanbul Turkey
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Blackburn J, Bennett A, Fifolt M, Rucks A, Taylor H, Wolff P, Sen B. Pediatric dental care use and parent- or caregiver-rated oral health among Alabama children enrolled in Medicaid. J Am Dent Assoc 2020; 151:416-426. [PMID: 32450980 PMCID: PMC9743449 DOI: 10.1016/j.adaj.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported prevalence and identified factors associated with children's dental care use, including the association with children's oral health. METHODS A cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means. RESULTS The 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33). CONCLUSIONS It was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship. PRACTICAL IMPLICATIONS Oral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children's oral health.
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Affiliation(s)
| | - Aleena Bennett
- University of Alabama at Birmingham School of Public Health
| | - Matt Fifolt
- University of Alabama at Birmingham School of Public Health
| | - Andrew Rucks
- University of Alabama at Birmingham School of Public Health
| | - Heather Taylor
- Indiana University Richard M. Fairbanks School of Public Health
| | - Paul Wolff
- University of Alabama at Birmingham School of Public Health
| | - Bisakha Sen
- University of Alabama at Birmingham School of Public Health
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Arrow P, Forrest H. Atraumatic restorative treatments improve child oral health-related quality of life: A noninferiority randomized controlled trial. Community Dent Oral Epidemiol 2020; 48:349-356. [PMID: 32424833 DOI: 10.1111/cdoe.12539] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/20/2020] [Accepted: 04/12/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Management of dental caries under dental general anaesthesia (DGA) in young children improves their quality of life. A randomized controlled trial was undertaken to test the changes in oral health-related quality of life among children treated under a DGA or managed using the Atraumatic Restorative Treatment and Hall crown approaches (ARTs). METHODS Children scheduled for a DGA for the management of dental caries after assessment at the Oral Health Centre of Western Australia were invited to participate. Inclusion and exclusion criteria were applied. Child oral health-related quality of life (COHRQoL) was evaluated through the Early Childhood Oral Health Impact Scale (ECOHIS) and the child-specific Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) at baseline and 12 months after consent. The changes in child oral health-related quality of life were analysed on an intention-to-treat basis. Paired t-test and Wilcoxon's matched-pairs rank test were used for within-group comparison and t-test, Mann-Whitney test, and test of proportions for between-group comparisons. Linear regression was used for multivariable analyses of the follow-up scores. RESULTS Sixty-five parents/carers agreed to participate and were randomized (Test = 32; Control = 33). Mean age = 4.7 years, SD 1.1; 51% male. At baseline, there were no statistically significant differences in age and sex between the groups; however, the ARTs group reported higher ECOHIS scores. At follow-up, both the ARTs and DGA groups had lower ECOHIS scores (20.7 vs 12.9 and 14.4 vs 13.3, respectively) and CARIES-QC scores (12.6 vs 7.1 and 9.9 vs 8.4, respectively). The within-group differences in the ARTs group were statistically significant while the differences in the DGA group were not, P < .01 and P > .05, respectively. In a linear regression of the follow-up scores, being in the DGA group increased the follow-up scores, but it was no longer statistically significant while baseline impact scores were significantly associated with greater follow-up scores for both the ECOHIS and the CARIES-QC, P < .01. CONCLUSION The child oral health-related quality life among children scheduled for dental general anaesthesia improved after receiving minimally invasive, atraumatic restorative treatments of dental caries.
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Affiliation(s)
- Peter Arrow
- Dental Health Services, Perth, WA, Australia
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Pereira JT, Knorst JK, Luz PB, Bonfadini I, Scapinello M, Hugo FN, Araujo FBD. Impact of Early Childhood Caries and Maternal Behaviors on Oral Health-Related Quality of Life of Children. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Pesaressi E, Villena RS, Frencken JE. Dental caries and oral health-related quality of life of 3-year-olds living in Lima, Peru. Int J Paediatr Dent 2020; 30:57-65. [PMID: 31594032 DOI: 10.1111/ipd.12582] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/19/2019] [Accepted: 10/04/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Untreated dental caries negatively impacts children and their families; the implication of which is best measured through assessing quality of life. Information related to Oral Health-Related Quality of Life (OHRQoL) in Peruvian pre-school children is scarce. AIM To investigate the relationship between dental caries and the OHRQoL of 3-year-old children. DESIGN Randomly selected government pre-schools (n = 17), situated in three low socio-economic status districts in Lima, participated. The OHRQoL data were obtained using the Peruvian (P) ECOHIS questionnaire. Clinical examinations using the Caries Assessment Spectrum and Treatment (CAST) instrument were performed on 308 children. From which, 213 parents returned the P-ECOHIS form. ANOVA, Tamhane, and Tukey methods were used to analyse the data. RESULTS The mean age of the children was 3.04 years. The two highest mean P-ECOHIS scores in the child section were 'child symptoms' and 'child psychology' while 'parent distress' scored highest in the parent section. The prevalence of dental caries was 64.3% (CAST scores 4-7). Including CASTcode 3 (enamel carious lesion), the dental caries prevalence was 93.4%. The mean P-ECOHIS scores for 'child symptoms', 'child functions', 'child impact', 'parent distress', and 'the sample' were statistically significantly higher for children with MaxCASTcodes 5 and 6 (dentine and pulpally involved cavities, respectively) than for those with MaxCASTcode 3. CONCLUSION The presence of cavitated teeth with and without pulpal involvement impacts negatively on the OHRQoL of 3-year-old children.
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Affiliation(s)
- Eraldo Pesaressi
- Department of Paediatric Dentistry, Dental School, San Martin de Porres University, Lima, Peru
| | - Rita S Villena
- Department of Paediatric Dentistry, Dental School, San Martin de Porres University, Lima, Peru
| | - Jo E Frencken
- Department of Oral Function and Prosthetic Dentistry, College of Oral Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Family Impacts of Severe Dental Caries among Children in the United Kingdom. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010109. [PMID: 31877854 PMCID: PMC6981411 DOI: 10.3390/ijerph17010109] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the family impacts of severe dental caries among children. Data from 3859 school-age children (5-, 8-, 12- and 15-year-olds) who participated in the 2013 Children's Dental Health Survey, a national cross-sectional survey in England, Wales and Northern Ireland, were used. Severe dental caries was defined as having at least one tooth with pulpal involvement, ulceration, fistula, or abscess (PUFA). Family impacts were measured using seven items of the Family Impact Scale (FIS). The association between severe dental caries and family impacts was assessed in logistic regression models, adjusting for child's age, gender, and country of residence; parent's marital status, education, and job classification; and area deprivation. Severe dental caries among children showed a significant negative impact on family life (Odds Ratio: 6.00; 95% Confidence Interval: 3.34-10.78). Parents of children with severe dental caries had greater odds of taking time off work (OR: 2.75; 95% CI: 1.16-6.54), reporting the child needed more attention (OR: 4.08; 95% CI: 2.15-7.75), feeling guilty (OR: 6.32; 95% CI: 3.26-12.26), feeling stressed (OR: 7.34; 95% CI: 4.15-12.99), having normal activities disrupted (OR: 5.78; 95% CI: 2.71-12.34), and having sleep disrupted (OR: 4.94; 95% CI: 2.78-8.76). Having severe dental caries was not associated with financial difficulties in the family (OR: 1.64; 95% CI: 0.49-5.51). The observed association between severe dental caries and family impacts was independent of child and family sociodemographic characteristics. The findings underscore the importance of preventive interventions to avoid severe dental caries in children and subsequently reduce negative impacts on their family life.
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Lebrun-Harris LA, Canto MT, Vodicka P. Preventive oral health care use and oral health status among US children: 2016 National Survey of Children's Health. J Am Dent Assoc 2019; 150:246-258. [PMID: 30922456 DOI: 10.1016/j.adaj.2018.11.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/22/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Research has identified significant gaps in preventive oral health care among certain subpopulations of US children. The authors of this study sought to estimate children's preventive oral health care use and oral health and investigate associations with child, family, and health care characteristics. METHODS Data for this observational, cross-sectional study came from the 2016 National Survey of Children's Health. Children aged 2 through 17 years were included (n = 46,100). Caregiver-reported measures were preventive dental visits, prophylaxis, toothbrushing or oral health care instructions, fluoride, sealants, fair or poor condition of the teeth, and problems with carious teeth or caries. Univariate, bivariate, and multivariable logistic regression analyses were conducted. RESULTS As reported by parents or caregivers, 8 in 10 children had a preventive dental visit in the past year but lower rates of specific services: 75% prophylaxis, 46% fluoride, 44% instructions, and 21% sealants. In addition, 12% had carious teeth or caries and 6% had fair or poor condition of the teeth. In adjusted analyses, young children (aged 2-5 years), children with no health insurance, and those from lower-income and lower-educated households had decreased likelihood of a preventive dental visit as well as specific preventive services. Children with preventive health care visits and a personal physician or nurse had increased likelihood of receiving preventive oral health care. CONCLUSIONS Preventive oral health services are lagging among young children and children from lower socioeconomic backgrounds. Further studies are needed to identify interventions that encourage use of specific preventive services. PRACTICAL IMPLICATIONS Dentists should work with caregivers and primary care providers to promote preventive oral health care, especially among young children and those from lower socioeconomic backgrounds.
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Do expectant mothers know how early childhood caries can be prevented? A cross-sectional study. Eur Arch Paediatr Dent 2019; 20:595-601. [PMID: 31004321 DOI: 10.1007/s40368-019-00442-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 04/15/2019] [Indexed: 10/27/2022]
Abstract
AIM To evaluate the awareness, knowledge, and beliefs about early childhood caries (ECC) among a sample of expectant mothers and to determine their preferences to help design appropriate interventions. METHODS Expectant mothers attending for antenatal care at a large public hospital were interviewed and asked to complete a questionnaire about ECC. The questionnaire was pre-tested and validated and contained questions about risk factors, presentations, management, and complications of ECC. Participants were also asked about their preferred method for oral health education about ECC. Data were analysed using SPSS for Windows release and descriptive statistics were generated. RESULTS Four-hundred expectant mothers were approached and 380 (95%) agreed to participate. 59% reported brushing twice or more daily, but only 10% attended the dentist regularly. Only 16% thought that tooth brushing should start as soon as primary teeth erupt. Most (68%) thought that bottle feeding does not need to stop before the age of two. The majority believed that sugar is better consumed between meals (81%) and in portions throughout the day (85%). Only 12% thought that a child should have their first dental visit by the age of one. Educational level influenced knowledge on several aspects of ECC prevention. The participants suggested leaflets (38%) and social media (24%) as methods for oral-health-education delivery. CONCLUSION Expectant mothers lack adequate knowledge about ECC prevention. There is a need for interventions that deliver advice on child toothbrushing, dietary practices, and dental attendance as part of wider general-health promotion.
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Fernandes IB, Souto-Souza D, Primo-Miranda EF, Marques LS, Ramos-Jorge ML, Ramos-Jorge J. Perceived impact of dental pain on the quality of life of children aged 1-3 years and their families. Eur Arch Paediatr Dent 2019; 20:557-563. [PMID: 30903614 DOI: 10.1007/s40368-019-00435-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the perceived impact of dental pain on oral health-related quality of life (OHRQoL) among children aged 1-3 years and their families. METHODS A cross-sectional study was conducted with 306 randomly selected preschool and day care children in the city of Diamantina, Brazil. Parents/caregivers answered a questionnaire on socio-demographic information, the Brazilian version of the Early Childhood Oral Health Impact Scale, their child's general/oral health and the Brazilian version of the Dental Discomfort Questionnaire. The children underwent an oral examination. Descriptive statistics, Spearman's correlations, the Kruskal-Wallis test, Mann-Whitney test and Poisson regression were used to determine associations between the variables (prevalence ratio [PR], α = 5%). RESULTS The prevalence of dental caries and dental pain was 43.1% and 40.2%, respectively. Dental pain (PR: 1.96, 95% CI 1.52-2.54; p < 0.001), monthly household income (PR: 1.38, 95% CI 1.04-1.83; p = 0.026) and dental caries (PR: 1.06, 95% CI 1.03-1.10; p < 0.001) were significantly associated with the perceived impact on OHRQoL. CONCLUSIONS Dental pain, household income and dental caries were associated with a negative impact on the OHRQoL of children aged 1-3 years and their families.
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Affiliation(s)
- I B Fernandes
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
| | - D Souto-Souza
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - E F Primo-Miranda
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - L S Marques
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - M L Ramos-Jorge
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - J Ramos-Jorge
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
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ElSalhy M, Ali U, Lai H, Flores-Mir C, Amin M. Caries reporting in studies that used the International Caries Detection and Assessment System: A scoping review. Community Dent Oral Epidemiol 2018; 47:92-102. [PMID: 30334280 DOI: 10.1111/cdoe.12430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/06/2018] [Accepted: 09/30/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To explore how caries was reported in studies that employed the International Caries Detection and Assessment System (ICDAS). METHODS A systematic database search up to August 2017 was carried out using PubMed, Ovid MEDLINE, Cochrane library and ISI Web of Science electronic databases. Only studies that used the ICDAS for dental caries examinations were included. Studies were excluded if the examination was done only for the validation or the calibration of the ICDAS and/or if the examination was not done for the whole dentition. Measures used to report caries were considered. RESULTS A total of 126 papers met the inclusion criteria. Forty-four different synthesis measures were used to report caries. Most of the studies used a combination of multiple measures to report patient's caries level. These reporting measures cluster into four main groups: the number of individual ICDAS scores (ie, total counts of every score); the number of decayed surfaces/teeth (ie, total counts of combined caries scores for surfaces or teeth); measures of caries experience (ie, total counts of combined caries scores, filled and/or missing surfaces or teeth); and measures of central tendency and dispersion. The number of decayed surfaces and individual ICDAS scores were the most commonly used measures. Three studies used mean ICDAS score (ie, total ICDAS scores divided by the number of teeth), two used mean ICDAS score of carious teeth (ie, total ICDAS scores divided by the number of carious teeth) and two used the maximum ICDAS score (ie, highest ICDAS score recorded). The total ICDAS score was used only once. Many studies synthesized from the ICDAS the number of decayed, missing and filled teeth/surfaces (dmft/DMFT, dmfs/DMFS) as a measure of caries experience. CONCLUSIONS There are variations among studies in the utilization of the system to summarize caries. Most studies presented caries data using the categorical characteristics of the ICDAS.
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Affiliation(s)
- Mohamed ElSalhy
- College of Dental Medicine, University of New England, Portland, ME, USA
| | - Ussama Ali
- Georgian College of Applied Arts and Technology, Barrie, Ontario, Canada
| | - Hollis Lai
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Amin
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Gomes MC, Perazzo MF, Neves ET, Siqueira MBLD, de Brito Costa EMM, Protasio APL, Silva AFLP, Botelho KVG, Granville-Garcia AF. Evaluation of determinant factors for the presence and activity of dental caries in five-year-old children: study with decision tree. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-017-0892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ruff RR, Niederman R. Silver diamine fluoride versus therapeutic sealants for the arrest and prevention of dental caries in low-income minority children: study protocol for a cluster randomized controlled trial. Trials 2018; 19:523. [PMID: 30257696 PMCID: PMC6158895 DOI: 10.1186/s13063-018-2891-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/30/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Dental caries is the most prominent childhood disease in the world. In the United States, more than 50% of children have experienced caries. Untreated caries can have negative impacts on quality of life, academic performance, and school attendance. To reduce oral health disparities, multiple organizations recommend school-based caries prevention. METHODS/DESIGN A longitudinal, cluster randomized, non-inferiority trial will be conducted in low-income children from primarily Hispanic/Latino backgrounds currently enrolled in public elementary schools in New York City, New York, United States, from 2018 to 2023. The primary objective is to compare the non-inferiority of silver diamine fluoride and fluoride varnish versus glass ionomer therapeutic sealants and fluoride varnish in the arrest and prevention of dental caries. Secondary objectives are to evaluate differences in effectiveness when care is provided by nurses versus dental hygienists and assess the impact of prevention on oral health-related quality of life and educational outcomes. Caries arrest will be evaluated after 2 years, and caries prevention and secondary outcomes will be assessed at the completion of the study. Data analysis will follow intent-to-treat, and statistical analyses will be conducted using a two-sided significance level of 0.05. DISCUSSION The comparative effectiveness of alternative caries prevention delivery models is considered to be one of the highest research priorities in the United States. Many treatments are currently available to prevent and arrest dental caries. The simplicity and affordability of silver diamine fluoride may be a viable alternative for the prevention of dental caries in high-risk children. TRIAL REGISTRATION U.S. National Library of Medicine, www.clinicaltrials.gov , ID: NCT03442309 . Registered on 22 February 2018.
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Affiliation(s)
- Ryan Richard Ruff
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, 433 First Avenue, Room 712, New York, NY, 10010, USA. .,New York University College of Global Public Health, New York, NY, USA.
| | - Richard Niederman
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, 433 First Avenue, Room 712, New York, NY, 10010, USA
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Corrêa-Faria P, Daher A, Freire MDCM, de Abreu MHNG, Bönecker M, Costa LR. Impact of untreated dental caries severity on the quality of life of preschool children and their families: a cross-sectional study. Qual Life Res 2018; 27:3191-3198. [PMID: 30097914 DOI: 10.1007/s11136-018-1966-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Untreated dental caries is a persistent oral problem among preschool children. Although there is vast evidence regarding the impact of dental caries on oral health-related quality of life (OHRQoL) in this age group, evidence on the impact of untreated caries severity is scarce. The purpose of this study was to investigate the impact of untreated caries severity on the OHRQoL of preschool children and their families. METHODS A cross-sectional study was conducted with 563 individuals in the city of Goiania, Brazil. Data were collected through interviews with parents/caregivers and clinical examinations of their children. The OHRQoL was measured by the Brazilian version of the Early Childhood Oral Health Impact Scale. Untreated dental caries severity was assessed using validated indices. Other independent variables were socioeconomic, toothache prevalence, and the questionnaire respondent. Statistical analysis involved bivariate comparisons and Poisson regression analyses. RESULTS A higher prevalence of impact on OHRQoL was found among preschool children with untreated dental caries with clinical consequences (PR 1.31; 95% CI 1.01-1.70) compared to those without caries; those aged 5 years (PR 1.47; 95% CI 1.18-1.82), compared to those aged two; and those with a toothache (PR 1.54; 95% CI 1.34-1.76), compared to those without toothache. Moreover, fathers (PR 0.71; 95% CI 0.55-0.92) and other respondents (PR 0.70; 95% CI 0.52-0.96) perceived less impact on the OHRQoL in comparison to mothers. CONCLUSIONS Severe untreated dental caries with clinical consequences had a negative impact on the children's OHRQoL, regardless of toothache and socioeconomic factors.
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Affiliation(s)
- Patrícia Corrêa-Faria
- Dentistry Graduate Program, Faculdade de Odontologia, Universidade Federal de Goiás, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, Goiânia, GO, 74605-220, Brazil.
| | - Anelise Daher
- Dentistry Graduate Program, Faculdade de Odontologia, Universidade Federal de Goiás, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, Goiânia, GO, 74605-220, Brazil
| | - Maria do Carmo Matias Freire
- Dentistry Graduate Program, Faculdade de Odontologia, Universidade Federal de Goiás, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, Goiânia, GO, 74605-220, Brazil
- Department of Oral Health, Faculdade de Odontologia, Universidade Federal de Goiás, Goiânia, GO, 74605-220, Brazil
| | | | - Marcelo Bönecker
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Luciane Rezende Costa
- Dentistry Graduate Program, Faculdade de Odontologia, Universidade Federal de Goiás, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, Goiânia, GO, 74605-220, Brazil
- Department of Community and Preventive Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Gomes MC, Perazzo MF, Neves ÉT, Martins CC, Paiva SM, Granville-Garcia AF. Oral Problems and Self-Confidence in Preschool Children. Braz Dent J 2018; 28:523-530. [PMID: 29160407 DOI: 10.1590/0103-6440201601295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/10/2017] [Indexed: 12/29/2022] Open
Abstract
The aim of the present study was to evaluate the impact of clinical oral factors, socioeconomic factors and parental sense of coherence on affected self-confidence in preschool children due to oral problems. A cross-sectional study with probabilistic sampling was conducted at public and private preschools with 769 five-year-old children and their parents/caretakers. A questionnaire addressing socio-demographic characteristics as well as the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5) and the Sense of Coherence Scale (SOC-13) were administered. The dependent variable was self-confidence and was determined using the SOHO-5 tool. Dental caries (ICDAS II), malocclusion and traumatic dental injury (TDI) were recorded during the clinical exam. Clinical examinations were performed by examiners who had undergone training and calibration exercises (intra-examiner agreement: 0.82-1.00 and inter-examiner agreement: 0.80-1.00). Descriptive statistics and Poisson regression analysis were performed (a=5%). Among the children, 91.3% had dental caries, 57.7% had malocclusion, 52.8% had signs of traumatic dental injury and 26.9% had bruxism. The following variables exerted a greater negative impact on the self-confidence of the preschool children due to oral problems: attending public school (PR=2.26; 95% CI: 1.09-4.68), a history of toothache (PR=4.45; 95% CI: 2.00-9.91) and weak parental sense of coherence (PR=2.27; 95% CI: 1.03-5.01). Based on the present findings, clinical variables (dental pain), socio-demographic characteristics and parental sense of coherence can exert a negative impact on self-confidence in preschool children due to oral problems.
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Affiliation(s)
- Monalisa Cesarino Gomes
- Postgraduate Program in Dentistry, UEPB - Universidade Estadual da Paraíba, Campina Grande, PB, Brazil
| | - Matheus França Perazzo
- Postgraduate Program in Dentistry, UEPB - Universidade Estadual da Paraíba, Campina Grande, PB, Brazil
| | - Érick Tássio Neves
- Postgraduate Program in Dentistry, UEPB - Universidade Estadual da Paraíba, Campina Grande, PB, Brazil
| | - Carolina Castro Martins
- Department of Paediatric Dentistry and Orthodontics, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Saul Martins Paiva
- Department of Paediatric Dentistry and Orthodontics, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Sá-Pinto AC, Rego TM, Marques LS, Martins CC, Ramos-Jorge ML, Ramos-Jorge J. Association between malocclusion and dental caries in adolescents: a systematic review and meta-analysis. Eur Arch Paediatr Dent 2018; 19:73-82. [PMID: 29594971 DOI: 10.1007/s40368-018-0333-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 02/25/2018] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the scientific evidence regarding the association between malocclusion and dental caries in adolescents. METHODS Searches were conducted of six electronic databases, complemented by manual searching of the reference lists of the selected articles and grey literature. Two independent reviewers performed the selection of the articles, data extraction and the evaluation of the risks of bias through an assessment of methodological quality. Meta-analysis was performed considering the mean decayed, missing and filled teeth (DMFT) index for caries and the Dental Aesthetic Index (DAI) for malocclusion. Heterogeneity was tested using the I2 statistic and a random effect model was employed. Summary effect measures were calculated as differences in means. RESULTS The initial search retrieved 2644 studies, only 15 of which were selected for full-text analysis. Four cross-sectional studies were included in the qualitative systematic review. Only one of these studies found no association between malocclusion and dental caries. The meta-analysis of three studies demonstrated that a lower DAI value was significantly associated with a lower mean DMFT index, except for the comparison of DAI 26-30 vs. 31-35. CONCLUSIONS Based on the studies analysed, the scientific evidence indicates an association between malocclusion and dental caries.
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Affiliation(s)
- A C Sá-Pinto
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua da Glória, 187-Centro, Diamantina, MG, 39.100-000, Brazil.
| | - T M Rego
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua da Glória, 187-Centro, Diamantina, MG, 39.100-000, Brazil
| | - L S Marques
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua da Glória, 187-Centro, Diamantina, MG, 39.100-000, Brazil
| | - C C Martins
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - M L Ramos-Jorge
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua da Glória, 187-Centro, Diamantina, MG, 39.100-000, Brazil
| | - J Ramos-Jorge
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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BaniHani A, Deery C, Toumba J, Munyombwe T, Duggal M. The impact of dental caries and its treatment by conventional or biological approaches on the oral health-related quality of life of children and carers. Int J Paediatr Dent 2018; 28:266-276. [PMID: 29288546 DOI: 10.1111/ipd.12350] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effect of untreated dental caries and the approaches taken to its treatment have not been extensively elucidated in children. AIM To investigate the impact of untreated dental caries on children aged 4-9 years and whether its treatment with either a conventional or a biological approach influenced the oral health-related quality of life (OHRQoL) of the children and their carers. DESIGN Children (n = 110) and their carers attending two specialist centres for treatment of carious primary teeth completed the Early Childhood Oral Health Impact Scale and the Self-reported Scale of Oral Health Outcomes for 5-year-old Children at baseline prior to dental treatment and at 3-6 months following completion of dental care. Dental treatment was provided using either a conventional or a biological approach. RESULTS Dental caries showed a negative impact on the child and family's OHRQoL (P = 0.001). Children reported difficulty eating (55.5%), sleeping (40%), and avoiding smiling because of how the teeth looked (27.3%). More than half of the parents reported their child had toothache. Parents perceived difficulty eating (40.9%), being irritable (38.2%), and difficulty drinking (30.9%) as being impacts of caries on their child's OHRQoL. In addition, approximately half the parents reported feeling a sense of guilt because of their child's dental disease. Following dental treatment, participants reported significant improvement in their overall health status (P = 0.001). Children's age, gender, or the treatment approach were not statistically significantly associated with changes in OHRQoL of the child or carer. Children and parents who initially reported greater impacts of untreated dental caries demonstrated greater improvements in their overall oral health status (P < 0.0001). CONCLUSION Dental caries was associated with negative impacts on children and parents' quality of life. Treatment of caries improved the quality of life of children and families significantly, irrespective of whether the treatment was provided by a conventional or a biological approach.
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Affiliation(s)
| | - Chris Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Jack Toumba
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Monty Duggal
- School of Dentistry, University of Leeds, Leeds, UK.,Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
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Faker K, Tostes MA, Paula VACD. Impact of untreated dental caries on oral health-related quality of life of children with special health care needs. Braz Oral Res 2018; 32:e117. [DOI: 10.1590/1807-3107bor-2018.vol32.0117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/01/2018] [Indexed: 02/05/2023] Open
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Aguirre PEA, Coelho MM, Rios D, Machado MAAM, Cruvinel AFP, Cruvinel T. Evaluating the Dental Caries-Related Information on Brazilian Websites: Qualitative Study. J Med Internet Res 2017; 19:e415. [PMID: 29237585 PMCID: PMC5745348 DOI: 10.2196/jmir.7681] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/25/2017] [Accepted: 10/30/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dental caries is the most common chronic oral disease, affecting 2.4 billion people worldwide who on average have 2.11 decayed, missing, or filled teeth. It impacts the quality of life of patients, socially and economically. However, the comprehension of dental caries may be difficult for most people, as it involves a multifactorial etiology with the interplay between the tooth surface, the dental biofilm, dietary fermentable carbohydrates, and genetic and behavioral factors. Therefore, the production of effective materials addressed to the education and counseling of patients for the prevention of dental caries requires a high level of specialization. In this regard, the dental caries-related contents produced by laypersons and their availability on the Internet may be low-quality information. OBJECTIVE The aim of this study was to assess the readability and the quality of dental caries-related information on Brazilian websites. METHODS A total of 75 websites were selected through Google, Bing, Yahoo!, and Baidu. The websites were organized in rankings according to their order of appearance in each one of the 4 search engines. Furthermore, 2 independent examiners evaluated the quality of websites using the DISCERN questionnaire and the Journal of American Medical Association (JAMA) benchmark criteria. The readability of the websites was assessed by the Flesch Reading Ease adapted to Brazilian Portuguese (FRE-BP). In addition, the information presented on the websites was categorized as etiology, prevention, and treatment of dental caries. The statistical analysis was performed using Spearman rank correlation coefficient, Mann-Whitney U test, hierarchical clustering analysis by Ward minimum variance method, Kruskal-Wallis test, and post hoc Dunn test. P<.05 was considered significant. RESULTS The Web contents were considered to be of poor quality by DISCERN (mean 33.48, standard deviation, SD 9.06) and JAMA (mean 1.12, SD 0.97) scores, presenting easy reading levels (FRE-BP: mean 62.93, SD 10.15). The rankings of the websites presented by Google (ρ=-.22, P=.08), Baidu (ρ=-.19, P=.53), Yahoo! (ρ=.22, P=.39), and Bing (ρ=-.36, P=.23) were not correlated with DISCERN scores. Moreover, the quality of websites with health- and nonhealth-related authors was similar (P=.27 for DISCERN and P=.47 for JAMA); however, the pages with a greater variety of dental caries information showed significantly higher quality scores than those with limited contents (P=.009). CONCLUSIONS On the basis of this sample, dental caries-related contents available on Brazilian websites were considered simple, accessible, and of poor quality, independent of their authorship. These findings indicate the need for the development of specific policies focused on the stimulus for the production and publication of Web health information, encouraging dentists to guide their patients in searching for recommended oral health websites.
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Affiliation(s)
- Patricia Estefania Ayala Aguirre
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Melina Martins Coelho
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Daniela Rios
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Thiago Cruvinel
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Souza JGS, Souza SE, Noronha MDS, Ferreira EFE, Martins AMEDBL. Impact of untreated dental caries on the daily activities of children. J Public Health Dent 2017; 78:197-202. [PMID: 29193108 DOI: 10.1111/jphd.12259] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 10/12/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Untreated dental caries can compromise oral health-related quality of life (OHRQoL). However, it is not clear which specific daily activities related to OHRQoL are compromised by the presence of this problem. Therefore, the purpose of this study was to identify which specific daily activities are affected by the presence of untreated dental caries using a representative sample of Brazilian children. METHODS A cross-sectional study using a representative sample of Brazilian children (12 years of age) was conducted. The presence of untreated dental caries was assessed using the "decayed - D" component of the DMFT (decayed, missing, and filled teeth) index. Clinical exams were conducted by trained and calibrated dentists. The daily activities were evaluated using the survey Oral Impacts on Daily Performance (OIDP), considering items and domains. Descriptive, bivariate, and multiple analyses were conducted (α = 0.05). RESULTS A total of 7,247 children were included, and 39.9 percent had at least one tooth with untreated dental caries, with 33.5 percent experiencing an impact on at least one of the OIDP activities. This study identified a greater chance of the presence of untreated dental caries in children having an impact on the psychological domain (P = 0.006), as well as on the "difficulty eating" (P = 0.007), and "difficulty sleeping" (P = 0.023) items. CONCLUSION The presence of untreated dental caries among Brazilian children was associated with an impact on specific daily activities (difficulty eating and sleeping) and the psychological domain of OHRQoL.
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Gomes GB, Vieira-Andrade RG, de Sousa RV, Firmino RT, Paiva SM, Marques LS, Granville-Garcia AF. Association between occlusal alterations and dental caries in preschool children. J Public Health (Oxf) 2017. [DOI: 10.1007/s10389-017-0797-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lomazzi M, Wordley V, Bedi R. Dental public health capacity worldwide: Results of a global survey. J Public Health Policy 2017; 37:528-542. [PMID: 28202926 DOI: 10.1057/s41271-016-0029-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The World Federation of Public Health Associations' Oral Health Working Group (WFPHA OHWG) carried out a survey to establish the extent of global dental public health (DPH) capacity. Senior stakeholders in DPH completed 124 surveys, covering 73 countries and all WHO regions. The survey evaluated DPH workforce within the country, funding, education, current services, and integration between public health and DPH in countries across the world. In 62 per cent of countries, DPH is only partially integrated in the public health system, while in 25 per cent of countries it has not yet been formally integrated. DPH programs at Masters level are available in 44 per cent of countries. Over half of countries have 0 to 10 trained DPH professionals. Because both poor oral and general health share several common risk factors, DPH must be integrated into national health systems and budgets, with an emphasis on having trained DPH specialists available in every country to collaborate in healthcare policy and provision.
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Affiliation(s)
- Marta Lomazzi
- World Federation of Public Health Associations, Geneva, Switzerland
| | - Valerie Wordley
- King's College London, Centre for International Child Oral Health, 26-29 Drury Lane, Rooms 329-331, London, UK
| | - Raman Bedi
- King's College London, Centre for International Child Oral Health, 26-29 Drury Lane, Rooms 329-331, London, UK.
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Perazzo MF, Gomes MC, Neves ÉT, Martins CC, Paiva SM, Costa EMMDB, Granville-Garcia AF. Oral problems and quality of life of preschool children: self-reports of children and perception of parents/caregivers. Eur J Oral Sci 2017; 125:272-279. [PMID: 28653417 DOI: 10.1111/eos.12359] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to evaluate the association between oral health problems and oral health-related quality of life (OHRQoL) of preschool children according to both self-reports and the reports of parents/caregivers. A school-based, cross-sectional study was conducted with 769 preschool children and their parents/caregivers. The OHRQoL was evaluated using the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5). Based on logistic regression for complex samples, the following variables were found to be associated with poorer OHRQoL in the parent/caregiver version: toothache (OR = 6.77; 95% CI: 3.95-11.59); consequences of untreated dental caries (OR = 2.69; 95% CI: 1.27-5.70); and anterior open bite (OR = 2.01; 95% CI: 1.13-3.56). The following variables were associated with poorer OHRQoL in the child self-report version: toothache (OR = 3.34; 95% CI: 2.11-5.29); cavitated lesions (anterior teeth) (OR = 2.20; 95% CI: 1.26-3.84); occurrence of traumatic dental injury (OR = 1.77; 95% CI: 1.19-2.61); and anterior open bite (OR = 1.95; 95% CI: 1.16-3.29). We conclude that children with dental caries (or its sequelae) had poorer OHRQoL. Having experienced a traumatic dental injury and having a malocclusion were also associated with a poorer OHRQoL.
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Affiliation(s)
- Matheus F Perazzo
- Department of Pediatric Dentistry and Orthodontic, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Monalisa C Gomes
- Department of Dentistry, State University of Paraíba, Campina Grande, Brazil
| | - Érick T Neves
- Department of Dentistry, State University of Paraíba, Campina Grande, Brazil
| | - Carolina C Martins
- Department of Pediatric Dentistry and Orthodontic, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Saul M Paiva
- Department of Pediatric Dentistry and Orthodontic, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Edja M M de B Costa
- Department of Dentistry, State University of Paraíba, Campina Grande, Brazil
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Pereira MA, Santos-Júnior RBD, Tavares JA, Oliveira AH, Leal PC, Takeshita WM, Barbosa-Júnior AM, Bertassoni LEB, Faria-e-Silva AL. No additional benefit of using a calcium hydroxide liner during stepwise caries removal. J Am Dent Assoc 2017; 148:369-376. [DOI: 10.1016/j.adaj.2017.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 10/19/2022]
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