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Guarnizo-Herreño CC, Singh A, Mathur MR, Sarawagi S, Peres MA. Making the case for a new typology of dental care systems. Community Dent Oral Epidemiol 2024. [PMID: 38984774 DOI: 10.1111/cdoe.12992] [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: 02/14/2024] [Revised: 06/16/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND AND RATIONALE Dental care systems have the potential to influence population oral health and patterns of socioeconomic inequalities. Therefore, understanding the impact of the ways in which countries fund, provide, and organize their dental care services is key in the analysis of determinants of oral health. In this commentary we offer a synopsis of recent typologies of healthcare systems, based on a rapid review, and highlight that none of them fit dental care services given the separation of dental care from general healthcare provision in many countries. The paper also summarizes evidence on dental care systems as determinants of population oral health and argues why a new typology of dental care systems is needed. CHALLENGES AND WAYS FORWARD We argue that a typology must consider institutional arrangements, structures, and processes behind the provision of dental care, and that specific dimensions/variables that inform the typology should result from a process of discussion and consensus. Some methodological considerations for developing typologies are also discussed, including the challenges in the collection and analysis of data followed by an advanced cluster analysis. Despite their limitations, typologies have evolved into an essential tool for comparing the similarities and differences of healthcare systems across countries. Therefore, a dental specific typology for health systems will be useful for researchers, policymakers, and dental professionals to characterize the provision of dentalcare services in different countries. This will also enable examining their potential role as determinants of population oral health and inequalities.
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Affiliation(s)
- Carol C Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogota, Colombia
| | - Ankur Singh
- Melbourne School of Population and Global Health and Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - Manu Raj Mathur
- Queen Mary University of London, London, UK
- Public Health Foundation of India, New Delhi, India
| | - Shilpa Sarawagi
- National Dental Research Institute, National Dental Centre and Oral Health Academic Clinical Programme, Health Services and Systems Research Program, Duke-NUS Medical School, Singapore, Singapore
| | - Marco A Peres
- National Dental Research Institute, National Dental Centre and Oral Health Academic Clinical Programme, Health Services and Systems Research Program, Duke-NUS Medical School, Singapore, Singapore
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Bomfim RA. Machine learning to predict untreated dental caries in adolescents. BMC Oral Health 2024; 24:316. [PMID: 38461227 PMCID: PMC10924973 DOI: 10.1186/s12903-024-04073-4] [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: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE This study aimed to predict adolescents with untreated dental caries through a machine-learning approach using three different algorithms METHODS: Data came from an epidemiological survey in the five largest cities in Mato Grosso do Sul, Brazil. Data on sociodemographic characteristics, consumption of unhealthy foods and behaviours (use of dental floss and toothbrushing) were collected using Sisson's theoretical model, in 615 adolescents. For the machine learning, three different algorithms were used: (1) XGboost; (2) decision tree and (3) logistic regression. The epidemiological baseline was used to train and test predictions to detect individuals with untreated dental caries, through eight main predictor variables. Analyzes were performed using the R software (R Foundation for Statistical Computing, Vienna, Austria). The Ethics Committee approved the study.. RESULTS For the 615 adolescents, xgboost performed better with an area under the curve (AUC) of 84% versus 81% for the decision tree algorithm. The most important variables were the use of dental floss, unhealthy food consumption, self-declared race and exposure to fluoridated water. CONCLUSIONS Family health teams can improve the work process and use artificial intelligence mechanisms to predict adolescents with untreated dental caries, and, in this way, schedule dental appointments for the treatment of adolescents earlier.
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Affiliation(s)
- Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.
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Bomfim RA, Constante HM, Cascaes AM. Explaining income inequities in tooth loss among Brazilian adults. J Public Health Dent 2023; 83:101-107. [PMID: 36700483 DOI: 10.1111/jphd.12556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/30/2022] [Accepted: 12/02/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the extent to which individual and contextual variables explain income inequities in tooth loss in Brazilian adults. METHODS A nationally representative sample of 65,784 Brazilian adults aged 18-59 who participated in the Brazilian National Health Survey 2019 was analyzed. Self-reported tooth loss was the outcome. Per capita income was the main exposure, and minimum wage was the cutoff point. Individual covariates included sex, race, and schooling, dental visits, smoking status, use of dental floss, and self-reported chronic conditions. Contextual covariates included access to treated water and geographic region of residence. Blinder-Oaxaca decomposition analysis was used to estimate the share of each factor in income-related tooth loss inequities by age groups. RESULTS Age-standardized tooth loss showed large income inequities. The average difference in tooth loss related to income inequities in the 18-34-year-old group was 0.50 (95% CI 0.39; 0.60), increasing to 4.51 (95% CI 4.09; 4.93) in the 45-59 years. Individual and contextual covariates explained almost 90% of income inequities in the 45-59 year group. Use of dental floss, schooling, and geographic region of residence (a proxy for human development level) had a higher proportion of contribution to the inequities examined. CONCLUSIONS Individual and contextual covariates (proxy for human development level and water fluoridation coverage) explained a large share of income-related tooth loss inequities. Tailored strategies to act at both levels can help reduce tooth loss inequities among Brazilian adults.
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Affiliation(s)
- Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Helena Mendes Constante
- Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Andreia Morales Cascaes
- Department of Public Health, Graduate Program in Dentistry and Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Roosevelt-Silva B, Gustavo-Chab P, Fernando-Pedrin-Carvalho F, José-Roberto-Magalhães B, Guilherme J, Raquel-Conceição F. Contextual and Individual Determinants of Anterior Open Bite in Adolescents. Int Dent J 2022; 73:128-135. [PMID: 35931560 PMCID: PMC9875233 DOI: 10.1016/j.identj.2022.07.001] [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: 01/24/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Studying the broader determinants of anterior open bite (AOB) may guide more equitable policies.This study estimates the prevalence of AOB in Brazilian adolescents and its association with contextual and individual determinants. METHODOLOGY The data for dentofacial anomalies in 15- to 19-year-olds from the National Oral Health Survey SBBrasil 2010 were analysed (N = 4748). AOB was based on the Dental Aesthetic Index (AOB = 0; AOB > 0); the contextual variables were the Human Development Index (HDI) and the Gini Index (2010). The individual sociodemographic variables included sex (male, female), self-reported skin colour/race (white, black, brown, and indigenous + yellow), family income (≥4 minimum wage [MW]; 0-3 MW), and educational attainment (ideal, delayed). The individual clinical variables were decayed, missing, and filled teeth (DMFT) (0, ≥1), first permanent molar loss (0, ≤3, 4), and molar relationship (normal, half cusp, full cusp). Multilevel logistic regression models with random intercepts and fixed slopes were used to estimate odds ratios (ORs) and confidence intervals (95% CIs). RESULTS AOB prevalence in Brazil was 8.78% (95% CI, 6.85-11.20) at 15 to 19 years of age. The lowest prevalence was in São Luis (2.63%; 95% CI, 0.58-11.03) and the highest was in João Pessoa (29.85%; 95% CI, 15.93-48.85), both capitals of the northeast Brazilian region. A higher prevalence of AOB (OR, 1.71; 95% CI, 1.04-2.80) was observed in municipalities with a lower HDI. Adolescents who declared their skin colour black, with lower family income, with delayed education, with DMFT ≥ 1, who lost 4 permanent first molars, and who had a complete molar cusp relationship were more likely to have AOB. CONCLUSIONS AOB varied amongst Brazilian municipalities. The HDI plays an important role in the prevalence of AOB; individual social determinants have also been associated with AOB malocclusion in adolescents.
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Affiliation(s)
- Bastos Roosevelt-Silva
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil,Corresponding author. Alameda Doutor Octávio Pinheiro Brisolla, 9-75, Bauru, SP, Brasil, 17012-901.
| | - Pistelli Gustavo-Chab
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil
| | | | | | - Janson Guilherme
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, São Paulo, Brasil
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Souza GCDA, Kusma SZ, Moysés SJ, Roncalli AG. [Implementation of the Brazilian National Oral Health Policy and its influence on oral health conditions in Brazilian state capitals in the first decade of the 21st century]. CAD SAUDE PUBLICA 2021; 37:e00320720. [PMID: 34909936 DOI: 10.1590/0102-311x00320720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/18/2021] [Indexed: 11/22/2022] Open
Abstract
The study aimed to analyze strategies for the implementation of the Brazilian National Oral Health Policy (PNSB) and its influence on oral health conditions in state capitals in the first decade of the 21st century. This is a policy assessment study. Data on oral health conditions were obtained from the databases of the Brazilian National Oral Health Surveys in 2003 and 2010 (SBBrasil 2003 and SBBrasil 2010), calculating the annual percent change in variables pertaining to oral health conditions as dependent variables for Brazilian state capitals. The PNSB was analyzed according to its conceptual foundations: oral healthcare model, organization of the supply of oral health services, implementation of oral health promotion strategies, and existence of fluoridation of the public water supply. Data were obtained from the national health databases and face-to-face interviews with oral health coordinators in 13 state capitals. The analyses were controlled and adjusted by the target population's socioeconomic conditions. An association was observed between the characteristics of oral health promotion, services supply, and model of care, indicating that the public services' dynamic is dependent on the management priorities and the policy's conduction. In conclusion, the PNSB is implemented differently in Brazil's state capitals according to the ways its guidelines are conducted in each capital and whether it favors best practices and strategies in oral healthcare. However, the influence of the PNSB is still not clear on the modification of oral health indicators from 2003 to 2010.
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Affiliation(s)
| | | | - Samuel Jorge Moysés
- Pontifícia Universidade Católica do Paraná, Curitiba, Brasil.,Universidade Federal do Paraná, Curitiba, Brasil
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Martinelli DLF, Cascaes AM, Frias AC, Souza LBD, Bomfim RA. Oral health coverage in the Family Health Strategy and use of dental services in adolescents in Mato Grosso do Sul, Brazil, 2019: cross-sectional study. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e20201140. [PMID: 34854464 DOI: 10.1590/s1679-49742021000400010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the association between the coverage by oral health teams in the Family Health Strategy (FHS-OH) and the use of dental services among 12-year-old adolescents in the state of Mato Grosso do Sul, Brazil, 2019. METHODS This is a cross-sectional study involving school-based research, which adopted the use of dental services as its outcome. Structural equation modeling was used to test the association between covariates and the outcome. RESULTS Of the 615 participants, 74.0% used dental services in the last three years. ESF-SB (oral health coverage by family health strategy, acronym in Portuguese) ≥50% was associated with a greater use of public dental services [standardized coefficient (SC) = 0.10 -95%CI 0.01;0.18], a lower use of these services for prevention (SC = -0.07 -95%CI -0.17;0.01) and higher unhealthy food consumption (SC = 0.19 -95%CI 0.11;0.26). CONCLUSION Higher ESF-SB coverage was associated with a lower use of dental services for prevention and higher unhealthy food consumption. Teams must organize the access to oral health service and qualify the work process.
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Affiliation(s)
| | - Andreia Morales Cascaes
- Universidade Federal de Santa Catarina, Departamento de Saúde Pública, Florianópolis, SC, Brasil
| | | | | | - Rafael Aiello Bomfim
- Universidade Federal de Mato Grosso do Sul, Faculdade de Odontologia, Campo Grande, MS, Brasil
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Bomfim RA, Watt RG, Tsakos G, Heilmann A, Frazão P. Does water fluoridation influence ethnic inequalities in caries in Brazilian children and adolescents? Community Dent Oral Epidemiol 2021; 50:321-332. [PMID: 34342029 DOI: 10.1111/cdoe.12676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to investigate the influence of community water fluoridation on ethnic inequalities in untreated dental caries among children and adolescents in Brazil while taking the human development context into account. METHODS Data from a nationwide Brazilian epidemiological population oral health survey were used (SB Brazil 2010). Outcomes were caries prevalence measured by the proportion of individuals with one or more untreated decayed teeth and caries severity defined by the mean number of untreated decayed teeth (DT). Three different contexts were considered: 1-cities with no water fluoridation; 2-cities with water fluoridation and low Human Development Index (HDI); and 3-cities with water fluoridation and high HDI. The exposure was ethnic/racial group (White, Pardo, Black) and covariates were age, sex and household income. Multilevel logistic and negative binomial regressions were performed with 6696 children (aged 5 years) and 11 585 adolescents (aged 12 and 15-19 years). RESULTS For both children and adolescents, ethnic differences in caries prevalence and mean DT were found in the nonfluoridated cities with low HDI and also in cities with high HDI, most of which were fluoridated. For example in nonfluoridated cities with low HDI, 5-year-old Pardo children were more likely to have untreated decay (OR = 1.22; 95% CI: 1.02, 1.46) and had more decayed teeth (RR = 1.18; 95% CI: 1.04, 1.34) than their White counterparts after adjusting for sex and household income. No statistically significant differences were observed in fluoridated cities with low HDI. CONCLUSION Water fluoridation appears to be associated with reduced ethnic inequalities in dental caries prevalence and mean DT among children and adolescents in more disadvantaged settings.
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Affiliation(s)
- Rafael Aiello Bomfim
- Department of Community Health, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Brazil.,Public Health School, University of São Paulo, São Paulo, Brazil
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Paulo Frazão
- Public Health School, University of São Paulo, São Paulo, Brazil
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Li A, Vermaire JH, Chen Y, van der Sluis LWM, Thomas RZ, Tjakkes GHE, Schuller AA. Trends in socioeconomic inequality of periodontal health status among Dutch adults: a repeated cross-sectional analysis over two decades. BMC Oral Health 2021; 21:346. [PMID: 34266415 PMCID: PMC8284001 DOI: 10.1186/s12903-021-01713-x] [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: 01/09/2021] [Accepted: 07/03/2021] [Indexed: 01/25/2023] Open
Abstract
Background Studies exclusively focusing on trends in socioeconomic inequality of oral health status in industrialized countries are relatively sparse. This study aimed to assess possible differences in oral hygiene and periodontal status among people of different socioeconomic status (SES) in the Netherlands over two decades.
Methods A repeated cross-sectional analysis of 3083 participants aged 25–54 years was conducted on the Dutch National Oral Health Surveys of 1995, 2002, 2007, and 2013. Plaque-free was defined according to the Simplified Oral Hygiene Index (OHI-S = 0). Periodontal status was classified in two different ways, either periodontal health/disease (probing pocket depth index [PDI] = 0/ ≥ 1) or with/without deep pockets (PDI = 2). We used the regression-based absolute and relative effect index to measure the absolute and relative socioeconomic inequalities. Multivariable logistic regressions were used to explore temporal trends in oral hygiene and periodontal status by low- and high-SES groups. Results Age-standardized percentages of individuals with plaque-free increased in the whole population from 1995 to 2013 (12.7% [95% CI 10.5–14.9] to 28.1% [24.8–31.5]). Plaque-free showed significant socioeconomic differences in absolute and relative inequalities in 2007 and 2013. Between 1995 and 2013, age-standardized percentage of periodontal health increased (from 51.4% [48.1–54.7] to 60.6% [57.0–64.1]). The significant absolute inequalities for periodontal health were seen in 2002 and 2013. The relative scale presented a similar pattern. Regarding deep pockets, there was little difference in the age-standardized overall prevalence in 1995 versus 2013 (from 6.5% [4.9–8.2] to 5.4% [3.7–7.0]). The significant absolute and relative inequalities in deep pockets prevalence were found in 1995. Yet, all interaction terms between survey year and SES did not reach significance (plaque-free: P = .198; periodontal health: P = .490; deep pockets: P = .678). Conclusions Socioeconomic inequalities in oral hygiene and periodontal status were present in the Netherlands in the last two decades.
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Affiliation(s)
- An Li
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
| | - Jan Hendrik Vermaire
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Child Health, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - Yuntao Chen
- Medical Statistics and Decision Making, Department of Epidemiology, UMCG, University of Groningen, Groningen, The Netherlands
| | - Luc W M van der Sluis
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Renske Z Thomas
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Geerten-Has E Tjakkes
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Annemarie A Schuller
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Child Health, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
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Galvão MHR, Medeiros ADA, Roncalli AG. Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis. PLoS One 2021; 16:e0254310. [PMID: 34242338 PMCID: PMC8270158 DOI: 10.1371/journal.pone.0254310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study verified the association between contextual and individual factors and public dental services utilisation in Brazil. METHODS The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey- 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was 'public dental service utilisation', and Andersen's behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level. RESULTS The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care. CONCLUSIONS Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.
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Affiliation(s)
- Maria Helena Rodrigues Galvão
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Arthur de Almeida Medeiros
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Angelo Giuseppe Roncalli
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Nociti FH. Systems Integration: A Key Step Toward Strengthening Oral Health. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.704624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Velasco SRM, Pistelli GC, Razera FPM, Menezes-Silva R, Bastos RS, Navarro MFDL. Dental caries spectrum profile in Brazilian public school children and adolescents. Braz Oral Res 2021; 35:e067. [PMID: 34133580 DOI: 10.1590/1807-3107bor-2021.vol35.0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022] Open
Abstract
Dental caries remains a major public health problem, with a higher prevalence among in adolescence. The present study aimed to assess the dental caries spectrum profile in children and adolescents in Brazilian public schools. A cross-sectional study was performed in two public schools in Brazil to examine the permanent teeth of children and adolescents. The dental caries were assessed by applying the Caries Assessment Spectrum and Treatment (CAST) instrument, and the results were distributed as per disease status (healthy/codes 0-2; pre-morbidity/code 3; morbidity/code 4-5; severe morbidity/codes 6-7; mortality/code 8) and by severity as per the CAST-F1 formula (no severity, mild, moderate, and severe). The CAST data were described by age groups (8-9 y, 10-11 y, 12-13 y, 14-15 y, 16-17 y, and 18-19 y). The Kruskal-Wallis test was used to investigate differences in CAST prevalence and severity among the groups (p < 0.05). Total 598 students were enrolled. Most of the subjects were male (53.34%) and belonged to the age group of 12-13 y (34.95%). The variables CAST 0/1 (p = 0.024), CAST (p = 0.024), and CAST-F1 (p = 0.029) showed significant differences among age groups, and the post hoc test showed the differences in these variables as per the age groups of 14-15 y and 16-17 y (CAST 0/1, p = 0.047; CAST, p = 0.047; CAST-F1, p = 0.033). The dental caries spectrum increased from 8 to 19 y with a peak in the prevalence and severity in the middle of adolescence.
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Affiliation(s)
- Sofia Rafaela Maito Velasco
- Universidade de São Paulo - USP, Faculty of Public Health, Department of Epidemiology, São Paulo, SP, Brazil
| | - Gustavo Chab Pistelli
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Pediatrics Dentistry, Orthodontics and Public Health, Bauru, SP, Brazil
| | - Fernanda Pátaro Marsola Razera
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Pediatrics Dentistry, Orthodontics and Public Health, Bauru, SP, Brazil
| | - Rafael Menezes-Silva
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Operative Dentistry, Bauru, SP, Brazil
| | - Roosevelt Silva Bastos
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Pediatrics Dentistry, Orthodontics and Public Health, Bauru, SP, Brazil
| | - Maria Fidela de Lima Navarro
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Operative Dentistry, Bauru, SP, Brazil
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Bomfim RA, Frias AC, Cascaes AM, Mazzilli LEN, Souza LBD, Carrer FCDA, Araújo MED. Sedentary behavior, unhealthy food consumption and dental caries in 12-year-old schoolchildren: a population-based study. Braz Oral Res 2021; 35:e041. [PMID: 33909863 DOI: 10.1590/1807-3107bor-2021.vol35.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 12/14/2020] [Indexed: 11/21/2022] Open
Abstract
This study analyzed the association between sedentary behavior (SB), unhealthy food consumption, and dental caries amongst 12-year-old schoolchildren. An epidemiological survey was carried out in the five largest cities (> 80,000 inhabitants) of the State of Mato Grosso do Sul, Brazil. Data were collected on decayed, missing and filled teeth index (DMFT), sociodemographic characteristics, SB, unhealthy food consumption, and water fluoridation status. The analysis was based on the theoretical framework established by J Sisson. Structural equation models were performed to test the association of dental caries experience with sociodemographic, contextual, and behavioral factors. The mean DMFT index in the five cities was 1.02 (95%CI: 0.39-1.66). Higher sedentary behavior (more than 2 hours/day) [standardized coefficient (SC) = 0.21 95%CI: 0.07-0.39] and higher unhealthy food consumption (more than 4 times/week) [SC = 0.23 (0.10-0.45)] were associated with higher DMFT index than their counterparts. Also, cities with fluoridated water were associated with lower DMFT index [SC = -0.85 (-1.20--0.50)]. Families who had a per capita income above the poverty line had a direct association with unhealthy food consumption [SC = -0.24 (-0.38--0.11)]. Unhealthy food consumption mediated the association of sedentary behavior on DMFT index [SC=0.07 (0.02-0.13)]. Sensitivity analysis confirmed the findings. Sedentary behavior mediated by unhealthy food consumption had a significant association with dental caries experience. Public policies must address transdisciplinary actions to reduce sedentary behavior and unhealthy food consumption and promote water fluoridation.
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Affiliation(s)
- Rafael Aiello Bomfim
- Universidade Federal do Mato Grosso do Sul - UFMS, School of Dentistry, Department of Community Health, Campo Grande, MS, Brazil
| | - Antonio Carlos Frias
- Universidade de São Paulo - USP, School of Dentistry, Department of Community Health, São Paulo, SP, Brazil
| | - Andreia Morales Cascaes
- Universidade Federal de Santa Catarina - UFSC, Department of Public Health, Florianópolis, SC, Brazil
| | | | - Luciana Bronzi de Souza
- Universidade Federal de Goiás - UFG, School of Nutrition, Department of Community Health, Goiânia, GO, Brazil
| | | | - Maria Ercília de Araújo
- Universidade de São Paulo - USP, School of Dentistry, Department of Community Health, São Paulo, SP, Brazil
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Galvão MHR, Roncalli AG. Does the implementation of a national oral health policy reduce inequalities in oral health services utilization? The Brazilian experience. BMC Public Health 2021; 21:541. [PMID: 33740941 PMCID: PMC7980604 DOI: 10.1186/s12889-021-10586-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to assess the trend in income-related inequalities in oral health services utilization by the Brazilian population from 1998 to 2013. This period represents a timeline that includes different stages of implementation of the National Oral Health Policy. Methods The design was based on repeated cross-sectional surveys using secondary data from household-based studies carried out in Brazil in 1998, 2003, 2008, and 2013. The dependent variable was “having access to a dentist appointment at least once in a lifetime (yes/no).” Monthly household per capita income, based on Brazil’s minimum wage, was included as the main independent variable. To measure the inequalities in oral health access related to economic position, the following complex indexes based on regression were used: (a) the slope index of inequality (SII) and (b) the relative index of inequality (RII). Results There was a reduction in the percentage of individuals who never had a dentist appointment for all age groups and income classifications. In general, there was a reduction trend in absolute inequality for all age groups (p < 0.001). The relative inequality and reduction trend were different between the age groups studied. Conclusions The National Oral Health Policy was very important for expanding free of charge, public access to dental appointment. However, despite policy implementation, there continues to be high levels of inequality in access to dental consultation. Assessing which strategies are necessary to overcome this challenge is discussed.
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Affiliation(s)
| | - Angelo Giuseppe Roncalli
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Kim HN, Kwon YB, Lee JH, Kim JB. Impacts of undernutrition and maternal oral health status on dental caries in Korean children aged 3-5 years. Int J Dent Hyg 2020; 18:369-377. [PMID: 32794317 DOI: 10.1111/idh.12460] [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: 02/07/2020] [Revised: 06/19/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The association between nutrition and oral health has been studied in the elderly. This study aimed to examine the impacts of undernutrition and the mothers' socioeconomic and oral health statuses on the incidence of dental caries in Korean preschool children. METHODS Data of 610 children aged 3-5 years and their mothers who underwent oral examinations and responded to the questionnaires in the 6th KNAHNES were used. Caries prevalence was measured by dft and dt among the primary teeth in children and DMFT among mothers. Dietary reference intake values were used to evaluate nutritional status, a nutritional quality index and the mean nutrient adequacy ratio. Complex sample correlation analysis was performed by using children's dft and dt statuses as dependent variables. Multilevel linear regression was applied to investigate the impacts of undernutrition and mothers' socioeconomic and oral health status on children's dft and dt statuses. Statistical significance was set as P < .05. RESULTS Factors significantly related to dft in children were age and food. Food insecurity was the only factor significantly associated with dt in children. Children's sex and mother's DMFT were likely to be relevant to dft in children. Children's age and a nutritional quality index value less than 1 were also likely to be relevant to the dt of children. CONCLUSIONS Children with an undernourished status had a higher caries experience. A comprehensive community dental health promotion programme should be developed to prevent the incidence of dental caries in vulnerable undernourished children.
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Affiliation(s)
- Han-Na Kim
- Department of Dental Hygiene, College of Health and Medical Sciences, Cheongju University, Cheongju, Korea
| | - Yong-Bong Kwon
- Department of Preventive and Social Dentistry, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jung-Ha Lee
- Department of Preventive and Social Dentistry, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jin-Bom Kim
- Department of Preventive and Social Dentistry, School of Dentistry, Pusan National University, Yangsan, Korea.,Dental and Life Science Institute, Pusan National University, Yangsan, Korea
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Silva JVD, Roncalli AG. Trend of social iniquities in reports of sexual violence in Brazil between 2010 and 2014. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200038. [PMID: 32491050 DOI: 10.1590/1980-549720200038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/02/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Sexual violence has emerged in the health field with changes in the epidemiological profiles of populations. METHODOLOGY An ecological study with 5,565 Brazilian municipalities between 2010 and 2014. A descriptive analysis of the variables (Population rate of sexual violence reporting, household income per capita and HDI) and their stratification by quintile was performed. In order to explore the factors associated with changes in social inequalities regarding the rate of reporting of sexual violence, the Slope Index of Inequality and Relative Index of Inequality were adopted. An Equiplot was constructed for the outcome on each independent variable. RESULTS The mean rate of reports of sexual violence in Brazil was 4.38 reports/100,000 inhabitants for the period. There was an increase in the rate of sexual violence and improvement in socioeconomic conditions. There was a higher rate of reporting in the quintile with better living conditions. An increase in the inequality of the rate of sexual violence as a function of household income and the HDI was observed. Several factors seem to influence the increase of reports of sexual violence in the country, among them the improvement in the living conditions of the population and greater moral sensitivity to violence. However, there is still a disparity in reporting among municipalities according to their socioeconomic status. CONCLUSION The lack of public policies on social equity in health has interfered with reports of sexual violence in the country and has widened health inequities.
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Afshar MK, Torabi M, Bahremand M, Afshar MK, Najmi F, Mohammadzadeh I. Oral Health Literacy and Related Factors among Pregnant Women Referring to Health Government Institute in Kerman, Iran. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Molook Torabi
- Kerman University of Medical Sciences, Iran; Kerman University of Medical Sciences, Iran
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Dutra LDC, de Lima LCM, Neves ÉTB, Gomes MC, de Araújo LJS, Forte FDS, Paiva SM, Ferreira FM, Granville-Garcia AF. Adolescents with worse levels of oral health literacy have more cavitated carious lesions. PLoS One 2019; 14:e0225176. [PMID: 31774850 PMCID: PMC6880994 DOI: 10.1371/journal.pone.0225176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/30/2019] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to investigate whether the ability to recognize and read oral health terms is associated with the number of teeth with cavitated carious lesions in adolescents. A population-based cross-sectional study was conducted involving a sample of 746 adolescents representative of students aged 15 to 19 years at the public and private school systems in a city in northeast Brazil. Two examiners who had undergone a training and calibration exercise (inter-examiner and intra-examiner Kappa coefficient: 0.87 to 0.93) performed the diagnosis of caries using the Nyvad Index and evaluated the level of OHL (BREALD-30) of the adolescents. The participants answered questions regarding their history of visits to the dentist and the parents/caregivers answered a questionnaire addressing socioeconomic characteristics. A directed acyclic graph was created to direct the selection of covariables for adjustments in the Poisson multiple regression analysis to test the association between dental caries and OHL (α = 5%). Cavitated carious lesions (codes 3 to 6 on the Nyvad index) were found in 41.6% of the adolescents. Only 29.4% had a high level of OHL (BREALD-30 scores between 23 and 30); 42.3% of the families belonged to the A-B social class and 93% of the adolescents had been to the dentist at least once in their lifetimes. In the multivariate analysis, adolescents with inadequate (PR: 1.69; 95% CI: 1.18–2.41; p = 0.004) and marginal (PR; 1.42; 95% CI: 1.01–1.99; p = 0.042) OHL and those in the lower social classes (C-D-E) (PR: 1.85; 95% CI: 1.39–2.47; p<0.001) had more teeth with cavitated carious lesions. In conclusion, adolescents aged 15 to 19 years with poorer levels of OHL had a larger number of teeth with cavitated carious lesions, independently of their socioeconomic status and history of visiting a dentist.
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Affiliation(s)
- Laio da Costa Dutra
- Graduate Program in Dentistry, State University of Paraiba (UEPB), Campina Grande, Paraiba, Brazil
| | | | | | - Monalisa Cesarino Gomes
- Graduate Program in Dentistry, State University of Paraiba (UEPB), Campina Grande, Paraiba, Brazil
| | | | | | - Saul Martins Paiva
- Graduate Program in Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Morais Ferreira
- Graduate Program in Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Singh A, Peres MA, Watt RG. The Relationship between Income and Oral Health: A Critical Review. J Dent Res 2019; 98:853-860. [PMID: 31091113 DOI: 10.1177/0022034519849557] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In this critical review, we summarized the evidence on associations between individual/household income and oral health, between income inequality and oral health, and income-related inequalities in oral health. Meta-analyses of mainly cross-sectional studies confirm that low individual/household income is associated with oral cancer (odds ratio, 2.41; 95% confidence interval [CI], 1.59-3.65), dental caries prevalence (prevalence ratio, 1.29; 95% CI, 1.18-1.41), any caries experience (odds ratio, 1.40; 95% CI, 1.19-1.65), tooth loss (odds ratio, 1.66; 95% CI, 1.48-1.86), and traumatic dental injuries (odds ratio, 0.76; 95% CI, 0.65-0.89). Reviews also confirm qualitatively that low income is associated with periodontal disease and poor oral health-related quality of life. Limited evidence from the United States shows that psychosocial and behavioral explanations only partially explain associations between low individual/household income and oral health. Few country-level studies and a handful of subnational studies from the United States, Japan, and Brazil show associations between area-level income inequality and poor oral health. However, this evidence is conflicting given that the association between area-level income inequality and oral health outcomes varies considerably by contexts and by oral health outcomes. Evidence also shows cross-national variations in income-related inequalities in oral health outcomes of self-rated oral health, dental care, oral health-related quality of life, outcomes of dental caries, and outcomes of tooth loss. There is a lack of discussion in oral health literature about limitations of using income as a measure of social position. Future studies on the relationship between income and oral health can benefit substantially from recent theoretical and methodological advancements in social epidemiology that include application of an intersectionality framework, improvements in reporting of inequality, and causal modeling approaches. Theoretically well-informed studies that apply robust epidemiological methods are required to address knowledge gaps for designing relevant policy interventions to reduce income-related inequalities in oral health.
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Affiliation(s)
- A Singh
- 1 Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - M A Peres
- 2 Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
| | - R G Watt
- 3 Research Department of Epidemiology and Public Health, University College London, London, UK
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Ferreira FM, Gomes MC, Granville-Garcia AF, Santin GC, Pintarelli TP, Feltrin J, Fraiz FC. How much does household food insecurity explain income inequalities in untreated dental caries? Int J Paediatr Dent 2019; 29:325-331. [PMID: 30664294 DOI: 10.1111/ipd.12471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The pathway by which socioeconomic disadvantages are manifested in the occurrence of dental caries remains unclear. AIM To explore how much the association between untreated dental caries and income inequalities is related to household food insecurity (HFI). DESIGN A population-based study was conducted with a sample of 466 12-year-old students. Dental caries was evaluated by an examiner who had undergone calibration exercises. HFI was assessed using the Food Insecurity Scale validated for Brazilian Portuguese. Poisson regression models were created to determine associations between dental caries and both household income and HFI. The proportion of the income effect on dental caries explained by HFI was determined by the variation in percentages between the crude prevalence ratio (PRc ) for dental caries and this measure adjusted by HFI (PRa ). RESULTS The prevalence of dental caries was higher among children from families with a per capita household income lower than US$ 71 (PR: 1.69; 95%CI: 1.15-2.49) or from US$ 71 to US$ 142 (PR: 1.50; 95%CI: 1.04-2.17). Moreover, 14% of the association between a low income and dental caries was explained by HFI. CONCLUSIONS Differences in the prevalence of dental caries in schoolchildren related to socioeconomic inequalities could partially be attributed to HFI in low-income families.
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Affiliation(s)
- Fernanda Morais Ferreira
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal de Minas gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Gabriela Cristina Santin
- Department of Dentistry, Universidade Estadual de Maringá
- Centro Universitário Ingá, Maringa, Brazil
| | | | - Juliana Feltrin
- Department of Stomatology, School of Dentistry, Federal University of Paraná, UFPR, Curitiba, Paraná, Brazil
| | - Fabian Calixto Fraiz
- Department of Stomatology, School of Dentistry, Federal University of Paraná, UFPR, Curitiba, Paraná, Brazil
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Barasuol JC, Garcia LP, Freitas RC, Dalpian DM, Menezes JVNB, Santos BZ. Dental care utilization among children in Brazil: an exploratory study based on data from national household surveys. CIENCIA & SAUDE COLETIVA 2019; 24:649-657. [DOI: 10.1590/1413-81232018242.03232017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/22/2017] [Indexed: 11/21/2022] Open
Abstract
Abstract Wide availability of access to dental services can be considered a predictor of better oral health outcomes in a population. This article aims to compare data from the Brazilian National Household Sample Surveys (PNAD) on dental services utilization among children aged 4 to 12 years. This cross-sectional study was carried out using data from the 1998, 2003, and 2008 National Household Sample Surveys, involving a total of 61.438, 64.659 and 59.561 children, respectively. Ninety-nine percent confidence intervals were considered for the prevalence of each outcome of interest. In 1998, 60.8% (99%CI: 59.4;62.1) of children had been to a dentist; this prevalence was 65.5% (99%CI: 64.4;66.7) in 2003 and 73.8% (99%CI: 72.1;74.2) in 2008. In 1998, 41.2% (99%CI: 39.1;43.3) of children in the lowest household income quartile had been to a dentist; this value was 61.4% (99%CI: 59.5;63.2) in 2008. Among children from families whose head of household had 4 years of formal education or fewer, 49.5% and 63% had been to a dentist in 1998 and 2008, respectively. The lifetime prevalence of dentist attendance among Brazilian children increased between 1998 and 2008, especially among those from low-income families and those whose head of household had a low educational level.
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Teixeira AKM, Roncalli AG, Noro LRA. Income Trajectories and Oral Health of Young People in a Life Course Study. Caries Res 2019; 53:347-356. [PMID: 30650428 DOI: 10.1159/000495038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the impact of the family's socioeconomic trajectory on the oral health status of young people in the city of Sobral, Ceará, Brazil, and test the hypotheses of the life course theory. METHODS This is a cohort study conducted in 2000, 2006, and 2012. In the third wave, 482 individuals between 17 and 21 years of age were examined and interviewed. The outcomes analyzed were the trajectory of tooth decay (decayed teeth in 2012 and cavity reoccurrence) and the trajectory of dental assistance (immediate dental assistance and untreated caries). The socioeconomic trajectory was measured by the mobility of the family's income between childhood and youth and the number of episodes of poverty throughout life. RESULTS The risk of developing decayed teeth in 2012 was greater for those who had always remained poor. Young people who were never poor had fewer decayed teeth in 2012, but more cavity reoccurrence. Downward mobility resulted in less access to immediate dental assistance. More experience of poverty throughout life implied more decayed teeth in 2012 and less immediate dental assistance. CONCLUSION The life course hypotheses regarding an influence of socioeconomic mobility and cumulative risk on oral health outcomes in youth were confirmed.
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Tomazoni F, Vettore MV, Baker SR, Ardenghi TM. Can a School-Based Intervention Improve the Oral Health-Related Quality of Life of Brazilian Children? JDR Clin Trans Res 2019; 4:229-238. [PMID: 30931715 DOI: 10.1177/2380084418816984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Evidence of the effectiveness of oral health promotion strategies among children from different socioeconomic backgrounds is necessary to support the implementation of public health interventions. OBJECTIVES This study aimed to test the effectiveness of a school-based intervention to enhance the sense of coherence (SOC) and oral health-related quality of life (OHRQoL) of socially vulnerable Brazilian children. Furthermore, we explored the pathways by which the intervention may improve OHRQoL and SOC, assessing the direct and indirect pathways among demographic, clinical, socioeconomic, behavioral, and psychosocial variables. METHODS In this cluster-randomized trial, 5 primary schools in Brazil were randomly allocated into intervention and control groups. The intervention comprised 7 sessions of SOC-based activities over 2 mo, which focused on making the school environment a place to develop children's SOC through involving teachers, school staff, and children. Trained teachers delivered the intervention. OHRQoL and SOC data were collected at baseline, 2 wk after the intervention, and at 3-mo follow-up. RESULTS Information about oral clinical conditions, socioeconomic status, OHRQoL, and SOC was obtained from 356 children aged 8 to 14 y (165 in the intervention group and 191 in the control group). Children from the SOC-based intervention group reported fewer impacts of their oral health on their daily lives (Child Perceptions Questionnaire mean, 7.22) than those from the control group (9.14). The intervention group also reported greater improvement of SOC at 2 wk (SOC mean, 52.98) and 3 mo (52.75) than the control group (52.21 and 51.65, respectively). CONCLUSION The intervention was effective in improving SOC and OHRQoL among socially vulnerable Brazilian children. Moreover, SOC was a relevant predictor for oral symptom and functional status in this population (Brazilian Clinical Trials Registry RBR-2N9NHJ). KNOWLEDGE TRANSFER STATEMENT Clinicians and policy makers can use the results of this study to decide which approach to use when planning public health policy to improve the SOC and OHRQoL of socially vulnerable children. Our findings can assist policy makers in making more appropriate community health decisions in school environments that will improve community empowerment.
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Affiliation(s)
- F Tomazoni
- 1 Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - M V Vettore
- 2 Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - S R Baker
- 2 Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - T M Ardenghi
- 1 Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
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MATICK ACC, NAVARRO CH, HIGASHI DT, PASCOTTO RC, FUJIMAKI M, TERADA RSS. Avaliação da solubilidade e sorção em água de alguns materiais restauradores diretos. REVISTA DE ODONTOLOGIA DA UNESP 2019. [DOI: 10.1590/1807-2577.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução A solubilidade e sorção dos materiais restauradores são considerados fatores críticos, pois podem interferir na qualidade e durabilidade das restaurações. Objetivo Avaliar a solubilidade e sorção de água de alguns materiais restauradores. Material e método Foram confeccionados quatorze espécimes de cada um dos seguintes materiais: Equia® Forte, Z100, Fuji IX/ e Vidrion R, os quais foram levados a uma dessecadora e pesados diariamente até estabilização. Em seguida, foram inseridos em recipientes individuais contendo 40 mL de água destilada cada e divididos em dois grupos de acordo com o tempo de armazenagem: 7 ou 30 dias. Ao final de cada período, os espécimes foram retirados da água, pesados, levados à dessecadora e pesados novamente até estabilização. Os resultados foram analisados estatisticamente utilizando os testes ANOVA 2 critérios e Tukey. Resultado Com exceção do Equia® Forte e Z100, os demais materiais, apresentaram uma variação significativa da solubilidade ao longo do tempo. Quanto à sorção, observa-se que apenas o material Z100 não apresentou diferença significativa em relação ao tempo de armazenagem, mas, na comparação entre os materiais, todos apresentaram diferenças significativas em ambos os períodos. Conclusão Após os períodos de armazenagem de 7 e 30 dias em água, os materiais restauradores Equia® Forte e Z100 não apresentam variação significativa da solubilidade, sendo mais estáveis que os materiais Fuji IX e Vidrion R. Os materiais à base de ionômero de vidro, Equia® Forte, Fuji IX e Vidrion R, sofrem mais sorção em água quando comparados ao material Z100 em ambos os períodos.
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Tomazoni F, Vettore MV, Mendes FM, Ardenghi TM. The Association between Sense of Coherence and Dental Caries in Low Social Status Schoolchildren. Caries Res 2018; 53:314-321. [PMID: 30359970 DOI: 10.1159/000493537] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022] Open
Abstract
The relationship between dental caries and sense of coherence (SOC) has not been substantiated in children and adolescents, particularly among those with a low socioeconomic status. The aim of this study was to investigate the association between SOC and dental caries in schoolchildren from a low socioeconomic background. A random sample of 356 8- to 14-year-old schoolchildren enrolled in public schools from the poorest region of Santa Maria, a southern city in Brazil, was selected. Dental examinations were performed to assess dental plaque and dental caries (DMF-S and dmf-s indexes). The children's SOC was assessed using a validated Brazilian version of the SOC-13 scale. Socioeconomic, demographic, and behavioral data were collected from parents using a questionnaire. Multilevel Poisson regression analysis was used following a hierarchical approach to investigate the association between the SOC and DMF-T + dmf-t mean. Children whose mothers had studied for 8 years or less (RR 1.30; 95% CI 1.08-1.57) and children with dental plaque (RR 1.29; 95% CI 1.06-1.58) presented with higher DMF-T scores than their counterparts (p < 0.05). A higher household income (RR 0.66; 95% CI 0.51-0.84) and greater SOC scores (RR 0.71, 95% CI 0.56-0.90) were associated with lower DMF-T in children (p < 0.05). Children's SOC seems to be a relevant protective psychosocial factor for dental caries experience in socially vulnerable children.
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Affiliation(s)
- Fernanda Tomazoni
- Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Mario Vianna Vettore
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, The University of Sheffield, Sheffield, United Kingdom
| | - Fausto Medeiros Mendes
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Federal University of São Paulo, São Paulo, Brazil
| | - Thiago Machado Ardenghi
- Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil,
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Lopes J, Palmier AC, Werneck MAF, Matta-Machado ATGD, Abreu MHNGD. A Survey About Dental Instruments at the Primary Health Care in Brazil. Braz Dent J 2018; 29:500-506. [DOI: 10.1590/0103-6440201801969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/30/2018] [Indexed: 11/22/2022] Open
Abstract
Abstract This study describes the structure of oral health services in primary health care in Brazil and the instruments available for the provision of oral health care and to compare the number of instruments according to organizational characteristics of health services and among the macroregions. Of the 23,251 oral health teams (OHTs) in the Public Health System, 17,513 (75.3%) participated in this study. Trained researchers observed the structures of the health services and determined the presence of and whether a sufficient quantity of 36 dental instruments existed. The score of each oral health service was determined by the sum of the number of dental instruments present in sufficient quantity (0 to 36). Central tendency measures were compared along with the variability in these scores according to the organizational characteristics of the services and according to the Brazilian macroregion. No instrument was found to be present in all evaluated services. Basic, surgical and restorative instruments were the most frequently found. Periodontal, endodontic and prosthetic instruments exhibited the lowest percentages. The mean and median numbers of dental instruments were higher for teams that operated over more shifts, those with an oral health technician and those in the South and Southeast regions. The oral health services were equipped with basic, surgical and restorative instruments. Instruments designed for periodontal diagnosis, emergency care and denture rehabilitation were less frequently found in these services. The worst infrastructure conditions existed in the OHTs with the worst forms of care organization and in regions with greater social issues.
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Affiliation(s)
- Joyce Lopes
- Universidade Federal de Minas Gerais, Brazil
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Dental caries and dental fluorosis according to water fluoridation among 12-year-old Brazilian schoolchildren: a nation-wide study comparing different municipalities. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-0901-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Martins MT, Sardenberg F, Bendo CB, Abreu MH, Vale MP, Paiva SM, Pordeus IA. Dental caries remains as the main oral condition with the greatest impact on children's quality of life. PLoS One 2017; 12:e0185365. [PMID: 28981545 PMCID: PMC5628830 DOI: 10.1371/journal.pone.0185365] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 09/10/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The objective of this study was to assess the negative impact of dental caries on the OHRQoL of 8- to 10-year-old Brazilian children. METHODS This population-based case-control study involved 546 children (8-10 years old), 182 cases with a high negative impact on OHRQoL and 364 controls with a low negative impact on OHRQoL. Children's OHRQOL was measured using the Child Perceptions Questionnaire (CPQ8-10). Cases and controls (1x2 ratio) were individually matched by school and gender. Dental caries experience, malocclusion, and traumatic dental injuries were used as independent variables. Dental examinations were carried out at school during daytime hours by two calibrated examiners (Kappa = 0.93-interexaminer and 0.95- intraexaminer). The data were analyzed by descriptive statistics, conditional bivariate and multiple logistic regression, with the significance level set at 5%. RESULTS There was no significant difference in traumatic dental injuries and malocclusion between the case and control groups (p>0.05). Children with DMFT/dmft ≥3 had a 2.06-fold (95%CI = 1.28-3.31, p = 0.003) greater chance of experiencing a high negative impact on OHRQoL than those with DMFT/dmft = 0. CONCLUSION Children with high dental caries experience are more likely to present a high negative impact on OHRQoL than those with no dental caries experience.
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Affiliation(s)
- Milene T. Martins
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Pediatric Dentistry, School of Dentistry, Estadual University of Montes Claros, Montes Claros, Brazil
- * E-mail:
| | - Fernanda Sardenberg
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristiane B. Bendo
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mauro Henrique Abreu
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Míriam P. Vale
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Saul M. Paiva
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Isabela A. Pordeus
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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da Fonseca EP, Frias AC, Mialhe FL, Pereira AC, Meneghim MDC. Factors associated with last dental visit or not to visit the dentist by Brazilian adolescents: A population-based study. PLoS One 2017; 12:e0183310. [PMID: 28859102 PMCID: PMC5578480 DOI: 10.1371/journal.pone.0183310] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 08/02/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives We investigated the factors associated with no dental visit within the last two years by adolescents in the state of São Paulo, Brazil, by using data from the Oral Health Conditions of São Paulo state population Project (SBSP-2015) conducted in 2015. Methods This was a cross-sectional epidemiological study with a representative sample of adolescents aged 15 to higher years residing in São Paulo State. The examiners were calibrated and dental visits were measured categorically as 1- Less than 1 year, 2- One to two years, 3 - Three years or more, 4- I have never visited the dentist. Based on the literature we dichotomized the outcome in two groups: response 1 plus 2 against response 3 plus 4. Then, Multilevel Poisson Regression (MPR) was used to estimate the prevalence ratios of last dental visit three years or had never been to a dentist by adolescents compared with those who had visited the dentist within the past two years, with contextual variables as the distal level; sociodemographic variables, mesial; and individual variables, proximal level. Results A high percentage of adolescents (84.9%) reported visiting the dentist in the last 2 years. Whereas, 626 (11.6%) had not visited the dentist for over 3 years and 188 (3.4%) had never been. A significantly higher proportion of females than males reported visiting the dentist in the past 2 years (p = 0.003). The oral and dental condition was reported as satisfactory by 4,350 respondents (80.6%), and when they accessed the health service, 2,286 (42.3%) went to the public service. Lower mean family income (1.62PR;95%CI;1.36–1.94); ≥ 1,000 inhabitant/Dental Surgeons (1.25PR;95%IC;1.03–1.56);male (1.26PR;95%CI; 1.11–1.43) non-Caucasian ethnicity (Mulatto:1.30PR;95%CI;1.13–1.50 and Black:1.58PR;95%CI;1.29–1.93); dissatisfaction with the oral health condition (1.20PR;95%CI;1.01–1.45),last visit to the public service versus private service (2.26PR; 95%CI;1.91–2.65) and presenting with periodontal disease in the form of dental calculus as the worst situation (1.38PR; 95%CI; 1.16–1.53) were associated with last visit to the dentist. Conclusions A high proportion of adolescents had visited the dentist in the last two years. No dental visit within the last two years by adolescents were associated with contextual, health care system, sociodemographic, personal and oral health status, demonstrating that this is a complex phenomenon. Actions to promote regular dental visits by adolescents in Brazil should take these factors into consideration.
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Affiliation(s)
- Emílio P. da Fonseca
- Department of Community Dentistry, Piracicaba Dental School, FOP/UNICAMP, Graduate Program, University of Campinas, Piracicaba, São Paulo, Brazil
- * E-mail:
| | - Antonio C. Frias
- Department of Community Dentistry, Dental School of São Paulo University, FO/USP, São Paulo University, São Paulo, Brazil
| | - Fábio L. Mialhe
- Department of Community Dentistry, Health Education and Health Promotion Area of Piracicaba Dental School, FOP/UNICAMP, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Antonio C. Pereira
- Department of Community Dentistry, Preventive Dentistry and Public Health Area of Piracicaba Dental School, FOP/UNICAMP, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Marcelo de C. Meneghim
- Department of Community Dentistry, Preventive Dentistry and Public Health Area of Piracicaba Dental School, FOP/UNICAMP, University of Campinas, Piracicaba, São Paulo, Brazil
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Aida J, Matsuyama Y, Tabuchi T, Komazaki Y, Tsuboya T, Kato T, Osaka K, Fujiwara T. Trajectory of social inequalities in the treatment of dental caries among preschool children in Japan. Community Dent Oral Epidemiol 2017; 45:407-412. [PMID: 28444902 DOI: 10.1111/cdoe.12304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/02/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The longitudinal trend of dental health inequalities among preschool children has not been described. In this study, we aimed to measure the trajectory of both relative and absolute inequalities in caries treatment among preschool children in Japan. METHODS We used data from the Longitudinal Survey of Babies in the 21st Century (LSB21), which is an ongoing national representative longitudinal study. The target population was families residing in Japan with newborn baby/babies born between 10 January and 17 January or 10 July and 17 July 2001. Data regarding caries treatment history and socioeconomic status (SES) were collected using a self-reported questionnaire. SES was assessed on the basis of the parents' educational attainment. In total, 35 260 children were followed from 2.5 to 5.5 years through annual surveys. To evaluate absolute and relative inequalities, we calculated the slope index of inequality (SII) and relative index of inequality (RII), respectively. RESULTS The rate of caries treatment at the age of 2.5 years was <10% for all SES groups; this increased to more than 30% at 5.5 years of age. Children with lower SES received more frequent caries treatment, and both absolute and relative social inequalities were statistically significant. SII showed a significant increase throughout the follow-up period, with values of 4.13% (95% confidence interval [CI], 3.16; 5.09) and 15.50% (95% CI, 13.68; 17.32) at 2.5 and 5.5 years of age, respectively. In contrast, RII decreased with an increase in the treatment rate for all groups, with values of 1.83 (95% CI, 1.59; 2.11) and 1.53 (95% CI, 1.46; 1.61) at 2.5 and 5.5 years of age, respectively. CONCLUSION Our results suggest that the rate of caries treatment is higher for preschool children with lower SES in Japan, with significant widening of absolute inequalities along with the growth of the children.
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Affiliation(s)
- Jun Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yusuke Matsuyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yuko Komazaki
- Section of Maxillofacial Orthognathics, Department of Maxillofacial Reconstruction and Function, Division of Maxillofacial/Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Tsuguhiko Kato
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
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The Association of Oral Health Literacy and Oral Health Knowledge with Social Determinants in Pregnant Brazilian Women. J Community Health 2016; 41:1027-32. [DOI: 10.1007/s10900-016-0186-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Drummond AMA, Ferreira EF, Gomes VE, Marcenes W. Inequality of Experience of Dental Caries between Different Ethnic Groups of Brazilians Aged 15 to 19 Years. PLoS One 2015; 10:e0145553. [PMID: 26694321 PMCID: PMC4692284 DOI: 10.1371/journal.pone.0145553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 12/04/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction The aim of this study was to assess inequality of experience of dental caries, based on race/ethnicity, among Brazilian adolescents aged 15 to 19 years in 2010 and test whether socioeconomic indicators fully explain ethnic differences in dental caries. Methods Data from a National Oral Health Survey conducted in Brazil in 2010 was analysed. Race/ethnicity was self-assigned and modified to White, African descents, East Asian descents, Mixed Race and Indigenous descents. The prevalence of caries experience by race/ethnic group in 2010(n = 5,367) was calculated. Further analysis included conceptual hierarchical modelling and mediation analysis. Results Caries experience was 76.9% in 15 to 19 year old Brazilians in 2010. While African descents were 32% more likely to have caries experience than Whites, Mixed Race were 69% more likely to have caries experience than Whites. Hierarchical conceptual modelling analysis confirmed the highly significant association between caries and race/ethnicity. Mixed Race and East Asian descents were 1.44 (95% CI 1.24–1.67) and 1.81 (95% CI 1.02–3.20) times more likely to experience caries than Whites after adjusting for age, sex, education and income. The difference in the likelihood of experiencing caries between Whites and African descents was not statistically significant after adjusting for years of education and family income. The results of mediation analysis confirmed that inequality of caries experience between Whites and Mixed Race and East Asian descents was mediated through education and income. The likelihood that Mixed Race and East Asian descents would experience caries compared to Whites was attenuated, by 14.8% and by 9.5% respectively, after adjusting for years of education and income. Conclusions Data analysis demonstrated that Whites have benefited more from the significant reduction in dental caries experience in 15 to 19 year old Brazilians, as compared to African descents and Mixed Race. Education and income fully explained ethnic inequalities in experience of dental caries between Whites and African descents, and largely explained inequalities between Whites and Mixed Race.
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Affiliation(s)
- Andreia Maria Araújo Drummond
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. London, United Kingdom
- Faculty of Dentistry, Universidade Federal de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | | | - Viviane Elisangela Gomes
- Faculty of Dentistry, Universidade Federal de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
| | - Wagner Marcenes
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. London, United Kingdom
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Pucca G, Gabriel M, de Araujo M, de Almeida F. Ten Years of a National Oral Health Policy in Brazil. J Dent Res 2015; 94:1333-7. [DOI: 10.1177/0022034515599979] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Brazil is the only country in the world to propose a universal health care system with the aim of guaranteeing delivery of all levels of health care, free of charge, to a population of over 200 million inhabitants by means of a unified health system (“Sistema Único de Saúde” [SUS]). The national policy of oral health, also known as Smiling Brazil (“Brasil Sorridente”), was implemented in 2004. Oral health was designated as 1 of the 4 priority areas of the SUS, transforming oral health care in Brazil, with the objective that the SUS achieve the integrality of care envisaged at its creation. The aim of this article is to share part of this experience in order to prompt reflection about the inclusion of oral health care in other health care systems around the world. The most significant results of Smiling Brazil can be seen in 3 areas: 1) oral health epidemiological indicators, 2) financial investment and professional development, and 3) the building of an oral health care network throughout the 10 y of the policy. The “Discovery!” article presented here portrays 10 y of evolution; however, it is important to point out that this is a process undergoing construction and that the oral health care network needs to be further expanded, refined, and solidified so that over time and through changes in the political parties in power, Smiling Brazil prevails as a perennial policy and not merely an action by a single government.
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Affiliation(s)
- G.A. Pucca
- Ministry of Health, Brasília, Brazil
- Department of Dentistry, University of Brasília, Brasília, Brazil
| | - M. Gabriel
- Department of Community Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
- Observatory for Oral Health Human Resources, São Paulo, Brazil
| | - M.E. de Araujo
- Observatory for Oral Health Human Resources, São Paulo, Brazil
- Discipline of Public Health, Department of Community Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - F.C.S. de Almeida
- Observatory for Oral Health Human Resources, São Paulo, Brazil
- Discipline of Expanded Clinics for Health Promotion, Department of Community Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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