Oral problems and quality of life of preschool children: self-reports of children and perception of parents/caregivers

Validity and reliability of the Brazilian version of the Illness Perception Questionnaire-Revised for Dental

This study aimed to test the validity and reliability of the Brazilian version of the "Illness Perception Questionnaire-Revised for Dental" (IPQ-RD) in parents/guardians of children aged six to 14 years. The sample consisted of 63 parents/guardians of schoolchildren from the municipal school system of Teófilo Otoni, MG. Remote and virtual data collection consisted of self-completion of personal data, socioeconomic questionnaire and the Brazilian short versions of the "Parental-Caregiver Perceptions Questionnaire" (16-P-CPQ) and the "Family Impact Scale" (4-FIS). The IPQ-RD was applied by telephone interview. Almost half of the sample belonged to socioeconomic classes C1 and C2. Approximately 1/3 classified their child's oral health as "regular" or "poor", while 11.1% reported "strong" or "very strong" impact on their child's well-being. The items most frequently cited as having an impact on the four domains of the 16-P-CPQ were: "bad breath" (23.8%), "mouth breathing" (20.7%), "feeling anxious or afraid" (20.7%), and "paying attention at school" (10%). In the 4-FIS, 11.1% "had little time for themselves or the family". There were higher IPQ-RD scores in the "disease coherence" domain for women and lower values of "emotional dimensions" for parents/guardians with incomplete education. The mean IPQ-RD score was 126.4 (±15.1), and domain scores were positively correlated. The internal consistency was "almost perfect" for the IPQ-RD total score, ranging from "moderate" to "almost perfect" for the "child-control" and "child-consequences" domains. The intraclass correlation coefficient ranged from 0.04 (poor) to 0.68 (substantial). The Brazilian Portuguese version of the IPQ-RD proved to be valid and reliable for assessing the cognitive and emotional perception of parents/guardians about childhood dental caries.

Self-reported oral health-related quality of life and caries experiences of 5-year-old children in Mandalay, Myanmar

BACKGROUND

This study aimed to examine the impact of dental caries and other potential socio-demographic factors on the oral health-related quality of life (OHRQoL) of preschool children from Myanmar. This was done using the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) as reported by both the children and their parents.

METHODS

A structured questionnaire was conducted to collect demographic information about the children and their caregivers, as well as socioeconomic data. The OHRQoL was assessed by interviewing the children and their parents using the Myanmar versions of SOHO-5c and SOHO-5p, respectively. Caries experience was assessed by two calibrated examiners and recorded using the dmft index. The Poisson regression model was adopted to investigate the association between OHRQoL and dental caries including socioeconomic factors.

RESULTS

A total of 454 pairs participated in the study. Among them, 64% of children and 70% of parents reported a negative impact on OHRQoL (with SOHO-5c and SOHO-5p scores exceeding 0). The mean score (SD) of the child self-report and parental version of the SOHO-5 was 1.86 (2.27) and 2.65 (3.13), respectively. Difficulties in eating and sleeping were the most commonly reported by both children and parents. The overall prevalence of dental caries was 87% (mean dmft score:5.59, SD:4.65). The final multivariate-adjusted model revealed that children with higher caries experiences were more likely to have lower OHRQoL for both child self-report (RR 4.38, 95% CI 3.16-6.14, p < 0.001) and parental report (RR 6.07, 95% CI 4.38-8.41, p < 0.001), respectively. A lower family income had a negative impact on the children's OHRQoL in child self-report (RR 1.59, 95% CI 1.26-2.04, p < 0.001) and parental report (RR 1.46, 95% CI 1.19-1.78, p < 0.001).

CONCLUSION

Two-thirds of the study children and their parents perceived the negative impact on children's OHRQoL. Higher caries experience and lower family income were associated with poorer OHRQoL of 5-year-old Myanmar children.

Agreement between schoolchildren and their parents on rating the child's oral health-related quality of life

The perceptions of parents/caregivers regarding their children's oral health can influence the standard of care and decision-making regarding oral health. The children's perspective on their own oral health-related quality of life (OHRQoL) may differ from the parents/caregivers' views. This cross-sectional study aimed to analyze the agreement between the perceptions of parents/caregivers and schoolchildren regarding OHRQoL. It was conducted with a sample of children between 8 and 11 years old and their parents/caregivers from Pelotas. Children answered the Child Perceptions Questionnaire 8-10 (CPQ), and parents/caregivers answered the short form of the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Socioeconomic data were also collected. Children's dental caries, traumatic dental injuries, and malocclusions were examined. The Spearman's correlation test was performed. A total of 119 parents/caregivers-children pairs were included. There was an agreement between the total scores of parents/caregivers and children (0.2770; p = 0.003), in the oral symptoms (0.1907; p = 0.038), and functional limitations (0.2233; p=0.015) domains. The Bland-Altman graph showed an agreement between children's and parents/caregivers' OHRQoL total score, but there was an underestimation of approximately two points in the parents/caregivers' perception compared to the children's score. There was an agreement between the reports of parents/caregivers and children regarding children's OHRQoL.

The Impact of Socio-Environmental, Individual, and Biological Factors on Oral Health-Related Quality of Life among Preschool Children: A Cohort Study with 3-Year Follow-Up

This study assessed impact of socio-environmental, individual, and biological factors on the worsening and severe worsening of oral health-related quality of life (OHRQoL) among preschoolers and their families. A cohort study was conducted in Diamantina, Brazil, with 151 children between 1 and 3 years of age and their mothers, who were evaluated at baseline (2014) and re-evaluated after 3 years (2017). The children were clinically examined to assess the presence of dental caries, malocclusion, dental trauma, and enamel defects. The mothers answered the Early Childhood Oral Health Impact Scale (B-ECOHIS) and a questionnaire addressing individual characteristics of the child and socio-environmental factors. Extensive caries found in the follow-up (relative risk [RR] = 1.91; 95% confidence interval [CI] = 1.26-2.91) and failure to undergo the dental treatment recommended at baseline (RR = 2.49; 95% CI = 1.62-3.81) were associated with worsening of OHRQoL over 3 years. An increase in the number of children in the household (RR = 2.95; 95% CI = 1.06-8.25), occurrence of extensive caries in the follow-up (RR = 2.06; 95% CI = 1.05-4.07), and failure to undergo the dental treatment recommended at baseline (RR = 3.68; 95% CI = 1.96-6.89) were associated with a severe worsening of OHRQoL. In conclusion, the risk of worsening and severe worsening of OHRQoL was higher in preschoolers with extensive caries at follow-up and among those who did not undergo dental treatment. Furthermore, severe worsening of OHRQoL was also impacted by an increase in the number of children in the household.

Translation and cultural adaptation of the Illness Perception Questionnaire-Revised for Dental to Brazil

This study aimed to translate and to perform the cultural adaptation of the instrument Illness Perception Questionnaire-Revised for Dental (IPQ-RD) into Brazilian Portuguese. The IPQ-RD consists of 34 items that assess the cognitive and emotional representation/perception of parents/caregivers of children with dental caries, with response options on a 5-point Likert scale, ranging from "Strongly agree" (score 1) to "Strongly disagree" (score 5). The higher the score, the lower the perception of the disease. The protocol consists of translation into Brazilian Portuguese, back-translation into English, revision by an Expert Review Committee, and pre-test (application in parents/caregivers of children in dental care). For some questions, the translated versions were identical (T1 = T2); for others, one version was preferred (T1 or T2); for still others, it was decided to modify terms to obtain greater clarity on the item (T3). In the first pre-test, three questions were misunderstood by more than 15% of the sample, after which the items were reviewed by the Expert Review Committee. In the second pre-test, the adapted version was applied to a new sample of parents/caregivers (n = 15) and the questions were understood by more than 85% of the participants. The Brazilian Portuguese version of the IPQ-RD was well understood by the evaluated population.

Vitamin D Supplementation, Characteristics of Mastication, and Parent-Supervised Toothbrushing as Crucial Factors in the Prevention of Caries in 12- to 36-Month-Old Children

Severe early childhood caries (S-ECC), defined as any sign of smooth-surface caries in a child younger than three years of age, remains a serious health issue. The aim of this study was to indicate oral health behaviours related to S-ECC. The study surveyed parents (socio-economic and medical factors, oral health behaviours) and clinically examined children including non-cavitated d1,2/cavitated d ≥ 3 lesions. %S-ECC, and caries indices (d1,2 d ≥ 3 mft and d1,2 d ≥ 3 mfs) were calculated. Spearman’s correlation and simple and multiple logistic regression were used to assess the relationships between various factors and S-ECC. A total of 496 children were examined. S-ECC occurred in 44.8%: d1,2 d ≥ 3 mft = 2.62 ± 3.88, d1,2 d ≥ 3 mfs = 4.46 ± 8.42. S-ECC was correlated with socio-economic factors, vitamin D supplementation, breastfeeding and using formula after the 18th month, and toothbrushing. Supplementation of vitamin D and toothbrushing tended to decrease the odds of S-ECC (OR = 0.49 (0.27−0.87); p = 0.016, OR = 0.46 (0.24−0.86) p = 0.015, respectively). Feeding exclusively with formula was observed to increase the odds of S-ECC (OR = 2.20 (1.29−3.76); p = 0.004). Consuming > three snacks daily (OR = 1.39 (0.97−1.98); p = 0.072) and the reluctance to eat resilient foods (OR = 1.63 (1.05−2.51); p = 0.028) were nullified by the confounding factors. Vitamin D supplementation, mastication of resilient food, breastfeeding in the first six months of a baby’s life, and parent-supervised toothbrushing are factors in the prevention of caries in toddlers. Breast- and bottle-feeding after the 18th month of life, the reluctance to eat solids, lack of vitamin D supplementation, hygienic neglect, and delay in introducing oral health behaviours may contribute to the development of caries in toddlers.

Impact of hypomineralised second primary molar on preschoolers' oral health-related quality of life-A hierarchical approach

BACKGROUND

Hypomineralised second primary molar (HSPM) is a developmental enamel defect associated with dental caries.

AIM

To evaluate the impact of HSPM on oral health-related quality of life (OHRQoL) in preschoolers through hierarchical analysis.

DESIGN

This population-based cross-sectional study assessed 834 5-year-old preschoolers, in Teresina, Piauí, Brazil, using sociodemographic questionnaires and Early Childhood Oral Health Impact Scale (ECOHIS). Dental examination was performed by two calibrated examiners (κ ≥ 0.80) for the diagnosis of HSPM (EAPD), dental caries (dmft and pufa indices), and malocclusion (Foster and Hamilton criteria). Analysis of the determinants of OHRQoL was stratified at three levels (P < .05).

RESULTS

Severe HSPM was associated with OHRQoL in bivariate analysis (P < .05). In adjusted final multivariate analysis (model 1), the presence of dental caries with or without clinical consequences was associated with worse OHRQoL (P < .05). In model 2, after the removal of dental caries, preschoolers with severe HSPM had greater probability of having a negative impact on OHRQoL in the child impact section (RR = 2.14; 95% CI = 1.26-3.65), family impact section (RR = 1.99; 95% CI = 1.16-3.42), and total score (RR = 2.09; 95% CI = 1.25-3.49) of the ECOHIS.

CONCLUSION

Severe HSPM had a negative impact on the OHRQoL of preschoolers and their families, but the presence of dental caries neutralised this impact.

Impact of early childhood caries on oral health-related quality of life: A systematic review and meta-analysis

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.

Pathways to anterior open bite after changing of pacifier sucking habit in preschool children: A cohort study

BACKGROUND

Pacifier use is a major cause of anterior open bite (AOB), which negatively impacts the quality of life of children affected.

AIM

To assess the direct and indirect pathways related to pacifier sucking habit and AOB in preschool children.

DESIGN

This 2-year cohort study evaluated a random sample of preschool children (2-5 years of age) from Southern Brazil. Caregivers answered a questionnaire addressing socio-economic and behavioural characteristics. Anterior open bite was recorded following the criteria recommended by Foster and Hamilton. Structural equation model was performed to assess the direct and indirect pathways among variables at baseline (T1) to predict the AOB at follow-up (T2).

RESULTS

Regarding the AOB, 407 children were evaluated at T1 and 187 at T2. The prevalence of AOB was 32.9% at baseline and 16.0% at follow-up. The presence of AOB at follow-up was directly affected by the change in pacifier sucking habit from T1 to T2. Considering the indirect paths, the AOB at T1 influenced the AOB in T2 via a change of pacifier sucking habit.

CONCLUSION

These findings suggest that the non-habit of sucking pacifiers is a fundamental strategy for the prevention of AOB as well as the promotion of health in childhood.

THE PERCEPTION OF CAREGIVERS OF POOR ORAL HEALTH OF THEIR CHILDREN AND ITS RELATED CLINICAL CONDITIONS

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.

Oral Health-Related Quality Of Life of Pre-School Children: Review and Perspectives for New Instruments

This study aimed to describe different approaches for the evaluation of the Oral health-related quality of life (OHRQoL) of preschool children and to discuss perspectives for future instruments. The OHRQoL is a concept that surpasses an exclusively clinical perception and includes functional, social, emotional, and environmental issues. The measure of OHRQoL represents a holistic approach for researchers and clinicians extending their visions beyond the mouth and understanding the entire context of the patient. Negative impacts of oral conditions on OHRQoL in childhood can reflect on health development, especially in a life stage marked by social and cognitive maturation. Instruments have been developed and cross-culturally adapted to evaluate the impact of oral conditions on the OHRQoL of preschool children and their families. Some features distinguish these instruments and influence their selection, such as: self- or proxy-report; generic- or specific-condition; long- or short-form, and less or more established used in literature. Moreover, theoretical framework, construct validation and availability should also be considered. Nine OHRQoL instruments for preschool children were included in the present literature review. They were created between 2003 and 2017 by developed countries in most cases. The shorter instrument has five items, and the larger has 31 items. Most of them are proxy-reported, generic-condition, and have been relatively well established in the literature. The diversity of instruments indicates the evolution of OHRQoL studies, but there are methodological issues still in need to be improved in future developments or cross-cultural adaptations, according to current psychometric evidence.

Changes in Parental Perceptions of Their Care of Their Children's Oral Health From Age 1 to 4 Years

Introduction: In this 3-year longitudinal study, parent/child attended 3 dental visits and in between, parents were called every 4 months and asked if their child had visited the dentist and if fluoride varnish had been applied. Methods: Objectives were to assess changes in parents’ perceptions of how well they do in taking care of their children’s teeth and/or gums across these 3 time points (at age 1, 2.5, and 4 years), assess differences in parents’ perceptions of how well they do taking care of their children’s teeth and/or gums versus taking care of their children’s medical health, and determine factors associated with parental perceptions of how well they do in taking care of the children’s teeth and/or gums longitudinally. Results: Participant pairs (1325) were enrolled and over time there was a significant improvement in parental perceptions of their job taking care of their children’s teeth and/or gums, increasing from 86% perceiving it to be excellent/very good/good at their child’s 1 year of age to 92% at child’s age 4 years. The estimated odds of parents perceiving they provided excellent/very good/good versus fair/poor care for the children’s teeth and/or gums were higher for those who cleaned and checked inside the children’s mouth and/or gums daily (odds ratio 4.74) or took their children to the dentist yearly or twice yearly (odds ratio; 2.73). Conclusions: Parents’ perceptions of the care of their children’s teeth and/or gums improved over time. Parents consistently perceived that they provided better medical care than dental care for their child.

Exploring the impact of oral health-related quality of life on the child’s family structure

Aim: The aim of this study was to explore the impact of oral health-related quality of life (OHRQoL) on the child’s family structure. Methods: A representative sample of 613 children from public preschools, in a city in southeastern Brazil, were enrolled in this cross-sectional study. The sample was determined through probabilistic sampling in two stages (preschools and children). The outcome variable (Early Childhood Oral Health Impact Scale [ECOHIS]) was multi-categorized in children and family. Independent individual variables were sex, race, family income, parents’/caregivers’ level of education, family income, dental caries, and malocclusion. Initially, individual analyses were performed, relating the study variables to the outcome variables, estimating the raw odds ratio with the respective confidence intervals of 95%. The variables with p < 0.20 in the individual analyses were tested in the multiple logistic regression models, and those with p < 0.10 remained in the model. Results: Impact on OHRQoL was reported by 40.9% of the children and 17% of their families. Children with low family income and caries experience had, respectively, 1.53 (95% CI: 1.00-2.32) (p = 0.0465) and 2.96 (95% CI: 1.81-4.84) (p < 0.0001) more chance of presenting negative impact on OHRQoL. Conclusions: The aspects that most affected the OHRQoL of child’s family structure were low income and dental caries experience.

Self-Perceptions of the Impact of Oral Problems on the Social Behavior of Preschoolers

Introduction:

Investigating preschool children’s social behaviors and the association with oral health variables helps to understand child development. Besides that, different perceptions need to be explored regarding the impact of oral problems on the social behavior between the child’s self-report and parent’s/caregiver’s proxy report.

Objective:

To determine which socioeconomic and oral factors are associated with difficulty sleeping and playing and the avoidance of smiling in preschoolers.

Methods:

A cross-sectional study was conducted with a representative random sample of 769 pairs of parents/caregivers and 5-y-old preschoolers. The preschoolers answered a questionnaire on difficulty sleeping, difficulty playing, and the avoidance of smiling for reasons related to oral problems. The parents/caregivers answered a questionnaire addressing socioeconomic characteristics as well as the use of dental services. Two calibrated dentists examined the children for the determination of dental caries, traumatic dental injury (TDI), malocclusion, and bruxism. Descriptive and Poisson regression analysis for complex samples with robust variance was used to test the associations (α = 5%).

Results:

The variables associated with difficulty sleeping were low household income (confidence interval [CI]: 1.40–3.01), number of untreated dental caries (CI, 1.02–1.04), dental pain (CI, 1.76–3.59), TDI (CI, 1.08–2.11), and anterior open bite (CI, 1.11–2.20). Difficulty playing also was associated with the low household income (CI, 1.34–3.15), number of untreated dental caries (CI, 1.01–1.04), dental pain (CI,1.42–3.61), and TDI (CI, 1.13–2.33). The number of untreated dental caries (CI, 1.02–1.05), dental pain (CI, 1.03–2.88), anterior open bite (CI, 1.30–3.26), and not using dental services (CI, 1.13–2.73) were determinant factors for the avoidance of smiling.

Conclusion:

Socioeconomic, symptomatic, and/or oral esthetic problems exerted an impact on the social behavior of the preschoolers analyzed, such as playing, sleeping, and smiling.

Knowledge Transfer Statement:

The results of the present study may help parents and clinicians to understand better the association of oral problems with the social behavior of preschool children. Moreover, this study shows the importance of listening to children in clinical decisions. These results also can help in the elaboration of oral health policies.

Risk of Dental Caries in Primary Teeth with Developmental Defects of Enamel: A Longitudinal Study with a Multilevel Approach

The risk of dental caries seems to be greater in the presence of developmental defects of enamel (DDE). The aim was to determine whether the presence of DDE in the primary teeth of preschool children increases the risk of dental caries in the primary dentition after a period of approximately 2 years. This study was conducted in two stages: baseline (T0) and follow-up (T1). At T0, examinations were conducted for the diagnosis of enamel defects using the DDE index (FDI, 1992), dental caries, and oral hygiene. The participants were allocated to two groups according to the presence (affected) or absence (unaffected) of DDE. At the second evaluation (T1), examinations were performed for the diagnosis of dental caries. Poisson regression analysis with a multilevel approach was used to determine the association between DDE and dental caries. The two levels of the analysis were tooth and child. Among the 339 children (113 affected and 226 unaffected) examined at baseline (T0), 325 were re-examined at follow-up (T1). According to the multilevel analysis, teeth with enamel hypoplasia had a greater risk of having dental caries (RR: 1.99; 95% CI: 1.19-3.33). The risk of caries was greater on posterior teeth (RR: 2.59; 95% CI: 2.18-3.07) and maxillary teeth (RR: 1.48; 95% CI: 1.26-1.75) that had DDE at T0. On the child level, dental caries at T1 was associated with having dental caries at T0 (RR: 1.38; 95% CI: 1.32-1.46). In conclusion, enamel hypoplasia and previous dental caries are risk factors for carious lesions in the primary dentition.

Socioeconomic inequalities in oral health-related quality of life in adolescents: a cohort study

PURPOSE

Socioeconomic inequalities are recognized as a major problem with people in low socioeconomic groups having worse subjective oral health outcomes, including oral health-related quality of life (OHRQoL). However, only a few longitudinal studies assessed the impact of contextual and individual socioeconomic determinants in adolescents' OHRQoL. We estimate the impact of socioeconomic inequalities on adolescents' OHRQoL over a 2-year period.

METHODS

This study followed up a random sample of 1134 12-year-old schoolchildren for 2 years in Brazil. OHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11- to 14-year-old Children (CPQ11-14) at baseline and follow-up. Participants were clinically examined for dental caries, gingival bleeding, and malocclusion. The schoolchildren's parents answered a questionnaire regarding socioeconomic status, social capital, and adolescents' use of dental service. Socioeconomic contextual variables were collected from official city publications. Multilevel linear regression models fitted the associations between socioeconomic factors and overall CPQ11-14 scores over time.

RESULTS

A total of 747, 14-year-old adolescents were reassessed for OHRQoL (follow-up rate of 66%). Adolescents with lower mean income school's neighborhood (P < 0.05), household income (P < 0.05), and maternal schooling (P < 0.05) had higher overall CPQ11-14 scores. Female sex, attending a dentist by toothache, dental caries, and malocclusion were also associated with higher overall CPQ11-14 scores.

CONCLUSIONS

Adolescents from low socioeconomic background reported worse OHRQoL at 2-year follow-up compared to those from high socioeconomic background. Actions toward health inequalities need to address socioeconomic factors in adolescence.

Contextual and individual determinants of oral health-related quality of life among five-year-old children: a multilevel analysis

Background

Contextual factors may influence oral health-related quality of life (OHRQoL) in children. The aim of the present study was to evaluate the influence of individual and contextual determinants of OHRQoL based on the perceptions of children.

Methods

A cross-sectional study was conducted with a representative sample of 769 five-year-old children from public and private preschools in a city in the countryside of northeast Brazil. Parents/caregivers answered questionnaires addressing psychological aspects, sociodemographic data and aspects of the child’s oral health. The children answered the child version of the Scale of Oral Health Outcomes for five-year-old children and were submitted to oral examinations. Variables related to the context were obtained from the schools and official municipal publications. Unadjusted and adjusted multilevel Poisson regression models were used to investigate associations between variables.

Results

In the adjusted analysis, parent’s/caregiver’s schooling, household income, parent’s/caregiver’s age, a history of dental pain, dental caries and its consequences and traumatic dental injury were considered individual determinants of OHRQoL according to the children’s self-reports. After the incorporation of the contextual determinants, the association between parent’s/caregiver’s schooling and OHRQoL lost its significance. Type of school was the context variable that remained associated with OHRQoL.

Discussion

Besides the clinical and sociodemographic individual characteristics, characteristics of the school environment in which the child studies are associated with self-reported impacts on OHRQoL.

Impact of oral health literacy on self-reported missing data in epidemiological research

OBJECTIVES

To investigate whether oral health literacy (OHL) impacts missing data obtained through self-reporting in oral health epidemiological research.

METHODS

A cross-sectional study was conducted with parents (n = 344) of 4- to 5-year-old children randomly selected from public schools within the city of Curitiba, Brazil. Parental OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Parents answered a set of questionnaires comprising 88 items concerning sociodemographic and economic data, children's access to dental services, oral hygiene behaviour, diet and mealtime behaviour. The total number of unanswered items (TUI) and the number of unanswered items in each type of question (open-ended, dichotomous, multiple choice with up to 4 options and with 5-9 options) for each participant was compared across different levels of OHL (chi-squared, Mann-Whitney, Kruskal-Wallis and Spearman's correlation test). Multiple Poisson regression was used to estimate rate ratios (RR) of TUI between OHL scores and their respective 95% confidence interval (95% CI).

RESULTS

Approximately one-third of studied parents (37%) exhibited low OHL (BREALD-30 ≤ 21). The prevalence of missing data in at least one item was 85.5%. Low OHL was associated with failing to respond open-ended items (P = 0.003) and multiple-choice items with up to 4 (P = 0.003) and between 5 and 9 options (P = 0.030). There was a negative correlation between OHL scores and TUI (r = -0.195; P < 0.001), as well as with the number of unanswered items in all types of questions (P < 0.01), except dichotomous questions. Parents with lower OHL were more likely to show higher values of TUI (RR 0.95: 0.93-0.98), when adjusted by income and education.

CONCLUSIONS

Participants with lower OHL were significantly more likely to fail to complete research questionnaires. The impact of OHL on missing data was greater with more complex types of items.

Impact of untreated dental caries severity on the quality of life of preschool children and their families: a cross-sectional study

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.

The biological basis of treating jaw discrepancies: An interplay of mechanical forces and skeletal configuration

Jaw discrepancies and malrelations affect a large proportion of the general population and their treatment is of utmost significance for individuals' health and quality of life. The aim of their therapy is the modification of aberrant jaw development mainly by targeting the growth potential of the mandibular condyle through its cartilage, and the architectural shape of alveolar bone through a suture type of structure, the periodontal ligament. This targeted treatment is achieved via external mechanical force application by using a wide variety of intraoral and extraoral appliances. Condylar cartilage and sutures exhibit a remarkable plasticity due to the mechano-responsiveness of the chondrocytes and the multipotent mesenchymal cells of the sutures. The tissues respond biologically and adapt to mechanical force application by a variety of signaling pathways and a final interplay between the proliferative activity and the differentiation status of the cells involved. These targeted therapeutic functional alterations within temporo-mandibular joint ultimately result in the enhancement or restriction of mandibular growth, while within the periodontal ligament lead to bone remodeling and change of its architectural structure. Depending on the form of the malrelation presented, the above treatment approaches, in conjunction or separately, lead to the total correction of jaw discrepancies and the achievement of facial harmony and function. Overall, the treatment of craniofacial and jaw anomalies can be seen as an interplay of mechanical forces and adaptations occurring within temporo-mandibular joint and alveolar bone. The aim of the present review is to present up-to-date knowledge on the mechano-biology behind jaw growth modification and alveolar bone remodeling. Furthermore, future molecular targeted therapeutic strategies are discussed aiming at the improvement of mechanically-driven chondrogenesis and osteogenesis.