Oral health-related quality of life and sense of coherence regarding the use of dental services by preschool children

Utilization of dental services by preschool children: prevalence and associated factors

Dental associations worldwide recommend that the first dental visit should take place before 12 months of age; however, preschoolers' utilization of dental services remains low. The aim of this study was to assess the prevalence of, and factors associated with, dental services utilization among children aged 1 to 3 years. This was a cross-sectional study carried out in the city of Diamantina, MG, Brazil, and involved a sample of 308 child-mother pairs. Mothers completed a questionnaire addressing sociodemographic and economic aspects of the family and characteristics pertaining to their child's oral health. The clinical assessment of the children included dental caries, trauma, malocclusion, and mucosal changes. Analysis of the data comprised statistical description, application of the chi-square test, and Poisson's regression analysis. Among the children studied, 39.6% had attended at least one dental visit in their lifetime. Children whose families had a greater number of members relying on the family's income (PR = 1.40, 95%CI:1.04 -1.89, p = 0.028) and those with moderate/extensive dental caries (Codes 3-6 of the ICDAS; PR = 1.44, 95%CI: 1.08 -1.93, p = 0.014) exhibited a higher prevalence of dental services utilization. In conclusion, the prevalence of dental services utilization among children aged 1 to 3 years was low, and was associated with a greater number of family members relying on the family's income, and with the occurrence of moderate/extensive dental caries.

Individual and Contextual Factors Associated with Adolescents' Self-Perceived Need for Treatment

The present study aimed to investigate associations between the self-perceived dental treatment need and clinical factors, familial characteristics, and school context in adolescents. A cross-sectional study was conducted with a representative sample of 746 students aged 15 to 19 years in a medium-sized city in Brazil. Data collection involved the use of a sociodemographic questionnaire, an oral health questionnaire, and the Family Adaptability and Cohesion Scales (FACES III) instrument. Clinical examinations were performed by two trained and calibrated examiners (Kappa > 0.80) using the Nyvad criteria. A robust logistic regression analysis for complex samples was performed using a multilevel approach (α = 5%). The individual factors associated with the self-perceived treatment need were dental pain (OR = 1.08; 95% CI: 1.01-1.16), the loss of the first molars (OR = 1.09; 95% CI: 1.03-1.15), and disengaged family cohesion (OR = 1.15; 95% CI: 1.01-1.31). In terms of context, attending a public school was associated with the self-perceived treatment need (OR = 1.17; 95% CI: 1.02-1.33). Thus, the individual factors of toothache, tooth loss, and a disengaged family, as well as the school context, exerted an influence on the self-perceived treatment need.

Evaluation of the predictors of oral health-related quality of life among 3-5-year-old children with dental trauma

This study evaluated the influence of socio-demographic, clinical, and parental psychological factors on oral health-related quality of life (OHRQoL) and determined their predictors in preschool-aged children with traumatic dental injury (TDI). The study sample consisted of 324 dyads of children and their parents attending the Clinics of Pediatric Dentistry at Istanbul University. After clinical examination, the Sense of Coherence (SOC), Generalized Self-Efficacy Scale, Early Childhood Oral Health Impact Scale, and Multidimensional Health Locus of Control Scale-MHLC questionnaires were administered to the parents. The statistical analyses included Spearman correlation coefficients, Mann-Whitney U tests, Kruskal-Wallis tests, multiple linear regression, and confirmatory factor analysis. Having mixed TDI, a non-nuclear family, fewer children, and weak parental SOC were important predictors of worse overall OHRQoL and its sections of child and family. Lower internal health locus of control and dental pain due to TDI were predictors of worse overall OHRQoL and child impact, respectively. Consideration of these predictors may help oral health professionals to develop prevention and treatment programs for TDI and oral health literacy programs for families.

Premature Primary Tooth Loss and Oral Health-Related Quality of Life in Preschool Children

The present study aimed to evaluate the association between premature primary tooth loss and oral health-related quality of life (OHRQoL) in preschool children. A cross-sectional study was conducted in 769 5-year-old preschool children. The children and their parents or guardians answered the Brazilian version of the Scale of Oral Health Outcomes for 5-Year-Old Children for the assessment of OHRQoL. Meanwhile, clinical examinations were performed for the assessment of premature primary tooth loss. Unadjusted and adjusted multilevel Poisson regression models were utilized to investigate the associations between the variables. In the parental version of the scale, premature posterior primary tooth loss (rate ratio [RR] = 2.65; 95% confidence interval [CI] = 1.51-4.68), weak sense of coherence (RR = 2.25; 95% CI = 1.62-3.11), and visit to a dentist (RR = 1.61; 95% CI = 1.04-2.52) were associated with OHRQoL. Based on the children's perceptions, only the preschool type was associated with OHRQoL (RR = 1.92; 95% CI = 1.21-3.05). Premature posterior primary tooth loss had a greater impact on OHRQoL based on the parents' perception, whereas only the preschool type was associated with OHRQoL based on the children's perception.

Impact of oral health literacy and psychoactive substances on tooth loss in adolescents

The aim of the present study was to investigate associations between tooth loss, and oral health literacy, the use of multiple psychoactive substances, and the reason for the last dental appointment in adolescents. A cross-sectional study was conducted with a representative sample of 746 adolescents aged 15 to 19 years in Campina Grande, Brazil. Parents/guardians answered a sociodemographic questionnaire. The adolescents answered the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), the Alcohol, Smoking and Substance Involvement Screening Test, and an oral health questionnaire from the National Oral Health Survey. The adolescents were then examined by two examiners who had undergone training and calibration exercises for the diagnosis of tooth loss due to caries (K> 0.80). Associations between variables were investigated using robust logistic regression analysis for complex samples (α = 5%). The prevalence of tooth loss was 17.4%. Oral health literacy (OR = 0.93; 95% CI: 0.89-0.97) was inversely associated with tooth loss, while multiple psychoactive substance use (OR = 2.01; 95% CI: 1.09-3.69) and last dental visit for treatment/symptoms (OR = 3.05; 95% CI: 1.73-5.36) were directly associated with tooth loss. Oral health literacy, multiple psychoactive substance use, and reason for last dental appointment exerted an influence on tooth loss among adolescents.

Impact on oral health-quality of life in infants: Multicenter study in Latin American countries

To assess the impact of oral conditions on oral health-related quality of life (OHRQoL) in infants in ten Latin America countries (LAC). A cross-sectional study was conducted with 930 pairs of 1-to-3-year-old children/parents from 10 LAC, as a complementary study of the Research Observatory for Dental Caries of the Latin American Region. The scale ECOHIS, previously tested and valid in ten countries, was applied to parents/caregivers of children to measure OHRQoL. Statistical analysis included descriptive data analysis and one-way analysis of variance (ANOVA-One-Way) were performed to compare age groups with OHRQoL. Bootstrapping procedures (1000 re-samplings; 95%CI Bca) were performed. The mean scores of the ‘Child Impact’ section in the LAC was 4.0(±8.3), in the ‘Family Impact’ section was 2.0(±4.0), and in overall ECOHIS score was 6.0(±12.0). In the ‘Child Impact’ section, Argentina 10.0(+2.4) and Venezuela 17.8(±17.5) demonstrated mean scores higher than the LAC total data. In the ‘Family Impact’ section, the countries with higher mean scores were Argentina 4.9(±2.0), Ecuador 2.1(±3.1) and Venezuela 7.9(±7.8). In the overall ECOHIS score, Argentina 15.1 (±4.1) and Venezuela 25.7(±25.2) has higher mean scores than the values of LAC. There is an association between children's age and parents' report of impact on the OHRQoL (p<0.001). Three-year-olds had a higher mean when compared to one- and two-year-olds, both in the Impact on the Child and Impact on the Family (p<0.001) sections, as well as in the overall ECOHIS (p<0.001). In conclusion, there are differences in OHRQoL among Latin American countries, impacting older children more significantly.

Association Between Sense of Coherence and Periodontal Outcomes: A Systematic Review and Meta-analysis

This systematic review and meta-analysis aimed to evaluate the association between sense of coherence (SOC) and periodontal outcomes. Electronic searches were performed in 6 databases. Seventeen studies that evaluated the association between SOC and periodontal outcomes were included. The included studies demonstrated that individuals with a stronger SOC were more likely to present improved periodontal outcomes. The meta-analysis showed that individuals with a lower SOC were 3.31 times more likely to present bleeding on probing. Sons/daughters of mothers with a lower SOC were 3.22 times more likely to present gingival bleeding. Individuals with a stronger SOC have better periodontal health.

Salutogenesis in oral health research in preschool children: A scoping review

BACKGROUND

Oral health research in children has focused both on identifying the risk factors for dental caries and on the impact the disease has on children's life.

AIM

Identifying studies that used the salutogenic theory to investigate positive aspects to promote a healthy condition in preschool children.

DESIGN

A literature scoping review was conducted to answer the question: 'What has been produced in scientific literature about children's oral health with a salutogenic theoretical reference?' The checklist preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) was applied. The research was conducted on the databases PubMed, Scopus, and Web of Science with no language, design, country or date restrictions. Three independent reviewers selected the studies to be included in the research, extracted data, and assessed the studies' contribution to the review.

RESULTS

Among the 38 studies retained, 10 were included, those were published between 2009 and 2018: five in Brazil, two in the United States of America, and one in Canada, China and India, respectively. All articles were published in English language. Nine studies investigated the relation between the parents'/caretakers' sense of coherence and aspects related to the children's oral health condition. One study investigated health factors among the parents of caries-free children.

CONCLUSION

Salutogenic orientation must be included in oral health research, so that salutary and risk factors may coexist, contributing to a new perspective for oral health promotion among children.

Longitudinal evaluation of determinants of the clinical consequences of untreated dental caries in early childhood

OBJECTIVES

This study aimed to evaluate whether the trajectory of family income, parental education and clinical variables are associated with the clinical consequences of untreated dental caries among children.

METHODS

A prospective cohort study was conducted with 439 children between one and three years of age, evaluated at baseline and re-evaluated after three years. Sociodemographic and economic variables, untreated dental caries and biofilm were investigated both at baseline and at the 3-year follow-up. The pufa index (pulpal involvement, ulceration, fistula and abscess) was used to diagnose the clinical consequences of untreated dental caries.

RESULTS

The prevalence of pufa ≥1 was 18.2% in the follow-up. The following variables were associated with a higher risk of clinical consequences of untreated dental caries: mother's low schooling level at baseline and follow-up (RR = 1.51; 95% CI: 1.04-2.18), incidence or baseline presence of biofilm (RR = 4.66; 95% CI: 2.02-10.74), cavitated dental caries at baseline (RR = 3.57; 95% CI:1.86 to 6.83) and incidence of cavitated dental caries (RR = 2.04; 95% CI: 1.24-3.35).

CONCLUSION

Low maternal schooling level, biofilm, cavitated dental caries at baseline, and incidence of dental caries were the factors determining the consequences of untreated dental caries.

Mother's sense of coherence and dental characteristics in children and adolescents with osteogenesis imperfecta: A paired study

BACKGROUND

The relevance of sense of coherence (SOC) is important to the wellbeing of parents, especially mothers of children and adolescents with osteogenesis imperfecta (OI).

OBJECTIVE

Determine whether the oral health status of children/adolescents with OI is associated with mother's SOC.

MATERIALS AND METHOD

A paired cross-sectional study was conducted with 37 children/adolescents with OI, 37 without OI, and their respective mothers. The children/adolescents were between two and 19 years of age, mean age 7.2 years, being 47 male and 27 female. The mothers completed Antonovsky's SOC questionnaire (SOC-13), and the oral status of the children/adolescents was investigated. The following clinical conditions were evaluated: dentinogenesis imperfecta, malocclusion, gingivitis, and dental caries experience.

RESULTS

The genetic condition of the children was significantly associated with mother's SOC (P < .001). Mothers of children with OI had lower SOC scores (mean: 35.6 [± 4.9]) than mothers of children without OI (mean: 38.5 [± 4.3]). In the group with OI, a low socioeconomic status was associated with lower mother's SOC scores (P = .004). In both groups, dental caries experience was associated with lower mother's SOC scores (P = .007). Most individuals with OI presented malocclusion (78.3%) and experience of dental caries (59.4%).

CONCLUSION

Having a child with OI influenced the sense of coherence of the mothers. Socioeconomic status and dental caries experience in children and adolescents with OI were associated with mother's SOC.

Global and regional estimates of dental pain among children and adolescents-systematic review and meta-analysis

AIM

We aimed to evaluate the pooled prevalence of dental pain amongst children and adolescents.

METHODS

Studies conducted in children and adolescents up to18 years of age and where prevalence of dental is reported or calculated were included. Search was performed in four major databases from inception to June 1st, 2019. Prevalence estimate at the maximal recall for the dental pain for the individual study was used to calculate the overall pooled estimate.

RESULTS

The prevalence of dental pain ranged from 1.33 to 87.8% in the included publications for quantitative synthesis (n = 97). More than half of the publications reported the lifetime prevalence of dental pain (n = 51) while few studies reported the current prevalence of dental pain (n = 3) and only one study evaluated the dental pain in the past one week. Heterogeneity was high among the included publications (Q = 49,063.12; P < 0.001; df = 96 and I² = 99.8; P < 0.001). Overall pooled prevalence of dental pain was 32.7 (CI = 29.6-35.9). No difference was seen with respect to the trends in prevalence of dental pain (Coefficient: 0.005; 95% CI - 0.001-0.011; P-value: 0.101).

CONCLUSION

Two out of ten children below five years, four out of ten children between 6 and 12 years and three out of ten adolescents between 13 and 18 years would have experienced pain in the past. Overall, three out of ten children or adolescents might have experienced dental pain in the past. There was no difference in the pain prevalence between male and females. Studies from Africa reported highest pooled prevalence (50.1%) with least being from Australia (20.7%). Studies from India (40.4%), China (41.3%) and Iran (42.6%) reported high pooled prevalence estimates of dental pain.

Can children's oral hygiene and sleep routines be compromised during the COVID-19 pandemic?

BACKGROUND

During COVID-19 pandemic, children are confined at home, with changes in family routines.

AIM

Evaluate sleep disorders among Brazilian and Portuguese children during social distancing, and its association with parental perception of child's oral hygiene.

DESIGN

In this cross-sectional study, Portuguese and Brazilian parents/caregivers of 3- to 15-year-old children, practicing social distancing due to COVID-19 pandemic, answered an online questionnaire, from April 24-26, 2020, evaluating sociodemographic characteristics, child's school activities online, child's sleep quality during social distancing. Two questions from the questionnaire, developed based on previous studies, evaluated the parental perception of child's oral hygiene quality and routine changes during social distancing. Parents/caregivers answered five domains of the Portuguese-language version of the Sleep Disturbances Scale for Children, evaluating sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence and sleep hyperhidrosis. Descriptive, Linear-by-linear association, Kruskal-Wallis and post hoc analysis were performed (P ≤ .05).

RESULTS

Participated in the study 253 parents/caregivers, 50.2% from Brazil. Most parents (72.2%) reported changes in child's routine during social distancing. Sleep breathing disorders (P = .019), sleep-wake transition disorders (P = .022), and disorders of excessive somnolence (P < .001) were associated with poor oral hygiene during social distancing.

CONCLUSION

Sleep disorders are associated with poor oral hygiene during social distancing.

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.

DOES DENTAL TRAUMA IN EARLY CHILDHOOD HAVE THE POTENTIAL TO AFFECT THE QUALITY OF LIFE OF CHILDREN AND FAMILIES?

OBJECTIVE

To evaluate the influence of dental trauma on oral health-related quality of life (OHRQoL) of children and their families.

METHODS

A total of 571 children aged five years were randomly selected at public schools. Trauma was clinically evaluated in accordance with the Andreasen classification. Caries experience in the anterior region and increased overjet were determined according to the World Health Organization criteria. The Early Childhood Oral Health Impact Scale (ECOHIS) was answered by the parents and used to evaluate OHRQoL. In addition, this questionnaire has aspects related to socioeconomic status. Simple logistic regression was performed, and the raw Odds Ratios with the respective 95% confidence intervals (95%CI) were estimated. The variables with p<0.20 were tested in multiple logistic regression models, and those with p≤0.05 remained in the model and the adjusted odds ratio with respective 95%CI was estimated.

RESULTS

Income showed a magnitude of association of 1.56 and 2.70 with the OHRQoL of children and families, respectively. The avulsion variable showed 9.65- and 8.25-times greater chance of influencing the OHRQoL of children and families, respectively. The experience of caries showed 3.80- and 2.42-times greater chance of influencing the OHRQoL of children and families, respectively.

CONCLUSIONS

Dental trauma did not influence OHRQoL of children and their families negatively. However, avulsion and caries experience in low-income families was associated with a negative perception of OHRQoL.

Patient-centered assessments: how can they be used in dental clinical trials?

Recently, there has been greater interest in adopting a more holistic approach to healthcare. However, this trend should not limit itself merely to the notion that a human being lies behind the mouth being treated. Rather, it should embrace the understanding that this human can actively participate in and contribute to the treatment process. Patient Report Outcome Measures (PROMs) and Patient Report Experience Measures (PREMs) provide means for measuring data from the patient's perspective, and enable health-related feelings and functions to be evaluated. Accordingly, this critical review aims to provide definitions, rationales and applications of patient-centered approaches in dental clinical research. Some patient-centered constructs are especially relevant to dental clinical trials, such as oral health-related quality of life, pain/discomfort, aesthetics and satisfaction concerning treatment and services. The selection and application of patient-reported measures can vary according to condition (generic, disease-specific or treatment-specific) and to the specific population evaluated (age and cognitive impairment). These measures can help weigh risks and benefits, as well as assess the cost effectiveness of treatments, thus influencing treatment recommendations and health policies. The incorporation of these measures into a professional's daily life not only represents an improvement in professional performance, but also addresses a humanitarian concern.

Oral status, sense of coherence, religious-spiritual coping, socio-economic characteristics, and quality of life in young patients

BACKGROUND

Several factors can influence the oral health.

AIM

To explore the clinical factors, individual characteristics, and environmental factors (religious-spiritual coping-RSC, sense of coherence [SOC], and socio-economic status) related to oral status and impact on oral health-related quality of life (OHRQoL) of children/adolescents (C/A).

DESIGN

This study evaluated C/A up to 15 years old and their caregivers. Number of decayed (NDT) and missing teeth (NMT); history of dental trauma; caregiver's RSC and SOC, socio-economic factors, and OHRQoL were evaluated. Theoretical model exploring the direct and indirect effects was tested using a structural equation analysis.

RESULTS

For younger group (0-6 years), having more NDT or more NMT had a greater impact on the OHRQoL (β = 0.382, β = 0.203, respectively). In the oldest group (7-15 years), a higher SOC had an inverse relationship with the impact on the family OHRQoL (β=-0.201). The higher the age of the C/A, the lower the NDT (β=-0.235), and the higher the family income the lower, the need for social benefit (β = 0.275). Indirect relationships were observed between schooling with social benefit and OHRQoL in younger group. The family income indirectly influenced the OHRQoL in oldest group.

CONCLUSIONS

Quality of life is affected directly and indirectly by environmental characteristics, oral status, and the age of patients.

Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children

Objectives

Dental caries is the most common chronic childhood disease that occurs in a continuum and can be prevented by children and their parents’ adherence to recommended oral health behaviors. Theory-driven tools help practitioners to identify the causes for poor adherence and develop effective interventions. This study examined the Expanded Theory of Planned Behaviour (TPB) Model by adding the concept of Sense of Coherence (SOC) to predict parental adherence to preschooler’s preventive dental visits.

Methods

Data regarding socio-economic demographics were collected from parents of children aged 2–6 years. Constructs of TPB including parental attitudes, subjective norms (SN), Perceived Behavioural Control (PBC), and intention to attend preventive dental visits for their preschoolers were collected by questionnaire, alongside parents’ sense of coherence (SOC). Dental attendance was measured by asking if the child had a regular dental visit during the last year. Structural Equation Modeling Analysis (SEMA) was carried out to identify significant direct and indirect (mediated) pathways in the extended TPB model.

Results

Three hundred and seventy-eight mothers (mean age = 34.41 years, range 22–48) participated in the study. The mean age of children was 3.92 years, range: 2–6), and 75.9% had dental insurance. Results of the final model showed that predisposing factors (child’s birthplace and mother’s birthplace) significantly predicted enabling resources (family monthly income and child’s dental insurance status); both predicted the TPB components (PBC, SN, and attitude). TPB components, in turn, predicted behavioural intention. However, contrary to expectation, intention did not significantly predict dental attendance in the past 12 months. Parent’s SOC significantly predicted TPB components and dental attendance. Overall, 56% of the variance in dental attendance was explained by the expanded TPB model.

Conclusions

The expanded TPB model explained a great deal of variance in preschooler’s dental attendance. These findings suggest that the expanded model could be used as the framework for designing interventions or strategies to enhance dental attendance among preschoolers; in particular, such strategies should focus specifically on enhancing parental SOC including empowerment.

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.

Trends in use of dental services by Brazilian pre-school children considering Age-Period-Cohort Effect

BACKGROUND

Besides the growth in Brazilian public oral health investments, no pre-school children preventive policies were done, and surveys demonstrated lower prevalences of use of dental service.

AIM

To verify trends in the use, type, and reason for seeking dental services among pre-school children considering time variations.

METHODS

This study used data of clinical examinations and structured interviews of three cross-sectional surveys of southern pre-school children in Brazil, from 2008, 2010, and 2013. Chi-square test for trends and hierarchical age-period-cohort (HAPC) analysis using the multilevel Poisson regression model assessing the influence of social and clinical variables in the use, type, and reason for seeking dental services were performed.

RESULTS

A total of 1765 pre-school children participated in all surveys. At least, one time-related variation affected one of three assessed outcomes. There was no significant change in prevalence of the use of dental services (75.8%, 77.4%, and 74.9%, respectively, for each year; P = 0.750). In the HAPC analysis, younger children and from low socio-economic backgrounds were less likely to have visited the dentist.

CONCLUSION

The prevalence of use of oral health services did not change and socio-economic inequalities persisted through the years, indicating a need of reviewing the policies to promote public health.

Association between psychological factors, socio-demographic conditions, oral habits and anterior open bite in five-year-old children

OBJECTIVE

The aim of the present study was to evaluate association between psychological factors, socio-demographic conditions, oral habits and anterior open bite in five-year-old preschool children.

MATERIALS AND METHODS

A cross-sectional study was conducted with 764 pairs of children and parents/caregivers in preschools. The parents/caregivers answered questionnaires addressing oral health-related quality of life (OHRQoL), sense of coherence, locus of control, oral habits and socio-demographic characteristics. The children answered a self-report questionnaire addressing OHRQoL and were submitted to a clinical examination for the anterior open bite by examiners. Descriptive analysis was conducted, followed by Poisson's regression analysis.

RESULTS

The prevalence of anterior open bite was 15.2%. The following variables remained significantly associated with anterior open bite: pacifier use (PR = 7.09; 95% CI: 4.06-12.39), attending a public preschool (PR = 2.40; 95% CI: 1.68-3.43), digit sucking (PR = 2.15; 95% CI: 1.27-3.62), greater number of residents in the home (PR = 1.67; 95% CI: 1.18-2.36) and impact on OHRQoL according to child's report (PR = 1.56; 95% CI: 1.11-2.20).

CONCLUSIONS

Anterior open bite was associated with OHRQoL according to the children's reports. Moreover, attending a public preschool, a greater number of residents in the home, digit sucking and pacifier sucking were associated with this type of malocclusion.

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 Caries Severity/Activity and Psychological Aspects of Caregivers on Oral Health-Related Quality of Life among 5-Year-Old Children

The aim of the present study was to evaluate the influence of the severity/activity of dental caries as well as sense of coherence (SOC) and locus of control (LOC) on oral health-related quality of life (OHRQoL) among 5-year-old children. A cross-sectional study was conducted involving 769 children at schools in a city in northeast Brazil. Parents/caregivers answered validated questionnaires addressing SOC and LOC. The children and parents/caregivers answered their respective modules of the Brazilian version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). Data were also collected on sociodemographic characteristics, visits to the dentist, and the occurrence of toothache. Clinical examinations were performed by 2 trained examiners. A directed acyclic graph was used to select covariates for statistical adjustment, and logistic regression for complex samples was used to test associations between the dependent and independent variables (α = 5%). For parents/caregivers, the variables associated with a negative impact on OHRQoL were the occurrence of toothache (odds ratio, OR: 10.53; 95% confidence interval, CI: 6.34-17.51; p < 0.001) and a low SOC (OR: 2.17; 95% CI: 1.37-3.43; p = 0.001). According to the children's perceptions, the following variables were associated with a negative impact on OHRQoL: toothache (OR: 3.58; 95% CI: 2.30-5.55; p < 0.001), caries activity (OR: 1.97; 95% CI: 1.07-3.62; p = 0.028), and traumatic dental injury (OR: 1.71; 95% CI: 1.15-2.53; p = 0.007). Among parents/caregivers, a low SOC led to poorer OHRQoL. For the children, however, neither psychological aspect affected OHRQoL. In the perception of both the parents/caregivers and children, toothache was the oral condition that exerted a negative impact on OHRQoL.

Perception of parents and self-reports of children regarding the impact of traumatic dental injury on quality of life

BACKGROUND/AIM

Traumatic dental injuries occur frequently among young children. The aim of this study was to evaluate the impact of traumatic dental injuries on oral health-related quality of life (OHRQoL) in preschool children using the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5).

MATERIALS AND METHODS

This study involved 769 five-year-old children enrolled at public and private preschools. Two examiners underwent a training process which involved the determination of interexaminer and intra-examiner agreement (Kappa statistic) for all clinical conditions (K > 0.82). Descriptive statistics were performed, followed by Poisson regression analysis (α = 5%).

RESULTS

The prevalence of the impact of oral problems on OHRQoL was 32.9% and 42.2% according to the parents/caregivers and children, respectively. Based on the children's self-reports, the occurrence of two or more injured teeth (PR = 1.30; 95% CI: 1.04-1.64), toothache (PR = 1.68; 95% CI: 1.35-2.09), and a low level of parent's schooling (PR = 1.54; 95% CI: 1.24-1.91) exerted impacts on OHRQoL. For the reports of parents/caregivers, the occurrence of non-complicated TDI (PR = 0.66; 95% CI: 0.44-0.98), toothache (PR = 8.03; 95% CI: 5.92-10.88), and a low level of parent's schooling (PR = 1.60; 95% CI: 1.17-2.17) remained associated with the final model.

CONCLUSIONS

The impact of oral problems on the OHRQoL of the preschool children was high. A greater number of injured teeth, the presence of toothache, and socioeconomic factors were associated with poorer OHRQoL, based on the reports of both the parents/caregivers and the children. The occurrence of non-complicated TDI was a protective factor for OHRQoL.