Dental pain and care-seeking in 11-14-yr-old adolescents in a low-income country

Contextual and individual factors associated with dental pain in adolescents from Southeastern Brazil

The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to determine the pooled prevalence of toothache in children and adolescents and to verify its association with sociodemographic characteristics and dental caries experience.

MATERIAL AND METHODS

Six main and three grey literature databases were searched in February 2021. Observational studies that assessed the prevalence of toothache and associated factors were included. The methodological quality of the studies was evaluated following the guidelines by Fowkes and Fulton. Proportion and association meta-analyses were performed in MedCalc and Revman software, respectively. The certainty of the evidence was determined with the GRADE approach.

RESULTS

Seventy-one studies met the inclusion criteria. Thirty-two presented high methodological quality and a low risk of bias. The overall pooled prevalence of toothache in children and adolescents was 36.2% (95%CI: 33.0-39.42; I²: 99.72%; P < 0.001). Females (OR: 1.17; 95%CI: 1.08-1.26; I²: 91%; P < 0.001) and children and adolescents whose caregivers had ≤ 8 years of schooling (OR: 1.42; 95%CI: 1.30-1.56; I²: 77%; P < 0.001) presented the higher chance of reporting toothache. Dental caries experience increased the chance of reporting toothache in 3.49 times (95%CI: 2.70-4.51; I²: 92%; P < 0.001). The certainty of the evidence was very low.

CONCLUSIONS

The overall pooled prevalence of toothache was considered high. Sociodemographic characteristics (sex and caregivers' educational level) and previous dental caries experience were significantly associated with toothache reports.

CLINICAL RELEVANCE

Toothache is still a recurrent issue in many countries. Thus, it is essential to understand its possible associated factors to reduce the occurrence of new episodes.

Racial variations in tooth pain and care-seeking in adolescents in Malaysia

Objective

Tooth pain among adolescents is a common event that impacts substantially on quality of life. The purpose of this paper is to explore the role of race in the tooth pain experience and associated care-seeking.

Design

A cross-sectional questionnaire survey was conducted on 14–18 years from four different public schools in Kuala Lumpur. Socio-demographic, pain symptoms, and social impacts data were collected as well as medication use and visiting a dentist for tooth pain.

Results

Of 1473 questionnaires distributed, 1452 (98.6%) completed questionnaires were returned, with 269 (18.5%) reported having experienced tooth pain in the past 1 month. Those who identified as Indian (26.1%) were more likely to report tooth pain compared to Chinese (16.5%) and Malay (20.9%). In regression analysis, no factors were identified as independently associated with medication use, but Chinese and Indians compared to Malays, and those expressing difficulty sleeping were more likely to report visiting a dentist for treatment.

Conclusion

Racial variations in the tooth pain experience and care-seeking have been identified. This may be related to socio-economic status, but further research is needed on the role of culture-related care-seeking and accessibility of dental services.

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.

Development and evaluation of CARIES-QC: a caries-specific measure of quality of life for children

BACKGROUND

Existing paediatric oral health-related quality of life (OHRQoL) measures are generic instruments designed to evaluate a range of oral conditions. It has been found that disease-specific measures may be more adept at detecting subtle changes which occur following treatment of the condition in question. Furthermore, existing self-report OHRQoL measures have not involved children at all stages of development of the measure. The aim of this study was to develop a caries-specific measure of quality of life for children.

METHODS

The first stage of the study involved a qualitative enquiry with children, aged 5-16 years, to inform the development of the measure. Children generated the potential items, contributed to item reduction and questionnaire design and participated in the testing of face and content validity. The resulting measure was evaluated in a cross-sectional validation study. Ethical approval was granted for the study.

RESULTS

The qualitative study found that children discussed a number of caries-related impacts which affected their daily lives. These were incorporated into a draft measure which was further refined following testing of face and content validity. This resulted in the production of the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC), comprising 16 items and one global question. Two hundred participants with a mean (range) age of 8.1 (5-16) years took part in the further evaluation of CARIES-QC. Four items, which did not fit the Rasch model, were removed from further analysis. The remaining 12 items demonstrated good internal consistency (alpha = 0.9) and the total score showed significant correlations with the number of decayed teeth, presence of pain, pulpal involvement, the Child Perceptions Questionnaire (16-item short form) and the global score (p < 0.01, Spearman's rho).

CONCLUSION

In conclusion, children's input allowed the development of a valid and reliable child-centred caries-specific quality of life measure. CARIES-QC can now be used to evaluate which interventions for dental caries are most effective in reducing impacts from the child's perspective.

Chronic Pediatric Pain in Low- and Middle-Income Countries

Chronic pain is a serious health concern and potentially debilitating condition, leading to anxiety, depression, reduced productivity and functionality, and poor quality of life. This condition can be even more detrimental and incapacitating in the pediatric patient population. In low- and middle-income countries (LMICs), pain services are often inadequate or unavailable, leaving most of the world’s pediatric population with chronic pain untreated. Many of these children in LMICs are suffering without treatment, and often die in pain. Awareness and advocacy for this population must be prioritized. We reviewed the available literature on the chronic pediatric pain burden in LMICs, barriers to treatments, and current efforts to treat these patients.

Impact of oral hygiene and socio-demographic factors on dental caries in a suburban population in Nigeria

AIM

This was to determine dental caries determinants in the study participants.

METHODOLOGY

This was a secondary data study extracted from primary data through a school-based study that recruited students from primary and secondary schools in a suburban population in Nigeria. The variables included age, gender, socio-economic status, oral hygiene status, type of parenting, birth rank, family size and presence of dental caries. The diagnosis of dental caries was based on the World Health Oral Health Survey recommendations while oral hygiene was determined using simplified-oral hygiene index (OHI-S). Data was analysed using STATA version 13, statistical significance was set at P < 0.05.

RESULTS

The prevalence of dental caries for the study population was 12.2%, DMFT and dmft were 0.16 and 0.06 respectively. Children within age groups 11-13 and 14-16 years had reduced chances of having dental caries (P = 0.01; P = 0.01); children with fair oral hygiene and poor oral hygiene had increased odds of having dental caries (P ≤ 0.001; P ≤ 0.001), last child of the family also had increased odds of having dental caries while children from large family size had reduced odds of having dental caries. This study also showed that first permanent molars and second primary molars were mostly affected by dental caries but there was no significant difference between distribution of the maxillary or mandibular jaw or between right and left quadrants.

CONCLUSION

Age, oral hygiene, birth rank and family size were the significant determinants of dental caries in the study population and the teeth mostly affected were first permanent molars and second primary molars.

Do children's previous dental experience and fear affect their perceived oral health-related quality of life (OHRQoL)?

Background

Oral health-related quality of life (OHRQoL) has been used to describe the consequences of oral health conditions and treatments in children. A better understanding of OHRQoL and its relationship with dental fear and previous dental experience is necessary to improve children’s oral health status. The aim of this study was to investigate the association of dental history and experience with dental fear and the OHRQoL of children aged 11 to 14 years.

Methods

A cross-sectional study was conducted using a multi-stage stratified sample of 1,312 middle school children. Information regarding OHRQoL was collected from the children using the Child Perceptions Questionnaire (CPQ_11–14), and information regarding dental fear was collected using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS). Information on past dental experiences and sociodemographic data were collected from the parents using self-administered questionnaires. Dental examinations were performed to assess caries experience.

Results

The multivariable model indicated that dental fear was the strongest predictor of OHRQoL as the fearful children had on average CPQ_11–14 scores that were 10 units higher than those of the non-fearful children. Regarding past dental experience, pain as the reason for the most recent dental visit was associated with poor OHRQoL, while receiving a filling during the previous dental visits was significantly associated with better OHRQoL. In addition, a larger number of siblings, a lower family income, a lower paternal education level, health problems and prior hospitalization were significantly associated with poor OHRQoL.

Conclusion

This study identified that dental fear and some factors related to previous dental experience are associated with OHRQoL. In dental practice, children with dental fear should be identified, guided and treated early to avoid deterioration of their OHRQoL.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-017-0338-9) contains supplementary material, which is available to authorized users.

Assessment of pain among a group of Nigerian dental patients

Background

Pain is considered a key symptom associated with possible impairment of oral-health-related quality of life and its assessment is important for the planning and evaluation of preventive and treatment effort. The tools for assessing pain must therefore be valid and consistent. The objective of this study was to assess dental patients’ level of pain based on the clinical diagnosis of their dental condition and the correlation between two pain assessment scales, Visual analogue scale (VAS) and the Full Cup Test (FCT), for the assessment of pain among dental patients.

Methods

A total of 185 patients presenting at the University of Benin Teaching Hospital dental outpatient clinics with various forms of orofacial pain were included in this study. The mean VAS scores and mean FCT scores for the different dental conditions were compared. Agreement between VAS and FCT was evaluated using the Intra-class correlation (ICC) coefficients and Cronbach alpha coefficient was also calculated to assess consistency of the two pain scales.

Results

Majority i.e. 95.1, 96.2 and 100% who presented with acute pulpitis, acute apical periodontitis and pericoronitis respectively, presented with moderate to severe pain levels (p < 0.05). Only 25.9 and 4% who presented with chronic marginal gingivitis and chronic pulpitis respectively presented with no pain (p < 0.05). A large proportion (75%) of patients with no pain had single diagnosis while more than half (52.1%) of those who presented with severe pain had multiple diagnoses (p = 0.025). The mean VAS and FCT scores for acute pain were 6.1 ± 2.1 and 5.9 ± 2.4 respectively and for chronic pain 3.9 ± 2.7 and 3.7 ± 2.7 respectively (P = 0.001). The interclass correlation coefficient revealed that the mean VAS and FCT scores were statistically correlated and reliable with a Cronbach alpha coefficient of 0.85.

Conclusion

It can be concluded that patients who presented with either acute or chronic dental conditions may experience moderate to severe level of pain, with patients with multiple diagnoses experiencing more severe pain, and there is a correlation between the VAS and FCT for pain assessment among dental patients.

Children’s Oral Health: The Opportunity for Improvement Using the WHO Health Promoting School Model

The health and quality of life of a large proportion of the world’s children are compromised by dental caries and periodontal disease. Those in developing countries and from disadvantaged populations suffer disproportionately from these forms of poor oral health; however, much of the primary disease and secondary pathology is preventable by simple and inexpensive measures that children can readily learn. WHO health promoting schools (HPS) are an established model for addressing public health issues through education of children in a manner that achieves acquisition of knowledge and health practices that promote behaviours that positively impact determinants of health. HPS programs that address poor oral health have achieved improvement in oral health practices and reduction in caries rates among disadvantaged populations of children. WHO has called for more programs to address the “epidemic” of poor oral health worldwide, and the WHO HPS model appears to be a relevant and applicable way forward. Health care professionals and educators who want to improve the health and quality of life of children related to caries and periodontal disease now have an opportunity to collaborate to initiate, deliver, and evaluate community-based HPS interventions using proven concepts, content, and process.

Oral impacts on daily performances and recent use of dental services in schoolchildren

OBJECTIVES

To explore whether oral impacts on daily performances are related to recent use of dental services among children and whether oral impacts on specific daily performances are more strongly related to recent use of dental services.

METHODS

Data from a cross-sectional survey, including 805 11-12-year-old children attending four randomly selected schools in Lima (Peru), were used. The child version of the oral impacts on daily performances (Child-OIDP) was used to assess prevalence, intensity, and extent of oral impacts. Use of dental services was assessed by self-reports of last dental visit and reason for the visit. Associations of the prevalence, intensity, and extent of oral impacts with use of dental services were tested in logistic regression models.

RESULTS

Children with oral impacts were 1.99 (95% CI: 1.17-3.37) times more likely to have used dental services recently than their counterparts. The intensity and extent of oral impacts were linearly associated with children's use of dental services. Difficulties in eating were the only type of oral impacts on daily performances associated with use of dental services, independent of children's demographic characteristics, and impacts on other performances.

CONCLUSION

Oral impacts on daily performances were related to recent use of dental services among these schoolchildren.

[Sociodemographic and clinical aspects of quality of life related to oral health in adolescents]

OBJECTIVE

To estimate the prevalence and to identify sociodemographic and oral health factors associated with the negative impact of oral health conditions on the quality of life in adolescents.

METHODS

Data from 5,445 adolescents aged 15-19, who took part in the Brazilian Oral Health Survey (SBBrasil 2010) were analyzed, using a multistage sampling design. The outcome was quality of life related to oral health, which was assessed using the Oral Impacts on Daily Performance questionnaire and analyzed as a discrete variable. The independent variables were sex, skin color, schooling, household income, age, untreated dental caries, malocclusion.,gingival bleeding, dental calculus, and periodontal pocket. Poisson regression analysis was carried out and mean ratios (MR) with their respective 95% confidence intervals (95%CI) were presented.

RESULTS

Of the total, 39.4% reported at least one negative impact on their quality of life. After adjustment, the mean negative impact was 1.52 (95%CI 1.16;2.00) times higher in females and 1.42 (95%CI 1.01;1.99), 2.66 (95%CI 1.40;5.07) and 3.32 (95%CI 1.68;6.56) higher in those with brown, yellow, and indigenous skin color, respectively, when compared to those with white skin. The lower the level of schooling, the greater the negative impact (MR 2.11, 95%CI 1.30;3.41), likewise for individuals with household income below R$ 500.00 (MR 1.84, 95%CI 1.06;3.17) compared with those with higher incomes. The greatest impact on quality of life was found among adolescents with four or more teeth with untreated dental caries (MR 1.53, 95%CI 1.12;2.10), one or more missing teeth (MR 1.44. 95%CI 1.16;1.80). those with dental pain (RM 3.62, 95%CI 2.93;4.46) and with severe (MR 1.52, 95%CI 1.04;2.23) and very severe malocclusion (MR 1.32, 95%CI 1.01;1.72).

CONCLUSIONS

Brazilian adolescents reported a high negative impact of oral health on their quality of life. Inequalities in distribution should be taken into account when planning preventive, monitoring and treatment strategies for oral health problems in groups with the highest impact on their quality of life.

Assessment of the quality of measures of child oral health-related quality of life

Background

Several measures of oral health-related quality of life have been developed for children. The most frequently used are the Child Perceptions Questionnaire (CPQ), the Child Oral Impacts on Daily Performances (C-OIDP) and the Child Oral Health Impact Profile (COHIP). The aim of this study was to assess the methodological quality of the development and testing of these three measures.

Methods

A systematic search strategy was used to identify eligible studies published up to December 2012, using both MEDLINE and Web of Science. Titles and abstracts were read independently by two investigators and full papers retrieved where the inclusion criteria were met. Data were extracted by two teams of two investigators using a piloted protocol. The data were used to describe the development of the measures and their use against existing criteria. The methodological quality and measurement properties of the measures were assessed using standards proposed by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) group.

Results

The search strategy yielded 653 papers, of which 417 were duplicates. Following analysis of the abstracts, 119 papers met the inclusion criteria. The majority of papers reported cross-sectional studies (n = 117) with three of longitudinal design. Fifteen studies which had used the original version of the measures in their original language were included in the COSMIN analysis. The most frequently used measure was the CPQ. Reliability and construct validity appear to be adequate for all three measures. Children were not fully involved in item generation which may compromise their content validity. Internal consistency was measured using classic test theory with no evidence of modern psychometric techniques being used to test unidimensionality of the measures included in the COSMIN analysis.

Conclusion

The three measures evaluated appear to be able to discriminate between groups. CPQ has been most widely tested and several versions are available. COHIP employed a rigorous development strategy but has been tested in fewer populations. C-OIDP is shorter and has been used successfully in epidemiological studies. Further testing using modern psychometric techniques such as item response theory is recommended. Future developments should also focus on the development of measures which can evaluate longitudinal change.

Prevalence of dental pain and its relationship to caries experience in school children of Udupi district

PURPOSE

To evaluate the prevalence of dental pain and its relationship to caries experience in 10-15-year-old school children of Udupi district of India.

METHODS

A cross-sectional survey was conducted in Udupi district among 10-15-year-old school children. A self-administered questionnaire was used to collect information on age, gender, type of school, location and socioeconomic status followed by Child Dental Pain Questionnaire. This was followed by clinical examination for dental caries.

RESULTS

A total of 306 children participated in the study; of whom, 56.5% were ≤12 years old, 58.8% were males, 50.7% attended a government school and 54.9% were from urban areas. The prevalence of dental pain was 35%. Only gender showed significant association with presence of tooth pain (p = 0.027). A total of 14.3% reported mild pain, 8.8% reported moderate pain and 11.7% reported severe pain. Almost half of the study participants (45.1%) had experienced dental caries. The mean scores of each subscale and total scale scores were significantly higher among caries-experienced than among caries-free children (p = 0.017, 0.043, 0.022 and 0.02, respectively). There was significant weak positive correlation of global single item question with prevalence (r = 0.115, p = 0.045), severity (r = 0.146, p = 0.010) impact subscales (r = 0.117, p = 0.040) and total scale (r = 0.144, p = 0.012).

CONCLUSION

The substantial effect that dental pain has on adolescents indicates an urgent need for public health strategies.

Toothache and social and economic conditions among adolescents in Northeastern Brazil

The scope of this study was to correlate toothache with social and economic conditions, access to oral health facilities and the lifestyle of adolescents in Sobral in the state of Ceará. It was conducted as a cross-sectional analytical study with a sample composed of 688 adolescents. The prevalence of toothache in the study group was 31.8%. A chi-square test of association was performed to measure the relationship between independent variables and toothache, estimating the prevalence ratio by Poisson regression. The factors that demonstrated the closest relationship with toothache were cavity severity, the reason for dental treatment being related to urgency, frequency of dental appointments and the distribution of toothbrushes at school. It was observed that the high prevalence of dental pain in adolescents is directly linked to the access conditions, as well as the characteristics of the actions developed by the health services. Just as there is a need for the deployment of services related to health promotion, based on equity and integration, it is necessary to introduce emergency services to intervene not just to curtail crippling pain, but also as a mechanism to stimulate the development of procedures for the prevention of oral diseases.

Dental pain in Brazilian schoolchildren: a cross-sectional study

AIM

To estimate the prevalence, intensity and associated factors of dental pain in 7- and 8-year-old schoolchildren in a Southern Brazilian city.

DESIGN

A cross-sectional study was carried out involving a representative sample (n=401) of schoolchildren of Tubarão, Brazil. The data were obtained through oral examinations, following WHO criteria. Dental pain was analysed using a specific questionnaire developed to measure it. Prevalence and intensity of spontaneous pain and pain caused by cold and hot food and liquids were analysed. Association studies were carried out using chi-square test followed by nonconditional multiple logistic regression analysis to test for independence of association between outcomes and explanatory variables.

RESULTS

The prevalence of spontaneous dental pain and dental pain caused by cold and hot food and liquids was 31.7 and 28.1%, respectively. Females and schoolchildren who had visited the dentist at least once showed statistically higher prevalence of spontaneous pain and pain caused by cold and hot food and liquids. Eight-year-old schoolchildren and those presenting cavities in the primary dentition also showed higher prevalence of spontaneous dental pain.

CONCLUSIONS

The prevalence and intensity of dental pain were considered high. The prevalence showed to be associated with female gender, higher age, the presence of cavities in the primary dentition and dental visit.

Impact of dental pain on daily living of five-year-old Brazilian preschool children: prevalence and associated factors

AIM

To assess the impact of dental pain on the daily living of 5-year-old preschool children using reports from parents/guardians.

DESIGN AND METHODS

A cross-sectional study was carried out involving 549 five-year-old children randomly selected from preschools in the city of Belo Horizonte, Brazil. Data were collected using a previously validated parent-reported questionnaire. The children received dental examinations from a single calibrated examiner. The following outcome variables were selected: age, gender, dental caries, filled teeth, missing teeth, caries involving pulp and social class. Simple and multiple logistic regression analyses were performed on the data.

RESULTS

According to parents' reports, 11.1% of children were affected by dental pain in the previous 4 months and of these 72.6% had their daily activities hampered by pain. The majority of these children had difficulty in eating, brushing teeth, sleeping, playing and going to school. The impact of dental pain had a statistically significant association with gender (p=0.001), social class (p=0.009), dental caries (p<0.001), missing teeth (p<0.001), filled teeth (p<0.001) and caries involving pulp (p<0.001).

CONCLUSION

The prevalence of difficulties performing tasks of daily living due to dental pain was relatively high among the children studied.

Dor dentária e fatores associados em adolescentes brasileiros: a Pesquisa Nacional de Saúde do Escolar (PeNSE), Brasil, 2009

O objetivo deste estudo foi estimar a prevalência da dor de dente em adolescentes brasileiros e analisar fatores sociodemográficos e comportamentais associados, utilizando os dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2009. A pesquisa foi realizada pelo Instituto Brasileiro de Geografia e Estatística e pelo Ministério da Saúde em escolares com idades entre 11 e 17 anos ou mais, das 27 capitais brasileiras, por meio de questionário autoaplicável. Utilizou-se a análise de regressão de Poisson, segundo um modelo hierárquico de determinação. A prevalência de dor na amostra (n = 54.985) nos últimos seis meses foi de 17,8% (IC95%: 17,5-18,1). Prevalências mais elevadas foram encontradas em mulheres, naqueles com 14 anos ou mais, das raças preta, parda e indígena, de escolas públicas, cujas mães tinham baixa escolaridade, que não moravam com a mãe, que haviam experimentado cigarro e álcool alguma vez na vida, que relataram menor frequência de escovação e maior consumo de guloseimas e refrigerantes. A prevalência de dor foi considerável e associada a aspectos sociodemográficos e de comportamentos relacionados à saúde.

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach

BACKGROUND

Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.

OBJECTIVES

To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.

METHODS

The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.

RESULTS

Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.

CONCLUSIONS

Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

Prevalence and Pattern of Pain Presentation among Patients Attending a Tertiary Dental Center in a Southern Region of Nigeria

Background and aims

Orofacial pain is one of the most common reasons for attendance at the dental clinic. The prevalence and the sources of orofacial pain vary from place to place and patients’ response to pain also differs. The aim of this study was to determine the prevalence and pattern of orofacial pain as well as the factors influencing patients’ response to orofacial pain among patients presenting for dental treatment in our center.

Materials and methods

Consecutive patients presenting with orofacial pain at the Dental Center, University of Port Harcourt Teaching Hospital during the one-year period of the study were recruited into the study. Patients’ demographic data were collected and recorded in special forms. Patients were later examined to confirm the specific cause of pain. This was also recorded. Data generated were analyzed using SPSS for Windows.

Results

Four hundred and forty-eight patients out of the 2,426 patients seen during the study period had orofacial pain, yielding a prevalence rate of 18.5%. There were 255 females and 193 males with most patients in the 17-27-year age group (49.1%). Lower jaw was commonly affected. Most patients presented after a period of at least one month, with severe and spontaneous pain. Most patients had drug therapy before presentation. Caries was the most common source of orofacial pain.

Conclusion

Orofacial pain was not uncommon in our center and it accounted for about 20% of patients’ attendance in the center. Dental caries and periodontal diseases were the most common sources of orofacial pain while temporomandibu-lar joint pain and atypical facial pain were not common in our center. Young adults and females were most commonly affected.

Millennium development goals and oral health in cities in Southern Brazil

OBJECTIVES

To investigate social determinants of oral health, analysing the occurrence of associations between millennium development goals (MDG) indicators and oral health (OH) indicators.

METHODS

An ecological study was performed in two distinct phases. In Phase 1, MDG indicators and related covariates were obtained from the demographic census of the Brazilian Institute of Geography and Statistics, the Ministry of Health database and the 2000 Human Development Atlas, making up the whole set of independent variables. Principal component analysis was carried out for the independent variables showing the correlations among the variables comprising the main components, and generating a synthetic index allowing the performance of the cities to be known with regard to the MDG (MDG index). In Phase 2, the DMFT index (mean number of decay, missing or filled permanent teeth) and the CF index (prevalence of caries-free individuals), in 12 years old were obtained from the epidemiological survey undertaken in 2002-2003, in 49 cities in southern Brazil, and were analysed in relation to the MDG index using Spearman's correlation.

RESULTS

  A statistically significant correlation was found for the DMFT and CF indices, respectively, with: the MDG index (R(2)=0.49 and 0.48; P = 0.00); the socioeconomic status of the population (R(2)= 0.12 and 0.12; P = 0.02); the socioenvironmental characteristics (R(2)=0.41 and 0.46; P= 0.00).

CONCLUSIONS

  The MDG synthetic index of the cities analysed and the respective components relating to their socioeconomic and socioenvironmental status demonstrated a positive correlation with OH indicators. As such, intersectoral public policies based on population strategies that act on social determinants of general and oral health need to be integrated so as to impact on the MDG and OH outcomes.

Social and dental status along the life course and oral health impacts in adolescents: a population-based birth cohort

Background

Harmful social conditions in early life might predispose individuals to dental status which in turn may impact on adolescents' quality of life.

Aims

To estimate the prevalence of oral health impacts among 12 yr-old Brazilian adolescents (n = 359) and its association with life course socioeconomic variables, dental status and dental services utilization in a population-based birth cohort in Southern Brazil.

Methods

Exploratory variables were collected at birth, at 6 and 12 yr of age. The Oral Impacts on Daily Performances index (OIDP) was collected in adolescence and it was analyzed as a ranked outcome (OIDP from 0 to 9). Unadjusted and adjusted multivariable Poisson regression with robust variance was performed guided by a theoretical determination model.

Results

The response rate was of 94.4% (n = 339). The prevalence of OIDP = 1 was 30.1% (CI95%25.2;35.0) and OIDP ≥ 2 was 28.0% (CI95%23.2;32.8). The most common daily activity affected was eating (44.8%), follow by cleaning the mouth and smiling (15.6%, and 15.0%, respectively). In the final model mother schooling and mother employment status in early cohort participant's life were associated with OIDP in adolescence. As higher untreated dental caries at age 6 and 12 years, and the presence of dental pain, gingival bleeding and incisal crowing in adolescence as higher the OIDP score. On the other hand, dental fluorosis was associated with low OIDP score.

Conclusion

Our findings highlight the importance of adolescent's early life social environmental as mother schooling and mother employment status and the early and later dental status on the adolescent's quality of life regardless family income and use of dental services.

Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: a cross-sectional study

Background

Dental caries, dental pain and reported oral problems influence people's oral quality of life and thus their perceived need for dental care. So far there is scant information as to the psychosocial impacts of dental diseases and the perceived treatment need in child populations of sub-Saharan Africa.

Objectives

Focusing on primary school students in Kilwa, Tanzania, a district deprived of dental services and with low fluoride concentration in drinking water, this study aimed to assess the prevalence of dental pain and oral impacts on daily performances (OIDP), and to describe the distribution of OIDP by socio-demographics, dental caries, dental pain and reported oral problems. The relationship of perceived need estimates with OIDP was also investigated.

Methods

A cross-sectional study was conducted in 2008. A total of 1745 students (mean age 13.8 yr, sd = 1.67) completed an extensive personal interview and under-went clinical examination. The impacts on daily performances were assessed using a Kiswahili version of the Child-OIDP instrument and caries experience was recorded using WHO (1997) criteria.

Results

A total of 36.2% (41.3% urban and 31.4% rural, p < 0.001) reported at least one OIDP. The prevalence of dental caries was 17.4%, dental pain 36.4%, oral problems 54.1% and perceived need for dental treatment 46.8% in urban students. Corresponding estimates in rural students were 20.8%, 24.4%, 43.3% and 43.8%. Adjusted OR for reporting oral impacts if having dental pain ranged from 2.5 (95% CI 1.8–3.6) (problem smiling) to 4.7 (95% CI 3.4–6.5) (problem sleeping),- if having oral problems, from 1.9 (95% CI 1.3–2.6) (problem sleeping) to 3.8 (95% CI 2.7–5.2) (problem eating) and if having dental caries from 1.5 (95% CI 1.1–2.0) (problem eating) to 2.2 (95% CI 1.5–2.9) (problem sleeping). Students who perceived need for dental care were less likely to be females (OR = 0.8, 95% CI 0.6–0.9) and more likely to have impacts on eating (OR = 1.9, 95% CI 1.4–2.7) and tooth cleaning (OR = 1.6, 95% CI 1.6–2.5).

Conclusion

Substantial proportions of students suffered from untreated dental caries, oral impacts on daily performances and perceived need for dental care. Dental pain and reported oral problems varied systematically with OIDP across the eight impacts considered. Eating and tooth cleaning problems discriminated between subjects who perceived need for dental treatment and those who did not.