Determinantes individuais e contextuais da cárie em crianças brasileiras de 12 anos em 2010

Impact of the use of dental services on dental pain according to adolescents' skin colour: a 10-year cohort

OBJECTIVE

Evaluate the association of the interaction between the use of dental services and the skin colour on the occurrence of dental pain over time.

MATERIAL AND METHODS

This study is a cohort with 10 years of follow-up, started in 2010 with a sample of 639 preschool children (1-5 years old). The use of dental services, race and the presence of dental pain were self-reported by the individuals according to predefined criteria. Multilevel logistic regression analysis was performed to assess the interaction between skin colour and use of dental services in the occurrence of dental pain over time.

RESULTS

About 449 and 429 were reassessed in 2017 and 2020, respectively. The occurrence of dental pain across the cohort was 60.7%. Caucasian individuals who used dental services throughout the cohort had a 51% lower chance of having a dental pain than those who used dental services but were non-white (OR 0.49; 95% IC 0.27-0.90).

CONCLUSION

There was a racial inequity in the occurrence of dental pain among individuals who managed to make use of dental services throughout the follow-ups.

CLINICAL RELEVANCE

The differences found should serve as a warning to the way how individuals with different characteristics are treated and must be used to combat this inequity. Individuals should receive resolute and personalized treatments according to their clinical condition and not according to their socioeconomic characteristics.

Number of dentists in the neighborhood and incidence of dental caries in the children permanent dentition

This study aimed to evaluate the influence of the number of dentists in the neighborhood on the incidence of dental caries in the children permanent dentition. This cohort began in 2010 (T1) with a random sample of 639 children (1 to 5 years-old) followed for 7 years, in southern Brazil. The follow-up reassessment (T2) took place in 2017. Untreated dental caries was evaluated at T2 through the Decayed, Missing, and Filled surfaces index (DMF-S). The number of dentists in the neighborhood was obtained from the city's official database and used as a contextual variable. Socioeconomic, demographic, and oral health variables at the individual level were evaluated at T1. A multilevel Poisson regression was performed to evaluate the influence of the predictor variables in the incidence of untreated dental caries. From 639 children at T1, 449 were reassessed at T2 (a 70.3% retention rate). The mean of decayed surfaces at T2 was 0.92 (SE 0.01). The greater the number of dentists in the neighborhoods where the children lived, the lower the incidence of dental caries. Children with low socioeconomic status, who have not routinely visited the dentist in the last 6 months, who presented a experience of dental caries, and whose parents perceived their oral health as fair/poor showed a higher incidence of surfaces with untreated dental caries. As conclusion, children who live in neighborhoods with fewer dentists have a higher incidence of untreated dental caries in permanent dentition.

Does the addition of chlorhexidine to glass ionomer cements influence its antimicrobial effect and survival rate? A systematic review

PURPOSE

To evaluate the influence of the addition of chlorhexidine on the antimicrobial effect and on the survival of restorations performed with glass ionomer cement.

METHODS

Nine databases were used to search for randomized clinical trials that compared the survival rate and the antimicrobial effect of glass ionomer cement (GIC) restorations with and without the incorporation of chlorhexidine (CHX), without restrictions on year or language. Cochrane Collaboration's Risk of Bias 2 was used to assess the risk of bias. The GRADE approach was used to assess the certainty of evidence.

RESULTS

From 593 studies found, seven met the inclusion criteria. The concentration of CHX varied between 0.5 and 2%. In general, the addition of CHX to GIC promoted reductions in Streptococcus mutans and Lactobacillus acidophilus burdens when compared to those without CHX. No study showed a difference in the survival of restorations between GIC with CHX and conventional GIC. Individual risk of bias varied from low to high and the certainty of evidence was classified as very low.

CONCLUSIONS

Based on a very low level of certainty, the evidence suggests that the incorporation of CHX in GIC might improve the antimicrobial effects for a short time, in addition to having little influence on the survival of the restoration.

Association between crack cocaine use and dental caries experience: a cross-sectional study in southern Brazil

The aim of the present study was to compare the prevalence of dental caries between crack cocaine users and a control group. The study included 106 participants in each group matched for age, sex, and exposure to tobacco. Crack cocaine users were selected from institutions for the treatment of chemical dependency, and the control group was recruited from a public school and among patients who sought dental care. A calibrated examiner determined dental caries experience [Decayed, Missing and Filled Teeth (DMFT) index]. The severity of tooth decay was determined using the Significant Caries Index (SiC). The prevalence of dental caries (DMFT ≥ 1) was 96.2 and 81.1% among the crack cocaine users and nonusers, respectively. Crack users had higher mean DMFT values (7.16 versus 4.92) for the decayed and missing components as well as a higher percentage of individuals with highly severe caries compared to nonusers. After the adjustments in the multivariate model, the prevalence of caries was 18% higher among the crack users (prevalence ratio: 1.18; 95% confidence interval: 1.08-1.30). Age, family income, crack cocaine use, and dental calculus were associated with the occurrence of dental caries. In conclusion, the prevalence of caries was higher among the crack users compared with the control group and remained associated with dental caries in the multivariate analysis.

[Fluoride levels in springs and water sources and in the public supply networks of municipalities in the State of Pernambuco, Brazil]

Fluoridation is considered an effective and wide-ranging measure in combatting dental caries. Despite being mandatory in Brazil since 1974, the implementation continues to be unequal throughout the country. The objective was to describe and analyze fluorine levels in the waters of the public supply grid of the 2nd macro region of the state of Pernambuco in municipalities with 50,000 inhabitants or more. This is a descriptive study based on a comparison of data from Pernambuco Sanitation Company (Compesa), the Vigifluor Project, the Water Quality Surveillance Information System for Human Consumption (Sisagua) the Brazilian Institute of Geography and Statistics (IBGE) and the National Sanitation Information System (SNIS), on the fluoridation of water in municipalities of the 2nd health macro region of Pernambuco. Although the municipalities studied do not have artificial fluoridation, significant levels of natural fluorine were found in the sources that supply the regions. However, these levels of fluorine do not remain constant in the waters of the supply network of the municipalities studied, therefore there is no effective prevention against caries. Artificial fluoridation is an effective measure in preventing caries and should therefore be expanded in regions that are not yet fluoridated.

Deprived areas and community water fluoridation in Brazil: a multilevel approach for refocusing public policy

OBJECTIVES

The aim of this study was to determine whether geographic location, socioeconomic status, infant mortality, and mortality from diarrheal disease in health regions are associated with the provision of community water fluoridation (CWF) in Brazilian municipalities.

METHODS

A multilevel ecological study was conducted based on data from the National Survey of Basic Sanitation and Human Development Atlas. A multilevel analysis was carried out considering Brazilian municipalities as the first level and health regions as the second level, comprising sanitation, demographic, socioeconomic, and health characteristics.

RESULTS

The observation units comprised 5,565 municipalities clustered in 438 health regions in Brazil. The lack of CWF provision was positively associated with the following municipal characteristics: a below-median proportion of inhabitants covered by the sewage network, medium to very low human development index, below-median per capita gross domestic product, and an above-median percentage of expenditures on sanitation. In relation to the health regions, the likelihood of a lack of CWF provision was greater in the municipalities belonging to the health regions located in the Northern and Northeastern areas of Brazil and in those where child mortality due to acute diarrheal disease and the proportion of people with low income were higher when adjusted by municipal indicators.

CONCLUSIONS

Information on the characteristics associated with CWF provision constitutes important input for refocusing public policy to reduce inequalities among Brazilian municipalities and health regions. These findings may help policy-makers to understand the challenges facing CWF expansion in low-, middle-, and high-income countries.

Condições de Saúde bucal e acuidade visual dos estudantes em um município do Baixo Amazonas

Resumo Objetivo Avaliar a prevalência da cárie dentária e da deficiência visual nos escolares do ensino fundamental da rede pública de ensino de Barreirinha-AM e verificar os fatores associados a estas condições. Método Estudo transversal, com 1.828 estudantes entre 06 e 17 anos, da rede pública de ensino, Barreirinha. A avaliação da cárie dentária seguiu as recomendações da Organização Mundial da Saúde utilizando os critérios estabelecidos para as condições dentárias, tanto para dentes decíduos, quanto para permanentes: cariados, perdidos e obturados. O índice Significant Caries Index mediu a severidade da cárie dentária nos indivíduos mais afetados com a doença. Realizou-se avaliação para acuidade visual e analisou-se idade, sexo e escola. Resultados Evidenciou-se elevada prevalência de cárie dentária, desigualdade em sua distribuição e associação entre esta doença e sexo (p = 0,005). A prevalência de dificuldades visuais entre os escolares foi baixa. Conclusão e implicações para prática O estudo sugere carência de tratamento odontológico restaurador e elevada prevalência de cárie dentária, evidenciando a necessidade de planejamento e desenvolvimento de ações de promoção de saúde bucal, com o intuito de minimizar os agravos provocados pela doença.

Cárie dentária e fatores associados aos 12 anos na Região Centro-Oeste do Brasil em 2010: um estudo transversal

Resumo O objetivo do estudo é analisar o índice de dentes cariados, perdidos e obturados (CPO-D) na idade de 12 anos da Região Centro-Oeste e identificar fatores associados, segundo a Pesquisa Nacional de Saúde Bucal, o SB Brasil 2010. É um estudo transversal de base populacional do banco de dados do SB Brasil 2010, realizado nas capitais de Mato Grosso, Mato Grosso do Sul, Goiás, Distrito Federal e uma amostra de municípios da região. Os dados foram analisados pelo teste de qui-quadrado e razões de prevalências com seus respectivos intervalos de confiança, a um nível de significância de 0,05. A regressão de Poisson foi empregada na análise múltipla para analisar a associação entre a variável desfecho e as variáveis explicativas. As variáveis independentes que se mostraram associadas ao CPO-D foram: o estado de moradia em Mato Grosso, Goiás e Mato Grosso do Sul; a renda per capita ≤ R$500,00; dificuldade para comer e dormir, e o motivo da consulta por Dor/Extração/Tratamento/Outros. A média do índice CPO-D foi de 2,14 e a prevalência da cárie dental foi de 41% dos adolescentes.

Effect of routine dental attendance on child oral health-related quality of life: A cohort study

BACKGROUND

There is an improvement in oral health status among people who receive preventive dental care during their lifetime, highlighting the possible effect in resolving oral health problems and consequently oral health-related quality of life (OHRQoL).

AIM

Assessed the effect of routine dental attendance on child OHRQoL.

DESIGN

This cohort study used baseline data from 639 preschoolers from 2010. After 7 years, 449 children were re-examined (70.3%). Mothers of the children completed a questionnaire collecting data on the pattern of use of dental services. Children were classified as adhering to long-term routine dental attendance according to their pattern of use (routine vs curative) in the baseline and in follow-up. The child OHRQoL was assessed through the Child Perception Questionnaire (CPQ8-10). The association between routine dental attendance and child OHRQoL was assessed using multilevel Poisson regression models.

RESULTS

The proportion of participants who reported the worst CPQ8-10 scores were higher among those who, at some point in their life, experienced a curative dental attendance. Also, the mean CPQ8-10 was two times higher for non-routine dental attendance.

CONCLUSION

The findings showed that there is an impact of long-term routine attendance on child OHRQoL. This is important for tackling oral health iniquities.

Oral health of 12-year-old children in Jilin province, China: A population-based epidemiological survey

There is a lack of population-based surveys on oral health in Jilin province. Accordingly, this study aimed to understand the oral health status of 12-year-old children in Jilin province, China, to demonstrate the prevalence of oral health-related diseases, as well as to identify the associated risk factors.From February to April 2017, a cross-sectional investigation was conducted among 2324 children aged 12 years from 63 public schools of 9 regions in Jilin province, China. A questionnaire of World Health Organization (WHO) was conducted to ascertain the potential risk factors associated with oral diseases. The 3 examiners, who received theoretical and clinical training before the investigation, underwent clinical examinations to assess dental caries, dental fluorosis, presence of calculus, and gingival bleeding. Furthermore, the mean decayed-missing-filled tooth (DMFT), the rate of pit and fissure closure, education level of patients, brushing habits, and sugar consumption were also evaluated. All data analyses were conducted using SPSS version 19.0.A total of 2324 twelve-year-old children from 9 regions in Jilin-China were examined from February to April 2017. The prevalence of dental caries, dental fluorosis, calculus, and gingival bleeding reached 40.8%%, 21.8%, 47.93%, and 48.88%, respectively; the mean DMFT was 0.8787. The proportion of DMFT was 83.7% for decayed teeth, 0.2% for missing teeth, and 16.1% for filling teeth. The prevalence of pit and fissure closure was 10%.Educational level of parents was negatively correlated with the prevalence of oral diseases, whereas sugar consumption was positively associated with dental caries prevalent in children. We also found that there was no association between brushing habits and dental caries in children aged 12 years in Jilin Province.

Impacto da cárie dentária na qualidade de vida de pré-escolares mensurado pelo questionário PedsQL

Resumo O objetivo do estudo foi avaliar o impacto da cárie dentária na qualidade de vida de pré-escolares. A população foi constituída por pré-escolares com idade de 5 anos, matriculados em instituições públicas e privadas de Teresina, PI, Brasil. Instrumento de qualidade de vida validado para população brasileira (Pediatric Quality of Life Inventory - PedsQL™) foi aplicado para as crianças e responsáveis, além de questionário socioeconômico-demográfico para os responsáveis. No exame dentário o índice ceod foi utilizado para avaliar a experiência de cárie. Das 566 crianças examinadas, 50,2% apresentaram experiência de cárie. Foi observada associação entre experiência de cárie e pior qualidade de vida no domínio de saúde bucal na percepção das crianças (RR= 0,981; IC95% = 0,97-0,99) e dos pais (RR= 0,955; IC95% = 0,94-0,97). De acordo com a percepção das crianças, cárie em dentes posteriores foi associada a pior qualidade de vida no domínio capacidade física (RR= 0,985; IC95% = 0,97-0,99). Concluiu-se que experiência de cárie impactou negativamente na QVRSB (qualidade de vida relacionada à saúde bucal) no domínio saúde bucal da criança de acordo com a percepção das crianças e dos pais. Cárie localizada em molares impactou negativamente na QVRSB no domínio capacidade física segundo a percepção das crianças.

Oral health of 12-year-old children in Quito, Ecuador: a population-based epidemiological survey

BACKGROUND

There is a paucity of population-based surveys on oral health conditions in Ecuador. Thus, the aim of this study was to conduct an epidemiological survey with a representative sample of children aged 12 years from public schools of Quito, Ecuador. The aim of this initial report was to describe the methodology used in the survey, as well to present results regarding calibration procedures and prevalence of oral-health related outcomes.

METHODS

We invited 33 public schools' coordinators from the urban area of Quito, and 1100 children (12 years old) to take part in this study. Six trained and calibrated examiners conducted clinical examinations using oral mirrors and ball-ended probes to assess: dental caries, traumatic dental injuries, malocclusion, gingival bleeding, presence of calculus and fluorosis. Children also responded a questionnaire on Oral Health-Related Quality of Life (OHRQoL). Individual sociodemographic data was collected through a questionnaire sent to parents. Moreover, some contextual data on school environment (infrastructure conditions, promotion of health practices and negative episodes) were also evaluated. Prevalence values, crude and weighted by sampling weights, and 95% confidence intervals (95%CI) were calculated.

RESULTS

Nine hundred and ninety-eight children from 31 schools were examined from March to May 2017. The adjusted prevalence values (95%CI) for the six outcomes evaluated were: dental caries = 60.3% (55.3 to 65.0%); traumatic dental injuries = 20.7% (17.2 to 24.8%); dental fluorosis = 63.7% (58.5 to 68.5%); gingival bleeding = 92.0% (87.1 to 95.2%); presence of calculus = 69.9 (60.5 to 77.9%); and malocclusion = 25.8% (21.8 to 30.3%). Adjusted mean of number of decayed, missed or filled permanent teeth (DMF-T) was 1.61 (1.37 to 1.84). Results on OHRQoL and other contextual variables will be reported in other articles.

CONCLUSION

The prevalence of the majority of oral health problems in 12-year-old children from public schools in Quito-Ecuador was compatible with those observed in other similar cities. However, periodontal health and fluorosis seem to be highly prevalent in children from Quito.

How to correct the odds ratio for lack of sensitivity and specificity

This commentary explains and exemplifies a method to estimate the Odds Ratio-OR with a correction for possible errors in diagnosis. This procedure allows reassessing hypotheses of association between health outcomes and exposures when the database entails lack of accuracy, and the estimates of sensitivity and specificity of the diagnostic tool are available. Misclassification is not uncommon in dental public health research. Classification errors should not be ignored; they should instead be subject of measurement and adjustment. However, the lack of diagnostic validity is an elusive error, which cannot be entirely controlled. The method described here is solely an attempt to explore further the assessment of factors impacting on health outcomes.

Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study

OBJECTIVE

To investigate whether patients' skin color could exert an influence on the dentist's decision-making for treatment, in four different cities in Brazil.

MATERIAL AND METHODS

Lists of dentists were obtained and the sample selection was performed systematically. Two questionnaires were produced for the same clinical case, but the images were digitally manipulated to obtain a patient with a black and a white skin color. Dentists were free to choose treatment without any restrictions, including the financial aspects. A random sequence (white or black) was generated which was placed at random in sealed, opaque envelopes. Dentists were questioned about the decision on the treatment of a severely decayed tooth and an ill-adapted amalgam restoration.

RESULTS

A total of 636 dentists agreed to participate in the study. After adjustments (multinomial logistic regression), it was observed that the black patient with a decayed tooth had a 50% lower risk of being referred for prosthetic treatment (p = 0.023) and a 99% higher risk of receiving a composite resin restoration, compared to the white patient (p = 0.027). No differences were observed regarding recommendation for tooth extraction (p = 0.657). In relation to an ill-adapted amalgam, the black patient had less risk of receiving a referral replacement with composite resin (0.09 95%CI [0.01-0.82]) and finishing and polishing (0.11 5%CI [0.01-0.99]) compared with the white patient.

CONCLUSION

Patient skin color influenced the dentist's choice of treatment. In general, black patients receive referrals for cheaper, simpler procedures.

CLINICAL SIGNIFICANCE

Skin color played an important role in dentists' treatment decisions. Professionals may contribute unconsciously to the propagation and replication of racial discrimination.

Aspectos sociodemográficos relacionados à gravidade da maloclusão em crianças brasileiras de 12 anos

Resumo Estudo transversal e analítico para caracterizar a maloclusão em crianças brasileiras de 12 anos e identificar os aspectos sociodemográficos associados, utilizando dados do SB Brasil 2010. Foram incluídas 5539 crianças dentre as quais 41% possuíam algum grau de maloclusão, de acordo com o índice Dental Aesthetic Index (DAI). Conduziu-se análises descritivas, bivariadas e múltiplas por regressão logística multinomial. A maloclusão definida foi maior entre os que avaliaram sua saúde bucal como nem satisfeito/nem insatisfeito (OR 1,24; IC 95%; 1,03-1,50) e insatisfeito (OR 1,76; IC 95%; 1,50-2,08). A maloclusão grave foi maior entre crianças do Sudeste (OR 1,44; IC 95%; 1,06-1,96) e Sul (OR 1,52; IC 95%; 1,05-2,19), sexo masculino (OR 1,24; IC 95%; 1,03-1,48), raça negro/pardo (OR 1,39; IC 95%; 1,14-1,69) e que avaliaram sua saúde bucal como nem satisfeito/nem insatisfeito (OR 1,79; IC 95%; 1,41-2,26) e insatisfeito (OR 2,20; IC 95%; 1,77-2,72). O nível muito grave foi maior entre os residentes de capitais (OR 1,36; IC 95%; 1,07-1,71) e que avaliaram sua saúde bucal como nem satisfeito/nem insatisfeito (OR 1,58; IC 95%; 1,22-2,05) e insatisfeito (OR 2,44; IC 95%; 1,96-3,03). A prevalência da maloclusão é alta entre crianças brasileiras, sendo suas diferentes gravidades associadas a aspectos sociodemográficos.

Impact of untreated dental caries on the daily activities of children

OBJECTIVES

Untreated dental caries can compromise oral health-related quality of life (OHRQoL). However, it is not clear which specific daily activities related to OHRQoL are compromised by the presence of this problem. Therefore, the purpose of this study was to identify which specific daily activities are affected by the presence of untreated dental caries using a representative sample of Brazilian children.

METHODS

A cross-sectional study using a representative sample of Brazilian children (12 years of age) was conducted. The presence of untreated dental caries was assessed using the "decayed - D" component of the DMFT (decayed, missing, and filled teeth) index. Clinical exams were conducted by trained and calibrated dentists. The daily activities were evaluated using the survey Oral Impacts on Daily Performance (OIDP), considering items and domains. Descriptive, bivariate, and multiple analyses were conducted (α = 0.05).

RESULTS

A total of 7,247 children were included, and 39.9 percent had at least one tooth with untreated dental caries, with 33.5 percent experiencing an impact on at least one of the OIDP activities. This study identified a greater chance of the presence of untreated dental caries in children having an impact on the psychological domain (P = 0.006), as well as on the "difficulty eating" (P = 0.007), and "difficulty sleeping" (P = 0.023) items.

CONCLUSION

The presence of untreated dental caries among Brazilian children was associated with an impact on specific daily activities (difficulty eating and sleeping) and the psychological domain of OHRQoL.

[Distribution of dental caries and its association with variables of social protection in children 12 years of age in the county of Avellaneda, Province of Buenos Aires]

Different international organizations have indicated the need to analyze the conditions of each population in order to identify groups and individuals at risk as an operational strategy in pursuit of greater equity, efficacy and efficiency in the health system. The aim of this study was to identify differentials in the dental caries profiles of children attending public schools in the county of Avellaneda (Province of Buenos Aires, Argentina) and their association with variables of social protection. In 2014, an observational, analytical and cross-sectional study was performed with a sample of 656 students 12 years of age from 40 public schools in the 8 county districts (out of a total universe of 3580 individuals distributed in 70 schools). The dental status of 12-year-old schoolchildren living in the localities evaluated showed an unequal distribution; sub-groups with high caries prevalence, morbidity and severity were identified, requiring the targeting of health interventions. An association between untreated disease and lack of social protection was observed.

Impact of oral clinical problems on oral health-related quality of life in brazilian children: a hierarchical approach

BACKGROUND

Oral health-related quality of life may be influenced by a series of characteristics. Considering the multidimensional character of quality of life, these impacts should be evaluated in the context of the physical, psychological, and social domains.

AIM

To evaluate the impact of clinical and perceived oral health problems on oral health-related quality of life in its different domains.

DESIGN

Clinical exams were conducted on a representative cross-sectional sample of 12-year-old children in Brazil. The instrument Oral Impacts on Daily Performance (OIDP) was used to evaluate the quality of life in relation to oral health. Descriptive, bivariate, and multiple hierarchical analyses were conducted.

RESULTS

Of the 7328 children studied, 2577 (33.5%) presented oral health-related impacts on quality of life. Clinical and perceived conditions of oral health were associated with the presence of overall impacts in the physical, psychological, and social dimensions of oral health-related quality of life. Furthermore, Family income was associated with overall impacts and the level of motivation to use dental health services was associated with the physical dimension.

CONCLUSIONS

The clinical and perceived conditions of oral health in Brazilian 12-year-olds were associated with a negative impact on oral health-related quality of life.

Oral health in the agenda of priorities in public health

This study describes the scientific production on oral health diffused in Revista de Saúde Pública, in the 50 years of its publication. A narrative review study was carried out using PubMed, as it is the search database that indexes all issues of the journal. From 1967 to 2015, 162 manuscripts specifically focused on oral health themes were published. This theme was present in all volumes of the journal, with increasing participation over the years. Dental caries was the most studied theme, constantly present in the journal since its first issue. Periodontal disease, fluorosis, malocclusions, and other themes emerged even before the decline of dental caries indicators. Oral health policy is the most recurring theme in the last two decades. Revista de Saúde Pública has been an important vehicle for dissemination, communication, and reflection on oral health, contributing in a relevant way to the technical-scientific interaction between professionals in this field. RESUMO Este estudo descreve a produção científica sobre saúde bucal veiculada na Revista de Saúde Pública, nos cinquenta anos de sua publicação. Foi realizado estudo de revisão narrativa, utilizando o PubMed como mecanismo de busca que indexa todos os fascículos da revista. De 1967 a 2015, foram publicados 162 manuscritos com foco específico em temas de saúde bucal. Essa temática esteve presente em todos os volumes da revista, com participação crescente ao longo dos anos. Cárie dentária foi o tema mais estudado, marcando presença constante na revista desde seu primeiro fascículo. Doença periodontal, fluorose, oclusopatias e outros temas emergiram antes mesmo do declínio dos indicadores de cárie. Políticas de saúde bucal é o tema mais recorrente nas duas últimas décadas. A Revista de Saúde Pública tem sido importante veículo de divulgação, comunicação e reflexão sobre saúde bucal, contribuindo de modo relevante para a interação técnico-científica entre os profissionais da área.

Functional Dentition in Brazilian Adults: An Investigation of Social Determinants of Health (SDH) Using a Multilevel Approach

OBJECTIVES

Estimate the prevalence of functional dentition among Brazilian adults using four different definitions and identify associated factors.

METHODS

A cross-sectional study was conducted involving 9564 Brazilian adults aged 35-44 years who participated in the 2010 National Oral Health Survey. Data collection involved oral examinations and the administration of questionnaires. The following definitions were used: 1-WHO Functional Dentition (FDWHO: ≥ 20 teeth present); 2-well-distributed teeth (WDT: ≥ 10 teeth in each arch); 3 -Functional dentition classified by esthetics and occlusion (FDClass5: dentitions that sequentially exhibit at least one tooth in each arch, at least 10 teeth in each arch, all maxillary and mandibular anterior teeth, three or four premolar posterior occluding pairs [POPs], and at least one molar POP bilaterally); 4-Functional dentition classified by esthetics, occlusion and periodontal status (FDClass6: corresponds to FDClass5 with the addition of periodontal status of all sextants in the oral cavity with, at most, shallow pockets and/or clinical attachment level of 5 mm (CPI ≤ 3 and/or CAL ≤ 1). The independent variables were individual factors (gender, self-declared skin color, schooling, monthly household income, age group, self-rated treatment need, dental pain, dental appointment in the previous 12 months and dental services) and contextual factors (Municipal Human Development Index [MHDI]), Gini coefficient, fluoridated water supply and oral health coverage). Multilevel mixed-effect Poisson regression analyses were performed.

RESULTS

The prevalence of functional dentition based on the FDWHO, WDT, FDClass5 and FDClass6 definitions was 77.9%, 72.9%, 42.6% and 40.3%, respectively. Adults with ≥12 years of schooling and monthly household income from US$ 853 to 2557 had higher prevalence rates of FDWHO (PR: 1.41 and 1.10, respectively), WDT (PR: 1.58 and 1.14, respectively), FDClass5 (PR: 2.03 and 1.27, respectively) and FDClass6 (PR: 2.15 and 1.35, respectively). These values in the final models were adjusted for gender, self-declared skin color (FDClass5), age group, self-rated treatment need (FDWHO, FDClass5 and FDClass6), dental appointment in the previous 12 months (FDWHO and WDT), dental services (FDWHO and WDT) and contextual factors. A very high MHDI and presence of fluoridated water supply were associated with higher prevalence rates of the four outcomes.

CONCLUSIONS

The incorporation of the criteria of new definitions of functional dentition led to a lower prevalence rate among Brazilian adults. Striking individual and contextual inequalities were identified with regard to the four definitions analyzed, which need to be addressed through inter-sector efforts.

Revista de Saúde Pública: 50 years disseminating the knowledge in nutrition

This work describes and comments on articles in the area of Public Health Nutrition published in Revista de Saúde Pública (RSP – Public Health Journal) from 1967 to 2016. We searched in the PubMed database restricted to the periodical “Revista de Saúde Pública” and using terms related to key topics in the area of Public Health Nutrition. We retrieved 742 articles and, after exclusion of duplicates and articles unrelated to the subject, we analyzed 441 articles, grouped according to subject: dental caries, anemia, hypovitaminosis A, macro/micronutrients, malnutrition, nutritional assessment, overweight/obesity, food consumption, low birthweight, and breastfeeding. We observed significant increase in the number of articles published and diversification of subjects addressed over the 50 years, representing the consistent development of the scientific field of Nutrition in Brazil. Since its inception, RSP has played an important role in the dissemination of knowledge about the main nutritional issues in Brazil.

[Tooth decay and associated factors among adolescents in the north of the State of Minas Gerais, Brazil: a hierarchical analysis]

This is a cross-sectional population-based study (n = 763) conducted in the north of the State of Minas Gerais, which aimed to investigate the prevalence of tooth decay among adolescents and to identify the potential determinants of same. Probability sampling by conglomerates in multiple stages was used. Trained and calibrated professionals performed the data collection by means of intraoral examination and interviews in the previously selected households. In the analysis of the determinant factor for the presence of tooth decay, hierarchical binary logistic regression models were used. The prevalence of tooth decay, decayed, missing and filled teeth were 71.3%, 36.5%, 55.6% and 16%, respectively. The following averages were observed: DMFT (3.4 teeth), number of decayed (0.8 teeth), restored (2.4 teeth) and missing (0.2 teeth). The incidence of tooth decay was higher among adolescents who stated they were black/indigenous/brown (OR = 1.76), lived in crowded households (OR = 2.4), did not regularly visit or had never been to a dentist (OR = 1.9), used public or philanthropic services (OR = 1,8), had smoking habits (OR = 4.1), consumed alcohol (OR = 1.8), perceived their oral health negatively (OR = 5.9 and OR = 1.9) and had toothac in the last six months (OR = 2.0).

Dental caries experience among indigenous children and adolescents

Investigations into the oral health status of indigenous populations are scarce. The aim of this study was to evaluate caries experience and associated factors among 342 indigenous children and adolescents aged 5-15 years of the Xukuru community in the municipality of Pesqueira, Brazil. A cross-sectional census study was carried out using the criteria of the World Health Organization to determine caries experience. Examinations were performed by two calibrated dentists and a questionnaire was administered to parents/caregivers addressing socio-demographic data, diet and oral hygiene habits. Logistic regression analysis were performed, with dmft and DMFT as the dependent variables (P < 0.05). Caries experience (dmft/DMFT) was high in both the primary and permanent dentition (75.6% and 62.9%, respectively). Mean dmft and DMFT indices were 3.11 and 2.21, respectively. Caries experience in the primary dentition was associated with children residing in villages far from urban areas (P = 0.016), while caries in the permanent dentition was associated with older children (P < 0.001) and with children from villages at an intermediate distance and far from urban areas (P < 0.001). The indigenous subjects exhibited a high degree of caries experience, which was associated with age and group of villages. Public policies are needed to improve the oral health status of this population.

Dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy

The aim of the present study was determine the prevalence and factors associated with dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy (CP). This is a cross-sectional study conducted with 80 patients ranging in age from 2 to 18 years old. Oral exams were conducted by an examiner with records of DMFT, dmft, Gingival Bleeding Index (GBI) and Community Periodontal Index (CPI). The statistical analysis used Poisson Regression with robust variance estimation (α = 0.05). The prevalence of dental caries was 59.3%, with DMFT and mean dmft of 1.71 ± 2.42 and 2.22 ± 3.23, respectively. The mean GBI was 22.44%, and in the CPI, the prevalence of gingival bleeding, calculus, shallow and deep pockets were 94.73%, 79.62%, 12.90% and 3.22%, respectively. The caregiver’s educational level of less than eight years were associated with the dental caries experience (PR = 1.439; 95%CI = 1.09–1.89). The periodontal alterations were associated with female sex (PR = 0.82; 95%CI = 0.69–0.97), caregiver’s educational level of less than eight years (PR = 1.15; 95%CI = 1.03–1.29), poor oral perception (PR = 0.89; 95%CI = 0.80–0.98), serious communication problem (PR = 0.87; 95%CI = 0.76–0.99) and athetoid type of CP (PR = 0.85; 95%CI = 0.75–0.97). The patients with CP presented high dental caries experience and periodontal alterations, which were associated with their demographic, socioeconomic, oral health perception and systemic information.

Oral health status of the ethnic group Xukuru from Ororubá: multilevel analysis

OBJECTIVE

To analyse the oral health status of the indigenous people Xukuru from Ororubá aged 10 to 14 years old, in Pernambuco, Brazil.

METHOD

A cross-sectional population-based study developed within the limits of the Indigenous Land Xukuru, from January to March 2010. Oral examinations were performed on a sample of 233 indigenous people. The software SPSS 13.0® was used for descriptive analysis. Later, in order to measure the effect of factors associated with the absence of caries, Poisson log-linear multilevel models were tested with the statistical software MLwiN 2.02®.

RESULTS

Oral examinations identified a DMFT Index average of 2.38 (± 2.62). Among all individuals examined, 26.61% were caries free. Multiple regression analysis revealed a negative association between the absence of caries and the variables: higher average of people per household in the villages, higher number of residents per household, older age, male sex, not knowing how to read and write, and very dissatisfied/dissatisfied with teeth/mouth. The variables higher income per capita, not sleeping due to dental problems, had never been to the dentist, no occurrence of toothache, and no need for dental treatment were positively associated with the absence of caries.

CONCLUSION

The absence of caries is associated with contextual and individual factors of the indigenous people Xukuru from Ororubá, aged 10 to 14 years old.