Cárie dentária em adolescentes de 15 a 19 anos de idade no Estado de São Paulo, Brasil, 2002

Water fluoridation for the prevention of dental caries

BACKGROUND

Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation (CWF) is currently practised in about 25 countries; health authorities consider it to be a key strategy for preventing dental caries. CWF is of interest to health professionals, policymakers and the public. This is an update of a Cochrane review first published in 2015, focusing on contemporary evidence about the effects of CWF on dental caries.

OBJECTIVES

To evaluate the effects of initiation or cessation of CWF programmes for the prevention of dental caries. To evaluate the association of water fluoridation (artificial or natural) with dental fluorosis.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and four other databases up to 16 August 2023. We also searched two clinical trials registers and conducted backward citation searches.

SELECTION CRITERIA

We included populations of all ages. For our first objective (effects of initiation or cessation of CWF programmes on dental caries), we included prospective controlled studies comparing populations receiving fluoridated water with those receiving non-fluoridated or naturally low-fluoridated water. To evaluate change in caries status, studies measured caries both within three years of a change in fluoridation status and at the end of study follow-up. For our second objective (association of water fluoridation with dental fluorosis), we included any study design, with concurrent control, comparing populations exposed to different water fluoride concentrations. In this update, we did not search for or include new evidence for this objective.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. For our first objective, we included the following outcomes as change from baseline: decayed, missing or filled teeth ('dmft' for primary and 'DMFT' for permanent teeth); decayed, missing or filled tooth surfaces ('dmfs' for primary and 'DMFS' for permanent teeth); proportion of caries-free participants for both primary and permanent dentition; adverse events. We stratified the results of the meta-analyses according to whether data were collected before or after the widespread use of fluoride toothpaste in 1975. For our second objective, we included dental fluorosis (of aesthetic concern, or any level of fluorosis), and any other adverse events reported by the included studies.

MAIN RESULTS

We included 157 studies. All used non-randomised designs. Given the inherent risks of bias in these designs, particularly related to management of confounding factors and blinding of outcome assessors, we downgraded the certainty of all evidence for these risks. We downgraded some evidence for imprecision, inconsistency or both. Evidence from older studies may not be applicable to contemporary societies, and we downgraded older evidence for indirectness. Water fluoridation initiation (21 studies) Based on contemporary evidence (after 1975), the initiation of CWF may lead to a slightly greater change in dmft over time (mean difference (MD) 0.24, 95% confidence interval (CI) -0.03 to 0.52; P = 0.09; 2 studies, 2908 children; low-certainty evidence). This equates to a difference in dmft of approximately one-quarter of a tooth in favour of CWF; this effect estimate includes the possibility of benefit and no benefit. Contemporary evidence (after 1975) was also available for change in DMFT (4 studies, 2856 children) and change in DMFS (1 study, 343 children); we were very uncertain of these findings. CWF may lead to a slightly greater change over time in the proportion of caries-free children with primary dentition (MD -0.04, 95% CI -0.09 to 0.01; P = 0.12; 2 studies, 2908 children), and permanent dentition (MD -0.03, 95% CI -0.07 to 0.01; P = 0.14; 2 studies, 2348 children). These low-certainty findings (a 4 percentage point difference and 3 percentage point difference for primary and permanent dentition, respectively) favoured CWF. These effect estimates include the possibility of benefit and no benefit. No contemporary data were available for adverse effects. Because of very low-certainty evidence, we were unsure of the size of effects of CWF when using older evidence (from 1975 or earlier) on all outcomes: change in dmft (5 studies, 5709 children), change in DMFT (3 studies, 5623 children), change in proportion of caries-free children with primary dentition (5 studies, 6278 children) or permanent dentition (4 studies, 6219 children), or adverse effects (2 studies, 7800 children). Only one study, conducted after 1975, reported disparities according to socioeconomic status, with no evidence that deprivation influenced the relationship between water exposure and caries status. Water fluoridation cessation (1 study) Because of very low-certainty evidence, we could not determine if the cessation of CWF affected DMFS (1 study conducted after 1975; 2994 children). Data were not available for other review outcomes for this comparison. Association of water fluoridation with dental fluorosis (135 studies) The previous version of this review found low-certainty evidence that fluoridated water may be associated with dental fluorosis. With a fluoride level of 0.7 parts per million (ppm), approximately 12% of participants had fluorosis of aesthetic concern (95% CI 8% to 17%; 40 studies, 59,630 participants), and approximately 40% had fluorosis of any level (95% CI 35% to 44%; 90 studies, 180,530 participants). Because of very low-certainty evidence, we were unsure of other adverse effects (including skeletal fluorosis, bone fractures and skeletal maturity; 5 studies, incomplete participant numbers).

AUTHORS' CONCLUSIONS

Contemporary studies indicate that initiation of CWF may lead to a slightly greater reduction in dmft and may lead to a slightly greater increase in the proportion of caries-free children, but with smaller effect sizes than pre-1975 studies. There is insufficient evidence to determine the effect of cessation of CWF on caries and whether water fluoridation results in a change in disparities in caries according to socioeconomic status. We found no eligible studies that report caries outcomes in adults. The implementation or cessation of CWF requires careful consideration of this current evidence, in the broader context of a population's oral health, diet and consumption of tap water, movement or migration, and the availability and uptake of other caries-prevention strategies. Acceptability, cost-effectiveness and feasibility of the implementation and monitoring of a CWF programme should also be taken into account.

Race (black-white) and sex inequalities in tooth loss: A population-based study

The effect of health inequalities is determined by different socioeconomic, sex, and race conditions. This study aimed to analyze the association of tooth loss with race (defined by self-reported skin color) and sex. Based on the hypothesis that the association between tooth loss and race may be modified by sex, we also aimed to evaluate possible interactions between race and sex in association with this event, in a population-based study in the city of Campinas, Brazil. A directed acyclic graph was used to select covariates. The prevalence, of tooth loss was 19% higher in black women compared to white men (Prevalence ratio [PR]: 1.19; 95%CI: 1.05–1.34). Moreover, the prevalence of tooth loss in black women was 26% higher than in white women (PR: 1.26; 95%CI: 1.13–1.42); and, within the strata of black people, black women had 14% higher dental loss (PR: 1.14; 95%CI: 1.02–1.27) compared to black men. This study found a significant interaction between race and sex in tooth loss, with a disadvantage for black women. In addition, this work contributes to the discussion of health inequities and can support policies for the provision of universal dental care.

Effectiveness of water fluoridation in an upper-middle-income country: A systematic review and meta-analysis

AIM

To summarize the information on the effectiveness of community water fluoridation (CWF) on the reduction of dental caries in the context of the wide use of fluoridated toothpaste in Brazil.

DESIGN

A systematic review was conducted regarding the effect of CWF based on studies with Brazilian population groups using the following electronic databases: MEDLINE/PubMed, LILACS, SciELO, and SCOPUS. The literature search was conducted up to August 2019. Studies that compared caries experience in at least two areas, one fluoridated and the other non-fluoridated, by mean dmft/DMFT (decayed, missing, and filled teeth) index or caries prevalence (caries vs. caries-free) were included. Considering the beginning of widespread use of fluoride dentifrice and the time for producing dental caries decline, studies published before 1995 were excluded. Descriptive analysis and meta-analyses were carried out. The effect size was measured by mean difference for dmft and DMFT ± SD and odds ratios on a logarithmic scale for caries prevalence.

RESULTS

Of the 574 studies retrieved, 16 and 10 were included in the qualitative and quantitative analysis, respectively. Fluoridated areas exhibited lower mean dmft/DMFT than non-fluoridated areas did. The mean difference in the dmft between non-fluoridated and fluoridated areas was -2.28 (95% CI -3.26; -1.30) for children aged 5-8 years and -1.12 (95% CI -1.93; -0.32) for those aged 3-12 years; the mean difference in the DMFT was -0.61 (95% CI -0.80; -0.42) for the children aged between 7 and 12 years. The caries prevalence was 1.4 times and 57% lower, respectively, at primary and permanent dentition in fluoridated areas. Heterogeneity was observed in all age groups, ranging from 77.6% to 98.2%.

CONCLUSION

Community water fluoridation remains effective in preventing dental caries in children younger than 13 years, even with the widespread use of fluoridated toothpaste.

Factors associated with dental caries in adolescents: a cross-sectional study, São Paulo State, Brazil, 2015

OBJECTIVE

To analyze association between prevalence and severity of dental caries and demographic, socioeconomic, behavioral and oral health status in adolescents.

METHODS

This was a cross-sectional study with secondary data on 5,558 adolescents examined in the São Paulo State Oral Health Survey in 2015. The zero-inflated negative binomial regression model was used, considering sample weights. Prevalence ratios (PR), ratios of mean (RM) and confidence intervals (CI) were estimated.

RESULTS

Caries prevalence was 71.7%, and was higher in females (PR=1.09 - 95%CI 1.04;1.15), associated with being behind at school (PR=1.11 - 95%CI 1.03;1.18), dental calculus (PR=1.10 - 95%CI 1.01;1.20) and no access to fluoridated water (PR=1.21 - 95%CI 1.01;1.45).

CONCLUSION

Identification of factors associated with dental caries can instruct the programming of health services aimed at controlling the disease.

Computing and Oral Health: Mobile Solution for Collecting, Data Analysis, Managing and Reproducing Epidemiological Research in Population Groups

Epidemiological inquiries study and evaluate the health status of the population. For dental caries, the World Health Organization (WHO) recommends the DMFT and DMFS indexes, which represent the sum of the decayed, missing and filled teeth, divided by the population studied. Traditionally these surveys are conducted using cellulose paper sheet. This study describes the development and presents the field performance of NutriOdonto, a software created for an Oral Health Survey carried out in 2018 and 2019 involving 2578 students from the municipal schools of Palmas/TO, located in the Brazilian Amazon region. This is a descriptive, applied research on the development of a software for the collecting, analysis, management and reproducibility of oral health epidemiological research. A software applied to the collecting, analysis and formation of the database was developed through the information obtained from the questionnaires applied to the participants of the study and the completion of the electronic oral examination form. Recent Information and Communication Technologies (ICT) are intelligently configured to create models and mobile applications (Apps) that can be useful to manage health issues, thus broadening the perspective of service provision in this sector. Some of these mobile devices, tablets and smartphones are being developed to generate information, for collection, recording, storage and analysis of oral health epidemiological research data. NutriOdonto contributed to the rapid collection, recording and storage of information, in the construction of the database and its analysis. Replacing paper forms with electronic forms minimized possible typos, reduced the use of cellulose paper and the financial costs, among other things. This software can contribute to decision making by managers and professionals and to improving the planning and implementation of actions in health promotion and oral disease prevention.

Adolescents with worse levels of oral health literacy have more cavitated carious lesions

The aim of the present study was to investigate whether the ability to recognize and read oral health terms is associated with the number of teeth with cavitated carious lesions in adolescents. A population-based cross-sectional study was conducted involving a sample of 746 adolescents representative of students aged 15 to 19 years at the public and private school systems in a city in northeast Brazil. Two examiners who had undergone a training and calibration exercise (inter-examiner and intra-examiner Kappa coefficient: 0.87 to 0.93) performed the diagnosis of caries using the Nyvad Index and evaluated the level of OHL (BREALD-30) of the adolescents. The participants answered questions regarding their history of visits to the dentist and the parents/caregivers answered a questionnaire addressing socioeconomic characteristics. A directed acyclic graph was created to direct the selection of covariables for adjustments in the Poisson multiple regression analysis to test the association between dental caries and OHL (α = 5%). Cavitated carious lesions (codes 3 to 6 on the Nyvad index) were found in 41.6% of the adolescents. Only 29.4% had a high level of OHL (BREALD-30 scores between 23 and 30); 42.3% of the families belonged to the A-B social class and 93% of the adolescents had been to the dentist at least once in their lifetimes. In the multivariate analysis, adolescents with inadequate (PR: 1.69; 95% CI: 1.18–2.41; p = 0.004) and marginal (PR; 1.42; 95% CI: 1.01–1.99; p = 0.042) OHL and those in the lower social classes (C-D-E) (PR: 1.85; 95% CI: 1.39–2.47; p<0.001) had more teeth with cavitated carious lesions. In conclusion, adolescents aged 15 to 19 years with poorer levels of OHL had a larger number of teeth with cavitated carious lesions, independently of their socioeconomic status and history of visiting a dentist.

Factors influencing the impact of oral health on the daily activities of adolescents, adults and older adults

OBJECTIVE:

Analyze if clinical, sociodemographic and access to dental services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults.

METHODS:

A cross-sectional study with secondary data from the State Oral Health Survey (SB São Paulo 2015) conducted in 163 cities of São Paulo. A total of 17,560 individuals from three age groups: 15–19-year-old (n = 5,558), 35–44-year-old (n = 6,051), and older people of 65 years or more (n = 5,951) participated in the survey. The selection was made by probabilistic sample by conglomerates in two stages. The endpoint variable was the impact of oral health on daily activities, evaluated by the Oral Impacts on Daily Performances questionnaire, containing questions about eating, talking, oral hygiene, relaxation, sports practice, smile, study or work, social contact, and sleep. Oral Impacts on Daily Performances was dichotomized with and without impact. The independent variables were sociodemographic, clinical and access variables, divided into three blocks. A hierarchical multiple logistic regression analysis was performed considering the complex sampling plan of clusters. Each observation received a specific weight, depending on the location that resulted in weighted frequencies and adjusted for the design effect.

RESULTS:

The presence of oral health impact was observed in 27.9% of the individuals. In block 1, female gender and black/brown ethnic group had a greater chance of impact of oral health on quality of life, as well as the adults and the older adults in relation to adolescents. In block 2, family income up to R$1,500 was associated with the presence of impact. In block 3, individuals who reported toothache, used the public service and sought dental treatment had a greater chance of impact.

CONCLUSIONS:

Sociodemographic, clinical and access to health services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults.

Inequality of Experience of Dental Caries between Different Ethnic Groups of Brazilians Aged 15 to 19 Years

Introduction

The aim of this study was to assess inequality of experience of dental caries, based on race/ethnicity, among Brazilian adolescents aged 15 to 19 years in 2010 and test whether socioeconomic indicators fully explain ethnic differences in dental caries.

Methods

Data from a National Oral Health Survey conducted in Brazil in 2010 was analysed. Race/ethnicity was self-assigned and modified to White, African descents, East Asian descents, Mixed Race and Indigenous descents. The prevalence of caries experience by race/ethnic group in 2010(n = 5,367) was calculated. Further analysis included conceptual hierarchical modelling and mediation analysis.

Results

Caries experience was 76.9% in 15 to 19 year old Brazilians in 2010. While African descents were 32% more likely to have caries experience than Whites, Mixed Race were 69% more likely to have caries experience than Whites. Hierarchical conceptual modelling analysis confirmed the highly significant association between caries and race/ethnicity. Mixed Race and East Asian descents were 1.44 (95% CI 1.24–1.67) and 1.81 (95% CI 1.02–3.20) times more likely to experience caries than Whites after adjusting for age, sex, education and income. The difference in the likelihood of experiencing caries between Whites and African descents was not statistically significant after adjusting for years of education and family income. The results of mediation analysis confirmed that inequality of caries experience between Whites and Mixed Race and East Asian descents was mediated through education and income. The likelihood that Mixed Race and East Asian descents would experience caries compared to Whites was attenuated, by 14.8% and by 9.5% respectively, after adjusting for years of education and income.

Conclusions

Data analysis demonstrated that Whites have benefited more from the significant reduction in dental caries experience in 15 to 19 year old Brazilians, as compared to African descents and Mixed Race. Education and income fully explained ethnic inequalities in experience of dental caries between Whites and African descents, and largely explained inequalities between Whites and Mixed Race.

[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).

Water fluoridation for the prevention of dental caries

BACKGROUND

Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation was initiated in the USA in 1945 and is currently practised in about 25 countries around the world; health authorities consider it to be a key strategy for preventing dental caries. Given the continued interest in this topic from health professionals, policy makers and the public, it is important to update and maintain a systematic review that reflects contemporary evidence.

OBJECTIVES

To evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries.To evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis.

SEARCH METHODS

We searched the following electronic databases: The Cochrane Oral Health Group's Trials Register (to 19 February 2015); The Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, 2015); MEDLINE via OVID (1946 to 19 February 2015); EMBASE via OVID (1980 to 19 February 2015); Proquest (to 19 February 2015); Web of Science Conference Proceedings (1990 to 19 February 2015); ZETOC Conference Proceedings (1993 to 19 February 2015). We searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization's WHO International Clinical Trials Registry Platform for ongoing trials. There were no restrictions on language of publication or publication status in the searches of the electronic databases.

SELECTION CRITERIA

For caries data, we included only prospective studies with a concurrent control that compared at least two populations - one receiving fluoridated water and the other non-fluoridated water - with outcome(s) evaluated at at least two points in time. For the assessment of fluorosis, we included any type of study design, with concurrent control, that compared populations exposed to different water fluoride concentrations. We included populations of all ages that received fluoridated water (naturally or artificially fluoridated) or non-fluoridated water.

DATA COLLECTION AND ANALYSIS

We used an adaptation of the Cochrane 'Risk of bias' tool to assess risk of bias in the included studies.We included the following caries indices in the analyses: decayed, missing and filled teeth (dmft (deciduous dentition) and DMFT (permanent dentition)), and proportion caries free in both dentitions. For dmft and DMFT analyses we calculated the difference in mean change scores between the fluoridated and control groups. For the proportion caries free we calculated the difference in the proportion caries free between the fluoridated and control groups.For fluorosis data we calculated the log odds and presented them as probabilities for interpretation.

MAIN RESULTS

A total of 155 studies met the inclusion criteria; 107 studies provided sufficient data for quantitative synthesis.The results from the caries severity data indicate that the initiation of water fluoridation results in reductions in dmft of 1.81 (95% CI 1.31 to 2.31; 9 studies at high risk of bias, 44,268 participants) and in DMFT of 1.16 (95% CI 0.72 to 1.61; 10 studies at high risk of bias, 78,764 participants). This translates to a 35% reduction in dmft and a 26% reduction in DMFT compared to the median control group mean values. There were also increases in the percentage of caries free children of 15% (95% CI 11% to 19%; 10 studies, 39,966 participants) in deciduous dentition and 14% (95% CI 5% to 23%; 8 studies, 53,538 participants) in permanent dentition. The majority of studies (71%) were conducted prior to 1975 and the widespread introduction of the use of fluoride toothpaste.There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries across socioeconomic status (SES) levels.There is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels.No studies that aimed to determine the effectiveness of water fluoridation for preventing caries in adults met the review's inclusion criteria.With regard to dental fluorosis, we estimated that for a fluoride level of 0.7 ppm the percentage of participants with fluorosis of aesthetic concern was approximately 12% (95% CI 8% to 17%; 40 studies, 59,630 participants). This increases to 40% (95% CI 35% to 44%) when considering fluorosis of any level (detected under highly controlled, clinical conditions; 90 studies, 180,530 participants). Over 97% of the studies were at high risk of bias and there was substantial between-study variation.

AUTHORS' CONCLUSIONS

There is very little contemporary evidence, meeting the review's inclusion criteria, that has evaluated the effectiveness of water fluoridation for the prevention of caries.The available data come predominantly from studies conducted prior to 1975, and indicate that water fluoridation is effective at reducing caries levels in both deciduous and permanent dentition in children. Our confidence in the size of the effect estimates is limited by the observational nature of the study designs, the high risk of bias within the studies and, importantly, the applicability of the evidence to current lifestyles. The decision to implement a water fluoridation programme relies upon an understanding of the population's oral health behaviour (e.g. use of fluoride toothpaste), the availability and uptake of other caries prevention strategies, their diet and consumption of tap water and the movement/migration of the population. There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across SES. We did not identify any evidence, meeting the review's inclusion criteria, to determine the effectiveness of water fluoridation for preventing caries in adults.There is insufficient information to determine the effect on caries levels of stopping water fluoridation programmes.There is a significant association between dental fluorosis (of aesthetic concern or all levels of dental fluorosis) and fluoride level. The evidence is limited due to high risk of bias within the studies and substantial between-study variation.

[Dental caries and treatment needs in adolescents from the state of São Paulo, Brazil]

OBJECTIVE

To estimate the prevalence of dental caries and treatment needs in 12-year-olds and adolescents.

METHODS

Cross-sectional study based on results from the epidemiological surveys: Oral Health Conditions in the State of Sao Paulo, 2002 and the Brazilian Oral Health Survey (SBBrasil) 2010. Secondary data for 5,782 (2002) and 369 (2010) 12-year-olds and 880 (2002) and 300 (2010) 15- to 19-year-olds were analyzed. Dental caries attack was evaluated using the DMFT (decayed, missing or filled teeth) index and the need for treatment verified using the criteria proposed by the World Health Organization. The Significant Caries Index was used to measure the severity of the decay in the tercile of the group with the highest prevalence of the disease. In order to analyze the results, the Chi-squared and Mann-Whitney tests were used, with a 5% significance.

RESULTS

There was a decrease of 39.3 percentage points in the DMFT index for 12-year-olds (p < 0.001) and of 41.1 percentage points for the adolescents (p < 0.001) between 2002 and 2010, and an increase of around 161.0 and 303.0 percentage in the group which was free from dental caries respectively. The percentage of restored teeth decreased in both age groups, although the prevalence of dental caries did not change in the group more affected by dental caries. In the group with few dental caries, there was a decrease in the component 'tooth loss' for adolescents and increase in the component 'decayed teeth' for the 12-years-old and the adolescents. There was an increase in the need for dental treatment in the group as a whole and in the group of 12-year-olds more affected by dental caries; and among the adolescents, the need for restoration on two or more surface decreased in the group as a whole and also in the group which suffered least from dental caries.

CONCLUSIONS

The decreasing need for non-complex treatment in adolescents suggests that promotion and prevention activities are having a positive effect on this group. Moreover, the two epidemiological surveys in the state of Sao Paulo show improvements in oral health conditions in both age groups studied and calls for monitoring aimed also at the group least affected by dental caries.

The impacts of oral health on quality of life in working adults

This study investigated the impacts of oral health-related quality of life (OHRQoL) on daily activities and work productivity in adults. A cross-sectional study was conducted in a supermarket chain in the state of São Paulo, which included 386 workers, age-range 20 - 64 years. Participants were examined for oral disease following WHO recommendations, and the oral health impact profile (OHIP) assessment was used to determine OHRQoL. Demographic, socio-economic, use of dental services, and OHRQoL data were obtained. Answers to the OHIP were dichotomized into no impact and some impact, and the relationship to OHRQoL was determined. Poisson regression with robust variance was performed using SPSS version 17.0. Dimensions with highest OHIP scores were physical pain and psychological discomfort. Sex (male: PR = 0.55, 95% CI 0.38 - 0.80), lower family income (PR = 1.49, 95% CI 1.04 - 2.12), visiting a dentist due to pain (PR = 2.14, 95% CI 1.57 - 3.43), tooth loss (PR = 1.59, 95% CI 1.09 - 2.32), and needing treatment for caries (PR = 1.59, 95% CI 1.09 - 2.32) were most likely to impact OHRQoL. Therefore, socioeconomic and demographic status and use of dental services impacted OHRQoL. These results indicate that oral health promotion strategies should be included in work environments.

Risk indicators for tooth loss in adult workers

Tooth loss continues to be a prevalent condition in Brazilian adults and elderly individuals. The aim of this cross-sectional study, conducted among workers in a wholesale grocery chain in the State of São Paulo, was to identify risk indicators for tooth loss in adults. The presence of caries and periodontal status were examined in 387 adults aged 20-64 years, according to World Health Organization criteria. Two outcomes were analyzed: loss of one or more teeth, and loss of four or more teeth. Independent variables analyzed were demographic and socioeconomic factors, clinical conditions, use of dental services, and self-perceived oral health. Poisson regression models were used for multivariate statistical analysis. Participants were missing a mean of 5.38 teeth, and 76.9% (n = 297) had lost at least one tooth; the most frequently lost teeth were permanent molars. Older age and the presence of visible dental biofilm were associated significantly with the two tooth loss outcomes (p < 0.05). Individuals who had visited the dentist 3 or more years previously showed a lower prevalence of tooth loss (prevalence ratio = 0.79; 95% confidence interval, 0.68-0.91). Those with lower household incomes were significantly more likely to have lost four or more teeth (prevalence ratio = 1.35; 95% confidence interval, 1.07-1.70). Study results indicated that age and dental biofilm were risk indicators for tooth loss, independently of socioeconomic factors. These risk indicators should be considered when planning oral health programs for adults.

Issues of Recruitment and Rationale for Conducting Clinical Trials on Mutans Streptococci Suppression in Mothers

The aims of this study are (1) to describe issues related to recruitment of mothers participating in a clinical trial of transmission of mutans streptococci (MS) from mother to child in Bauru, Brazil and (2) to perform cross-cultural and temporal comparisons of levels of infection of the MS in mothers of Bauru. A total of 1422 mothers were visited at their domiciles. Cutoff levels for the MS were established at ≥10⁵ CFU/mL saliva. The main reason for a mother not enrolling was not being highly infected by the MS, yet 76% of mothers presented with levels ≥10⁵ CFU/mL saliva. Recent studies in industrialized countries showed a negative coefficient for linear tests indicating significant decline overtime in the levels of MS in mothers. Intercountry comparisons for mothers' salivary levels of the MS with the Bauru study as the reference revealed significant differences with studies conducted in the last two decades.

Prevalência de cárie dentária e condições socioeconômicas em jovens alistandos de Manaus, Amazonas, Brasil

A cárie dentária tem origem multifatorial e a condição socioeconômica está inserida neste contexto. O objetivo deste estudo foi conhecer a prevalência de cárie, além de verificar sua associação com variáveis socioeconômicas em jovens alistandos de 17 a 19 anos de idade, sexo masculino, em Manaus, Amazonas, Brasil. Foi realizado um estudo transversal com uma amostra de conveniência dos conscritos das Forças Armadas Brasileiras. Os critérios de diagnóstico e questionário socioeconômico foram baseados no levantamento nacional SB Brasil e OMS. Uma única examinadora (kappa = 0,96) realizou o exame bucal em 578 alistandos. Foi utilizado o teste Shapiro-Wilk para verificação de normalidade dos dados; não sendo aceita a normalidade (p = 0,0001), foi utilizado o teste não-paramétrico Kruskall-Walis para comparação das médias e assim verificar a diferença significativa entre CPOD e seus componentes com as variáveis avaliadas. A prevalência de cárie encontrada foi de 88,8% e o índice CPOD médio foi igual a 5,16 ± 0,17. Diferenças estatisticamente significantes foram encontradas nas médias dos componentes Cariado, Perdido e Obturado do índice CPOD, sendo os piores indicadores verificados nos grupos de menor escolaridade, menor renda e procedentes de escola pública, demonstrando maior necessidade de medidas preventivas e assistenciais para estes grupos.

Color/race inequalities in oral health among Brazilian adolescents

This study assessed oral health outcomes (perceived dental treatment need, untreated dental caries, gingival bleeding, periodontal pockets, and pain in teeth and gums), in relation to color/race inequalities among adolescents in each Brazilian region. The database included dental examination and interview of 16,833 15-19-year-old adolescents, surveyed by the Brazilian health authority, from May 2002 to October 2003, in accordance with international diagnostic criteria standardized by the World Health Organization. Prevalence ratios estimated by Poisson regression, and controlled by socioeconomic status and access to fluoridated piped water, assessed oral health differentials among color/race groups and country's regions. Except for periodontal pockets, prevalence figures were higher in the North and Northeast: perceived dental treatment needs, untreated dental caries, gingival bleeding at probing and pain in teeth and gums varied between 80-83%, 75-76%, 38-43%, and 17-18%, respectively, in these regions. Adolescents living in the Southeast - the richest Brazilian region - presented a better general profile of oral health than their counterparts living in the remaining regions; they had a lower prevalence of untreated dental caries (54%) and unfavorable gingival status (29%). However, the Southeast presented color/race inequalities in all oral health outcomes, with a poorer profile systematically affecting browns or blacks, depending on the oral health condition under consideration. These results reinforce the need for expanding the amplitude of health initiatives aimed at adolescent oral health. Socially appropriate health programs should concurrently aim at the reduction of levels of oral disease and its inequalities.

Relationship between oral health and its impact on quality of life among adolescents

The aim of this study was to assess oral health status and its relationship with quality of life. A household population, cross-sectional study was carried out; participants were between 15 and 17 years of age (n = 247) and were examined by two calibrated dentists. Socio-economic status was classified according to ANEP-ABIPEME criteria. Clinical examinations to observe DMFT, CPI and Dean indices were performed as per WHO criteria. The Significant Caries Index (SiC) was used to evaluate polarization of the occurrence of caries among participants of the tercile with higher DMF-T. The OHIP instrument was used to measure quality of life. The Spearman and Mann-Whitney tests were used for assessing correlations (5% significance level). Examinations were carried out in 117 (47.37%) females and in 130 (52.63%) males. Of the examined participants, 45.75% were classified as belonging to socio-economic class C. Caries occurrence was observed in 218 subjects (88.26%); the mean DMFT was 5.40. The SiC index was 9.97. Almost half (47.77%) of the participants examined did not present sextants affected by periodontal disease. Of the participants examined, 80.16% presented absence of fluorosis. The mean OHIP was 3.95. The following correlations were observed: a positive and statistically significant correlation between the highest score in the OHIP and decayed teeth; a positive correlation with threshold significance between OHIP and DMFT; an inverse correlation between intact teeth and OHIP; and a positive and non statistically significant correlation between SiC and OHIP (correlation coefficient = 0.13, p = 0.245). Association between the mean OHIP and the terciles was not significant (p = 0.146); there were also no associations between periodontal condition and OHIP nor were there associations between the presence of fluorosis and mean OHIP.

[Prevalence of cavities among adolescents in public and private schools in João Pessoa, Paraíba State, Brazil]

The purpose of this study was to ascertain the prevalence of cavities among adolescents in public and private schools in João Pessoa, Paraíba State, Brazil, comparing the DMFT in terms of gender and age, as well as education levels and quality among mothers in these two types of schools. The sample consisted of 3,330 adolescents between twelve and fifteen years old: 1,665 attending public schools and 1,665 attending private schools. The DMFT was evaluated by the WHO criteria (1997), using the Kappa (0.92) intra-examiner agreement for cavity diagnoses and the Mann-Whitney and Kruskal-Wallis statistical analyses. The prevalence of cavities in public schools was 51.6%, compared to 9.3% in private schools. The DMFT for girls was 4.79 and 3.46 for boys in public schools (p<0.0001) and 2.11 and 1.65 (p=0.0007) in private schools. At the age of 12 years, the DMFT was 3.37 in public schools and 1.35 in private schools, while for the age of 15 it was 5.65 and 2.88 for each type of school. Among children whose mothers graduated from high school, the average DMFT was 4.21 in public schools and 1.81 in private schools. The prevalence of cavities was higher among girls in public schools, increasing with age and decreasing with higher education levels among mothers.

A saúde bucal de adolescentes: aspectos de higiene, de cárie dentária e doença periodontal nas cidades de Recife, Pernambuco e Feira de Santana, Bahia

OBJETIVO: Caracterizar a saúde bucal de adolescentes nas cidades de Recife e Feira de Santana, pela avaliação de higiene bucal, cárie dentária e doença periodontal. MÉTODO: Foram avaliados 40 adolescentes com 10 a 18 anos de idade em Recife, em estudo exploratório, em 2005 e, em Feira de Santana, 971 adolescentes com 12 anos idade, num estudo de prevalência, em 2002. Avaliaram-se: cárie, pelo número de dentes cariados, perdidos e obturados; placa dentária visível, sangramento gengival e condição periodontal. Para análise, utilizaram-se os testes Quiquadrado, Kruskall-Wallis, Exato de Fisher, com intervalo de confiança de 95%. RESULTADOS: A maioria dos adolescentes realizavam higiene oral três vezes ao dia. Os valores do CPOD apresentaram mediana de 1,5 em Recife e médias de 1,89 nas escolas estaduais, 2,17 nas municipais e 2,39 nas particulares, em Feira de Santana. O sangramento gengival em Recife teve mediana de 27% e, em Feira de Santana, a média de sextantes sadios foi de 4,36, 4,08 e 5,16, nas escolas estaduais, municipais e particulares respectivamente. CONCLUSÃO: A freqüência da cárie dentária foi baixa, a maioria dos adolescentes relatou bons hábitos de higiene bucal e a condição periodontal nos adolescentes foi favorável.

Prevalence and Severity of Dental Caries in Adolescents Aged 12 and 15 Living in Communities with Various Fluoride Concentrations

OBJECTIVES

To determine the experience, prevalence, and severity of dental caries in adolescents naturally exposed to various fluoride concentrations.

METHODS

A cross-sectional census was conducted on 1,538 adolescents aged 12 and 15 years living at high altitude above sea level (> 2,000 m or > 6,560 ft) in above-optimal fluoridated communities (levels ranging from 1.38 to 3.07 ppm) of Hidalgo, Mexico. Sociodemographic and socioeconomic data were collected using questionnaires. Two previously trained and standardized examiners performed the dental exams.

RESULTS

Caries prevalence was 48.6 percent and mean of decay, missing, and filling teeth (DMFT) for the whole population was 1.15 +/- 1.17. In terms of severity, 9.6 percent of the adolescents had DMFT > or = 4, and 1.7 percent had > or = 7. The significant caries index (SiC) was 2.41 in the group of 12-year-olds, and 3.46 in the 15-year-olds. Higher experience and prevalence were observed in girls, in children with dental visit in the past year, those in the wealthiest socioeconomic status (SES) (quartiles 2, 3, and 4), those whose locale of residence is in San Marcos and Tula Centro, and in fluorosis-free children and those with moderate/severe fluorosis. In an analysis of caries severity (DMFT > or = 4), both adolescents with very mild/mild and moderate/severe dental fluorosis have higher caries severity.

CONCLUSIONS

The results indicated that caries experience, prevalence, and severity as well as SiC index among 12- and 15-year-old adolescents were relatively low. Sociodemographic and socioeconomic variables commonly associated with dental caries were also observed in Mexican adolescents. Unlike other studies, we found that caries increased with higher SES. Fluoride exposure (measured through fluorosis presence) does not appear to be reducing the caries prevalence (DMFT > 0) or caries severity (DMFT > or = 4) in these high-altitude communities.

Declínio da cárie em um município da região noroeste do Estado de São Paulo, Brasil, no período de 1998 a 2004

O objetivo do estudo foi analisar os índices CPOD, ceod, SiC Index e a porcentagem de crianças livres de cárie, em escolares de 5 a 12 anos da rede pública do Município de Bilac, São Paulo, Brasil, em estudos realizados nos anos de 1998, 2000, 2002 e 2004. Utilizou-se a mesma metodologia (OMS-1997) em todos os levantamentos. O teste estatístico kappa foi calculado a cada estudo, obtendo-se o valor de concordância interexaminadores mínimo de 0,86 e máximo de 0,89, e intra-examinador mínimo de 0,91. O índice ceod diminuiu pouco nos anos de 1998 e 2004. Houve uma redução contínua do índice CPOD aos 12 anos, passando de 5,28 em 1998 para 4,11 em 2000, 3,47 em 2002 e 2,62 em 2004, e o fenômeno da polarização. Na proporção inversa, a porcentagem de crianças com 5 anos livres de cárie aumentou de 37,9% em 1998 para 40% em 2000 e 2002, e 45,3% em 2004. Conclui-se que está ocorrendo a redução da cárie dentária na faixa etária de 12 anos entre escolares do ensino público do município.