Longitudinal study for dental caries calibration of dentists unexperienced in epidemiological surveys

Abstract This study aimed to make a longitudinal analysis of interexaminer calibration reproducibility in diagnosing dental caries in posterior teeth, by examiners without previous experience in epidemiological studies. A group of 11 inexperienced examiners underwent theoretical-practical training and calibration assessments, assisted by a standard examiner. An examiner who did not participate directly in the research selected 5-year-old children with and without caries. The D3 diagnostic threshold was used to evaluate dental caries, based on the World Health Organization (WHO) criteria. The initial calibration (baseline) was performed after the theoretical-practical training session, and consisted of examining 20 children; the second calibration occurred three months later, and involved evaluating another 18 children. The interexaminer agreement was obtained by kappa statistics, and by overall percentage agreement. The paired t-test was applied to compare the values for kappa means and overall percentage agreement between the time points studied. At baseline, the values for kappa (> 0.81) and overall percentage agreement (> 95.63%) were considered high. At the 3-month calibration assessment, all the examiners showed some decrease in both kappa (p < 0.0001) and overall percentage agreement (p = 0.0102). The calibration process currently proposed by the WHO is effective. However, reproducibility was not maintained over time for inexperienced examiners evaluating the posterior teeth of 5-year-old children, under epidemiological conditions.

Análise do teor de fluoretos nas águas de abastecimento público em um município da região metropolitana de Curitiba/PR: doze meses de heterocontrole / Analysis of fluoride content in the public water supply in a city of the metropolitan region of Curitiba/PR: twelve months of external control

Resumo Introdução A fluoretação das águas de abastecimento tem sido apontada em estudos nacionais e internacionais como a mais eficiente e equânime forma de acesso a fluoretos na prevenção da cárie dentária. Objetivo Relatar os resultados do heterocontrole nas águas de abastecimento público do município de Colombo/PR, no período de dezembro de 2013 a novembro de 2014. Método Foram coletadas amostras mensais em 15 Unidades Básicas de Saúde, em dias da semana aleatórios, no período de 12/2013 a 11/2014. As amostras foram analisadas pelo método eletrométrico na Faculdade de Odontologia da Universidade Federal Fluminense. Resultados Foram analisadas 180 amostras, que variaram de <0,001 a 1,480 mg/L (média 0,715±0,232 mg/L). De acordo com o critério estabelecido pelo Centro Colaborador do Ministério da Saúde em Vigilância da Saúde Bucal, 51,11% das amostras apresentavam níveis de fluoretos adequados, 13,34% concentrações de flúor acima do ideal, e 35,56% abaixo do ideal. Conclusão O heterocontrole representa uma das principais estratégias de vigilância em saúde bucal, e, dessa forma, deve ser implementado e efetuado em todas as regiões que utilizam água fluoretada, a fim de garantir a manutenção de níveis ótimos de fluoretos.

Abstract Background The fluoridation of water supply has been pointed out in national and international studies as the most efficient and equal way of accessing fluorides in the prevention of dental caries. Objective To report the results of heterocontrol in public water supply in the municipality of Colombo/PR, from December 2013 to November 2014. Method The samples were monthly collected in 15 Basic Health Units, on random days of the week, from 12/2013 to 11/2014. The samples were analyzed by the electrometric method at the Faculty of Dentistry of Fluminense Federal University. Results 180 samples were analyzed, ranging from <0.001 to 1.480 mg/L (mean 0.715 ± 0.232 mg/L). According to the criteria established by the Collaborating Center of the Ministry of Health in Oral Health Surveillance, 51.11% of the samples had adequate fluoride levels, 13.34% above ideal fluoride levels, and 35.56% below ideal levels. Conclusion Heterocontrol could represent one of the main strategies of oral health surveillance, and, therefore, it should be implemented and carried out in all regions that use fluoridated water, in order to guarantee the maintenance of optimal fluoride levels.

Association of clinical, social and environmental variables with dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water / Associação de variáveis clínicas, sociais e ambientais sobre a cárie dentária em adolescentes de um município brasileiro com água fluoretada

Abstract Background Although a trend towards dental caries reduction has been observed, further investigations on its pattern and development are still needed. Objective To investigate the influence of clinical, social and environmental variables on dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water in 2018. Method This study was conducted with a non-probabilistic sample of 277 adolescents aged 12 years of public schools in Nova Friburgo, state of Rio de Janeiro, Brazil. Clinical examinations were carried out by calibrated examiners to assess caries, periodontal disease, and fluorosis according to criteria of the World Health Organization (WHO). Semi-structured questionnaires were applied to record socio-environmental information. Results Individuals living in regions supplied with fluoridated water below the minimum required levels (OR=3.60, p=0.0006), with low income (OR=1.90, p=0.0444), presence of gingivitis (OR=3.36; p=0.0016), and whose reason for visiting the dentist was dental treatment (OR=2.41; p=0.0203) were more likely to have dental caries. A significant reduction (p<0.0001) in dental caries indexes was observed between 2012 and 2018. Conclusion Fluoridation of public water supply at unsuitable levels, as well as other social and clinical variables can influence the caries pattern in adolescents.

Resumo Introdução A tendência de redução da cárie dentária tem sido constatada, apesar de maiores investigações sobre seu padrão e desenvolvimento serem ainda necessárias. Objetivo investigar a influência de variáveis clínicas, sociais e ambientais sobre a cárie em adolescentes de um município brasileiro com água fluoretada, no ano de 2018. Método Empregou-se uma amostra não probabilística de 277 adolescentes de 12 anos, de escolas públicas de Nova Friburgo, Rio de Janeiro, Brasil. Exames clínicos foram realizados por examinadores calibrados, para avaliação de cárie, doença periodontal e fluorose, sob critérios da Organização Mundial da Saúde (OMS). Questionários semiestruturados foram aplicados para coletar informações socioambientais. Resultados Indivíduos residentes em regiões com flúor na água em subdoses (OR=3,60, p=0,0006), e aqueles com baixa renda (OR =1,90, p=0,0444), com presença de gengivite (OR = 3,36; p = 0,0016) e cuja razão para a visita ao dentista foi para tratamento dentário (OR=2,41; 0,0203), apresentaram mais chances de terem cárie. Uma redução significativa (p<0,0001) nos índices de cárie foi observada entre 2012 (primeiro levantamento epidemiológico) e 2018. Conclusão A fluoretação das águas de abastecimento público, quando em níveis não adequados, assim como outras variáveis sociais e clínicas, podem influenciar o padrão de cárie nos adolescentes.

Clinical and Social Variables Association on the Frequency of Intellectual Disability Persons to Dental Care

ABSTRACT Objective: To evaluate the association of oral health indicators and social variables on the frequency of visit to the dentist by persons with intellectual disability (ID). Material and Methods: The study comprised a sample consisting of 149 participants with ID, aged from 11 to 29 years, from non-governmental institutions. Semi-structured interviews were held to collect sociodemographic and psychosocial information with their parents/guardians, followed by oral health evaluations in accordance with World Health Organization criteria. Crude analyses and multiple analysis were conducted to test whether oral health indicators and social data were predictors of the visit to dental care services. Results: In the multiple logistic regression model, individuals with lower DMF-t (OR=3.13; 95% CI=1.40-6.97) and those with less crowded housing (OR=2.33; 95% CI=1.06-5.12) presented less frequency of visits to oral health services. Conclusion: DMFT and crowded housing are associated to the frequency of persons with intellectual disability to dental care as well as this outcome measure affects the oral health of persons with ID. Therefore, identifying limiting factors to dental care of persons with intellectual disability is needed so that this group can receive adequate attention.

Dental caries surveys: considerations about reproducibility / Inquéritos de cárie dentária: considerações sobre a reprodutibilidade

Aim:To evaluate the impact of the recording of teeth whose clinical conditions rarely vary (anterior teeth and third molars) in inter-examiner agreement measurements. Methods:Clinical data from 56 schoolchildren, 12 years of age, previously collected by two examiners, according to the "Oral Health Surveys: basic methods" codes and criteria, were analyzed in the present study. The effects from including/excluding such teeth upon reproducibility were measured by general percentage agreement (GPA) and Kappa statistics (к) performances. Results: The exclusion of anterior teeth associated with the inclusion of third molars produced a decrease in GPA that was simultaneous to an increase in the weighted Kappa (nominal data) and simple (dichotomous data) values. The incorrect inclusion of third molars (GPA = 100%; к = + 1) in the reproducibility measurement artificially increased the inter-examiner Kappa values. Conclusion: The inclusion/exclusion of anterior teeth and third molars, seeking a more reliable agreement among examiners, can have a positive or negative impact on the measured reproducibility values. A clear warning about the impact of including third molars in the reproducibility measurement, in the 12 years old age group, should be performed in "Oral Health Surveys: basic methods" and similar manuals.

Objetivo: Avaliar o impacto do registro de dentes anteriores e terceiros molares, cujas condições clínicas pouco variam, sobre as mensurações de concordância inter-examinadores. Métodos: Dados clínicos de 56 escolares de 12 anos de idade, previamente coletados por 2 examinadores, segundo os códigos e critérios expressos no "Levantamentos em Saúde Bucal: métodos básicos" foram analisados neste estudo. Os efeitos da inclusão/exclusão destes dentes sobre a concordância inter-examinadores foram mensurados calculando-se a porcentagem geral de concordância (GPA) e estatística Kappa (к). Resultados:A inclusão de terceiros molares aumentou a GPA para dados dicotomizados ou não. A exclusão de dentes anteriores diminuiu a GPA para dados dicotomizados ou não. Quando associada à inclusão de terceiros molares, sob perfeita concordância (к = +1), os valores de Kappa foram artificialmente aumentados tanto para dados dicotomizados quanto não-dicotomizados. Conclusão: A inclusão/exclusão de dentes anteriores e/ou de terceiros molares, no sentido de se evidenciar melhor as discordâncias entre examinadores, podem impactar positiva ou negativamente sobre a fidedignidade da reprodutibilidade mensurada. Uma advertência clara sobre o impacto da inclusão dos dentes terceiros molares no cálculo da reprodutibilidade, para a faixa etária de 12 anos, deveria estar presente no "Levantamentos em Saúde Bucal: métodos básicos" e manuais semelhantes.

The influence of the Brazilian school health program on the oral-health-related quality of life of adolescents

Abstract The aim of this study was to evaluate the influence of the Brazilian School Health Program (SHP) on dental clinical disorders such as caries, gingivitis, and dental trauma as well as on the oral-health-related quality of life (OHRQoL) of adolescents in Nova Friburgo, RJ, Brazil. The study consisted of a non-probabilistic (convenience) sample comprising 319 12-year-old adolescents, both participants and non-participants of the SHP, for at least two years. Socio-demographic and OHRQoL questionnaires (CPQ11-14, the Child Perceptions Questionnaire) were applied as well as clinical examinations for caries, periodontal disease, and dental trauma following the World Health Organization (WHO) criteria by calibrated researchers. Mann-Whitney, chi-square tests, and multiple logistic regression models were used for the data analysis. Statistically significant differences were observed between the groups covered and not covered by the SHP for gingivitis (p = 0.0373) and OHRQoL on the social welfare subscale (p = 0.0265) and total scale (p = 0.0449) of CPQ11-14. Multivariate analysis showed that female adolescents were 1.74 times more likely to present a lower OHRQoL (OR = 1.74, 95%IC = 1.10-2.77, p = 0.0183) than males. In addition, non-SHP subjects were 1.56 times more likely to have poor OHRQoL (OR = 1.56, 95%IC = 0.94-2.59, p = 0.0873) than program participants. In conclusion, SHP positively influenced the OHRQoL of adolescents. However, follow-up studies are needed to verify the continued effectiveness of this Brazilian SHP in improving the oral health levels and quality of life of adolescents.

Temporomandibular disorders and relationship with socio-demographic and clinical variables in a University of the state of Rio de Janeiro / Disfunções temporomandibulares e a relação com determinantes sócio-demográficos e clínicos em uma universidade do estado do Rio de Janeiro

ABSTRACT BACKGROUND AND OBJECTIVES: This study aimed at identifying the prevalence of suspected temporomandibular disorders in employees and students of a Brazilian university and at evaluating the influence of socio-demographic and clinical variables on this disorder. METHODS: This study had a non-probabilistic sample of 575 volunteers who were evaluated by a questionnaire proposed by the American Academy of Orofacial Pain. RESULTS: Suspected temporomandibular disorder was present in 60.87% of the population. By means of multiple logistic regression analysis, just clinical variables were associated to the presence of suspected temporomandibular disorder, such as: headache, neck pain or teethache (OR=47.60), stiff, tight or regularly tired jaws (OR=13.37), mouth opening difficulty (OR=13.55) and pain around the ears, temples or cheeks (OR=4.61). CONCLUSION: The questionnaire was effective as a pre-screening tool to identify symptoms, and results support the importance of clinical symptoms for the identification and follow up of patients with such disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi identificar a prevalência de suspeita de disfunção temporomandibular em funcionários e estudantes em uma universidade no Brasil e analisar a influência das variáveis sócio-demográficas e clínicas sobre essa disfunção. MÉTODOS: Este estudo teve uma amostra não probabilística compreendendo 575 voluntários que foram avaliadas por um questionário, proposto pela Academia Americana de Dor Orofacial. RESULTADOS: A suspeita de disfunção temporomandibular estava presente em 60,87% da população. Por meio da análise de regressão logística múltipla, apenas variáveis clínicas foram associadas com a presença de suspeita de disfunção temporomandibular, como: apresentar cefaleia, dores no pescoço ou nos dentes (OR=47,60), maxilares rígidos, apertados ou cansados com regularidade (OR=13,37), dificuldade na abertura da boca (OR=13,55) e dor ao redor das orelhas, têmporas ou bochecha (OR=4,61). CONCLUSÃO: O questionário foi eficaz como um instrumento de pré-triagem no levantamento dos sintomas; e os resultados suportam o ponto forte dos sintomas clínicos na identificação e acompanhamento de indivíduos com tais lesões.

Ensino e Aprendizagem em Odontologia: Análise de Sujeitos e Práticas / Teaching and Learning in Dentistry: Analysis of Individuals and Practices

RESUMO O presente estudo pedagógico objetivou investigar o processo de formação em Odontologia com base na visão dos gestores, docentes e discentes de um curso de Odontologia em uma instituição de ensino superior (IES) – Faculdade de Odontologia do Instituto de Saúde de Nova Friburgo da Universidade Federal Fluminense (FO/ISNF/UFF). A amostra não probabilística foi composta por 98 sujeitos (8 gestores, 28 docentes e 62 alunos), que foram entrevistados ou responderam a questionários semiestruturados. A análise dos resultados foi realizada por meio da técnica do Discurso do Sujeito Coletivo (DSC) e representações sociais. Os resultados apontaram que 49,0% e 76,5% do corpo docente e discente da IES não têm conhecimento sobre as Diretrizes Curriculares Nacionais (DCN). As sugestões de melhoria incluíram a oferta de cursos de formação continuada em docência, inclusive a respeito das DCN, melhorias na infraestrutura do campus universitário e uma relação professor/aluno mais compatível. O estudo permitiu verificar algumas deficiências nas práticas e posturas, percebidas pelos sujeitos entrevistados. Entretanto, parece haver uma relevante preocupação de alguns sobre um alinhamento do Projeto Político Pedagógico (PPP) com as DCN.

ABSTRACT This pedagogical study aimed to investigate the training process in dentistry, from the perspective of managers, teachers and students of a dentistry course at a Higher Education Institution (HEI) – the Fluminense Federal University (CNF-UFF) Dental School – Nova Friburgo Campus. A non-probabilistic sample was comprised of 98 subjects (8 managers, 28 teachers and 62 students) who completed questionnaires. The analysis was performed using the Collective Subject Discourse technique (DCS) and social representations. The results showed that 49% and 76.5% of the professors and students of HEI, respectively, do not know about the NCGs (National Curricular Guidelines). The suggestions for improvement included the provision of teacher training courses, including subjects for discussions such as NCGs, improvements in campus infrastructure and a more compatible student-teacher ratio. Therefore, the study showed some shortcomings in the practices and attitudes perceived by managers, teachers and students. However, some people seem to be duly concerned about the alignment of the Pedagogical Political Project (PPP) with the NCGs.

Interexaminer agreement dental caries epidemiological surveys: the importance of disease prevalence in the sample / Concordância interexaminador em levantamentos epidemiológicos de cárie dentária: a importância da prevalência da doença na amostra

Abstract: Objective: To identify desirable characteristics, including different sample sizes and dental caries prevalences, in virtual samples that allow, at the same time, higher values of general agreement percentage (GPA) and Kappa coefficient (κ), under a low confidence interval (CI), in reproducibility studies. Method: A total of 384 statistical simulations of inter-examiner calibration, varying sample size (12, 15, 20, 60, 200 and 500 individuals), caries prevalence (30, 50, 60 and 90%) and percentages of positive (PA) and negative (NA) agreement (30, 50, 60 and 90%) were undertaken. GPA and κ were used to measure reproducibility and define deviation between them. Results: The sample of 60 individuals, under caries prevalence of 50%, PA and NA of 90%, presented a GPA and Kappa values of 90 and 80%, respectively, a relative small confidence interval (95%CI 0.65 - 0.95) and a GPA/Kappa deviation of 10.00. Conclusion: A virtual sample of 60 individuals, under caries prevalence of 50%, seems feasible to produce a satisfactory interexaminer agreement at epidemiological conditions. However, epidemiological studies to corroborate or refute this assertion are necessary.

Resumo: Objetivo: Identificar características desejáveis, considerando diferentes tamanhos de amostra e prevalências de cárie em amostras virtuais que possibilitem, simultaneamente, altos valores de porcentagem geral de concordância (PGC) e do coeficiente Kappa (κ), sob baixo intervalo de confiança (IC), em estudos de reprodutibilidade. Método: Ao total, 384 simulações estatísticas de calibração interexaminador, variando o tamanho da amostra (12, 15, 20, 60, 200 e 500 indivíduos), a prevalência de cárie (30, 50, 60 e 90%) e as taxas de concordâncias positiva (CP) e negativa (CN) (30, 50, 60 e 90%) foram realizadas. Os valores de PGC e κ foram utilizados para mensurar a reprodutibilidade e o desvio entre as respectivas medidas PGC/Kappa. Resultados: A amostra de 60 indivíduos, com prevalência de cárie de 50% e taxas de concordância positiva e negativa de 90%, apresentou um valor de PGC = 90%, Kappa = 80%, um intervalo de confiança (IC95% 0,65 - 0,95) relativamente pequeno e um desvio PGC/Kappa de 10,00. Conclusão: A amostra virtual de 60 indivíduos parece ser viável, em condições epidemiológicas, para produzir uma concordância interexaminadores satisfatória. Contudo, estudos epidemiológicos para corroborar ou refutar esta conclusão são necessários.

Dental Care for an adolescent with chromosome pentasomy: rare case report with a two year follow-up / Atenção Odontológica a jovem com pentassomia cromossômica: relato de caso raro com acompanhamento de 2 anos

Pentasomy of the x chromosome is a rare syndrome of unknown incidence and there are few reports in the scientific literature, especially in terms of dental care for patients with this syndrome. The aim of this study was to report the dental care given to an adolescent with pentasomy of the X chromosome. The patient presented a cleft palate, impacted teeth, malocclusion, high caries activity, gingivitis and multiple tooth loss due to caries. Despite the difficulties of carrying out the dental work due to involuntary movements and the initial lack of collaboration from the patient the overall dental care was completed on an outpatient basis. The therapeutic success of the treatment was strongly supported by the significant cooperation and relationship that grew up along the period of the treatment, as well as the desire to have the treatment done by both the patient and her parents.

A pentassomia do cromossomo x é uma síndrome rara, de incidência desconhecida e com poucos relatos na literatura científica, especialmente no que diz respeito à atenção odontológica para pacientes portadores da mesma. O objetivo deste estudo foi relatar um caso de atenção odontológica a uma jovem com pentassomia do cromossomo x, que apresentava fenda palatina, dentes inclusos, má-oclusão, alta atividade de cárie, gengivite e múltiplas perdas dentárias devido à cárie. Apesar das dificuldades de se realizar o tratamento dentário devido aos movimentos involuntários e a não colaboração inicial da paciente, houve total viabilidade da atenção odontológica em âmbito ambulatorial, observando-se significativa cooperação, formação de vínculo e adesão ao tratamento pela mesma e seus responsáveis, o que gerou sucesso terapêutico.

Determinantes Sociais e sua Relação com a Experiência de Cárie em Adolescentes: um Estudo Transversal / Social Determinants and Their Relationship with the Dental Caries in Adolescents: a Cross Sectional Study

Recursos materiais e não materiais têm sido investigados para o entendimento do processo saúde-doença. Entretanto, o papel do suporte social na proteção/desenvolvimento de doenças bucais, como a cárie dentária, ainda parece obscuro. O objetivo deste estudo foi avaliar a influência dos recursos socioeconômicos e psicossociais na experiência de cárie em adolescentes residentes em duas regiões de Nova Friburgo, Lumiar e Olaria. A amostra não probabilística compreendeu 45 adolescentes de Lumiar e 75 de Olaria de 12 anos de idade de escolas públicas deambas regiões. Os resultados foram avaliados através de análise descritiva e mostraram uma baixa prevalência de cárie (CPO-D 1,13), para os adolescentes de Lumiar, e CPO-D= 3,27 para grupo de polarização da doença. Em Olaria, observou-se um valor médio de CPO-D dosadolescentes de 1,84. O grupo de polarização da cárie nos residentes do bairro de Olaria apresentou CPO-D= 4,21. Houve tendência à maiorescolaridade estar relacionada aos responsáveis dos adolescentes livres de cáries. Concluiu-se que a escolaridade dos responsáveis parece ser um possível fator relacionado à experiência de cárie e que o capital social pode ter influenciado a experiência de cárie.

Material and non-material resources have been investigated to understand the health-disease process. However, the role of social support in the protection/development of oral diseases such as dental caries still seems unclear. This study evaluated the effect of socio-economic and psychosocial resources on caries experience in adolescents in two regions of Nova Friburgo, Lumiar and Olaria. The non-probabilistic sample comprised of 45 and 75 12 year old students of public schools, living in Lumiar and Olaria, respectively. The evaluation involved an examination of dental caries on the adolescents, according to WHO criteria, besides a semi-structured interview with each tutor of the adolescents, in home environments, in order to record information about the different material and non-material resources. The descriptive results showed a low prevalence of caries (D3 MFT 1.13) and a polarization group- SIC Index (Significant Caries Index) - with a D3 MFT mean of 3.27 for the adolescents living in Lumiar. The D3 MFT mean was 1.84 and SIC Index was 4.21 in the adolescent group in Olaria. Thus,education of the tutor seemed to lead to protection against the disease and social capital may have influenced the caries experience by behavingnegatively as a detrimental factor to oral health in adolescents.

Different methods of dental caries diagnosis in an epidemiological setting

To evaluate the performance of dental caries detection when adjunct methods are associated and their applicability in epidemiological survey of dental caries, at D3 cavitated carious lesions at dentin layer and D1+D3 non cavitated and cavitated carious lesions at enamel/dentin layer diagnostic thresholds. METHODS: A total of 2189 posterior teeth from 165 12-year-old schoolchildren underwent visual examination without CL1 and with artificial lighting CL2, radiographic bitewing BW, fiber-optic transillumination/FOTI FT, DIAGNOdentTM DD and associations of these methods. Reproducibility was calculated by Kappa statistics and validity was calculated by sensitivity, specificity and accuracy tests. ANOVA Scott-Knott test was performed in order to compare the average values of DMF-S obtained by the diagnostic methods. RESULTS: The CL2FTDDBW D3 and CL2BW D1+D3 exams presented the highest values for accuracy at epidemiological setting. The DMF-S index obtained for those exams was statistically different at D3 and D1+D3 thresholds. CONCLUSIONS: The association of adjunct methods increased the validity of dental caries examination in an epidemiological setting. However, the potential of CL2BW traditional caries detection methods or visual exam performed under a more refined diagnostic criteria must be considered in dental caries epidemiological surveys...

Fluoretação da Água e seu Heterocontrole no Município de Nova Friburgo, Rio de Janeiro - Brasil / Water Fluoridation and its external control in the municipality of Nova Friburgo, Rio de Janeiro - Brazil

A fluoretação da água, apoiada pela Política Nacional de Saúde Bucal, tem sido um desafio no Brasil, devido a algumas insuficiências atuais na gestão pública para a implantação e controle desta medida. Este estudo objetivou vigiar, de forma periódica e sistemática, os níveis de fluoretos na água para consumo humano, em Nova Friburgo - RJ- Brasil (NF), por um período de 12 meses, como medida de heterocontrole, realizada por uma universidade pública. As amostras de água foram coletadas mensalmente, em duplicata, em 26 localidades em todo o município e em datas estabelecidas por sorteio. O método para medir a concentração de fluoretos nas amostras de água foi o eletrométrico, utilizando-se um potenciômetro digital com eletrodo específico para o íon flúor. A concentração de fluoretos nas amostras foi analisada de acordo com padrões fornecidos pelo Cecol/USP (2011). Os dados mostraram grande variação na concentração de fluoretos nas amostras, variando entre um mínimo de 0,00 ppmF e um máximo de 0,98 ppmF, com algumas dentro do intervalo de 0,65 e 0,94 ppmF, considerado o de melhor benefício para prevenir a cárie dentária. A concentração de fluoretos na água de abastecimento público do município foi considerada abaixo dos níveis mínimos exigidos, na maioria das amostras avaliadas, mesmo naquelas pertencentes às Estações de Tratamento de Água (ETA), cuja medida de fluoretação fora previamente implantada. Desta forma, a fluoretação da água e seu respectivo heterocontrole deveriam ser estabelecidos de forma contínua em NF, já que são medidas públicas relevantes para a promoção de saúde bucal.

Water fluoridation, supported by the Brazilian Oral Health Policy, has been a challenge as a public measure to protect Oral Health, due to some current insufficiencies in public management for the implantation of this measure in most Brazilian cities. The present study aimed to monitor, the levels of fluoride in drinking water in Nova Friburgo - RJ-Brazil (NF), on a regular and a systematic manner for a 12 months period, as an external control measurement performed by a public university. Water samples were collected, in duplicate, from 26 localities throughout the city, on a monthly basis, on randomly established dates. The fluoride concentration in the water samples was measured by using an ion-specific electrode coupled to a potentiometer, according to standards supplied by Cecol/USP (2011). Data showed a large variation of fluoride concentration in water samples, ranging from minimum 0.00 ppmF and maximum 0.98 ppmF, with few samples into the interval between 0.65 and 0.94 ppmF, which had the best benefit to prevent dental caries. Fluoride concentration in public water in this city can be considered under the minimum required levels in most of the evaluated samples, even in those from the Water Treatment System (WTS), which has water fluoridation. Thus, water fluoridation and its external control should be established on a regular basis in Nova Friburgo-RJ, Brazil because they are relevant public measures to promote oral health.

Dental caries in inland Brazilian adolescents and its relationship with social determinants

AIM: To identify the prevalence of dental caries in inland Brazilian adolescents, and to analyze the influence of socio-demographic and clinical variables, and access to dental service on caries experience. METHODS: This study had a non-probabilistic sample comprising 504 adolescents aged 12 years, attending public schools in the city of Nova Friburgo, mountain region of Rio de Janeiro, Brazil. The World Health Organization (WHO, 1997) criterion was used by previously calibrated examiners to report dental caries. Variables were obtained by means of a semi-structured questionnaire applied to the adolescents' parents. RESULTS: The D3MFT mean was 1.90 and the Significant Caries (SIC) Index was 4.54, mainly represented by the carious component. Multiple logistic regression analysis revealed that parents with over 8 years of schooling (OR=0.579), absence of pain (OR=0.396) and not visiting the dentist (OR=0.270) might suggest protective factors against the disease; the possible risk factors were male gender (OR=1.982) and pain, extraction and others were reasons for consultation (OR=2.435). CONCLUSIONS: Although the prevalence of caries was slightly below the national mean, polarization of the disease was clearly observed. Education and no access to the dentist led to protection against the disease. These results may contribute to planning of oral health actions directed towards this target population for the control of caries...

Epidemiological assessment of predictors of caries increment in 7-10- year-olds: a 2-year cohort study

OBJECTIVE: The aim of this 2-year cohort study (2003 to 2005) was to investigate how caries experience, at initial lesions (early or non-cavited lesions) and cavited stages, predicts caries increment in permanent teeth in 7-10- year-olds. MATERIAL AND METHODS: The random sample of 765 children attending public schools in the city of Piracicaba, SP, Brazil, was divided into two groups: 423 children aged 7-8 years and 342 children aged 9-10 years. All subjects were examined by a calibrated examiner, using dental mirror and ball-ended probes, after tooth brushing and air-drying in an outdoor setting, based on the World Health Organization criteria. Active caries with intact surfaces were also recorded as initial lesion (IL). Univariate analysis was used for statistical analysis (Odds Ratios and Chi-square). RESULTS: The association between the DMFT (decayed, missing and filled teeth) increment and the presence of IL was significant only for 9-10-year-old children. The children with DMFT>0 at baseline were more prone to have DMFT increment, with the highest risk for caries increment occurring in children aged 7-8 years. CONCLUSIONS: The predictors of caries increment were the presence (at baseline) of caries experience in permanent teeth for both age groups (7-8; 9-10-year-olds) and the presence of the IL (at baseline) for 9-10-year-olds.

Influência de variáveis socioeconômicas, clínicas e demográfica na experiência de cárie dentária em pré-escolares de Piracicaba, SP / Influence of socioeconomic, clinical and demographic variables on caries experience of preschool children in Piracicaba, SP

OBJETIVO: Avaliar a influência de variáveis socioeconômicas, clínicas e demográfica na experiência de cárie em pré-escolares de 5 anos de idade da cidade de Piracicaba. METODOLOGIA: A amostra consistiu de 728 crianças matriculadas em 22 pré-escolas públicas (n = 428) e 18 pré-escolas privadas (n = 300). A cárie dentária foi avaliada pelos índices ceo-d e ceo-s e pela detecção de lesão inicial (LI). Outras variáveis clínicas como gengivite, apinhamento, espaçamento, fluorose e respiração bucal também foram coletadas. As variáveis socioeconômicas (renda familiar mensal, número de residentes na mesma casa, escolaridade do pai e da mãe, habitação e posse de automóvel) foram obtidas por meio de um questionário semi-estruturado enviado aos pais. RESULTADOS: As médias (desvio-padrão) do ceo-d e ceo-s foram de 1,30 (2,47) e 3,08 (7,55), respectivamente, sendo que 62,2 por cento da amostra estava livre de cárie. As médias (desvio-padrão) do ceo-d+LI e ceo-s+LI foram 1,72 (3,36) e 3,45 (7,94), respectivamente e 59,7 por cento estavam livres de cáries. Por meio da análise de regressão logística múltipla, as crianças com fluorose (Odds Ratio-OR=0,40) ou de famílias com renda superior a 4 salários mínimos (OR = 0,49) apresentaram menor probabilidade de ter experiência de cárie. Aquelas com gengivite (OR = 1,87) tiveram maior chance de ter a doença. Para o critério de diagnóstico de cárie com a inclusão de LI, as crianças com fluorose (OR = 0,39) ou de famílias com renda superior a 4 salários mínimos (OR = 0,52) tiveram menor chance de ter cárie. Aquelas com gengivite (OR=1,80), apinhamento (OR = 2,63 e OR = 1,01) ou respiração bucal (OR = 1,37) apresentaram maior probabilidade de ter a doença. CONCLUSÃO: Os pré-escolares que apresentaram gengivite, apinhamento, respiração bucal ou renda familiar mensal inferior a 4 salários mínimos tiveram maior probabilidade de ter experiência de cárie. Assim, o planejamento de ações de prevenção e intervenção direcionadas a este...

A new approach for interexaminer reliability data analysis on dental caries calibration

Objectives: a) to evaluate the interexaminer reliability in caries detection considering different diagnostic thresholds and b) to indicate, by using Kappa statistics, the best way of measuring interexaminer agreement during the calibration process in dental caries surveys. Methods: Eleven dentists participated in the initial training, which was divided into theoretical discussions and practical activities, and calibration exercises, performed at baseline, 3 and 6 months after the initial training. For the examinations of 6-7-year-old schoolchildren, the World Health Organization (WHO) recommendations were followed and different diagnostic thresholds were used: WHO (decayed/missing/filled teeth - DMFT index) and WHO + IL (initial lesion) diagnostic thresholds. The interexaminer reliability was calculated by Kappa statistics, according to WHO and WHO+IL thresholds considering: a) the entire dentition; b) upper/lower jaws; c) sextants; d) each tooth individually. Results: Interexaminer reliability was high for both diagnostic thresholds; nevertheless, it decreased in all calibration sections when considering teeth individually. Conclusion: The interexaminer reliability was possible during the period of 6 months, under both caries diagnosis thresholds. However, great disagreement was observed for posterior teeth, especially using the WHO+IL criteria. Analysis considering dental elements individually was the best way of detecting interexaminer disagreement during the calibration sections.

Comparação entre medidas de reprodutibilidade para a calibração em levantamentos epidemiológicos da cárie dentária / Comparison of reproducibility measurements for calibration of dental caries epidemiological surveys

Comparar três medidas (kappa, porcentagem geral de concordância e índice dice) utilizadas para se determinar a reprodutibilidade do diagnóstico da cárie em levantamentos epidemiológicos, sob diferentes níveis de detecção da doença. Onze examinadores com experiência prévia em levantamentos epidemiológicos foram submetidos a um processo teórico-clínico de calibração. Dois níveis de detecção da cárie foram adotados: Organização Mundial da Saúde (OMS) e OMS com inclusão de lesões iniciais em esmalte (OMS + LI). Os exames foram realizados em 23 crianças de 6-7 anos de idade com e sem atividade da doença. A análise dos dados foi realizada mediante dois limiares: OMS e OMS + LI. Valores médios dos índices kappa, porcentagem geral de concordância e dice foram considerados altos (>0,90), à exceção do índice dice para o limiar OMS + LI (0,69). O kappa, por ser um índice de concordância ajustado, pode ser considerado como instrumento de escolha para a calibração dos examinadores. Entretanto, na impossibilidade de seu uso, recomenda-se a utilização da porcentagem geral de concordância associada ao índice dice, a fim de direcionar e aprimorar os examinadores no exame das lesões cariosas.

Avaliação clínica do sistema de laser fluorescente no diagnóstico de lesões de cárie oclusal / Clinical evaluation of a laser fluorescence system for the diagnosis of occlusal caries lesions

Este estudo teve por objetivo verificar a efetividades do aparelho DIAGNOdent (Kavo, Birberach, Alemnaha), que utiliza o laser fluorescente no diagnóstico de lesões de cáries oclusais, validando os resultados através da abertura de cavidade. A amostra foi constituída de escolares na faixa etária de seia a oito anos, matriculados em escolas da rede municipal de ensino da cidade de Piracicaba. Os exames foram realizados em consultório padrão, utilizando luz artificial, espelho bucal plano e sonda exploradora para a remoção de placa bacteriana, quando necessário. A validação do estudo deu-se por meio da abertura de cavidade com as brocas esféricas até se verificar a total remoção do tecido cariado. Os resultados mostraram que os valores de sensibilidade e predição positiva do DIAGNO-dent foram altos quando se utilizou critérios de validação carie em esmalte, com valores de sensibilidade de 0,99 no cut-point 20 e 0,98 no 30. Os valores de predição positiva observados foram de 0,97 e 1,00, respectivamente, para os dois limiares de corte estabelecidos. Em relação à validação em dentina, os valores de sensibilidade foram de 0,84 no cut-point 30 e 0,99 no 20. Os valores de predição positiva para o cut-point 20 e 30 foram, respectivamente, 0´80 e 0,89. Dessa forma, pode-se concluir que o aparelho DIAGNO-dent apresentou boa capacidade de identificar alterações precoces no esmalte dentário, no entanto mostrou um elevado número de diagnósticos falso-positivos, quando se utilizou como critério de validação lesões em dentina

Influence of initial carious lesions on oral health planning

The aim of this cross-sectional study was to verify the importance of including initial carious lesions (IL) in the oral health planning of a public health service. The sample comprised 692 schoolchildren at the ages of 5 (n=171), 6 (n=203), 12 (n=236) and 15 (n=82), enrolled in state schools in Iracemapolis, SP, Brazil. Clinical examination was performed, using dental mirror and CPI (Community Periodontal Index) probe, after tooth brushing and drying. Two diagnostic thresholds were used for measuring the outcome: diagnostic threshold based on cavitated lesions and diagnostic threshold based on the inclusion of IL. The mean value for dmft was 1.56 for 5-year-olds and 1.98 for 6-yearolds. The mean value for DMFT was 1.19 for the age of 12 and 2.90 for the age of 15. The dmft and DMFT indexes increased significantly for all ages (paired t test, p<0.05) when IL was included in the examinations (29.59%, 12.25%, 21.71%, 26.82% for the ages of 5, 6, 12 and 15, respectively). The inclusion of IL in surveys generated a statistically significant percent increase in caries indexes for all age groups, contributing to obtain additional information for oral health planning in public services.