Is oral health literacy associated with conceptions of care and behavior related to the prevention of COVID-19?

Abstract The aim of the present study was to investigate the impact of oral health literacy (OHL) on conceptions of care and behaviors related to COVID-19. The sample came from two preliminary cross-sectional studies that determined the level of OHL of parents/guardians of six-to-12-year-old children in two major Brazilian cities (Curitiba and Belo Horizonte). Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14) for the evaluation of interactive OHL. Participants were recruited through e-mail, social media, and telephone contact. The questionnaire on conceptions of care and behaviors related to COVID-19 was created based on the guidelines of the World Health Organization. Two hundred nineteen individuals participated in the study. There was no significant difference in socioeconomic and demographic variables and in the medians of BREALD and HeLD-14 between the two cities (P>0.05). Higher levels of functional OHL were associated with an appropriate conception that individual care affects collective care (P=0.038), but with an inappropriate conception of seeking medical assistance in cases of mild symptoms (P=0.030). Higher levels of interactive OHL were related to social distancing behavior in the city of Curitiba (P=0.049) and in the overall sample (P=0.040). It is concluded that functional OHL was associated with two of the investigated conceptions about COVID-19, while interactive OHL was associated with social distancing behavior. These data may suggest that different dimensions of the OHL can have an impact on different aspects of coping with the pandemic.

Are Premature Birth and Low Birth Weight Associated with Delay on the Eruption of Deciduous Teeth? A Systematic Review and Meta-analysis

ABSTRACT Objective: To investigate whether children with premature birth (PB) and/or with low birth weight (LBW) have different tooth eruption patterns than those born at term or with normal weight. Material and Methods: Searches were performed in the PubMed, Cochrane Library, Sc1opus, Web of Science, LILACS, and BBO databases as well as the grey literature. Three independent reviewers were involved in study selection, data extraction, and bias assessment. The risk of bias was assessed using the Modified Newcastle-Ottawa Scale. Meta-analysis was conducted to compute the mean difference (MD) in mean chronological or adjusted age at the eruption of the first deciduous tooth between preterm children and those born at full term. The GRADE approach was used. Results: Among a total of 316 articles identified, 21 were eligible for inclusion and three were included in the meta-analysis. PB was associated with the delay in the first tooth deciduous eruption when chronological age was considered (MD: 1.36; 95%CI: 1.02-1.69) but not when considering adjusted age (MD: -0.30; 95%CI: -0.67-0.07). The evidence was graded as having very low quality. Conclusion: Based on a low certainty of evidence the PB is associated with the delayed eruption of the first deciduous tooth when considering chronological age but not when adjusted age is considered.

Different dimensions of oral health literacy are associated with social determinants of health in Brazilian adults

Abstract Social determinants of health (SDH) are strongly associated with oral health outcomes, and oral health literacy (OHL) is a potential factor that can modify this association. This study evaluated the association between SDH and OHL, including functional and interactive dimensions of OHL. The cross sectional study was conducted with 354 adults recruited from public dental clinics in southern Brazil. Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14), for the evaluation of interactional OHL. SDH was evaluated through a structured questionnaire, and economic class was determined based on the Brazilian Economic Classification Criteria. The statistical analysis involved bivariate and multivariate Poisson regression with robust variance (α=0.05) to estimate rate ratios (RR) and 95% confidence intervals (CI). Among the 354 participants, 284 (80.2%) were women and the mean age was 22.9 ± 4.9 years. The median BREALD-30 score was 24 (1st/3rd quintile: 20/27) and the median HeLD-14 score was 45 (1st/3rd quintile: 37/50). Most participants had up to eight years of schooling (71.5%) and belonged to the "C" Economic Class or lower (94.1%). The multiple regression analysis showed that schooling and economic class were associated with the BREALD-30 and HeLD-14 scores, income and age were associated with the HeLD-14 score, and marital status and occupation were associated with the BREALD-30 score. Different dimensions of OHL were associated with SDH in Brazilian adults. This aspect should be incorporated into strategies for improving OHL levels in individuals or populations.

What are the Systemic Factors Associated with the Molar-Incisor Hypomineralization Etiology?

ABSTRACT Objective: To evaluate the systemic factors associated with Molar-Incisor Hypomineralization (MIH) etiology. Material and Methods: A total of 731 8-year-old schoolchildren enrolled in the public school system in Curitiba, Brazil, was randomly selected. The MIH diagnosis was performed by calibrated examiners (Kappa >0.80) according to the European Academy of Pediatric Dentistry criteria (2003). The systemic factors were collected through a semi-structured questionnaire and applied to the children's mothers, addressing the medical history from pregnancy to the first three years of children's life. Associations were analyzed by Poisson regression analysis with robust variance (p<0.05). Results: The systemic factors in the prenatal and perinatal periods were not associated with MIH (p>0.05). The children who used medications during the first years of life had a significantly higher prevalence of MIH (PRc = 2.18 CI = 95% 1.06-4.48; p=0.033). Conclusion: The use of medications during the first three years of children's life is associated with a higher prevalence of MIH.

Oral manifestations and craniofacial characteristics of hutchinson-gilford progeria syndrome: a case report

Introduction: Hutchinson-Guilford progeria syndrome (HGPS) is a rare genetic disease with a characteristic phenotype of premature aging in young children caused by a mutation in the LMNA gene and consequent accumulation of progerinin the cell. Aim: Describe oral manifestations of Hutchinson-Guilford progeria syndrome. Case Report: This is a case report of a six-year-old female patient with Hutchinson-Guilford Progeria syndrome. The physical examination revealed skin atrophy, lipodystrophy, hair rarefaction, prominent blood vessels of the scalp, craniofacial disproportion, perioral cyanosis and enlarged knee joints. The intraoral exam revealed limited mouth opening, mixed dentition with normal tooth anatomy and anteroinferior crowding. The eruption sequence and chronology were abnormal. The treatment plan included professional prophylaxis, the topical application of fluoride as well as both oral hygiene and dietary counselling. Monitoring the development of dentition and an early and timely dental intervention contributed to the maintenance of child's oral health. Conclusion: Early clinical and educational interventions can help patients with HGPS maintain adequate oral health status and improve their quality of life.

Introdução: A Progéria ou Síndrome de Hutchinson-Guilford (HGPS) é uma doença genética rara com um fenótipo característico de envelhecimento precoce em crianças pequenas, causado por uma mutação no gene LMNA e conseqüente acúmulo de progerina na célula. Objetivo: Descrever as manifestações orais da Síndrome de Hutchinson-Guilford. Relato do Caso: Este é um relato de caso de uma paciente de seis anos com Síndrome de Hutchinson-Guilford. O exame físico revelou atrofia da pele, lipodistrofia, rarefação dos cabelos, vasos sangüíneos proeminentes no couro cabeludo, desproporção craniofacial, cianose perioral e aumento das articulações dos joelhos. O exame intraoral revelou abertura bucal limitada, dentição mista com anatomia dentária normal e apinhamento ântero-inferior. A sequência e a cronologia de erupção estavam alteradas. O plano de tratamento incluiu profilaxia profissional, aplicação tópica de flúor, bem como orientação de higiene bucal e aconselhamento dietético. O acompanhamento do desenvolvimento da dentição e a intervenção odontológica precoce e oportuna colaboraram com a manutenção da saúde bucal da criança. Conclusão: Intervenções clínicas e educacionais precoces podem ajudar os pacientes com HGPS a manter um estado de saúde bucal adequado e melhorar sua qualidade de vida.

Hipomineralização de molares e incisivos e doença celíaca / Molar incisor hypomineralization and celiac disease

ABSTRACT BACKGROUND: Molar incisor hypomineralization (MIH) is a developmental enamel defect with multifactorial etiology. Although the relationship between celiac disease (CD) and developmental enamel defect was demonstrated, the association between CD and MIH is uncertain. OBJECTIVE: The objective of this study was to analyze the occurrence of MIH in CD patients. METHODS: Forty CD patients and a control group with 40 healthy individuals were selected. A calibrated examiner (k≥0.889) according to the European Academy of Pediatric Dentistry criteria performed the diagnosis of MIH. Data were analyzed by descriptive statistics and Fischer's exact test (α=0.05). RESULTS: Of the 80 participants, ten presented MIH with eight individuals with CD. Celiac patients presented 4.75 times the chance of occurrence of MIH than the control group (95% CI: 2.22-10.18; P=0.044). In all the evaluated teeth (n=978), 22 had MIH: 20 teeth in individuals with CD and two in those without the disease. All CD participants with MIH presented the classic form of the disease. CD participants showed 17 teeth (85.0%) with demarcated opacities, two (10.0%) post-eruptive collapses and one (5.0%) atypical restoration. The control group presented only demarcated opacities. CONCLUSION: CD increased the chance of MIH and associated with its clinical manifestations can assist in the diagnosis of CD.

RESUMO CONTEXTO: A hipomineralização de molares e incisivos (HMI) é um defeito de desenvolvimento de esmalte com etiologia multifatorial. Embora a relação entre doença celíaca (DC) e defeito de desenvolvimento de esmalte já tenha sido demonstrada, a associação entre DC e HMI ainda é incerta. OBJETIVO: O objetivo deste estudo foi analisar a ocorrência de HMI em pacientes com DC. MÉTODOS: Foram selecionados 40 pacientes com DC e um grupo controle com 40 indivíduos sem a doença. O diagnóstico da HMI foi realizado por examinador calibrado (k≥0,889) segundo critérios da Academia Europeia de Odontopediatria. Dados foram analisados por estatística descritiva e teste exato de Fischer (α=0,05). RESULTADOS: Dos 80 participantes, 10 apresentaram HMI sendo 8 indivíduos com DC. Pacientes celíacos apresentaram 4,75 vezes a chance de ocorrência de HMI que grupo controle (IC 95%: 2,22-10,18; P=0,044). No total dos dentes avaliados (n=978), 22 apresentaram HMI: 20 dentes em indivíduos com DC e 2 entre aqueles sem a doença. Todos os participantes com DC e portadores de HMI apresentavam a forma clássica da doença. Participantes com DC mostraram 17 (85,0%) dentes com opacidades demarcadas, 2 (10,0%) colapsos pós-eruptivos e 1 (5,0%) restauração atípica. Grupo controle apresentou apenas opacidades demarcadas. CONCLUSÃO: DC aumentou a chance de HMI e associada a manifestações clínicas da DC pode auxiliar no diagnóstico da doença.

Urgência e descontinuidade do cuidado em saúde bucal de crianças e adolescentes / Urgency and discontinuity of oral health care in children and adolescents

Resumo Este trabalho estudou a descontinuidade do cuidado (DC) em saúde bucal entre crianças e adolescentes que acessaram os serviços de urgência nas unidades básicas de saúde (UBS) e de pronto atendimento (UPA). Foram avaliados prontuários de indivíduos de 0 a 17 anos vinculados ao Sistema Único de Saúde de Curitiba. Considerou-se DC quando não houve o registro de consulta eletiva na UBS nos 6 meses subsequentes ao atendimento de urgência. A amostra foi estratificada pelo Índice de Desenvolvimento Humano Municipal (IDHM) da Unidade de Desenvolvimento Humano em que o paciente residia em ≤0,799 ou ≥0,800. A associação entre DC e demais covariáveis foi analisada através de regressão de Poisson com variância robusta uni e multivariada (α=0,05). A incidência de DC foi de 42,2%. No estrato de IDHM≤0,799, o risco de DC foi maior para as crianças com menos de 5 anos de idade e aqueles que não visitaram o dentista no último ano. Nos dois estratos, o risco de DC foi maior para aquelas que utilizaram a UPA para o atendimento de urgência quando comparadas com as que receberam atendimento na UBS. A DC em saúde bucal apresentou alta incidência, sendo que entre os residentes em regiões com menor IDHM, sofreu uma maior influência das características de uso dos serviços.

Abstract The aim of the present study was to investigate the discontinuity of oral health care among children and adolescents who accessed emergency services at primary care units and urgent care units. Records were reviewed of patients aged 0 to 17 years treated in the public healthcare system in city of Curitiba, Brazil. Discontinuity was considered when elective treatment was not registered at the primary care unit within six months after urgent care. The sample was stratified based on the Municipal Human Development Index (MHDI) (≤0.799 or ≥0.800). The association between discontinuity and covariables was assessed using univariate and multivariate Poisson regression models with robust variance (α=0.05). The incidence of discontinuity was 42.2%. In the MHDI≤0.799 stratum, the risk of discontinuity was greater among children younger than five years of age and individuals who had not had a dental appointment in the previous year. In both MHDI strata, the risk of discontinuity was higher in patients who received urgent care at an urgent care unit than those treated at a primary care unit. The incidence of the discontinuity of oral health care was high and was strongly influenced by the characteristics of dental service utilization among individuals living in regions with a lower MHDI.

Association Between Periodontal Health Knowledge and Oral Hygiene in Brazilian Adolescents

Abstract Objective: To evaluate the influence of oral health knowledge in adolescents' oral hygiene pattern. Material and Methods: Cross-sectional study involving 291 participants aged between 14 and 19 years old enrolled in a public school in Curitiba, Brazil. A self-administered questionnaire containing five affirmations about periodontal diseases and their forms of prevention was arranged on a three-point Likert scale. Correct answers were given a weight=1 and incorrect ones, weight=0. The knowledge score (KS) was determined by the sum. Socioeconomic and demographic data were obtained by a questionnaire sent to those responsible. The oral hygiene pattern was evaluated through the simplified oral hygiene index (OHI-S) by a calibrated researcher (K=0.89). Mann-Whitney U test and univariate and multivariate Poisson regression with robust variance were used for data analysis (α=0.05). Results: There was an inversely proportional association between KS and OHI-S (p=0.018). The multiple model showed that adolescents with a lower KS (PR = 0.93, CI95%: 0.88-0.99), male gender (PR = 1.17, CI95%: 1.01-1.37) and whose caregivers presented a lower level of education (PR=1.30, CI95%: 1.03-1.64) showed a higher index of dental plaque. Conclusion: The level of oral health knowledge, the gender and the caregivers' level of education influences the adolescents' oral hygiene pattern.

A Survival Analysis of Different Pulp Therapies in Decayed Primary Teeth

Abstract Objective: To identify the clinical and radiographic conditions associated with failure of pulp therapy in primary teeth through a survival analysis. Material and Methods: A total of 1000 records of children assisted at the pediatric dentistry clinic of the Federal University of Parana, Brazil, from the years 2000 to 2010, were analyzed. The mean evaluation time was 10.61 months (minimum/maximum: 1/28) from the report of pulp therapy. The different types of treatments analyzed included indirect pulp treatment (IPT), direct pulp treatment (DPT), pulpotomy and pulpectomy. The Kaplan-Meyer method and log-rank test were used for the survival analysis. Exodontia was considered as the outcome variable and censors included: traumatic tooth loss, presence of the tooth in the oral cavity and physiologic tooth exfoliation. Results: A total of 122 records reporting pulp therapy in the primary teeth were selected. From this, 16 teeth (13.12%) were extracted. Survival analysis showed that pulpectomy presented lower survival rates when compared to conservative therapies (p=0.0297). Teeth with furcal lesions and pathological root resorption before pulp therapy had lower survival rates when compared to those that did not present these conditions (P=0.006). Presence of fistula and abscess after pulp therapy were also associated with lower survival rates (P=0.0062 and 0.0143, respectively). Conclusion: Signals of pulp necrosis were associated to lower survival rates in primary teeth submitted to pulp therapy.

Demarcated opacity in primary teeth increases the prevalence of molar incisor hypomineralization

Abstract This cross-sectional study aimed to assess the prevalence of molar incisor hypomineralization (MIH) and its relationship with the number of primary teeth with developmental defects of enamel (DDE). A representative population-based sample of 731 schoolchildren was randomly selected from the public school system in Curitiba, Brazil. Schoolchildren aged 8 years with fully erupted permanent first molars and incisors were eligible for the study. MIH and DDE were classified by four calibrated examiners (kappa > 0.75) according to EAPD criteria and to the FDI-modified DDE index. Clinical data were collected in a school environment. Socioeconomic information was collected through a self-administered semistructured questionnaire applied to the children's caregivers. Statistical analyses were carried out using Poisson multiple regression with robust variance (α = 0.05). MIH prevalence was 12.1% (95%CI: 10-15), and opacities were the most prevalent defect. Socioeconomic factors were not associated with MIH. Children with demarcated opacity in primary teeth presented a higher prevalence of MIH than those without DDE in primary teeth. In the multiple analysis, the increase of one primary tooth affected by demarcated opacity increased the prevalence of MIH by 33% (PR = 1.33, 95%CI: 1.15-1.53, p < 0.001). Asian children had a higher prevalence of MIH (PR = 2.91, 95%CI: 1.08-8.09 p = 0.035) than did Caucasian children.Conclusion: Based on these findings, the prevalence of MIH in Curitiba was 12.1%. Demarcated opacity in primary teeth could be considered a predictor of MIH.

Dental caries among preschool children: effects of social inequality and the impact of a university extension project / Cárie-dentária em pré-escolares: efeitos das desigualdades sociais e impactos de projeto de extensão universitária

ABSTRACT Objective The aims of this study were to assess the prevalence of dental caries among preschoolers at public and private schools and to evaluate the associations among the prevalence of the disease, socioeconomic factors, and the impact of a university extension project. Methods Five-year-old preschool children were examined and were divided into three groups: children from private schools who were not receiving regular preventive care (group 1), children from public schools who were not receiving regular preventive care (group 2), children from public schools who were receiving preventive care through a university extension project (group 3). The children were examined for decay-missing-filled index, and their caregivers were interviewed to collect data on socioeconomic factors. Fisher's and Chi-squared tests were used to analyze the data. Results Group 1 showed better socioeconomic and oral conditions compared with groups 2 and 3. Parents'/guardians' level of education was associated with the presence of disease in their children; however, income showed no association. Conclusion Dental caries were more prevalent in the group with worse socioeconomic indicators, and although the university extension project had been implemented in one of the groups, it was not able to overcome health inequalities.

RESUMO Objetivo O objetivo deste estudo foi verificar a prevalência da cárie dentária em pré-escolares de escola pública e privada, avaliando sua associação a fatores socioeconômicos e impactos projeto de extensão universitária. Métodos Foram examinados pré-escolares de 5 anos, alocados em 3 grupos: G1 - crianças de colégio privado, sem projeto preventivo em saúde bucal; G2 - crianças de ensino público também sem cuidados preventivos regulares; G3 - pré-escolares de ensino público que recebem cuidados preventivos através de projeto de extensão universitária. As crianças foram examinadas para aferição do índice ceo-d e seus responsáveis foram entrevistados para verificação de fatores socioeconômicos. Para análise dos dados foi utilizado o teste de Fisher e o teste Qui-quadrado Resultados A escola referente ao G1 mostrou melhores condições socioeconômicas e bucais, comparada com os grupos G2 e G3. A escolaridade dos pais esteve associada à presença de doença nos filhos, porém, a renda não demonstrou associação. Conclusão A cárie dentária foi mais prevalente no grupo com piores indicadores socioeconômicos, e apesar do projeto de extensão universitária em saúde bucal estar presente em uma das situações ele não foi capaz de superar as desigualdades em saúde.

Molar-Incisor Hypomineralization and Associated Factors: A Case- Control Study

Objective: To evaluate systemic factors those are related to molar incisor hypomineralization (MIH), its association with dental caries, and the impact on oral health-related quality of life (OHRQoL) in Brazilian children. Material and Methods: This case-control study was conducted at the Pediatric Dentistry Clinic, Federal University of Parana, Brazil. Patients with MIH who were assisted from 2014 to 2015 were included in the study, for a total of 31 children, 6-13 years of age. The control group consisted of 62 children who were matched by sex and age. European Academy of Pediatric Dentistry criteria were used for MIH diagnosis. The children's mothers answered a questionnaire regarding the children's history of health intercurrences in the pre-, peri-, and postnatal periods. The Decayed, Missing, or Filled Teeth indices for permanent and primary teeth (dmft index and DMFT index, respectively) were used for dental caries examination by two calibrated examiners. Child Perceptions Questionnaires for 8- to 10-year-old children and 11- to 14-year-old children (CPQ8-10 and CPQ11-14) were used to assess OHRQoL. Results: Prematurity and prolonged delivery were significantly associated with the occurrence of MIH. In the postnatal period, recurrent fevers in the first 3 years of life were associated with MIH. Of the 339 incisors and first permanent molars that were examined, 178 presented MIH, of which 116 (65%) were demarcated opacities. A significant difference was found in the mean DMFT index between groups. No impact of MIH on OHRQoL was observed. Conclusion: The present results suggest higher intercurrences during the perinatal period and a higher incidence of caries among children with MIH.

Emergency Dental Care of Children and Adolescents in Basic Health Unit and Emergency Care Unit

Objective: To evaluate the factors related to the dental emergency care of children and adolescents in Basic Health Units (UBS) and Emergency Care Units (UPA) affiliated with the public dental network of Curitiba, Brazil. Material and Methods: Crosssectional study that evaluated 1,012 emergency cases in individuals aged up to 17 years old and with a permanent record in the Unified Health System of Curitiba. Demographic data of individuals and of services were taken from electronic medical records. Statistical analysis was performed using the chi-square test and chi-square test for linear trend (α = 0.05), estimating the prevalence ratio (PR) (95%CI). Results: Of the total of emergency cases, 68.2% and 31.8% were of children and adolescents, respectively. UBS accounted for 89.7% of the cases while UPA represented 10.3%, and 12.2% of the treatments were characterized as first access to the system. Adolescents used UPAs for emergency care more often than children (PR = 1.84; 95%CI: 1.28-2.64). Among children, those with more than 1 year since the last appointment used UPAs for emergency care more often (PR = 1.86; 95%CI: 1.09-3.17). Adolescents for whom emergency care was characterized as first access to the system used UPAs more often (PR = 2.16; 95%CI: 1.04-4.46). The proximity between the UBS of origin and the UPA was associated with greater UPA utilization by both groups. Conclusion: UBSs accounted for most of the dental emergency treatments. Children and adolescents with a poorer connection with UBSs and those who lived near an UPA had a higher prevalence of UPA utilization for emergency care.

Oral Findings in Brazilian Infants Born at Full Term

Objective: To evaluate the oral findings of Brazilian infants born at full term as well as to identify the presence of abnormalities at birth. Material and Methods: Cross-sectional study comprising 190 infants aged up to 2 days old. Data were obtained by applying a structured questionnaire to the mothers as well as by collecting information from the infants' medical records. Clinical examination was conducted to evaluate the infants' oral features and it included the relationship of alveolar ridges and shape of the gum pads and the insertion of the lingual and labial frenula. The presence of oral developmental abnormalities was also evaluated. Chi-square and Mann-Whitney U tests were used to analyze the infants' abnormalities and gender (α = 0.05). Results: Most infants presented round upper gum pads (71.6%) and U-shaped lower one (52.6%). The mean discrepancy between the alveolar ridges was 3.33mm. Interference with tongue movement was found in 12.6% of the newborns. There was 50.0% prevalence of oral cysts. Among them, Epstein pearl was found in 27.4% of the cases, Bohn nodules in 26.3%, and dental lamina cysts in 11.1%. There was no significant difference between the occurrence of abnormalities and the infants' gender. The normal features of the oral cavity meet the literature data. The herein found congenital developmental abnormalities were oral cysts and ankyloglossia. Conclusion: Different classification forms made it difficult to compare the current study data with those from other studies. Therefore, it suggests the need for standardization in order to evaluate these abnormalities.

Training and calibration of interviewers for oral health literacy using the BREALD-30 in epidemiological studies

Abstract The objective of this study was to describe an interviewer training and calibration method to evaluate oral health literacy using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) in epidemiological studies. An experienced researcher (gold standard) conducted all training sessions. The interviewer training and calibration sessions included three different phases: theoretical training, practical training, and calibration. In the calibration phase, six interviewers (dentists) independently assessed 15 videos of individuals who had different levels of oral health literacy. Accuracy and reproducibility were evaluated using the kappa coefficient and the intraclass correlation coefficient (ICC). The percentage of agreement for each word in the instrument was also calculated. After training, the kappa values were higher than 0.911 and 0.893 for intra- and inter-rater agreement, respectively. When the results were analyzed separately for the different levels of literacy, the lowest agreement rate was found when evaluating the videos of individuals with low literacy (K = 0.871), but still within the range considered to be near-perfect agreement. The ICC values were higher than 0.990 and 0.975 for intra- and inter-rater agreement, respectively. The lowest percentage of agreement was 86.6% for the word "hipoplasia" (hypoplasia). This interviewer training and calibration method proved to be feasible and effective. Therefore, it can be used as a methodological tool in studies assessing oral health literacy using the BREALD-30.

Epidemiologia da cárie dentária em crianças da primeira infância no município de Belém, PA / Caries epidemiology of children in the primary infancy in the City of Belém, PA

Objetivo: O objetivo deste estudo foi avaliar o perfil epidemiológico da cárie dentária em crianças de 6 a 36 meses de idade no município de Belém-PA. Métodos: A amostra consistiu de 340 crianças. Nove examinadores calibrados participaram deste estudo. Índices ceo-d e ceo-s foram utilizados para o exame clínico. As crianças foram divididas de acordo com a idade em: 6-12, 13-24 e 25-36 meses. Os dados foram estatisticamente avaliados através do teste de qui- -quadrado, adotando-se um nível de significância de 5%. Resultados: A prevalência de cárie foi de 32,9% no total da amostra examinada. Índices ceo-d e ceo-s médios foram de 1,12 (dp=2,31) e 1,64 (dp=4,00), respectivamente. Observou-se um aumento significativo quanto à presença da cárie de acordo com a idade (P=0,0020). Do total de 6340 dentes decíduos examinados, houve maior proporção para o componente “cariado” com 362 dentes. Foi observada relação significativa de tratamentos curativos e a faixa etária de 25 a 36 meses (P=0,0057). Conclusão: Estes dados reforçam a importância da atenção odontológica precoce em crianças que se encontram na primeira infância neste município.

Objective: The objective of this study was to evaluate the epidemiological profile of children aged 6-36-months-old living in the city of Belém, Pará, Brazil. Methods: The final sample was 340 children. Nine calibrated examiners participated in this study. The DMFT and DMFS indexes were used for clinical examination. The children were divided by age in: 6-12, 13-24 and 25-36-months-old. Data was statistically analyzed using the Qui-square test, with a significance level of 5%. Results: The prevalence of dental caries was 32,9% in the total of the sample. Indexes dmft and dmfs were 1.12 (sd=2.31) and 1.64 (sd=4,00), respectively. There has been a highly significant increase in caries experience proportionally with increasing age (P=0.0020). From the 6340 examined teeth, it was observed a higher proportion for decayed component with 362 teeth. There was a statistically significance relationship between curatives treatments and the age of 25 to 36-months-old (P=0.0057). Conclusions: The results of the current study emphasize the importance of an early odontological assistance for primary infants living at this city.

Dental development of children and adolescents with cleft lip and palate

Aim: To evaluate the dental development of Brazilian children and adolescents with cleft lip and palate. Methods: The sample consisted of 107 panoramic radiographs of children and adolescents with cleft lip and/or palate (cleft group) and 107 panoramic radiographs of children and adolescents without cleft lip and/or palate (control group), with chronological ages ranging from 6 to 15 years, matched in gender and chronological age within 60 days. Radiographs were digitized and masked and dental age was assessed using the method described by Demirjian et al. (1973). Three trained examiners conducted the assessments. Each examiner evaluated the radiographs three times. Data were statistically analyzed using non-parametric tests and univariate linear regression (p<0.05). Results: The dental age was overestimated in relation to the chronological age in both groups (p<0.0001). Compared to the control group, there was a delay in the dental age in the cleft group of 0.17 years (2.1 months). However, no statistically significant difference in the dental age between the cleft and the control group was found even when considering the different cleft types (p=0.152). Conclusions: There was no statistically significant difference in the dental age between the cleft and the control groups. The evaluation of dental development in individuals with cleft lip and palate should be approached in the same way as in individuals without clefts, with a focus on the individualization of diagnosis and treatment planning.

Weaning and associated factors in children from low-income communities / Fatores associados ao desmame em crianças de comunidades de baixa renda

Introduction: The average duration of breastfeeding is still insufficient and differ widely taking in account the location and specific characteristic of local people involved in these studies. Aim: This research aimed at studying factors associated to weaning among South Brazilian children living in a low-income household. Material and method: Cross-sectional study was carried out enrolling 124 mothers of 1 to 12-month-old children, who were interviewed at "Pastoral da Criança" (non-governmental organization) in Almirante Tamandaré, Paraná, Brazil. The risk of weaning considered was the dependent variable and the information collected from the questionnaires, independent variables. The method used to collect information in this study was Kaplan-Meier method and Cox regression model and Spearman's rank correlation (α = 0.05). Result: Actuarial life table presented a higher weaning conditional probability at 12 months of age, followed by first and fourth months of age. Multivariate analysis pointed out that contact with bottle feeding before the sixth month of age [HR=17.16 (2.34-125.86)] and contact with pacifier before the sixth months of age [HR=3.48 (1.90-6.38)] are risk factors associated with weaning. Among children who were not breastfed at the moment of the interview, breastfeeding duration presented a positive correlation with the ages when the children had their first contact with sugar (r s =+0.419, p=0.001) and negative correlation with the use of pacifier (r s =-0.300, p=0.017). Conclusion: Results from this study showed that the use of the feeding bottle and pacifier were related to a shorter breastfeeding time span at these communities. .

Introdução: A duração média do aleitamento materno ainda é insuficiente e apresenta grandes variações em razão do local e das características da população estudada. Objetivo: Analisar os fatores associados ao desmame em crianças sul brasileiras de comunidades de baixa renda. Material e método: Estudo transversal realizado através de entrevista envolvendo 124 mães de crianças com até 12 meses de idade, atendidas pela Pastoral da Criança, em Almirante Tamandaré, Paraná, Brasil. O risco ao desmame foi considerado como variável resposta e os dados do questionário, variáveis preditoras. Os dados foram analisados através do método de Kaplan-Meier, modelo de regressão de Cox e correlação de Spearman (α = 0,05). Resultado: A tábua de vida atuarial revelou uma probabilidade condicional de desmame maior aos 12 meses de idade, seguido do primeiro e quarto meses. A análise multivariada mostrou que o contato com a mamadeira antes do sexto mês de vida [HR=17,16 (2,34-125,86)] e o contato com a chupeta antes do sexto mês de vida [HR=3,48 (1,90-6,38)] foram variáveis de risco associadas ao desmame. Entre as crianças desmamadas, por ocasião da entrevista, a duração da amamentação apresentou correlação positiva com a idade do primeiro contato com açúcar (r s =+0,419; p=0,001) e negativa com a duração do uso de chupeta (r s =-0,300; p=0,017). Conclusão: O uso da mamadeira e da chupeta estiveram relacionados a uma menor duração do aleitamento materno nestas comunidades. .

Terapia endodôntica em dentes decíduos por odontopediatras / Endodontic Therapy in Primary Teeth by Pediatric Dentists

Objetivo: Verificar a conduta de odontopediatras quanto à escolha da terapia endodôntica em dentes decíduos, assim como os fatores que influenciam essa eleição e os materiais nela utilizados. Método: Estudo transversal com 30 odontopediatras atuantes no Estado do Pará, Região Amazônica do Brasil, a partir de um questionário elaborado contendo informações pessoais e questões de caráter específico sobre possíveis técnicas de terapias endodônticas em dentes decíduos. Os dados foram apurados utilizando o softwareMicrosoft Excel 2010, onde foi elaborada a estatística descritiva.Resultados: Em caso de molar decíduo com cárie profunda sem exposição pulpar, 86,7% dos odontopediatras realizariam a proteção pulpar indireta (PPI). No caso de pequena exposição acidental da polpa, 50% fariam proteção pulpar direta (PPD) e 46,7%, a pulpotomia. Já em grande exposição pulpar com inflamação suave, 56,7% fariam a pulpotomia e 43,3% a PPD. Em polpa exposta, a pulpectomia foi o tratamento mais relatado em dentes com 1/3 de reabsorção radicular, presença de pólipo pulpar e presença de fístula. Nos casos de extensa lesão radicular e fístula, a maioria (93,3%) faria exodontia. Como medicação intracanal indicada, 36,7% escolheria a pasta Guedes Pinto em casos de pulpectomia. Em caso de pulpotomia, Hidróxido de cálcio (36,7%) e formocresol (33,3%) foram os materiais mais indicados. A pasta de hidróxido de cálcio é o material de escolha na PPD e na PPI para, respectivamente, 83,3% e 86,7% dos profissionais. Conclusão: Não foi observada uniformidade nas respostas da maioria das situações, especialmente nos casos de exposição da polpa e na escolha do material para a técnica. Estes dados confirmam a necessidade de um protocolo clínico para o tratamento pulpar em dentes decíduos baseado em comprovada evidência científica.

Objective: To evaluate the pediatric dentist?s approach with regards to choice of the endodontic therapy in primary teeth and the factors that account to the election of treatment and the materials.Method: This research was a cross-sectional study involving 30 pediatric dentists from the Pará State in the northern Brazil, based on the answers to a questionnaire containing personal information and specific questions addressing the possible endodontic therapies for primary teeth. The collected data were analyzed using Microsoft Excel 2010 software, in which a descriptive statistics was carried out.Results: In primary molars with deep caries without pulp exposure, 86.7% of the pediatric dentists would choose indirect pulp capping (IPC). In case of a small accidental pulp exposure, 50% would perform direct pulp capping (DPC) and 46.7% would perform pulpotomy. In case of a large pulp exposure with mild inflammation, 56.7% of the interviewers would do pulpotomy and 43.3% DPC. Pulpectomy was the most reported treatment for teeth with pulp exposure, 1/3 of root resorption, pulpal polypus and fistula. In case of extensive root lesion and fistula, most participants (93.3%) would perform exodontia. For intracanal dressing in cases of pulpectomy, 36.7% would choose the Guedes Pinto paste. For pulpotomy, calcium hydroxide (36.7%) and formocresol (33.3%) were the most frequently indicated. Calcium hydroxide paste was the material of choice for IPC and DPC for 83.3% and 86.7% of the professionals, respectively.Conclusion: There were no uniformity in the answers for most situations, especially for choosing the treatment and material for cases of pulp exposure. The results emphasize the need for establishing a research-based clinical protocol for pulpal therapy in primary teeth.

Luxation injuries in primary teeth: a retrospective study in children assisted at an emergency service

The purpose of this study was to analyze luxation injuries in children between the ages of 0 and 5 years treated at an emergency service department. A total of 1,703 records, corresponding to a period of 10 years at the Emergency Center of the Baby Clinic at Londrina State University, Brazil, were analyzed. The age, gender, etiologic factors, type of injury, injured teeth, treatment and time interval between injury and treatment were determined for each patient. Of the examined records, 409 patients met the study criteria and included a total of 679 injured teeth. Statistical analyses were carried out using the chi-square test with the level of significance set at 5 percent. Trauma incidence was higher in boys (57.0 percent) and in children less than two years of age (40.3 percent). Falling while walking or running was the most predominant etiologic factor (37.7 percent), and the most prevalent type of injury was subluxation (32.6 percent). Luxation injuries decreased with increasing age (p = 0.045). Treatment usually occurred within the first 1-15 days and was significantly associated with the type of trauma (p = 0.041). "Monitor only" was the treatment most frequently observed (74.0 percent). In conclusion, more luxation injuries were found in younger children, predominantly in boys. Falls resulting from walking or running were the etiologic factor most observed, with subluxation as the most common type of trauma. Treatment usually occurred within the first 15 days after the injury. Despite the severity of these injuries, "monitor only" was the eligible treatment.