Predictors associated with malocclusion in children with and without sleep disorders: a cross-sectional study

Abstract The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43-2.86), mouth breathing (OR = 1.04; 95%CI: 1.02-1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37-4.85), and obesity (OR = 1.54; 95%CI: 1.02-2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

Temporomandibular Disorders are Associated with Sociodemographic Factors, Health-Related and Oral Conditions in Adolescents: A Cross-Sectional Study

Abstract Objective: To assess the association between temporomandibular disorder (TMD) with sociodemographic factors, health-related factors, and oral conditions in adolescents. Material and Methods: This cross-sectional study was developed with 89 adolescents between 13 to 18 years. TMD diagnosis was obtained by the Research Diagnostic Criteria for Temporomandibular Disease (RDC/TMD) Axis I. Diagnoses of chronic pain, depression, presence of non-specific physical symptoms, including pain and anxiety, were obtained by the RDC/TMD Axis II. The feeling of happiness was measured by the Subjective Happiness Scale. Socio-economic and demographic characteristics were collected through self-administered questionnaires. Patients were examined for dental caries, dental trauma, malocclusion, and tooth wear. Parents answered a sociodemographic, economic, and general health questionnaire. Data were submitted to descriptive statistics, and a logistic regression model was used to assess the association between TMD and the socio-economic, demographic, health-related, and clinical variables. Results: TMD prevalence was 42%. TMD was associated to skin color (p=0.040), use of medications in the past year (p = 0.020) and previous dental trauma (p=0.030). Also, it tended to be associated with the presence of probable awake bruxism (p=0.053). Conclusion: Sociodemographic factors, health-related factors, and oral conditions play a role in TMD, with nonwhite adolescents, those who had used medications in the past year and/or had previous dental trauma having a greater chance of present this disorder (AU).

Development and validation of a short form of the BOHLAT-P

Abstract: The authors developed and validated a short form of the Brazilian Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P). Data included responses from 200 parents of preschoolers to sociodemographic and oral health service access questions on the BOHLAT-P, the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), and the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS). Data on the preschoolers' dental caries experience (ICDAS-II) were also included. An item response theory-based approach was employed to develop the short form, while confirmatory factor analysis evaluated the instrument dimensionality. The validity and reliability of the short form were tested by statistical analysis using BREALD-30, B-ECOHIS, and sociodemographic and dental caries experience data. The short form (BOHLAT-P-30) comprises 30 items, is unidimensional, and presents better model fit estimates (TLI = 0.94; CFI = 0.94; RMSEA = 0.05) than those of the BOHLAT-P. Moreover, BOHLAT-P-30 demonstrated excellent reliability (Cronbach's alpha = 0.91; intraclass correlation coefficient [ICC] = 0.95). BOHLAT-P-30 scores were positively correlated with BREALD-30 scores (r = 0.71), with the number of years of schooling (r = 0.60), and with the number of hours spent reading (r = 0.33). BOHLAT-P-30 scores were negatively correlated with B-ECOHIS scores (r = -0.21), and with the number of teeth with cavitated caries (r = -0.18). After controlling for confounding factors, BOHLAT-P-30 scores were not found to be associated with caries presence, or with the number of teeth with cavitated caries. The BOHLAT-P-30 had properties similar to those of the BOHLAT-P, and proved to be a valid measure to assess the OHL of Brazilian parents.

Pediatric Oral Health Self-reported by Caregivers of NormalHearing and Hearing-Impaired Children

Abstract Objective: To verify and compare the sociodemographic data and caregivers' self-perception of children's oral health condition, hygiene habits and seek for dental services among family units of deaf and normalhearing children. Material and Methods: A comparative cross-sectional study was conducted with 64 parents/caregivers of 16 deaf and 48 normal-hearing children of 3-14 years old, belonging to reference centers in Belo Horizonte, southeastern Brazil. Deaf and hearing children were matched according to their sex and age. Sociodemographic characteristics of the family units and self-report of oral health conditions and care were assessed using a structured questionnaire, including information regarding seeking pediatric dental services. Descriptive analysis and chi-square test were performed (p<0.05). Results: Most individuals in the sample were mothers (84.4%). Low family income (p=0.024) and higher education level of guardians (p=0.018) were associated with families of hearing children. The report of clinical treatment or toothache as the main reason for the children's last dental appointment was associated with families of deaf children (p=0.047). Conclusion: Based on caregivers' reports, hearing-impaired children demonstrated greater vulnerability to present dental pain or clinical treatment as the main reasons for their last access to dental appointments.

Family structure, sociodemographic factors and type of dental service associated with oral health literacy in the early adolescence / Estrutura familiar, fatores sociodemográficos e tipo de serviço odontológico associados ao alfabetismo em saúde bucal no início da adolescência

Abstract The aim of this study was to evaluate associations between oral health literacy and family, sociodemographic and dental service characteristics in early adolescents. A cross-sectional study was conducted with 740 schoolchildren. The following variables were investigated using validated questionnaires: oral health literary (BREALD-30), sociodemographic characteristics, type of dental service and family functioning (FACES III). Associations were tested using robust Poisson regression analysis (α=5%). Higher oral health literacy was associated with the female sex (RR=1.09; 95%CI: 1.03-1.14), connected type of family cohesion (RR=1.12; 95%CI: 1.05-1.20), rigid (RR=1.14; 95%CI: 1.04-1.25) and structured (RR=1.11; 95%CI: 1.04-1.20) types of family adaptability, more than eight years of mother's schooling (RR=1.16; 95%CI: 1.10-1.22), age of caregiver more than 38 years (RR=1.07; 95%CI: 1.02-1.13) and the use of private dental services (RR=1.06; 95%CI: 1.01-1.12). The level of oral health literacy in early adolescents was associated with sex, family structure, mother's schooling, caregiver's age and type of dental service used.

Resumo Este estudo avaliou a associação de fatores sociodemográficos, familiares e do tipo de serviço odontológico utilizado ao alfabetismo em saúde bucal em pré-adolescentes. Trata-se de um estudo transversal com 740 escolares. Foram avaliados o alfabetismo em saúde bucal (BREALD-30), fatores sociodemográficos, tipo de serviço odontológico e funcionalidade familiar (FACES III) por meio de questionários validados. A associação entre as variáveis foi avaliada por meio de regressão de Poisson robusta (α=5%). Um maior alfabetismo em saúde bucal foi associado ao sexo feminino (RR=1.09; IC95%: 1.03-1.14), coesão familiar do tipo conectada (RR=1.12; IC95%: 1.05-1.20), adaptabilidade familiar dos tipos rígida (RR=1.14; IC95%: 1.04-1.25) e estruturada (RR=1.11; IC95%: 1.04-1.20), escolaridade materna superior a oito anos de estudo (RR=1.16; IC95%: 1.10-1.22), idade do responsável superior a 38 anos (RR=1.07; IC95%: 1.02-1.13) e uso de serviços odontológicos privados (RR=1.06; IC95%: 1.01-1.12). O nível de alfabetismo em pré-adolescentes foi associado ao sexo, estrutura familiar, idade e escolaridade do responsável e tipo de serviço odontológico utilizado.

Can bulk-fill resin restorations be an alternative to resin-modified glass ionomer cement restorations in primary molars of toddlers? a randomized clinical trial protocol / ¿Pueden las restauraciones de resina bulk-fill ser una alternativa a las restauraciones de cemento de ionómero de vidrio modificado con resina en los molares primarios en niños preescolares? un protocolo de ensayo clínico aleatorizado

Background: The aim of this study was to elaborate a randomized clinical trial protocol to evaluate the effectiveness of class I restorations in resin-modified glass ionomer cement (RMGIC) and bulk-fill resin in primary molars with untreated early childhood caries in toddlers. Material and Methods: A total of 59 toddlers up to 36 months old with at least two primary molar teeth with untreated dental caries of single surface on different sides of the mouth will be selected at the Pediatric Dentistry Clinics of the Faculty of Dentistry at Federal University of Minas Gerais (UFMG), Brazil. Teeth with untreated dental caries in the left and right sides of each patient's mouth will be randomly distributed into 2 groups: Group 1 (Control): encapsulated RMGIC restoration with Riva light cure (SDI, Florida, USA) and Group 2 (Test): Filtek bulk-fill composite resin restoration (3M/ESPE, St. Paul, USA) with universal single bond adhesive system (3M/ESPE, St. Paul, USA). A single trained dentist will perform all restorative procedures. The restorations will be evaluated after 1, 6, 12, 18 and 24 months by two trained and calibrated examiners. Cost-efficacy analysis will be carried out. Kaplan-Meier survival analysis, Log-rank test, Cox regression, Poisson regression analysis, Mann-Whitney test or Kruskal-Wallis will be performed to analyze data. Conclusion: The protocol will make it possible to determine the most efficacy material for the restoration of cavities in cavities in primary molars of toddlers.

Antecedentes: El objetivo de este estudio fue elaborar un protocolo de ensayo clínico aleatorizado para evaluar la efectividad de las restauraciones de clase I en cemento de ionómero de vidrio modificado con resina (RMGIC) y resina bulk-fill en molares primarios con caries de la primera infancia no tratadas en niños preescolares. Material y Métodos: Un total de 59 niños de hasta 36 meses de edad con al menos dos molares temporales con caries no tratada de superficie única en diferentes lados de la boca serán seleccionados en las Clínicas de Odontología Pediátrica de la Facultad de Odontología de la Universidad Federal de Minas Gerais (UFMG), Brasil. Los dientes con caries no tratada en los lados izquierdo y derecho de la boca de cada paciente se distribuirán aleatoriamente en 2 grupos: Grupo 1 (Control): restauración RMGIC encapsulada con fotopolimerización Riva (SDI, Florida, EE. UU.) Y Grupo 2 (Prueba): Restauración de resina compuesta bulk-fill Filtek (3M / ESPE, St. Paul, EE. UU.) con sistema adhesivo de unión simple universal (3M / ESPE, St. Paul, EE. UU.). Un solo dentista capacitado realizará todos los procedimientos de restauración. Las restauraciones serán evaluadas después de 1, 6, 12, 18 y 24 meses por dos examinadores capacitados y calibrados. Se llevará a cabo un análisis de coste-eficacia. Se realizarán análisis de supervivencia de Kaplan-Meier, prueba de rango logarítmico, regresión de Cox, análisis de regresión de Poisson, prueba de Mann-Whitney o Kruskal-Wallis para analizar los datos. Conclusión: El protocolo permitirá determinar el material más eficaz para la restauración de caries en molares temporales de niños preescolares.

Contextual and individual factors associated with oral health literacy in adolescents: A multi-level approach

Abstract This study aimed to evaluate the association of contextual and individual factors with Oral Health literacy (OHL) in early adolescence. This is a population-based cross-sectional study carried out with 740 12-year-old adolescents randomly selected by a two-stage probabilistic cluster sampling process from schools in Campina Grande, Brazil. The guardians provided sociodemographic information. Adolescents answered the Brazilian version of the Family Adaptability and Cohesion Scales (FACES III) to measure family functioning, and the Brazilian Rapid Estimate of Literacy in Dentistry (BREALD-30) to measure OHL. Descriptive analysis was conducted, followed by robust Poisson's regression analysis for complex samples with a multilevel approach (p<0.05). Rate ratio (RR) and 95% confidence intervals (CI) were calculated. The two levels of the analysis were students and schools. Adolescents enrolled at schools with higher grade-retention rate had slightly worse OHL scores (RR = 0.99; 95% CI: 0.98 to 0.99). The following individual factors were associated with the level of OHL: the female sex (RR = 1.05; 95% CI: 1.01 to 1.10), mother's schooling more than eight years (RR = 1.13; 95% CI: 1.08 to 1.19), younger guardians (RR = 0.94; 95% CI: 0.90 to 0.97) and a balanced family functioning (RR = 1.08; 95% CI: 1.01 to 1.14). Individual and contextual factors were associated with OHL in early adolescence.

Resumo O objetivo deste estudo foi avaliar o efeito de um nanocomplexo recém-desenvolvido formado entre hidroxipropil-β-ciclodextrina e 1% de tetrafluoreto de titânio (TiF4) após distintos períodos de complexação (12/72 horas) na desmineralização do esmalte bovino in vitro. Blocos de esmalte (n = 60) foram alocados para cada grupo: água Mili-Q, hidroxipropil-β-ciclodextrina, TiF4 a 1%, hidroxipropil-β-ciclodextrina + TiF4 1% após 12 horas de complexação e hidroxipropil-β-ciclodextrina + TiF4 1% após 72 horas de complexação. As amostras foram avaliadas pela microdureza superficial, microdureza transversal e micro-CT. Microscopia eletrônica de varredura / espectrometria de raios X por dispersão de energia (MEV / EDX) foram obtidas. A hidroxipropil-β-ciclodextrina + TiF4 1% após 12h de complexação resultou em um menor percentual de perda de microdureza superficial em comparação com água Mili-Q, hidroxipropil-β-ciclodextrina, TiF4 a 1% e hidroxipropil-β-ciclodextrina + TiF4 1% após 72 horas de complexação com uma ampla magnitude de efeito (de 1,307 a 2,943) e alto poder (84,9 a 99%). Todos os grupos resultaram em similar perda integrada de minerais (ΔZ) obtida por ambas as técnicas de microdureza e micro-CT. O esmalte tratado com os grupos TiF4 e TiF4 + hidroxipropil-β-ciclodextrina apresentou camada de esmalte TiO2, enquanto a avaliação de EDX identificou Ti. A solução contendo o complexo de inclusão de hidroxipropil-β-ciclodextrina + TiF4 com 12 horas de período de complexação demonstrou uma capacidade significativa para reduzir a desmineralização superficial do esmalte hígido sob um desafio cariogênico artificial.

Family and contextual factors associated with licit drug use in adolescence

ABSTRACT OBJECTIVE: TO evaluate the family and contextual factors associated with licit drug use among 15 to 19-year-old adolescents in the school context. METHODS: This is a representative, school-based, cross-sectional study conducted with 746 adolescents from 15 to 19 years old enrolled in public and private schools. Parents/guardians reported on the sociodemographic variables, while adolescents answered questionnaires on drug use, family cohesion and adaptability, oral health literacy and visits to the dentist. Information on school context was obtained at the institution and via municipal publications. Associations between variables were analyzed using unadjusted and adjusted multilevel Poisson regression models. RESULTS: Prevalence of licit drug use at least once and a pattern indicative of harmful drug use were 39.8% and 15.1%, respectively. After the adjusted analysis of licit drug use at least once, the variables gender (PR = 1.26; 95%CI: 1.01-1.59), family cohesion (PR = 9.81; 95%CI: 1.23-72.54), and average income of the school district (PR = 0.72; 95%CI: 0.57-0.91) remained in the final model. As for drug abuse, only the detached type (PR = 23.01; 95%CI: 2.46-214.87) and separated type (PR = 13.54; 95%CI: 1.40-130.97) of family cohesion remained in the final model. CONCLUSION: Experience with licit drug use was associated with family and contextual factors among the adolescents, while family cohesion was the main factor related to harmful drug use.

Contributions of school context to caries on anterior teeth: a multilevel analysis

ABSTRACT OBJECTIVE To investigate whether oral health literacy (OHL) and school context are associated with untreated dental caries on the anterior teeth of adolescents. METHODS A representative cross-sectional study was conducted with 746 students aging 15 to 19 in the city of Campina Grande, Brazil. The guardians answered a questionnaire addressing sociodemographic data and the absence/presence of private health insurance. Two examiners were trained for the diagnosis of dental caries using the Nyvad criteria and the measurement of OHL using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) (Kappa > 0.80). Contextual aspects of the schools were obtained from the 2017 National School Census. Descriptive statistics were conducted, followed by unadjusted and adjusted robust negative binomial regression for complex samples (p < 0.05). RESULTS The average number of anterior teeth with untreated caries was 0.95 (SD = 1.77). Among individual factors, the male sex (RR = 1.64; 95%CI: 1.24-2.16), inadequate level of OHL (RR = 2.03; 95%CI: 1.13-1.63), marginal level of OHL (RR = 1.87; 95%CI: 1.05-3.33) and not having private health insurance (RR = 1.34; 95%CI: 1.07-1.68) were associated with untreated caries on anterior teeth. Among school contextual factors, the number of students in the classroom (RR = 2.64; 95%CI: 1.78-3.93), number of public oral health services in the district (RR = 0.14; 95%CI: 0.05-0.39) and average income of the district in which the school is located (RR = 0.99; 95%CI: 0.98-0.99) were associated with the outcome. CONCLUSIONS Sociodemographic factors, having private health insurance, OHL, and school context exerted an influence on the occurrence of untreated dental caries on anterior teeth in adolescents aging 15 to 19.

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.

Do Parents' Oral Health Literacy Levels Influence Their Response to Interventions to Improve Their Knowledge of Traumatic Dental Injuries?

Abstract Objective: To measure the influence of oral health literacy (OHL) level in the improvement of knowledge about traumatic dental injuries (TDI) after an educational intervention. Material and Methods: A total of 257 parents of children aged 0-12 years had their OHL level evaluated (BREALD-30). A leaflet with information about how to respond to TDI Emergency was developed and delivered to the parents. A questionnaire about attitudes towards TDI was administered before (TDIQ1) and after (TDIQ2) parents read the educational leaflet. The hypotheses were evaluated by non-parametric tests, correlation analysis and logistic regression. Results: The mean OHL score was 21.6. The means of correct answers in TDIQ1 were 5.5 and 5.9 (p = 0.066) and in TDIQ2 were 6.6 and 7.7 (p=0.003) between the groups with inadequate and marginal/adequate OHL, respectively. In the logistic regression, the total score of BREALD-30 and the maximum number of correct answers in TDIQ2 maintained statistical association when adjusted for schooling, gender, age of the parents, family income and the number of correct answers in the first application of the questionnaire. Conclusion: The level of OHL influenced the improvement of parents' knowledge about emergency care in cases of TDI in children from an educational intervention using a leaflet, and this intervention was more effective for parents with adequate OHL.

Can be Grandmother as Childs Daytime Caregiver a Risk Factor for Higher Caries Experience in Early Childhood? A Retrospective Study

Abstract Objective: To investigate the association between child's daytime caring person and risk for higher early childhood caries (ECC) experience. Material and Methods: The sample consisted of all clinical records (census) of children (0-3 years old) attended in a public dental clinic, which contained information about caries experience and child's daytime caring person (mother, grandmother or others). Caries experience was dichotomized as dmft ≤ 2 or dmft >2. Data were analyzed by the chi-square (α = 0.05). Binary logistic regression models were built. Results: From a total of 310 children, 19% of children had the grandmother as daytime caring person. There was no association between child's daytime caring person and caries experience (p=0.32). Logistic regression analysis showed that low daytime caregiver schooling (OR: 5.76 95%CI 1.18-28.18; p=0.02) and child's age (OR: 1.14 95% CI 1.09-1.19; p=0.00) were risk factors, and breastfeeding duration (> 9 months - OR: 0.38 95% CI 0.21-0.68; p=0.00), no nocturnal feeding (OR: 0.50 95% CI 0.27-0.91; p=0.02), and absence of sugar consumption between main meals (OR: 0.50 95% CI 0.28-0.89; p=0.02) were protection factors for ECC. Conclusion: A higher caries experience in early childhood is not associated to child's daytime caring person. On the other hand, the higher caries experience is associated with low caregiver schooling and older children.

Degree of family cohesion and social class are associated with the number of cavitated dental caries in adolescents

Abstract The aim of this study was to evaluate the association between number of cavitated dental caries in adolescents and family cohesion, drug use, sociodemographic factors and visits to the dentist. A cross-sectional study was conducted with 746 adolescents aged 15 to 19 years from Campina Grande, Brazil. The parents answered a questionnaire addressing sociodemographic data, and the adolescents answered questionnaires on drug use, type of family cohesion and visits to the dentist. Two examiners underwent training and calibration exercises (K > 0.80) to diagnose dental caries using the Nyvad criteria. A directed acyclic graph was created to select the variables to be controlled in the statistical model. Associations between the independent variables and the outcome were determined using robust Poisson Regression analysis for complex samples (α = 5%). Rate ratios (RR) and 95% confidence intervals (CI) were calculated. The prevalence of dental caries and cavitated lesions among the adolescents was 92.8% and 41.6%, respectively. The following variables remained associated with the number of cavitated lesions in the multivariate analysis: disengaged (RR: 6.30; 95%CI: 1.24-31.88; p = 0.028 ), separated (RR: 4.80; 95%CI: 1.03-22.35; p = 0.046) and connected (RR: 5.23; 95%CI: 1.27-21.59; p = 0.024) levels of family cohesion, and high social class (RR: 0.55; 95%CI: 0.39-0.76; p = 0.001). In conclusion, this paper posits that adolescents with a lower socioeconomic status, and those whose family cohesion was classified as disengaged, separated or connected, had a larger number of cavitated lesions.

Cross-cultural adaptation of the Clear Communication Index to Brazilian Portuguese

ABSTRACT OBJECTIVE To perform a cross-cultural adaptation of the Clear Communication Index instrument from the Centers for Disease Control and Prevention (CDC-CCI) from English to Brazilian Portuguese. METHODS This study comprised initial discussion about the conceptual equivalence of the instrument by a committee formed by experts on health education. We performed translations, synthesis of translations, back-translations, revision by the committee, and linguistic revision. Semantic equivalence was obtained by analyzing the referential and general meaning of each item by the committee, resulting in a pre-final version of the instrument. Subsequently, thirty professionals with health sciences degrees performed a pre-test. These professionals used the pre-final version of the instrument to assess a health education material. A questionnaire was applied to evaluate the acceptability of the instrument, the understanding of each of the 20 items, as well as the individual and professional variables. We analyzed the scores attributed to the health education material, the variables related to healthcare professionals, the proportions of the acceptability of the instrument, and the comprehension of each item. RESULTS After we obtained the conceptual equivalence of the instrument, the committee of experts, the instrument's main author, and the linguist produced the pre-final version using two translations, a synthesis of the translations, and two back-translations. A general equivalence was maintained in 15 of the 20 items (75%), four of the items were slightly altered (20%), and one item was very altered (5%). Nineteen items presented referential equivalence or near equivalence (95%). We then carried out with the pre-test, in which the professionals used the pre-final version. Two items in the domains of "risks" and "main message" were unclear and needed to be revised. CONCLUSION The process of cross-cultural adaptation of the Clear Communication Index provided an adapted version to the Brazilian Portuguese language.

Socioeconomic status and family functioning influence oral health literacy among adolescents

ABSTRACT OBJECTIVE Evaluate socio-demographic, family and behavioral factors associated with oral health literacy (OHL) in adolescents. METHODS Cross-sectional study conducted with adolescents aged 15 to 19 years in Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing socio-demographic data. The adolescents answered validated instruments on family cohesion and adaptability (family adaptability and cohesion evaluation scale), drug use (alcohol, smoking and substance involvement screening test), type of dental service used for last appointment and OHL (Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry). Two dentists were trained to evaluate OHL (K = 0.87-0.88). Descriptive analysis was performed, followed by Poisson regression analysis (α = 5%). A directed acyclic graph was used to select independent variables in the study. RESULTS The following variables remained associated with better OHL: high mother's schooling level (RR = 1.07; 95%CI: 1.03-1.12), high income (RR = 1.04; 95%CI: 1.01-1.09), white ethnicity/skin color (RR = 1.05; 95%CI: 1.01-1.10), married parents (RR = 1.04; 95%CI: 1.01-1.09), "enmeshed" family cohesion (RR = 1.21; 95%CI: 1.12-1.30), "structured" (RR = 1.06; 95%CI: 1.01-1.12) or "rigid" (RR = 1.11; 95%CI: 1.04-1.19) family adaptability, having more than five residents in the home (RR = 1.07; 95%CI: 1.01-1.14) and having used a private dental service during the last appointment (RR = 1.08; 95%CI: 1.03-1.13). CONCLUSION Family functioning and socio-demographic factors influence the level of oral health literacy among adolescents.

Caregiver's oral health literacy is associated with prevalence of untreated dental caries in preschool children / Alfabetismo em saúde bucal dos cuidadores é associado com a prevalência de cárie não tratada em pré-escolares

Abstract The aim of this study was to evaluate the relationship between oral health literacy (OHL) among caregivers and untreated dental caries among preschoolers. A cross-sectional study was conducted involving 415 preschool children and their caregivers from Curitiba, Brazil. The children were examined for dental caries and dental plaque. The caregivers' OHL was evaluated using an instrument translated and validated for Brazilian Portuguese: the Brazilian Rapid Estimate of Adult Literacy in Dentistry-30. The prevalence of children with untreated caries was 42.9% (95%CI: 38.1-47.7%). A low degree of OHL was found among 15.7% (95%CI: 12.2-19.2) of caregivers. The multivariable Poisson regression analysis indicated a higher prevalence of untreated caries among children whose caregivers had a low OHL (PR = 1.35; 95% CI: 1.01-1.79), those with visible plaque (PR = 1.28; 95% CI: 1.01-1.62) and those who never or only occasionally had their teeth brushed by their caregivers (PR = 1.48; 95% CI: 1.16-1.91) in comparison to those without these conditions. In conclusion, a higher prevalence of untreated dental caries was found among preschool children whose caregivers had a low degree of OHL.

Resumo O objetivo deste estudo foi avaliar a relação entre a alfabetização em saúde bucal (ASB) entre os cuidadores e a cárie dentária não tratada entre pré-escolares. Um estudo transversal foi realizado envolvendo 415 crianças pré-escolares e seus cuidadores de Curitiba-Brasil. As crianças foram examinadas para cárie dentária e placa dental. O ASB dos cuidadores foi avaliado usando um instrumento traduzido e validado para o idioma português do Brasil, o Brazilian Rapid Estimate of Adult Literacy in Dentistry-30. A prevalência de crianças com cárie não tratada foi de 42,9% (IC 95%: 38,1-47,7%). Um baixo grau de ASB foi encontrado entre 15,7% (IC 95%: 12,2-19,2) de cuidadores. A análise de regressão de Poisson multivariada indicou uma maior prevalência de cárie não tratada entre crianças cujos cuidadores apresentaram baixo ASB (PR = 1,35; IC 95%: 1,01-1,79), aqueles com placa visível (PR = 1,28; IC 95%: 1,01-1,62) e aqueles que nunca ou apenas ocasionalmente tiveram seus dentes escovados por seus cuidadores (PR = 1,48; IC 95%: 1,16-1,91) em comparação com aqueles sem essas condições. Pode-se concluir que uma maior prevalência de cárie dentária não tratada foi encontrada entre os pré-escolares cujos cuidadores tinham um baixo grau de ASB.

No-shows at public secondary dental care for pediatric patients: a cross-sectional study in a large Brazilian city / Não comparecimento na atenção secundária pública em saúde bucal de pacientes pediátricos: estudo transversal em uma grande cidade brasileira

Abstract Missed appointments have a great economic, social and administrative impact on the management of public health services. This research aimed to study factors associated with non-attendance to the first appointments of pediatric patients in secondary dental care services in the city of Curitiba, Brazil. A cross-sectional study was performed using secondary data from the electronic health records of the Curitiba Municipal Secretary of Health. The study included all children (0-12 years) referred to secondary dental clinics in the years 2010 to 2013. Data were analyzed by the chi-square test and Pearson linear trend chi-square (α = 0.05). Binary logistic regression models were built. Data from 1,663 children were assessed and the prevalence of non-attendance was 28.3%. The variables associated with the non-attendance in inferential analysis (p < 0.05) and in the final model were the household income per capita (95% CI: 1.93-2.82) and the waiting time in virtual queue (95% CI: 1.000-1.002). Socioeconomic aspects and the waiting time in virtual queue, should be considered in the strategic planning of health services as they may influence the attendance of pediatric patients in secondary dental referral service.

Resumo O não comparecimento a consultas tem um grande impacto no gerenciamento dos serviços de saúde pública. O objetivo foi avaliar os fatores associados ao não comparecimento às primeiras consultas de pacientes pediátricos nos serviços de atenção secundária em saúde bucal na cidade de Curitiba, Brasil. Um estudo transversal foi desenvolvido com dados secundários obtidos de cadastros eletrônicos da Secretaria Municipal de Saúde de Curitiba. Participaram crianças de 0 a 12 anos de idade encaminhadas para atenção secundária nos anos de 2010 a 2013. Os dados foram analisados pelos testes de qui-quadrado de Pearson e qui-quadrado de tendência linear (α = 0,05). Foram constituídos modelos de regressão logística binária. Foram analisados os dados de 1.663 crianças. A prevalência de não comparecimento às primeiras consultas foi de 28,3%. As variáveis que estiveram associadas ao não comparecimento na análise inferencial (p < 0,05) e no modelo final foram a renda per capita familiar (95% CI: 1,93-2,82) e o tempo de espera em fila virtual (95% CI: 1,000-1,002). Aspectos econômicos e o tempo de espera em fila virtual devem ser considerados no planejamento estratégico dos serviços públicos de saúde bucal, pois podem influenciar o comparecimento de pacientes na atenção secundária.

Excess Body Weight, Snack Limits and Dental Caries in Brazilian Preschoolers: A Population-Based Study

Objective: To evaluate the relationship between excess body weight (EBW) and the prevalence of dental caries in preschoolers considering parental control regarding snack consumption. Material and Methods: An observational, population-based, cross-sectional study was conducted at Municipal Child Education Centers in the city of Curitiba, Brazil, involving a representative sample of 686 preschool children aged four to five years and eleven months and their parents/caregivers. Dental caries was analyzed using the dmft index. Weight and height were measured for the determination of the body mass index, which was categorized for each zscore range considering age and sex. Children with overweight or obesity were considered to have EBW. The assessment of nutritional status was performed with the aid of the WHO Anthro and WHO Anthro Plus programs. The data were analyzed using univariate and multivariate Poisson regression analysis with robust variance (α= 0.05). Results: The children with EBW had a lower prevalence rate of caries, but this association lost its significance when adjusted by the other variables included in the multivariate model. In the multivariate regression analysis, household income per capita (PR=0.804; 95%CI: 0.665-0.972), child's age (PR=1.015; 95%CI: 1.001-1.029) and snack limits (PR=0.839; 95%IC: 0.732-0.962) were associated with a greater prevalence rate of dental caries. Conclusion: Excess body weight was not significantly associated with dental caries, whereas a lower parental limit regarding snack consumption by the children was independently associated with a higher prevalence rate of dental caries.

Toothache and non-clinical individual and school factors in five-year-old children: multilevel analysis

Abstract The objective of the present study was to evaluate the influence of individual and contextual factors on the occurrence of toothache in five-year-old children. A cross-sectional study was conducted with 756 five-year-old children from public and private preschools in a city in the countryside of the northeast of Brazil. The sample was determined through probabilistic sampling in two stages (preschools and children). The children included could not have systematic diseases, permanent tooth or orthodontic treatment. Parents/caregivers were required to spend at least 12 hours per day with their children. The history of toothache during the life of the child was reported by parents/guardians. Socioeconomic and psychological questionnaires were completed by parents/guardians. Variables related to social context were obtained from the preschools in which the children studied and the official publications of the municipal region. Unadjusted and adjusted multilevel Poisson regression models were used to investigate the association between individual and contextual characteristics and history of toothache. The history of toothache was found for 23.8% of the children. Among the individual determinants, gender of the child, order of birth, and schooling of parent/guardian were associated with toothache in children. The individual variables remained associated with the outcome after the addition of the contextual variables to the model. The type of preschool was the contextual determinant associated with toothache in the final model. Both individual (gender, order of birth and schooling of parents/guardians) and contextual (type of preschool) determinants were associated with history of toothache in five-year-old children.

Resumo O objetivo do presente estudo foi avaliar a influência de fatores individuais e contextuais na ocorrência de dor de dente em crianças de cinco anos de idade. Um estudo transversal foi realizado com 756 crianças de cinco anos de idade de pré-escolas públicas e privadas em uma cidade no interior do Nordeste do Brasil. A seleção da amostra foi realizada por meio de amostragem probabilística em duas etapas (pré-escolas e crianças). As crianças incluídas não poderiam ter doenças sistêmicas, dentes permanentes ou tratamento ortodôntico. Foram incluídos apenas pais/responsáveis que passavam pelo menos 12 horas por dia com seus filhos. O histórico de dor de dente durante a vida da criança foi relatado pelos pais/responsáveis. Os questionários socioeconômicos e psicológicos foram preenchidos pelos pais/responsáveis. As variáveis relacionadas ao contexto social foram obtidas na pré-escola em que as crianças estudaram e nas publicações oficiais da região municipal. Os modelos de regressão de Poisson multinível não ajustados e ajustados foram utilizados para investigar a associação entre características individuais e contextuais e histórico de dor de dente. O histórico de dor de dente foi encontrado em 23,8% das crianças. Entre os determinantes individuais, gênero da criança, ordem de nascimento e escolaridade dos pais/responsáveis ​​foram associados com dor de dente em crianças. As variáveis ​​individuais permaneceram associadas ao resultado após a adição das variáveis ​​contextuais ao modelo. O tipo de pré-escola foi o determinante contextual associado ao histórico de dor de dente no modelo final. Tanto o indivíduo (gênero, ordem de nascimento e escolaridade dos pais/responsáveis) quanto os determinantes contextuais (tipo de pré-escolar) foram associados com o histórico de dor de dente em crianças de cinco anos de idade.

Influence of light transmission through fiber posts: Quantitative analysis, microhardness, and on bond strength of a resin cement

Light transmission (LT) into deeper areas of the dentin root is limited. Aim: The aim of this study is to perform a quantitative investigation of the radial transmission of light (LT) through different fiber posts and its influence on the Knoop hardness number (KHN) and bond strength (BS) of a dual-cure self-adhesive resin cement at 3 different depths. Materials and Methods: Four types of fiber posts (2 translucent and 2 conventional) were used. LT and KHN analyses were performed in a specially designed matrix, which allowed measurements at 3 different depths. LT was measured using a volt-ampere meter while KHN tests were performed in a microhardness tester. For BS analysis, endodontically treated bovine roots were divided into 4 groups, each group receiving one type of post. After cementation, cross sections of the root were tested for resistance to displacement using a universal testing machine. Statistical Analysis Used: Statistical analysis was performed by using this ANOVA and Tukey's test. Results: For LT, translucent posts showed significantly higher values at all depths compared to the conventional ones. For all posts, LT decreased at the deeper depths. The KHN results showed no statistical differences among the different posts, regardless of depth. For BS, a translucent post showed the highest values, and comparative analyses between the different depths of posts also showed statistically significant differences while comparisons among the different depths of the same post showed no differences. Conclusions: LT depended on the type of post and on depth. The type of post did not significantly influence the cement KHN. A translucent post showed higher BS in pooled data.