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.

Factors Associated with the Intake of Ultra-Processed Cariogenic Foods by Preschoolers During the COVID-19 Pandemic

ABSTRACT Objective: To evaluate the characteristics and factors associated with the intake of ultra-processed cariogenic foods (UFC) by preschoolers during the COVID-19 pandemic. Material and Methods: This is a cross-sectional study involving parents of 672 children from two to five years old enrolled at public schools in Curitiba, Brazil. Parents answered a questionnaire about socioeconomic and demographic data, their behavior regarding the dietary education of their children (Parent Mealtime Action Scale - translated and validated for use in Brazil), and children's food intake (qualitative food frequency questionnaire - list of foods based on a report from the Pan American Health Organization). The data were analyzed using Poisson regression analysis (α=0.05). Results: About 43% of parents/guardians reported changes in their children's diet during the pandemic, being that diet got worse and better in 19% and 24% of the cases, respectively. The ultra-processed cariogenic foods with the highest daily intake frequencies were sweetened juices/sweetened drinks (0.52), followed by cookies (0.37), and candies (0.35). Parents with a lower level of education reported a daily frequency of UCF intake 1.36 times higher (PR=1.359; CI 95%: 1.106-1.669) in their children compared to those with a higher level of education. On the other hand, parents'/guardians' report of higher intake and greater offer of fruits and vegetables to children was associated with low UCF intake (PR=0.716; CI 95%: 0.592-0.866). Conclusion: The lower level of formal education of parents/guardians and lower availability of fruits and vegetables were related to higher consumption of ultra-processed cariogenic foods by children.

Parental oral health literacy influences preschool children's utilization of dental services

Abstract: Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03-1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09-1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03-1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level.

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.

Daily Toothbrushing Frequency and the Association with Parental Report of Dental Pain and Discomfort in Preschool Children

Abstract Objective: To evaluate the impact of daily toothbrushing frequency on parental reports of dental pain and discomfort in preschoolers. Material and Methods: An observational cross-sectional study was conducted involving 376 children between four and five years of age at public preschools in the city of Campo Magro, Brazil. Parents/guardians answered a socioeconomic questionnaire that contained a single question on the child's daily toothbrushing frequency and the Brazilian version of the Dental Discomfort Questionnaire (DDQ-B). Statistical analysis involved bivariate and multivariate Poisson regression analyses (α=0.05). Results: After the adjustments in the multivariate analysis, the prevalence of dental pain and discomfort was lower among children whose last visit to the dentist was for prevention (PR = 4.42; 95% CI: 1.75- 11.14; p=0.002) and those with a higher daily toothbrushing frequency (PR = 2.13; 95% CI: 1.12-4.05; p=0.021). Conclusion: A lower toothbrushing frequency is associated with parental reports of dental pain and discomfort in preschoolers. Educational and preventive measures that stimulate an increase in daily toothbrushing frequency can contribute to a better oral health status in preschoolers, consequently, less prevalence of dental pain and discomfort.

Untreated early childhood caries: the role of parental eating behavior

Abstract The aim of the present study was to analyze the association between parental eating behavior and untreated early childhood caries (ECC). A cross-sectional study was conducted with a representative sample of 432 parent-child dyads with children aged 18 to 36 months, at Municipal Child Education Centers in São José dos Pinhais, Brazil. The parents answered a questionnaire addressing demographic and socioeconomic characteristics, and the children were examined for dental caries (modified dmft index) by a single examiner (kappa = 0.80). A six-item questionnaire was administered addressing parental food consumption, parental control of the child's food consumption, and parental offering of foods to the child. Three items were considered indicative of positive behavior, and three, of negative behavior. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). The prevalence of untreated ECC was 20.3% (95%CI: 16.7-24.4). In the multiple regression model adjusted for the child's age and the parent's schooling, negative parental behavior was associated with a greater frequency of untreated ECC (PRa = 1.213; 95%CI:1.032-1.427, p = 0.019), but lost its significance when adjusted by positive parental behavior (PRa = 1.156; 95%CI: 0.983-1.358, p = 0.079). Based on the present findings, positive parental eating behaviors are capable of minimizing the impact of negative parental behaviors on the prevalence of untreated early childhood caries.

Can Hemophilia Impact on the Oral Health Conditions of Children and Adolescents? A Systematic Review and Metanalysis

Abstract Objective: To analyze if the oral health conditions in children and adolescents are associated with hemophilia (PROSPERO-42020168192). Material and Methods: The search strategy was performed in PubMed, Scopus, Lilacs/BBO, Web of Science, Cochrane, and Grey literature databases. Two independent researchers assessed the risk of bias in these studies by the Newcastle-Ottawa Scale. For the meta-analysis, the clinical conditions data were extracted as numerical variables according to their indexes, such as dental caries experience (dmft/DMFT), gingival condition (Modified Gingival Index - IGM), and oral hygiene (Plaque Index - PI). The quality of the evidence of the meta-analysis was evaluated by the GRADE tool (GRADEproGDT). Results: From a total of 431 studies, 27 were included, and 10 were included in the meta-analysis. The studies presented a moderate risk of bias, ranging from 2 to 7 points. The dental caries experience in primary (-0.62; CI95%: -1.68-0.43) and permanent dentitions (-0.05; CI95%: -0.69-0.59), gingival condition (-0.12; CI95%: -0.27-0.03), and oral hygiene (0.36; CI95%: -0.06-0.77) did not differ between the groups. Conclusion: Based on studies with very weak evidence, there were no differences in the oral health conditions of children and adolescents with and without hemophilia (AU).

Insegurança alimentar e fatores sociodemográficos em crianças de São José dos Pinhais, Paraná, 2017: estudo transversal / Inseguridad alimentaria y factores sociodemográficos en niños de São José dos Pinhais, Paraná, Brasil, 2017: estudio transversal / Food insecurity and sociodemographic factors among children in São José dos Pinhais, Paraná, Brazil, 2017: a cross-sectional study

Objetivo: Analisar a associação entre insegurança alimentar (IA) e fatores sociodemográficos em crianças. Métodos: Estudo realizado no período maio-novembro de 2017, com mães de crianças (18-35 meses) matriculadas na rede pública de ensino de São José dos Pinhais, Paraná, Brasil. A IA foi acessada pela Escala Brasileira de Insegurança Alimentar. Utilizou-se regressão logística multinomial com modelo hierárquico. Resultados: Participaram 395 mães/crianças. A prevalência da IA foi de 34,7% (IC95% 28,5;41,5), sendo 25,7% (IC95% 19,2;32,3) para IA leve (IAL) e 9,0% (IC95% 8,5;9,4) para IA moderada/grave (IAMG). Famílias pertencentes ao menor tercil de renda tiveram maior chance de IAL (OR=3,06 - IC95% 1,26;7,41) ou IAMG (OR=6,35 - IC95% 1,89;21,4), comparadas ao maior tercil. Maior prevalência de IAL foi identificada em meninos (OR=2,34 - IC95% 1,49;3,68). Conclusão: IA foi associada a menor renda; e IAL, ao sexo masculino da criança. Políticas públicas de aumento de renda devem ser incluídas nas estratégias de redução da IA.

Objetivo: Analizar la asociación entre inseguridad alimentaria (IA) y factores sociodemográficos en niños. Métodos: Estudio realizado de mayo a noviembre (2017) con madres de niños (18 - 35 meses) de escuelas públicas de São José dos Pinhais, Paraná, Brasil. AI fue medida por la Escala Brasileña de Inseguridad Alimentaria. Se utilizó regresión logística multinomial, con un modelo jerárquico. Resultados: 395 madres/niños participaron. La prevalencia de IA fue 34,7% (IC95% 28,5;41,5), con 25,7% (IC95% 19,2;32,3) para IA leve (IAL) e 9,0% (IC95% 8,5;9,4) para IA moderada/grave (IAMG). Familias en el tercil de ingresos más bajo tenían mayor IAL (RO=3,06 - IC95% 1,26;7,41) o IAMG (RO=6,35 - IC95% 1,89;21,4) en comparación con el mayor tercil. Hubo mayor prevalencia de IAL en varones (RO=2,34 - IC95% 1,49;3,68). Conclusión: La IA se asoció con menores ingresos y la IAL con el sexo masculino del niño. Las políticas públicas para aumentar los ingresos deben incluirse en las estrategias de reducción de la IA.

Objective: To analyze association between food insecurity (FI) and sociodemographic factors among children. Methods: The study was carried out from May to November 2017 with mothers of children (18 - 35 months old) enrolled at public education facilities in São José dos Pinhais, Paraná, Brazil. FI was determined by the Brazilian Household Food Insecurity Measurement Scale. Multinomial logistic regression was used with a hierarchical model. Results: 395 mothers/children participated. Overall FI prevalence was 34.7% (95%CI 28.5;41.5), with prevalence of 25.7% (95%CI 19.2;32.3) for mild FI (MFI) and 9.0% (95%CI 8.5;9.4) for moderate/severe FI (MSFI). Families in the lowest income tercile had higher likelihood of MFI (OR=3.06 - 95%CI 1.26;7.41) or MSFI (OR=6.35 - 95%CI 1.89;21.4) when compared to the highest tercile. Higher MFI prevalence was identified in male children (OR=2.34 - 95%CI 1.49;3.68). Conclusion: FI was associated with lower income and MFI with male children. Public policies to increase income must be included in FI reduction strategies.

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.

Auriculotherapy for sleep bruxism in children: a series of cases

Sleep bruxism is defined as a behavior that causes masticatory muscle activities during sleep. Sleep bruxism in childhood leads to consequences, which may vary from teeth wear in deciduous dentition to temporomandibular disfunction symptoms. There's no data that demonstrates improvement of children with sleep bruxism during and after auricular acupuncture treatment. Objective: Therefore, this case report series aimed to evaluate the effect of auriculotherapy on children presenting sleep bruxism. Methods: Twelve patients were included in this study, in the mean age of 6,9. The diagnosis was evaluated by the question: "Does your kid grind their teeth while sleeping?". Treatment was performed by an acupuncture specialist in a standardized way. The therapy was given for three weeks and the effect was evaluated through a sleep diary, in which the parents noted whether or not their child grinded teeth while sleeping before (baseline) and during therapy (T1 to T3). Sleep bruxism was categorized as presence or absence of nocturnal teeth grinding and the frequency varied from 0 to 7 (baseline), 0 to 5 (T1), 0 to 7 (T2) and 0 to 4 (T3) between patients. The intensity of the reported sleep bruxism was compared according to the periods by pared T-test ( =0.05). Results: It was observed that the frequency of reports decreased significantly from baseline to T3. Conclusion: These results suggest that ear acupuncture may be an alternative therapy for sleep bruxism in childhood, once it demonstrated to reduce its frequency in this study, although patients may present different effects to therapy due to biological variability.

Introdução: Bruxismo do sono é definido como um comportamento que causa atividades musculares durante o sono. Na infância, leva a consequências que podem variar de desgaste dentário na dentição decídua a sintomas de disfunção temporomandibular. Não há estudos que demonstrem melhora de casos de crianças com bruxismo do sono durante e após tratamento com auriculoterapia. Objetivo: portanto, esta série de casos visou avaliar o efeito da auriculoterapia em crianças apresentando este quadro. Métodos: Doze pacientes foram inclusos neste estudo, com a media de idade de 6,9. O diagnóstico foi avaliado pela pergunta "Seu filho range os dentes quando dorme?". O tratamento foi executado por um especialista em acupuntura de forma padronizada. A terapia foi feita por três semanas e o efeito foi avaliado através de um diário do sono, no qual os pais anotavam se a criança rangeu os dentes enquanto dormia antes (baseline) e durante a terapia (T1 a T3). Bruxismo do sono foi categorizado como presença ou ausência de ranger de dentes e a frequência variou de 0 a 7 (baseline), 0 a 5 (T1), 0 a 7 (T2) e 0 a 4 (T3) entre os pacientes. A intensidade foi comparada de acordo com os períodos pelo teste-T pareado (=0,05). Resultados: Foi observado que a frequência de relatos diminuiu significativamente de baseline a T3. Conclusão: Estes resultados sugerem que auriculoterapia pode ser uma terapia alternativa para o bruxismo do sono na infância, uma vez que demonstrou reduzir sua frequência neste estudo, embora os pacientes possam apresentar efeitos diferentes devido à variabilidade biológica.

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.

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.

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.

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.