Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis

Abstract The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children’s Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children’s dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers’ associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children’s ages, family income, parents’ schooling, mothers’ participation in their children’s school activities, dental caries, and presence of workers’ associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.

Trend of traumatic crown injuries and associated factors in preschool children

Abstract The aim of this study was to assess trends in traumatic crown injuries (TCIs), their prevalence, and association with socioeconomic and clinical factors in preschool children over a 5-year period. A series of cross-sectional surveys was conducted in Santa Maria, Brazil, on children attending a National Day of Children's Vaccination. The same protocol was used in all surveys conducted in 2008, 2010, and 2013. Clinical examinations were performed to evaluate types of traumatic crown injuries using the O'brien index. A semi-structured questionnaire was answered by the parents. It provided information about several socioeconomic factors as well as the parents' perception of their child's oral health. The chi-square for trends test was used to verify changes in TCI prevalence throughout the years. The association between socioeconomic and clinical factors with TCI was assessed by the Poisson regression analysis. A total of 1,640 children were examined. The prevalence of TCIs decreased significantly from 2008 to 2013 (10.12%; p < 0.001). Central incisors were the most vulnerable to injury, independent of the year. Moreover, older children and those with inadequate lip coverage were more likely to present with some traumatic dental injury (p < 0.001). prevalence of traumatic crown injuries decreased following the years, however TCI remain an important subject to consider when planning oral health policies.

Impact of malocclusion on oral health-related quality of life of preschool children / Impacto da maloclusão na qualidade de vida relacionada à saúde bucal em pré-escolares

OBJECTIVE: This study assessed the relationship of dental malocclusion with COHRQoL considering socioeconomic backgrounds and clinical factors. METHODS: A survey was carried out in Santa Maria, Brazil, during the National Children's Vaccination Day. The sample comprised 478 children aged 12 to 59 months. Fifteen trained and calibrated examiners evaluated the presence of anterior malocclusion traits (AMT) - anterior open bite, overjet and sealing lip. COHRQoL was measured through overall scores of the Brazilian version of ECOHIS (Early Childhood Oral Health Impact Scale). The assessment of association used adjusted Poisson regression models. RESULTS: The unadjusted assessment observed age, untreated dental caries and anterior open bite as the main covariates of the overall ECOHIS score. After the adjustment, the presence of anterior open bite had a negative impact on COHRQoL. There was no association between overjet and sealing lip with COHRQoL. CONCLUSION: In conclusion, anterior open bite present a negative impact on COHRQoL. .

OBJETIVOS: Este estudo avaliou o impacto da maloclusão dentária na qualidade de vida relacionada à saúde bucal, considerando fatores socioeconômicos e condições clínicas. METODOS: Um estudo foi realizado em Santa Maria, Brasi, durante a Campanha Nacional de Multivacinação Infantil. A amostra compreendeu 478 crianças na faixa etária de 12 a 59 meses. Quinze examinadores treinados e calibrados avaliaram a presença de maloclusão na região anterior - mordida aberta anterior, overjet e selamento labial. na qualidade de vida relacionada à saúde bucal foi mensurada por meio de escores totais da versão em português do questionário ECOHIS (Early Childhood Oral Health Impact Scale). Para verificar as possíveis variáveis associadas foram aplicados modelos de regressão de Poisson. RESULTADOS: O modelo não ajustado revelou associação da idade, cárie dentária não tratada e e mordida aberta anterior aos escores totais do ECOHIS. Após o ajuste, verificou-se que mordida aberta anterior teve um impacto negativo na qualidade de vida relacionada à saúde bucal. Não houve associação entre a presença de overjet e elamento labial à qualidade de vida relacionada à saúde bucal. CONCLUSÃO: Pode-se concluir que que mordida aberta anterior teve um impacto negativo na qualidade de vida relacionada à saúde bucal. .

Prevalence of dental caries in preschool children by icdas diagnostic methodology

To evaluate the prevalence of caries with the ICDAS index (International Caries Detection and Assessment System) using different cut-off points in children from public and private institutions as well as to associate the presence of caries with socioeconomic indicators, sex, age, type of school (urban or rural) and also family health program with dentist's presence at the school. Material and Methods:An analytical cross-sectional study with a stratified sample (n = 612) in children ranging from three to six years old, in public and private institutions of the city of Barras, State of Piaui, Brazil. The clinical examination was based on ICDAS criteria, and a questionnaire for socioeconomic and educational level data was also applied. Different cut-offpoints were used, as follows: cut-off point 1 (scores 0 and 1 considered as healthy and scores 2-6 classified as decayed); cut-off point 2 (scores from 0 to 2 classified as healthy, scores 3 to 6 as decayed) and cut-off point 3 (0 to 3 healthy, 4 to 6 decayed). Univariate and Multiple Poisson regression analysis were performed, with 5% significance level.Results:For cut-off point 1, the prevalence was 68.8%; Cut-off point 2, 67.9% and at the cut-off point 3, 60.6%. An association was found in the prevalence of caries with the child's age (p = 0.004), school zone (urban or rural) (p = 0.004) and the presence of the dentist at school (p = 0.001).Conclusion:Taking into account the various cut-off points, the prevalence of caries in preschool children was considered high. The presence of caries lesions is more likely to occur in five year-old boys living in the countryside...

Toothache, Associated Factors, and Its Impact on Oral Health-Related Quality of Life (OHRQoL) in Preschool Children

The aim of this study was to assess the prevalence of toothache, associated factors and impact of this condition on the Child Oral Health Related Quality of Life (COHRQoL) in preschoolers. The study was carried out in Santa Maria, Brazil, during the National Children's Vaccination Day, and 534 children aged 0 to 5 years were included. Clinical variables included dental caries and dental trauma. A questionnaire was responded by the parents and provided information about several socioeconomic indicators, dental service use and toothache. Toothache was collected by the question: "Has your child ever had a toothache - Yes or no?". Data on COHRQoL were assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Multivariable Logistic regression models were performed to assess the association between the predictor variables and outcomes. The prevalence of toothache was 10.11% (95% CI: 7.55% - 12.68%). Older children had a higher chance of presenting dental pain (OR 2.72; 95% CI: 1.01 - 7.56), as well as children with caries experience (OR 3.43; 95% CI: 1.81 - 6.52). Moreover, children who had not visited the dental service in the last 6 months were less likely to present toothache (OR 0.51; 95% CI: 0.28 - 0.95). The presence of dental pain negatively affects the COHRQoL; those with toothache presented a higher chance of having higher impact on the total scores of ECOHIS (OR 4.18; 95% CI: 1.76 - 9.95) than those without toothache. Similar observation was found for the child section of the questionnaire (OR 5.54; 95% CI: 2.15 - 14.24). Toothache negatively affects COHRQoL and is associated with caries experience, age and use of dental service.

O objetivo deste estudo foi avaliar a prevalência de dor dentaria, os fatores associados e seu impacto na qualidade de vida relacionada a saúde bucal de crianças pré-escolares. Esse estudo foi realizado em Santa Maria, Brasil, durante o dia nacional de vacinação infantil, e 534 crianças de 0 a 5 anos foram incluídas. As variáveis clinicas incluídas foram carie dental e traumatismo dentário. Um questionário foi respondido pelos pais, fornecendo informações sobre as condições socioeconômicas, uso de serviços odontológicos e dor dentaria. Dor de dente foi coletada através da pergunta: "Seu filho já teve dor de dente - Sim ou Não?". Os dados sobre qualidade de vida relacionada a saúde bucal foram obtidos através da versão brasileira do questionário "Early Childhood Oral Health Impact Scale" (ECOHIS). Modelos multivariáveis de regressão logística foram utilizados para avaliar a associação entre as variáveis preditoras e os desfechos. A prevalência de dor dentaria foi 10,11% (95% IC: 7,55% - 12,68%). Crianças mais velhas apresentaram uma maior chance de ter tido dor dentaria (OR 2,72; 95% IC: 1,01 - 7,56), assim como crianças com experiência de carie (OR 3,43; 95% IC: 1,81 - 6,52). Além disso, as crianças que não tinham visitado o dentista nos últimos 6 meses foram menos propensas a apresentar dor dentária (OR 0,51; 95% IC: 0,28 - 0,95). A presença de dor dentária afeta negativamente a qualidade de vida relacionada a saúde bucal das crianças; aquelas que tiveram dor de dente apresentaram uma maior chance de ter piores impactos nos escores totais do ECOHIS (OR 4,18; 95% IC: 1,76 - 9,95) quando comparadas àquelas que não tiveram dor dentária. O mesmo se pode observar para a seção do questionário correspondente aos impactos na criança (OR 5,54; 95% IC: 2,15 - 14,24. Dor dentaria afeta negativamente a qualidade de vida relacionada a saúde bucal e esta associada com experiência de carie, idade e uso de serviços odontológicos.

Expectativas de escolares de uma comunidade vulnerável: qualidade de vida e esperança sobre profissionais/governantes / Expectations of students of a vulnerable community: quality of life and hope in professional/rulers

Objetivou-se conhecer as expectativas/anseios de escolares sobre mudanças pessoais que possibilitariam melhorias na sua qualidade de vida e o que esperam dos profissionais da saúde e governantes. Estudo transversal, realizado com 435 escolares, de dez anos ou mais, matriculados do quinto ano do ensino fundamental até o último ano do ensino médio. Utilizou-se um questionário com questões fechadas e após a análise estatística descritiva. 45,3% dos pesquisados responderam que gostariam de estudar mais; 26,7%, de valorizar mais os pais. Praticamente metade dos sujeitos gostaria que os profissionais de saúde lhes dessem mais atenção e orientações. Destes, 19,7% consideravam importante o profissional de saúde na escola. 40% dos estudantes esperam honestidade dos governantes e 34,9%, que estes pensem mais no povo. Os escolares têm noção dos seus direitos de cidadania, expressam de forma consciente as expectativas/anseios em relação às mudanças pessoais e o que esperam de profissionais da saúde e governantes.

This study aimed to describe students’ expectations about personal changes that would bring improvements to their quality of life and also about their hope in health professionals and governments. Cross-sectional study, conducted with 435 students, ten years old or more, enrolled in the fifth year of elementary school to the last year of high school. We used a questionnaire with closed questions and after the descriptive statistical analysis. 45.3% of respondents said they would like to study more; 26.7% would like to give parents more value. Nearly half of the subjects would like health professionals to give them more attention and guidance. Among them, 19.7% considered important the presence of health professional in school. 40% of students expect honesty from rulers and 34.9% expect they think more in people. The students are aware of their rights of citizenship, they have conscience to express the expectations / aspirations regarding personal changes and what they expect from health professionals and government.

Este estudio tuvo como objetivo conocer expectativas/aspiraciones de estudiantes acerca de los cambios personales que permitan la mejora de su calidad de vida y lo que esperan de los profesionales de la salud y responsables políticos. Estudio transversal con 435 estudiantes, de diez años de edad o más, en el quinto año de la escuela primaria hasta el último año de la escuela secundaria. Se utilizó un cuestionario con preguntas cerradas y después del análisis estadístico descriptivo. El 45,3% de los encuestados dijo que les gustaría estudiar más; el 26,7% de dar más valor a los padres. A casi la mitad de los sujetos les gustaría que profesionales de la salud les dieran más atención y orientación. De éstos, el 19,7% considera que es importante tener en la escuela el profesional de la salud. El 40% de los estudiantes espera honestidad de los gobernantes y el 34,9% espera que pensaran más en las personas. Los estudiantes son conscientes de sus derechos de ciudadanía, expresan conscientemente expectativas/aspiraciones con respecto a los cambios personales y lo que esperan de los profesionales de la salud y responsables políticos.

Self-Perceived Oral Health Influences Tooth Brushing in Preschool Children

This study assessed the influence of socioeconomic and clinical factors, as well as parent's perception of child's oral health on the toothbrushing frequency of 0-5-year-old children. The study was carried out in Santa Maria, RS, Brazil, during the National Children's Vaccination Day, and 478 children aged 0 - 5 years were included. Data were collected by clinical examinations and a structured questionnaire, conducted by 15 calibrated examiners and 30 supports. A questionnaire was filled out by the parents with information about several socioeconomic indicators, perception of child's oral health and frequency of tooth brushing. The main outcome was collected by the question: "How many times a day do you brush your child's teeth?". Multivariable Poisson regression model taking into account the cluster sample was performed to assess the association between the predictors and outcome. Children whose parents related worse perception of child's oral health showed less tooth brushing frequency (PR 1.23; 1.06 - 1.43). Young children brush their teeth less than the older ones (PR 0.90; 0.84 - 0.96); and lack of visit to a dentist was predictor for less tooth brushing frequency (PR 1.29; 1.05 - 1.59). Parent's perception of child oral health influence children's healthy behaviors, supporting the evidence that psychosocial factors are strong predictors of children's oral health.

O estudo avaliou a influência de fatores socioeconômicos, clínicos e a percepção dos pais quanto à saúde de seus filhos na frequência de escovação de pré-escolares de 0 a 5 anos de Santa Maria-RS, Brasil. O estudo foi realizado em Santa Maria, Brasil, durante o Dia Nacional de Vacinação das Crianças e 478 crianças de 0 - 5 anos foram incluídas. Os dados foram coletados por meio de exames clínicos e por um questionário estruturado, realizados por 15 examinadores calibrados e 30 auxiliares. Os responsáveis forneceram informações sobre diversos indicadores socioeconômicos, auto-percepção de saúde bucal e frequência de escovação dentária. O principal desfecho foi coletado pela pergunta "Quantas vezes por dia você escova os dentes de seu filho?". Os dados foram analisados utilizando modelo de regressão de Poisson, considerando pesos relativos à amostragem complexa. Pais que relataram pior percepção de saúde bucal dos seus filhos em relação às outras crianças apresentavam uma menor frequência de escovação (RP 0,23; IC: 1,06 - 1,43). Crianças mais novas escovavam menos os dentes que as de idade mais elevada (RP 0,90; IC: 0,84 - 0,96) e a não-procura pelo dentista foi preditor para menor frequência de escovação (RP 1,29; IC: 1,05 - 1,59). A percepção dos pais influencia hábitos saudáveis da criança, suportando a evidência de que aspectos psicossociais são fortes preditores de saúde bucal na infância.

Desigualdades na prevalencia de carie dentaria nao tratada em criancas pre-escolares no Brasil / Desigualdades en la prevalencia de caries dentaria no tratada en ninos pre-escolares en Brasil / Inequalities in untreated dental caries prevalence in preschool children in Brazil

OBJETIVO: Avaliar a influência de desigualdades sociais de ordem individual e contextual na experiência de cárie dentária não tratada em crianças no Brasil. MÉTODOS: Os dados sobre a prevalência de cárie dentária foram obtidos do Projeto Pesquisa Nacional de Saúde Bucal – SBBrasil 2010, levantamento epidemiológico de saúde bucal com amostra representativa para o país e cada uma de suas macrorregiões geográficas. Crianças de cinco anos de idade (n = 7.217) em 177 municípios foram examinadas e seus responsáveis responderam ao questionário. Características contextuais referentes aos municípios em 2010 (renda mediana, fluoretação da água e proporção de domicílios com abastecimento de água) foram informadas pela Fundação Instituto Brasileiro de Geografia e Estatística. O estudo de associação utilizou modelos multinível de análise de regressão de Poisson. RESULTADOS: A prevalência de cárie não tratada foi de 48,2%; mais da metade da amostra apresentou ao menos um dente decíduo com experiência de cárie. O índice de cárie na dentição decídua ceo-d médio foi 2,41, sendo maior para as regiões Norte e Nordeste. Crianças de cor da pele preta e parda, e aquelas com renda familiar menos elevada tiveram maior prevalência de cárie não tratada. No nível contextual, renda mediana no município e adição de flúor na água de abastecimento associaram-se inversamente com a prevalência do desfecho. CONCLUSÕES: Desigualdades na prevalência de cárie não tratada persistem, afetando as crianças com dentição decídua no Brasil. O planejamento de medidas públicas para a promoção de saúde bucal deve ...

OBJETIVO: Evaluar la influencia de desigualdades sociales de orden individual y contextual en la experiencia de caries dentaria no tratada en niños en Brasil. MÉTODOS: Los datos sobre la prevalencia de caries dentaria fueron obtenidos del Proyecto Investigación Nacional de Salud Bucal – SBBrasil 2010, pesquisa epidemiológica de salud bucal con muestra representativa para el país y cada una de sus macro regiones geográficas. Niños de cinco años de edad (n= 7.217) en 177 municipios fueron examinados y sus responsables respondieron el cuestionario. Características contextuales referentes a los municipios en 2010 (renta mediana, fluororación del agua y proporción de domicilios con abastecimiento de agua) fueron informadas por la Fundación Instituto Brasileño de Geografía y Estadística. El estudio de asociación utilizó modelos multinivel de análisis de regresión de Poisson. RESULTADOS: La prevalencia de caries no tratada fue de 48,2%; más de la mitad de la muestra presentó al menos un diente deciduo con experiencia de caries. El índice de caries en la dentición decidua ceo-d promedio fue 2,41, siendo mayor para las regiones Norte y Noreste. Niños con color de piel negra y parda, y aquellas con renta familiar menos elevada tuvieron mayor prevalencia de caries no tratada. En el nivel contextual, renta mediana en el municipio y adición de flúor en el agua de abastecimiento se asociaron inversamente con la prevalencia del resultado. CONCLUSIONES: Desigualdades en la prevalencia de caries no tratada persisten, afectando a los niños con dentición decidua en Brasil. La planificación de medidas públicas para la promoción de salud bucal debe considerar el efecto de factores contextuales como determinante de riesgos individuales. .

OBJECTIVE: To evaluate the influence of social inequalities of individual and contextual nature on untreated dental caries in Brazilian children. METHODS: The data on the prevalence of dental caries were obtained from the Brazilian Oral Health Survey (SBBrasil 2010) Project, an epidemiological survey of oral health with a representative sample for the country and each of the geographical micro-regions. Children aged five (n = 7,217) in 177 municipalities were examined and their parents/guardians completed a questionnaire. Contextual characteristics referring to the municipalities in 2010 (mean income, fluorodized water and proportion of residences with water supply) were supplied by the Fundação Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Multilevel Poisson regression analysis models were used to assess associations. RESULTS: The prevalence of non-treated dental caries was 48.2%; more than half of the sample had at least one deciduous tooth affected by dental caries. The index of dental caries in deciduous teeth was 2.41, with higher figures in the North and Northeast. Black and brown children and those from lower income families had a higher prevalence of untreated dental caries. With regards context, the mean income in the municipality and the addition of fluoride to the water supply were inversely associated with the prevalence of the outcome. CONCLUSIONS: Inequalities in the prevalence of untreated dental caries remain, affecting deciduous teeth of children in Brazil. Planning public policies to promote oral health should consider the effect of contextual factors as a determinant of individual risk. .

Impacto dos problemas bucais na qualidade de vida em pré-escolares / Impact of Oral Problems on the Quality of Life of Preschool Children

Objetivo: Avaliar o impacto das condições clínicas bucais e fatores socioeconômicos na qualidade de vida relacionada à saúde bucal (QVRSB) de pré-escolares. Metodologia: A amostra consistiu de todas as crianças de seis a 72 meses de idade e pais residentes em Venda Branca, Casa Branca/SP. Foram aplicados dois questionários sobre QVREB (ECOHIS) e condições socioeconômicas. Um examinador calibrado avaliou a presença da doença cárie, maloclusões e lesões traumáticas. Utilizou-se análise de regressão de Poisson. Resultados: As prevalências observadas para o trauma dentário, mordida aberta anterior, selamento labial inadequado e doença cárie foram respectivamente 1,63%; 27,97%; 4,92% e 54,10%. A análise univariada mostrou associação entre a criança ter casa própria e melhor qualidade de vida. A mordida aberta anterior e a doença cárie foram associadas à pior qualidade de vida. A análise múltipla confirmou a análise univariada, na qual as variáveis casa própria, mordida aberta anterior e doença cárie foram associadas à melhoria da qualidade de vida relacionada à saúde bucal nas crianças. Conclusão: Fatores socioeconômicos e clínicos causam impacto negativo na qualidade de vida dos pré-escolares.

Objective: To evaluate the impact of oral clinical conditions and socioeconomic factors on the quality of life related to oral health (QLROH) of preschool children.Method: The sample included all children aged 6 to 72 months and their parents living in Venda Branca, in the city of Casa Branca, SP, Brazil. Two questionnaires on QLROH (ECOHIS) and socioeconomicconditions were applied. A calibrated examiner evaluated the presence of caries disease, malocclusions and traumatic injuries. Poisson?s regression analysis was used.Results: Prevalence of dental trauma, open anterior bite, inadequate lip seal and caries disease was respectively 1.63%, 27.97%, 4.92% and 54.10%. Univariate analysis showed association between living in an own house and having better quality of life. Open anterior bite and caries disease were associated with worse quality of life. Multiple analyses corroborated the univariate analysis, as the variables ownhouse, open anterior bite and caries disease were associated withimproved QLROH in the children.Conclusion: Socioeconomic and clinical factors were shown to have a negative impact on the preschool children?s quality of life.

Socioeconomic and clinical factors associated with traumatic dental injuries in Brazilian preschool children

The aim of this paper was to assess the epidemiology of traumatic dental injury (TDI) in preschool children and its relation to socioeconomic and clinical factors. This study was carried out in Santa Maria, Brazil, during National Children's Vaccination Day, and 441 children aged 12 to 59 months were included. Data about socioeconomic status were collected through a semi-structured questionnaire administered to parents. Calibrated examiners evaluated the prevalence of TDI, overjet, and lip coverage. Data were analyzed with a Poisson regression model (PR; 95% confidence intervals). The TDI prevalence was 31.7%. The maxillary central incisors were the most frequently traumatized teeth. The most common TDI was enamel fracture. No association was found between TDI prevalence and the socioeconomic status of children. After adjustments were performed, the eldest children with an overjet > 3 mm were more likely to have TDI than their counterparts. The data indicated a high prevalence of TDI. Only overjet was a strong predictor for TDI, whereas socioeconomic factors were not associated with TDI in this age group.

Impacto da cárie e da fluorose dentária na qualidade de vida de crianças e adolescentes / Impact of dental caries and fluorosis on child oral healthrelated quality of life (OHRQoL)

O uso de instrumentos que relacionam saúde bucal com a qualidade de vida tem aumentadonas pesquisas odontológicas com crianças e adolescentes nas últimas décadas. Entretanto, amaioria dos estudos já publicados considera o impacto da doença cárie na qualidade de vidarelacionada à saúde bucal (OHRQoL). Poucos estudos relatam o impacto da fluorose dental naqualidade de vida de crianças e adolescentes. Portanto, o objetivo dessa revisão de literatura édescrever a associação da cárie e da fluorose dentária com a qualidade de vida de crianças eadolescentes. A literatura é clara ao relatar o efeito causado pelas lesões de cárie, principalmenteem estágios cavitados, na qualidade de vida dos indivíduos. Em relação à fluorose dentária, osestudos reportam que nos graus leves de severidade - maioria dos casos- essa condição parecenão afetar a qualidade de vida e auto-percepção dos indivíduos afetados.

Over the last decades, assessing the self-report of oral health-related quality of life (OHRQoL)in children and adolescents hás increased. However, most studies evaluate the impactof dental caries on oral health-related quality of life. Few studies have reported the impactof dental fluorosis in the quality of life of children and adolescents. Therefore, the aim of thisreview was to describe the association between caries and dental fluorosis with the OHRQoL inchildren and adolescents. The literature is clear in reporting the effect caused by caries, particularlyin cavitated stages, on individuals's quality of life. Regarding dental fluorosis, the resultsof studies showed that its impact on quality of life can be seen only when this is presented insevere stages.

Avaliação da atividade de lesões de cárie em levantamentos epidemiológicos com crianças pré-escolares / Dental caries activity assessment in oral health epidemiological survey with preschool children

O objetivo do presente estudo foi avaliar a magnitude da redução nos parâmetros de cárie após a inclusão da avaliação da atividade e investigar a associação dos fatores socioeconômicos e biológicos com o status de atividade das lesões de cárie em pré-escolares brasileiros. A pesquisa foi realizada em Santa Maria, Brasil, durante a Campanha Nacional de Multivacinação Infantil, e 639 crianças com idade entre 12 meses e 59 meses foram incluídas. Quinze examinadores avaliaram as crianças utilizando o International Caries Detection and Assessment System (ICDAS) e um critério adicional para avaliação da atividade das lesões. Um questionário estruturado foi aplicado aos responsáveis da criança para coletar informações relacionadas às características demográficas, socioeconômicas e biológicas. A média de dentes e superfícies cariadas e a prevalência de cárie foram calculadas inicialmente nos diferentes pontos de corte do ICDAS. A avaliação da atividade foi realizada, e as lesões inativas foram consideradas como hígidas na segunda análise. Posteriormente, os mesmos parâmetros de cárie, nos mesmos pontos de corte do ICDAS, foram recalculados. A redução nos parâmetros de cárie após a inclusão da atividade e o número de crianças que precisavam ser avaliadas com a finalidade de mudar sua classificação de cariada para hígida foram também calculados. Além disso, análise de regressão de Poisson foi realizada para avaliar a associação entre as variáveis independentes e 7 desfechos que incluíam o número de lesões de cárie não-cavitadas (ativas, inativas e total), o número de lesões de cárie cavitadas (ativas, inativas e total) e todas as lesões. A maioria das lesões foi classificada como ativa, principalmente nos limiares de cavidade. Quando a atividade foi considerada, os valores dos parâmetros de cárie diminuíram. Esse decréscimo foi mais evidente nos limiares de lesões de cárie não-cavitadas. O número de crianças que precisavam ser avaliadas para mudar sua classificação de cariada para hígida foi menor que 20 quando todas as lesões foram consideradas; entretanto, esse valor aumentou para aproximadamente 100 quando somente as lesões cavitadas foram consideradas. As variáveis independentes estudadas foram associadas similarmente com os diferentes desfechos independente do status de atividade das lesões. Idade da criança e presença de placa bacteriana foram associadas significativamente com os desfechos relacionados às lesões de cárie não-cavitadas. Algumas variáveis socioeconômicas foram significativamente associadas com o número de lesões de cárie cavitadas, independente do status de atividade das lesões. Portanto, pode-se concluir que inclusão da avaliação da atividade em pesquisas epidemiológicas relacionadas à cárie dentária tem pouco impacto sobre os parâmetros de cárie considerando ambas as lesões de cárie cavitadas e não-cavitadas, e a avaliação da atividade da doença não é vantajosa para identificar os fatores de risco no contexto de saúde pública.

This study aimed to evaluate the magnitude of the reduction in caries parameters after inclusion of dental caries activity assessment and to investigate the strength of association of socioeconomic and biological factors with dental caries lesions activity status in Brazilian preschool children. The survey was carried out in Santa Maria, Brazil, during the National Childrens Vaccination Day, and 639 children aged from 12 months to 59 months were included. Fifteen examiners assessed the children based on the International Caries Detection and Assessment System (ICDAS) and an additional lesion activity assessment criterion. A structured questionnaire was answered by each childs guardian to collect information about demographic, socioeconomic and biological characteristics.The mean of decayed surfaces (d-s), the mean of decayed teeth (d-t), caries prevalence, and 95% confidence intervals were calculated, initially by classifying all lesions using the various thresholds defined by the ICDAS. Caries activity status was then evaluated, and inactive lesions were classified as sound in the second analysis; subsequently, the same caries parameters, at the same thresholds, were recalculated. The reduction in caries parameters and the number of children needed to be assessed in order to change their classification from decayed to sound were also calculated. Furthermore, multivariate Poisson regression analyses using a hierarchical approach was performed to evaluate the association between several independent variables and seven outcomes including number of non-cavitated caries lesions (active, inactive and total), number of cavitated caries lesions (active, inactive and total) and all lesions. The majority of lesions were classified as active, mainly at cavitated thresholds. When activity was considered, values of all caries parameters decreased. This decrease was more evident at non-cavitated thresholds. The number of children requiring assessment in order to change their classification from decayed to sound was less than 20 considering all lesions, but this value increased to approximately 100 when we included only cavitated lesions. The explanatory variables studied were similarly associated with the different outcomes, independently of the caries lesions activity status. Childs age and presence of bacterial plaque were statistically significant associated with non-cavitated caries lesions outcomes. Some socioeconomic variables were statistically significant associated with number of cavitated caries lesions, independently of their activity status. In conclusion, the inclusion of activity assessment in caries epidemiological surveys has little impact on dental caries parameters considering both non-cavitated and cavitated lesions and caries activity assessment is not advantageous to identify risk groups in a public health context.

Influence of self-perceived oral health and socioeconomic predictors on the utilization of dental care services by schoolchildren

The influence of socioeconomic factors and self-rated oral health on children's dental health assistance was assessed. This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. A dental examination provided information on the prevalence of dental caries (DMFT index). Data about the use of dental service, socioeconomic status, and self-perceived oral health were collected by means of structured interviews. These associations were assessed using Poisson regression models (prevalence ratio; 95 percent confidence interval). The prevalence of regular use of dental service was 47.8 percent. Children from low socioeconomic backgrounds and those who rated their oral health as "poor" used the service less frequently. The distribution of the kind of oral healthcare assistance used (public/private) varied across socioeconomic groups. The better-off children were less likely to have used the public service. Clinical, socioeconomic, and psychosocial factors were strong predictors for the utilization of dental care services by schoolchildren.

Inequalities in the distribution of dental caries among 12-year-old Brazilian schoolchildren

We assessed the inequality in the distribution of dental caries and the association between indicators of socioeconomic status and caries experience in a representative sample of schoolchildren. This study followed a cross-sectional design, with a sample of 792 schoolchildren aged 12 years, representative of this age group in Santa Maria, RS, Brazil. Guardians answered questions on socioeconomic status and a dental examination provided information on the dental caries experience (DMF-T). Inequality in dental caries distribution was measured by the Gini coefficient and the Significant Caries Index (SiC). The assessment of association used Poisson regression models. Socioeconomic factors were associated with prevalence of dental caries for the whole sample and also for individuals with a high-caries level. Children from low-income households had the highest prevalence of dental caries. The Gini coefficient was 0.7 and the SiC Index 2.5. The percentage of caries prevalence was 39.3 percent (95 percent CI: 35.8 percent-42.8 percent) and the mean for DMF-T was 0.9 (± SD 1.5). Inequalities in the distribution of dental caries were observed and socioeconomic factors were found to be strong predictors of the prevalence of oral disease in children of this age group.

Oral health-related quality of life in children: conceptual issues / Avaliação da qualidade de vida relacionada à saúde bucal em crianças: aspectos conceituais

Oral health-related quality of life (OHRQoL) instruments have being widely used in oral health studies. However, most OHRQoL measures are designed to assess the adult population, mainly due to the difficulties for developing such measures for children and their validation. The aim of this review was to describe the impact of oral health on children's quality of life and its importance for this specific age group. The use of indicators of OHRQoL in children is necessary since they are based on self-perception and oral health impact, which is essential for planning of actions for health promotion considering biological and psychosocial aspects. It is also suggested the need of studies using quali-quantitative methods as an alternative approach to the use of OHRQoL instruments in children.

O uso de instrumentos que relacionam saúde bucal com a qualidade de vida tem sido freqüente em pesquisas odontológicas. Porém, a maioria desses estudos refere-se à população adulta, principalmente devido às dificuldades de desenvolvimento e validação dessas medidas para a população infantil. O objetivo deste trabalho é descrever, através de uma revisão na literatura, o impacto das doenças bucais na qualidade de vida de crianças e a importância dos métodos de mensuração para as mesmas. Observou-se que a utilização de indicadores que associam saúde bucal e qualidade de vida em crianças é fundamental, uma vez que são baseados na auto-percepção e no impacto odontológico e possibilitam condições para o planejamento de ações para promoção de saúde considerando aspectos biológicos e psicossociais. Também pôde-se perceber a necessidade de mais estudos de desenho quanti-qualitativo como uma alternativa complementar à utilização destes indicadores na população infantil.