System dynamics modeling for tooth decay treatment in Brazilian children

Abstract Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children's decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.

Lack of association between dietary inflammatory index and low impact fractures in the Brazilian population: the Brazilian Osteoporosis Study (BRAZOS)

Abstract Introduction: Adequate nutrition, including intake of dietary calcium and vitamin D, is important to maintain bone health. Evidence suggests that a deficiency in micronutrients may contribute to bone loss during aging and exert generalized effects on chronic inflammation. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of individual diets. Our aim was to evaluate the DII in a representative sample and verify its association with low-impact fractures. Methods: Individuals from The Brazilian Osteoporosis Study (BRAZOS) database had their DII calculated. BRAZOS is an important cross-sectional epidemiological study carried out with a representative sample of men and women ≥40 years old. The research was conducted through in-home interviews administered by a trained team. Nutrition Database System for Research (NDSR) software was used to analyze data on the intake of nutrients, which were employed to calculate the DII using Statistical Analysis Software (SAS®) and Statistical Package for the Social Sciences (SPSS®) to assess its association with low-impact fractures. Results: A total of 2269 subjects had their DII score calculated using information from 24-h recall data. Males had lower DII than females (DII = 1.12 ± 1.04 vs DII = 1.24 ± 0.99, p = 0.012). Women taking statins had lower DII (DII = 0.65 ±1.14 vs DII + 1.26 ± 0.98, p = 0.002), indicating a greater potential for diet-related anti-inflammatory effects. Conclusion: Our findings suggest that women might have a pro-inflammatory diet pattern compared to men. However, we did not find any association between DII scores and low-impact fractures.

O potencial impacto financeiro dos problemas bucais na família de pré-escolares / The potential financial impact of oral health problems in the families of preschool children

Resumo O objetivo do estudo foi avaliar a percepção dos pais/responsáveis quanto ao impacto financeiro dos problemas de saúde bucal na família de pré-escolares. Um estudo transversal, foi realizado com 834 crianças pré-escolares, em Campina Grande, Brasil. Pais/responsáveis responderam ao Early Childhood Oral Health Impact Scale (B-ECOHIS). O item “impacto financeiro” foi a variável dependente. Questionários de variáveis sociodemográficas, histórico de dor de dente e percepções de saúde foram administrados. Os exames clínicos foram realizados por três dentistas previamente calibrados (Kappa: 0.85-0.90). Estatística descritiva foi realizada, seguida de regressão logística para amostras complexas (α = 5%). A frequência de impacto financeiro devido a problemas de saúde bucal em pré-escolares foi de 7,7%. As seguintes variáveis foram significativamente associadas com o impacto financeiro: percepção ruim dos pais sobre saúde bucal, a interação entre histórico de dor de dente e ausência de cárie dentária e interação entre histórico de dor de dente e presença de cárie dentária. Pode-se concluir que na maioria das vezes os pais/responsáveis relatam impacto financeiro em decorrência da procura por tratamento tardio, principalmente pela presença de dor e complicações no quadro clínico.

Abstract The aim of the study was to evaluate the perception of parents/caregivers regarding the financial impact of oral health problems on the families of preschool children. A preschool-based, cross-sectional study was conducted with 834 preschool children in Campina Grande, Brazil. Parents/caregivers answered the Early Childhood Oral Health Impact Scale. “Financial impact” was the dependent variable. Questionnaires addressing socio-demographic variables, history of toothache and health perceptions were administered. Clinical exams were performed by three dentists previously calibrated (Kappa: 0.85-0.90). Descriptive statistics were performed, followed by logistic regression for complex samples (α = 5%). The frequency of financial impact due to oral health problems in preschool children was 7.7%. The following variables were significantly associated with financial impact: parental perception of child’s oral health as poor, the interaction between history of toothache and absence of dental caries and the interaction between history of toothache and presence of dental caries. It is concluded that often parents/caregivers reported experiencing a financial impact due to seeking treatment late, mainly by the presence of toothache and complications of the clinical condition.

Impacto económico en las familias de niños que presentan caries de infancia temprana atendidos en el Servicio de Atención del Infante de Instituto Nacional del Niño, Lima-Perú 2009 / Economic impact on families of children's early childhood caries attended at National Institute Child Heath, Lima-Peru 2009

Objetivo: determinar el impacto que genera la caries de infancia temprana sobre la economía en las famílias de niños que sufren caries de infancia temprana. Material y métodos: se empleó una muestra probabilística de 629 niños entre 0 a 36 meses de edad, todos ellos pertenecientes al Instituto Nacional de Salud de Salud del Niño en Lima- Perú. Resultados: se determinó que el impacto es alto, siendo 7 veces más costosa la terapia curativa que la terapia preventiva. El gasto económico de las famílias en prevención por un año es de S/. 39.21 y en tratamientos curativos es de es de S/. 282.10. Pero estos costos son subvencionados por el hospital, el costo real ser¡a de S/. 310.36 y de S/. 1269.08, respectivamente. Las famílias con vulnerabilidad económica se ven beneficiados por el subsídio otorgado por el Estado. El nível de adherencia de la fase de mantenimiento es bajo con un 26%. Los costos indirectos que afectan a estas famílias por ausencia laboral representa en promedio 9 días de semana al trabajo, representando S/. 259.60, si a esto se calcula en base al total de niños afectados en el Perú corresponde a S/. 306 141.217 millones de soles. Conclusiones: las medidas preventivas son altamente más económicas. Los tratamientos curativos son 7 veces más costosos que la terapia preventiva. Las caries de infancia temprana constituyen un importante problema de salud pública que ocasiona gastos directos e indirectos por ausentismo laboral, que afecta el desarrollo de la economía.

Objective: to determine the impact that early childhood caries generates on the economy on families of children suffering early childhood caries. Material and methods: we used a nonrandom sample of 629 children between 0-36 months of age; all of them are from the National Institute of Child Health in Lima. Peru. Results: we found that the impact is high, being 7 times more expensive the curative therapy than the preventive therapy. The economic spending of families in prevention for one year is S/. 39.21 And curative treatments is S/. 310.36 And S/. 1269.08, respectively. Families with economic vulnerability are benefiting for the subsidy provided by the state. The level of adherence to the maintenance phase is low at 26%. Indirect costs that effect these families for absenteeism represents an average of 9 days work per week, representing S/. 259.60, if this is calculated based on the total number of children affected in Peru corresponds to S/. 306,141.217 million soles. Conclusion: preventive measures are highly cheaper. The cures treatments are 7 times more expensive than preventive therapy. Early childhood caries area significant public health problem that causes direct and indirect cost from work absenteeism, affecting the development of regional and national economy.

Custo-efetividade da escovação dental supervisionada convencional e modificada na prevenção da cárie em molares permanentes de crianças de 5 anos de idade / Cost-effectiveness of conventional and modified supervised toothbrushing in preventing caries in permanent molars among 5-year-old children

O custo-efetividade de um programa modificado de escovação dental supervisionada foi comparado ao programa convencional. Participaram 284 crianças de 5 anos com, pelo menos, um molar permanente com a superfície oclusal irrompida/hígida. Nas unidades de controle, o programa convencional composto de atividade educativa com distribuição de escova e creme dental fluorado foi desenvolvido quatro vezes por ano. Nas unidades de teste, as crianças receberam também escovação profissional nas superfícies oclusais desses dentes, realizada por auxiliar de saúde bucal, empregando-se a técnica de escovação vestíbulo-lingual cinco vezes por ano. Cárie de esmalte/dentina foi registrada nas superfícies vestibular, oclusal e lingual dos molares permanentes durante 18 meses. A razão da densidade de incidência (RDI) foi estimada usando o modelo de regressão de Poisson, sendo 50 por cento menor entre os meninos no grupo de teste (p = 0,016). O programa modificado custou R$ 3,04 por criança. A razão de custo-efetividade marginal foi de R$ 10,71 por lesão evitada entre os meninos. O programa modificado foi custo-efetivo nos meninos.

The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of18 months. The incidence density (ID) ratio was estimated using Poisson's regression model. The ID was 50 percent lower among boys in the test group (p = 0.016). The cost of the modified program was US$ 1.79 per capita. The marginal cost-effectiveness ratio among boys was US$ 6.30 per avoided carie. The modified supervised toothbrushing program was shown to be cost-effective in the case of boys.

Assessment of dental treatment required and analysis of cost in the management of dental caries among semiurban primary school children of Kerala.

The study was carried out with the purpose of assessing the dental treatment requirement and analysis of cost in the management of dental caries among primary school children of Kerala. The sample consisted of 750 primary school children and their parents. 68.5% children were affected with dental caries. Decayed teeth accounted for the largest component. One surface restorations were the most frequent type of treatment required followed by extractions, pit and fissure sealants and pulp therapy. The treatment cost increased in direct proportion to the number of teeth involved. The average cost incurred for various dental treatment varied from Rs. 50 (consultation) to Rs. 300 (for filling and extraction) depending on the nature of treatment. Only 1/3rd of children requiring immediate dental treatment had approached for any form of dental consultation. The study also revealed that all the children who had approached the dentist for consultation and treatment had only done for temporary relief in relation to emergency management.