Dental fluorosis treatment can improve the individuals' ohrqol? results from a randomized clinical trial

Abstract This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito na qualidade de vida relacionada à saúde bucal (QVRSB) de dois protocolos de tratamento para fluorose dentária, em indivíduos incluídos em um ensaio clínico randomizado. Setenta voluntários, os quais viviam em uma área de fluorose endêmica no Brasil, e que possuíam pelo menos quatro dentes ântero-superiores com índice de Thylstrup e Fejerskov de 1 a 7, foram randomizados em dois grupos de tratamento (n= 35): GI- microabrasão de esmalte; ou GII- microabrasão associada com clareamento caseiro. A microabrasão foi realizada com ácido fosfórico 37% e pedra pomes e, o clareamento caseiro com peróxido de carbamida 10% e uso de moldeira. Os voluntários responderam um questionário antes e 1 mês após o tratamento, visando avaliar mudanças na QVRSB através do instrumento Oral Impact on Daily Performance (OIDP). Diferenças nos escores de impacto geral entre e nos mesmos grupos de tratamento foram analisadas através dos testes Wilcoxon (mesmo grupo) e Mann-Whitney (entre grupos), respectivamente. Alterações no escores dos domínios foram analisadas usando o teste Wilcoxon (a<0.05). Um mês após o tratamento, os indivíduos relataram melhora na QVRSB. Ambos os grupos apresentaram menores escores do OIDP (p<0,001), sem diferença entre eles. Os escores dos domínios comer, limpar os dentes, sorrir e estado emocioal diminuíram após o tratamento para toda a amostra. Concluiu-se que o tratamento com microabrasão melhorou a QVRSB de indivíduos vivendo em uma área de fluorose endêmica independentemente da associação com o clareamento caseiro.

Dental fluorosis and its influence on children’s life

This study verified the prevalence of dental fluorosis in 12-year-old children and its association with different fluoride levels in the public water supply, and evaluated the level of perception of dental fluorosis by the studied children. To assess fluorosis prevalence, clinical examinations were performed and a structured instrument was used to evaluate the self-perception of fluorosis. The water supply source in the children’s area of residence since birth was used as the study criterion. In total, 496 children were included in the study. Fluorosis was diagnosed in 292 (58.9%) children; from these, 220 (44.4%) children were diagnosed with very mild fluorosis, 59 (11.9%) with mild fluorosis, 12 (2.4%) with moderate fluorosis, and 1 (0.2%) child with severe fluorosis. A significant association (p = 0.0004) was observed between the presence of fluorosis and areas with excessive fluoride in the water supply. Among the 292 children that showed fluorosis, 40% perceived the presence of spots in their teeth. The prevalence of fluorosis was slightly high, and the mildest levels were the most frequently observed. Although most of the children showed fluorosis to various degrees, the majority did not perceive these spots, suggesting that this alteration did not affect their quality of life.

Percepção da fluorose dentária e avaliação da concordância entre pais e filhos: validação de um instrumento / Perceptions of dental fluorosis and evaluation of agreement between parents and children: validation of a questionnaire

Objetivou-se validar o Child's and Parent's Questionnaire about Teeth Appearance, avaliando as preocupações relacionadas à fluorose em 213 pares de pais/crianças (12 anos) de duas regiões brasileiras. A confiabilidade foi avaliada pelo alfa de Cronbach e pelo coeficiente de correlação intraclasse; e a validade de constructo e de critério, pela correlação de Spearman. Para comparar as duas regiões e avaliar a concordância pais/filhos, foi utilizado o teste t de Student. A consistência interna foi aceitável, e a confiabilidade teste-reteste, moderada a excelente. Houve correlação significativa entre percepção da fluorose moderada e severa e os dados clínicos e entre percepção da fluorose e preocupações dos indivíduos. Embora os pais de Rafael Arruda, Ceará, Brasil, tenham tido maior percepção da fluorose, o incômodo e a preocupação com a aparência foram maiores em Piracicaba, São Paulo. Os pais se mostraram mais incomodados, preocupados e insatisfeitos com a aparência dentária das crianças do que elas mesmas. Essa versão é válida e confiável para avaliar a percepção da estética dentária em crianças e em seus pais.

This study aimed to validate the Child's and Parent's Questionnaire about Teeth Appearance and to evaluate concerns relative to fluorosis among 213 pairs of parents and 12-year-old children from two regions of Brazil. Reliability was assessed by Cronbach's alpha and intraclass correlation coefficient, and construct and criterion validity by Spearman's correlations. Student t-test was used to compare the two regions and to assess parent/child agreement. Internal consistency was acceptable, and test-retest reliability was moderate to excellent. Perception of moderate to severe fluorosis and clinical data were significantly correlated, as were perception of fluorosis and subjects' concerns. Although parents from Rafael Arruda, Ceará State, showed a higher perception of fluorosis, parental concern was greater in Piracicaba, São Paulo State. Parents were more worried and dissatisfied with their children's dental appearance than the children themselves. This version of the questionnaire proved to be valid and reliable for assessing children's and parents' perceptions of dental fluorosis.

An investigation of social judgments made by young adults toward appearance of dental fluorosis.

Background : Smile is a crucial factor in creating a good first impression. However conditions like dental fluorosis hamper the esthetics of teeth. This study was conducted to find out whether young adults attribute socially relevant characteristics to people with dental fluorosis. Materials and Methods : A total of 150 young adults were presented with images of individuals with different severity levels of dental fluorosis along with images of normal tooth appearance on a computer screen. They had to attribute various socially relevant characteristics to these images. Images were digitally manipulated to simulate dental fluorosis. Images were displayed on a computer screen and Visual Basic Software was used to record the participants' responses as well as the time taken to respond. The time taken to respond or response latency indicates the response strength. Statistical analysis : A chi-square test was used to test the association between the dental appearances and the socially relevant characteristics. A Mann--Whitney test was used to compare the time taken to respond. Results : As the severity of fluorosis increases, participants attribute less and less of positive characteristics. Attribution of negative characteristics also increases with the severity of dental fluorosis. For images with moderate and severe fluorosis, respondents took more time to accept positive characteristics and less time to reject positive characteristic. This means that the participants felt strongly when rejecting positive characteristics in these images. Conclusion : Social judgments are made by young adults when viewing digitally manipulated images of different levels of fluorosis.

Evaluation of the Family Impact Scale for use in Brazil

OBJECTIVES: The objectives of this study were to assess the validity and reliability of the Family Impact Scale (FIS) applied in Brazilian parents after translations and cultural adaptations to Brazilian Portuguese language and to evaluate the nature and extent to which the family functioning is compromised by the child oral conditions. MATERIAL AND METHODS: Parents were recruited from general populations for pre-testing (n=20), validity (n=210) and test-retest reliability (n=20) studies. The children were examined for dental caries, gingivitis, fluorosis and malocclusion. RESULTS: The FIS discriminated among the categories of malocclusion and showed good construct validity. The Cronbach's alpha and intraclass correlation coefficients were 0.87 and 0.90, respectively. Almost 20 percent of the informants reported some family impact `sometimes' or `often/everyday' from the child's oral condition. Impact on FIS domains of this frequency ranged from 13.8 percent for financial difficulties to 24.4 percent for parental or family activities. CONCLUSIONS: The Brazilian Portuguese version of FIS is valid and reliable. The results suggest that child oral conditions have a negative impact on the family. Further research is required, as these findings were based on cross-sectional study and convenience samples.

Fluorose: tratamento em saúde pública / Fluorose: public health treatment

A fluorose dentária acomete qualquer grupo da população, desde que os fatores predisponentes ao seu aparecimento estejam presentes. As manchas nas superfícies dentárias provocam constrangimentos aos jovens pacientes portadores desta condição, podendo ocorrer transtornos psicossociais que devem e podem ser evitados. As ações em Saúde Pública necessitam ser simples e eficazes. Através de uma revisão da literatura, procuramos encontrar a técnica de tratamento da Fluorose que atenda a estes requisitos