Sampling strategy of an epidemiological survey using a satellite image program

ABSTRACT OBJECTIVE To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process. METHODS A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O'Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed. RESULTS Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy. CONCLUSIONS The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.

Dental flossing as a diagnostic method for proximal gingivitis: a validation study

ABSTRACT This study evaluated the clinical diagnosis of proximal gingivitis by comparing two methods: dental flossing and the gingival bleeding index (GBI). One hundred subjects (aged at least 18 years, with 15% of positive proximal sites for GBI, without proximal attachment loss) were randomized into five evaluation protocols. Each protocol consisted of two assessments with a 10-minute interval between them: first GBI/second floss, first floss/second GBI, first GBI/second GBI, first tooth floss/second floss, and first gum floss-second floss. The dental floss was slid against the tooth surface (TF) and the gingival tissue (GF). The evaluated proximal sites should present teeth with established point of contact and probing depth ≤ 3mm. One trained and calibrated examiner performed all the assessments. The mean percentages of agreement and disagreement were calculated for the sites with gingival bleeding in both evaluation methods (GBI and flossing). The primary outcome was the percentage of disagreement between the assessments in the different protocols. The data were analyzed by one-way ANOVA, McNemar, chi-square and Tukey's post hoc tests, with a 5% significance level. When gingivitis was absent in the first assessment (negative GBI), bleeding was detected in the second assessment by TF and GF in 41.7% (p < 0.001) and 50.7% (p < 0.001) of the sites, respectively. In the absence of gingivitis in the second assessment (negative GBI), TF and GF detected bleeding in the first assessment in 38.9% (p = 0.004) and 58.3% (p < 0.001) of the sites, respectively. TF and GF appears to be a better diagnostic indicator of proximal gingivitis than GBI.

Diagnóstico do processo saúde-doença gengival em dentes e implantes - uma revisão de índices epidemiológicos / Diagnosis of health- disease gingival process in teeth and implants – a review of epidemiological indexes

A gengivite e a mucosite são patologias causadas pelo acúmulo de biofilme supragengival. Considerando o fato de a gengivite/mucosite sempre preceder a periodontite/peri-implantite, o diagnóstico da inflamação marginal permite monitoramento da qualidade do controle de placa caseiro. O objetivo desta revisão de literatura é apresentar, comparar e discutir detalhadamente os principais índices de diagnóstico da gengivite e mucosite. Alguns índices gengivais para dentes e implantes avaliam os aspectos visuais junto da presença de sangramento marginal após estímulo mecânico. Já outros avaliam apenas aspectos visuais. Ainda, há os que utilizam somente o componente de sangramento de acordo com sua extensão, seu tempo de sangramento ou apenas a presença ou ausência do mesmo. Conclui-se que o diagnóstico clínico da gengivite pode ser realizado por diferentes métodos. No ambiente clínico, alterações de sangramento avaliadas dicotomicamente parecem ser melhores pela simplicidade, velocidade e pouca subjetividade. Além disso, a ausência de sangramento gengival à sondagem é desejável, indicando um baixo risco de futura perda de inserção clínica. No plano de pesquisa, a incorporação de critérios visuais associado à presença de sangramento parece diferenciar com maior clareza pequenas alterações gengivais, aumentando a sensibilidade do método. Embora os diversos índices gengivais para dentes/implantes apresentem semelhanças e diferenças, nenhum tem aplicação ou aceitação universal, sendo a eleição do mesmo dependente do objetivo que se deseja avaliar.

Gingivitis and mucositis are diseases caused by the accumulation of supragingival biofilm. Considering the fact gingivitis/mucositis always precede periodontitis/peri-implantitis, the diagnosis of marginal inflammation helps with the monitoring of the home plaque control quality. The goal of this review is to present, compare and discuss in details the major indexes for diagnosis of gingivitis and mucositis. Some gingival indexes for teeth and implants evaluate the visual aspects with the presence of marginal bleeding after mechanical stimulation. Others evaluate only visual aspects. Even more, there are those using only bleeding component according to its extent, bleeding time or just it ́s presence or absence. We conclude that the clinical diagnosis of gingivitis can be done by different methods. In the clinical environment, changes in bleeding dichotomously evaluated seem to be better for the simplicity, velocity to do and lower subjectivity. Moreover, absence of gingival bleeding on probing is a goal, indicating low risk of future clinical attachment loss. In the research plan, the incorporation of visual criteria associated with the presence of bleeding seems to better to clarify small gingival changes, increasing the sensitivity of the method. Despite all indexes presenting similarities and differences, none has universal acceptance or application, and the election of the index has to be dependent on the goals that need to be evaluated.