Artificial intelligence, ChatGPT, and dental education: Implications for reflective assignments and qualitative research.

INTRODUCTION: Reflections enable students to gain additional value from a given experience. The use of Chat Generative Pre-training Transformer (ChatGPT, OpenAI Incorporated) has gained momentum, but its impact on dental education is understudied. OBJECTIVES: To assess whether or not university instructors can differentiate reflections generated by ChatGPT from those generated by students, and to assess whether or not the content of a thematic analysis generated by ChatGPT differs from that generated by qualitative researchers on the same reflections. METHODS: Hardcopies of 20 reflections (10 generated by undergraduate dental students and 10 generated by ChatGPT) were distributed to three instructors who had at least 5 years of teaching experience. Instructors were asked to assign either 'ChatGPT' or 'student' to each reflection. Ten of these reflections (five generated by undergraduate dental students and five generated by ChatGPT) were randomly selected and distributed to two qualitative researchers who were asked to perform a brief thematic analysis with codes and themes. The same ten reflections were also thematically analyzed by ChatGPT. RESULTS: The three instructors correctly determined whether the reflections were student or ChatGPT generated 85% of the time. Most disagreements (40%) happened with the reflections generated by ChatGPT, as the instructors thought to be generated by students. The thematic analyses did not differ substantially when comparing the codes and themes produced by the two researchers with those generated by ChatGPT. CONCLUSIONS: Instructors could differentiate between reflections generated by ChatGPT or by students most of the time. The overall content of a thematic analysis generated by the artificial intelligence program ChatGPT did not differ from that generated by qualitative researchers. Overall, the promising applications of ChatGPT will likely generate a paradigm shift in (dental) health education, research, and practice.

Effect of erosive conditions on different sealant materials used in paediatric dentistry.

To evaluate the effect of acidic challenge on erosion depth and topographic characteristics of different materials used as occlusal sealants. Two hundred specimens of five sealant materials (Fuji IX, Ketac Molar, Fuji II, Equia and Clinpro) and forty bovine teeth enamel samples (control) were prepared and exposed to acidic challenge. The specimens were immersed in four different solutions (orange juice, coke drink, citric acid or distilled water) under mildly shaken conditions for 3 days. The erosion depth profiles were measured using a profilometer and Scanning Electron Microscope (SEM). Two-way ANOVA with Tukey post-hoc test was performed to evaluate the interactions. Sealant material and acidic challenge had significant effects on erosion depth. Among the materials, Fuji II presented the highest mean of erosion depth after immersion in orange juice, coke drink, and citric acid. All materials groups presented higher erosion depth values after immersion in the citric acid solution, except Clinpro. Bovine enamel presented higher erosion depth values compared to all materials when submitted to erosive challenge. Sealant materials submitted to the acidic challenge presented different degrees of erosion and topographic modification; however, they are less susceptible to erosion than bovine teeth enamel.

Do progression rates of initial and moderate caries lesions and sound surfaces of primary teeth increase significantly after 7 years?

BACKGROUND: Initial caries lesions in primary teeth have presented a low progression rate after 2 years, but it could be higher in longer follow-ups. AIM: To evaluate the progression rates of sound surfaces and initial and moderate caries lesions after 7 years. DESIGN: This prospective 7-year cohort study included 639 preschool children aged 1-5 years in 2010. In 2017, 449 children were reassessed (70.3% retention rate). Dental caries was collected using the International Caries Detection and Assessment System (ICDAS) in both assessments. Incidence rate (IR) per 100 surface-years estimated the progression rates of sound surfaces and initial and moderate lesions for worse conditions. Cox regression with shared frailty evaluated the possible risk factors. RESULTS: IR was 1.0% for sound surfaces, 2.8% and 4.2% for ICDAS scores 1 and 2, respectively, and about 17.0% for moderate lesions. The most significant risk factor for the progression was the presence of cavitated lesions in other teeth. The type of surface and tooth also influenced the outcome. CONCLUSION: The progression rate of initial caries lesions in primary teeth remains low even after 7 years, but cavitated caries lesions in other teeth increase this risk. Moderate lesions demonstrate a higher risk of progression when compared to sound surfaces and initial caries lesions.

Pathway analysis between dental caries and oral health-related quality of life in the transition from childhood to adolescence: a 10-year cohort study.

PURPOSE: To evaluate the direct and indirect pathways between cavitated carious lesions and oral health-related quality of life (OHRQoL) during the transition from childhood to adolescence. METHODS: A prospective cohort study followed an initial sample of 639 children (one to five years old), in southern Brazil for ten years. In addition to the baseline (T1), two subsequent reassessments were conducted after seven (T2) and ten years (T3). OHRQoL was measured through the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Perceptions Questionnaire (CPQ8-10 and CPQ11-14), according to the age group. Dental caries was evaluated using the International Caries Detection and Assessment System (ICDAS) in the three waves. Socioeconomic variables and other factors related to oral health (frequency of toothbrushing and toothache) were also collected. Structural equation modeling was used to estimate the direct and indirect effects among the variables over ten years. RESULTS: A total of 449 and 429 children were reevaluated at T2 and T3 (positive response rates of 70.3% and 67.1%, respectively). Dental caries in T1 and T2 directly predicted the occurrence of a worse OHRQoL in the respective follow-up periods. Dental caries at T3 indirectly predicted a worse OHRQoL (T3), via toothache. Dental caries at T1 and T2 directly predicted the occurrence of dental caries at T3, while a worse OHRQoL at T2 directly predicted a worse OHRQoL at T3. CONCLUSION: Dental caries negatively impacts, directly and indirectly, the OHRQoL from early childhood to adolescence.

Short and long effects of the COVID-19 context on oral health-related quality of life of adolescents.

AIM: To assess the immediate and late effects of the COVID-19 pandemic on the oral health-related quality of life (OHRQoL) of adolescents. DESIGN: This is a longitudinal study performed with adolescents (11-15 years old) from Southern Brazil who were evaluated before the COVID-19 outbreak, and 3 (T2) and 15 (T3) months after the beginning of the pandemic. OHRQoL was assessed using the CPQ11-14. Sociodemographic and clinical variables were also collected. Changes in OHRQoL before, 3 and 15 months after the start of the pandemic were analyzed through multilevel Poisson regression models for repeated measures. RESULTS: A total of 290 adolescents were evaluated at T1, 207 were re-evaluated at T2, and 204 at T3. Overall CPQ11-14 scores over follow-ups were 11.0 (SD 8.0) at T1, 8.3 (SD 7.8) and 12.8 (SD 8.8) at T3. Compared to T1, adolescents presented 29% lower overall CPQ11-14 scores (IRR 0.71 95% CI 0.66-0.75) at T2, and 11% higher scores at T3 (IRR 1.11 95% CI 1.05-1 0.17), especially for the emotional and social well-being domains. CONCLUSION: COVID-19 pandemic impacted the adolescents' OHRQoL differently over time, indicating a reduction in impacts immediately after the beginning and worsening over long term exposure to this scenario.

Impact of orthodontic treatment on OHRQoL of adolescents: a longitudinal study.

OBJECTIVE: The aim of this study was to evaluate the extent to which orthodontic treatment need is perceived by the patients and by the orthodontist, as well as the possible impacts on the OHRQoL (Oral Health-Related Quality of Life) over the course of conventional orthodontic treatment in adolescent patients. METHODS: The sample consisted of 55 adolescents. The perception of patients and orthodontists relative to the malocclusion was evaluated by the IOTN (Index of Orthodontic Treatment Need). The OHRQoL was evaluated by the Child-OIDP (Child-Oral Impacts on Daily Performances) questionnaire before the conventional orthodontic appliance was bonded (T0); and at the following time intervals: after one week (T1), one month (T2), three months (T3), six months (T4), and after the end of orthodontic treatment (T5). RESULTS: Adolescents who had large orthodontic treatment needs had a poor OHRQoL, according to their self-perception (p=0.003) and according to the orthodontist's perception (p<0.001), when compared with patients with small and moderate needs. There was statistically significant difference in the OHRQoL between the time intervals T0 and T1 (p=0.021), T2 and T3 (p<0.001), T3 and T4 (p=0.033), and T0 and T5 (p<0.002). At the end of treatment, all evaluated participants reported an improvement in OHRQoL. CONCLUSIONS: It was concluded that adolescents and orthodontists agreed with regard to the perception of orthodontic treatment need. In the first week and in the first month of orthodontic treatment, there was a negative impact on the OHRQoL. After three months, an improvement of OHRQoL was detected, which has progressed over time.

Community and individual socioeconomic inequalities and dental caries from childhood to adolescence: A 10-year cohort study.

PURPOSE: To evaluate the effect of individual and contextual socioeconomic inequalities in the occurrence of untreated dental caries during the transition from childhood to adolescence. METHODS: This 10-year prospective cohort study followed up an initial sample of 639 1-5 years old schoolchildren from southern Brazil. After 7 and 10 years from the baseline (T1), two other reassessments were conducted (T2 and T3), respectively. Untreated dental caries was measured through the International Caries Detection and Assessment System (ICDAS- scores 3, 5 and 6) at T1 and T3. Socioeconomic status (SES) at the contextual and individual level was assessed at T1. At T2, socioeconomic, behavioural and psychosocial characteristics were evaluated as possible pathways of explanation. Structural equation modelling was used to estimate the direct and indirect effects among the variables over 10 years. RESULTS: A total of 429 adolescents were reevaluated at 10-year follow-up (cohort retention rate of 67.1%). About 30.6% presented untreated dental caries at T3. Low individual SES at T1 directly impacted a higher occurrence of dental caries at T3. Non-white skin colour at T1 also indirectly impacted a higher occurrence of dental caries at T3 through low individual SES at T1 and lower household income at T2. Contextual SES did not predict, directly or indirectly, dental caries at T3. CONCLUSION: There is strong evidence that socioeconomic inequalities at the individual level play an important role on the occurrence of dental caries from childhood to adolescence. On the other hand, there was no evidence that contextual SES influences the occurrence of dental caries over time.

Trends and age-period-cohort effect on dental caries prevalence from 2008 to 2019 among Brazilian preschoolers.

This study aimed to evaluate trends in the prevalence of dental caries in preschool children and associated factors considering different time variations. This is a time series study performed using data from three cross-sectional studies with pre-school children from southern Brazil in 2008, 2013 and 2019. This children group was born between the years of 2003 to 2018. Dental caries was evaluated by decayed, missing and filled deciduous teeth (dmft index). Demographic, socioeconomic, behavioural and psychosocial variables were also collected. Chi-square test for trends and a hierarchical age-period-cohort (HAPC) analysis using multilevel Poisson regression model for testing the associations between predictor variables and dental caries experience were used. A total of 1,644 pre-school children participated in all surveys. There was a significant difference in caries experience considering all APC effects. The prevalence of dental caries was 25.0% in 2008, 16.3% in 2013, and 19.4% in 2019 (p < 0.01) and no statistical difference was observed. An age effect showed that older children were more likely to experience dental caries. Considering the cohort effect, there is a significant difference between the generations, mainly between 2003 and 2018. Household income, use of dental services, and parent's perception of child oral health were associated with dental caries experience no matter the time variation. Despite recent declines in dental caries prevalence among preschool children, caries levels increased with age and social inequalities persisted through the years, indicating a need of reviewing the policies to reduce the burden of this oral disease.

Impact of licit and illicit substances on the oral health-related quality of life in adolescents.

OBJECTIVE: To assess the impact of the consumption of licit and illicit substances on the oral health-related quality of life (OHRQoL) of adolescents from public schools in the south of Brazil. METHODS: This cross-sectional study was carried out with a random sample of adolescents aged between 17 and 18 years old from Santa Maria, Brazil. The consumption of licit and illicit substances was measured through a self-administered questionnaire with questions from the National Survey of Scholar Health. The OHRQoL was collected using the Brazilian short version of Child Perceptions Questionnaire 11-14 (CPQ11-14). Multilevel Poisson regression models were used to estimate the association between the outcome and the explanatory variables where the adolescents (first level) were nested in their schools (second level). RESULTS: A total of 768 adolescents were evaluated. Of these, about 15.6% have already used illegal substances. Adolescents who reported the use of illicit substances had 28% higher CPQ11-14 scores when compared to their counterparts. Alcohol use was also related to worse levels of OHRQoL, while the consumption of cigarettes acted as a protective factor. CONCLUSIONS: This study found an association between the use of alcohol and illicit drugs with worse levels of OHRQoL.

Impact of pulpectomy versus tooth extraction in children's oral health-related quality of life: A randomized clinical trial.

AIM: The aim of this randomized clinical trial was to compare the impact of two management options for primary molars with pulp necrosis (pulpectomy or extraction) on children's oral health-related quality of life (OHRQoL). DESIGN: A total of 100 children aged 3-5 years with at least one necrotic primary molar were selected and randomized into the study groups. The Brazilian version of early childhood oral health impact scale (B-ECOHIS) was completed by the parent proxy reports at baseline and after 4, 8 and 12 months. Differences between the trial groups were assessed through bootstrap linear regression for B-ECOHIS scores, logistic regression for dental pain self-reports and anxiety scores (α = 5%). RESULTS: The mean (SD) B-ECOHIS scores at baseline and after 12 months were 17.7 (6.5) and 3.0 (4.0) in the pulpectomy group and 18.8 (7.7) and 7.9 (7.7) in the extraction group. Both treatments significantly improved OHRQoL, but tooth extraction group showed higher scores in total B-ECOHIS (p < .001) and most domains, indicating lower OHRQoL. Furthermore, higher anxiety levels were reported for dental extraction compared to pulpectomy (OR = 2.52; p = .008). CONCLUSION: Pulpectomy resulted in an improved OHRQoL scores after 12 months when compared to tooth extraction and should be considered as the treatment of choice for necrotic primary molars.

Association of children's oral health and school environment on academic performance in 12-year-old schoolchildren of Quito, Ecuador.

OBJECTIVES: The primary aim of this study was to evaluate if children's oral health and oral health-related quality of life (OHRQoL) were associated with school performance. Moreover, the study aimed to examine whether school environment factors influenced this association. METHODS: This cross-sectional study was based on a population-based sample of 998 12-year-old schoolchildren from 31 public schools in Quito, Ecuador. Trained and calibrated examiners conducted clinical exams for dental caries, dental trauma and malocclusion. Furthermore, children completed the Spanish version of the Child Perception Questionnaire (CPQ11-14 ), and their parents answered questions about socio-economic status. School coordinators provided information on the physical environment, promotion of health practices and the occurrence of negative episodes in the school. There were three outcomes: grades obtained in Spanish language and mathematics and the number of missed school days. Multilevel linear and Poisson regression models were conducted using a hierarchical approach to include the variables guided by a previously created direct acyclic graph. RESULTS: Children with dental trauma and higher CPQ11-14 scores showed lower grades and school attendance. Schoolchildren from schools with episodes of vandalism had more school days missed. CONCLUSION: The school performance of 12-year-old children is affected by dental trauma and by a worse OHRQoL, as well as a negative school environment. Therefore, supportive environments and promoting health measures in schools could overcome this worse academic performance in children with oral health problems.

The role of differential exposure and susceptibility to heavy drinking linking income inequalities and tooth loss: An investigation of the alcohol harm paradox using a four-way decomposition analysis.

OBJECTIVES: To examine the extent to which the effect of income inequalities on tooth loss is attributable to differential exposure and susceptibility to heavy drinking in older Brazilian adults. METHODS: We conducted a secondary analysis using data from The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016), a nationally representative sample of community-dwelling people aged 50 years and over. Causal mediation analysis based on the counterfactual outcome framework decomposed the effect of income on tooth loss mediated by heavy drinking into four components (four-way decomposition): controlled direct effect (neither mediation nor interaction), reference interaction (interaction only), mediated interaction (both mediation and interaction) and pure indirect effect (mediation only). Proportions of effect attributable to each component were calculated to estimate the differential exposure (the sum of the third and fourth components) and differential susceptibility (the sum of the second and third components) to heavy drinking. RESULTS: The analytical sample comprised 8114 participants. After adjusting for covariates, 7.3% (95% CI: 3.8%; 10.9%) and -39.5% (95% CI: -75.8%; -3.3%) of the effects of income on tooth loss were attributable to differential exposure and susceptibility to heavy drinking, respectively, consistent with the alcohol harm paradox. When setting non-functional dentition as outcome, only the effect of differential susceptibility remained (-81.7% [95% CI: -128.2%; -35.2%]). CONCLUSION: Our findings suggest that individuals of low-income groups appear to be more susceptible to the effects of heavy drinking on tooth loss.

School type and oral conditions associated with school performance and absenteeism in adolescents: A multilevel analysis.

BACKGROUND: Investigations assessing how oral health status affects school performance and attendance considering individual and community variables are lacking. AIM: To analyze the association of school contextual factors and oral conditions with school performance and absenteeism in early adolescence. DESIGN: This cross-sectional study was carried out with 593 12-year-old students from 20 schools in Passo Fundo, a southern city in Brazil. The caregivers provided sociodemographic information by means of a questionnaire. Oral health status was clinically examined for dental caries and gingival bleeding. Students answered the CPQ11-14 questionnaire to assess the oral health-related quality of life (OHRQoL). Information on contextual factors was obtained from the schools' administrators. "School performance" was measured by Portuguese and Mathematic tests' scores, and "school absenteeism" by the number of school days missed. Descriptive statistics was conducted, followed by unadjusted and adjusted multilevel linear regression. RESULTS: At the individual level, low OHRQoL was associated with lower school performance and higher absenteeism. At the contextual level, students from private schools had higher school performance and lower mean of school days missed. CONCLUSIONS: The type of school and OHRQoL were associated with school performance and attendance of adolescents.

Impact of orthodontic treatment on OHRQoL of adolescents: a longitudinal study

ABSTRACT Objective: The aim of this study was to evaluate the extent to which orthodontic treatment need is perceived by the patients and by the orthodontist, as well as the possible impacts on the OHRQoL (Oral Health-Related Quality of Life) over the course of conventional orthodontic treatment in adolescent patients. Methods: The sample consisted of 55 adolescents. The perception of patients and orthodontists relative to the malocclusion was evaluated by the IOTN (Index of Orthodontic Treatment Need). The OHRQoL was evaluated by the Child-OIDP (Child-Oral Impacts on Daily Performances) questionnaire before the conventional orthodontic appliance was bonded (T0); and at the following time intervals: after one week (T1), one month (T2), three months (T3), six months (T4), and after the end of orthodontic treatment (T5). Results: Adolescents who had large orthodontic treatment needs had a poor OHRQoL, according to their self-perception (p=0.003) and according to the orthodontist's perception (p<0.001), when compared with patients with small and moderate needs. There was statistically significant difference in the OHRQoL between the time intervals T0 and T1 (p=0.021), T2 and T3 (p<0.001), T3 and T4 (p=0.033), and T0 and T5 (p<0.002). At the end of treatment, all evaluated participants reported an improvement in OHRQoL. Conclusions: It was concluded that adolescents and orthodontists agreed with regard to the perception of orthodontic treatment need. In the first week and in the first month of orthodontic treatment, there was a negative impact on the OHRQoL. After three months, an improvement of OHRQoL was detected, which has progressed over time.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o quanto a necessidade de tratamento ortodôntico é percebida pelos pacientes e pelo ortodontista, bem como os possíveis impactos na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) ao longo do tratamento ortodôntico convencional em pacientes adolescentes. Métodos: A amostra foi composta por 55 adolescentes. A percepção dos pacientes e ortodontistas em relação à má oclusão foi avaliada pelo Índice de Necessidade de Tratamento Ortodôntico (IOTN). A QVRSB foi avaliada pelo questionário Child-OIDP (Child-Oral Impacts on Daily Performances) antes da colagem do aparelho ortodôntico convencional (T0); e nos seguintes intervalos de tempo: após uma semana (T1), um mês (T2), três meses (T3), seis meses (T4) e após o término do tratamento ortodôntico (T5). Resultados: Adolescentes que apresentavam grandes necessidades de tratamento ortodôntico apresentaram baixa QVRSB, segundo sua autopercepção (p=0,003) e segundo a percepção do ortodontista (p<0,001), quando comparados com pacientes com necessidades pequenas e moderadas . Houve diferença estatisticamente significativa na QVRSB entre os intervalos de tempo T0 e T1 (p=0,021), T2 e T3 (p<0,001), T3 e T4 (p=0,033) e T0 e T 5 (p<0,00 2 ). Ao final do tratamento, todos os participantes avaliados relataram melhora na QVRSB. Conclusões: Concluiu-se que adolescentes e ortodontistas concordaram quanto à percepção da necessidade de tratamento ortodôntico. Na primeira semana e no primeiro mês de tratamento ortodôntico, houve impacto negativo na QVRSB. Após três meses, foi detectada uma melhora na QVRSB, que progrediu ao longo do tempo.

Trends and age-period-cohort effect on dental caries prevalence from 2008 to 2019 among Brazilian preschoolers

Abstract This study aimed to evaluate trends in the prevalence of dental caries in preschool children and associated factors considering different time variations. This is a time series study performed using data from three cross-sectional studies with pre-school children from southern Brazil in 2008, 2013 and 2019. This children group was born between the years of 2003 to 2018. Dental caries was evaluated by decayed, missing and filled deciduous teeth (dmft index). Demographic, socioeconomic, behavioural and psychosocial variables were also collected. Chi-square test for trends and a hierarchical age-period-cohort (HAPC) analysis using multilevel Poisson regression model for testing the associations between predictor variables and dental caries experience were used. A total of 1,644 pre-school children participated in all surveys. There was a significant difference in caries experience considering all APC effects. The prevalence of dental caries was 25.0% in 2008, 16.3% in 2013, and 19.4% in 2019 (p < 0.01) and no statistical difference was observed. An age effect showed that older children were more likely to experience dental caries. Considering the cohort effect, there is a significant difference between the generations, mainly between 2003 and 2018. Household income, use of dental services, and parent's perception of child oral health were associated with dental caries experience no matter the time variation. Despite recent declines in dental caries prevalence among preschool children, caries levels increased with age and social inequalities persisted through the years, indicating a need of reviewing the policies to reduce the burden of this oral disease.

Does bullying due to oral conditions influence cigarette smoking in adolescents? A structural equation modeling.

This study aimed to explore the pathways that can influence cigarette smoking among adolescents. This population-based cohort followed a random sample of 12-year-old adolescents from southern Brazil for 6 years. Regular cigarette smoking was assessed through a self-reported question, previously used in the Brazilian National Survey of Scholar Health. We also gathered data on bullying, dental caries at baseline, incidence of caries, sex, friend network, and Sense of Coherence (SOC). Socioeconomic and demographic characteristics were also collected. Structural equation modeling was used to evaluate the pathways. Of the 1,134 adolescents examined at baseline, 768 were re-evaluated (67.7% retention rate). The prevalence of smoking was 37.6%. This prevalence was directly affected by low SOC (SC: -0.14, p < 0.01), low household income (SC: -0.12, p < 0.01), and male sex (SC: 0.15, p < 0.01). Presence of dental caries at baseline indirectly influenced the occurrence of dental bullying at follow-up via the incidence of dental caries (SC: 0.01, p < 0.05). Dental bullying indirectly influenced cigarettes consumption via SOC (SC: 0.62, p < 0.05). Friend network also indirectly influenced the consumption of cigarettes via SOC (SC: 0.32, p < 0.05). Psychosocial factors influence adolescent cigarette consumption through its higher direct and indirect effects (via bullying). In addition, behavioral, sociodemographic, and clinical factors also influence the occurrence of smoking.

Discriminant validity of the current gingivitis classification in adolescents: a cohort study.

OBJECTIVES: To compare the prevalence of gingivitis estimated by the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification with the other case definitions and assess the ability of this classification system in discriminating sociodemographic and clinical factors associated with the presence of gingivitis in a cohort study. MATERIALS AND METHODS: A multistage random sample of 1134 12-year-old adolescents was submitted to a full-mouth examination according to the Community Periodontal Index. Socioeconomic and clinical variables were collected at baseline. Gingivitis was considered according to the following criteria: (a) ≥ 10% of bleeding sites (the 2018 EFP/AAP criteria); (b) ≥ 15% of bleeding sites; and (c) the mean full-mouth bleeding sites. Adjusted multilevel Poisson regression assessed the association between independent variables at baseline and each definition of gingivitis at 2-year follow-up. RESULTS: Seven hundred forty-two 14-year-old adolescents were re-revaluated at follow-up. The prevalence of gingivitis was 28.7% according to 10% of bleeding threshold. The 2018 EFP/AAP criteria and other definitions showed higher prevalence and mean of gingivitis for low-household income adolescents and for those with higher levels of dental plaque and untreated dental caries. Nonetheless, the highest strengths of association were observed for the threshold of ≥ 15% of bleeding sites. CONCLUSION: The 2018 EFP/AAP case definition of gingivitis showed a similar discriminant validity compared to the 15% threshold and the mean full-mouth bleeding sites. CLINICAL RELEVANCE: The 2018 EFP/AAP classification allows the discrimination of important risk factors and should be used for the establishment of priorities for large-scale therapeutic programs.

Impact of the COVID-19 pandemic on sleep bruxism among adolescents in Brazil: A longitudinal study.

AIM: To evaluate the immediate and late impact of the COVID-19 pandemic on the occurrence of possible sleep bruxism (SB) among adolescents in Brazil. DESIGN: This is a longitudinal study performed with adolescents (11-15 years old) from Southern Brazil. Baseline data were collected before the Brazilian COVID-19 outbreak (T1). Posteriorly, data were collected after 3 (T2) and 15 months under the Brazilian COVID-19 outbreak. The possible SB was evaluated by the question: 'Do you grind your teeth during your sleep?'. Sociodemographic, psychosocial and clinical variables were also collected. Changes in SB were evaluated by multilevel logistic regression models for repeated measures. RESULTS: Of the 290 adolescents assessed at T1, 182 were reassessed at both follow-ups. The prevalence of possible SB was 13% at T1, 11% at T2 and 22% at T3. There were no immediate effects of the COVID-19 pandemic on the occurrence of possible SB (T2). Adolescents had odds 2.77 times greater of presented possible SB after 15 months (T3) of COVID-19 pandemic scenarios when compared to T1. CONCLUSION: There was a considerable and late increase in the possible SB in adolescents in Brazil during the COVID-19 pandemic.

Impact of dental bullying on bruxism associated with poor sleep quality among adolescents.

This study aimed to investigate the impact of school bullying and oral health-related verbal bullying on the occurrence of bruxism associated with poor sleep quality among adolescents. This cross-sectional study was nested in a cohort study performed with a sample of children from southern Brazil. Possible sleep bruxism was determined by the question: "Has anyone told you that you grind your teeth in your sleep?" Sleep quality was determined by answering the following question: "How would you classify the quality of your sleep?". The outcome was created by combining occurrence of sleep bruxism and poor sleep quality. The Sense of Coherence (SOC) was assessed using the SOC-13 scale. Bullying was investigated using the victim scale of the Olweus Bullying Questionnaire and oral health-related verbal bullying using an item from the Child Perceptions Questionnaire-11-14. Demographic, socioeconomic, psychosocial, and clinical data were also collected. Poisson regression models with robust variance were used. Results were expressed as prevalence ratio (PR) and 95% confidence intervals (95% CI). A total of 429 adolescents with a mean age of 12.6 (standard deviation 1.3) years were evaluated. The prevalence of bruxism associated with poor sleep quality was 23.7%. Victims of school bullying (PR 2.06; 95%CI: 1.01-4.22) and oral health-related verbal bullying (PR 1.87; 95%CI: 1.18-2.95) presented higher prevalence of bruxism associated with poor sleep quality. Factors such as skin color and SOC were also associated with the outcome. These findings suggest an association between episodes of bullying and bruxism related to poor sleep quality.

Dental caries prediction and the indication of pit and fissure sealant in children first permanent molars: A prospective study.

OBJECTIVES: To evaluate predictors for caries incidence on first permanent molars and to assess the accuracy and efficiency of these predictors for the indication of pit and fissure sealants. METHODS: This 7-y cohort study started in 2010 with a sample of 639 children (1-5 years) from Southern Brazil. Dental caries was assessed using the ICDAS. Maternal education, family income, parental perception on child oral health and severe dental caries experience were collected at baseline and used to test the prediction of dental caries. Predictive values, accuracy and efficiency were estimated for each possible predictor. RESULTS: 449 children were re-assessed at follow-up (70.3% retention rate). The baseline characteristics showed similar risks for dental caries incidence in first permanent molars. Low family income and poor parental perception of child oral health were moderately accurate in correctly identifying sound children who would not need to receive pit and fissure sealant. However, all the adopted criteria have lower accuracy incorrectly identifying children who later developed dental caries in first permanent molars. CONCLUSIONS: Distal and intermediate factors were relatively accurate in determining caries risk incidence on children's first permanent molars. The criteria adopted were more accurate in identifying sound children than those who need to receive pit and fissure sealant. CLINICAL RELEVANCE: Our findings reinforce the idea that investing in strategies that take into account common risk factors still represents the best option for dental caries prevention. However, adopting only these parameters is not enough to indicate pit and fissure sealants.