Development and external validation of a head and neck cancer risk prediction model.

BACKGROUND: Head and neck cancer (HNC) incidence is on the rise, often diagnosed at late stage and associated with poor prognoses. Risk prediction tools have a potential role in prevention and early detection. METHODS: The IARC-ARCAGE European case-control study was used as the model development dataset. A clinical HNC risk prediction model using behavioral and demographic predictors was developed via multivariable logistic regression analyses. The model was then externally validated in the UK Biobank cohort. Model performance was tested using discrimination and calibration metrics. RESULTS: 1926 HNC cases and 2043 controls were used for the development of the model. The development dataset model including sociodemographic, smoking, and alcohol variables had moderate discrimination, with an area under curve (AUC) value of 0.75 (95% CI, 0.74-0.77); the calibration slope (0.75) and tests were suggestive of good calibration. 384 616 UK Biobank participants (with 1177 HNC cases) were available for external validation of the model. Upon external validation, the model had an AUC of 0.62 (95% CI, 0.61-0.64). CONCLUSION: We developed and externally validated a HNC risk prediction model using the ARCAGE and UK Biobank studies, respectively. This model had moderate performance in the development population and acceptable performance in the validation dataset. Demographics and risk behaviors are strong predictors of HNC, and this model may be a helpful tool in primary dental care settings to promote prevention and determine recall intervals for dental examination. Future addition of HPV serology or genetic factors could further enhance individual risk prediction.

Research on racial/ethnic inequities in oral health over the past 80 years: The role of racism.

AIM: This study aims to (1) describe trends in explanations provided for racial/ethnic inequities in dental caries and periodontitis, and (2) explore the patterns of relatedness among explanations for these inequities. MATERIALS AND METHODS: Highly cited publications based on studies indexed in the Scopus database were retrieved and assessed for eligibility. Explanations for racial/ethnic inequities were classified into eight different, but interrelated domains. We assessed trends and examined the relations among explanations using multiple correspondence analysis. RESULTS: A total of 200 articles among the most cited publications were selected. The proportion of studies invoking racism as an explanation for racial inequities in oral health increased from 0% to 14.3%, from 1937 to 2020. The proportions of individual socio-economic factors increased from 52.0% to 82.9%, and dental care from 28.0% to 62.9%. The remaining explanations were stable: psychological/behavioural processes (62.5%), biological factors (49.5%), contextual/area-level effects (24.0%) and immigrant paradox (4.0%). Multiple correspondence analysis revealed a smaller axial distance between racism and the following categories: studies from Brazil, recent publications and Blacks/Hispanics/mixed-race groups. Publications about immigrants were axially closer to the high-income countries category. CONCLUSIONS: Our findings call on dental researchers to consider racism as a cause for existing racial/ethnic inequities in oral health.

Tooth loss over 13 years of follow-up: Can regular dental visits reduce racial and socioeconomic inequalities?

OBJECTIVES: To assess if regular dental visits modify the effects of social and racial indicators on the incidence of tooth loss. METHODS: This is a longitudinal analysis using data from the Pro-Saude Study. In 1999-2001, 3253 civil servants responded to self-administered questionnaires, and then in 2012-2013, with 19% attrition. The outcome was any increase in self-reported tooth loss, measured in four ordered categories (none, one or few, many, all or almost all). Main variables included income, education, race/ethnicity and an adapted version of Everyday Discrimination Scale. The dental visit was dichotomized into regular and problem-oriented attenders. Potentially confounding factors were age and sex; effect modification was estimated using the relative excess of risk due to interaction (RERI). RESULTS: An increase in the tooth loss category was reported by 23.1% of the individuals over 13 years of follow-up. Among problem-oriented attenders, 27.3% reported an increase against 20.4% in regular users (p<0.01). Interaction results are inconclusive. Even though not significant, either antagonism or synergism were observed: between lower income and problem-oriented (RERI = -0.22; 95%CI: -0.75: 0.31), being Black+Brown and problem-oriented (RERI = -0.25; 95%CI: -0.64: 0.14), discrimination and problem-oriented (RERI = -0.15; 95%CI: -0.55: 0.25), and between having less than university degree and being problem-oriented (RERI = 0.21; 95%CI: -0.19: 0.62). CONCLUSIONS: Regular attenders from advantaged groups seem to benefit more from dental care than disadvantaged groups, increasing unfair inequalities. Inconsistencies in current findings warrant further investigations. CLINICAL SIGNIFICANCE: Regular attenders from advantaged groups seem to benefit more from dental care than disadvantaged groups, increasing inequities, but the effect size of the Relative Excess of Risk due to Interaction was not large and was inconclusive.

Parenting practices and oral impact on daily performance in southern Brazil.

OBJECTIVES: To explore the relationship between parents' practices and the oral health-related quality of life of children according to the child's point of view. METHODS: It is a cross-sectional study with all children (response rate 75.6 percent, n = 329) from fourth grade of Elementary School to the third grade of High School in 2016 in a small city of southern Brazil. Oral health related quality of life was measured using the oral impact on daily performances (OIDP) using the prevalence of any impact as outcome (OIDP score > 0). Seven parenting practices were evaluated by the inventory of parenting Styles for both father and mother. Logistic regression models were fitted to estimate the association of each parenting practice with OIDP score > 0, and adjusted by sex, age, family equivalent income, mother and father's educational level. RESULTS: About 55.3 percent of the children had at least one impact on daily performances. Respectively, the parenting practices with the highest and lowest percentage for both parents' risk behavior was physical abuse (28.8 percent) and negative monitoring (7.8 percent), while families in which both parents' risk behavior for negligence was 14.7 percent. In the adjusted models, families in which both parents' risk behavior on negligence [odds ratio (OR) = 2.74, 95% confidence intervals (95%CI): 11.27-6.23] and physical abuse (OR = 2.16, 95%CI: 1.13-4.19) and (lack of) positive monitoring (OR = 2.99, 95%CI: 1.32-7.40) had a greater impact on daily life compared to those in which no parents' had risk behavior. CONCLUSIONS: Having any impact on OIDP was associated with negligence, physical abuse, and lack of monitoring among children and adolescents.

The impact on the quality of life caused by the early loss of primary molars.

INTRODUCTION: Evidence regarding the impact of early loss of primary molars (ELPM) on Oral Health-Related Quality of Life (OHRQoL) is lacking. The aim of the present study was evaluating the impact of ELPM on OHRQoL of Brazilian schoolchildren aged 6-10 years. METHODS: This observational prospective cohort study was conducted with 163 schoolchildren, assigned in the primary tooth loss group (PTLG), in which all tooth loss was caused by carious lesions, and in a control group without tooth loss (CG). Two calibrated examiners conducted the clinical oral assessments to determine caries experience and tooth loss. OHRQoL was assessed using the Child Perception Questionnaire 8-10 years (CPQ8-10) instrument administered at baseline and at 10-12 months of follow-up. RESULTS: Children in PTLG exhibited significantly more negative impact on OHRQoL at baseline (p < 0.01) than CG, and also after the follow-up period (p < 0.01). It was also possible to observe a significant reduction in the negative impact on OHRQoL in both CG and PTLG in the longitudinal analysis (p < 0.01). Nevertheless, there was an even more substantial reduction in the negative impact on OHRQoL in children in PTLG. CONCLUSIONS: This study provides evidence that early tooth loss is associated with negative impact on OHRQoL. Moreover, it indicates that access to dental treatment can have a positive impact on the OHRQoL of children with dental caries and ELPM.

Beliefs about managing dental problems among older people and dental professionals in Southern Brazil.

OBJECTIVES: To explore the sociocultural context in which patients and dentists in urban and rural communities in Southern Brazil interpret dental problems. METHOD: Beliefs and experiences related to dental problems were explored in eight focus groups involving a total of 41 older patients, and in direct interviews with two dentists and two dental assistants. The interactions were audio recorded and transcribed for thematic analysis. RESULTS: The beliefs and experiences of the participants focused on four main themes: cultural beliefs; dental services; decisions to extract teeth; and expectations for change. A culture of pre-nuptial tooth loss and complete dentures was considered beneficial to young women. Although dental services at the time were scarce in the region, demands for relief of pain were extensive despite the fear and anxiety of the participants. Extraction of teeth and fabrication of complete dentures were the usual dental treatments available, although some participants felt that dentists withheld other treatment options. Participants were hopeful that dental services would improve for their children. CONCLUSIONS: Patients and dental professionals in urban and rural communities of Southern Brazil managed dental problems within a culture of limited access and availability of services that favoured dental extractions and complete dentures.

Concerns about dental aesthetics are associated with oral health related quality of life in Southern Brazilian adults.

It aims to evaluate the association between dental appearance and Oral Health Related Quality of Life. Fifteen primary care services with dental services were selected in Porto Alegre, Brazil. Individuals were interviewed from a random sampling of households in the catchment area of the health centres. The outcome was having an OHIP14 score > 0 (any impact). The main exposures included self-reported tooth colour and position, perception of oral health and concern with dental aesthetics. Data were analysed with stepwise logistic regression. Of 1943 individuals contacted, 433 used public dental services in the last year. Seventy-three percent had some impact on quality of life, 35.2% and 47.5% reported stained and crowded teeth, respectively. Also, 22.2% had already tried bleaching their teeth. Individuals concerned with colour were 2.56 times (95% CI: 1.34-4.89) more likely to report any impact after adjusting for number of teeth, smoking and education. Concerns about tooth position, reporting stained or crowded teeth, age, sex and income were not significant (p > 0.30). There is a direct and independent association between concerns with tooth colour and quality of life. The effect of tooth colour on quality of life may be mediated by individuals' perceptions of aesthetics.

Decomposing early and adult life social position effects on oral health and chronic diseases in a cross-sectional study of Southern Brazil.

OBJECTIVES: As the socio-economic trajectory can influence on individual health during the life course, the aim of this study was to test a model of socio-economic life course effects on chronic diseases, tooth loss and on oral health-related quality of life using structural equation model (SEM) to decompose direct and indirect effects. METHODS: This cross-sectional study was performed in southern Brazil, within public healthcare users with 18 years old or more (n = 433). Latent variables were the Oral Health Impact Profile (OHIP), Childhood Socio-economic Status (SESC) and Adulthood (SESA), and Chronic Diseases (CD), and observed variables were sex, age, smoking status and tooth loss. The statistical analysis was performed using structural equation modelling (SEM) using WLSMV estimator. For the final model, we kept only plausible significant paths with P < 0.30. RESULTS: Final model presented an adequate fit: RMSA 0.03, Comparative Fit Index (CFI) 0.97, TLI 0.97, and Weighted Root Mean Square Residual (WRMR) 1.19. The direct effect from SESC to tooth loss was ß = -0.08 (P = 0.19) and the indirect was ß = -0.12 (P = 0.02). The indirect effect from SESC to OHIP was ß = -0.14 (P = 0.01) and there is no direct effect. The direct effect from SESA to tooth loss was ß = -0.21 (P < 0.01) and there is no indirect effect. The direct effect from SESA to OHIP was ß = -0.14 (P = 0.05). The association of SESA on SESC was ß = 0.59 (P < 0.01). CONCLUSIONS: SESC had indirect effects on OHIP and number of teeth via SESA, supporting the chain of effects theory, but not for chronic diseases.

Concerns about dental aesthetics are associated with oral health related quality of life in Southern Brazilian adults / Preocupações sobre a estética dentária com qualidade de vida relacionada à saúde bucal em adultos no sul do Brasil

Abstract It aims to evaluate the association between dental appearance and Oral Health Related Quality of Life. Fifteen primary care services with dental services were selected in Porto Alegre, Brazil. Individuals were interviewed from a random sampling of households in the catchment area of the health centres. The outcome was having an OHIP14 score > 0 (any impact). The main exposures included self-reported tooth colour and position, perception of oral health and concern with dental aesthetics. Data were analysed with stepwise logistic regression. Of 1943 individuals contacted, 433 used public dental services in the last year. Seventy-three percent had some impact on quality of life, 35.2% and 47.5% reported stained and crowded teeth, respectively. Also, 22.2% had already tried bleaching their teeth. Individuals concerned with colour were 2.56 times (95% CI: 1.34-4.89) more likely to report any impact after adjusting for number of teeth, smoking and education. Concerns about tooth position, reporting stained or crowded teeth, age, sex and income were not significant (p > 0.30). There is a direct and independent association between concerns with tooth colour and quality of life. The effect of tooth colour on quality of life may be mediated by individuals' perceptions of aesthetics.

Resumo O objetivo do presente estudo foi avaliar a associação entre a aparência dos dentes com a qualidade de vida relacionada à saúde bucal. Quinze centros de atenção primária com serviços odontológicos foram selecionados em Porto Alegre, Brasil. Os indivíduos foram entrevistados a partir de uma amostragem aleatória de domicílios. O desfecho avaliado foi ter um escore de OHIP14 > 0. As exposições foram: cor e posição autorreferida dos dentes, percepção da saúde bucal e preocupação com a estética dental. Os dados foram analisados com regressão logística. De 1.943 indivíduos contatados, 433 utilizaram os serviços públicos odontológicos, dos quais 73% tinham algum impacto na qualidade de vida; 35,2% dentes manchados e 47,5% dentes apinhados. Além disso, 22,2% já haviam tentado clarear os dentes. Indivíduos preocupados com a cor tinham 2,56 vezes (IC 95%: 1.34-4.89) mais chances de relatar qualquer impacto após o ajuste para número de dentes, tabagismo e educação. Preocupações com a posição dos dentes, relato de dentes manchados ou apinhados, idade, sexo e renda não foram significativas (p > 0,30). Houve uma associação direta e independente entre as preocupações com a cor do dente e qualidade de vida. O efeito da cor do dente pode ser mediado pela percepção da estética.

A Clínica Ampliada como ferramenta de cuidado e ensino em Geriatria / The Expanded Clinic as a Geriatric care and teaching tool

O envelhecimento populacional é uma característica mundial, ocorrendo inclusive no Brasil. Frente aos desafios para o Sistema Único de Saúde e seus profissionais, se faz necessária uma mudança de abordagem, no sentido de ampliação da clínica. O objetivo deste estudo é relatar a experiência de integração entre ensino, serviços de saúde e comunidade, por meio da construção da disciplina do Estágio em Odontogeriatria. A partir da criação do curso de Odontologia noturno, os professores da disciplina buscaram alternativas de campos de estágio no turno da noite, já que a instituição de longa permanência para idosos e as Unidades de Saúde da Rede de Atenção em Saúde da Prefeitura Municipal de Porto Alegre, que recebem os estagiários do curso diurno, não realizam atendimento de idosos depois das 18:30 horas. Assim, professores, gestores municipais e duas equipes de Saúde da Família (ESF) realizaram rodas de conversa para estruturar o estágio noturno, almejando trabalhar com os estudantes, além de conhecimentos, atitudes e práticas. Foram pactuadas atividades teóricas, oficinas sobre Avaliação Global do Idoso, além de visitas domiciliares a idosos - em seu contexto - acompanhadas de profissionais da ESF. Os grupos de preceptoria foram realizados visando o planejamento de Projetos Terapêuticos Singulares para e com os idosos que foram visitados, a partir da problematização de suas condições de vida. Frente aos resultados já obtidos por relatos e observações, acredita-se no potencial do Estágio em Odontogeriatria do curso noturno na construção de um novo paradigma em Odontologia relacionado à ampliação da clínica e à interdisciplinaridade (AU).

Population aging is a universal characteristic, occurring even in Brazil. Facing the challenges to the Unified Health System and its professionals, it seems necessary to reflect on the time and opportunity of the Clinic Expansion. This study aims to report the experience of integration between education, health services, and community, through the construction of the subject Geriatric Dentistry Internship. Since the creation of the night-shift Dentistry course, the teachers have sought alternatives to the nightshift internship, since the long-term institution for the elderly and the Health Units of the Porto Alegre's Care Network, that receive day course trainees, do not perform care to elderly after 6:30 PM. Thus, teachers, municipal managers and two Family Health Teams (FHT) participated in conversation circles to structure the internship to the nocturnal course, aiming to work with the students besides knowledge, attitudes, and practices. Theoretical activities, workshops on the Elderly Global Assessment and also home visits were agreed. The elderly were visited in their context and accompanied by FHT professionals. The preceptory groups were carried out for planning the Singular Therapeutic Projects for and with the elderly who were visited, from the problematization of their living conditions. Since the results already obtained by reports and observations, we believe in the potential of the this for construction of a new Dental paradigm, related to the expansion of the clinic and interdisciplinarity (AU).

Is the relative increase in income inequality related to tooth loss in middle-aged adults?

OBJECTIVES: To assess whether Brazilian middle-aged adults living in cities that experienced a relative increase on income inequality were more likely to have severe tooth loss and lack a functional dentition. METHODS: Data on Brazilian adults aged 35-44 years from state capitals and Federal District from the 2010 Brazilian Oral Health Survey (SBBrasil 2010) were analyzed. Clinically assessed tooth loss outcomes were severe tooth loss (<9 remaining natural teeth) and lack of functional dentition (<21 natural teeth). Income inequality was assessed by Gini Index in 1991, 2000, and 2003 using tertiles of distribution. Variation in Gini Index was assessed by changes in the tertiles distribution between years. Multilevel logistic regression models were used to estimate odds ratios (ORs) and 95 percent confidence intervals (95 percent CI) between variation in income inequality and tooth loss outcomes adjusting for individual socio-demographic characteristics. RESULTS: Prevalence of severe tooth loss and lack of functional dentition was 4.8 percent and 21.2 percent, respectively. Individuals living in cities with moderate and high increase in income inequality between 1991 and 2003 were more likely to have severe tooth loss and lack a functional dentition in 2010 compared with those living in cities with stable income inequality in the same period. Relationships between low family income and both tooth loss outcomes were significantly attenuated by relative increases in income inequality. CONCLUSIONS: Relative increases in income inequality were significantly associated with severe tooth loss and lack of a functional dentition in Brazilian middle-aged adults.