Factores de riesgo hereditarios y socioeconómicos para labio o paladar hendido no asociados a un síndrome en México: estudio de casos y controles pareado / Family history and socioeconomic risk factors for non-syndromic cleft lip and palate: a matched case-control study in a less developed country

Objetivo. Identificar los factores de riesgo hereditarios y socioeconómicos relacionados con la presencia de labio o paladar hendido no asociados a un síndrome. Materiales y métodos. Se hizo un estudio de casos y controles en el que se incluyeron 208 casos con diagnóstico de labio, paladar hendido o ambos no asociados a un síndrome, los cuales fueron pareados por edad y sexo con 416 controles. Se incluyeron todos los pacientes quirúrgicos atendidos durante el periodo 2002-2004 en el programa estatal de labio o paladar hendido de Campeche, México. Se aplicó un cuestionario en el que se recogió información sobre variables sociodemográficas y socioeconómicas, así como sobre antecedentes hereditarios de labio o paladar hendido no asociados a un síndrome en la familia. Debido a que el diseño fue pareado, el análisis se hizo con regresión logística condicionada. Resultados. En el modelo multivariado para labio o paladar hendido no asociado a un síndrome se identificaron de forma significativa (p<0,05) los siguientes factores de riesgo: nivel socioeconómico bajo (razón de momios, RM=2,02), nacimiento en el sur del estado (RM=3,96), nacimiento en casa (RM=2,51) o nacimiento en hospital público (RM=4,08), antecedentes heredofamiliares paternos (RM=5,38), antecedentes heredofamiliares maternos (RM=4,11), tener otro hijo con labio o paladar hendido en la familia (RM=46,02), presentar algún otro defecto congénito asociado (RM=8,20) e infección en el embarazo (RM=2,90), y como factor protector, el cuidado prenatal y el uso de vitaminas (RM=0,29). Conclusiones. El mayor riesgo en nuestra muestra para labio, paladar hendido o ambos, no asociados a un síndrome, radica en las variables relacionadas con los antecedentes familiares y hereditarios, y las indicadoras de la posición socioeconómica. Se observó un efecto protector del manejo prenatal con vitaminas.

Introduction. From an epidemiological point of view, non-syndromic orofacial clefts are the most common oral congenital deformities worldwide.Objective. Family histories were traced and socioeconomic risk factors were identified for non-syndromic cleft lip with or without cleft palate. Material and methods. A case-control study was carried out with 208 cases of non-syndromic cleft lip with or without cleft palate, and matched by age and sex with 416 controls. Cases were patients attending a referral clinic from 2002 through 2004 in Campeche, Mexico. A questionnaire was administered to collect sociodemographic and socioeconomic variables as well as familial background relevant to non-syndromic cleft lip with or without cleft palate. Conditional logistic regression models were used; adjusted odds ratios and 95% confidence intervals were calculated. Results. In the multivariate model, the following risk factors were identified: 1) low socioeconomic status; 2) birth in the southern region of Campeche state; 3) home delivery or delivery in a publicly funded hospital; 4) occurrence of prior non-syndromic cleft lip with or without cleft palate cases in the father’s or mother’s family: 5) having a sibling with non-syndromic cleft lip with or without cleft palate; 6) the proband having another malformation, and 7) a history of infections during pregnancy. Prenatal care consisting of vitamin supplementation was a protective factor for non-syndromic cleft lip with or without cleft palate (odds ratio=0.29). Conclusions. A “social gradient in health” was seen to link oral malformation with diet components, and several socioeconomic and socio-demographic factors broadly encompassed in low socioeconomic status. Further characterization of risk factors will guide the assemblage of a pro-active counseling and prevention program for families at risk for non-syndromic cleft lip and cleft palate.

Family history and socioeconomic risk factors for non-syndromic cleft lip and palate: a matched case-control study in a less developed country.

INTRODUCTION: From an epidemiological point of view, non-syndromic orofacial clefts are the most common oral congenital deformities worldwide. OBJECTIVE: Family histories were traced and socioeconomic risk factors were identified for non-syndromic cleft lip with or without cleft palate. MATERIAL AND METHODS: A case-control study was carried out with 208 cases of non-syndromic cleft lip with or without cleft palate, and matched by age and sex with 416 controls. Cases were patients attending a referral clinic from 2002 through 2004 in Campeche, Mexico. A questionnaire was administered to collect sociodemographic and socioeconomic variables as well as familial background relevant to non-syndromic cleft lip with or without cleft palate. Conditional logistic regression models were used; adjusted odds ratios and 95% confidence intervals were calculated. RESULTS: In the multivariate model, the following risk factors were identified: 1) low socioeconomic status; 2) birth in the southern region of Campeche state; 3) home delivery or delivery in a publicly funded hospital; 4) occurrence of prior non-syndromic cleft lip with or without cleft palate cases in the father's or mother's family: 5) having a sibling with non-syndromic cleft lip with or without cleft palate; 6) the proband having another malformation, and 7) a history of infections during pregnancy. Prenatal care consisting of vitamin supplementation was a protective factor for non-syndromic cleft lip with or without cleft palate (odds ratio=0.29). CONCLUSIONS: A "social gradient in health" was seen to link oral malformation with diet components, and several socioeconomic and socio-demographic factors broadly encompassed in low socioeconomic status. Further characterization of risk factors will guide the assemblage of a pro-active counseling and prevention program for families at risk for non-syndromic cleft lip and cleft palate.

[Tooth loss and periodontal status variables among policemen from Campeche, Mexico]. / Pérdida de dientes y variables del estado periodontal asociadas en hombres policías adultos.

OBJECTIVE: Identify the variables associated with periodontal status and tooth loss among a sample of adults. MATERIAL AND METHODS: We carried out a cross-sectional study among 161 policemen. Our sample was representative of socioeconomics status and lifestyle among policemen in Campeche, Mexico. All periodontal clinical examinations were assessed using the Florida Probe System using a fixed dental chair and one examiner. The variables we measured included presence of dental plaque, calculus, probing deep, gingival insertion, loss of attachment, gingival retraction, suppuration, and probing blood. We examined six sites surrounding all teeth available in the mouth (maximum 168 sites and excluded third molars). Statistical analyses were performed with STATA 8.2 using a bivariate negative binomial regression model due to over-dispersion in the dependent variable. RESULTS: The mean age was 38.36 +/- 10.99 (range: 20-78). The mean of tooth and sites examined in participants was 24.45 +/- 4.63 and 146.72 +/- 27.80, respectively. The prevalence of tooth loss was 73.3%. 571 teeth were missing and the overall mean of missing teeth was 3.55 +/- 4.63 and within subjects with tooth loss was 4.84 +/- 4.80. The prevalence of functional dentition (21 tooth or more) was 83.8%. To have > 20% gingivitis, > 5% of sites with probing deep > or = 4 mm, > 5% of sites with gingival retraction, > 70% of sites with attachment loss > 2 mm, and each unit of age increase the mean expected of tooth loss by 70.6%, 41.8, 156.4%, 86.9%, and 3.6%, respectively. CONCLUSIONS: Our study findings confirm that lost teeth are common among study participants. Higher prevalence and average of tooth loss was observed among this adult population. Several variables of periodontal status were associated with tooth loss.

[Epidemiologic study on dental caries and treatment needs in schoolchildren aged six to twelve years from San Luis Potosi]. / Estudio epidemiológico sobre caries dental y necesidades de tratamiento en escolares de 6 a 12 años de edad de San Luis Potosí.

OBJECTIVE: To determine the experience, prevalence and severity of dental caries, as well as the Significant Caries Index (SiC) and the treatment needs (TN) in schoolchildren aged six to twelve years. Equally, to estimate the effect of caries in primary dentition on caries in permanent dentition. MATERIAL AND METHODS: A cross-sectional study was realized in 3865 schoolchildren from San Luis Potosí City, Mexico. Subjects were clinically evaluated by three standardized examiners (kappa > 0.85). For detection of caries was employed the WHO's criteria for primary (dmft) and permanent (DMFT) dentitions. In the statistical analyzes non-parametric test and logistic regression were used. RESULTS: Mean of age was 8.69 +/- 1.79 and 51.3% were women. In the primary dentition: dmft index was 1.88 +/- 2.34 and the caries prevalence (dmft >0) of 56.8%. In account to severity 22.0% and 5.6% have dmft >3 and dmft >6, respectively. In children of six years, the caries prevalence was 56.0% and the SiC of 5.45. In the permanent dentition: DMFT index was 1.11 +/- 2.03 and the caries prevalence (DMFT >0) of 36.8%. In account to severity 11.8% and 2.8% have DMFT >3 and DMFT >6, respectively. In children of twelve years, the DMFT index caries 4.14 +/- 4.15 and the SiC of 9.15. The TN index was of 88.5% for primary dentition and 93.6% for the permanent. In logistic regression we observed associated to caries prevalence in permanent dentition; presence of caries in primary dentition (OR = 6.37; p < 0.001), female sex (OR = 1.33; p < 0.001) and higher age (OR = 1.69; p < 0.001). CONCLUSIONS: Caries prevalence to six years old and DMFT index to twelve years old were highest to values established by WHO. Caries severity in the primary dentition was two times than observed in the permanent dentition. High TN in both dentitions was observed. Presence of caries in primary dentition was a strong risk indicator for to present caries in permanent dentition.

Necesidades de tratamiento periodontal en adultos de la región rural Mixteca del Estado de Puebla, México / Periodontal treatment needs in adults from Mixteca rural area in Puebla State, Mexico

Objetivo Determinar las necesidades de tratamiento periodontal (NTP) utilizando el índice Comunitario de Necesidades de Tratamiento Periodontal (ICNTP) en una muestra de habitantes de la región Mixteca del estado de Puebla. Material y Métodos Se realizó un estudio transversal en el que se incluyeron 50 pacientes de la clínica rural de Nativitas Cautempan, Puebla., México. Para determinar el estado de salud periodontal se utilizaron el índice Gingival y el índice Comunitario de Necesidades de Tratamiento Periodontal propuesto por la Organización Mundial de la Salud y la Federación Dental Internacional, aplicados por el mismo investigador previamente capacitado y estandarizado. En el análisis, se calculó media y desviación estándar para las variables cuantitativas y frecuencias y proporciones para las variables categóricas. Resultados La edad promedio fue 37,6± 13,6 años. El 60,0 por ciento fueron mujeres, cuya principal ocupación fue amas de casa (46,0 por ciento). El 14 por ciento fueron campesinos. El índice gingival reportó 50,0 por ciento, 32,0 por ciento y 14,0 por ciento para gingivitis leve, moderada y severa, respectivamente. Los sextantes posteriores superiores presentaron mas comúnmente bolsas de 4 a 5 mm, los sextantes anteriores, cálculo y los posteriores inferiores cálculo y hemorragia. El 94,0 por ciento de los pacientes requiere tratamiento periodontal en un promedio de 3,6 sextantes por paciente. Conclusiones Las necesidades de tratamiento periodontal fueron altas en este estudio, nueve de cada diez pacientes de la región Mixteca del Estado de Puebla lo requieren. Es necesario encaminar esfuerzos con el fin de mejorar la salud bucal en las comunidades indígenas.

Objective This study was aimed at determining periodontal treatment needs, as determined by the Community Periodontal Index of Treatment Need (CPITN), in a sample of adults from the Mixteca region of the State of Puebla, in Mexico. Materials and Methods This was a descriptive, cross-sectional, single-centre study. Previous informed consent was obtained; 60.0 percent of the sample were women whose main activity was housework (46 percent), 14.0 percent were farmers. Average age was 37.6 ± 13.6. Gingival and Community Periodontal Index of Treatment Need proposed by the World Health Organisation and the International Dental Federation were used; they were implemented by the same, previously-standardised researcher. Means, standard deviations and confidence intervals were calculated for dimensional variables and percentages for categorical ones. Results The gingival index gave 50.0 percent light gingivitis, 32.0 percent moderate and 14.0 percent severe gingivitis. The rear superior sextants commonly showed more 4 to 5 mm pockets, the front sextants calculus and the rear inferior sextants showed calculus and bleeding. 94.0 percent of the patients required periodontal treatment (3.6 sextants per patient average). Conclusions Periodontal treatment needs were high in this study; nine out of ten patients in the Mixteca region of the State of Puebla required periodontal treatment. Efforts must thus be guided towards improving oral health in indigenous communities.

[Periodontal treatment needs in adults from Mixteca rural area in Puebla State, Mexico]. / Necesidades de tratamiento periodontal en adultos de la región rural Mixteca del Estado de Puebla, México.

OBJECTIVE: This study was aimed at determining periodontal treatment needs, as determined by the Community Periodontal Index of Treatment Need (CPITN), in a sample of adults from the Mixteca region of the State of Puebla, in Mexico. MATERIALS AND METHODS: This was a descriptive, cross-sectional, single-centre study. Previous informed consent was obtained; 60.0 % of the sample were women whose main activity was housework (46 %), 14.0 % were farmers. Average age was 37.6 ± 13.6. Gingival and Community Periodontal Index of Treatment Need proposed by the World Health Organisation and the International Dental Federation were used; they were implemented by the same, previously-standardised researcher. Means, standard deviations and confidence intervals were calculated for dimensional variables and percentages for categorical ones. RESULTS: The gingival index gave 50.0 % light gingivitis, 32.0% moderate and 14.0 % severe gingivitis. The rear superior sextants commonly showed more 4 to 5 mm pockets, the front sextants calculus and the rear inferior sextants showed calculus and bleeding. 94.0 % of the patients required periodontal treatment (3.6 sextants per patient average). CONCLUSIONS: Periodontal treatment needs were high in this study; nine out of ten patients in the Mixteca region of the State of Puebla required periodontal treatment. Efforts must thus be guided towards improving oral health in indigenous communities.

[Socioeconomic inequalities in oral health: factors associated with tooth brushing frequency among Nicaraguan schoolchildren]. / Desigualdades socioeconómicas en salud bucal: factores asociados a la frecuencia de cepillado dental en escolares nicaragüenses.

OBJECTIVE: To identify the association between tooth brushing frequency and variables of socioeconomic position in Nicaraguan schoolchildren. MATERIAL AND METHODS: A cross sectional study was undertaken in 1353 schoolchildren ages 6 to 12 randomly selected from 25 elementary schools in Leon, Nicaragua. Using a questionnaire addressed to mothers, sociodemographic, socioeconomic and behavioral variables were collected. The dependent variable was tooth brushing frequency, which was dichotomized in 0 "at least one 7 times/week" and 1 "7 or more times/week". A multivariate analysis was carried out with logistic regression in STATA 9. RESULTS: The average age of child participants was 8.99 +/- 2.00 years and 49.7% were women. In the final model, older age (OR = 2.04), female sex (OR = 1.39) and having a mother with positive attitudes toward oral health (OR = 2.5) were positively associated with the tooth brushing frequency (p < 0.05). Larger family size (OR = 0.89) and having low socioeconomic status (1st quartile; OR = 0.54, 2nd quartile; OR = 0.62, 3rd quartile; OR = 0.67) showed a negative relationship with the tooth brushing frequency. To have had at least one preventive dental visit in the previous year was positively associated (p < 0.10) with tooth brushing frequency. CONCLUSION: This study suggested that existence of indicators of socioeconomic inequalities exist even within less developed countries, and thus emphasize the need to target health promotion programs to vulnerable socioeconomic groups.

Dental fluorosis in 12- and 15-year-olds at high altitudes in above-optimal fluoridated communities in Mexico.

OBJECTIVE: The purpose of this study was to determine the prevalence and severity of dental fluorosis in Mexican adolescents. MATERIALS AND METHODS: A cross-sectional epidemiological study was carried out in 1,024 adolescents 12 and 15-years-old residing in three naturally fluoridated locales at high altitudes above sea level (> 2,000 m or > 6,560 ft) in Tula de Allende, Hidalgo, Mexico. Participants had lived in those communities from birth to their sixth birthday. Both the Modified Dean Index and the Community Fluorosis Index were calculated. RESULTS: The overall fluorosis prevalence was 83.8 percent. Fluorosis prevalence in El Llano (3.07 ppmF), San Marcos (1.38 ppmF), and Tula Centro (1.42 ppmF) was 94.7, 89.8, and 81.9 percent, respectively. Overall, the Community Fluorosis Index was 1.85. We observed a high prevalence of dental fluorosis--mostly very mild (35.9 percent), but also uncommonly severe (20.6 percent). CONCLUSIONS: At least 8 out of 10 adolescents had some level of fluorosis, and such prevalence is considered to be a dental public health problem. A relationship between fluoride concentration in water in each community and fluorosis was observed. The high fluorosis prevalence and severity might possibly be associated with the high altitude of the communities.

Prevalence and severity of dental caries in adolescents aged 12 and 15 living in communities with various fluoride concentrations.

OBJECTIVES: To determine the experience, prevalence, and severity of dental caries in adolescents naturally exposed to various fluoride concentrations. METHODS: A cross-sectional census was conducted on 1,538 adolescents aged 12 and 15 years living at high altitude above sea level (> 2,000 m or > 6,560 ft) in above-optimal fluoridated communities (levels ranging from 1.38 to 3.07 ppm) of Hidalgo, Mexico. Sociodemographic and socioeconomic data were collected using questionnaires. Two previously trained and standardized examiners performed the dental exams. RESULTS: Caries prevalence was 48.6 percent and mean of decay, missing, and filling teeth (DMFT) for the whole population was 1.15 +/- 1.17. In terms of severity, 9.6 percent of the adolescents had DMFT > or = 4, and 1.7 percent had > or = 7. The significant caries index (SiC) was 2.41 in the group of 12-year-olds, and 3.46 in the 15-year-olds. Higher experience and prevalence were observed in girls, in children with dental visit in the past year, those in the wealthiest socioeconomic status (SES) (quartiles 2, 3, and 4), those whose locale of residence is in San Marcos and Tula Centro, and in fluorosis-free children and those with moderate/severe fluorosis. In an analysis of caries severity (DMFT > or = 4), both adolescents with very mild/mild and moderate/severe dental fluorosis have higher caries severity. CONCLUSIONS: The results indicated that caries experience, prevalence, and severity as well as SiC index among 12- and 15-year-old adolescents were relatively low. Sociodemographic and socioeconomic variables commonly associated with dental caries were also observed in Mexican adolescents. Unlike other studies, we found that caries increased with higher SES. Fluoride exposure (measured through fluorosis presence) does not appear to be reducing the caries prevalence (DMFT > 0) or caries severity (DMFT > or = 4) in these high-altitude communities.