Clinical manifestations of tooth eruption in the first year of life and related risk factors in three regions of Brazil: multicenter birth cohort study.

PURPOSE: Estimate the incidence of teething symptoms and investigate risk factors at three centers in different regions of Brazil. METHODS: A prospective cohort study enrolled children at birth in the cities of Manaus (northern region), Porto Alegre (southern region) and Salvador (northeast region). Sociodemographic and anthropometric variables were collected at baseline and 6 months. At 12 months, data were collected on the child's health through structured interviews and dental examinations, including the primary outcome: occurrence of signs and symptoms of tooth eruption reported by parents. Statistical analysis involved Poisson regression with robust variance, with calculation of relative risks (RR). RESULTS: The incidence of teething symptoms was 82.4% (238/289). The multivariate analysis revealed a higher occurrence of the outcome in the city of Salvador (RR = 1.39; 95% CI 1.23-1.58), when mother's education was more than 11 years (RR = 1.31; 95% CI 1.04-1.65), when a larger number of individuals resided in the home (RR = 1.15; 95% CI 1.02-1.29), when a smoker resided in the home (RR = 1.16; 95% CI 1.03-1.31) and when the child presented flu or cold in the first year of life (RR = 1.23; 95% CI 1.09-1.38). The most reported symptoms were fever (50.5%), irritability (42.6%), itching (40.8%) and diarrhea (35.3%). Most parents (82%) took some action to alleviate symptoms, including unprescribed systemic medication, such as analgesic, anti-inflammatory and anti-diarrheic agents. CONCLUSION: Reports of teething symptoms were associated with the city investigated, socioeconomic factors of the families and characteristics of the child's health. A high rate of administering unprescribed medication was also found.

Dental behaviour management problems and associated factors in Brazilian children.

AIM: To identify factors associated with negative child behaviour in the dental setting. MATERIALS AND METHODS: A cross-sectional study was conducted with a sample of 324 mother-child pairs (children aged 3 to 12 years) seen at a university clinic in Canoas, southern Brazil. Mother's anxiety was measured using the Beck Anxiety Inventory. Oral examinations were performed to determine caries experience (dmft/DMFT index) in the mothers and children. Child behaviour was evaluated at six moments of the dental visit using the Frankl scale. Statistical analysis involved Poisson regression with robust variance. RESULTS: The prevalence of negative child behaviour was 9.3%, with a greater frequency among younger children, those with no previous use of dental services and those whose mothers exhibited a moderate to severe level of anxiety. The multivariable analysis demonstrated that the probability of negative behaviour was 2.4-fold greater among children who had not previous dental services attendance (PR = 2.37, 95% CI:1.13-4.95; p=0.022) and 3.1-fold greater among those whose mothers had a moderate to severe level of anxiety (PR = 3.08, 95% CI:1.64-5.75; p<0.001). CONCLUSION: Mother's anxiety, younger age and no previous history of visiting a dentist are associated with negative behaviour during a dental appointment and therefore merit special attention.

Developmental defects of enamel in primary teeth: highly prevalent, unevenly distributed in the oral cavity and not associated with birth weight.

AIM: Estimate the prevalence of developmental defects of enamel (DDE) in the primary dentition, describe the distribution among tooth groups and investigate the association with birth weight. METHODS: A cross-sectional study was conducted with a sample of 827 children aged 2-5 years representative of the city of Canela in southern Brazil. Demographic characteristics (gender and age) and birth weight were collected from vaccination cards. The diagnosis of DDE was performed by six trained examiners following the criteria of the Federation Dentaire International. DDE were described both jointly and separately as opacity and hypoplasia. Statistical analysis involved the Chi square test, Mann-Whitney test and Poisson regression with robust variance. RESULTS: The prevalence of DDE was 55.1% (95% CI 51.6-58.5%), with a mean of 3.0 ± 2.2 teeth affected. Opacity was the more frequent defect (50.4%), followed by hypoplasia (15.5%). Distribution of the defects was uneven, with opacity predominant on second molars and hypoplasia predominant on canines and second molars. Children with a low birth weight did not have a greater probability of opacity (PR: 1.13; 95% CI 0.91-1.41), hypoplasia (PR: 1.33; 95% CI 0.80-2.22) or DDE (PR: 1.11; 95% CI 0.91-1.37). CONCLUSION: The prevalence of DDE was high, predominant on second molars and not associated with birth weight. These findings indicate directions for future examination/diagnosis protocols and specific orientations.

Neighbourhood Determinants of Caries Experience in Preschool Children: A Multilevel Study.

OBJECTIVES: To investigate the association between neighbourhood factors and decayed, missing, and filled teeth (dmft) index among preschool children. METHODS: The sample of this cross-sectional study comprised 1,110 children (0-5 years old) clustered in 16 official neighbourhoods of Canoas city, southern Brazil. Multilevel binomial models were used to estimate the association of contextual variables at neighbourhood level (Human Development Index, average income, and public primary health care units) with two oral health outcomes: decayed teeth (dt) and missing or filled teeth (mft), after adjusting for individual variables (gender, age, maternal education, equivalent household income logarithm, household, and point of care). RESULTS: Overall, 24.9% of the sample had dental caries experience (dmft >0), and 92.3% of the dmft was untreated caries. There was no statistical significant association (p > 0.05) of contextual characteristics with the decay component. The teeth of children living in richer areas had 2.87 (95% CI: 1.05-7.86) times more chances of being treated (mft component). Variance attributed to neighbourhood level was estimated as 5.9% (p < 0.01) and 4.1% (p = 0.17) for dt and mft, respectively, in adjusted models. CONCLUSIONS: Intra-urban areas seem homogeneous, with small variability between neighbourhoods, having no contextual effect on untreated dental caries (dt). Contextual variables may influence treatment access (mft) through the use of dental services in preschool children.

Maternal education is an independent determinant of cariogenic feeding practices in the first year of life.

AIM: To identify risk factors for cariogenic feeding practices in the first year of life. STUDY DESIGN: Cohort study. METHODS: 500 children born within the public health care system in São Leopoldo, Brazil, were recruited in a follow-up program. Anthropometric and demographic data were collected soon after birth; data on feeding practices were assessed at 12 months of age using a standardised questionnaire; clinical examination at 4 years of age allowed identification of cariogenic feeding practices in the first year of life and to quantify their relative risks. In the present study, the attributable risks of each child were summed, and the outcome was assessed for the upper quartile of scores for cariogenic feeding practices. STATISTICS: Adjusted relative risks for the outcome were estimated using robust Poisson regression models. RESULTS: A total of 327 children comprised the final study sample, i.e. were followed from birth to 4 years of age. Multivariate analysis showed that the risk of cariogenic feeding practices doubled in children from mothers with less than 5 years of education (RR 2.19, 95%CI 1.26-3.82) and was 70% higher in children from mothers with 5-8 years of education when compared with maternal education >8 years. The other independent variables were not associated with the outcome. CONCLUSIONS: Low maternal education is a risk factor for cariogenic feeding practices, independently of other factors. Mothers with low educational levels should be the focus of child health promotion interventions, especially those aimed at controlling dental caries.

Evaluation of laser fluorescence in the monitoring of the initial stage of the de-/remineralization process: an in vitro and in situ study.

This study aimed to evaluate laser fluorescence (LF) for monitoring the initial stage of subsurface de- and remineralization (<150 microm depth). Ninety-six sound blocks of bovine enamel, selected according to surface hardness (SH) and LF were used in two experimental studies, in vitro and in situ. In vitro, blocks were exposed to a demineralizing solution, then remineralized by pH cycling for 6 days. In situ, 10 volunteers wore acrylic palatal appliances, each containing 4 dental enamel blocks that were demineralized for 14 days by exposure to 20% sucrose solution. Following this treatment, blocks were submitted to remineralization for 1 week with fluoride dentifrice (1,100 microg F/g). In both experiments, SH and LH were measured after demineralization and after remineralization. Further, enamel blocks were selected after the demineralization/remineralization steps for measurement of cross-sectional hardness and integrated loss of subsurface hardness (Delta KHN). SH and Delta KHN showed significant differences among the phases in each study. LF values for sound, demineralized and remineralized enamel were: 5.2 +/- 1.1, 8.1 +/- 1.2 and 5.6 +/- 0.8, respectively, in the in vitro study, and 5.3 +/- 0.3, 16.5 +/- 4.7 and 6.5 +/- 2.5, respectively, in the in situ study, values for demineralized enamel being significantly higher than for sound and remineralized enamel in both studies. However, LF was correlated with Delta KHN only in situ. LF was capable of monitoring de- and remineralization in early lesions in situ, when bacteria are presumably present in the caries lesion body, but is not correlated with mineral changes in bacteria-free systems.

The immediate and long-term effects of invasive and noninvasive pit and fissure sealing techniques on the microflora in occlusal fissures of human teeth.

The purpose of this study was to evaluate the effect of acid conditioning and occlusal sealant on microbial colonization of pit and fissures submitted to ameloplasty or left intact. Human enamel blocks containing fissures prepared from the occlusal surfaces of unerupted third molars were implanted in occlusal fillings in molars of 12 patients for seven, 30, 60, and 120 days. After seven days of exposure to the oral environment, the pit and fissure blocks were removed and found to be colonized, mainly with gram-positive coccal flora. The acid-etching procedure itself reduced the number of cultivable microorganisms by about 95%. Subsequent application of occlusal sealant caused a gradual decrease of the remaining viable microorganism throughout the experiment. Despite the decrease of 100% after acid etching in most of the fissures submitted to ameloplasty, the occlusal sealant did not lead to a subsequent significant reduction.