Caesarean delivery and early childhood caries: Estimation with marginal structural models in Brazilian pre-schoolers.

OBJECTIVE: This study analysed the association between caesarean section and early childhood caries (ECC), estimating the effects using regression and causal inference models. METHODS: This was a historical cohort study of 697 mother-child dyads, conducted in São Luís, Brazil. The caesarean section was the exposure, and the severity of ECC (dmft) was the outcome. Covariates household income, maternal schooling, maternal hypertension, maternal obesity and birth weight were adjusted for in the models. The effects were estimated by Poisson regression (Means Ratio-MR) and causal inference using a marginal structural model (MSM) (MR and Average Treatment Effect-ATE coefficients), weighted by the inverse probability (IPW) of exposure. RESULTS: Caesarean section was protective against caries in the bivariate (MR 0.81; CI 0.70-0.94; P = 0.005) and multivariate (MR 0.78; CI 0.67-0.91; P = 0.002) models. In MSM analyses, the caesarean section had no effect on ECC (ATE = -0.35; P = 0.107), controlling for IPW of exposure. CONCLUSION: The apparent association between caesarean section and ECC severity seems spurious, as it did not persist after employing a superior approach to estimating causality.

Proinflammatory cytokines in early childhood caries: Salivary analysis in the mother/children pair.

HYPOTHESIS: Proinflammatory cytokines are increased in saliva of mother/children pairs with caries. DESIGN: Case-control study involving caries-free children (n = 20) and children with early childhood caries (ECC) (n = 20), and their mothers (n = 40). The maternal variables analyzed were waist circumference (WC), decayed, missing and filled teeth (DMFT) and sugar intake; and in the children were body mass index (BMI), def-t and sugar intake. Salivary levels of VEGF, IL-6 and TNF-α were analyzed of mother/children pairs. RESULTS: In the mothers, salivary VEGF levels were correlated with DMFT (r = 0.35; p = .03), WC (r = 0.35; p = .02), and sugar intake (r = 0.32; p = .04). Higher salivary IL-6 levels were also correlated with maternal DMFT (r = 0.45; p = .004) and WC (r = 0.32; p = .04). In the children, higher salivary VEGF levels were correlated with higher def-t scores (r = 0.42; p = .008). Children with caries had a 63% higher median salivary VEGF and twofold higher mean IL-6 levels compared to caries-free children. Mothers of children with ECC showed higher mean of salivary IL-6 levels compared to those of children without ECC (p = .03). CONCLUSION: Salivary proinflammatory cytokines are correlated with the severity of caries in the mother-children pair. Obesity and excessive sugar consumption seem to underlie the associations between proinflammatory cytokines and caries in the family environment.

The dentist's role in identifying child abuse: an evaluation about experiences, attitudes, and knowledge.

This study sought to investigate dentists' experiences, attitudes, and knowledge in recognizing and reporting suspected cases of child abuse. It was designed as a cross-sectional study across dental practices. Data were collected through a self-administered questionnaire, which was distributed randomly to 500 dentists. The questionnaire investigated characteristics of the population, education concerning child abuse, experience and attitudes in reporting suspected cases, and the ability to recognize signs of abuse. Approximately 60% of the dentists responded to the survey. Among the dentists who participated in the survey, 87% believed that recognizing child abuse is important, however, 63.2% reported that they did not know how to act in such situations, and 44.2% were unaware of the proper child protection authorities to contact. Among the dentists surveyed, 94.7% reported they did not receive enough education concerning child abuse in their undergraduate studies. While 31.3% of dentists suspected child abuse among their patients, 84% reported their suspicions to the proper authorities. The reason cited most often (33.3%) for not reporting suspected abuse was the fear of litigation and its potential impact on their practice. Only 34.2% of dentists demonstrated knowledge about the potential signs of child abuse.

Assessment of mothers' participation in a program of prevention and control of caries and periodontal diseases for infants.

OBJECTIVE: To evaluate mothers who participated in an educational and preventive program for infants in relation to their knowledge on oral health practices. METHODS: A cohort study was performed with 112 mothers and their babies aged 0 to 8 months and registered in the project "Promotion of Oral Health in Early Childhood" from the Federal University of Maranhão (Northeast Brazil). Initially, semi-structured interviews on the level of mothers' knowledge as to their babies' oral health were conducted. The oral cavities of the infants were also examined regarding: level of plaque, gingival bleeding, and dental caries. Then, educational lectures were ministered and, after a year of follow-up, new interviews and clinical examination were performed. For statistical analysis, the chi-square and Fisher exact tests were applied, being significant p<0.05. RESULTS: Before the educational lectures, 93% of the mothers performed oral hygiene of their babies and 57.3% performed it at daytime and nighttime. After the lectures, all mothers performed the oral hygiene (p>0.02) and 74.7% performed it at daytime and nighttime (p=0.01). There were no differences regarding the consumption of cariogenic food in the initial and final questionnaires (p>0.05). Initially, 5.6% of dental surfaces had caries; 29.7%, plaques; and 11.9%, gingival bleeding. After the lectures, only 0.4% of the dental surfaces had caries (p<0.0001); 2.4%, plaque (p<0.0001); and 10.61%, gingival bleeding (p<0.0001). CONCLUSIONS: Knowledge acquisition is essential to improve oral health conditions.