Utilization of dental services by preschool children: prevalence and associated factors.

Dental associations worldwide recommend that the first dental visit should take place before 12 months of age; however, preschoolers' utilization of dental services remains low. The aim of this study was to assess the prevalence of, and factors associated with, dental services utilization among children aged 1 to 3 years. This was a cross-sectional study carried out in the city of Diamantina, MG, Brazil, and involved a sample of 308 child-mother pairs. Mothers completed a questionnaire addressing sociodemographic and economic aspects of the family and characteristics pertaining to their child's oral health. The clinical assessment of the children included dental caries, trauma, malocclusion, and mucosal changes. Analysis of the data comprised statistical description, application of the chi-square test, and Poisson's regression analysis. Among the children studied, 39.6% had attended at least one dental visit in their lifetime. Children whose families had a greater number of members relying on the family's income (PR = 1.40, 95%CI:1.04 -1.89, p = 0.028) and those with moderate/extensive dental caries (Codes 3-6 of the ICDAS; PR = 1.44, 95%CI: 1.08 -1.93, p = 0.014) exhibited a higher prevalence of dental services utilization. In conclusion, the prevalence of dental services utilization among children aged 1 to 3 years was low, and was associated with a greater number of family members relying on the family's income, and with the occurrence of moderate/extensive dental caries.

Effect of oral hygiene in infants before dental eruption on Candida spp. colonization and the occurrence of oral candidiasis: A randomized clinical trial.

Background: To assess the influence of oral hygiene in infants before the primary tooth eruption on colonization by Candida spp. and the occurrence of oral candidiasis. Material and Methods: Fifty-six infants were randomly selected in their first 48 hours of life and allocated into 2 groups: Group I (Mothers were instructed to sanitize the oral cavity of the infant with gauze and filtered water once a day) and Group II (Mothers were instructed not to sanitize the oral cavity of the infant before the dental eruption). Data collection was performed one month after the birth of the infant, in their residence, including saliva collection for identification and quantification of Candida spp. Results: Colonization by Candida spp. species was found in 49.1% of the infants evaluated. There was no statistically significant difference between colonization by Candida spp. and intervention groups (p=0.947). 13.2% of the participants presented oral candidiasis during the first month of life, this prevalence was 15.4% in the control group and 11.1% in the intervention group, however, this difference was not significant (p=0.704). Conclusions: The Candida spp. colonization and the oral candidiasis occurrence, in the first month of the life of the infant, were not influenced by oral hygiene. Key words:Infants, oral hygiene, oral health, oral candidiasis.

The Impact of Socio-Environmental, Individual, and Biological Factors on Oral Health-Related Quality of Life among Preschool Children: A Cohort Study with 3-Year Follow-Up.

This study assessed impact of socio-environmental, individual, and biological factors on the worsening and severe worsening of oral health-related quality of life (OHRQoL) among preschoolers and their families. A cohort study was conducted in Diamantina, Brazil, with 151 children between 1 and 3 years of age and their mothers, who were evaluated at baseline (2014) and re-evaluated after 3 years (2017). The children were clinically examined to assess the presence of dental caries, malocclusion, dental trauma, and enamel defects. The mothers answered the Early Childhood Oral Health Impact Scale (B-ECOHIS) and a questionnaire addressing individual characteristics of the child and socio-environmental factors. Extensive caries found in the follow-up (relative risk [RR] = 1.91; 95% confidence interval [CI] = 1.26-2.91) and failure to undergo the dental treatment recommended at baseline (RR = 2.49; 95% CI = 1.62-3.81) were associated with worsening of OHRQoL over 3 years. An increase in the number of children in the household (RR = 2.95; 95% CI = 1.06-8.25), occurrence of extensive caries in the follow-up (RR = 2.06; 95% CI = 1.05-4.07), and failure to undergo the dental treatment recommended at baseline (RR = 3.68; 95% CI = 1.96-6.89) were associated with a severe worsening of OHRQoL. In conclusion, the risk of worsening and severe worsening of OHRQoL was higher in preschoolers with extensive caries at follow-up and among those who did not undergo dental treatment. Furthermore, severe worsening of OHRQoL was also impacted by an increase in the number of children in the household.

Mothers' sense of coherence and oral health-related quality of life of preschoolers: a 3-year cohort study.

The aim of the present study was to assess whether mothers' sense of coherence (SOC) was a predictor of decline in oral health-related quality of life (OHRQoL) of preschoolers. A 3-year cohort study was conducted in Diamantina, Brazil. At baseline, 162 preschoolers aged one to three years were randomly selected from among children registered in local Primary Healthcare Units. In the first stage, mothers completed a sociodemographic questionnaire, the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS), and the Brazilian short version of the Sense of Coherence Scale (SOC-13). The total score obtained from the SOC-13 was used to select exposed and unexposed children. Clinical examinations were performed to detect the presence of dental caries, traumatic dental injury, and malocclusion. At follow-up, mothers completed the sociodemographic questionnaire and the B-ECOHIS again. The incidence of severe dental caries and adherence to the proposed treatment at baseline were evaluated. A decline in OHRQoL was considered if there was an increase in the B-ECOHIS score of at least one unit. The chi-square test and Poisson regression were performed. A total of 151 preschoolers participated in the study, among whom 37.7% showed a decline in OHRQoL. Mothers' SOC was not associated with a negative impact on OHRQoL (RR = 1.24; 95%CI = 0.81-1.88), while the incidence of severe dental caries had a greater impact on the decline in OHRQoL (RR = 2.02; 95%CI = 1.29-3.16). Mothers' low SOC was not a predictor of decline in the OHRQoL of preschoolers after a 3-year follow-up period.

Family income modifies the association between frequent sugar intake and dental caries.

AIM: The aim of this cross-sectional study was to investigate whether family income modifies associations between dental caries and sex, age, mother's education, type of preschool, sugar intake, and toothbrushing. BACKGROUND: Dental caries is a multifactorial dyanamic disease primarily mediated by biofilm and sugar. DESIGN: A randomly selected sample of 308 Brazilian preschool children aged 1-3 years underwent a clinical oral examination for the assessment of moderate/extensive dental caries using codes 3-6 of the International Caries Detection and Assessment System. Mothers were asked to fill out a form addressing the child's demographic and socioeconomic characteristics as well as the frequency of sugar intake. Statistical analysis involved descriptive statistics, the chi-squared test, and Poisson regression models. RESULTS: The prevalence of moderate/extensive dental caries was 42.5%. The adjusted model revealed that within low-income families (<2 times the monthly minimum wage), the prevalence of dental caries was higher among children with a high frequency of sugar intake (≥ twice per day) than in those with a low frequency of sugar intake (< twice a day) (RR = 1.79; CI: 1.38-2.33). In families with higher income (≥2 times the monthly wage), no significant association between sugar intake and dental caries was, however, found. CONCLUSIONS: In conclusion, monthly family income can modify the association between the high frequency of sugar intake and dental caries.

Association between child's behaviour during first dental appointment and effectiveness of dental plaque removal by caregivers.

OBJECTIVE: To evaluate the association between the behaviour of children aged 1 to 4 years during their dental appointment and the effectiveness of dental plaque removal by caregivers. METHODS: This longitudinal study with intervention had the participation of 146 children (mean age = 34.89 months), 75 of whom (51.4%) showed positive behaviour (+ and ++) and 71 (48.6%), negative behaviour (- and - -). The children were evaluated at the first dental appointment, according to the Frankl scale. They were subjected to an assessment of oral conditions, and their plaque level was recorded (Quigley-Hein Index modified by Turesky) using the Evince® device. Caregivers received oral hygiene guidance. The dental plaque assessment was performed before giving the oral hygiene guidance and 14 days later. The statistical analysis included a descriptive assessment and the Wilcoxon test (p < 0.05). RESULTS: Mean dental plaque levels dropped significantly from the first to the second assessment (p < 0.001). The sample was divided according to the child's behaviour, observing that only the group of children with positive behaviour showed significantly less dental plaque in the second assessment (p < 0.001). CONCLUSION: The positive behaviour of children aged 1 to 4 years during the first dental appointments is associated with more effective dental plaque removal by caregivers.

Mothers' sense of coherence and oral health-related quality of life of preschoolers: a 3-year cohort study

Abstract The aim of the present study was to assess whether mothers' sense of coherence (SOC) was a predictor of decline in oral health-related quality of life (OHRQoL) of preschoolers. A 3-year cohort study was conducted in Diamantina, Brazil. At baseline, 162 preschoolers aged one to three years were randomly selected from among children registered in local Primary Healthcare Units. In the first stage, mothers completed a sociodemographic questionnaire, the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS), and the Brazilian short version of the Sense of Coherence Scale (SOC-13). The total score obtained from the SOC-13 was used to select exposed and unexposed children. Clinical examinations were performed to detect the presence of dental caries, traumatic dental injury, and malocclusion. At follow-up, mothers completed the sociodemographic questionnaire and the B-ECOHIS again. The incidence of severe dental caries and adherence to the proposed treatment at baseline were evaluated. A decline in OHRQoL was considered if there was an increase in the B-ECOHIS score of at least one unit. The chi-square test and Poisson regression were performed. A total of 151 preschoolers participated in the study, among whom 37.7% showed a decline in OHRQoL. Mothers' SOC was not associated with a negative impact on OHRQoL (RR = 1.24; 95%CI = 0.81-1.88), while the incidence of severe dental caries had a greater impact on the decline in OHRQoL (RR = 2.02; 95%CI = 1.29-3.16). Mothers' low SOC was not a predictor of decline in the OHRQoL of preschoolers after a 3-year follow-up period.

Risk indicators of untreated dental caries incidence among preschoolers: a prospective longitudinal study.

The aim of the present study was to evaluate the influence of socioeconomic factors, oral conditions and the impact of OHRQoL as possible risk indicators related to the incidence of untreated dental caries in preschool children two years after an initial examination. A prospective longitudinal study was performed with a sample of 288 preschool children allocated to two groups at baseline (T0): caries free (n = 144) and with untreated dental caries (n = 144). Untreated dental caries was determined through clinical examinations performed by a calibrated dentist at T0 (Kappa > 0,89) and T1 (two years after the baseline) (Kappa > 0,91) using the dmft criteria. Parents/caregivers answered a socioeconomic questionnaire and the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) at T0 and T1. Mann-Whitney test and hierarchically adjusted Poisson regression models were used (95%CI, p < 0,05). The incidence of untreated dental caries was 41.3%. Low (RR = 1.63; 95%CI:1.18-2.26; p < 0.001) and high severity of untreated dental caries (RR = 1.92; 95%CI:1.36-2.72; p < 0.001), monthly household income less than two times the Brazilian minimum salary (RR = 1.79; 95%CI:1.04-3.25; p = 0.042) and overall B-ECOHIS score (RR = 1.03; 95%CI:1.02-1.05; p < 0.001) at T0 were risk indicators for the incidence of untreated dental caries among the preschool children. In conclusion, the incidence of untreated dental caries was high and the higher severity of untreated dental caries, the lower monthly income and the higher the B-ECOHIS score (indicating a negative impact on quality of life) were risk indicators to the developing of new lesions of untreated dental caries after 2 years.

Association of the prevalence and severity of untreated traumatic dental injuries with body mass index among Brazilian preschool children.

BACKGROUND/AIM: Children with excess weight may be more predisposed to traumatic dental injuries (TDI). The aim of this study was to investigate the association between overweight/obesity and TDI presence and severity in Brazilian preschool children. MATERIAL AND METHODS: A cross-sectional study was conducted of 347 children aged three to five years. The main exposure was evaluated based on the body mass index (BMI). Socioeconomic-demographic characteristics and harmful oral habits were investigated using a questionnaire sent to the parents/guardians. Oral clinical examinations were performed to determine overjet (criteria proposed by Foster and Hamilton), and the presence and severity of TDI (criteria proposed by Andreassen). Descriptive statistics were performed. Univariate and multivariate Poisson regression analyses were conducted for each outcome. RESULTS: The prevalence of TDI in the sample was 41.5% and 16% of the children had enamel and dentin fractures. In the multivariate analysis, BMI and overjet were associated with the presence and severity of TDI (PR: 2.04 and 1.78, respectively) of TDI (PR: 2.27 and 2.24, respectively) (p < .001 for all associations). CONCLUSION: Overweight/obesity was associated with both the presence and severity of TDI in early childhood.

Association between different stages of dental caries in preschoolers and familial socioeconomic factors.

This study evaluated the association between socioeconomic factors and stages of dental caries in children one to five years of age. A cross-sectional study was conducted involving 759 children enrolled in preschools in Diamantina, Brazil. The parents/caregivers filled out a form addressing socioeconomic factors. Add to the end of this sentence: and categorized in caries free (code 0 and 1), no obvious decay (code 2 and 3) and obvious decay (code 4, 5 and 6). Statistical analysis was performed using the Mann-Whitney test and multinomial regression. The prevalence of "no obvious decay" was higher among children from families with a larger number of income-dependent individuals (OR: 2.47; 95%CI: 1.41-4.31). The higher prevalence of "obvious decay" was associated with the child's age (OR: 1.36; 95%CI: 1.16-1.58), attending a public preschool (OR: 2.38; 95%CI: 1.31-4.34), a larger number of income-dependent individuals (four to five individuals: OR: 1.71; 95%CI: 1.09-2.74; more than five individuals: OR: 3.41; 95%CI: 1.95-5.94), no access to a dentist (OR: 2.14; 95%CI: 1.48-3.09), and lower income (OR: 1.72; 95%CI: 1.19--2.49). It was concluded that the variable of a larger number of income-dependent individuals was associated with both no obvious decay and obvious decay. Child's age, type of preschool, access to a dentist, and income were associated with obvious decay.

Children who have more toothache-related behaviors have worse masticatory performance.

Inadequate masticatory function can be linked to oral problems and result in functional limitation. In children, this function is extremely important for their development, and therefore efforts are made to keep it adequate. To evaluate whether dental pain-related behaviors are associated with masticatory performance (MP). A cross-sectional study was conducted with a sample of 123 children from 3 to 5 years old. Toothache was evaluated using the Dental Discomfort Questionnaire. Anthropometric data, predominant type of breathing, presence of malocclusion, number of posterior teeth cavitated by dental caries, and masticatory units were collected. MP was measured by the median size of the crushed particles (X50 ) after 20 cycles of chewing the Optocal test material and was calculated with the Rosin-Rammler equation. Data analysis involved a description of variable frequencies, as well as simple and multiple linear regression, and a confidence level set at 95%. The mean scores of dental pain-related behaviors were 1.14 (±1.90) points, and the mean X50 value was 3.96 mm (±1.34). In the multiple linear regression, a larger median size of the particles remained associated with a higher score of dental pain-related behaviors (ß = +.81, p = .01); mouth breathing (ß = +.22, p = .01); and a smaller number of masticatory units (ß = -.22, p = .02). Greater dental pain-related behavior scores are associated with worse MP, regardless of the presence of associations with predominantly oral breathing and fewer chewing units.

Association between obesity and traumatic dental injuries in pre-school children-A case-control study.

BACKGROUND/AIM: Obese children are more prone to accidents due to poorer motor skills which increase the likelihood of falls and the occurrence of traumatic dental injuries (TDIs). The aim of this study was to determine the association between overweight/obesity and TDI in pre-school children. MATERIAL AND METHODS: The case group was formed by children with TDI identified during a clinical examination (n = 262). Each pre-school child identified as a case was matched by a peer of the same age, gender and pre-school but without TDI to form the control group (n = 262). TDI was evaluated using the criteria proposed by Andreasen. The weight and height of the children were measured for the calculation of the body mass index which was plotted on the growth curve established by the World Health Organization. Socio-demographic variables were collected through questionnaires sent to the parents/guardians. Data analysis involved the determination of frequency distribution, the chi-square test and logistic regression analysis. RESULTS: The sample was composed of 253 children in each group. Among the children in the case group, 15.4% (n = 39) were overweight and 15.8% (n = 40) were obese. In the control group, 13.8% (n = 35) were overweight and 8.3% (n = 21) were obese. Children with trauma were more likely to be obese than children without trauma (OR = 2.05; 95%CI: 1.14 to 3.67; p = .016). In contrast, TDI was not associated with being overweight. A greater odds of TDI was also associated with an open bite (OR = 3.61; 95% CI: 1.64 to 7.96; p = .001) and accentuated overjet (OR = 2.19; 95% CI: 1.37 to 3.50; p = .001). CONCLUSIONS: Pre-school children with a history of dental trauma were more likely to be obese than those without a history of dental trauma whereas being overweight was not associated with TDI.

Longitudinal evaluation of determinants of the clinical consequences of untreated dental caries in early childhood.

OBJECTIVES: This study aimed to evaluate whether the trajectory of family income, parental education and clinical variables are associated with the clinical consequences of untreated dental caries among children. METHODS: A prospective cohort study was conducted with 439 children between one and three years of age, evaluated at baseline and re-evaluated after three years. Sociodemographic and economic variables, untreated dental caries and biofilm were investigated both at baseline and at the 3-year follow-up. The pufa index (pulpal involvement, ulceration, fistula and abscess) was used to diagnose the clinical consequences of untreated dental caries. RESULTS: The prevalence of pufa ≥1 was 18.2% in the follow-up. The following variables were associated with a higher risk of clinical consequences of untreated dental caries: mother's low schooling level at baseline and follow-up (RR = 1.51; 95% CI: 1.04-2.18), incidence or baseline presence of biofilm (RR = 4.66; 95% CI: 2.02-10.74), cavitated dental caries at baseline (RR = 3.57; 95% CI:1.86 to 6.83) and incidence of cavitated dental caries (RR = 2.04; 95% CI: 1.24-3.35). CONCLUSION: Low maternal schooling level, biofilm, cavitated dental caries at baseline, and incidence of dental caries were the factors determining the consequences of untreated dental caries.

Association between different stages of dental caries in preschoolers and familial socioeconomic factors

Abstract: This study evaluated the association between socioeconomic factors and stages of dental caries in children one to five years of age. A cross-sectional study was conducted involving 759 children enrolled in preschools in Diamantina, Brazil. The parents/caregivers filled out a form addressing socioeconomic factors. Add to the end of this sentence: and categorized in caries free (code 0 and 1), no obvious decay (code 2 and 3) and obvious decay (code 4, 5 and 6). Statistical analysis was performed using the Mann-Whitney test and multinomial regression. The prevalence of "no obvious decay" was higher among children from families with a larger number of income-dependent individuals (OR: 2.47; 95%CI: 1.41-4.31). The higher prevalence of "obvious decay" was associated with the child's age (OR: 1.36; 95%CI: 1.16-1.58), attending a public preschool (OR: 2.38; 95%CI: 1.31-4.34), a larger number of income-dependent individuals (four to five individuals: OR: 1.71; 95%CI: 1.09-2.74; more than five individuals: OR: 3.41; 95%CI: 1.95-5.94), no access to a dentist (OR: 2.14; 95%CI: 1.48-3.09), and lower income (OR: 1.72; 95%CI: 1.19--2.49). It was concluded that the variable of a larger number of income-dependent individuals was associated with both no obvious decay and obvious decay. Child's age, type of preschool, access to a dentist, and income were associated with obvious decay.

Risk indicators of untreated dental caries incidence among preschoolers: a prospective longitudinal study

Abstract: The aim of the present study was to evaluate the influence of socioeconomic factors, oral conditions and the impact of OHRQoL as possible risk indicators related to the incidence of untreated dental caries in preschool children two years after an initial examination. A prospective longitudinal study was performed with a sample of 288 preschool children allocated to two groups at baseline (T0): caries free (n = 144) and with untreated dental caries (n = 144). Untreated dental caries was determined through clinical examinations performed by a calibrated dentist at T0 (Kappa > 0,89) and T1 (two years after the baseline) (Kappa > 0,91) using the dmft criteria. Parents/caregivers answered a socioeconomic questionnaire and the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) at T0 and T1. Mann-Whitney test and hierarchically adjusted Poisson regression models were used (95%CI, p < 0,05). The incidence of untreated dental caries was 41.3%. Low (RR = 1.63; 95%CI:1.18-2.26; p < 0.001) and high severity of untreated dental caries (RR = 1.92; 95%CI:1.36-2.72; p < 0.001), monthly household income less than two times the Brazilian minimum salary (RR = 1.79; 95%CI:1.04-3.25; p = 0.042) and overall B-ECOHIS score (RR = 1.03; 95%CI:1.02-1.05; p < 0.001) at T0 were risk indicators for the incidence of untreated dental caries among the preschool children. In conclusion, the incidence of untreated dental caries was high and the higher severity of untreated dental caries, the lower monthly income and the higher the B-ECOHIS score (indicating a negative impact on quality of life) were risk indicators to the developing of new lesions of untreated dental caries after 2 years.

The prevalence of malocclusion is higher in schoolchildren with signs of hyperactivity.

INTRODUCTION: Attention deficit-hyperactivity disorder is a behavioral disorder characterized by a lack of focus, impulsive behavior, and or excessive activity. This research aimed to evaluate the association between signs of attention deficit-hyperactivity disorder and malocclusion in schoolchildren. METHODS: A cross-sectional study was conducted with a representative sample of 633 children aged 7-12 years. The children were clinically examined for malocclusion using the Dental Aesthetic Index. The predominant breathing pattern was also determined. Parents answered a questionnaire addressing socioeconomic characteristics and the presence of nonnutritive sucking habits. The Swanson, Nolan, and Pelham Scale-IV was filled out by both parents and teachers to compare behavioral patterns. The children were submitted to a neuropsychological evaluation using the Raven's Colored Progressive Matrix Test. Data analysis involved the chi-square test and Poisson regression analysis. RESULTS: The prevalence of malocclusion was 42% higher among children with signs of hyperactivity reported by both parents and teachers (prevalence ratio [PR], 1.42; 95% confidence interval [CI], 1.11-1.81; P = 0.004). In the final Poisson regression model, the prevalence of malocclusion was lower among schoolchildren aged 11 and 12 years (PR, 0.62; 95% CI. 0.52-0.73; P <0.001) and higher among those who used a pacifier for at least 4 years (PR, 1.25; 95% CI, 1.02-1.54; P = 0.029) as well as those classified as mouth breathers (PR, 1.28; 95% CI, 1.09-1.51; P = 0.003). CONCLUSIONS: The prevalence of malocclusion was higher among children with signs of hyperactivity independently of age, pacifier use, and mouth breathing.

Untreated dental caries and visible plaque of mothers are not determinant for the incidence of caries in dentin among children: evidence from a 3-year prospective cohort study.

OBJECTIVES: To evaluate whether characteristics related to mother's oral health, trajectory of family income, and maternal education are associated with the incidence of caries in dentin in preschool children. MATERIALS AND METHODS: One hundred fifty-eight mothers and their children were evaluated at baseline and re-evaluated after 3 years. Sociodemographic variables, dental caries, and biofilm of the mothers and children and daily sugar intake of the children were evaluated. Poisson regression was used to evaluate what factor represents risk for the incidence of caries in dentin at four to 6 years of age. RESULTS: The risk of the incidence of caries in dentin was 54% higher in children whose mothers had a low level of education at both baseline and follow-up. Children from families with an income lower at baseline and follow-up (RR 2.49; 95% CI 1.62-3.83) and those whose families experienced a reduction in income in this period (RR 2.05; 95% CI 1.29-3.26) had a greater risk of the incidence of caries in dentin. Moreover, children who increased their daily sugar intake (RR 1.67; 95% CI 1.09-2.52), those that maintained high sugar intake (RR 1.81; 95% CI 1.14-2.87), and those with cavitated caries at baseline (RR 1.53; 95% CI 1.19-1.97) had a greater risk of the incidence of caries in dentin. CONCLUSIONS: Low mother's education, a lower family income, a reduction in family income, a high frequency of daily sugar intake, and a history of cavitated caries were risk factors for the incidence of caries in dentin. CLINICAL RELEVANCE: The results could help in the targeting of improved prevention and control strategies for dental caries.

Influence of breastfeeding duration on the incidence of dental caries in preschoolers: a cohort study / Influência da duração da amamentação na incidência de cárie dentária em pré-escolares: um estudo de coorte

Abstract Objectives: investigate the association between breastfeeding duration and the incidence of severe caries in preschoolers. Methods: a cohort study was conducted with 132 pairs of mothers and children in the city of Diamantina, Brazil. Data collection was performed in 2 moments: when the children were between two and three years of age (baseline- 2013/2014) and after three years (T1-2016/2017). In both moments, children were evaluated for dental caries (International Caries Detection and Assessment System - ICDAS) and a questionnaire was administered to the mothers addressing socioeconomic aspects and thee habits of children. The outcome evaluated was the incidence of severe caries (Dentin caries - ICDAS Codes 5 and 6). Data analysis involved descriptive statistics, chi-squared test and Poisson hierarchical regression with robust variance. Results: children who breastfed for more than 24 months (RR = 2.24 CI95%= 1.23-4.08), those whose parents were separated (RR = 1.73 CI95%= 1.11-2.69), and those with estab-lished/severe caries (RR = 2.74 CI95%= 1.37-5.49) at baseline were at greater risk of incidence of severe caries after three years. Conclusion: breastfeeding for more than 24 months is a risk factor for incidence of severe caries. In addition, family structure and established or severe baseline caries were associated.

Resumo Objetivos: investigar a associação entre a duração da amamentação e a incidência de cárie grave em pré-escolares. Métodos: foi realizado um estudo de coorte com 132 pares de mães e crianças de Diamantina, Minas Gerais, Brasil. As crianças foram avaliadas em dois momentos: dois e três anos de idade (baseline-2013/2014) e após três anos (T1- 2016/2017). Dados socioeconómicos e relativos aos hábitos das criançasforam obtidos por meio de entrevistas com as mães e a presença de cárie dentária foi diagnosticada segundo o protocolo "International Caries Detection and Assessment System - ICDAS". O desfecho foi a incidência de cárie grave (cárie em dentina - códigos ICDAS 5 e 6). Para análise dos dados empregou-se regressão hierárquica de Poisson com variância robusta. Resultados: crianças que amamentaram por mais de 24 meses (RR = 2,24 IC95%= 1,234,08), cujos pais viviam separados no baseline (RR = 1,73 IC95%= 1,11-2,69) e aquelas com cárie estabelecida ou grave no baseline (RR = 2, 74 IC950%= 1,37-5,49) estavam em maior risco de incidência de cárie grave após 3 anos. Conclusão: a amamentação por mais de 24 meses foi um fator de risco para a incidência de cárie dentária grave em pré-escolares. Além disso, estrutura familiar e cárie estabelecida ou grave no baseline estiveram associados.

Acidic food choice among adolescents with bulimic symptomatology: a major risk factor for erosive tooth wear?

PURPOSE: Evaluate dietary habits and the presence of erosive tooth wear (ETW) among female adolescents with varying severity of bulimic symptomatology. METHODS: An explanatory study was conducted with 72 female school adolescents with bulimic symptomatology, aged 15-18 years in Southeastern Brazil. Dietary habits were evaluated through a food frequency questionnaire. Bulimic symptomatology was evaluated and classified (mild, moderate and severe) according to the Bulimic Investigatory Test of Edinburgh. ETW examinations were performed. Data analysis involved descriptive statistics, bivariate analysis, Kruskal-Wallis/Mann-Whitney tests and Poisson regression. Ethical approval and informed consents were obtained. RESULTS: The final population consisted of 62 participants. The prevalence of ETW differed among adolescents with mild, moderate and severe bulimic symptomatology (p = 0.001), corresponding to 5.9%, 8.0% and 45.0%, respectively. Adolescents with severe bulimic symptomatology presented higher daily consumption of acidic food: citric fruits (p < 0.005), diet soda (p < 0.009) and ketchup (p = 0.004). No difference related to vomiting practices was observed between groups (p = 0.060). The adjusted regression model showed that a higher prevalence of ETW was associated with self-induced vomit at least once a week (PR = 2.42, 95% CI = 1.00-5.86, p = 0.05) and higher frequencies of consumption of citric fruits (PR = 7.96, 95% CI = 1.50-42.11, p = 0.015) and diet soda (PR = 2.32, 95% CI = 1.09-4.91, p = 0.029). CONCLUSION: It was the food choices (acidic food) and not purging practices that differed among adolescents with varying severity of bulimic symptomology. Likewise, higher consumption of citric fruits was the main factor associated with higher prevalence of ETW. LEVEL OF EVIDENCE: III case-control analytic study.

The influence of malocclusion, sucking habits and dental caries in the masticatory function of preschool children.

The aim of this study was to evaluate the association of malocclusion, nutritive and non-nutritive sucking habits and dental caries in the masticatory function of preschool children. A cross-sectional study was conducted with a sample of 384 children aged 3-5 years. A single examiner calibrated for oral clinical examinations performed all the evaluations (kappa > 0.82). Presence of malocclusion was recorded using Foster and Hamilton criteria. The number of masticatory units and of posterior teeth cavitated by dental caries was also recorded. The parents answered a questionnaire in the form of an interview, addressing questions about the child's nutritive and non-nutritive sucking habits. The masticatory function was evaluated using Optocal test material, and was based on the median particle size in the masticatory performance, on the swallowing threshold, and on the number of masticatory cycles during the swallowing threshold. Data analysis involved simple and multiple linear regression analyses, and the confidence level adopted was 95%. The sample consisted of 206 children in the malocclusion group and 178 in the non-malocclusion group. In the multiple regression analysis, the masticatory performance was associated with age (p = 0.025), bottle feeding (p = 0.004), presence of malocclusion (p = 0.048) and number of cavitated posterior teeth (p = 0.030). The swallowing threshold was associated with age (p = 0.025), bottle feeding (p = 0.001) and posterior malocclusion (p = 0.017). The number of masticatory cycles during the swallowing threshold was associated with the number of cavitated posterior teeth (p = 0.001). In conclusion, posterior malocclusion, bottle feeding and dental caries may interfere in the masticatory function of preschool children.