Association between Sense of Coherence and Caries Activity and Caries Experience among Male Adolescents from Southern Brazil: A Cross-Sectional Study.

INTRODUCTION: This cross-sectional study assessed the association between sense of coherence (SoC) and caries activity (number of active caries lesions) and caries experience (DMFT index) among 18-19-year-old male adolescents who joined the Brazilian Army as draftees for mandatory military service (n = 507). METHODS: Data collection included a questionnaire (level of education, family income, and tooth brushing frequency), the Brazilian short version of the SoC scale (SOC-13), and clinical caries examination (noncavitated/cavitated, inactive/active). The main predictor variable was SoC, categorized as low, moderate, or high. Poisson regression models were used for statistical analysis. RESULTS: A high SoC was significantly associated with a lower number of active lesions (adjusted rate ratio = 0.85; 95% CI = 0.74-0.98). No association between SoC and DMFT was detected. CONCLUSION: A high SoC was found to be a protective factor to caries activity in this population.

Is Patient's Caries Activity Associated with Caries Increment among Adolescents, Regardless of Caries Experience?

This 2.5-year cohort study investigated whether patient's caries activity is independently associated with caries increment among adolescents, regardless of previous caries experience, in a sample of 801 adolescents from South Brazil. Caries examination was performed at baseline (12 y) and at follow-up (14-15 y). Caries activity was significantly associated with caries increment even after adjustment for sex, socioeconomic status, type of school, and previous caries experience at both cavity and non-cavitated levels. Caries-active adolescents had approximately 2-fold higher risk of caries increment than those without caries activity (cavity level, incidence risk ratio [IRR] = 1.90, 95% confidence interval [CI] = 1.45-2.49, p < 0.001; non-cavitated level, IRR = 2.16, 95% CI = 1.63-2.86, p < 0.001).

Underlying Dentin Shadows (ICDAS 4) in Occlusal Surface of Permanent Teeth Have Low Progression Rate after 1-2 Years.

The aim of this prospective cohort study was to assess the radiographic progression of underlying dentin shadows (UDS) on the occlusal surfaces of permanent posterior teeth of adolescents and young adults over 1-2 years and to identify possible risk factors. A total of 149 UDS lesions (from 101 individuals) were included at baseline. Each participant had to present at least one UDS to be considered eligible for the study. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs, performed at baseline and after 1-2 years. The association between possible predictors and UDS progression (defined radiographically as an increase in the radiographic score from baseline to follow-up) was assessed using Weibull regression models. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated. A total of 81 individuals (mean age: 24.0, standard deviation: 8.03) were reexamined after 1-2 years (742 occlusal surfaces, of which 118 were UDS). The overall progression rate was 8.6% after 1-2 years, being 12.6% for UDS without baseline radiolucency and 20% for UDS with baseline radiolucency. The risk analysis showed that UDS without radiolucency at baseline had a similar likelihood of progression (adjusted HR = 1.71, 95% CI = 0.68-4.32, p = 0.26) while UDS with radiolucency at baseline were more likely to progress (adjusted HR = 2.96, 95% CI = 1.06-8.26, p = 0.04) than the reference category (sound occlusal surfaces without radiolucency). These estimates were adjusted for caries prevalence, tooth type, and arch. This study showed low progression rates of UDS after 1-2 years. The presence of radiolucency at baseline was found to predict UDS progression.

Factors associated with a cariogenic diet among adolescents: a structural equation modeling approach.

OBJECTIVE: To investigate the factors directly and indirectly associated with a cariogenic diet among southern Brazilian adolescents. MATERIALS AND METHODS: This cross-sectional study included 15-19-year-old students attending high schools in Santa Maria, southern Brazil. The participants completed a questionnaire on sociodemographic and behavioral variables. The Oral Health Impact Profile-14 was applied to collect data on oral health-related quality of life (OHRQoL). Clinical examination was used to assess the dental caries status (decayed, missing, and filled teeth index). A cariogenic diet was considered a latent variable measured by the self-perception of a healthy diet and the frequency of consumption of sugary foods and drinks. Structural equation modeling was used to analyze the direct and indirect pathways to a cariogenic diet. RESULTS: A total of 1197 adolescents were included. Low toothbrushing frequency (standardized coefficient (SC), 0.10; p < 0.05), cigarette smoking (SC, 0.15; p < 0.01), and alcoholic beverages (SC, 0.14; p < 0.01) were directly linked to a cariogenic diet, which, in turn, was directly linked to untreated dental caries (SC, 0.18; p < 0.01) and poor OHRQoL (SC, 0.16; p < 0.01). In addition, household income (via toothbrushing frequency) and age (via alcoholic beverages) were indirectly linked to a cariogenic diet. CONCLUSION: A cariogenic diet was consistently associated with a range of unhealthy behaviors during adolescence as well as poor household income. CLINICAL RELEVANCE: Health promotion strategies to restrict sugar consumption and encourage healthier lifestyles should be aware of the synergism observed among unhealthy behaviors during adolescence.

Classification of a patient's caries activity based on lesion activity assessment among adults: findings from a prospective cohort study.

OBJECTIVE: To investigate whether the classification of a patient's caries activity based on lesion activity assessment can predict the increment and progression of coronal and root caries lesions among adults. METHODS: This population-based prospective cohort study followed 413 individuals (mean age 54.1) from southern Brazil for 4 years. Data collection included a questionnaire and clinical examination to record coronal/root caries and gingival recession. The main outcomes were caries increment measured as decayed, missing and filled tooth surfaces (DMFS) and caries progression (surface-level analysis). The main predictor variable was patients' caries activity at baseline ("caries-inactive" or "caries-active"). Negative binomial regression models (unadjusted and adjusted) were used. RESULTS: Caries-active individuals were more likely to present DMFS increment than caries-inactive ones when migrations among DMFS components were considered (IRR [incidence risk ratio] = 1.26, 95%CI [confidence interval] = 1.01-1.58). On the other hand, no such association was found when these migrations were disregarded. The risk for coronal caries progression on filled surfaces was 90% higher among caries-active patients (IRR=1.9; 95%CI=1.4-2.6). In addition, patient's caries activity was able to predict higher risk for root caries progression in newly exposed root surfaces (IRR=1.9; 95%CI=1.0-3.6). CONCLUSION: The classification of a patient's caries activity based on lesion activity was able to foresee lesion progression on the coronal and root surfaces more susceptible to caries among adults. Clinical relevance Classifying a patient's caries activity is a useful tool for the clinical management of dental caries in adults.

Impact of detection criteria on coronal and root caries estimates in adults with and without type 2 diabetes mellitus.

OBJECTIVE: To compare caries prevalence and extent in adults with or without diabetes mellitus (DM) according to different caries detection criteria (WHO, ICDAS, and Nyvad). MATERIALS AND METHODS: A cross-sectional study was carried out including 122 individuals, 44 without DM and 78 with type 2 DM. Trained and calibrated examiners performed a visual-tactile inspection to record coronal and root caries lesions (weighted kappa > 0.7). Caries prevalence and extent were calculated according to the WHO (only cavitated lesions, missing and filled surfaces), ICDAS (all non-cavitated and cavitated lesions, missing and filled surfaces), and Nyvad (only active lesions, non-cavitated and cavitated). For root caries, lesions were classified as active or inactive. RESULTS: A significantly higher overall caries experience (DMF-S) was observed among patients with DM when the WHO (RR = 1.37; 95% CI = 1.09-1.71) and the ICDAS (RR = 1.32; 95% CI = 1.07-1.62) criteria were adopted. No difference between groups was found when the Nyvad criterion was used, although a low study power was observed in this comparison. Estimates for root caries showed a higher prevalence (PR = 2.65; 95% CI = 1.05-6.70) and risk (RR = 6.02, 95% CI = 1.81-20.00) of total D-S among diabetic patients. CONCLUSIONS: DM can predispose individuals to a higher number of root caries lesions, independently of their past caries experience. Missing teeth can overestimate caries extent in individuals with DM. CLINICAL RELEVANCE: Individuals with DM should be monitored for the prevention and control of root caries. It is recommended to splitting missing teeth from the caries estimates in studies involving adults, particularly diabetic ones.

Is neighborhood income associated with untreated dental caries irrespective of family income?

OBJECTIVE: To assess the status of untreated dental caries in adolescents exposed to different conditions of family and neighborhood income. MATERIALS AND METHODS: This cross-sectional study included a representative sample of 1197 15-19-year-old adolescents attending high schools from Santa Maria, southern Brazil. Data collection included a questionnaire and clinical examination (DMFT index). Neighborhood mean income was collected from official sources. The main predictor variable was a combination of household income and neighborhood mean income resulting in four categories: low household income/low neighborhood income, low household income/high neighborhood income, high household income/low neighborhood income, or high household income/high neighborhood income. The outcome was untreated caries (number of teeth with dentin cavities or residual roots). Multilevel Poisson regression analysis was used to assess the association between predictors and untreated caries. Rate ratio (RR) and 95% confidence intervals (CI) were estimated. RESULTS: The prevalence of untreated dental caries was 26% (n = 312), with a mean (± standard deviation) of 0.47 (± 1.05) teeth. Adolescents with low household income living in areas with low neighborhood income had the worse caries scenario. Compared with them, those classified as low-income households residing in high-income neighborhoods had 37% lower rate of untreated dental caries (adjusted RR = 0.63; 95%CI = 0.44-0.89). No neighborhood effect was detected among adolescents of more affluent families. CONCLUSIONS: Neighborhood income contributed to the rate of untreated dental caries over and above household income among adolescents with low household income only. CLINICAL RELEVANCE: Improving living conditions in disadvantaged neighborhoods may positively impact the oral health of residents, thus reducing oral health inequalities.

Is Toothbrush Bristle Stiffness Associated with Erosive Tooth Wear in Adolescents? Findings from a Population-Based Cross-Sectional Study.

This population-based cross-sectional study investigated the association between toothbrush bristle stiffness and the occurrence of erosive tooth wear (ETW) among 15- to 19-year-old adolescents from southern Brazil. Data collection included the application of questionnaires and clinical examination. One questionnaire on sociodemographic information (sex, age, and socioeconomic status) was sent to the parents/legal guardians, while the other was applied to students and collected data regarding oral hygiene habits (toothbrushing frequency, toothbrushing after meals, and toothbrush bristle stiffness) and dietary habits (frequency of consumption of soft drinks, citric fruits, and fruit juice). After tooth cleaning and drying, all erupted permanent teeth were clinically assessed and classified according to the Basic Erosive Wear Examination (BEWE) by 2 calibrated examiners. The association between explanatory variables and ETW prevalence was assessed using Poisson regression models. Prevalence ratios (PRs) and their 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included (participation rate 72.3%). The overall prevalence of ETW was 57%. The final model showed that individuals who used toothbrushes with soft (PR = 1.28, 95% CI = 1.02-1.60) or medium (PR = 1.30, 95% CI = 1.01-1.69) bristles presented a higher ETW prevalence than those who used toothbrushes with extra-soft bristles, even after the adjustment for important cofactors. In conclusion, this study found a very weak but significant association between toothbrush bristle stiffness and ETW among Brazilian adolescents. Considering the cross-sectional design of this study and considering that some association was found even in such a young population, future studies using different designs and including different age-groups might elucidate the clinical relevance of this finding.

Traumatic dental injury and oral health-related quality of life among 15 to 19 year old adolescents from Santa Maria, Brazil.

BACKGROUND/AIMS: The literature is scarce on the association between traumatic dental injuries (TDI) and oral health-related quality of life (OHRQoL) among adolescents, and there is no study assessing this relationship using clinical criteria for the assessment of TDI in this age group. The aim of this study was to assess the association between TDI and OHRQoL among 15 to 19yearold adolescents from Santa Maria, Brazil. MATERIALS AND METHODS: A population-based cross-sectional study was conducted including a representative sample of 1197 15 to 19yearold adolescents attending 31 public and private schools. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed to diagnose TDI based on the O'Brien classification. Demographic information, socioeconomic status, and clinical characteristics (caries experience, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between TDI and OHRQoL. Rate ratios (RR) and 95% confidence intervals (95% CI) were estimated. RESULTS: The overall prevalence of TDI was 17%, mild trauma was 12%, and severe trauma was 5%. In the adjusted models, adolescents with TDI had poorer OHRQoL than those without TDI (RR = 1.10; 95% CI = 1.05-1.16). This negative effect was related to the psychological disability domain (RR = 1.16; 95% CI = 1.02-1.32), to the social disability domain (RR = 1.34; 95% CI = 1.13-1.59), and to the handicap domain (RR = 1.35; 95% CI = 1.10-1.66). CONCLUSIONS: Despite its low severity, TDI negatively affected the OHRQoL of 15 to 19yearold adolescents from Santa Maria, Brazil.

Sex differences in the association between obesity and gingivitis among 12-year-old South Brazilian schoolchildren.

OBJECTIVE: To assess the association between weight status and gingivitis in a representative sample of 12-year-old schoolchildren from South Brazil. BACKGROUND: An association between obesity and gingivitis in children and adolescents has been observed; however, the present evidence has major limitations. METHODS: A cross-sectional study was conducted in Porto Alegre, South Brazil, from September 2009 to December 2010 and included a representative sample of 1528 12-year-old schoolchildren attending public and private schools. Data collection included the application of a questionnaire, recording of anthropometric measures (weight and height), and clinical examination (gingival bleeding index, recorded in four sites per tooth). The outcome of the study was the prevalence of gingivitis, defined as the proportion of schoolchildren presenting ≥52% of bleeding sites (based on the median). Weight status was categorized according to body mass index into normal, overweight, or obese. The association between predictor variables and gingivitis prevalence was assessed using Poisson regression models. Unadjusted and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI) were estimated. RESULTS: Gingivitis prevalence was 48.7% (95% IC = 33.8-63.6) and, on average, schoolchildren presented 51.8% (95% IC = 46.2-57.5) of bleeding sites. Obese individuals had 13% higher prevalence for presenting gingivitis than did normal-weight ones (PR = 1.13, 95% CI = 1.09-1.18, P < .001). The stratified analysis showed that this association was sex-specific: Obese girls presented a greater chance of having gingivitis (adjusted PR = 1.21, 95% CI = 1.09-1.34, P < .001), but such association was not observed among boys (PR = 1.07, 95% CI = 0.95-1.20, P = .29). CONCLUSION: This study showed sex differences in the association between obesity and gingivitis among 12-year-old South Brazilian schoolchildren.

Can We Diagnose a Patient's Caries Activity Based on Lesion Activity Assessment? Findings from a Cohort Study.

This cohort study evaluated the fate of sound surfaces and inactive non-cavitated (INC) and active non-cavitated (ANC) caries lesions in a population-based sample of South Brazilian adolescents, in answer to the question: "Is lesion activity assessment a reliable criterion to diagnose a patient's caries activity?" A total of 801 schoolchildren were examined at baseline (aged 12 years) and after a mean time interval of 2.5 years. Data collection included a questionnaire and clinical examination. Patients were classified as caries-free (patients without any lesion), caries-inactive (patients with only inactive lesions), and caries-active (patients with at least one active lesion). The primary outcome was caries progression (presence of cavity, underlying dentin shadow, filling, or extraction at the follow-up exam). Negative binomial regression models were used to estimate the risk for caries progression. The main predictor variable was status of the surface at baseline: sound, INC, or ANC. Progression rates of 1.0, 9.0, and 12.6% were found for sound surfaces, INC, and ANC, respectively. INC (incidence risk ratio [IRR] 5.37, 95% CI 4.22-6.83) and ANC (IRR 4.96, 95% CI 3.43-7.17) had greater risk for caries progression than sound surfaces. Similar risks for progression were found for ANC and INC (IRR 0.92, 95% CI 0.64-1.32). Progression rates were 0.6, 1.1, and 2.2% for caries-free, caries-inactive, and caries-active individuals, respectively (p < 0.05). The risk for caries progression of sound surfaces was higher among caries-active adolescents (caries-free: IRR 2.78, 95% CI 1.63-4.72; caries-inactive: IRR 2.19, 95% CI 1.65-2.90). Caries-inactive patients behaved similarly to caries-free individuals (IRR 1.27, 95% CI 0.73-2.20). This study demonstrated the possibility of defining a patient's caries activity profile based on lesion features.

Responsiveness of Oral Health-Related Quality of Life Questionnaires to Dental Caries Interventions: Systematic Review and Meta-Analysis.

This systematic review and meta-analysis were undertaken to assess the responsiveness of validated oral health-related quality of life (OHRQoL) questionnaires to dental caries interventions in children, adolescents, and young adults. Studies eligible were randomized clinical trials (RCTs), controlled clinical trials (CCTs), and prospective case series (PCS), which had OHRQoL questionnaires answered before and after caries intervention(s). The main outcome was improvement in OHRQoL mean scores following caries intervention. Twenty-six studies were selected for the quality assessment and 14 were selected for the meta-analysis. Most of the studies were PCS with a single group pretest and posttest study design (n = 19). Five studies were CCT and only 2 were RCT. The numbers of participants were 3,522 in the control group (baseline = 2,002; final = 1,520) and 5,917 in the test group (baseline = 3,102; final = 2,815). The age of the subjects ranged from 3 to 19 years. All studies showed significant improvement in OHRQoL following caries intervention. Most of nonrandomized studies (n = 15) had low or moderate risk of bias. The meta-analysis showed the effect of caries interventions (standardized weighted mean differences = -1.24; 95% CI: -1.68 to -0.81; p < 0.001). However, high heterogeneity between the studies was found. The Grading of Recommendations Assessment, Development and Evaluation approach classified the quality of evidence as very low and its strength weak. In conclusion, there is evidence that the OHRQoL of children and adolescents improved following caries intervention procedures, but the quality of the evidence was very low. In spite of that, caries interventions are highly recommended as abstaining from treatment is likely to result in a deterioration of OHRQoL.

Does the Duration of Fixed Orthodontic Treatment Affect Caries Activity among Adolescents and Young Adults?

This cross-sectional study assessed the relationship between fixed orthodontic treatment duration and caries activity. Two hundred and sixty 10- to 30-year-olds were divided into 4 groups (n = 65): no fixed orthodontic appliances (G0), orthodontic treatment for 1 year (G1), 2 years (G2), or 3 years (G3). Orthodontic treatment duration was significantly associated with active caries: prevalence was 1.5% for G0, 27.7% for G1, and 72.3% for G2 and G3; the median number of lesions was 0 for G0 and G1 and 2 for G2 and G3. No differences were observed between G2 and G3. The longer the duration of orthodontic treatment, the higher the prevalence/extent of active caries lesions.

The effect of dental treatment on oral health-related quality of life in adolescents.

OBJECTIVES: The objective of the study is to assess the effect of dental treatment on the oral health-related quality of life (OHRQoL) of adolescents from a city in South Brazil. MATERIALS AND METHODS: This longitudinal study included 129 adolescents aged 10 to 15 years who received dental caries treatment in a university clinic in Santa Maria, Brazil. The OHRQoL was measured using the Brazilian version of the Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14). The questionnaire was administered through face-to-face interviews before treatment and 1 month after its completion. Paired t tests and effect sizes were used to evaluate changes in CPQ11-14 scores after completion of treatment. RESULTS: In total, 43.4% of the study participants received solely restorations, 15.5% received endodontic treatment, and 44.2% underwent tooth extractions. The mean CPQ11-14 score before treatment was 15.9 ± 10.3, which decreased to 6.3 ± 6.5 after treatment (P < 0.001). The same pattern was observed in the four domains of CPQ11-14 (oral symptoms, functional limitation, emotional well-being, and social well-being). The effect sizes varied from 0.4 to 1.1, with oral symptoms and emotional well-being domains showing the greatest changes. CONCLUSIONS: Dental treatment resulted in a significant improvement in the OHRQoL of the evaluated adolescents. CLINICAL RELEVANCE: Providing dental treatment has beneficial effects on the quality of life of adolescents, especially for oral symptoms and emotional well-being.

Proximal carious lesions infiltration-a 3-year follow-up study of a randomized controlled clinical trial.

INTRODUCTION: Infiltration of carious lesion has been claimed as a promising approach for the management of non-cavitated proximal lesions (NCPL). Clinical studies have suggested that this approach may reduce NCPL progression in individuals whose caries risk was not change over the studied period. OBJECTIVE: This study aimed to assess the additional benefit of infiltration of NCPL over a 3-year period in a group of individuals who received treatment and control of carious activity. MATERIALS AND METHODS: Twenty-two caries-active subjects that possessed at least a pair of NCPL in posterior teeth were selected for this study totalizing 36 pairs of lesion. In a split-mouth design, lesions were randomly allocated to test (infiltration) or placebo treatments. At follow-up, lesions were radiographically analyzed, progression was determined by radiographic pair-wise comparison and differences in number of progressing lesions between test, and placebo-treated surfaces were compared. RESULTS: Seventeen subjects (27 pairs of lesions) were followed up. Only four subjects were caries-active at the follow-up. In the test group, 2/27 (7.4%) lesions and in the placebo group 5/27 (18.5%) lesions had progressed. No statistical difference was observed between the studied groups (p = 0.453). CONCLUSION: Subjects under treatment focusing on controlling caries activity presented low progression rates in both infiltrated and non-infiltrated NCPL. As only very few lesions progressed in both groups, no significant additional effect could be found. Further studies with larger sample sizes are necessary. CLINICAL RELEVANCE: Infiltration of NCPL may have limited additional effect if other treatments focused on controlling caries activity are successful.

Gingival enlargement in orthodontic patients: Effect of treatment duration.

INTRODUCTION: In this study, we aimed to assess the effect of the duration of fixed orthodontic treatment on gingival enlargement (GE) in adolescents and young adults. METHODS: The sample consisted of 260 subjects (ages, 10-30 years) divided into 4 groups: patients with no fixed orthodontic appliances (G0) and patients undergoing orthodontic treatment for 1 year (G1), 2 years (G2), or 3 years (G3). Participants completed a structured questionnaire on sociodemographic characteristics and oral hygiene habits. Clinical examinations were conducted by a calibrated examiner and included the plaque index, the gingival index, and the Seymour index. Poisson regression models were used to assess the association between group and GE. RESULTS: We observed increasing means of plaque, gingivitis, and GE in G0, G1, and G2. No significant differences were observed between G2 and G3. Adjusted Poisson regression analysis showed that patients undergoing orthodontic treatment had a 20 to 28-fold increased risk for GE than did those without orthodontic appliances (G1, rate ratio [RR] = 20.2, 95% CI = 9.0-45.3; G2, RR = 27.0, 95% CI = 12.1-60.3; G3 = 28.1; 95% CI = 12.6-62.5). CONCLUSIONS: The duration of orthodontic treatment significantly influenced the occurrence of GE. Oral hygiene instructions and motivational activities should target adolescents and young adults undergoing orthodontic treatment.

Erosive tooth wear among 12-year-old schoolchildren: a population-based cross-sectional study in Montevideo, Uruguay.

The aim of this study was to assess the prevalence, extent, severity, intraoral distribution and risk indicators for erosive tooth wear (ETW) among 12-year-old schoolchildren from Montevideo, Uruguay. A population-based, cross-sectional survey was conducted using a representative sample of 1,136 12-year-old schoolchildren attending public and private schools. Parents answered questions on socioeconomic status and general health. Schoolchildren answered questions on dietary and oral hygiene habits. Two calibrated examiners recorded ETW on permanent teeth according to the Basic Erosive Wear Examination (BEWE) score system. Logistic regression models were performed to assess the association between the predictor variables and the prevalence of ETW (overall and severe ETW). Odds ratios (OR) and the respective 95% confidence intervals (CI) were estimated. The prevalence of ETW was 52.9%, being mild erosion (BEWE = 1) in the vast majority of cases (48.5%). Severe erosion (BEWE ≥2) was detected in 4.4% of schoolchildren. The overall prevalence of ETW differed significantly between categories of gender and socioeconomic status, but only between gender in the severe ETW analysis. The overall extent of ETW was significantly different between categories of gender, socioeconomic status, and swish before swallow. The extent of severe ETW differed between categories of swish before swallow and brushing frequency. In the logistic regression analysis, no association was found between the studied variables and the overall prevalence of ETW. Males were more likely to have severe ETW than females (OR = 3.22, 95% CI = 1.50-6.89). ETW may be considered a public health problem among 12-year-old-Uruguayan schoolchildren.

Dental erosion among 12-year-old schoolchildren: a population-based cross-sectional study in South Brazil.

OBJECTIVE: To assess the epidemiology and risk indicators for dental erosion among 12-year-old schoolchildren in South Brazil. METHODS: A population-based cross-sectional survey was conducted in Porto Alegre, Brazil, using a representative sample of 12-year-old schoolchildren (n = 1,528). Dental erosion was recorded according to the Basic Erosive Wear Examination (BEWE) index. Parents answered questions on socio-economic status, brushing frequency and general health. Schoolchildren answered questions on dietary habits. Anthropometric data were collected. Statistical analysis included logistic and Poisson regression models. RESULTS: The prevalence of dental erosion was 15% [95% confidence interval (95% CI): 13.6-16.5], being mainly mild erosion. Boys [odds ratio (OR) = 1.57, 95% CI: 1.17-2.10], private school attendees (OR = 1.45, 95% CI: 1.01-2.06) and schoolchildren reporting the daily consumption of soft drinks (OR = 5.04, 95% CI: 1.17-21.71) were more likely to have at least one tooth with dental erosion. Gender [boys, rate ratio (RR) = 1.66, 95% CI: 1.28-2.17], type of school (private, RR = 1.89, 95% CI: 1.53-2.35), the consumption of soft drinks (sometimes: RR = 5.27, 95% CI: 1.46-19.05; daily: RR = 6.82, 95% CI: 1.39-33.50) and the daily consumption of lemon (RR = 1.49, 95% CI: 1.11-2.00) were significantly associated with the number of affected surfaces. CONCLUSIONS: The present study found a moderate prevalence of dental erosion among young schoolchildren, with mild erosion being the most prevalent condition. Socio demographic variables and dietary habits were associated with dental erosion in this population.

Restorations performance after selective caries removal to soft dentine: 18-month follow-up of a controlled clinical trial.

OBJECTIVE: This randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period. METHODS: Inclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50 % of the dentin thickness). Teeth were submitted to SCRSD (n = 76) or SW (n = 76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc). RESULTS: The follow-up period ranged from 6 to 18 months (mean ± SD 16.3 ± 3.4 months). Patients' ages ranged from 9 to 55 years (mean ± SD 29 ± 10.5 years). A total of 135 teeth (SCRSD = 72; SW = 63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4 %) and SCRSD (97.9 %) (p = 0.16). Patients presenting gingivitis (≥20 % of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20 % of bleeding sites (p = 0.03). CONCLUSION: This study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months. CLINICAL SIGNIFICANCE: SCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity.

Association between underlying dentin shadows (ICDAS 4) and OHRQoL among adolescents from southern Brazil.

This study aimed to assess the association between underlying dentin shadows (UDS) and oral health-related quality of life (OHRQoL) among 15-19-year-old adolescents from southern Brazil. This population-based cross-sectional study included a representative sample of 1,197 15-19-year-old adolescents attending 31 public and private schools from Santa Maria, Brazil. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed by two calibrated examiners (intra/interexaminer kappa values for caries examination ≥ 0.80) to diagnose UDS (ICDAS code 4 caries lesions). Sociodemographic information and clinical characteristics (overall caries experience, traumatic dental injury, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between UDS and OHRQoL. Rate ratios (RR) and 95% confidence intervals (CI) were estimated. The UDS prevalence was 8.8% (n = 106 adolescents). In the adjusted models, adolescents with UDS had poorer OHRQoL than those without UDS, and the strength of the association was dependent on the number of lesions per individual. Individuals with 1-2 UDS had a mean OHIP-14 score 8% higher (RR = 1.08; 95%CI: 1.01-1.17) than adolescents without UDS, while those with 3-4 UDS had a mean score 35% higher (RR = 1.35; 95%CI: 1.12-1.63). This negative association was related to physical disability, psychological disability, social disability, and handicap domains. This study showed that UDS was associated negatively with OHRQoL among 15-19-year-old adolescents from southern Brazil. The negative effect of UDS on OHRQoL emphasizes the importance of addressing issues regarding OHRQoL even in the posterior teeth of adolescents.