The influence of different dimensions of oral health literacy on parental attitudes and comprehension of an information leaflet about permanent tooth avulsion.

BACKGROUND/AIM: Permanent tooth avulsion requires proper management at the time of the accident and parental oral health literacy (OHL) may influence decision-making with regards to dental trauma. The aim of this study was to investigate the influence of OHL on: (1) self-rated comprehension of an information leaflet (IL), (2) self-rated capacity to execute the tasks proposed on the IL, and (3) attitudes regarding the avulsion of a permanent tooth in children. MATERIAL AND METHODS: A longitudinal study was conducted involving the reading of an IL by 466 parents/caregivers. Evaluations were performed prior to the IL (Phase I), immediately after the application of the IL (Phase II) and 60 days after the application of the IL (Phase III). Self-rated comprehension and capacity to execute the proposed tasks were analyzed in Phase II. Attitude was evaluated in all three phases. Functional OHL was measured using the BREALD-30 and interactive OHL was measured using HeLD-14. RESULTS: Correlations were found between self-rated comprehension and both the OHL/BREALD-30 score (rs = 0.179; p = .012) and OHL/HeLD-14 score (r = 0.258; p < .001). Correlations were also found between the self-rated capacity to execute the proposed tasks and both the OHL/BREALD-30 score (rs = 0.133; p = .047) and the OHL/HeLD-14 score (rs = 0.225; p < .001). Higher BREALD-30 and HeLD-14 scores were associated with a better performance regarding parental attitudes toward permanent tooth avulsion comparing Phases I and II and Phases II and III (p < .05). CONCLUSIONS: Higher levels of OHL were associated with better parental self-rated comprehension of the IL and the capacity to execute the tasks proposed therein as well as more adequate attitudes regarding the avulsion of a permanent tooth.

Association between Level of Parental Oral Health Literacy and the Rational Use of Fluoride for Children from 0 to 4 Years of Age after Instruction: An Intervention Trial.

An inadequate level of oral health literacy (OHL) can hinder the understanding of dental information, which can have a negative impact on health promotion actions, such as the rational use of fluoride. The aims of the present study were (1) to look for association between parents/guardians' OHL and the amount of fluoride toothpaste used for children from zero to four years of age; (2) to compare the effect of different modes of educational interventions on the amount of fluoride toothpaste used for children from zero to four years of age; and (3) to assess the ability of parents/guardians to choose a toothpaste with adequate fluoride concentration, after the educational intervention. A randomized intervention study was conducted with parents/guardians of children from zero to four years of age (n = 145). The participants answered the Oral Health Literacy Adults Questionnaire and a questionnaire addressing sociodemographic characteristics. The participants were allocated to four intervention groups based on type of counseling (written, oral, written + photograph, and oral + photograph), with randomization stratified by level of OHL. The participants were instructed to place the adequate amount of toothpaste on a toothbrush for children from zero to four years of age (smear of 0.125 mg) before and after the intervention. The correct choice of toothpaste was also evaluated by the interpretation of the labels of four toothpastes of different brands and with different concentrations of fluoride. Associations between variables were tested using the Student's t test and one-way ANOVA. Level of OHL was associated with the amount of fluoride toothpaste deposited prior to the educational intervention (p = 0.021) and the percentage of approximation to the appropriate amount of fluoride toothpaste (p < 0.05). The choice of toothpaste was associated with schooling (p = 0.031). In conclusion, parents/guardians with adequate OHL better quantified fluoride toothpaste before and after the educational intervention and also came closer to the appropriate amount of toothpaste after the educational intervention. No significant differences in the final amount of toothpaste placed on the toothbrush were found among the intervention groups. The choice of the correct toothpaste was associated with a higher level of schooling.

Factors associated with awake bruxism according to perceptions of parents/guardians and self-reports of children.

BACKGROUND: Bruxism is a repetitive activity of the masticatory muscles that has been associated with orofacial disorders and psychosocial factors AIM: The aim of this study was to investigate associations between possible awake bruxism (PAB) and family functioning, bullying, and dental caries in children 8-10 years of age. DESIGN: A school-based study was conducted with 739 pairs of parents/guardians and children. The parents/guardians answered the Family Adaptability and Cohesion Evaluation Scales for the establishment of family functioning. Information on bullying due to dental conditions was collected from the children. Dental caries in the children was evaluated using International Caries Detection and Assessment System criteria. A directed acyclic graph was used to define the theoretical model and select control factors. Descriptive analysis was performed, followed by multivariate logistic regression for complex samples. RESULTS: Considering the parental reports, fewer years of mother's schooling, a low family income, very flexible family adaptability, and cavitated dental caries were associated with PAB. The female sex, bullying, and orofacial dysfunction were associated with self-reported PAB. CONCLUSIONS: Therefore, the factors associated with PAB differ according to the reports of parents/guardians or self-reports of children. Healthcare providers should consider both reports for a more effective intervention addressing PAB.

Association of Oral Health Literacy and School Factors with Untreated Dental Caries among 12-Year-Olds: A Multilevel Approach.

Dental caries are a global health problem that affects all age groups and must be considered a public health priority due to its significant financial costs and impact on the quality of life. This study evaluated the association between oral health literacy (OHL), school factors, and untreated dental caries in 12-year-old Brazilian adolescents using a multilevel approach. A population-based cross-sectional study was carried out with 740 adolescents randomly selected from private and public schools in Campina Grande, Brazil. Two dentists were trained and calibrated to diagnose dental caries using the Nyvad index and OHL using the Brazilian Rapid Estimate of Literacy in Dentistry (BREALD-30). The caregivers of the adolescents reported demographic data (sex, skin color, and socioeconomic status). Data of school factors such as the type of school and the school grade retention rate were classified through a 2-step hierarchical cluster analysis to obtain the school environment. A robust multilevel log-linear negative binomial regression for complex samples was performed (p < 0.05). In the analysis, adjusted by individual determinants, nonwhite skin color (RR = 2.20; 95% CI 1.56-3.12), a low socioeconomic status (RR = 1.60; 95% CI 1.09-2.34), a low OHL score (RR = 0.94; 95% CI 0.91-0.98), and low satisfaction with the last dental appointment (RR = 2.25; 95% CI 1.67-3.04) were associated with untreated dental caries. The following factors remained associated with untreated dental caries in the final model: students from an unfavorable learning environment (RR = 2.20; 95% CI 1.27-3.80), nonwhite skin color (RR = 1.92; 95% CI 1.27-2.91), a low socioeconomic status (RR = 1.82; 95% CI 1.12-2.94), a low OHL score (RR = 0.95; 95% CI 0.91-0.98), and low satisfaction with the last dental appointment (RR = 2.07; 95% CI 1.47-2.91). Untreated dental caries in early adolescence were impacted by the school environment, the socioeconomic status, OHL, and the adolescent's satisfaction with the last dental appointment.

Performance of distant diagnosis of dental caries by teledentistry in juvenile offenders.

BACKGROUND: Telehealth has been considered a practical and potentially cost-effective method of providing healthcare to the underprivileged population. The aim of this study was to determine whether a teledentistry system is a valid tool to screen for the presence of dental caries in a cohort of 102 Brazilian juvenile offenders. MATERIALS AND METHODS: Clinical examinations were performed to evaluate the decayed, missing, and filled teeth (DMFT) index and oral conditions of each adolescent, documented using a digital camera. For distant diagnosis, two methods of image transmission were tested. In the first, images were uploaded on a file-sharing service, and the link was sent via e-mail to one distant consultant. The other consultant received the images recorded on a compact disc. Both assessed the files and calculated the DMFT index for each case. The degree of agreement between the traditional examination and distant consultant assessments was measured by the kappa coefficient of agreement. Sensitivity and specificity were also calculated. RESULTS: According to the traditional clinical examination, 93.1% of the adolescents had at least one instance of dental caries with a mean DMFT index of 5.9. Kappa statistics ranged from "strong" to "almost perfect." Sensitivity ranged from 48% to 73%, and specificity was either 97% or 98%. CONCLUSIONS: Adolescent inmates could benefit from oral health screening using digital photography. Teledentistry appears to be a reliable alternative to the traditional oral examination for dental caries assessment.

Associations between Anxiety, Depression, Chronic Pain and Oral Health-Related Quality of Life, Happiness, and Polymorphisms in Adolescents' Genes.

Adolescence is marked by changes and vulnerability to the emergence of psychological problems. This study aimed to investigate associations between anxiety/depression/chronic pain and oral health-related quality of life (OHRQoL)/happiness/polymorphisms in the COMT, HTR2A and FKBP5 genes in Brazilian adolescents. A cross-sectional study was conducted with ninety adolescents 13 to 18 years. Anxiety, depression and chronic pain were evaluated using the RDC/TMD. The Oral Health Impact Profile was used to assess oral OHRQoL. The Subjective Happiness Scale was used to assess happiness. Single-nucleotide polymorphisms in COMT (rs165656, rs174675), HTR2A (rs6313, rs4941573) and FKBP5 (rs1360780, rs3800373) were genotyped using the Taqman® method. Bivariate and multivariate logistic regression analyses were performed (p < 0.05). Chronic pain and depression were associated with feelings of happiness (p < 0.05). A significant inverse association was found between anxiety and OHRQoL (p = 0.004). The presence of minor allele C of COMT rs174675 was significantly associated with depression (p = 0.040). Brazilian adolescents with depression and chronic pain considers themselves to be less happy than others and those with anxiety are more likely to have a negative impact on OHRQoL. Moreover, the rs174675 variant allele in the COMT gene was associated with depressive symptoms in Brazilian adolescents.

Parental oral health literacy influences preschool children's utilization of dental services.

Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03-1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09-1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03-1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level.

Is oral health literacy associated with conceptions of care and behavior related to the prevention of COVID-19?

The aim of the present study was to investigate the impact of oral health literacy (OHL) on conceptions of care and behaviors related to COVID-19. The sample came from two preliminary cross-sectional studies that determined the level of OHL of parents/guardians of six-to-12-year-old children in two major Brazilian cities (Curitiba and Belo Horizonte). Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14) for the evaluation of interactive OHL. Participants were recruited through e-mail, social media, and telephone contact. The questionnaire on conceptions of care and behaviors related to COVID-19 was created based on the guidelines of the World Health Organization. Two hundred nineteen individuals participated in the study. There was no significant difference in socioeconomic and demographic variables and in the medians of BREALD and HeLD-14 between the two cities (P>0.05). Higher levels of functional OHL were associated with an appropriate conception that individual care affects collective care (P=0.038), but with an inappropriate conception of seeking medical assistance in cases of mild symptoms (P=0.030). Higher levels of interactive OHL were related to social distancing behavior in the city of Curitiba (P=0.049) and in the overall sample (P=0.040). It is concluded that functional OHL was associated with two of the investigated conceptions about COVID-19, while interactive OHL was associated with social distancing behavior. These data may suggest that different dimensions of the OHL can have an impact on different aspects of coping with the pandemic.

Cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for use on Brazilian adolescents.

The present study aimed to perform the cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for native Brazilian Portuguese-speaking adolescents (DHLI-BrA). Cross-cultural adaptation consisted of the following steps: translation, assessment, and adjustments by the expert committee to ensure cultural equivalence; back-translation, and synthesis of back-translations. Cognitive testing was then performed in a pretest with adolescents using cognitive interviews with probing questions on the item's understanding interpretation and response options. Cronbach's alpha coefficient and McDonald's omega were used to estimate the instrument's reliability. Forty-two Brazilian adolescents participated in the study (mean age: 16.0 ± 2.0 years; range: 13 to 19 years). Items that were difficult to understand were adapted to the context of Brazilian adolescents. Cronbach's alpha coefficient and McDonald's omega for the 21 items of the DHLI-BrA were, respectively, 0.79 and 0.80. Cronbach's alpha coefficient for the subscales of the self-report instrument was 0.53-0.79 (range), demonstrating good reliability in the total instrument and moderate reliability in the subscales. This study provides the cross-cultural adapted version of the Digital Health Literacy Instrument (DHLI), which is an instrument for measuring digital Health literacy, for use in Brazilian adolescents (DHLI-BrA).

Seeking treatment for traumatic dental injuries in schoolchildren: A multilevel analysis.

To investigate individual and contextual factors associated with seeking treatment for traumatic dental injuries. A cross-sectional study was conducted with 739 pairs of guardians and children. Guardians answered a questionnaire addressing sociodemographic characteristics, seeking treatment for a tooth injury in the child, and the Oral Health Literacy-Adult Questionnaire. Descriptive analysis and unadjusted and adjusted multilevel Poisson regression analysis (p<0.05). The prevalence of seeking treatment for traumatic dental injury was 44.7%. Sociodemographic variables associated were white skin of the child (PR = 1.30; 95% CI: 1.08-1.76), mother's age older than 35 years (PR = 1.70; 95% CI: 1.50-1.90), married parents (PR = 1.93; 95% CI: 1.70-2.23), guardians with more than eight years of schooling (PR = 2.00; 95% CI: 1.76-2.23), with adequate oral health literacy (PR = 3.33; 95% CI: 3.01-3.62) and the daily use of electronic devices by the child (PR = 1.26; 95% CI: 1.02-1.50). On the contextual level, attending a private school (PR = 1.77; 95% CI: 1.02-3.05) and the number of primary care units with oral health teams in the school district (PR = 1.78; 95% CI: 1.12-2.38) remained associated. Among the children who suffered TDI, adequate oral health literacy on the part of the parents stood out among the factors associated with seeking treatment.

Different dimensions of oral health literacy are associated with social determinants of health in Brazilian adults.

Social determinants of health (SDH) are strongly associated with oral health outcomes, and oral health literacy (OHL) is a potential factor that can modify this association. This study evaluated the association between SDH and OHL, including functional and interactive dimensions of OHL. The cross sectional study was conducted with 354 adults recruited from public dental clinics in southern Brazil. Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14), for the evaluation of interactional OHL. SDH was evaluated through a structured questionnaire, and economic class was determined based on the Brazilian Economic Classification Criteria. The statistical analysis involved bivariate and multivariate Poisson regression with robust variance (α=0.05) to estimate rate ratios (RR) and 95% confidence intervals (CI). Among the 354 participants, 284 (80.2%) were women and the mean age was 22.9 ± 4.9 years. The median BREALD-30 score was 24 (1st/3rd quintile: 20/27) and the median HeLD-14 score was 45 (1st/3rd quintile: 37/50). Most participants had up to eight years of schooling (71.5%) and belonged to the "C" Economic Class or lower (94.1%). The multiple regression analysis showed that schooling and economic class were associated with the BREALD-30 and HeLD-14 scores, income and age were associated with the HeLD-14 score, and marital status and occupation were associated with the BREALD-30 score. Different dimensions of OHL were associated with SDH in Brazilian adults. This aspect should be incorporated into strategies for improving OHL levels in individuals or populations.

Impact of the COVID-19 pandemic on sleep quality and sleep bruxism in children eight to ten years of age.

This study aimed to determine the impact of the COVID-19 pandemic on sleep quality and possible sleep bruxism (SB) in children eight to ten years of age. The study hypothesis was that sleep disturbances influenced a higher occurrence of bruxism during the COVID-19 pandemic. A longitudinal study was conducted at two time points: in person prior to the COVID-19 pandemic (T1), and online during the pandemic (T2). The sample comprised 105 children. Parents/caregivers answered a questionnaire addressing sociodemographic characteristics, the use of electronic devices, reported (vs. clinical) SB, and the Sleep Disturbance Scale for Children (SDSC) at both T1 and T2. McNemar's and Wilcoxon's tests were used to compare SB and sleep disorders at both time points. Poisson regression analysis determined the relative risk (RR) among the variables, and the incidence of possible SB (p≤0.05). The comparison of the two time points (T1 and T2) revealed a significant increase in possible SB (p<0.01) and sleep disorders (p < 0.04). Children whose parents had a lower schooling level (RR: 2.67; 95%CI: 1.19-6.01), those with their own electronic devices (RR: 1.97; 95%CI: 1.09-2.50), and those with sleep disorders during the pandemic (RR: 1.74; 95%CI: 1.35-2.24) were at greater risk of developing SB during the pandemic. Moreover, the incidence of bruxism and sleep disorders was greater during the pandemic. The factors influencing SB incidence during the pandemic were a lower level of mothers' schooling, greater access to electronic devices, and the occurrence of sleep disorders.

Brazilian Children's Understanding of the Quality of Life in Their Living Environment: A Qualitative Study.

(1) Objective: To understand the perception of Brazilian children about the Quality of Life (QoL) considering their living environment. (2) Methods: This is a qualitative study conducted with children aged 6-10 years, from a medium-sized Brazilian municipality, recruited from public and private schools. An adaptation of the "draw, write, and say" method was used to collect data. At first, all children (n = 252) drew a "neighborhood with QoL". On the same day, the researcher analyzed the graphic elements of the representations and intentionally selected the two best-detailed drawings from each class (n = 49) and the children were invited to narrate them. The narratives were analyzed through content analysis. (3) Results: Two major themes emerged from the content analysis, namely, the physical environment and social environment. The first included the needs to live in a community, such as housing, places of leisure, essential services, and natural elements. The second was relationships with family and friends. (4) Conclusion: The children presented the meaning of an environment with QoL, pointing out essential items to have this ideal environment. The social environment and the physical environment were perceived interdependently; that is, any change in one of these aspects may affect children's QoL.

Effects of different toothpaste formulations on erosive tooth wear prevention: systematic review / Efeitos de diferentes dentifrícios na prevenção do desgaste dentário erosivo: revisão sistemática de literatura

Objective: erosive tooth wear is a multifactorial condition that results in loss of dental hard tissue, caused by a chemical and mechanical process. This paper aims to carry out a systematic review presenting the effects of different toothpaste formulations on the loss of dental enamel surface in vitro. Material and Methods: the searches were performed in the databases PubMed, Web of Science, LILACS and Scielo. Articles published from 2010 to 2020 were filtered, without language restriction. Articles that included abrasion and erosion protocols were searched, as they were more similar to clinical reality, since toothpaste is applied through tooth brushing. The searches with descriptors and free terms on the topic resulted in 992 articles, however only 12 were within the search criteria. Results: the selected studies appointed that association of conventional fluorides (NaF) with metallic fluorides can be a promising strategy for the reduction of surface loss by erosive tooth wear. Toothpastes containing sodium fluoride, as well as tin without chitosan, showed a reduction in surface loss, considered sufficient for individuals with medium exposure to acids. In children's toothpastes, the one containing sodium fluoride showed a reduction in surface loss when compared to non-fluoride dentifrices. Conclusion: different protocols may result in less or greater loss of enamel surface, and methodological differences should be considered. To clarify the effects of dentifrices on erosive tooth wear, other properties of dentifrices should be investigated. (AU)

Objetivo: o desgaste erosivo é uma condição multifatorial que resulta em perda de tecido duro dentário, causado por um processo químico e mecânico. Este trabalho tem como objetivo realizar uma revisão sistemática de literatura apresentando os efeitos de diferentes formulações de dentifrícios na perda de superfície de esmalte dentário in vitro. Material e Métodos: a busca foi realizada nas bases de dados PubMed, Web of Science, LILACS e Scielo. Foram filtrados artigos publicados no intervalo de 2010 a 2020, sem restrição de idioma. Buscou-se artigos que incluíssem protocolos de abrasão e erosão, por mais se assemelhar a realidade clínica, uma vez que o dentifrício é aplicado através da escovação dentária. A busca com descritores e termos livres sobre o tema encontrou 992 artigos, entretanto somente 12 estavam dentro dos critérios da pesquisa. Resultados: os estudos selecionados apontaram que associação dos fluoretos convencionais (NaF) com os metálicos pode ser uma estratégia promissora para a redução de perda de superfície pelo desgaste dentário erosivo. Dentifrícios contendo fluoreto de sódio, assim como estanho sem quitosana, apresentaram redução na perda de superfície, sendo considerada suficiente para indivíduos com exposição média aos ácidos. Em dentifrícios infantis, aquele que continha fluoreto de sódio apresentou uma redução de perda de superfície quando comparado com dentifrícios sem fluoreto. Conclusão:diferentes protocolos podem resultar em menor ou maior perda de superfície de esmalte e as diferenças (AU)

Parental oral health literacy influences preschool children's utilization of dental services

Abstract: Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03-1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09-1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03-1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level.

Seeking treatment for traumatic dental injuries in schoolchildren: A multilevel analysis

ABSTRACT To investigate individual and contextual factors associated with seeking treatment for traumatic dental injuries. A cross-sectional study was conducted with 739 pairs of guardians and children. Guardians answered a questionnaire addressing sociodemographic characteristics, seeking treatment for a tooth injury in the child, and the Oral Health Literacy-Adult Questionnaire. Descriptive analysis and unadjusted and adjusted multilevel Poisson regression analysis (p<0.05). The prevalence of seeking treatment for traumatic dental injury was 44.7%. Sociodemographic variables associated were white skin of the child (PR = 1.30; 95% CI: 1.08-1.76), mother's age older than 35 years (PR = 1.70; 95% CI: 1.50-1.90), married parents (PR = 1.93; 95% CI: 1.70-2.23), guardians with more than eight years of schooling (PR = 2.00; 95% CI: 1.76-2.23), with adequate oral health literacy (PR = 3.33; 95% CI: 3.01-3.62) and the daily use of electronic devices by the child (PR = 1.26; 95% CI: 1.02-1.50). On the contextual level, attending a private school (PR = 1.77; 95% CI: 1.02-3.05) and the number of primary care units with oral health teams in the school district (PR = 1.78; 95% CI: 1.12-2.38) remained associated. Among the children who suffered TDI, adequate oral health literacy on the part of the parents stood out among the factors associated with seeking treatment.

Resumo Investigar fatores individuais e contextuais associados à busca de tratamento para lesões dentárias traumáticas. Foi realizado um estudo transversal com 739 pares de responsáveis e crianças. Os responsáveis responderam a um questionário abordando características sociodemográficas, busca por tratamento para traumatismo dentário na criança e o Questionário de alfabetização em saúde bucal para adulto. Análise descritiva e análise de regressão de Poisson multinível não ajustada e ajustada (p<0,05) foram realizadas. A prevalência de busca de tratamento para lesão dentária traumática foi de 44,7%. As variáveis sociodemográficas associadas foram a pele branca da criança (RP = 1,30; IC 95%: 1,08-1,76), idade da mãe maior que 35 anos (RP = 1,70; IC 95%: 1,50-1,90), os responsáveis casados (RP = 1,93; IC 95%: 1,70-2,23), com mais de oito anos de estudo (RP = 2,00; IC 95%: 1,76-2,23), com alfabetização adequada em saúde bucal (RP = 2,00; IC 95%: 1,76-2,23) e uso diário de dispositivos eletrônicos pela criança (RP = 1,26; IC 95%: 1,02-1,50). No nível contextual, frequentar uma escola particular (PR = 1,77; IC 95%: 1,02-3,05) e a quantidade de unidades básicas de saúde com equipes de saúde bucal no distrito sanitário da escola (PR = 1,78; IC 95%: 1,12-2,38) permaneceram associados. Entre as crianças que sofreram TDI, a alfabetização em saúde bucal adequada dos pais foi um fator que se destacou na busca por tratamento.

Cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for use on Brazilian adolescents

Abstract The present study aimed to perform the cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for native Brazilian Portuguese-speaking adolescents (DHLI-BrA). Cross-cultural adaptation consisted of the following steps: translation, assessment, and adjustments by the expert committee to ensure cultural equivalence; back-translation, and synthesis of back-translations. Cognitive testing was then performed in a pretest with adolescents using cognitive interviews with probing questions on the item's understanding interpretation and response options. Cronbach's alpha coefficient and McDonald's omega were used to estimate the instrument's reliability. Forty-two Brazilian adolescents participated in the study (mean age: 16.0 ± 2.0 years; range: 13 to 19 years). Items that were difficult to understand were adapted to the context of Brazilian adolescents. Cronbach's alpha coefficient and McDonald's omega for the 21 items of the DHLI-BrA were, respectively, 0.79 and 0.80. Cronbach's alpha coefficient for the subscales of the self-report instrument was 0.53-0.79 (range), demonstrating good reliability in the total instrument and moderate reliability in the subscales. This study provides the cross-cultural adapted version of the Digital Health Literacy Instrument (DHLI), which is an instrument for measuring digital Health literacy, for use in Brazilian adolescents (DHLI-BrA).

Resumo O estudo teve o objetivo de adaptar transculturalmente o Digital Health Literacy Instrument (DHLI) para adolescentes nativos do idioma português do Brasil (DHLI-BrA). O estudo de adaptação transcultural consistiu nas seguintes etapas: tradução, avaliação e adequação de equivalência cultural da tradução por comitê de especialistas; retrotradução e síntese das retrotraduções. Foi realizada a testagem cognitiva em pré-teste com adolescentes, utilizando-se entrevistas cognitivas com perguntas de sondagem sobre a compreensão e interpretação dos itens e opções de resposta. O alfa de Cronbach e ômega de McDonald's foram utilizados para estimar a confiabilidade do instrumento. Participaram do pré-teste 42 adolescentes brasileiros com média de idade de 16,0 ± 2,0 (variação de 13-19) anos. Os itens com dificuldade de compreensão foram adaptados ao contexto dos adolescentes brasileiros. O coeficiente alfa de Cronbach e o ômega de McDonald's, para os 21 itens do DHLI-BrA foi respectivamente, 0,79 e 0,80. O coeficiente alfa de Cronbach para as subescalas do instrumento de autorrelato foi de 0,53-0,79 (variação), demonstrando boa confiabilidade no instrumento total e confiabilidade moderada nas subescalas. Este estudo fornece a versão adaptada transculturalmente do Digital Health Literacy Instrument (DHLI), um instrumento de mensuração do letramento digital em saúde, para utilização em adolescentes brasileiros (DHLI-BrA).

Is oral health literacy associated with conceptions of care and behavior related to the prevention of COVID-19?

Abstract The aim of the present study was to investigate the impact of oral health literacy (OHL) on conceptions of care and behaviors related to COVID-19. The sample came from two preliminary cross-sectional studies that determined the level of OHL of parents/guardians of six-to-12-year-old children in two major Brazilian cities (Curitiba and Belo Horizonte). Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14) for the evaluation of interactive OHL. Participants were recruited through e-mail, social media, and telephone contact. The questionnaire on conceptions of care and behaviors related to COVID-19 was created based on the guidelines of the World Health Organization. Two hundred nineteen individuals participated in the study. There was no significant difference in socioeconomic and demographic variables and in the medians of BREALD and HeLD-14 between the two cities (P>0.05). Higher levels of functional OHL were associated with an appropriate conception that individual care affects collective care (P=0.038), but with an inappropriate conception of seeking medical assistance in cases of mild symptoms (P=0.030). Higher levels of interactive OHL were related to social distancing behavior in the city of Curitiba (P=0.049) and in the overall sample (P=0.040). It is concluded that functional OHL was associated with two of the investigated conceptions about COVID-19, while interactive OHL was associated with social distancing behavior. These data may suggest that different dimensions of the OHL can have an impact on different aspects of coping with the pandemic.

Effect of mixing process on microleakage of glass ionomer cements used in atraumatic restorative treatment on primary molars.

Aiming to assess the effect of mixing process on microleakage, 40 primary molars were filled with encapsulated glass ionomer cements (GICs) (Vidrion, RCaps and Fuji, IXGPFAST) or with GICs stored in bottles (Vidrion, R and Fuji, IX). Dye penetration was assessed using scores. Encapsulation and mechanical mixing have reduced significantly marginal microleakage levels in class II restorations performed with conventional GICs if compared to the values obtained by their bottled correspondents (p=0.000).

Different dimensions of oral health literacy are associated with social determinants of health in Brazilian adults

Abstract Social determinants of health (SDH) are strongly associated with oral health outcomes, and oral health literacy (OHL) is a potential factor that can modify this association. This study evaluated the association between SDH and OHL, including functional and interactive dimensions of OHL. The cross sectional study was conducted with 354 adults recruited from public dental clinics in southern Brazil. Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14), for the evaluation of interactional OHL. SDH was evaluated through a structured questionnaire, and economic class was determined based on the Brazilian Economic Classification Criteria. The statistical analysis involved bivariate and multivariate Poisson regression with robust variance (α=0.05) to estimate rate ratios (RR) and 95% confidence intervals (CI). Among the 354 participants, 284 (80.2%) were women and the mean age was 22.9 ± 4.9 years. The median BREALD-30 score was 24 (1st/3rd quintile: 20/27) and the median HeLD-14 score was 45 (1st/3rd quintile: 37/50). Most participants had up to eight years of schooling (71.5%) and belonged to the "C" Economic Class or lower (94.1%). The multiple regression analysis showed that schooling and economic class were associated with the BREALD-30 and HeLD-14 scores, income and age were associated with the HeLD-14 score, and marital status and occupation were associated with the BREALD-30 score. Different dimensions of OHL were associated with SDH in Brazilian adults. This aspect should be incorporated into strategies for improving OHL levels in individuals or populations.