Dental caries remains as the main oral condition with the greatest impact on children's quality of life.

PURPOSE: The objective of this study was to assess the negative impact of dental caries on the OHRQoL of 8- to 10-year-old Brazilian children. METHODS: This population-based case-control study involved 546 children (8-10 years old), 182 cases with a high negative impact on OHRQoL and 364 controls with a low negative impact on OHRQoL. Children's OHRQOL was measured using the Child Perceptions Questionnaire (CPQ8-10). Cases and controls (1x2 ratio) were individually matched by school and gender. Dental caries experience, malocclusion, and traumatic dental injuries were used as independent variables. Dental examinations were carried out at school during daytime hours by two calibrated examiners (Kappa = 0.93-interexaminer and 0.95- intraexaminer). The data were analyzed by descriptive statistics, conditional bivariate and multiple logistic regression, with the significance level set at 5%. RESULTS: There was no significant difference in traumatic dental injuries and malocclusion between the case and control groups (p>0.05). Children with DMFT/dmft ≥3 had a 2.06-fold (95%CI = 1.28-3.31, p = 0.003) greater chance of experiencing a high negative impact on OHRQoL than those with DMFT/dmft = 0. CONCLUSION: Children with high dental caries experience are more likely to present a high negative impact on OHRQoL than those with no dental caries experience.

Impact of traumatic dental injuries among adolescents on family's quality of life: a population-based study.

AIM: To evaluate the impact of traumatic dental injury (TDI) among Brazilian adolescents on their families' quality of life (QoL). DESIGN: A cross-sectional study was carried out with a population-based sample of 1122 schoolchildren aged 11-14 years selected using a multistage sampling procedure. Parents/caregivers answered the Brazilian version of the 14-item Family Impact Scale (B-FIS) to assess the impact on family's QoL. The main independent variable was TDI, which was diagnosed using the Andreasen classification. Malocclusion, dental caries, gender and socio-economic classification were the other independent variables. Poisson regression analyses were carried out (P<0.05). RESULTS: The prevalence of TDI was 14.8%. The multivariate model demonstrated that families of adolescents diagnosed with fracture involving the dentine or dentine/pulp were more likely to report a negative impact on the overall B-FIS score [rate ratio (RR)=1.44; 95% confidence interval (CI): 1.10-1.88] as well on the Parental/Family Activity (RR=1.45; 95% CI: 1.09-1.94), Parental Emotions (RR=1.45; 95% CI: 1.03-2.04) and Family Conflict (RR=1.46; 95% CI: 1.01-2.11) subscales in comparison with those who had no signs of TDI. CONCLUSIONS: Families of adolescents with more severe TDI were more likely to report a negative impact on QoL, affecting family activities and emotions, which can result in family conflicts.

Oral health-related quality of life and traumatic dental injuries in Brazilian adolescents.

OBJECTIVES: To evaluate the impact of traumatic dental injuries (TDI) on oral health-related quality of life (OHRQoL) among Brazilian adolescents. METHODS: A population-based case-control study was carried out, which was nested to a cross-sectional study with a sample of 1215 adolescents aged 11-14 years from Belo Horizonte, Brazil. OHRQoL was measured using the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14 )--Impact Short Form (ISF:16). Two-step cluster analysis was performed to define cases and controls based on CPQ11-14--ISF:16 scores. This method considers the pattern of responses for each item separately and how important each item is to the formation of clusters. The case group included those adolescents who presented higher negative impact on OHRQoL (n=405), while the control group included those with lower negative impact (n=810). Two controls for each case were individually matched from the same school and gender. The main independent variable was TDI, diagnosed by the Andreasen's classification. Untreated dental caries, malocclusion, and age were confounding variables. Conditional logistic regression analysis was performed with the significance level set at 5%. RESULTS: A multiple conditional logistic regression model demonstrates that adolescents diagnosed with fracture involving dentin and/or pulp had a 2.40-fold greater chance of presenting high negative impact on QHRQoL [95% CI=1.26-4.58; P=0.008] than those without evidence of fractures. Enamel fracture only [P=0.065] and restored fractures [P=0.072] were not statistically associated with OHRQoL. CONCLUSIONS: Adolescents with more severe untreated TDI, such as fractures involving dentin and/or pulp, were more likely to self-report a higher negative impact on their OHRQoL than those without TDI.

Malocclusion and oral health-related quality of life in Brazilian school children.

OBJECTIVE: To test the hypothesis that malocclusion and its impact on quality of life has no effect on 8- to 10-year-old Brazilian schoolchildren as measured by an oral health-related quality of life (OHRQoL) instrument. MATERIALS AND METHODS: A cross-sectional study was carried out with a population-based sample of 1204 8- to 10-year-old children attending elementary schools in Belo Horizonte, Brazil. Dental examinations were carried out by two calibrated examiners. OHRQoL was assessed using the Brazilian version of the Child Perceptions Questionnaire. The Dental Aesthetic Index was used for the clinical assessment of malocclusion. Dental caries and socioeconomic factors were used as controlling variables. Bivariate analysis involved the chi-square test and the Fisher exact test. A Poisson regression model was employed for the multivariate analysis (P < .05). RESULTS: Anterior segment spacing and anterior mandibular overjet were significantly associated with impact on OHRQoL (P < .05). Schoolchildren with malocclusion were 1.30-fold (95% CI: 1.15-1.46; P < 0.001) more likely to experience a negative impact on OHRQoL than those without malocclusion. Children belonging to families with an income less than or equal to two times the minimum wage were 1.59-fold (95% CI: 1.35-1.88; P < 0.001) more likely to experience a negative impact on OHRQoL than those belonging to families with the highest income. CONCLUSIONS: Schoolchildren with malocclusion from lower-income families experience a greater negative impact on OHRQoL.

Association between childhood dental experiences and dental fear among dental, psychology and mathematics undergraduates in Brazil.

The aim of the present study was to evaluate the association between childhood dental experiences and dental fear in adulthood among dentistry, psychology and mathematics undergraduate students. A cross-sectional study of 1,256 students from the city of Belo Horizonte, Brazil, was performed. Students responded to the Brazilian version of the Dental Fear Survey (DFS) and a questionnaire regarding previous dental experiences. Both the DFS and the questionnaire were self-administered. Association was tested using descriptive, bivariate and multivariate linear regression analysis, with a 5% significance level. Dentistry undergraduates reported lower scores than psychology (p < 0.001) and mathematics undergraduates (p < 0.05) for all three dimensions of the DFS. Negative dental experiences in childhood was associated with dimensions of Avoidance (B = 2.70, p < 0.001), Physiological arousal (B = 1.42, p < 0.001) and Fears of specific stimuli/situations (B = 3.44, p < 0.001). The reason for first visit to dentist was associated with dimensions of Physiological arousal (B = 0.76, p < 0.01) and Fears of specific stimuli/situations (B = 1.29, p < 0.01). Dentists should be encouraged to evaluate the dental fear of their patients before treatment. The DFS has been found to be an effective instrument for this purpose.

Association between binge drinking, type of friends and gender: a cross-sectional study among Brazilian adolescents.

BACKGROUND: Hazardous drinking among adolescents is a major public health concern. The purpose of this study was to examine the prevalence of binge drinking/alcohol consumption and its association with different types of friendship networks, gender and socioeconomic status among students in Belo Horizonte, Minas Gerais, Brazil. METHODS: We conducted a cross-sectional study on a representative random sample of 891 adolescents (41% male, aged 15-19 years) from public and private schools in 2009-2010. Information on friendship networks and binge drinking was collected using two validated self-administered questionnaires: the Integrated Questionnaire for the Measurement of Social Capital and the first 3 items in the Alcohol Use Disorders Identification Test (AUDIT C). We used the area-based Social Vulnerability Index (SVI), mother and father's educational background, and the type of school to assess socioeconomic status. The chi-squared test was used to examine the associations between sample characteristics or the type of friends and binge drinking (p-values <0.05 were considered statistically significant). Ordinal logistic regression was used to estimate the association between binge drinking and the independent variables. RESULTS: A total of 321 (36%) adolescents reported binge drinking (5 or more drinks in one occasion), and among them, 233 (26.2%) adolescents reported binge drinking less than monthly to monthly, and 88 (9.9%) weekly to daily. Binge drinking was associated with being male (OR = 1.52, 95% CI 1.01-2.28) and with living in a low vulnerability area (having the best housing conditions, schooling, income, jobs, legal assistance and health) (OR = 1.66, 95% CI 1.05-2.62). Students who reported that their closest friends were from school (as opposed to friends from church) had an increased risk of binge drinking (OR = 3.55, 95% CI 1.91-5.87). In analyses stratified by gender, the association was significant only among the female students. CONCLUSIONS: The prevalence of binge drinking was high in this sample of Brazilian adolescents, and gender, low social vulnerability and friendship network were associated with binge drinking.

The PedsQL™ Oral Health Scale: feasibility, reliability and validity of the Brazilian Portuguese version.

BACKGROUND: Oral and orofacial problems may cause a profound impact on children's oral health-related quality of life (OHRQoL) because of symptoms associated with these conditions that may influence the physical, psychological and social aspects of their daily life. The OHRQoL questionnaires found in the literature are very specific and are not able to measure the impact of oral health on general health domains. Consequently, the objective of this study was to evaluate the psychometric properties of the Portuguese version for Brazilian translation of the Pediatric Quality of Life Inventory™ (PedsQL™) Oral Health Scale in combination with the PedsQL™ 4.0 Generic Core Scales. METHODS: The PedsQL™ Oral Health Scale was forward-backward translated and cross-culturally adapted for the Brazilian Portuguese language. In order to assess the feasibility, reliability and validity of the Brazilian version of the instrument, a study was carried out in Belo Horizonte with 208 children and adolescents between 2 and 18 years-of-age and their parents. Clinical evaluation of dental caries, socioeconomic information and the Brazilian versions of the PedsQL™ Oral Health Scale, PedsQL™ 4.0 Generic Core Scales, Child Perceptions Questionnaire (CPQ11-14 and CPQ8-10) and Parental-Caregiver Perception Questionnaire (P-CPQ) were administered. Statistical analysis included feasibility (missing values), confirmatory factor analysis (CFA), internal consistency reliability, and test-retest intraclass correlation coefficients (ICC) of the PedsQL™ Oral Health Scale. RESULTS: There were no missing data for both child self-report and parent proxy-report on the Brazilian version of the PedsQL™ Oral Health Scale. The CFA showed that the five items of child self-report and parent proxy-report loaded on a single construct. The Cronbach's alpha coefficients for child/adolescent and parent oral health instruments were 0.65 and 0.59, respectively. The test-retest reliability (ICC) for child self-report and parent proxy-report were 0.90 [95% confidence interval (CI) = 0.86-0.93] and 0.86 (95%CI = 0.81-0.90), respectively. The PedsQL™ Oral Health Scale demonstrated acceptable construct validity, convergent validity and discriminant validity. CONCLUSIONS: These results supported the feasibility, reliability and validity of the Brazilian version of the PedsQL™ Oral Health Scale for child self-report for ages 5-18 years-old and parent proxy-report for ages 2-18 years-old children.

Orthodontic treatment of a child with Crigler-Najjar syndrome type I using tacrolimus following liver transplantation.

The present study reports the orthodontic treatment of a child with Crigler-Najjar syndrome type I following a liver transplant and administration of tacrolimus (1 mg/day). Tacrolimus (FK506) is fundamental to immunosuppression following transplantation. The child exhibited Class II division 1 malocclusion. The treatment option was to use a Herbst appliance for seven months and a fixed appliance (straight wire) for 12 months.

Incidence of malocclusion between primary and mixed dentitions among Brazilian children. A 5-year longitudinal study.

OBJECTIVE: To determine the incidence of malocclusion in a 5-year follow-up of school children and verify the hypothesis that individuals with previous malocclusion are more prone to maintain the same characteristics in the transition from primary to mixed dentition. MATERIALS AND METHODS: School children, ages 8 to 11 years, participated. Inclusion criteria consisted of normal occlusion in primary dentition or subsequent malocclusions, anterior open bite and/or posterior crossbite and/or overjet measuring more than 3 mm, and that subjects had not submitted to orthodontic treatment and adenoidectomy. Data collection was based on evaluation of occlusion in school children in the actual stage of mixed dentition. Descriptive, Chi-square, and relative risk (RR) 95% confidence interval (CI) analyses were carried out. RESULTS: The greatest incidence of malocclusion was found in children with malocclusion (94.1%) when compared with those without malocclusion (67.7%) (RR  =  1.4 [1.2-1.6]; P < .001). Anterior open bite (RR  =  3.1 [1.7-5.8]), posterior crossbite (RR  =  7.5 [4.9-11.5]), and overjet greater than 3 mm (RR  =  5.2 [3.4-8.0]) in the primary dentition are risk factors for malocclusion in early mixed dentition. Spontaneous correction of the anterior open bite was confirmed in 70.1% of cases. Posterior crossbite and overjet greater than 3 mm were persistent in 87.8% and 72.9% of children. CONCLUSIONS: Malocclusion incidence was high. Individuals with previous anterior open bite, greater overjet, and posterior crossbite had greater risk of having the same characteristics in the mixed dentition.

Prevalence and association of dental injuries with socioeconomic conditions and alcohol/drug use in adolescents between 15 and 19 years of age.

BACKGROUND: The aim of the present study was to investigate the prevalence of dental trauma, etiological factors, predisposing factors, and associations with socioeconomic status and the risk of alcohol and illicit drug use among adolescents in the city of Belo Horizonte, Brazil. METHODS: A cross-sectional study was carried out that included clinical examinations and self-administered questionnaires. The sample population was composed of 891 adolescents from public and private schools. The Social Vulnerability Index (SVI) was used for socioeconomic classification. Information on alcohol and illicit drug use was obtained using two questionnaires: the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). RESULTS: The prevalence of traumatic dental injury (TDI) was 24.7%. Falls (17.7%) was the most frequently cited etiological factor in dental injury. Among the participants with TDI, 32.8% were students in the private school system (P = 0.006). A total of 56.8% of individuals with accentuated overjet had some type of TDI (P = 0.000). There was a high prevalence of adolescents who consumed alcoholic beverages (50.3%) and used illicit substances (15.2%). However, no statistically significant associations were found between these variables and the presence of TDI. The results of the analysis demonstrate that individuals in a private school system [prevalence ratio (PR) = 1.11; 95% confidence interval (CI): 1.03-1.20] and those with accentuated overjet (>3 mm) (PR = 1.17; 95% CI: 1.10-1.25) had a 1.11- and 1.17-fold greater chance of belonging to the group of individuals diagnosed with some type of TDI. CONCLUSIONS: The prevalence of dental trauma in the study population was high. The same was true regarding alcohol and illicit drug use among the adolescents examined, although no statistically significant associations were found between these variables and a history of TDI. Private school system and accentuated overjet were significantly associated with dental trauma.

Social vulnerability and traumatic dental injury among Brazilian schoolchildren: a population-based study.

The aim of the present study was to test the association between social vulnerability and the prevalence of traumatic dental injury (TDI). A population-based cross-sectional study was carried out with 1,556 schoolchildren aged 11 to 14 years in the city of Belo Horizonte, Brazil. The participants were examined for TDI using Andreasen's criteria and those diagnosed with TDI were interviewed to determine the history of the injury. The Social Vulnerability Index (SVI) was used for socioeconomic classification, which addresses environmental, cultural, economic, legal and security/survival dimensions. The Poisson regression model was used for the multivariate analysis, with the significance level set at 5%. The prevalence of TDI was 14.1%; 59.3% of the participants with TDI did not seek a dentist after the incident. Poorer environmental, economic and legal conditions were statistically associated with the occurrence of untreated TDI (p < 0.05) and all the five SVI dimensions were associated with seeking a dentist due to TDI (p < 0.006). The prevalence of untreated TDI was higher among boys (PR: 1.42; 95%CI: 1.11-1.81) and those in situations of greater social vulnerability (PR: 2.27; 95%CI: 1.11-4.61). In conclusion, the male gender and high social vulnerability proved to be associated with the occurrence of TDI.

Validity and reliability of the Brazilian version of the psychosocial impact of dental aesthetics questionnaire.

Oral health-related quality of life (OHRQoL) is an important aspect of health outcomes and its assessment should be made using validated instruments. The psychosocial impact of dental aesthetics questionnaire (PIDAQ) is an OHRQoL instrument that assesses the psychosocial impact of dental aesthetics was developed and validated for use on young adults. The aim of the present study was to assess the reliability, validity, and applicability of the PIDAQ for young adults in Brazil. After translation and cross-cultural adaptation, the questionnaire was completed by 245 individuals (124 males and 121 females) aged 18-30 years from the city of Belo Horizonte, Brazil. In order to test discriminant validity, the subjects were examined for the presence or absence of malocclusion based on the dental aesthetic index criteria. Dental examinations were carried out by a previously calibrated examiner [weighted kappa = 0.64-1.00, intraclass correlation coefficient (ICC) = 0.78-1.00]. Internal consistency measured by Cronbach's alpha of the subscales was between 0.75 and 0.91 and test-retest reliability was assessed using the ICC, which ranged from 0.89 to 0.99 for dental self-confidence and social impact, thereby revealing satisfactory reliability. Discriminant validity revealed that subjects without malocclusion had different PIDAQ scores when compared with those with malocclusion. The results suggest that the Brazilian version of the PIDAQ has satisfactory psychometric properties and is thus applicable to young adults in Brazil. Further research is needed to assess these properties in population studies.

Association between treated/untreated traumatic dental injuries and impact on quality of life of Brazilian schoolchildren.

BACKGROUND: Traumatic dental injury (TDI) could have physical and psychosocial consequences for children. Thus, it is important to measure the impact of TDI on the quality of life of children (QoL). The aim of the present study was to investigate the association between treated/untreated TDI and the impact on the quality of life of 11-to-14-year-old Brazilian schoolchildren. METHODS: A cross-sectional study was carried out involving 1612 male and female schoolchildren aged 11 to 14 years attending public and private elementary schools in the city of Belo Horizonte, Brazil. A multi-stage sampling technique was adopted to select the children. Three calibrated examiners used the Andreasen classification for the diagnosis of TDI. Oral health-related quality of life was assessed using the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) - Impact Short Form (ISF:16), composed of 16 items and self-administered by all children. Other oral conditions (dental caries and malocclusion) and the Social Vulnerability Index were determined and used as controlling variables. RESULTS: Two hundred nineteen children were diagnosed with untreated TDI and 64 were diagnosed with treated TDI. There were no statistically significant associations between untreated or treated TDI and overall CPQ11-14 (Fisher = 0.368 and Fisher = 0.610, respectively). Children with an untreated TDI were 1.4-fold (95% CI = 1.1-2.1) more likely to report impact on the item "avoided smiling/laughing" than those without TDI, whereas children with a treated TDI were twofold (95% CI = 1.1-3.5) more likely to report impact on the item "other children asked questions" than those without TDI. CONCLUSIONS: Neither treated nor untreated TDI was associated with oral symptoms, functional limitations or emotional wellbeing. However, children with a TDI in the anterior teeth experienced a negative impact on social wellbeing, mainly with regard to avoiding smiling or laughing and being concerned about what other people may think or say.

Prevalence and associated factors of traumatic dental injuries in Brazilian schoolchildren.

OBJECTIVES: This study investigated the prevalence of traumatic dental injury (TDI) and associated factors in the permanent incisors of Brazilian schoolchildren. METHODS: A cross-sectional survey was carried out with 1,612 male and female children aged 11 to 14 attending public and private elementary schools in Belo Horizonte, Brazil. A multistage sampling technique was adopted to select the children. Oral examinations were performed by calibrated examiners for the diagnosis of TDI (criteria proposed by Andreasen) and dental caries [Decayed, Missing and Filled Teeth Index (DMFT)]. The Social Vulnerability Index was used for socioeconomic classification. Data analysis involved descriptive statistics and the Poisson regression model. RESULTS: The prevalence of TDI was 17.1%. Falls (43.6%) were the most common cause of TDI, mainly at home (41.8%). Boys were more affected than girls. There was no statistically significant association between TDI and socioeconomic status. The adjusted results revealed that TDI was significantly associated with DMFT [1.11, 95% confidence interval (CI): 1.06 to 1.16] and overjet (1.15, 95% CI: 1.00 to 1.31). CONCLUSIONS: TDI was associated with dental caries and overjet and was not influenced by socioeconomic status.

Oral disease and social class in a random sample of five-year-old preschool children in a Brazilian city.

PURPOSE: The objective of the present study was to determine the association between oral disease, access to dental care and social class in a random sample of five-year-old preschool children in Belo Horizonte, Minas Gerais, Brazil. MATERIALS AND METHODS: A cross-sectional study was carried out on a sample of 551 five-year-old children who were randomly selected from preschools. Oral health status was assessed using the decayed, missing or filled teeth (dmft) index as well as the presence of visible plaque, gingivitis and supragingival calculus. Oral examinations were performed by two examiners (j > 0.80). The clinical outcome variables were dental caries, filled and missing teeth, dental pulp exposure due to caries, dental root fragment, visible plaque, gingivitis and supragingival calculus. Social class was assessed using the City Hall database. RESULTS: Children without caries represented 63.9% of the sample. Mean overall dmft was calculated to be 1.56, and the decayed teeth component was the highest in all of the social classes. Missing teeth, caries with pulp involvement and dental root fragment had higher proportions and the filled teeth component had the lowest proportion in children from the lowest social class. Visible dental plaque was present in 45.4% of the children. Except for the filled teeth component, all of the clinical outcome variables had a significant association with social class status (P < 0.001), regardless of child's gender. CONCLUSIONS: Oral disease in the primary dentition and access to dental treatment are affected by social and cultural factors.

Psychometric properties of the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) - short forms.

BACKGROUND: The need to evaluate the impact of oral health has led to the development of instruments for measuring oral health-related quality of life (OHQoL). One such instrument is the Child Perceptions Questionnaire (CPQ(11-14)), developed specifically for 11-to-14-year-old children. As this questionnaire was considered long (37 items), shorter forms were developed with 8 (Impact Short Form: 8--ISF:8) and 16 items (Impact Short Form: 16--ISF:16) to facilitate use in the clinical setting and population-based health surveys. The aim of the present study was to translate and cross-culturally adapt these CPQ(11-14) short forms for Brazilian Portuguese and evaluate the measurement properties of these versions for use on Brazilian children. METHODS: Following translation and cross-cultural adaptation, the ISF:8 and ISF:16 were tested on 136 children from 11 to 14 years of age in the city of Belo Horizonte, Brazil. The instrument was administered by a trained researcher who also performed clinical examinations. The measurement properties (i.e. criterion validity, construct validity, internal consistency reliability, test-retest reliability) were determined. Discriminant validity was tested between groups, which were divided into children with no cavities and no malocclusion; children with cavities and without malocclusion; and children with malocclusion and without cavities. RESULTS: The mean total score was 6.8 [standard deviation (SD) 4.2] for the ISF:8 and 11.9 (SD 7.6) for the ISF:16 (p < 0.001). Statistically significant associations were found between oral abnormalities and the subscales of the ISF:8 and ISF:16 (p < 0.05). Both test-retest stability and internal consistency, as measured by the intra-class correlation coefficient (ICC) (ISF:8 = 0.98 and ISF:16 = 0.97) and Cronbach's alpha (ISF:8 = 0.70 and ISF:16 = 0.84) proved to be adequate. Construct validity was confirmed from the correlation between the short form scores and oral health and overall well-being ratings. The score on the short forms of the CPQ(11-14) was able to discriminate between different oral conditions. Criterion validity was satisfactory (p < 0.05). CONCLUSION: The Brazilian versions of CPQ(11-14) ISF:8 and ISF:16 have satisfactory psychometric properties, similar to those of the original instrument.