Breastfeeding, bottle feeding practices and malocclusion in the primary dentition: a systematic review of cohort studies.

The World Health Organization recommends exclusive breast feeding for at least six months. However, there is no scientific evidence of the benefits of breast feeding for oral health in children under primary dentition. This study aimed to search for scientific evidence regarding the following question: is bottle feeding associated with malocclusion in the primary dentition compared to children that are breastfed? An electronic search was performed in seven databases. The systematic review included 10 cohort studies. It was not possible to conduct meta-analysis; therefore a qualitative analysis was assessed. The majority of studies evaluated feeding habits by means of questionnaires and conducted a single examination. Three studies observed that bottle feeding was significantly associated with overjet and posterior crossbite. Studies reported several cut-off times for breastfeeding (varying from 1 month up to 3 years of age) and several types of malocclusion. Controlling for non-nutritive sucking habits was reported for only half of the studies and this may have led to biased results. The scientific evidence could not confirm a specific type of malocclusion associated with the feeding habits or an adequate time of breastfeeding to benefit the children against malocclusion. Further cohort studies are needed to confirm this evidence.

Anxiety and worry when coping with cancer treatment: agreement between patient and proxy responses.

PURPOSE: Assess agreement between proxy respondents (caregivers) and children/adolescents related to the impact of cancer on children's/adolescents' health-related quality of life, with respect to anxiety and worry issues. METHODS: A cross-sectional study was conducted among 83 Brazilian children/adolescents, of both genders, diagnosed with cancer, aged 5-18 years and their proxy respondents. Anxiety and worry were assessed through items of the instrument Pediatric Quality of Life Inventory™ Cancer Module Scale. Participants were recruited from the pediatric hematology/oncology centers at two public hospitals. All individuals were receiving medical care. Descriptive statistics were performed as well as a weighted kappa coefficient, Spearman's correlation coefficient, Wilcoxon signed-rank test and Bland-Altman plots. The magnitude of the difference between the mean scores obtained from children/adolescents and that of their proxy respondents was evaluated through effect size. RESULTS: The proxy respondents underestimated the feelings of worry among children (8-12 years) (p < 0.001; effect size 0.71) and overestimated adolescents' (13-18 years) treatment anxiety (p < 0.05; effect size 0.57). The comparison between the three age groups (5-7, 8-12, 13-18 years) showed a tendency for children/adolescents to report increasing feelings of worry as they got older. In the 'treatment anxiety' subscale, there was a tendency for proxy respondents to present higher mean scores, revealing that proxy respondents believed the children's/adolescents' treatment anxiety decreased as they aged. CONCLUSIONS: Discrepancies between the reports of children/adolescents and their proxy respondents were observed. Children's/adolescents' reports should not be ignored nor replaced by proxy reports; both reports should be analyzed together.

Tooth erosion and eating disorders: a systematic review and meta-analysis.

BACKGROUND: Eating disorders are associated with the highest rates of morbidity and mortality of any mental disorders among adolescents. The failure to recognize their early signs can compromise a patient's recovery and long-term prognosis. Tooth erosion has been reported as an oral manifestation that might help in the early detection of eating disorders. OBJECTIVES: The aim of this systematic review and meta-analysis was to search for scientific evidence regarding the following clinical question: Do eating disorders increase the risk of tooth erosion? METHODS: An electronic search addressing eating disorders and tooth erosion was conducted in eight databases. Two independent reviewers selected studies, abstracted information and assessed its quality. Data were abstracted for meta-analysis comparing tooth erosion in control patients (without eating disorders) vs. patients with eating disorders; and patients with eating disorder risk behavior vs. patients without such risk behavior. Combined odds ratios (ORs) and a 95% confidence interval (CI) were obtained. RESULTS: Twenty-three papers were included in the qualitative synthesis and assessed by a modified version of the Newcastle-Ottawa Scale. Fourteen papers were included in the meta-analysis. Patients with eating disorders had more risk of tooth erosion (OR = 12.4, 95%CI = 4.1-37.5). Patients with eating disorders who self-induced vomiting had more risk of tooth erosion than those patients who did not self-induce vomiting (OR = 19.6, 95%CI = 5.6-68.8). Patients with risk behavior of eating disorder had more risk of tooth erosion than patients without such risk behavior (Summary OR = 11.6, 95%CI = 3.2-41.7). CONCLUSION: The scientific evidence suggests a causal relationship between tooth erosion and eating disorders and purging practices. Nevertheless, there is a lack of scientific evidence to fulfill the basic criteria of causation between the risk behavior for eating disorders and tooth erosion.

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.

Tooth erosion awareness in a Brazilian dental school.

The aim of this cross-sectional study was to assess awareness and attitudes related to tooth erosion among dental students, patients, and faculty members in a Brazilian dental school. Data were collected by means of a self-applied questionnaire that was distributed among 298 participants. The response rate was 89.6 percent. Chi-square and Fisher's exact tests were used for statistical analysis (p<0.05). The majority of the participants had heard about erosion (72.9 percent), with lower percentages among the patients (p<0.001). In total, 74.9 percent believe that sugar can contribute to erosion (p=0.004). Almost 30 percent of the students did not know if they had had a patient with erosion, and 73.1 percent reported they were not advised by their clinical supervisor to examine their patients for tooth erosion (p=0.138). Concerning the faculty, 23.6 percent of them along with 61.5 percent of the students did not feel prepared to diagnose the condition (p<0.001). Reducing the consumption of acidic drinks was the practice most frequently mentioned as recommended to prevent erosion (89.6 percent). Knowledge about tooth erosion was not as widely evident as it should be in this sample, suggesting the need for better understanding and communication in this important area of oral health care.

Occupational exposure to potentially infectious biological material in a dental teaching environment.

The aims of this cross-sectional study were to determine the prevalence of occupational accidents with exposure to biological material among undergraduate students of dentistry and to estimate potential risk factors associated with exposure to blood. Data were collected through a self-administered questionnaire (86.4 percent return rate), which was completed by a sample of 286 undergraduate dental students (mean age 22.4 +/-2.4 years). The students were enrolled in the clinical component of the curriculum, which corresponds to the final six semesters of study. Descriptive, bivariate, simple logistic regression and multiple logistic regression (Forward Stepwise Procedure) analyses were performed. The level of statistical significance was set at 5 percent. Percutaneous and mucous exposures to potentially infectious biological material were reported by 102 individuals (35.6 percent); 26.8 percent reported the occurrence of multiple episodes of exposure. The logistic regression analyses revealed that the incomplete use of individual protection equipment (OR=3.7; 95 percent CI 1.5-9.3), disciplines where surgical procedures are carried out (OR=16.3; 95 percent CI 7.1-37.2), and handling sharp instruments (OR=4.4; 95 percent CI 2.1-9.1), more specifically, hollow-bore needles (OR=6.8; 95 percent CI 2.1-19.0), were independently associated with exposure to blood. Policies of reviewing the procedures during clinical practice are recommended in order to reduce occupational exposure.

Diet and dental erosion in young people in south-east Brazil.

BACKGROUND: The regular consumption of acidic foods and drinks may be associated with dental erosion, and soft drink consumption appears to be increasing both in developed and developing countries. Dentists are aware that an acidic diet can contribute to the development of erosion; however, there may be confusion within the profession concerning the general health message of eating five portions of fruits and vegetables each day. OBJECTIVE: The aim of this study was to investigate associations between dental erosion and the consumption of acidic foods and beverages in schoolchildren in south-east Brazil. The objective was to gather information, by means of a dietary questionnaire, on frequency of intake and patterns of consumption of acidic foods and drinks in a group of schoolchildren. The hypothesis was that the experience of dental erosion among the study sample was associated with the frequency and pattern of consumption of soft drinks, fruit juices, fruits, and yogurt. METHODS: A cross-sectional study was conducted in Três Corações, south-east Brazil. A sample of 458 schoolchildren, mean age 13.8 (SD 0.39) years, completed the study. Information about potential dietary risk factors for dental erosion was collected through a questionnaire survey completed by the schoolchildren. For the dental examinations, the subjects were examined for dental erosion in a school room. Associations between dental erosion and the variables under study were investigated through processes of bivariate and multivariate analyses. The statistical significance level was set at 5%. RESULTS: Analysis of the questionnaire surveys showed that the frequency of consumption of sugared carbonated drinks was the only variable independently associated with the erosive process, with subjects who had a daily consumption of such drinks having a greater likelihood of having erosion (P = 0.015, odds ratio 1.752, 95% confidence interval 1.116-2.750). CONCLUSIONS: Of all tested factors in this sample of schoolchildren the consumption of sugared carbonated drinks is most associated with dental erosion.

Dental erosion amongst 13- and 14-year-old Brazilian schoolchildren.

OBJECTIVES: To assess the prevalence of dental erosion in a sample of 13- and 14-year-old Brazilian schoolchildren and to assess the relationship of dental erosion and socio-demographic characteristics. METHODS: A convenience sample of 458 children (190 boys and 268 girls) from 14 schools in Três Corações, south east Brazil, was examined. Socio-demographic data were collected by self-completion questionnaires. RESULTS: Dental erosion was observed in 34.1% of subjects, involving enamel only and showing a symmetrical distribution. The palatal surfaces of the upper incisors were the most commonly affected surfaces. Erosion experience was higher in boys; pupils from Government funded schools; those resident in rural areas and those from the high economic class, but none of these were statistically significant. CONCLUSION: These data are the first to show that in a cohort of 13-14-year old Brazilian schoolchildren, approximately one third of those examined showed mild erosion, requiring clinical preventive counselling. No statistically significant association was observed between erosion, gender and socioeconomic factors.