Structural Determinants and Children's Oral Health: A Cross-National Study.

Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries ( N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children's oral health. The structural determinants accounted for between 5% and 21% of the variance in children's oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.

Psychometric assessment of the short-form Child Perceptions Questionnaire: an international collaborative study.

OBJECTIVE: To examine the factor structure and other psychometric characteristics of the most commonly used child oral-health-related quality-of-life (OHRQoL) measure (the 16-item short-form CPQ11-14 ) in a large number of children (N = 5804) from different settings and who had a range of caries experience and associated impacts. METHODS: Secondary data analyses used subnational epidemiological samples of 11- to 14-year-olds in Australia (N = 372), New Zealand (three samples: 352, 202, 429), Brunei (423), Cambodia (244), Hong Kong (542), Malaysia (439), Thailand (220, 325), England (88, 374), Germany (1055), Mexico (335) and Brazil (404). Confirmatory factor analysis (CFA) was used to examine the factor structure of the CPQ11-14 across the combined sample and within four regions (Australia/NZ, Asia, UK/Europe and Latin America). Item impact and internal reliability analysis were also conducted. RESULTS: Caries experience varied, with mean DMFT scores ranging from 0.5 in the Malaysian sample to 3.4 in one New Zealand sample. Even more variation was noted in the proportion reporting only fair or poor oral health; this was highest in the Cambodian and Mexican samples and lowest in the German sample and one New Zealand sample. One in 10 reported that their oral health had a marked impact on their life overall. The CFA across all samples revealed two factors with eigenvalues greater than 1. The first involved all items in the oral symptoms and functional limitations subscales; the second involved all emotional well-being and social well-being items. The first was designated the 'symptoms/function' subscale, and the second was designated the 'well-being' subscale. Cronbach's alpha scores were 0.72 and 0.84, respectively. The symptoms/function subscale contained more of the items with greater impact, with the item 'Food stuck in between your teeth' having greatest impact; in the well-being subscale, the 'Felt shy or embarrassed' item had the greatest impact. Repeating the analyses by world region gave similar findings. CONCLUSION: The CPQ11-14 performed well cross-sectionally in the largest analysis of the scale in the literature to date, with robust and mostly consistent psychometric characteristics, albeit with two underlying factors (rather than the originally hypothesized four-factor structure). It appears to be a sound, robust measure which should be useful for research, practice and policy.

Dental erosion in 12-year-old schoolchildren: a cross-sectional study in Southern Brazil.

OBJECTIVE: The aim of this study was to assess the prevalence and severity of dental erosion among 12-year-old schoolchildren in Joaçaba, southern Brazil, and to compare prevalence between boys and girls, and between public and private school students. METHODS: A cross-sectional study was carried out involving all of the municipality's 499, 12-year-old schoolchildren. The dental erosion index proposed by O'Sullivan was used for the four maxillary incisors. Data analysis included descriptive statistics, location, distribution, and extension of affected area and severity of dental erosion. RESULTS: The prevalence of dental erosion was 13.0% (95% confidence interval = 9.0-17.0). There was no statistically significant difference in prevalence between boys and girls, but prevalence was higher in private schools (21.1%) than in public schools (9.7%) (P < 0.001). Labial surfaces were less often affected than palatal surfaces. Enamel loss was the most prevalent type of dental erosion (4.86 of 100 incisors). Sixty-three per cent of affected teeth showed more than a half of their surface affected. CONCLUSION: The prevalence of dental erosion in 12-year-old schoolchildren living in a small city in southern Brazil appears to be lower than that seen in most of epidemiological studies carried out in different parts of the world. Further longitudinal studies should be conducted in Brazil in order to measure the incidence of dental erosion and its impact on children's quality of life.

[Prevalence, treatment needs, and predisposing factors for traumatic injuries to permanent dentition in 11-13-year-old schoolchildren]. / Prevalência, necessidade de tratamento e fatores predisponentes do traumatismo na dentição permanente de escolares de 11 a 13 anos de idade.

The objective of this study was to assess the prevalence of traumatic injuries to the permanent incisors and the association with clinical predisposing factors and parents' schooling. A cross-sectional survey was conducted with schoolchildren aged 11 to 13 years in Biguaçu, Brazil. Dental examinations were conducted by a dentist, and the criteria for traumatic dental injuries used in the children's dental health survey in the United Kingdom were adopted. the study recorded the type of damage sustained, treatment performed or needed, the size of incisal overjet, and whether lip coverage was adequate. Socio-demographic data included sex, age, and parents' level of schooling. a total of 2,260 children were examined, and prevalence rates were 10.4%, 10.6%, and 11.2% in 11, 12, and 13-year-old children, respectively. Treatment need was 6.3 interventions per thousand incisors. Male gender and overjet greater than 5mm were significantly related to having a traumatic dental injury. Inadequate lip coverage and parents' educational level were not associated with dental trauma. The study concluded that male gender and incisal overjet greater than 5mm are associated with the occurrence of dental injury.

Prevalência, necessidade de tratamento e fatores predisponentes do traumatismo na dentição permanente de escolares de 11 a 13 anos de idade / Prevalence, treatment needs, and predisposing factors for traumatic injuries to permanent dentition in 11-13-year-old schoolchildren

Este estudo objetivou determinar a prevalência do traumatismo dentário na dentição permanente e observar associações com fatores predisponentes. Foi realizado um estudo transversal com escolares de 11 a 13 anos de Biguaçu, Santa Catarina, Brasil. Os exames foram realizados por um cirurgião-dentista utilizando os mesmos critérios do Children's Dental Health Survey do Reino Unido. Foram observados tipo de dano, tratamento providenciado e necessidade, overjet incisal, adequabilidade da cobertura labial, idade, sexo e nível de educação dos pais. Foram examinadas 2.260 crianças e as prevalências encontradas foram: 10,4 por cento, 10,6 por cento e 11,2 por cento aos 11, 12 e 13 anos, respectivamente. A necessidade de tratamento foi de 6,3 incisivos por mil examinados. Escolares do sexo masculino e com overjetmaior que 5mm tiveram mais traumatismo dentário do que escolares do sexo feminino e com overjetincisal até 5mm. Cobertura labial inadequada e nível de educação dos pais não estiveram estatisticamente associados com o traumatismo dentário. Concluiu-se que ser do sexo masculino ou ter um overjetincisal maior do que 5mm aumenta a chance de sofrer traumatismo dentário.

Socio-economic correlates of traumatic injuries to the permanent incisors in schoolchildren aged 12 years in Blumenau, Brazil.

This study aimed to assess the prevalence of injuries to the permanent incisors in Blumenau, Brazil. In addition, the relationship between dental injuries and socio-economic indicators was examined. A cross-sectional survey was carried out. It included a random sample of 652 children aged 12 years, from both sexes, attending public and private primary schools in Blumenau, Brazil. Multi-stage sampling technique and proportional representation were adopted. A trained and calibrated dentist collected the data through clinical examinations and interviews. Clinical examination included type of damage, treatment provided and needed, size of incisal overjet and type of lip coverage. The response rate was 82.5%. The prevalence of dental injuries was 58.6%. Boys experienced more injuries than girls, 67.2% and 50.2% (P=0.001), respectively. Children from mothers with higher schooling experienced more dental injuries than those from of mothers with lower schooling, 68.2% and 56.6% (P=0.03). Father's level of education, parents' employment status and family income were not statistically significantly associated with dental injuries (P>0.05). There was a tendency for children with incisal overjet greater than 5 mm (P=0.2) and inadequate lip coverage (P=0.1) to have more dental injuries, but differences were not statistically significant. Nearly all (97.3%) children who had dental injuries needed treatment. In conclusion, the prevalence of dental injuries in Blumenau, Brazil, was very high, treatment of dental injuries was severely neglected, and boys and children from mothers with high schooling were more likely to have experienced dental injuries.

[Prevalence and severity of dental caries among schoolchildren aged six and twelve]. / Prevalência e severidade da cárie dentária em escolares de seis e doze anos de idade.

OBJECTIVE: To determine the prevalence and severity of dental caries and to assess treatment needs among schoolchildren aged 6 and 12 in Blumenau, Brazil, and to compare the results found for private and public schools. METHODS: A schoolchildren population of Blumenau, SC, Brazil, was studied. A random sample of 1,473 schoolchildren from Blumenau, Brazil, was obtained. Four strata were studied: 6 and 12 years old schoolchildren attending public and private schools. WHO (1997) criteria for caries diagnosis and treatment needs were used. RESULTS: The prevalence of caries in the primary dentition of 6-years-old children was 60.9% and 34.9% in public and private schools (p<0.0001), respectively. The mean DMF-T for children aged 6 was 2.98 and 1.32 for public and private schools, respectively, (p<0.0001), and 2.42 for the whole sample. The prevalence of caries in the permanent dentition of 12-years-old children was 54.7% and the mean DMF-T was 1.46 for public schools. The response rate for private schools was low and the results could not be analyzed. Forty-two percent and 77.0% of children aged six of public and private schools, respectively, had no treatment needs. For those aged 12, the percentage was 53.0% for public schools. CONCLUSIONS: The prevalence of caries and the treatment needs among schoolchildren in Blumenau was low, but there was a statistically significant higher prevalence and higher severity in public school children aged six. The prevalence of caries and treatment needs at the age of 12 in public schools were also low.

[Calibration of examiners for dental caries epidemiologic studies]. / Calibração de examinadores para estudos epidemiológicos de cárie dentária.

The aim of this study was describe a training and calibration exercise for dental caries and to discuss the use of validity and reliability statistical tests. Eight dentists examined seventeen 12 year-old schoolchildren using World Health Organization (1997) criteria. Data analysis included calculation of the DMF-T index, the percent agreement, and the kappa scores on a tooth-by-tooth basis. Inter-examiner agreement was tested against a gold standard examiner. Scores for measures of agreement calculated on a tooth-by-tooth basis were lower than those calculated for the whole mouth. The training and calibration exercise is a crucial step in cross-sectional epidemiological surveys, and the kappa test calculated on a tooth-by-tooth basis is the appropriate measurement to test agreement between examiners for dental caries.

[Behavioral eating disorders and their effects on the oral health in adolescence]. / Transtornos alimentares de ordem comportamental e seus efeitos sobre a saúde bucal na adolescência.

Anorexia nervosa and bulimia nervosa are serious eating disorders that affect a significant number of adolescents and young adults. Individuals with anorexia nervosa tend to ignore or deny their excessive dieting and may present purging habits. The individual with bulimia nervosa spends great effort and time in compensating the effects of binge eating with dieting and fasting, self-inducing vomiting, utilization of laxatives or overexercising. The incidence of those behavioral disorders seems to be increasing, but there are no epidemiological data on that matter in Brazil. The dental practitioner has an important role in identifying these disorders since toothwear is very frequent due to the acidic oral environment caused by vomiting. The dentist can help to minimize the effects of anorexia and bulimia on the dentition. The objective of this study is to review the features of those behavioral eating disorders and to highlight the importance of being prepared to diagnose them and implement a comprehensive treatment of patients.

Causes and prevalence of traumatic injuries to the permanent incisors of school children aged 12 years in Jaragua do Sul, Brazil.

AIM: To assess the causes and the prevalence of traumatic injuries to the permanent incisors of 12-year-old schoolchildren in Jaragua do Sul, Brazil. DESIGN: Cross-sectional survey. SETTING: Public and private primary schools. PARTICIPANTS: 476 children of both sexes, selected by multistage sampling technique. METHODS: Clinical examination of upper and lower permanent incisors. MAIN OUTCOME MEASURES: Incisal overjet, lip coverage, traumatised anterior teeth, cause of trauma. Parents' levels of education and employment status and family income. RESULTS: Boys experienced double the percentage of injuries compared to girls. Children with incisal overjet greater than 5 mm (P = 0.077) and inadequate lip coverage (P = 0.667) were not more likely to have experienced dental injuries. The main causes of injuries to the permanent incisors were falls (26 per cent), traffic accidents (20.5 per cent), sports (19.2 per cent), violence (16.4 per cent) and collisions with people or inanimate objects (6.8 per cent). Socio-economic measures had no significant effect on prevalence of trauma. CONCLUSIONS: Policy makers must take the causes of trauma into account when developing a strategy for the prevention of dental injuries. The role of violence in causing traumatic dental injuries has been underestimated.

[Implications in terms of costs and manpower of using the Scandinavian dental care model in Brazil]. / Implicações de custo financeiro e recursos humanos em assistência odontológica no Brasil segundo o modelo escandinavo.

The implications in terms of dental manpower and costs of applying the Scandinavian system of dental care in Brazil are specified and analysed. Two societies were chosen for study: those of Sweden, in Scandinavia and Santa Catarina, State in southern Brazil. The theoretical analysis of the implications was undertaken on the basis of an estimate of dental and auxiliary manpower required to deal with the high levels of oral disease and needs (caries, teeth needing extraction, periodontal diseases and the need for full dentures) in Santa Catarina. This estimate was undertaken by means of the World Health Organization-Fédération Dentaire Internationale (WHO-FDI) Model "Health Through Oral Health" (1989). The implications in costs, taking the total Swedish expenditure per dentist as a basis, were calculated and applied to the manpower calls for by the WHO-FDI model. The high costs resulting showed that the application of the Swedish model of dental care to Santa Catarina would be unrealistic. The implications in terms of manpower were calculated by applying the manpower ratios considered desirable in Sweden to Santa Catarina. In order to achieve the Swedish dentist: population ration, Santa Catarina would need 85% more dentists that it had in 1990. Regarding auxiliary personnel, the Brazilian State of Santa Catarina would need to train a large number of new personnel in order to attain the Swedish auxiliary: dentist ratio. In the light of the findings of this study, the adoption of the Swedish model of providing dental care by Santa Catarina in terms of costs and manpower is not feasible. Therefore, alternative approaches for the improvement of oral health in Santa Catarina and in the rest to Brazil should be sought. These approaches should take consider political, cultural and socio-economic aspects of Brazilian society into consideration.

Auto-percepção das condições de saúde da população adulta, Sul do Brasil

O objetivo do estudo foi estimar como a população adulta (20 a 59 anos) de Joaçaba, SC, avalia sua condição de saúde. Realizou-se um estudo transversal em 2006 envolvendo amostra representativa (n= 707). O questionário levantou condições sociodemográficas, restrição das atividades diárias, realização de consulta médica, internação hospitalar e auto-percepção de saúde. Procedeu-se a análise de regressão logística múltipla hierarquizada. Constatou-se que 74,7% dos indivíduos percebia sua saúde como boa e 3,9% a percebia como ruim/muito ruim. Não estar trabalhando no momento da entrevista e deixar de realizar atividades habituais por problemas de saúde aumentaram significativamente a chance de uma auto-avaliação da condição de saúde como ruim/muito ruim. Arquivos disponíveis para leitura e/ou download nos ícones ao lado.