Individual and contextual determinants associated with traumatic dental injuries in children eight to ten years of age: a multilevel analysis.

OBJECTIVE: Investigate individual and contextual determinants associated with traumatic dental injuries in schoolchildren. METHODS: A cross-sectional study with 739 pairs of parents and children. Parents answered a sociodemographic questionnaire, the Family Adaptability and Cohesion Evaluation Scale and a questionnaire on the child's use of electronic devices. Examinations of the children were conducted at the school by calibrated examiners using the diagnostic criteria proposed by Andreasen. Contextual variables of the school were also collected. Multilevel Poisson regression for complex samples was performed (p < 0.05). RESULTS: The individual factors associated with the outcome were children of single parents (PR = 2.33; 95% CI: 1.79-2.66), practice of sports (PR = 2.46; 95% CI: 1.70-3.22), the daily use of electronic devices (PR = 1.78; 95% CI: 1.31-1.81), more than 2 h per day of screen time (PR = 3.84; 95% CI: 1.94-4.28) and chaotic family adaptability (PR = 4.22; 95% CI: 3.44-4.99). The contextual variables were studying at a public school (PR = 1.77; 95% CI: 1.02-3.05) and the presence of rigid floor in the school courtyard (PR = 1.99; 95% CI: 1.15-3.15). CONCLUSION: Individual determinants, studying at a public school and the presence of rigid floor in the school courtyard were associated with traumatic dental.

Impact of oral health literacy and psychoactive substances on tooth loss in adolescents.

The aim of the present study was to investigate associations between tooth loss, and oral health literacy, the use of multiple psychoactive substances, and the reason for the last dental appointment in adolescents. A cross-sectional study was conducted with a representative sample of 746 adolescents aged 15-19 years in Campina Grande, Brazil. Parents/guardians answered a sociodemographic questionnaire. The adolescents answered the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), the alcohol, smoking, and substance involvement screening test, and an oral health questionnaire from the National Oral Health Survey. The adolescents were then examined by two examiners who had undergone training and calibration exercises for the diagnosis of tooth loss due to caries (K > 0.80). Associations between variables were investigated using robust logistic regression analysis for complex samples (α = 5%). The prevalence of tooth loss was 17.4%. Oral health literacy (OR = 0.93; 95% CI: 0.89-0.97) was inversely associated with tooth loss, while multiple psychoactive substance use (OR = 2.01; 95% CI: 1.09-3.69) and last dental visit for treatment/symptoms (OR = 3.05; 95% CI: 1.73-5.36) were directly associated with tooth loss. Oral health literacy, multiple psychoactive substance use, and reason for last dental appointment exerted an influence on tooth loss among adolescents.

Influence of the practice of sports, sleep disorders, and habits on probable sleep bruxism in children with mixed dentition.

OBJECTIVE: Investigate the association between sleep disorders and probable sleep bruxism (SB) in children eight to ten years of age. METHODS: A cross-sectional study was conducted with 739 schoolchildren in Brazil. Parents/guardians answered a sociodemographic questionnaire, the sleep disturbance scale for children, and the Circadian Energy Scale. Parafunctional habits were evaluated using the Nordic Orofacial Test-Screening. Multivariate logistic regression was performed (α = 5%), and a directed acyclic graph was used in the statistical model. RESULTS: The prevalence of probable SB was 9.1% and 58.6% of the children had sleep disorders. In the final model, having unmarried parents/guardians (OR = 1.98; 95% CI: 1.07-3.65), exhibiting parafunctional habits (OR = 2.02; CI: 1.01-4.06), not practicing sports (OR = 1.92; CI: 1.04-3.54), sleep-wake transition disorders (SWTD) (OR = 2.01; 95%CI: 1.12-3.62), and excessive daytime sleepiness (EDS) (OR = 2.17; 95%CI: 1.11-4.29) were significant associated with probable SB. CONCLUSION: The occurrence of probable sleep bruxism was influenced by the marital status of the parents/guardians, parafunctional habits, the non-practice of sports, and sleep disturbance (SWTD and EDS). This research contributes to the planning of public policies that include educational regimens at school to prevent sleep disorders and favor the reduction in sleep bruxism prevalence.

The effect of sleep disorders, school jet lag, and anxiety in students 8-10 years of age on traumatic dental injuries.

BACKGROUND/AIM: Traumatic dental injuries (TDI) constitute a public health problem. The aim of the present study was to investigate whether sleep disorders, school jet lag, and anxiety are associated with TDI in schoolchildren 8-10 years of age. METHODS: An analytical, cross-sectional study was conducted with 739 pairs of parents/guardians and children enrolled in public and private schools. The parents/guardians answered a socioeconomic questionnaire, the Sleep Disturbance Scale for Children, Circadian Energy Scale, and Revised Children's Manifest Anxiety Scale. Four examiners underwent calibration exercises for the diagnosis of TDI (K > 0.80) using the criteria proposed by Andreasen (2007). A directed acyclic graph was used for the formulation of the theoretical model and statistical adjustments. Unadjusted and adjusted robust binary logistic regression analyses were performed (α = 5%). RESULTS: The prevalence of TDI was 16.2%. The following variables remained associated with the outcome in the final model: family income less than or equal to the minimum monthly wage (OR = 1.77; 95% CI: 1.09-2.88; p = .02), child's height >137.6 cm (OR = 1.68; 95% CI: 1.06-2.64; p = .02), the occurrence of school jet lag (OR = 2.12; 95% CI: 1.27-3.53; p = .004), anxiety (OR = 1.77; 95% CI: 1.04-3.00; p = .04) and sleep disorders (OR = 1.63; 95% CI: 1.38-1.93; p = .05). CONCLUSION: Children from families with a lower income, taller children, those with school jet lag, those with anxiety and those with sleep disorders had a greater occurrence of TDI.

The relationship between temperament and dental fear and anxiety: a systematic review.

OBJECTIVE: To investigate the relationship between temperament traits and dental fear and anxiety (DFA) in children and adolescents by the means of a systematic review (PROSPERO #CRD42020207578). METHODS: The PEO (Population, Exposure, and Outcome) strategy was followed using children and adolescents as the population, temperament as the exposure, and DFA as the outcome. A systematic search for observational studies (cross-sectional, case-control, and cohort) without restrictions on year or language of publication was performed in seven databases (PubMed, Web of Science, Scopus, Lilacs, Embase, Cochrane, and PsycINFO) in September 2021. Grey literature search was performed in OpenGrey, Google Scholar, and in the reference list of included studies. Study selection, data extraction, and risk of bias assessment were carried out independently by two reviewers. The Fowkes and Fulton Critical Assessment Guideline was used to assess methodological quality of each study included. The GRADE approach was performed to determine the certainty of evidence of relationship between temperament traits. RESULTS: This study recovered 1362 articles, of which 12 were included. Despite the high heterogeneity of methodological aspects, qualitative synthesis by subgroups showed a positive association/correlation between emotionality, neuroticism, and shyness with DFA in children and adolescents. Different subgroups analysis showed similar results. Eight studies were classified as having low methodological quality. CONCLUSION: The main shortcoming of the included studies is the high risk of bias and a very low certainty of evidence. Within its limitations, children and adolescents with a temperament-like emotionality/neuroticism and shyness are more likely to present higher DFA.

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.

Association of the prevalence and severity of untreated traumatic dental injuries with body mass index among Brazilian preschool children.

BACKGROUND/AIM: Children with excess weight may be more predisposed to traumatic dental injuries (TDI). The aim of this study was to investigate the association between overweight/obesity and TDI presence and severity in Brazilian preschool children. MATERIAL AND METHODS: A cross-sectional study was conducted of 347 children aged three to five years. The main exposure was evaluated based on the body mass index (BMI). Socioeconomic-demographic characteristics and harmful oral habits were investigated using a questionnaire sent to the parents/guardians. Oral clinical examinations were performed to determine overjet (criteria proposed by Foster and Hamilton), and the presence and severity of TDI (criteria proposed by Andreassen). Descriptive statistics were performed. Univariate and multivariate Poisson regression analyses were conducted for each outcome. RESULTS: The prevalence of TDI in the sample was 41.5% and 16% of the children had enamel and dentin fractures. In the multivariate analysis, BMI and overjet were associated with the presence and severity of TDI (PR: 2.04 and 1.78, respectively) of TDI (PR: 2.27 and 2.24, respectively) (p < .001 for all associations). CONCLUSION: Overweight/obesity was associated with both the presence and severity of TDI in early childhood.

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.

Orofacial dysfunction, nonnutritive sucking habits, and dental caries influence malocclusion in children aged 8-10 years.

INTRODUCTION: Malocclusion is one of the most prevalent oral health problems and can affect self-esteem, social relations, and oral health-related quality of life. The present study aimed to evaluate associations between malocclusion and orofacial dysfunction, nonnutritive sucking habits, cavitated carious lesions, and anxiety in Brazilian children. METHODS: An analytical cross-sectional study was conducted with a representative sample of 739 children aged 8-10 years. Parents or guardians provided sociodemographic data and information on the nonnutritive sucking habits of the children. The children answered the Revised Children's Manifest Anxiety Scale. Four trained examiners examined the children for the diagnosis of malocclusion (dental aesthetic index), dental caries (International Caries Detection and Assessment System), and orofacial dysfunction (Nordic Orofacial Test-Screening). The control variables were selected using a directed acyclic graph. Descriptive statistics were performed, followed by unadjusted and adjusted robust logistic regression analysis (P <0.05). RESULTS: The following variables remained associated with the occurrence of malocclusion in the final model: nonnutritive sucking habits (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.25-4.08), orofacial dysfunction (OR, 1.56; 95% CI, 1.13-2.17), and cavitated carious lesion (OR, 1.39; 95% CI, 1.03-1.89). CONCLUSIONS: Nonnutritive sucking habits, orofacial dysfunction, and cavitated carious lesions were associated with the presence of malocclusion in children aged 8-10 years.

The Top 100 Most-Cited Papers in Cariology: A Bibliometric Analysis.

A highly cited paper is seen as a landmark in any field and can influence both research and clinical practice. This study aimed to quali-quantitatively analyze the 100 most-cited papers in Cariology. A search strategy was first determined using specific keywords related to the field. A comprehensive search was then conducted in the Thompson Reuters Web of Science citation indexing database up to April 2019. Papers focused on any aspect of Cariology were included. A panel of 4 researchers conducted the selection of papers and extracted data on the number of citations, title, authors, country, year, journals, study design, and topic of interest. Scopus and Google Scholar were also searched to compare the number of citations. The VOSviewer software was used to generate bibliometric networks. The number of citations among the top 100 most-cited papers ranged from 168 to 1,961 with a mean of 292,66. Three papers had more than 1,000 citations. The Journal of Dental Research (20%) and Caries Research (17%) had more top papers. The oldest and the most recent papers were published in 1960 and 2015. Literature reviews (35%) and laboratorial studies (31%) were the most common study designs. The countries with the highest number of most-cited papers were the USA (40%), Sweden (10%), and Japan (9%). The most studied fields of interest were etiology/pathogenesis (41%) and prevention (20%). VOSviewer maps revealed collaborative networks between countries and organizations. The top 100 most-cited papers in Cariology were published mainly by European and Anglo-Saxon American authors and were composed mainly of literature reviews with etiology/pathogenesis as the most frequent topic of interest.

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.

Association Between Sense of Coherence and Periodontal Outcomes: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to evaluate the association between sense of coherence (SOC) and periodontal outcomes. Electronic searches were performed in 6 databases. Seventeen studies that evaluated the association between SOC and periodontal outcomes were included. The included studies demonstrated that individuals with a stronger SOC were more likely to present improved periodontal outcomes. The meta-analysis showed that individuals with a lower SOC were 3.31 times more likely to present bleeding on probing. Sons/daughters of mothers with a lower SOC were 3.22 times more likely to present gingival bleeding. Individuals with a stronger SOC have better periodontal health.

Trait Emotional Intelligence Questionnaire-Short Form: Brazilian Validation and Measurement Invariance between the United Kingdom and Latin-American Datasets.

The present study aimed to evaluate the psychometric properties of the Brazilian adaptation of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF). In a sample of 512 participants, we tested model fit by bifactor Exploratory Structural Equation Modeling (ESEM), followed by measurement invariance testing against UK and Chilean datasets of the measure. The Big Five Mini-Markers, Satisfaction with Life Scale and Subjective Happiness Scale were also administered as external validation measures. We obtained the following results: (a) final adequate bifactor ESEM model fit; (b) a significantly higher global trait EI mean for men (d = .27); (c) high internal consistency for global trait EI (α = .88), in spite of lower Cronbach's α values at the factor level (.60-.85); (d) high correlation (r = .89) in the test-retest; (e) significant correlation between global trait EI and most of the Big Five dimensions (r = -.66-.46), life satisfaction (.59) and happiness (.68); (f) evidence of incremental validity of trait EI for life satisfaction and happiness over and above the Big Five; (g) equivalent measurement across the Brazilian, UK and Chilean versions of the TEIQue-SF. We conclude that the Brazilian TEIQue-SF is psychometrically sound and can be recommended for research and practical use.

Structuring adolescent's oral health effects on labour market entry in a cohort study.

AIM: To evaluate the influence of the oral conditions and oral health-related quality of life (OHRQoL) on the entry of adolescents on labour. DESIGN: This cohort study was performed in southern Brazil, within a random sample of 12-year-old adolescents (n = 1134). Oral health (dental caries, malocclusion, and toothache), OHRQoL (Child Perceptions Questionnaire 11-14), demographic factors, and family's socioeconomic status (household income and mother's education) were collected at baseline (2012). Education level and employment outcomes, such as labour market entry and earnings from work, were collected at 6-year follow-up. Path analysis was used to estimate the overall fit measurement, standardized coefficients (SC), and its direct and indirect effects. RESULTS: Among 1134 participants, 768 adolescents with mean of age 17.5 years old were reassessed (retention rate of 68%). There was direct effect from poor OHRQoL on labour market entry (SC 0.057; P = .02). Sex and age also had a direct effect on employment outcomes. Socioeconomic status impacts oral health conditions as well as OHRQoL scores (P < .01). Household income, malocclusion, and toothache had indirect effects on labour market entry. CONCLUSION: Oral health indirectly affects employment outcomes, through its effects on OHRQoL. Moreover, OHRQoL directly affects labour market entry in adolescents.

Can children's oral hygiene and sleep routines be compromised during the COVID-19 pandemic?

BACKGROUND: During COVID-19 pandemic, children are confined at home, with changes in family routines. AIM: Evaluate sleep disorders among Brazilian and Portuguese children during social distancing, and its association with parental perception of child's oral hygiene. DESIGN: In this cross-sectional study, Portuguese and Brazilian parents/caregivers of 3- to 15-year-old children, practicing social distancing due to COVID-19 pandemic, answered an online questionnaire, from April 24-26, 2020, evaluating sociodemographic characteristics, child's school activities online, child's sleep quality during social distancing. Two questions from the questionnaire, developed based on previous studies, evaluated the parental perception of child's oral hygiene quality and routine changes during social distancing. Parents/caregivers answered five domains of the Portuguese-language version of the Sleep Disturbances Scale for Children, evaluating sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence and sleep hyperhidrosis. Descriptive, Linear-by-linear association, Kruskal-Wallis and post hoc analysis were performed (P ≤ .05). RESULTS: Participated in the study 253 parents/caregivers, 50.2% from Brazil. Most parents (72.2%) reported changes in child's routine during social distancing. Sleep breathing disorders (P = .019), sleep-wake transition disorders (P = .022), and disorders of excessive somnolence (P < .001) were associated with poor oral hygiene during social distancing. CONCLUSION: Sleep disorders are associated with poor oral hygiene during social distancing.

Early childhood caries and oral health-related quality of life of Brazilian children: Does parents' resilience act as moderator?

BACKGROUND: Early childhood caries (ECC) is the most common chronic disease in childhood. Measures to reduce the prevalence of ECC cannot be taken without recognizing that oral health is influenced by biopsychosocial factors on individual and community levels. AIM: To evaluate the impact of ECC on OHRQoL and moderation effect of parents' resilience. DESIGN: Population-based, cross-sectional study with 497 children (4-6 years old) at preschools in Ribeirão das Neves, MG, Brazil. Parents self-completed the Brazilian version of the early childhood oral health impact scale (B-ECOHIS), the Resilience Scale and questionnaires about socioeconomic and oral health behaviour factors. Calibrated dentists conducted examinations for ECC (ICDASepi) and pulp consequences (pufa). Data analysis used multivariate Poisson regression for complex sample (P < .05). RESULTS: Model#1, adjusted for parents' resilience and socioeconomic factors, revealed that preschoolers with pulp involvement had 2.36 (95% CI: 1.60-3.49) and fistula/abscess had 3.57 (95% CI: 2.23-5.72) more prevalence of negative impact on OHRQoL than preschoolers with ECC without pulp consequences. In Model#2, resilience was removed from the analysis and the strength of associations almost did not change (OHRQoL vs pulp involvement RP = 2.33;95% CI: 1.58-3.43; OHRQoL vs fistula/abscess RP = 3.65;95% CI: 2.22-5.99). CONCLUSION: Early childhood caries with pulp consequences had negative impact on OHRQoL of preschoolers and families, and it is not moderated by parents' resilience.

Oral health literacy, sociodemographic, family, and clinical predictors of dental visits among Brazilian early adolescents.

BACKGROUND: The prevalence of dental caries is high in adolescents worldwide, and a large percentage have never been to a dentist or have not had regular dental appointments. AIM: To evaluate the influence of oral health literacy and sociodemographic, clinical, and family factors on dental visits among early adolescents. DESIGN: A cross-sectional study was conducted with 740 12-year-old students in Campina Grande, Brazil. Students answered about their level of oral health literacy (BREALD-30), levels of family adaptability and cohesion (FACES III), and visits to the dentist sometime in life. Dental caries experience was evaluated using Nyvad criteria. Robust Poisson regression for complex samples was performed. RESULTS: A higher level of oral health literacy (PR = 1.01; 95% CI: 1.01-1.03), high social class (PR = 1.28; 95% CI: 1.09-1.50), higher mother's schooling (PR = 1.58; 95% CI: 1.37-1.83), family cohesion classified as enmeshed (PR = 1.55; 95% CI: 1.19-2.02) and connected (PR = 1.22; 95% CI: 1.02-1.44), and the absence of toothache (PR = 1.18; 95% CI: 1.01-1.38) remained associated with having visited a dentist. CONCLUSIONS: Oral health literacy and sociodemographic, family, and clinical factors were predictors of having visited a dentist among early adolescents.

The prevalence of malocclusion is higher in schoolchildren with signs of hyperactivity.

INTRODUCTION: Attention deficit-hyperactivity disorder is a behavioral disorder characterized by a lack of focus, impulsive behavior, and or excessive activity. This research aimed to evaluate the association between signs of attention deficit-hyperactivity disorder and malocclusion in schoolchildren. METHODS: A cross-sectional study was conducted with a representative sample of 633 children aged 7-12 years. The children were clinically examined for malocclusion using the Dental Aesthetic Index. The predominant breathing pattern was also determined. Parents answered a questionnaire addressing socioeconomic characteristics and the presence of nonnutritive sucking habits. The Swanson, Nolan, and Pelham Scale-IV was filled out by both parents and teachers to compare behavioral patterns. The children were submitted to a neuropsychological evaluation using the Raven's Colored Progressive Matrix Test. Data analysis involved the chi-square test and Poisson regression analysis. RESULTS: The prevalence of malocclusion was 42% higher among children with signs of hyperactivity reported by both parents and teachers (prevalence ratio [PR], 1.42; 95% confidence interval [CI], 1.11-1.81; P = 0.004). In the final Poisson regression model, the prevalence of malocclusion was lower among schoolchildren aged 11 and 12 years (PR, 0.62; 95% CI. 0.52-0.73; P <0.001) and higher among those who used a pacifier for at least 4 years (PR, 1.25; 95% CI, 1.02-1.54; P = 0.029) as well as those classified as mouth breathers (PR, 1.28; 95% CI, 1.09-1.51; P = 0.003). CONCLUSIONS: The prevalence of malocclusion was higher among children with signs of hyperactivity independently of age, pacifier use, and mouth breathing.

Acidic food choice among adolescents with bulimic symptomatology: a major risk factor for erosive tooth wear?

PURPOSE: Evaluate dietary habits and the presence of erosive tooth wear (ETW) among female adolescents with varying severity of bulimic symptomatology. METHODS: An explanatory study was conducted with 72 female school adolescents with bulimic symptomatology, aged 15-18 years in Southeastern Brazil. Dietary habits were evaluated through a food frequency questionnaire. Bulimic symptomatology was evaluated and classified (mild, moderate and severe) according to the Bulimic Investigatory Test of Edinburgh. ETW examinations were performed. Data analysis involved descriptive statistics, bivariate analysis, Kruskal-Wallis/Mann-Whitney tests and Poisson regression. Ethical approval and informed consents were obtained. RESULTS: The final population consisted of 62 participants. The prevalence of ETW differed among adolescents with mild, moderate and severe bulimic symptomatology (p = 0.001), corresponding to 5.9%, 8.0% and 45.0%, respectively. Adolescents with severe bulimic symptomatology presented higher daily consumption of acidic food: citric fruits (p < 0.005), diet soda (p < 0.009) and ketchup (p = 0.004). No difference related to vomiting practices was observed between groups (p = 0.060). The adjusted regression model showed that a higher prevalence of ETW was associated with self-induced vomit at least once a week (PR = 2.42, 95% CI = 1.00-5.86, p = 0.05) and higher frequencies of consumption of citric fruits (PR = 7.96, 95% CI = 1.50-42.11, p = 0.015) and diet soda (PR = 2.32, 95% CI = 1.09-4.91, p = 0.029). CONCLUSION: It was the food choices (acidic food) and not purging practices that differed among adolescents with varying severity of bulimic symptomology. Likewise, higher consumption of citric fruits was the main factor associated with higher prevalence of ETW. LEVEL OF EVIDENCE: III case-control analytic study.

Association between sense of coherence and dental caries: systematic review and meta-analysis.

Sense of coherence (SOC) is regarded as the individuals' capacity for managing the stressors over their lifespan. The aim of this systematic review and meta-analysis was to evaluate the association between SOC and dental caries. Electronic searchers were conducted in six databases: PubMed, Medline, Scopus, Web of Science, Lilacs and Proquest from their date of inception until November/2017. An update took place in August/2018. A hand search in the reference list of the included articles and gray literature search were also carried out. Retrieved titles/abstracts were screened by two review authors. Data of the included articles were extracted and quality assessment was also conducted. The first search retrieved 346 titles/abstracts. The update retrieved 33 records. Following the removal of 70 duplicates, 309 references were screened and 17 were included. The quality assessment ranged from low quality articles to high quality articles. High quality study showed that adult individuals with lower SOC were more likely to have dental caries. Meta-analysis showed that adolescents with low SOC were 5.41 times more likely to present dental caries than adolescents with high SOC (CI = 2.15-13.59). Mothers with low SOC were 5.55 times more likely to have children/adolescents with dental caries than mothers with high SOC (CI = 2.92-10.57). The subgroup analysis exploring continuous data showed that the SOC of mothers of children/adolescents without dental caries was significantly higher than the SOC of mothers of children/adolescents with dental caries (CI = 0.10-0.51). Higher levels of SOC seem to be associated with lower levels of dental caries.