Maternal characteristics, home environment, and other factors associated with traumatic dental injuries in preschool children.

BACKGROUND/AIMS: The importance of external factors such as maternal and home characteristics on traumatic dental injuries needs to be investigated. The aim of this study was to evaluate the association between maternal and home characteristics and dental trauma in preschool children. MATERIAL AND METHODS: This cross-sectional study using a cluster random sample evaluated children between 3 and 4 years of age from Porto Alegre, Brazil. Mothers completed the Brazilian version of the Beck Depression and Anxiety Inventories (BDI and BAI). They answered questions about sociodemographics, maternal behaviors, and home characteristics. Dental trauma was assessed by the Children's Dental Health Survey criteria. Malocclusion and deleterious habits were also assessed. The multinomial logistic regression model was used to investigate the association of exploratory variables with different categories of dental trauma. Odds ratios (OR) and 95% confidence intervals were calculated. RESULTS: A total of 163 pairs of children and mothers agreed to participate (78.4% response rate). The prevalence of dental trauma was 49.8%. Mother's work outside the home, overjet, and anterior crossbite were associated with the occurrence of enamel trauma, while having a younger mother, families having more siblings, and having a mother with university education were associated with increased odds of dentin/pulp trauma. CONCLUSION: Depression and anxiety in the mothers were not associated with dental trauma, while malocclusion characteristics were more relevant for less severe, enamel trauma. Socioeconomic and home environment characteristics played a role in more severe, dentin/pulp trauma.

Caries progression as a risk factor for increase in the negative impact on OHRQOL-a longitudinal study.

OBJECTIVES: The aim of this study is to evaluate the association between caries lesions progression and oral health-related quality of life (OHRQoL) among Brazilian preschools, after 2 years. MATERIALS AND METHODS: At baseline, 163 children (3-4 years old) enrolled in 12 public primary care services in Porto Alegre/RS-Brazil were evaluated. After 2 years, 119 children were re-evaluated. Calibrated examiners employing the ICDAS criteria conducted clinical examinations. A socio-demographic questionnaire and the Brazilian version of the Early Childhood Oral Health Impact Scale were applied to the parents of the children at baseline and 2-year follow-up. Data analysis was performed using a hierarchical approach based in a conceptual framework testing by Poisson regression. RESULTS: The number of surfaces that progressed from baseline to 2-year follow-up was associated with an increased negative impact on OHRQoL. CONCLUSIONS: Caries progression increased the negative impact on OHRQoL. CLINICAL RELEVANCE: The progression of caries lesions could negative impact on OHRQoL in Brazilian preschoolers.

Efficacy of an ionic toothbrush on gingival crevicular fluid--a pilot study.

The aim of this study was to compare the efficacy of an ionic and a conventional toothbrush in reducing gingival inflammation measured by gingival crevicular fluid (GCF) volume. Twenty dental students participated in this randomized crossover clinical trial. Quigley-Hein (QH) Plaque Index was assessed in six sites per tooth. GCF was measured in 3 teeth. Two experimental periods of 28 days with a 14-day washout were set. Mean values of GCF were calculated and tested by paired sample t-test. Correlations between % QH = O and alterations in GCF were performed. No significant differences were observed between conventional and ionic toothbrushes respectively neither at baseline (.62 +/- .19 vs. .55 +/- .18) nor at 28 days (.44 +/- .12 vs. .47). A negative correlation (-.33) was detected between the increase in % of QH = O and GCF for both brushes. It may be concluded that the performance of an ionic toothbrush does not differ from that of a conventional brush.

A clinical trial testing the efficacy of an ionic toothbrush for reducing plaque and gingivitis.

OBJECTIVE: This study was designed to assess the efficacy of an ionic toothbrush on reducing plaque and gingivitis. METHODOLOGY: Twenty first-year dental students were included in the study. Ten individuals were randomly assigned to use either an ionic or a conventional toothbrush. Two periods of 28 days each were used with each brush, with a wash-out period of 14 days. A calibrated examiner used the Quigley-Hein Plaque Index (QHI) and Gingival Bleeding Index (GBI) on six sites per tooth, on all teeth, both pre- and post-brushing. The examiner was unaware of the toothbrush used by the subjects. Means were calculated, and for intra and inter-group comparisons a paired sample t-test was used (alpha = 0.05). RESULTS: On buccal-lingual surfaces, both toothbrushes significantly reduced plaque; there was no statistically significant difference between the two toothbrushes (1.56 and 1.52 for ionic and conventional toothbrushes, respectively). In interdental spaces, an increase of QHI was detected for both brushes, but without significant differences between them. For the GBI on buccal/lingual surfaces, no significant differences were detected between toothbrushes. The GBI did not significantly change for either toothbrush on interdental surfaces during the study period. CONCLUSION: The ionic and the conventional toothbrushes did not present statistically significant differences on plaque and gingival bleeding reductions.

A Longitudinal Study of Early Childhood Caries and Associated Factors in Brazilian Children.

Early childhood caries (ECC) affects children all over the world and has high prevalence and severity in preschool children. Different social, biological and behavioral factors compose a network of causal factors for ECC. The aim was to evaluate the association between socioeconomic variables and caries at baseline, and the presence of Streptococcus mutans and Lactobacillus spp. microorganisms with the progression of caries lesions after two years of follow-up in a group of children. At baseline, 163 children (3-4 years old) living in the areas of 12 primary care services of the Hospital Group Conceição (GHC, Porto Alegre, RS, Brazil) were evaluated. After two years, 119 children were re-evaluated. Clinical examinations were conducted by calibrated examiners using the ICDAS criteria. A sociodemographic questionnaire was applied to the children's parents and saliva samples were collected from the children for microbiological analysis. Descriptive statistics and multivariate Poisson regression analysis were performed in the statistical analysis. The factors associated with the caries progression were marital status of mothers (p=0.040), higher S. mutans counts (p=0.031) and the presence of cavitated lesions at baseline (p<0.001). The caries lesions progression in preschool children enrolled in primary health care was directly associated with marital status, presence of cavitated lesions at baseline and higher S. mutans counts at two-year follow-up.

Independent and Additive Effects of Different Sources of Fluoride and Dental Fluorosis.

PURPOSE: To investigate the contribution of different sources of fluoride related to dental fluorosis. METHODS: This population-based, matched, case-control study (67 pairs) used a representative sample of 271 schoolchildren. Dental fluorosis was measured using Dean's index. Children's caregivers were interviewed about nine risk factors. Data were analyzed using conditional logistic regression. RESULTS: The prevalence of questionable cases was 18.8 percent, and the prevalence of very mild, mild, or moderate cases of dental fluorosis was 11.5 percent, with no severe case. Age of start of toothbrushing, drinking water from wells, frequency of toothbrushing, type of tooth-paste, standard/ children's mouthrinse usage, and fluoride supplements were not significant (P>0.15). Drinking water from wells and using supplements were underpowered (N less than six). Children who frequently ate toothpaste had an odds ratio of 5.56 (95% confidence interval (CI) 1.75 to 17.73) times more fluorosis; those applying toothpaste to cover the bristles had 5.55 times more fluorosis (95% CI 1.44 to 21.42); and those using an adult size toothbrush had 3.17 times more flurosis (95% CI 1.15 to 8.71). There was a significant additive interaction (P<0.01). CONCLUSION: In a community with water fluoridation, the factors associated with dental fluorosis are intentional toothpaste ingestion and tooth-paste applied on the whole toothbrush.

Differential Impacts of Caries Classification in Children and Adults: A Comparison of ICDAS and DMF-T.

The aim of this study was to describe and compare findings regarding the prevalence and severity of dental caries when using ICDAS and DMFT/dmft in an epidemiological study with children and their mothers. This cross-sectional study evaluated 150 preschoolers and their mothers. Data were collected with ICDAS and then transformed into DMFT/dmft. ICDAS scores related to caries were analyzed according to three different cut-off-points: CP1 (0-healthy/1-6-caries), CP2 (0-1-healthy/2-6-caries) and CP3 (0-2-healthy/3-6-caries), representing the D/d of DMFT/dmft. ICDAS codes regarding restorations, except sealants, were considered the F/f and the code 97 as the M/m of DMFT/dmft index. Prevalence of caries and its severity with ICDAS were 92%, 84% and 31.3% in children and 97.3%, 96.6% and 80% in adults according to CP1/CP2/CP3, respectively. Admitting CP3 as the standard for data transformation of ICDAS in DMFT/dmft, it was observed that DMFT/dmft index would underestimate 60% of non-cavitated lesions in children and 16.6% in adults. The DMFT/dmft underestimated the presence of disease to disregard non-cavitated lesions for the pediatric population evaluated. The choice of which is the best index for epidemiological surveys will depend on the purpose of the research and the target population: if it is to estimate the needs of the population to determine clinical care in children and adults, the DMFT/dmft may be sufficient. However, if the objective is to have a more comprehensive diagnosis of caries at the population level in order to develop preventive strategies, to halt and reverse the disease, the detection of non-cavitated-lesions becomes important, mainly in young children.

The Role of Mother's Knowledge, Attitudes, Practices in Dental Caries on Vulnerably Preschool Children

Abstract Objective: To analyze the association between Early Childhood Caries (ECC) and mother´s knowledge, attitudes, and practices (KAP). Material and Methods: This cross-sectional study included a random sample of 163 preschool children aged 3-4 old in southern Brazil. The severity of dental caries and ECC was assessed by ICDAS criteria, while mothers completed the semi-structured questionnaire (KAP-ECC). Maternal behavior characteristics and answered questions about socioeconomic and demographic variables. Logistic regression was performed to evaluate the association of exploratory variables with ECC. For this approach, we calculated the odds ratio (OR) and 95% confidence intervals (95% IC). Results: Dental examinations revealed that 91.4% of children presented ECC (ICDAS = 3, 4, 5 or 6). Among those children, 31.9% presented cavities (ICDAS ≥ 3). Family income was significantly associated with the presence of ECC (OR 2.17; 95% CI: 1.41-3.36). Regarding KAP-ECC, mothers have knowledge related to ECC etiology, reported dental hygiene attitudes and practices that can prevent ECC but reported less healthy attitudes and practices regarding child's diet, specifically with respect to bottle and breastfeeding habits (OR 0.52; 95% CI: 0.33-0.81). Conclusion: ECC was more frequent in children from low-income families and whose mothers reported the belief that milk with chocolate does not contribute to caries and that disagreed that it is normal that a 2-year-old baby wakes up during the night to suckle. That is, good knowledge toward health habits may impact on lower occurrence of ECC; however, this condition also depends on the socioeconomic level.

Impact of Early Childhood Caries and Maternal Behaviors on Oral Health-Related Quality of Life of Children

Abstract Objective: To evaluate the impact of early childhood caries, maternal behaviors and associated factors on the oral health-related quality of life (OHRQoL) of preschool children. Material and Methods: This cross-sectional study was conducted with 163 preschool children aged 3-4 old from Porto Alegre, Southern Brazil. Mothers completed the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) and answered questions about sociodemographic and maternal behaviors characteristics. The severity of dental caries was assessed by ICDAS criteria for evaluated early childhood caries (ECC). A Poisson regression model was used to investigate the association of ECC and associated factors on OHRQoL. Results: A total of 91.4% of preschooler children was ECC (ICDAS ≥ 1). Mean ECOHIS function domain and parental anxiety domain scores were significantly higher in children with dental caries (p<0.05). The adjusted Poisson regression model showed that household income, maternal education, mother's job status and breastfeeding time was significantly associated with ECOHIS scores. Regarding oral conditions, child caries experience was associated with worsening child and family quality of life (RR 2.21; 95% IC: 1.43-3.41). Conclusion: Our findings suggest that ECC, socioeconomic and maternal behaviors characteristics influence children's OHRQoL.

A Longitudinal Study of Early Childhood Caries and Associated Factors in Brazilian Children

Abstract Early childhood caries (ECC) affects children all over the world and has high prevalence and severity in preschool children. Different social, biological and behavioral factors compose a network of causal factors for ECC. The aim was to evaluate the association between socioeconomic variables and caries at baseline, and the presence of Streptococcus mutans and Lactobacillus spp. microorganisms with the progression of caries lesions after two years of follow-up in a group of children. At baseline, 163 children (3-4 years old) living in the areas of 12 primary care services of the Hospital Group Conceição (GHC, Porto Alegre, RS, Brazil) were evaluated. After two years, 119 children were re-evaluated. Clinical examinations were conducted by calibrated examiners using the ICDAS criteria. A sociodemographic questionnaire was applied to the children’s parents and saliva samples were collected from the children for microbiological analysis. Descriptive statistics and multivariate Poisson regression analysis were performed in the statistical analysis. The factors associated with the caries progression were marital status of mothers (p=0.040), higher S. mutans counts (p=0.031) and the presence of cavitated lesions at baseline (p<0.001). The caries lesions progression in preschool children enrolled in primary health care was directly associated with marital status, presence of cavitated lesions at baseline and higher S. mutans counts at two-year follow-up.

Resumo A cárie precoce na infância (CPI) acomete crianças em todo o mundo e apresenta alta prevalência e severidade em pré-escolares. Diferentes fatores sociais, biológicos e comportamentais constituem uma rede de fatores causais da CPI. O objetivo deste estudo foi avaliar a associação entre as variáveis socioeconômicas e presença de cárie na linha de base e a presença de Streptococcus mutans e Lactobacillus spp. com a progressão de lesões de cárie após dois anos de acompanhamento em um grupo de crianças. Na avaliação inicial, foram avaliadas 163 crianças (3-4 anos de idade) pertencentes a 12 unidades básicas de saúde do Grupo Hospitalar Conceição (GHC, Porto Alegre, RS, Brasil). Após dois anos, foram reavaliadas 119 crianças. Os exames clínicos foram realizados por examinadores calibrados usando os critérios ICDAS. Um questionário sociodemográfico foi aplicado aos pais das crianças e amostras de saliva foram coletadas de crianças para análise microbiológica. Foram realizadas estatísticas descritivas e regressão multivariada de Poisson na análise estatística. Os fatores associados com a progressão de cárie foram o estado marital das mães (p=0,040) e a presença de lesões cavitadas no início do estudo e uma maior contagem de S. mutans (p=0,031) após dois anos de acompanhamento. A progressão de cárie em pré-escolares pertencentes às unidades de atenção primária em saúde foi diretamente associada com o estado marital das mães, presença de lesões cavitadas na linha de base e maior contagem de S. mutans após dois anos de acompanhamento.

Differential Impacts of Caries Classification in Children and Adults: A Comparison of ICDAS and DMF-T

Abstract The aim of this study was to describe and compare findings regarding the prevalence and severity of dental caries when using ICDAS and DMFT/dmft in an epidemiological study with children and their mothers. This cross-sectional study evaluated 150 preschoolers and their mothers. Data were collected with ICDAS and then transformed into DMFT/dmft. ICDAS scores related to caries were analyzed according to three different cut-off-points: CP1 (0-healthy/1-6-caries), CP2 (0-1-healthy/2-6-caries) and CP3 (0-2-healthy/3-6-caries), representing the D/d of DMFT/dmft. ICDAS codes regarding restorations, except sealants, were considered the F/f and the code 97 as the M/m of DMFT/dmft index. Prevalence of caries and its severity with ICDAS were 92%, 84% and 31.3% in children and 97.3%, 96.6% and 80% in adults according to CP1/CP2/CP3, respectively. Admitting CP3 as the standard for data transformation of ICDAS in DMFT/dmft, it was observed that DMFT/dmft index would underestimate 60% of non-cavitated lesions in children and 16.6% in adults. The DMFT/dmft underestimated the presence of disease to disregard non-cavitated lesions for the pediatric population evaluated. The choice of which is the best index for epidemiological surveys will depend on the purpose of the research and the target population: if it is to estimate the needs of the population to determine clinical care in children and adults, the DMFT/dmft may be sufficient. However, if the objective is to have a more comprehensive diagnosis of caries at the population level in order to develop preventive strategies, to halt and reverse the disease, the detection of non-cavitated-lesions becomes important, mainly in young children.

Resumo O objetivo deste estudo foi descrever e comparar os achados sobre a prevalência e severidade da cárie dentária ao utilizar ICDAS e CPOD/ceod em um estudo epidemiológico com crianças e suas mães. Este estudo transversal avaliou 150 pré-escolares e suas mães. Os dados foram coletados utilizando-se o ICDAS e depois transformados em CPOD/ceod. Os códigos do ICDAS relacionados à cárie foram analisados de acordo com três diferentes pontos de corte: CP1 (0-hígido/1-6-cárie), CP2 (0-1 hígido/2-6-cárie) e CP3 (0-2 hígido/3-6-cárie), representando o D/d do índice CPOD/ceod. Os códigos do ICDAS referentes às restaurações, exceto selantes, foram considerados o O/o e o código 97 do ICDAS como o P/e do índice CPOD/ceod. A prevalência de cárie e sua severidade com o ICDAS foram de 92%, 84% e 31,3% em crianças e 97,3%, 96,6% e 80% em adultos de acordo com o CP1 / CP2 / CP3, respectivamente. Admitindo o ponto de corte CP3 como o padrão para a transformação de achados do ICDAS em CPOD/ceod, foi observado que o índice CPOD/ceod subestimaria 60% das lesões não cavitadas em crianças e 16,6% em adultos. O CPOD/ceod subestima a presença da doença ao desconsiderar as lesões não cavitadas na população pediátrica avaliada. A escolha de qual é o melhor índice para levantamentos epidemiológicos vai depender do propósito da pesquisa e da população-alvo: se o objetivo for estimar as necessidades da população para determinar cuidados clínicos em crianças e adultos, o CPOD/ceod pode ser suficiente. No entanto, se o objetivo for ter um diagnóstico mais abrangente da doença ao nível da população, a fim de desenvolver estratégias preventivas, para paralisar e reverter a doença, a detecção de lesões não cavitadas torna-se importante, principalmente em crianças pequenas.

ART acceptability in children: a randomized clinical trial / Aceitabilidade da ART em crianças: um ensaio clínico randomizado

Aim: to compare the acceptability of the ART and the conventional restoration approaches in children. Methods: The sample of the current randomized clinical trial was 30 children 4 to 7 years old who had at least one class II active cavity in a primary molar that was accessible to hand instruments. The treatment groups were: Control Group- treatment with local anesthesia, rubber dam, rotary instruments and composite resin. Test Group- treatment according to ART approach using only hand instruments, no anesthesia and glass ionomer. In both groups, only the demineralized carious tissue and unsupported enamel were removed. The acceptability of the two groups was assessed by measuring the emotional feelings represented by Face Image Scale (FIS) before and after the procedure. Results: There was no significant difference between the two groups regarding changes in FIS scores. Fifty percent of the children from the Test Group got more satisfied after the procedure, while 64% of the participants from Control Group did not change their feelings.Conclusion: The ART approach had not demonstrated to have a best acceptability then the conventional approach. However the short time taken to complete the procedure seems to be worthy aspects when dealing with very young children or patients with behaviors problems.

Objetivo: comparar a aceitabilidade da ART e de restaurações convencionais em crianças. Material e métodos: A amostra do presente ensaio clínico randomizado foi composta por 30 crianças de 4 a 7 aanos de idade que tinham pelo menos uma cavidade ativa classe II em um primeiro molar que era acessível a instrumentos manuais. Os grupos de tratamento foram: grupo controle– tratamento com anestesia local, isolamento absoluto, instrumentos rotatórios e resina composta; grupo teste– tratamento de acordo com ART utilizando instrumentos manuais somente, sem anestesia e ionômerode vidro. Em ambos os grupos, somente tecido cariado desmineralizado e esmalte sem suporte foram removidos. Aaceitabilidade dos dois grupos foi acessada por mensuração das sensações emocionais usando a Escala de Imagem Facial (EIF) antes e depois do procedimento. Resultados : Não houve diferenças significativas entre os grupos na mudanças dos escores da EIF. 50% das crianças do grupo teste ficaram mais satisfeitas, enquanto 64%das crianças do controle não mudaram seus sentimentos. Conclusão: ART não demonstrou ter melhor aceitabilidade do que o tratamento convencional. Entretanto, o menor tempo utilizado paracompletar o procedimento parece ser um aspecto válido em crianças muitojovens ou pacientes com problemas de comportamento.

Alterações no fluido gengival em sítios sem sinais clínicos de inflamação - ensaio com duas escovas dentais / Alterations in gingival fluid in sites without clinical signs of inflammation - trial with two toothbrushes

O presente estudo objetivou avaliar alterações no volume de fluido crevicular gengival (FCG) em sítios com ausência de sangramento gengival; 20 estudantes do primeiro ano de Odontologia foram incluídos. O delineamento experimental foi ensaio clínico cruzado. Volume de FCG foi medido em três sítios por paciente e as alterações no volume de FCG nos sítios com índice de sangramento gengival (ISG) igual a zero foram avaliadas. Estudantes foram alocados, após randomização, em dois grupos em cada período experimental para a utilização de escova iônica ou escova convencional. Dois períodos de 28 dias separados por um wash-out de 14 dias foram utilizados. Um examinador treinado realizou o ISG e o volume de FCG foi medido com tiras de papel absorvente e quantificado através do Periotron, no começo e no final de cada período experimental. Médias das alterações percentuais no volume de FCG foram comparadas entre os grupos pelo teste t pareado,  = 5%. Uma redução no percentual de volume de FCG foi observada nos dois grupos (-17,56 ± 20,12 e -22,22 ± 21,02) para a escova convencional e iônica respectivamente. Diferenças estatisticamente significantes não foram observadas entre os grupos. Pode-se concluir que em indivíduos com ISG igual a zero, uma redução no volume de FCG foi observada independentemente da escova utilizada ou do uso de recursos de controle de placa interproximal.