Association between sense of coherence and oral health-related quality of life among toddlers.

OBJECTIVE: To assess the relationship between sense of coherence (SOC) and oral health-related quality of life (OHRQoL) among children aged one to three years. PARTICIPANTS: A cross-sectional study was conducted with 276 mother-child pairs randomly selected from the city of Diamantina, Brazil. METHOD: Information was obtained on socio-demographic factors. The short version of Antonovsky's sense of coherence scale (SOC 13) and the Early Childhood Oral Health Impact Scale (ECOHIS) were administered. The children were examined for dental caries. Statistical analysis involved descriptive statistics, the calculation of Spearman's correlation coefficients and adjusted Poisson regression models. RESULTS: SOC was significantly associated with the child's OHRQoL in the multivariate analysis. Children of mothers with high SOC (PR 0.96; 95%CI 0.93,0.98; p=0.045) had a lower prevalence of a negative impact on OHRQoL. Children with severe dental caries had a greater prevalence of a negative impact on OHRQoL (PR 2.53; 95%CI 1.77,3.62; p⟨0.001). CONCLUSIONS: Maternal SOC could be a psychosocial determinant of the OHRQoL of children aged one to three years. Severe dental caries was associated with poorer quality of life.

"Association between caries in anterior teeth and bullying victimization in Brazilian schoolchildren aged 6 to 10 years.: a cross sectional study".

AIM: To investigate the association between presence of caries in anterior teeth and bullying victimization in schoolchildren. METHODS: A cross-sectional study was conducted in Brazil with a sample of 387 schoolchildren aged 6 to 10 years. The presence of moderate/extensive dental caries was assessed using the International System for the Evaluation and Detection of Dental Caries (ICDAS-II). The children answered the "Olweus Bullying" (QBO). Descriptive analyses were performed, and the associations between bullying victimization and independent variables collected were determined by univariate and multivariate Poisson regression. RESULTS: The prevalence of bullying victimization was 66.4%. Bullying victimization was higher among children who had moderate/extensive caries in some anterior teeth (p = 0.010). 8-year-old (p = 0.048), 9-year-old (p = 0.001), and 10-year-old (p = 0.002) children reported greater bullying victimization when compared to 6-year-olds. CONCLUSION: The presence of moderate/extensive dental caries in anterior teeth is associated with bullying victimization in schoolchildren.

Impact of early childhood caries on the oral health-related quality of life of preschool children and their parents.

The aim of the present population study was to evaluate the impact of early childhood caries (ECC) on the oral health-related quality of life (OHRQoL) of preschool children and their parents/caregivers. A random sample of 638 children (aged 2-5 years) underwent a clinical oral examination to assess ECC, and their parents were invited to answer two questionnaires: one on the OHRQoL of the child, the Early Childhood Oral Health Impact Scale, and another on the characteristics and sociodemographic conditions of the child. Descriptive analysis, χ(2) test, Mann-Whitney test, Kruskal-Wallis test, and hierarchically adjusted Poisson regression models were used. The prevalence of ECC was 52.2%. The number of teeth with decay ranged from 1 (n = 42; 6.6%) to 20 (n = 5; 0.8%), averaging 2.86 (SD = 4.04). There was a significant difference between the severity of ECC and OHRQoL in terms of the impact on both child and family (p < 0.001). An increase in the severity of ECC resulted in an increased negative impact on the quality of life of the child (rate ratio, RR = 5.32; 95% confidence interval, CI: 3.67-7.71). Greater age of the mother had a positive impact on the OHRQoL of preschool children (RR = 0.72; 95% CI: 0.54-0.97). Increased age resulted in an increased negative impact on the quality of life of the child (RR = 2.97; 95% CI: 1.61-5.47). ECC has a negative impact on the OHRQoL of children aged 2-5 years and their parents. Mothers aged 30 or older reported better OHRQoL, independent of the presence of ECC and the age of the child.

Cross-sectional study on factors associated with flossing in Brazilian young children.

PURPOSE: This cross-sectional study aimed at evaluating the factors associated with flossing by caregivers in Brazilian young children. METHODS: Its sample consisted of 305 children aged 1-3 and their mothers from the Brazilian city of Diamantina. They were selected through the Municipal Health Department from a list of registered children who had recently used the public health services. Data collection was done by means of the mothers answering a questionnaire which addressed economic and socio-demographic factors and also the mother and child characteristics and habits. In addition, an oral clinical examination was performed in order to assess Baume arch type and caries occurrence. Descriptive statistical analysis, chi-square test and Poisson regression were performed. RESULTS: It was found that the sample presented a prevalent flossing habit in 20.3% of the subjects. The flossing habit in the children was associated with the mothers' own habit of flossing daily (PR 2.32; 95% CI 1.12-4.82) and with the frequent children's tooth brushing by the mother (PR 2.85; 95% CI 1.05-7.76). CONCLUSION: A higher prevalence of flossing by caregivers in young children is associated with the mothers' own habit of flossing daily and with the frequent children's tooth brushing by the mother.

Malocclusion: social, functional and emotional influence on children.

OBJECTIVES: To determine the association between types of malocclusion and quality of life in children between 8-10 years of age and establish correlations between the severity of the malocclusion and particular bio-psychosocial variables. STUDY DESIGN: The sample was made up of 102 schoolchildren aged 8-10 years. Clinical exams were performed using the criteria of the Dental Aesthetic Index (DAI) to determine the presence and severity of malocclusions. The impact on quality of life was assessed using the Child Perceptions Questionnaire (CPQ8-10). Statistical analysis involved the chi-square test, Fisher's exact test and Spearman's correlation analysis. RESULTS: Malocclusions affected 61% of the children examined. There was a positive correlation between total CPQ8-10 and DAI scores (P = 0.034). The following types of malocclusion had a significant effect on the quality of life of the children: upper anterior irregularity > or = 2 mm, anterior open bite > or = 2 mm and diastema > or = 2 mm. Children with malocclusion experienced a greater negative impact on quality of life in comparison to those without malocclusion. CONCLUSIONS: Malocclusions had a negative influence over the quality of life of children between 8-10 years of age. More severe malocclusions had a greater impact with regard to social, emotional and functional aspects.

Esthetic smile rehabilitation through autogenous bonding of dental fragment: a case report.

Autogenous tooth fragment bonding offers advantages over restorations with composite resins and porcelain, including better esthetics, greater durability, reestablishment of the natural function of the dental element and short execution time. A case is presented of a 14-year-old male patient who suffered an oblique crown fracture of the permanent right maxillary central incisor (11) due to a traumatic fall. The clinical examination revealed pulp exposure with no invasion of the biological space. Due to the extension of the fracture, endodontic treatment and the placement of an intra-root esthetic pin was needed. The tooth was restored using the autogenous fragment bonding method. Excellent esthetic and functional results were observed after two years of follow up.

Prevalence and risk indicators of temporomandibular disorder signs and symptoms in a pediatric population with spastic cerebral palsy.

OBJECTIVE: To determine risk indicators for signs and symptoms of temporomandibular disorders (TMD) in children with cerebral palsy (n = 60) and control subjects (n = 60). STUDY DESIGN: The subjects were assessed by means of questionnaire and clinical exam: 1) signs and symptoms of TMD; 2) malocclusions [Dental Aesthetic Index (DAI)]; 3) harmful habits; and 4) bio-psychosocial characteristics. Statistical analysis involved the chi-square, Fisher's exact tests (p < or = 0.05) and multivariate logistic regression (forward stepwise procedure). Variables that achieved a p-value < or = 0.20 were used as potential predictors of signs and symptoms of TMD and applied as co-variables in the multivariate analysis. RESULTS: The prevalence of at least one sign and/or symptom of TMD in the present sample was 1.7% (n = 1) among the individuals in the control group and 13.3% (n = 8) among the individuals with cerebral palsy. The presence of cerebral palsy (Odds Ratio: 9.08; p = 0.041), male gender (OR: 6.21; p = 0.027), severity of the malocclusion (OR: 4.75; p = 0.031), mouth breathing (OR: 5.40; p = 0.022) and mixed dentition (OR: 4.73; p = 0.035) were identified as risk indicators for signs and symptoms of TMD. CONCLUSIONS: It was concluded that children with cerebral palsy had a significantly greater chance of developing signs and symptoms of TMD.

Relationship between mothers' sense of coherence and oral health status of preschool children.

OBJECTIVE: The aim of the present study was to investigate the relationship between mothers' sense of coherence (SOC) and oral health status in a representative sample of 5-year-old preschool children. METHODS: A cross-sectional study was conducted in Belo Horizonte (Brazil) on a sample of 546 mothers and their 5-year-old children, randomly selected from preschools. Data were collected through questionnaires (mothers), the short version of Antonovsky's SOC scale (SOC-13) and clinical dental examinations (children). Simple and multiple logistic regression analyses were performed on the data. The following 8 outcome variables were selected: dental caries, filled and missing teeth, dental pulp exposure due to caries, dental root fragment, visible plaque, gingivitis and supragingival calculus. The examination was carried out by 2 trained, calibrated examiners. RESULTS: Mothers with a lower SOC were more likely to have children with decayed teeth (OR = 1.59, 95% CI = 1.01-2.29), dental pulp exposure (OR = 1.99, 95% CI = 1.06-3.77) or filled teeth (OR = 1.85, 95% CI = 1.12-3.06) regardless of the child's social class and gender. CONCLUSION: The data indicate that mothers' SOC is an important psychosocial determinant of the oral health status among preschool children.

Self-perception regarding the need for orthodontic treatment among impoverished schoolchildren in Brazil.

AIM: The objectives of the present study were to assess predictive factors associated to self-perception regarding the need for orthodontic treatment among 170 impoverished schoolchildren. MATERIALS AND METHODS: A cross- sectional study was conducted in public schools in the city of Belo Horizonte-MG (Brazil). Children's self-perception regarding the need for treatment was assessed using the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) and a questionnaire addressing biopsychosocial factors. The chi-square test and multiple logistic regression were used in the data analysis. RESULTS: The predictive factors for the self-perception of orthodontic treatment need on the part of the impoverished schoolchildren included ridicule from persons close to the children regarding the appearance of the teeth (OR 2.81; 95%CI 1.2 to 6.4), dissatisfaction with oral aesthetics due to the alignment of the teeth (OR 2.45; 95%CI 1.1 to 5.4) and missing teeth (OR 3.02; 95%CI 1.0 to 9.23). CONCLUSION: The alignment of the teeth, missing teeth and ridicule from others regarding the appearance of the teeth are the factors that most strongly influence self- perception regarding the need for orthodontic treatment among impoverished schoolchildren.

Perceived impact of dental pain on the quality of life of children aged 1-3 years and their families.

PURPOSE: To evaluate the perceived impact of dental pain on oral health-related quality of life (OHRQoL) among children aged 1-3 years and their families. METHODS: A cross-sectional study was conducted with 306 randomly selected preschool and day care children in the city of Diamantina, Brazil. Parents/caregivers answered a questionnaire on socio-demographic information, the Brazilian version of the Early Childhood Oral Health Impact Scale, their child's general/oral health and the Brazilian version of the Dental Discomfort Questionnaire. The children underwent an oral examination. Descriptive statistics, Spearman's correlations, the Kruskal-Wallis test, Mann-Whitney test and Poisson regression were used to determine associations between the variables (prevalence ratio [PR], α = 5%). RESULTS: The prevalence of dental caries and dental pain was 43.1% and 40.2%, respectively. Dental pain (PR: 1.96, 95% CI 1.52-2.54; p < 0.001), monthly household income (PR: 1.38, 95% CI 1.04-1.83; p = 0.026) and dental caries (PR: 1.06, 95% CI 1.03-1.10; p < 0.001) were significantly associated with the perceived impact on OHRQoL. CONCLUSIONS: Dental pain, household income and dental caries were associated with a negative impact on the OHRQoL of children aged 1-3 years and their families.

The role of Toll-like receptors 2 and 4 on reactive oxygen species and nitric oxide production by macrophage cells stimulated with root canal pathogens.

INTRODUCTION: Periapical lesions arise as a result of the activation and interaction of the host immune responses against root canal infection. Recently identified Toll-like receptors (TLR) seem to be involved in the recognition and development of immune responses against a myriad of microorganisms. However, very little information is available on the role of TLR in the induction of periapical lesions. METHOD: The role of TLR-2 and TLR-4 in the activation of murine macrophages stimulated using Fusobacterium nucleatum and Peptostreptococcus anaerobius was investigated. The production of nitric oxide (NO) and reactive oxygen species (ROS) was assessed. RESULTS: The results demonstrate that TLR-2 and TLR-4 are involved in the production of ROS by activated macrophages. The microorganisms induced similar levels of NO production by TLR-2-competent and TLR-2-deficient macrophages, regardless of the addition of interferon-gamma (IFN-gamma), ruling out a role for TLR-2 in the NO production induced by these bacteria. Only P. anaerobius induced NO production by TLR-4-competent macrophages without the addition of IFN-gamma. However, after IFN-gamma addition, F. nucleatum induced macrophage NO production. Therefore, NO production stimulated by IFN-gamma and these microorganisms seems to be TLR-4-independent. CONCLUSION: TLR-2 seems to be involved in the induction of ROS production by macrophages in response to prevalent root canal bacteria, while only F. nucleatum induced ROS production by TLR-4-competent macrophages. Both microorganisms significantly induced large amounts of NO independent of TLR-2 and TLR-4. We conclude that microorganisms may participate in the induction and progression of periapical lesions through NO and ROS production by activated macrophages.

Prospective study of the association between fluoride intake and dental fluorosis in permanent teeth.

OBJECTIVE: To evaluate the relationship between fluoride intake and dental fluorosis in permanent central incisors and first molars. METHODS: Fluoride intake (mg F/kg body weight/day) from diet, dentifrice and both combined was determined on a single occasion in 1998 among children aged 19-39 months living in two fluoridated Brazilian communities (0.6-0.8 ppm F). Six years later, when the permanent teeth of these children had erupted (central incisors and first molars), 49 children aged 7-9 years [20 girls (40.8%) and 29 boys (58.2%)] were evaluated for dental fluorosis. To test the association between fluorosis and fluoride intake, children were dichotomized into two groups, cases (children with dental fluorosis on at least two teeth, TFI > or =1) and noncases (children without dental fluorosis, TFI = 0). RESULTS: Among the case group (n = 29), median fluoride doses from diet, dentifrice and combined were 0.031, 0.050 and 0.083 mg F/kg/day, respectively. Among the noncase group (n = 20), median fluoride doses were 0.029, 0.049, 0.084 mg F/kg/day, respectively. There was no association between dental fluorosis in permanent teeth and fluoride intake from diet, dentifrice and combined (p > 0.05). CONCLUSIONS: There was no difference between children with and without fluorosis in the permanent central incisors and first molars regarding fluoride intake. However, this study has limitations that must be recognized: fluoride intake was only measured once, and there were no children in the sample with severe degrees of dental fluorosis.

Association between malocclusion and dental caries in adolescents: a systematic review and meta-analysis.

AIM: To evaluate the scientific evidence regarding the association between malocclusion and dental caries in adolescents. METHODS: Searches were conducted of six electronic databases, complemented by manual searching of the reference lists of the selected articles and grey literature. Two independent reviewers performed the selection of the articles, data extraction and the evaluation of the risks of bias through an assessment of methodological quality. Meta-analysis was performed considering the mean decayed, missing and filled teeth (DMFT) index for caries and the Dental Aesthetic Index (DAI) for malocclusion. Heterogeneity was tested using the I2 statistic and a random effect model was employed. Summary effect measures were calculated as differences in means. RESULTS: The initial search retrieved 2644 studies, only 15 of which were selected for full-text analysis. Four cross-sectional studies were included in the qualitative systematic review. Only one of these studies found no association between malocclusion and dental caries. The meta-analysis of three studies demonstrated that a lower DAI value was significantly associated with a lower mean DMFT index, except for the comparison of DAI 26-30 vs. 31-35. CONCLUSIONS: Based on the studies analysed, the scientific evidence indicates an association between malocclusion and dental caries.

Fluoride intake by children at risk for the development of dental fluorosis: comparison of regular dentifrices and flavoured dentifrices for children.

The aim of the present study was to determine fluoride intake by children at risk of dental fluorosis according to the type of dentifrice used. Forty-two volunteers aged between 20 and 30 months, from 2 kindergartens, were supervised while brushing their teeth with regular dentifrices (nominally 1,500 ppm F) and dentifrices flavoured for children (nominally 1,100 ppm F), brushing 3 times with each type in random order to minimize bias. The amount of fluoride ingested was determined by subtracting the weight of dentifrice recovered from the weight used and calculating the mean of the 3 brushings. Fluoride was analyzed with specific electrodes. Parents were asked how often the children brushed their teeth and the daily tooth brushing frequency was used to calculate the daily fluoride intake. The average fluoride intake using regular dentifrices and those flavoured for children was 0.567 +/- 0.300 and 0.630 +/- 0.320 mg F/day, respectively, corresponding to doses of 0.046 +/- 0.023 and 0.051 +/- 0.026 mg F/kg/day (p > 0.05). Fluoride intake was slightly higher with the use of dentifrices flavoured for children. Moreover, the dose to which children were exposed with either type of dentifrice was very close to that which is considered the limit (0.05-0.07 mg F/kg/day).

Maternal identification of dental caries lesions in their children aged 1-3 years.

AIM: To analyse the maternal identification of different stages of dental caries in children aged 1-3 years. METHODS: A cross-sectional study was conducted with 274 children and their mothers. The mothers answered a questionnaire on the occurrence of dental caries in their children and completed questions addressing their demographic/socio-economic status. The oral examination of the children was performed using the International Caries Detection and Assessment System. Descriptive, Chi square test and Poisson regression statistical analyses were performed. RESULTS: The prevalence of initial and established/severe dental caries lesions by age were: 1 year (23.2 and 24.2%), 2 years (17.9 and 55.7%) and 3 years (23.3 and 60.3%) respectively. Significant associations between clinical examinations and the mothers' reports were observed among children aged 1 year old who had initial stage caries lesions (p = 0.006) and in children aged 1, 2 and 3 years old who had established/severe stage caries lesions (p < 0.001). After adjustment for confounding variables it was found that mothers were more able to identify dental caries both at initial (PR 4.01, 95% CI 1.35-11.94) and established/severe stages (PR 9.14, 95% CI 2.49-33.56) in children aged 1 year old. In children aged 2 and 3 years, this identification was more evident in the established/severe stage (2 years, PR 2.98, 95% CI 1.42-6.26; 3 years, PR 2.75, 95% CI 1.09-6.93). CONCLUSIONS: Mothers of children aged 1 year old identified dental caries at initial and established/severe stages. Mothers of children aged 2 and 3 years identified dental caries only at established/severe stages.

Effect of dark discolouration and enamel/dentine fracture on the oral health-related quality of life of pre-schoolers.

AIM: To determine the effect of different types of dental trauma on oral health-related quality of life (OHRQoL) among pre-school children. METHODS: Four hundred fifty-nine Brazilian pre-schoolers aged 3-5 years were submitted to an oral examination in the school environment for the evaluation of dental trauma using the criteria proposed by Andreasen et al. (2007). Parents answered a questionnaire on the OHRQoL of the children using the Early Childhood Oral Health Impact Scale (ECOHIS) and another one on socio-demographic characteristics of the children and their families. The questionnaires were sent to the parents to be answered at home. Descriptive statistics, Mann-Whitney test and Poisson regression were used for statistical analysis. RESULTS: Children with dark discolouration and enamel-dentine fracture without pulp exposure had higher mean ECOHIS scores than those without these alterations. The multivariate regression analysis demonstrated that pre-school children with dark discolouration (PR 1.79; 95% CI 1.24-2.58) and enamel-dentine fracture without pulp exposure (PR 1.89; 95% CI 1.22-2.92) had a higher impact on quality of life than those without these alterations. CONCLUSION: Dark discolouration and enamel-dentine fracture without pulp exposure were associated with a negative impact on the life of pre-schoolers.

Head and neck cancer among marijuana users: a meta-analysis of matched case-control studies.

OBJECTIVES: The scientific literature presents conflicting data on a possible causal relationship between marijuana users and the development of head and neck cancer. DESIGN: This study performed a systematic review with meta-analysis. Articles were selected from various electronic databases using keywords obtained from the Medical Subject Headings (MeSH). After reading by three reviewers and scoring of methodological quality, six articles (totaling nine case-control studies) were assessed with Comprehensive Meta-Analysis(®) software. The value of effect (odds ratio) was calculated, which represented the chance of developing head and neck cancer between individuals who had smoked marijuana in their lifetime in models controlled for age, gender, race, and tobacco consumption. RESULTS: Approximately 12.6% of cases and 14.3% of controls were marijuana users. The meta-analysis found no association between exposure and disease (OR=1.021; IC 95%=0.912-1.14; p=0.718). CONCLUSION: No association between lifetime marijuana use and the development of head and neck cancer was found. The different methods of collection/presentation of results in the selected articles prevented other analyzes from being conducted. Additional studies are needed to assess for long-term effects.

Malocclusion in preschool children: prevalence and determinant factors.

PURPOSE: To evaluate the prevalence of malocclusion and associated factors in the primary dentition of preschoolers in the city of Diamantina, Brazil. METHODS: A cross-sectional study was carried out with 381 children aged 3-5 years treated at the 10 basic health care units in the city during immunisation campaigns. The dependent variables (presence of malocclusion, open bite, crossbite and crowding) were evaluated through a clinical oral exam. The independent variables (gender, age, health problems, breastfeeding, bottle feeding, harmful oral habits, mother's schooling, household income and number of children in the home) were collected through interviews. Statistical analysis involved descriptive analysis, Chi square test and Poisson regression. RESULTS: The prevalence of malocclusion was 32.5%. Open bite was the most frequent type of malocclusion. Children with a history of bottle feeding (PR 1.74; 95% CI 1.24-2.44) and those with harmful oral habits (PR 1.49; 95% CI 1.23-1.99) had greater prevalence rates of malocclusion. Greater prevalence rates of open bite were also found in children with a history of bottle feeding (PR 5.00; 95% CI 1.99-12.5) and those with harmful oral habits (PR 2.90; 95% CI 1.59-5.29), whereas greater prevalence rates of crossbite were found in boys (PR 1.79; 95% CI 1.10-2.91) and were associated with mother's schooling (PR 1.91; 95% CI 1.20-3.06). CONCLUSION: A history of bottle feeding and the presence of harmful oral habits were identified as determinants for the occurrence of malocclusion in preschoolers.

Mothers' reports on systemic signs and symptoms associated with teething.

PURPOSE: The purpose of this study was to compare mothers' actual observations of signs and symptoms associated with the eruption of primary incisors in their infants with their own recollections of the same period after eruption was completed. METHODS: A comparative study was carried out with 45 non-institutionalized infants and their mothers. Oral clinical exams were performed daily for detection of tooth eruption. The mothers were also interviewed daily about signs and symptoms they thought were associated with teething in the previous 24 hours. One week after the data collection was done, the mothers answered the same questionnaire. Descriptive analysis and the McNemar test (P<.05) were performed. RESULTS: Statistically significant differences were found between the prospective and retrospective studies. Increased salivation (P<.04) and runny nose (P<.001) were reported less often and fever was reported more often (P<.001) in the retrospective evaluation. CONCLUSIONS: Mothers reported similar manifestations of sleep disturbance, diarrhea, loss of appetite, and irritability in the prospective and retrospective studies. Increased salivation and runny nose were more frequently reported in the prospective study, whereas fever was reported 5 times more often in the retrospective study.