Dental research related to COVID-19 in Brazil: research presented at the 38th SBPqO Meeting.

The aim of this study was to identify and describe the characteristics of coronavirus (COVID-19)-disease related dental research in Brazil presented at the 38th Annual Meeting of the Brazilian Division of the International Association for Dental Research (SBPqO). A search was carried out in the proceedings of the meeting to retrieve all abstracts. Those containing the term "COVID-19" in titles, abstracts, or keywords, and/or those of which the scope approached a COVID-19-related topic were included. The variables extracted from abstracts were: presenter category, field of study, design, data collection method, population, affiliation, and authors' gender. Descriptive and inferential statistics were used, with a significance level of α = 0.05. The search retrieved 185 abstracts, 5 did not meet study eligibility criteria and were excluded. COVID-19-related research was presented by either aspiring/associate members (67.8%) or beginner members (32.2%). Data collection methods were predominantly digitally mediated (65%), followed by secondary data use (25%), and in-person data collection (7.2%). Irrespective of the role of authorship, there were a ratio of two female authors to each male. Among the last authors, the ratio was three females to each male. Female lead authors more frequently came from the Southeast region (71.8%; p = 0.470). There was an association between presenter category and study design (p = 0.012), clinical and epidemiological studies were more concentrated among experienced presenters. In conclusion, female dental researchers affiliated to southeastern institutions approached the topic of pandemic more frequently than male colleagues. The use of digital technology for data collection may have long-lasting impacts on the teaching and publication of dental research.

Factors associated with the impact of fixed appliance orthodontic treatment on the oral health-related quality of life of adolescents: Assessment using a condition-specific instrument.

Background: Oral outcomes may have an impact on quality of life. The aim of this study was to assess factors associated with the impact of fixed appliance orthodontic treatment on the oral health-related quality of life (OHRQoL) of adolescents. Material and Methods: Individuals aged 10 to 18 years undergoing orthodontic treatment were included. Data regarding adolescents' sex and age, parental schooling, family income, and number of individuals who depend on income were collected. Clinical variables, orthodontic tooth extraction and malocclusion severity were also analyzed. OHRQoL was assessed with a questionnaire with items distributed across nine domains: aesthetics, functional limitation, diet, hygiene, maintenance, physical impact, social impact, time constraints, and transport/cost inconveniences. The higher the score, the more negative the adolescent's perception of his/her OHRQoL. Statistical analysis was performed. Results: Seventy-five adolescents participated. Individuals aged ≤12 years had a more negative perception of the diet domain (p=0.026). Individuals whose parents/guardians had ≥8 years of schooling had a more negative perception of the impact on the hygiene domain (p<0.024). Individuals whose families had an income of ≤2 salaries had a more negative perception of the maintenance domain (p=0.016). Girls had a more negative perception of the physical impact domain (p<0.018). Girls (p=0.011), adolescents whose families had an income of ≤2 salaries (p=0.003), and adolescents who had severe malocclusion (p=0.026) had a more negative perception of the transport/cost inconveniences domain. Girls had a significantly higher overall score in response to the questionnaire than boys (p=0.041). Conclusions: Adolescents' sex, age, and malocclusion as well as parental education and family income were associated with the impact of orthodontic treatment on adolescents' OHRQoL. Key words:Adolescent, Quality of life, Orthodontic treatment, Fixed appliance.

Individual and Contextual Factors Associated with Adolescents' Self-Perceived Need for Treatment.

The present study aimed to investigate associations between the self-perceived dental treatment need and clinical factors, familial characteristics, and school context in adolescents. A cross-sectional study was conducted with a representative sample of 746 students aged 15 to 19 years in a medium-sized city in Brazil. Data collection involved the use of a sociodemographic questionnaire, an oral health questionnaire, and the Family Adaptability and Cohesion Scales (FACES III) instrument. Clinical examinations were performed by two trained and calibrated examiners (Kappa > 0.80) using the Nyvad criteria. A robust logistic regression analysis for complex samples was performed using a multilevel approach (α = 5%). The individual factors associated with the self-perceived treatment need were dental pain (OR = 1.08; 95% CI: 1.01-1.16), the loss of the first molars (OR = 1.09; 95% CI: 1.03-1.15), and disengaged family cohesion (OR = 1.15; 95% CI: 1.01-1.31). In terms of context, attending a public school was associated with the self-perceived treatment need (OR = 1.17; 95% CI: 1.02-1.33). Thus, the individual factors of toothache, tooth loss, and a disengaged family, as well as the school context, exerted an influence on the self-perceived treatment need.

Early Childhood Caries and Its Consequences Impact Sleep in Preschool Children.

Purpose: To assess the impact of early childhood caries (ECC) and its clinical conse- quences on preschool children's sleep, as reported by caregivers. Methods: A representative cross-sectional study was carried out with preschoolers aged four to six years in Brazil. Caregivers responded to the Brazilian version of the Early Childhood Oral Health Impact Scale and a specific question from this questionnaire was used to determine sleep-related quality of life: "Has your child had trouble sleeping because of dental problems or dental treatments?" Additionally, a self-administered questionnaire with socioeconomic questions was used. Clinical examinations were performed by two calibrated dentists to diagnose dental caries (International Caries Detection and Assessment System -epi) and its clinical consequences (pulpal involvement, tissue ulceration, fistula and abscesses [pufa] index). Adjusted and unadjusted Poisson regression was used for data analysis (P<0.05). Results: The sample consisted of 533 preschoolers, with 259 girls (51.4 percent) (n=259). The mean age of preschoolers was 4.78±0.6 (standard deviation) years. One-third (n=176) exhibited extensive carious lesions, and 14.1 percent (n=75) had clinical consequences of ECC. Conclusion: Children with clinical consequences of ECC were approximately 3.04 times more likely to have difficulty sleeping than children without them (95 percent confidence interval=1.75 to 5.25). The clinical consequences of ECC were significantly associated with difficulty sleeping among preschool children.

Late Eruption of Mandibular Central Incisor in Small for-Gestational-Age Infants: A Cohort Study.

Purpose: To evaluate the chronology of the eruption of primary mandibular central incisors in infants born preterm and with low weight (PLBW) and its association with weight/length ratio for gestational age (GA) at birth, individual characteristics and hospitalization at birth. Methods: A cohort of 46 infants was followed at a multidisciplinary reference center at a university hospital in Belo Horizonte, Brazil. The inclusion criteria were infants born preterm with low/very low/extreme low birth weight and at least four months of age. Oral clinical examinations were carried out by a calibrated dentist for a total of eight months, with a one-month interval between each examination, to verify the chrono- logy of eruption of the primary mandibular central incisors. Caregivers completed a sociodemographic and health questionnaire. Data on neonatal hospitalization were collected from medical records. Data were analyzed with the Kaplan-Meier method and log rank test, and bivariate analysis was done using the Mann-Whitney method and Kruskal-Wallis test (P <0.05). Results: The average age at eruption of primary lower central incisors was 11 months for both sexes. No association was found between tooth eruption and child hospitalization or individual characteristics (P >0.05). Infants large for gestational age had earlier tooth eruption (9.3±1.41 months) than infants small for gestational age (13.6±3.29 months; P <0.05).Conclusion: The most likely age for the eruption of the first primary teeth in infants born preterm and with low weight was 11 months, and there was no influence of individual characteristics and hospitalization at birth. Small-for-gestational age infants experienced delayed tooth eruption compared to large-for-GA infants.

Impact of dental sedation treatment on the oral health-related quality of life of distressed young children: A secondary analysis of a randomized clinical trial.

INTRODUCTION: Little is known regarding the impact of dental treatment under sedation on distressed young children's oral health-related quality of life (OHRQoL). AIM: To evaluate the impact of dental treatment under sedation on the OHRQoL of children and their families. METHODS: Caregivers of two-to-six-year-old children answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS): (1) before treatment under sedation (T0), (2) two weeks (T1) and (3) 3 months after the completion of treatment (T2). A global transition judgment was included in the posttreatment evaluations to determine the perception of changes in OHRQoL after dental treatment. Bivariate analysis was performed. Changes in scores and effect sizes (ES) were calculated. RESULTS: Reductions were found at both posttreatment evaluations in the total B-ECOHIS scores (median [25th-75th percentile] at T0: 14 [9.8-21.7]; T1: 2.0 [0.0-5.1]; T2: 2.0 [0.0-6.7]); "child impact" section (T0: 8.8 [4.0-13.1]; T1: 0.0 [0.0-2.2]; T2: 0.0 [0.0-4.3]) and "family impact" section (T0: 6.0 [4.0-8.5]; T1: 0.0 [0.0-2.0]; T2: 0.0 [0.0-2.0]) (≤0.001; large ES). In 92.3% of cases at T1 and 88.3% at T2, caregivers reported that their child's oral health improved considerably. CONCLUSION: Dental treatment under sedation significantly improved the OHRQoL of the children and their families.

Orthodontic treatment during pregnancy, lactation, and postmenopausal period: a questionnaire development.

This study aimed to develop and validate a self-administered questionnaire in Brazilian Portuguese to verify the level of knowledge of orthodontists in the care of pregnant, lactating, and postmenopausal women, named "Considerations on Orthodontic Treatment during Pregnancy, Lactation, and Postmenopausal Periods." The development and validation of the questionnaire consisted of the following steps: a) item generation; b) item reduction; c) questionnaire design; and d) validity and reliability tests in a cross-sectional study with 258 orthodontists working in the field from different Brazilian states. A total of 60 orthodontists participated in test-retest over a mean period of 45 days. The preliminary questionnaire consisted of a total of 60 questions. After item reduction, 40 questions were selected for the final version of the questionnaire, with eight questions about pregnant women; six about lactating women; 18 about postmenopausal women, and eight about general knowledge in dentistry. Each item had three response options in the Likert scale format. Face and content validity analysis, reliability assessment through internal consistency (Cronbach's alpha and McDonald's omega), and test-retest reliability through the intraclass correlation coefficient (ICC) and Spearman's correlation coefficient were performed. Face and content validity indicated that the questionnaire was considered valid, objective, and easily understandable. The questionnaire had good internal consistency (Cronbach's alpha = 0.77; McDonald's omega = 0.78) and good test-retest reliability (ICC = 0.71; Spearman's correlation coefficient = 0.51). The questionnaire was considered valid and reliable to assess the level of knowledge of orthodontists in the care of pregnant, lactating, and postmenopausal women.

Sleep disorders, anxiety and obesity associated with untreated dental caries in children eight to ten years of age.

OBJECTIVE: To evaluate the presence of sleep disorders, obesity and anxiety associated with cavitated carious lesions in children aged 8 to 10 years. MATERIALS AND METHODS: A cross-sectional study was carried out in the Northeast of Brazil. The sample was comprised of 793 schoolchildren randomly selected from public and private schools. Calibrated examiners (Kappa >0.80) performed the clinical examination of dental caries using the International Caries Detection and Assessment System and applied the Revised Children's Manifest Anxiety Scale and the Sleep Disturbance Scale for Children questionnaires. The anthropometric variables evaluated were weight and height. Negative binomial regressions (α ≤ 0.05) were performed. A Directed Acyclic Graph was prepared using DAGitty software (version 3.0), to select the co-variables for the statistical fits. RESULTS: The prevalence of tooth decay was 52.8%. The mean number of tooth surfaces with cavitated caries was 2.2(2.8), 58.9% of the schoolchildren had some type of sleep disorder, while 20.2% were anxious and 29.1% were obese. Sleep disturbance (RR = 1.38; 95% CI: 1.05-1.83), general anxiety (RR = 1.71; 95% CI: 1.32-2.21), obesity (RR = 1.48; 95% CI: 1.17-1.86) were associated with dental caries in the final model. CONCLUSION: The presence of carious lesions was higher in children with sleep disorders, anxiety, obesity, and those who experienced dry mouth.

Oral health characteristics in children and adolescents with Down syndrome.

AIM: To compare oral health indicators of children/adolescents with Down syndrome (DS) with a group of children/adolescents without DS. METHODS AND RESULTS: This cross-sectional study included 144 individuals with DS, ages 4 to 18 years, matched for age and sex with a group of 144 individuals without DS, and their parents/caregivers. Parents/caregivers completed a questionnaire regarding sociodemographic information and habits related to their children's oral health. Clinical examination of the children/adolescents evaluated dental caries experience (DMFT/dmft), bleeding on periodontal probing, presence of visible plaque, clinical consequences of untreated dental caries (PUFA/pufa), and malocclusion (DAI). The chi-square test, linear by linear test, and Mann-Whitney test were used to compare the variables between the groups (p < .05). Children/adolescents without DS brushed their teeth more times per day (p < .001) and had a higher frequency of daily sugar intake (p < .001). The children/adolescents in the DS group had a greater presence of gingival bleeding (p < .001) and had a greater number of cases of "severe malocclusion" and "very severe malocclusion" (p = .001). No difference was found in the prevalence of dental caries between the two groups. CONCLUSION: The children/adolescents in the DS group had a greater presence of gingival bleeding during the clinical examination and had a greater need for orthodontic treatment.

Impact of pulpectomy versus tooth extraction in children's oral health-related quality of life: A randomized clinical trial.

AIM: The aim of this randomized clinical trial was to compare the impact of two management options for primary molars with pulp necrosis (pulpectomy or extraction) on children's oral health-related quality of life (OHRQoL). DESIGN: A total of 100 children aged 3-5 years with at least one necrotic primary molar were selected and randomized into the study groups. The Brazilian version of early childhood oral health impact scale (B-ECOHIS) was completed by the parent proxy reports at baseline and after 4, 8 and 12 months. Differences between the trial groups were assessed through bootstrap linear regression for B-ECOHIS scores, logistic regression for dental pain self-reports and anxiety scores (α = 5%). RESULTS: The mean (SD) B-ECOHIS scores at baseline and after 12 months were 17.7 (6.5) and 3.0 (4.0) in the pulpectomy group and 18.8 (7.7) and 7.9 (7.7) in the extraction group. Both treatments significantly improved OHRQoL, but tooth extraction group showed higher scores in total B-ECOHIS (p < .001) and most domains, indicating lower OHRQoL. Furthermore, higher anxiety levels were reported for dental extraction compared to pulpectomy (OR = 2.52; p = .008). CONCLUSION: Pulpectomy resulted in an improved OHRQoL scores after 12 months when compared to tooth extraction and should be considered as the treatment of choice for necrotic primary molars.

Orthodontic treatment during pregnancy, lactation, and postmenopausal period: a questionnaire development

Abstract This study aimed to develop and validate a self-administered questionnaire in Brazilian Portuguese to verify the level of knowledge of orthodontists in the care of pregnant, lactating, and postmenopausal women, named "Considerations on Orthodontic Treatment during Pregnancy, Lactation, and Postmenopausal Periods." The development and validation of the questionnaire consisted of the following steps: a) item generation; b) item reduction; c) questionnaire design; and d) validity and reliability tests in a cross-sectional study with 258 orthodontists working in the field from different Brazilian states. A total of 60 orthodontists participated in test-retest over a mean period of 45 days. The preliminary questionnaire consisted of a total of 60 questions. After item reduction, 40 questions were selected for the final version of the questionnaire, with eight questions about pregnant women; six about lactating women; 18 about postmenopausal women, and eight about general knowledge in dentistry. Each item had three response options in the Likert scale format. Face and content validity analysis, reliability assessment through internal consistency (Cronbach's alpha and McDonald's omega), and test-retest reliability through the intraclass correlation coefficient (ICC) and Spearman's correlation coefficient were performed. Face and content validity indicated that the questionnaire was considered valid, objective, and easily understandable. The questionnaire had good internal consistency (Cronbach's alpha = 0.77; McDonald's omega = 0.78) and good test-retest reliability (ICC = 0.71; Spearman's correlation coefficient = 0.51). The questionnaire was considered valid and reliable to assess the level of knowledge of orthodontists in the care of pregnant, lactating, and postmenopausal women.

Usefulness, Reliability, Quality, and Content of Portuguese Language YouTube Videos on COVID-19

Abstract Objective: To investigate the usefulness, reliability, quality, and content of Portuguese-language YouTube videos on COVID-19. Material and Methods: Three keywords selected on Google Trends were searched on YouTube, and the 60 first videos listed with each term were analyzed. Two calibrated researchers evaluated the reliability (DISCERN Modified Scale), the quality (Global Quality Score - GQS), and the usefulness of videos for the users (COVID-19 Specific Score - CSS). The number of views, likes, and engagement were also analyzed. The data were evaluated by the Mann-Whitney test and Spearman correlation (α=5%). Results: 59 videos were included. The average scores of quality, reliability, and usefulness were 3.0 (±1.1), 3.2 (± 0.8), and 1.5 (± 0.9), respectively. Two-thirds of the videos (64.4%) had low/moderate quality, and the majority (76.2%) were about signs and symptoms. The numbers of views (p=0.005), likes (p=0.006), and engagement (p=0.014) were significantly higher in moderate/good quality videos. The number of comments (p=0.007), duration of videos (p=0.004), and the DISCERN score (p<0.001) were significantly higher in videos made by health professionals. The general quality of the videos was positively correlated to the CSS scores, number of views, likes, and engagement (p<0.05). Conclusion: Most videos had moderate quality and reliability and low usefulness for the users.

Changes in Oral Health-Related Behaviors and Oral Health of Children in Early Childhood during Social Isolation Caused by COVID-19

ABSTRACT Objective: To assess changes in oral health-related behavior and oral health status in Brazilian children in early childhood perceived by their parents/caregivers during social isolation caused by COVID-19. Material and Methods: A cross-sectional study with parents/caregivers of children in southeastern Brazil aged 0-5 years who responded to an online questionnaire about sociodemographic data, dietary changes, oral hygiene, and oral health status of children during the COVID-19 pandemic. Results: Of the 119 parents/caregivers, 54.60% did not observe any changes in eating habits, and 81.50% maintained their children's oral hygiene. Associations were observed between the impact of the pandemic on the family income and changes in eating habits (p=0.02) and between lower family income and dental caries perceived by parents/caregivers (p=0.05). Z tests with Bonferroni correction showed that families with drastic income reduction were more likely to consume lower-cost foods (62.50%) than families with no impact or slight reduction on family income. Parents/caregivers did not identify dental caries (89.10%), toothache (92.40%), and dental trauma (92.40%) in their children. Conclusion: Parents/caregivers of children in southeastern Brazil aged 0-5 years observed behavioral changes in the dietary habits of families whose income was impacted by the pandemic, and their perception of dental caries was significantly associated with family income.

Early-life sugar consumption and breastfeeding practices: a multicenter initiative in Latin America.

The aim of this multicenter study was to explore the early-life sugar consumption and dietary practices in Latin America as well as to investigate the association between breastfeeding duration and the age at which foods and beverages with added sugars are introduced. A cross-sectional study was conducted with 805 1- to 3-year-old children from 10 Latin American countries, as a complementary study to the Research Observatory for Dental Caries of the Latin American Region (OICAL). A Food Frequency Questionnaire previously tested in different countries was applied to children's mothers and data on breastfeeding and age at introduction of sugary foods and beverages was collected. Statistical analysis included the Kruskal-Wallis test and Poisson regression with robust variance, with the calculation of crude and adjusted mean ratios (MR) and 95% of confidence intervals (CI). The average age at introduction of sugary foods and beverages was 10.1 months (95%CI 9.7-10.4) and 9.6 (95%CI 9.2-9.9) months, respectively, with a significant variation between countries (p < 0.001). The average daily frequency of sugary foods-beverages was 3.3 times per day (95%CI 3.1-3.5) and varied significantly between countries (p = 0.004). Breastfeeding duration of over six months was associated with an increase in the age of introduction of sweet drinks (16%; MR 1.16; 95%CI 1.05-1.28) and foods (21%; MR 1.21; 95%CI 1.10-1.33). In conclusion, most children from vulnerable settings in Latin America start consuming sugary products in the first year of life and a high frequency of consumption was reported through early childhood. Additionally, breastfeeding contributes to a delay in the introduction of sugary products.

Consensus for teaching dental caries in the Portuguese Language at Brazilian dental schools.

The aim of this paper was to present a summary of the process of developing and preparing the final documents of the national consensus for teaching undergraduate Brazilian dental students the dental caries curriculum in the Portuguese language. The final document was developed in three steps: a) The ABENO and LAOHA cariology group invited experts from all five regions of Brazil to participate in the discussion. The theoretical support for crafting the first draft of the consensus was based on two publications: National Curriculum Guidelines of the Dentistry graduation in Brazil, Ministry of Education (2021) and the competences described in the European Core Curriculum for Cariology (ORCA-ADEE, 2011); b) The group of experts was divided into 5 working groups: G1-Domain, Main and Specific Competences, G2-Essential knowledge, G3-Life course perspective, G4-Social determinants and dental caries, G5- Glossary. The document was finalized by thoroughly reviewing the process using Delphi methodology; c) The 5-chapter document (one from each working group) was submitted to three open public consultations in 2022 (May-June, August, and October) using Google-forms. The suggestions (content/wording) were discussed within the group as: totally accepted, partially accepted, and rejected. A total of 192 suggestions were registered from 31 dental schools in all regions of Brazil. The number of suggestions received per Group were: 84, 28, 26, 24, 30 suggestions for G1, G2, G3, G4 and G5, respectively. The majority of suggestions were totally accepted by the group of experts (n = 172, 89.6%), 15 were partially accepted (7.8%), and 5 were rejected. Conclusion The final document could be considered to be the first national consensus for teaching the dental caries curriculum in Brazil.

Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption.

Policy evaluation and guidance on fluoride use and sugar consumption in Latin American and Caribbean countries (LACC) may provide a scientific evidence basis for policymakers, dental professionals, civil society organizations and individuals committed to improving public oral health. A cross-sectional study was conducted to evaluate the extent of implementation of policies/guidelines on fluoride use, and sugar consumption in LACC. The study had two stages. First a questionnaire covering four major areas was developed: fluoridation of public water supplies; salt fluoridation; fluoride dentifrices, and sugar consumption. Then, the questionnaire was applied to collect data among representative participants in public oral health from LACC. Ninety-six participants from 18 LACC answered the questionnaire. One-hundred seventy documents were attached, and 285 links of websites were provided by the respondents. Implementation of policies and guidelines on water and table salt fluoridation and processed and ultra-processed food consumption were found in most countries, with some issues in the consensus and coverage. Thus, differences were identified in the extent of implementation of public oral health strategies on sugar consumption and fluoridation among the countries. There is no consensus on the policies in LACC to reduce sugar consumption and for the use of fluoride. A few policies and guidelines were applied in isolated countries, with a variety of strategies and standards. For future actions, it will be important to encourage the development of strategies and public policies within countries, and to evaluate the effectiveness of existing policies in reducing dental caries and in improving oral health in LACC.

Cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for use on Brazilian adolescents.

The present study aimed to perform the cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for native Brazilian Portuguese-speaking adolescents (DHLI-BrA). Cross-cultural adaptation consisted of the following steps: translation, assessment, and adjustments by the expert committee to ensure cultural equivalence; back-translation, and synthesis of back-translations. Cognitive testing was then performed in a pretest with adolescents using cognitive interviews with probing questions on the item's understanding interpretation and response options. Cronbach's alpha coefficient and McDonald's omega were used to estimate the instrument's reliability. Forty-two Brazilian adolescents participated in the study (mean age: 16.0 ± 2.0 years; range: 13 to 19 years). Items that were difficult to understand were adapted to the context of Brazilian adolescents. Cronbach's alpha coefficient and McDonald's omega for the 21 items of the DHLI-BrA were, respectively, 0.79 and 0.80. Cronbach's alpha coefficient for the subscales of the self-report instrument was 0.53-0.79 (range), demonstrating good reliability in the total instrument and moderate reliability in the subscales. This study provides the cross-cultural adapted version of the Digital Health Literacy Instrument (DHLI), which is an instrument for measuring digital Health literacy, for use in Brazilian adolescents (DHLI-BrA).