Exploring the perception of orthodontic treatment need using the Dental Aesthetic Index and Index of Orthodontic Treatment Need.

INTRODUCTION: This study aimed to explore the perception of orthodontic treatment need by using the Dental Aesthetic Index (DAI) and the Index of Orthodontic Treatment Need (IOTN). METHODS: A cross-sectional study was conducted on a representative random sample (N = 248) of adolescents aged 12 years. The DAI and both components of IOTN were used to evaluate malocclusion. The association between the Dental Health Component of the IOTN with gender and ethnic group were analyzed by chi-square test. The concordances between the indexes were analyzed by the kappa statistic, with 95% confidence intervals (CIs). RESULTS: The prevalence of adolescents with high severity and orthodontic treatment need was 10.5% (95% CI, 6.7-14.3), 36.5% (95% CI, 32.3-44.3), and 73.4% (95% CI, 67.9-78.9) for the Aesthetic Component of the IOTN, Dental Health Component of the IOTN, and DAI, respectively. The indexes showed high agreement for the cases with low treatment need, whereas low concordance was observed for the cases with high treatment need. CONCLUSIONS: The perception of orthodontic treatment need was assessed differently using DAI and IOTN.

Association between malocclusion and the contextual factors of quality of life and socioeconomic status.

INTRODUCTION: The purpose of this study was to examine associations among malocclusion and the contextual factors of quality of life and socioeconomic status. METHODS: A cross-sectional study was conducted with a population-based sample of 1256 children from 7 to 10 years old. Malocclusion was assessed clinically; oral health-related quality of life (OHRQoL) was assessed using the Brazilian version of the child perceptions questionnaire; socioeconomic status was determined from data made available by the Research and Planning Institute of Piracicaba, São Paulo, Brazil. Initially, bivariate analyses were performed; after this, starting with variables with P ≤0.20, multilevel multiple logistic regression models were estimated, in which the binomial distribution, function of the logistic connection, and criteria for remaining in the model at P ≤0.05 were considered. RESULTS: Of the children, 82.1% had some type of malocclusion. Increased age associated with low socioeconomic status was the determinant for occlusal problems. The determination of low OHRQoL appears to be associated with the socioeconomic status in the individual factors, and increased overjet appears to be associated with factors at the contextual level. CONCLUSIONS: Socioeconomic status and age are risk factors for malocclusion. Of the malocclusions evaluated, increased overjet had the most negative influence on the OHRQoL.

Longitudinal evaluation of the impact of dental caries treatment on oral health-related quality of life among schoolchildren.

This study aimed to evaluate the impact of dental caries treatment on oral health-related quality of life (OHRQoL) among schoolchildren and the responsiveness of the Child Perceptions Questionnaire (CPQ8-10 ) instrument. Brazilian schoolchildren, 8-10 yr of age, were randomly selected and assigned to two groups--dental caries treatment (DCT) and caries-free (CF)--according to their caries experience [decayed, missing, or filled primary teeth (dmft) and decayed, missing or filled secondary teeth (DMFT) values of ≥ 0]. The CPQ8-10 instrument was administered at baseline and at 4 wk of follow-up (i.e. 4 wk after completion of dental treatment). In the DCT group, increases in CPQ8-10 scores were observed between the baseline and follow-up results. However, longitudinal evaluation of the CF group demonstrated no statistically significant difference in CPQ8-10 scores. Responsiveness of the CPQ8-10 instrument (magnitude of change in CPQ8-10 scores) in the DCT group was greater (effect size >0.7) than in the CF group. The findings of this study show that dental caries treatment has an important impact on OHRQoL of children. The CPQ8-10 was considered an acceptable instrument for longitudinal measurement of changes in OHRQoL.

Oral health, socio-economic and home environmental factors associated with general and oral-health related quality of life and convergent validity of two instruments.

BACKGROUND: The objective of this study was to evaluate the convergent validity between the domains of the Autoquestionnaire Qualité de Vie Enfant image (AUQUEI) and the Child Perceptions Questionnaire instrument (CPQ(11-14)) among schoolchildren and to assess the difference between socio-economic and clinical variables associated with their scores. METHODS: An analytical cross-sectional study was conducted in Juiz de Fora, Minas Gerais, Brazil, with 515 schoolchildren aged 12 years from 22 public and private schools, selected with the use of a random multistage sampling design. They were clinically examined for dental caries experience (DMFT and dmft index) and orthodontic treatments needs (DAI index) and were asked to complete the Brazilian versions of Child Perception Questionnaire (CPQ(11-14)) and Autoquestionnaire Qualité de Vie Enfant image (AUQUEI). In addition, a questionnaire was sent to their parents inquiring about their socio-economic status and home characteristics. The convergent validity of the Brazilian versions of CPQ(11-14) and AUQUEI instruments was analyzed by Spearman's correlation coefficients. For comparison between the summarized scores of each questionnaire with regard to the schoolchildren's socio-environmental and clinical aspects the nonparametric Mann-Whitney was used at level of significance of 5%. RESULTS: The mean DMFT index was 1.09 and 125 (24.3%) children had orthodontic treatment needs (DAI ≥ 31). There was a similarity and a weak correlation between the scores of the domains of CPQ(11-14) and AUQUEI (r ranged between -0.006 and 0.0296). In addition, a significant difference was found between the scores of the two instruments according to the socio-economic variables (p < 0.05) and presence of teeth with carious lesions (p < 0.05). CONCLUSIONS: The general and oral health-related quality of life instruments AUQUEI and CPQ(11-14) were both found to be useful, and significant influence of socio-economic and clinical variables were detected with both instruments.

Custo-Efetividade de Diferentes Tratamentos Minimamente Invasivos Para Disfunção Temporomandibular de Origem Articular sob a Perspectiva do Sistema Público de Saúde Brasileiro.

OBJECTIVE: This study aimed to evaluate the cost-effectiveness (CE) of minimally invasive interventions for pain associated with articular temporomandibular dysfunction from the Brazilian Public Health System (SUS) perspective. METHODS: This is a CE study with a 1-year time horizon. Effectiveness data were extracted from a network meta-analysis, and 2 treatments with moderate levels of evidence certainty were evaluated: arthrocentesis (ARTRO) plus intra-articular corticosteroid (CO) injection and ARTRO plus intra-articular injection of sodium hyaluronate (SH). For CE analysis, the costs of 2 types of SH (low and high molecular weight) and 4 COs (betamethasone [B], dexamethasone acetate [D], methylprednisolone sodium succinate [M], or triamcinolone hexacetonide [T]) were considered. Modeling was conducted using TreeAge Pro Healthcare software, with the construction of a decision tree representing a hypothetical cohort of adults with articular temporomandibular dysfunction. Deterministic and probabilistic sensitivity analyses were performed. In addition, an acceptability curve was developed. RESULTS: The total costs per joint for ARTRO plus low- and high-molecular-weight SH and ARTRO plus COs B, D, M, and T were, respectively, R$583.32, R$763.85, R$164.39, R$133.93, R$138.57, and R$159.86. ARTRO plus dexamethasone acetate was considered cost-effective, with lower cost and higher net monetary benefit than other technologies. In all sensitivity analysis scenarios, it remained cost-effective. It also showed greater acceptability. CONCLUSION: ARTRO plus dexamethasone acetate was considered the cost-effective technology, exhibiting higher net monetary benefit and higher acceptability from the SUS perspective.

The influence of oral health conditions, socioeconomic status and home environment factors on schoolchildren's self-perception of quality of life.

BACKGROUND: The objective this study was to investigate the influence of clinical conditions, socioeconomic status, home environment, subjective perceptions of parents and schoolchildren about general and oral health on schoolchildren's oral health-related quality of life (OHRQoL). METHODS: A sample of 515 schoolchildren, aged 12 years was randomly selected by conglomerate analysis from public and private schools in the city of Juiz de Fora, Brazil. The schoolchildren were clinically examined for presence of caries lesions (DMFT and dmft index), dental trauma, enamel defects, periodontal status (presence/absence of bleeding), dental treatment and orthodontic treatment needs (DAI). The SiC index was calculated. The participants were asked to complete the Brazilian version of Child Perceptions Questionnaire (CPQ11-14) and a questionnaire about home environment. Questions were asked about the presence of general diseases and children's self-perception of their general and oral health status. In addition, a questionnaire was sent to their parents inquiring about their socioeconomic status (family income, parents' education level, home ownership) and perceptions about the general and oral health of their school-aged children. The chi-square test was used for comparisons between proportions. Poisson's regression was used for multivariate analysis with adjustment for variances. RESULTS: Univariate analysis revealed that school type, monthly family income, mother's education, family structure, number of siblings, use of cigarettes, alcohol and drugs in the family, parents' perception of oral health of schoolchildren, schoolchildren's self perception their general and oral health, orthodontic treatment needs were significantly associated with poor OHRQoL (p < 0.001). After adjusting for potential confounders, variables were included in a Multivariate Poisson regression. It was found that the variables children's self perception of their oral health status, monthly family income, gender, orthodontic treatment need, mother's education, number of siblings, and household overcrowding showed a strong negative effect on oral health-related quality of life. CONCLUSIONS: It was concluded that the clinical, socioeconomic and home environment factors evaluated exerted a negative impact on the oral health-related quality of life of schoolchildren, demonstrating the importance of health managers addressing all these factors when planning oral health promotion interventions for this population.

Using textile industrial sludge, sewage wastewater, and sewage sludge as inoculum to degrade recalcitrant textile dyes in a co-composting process: an assessment of biodegradation efficiency and compost phytotoxicity.

Recalcitrant dyes found in textile wastewater represent a threat for sustainable textile production due to their resistance to conventional treatments. This study assessed an alternative co-composting system for the treatment of recalcitrant textile dyes where textile industrial sludge, sewage wastewater, or sewage sludge were used as microbial compost inocula. The biodegradation efficiency of bioreactor trials and compost quality of the co-composting system were assessed by visible spectrophotometry and by a phytotoxicity test. The co-composting system (dry weight (dw) basis) consisted of 200 g of restaurant organic residues + 200 g sewage sludge (or 100 mL sewage wastewater, or 200 g textile sludge) + 100 mL of a 10% dye solution (Reactive Red 195, or Synolon Brown, or Orange Remazol, or Yellow Synozol, or Reactive Orange 122, or Reactive Black 5). After 60 days of composting, all dyes were biodegraded according to spectrophotometric data, with efficiency varying from 97.2 to 99.9%. Inoculum efficiency ranking was textile sludge > sewage sludge > sewage wastewater. Regarding compost quality, a phytotoxicity study with lettuce showed no toxicity effect. Thus, co-composting can be a low-cost and efficient method for recalcitrant textile dye biodegradation and for managing textile sludge in terms of waste recycling, contributing to environmental sustainability.

Cost-Effectiveness Analysis of Rehabilitation Interventions for Teeth With Extensive Coronary Destruction.

OBJECTIVE: To perform a cost-effectiveness analysis of rehabilitation interventions for management of posterior teeth (molar) with extensive coronary destruction. METHODOLOGY: An economic model by Markov simulated a hypothetical 10-year cohort with 1,000 patients requiring treatment for a molar tooth with pulp necrosis and extensive coronary destruction. This study adopted the perspective of a local manager from Specialized Center in Dentistry, based on the transfer from the Ministry of Health. Treatments were proposed: Tooth Extraction + Removable Partial Denture (TE+RPD); Root Canal Treatment + Intra-Radicular Restoration + Single Crown (RCT+RIR+SC); and Tooth Extraction + Dental Implant + Single Crown (TE+DI+SC). The costs were obtained from the SUS Integrated System of Procedures, Medicines and orthoses; prostheses and special materials table management (SIGTAP). Failure and survival rates were obtained from systematic reviews. The variable "years of survival" was an outcome of effectiveness. The probabilistic simulation considered the confidence interval of 95%, variation of parameters by 5% and annual discount rate of 5%. RESULTS: TE+RPD intervention presented lower cost and effectiveness. The incremental cost-effectiveness ratio (ICER) of RCT+IRR+SC and TE+DI+SC interventions compared to TE+RPD were $13.06 and $9.92 per year of survival. Compared to RCT+IRR+SC, the TE+DI+SC intervention had an ICER=$26.90 per year of survival. The acceptability curve indicates that the choice of intervention depends on the willingness to pay. CONCLUSION: The RCT+IRR+SC intervention presented a balance of cost-effectiveness. Rehabilitation with implants can be considered in view of the higher expectation of longevity and, especially, greater willingness to pay.

Oral health of a Brazilian population on renal dialysis.

The purpose of this study was to assess the oral health of patients with chronic renal failure (CRF) undergoing hemodialysis in Brazil. A dentist examined 160 subjects aged 40 to 85 years of age. Data was collected on dental caries, use of and need for dentures, oral mucosa, periodontal disease and temporomandibular joint status. All subjects were interviewed about their socioeconomic status, dental and medical history, and oral hygiene habits. Most subjects had hypertension (49.4%); used the public service for their medical care (69.4%); had a middle school educational level (83.1%); and did not complain of xerostomia (60.0%). The majority used private oral healthcare services and used a toothbrush only for oral hygiene. The mean DMFT was 26.0 (standard deviation 7.7). Most individuals did not wear dentures, but needed some type of prosthesis. Lesions of the oral mucosa (3.1%), signs (2.5%) and symptoms (3.8%) of temporomandibular dysfunction could be observed in only a few patients. The oral health of the subjects examined was poor. These persons needed their oral condition monitored by a dentist and their oral disease treated as well as receiving instruction on oral hygiene.

Evaluation of an educational program for children with high risk of caries.

The goal of this study was to evaluate a 15-month educational program designed to children. The sample consisted of 60 six-year olds, randomly assigned into control and experimental group. The control consisted of tooth brushing training, once a year. The experimental group received intensive individual tooth brushing training every three months and guidance on oral health. Initially, both groups were assessed using plaque, gingival, dmfs and DMF-S indexes every three months. In the control, no statistically significant difference was observed for plaque and gingival indexes. The experimental group showed a statistically significant reduction in mean values for two indexes. The caries indexes showed no statistically significant difference. The proposed educational program developed was efficient in reducing gingival and plaque indexes as well caries incidence.

Factors associated with last dental visit or not to visit the dentist by Brazilian adolescents: A population-based study.

OBJECTIVES: We investigated the factors associated with no dental visit within the last two years by adolescents in the state of São Paulo, Brazil, by using data from the Oral Health Conditions of São Paulo state population Project (SBSP-2015) conducted in 2015. METHODS: This was a cross-sectional epidemiological study with a representative sample of adolescents aged 15 to higher years residing in São Paulo State. The examiners were calibrated and dental visits were measured categorically as 1- Less than 1 year, 2- One to two years, 3 - Three years or more, 4- I have never visited the dentist. Based on the literature we dichotomized the outcome in two groups: response 1 plus 2 against response 3 plus 4. Then, Multilevel Poisson Regression (MPR) was used to estimate the prevalence ratios of last dental visit three years or had never been to a dentist by adolescents compared with those who had visited the dentist within the past two years, with contextual variables as the distal level; sociodemographic variables, mesial; and individual variables, proximal level. RESULTS: A high percentage of adolescents (84.9%) reported visiting the dentist in the last 2 years. Whereas, 626 (11.6%) had not visited the dentist for over 3 years and 188 (3.4%) had never been. A significantly higher proportion of females than males reported visiting the dentist in the past 2 years (p = 0.003). The oral and dental condition was reported as satisfactory by 4,350 respondents (80.6%), and when they accessed the health service, 2,286 (42.3%) went to the public service. Lower mean family income (1.62PR;95%CI;1.36-1.94); ≥ 1,000 inhabitant/Dental Surgeons (1.25PR;95%IC;1.03-1.56);male (1.26PR;95%CI; 1.11-1.43) non-Caucasian ethnicity (Mulatto:1.30PR;95%CI;1.13-1.50 and Black:1.58PR;95%CI;1.29-1.93); dissatisfaction with the oral health condition (1.20PR;95%CI;1.01-1.45),last visit to the public service versus private service (2.26PR; 95%CI;1.91-2.65) and presenting with periodontal disease in the form of dental calculus as the worst situation (1.38PR; 95%CI; 1.16-1.53) were associated with last visit to the dentist. CONCLUSIONS: A high proportion of adolescents had visited the dentist in the last two years. No dental visit within the last two years by adolescents were associated with contextual, health care system, sociodemographic, personal and oral health status, demonstrating that this is a complex phenomenon. Actions to promote regular dental visits by adolescents in Brazil should take these factors into consideration.

Geographic information systems (GIS) in assessing dental health.

The present study investigated the distribution profile of dental caries and its association with areas of social deprivation at the individual and contextual level. The cluster sample consisted of 1,002 12-year-old schoolchildren from Piracicaba, SP, Brazil. The DMFT Index was used for dental caries and the Care Index was used to determine access to dental services. On the individual level, variables were associated with a better oral status. On the contextual level, areas were not associated with oral status. However, maps enabled determining that the central districts have better social and oral conditions than the deprived outlying districts.

Perception of dental fluorosis and other oral health disorders by 12-year-old Brazilian children.

AIM: The aim of this study was to verify the perception of dental fluorosis as an oral health problem by 12-year-old Brazilian children and to evaluate if they were able to detect other oral disorders. METHODOLOGY: The sample consisted of 401 schoolchildren. Firstly, clinical examinations were performed using a visual method under natural light. After that, children answered a questionnaire with the purpose of assessing the self-perception of their oral health problems. Next, the volunteers were shown a photo album containing 24 photographs, and had to match each photo with a severity scale. RESULTS: The prevalence of fluorosis was 18.2%; 81.8% of this total in fluorosis scale T-F 1. Of the 401 children, 48.9% (n = 196) answered oral health problems related to concerns, such as aesthetic appearance or pain. Among them, only two children, both with fluorosis T-F 2, correlated their problems with the presence of stained teeth. As regards the photo album analysis, the children considered photos showing fluorosis T-F 7-9 as the most severe, whereas the photo of an orally healthy patient was considered the least severe. CONCLUSION: Children did not show negative perception of dental fluorosis, except for dental fluorosis at severe levels (T-F 7-9), and were mainly able to detect aesthetic or pain-related problems.

Avaliaçäo da prevalência de cárie dentária em escolares de localidade urbana da regiäo sudeste do Brasil / Evaluation of the prevalence of dental caries in school-children in an urban area of Southeastern Brazil

Realizou-se no ano de 1994, na cidade de Paulínia, Estado de Säo Paulo (Brasil), um levantamento epidemiológico de cárie dentária com o intuito de comparar a atual prevalência com os dados de um estudo prévio de 1980. Foram examinados 1.416 escolares de 7 a 14 anos de idade, de ambos os sexos, por 10 dentistas previamente calibrados, utilizando-se os índices CPO.D e CPO.S. Verificou-se que houve uma queda da prevalência de cárie em 67,8 por cento em relaçäo aos dados de 1980. Observou-se uma inversäo dos componentes do índice CPO-D: em 1980 prevalecia o componente cariado (69,5 por cento), enquanto que o componente obturado prevaleceu em 1994 (79,0 por cento). Os componentes extraídos e a extraçäo indicada praticamente desapareceram no ano de 1994

Manifestaçöes clínicas associadas ao herpesvirua humano tipo 6, incluindo aspectos da infecçäo na síndrome da imunodeficiência adquirida / Clinical features related to human herpesvirus type 6, including aspects of the infection in acquired immnunodeficience syndrome

O herpesvirus humano tipo 6 foi isolado em 1986 de pacientes com doenças linfoprolíferativas. Estudos posteriores demonstraram que o HHV-6 é frequentemente encontrado em seres humanos e que a infecçäo primária comumente ocorre nos primeiros anos de vida, algumas vezes causando uma doença benígna da infåncia denominada exantema súbito. Nesta revisäo, as síndromes relacionadas ao HHV-6 e a infecçäo em hospedeiros imunocomprometidos, incluindo a síndrome da imunodeficiência adquirida, säo descritas