Validity of self-reported oral conditions among Brazilian older women: Do socio-economic factors matter?

OBJECTIVE: To validate the level of agreement between self-report and clinical examination for oral conditions and evaluate the effect of sociodemographic conditions on the validity of self-report among women aged 60 and older. METHODS: A cross-sectional study was conducted in a social community center for seniors in Southern Brazil. Sociodemographic data (age, level of education, and income) were measured. Participants were interviewed and clinically examined for the number of teeth (DMF-T index) and the use of dental prostheses. The self-reported number of teeth in each arch and the use of dental prostheses were gathered through interviews. The level of agreement was estimated using the observed agreement, Kappa statistics, sensitivity/specificity (edentulism/prostheses) and Lin's concordance correlation coefficient, and related tests (number of teeth). The validity of the oral conditions was estimated according to sociodemographic information. RESULTS: Ninety-nine women participated in the study. High levels of agreement were observed for edentulism (97.8%; 95%CI 92.8;99.7; Kappa 0.947) and the use of dental prostheses (97.0%; 95%CI 91.3;99.4; Kappa 0.922). In both conditions, despite achieving similar concordance correlation coefficients (ranging from weak to moderate), the mean number of upper teeth was lower in clinical examination (7.1 ± 5.2) compared with self-reported (8.6 ± 3.6), while the opposite was observed for lower teeth (clinical examination: 9.1 ± 3.4; self-reported: 6.6 ± 5.3). Larger differences were found among women of low income and educational levels. CONCLUSIONS: Our findings suggest that the participants' socio-economic position might influence their self-reported number of teeth.

Higher experience of caries and lower income trajectory influence the quality of restorations: A multilevel analysis in a birth cohort.

OBJECTIVES: This study aimed to evaluate the quality of posterior restorations (amalgam or composite) placed in adults from a birth cohort and its association with clinical and socioeconomic determinants experienced during their life course. METHODS: A representative sample (n=539) of all 5914 births occurring in Pelotas (Brazil) in 1982 was prospectively investigated. Quality of posterior restorations (satisfactory or unsatisfactory) was assessed at 31 yrs-old, using modified USPHS criteria. Trained and calibrated dentists performed clinical examination. Explanatory variables included demographic and socioeconomic, oral health and dental service utilization patterns during the life course. Tooth related variables (type of tooth, material, size of cavity) were also analyzed. Untreated caries and socioeconomic status were assessed by group-based trajectories analyses. Multilevel Regression models were used to determine factors associated with restoration outcomes. RESULTS: In total 2123 restorations (53% composite) were evaluated of which 107 (5%) were assessed as failed. The main reasons for failure were tooth/restoration fracture (50.5%) and secondary caries (30.7%). Failures in posterior restorations showed a significant association with socioeconomic aspects (lower tertile of income at age 30 - prevalence ratio (PR) 2.21 [95% CI 1.19-4.09]), clinical variables (trajectory of higher untreated caries - PR 2.11 [95% CI 1.23-3.61]) and also with tooth-related factors (Restorations involving three or more surfaces - PR 5.51 [95% CI 3.30-9.19]) after adjustment for each other. CONCLUSIONS: These findings suggest that, although tooth-related variables have an important role in restoration longevity, patient-related factors, such as socioeconomic variables and untreated caries are also associated with failure and should be taken into account when evaluating longevity of posterior restorations. CLINICAL SIGNIFICANCE: This was the first study assessing long-term trajectory of untreated caries, showing an association between higher experience of caries during the life-course and unsatisfactory restorations. The findings suggest that individual related factors should be considered when planning treatment and in future research evaluating the longevity of dental restorations.

Prediction of Periodontitis Occurrence: Influence of Classification and Sociodemographic and General Health Information.

BACKGROUND: Prediction of periodontitis development is challenging. Use of oral health-related data alone, especially in a young population, might underestimate disease risk. This study investigates accuracy of oral, systemic, and socioeconomic data on estimating periodontitis development in a population-based prospective cohort. METHODS: General health history and sociodemographic information were collected throughout the life-course of individuals. Oral examinations were performed at ages 24 and 31 years in the Pelotas 1982 birth cohort. Periodontitis at age 31 years according to six classifications was used as the gold standard to compute area under the receiver operating characteristic curve (AUC). Multivariable binomial regression models were used to evaluate the effects of oral health, general health, and socioeconomic characteristics on accuracy of periodontitis development prediction. RESULTS: Complete data for 471 participants were used. Periodontitis classifications with lower thresholds yielded superior predictive power. Calculus, pocket, or bleeding presence at age 24 years separately presented fair accuracy. Accuracy increased using multivariable models; for example, the Beck et al. classification AUC from 0.59 to 0.75 combining proportion of teeth with calculus, bleeding, or pocket with income; number of lost teeth; sex; education; people living in the house; prosthetic needs; or number of decayed, missing, or filled teeth (DMFT). Proportion of teeth with pocket, bleeding, or calculus; number of DMFT; toothbrushing frequency; blood pressure; sex; and income were most frequently associated. CONCLUSIONS: Choice of classification might have an impact on accuracy to predict periodontitis occurrence. Regardless of the classification, predictive value for development of periodontitis in young adults might be increased by combining periodontal information, sociodemographic information, and general health history.

Dental prosthesis use and/or need impacting the oral health-related quality of life in Brazilian adults and elders: Results from a National Survey.

OBJECTIVES: This study aimed to assess the impact of use of and need for dental prosthesis (DP) on oral health related quality of life (OHRQoL) among Brazilian adults and elders. METHODS: This cross-sectional, population-based study, used data from the Brazilian Oral Health National Survey performed in 2010. The sample was representative of adults (35-44 years of age) and elders (65-74 years) at national level. Oral Impact on Daily Performance (OIDP) questionnaire was used to assess the individuals' OHRQoL. Interest variables included use of and need for DP and location of tooth losses. Covariates included socioeconomic, behavioral and clinical characteristics. Associations were performed using Negative Binomial regression models, estimating the rate ratios (RR) and respective 95% confidence intervals. RESULTS: From the total of 17,398 individuals evaluated, 68.3% needed some type of DP, while the prevalence of DP usage was 49.2%. After adjustments, those needing prosthesis, regardless of already using prosthesis presented an impact more than 50% higher on OHRQoL, and those needing a greater the number of teeth to be replaced and those presenting losses on anterior and posterior regions had higher impact on OHRQoL. CONCLUSIONS: These findings suggest that improvement of strategies focused on oral rehabilitation of adults and elders are crucial to promote population oral health. CLINICAL SIGNIFICANCE: The high prevalence of normative need for prosthetic rehabilitation in adult and elder Brazilian population impacts significantly on oral health-related quality of life highlighting the importance of providing prosthetic oral rehabilitation in this population.

Oral health-related quality of life and associated factors in Southern Brazilian elderly.

OBJECTIVE: The aim of the present study was to describe oral health-related quality of life (OHRQoL) and associated factors in elderly individuals treated at Family Health Units in urban areas of the city of Pelotas, Brazil. METHODS: The sample was composed of 438 individuals aged 60 years old or older. Demographic, socio-economic, general health and behavioural variables were collected using standardised questionnaires. OHRQoL was measured with the oral health impact profile (OHIP-14). Poisson regression analysis was employed to identify factors associated with OHRQoL. RESULTS: The mean total OHIP-14 score was 9.1 (standard deviation: 10.6), and major impacts were related to feeling conscious of psychological discomfort (28.1%) and difficulty eating (24.4%) due to teeth, mouth or dentures. The multivariate analysis revealed higher oral health impact scores among non-White individuals [Prevalence ratios (PR) = 1.33, 95% CI: 1.07-1.66; p = 0.011], those with depressive symptoms (PR = 1.61, 95% CI: 1.30-1.99; p < 0.001), tobacco users (PR = 1.46, 95% CI: 1.07-1.99; p = 0.016), non-denture users (PR = 1.42, 95% CI: 1.10-1.85, p = 0.008), those with a perceived need for dental treatment (PR = 1.99, 95% CI: 1.58-2.51; p < 0.001) and those with poor or very poor self-rated oral health (PR = 2.86, 95% CI: 1.93-4.24; p < 0.001). Lower scores were found among individuals aged 80 years or older (PR = 0.52, 95% CI: 0.33-0.82; p = 0.005) and those with household income of more than 1.5 times the minimum wage (PR = 0.65, 95% CI: 0.46-0.93; p = 0.018). CONCLUSIONS: The findings of the present study underscore the need for public policies aimed at reducing social inequalities and providing adequate dental treatment to improve OHRQoL among elderly individuals.

Scholarships for scientific initiation encourage post-graduation degree.

This study aimed to evaluate the factors associated with the decision to attend an academic post-graduation program by dental students. A cross-sectional study was conducted in 2012, last-year undergraduate students from Dental Schools of Southern Brazil. A closed questionnaire was applied including questions grouped in three different blocks: pre-graduate, undergraduate period and future perspectives. The outcome was the decision to pursuit an academic post-graduation degree. Associations were tested using chi-squared test and chi-squared test for linear trends when appropriate. Multivariate Poisson regression was also performed. The sample was composed by 671 students (response rate of 69.9%, n=467). In relation to future perspectives, 68% of the interviewed students intended to attend a post-graduation program, but only 17.5% would choose a program with academic and research post-graduation program (Master and PhD programs). In the final model, students from public universities (PR 2.08, 95%CI 1.41-3.08) and students that received scientific initiation scholarship (PR 1.93 95%CI 1.14-3.27) presented a twice greater prevalence to seek academic post-graduate programs. Students with higher family incomes showed a lower prevalence to seek these programs (PR 0.50, 95%IC 0.28-0.90). Scholarships seem to encourage undergraduate students to pursue stricto sensu post-graduation.

Scholarships for Scientific Initiation Encourage Post-Graduation Degree

This study aimed to evaluate the factors associated with the decision to attend an academic post-graduation program by dental students. A cross-sectional study was conducted in 2012, last-year undergraduate students from Dental Schools of Southern Brazil. A closed questionnaire was applied including questions grouped in three different blocks: pre-graduate, undergraduate period and future perspectives. The outcome was the decision to pursuit an academic post-graduation degree. Associations were tested using chi-squared test and chi-squared test for linear trends when appropriate. Multivariate Poisson regression was also performed. The sample was composed by 671 students (response rate of 69.9%, n=467). In relation to future perspectives, 68% of the interviewed students intended to attend a post-graduation program, but only 17.5% would choose a program with academic and research post-graduation program (Master and PhD programs). In the final model, students from public universities (PR 2.08, 95%CI 1.41-3.08) and students that received scientific initiation scholarship (PR 1.93 95%CI 1.14-3.27) presented a twice greater prevalence to seek academic post-graduate programs. Students with higher family incomes showed a lower prevalence to seek these programs (PR 0.50, 95%IC 0.28-0.90). Scholarships seem to encourage undergraduate students to pursue stricto sensu post-graduation.

Este estudo objetivou avaliar os fatores associados com a decisão de estudantes de Odontologia em participar de um programa de pósgraduação acadêmica. Um estudo transversal foi conduzido em 2012, com estudantes do último ano do curso de Odontologia do Sul do Brasil. Foi aplicado um questionário fechado composto por três diferentes blocos: período prévio à graduação, período da graduação e perspectivas futuras. O desfecho deste trabalho foi definido como a decisão de buscar uma pós-graduação acadêmica. As associações foram testadas com o teste de Qui-quadrado e de Qui-quadrado de tendência linear, quando apropriado. Além disso, foi feita a regressão multivariada de Poisson. A amostra foi composta por 671 estudantes (taxa de resposta de 69,9%, n=467). Em relação às perspectivas futuras, 68% dos estudantes entrevistados pretendem ingressar em um curso de pós-graduação, mas somente 17,5% escolheriam um programa com pós-graduação acadêmica e pesquisa (Programas de Mestrado e Doutorado). No modelo final, estudantes de universidades públicas (RP 2,08, 95% CI 1,41-3,08) e estudantes que receberam bolsa de iniciação científica (RP 1,93 95% CI 1,14-3,27) apresentaram prevalência duas vezes maior na busca de pós-graduação acadêmica. Estudantes de famílias com renda alta mostraram menor prevalência na busca destes cursos (RP 0,50, 95%IC 0,28-0,90). Desta forma, bolsas parecem incentivar os alunos de graduação na busca por pós-graduação stricto sensu.

Children's use of dental services: influence of maternal dental anxiety, attendance pattern, and perception of children's quality of life.

OBJECTIVES: The purpose of the study was to investigate the influence of a child's clinical condition; maternal characteristics such as dental anxiety and dental visit pattern; socioeconomic conditions; and maternal perception of the child's oral health-related quality of life (OHRQoL) on a child's use of dental care services. METHODS: A cross-sectional study of 608 mother-child dyads was conducted during the Children's Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire regarding their use of dental services, dental anxiety (Dental Anxiety Scale), socioeconomic status, and perception of their children's OHRQoL (the Early Childhood Oral Health Impact Scale). Clinical examination of the children was performed to assess dental caries (dmf-t). Associations between the above-mentioned factors and child use of dental services were assessed using Poisson regression models (prevalence ratio [PR]; 95% CI; P ≤ 0.05). RESULTS: The majority of children (79.3%) had never had a dental appointment and of the children who had visited a dentist, 55 (43.65%) presented with untreated dental caries at the time of examination. More than half the mothers (60.2%) did not visit a dentist regularly. In the final model, low schooling level of mothers (PR, 0.64) and irregular visits to a dentist by the mother (PR, 0.48) were factors because of which a child did not have a dental appointment. Children who had experienced pain (PR, 1.56), those who had poor OHRQoL (PR, 1.49), and older children (PR, 2.14) visited a dentist with higher frequency. CONCLUSIONS: Use of dental care services by preschool children was low, and treatment was neglected even among children who had visited a dentist. Children of mothers with low schooling level who do not visit a dentist regularly were at greater risk of not receiving dental care. Maternal perception of their child's oral health motivated visits to the dentist.

Validity of partial protocols to assess the prevalence of periodontal outcomes and associated sociodemographic and behavior factors in adolescents and young adults.

BACKGROUND: Most studies comparing prevalence of periodontal disease and risk factors by using partial protocols were performed in adult populations, with several studies being conducted in clinical settings. The aim of this study is to assess the accuracy of partial protocols in estimating the prevalence of periodontal outcomes in adolescents and young adults from two population-based birth cohorts from Pelotas, Brazil, and to assess differences in the estimation and strength of the effect measures when partial protocols are adopted compared to full-mouth examination. METHODS: Gingival bleeding at probing among adolescents (n = 339) and young adults (n = 720) and dental calculus and periodontal probing depth among young adults were assessed using full-mouth examinations and four partial protocols: Ramfjord teeth (RT), community periodontal index (CPI), and two random diagonal quadrants (1 and 3, 2 and 4). Socioeconomic, demographic, and periodontal health-related variables were also collected. Sensitivity, absolute and relative bias, and inflation factors were calculated. Prevalence ratio for each periodontal outcome for the risk factors was estimated. RESULTS: Two diagonal quadrants showed better accuracy; RT had the worst, whereas CPI presented an intermediate pattern when compared to full-mouth examination. For bleeding assessment in adolescence, RT and CPI underestimated by 18.4% and 16.2%, respectively, the true outcome prevalence, whereas among young adults, all partial protocols underestimated the prevalence. All partial protocols presented similar magnitude of association measures for all investigated periodontal potential risk factors. CONCLUSION: Two diagonal quadrants protocol may be effective in identifying the risk factors for the most relevant periodontal outcomes in adolescence and in young adulthood.

Longevity of posterior composite restorations: not only a matter of materials.

Resin composites have become the first choice for direct posterior restorations and are increasingly popular among clinicians and patients. Meanwhile, a number of clinical reports in the literature have discussed the durability of these restorations over long periods. In this review, we have searched the dental literature looking for clinical trials investigating posterior composite restorations over periods of at least 5 years of follow-up published between 1996 and 2011. The search resulted in 34 selected studies. 90% of the clinical studies indicated that annual failure rates between 1% and 3% can be achieved with Class I and II posterior composite restorations depending on several factors such as tooth type and location, operator, and socioeconomic, demographic, and behavioral elements. The material properties showed a minor effect on longevity. The main reasons for failure in the long term are secondary caries, related to the individual caries risk, and fracture, related to the presence of a lining or the strength of the material used as well as patient factors such as bruxism. Repair is a viable alternative to replacement, and it can increase significantly the lifetime of restorations. As observed in the literature reviewed, a long survival rate for posterior composite restorations can be expected provided that patient, operator and materials factors are taken into account when the restorations are performed.