Six-year trends in dental pain and maternal education inequalities among Brazilian adolescents.

OBJECTIVE: To analyse trends in dental pain prevalence among Brazilian adolescent students over 6 years, focusing on inequalities by maternal education. METHODS: Data from the National Adolescent School-Based Health Survey (PeNSE) carried out in 2009 (n = 45 239), 2012 (n = 46 482) and 2015 (n = 35 592) were analysed, including ninth grade students from the 27 state capitals in Brazil who were of ages 11-17 years or older. Variables analysed were dental pain within the last 6 months (yes/no) and the following sociodemographic factors: age, sex, race, type of school and maternal schooling (years of study: ≤8; 9-11; ≥12). The prevalence of dental pain in the 3 years was compared using the Rao-Scott test. Relative and absolute measures of socioeconomic (maternal education) inequalities in dental pain were applied using the slope index of inequality (SII) and the relative concentration index (RCI). RESULTS: The prevalence of dental pain increased from 17.5% (95% CI = 16.9-18.2) in 2009 to 20.4% (95% CI = 19.7-21.1) in 2012, then to 21.8% (95% CI = 21.1-22.5) in 2015. All sociodemographic factors investigated were associated with dental pain in all survey years. There was an increasing proportion of the outcome in all categories of maternal education over the years studied. Absolute (SII) and relative (RCI) inequalities regarding of maternal education were found; these indicate higher levels of dental pain in the lower socioeconomic group in each study year. However, no significant changes in inequalities were found from 2009 to 2015. CONCLUSIONS: The prevalence of dental pain increased in the 2009-2012 and 2012-2015 periods, and social inequalities were found. Higher levels of dental pain persisted in the lower maternal education group. Inequalities remained stable over time. Broader actions to reduce the existing inequalities are needed and should be a priority for public policies.

Socioeconomic Factors and Caries in People between 19 and 60 Years of Age: An Update of a Systematic Review and Meta-Analysis of Observational Studies.

This study is aimed to perform an update of a systematic review and meta-regression to evaluate the effect modification of the socioeconomic indicators on caries in adults. We included studies that associated social determinants with caries, with no restriction of year and language. The Newcastle-Ottawa Scale was used to evaluate the risk of bias. With regard to the meta-analysis, statistical heterogeneity was evaluated by I², and the random effect model was used when it was high. A subgroup analysis was conducted for socioeconomic indicators, and a meta-regression was performed. Publication bias was assessed through Egger's test. Sixty-one studies were included in the systematic review and 25 were included in the meta-analysis. All of the studies were published between 1975 and 2016. The most frequent socioeconomic indicators were schooling, income, and socioeconomic status (SES). In the quantitative analysis, the DMFT (decayed, missing, filled teeth) variation was attributed to the studies' heterogeneity. The increase of 10.35 units in the proportion of people with lower SES was associated with an increase of one unit in DMFT, p = 0.050. The findings provide evidence that populations with the highest proportions of people with low SES are associated with a greater severity of caries. The results suggest the need for actions to reduce the inequalities in oral health (PROSPERO [CRD42017074434]).

Dental Procedures in Primary Health Care of the Brazilian National Health System.

The aim of this study was to examine the procedures of primary dental health care performed by oral health teams (OHTs) adhering to the second cycle of the 'National Programme for Improving Access and Quality of Primary Care' (PMAQ-AB) in Brazil. A cross-sectional descriptive analysis was performed, across 23 dental procedures comprising preventive, restorative/prosthetic, surgical, endodontic and oral cancer monitoring. Descriptive analysis shows that most of the oral health teams carry out basic dental procedures. However, most of the time, they do not keep adequate records of suspected cases of oral cancer, diagnosis tests or follow-ups, and do not perform dental prosthetic procedures. Data also showed disparities in the average number of procedures performed in each Brazilian geographical region in 2013-2014, ranging from 13.9 in the northern to 16.5 in the southern and south-eastern regions, reinforcing the great social disparities between them. Brazilian regions with the highest volume of dental needs deliver the lowest number of dental procedures. The need to expand the supply of prostheses and the early diagnosis of oral cancer in primary health care (PHC) is evident.

Recognizing preschool children with primary teeth needing dental treatment because of caries-related toothache.

OBJECTIVES: The Dental Discomfort Questionnaire (DDQ), which is an observational instrument that assesses dental pain in preschool children, has not been extensively tested for its ability to identify dental treatment needs in this population. This study aimed to explore the accuracy of the Brazilian version of the DDQ (DDQ-B) to identify preschool children needing dental treatment. METHODS: The participants were 326 children (57.7% boys), aged 15-72 months [mean 49.8, standard deviation (SD) 14.8], who were examined to assess their dental treatment needs at the same time that their parents filled out the DDQ-B. The DDQ-B median score (outcome variable) was compared to the median index of dental treatment needs or categories (nonparametric tests). The area under the receiver operating characteristic (ROC) curve (AUC) and diagnostic tests were performed to test the DDQ-B accuracy for identifying preschoolers with untreated teeth needing dental treatment. The data were analysed using SPSS 19.0, and the significance level was set at 5%. RESULTS: Overall, 326 questionnaires were completed and considered for analyses. Additionally, 63.5% of children had untreated teeth needing dental care. The median DDQ-B score, 2.0 (first-third quartile 1.0-5.0), was positively associated with the median index for needing dental care, 3.0 (0.0-5.0) (ρ = 0.49, P < 0.001). Children with more invasive intervention needs, such as pulp therapy, 5.0 (2.0-7.0), and extraction, 6.0 (4.0-8.5), had the highest DDQ-B scores (P < 0.001). The DDQ-B could identify children with more invasive dental care needs [AUC 0.86, 95% confidence interval (CI) 0.80-0.91, P < 0.001]. A score of 5 or higher was a reliable cut-off point to confirm that children who were screened with caries-related toothache by the DDQ-B do, in fact, have untreated teeth needing dental treatment, especially for pulpal care and extraction. CONCLUSIONS: The DDQ-B is an accurate observational tool for identifying preschool children with dental treatment needs; children who scored 5 or higher require dental care for more invasive procedures.

Impact of the first eight months of orthodontic treatment with a fixed appliance on the families of adolescent patients.

OBJECTIVE: To evaluate the impact of the first 8 months of orthodontic treatment with a fixed appliance on the families of adolescent patients and to examine the evaluative properties of the Family Impact Scale (FIS). MATERIALS AND METHODS: The study involved a sample of 94 parents/caregivers of adolescents undergoing orthodontic treatment with a fixed appliance. The participants were asked to answer the Brazilian version of the FIS before treatment (T1) and 8 months after the bonding of the fixed appliance (T2). Statistical analysis was carried out using the Wilcoxon signed rank test and the Bonferroni correction for the overall score and FIS subscales. Responsiveness of the measure and the minimal clinically important difference (MCID) were also assessed. RESULTS: Among the 94 participants initially admitted to the present study, two were excluded as a result of treatment dropout and failure to return the second questionnaire. Thus, a sample of 92 parents/caregivers participated (response rate: 97.8%). Among the 92 participants, 70 were the mothers of patients, 16 were fathers, and six were other family members. Statistically significant improvements were found in the overall score (P < .001) as well as in both parental activity and parental emotions subscales (P < .001). The reductions in scores were associated with effect sizes showing moderate clinically meaningful changes in the overall FIS and in the parental/family activity, parental emotions, and family conflict subscales. The MCID was 2.66 for the overall FIS. CONCLUSION: The first 8 months of orthodontic treatment with a fixed appliance had a positive impact on the families of adolescents.

A systematic review of socioeconomic indicators and dental caries in adults.

Increasing evidence suggests that socioeconomic factors may be associated with an increased risk of dental caries. To provide better evidence of the association between dental caries in adults and socioeconomic indicators, we evaluated the relation between these two conditions in a thorough review of the literature. Seven databases were systematically searched: Pubmed, Cochrane, Web of Science, Bireme, Controlled Trials, Clinical Trials and the National Institute for Health and Clinical Excellence. No restrictions were placed on the language or year of publication. The search yielded 41 studies for systematic review. Two independent reviewers screened the studies for inclusion, extracted data and evaluated quality using the Newcastle-Ottawa scale. The following socioeconomic indicators were found: educational level, income, occupation, socio-economic status and the community index. These indicators were significantly associated with a greater occurrence of dental caries: the subject's education, subject's income, subject's occupation and the Gini coefficient. A high degree of heterogeneity was found among the methods. Quality varied across studies. The criteria employed for socioeconomic indicators and dental caries should be standardized in future studies. The scientific evidence reveals that educational level, income, occupation and the Gini coefficient are associated with dental caries.