Ethnicity, Social Support and Oral Health Among English Individuals.

OBJECTIVE: To determine whether social support explains ethnic inequalities in oral health among English individuals. METHODS: Data from 42704 individuals across seven ethnic groups in the Health Survey for England (1999-2002 and 2005) were analysed. Oral health was indicated by self-reports of edentulousness and toothache. Social support was indicated by marital status and a 7-item scale on perceived social support. Confounder-adjusted regression models were fitted to evaluate ethnic inequalities in measures of social support and oral health (before and after adjustment for social support). RESULTS: Overall, 10.4% of individuals were edentulous and 21.7% of dentate individuals had toothache in the past 6 months. Indian (Odd Ratio: 0.50, 95% Confidence Interval: 0.32-0.78), Pakistani (0.50, 95%CI: 0.30-0.84), Bangladeshi (0.29, 95%CI: 0.17-0.47) and Chinese (0.42, 95%CI: 0.25-0.71) individuals were less likely to be edentulous than white British individuals. Among dentate participants, Irish (1.21, 95%CI: 1.06-1.38) and black Caribbean individuals (1.37, 95%CI: 1.18-1.58) were more likely whereas Chinese individuals (0.78, 95%CI: 0.63-0.97) were less likely to experience toothache than white British individuals. These inequalities were marginally attenuated after adjustment for marital status and perceived social support. Lack of social support was associated with being edentulousness and having toothache whereas marital status was associated with edentulousness only. CONCLUSION: The findings did not support the mediating role of social support in the association between ethnicity and oral health. However, perceived lack of social support was inversely associated with worse oral health independent of participants' sociodemographic factors.

Effects of universal oral healthcare coverage in an adult population: A long-term nationwide natural experiment.

OBJECTIVES: A large and long-term natural experiment occurred in Finland from the late 1980s-2000, when adults' entitlement to subsidized oral healthcare was strongly dependent on the arbitrary classification based on their year of birth: people born in 1956 or later were entitled to subsidized care, while people born before 1956 were not. The aim of this study was to investigate the effect of this expanded universal oral healthcare coverage on service use and oral health outcomes. METHODS: Data from annual nationally representative cross-sectional postal surveys among 15-64-year-olds between 1990 and 2014 were used. For this study, the following outcome variables were formed: experiencing toothache during the past month (yes/no), the number of missing teeth with three different thresholds (over 10, over 5 or at least 1 missing tooth), brushing more than once a day and the number of visits to the dentist. Regression discontinuity plots and bias-corrected local polynomial regression discontinuity estimators measuring the effect of the extended universal coverage on the outcomes at the year-of-birth cut-off of 1956 were generated separately from the data from 1990 to 2000 and from 2002 to 2014. RESULTS: Between 1990 and 2000, the number of visits to the dentist (0.2 visits, 95% CI, confidence intervals: -0.03; 0.43) and the proportion of those who visited the dentist during the past 12 months (4.2%, 95% CI: 0.1%; 8.3%) increased at the year-of-birth cut-off of 1956. There were minor drops (1.5%-1.9%) in the number of missing teeth across all thresholds (over 10, over 5, or at least 1 missing teeth) at the cut-off. Analyses with the data from the surveys from 2002 to 2014 showed that there were no discontinuities in these outcomes at the cut-off of 1956. Regression discontinuity estimates related to toothache experience and toothbrushing frequency were inconclusive due to high variability in the underlying data and the likely small effect of the more universal coverage on these outcomes. CONCLUSIONS: The current study provided evidence of the beneficial effects of universal oral healthcare coverage on the oral healthcare service use and teeth preservation from a large and long-term natural experiment occurred in Finland from the late 1980s to 2000.

Social Economic Disadvantage and Untreated Dental Caries: Findings from a Cohort Study in Adolescents.

This study aimed to assess the impact of determinants of the individual and contextual level on the untreated dental caries during adolescence. A cohort study was started in 2012 with a random sample of 1,134 12-year-old adolescents in the city of Santa Maria, RS, Brazil. The adolescents were clinically evaluated by calibrated dentists and investigated variables: contextual, demographic, socioeconomic factors, dental service use, toothache, and subjective variables. After 2 years (T2) and 6 years (T3), the same adolescents were reevaluated (retention rate of 67.9% and 67.8%, respectively). Untreated dental caries (component "D" of the DMFT index) was the outcome and was collected at all three times. Multilevel Poisson regression analyses considered repeated measures (level 1 - times), nested to adolescents (level 2), were used to assess the association between predictors (baseline) and untreated dental caries. High neighborhood's mean income was associated with the lowest risk of dental caries. Low household income (incidence rate ratio [IRR] 1.57; confidence interval 95% [CI]: 1.35-1.82), low mother education (IRR 1.19; 95% CI: 1.03-1.38), toothache (IRR 1.73; 95% CI: 1.47-2.03), and poor self-perception of oral health (IRR 1.19; 95% CI: 1.07-1.32) were risk factors for untreated dental caries. In conclusion, our results showed that socioeconomic disadvantages and oral conditions in early adolescence are risk factors for untreated caries among adolescents.

Disparities in Caregiver-Reported Dental Cavities and Toothaches Among Children in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) Program.

Purpose: Dental caries is prevalent among low-income and minority children despite oral health promotion programs. The purpose of this study was to examine disparities associated with caregiver-reported cavities and toothaches among children in the United States aged 2-4 years by their eligibility for and participation in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) program.Methods: A secondary data analysis was performed using the 2016 National Survey of Children's Health (NSCH) data on children aged 2-4 years (n=7,719) with complete WIC participation information. Three groups were formed based on WIC eligibility and participation status: WIC participants, income-eligible non-participants, and higher-income non-participants. Caregiver-reported cavities and toothaches were compared by WIC eligibility and participation using chi-square tests and multivariate logistic regression analysis.Results: Among all children in the data set, 2,069 were WIC eligible, 49.8% of whom participated in WIC. Participants in WIC had higher reported cavities and toothaches (10.0% and 5.2%) than income-eligible, or higher-income non- WIC participating children (8.9% and 3.2%; 4.4% and 0.1%, respectively; p < 0.001). However, non-Hispanic, white WIC participants, had a higher proportion of reported cavities (14.0%) and toothaches (8.2%) than income-eligible non-participants (6.7% and 1.9%, respectively; p < 0.05). While non-Hispanic, black WIC participating children, had nearly 3.6 times more reported cavities than income-eligible nonparticipants (9.0% vs. 2.5%, p < 0.05).Conclusion: Caregiver-reported cavities and toothaches varied by sociodemographic characteristics within WIC participation and eligibility groups. These findings suggest that more research is warranted to explore factors that are contributing to oral health disparities associated with WIC eligibility and participation.

Associação entre dor dentária, uso de serviços odontológicos e absenteísmo escolar: Pesquisa Nacional de Saúde do Escolar 2015 / Asociación entre dolor dental, uso de servicios dentales y absentismo escolar: Encuesta Nacional de Salud Estudiantil, Brasil, 2015 / Association between dental pain, use of dental services and school absenteeism: 2015 National School Health Survey, Brazil

Objetivo: Analisar a associação entre dor dentária, uso de serviços odontológicos e absenteísmo escolar em adolescentes brasileiros. Métodos: Estudo transversal, sobre dados da Pesquisa Nacional de Saúde do Escolar (PeNSE 2015). A variável dependente do estudo foi o absenteísmo escolar por motivo de saúde nos últimos 12 meses. Características socioeconômicas, dor dentária e utilização de serviços odontológicos foram as variáveis independentes avaliadas. Empregou-se regressão logística, para estimar odds ratio (OR) e respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram incluídos 102.072 escolares. A prevalência de absenteísmo por motivo de saúde foi de 53,7% (IC95% 53,2;54,3). Pela análise ajustada, houve associação entre dor dentária e absenteísmo (OR=1,35 - IC95% 1,26;1,45), e aumento na ocorrência de absenteísmo conforme o maior número de consultas odontológicas. Conclusão: Os resultados sugerem que a dor dentária e a frequência de consultas odontológicas podem estar relacionadas ao absenteísmo escolar.

Objetivo: Analizar la asociación entre dolor dental, el uso de servicios dentales y el absentismo escolar en adolescentes brasileños. Métodos: Estudio transversal con datos de la Encuesta Nacional de Salud Escolar (PeNSE 2015). La variable dependiente del estudio fue el absentismo escolar por razones de salud en los últimos 12 meses. Características socioeconómicas, dolor dental y frecuencia del uso de los servicios dentales fueron las variables independientes evaluadas. La regresión logística se usó para estimar los odds ratio (OR) e intervalos de confianza del 95% (IC95%). Resultados: Se incluyeron datos de 102.072 estudiantes. La prevalencia de absentismo por razones de salud fue del 53,7% (IC95% 53,2; 54,3). En el análisis ajustado, hubo una asociación entre el dolor dental y el absentismo escolar (OR=1,35; - IC95% 1,26; 1,45), y un aumento del absentismo según el mayor número de consultas dentales. Conclusión: Los resultados sugieren que el dolor dental y la frecuencia de las visitas al dentista pueden estar relacionados con el absentismo escolar.

Objective: To analyze association between dental pain, use of dental services and school absenteeism in Brazilian adolescents. Methods: This was a cross-sectional study with data from the National School Health Survey (PeNSE 2015). The study's dependent variable was school absenteeism due to health reasons in the last 12 months. Socioeconomic characteristics, dental pain and use of dental services were the independent variables evaluated. Logistic regression was used to estimate odds ratios (OR) and respective 95% confidence intervals (95%CI). Results: Data on 102,072 schoolchildren were included. Absenteeism prevalence due to health reasons was 53.7% (95%CI 53.2;54.3). In the adjusted analysis, there was association between dental pain and school absenteeism (OR=1.35 - 95%CI 1.26;1.45), and an increase in absenteeism occurrence the greater the number of dental visits. Conclusion: The results suggest that dental pain and frequency of dental visits may be related to school absenteeism.

Impact of Oral Conditions and Subjective Factors on Academic Performance

ABSTRACT Objective: To evaluate the influence of oral health clinical and non-clinical indicators on adolescents' academic performance. Material and Methods: A longitudinal design was performed with a random sample of 1,134 12-year-old Brazilian adolescents. In 2012, the adolescents were clinically assessed by calibrated dentists and investigated about demographics, socioeconomic factors, dental service use, toothache, and verbal bullying related to oral condition via structured questionnaires. The contextual variable was obtained from the city's official database. After two years, 771 adolescents were reassessed. The outcome adolescent's academic performance (good or poor) was collected through official school's register. Multilevel logistic regression analyses were performed to assess associated factors for adolescents' academic performance. Results: Adolescents with toothache (OR 1.74; CI 95%: 1.05-2.89), who have been a victim of bullying (OR 2.23; CI 95%: 1.21-4.09), and were male (OR 1.92; CI 95%: 1.19-3.09) had a lower academic performance. On the other hand, adolescents whose mothers had higher educational levels (OR 1.79; CI 95%: 1.08-2.97) and belonged to higher-income households (OR 1.95; CI 95%: 1.18-3.23) had higher academic performance when compared to their peers. Conclusion: Adverse oral conditions, as well as subjective and socioeconomic factors, impacted on adolescents' academic performance.

Impact of oral health conditions on the quality of life of quilombola and non-quilombola rural adolescents in the countryside of Bahia, Brazil: a cross-sectional study.

BACKGROUND: This study aimed to estimate the prevalence of negative impacts of oral health conditions on the quality of life of quilombola and non-quilombola rural adolescents and identify associated factors. METHODS: This cross-sectional study was carried out in a rural area in the countryside of Bahia, Brazil, in 2015. Participants were asked to complete the Oral Impacts on Daily Performance Questionnaire. Prevalence and prevalence ratios (PR) were estimated together with their respective 95% confidence intervals. Multiple analysis was conducted using Poisson regression with robust error variance and hierarchical entry of variables. RESULTS: Of the 390 rural adolescents who took part in the study, 42.8% were quilombolas, and 45.6% of all participants reported a negative impact of their oral health conditions on their quality of life. The most prevalent impact was difficulty eating (32.6%). After adjusted analysis, the following factors were found to be associated with the negative impact of oral health conditions on quality of life: age (PR = 1.04), feeling lonely (PR = 1.42), worst evaluation of oral health (PR = 1.52), need of dental care (PR = 1.33), and occurrence of toothache in the last 6 months (PR = 1.83). Quilombolas and non-quilombolas presented with a different prevalence of discomfort when brushing their teeth and had different factors associated with the negative impact of oral health conditions on their quality of life. Both quilombola and non-quilombola rural adolescents showed a high prevalence of negative impact of oral health conditions on their quality of life. CONCLUSIONS: These results support the need for improved oral healthcare for specific populations like the quilombolas. Furthermore, the results illustrate the importance of incorporating oral healthcare strategies that take into consideration the sociocultural context of adolescents.

Odontogenic Infection and dental Pain negatively impact Schoolchildren's Quality of Life.

The aim of this study is to assess the prevalence of odontogenic infection in low-income Brazilian schoolchildren and evaluate its association with the subjective variables of oral health-related quality of life and dental pain. In this cross-sectional study, 230 schoolchildren aged eight to ten years old underwent a clinical oral survey in which the DMFT/dmft and PUFA/pufa indexes were measured. Afterward, children responded individually to the Child Perceptions Questionnaire (CPQ8-10) and self-reports of dental pain were collected. Data were statistically analyzed using MannWhitney or Kruskal-Wallis test with a post-test by Dunn's and Pearson correlation. Of the children evaluated, 42.6% had odontogenic infection and 80% reported experiencing dental pain. Children's age (p = 0.034) and past experience of dental pain (p < 0.002) were associated with odontogenic sepsis, in addition to impairment of their emotional well-being (p = 0.008), social welfare (p = 0.009) and overall impact on quality of life (p = 0.019). Toothache intensity (p < 0.001), frequency (p < 0.001) and duration (p < 0.001) were correlated to the overall impact on children's quality of life. The prevalence of odontogenic infection remains high among low-income Brazilian schoolchildren. Pediatric infection and its related pain induce not only various biological disorders but also impair children's self-perception of quality of life.

O objetivo deste estudo foi avaliar a prevalência de infecção odontogênica em crianças escolares brasileiras de baixa renda e analisar a sua associação com as variáveis subjetivas da autopercepção de qualidade de vida relacionada à saúde bucal e dor dentária. Neste estudo transversal, 230 crianças escolares com 8 a 10 anos de idade realizaram exame clínico bucal no qual os índices CPO-D/ceo-d e PUFA/pufa foram mensurados. Com isso, as crianças responderam individualmente ao Child Perceptions Questionnaire (CPQ8-10) e relatos de dor dentária foram coletados. Os dados foram estatisticamente analisados utilizando-se o teste Mann-Whitney ou Kruskal-Wallis, com posterior teste da correlação de Dunn e Pearson. Dentre as crianças examinadas, 42,6% apresentavam infecção odontogênica e 80% reportou experiência de dor dentária. A idade (p=0,034) e experiência de dor dentária (p<0,002) das crianças foram associadas à infecção odontogênica, bem como o seu bem-estar emocional (p=0,008) e social (p=0,009) e impacto geral na qualidade de vida (p=0,019). Além disso, a intensidade (p<0,001), frequência (p<0,001) e duração (p<0,001) da odontalgia foram correlacionadas com o impacto geral na qualidade de vida da criança. A prevalência de infecção odontogênica permanece elevada em crianças escolares brasileiras. Infecção pediátrica e sua dor relacionada induzem não apenas diversas desordens biológicas, mas também afetam negativamente a auto-percepção de qualidade de vida das crianças.

Odontogenic Infection and dental Pain negatively impact Schoolchildrens Quality of Life / Infecção odontogênica e odontalgia impactam negativamente a qualidade de vida de crianças escolares

ABSTRACT The aim of this study is to assess the prevalence of odontogenic infection in lowincome Brazilian schoolchildren and evaluate its association with the subjective variables of oral healthrelated quality of life and dental pain. In this crosssectional study, 230 schoolchildren aged eight to ten years old underwent a clinical oral survey in which the DMFT/dmft and PUFA/pufa indexes were measured. Afterward, children responded individually to the Child Perceptions Questionnaire (CPQ810) and selfreports of dental pain were collected. Data were statistically analyzed using MannWhitney or KruskalWallis test with a posttest by Dunn's and Pearson correlation. Of the children evaluated, 42.6% had odontogenic infection and 80% reported experiencing dental pain. Children's age (p = 0.034) and past experience of dental pain (p < 0.002) were associated with odontogenic sepsis, in addition to impairment of their emotional wellbeing (p = 0.008), social welfare (p = 0.009) and overall impact on quality of life (p = 0.019). Toothache intensity (p < 0.001), frequency (p < 0.001) and duration (p < 0.001) were correlated to the overall impact on children's quality of life. The prevalence of odontogenic infection remains high among lowincome Brazilian schoolchildren. Pediatric infection and its related pain induce not only various biological disorders but also impair children's selfperception of quality of life.

RESUMO O objetivo deste estudo foi avaliar a prevalência de infecção odontogênica em crianças escolares brasileiras de baixa renda e analisar a sua associação com as variáveis subjetivas da autopercepção de qualidade de vida relacionada à saúde bucal e dor dentária. Neste estudo transversal, 230 crianças escolares com 8 a 10 anos de idade realizaram exame clínico bucal no qual os índices CPOD/ ceod e PUFA/pufa foram mensurados. Com isso, as crianças responderam individualmente ao Child Perceptions Questionnaire (CPQ810) e relatos de dor dentária foram coletados. Os dados foram estatisticamente analisados utilizandose o teste MannWhitney ou KruskalWallis, com posterior teste da correlação de Dunn e Pearson. Dentre as crianças examinadas, 42,6% apresentavam infecção odontogênica e 80% reportou experiência de dor dentária. A idade (p=0,034) e experiência de dor dentária (p<0,002) das crianças foram associadas à infecção odontogênica, bem como o seu bemestar emocional (p=0,008) e social (p=0,009) e impacto geral na qualidade de vida (p=0,019). Além disso, a intensidade (p<0,001), frequência (p<0,001) e duração (p<0,001) da odontalgia foram correlacionadas com o impacto geral na qualidade de vida da criança. A prevalência de infecção odontogênica permanece elevada em crianças escolares brasileiras. Infecção pediátrica e sua dor relacionada induzem não apenas diversas desordens biológicas, mas também afetam negativamente a autopercepção de qualidade de vida das crianças.

Community pharmacy staff oral health training, training needs and professional self-efficacy related to managing children's dental problems.

OBJECTIVES: Few studies have explored the oral health training needs and professional self-efficacy (PSE) in both pharmacy support staff and pharmacists related to managing children's dental problems. This study assessed community pharmacy staff perceptions of their (i) training experiences and interests; (ii) PSE; and (iii) whether this was influenced by the pharmacy being part of a minor ailment scheme (MAS), where staff could directly offer advice and issue prescription medications without patients seeing a doctor. METHODS: All of the 1851 community pharmacies across London, UK, were invited to participate in an online questionnaire. Staff rated their prior training, perceived need for further training and confidence in giving parents advice related to three dental problems in children (dental pain, mouth ulcers and dental trauma). Information was collected about staff roles and whether the pharmacy was a MAS. KEY FINDINGS: From 752 community pharmacies, 846 community pharmacy staff participated. Positive experiences of training were variable but interest in further training for all three dental problems was high. Pharmacy support staff had significantly lower PSE scores than pharmacy professionals (P = 0.009). A significant interaction showed that pharmacy staff who had poorly rated prior training on advising parents about managing their child's dental pain and who did not work in a MAS had lower PSE scores than staff who had highly rated training and who worked in a MAS (P = 0.02). CONCLUSIONS: Minor ailment scheme pharmacies may be an optimal environment for frontline pharmacy support staff to develop higher PSE when combined with good quality oral health training.

Access to oral healthcare services of adolescents of a large-size municipality in northeastern Brazil.

The aim of this study was to describe and evaluate access to oral health services among adolescents enrolled in public schools of Campina Grande, Paraíba, Brazil, a large-size municipality in the Northeast of Brazil. An observational, descriptive, analytical, quantitative, and cross-sectional study was carried out through a school survey, in which four validated questionnaires were applied to 438 adolescents aged 12 to 19 years. Data were processed using the SPSS statistical software version 20.0, with bivariate analysis and multivariate analysis through Poisson regression. About 90.9% of adolescents reported having visited the dentist at least once; however, when considering the last 6 months, this percentage fell to 48.4%. Adolescents used private services (50.2%) or the public service (49.8%). About 70.6% of interviewees reported dental treatment (61.1%) as the main reason for seeking the service. Through multivariate analysis, it was observed that the demand for the service was higher among female adolescents (60.5%, p <0.001); the other variables did not present statistically significant differences. In conclusion, the access to oral healthcare services reported by adolescents was good, but there is still a considerable part of this population with no access. Variables that presented significant associated with dental services were gender and toothache history, but only gender remained significant in the multivariate model.

Assessment of the impact of toothache, untreated caries and its consequences on the quality of life among poor Brazilian children / Avaliação do impacto da dor de dente, da cárie não tratada e suas consequências na qualidade de vida de crianças brasileiras

Purpose: to evaluate the impact of dental pain and the consequences of untreated dental caries on the quality of life in children of low social-economic status aged from 8 to 10 years old. Materials and Methods: in this cross-sectional study, 230 children were submitted to a clinical examination in which the caries-pufa ratio was measured, afterward, they answered to two questionnaires: one about their quality of life (CPQ8-10) and the other about dental pain. Data were statistically analyzed through Chi-square, Mann-Whitney or Kruskal-Wallis tests to evaluate the association between the variables with impact on children's OHRQoL. To establish the existence of risk factors among variables and impact on OHRQoL a Poisson Regression model was applied. Results: dental caries (p = 0.003; PR 2.39; 95% CI 1.04­1.56), severity of untreated caries (p = 0.008; PR 2.86; 95% CI 1.13­2.00), toothache (p < 0.001; PR 2.31; 95% CI 1.64­3.27) and PUFA + pufa index (p < 0.023; PR 2.68; 95% CI 1.10­1.87) were associated with and were a predictor factor for impact on overall OHRQoL. All of these variables also had an effect over the social welfare subscale (p ≤ 0.001), whereas caries presence was also statistically linked with the emotional wellbeing subscale (p = 0.008) and dental pain with all four subscales (p ≤ 0.001). Conclusion: untreated dental caries' clinical consequences and dental pain exerted a negative influence on the quality of life of schoolchildren analyzed.(AU)

Objetivo: avaliar o impacto da dor de dente e das consequências da cárie não tratada na qualidade de vida de crianças entre 8 e 10 anos com baixos indicadores socioeconômicos. Métodos: neste estudo transversal, 230 crianças escolares foram submetidas a um exame clínico, no qual foram avaliados seus CPO/ceo (Dentes cariados, perdidos e obturados) e PUFA/pufa (Envolvimento pulpar, ulceração, fístula e abscesso). Em um segundo momento, elas responderam a dois questionários: um sobre a qualidade de vida (CPQ8-10) e outro sobre odontalgia. Os dados foram analisados estatisticamente por meio dos testes de Chi-quadrado, Mann-Whitney ou Kruskal-Wallis, para avaliar a associação entre as variáveis e o impacto na qualidade de vida relacionada à saúde oral (QdVRSO) da criança. Para estabelecer a existência de fatores de risco para impacto na QdVRSO entre as variáveis, um modelo de regressão de Poisson foi aplicado. Resultados: a presença de cárie (p = 0,003; RP 2,39; 95% IC 1,04-1,56), a severidade da cárie não tratada (p = 0,008; RP 2,86; 95% IC 1,13-2,00), dor de dente (p < 0,001; RP 2,31; 95% IC 1,64-3,27) e PUFA/pufa (p < 0,023; RP 2,68; 95% IC 1,10- 1,87) foram associados com impacto na QdVRSO, assim como também foram fatores preditores para o impacto na qualidade de vida relacionada à saúde oral. Todas as então citadas variáveis também exerceram efeito sobre a subescala do bem-estar social (p ≤ 0,001), enquanto a presença de cárie esteve estatisticamente conectada com a subescala do bem-estar emocional (p = 0,008) e a dor dentária com todas as subescalas da QdVRSO (p ≤ 0,001). Conclusão: as consequências clínicas da cárie não tratada e a dor dentária exercem uma influência negativa na qualidade de vida das crianças analisadas.(AU)

The influence of clinical and psychosocial characteristics on children behaviour during sequential dental visits: a longitudinal prospective assessment.

PURPOSE: This is the first study to adopt a multilevel approach to assess the impact of the order of dental visits on child's behaviour. The aim was to investigate which factors directly interfere with child's behaviour regardless of the order of sequential dental visits. METHODS: In this prospective longitudinal study, children aged 7-12 years were invited to participate. Child behaviour was assessed using the Frankl Scale during four sequential dental visits. Chi-square test was used to analyse the effect of dental fear on children's non-cooperative behaviour according to the presence of dental fear. Multilevel mixed logistic regression model was used to assess the association between predictor variables and the outcome (child behaviour) during the sequential dental visits. RESULTS: Overall, 111 children participated in this study. Maternal dental anxiety, dental pain and complexity of the treatment were associated with the non-cooperative behaviour in children aged 7-12 years. When stratified by dental fear, the complexity of the treatment remained associated with non-cooperative behaviour. CONCLUSIONS: The results provide evidence that, even with the familiarization of child with the dental environment, maternal dental anxiety, dental pain in the last month, and the complexity of dental treatment negatively affect the children's behaviour aged 7-12 years.

Access to oral healthcare services of adolescents of a large-size municipality in northeastern Brazil

Abstract: The aim of this study was to describe and evaluate access to oral health services among adolescents enrolled in public schools of Campina Grande, Paraíba, Brazil, a large-size municipality in the Northeast of Brazil. An observational, descriptive, analytical, quantitative, and cross-sectional study was carried out through a school survey, in which four validated questionnaires were applied to 438 adolescents aged 12 to 19 years. Data were processed using the SPSS statistical software version 20.0, with bivariate analysis and multivariate analysis through Poisson regression. About 90.9% of adolescents reported having visited the dentist at least once; however, when considering the last 6 months, this percentage fell to 48.4%. Adolescents used private services (50.2%) or the public service (49.8%). About 70.6% of interviewees reported dental treatment (61.1%) as the main reason for seeking the service. Through multivariate analysis, it was observed that the demand for the service was higher among female adolescents (60.5%, p <0.001); the other variables did not present statistically significant differences. In conclusion, the access to oral healthcare services reported by adolescents was good, but there is still a considerable part of this population with no access. Variables that presented significant associated with dental services were gender and toothache history, but only gender remained significant in the multivariate model.

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 gradients in toothache experience among Australian adults: A time trend analysis from 1994 to 2013.

OBJECTIVES: To identify time trend pattern in toothache and to estimate whether toothache prevalence differs by socioeconomic position and residential location over time. METHODS: Data from nine successive National Dental Telephone Interview Surveys (NDTIS) from 1994 (n = 6907) to 2013 (n = 6778) performed in Australia among individuals aged 15 years or over were used. The dependent variable was toothache reported very often, often or sometimes during the previous 12 months. Independent variables were age group, household income (tertiles), insurance/cardholder status and geographical remoteness. Prais-Winsten analyses were performed, and the average annual percentage change (AAPC) for toothache prevalence was estimated. RESULTS: Toothache affected slightly more than 10% of the overall population in 1994 (11.6%) and 1995 (11.4%), reaching approximately one-sixth (16.2%) of individuals in 2013. Overall, there was a significant increase in toothache prevalence over time (AAPC = 2.0% [95% CI 0.7;1.34]) and in those aged 25-44 (AAPC 2.1% [95% CI 0.6;3.6]) and 45-64 (AAPC 3.4% [95% CI 1.5;5.3]) years and markedly among those in the lowest income group (AAPC 3.4% [95% CI 0.1;6.7]). All geographic locations except for remote/very remote areas had upward toothache prevalence over time. Insured status was not associated with increased toothache prevalence during the investigated period. CONCLUSIONS: Toothache prevalence increased from 1994 to 2013 in Australian adults particularly among the lowest socioeconomic group.

A program review of a community-based oral health care program for socially vulnerable and underserved citizens in Denmark.

OBJECTIVES: To describe the oral health and oral health-related quality of life among social vulnerable adults enrolled in a special oral care program, and to evaluate the effect of oral care on their oral health-related quality of life. METHOD: Social workers identified social vulnerable persons in social centres and referred them to the program. Dental clinics were arranged including a well-motivated staff to be special responsive to these clients. The participants, (n = 235, mean age 43.5 years) with drug abuse, being homeless, permanently unemployed, or with mental problems were offered low-cost treatment services. Data collection was made by clinical registration and questionnaires. Oral health-related quality of life was measured by means of the Oral Health Impact Profile-14 index (OHIP-14). RESULTS: 94% of the participants had actual decayed teeth (mean 9.5). Forty-four per cent had not visited a dentist within 5 years and less than one-third reported tooth brushing twice a day, 17% even less frequent. One hundred and forty-six completed the dental program within the program period. Mean OHIP-14 score was 28.6 at baseline. Among those who fulfilled the program, the OHIP-14 score was reduced to 9.9 (p < .001). CONCLUSION: Oral health among the study population was very poor. However, oral problems in this group can be solved, and their oral health-related quality of life can be increased although it requires special arrangements and special clinical environment.

Self-Medication for Toothache and its Associated Factors in Children and Adolescents

Objective: To evaluate self-medication for toothache and its associated factors in children and adolescents. Material and Methods: A cross-sectional study was carried out with 252 children/adolescents aged 6-16 years. A questionnaire was applied with questions related to demographic and socioeconomic characteristics; experience of, and self-medication for, toothache; as well as aspects related to the condition. Descriptive and inferential statistical analyses (Pearson's Chi-square test and Fisher's exact test) were performed, with a 5% significance level. Results: The prevalence of toothache was 41.7%. In 96 cases analyzed, there was prevalence of 69.8% of self-medication for toothache. There were no statistically significant associations between self-medication for toothache and variables related to the children/adolescents (gender and age), their parents or guardians (age and schooling), socioeconomic characteristics (family income and number of people in the household) and aspects related to toothache (fever, crying and school absenteeism) (p>0.05). The most commonly used drug was paracetamol (60.7%), whose choice was based to its previous use by the study population for conditions not related to toothache (47.8%). Conclusion: There was a high prevalence of self-medication for toothache in the study population. No independent variable was associated with self-medication practice.

Impact of Untreated Dental Caries on Daily Performances of Children From Low Social Class in an Urban African Population: The Importance of Pain

Objective: To determine the impact of untreated dental caries on the oral health related quality of life (OHRQoL) of children from low social class in an urban Nigerian population. Material and Methods: The study was conducted among 6 to 15-year-old pupils from low social class in randomly selected primary schools in Ibadan. An interviewer-administered Child Oral Impact on Daily Performances (C-OIDP) questionnaire was used to obtain required information. Oral examination was conducted by calibrated examiners. Data obtained were analyzed with SPSS and test of association done with Mann-Whitney U and Chi-square tests. Results: A total of 1286 pupils participated in the study and 130 (10.1%) had untreated dental caries, out of which 26 (20.0%) had pain from carious tooth. The C-OIDP of children with dental caries was similar to that of children without caries [median 0.0 vs. median 0.0; r = -0.025; p=0.368]. The median COIDP (3.0) of those with untreated dental caries and pain was higher than that of participants with painless caries [0.0; r=-0.768; p<0.001]. There were significant impacts on all eight domains of the OHRQoL of those with untreated dental caries and pain (71.4 ­ 100.0%) when compared to those with painless caries (0.0 ­ 28.6%; p<0.05). Conclusion: Untreated dental caries significantly impacts on OHRQoL of pupils from low social class only when associated with pain.

Nondental orofacial pain in dental practices - diagnosis, therapy and self-assessment of German dentists and dental students.

BACKGROUND: Patients with non-dental orofacial pain syndromes will often primarily consult general dentists and other dental specialists. Early and correct diagnosis and therapy is crucial to prevent chronification. METHODS: We assessed the experience of dentists (general dentists and dental specialists; n = 533) and knowledge level of dental students (n = 130) on the diagnosis and treatment of non-dental orofacial pain. We used an anonymized survey containing 14 items with the four main themes (1) prescription patterns, (2) treatment strategies in non-dental orofacial pain, (3) interdisciplinary cooperation, and (4) self-assessment of knowledge as well as post-graduate education. RESULTS: Ninety-two percent of dental students stated that they feel either 'not at all' (56%) or only 'somewhat' (36%) prepared for the diagnosis or treatment of non-dental orofacial pain. Only 23% of the dentists reported 'good' or 'very good' confidence for the diagnosis of non-dental orofacial pain. NSAID were the analgesics of choice when the pain is unspecific (25%) or even neuralgic (10%). Dentists referred patients with non-dental orofacial pain mostly to ENT-physicians (59%), oral and maxillofacial surgeons (54%) or TMD specialists (51%). CONCLUSION: Interdisciplinary pain treatment seems to be well acknowledged, however, with a focus on referral within the community of dental specialists. Dental curricula and post-graduate trainings need to implement the diagnosis and treatment options of non-dental orofacial pain.