Genes and single nucleotide polymorphisms in the pathway of saliva and dental caries: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to investigate the influence of single nucleotide polymorphisms (SNPs), related to genes in salivary composition and flow, on dental caries experience. Sixteen studies were included in the systematic review and ten in the meta-analysis. Forty-four SNPS, covering four genes (CA6, AQP2, AQP5, and MUC5B) were identified. Most of the SNPs were not associated with caries in meta-analysis. Homozygous TT genotype of the SNP CA6 rs17032907(C/T) was associated with caries [OR = 3.23(1.39-7.49)]. The pool effect of the SNPs assessed in AQP5 was associated with a reduction in the likelihood of caries [OR = 0.75(0.59-0.95)]. Considering all SNPs of salivary composition and flow, the effect allele was associated with a 75% increase in the likelihood of caries [OR = 1.75(1.06-2.89)] in the homozygous genotype. The present findings showed that the genes in salivary composition and flow can play an important role in dental caries experience.

Validity of partial protocols to evaluate the prevalence of developmental defects of enamel in permanent dentition: a birth cohort study in Southern Brazil.

OBJECTIVES: To evaluate the validity of partial protocols (PP) to assess the prevalence of developmental defects of enamel (DDE) in permanent teeth and identify the strength of the association between DDE and some risk factors, using PP compared to the full-mouth (FM) exam. MATERIALS AND METHODS: This study was conducted in a population-based birth cohort of children born in 2004 in Pelotas, Southern Brazil. Socioeconomic, demographic, pre-, per-, and post-birth variables were collected. A subsample of 994 children was clinically examined for DDE in 2017, using the modified DDE index, using the "full- mouth" (FM) protocol. After FM had been performed, a dataset was created. Two different partial protocols (PP) were simulated from FM data: "only buccal surfaces (BS)" and "incisive and molars only (IM)." Sensitivity, absolute and relative bias, and inflation factors were calculated. RESULTS: For any DDE, FM had prevalence of 40.8%. The prevalence of DDE was 38.8% and 36.0%, for BS and IM protocols, respectively. When tested for any DDE, PP "BS" and "IM" showed high sensitivity. The underestimation of the true prevalence did not exceed 6.9% for PP "BS" and 16.1% for PP "IM." All protocols showed similar magnitude of association with the selected risk factors. CONCLUSION: Both PP "BS" and "IM" can be used to estimate the prevalence of DDE in epidemiological studies. CLINICAL RELEVANCE: Oral health surveys now have the option of using PP to collect DDE prevalence and investigate their association with risk factors, being less time-consuming, expensive, and labor intensive.

Is the effect of COVID-19 on periodontal treatment similar to that in general dental care and primary medical care? an observational study in Brazil.

The present study aimed to analyze the effect of the COVID-19 pandemic on the rates of periodontal procedures, and provide a comparison with general dental care and primary medical care procedures carried out in the Brazilian Public Health System. The study had an ecological, retrospective design with data from 5,564 Brazilian municipalities (99.9%). A multilevel mixed-effects linear regression was used to analyze the longitudinal associations between the COVID-19 pandemic and the rate of procedures. There was a significant reduction in the number of periodontal procedures (Coef. -428.6 [95%CI -774.3/-82.9]) during the COVID-19 pandemic, although this reduction was no greater than that of medical and general dental procedures. Medical procedures witnessed the sharpest drop in procedures (Coef. -2831.5 [95%CI -3964.1/-1699.0]). A lower rate of general dental procedures was also identified during the pandemic (Coef. -2,110.6 [95%CI -3,400.8/-820.4]). The COVID-19 pandemic has had a negative effect on the rate of periodontal procedures carried out in the Brazilian Public Health System. The highest recutions were observed in general dental and medical procedures.

A cross-sectional questionnaire study in a phototherapy unit during COVID-19.

BACKGROUND: In March 2020, social isolation measures were imposed in Brazil to contain the spread of the novel coronavirus (SARS-CoV-2), requiring health services to implement contingency plans. The main objective of the study was to verify the status of the disease, self-reported by patients who discontinued phototherapy, during a period of social isolation. METHODS: All patients receiving phototherapy at the Santa Casa de Porto Alegre, Brazil, prior to the implementation of social distancing measures were eligible for inclusion in the study. 86 patients answered a questionnaire during a medical evaluation. RESULTS: 95% of patients who stopped phototherapy reported a worsening of disease status. Only 19% of patients continued to attend phototherapy sessions during the social isolation period. CONCLUSION: The COVID-19 pandemic led most patients to stop phototherapy, resulting in the perception of increased disease severity in an outpatient sample in southern Brazil.

Single nucleotide polymorphisms of taste genes and caries: a systematic review and meta-analysis.

OBJECTIVE: The aim of the present study was to systematically review the literature investigating the single nucleotide polymorphisms (SNP) related to taste genes and their influence on caries. MATERIAL AND METHODS: Search was performed in five databases to respond to the question: 'Are the polymorphisms of taste genes associated with dental caries?'. Studies in humans were included. Assessment of quality of studies, meta-analysis and sensitivity analysis were performed. RESULTS: Seven studies were included in the systematic review and two in meta-analysis. Most of studies (71.4%) presented cohort design with low-level of evidence. A total of 4,032 individuals were evaluated. Four different taste genes (TAS1R2, TAS2R38, TAS1R3 and GLUT2) and 12 SNPs were reported. Most SNPs of taste genes showed a protective effect of the minor allele against dental caries. Meta-analysis included the SNP rs713598 placed in the TAS2R38 gene. The results suggest an effect of the heterozygote genotype (CG), which was associate with low caries experience (OR = 0.35 CI95% [0.17-0.75]). However, the genotype GG was not associated (OR = 0.17 CI95% [0.03-1.04]). Sensitivity analysis showed an important influence of one study in the results. CONCLUSIONS: SNP of taste genes seems to be associated with caries experience. Causal inferences should be interpreted with caution and the results must be replicated in different populations.

Genes and SNPs in the pathway of immune response and caries risk: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to pool the data on Single Nucleotide Polymorphisms (SNPs) in immune response genes associated with dental caries. Nineteen studies were included in the review and 18 in the meta-analysis. Twenty-two SNPs were evaluated, which are linked to six different genes (MBL2, LFT, MASP2, DEFB1, FCN2 and MUC5B). Most SNPs (81.8%) are related to the possible functional impact on protein coding. The MBL2 gene was associated with caries experience in the analysis of the homozygote (OR = 2.12 CI95%[1.12-3.99]) and heterozygote (OR = 2.22 CI95%[1.44-3.44]) genotypes. The MUC5B gene was associated according to an analysis of the heterozygous genotype (OR = 1.83 CI95%[1.08-3.09]). Thus, SNPs related to immune response genes are linked to the phenotype of caries experience. Although the meta-analysis showed that the genes MBL2 and MUC5B were associated with caries, these results should be interpreted with caution due to the quality of the evidence.

Complications and sequelae of concussion and subluxation in permanent teeth: A systematic review and meta-analysis.

BACKGROUND/AIM: The overall prognosis for teeth that have suffered concussion and/or subluxation is not yet known. The aim of this study was to systematically review the literature to identify the incidence of sequelae or complications associated with concussion and subluxation of permanent teeth. METHODS: Four databases were used as follows: PubMed, Web of Science, Scopus, and Lilacs. The search for studies was carried out up to March 31, 2019, to identify studies evaluating patients diagnosed with dental trauma classified as concussion or subluxation and reporting their respective sequelae and/or complications. No restrictions were made for gender, follow-up period, and the year of publication or language. The selection of studies and data extraction were carried out independently by two researchers. The studies were grouped according to the type of trauma. A random-effect model was applied to calculate the pooled odds ratios (OR) and their respective 95% confidence intervals for each type of trauma. RESULTS: Thirteen articles were included in the systematic review, and six were included in the meta-analysis. The pooled incidence of unfavorable outcomes (any sequel or complication) in teeth with concussion was 12% by the end of 1 year of follow up (0.12; CI95% 0.00-0.26). The pooled incidence of unfavorable outcomes in teeth with subluxation was 18% (0.18; CI95 % 0.07-0.29) by the end of 1 year of follow up. CONCLUSION: Concussion and subluxation showed sequelae and/or complications by the end of 1 year, including pulp necrosis. Patients who have suffered mild supportive tissue injuries should be monitored.

The role of asthma in caries occurrence - meta-analysis and meta-regression.

Objective: We aimed to conduct a systematic review of the literature regarding the association between asthma and caries, assess the effect of asthma on the occurrence of caries in primary and permanent dentitions, and determine factors that could affect the estimates of this association. Data source: We used the following databases: PubMed, Web of Science, SCOPUS, and LILACS/BVS, for the literature review. Study selection: We included observational studies that investigated the association between asthma and dental caries, excluding studies with syndromic patients, literature reviews, case reports, and in vitro and in situ studies. A meta-analysis was performed to estimate a pooled effect, and meta-regression was conducted to determine study factors that could affect the estimates. Results: From 674 studies initially identified, 40 fulfilled the inclusion criteria, and 36 of these were used in the meta-analysis. Odds ratio (OR) for the pooled effect was 1.45 (95% confidence interval (CI): 1.22-1.72; I2, 71.8%; p < 0.001) and 1.52 (95% CI: 1.34-1.73; I2, 83.1%; p < 0.001) for primary and permanent dentitions, respectively. In addition, a small proportion of the heterogeneity was attributed to included factors in the meta-regression (primary dentition, 10.7%; and permanent dentition, 3.1%). Conclusions: This study provides reliable and robust evidence that emphasizes the impact of asthma on the occurrence of dental caries in both, primary and permanent, dentitions. The findings provide useful data for recommending that dentists and physicians collaborate to establish the control for both diseases in a multidisciplinary manner.

Anxiety symptoms have a direct effect on oral health perception in young women.

PURPOSE: Assess the influence of anxiety symptoms on oral health related-quality of life in young women from a cohort study in Southern Brazil. METHODS: A sample of 535 young mothers were analyzed. Interviews and psychological evaluations were carried out by trained psychologists. The Brazilian version of the Corah's dental anxiety scale and the Beck anxiety inventory were used to evaluate dental anxiety and anxiety symptoms, respectively. The oral health-related quality of life (OHRQoL) was assessed by the Oral Impacts on Daily Performance instrument. Dental examinations were performed by trained dentists to assess oral health status (DMFT). The effect of anxiety symptoms on oral health-related quality of life was estimated using the parametric g-formula. RESULTS: The prevalence of negative impact on OHRQoL was of 46.3 and 28% of the women presented anxiety symptoms. Unadjusted analysis showed that women with anxiety symptoms had 2.5 higher impact on OHRQoL (OR 2.55; CI 95% 1.72-3.79). The parametric g-formula revealed that anxiety had a direct effect on oral health perception (OR 1.16; CI 95% 1.04-1.30), not mediated by dental anxiety. CONCLUSION: Oral health-related quality of life is influenced by anxiety symptoms, regardless of dental anxiety.

Oral health-related quality of life of schoolchildren: impact of clinical and psychosocial variables.

BACKGROUND: Besides the clinical aspects, the patient's perspective of oral health-related quality of life (OHRQoL) may be influenced by a series of individual characteristics. AIM: The aim was to investigate the impact of clinical and psychosocial variables on the OHRQoL of Brazilian schoolchildren. DESIGN: A school-based cross-sectional study was conducted with children of 8-10 year old attending public (15) and private (5) schools (n = 749). Questionnaires were applied to parents to obtain socioeconomic characteristics, and children were interviewed. Assessment of OHRQoL was performed using the Child Perceptions Questionnaire 8-10 (CPQ). Oral health examinations included periodontal condition, dental caries, dental trauma, and malocclusion assessment. Unadjusted analyses were undertaken using t-tests and one-way analysis of variance. Multiple linear regression was used to assess the effects of independent variables on CPQ scores. RESULTS: Factors associated with higher CPQ scores in the linear regression analysis after adjustments were family income, presence of decayed teeth, self-reported dental trauma, dental fear, and dental pain. CONCLUSION: Oral health-related quality of life was influenced by psychosocial and clinical variables.

Comparison of Wealth-Related Inequality in Tetanus Vaccination Coverage before and during Pregnancy: A Cross-Sectional Analysis of 72 Low- and Middle-Income Countries.

Immunization of pregnant women against tetanus is a key strategy for reducing tetanus morbidity and mortality while also achieving the goal of maternal and neonatal tetanus elimination. Despite substantial progress in improving newborn protection from tetanus at birth through maternal immunization, umbilical cord practices and sterilized and safe deliveries, inequitable gaps in protection remain. Notably, an infant's tetanus protection at birth is comprised of immunization received by the mother during and before the pregnancy (e.g., through childhood vaccination, booster doses, mass vaccination campaigns, or during prior pregnancies). In this work, we examine wealth-related inequalities in maternal tetanus toxoid containing vaccination coverage before pregnancy, during pregnancy, and at birth for 72 low- and middle-income countries with a recent Demographic and Health Survey or Multiple Indicator Cluster Survey (between 2013 and 2022). We summarize coverage levels and absolute and relative inequalities at each time point; compare the relative contributions of inequalities before and during pregnancy to inequalities at birth; and examine associations between inequalities and coverage levels. We present the findings for countries individually and on aggregate, by World Bank country income grouping, as well as by maternal and neonatal tetanus elimination status, finding that most of the inequality in tetanus immunization coverage at birth is introduced during pregnancy. Inequalities in coverage during pregnancy are most pronounced in low- and lower-middle-income countries, and even more so in countries which have not achieved maternal and neonatal tetanus elimination. These findings suggest that pregnancy is a key time of opportunity for equity-oriented interventions to improve maternal tetanus immunization coverage.

Gender Division of Housework and Intimate Partner Violence Among Mothers of Toddlers During the COVID-19 Pandemic: Findings from the 2019 Rio Grande (Brazil) Birth Cohort.

During the COVID-19 pandemic, we evaluated the association between gender division of housework and intimate partner violence (IPV) victimization in a population-based cohort of mothers. We collected data on psychological, physical, and sexual IPV using an adapted version of the World Health Organization Violence Against Women instrument and division of housework using a validated questionnaire. We used logistic regression to calculate adjusted odds ratios. We found that in mothers who reported an unequal gender division of housework (higher load), the odds of suffering psychological, physical, or sexual IPV were higher during the first and second years of the pandemic.

Child immunization status according to number of siblings and birth order in 85 low- and middle-income countries: a cross-sectional study.

Background: Identification of unvaccinated children is important for preventing deaths due to infections. Number of siblings and birth order have been postulated as risk factors for zero-dose prevalence. Methods: We analysed nationally representative cross-sectional surveys from 85 low and middle-income countries (2010-2020) with information on immunisation status of children aged 12-35 months. Zero-dose prevalence was defined as the failure to receive any doses of DPT (diphtheria-pertussis-tetanus) vaccine. We examined associations with birth order and the number of siblings, adjusting for child's sex, maternal age and education, household wealth quintiles and place of residence. Poisson regression was used to calculate zero-dose prevalence ratios. Findings: We studied 375,548 children, of whom 13.7% (n = 51,450) were classified as zero-dose. Prevalence increased monotonically with birth order and with the number of siblings, with prevalence increasing from 11.0% for firstborn children to 17.1% for birth order 5 or higher, and from 10.5% for children with no siblings to 17.2% for those with four or more siblings. Adjustment for confounders attenuated but did not eliminate these associations. The number of siblings remained as a strong risk factor when adjusted for confounders and birth order, but the reverse was not observed. Among children with the same number of siblings, there was no clear pattern in zero-dose prevalence by birth order; for instance, among children with two siblings, the prevalence was 13.0%, 14.7%, and 13.3% for firstborn, second, and third-born, respectively. Similar results were observed for girls and boys. 9513 families had two children aged 12-35 months. When the younger sibling was unvaccinated, 61.9% of the older siblings were also unvaccinated. On the other hand, when the younger sibling was vaccinated, only 5.9% of the older siblings were unvaccinated. Interpretation: The number of siblings is a better predictor than birth order in identifying children to be targeted by immunization campaigns. Zero-dose children tend to be clustered within families. Funding: Gavi, the Vaccine Alliance.

Contextual inequalities in specialized dental public health care in Brazil.

The present study aimed to investigate the contextual inequalities of specialized public dental care (SPDC) in Brazil. The outcome was the trajectory of dental specialized production in municipalities with SPDC (from 2015 to 2017) obtained by group-based trajectory modeling. A Poisson regression model was used to analyze the factors associated with the high trajectory of SPDC production. The inequality indicators for SPDC production were the slope index and the concentration index according to contextual factors. The study included 954 SPDC units distributed across 893 municipalities. Among the municipalities evaluated, 62.9% had a low trajectory of SPDC. Large-sized municipalities had the highest production (IRR = 2.84, 95%CI: 1.94-4.14) and the southern region had the lowest production (IRR = 0.73, 95%CI: 0.58-0.92). Municipalities presenting a very high human development index (HDI) showed the greatest SPDC production (IRR = 3.34, 95%CI: 1.09-10.24), as well as municipalities with the highest tertile of schooling rate (IRR = 1.23, 95%CI: 1.00-1.50). The absolute inequality was 52.1 percentage points for the average monthly wage (p < 0.001), 61.0 percentage points for the HDI (p < 0.001), -22.1 for infant mortality rate (p <0.001), and 14.8 for the schooling rate (p = 0.012). Thus, there are contextual inequalities in the Brazilian SPDC. Higher scores for social indicators were associated with better SPDC performance.

Socioeconomic inequalities related to maternal perception of children's oral health at age 4: Results of a birth cohort.

OBJECTIVES: To estimate socioeconomic inequalities in the maternal perception of children's oral health from a birth cohort study in Brazil. METHODS: The data from this study were collected through perinatal interviews and at the 48-month follow-up from the 2015 Pelotas Birth Cohort Study. The main outcome was the maternal perception of children's oral health, dichotomized into positive (good/very good) and negative (fair/bad/very bad). The secondary outcome was untreated dental caries (absence and presence, according to the ICDAS index - International Caries Detection and Assessment System). For the statistical analysis, the absolute inequality index (Slope Index of Inequality - SII) and the relative concentration index (Concentration Index - CIX) were used. Analyses were stratified by maternal educational level, family income and wealth index. RESULTS: The prevalence of outcomes was 19.4% (95% CI 18.2; 20.7) for the negative maternal perception of children's oral health and 15.6% (95% CI 14.4; 16.8) for untreated dental caries. Socioeconomics inequalities were observed in negative maternal perception of children's oral health in both absolute and relative terms. A SII of -16.6 (95% CI -20.8; -12.5) was observed for family income, with higher prevalence in poor families. A higher prevalence of the negative maternal perception of children's oral health was observed in mothers without any educational level or a few years of study (CIX -21.1 [95% CI -24.5; -17.7]). CONCLUSIONS: This study demonstrates socioeconomics disparities in the maternal perception of children's oral health and in the prevalence of untreated caries in children. A higher concentration of negative maternal perception of children's oral health was identified among the most socioeconomically vulnerable individuals. The findings reinforce the presence of socioeconomic inequalities in subjective measures about children's oral health.

Development of an online course for caregivers of older stroke patients.

OBJECTIVE: To describe the development process of a massive, open, and online course for family caregivers of older people who had a medically diagnosed stroke. METHOD: Experience report on the development of a massive, open, and online course. The preparation of the course took place from July 2021 to October 2022 and consisted of the stages:definition and analysis of the contents of the course; construction and approval of the storyboard; digital construction and approval of the early version; making the project available on a digital platform; preliminary evaluation and approval of the final version. RESULTS: The course aims to provide tools for the family care of older people who have suffered a stroke, improving their ability to provide care. It was built in twelve modules, using demonstrative videos, hypertext, pictures, and narrations. CONCLUSION: The course development process required a team with expertise in different areas and had a positive preliminary assessment.

Association among oral health and academic performance: a longitudinal study in a university in Southern Brazil.

This longitudinal study aimed to investigate the association between self-perceived oral health, oral-health-related quality-of-life (OHRQoL), toothache, and university students' academic performance or dropout. A cohort of 2,089 students from 64 different courses at a public university in southern Brazil was interviewed in 2016 regarding their self-perceived oral health (Locker instrument; dichotomized into good/poor), OHRQoL (Oral Impacts on Daily Performances instrument, OIDP) and having had any toothache over the last 6 months (yes/no). After three years (2020), the academic records of 1,870 of these students were assessed, their average grade over all courses evaluated, and their dropout status was determined. Multivariable linear or logistic regression adjusting for gender, skin color, age, family income and maternal education was used to associate oral health variables (self-perceived oral health, OIDP, toothache) and academic performance or dropout. In 2016, 28.6% reported negative self-perceived oral health through the Locker instrument and 31.4% had toothache in the last 6 months. Over the next three years, 36.2% had dropped out. In multivariable regression, toothache in the last 6 months had a decrease of 0.32 (ß -0.32, CI95% -0.59; -0.04) points in the final grade and were 35% (OR 1.35 CI95% 1.08; 1.69) more likely to dropout than students without toothache. In conclusion, this study showed that worse oral health conditions may be associated with worse academic performance or dropping out.

Association Involving Possible Sleep Bruxism, Stress, and Depressive Symptoms in Brazilian University Students: A Cross-sectional Study.

The aim of the present study was to examine the association regarding sleep bruxism (SB), depression, and stress in Brazilian university students. We conducted a cross-sectional study with a large-sample of university students ( n = 2,089) in the city of Pelotas, Rio Grande do Sul, Southern Brazil. A self-administered questionnaire was sent to classrooms to evaluate socioeconomic and demographic characteristics. Possible SB was detected by self-report according to the International Consensus on The Assessment of Bruxism Criteria (2018). The Patient Health Questionnaire-9 and the Perceived Stress Scale were used to assess depression and stress symptoms respectively. Crude and adjusted Poisson regression analyses were performed. The prevalence of possible SB, high level of stress, and depressive symptoms in the sample were of 20.4%, 16.6%, and 16.6% respectively. Stress in female students was significantly associated with an increased prevalence of possible SB, but not in male students. Regarding depression, the prevalence of SB was 28% higher in students with depressive symptoms. Students with stress or depression had a 35% higher prevalence of SB than those without any symptoms. Conclusion The findings have shown that university students with stress and depressive symptoms were more likely to be detected with possible SB.