How different attributes are weighted in professionals' decision-making in Pediatric Dentistry-a protocol for guiding discrete choice experiment focused on shortening the evidence-based practice implementation for dental care.

BACKGROUND: Important evidence has been constantly produced and needs to be converted into practice. Professional consumption of such evidence may be a barrier to its implementation. Then, effective implementation of evidence-based interventions in clinical practice leans on the understanding of how professionals value attributes when choosing between options for dental care, permitting to guide this implementation process by maximizing strengthens and minimizing barriers related to that. METHODS: This is part of a broader project investigating the potential of incorporating scientific evidence into clinical practice and public policy recommendations and guidelines, identifying strengths and barriers in such an implementation process. The present research protocol comprises a Discrete Choice Experiment (DCE) from the Brazilian oral health professionals' perspective, aiming to assess how different factors are associated with professional decision-making in dental care, including the role of scientific evidence. Different choice sets will be developed, either focusing on understanding the role of scientific evidence in the professional decision-making process or on understanding specific attributes associated with different interventions recently tested in randomized clinical trials and available as newly produced scientific evidence to be used in clinical practice. DISCUSSION: Translating research into practice usually requires time and effort. Shortening this process may be useful for faster incorporation into clinical practice and beneficial to the population. Understanding the context and professionals' decision-making preferences is crucial to designing more effective implementation and/or educational initiatives. Ultimately, we expect to design an efficient implementation strategy that overcomes threats and potential opportunities identified during the DCEs, creating a customized structure for dental professionals. TRIAL REGISTRATION: https://osf.io/bhncv .

Economic evaluation of fluoride varnish application in preschoolers: A systematic review.

BACKGROUND: Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations. AIM: To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers. DESIGN: We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools. RESULTS: Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost-effectiveness studies were included: five modeling and three within-trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost-effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost-effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost-effectiveness. CONCLUSION: We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost-effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/).

Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses.

BACKGROUND: Dental anxiety (DA) negatively impacts oral health-related quality of life, and patients with DA usually require more dental treatment time. AIM: To describe the global prevalence of DA in children and adolescents and to examine the influence of individual factors (age, sex, and caries experience) and variables related to DA measurement on pooled prevalence. DESIGN: Systematic review with meta-analyses of observational studies published between 1985 and 2020 (PROSPERO CRD42014013879). RESULTS: Searches yielded 1207 unique records; 224 full-text articles were screened, and 50 studies were used in the qualitative and quantitative synthesis. No study was considered as having high methodological quality according to 'The Joanna Briggs Institute assessment tool'. Overall pooled DA prevalence was 23.9% (95% CI 20.4, 27.3). Pooled prevalence in preschoolers, schoolchildren, and adolescents was as follows: 36.5% (95% CI 23.8, 49.2), 25.8% (95% CI 19.5, 32.1), and 13.3% (95% CI 9.5, 17.0), respectively. DA was significantly more prevalent in preschool children (one study) and schoolchildren (two studies) with caries experience and in female adolescents (one study). The scale used for DA assessment was shown to influence pooled prevalence in preschoolers and adolescents. CONCLUSION: DA is a frequent problem in 3- to 18-year-olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents.

The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis.

OBJECTIVES: To investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments. METHODS: Systematic review (CRD42016036963) of controlled clinical trials. Searches were performed in 9 electronic databases, 5 registers of ongoing trials, and reference lists of identified review articles. Two researchers carried out data extraction and quality appraisal independently. The primary outcome was the difference in caries increment (decayed, missing, and filled surfaces or teeth - dmfs or dmft) between SDF and control groups. These differences were pooled as weighted mean differences (WMD) and prevented fractions (PF). RESULTS: Searches yielded 2,366 unique records; 6 reports of 4 trials that randomized 1,118 and analyzed 915 participants were included. Two trials compared SDF to no treatment, 1 compared SDF to placebo and sodium fluoride varnish (FV), and 1 compared SDF to high-viscosity glass ionomer cement (GIC). All studies had at least 1 domain with unclear or high risk of bias. After 24 months of follow-up, in comparison to placebo, no treatment, and FV, SDF applications significantly reduced the development of new dentin caries lesions (placebo or no treatment: WMD = -1.15, PF = 77.5%; FV: WMD = -0.43, PF = 54.0%). GIC was more effective than SDF after 12 months of follow-up but the difference between them was not statistically significant (WMD, dmft: 0.34, PF: -6.09%). CONCLUSION: When applied to caries lesions in primary teeth, SDF compared to no treatment, placebo or FV appears to effectively prevent dental caries in the entire dentition. However, trials specifically designed to assess this outcome are needed.

Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis.

The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was -0.30 (95% CI -0.69, 0.09) and at the surface level -0.77 (95% CI -1.23, -0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services.

A systematic review of the effects of supervised toothbrushing on caries incidence in children and adolescents.

BACKGROUND: The anticaries effect of supervised toothbrushing, irrespective of the effect of fluoride toothpaste, has not been clearly determined yet. AIM: To assess the effects of supervised toothbrushing on caries incidence in children and adolescents. DESIGN: A systematic review of controlled trials was performed (CRD42014013879). Electronic and hand searches retrieved 2046 records, 112 of which were read in full and independently assessed by two reviewers, who collected data regarding characteristics of participants, interventions, outcomes, length of follow-up and risk of bias. RESULTS: Four trials were included and none of them had low risk of bias. They were all carried out in schools, but there was great variation regarding children's age, fluoride content of the toothpaste, baseline caries levels and the way caries incidence was reported. Among the four trials, two found statistically significant differences favouring supervised toothbrushing, but information about the magnitude and/or the precision of the effect estimate was lacking and in one trial clustering effect was not taken into consideration. No meta-analysis was performed due to the clinical heterogeneity among the included studies and differences in the reporting of data. CONCLUSIONS: There is no conclusive evidence regarding the effectiveness of supervised toothbrushing on caries incidence.

Is the Neonatal Tongue Screening Test a valid and reliable tool for detecting ankyloglossia in newborns?

BACKGROUND: Although there is a lack of strong evidence for the association between ankyloglossia in newborns and impaired breastfeeding, screening for ankyloglossia using the Neonatal Tongue Screening Test (NTST) is mandated by law in Brazilian maternities. AIM: To assess the reliability and validity of the NTST. DESIGN: cohort study; baseline sample comprised 268 mother-newborn dyads. At follow-up, 169 mothers were contacted by telephone. Interviews with the mothers for data collection were performed up to 48 h and at 1-3 months after childbirth. Trained and calibrated personnel performed the oral examinations of the newborns. Thirty newborns were examined for inter-reproducibility assessment. RESULTS: Of the 268 newborns included, 212 had a lingual frenulum that could be visually inspected and their NTST scores ranged from zero to nine (mean = 2.0, ±2.0). Interexaminer reproducibility was acceptable (Intraclass correlation coefficient = 0.77). Internal consistency of the NTST was poor (Cronbach's alpha = 0.28). Construct validity was investigated through the association between NTST scores and difficulties in breastfeeding at baseline and follow-up, and infants' weight gain at follow-up (mean age 32 ± 6.7 days). No statistically significant associations were found. CONCLUSION: NTST is neither reliable nor valid for detecting ankyloglossia that may interfere with breastfeeding in newborns.

Oral health-related quality of life changes in patients with severe Class III malocclusion treated with the 2-jaw surgery-first approach.

INTRODUCTION: In this nonrandomized prospective study, we compared the effects of the surgery-first approach with conventional 2-jaw orthognathic surgery on skeletal Class III patients' oral health-related quality of life (OHRQoL), quality of the orthodontic outcome, and average treatment duration. METHODS: The sample consisted of 16 patients with severe skeletal Class III malocclusion, who needed 2-jaw orthognathic surgery: 8 were treated with the surgery-first approach, and 8 were treated with the traditional orthodontic-surgical approach. OHRQoL was assessed by using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Oral Health Impact Profile-short version (OHIP-14). Malocclusion severity and esthetic self-perception were assessed with the Index of Orthodontic Treatment Need. Dental health status was determined using the Decayed, Missing and Filled Teeth Index. Tests were repeated at 7 times: baseline, 1 month after appliance placement, and 3 months, 6 months, 1 year, and 2 years after the beginning of the treatment; and for both groups, there was an also evaluation stage after the orthognathic surgery. RESULTS: After 2 years, the surgery-first group showed a significant decrease in malocclusion severity (P <0.001) and had significant reductions in OQLQ (P <0.001) and OHIP-14 scores (P <0.001). These changes began after the orthognathic surgery and were progressive throughout the evaluation periods. In the traditional orthodontic-surgical approach group, after 2 years of monitoring, all patients were still in the preoperative orthodontic preparation phase, and their malocclusion severity increased significantly, thereby resulting in a not statistically significant worsening of their OHRQoL (OHIP-14, P = 0.89; OQLQ, P = 0.11). CONCLUSIONS: OHRQoL improved significantly in a linear trend of progressive improvements in all severe Class III patients who had the surgery-first approach after the surgical procedure through 2 years of follow-up, as their malocclusion and esthetic self-perception also improved.

Semiannual Fluoride Applications in Low-Risk Toddlers May Not Be More Effective Than Toothbrushing Instruction and Dietary Counseling in Controlling Dental Caries.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effectiveness of early preventive intervention with semiannual fluoride varnish application in toddlers living in high-risk areas: A stratified cluster-randomized controlled trial. Anderson M, Dahlöf G, Twetman S, Jansson L, Bergenlid AC, Grindefjord M. Caries Res 2016;50(1):17-23. SOURCE OF FUNDING: The study was commissioned and supported by Stockholm County Council and Karolinska Institutet. TYPE OF STUDY/DESIGN: Non-blinded, cluster-randomized controlled field trial with two parallel arms.

Psychometric properties of the Brazilian version of the Orthognathic Quality of Life Questionnaire.

PURPOSE: To assess the construct validity and reliability of the Brazilian version of the Orthognathic Quality of Life Questionnaire (B-OQLQ). MATERIALS AND METHODS: A cross-sectional study was performed, and 101 patients in need of orthodontic-surgical treatment were recruited at a public hospital (Hospital Universitário Pedro Ernesto) and a public dental school (Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro). The B-OQLQ was self-completed. The mean age of the participants was 26.51 ± 9.25 years, and most were female (58.42%; n = 59). The construct validity was assessed using Spearman's correlation coefficient between the B-OQLQ and the Oral Health Impact Profile (OHIP-14) scores and between the B-OQLQ and subjective health indicators' scores. The reliability was assessed in terms of internal consistency and stability (test-retest) using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. RESULTS: Significant correlations were found between the B-OQLQ scores and the following: OHIP-14 total score (rs = 0.70, P < .001), perception of oral health (rs = -0.24, P = .02), single-item evaluation of quality of life (rs = -0.29, P = .03), satisfaction with physical appearance (rs = -0.40, P < .001), and satisfaction with facial appearance (rs = -0.39, P = .0001). Cronbach's alpha and the ICC was 0.95 and 0.90, respectively. The domains of B-OQLQ causing the most effect on the quality of life included "social aspects of deformity" (13.0 ± 10.54) and "facial aesthetics" (11.81 ± 6.23). CONCLUSIONS: The Brazilian version of the OQLQ was shown to be valid and reliable with good psychometric properties and might thus be considered an appropriate tool to assess the effect of dentofacial deformities on the quality of life of individuals with this condition.

Influence of orthodontic treatment on adolescents' self-perceptions of esthetics.

INTRODUCTION: The aim of this prospective evaluation was to assess changes in esthetic self-perception of Brazilian adolescents who were receiving fixed orthodontic treatment during a 2-year period. METHODS: The treatment group consisted of 92 patients, ages 12 to 15 years, treated at the Rio de Janeiro State University orthodontic clinic. The control group consisted of 226 untreated adolescents; 124 subjects were waiting for treatment at this clinic, and 102 subjects were attending public school and had never undergone or sought treatment. The index of orthodontic treatment need was used to assess malocclusion severity, esthetic status (measured by an orthodontist), and esthetic self-perception. All subjects were interviewed 3 times during the study: at baseline; 1 year after placement of the fixed appliance for the treatment group and 1 year after the first interview for the school and waiting groups; and 2 years after placement of the fixed appliance for the treatment group and 2 years after the first interview for the school and waiting groups. The index of orthodontic treatment need scores were analyzed by using negative binomial regression in generalized estimating equations for correlated data. RESULTS: During the follow-up period, the treatment group's esthetic self-perception scores had a statistically significant decrease (P <0.01), the waiting group's scores had an increase (P = 0.08), and the school group's scores were stable (P = 0.79). At baseline, the treatment group had an esthetic self-perception score of 96% (risk ratio = 1.96; 95% confidence interval, 1.70-2.26) higher than the school group, but at the final interview, the treatment group's score was 20% lower (risk ratio = 0.81; 95% confidence interval, 0.68-0.96) than the initial score of the school group. Age; sex; the index of decayed, missing, and filled teeth; and socioeconomic position did not affect the adolescents' esthetic self-perceptions at follow up, but malocclusion severity and the group had a significant interaction. CONCLUSIONS: Fixed orthodontic treatment in patients 12 to 15 years of age significantly improved their esthetic self-perceptions.

How does orthodontic treatment affect young adults' oral health-related quality of life?

INTRODUCTION: Studies in the dental literature do not yet provide conclusive evidence for the functional and psychosocial benefits of orthodontic treatment. In this cross-sectional study, we aimed to assess the oral health-related quality of life of young Brazilian adults, aged 18 to 30 years, who had completed orthodontic treatment compared with untreated subjects waiting for treatment. METHODS: The subjects were recruited at a state-funded university clinic. The sample comprised 100 patients in the retention phase of orthodontic treatment for more than 6 months (treated group) and 100 persons who were seeking orthodontic treatment and were still on a waiting list (nontreated group). Data were collected by using the oral health impact profile, the index of orthodontic treatment need (malocclusion severity and esthetic impairment), the Brazilian economic classification criteria (socioeconomic status), and the index of decayed, missing, and filled teeth (oral health status). Statistical analyses were performed by using chi-square and Fisher exact tests and negative binomial regression. RESULTS: The mean oral health impact profile scores were 3.1 (SD ± 2.99) and 15.1 (SD ± 8.02) in the treated and nontreated groups, respectively. The most frequent impacts in the treated and nontreated groups were "painful aching" and "been self-conscious," respectively. Comparisons between the groups were controlled for malocclusion severity, clinician-assessed esthetic impairment, age, sex, socioeconomic status, and oral health status. Nontreated young adults had mean oral health impact profile scores 5.3 times higher than did the treated subjects. CONCLUSIONS: Young Brazilian adults who received orthodontic treatment had significantly better oral health-related quality of life scores in the retention phase, after treatment completion, than did nontreated subjects.

Oral manifestations of congenital Zika virus infection in children with microcephaly: 18-month follow-up case series.

AIMS: To describe oral manifestations in children born with microcephaly attributed to congenital Zika virus syndrome (CZS). METHODS: Data was collected in semiannual intervals from 2017 to 2019, by oral exams of the children and interview with caregivers at a Public Dental Center in Rio de Janeiro, Brazil. A single calibrated examiner performed clinical examinations. RESULTS: Of 38 eligible children, 34 were followed-up from 12 to 30 months of age, 20 boys and 14 girls. The mean age of emergence of their first primary tooth was 12.4 months (SD = 2.9). By 30 months of age only 14.7% (n = 5) had complete primary dentition. Alteration in the sequence of tooth emergence was observed in 41.1% (n = 14). Radiographic examination demonstrated dental agenesis (14.7% n = 5). Dental developmental alterations (38.2%, n = 13), enamel defects (14.7%, n = 5), eruption cysts/hematoma (23.5%, n = 8), gingival bleeding (55.8%, n = 19), narrow palate, and bruxism (64.7%, n = 22) were also observed. No child had dental caries. CONCLUSION: Children with microcephaly attributed to CZS presented oral manifestations early in life.

Validation of the brazilian version of the oral health impact profile - Aesthetic questionnaire.

The aim of the study was to develop the Brazilian version of the Oral Health Impact Profile - Aesthetic Questionnaire (OHIP-Aes-Braz) and test its psychometric properties. The questionnaire test versions were developed by a panel of experts and a pre-test was conducted in a focus group. Data used for testing its psychometric properties were obtained from a randomized controlled clinical trial on tooth bleaching. Seventy-nine Brazilian adults were included. The questionnaires were applied before tooth bleaching treatment (baseline), one week (T1), and one month after the intervention (T2). Reliability was assessed in terms of internal consistency and stability, while validity was ascertained by criterion and construct validity. The sensitivity to change was assessed comparing the total scores at baseline and T2, using the Wilcoxon test (α = 0.05). Both stability and internal consistency (intra-class correlation coefficient=0.95, Cronbach's α = 0.92) proved to be adequate. Construct validity was confirmed as the correlation between OHIP-Aes-Braz scores with tooth color satisfaction and self-perceived oral health were in the expected direction. A positive correlation between OHIP-Aes-Braz and OHIP-14 (rs=0.63) and OIDP (rs=0.77) was observed. The instrument was responsive once differences in total scores before and after treatment were statistically significant (p<0.001). The OHIP-Aes-Braz presented good psychometric properties and showed sensitivity to change regarding aesthetics evaluation in Brazilian adults treated with tooth bleaching. A valid and reliable instrument allows a suitable assessment of oral health-related quality of life in Brazilian patients submitted to aesthetics dental interventions.

Inconsistencies in recommendations on oral hygiene practices for children by professional dental and paediatric organisations in ten countries.

BACKGROUND: Some of the basic dental health practices that are recommended to the public by professionals are not evidence based. Incorrect oral health messages may adversely affect children's oral health behaviours. AIM: To identify and list the recommendations concerning children's oral hygiene practices provided by dental and paediatric organisations, and to assess how these recommendations relate to the scientific evidence currently available. DESIGN: Cross-sectional. The authors contacted professional organisations in ten countries requesting items (brochures, leaflets or folders) containing messages on children's oral hygiene practices. They then listed these recommendations and assessed how they related to scientific evidence obtained from systematic reviews available at PubMed and the Cochrane Library. RESULTS: Fifty-two of 59 (88%) organisations responded to our request and 24 dental health education materials were submitted to the authors. They mentioned recommendations on oral hygiene practices for children, such as toothbrushing frequency, supervision and technique; when to start and how long toothbrushing should last; toothbrush design and replacement; flossing; gums/teeth wiping; tongue cleaning; type and amount of toothpaste and advice on toothpaste ingestion. The search at PubMed and the Cochrane Library resulted in 11 systematic reviews addressing these topics. CONCLUSIONS: Several oral hygiene messages delivered by professional organisations showed inconsistencies and lacked scientific support.

Psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS).

BACKGROUND: Oral disorders can have a negative impact on the functional, social and psychological wellbeing of young children and their families and cause pain/discomfort for the child. Oral health-related quality of life (OHRQoL) has emerged as an important health outcome in clinical trials and healthcare research. The Early Childhood Oral Health Impact Scale (ECOHIS) is a proxy measure of children's OHRQoL designed to assess the negative impact of oral disorders on the quality of life of preschool children. The objective of this study was to evaluate the psychometric properties of the Brazilian version of the ECOHIS (B-ECOHIS). METHODS: This investigation was carried out in preliminary and field studies. The preliminary study comprised a cross-sectional study carried out in the city of Petropolis, Brazil. A sample of 150 children from two to five years of age was recruited at a public hospital. In the field study, an epidemiological survey was carried out in public and private preschools of Belo Horizonte, Brazil. The B-ECOHIS was answered by 1643 parents/caregivers of five-year-old male and female preschool children. In both phases, oral examinations were performed by a single previously calibrated dentist. Reliability was determined through test-retest reliability and internal consistency. Validity was determined through convergent and discriminant validities. The correlation between the scores obtained on the child and family impact sections was assessed. RESULTS: In the preliminary (P) and field (F) study, test-retest reliability correlation values were 0.98 and 0.99 for the child impact section and 0.97 and 0.99 for the family impact section, respectively. The B-ECOHIS demonstrated internal consistency: child impact section (P: α = 0.74; F: α = 0.80) and family impact section (P: α = 0.59; F: α = 0.76). The correlation between the scores obtained on the child and family impact sections was statistically significant (P: rs = 0.54; F: rs = 0.62; p ≤ 0.001). In both phases of the study, B-ECOHIS scores were significantly associated with the decayed, missing and filled teeth index, decayed teeth and discolored upper anterior teeth (p < 0.05). CONCLUSION: The B-ECOHIS proved reliable and valid for assessing the negative impact of oral disorders on the quality of life of preschool children.

Information-seeking behaviors and barriers to the incorporation of scientific evidence into clinical practice: A survey with Brazilian dentists.

The aim of this online cross-sectional study is to identify the sources of scientific information used by Brazilian dentists in clinical decision-making and the barriers that they perceive as important to the incorporation of scientific evidence into clinical practice. A pretested questionnaire created in Google Forms which was made available to participants through links sent by e-mail or shared on Facebook® and Instagram® was used to collect the data between October 2018 and May 2019. Only dentists who were involved in direct or indirect care of patients (i.e. clinicians who performed dental procedures or dental educators who participated in the clinical training of graduate or postgraduate dental students) were asked to complete the questionnaire. The sample was comprised of 528 dentists (the response rate from the alumni database was 6.9%); their mean age was 45.2 years (±12.5) and 30.9% had an academic position. The majority were women (68.0%) and lived in Southern or Southeastern Brazil (96.0%). The sources of scientific information more frequently used by them in clinical decision-making were clinical guidelines (65.1%; 95% CI: 60.9, 69.2), scientific articles (56.8%; 95%CI: 52.5, 61.1) and bibliographic databases (48.3%; 95% CI: 43.9, 52.6). The information resource less frequently used was social media. The most important barriers to the clinical use of scientific evidence were: difficulty in determining whether scientific contents found on the Internet were reliable or not (41.8%; 95% CI: 37.6, 46.2), high cost of access to scientific papers (37.7%; 95% CI: 33.5, 41.9), and lack of time for reading scientific articles (32.4%; 95% CI: 28.4, 36.6). Although Brazilian dentists show a positive attitude towards obtaining scientific evidence from reliable sources, there still remain important barriers to the translation of evidence into practice. This can have significant implications for quality of care and should be further investigated.

Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus.

Dental caries can be effectively managed and prevented from developing into cavitated lesions while preserving tooth structure at all levels. However, the strong correlation between caries and socioeconomic factors may compromise the efficacy of preventive strategies. The high prevalence of persistent inequalities in dental caries in Latin American and Caribbean countries (LACC) is a matter of concern. The estimates of the burden of disease in some countries in this region are outdated or absent. This paper aims to summarize and present the final recommendations of a regional Consensus for Dental Caries Prevalence, Prospects, and Challenges for LACC. This consensus is based on four articles that were written by a team of Latin American experts, reviewed by dental associations, and presented and discussed in two consensus events. The following domains were explored: epidemiology, risk factors, prevention strategies, and management of dental caries with a focus on restorative procedures. Dental caries can manifest throughout the lifespan of an individual, making it a matter of concern for infants, children, adults, and older people alike. The prevalence rates of untreated caries in deciduous and permanent teeth are high in many parts of the world, including LACCs. Previous evidence suggests that the prevalence of dental caries in 12-year-olds is moderate to high in most Latin American countries. Moreover, the prevalence of treatment needs and dental caries in the adult and elderly population can also be regarded as high in this region. The risk/protective factors (e.g., sugar consumption, exposure to fluoride, and oral hygiene) probably operate similarly in all LACCs, although variations in the interplay of these factors in some countries and within the same country cannot be ruled out. Although salt and water fluoridation programs are implemented in many countries, there is a need for implementation of a surveillance policy. There is also room for improvement with regard to the introduction of minimal intervention techniques in practice and public health programs. Dental caries is a marker of social disadvantage, and oral health promotion programs and interventions aimed at reducing the burden of dental caries in LACCs must consider the complexity of the socioeconomic dynamics in this region. There is an urgent need to promote engagement of stakeholders, policymakers, medical personnel, universities, dental associations, community members, and industries to develop regional plans that enhance the oral health agenda for LACCs. A list of recommendations has been presented to underpin strategies aimed at reducing the prevalence and severity of dental caries and improving the quality of life of the impacted LACC population in the near future.

Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions.

Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions. Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country. Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0-5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA). Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers.