Impact of COVID-19 pandemic on pediatric dental procedures in primary healthcare settings in Piracicaba, Brazil: an ecological study.

BACKGROUND: The COVID-19 pandemic brought significant changes to dental care, which may have affected pediatric dental care offered in primary healthcare settings. Therefore, the aim of this study was to analyze the quantity of dental procedures performed in primary healthcare for children aged 6 to 12 years, before and during the COVID-19 pandemic. METHODS: This is an ecological study using data from the health information system of Piracicaba, São Paulo, Brazil. The variables considered were: coverage of first programmed dental consultation, restoration of permanent and deciduous teeth, topical fluoride application (individual per session), emergency care, and deciduous tooth extraction. Two periods were considered: period I (March 1, 2019 to February 29, 2020) and period II (April 1, 2020 to March 31, 2021), before and during the pandemic, respectively. Comparisons between periods were made using the paired nonparametric Wilcoxon test with a significance level of 5%. RESULTS: There was an increase in emergency care from 15.4 to 32.4% (p = 0.0095) and a decrease in the number of restorations of deciduous teeth from 32.8 to 20.2% (p = 0.0217). The first programmed consultation showed a decrease of 9.60% (p = 0.0930) in period II. CONCLUSIONS: The COVID-19 pandemic has hindered access to primary dental care for children, impacting the quantity of emergency care, reducing restorations of deciduous teeth, and first programmed dental consultations. These findings highlight the need for strategies to ensure that pediatric dental care is not neglected during pandemics.

Esthetic impact of maxillary midline diastema and mandibular crowding in children in the mixed dentition.

INTRODUCTION: This study aimed to investigate the esthetic impact of mandibular crowding and maxillary midline diastema in children in the mixed dentition. METHODS: The sample for this cross-sectional study comprised 785 children, aged 8-10 years, in the late mixed dentition. Mandibular crowding and maxillary midline diastema were evaluated clinically with the Dental Aesthetic Index. Mandibular crowding and maxillary midline diastema were evaluated to determine tooth size-arch length discrepancies. The sample was stratified as group 1, children without maxillary midline diastema or mandibular crowding (n = 177); group 2, children with maxillary midline diastema (n = 256); group 3, children with mandibular crowding (n = 208); and group 4, children with maxillary midline diastema and mandibular crowding (n = 144). The subjective esthetic impact was evaluated using the Orthodontic Aesthetic Subjective Impact Score. Descriptive and exploratory analyses of the data were performed. A generalized linear model was applied, adjusted for the possible confounding variables (age, gender, and race) with a significance level of 5% because the Orthodontic Aesthetic Subjective Impact Score did not meet the assumptions of analysis of variance. RESULTS: Children in groups 2 and 3 showed greater esthetic concern than group 1 (P <0.05). Children in groups 2 and 3 did not show a significant difference with children in group 4 (P >0.05). CONCLUSIONS: Children with mixed dentition with mandibular crowding or maxillary median diastema reported significantly more esthetic concern than children without these conditions.

Self-perceived dental treatment need among adolescents: A hierarchical analysis.

OBJECTIVES: The aim of the present study was to analyse the factors associated with self-perceived need for dental treatment among adolescents. METHODS: A representative sample in the state of São Paulo, Brazil, comprising 5558 adolescents, was evaluated in 2015. The adolescents were selected by probabilistic sampling by conglomerates in two stages. The outcome evaluated was self-perceived treatment need measured via a validated questionnaire. Independent variables included sociodemographic factors, type, frequency and reason for last dental visit, and examination of oral conditions. Statistical analysis was based on the multiple hierarchical logistic regression model. RESULTS: Of the total sample, 3340 (62.6%) adolescents reported needing dental treatment. After fitting the model, the self-perceived need for treatment was associated with adolescents with family income of up to $1,500 BRL (OR 1.39; [95% CI = 1.20-1.60]; P < .001), who sought dental services solely for curative treatment (OR 1.58; [95% CI = 1.46-1.72]; P < .001), reported toothaches in the previous six months (OR 2.88; [95% CI = 2.53-3.28]; P < .001), were dissatisfied with the appearance of their teeth and mouth (OR 5.94; [95% CI = 5.03-7.01]; P < .001), had caries in the posterior teeth only (OR 3.04; [95% CI = 2.77-3.33]; P < .001) or had caries in the anterior teeth (OR 4.75; [95% CI = 4.05-5.56]; P < .001). CONCLUSIONS: The self-perceived need for dental treatment among Brazilian adolescents was associated with normative and subjective needs, and sociodemographic context factors. This finding provides important evidence for collective health planning.

Spatial analysis of the death associated factors due oral cancer in Brazil: an ecological study.

BACKGROUND: Oral cancer (OC) is among the ten most common cancers and the seventh most frequent cause of death worldwide. It has been reported that these incidence rates are higher in developed country and these mortality rates are higher in less developed areas. So, the objective of the present study was to analyze the spatial joint distribution and to explore possible associations of the epidemiological aspects with mortality rates due to OC in the Brazil. METHODS: An exploratory ecological study investigated the global spatial autocorrelation of epidemiological aspects with mortality rates due to OC from the Brazilian Federative Units (FUs) (n = 27) in the period 2005-2014, using the "global" and "local" Moran statistic method and a multiple spatial regression, having as variables of exposure the habits and lifestyle, sociodemographic indicators, the consumption of pesticides, the presence of comorbidities, the use of health services and food consumption; and, as a variable response, mortality rates due to OC. The software used was Stata 11.0, SPSS 18.0 and GeoDa 0.95-i. RESULTS: The spatial distribution of OC mortality rates to age-standard was not random and showed high spatial autocorrelation and predominance of significant spatial groupings in the Central-South region of Brazil. In the multiple regression, statistically negative associations were observed between the Human Development Index (HDI) and OC age-standardized in the studied period (p < 0.05) and positive associations among the proportion of the population with dental appointment within last year, percentage of consumption of oils and fats, percentage of consumption of ready-to-eat foods and industrial mixtures and percentage of overweight adults with this type of cancer (p < 0.05). CONCLUSION: This is the first study that analyzed the factors associated to the spatial clusters of mortality due to oral cancer in the Brazilian FUs. A fairly unequal distribution of OC mortality rates was found, being that these rates presented inverse association with HDI and direct association with dental appointment, consumption of oils and fats, ready-to-eat foods and industrial mixtures consumption and overweight these rates. It suggests the need to redirect Brazilian public policies aimed at combating them so that they cease to be temporary and become permanent.

Social vulnerability and factors associated with oral impact on daily performance among adolescents.

BACKGROUND: Oral disorders may negatively affect the quality of life (QoL) of adolescents. To investigate how social vulnerability and oral-health status factors affect QoL in 15-19 years olds who participated in the "SB São Paulo 2015" state survey. METHODS: The relationship of several independent variables, namely Paulista Social Vulnerability Index (PSVI) score, gender, skin color, family income, age, untreated caries, tooth loss [determined by the Decayed, Missing, Filled-Teeth (DMF-T) index], toothache, periodontal condition [determined by the Community Periodontal Index (CPI)], and malocclusion (maxillary overjet, cross bite, or open bite) affect daily life, measured by the Oral Impacts on Daily Performance (OIDP) instrument. Logistic regression analyses were carried out based on a hierarchical model. RESULTS: The final sample consisted of 5402 adolescents. The prevalence of at least one negative impact of oral health on QoL was 37.3%. After adjustment, demographic factors that were found to influence this impact significantly (p < 0.01) were female gender [odds ratio (OR) 1.78, 95% confidence interval (CI) = 1.59-2.0], non-white skin color (OR 1.66, 95% CI = 1.47-1.88), and a low family income (OR 1.28, 95% CI = 1.28-1.29). Additionally, oral conditions associated with oral health impact on QoL included the presence of at least one untreated tooth decay lesion (OR 1.42, 95% CI = 1.25-1.61), loss of at least one tooth (OR 1.49; 95% CI = 1.25-1.78), toothache (OR 4.87, 95% CI = 4.25-5.59), bleeding on probing (OR 1.45, 95% CI = 1.25-1.68), and severe maxillary overjet (OR 1.68, 95% CI = 1.15-2.45). CONCLUSION: Social vulnerability (PSVI score) was not associated with the OIDP score, but oral health conditions and socio-demographic variables, including gender, skin color, and income, were found to affect adolescents' daily activities. Strategies that consider the perceptions of this segment of the population should be implemented to strengthen their autonomy and totality of care.

The impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of addicted persons.

BACKGROUND: The aim of this cross-sectional study was to evaluate the impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of alcohol and drug addicted persons, receiving care at outpatient treatment facilities in Brazil. METHODS: A random sample of 262 participants, mean age 37 years, from Psychosocial Care Centers for Alcohol and Drugs (CAPS AD) located in three cities in the state of São Paulo, Brazil, were clinically examined for caries experience (DMFT index) by a calibrated examiner. They were asked to complete a series of questionnaires, including the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), socioeconomic characteristics, and the World Health Organization Quality of Life assessment (WHOQOL), which were considered the outcome variables of the study. Associations between oral health status, socioeconomic characteristics, substance involvement with WHOQOL were investigated by means of the chi-square test and multiple logistic regression analysis with a level of significance α < 0.05. RESULTS: The mean DMF index of the group was 13.0. Subjects with DMFT >14 (OR = 2.25; CI 95% = 1.30-3.89); low-income (OR = 2.41; CI 95% = 1.22-4.77) and users of cocaine/crack (OR = 2.02; CI 95% = 1.15-3.59) were more likely to have poor general quality of life. CONCLUSION: This study demonstrated that the general quality of life of addicted persons was associated with caries experience, low income and cocaine/crack use.

Individual and contextual factors related to dental caries in underprivileged Brazilian adolescents.

BACKGROUND: Investigate the individual and contextual variables related to caries in underprivileged adolescents, and the disparity in distribution of the disease. METHODS: Cross-sectional analytical study, conducted in the city of Piracicaba, SP, Brazil, in 2012. The probabilistic sample was composed of 1,179 adolescents from 15-19 years of age, randomly selected from 21 state schools and 34 Primary Health Units--Family Health (PHU-FH). The dependent variables studied were number of decayed teeth and caries experience (DMFT). The independent variables were classified into individual (clinical, sociodemographic, psychosocial, self-perception, impact on oral health, access to services, and quality of life) and contextual (social exclusion index, total number of residents in suburb, literacy rate, and the following variables given in percentages: residences in the home ownership category, provision of domestic sewerage, trash collection, families with income of over 1 minimum wage per month, and families without monthly income) variables. The multilevel regression model was estimated by the PROC GLIMMIX (Generalized Linear Models-Mixed) procedure, considering the individual variables as Level 1 and the contextual variables of the suburbs as Level 2. Adjustment of the model was evaluated by -2 Res Log Likelihood with α = 0.05. RESULTS: As regards the individual variables, adolescents who declared having a prison inmate in the Family and resided in homes with a larger number of persons, showed a higher number of decayed teeth. There were a larger number of decayed teeth, a higher DMFT value, and worse self-perception as regards the health of their teeth and mouth. Other variables, such as being of the female gender, age and time since last visit to the dentist were related to the DMFT index. As regards the contextual variables, the DMFT was lower in suburbs with greater access to domestic sewage, and the number of decayed teeth was higher in suburbs with the worst social exclusion indices. CONCLUSION: Individual and contextual variables were associated with the presence of caries and DMFT index in underprivileged adolescents, indicating that they must be taken into consideration in the formulation of policies directed towards oral health promotion and prevention activities in this group.

Evaluation of the effectiveness of a voice training program for teachers.

OBJECTIVES: To investigate the effects of a voice education program to teachers on vocal function exercise and voice hygiene and compare a pre- and post-vocal exercise for the teacher's voice quality. METHODS: A random sample of 102 subjects was divided into two groups: experimental group (29 women and seven men) with vocal hygiene and training exercises and control group (52 women and 14 men) with vocal hygiene. Two sessions were held about voice hygiene for the control group and five sessions for the experimental group, one being with reference to the vocal hygiene habit and four vocal exercise sessions. Acoustic analysis of the vowel [i] was made pre- and post-vocal exercise and for the situations of initial and final evaluation of the educational program. Student t test (paired) and Proc MIXED (repeated measures) were used for analyses with level of significance (α = 0.05). RESULTS: The training exercises, posture and relaxation cervical, decreased the mean of fundamental frequency (f(0)) for men (P = 0.04), and for the phonation, intensity, and frequency exercises, there was a significant increase for f(0) in woman (P = 0.02) and glottal to noise excitation ratio (P = 0.04). There was no statistically significant difference intergroup evaluations after 3 months. The control group presented increased mean voice intensity in the final evaluation (P = 0.01). CONCLUSIONS: Voice training exercises showed a positive and immediate impact on the teacher's quality of voice, but it was not sustained longitudinally, suggesting that actions for this purpose should be continued at schools.

Influência dos determinantes subjetivos para a decisão de tratamento ortodôntico, em diferentes prevalências de cárie dentária / Influence of subjective determinants on the decision for orthodontic treatment in different dental caries prevalence

Objetivo: Este estudo objetivou avaliar a influência dos determinantes subjetivos no tratamento ortodôntico, em diferentes prevalências de cárie dentária em adolescentes de 15 anos do município de Piracicaba - SP. Métodos: O delineamento obedeceu à seguinte ordem: calibração dos examinadores; avaliação da prevalência de cárie; necessidade de tratamento ortodôntico (índice DAI e DHC-IOTN) e de variáveis subjetivas (autoestima: GSE, autoavaliação: AC-IOTN, autopercepção: OASIS e interesse ortodôntico declarado). Tratou-se de um estudo transversal observacional com amostra por conglomerados de 528 adolescentes selecionados em dez escolas públicas. Resultados: Quando se considerou a influência da cárie dentária, autoestima e interesse ortodôntico à necessidade de tratamento determinada pelos índices DAI e IOTN, não se observou significância estatística. Ao considerar a autopercepção, essa teve influência estatística para a necessidade de tratamento determinada pelos índices DAI e IOTN. Conclusão: Conclui-se que a prevalência de cárie dentária não foi associada à necessidade de tratamento ortodôntico e que, das variáveis subjetivas, a autopercepção foi importante na decisão do tratamento ortodôntico.

Effect of different diagnostic thresholds on dental caries calibration - a 12 month evaluation.

OBJECTIVE: To analyze the reproducibility of a calibration trial, at different diagnostic thresholds of dental caries, in a 12-month evaluation. METHODS: A group of dental examiners (n = 11), who had previous experience in epidemiological surveys, participated in the study. An initial training phase (theoretical and clinical) and five calibration exercises (baseline, 3, 6, 9 and 12 months) were arranged. World Health Organization (WHO) criteria, including the active initial lesions (IL) were used. Six- to 7-year-old children took part in the study. They were selected according to past history and dental caries activity. The data were analyzed at WHO and WHO + IL diagnostic thresholds in accordance with tooth and dental surfaces. RESULTS: Excellent mean intra- and inter-examiner Kappa values were obtained for both diagnostic thresholds, in accordance with tooth and surface, during the calibration phases. However, the most relevant errors were related to the decayed component and to IL diagnosis. CONCLUSION: It was possible to use the methodology proposed in this study in epidemiological surveys when examining the mixed dentition, although new strategies to improve training in IL diagnosis and calibration are necessary.

Comparison of three methods for detection of carious lesions in proximal surfaces versus direct visual examination after tooth separation.

The present study aimed to compare clinical, fiber-optic transillumination and bite-wing radiographic assessment of carious lesion depth in contacting proximal surfaces with the results obtained by direct visual inspection after tooth separation of the respective surfaces. It is suggested that when a carious lesion is diagnosed as non-cavitated by clinical examination or restricted to enamel by FOTI or radiographic examinations in a population of children with low caries prevalence, dentists should adopt a preventive approach.