Individual and contextual determinants of dental pain in adolescents: Evidence from a national survey.

OBJECTIVE: To investigate the prevalence of dental pain among adolescent students and its association with individual, school and city variables, using a multilevel approach. SUBJECTS AND METHODS: Individual and school data were obtained from the National Adolescent School-Based Health Survey (PeNSE) conducted in Brazil in 2015 in a sample of 34,776 students from 1,339 schools in the 27 Brazilian capital cities. Secondary data on socioeconomic, structural and health indicators of the cities were obtained from public databases. The outcome was the prevalence of dental pain in the last six months (yes/no). Independent variables, consisting of potential social and behavioural determinants of dental pain, were structured in three levels: individual, school and city. Multilevel logistic regression was performed. RESULTS: Prevalence of dental pain was 21.8% (95% CI = 21.0-22.7). Unadjusted analysis showed significant associations between the outcome and most of the factors in the individual and in the contextual levels. In the final adjusted model, adolescents who reported unfavourable health-related behaviours, adverse socioeconomic or psychosocial characteristics, as well as those attending public schools and living in cities with high caries prevalence (DMFT) at age 12, were more likely to report dental pain. CONCLUSIONS: Prevalence of dental pain was high and associated with adverse individual and contextual factors in the school and city levels.

The association of openness personality trait with stress-related salivary biomarkers in burning mouth syndrome.

BACKGROUND: Burning mouth syndrome (BMS) is a chronic disorder defined as a burning sensation in the oral mucosa without evidence of pathological findings. Its pathophysiology is largely unknown, but psychiatric disorders and personality traits have been implicated. OBJECTIVE: This study investigated whether there is any association between salivary biomarkers and personality traits in BMS patients. METHODS: It was a cross-sectional, controlled study that evaluated 30 individuals with BMS and 32 controls. All subjects were assessed with a structured psychiatric interview (Mini International Neuropsychiatric Interview) and the Big Five inventory. Salivary levels of brain-derived neurotrophic factor (BDNF), neural growth factor, tumor necrosis factor-α, interleukin (IL)-6, IL-10 and cortisol were determined. RESULTS: We found that BMS patients exhibited more traits of neuroticism and lower openness than controls. Openness showed a moderate and negative correlation with cortisol, BDNF and IL-6. CONCLUSION: Personality traits are associated with salivary biomarkers in BMS.

Parents' and caregivers' perceptions of the quality of life of adolescents in the first 4 months of orthodontic treatment with a fixed appliance.

OBJECTIVES: To evaluate adolescents oral health-related quality of life (OHRQoL) in the first 4 months of fixed orthodontic appliance treatment using parents and caregivers as proxies. DESIGN: Descriptive study. SETTING: Department of Pediatric Dentistry and Orthodontics at Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. PARTICIPANTS: A sample of parents and caregivers of 95 adolescents undergoing orthodontic treatment with a fixed appliance. METHODS: Participants were required to answer the Brazilian version of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) before adolescent's treatment (T1) and 4 months after bonding of the fixed appliance (T2). Statistical analysis was carried out using the Wilcoxon signed rank test and the Bonferroni correction for the domains of P-CPQ. RESULTS: Among the 95 participants, there were 73 mothers, 18 fathers and 4 were other relations. There was a statistically significant improvement in the overall score as well as in both emotional and social wellbeing subscales (P<0·001). CONCLUSION: Parents and caregivers report an improvement on their adolescent's OHRQoL in the first 4 months of orthodontic treatment with a fixed appliance.

Erosive and cariogenicity potential of pediatric drugs: study of physicochemical parameters.

BACKGROUND: Pediatric medications may possess a high erosive potential to dental tissues due to the existence of acid components in their formulations. The purpose was to determine the erosive and cariogenic potential of pediatric oral liquid medications through the analysis of their physicochemical properties in vitro. METHODS: A total of 59 substances were selected from the drug reference list of the National Health Surveillance Agency (ANVISA), which belong to 11 therapeutic classes, as follows: analgesics, non-steroidal anti-inflammatory, corticosteroids, antihistamines, antitussives, bronchodilators, antibacterials, antiparasitics, antiemetics, anticonvulsants and antipsychotics. Measurement of pH was performed by potentiometry, using a digital pH meter. For the Total Titratable Acidity (TTA) chemical assay, a 0.1 N NaOH standard solution was used, which was titrated until drug pH was neutralized. The Total Soluble Solids Contents (TSSC) quantification was carried out by refractometry using Brix scale and the analysis of Total Sugar Content was performed according to Fehling's method. In addition, it was analyzed the information contained in the drug inserts with regard to the presence of sucrose and type of acid and sweetener added to the formulations. RESULTS: All drug classes showed acidic pH, and the lowest mean was found for antipsychotics (2.61 ± 0.08). There was a large variation in the TTA (0.1% - 1.18%) and SST (10.44% - 57.08%) values. High total sugar contents were identified in the antitussives (53.25%) and anticonvulsants (51.75%). As described in the drug inserts, sucrose was added in 47.5% of the formulations, as well as citric acid (39.0%), sodium saccharin (36.4%) and sorbitol (34.8%). CONCLUSION: The drugs analyzed herein showed physicochemical characteristics indicative of a cariogenic and erosive potential on dental tissues. Competent bodies' strategies should be implemented in order to broaden the knowledge of health professionals, drug manufacturers and general consuming public about the risks from the consumption of medicines potentially harmful to dental tissues.

Preadolescent's oral health-related quality of life during the first month of fixed orthodontic appliance therapy.

OBJECTIVES: To evaluate preadolescent oral health related quality of life (OHRQoL) during the first month of fixed orthodontic appliance therapy. DESIGN: Descriptive study. SETTING: The Department of Pediatric Dentistry and Orthodontics at Federal University of Minas Gerais, Belo Horizonte, Brazil. PARTICIPANTS: This study included a sample of 96 preadolescent children aged between 11 and 12 years undergoing orthodontic treatment with a fixed appliance. METHODS: Preadolescent children were required to answer the short form of the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) before treatment (T0) and 1 month after placement of the fixed appliance (T1). Statistical analysis was performed using the Wilcoxon signed rank test and the Bonferroni correction for the domains of CPQ11-14. RESULTS: Out of the 96 patients originally admitted, one gave up the treatment before the placement of bands and one failed to return the second questionnaire (T1). So, a sample of 94 preadolescents participated in this study, with a response rate of 97·9%. Among the 94 participants, 49 were females (52·1 %) and 45 were males (47·9 %). The mean age was 11·5 years (SD = 0·502). There was a statistically significant improvement in emotional well-being domain (P<0·001) as well as in the overall score (P = 0·032). However, there were no significant changes in oral symptoms, functional limitations and social well-being domains (P>0·013) before treatment and 1 month after the placement of fixed appliance. CONCLUSION: One month after the placement of fixed orthodontic appliance, the preadolescents had positive alterations in their OHRQoL mainly in the emotional well-being domain.

Burning mouth syndrome: a therapeutic approach involving mechanical salivary stimulation.

OBJECTIVE: The study aimed to evaluate the effects of salivary stimulation therapy on the salivary flow, quality of saliva, and symptoms in patients with burning mouth syndrome (BMS). BACKGROUND: BMS is a chronic disorder characterized by a burning sensation. Some reports have proposed a role for saliva in the pathogenesis of BMS. METHODS: Twenty-six BMS patients underwent treatment with salivary mechanical stimulation. Resting and stimulated saliva were collected before and after therapy. Salivary levels of total protein, brain-derived neurotrophic factor, interleukin-10, tumor necrosis factor-α, interleukin-6, and nerve growth factor were assessed before and 90 days after therapy by enzyme-linked immunosorbent assay. RESULTS: A significant reduction in the burning sensation and number of burning sites as well as an improvement of taste disturbances and xerostomia were observed after therapy. The salivary flow was not significantly modified. However, the therapy resulted in a significant decrease in salivary levels of total protein and an increase of tumor necrosis factor-α. CONCLUSION: Salivary mechanical stimulation therapy is effective in reducing clinical symptoms of BMS.

The impact of burning mouth syndrome on health-related quality of life.

BACKGROUND: Burning mouth syndrome is a chronic disorder that is characterized by a burning sensation and a normal clinical appearance of the oral mucosa. This condition often affects the health-related quality of life in patients. As such, the aim of this study was to compare the health-related quality of life of patients with BMS and healthy controls, using the validated Portuguese versions of the SF-36 and OHIP-49 questionnaires. METHODS: A calculated sample of Brazilian patients with BMS (n = 26) was compared with a control group (n = 27), paired for gender and age. Sociodemographic information and clinical characteristics were obtained, and interviews were conducted using the SF-36 and OHIP-49. To evaluate the normality of the variables, we used the Kolmogorov-Smirnov test. The chi-square test, Fisher exact test and Mann-Whitney U-Test were used to compare sociodemographic and clinical characteristics of individuals with BMS and controls Mann-Whitney U-test were carried out to compare SF-36 and OHIP-49 between BMS patients and controls. The significance level was set at 0.05. To compare the dimensions of the SF-36 and OHIP-49 between BMS patients and controls, we considered Bonferroni correction. So for comparison of the dimensions, the significance level was set at 0.00625 for SF-36 and at 0.00714 for OHIP-49. RESULTS: The clinical and demographic data were similar in both groups (P > 0.05). SF-36 scores were significantly lower in all domains for patients with BMS (P < 0.00625). OHIP-49 scores were higher for individuals with BMS (P < 0.00714). CONCLUSIONS: BMS has a negative impact on the health-related quality of life of individuals, as can be shown by instruments such as the SF-36 and OHIP-49. So, the evaluation of quality of life might be useful for more information about the nature and severity of BMS, to evaluate the effects of treatment protocols, in order to improve their outcomes by means a humanized clinical practice.

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.

Using Item Response Theory to evaluate the psychometric characteristics of questions in a Brazilian programme and the performance of dental teams in primary care.

OBJECTIVES: First, to assess the psychometric properties of key questions included in a public sector evaluation of primary dental care in Brazil; and second, to evaluate the performance of dental teams in relation to these items. METHODS: Secondary analysis of a national primary care dataset monitoring quality and access to dental care. Data were collected through face-to-face interviews with representatives of dental teams participating in the 'National Programme for Improving Access and Quality of Primary Care'. Twenty-three mandatory questions about the dentists' reported delivery of dental procedures were included in the analysis. Item Response Theory (IRT) modelling was applied to measure the psychometric properties of the instrument-level of difficulty and discrimination parameter of each item-and then to estimate dental team performance scores based on these parameters. Based on IRT, possible scores ranged from -4 to +4. RESULTS: Three of the 23 mandatory items were removed due to poor internal consistency, resulting in a scale of 20 items for assessing dental team performance. The results showed variation in procedures delivered by the dental teams; whilst more than a half of the procedures were executed by at least 80% of the dental teams, those relating to dentures (partial/total) and frenectomy (lingual/labial) were performed by less than 30%. Amongst the 20 items included in the model, those related to partial/total dentures and oral cancer follow-up presented higher levels of difficulty and were less frequently provided. The items relating to the treatment of deciduous teeth and access to the dental pulp of permanent teeth had the highest discrimination parameters and, consequently, greater weight in the performance's score estimation; therefore, dental teams that did not perform these items had the lowest performance scores. In the present study, dental team performance scores ranged from -3.66 to +1.87 with a mean/median of -0.06/+0.01. CONCLUSION: The findings suggest that whilst the items within the instrument demonstrated some potential to discriminate between poor and very poor teams, they were ineffective in discriminating between poor and good teams. Whilst Brazilian dental teams perform many mandatory procedures, variation in the nature of their delivery of care requires further investigation to enhance service provision to the population.

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

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

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

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

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

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

Agreement between adolescents and parents/caregivers in rating the impact of malocclusion on adolescents' quality of life.

OBJECTIVE: To assess the agreement between adolescents and their parents/caregivers regarding the impact of malocclusion on adolescents' oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: A consecutive sample of 141 adolescent and parent/caregiver pairs was selected. Adolescents answered the short version of the Child Perceptions Questionnaire (CPQ11-14), while parents answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ). The CPQ11-14 and the P-CPQ have 14 items in common that are organized through four subscales: oral symptoms (OS), functional limitations (FL), emotional well-being (EW), and social well-being (SW). Agreement on the overall score and agreement on the subscales were determined using comparison and correlation analysis. The comparison analysis was carried out by comparing the mean directional and absolute differences, and the correlation analysis was performed using the intraclass correlation coefficient (ICC). RESULTS: A total of 135 pairs of adolescents and parents/caregivers agreed to answer the questionnaires, providing a response rate of 95.7%. The mean age of the adolescents was 11.50 years. The mean directional difference was significant for the OS (P < .001) and FL (P = .040) subscales as well as for the overall score (P = .007). Adolescents' reports were higher than parents/caregivers' reports. The mean absolute difference for the overall score was 7.26, representing 12.9% of the maximum possible overall score. The ICC was 0.16 for the overall score, indicating poor agreement. CONCLUSION: Poor agreement was observed between adolescents and their parents/caregivers in rating the impact of malocclusion on adolescents' OHRQoL.

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

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

A survey of the perception of comprehensiveness among dentists in a large Brazilian city.

OBJECTIVES: To quantitatively identify the perception of dentists regarding comprehensiveness and its domains of "patient welcoming", "bonding" and "quality of care" in primary dental care settings of a large Brazilian city. METHODS: A questionnaire was administered to all dentists comprising the primary health care service to Belo Horizonte with tenured jobs and 40 work hours per week, totalling a population of 207 professionals. The response rate was 90.34%. A pilot test was conducted with 44 dentists working in primary care for at least two years and who did not participate in the main study. Descriptive statistical analysis involved calculating proportions. No confidence intervals were calculated because this was a census study. RESULTS: In most items (79.0%), professionals' perceptions about the comprehensiveness were overwhelmingly positive. When we stratified the analysis by domain and checked those items about which dentists had a less favourable perception, 22.7% were in the patient welcoming domain, 25.0% were in the bonding domain and 12.5% were in quality of care. CONCLUSIONS: Comprehensiveness, as an approach in health care practice, needs to be enhanced, and there is evidence that these dentists are aware of its importance.

High dental caries among adults aged 35 to 44 years: case-control study of distal and proximal factors.

The aim of this study was to determine whether a high degree of dental caries severity is associated with the distal and proximal determinants of caries in a group of Brazilian adults aged 35 to 44 years. A population-based case-control study was conducted using two groups-a case group with high caries severity (DMFT ≥ 14) and a control group without high caries severity (DMFT < 14). The sample comprised adults from metropolitan Belo Horizonte, Brazil (180 cases and 180 controls matched for gender and age). The exam was performed by calibrated dentists using the DMFT index. The statistical analysis used the Mann-Whitney test and bivariate and multivariate logistic regression (the conditional backward stepwise method). The mean DMFT was 8.4 ± 3.9 in the control group and 20.1 ± 4.5 in the case group. High caries severity was associated with regular visits to the dentist, low income, use of private/supplementary dental service and not petitioning the authorities for community benefits. The results of the study underscore the importance of considering distal and proximal factors in the assessment of the severity of dental caries. Greater caries severity persists among low-income families and among groups with a low degree of social cohesion.

Psychiatric disorders in burning mouth syndrome.

BACKGROUND: Prevalence of psychiatric disorders in burning mouth syndrome (BMS) is high, but their role in the pathogenesis of BMS remains unclear. OBJECTIVE: The authors aimed to assess the frequency of psychiatric disorders and the severity of psychopathology in BMS. METHODS: Thirty BMS patients and thirty-one controls underwent a psychiatric evaluation which included a structured interview (MINI-Plus) and five psychometric scales. A Visual Analogue Scale (VAS) was used to measure the intensity of burning sensation. RESULTS: Patients with BMS showed a higher frequency of current major depressive disorder, past major depressive disorder, generalized anxiety disorder, hypochondria and cancerophobia (p<0.05). In BMS patients, generalized anxiety disorder was significantly associated with current major depression and social phobia (p<0.05). As expected, cancerophobia was significantly associated with hypochondria (p<0.05). Patients with BMS had higher scores in Hamilton Rating Scale for Depression (HRSD), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Dutch Fatigue Scale (DUFS) (p<0.05). CONCLUSION: BMS patients may have a particular psychological and/or psychiatric profile. Psychometric scales might be useful in screening psychiatric disorders, as well as for assessment of treatment outcomes. In the presence of clinical relevant psychiatric symptoms, patients must be treated appropriately.

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

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

Prevalence of enamel pearls in teeth from a human teeth bank.

Enamel pearls are anatomical structures that can bring about clinical implications if associated with the retention of plaque, in turn resulting in periodontal disease. In an attempt to avoid periodontal disease, the removal and treatment of these enamel pearls, may be a necessity in some circumstances. A total of 45,785 extracted teeth from a human teeth bank were analyzed for the presence of enamel pearls. The most prevalent anatomical location of enamel pearls was the permanent maxillary first and second molar region. An association between the prevalence of enamel pearls and dental class (P < 0.001) was observed, most frequently in the maxillary molars. In the maxillary molars, the most prevalent anatomical location of enamel pearls in the first and second molars was the furcation between the distobuccal and palatal roots. Enamel pearls are a common observation in molars in general, but are most commonly found in maxillary molars.