Association between psychosocial determinants of adverse childhood experiences and severe early childhood caries among First Nations children.

AIM: To determine whether psychosocial determinants of adverse childhood experiences (ACE), from pregnancy to 2 years old, are associated with severe early childhood caries (S-ECC) in Indigenous children. DESIGN: Secondary data analyses from an ECC prevention trial among 344 First Nations mother-child dyads living on- and off-reserve in Ontario and Manitoba, Canada. Stratified (on-/off-reserve) logistic regression, controlling for mother's age and income source, assessed three categories of psychosocial ACE determinants: alcohol/drug misuse, household financial hardship (overcrowding and food insecurity) and emotional/social well-being (Perceived Stress Scale (PSS-14), sense of personal control (SOC), social support, subjective social status). RESULTS: Household overcrowding [adjusted odds ratio (AOR) = 1.89 (95% CI: 1.06-3.38)], food insecurity [AOR = 2.86 (1.53-5.34)] and mothers' high perceived stress [AOR = 2.48 (1.40-4.37)] were associated with S-ECC (dmft > 9) for those on-reserve. Maternal SOC had a protective effect for off-reserve children [AOR = 0.17 (0.03-0.95)]. CONCLUSIONS: Increased efforts to reduce psychosocial ACE determinants are paramount to decreasing Indigenous children's vulnerability to S-ECC.

Oral health literacy and oral health outcomes in an adult population in Brazil.

BACKGROUND: To investigate the association between critical and communicative oral health literacy (OHL) and oral health outcomes (status, oral health-related quality of life and practices) in adults. METHODS: This cross-sectional study examined a household probability sample of 248 adults, representing 149,635 residents (20-64 years old) in Piracicaba-SP, Brazil. Clinical oral health and socioeconomic and demographic data, as well as data on oral health-related quality of life (OHIP-14) and health practices were collected. The oral examinations were carried out in the participants' homes, using the World Health Organization criteria for oral diseases. The critical and communicative OHL instrument was the primary independent variable, and it was measured using five Likert items that were dichotomized as 'high' ('agree' and 'strongly agree' responses for the 5 items) and 'low' OHL. Binary and multinomial logistic regressions were performed on each outcome (oral health status and practices), controlling for age, sex and socioeconomic status (SES). RESULTS: Approximately 71.5% presented low OHL. When adjusted for age and sex (first model) low OHL was associated with untreated caries (Odds Ratio = 1.92, 95% Confidence Interval = 1.07-3.45), tooth brushing <3 times a day (OR = 2.00, 1.11-3.62) and irregular tooth flossing (OR = 2.17, 1.24-3.80). After SES inclusion in the first model, significant associations were found for low OHL when the outcomes were: presence of biofilm (OR = 1.83, 1.08-3.33), dental care for emergency only (OR = 2.24, 1.24-4.04) and prevalence of oral health impact on quality of life (OR = 2.06, 1.15-3.69). CONCLUSION: Adjusting for age, sex and SES, OHL is related to a risk factor (biofilm) and a consequence of poor oral health (emergency dental visits) and can interfere with the impact of oral diseases on quality of life. As low OHL can be modified, the results support oral health promotion strategies directed at improving critical and communicative oral health literacy in adult populations.

Impact of tooth loss related to number and position on oral health quality of life among adults.

BACKGROUND: The objective of this study was to evaluate the impact of tooth loss on oral health-related quality of life (OHRQoL) in adults with emphasis on the number of teeth lost and their relative position in the mouth. METHODS: The study population was a cross-sectional household probability sample of 248, representing 149,635 20-64 year-old residents in Piracicaba-SP, Brazil. OHRQoL was measured using the OHIP-14. Socioeconomic, demographic, health literacy, dental services use data and clinical variables were collected. Oral examinations were performed using WHO criteria for caries diagnosis, using the DMFT index; that is, the sum of decayed, missing and filled teeth (DMFT). An ordinal scale for tooth loss, based on position and number of missing teeth, was the main explanatory variable. The total OHIP score was the outcome for negative binomial regression and OHIP prevalence was the outcome for logistic regression at 5% level. A hierarchical modeling approach was adopted according to conceptual model. RESULTS: OHIP score was 10.21 (SE 1.16) with 48.1% (n=115) reporting one or more impacts fairly/very often (OHIP prevalence). Significant prevalence rate ratios (PRRs) for OHIP severity were observed for those who had lost up to 12 teeth, including one or more anterior teeth (PRR=1.63, 95%CI 1.06-2.51), those who had lost 13-31 teeth (PRR=2.33, 95%CI 1.49-3.63), and the edentulous (PRR=2.66, 95%CI 1.55-4.57) compared with fully dentate adults. Other significant indicators included those who only sought dental care because of dental pain (PRR=1.67, 95%CI 1.11-2.51) or dental needs (PRR=1.84, 95%CI 1.24-2.71) and having untreated caries (PRR=1.57 95%CI 1.09-2.26). Tooth loss was not significantly associated with OHIP prevalence; instead using dental services due to dental pain (PR=2.43, 95%CI 1.01-5.82), having untreated caries (PR=3.96, 95%CI 1.85-8.51) and low income (PR=2.80, 95%CI 1.26-6.42) were significant risk indicators for reporting OHIP prevalence. CONCLUSION: Our analyses showed OHRQoL gradients consistent with the number and position of teeth missing due to oral disease. These findings suggest that the quantity of teeth lost does not necessarily reflect the impact of tooth mortality on OHRQoL and that future studies should take this into consideration.

[Tooth loss classification: factors associated with a new classification in an adult population group]. / Classificação das perdas dentárias: fatores associados a uma nova medida em uma população de adultos.

This study evaluated tooth loss and factors associated with a new classification, which considers not only the number of teeth lost, but also the number and position that they occupied in the mouth. In Piracicaba, State of São Paulo, Brazil, 248 adults (20-64 year-olds) were examined using a household probability sample. The oral examinations followed the WHO criteria for caries and periodontal disease. Socioeconomic, demographic and dental service use data were collected. The tooth loss outcome, based on tooth position and number of missing teeth, was analyzed by hierarchical multinomial logistic regression using a conceptual model. The mean number of missing teeth was 8.52 (DP = 9.24). For those who had lost up to 12 posterior teeth, age (PR = 1.1) and low social class (PR = 2.6) were significant; for those who lost up to 12 including anterior teeth, age (PR = 1.1) and clinical attachment loss>4mm (PR = 2.9); and for tooth loss in excess of 13 teeth, age (PR = 1.3), low social class (PR = 3.8), and visiting a dentist due to emergency (PR = 9.4) were significant. Age was associated with tooth loss. The classification made it possible to differentiate variables in accordance with position or the number of teeth lost.

Classificação das perdas dentárias: fatores associados a uma nova medida em uma população de adultos / Tooth loss classification: factors associated with a new classification in an adult population group

ResumoO objetivo deste estudo foi avaliar a perda dentária e os fatores associados com uma nova classificação, que considera não apenas o número de dentes perdidos mas a posição que os mesmos ocupavam na boca. Foram examinados por amostragem probabilística 248 adultos (20 – 64 anos), de Piracicaba-SP, Brasil, segundo a cárie e a doença periodontal, critérios da OMS. Dados socioeconômicos, demográficos e de uso de serviço odontológico foram obtidos por questionário. O desfecho perdas dentárias, considerando a posição e o número de dentes perdidos, foi analisado por regressão logística multinomial hierárquica, utilizando modelo conceitual. A média de dentes perdidos foi 8,52 (± 9,24) e apenas 28,3% não perderam dentes devido a doenças bucais. Dos que haviam perdido até 12 dentes posteriores, idade (RP = 1,1) e classe social baixa (RP = 2,6) foram significativas: os que perderam até 12, incluindo anteriores, idade (RP = 1,1) e bolsa periodontal > 4mm (RP = 2,9); para perda acima de 13, a idade (RP = 1,3), classe social baixa (RP = 3,8); e ida ao dentista por emergência (PR = 9,4). Idade foi associada a perdas dentárias no presente estudo. A classificação permitiu diferenciar variáveis de acordo com a posição ou o número de dentes perdidos.

AbstractThis study evaluated tooth loss and factors associated with a new classification, which considers not only the number of teeth lost, but also the number and position that they occupied in the mouth. In Piracicaba, State of São Paulo, Brazil, 248 adults (20–64 year-olds) were examined using a household probability sample. The oral examinations followed the WHO criteria for caries and periodontal disease. Socioeconomic, demographic and dental service use data were collected. The tooth loss outcome, based on tooth position and number of missing teeth, was analyzed by hierarchical multinomial logistic regression using a conceptual model. The mean number of missing teeth was 8.52 (DP = 9.24). For those who had lost up to 12 posterior teeth, age (PR = 1.1) and low social class (PR = 2.6) were significant; for those who lost up to 12 including anterior teeth, age (PR = 1.1) and clinical attachment loss>4mm (PR = 2.9); and for tooth loss in excess of 13 teeth, age (PR = 1.3), low social class (PR = 3.8), and visiting a dentist due to emergency (PR = 9.4) were significant. Age was associated with tooth loss. The classification made it possible to differentiate variables in accordance with position or the number of teeth lost.