Structural Relationships between Asthma and Dental Caries in Children: A Birth Cohort Study in Southern Brazil.

INTRODUCTION: There is an inconclusive causal association between asthma symptoms and dental caries in the primary dentition. This study aimed to investigate, using SEM (structural equation modeling), a possible causal relation between asthma and dental caries in the primary dentition. METHODS: Using data from the 2004 Pelotas Birth Cohort Study, a sub-sample of 1,303 individuals was selected. Dental caries was clinically evaluated at 5 years old based on decayed, missing, and filled tooth (dmft) index criteria. Asthma-related symptoms (wheezing and shortness of breath) at 1- and 4-year-olds composed a latent variable and were the main exposures to caries occurrence. SEM was used to identify possible direct, indirect, and mediated effects of asthma in primary dentition dental caries. RESULTS: The general prevalence of caries at age 5 was 1.95 (SD: 3.56). When comparing the dmft values for children with asthma symptoms and those without, they presented similar values in both periods where asthma symptoms were evaluated (1- and 4-year-old). SEM analysis showed that asthma was neither directly nor indirectly related to dental caries. CONCLUSION: Asthma, using a latent variable constructed based on asthma symptoms, showed no causal effect on dental caries occurrence in the primary dentition.

The influence of breastfeeding and pacifier use on the association between preterm birth and primary-dentition malocclusion: A population-based birth cohort study.

INTRODUCTION: Little is known about the influence of biological characteristics on the occurrence of malocclusion. This study aimed to investigate the association between preterm birth and primary-dentition malocclusion and how breastfeeding and the use of pacifiers are related to this association. METHODS: A representative sample (n = 1129) of children from the 2004 Pelotas, Brazil birth cohort study underwent a dental examination at age 5 years. Malocclusions were diagnosed according to the World Health Organization criteria, and the outcome was considered as the presence of moderate or severe malocclusion (MSM). Questionnaires including the children's oral health information were completed by the mothers. Data on socioeconomic status, breastfeeding, and preterm birth were obtained from previous follow-ups. Poisson regression analysis was conducted, followed by an interaction test. RESULTS: The prevalence of MSM was 26.3% (95% confidence interval [CI], 23.6%-29.1%) in the total sample, 24.1% (95% CI, 21.5%-26.9%) in full-term births, and 42.2% (95% CI, 39.1%-45.3%) in preterm births. After adjustment, the prevalence of MSM was 42% higher in preterm births. Breastfeeding duration and pacifier use up to age 4 years modified the effect of gestational age on MSM. CONCLUSIONS: Preterm birth is associated with the development of MSM. Breastfeeding reduces the effect of preterm birth on MSM, and pacifier use strengthens this association. Dentists should be aware that preterm birth may be a risk factor for malocclusion in primary dentition. The findings reinforce the benefits of breastfeeding on occlusal development and the negative consequences of pacifier use.

Perception of parents and caregivers about the need for dental appointments for adolescents from a Brazilian birth cohort.

OBJECTIVE: To investigate the perception of parents or caregivers regarding the need for dental appointments for adolescents aged 12-13 years and associated factors. METHODS: Data from the Pelotas 2004 Birth Cohort were used. The outcome variable was the need for dental appointments for young adolescents perceived by parents or caregivers. Demographic and economic exposure variables were obtained from the first (2004) and sixth general follow-up (2015), respectively. The exposure variables 'previous history of dental pain', 'self-rated oral health', clinical variables and the outcome variable were obtained from the second oral health follow-up (2017). Unadjusted and adjusted multivariate Poisson regression analyses provided prevalence ratios (PR) and respective 95% confidence intervals (CI). RESULTS: At the first oral health follow-up (2009), 1303 five-year-old children were recruited, 996 of whom were reassessed and underwent oral health examinations at 12 and 13 years of age (response rate: 76.4%). The findings showed that 72.4% of parents/caregivers perceived that the adolescents needed dental appointments. No associations were found between the outcome and sociodemographic or economic variables. After adjustments, the outcome remained positively associated with previous history of toothache (PR 1.22; 95% CI 1.14-1.32), self-rated oral health as fair or poor (PR 1.26; 95% CI 1.15-1.39), the presence of dental caries (PR 1.27; 95% CI 1.20-1.38) and severe or disabling malocclusion (PR 1.14; 95% CI 1.05-1.25). CONCLUSIONS: The perception of parents/caregivers regarding the need for dental appointments on the part of their adolescent sons and daughters was associated with oral health problems, and these findings can serve as the basis for creating and improving oral health programmes that seek a better understanding on the part of parents and caregivers regarding the importance of integral care for their adolescent children.

Two decades of socioeconomic inequalities in the prevalence of untreated dental caries in early childhood: Results from three birth cohorts in southern Brazil.

OBJECTIVES: To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. METHODS: The socioeconomic data to this study were collected at the 48-month follow-up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality-SII and Concentration Index-CIX) were used. RESULTS: The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro-poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. CONCLUSIONS: Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children.

Influence of maternal characteristics and caregiving behaviours on children's caries experience: An intergenerational approach.

OBJECTIVES: This study adopted an intergenerational approach, aiming to answer the following research questions: (a) Are maternal oral health-related behaviours and oral health associated with dental caries in preschool children?; (b) Do maternal caregiving behaviours mediate the association between maternal oral health-related behaviours and dental caries in preschool children. METHODS: Children aged 5 years, enrolled in the 2004 Pelotas (Brazil) Birth Cohort, were investigated (n = 1303). Children were dentally examined using WHO criteria to assess the number of decayed, missing and filled surfaces (dmfs), and their mothers were interviewed. Standardized direct, indirect and total effects of maternal characteristics (frequency of toothbrushing, dental anxiety, the pattern of dental attendance, self-perception about oral health and self-reported dental caries) on maternal caregiving behaviours and children's dmfs were assessed using path analysis. RESULTS: Mean dmfs was 4.1 (95% CI 3.6;4.5). Maternal oral health-related behaviours had no direct effect on children's dental caries: child dental attendance pattern partially mediates the effect of maternal dental attendance pattern on dental caries (87.8%; P < 0.05) and partially mediates the effect of maternal dental anxiety (39.9%; P < 0.001). Child frequency of toothbrushing mediates 28.0% (P < 0.001) of the effect of maternal frequency of toothbrushing on dental caries. CONCLUSIONS: Socioeconomic factors directly influenced children's caries experience, whereas maternal oral health-related behaviours had no direct effect. It was observed an indirect effect of maternal dental anxiety and dental attendance pattern on children's dental caries mediated by caregiving behaviours, such as child dental attendance pattern and frequency of toothbrushing.

Brazilian cohorts with potential for life-course studies: a scoping review / Coortes no Brasil com potencial para estudos do ciclo vital: uma revisão de escopo

ABSTRACT OBJECTIVE To identify the Brazilian cohorts that started either in the prenatal period or at birth, to describe their characteristics and the explored variables, and to map the cohorts with potential for studies on early determinants on health and the risk of falling ill on later stages of the life cycle. METHODS A scoping review was carried out. The articles were searched in the electronic databases PubMed and Virtual Health Library (VHL). The descriptors used were [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND (Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. The inclusion criteria were Brazilian cohorts that started the baseline in the prenatal period or at birth and with at least two follow-ups with the participants. In order to meet the concept of LCE, we excluded those cohorts whose follow-ups were restricted to the first year of life, as well as those that did not address biological, behavioral and psychosocial aspects, and cohorts with data collection of a single stage of the life cycle. RESULTS The search step identified 5,010 articles. Eighteen cohorts were selected for descriptive synthesis. The median number of baseline participants was 2,000 individuals and the median age at the last follow-up was 9 years. Sample loss at the last follow-up ranged from 9.2 to 87.5%. Most cohorts monitored two phases of the life cycle (the perinatal period and childhood). The Southern region had the highest number of cohorts. The main variables collected were sociodemographic and environmental aspects of the family, morbidity aspects, nutritional practices and lifestyle. CONCLUSIONS We recommend the continuity of these cohorts, the approach to different social contexts and the performance of follow-ups with participants in different phases of the life cycle for the strengthening and expansion of life course epidemiology analyses in Brazil.

RESUMO OBJETIVO Identificar as coortes brasileiras iniciadas no período pré-natal ou no nascimento, descrever suas características e as variáveis exploradas, além de mapear as coortes com potencial para se estudar os determinantes precoces de saúde e doença e o risco de adoecer em etapas posteriores do ciclo vital. MÉTODOS Realizou-se uma revisão de escopo. A busca dos artigos foi realizada nas bases de dados PubMed e Biblioteca Virtual em Saúde em 16 de junho de 2018. Os descritores utilizados foram [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND ("Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. Os critérios de inclusão foram coortes brasileiras que iniciaram a linha de base no período pré-natal ou no nascimento e com pelo menos dois acompanhamentos com os participantes. Foram excluídas as coortes cujos acompanhamentos foram restritos ao primeiro ano de vida, as que não abordaram aspectos biológicos, comportamentais e psicossociais e também aquelas com coleta de informações em um único estágio do ciclo vital. RESULTADOS A etapa de busca identificou 5.010 artigos. Foram selecionadas 18 coortes para a síntese descritiva. A mediana do número de participantes na linha de base foi 2.000 indivíduos e a mediana de idade no último acompanhamento foi 9 anos. A perda amostral no último acompanhamento variou de 9,2 a 87,5%. A maioria das coortes realizou acompanhamentos em duas fases do ciclo vital (período perinatal e infância). A região Sul contemplou o maior número de coortes. As principais variáveis coletadas foram sociodemográficas e ambientais da família, aspectos de morbidade, práticas alimentares e estilo de vida dos participantes. CONCLUSÕES Recomenda-se a continuidade dessas coortes, a abordagem de diferentes contextos sociais e a realização de acompanhamentos com os participantes em diferentes fases do ciclo vital para o fortalecimento e ampliação das análises de epidemiologia do ciclo vital no Brasil.

In vivo transfer of a foreign gene to keratinocytes using the hemagglutinating virus of Japan-liposome method.

The hemagglutinating virus of Japan (HVJ)-liposome method involves the entrapment of DNA and nuclear protein within liposomes and the use of HVJ to enhance liposome fusion with cell membranes. This method has been used successfully for in vivo gene transfer to various types of tissue. In this study, we investigated whether this method transfers genes effectively to normal and malignantly transformed keratinocytes in vivo. We applied HVJ-liposome complex (HLC) containing the beta-galactosidase gene to the tape-stripped skin of hairless rats and detected the enzyme activity in the keratinocytes of the treated skin. Comparison of this method with the naked DNA injection method, which was shown recently to be useful for in vivo gene transfer to keratinocytes, demonstrated that the transfer efficiency of the latter was about 5 times higher than that of the former. We assessed the efficacy of the HVJ-liposome method for gene transfer to transformed keratinocytes by examining the effect of HLC containing the herpes simplex virus thymidine kinase gene on the growth of mouse squamous cell carcinomas. Local injection of HLC into the tumors followed by administration of ganciclovir to mice resulted in tumor growth inhibition. These results indicate that the HVJ-liposome method is suitable for in vivo gene transfer to keratinocytes; also that this method may prove a good tool for basic research into keratinocyte biology and future keratinocyte gene therapy.

Changes in oral health related quality of life after dental bleaching in a double-blind randomized clinical trial.

OBJECTIVES: This study aimed to assess changes in oral health-related quality of life (OHRQoL) in individuals enroled in a double-blind randomized clinical trial conducted to evaluate the efficacy and safety of two carbamide peroxide concentrations used in at-home vital bleaching in the city of Pelotas, Southern Brazil. METHODS: Ninety-two volunteers with a shade mean of C1 or darker for the six maxillary anterior teeth were randomized into two balanced groups (n=46) according to bleaching agent concentration: 10% or 16% carbamide peroxide. The patients were instructed to use the whitening agent in a tray for 2h once a day for three weeks. To assess changes in OHRQoL, participants completed the oral impact on daily performance (OIDP) at the start and one week after the completion of treatment. Because there was no difference with regard to whitening effect or tooth sensitivity during or after treatment the two groups were merged for the analyses of the current article. Before-and-after changes in OIDP scores were assessed by chi-square and McNemar tests (p<0.05). RESULTS: Mean pre- and post-treatment OIDP scores varied from 0.42 to 0.60. When the frequency of impacts for different activities were compared, there was an increase in difficulty in cleaning teeth (p=0.02) and a significant reduction in smiling and showing teeth with embarrassment (p=0.03). Regarding the symptoms and main oral conditions that generated impact, there was higher number of participants reporting pain (p=0.05) after treatment. In opposite, significant decrease was observed in individuals reporting being unhappy with their appearance (p=0.03). On the contrary, it was showed a decrease in impacts resulting from dental colour was observed after bleaching (p=0.03). CONCLUSION: Quality of life is complex and encompasses different domains. Although positive impact of the dental bleaching was detected, with patients showing more their teeth without embarrassment, difficult in dental hygiene and pain resulting from the treatment were also reported, and this can negatively impact daily performances. Dentists must consider these aspects when performing aesthetics procedures.

Predictors of dental visits for routine check-ups and for the resolution of problems among preschool children.

OBJECTIVE: To estimate the prevalence of dental visits among preschool children and determine the factors associated with using dental services. METHODS: A cross-sectional study was conducted with 1,129 five-year-old children from the Pelotas Birth Cohort Study in Pelotas (Southern Brazil) 2004, from September 2009 to January 2010. Use of dental services at least once in the child's life and the reason for the child's first dental visit were recorded. The categories assigned for the first dental visit were: routine check-up, resolution of a problem, or never saw a dentist. The oral examinations and interviews were performed in the children's homes. Socioeconomic aspects and independent variables related to the mother and child were analyzed using multivariable logistic regression. RESULTS: The prevalence of dental visits (both categories combined) was 37.0%. The main predictors for a routine visit were higher economic status, mothers with more schooling, and mothers who had received guidance about prevention. Major predictors for a visit because of a problem were having felt pain in the previous six months, mothers with higher education level, and mothers who had received guidance about prevention. Approximately 45.0% of mothers received information about how to prevent cavities, usually from the dentist. Children of mothers who adhered to health programs were more likely to have had a routine dental visit. CONCLUSIONS: The rate of preschool visits to dental services was lower than the rate for medical appointments (childcare). In addition to income and education, maternal behavior plays an important role in routine visits. Pain reported in the last six months and a high number of teeth affected by tooth decay, independent of other factors, were associated with visits for a specific problem. It is important to integrate oral health instruction into maternal and child health programs.

Preditores da realização de consultas odontológicas de rotina e por problema em pré-escolares / Predictors of dental visits for routine check-ups and for the resolution of problems among preschool children / Predictores de la realización de consultas odontológicas de rutina y por problema en preescolares

OBJETIVO: Estimar a prevalência do uso de serviços odontológicos por pré-escolares e fatores associados. MÉTODOS: Estudo transversal com 1.129 crianças de cinco anos de idade da Coorte de Nascimentos de Pelotas 2004, RS, de setembro de 2009 a janeiro de 2010. Registrou-se o uso de serviço odontológico pelo menos uma vez na vida e o motivo para a primeira consulta odontológica da criança. As categorias do desfecho foram: ter feito a primeira consulta por rotina, para resolver um problema ou nunca ter ido ao dentista. Os exames bucais e as entrevistas foram realizados nos domicílios. Aspectos socioeconômicos e variáveis independentes ligadas à mãe e à criança foram analisados por meio de regressão logística multinomial. RESULTADOS: A prevalência de uso por qualquer motivo foi 37,0 por cento. Os principais preditores para consulta de rotina foram nível econômico mais elevado, mãe com maior escolaridade e ter recebido orientação sobre prevenção. Principais preditores para consulta por problema foram ter sentido dor nos últimos seis meses, mãe com maior escolaridade e ter recebido orientação sobre prevenção. Cerca de 45,0 por cento das mães receberam orientação de como prevenir cárie, principalmente fornecida por dentistas. Filhos de mães com história de maior aderência a programas de saúde tiveram maior probabilidade de ter feito uma consulta odontológica de rotina. CONCLUSÕES: A taxa de utilização dos serviços odontológicos por pré-escolares foi inferior às de consultas médicas (puericultura). Além da renda e da escolaridade, comportamentos maternos têm papel importante no uso por rotina. Relato de dor nos últimos seis meses e número elevado de dentes afetados por cárie, independentemente dos demais fatores, estiveram associados ao uso para resolver problema. É necessária a integração de ações de saúde bucal nos programas materno-infantis.

OBJECTIVE: To estimate the prevalence of dental visits among preschool children and determine the factors associated with using dental services. METHODS: A cross-sectional study was conducted with 1,129 five-year-old children from the Pelotas Birth Cohort Study in Pelotas (Southern Brazil) 2004, from September 2009 to January 2010. Use of dental services at least once in the child's life and the reason for the child's first dental visit were recorded. The categories assigned for the first dental visit were: routine check-up, resolution of a problem, or never saw a dentist. The oral examinations and interviews were performed in the children's homes. Socioeconomic aspects and independent variables related to the mother and child were analyzed using multivariable logistic regression. RESULTS: The prevalence of dental visits (both categories combined) was 37.0 percent. The main predictors for a routine visit were higher economic status, mothers with more schooling, and mothers who had received guidance about prevention. Major predictors for a visit because of a problem were having felt pain in the previous six months, mothers with higher education level, and mothers who had received guidance about prevention. Approximately 45.0 percent of mothers received information about how to prevent cavities, usually from the dentist. Children of mothers who adhered to health programs were more likely to have had a routine dental visit. CONCLUSIONS: The rate of preschool visits to dental services was lower than the rate for medical appointments (childcare). In addition to income and education, maternal behavior plays an important role in routine visits. Pain reported in the last six months and a high number of teeth affected by tooth decay, independent of other factors, were associated with visits for a specific problem. It is important to integrate oral health instruction into maternal and child health programs.

OBJETIVO: Estimar la prevalencia del uso de servicios odontológicos por preescolares y factores asociados. MÉTODOS: Estudio transversal con 1.129 niños de cinco años de edad de la Cohorte de Nacimientos de Pelotas 2004, RS, de septiembre de 2009 a enero de 2010. Se registró el uso de servicio odontológico por lo menos una vez en la vida y el motivo para la primera consulta odontológica del niño. Las categorías del resultado fueron: haber realizado la primera consulta por rutina, para resolver un problema, o no haber ido nunca al dentista. Los exámenes bucales y las entrevistas se realizaron en los domicilios. Aspectos socioeconómicos y variables independientes ligadas a la madre y al niño fueron analizados por medio de regresión logística multinomial. RESULTADOS: La prevalencia de uso por cualquier motivo fue de 37,0 por ciento. Los principales predictores para consulta de rutina fueron nivel económico más elevado, madre con mayor escolaridad y haber recibido orientación sobre prevención. Los principales predictores para consulta por problema fueron haber sentido dolor en los últimos seis meses, madre con mayor escolaridad y haber recibido orientación sobre prevención. Cerca de 45,0 por ciento de las madres recibieron orientación de cómo prevenir caries, principalmente suministrada por dentistas. Hijos de madres con historia de mayor adherencia a programas de salud tuvieron mayor probabilidad de haber hecho una consulta odontológica de rutina. CONCLUSIONES: La tasa de utilización de los servicios odontológicos por preescolares fue inferior a la de consultas médicas (puericultura). Además de la renta y de la escolaridad, conductas maternas tienen papel importante en el uso por rutina. Relato de dolor en los últimos seis meses y número elevado de dientes afectados por caries, independientemente de los demás factores, estuvieron asociados al uso para resolver problema. Es necesaria la integración de acciones de salud bucal en los programas materno-infantiles.

[Antioxidant activity of inhibitors of free radical reactions in the dressing materials for wound healing].

Antioxidant activity (AA) of inhibitors of free radical reactions (FRR) (dieton, mexidol, trypsin), aplied to the dressing material for wound healing was studied. In our work we used a model system containing suspension of laminated liposome, formed from fraction of total chicken yolk phospholipids. Lipid peroxidation (LPO) of liposome membranes was initiated by addition of Fe2+ ions. The kinetics of FRR was followed by coumarine-enhanced chemiluminescence (CL). It was found that AA of the inhibitors was determined by their ability to intersept aqueous and hydrofobic free radicals and chelate Fe2+ ions. Their ability to intersept radicals reduced in the following order: dieton > trypsin > mexidol. In addition we discovered unknown ability of mexidol to interact with Fe2+, that resulted in elemination of FRR catalyst. Investigating AA of the FRR inhibitors in the two-components mixture, consisting of dieton and mexidol, we observed the effect of multifunctionality: dieton, increased the duration of latent period of CL by intersepting lipid peroxyl radicals, while mexidol, decreased its value by interacting with Fe2+, i.e. mexidol masked the action of dieton. Investigating AA of two-components mixture, consisting of mexidol and trypsine, we observed the same effect of multifunctionality. In the two-component mixture, consisting of trypsine and dieton, the action of the inhibitors was found to be synergistic. All antioxidant properties of these FRR inhibitors were also preserved in the three component mixture. Hence, mixture components, dieton, mexidol and trypsin, possess high AA, that validates their use in dressing materials employed for wound healing.

Comparative study of antioxidant properties of immunoregulatory peptides.

We studied antioxidant properties of immunofan, bursin, cyclobursin, thymopoietin II fragment, glycine, and Siberian ginseng. Experiments were performed in 2 model systems: Fe(2+)-induced oxidation of multilamellar phospholipid liposomes in a heterogeneous water-lipid system and oxidation of luminol induced by alpha,alpha'-azo-bis(isobutyramidine dihydrochloride) in a homogenous aqueous system. By the ability to entrap lipid peroxyl radicals, antioxidant activity of substances decreased in the following order: Siberian ginseng extract>bursin>cyclobursin>thymopoietin II fragment>immunofan, glycine. Siberian ginseng extract and thymopoietin II fragment interacted with Fe(2+), which contributed to elimination of catalyst of lipid peroxidation from the system. The ability of substances to interact with aqueous peroxyl radicals and luminol radicals decreased in the following order: Siberian ginseng extract>thymopoietin II fragment>immunofan>glycine, cyclobursin, bursin. Substances with high antioxidant activity improved the state of the endogenous antioxidant system and protected cells from oxidative stress. They entrapped reactive oxygen species formed in the cytoplasm, modulated free radical processes, and regulated the synthesis of bioactive molecules.

Adultos livres de cárie: estudo de casos e controles sobre conhecimentos, atitudes e práticas preventivas / Adults free of caries: a case-control study about: awareness/consciousness, attitudes and preventive practices

Com o objetivo de investigar o efeito do conhecimento e atitudes pessoais, hábitos de higiene oral e uso de fluoretos sobre a total ausência de cáries, realizou-se um estudo do tipo caso-controle entre estudantes universitários da regiäo sul do Brasil. A análise bruta por regressäo logística condicional näo demonstrou efeito para as variáveis relacionadas ao uso de fluoretos e hábitos de higiene oral (p > 0,20). Já o uso de fio dental apareceu como um fator de risco: os que afirmaram näo usá-lo apresentaram "odds ratio" (OR) bruto de 0,70, e de 0,73 quando ajustado para visitas regulares ao dentista. O efeito para as visitas regulares ao dentista foi de risco. Pessoas com história de cárie visitavam mais os profissionais. Aqueles com história de cárie apresentaram um "odds ratio" bruto de 1,55; após o ajuste para uso de fio dental o risco foi levemente superior (OR = 1,67). Hábitos de higiene oral näo demonstraram efeito protetor esperado. O uso de fluoretos näo esteve significativamente associado à ausência de cáries. Permanece intrigando o fato de que algumas pessoas näo desenvolvam cáries, mesmo näo relatando cuidados considerados ideais à saúde bucal.