Geographic information system and multilevel analysis: gingival status among 12-year-old schoolchildren in São Paulo, Brazil.

OBJECTIVE: To evaluate gingival and calculus status among schoolchildren 12 years of age using a geographic information system and multilevel analysis. METHODS: A total of 1 002 schoolchildren were selected from 18 municipal districts by means of cluster sampling, from among 25 public and private schools in Piracicaba, São Paulo, Brazil, in 2005. Examinations were carried out by a single calibrated examiner utilizing the criteria of the World Health Organization, as well as the Community Periodontal Index. Social, economic, and behavioral variables were recorded with the use of a questionnaire and were used in the individual analysis (first level). The variables "percentage of heads of families without income" and "percentage of illiterate heads of families" were used in the contextual analysis (second level). RESULTS: A geographic information system was constructed for mapping the distribution of gingival bleeding. The variables were visually distinguished in the maps and demonstrated a tendency toward better gingival health in the central areas of the city, which are recognized as more privileged. On the contextual level, only the "percentage of illiterate heads of families" was significantly associated to gingival bleeding. CONCLUSIONS: The study confirms better oral health status among schoolchildren from privileged families, but does not confirm the data regarding "income." The individuals from areas in which the heads of family did not have income were not associated to a higher prevalence of gingival problems. This suggests that these individuals are reasonably protected from the impact of social privation due to the actions of public health care services in the municipality.

A cohort study of caries incidence and baseline socioeconomic, clinical and demographic variables: a Kaplan-Meier survival analysis.

PURPOSE: To determine the incidence of dental caries and evaluate the influence of socioeconomic, clinical and demographic variables on the time for disease to appear in the permanent teeth after 3 years of follow-up. MATERIALS AND METHODS: The random sample of this cohort study consisted of 427 5-year-old preschool children attending 22 public preschools in Piracicaba, SP, Brazil. Dental caries was measured using the dmf/DMF indices. The Kaplan- Meier survival analysis method was used to study the isolated effect of socioeconomic, clinical and demographic variables on caries incidence after 3 years. A Cox proportional hazards regression model was built to test the influence of the variables collected at baseline on time to develop DMFT increment. RESULTS: Survival analysis showed that children without past caries experience in primary teeth at baseline remained caries free in permanent teeth for a longer period than children with past caries experience at baseline. The variables monthly family income, parents' educational level, number of people living in the household, home ownership and car ownership were not significant. CONCLUSION: Children who presented past caries experience in primary teeth at baseline are at greater risk of developing DMFT increment than children who have no past caries experience at baseline.

Validity of caries-detection methods under epidemiological setting.

PURPOSE: To evaluate the validity of the visual exam and adjunct diagnostic technologies for posterior permanent teeth under epidemiological conditions. METHODS: A probabilistic sample of 165 12-year-old schoolchildren from Piracicaba, São Paulo, Brazil, was examined by visual exam (VI1), visual exam + artificial lighting (VI2), bitewing (BW), fiber optic transillumination (FOTI), DIAGNOdent and the associations among them. The D1+D3 and D3 diagnostics criteria, under epidemiological conditions, were adopted. The sensitivity, specificity and accuracy were calculated to determine the validity of the exams. RESULTS: The most accurate diagnostic method was VI2+BW exam for all dental surfaces under both diagnostic criteria. It was concluded that the BW was the best adjunct diagnostic technology on epidemiological dental caries surveys, increasing the validity of the dental exams.

Reproducibility of adjunct techniques for diagnosis of dental caries in an epidemiological situation.

PURPOSE: To evaluate the reproducibility of visual exams under natural light (VE1), visual exams under artificial light (VE2), radiographic bitewing exams (BW), fibre optic transillumination exams (FOTI) and DIAGNOdent exams (DD) in epidemiological settings. MATERIALS AND METHODS: Three examiners and one benchmark examiner examined thirteen 12-year-old schoolchildren under epidemiological conditions for the D3 (carious lesions in dentin) and D1+D3 (carious lesions in enamel or dentin) diagnostic criteria. RESULTS: The reproducibility (intra/interexaminer agreement) under both diagnostic criteria was 'almost perfect' for the exams VE1 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.89/κinter = 0.84), VE2 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.88/κinter = 0.83), BW (D3: κintra = 0.95/κinter = 0.92; D1+D3: κintra = 0.99/κinter = 0.90) and FOTI (D3: κintra = 0.97/κinter = 0.93; D1+D3: κintra = 0.87/κinter = 0.83) exams and 'fair' for the DD exam (D3: κintra = 0.36/κinter = 0.35; D1+D3: κintra = 0.30/κinter = 0.32). CONCLUSION: It was concluded that the VE1, VE2, BW, and FOTI exams presented good reproducibility under epidemiological conditions, and can be used accurately in epidemiological surveys.

Assessment of caries experience in 12-year-old adolescents in Piracicaba, Sao Paulo, Brazil.

PURPOSE: The aim of the present study was to analyse the association between socioeconomic and behavioural factors and the presence of active non-cavitated caries lesions in 12-year-old adolescents in Piracicaba, São Paulo, Brazil. MATERIALS AND METHODS: A cross-sectional study was carried out in 1001, 12-year-old adolescents who were selected by the cluster sampling method. A modified version of the World Health Organization criteria for identifying lesions including white lesions (WL) in enamel was used. Information on behavioural and socioeconomic factors was obtained using a semi-structured questionnaire. The outcome variables were DMFS, DMFS+WL and WL. The data obtained were analysed using the chi-square test and a logistic regression model. RESULTS: The mean DMFS was 1.87 (SD = 3.05) and DMFS+WL was 2.27 (SD = 3.66). The logistic regression model showed that income was statistically significantly associated with DMFS, DMFS+WL and WL, whereas educational level of the father, number of residents in the house and number of dental visits were associated with DMFS and DMFS+WL. The onset of toothbrushing was associated with WL. CONCLUSIONS: The present study showed that economic factors are associated with all stages of caries development. In addition to these factors, family size, number of dental visits, educational level of the father and onset of toothbrushing could be considered markers of dental health risk.

Risk indicators of temporomandibular disorder incidences in early adolescence.

PURPOSE: Although temporomandibular disorder (TMD) has been presumed to be a condition affecting adults, studies have reported the presence of signs and symptoms in children. The purpose of this paper was to verify the influence of gender, mother's gestational behavior, malocclusion, and oral habits as risk indicators for TMD in 12-year-old adolescents. METHODS: TMD pain was assessed by research diagnostic criteria for temporomandibular disorders (RDC/TMD; axis I). Five-hundred fifty-eight subjects (330 girls and 228 boys) underwent examinations. Bivariate analyses were performed using the chisquare test. The logistic regression models were adjusted estimating the odds ratio (OR), 95% confidence interval (CI), and significance level. RESULTS: Only 2% of boys and 7% of girls presented one of the axis I categories. Gender was significantly related to TMD diagnosis (P<.01). Menarche, however, was not associated. Malocclusion, mother's gestational behavior, and children's oral habits were not associated with incidence of TMD (P>.05). Girls were almost 4 times more affected than boys (OR=3.97; CI=1.51-10.53). CONCLUSIONS: The mothers' gestational behavior and presence of menarche, malocclusion, and oral habits by their adolescents were not associated with diagnosis of temporomandibular disorder. Gender was the only factor associated with the incidence of TMD in 12-year-old adolescents.

Sugar consumption and dental health: Is there a correlation?

This study investigated the correlation between sugar consumption and dental caries in a random sample of 184 schoolchildren (all 12 years of age) from public and private schools in Piracicaba, Brazil. A seven-day diet record was administered in a cross-sectional survey. Diet records were used to determine the frequency of sugar consumption both during and between meals. Socioeconomic and behavioral variables were collected in a semi-structured questionnaire. Using Community Periodontal Index (CPI) probes and mirrors and following WHO recommendations, a calibrated dentist assessed the number of decayed, missing, and filled surfaces (DMFS) on permanent teeth, the CPI, and the number of noncavitated (NC) carious lesions. Data analysis demonstrated significant correlations between NC carious lesions and sugar consumption during morning snack (p = 0.0282; r = 0.1618), NC carious lesions and sugar consumption during lunch (p = 0.0539; r = 0.1425), monthly family income and sugar consumption during dinner (p < 0.001; r = 0.2970), father's education and sugar consumption during dinner (p = 0.0027; r = 0.2430), and onset of toothbrushing and sugar consumption during dinner (p = 0.0159; r = 0.1786). A high consumption of sweet foods/beverages occurred between meals (mean = 17.48; standard deviation = 14.68). Although there was no correlation between DMFS and sugar consumption, there was a correlation between NC carious lesions and sugar consumption, indicating that the rational use of sugar is an important factor in caries prevention.

Risk indicators for signs and symptoms of temporomandibular dysfunction in children.

OBJECTIVES: The aim of this study was to determine the risk indicators for signs and symptoms of temporomandibular dysfunction (TMD) in children between 4 and 12 years of age. STUDY DESIGN: One hundred six patients were assessed for the following variables: (1) signs and symptoms of TMD (deviation when opening mouth, joint noises, limitation of movement, pain in the mandible or during movement), (2) dentition and occlusal abnormalities, and 3) habits (pacifier sucking, nonnutritive sucking, finger sucking, nail biting, and teeth grinding (bruxing). Multivariate logistic regression was performed with the level of significance set at P < 0.05. RESULTS: The prevalence of at least one sign or symptom of TMD in the present sample was 12.26% (n = 13). Only bruxing (P = 0.01, odds ratio 6.08, CI 1.51-24.51) and posterior crossbite (P = 0.03, odds ratio 5.74, CI, 1.18-27.85) achieved statistical significance in the multivariate regression model and were considered risk indicators for signs and symptoms of TMD. CONCLUSIONS: Children with bruxing or clenching habits and those with posterior crossbite have a greater likelihood of developing signs and symptoms of TMD.

Risk indicators of gingivitis in 5-year-old Brazilian children.

PURPOSE: To identify the risk indicators of gingivitis among socioeconomic, clinical and gender variables in 5-year-old children attending preschools in Piracicaba, Brazil, in 2005. MATERIALS AND METHODS: The sample consisted of 728 subjects attending 22 public (n = 428) and 18 private (n = 300) preschools. A previously calibrated examiner performed the clinical examination in an outdoor setting, under natural light, using a dental mirror, Community Periodontal Index probe and air-drying. Gingival status was measured using the gingival alteration index for 5-year-olds according to the national survey carried out in 2002 in Brazil (Health Ministry of Brazil, 2004). Socioeconomic variables (monthly family income, number of people living in the household, parents' educational level, home ownership and car ownership) were collected by means of a parental semi-structured questionnaire. RESULTS: The prevalence of gingivitis was 16.6%. Monthly family income (p < 0.0001), father's education (p < 0.0007), mother's education (p = 0.0004), type of school (p < 0.0001), car ownership (p = 0.0854), gender (p = 0.0087), initial lesion (p < 0.0001), dental caries (p = 0.0008), crowding (p = 0.0054) and spacing (p = 0.0019) were associated with gingival bleeding at p < 0.15 and were selected for the regression analysis. By means of multiple logistic regression analyses, monthly family income of up to 4 Brazilian minimum wages, presence of initial lesion, presence of crowding and male gender were found to be risk indicators of gingivitis. CONCLUSION: The prevalence of gingivitis in 5-year-old preschool children in Piracicaba was 16.6%. Also, family income of up to 4 minimum wages, male gender, the presence of initial caries lesion and crowding were risk indicators of gingivitis.

Dental caries in 12-year-old schoolchildren and its relationship with socioeconomic and behavioural variables.

PURPOSE: This study attempts to describe the caries experience in 12-year-old schoolchildren in Piracicaba, Brazil, and to verify the relationship between the disease and socioeconomic factors, and behavioural variables related to oral health. MATERIALS AND METHODS: The random sample consisted of 939 individuals from public and private schools in Piracicaba, São Paulo State, Brazil, in 2005. A calibrated dentist performed the examination in an outdoor setting, under natural light, using CPI probes and mirrors, following WHO recommendations. A questionnaire was sent to the parents to collect information on socioeconomic level and behavioural variables related to dental health. The mean number of decayed, missing and filled permanent teeth and surfaces (DMFT/DMFS), the Care Index and the SiC (Significant Caries Index) were determined. Multiple logistic regression analyses using the stepwise procedure were performed in order to identify the risk indicators for the DMFT and for the polarisation group. RESULTS: The DMFT and the SiC Index were 1.32 (SD = 1.92) and 3.52 (SD = 1.86), respectively, and the Care Index was 75.0%. The regression models showed that females and children with either low family income or low education level of the fathers were prone to have caries or take part in the polarisation group. CONCLUSION: The 12-year-old individuals from Piracicaba presented a low prevalence of caries. Nevertheless, those high caries-level individuals showed moderate caries experience. The socioeconomic and the behavioural variables related to dental health were risk indicators of caries in permanent dentition not only for the entire sample, but also for the polarisation group.

[Sample size and costs estimate in epidemiological survey of dental caries]. / Tamanho de amostra e estimativa de custo em levantamento epidemiológico de cárie dentária.

This study aimed to analyze how the prevalence and the distribution of dental caries influence the sample size in epidemiological surveys, and how much are the costs. Secondary data of oral health surveys in 12-year-old schoolchildren from Bauru in 1976, 1984, 1990, 1994, and 2001, and from Piracicaba in 2001 and 2005 were studied. Sample sizes were estimated taking into account the mean DMFT and standard deviation of each survey, establishing sampling errors of 1%, 2%, 5%, and 10%. Costs were estimated considering permanent material, consumption material and human resources. The sample size in both towns needed to be increased, ranging from 119 in 1976 to 1,118 in 2001 in Bauru, and from 954 in 2001 to 1,252 in 2005 in Piracicaba, when a sampling error of 10% was considered. The cost of dental caries surveys was verified considering different sampling errors. This cost depends on how acceptable is the margin of difference between the true mean and the one found in the survey. In conclusion, the reduction in the prevalence of dental caries has determined the need for increase in sample size and in costs for conducting the surveys.

Diagnosis of secondary caries in esthetic restorations: influence of the incidence vertical angle of the X-ray beam.

The aim of this study was to evaluate the accuracy on the diagnosis of secondary caries-like lesions simulated on esthetic restorations of different materials, changing the incidence vertical angle (IVA) of the x-ray beam. Twenty human teeth received MOD inlay preparations. In the experimental group (n=10), a round cavity was made in the floor of the proximal box to simulate the caries-like lesion. All teeth were restored with 3 composite resins (Charisma, Filtek-Z250 and TPH-Spectrum) at 3 moments. Two radiographic images were acquired with 0º and 10º IVA. Ten observers evaluated the images using a 5-point confidence scale. Intra- and interobserver reliability was analyzed with the Interclass Correlation Coefficient and the diagnostic accuracy was evaluated using the area under the ROC curve (A(z)), Friedman test and Wilcoxon test (α=0.05). Higher accuracy values were obtained with 10º IVA (A(z)=0.66, Filtek-Z250>A(z)=0.56, TPH-Spectrum) compared to 0º (A(z)=0.55, Charisma>A(z)=0.37, TPH-Spectrum), though without statistically significant difference (p>0.05). The detection of secondary caries-like lesions simulated on esthetic restorations of different materials suffered no negative influence by changing the IVA of the x-ray beam.

Relação entre fatores socioeconômicos, clínicos e saúde bucal em escolares da zona rural: um estudo longitudinal / Relationship among socioeconomic and clinical factors with oral health, in schoolchildren from rural areas: a longitudinal study

Objetivos: Este estudo longitudinal avaliou: a) o impacto de ações bimestrais de atenção básica em saúde bucal no incremento da cárie e mancha branca em uma população rural; b) associações entre variáveis sociais, econômicas e cárie e mancha branca. Materiais e método: exames (baseline, após 6 e 12 meses) e ações educativas e preventivas bimestral (baseline, 2, 4, 6, 8, 10, 12 meses) foram realizados em 161 crianças. A análise univariada (Qui-Quadrado) utilizou CPOD, ceod e mancha branca como variáveis de desfecho (p<0,05). Resultados: a mancha branca estava presente em 42,82%, 33,33% e 28,03% das crianças no baseline, após 6 e 12 meses, respectivamente. No baseline, houve associação significativa entre grau de escolaridade da mãe (p=0,0040) e número de pessoas na família (p=0,0068), para os desfechos CPOD e ceod, respectivamente. Após seis meses, houve associação entre CPOD e grau de escolaridade da mãe (p=0,0059), ceod e número de pessoas na família (p=0,0173) e grau de escolaridade do pai (p=0,0412), além de associação entre mancha branca e água ingerida (p=0,0350). Após doze meses, apenas o grau de escolaridade da mãe (p=0,0049) foi estatisticamente associado ao CPOD. Conclusão: apesar da alta experiência de cárie, houve diminuição substancial das manchas brancas após implementaçãodo programa preventivo.

Associação do risco familiar com saúde bucal, qualidade de vida e variáveis socioeconômicas / Association of familial risk with oral health, quality of life and socioeconomic variables / Asociación del riesgo familiar con salud oral, calidad de vida y variables socioeconómicas

Objetivo: avaliar a relação do risco familiar com saúde bucal, qualidade de vida e variáveis socioeconômicas. Métodos: estudo observacional transversal com 311 indivíduos com idade entre 18 e 71 anos, residentes na área de abrangência de quatro unidades de saúde da família (USF), localizadas em dois municípios do estado de São Paulo. Os voluntários foram avaliados de acordo com: (1) situação clínica (CPO-D e necessidade de tratamento), (2) autopercepção de saúde bucal (OHIP-14), (3) qualidade de vida (WHOQOL-BREF), e (4) condição socioeconômica. Para avaliar o risco familiar, utilizou-se a Escala de Coelho. Os dados foram analisados por meio de modelo multinível formado por componentes fixos (representados pelas variáveis estudadas) e componentes aleatórios (representados pelos bairros e pelas variâncias nos diferentes níveis). Resultados: a média de idade dos participantes foi de 36,7 anos (dp=13), com CPO-D médio de 12,9 (dp=7,0). A média da Escala de Risco de Coelho entre os voluntários foi de 2,67 com erro padrão de 0,32. Apresentaram maior escore de risco total os indivíduos de maior idade (p=0,0486), que moravam em casas com mais residentes (p<0,001), com menos anos de escolaridade (p=0,0137), que não possuíam automóvel (p=0,0048) e com maior escore de OHIP-14 (p=0,0130). Conclusão: a escala de risco familiar associou-se positivamente às variáveis socioeconômicas, e os indivíduos com maior risco familiar apresentaram pior autopercepção da saúde bucal, mas não percebiam uma pior qualidade de vida em geral.

Objective: to assess the relation of familial risk with oral health, quality of life and socioeconomic variables. Methods: cross-sectional observational study encompassing 311 individuals (18 to 71 years old) living in the catchment area of four Family Health Units located in two municipalities of São Paulo state. The participants were evaluated according to: (1) clinical situation (CPO-D and treatment necessity); (2) self-perception oral health (OHIP-14), (3) quality of life (WHOQOL-BREF); and (4) socioeconomic status. The Coelho Scale was used for assessing familial risk. Data were analyzed using a multilevel model formed by fixed components (represented by the studied variables) and random components (represented by the neighborhoods and the variances in the different levels). Results: the participants' average age was 36.7 years old (SD=13), and the average CPO-D was 12.9 (SD=7.0). The average of the Coelho´s Risk Scale among the volunteers was 2.67, with a standard error of 0.32. The participants with higher total risk score were older individuals (p=0.0486) who lived in houses with more residents (p<0.001), who wereless educated (p=0.0137), who did not own a vehicle (p=0.0048), and who had a higher OHIP-14 score (p=0.0130). Conclusion: the familial risk scale was positively associated with the socioeconomic variables, and the individuals with higher familial risk score had worse self-perception of their oral health. However, they did not perceive themselves as having worse general quality of life.

Objetivo: evaluar la relación del riesgo familiar con salud bucal, calidad de vida y las variables socioeconómicas. Métodos: estudio observacional transversal que abarca 311 individuos (18 a 71 años de edad) habitantes en la zona de captación de cuatro Unidades de Salud Familiar ubicadas em dos municipios del estado de São Paulo. Los participantes fueron evaluados de acordo con: (1) situación clínica (necesidad de tratamiento y CPOD); (2) auto percepción de salud bucal (OHIP-14): (3) calidad de vida (WHOQOL-BREF); y (4) nivel socioeconómico. Para medición del riesgo familiar, se utilizo la Escala de Coelho. Los datos fueron analizados mediante el modelo multinivel que consiste de componentes fijos (representados por las variables) y componentes aleatorios (representados por los barrios y las variaciones en los diferentes niveles). Resultados: la edad media de los participantes fue 36,7 años (de = 13), y la media de lo CPO-D fue 12,9 (de = 7,0). La media de riesgo de la Escala de Coelho fue 2,67 con un error estándar de 0,32. Tuvieran puntuaciones de riesgo más altas los individuos de mayor edad (p = 0,0486), que vivían en hogares con más residentes (p <0,001), con menos años de educación (p = 0,0137), que no tenían coche (p = 0,0048) y que tuvieran mayor score de OHIP-14 (p = 0,0130). Conclusión: la escala de riesgo familiar se asoció positivamente con las variables socioeconómicas y los individuos con mayor riesgo familiar tuvieran una percepción peor de su salud bucal, sin embargo, no se percibirán como que teniendo peor calidad de vida en general.

Relationships of beta-blockers and anxiolytics intake and salivary secretion, masticatory performance and taste perception.

OBJECTIVE: Assess the influence of salivary flow on physiological parameters of the stomatognathic system in patients who take beta-blockers or anxiolytic medications. DESIGN: Sixty patients were divided into three groups based on the following criteria: Group 1, control (n=20; no use of medication); Group 2, use of antihypertensive beta-blockers (n=20); and Group 3, use of benzodiazepine anxiolytics (n=20). Salivary flow was assessed by determining stimulated and non-stimulated flow/minute. The quantification of the sense of taste was determined on a visual analogue scale (VAS) using solutions of 0.9% NaCl (salty), 50% sucrose (sweet), 20% unsweetened coffee (bitter) and 4.2% vinegar (sour). The DMFT index (number of decayed/missing/filled teeth) was determined by a calibrated examination, following the criteria of the World Health Organization (WHO). Masticatory performance was assessed with an Optosil comminution test and Rosim-Ramler equation. RESULTS: The results did not reveal a significant correlation between salivary flow and masticatory performance (p>0.05). We observed significant decreased non-stimulated salivary flow for Group 2 (p=0.05) when compared to controls. However, taste perception was not influenced by salivary secretion amongst groups. Furthermore, we observed a significant negative correlation between non-stimulated salivary flow and DMFT in Group 1 (p=0.02; r=-0.52). CONCLUSIONS: Patients under beta-blockers therapy presented reduced non-stimulated salivary flow when compared to controls, without influencing the sense of taste or masticatory performance. The use of anxiolytics did not affect salivary flow and taste perception in the studied sample.

Estimate of DMFT index using teeth most affected by dental caries in twelve-year-old children.

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.

Geographic information system and multilevel analysis: gingival status among 12-year-old schoolchildren in São Paulo, Brazil / Sistema de información geográfica y análisis de niveles múltiples: estado gingival en escolares de 12 años de edad en São Paulo, Brasil

OBJECTIVE: To evaluate gingival and calculus status among schoolchildren 12 years of age using a geographic information system and multilevel analysis. METHODS: A total of 1 002 schoolchildren were selected from 18 municipal districts by means of cluster sampling, from among 25 public and private schools in Piracicaba, São Paulo, Brazil, in 2005. Examinations were carried out by a single calibrated examiner utilizing the criteria of the World Health Organization, as well as the Community Periodontal Index. Social, economic, and behavioral variables were recorded with the use of a questionnaire and were used in the individual analysis (first level). The variables "percentage of heads of families without income" and "percentage of illiterate heads of families" were used in the contextual analysis (second level). RESULTS: A geographic information system was constructed for mapping the distribution of gingival bleeding. The variables were visually distinguished in the maps and demonstrated a tendency toward better gingival health in the central areas of the city, which are recognized as more privileged. On the contextual level, only the "percentage of illiterate heads of families" was significantly associated to gingival bleeding. CONCLUSIONS: The study confirms better oral health status among schoolchildren from privileged families, but does not confirm the data regarding "income." The individuals from areas in which the heads of family did not have income were not associated to a higher prevalence of gingival problems. This suggests that these individuals are reasonably protected from the impact of social privation due to the actions of public health care services in the municipality.

OBJETIVO: Evaluar el estado gingival y la presencia de sarro en escolares de 12 años de edad mediante el empleo de un sistema de información geográfica y análisis de niveles múltiples. MÉTODOS: En el año 2005, se seleccionó a un total de 1 002 escolares de 18 distritos municipales mediante muestreo por grupos, con la participación de 25 escuelas públicas y privadas de Piracicaba, en el estado de São Paulo, Brasil. Un único examinador calibrado, que utilizó los criterios de la Organización Mundial de la Salud, así como el Índice Periodontal Comunitario, llevó a cabo los exámenes. Mediante un cuestionario, se registraron las variables sociales, económicas y conductuales, y estas se emplearon en el análisis individual (primer nivel). En el análisis contextual (segundo nivel), se utilizaron las variables "porcentaje de cabezas de familia sin ingresos" y "porcentaje de cabezas de familia analfabetas". RESULTADOS: Se construyó un sistema de información geográfica para elaborar mapas de la distribución de la hemorragia gingival. Los mapas, donde se pueden distinguir visualmente las variables, demostraron una tendencia hacia una mejor salud gingival en las zonas del centro de la ciudad, consideradas como privilegiadas. En el nivel contextual, únicamente el "porcentaje de cabezas de familia analfabetas" se asoció significativamente con el sangrado gingival. CONCLUSIONES: El presente estudio confirma una mejor salud bucodental en los escolares pertenecientes a familias privilegiadas, pero no confirma los datos en cuanto a "ingresos". Las personas residentes en zonas donde las cabezas de familia no tenían ingresos no presentaron una mayor prevalencia de problemas gingivales. Esto indica que estas personas, como consecuencia de las actividades de los servicios de atención de salud pública del municipio, están razonablemente protegidas de la repercusión de la privación social.

Estudo longitudinal dos sinais e sintomas de disfunção temporomandibular frente a tratamento conservador com placa estabilizadora em clínica de graduação / Longitudinal study of signs and symptoms of temporomandibular dysfunction aftre conservative tretment with stabilizing splints by undergraduate students

Objetivo: Avaliar longitudinal a eficácia da terapia oclusal em pacientes com Disfunção Temporomandibular (DTM) atendidos em clínica de graduação de curso de Odontologia. Materiais e Métodos: Os indivíduos foram examinados clinicamente utilizando-se o índice internacional Research DiagnosticCriteria for Temporomandibular Disorders (RDC/TMD) na época de seu atendimento (T0) e reavaliados 6meses após o início do tratamento com placas estabilizadoras (T1). Dezesseis pacientes participaram das duasavaliações. Oitenta e oito por cento dos pacientes examinados eram do sexo feminino. Foram avaliados os seguintes parâmetros: 1) Dor: através de Escala VAS (dor no momento da avaliação, dor média nos últimos 6 meses e pior dor nos últimos 6 meses), 2) Amplitude dos movimentos mandibulares (abertura bucal, protrusão e lateralidade); 3) Sons articulares (clique, crepitação) e 4) Sensibilidade à palpação dos músculos mastigatórios e da articulação temporomandibular. Os dados foram comparados entre os dois momentos utilizando-se o teste “t” pareado ou Wilcoxon. Correlação de Pearson foi realizada entre as variáveis dor e amplitude dos movimentos mandibulares. O índice de significância foi ajustado em p<0,05. Resultados: Houve melhora significativa entre as duas sessões para as variáveis relacionadas à dor e amplitude dos movimentos mandibulares (p<0,05), exceto protrusão (p=0,438). Houve correlação negativa significativa somente entre a dor média e aamplitude da abertura bucal antes do tratamento (p<0,05). Após o tratamento, essa correlação não persistiu (p>0,05). Conclusões: As placas oclusais lisas planas mostraram melhora significativa para a dor e amplitude dos movimentos mandibulares, mostrando ser um tratamento eficiente a ser realizado em clínicas de graduação para pacientes com dor miofascial e deslocamento de disco.

Tamanho de amostra e estimativa de custo em levantamento epidemiológico de cárie dentária / Sample size and costs estimate in epidemiological survey of dental caries

O objetivo do presente estudo foi analisar como a prevalência e a distribuição da cárie dentária influenciam o tamanho da amostra em levantamentos epidemiológicos, e os custos para sua realização. Foram utilizados dados de levantamentos realizados em escolares de 12 anos em Bauru nos anos de 1976, 1984, 1990, 1994 e 2001, e em Piracicaba nos anos de 2001 e 2005. Os tamanhos amostrais foram dimensionados considerando-se a média e o desvio padrão obtidos, fixando-se erro amostral em 1 por cento, 2 por cento, 5 por cento e 10 por cento. Os custos foram estimados considerando material permanente, de consumo e recursos humanos. Verificou-se aumento no tamanho das amostras em ambos os municípios, variando de 119 em 1976 para 1.118 em 2001 em Bauru, e de 954 em 2001 para 1.252 em 2005 em Piracicaba, considerando-se um erro amostral de 10 por cento. Considerando-se diferentes erros amostrais, verificou-se o custo para o levantamento, sendo que o mesmo depende do quanto o pesquisador se permite errar em relação ao verdadeiro valor da média da população. Conclui-se que a diminuição da prevalência da cárie dentária determinou o aumento no tamanho das amostras e a elevação dos custos para realização dos levantamentos.

This study aimed to analyze how the prevalence and the distribution of dental caries influence the sample size in epidemiological surveys, and how much are the costs. Secondary data of oral health surveys in 12-year-old schoolchildren from Bauru in 1976, 1984, 1990, 1994, and 2001, and from Piracicaba in 2001 and 2005 were studied. Sample sizes were estimated taking into account the mean DMFT and standard deviation of each survey, establishing sampling errors of 1 percent, 2 percent, 5 percent, and 10 percent. Costs were estimated considering permanent material, consumption material and human resources. The sample size in both towns needed to be increased, ranging from 119 in 1976 to 1,118 in 2001 in Bauru, and from 954 in 2001 to 1,252 in 2005 in Piracicaba, when a sampling error of 10 percent was considered. The cost of dental caries surveys was verified considering different sampling errors. This cost depends on how acceptable is the margin of difference between the true mean and the one found in the survey. In conclusion, the reduction in the prevalence of dental caries has determined the need for increase in sample size and in costs for conducting the surveys.

Diagnosis of secondary caries in esthetic restorations: influence of the incidence vertical angle of the X-ray beam

The aim of this study was to evaluate the accuracy on the diagnosis of secondary caries-like lesions simulated on esthetic restorations of different materials, changing the incidence vertical angle (IVA) of the x-ray beam. Twenty human teeth received MOD inlay preparations. In the experimental group (n=10), a round cavity was made in the floor of the proximal box to simulate the caries-like lesion. All teeth were restored with 3 composite resins (Charisma, Filtek-Z250 and TPH-Spectrum) at 3 moments. Two radiographic images were acquired with 0º and 10º IVA. Ten observers evaluated the images using a 5-point confidence scale. Intra- and interobserver reliability was analyzed with the Interclass Correlation Coefficient and the diagnostic accuracy was evaluated using the area under the ROC curve (Az), Friedman test and Wilcoxon test (α=0.05). Higher accuracy values were obtained with 10º IVA (Az=0.66, Filtek-Z250>Az=0.56, TPH-Spectrum) compared to 0º (Az=0.55, Charisma>Az=0.37, TPH-Spectrum), though without statistically significant difference (p>0.05). The detection of secondary caries-like lesions simulated on esthetic restorations of different materials suffered no negative influence by changing the IVA of the x-ray beam.

O objetivo deste estudo foi avaliar a precisão no diagnóstico de lesões iguais-à-cárie secundárias simuladas em restaurações estéticas de materiais diferentes, mudando o ângulo vertical de incidência (AVI) do feixe de raios-x. Vinte dentes humanos foram submetidos a preparo cavitário inlay MOD. No grupo experimental (n=10), no soalho da caixa de proximal, foi confeccionada uma cavidade esférica para simular lesões iguais-a-cárie. Todos os dentes foram restaurados com 3 resinas compostas (Charisma, Filtek-Z250, TPH-Spectrum), em três tempos diferentes. Duas imagens radiográficas foram adquiridas com 0 e 10 graus de AVI o feixe de raios-x. Dez observadores avaliaram as imagens usando uma escala de confiança de 5-pontos. A reprodutibilidade intra- e inter- observador foi analisada com o coeficiente de correlação interclasse e a precisão do diagnóstico foi avaliada usando a área sob a curva ROC (Az), o teste de Friedman e de Wilcoxon (α=0,05). Os mais altos valores de precisão (p>0,05) foram observados com o AVI em 10º (Filtek-Z250 Az=0,66>TPH-Spectrum Az=0,56) comparado com 0º (Charisma Az=0,55>TPH-Spectrum Az=0,37), porém, sem diferenças estatisticamente significantes (p>0,05). A detecção de lesões iguais-à-cárie secundárias simulada em restaurações estéticas de diferentes materiais não foi influenciada pela mudança de AVI do feixe de raios-x.