Life course social mobility, race and tooth loss in adulthood: The role of dental health services.

OBJECTIVES: To evaluate the extent to which dental care factors in adulthood modify and, at the same time, mediate the association between race/ethnicity and social mobility from childhood to adulthood with two oral health outcomes in adults. METHODS: In 2012, 1222 individuals 20-59 years old participated in the second wave of the Epi-Floripa Study in Florianopolis, Brazil. Exposures included social mobility based on adulthood and childhood events, dental care in previous years, type of dental care coverage, reason for dental visits and race. The number of missing and decayed teeth were dichotomised as MT >0 and DT >0. RESULTS: The prevalence of missing and decayed teeth was 61.9% and 23.0%, respectively. Age-sex adjusted inequalities in decayed and missing teeth among Black and White individuals were 41.2 percentage points (pp) (95% CI: 3.9-78.7) and 53.1 pp (19.5:86.7), respectively. Inequalities between those persistently higher and lower in socioeconomic position were 42.6 pp (14.6-70.7) and 90.0 pp (62.1-100). The Relative Excess of Risk due to Interaction (RERI) was not statistically significant (p < 0.05). Oaxaca-Blinder decomposition analyses showed that dental care variables accounted for a small proportion of inequalities. CONCLUSIONS: This result implies that dental care is unlikely to significantly reduce or increase oral health inequalities in this particular population.

Dental caries among over 1.5 million records of schoolchildren in Singapore, 2007 - 2019: age-period-cohort effect analyses.

INTRODUCTION: This study aimed to examine the effects of age, period (historical events), and cohort (generational impact) - APC on caries prevalence and mean DMFT among Singapore schoolchildren from 2007 to 2019. METHODS: Anonymized records of all 6-year-old Primary 1 (P1), 11-year-old Primary 6 (P6), and 14-year-old Secondary 3 (S3) students before the start of each school year between 2007 and 2019 were extracted from the Integrated Dental Electronic Assessment System (IDEAS), categorised by school level, ethnicity, and sex. Poisson regression and Partial Least Squares (PLS) regressions were applied to estimate APC effects. RESULTS: In total, 502339 P1, 535579 P6, and 496725 S3 records were included from 2007 to 2019, with 1058589 (69.0%) Chinese, 187948 (12.2%) Malay, and 152618 (9.9%) Indian students; 245447 (48.8%) P1, 259389 (48.4%) P6, and 243941 (49.1%) S3 students were girls. Overall, the APC effects on caries prevalence and mean DMFT showed a strong age effect, with the lowest prevalence in the youngest P1 group and the highest in the oldest S3 group. Period and cohort effects were identified, with the prevalence decreasing among those born after 1995 and the lowest prevalence rate in 2013. Similarly, period and cohort effects on mean DMFT were also detected, with decreased mean DMFT after period 2009 and the highest mean DMFT (0.72 in P6 and 1.13 in S3) in cohort 1995. CONCLUSION: Caries prevalence and DMFT increased with age. While both decreased in individuals born after 1995, mean DMFT began to rise again in those born after 2003.

The Controlled Direct Effect of Early-Life Socioeconomic Position on Periodontitis in a Birth Cohort.

This study used data from the 1982 Pelotas Birth Cohort Study, Brazil, to estimate the controlled direct effect of early-life socioeconomic position (SEP) on periodontitis at age 31 years, controlling for adulthood income and education, smoking, and dental hygiene. Sex was included as a covariate. Early-life SEP was measured at participant birth based on income, health services payment mode, maternal education, height, and skin color (lower versus middle/higher SEP). Periodontitis was assessed through clinical examination at age 31 years (healthy, mild periodontitis, or moderate-to-severe disease). Adulthood behaviors (smoking, dental hygiene) were the mediators, and adulthood SEP (education and income) represented the exposure-induced mediator-outcome confounders. A regression-based approach was used to assess the controlled direct effect of early-life SEP on periodontitis. Multinomial regression models were used to estimate risk ratios and their 95% confidence intervals. The prevalences of mild and moderate-to-severe periodontitis were 23.0% and 14.3%, respectively (n = 539). Individuals from the lowest early-life SEP had a higher risk of moderate-to-severe periodontitis controlled for mediators and exposure-induced mediator-outcome confounders: risk ratio = 1.85 (95% confidence interval: 1.06, 3.24), E value 3.1. We found that early-life SEP was associated with the development of periodontitis in adulthood that was not mediated by adulthood SEP and behaviors.

Deciduous-dentition malocclusion predicts orthodontic treatment needs later: findings from a population-based birth cohort study.

INTRODUCTION: Estimating orthodontic treatment need in the permanent dentition using information from the deciduous-dentition malocclusion may assist in defining the time for appropriate orthodontic intervention. Our objective was to investigate whether malocclusion in the deciduous teeth predicts orthodontic treatment need in the permanent dentition. METHODS: Two oral health studies nested in a birth cohort were carried out at ages 6 (n = 359) and 12 (n = 339) years. Open bite, crossbite, and canine malocclusion were assessed in the deciduous teeth. Orthodontic treatment need was determined in the permanent dentition using the dental esthetic index. Prevalence ratios were estimated using 2 dental esthetic index cutoff points: highly desirable/mandatory orthodontic treatment and only mandatory orthodontic treatment. We tested all combinations of the deciduous malocclusion and the outcomes, controlling for confounders. RESULTS: Children with only open bite and those with concurrent open bite and canine malocclusion were more likely to have either highly desirable/mandatory orthodontic treatment or only mandatory orthodontic treatment needs by age 12. The combination of crossbite and open bite in the deciduous teeth was associated with the highest risk of need for mandatory orthodontic treatment. CONCLUSIONS: Malocclusion in the deciduous teeth is a risk factor for orthodontic treatment need in the permanent dentition. Children with malocclusion at a young age should be monitored regularly, and caregivers may be able to better prepare for possible orthodontic treatment.

Trends in dental caries among Brazilian schoolchildren: 40 years of monitoring (1971-2011).

The study aimed to estimate the prevalence, severity, and inequality in the distribution of dental caries in schoolchildren from Florianópolis, Santa Catarina, Brazil, in 2011, and to compare the results with data from previous studies carried out since 1971. All 12- and 13-year-old schoolchildren enrolled in a public school were eligible. Dental caries were assessed according to the World Health Organisation diagnostic criteria. Decayed, missing and filled surfaces and teeth (DMFS/DMFT) indexes, the Significant Caries Index (SiC) and the Gini coefficient (to assess inequalities in the distribution of dental caries) were estimated. The response rate was 82.3% (n = 130). The prevalence of dental caries decreased from 98.0% (95% CI 96.0-100.0) in 1971 to 36.9% (95% CI 28.5-45.3) in 2011. The mean DMFT ranged from 9.2 in 1971 to 0.7 in 2011. The mean DMFS index was 1.2 (95% CI 0.8-1.6) in 2011. The Gini coefficient was 0.624 in 2002 but increased to 0.725 in 2011; the Lorenz curve showed that 70-75% of dental caries attacks was restricted to 20% of the population in 2011. A reduction of 41.2% in the mean SiC index was observed between 2002 (3.4, 95% CI 3.0-3.8) and 2011 (1.9, 95% CI 1.6-2.1). An effective decline in the prevalence and severity of dental caries in schoolchildren was observed throughout 40 years of monitoring. However, a small proportion of the population has experienced most of the caries burden in the recent years studied.

Socioeconomic status in life course is associated with dental appearance dissatisfaction.

The present study aimed to investigate the prevalence of dissatisfaction with dental appearance among 24-year-old Brazilian adults and the associated factors in life course. A subsample (n = 720) of the 1982 Pelotas Birth Cohort in southern Brazil was investigated at the ages of 15 and 24 years using clinical (caries and periodontal) examinations and interviews. The outcome was dissatisfaction with dental appearance at the age of 24 years. Covariate variables included socioeconomic factors, oral health, and dissatisfaction with general appearance collected during different periods of life. Poisson regression models with robust variance were applied. The prevalence of dissatisfaction with dental appearance was 43.5% (95%CI: 39.8-47.1). Individuals with downward income mobility (PR = 1.22, 95%CI: 1.07-1.79) and those always poor (PR = 1.21, 95%CI: 1.00-1.57) presented a higher prevalence of dissatisfaction with their dental appearance even after oral health variables and dissatisfaction with general appearance were controlled for. Moderate/severe malocclusion at 15 years (PR = 1.34, 95%CI: 1.13-1.59), highest experience of untreated dental caries at 24 years (PR = 1.82, 95%CI: 1.46-2.27), and dental pain experience at 24 years (PR = 1.29, 95%CI: 1.22-1.75) were associated with the outcome. Also, the prevalence of dissatisfaction with dental appearance was 20% higher (PR = 1.20, 95%CI: 1.01-1.43) among those dissatisfied with their general appearance. Our findings demonstrated a high prevalence of dissatisfaction with dental appearance among young adults. Lifetime economic disadvantage and dental problems (malocclusion at 15 years, untreated dental caries at 24 years, and dental pain at 24 years) were associated with dissatisfaction with dental appearance among young adults.

Multilevel analysis of the association between posterior restorations and gingival health in young adults: a population-based birth cohort.

OBJECTIVE: To investigate the association of direct posterior restorations with gingival bleeding and dental calculus in young adults from a birth cohort. METHODS: A representative sample (n = 720) of 5914 infants born live in Pelotas, Brazil, in 1982, were prospectively investigated, and posterior restorations and periodontal health outcomes assessed when they were 24 years of age. Tooth-level exploratory variables included the presence and number of restoration's surfaces. Demographic and socio-economic characteristics, oral health instructions, dental floss usage, dental caries presence and smoking were also considered whilst gingival bleeding and dental calculus were the outcomes. Multilevel logistic regression was carried out. RESULTS: Class I cavities were found in 15.2% (95% CI 14.5-15.9) of the teeth and class II in 3.6% (3.3-4.0). Percentage of teeth with gingival bleeding was 6.1% (5.6-6.6) and that with dental calculus 22% (21.2-22.8). Even after all the individual variables were controlled for, the presence of a class I [OR1.51 (1.14-2.00)] and class II [OR 1.76 (1.04-2.97)] cavities was positively associated with gingival bleeding. Class I [OR1.36 (1.13-1.65)] and Class II [OR1.80 (1.28-2.53)] cavities were associated with dental calculus also. CONCLUSIONS: Posterior restoration and higher number of restored surfaces was associated with a higher prevalence of gingival bleeding and dental calculus around the restoration.

Prevalence and experience of dental caries among Singaporean schoolchildren: A time-trend analysis from 2007 to 2019.

OBJECTIVES: This study aimed to describe caries prevalence and experience trends of permanent teeth among Singapore schoolchildren between 2007 and 2019. METHODS: Anonymized records of all 6-year-old Primary 1 (P1), 11-year-old Primary 6 (P6) and 14-year-old Secondary 3 (S3) before the start of each school year were extracted from the Integrated Dental Electronic Assessment System (IDEAS) by school level, ethnicity and sex. Prais-Winsten regression was used to assess trends of mean decayed, missing and filled teeth (DMFT) and caries prevalence (% DMFT > 0) among the schoolchildren by school level, with reported Average Annual Percentage Change (AAPC) together with respective 95% confidence interval (CI). RESULTS: In total, 519 471 P1, 566 573 P6 and 548 138 S3 were included during the above period, and the majority were comprised of Chinese children (P1: 67.2%, P6: 68.8% and S3: 71.0%, respectively). Overall, the prevalence of caries dropped from 6.9% in 2007 to 3.5% in 2019 among P1, from 34.5% in 2009 to 20.3% in 2019 among P6 and from 41.5% in 2007 to 33.5% in 2019 among S3 schoolchildren. The mean DMFT reduced from 0.11 to 0.05 among P1, 0.72 to 0.35 among P6 and 1.05 to 0.76 among S3 schoolchildren during the same period. Caries prevalence and mean DMFT were consistently higher among girls. On average, caries prevalence decreased 5% per year in P1 (AAPC -5.0 [95% CI: -6.1, -3.9]) and P6 (AAPC -4.9 [95% CI: -5.7, -4.1]) and 2% among S3 (AAPC -2.0 [95% CI: -3.5, -0.4]) schoolchildren. Caries prevalence decreased approximately 4% ~ 5% annually among P1 and P6 schoolchildren regardless of ethnicity. The average decrease in caries prevalence was lower (about 2%) among all ethnicities at S3 school level. CONCLUSION: Dental caries in permanent dentition of Singaporean schoolchildren had decreased from 2007 to 2019. However, the decrease observed among primary school students was more than double that among secondary schoolchildren.

Association between obesity and periodontal disease in young adults: a population-based birth cohort.

AIM: To evaluate the association between obesity and periodontal disease and the mediating effect of oral hygiene, systemic inflammation and carbohydrate intake. MATERIAL AND METHODS: Subjects born in 1982 in Pelotas, Brazil (n = 5,914), have been followed for several times. Oral health was assessed in a representative sample of 720 individuals at 24 years. Obesity, waist circumference and number of episodes with obesity between 15 and 23 years of age were the main exposures. Mediating effect of oral hygiene, C-reactive protein level and carbohydrate consumption was also assessed. RESULTS: Obese individuals were more likely to have ≥ 2 teeth with gingival bleeding. However, after adjusting for confounders, the association was not statistically significant [OR (obese × 2 or more teeth) 1.72 (95% CI: 0.95, 3.11)] and adjustment for potential mediators decreased the OR (OR = 1.38). The risk of presenting calculus in obese subjects was 10% higher [PR 1.10 (95% CI: 1.02, 1.18)]. The number of episodes of obesity between 15 and 23 years was associated with dental calculus. Periodontal pockets were not associated with obesity. CONCLUSION: Systemic inflammation and oral hygiene may be mediating the association between obesity and gingivitis. Obesity was not associated with periodontal pockets in young adults in this cohort.

Counterfactual approach on the effect of metabolic syndrome on tooth loss: A population-based study.

BACKGROUND: This study aimed to investigate the effect of metabolic syndrome (MetS) on tooth loss in adults from a population-based sample. METHODS: Cross-sectional analysis based on data from a cohort study (2009 to 2014) with adults from Southern Brazil. MetS (exposure), lack of functional dentition and number of lost teeth (outcomes) were assessed using self-reported, laboratory and clinical data. Possible confounders included sex, age, family income, education level, smoking status, and sugar consumption. The effect of MetS on the outcomes was estimated using conventional logistic or negative binomial regression models. Marginal structural modeling (MSM) with stabilized weights (a counterfactual analytical method) was also used to enhance group comparability and estimate causal effects. RESULTS: A total of 1,283 participants had available information for the outcomes. Individuals with MetS were more likely to experience a lack of functional dentition than those without MetS (odds ratio [OR] from logistic regression, 1.7; 95% CI, 1.0 to 2.9; OR from MSM, 3.2; 95% CI, 2.3 to 4.6). Moreover, the number of teeth lost was 20% higher in participants with MetS compared with those without MetS in conventional analysis (mean ratio [MR], 1.2; 95% CI, 1.1 to 1.3). The MR increased to 1.7 (95% CI, 1.5 to 2.0) when using MSM. CONCLUSION: Our findings provide evidence on the effect of MetS on tooth loss.

Socioeconomic inequalities explain the association between source of drinking water and dental caries in primary dentition.

OBJECTIVE: To evaluate the association between source of drinking water and dental caries at age 5 and to test whether socioeconomic conditions act as confounding factors in such association. METHODS: The study was carried out in a sub-sample of the 2004 Pelotas Birth Cohort, which comprised the application of a questionnaire and clinical oral examination. The exposure was source of drinking water, collected through a question to the primary caregiver. The outcome was dental caries in primary dentition, measured through several standardized indicators of the decayed, missing and filled teeth index (dmft), assessing past and present dental caries. Socioeconomic indicators (family income and maternal education) were identified as potential confounding factors. After descriptive analysis, the association between source of water and measures of dental caries was assessed by Regression models. RESULTS: 1,084 children were evaluated and had complete information in all variables (83.2 % of the targeted sample). Dental caries experience was observed in 48.7 % of the children, with a mean of 1.9 decayed, missing or filled teeth. Most children consumed water from public water supply (76.0 %), and a socioeconomic pattern was observed, with children from lower income more likely to drink water from public supply. In crude analysis, children who consumed bottled water had a lower risk of decayed teeth, lower experience of dental caries and less severe disease. No associations were observed after adjustments for socioeconomic conditions. CONCLUSION: Underlying socioeconomic inequalities explained the association between prevalence and severity of dental caries in primary dentition and source of drinking water. CLINICAL SIGNIFICANCE: Drinking fluoridated tap water is as effective in dental caries prevention as bottled water with acceptable levels of fluoride, with the advantage of being accessible to all. Oral health prevention and treatment should be implemented as early in life as possible and should take into consideration the family's socioeconomic context.

[Accumulated risk from poverty and tooth loss at 31 years of age: the 1982 live birth cohort in Pelotas, Rio Grande do Sul State, Brazil]. / Acúmulo de risco decorrente da pobreza e perda dentária aos 31 anos, coorte de nascidos vivos de 1982, Pelotas, Rio Grande do Sul, Brasil.

The objective was to estimate the effect of accumulated risk from poverty and tooth loss at 31 years, using longitudinal data from the 1982 live birth cohort in Pelotas, Rio Grande do Sul State, Brazil. The income trajectory variables were built with four time points: birth and 15, 24, and 30 years of age. Potential confounding factors were sex, maternal schooling, maternal skin color, and smoking at 24 years. Potential mediators used the history of dentistry services use and caries based on the Significant Index Caries (SIC). The trajectory variable in the accumulated risk model was created with group-based trajectory modeling. The target outcome was the number of missing teeth at 31 years. Mean number of missing teeth at 31 years was 1.25. In the accumulated risk model after adjusting for confounders and mediators, individuals that were poor at one or two time points showed risk ratio - RR = 1.92 (95%CI: 1.40-2.63), and those with three or four episodes of poverty showed RR = 1.97 (95%CI: 1.24-3.13) for tooth loss. The results highlight the effect of lifetime poverty on tooth loss. The effect was expanded in individuals that were exposed to poverty longer. Public policies aimed at improving income conditions also help reduce tooth loss.

Periodontal disease is associated with poor self-rated oral health among Brazilian adults.

OBJECTIVE: The aim of this study was to investigate the association between periodontal disease and self-rated oral health among Brazilian adults. MATERIAL AND METHODS: Data on 11,874 adults in 250 cities from all the Brazilian regions were analysed. The outcome investigated was self-rated oral health (dichotomized into "Good" and "Poor") and the main exposure was periodontal disease defined as the combination of periodontal pocket depth >or=4 mm and clinical attachment loss >or=4 mm. Demographic characteristics, socioeconomic conditions, clinical oral health conditions (dental caries, dental and gingival pain, tooth loss and use of prosthesis) and use of dental services were the other explanatory variables. Simple and multivariate Poisson regression was performed allowing the estimation of prevalence ratios (PRs). All analyses were adjusted for the cluster sampling design. RESULTS: The prevalence of periodontal disease was 8.9% ((95%)CI 7.6-10.3) and poor self-rated oral health was 23.6% ((95%)CI 21.9-25.2) which was significantly higher among those who presented periodontal disease (PR 1.4; (95%)CI 1.2-1.5), after the adjustment for possible confounders. CONCLUSIONS: Periodontal disease was associated with poor self-rated oral health. The results of this study should be considered by population health planners in order to assess and plan periodontal services.

Direct effect of common mental disorders on xerostomia in adults estimated by marginal structural models: A population-based study.

OBJECTIVE: To investigate the controlled direct effect (CDE) of common mental disorders (CMD) on xerostomia which is not mediated by psychoactive medication intake. METHODS: A population-based cross-sectional study was conducted with 1720 individuals aged 20-59 years from Florianópolis, Brazil, in 2009. A two-stage cluster sample design was adopted, with a systematic selection of census tracts, followed by a random selection of households. All inhabitants of the selected households belonging to the age group of interest were considered eligible to participate. CMD were assessed using the Self-Reporting Questionnaire (SRQ > 7). Xerostomia was the outcome assessed by asking: "How often do you feel dry mouth?" with responses "often" and "always" taken as indicating xerostomia. Psychoactive medication intake was set as the mediator. Confounding factors included sex, age, per capita family income, educational attainment and smoking status. Marginal structural models were performed to quantify the CDE of CMD on xerostomia. Missing data were handled by multiple imputation by chained equations, and sensitivity analysis for unmeasured confounding was carried out. RESULTS: The overall prevalence of xerostomia was 8.8% and 15.3% of the individuals presented with CMD. After adjustment, the prevalence of xerostomia among individuals with CMD was 3.2 times higher than that among individuals without CMD (PR = 3.2 [95% CI: 2.3; 4.5]). The CDE of CMD on xerostomia which is not mediated by the medication intake resulted in a three times greater prevalence of xerostomia (PR = 3.0 95% CI: 2.0; 4.5) among those individuals with CMD. CONCLUSIONS: Common mental disorders is directly and negatively associated with xerostomia. Clinicians should bear in mind the emotional state when investigating the underlying factors and managing patients with xerostomia.

Potential years of life lost due to oropharyngeal cancer in Brazil: 1979 to 2013.

OBJECTIVE: To estimate the years of life lost by the Brazilian population due to mouth and pharynx cancer from 1979 to 2013, and analyze the temporal trends in the studied period, according to the country's region, sex and anatomical site. METHODS: The death records were obtained from the Mortality Information System and the data referring to the population, from the censuses of the Brazilian Institute of Geography and Statistics of 1980, 1991, 2000, 2010, and from intercensal estimates for the other years. The rates of potential years of life lost were calculated by applying the method suggested by Romeder and McWhinnie, and their trends were calculated using the Prais-Winsten method with first-order autocorrelation. The historical series were smoothed with the centered moving average technique of third order for white noise reduction. RESULTS: In the period from 1979 to 2013 in Brazil, there were a total of 107,506 premature deaths due to mouth and pharynx cancer, which generated a total of 1,589,501 potential years of life lost, the equivalent to a rate of 3.6 per 10,000 inhabitants. Males, whose rate was six times higher than for females, contributed with 85% of the years lost. The trends in the rates of years of life lost showed an annual 0.72% increase for men, 1.13% for women and 1.05% for pharynx cancer. CONCLUSIONS: The rate of potential years of life lost due to mouth and pharynx cancer in the country showed an upward trend within the studied period for both sexes, as well as for pharynx cancer and for the North, Northeast and Midwest regions.

Socioeconomic status in life course is associated with dental appearance dissatisfaction

Abstract The present study aimed to investigate the prevalence of dissatisfaction with dental appearance among 24-year-old Brazilian adults and the associated factors in life course. A subsample (n = 720) of the 1982 Pelotas Birth Cohort in southern Brazil was investigated at the ages of 15 and 24 years using clinical (caries and periodontal) examinations and interviews. The outcome was dissatisfaction with dental appearance at the age of 24 years. Covariate variables included socioeconomic factors, oral health, and dissatisfaction with general appearance collected during different periods of life. Poisson regression models with robust variance were applied. The prevalence of dissatisfaction with dental appearance was 43.5% (95%CI: 39.8-47.1). Individuals with downward income mobility (PR = 1.22, 95%CI: 1.07-1.79) and those always poor (PR = 1.21, 95%CI: 1.00-1.57) presented a higher prevalence of dissatisfaction with their dental appearance even after oral health variables and dissatisfaction with general appearance were controlled for. Moderate/severe malocclusion at 15 years (PR = 1.34, 95%CI: 1.13-1.59), highest experience of untreated dental caries at 24 years (PR = 1.82, 95%CI: 1.46-2.27), and dental pain experience at 24 years (PR = 1.29, 95%CI: 1.22-1.75) were associated with the outcome. Also, the prevalence of dissatisfaction with dental appearance was 20% higher (PR = 1.20, 95%CI: 1.01-1.43) among those dissatisfied with their general appearance. Our findings demonstrated a high prevalence of dissatisfaction with dental appearance among young adults. Lifetime economic disadvantage and dental problems (malocclusion at 15 years, untreated dental caries at 24 years, and dental pain at 24 years) were associated with dissatisfaction with dental appearance among young adults.

Reasons for direct restoration failure from childhood to adolescence: A birth cohort study.

OBJECTIVES: The aim of this study was to assess the prevalence of direct restorations in posterior teeth in children aged 12, from a birth cohort, and to test the association between the quality of the restorations and individual variables experienced in the life cycle. METHODS: All live-born children in Pelotas, in 2004, were prospectively investigated and a representative sample was assessed for oral conditions at ages 5 and 12. The outcome was the quality of the restoration (satisfactory/unsatisfactory). Independent variables included socioeconomic, behavioral and oral health characteristics at the individual level and the size of cavity and material at the tooth level. Associations were tested using multilevel logistic regression models. RESULTS: A total of 1,000 participants and 249 restorations in the permanent dentition were examined. Most of the restorations were composites (73.5%), while only 6.8% were amalgam. After adjusted analyses, children whose parents received information on how to prevent their child from developing caries before reaching 5 years of age had 91.0% less chance of having an unsatisfactory restoration compared to children whose parents never received information (OR = 0.09; 95% CI 0.01-0.59). Also, the chances of presenting unsatisfactory restorations were 5.3 higher in children at high-risk for untreated dental caries in the permanent dentition, in comparison with children at low risk (OR = 5.32; 95% CI 1.07-26.6). CONCLUSIONS: Low-risk for untreated dental caries and having received information on preventing dental caries, reduced the chance of presenting failed restorations, showing that factors related to individuals play an important role in the quality of restorations. CLINICAL SIGNIFICANCE: Our findings highlight the role that individual-related factors play in restoration longevity in children, reinforcing the need for a patient-centered approach in restorative dentistry.

Toothache prevalence and associated factors: a life course study from birth to age 12 yr.

This study estimated the lifetime prevalence of toothache at ages 6 and 12 yr, the prevalence of toothache during the last month, and their association with social, behavioural and clinical exposures in the course of life of 339 12-yr-old children from a birth cohort in Pelotas, Brazil. Exploratory variables were collected in the perinatal study and during several follow-up studies. Prevalence ratios were calculated using Poisson regression, following a hierarchical conceptual model. The lifetime prevalence of toothache at ages 6 and 12 yr were 39% [95% confidence interval (CI) = (34;45)] and 63% [95% CI = (58;69)], respectively. Toothache during the last month was reported by 11% [95% CI = (8;15)]. Children who did not live with their biological father at birth, and children with higher dmf-t counts, reported a higher lifetime prevalence of toothache at age 6 yr. Children experiencing poverty between ages 0 and 4 yr, with higher dmf-t and DMF-T indexes presented a greater lifetime prevalence of toothache at 12 yr. Toothache within the last month was more likely to be reported by girls and by children who did not live with their biological father at birth. Preventive strategies should be implemented in early stages of the life cycle, taking into account the socio-economic and family context in which pain mostly occurs.

Incidence of dental trauma among adolescents: a prospective cohort study.

We estimated the incidence of traumatic dental injuries (TDI) in a 2-year follow-up of adolescents with and without previous dental trauma and verified the hypothesis that individuals with previous trauma are more prone to recurrent TDI events. The present study was developed in three phases. First, a dental trauma cross-sectional study was carried out with 2260 schoolchildren aged 11-13 years in Biguaçu, southern Brazil. In the second phase, a case-control study was developed to identify risk factors associated with dental trauma. The third step was a 2-year longitudinal observational study with the participants of the second phase of the study. The exposed group of individuals with previous dental traumatism (208) and a non-exposed group (208) of participants who had no previous signs of dental trauma were followed up for 2 years. Descriptive, univariate, simple and conditional multiple logistic regression analyses were performed. The greatest incidence of dental trauma was identified among adolescents with previous dental trauma (11.9%-11.44/1000 incisors) when compared with those without previous dental trauma (2.7%-2.45/1000 incisors) (P < 0.001). In the study period, adolescents with previous dental trauma showed a 4.85 times greater odds ratio for presenting further dental trauma when compared with adolescents without previous dental trauma (P = 0,005) after adjusting for incisal overjet, lip coverage and mother's schooling. A notable difference was observed regarding the incidence of TDI between the case and control groups. Individuals with previous dental trauma had greater chances of developing develop further dental trauma in a 2-year follow-up.

Effectiveness of two mouth rinses solutions in arresting caries lesions: a short-term clinical trial.

PURPOSE: To clinically evaluate the additional effect of adding 0.12% chlorhexidine digluconate (CHX) to a 0.05% sodium fluoride (NaF) mouth rinse in arresting active enamel caries lesions after 28 days. MATERIALS AND METHODS: A short-term double-blind clinical trial that included a total of 170 children, aged 11 to 15 years, with active smooth surface caries lesions (average 6.52) was conducted. The participants were enrolled and randomly distributed into two equal groups. Under the supervision of the research team, the children rinsed with a 15 ml solution of either 0.05% NaF (G1) or 0.05% NaF + 0.12% CHX (G2) for 1 min/day for 28 days. A clinical examination was carried out at the beginning and at the end of the study with children who underwent supervised tooth brushing. A calibrated examiner, who was unaware of the treatment given to each subject, examined all smooth surfaces dried with compressed air, isolated and illuminated with a reflector. The surface was considered active (A) or arrested (I). The frequency of A or I surfaces was evaluated by calculating the difference between the number found at the beginning and at the end of the trial. RESULTS: No significant differences were detected between the two groups with respect to caries lesion surfaces at baseline (6.49 +/- 4.45 - G1, 6.55 +/- 4.23 - G2, respectively), nor were differences found when age and gender wer taken into consideration. Arrestment proportions were 84.4% (G1) and 85.3% (G2) (P = 0.71; not significant). CONCLUSIONS: Although both solutions showed high arrestment proportions, the addition of CHX did not improve the arrestment capacity of the NaF mouth rinse.