The association between malocclusion and health-related quality of life in adolescents: A mediation analysis.

This study investigated the role of oral health-related functional limitations and social well-being, self-perceived health, psychosocial factors, and social support in mediating the impact of malocclusion on health-related quality of life (HRQoL). A school-based 6-month cohort study was conducted with 376 12-year-old deprived adolescents. Measures at baseline included malocclusion (DAI score), dental caries, sociodemographic characteristics, psychosocial traits (self-esteem, sense of coherence, oral health beliefs), and social support. The oral health-related functional limitations and symptoms (social well-being) domains of the CPQ11-14 , self-perceived health, and HRQoL (Kiddo-KINDL) were evaluated at the 6-month follow-up. Associations between observed and latent variables (social support, psychosocial factors, and HRQoL) were evaluated using structural equation modelling, according to the Wilson and Cleary theoretical model. Malocclusion was indirectly associated with worse HRQoL, mediated by functional limitations, social well-being, and self-perceived health. Better psychosocial status was directly associated with better HRQoL, and higher social support was indirectly associated with better HRQoL via psychosocial factors. Dental caries experience, female sex, and lower family income were indirectly associated with worse HRQoL. The impact of malocclusion on HRQoL was mediated by oral health-related functional limitations, social well-being, and self-perceived health. Sociodemographic and psychosocial factors, and social support also impacted HRQoL.

Contextual and individual factors associated with traumatic dental injuries in deprived 12-year-old schoolchildren: A cohort study.

AIM: Traumatic dental injuries (TDIs) among children and adolescents have been acknowledged as of public health concern worldwide. The aim of the study was to assess the relationship between contextual and individual characteristics and TDIs in 12-year-old schoolchildren. MATERIALS AND METHODS: A cohort study was conducted with 355 schoolchildren living in deprived communities in the city of Manaus, Brazil. Contextual factors (place of residence and socio-economic indicators) and individual characteristics, including sex, family income, parents/guardians years of schooling, overjet and open bite (Dental Aesthetic Index), self-esteem (Rosenberg Self-Esteem Scale), sense of coherence (Sense of Coherence Scale), oral health beliefs, social support (Social Support Appraisals) were assessed at baseline. TDIs were measured at baseline and at 2-year follow-up using the O'Brien Index. Data were analysed through confirmatory factor analysis and structural equation modeling. RESULTS: The baseline prevalence of TDIs was 17.6% and the incidence of TDIs at 2-year follow-up was 26.8%. Better psychosocial status had a direct protective effect on the incidence of TDIs (ß = -.184). Better contextual characteristics (ß = -.135) and greater overjet (ß = -.203) were directly associated with poor psychosocial status. Higher schooling of parents/guardians directly predicted better psychosocial status (ß = .154). Psychosocial status mediated the relationship of greater overjet (ß = .036), contextual factors (ß = .024) and parental/guardian schooling (ß = -.027) with TDIs. CONCLUSIONS: Contextual factors and individual characteristics predicted TDIs. Psychosocial status was a relevant individual attribute in the causal network of TDIs, due to the direct effect on the incidence of TDIs as well as a mediator on the influence of contextual factors, overjet and parents/guardians schooling on the incidence of TDIs.

Untreated osteoporosis and higher FRAX as risk factors for tooth loss: a 5-year prospective study.

INTRODUCTION: Studies have shown that an impaired bone condition, represented by osteoporosis and increased fracture risk, may potentially aggravate periodontal disease and, consequently, the risk of tooth loss. This 5-year prospective study aimed to investigate whether systemic bone condition represents risk factor for tooth loss due to periodontal disease amongst elderly women. MATERIAL AND METHODS: Seventy-four participants, aged ≥ 65 years, who attended the 5-years recall for periodontal evaluation were involved. Baseline exposures were osteoporosis and fracture risk probabilities (FRAX). Women were grouped according to bone mineral density (BMD) and years of bone treatment for osteoporosis. The primary outcome at a 5-year follow-up was the number of tooth loss due to periodontal disease. Periodontitis staging and grading, and causes of tooth loss were recorded. RESULTS: The multivariate Poisson regression models showed that women with untreated/shortly treated osteoporosis were 4 times more likely to present higher number of tooth loss due to periodontal disease than those with normal BMD or treated for ≥ 3 years (risk ratio (RR) = 4.00, 95% CI 1.40-11.27). Higher FRAX was also linked to tooth loss (RR = 1.25, 95% CI 1.02-1.53). Receiver-operating characteristic (ROC) curve suggested that women with history of ≥ 1 tooth losses have higher chances of worse major FRAX (sensitivity = 72.2%; specificity = 72.2%). CONCLUSION: In this 5-year study, higher FRAX and untreated osteoporosis were risk factors for tooth loss. Women with normal BMD or treated for osteoporosis for ≥ 3 years did not show increased risk. Management of skeletal conditions should be emphasized with periodontal care for the prevention of tooth loss in elderly women.

The Impact of Socio-Environmental, Individual, and Biological Factors on Oral Health-Related Quality of Life among Preschool Children: A Cohort Study with 3-Year Follow-Up.

This study assessed impact of socio-environmental, individual, and biological factors on the worsening and severe worsening of oral health-related quality of life (OHRQoL) among preschoolers and their families. A cohort study was conducted in Diamantina, Brazil, with 151 children between 1 and 3 years of age and their mothers, who were evaluated at baseline (2014) and re-evaluated after 3 years (2017). The children were clinically examined to assess the presence of dental caries, malocclusion, dental trauma, and enamel defects. The mothers answered the Early Childhood Oral Health Impact Scale (B-ECOHIS) and a questionnaire addressing individual characteristics of the child and socio-environmental factors. Extensive caries found in the follow-up (relative risk [RR] = 1.91; 95% confidence interval [CI] = 1.26-2.91) and failure to undergo the dental treatment recommended at baseline (RR = 2.49; 95% CI = 1.62-3.81) were associated with worsening of OHRQoL over 3 years. An increase in the number of children in the household (RR = 2.95; 95% CI = 1.06-8.25), occurrence of extensive caries in the follow-up (RR = 2.06; 95% CI = 1.05-4.07), and failure to undergo the dental treatment recommended at baseline (RR = 3.68; 95% CI = 1.96-6.89) were associated with a severe worsening of OHRQoL. In conclusion, the risk of worsening and severe worsening of OHRQoL was higher in preschoolers with extensive caries at follow-up and among those who did not undergo dental treatment. Furthermore, severe worsening of OHRQoL was also impacted by an increase in the number of children in the household.

Does using the sociodental approach in oral health care influence use of dental services and oral health of adolescents living in deprived communities? a one-year follow up study.

BACKGROUND: Oral health needs assessment is important for oral health care planning. This study compared dental treatment needs between normative and sociodental needs. We also longitudinally examined the relationships of baseline sociodental needs measures and socioeconomic status with one-year follow up measures of use of dental services, dental caries, filled teeth, and oral health-related quality of life (OHRQoL). METHODS: A prospective study was conducted with 12-year-old adolescents from public schools in deprived communities in the city of Manaus, Brazil. Validated questionnaires were used to collect adolescents' sex and socioeconomic status, OHRQoL (CPQ11 - 14) and behaviours (sugar intake, frequency of toothbrushing, regular use of fluoridated toothpaste and pattern of dental attendance). Normative need was assessed according to decayed teeth, clinical consequences of untreated dental caries, malocclusion, dental trauma, and dental calculus. The relationships between variables were tested thorough Structural equation modelling. RESULTS: Overall 95.5% of adolescents had normative dental treatment needs. Of these, 9.4% were classified as high level of propensity. Higher normative/impact need and greater propensity-related need directly predicted use of dental services at one-year follow up. The latter mediated the association of normative/impact need and propensity-related need with incidence of dental caries and filled teeth. Normative/impact need and use of dental services were directly associated with filled teeth at one-year follow up. Poor OHRQoL at one-year follow-up was directly predicted by higher normative/impact need at baseline and less filled teeth at one-year follow up. Greater socioeconomic status was directly associated with better propensity-related need. Socioeconomic status indirectly predicted incidence of dental caries and filled teeth via propensity-related need and use of dental services. CONCLUSIONS: Sociodental needs measures were related to use of dental services, dental caries, filled teeth and OHRQoL after one year among adolescents living in deprived communities. Adolescents with dental needs treatment priorities according to the sociodental approach had more filled teeth via use of dental services. Dental services utilisation did not attenuate the impact of normative and impact-related need on dental caries incidence and poor OHRQoL after one year. Our findings suggest the importance of developing oral health promotion and enhancing access to dental care to improve oral health of adolescents living in deprived communities.

Sense of coherence moderates the relationship between social capital and oral health­related quality of life in schoolchildren: a 10-year cohort study.

BACKGROUND: This study aimed to evaluate the moderating effect of sense of coherence (SOC) on the relationship between social capital and oral health-related quality of life (OHRQoL) among schoolchildren. METHODS: A cohort study was conducted in the city of Santa Maria, Brazil, involving children aged 1-5 years at baseline who were reassessed after 10 years in adolescence (11-15 years-old). Social capital was assessed at baseline and follow-up through social networks and social trust. Sense of coherence scale (SOC-13) and the short form of the Child Perceptions Questionnaire 11-14 (CPQ11-14) were measured at 10-years follow-up. Demographic and socioeconomic characteristics, and dental caries were also evaluated. Moderating effect of SOC on the relationship between social capital and OHRQoL was tested using multilevel adjusted Poisson regression analysis and simple slope test. RESULTS: From the 639 subjects assessed at baseline, 429 were reassessed at follow-up (cohort retention rate 67.1%). Moderate and high levels of SOC demonstrated a moderating effect on the relationship between social capital and OHRQoL. Among individuals who presented low social capital at baseline and follow-up, those who had high SOC reported, respectively, an impact 63% and 70% lower on OHRQoL when compared to those with low SOC. The greatest margin effect was observed in individuals with low social capital and low SOC at follow-up (24.25; p < 0.05). CONCLUSION: Our findings suggest that SOC moderates the negative impact of low social capital on poor OHRQoL in schoolchildren.

The impact of orthognathic surgery on quality of life in individuals with oral clefts.

BACKGROUND/OBJECTIVES: To evaluate the relationships between individual, environmental, clinical factors and oral health-related quality of life (OHRQoL) in patients with cleft lip and palate (CLP) following orthognathic surgery. MATERIALS AND METHODS: A follow-up study was conducted involving 69 adults with unilateral and bilateral CLP under orthodontic treatment. Interviews and oral examinations were conducted prior to orthognathic surgery (T0) to evaluate age, gender, psychological well-being, dental caries, malocclusion, social support, social networks, family income and education and OHRQoL. All participants were reviewed after 6 months (T1) to re-assess psychological well-being, malocclusion and OHRQoL. Structural equation modeling estimated the associations between the variables. RESULTS: OHRQoL total scores reduced following orthognathic surgery, from 11.7 to 6.9 (P < 0.01). Occlusal characteristics and psychological well-being improved between T0 and T1. In the structural equation modeling, reduction of malocclusion (ß = 0.02) between T0 and T1 directly predicted poor OHRQoL at T1. Improvement of psychological well-being between T0 and T1 was associated with better OHRQoL at T1 (ß = -0.07). Dental caries and malocclusion at T0 were indirectly linked to poor OHRQoL at T1 (ß = 0.02). LIMITATIONS: The short follow-up period of 6 months after orthognathic surgery. CONCLUSIONS/IMPLICATIONS: This represents the first prospective study examining the interrelationships of predictors of OHRQoL in patients with CLP after orthognathic surgery. OHRQoL and psychological well-being improved after orthognathic surgery. Clinical and psychological characteristics were important determinants of OHRQoL. These findings suggest the importance of the biopsychosocial model of health and the patient-centered approach in oral health care in individuals with CLP.

Malocclusion characteristics amongst individuals with autism spectrum disorder: a systematic review and meta-analysis.

BACKGROUND: To estimate the prevalence of malocclusion in individuals with autism spectrum disorders (ASD) and to assess the relationship between ASD and malocclusion. METHODS: We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane, Embase, SciELO LILACS, Proquest, OpenGrey and Google Scholar. There were no language or publication dates restrictions. Two researchers independently performed selection, data extraction and quality assessment. Quality assessment and risk of bias were evaluated through the Newcastle-Ottawa scale and ROBINS-E tool. Meta-analyses using random effect models were used to estimate pooled measures of prevalence of malocclusion characteristics in individuals with ASD and pooled odds ratio (OR) on the relationship between ASD and malocclusion characteristics. Subgroup meta-analyses were conducted according to children and adolescents, history of orthodontic treatment, and occurrence of other syndromes and medical conditions. RESULTS: Searching identified 5549 papers with 238 were selected for full assessment. Eighteen cross-sectional studies were included according to inclusion criteria. Of them, eleven studies were considered of moderate quality. A judgement of critical risk of bias occurred for thirteen studies. The most prevalent malocclusion characteristics in individuals with ASD were crowding (33%; 95% CI 22 to 44%) and increased maxillary overjet (39%; 95% CI 23 to 54%). Individuals with ASD had higher odds of Angle's Class II (OR 1.92; 95% CI 1.36 to 2.72), Angle's Class III (OR 2.33; 95% CI 1.29 to 4.23), open bite (OR 1.96; 95% CI 1.21 to 3.16), and increased maxillary overjet (OR 1.53; 95% CI 1.06 to 2.21) than individuals without ASD. CONCLUSIONS: Angle's Class II, Angle's Class III, anterior open bite and increased maxillary overjet were more prevalent in individuals with ASD than those without ASD. Further high-quality studies are needed.

The role of dental pain and psychosocial factors on the relationship between dental caries and oral health-related quality of life in children.

BACKGROUND: To examine the role of dental pain, sense of coherence (SOC) and social support on the relationship between dental caries and oral health-related quality of life (OHRQoL) in children aged 12 years. METHODS: A cross-sectional study involving 400 schoolchildren selected from public schools in a socioeconomically disadvantaged region in the city of Manaus, Brazil was carried out. The predictors of OHRQoL were selected according to the Wilson and Cleary theoretical model, including number of decayed teeth and its clinical consequence (component D of the DMFT index and PUFA/pufa index), dental pain (symptom status), and SOC and social support (individual and environmental characteristics). Statistical analysis was conducted through structural equation modelling and multivariable negative binomial regression. The significance level established for all analyses was 5%. RESULTS: Number of dental caries was indirectly linked with OHRQoL (ß = 0.19, 95% CI 0.11/0.29) through dental pain, SOC and social support. Clinical consequences of untreated caries directly predicted poor OHRQoL (ß = 0.12, 95% CI 0.01/0.23). Dental pain, SOC and social support did not moderate the effect of dental caries measures on OHRQoL. CONCLUSION: Our findings suggest the role of dental pain, SOC and social support as mediator factors on the link between dental caries and OHRQoL. Tackling dental caries along with psychosocial factors may attenuated the impact of oral health on OHRQoL in children.

Clinical consequences of untreated dental caries and school performance in low-income adolescents.

BACKGROUND: The possible link between dental status and school performance has been investigated. The influence of the clinical consequences of untreated dental caries in this association, however, has been minimally explored. AIM: To assess the relationship between clinical consequences of untreated dental caries and school performance in adolescents, and to examine the demographics and socioeconomic status pathways by which clinical consequences of untreated dental caries is associated with school performance. DESIGN: A cross-sectional study involving 363 low-income school adolescents was conducted in the city of Manaus, Brazil. Dental clinical measures were registered by five calibrated examiners to evaluate dental caries experience (decayed, missing, and filled teeth index [DMFT]) and clinical sequelae of dental caries (PUFA/pufa index). School performance was assessed using school grade history obtained from official records. Statistical analysis was conducted using pathway analysis to estimate beta coefficients (ß) of the direct and indirect effects between variables. RESULTS: DMFT and PUFA/pufa mean were 1.93 and 0.30, respectively. PUFA/pufa scores (ß = -0.19) and male sex (ß = 0.35) directly predicted poor school performance. DMFT was indirectly linked to poor school performance via PUFA/pufa scores (ß = -0.03). CONCLUSIONS: Dental caries and clinical consequences of dental caries were important predictors of poor school performance in low-income adolescents via direct and indirect effects.

The influence of change on sense of coherence on dental services use among adolescents: a two-year prospective follow-up study.

BACKGROUND: To investigate the influence of change on sense of coherence (SOC) on dental services use in adolescents over a two-year period. METHODS: A prospective follow-up study was conducted involving 334 12-year-old adolescents from public schools in the city of Manaus, Amazonas, Brazil. The predictors of use of dental services in the last 12 months were selected according to the Andersen's behavioural theoretical model. The predisposing factors included sex, self-reported skin colour and SOC. The enabling factors were dental insurance, monthly family income and parents/guardians schooling. Dental pain, perceived oral health status, dental caries and gingival status were used to assess need factors. Multivariable Poisson regression with robust variance was used to estimate incidence-rate ratios (IRR) and 95% confidence intervals between the independent variables and use of dental services. RESULTS: Adolescent's SOC scores decreased significantly between baseline and one-year follow-up. SOC decline decreased the likelihood of using dental services in the last 12 months (IRR = 0.96 95%CI 0.92-0.99). Dental caries (IRR = 1.03 95%CI 1.01-1.04) and gingival bleeding (IRR = 1.01 95%CI 1.01-1.02) remained associated with use of dental services in the last 12 months. Adolescents with dental pain were more likely to have visited a dentist in the last year (IRR = 1.03, 95%CI 1.01-1.06). CONCLUSION: SOC decrease over one-year period was a meaningful factor of dental services use among 12-year-old adolescents. Dental pain and clinical conditions were also relevant factors that can influence use of dental services in this group.

Socioeconomic status, social support, oral health beliefs, psychosocial factors, health behaviours and health-related quality of life in adolescents.

PURPOSE: This study assessed the relationships between socioecononic status (SES), social support, oral health beliefs, psychosocial factors, health-related behaviours and health-related quality of life (HRQoL) in adolescents. METHODS: A school-based follow-up study involving 376 12-year-old adolescents was conducted in Manaus, Brazil. Baseline data included sociodemographic characteristics (sex, parental schooling, family income, household overcrowding and number of goods), social support (SSA questionnaire), oral health beliefs and psychosocial factors (Sense of Coherence [SOC-13 scale] and self-esteem [Rosenberg Self-Esteem Scale]). Health-related behaviours (toothbrushing frequency, sedentary behaviour, smoking and sugar consumption) and HRQoL [KINDL questionnaire] were assessed at 6-month follow-up. Structural Equation Modelling assessed the relationships between variables. RESULTS: Greater social support (ß = 0.30), higher SOC (ß = 0.23), higher self-esteem (ß = 0.23), higher toothbrushing frequency (ß = 0.14) and less smoking (ß = - 0.14) were directly linked with better HRQoL. SES (ß = 0.05), social support (ß = 0.26), oral health beliefs (ß = - 0.02) were indirectly linked to HRQoL. Higher SES directly predicted higher toothbrushing frequency (ß = 0.14) and less smoking (ß = - 0.22). Greater social support also directly predicted higher SOC (ß = 0.55), positive oral health beliefs (ß = - 0.31) and higher self-esteem (ß = 0.58). Greater social support indirectly predicted less smoking via oral health beliefs (ß = - 0.05) and less sugar consumption via SOC (ß = - 0.07). CONCLUSION: Socioeconomic status, social support, oral health beliefs and psychosocial factors were important predictors of adolescent's health behaviours and HRQoL over 6-month period through direct and indirect mechanisms. Health behaviours also directly influenced HRQoL.

Utilisation of dental services by Brazilian adults in rural and urban areas: a multi-group structural equation analysis using the Andersen behavioural model.

BACKGROUND: The utilisation of health services is determined by complex interactions. In this context, rural populations face greater barriers in accessing dental services than do urban populations, and they generally have poorer oral health status. The evaluation of the determinants of health services utilisation is important to support planning and management of dental services. The aim of this study was to evaluate the predictors of dental services utilisation of Brazilian adults living in rural and urban areas. METHODS: Data from 60,202 adults aged 18 years or older who took part in the Brazilian National Health Survey carried out in 2013 were analysed. Predisposing (age, sex, education, social networks), enabling financing (income, durable goods and household's crowding), enabling organisation (health insurance, registration in primary health care [PHC]) and need variables (eating difficulties, self-perceived tooth loss and self-perceived oral health) were selected based upon the Andersen behavioural model. Multi-group structural equation modeling assessed the direct and indirect associations of independent variables with non-utilisation of dental services and the interval since the last dental visit for individuals living in rural and urban areas. RESULTS: Adults living in urban areas were more likely to use dental services than those living in rural areas. Lower enabling financing, lower perceived dental needs and lack of PHC registration were directly associated with lower utilisation of dental services (non-utilisation, ß = - 0.36, ß = - 0.16, ß = - 0.03, respectively; and interval since last dental visit, ß = 1.25, ß = 0.82, ß = - 0.12, respectively). The enabling financing (non-utilisation, ßrural = - 0.02 [95%CI: - 0.03 to - 0.02], ßurban = 0.00 [95%CI: - 0.01 to 0.00]) and PHC registration (non-utilisation, ßrural = - 0.03 [95%CI: - 0.04 to - 0.02], ßurban = - 0.01 [95%CI, - 0.01 to - 0.01]) non-standardised total effects were stronger in rural areas. Enabling organisation (ß = 0.16) and social network (ß = - 2.59) latent variables showed a direct effect on the interval since last dental visit in urban areas. Education and social networks influenced utilisation of dental services through different pathways. Males showed less use of dental services in both urban and rural areas (non-utilisation, ßrural = - 0.07, ßurban = - 0.04; interval since last dental visit, ßrural = - 0.07, ßurban = - 0.07) and older adults have used dental services longer than younger ones, mainly in rural areas (ßrural = 0.26, ßurban = 0.17). CONCLUSION: Dental services utilisation was lower in rural areas in Brazil. The theoretical model was supported by empirical data and showed different relationships between the predictors in the two geographical contexts. In rural areas, financial aspects, education, primary care availability, sex and age were relevant factors for the utilisation of services.

The Association of Oral Health Status, demographic characteristics and socioeconomic determinants with Oral health-related quality of life among children: a systematic review and Meta-analysis.

BACKGROUND: Health-related quality of life (HQoL) indicators are considered valid measures of patient assessment in physical, mental and oral healthcare. This study aimed to examine the evidence on the relationship of oral health status, demographic and socioeconomic characteristics with oral health-related quality of life (OHRQoL) in children. METHODS: Studies in English published up to December 2019 were searched on PsycINFO, PubMed, SciELO, Scopus, and Web of Science databases. Epidemiological studies simultaneously assessing sociodemographic factors related to oral health (age, income, gender, maternal education), oral health measures (orthodontic treatment needs, dental caries and periodontal disease) and OHRQoL in children aged 3-12 years were included. Methodological quality was assessed using a Critical Appraisal Checklist. Meta-analysis was used to estimate pooled measures between sociodemographic factors and oral health measures with OHRQoL. RESULTS: Eleven articles were included. Lower children's age (3-5 years vs > 5), gender (girls vs boys), lower income (< 70$ vs ≥ $70), low maternal education (≤ 6 vs > 6 years) were associated with poor OHRQoL among children. Orthodontic treatment needs, dental caries and periodontal diseases were also associated with poor children's OHRQoL. Meta-regression showed that Human Development Index, sample size, year of publication and participant's age were relevant aspects that influenced the above mentioned relationships. CONCLUSIONS: Our findings suggest that oral health promotion strategies to improve children's OHRQoL should consider the social and environmental where they live as well their oral health status. Further longitudinal studies are needed to explore the determinants of OHQoL in children.

Clinical Consequences of Untreated Dental Caries, Individual Characteristics, and Environmental Factors on Self-Reported Oral Health Measures in Adolescents: A Follow-Up Prevalence Study.

BACKGROUND/AIMS: This study evaluated the relationships of clinical consequences of untreated dental caries, individual characteristics, and environmental factors on self-reported oral health measures in adolescents. METHODS: A follow-up prevalence study was conducted involving 406 twelve-year-old adolescents selected from public schools in the eastern area of the city of Manaus, Brazil. Baseline data included clinical consequences of untreated caries (PUFA/pufa index), DMFT, sociodemographic characteristics (sex, parental schooling, and family income), psychosocial factors (sense of coherence [SOC-13 scale], oral health beliefs and self-esteem [Rosenberg Self-Esteem Scale]), and social support (SSA questionnaire). Oral health-related quality of life (OHRQoL [CPQ11-14]) and self-rated oral health were assessed at the 6-month follow-up. Structural equation modelling was used to explore the relationships between variables according to the Wilson and Cleary model. RESULTS: The prevalence of PUFA/pufa was 17.8% and mean DMFT was 1.5. The number of teeth with clinical consequences of untreated caries predicted poor self-rated oral health at the 6-month follow-up. Low parental schooling predicted low family income and clinical consequences of untreated dental caries. Psychosocial factors predicted OHRQoL directly and self-rated oral health indirectly. OHRQoL was linked to self-rated oral health. Clinical consequences of untreated dental caries mediated the relationship of parental schooling with OHRQoL and self-rated oral health. OHRQoL mediated the relationship of psychosocial factors and sex with self-rated oral health. Clinical consequences of untreated dental caries was associated with adolescents' self-rated oral health. Furthermore, the former was an important mediator on the link between low parental education and adolescents' self-reported oral health measures. CONCLUSIONS: Socioeconomic status, psychosocial factors, and social support were related to OHRQoL and self-rated oral health via direct and indirect pathways.

The association between nutritional status and dental caries in low-income children: A multilevel analysis.

BACKGROUND: The possible association between obesity, underweight, and dental caries remains in debate. In addition, the role of sugar consumption on the abovementioned relationship was little explored. AIM: This study aimed to investigate the relationship between nutritional status and dental caries in 12-year-old low-income children. DESIGN: This cross-sectional school-based study involved 406 12-year-old children living with limited economic resources. Dental caries was assessed using the decayed component of DMFT and PUFA/pufa index. Children were weighed and measured to assess nutritional status according to z-score/body mass index. Data on socio-economic and demographic characteristics, sugar consumption, sedentary behaviour, and psychosocial factors were collected through validated questionnaires. Multivariable multilevel Poisson regression was performed. RESULTS: Underweight children had 60% (RR = 1.60; 95% CI 1.13-2.57) higher mean of decayed teeth and had mean PUFA/pufa 2.8 times higher than children with normal nutritional status. Underweight children with high annual sugar intake had a greater mean of decayed teeth (RR = 2.72; 95% CI 1.46-5.06) than underweight children with low sugar intake. CONCLUSIONS: Our findings suggest that malnutrition is associated with dental caries among children from low-income families.

Oral status, sense of coherence, religious-spiritual coping, socio-economic characteristics, and quality of life in young patients.

BACKGROUND: Several factors can influence the oral health. AIM: To explore the clinical factors, individual characteristics, and environmental factors (religious-spiritual coping-RSC, sense of coherence [SOC], and socio-economic status) related to oral status and impact on oral health-related quality of life (OHRQoL) of children/adolescents (C/A). DESIGN: This study evaluated C/A up to 15 years old and their caregivers. Number of decayed (NDT) and missing teeth (NMT); history of dental trauma; caregiver's RSC and SOC, socio-economic factors, and OHRQoL were evaluated. Theoretical model exploring the direct and indirect effects was tested using a structural equation analysis. RESULTS: For younger group (0-6 years), having more NDT or more NMT had a greater impact on the OHRQoL (ß = 0.382, ß = 0.203, respectively). In the oldest group (7-15 years), a higher SOC had an inverse relationship with the impact on the family OHRQoL (ß=-0.201). The higher the age of the C/A, the lower the NDT (ß=-0.235), and the higher the family income the lower, the need for social benefit (ß = 0.275). Indirect relationships were observed between schooling with social benefit and OHRQoL in younger group. The family income indirectly influenced the OHRQoL in oldest group. CONCLUSIONS: Quality of life is affected directly and indirectly by environmental characteristics, oral status, and the age of patients.

The Association between Sense of Coherence and Dental Caries in Low Social Status Schoolchildren.

The relationship between dental caries and sense of coherence (SOC) has not been substantiated in children and adolescents, particularly among those with a low socioeconomic status. The aim of this study was to investigate the association between SOC and dental caries in schoolchildren from a low socioeconomic background. A random sample of 356 8- to 14-year-old schoolchildren enrolled in public schools from the poorest region of Santa Maria, a southern city in Brazil, was selected. Dental examinations were performed to assess dental plaque and dental caries (DMF-S and dmf-s indexes). The children's SOC was assessed using a validated Brazilian version of the SOC-13 scale. Socioeconomic, demographic, and behavioral data were collected from parents using a questionnaire. Multilevel Poisson regression analysis was used following a hierarchical approach to investigate the association between the SOC and DMF-T + dmf-t mean. Children whose mothers had studied for 8 years or less (RR 1.30; 95% CI 1.08-1.57) and children with dental plaque (RR 1.29; 95% CI 1.06-1.58) presented with higher DMF-T scores than their counterparts (p < 0.05). A higher household income (RR 0.66; 95% CI 0.51-0.84) and greater SOC scores (RR 0.71, 95% CI 0.56-0.90) were associated with lower DMF-T in children (p < 0.05). Children's SOC seems to be a relevant protective psychosocial factor for dental caries experience in socially vulnerable children.

Determinants of Health-Related and Oral Health-Related Quality of Life in Adults With Orofacial Clefts: A Cross-Sectional Study.

OBJECTIVES: To investigate the structural and intermediary determinants of health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) among adults with cleft lip and/or palate (CL/P). DESIGN AND PARTICIPANTS: A cross-sectional study was conducted with patients enrolled at the referral center for craniofacial anomalies in Manaus, Brazil. Adults aged 18 years or more with nonsyndromic CL/P were selected. MAIN OUTCOME MEASURES: Both HRQoL and OHRQoL were assessed using the 36-item Short-Form Health Survey and the Oral Impacts on Daily Performance, respectively. Individual interviews and oral examinations were conducted to collect data on socioeconomic and demographic characteristics, social ties, health-related behaviors, compliance of CL/P protocol, chronic diseases, type of CL/P, oral clinical measures, and CL/P-related measures. Poisson regression was used to test the association of independent variables with HRQoL and OHRQoL outcomes. RESULTS: The mean age of the 96 participants was 29.4 ± 9.1 years. Low family income, female sex, low social support, type of CL/P, and dental caries were associated with poor HRQoL and poor OHRQoL ( P < .05). Poor HRQoL was also associated with chronic diseases ( P < .05). Adults with low education, low social network, and smokers were more likely to have worse OHRQoL ( P < .05). CONCLUSIONS: Structural and intermediary determinants were related to HRQoL and OHRQoL in adults with CL/P, suggesting the need for interdisciplinary approaches to improve the management of CL/P and intersectoral actions to reduce the impact of social inequalities.

Protective psychosocial factors and dental caries in children and adolescents: a systematic review and meta-analysis.

BACKGROUND: Psychosocial protective factors include dispositional and family attributes that may reduce the occurrence of dental caries. AIM: This review analysed the evidence on the relationship between protective psychosocial factors and dental caries in children and adolescents. DESIGN: Primary studies involving children and adolescents were searched in the following electronic databases: Medline, SCOPUS, LILACS, SciELO, and Web of Science. The reference lists were also screened. Protective psychosocial factor descriptors were in accordance with the salutogenic theory. The outcome was clinical measure of dental caries. Quality assessments were performed using the Newcastle-Ottawa scale. RESULTS: The final search resulted in 35 studies, including 7 cohort, one case-control, and 27 cross-sectional studies. Most studies were of moderate quality. Meta-analyses revealed that low parental internal locus of control (cohort studies: OR = 1.42, 95% CI: 1.20-1.64; cross-sectional studies: OR = 1.30, 95% CI: 1.19-1.41), high parental external chance (OR = 1.20, 95% CI: 1.10-1.29), and high maternal sense of coherence (OR = 0.77, 95% CI: 0.62-0.93) were associated with dental caries in children. High social support (OR = 0.81, 95% CI: 0.68-0.93) and greater self-efficacy (OR = 1.50, 95% CI: 1.12-1.22) were also associated with dental caries in adolescents. CONCLUSIONS: The current evidence suggests that some salutogenic factors are important protective factors of dental caries during childhood and adolescence.