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.

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

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

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.

Chronic diseases and socioeconomic inequalities in quality of life among Brazilian adults: findings from a population-based study in Southern Brazil.

Background: To evaluate the association between sociodemographic conditions and the quality of life (QoL) in adults and investigate whether these inequalities are greater among individuals with long-lasting chronic health conditions. Methods: Cross-sectional analysis of the second wave (2012) of the EpiFloripa Study, a population-based cohort of 1720 adults living in Southern Brazil. QoL domains (physical, psychological, social relationships and environmental) were evaluated using the WHOQoL-BREF. Unadjusted and adjusted means of QoL according to socioeconomic and demographic variables were estimated and stratified by the presence of long-lasting chronic conditions (heart disease, stroke, diabetes, hypertension, chronic kidney disease, cirrhosis, tendinitis, arthritis, rheumatism and/or fibromyalgia) were peformed in 2016. Results: Among 1222 interviewed adults (56.6% females, mean age 41.7 ± 11.4 years; follow-up rate 71.1%), the prevalence of 1+ long-lasting chronic disease was 37.3% (95%CI: 34.4-40.3). Their effect on the QoL was four times higher on the physical component (-9.6; 95%CI -12.1; -7.1) than on the other domains. Adults aged 40+ years with black skin colour or lower educational level had a lower physical QoL score only when any chronic disease was present. Among those with some chronic illness, the psychological domain was also lower among those aged 40+ years and with a lower family income. No interaction between sociodemographic variables and chronic diseases was observed for the other QoL domains. Conclusions: The occurrence of long-lasting chronic diseases is associated with inequalities in QoL (physical and psychological domains), with stronger adverse effects among older adults, blacks and individuals with lower income or educational levels.

Tooth loss and general quality of life in dentate adults from Southern Brazil.

PURPOSE: This study aimed to estimate the association between the number of teeth and general quality of life in adults. METHODS: A population-based study was conducted with 1720 individuals aged 20-59 years residing in Florianópolis, Brazil, in 2009. Data were collected at participants' households using a structured questionnaire. In 2012, a second wave was undertaken with 1222 individuals. Oral examinations were performed for number of teeth, prevalence of functional dentition (≥21 natural teeth), and shortened dental arch (SDA), which were considered the main exposures. General quality of life was the outcome and was assessed with the WHO Abbreviated Instrument for Quality of Life (WHOQOL-BREF). Covariates included sociodemographic factors, health-related behaviors, and chronic diseases. Multivariable linear regression models were performed to test the associations between the main exposures and the outcome adjusted for covariates. RESULTS: In 2012, 1222 individuals participated in the study (response rate = 71.1%). Having more teeth was associated with greater scores on physical domain of the WHOQOL-BREF [ß = 0.24 (95% CI 0.01; 0.46)] after adjustment for covariates. Absence of functional dentition was associated with lower scores on the physical domain [ß = -3.94 (95% CI -7.40; -0.48)] in the adjusted analysis. There was no association between both SDA definitions and the domains of general quality of life. CONCLUSIONS: Oral health as measured by tooth loss was associated with negative impacts on general quality of life assessed by the WHOQOL-BREF. There was a lack of evidence that SDA is a condition that negatively affects general quality of life.

Prevalence and Associated Factors of Tooth Erosion in 8 -12-Year-Old Brazilian Schoolchildren.

OBJECTIVE: This study estimated the prevalence, distribution and associated factors of tooth erosion in Brazilian schoolchildren. STUDY DESIGN: A cross-sectional study was carried out in a representative sample of children aged 8-12-years-old from public and private schools. Six calibrated examiners assessed tooth erosion (O'Sullivan index) and other oral conditions (dental trauma, enamel defects, plaque, dental caries and dental crowding). Socio-demographic and behavioral data were collected using questionnaires. Interviews were conducted in children and in parents. Data were analyzed using Poisson regression model considering the cluster sample (Prevalence Ratio-PR; 95% Confidence Interval-CI). RESULTS: A total of 1,210 children participated and were examined. Tooth erosion was observed in 25.1% of the children. Lesions were mostly observed in enamel and less than a half of the buccal surface was affected. The type of school and age were significant associated with higher prevalence of tooth erosion and dental crowding was associated with less probability of tooth erosion significantly. Acidic food or drinks were not associated with dental erosion. CONCLUSION: The prevalence of tooth erosion in the studied population was high. Erosive lesions were not severe, confined in enamel. Tooth erosion was associated with age, type of school, socioeconomic level and dental crowding.

Effect of breastfeeding on malocclusions: a systematic review and meta-analysis.

AIM: The objective of this systematic review was to investigate whether breastfeeding decreases the risk of malocclusions. METHODS: Six databases were systematically searched to the end of October 2014. Observational and interventional studies were included. Breastfeeding was evaluated in three categories: (i) ever versus never; (ii) exclusive versus absence of exclusive; and (iii) longer periods versus shorter periods. All types of malocclusion were considered as the outcome. Pooled adjusted odds ratio and its 95% confidence interval (95%CI) were obtained from meta-analyses. Heterogeneity was assessed with both the Q-test and the I-square. Funnel plots and Egger's test were employed to assess publication bias. RESULTS: Forty-eight studies were included in the systematic review, and 41 were included in the overall meta-analysis (n = 27 023 participants). Subjects who were ever breastfed were less likely to develop malocclusions than those never breastfed (OR 0.34; 95% CI 0.24; 0.48), those who were exclusively breastfed presented lower risk to present malocclusion than those with absence of exclusive breastfeeding (OR 0.54; 95% CI 0.38; 0.77), and subjects longer breastfed were less likely to have malocclusions than those shorter breastfed (OR 0.40; 95% CI 0.29; 0.54). CONCLUSION: Breastfeeding decreases the risk of malocclusions.

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.

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.

Breastfeeding Protects from Overjet in Adolescence by Reducing Pacifier Use: A Birth Cohort Study.

Increased dental overjet in adolescence is a clinically relevant outcome associated with the complexity and high cost of treatment, indicating the need for prevention strategies. We investigated the long-term impact of breastfeeding and pacifier use on increased overjet (IOVJ) in permanent dentition. A prospective cohort nested in a randomized controlled trial was conducted from birth to 12 years of age (n = 214). Breastfeeding and pacifier use were recorded monthly until 12 months. Overjet was assessed at age 12 years. We employed a causal mediation analysis using parametric regression models assuming no interaction between breastfeeding and pacifier usage. We found a total protective effect of breastfeeding on IOVJ (OR 0.49; 95% CI 0.28-0.96), where 63.1% were mediated by pacifier use (OR 0.61; 95% CI 0.44-0.87). Breastfeeding directly decreased the odds of IOVJ by 20%; however, the confidence interval included the null estimate (OR 0.81; 95% CI 0.41-1.60). In conclusion, breastfeeding protects by half of the IOVJ in adolescence through reducing pacifier use. Oral and general health professionals should collaborate to support WHO breastfeeding guidelines during individual patient counseling. Guidelines for practice, policy or public information require messages that include a common risk approach to oral and general health.

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.

[Prevalence rates and inequalities in access to medicines by users of the Brazilian Unified National Health System in 2013 and 2019]. / Prevalências e desigualdades no acesso aos medicamentos por usuários do Sistema Único de Saúde no Brasil em 2013 e 2019.

The study aimed to analyze and compare the prevalence of access to medicines and associated factors among users of the Brazilian Unified National Health System (SUS). The authors analyzed data from the 2013 and 2019 editions of the Brazilian National Health Survey, a nationwide health study, representative of the Brazilian population. The outcomes were: (1) obtaining from the SUS all the medicines prescribed during care received in the SUS itself in the two weeks prior to the interview (2) and obtaining all the medicines, regardless of the source. Demographic and socioeconomic characteristics were included as independent variables. In 2019, 29.7% of the interviewees obtained all the prescribed medicines from the SUS, 81.8% obtained all the medicines in general (considering all sources), and 56.4% paid some amount for the medicines. The proportion who did obtain any medicine from the SUS and that made some out-of-pocket payment increased from 2013 to 2019. The likelihood of obtaining all the medicines in the SUS was higher among the poorest, and that of obtaining the medicines regardless of source was higher among the wealthiest. Approximately two out of three persons that were unable to access all the medicines reported difficulties obtaining them in services funded by the public sector. There was an increase in out-of-pocket expenditure on medicines in Brazil and a reduction in access through the SUS, among users of the system.

O objetivo do estudo foi analisar e comparar a prevalência, a forma de obtenção e os fatores associados ao acesso a medicamentos entre usuários do Sistema Único de Saúde (SUS) no Brasil. Foram analisados os dados das edições 2013 e 2019 da Pesquisa Nacional de Saúde, estudo de abrangência nacional e representativo da população brasileira. Os desfechos foram: (1) a obtenção total, por meio do SUS, dos medicamentos prescritos em atendimentos em saúde realizados no próprio SUS nas duas semanas anteriores à entrevista, e (2) a obtenção total dos medicamentos independentemente da fonte. Características demográficas e socioeconômicas foram incluídas como variáveis independentes. Em 2019, observou-se que 29,7% dos entrevistados obtiveram no SUS todos os medicamentos prescritos, que 81,8% tiveram acesso total aos medicamentos quando consideradas todas as fontes de obtenção e que 56,4% pagaram algum valor pelos medicamentos. A proporção de pessoas que não obtiveram nenhum medicamento no SUS e que efetuaram algum desembolso direto aumentou entre 2013 e 2019. A probabilidade de obter todos os medicamentos no SUS foi maior entre os mais pobres, e de consegui-los, independentemente da fonte, foi maior entre os mais ricos. Dentre as pessoas que não conseguiram acesso a todos os medicamentos, aproximadamente duas em cada três indicaram como principal motivo dificuldades de obtenção encontradas em serviços financiados pelo setor público. Verificou-se ampliação do desembolso direto para compra de medicamentos no Brasil e redução de acesso pelo SUS entre usuários do sistema.

El objetivo de este estudio fue analizar y comparar la prevalencia, la forma de obtención y los factores asociados al acceso a los medicamentos entre los usuarios del Sistema Único de Salud (SUS) en Brasil. Se analizaron los datos de las ediciones 2013 y 2019 de la Encuesta Nacional de Salud, un estudio de cobertura nacional y representativo de la población brasileña. Los resultados fueron: (1) la obtención total, a través del SUS, de los medicamentos prescritos en los servicios de salud realizados en el propio SUS en las dos semanas anteriores a la entrevista, y (2) la obtención total de los medicamentos independientemente de la fuente. Las características demográficas y socioeconómicas se incluyeron como variables independientes. En 2019 se observó que el 29,7% de los entrevistados obtuvo todos los medicamentos prescritos en el SUS, que el 81,8% tuvo acceso total a los medicamentos al considerar todas las fuentes de obtención y que el 56,4% pagó por los medicamentos. La proporción de personas que no obtuvieron ningún medicamento en el SUS y que realizaron algún gasto directo aumentó entre 2013 y 2019. Entre los pobres, la probabilidad de obtener todos los medicamentos del SUS fue mayor, y entre los más ricos también fue mayor esta obtención independientemente de la fuente. Entre las personas que no pudieron acceder a todos los medicamentos, aproximadamente dos de cada tres indicaron como razón principal las dificultades que se encuentran en los servicios financiados con fondos públicos. Hubo un aumento del gasto directo para la compra de medicamentos en Brasil y una reducción del acceso a través del SUS entre los usuarios del sistema.

Tooth wear and socioeconomic status in childhood and adulthood: Findings from a systematic review and meta-analysis of observational studies.

OBJECTIVES: To evaluate the association and level of evidence between socioeconomic status (SES) and tooth wear (TW) in children, adolescents, and adults. DATA: Eligibility criteria comprised population-based observational studies assessing the association between SES and TW in permanent dentition of adolescents and adults. Interventional and descriptive studies or those without an internal comparison between exposed and nonexposed groups were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied where applicable. Risk of bias (RoB) was assessed using the Newcastle-Ottawa scale. Meta-analyses were conducted to estimate the pooled effect measures. Q-statistic, I2statistic, subgroup and sensitivity analyses assessed study heterogeneity. SOURCES: PubMed/Medline, Embase, Scopus, Web of Science, LILACS, SciELO, Cochrane Library, and Google Scholar databases were searched for articles published in English between 1st January 1980 and 31st March 2021. RESULTS: Sixty-five studies were included, involving 63,893 participants in over 30 countries. A positive association was found between TW and education (OR=1.25 [0.96; 1.62]), family income (OR=1.18 [0.91; 1.53]), and private school (OR= 1.24 [0.90; 1.72]) among adolescents. Higher educated adults had a lower risk for TW (OR=0.70 [0.52; 0.93]). Most included studies had a moderate RoB. Limitations relating to population representation and assessment methodologies were identified in the included studies. CONCLUSIONS: SES was associated with TW with its direction depending on the individuals' age. The overall quality of evidence was moderate. CLINICAL SIGNIFICANC: SES should be included as part of the routine screening and risk assessment for tooth wear.

Influence of biological, social and psychological factors on abnormal eating attitudes among female university students in Brazil.

The objective of the study was to estimate abnormal eating attitudes influenced by associated factors among female students of the Universidade Federal de Santa Catarina, Florian6polis, southern Brazil. Abnormal eating attitudes were investigated using the eating attitudes test (EAT-26), according to the presence (EAT+) and absence (EAT-) of symptoms in a sample of 220 students. The body-image was assessed by the body-shape questionnaire (BSQ-34). Body mass index, body-fat percentage, waist-circumference, food intake (24-hour food recall), and socioeconomic characteristics (monthly household income, monthly per-capita income, and parental schooling) were also investigated. Statistical associations were tested by multivariate Poisson regression analysis. The prevalence of EAT+ and dissatisfaction with the body-image were 8.3% [confidence interval (CI) 95% 4.6-12.0] and 20.0% (CI 95% 14.7-25.3) respectively. Dissatisfaction with the body-image maintained its independent association with abnormal eating attitudes, indicating symptoms of anorexia nervosa. The results of this work highlight the importance of the planning of nutrition-education programmes in universities, aiming at assisting in the choices of food that comprise a healthful diet in a period of life of so many changes and decisions.

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.

Skin color affect the replacement of amalgam for composite in posterior restorations: a birth-cohort study.

The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.