Chronic oral disease burden at the first 1000 days: Intergenerational risk factors, BRISA cohort.

OBJECTIVE: To analyze multiple-causal models, including socioeconomic, obesity, sugar consumption, alcohol smoking, caries, and periodontitis variables in pregnant women with early sugar exposure, obesity, and the Chronic Oral Disease Burden in their offspring around the first 1000 days of life. METHODS: The BRISA cohort study, Brazil, had two assessments: at the 22nd-25th gestational weeks and during the child's second year (n = 1141). We proposed a theoretical model exploring the association between socioeconomic and pregnancy factors (age, smoking, alcohol, sugars, obesity, periodontitis, and caries) and child's variables (sugars and overweight) with the outcome, Chronic Oral Disease Burden (latent variable deduced from visible plaque, gingivitis, and tooth decay), using structural equation modeling. RESULTS: Caries and periodontitis were correlated in pregnant women. Addictive behaviors in the gestational period were correlated. Obesity (Standardized coefficient - SC = 0.081; p = 0.047) and added sugar consumption (SC = 0.142; p = 0.041) were observed intergenerationally in the pregnant woman-child dyads. Sugar consumption by the children (SC = 0.210; p = 0.041) increased the Chronic Oral Disease Burden. CONCLUSIONS: Poor caries and periodontal indicators were correlated in pregnant women and their offspring. Obesity and sugar consumption act intergenerationally. Oral health in early life may change life trajectory since the worst oral conditions predict main NCDs.

Prediction of deciduous teeth eruption in Brazilian children: A cross-sectional study nested in a prospective birth cohort (BRISA).

BACKGROUND: Dental eruption is part of a set of children´s somatic growth phenomena. The worldwide accepted human dental eruption chronology is still based on a small sample of European children. However, evidence points to some population variations with the eruption at least two months later in low-income countries, and local standards may be useful. So, this study aimed to predict deciduous teeth eruption from 12 months of age in a Brazilian infant population. METHODS: We developed a cross-sectional study nested in four prospective cohorts - the Brazilian Ribeirão Preto and São Luís Cohort Study (BRISA) - in a sample of 3,733 children aged 12 to 36 months old, corrected by gestational age. We made a reference curve with the number of teeth erupted by age using the Generalized Additive Models for location, scale, and shape (GAMLSS) technique. The explanatory variable was the corrected children´s age. The dependent variable was the number of erupted teeth, by gender, evaluated according to some different outcome distributional forms. The generalized Akaike information criterion (GAIC) and the model residuals were used as the model selection criterion. RESULTS: The Box-Cox Power Exponential method was the GAMLSS model with better-fit indexes. Our estimation curve was able to predict the number of erupted deciduous teeth by age, similar to the real values, in addition to describing the evolution of children's development, with comparative patterns. There was no difference in the mean number of erupted teeth between the sexes. According to the reference curve, at 12 months old, 25% of children had four erupted teeth or less, while 75% had seven or fewer and 95% had 11 or fewer. At 24 months old, 5% had less than 12, and 75% had 18 or more. At 36 months old, around 50% of the population had deciduous dentition completed (20 teeth). CONCLUSION: The adjusted age was an important predictor of the number of erupted deciduous teeth. This outcome can be a variable incorporated into children's growth and development curves, such as weight and height curves for age to help dentists and physicians in the monitoring the children's health.

Depression and associated factors among Brazilian adults: the 2019 national healthcare population-based study.

BACKGROUND: Mental disorders represent a major public health challenge worldwide, affecting 80% of people living in low- and middle-income countries. Depression, a mental disorder, is a chronic disease of long duration that causes changes in the brain, resulting from a combination of genetic, physiologic, environmental, and behavioral factors. The aim of this study was to investigate possible factors associated with depression in Brazilian adults. METHODS: A population-based, cross-sectional study was carried out using the public domain database of the 2019 National Health Survey, conducted in Brazil. Depression was considered the dependent variable, and through hierarchical analysis, predictor variables were investigated such as, at the distal level-socioeconomic variables, at the intermediate level-variables related to lifestyle behavior, health condition, and history, and at the proximal level-demographic variables. Logistic regression analysis was used to obtain the adjusted Odds Ratio and the respective 95% confidence interval to identify possible factors associated with depression. RESULTS: The study included 88,531 participant records with 10.27% diagnosed with depression. The adjusted association measurements, after selecting the independent variables in the hierarchical analysis, showed the following factors associated with depression with differing magnitudes: age, brown and white race/skin color, female sex, poor, very poor, or regular self-reported health condition, diagnosis of cardiovascular disease, work-related musculoskeletal disorder, history of smoking habit, and macroeconomic region. CONCLUSIONS: An effective strategy for preventing and managing depression in Brazilian adults must include the control of health status and lifestyle behavior factors, with actions and programs to reduce people's exposure to these factors, understanding that socioeconomic-demographic differences of each population can potentially reduce the disease burden.

Pre- and perinatal exposures associated with molar incisor hypomineralization: Birth cohort, Brazil.

OBJECTIVE: To analyze prenatal and perinatal stressors associated with molar incisor hypomineralization (MIH) in adolescents. METHODS: Prospective cohort study collected prenatal (socioeconomic status, maternal age, number of prenatal visits, smoking, obesity during pregnancy, abortion history, gestational hypertension) and perinatal stressors (type of delivery, gestational age, birth weight, intensive care unit-ICU at birth). The outcome was MIH at 18-19 years follow-up (n = 590). MIH was defined according to the Ghanim criteria - Model I. We performed a sensitivity analysis, including opacities demarcated in index tooth, incisive or molars, Model II. Through structural equation modeling, we analyzed direct and mediating pathways between multiple stressors with outcomes. RESULTS: MIH was observed in 15.25% (n = 90), and opacities demarcated in any index tooth were observed in 22.8% of adolescents (n = 135). In Model I, no stressor explained MIH significantly, although we watched high standardized coefficients (SC) for low birth weight (SC = 0.223, p = 0.147), lower gestational age (SC = 0.351; p = 0.254), and ICU admission (SC = 0.447, p = 0.254). In Model II, advanced maternal age (SC = 0.148; p < 0.05) and not undergoing prenatal care (SC = 0.384, p < 0.03) explained opacities demarcated in incisors or molars. CONCLUSION: Advanced maternal age and not undergoing prenatal care were associated with MIH lesion-like in incisors or molars.

Investigating oral and systemic pathways between unhealthy and healthy dietary patterns to periodontitis in adolescents: A population-based study.

AIM: To investigate pathways between unhealthy and healthy dietary patterns and periodontitis in adolescents (18-19 years of age). MATERIALS AND METHODS: This population-based study (n = 2515) modelled direct and mediated pathways (via biofilm and obesity) from patterns of healthy diet (fruits, fibre, vegetables, and dairy) and unhealthy diet (sugars, snacks, and salty/fast foods) with initial periodontitis (bleeding on probing [BoP], probing depth [PD] ≥ 4 mm, clinical attachment loss [CAL] ≥ 4 mm), moderate periodontitis (BoP, PD ≥ 5 mm, and CAL ≥ 5 mm), and European Federation of Periodontology and the American Academy of Periodontology (EFP-AAP) periodontitis definitions, adjusting for sex, socio-economic status, smoking, and alcohol, through structural equation modelling (α = 5%). RESULTS: Higher values of healthy diet were associated with lower values of initial periodontitis (standardized coefficient [SC] = -0.160; p < .001), moderate periodontitis (SC = -0.202; p < .001), and EFP-AAP periodontitis (p < .05). A higher value of unhealthy diet was associated with higher values of initial periodontitis (SC = 0.134; p = .005) and moderate periodontitis (SC = 0.180; p < .001). Biofilm mediated the association between higher values of unhealthy diet and all periodontal outcomes (p < .05). CONCLUSIONS: Our findings suggest that both healthy and unhealthy dietary patterns may contribute to reduced or increased extent and severity of periodontitis by local and systemic mechanisms, preceding the effect of other established causes such as smoking and obesity, in younger population.

Sugar intake above international recommendations and oral disease burden: A population-based study.

OBJECTIVE: To evaluate the association between added sugar intake above the daily limit for the risk of noncommunicable diseases (NCDs) and the Chronic Oral Disease Burden in adolescents. METHODS: This was a population-based study using cross-sectional data nested to RPS Cohorts Consortium, São Luís, Brazil, from the 18-19-year-old follow-up (n = 2515). High consumption of added sugars was estimated according to the limits of the World Health Organization guidelines (WHO) (≥5% of total energy/day) and the American Heart Association statement (AHA) (≥25 g/day). The Chronic Oral Disease Burden was a latent variable (number of decayed teeth, periodontal probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding on probing). Models were adjusted for Socioeconomic Status, sex, obesity, and plaque index and analyzed through structural equation modeling. RESULTS: Adolescents had high sugar consumption according to the WHO (78.6%) and AHA (81.4%) recommendations. High sugar intake, according to WHO (SC = 0.096; p = 0.007) and AHA (SC = 0.056; p = 0.027), was associated with a heavier Chronic Oral Disease Burden. Even half of the recommended dose was sufficient to affect some oral disease indicators. CONCLUSION: Sugar intake over international statements to prevent NCDs is associated with higher Chronic Oral Disease Burden among adolescents.

Adverse pregnancy outcomes and occlusal traits in the primary dentition: A prospective cohort (BRISA).

OBJECTIVES: This study aimed to analyse the relationship between adverse pregnancy outcomes (APO) and occlusal traits in the primary dentition, checking for different mediation paths. SETTING AND SAMPLE POPULATION: Children evaluated at birth (T1), between 12 and 24 months (T2), and between 24 and 36 months (T3) were included. Two hundred and seventeen children who participated in T1 and T2 were randomly selected to perform the occlusion examination. MATERIALS AND METHODS: This is a prospective cohort study (BRISA). The theoretical model was tested by structural equation modelling (SEM), estimating standardized coefficients (Coeff.) (α = 0.05). The primary exposure was APO-a latent variable manifested from three health problems at birth: low birthweight (LBW), pre-term birth (PTB) and intrauterine growth restriction (IUGR), evaluated in T1. The outcomes were four different occlusal traits assessed in T3: overjet, anterior and posterior crossbite, and crowding. Each outcome's direct and indirect effects were tested, mediated by growth, breathing, breastfeeding, and pacifier use. RESULTS: There was no direct association between APO and any of the outcomes: overjet (Coeff. = -0.163, P = .241), anterior crossbite (Coeff. = -0.696, P = .065), posterior crossbite (Coeff. = -0.087, P = .589) and crowding (Coeff. = 0.400, P = .423). The indirect (total and specifics) effects tested also showed no association (P > .05). However, APO was associated with lower child growth in all models; breastfeeding was associated with higher child growth in all models, and pacifier use was associated with overjet (Coeff. = 0.184, P < .001) and posterior crossbite (Coeff. = 0.373, P = .011). CONCLUSION: APO was not a risk factor for overjet, crossbite and crowding in an early stage of the primary dentition by direct and indirect pathways. However, growth has been lower in children with APO and higher in children breastfed. Also, the harmful effects of using a pacifier in dental occlusion are highlighted.

[Factors associated with hospitalizations for primary care-sensitive conditions in Brazil: an ecological studyFactores asociados a las hospitalizaciones infantiles por afecciones que podrían tratarse en la atención primaria en Brasil: estudio ecológico]. / Fatores associados às internações infantis por condições sensíveis à atenção primária no Brasil: estudo ecológico.

Objective: To investigate whether structural aspects of primary care units (PCUs) and the work processes of primary care teams are associated with the rate of hospitalizations for primary care-sensitive conditions (HPCSC) in children younger than 5 years of age in Brazil. Method: For this longitudinal ecological study, secondary data were obtained from the Brazilian Hospital Information System and from three cycles of the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) (2012, 2014, 2017/2018). The analysis included 42 916 PCUs. A multilevel random intercept model with fixed slope was used. In the first level, the outcome (HPCSC rates) and explanatory variables (structure and process indicators) aggregated by PCU were analyzed. Social determinants (represented by a stratification criterion combining municipality population and health care management indicators) were entered in the second level. The t test with Bonferroni correction was used to compare indicator means between regions, and multilevel linear regression was used to estimate the correlation coefficients. Results: The HPCSC rate in children younger than 5 years was 62.78/100 thousand population per estimated PCU coverage area. A direct association with the outcome was observed for: participation in one or more PMAQ-AB cycles; team planning; special hours; dedicated pediatric care area; and availability of vaccines. Equipment, materials, supplies, and being a small or medium-size municipality were inversely associated with HPCSC. Conclusions: HPCSC rates in children below 5 years of age may potentially be reduced through improvements in PCU structure and process indicators and in municipal social determinants.

Objetivo: Determinar la asociación de la estructura de las unidades básicas de salud (UBS) y del proceso de trabajo de los equipos de atención primaria con los determinantes sociales y las tasas de hospitalización por afecciones que podrían tratarse en la atención primaria en menores de 5 años en Brasil. Métodos: Estudio longitudinal ecológico, con datos secundarios del Sistema de Informaciones Hospitalarias y los tres ciclos del Programa Nacional de Mejora del Acceso y de la Calidad de la Atención Básica (PMAQ-AB) (2012, 2014, 2017-2018). Se analizaron 42.916 UBS. Se aplicó un modelo multinivel con pendiente fija e intercepción aleatoria. En el primer nivel, se analizaron el desenlace (tasas de hospitalización por afecciones que podrían tratarse en los servicios de atención primaria) y las variables explicativas (indicadores estructurales y procedimentales) consolidados por UBS. En el segundo nivel, se incluyeron determinantes sociales municipales (representados por un criterio de estratificación que combina el tamaño del municipio con indicadores que influyen en la gestión de salud). Se utilizó la prueba de la t con la corrección de Bonferroni para comparar las medias de los indicadores entre las regiones y la regresión lineal multinivel para estimar los coeficientes de correlación. Resultados: La tasa de hospitalización por afecciones que podrían tratarse en los servicios de atención primaria en menores de 5 años fue de 62,78/100 mil habitantes por área estimada de cobertura de UBS. Los siguientes factores presentaron una asociación directa con el desenlace: participación en uno o más ciclos del PMAQ-AB; planificación del equipo; horario especial; dependencias de atención infantil en la unidad; y disponibilidad de vacunas. La variable relativa a equipos, materiales e insumos y la clasificación como municipio pequeño o mediano se asociaron inversamente con las hospitalizaciones por afecciones que podrían tratarse en los servicios de atención primaria. Conclusiones: Las hospitalizaciones de menores de 5 años por afecciones que podrían tratarse en los servicios de atención primaria pueden reducirse mejorando los indicadores estructurales y procedimentales de las UBS y los determinantes sociales municipales.

Low bone mineral density is associated with severe periodontitis at the end of the second decade of life: A population-based study.

AIM: To evaluate the association between low bone mineral density (BMD) and severe periodontitis at the end of the second decade of life. MATERIALS AND METHODS: This population-based study analysed 2032 youngers (18-19 years old) of the RPS cohort. BMD of lumbar spine (BMD-LS) and of the whole body (BMD-WB) were assessed by dual x-ray emission densitometry. Low BMD-LS (Z-score ≤ -2) and low BMD-WB (Z-score ≤ -1.5) were correlated with severe periodontitis. The extent of periodontal disease was also evaluated as the following outcomes: proportions of teeth affected by clinical attachment loss ≥5 mm and probing depth ≥5 mm. Multivariate models by sex, education, family income, risk of alcohol dependence, smoking, plaque, bleeding index, and body mass index were estimated through logistic regression (binary outcomes) and Poisson regression (continuous outcomes). RESULTS: The prevalence of severe periodontitis was 10.97%. Low BMD-LS (odds ratio [OR] = 2.08, confidence interval [CI] = 1.12-3.85, p = .01) and low BMD-WB (OR = 1.34, CI = 1.001-1.81, p = .04) were associated with severe periodontitis in the final multivariate models. Low BMD-LS and BMD-WB were also associated with a greater extent of periodontitis (p < .05). CONCLUSIONS: Low BMD was found to be associated with the severity and extent of periodontitis in adolescents. Adolescents at peak bone mass age presenting low BMD are more likely to be affected by severe periodontitis.

Hyperglycaemia and factors associated with dental caries in immediate postpartum women.

Objective: Dental caries and hyperglycaemia share common risk factors. The aim of this study was to identify factors associated with dental caries in women in the immediate postpartum period. It also verified whether women with hyperglycaemia presented more dental caries than those with normal glycaemia.Material and Methods: This cross-sectional study was performed on 297 women recruited from a teaching hospital in Brazil (from October 2011 to November 2012). Dental caries and oral biofilm were evaluated by oral examination. The blood glucose was accessed by Haemoglobin A1c test. Information on socioeconomic characteristics, harmful habits and oral health habits was also gathered.Results: More than half (66%) of the women had carious lesions. Univariate analysis showed no association between hyperglycaemia and dental caries (p = .39). The hierarchical logistic regression model showed that the following variables were associated with dental caries: maternal education level ≤8 years (ORadjusted = 2.40 [CI 1.19-4.82]), previous children (ORadjusted = 1.81 [CI 1.08-3.03), use of dental floss (ORadjusted = .48 [CI 0.27-0.86]), and visible plaque index ≥30% (ORadjusted = 1.83 [CI 1.05-3.20]).Conclusions: These findings call attention to the need to implement effective public policies directed at avoiding tooth decay in pregnancy and in the postpartum period.

Exploring lay public and dental professional knowledge around HPV transmission via oral sex and oral cancer development.

BACKGROUND: Human papillomavirus (HPV) has been associated with certain types of oropharyngeal cancers and yet, the level of knowledge that dental professionals and the lay public have in terms of HPV transmission, oral sexual activities, and oral cancer development needs exploration. The aim of this study was to assess the knowledge held by practicing dental professionals as well as the lay public regarding Human Papillomavirus (HPV) transmission through oral sex and subsequent oropharyngeal cancer development. METHODS: Textual data were collected from a public forum with dental professionals in. Vancouver, who discussed the HPV-oral sex-oral cancer triad, and from survey data gathered from 212 lay public participants (also in Vancouver) who answered a 13-item questionnaire on the perceived risks of oral sex in terms of HPV infection and oropharyngeal cancer development. The data were analyzed statistically by age group, gender, and sexual orientation using descriptive statistics, while an ANOVA test was used to compare variation in the responses to the survey (p-value = 0.05). RESULTS: The forum engaged 46 health care professionals, many of whom were aware of the potential risks for head and neck cancer development due to HPV infection, while also questioning "how to effectively talk about HPV with patients." The survey revealed that 34.5% of the participants believed that oral sex is an activity with no or low risk for the transmission of HPV, while 84% of participants believed the same sexual practices were of low or no-risk for HIV (Human Immunodeficiency Virus) transmission. Most participants (82%) never discussed oral sexual activities with their physicians or dentists/dental hygienists. CONCLUSIONS: The general public remains mostly unaware of the potential links between HPV infection and oropharyngeal cancer. Physicians and dental providers should discuss oral sexual practice with their patients to raise awareness.

Periodontopathogenic microbiota, infectious mechanisms and preterm birth: analysis with structural equations (cohort-BRISA).

PURPOSE: The association between periodontopathogenic microbiota and preterm birth (PTB) has been overly studied. However, the biological mechanisms involved are little known. The objective is to evaluate the effect of periodontopathogenic bacteria burden (PBB), periodontal disease and other infections during pregnancy on preterm birth (PTB), through Structural Equation Modeling. METHODS: This was a case-control study nested in a prospective cohort called BRISA, including 330 pregnant women, 110 cases and 220 controls. This study included the following variables: cytokines interleukin-10 (IL-10) and transforming growth factor beta (TGF-ß), periodontal disease, PBB, age, socioeconomic status (SES), systemic infections and PTB. The correlations between variables were analyzed using Standardized Coefficient (SC). RESULTS: Greater PBB interfered positively with the occurrence of periodontal disease (SC: 0.027; p: 0.011), but these were not associated with the cytokines studied, nor with PTB. The lower serum levels of IL-10 (SC - 0.330; p 0.022) and TGF-ß (SC - 0.612; p < 0.001), and the presence of other systemic infections during pregnancy (SC 0.159; 0.049) explained the higher occurrence of PTB. CONCLUSION: It is possible that only the more severe periodontal disease and other systemic infections are capable of altering the cascade of cytokines regulating the inflammatory process and have an effect on the occurrence of PTB.

Effects of conventional and orthodontic pacifiers on the dental occlusion of children aged 24-36 months old.

AIM: To investigate the effects of conventional and orthodontic pacifiers on the prevalence of malocclusion (MO) considering frequency, duration, and intensity of the sucking habit. DESIGN: Data were collected at three time-points: birth, T1; (12-24 months old), T2; (24-36 months old), T3 and were divided into three groups: control (GC; 110), without non-nutritive sucking habits; orthodontic pacifiers (GOrth; 55); conventional pacifiers (GConv; 55). A questionnaire was applied. Clinical examination was performed at T3. The groups were compared as to the prevalence and severity of anterior open bite (AOB), accentuated overjet, anterior crossbite, posterior crossbite (PCB). RESULTS: The use of pacifiers was associated with occurrence of MO compared to GC (P < 0.05). Frequency, intensity, and duration of pacifier use was also associated with of MO. There was significant difference in the prevalence of MO between GConv and GOrth for AOB (P = 0.027). Only GConv exhibited higher odds of PCB compared to GC (P = 0.040). The prevalence of MO was significantly higher in pacifiers users (P < 0.001). CONCLUSION: The prevalence of MO was higher among children who used pacifiers. According to a general trend, the use of conventional pacifiers was associated to severe anterior open bite and overjet.

Effect of maternal periodontitis and low birth weight--a case control study.

INTRODUCTION: Since the 1990s, evidence has been raised that there is an association between maternal periodontal disease and undesirable gestational events, for example low birth weight; this issue is controversial. OBJECTIVE: To evaluate whether there is an association between maternal periodontitis and low birth weight (LBW). METHODS: A case-control study was carried out on 951 mothers that had been cared for by the Brazilian Unified Health System in Petrolina-PE and Juazeiro-BA, Brazil. The case group (n = 269) consisted of mothers of newborns with birth weight <2500 g and a control group (n = 682) of mothers of newborns with birth weight ≥2500 g. An interview was realized, using a questionnaire as well as a full mouth examination to diagnose the periodontal condition. Women who had at least four teeth with probing depth ≥4 mm and clinical attachment loss ≥3 mm, with bleeding on probing at the same site, were diagnosed with periodontitis. The birth weight was obtained through the hospital book record. The main association was evaluated using the multivariate regression model, considering confounders. RESULTS: The frequency of periodontitis was 16.4% (case group) and 17.4% (control group). Periodontitis did not show an association with LBW (ORcrude = 0.92; 95% CI = 0.63-1.35), even after adjustment for the following confounders: maternal age, pre-gestational body mass index, number of pre-natal consultations, number of pregnancies, maternal schooling level, smoking habit during pregnancy and hypertension (ORadjusted = 1.00; 95% CI = 0.61-1.68). CONCLUSION: The findings of this study showed no association between maternal periodontal disease and low birth weight, even after appropriate adjustments for confounding factors.

Scaling and Root Planning decreases the Number of Melanosomes within Keratinocytes in Human Gingiva: Ultrastructural Analysis of Three Cases.

AIM: The aim of the present report was to evaluate the number of melanosomes within keratinocytes on pigmented gingiva, after and before scaling and root planning. MATERIALS AND METHODS: Inflamed gingiva biopsies were taken from three patients (group 1). Forty days after scaling and root planning, biopsies were collected from the homologous contralateral areas (group 2). Samples were fixed in 2% glutaraldehyde-2.5% formaldehyde (freshly prepared from paraformaldehyde) in 0.1 M sodium cacodylate buffer, pH 7.4 for 4 hours, and then processed for transmission electron microscopy. Eighty electron micrographs were evaluated for recording the number of granules by a cross-section grid. The granules that were on intersections were recorded as well as the points that appeared on the cytoplasm for calculating the volumetric density (Vd), i.e the volume that the melanosomes occupied into the cytoplasm of keratinocytes. The presence of melanosomes in different stages of maturation and distribution into the cells were recorded with the aid of a magnifying glass. For the statistical analysis, a student t-test was applied. RESULTS: Results of the present report showed that melanosomes within keratinocytes were present in a higher number in inflamed gingiva A (11.08 ± 1.47), B (3.16 ± 0.38) and C (4.92 ± 0.89) and decreased after resolving of gingival inflammation A (9.46 ± 0.88), B (1.73 ± 0.25) and C (0.76 ± 0.18). CONCLUSION: There is a possibility that inflammation influences the intensity of gingival melanin pigmentation. CLINICAL SIGNIFICANCE: The periodontal treatment appears to have an effect on gingival melanin pigmentation.

Factors underlying the polarization of early childhood caries within a high-risk population.

BACKGROUND: Early childhood caries (ECC) are particularly prevalent in disadvantaged populations, and socioeconomic factors are associated with the polarization of disease. A previous study showed that even within a homogenous low-income population disease is polarized, indicating that other factors apart from income may contribute to disease susceptibility. METHODS: This study used a hierarchical approach to identify factors associated with polarization of ECC in low-income subjects. This cross-sectional study was conducted retrospectively using a cohort of 244 children (aged 48-72 months) with family incomes not exceeding double the minimum wage (U.S. $8,208.00/year), living in neighborhoods on the outskirts of São Luís, Maranhão, Brazil. The sample was divided into three groups based on the Significant Caries (SiC) Index: no caries group, few caries group (mean 1.38 lesions), and a high caries group (mean 3.82 lesions). Hierarchical multinomial logistic regression analyses were performed based on a theoretical model. RESULTS: Twenty-eight (11.5%) of the 244 children presented with high caries. Age (p = 0.026; prevalence ratio (PR) = 1.10; 95% confidence interval (CI) 1.01-1.20) and frequency of sucrose consumption - p = 0.001; PR 4.65 (95% CI 1.83-11.84) were associated with increased risk of ECC. CONCLUSIONS: In the high caries group, greater consumption of sucrose between main meals may explain why, in a group of children with homogenous social and health conditions, some had more caries than others.

A protocol to identify non-classical risk factors for preterm births: the Brazilian Ribeirão Preto and São Luís prenatal cohort (BRISA).

BACKGROUND: Preterm birth is the main cause of morbidity and mortality during the perinatal period. Classical risk factors are held responsible for only 1/3 of preterm births and no current intervention has produced an appreciable reduction of this event. It is necessary to explore new hypotheses and mechanisms of causality by using an integrated approach, collaboration among research groups and less fragmented theoretical-methodological approaches in order to detect new risk factors and to formulate more effective intervention strategies. METHODS: The study will be conducted on a convenience cohort of Brazilian pregnant women recruited at public and private prenatal health services. A total of 1500 pregnant women in São Luís, and 1500 in Ribeirão Preto, will be invited for an interview and for the collection of biological specimens from the 22nd to the 25th week of gestational age (GA). At the time of delivery they will be reinterviewed. GA will be determined using an algorithm based on two criteria: date of last menstruation (DLM) and obstetric ultrasound (OUS) performed at less than 20 weeks of GA. Illicit drug consumption during pregnancy will be determined using a self-applied questionnaire and the following instruments will be used: perceived stress scale, Beck anxiety scale, screening for depression of the Center of Epidemiological Studies (CES-D), experiences of racial discrimination, social network and social support scale of the Medical Outcomes Study and violence (Abuse Assessment Screening and violence questionnaire of the WHO). Bacterial vaginosis, urinary tract infection and periodontal disease will also be identified. Neuroendocrine, immunoinflammatory and medical intervention hypotheses will be tested. The occurrence of elective cesarean section in the absence of labor will be used as a marker of medical intervention. CONCLUSION: Psychosocial, genetic and infectious mechanisms will be selected, since there are indications that they influence preterm birth (PTB). The studies will be conducted in two Brazilian cities with discrepant socioeconomic conditions. The expectation is to identify risk factors for PTB having a greater predictive power than classically studied factors. The final objective is to propose more effective interventions for the reduction of PTB, which, after being tested, might subsidize health policies.

Comparative Study on the Periodontal Parameters Used in Diagnosing Periodontitis in Puerperae and Periodontitis' Relationship with the Birth of Preterm Infants: A Case-Control Study.

To compare different criteria for the diagnosis of periodontitis and to evaluate the association of this condition with prematurity, this case-control study was conducted on 283 mothers of infants, divided into two groups based on gestational age (cases: <37 weeks, controls: ≥37 weeks), with 71 cases and 212 controls. The periodontal evaluation included probing depth (PD), clinical attachment level (CAL), plaque index, and bleeding on probing (BOP). Participants were classified regarding periodontitis per 14 criteria based on different periodontal parameters. The criterion selected as the gold standard was the presence of at least four teeth with one or more sites with a PD ≥ 4 mm, CAL ≥ 3 mm, and BOP at the same site. The prevalence of periodontal disease ranged from 8.1% to 55.1%. Moreover, compared to the gold standard, the sensitivities of the other criteria were 100%, while specificity ranged from 50.4% to 96.4%. Periodontitis, defined by six of the selected criteria, was associated with prematurity after multivariate adjustment, with OR ranging from 1.85 to 2.69 and 95% CI from 1.01 to 5.56; one of them was the gold standard mentioned above. Measurements using the clinical parameters of PD, CAL, and bleeding at the same site (criteria 5, 6, 7, 8), CPI (criterion 10), and at least four teeth with a PD ≥ 4 mm and CAL ≥ 3 mm (criterion 11) to define periodontitis showed a statistically significant association (p < 0.05). Given this study's limitations, we can conclude that the diagnostic criteria for a periodontitis definition using a PD ≥ 4 mm and CAL ≥ 3 mm in two or more teeth, with BOP at the same site, seem stronger when detecting an association between periodontitis and prematurity.

Obesity, Insulin Resistance, Caries, and Periodontitis: Syndemic Framework.

(1) Background: To investigate the grouping of obesity and insulin resistance with caries and periodontitis from a syndemic perspective through pathways of socioeconomic inequalities, smoking, alcohol, and high sugar consumption in adolescence. (2) Methods: The population-based RPS Cohort study, São Luís, Brazil, in ages 18-19 years (n = 2515) was used. The outcomes were the grouping of pbesity and Insulin Resistance Phenotype (latent variable formed by Triglycerides/HDL ratio, TyG index, and VLDL) and the Chronic Oral Disease Burden (latent variable comprising caries, bleeding on probing, probing depth ≥ 4 mm, clinical attachment level ≥ 3 mm, and visible plaque index ≥ 15%). Socioeconomic Inequalities influencing the Behavioral Risk Factors (latent variable formed by added sugar, smoking, and alcohol) were analyzed using structural equation modeling. (3) Results: Socioeconomic Inequalities were associated with the Chronic Oral Disease Burden [Standardized Coefficient (SC) = 0.222, p < 0.001]. Behavioral Risk Factors were associated with increased Chronic Oral Disease Burden (SC = 0.103; p = 0.013). Obesity was associated with the Insulin Resistance Phenotype (SC = 0.072; p < 0.001) and the Chronic Oral Disease Burden (SC = 0.066; p = 0.005). The Insulin Resistance Phenotype and the Chronic Oral Disease Burden were associated (SC = 0.053; p = 0.032). (4) Conclusion: The grouping of obesity and early events of diabetes with caries and periodontitis call for a syndemic approach in adolescence.

Small for gestational age and early childhood caries: the BRISA cohort study.

This study tests the hypothesis that children 12-30 months born small for gestational age (SGA) aged are more susceptible to severe early childhood caries (S-ECC). We used data on 865 children aged 12-30 months from a prospective cohort study conducted in a city in the northeast of Brazil. The study outcome was S-ECC, defined based on the proportion of decayed tooth surfaces (cavitated or not). The main exposure variable was SGA, defined according to the Kramer criterion and the INTERGROWTH-21st standard. Direct (SGA → S-ECC) and indirect effects were estimated using structural equation modeling, calculating standardized factor loadings (SFL) and P-values (alpha = 5%). The final models showed a good fit. SGA influenced S-ECC in the direct and indirect paths. In the group of SGA children with 12 or more erupted teeth defined according to the Kramer criterion, the direct effect was positive (SFL = 0.163; P = 0.019); while among all SGA children defined according to the INTERGROWTH-21st standard, the direct effect was negative (SFL = - 0.711; P < 0.001). Age and number of erupted teeth may influence the occurrence of S-ECC in SGA children, as the number of teeth affects the time of exposure to disease risk factors.