Acceptability of dental students and professionals concerning child behaviour management techniques: Systematic review.

INTRODUCTION: During child dental treatment, different behavior management techniques (BMTs) are applied and it is important to understand the possible discomfort in the operator. OBJECTIVE: The present systematic review aimed to evaluate the acceptability of dental students and professionals concerning BMTs applied with paediatric dentistry patients. MATERIALS AND METHODS: A systematic search was conducted, following the PEOS strategy: Population (P) - dental students/professionals (S); Exposure (E) - BMTs preconized by the American Academy of Paediatric Dentistry, Outcome (O) - proportion of BMT acceptance; and Study design (S) - observational studies based on data from PubMed, Scopus, Web of Science, BVS (Lilacs/BBO), Cochrane, and Open Grey databases up to September 2021. The eligible studies were submitted to data extraction and to the evaluation of methodological quality, using the Joanna Briggs Institute Critical Appraisal Tool. The certainty of evidence was evaluated by GRADE. RESULTS: The search retrieved 710 articles; a total of 21 fulfilled the eligibility criteria and were used for qualitative analysis. Among the undergraduate students and dentists, the most accepted techniques were tell-show-do and positive reinforcement, while paediatric dentists preferred the tell-show-do technique and dental professionals with graduate degrees preferred sedation using nitrous oxide and positive reinforcement. The least accepted technique was protective stabilization. Seven students presented a low risk for bias, while 14 presented a high risk. The certainty of evidence was classified as very low. CONCLUSION: Although the basis of available certainty of evidence is scarce and with a considerable risk for bias, it is still possible to conclude that the more accepted techniques were based on communication.

Determination of dental caries, molar-incisor hypomineralization, and oral health-related quality of life in schoolchildren: A structural equation modeling approach.

BACKGROUND: Some oral conditions can have psychosocial consequences that affect children's daily life and well-being. AIM: To create a structural model for the determination of dental caries, molar-incisor hypomineralization (MIH), and the impact of these conditions and socioeconomic status on schoolchildren's oral health-related quality of life (OHRQoL). DESIGN: A representative cross-sectional study was conducted in Lavras, Brazil, with 1181 female and male schoolchildren 8-9 years of age. OHRQoL was measured using the Brazilian version of the CPQ8-10. Clinical examinations were performed by a calibrated dentist for the diagnosis of dental caries (WHO) and MIH (EAPD). Parents/caregivers answered questionnaires addressing the child's medical history and socioeconomic status. Data were analyzed using structural equation modeling. RESULTS: The model revealed that greater MIH severity (ß = .874; p < .001) and worse socioeconomic status (ß = -.060; p = .001) were associated with a greater number of teeth with caries experience. The higher the number of teeth with caries experience (ß = .160; p = .007) and worse socioeconomic status (ß = -.164; p < .001), the greater the negative impact on OHRQoL. CONCLUSION: The model created showed that dental caries and socioeconomic status had a direct negative impact on the OHRQoL of schoolchildren and MIH had an indirect impact mediated by the occurrence of caries experience.

The relationship between temperament and dental fear and anxiety: a systematic review.

OBJECTIVE: To investigate the relationship between temperament traits and dental fear and anxiety (DFA) in children and adolescents by the means of a systematic review (PROSPERO #CRD42020207578). METHODS: The PEO (Population, Exposure, and Outcome) strategy was followed using children and adolescents as the population, temperament as the exposure, and DFA as the outcome. A systematic search for observational studies (cross-sectional, case-control, and cohort) without restrictions on year or language of publication was performed in seven databases (PubMed, Web of Science, Scopus, Lilacs, Embase, Cochrane, and PsycINFO) in September 2021. Grey literature search was performed in OpenGrey, Google Scholar, and in the reference list of included studies. Study selection, data extraction, and risk of bias assessment were carried out independently by two reviewers. The Fowkes and Fulton Critical Assessment Guideline was used to assess methodological quality of each study included. The GRADE approach was performed to determine the certainty of evidence of relationship between temperament traits. RESULTS: This study recovered 1362 articles, of which 12 were included. Despite the high heterogeneity of methodological aspects, qualitative synthesis by subgroups showed a positive association/correlation between emotionality, neuroticism, and shyness with DFA in children and adolescents. Different subgroups analysis showed similar results. Eight studies were classified as having low methodological quality. CONCLUSION: The main shortcoming of the included studies is the high risk of bias and a very low certainty of evidence. Within its limitations, children and adolescents with a temperament-like emotionality/neuroticism and shyness are more likely to present higher DFA.

Impact of hypomineralised second primary molar on preschoolers' oral health-related quality of life-A hierarchical approach.

BACKGROUND: Hypomineralised second primary molar (HSPM) is a developmental enamel defect associated with dental caries. AIM: To evaluate the impact of HSPM on oral health-related quality of life (OHRQoL) in preschoolers through hierarchical analysis. DESIGN: This population-based cross-sectional study assessed 834 5-year-old preschoolers, in Teresina, Piauí, Brazil, using sociodemographic questionnaires and Early Childhood Oral Health Impact Scale (ECOHIS). Dental examination was performed by two calibrated examiners (κ ≥ 0.80) for the diagnosis of HSPM (EAPD), dental caries (dmft and pufa indices), and malocclusion (Foster and Hamilton criteria). Analysis of the determinants of OHRQoL was stratified at three levels (P < .05). RESULTS: Severe HSPM was associated with OHRQoL in bivariate analysis (P < .05). In adjusted final multivariate analysis (model 1), the presence of dental caries with or without clinical consequences was associated with worse OHRQoL (P < .05). In model 2, after the removal of dental caries, preschoolers with severe HSPM had greater probability of having a negative impact on OHRQoL in the child impact section (RR = 2.14; 95% CI = 1.26-3.65), family impact section (RR = 1.99; 95% CI = 1.16-3.42), and total score (RR = 2.09; 95% CI = 1.25-3.49) of the ECOHIS. CONCLUSION: Severe HSPM had a negative impact on the OHRQoL of preschoolers and their families, but the presence of dental caries neutralised this impact.

Breathing problems, being an only child and having parents with possible sleep bruxism are associated with probable sleep bruxism in preschoolers: a population-based study.

PURPOSE: To determine the prevalence of probable sleep bruxism (SB) in preschoolers and associated factors. METHODS: A cross-sectional, population-based study was carried out with 862 dyads of parents/preschoolers aged 5 from Teresina, Brazil. Data collection was performed through a questionnaire answered by parents/guardians about socioeconomic, demographic, and health condition data. Each child was examined for diagnosis of probable SB based on the presence of dental wear associated or not with the report of teeth grinding by parents/guardians. The analysis of independent variables was stratified into four levels of determinants: demographic characteristics of the child (distal), characteristics of the family, environmental factors (intermediate), and health conditions (proximal). Descriptive analysis and bivariate and multivariate Poisson's regression were performed using a hierarchical approach (p < 0.05). RESULTS: The prevalence of probable SB was 36%. In the final adjusted multivariate hierarchical model, a preschooler who was the only child (PR = 1.25; 95%CI = 1.02-1.51), with breathing problems (PR = 1.43; 95%CI = 1.19-1.73), and having parents/guardians with possible sleep bruxism (PR = 1.65; 95%CI = 1.32-2.07) had a higher prevalence of probable SB. CONCLUSION: The prevalence of probable SB in preschoolers was high and associated with the condition of being an only child, the presence of breathing problems, and having parents/guardians with possible sleep bruxism.

Early childhood caries and oral health-related quality of life of Brazilian children: Does parents' resilience act as moderator?

BACKGROUND: Early childhood caries (ECC) is the most common chronic disease in childhood. Measures to reduce the prevalence of ECC cannot be taken without recognizing that oral health is influenced by biopsychosocial factors on individual and community levels. AIM: To evaluate the impact of ECC on OHRQoL and moderation effect of parents' resilience. DESIGN: Population-based, cross-sectional study with 497 children (4-6 years old) at preschools in Ribeirão das Neves, MG, Brazil. Parents self-completed the Brazilian version of the early childhood oral health impact scale (B-ECOHIS), the Resilience Scale and questionnaires about socioeconomic and oral health behaviour factors. Calibrated dentists conducted examinations for ECC (ICDASepi) and pulp consequences (pufa). Data analysis used multivariate Poisson regression for complex sample (P < .05). RESULTS: Model#1, adjusted for parents' resilience and socioeconomic factors, revealed that preschoolers with pulp involvement had 2.36 (95% CI: 1.60-3.49) and fistula/abscess had 3.57 (95% CI: 2.23-5.72) more prevalence of negative impact on OHRQoL than preschoolers with ECC without pulp consequences. In Model#2, resilience was removed from the analysis and the strength of associations almost did not change (OHRQoL vs pulp involvement RP = 2.33;95% CI: 1.58-3.43; OHRQoL vs fistula/abscess RP = 3.65;95% CI: 2.22-5.99). CONCLUSION: Early childhood caries with pulp consequences had negative impact on OHRQoL of preschoolers and families, and it is not moderated by parents' resilience.

Prevalence of dental caries in preschool children born preterm and/or with low birth weight: A systematic review with meta-analysis of prevalence data.

The aim of the present systematic review and meta-analysis was to evaluate the prevalence of dental caries among preschool children who had been born preterm and/or with low birth weight (LBW) compared with those who had been born full term and/or with normal birth weight (NBW). Eight electronic databases were searched from interception up to November 2018 with no restrictions imposed regarding the date of publication or language. Two independent reviewers screened studies, extracted data, and assessed the risk of bias. A random-effects meta-analysis was run to pool the crude prevalence of dental caries according to gestational age and birth weight. We performed a narrative synthesis and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Fifty-nine observational studies were included (55 in the meta-analysis). The prevalence of dental caries was 39% among preterm children, 30% among full-term children, 40% among LBW children, and 33% among NBW children (I2 :97%-99%). The majority of studies reported that dental caries was not associated with gestational age or birth weight, with very low certainty of evidence. Preschool children born preterm or with LBW have similar dental caries experience as those born full term or with NBW, with very low certainty of evidence (PROSPERO #CDR42018118086).

Validation for Brazilian Portuguese language of the Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P).

BACKGROUND: Oral health literacy (OHL) is associated with oral health outcomes. AIM: To validate the Brazilian Portuguese version of the Hong Kong OHL Assessment Task for Paediatric Dentistry (HKOHLAT-P). DESIGN: We performed cross-cultural adaptation of the HKOHLAT-P. A sample of 200 pre-schoolers and caregivers from Campina Grande, Brazil completed the Brazilian HKOHLAT-P (BOHLAT-P), sociodemographic questionnaire, the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS), and the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Child dental caries was assessed. Instrument reliability was measured by internal consistency (Cronbach's alpha) and test-retest (ICC). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) evaluated dimensionality. Regression models tested associations between BOHLAT-P and exploratory variables (P < .05). RESULTS: BOHLAT-P demonstrated excellent reliability (Cronbach's alpha = 0.92; ICC = 0.95). BOHLAT-P and BREALD-30 scores (r = .71), number of schooling years (r = .60), and reading hours (r = .34) were positively correlated. BOHLAT-P and B-ECOHIS scores (r = -.22), and BOHLAT-P scores and number of cavitated teeth (r = -.15) were negatively correlated. After controlling for confounding variables, BOHLAT-P scores were not associated with caries or number of teeth with cavitated caries. CONCLUSION: BOHLAT-P is a valid and reliable instrument to assess the OHL of Brazilian parents.

Factors associated with molar-incisor hypomineralisation in schoolchildren aged 8-10 years: a case-control study.

BACKGROUND: The aetiology of molar-incisor hypomineralisation (MIH) is multifactorial and may involve genetic and environmental factors. AIM: To verify the factors associated with MIH in schoolchildren from 8 to 10 years of age. DESIGN: This is a case-control study with a sample consisting of children aged 8 to 10 years, paired by gender and school type, in a ratio of 1:3. The case group included 186 children with MIH and the control included 558 children without MIH. Data were collected through a semi-structured questionnaire and clinical examination. Chi-square, linear-by-linear, Mann-Whitney, and logistic regression tests were conducted. A value of P < 0.05 was considered significant. RESULTS: The prevalence of mild MIH was 19.5%, moderate MIH 2.2% and severe MIH 3.2%. An association was observed between MIH with treatment need and a higher mean DMF-T and decayed and missing teeth (P < 0.05). According to the aetiological factors studied, mothers who presented a fever during pregnancy had a 2.54 times greater chance of having children with severe MIH than mothers who did not present a fever (P = 0.045). CONCLUSION: The presence of fever during pregnancy and the need for treatment were associated with MIH.

Negative effect of malocclusion on the emotional and social well-being of Brazilian adolescents: a population-based study.

BACKGROUND/OBJECTIVES: The aesthetic impact of malocclusion can have negative repercussions on quality of life, social interaction, interpersonal relationships, and psychological well-being. The aim of this study was to evaluate the impact of malocclusion on the quality of life of Brazilian adolescents. METHODS: A representative cross-sectional study of 1612 adolescents from Belo Horizonte, Minas Gerais was conducted. The adolescents responded to the Brazilian version of the Child Perception Questionnaire (CPQ11-14-ISF:16) to assess the impact of the condition on quality of life. Cases of malocclusion were diagnosed using the Dental Aesthetic Index while clinical examination was performed by three calibrated examiners. Data regarding traumatic dental injuries, dental caries, gender, type of school, age and social vulnerability was collected. Data analysis was performed using bivariate and multivariate Poisson regression with robust variance (P < 0.05). RESULTS: The prevalence of malocclusion was 31.3%. The presence of definite malocclusion (PR = 1.28; CI = 1.13-1.45), severe malocclusion (PR = 1.24; CI = 1.04-1.47) and handicapping malocclusion (PR = 1.55; CI = 1.31-1.84) was associated with a greater negative impact on Emotional Well-Being. The presence of definite malocclusion (PR = 1.18; CI = 1.02-1.36), severe malocclusion (PR = 1.46; CI = 1.21-1.76) and handicapping malocclusion (PR = 1.61; CI = 1.35-1.94) was also associated with a greater negative impact on Social Well-Being. CONCLUSIONS: Adolescents with handicapping malocclusion, where the need for treatment was mandatory, suffered from a greater negative impact on quality of life, with emotional and social aspects most affected.

Verbal school bullying and life satisfaction among Brazilian adolescents: profiles of the aggressor and the victim.

BACKGROUND: Bullying is a common occurrence in adolescence that may damage the physical and emotional health. OBJECTIVE: The purpose of the present cross-sectional study was to analyze the profile of the adolescent aggressor only, aggressor/victim, victim only, and those not involved in verbal school bullying, and to associate their profiles with life satisfaction and familial characteristics evaluated through socioeconomic status. SUBJECTS AND METHODS: A cross-sectional study was carried out with 366 Brazilian adolescents between 13 and 15years. Verbal school bullying was identified using the Brazilian National School-Based Adolescent Health Survey (PeNSE) questionnaire. The life satisfaction of the adolescents was assessed using the Multidimensional Life Satisfaction Scale for Adolescents (MLSSA). Statistical analyses involved the chi-square test, Fisher's exact test and the Poisson regression with robust variance. RESULTS: Sixty-six adolescents (18%) were aggressors, 5.5% were victims, 2.7% were both aggressor and victim, and 73.8% were not involved in verbal school bullying. Most aggressors were male (PR=1.97, 95% CI: 1.23-3.14) and were satisfied with their family life (PR=2.13, 95% CI: 1.18-3.8). Victims of verbal school bullying exhibited a low prevalence of non-violence (PR=0.24, 95% CI: 0.09-0.64). Those who were both aggressors and victims were associated with factors of family support (PR=0.25, 95% CI: 0.07-0.89) and self-efficacy (PR=6.29, 95% CI: 1.54-25.6). Most of the adolescents who were not involved in verbal school bullying were female (PR=1.32, 95% CI: 1.16-1.51). CONCLUSIONS: Boys tend to be aggressors and girls tend not to get involved in verbal school bullying. Family satisfaction, self-esteem, self-efficacy, and levels of violence are important factors that can influence the profile of adolescents in relation to verbal school bullying.

Determining Cut-Off Points for the Dental Fear Survey.

OBJECTIVE: To determine a high fear cut-off point score for the Dental Fear Survey (DFS) using a single-item self-report questionnaire. METHODS: The DFS, a 20-item questionnaire assessing fear of dental treatment, was completed by 1,256 participants with a mean age of 22.3 years (SD = 5.1). Another self-report questionnaire was used to collect data on previous dental experiences. A high fear cut-off point score was determined by calculating the receiver operating characteristic (ROC) curve for the DFS. Descriptive statistics and multinomial logistic regression were calculated; a significance level of p < 0.05 was used for all tests. RESULTS: The ROC curve indicated that a DFS score ≥ 53 corresponds to a sensitivity of 88.9% and a specificity of 92.5%. Most participants (n = 895; 71.5%) reported no fear of going to the dentist. There was significant association between DFS score and fear assessed with the question "Are you fearful of going to the dentist?" (p < 0.001). CONCLUSION: A cut-off point of 53 on the DFS total score represents the best compromise between sensitivity and specificity and can be used to predict high dental fear.

Dental Fear Survey: a cross-sectional study evaluating the psychometric properties of the Brazilian Portuguese version.

OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the Brazilian version of the Dental Fear Survey (DFS), previously translated to the Brazilian Portuguese language and validated. METHODS: A cross-sectional study with 1,256 undergraduates from the city of Belo Horizonte, Brazil, was carried out. The DFS and a questionnaire about previous dental experiences were self-administered. Data analysis involved descriptive statistics, principal components analysis (PCA), confirmatory factor analysis (CFA), internal consistency and test-retest reliability, and construct, discriminant, and convergent validity. RESULTS: PCA identified a three-factor structure. CFA confirmed the multidimensionality of the Brazilian version of the DFS. A modified model of the Brazilian version of the DFS fits better than the hypothesized model. The Cronbach's alpha coefficient for the total DFS scale was 0.95. CONCLUSION: The DFS demonstrated acceptable construct validity, convergent validity, and discriminant validity. These results supported the reliability and validity of the DFS among Brazilian undergraduates.

Explicit discrimination among Brazilian dental students: A multicenter study.

OBJECTIVE: To test the association between socioeconomic and sociodemographic status of Brazilian dental students with discriminatory experiences suffered by them. METHODS: This multicenter cross-sectional study was conducted with 531 undergraduate dental students from four different Brazilian states. The Explicit Discrimination Scale (EDS) was used to measure the experience of discrimination in several daily situations. A questionnaire about sociodemographic and socioeconomic characteristics, form of admission, and permanence in dental schools was developed and validated by experts and six dental students through cognitive interviews. The EDS and questionnaire were sent to students by an online platform using snowball sampling. Descriptive analysis, bivariate tests, and multiple Poisson regression were performed. RESULTS: Among the participants, most were female, white, heterosexual, and cisgender. The mean EDS total score was higher among those students who used Brazilian Affirmative Actions for higher education access and permanence (p < 0.005). The multiple analysis indicated that students who were black (prevalence ratio [PR] = 1.484; 95% confidence interval [95%CI]: 1.291-1.705), women (PR = 1.227; 95%CI: 1.030-1.462), had lower monthly income (PR = 1.212; 95%CI: 1.043-1.409) and were lesbian, gay, bisexual, transgender, intersex, queer, pansexual, and plus (LGBTQIAP+) (PR = 1.466; 95%CI: 1.238-1.735) showed a higher probability of discriminatory experiences when compared to white, male and heterosexual students with higher monthly income. CONCLUSION: There is a racial and social class pattern among dental students. The exclusionary factors such as black race, female gender, lower monthly income and being LGBTQIAP+ make students more vulnerable to discriminatory experiences.

Parental Reports of Children's Dental Pain Experience and Associated Factors among Brazilian Children.

Exploring children's dental pain experiences helps to develop healthcare policies for improving oral health and quality of life. A cross-sectional study involved 300 parents/caregivers of four- to seven-year-old children using snowball sampling. Parents/caregivers self-completed an online questionnaire on sociodemographic characteristics, parenting styles, their child's oral hygiene practices, free sugar consumption, and dental history. The questionnaire was created using Google Forms and was disseminated to parents/caregivers via E-mail and/or WhatsApp©. Descriptive and Poisson regression analyses were performed (p < 0.05). Children's dental pain experience was reported by 20.3% of the parents. The authoritative parenting style was predominant. The child's mean age at the first consumption of sugar was 1.38 (±0.64) years, and 40.3% of the children had high-free sugar consumption. The mean age for the first dental appointment was 2.26 (±1.31) years, and 24.3% of the children never went to a dental appointment. The prevalence of dental pain experience was higher in children who attended their first dental appointment later (PR: 1.02; CI 95%: 1.01-1.03) and among those with high-free sugar consumption (PR: 1.90; CI 95%: 1.21-3.00). High sugar consumption and delay in the first dental appointment may increase the likelihood that children will experience dental pain.

Early Childhood Caries and Its Consequences Impact Sleep in Preschool Children.

Purpose: To assess the impact of early childhood caries (ECC) and its clinical conse- quences on preschool children's sleep, as reported by caregivers. Methods: A representative cross-sectional study was carried out with preschoolers aged four to six years in Brazil. Caregivers responded to the Brazilian version of the Early Childhood Oral Health Impact Scale and a specific question from this questionnaire was used to determine sleep-related quality of life: "Has your child had trouble sleeping because of dental problems or dental treatments?" Additionally, a self-administered questionnaire with socioeconomic questions was used. Clinical examinations were performed by two calibrated dentists to diagnose dental caries (International Caries Detection and Assessment System -epi) and its clinical consequences (pulpal involvement, tissue ulceration, fistula and abscesses [pufa] index). Adjusted and unadjusted Poisson regression was used for data analysis (P<0.05). Results: The sample consisted of 533 preschoolers, with 259 girls (51.4 percent) (n=259). The mean age of preschoolers was 4.78±0.6 (standard deviation) years. One-third (n=176) exhibited extensive carious lesions, and 14.1 percent (n=75) had clinical consequences of ECC. Conclusion: Children with clinical consequences of ECC were approximately 3.04 times more likely to have difficulty sleeping than children without them (95 percent confidence interval=1.75 to 5.25). The clinical consequences of ECC were significantly associated with difficulty sleeping among preschool children.

Late Eruption of Mandibular Central Incisor in Small for-Gestational-Age Infants: A Cohort Study.

Purpose: To evaluate the chronology of the eruption of primary mandibular central incisors in infants born preterm and with low weight (PLBW) and its association with weight/length ratio for gestational age (GA) at birth, individual characteristics and hospitalization at birth. Methods: A cohort of 46 infants was followed at a multidisciplinary reference center at a university hospital in Belo Horizonte, Brazil. The inclusion criteria were infants born preterm with low/very low/extreme low birth weight and at least four months of age. Oral clinical examinations were carried out by a calibrated dentist for a total of eight months, with a one-month interval between each examination, to verify the chrono- logy of eruption of the primary mandibular central incisors. Caregivers completed a sociodemographic and health questionnaire. Data on neonatal hospitalization were collected from medical records. Data were analyzed with the Kaplan-Meier method and log rank test, and bivariate analysis was done using the Mann-Whitney method and Kruskal-Wallis test (P <0.05). Results: The average age at eruption of primary lower central incisors was 11 months for both sexes. No association was found between tooth eruption and child hospitalization or individual characteristics (P >0.05). Infants large for gestational age had earlier tooth eruption (9.3±1.41 months) than infants small for gestational age (13.6±3.29 months; P <0.05).Conclusion: The most likely age for the eruption of the first primary teeth in infants born preterm and with low weight was 11 months, and there was no influence of individual characteristics and hospitalization at birth. Small-for-gestational age infants experienced delayed tooth eruption compared to large-for-GA infants.

Quality of life in children and adolescents with blood coagulation disorders and hemoglobinopathies.

The aim of this study was to evaluate the impact of oral conditions and health-related quality of life (HRQoL) on oral health-related quality of life (OHRQoL) in children and adolescents with blood coagulation disorders and hemoglobinopathies (BCDH). The study was cross-sectional and included 61 individuals aged 2 to 18 years with BCDH. Exams for dental caries (dmft/DMFT index), oral hygiene (simplified oral hygiene index - OHI-S), and gingival health (modified gingival index - MGI) were performed. The pediatric quality of life inventory™ (PedsQL™) generic core scale and oral health scale were used to measure HRQoL and OHRQoL. Spearman's correlation coefficient (ρ) and the Mann-Whitney test (α = 0.05) were conducted to assess the relationship between covariates and the PedsQL™ oral health scale. The mean PedsQL™ oral health scale score was 76.66 (SD = 21.36). Worse OHRQoL was correlated with poor oral hygiene (ρ = -0.383; p: 0.004), poor gingival health (ρ = -0.327; p = 0.014), and better HRQoL (ρ = 0.488; p < 0.001). Greater untreated dental caries experience was associated with worse OHRQoL (p = 0.009). Worse oral health status in children and adolescents with BCDH negatively impacts OHRQoL, and OHRQoL and quality of life analyzed from a generic perspective are positively correlated constructs in this population.

Early Introduction of Total Sugar Foods and Early Childhood Caries.

Purpose: To evaluate the association between the introduction of total sugar foods (TSF) in the first six months of age and the prevalence of early childhood caries (ECC) and its consequences for dental pulp in preschool children. Methods: A representative cross-sectional study was conducted with 533 preschool children (four to six years old) in Ribeirão das Neves, Brazil. The decayed, missing, and filled teeth (dmft) index was used for determining ECC. The visible pulp, oral mucosa ulceration due to root fragments, fistula, and abscess (pufa) index was used for the pulp consequences of dental caries. Parents/caregivers answered a questionnaire addressing sociodemographic characteristics and the children's diet. Statistical analysis was performed using multiple logistic regression (P<0.05). Results: The multiple logistic regression model adjusted for family income and breastfeeding showed that preschool children who were introduced to TSF prior to six months of age were 1.58 times more likely to have ECC (95 percent confidence interval equals 1.09 to 2.30). The multiple logistic regression model, adjusted for family income, breastfeeding, and brushing behaviors, showed that preschool children who were introduced to TSF prior to six months of age were 2.30 times more likely to have pulp consequences (95 percent confidence interval equals 1.35 to 3.91). Conclusion: The early introduction TSF is associated with a higher prevalence of early childhood caries and pulp consequences in preschool children. The negative effects on oral health may be greater when the introduction of TSF occurs prior to six months of age.

Psychosocial associated factors of early childhood caries and oral health-related quality of life: Structural equation model approach.

OBJECTIVE: To identify a structural model for the identification of psychosocial associated factors of early childhood caries (ECC) and oral health-related quality of life (OHRQoL) in preschool children and their families. METHODS: A population-based cross-sectional study was conducted with 533 preschool children from 4 to 6 years-old public and private preschools, from Ribeirão das Neves, MG. Parents/caregivers self-completed the Brazilian versions of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and Resilience Scale as well as a structured questionnaire addressing socioeconomic status and child's oral health behavior. Two dentists who had undergone training and calibration exercises for ICDAS­epi and pufa index (Kappa≥0.95) performed the examinations for ECC. Stages of ECC were classified as free of visible carious lesion, initial caries, moderate caries, extensive caries without pulp consequences and extensive caries with pulp consequences. Data were analyzed using structural equation modeling, using Mplus version 8.6. RESULTS: Lower socioeconomic status (b=-0.250; p<0.001) and higher frequency of free sugar consumption (b = 0.122; p = 0.033) were directly associated with a more severe stage of ECC. Lower parental resilience had an indirect impact on more severe stage of ECC which was mediated by the variable 'frequency of free sugar consumption' (b=-0.089; p = 0.048). ECC was associated with lower child's OHRQoL (b = 0.587; p<0.001) and lower family's OHRQoL (b = 0.506; p<0.001). CONCLUSION: Structural modeling revealed that the severity of ECC negatively impacted the OHRQoL of preschoolers and their families. The main associated factors of the severity of ECC were lower socioeconomic status, higher frequency of free sugar consumption and lower parental resilience. CLINICAL SIGNIFICANCE: T The findings indicate that psychosocial and behavior variables can be associated with the severity of ECC, and ECC can be associated with negative impact on wellbeing and ability to perform daily activities of preschoolers and their families.