Sampling strategy of an epidemiological survey using a satellite image program.

OBJECTIVE: To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process. METHODS: A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O'Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed. RESULTS: Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy. CONCLUSIONS: The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.

Sampling strategy of an epidemiological survey using a satellite image program

ABSTRACT OBJECTIVE To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process. METHODS A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O'Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed. RESULTS Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy. CONCLUSIONS The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.

Edema and gingival bleeding in anterior region have a negative influence on quality of life of adolescents.

The aim of the present study was to verify if clinical signs of gingivitis such as color changes, edema, and bleeding in the anterior region influence the OHRQoL of adolescents. We followed a cross-sectional convenience sample of 67 adolescents aged 11 to 16 years receiving dental treatment at the Federal University of Santa Maria (UFSM), in southern Brazil. The participants were evaluated for the following clinical variables: edema, gingival color alteration, and marginal bleeding of the gingival tissues, collected at 6 sites per tooth in the anterior region of the mouth. Socioeconomic variables were collected through questionnaires and OHRQoL was evaluated through the Brazilian version of the Children Perception Questionnaire (CPQ 11-14) short form. A Poisson regression model was used to verify associations between clinical variables and general CPQ11-14 scores. In the unadjusted analysis, edema, color alterations, and marginal bleeding in the anterior region were associated with worse scores of OHRQoL. Edema and marginal bleeding remained associated after adjusting for clinical and sociodemographic variables. Adolescents with higher levels of marginal bleeding and edema in the anterior region had higher mean CPQ11-14 scores. Therefore, the presence of bleeding and gingival edema in the anterior region can be considered clinical signs of gingivitis that are associated with a worse OHRQoL in adolescents.

Oral health related quality of life among pregnant women: a randomized controlled trial.

The aim of the present study was to compare negative impacts of oral conditions in Oral Heath Related Quality of Life (OHRQoL) assessed by the Oral Health Impact Profile-14 (OHIP-14) scores in pregnant women receiving or not comprehensive periodontal treatment. This randomized controlled clinical trial included pregnant women aged between 18 and 35 years old. Participants were randomized in a test group with 96 and a control group with 114 women. Patients in the test group received comprehensive periodontal treatment, supra and subgingival scaling and root-planning and periodontal maintenance appointments. The OHIP-14 was applied before and after treatment. The primary outcome was changes in OHIP-14 scores after follow-up period. The impact of having received or not comprehensive periodontal treatment on the change of the OHIP-14 scores was also investigated. Both groups showed significant reduction in OHIP-14 scores and effect size for the test group was 0.60 and 0.36 for the control group. Multinomial logistic regression analysis showed that participants of the control group had 5.9-fold odds (CI 95% 1.88-18.52) of worsening in OHIP-14 scores and their perception of oral conditions in relation to test group. Comprehensive periodontal treatment during pregnancy can reduce the negative impacts in OHRQoL.

Oral health related quality of life among pregnant women: a randomized controlled trial

Abstract: The aim of the present study was to compare negative impacts of oral conditions in Oral Heath Related Quality of Life (OHRQoL) assessed by the Oral Health Impact Profile-14 (OHIP-14) scores in pregnant women receiving or not comprehensive periodontal treatment. This randomized controlled clinical trial included pregnant women aged between 18 and 35 years old. Participants were randomized in a test group with 96 and a control group with 114 women. Patients in the test group received comprehensive periodontal treatment, supra and subgingival scaling and root-planning and periodontal maintenance appointments. The OHIP-14 was applied before and after treatment. The primary outcome was changes in OHIP-14 scores after follow-up period. The impact of having received or not comprehensive periodontal treatment on the change of the OHIP-14 scores was also investigated. Both groups showed significant reduction in OHIP-14 scores and effect size for the test group was 0.60 and 0.36 for the control group. Multinomial logistic regression analysis showed that participants of the control group had 5.9-fold odds (CI 95% 1.88-18.52) of worsening in OHIP-14 scores and their perception of oral conditions in relation to test group. Comprehensive periodontal treatment during pregnancy can reduce the negative impacts in OHRQoL.

Edema and gingival bleeding in anterior region have a negative influence on quality of life of adolescents

Abstract The aim of the present study was to verify if clinical signs of gingivitis such as color changes, edema, and bleeding in the anterior region influence the OHRQoL of adolescents. We followed a cross-sectional convenience sample of 67 adolescents aged 11 to 16 years receiving dental treatment at the Federal University of Santa Maria (UFSM), in southern Brazil. The participants were evaluated for the following clinical variables: edema, gingival color alteration, and marginal bleeding of the gingival tissues, collected at 6 sites per tooth in the anterior region of the mouth. Socioeconomic variables were collected through questionnaires and OHRQoL was evaluated through the Brazilian version of the Children Perception Questionnaire (CPQ 11-14) short form. A Poisson regression model was used to verify associations between clinical variables and general CPQ11-14 scores. In the unadjusted analysis, edema, color alterations, and marginal bleeding in the anterior region were associated with worse scores of OHRQoL. Edema and marginal bleeding remained associated after adjusting for clinical and sociodemographic variables. Adolescents with higher levels of marginal bleeding and edema in the anterior region had higher mean CPQ11-14 scores. Therefore, the presence of bleeding and gingival edema in the anterior region can be considered clinical signs of gingivitis that are associated with a worse OHRQoL in adolescents.

Effect of 15% Alcohol Dependence on Alveolar Bone Loss and TNF-α Secretion in Wistar Rats.

The aim of the present study was to evaluate the effect of 15% alcohol dependence on ligature-induced alveolar bone loss and TNF-α secretion in Wistar rats. Thirty-three male Wistar rats aged 45-60 days (mean weight=253 g) were randomly allocated test or control groups. Test group (n=18) received 15% alcohol as liquid intake and control group (n=15) received water during the experimental period. TNF-α was analyzed by ELISA assay in 11 animals per group. After 14 days of alcohol/water intake, alcohol dependency was assessed and silk ligatures were placed around the left second upper molars. Ligature presence and body weight were checked weekly. After 40 days, animals were sacrificed and the maxillae were defleshed for morphometric analysis using standardized images. All animals in the test group displayed signs of alcohol dependency at day 14. No statistically significant differences in final body weight (334.83±21.38 vs. 322.48±30.65 g, p=0.20) were observed between groups. In relation to alveolar bone loss, no statistically significant difference was observed among test and control groups both for ligated teeth (0.76±0.06 vs. 0.74±0.10 mm, p=0.60) and unligated teeth (0.41±0.16 vs. 0.35±0.05 mm, p=0.22). The TNF-α secretion also did not display statistically significant differences between test and control groups (10.78±1.84 vs. 12.13±2.11 pg/mL, p=0.12). It may be concluded that 15% alcohol dependency was not capable to alter alveolar bone loss and TNF-α secretion in Wistar rats.

Effect of 15% Alcohol Dependence on Alveolar Bone Loss and TNF-α Secretion in Wistar Rats

Abstract The aim of the present study was to evaluate the effect of 15% alcohol dependence on ligature-induced alveolar bone loss and TNF- secretion in Wistar rats. Thirty-three male Wistar rats aged 45-60 days (mean weight=253 g) were randomly allocated test or control groups. Test group (n=18) received 15% alcohol as liquid intake and control group (n=15) received water during the experimental period. TNF-α was analyzed by ELISA assay in 11 animals per group. After 14 days of alcohol/water intake, alcohol dependency was assessed and silk ligatures were placed around the left second upper molars. Ligature presence and body weight were checked weekly. After 40 days, animals were sacrificed and the maxillae were defleshed for morphometric analysis using standardized images. All animals in the test group displayed signs of alcohol dependency at day 14. No statistically significant differences in final body weight (334.83±21.38 vs. 322.48±30.65 g, p=0.20) were observed between groups. In relation to alveolar bone loss, no statistically significant difference was observed among test and control groups both for ligated teeth (0.76±0.06 vs. 0.74±0.10 mm, p=0.60) and unligated teeth (0.41±0.16 vs. 0.35±0.05 mm, p=0.22). The TNF-α secretion also did not display statistically significant differences between test and control groups (10.78±1.84 vs. 12.13±2.11 pg/mL, p=0.12). It may be concluded that 15% alcohol dependency was not capable to alter alveolar bone loss and TNF-α secretion in Wistar rats.

Resumo O objetivo do presente estudo foi avaliar o efeito da dependência de álcool a 15% sobre a perda óssea alveolar induzida e secreção de TNF-α em ratos Wistar. Trinta e três ratos wistar com idade entre 45 e 60 dias (peso médio=253 g) foram alocados aleatoriamente para o grupo teste ou controle. O grupo teste (n=18) recebeu álcool a 15% como ingestão líquida e o grupo controle (n=15) recebeu água durante o período experimental. TNF-α foi analisado por meio de ELISA em 11 animais por grupo. Após 14 dias de ingestão de álcool/água a dependência do álcool foi determinada e ligaduras de seda foram colocadas ao redor dos segundos molares superiores esquerdos. A presença das ligaduras e o peso corporal foram verificadas semanalmente. Depois de 40 dias os animais foram sacrificados e as maxilas foram preparadas para análise morfométrica em fotografias estandardizadas. Todos os animais do grupo teste apresentaram sinais de dependência de álcool no dia 14. Não foram observadas diferenças estatisticamente significativas no peso corporal final entre os grupos (334,83±21,38 vs. 322,48±30,65 gramas, p=0,20) Em relação a perda óssea alveolar, não foram observadas diferenças estatisticamente significativas entre os grupos teste e controle tanto para dentes com (0,76±0,06 vs. 0,74±0,10 mm, p=0,60) como para dentes sem ligadura (0,41±0,16 vs. 0,35±0,05 mm, p=0,22). A secreção de TNF-α também não demonstrou diferenças estatisticamente significativas entre os grupos teste e controle (10,78±1,84 vs. 12,13±2,11 pg/mL, p=0,12). Pode-se concluir que a dependência de álcool a 15% não foi capaz de alterar a perda óssea alveolar e a secreção de TNF-α em ratos Wistar.

Perception of smile esthetics varies between patients and dental professionals when recession defects are present.

The aim of this study was to compare the smile esthetic perception of patients, dental students and dentists faced to different situations concerning gingival margin position. A total of 123 individuals (41 patients, 41 dental students and 41 dentists) completed a structured questionnaire and evaluated 6 pictures of the same smile modified in Adobe Photoshop® image-editing software representing: no gingival recession, 2 mm recession in one maxillary lateral incisor, 2 mm recession in both maxillary lateral incisors, 2 mm recession in one maxillary canine, 2 mm recession in both maxillary canines and generalized 2 mm recession. The visual analogue scale (VAS) was used to rate the esthetic perception. Mean VAS values were calculated and compared among gingival situations as well as group of respondents by one-way ANOVA, with an alpha level of 0.05. VAS analysis revealed that mean values ranged from 4.2 (±1.8) to 6.8 (±1.7). Images with no gingival recession received the highest score by all groups, with statistically significant differences among dentists and dental students. However, patients scored images with no recession with significantly lower ranks as compared with dentists and dental students. No significant differences were observed among patients for any of the situations. When dentists and dental students were compared, the worst situation was observed for generalized gingival recession, with scores 4.2 (±1.8) and 4.9 (±1.8), respectively. Patients and dental professionals had different perceptions about esthetics related to gingival margin position.

Perception of Smile Esthetics Varies Between Patients and Dental Professionals When Recession Defects are Present

The aim of this study was to compare the smile esthetic perception of patients, dental students and dentists faced to different situations concerning gingival margin position. A total of 123 individuals (41 patients, 41 dental students and 41 dentists) completed a structured questionnaire and evaluated 6 pictures of the same smile modified in Adobe Photoshop® image-editing software representing: no gingival recession, 2 mm recession in one maxillary lateral incisor, 2 mm recession in both maxillary lateral incisors, 2 mm recession in one maxillary canine, 2 mm recession in both maxillary canines and generalized 2 mm recession. The visual analogue scale (VAS) was used to rate the esthetic perception. Mean VAS values were calculated and compared among gingival situations as well as group of respondents by one-way ANOVA, with an alpha level of 0.05. VAS analysis revealed that mean values ranged from 4.2 (±1.8) to 6.8 (±1.7). Images with no gingival recession received the highest score by all groups, with statistically significant differences among dentists and dental students. However, patients scored images with no recession with significantly lower ranks as compared with dentists and dental students. No significant differences were observed among patients for any of the situations. When dentists and dental students were compared, the worst situation was observed for generalized gingival recession, with scores 4.2 (±1.8) and 4.9 (±1.8), respectively. Patients and dental professionals had different perceptions about esthetics related to gingival margin position.

O objetivo do estudo foi comparar a percepção estética do sorriso de pacientes, estudantes de odontologia e dentistas, em relação a diferentes situações de posição da margem gengival. Cento e vinte e três indivíduos (41 pacientes, 41 estudantes de odontologia e 41 dentistas) responderam um questionário estruturado e avaliaram 6 fotografias de um mesmo sorriso modificadas no Photoshop representando: periodonto inalterado (sem recessão gengival), recessão de 2 mm em um incisivo lateral superior, recessão de 2 mm em ambos incisivos laterais superiores, recessão de 2 mm em um canino superior, recessão de 2 mm em ambos caninos superiores e recessão generalizada de 2 mm. Uma escala visual analógica (EVA) foi usada para graduar a percepção estética. Médias da EVA foram calculadas e comparadas entre as situações gengivais, bem como entre os grupos de respondentes pela ANOVA de um critério com nível de significância de 0,05. A análise da EVA revelou que os valores médios variaram entre de 4,2 (±1,8) a 6,8 (±1,7). Periodonto inalterado foi avaliado com o maior escore por todos os grupos (com diferença estatisticamente significativa entre dentistas e estudantes de odontologia). Entretanto, pacientes avaliaram periodonto inalterado com valores menores quando comparados a dentistas e estudantes de odontologia. Entre pacientes nenhuma diferença significativa foi observada para nenhuma das situações apresentadas. Quando dentistas e estudantes de odontologia foram considerados, a pior situação foi observada para recessão gengival generalizada (4,2±1,8 e 4,9±1,8, respectivamente). Pacientes e profissionais da odontologia demonstraram diferentes percepções sobre as situações de estética relacionadas à posição da margem gengival.

Obstetricians' knowledge of periodontal disease as a potential risk factor for preterm delivery and low birth weight.

There is little information about the knowledge and attitudes of physicians regarding oral care. This study aimed to assess the knowledge and attitudes of obstetricians about the relationship between periodontal disease and preterm/low birth weight. A questionnaire was emailed to members of the Brazilian Federation of Gynecology and Obstetrics (FEBRASGO). The questionnaire elicited both personal information and knowledge and attitudes regarding the relationship between periodontal diseases and preterm labor. A total of 875 obstetricians responded to the questionnaire. The majority of respondents were female (54.1%), resided in the Southeast (45.6%), worked in both the public and private sectors (61.4%), and had over 15 years of experience in obstetrics (48.9%). A large proportion of obstetricians (93.4%) stated that bacteria were associated with periodontal disease, and 94% reported that periodontitis was a condition more severe than gingivitis. In total, over 80% of participating obstetricians reported smoking, preeclampsia, bacterial vaginosis and periodontal disease as risk factors or possible risk factors for preterm birth or low birth weight. A correlation between the experience of the obstetricians and referral of their patients for dental examinations (p < 0.001) was observed. Also, obstetricians who had had their own dental visits more recently were more likely to recommend the same for their patients (p < 0.001). It is concluded that, although obstetricians were aware of the association between gingival inflammation and adverse obstetric outcomes, the attitudes of these professionals were not in agreement with their apparent knowledge regarding periodontal diseases and their possible repercussions.

Obstetricians' knowledge of periodontal disease as a potential risk factor for preterm delivery and low birth weight

There is little information about the knowledge and attitudes of physicians regarding oral care. This study aimed to assess the knowledge and attitudes of obstetricians about the relationship between periodontal disease and preterm/low birth weight. A questionnaire was emailed to members of the Brazilian Federation of Gynecology and Obstetrics (FEBRASGO). The questionnaire elicited both personal information and knowledge and attitudes regarding the relationship between periodontal diseases and preterm labor. A total of 875 obstetricians responded to the questionnaire. The majority of respondents were female (54.1 percent), resided in the Southeast (45.6 percent), worked in both the public and private sectors (61.4 percent), and had over 15 years of experience in obstetrics (48.9 percent). A large proportion of obstetricians (93.4 percent) stated that bacteria were associated with periodontal disease, and 94 percent reported that periodontitis was a condition more severe than gingivitis. In total, over 80 percent of participating obstetricians reported smoking, preeclampsia, bacterial vaginosis and periodontal disease as risk factors or possible risk factors for preterm birth or low birth weight. A correlation between the experience of the obstetricians and referral of their patients for dental examinations (p < 0.001) was observed. Also, obstetricians who had had their own dental visits more recently were more likely to recommend the same for their patients (p < 0.001). It is concluded that, although obstetricians were aware of the association between gingival inflammation and adverse obstetric outcomes, the attitudes of these professionals were not in agreement with their apparent knowledge regarding periodontal diseases and their possible repercussions.

O efeito do tratamento periodontal sobre os níveis de proteína C-reativa durante a gestação: um ensaio clínico randomizado / Changes in C-reactive protein levels after periodontal treatment during pregnancy: a randomized clinical trial

A associação entre doenças periodontais e desfechos adversos durante a gestação tem ganho grande atenção nos últimos anos. Apesar da maior parte dos estudos mostrar uma relação entre doença periodontal e parto prematuro, estudos que avaliam o impacto do tratamento periodontal nem sempre tem encontrado reduções nas taxas de prematuridade. A explicação para este fato pode estar no impacto do tratamento periodontal sobre mediadores inflamatórios relacionados aos mecanismos dos desfechos adversos durante a gestação. Por este motivo, o estudo de marcadores inflamatórios, como a proteína C-reativa, é de suma importância para a melhor compreensão do impacto inflamatório sistêmico do tratamento periodontal em gestantes. O objetivo deste estudo foi comparar os níveis sistêmicos de PCR em gestantes que receberam ou não tratamento periodontal. Esta dissertação consiste na avaliação dos níveis de PCR de 89 gestantes que receberam tratamento periodontal durante (grupo teste, n=44) ou após a gestação (grupo controle, n=45). Foram realizados dois exames periodontais completos, o primeiro em um momento anterior à 20° semana de gestação e o segundo entre a 26ª e a 28ª semanas de gestação. As pacientes do grupo teste receberam tratamento periodontal que incluiu raspagem...

The association between periodontal diseases and adverse pregnancy outcomes has been subject of great attention in recent years. Although most studies have shown an association between periodontal diseases and premature birth, studies assessing the impact of periodontal treatment have not found a reduction in these figures. The explanation for this may lie on the impact of periodontal treatment on inflammatory mediators associated with the mechanisms of adverse pregnancy outcomes. For this reason, the study of inflammatory markers such as C-reactive protein is of paramount importance for better comprehension of the impact of systemic inflammatory periodontal treatment in pregnant women. The aim of this study was to compare the systemic levels of CRP in pregnant women who received or not periodontal treatment. This paper was based in the assessment of CRP levels of 89 pregnant women who received periodontal treatment during (test group, n = 44) or after pregnancy (control group, n = 45). Two periodontal examinations were performed, before of 20 weeks of gestation and the second between the 26th and 28th weeks of gestation. Patients in the test group received treatment that included periodontal scaling and root planing and hygiene instructions. Professional cleaning and oral hygiene instruction were performed after treatment until the final exam, according to individual needs. CRP levels were evaluated by immunoturbidimetry. No statistically significant difference was...

Substituição do dente por implante: os limites do tratamento periodontal / Substitution of tooth by implant: the limits of periodontal therapy

A literatura demonstra, de maneira convincente, que a doença periodontal tem cura e que mesmo dentes com reduzido suporte periodontal têm bom prognóstico, desde que tratados e mantidos de maneira adequada. Implantes dentários, quando bem indicados e tecnicamente bem executados, também apresentam bons resultados. Porém existe um certo ceticismo em relação aos limites do tratamento periodontal por parte de dentistas e pacientes, enquanto uma popularização crescente está relacionada ao uso de implantes. Uma análise crítica da literatura revela diferenças consideráveis entre as populações estudadas, os desenhos metodológicos e o período de acompanhamento de estudos que envolvem dentes e implantes. Fatores de risco associados à perda dentária, como suscetibilidade à doença e hábito de fumar parecem também estar associados a maiores complicações em implantes. Quando observadas apenas as taxas de sobrevivência, dentes e implantes apresentam resultados similares. Entretanto, as complicações biológicas associadas aos implantes (principalmente a periimplantite) são comuns e cada vez mais prevalentes com o passar do tempo, embora ainda pouco estudadas. A opção pela extração dentária parece não estar ligada apenas ao efeito da progressão da doença periodontal, mas sim, a presença de múltiplos complicadores do prognóstico, como necessidade de tratamento endodôntico, reconstrução protética com pinos e presença de fatores sistêmicos. Com base nos estudos da literatura, a Odontologia necessita fazer uma reflexão crítica sobre o seu papel, especialmente não abreviando a vida de órgãos humanos.