Restorations performance after selective caries removal to soft dentine: 18-month follow-up of a controlled clinical trial.

OBJECTIVE: This randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period. METHODS: Inclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50% of the dentin thickness). Teeth were submitted to SCRSD (n=76) or SW (n=76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc). RESULTS: The follow-up period ranged from 6 to 18 months (mean±SD 16.3±3.4 months). Patients' ages ranged from 9 to 55 years (mean±SD 29±10.5 years). A total of 135 teeth (SCRSD=72; SW=63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4%) and SCRSD (97.9%) (p=0.16). Patients presenting gingivitis (≥20% of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20% of bleeding sites (p=0.03). CONCLUSION: This study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months. CLINICAL SIGNIFICANCE: SCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity.

Association between Sense of Coherence and Caries Activity and Caries Experience among Male Adolescents from Southern Brazil: A Cross-Sectional Study.

INTRODUCTION: This cross-sectional study assessed the association between sense of coherence (SoC) and caries activity (number of active caries lesions) and caries experience (DMFT index) among 18-19-year-old male adolescents who joined the Brazilian Army as draftees for mandatory military service (n = 507). METHODS: Data collection included a questionnaire (level of education, family income, and tooth brushing frequency), the Brazilian short version of the SoC scale (SOC-13), and clinical caries examination (noncavitated/cavitated, inactive/active). The main predictor variable was SoC, categorized as low, moderate, or high. Poisson regression models were used for statistical analysis. RESULTS: A high SoC was significantly associated with a lower number of active lesions (adjusted rate ratio = 0.85; 95% CI = 0.74-0.98). No association between SoC and DMFT was detected. CONCLUSION: A high SoC was found to be a protective factor to caries activity in this population.

Association between socioeconomic status and traumatic dental injury in permanent teeth: A systematic review with meta-analysis.

OBJECTIVE: The aim of this study was to systematically review observational studies assessing the association between socioeconomic status (SES) and traumatic dental injuries (TDI) in permanent dentition. METHODS: Electronic searches were performed in PubMed, EMBASE, Web of Science, LILACS, CINAHL, COCHANE Library and ScoINDEX databases for articles published up to February 2023. Two independent reviewers performed the search and critical appraisal of the studies. The inclusion criteria were observational studies that evaluated the association between individual-level socioeconomic indicators and TDI (clinically examined) in permanent teeth. Quality assessment of included articles was conducted using the Newcastle-Ottawa Scale. Global meta-analysis was performed with all studies and different subgroup analysis based on socioeconomic indicators (household income, educational level or any other indicator), age (children, early adolescents, late adolescents or young adults) and economic classification of the country (high, upper-middle or lower-middle). A random-effects model was used to estimate pooled prevalence ratios (PR) and respective 95% confidence intervals (CI) for each study. RESULTS: The search strategy retrieved 11 315 publications. According to eligibility criteria, 17 articles were included in the meta-analysis. Individuals with low SES were 17% more likely to have TDI (PR 1.17; 95% CI 1.05-1.30). The subgroup analysis also revealed that the indicator (household income, PR 1.16; 95% CI 1.00-1.34) and the economic classification of the country (upper-middle, PR 1.19; 95% CI 1.07-1.33) influenced the association of SES with TDI occurrence. CONCLUSIONS: Individuals with lower SES were more likely to present with TDI in permanent dentition than those with higher SES.

Association between toothbrushing frequency and dental caries and tooth loss in adolescents: a cohort study.

This cohort study assessed the association between toothbrushing frequency and the increment of dental caries and tooth loss in a population-based sample of southern Brazilian adolescents, to investigate whether there is any additional benefit in performing a third daily brushing. At baseline, 1,528 12-year-old schoolchildren attending 42 schools were examined for gingivitis and dental caries, and answered a questionnaire. After a mean period of 2.5 years, 801 schoolchildren were re-examined. Dental caries and tooth loss increment were outcomes of the study. The main predictor variable was toothbrushing frequency (≥3 times/day vs. twice/day or ≤1 time/day). Poisson regression models were used to estimate the risk for caries and tooth loss increment. Incidence risk ratios (IRR) and 95% confidence intervals (CI) were estimated. The final model adjusted for sociodemographic, behavioral, and clinical variables showed that brushing twice/day afforded 40% greater risk (IRR = 1.40; 95%CI: 1.02-1.92) for caries increment than ≥3 times/day. Regarding the tooth loss increment, adolescents who brushed their teeth twice/day had a fourfold greater risk (IRR = 3.92; 95%CI: 1.23-12.49) than those who brushed ≥ 3 times/day. Sex, school type, and gingivitis were found to act as effect modifiers, inasmuch as a third daily brushing presented advantages against tooth loss only for girls, public school attendees, and those with ≥ 50% of bleeding sites. This study suggests that adolescents benefit from a third daily toothbrushing. Increasing brushing frequency to 3 times/day may be a suitable strategy to control dental caries and tooth loss among high-risk adolescents.

Sense of coherence and oral health-related quality of life among southern Brazilian male adolescents.

This study evaluated the association between sense of coherence (SoC) and oral health-related quality of life (OHRQoL) among conscripts of the Brazilian Army, in two cities of southern Brazil. A cross-sectional study included all 18-19-year-old adolescents who joined the Brazilian Army as draftees for mandatory military service in the cities of Itaqui, RS, and Santiago, RS (n = 505). Data collection was conducted from 2019 to 2021, and included the application of questionnaires and a clinical oral examination to record gingivitis, malocclusion, and dental caries. OHRQoL was collected through the Brazilian short version of the Oral Health Impact Profile (OHIP), composed of 14 questions. The adolescents' SoC was assessed using the validated Brazilian version of the SOC-13 scale. The primary outcome of this study was OHRQoL, modeled as a discrete variable (OHIP-14 scores). The main predictor variable was SoC, categorized as low, moderate, or high. The association between predictor variables and OHRQoL was assessed by Poisson regression models using a hierarchical approach. Unadjusted and adjusted rate ratios (RR), and 95% confidence intervals (CI) were estimated. All the analyses were performed using STATA software version 14.2. Adolescents with a moderate and high SoC had 27% (RR = 0.73, 95%CI = 0.64-0.84) and 51% (RR = 0.49, 95%CI = 0.41-0.58) lower mean OHIP-14 scores, respectively, than those with a low SoC score, after the inclusion of behavioral and clinical variables. This study showed a significant association between SoC and OHRQoL among 18-19-year-old southern Brazilian adolescents. Strengthening the SoC as a psychosocial resource may improve the well-being and OHRQoL of adolescents.

Association between obesity and early tooth eruption in adolescents: Findings from a popu-lation-based cohort study in southern Brazil.

Background: Obesity is a prevalent chronic condition affecting children and adults worldwide, and it seems to influence the timing of tooth eruption. The aim of this study was to assess the as-sociation between weight status at age 12 and the eruption of permanent teeth at ages 12 and 14-15 among schoolchildren from southern Brazil. Material and Methods: A cross-sectional survey was conducted in Porto Alegre, southern Brazil, and included a representative sample of 1,528 12-year-old schoolchildren. After 2.5 years, 801 individuals were reexamined. Baseline data collection included a questionnaire, the record-ing of anthropometric measures (height and weight), and clinical examination to register the number of erupted permanent teeth. At follow-up, the eruption stage of second perma-nent molars was recorded. Statistical analysis used Poisson regression. Results: Overweight and obese individuals were 32% and 88% more likely to have com-plete permanent dentition at age 12, respectively (overweight, PR=1.32, 95%CI=1.13-1.55; obese, PR=1.88, 95%CI=1.75-2.02). Obese 12-year-olds were more likely to present erupt-ed #17, #27, #37, and #47 at age 12 and to present completely erupted second molars at age 14-15 than normal weight ones. Conclusions: This population-based study found a significant association between over-weight/obesity at age 12 and early tooth eruption at ages 12 and 14-15 among schoolchil-dren from southern Brazil. Key words:Tooth eruption, Obesity, Permanent teeth, Epidemiology.

Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions.

A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.

Underlying Dentin Shadows (ICDAS 4) in Occlusal Surface of Permanent Teeth Have Low Progression Rate after 1-2 Years.

The aim of this prospective cohort study was to assess the radiographic progression of underlying dentin shadows (UDS) on the occlusal surfaces of permanent posterior teeth of adolescents and young adults over 1-2 years and to identify possible risk factors. A total of 149 UDS lesions (from 101 individuals) were included at baseline. Each participant had to present at least one UDS to be considered eligible for the study. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs, performed at baseline and after 1-2 years. The association between possible predictors and UDS progression (defined radiographically as an increase in the radiographic score from baseline to follow-up) was assessed using Weibull regression models. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated. A total of 81 individuals (mean age: 24.0, standard deviation: 8.03) were reexamined after 1-2 years (742 occlusal surfaces, of which 118 were UDS). The overall progression rate was 8.6% after 1-2 years, being 12.6% for UDS without baseline radiolucency and 20% for UDS with baseline radiolucency. The risk analysis showed that UDS without radiolucency at baseline had a similar likelihood of progression (adjusted HR = 1.71, 95% CI = 0.68-4.32, p = 0.26) while UDS with radiolucency at baseline were more likely to progress (adjusted HR = 2.96, 95% CI = 1.06-8.26, p = 0.04) than the reference category (sound occlusal surfaces without radiolucency). These estimates were adjusted for caries prevalence, tooth type, and arch. This study showed low progression rates of UDS after 1-2 years. The presence of radiolucency at baseline was found to predict UDS progression.

Chapter 9.3: Current Concepts of Caries Removal in Daily Practice.

Although the discussion about the amount of carious dentin to be removed during cavity preparation is quite old, concepts for caries removal have evolved and changed considerably over the last decades. The antiquate understanding that it was necessary to eliminate the microbial contamination of a cavity before placing the restoration was replaced by the current knowledge that maintaining contaminated dentin beneath restorations is inevitable and is not associated with treatment failure. This chapter brings together the body of evidence behind carious dentin removal to indicate a conservative treatment, aiming to preserve both tooth vitality and structure. Studies that evaluated the effects of sealing contaminated dentin are described, which are focused on different outcomes, such as microbiological counts, clinical characteristics, laboratory analysis, and radiographic findings. Long-term studies and randomized clinical trials also support the current recommendations. After addressing the available literature on this topic, this chapter concludes that (1) the amount of carious dentin to be removed should be defined by lesion depth; (2) sealing and/or selective caries removal to firm dentin is recommended for the management of shallow and moderate lesions; (3) the selective caries removal to soft dentin in a single session is indicated for deep caries lesions aiming to preserve tooth vitality; and (4) the use of a cavity liner after selective caries removal seems to be an unnecessary clinical step.

Is Patient's Caries Activity Associated with Caries Increment among Adolescents, Regardless of Caries Experience?

This 2.5-year cohort study investigated whether patient's caries activity is independently associated with caries increment among adolescents, regardless of previous caries experience, in a sample of 801 adolescents from South Brazil. Caries examination was performed at baseline (12 y) and at follow-up (14-15 y). Caries activity was significantly associated with caries increment even after adjustment for sex, socioeconomic status, type of school, and previous caries experience at both cavity and non-cavitated levels. Caries-active adolescents had approximately 2-fold higher risk of caries increment than those without caries activity (cavity level, incidence risk ratio [IRR] = 1.90, 95% confidence interval [CI] = 1.45-2.49, p < 0.001; non-cavitated level, IRR = 2.16, 95% CI = 1.63-2.86, p < 0.001).

Factors associated with a cariogenic diet among adolescents: a structural equation modeling approach.

OBJECTIVE: To investigate the factors directly and indirectly associated with a cariogenic diet among southern Brazilian adolescents. MATERIALS AND METHODS: This cross-sectional study included 15-19-year-old students attending high schools in Santa Maria, southern Brazil. The participants completed a questionnaire on sociodemographic and behavioral variables. The Oral Health Impact Profile-14 was applied to collect data on oral health-related quality of life (OHRQoL). Clinical examination was used to assess the dental caries status (decayed, missing, and filled teeth index). A cariogenic diet was considered a latent variable measured by the self-perception of a healthy diet and the frequency of consumption of sugary foods and drinks. Structural equation modeling was used to analyze the direct and indirect pathways to a cariogenic diet. RESULTS: A total of 1197 adolescents were included. Low toothbrushing frequency (standardized coefficient (SC), 0.10; p < 0.05), cigarette smoking (SC, 0.15; p < 0.01), and alcoholic beverages (SC, 0.14; p < 0.01) were directly linked to a cariogenic diet, which, in turn, was directly linked to untreated dental caries (SC, 0.18; p < 0.01) and poor OHRQoL (SC, 0.16; p < 0.01). In addition, household income (via toothbrushing frequency) and age (via alcoholic beverages) were indirectly linked to a cariogenic diet. CONCLUSION: A cariogenic diet was consistently associated with a range of unhealthy behaviors during adolescence as well as poor household income. CLINICAL RELEVANCE: Health promotion strategies to restrict sugar consumption and encourage healthier lifestyles should be aware of the synergism observed among unhealthy behaviors during adolescence.

Classification of a patient's caries activity based on lesion activity assessment among adults: findings from a prospective cohort study.

OBJECTIVE: To investigate whether the classification of a patient's caries activity based on lesion activity assessment can predict the increment and progression of coronal and root caries lesions among adults. METHODS: This population-based prospective cohort study followed 413 individuals (mean age 54.1) from southern Brazil for 4 years. Data collection included a questionnaire and clinical examination to record coronal/root caries and gingival recession. The main outcomes were caries increment measured as decayed, missing and filled tooth surfaces (DMFS) and caries progression (surface-level analysis). The main predictor variable was patients' caries activity at baseline ("caries-inactive" or "caries-active"). Negative binomial regression models (unadjusted and adjusted) were used. RESULTS: Caries-active individuals were more likely to present DMFS increment than caries-inactive ones when migrations among DMFS components were considered (IRR [incidence risk ratio] = 1.26, 95%CI [confidence interval] = 1.01-1.58). On the other hand, no such association was found when these migrations were disregarded. The risk for coronal caries progression on filled surfaces was 90% higher among caries-active patients (IRR=1.9; 95%CI=1.4-2.6). In addition, patient's caries activity was able to predict higher risk for root caries progression in newly exposed root surfaces (IRR=1.9; 95%CI=1.0-3.6). CONCLUSION: The classification of a patient's caries activity based on lesion activity was able to foresee lesion progression on the coronal and root surfaces more susceptible to caries among adults. Clinical relevance Classifying a patient's caries activity is a useful tool for the clinical management of dental caries in adults.

Sense of coherence and oral health-related quality of life among southern Brazilian male adolescents

Abstract This study evaluated the association between sense of coherence (SoC) and oral health-related quality of life (OHRQoL) among conscripts of the Brazilian Army, in two cities of southern Brazil. A cross-sectional study included all 18-19-year-old adolescents who joined the Brazilian Army as draftees for mandatory military service in the cities of Itaqui, RS, and Santiago, RS (n = 505). Data collection was conducted from 2019 to 2021, and included the application of questionnaires and a clinical oral examination to record gingivitis, malocclusion, and dental caries. OHRQoL was collected through the Brazilian short version of the Oral Health Impact Profile (OHIP), composed of 14 questions. The adolescents' SoC was assessed using the validated Brazilian version of the SOC-13 scale. The primary outcome of this study was OHRQoL, modeled as a discrete variable (OHIP-14 scores). The main predictor variable was SoC, categorized as low, moderate, or high. The association between predictor variables and OHRQoL was assessed by Poisson regression models using a hierarchical approach. Unadjusted and adjusted rate ratios (RR), and 95% confidence intervals (CI) were estimated. All the analyses were performed using STATA software version 14.2. Adolescents with a moderate and high SoC had 27% (RR = 0.73, 95%CI = 0.64-0.84) and 51% (RR = 0.49, 95%CI = 0.41-0.58) lower mean OHIP-14 scores, respectively, than those with a low SoC score, after the inclusion of behavioral and clinical variables. This study showed a significant association between SoC and OHRQoL among 18-19-year-old southern Brazilian adolescents. Strengthening the SoC as a psychosocial resource may improve the well-being and OHRQoL of adolescents.

Association between toothbrushing frequency and dental caries and tooth loss in adolescents: a cohort study

Abstract This cohort study assessed the association between toothbrushing frequency and the increment of dental caries and tooth loss in a population-based sample of southern Brazilian adolescents, to investigate whether there is any additional benefit in performing a third daily brushing. At baseline, 1,528 12-year-old schoolchildren attending 42 schools were examined for gingivitis and dental caries, and answered a questionnaire. After a mean period of 2.5 years, 801 schoolchildren were re-examined. Dental caries and tooth loss increment were outcomes of the study. The main predictor variable was toothbrushing frequency (≥3 times/day vs. twice/day or ≤1 time/day). Poisson regression models were used to estimate the risk for caries and tooth loss increment. Incidence risk ratios (IRR) and 95% confidence intervals (CI) were estimated. The final model adjusted for sociodemographic, behavioral, and clinical variables showed that brushing twice/day afforded 40% greater risk (IRR = 1.40; 95%CI: 1.02-1.92) for caries increment than ≥3 times/day. Regarding the tooth loss increment, adolescents who brushed their teeth twice/day had a fourfold greater risk (IRR = 3.92; 95%CI: 1.23-12.49) than those who brushed ≥ 3 times/day. Sex, school type, and gingivitis were found to act as effect modifiers, inasmuch as a third daily brushing presented advantages against tooth loss only for girls, public school attendees, and those with ≥ 50% of bleeding sites. This study suggests that adolescents benefit from a third daily toothbrushing. Increasing brushing frequency to 3 times/day may be a suitable strategy to control dental caries and tooth loss among high-risk adolescents.

Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions

Abstract A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.

Loss of dental tissue after restoration or sealing of occlusal carious lesions: 3-4-year results of randomized clinical trials.

Context: Although preservation of the tooth structure is quoted as the main advantage of sealing of carious lesions, there are no long-term studies comparing the maintenance of dental tissue after restoration or after caries sealing. Aim: To measure the radiographically visible loss of dental tissue after conventional restoration and sealing of carious lesions. Subjects and Methods: This study was a secondary analysis of two randomized controlled clinical trials, one conducted in Brazil and another in Belgium, which evaluated two different therapies for the treatment of occlusal carious lesions in permanent teeth: sealant (SE) without previous carious tissue removal or restoration (RE) with total removal of carious dentin. The greater depth and width of sealed carious lesions and restorations were compared. Statistical Analysis: The independent t-test was used to compare therapies at different time points, while the paired t-test was used to compare the same therapy over time. Results: Carious lesions in the RE and SE groups showed similar measurements at baseline (P > 0.05). Over time, significantly greater loss of tooth structure was observed in the RE group than in the SE group. No increase in lesion depth or width was observed in the SE group, suggesting no progression of sealed lesions. Conclusion: Sealing of carious lesions resulted in greater preservation of dental tissue.

Efficacy of fluoride gel in arresting active non-cavitated caries lesions: a randomized clinical trial.

This study evaluated the efficacy of fluoride gel in arresting active non-cavitated caries lesions in permanent teeth. This randomized, triple-blind, placebo-controlled clinical trial randomized 100 schoolchildren aged 10.7 ± 2.2 years to test treatment (1.23% acidulated phosphate fluoride [APF] gel) or control treatment (placebo gel) for 4-6 applications at weekly intervals. Data collection included the visible plaque index, gingival bleeding index, visible plaque accumulation on the occlusal surfaces, eruption stage, and dental caries. The association between group and lesion arrestment was assessed using logistic regression, and estimates were adjusted for plaque accumulation over the lesion at baseline, surface type, and tooth type. Models were fitted using generalized estimating equations for accounting for the clustering of data (i.e., the same individual contributed > 1 lesion). Ninety-eight children completed the study (48 fluoride and 50 placebo). When all dental surfaces were analyzed, the likelihood of lesion arrestment was similar between both groups (p > 0.05). A secondary analysis including only the occlusal lesions in molars showed that for teeth under eruption, lesions receiving the 1.23% APF gel were about 3-fold more likely to become arrested than lesions receiving the placebo gel (OR = 2.85; 95%CI = 1.23-6.61; p = 0.01). No significant difference was detected for molars with complete eruption (p > 0.05). The benefit of fluoride gel for arresting non-cavitated caries lesions could not be identified by clinical assessment in this short-term trial. Notwithstanding, when the cariogenic challenge was greater (as on the occlusal surfaces of erupting molars), 1.23% APF gel treatment was an important tool for caries control.

Association between the city region and traumatic dental injuries among adolescents from Santa Maria, South Brazil.

This study investigated the association between the city region and traumatic dental injury (TDI) among adolescents from Santa Maria, Rio Grande do Sul, Brazil. A population-based cross-sectional survey was conducted from March to November 2018, which included a representative sample of adolescents (15-19-year-old) attending public and private high schools. A questionnaire on sociodemographic information was sent to the parents/legal guardians of the selected adolescents. TDI in the upper and lower permanent incisors and canines was recorded based on the O'Brien classification. Environmental variables (sociodemographic and structural characteristics of the neighborhoods) were obtained from official publications. Multilevel Poisson regression models were used, and prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. A total of 1,146 adolescents participated in this study. The overall prevalence of TDI was 17.3%, mild trauma was 12.7%, and severe trauma was 5.8%. Adolescents living in the southern region had a prevalence of TDI of 25.3%, compared with 13.6% in the northern region. After adjusting for important cofactors, adolescents living in the southern region were more likely to have TDI than their counterparts in the northern region (PR, 1.91; 95%CI: 1.18-3.11; p = 0.009). Analyzing the number of environmental risk indicators in different regions, the southern region presented a higher mean and median than all other regions. In conclusion, living in the southern region was associated with a higher prevalence and severity of TDI among adolescents from Santa Maria, southern Brazil. Our findings suggest the role of the environment in the epidemiology of TDI.

Is neighborhood income associated with untreated dental caries irrespective of family income?

OBJECTIVE: To assess the status of untreated dental caries in adolescents exposed to different conditions of family and neighborhood income. MATERIALS AND METHODS: This cross-sectional study included a representative sample of 1197 15-19-year-old adolescents attending high schools from Santa Maria, southern Brazil. Data collection included a questionnaire and clinical examination (DMFT index). Neighborhood mean income was collected from official sources. The main predictor variable was a combination of household income and neighborhood mean income resulting in four categories: low household income/low neighborhood income, low household income/high neighborhood income, high household income/low neighborhood income, or high household income/high neighborhood income. The outcome was untreated caries (number of teeth with dentin cavities or residual roots). Multilevel Poisson regression analysis was used to assess the association between predictors and untreated caries. Rate ratio (RR) and 95% confidence intervals (CI) were estimated. RESULTS: The prevalence of untreated dental caries was 26% (n = 312), with a mean (± standard deviation) of 0.47 (± 1.05) teeth. Adolescents with low household income living in areas with low neighborhood income had the worse caries scenario. Compared with them, those classified as low-income households residing in high-income neighborhoods had 37% lower rate of untreated dental caries (adjusted RR = 0.63; 95%CI = 0.44-0.89). No neighborhood effect was detected among adolescents of more affluent families. CONCLUSIONS: Neighborhood income contributed to the rate of untreated dental caries over and above household income among adolescents with low household income only. CLINICAL RELEVANCE: Improving living conditions in disadvantaged neighborhoods may positively impact the oral health of residents, thus reducing oral health inequalities.

Sociodemographic, behavioral, and clinical indicators for added value of radiography in caries diagnosis in adolescents: A cross-sectional study.

OBJECTIVE: The aim was to assess the value of sociodemographic, behavioral, and clinical characteristics in identifying adolescents who would benefit from radiographs for dental caries detection in a high-caries experience population. STUDY DESIGN: In total, 356 adolescents answered a validated questionnaire on sociodemographic characteristics and oral health behavior and were clinically and radiographically examined for caries. The outcome was the benefit arising from radiographs for caries detection at the patient level, defined as the number of surfaces clinically classified as sound but presenting radiolucency. RESULTS: A total of 169 participants (47.5%) benefited from radiographs. One-third of approximal lesions were detected clinically, whereas two-thirds, mostly initial lesions, were detected radiographically only. Adolescents who reported frequent consumption of soft drinks and sugary food, those with D1MFS (noncavitated and cavitated caries experience) ≥12, D5MFS (cavitated caries experience) ≥1, clinically detected approximal lesions, and active caries were significantly more likely to benefit from radiographs (P ≤ .002). Although some indicators showed moderate-to-good sensitivity (consumption of sugary food, caries activity) or specificity (absence of clinically diagnosed approximal lesions), the accuracy of indicators evaluated (isolated or combined) never reached 0.60. CONCLUSIONS: The possibility of correctly identifying which adolescents would benefit from radiographs for caries detection purposes was limited in a population with high-caries experience.