Association between underlying dentin shadows (ICDAS 4) and OHRQoL among adolescents from southern Brazil.

This study aimed to assess the association between underlying dentin shadows (UDS) and oral health-related quality of life (OHRQoL) among 15-19-year-old adolescents from southern Brazil. This population-based cross-sectional study included a representative sample of 1,197 15-19-year-old adolescents attending 31 public and private schools from Santa Maria, Brazil. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed by two calibrated examiners (intra/interexaminer kappa values for caries examination ≥ 0.80) to diagnose UDS (ICDAS code 4 caries lesions). Sociodemographic information and clinical characteristics (overall caries experience, traumatic dental injury, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between UDS and OHRQoL. Rate ratios (RR) and 95% confidence intervals (CI) were estimated. The UDS prevalence was 8.8% (n = 106 adolescents). In the adjusted models, adolescents with UDS had poorer OHRQoL than those without UDS, and the strength of the association was dependent on the number of lesions per individual. Individuals with 1-2 UDS had a mean OHIP-14 score 8% higher (RR = 1.08; 95%CI: 1.01-1.17) than adolescents without UDS, while those with 3-4 UDS had a mean score 35% higher (RR = 1.35; 95%CI: 1.12-1.63). This negative association was related to physical disability, psychological disability, social disability, and handicap domains. This study showed that UDS was associated negatively with OHRQoL among 15-19-year-old adolescents from southern Brazil. The negative effect of UDS on OHRQoL emphasizes the importance of addressing issues regarding OHRQoL even in the posterior teeth of adolescents.

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.

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.

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.

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.

Self-perceived neighborhood factors and OHRQoL among adolescents: a population-based study in southern Brazil.

This study aimed to assess the relationship between self-perceived neighborhood factors and oral health-related quality of life (OHRQoL) among adolescents from southern Brazil. A representative sample of 15-19-year-old students from Santa Maria, Brazil, was included. The Oral Health Impact Profile (OHIP-14) was used to assess the OHRQoL. Self-perceived neighborhood factors were assessed through a structured questionnaire and included characteristics of the neighborhood where the adolescents lived, such as the presence of paved streets, tap water, community social networks, and availability of dental services and the Family Health Strategy (FHS). In addition, socioeconomic, behavioral, and clinical variables (dental caries and malocclusion) were also evaluated. Multilevel Poisson regression analysis with a hierarchical approach was used to assess the association between predictors and OHIP-14. The rate ratio (RR) and 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included in this study (participation rate: 72.3%). The mean OHIP-14 score was 8.4 (standard error = 0.2), ranging from 0 to 49. Living in residences with unpaved streets (RR = 1.11, 95%CI:1.06-1.17), no tap water (RR = 1.11, 95%CI: 1.02-1.20), absence of the FHS services (RR = 1.15, 95%CI: 1.09-1.20), and the availability of dental services (RR = 1.08, 95%CI: 1.03-1.14) were associated with higher OHIP-14 scores, indicating a poorer OHRQoL. In addition, lower socioeconomic status, visiting the dentist for curative reasons, lower frequency of brushing teeth, and higher sugar consumption were also associated with higher OHIP-14 scores. In conclusion, self-perceived neighborhood characteristics were associated with OHRQoL in adolescents. Adolescents who perceived their neighborhood as deprived had poorer OHRQoL.

Prevalence, extent, risk indicators, and intraoral distribution of underlying dentin shadows (ICDAS 4) among 15-19-year-old South Brazilian adolescents.

Background and Objective: This study aimed to assess the prevalence, extent, risk indicators, and intraoral distribution of underlying dentin shadows (UDS) in the occlusal surfaces of the permanent posterior teeth. Subjects and Methods: A total of 1197 adolescents were included in the study (participation rate of 72.3%). The association between the independent variables, on the one hand, and the prevalence and extent of UDS were assessed using multilevel Poisson regression models. The prevalence ratios (PR), rate ratios (RR), and 95% confidence intervals (95% CIs) were estimated. The overall prevalence of UDS was 8.8% (95% CI = 6.0-11.5), with an overall mean of 0.13 (95% CI = 0.08-0.17) lesions per individual. Those with UDS exhibited a mean of 1.45 (95% CI = 1.28-1.62) lesions. Results: Lower family income (PR = 1.58; 95% CI = 1.03-2.41) and caries activity (PR = 1.53; 95% CI = 1.01-2.31) were significantly associated with UDS prevalence, while age ≥17 years (RR = 1.43; 95% CI = 1.03-1.99) and caries activity (RR = 1.63; 95% CI = 1.55-2.30) were significantly associated with caries extent. The most commonly affected teeth were lower first molars, followed by upper first molars and lower second molars. Conclusion: This study found a low prevalence and extent of UDS in the occlusal surface. Sociodemographic variables and caries activity were associated with the occurrence of UDS.

Self-perceived neighborhood factors and OHRQoL among adolescents: a population-based study in southern Brazil

Abstract This study aimed to assess the relationship between self-perceived neighborhood factors and oral health-related quality of life (OHRQoL) among adolescents from southern Brazil. A representative sample of 15-19-year-old students from Santa Maria, Brazil, was included. The Oral Health Impact Profile (OHIP-14) was used to assess the OHRQoL. Self-perceived neighborhood factors were assessed through a structured questionnaire and included characteristics of the neighborhood where the adolescents lived, such as the presence of paved streets, tap water, community social networks, and availability of dental services and the Family Health Strategy (FHS). In addition, socioeconomic, behavioral, and clinical variables (dental caries and malocclusion) were also evaluated. Multilevel Poisson regression analysis with a hierarchical approach was used to assess the association between predictors and OHIP-14. The rate ratio (RR) and 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included in this study (participation rate: 72.3%). The mean OHIP-14 score was 8.4 (standard error = 0.2), ranging from 0 to 49. Living in residences with unpaved streets (RR = 1.11, 95%CI:1.06−1.17), no tap water (RR = 1.11, 95%CI: 1.02−1.20), absence of the FHS services (RR = 1.15, 95%CI: 1.09−1.20), and the availability of dental services (RR = 1.08, 95%CI: 1.03−1.14) were associated with higher OHIP-14 scores, indicating a poorer OHRQoL. In addition, lower socioeconomic status, visiting the dentist for curative reasons, lower frequency of brushing teeth, and higher sugar consumption were also associated with higher OHIP-14 scores. In conclusion, self-perceived neighborhood characteristics were associated with OHRQoL in adolescents. Adolescents who perceived their neighborhood as deprived had poorer OHRQoL.

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

Abstract 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 Toothbrush Bristle Stiffness Associated with Erosive Tooth Wear in Adolescents? Findings from a Population-Based Cross-Sectional Study.

This population-based cross-sectional study investigated the association between toothbrush bristle stiffness and the occurrence of erosive tooth wear (ETW) among 15- to 19-year-old adolescents from southern Brazil. Data collection included the application of questionnaires and clinical examination. One questionnaire on sociodemographic information (sex, age, and socioeconomic status) was sent to the parents/legal guardians, while the other was applied to students and collected data regarding oral hygiene habits (toothbrushing frequency, toothbrushing after meals, and toothbrush bristle stiffness) and dietary habits (frequency of consumption of soft drinks, citric fruits, and fruit juice). After tooth cleaning and drying, all erupted permanent teeth were clinically assessed and classified according to the Basic Erosive Wear Examination (BEWE) by 2 calibrated examiners. The association between explanatory variables and ETW prevalence was assessed using Poisson regression models. Prevalence ratios (PRs) and their 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included (participation rate 72.3%). The overall prevalence of ETW was 57%. The final model showed that individuals who used toothbrushes with soft (PR = 1.28, 95% CI = 1.02-1.60) or medium (PR = 1.30, 95% CI = 1.01-1.69) bristles presented a higher ETW prevalence than those who used toothbrushes with extra-soft bristles, even after the adjustment for important cofactors. In conclusion, this study found a very weak but significant association between toothbrush bristle stiffness and ETW among Brazilian adolescents. Considering the cross-sectional design of this study and considering that some association was found even in such a young population, future studies using different designs and including different age-groups might elucidate the clinical relevance of this finding.

Traumatic dental injury and oral health-related quality of life among 15 to 19 year old adolescents from Santa Maria, Brazil.

BACKGROUND/AIMS: The literature is scarce on the association between traumatic dental injuries (TDI) and oral health-related quality of life (OHRQoL) among adolescents, and there is no study assessing this relationship using clinical criteria for the assessment of TDI in this age group. The aim of this study was to assess the association between TDI and OHRQoL among 15 to 19yearold adolescents from Santa Maria, Brazil. MATERIALS AND METHODS: A population-based cross-sectional study was conducted including a representative sample of 1197 15 to 19yearold adolescents attending 31 public and private schools. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed to diagnose TDI based on the O'Brien classification. Demographic information, socioeconomic status, and clinical characteristics (caries experience, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between TDI and OHRQoL. Rate ratios (RR) and 95% confidence intervals (95% CI) were estimated. RESULTS: The overall prevalence of TDI was 17%, mild trauma was 12%, and severe trauma was 5%. In the adjusted models, adolescents with TDI had poorer OHRQoL than those without TDI (RR = 1.10; 95% CI = 1.05-1.16). This negative effect was related to the psychological disability domain (RR = 1.16; 95% CI = 1.02-1.32), to the social disability domain (RR = 1.34; 95% CI = 1.13-1.59), and to the handicap domain (RR = 1.35; 95% CI = 1.10-1.66). CONCLUSIONS: Despite its low severity, TDI negatively affected the OHRQoL of 15 to 19yearold adolescents from Santa Maria, Brazil.

Erosive tooth wear among South Brazilian adolescents, and its association with sociodemographic variables.

The aim of this study was to assess the occurrence of erosive tooth wear (ETW) among 15-19-year-old South Brazilian adolescents, regarding prevalence, extent, severity, intraoral distribution, and sociodemographic risk indicators. A population-based cross-sectional survey was conducted in Santa Maria, southern Brazil, and included a representative sample of 15-19-year-old adolescents. Data collection included the application of a questionnaire and a clinical examination. A questionnaire was sent to the parents/legal guardians of the selected students, containing questions on demographic information, socioeconomic characteristics, and living conditions. After tooth cleaning and drying, all erupted permanent teeth were clinically assessed by two calibrated examiners, and classified according to the Basic Erosive Wear Examination (BEWE). The association between explanatory variables and the outcomes (ETW prevalence and extent) was assessed using Poisson regression models (both unadjusted and adjusted). A total of 1,197 adolescents were included in the study (participation rate of 72.3%). The overall prevalence of ETW was 57%. Severe ETW affected 16% of the sample. Overall, this adolescent population presented 13.3 affected surfaces, and 8.34 affected teeth. In the risk assessment analysis, gender, skin color, socioeconomic status, and family income were significantly associated with ETW. Boys, white adolescents, and those with higher socioeconomic status were more affected by ETW. This population-based cross-sectional study revealed that the prevalence of ETW was high, and that it was associated with sociodemographic variables in this South Brazilian population of adolescents.