Differential effect of social mobility on tooth loss by race in adulthood: 1982 Pelotas Birth Cohort Study.

OBJECTIVES: To examine the association between social mobility and tooth loss in adults from the 1982 Pelotas Birth Cohort Study and whether race modifies this association. METHODS: The Oral Health Study used data from 541 individuals who were followed up to 31 years of age. Social mobility, composed of the participants' socioeconomic position (SEP) at birth and at age 30, was categorized as never poor, upwardly mobile, downwardly mobile and always poor. The outcome was the prevalence of at least one tooth lost due to dental caries when the participants were examined at 31 years of age. The effect modifier was race (Black/Brown versus white people). Log-binomial regression models were used to estimate crude and sex-adjusted prevalence ratios (PR) and to determine whether the association varied with race. Statistical interactions were tested using an additive scale. RESULTS: The prevalence of any tooth loss was 50.8% (n = 274). In social mobility groups, the prevalence of at least one tooth lost in the never-poor group was about 31% points higher for Black/Brown (68.2%) than for white people (37.4%). Antagonistic findings were found for the interaction between race and social mobility (Sinergy Index = 0.48; 95% CI 0.24, 0.99; and relative excess of risk due to the interaction = -1.38; 95% CI -2.34, -0.42), suggesting that the observed joint effect of race and social mobility on tooth loss was lower than the expected sum of these factors. The estimates for Black/Brown people were smaller for those who were always poor during their lives, relative to their white counterparts. CONCLUSIONS: The findings suggest a higher prevalence of at least one tooth lost among people in the downward mobile SEP group and Black/Brown people. Greater racial inequity was found among Black/Brown people who had never experienced episodes of poverty, with Black/Brown people having a greater prevalence of at least one tooth lost than their white counterparts.

Self-perception of need to replace dentures and oral health-related quality of life: cross-sectional study nested in a Cohort in Southern Brazil

Aim: With the significant increase in life expectancy over the last decades, it is important to understand how oral health can impact the oral health-related quality of life of older adults. This study aimed to investigate the association between need to replace dentures and oral health-related quality of life (OHRQoL) among older adults belonging to a Cohort in southern Brazil. Methods: This cross-sectional study was conducted with data from the 2019 Pelotas Elderly Cohort. The OHRQoL was assessed using the GOHAI. Need to replace dentures was self-report using a question dichotomized into yes/no. In the statistical analysis, unadjusted and adjusted models estimate from linear regression models were calculated. The significance level adopted was 5%. Results: A total of 493 older adults were included. On the GOHAI questionnaire, the mean score was 32.74 (SD±0.16). Individuals considering need of prosthesis replacement were 47.89%. Report of need to replace dentures was associated to lowest mean on the GOHAI score (ß -1.14; 95%CI - 1.80; -0.478, and on the physical (ß -0.56; 95%CI - 0.94 -0.17) and psychosocial (ß -0.48; 95%CI - 0.74; -0.22) dimensions. Conclusion: Our findings highlight the importance of also considering subjective measures of oral health in the dental care of older adults, since reporting the need for denture replacement, regardless of the reason, was associated with a worse oral health-related quality of life, including physical and psychosocial aspects

Fairness of Machine Learning Algorithms for Predicting Foregone Preventive Dental Care for Adults.

Importance: Access to routine dental care prevents advanced dental disease and improves oral and overall health. Identifying individuals at risk of foregoing preventive dental care can direct prevention efforts toward high-risk populations. Objective: To predict foregone preventive dental care among adults overall and in sociodemographic subgroups and to assess the algorithmic fairness. Design, Setting, and Participants: This prognostic study was a secondary analyses of longitudinal data from the US Medical Expenditure Panel Survey (MEPS) from 2016 to 2019, each with 2 years of follow-up. Participants included adults aged 18 years and older. Data analysis was performed from December 2022 to June 2023. Exposure: A total of 50 predictors, including demographic and socioeconomic characteristics, health conditions, behaviors, and health services use, were assessed. Main Outcomes and Measures: The outcome of interest was foregoing preventive dental care, defined as either cleaning, general examination, or an appointment with the dental hygienist, in the past year. Results: Among 32 234 participants, the mean (SD) age was 48.5 (18.2) years and 17 386 participants (53.9%) were female; 1935 participants (6.0%) were Asian, 5138 participants (15.9%) were Black, 7681 participants (23.8%) were Hispanic, 16 503 participants (51.2%) were White, and 977 participants (3.0%) identified as other (eg, American Indian and Alaska Native) or multiple racial or ethnic groups. There were 21 083 (65.4%) individuals who missed preventive dental care in the past year. The algorithms demonstrated high performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.84 (95% CI, 0.84-0.85) in the overall population. While the full sample model performed similarly when applied to White individuals and older adults (AUC, 0.88; 95% CI, 0.87-0.90), there was a loss of performance for other subgroups. Removing the subgroup-sensitive predictors (ie, race and ethnicity, age, and income) did not impact model performance. Models stratified by race and ethnicity performed similarly or worse than the full model for all groups, with the lowest performance for individuals who identified as other or multiple racial groups (AUC, 0.76; 95% CI, 0.70-0.81). Previous pattern of dental visits, health care utilization, dental benefits, and sociodemographic characteristics were the highest contributing predictors to the models' performance. Conclusions and Relevance: Findings of this prognostic study using cohort data suggest that tree-based ensemble machine learning models could accurately predict adults at risk of foregoing preventive dental care and demonstrated bias against underrepresented sociodemographic groups. These results highlight the importance of evaluating model fairness during development and testing to avoid exacerbating existing biases.

Functional dentition and edentulism associated with mortality: A cohort study of older adults in Southern Brazil.

OBJECTIVE: The aim of this study was to evaluate the association between the lack of a functional dentition and edentulism with mortality in a cohort of older adults in a Southern Brazilian city. MATERIALS AND METHODS: This is a longitudinal study carried out with community-dwelling older adults (≥60 years old) from Pelotas, Brazil, using data from the baseline (2014) and the first follow-up (2017). Main exposures were functional dentition (20+ teeth present) and edentulism (absence of all teeth), derived from self-reported number of teeth. All-causes mortality was evaluated according to the city's Epidemiological Surveillance Department. Potential confounders were age, sex, socioeconomic position, smoking, diabetes, hypertension, and body mass index (BMI). To test the association between functional dentition and edentulism with mortality, Poisson regression models with robust variance were used, to estimate Relative Risks and 95% confidence intervals. RESULTS: A total of 1289 older adults had information on all variables of interest and comprise the analytical sample (from 1451 at baseline). When analysing the presence of functional dentition, only 222 individuals (17.2%) had 20 or more teeth in their mouth, while 490 older adults were edentulous (38.0%). Crude analysis showed an association between tooth loss indicators and mortality. Models adjusted for sociodemographic variables and health conditions and behaviours revelled no association between the exposures and mortality. CONCLUSIONS: With the findings of this study, we did not identify an association between edentulism and functional dentition with mortality, after considering important shared risk factors.

Causal inference in dentistry: Time to move forward.

Oral conditions represent a critical public health challenge, and together with descriptive and predictive epidemiology, causal inference has a crucial role in developing and testing preventive oral health interventions. By identifying not just correlations but actual causes of disease, causal inference may quantify the average effect of interventions and guide policies. Although authors are not usually explicit about it, most oral health studies are guided by causal questions. However, methodological deficiencies limit their interpretability and the implementation of their findings. This manuscript is a call to action on the use of causal inference in oral research. Its application starts with asking theoretically sound questions and being explicit about causal relationships, defining the estimates to evaluate, and measuring them properly. Beyond promoting causal analytical approaches, we emphasize the need for more causal thinking to promote thoughtful research questions and the use of appropriate methods to answer them. Causal inference relies on the plausibility of assumptions underlying the data analysis and the quality of the data, and we argue that high-quality observational studies can be used to estimate average causal effects. Although individual efforts to embrace causal inference in dentistry are essential, they will not yield substantial results if not led by a systematic and structural change in the field. We urge scientific societies, funding bodies, dental schools, and journals to promote transparency in research, causal thinking, and causal inference projects to move the field toward more meaningful studies. It is also time for researchers to move forward and connect with the community, co-produce investigations and translate their findings, and engage in interventions that impact public health. We conclude by highlighting the importance of triangulating results from different data sources and methods to support causal inference and inform decision-making on interventions to effectively improve population oral health.

Early Sugar Introduction Associated with Early Childhood Caries Occurrence.

Consensus has yet to be reached on the impact of early sugar introduction on early childhood dental caries (ECC). This study aimed to evaluate the association between the time of introduction of sugar in the infant's diet and ECC at 48 months, using data from the 2015 Pelotas Birth Cohort Study. This cohort comprises 4,275 children. At 48 months, 3,654 (91.1%) children had their oral health clinically evaluated by a team of 12 trained and calibrated dentists and their dental caries experience and cavitated lesions were assessed. The period of life in which sugar was first introduced into the child's diet was considered the primary exposure of the study, collected through questionnaires at 3, 12, 24, and 48 months of age. Analyses were conducted using Stata, version 15.0. Descriptive analyses were initially performed. Poisson regression with robust variance adjustment for the crude and adjusted analysis was used to estimate the effect of the sugar introduction on ECC. The highest prevalence of caries experience (43.3%) was in children in which sugar was introduced into the infant's diet before 12 months of age. A higher prevalence of caries experience was found for less educated (49.8%) and younger (51.7%) mothers, and in poorer families (48.3%). In the adjusted analysis, the experience of caries was 48% greater in the group with sugar introduction before 12 months of age, compared to those where sugar was introduced after 24 months of age In conclusion, our results support the adoption of preventive measures to delay the supply of sugar in early life in order to reduce the caries experience in children.

Gender inequities in dental research publications: Findings from 20 years.

BACKGROUND: The first steps towards gender equity in science are measuring the magnitude of inequity and increasing awareness of the problem. OBJECTIVES: To describe trends in gender disparities in first and last authorship in the most cited dental publications and general dental literature over a 20-year period. METHODS: Articles and bibliometric data were retrieved from the Scopus database for the period 1996 to 2015. Two groups of 1000 articles each were retrieved: a random sample and another sample of top-cited articles for each year. The gender of the first and last author of each publication was manually identified. When this was not possible, we used an online software platform (https://genderize.io/). Descriptive analyses identified the proportion of women first and last authors in both samples, stratifying by dental discipline and geographic region. Trends were ascertained by frequency metrics across years. Gender disparity was observed in both first and last authorship, with a larger gap being observed in the top-cited sample. RESULTS: Women led 28.4% and 20.3% of articles in the random and top-cited samples, respectively. A similar pattern was observed for the last authorship group (22.1% and 16.1%, respectively). An increasing trend in the proportion of articles led by women over time was observed in both samples. This increase was larger in the top-cited sample (from 15.0% in 1996-2000 to 25.1% in 2015) than in the random sample (from 26.3% in 1996-2000 to 33.2% in 2011). CONCLUSIONS: Clear gender disparities in dental research publications in the last 20 years were identified in both general and top-cited manuscripts, across dental disciplines, across countries, across first and last authorship, and over time. It is paramount that actions are taken to attract, retain and promote women in science, as well as to monitor and ensure progress towards gender equity.

Temporal trends of women with oral cavity, base of tongue and lip cancers in Brazil: An ecological study covering mortality data from 1980 to 2018.

OBJECTIVES: Obtaining robust evidence about the local mortality levels, trends and impact of oral cavity/base of tongue cancers and lip cancer, especially for women, is imperative in the fight against cancer. This descriptive retrospective ecological time-series study explored trends in oral cavity/base of tongue cancers and lip cancer mortality rates for women in Brazil from 1980 to 2018, by geographic region and anatomical location. METHODS: The crude and age-adjusted annual mortality rates were obtained by sex, anatomical location and macro-regions of Brazil. The number of deaths from oral cavity/base of tongue cancers and lip cancers in Brazil was based on official population counts and estimates. The annual percentage change was calculated based on age-adjusted rates. Data set were analysed using the Joinpoint Regression program. RESULTS: A total of 81,918 individuals died of oral cavity/base of tongue cancers and lip cancer between 1980 and 2018 in Brazil. The age-adjusted mortality rate for women was 0.47 and 0.57 per 100,000 in 1980 and 2018, respectively. The cumulative female mortality rates standardized by age were 0.01/100,000 for lip cancer and 0.5/100,000 for oral cavity and base of tongue cancers. A decrease in deaths related to oral cavity and base of tongue cancers was identified in the 1980s; however, over the last two decades, there has been an increase in the number of deaths of women with cancer at the base of tongue and neighbouring areas and on the floor of mouth. Importantly, Brazilian regions showed wide variability in trends of oral cavity, base of tongue and lip cancers rate and, in 2018, the regions with the highest rates were the Southeast, South and Northeast for both sexes and specifically for women. The North region showed the greatest recent significant upward trend. CONCLUSIONS: During the last 38 years, Brazil has shown a significant increase in the trend of the mortality rate due to oral cavity/base of tongue and lip cancers in women. Preventive strategies with control of risk factors should be strongly emphasized in order to improve the survival rates of individuals with oral cavity/base of tongue and lip cancers.

Social and racial inequity in self-rated oral health in adults in Southern Brazil.

This study aimed to estimate social and racial inequalities in self-rated oral health in adults from the Brazilian birth cohort study. This study belongs to 1982 Pelotas (Brazil) birth cohort study. Data from this study was collected for oral health conditions 31 years old (Oral Health Study). The outcome was self-rated oral health, dichotomized into positive (good/very good) and negative (regular/bad/very bad). Analyses were stratified by gender, racial/skin color groups, schooling level and income. For statistical analysis, the slope index of inequality (SII) and the concentration index (CIX) were used. The prevalence of negative self-rated oral health was 36.1%. Social inequalities were observed in self-rated oral health in both absolute and relative terms. A SII of -30.0 (95%CI: -43.6; -16.4) was observed for income, and -27.7 (95%CI: -41.9; -13.4) for schooling level. Both the individuals' income and the schooling level had negative CIX (CIXincome -14.6 [95%CI: -21.2; -8.0] and CIXschooling level -14.1 [95%CI: -20.7; -7.5]). Furthermore, the prevalence of negative self-rated oral health in black/brown/indigenous individuals from the highest income/schooling level was comparable to prevalence of the outcome in the white individuals belonging to the lowest income/schooling levels. This study results demonstrate racial disparities in oral health regardless of income and schooling levels. Furthermore, a higher concentration of negative self-rated oral health was identified among the most socioeconomically vulnerable individuals. Our findings reinforce the presence of racial and socioeconomic inequalities in oral health.

Medo odontológico e saúde bucal: avaliação transversal do ciclo do medo entre universitários brasileiros / Dental fear and oral health: cross-sectional evaluation of the cycle of dental fear theory among Brazilian undergraduate students

Objetivo: Avaliar a presença do medo odontológico em universitários brasileiros e observar se a teoria do ciclo vicioso do medo é identificada nesta população. Materiais e métodos: Foi realizado um estudo transversal com universitários ingressantes na Universidade Federal de Pelotas em 2016. Os dados sociodemográficos, medo odontológico, o uso de serviços odontológicos, a percepção de cárie e dor dentária foram coletados através de um questionário auto--administrado. A exposição do estudo foi medo odontológico, e os desfechos incluíram padrão de consulta odontológica, experiência de cárie e dor dentária e autopercepção de saúde bucal. Características sociodemográficas foram incluídas como fatores de confusão. Para testar a associação do medo odontológico com os desfechos, foram utilizados modelos de regressão de Poisson com variância robusta, a fim de estimar as Razões de Prevalência e Intervalos de Confiança. Resultados: Foram avaliados 2.014 universitários, dos quais 22.4% reportaram medo odontológico. Aqueles que reportaram medo odontológico apresentaram uma maior prevalência de não terem ido ao dentista no último ano e, entre os que consultaram, a visita ter sido motivada por dor/problema. Adicionalmente, ter medo aumentou a presença de cárie, dor dentária e autorrelato da saúde bucal negativa. Discussão: Os achados sugerem a presença do ciclo vicioso do medo nesta população de universitários do sul do Brasil. Conclusão: Evidenciou-se a associação entre a presença de medo odontológico e a menor procura por atendimento odontológico, a presença de cárie dentária, dor dentária e saúde bucal autorreportada negativa, corroborando com a teoria do ciclo do medo.

Aim: To evaluate the presence of dental fear among Brazilian undergraduate students and to observe whether the cycle of dental fear theory applies to this population. Materials and methods: A cross-sectional study were conducted with first year students of the Federal University of Pelotas, Brazil, in 2016. Sociodemographic data, dental fear, as well as the use of dental services and perception of caries and dental pain were collected through a self-administered questionnaire. The exposure was dental fear, and the outcomes included dental visit pattern, experience of dental caries and dental fear and self-rated oral health (SROH). Sociodemographic characteristics were included as aconfounding factor. To test the association between dental fear and the outcomes, Poisson regression models with robust variance were used, to estimate Prevalence Rations and Confidence Intervals. Results: 2,014 undergraduate students were evaluated and 22.4% of them reported dental fear. Those who reported dental fear had a higher prevalence of not visiting the dentist in the last year and, among those who visited, to have had only a pain/problem-oriented visit. Additionally, having fear increased the presence of dental caries, dental pain and negative SROH. Discussion: Our findings suggest the presence of the vicious cycle of dental fear in this population of undergraduate students in southern Brazil. Conclusion: This study provided evidence on the association between dental fear and the lower frequency of dental visit, dental caries, dental pain experience and negative SROH, corroborating with the cycle of dental fear theory.

Iniquidades socioeconômicas na saúde bucal de estudantes universitários do sul do Brasil / Socioeconomic inequities in the oral health of university students in southern Brazi

Objetivo: Identificar a magnitude da associação entre experiência de cárie dentária e autopercepção negativa de saúde bucal com determinantes socioeconômicos. Métodos: Estudo transversal realizado com dados de uma coorte prospectiva com os universitários ingressantes na Universidade Federal de Pelotas (UFPel) no ano de 2016. Os dados foram coletados por meio de questionário autoaplicável, incluindo características demográficas, socioeconômicas e psicossociais. Os desfechos do presente estudo foram a experiência de cárie autorrelatada (histórico de doença cárie) e autopercepção de saúde bucal (positiva versus negativa). Resultados: Um total de 3.237 alunos ingressou, dos quais 2.089 (64,5%) concordaram em participar do estudo. O modelo de regressão de Poisson mostrou que universitários com renda familiar de R$ 1001,00 a 5000,00 e R$ 5001,00 ou mais apresentaram, respectivamente, uma razão de prevalência (RP) 14% (RP = 0,86; IC95% 0,80-0,92) e 18% (RP = 0,82; IC95% 0,74 a 0,90) menor de experiência de cárie, assim como indivíduos cujas mães tinham ensino médio completo apresentaram uma prevalência 14% menor (RP = 0,86; IC95% 0,80 a 0,92) e ensino superior completo 19% (RP = 0,81; IC95% 0,75 a 0,87) menor de experiência de cárie, quando comparados aos grupos de referência. Na autopercepção de saúde bucal, os resultados para renda familiar de R$1001 a 5000,00 e R$ 5001 ou mais apresentaram, respectivamente, uma prevalência 23% (RP = 0,77; IC95% 0,64 a 0,91) e 43% (RP = 0,57; IC95% 0,45 a 0,72) menor de ter autopercepção de saúde bucal negativa e indivíduos cujas mães tinham ensino superior completo reportaram uma prevalência 21% menor de autopercepção de saúde bucal negativa quando comparados à referência (RP = 0,79; IC95% 0,66 a 0,97). Conclusões: Os achados do presente estudo confirmam que os indicadores socioeconômicos influenciam a experiência de cárie autorrelatada e a autopercepção de saúde bucal dos universitários.

Objective: To identify the magnitude of the association between dental caries experience and negative self-per-ception of oral health with socioeconomic determinants. Methods: Cross-sectional study conducted with data from a prospective cohort with university students entering the Federal University of Pelotas (UFPel) in 2016. Data were collected through a self-administered questionnaire, including demographic, socioeconomic and psychosocial characteristics. The outcomes of the present study were experience of self-reported caries (history of caries disease) and self-perceived oral health (positive versus negative). Results: A total of 3,237 students joined, of which 2,089 (64.5%) agreed to participate in the study. The Poisson regression model known that university students with an income of R$ 1001 to 5000.00 and R$ 5001 or more primary, respectively, a prevalence ratio (PR) 14% (PR = 0,86; 95%CI 0,80-0,92) and 18% (PR = 0,82; 95%CI 0,74 a 0,90) lower of caries experience, as well as individualizing mothers had completed high school prevalence a 14% (PR = 0,86; 95%CI 0,80 a 0,92) lower prevalence and complete higher education 19% (PR = 0,81; 95%CI 0,75 a 0,87) less caries experi-ence when compared to reference groups. In the self-perception of oral health, the results for income of R$ 1001 to 5000.00 and R$ 5001 or more dissipated, respectively, a 23% (PR = 0,77; 95%CI 0,64 a 0,91) and 43% (PR = 0,57; 95%CI 0,45 a 0,72) lower prevalence of having negative self-perception of oral health and qualified originating from complete higher education reported a 23% lower prevalence of negative self-perceived oral health when compared to the reference (PR = 0,79; 95%CI 0,66 a 0,97). Conclusions: The findings of the present study confirm that socioeconomic indicators influence the experience of caries and self-perceived oral health among university students

Estimated prevalence of dental fear in adults: A systematic review and meta-analysis.

OBJECTIVES: To systematically review the literature about: 'What is the global estimated prevalence of dental fear in adults?'. DATA/SOURCES: Inclusion criteria were observational population-based studies reporting the prevalence or raw data of dental fear in adults (>18 years). Five electronic databases (Embase, PubMed, Scopus, Virtual Health Library and Web of Science) were searched without language restrictions up to March 2020. Two researchers independently performed the study selection, data extraction and quality assessment of the included studies. Risk of bias was performed using the Joanna Briggs Critical Appraisal Checklist for Prevalence and Incidence studies. The prevalence pooled estimates of dental fear were calculated using fixed- and random-effect models. Subgroup analyses were performed. STUDY SELECTION: The search strategy identified 4,486 studies. After removal of duplicates (1,722), title and abstract screening (2,764) and full-text reading (108), 31 publications were deemed eligible for this systematic review. Three studies presented low risk of bias and 28 studies presented high risk of bias. A total of 72,577 individuals 18 years of age or older composed the sample of this systematic review. The global estimated prevalence of dental fear and anxiety (DFA), high DFA and severe DFA in adults were 15.3 % (95 %CI 10.2-21.2), 12.4 % (95 %CI 9.5-15.6) and 3.3 % (95 %CI 0.9-7.1), respectively. Subgroup analyses showed a higher prevalence of DFA, high DFA and severe DFA among women and younger adults. The instruments used to measure dental fear also affected its prevalence. CONCLUSIONS: Dental fear and high dental fear are prevalent in adults worldwide, being more prevalent among women. CLINICAL SIGNIFICANCE: Evidence suggests fear negatively impacts dental care pattern, clinical and subjective oral health conditions. A better knowledge of the global prevalence and the factors associated with this problem will allow that prevention or even behavior modulation strategies of the fearful individual's in dental setting being carried out.

The impact of gender on scientific writing: An observational study of grant proposals.

OBJECTIVES: This study aimed to determine whether there are differences in the language used in grant applications submitted to a Southern Brazil Research Support Foundation (FAPERGS) according to the gender, career stage, and the number of publications of applicants. STUDY DESIGN AND SETTING: This observational study also evaluated the relationship between gender, career stage, curriculum, and writing characteristics. Summaries of all research proposals in the biomedical field of FAPERGS during the years of 2013 and 2014 were evaluated according to six language patterns (Positive emotions, Negative emotions, Analytic thinking, Clout, Authenticity, and Emotional tone) defined by the LIWC software. Applicant's gender, career stage, and the number of publications were also collected. RESULTS: Three hundred and forty-four (344) grant proposals met the inclusion criteria and were included in the analysis. No statistical differences were observed in the language pattern used by different gender applicants. In the language used by successful and unsuccessful applicants, we only found a small difference for clout (score 54.5 for not funded and 56.5 for funded grants). However, the principal investigators of successful applications had a significantly higher number of papers published (mean number of papers: 104 versus 58.5). CONCLUSIONS: Gender bias appears to be a more complex problem than just the type of language used; the way society is organized causes several gender biases that may be reflected throughout the women's career.

Prevention and Management of Dental Trauma in Primary Teeth in the Context of the COVID-19: A Critical Literature Review

ABSTRACT Objective: To evaluate and discuss the prevention and management of dental trauma in primary teeth during the COVID-19 pandemic. Material and Methods: Critic literature review, searching electronic databases and Google for articles and guidelines published in English that described prevention and management of dental trauma in primary dentition during the pandemic of COVID-19. Results: 5 publications regarding management and 1 leaflet about prevention for parents were identified. Urgent care is required when the child presents tooth fracture resulting in pain or causing soft tissue trauma and luxation affecting bite. Avulsed teeth should not be replanted and advice and self-help may be sufficient in some situations. Instructions about soft diet and hygiene must be provided. Remote consults are recommended for non-urgent situations and during follow-up to evaluate the presence of sequelae. Aerosol generating procedures should be avoided and, in cases of poor prognosis, extraction is recommended to prevent recurring visits to the dental office. Conclusion: During COVID-19 pandemic, remote consults should be recommended to evaluate traumatic dental injuries in primary dentition. Follow-up should not be neglected and may be performed through remote consultation.

Regular use of dental services among university students in southern Brazil.

OBJECTIVE To verify the prevalence and factors associated with regular use of dental services in university students of the Universidade Federal de Pelotas (UFPel). METHODS This cross-sectional study interviewed 1,865 students aged 18 years or older, starting bachelor's degrees in 2017, enrolled in the second academic semester of 2017 and in the first of 2018 in classroom courses at UFPel. We considered regular users those who reported regularly going to the dentist with or without perceived dental problems. To test factors associated with regular use of dental services, demographic, socioeconomic and oral health variables were collected. Statistical analyses were based on Poisson regression models. RESULTS The prevalence of regular use of dental services was 45.0% (95%CI 42.7-47.3). University students of high economic class (PR = 1.47; 95%CI 0.91-2.36), with last private dental appointment (PR = 1.29; 95%CI 1.03-1.61), positive self-perception of oral health (PR = 2.33; 95%CI 1.79-3.03) and no report of toothache in the last six months (PR = 1.22; 95%CI 1.03-1.45) showed higher prevalence of regular use of dental services. CONCLUSION The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life among these young adults.

Regular use of dental services among university students in southern Brazil / Uso regular de serviços odontológicos entre alunos de uma universidade do sul do Brasil

ABSTRACT OBJECTIVE To verify the prevalence and factors associated with regular use of dental services in university students of the Universidade Federal de Pelotas (UFPel). METHODS This cross-sectional study interviewed 1,865 students aged 18 years or older, starting bachelor's degrees in 2017, enrolled in the second academic semester of 2017 and in the first of 2018 in classroom courses at UFPel. We considered regular users those who reported regularly going to the dentist with or without perceived dental problems. To test factors associated with regular use of dental services, demographic, socioeconomic and oral health variables were collected. Statistical analyses were based on Poisson regression models. RESULTS The prevalence of regular use of dental services was 45.0% (95%CI 42.7-47.3). University students of high economic class (PR = 1.47; 95%CI 0.91-2.36), with last private dental appointment (PR = 1.29; 95%CI 1.03-1.61), positive self-perception of oral health (PR = 2.33; 95%CI 1.79-3.03) and no report of toothache in the last six months (PR = 1.22; 95%CI 1.03-1.45) showed higher prevalence of regular use of dental services. CONCLUSION The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life among these young adults.

RESUMO OBJETIVO Verificar a prevalência e os fatores associados ao uso regular de serviços odontológicos em acadêmicos da Universidade Federal de Pelotas (UFPel). MÉTODOS Este estudo transversal entrevistou 1.865 estudantes de 18 anos ou mais de idade, ingressantes em 2017, matriculados no segundo semestre letivo de 2017 e no primeiro de 2018 em cursos presenciais da UFPel. Consideraram-se usuários regulares os indivíduos que relataram ir regularmente ao dentista com ou sem problemas dentários percebidos. A fim de testar fatores associados ao uso regular de serviços odontológicos, foram coletadas variáveis demográficas, socioeconômicas e de saúde bucal. As análises estatísticas foram baseadas em modelos de regressão de Poisson. RESULTADOS A prevalência de uso regular de serviços odontológicos foi de 45,0% (IC95% 42,7-47,3). Os universitários de classe econômica elevada (RP = 1,47; IC95% 0,91-2,36), com última consulta odontológica particular (RP = 1,29; IC95% 1,03-1,61), autopercepção positiva da saúde bucal (RP = 2,33; IC95% 1,79-3,03) e sem relato de dor de dente nos últimos seis meses (RP = 1,22; IC95% 1,03-1,45) apresentaram maiores prevalências de uso regular dos serviços odontológicos. CONCLUSÃO Os resultados apontam para desigualdades no uso regular dos serviços odontológicos relacionadas a fatores socioeconômicos e um menor uso entre os universitários com piores condições de saúde bucal. Esses resultados sugerem que políticas públicas de prevenção e promoção em saúde em instituições de ensino superior devem ser realizadas para garantir qualidade de vida entre esses jovens.

Parent-child interaction and stimulation in early life can be related to caries in primary dentition? Hypotheses from a life-course approach.

Dental caries has common risk factors with impairments in growth, cognitive development and child general health. Identifying socioeconomic contexts and parental behaviors in early life that may be associated with negative outcomes in the child's future and their causal mechanisms can contribute to planning early interventions. Therefore, the aim of this paper is to propose and discuss possible ways to explain how early childhood stimulation may be associated with future oral health status, based on the life-course theory of chain-of-risk model and accumulation of risk model. Two hypotheses were suggested: (1) each social exposure or parental behavior in the child's first years of life increase the risk of chronic diseases, such as dental caries in primary dentition, in a simply additive effect; (2) parental factors could negatively influence the establishment of the pattern of child stimulation (child care) or lead to a modification of the established behavior on the risk of dental caries in the child primary dentition. Prevention of dental caries seems to be the most feasible way of solving this serious public health problem. It therefore justifies the importance of identifying exposures in the child's early life that may lead to the occurrence of chronic diseases in the future. The evidence seem to converge to the idea that child stimulation in early life may be associated with future health problems related to behaviors and care by parents, including caries.

The Controlled Direct Effect of Early-Life Socioeconomic Position on Periodontitis in a Birth Cohort.

This study used data from the 1982 Pelotas Birth Cohort Study, Brazil, to estimate the controlled direct effect of early-life socioeconomic position (SEP) on periodontitis at age 31 years, controlling for adulthood income and education, smoking, and dental hygiene. Sex was included as a covariate. Early-life SEP was measured at participant birth based on income, health services payment mode, maternal education, height, and skin color (lower versus middle/higher SEP). Periodontitis was assessed through clinical examination at age 31 years (healthy, mild periodontitis, or moderate-to-severe disease). Adulthood behaviors (smoking, dental hygiene) were the mediators, and adulthood SEP (education and income) represented the exposure-induced mediator-outcome confounders. A regression-based approach was used to assess the controlled direct effect of early-life SEP on periodontitis. Multinomial regression models were used to estimate risk ratios and their 95% confidence intervals. The prevalences of mild and moderate-to-severe periodontitis were 23.0% and 14.3%, respectively (n = 539). Individuals from the lowest early-life SEP had a higher risk of moderate-to-severe periodontitis controlled for mediators and exposure-induced mediator-outcome confounders: risk ratio = 1.85 (95% confidence interval: 1.06, 3.24), E value 3.1. We found that early-life SEP was associated with the development of periodontitis in adulthood that was not mediated by adulthood SEP and behaviors.

The role of contextual and individual factors on periodontal disease in Uruguayan adults.

The present study aimed at understanding the relationship between periodontitis and socio-contextual and individual determinants of health. Data from "The First Uruguayan Oral Health Survey, 2011", which included 223 and 455 individuals with 35-44 and 65-74 years old respectively, were used. A stratified, multistage cluster sampling design was adopted (cities with ≥ 20.000 residents). Periodontitis was assessed using the modified Community Periodontal Index (CPI) and clinical attachment loss (CAL) (periodontal pocket and CAL ≥ 4 mm). Independent variables included contextual socioeconomic status (SES) measured by proportion of houses with Unsatisfied Basic Needs (UBN) and individual demographic and behavioral factors. Logistic regression multilevel models were generated. Living in contexts with a higher UBN was associated with higher odds for periodontitis in both age groups, even when adjusting for individual level variables (odds ratio [OR] = 1.51, 95%CI = 1.42-1.60 and 1.31, 95%CI = 1.21-1.42, respectively). Being male or heavy smoker increased the odds of periodontitis in this population for both age groups. Social structure impacts periodontal disease by modifying individual socioeconomic situations: in better socioeconomic context, UBN acts increasing the protector role of socioeconomic situation but in a poverty context the role is attenuated. Conclusions for this study are that periodontitis varies across contextual socio-demographic groups being higher in the population with a lower SES, challenging health authorities to integrate oral health into national non-communicable diseases programs.

The role of contextual and individual factors on periodontal disease in Uruguayan adults

Abstract The present study aimed at understanding the relationship between periodontitis and socio-contextual and individual determinants of health. Data from "The First Uruguayan Oral Health Survey, 2011", which included 223 and 455 individuals with 35-44 and 65-74 years old respectively, were used. A stratified, multistage cluster sampling design was adopted (cities with ≥ 20.000 residents). Periodontitis was assessed using the modified Community Periodontal Index (CPI) and clinical attachment loss (CAL) (periodontal pocket and CAL ≥ 4 mm). Independent variables included contextual socioeconomic status (SES) measured by proportion of houses with Unsatisfied Basic Needs (UBN) and individual demographic and behavioral factors. Logistic regression multilevel models were generated. Living in contexts with a higher UBN was associated with higher odds for periodontitis in both age groups, even when adjusting for individual level variables (odds ratio [OR] = 1.51, 95%CI = 1.42-1.60 and 1.31, 95%CI = 1.21-1.42, respectively). Being male or heavy smoker increased the odds of periodontitis in this population for both age groups. Social structure impacts periodontal disease by modifying individual socioeconomic situations: in better socioeconomic context, UBN acts increasing the protector role of socioeconomic situation but in a poverty context the role is attenuated. Conclusions for this study are that periodontitis varies across contextual socio-demographic groups being higher in the population with a lower SES, challenging health authorities to integrate oral health into national non-communicable diseases programs.