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

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

Early Introduction of Total Sugar Foods and Early Childhood Caries.

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

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

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

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

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

Cárie na primeira infância, má oclusão, fatores psicossociais e qualidade de vida relacionada à saúde bucal de crianças e suas famílias / Early childhood caries, malocclusion, psychosocial factors and oral health-related quality of life in children and their families

Cárie na primeira infância (CPI) e má oclusão podem afetar a qualidade de vida relacionada à saúde bucal (QVRSB) de crianças e suas famílias. Fatores psicossociais relacionados às crianças, suas famílias e comunidade na qual estão inseridas devem ser estudados. Diante disso, os objetivos desta tese foram: 1) verificar a associação entre fatores psicossociais associados à CPI e à QVRSB em pré-escolares e suas famílias (Artigo 1); 2) avaliar o impacto da mordida aberta anterior (MAA) e da mordida profunda (MP) na QVRSB de préescolares, e verificar o papel da resiliência parental como um fator moderador nessa associação (Artigo 2). Foi realizado um estudo transversal representativo com pré-escolares de 4-6 anos de idade e seus pais/responsáveis em Ribeirão das Neves, MG, Brasil. Os pais/responsáveis responderam às versões brasileiras do Early Childhood Oral Health Impact Scale (ECOHIS) e Escala de Resiliência, e um questionário com dados socioeconômicos e de comportamento de saúde bucal da criança. Os pré-escolares foram examinados por duas dentistas treinadas e calibradas para o diagnóstico de CPI e consequências pulpares de lesões cariosas não tratadas (Kappa>0,95), utilizando-se a versão epidemiológica do International Caries Detection and Assessment System (ICDASepi) combinado com o índice pufa e, assim categorizados: sem cárie, estágio inicial (opacidade notável/pigmentação retida em fundo de fóssulas e fissuras), estágio moderado (cavitação em esmalte/sombreamento em dentina subjacente), estágio extenso sem consequências pulpares (cavitação com exposição dentinária) e estágio extenso com consequências pulpares (cavitação com exposição dentinária, com envolvimento pulpar e/ou presença de fístulas/abscessos). A presença de MAA e MP foi avaliada através do índice de Foster e Hamilton. Os dados foram analisados por meio da modelagem por equações estruturais, utilizando-se o software Mplus, versão 8.6 (Artigo 1) e por meio da análise de moderação, utilizando-se o PROCESS (PROCESS for SPSS, version 3.4) (Artigo 2). Os resultados do artigo 1 demonstraram que menor status socioeconômico (ß =-0,250; p<0,001) e maior frequência de consumo de açúcares livres (ß=0,122; p=0,033) foram associados diretamente com estágio extenso de cárie com consequência pulpar, enquanto menor resiliência dos pais impactou indiretamente estágios mais avançados da CPI, por meio da variável frequência de consumo de açúcares livres (ß =-0,089; p=0,048). Além disso, CPI foi associada com piores escores tanto da QVRSB da criança (b=0,587; p<0,001) quanto da família (ß =0,506; p<0,001). Os resultados do artigo 2 demonstraram que préescolares filhos de pais com baixa resiliência, e que possuíam MAA apresentaram impacto negativo na QVRSB (ß:3,95;p=0,025) em comparação àqueles que apresentaram oclusão normal. A resiliência parental não atuou como fator moderador na associação entre MP e QVRSB (p>0,05). Conclui-se que quanto maior a gravidade da CPI, maior o impacto negativo na QVRSB de pré-escolares e suas famílias. Os principais fatores associados à CPI mais grave foram menor nível socioeconômico, maior frequência de consumo de açúcar livre e menor resiliência parental (Artigo 1). MAA interferiu negativamente na QVRSB dos pré-escolares, sendo essa associação mais forte quando a resiliência parental era baixa. Portanto, a resiliência dos pais atuou como fator moderador na relação entre MAA e QVRSB (Artigo 2).

Early childhood caries (ECC) and malocclusion can affect the oral health-related quality of life (OHRQoL) of children and families. Psychosocial factors related to children, their families and the community in which they are inserted must be studied. Therefore, the objectives of this thesis were: 1) to verify the association between psychosocial factors with ECC and OHRQoL in preschoolers and their families (Manuscript #1); 2) to evaluate the impact of anterior open bite (AOB) and deep bite (DB) on the OHRQoL of preschool children and the role of parental resilience as a moderating factor in such association (Manuscript #2). A representative crosssectional study was carried out with 4-to-6-year-old preschoolers and their parents/caregivers from Ribeirão das Neves, MG, Brazil. Parents/caregivers selfadministered the Brazilian versions of the Early Childhood Oral Health Impact Scale (ECOHIS) and the Resilience Scale, as well as a questionnaire about socioeconomic and child's oral health behavior data. Preschoolers were examined by two trained and calibrated dentists for the diagnosis of ECC and pulpal consequences of untreated carious lesions (Kappa>0.95), using the epidemiological version of the International Caries Detection and Assessment System (ICDASepi) index combined with the pufa index: no caries, early stage (notable opacity/retained pigmentation in the background of pits and fissures), moderate stage (cavitation in enamel/shading in underlying dentin), extensive stage without pulpal consequences (cavitation with dentin exposure) and extensive stage with pulpal consequences (cavitation with dentin exposure, and pulp involvement and/or fistulas/abscesses). The presence of AOB and DB were evaluated using the Foster and Hamilton index. Data were analysed through Structural Equation Model (SEM), using the Mplus software, version 8.6 (Manuscript #1) and through moderation analysis, using PROCESS (PROCESS for SPSS, version 3.4) (Manuscript #2). The results of the Manuscript #1 demonstrated that lower socioeconomic status (b=-0.250; p<0.001) and higher frequency of consumption of free sugars (ß=0.122; p=0.033) were directly associated with an extensive stage of caries with pulpal consequences, while lower parental resilience indirectly impacted more advanced stages of ECC, through the variable frequency of consumption of free sugars (b=-0.089; p=0.048). In addition, ECC was associated with worse scores in both the child's (ß=0.587; p<0.001) and the family's (ß=0.506; p<0.001) OHRQoL. The results of the Manuscript #2 demonstrated that preschoolers whose parents presented low resilience, and preschoolers who presented OAB, had a negative impact on OHRQoL (ß:3.95; p=0.025) compared to those who had normal occlusion. Parental resilience did not act as a moderating factor in the association between DB and OHRQoL (p>0.005). It is concluded that the severity of ECC negatively impacted the OHRQoL of preschoolers and their families, and the main factors associated with the severity of ECC were lower socioeconomic status, higher frequency of free sugar consumption and lower parental resilience (Manuscript #1). OAB negatively interfered with the OHRQoL of preschoolers, with this association being stronger when parental resilience was low. Therefore, parental resilience acted as a moderating factor in the relationship between OAB and OHRQoL (Manuscript # 2).

Cárie dentária em molares decíduos, doenças comuns na infância e condição socioeconômica: estudo representativo de escolares brasileiros / Dental caries in deciduous molars, common childhood diseases and socioeconomic status: a representative study of brazilian schoolchildren

Objetivo: verificar a experiência de cárie em molares decíduos e a sua associação com doenças comuns na infância, uso de medicamentos, condições socioeconômicas. Materiais e Métodos: foi realizado um estudo transversal representativo com uma amostra de 1181 crianças entre 8 e 9 anos, de ambos os sexos. O exame clínico foi realizado em ambiente escolar por uma dentista calibrada para diagnóstico de cárie dentária através do índice de dentes cariados, extraídos ou com extração indicada e obturados (Índice ceo-d). Os responsáveis responderam questionários sobre a história médica da criança e condições socioeconômicas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa Local. Os dados foram analisados através da Regressão de Poisson, sendo que as variáveis com p<0,20 foram introduzidas em um modelo multivariado e hierárquico (p<0,05). Razão de Prevalência (RP) e Intervalo de Confiança (IC) de 95% foram calculados. Resultados: a maioria das crianças apresenta cárie em molares decíduos (54,6%). Doenças comuns na infância e uso medicamentos não apresentaram associação estatisticamente significativa com cárie dentária (p>0,05). Estudantes de escolas públicas tiveram uma prevalência 27% maior de (IC95%=1,05-1,59) experiência de cárie em molares decíduos quando comparados aos estudantes de escolas particulares. Menor escolaridade materna também se mostrou associada à experiência de cárie em molares decíduos, sendo que crianças cujas mães tinham até 4 anos de estudo tinham uma prevalência 60% maior de cárie dentária (IC95%:1,19-2,16). Conclusão: a maioria das crianças apresentou experiência de cárie em molares decíduos, mas esta condição não foi associada com doenças e medicamentos utilizados até os 4 anos de idade. Entretanto, crianças de escola pública e cujas mães possuíam menor escolaridade apresentaram maior experiência de cárie.

Objective: to verify the caries experience in deciduous molars and its association with common childhood diseases, medication use, socioeconomic conditions. Materials and Methods: a representative cross-sectional study was carried out with a sample of 1181 children between 8 and 9 years old, of both sexes. The clinical examination was performed in a school environment by a dentist calibrated for the diagnosis of dental caries through the index of decayed teeth, extracted or with the indicated and filled samples (ceo-d index). Those responsible for the child answered about the child's medical history and socioeconomic conditions. The project was approved by the Research Ethics Committee Local. The data were analyzed using an analysis model, and as p<0.20, varied with variables were evaluated in a model and hierarchical. Prevalence Ratio (PR) and 95% Confidence Interval (CI) were calculations. Results: 54.6% of the children had caries experience in the deciduous molars. Common childhood diseases and medication use were not significantly associated with dental caries (p>0.05). Public school students had a prevalence of 27% of students (95%CI=1.05-1.59) of caries experience in deciduous molars when compared to school students. Lower maternal schooling was also associated with caries experience in deciduous molars, with mothers with up to 4 years of schooling having a 60% higher probability of having children with dental caries (95%CI:1.19-2.16). Conclusion: most children had caries experience in deciduous molars, but it was not associated with diseases and medications used between 0 and 4 years old. However, school children and whose mothers had less schooling had a greater experience of caries.

Impact on oral health-quality of life in infants: Multicenter study in Latin American countries.

To assess the impact of oral conditions on oral health-related quality of life (OHRQoL) in infants in ten Latin America countries (LAC). A cross-sectional study was conducted with 930 pairs of 1-to-3-year-old children/parents from 10 LAC, as a complementary study of the Research Observatory for Dental Caries of the Latin American Region. The scale ECOHIS, previously tested and valid in ten countries, was applied to parents/caregivers of children to measure OHRQoL. Statistical analysis included descriptive data analysis and one-way analysis of variance (ANOVA-One-Way) were performed to compare age groups with OHRQoL. Bootstrapping procedures (1000 re-samplings; 95%CI Bca) were performed. The mean scores of the 'Child Impact' section in the LAC was 4.0(±8.3), in the 'Family Impact' section was 2.0(±4.0), and in overall ECOHIS score was 6.0(±12.0). In the 'Child Impact' section, Argentina 10.0(+2.4) and Venezuela 17.8(±17.5) demonstrated mean scores higher than the LAC total data. In the 'Family Impact' section, the countries with higher mean scores were Argentina 4.9(±2.0), Ecuador 2.1(±3.1) and Venezuela 7.9(±7.8). In the overall ECOHIS score, Argentina 15.1 (±4.1) and Venezuela 25.7(±25.2) has higher mean scores than the values of LAC. There is an association between children's age and parents' report of impact on the OHRQoL (p<0.001). Three-year-olds had a higher mean when compared to one- and two-year-olds, both in the Impact on the Child and Impact on the Family (p<0.001) sections, as well as in the overall ECOHIS (p<0.001). In conclusion, there are differences in OHRQoL among Latin American countries, impacting older children more significantly.

Impact on oral health-quality of life in infants: Multicenter study in Latin American countries

Abstract To assess the impact of oral conditions on oral health-related quality of life (OHRQoL) in infants in ten Latin America countries (LAC). A cross-sectional study was conducted with 930 pairs of 1-to-3-year-old children/parents from 10 LAC, as a complementary study of the Research Observatory for Dental Caries of the Latin American Region. The scale ECOHIS, previously tested and valid in ten countries, was applied to parents/caregivers of children to measure OHRQoL. Statistical analysis included descriptive data analysis and one-way analysis of variance (ANOVA-One-Way) were performed to compare age groups with OHRQoL. Bootstrapping procedures (1000 re-samplings; 95%CI Bca) were performed. The mean scores of the 'Child Impact' section in the LAC was 4.0(±8.3), in the 'Family Impact' section was 2.0(±4.0), and in overall ECOHIS score was 6.0(±12.0). In the 'Child Impact' section, Argentina 10.0(+2.4) and Venezuela 17.8(±17.5) demonstrated mean scores higher than the LAC total data. In the 'Family Impact' section, the countries with higher mean scores were Argentina 4.9(±2.0), Ecuador 2.1(±3.1) and Venezuela 7.9(±7.8). In the overall ECOHIS score, Argentina 15.1 (±4.1) and Venezuela 25.7(±25.2) has higher mean scores than the values of LAC. There is an association between children's age and parents' report of impact on the OHRQoL (p<0.001). Three-year-olds had a higher mean when compared to one- and two-year-olds, both in the Impact on the Child and Impact on the Family (p<0.001) sections, as well as in the overall ECOHIS (p<0.001). In conclusion, there are differences in OHRQoL among Latin American countries, impacting older children more significantly.

Resumo Avaliar o impacto das condições bucais na qualidade de vida relacionada à saúde bucal (QVRSB) em crianças de dez países da América Latina (AL). Foi realizado um estudo transversal com 930 pares de crianças/pais de 1 a 3 anos de 10 países da AL, como estudo complementar do Research Observatory for Dental Caries of the Latin American Region. A escala ECOHIS, previamente testada e validada em dez países, foi aplicada a pais/cuidadores de crianças para mensurar a QVRSB. A análise estatística incluiu análise descritiva de dados e análise de variância unidirecional (ANOVA-One-Way) para comparar grupos etários com QVRSB. Procedimentos de bootstrapping (1000 reamostragens; 95%IC Bca) foram realizados. A pontuação média da seção 'Impacto na Criança' na AL foi 4,0 (±8,3), na seção 'Impacto na Família' foi 2,0 (±4,0) e no escore total do ECOHIS foi 6,0 (±12,0). Na seção 'Impacto na Criança', Argentina 10,0(+2,4) e Venezuela 17,8(±17,5) demonstraram pontuações médias superiores aos dados totais da AL. Na seção 'Impacto na Família', os países com pontuações médias mais altas foram Argentina 4,9(±2,0), Equador 2,1(±3,1) e Venezuela 7,9(±7,8). No escore total do ECOHIS, Argentina 15,1 (±4,1) e Venezuela 25,7(±25,2) apresentaram escores médios superiores aos valores de AL. Houve associação entre a idade das crianças e o relato dos pais de impacto na QVRSB (p<0,001). As crianças de três anos tiveram média maior quando comparadas às de um e dois anos, tanto nas seções 'Impacto na Criança' e 'Impacto na Família' (p<0,001), quanto no escore total ECOHIS (p<0,001). Em conclusão, houveram diferenças na QVRSB entre os países da América Latina, impactando de forma mais significativa as crianças mais velhas.

Adolescents' and Parents' Perspective on Impact of Dental Caries and Malocclusion on Quality of Life.

Purpose: To evaluate the impact of malocclusion and dental caries on oral health- related quality of life (OHRQoL) in adolescents and the differences between adoles- cents' self-reports and caregiver's proxy reports. Methods: A population-based cross-sectional study was conducted with 1,612 Brazil- ian adolescents and 1,168 caregivers. Adolescents completed the Child Perceptions Questionnaire and caregivers completed the Parental-Caregiver Perceptions Question- naire. Malocclusion (dental esthetic index) and dental caries (DMFT) were documented. Multiple Poisson regression was conducted. Results: A self-reported model demonstrated that adolescents with malocclusion had an impact on emotional (PR=1.14; 95 percent confidence interval [95% CI=1.03 to 1.26) and social domains (PR=1.35; 95% CI=1.20 to 1.50). Dental caries had an impact on the emotional domain (prevalence ratio [PR]=1.34; 95% CI=1.21 to 1.48). The caregiver model showed that malocclusion had an impact on oral symptoms (PR=1.12; 95% CI=1.03 to 1.21), functional limitations (PR=1.18; 95% CI= 1.05 to 1.33), and emotional (PR=1.23; 95% CI=1.10 to 1.54) and social domains (PR=1.22; 95% CI=1.02 to 1.45). Those with dental caries felt an impact on oral symptoms (PR=1.09; 95% CI=1.01 to 1.19), functional limitations (PR=1.18; 95% CI=1.05 to 1.33) and social domains (PR=1.24; 95% CI=1.04 to 1.45). Conclusions: Adolescents reported a negative impact on OHRQoL both in relation to dental caries and malocclusion. Caregivers observed the impact of oral conditions on more domains than the adolescents reported.

Impact of Oral Health Literacy on the Clinical Consequences of Untreated Dental Caries in Preschool Children.

Purpose: To evaluate the association between parental oral health literacy (OHL) and untreated early childhood caries and its clinical consequences in children. Methods: Population-based, cross-sectional study was conducted with 449 parent-preschooler dyads (four-to-six-year-olds) in Ribeirão das Neves, Minas Gerais, Brazil. Parents answered a socioeconomic questionnaire and the Brazilian version of the Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P), which measures parental OHL in pediatric dentistry. Preschoolers were examined by two calibrated dentists for the diagnosis of caries (ICDASepi-merged) and its clinical consequences: visible pulp; oral mucosa ulceration due to root fragments; fistula; and abscess (pufa). Data were submitted to univariable and multivariable logistic regression analyses (P<0.05). Results: A multivariable model that adjusted for socioeconomic status showed that parental OHL was not associated with untreated dental caries (P=0.618). Parents with lower OHL had a greater odds of having children with at least one clinical consequence of untreated dental caries (odds ratio equals 0.94; 95 percent confidence interval equals 0.89 to 0.98) than parents with higher OHL. Conclusions: Low parental OHL appears to impact the occurrence of at least one clinical consequence of untreated dental caries in children but not in the simple presence of untreated dental caries.

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

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

Traumatismo dentário na dentição decídua e condição socioeconômica: uma revisão crítica da literatura / Traumatic dental injury in primary teeth and socioeconomic factors: a critical literature review

Objetivo: Verificar a associação entre a condição socioeconômica e o traumatismo dentário em crianças na dentição decídua. Métodos: Foi realizada uma busca bibliográfica na base de dados PubMed, seguindo uma estratégia de combinação de palavras-chave. Não houve restrição em relação ao ano de publicação, tipo de estudo e o local em que foi realizado. A seleção dos estudos foi realizada em duas etapas: através do processo de leitura dos títulos e resumos, e em seguida, por meio da obtenção e leitura dos artigos completos selecionados. Resultados: De um total de 94 artigos encontrados, 16 foram selecionados para a revisão de literatura. Desses, 13 preencheram todos os critérios metodológicos analisados. A maioria dos estudos foram realizados no Brasil. A idade das crianças não ultrapassou os seis anos. Associações estatisticamente significantes entre a prevalência do traumatismo dentário na dentição decídua e condição socioeconômica foram encontradas em quatro artigos. Conclusão: A maioria dos estudos não encontrou associação entre o traumatismo dentário na dentição decídua com a condição socioeconômica.

Aim: To verify the association between socioeconomic factors and traumatic dental injuries in preschool children in primary dentitions. Methods: A bibliographic search was made in the PubMed electronic database, following a keyword combination strategy. There were no restrictions regarding the year of publication, type of study, and place where it was performed. The selection of the studies was achieved in two steps: through the process of reading the titles and abstracts and by obtaining and reading the complete selected articles. Results: From the 94 articles that were found, 16 were eligible for inclusion in the literature review. Of these, 13 articles met all of the proposed methodology criteria. Most of the studies were conducted in Brazil. The age of the children did not exceed 6 years. Statistically significant associations between the prevalence of traumatic dental injury in the primary dentition and socioeconomic factors were found in 4 articles. Conclusion:The majority of studies found no association between dental trauma in primary dentition and socioeconomic status.

Malocclusion and social vulnerability: a representative study with adolescents from Belo Horizonte, Brazil. / Má oclusão e vulnerabilidade social: estudo representativo de adolescentes de Belo Horizonte, Brasil.

Malocclusion is public health problem because of its high prevalence, treatment possibility, and impact on the individual's quality of life. This article aims to determining the prevalence of malocclusion in adolescents and to test its association with social vulnerability. A representative transversal study was performed with 1612 adolescents aged between 11 and 14 years old who came from public and private schools in Belo Horizonte, Brazil. The adolescents were examined by three calibrated examiners for diagnosis of malocclusion, using the Dental Aesthetic Index. The Social Vulnerability Index from Belo Horizonte was used to determine the degree of social vulnerability from adolescents. The data were analyzed using Poisson regression with robust variance (p<0,05). Most adolescents presented absence/minor malocclusion (68.7%). Dental crowding was diagnosed in 51.9% from the sample, diastema in 23.7%, anterior open bite in 7.6 %. Malocclusion was associated with social vulnerability (PR=1.25;95% CI=1.01-1.55). Dental crowding was the most prevalent type of malocclusion. The more socially vulnerable adolescents had worse indicators of malocclusion.

A má oclusão é um problema de saúde pública devido à alta prevalência, possibilidade de tratamento e por interferir na qualidade de vida dos indivíduos. O objetivo deste artigo é determinar a prevalência da má oclusão em adolescentes e testar sua associação com indicador de vulnerabilidade social. Foi realizado um estudo transversal representativo com 1.612 adolescentes, entre 11 e 14 anos de idade, de escolas públicas e privadas de Belo Horizonte, Brasil. Os adolescentes foram avaliados por três examinadores calibrados para o diagnóstico de má oclusão, utilizando o Índice Estético Dental. O Índice de Vulnerabilidade Social de Belo Horizonte foi utilizado para determinar o grau de vulnerabilidade social dos adolescentes. Os dados foram analisados através da regressão de Poisson com variância robusta (p < 0,05). A maioria dos adolescentes apresentou má oclusão ausente/leve (68,7%). Diagnosticou-se apinhamento dentário em 51,9% da amostra, diastema em 23,7%, mordida aberta anterior em 7,6 %. A má oclusão mostrou-se associada à vulnerabilidade social (RP = 1,25;95% IC = 1,01-1,55). O apinhamento dentário foi o tipo de má oclusão mais prevalente. Os adolescentes mais vulneráveis socialmente apresentaram piores indicadores de má oclusão.

Má oclusão e vulnerabilidade social: estudo representativo de adolescentes de Belo Horizonte, Brasil / Malocclusion and social vulnerability: a representative study with adolescents from Belo Horizonte, Brazil

Resumo A má oclusão é um problema de saúde pública devido à alta prevalência, possibilidade de tratamento e por interferir na qualidade de vida dos indivíduos. O objetivo deste artigo é determinar a prevalência da má oclusão em adolescentes e testar sua associação com indicador de vulnerabilidade social. Foi realizado um estudo transversal representativo com 1.612 adolescentes, entre 11 e 14 anos de idade, de escolas públicas e privadas de Belo Horizonte, Brasil. Os adolescentes foram avaliados por três examinadores calibrados para o diagnóstico de má oclusão, utilizando o Índice Estético Dental. O Índice de Vulnerabilidade Social de Belo Horizonte foi utilizado para determinar o grau de vulnerabilidade social dos adolescentes. Os dados foram analisados através da regressão de Poisson com variância robusta (p < 0,05). A maioria dos adolescentes apresentou má oclusão ausente/leve (68,7%). Diagnosticou-se apinhamento dentário em 51,9% da amostra, diastema em 23,7%, mordida aberta anterior em 7,6 %. A má oclusão mostrou-se associada à vulnerabilidade social (RP = 1,25;95% IC = 1,01-1,55). O apinhamento dentário foi o tipo de má oclusão mais prevalente. Os adolescentes mais vulneráveis socialmente apresentaram piores indicadores de má oclusão.

Abstract Malocclusion is public health problem because of its high prevalence, treatment possibility, and impact on the individual's quality of life. This article aims to determining the prevalence of malocclusion in adolescents and to test its association with social vulnerability. A representative transversal study was performed with 1612 adolescents aged between 11 and 14 years old who came from public and private schools in Belo Horizonte, Brazil. The adolescents were examined by three calibrated examiners for diagnosis of malocclusion, using the Dental Aesthetic Index. The Social Vulnerability Index from Belo Horizonte was used to determine the degree of social vulnerability from adolescents. The data were analyzed using Poisson regression with robust variance (p<0,05). Most adolescents presented absence/minor malocclusion (68.7%). Dental crowding was diagnosed in 51.9% from the sample, diastema in 23.7%, anterior open bite in 7.6 %. Malocclusion was associated with social vulnerability (PR=1.25;95% CI=1.01-1.55). Dental crowding was the most prevalent type of malocclusion. The more socially vulnerable adolescents had worse indicators of malocclusion.

A resiliência dos pais afeta o impacto da cárie dentária e suas consequências pulpares na qualidade de vida de pré-escolares? / Does parental resilience affect the impact of dental caries and their pulprelated consequences for the quality of life of preschool children?

A cárie dentária é a condição bucal que mais afeta a qualidade de vida de crianças préescolares e sua presença pode trazer consequências pulpares, como envolvimento pulpar, fístulas e abscessos. Estes, por sua vez, podem ser mais prejudiciais para a saúde e bemestar da criança do que as próprias lesões cariosas. Dessa forma, é importante explorar resultados de saúde bucal utilizando um quadro mais amplo com a inclusão de fatores contextuais e, dentre estes fatores, está a resiliência. Esta, por sua vez, pode alterar a atitude dos pais/responsáveis, sendo que isto pode influenciar a saúde bucal e a percepção do seu impacto na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) de seus filhos. Observa-se que não há, na literatura, estudos que testam se a resiliência dos pais e/ou responsáveis afeta a QVRSB das crianças. Diante disso, o objetivo desse estudo foi avaliar o impacto da cárie dentária e suas consequências pulpares na QVRSB de pré-escolares, bem como se a resiliência dos pais/responsáveis atua como fator moderador alterando a forma de percepção e relato desse impacto. Foi realizado um estudo transversal representativo de pré-escolares de 4-6 anos de idade de Ribeirão das Neves, MG. Os pais/responsáveis responderam as versões brasileiras do Early Childhood Oral Health Impact Scale (ECOHIS) e da Escala de Resiliência, assim como um questionário com dados socioeconômicos e de comportamento de saúde bucal da criança. Um total de 497 préescolares foi examinado por duas dentistas calibradas para o diagnóstico de cárie dentária, utilizando-se o índice ICDAS simplificado: estágio inicial (opacidade notável/pigmentação retida em fundo de fóssulas e fissuras), estágio moderado (cavitação em esmalte/sombreamento em dentina subjacente), estágio extenso (cavitação com exposição pulpar); e suas consequências pulpares, por meio do índice pufa: envolvimento pulpar, ulceração causada por fragmentos de dentes, fístula e abscesso. Análises descritivas, regressão de Poisson bivariada e multivariada, com abordagem hierárquica, e teste de sensibilidade foram utilizadas para análise dos dados (p<0,05). O modelo multivariado final, ajustado para resiliência, condições socioeconômicas e comportamentais, mostrou que a presença de lesões cariosas não impacta a QVRSB de pré-escolares, independente do estágio do ICDAS (p>0,05). Entretanto, quando consideramos as consequências pulpares das lesões cariosas, observamos que envolvimento pulpar (RP=2,01; 95%IC:1,47-2,74) e fístula/abscesso (RP=3,18; 95%IC:2,05-4,92) apresentam associação com maiores escores do ECOHIS, comparado com aquelas lesões cariosas que não apresentam consequências pulpares. As seções do ECOHIS, Impacto na Criança e Impacto na Família, também estavam associados à presença de envolvimento pulpar (RP=2,11 ;95%IC:1,48-3,00; RP=1,99; 95%IC:1,36-2,91) e fístula/abscesso (RP=3,38; 95%IC:2,14-5,33; RP=2,85; 95%IC:1,73-4,67), respectivamente. Além disso, o teste de sensibilidade mostrou que praticamente não houve diferença na força da associação, quando a resiliência foi removida do modelo, entre presença de envolvimento pulpar e fístula/abscesso com as Seções de Impacto na criança (RP=2,10; 95%IC:1,48-2,98; p<0,001; RP=1,99; 95%IC:1,37-2,87; p<0,001) e Impacto na Família (RP=3,43; 95%IC:2,16-5,45; p<0,001; RP=2,88; 95%IC:1,75-4,75; p<0,001), respectivamente. Portanto, conclui-se que a presença de consequências clínicas pulpares da cárie repercutiu negativamente na QVRSB de préescolares e suas famílias e a resiliência dos pais não atuou como fator moderador alterando esta associação. (AU)

Dental caries is the oral condition that most affects the quality of life of preschool children, and their presence can have pulp-related consequences, such as pulp involvement, fistulas and abscesses. These may be more harmful to the health and well-being of the child than the carious lesions themselves. It is therefore important to explore oral health outcomes using a broader framework, including contextual factors such as resilience. This can change the attitude of parents/caregivers, and can influence oral health and the perception of its impact on the oral health-related quality of life (OHRQoL) of their children. There are no studies in literature that test whether the resilience of parents and/or caregivers affects the OHRQoL of their children. The aim of the present study was therefore to evaluate the impact of dental caries and their pulp-related consequences on the OHRQOL of preschoolers, as well as whether caregiver resilience acts as a moderator, affecting how they perceive and report this impact. A representative cross-sectional study with 4-6-year-old preschool children from Ribeirão das Neves, Minas Gerais, Brazil was carried out. Parents/caregivers responded to the Brazilian versions of the Early Childhood Oral Health Impact Scale (ECOHIS) and the Resilience Scale, as well as a questionnaire with socioeconomic data and child's oral health behavior. A total of 497 preschool children were examined by two calibrated dentists to diagnose dental caries, using the simplified ICDAS index: initial stage caries (first or distinct visual changes in enamel), moderate stage caries (localized enamel breakdown or an underlying dentin shadow), extensive stage caries (distinct cavity with visible dentin); and their pulp-related consequences, through the pufa index: pulp involvement, ulceration caused by root fragments, fistulas or abscesses. Descriptive analyses, bivariate and multivariate Poisson regression with a hierarchical approach, and sensitivity testing were used for data analyses (p<0.05). The final multivariate model was adjusted for resilience and socioeconomic and behavioral conditions and showed that the presence of carious lesions does not impact the OHRQoL of preschool children, independent of ICDAS stage (p>0.05). However, when the pulp-related consequences of carious lesions were considered, it was observed that pulp involvement (PR=2.01; 95%CI:1.47-2.74) and fistulas/abscesses (PR=3.18; 95%CI:2.05-4.92) are associated with higher ECOHIS scores, compared with carious lesions that do not exhibit pulp-related consequences. The ECOHIS Sections Impact on the Child and Impact on the Family were also associated with the presence of pulp involvement (PR=2.11;95%CI:1.48-3.00; PR=1.99; 95%CI:1.36-2.91) and fistulas/abscesses (PR=3.38; 95%CI:2.14-5.33; PR=2.85; 95%CI:1.73-4.67), respectively. In addition, the sensitivity test showed that there was almost no difference in strength of association, without resilience in the model, between the presence of pulp involvement and fistulas/abscesses and the sections Child Impact (PR=2.10; 95%CI:1.48-2.98; p<0.001; PR=1.99; 95%CI:1.37-2.87; p <0.001) and Family Impact (PR=3.43; 95% CI:2.16-5.45; p<0.001; PR=2.88; 95%CI:1.75-4.75; p<0.001), respectively. In conclusion, the presence of the clinical pulp-related consequences of caries, and not the presence of carious lesions per se, had a negative repercussion on the OHRQoL of preschool children and their families, and parental resilience did not act as a moderating factor for this association. (AU)

Impacto do traumatismo dentário na qualidade de vida de crianças, adolescentes e suas famílias: revisão crítica da literatura / Impact of traumatic dental injuries on the quality of life of children, adolescents, and their families: critical review of the literature

Objetivo: Verificar a associação entre o traumatismo em dentes permanentes e o impacto na qualidade de vida relacionada à saúde bucal (QVRSB) de crianças, adolescentes e suas famílias, através de uma revisão crítica da literatura. Métodos: Foi realizada uma busca bibliográfica na base de dados PubMed, com uma combinação de palavras-chave, sem restrições quanto ao ano de publicação ou idioma. Artigos duplicados foram excluídos e a seleção dos estudos foi realizada em duas etapas: leitura do título e resumo, e os artigos que se encaixavam no tema foram selecionados para leitura completa. Logo após, foi realizada extração de dados dos artigos selecionados utilizando uma tabela padronizada. Resultados: Dos 397 artigos encontrados, apenas 14 apresentavam todas as informações exigidas pelos critérios metodológicos. Dentre estes estudos, dois utilizaram o desenho de estudo longitudinal, sete utilizaram o desenho transversal e cinco utilizaram o desenho caso-controle. Onze estudos foram realizados no Brasil, um no Canadá, um no Reino Unido e um na Albânia. Os indivíduos abrangidos pela pesquisa possuíam entre 8 e 19 anos de idade. Foram encontradas associações significativas entre traumatismo dentário e impacto na QVRSB em 13 estudos. Traumatismo dentários mais complexos como de dentina e/ou polpa estiveram associados a dificuldade de mastigar e higienizar a boca, problemas emocionais e de socialização, sentimento de culpa nos pais e estresse familiar. Conclusão: A maioria dos estudos demonstrou que crianças/adolescentes com traumatismo dentário mais grave apresentaram impacto negativo na sua QVRSB e de seus familiares. (AU)

Aim: To verify the association between dental trauma in permanent teeth and its impact on oral health-related quality of life (OHRQoL) of children, adolescents, and their families, using a critical literature review. Methods: A bibliographic study was carried out using the PubMed database, using a combination of key-words, with no restrictions on language or publication date. Duplicate articles were excluded, and the selection of the studies was carried out in two phases. In the first stage, the ttitle and abstract we read, and the articles that fit the theme were selected for further reading of the complete text. In addition, data extraction from the selected studies was conducted using a normalized table. Results: Of the 397 articles encountered in this search, only 14 presented all of the information required by the methodological criteria. Among these studies, two used the longitudinal study method, seven used the cross-sectional study method, and 5 used the case-control study method. Eleven studies had been conducted in Brazil, one in Canada, one in the United Kingdom, and one in Albania. The individuals included in this study ranged from 8 to 19 years of age. Significant associations between dental trauma and its impact on OHRQoL were found in 13 studies. Conclusion: The majority of the studies found an association between dental trauma and the OHRQoL of children/adolescents and their families. (AU)

Ansiedade odontológica autorrelatada pelas crianças atendidas na Faculdade de Odontologia da Universidade Federal de Minas Gerais: fatores associados e correlação com o medo dos pais / Self-reported dental anxiety by children attended in the Dental School of the Universidade Federal de Minas Gerais: associated factors and correlation with parents' dental fear

Objetivo: Avaliar a correlação da ansiedade odontológica das crianças atendidas nas clínicas de Odontopediatria da Faculdade de Odontologia da Universidade Federal de Minhas Gerais (FAO-UFMG) com o medo odontológico de seus pais/responsáveis. Além disso, avaliar a associação entre a presença de ansiedade dessas crianças com tipo de tratamento necessário, o tempo em que faz tratamento na FAO-UFMG e com seu comportamento. Métodos: Foi realizado um estudo transversal com uma amostra de conveniência de 65 crianças de 4 a 11 anos de idade atendidas nas clínicas de Odontopediatria da FAO-UFMG e seus pais/responsáveis. Os Questionários Venham Picture Test Modificado e Dental Fear Survey foram utilizados para mensurar a ansiedade e medo autorrelatados frente o tratamento odontológico das crianças e dos responsáveis, respectivamente. Tipo de tratamento odontológico, tempo em tratamento nas clínicas (FAO-UFMG) e comportamento da criança (escala de Frankl) foram obtidos através da ficha clínica. Sexo e idade (criança) sexo, grau de parentesco e escolaridade (responsável) através de um questionário. Os dados foram analisados através da correlação de Spearman e teste Kruskal-Wallis. Resultados: Não houve correlação significativa entre a ansiedade das crianças e o medo dos pais/responsáveis (r = -0,029; p = 0,820). A ansiedade odontológica foi maior em crianças submetidas à exodontia (média = 3,17; DP = 2,639) do que naquelas submetidas à procedimentos restauradores/endodônticos (média = 0,96; DP = 2,021; p = 0,013) ou sem necessidade de tratamento (média = 0,30; DP = 0,483; p = 0,032). Crianças com 4-21 meses em tratamento apresentaram maior ansiedade comparada àquelas com mais de 21 meses em tratamento (p = 0,045). Não houve associação significativa entre ansiedade odontológica e comportamento da criança (p = 0,221). Conclusão: A ansiedade odontológica das crianças não foi associada ao medo de seus pais/responsáveis. Entretanto, a necessidade de procedimentos mais complexos e o tempo em que a criança estava sob tratamento na clínica foram associados à presença de ansiedade odontológica. (AU)

Aim: To evaluate the presence of dental anxiety in children who receive dental care in the Pediatric Dentistry Clinic of the School of Dentistry at Universidade Federal de Minas Gerais (FAO-UFMG) and their correlation with their parents'/guardians' dental fears. This study also seeks to evaluate the association between these children's dental anxiety with the type of necessary dental treatment, the time needed for treatment at FAO-UFMG, and their behavior. Methods: A cross-sectional convenience study was conducted with 65 children of 4 to 11 years of age who received dental care in the Pediatric Dentistry Clinic of the FAO-UFMG and their parents/guardians. The questionnaires "Modified Venham Picture Test" and "Dental Fear Survey" were used to measure the self-reported dental anxiety and fear concerning the dental treatment of the children and their parents, respectively. The type of dental treatment, length of treatment (FAO-UFMG), and the child's behavior (Frankl scale) were obtained from the clinical record. Gender and age (child), gender, kinship, and education level (responsible) were obtained through a questionnaire. The data were analyzed using Spearman correlation and Kruskal-Wallis tests. Results: There was no significant correlation between children's anxiety and the fear of parents/caregivers (r = -0.029; p = 0.820). Dental anxiety was higher in children undergoing extraction (mean = 3.17; SD = 2.639) than in children undergoing restorative/endodontic procedures (mean = 0.96; SD = 2.021; p = 0.013) or without treatment (mean = 0.30; SD = 0.483; p = 0.032). Children who had been undergoing treatment for 4-21 months presented higher anxiety when compared to children who had been undergoing treatment for more than 21 months (p = 0.045). No significant association was observed between dental anxiety and the child's behavior (p = 0.221). Conclusion: Children's dental anxiety was not associated with their parents'/guardians' dental fear. However, the need for more complex procedures and the time the child had been undergoing treatment at the clinic were associated with the presence of dental anxiety. (AU)

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

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