Caries experience, obesity and demographic factors in school children: A cluster analysis.

OBJECTIVE: To determine the association between caries experience, obesity, and socioeconomic and environmental factors in 2, 5 and 12 years-old schoolchildren. Secondarily, the influence of school infrastructure was assessed. METHODS: Primary data from 1762 schoolchildren from the municipality of Cajamar (SP, Brazil) and socioeconomic and environmental secondary data (Brazilian Census 2010, School Census, Prova Brasil/2017) were used. Caries and treatment experience (dmft/DMFT indices), dental occlusion, visible biofilm, weight and height were assessed. RESULTS: Caries experience was found in 6.5%, 40.2% and 46.5% of children at 2, 5 and 12 years, respectively. At 12y, greater caries experience was observed among children financially assisted by the Bolsa Família governmental program. Excess weight was found in 30%, 35% and 34% at 2, 5 and 12 years. At 2 and 5 years, the highest dental caries indices were associated with disadvantageous socioeconomic indicators (households water supply and sewage system, garbage collection, literate head and income), while overweight was associated with female sex and better socioeconomic aspects. At 12y, the group with obesity was characterized by low dmf+DMFT index and better household aspects, while the group with greater dmf+DMFT index comprised normal-weight children. A correlation between the percentage of caries experience and student/employee ratio of the school was observed. CONCLUSION: An association between disadvantageous socioeconomic and environmental aspects and dental caries was observed, while obesity was associated with better socioeconomic status of the schoolchildren. While no direct association was found between obesity and dental caries, the results emphasize the influence of socioeconomic/environmental variables on health outcomes.

Impact of asthma on children´s gustatory sensitivity, masticatory and feeding behaviors.

Asthma is a chronic inflammatory disease, in which disturbances in breathing, masticatory and swallowing functions may impact the eating behavior. The aim of the study was to evaluate the impact of asthma on taste sensitivity, masticatory behavior and feeding problems in children. The sample consisted of 91 children (6-7y) divided into two groups: asthma (n=46) and control group (n=45). Interviews were held with parents/guardians and clinical examinations were performed to gather information on medical, dental and feeding aspects. The gustatory sensitivity for sucrose and urea (sweet and bitter, respectively) were measured by staircase method designed for this age-range. The respiratory and masticatory functions were evaluated using the Orofacial Myofunctional Evaluation with Scores-expanded (OMES-e) protocol. Feeding problems were assessed using the Montreal Children's Hospital Feeding Scale, exploring oral motor, sensory, appetite, maternal concerns, child's behavior, and strategy aspects after transcultural adaptation to Brazilian Portuguese. The two groups were homogeneous relative to sociodemographic characteristics and nutritional status. Although the total OMES-e scores did not differ between groups, the frequency of changes in food incision and escape were different (p=0.007 and p=0.0011, respectively). The Asthma group required more time and higher number of masticatory cycles to eat the test-food (p<0.05). The gustatory thresholds for sweet and bitter were different, with asthmatic children requiring significantly higher concentrations to perceive the taste (p<0.001). The frequency of children classified by their parents according to feeding difficulties also differed between groups (p=0.001; Fisher's exact test). Asthmatic children showed remarkable changes in taste, chewing and eating behaviors, thereby pointing out the eating problems they may experience, which should be considered when designing and implementing therapeutic interventions.

Educational strategies and atraumatic restorative treatment effect on salivary characteristics: A controlled clinical trial.

OBJECTIVE: To evaluate educational strategies and atraumatic restorative treatment (ART)-restoration impact on salivary physicochemical and microbiological characteristics. DESIGN: Two groups of 6- to 7-year-old children were included: GART , with at least one decayed primary molar (n = 36), submitted to four sessions of oral health educational strategy (OHES) and ART restoration; GC , a paired caries-free group (n = 36), submitted to four sessions of OHES. Three evaluations were carried out: baseline, 1 week after OHES, and 1 month after OHES or ART, when biofilm and gingivitis frequencies, salivary flow, pH, buffer capacity, calcium and phosphorus concentrations were assessed. Total bacteria and Streptococcus mutans were quantified in unstimulated saliva (qPCR). RESULTS: Improvement in biofilm and gingivitis scores, salivary pH, and buffering capacity after OHES was observed in GC , with a decrease in total bacteria and S. mutans counts. GART also showed changes in salivary parameters, even before ART restoration was delivered, and total bacteria count remained lower than baseline 1 month after ART restoration, although a trend to increase the proportion of S. mutans was observed. CONCLUSION: Improvements in salivary physicochemical and microbiological characteristics were observed after educational strategies, thus reducing the caries risk of children with decayed teeth, although a trend to increase the S. mutans percentage was observed 1 month after ART restoration.

Assessment of quality of life, anxiety, socio-economic factors and caries experience in Brazilian children with overweight and obesity.

PURPOSE: This study evaluated the association between excess weight and quality of life (QoL), symptoms of anxiety, caries experience and socio-economic factors in a representative sample of 8- to 10-year-old children from three public schools of Piracicaba (SP, Brazil). MATERIALS AND METHODS: The Autoquestionnaire Qualité de Vie Enfant Image was applied to explore family and social relations, activities, health, body functions and separation domains, and, by means of the Multidimensional Anxiety Scale for Children, symptoms of anxiety were screened. Clinical examination was performed using DMFT/dmft indexes to assess oral health and caries experience. Medical and nutritional history, parents' schooling, monthly income and ownership of household goods and services were also evaluated. RESULTS: Of the 313 subjects included, four subjects were underweight, 188 normal weight, 67 overweight and 54 presented obesity (38.7% with excess weight). Measures of QoL, anxiety scores and caries experience did not differ between groups. The regression model showed a significant association between excess weight and the ownership of household goods and services (OR = 5.4/CI = 1.6-18.3). CONCLUSIONS: High prevalence of excess weight was observed among prepubertal children, emphasizing the need for continued health programmes to limit risk factors for obesity. QoL, anxiety scores and caries experience did not differ between subjects with different body weights, although children from public schools with higher ownership of goods and services were more likely to present excess weight.

Electromyographic evaluation of masticatory muscles at rest and maximal intercuspal positions of the mandible in children with sleep bruxism.

UNLABELLED: In adults, sleep bruxism (SB) may be related to reports of pain or fatigue in the muscles of mastication, resulting from multiple muscle contractions that occur during the night. In children, little is known about the consequences of this parafunction. PURPOSE: The objective was to compare the electromyographic activity (EMG) of the masseter and anterior portion of the temporalis muscles in children with and without SB; acquisitions were made at rest (RE) and in maximal intercuspal (MI) positions of the mandible. METHODS: Twenty children with signs and symptoms of SB (mean age 7.20 years ± 0.52) and 20 controls without signs or symptoms of SB (mean age 7.40 years ± 0.50) were selected. The controls were matched to the type of occlusal morphology evaluated according to Björk et al. (Acta Odontol Scand 22:27-40, 1964). Muscle activity was measured with the mandible at RE, MI and maximal clenching with cotton roll (MC), on the left and right sides. Data from the RE and MI (mV) were normalized by calculating them as % MC. The results were analyzed by descriptive statistics, Shapiro-Wilk test, Wilcoxon and Mann-Whitney tests. RESULTS: The subjects' age did not differ significantly between groups. EMG of temporalis muscle at RE differed between the right and left sides in both groups. There was no significant difference in EMG of masseter and temporalis muscles between groups. CONCLUSION: Children with SB showed no significant difference in EMG of masticatory muscles at RE and in MI positions of the mandible when compared with the control group.

Evaluation of oro-facial function in young subjects with temporomandibular disorders.

The aim of this study was to evaluate bite force (BF) and oro-facial functions at different dentition phases (initial-mixed, intermediate-mixed, final-mixed and permanent dentition) in children and adolescents diagnosed with temporomandibular disorders (TMDs). The sample was selected from four public schools in Piracicaba, São Paulo, Brazil. Of the 289 participants recruited, aged 8-14 years old, 46 were placed into the TMD group. TMD was diagnosed using Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (2011). Oro-facial functions were evaluated using the Nordic Orofacial Test-Screening (NOT-S), which involves both an interview and a clinical examination. BF was measured using a digital gnathodynamometer. Age and body mass index (BMI) were also considered. The data were analysed by the following tests: Kolmogorov-Smirnov test, Student's t-test, Spearman and Pearson coefficients, Qui-square test, Fisher's exact or binomial test, as indicated. Moreover, univariate and multivariable logistic regression were applied. For the TMD group, scores associated with NOT-S interview and NOT-S total were higher than for the control group (P = 0.033 and P = 0.0062, respectively). No differences in BF between genders or groups (P > 0.05) were detected. Variables included in the multivariate logistic regression were BMI and NOT-S total. Based on this analysis, NOT-S total was associated with TMDs. Reported sensory function was the specific domain within NOT-S interview that established the significant difference between the groups (P = 0.021). The TMD group also had a greater number of alterations in the face-at-rest domain of the NOT-S exam (P = 0.007). Concluding, it did not detect an association between TMDs and either dentition phase or BF. Instead, BF correlated with age and BMI. Oro-facial dysfunction was associated with TMD in the studied sample, but this association may be bidirectional, requiring further researches.

Relationship between orofacial function, dentofacial morphology, and bite force in young subjects.

OBJECTIVE: The aim was to evaluate the relationship between orofacial function, dentofacial morphology, and bite force in young subjects. SUBJECTS AND METHODS: Three hundred and sixteen subjects were divided according to dentition stage (early, intermediate, and late mixed and permanent dentition). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Orthodontic treatment need, bite force, lateral and frontal craniofacial dimensions and presence of sleep bruxism were also assessed. The results were submitted to descriptive statistics, normality and correlation tests, analysis of variance, and multiple linear regression to test the relationship between NOT-S scores and the studied independent variables. RESULTS: The variance of NOT-S scores between groups was not significant. The evaluation of the variables that significantly contributed to NOT-S scores variation showed that age and presence of bruxism related to higher NOT-S total scores, while the increase in overbite measurement and presence of closed lip posture related to lower scores. Bite force did not show a significant relationship with scores of orofacial dysfunction. No significant correlations between craniofacial dimensions and NOT-S scores were observed. CONCLUSION: Age and sleep bruxism were related to higher NOT-S scores, while the increase in overbite measurement and closed lip posture contributed to lower scores of orofacial dysfunction.

Masticatory performance and taste perception in patients submitted to cancer treatment.

The aim of this study was to analyse mastication and the sense of taste in 39 patients submitted to cancer treatment in different areas of the body and to compare these variables with those of 44 control individuals within the same age range. The following aspects were assessed: dental status (DMFT); stimulated and non-stimulated salivary flow; sense of taste (salty, sweet, bitter and sour); and masticatory performance (MP), through the calculation of X(50). Logistic regression models were established to test the association between the independent variables and cancer treatment. Cancer patients had lesser stimulated salivary flow, a smaller number of teeth and occlusal units, worse MP, higher salty, sweet and sour taste scores and a lower bitter taste score (P < 0·05). A significant positive correlation was found between MP and the DMFT index in both groups (P < 0·05), meaning that a lower DMFT index value denoted a smaller X(50) value (better masticatory performance). The logistic regression model revealed that patients who had undergone cancer treatment had a greater probability of exhibiting a smaller number of teeth, higher salty and smaller bitter taste scores (P < 0·05). It was concluded that patients who were submitted to cancer treatment presented oral physiology alterations when compared with control subjects at the same age range.

Evaluation of masticatory performance and bite force in children with sleep bruxism.

The aim of this study was to evaluate the association between masticatory performance (MP) and bite force (BF) in children with sleep bruxism (SB) during the mixed dentition stage, considering also the occlusal characteristics. The sample was composed by 52 healthy children of both genders, aged 6-10 years. From those, 22 presented signs and symptoms of SB and 30 were the controls. SB diagnosis consisted of both parental report and presence of tooth wear. MP was evaluated by the individual's ability to communicate an artificial chewable test material for determining the median particle size (X50) and distribution of particles in the different sieves (b). BF was measured using a digital gnathodynamometer with fork strength of 8 mm. The results were submitted to descriptive statistics, Mann-Whitney and chi-square tests, Spearman's correlation and multiple logistic regression. Mean BF and X50 did not differ between groups with and without SB. A significant negative correlation was observed between BF and X50 only in the group of children with SB. Moreover, the logistic regression model showed an association between the presence of SB and higher b index. The other independent variables included in the model showed no association with SB. BF did not differ between children with and without SB. Besides, higher BFs in children with SB meant better MP; however, they were more likely to present chewed particles retained in the larger aperture sieves, consequently requiring more chewing cycles to break down the test material in smaller particles.

Associations between oral health-related quality of life and emotional statuses in children and preadolescents.

OBJECTIVES: To evaluate the associations between oral health-related quality of life (OHRQoL) and emotional statuses in children and preadolescents. METHODS: One hundred and forty-five Brazilian students (8-14 years) were clinically examined for caries, gingivitis, fluorosis, malocclusions, and temporomandibular disorders (TMD). OHRQoL was measured using two global ratings of oral health (OH) and overall well-being (OWB). The Revised Children's Manifest Anxiety Scale (R-CMAS) and Children's Depression Inventory (CDI) were used to assess anxiety and depression, respectively. Saliva was collected 30 min after waking and at night to determine the diurnal decline in salivary cortisol (DDSC). The results were analyzed using non-paired t test/one-way ANOVA, Pearson's correlation test, and multiple linear regression analyses. RESULTS: 11-14-year-old participants had higher CDI scores (P < 0.01) and DDSC concentrations (P < 0.001). Participants with fewer caries and without gingivitis had higher DDSC concentrations (P < 0.05). TMD patients had higher DDSC concentrations and OWB ratings (P < 0.001). Girls had higher Revised Children's Manifest Anxiety Scale (RCMAS) scores (P < 0.01). There was positive correlation between RCMAS and CDI scores and OWB ratings (P < 0.05). The OH model retained age (ß =0.312; P < 0.001) and the OWB model retained TMD (ß = 0.271; P < 0.001) and CDI scores (ß=0.175; P < 0.05). CONCLUSIONS: Children and preadolescents with poor emotional well-being are more sensitive to the impacts of OH and its effects on OWB.

Salivary cortisol, alpha-amylase and heart rate variation in response to dental treatment in children.

OBJECTIVE: Anxiety and stress are usually related to the dental treatment situation. The objective was to investigate salivary cortisol and alpha-amylase levels (salivary biomarkers) and heart rate in children undergoing a minor dental procedure (dental prophylaxis). STUDY DESIGN: In total, 31 children (range 84-95 months) of both genders without caries or history of dental treatment/pain/trauma were selected. Three saliva samples were gathered: one prior to dental prophylaxis, one immediately after and one ten minutes later. Weight and height were assessed, and heart rate was evaluated prior to and during the procedure. Data were analyzed by correlation tests and t-test/Wilcoxon (alpha = 0.05). RESULTS: Higher cortisol and amylase levels were observed before prophylaxis compared to afterward. Cortisol and amylase levels did not show a significant correlation, nor did salivary biomarkers and body mass index. However, heart rate and amylase levels showed a significant positive correlation. CONCLUSIONS: In the studied sample, certain anticipation of the dental treatment was observed because higher cortisol and amylase levels were observed before, rather than after the event; moreover a significant correlation between amylase levels and heart rate was observed Thus, salivary biomarkers may be a valuable tool for evaluating anxiety-producing events, such as dental treatment, in children.

Avaliação da adequação legal de receitas e notificações de receita de medicamentos sujeitos a controle especial dos setores públicos e privados / Evaluation of the legal prescription and notifications adequacy for special control medicinesin the public and private sectors

Os objetivos desta pesquisa foram avaliar a adequação legal de receitas de controle especial e notificações de receitas dispensadas em uma Drogaria de Varginha ? MG, estabelecer uma comparação entre as prescrições provenientes da rede pública e privada e detectar as classes de medicamentos mais prescritas. Analisaram-se 960 prescrições através de um formulário com itens obrigatórios de acordo com a legislação vigente. Os dados obtidos foram analisados pelo Teste Qui-quadrado, utilizando a origem das notificações e receitas como desfecho. Considerando as receitas; a única variável que apresentou diferença entre os setores público e privado foi a descrição por extenso da quantidade de medicamento, que foi mais adequadamente cumprida pelo setor privado. Em relação às notificações, a legibilidade foi significativamente mais freqüente em notificações provenientes de centros públicos, enquanto a designação da Unidade Federativa e a descrição por extenso da quantidade de medicamento foram mais presentes no setor privado. Por outro lado, a descrição completa da posologia, da data da notificação, a presença de carimbo e descrição da forma farmacêutica foram mais adequadas no setor público. Nenhuma das prescrições foi considerada totalmente adequada aos dados exigidos pela Portaria 344/98. As classes medicamentosas mais prescritas foram os benzodiazepínicos em notificações de receita e os antidepressivos em receituário de controle especial. Concluiu-se que a prescrição de medicamentos sujeitos a controle especial apresenta falhas de acordo com a legislação vigente.

The objectives of the present study were to evaluate the legal prescription adequacy in one drugstore located in the south of Minas Gerais state, in order to establish comparisons between the prescriptions of public and private services and to detect the most commonly classes of medicines prescribed. It was analyzed 960 prescriptions in accordance with the current law. The data were analyzed by descriptive statistics and compared using frequency distribution test(Chi-square test) considering private and public sources of prescription as the dependent variable. Considering special control prescriptions, the extensive description of the amount of medicine was fulfilled more frequently by the private sector. However, for the notifications; legibility, dosage, pharmaceutical form, date of issue and presence of stamp were more frequently present in the public service, while assignment of the Federative Union, the extensive description of the amount of medicine and the dosage was more present in the private sector. None of the evaluated prescriptions was considered totally adjusted with law 344/98. The prescribed medicines more commonly found were benzodiazepines for prescription notifications and antidepressants in special control prescriptions. It was concluded that the medicine prescriptions subjected to special control are frequently not adequate to the current law.

Evaluation of facial asymmetry and masticatory muscle thickness in children with normal occlusion and functional posterior crossbite.

AIM: The aim of this study was to evaluate facial asymmetry and the thickness of the masticatory muscles in young children with normal occlusion and functional posterior crossbite. METHODS: The sample comprised 72 children of both genders (64.71±7.04 months) in the primary and early mixed stage of dentition, divided into four groups: primary-normal occlusion (PriN; N=19), primary-crossbite (PriC; N=19), mixed-normal occlusion (MixN; N=27), and mixed-crossbite (MixC; N=16). The thickness of the masseter and anterior portion of the temporalis muscle at rest and during maximal clenching were assessed by ultrasonography. Facial morphology and asymmetry were evaluated by standardized front-view photographs, in which the following measurements were recorded: anterior face height (AFH), bizygomatic facial width (BFW), angle of the eye (AE) and angle of the mouth (AM) (interpupillary and commissure planes in relation to mid-sagittal plane, respectively). RESULTS: The results showed that muscle thickness did not differ significantly between the sides of the dental arches in all groups (paired t-test). Only the groups with normal occlusion presented significant positive correlation between AE and AM (Pearson's correlation test). In PriN, only body weight was significantly related to masseter thickness; in MixN, facial morphology contributed significantly to masseter thickness at rest and maximal clenching, while the covariates weight, height and age did not relate to muscle thickness (stepwise backward multiple regression). CONCLUSION: In the studied sample, children with crossbite presented greater facial asymmetry than those with normal occlusion, and a greater masseter thickness was related to larger faces in the mixed dentition.

Ultrasound and tomographic evaluation of temporomandibular joints in adolescents with and without signs and symptoms of temporomandibular disorders: a pilot study.

OBJECTIVES: Condylar position in the glenoid fossa has been linked to temporomandibular disorders (TMDs); however its importance in TMD aetiology is still unclear. The purpose of this study was to determine joint spaces and condylar position in adolescents with TMDs using ultrasound static images and linear corrected tomograms at the mandibular rest position. METHODS: Craniomandibular index (CMI) and a symptom questionnaire were assessed in 217 subjects aged 12-18 years. Those with the lowest and the highest scores were divided into control (n=20) and SSTMD (presence of signs and symptoms of TMD) groups (n=20). Ultrasound images and tomography were used to measure the distance between the capsule and the lateral surface of the condyle and to determine the condyle location at the mandibular resting position, respectively. RESULTS: The mean distances obtained from ultrasound images did not correlate with CMI scores and they did not differ between the two groups (P>0.05). Posterior positioned condyles were determined on tomograms, and they were more prevalent both in the SSTMD group (P=0.05) and in girls (P<0.05). CONCLUSIONS: Even though there was a significant difference in condyle position between the control and SSTMD groups, determined by axially corrected tomograms, it cannot be inferred that posteriorly positioned condyles can predict TMDs. In addition, there was no association between the articular capsule and the lateral condyle surface distances measured by ultrasound using a 10 MHz linear transducer and the clinical diagnosis of TMD. Further studies in diagnostic imaging of TMJs with ultrasound should be encouraged, since it has some useful diagnostic applications and does not require special facilities.

Molar bite force and its correlation with signs of temporomandibular dysfunction in mixed and permanent dentition.

The aim of the study was to evaluate molar bite force (BF) magnitude and its correlation to the signs of temporomandibular dysfunction (TMD), gender, weight, height and age in 101 students ranging in age from 6 to 18 years (32 boys/21 girls with mixed dentition and 23 boys/25 girls with permanent dentition). TMD clinical signs were evaluated using the Craniomandibular Index (CMI), and two subscales, the Dysfunction Index (DI) and the Palpation Index (PI). BF was determined with a pressurized tube connected to a sensor (MPX5700-Motorola SPS). anova, Tukey's test, and Pearson's and Spearman's coefficients were evaluated. BF was higher in the permanent dentition (P < 0.05). There was no difference in BF between genders within the groups, but boys with permanent dentition had higher values than children with mixed dentition (P < 0.05). The girls with permanent dentition presented negative correlation in BF with PI and CMI (P < 0.05). BF was positively correlated with weight, height and age in the permanent dentition group (P < 0.05). It was concluded that BF increased from mixed to permanent dentition, with an assumed enhancing influence of body variables and ageing. The TMD signs in older girls were correlated to decreasing BF, suggesting an influence of muscle tenderness preventing subjects from exerting maximum BF.

Bite force determination in adolescents with and without temporomandibular dysfunction.

The aims of this study were to compare bite force in adolescents with and without temporomandibular dysfunction (TMD), and to investigate the influence of gender, age, height and weight on bite force magnitude. The TMD was evaluated using a self-report questionnaire and the Craniomandibular Index, which has two subscales, the Dysfunction Index and the Palpation Index. Subjects with lower and upper extremity values were used to integrate the control (Group I -n = 20) and TMD (Group II -n = 20) groups, respectively. In addition, the TMD group should have at least one subjective symptom. Bite force was determined with a transducer, which consisted of a pressurized rubber tube connected to a sensor element (MPX 5700 - Motorola SPS, Austin, TX, USA). Analysis of covariance, Pearson's coefficient, Mann-Whitney and t-tests were applied to analyse the data. The results showed that Group II presented smaller values for bite force than Group I and boys had greater values than girls in Group II (P < 0.05). Bite force values were significantly smaller for girls between groups (P < 0.05), whereas for boys there was no statistical difference. Weak positive correlation between bite force and weight, height and age (P > 0.05) and significant negative correlation between bite force and Palpation and Craniomandibular Indexes (P < 0.05) were found. It was concluded that decreased bite force was correlated with TMD in girls, primarily with muscle tenderness.

Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition.

UNLABELLED: The aim of this study was to evaluate the relationship between nutritive and parafunctional habits and the presence of temporomandibular dysfunction (TMD) in children with primary dentition. METHODS: Ninety nine children, aged 3-5 years, were examined to check for the presence or absence of signs and symptoms of TMD (headache, preauricular pain, earache, masticatory muscle tenderness, deviation on opening, occlusal interference and asymmetric movement of the mandible), oral parafunctions (bruxism, nail biting, finger/thumb sucking, speech alteration, mouth breathing, pacifier and atypical swallowing) and nutritive habits (breast- or bottle-feeding) through interview and clinical examination. The results were submitted to descriptive statistical analysis and Fisher's exact test. RESULTS: The results showed that only atypical swallowing was positively related to TMD (P < 0.0001); other oral parafunctional and nutritive habits were not related to TMD. CONCLUSIONS: It was concluded that parafunctional habits, with the exception of atypical swallowing, and feeding methods were not determinants for the presence of signs and/or symptoms of TMD in the sample of children included in the study.