Traumatic dental injuries and molar incisor hypomineralization: a cross-sectional study of schoolchildren from southern Brazil.

PURPOSE: To describe the prevalence and the variables associated with TDIs in schoolchildren aged 8 to 14 years in Estância Velha city in southern Brazil, placing emphasis on molar incisor hypomineralization. METHODS: Students enrolled in public schools of a medium-sized city in the southern Brazil were selected using cluster random sampling. Clinical examinations assessed molar incisor hypomineralization-MIH (European Academy of Pediatric Dentistry criteria), dental caries (DMFT index), and TDIs (O'Brien's criteria). Socioeconomic and demographic variables were assessed using a standardized questionnaire. Prevalence ratios were estimated using Poisson regression (p < 0.05). RESULTS: 513 students (54.8% female), with a mean age of 11.6 (± 1.9) years, participated in the study. The prevalence of TDIs was 11.3%, with enamel fracture representing 90.4%. The high prevalence of traumatic dental injuries was associated with MIH (PR: 2.22 CI: 1.27; 3.87; p < 0.01) and overjet > 3 mm (PR: 2.03 CI 1.19; 3.45; p < 0.01). CONCLUSION: The sample of schoolchildren from southern Brazil had a low prevalence of traumatic dental injuries. Molar incisor hypomineralization and increased overjet were associated with the higher prevalence of traumatic dental injuries.

Contextual and individual determinants of tooth loss in the Afro-descendant older adult populations of different countries: a scoping review.

BACKGROUND: The Black population has poorer oral health than other racial groups; however, little is known about the mechanisms that explain this difference. OBJECTIVE: To study the association between race and tooth loss and map the evidence on factors associated with tooth loss in Black older populations. METHODS: Scoping review following the PRISMA Extension for Scoping Reviews conducted according to the recommendations of the Joanna Briggs Institute. A three-step search strategy was applied, and data were collected between April and July 2021. Searches were performed in the PubMed, Lilacs, and SciELO databases. The grey literature was searched using Google Scholar (https://www.scholar.google.com/). The reference lists of included studies were used as additional sources. Studies published in English and Portuguese of the association between tooth loss and different racial groups and the factors associated with tooth loss and tooth retention in Black older adult populations were included. RESULTS: Twenty-one of 913 original articles published between 1995 and 2020 were included. Of these, 75% were research articles, 15% were reports, and 10% dissertations. Eighty per cent reported cross-sectional and 20% longitudinal data. African ancestry was associated with increased odds of tooth loss in older adult populations. Periodontal disease, female sex, and advanced age were the exposures most frequently associated with tooth loss. CONCLUSION: Race, educational level, advanced age, and oral diseases such as periodontitis are associated with increased tooth loss in Afro-descendant older populations.

Role of Dentistry in Global Health: Challenges and Research Priorities.

Despite some improvements in the oral health of populations globally, major problems remain all over the planet, most notably among underprivileged communities of low- and middle-income countries but also in high-income countries. Furthermore, essential oral health care has been a privilege, instead of a right, for most individuals. The release of the Lancet issue on oral health in July 2019 built up some momentum and put oral conditions and dental services in the limelight. Yet, much work is still needed to bridge the gap between dental research and global health and get oral health recognized as a population health priority worldwide. Using the framework proposed by Shiffman, we argue that a global health network for oral health must be harnessed to influence global health policy and drive health system reform. We have identified challenges around 4 key areas (problem definition, positioning, coalition building, and governance) from our experience working in the global health arena and with collaborators in multidisciplinary teams. These challenges are outlined here to validate them externally but also to call the attention of interested players inside and outside dentistry. How well our profession addresses these challenges will shape our performance during the Sustainable Development Goals era and beyond. This analysis is followed by a discussion of fundamental gaps in knowledge, particularly in 3 areas of oral health action: 1) epidemiology and health information systems; 2) collection, harmonization, and rigorous assessment of evidence for prevention, equity, and treatment; and 3) optimal strategies for delivering essential quality care to all who need it without financial hardship.

Trends of mortality due to oral and oropharyngeal cancers in Uruguay from 1997 to 2014.

BACKGROUND: To analyze the trends of oral and oropharyngeal cancer mortality in Uruguay between 1997 and 2014 according to sex and age groups and its possible association with sociodemographic factors. MATERIAL AND METHODS: A time-series ecological study using secondary data was performed. The data about mortality due to oral and oropharyngeal cancers were obtained from the Statistics Vitals Department of the Public Health Ministry of Uruguay. To estimate the mortality trends of the historical series, by sex, anatomical site and age groups, linear regressions generated by the Prais-Winsten procedure were used. RESULTS: The analysis of mortality trends for oral cavity and oropharyngeal cancers in Uruguay indicated that the global mortality rate was stable over the studied period. The women's mortality rate increased from 0.51 per 100,000 in 1997 to 0.65 per 100,000 in 2014 while for men, rates per 100,000 went from 3.22 in 1997 to 2.20 per 100,000 in 2014. Mortality from oral cancer in men decreased between 1997 and 2014. Mortality by oropharyngeal cancer, irrespective of sex, remained stable. Analysis by cancer site revealed decreasing trends tumors situated in the base of the tongue and gum. Years of education, unemployment, smoking and Gini index were not associated with mortality trends. CONCLUSIONS: The overall mortality from oral and oropharyngeal cancer in Uruguay has remained constant in the period between 1997 and 2014. Oral cancer mortality decreased in men and increased in women and decreased at the base of the tongue. It's necessary to continue monitoring the behavior of these diseases.

The Challenge of Evaluating the Oral Health Status of Older Persons in Latin America.

Knowledge Transfer Statement: This article provides an overview of the oral health status of older people from Latin American countries and the emergence of recent gerodontology research initiatives within the region.

Association between oropharyngeal dysphagia, oral functionality, and oral sensorimotor alteration.

OBJECTIVE: To evaluate whether the oral functionality and the oral sensorimotor alterations are associated with oropharyngeal dysphagia in community-dwelling older persons and long-term care older residents. METHODS: An exploratory study with 265 independent older persons of the southern state of Brazil. The diagnosis of dysphagia, as well as the condition of the oral sensorimotor system, was assessed by a speech-language therapist and the oral health status by a dentist. Poisson Regression with robust variance was used to calculate the crude and adjusted Prevalence Ratios (PR) and their respective confidence intervals of 95%. RESULTS: The mean age was 73.5 (±8.9) years, women represented 59.2% of the sample. The frequency of dysphagia in the studied population was 45.3% (n = 120), being more frequent in the long-term care older residents (62.5%; n = 75) than in the community-dwelling older persons (37.5%; n = 45). Individuals with four or more oral sensorimotor alterations (PR = 2.01; 95% CI 1.27-3.18), as well as those who presented a non-functional oral status (PR = 1.61; 95% CI 1.02-2.54) presented a higher frequency of dysphagia. Subgroup analysis indicates the same trend of results, when stratified by community-dwelling older persons and long-term older residents. CONCLUSION: A non-functional oral health status and oral sensorimotor alterations are associated with a higher prevalence of oropharyngeal dysphagia.

Psychological distress and salivary secretory immunity.

Stress-induced impairments of mucosal immunity may increase susceptibility to infectious diseases. The present study investigated the association of perceived stress, depressive symptoms, and loneliness with salivary levels of secretory immunoglobulin A (S-IgA), the subclasses S-IgA1, S-IgA2, and their transporter molecule Secretory Component (SC). S-IgA/SC, IgA1/SC and IgA2/SC ratios were calculated to assess the differential effects of stress on immunoglobulin transport versus availability. This study involved 113 university students, in part selected on high scores on the UCLA Loneliness Scale and/or the Beck Depression Inventory. Stress levels were assessed using the Perceived Stress Scale. Unstimulated saliva was collected and analysed for total S-IgA and its subclasses, as well as SC and total salivary protein. Multiple linear regression analyses, adjusted for gender, age, health behaviours, and concentration effects (total protein) revealed that higher perceived stress was associated with lower levels of IgA1 but not IgA2. Perceived stress, loneliness and depressive symptoms were all associated with lower IgA1/SC ratios. Surprisingly, higher SC levels were associated with loneliness and depressive symptoms, indicative of enhanced transport activity, which explained a lower IgA1/SC ratio (loneliness and depression) and IgA2/SC ratio (depression). This is the first study to investigate the effects of protracted psychological stress across S-IgA subclasses and its transporter SC. Psychological stress was negatively associated with secretory immunity, specifically IgA1. The lower immunoglobulin/transporter ratio that was associated with higher loneliness and depression suggested a relative immunoglobulin depletion, whereby availability was not keeping up with enhanced transport demand.

Apical periodontitis and incident cardiovascular events in the Baltimore Longitudinal Study of Ageing.

AIM: To evaluate whether the presence of apical periodontitis (AP), root canal treatment (RCT) and endodontic burden (EB) - as the sum of AP and RCT sites - were associated with long-term risk of incident cardiovascular events (CVE), including cardiovascular-related mortality, using data on participants in the Baltimore Longitudinal Study of Ageing (BLSA). METHODOLOGY: This retrospective cohort included 278 dentate participants in the BLSA with complete medical and dental examinations. Periodontal disease (PD) and missing teeth were recorded. The total number of AP and RCT sites was determined from panoramic radiographs. EB was calculated as the sum of AP and RCT sites. Oral inflammatory burden (OIB) was calculated combining PD and EB. The main outcome was incident CVE including angina, myocardial infarction and cardiovascular-related death. Participants were monitored for up to 44 years (mean = 17.4± 11.1 years) following dental examination. Relative risks (RRs) were calculated through Poisson regression models, estimating the relationship between AP, RCT, EB, PD, OIB and incident CVE. RESULTS: Mean age at baseline was 55.0 ±16.8 years and 51.4% were men. Sixty-two participants (22.3%) developed CVE. Bivariate analysis showed that PD, EB, number of teeth and OIB were associated with incident CVE. Multivariate models, adjusted for socio-demographic and medical variables, showed that age ≥60 years (RR = 3.07, 95% CI =1.68-5.62), hypertension (RR = 2.0, 95% CI = 1.16-3.46) and EB ≥3 (RR = 1.77, 95% CI = 1.04-3.02) were independently associated with incident CVE. The association between OIB and incident CVE was reduced to nonsignificance after adjustments (RR = 1.97, 95% CI = 0.83-4.70). CONCLUSIONS: EB in midlife was an independent predictor of CVE amongst community-dwelling participants in the BLSA. Prospective studies are required to evaluate cardiovascular risk reduction with the treatment of AP.

Depressive symptoms and untreated dental caries in older independently living South Brazilians.

BACKGROUND: The importance of psychological reactions in modifying oral health behaviors and salivary immunity has been shown previously, but few studies assessed whether psychological reactions are associated with caries in populations. Thus, the aim of this study was to examine the association of depressive symptoms with untreated caries using a hierarchal approach. METHODS: In this cross-sectional study, a random sample of 390 South Brazilians aged 60 years or more was evaluated using a structured questionnaire assessing sociodemographic, behavior, health and depressive symptoms (Geriatric Depression Scale) data. Oral examinations were carried out in order to assess: (1) dental status, using the DMFT index; (2) dental plaque, using the Visible Plaque Index, and (3) unstimulated saliva flow, using the spit method. A hierarchical model based on the framework of caries was carried out to assess whether depressive symptoms were associated with prevalent untreated dental caries (or D >0). RESULTS: Depressive symptoms, number of teeth and plaque accumulation were significant predictors of caries with respect to the D >0 outcome. CONCLUSION: Our findings suggest that depressive symptoms may act as determinants of caries, adding to the body of knowledge supporting the importance of psychological reactions in oral health/disease processes.

Number of teeth and its association with central obesity in older Southern Brazilians.

UNLABELLED: Evidence suggests that older adults with extensive tooth loss may present dietetic restrictions and frequently choose softer and more processed foods, which consequently may lead to obesity. OBJECTIVE: To evaluate whether there was an association between dental status and central obesity in community-dwelling elderly. BASIC RESEARCH DESIGN: A simple random sample of 471 community-dwelling Brazilian elderly ranging from 60 to 89 years old was evaluated in 2006. A questionnaire on socio-demographic, behaviour, general and oral health variables was applied. The number of natural teeth and the use of dental prostheses, following the World Health Organization (WHO) criteria, were assessed. MAIN OUTCOME MEASURES: The circumferences of the waist and the hip were measured in order to provide the waist circumference (WC) and the waist-hip ratio (WHR) measures. For both measures, participants were categorised as non-obese or obese according to the WHO-established cut-off points. RESULTS: Participants with more than 8 teeth were less likely to have central obesity, as measured by WHR [OR = 0.49 (0.32 to 0.87)], while participants with only 1-8 natural teeth were more likely to have central obesity when evaluated by WC [OR = 3.28 (CI 1.43 to 7.52)]. CONCLUSIONS: Tooth loss was associated with central obesity, even when controlled for confounders, suggesting a relationship between oral health status and nutritional status in this sample of community-dwelling Brazilian elderly. Preserving natural teeth may have a positive impact on the nutritional status of older adults and on obesity-related morbidity.

Edentulism, use of dentures and consumption of fruit and vegetables in south Brazilian community-dwelling elderly.

There is evidence suggesting that edentulous older persons modify their diet, avoiding foods that are difficult to chew, such as fruit and vegetables; meanwhile, the consumption of these foods is associated with prevention of chronic diseases. However, few studies evaluated whether a poor oral status without prosthetic rehabilitation is associated with a reduction in the consumption of fruit and vegetables in community-dwelling older persons. We evaluated the association of oral status with emphasis on complete dentures use with the daily consumption of at least 400 g of fruit and vegetables, following the recommendations of the WHO. A random sample of 282 south Brazilians ≥60 years of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behaviour, and health data; consume of fruit and vegetables by means of a 24-h diet recall, and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prosthesis. Multivariate Poisson regression showed that the only variable significantly associated with inadequate consumption of fruit and vegetables was edentulism with the use of only one denture [PR=1·75 (1·11-2·74)]. Edentulous participants wearing only one denture were less likely to consume at least 400 g day(-1) of fruit and vegetables. These results indicate that, in edentulous community-dwelling elderly, oral health rehabilitation might play an important role in the maintenance of consumption of adequate amounts of fruit and vegetables, which is an important component of a healthy diet and also in the prevention of chronic diseases.

Psychological distress in Brazilian caregivers of relatives with dementia.

The authors evaluated stress, anxiety, depression, and feelings of hopelessness in caregivers of relatives with dementia. One hundred and twenty-nine caregivers and 145 non-caregivers who lived in metropolitan Porto Alegre, Brazil completed Lipp's Inventory of Stress Symptoms for Adults, (ISSL), and Beck's Anxiety (BAI), Depression (BDI), and Hopelessness (BHS) scales. Caregivers showed higher levels of anxiety, depression, hopelessness, resistance/pre-exhaustion stress than controls. This study indicates that constant caregiving may significantly increase the risk of physical and mental health problems for caregivers in Brazil.

Stress, cortisol, and periodontitis in a population aged 50 years and over.

Periodontitis and its relationship with psycho-neuro-immunological variables, such as psychological stress and cortisol, have been little explored. The objective of this study was to evaluate the extent and severity of chronic periodontitis and its association with the levels of salivary cortisol and the scores obtained with a stress questionnaire in a population aged 50 years and over. We studied 235 individuals in a cross-sectional study. They answered the Lipp's Inventory of Stress Symptoms for Adults, were instructed to collect three saliva samples for cortisol analysis, and were examined for evaluation for periodontitis. Based on logistic regression, cortisol levels were positively associated with the following outcomes: means of clinical attachment level (CAL) > = 4 mm [OR = 5.1, 95%CI (1.2, 20.7)]; 30% of sites with CAL > = 5 mm [OR = 6.9, 95%CI (1.7, 27.1)]; and 26% of sites with probing depth > = 4 mm [OR = 10.7, 95%CI (1.9, 54.1)] after adjustment for confounding variables. The results suggest that cortisol levels were positively associated with the extent and severity of periodontitis.