Oral conditions associated with oral health related quality of life: A population-based cross-sectional study in Brazil.

AIM: To investigate the association between 11 oral conditions and oral health related quality of life (OHRQoL). MATERIALS AND METHODS: This cross-sectional study used a multistage sampling strategy to draw a representative sample of adults aged ≥35 years living in Porto Alegre, Brazil. OHRQoL was assessed using OHIP-14. Oral examinations were conducted to assess gingivitis, dental calculus, tooth loss, gingival recession (GR), dentine hypersensitivity (DHS), dental caries (DFT), dental erosion, and non-carious cervical lesions (NCCL). Questionnaires recorded the following self-reported oral variables: xerostomia, halitosis, and perceived need for dental treatment. Structural Equation Models were used to assess the associations adjusting to demographic and behavioral variables. RESULTS: 1022 individuals were analyzed. The overall OHIP mean equaled 9.2 ± 9.7 points. Xerostomia [coefficient (coef)=0.10], halitosis (coef=0.28), DFT (coef=0.16), and DHS (coef=0.19) were significantly and directly associated with negative impacts of OHIP-14. GR was significantly and indirectly associated with poor OHRQoL due to higher DHS. Perceived need for dental treatment was significantly and directly associated with higher OHIP-14 (coef=0,40). CONCLUSIONS: Poor OHRQoL was observed in a sample of Brazilian adults and old people. Five important oral conditions were associated to poor OHRQoL. Tooth loss, gingivitis, calculus, dental erosion and NCCL did not associate with OHRQoL. CLINICAL SIGNIFICANCE: Poorer oral health related quality of life is observed in a Brazilian urban area compared to other parts of the world. Xerostomia, halitosis, dental caries, gingival recession, and dentine hypersensitivity may be targeted to improve oral health and consequently oral health related quality of life.

Changes in gingivitis and protective factors among adults: A 4-year prospective population-based study.

OBJECTIVES: There are limited longitudinal data regarding gingival inflammation in adults. This study aimed to assess changes in gingivitis over 4 years and to determine protective factors. METHODS: A representative sample of 1023 adults living in Porto Alegre, Brazil, was obtained in the Caries-Perio Collaboration Study. At follow-up, 402 individuals were re-examined. Gingivitis was assessed by the gingival bleeding index (GB) at both time points. Individuals were dichotomized into those showing reductions ≥ 15% and those showing reductions < 15% or increase in bleeding sites. Multivariable Poisson regression models were fitted with 11 possible risk factors, estimating relative risks (RR) and 95% confidence intervals (95% CI). RESULTS: Percentage of individuals with GB ≥ 10% reduced from 72.4% to 53.8%. Bleeding sites significantly reduced (25.9%-20.1%), and in a higher magnitude in buccal/palatal sites (34.1%-24.0%). 31.0% of individuals presented GB reduction ≥ 15% in all sites. Toothbrushing ≥ 3 times/d increased 72% the probability of ≥15% GB reduction compared with ≤1/d (RR = 1.72; 95% CI 1.01-3.16). For each 10 pack-years smoked, the probability of ≥15% GB reduction was 3% higher (RR = 1.03; 95% CI: 1.01-1.04). At buccal/palatal sites, normal weight individuals had 26% higher probability of reducing GB than overweight-obese individuals (RR = 1.26; 95% CI: 1.01-1.62). A 5% higher decrease in GB sites was observed in the absence than the presence of periodontitis. Younger individuals had higher reduction in GB sites. CONCLUSIONS: In the studied population, gingivitis reduced over time, with younger age, better oral hygiene, absence of periodontitis and normal weight being found to be protective factors. Smoking was associated with lower levels of gingivitis over time, probably due to its vasoconstrictive effect.

Incidence and progression of gingival recession over 4 years: A population-based longitudinal study.

AIM: To describe changes in gingival recession (GR) at buccal and palatal sites in adults over an average follow-up of 4 years. MATERIALS AND METHODS: Baseline data were obtained from a multistage probabilistic representative sample of 1023 individuals aged ≥35 years from Porto Alegre, Brazil. Buccal and palatal/lingual GR were analysed. RESULTS: 402 individuals (6,862 teeth) were followed. At baseline, 3,356 (48.9%) teeth did not have GR at the buccal site and 1206 developed the condition overtime (incidence =35.9%; 95% CI 32.6-38.9). Percentage of incident teeth was higher among individuals with (42.3%) than those without (29.5%) periodontitis stages III/IV. Also, 38.5% of teeth with proximal attachment loss at follow-up had incident GR compared to 7.6% of those without proximal attachment loss. Incidence of palatal GR was observed in 32.5% of teeth (95% CI 29.7-35.3). Mean buccal and palatal/lingual GR incidence was 2.11 mm and 2.33 mm, whereas buccal and palatal/lingual GR progression equalled 0.40 mm and 0.48 mm. The prevalence of GR ≥3 mm increased in individuals with (from 35.9% to 47.4%) and without (from 25.2 to 41.5%) periodontitis. CONCLUSION: Incidence and progression of GR are high in a general urban Brazilian population of adults.

Gingival recession and oral health-related quality of life: a population-based cross-sectional study in Brazil.

OBJECTIVES: To assess the association between gingival recession (GR) and oral health-related quality of life (OHRQoL) in a Brazilian population of adults. METHODS: A representative sample from Porto Alegre city was drawn in 2011 using a multistage probability sampling strategy. For this study, 740 individuals, 35-59 years of age and with ≥6 teeth, were included. GR was assessed by two calibrated examiners at four sites in all present teeth. The Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL. OHIP-14 was dichotomized using 'fairly often' as the cutoff point for a negative impact. Multiple logistic regression models were fitted to define which descriptors of GR were associated with the dichotomous outcome of OHIP-14, including dentine hypersensitivity in separate models, adjusting for age, gender, socioeconomic status, smoking, dental care, and missing teeth. RESULTS: Mean OHIP was significantly higher for individuals with ≥1 tooth with GR ≥2, ≥3, ≥4, and ≥5 mm. Individuals with ≥1 tooth with GR ≥2 mm had approximately two times higher chance of having a negative impact than individuals without GR of this threshold [odds ratio (OR) = 1.99, 95% confidence interval (CI) 1.05-3.78]. When buccal and proximal sites were analyzed separately, the presence of GR was significantly associated with worst quality of life only in anterior and not in posterior teeth. GR in the lower arch had no impact on OHRQoL. GR ≥2 mm affected only physical pain (OR = 2.61; 95% CI 1.06-6.42), whereas GR ≥4 mm affected functional limitation, physical pain, psychological discomfort, physical and psychological disabilities, with ORs ranging from 1.43 to 1.91. Dentine hypersensitivity alone was not associated with OHRQoL, but it modified the association between GR and OHIP when present concomitantly with GR, mainly in buccal sites. CONCLUSIONS: OHRQoL is poorer in this adult population in the presence of GR, mainly in upper and anterior teeth. Dentine hypersensitivity and esthetics were found to be factors linking GR to OHRQoL.

Estimates and multivariable risk assessment of gingival recession in the population of adults from Porto Alegre, Brazil.

AIM: To describe estimates and determine risk indicators of gingival recession in the urban population of Porto Alegre, Brazil. MATERIALS AND METHODS: A representative sample of 1023 adults 35 years and older was obtained using a multistage probability sampling strategy. A structured questionnaire was applied and a clinical examination was performed at four sites of all teeth present. Complex survey commands were used for the estimation of gingival recession (GR) and during risk assessment. RESULTS: GR ≥1 mm affected 99.7% of subjects. The percentage of subjects with ≥1 tooth with GR ≥3 mm and ≥5 mm was 75.4% and 40.7%, respectively. 67.6%, 27.8% and 9.5% of teeth per subject showed GR ≥1 mm, ≥3 mm and ≥5 mm, respectively. Older age, male gender, smoking exposure, poor self-reported oral hygiene, history of periodontal treatment and high percentage of calculus were significant risk indicators for GR found after multivariable risk assessment. When buccal GR was analysed separately, only gender, age, smoking and high education were significant risk indicators for GR, whereas variables related to oral hygiene were not associated. CONCLUSION: GR is highly prevalent in this Brazilian population. Preventive strategies for GR may target a variety of socio-demographic, behavioural and clinical risk indicators.

Prevalence and risk indicators of dentin hypersensitivity in adult and elderly populations from Porto Alegre, Brazil.

BACKGROUND: Dentin hypersensitivity (DH) is a clinical condition with potential implications for patients. However, little is known about its occurrence and determinants in the general population. The aim of this study is to assess the prevalence and risk indicators of DH in Porto Alegre, Brazil. METHODS: A representative multistage probability sample of 1,023 adults aged ≥ 35 years was obtained. Individuals were interviewed and clinically examined in their homes. DH was assessed dichotomously in all present teeth by a blast of air and a manual probe. Teeth restored with crowns and presenting with carious cavitation were excluded. Survey logistic regression using sampling weights was applied to assess demographics and behavioral and clinical determinants. RESULTS: Overall prevalence estimates for DH diagnosed by air and probe were 33.4% and 34.2%. DH affected ≈ 1 tooth per individual, and approximately 10% of teeth with gingival recession (GR) had DH. In a multivariable model for DH diagnosed with air, females had increased chance of DH (odds ratio [OR] = 2.14; 95% confidence interval [CI] = 1.57 to 2.91). Smoking, periodontal treatment, and GR were also associated with increased DH risk. The chance of DH was lower (OR = 0.47, 95% CI = 0.29 to 0.76) among individuals ≥ 60 than among those aged 35 to 49 years. Oral hygiene practices, socioeconomic and education status, dental visits, and gingival inflammation were not associated with DH. CONCLUSIONS: DH may be considered a concern in a Brazilian general population. Reduction of DH may be achieved by smoking cessation and periodontal health improvements.