Contextual and individual factors associated with traumatic dental injuries in deprived 12-year-old schoolchildren: A cohort study.

AIM: Traumatic dental injuries (TDIs) among children and adolescents have been acknowledged as of public health concern worldwide. The aim of the study was to assess the relationship between contextual and individual characteristics and TDIs in 12-year-old schoolchildren. MATERIALS AND METHODS: A cohort study was conducted with 355 schoolchildren living in deprived communities in the city of Manaus, Brazil. Contextual factors (place of residence and socio-economic indicators) and individual characteristics, including sex, family income, parents/guardians years of schooling, overjet and open bite (Dental Aesthetic Index), self-esteem (Rosenberg Self-Esteem Scale), sense of coherence (Sense of Coherence Scale), oral health beliefs, social support (Social Support Appraisals) were assessed at baseline. TDIs were measured at baseline and at 2-year follow-up using the O'Brien Index. Data were analysed through confirmatory factor analysis and structural equation modeling. RESULTS: The baseline prevalence of TDIs was 17.6% and the incidence of TDIs at 2-year follow-up was 26.8%. Better psychosocial status had a direct protective effect on the incidence of TDIs (ß = -.184). Better contextual characteristics (ß = -.135) and greater overjet (ß = -.203) were directly associated with poor psychosocial status. Higher schooling of parents/guardians directly predicted better psychosocial status (ß = .154). Psychosocial status mediated the relationship of greater overjet (ß = .036), contextual factors (ß = .024) and parental/guardian schooling (ß = -.027) with TDIs. CONCLUSIONS: Contextual factors and individual characteristics predicted TDIs. Psychosocial status was a relevant individual attribute in the causal network of TDIs, due to the direct effect on the incidence of TDIs as well as a mediator on the influence of contextual factors, overjet and parents/guardians schooling on the incidence of TDIs.

Prevalence of dental caries, periodontal disease, malocclusion, and tooth wear in indigenous populations in Brazil: a systematic review and meta-analysis.

The aim of this review was to evaluate the prevalence of dental caries, periodontal disease, malocclusion, and tooth wear in indigenous in Brazil. A systematic review of observational studies was performed according to the PRISMA guidelines (CRD42020218704). The search strategy involved the electronic databases of Embase, LILACS, PubMed, Web of Science, Scopus, and the CAPES Theses and Dissertations for gray literature. The eligibility criteria consisted of publications that assessed the prevalence of oral conditions in indigenous populations in Brazil. Studies with indigenous people living in urban area were excluded. The risk of bias was evaluated by using JBI Critical Appraisal for prevalence studies. Thirty studies were included in the review, and the majority showed a low risk of bias. A meta-analysis of 20 studies was conducted using the random-effects model and a 95% confidence interval. Several ethnicities were studied in isolation or in groups (n = 7,627 for dental caries; n = 2,774 for periodontal disease; n = 1,067 for malocclusion; n = 150 for tooth wear). The prevalence of caries ranged from 50% among indigenous people aged 18-36 months to 100% among those aged 65-74 years. The prevalence of periodontal disease ranged from 58% to 83%. The prevalence of malocclusion was 43%. Tooth wear was assessed in only one ethnic group and showed a prevalence of 100% in indigenous people aged >18 years. The certainty of evidence assessed by the GRADE system ranged from very low to moderate. This systematic review showed significant differences in the prevalence of dental caries, periodontal disease and malocclusion between indigenous population groups and territories in which indigenous people live.

Does using the sociodental approach in oral health care influence use of dental services and oral health of adolescents living in deprived communities? a one-year follow up study.

BACKGROUND: Oral health needs assessment is important for oral health care planning. This study compared dental treatment needs between normative and sociodental needs. We also longitudinally examined the relationships of baseline sociodental needs measures and socioeconomic status with one-year follow up measures of use of dental services, dental caries, filled teeth, and oral health-related quality of life (OHRQoL). METHODS: A prospective study was conducted with 12-year-old adolescents from public schools in deprived communities in the city of Manaus, Brazil. Validated questionnaires were used to collect adolescents' sex and socioeconomic status, OHRQoL (CPQ11 - 14) and behaviours (sugar intake, frequency of toothbrushing, regular use of fluoridated toothpaste and pattern of dental attendance). Normative need was assessed according to decayed teeth, clinical consequences of untreated dental caries, malocclusion, dental trauma, and dental calculus. The relationships between variables were tested thorough Structural equation modelling. RESULTS: Overall 95.5% of adolescents had normative dental treatment needs. Of these, 9.4% were classified as high level of propensity. Higher normative/impact need and greater propensity-related need directly predicted use of dental services at one-year follow up. The latter mediated the association of normative/impact need and propensity-related need with incidence of dental caries and filled teeth. Normative/impact need and use of dental services were directly associated with filled teeth at one-year follow up. Poor OHRQoL at one-year follow-up was directly predicted by higher normative/impact need at baseline and less filled teeth at one-year follow up. Greater socioeconomic status was directly associated with better propensity-related need. Socioeconomic status indirectly predicted incidence of dental caries and filled teeth via propensity-related need and use of dental services. CONCLUSIONS: Sociodental needs measures were related to use of dental services, dental caries, filled teeth and OHRQoL after one year among adolescents living in deprived communities. Adolescents with dental needs treatment priorities according to the sociodental approach had more filled teeth via use of dental services. Dental services utilisation did not attenuate the impact of normative and impact-related need on dental caries incidence and poor OHRQoL after one year. Our findings suggest the importance of developing oral health promotion and enhancing access to dental care to improve oral health of adolescents living in deprived communities.

Socio-economic status, psychosocial factors, health behaviours and incidence of dental caries in 12-year-old children living in deprived communities in Manaus, Brazil.

OBJECTIVES: This study examines the relationships between socio-economic status, psychosocial factors, health-related behaviours and the incidence of dental caries amongst 12-year-old schoolchildren living in deprived communities in Manaus, Brazil. METHODS: A longitudinal study involving 312 children aged 12 years was conducted in the city of Manaus, Brazil. Baseline data including socio-economic status (number of goods, household overcrowding, parents' schooling, family income), psychosocial factors (sense of coherence [SOC-13], social support [Social Support Appraisals questionnaire]) and health-related behaviours (frequency of toothbrushing, sugar consumption, sedentary behaviour) were collected through structured questionnaires. The number of decayed teeth was clinically assessed at baseline and one-year follow-up. A hypothesised model evaluating the direct and indirect pathways between the variables was tested using confirmatory factor analysis and structural equation modelling. RESULTS: The incidence of dental caries at the one-year follow-up was 25.6%. Sugar consumption (ß = 0.103) and sedentary behaviour (ß = 0.102) directly predicted the incidence of dental caries. A higher socio-economic status was directly linked with lower sugar consumption (ß = -0.243) and higher sedentary behaviour (ß = 0.227). Higher social support directly predicted lower sugar consumption (ß = -0.114). Lower socio-economic status (ß = -0.046) and lower social support (ß = -0.026) indirectly predicted the incidence of dental caries via sugar consumption and sedentary behaviour. CONCLUSIONS: In the population studied, sugar consumption and sedentary behaviour are meaningful predictors of the incidence of dental caries amongst schoolchildren living in deprived communities. Indirect pathways of lower socio-economic status and low social support with dental caries incidence via sugar consumption and sedentary behaviour were detected. These findings should be considered in oral interventions and oral health care policies to prevent dental caries amongst children living in deprivation. CLINICAL SIGNIFICANCE: Social conditions, social support, sedentary behaviour and sugar consumption directly influence dental caries in children.

Prevalence of dental caries, periodontal disease, malocclusion, and tooth wear in indigenous populations in Brazil: a systematic review and meta-analysis

Abstract The aim of this review was to evaluate the prevalence of dental caries, periodontal disease, malocclusion, and tooth wear in indigenous in Brazil. A systematic review of observational studies was performed according to the PRISMA guidelines (CRD42020218704). The search strategy involved the electronic databases of Embase, LILACS, PubMed, Web of Science, Scopus, and the CAPES Theses and Dissertations for gray literature. The eligibility criteria consisted of publications that assessed the prevalence of oral conditions in indigenous populations in Brazil. Studies with indigenous people living in urban area were excluded. The risk of bias was evaluated by using JBI Critical Appraisal for prevalence studies. Thirty studies were included in the review, and the majority showed a low risk of bias. A meta-analysis of 20 studies was conducted using the random-effects model and a 95% confidence interval. Several ethnicities were studied in isolation or in groups (n = 7,627 for dental caries; n = 2,774 for periodontal disease; n = 1,067 for malocclusion; n = 150 for tooth wear). The prevalence of caries ranged from 50% among indigenous people aged 18-36 months to 100% among those aged 65-74 years. The prevalence of periodontal disease ranged from 58% to 83%. The prevalence of malocclusion was 43%. Tooth wear was assessed in only one ethnic group and showed a prevalence of 100% in indigenous people aged >18 years. The certainty of evidence assessed by the GRADE system ranged from very low to moderate. This systematic review showed significant differences in the prevalence of dental caries, periodontal disease and malocclusion between indigenous population groups and territories in which indigenous people live.

Psychometric Properties of the Brazilian Version of GOHAI among Community-Dwelling Elderly People.

This study assessed the psychometric properties of the Brazilian version of the Geriatric Oral Health Assessment Index (GOHAI). A representative sample of 613 community-dwelling elderly people aged from 65 to 74 years was selected. Sociodemographic data, GOHAI and self-perceived oral health measures were collected. Dental clinical measures were obtained through oral examinations. The dimensional structure and adequacy of components were assessed using Confirmatory Factor Analysis (CFA), inter-item correlations and item-scale correlations. Reliability was evaluated by internal consistency and Intraclass Correlation Coefficients. Correlations between GOHAI scores and self-reported oral health measures were conducted to assess convergent validity. The relationship between dental clinical measures and GOHAI was tested through Poisson Regression to examine discriminant validity. The link between GOHAI items and dimensions was supported by CFA. Item 12 showed a poor factor loading. The inter-item correlations varied from 0.047 to 0.442, and item-scale correlations ranged from 0.305 to 0.612. Cronbach's alpha was 0.704. The test-retest correlation for GOHAI was 0.882. GOHAI scores were correlated by self-rated oral health measures. Poor dental clinical measures were associated with GOHAI. The Brazilian version of GOHAI showed adequate psychometric properties. However, the weak dimensional structure of GOHAI suggests the need to perform cross-cultural adaptation of GOHAI for Brazilian elderly people.

The role of dental pain and psychosocial factors on the relationship between dental caries and oral health-related quality of life in children.

BACKGROUND: To examine the role of dental pain, sense of coherence (SOC) and social support on the relationship between dental caries and oral health-related quality of life (OHRQoL) in children aged 12 years. METHODS: A cross-sectional study involving 400 schoolchildren selected from public schools in a socioeconomically disadvantaged region in the city of Manaus, Brazil was carried out. The predictors of OHRQoL were selected according to the Wilson and Cleary theoretical model, including number of decayed teeth and its clinical consequence (component D of the DMFT index and PUFA/pufa index), dental pain (symptom status), and SOC and social support (individual and environmental characteristics). Statistical analysis was conducted through structural equation modelling and multivariable negative binomial regression. The significance level established for all analyses was 5%. RESULTS: Number of dental caries was indirectly linked with OHRQoL (ß = 0.19, 95% CI 0.11/0.29) through dental pain, SOC and social support. Clinical consequences of untreated caries directly predicted poor OHRQoL (ß = 0.12, 95% CI 0.01/0.23). Dental pain, SOC and social support did not moderate the effect of dental caries measures on OHRQoL. CONCLUSION: Our findings suggest the role of dental pain, SOC and social support as mediator factors on the link between dental caries and OHRQoL. Tackling dental caries along with psychosocial factors may attenuated the impact of oral health on OHRQoL in children.

Fluoride toothpaste, sanitary surveillance and the SUS: the case of Manaus-AM, Brazil.

OBJECTIVE: To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS: Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS: The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION: We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

Fluoride toothpaste, sanitary surveillance and the SUS: the case of Manaus-AM, Brazil / Dentifrício fluoretado, vigilância sanitária e o SUS: o caso de Manaus-AM

ABSTRACT OBJECTIVE To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

RESUMO OBJETIVO Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorofosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à resolução ANVISA RDC Nº 530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

The influence of change on sense of coherence on dental services use among adolescents: a two-year prospective follow-up study.

BACKGROUND: To investigate the influence of change on sense of coherence (SOC) on dental services use in adolescents over a two-year period. METHODS: A prospective follow-up study was conducted involving 334 12-year-old adolescents from public schools in the city of Manaus, Amazonas, Brazil. The predictors of use of dental services in the last 12 months were selected according to the Andersen's behavioural theoretical model. The predisposing factors included sex, self-reported skin colour and SOC. The enabling factors were dental insurance, monthly family income and parents/guardians schooling. Dental pain, perceived oral health status, dental caries and gingival status were used to assess need factors. Multivariable Poisson regression with robust variance was used to estimate incidence-rate ratios (IRR) and 95% confidence intervals between the independent variables and use of dental services. RESULTS: Adolescent's SOC scores decreased significantly between baseline and one-year follow-up. SOC decline decreased the likelihood of using dental services in the last 12 months (IRR = 0.96 95%CI 0.92-0.99). Dental caries (IRR = 1.03 95%CI 1.01-1.04) and gingival bleeding (IRR = 1.01 95%CI 1.01-1.02) remained associated with use of dental services in the last 12 months. Adolescents with dental pain were more likely to have visited a dentist in the last year (IRR = 1.03, 95%CI 1.01-1.06). CONCLUSION: SOC decrease over one-year period was a meaningful factor of dental services use among 12-year-old adolescents. Dental pain and clinical conditions were also relevant factors that can influence use of dental services in this group.

Clinical consequences of untreated dental caries and school performance in low-income adolescents.

BACKGROUND: The possible link between dental status and school performance has been investigated. The influence of the clinical consequences of untreated dental caries in this association, however, has been minimally explored. AIM: To assess the relationship between clinical consequences of untreated dental caries and school performance in adolescents, and to examine the demographics and socioeconomic status pathways by which clinical consequences of untreated dental caries is associated with school performance. DESIGN: A cross-sectional study involving 363 low-income school adolescents was conducted in the city of Manaus, Brazil. Dental clinical measures were registered by five calibrated examiners to evaluate dental caries experience (decayed, missing, and filled teeth index [DMFT]) and clinical sequelae of dental caries (PUFA/pufa index). School performance was assessed using school grade history obtained from official records. Statistical analysis was conducted using pathway analysis to estimate beta coefficients (ß) of the direct and indirect effects between variables. RESULTS: DMFT and PUFA/pufa mean were 1.93 and 0.30, respectively. PUFA/pufa scores (ß = -0.19) and male sex (ß = 0.35) directly predicted poor school performance. DMFT was indirectly linked to poor school performance via PUFA/pufa scores (ß = -0.03). CONCLUSIONS: Dental caries and clinical consequences of dental caries were important predictors of poor school performance in low-income adolescents via direct and indirect effects.

Clinical Consequences of Untreated Dental Caries, Individual Characteristics, and Environmental Factors on Self-Reported Oral Health Measures in Adolescents: A Follow-Up Prevalence Study.

BACKGROUND/AIMS: This study evaluated the relationships of clinical consequences of untreated dental caries, individual characteristics, and environmental factors on self-reported oral health measures in adolescents. METHODS: A follow-up prevalence study was conducted involving 406 twelve-year-old adolescents selected from public schools in the eastern area of the city of Manaus, Brazil. Baseline data included clinical consequences of untreated caries (PUFA/pufa index), DMFT, sociodemographic characteristics (sex, parental schooling, and family income), psychosocial factors (sense of coherence [SOC-13 scale], oral health beliefs and self-esteem [Rosenberg Self-Esteem Scale]), and social support (SSA questionnaire). Oral health-related quality of life (OHRQoL [CPQ11-14]) and self-rated oral health were assessed at the 6-month follow-up. Structural equation modelling was used to explore the relationships between variables according to the Wilson and Cleary model. RESULTS: The prevalence of PUFA/pufa was 17.8% and mean DMFT was 1.5. The number of teeth with clinical consequences of untreated caries predicted poor self-rated oral health at the 6-month follow-up. Low parental schooling predicted low family income and clinical consequences of untreated dental caries. Psychosocial factors predicted OHRQoL directly and self-rated oral health indirectly. OHRQoL was linked to self-rated oral health. Clinical consequences of untreated dental caries mediated the relationship of parental schooling with OHRQoL and self-rated oral health. OHRQoL mediated the relationship of psychosocial factors and sex with self-rated oral health. Clinical consequences of untreated dental caries was associated with adolescents' self-rated oral health. Furthermore, the former was an important mediator on the link between low parental education and adolescents' self-reported oral health measures. CONCLUSIONS: Socioeconomic status, psychosocial factors, and social support were related to OHRQoL and self-rated oral health via direct and indirect pathways.

The role of socioeconomic status and psychosocial factors on gingivitis in socially disadvantaged adolescents.

BACKGROUND: Evidence on the possible influence of social and psychosocial factors on gingival status in socially disadvantaged children is scarce. The aim of this study is to assess the relationships among socioeconomic status, pattern of dental visits, self-esteem, oral health beliefs, toothbrushing frequency, oral hygiene effectiveness, and gingivitis in low social status adolescents. METHODS: A cross-sectional study was performed involving 406 12-year-old students recruited in Manaus, Brazil. Socioeconomic status (family income, parent's schooling, number of goods, and household crowding), self-esteem, oral health beliefs, and frequency of toothbrushing were collected through self-completed questionnaires. Gingival status (bleeding on probing) and oral hygiene effectiveness (dental calculus) were evaluated by calibrated dentists through oral examinations. Structural equation modeling assessed the direct and indirect relationships between variables guided by a theoretical model. RESULTS: The prevalence of gingivitis was 77.6%. Worse socioeconomic status and poor oral hygiene effectiveness directly predicted gingival bleeding. Socioeconomic status was also linked to toothbrushing frequency. Positive oral health beliefs and higher self-esteem predicted higher frequency of toothbrushing. The latter was directly linked to greater oral hygiene effectiveness. Oral health beliefs and self-esteem indirectly predicted gingival bleeding via toothbrushing frequency and oral hygiene effectiveness. CONCLUSION: The present findings suggest the importance of socioeconomic status and psychosocial factors on gingival status in underprivileged adolescents. Poor oral hygiene mediated the associations between psychosocial factors and gingival status.

Socioeconomic status, social support, oral health beliefs, psychosocial factors, health behaviours and health-related quality of life in adolescents.

PURPOSE: This study assessed the relationships between socioecononic status (SES), social support, oral health beliefs, psychosocial factors, health-related behaviours and health-related quality of life (HRQoL) in adolescents. METHODS: A school-based follow-up study involving 376 12-year-old adolescents was conducted in Manaus, Brazil. Baseline data included sociodemographic characteristics (sex, parental schooling, family income, household overcrowding and number of goods), social support (SSA questionnaire), oral health beliefs and psychosocial factors (Sense of Coherence [SOC-13 scale] and self-esteem [Rosenberg Self-Esteem Scale]). Health-related behaviours (toothbrushing frequency, sedentary behaviour, smoking and sugar consumption) and HRQoL [KINDL questionnaire] were assessed at 6-month follow-up. Structural Equation Modelling assessed the relationships between variables. RESULTS: Greater social support (ß = 0.30), higher SOC (ß = 0.23), higher self-esteem (ß = 0.23), higher toothbrushing frequency (ß = 0.14) and less smoking (ß = - 0.14) were directly linked with better HRQoL. SES (ß = 0.05), social support (ß = 0.26), oral health beliefs (ß = - 0.02) were indirectly linked to HRQoL. Higher SES directly predicted higher toothbrushing frequency (ß = 0.14) and less smoking (ß = - 0.22). Greater social support also directly predicted higher SOC (ß = 0.55), positive oral health beliefs (ß = - 0.31) and higher self-esteem (ß = 0.58). Greater social support indirectly predicted less smoking via oral health beliefs (ß = - 0.05) and less sugar consumption via SOC (ß = - 0.07). CONCLUSION: Socioeconomic status, social support, oral health beliefs and psychosocial factors were important predictors of adolescent's health behaviours and HRQoL over 6-month period through direct and indirect mechanisms. Health behaviours also directly influenced HRQoL.

Contextual and individual determinants of non-utilization of dental services among Brazilian adults.

OBJECTIVES: To examine the association of contextual and individual determinants with non-utilization of dental services among Brazilian adults. METHODS: Data were from adults aged 35-44 years (N = 7,265) from the 2010 Brazilian Oral Health Survey (SB Brasil Project). Non-utilization of dental services was assessed whether the individual has never had a dental visit over the whole life time. Independent variables were selected according to Andersen's behavioral model. Contextual variables included Human Development Index-longevity (HDI-Longevity) (predisposing demographic), HDI-Education and Gini index (predisposing social), integration of oral health teams into Primary Care (enabling health policy), and HDI-Income (enabling financing). Individual data were age and sex (predisposing demographic), ethnicity and schooling (predisposing social), family monthly income (predisposing enabling), perceived dental treatment (perceived need), and decayed teeth (evaluated need). The relationship of contextual and individual variables with non-utilization of dental services was assessed through multilevel logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (95% CI). RESULTS: The prevalence of non-utilization of dental services was 4.7 percent. Adults living in cities with high HDI-Income were less likely to never have a dental visit. The odds of non-utilization of dental services were lower for adults living in cities with high HDI-Longevity. Sex, skin color, dental treatment needs, poor socioeconomic characteristics, perceived dental treatment needs, and decayed teeth were also associated with non-utilization of dental services. CONCLUSIONS: The results suggest that contextual enabling and predisposing factors, individual sociodemographic, and needs-related characteristics influence non-utilization of dental services by Brazilian adults.

Does oral health influence school performance and school attendance? A systematic review and meta-analysis.

AIM: To examine the evidence on the influence of oral health status on school performance and school attendance in children and adolescents. DESIGN: A systematic review was performed in accordance with PRISMA included epidemiological studies that assessed concomitantly oral health measures, participants' school performance and/or school attendance. Electronic search was conducted on MEDLINE, SCOPUS, Web of Science, ScienceDirect, and LILACS. Studies published up to May 2018 in any language were eligible. The risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis was used to obtain pooled estimates between oral health measures and school performance and school attendance. RESULTS: Eighteen studies were included. Of them, fifteen studies were used for the meta-analyses. Most studies were assessed as moderate quality. Children with one or more decayed teeth had higher probability of poor school performance (OR = 1.44 95%CI: 1.24-1.64) and poor school attendance (OR = 1.57 95%CI: 1.08-2.05) than caries-free children. Poor parent's perception of child's oral health increased the odds of worse school performance (OR = 1.51 95%CI: 1.10-1.92) and poor school attendance (OR = 1.35 95%CI: 1.14-1.57). CONCLUSIONS: Children and adolescents with dental caries and those reporting worse oral health experience poor school performance and poor school attendance.

The Association between Participation of Adolescents in Community Groups and Dental Caries in a Deprived Area in Brazil.

There is limited evidence concerning the role of social networks on the oral health of adolescents. This study assessed the association between the participation of adolescents in community groups and dental caries. A cross-sectional household-based study was carried out involving 200 subjects aged 15-19 years living in a deprived area in the state of Amazon, Brazil. Dental caries was assessed through dental examinations using the DMFT index conducted by a single examiner who was previously calibrated. Four dental caries outcomes were investigated, including caries experience (DMFT score), current caries (number of current decayed teeth), missing teeth due to caries, and the care index (ratio between number of filled teeth and DMFT score). Details of participation of adolescents in community groups, demographic and socioeconomic data and information on dental visiting were obtained through individual interviews. All caries measures were significantly higher in adolescents who did not participate in community groups compared to their counterparts. Multivariate Poisson regression showed that participation of adolescents in community groups was independently associated with all dental caries outcomes. After adjusting for confounders, participation in community groups was statistically associated with lower DMFT score (ratio of mean, RM: 0.33, 95% CI: 0.24-0.46), fewer decayed teeth (RM: 0.23, 95% CI: 0.11-0.47), fewer missing teeth (RM: 0.28, 95% CI: 0.17-0.47), and higher care index (RM: 1.69, 95% CI: 1.24-2.29) than those who did not participate. Participation of adolescents in community activities was related to lower levels of dental caries.