Early Childhood Predictors for Dental Caries: A Machine Learning Approach.

We aimed to develop and validate caries prognosis models in primary and permanent teeth after 2 and 10 y of follow-up through a machine learning (ML) approach, using predictors collected in early childhood. Data from a 10-y prospective cohort study conducted in southern Brazil were analyzed. Children aged 1 to 5 y were first examined in 2010 and reassessed in 2012 and 2020 regarding caries development. Dental caries was assessed using the Caries Detection and Assessment System (ICDAS) criteria. Demographic, socioeconomic, psychosocial, behavioral, and clinical factors were collected. ML algorithms decision tree, random forest, and extreme gradient boosting (XGBoost) were employed, along with logistic regression. The discrimination and calibration of models were verified in independent sets. From 639 children included at the baseline, we reassessed 467 (73.3%) and 428 (66.9%) children in 2012 and 2020, respectively. For all models, the area under receiver operating characteristic curve (AUC) at training and testing was above 0.70 for predicting caries in primary teeth after 2-y follow-up, with caries severity at the baseline being the strongest predictor. After 10 y, the SHAP algorithm based on XGBoost achieved an AUC higher than 0.70 in the testing set and indicated caries experience, nonuse of fluoridated toothpaste, parent education, higher frequency of sugar consumption, low frequency of visits to the relatives, and poor parents' perception of their children's oral health as top predictors for caries in permanent teeth. In conclusion, the implementation of ML shows potential for determining caries development in both primary and permanent teeth using easy-to-collect predictors in early childhood.

Pathways between Social Capital and Oral Health from Childhood to Adolescence.

This study aimed to evaluate the theoretical pathways by which social capital can influence dental caries and oral health-related quality of life (OHRQoL) of children over time. This 10-y prospective cohort started in 2010 with a sample of 639 preschoolers aged 1 to 5 y from the southern Brazil. Community and individual social capital were assessed at baseline through the presence of formal institutions in the neighborhood and social networks, respectively. In the 10-y follow-up, the individual social capital was evaluated by social trust and social networks. Dental caries was measured by the International Caries Detection and Assessment System (ICDAS), and the short version of the Child Perception Questionnaire (CPQ11-14) was used to assess OHRQoL. Demographic, socioeconomic, behavioral (frequency of toothbrushing and use of dental services), and psychosocial (sense of coherence) characteristics were also assessed. Structural equation modeling was used to evaluate the associations between variables over time. About 429 children were reassessed at 10-y follow-up (67.1% cohort retention rate). High community social capital at baseline directly predicted lower occurrence of dental caries and better OHRQoL after 10 y. Social capital at community level also indirectly predicted lower occurrence of dental caries through sense of coherence, frequency of toothbrushing, and use of dental services. Individual social capital at follow-up was indirectly linked to OHRQoL via the psychosocial pathway (sense of coherence). Community-level social capital was associated with dental caries and OHRQoL over time. The relationship between individual social capital and oral health was mediated through the psychosocial pathway.

Is secondhand smoke exposure associated with poor periodontal status in children and adolescents? A systematic review and meta-analysis.

PURPOSE: We aimed to systematically evaluate whether SHS exposure is associated with poor periodontal status in individuals up to 15 years. METHODS: Seven databases were searched by two independent reviewers according to pre-specified eligibility criteria up to November 2021. The methodological quality of included studies was appraised using The Newcastle-Ottawa Scale and GRADE was used for assessing the certainty of evidence. Random-effects pairwise meta-analyses compared the periodontal status of those exposed and unexposed to SHS through standardized mean differences (SMDs) and associated confidence intervals (95% CI). RESULTS: Eight cross-sectional studies were eligible for inclusion and two present high methodological quality. All studies contributed to the meta-analysis for gingival index scores (GI) and four for probing pocket depth (PPD). Those exposed exhibited significantly higher levels of GI compared to unexposed (SMD = 1.03, 95% CI 0.17-1.89), but no difference was observed for PPD (SMD = 0.34, 95% CI - 0.14-0.82), with overall very low certainty on evidence. CONCLUSION: Therefore, very low certainty evidence supports that children and adolescents exposed to SHS possibly present poorer periodontal status due to higher levels of GI.

Can a School-Based Intervention Improve the Oral Health-Related Quality of Life of Brazilian Children?

INTRODUCTION: Evidence of the effectiveness of oral health promotion strategies among children from different socioeconomic backgrounds is necessary to support the implementation of public health interventions. OBJECTIVES: This study aimed to test the effectiveness of a school-based intervention to enhance the sense of coherence (SOC) and oral health-related quality of life (OHRQoL) of socially vulnerable Brazilian children. Furthermore, we explored the pathways by which the intervention may improve OHRQoL and SOC, assessing the direct and indirect pathways among demographic, clinical, socioeconomic, behavioral, and psychosocial variables. METHODS: In this cluster-randomized trial, 5 primary schools in Brazil were randomly allocated into intervention and control groups. The intervention comprised 7 sessions of SOC-based activities over 2 mo, which focused on making the school environment a place to develop children's SOC through involving teachers, school staff, and children. Trained teachers delivered the intervention. OHRQoL and SOC data were collected at baseline, 2 wk after the intervention, and at 3-mo follow-up. RESULTS: Information about oral clinical conditions, socioeconomic status, OHRQoL, and SOC was obtained from 356 children aged 8 to 14 y (165 in the intervention group and 191 in the control group). Children from the SOC-based intervention group reported fewer impacts of their oral health on their daily lives (Child Perceptions Questionnaire mean, 7.22) than those from the control group (9.14). The intervention group also reported greater improvement of SOC at 2 wk (SOC mean, 52.98) and 3 mo (52.75) than the control group (52.21 and 51.65, respectively). CONCLUSION: The intervention was effective in improving SOC and OHRQoL among socially vulnerable Brazilian children. Moreover, SOC was a relevant predictor for oral symptom and functional status in this population (Brazilian Clinical Trials Registry RBR-2N9NHJ). KNOWLEDGE TRANSFER STATEMENT: Clinicians and policy makers can use the results of this study to decide which approach to use when planning public health policy to improve the SOC and OHRQoL of socially vulnerable children. Our findings can assist policy makers in making more appropriate community health decisions in school environments that will improve community empowerment.

The use of crack and other illicit drugs impacts oral health-related quality of life in Brazilians.

OBJECTIVE: The aim of this study was to investigate the impact of the use of crack and other illicit drugs on oral health-related quality of life (OHRQoL) in young adults. METHODS: This cross-sectional study evaluated 106 crack users at a public treatment center for drug addiction and 106 controls matched for gender, age, and use of tobacco. Clinical examinations were performed for dental caries and periodontal disease. The outcome was OHRQoL, which was determined using the Oral Health Impact Profile (OHIP-14). The association between OHRQoL and illicit drugs was modeled using conditional Poisson regression. RESULTS: Users of crack and other illicit drugs had a poorer OHRQoL than the controls (p < .001). Among the crack users, the odds ratio to yield high OHIP-14 was 3.40 (95% confidence interval, 1.91-6.08). Adjustment for sex, age, schooling, income, smoking, dental caries, and periodontal disease did not change such an estimate considerably. The functional limitation and psychological discomfort domains were associated with the use of illicit drugs. CONCLUSION: Users of crack and other illicit drugs exerted a negative impact on OHRQoL independently of socio-demographic characteristics and tobacco use, suggesting the need for special attention regarding the specific oral health needs of this population as well as drug prevention and treatment strategies.

Validation of Visual Caries Activity Assessment: A 2-yr Cohort Study.

We evaluated the predictive and construct validity of a caries activity assessment system associated with the International Caries Detection and Assessment System (ICDAS) in primary teeth. A total of 469 children were reexamined: participants of a caries survey performed 2 yr before (follow-up rate of 73.4%). At baseline, children (12-59 mo old) were examined with the ICDAS and a caries activity assessment system. The predictive validity was assessed by evaluating the risk of active caries lesion progression to more severe conditions in the follow-up, compared with inactive lesions. We also assessed if children with a higher number of active caries lesions were more likely to develop new lesions (construct validity). Noncavitated active caries lesions at occlusal surfaces presented higher risk of progression than inactive ones. Children with a higher number of active lesions and with higher caries experience presented higher risk of developing new lesions. In conclusion, the caries activity system associated with the ICDAS presents predictive and construct validity in primary teeth in the assessment of occlusal caries lesions, but predictive validity was not observed in smooth surfaces.

Preliminary results of the survival and fracture load of roots restored with intracanal posts: weakened vs nonweakened roots.

PURPOSE: To evaluate the fracture load and survival rate of weakened and non-weakened roots restored with different intracanal posts. METHODS: Eighty teeth (16 mm) were prepared to a length of 10 mm with a custom drill. Fifty roots were weakened with a tapered diamond drill, and 30 roots were not. The specimens were embedded with acrylic resin up to 3 mm from the coronal aspect, and the periodontal ligament was simulated. The 50 weakened roots were restored with (n=10) CPC-gold (cast post and core made of gold alloy), CPC-Ni (cast post and core made of Ni-Cr alloy), FP (glass fiber posts), FP-W (glass fiber posts with a wider coronal diameter), and FP-CR (fiber posts relined with composite resin). The 30 nonweakened roots were restored with (n=10) CPC-gold, CPC-Ni, and FP. All of the posts were adhesively cemented. All of the specimens were mechanically cycled (37°C, 45°, 130 N, 2.2 Hz, and 1.5 million pulses) and evaluated after every 5 × 10(4) cycles to evaluate the presence of cracks as a primary outcome (event). The specimens that survived cycling were subjected to a fracture load test (load application on the palatal aspect at a 45° inclination). Failure mode was classified as favorable (above the simulated bone level) and catastrophic (below the simulated bone level). Survival rates were estimated using the Kaplan-Meier method. Fracture load data were analyzed using the Kruskal-Wallis test (α=0.05) for weakened roots, one-way analysis of variance, and Tukey test (p<0.05) for non-weakened roots, and Student t-test (p<0.05) compared nonweakened vs weakened roots for the same post system. RESULTS: For the preliminary survival results, FP-W showed a higher survival rate when compared with CPC (gold/Ni). For the fracture load (N), the statistical analysis (p<0.0001) presented differences among the weakened groups: CPC-gold (541.4) = CPC-Ni (642.6) > FP (282.2) = FP-W (274.1) = FP-RC (216.6). No differences were observed for the groups that were nonweakened (majority of favorable failures): CPC-gold (459.3) = CPC-Ni (422.0) = FP (347.9). Weakened roots restored with CPC-gold promoted high values of load fracture and unfavorable failure rates. CONCLUSION: Cast post and cores or fiber posts can be used for restoring nonweakened roots. However, for weakened roots, a fiber post with a wider cervical emerging diameter appears to be a better alternative when compared with cast post and cores.

Influence of maternal dental anxiety on the child's dental caries experience.

This study assessed the influence of maternal dental anxiety-related behavior on the child's caries experience. A cross-sectional study with 608 mother-child dyads during the Children's National Immunization Campaign in Pelotas, Brazil was performed. Mothers were asked to answer a questionnaire and dental examination of the children was performed (dmft). The association assessment used Poisson regression. Children from anxious mothers were more likely to present untreated caries even after covariate adjustment. Boys, older children and low-income family children presented a higher dmft mean. Preventive strategies should focus not only on child and family characteristics, but also on maternal dental anxiety-related behaviors.

Tooth erosion with low severity does not impact child oral health-related quality of life.

BACKGROUND: Prevalence data about tooth erosion has attracted increasing attention in the dental community; however, no study has addressed the impact of this condition on child oral health-related quality of life (COHRQoL). This study assessed the impact of tooth erosion on COHRQoL. METHODS: This study followed a cross-sectional design, with a multistage random sample of 944 11- to 14-year-old children representative of Santa Maria, a southern city in Brazil. They were examined for recording the prevalence and severity of tooth erosion by 2 examiners. Children completed the Brazilian version of Child Perceptions Questionnaire (CPQ(11-14)) and data about socioeconomic variables of the target population were collected by means of a structured questionnaire. The Poisson regression model using robust variance was performed to assess the association between the predictor variables and the outcomes. RESULTS: Prevalence of tooth erosion (7.2%) and severity were low. Poisson regression models showed a distinct gradient in mean CPQ(11-14) scores by socioeconomic indicators. Children with tooth erosion with low levels of severity did not report higher means in the total scores or domains of CPQ(11-14). CONCLUSION: The presence of tooth erosion of low severity did not have a significant negative impact on the children's perception of oral health or on their daily performance.

In vivo effectiveness of laser fluorescence compared to visual inspection and radiography for the detection of occlusal caries in primary teeth.

The purpose of this study was to evaluate the in vivo effectiveness of laser fluorescence compared to visual inspection and radiography for the detection of occlusal caries in primary teeth. Fifty sites from 30 molars in 29 patients were selected and evaluated under standardized conditions by 2 previously trained examiners according to the 3 diagnostic methods. Histological examination served as gold standard after exfoliation or extraction. Values obtained for sensitivity, specificity and accuracy were 0.60, 0.90 and 0.73 for laser fluorescence, 0.82, 0.85 and 0.84 for visual inspection and 0.62, 0.73 and 0.67 for radiography, respectively. Considering only dentinal caries, values were 0.73, 0.95 and 0.90 for laser fluorescence, 0.61, 1.00 and 0.90 for visual inspection and 0.96, 0.81 and 0.85 for radiography, respectively. We conclude that for the detection of occlusal caries in primary molars laser fluorescence presents a similar accuracy when compared to visual inspection and radiography, although visual inspection showed better values for sensitivities for both enamel and dentin lesions.