LGB prevalence in schools is associated with unhealthy weight-control behaviors in lesbian, gay, and bisexual youth: a multilevel analysis.

BACKGROUND: Previous studies have found that a school climate of more heteronormativity is associated with adverse effects on the mental health of LGB students. Accordingly, our aim was to assess the association between lower LGB prevalence in schools and unhealthy weight-control behaviors among LGB youth. METHODS: A cross-sectional, multilevel study based in public high schools in the city of Olinda, Northeast Brazil. A multilevel logistic regression was performed, including 2500 adolescents enrolled in 27 schools. The contextual variable was the prevalence of LGB youth in each school (as a proxy for heteronormativity in schools), while the outcome was unhealthy weight-control behaviors (fasting, purging, and taking diet pills). We controlled for socioeconomic characteristics (age, sex, receiving a family allowance), obesity, and self-reported happiness. RESULTS: Lower LGB prevalence in schools was associated with higher odds of engaging in unhealthy weight-control behaviors (OR: 1.5, 95%CI: 1.0, 2.2) among all youth, regardless of sexual orientation. No cross-level interactions between school context and individual characteristics were statistically significant. CONCLUSION: Lower LGB prevalence in schools was associated with a higher risk of unhealthy weight-control behaviors in youth regardless of sexual orientation, which may reflect either the contextual influence of school climate, or may be due to residual confounding.

Denture-related oral mucosal lesions in Alzheimer disease: a case-control study.

The aim of this case-control study was to evaluate the association between denture-related oral mucosal lesions and Alzheimer disease (AD) in older adults (60 years and older). Seventy elderly adults (35 with AD and 35 classified as mentally healthy) were included in this study, which was carried out in a Brazilian medical center. Clinical data on oral lesions and mucosal findings were recorded, including alterations in the color or appearance of any lesions, if present. The influence of possible confounding factors, including sex, age, race, education level, health conditions, harmful habits, gait speed, and oral status (use of removable prostheses and denture hygiene), was analyzed. There was no statistically significant difference between groups in the frequency of denture-related oral mucosal lesions. Logistic regression analysis showed a higher prevalence of AD among individuals aged 80 years and older, those who were illiterate, users of tobacco, and patients with a slower gait. These results suggest that AD is not a risk factor for denture-related oral mucosal lesions.

Bond strength of fiber posts to the root canal: Effects of anatomic root levels and resin cements.

STATEMENT OF PROBLEM: Decementation is one of the most frequent causes of failure in the post-cement system. The bond strength in different parts of the canal may be influenced by technical and anatomic factors. PURPOSE: The purpose of this in vitro study was to assess the effects of anatomic root levels to reach the canal and different resin cements on the bond strength of fiberglass posts along the canal. MATERIAL AND METHODS: One hundred thirty-five roots of bovine teeth were endodontically treated, prepared with 15-mm-long post spaces and divided according to the anatomic root level: coronal (with 15-mm post space), middle (with 10-mm post space), and apical (with 5-mm post space). Fiberglass posts were luted with the cements (n=15): conventional resin cement with 3-step etch-and-rinse adhesive system (RelyX ARC/SBMP); self-adhesive resin cement (RelyX U200) and autopolymerizing resin cement with etch-and-rinse adhesive system (C&B/All-Bond 2). After 24 hours, specimens were sectioned and subjected to the push-out test. The maximum extrusion load was recorded (0.5 mm/minute, 200 N). Data were analyzed with analysis of variance (ANOVA) and the Tukey test (α=.05). Failure mode was analyzed by using multinomial logistic regression. RESULTS: There were no significant effects of resin cements (P>.05). The bond strength at apical third was higher when the canal was reached at the apical level than at the coronal level (P=.022). When each root level was directly reached, the coronal bond strength was lower than apical (P=.001) and middle (P=.021) for all cements. CONCLUSIONS: When the canal was reached at the coronal, medium, and apical levels, the bond strength of conventional, self-adhesive and autopolymerizing resin cements was lower in the coronal root third.

Functional Dentition in Brazilian Adults: An Investigation of Social Determinants of Health (SDH) Using a Multilevel Approach.

OBJECTIVES: Estimate the prevalence of functional dentition among Brazilian adults using four different definitions and identify associated factors. METHODS: A cross-sectional study was conducted involving 9564 Brazilian adults aged 35-44 years who participated in the 2010 National Oral Health Survey. Data collection involved oral examinations and the administration of questionnaires. The following definitions were used: 1-WHO Functional Dentition (FDWHO: ≥ 20 teeth present); 2-well-distributed teeth (WDT: ≥ 10 teeth in each arch); 3 -Functional dentition classified by esthetics and occlusion (FDClass5: dentitions that sequentially exhibit at least one tooth in each arch, at least 10 teeth in each arch, all maxillary and mandibular anterior teeth, three or four premolar posterior occluding pairs [POPs], and at least one molar POP bilaterally); 4-Functional dentition classified by esthetics, occlusion and periodontal status (FDClass6: corresponds to FDClass5 with the addition of periodontal status of all sextants in the oral cavity with, at most, shallow pockets and/or clinical attachment level of 5 mm (CPI ≤ 3 and/or CAL ≤ 1). The independent variables were individual factors (gender, self-declared skin color, schooling, monthly household income, age group, self-rated treatment need, dental pain, dental appointment in the previous 12 months and dental services) and contextual factors (Municipal Human Development Index [MHDI]), Gini coefficient, fluoridated water supply and oral health coverage). Multilevel mixed-effect Poisson regression analyses were performed. RESULTS: The prevalence of functional dentition based on the FDWHO, WDT, FDClass5 and FDClass6 definitions was 77.9%, 72.9%, 42.6% and 40.3%, respectively. Adults with ≥12 years of schooling and monthly household income from US$ 853 to 2557 had higher prevalence rates of FDWHO (PR: 1.41 and 1.10, respectively), WDT (PR: 1.58 and 1.14, respectively), FDClass5 (PR: 2.03 and 1.27, respectively) and FDClass6 (PR: 2.15 and 1.35, respectively). These values in the final models were adjusted for gender, self-declared skin color (FDClass5), age group, self-rated treatment need (FDWHO, FDClass5 and FDClass6), dental appointment in the previous 12 months (FDWHO and WDT), dental services (FDWHO and WDT) and contextual factors. A very high MHDI and presence of fluoridated water supply were associated with higher prevalence rates of the four outcomes. CONCLUSIONS: The incorporation of the criteria of new definitions of functional dentition led to a lower prevalence rate among Brazilian adults. Striking individual and contextual inequalities were identified with regard to the four definitions analyzed, which need to be addressed through inter-sector efforts.

Functional, esthetical, and periodontal determination of the dentition in 35- to 44-year-old Brazilian adults.

AIMS: The aims of the present study were to evaluate oral health status among Brazilian adults aged 35 to 44 years with regard to functional dentition based on four different definitions and classify dentition configurations using a dental functional status classification system. METHODS: The sample was composed of 9564 individuals who participated in the 2010 National Oral Health Survey. The definitions were "well-distributed teeth" concept (WDT), the World Health Organization functional dentition concept (FDWHO), functional dentition classified by esthetics and occlusion (FDClass5), and functional dentition classified by esthetics, occlusion, and periodontal status (FDClass6). Dentitions were classified on six sequential, accumulative levels (anyone reaching level VI necessarily met the criteria on all previous levels): I-≥one tooth in each arch; II-≥10 teeth in each arch (WDT) or ≥20 teeth present (FDWHO); III-all 12 anterior teeth present; IV-≥3 premolar posterior occluding pairs (POPs) present; V-≥one molar POP bilaterally (FDClass5); VI-all sextants with Community Periodontal Index <3 and/or loss of attachment ≤1 (FDClass6). RESULTS: The prevalence rates of the different definitions of functional dentition ranged from 42.6 % (FDClass5) and 40.3 % (FDClass6) to 72.9 % (WDT) and 77.9 % (FDWHO). CONCLUSIONS: The oral health status of Brazilian adults exhibited considerable variation due to the different definitions of functional dentition, and less than half of Brazilian adults met all the criteria of function. CLINICAL RELEVANCE: The indication and planning of prosthetic rehabilitation should not only be based on the absence of teeth but also the distribution and periodontal status of the teeth present.

Prevalence of traumatic dental injuries and its association with binge drinking among 12-year-olds: a population-based study.

OBJECTIVE: To determine the prevalence of traumatic dental injuries and its association with binge drinking among 12-year-old schoolchildren. METHODS: A cross-sectional study was carried out involving 588 students from a medium-sized city in Brazil. Data were collected through a clinical examination and self-administered questionnaires. Andreasen's classification was used for the determination of traumatic dental injuries. The consumption of alcoholic beverages and binge drinking were evaluated using the Alcohol Use Disorders Identification Test--Consumption. Socio-economic status, overjet, and inadequate lip seal were also analysed. Associations were tested using the multivariate logistic regression analysis. RESULTS: The prevalence rates of traumatic dental injuries, alcohol consumption in one's lifetime, and binge drinking were 29.9%, 45.6%, and 23.1%, respectively. The prevalence of traumatic dental injuries was significantly higher among those who engaged in binge drinking (PR = 1.410; 95% CI: 1.133-1.754) and even higher among those with inadequate lip protection and accentuated overjet (PR = 3.288; 95% CI: 2.391-4.522 and PR = 1.838; 95% CI: 1.470-2.298, respectively). CONCLUSIONS: A higher prevalence rate of traumatic dental injuries was found among 12-year-olds who engaged in binge drinking. The high rate of alcohol intake among adolescents is worrisome considering the vulnerability of this population due to the intense transformations that occur in the transition from childhood to adulthood.

The oral health of seniors in Brazil: addressing the consequences of a historic lack of public health dentistry in an unequal society.

OBJECTIVE: National epidemiological data on the oral health of elders was analysed to examine relationships between the need for oral treatment and external environment, the dental care delivery system, personal characteristics and subjective conditions of oral health. BACKGROUND: Brazil's universal public healthcare system is theoretically responsible to provide dental care to Brazilians of all ages. However, as dentists were integrated into public primary care facilities only in 2000, Brazilian seniors have accumulated needs. MATERIALS AND METHODS: Seniors (65-74 years old) were examined and interviewed by calibrated professionals. The association of overall need for oral treatment and component factors were analysed. Associations with socio-demographic factors and self-reported attitudes and behaviours were also calculated. RESULTS: A total of 85.9% of Brazilian seniors demonstrated a need for some oral treatment, 83.8% of the dentate needed periodontal treatment and 57.3% of all seniors needed full or partial prostheses. Social inequalities were also evident as Brazilians using free oral care services demonstrated a higher degree of need, as did elders who had not previously accessed dental services, nonwhites and males. CONCLUSIONS: Our findings demonstrate that the elderly population in Brazil has a very high degree of need in general and that certain subgroups have been especially vulnerable to oral disease.

Validity and reproducibility of the revised oral assessment guide applied by community health workers.

OBJECTIVE: To determine the validity and reproducibility of the Revised Oral Assessment Guide (ROAG) as pre-diagnostic tool used in elderly citizens by community health workers (CHWs) of the Family Health Strategy (FHS). MATERIAL AND METHODS: Initially, we adjusted the English version to Portuguese and then developed a training program for use of ROAG, with the participation of CHWs, in selected districts that had the highest enrolled number of elderly people in the city. The elderly persons were distributed among 10 previously trained CHWs. To assess the validity of the ROAG, a CHW and a dentist (considered as the gold standard) independently evaluated the same individual. The reproducibility of the ROAG was evaluated by each of the CHWs examining 5-6 elderly individuals twice with a 7-day interval. RESULTS: The sensitivity ranged from 0.17 for evaluation of saliva to 0.80 for voice. The specific ranged from 0.69 for teeth/dentures to 0.98 for saliva using mirror and the accuracy ranged from 0.92 for swallow to 0.64 for mucosa. The intra-rater reproducibility of the ROAG was perfect for evaluation of voice, lips and swallow (κ=1.000). CONCLUSION: When used by trained CHWs, the ROAG is a tool with high sensitivity and specificity to assess voice, swallowing, tongue and teeth/dentures. Moreover, it can efficiently detect patients showing no alteration in lips, saliva, mucosa and gums. High reproducibility was observed in almost all the categories. Trained CHWs can use this tool to improve the access of elderly patients to dental services.

Influence of surface area and geometry of specimens on bond strength in a microtensile test: an analysis by the three-dimensional finite element method.

PURPOSE: This study employed three-dimensional (3D) finite element analysis to investigate the stress distribution patterns in a microtensile test with the goal of evaluating the effects of the bond surface area and geometry on bond strength. MATERIALS AND METHODS: Finite element models of six specimens were generated: three stick models and three hourglass models. All models simulated the bond strength between dentin and ceramic. The mechanical properties of the materials-the modulus of elasticity and Poisson's coefficient-were defined according to a literature review. The base of each specimen was considered inserted (constrained area) and possessed nodes with displacements restricted in all directions. A traction load, which was calculated to generate a uniformly distributed stress of 20 N/mm(2) at the bond interface, was applied to the top of the specimen. The distribution pattern of the generated stress was qualitatively and quantitatively measured based on color scales ranging from blue to red, according to the von Mises equivalent stress. RESULTS: Specimens with similar shapes demonstrated similar stress distributions. Ceramic specimens had a higher stress value (30.35 MPa) compared to specimens consisting of resinous cement (23.59 MPa) and dentin (19.77 MPa). At the bond interface, the specimens with square sections demonstrated stress values ranging from 22.00 to 24.20 MPa. For the circular section, the stress values ranged from 23.40 to 27.00 MPa. CONCLUSION: The maximum stress values determined for the circular and square sections were similar among specimens with the same interface area. At the bond interface, the highest stress values were observed in hourglass-shaped specimens.