Survival and prognostic factors in patients with oral squamous cell carcinoma.

BACKGROUND: This study aimed to evaluate sociodemographic and clinical factors influencing overall survival (OS) in patients with oral squamous cell carcinoma (OSCC). MATERIAL AND METHODS: Medical charts of 547 patients with OSCC from a public hospital in northeastern Brazil seen between 1999 and 2013 were evaluated. Survival analysis was performed using the Kaplan-Meier method. The influence of age, sex, ethnicity, clinical stage, anatomical location, type of treatment, and comorbidities on the patients' prognosis was evaluated. Cox proportional hazards regression model was used to identify independent prognostic factors. RESULTS: The 5-year OS was 39%. Multivariate analysis showed that age < 40 years (HR = 2.20; 95%CI: 1.02-4.72) and a single treatment modality (HR = 1.91; 95%CI: 1.37-2.67) were associated with a poor prognosis, while early clinical stage resulted in better outcomes (HR = 0.38; 95%CI: 0.25-0.58). CONCLUSIONS: OSCC patients in advanced clinical stages, diagnosed at a younger age, and submitted to a single therapeutic modality have a poorer prognosis.

Desensitizing Toothpastes for Dentin Hypersensitivity: A Network Meta-analysis.

The goal of this systematic review and network meta-analysis was to compare the relative effects of toothpaste formulations for dentin hypersensitivity (DH), tested in randomized controlled trials (RCTs). We searched 7 databases to February 2019. Paired reviewers independently screened studies, extracted data, and performed risk of bias assessment. The outcome of interest was painful response measured through tactile, cold, and air stimuli. We conducted a random-effects Bayesian network meta-analysis using standardized mean difference (SMD) and their credible intervals (CIs) as the measure of effect for each pain stimuli. We assessed certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included 125 RCTs (12,541 patients). For tactile stimulus, the following active ingredients showed large beneficial effects compared to fluoride with moderate certainty of evidence (SMD; 95% CI): potassium + stannous fluoride (SnF2) (3.05; 1.69-4.41), calcium sodium phosphosilicate (CSP) (2.14; 0.75-3.53), SnF2 (2.02; 1.06-2.99), potassium + hydroxyapatite (2.47; 0.3-4.64), strontium (1.43; 0.46-2.41), and potassium (1.23; 0.48-1.98). For cold stimulus, CSP showed large beneficial effects compared to fluoride (3.93; 0.34-7.53) with moderate certainty; for air stimulus, arginine (2.22; 1.45-2.99), potassium + hydroxyapatite (2.44; 0.33-4.55), potassium + SnF2 (2.28; 0.87-3.69), CSP (1.98; 0.99-2.98), and SnF2 (1.9; 1.03-2.77) showed large beneficial effects compared to fluoride with moderate to high certainty. Most toothpaste formulations showed evidence of superiority against placebo or fluorides (amine fluoride, sodium monofluorophosphate, or sodium fluoride). CSP was most beneficial for all 3 stimuli with high to moderate certainty. SnF2 alone and potassium combined with SnF2 or hydroxyapatite were beneficial for tactile and air stimulus with high to moderate certainty. Arginine was beneficial for air stimulus, and strontium and potassium were beneficial for tactile stimulus, with moderate certainty.

Children's perceptions regarding functional limitations due to oral problems.

AIM: To evaluate factors associated with difficulty eating and speaking due to oral problems according to the reports of children. METHODS: A cross-sectional study was conducted with 769 5-year-old children at preschools in a city in northeast Brazil. Parents/caretakers answered a questionnaire addressing socio-demographic data and a history of dental pain. The children answered the scale of oral health outcomes for 5-year-old children, which was used to evaluate the dependent variables. Clinical examinations of the children were performed by examiners who had undergone calibration exercises. Data analysis involved descriptive statistics and Poisson regression analysis (α = 5%). RESULTS: The prevalence of the perception of functional limitations on the part of the children was 35.5% for difficulty eating and 22.9% for difficulty speaking. Difficulty eating was associated with a history of dental pain (PR = 1.68; 95% CI 1.27-2.22) and the occurrence of traumatic dental injury (TDI) (PR = 1.23; 95% CI 1.01-1.52). Difficulty speaking due to oral problems was associated with studying at a public preschool (PR = 1.71; 95% CI 1.19-2.46), a history of dental pain (PR = 1.54; 95% CI 1.07-2.20), and the occurrence of TDI (PR = 1.52; 95% CI 1.12-2.06). CONCLUSIONS: Pain symptoms and the occurrence of TDI can exert an influence on the development of functional limitations. With regard to socioeconomic factors, studying at a public preschool can influence difficulty speaking in children.

Self-Perceptions of the Impact of Oral Problems on the Social Behavior of Preschoolers.

INTRODUCTION: Investigating preschool children's social behaviors and the association with oral health variables helps to understand child development. Besides that, different perceptions need to be explored regarding the impact of oral problems on the social behavior between the child's self-report and parent's/caregiver's proxy report. OBJECTIVE: To determine which socioeconomic and oral factors are associated with difficulty sleeping and playing and the avoidance of smiling in preschoolers. METHODS: A cross-sectional study was conducted with a representative random sample of 769 pairs of parents/caregivers and 5-y-old preschoolers. The preschoolers answered a questionnaire on difficulty sleeping, difficulty playing, and the avoidance of smiling for reasons related to oral problems. The parents/caregivers answered a questionnaire addressing socioeconomic characteristics as well as the use of dental services. Two calibrated dentists examined the children for the determination of dental caries, traumatic dental injury (TDI), malocclusion, and bruxism. Descriptive and Poisson regression analysis for complex samples with robust variance was used to test the associations (α = 5%). RESULTS: The variables associated with difficulty sleeping were low household income (confidence interval [CI]: 1.40-3.01), number of untreated dental caries (CI, 1.02-1.04), dental pain (CI, 1.76-3.59), TDI (CI, 1.08-2.11), and anterior open bite (CI, 1.11-2.20). Difficulty playing also was associated with the low household income (CI, 1.34-3.15), number of untreated dental caries (CI, 1.01-1.04), dental pain (CI,1.42-3.61), and TDI (CI, 1.13-2.33). The number of untreated dental caries (CI, 1.02-1.05), dental pain (CI, 1.03-2.88), anterior open bite (CI, 1.30-3.26), and not using dental services (CI, 1.13-2.73) were determinant factors for the avoidance of smiling. CONCLUSION: Socioeconomic, symptomatic, and/or oral esthetic problems exerted an impact on the social behavior of the preschoolers analyzed, such as playing, sleeping, and smiling. KNOWLEDGE TRANSFER STATEMENT: The results of the present study may help parents and clinicians to understand better the association of oral problems with the social behavior of preschool children. Moreover, this study shows the importance of listening to children in clinical decisions. These results also can help in the elaboration of oral health policies.

The prevalence of sleep bruxism and associated factors in children: a report by parents.

AIM: To evaluate the prevalence of sleep bruxism and associated factors among children aged 3-12 years as reported by parents via a questionnaire. METHODS: A cross-sectional study was conducted with a sample of 148 parents/caregivers of children aged 3-12 years treated at paediatric dentistry clinics. Parents/caregivers answered a questionnaire in the waiting room. Information on the gender and age of the child, age of parent/caregiver, meaning of bruxism and child's sleep (type of sleep, if he/she slept alone, hours of sleep per night and if nocturnal bruxism could affect his/her health) were collected. Descriptive statistics were performed and Poisson regression with robust variance was employed (p < 0.05). RESULTS: The prevalence of sleep bruxism was 32.4%. Most parents (64.2%) did not know the meaning of bruxism. In the final Poisson regression model, child's gender (PR 1.32; 95% CI 1.06-1.66) and restless sleep (PR 1.39; 95% CI 1.12-1.72) were significantly associated with sleep bruxism. CONCLUSION: The prevalence of sleep bruxism was high and was associated with gender and having restless sleep. Most parents/guardians did not know the meaning of bruxism.

Association between oral conditions and functional limitations in childhood.

The aim of this study was to evaluate the impact of oral conditions on functional limitations among preschoolers. A preschool-based, cross-sectional study was carried out with 843 preschoolers in Campina Grande, Brazil. Parents/caregivers answered a questionnaire addressing socio-demographic characteristics and perceptions regarding the general/oral health of their children as well as the Brazilian version of the Early Childhood Oral Health Impact Scale. The nonparametric Kruskal-Wallis test followed by Mann-Whitney test (α = 5%) was used to compare mean children's quality-of-life scores for each independent variable. Poisson regression analysis was used to test associations between the independent and dependent variables (difficulties eating, drinking and speaking) (α = 5%). The multivariate regression model involved a hierarchical approach with four levels (distal to proximal determinants): (i) socio-demographic aspects; (ii) health perceptions; (iii) oral conditions; and (iv) pain conditions. The prevalence of negative impact on function was 24.7% for eating/drinking and 8.0% for speaking. Significant associations were found between toothache and negative impact on eating/drinking (PR = 5.38; 95%CI: 3.20-9.02) as well as between high severity dental caries and negative impact on speaking (PR = 14.91; 95%CI: 1.98-112.32). Dental caries, traumatic dental injury and malocclusion were not significantly associated with a negative impact on eating or drinking. However, toothache was an indicator of negative impact on eating/drinking and dental caries severity was an indicator of negative impact on speaking.

Dental trauma among Brazilian schoolchildren: prevalence, treatment and associated factors.

AIM: To assess the prevalence of traumatic dental injury (TDI), as well as associated factors, behaviour of affected schoolchildren and normative treatment needs. METHODS: The present cross-sectional study involved 590 children aged 7-14 years at state schools in Campina Grande, Brazil. The O'Brien classification [1994] was used for the diagnosis of TDI and the body mass index (BMI) was used as an indicator of overweight/obesity. Clinical tests were carried out by two duly calibrated examiners (intra-observer and inter-observer agreement: 0.87 and 0.90, respectively). The Chi-square test was used (5% level of significance) to determine whether TDI was associated with age, gender, ethnicity, overweight/obesity, lip seal and overjet. Backward stepwise multivariate regression analysis was performed. Normative treatment needs were determined based on the criteria of the International Association of Dental Traumatology (IADT). When the absence of treatment was detected, each child/adolescent was asked about the reason for non-treatment. RESULTS: The prevalence of TDI was 12.7%. The most common type of trauma was enamel fracture (67.0%), followed by enamel-dentine fracture (25.3%). TDI was 4.9-fold greater (95% CI: 1.6-14.4) among children aged 13 and 14 years, 1.9- fold greater (95% CI: 1.1-3.2) among males and 2.6-fold greater (95% CI: 1.2-5.4) among those with inadequate lip seal. The majority of schoolchildren did not undergo treatment (82.6%) due to a belief that it was unnecessary (53.2%). The normative clinical evaluation revealed that adhesive restoration was the most common form of treatment (84.0%). CONCLUSION: The prevalence of TDI was low. Age, gender and inadequate lip seal were associated with dental trauma. A significant number of schoolchildren did not receive treatment for dental trauma.

Maxillofacial injuries and dental trauma in patients aged 19-80 years, Recife, Brazil

Objetivo: Se llevó a cabo un estudio retrospectivo para evaluar las causas de traumatismomaxilofacial en Recife, Pernambuco, Brasil.Método: Se hizo una revisión de 186 pacientes con lesiones maxilofaciales de 19 a 83 años atendidosy tratados en el Hospital da Restauração entre Enero y Diciembre 2006, analizándoles segúnedad, sexo, etiología, localización de la fractura, traumatismo dentoalveolar y abuso de alcohol.Se llevó a cabo el análisis en Epi Info, utilizando el Chi cuadrado y la prueba exacta de Fisher.Resultados: Resultó que las lesiones maxilofaciales fueron más frecuentes en los hombres (89,2%)y en el grupo de edad de 19-28 años (46,8%). Accidentes de tráfico/motocicleta (23,7%) y violenciafísica (20,4%) fueron los factores etiológicos más comunes. Las fracturas faciales fueron detectadasen 90,9%, con una diferencia estadisticamente significativa entre el sexo y la fractura facial(p = 0,000). La fractura facial más común fue maxilar (29,1%), seguida por la de la mandíbula(27,5%). Hubo una asociación positiva entre la presencia de la fractura facial y el consumo dealcohol (p = 0,002). El traumatismo dentoalveolar estuvo presente en el 7,5% de los pacientes.Conclusión: La incidencia de las fracturas faciales en la población Brasileña es similar a la informadapreviamente en otros lugares. Las fracturas fueron más comunes en pacientes masculinos,principalmente debidas a accidentes de tráfico/motocicletas y a la violencia física(AU)

Aim: A retrospective study was undertaken to assess causes of maxillofacial trauma inRecife, Pernambuco, Brazil.Method: A review of 186 patients with maxillofacial injuries aged 19 and 83 years old seenand treated at the Hospital da Restauração between January and December 2006 wasconducted and were analyzed according to age, sex, etiology, site of fracture, dentoalveolartrauma and alcohol abuse. Analysis was made in Epi Info using the Chi-square and Fisher’sExact Tests.Results: It was found that maxillofacial injuries were most frequent in males (89.2%) and inthe 19-28 year age group (46.8%). Traffic accidents/motorcycle (23.7%) and physical violence(20.4%) were the most common etiological factor. Facial fractures were detected in 90.9%and a statistically significant difference between sex and facial fracture was found (p =0.000). The most common facial fracture was maxilla (29.1%), followed by the mandible(27.5%). A positive association between the presence of facial fracture and alcoholconsumption was observed (p = 0.002). Dentoalveolar trauma was present in 7.5% ofpatients.Conclusion: The incidence of facial fractures in Brazilian population is similar thanpreviously reported elsewhere. There were most common in male patients, mainly due totraffic accidents/motorcycle and physical violence(AU)