Cárie dentária em crianças e adolescentes com Diabetes tipo 1: uma revisão sistemática e meta-análise / Dental caries in children and adolescents with type 1 Diabetes: a systematic review and meta-analysis

Objetivo: O objetivo dessa revisão sistemática e meta-análise foi avaliar estudos que fizeram uma comparação da ocorrência de cárie dentária entre crianças/adolescentes com Diabetes tipo 1 (DM1) e crianças/adolescentes sem essa condição. Métodos:Buscas computadorizadas no Web ofScience, Scopus, Lilacs, PubMed, OpenGrey e Google Scholar foram realizadas até dezembro de 2020. A seleção dos estudos foi feita por dois autores independentemente. Referências que preenchiam os critérios de elegibilidade foram incluídas. O risco de viés foi avaliado com a escala Newcastle Ottawa. Meta-análises foram conduzidas. Diferença média (DM) e intervalos de confiança (IC) foram fornecidos. Resultados: Durante as buscas nas bases de dados, 751 referências foram recuperadas. Após remoção de 102 duplicatas, 649 referências foram avaliadas e 16 estudos foram incluídos nessa revisão sistemática e meta-análise. Os estudos incluídos tiveram resultados discrepantes. Duas meta-análises demonstraram que não houve diferença significativa na média de dentes permanentes com cárie entre crianças/adolescentes com DM1 e crianças/adolescentes sem DM1 (DM = 0,07; IC = -0,68 ­ 0,82) e que não houve diferença significativa na média de superfícies de dentes permanentes com cárie entre crianças/adolescentes com DM1 e crianças/adolescentes sem DM1 (DM = 0,20; IC = -2,22 ­ 2,61). Uma terceira meta-análise revelou que crianças/adolescentes sem DM1 apresentavam uma média de dentes decíduos com cárie significativamente maior do que crianças/adolescentes com DM1 (DM = 0,34; IC = 0,31 ­ 0,37). O maior problema de risco de viés dos estudos foi para a definição dos controles e comparação de casos e controles. Conclusão: A ocorrência de cárie parece ser menor entre crianças/adolescentes com DM1 em comparação a crianças/adolescentes sem DM1.

Aim:The aim of this systematic review and meta-analysis was to evaluate studies in which children/adolescents with type 1 Diabetes (DM1) were compared with children/adolescents without DM1 as regards dental caries. Methods: Electronic searches in Web ofScience, Scopus, Lilacs, PubMed, OpenGrey, and Google Scholar databases were conducted up to December/2020. Study selection was carried out separately by two reviewers. References that met the eligibility criteria were included. Risk of bias was evaluated using the Newcastle Ottawa scale. Meta-analyses were conducted. Mean difference (MD) and confidence intervals (CI) were provided. Results:In the database searches, 751 references were retrieved. Following the removal of 102 duplicates, 649 references were assessed, and 16 studies were included in this systematic review and meta-analysis. Discrepancies in results were found among the included studies. Two meta-analyses demonstrated no significant difference between children/adolescents with DM1 and children/adolescents without DM1 regarding the mean number of permanent teeth with caries (MD = 0.07; CI = -0.68 ­ 0.82), as well as no significant difference between children/adolescents with DM1 and children/adolescents without DM1 with respect to the mean number of permanent tooth surfaces with caries (MD = 0.20; CI = -2.22 ­ 2.61). The third meta-analysis revealed that children/adolescents without DM1 had a significantly higher mean number of primary teeth with caries in comparison to children/adolescents with DM1 (MD = 0.34; CI = 0.31 ­ 0.37). The major issues in the risk of bias assessment were the definition of controls and comparison between cases and controls. Conclusion: The occurrence of caries seems to be lower in children/adolescents with DM1 than in children/adolescents without DM1.

Gestão em Saúde Pública, enfrentamentos cotidianos: direitos e deveres / Management in public health, daily confrontations: rights and duties

O guia tem a finalidade de informar e orientar profissionais, estudantes e todos os envolvidos na saúde do país, quanto à Gestão em Saúde Pública e seu enfrentamento cotidiano

Severe malocclusion negatively impacts adolescents' quality of life

Aim: To assess the impact of severe malocclusion on adolescents' oral health- related quality of life (OHRQoL). Methods: This study consisted of a sample of 117 adolescents between 11 and 12 years, who answered the Brazilian version of the short form of the Child Perception Questionnaire (CPQ 11-14 ). This questionnaire has 16 items distributed equally across four domains: oral symptoms (OS), functional limitations (FL), emotional well-being (EW) and social well-being (SW). Higher scores indicate a greater negative impact on OHRQoL. Malocclusion was evaluated using the Dental Aesthetic Index. Adolescents were assigned to the following categories: no or slight malocclusion, defined malocclusion and severe malocclusion. Descriptive analysis, the Kruskal Wallis test, post hoc test, univariate and multivariate logistic regression were conducted. Results: Individuals with severe malocclusion presented significantly higher scores than those with no or slight malocclusion for the EW ( p =0.001), SW ( p =0.027) and for the overall CPQ 11-14 score ( p =0.015). Adolescents with severe malocclusion showed a 2.63 greater chance of presenting a high negative impact on OHRQoL than those with no or slight malocclusion regardless of the confounding variables (CI=1.07­6.45, p =0.035). Conclusion: Severe malocclusion negatively impacts adolescents' OHRQoL.

Objetivo: Avaliar o impacto da má oclusão severa na qualidade de vida relacionada à saúde bucal de adolescentes (OHRQoL). Métodos: Este estudo consistiu em uma amostra de 117 adolescentes entre 11 e 12 anos, que responderam à versão brasileira da forma abreviada do Child Perception Questionnaire (CPQ11- 14). Este questionário tem 16 itens distribuídos igualmente em quatro domínios: sintomas bucais (SO), limitações funcionais (LF), bem-estar emocional (BE) e bem- estar social (BS). Escores mais altos indicam um impacto negativo maior na OHRQoL. A má oclusão foi avaliada por meio do Índice Estético Dental. Os adolescentes foram alocados nas seguintes categorias: sem má oclusão/má oclusão leve, má oclusão definitiva e má oclusão severa. Análise descritiva, teste de Kruskal Wallis, teste de Dunn, regressão logística univariada e multivariada foram conduzidas. Resultados: Indivíduos com má oclusão severa apresentaram escores significativamente mais elevados do que aqueles sem má oclusão/má oclusão leve para o BE ( p =0,001), BS ( p =0,027) e para o escore total do CPQ11-14 ( p =0,015). Adolescentes com má oclusão severa apresentaram 2,63 vezes mais chance de apresentar um impacto negativo alto na OHRQoL do que aqueles sem má oclusão/má oclusão leve, independentemente das variáveis de confusão (IC=1,07-6,45, p =0,035). Conclusão: A má oclusão severa afeta negativamente a OHRQoL dos adolescentes.

Perceptions of pain levels and chewing impairment among adolescents undergoing orthodontic treatment with fixed appliances

Aim: the aim of this cohort study was to evaluate the perceptions of adolescents regarding pain levels and chewing impairment throughout the first 12 months of orthodontic treatment with fixed appliances. methods: a total of 120 adolescents aged 11 and 12 years undergoing orthodontic treatment at the faculty of dentistry of the Federal University of Minas Gerais participated in this study. malocclusion was evaluated by means of the dental aesthetic index. pain level and degree of chewing impairment were evaluated by means of two questions selected from the short form of the child perceptions questionnaire (CPQ11-14). each question had five response options with the following scoring system: never (0), once or twice (1), sometimes (2), often (3) and every day/almost every day (4). both questions were answered by the adolescents at four different times: before fixed appliances' placement (T1), one month after banding and fixed appliances' bonding (T2), four months after banding and fixed appliances' bonding (T3), and 12 months after banding and fixed appliances' bonding (T4). results: the mean age of adolescents was 11.39 (±0.68). significant differences were observed for pain levels (p=0.038) and chewing impairment (p=0.020) over the study period. pain levels at T1 were significantly lower than at T2 (p=0.038) and T4 (p=0.020). chewing impairment at T1 was significant lower than at T2 (p<0.001), T3 (p=0.014) and T4 (p=0.005). conclusion: adolescents undergoing orthodontic treatment with fixed appliances present an increase in pain levels and in chewing impairment.