Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis.

This review aimed to assess the association between overweight/obesity and dental caries in Brazilian children/adolescents. Searches were performed in the Web of Science, Scopus, Cochrane, PubMed, Embase and SciELO, Lilacs and Open Grey literature databases up to June 2022. The Joanna Briggs Institute checklist for analytical cross-sectional studies, the checklist for cohort studies, and the checklist for case-control studies were used. A total of 41 publications were included, and 15 meta-analyses were performed. The authors analyzed the differences in weighted mean difference (MD) and odds ratios (OR), and their corresponding confidence intervals (CI) (95%) for dental caries among eutrophic and obese and/or overweight children/adolescents. Meta-analyses showed that there was no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI (Body Mass Index). A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve (OR = 2.53, 95% CI;1.49-4.29; p = 0.0006; I2 = 0%) in dichotomous outcome studies, and (MD = 0.61, 95%CI: 0.08-1.15; p = 0.02; I2 = 0%) in continuous studies. The strength of the evidence of the results was classified as very low, low or moderate. It was concluded that there is no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI. A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve.

Knowledge of Brazilian Dentists about Dentoalveolar Trauma Care and their Experiences during the COVID-19 Pandemic

ABSTRACT Objective: To assess dentists' knowledge from Minas Gerais, Brazil, about dentoalveolar trauma (DT) and their experiences during the COVID-19 pandemic. Material and Methods: An online questionnaire with 34 questions was applied to collect personal data, professional training, self-assessment of experience/knowledge about DT, experience in care provided during the social distancing, and knowledge/conduct. The specific responses were evaluated based on the guidelines of the International Association of Dental Traumatology (IADT). Descriptive analysis and Pearson's chi-square test were performed. The level of significance was set at p≤0.05. Results: Most professionals (97.7%) had received information on DT, and only 4.6% of the participants considered their knowledge poor or very poor. However, 92.7% felt the need for more information on the subject. Regarding experiences during the pandemic, 55.7% provided trauma care during that period. Forty percent of the consultations were performed in person, and 33.3% of the professionals noted an increase in cases during the pandemic; 56.6% reported that the frequency did not change. The overall mean number of correct answers about DT was 5.29±2.11, indicating an acceptable level of knowledge. The mean percentage of hits for the specific questions was 44.1%. Conclusion: Although the level of knowledge of the dentists evaluated was acceptable, some aspects were deficient, with the need for more information about the IADT guidelines.

Changes in Oral Health-Related Behaviors and Oral Health of Children in Early Childhood during Social Isolation Caused by COVID-19

ABSTRACT Objective: To assess changes in oral health-related behavior and oral health status in Brazilian children in early childhood perceived by their parents/caregivers during social isolation caused by COVID-19. Material and Methods: A cross-sectional study with parents/caregivers of children in southeastern Brazil aged 0-5 years who responded to an online questionnaire about sociodemographic data, dietary changes, oral hygiene, and oral health status of children during the COVID-19 pandemic. Results: Of the 119 parents/caregivers, 54.60% did not observe any changes in eating habits, and 81.50% maintained their children's oral hygiene. Associations were observed between the impact of the pandemic on the family income and changes in eating habits (p=0.02) and between lower family income and dental caries perceived by parents/caregivers (p=0.05). Z tests with Bonferroni correction showed that families with drastic income reduction were more likely to consume lower-cost foods (62.50%) than families with no impact or slight reduction on family income. Parents/caregivers did not identify dental caries (89.10%), toothache (92.40%), and dental trauma (92.40%) in their children. Conclusion: Parents/caregivers of children in southeastern Brazil aged 0-5 years observed behavioral changes in the dietary habits of families whose income was impacted by the pandemic, and their perception of dental caries was significantly associated with family income.

Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis

Abstract This review aimed to assess the association between overweight/obesity and dental caries in Brazilian children/adolescents. Searches were performed in the Web of Science, Scopus, Cochrane, PubMed, Embase and SciELO, Lilacs and Open Grey literature databases up to June 2022. The Joanna Briggs Institute checklist for analytical cross-sectional studies, the checklist for cohort studies, and the checklist for case-control studies were used. A total of 41 publications were included, and 15 meta-analyses were performed. The authors analyzed the differences in weighted mean difference (MD) and odds ratios (OR), and their corresponding confidence intervals (CI) (95%) for dental caries among eutrophic and obese and/or overweight children/adolescents. Meta-analyses showed that there was no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI (Body Mass Index). A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve (OR = 2.53, 95% CI;1.49-4.29; p = 0.0006; I2 = 0%) in dichotomous outcome studies, and (MD = 0.61, 95%CI: 0.08-1.15; p = 0.02; I2 = 0%) in continuous studies. The strength of the evidence of the results was classified as very low, low or moderate. It was concluded that there is no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI. A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve.

Perceptions of Parents/Caregivers About the Impact of Oral Conditions on the Quality of Life of Children and Adolescents with Autism Spectrum Disorder.

PURPOSE: To investigate the perceptions of parents/caregivers about the impact of oral conditions on the oral health-related quality of life (OHRQoL) of children/adolescents with autism spectrum disorder (ASD) compared to the perceptions of parents/caregivers of children/adolescents without ASD. METHODS: A comparative cross-sectional study was conducted involving 80 children/adolescents with ASD three to 16 years of age matched by sex and age with 80 children/adolescents without ASD and their parents/caregivers. Clinical examinations were performed for the diagnosis of dental caries experience (DMFT/dmft), clinical consequences of untreated dental caries (PUFA/pufa), visible plaque (VPI), bleeding on probing (BPI), malocclusion and traumatic dental injury (TDI). Parents/caregivers answered a questionnaire addressing sociodemographic characteristics and the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ), which measures OHRQoL from the perspective of parents/caregivers. Data analysis involved the Wilcoxon test, chi-squared test and Poisson regression. RESULTS: Dental caries experience impacted OHRQoL in the group with ASD regarding the total P-CPQ score (p < 0.001) as well as the "oral symptoms" (p = 0.011) and "wellbeing" (p < 0.011) domains. No differences were found between the perceptions of parents/caregivers of children/adolescents with ASD and perceptions of parents/caregivers of children/adolescents without ASD (p = 0.721). CONCLUSION: Dental caries experience can have a negative impact on the OHRQoL of children/adolescents with ASD.

Elementary school teachers' knowledge and attitudes toward emergency management of traumatic dental injuries.

The consequences of traumatic dental injuries can be even more serious when their emergency management procedures are inadequate. Since traumatic accidents frequently occur at school, it is crucial that teachers be knowledgeable enough to assist an injured child. This study aimed to assess the knowledge and attitudes of the elementary school teachers of a Brazilian city toward dental trauma in permanent teeth, and its emergency practices. A combination of convenience and snowball sampling methods was used. An online questionnaire was distributed through social media, consisting of three parts: demographic characteristics and professional information; previous experiences and attitudes toward dental trauma; teachers' knowledge of this subject. Descriptive and statistical analyses were carried out. Pearson chi-squared test (p < 0.05) was used. A total of 217 teachers participated in the study. The power of the sample was 95%. Half of the teachers had already witnessed a dental trauma incident involving students, and 70.5% never received any information on the subject. The teachers who were provided previous information were the ones who opted to search for the tooth fragment (p=0.036) in cases of crown fracture, and for the lost tooth (p = 0.025) in cases of avulsion. They were also the ones who chose to wash the tooth in running water (p = 0.018), and look for a dentist in the first 30 or 60 minutes after the trauma (p = 0.026). Most of the teachers assessed did not have adequate knowledge of dental trauma. Having previous information was associated with more assertive practices in trauma management.

Oral health characteristics in children and adolescents with Down syndrome.

AIM: To compare oral health indicators of children/adolescents with Down syndrome (DS) with a group of children/adolescents without DS. METHODS AND RESULTS: This cross-sectional study included 144 individuals with DS, ages 4 to 18 years, matched for age and sex with a group of 144 individuals without DS, and their parents/caregivers. Parents/caregivers completed a questionnaire regarding sociodemographic information and habits related to their children's oral health. Clinical examination of the children/adolescents evaluated dental caries experience (DMFT/dmft), bleeding on periodontal probing, presence of visible plaque, clinical consequences of untreated dental caries (PUFA/pufa), and malocclusion (DAI). The chi-square test, linear by linear test, and Mann-Whitney test were used to compare the variables between the groups (p < .05). Children/adolescents without DS brushed their teeth more times per day (p < .001) and had a higher frequency of daily sugar intake (p < .001). The children/adolescents in the DS group had a greater presence of gingival bleeding (p < .001) and had a greater number of cases of "severe malocclusion" and "very severe malocclusion" (p = .001). No difference was found in the prevalence of dental caries between the two groups. CONCLUSION: The children/adolescents in the DS group had a greater presence of gingival bleeding during the clinical examination and had a greater need for orthodontic treatment.

Efeito da intervenção educativa sobre o nível de conhecimento de acadêmicos de medicina, participantes de uma equipe do Serviço de Atendimento Móvel de Urgência (SAMU), em relação a avulsão de dentes permanentes / Effect of educational intervention on the level of knowledge of participants in a mobile emergency care team (SAMU) in cases of avulsion of permanent teeth

Objetivo: Avaliar o efeito de uma intervenção educativa, sobre avulsão de dentes permanentes, no nível de conhecimento de participantes de uma equipe do SAMU. Métodos: Participaram acadêmicos de Medicina que compunham a equipe do SAMU de Juiz de Fora (MG). A intervenção educativa foi realizada por meio de uma palestra com duração de 15 minutos. Para coleta dos dados foi utilizado um questionário, contendo 13 perguntas sobre avulsão dentária, aplicado em três etapas: antes da palestra (T0), imediatamente após a palestra (T1) e quinze dias após a palestra (T2). Foi realizada análise descritiva e teste McNemar para análise estatística (p < 0,05). Resultados:A amostra foi composta por 36 indivíduos. Nenhum participante relatou ter prestado atendimento a um caso de avulsão dentária. Trinta e quatro acadêmicos informaram não ter recebido orientações anteriores sobre o que fazer diante desse episódio e 35 afirmaram que esse conhecimento é necessário para o médico do SAMU. Houve aumento na porcentagem de acertos após os acadêmicos assistirem a palestra educativa (T1), para sete questões avaliadas. As mesmas questões também apresentaram maior percentual de acertos quinze dias após a palestra educativa (T2). Não houve diferença na capacidade dos acadêmicos reimplantarem um dente avulsionado tanto imediatamente após a palestra educativa (T1), quanto quinze dias após as orientações (T2) (T0-T1: p = 0,999; T0-T2: p = 0,999). Conclusão:A palestra educativa influenciou de forma significativa à melhora do conhecimento sobre avulsão dentária dos acadêmicos de Medicina que fazem parte da equipe do SAMU-JF.

Aim: To evaluate the effect of an educational intervention concerning the avulsion of permanent teeth upon the level of knowledge of members of a SAMU (Ambulance) team. Methods:Medical students who were members of the SAMU team in Juiz de Fora (MG) participated in this study. The educational intervention on the theme was carried out by means of a 15-minute lecture. Data collection was conducted using a structured questionnaire containing 13 objective questions on tooth avulsion, applied to the medical students in three stages: before the lecture (T0), immediately after the lecture (T1), and fifteen days after the lecture (T2). Descriptive analysis and the McNemar test were performed (p < 0.05). Results: The sample consisted of 36 individuals. All participants reported never having attended a dental avulsion case. Thirty-four students reported that they had not received previous guidance on what to do when faced with this type of episode, and 35 stated that information about dental avulsion is necessary for SAMU doctors. For seven of the evaluated questions, an increase was identified in the percentage of correct answers after the students attended the educational lecture (T1). The same questions also showed a higher percentage of correct answers fifteen days after the educational lecture (T2). No difference was found in the students' ability to reimplant an avulsed tooth either immediately after the educational lecture (T1) or fifteen days after receiving guidance on the subject (T2) (T0-T1: p = 0.999; T0-T2: p = 0.999). Conclusion: The educational lecture significantly influenced the improvement of knowledge about dental avulsion among medical students who are members of the SAMU-JF team.

Elementary school teachers' knowledge and attitudes toward emergency management of traumatic dental injuries

Abstract The consequences of traumatic dental injuries can be even more serious when their emergency management procedures are inadequate. Since traumatic accidents frequently occur at school, it is crucial that teachers be knowledgeable enough to assist an injured child. This study aimed to assess the knowledge and attitudes of the elementary school teachers of a Brazilian city toward dental trauma in permanent teeth, and its emergency practices. A combination of convenience and snowball sampling methods was used. An online questionnaire was distributed through social media, consisting of three parts: demographic characteristics and professional information; previous experiences and attitudes toward dental trauma; teachers' knowledge of this subject. Descriptive and statistical analyses were carried out. Pearson chi-squared test (p < 0.05) was used. A total of 217 teachers participated in the study. The power of the sample was 95%. Half of the teachers had already witnessed a dental trauma incident involving students, and 70.5% never received any information on the subject. The teachers who were provided previous information were the ones who opted to search for the tooth fragment (p=0.036) in cases of crown fracture, and for the lost tooth (p = 0.025) in cases of avulsion. They were also the ones who chose to wash the tooth in running water (p = 0.018), and look for a dentist in the first 30 or 60 minutes after the trauma (p = 0.026). Most of the teachers assessed did not have adequate knowledge of dental trauma. Having previous information was associated with more assertive practices in trauma management.

COVID-19 e o ensino remoto emergencial: percepção de alunos de graduação em odontologia com a disciplina de odontopediatria / COVID-19 and emergency remote education: perception of undergraduate students in dentistry with the discipline of pediatric dentistry

Objetivo: Este estudo teve como objetivo avaliar a percepção de alunos do curso de Odontologia sobre sua experiência no ensino remoto na disciplina de Odontopediatria instituído devido à pandemia da COVID-19. Métodos: Trata-se de um estudo transversal descritivo que incluiu acadêmicos matriculados na disciplina de Odontopediatria, no curso de Odontologia, de uma Instituição Privada de Ensino Superior da cidade de Juiz de Fora, Minas Gerais, Brasil. Os acadêmicos foram convidados a responder a um questionário contendo 14 itens objetivas um mês após o início das atividades de Ensino Remoto Emergencial (ERE). Os itens avaliavam a percepção do acadêmico em relação ao método de ensino adotado. Foi realizada análise descritiva (frequências absolutas e relativas) para todas as variáveis. Resultados:Um total de 64 acadêmicos participaram do estudo com média de idade de 22,3 (+3,5) anos. A soma dos participantes que concordaram e concordaram fortemente que o conteúdo de Odontopediatria proporcionou embasamento teórico para experiências da vida real foi 42 (65,62%). Juntos, os indivíduos que concordaram e concordaram fortemente que o aprendizado no ERE foi comparável ao método tradicional totalizaram 51 acadêmicos (79,68%) e 35 (54,68%) concordaram/concordaram fortemente que a nota da avaliação foi semelhante à nota que receberiam em sala de aula. A explicação do professor foi considerada igual (n = 56; 87,50%) ou melhor (n = 8; 12,50%) ao método convencional. Houve satisfação da maioria dos participantes (n = 41; 64,06%). A quantidade de conteúdo da Odontopediatria ministrado no ERE não foi considerada a mesma que aprenderiam na sala de aula tradicional para muitos dos participantes (n = 51; 79,68%) e a interação entre aluno e professor foi avaliada como pior comparada à sala de aula tradicional (n = 50; 78,12%). Conclusão: O ERE adotado na disciplina de Odontopediatria, no período avaliado, foi satisfatório em diversos aspectos e deve ser aprimorado, levando em consideração as fortalezas e fraquezas apontadas pelos acadêmicos.

Aim: This study aimed to evaluate the perception of dental students about their experience in remote teaching in the Pediatric Dentistry discipline established due to the COVID-19 pandemic. Methods: This is a descriptive cross-sectional study that included students enrolled in the Pediatric Dentistry discipline, in the Dentistry course at a Private Higher Education Institution in the city of Juiz de Fora, Minas Gerais, Brazil. Academics were invited to answer a questionnaire containing 14 objectives items one month after the beginning of the Emergency Remote Teaching (ERE) activities. The items evaluated the student's perception of the teaching method adopted. Descriptive analysis (absolute and relative frequencies) was performed for all variables. Results: A total of 64 academics participated in the study with a mean age of 22.3 (+ 3.5) years. The sum of participants who agreed and strongly agreed that the content of Pediatric Dentistry discipline provided theoretical basis for real-life experiences was 42 (65.62%). Together, the individuals who agreed and strongly agreed that learning in the ERE was comparable to the traditional method totaled 51 academics (79.68%) and 35 (54.68%) strongly agreed/agreed that the assessment grade was similar to the grade that would receive in the classroom. The teacher's explanation was considered equal (n = 56; 87.50%) or better (n = 8; 12.50%) to the conventional method. Most participants were satisfied (n = 41; 64.06%). The amount of Pediatric Dentistry discipline content taught at the ERE was not considered the same as what they would learn in the traditional classroom for many of the participants (n = 51; 79.68%) and the interaction between student and teacher was evaluated as worse compared to the classroom. traditional class (n = 50; 78.12%). Conclusion: The ERE adopted in the Pediatric Dentistry discipline, in the period evaluated, was satisfactory in several aspects and should be improved, taking into account the strengths and weaknesses pointed out by the academics.

Avulsão de dentes permanentes e seu manejo: conhecimento de estudantesde Odontologia, Medicina e Enfermagem / Avulsion of permanent teeth and their management: knowledge of students of Dentistry, Medicine and Nursing students

O objetivo do presente estudo foi avaliar o conhecimento de estudantesdos cursos da área da saúde (Odontologia, Medicina e Enfermagem) de uma instituição pública de ensino superior sobre avulsão de dentes permanentes, bem como sobre as condutas de urgência a serem tomadas frente à lesão. Foram coletadas informações, por meio de um questionário estruturado autoaplicável, sobre dados pessoais, experiências anteriores, conhecimento sobre avulsão dentária e sobre as principais condutas a serem tomadas frente a este tipo de traumatismo. Foi realizada análise descritiva e análise estatística, utilizando o teste de Qui-quadrado de Pearson. O nível de significância adotado foi de 5% (p<0,05). A amostra, selecionada por conveniência, foi composta por 390 acadêmicos daUniversidade Federal de Juiz de Fora, sendo 154 do curso de Odontologia, 93 de Enfermagem e 143 de Medicina. Menos da metade dos entrevistados relataram ter recebidoanteriormentealguma informação sobre traumatismos dentoalveolares, sendo que a maioria que recebeu informação era do curso de Odontologia (p<0,01). A maioria também não teve nenhuma experiência anterior com esse tipo de traumatismo, sem diferença entre os cursos (p≥0,05). O estudo revelou que há falta de conhecimento sobre o manejo da avulsão de dentes permanentes pelos estudantesavaliados, principalmente os dos cursos de Medicina e Enfermagem. Desta forma, existegrande necessidade dodesenvolvimento de programas de educação, informação e treinamento, que enfatizem o tratamento emergencial para avulsão dentária, dirigidos aos alunos desses cursos (AU).

The aimof the present study was to evaluate the knowledge of undergraduate students ofhealth care courses (dentistry, medicine and nursing) from a public higher education institution about theavulsion of permanent teeth, as well as on emergency procedures to be taken in the occurrenceof this type of injury. Information was collected through self-administered structured questionnairecontainingpersonal data, previous experiences, knowledge about dental avulsion and about the main proceduresto be taken in the occurrenceof this type of trauma. Descriptive and statistical analysis was performed using Pearson's chi-square test. The significance level adopted was 5% (p <0.05). The sample, selected for convenience, was composed of 390 students from the Federal University of Juiz de Fora, 154 of them dentistrystudents,93 nursing studentsand 143 medicinestudents. Less than half of interviewees reported having previously received anyinformation about dentoalveolar trauma, and the majority who received some information were dentistrystudents (p <0.01). The majority also had no previous experience with this type of trauma, with no difference between courses (p≥0.05). The study revealed that there is lack of knowledge about the management of avulsion of permanent teeth by evaluatedstudents, especially those enrolled in medicine and nursing courses. Thus, there is great need for the development of education, information and training programs emphasizingthe emergency treatment for dental avulsion aimed at students of these courses (AU).

Occurrence of Dental Trauma in a Group of Children with Autistic Spectrum Disorder

ABSTRACT Objective: To assess the occurrence of dental trauma in a group of children with Autistic Spectrum Disorder (ASD) in comparison to children without the disorder. Material and Methods: This is a cross-sectional study conducted at the Department of Children and Adolescents Health in the Department of Health of Juiz de Fora, Brazil. The study included individuals with and without ASD, between three and 16 years old, and their parents/caregivers. Children/adolescents were assessed for dental trauma by clinical examination. All exams were performed by a trained and calibrated examiner (MCT), and intra-examiner reliability was previously established (Kappa=0.93). The Socio-demographic status was reported by parents/caregivers. Data analysis included descriptive statistics and generation of frequency distributions. Fisher's exact test was used to evaluate the association between groups of children/adolescents with and without ASD about the presence of dental trauma. The significance level was set at p < 0.05. Results: Sixty children of both sexes participated in the study, thirty with a diagnosis of ASD and thirty without. The age ranging from 3 to 13 years, with an average of 7.5 ± 3.2 years. Children with ASD had a higher frequency of dental trauma than children without ASD (p=0.02), and the most frequent type of trauma was enamel fracture (57.10%), followed by enamel/dentin fracture without pulp exposure (42.90%). Conclusion: Children with ASD, when compared to children who did not have ASD, had a higher occurrence of dental trauma.

Early Childhood Caries Experience of Children from Poor Families Living Below and Above Poverty Line

ABSTRACT Objective: To evaluate the role of poverty and its related factors on early childhood caries (ECC) experience among deprived children. Material and Methods: This population-based cross-sectional study surveyed 418 children aged one to six years enrolled in Brazilian public preschools from an area of the country known for its high social deprivation. Intraoral examination of children evaluated dental caries experience (dmft). Parents/caregivers answered a questionnaire with sociodemographic indicators. Family income was dichotomized into below or above poverty line. Data analysis used Chi-square test, Mann-Whitney test, and Multivariate Logistic Regression analysis (p<0.05). Results: Predisposing variables for an increased chance of ECC were: age group 3-4 years (OR: 4.89; 95% CI: 2.32-10.31), age group 5-6-years (OR: 5.60; 95% CI: 2.60-12.04), being part of families living below poverty line (OR: 1.88; 95% CI: 1.04-3.38) and having mothers with less than nine years of schooling (OR: 2.86; 95% CI: 2.77-7.14). Children from families living below poverty line presented higher dmft (2.9 +3.8; p=0.001) and untreated dental caries (d component) (2.7 +3.7; p=0.002). Conclusion: ECC in a poor population was influenced by indicators of social deprivation. The poorest of poor children from mothers with less years of schooling were at higher risk.

Association Between Dental Caries Experience and Socioeconomic Determinants on Oral Health-Related Quality of Life among Children and their Families

ABSTRACT Objective: To assess the association between dental caries experience, severe dental caries experience and socioeconomic determinants on oral health-related quality of life among children and their families. Material and Methods: This is a cross-sectional study whose sample was composed of children aged 4-12 years, who sought dental care in a dentistry school clinic, and their parents/caregivers. Dental caries experience and severe dental caries experience were assessed according to the DMF-T/dmf-t indexes. Parents/caregivers answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ), the Family Impact Scale (FIS) and a questionnaire on socioeconomic and demographic conditions. Data analysis included the chi-square test and Poisson regression (PR). Results: The sample was composed of 105 children and their parents/caregivers. Severe dental caries experience in children was determinant for negative perception of children's OHRQoL by parents/caregivers (PR = 1.22; CI = 1.05-1.41). Negative impact on OHRQoL perceived by family members was determined by severe dental caries experience in children (PR = 1.22; CI = 1.05-1.42) and family income <5 minimum wage (PR = 1.32; CI = 1.08-1.61). Conclusion: Severe dental caries experience was associated with a negative impact on OHRQoL perceived by children and their families. Low family income was associated with a negative impact on the OHRQoL perceived by children and their families.

Conhecimento dos pais e responsáveis sobre hábitos saudáveis de higiene bucal e dieta na infância / Knowledge of parents and caregivers about healthy oral hygiene habits and diet in childhood

Introdução: Para garantir que as instruções sobre saúde bucal para crianças sejam administradas assertivamente, deve-se conhecer o nível de conhecimento sobre saúde bucal infantil dos pais/responsáveis. Objetivo: Avaliar o conhecimento dos pais/responsáveis sobre hábitos saudáveis de higiene bucal e dieta na infância. Materiais e Métodos: Trata-se de um estudo observacional transversal. Foi aplicado um questionário estruturado aos pais/responsáveis contendo dados de identificação e 10 perguntas destinadas ao tema. Foi realizada análise descritiva dos dados obtidos. Resultados: O estudo incluiu uma amostra de 86 pais/responsáveis de escolares de duas escolas públicas em Minas Gerais. A maioria dos participantes já recebeu informações sobre a importância da saúde bucal e da alimentação saudável (93%) assim como também concordam que os dentes decíduos devem ser escovados todos os dias (91,9%). Todos os participantes acharam essas informações importantes para a manutenção da saúde bucal das crianças (100%). A quantidade de dentifrício fluoretado menor que a metade da extensão das cerdas da escova de dente foi recomendada por 23,3% dos participantes, 15,3% responderam que o fio dental deve ser utilizado durante a higiene bucal das crianças. Um total de 40,7% acredita que a ingestão de alimentos açucarados pela criança interfere no desenvolvimento da cárie. Conclusão: Embora a maioria dos participantes já tenha recebido informações sobre a importância da higiene bucal e da alimentação saudável e todos achem essas informações importantes para manutenção da saúde bucal das crianças, algumas questões sobre o assunto ainda não são de conhecimento da maioria dos pais/responsáveis. (AU)

Introduction: To ensure that instructions on oral health for children are administered assertively, you must know the level of knowledge about children's oral health of parents/caregivers. Objective: Assess the knowledge of parents/ caregivers about healthy hygiene and diet habits in childhood. Materials and Methods: This is a cross-sectional observational study. A structured questionnaire was applied to parents/caregivers containing identification data and 10 questions for the theme. Descriptive analysis was performed on the data obtained. Results: It included a sample of 86 parents/caregivers of schoolchildren from two public schools in Minas Gerais. Most participants have already received information about the importance of oral health and healthy eating (93%) as well as agreeing that primary teeth should be brushed every day (91.9%). All participants found this information important for maintaining children's oral health (100%). The amount of fluoride dentifrice less than half the length of the toothbrush bristles was recommended by 23.3% of the participants, 15.3% answered that dental floss should be used during children's oral hygiene. A total of 40.7% believe that the child's intake of sugary foods interferes with the development of caries. Conclusion: Although most of the participants have already received information about the importance of oral hygiene and healthy eating, and everyone thinks this information is important for maintaining the oral health of children, some questions on the subject are not yet known to most parents/caregivers. (AU)

Impact of oral conditions of children/adolescents with Down syndrome on their families' quality of life.

AIMS: To assess the impact of oral conditions among children/adolescents with Down syndrome (DS) on the Oral Health-related Quality of Life (OHRQoL) of their families in comparison with a group without DS. METHODS AND RESULTS: Families of 144 children/adolescents with DS aged 4-18 years were compared with families of individuals without DS. Dental caries experience (DMFT/dmft), clinical consequences of untreated dental caries (PUFA/pufa), gingival bleeding (GBI), visible plaque (VPI), and malocclusion were evaluated. Parents/caregivers answered the Family Impact Scale (FIS) and questionnaires on sociodemographic conditions and the health of children/adolescents. Data analysis included chi-square test and Poisson regression. There was no difference between groups regarding the impact of the children's/adolescents' oral condition on their families' OHRQoL for all domains and the total FIS score (P > 0.05). A negative impact on the OHRQoL of families of children/adolescents with DS was determined by dental caries (PR = 3.95, CI = 2.09-7.46), clinical consequences of untreated dental caries (PR = 1.83, CI = 1.18-2.84), defined malocclusion (PR = 2.75, CI = 1.23-6.13), and severe malocclusion (PR = 2.82, CI = 1.02-7.74). CONCLUSION: There is no difference on the OHRQoL of families of children/adolescents with and without DS. Dental caries experience, clinical consequences of untreated dental caries, defined malocclusion, and severe malocclusion determined the negative impact on the OHRQoL of families of children/adolescents with DS.

Perception of parents/caregivers on the oral health of children/adolescents with Down syndrome.

INTRODUCTION: Oral health affects the general health of people with Down syndrome (DS), with repercussions on their ability to chew and to communicate. OBJECTIVE: To evaluate the influence of sociodemographic characteristics and clinical indicators on the perceptions of parents/caregivers regarding the oral health of individuals with DS. METHODS: Parents/caregivers completed a questionnaire containing sociodemographic information and answered the 20 questions of the Brazilian version of the Oral Health Scale for People with DS. Intra-oral clinical exam of children/adolescents was performed to assess dental caries, periodontal disease, and malocclusion. Descriptive statistics, bivariate analyses, and Poisson regression model analyses were carried out. RESULTS: In this study, 55.1% of the parents/caregivers showed a positive perception regarding the oral health of their children/adolescents. Parents/caregivers of individuals between 4 and 9 years old (Prevalence Ratio (PR) = 1.13; Confidence Interval (CI), 1.04 - 1.23; p = 0.003) and parents/caregivers of those with definite malocclusion (PR = 1.14; CI, 1.00 - 1.31; p = 0.047) had a higher prevalence of reporting a more negative perception of their children's/adolescents' oral health. CONCLUSION: DS individuals' age and the severity of malocclusion were indicators of a more negative perception of parents/caregivers regarding their sons'/daughters' oral health.

Periodontal disease in patients with Down syndrome: A systematic review.

BACKGROUND: The authors systematically reviewed the scientific evidence of an association between periodontal disease and Down syndrome (DS). TYPES OF STUDIES REVIEWED: In this systematic review, the authors included observational studies in which the investigators assessed the prevalence, incidence, or experience of periodontal disease in patients with DS compared with that in healthy patients. The authors used the Population, Exposure, Comparison, Outcome structure. The population was patients of any age, the exposure was the presence of DS, the comparison was the absence of DS, and the outcome was the presence of periodontal disease. The authors conducted an electronic search in 5 databases through March 2017. Two independent reviewers assessed the risk of bias by using the Fowkes and Fulton scale. The authors performed a meta-analysis to compare periodontal disease among patients with DS and those without DS. The authors calculated a summary effect measure-standard mean difference-when evaluating the means of the oral hygiene index. The authors assessed the strength of evidence from the selected studies by using a modified Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The authors included 23 case-control studies in the systematic review and submitted 3 to meta-analysis. In the qualitative analysis, results from most studies showed that the prevalence of some periodontal parameters was higher among patients with DS than among those without DS. Evaluations of the Fowkes and Fulton scale point to many methodological problems in the studies evaluated. Results of the meta-analysis revealed no differences between groups with regard to the oral hygiene index (standard mean difference, 0.05; 95% confidence interval, -0.55 to 0.65; I2 = 0.0%). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Further research is required, in particular well-designed studies that avoid the deficiencies identified in the studies in this review.

Impacto de condições bucais na qualidade de vida de crianças/adolescentes com Síndrome de Down e de seus familiares / Impact of oral conditions on the quality of life of children/adolescents with Down Syndrome

O objetivo deste estudo foi avaliar a percepção dos pais/cuidadores sobre o impacto das condições bucais na qualidade de vida de crianças/adolescentes com síndrome de Down (SD) e de seus familiares comparados com crianças/adolescentes sem SD. Trata-se de um estudo tranversal comparativo desenvolvido com 144 crianças/adolescentes com SD de quatro a 18 anos pareados por sexo e idade com 144 crianças/adolescentes sem SD, assim como os pais/cuidadores dos indivíduos de cada grupo. Para avaliação do impacto de condições bucais na qualidade de vida de crianças/adolescentes, pais/cuidadores responderam a versão curta do ParentalCaregiver Perceptions Questionnaire (P-CPQ), o qual é composto por três domínios: sintomas bucais, limitações funcionais e bem-estar. Para a avaliação do impacto da saúde bucal das crianças/adolescentes na qualidade de vida de seus familiares foi aplicado o Family Impact Scale (FIS) composto por quatro domínios: atividade dos pais/familiares, emoções dos pais/familiares, conflito familiar e encargos financeiros. Além disso, informações sociodemográficas e de saúde geral das crianças/adolescentes foram coletadas por meio de um questionário estruturado auto-aplicado. Um único examinador avaliou os seguintes indicadores clínicos: cárie dentária (CPO-D/ceo-d), consequências clínicas da cárie dentária não tratada (PUFA/pufa), sangramento à sondagem periodontal (ISS), presença de placa visível (IPV) e má oclusão (IED). A má oclusão foi categorizada pelo Índice Estético Dental (IED) em má oclusão ausente ou leve (IED 25), má oclusão definida (IED de 26 a 30), má oclusão severa (IED de 31 a 35) e má oclusão muito severa (IED 36). A examinadora foi treinada e calibrada para realização do exame clínico. Para cada condição bucal avaliada, foram determinadas as concordância inter-examinador (k = 0,81 a k = 0,92) e intra-examinador (k = 0,89 a k = 0,94). Os coeficientes Kappa mostraram-se satifatórios para realização do estudo epidemiológico. O teste Wilcoxon comparou os domínios e o escore total do P-CPQ e do FIS entre indivíduos com e sem SD. O teste qui-quadrado de Pearson, exato de Fisher e de tendência linear foram empregados para avaliar a associação entre o escore total do P-CPQ e do FIS com os dados sociodemográficos, com os dados de saúde e com os indicadores clínicos das crianças/adolescentes com SD. Os mesmos testes foram empregados para testar a associação entre o escore total do P-CPQ com as variáveis independentes para as crianças/adolescentes sem SD. As variáveis que apresentaram um nível de significância (p < 0,25) na análise bivariada foram incorporadas no modelo final da regressão de Poisson (IC: 95%, p < 0,05). Pais/cuidadores das crianças/adolescentes com SD apresentaram uma percepção mais negativa sobre as repercussões das condições bucais na qualidade de vida de seus filhos quando comparados à percepção dos pais/cuidadores dos indivíduos sem SD (p = 0,02). A mesma tendência também foi observada para o domínio de limitações funcionais (p < 0,01). As variáveis clínicas determinantes para uma percepção negativa dos pais/cuidadores de indivíduos com SD foram conseqüências clínicas da cárie dentária não tratada (RP = 1,72; IC = 1,04 2,84) e presença de placa visivel (RP = 1,48; IC = 1,08 2,03). Inversamente, para o domínio sintomas bucais pais/cuidadores das crianças/adolescentes sem SD apresentaram uma percepção mais negativa do impacto de condições bucais na qualidade de vida de seus filhos quando comparados à percepção dos pais/cuidadores dos indivíduos com SD (p < 0,01). Os determinantes para este resultado foram visita prévia ao dentista (RP = 2,19; IC = 1,32 3,63), conseqüências clínicas da cárie dentária não tratada (RP = 2,43; IC = 1,22 4,83), sangramento à sondagem periodontal (RP = 1,86; IC = 1,29 2,70) e má oclusão severa (RP = 3,33; IC = 1,07 5,00). Não houve diferença entre os grupos com e sem SD quanto ao impacto das codições bucais das crianças/adolescentes na qualidade de vida de suas famílias para os domínios e para o escore total da FIS (p > 0,05). As condições bucais determinantes para o impacto negativo na qualidade de vida das famílias de crianças/adolescentes com SD foram cárie dentária (RP = 3,95; IC = 2,09 7.46), conseqüências clínicas de cárie dentária não tratada (RP = 1,83; IC = 1,18 2,84), maloclusão definida (RP = 2,75; IC = 1,23 6,13) e má oclusão severa (RP = 2,82; IC = 1,02 7,74). O impacto das condições bucais na qualidade de vida de crianças/adolescentes com SD mostrou-se mais negativo quando comparado ao de crianças/adolescentes sem SD. As conseqüências clínicas da cárie dentária não tratada e a presença de placa visível foram determinates para o impacto negativo na qualidade de vida relacionada à saúde bucal das crianças/adolescentes com SD. Experiencia de cárie dentária, conseqüências clínicas da cárie dentária não tratada, má oclusão definida e má oclusão severa foram as condições bucais determinantes para o impacto negativo na qualidade de vida de seus familiares.

Impact of oral conditions on the quality of life of children/adolescents with Down syndrome The objective of the study was to evaluate the impact of oral conditions on the quality of life of children/adolescents with Down syndrome (DS) and their family members compared to children/adolescents without DS. This is a comparative cross-sectional study. Participated in the study 144 children/adolescents with DS aged 4 to 18 years matched by sex and age with 144 children/adolescents without DS, as well as the parents/caregivers of individuals in each group. To assess the impact of oral conditions on the quality of life of children/adolescents, parents/caregivers answered the short version of Parental-Caregiver Perceptions Questionnaire (P-CPQ), which consists of three domains: oral symptoms, functional limitations and well-being. The Family Impact Scale (FIS) was used to assess the impact of oral conditions of children/adolescents on the quality of life of their family members. It consists of four domains: parents' activity, parents' emotions, family conflict and financial charges. In addition, sociodemographic and general health information of the children/adolescents were collected through a structured questionnaire. A single examiner assessed the following clinical parameters: dental caries (DMF-T/dmf-t), clinical consequences of untreated dental caries (PUFA/pufa), gingival bleeding (GBI), visible plaque (VPI) and malocclusion were evaluated (DAI). Malocclusion was categorized by Dental Aesthetic Index (DAI) in absent or mild malocclusion (DAI 25), defined malocclusion (DAI of 26 to 30), severe malocclusion (DAI of 31 to 35) and very severe malocclusion (DAI 36). The examiner was trained and calibrated to perform the clinical examination. For each oral condition evaluated, the inter-examiner agreement (k = 0.81 a k = 0.92) and intra-examiner (k = 0.89 a k = 0.94) were determined. The Kappa coefficients were satisfactory for the accomplishment of the epidemiological study. The Wilcoxon test compared the domains and the total score of P-CPQ and FIS between individuals with and without SD. Pearson's Chi-square test, Fisher's exact and linear trend were used to evaluate the association between the total P-CPQ and FIS score with sociodemographic data, health data and clinical indicators of children/adolescents with DS. The same tests were used to test the association between the total P-CPQ score and the independent variables for children/adolescents without DS. The variables that presented a level of significance (p < 0.25) in the bivariate analysis were incorporated into the final Poisson regression model (CI: 95%, p < 0.05). Parents/caregivers of children/adolescents with DS presented a more negative perception about the repercussions of oral conditions on the quality of life of their children when compared to the perception of parents/caregivers of individuals without DS (p = 0.02). The same trend was also observed for the domain of functional limitations (p < 0.01). The determining clinical variables for a negative perception of the parents/caregivers of individuals with DS were clinical consequences of untreated dental caries (RP = 1.72, CI = 1.04 - 2.84) and presence of visible plaque (RP = 1.48, CI = 1.08 - 2.03). Conversely, for the domain of oral symptoms parents/caregivers of children/adolescents without DS presented a more negative perception of the impact of oral conditions on their children's quality of life when compared to the perception of the parents/caregivers of DS individuals (p < 0. 01). The determinants for this result were a previous visit to the dentist (RP = 2.19, CI = 1.32 - 3.63), clinical consequences of untreated dental caries (RP = 2.43, CI = 1.22-4.83), gingival bleeding (RP = 1.86, CI = 1.29 - 2.00) and severe malocclusion (RP = 3.33, CI = 1.07 - 5.00). There was no difference between the groups with and without DS regarding the impact of the children's/adolescents' oral coding on the quality of life of their families for the domains and for the total FIS score (p > 0.05). The oral conditions determining the negative impact on the quality of life of families of children/adolescents with DS were dental caries (RP = 3.95, CI = 2.09 - 7.46), clinical consequences of untreated dental caries (RP = 1.83, CI = 1.18 - 2.84), defined malocclusion (RP = 2.75, CI = 1.23 - 6.13) and severe occlusion (RP = 2.82, CI = 1.02 - 7.74). In general, the impact of oral conditions on the quality of life of children/adolescents with DS was more negative when compared to children/adolescents without DS. The presence of clinical consequences of untreated dental caries and visible plaque were the determining oral conditions for a negative impact on oral health related quality of life of children/adolescents with DS. Dental caries, clinical consequences of untreated dental caries, defined malocclusion and severe malocclusion were the determinant oral conditions for the impact on the quality of life of families of children/adolescents with DS. Key-words: Down Syndrome. Oral Health. Children/Adolescents. Quality of life. Oral Health-Related Quality of Life.

Relationship Between Salivary Cortisol Levels and Children's Behavior During a Dental Examination.

PURPOSE: To correlate the salivary cortisol levels in children attending a university dental clinic with their behavior during the dental appointment. METHODS: A prospective study was conducted with 43 seven- to 10-year-old children whose behavior during the dental appointment was assessed using the Frankl scale. Participants were divided into two groups: (1) cooperative children; and (2) uncooperative children. All children had four saliva samples collected as follows: prior to the dental examination (S1); shortly after the dental examination (S2); 30 minutes after waking up in the morning after the day of the appointment (S3); and in the afternoon, 24 hours after the dental appointment (S4). Salivary cortisol levels were measured by the chemiluminescent assay method. Statistical analysis included the Friedman and the Wilcoxon signed rank tests. RESULTS: For the cooperative group, salivary cortisol levels were significantly lower at S1 (P=0.004), S2 (P=0.006), and S4 (P=0.001) compared to S3. For the uncooperative group, salivary cortisol levels were significantly higher at S1 compared to S2 (P=0.005). CONCLUSIONS: Uncooperative children presented high levels of salivary cortisol prior to and shortly after the dental appointment. The period anticipating the consultation was considered highly stressful.