Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods.

The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.

Experience, Prevalence, and Severity of Dental Caries in Mexican Preschool and School-Aged Children.

Objective Dental caries in Mexico continues to be a public health problem, indicated by it is high prevalence and incidence in children. This disease is associated with pain in preschool and school children, with large-scale consequences for the individual, society, and health systems. The objective of the present study was to determine the experience (mean of caries indices), prevalence, and severity of caries in children 2-12 years of age who sought dental care at a dental school in Mexico. Material and methods A cross-sectional study was carried out on 826 clinical records of patients ages 2-12 years. The dependent variable was caries, in terms of experience (mean primary teeth (dmft) and permanent teeth (DMFT) indices), prevalence (dmft and DMFT greater than 0), and severity (cutoffs of caries indices at various levels). The independent variables were age and sex. The data were analyzed in Stata 14 (StataCorp LLC, College Station, Texas). Results The average age was 7.2±2.3; 52.4% were boys. In the primary dentition, the caries experience (mean dmft) was 3.01±3.30, the prevalence of caries was 65.8%, and the severity dmft>3=37.3% and dmft>6=15.6%. In the permanent dentition, the caries experience (mean DMFT) was 0.99±1.88, the prevalence of caries was 31.5%, and the severity DMFT>3=12.5% ​​and DMFT>6=1.6%. The percentage of caries-free children in both dentitions was 26.1% (n=216/826). The experience, prevalence, and severity of caries were statistically different by age (p<0.001). Only in the severity of dmft>3 were differences observed across sex (p<0.05). Among children with mixed dentition, primary teeth were more affected than permanent teeth (2.46±2.87 vs 0.88±1.61; p<0.0001). Conclusions About seven out of 10 children were affected by cavities in either or both dentitions. It was observed that age was positively associated with dental caries, equally affecting girls and boys. In this sample, the primary dentition was impacted more than the permanent dentition. Despite being preventable, dental caries continues to be a health problem in children.

Socioeconomic Inequalities and Toothbrushing Frequency among Schoolchildren Aged 6 to 12 Years in a Multi-Site Study of Mexican Cities: A Cross-Sectional Study.

Periodic toothbrushing is the most common, effective, and reliable way to mechanically remove biofilm from oral tissues. The objective of the present study was to determine the association between toothbrushing frequency and socioeconomic position for schoolchildren between 6 and 12 years of age in four cities in Mexico. A cross-sectional study was conducted on 500 Mexican schoolchildren between 6 and 12 years of age from public schools in four Mexican cities. Questionnaires were administered to the parents/guardians of the schoolchildren to obtain the variables included in the study. The dependent variable was toothbrushing frequency, dichotomized as: 0 = less than twice a day and 1 = at least twice a day. The analysis was performed in Stata. The average age of the schoolchildren was 8.9 ± 1.9 years; 50.4% were female. The prevalence of toothbrushing was 52.8% (at least twice a day) (95% CI = 48.4−57.1). In the multivariate model, the variables associated (p < 0.05) with toothbrushing frequency were older age of the schoolchild (OR = 1.14); younger age of the mother (OR = 0.93); being a girl (OR = 1.70); being enrolled in Seguro Popular (OR = 0.69); being in a household that was owned (OR = 2.43); and being a schoolchild who lived in a home that owned a car (OR = 1.31). The prevalence of toothbrushing at least twice a day was just over 50% in these Mexican children. We found demographic and socioeconomic variables to be associated with toothbrushing. Based on socioeconomic variables that were associated with toothbrushing frequency­such as health insurance, home ownership and the household owning a car­the results of the present study confirm the existence of health inequalities in toothbrushing frequency.

Factors Associated with Self-Report of Type 2 Diabetes Mellitus in Adults Seeking Dental Care in a Developing Country.

The aims of the present study were to identify the prevalence and risk indicators of type 2 diabetes mellitus (T2DM) in urban-based Mexican adults seeking care in a university-based triage/intake dental clinic, and to develop a predictive model. A cross-sectional study was conducted on 3354 medical/dental records of adults who sought care at the triage/intake dental clinics of a public university. The dependent variable was self-report of a previous diagnosis of T2DM made by a physician. Several socio-demographic and socioeconomic covariates were included, as well as others related to oral and general health. A multivariate binary logistic regression model was generated. We subsequently calculated well-known statistical measures employed to evaluate discrimination (classification) using an (adjusted) multivariate logistic regression model (goodness-of-fit test). The average age of patients was 42.5 ± 16.1 years old and the majority were female (64.1%). The prevalence of T2DM was 10.7% (95%CI = 9.7−11.8). In the final multivariate model, the variables associated (p < 0.05) with the presence of T2DM were older age (40 to 59 years old, OR = 2.00; 60 to 95 years old, OR = 2.78), having any type of health insurance (OR = 2.33), having high blood pressure (OR = 1.70), being obese (OR = 1.41), and having a functional dentition (OR = 0.68). Although the global fit of the model and the calibration tests were adequate, the sensitivity (0.0%) and positive predictive (0.0%) values were not. The specificity (100%) and negative predictive (89.3%) values, as well as the correctly classified (89.3%) value, were adequate. The area under the ROC curve, close to 0.70, was modest. In conclusion, a prevalence of T2DM of 10.7% in this sample of Mexican adults seeking dental care was similar to national figures. Clinical (blood pressure, BMI and functional dentition), demographic (age), and socioeconomic (health insurance) variables were found to be associated with T2DM. The dental setting could be appropriate for implementing preventive actions focused on identifying and helping to reduce the burden of T2DM in the population.

Self-reported oral hygiene practices with emphasis on frequency of tooth brushing: A cross-sectional study of Mexican older adults aged 60 years or above.

The objective of the study was to characterize self-reported oral hygiene practices among Mexican older adults aged ≥60 years, and to measure the association between frequency of tooth brushing and a set of sociodemographic, socioeconomic, and dental variables.We conducted a cross-sectional study of 139 older adults aged ≥60 years in Pachuca, Mexico. A questionnaire and a clinical dental examination were administered to identify specific variables. We determined frequency of tooth brushing (or cleaning of dentures or prostheses) and use of toothpaste, mouthwash, and dental floss among respondents. Non-parametric testing was performed for statistical analysis and a multivariate logistic regression model was generated with Stata 11 software to determine frequency of tooth brushing.In our study sample, 53.2% of participants reported brushing their teeth at least once a day, 50.4% always using toothpaste, 16.5% using mouthwash and 3.6% using floss for their oral hygiene. In general, younger and female respondents used oral hygiene aids more than the others. Our multivariate model yielded an association (P < .05) between tooth brushing at least once daily and the following variables: having functional dentition (OR = 12.60), lacking health insurance (OR = 3.72), being retired/pensioned (OR = 4.50), and suffering from a chronic disease (OR = 0.43).The older adults in our sample exhibited deficient oral hygiene behaviors. The results suggest certain socioeconomic inequalities in oral health. The findings of this study should be considered when designing dental care instructions for older adults.

Dental pain and associated factors in Mexican adolescents and young adults: a cross-sectional study.

OBJECTIVE: To identify the factors associated with the prevalence of dental pain in Mexican adolescents and young adults. MATERIAL AND METHODS: This is a cross-sectional study in which data from 638 Mexican subjects, 16-25 years of age, who were randomly selected from college applicants, were analysed. Questionnaires were administered to collect sociodemographic, economic and behavioural variables. Clinical examinations were carried out to determine the decayed, missing and filled teeth (DMFT) index. The outcome variable was dichotomised as 0 (no dental pain in the last 12 months) or 1 (dental pain in the last 12 months). Statistical analyses included binary logistic regression. RESULTS: Average age was 18.76 ± 1.76 years, and 49.2% of participants were women. Prevalence of dental pain was 34.0%. In the final model, variables significantly (P < 0.05) associated with the experience of dental pain were the use of preventive dental services (OR = 0.34), being a former smoker (OR = 2.37), self-report of very poor/poor oral health (OR = 1.94) or fair oral health (OR = 1.94), self-reported dental disease (OR = 2.06) or gingival disease (OR = 2.84). CONCLUSIONS: The prevalence of dental pain was associated with self-reported oral health status, preventive dental visits and smoking; these results have implications for dental practice. We found that recent experience of dental pain was common in young adults, being reported by one out of three subjects.

Ecological study on needs and cost of treatment for dental caries in schoolchildren aged 6, 12, and 15 years: Data from a national survey in Mexico.

To determine the treatment needs and the care index for dental caries in the primary dentition and permanent dentition of schoolchildren and to quantify the cost of care that would represent the treatment of dental caries in Mexico.A secondary analysis of data from the First National Caries Survey was conducted, which was a cross-sectional study conducted in the 32 states of Mexico. Based on dmft (average number of decayed, extracted, and filled teeth in the primary dentition) and DMFT (average number of decayed, extracted, and filled teeth in permanent dentition) information, a treatment needs index (TNI) and a caries care index (CI) were calculated.At age 6, the TNI for the primary dentition ranged from 81.7% to 99.5% and the CI ranged from 0.5% to 17.6%. In the permanent dentition, the TNI ranged from 58.8% to 100%, and the CI ranged from 0.0% to 41.2%. At age 12, the TNI ranged from 55.4% to 93.4%, and the CI ranged from 6.5% to 43.4%. At age 15, the TNI ranged from 50.4% to 98.4%, and the CI ranged from 1.4% to 48.3%. The total cost of treatment at 6 years of age was estimated to range from a purchasing power parity (PPP) of USD $49.1 to 287.7 million in the primary dentition, and from a PPP of USD $3.7 to 24 million in the permanent dentition. For the treatment of the permanent dentition of 12-year-olds, the PPP ranged from USD $13.3 to 85.4 million. The estimated cost of treatment of the permanent dentition of the 15-year-olds ranged from a PPP of USD $10.9 to 70.3 million. The total estimated cost of caries treatment ranged from a PPP of USD $77.1 to 499.6 million, depending on the type of treatment and provider (public or private).High percentages of TNI for dental caries and low CI values were observed. The estimated costs associated with the treatment for caries have an impact because they represent a considerable percentage of the total health expenditure in Mexico.

Prevalence of multimorbidity in subjects aged ≥60 years in a developing country.

BACKGROUND: Aging is one of the most prominent features in recent population dynamics around the world. As populations age, the prevalence of simultaneous chronic diseases increases, which is known as multimorbidity. OBJECTIVE: The aim of the present study was to determine the prevalence of multimorbidity and associated factors in a sample of elderly Mexican subjects. MATERIALS AND METHODS: A cross-sectional descriptive study was performed on a convenience sample of 139 subjects aged ≥60 years. The dependent variable was the multimorbidity diagnosis performed by a physician, which was categorized as 0 for subjects with no chronic disease or only 1 disease and 1 for subjects with 2 or more chronic diseases. Questionnaires were used to collect the information on the different variables. A statistical analysis was performed in Stata 11.0. RESULTS: The mean age was 79.06±9.78 years, and 69.1% of the subjects were women. A total of 69.1% (95% confidence interval =61.3-76.8) reported at least 1 morbidity. The mean morbidity by subject was 1.04±1.90. Cardiovascular diseases (25.9%), hypertension (20.1%), musculoskeletal disorders (19.4%), and diabetes (13.7%) were the most frequently reported conditions. The prevalence of multimorbidity (2 or more diseases) was 27.3% (95% confidence interval =19.8-34.8). No significant differences were observed in the independent variables. CONCLUSION: In conclusion, the prevalence of multimorbidity in this sample of elderly Mexican subjects was relatively low. The distribution across the included variables was not significantly different. Interventions focused on the health care of older adults with multimorbidity should pay special attention to cardiovascular diseases, hypertension, and musculoskeletal disorders.

[Socioeconomic inequalities in oral health service utilization any time in their lives for Mexican schoolchildren from 6 to 12 years old]. / Desigualdades socioeconómicas en la utilización de servicios de salud bucal (USSB) alguna vez en la vida por escolares Mexicanos de 6-12 años de edad.

OBJECTIVE: To determine the prevalence and the existence of socioeconomic inequalities in dental health service utilization (DHSU) any time in the life of Mexican schoolchildren aged 6-12 years of Pachuca Hidalgo, Mexico. MATERIAL AND METHODS: We performed a cross-sectional study in 1,404 school children 6-12 years of age from 14 public schools in the city of Pachuca, Hidalgo, Mexico. Questionnaires were distributed to determine socioeconomic position variables (SEP). The dependent variable was DHSU once in life (0 = No, 1 = Yes). The analysis was performed in Stata 9 using chi-square tests. RESULTS: The mean age was 8.97 ± 1.99 years, 50.1% were boys. The prevalence of DHSU any time in life was 71.4%. The DHSU percentage increased according increasing age (p < 0.05). Significant differences (p < 0.05) in percentages of USSB through SEP variables: health insurance, car ownership in the home, dwelling and household characteristics, a better level of SEP increased prevalence of DHSU. Although in the mother's schooling no differences were observed (p > 0.05), father's schooling was associated (p < 0.05) inversely to expectations. CONCLUSIONS: The findings of this study demonstrate that the prevalence of DHSU was not 100%; 28.6% of children have never had contact with a dentist. We identified certain indicator variables of SEP associated with DHSU, indicating the existence of inequalities in this oral health indicator.

[Oral hygiene customs in 6-12 year old schoolchildren]. / Uso de auxiliares para la higiene bucal y su distribucion por edad u sexo en escolares de seis a 12 anos de edad.

OBJECTIVE. To characterize utilization of oral hygiene devices and customs in schoolchildren. MATERIAL AND METHODS. We performed a cross-sectional study in 1,404 schoolchildren (6- 12 year olds) from 14 public schools in Pachuca, Hidalgo, México, using a questionnaire for sociodemographic variables and 1) Tooth brushing frequency (<1/d vs. at least 1/d), 2) Use of toothpaste (not always vs. always), 3) Flossing (never, does not know vs. at least 1/week), 4) Use of mouthwash (never, does not know vs. at least 1/week). Analyses were performed with nonparametric tests. RESULTS. Mean age was 8.97 ± 1.99 years; 50.1% were male. Prevalence of utilization of oral hygiene devices and associated customs were 85.5% tooth brushing, 90.9% toothpaste, 19.4% flossing, and 28.2% mouthwash. Only 11.8% of participants reported utilization in all 4 categories. We observed differences (p < 0.05) across sexes only in the use of toothpaste, as women used it more often. Differences across age were observed (p < 0.05) for tooth brushing (younger children brushed more often) and flossing (older children flossed more often). CONCLUSIONS. Tooth brushing was the oral hygiene practice more often performed in this sample, with other frequencies being relatively low. There were differences by age and sex across some variables.

[Associated costs with dental studies in a public Mexican university]. / Estudiar para cirujano dentista en una universidad pública. Los costos relacionados.

OBJECTIVE: To calculate associated costs with dental studies (ACDS) in a public university. METHODS: We performed a cross-sectional study using a costing system on a random sample of 376 dental students enrolled at any semester in a public university. To calculate ACDS (Mexican pesos of 2009-1), we used a questionnaire divided into eight sections. Sociodemographic and socioeconomic variables, housing costs, food, transportation, instruments and equipment, as well as remunerations associated with patient care along 16 weeks of classes in each semester were included. We used linear regression. RESULTS: The average of ACDS was of 18,357.54 ± 12,746.81 Mexican pesos. The largest percentage of ACDS (30.2 %) was for clinical instruments (5,537.66 ± 6,260.50). Students also spent funds in paying to patients for their time during care delivered (2,402.11 ± 4,796.50). Associated variables (p 〈 0.001) with the ACDS were having completed at least one clinical course or one theoretical-practical course, living within the state or out of state (compared to students who live in the city where dental studies take place), and being enrolled in the more advanced dental studies. CONCLUSIONS: The results indicate that a significant percentage of the cost to students (13.1 %) is related with clinical care delivery.

OBJETIVO: calcular los costos relacionados con el estudio de la carrera de cirujano dentista (CRELCD) en una universidad pública del estado de Hidalgo, México. MÉTODOS: se empleó un sistema de costeo en una muestra aleatoria de alumnos de la carrera de cirujano dentista. Se incluyeron 376 estudiantes de segundo a décimo semestre. Para realizar el cálculo de los costos (pesos mexicanos para 2009) se utilizó un cuestionario. Se incluyeron variables sociodemográficas, socioeconómicas, sobre costos en vivienda, alimentación, transporte, instrumental y material, así como en atención a pacientes; para ello se consideraron 16 semanas de clases. Para el modelo final se empleó regresión lineal. RESULTADOS: el promedio del CRELCD fue 18 357.54 ± 12 746.81 pesos; 30.2 % consistió en el costo del instrumental (5537.66 ± 6260.50). Los alumnos gastaron en la remuneración a sus pacientes 2402.11 ± 4796.50 pesos. Las variables relacionadas fueron haber cursado al menos una asignatura clínica y una teórico-práctica, vivir en el interior o fuera del estado (en comparación quienes vivían en la ciudad donde cursaban la carrera) y ser alumno de semestres más avanzados. CONCLUSIONES: un porcentaje importante (13.1 %) de alumnos gasta en el tratamiento de sus pacientes. Es necesario identificar si estos costos representan barreras inequitativas en la decisión de emprender, continuar o finalizar estudios de odontología.

Impact of socio-demographic, socioeconomic, and water variables on dental fluorosis in adolescents growing up during the implementation of a fluoridated domestic salt program.

The objective of this study is to determine the impact of socio-demographic, socioeconomic, and other risk indicators on dental fluorosis (DF) among Mexican adolescents. A cross-sectional study was carried out in 1,538 adolescents 12 and 15 years of age in semi-rural communities located at high altitude (>2,000 m) and with high concentration of fluoride in water (1.38-3.07 ppm) in Hidalgo, Mexico. DF was determined by means of Dean's Index and all teeth were examined. Remaining variables were collected using a questionnaire. The adjusted final model was performed using ordered logistic regression. After adjusting for sex, the variables associated with DF were (p < 0.05): being 12 years old (OR = 1.10) versus 15 years old; having lived the first 6 years of life in El Llano (3.07 F ppm) (OR = 3.19) or San Marcos (1.38 F ppm) (OR = 1.63) versus Tula (1.42 F ppm); having public (OR = 1.35) or private health insurance (OR = 1.36) versus those without insurance; belonging to the lower quartiles of socioeconomic position (SEP) [1st quartile (OR = 2.48), 2nd quartile (OR = 1.81), 3rd quartile (OR = 1.49)] versus the highest quartile; having drunk tap water (OR = 1.83) or from a well or spring (OR = 2.30) versus those who drank water purchased in large containers or bottles. Demographic and socioeconomic variables were associated with DF. While better SEP appeared to play an important role in DF, a pattern of water intake associated with water purchased in large containers or bottles (which have different connotations to the use of bottled water in industrialized Western countries) did reduce DF risk in these high fluoride content, high altitude communities.

Dental plaque, preventive care, and tooth brushing associated with dental caries in primary teeth in schoolchildren ages 6-9 years of Leon, Nicaragua.

BACKGROUND: Our study aimed to evaluate the effect of various risk indicators for dental caries on primary teeth of Nicaraguan children (from Leon, Nicaragua) ages 6 to 9, using the negative binomial regression model. MATERIAL/METHODS: A cross-sectional study was carried out to collect clinical, demographic, socioeconomic, and behavioral data from 794 schoolchildren ages 6 to 9 years, randomly selected from 25 schools in the city of León, Nicaragua. Clinical examinations for dental caries (dmft index) were performed by 2 trained and standardized examiners. Socio-demographic, socioeconomic, and behavioral data were self-reported using questionnaires. Multivariate negative binomial regression (NBR) analysis was used. RESULTS: Mean age was 7.49 ± 1.12 years. Boys accounted for 50.1% of the sample. Mean dmft was 3.54 ± 3.13 and caries prevalence (dmft >0) was 77.6%. In the NBR multivariate model (p<0.05), for each year of age, the expected mean dmft decreased by 7.5%. Brushing teeth at least once a day and having received preventive dental care in the last year before data collection were associated with declines in the expected mean dmft by 19.5% and 69.6%, respectively. Presence of dental plaque increased the expected mean dmft by 395.5%. CONCLUSIONS: The proportion of students with caries in this sample was high. We found associations between dental caries in the primary dentition and dental plaque, brushing teeth at least once a day, and having received preventive dental care. To improve oral health, school programs and/or age-appropriate interventions need to be developed based on the specific profile of caries experience and the associated risk indicators.

Cuidados de la dentición primaria de escolares de 6 y 7 años de edad / Care index for primary teeth in schoolchildren aged 6 and 7 years

Determinar la existencia, prevalencia y gravedad de caries dental, así como establecer las necesidades de tratamiento y el índice de cuidados en la dentición primaria de niños mexicanos de 6 y 7 años de edad. Material y métodos: Este estudio transversal incluyó 357 escolares de la ciudad de Campeche, México. El índice de dientes cariados, indicados para extracción/extraídos y perdidos (índice ceod) fue utilizado para determinar la existencia de caries dental, y con él se calcularon igualmente la prevalencia (ceod > 0), la gravedad (ceod ≥ 4), así como las necesidades de tratamiento (INT) y el índice de cuidados. Se utilizaron cuestionarios para identificar las variables sociodemográficas, socioeconómicas y de conductas de salud bucal. En el análisis se empleó el modelo de regresión logística binaria. Resultados: El índice ceod global fue de 2.29 ± 2.95. La prevalencia y la gravedad fueron 52.4% y 29.1%, respectivamente. El porcentaje del INT fue de 88.1% y el índice de cuidados de 11.4%. En el modelo multivariado, la actitud negativa hacia la salud bucal (odds ratio [OR] = 2.32; intervalo de confianza [IC] del 95%: 1.36-3.94) y las visitas al dentista en el año previo al estudio (OR = 1.93; IC 95%: 1.44-2.54), resultaron asociadas a la prevalencia de caries. Conclusiones: Más de la mitad de los escolares presentan lesiones de caries en la dentición primaria. Se observó un alto porcentaje de lesiones cariosas con necesidad de tratamiento. Observamos que la actitud que tiene la madre hacia la salud bucal de su hijo tiene cierto grado de influencia sobre la prevalencia de caries en la dentición primaria. Es necesario implementar estrategias que permitan mejorar la salud bucal de los escolares...

[Principal reasons for extraction of permanent tooth in a sample of Mexicans adults]. / Principales razones de extracción de dientes permanentes en una muestra de adultos mexicanos.

BACKGROUND: Tooth extractions are one of the most common procedures in oral surgery. The objective of this study was to identify the reasons for tooth extraction in adult patients seeking care at teaching dental clinics. MATERIAL AND METHODS: A cross-sectional study was carried out in 331 subjects between 18 and 85 (45.37 +/- 13.85) years of age seeking dental care in dental clinics of the Universidad Autónoma del Estado de Hidalgo, from January 2009 to December, 2009. Data pertaining to age, sex, tooth number and the reason for extraction according to Kay & Blinkhorn were analyzed with non-parametric tests. RESULTS: 779 extractions were undertaken. The main reason for extraction was dental caries (43.1%), periodontal disease (PD) (27.9%), and prosthetic reasons (21.5%). There was no significant difference across sex for reasons of extraction (p > 0.05). Significant differences (p < 0.001) were found for age (extraction due to periodontal disease increased with age); in patients attending in a single visit vs. patients attending a series of dental appointments (caries reasons were more common in patients having a single appointment vs. PD in those attending a series of appointments); for type of teeth (upper, posterior, and molars were extracted primarily because of caries, while lower, anterior and incisors were more often extracted because of PD). CONCLUSIONS: Dental caries was the most common reason for tooth extraction, followed by periodontal disease. Differences in the reasons for extraction were observed across patient characteristics and type of tooth.

[Dental fluorosis prevalence in eight cohorts of Mexicans born during the implementation of the Fluoridated Domestic Salt National Program]. / Prevalencia de fluorosis dental en ocho cohortes de mexicanos nacidos durante la instauración del Programa Nacional de Fluoruración de la Sal Doméstica.

OBJECTIVE: to determine the effect of birth cohort on dental fluorosis in Mexican schoolchildren during the implementation of the national program to fluoridate domestic salt. MATERIAL AND METHODS: in a cross-sectional study we examined 1,644 schoolchildren 6-13 years old born between 1985-1992 in Campeche, México; a community where there is negligible naturally available fluoride in water supplies. Dental fluorosis was assessed with the Dean's index in the permanent dentition. Questionnaires were used to identify diverse socio-demographic and socio-economic variables. In the statistical analysis logistic regression was used. RESULTS: the prevalence of fluorosis was 15.5%. In the multivariate model,we observed fluorosis was associated with larger family sizes (OR: 0.91; 95% CI: 0.84-0.99) and female sex (OR: 0.74; 95%CI: 0.57-0.98). Furthermore, using the cohort of 1985 as a comparison group, no significant dental fluorosis differences were found with those born between 1986-1987; in contrast, in the cohorts born between 1989-1992 the risk of dental fluorosis increased by almost four times (p < 0.05). CONCLUSION: the prevalence of fluorosis was low compared to other studies in Mexico. In this community with negligible fluoride in water supplies the likelihood of dental fluorosis increased as the windows of susceptibility in birth cohorts were closer to the chronologic beginning of the national domestic salt fluoridation program in 1991. This trend was more apparent after 1991.

Impacto de la posición socioeconómica sobre los defectos de desarrollo del esmalte en dentición primaria / Impact of socioeconomic position on the developmental enamel defects on primary dentition

Introducción y ObjetivoLos defectos de desarrollo del esmalte (DDE) son alteraciones del esmalte dental que resulta de diversosdisturbios durante la amelogénesis.Determinar el impacto de la posición socioeconómica (PSE) sobre los DDE en la dentición primaria deniños escolares de 6 a 9 años de edad.Material y MétodosSe realizó un estudio transversal en 925 escolares de seis a nueve años de edad. El criterio utilizado paraDDE fue el propuesto por la Federación Dental Internacional, específicamente las opacidades marcadasy difusas e hipoplasias, excluyendo fluorosis dental y otras decoloraciones, a través de un examen clínicorealizado por tres examinadores previamente estandarizados (kappa> 0,80). Se utilizó un cuestionariodirigido a las madres/tutores de los niños se recogieron diversas variables sociodemográficas ysocioeconómicas. La PSE fue determinada con la ocupación y escolaridad de los padres. El análisisestadístico se realizó calculando razones de momios con regresión logística en STATA 9.0.ResultadosLa edad promedio fue 7,56±1,13 años y 50,3% fueron varones. El promedio de DDE fue 0,17±0,75, y laprevalencia de 9,9%. En el análisis multivariado de regresión logística, se observó que los momios depresentar DDE en los dientes primarios aumentaron (p<0,05) en los niños de 8-9 años, en los que visitanal dentista con mayor frecuencia y los de peor PSE.ConclusionesEste estudio permitió identificar que la PSE tiene un impacto en la presencia de DDE en la denticiónprimaria. Es necesario realizar más estudios que confirmen esta asociación y clarifiquen la relación,preferentemente de tipo longitudinal.

Introduction and objectiveDevelopmental enamel defects (DED) can be defined as any alteration of tooth enamel resulting fromvarious disturbances during amelogenesis. The objective of this report was to determine the impact ofsocioeconomic position (SEP) on the DEDin primary teeth of 6 to 9 year old school children.Material and MethodsA cross-sectional study in 925 school children from six to nine years old was carried out. The diagnosticcriteria used for DED was proposed by the FDI, specifically marked and diffuse opacities and hypoplasia,excluding dental fluorosis and other discolorations, through a clinical examination conducted by threetrained and calibrated examiners (kappa> 0,80). Sociodemographic and socioeconomic variables werecollected through a questionnaire directed to mothers / guardians of children. Socioeconomic position(SEP) was determined with the parental occupation and schooling. Statistical analysis was performed bycalculating odds ratios with logistic regression in STATA 9.0.ResultsThe mean age was 7,56±1,13 years and 50,3% were male. Average DED was 0,17 ± 0,75, and theprevalence of 9,9%. Multivariate logistic regression analysis indicated that the odds presenting DED inprimary teeth increased (p <0,05) in children between 8-9 years old, visiting the dentist more often andthe worst SEP.ConclusionsThis study has shown that the PSE has an impact on the presence of DED in the primary dentition.Further studies, which are preferably longitudinal, are needed to confirm this association and clarify therelationship.