Dentin hypersensitivity and toothache among patients diagnosed with Molar-Incisor Hypomineralization: A systematic review and meta-analysis.

OBJECTIVES: To determine the prevalence of dentin hypersensitivity (DH) and toothache in patients with Molar-Incisor Hypomineralization (MIH); and evaluate whether patients with MIH have greater likelihood of presenting DH/toothache than controls. DATA: Studies evaluating DH/toothache in patients with MIH were included. Studies focusing on other enamel defects were excluded. SOURCES: Eight databases, including grey literature, were searched in January 2024. STUDY SELECTION: The methodological quality of studies was assessed using the Joanna Briggs Institute checklist for Cross-sectional studies. Proportion and association meta-analyses, subgrouped by diagnostic methods, were conducted. The certainty of evidence was assessed using GRADE approach. RESULTS: Fifteen studies were included in the qualitative analysis and fourteen in the meta-analyses. Two studies fulfilled all items of the methodological quality checklist. The overall prevalence of DH/toothache among patients with MIH was 45 %. Prevalence rates of 30 %, 47 %, and 55 % were estimated based on proxy reports, self-reports, and air stimulation, respectively. The overall prevalence of DH/toothache per tooth was 22 %, ranging from 16 % to 29 % according to the diagnostic method. Patients with MIH demonstrated higher likelihood of presenting proxy reports of DH/toothache compared to those without MIH (OR: 1.51, 95 % CI [1.23-1.85], P < 0.01, I2: 0 %). The certainty of evidence was very low, mainly due to the low methodological quality of included studies and high inconsistency. CONCLUSIONS: The global prevalence of DH/toothache was 22 %, per tooth, and 45 % per patient. Estimates vary according to diagnostic methods. Patients with MIH showed higher likelihood of presenting proxy reports of DH/toothache than controls. CLINICAL SIGNIFICANCE: This systematic review contributes valuable information to the dental literature by assessing the prevalence and associated factors of DH/toothache in patients with MIH. The findings can guide future research, inform clinical practices and public policy makers, and ultimately improve the management of oral health of patients with MIH. REGISTRATION: PROSPERO CRD42023432805.

Parental oral health literacy influences preschool children's utilization of dental services.

Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03-1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09-1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03-1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level.

Is oral health literacy associated with conceptions of care and behavior related to the prevention of COVID-19?

The aim of the present study was to investigate the impact of oral health literacy (OHL) on conceptions of care and behaviors related to COVID-19. The sample came from two preliminary cross-sectional studies that determined the level of OHL of parents/guardians of six-to-12-year-old children in two major Brazilian cities (Curitiba and Belo Horizonte). Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14) for the evaluation of interactive OHL. Participants were recruited through e-mail, social media, and telephone contact. The questionnaire on conceptions of care and behaviors related to COVID-19 was created based on the guidelines of the World Health Organization. Two hundred nineteen individuals participated in the study. There was no significant difference in socioeconomic and demographic variables and in the medians of BREALD and HeLD-14 between the two cities (P>0.05). Higher levels of functional OHL were associated with an appropriate conception that individual care affects collective care (P=0.038), but with an inappropriate conception of seeking medical assistance in cases of mild symptoms (P=0.030). Higher levels of interactive OHL were related to social distancing behavior in the city of Curitiba (P=0.049) and in the overall sample (P=0.040). It is concluded that functional OHL was associated with two of the investigated conceptions about COVID-19, while interactive OHL was associated with social distancing behavior. These data may suggest that different dimensions of the OHL can have an impact on different aspects of coping with the pandemic.

The influence of different dimensions of oral health literacy on parental attitudes and comprehension of an information leaflet about permanent tooth avulsion.

BACKGROUND/AIM: Permanent tooth avulsion requires proper management at the time of the accident and parental oral health literacy (OHL) may influence decision-making with regards to dental trauma. The aim of this study was to investigate the influence of OHL on: (1) self-rated comprehension of an information leaflet (IL), (2) self-rated capacity to execute the tasks proposed on the IL, and (3) attitudes regarding the avulsion of a permanent tooth in children. MATERIAL AND METHODS: A longitudinal study was conducted involving the reading of an IL by 466 parents/caregivers. Evaluations were performed prior to the IL (Phase I), immediately after the application of the IL (Phase II) and 60 days after the application of the IL (Phase III). Self-rated comprehension and capacity to execute the proposed tasks were analyzed in Phase II. Attitude was evaluated in all three phases. Functional OHL was measured using the BREALD-30 and interactive OHL was measured using HeLD-14. RESULTS: Correlations were found between self-rated comprehension and both the OHL/BREALD-30 score (rs = 0.179; p = .012) and OHL/HeLD-14 score (r = 0.258; p < .001). Correlations were also found between the self-rated capacity to execute the proposed tasks and both the OHL/BREALD-30 score (rs = 0.133; p = .047) and the OHL/HeLD-14 score (rs = 0.225; p < .001). Higher BREALD-30 and HeLD-14 scores were associated with a better performance regarding parental attitudes toward permanent tooth avulsion comparing Phases I and II and Phases II and III (p < .05). CONCLUSIONS: Higher levels of OHL were associated with better parental self-rated comprehension of the IL and the capacity to execute the tasks proposed therein as well as more adequate attitudes regarding the avulsion of a permanent tooth.

Are Premature Birth and Low Birth Weight Associated with Delay on the Eruption of Deciduous Teeth? A Systematic Review and Meta-analysis

ABSTRACT Objective: To investigate whether children with premature birth (PB) and/or with low birth weight (LBW) have different tooth eruption patterns than those born at term or with normal weight. Material and Methods: Searches were performed in the PubMed, Cochrane Library, Sc1opus, Web of Science, LILACS, and BBO databases as well as the grey literature. Three independent reviewers were involved in study selection, data extraction, and bias assessment. The risk of bias was assessed using the Modified Newcastle-Ottawa Scale. Meta-analysis was conducted to compute the mean difference (MD) in mean chronological or adjusted age at the eruption of the first deciduous tooth between preterm children and those born at full term. The GRADE approach was used. Results: Among a total of 316 articles identified, 21 were eligible for inclusion and three were included in the meta-analysis. PB was associated with the delay in the first tooth deciduous eruption when chronological age was considered (MD: 1.36; 95%CI: 1.02-1.69) but not when considering adjusted age (MD: -0.30; 95%CI: -0.67-0.07). The evidence was graded as having very low quality. Conclusion: Based on a low certainty of evidence the PB is associated with the delayed eruption of the first deciduous tooth when considering chronological age but not when adjusted age is considered.

Is oral health literacy associated with conceptions of care and behavior related to the prevention of COVID-19?

Abstract The aim of the present study was to investigate the impact of oral health literacy (OHL) on conceptions of care and behaviors related to COVID-19. The sample came from two preliminary cross-sectional studies that determined the level of OHL of parents/guardians of six-to-12-year-old children in two major Brazilian cities (Curitiba and Belo Horizonte). Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14) for the evaluation of interactive OHL. Participants were recruited through e-mail, social media, and telephone contact. The questionnaire on conceptions of care and behaviors related to COVID-19 was created based on the guidelines of the World Health Organization. Two hundred nineteen individuals participated in the study. There was no significant difference in socioeconomic and demographic variables and in the medians of BREALD and HeLD-14 between the two cities (P>0.05). Higher levels of functional OHL were associated with an appropriate conception that individual care affects collective care (P=0.038), but with an inappropriate conception of seeking medical assistance in cases of mild symptoms (P=0.030). Higher levels of interactive OHL were related to social distancing behavior in the city of Curitiba (P=0.049) and in the overall sample (P=0.040). It is concluded that functional OHL was associated with two of the investigated conceptions about COVID-19, while interactive OHL was associated with social distancing behavior. These data may suggest that different dimensions of the OHL can have an impact on different aspects of coping with the pandemic.

Parental oral health literacy influences preschool children's utilization of dental services

Abstract: Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03-1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09-1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03-1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level.

Factors Associated with the Intake of Ultra-Processed Cariogenic Foods by Preschoolers During the COVID-19 Pandemic

ABSTRACT Objective: To evaluate the characteristics and factors associated with the intake of ultra-processed cariogenic foods (UFC) by preschoolers during the COVID-19 pandemic. Material and Methods: This is a cross-sectional study involving parents of 672 children from two to five years old enrolled at public schools in Curitiba, Brazil. Parents answered a questionnaire about socioeconomic and demographic data, their behavior regarding the dietary education of their children (Parent Mealtime Action Scale - translated and validated for use in Brazil), and children's food intake (qualitative food frequency questionnaire - list of foods based on a report from the Pan American Health Organization). The data were analyzed using Poisson regression analysis (α=0.05). Results: About 43% of parents/guardians reported changes in their children's diet during the pandemic, being that diet got worse and better in 19% and 24% of the cases, respectively. The ultra-processed cariogenic foods with the highest daily intake frequencies were sweetened juices/sweetened drinks (0.52), followed by cookies (0.37), and candies (0.35). Parents with a lower level of education reported a daily frequency of UCF intake 1.36 times higher (PR=1.359; CI 95%: 1.106-1.669) in their children compared to those with a higher level of education. On the other hand, parents'/guardians' report of higher intake and greater offer of fruits and vegetables to children was associated with low UCF intake (PR=0.716; CI 95%: 0.592-0.866). Conclusion: The lower level of formal education of parents/guardians and lower availability of fruits and vegetables were related to higher consumption of ultra-processed cariogenic foods by children.

Are technology-based health education methods able to reduce oral health inequalities between the sexes in adolescents? A cluster randomized trial.

PURPOSE: Determine if different technology-based health education interventions can reduce oral health inequalities between the sexes in a sample of adolescents. METHODS: A cluster randomized clinical trial was conducted in three phases with an initial sample of 291 male and female adolescents 14-19 years of age. Phase I (n = 288) comprised a clinical examination performed by a calibrated examiner using the simplified oral hygiene index (OHI-S) and gingival bleeding index (GBI). Phase II involved two educational interventions: video (VD; n = 147) or oral counselling (OR; n = 141) with standardized content. In phase III, an App was made available to half of the clusters (OR + App; n = 66/OR without App; n = 71/VD + App; n = 63/VD without App; n = 63), and the clinical examination was performed a second time. Data were evaluated using descriptive analysis and nonparametric tests. RESULTS: In phase I, boys had a lower standard of oral hygiene compared with girls, with higher mean OHI-S (p = 0.039) and GBI (p = 0.015). After VD and OR interventions, no significant difference between sexes was found regarding the mean OHI-S. However, males had a higher mean GBI compared with females in the OR group (p = 0.006). When the App was added to OR and VD groups, males in the 'OR without App' group had a higher mean GBI compared with females (p = 0.007). CONCLUSION: This clinical trial demonstrated that educational interventions involving information technologies were effective at reducing oral health inequalities between the sexes among adolescents. However, oral counselling alone was not efficient in reducing GBI in male adolescents.

Different dimensions of oral health literacy are associated with social determinants of health in Brazilian adults.

Social determinants of health (SDH) are strongly associated with oral health outcomes, and oral health literacy (OHL) is a potential factor that can modify this association. This study evaluated the association between SDH and OHL, including functional and interactive dimensions of OHL. The cross sectional study was conducted with 354 adults recruited from public dental clinics in southern Brazil. Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14), for the evaluation of interactional OHL. SDH was evaluated through a structured questionnaire, and economic class was determined based on the Brazilian Economic Classification Criteria. The statistical analysis involved bivariate and multivariate Poisson regression with robust variance (α=0.05) to estimate rate ratios (RR) and 95% confidence intervals (CI). Among the 354 participants, 284 (80.2%) were women and the mean age was 22.9 ± 4.9 years. The median BREALD-30 score was 24 (1st/3rd quintile: 20/27) and the median HeLD-14 score was 45 (1st/3rd quintile: 37/50). Most participants had up to eight years of schooling (71.5%) and belonged to the "C" Economic Class or lower (94.1%). The multiple regression analysis showed that schooling and economic class were associated with the BREALD-30 and HeLD-14 scores, income and age were associated with the HeLD-14 score, and marital status and occupation were associated with the BREALD-30 score. Different dimensions of OHL were associated with SDH in Brazilian adults. This aspect should be incorporated into strategies for improving OHL levels in individuals or populations.

Access to dental care for patients with inherited bleeding and hemoglobin disorders.

AIM: To identify the main barriers to dental care access for patients with inherited bleeding (IBD) and hemoglobin disorders (HbD). METHODS: Patients with IBD and HbD were invited to participate in this study between August 2019 and March 2020. Data were collected through a questionnaire consisting of socioeconomic and demographic items and questions about access to dental services and history of dental treatment. Univariate and multiple Poisson regression model was used to determine associations between professional refusal of dental care and other co-variables (p < .05). RESULTS: The participants (29.1%) have already had professional refusal of dental care and participants with IBD (53.2%) did not feel confident with their local dentist due to their bleeding tendency. Most (64.6%) felt apprehensive about visiting the local dentist and high prevalence of refusal to provide dental care was associated with age (prevalence ratio [PR] = 1.021; 95% confidence interval [CI] = 1.010-1.032). Individuals with low bleeding risk were less likely to be denied dental care by a professional compared to those with high bleeding risk (PR = 0.536; 95%CI = 0.291-0.990). CONCLUSION: Professional refusal of dental care was high among patients with IBD, particularly older adults and with an increased risk of bleeding.

Untreated early childhood caries: the role of parental eating behavior.

The aim of the present study was to analyze the association between parental eating behavior and untreated early childhood caries (ECC). A cross-sectional study was conducted with a representative sample of 432 parent-child dyads with children aged 18 to 36 months, at Municipal Child Education Centers in São José dos Pinhais, Brazil. The parents answered a questionnaire addressing demographic and socioeconomic characteristics, and the children were examined for dental caries (modified dmft index) by a single examiner (kappa = 0.80). A six-item questionnaire was administered addressing parental food consumption, parental control of the child's food consumption, and parental offering of foods to the child. Three items were considered indicative of positive behavior, and three, of negative behavior. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). The prevalence of untreated ECC was 20.3% (95%CI: 16.7-24.4). In the multiple regression model adjusted for the child's age and the parent's schooling, negative parental behavior was associated with a greater frequency of untreated ECC (PRa = 1.213; 95%CI:1.032-1.427, p = 0.019), but lost its significance when adjusted by positive parental behavior (PRa = 1.156; 95%CI: 0.983-1.358, p = 0.079). Based on the present findings, positive parental eating behaviors are capable of minimizing the impact of negative parental behaviors on the prevalence of untreated early childhood caries.

Different dimensions of oral health literacy are associated with social determinants of health in Brazilian adults

Abstract Social determinants of health (SDH) are strongly associated with oral health outcomes, and oral health literacy (OHL) is a potential factor that can modify this association. This study evaluated the association between SDH and OHL, including functional and interactive dimensions of OHL. The cross sectional study was conducted with 354 adults recruited from public dental clinics in southern Brazil. Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14), for the evaluation of interactional OHL. SDH was evaluated through a structured questionnaire, and economic class was determined based on the Brazilian Economic Classification Criteria. The statistical analysis involved bivariate and multivariate Poisson regression with robust variance (α=0.05) to estimate rate ratios (RR) and 95% confidence intervals (CI). Among the 354 participants, 284 (80.2%) were women and the mean age was 22.9 ± 4.9 years. The median BREALD-30 score was 24 (1st/3rd quintile: 20/27) and the median HeLD-14 score was 45 (1st/3rd quintile: 37/50). Most participants had up to eight years of schooling (71.5%) and belonged to the "C" Economic Class or lower (94.1%). The multiple regression analysis showed that schooling and economic class were associated with the BREALD-30 and HeLD-14 scores, income and age were associated with the HeLD-14 score, and marital status and occupation were associated with the BREALD-30 score. Different dimensions of OHL were associated with SDH in Brazilian adults. This aspect should be incorporated into strategies for improving OHL levels in individuals or populations.

Can Hemophilia Impact on the Oral Health Conditions of Children and Adolescents? A Systematic Review and Metanalysis

Abstract Objective: To analyze if the oral health conditions in children and adolescents are associated with hemophilia (PROSPERO-42020168192). Material and Methods: The search strategy was performed in PubMed, Scopus, Lilacs/BBO, Web of Science, Cochrane, and Grey literature databases. Two independent researchers assessed the risk of bias in these studies by the Newcastle-Ottawa Scale. For the meta-analysis, the clinical conditions data were extracted as numerical variables according to their indexes, such as dental caries experience (dmft/DMFT), gingival condition (Modified Gingival Index - IGM), and oral hygiene (Plaque Index - PI). The quality of the evidence of the meta-analysis was evaluated by the GRADE tool (GRADEproGDT). Results: From a total of 431 studies, 27 were included, and 10 were included in the meta-analysis. The studies presented a moderate risk of bias, ranging from 2 to 7 points. The dental caries experience in primary (-0.62; CI95%: -1.68-0.43) and permanent dentitions (-0.05; CI95%: -0.69-0.59), gingival condition (-0.12; CI95%: -0.27-0.03), and oral hygiene (0.36; CI95%: -0.06-0.77) did not differ between the groups. Conclusion: Based on studies with very weak evidence, there were no differences in the oral health conditions of children and adolescents with and without hemophilia (AU).

Untreated early childhood caries: the role of parental eating behavior

Abstract The aim of the present study was to analyze the association between parental eating behavior and untreated early childhood caries (ECC). A cross-sectional study was conducted with a representative sample of 432 parent-child dyads with children aged 18 to 36 months, at Municipal Child Education Centers in São José dos Pinhais, Brazil. The parents answered a questionnaire addressing demographic and socioeconomic characteristics, and the children were examined for dental caries (modified dmft index) by a single examiner (kappa = 0.80). A six-item questionnaire was administered addressing parental food consumption, parental control of the child's food consumption, and parental offering of foods to the child. Three items were considered indicative of positive behavior, and three, of negative behavior. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). The prevalence of untreated ECC was 20.3% (95%CI: 16.7-24.4). In the multiple regression model adjusted for the child's age and the parent's schooling, negative parental behavior was associated with a greater frequency of untreated ECC (PRa = 1.213; 95%CI:1.032-1.427, p = 0.019), but lost its significance when adjusted by positive parental behavior (PRa = 1.156; 95%CI: 0.983-1.358, p = 0.079). Based on the present findings, positive parental eating behaviors are capable of minimizing the impact of negative parental behaviors on the prevalence of untreated early childhood caries.

Daily Toothbrushing Frequency and the Association with Parental Report of Dental Pain and Discomfort in Preschool Children

Abstract Objective: To evaluate the impact of daily toothbrushing frequency on parental reports of dental pain and discomfort in preschoolers. Material and Methods: An observational cross-sectional study was conducted involving 376 children between four and five years of age at public preschools in the city of Campo Magro, Brazil. Parents/guardians answered a socioeconomic questionnaire that contained a single question on the child's daily toothbrushing frequency and the Brazilian version of the Dental Discomfort Questionnaire (DDQ-B). Statistical analysis involved bivariate and multivariate Poisson regression analyses (α=0.05). Results: After the adjustments in the multivariate analysis, the prevalence of dental pain and discomfort was lower among children whose last visit to the dentist was for prevention (PR = 4.42; 95% CI: 1.75- 11.14; p=0.002) and those with a higher daily toothbrushing frequency (PR = 2.13; 95% CI: 1.12-4.05; p=0.021). Conclusion: A lower toothbrushing frequency is associated with parental reports of dental pain and discomfort in preschoolers. Educational and preventive measures that stimulate an increase in daily toothbrushing frequency can contribute to a better oral health status in preschoolers, consequently, less prevalence of dental pain and discomfort.

Food insecurity and sociodemographic factors among children in São José dos Pinhais, Paraná, Brazil, 2017: a cross-sectional study. / Insegurança alimentar e fatores sociodemográficos em crianças de São José dos Pinhais, Paraná, 2017: estudo transversal.

OBJECTIVE: To analyze association between food insecurity (FI) and sociodemographic factors among children. METHODS: The study was carried out from May to November 2017 with mothers of children (18 - 35 months old) enrolled at public education facilities in São José dos Pinhais, Paraná, Brazil. FI was determined by the Brazilian Household Food Insecurity Measurement Scale. Multinomial logistic regression was used with a hierarchical model. RESULTS: 395 mothers/children participated. Overall FI prevalence was 34.7% (95%CI 28.5;41.5), with prevalence of 25.7% (95%CI 19.2;32.3) for mild FI (MFI) and 9.0% (95%CI 8.5;9.4) for moderate/severe FI (MSFI). Families in the lowest income tercile had higher likelihood of MFI (OR=3.06 - 95%CI 1.26;7.41) or MSFI (OR=6.35 - 95%CI 1.89;21.4) when compared to the highest tercile. Higher MFI prevalence was identified in male children (OR=2.34 - 95%CI 1.49;3.68). CONCLUSION: FI was associated with lower income and MFI with male children. Public policies to increase income must be included in FI reduction strategies.

Food insecurity and sociodemographic factors in children in São José dos Pinhais, Paraná, Brazil, 2017: cross-sectional study / Inseguridad alimentaria y factores sociodemográficos en niños de São José dos Pinhais, Paraná, Brasil, 2017: estudio transversal / Insegurança alimentar e fatores sociodemográficos em crianças de São José dos Pinhais, Paraná, 2017: estudo transversal

Objective: To analyze the association between food insecurity (FI) and sociodemographic factors in children. Methods: Study carried out from May to November 2017 with mothers of children (18 - 35 months) from the public school in São José dos Pinhais, Paraná, Brazil. FI was accessed through Brazilian Household Food Insecurity Measurement Scale. Multinomial logistic regression was used, with a hierarchical model. Results: 395 mothers/children participated. The prevalence of FI was 34.7 (95%CI 28.5;41.5) with 25.7% (95%CI 19.2;32.3) for mild FI (MiFI) and 9.0% (95%CI 8.5;9.4) for moderate/severe FI (MoSFI). Families in the lowest income tercile had a higher chance of MiFI (OR=3.06 ­ 95%CI 1.26;7.41) or MoSFI (OR=6.35 ­ 95%CI 1.89;21.4) when compared to the largest tercile. Higher prevalence of MiFI was identified in male children (OR=2.34 ­ 95%CI 1.49;3.68). Conclusion: AI was associated with lower income and MiFi with male children. Public policies to increase income must be included in AI reduction strategies.

Objetivo: Analisar a associação entre insegurança alimentar (IA) e fatores sociodemográficos em crianças. Métodos: Estudo realizado no período maio-novembro de 2017, com mães de crianças (18-35 meses) matriculadas na rede pública de ensino de São José dos Pinhais, Paraná, Brasil. A IA foi acessada pela Escala Brasileira de Insegurança Alimentar. Utilizou-se regressão logística multinomial com modelo hierárquico. Resultados: Participaram 395 mães/crianças. A prevalência da IA foi de 34,7% (IC95% 28,5;41,5), sendo 25,7% (IC95% 19,2;32,3) para IA leve (IAL) e 9,0% (IC95% 8,5;9,4) para IA moderada/grave (IAMG). Famílias pertencentes ao menor tercil de renda tiveram maior chance de IAL (OR=3,06 ­ IC95% 1,26;7,41) ou IAMG (OR=6,35 ­ IC95% 1,89;21,4), comparadas ao maior tercil. Maior prevalência de IAL foi identificada em meninos (OR=2,34 ­ IC95% 1,49;3,68). Conclusão: IA foi associada a menor renda; e IAL, ao sexo masculino da criança. Políticas públicas de aumento de renda devem ser incluídas nas estratégias de redução da IA.

Caesarean delivery and early childhood caries: Estimation with marginal structural models in Brazilian pre-schoolers.

OBJECTIVE: This study analysed the association between caesarean section and early childhood caries (ECC), estimating the effects using regression and causal inference models. METHODS: This was a historical cohort study of 697 mother-child dyads, conducted in São Luís, Brazil. The caesarean section was the exposure, and the severity of ECC (dmft) was the outcome. Covariates household income, maternal schooling, maternal hypertension, maternal obesity and birth weight were adjusted for in the models. The effects were estimated by Poisson regression (Means Ratio-MR) and causal inference using a marginal structural model (MSM) (MR and Average Treatment Effect-ATE coefficients), weighted by the inverse probability (IPW) of exposure. RESULTS: Caesarean section was protective against caries in the bivariate (MR 0.81; CI 0.70-0.94; P = 0.005) and multivariate (MR 0.78; CI 0.67-0.91; P = 0.002) models. In MSM analyses, the caesarean section had no effect on ECC (ATE = -0.35; P = 0.107), controlling for IPW of exposure. CONCLUSION: The apparent association between caesarean section and ECC severity seems spurious, as it did not persist after employing a superior approach to estimating causality.

Unexpected formation of root-like structures subsequent to the avulsion of immature permanent teeth: Case report.

This report describes the unexpected formation of root-like structures following the avulsion of immature permanent teeth without replantation. A 6-year-old female patient had avulsed the four permanent mandibular incisors and the two deciduous mandibular canines. The patient was seen in an emergency healthcare unit but did not receive specialized treatment for tooth replantation. As follow-up treatment, she received a removable prosthesis. After 4 years of follow-up, an image obtained by panoramic radiography showed formations similar to four root structures in the alveolus of the previously avulsed permanent teeth. This finding was confirmed by periapical radiography and computed tomography. This case report demonstrates that in teeth with incomplete root development, even after avulsion without replantation, cells from the pulp stump may have the capacity to form mineralized structures that appear radiographically comparable to root dentin.