Associations between Caries among Children and Household Sugar Procurement, Exposure to Fluoridated Water and Socioeconomic Indicators in the Brazilian Capital Cities.

The objective of this ecological study was to investigate the association between caries experience in 5- and 12-year-old Brazilian children in 2010 and household sugar procurement in 2003 and the effects of exposure to water fluoridation and socioeconomic indicators. Sample units were all 27 Brazilian capital cities. Data were obtained from the National Surveys of Oral Health; the National Household Food Budget Survey; and the United Nations Program for Development. Data analysis included correlation coefficients, exploratory factor analysis, and linear regression. There were significant negative associations between caries experience and procurement of confectionery, fluoridated water, HDI, and per capita income. Procurement of confectionery and soft drinks was positively associated with HDI and per capita income. Exploratory factor analysis grouped the independent variables by reducing highly correlated variables into two uncorrelated component variables that explained 86.1% of total variance. The first component included income, HDI, water fluoridation, and procurement of confectionery, while the second included free sugar and procurement of soft drinks. Multiple regression analysis showed that caries is associated with the first component. Caries experience was associated with better socioeconomic indicators of a city and exposure to fluoridated water, which may affect the impact of sugars on the disease.

Cárie dentária, disponibilidade de açúcar e fatores associados nas capitais brasileiras em 2003: um estudo ecológico / Dental caries, sugar availability and associated factors in the Brazilian capital cities: an ecological study

Introdução: A associação entre a disponibilidade de açúcar e a cárie dentária, utilizando-se dados populacionais, ainda não foi testada na população brasileira. Objetivo: Investigar a associação entre a experiência de cárie em crianças e a disponibilidade domiciliar de açúcar no Brasil, em 2003. Buscou-se ainda testar a provável influência de indicadores socioeconômicos e do acesso à água fluoretada. Material e Método: Este estudo ecológico analisou dados das 27 capitais brasileiras sobre cárie em crianças de cinco e 12 anos, e abastecimento de água fluoretada, obtidos do levantamento nacional de saúde bucal de 2003. Os dados sobre disponibilidade domiciliar de açúcar foram obtidos da Pesquisa de Orçamento Familiar (POF) de 2003 e, sobre indicadores socioeconômicos, do Programa das Nações Unidas para o Desenvolvimento em 2000. Na análise estatística, foram utilizados testes de correlação e regressão linear simples e múltipla. Resultado: Não houve associação significativa entre a experiência de cárie em crianças de cinco anos e as variáveis independentes. Na idade de 12 anos, menor experiência de cárie foi correlacionada à maior aquisição de refrigerantes, ao maior tempo de fluoretação e ao IDH e à renda per capita mais elevados. O resultado da regressão linear múltipla, ajustado pelo tempo de fluoretação das águas, indicou que esta variável explica os níveis de cárie mais baixos. Após o ajuste pelos demais fatores, nenhuma variável foi associada à cárie. Conclusão: Não houve associação entre a experiência de cárie em crianças e a disponibilidade domiciliar de açúcar nas capitais brasileiras em 2003, quando indicadores socioeconômicos e presença de água fluoretada foram considerados na análise.

Introduction: The association between sugar availability and dental caries, using population data, was not tested in the Brazilian population yet. Objective: To investigate the association between dental caries experience in children and household sugar availability in Brazil in 2003. It was also aimed to test the possible influence of socioeconomic indicators and presence of fluoridated water supply. Material and Method: This ecological study analyzed data of the 27 Brazilian capital cities on caries experience of 5 and 12 years-old children and water fluoridation obtained from the National Survey of Oral Health in 2003; sugar availability from the Household Budget Survey in 2003; and socioeconomic indicators from the United Nations Development Programme in 2000. Correlation tests, simple and multiple linear regression were used in the statistical analysis. Result: There was no association between caries experience in the 5 years-old and the independent variables. At the age 12, lower caries experience was correlated with higher acquisition of soft drinks, public water fluoridation, Human Development Index and per capita income. Results of the multiple linear regression, adjusted by time of water fluoridation showed that this variable explained the lower levels of caries. After adjusting for the other factors, none of the variables were significantly associated to dental caries. Conclusion: There was no association between dental caries in children and sugar availability in the Brazilian capital cities in 2003 when socioeconomic indicators and presence of fluoridated water were considered in the analysis.

[Oral health in 12 year-old students from public and private schools in the city of Goiânia, Brazil]. / Condição de saúde bucal em escolares de 12 anos de escolas públicas e privadas de Goiânia, Brasil.

OBJECTIVE: To compare 12-year-old students from public and private schools in the city of Goiânia, Brazil, in terms of the prevalence of caries, periodontal conditions, dentofacial anomalies, and fluorosis. METHODS: In 2003, the 2002-2003 Oral Health Conditions in the Brazilian Population project (SB Brasil) was expanded to Goiânia as a cross-sectional study, as described in the present article. The sample included 1 947 students from urban schools: 1 790 (91.9%) attended public schools and 157 (8.1%) attended private schools. Data on the following oral conditions were collected through clinical examination: dental caries (decayed, missing, or filled teeth index, DMFT), periodontal condition (Community Periodontal Index, CPI), dentofacial anomaly (Dental Aesthetics Index, DAI), and dental fluorosis (Dean index). The groups were compared using the chi-square and Mann-Whitney U tests. RESULTS: There were differences between the public and private schools for all the variables. DMFT, CPI, and DAI indexes were higher in children from public schools (P < 0.05). Fluorosis was more prevalent in students from private schools (P < 0.05). CONCLUSIONS: The type of school was associated with the oral health condition of the children in this sample. Investments in actions and services to mitigate this inequality and its effects should be made as part of the policies to promote oral health.

Condição de saúde bucal em escolares de 12 anos de escolas públicas e privadas de Goiânia, Brasil / Oral health in 12 year-old students from public and private schools in the city of Goiânia, Brazil

OBJETIVO: Comparar os alunos de 12 anos das escolas públicas e privadas de Goiânia, Goiás, quanto à prevalência de cárie, condição periodontal, anomalia dentofacial e fluorose. MÉTODOS: Em 2003, o Projeto Condições de Saúde Bucal da População Brasileira 2002-2003 (SB Brasil) foi ampliado para Goiânia na forma de um estudo transversal, descrito neste trabalho. A amostra foi constituída por 1 947 escolares de 12 anos frequentando escolas da zona urbana do Município: 1 790 (91,9 por cento) eram de escolas públicas e 157 (8,1 por cento) de escolas privadas. Através de exame clínico, foram coletados dados sobre as seguintes condições bucais: cárie dentária (índice de dentes cariados, perdidos e obturado, CPOD), condição periodontal (índice periodontal comunitário, CPI), anormalidade dento-facial (índice de estética dental, DAI) e fluorose dentária (índice de Dean). Para comparação entre os grupos foram utilizados os testes do qui-quadrado e U de Mann Whitney. RESULTADOS: Houve diferença entre os tipos de escola para todas as variáveis investigadas. Os escolares de instituições públicas apresentaram índices mais elevados de cárie, condição periodontal e anomalia dentofacial do que aqueles de escolas privadas (P < 0,05). Os escolares de instituições privadas apresentaram maior prevalência de fluorose (P < 0,05). CONCLUSÕES: O tipo de escola foi associado à condição de saúde bucal dos escolares pesquisados. São recomendados investimentos em ações e serviços que busquem minimizar tais desigualdades e seus efeitos como parte das políticas de saúde bucal.

OBJECTIVE: To compare 12-year-old students from public and private schools in the city of Goiânia, Brazil, in terms of the prevalence of caries, periodontal conditions, dentofacial anomalies, and fluorosis. METHODS: In 2003, the 2002-2003 Oral Health Conditions in the Brazilian Population project (SB Brasil) was expanded to Goiânia as a cross-sectional study, as described in the present article. The sample included 1 947 students from urban schools: 1 790 (91.9 percent) attended public schools and 157 (8.1 percent) attended private schools. Data on the following oral conditions were collected through clinical examination: dental caries (decayed, missing, or filled teeth index, DMFT), periodontal condition (Community Periodontal Index, CPI), dentofacial anomaly (Dental Aesthetics Index, DAI), and dental fluorosis (Dean index). The groups were compared using the chi-square and Mann-Whitney U tests. RESULTS: There were differences between the public and private schools for all the variables. DMFT, CPI, and DAI indexes were higher in children from public schools (P < 0.05). Fluorosis was more prevalent in students from private schools (P < 0.05). CONCLUSIONS: The type of school was associated with the oral health condition of the children in this sample. Investments in actions and services to mitigate this inequality and its effects should be made as part of the policies to promote oral health.