Early Introduction of Total Sugar Foods and Early Childhood Caries.

Purpose: To evaluate the association between the introduction of total sugar foods (TSF) in the first six months of age and the prevalence of early childhood caries (ECC) and its consequences for dental pulp in preschool children. Methods: A representative cross-sectional study was conducted with 533 preschool children (four to six years old) in Ribeirão das Neves, Brazil. The decayed, missing, and filled teeth (dmft) index was used for determining ECC. The visible pulp, oral mucosa ulceration due to root fragments, fistula, and abscess (pufa) index was used for the pulp consequences of dental caries. Parents/caregivers answered a questionnaire addressing sociodemographic characteristics and the children's diet. Statistical analysis was performed using multiple logistic regression (P<0.05). Results: The multiple logistic regression model adjusted for family income and breastfeeding showed that preschool children who were introduced to TSF prior to six months of age were 1.58 times more likely to have ECC (95 percent confidence interval equals 1.09 to 2.30). The multiple logistic regression model, adjusted for family income, breastfeeding, and brushing behaviors, showed that preschool children who were introduced to TSF prior to six months of age were 2.30 times more likely to have pulp consequences (95 percent confidence interval equals 1.35 to 3.91). Conclusion: The early introduction TSF is associated with a higher prevalence of early childhood caries and pulp consequences in preschool children. The negative effects on oral health may be greater when the introduction of TSF occurs prior to six months of age.

Psychosocial associated factors of early childhood caries and oral health-related quality of life: Structural equation model approach.

OBJECTIVE: To identify a structural model for the identification of psychosocial associated factors of early childhood caries (ECC) and oral health-related quality of life (OHRQoL) in preschool children and their families. METHODS: A population-based cross-sectional study was conducted with 533 preschool children from 4 to 6 years-old public and private preschools, from Ribeirão das Neves, MG. Parents/caregivers self-completed the Brazilian versions of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and Resilience Scale as well as a structured questionnaire addressing socioeconomic status and child's oral health behavior. Two dentists who had undergone training and calibration exercises for ICDAS­epi and pufa index (Kappa≥0.95) performed the examinations for ECC. Stages of ECC were classified as free of visible carious lesion, initial caries, moderate caries, extensive caries without pulp consequences and extensive caries with pulp consequences. Data were analyzed using structural equation modeling, using Mplus version 8.6. RESULTS: Lower socioeconomic status (b=-0.250; p<0.001) and higher frequency of free sugar consumption (b = 0.122; p = 0.033) were directly associated with a more severe stage of ECC. Lower parental resilience had an indirect impact on more severe stage of ECC which was mediated by the variable 'frequency of free sugar consumption' (b=-0.089; p = 0.048). ECC was associated with lower child's OHRQoL (b = 0.587; p<0.001) and lower family's OHRQoL (b = 0.506; p<0.001). CONCLUSION: Structural modeling revealed that the severity of ECC negatively impacted the OHRQoL of preschoolers and their families. The main associated factors of the severity of ECC were lower socioeconomic status, higher frequency of free sugar consumption and lower parental resilience. CLINICAL SIGNIFICANCE: T The findings indicate that psychosocial and behavior variables can be associated with the severity of ECC, and ECC can be associated with negative impact on wellbeing and ability to perform daily activities of preschoolers and their families.

Determinantes sociais do letramento em saúde bucal de pais/responsáveis por crianças / Psychosocial determinants of oral health literacy in parents/caregivers of children

O Letramento em Saúde Bucal (LSB) é definido como a capacidade dos indivíduos em obter, processar e compreender informações básicas sobre saúde bucal, serviços necessários para aplicar informações e fazer escolhas de saúde adequadas. Outros fatores determinantes para os cuidados e a manutenção de uma saúde bucal adequada são a percepção em saúde bucal, o uso de serviços odontológicos e aspectos socioeconômicos das familias. O conhecimento, a percepção e a valorização destas informações influenciam o comportamento dos indivíduos. Assim, os objetivos deste estudo foram associar o LSB dos pais/responsáveis com saúde bucal autopercebida e proxy-percebida de seus filhos, e as condições socioeconômicas, além de verificar o impacto da cárie na primeira infância (CPI) e do LSB dos pais/responsáveis no uso de serviços odontológicos por crianças. Foi realizado um estudo transversal representativo com 449 pares de pais e pré-escolares de 4 a 6 anos de idade de Ribeirão das Neves, MG. Os pais/responsáveis responderam à versão brasileira do questionário Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P) para mensurar LSB, um questionário sociodemográfico, além de questões sobre sua saúde bucal autopercebida e proxypercebida de seus filhos, influencia da saúde bucal do filho no bem estar geral e uso de serviços odontológicos pelo filho. Duas examinadoras treinadas e calibradas realizaram o diagnóstico de CPI usando o Sistema Internacional de Detecção e Avaliação de Cárie (ICDAS). Os dados dos estudos foram analisados por meio da Regressão de Poisson com variância robusta com abordagem hierárquica e regressão logística multivariável (p<0,05). A análise do estudo 1, com abordagem multivariável hierárquica demonstrou que pais/responsáveis com boa percepção do estado de saúde bucal dos seus filhos (RT=1,04;95%IC:1,00-1,09) e que não percebiam impacto da condição bucal no bem estar geral dos filhos (RT=1,03; 95%IC:1,01-1,10) tinham maiores probabilidade de ter alto LSB. O modelo hierarquico múltiplo foi ajustado pelas variáveis renda familiar, auxílio do governo, histórico de ida ao dentista do respondente, percepção do respondente em relação a condição bucal do pré-escolar e percepção do respondente em relação a influência da condição bucal no bem-estar geral do pré-escolar. Pais/responsáveis que possuíam renda familiar >2 saláriosmínimos apresentavam escores do LSB em média 6% maiores do que aqueles com menor renda familiar (RT=1,06; 95%CI: 1,02-1,10). Pais/responsáveis que não recebiam auxílio do governo apresentavam escores do LSB em média 9% maiores do que aqueles que recebiam tal auxílio (RT=1,09; 95%CI: 1,03- 1,14). A regressão logística multivariável do estudo 2 revelou que crianças cujos pais/responsáveis tinham pior LSB tinham 34% menos chances de usar serviços odontológicos em comparação com aquelas cujos pais tinham melhor LSB (OR=0,66; 95%IC:0,45-0,99). Pré-escolares com presença de lesão de cárie cavitada tiveram 1,82 vezes mais chances de usar serviços odontológicos (OR=1,82; 95%IC:1,23-2,70) em comparação com aqueles com ausência de cárie lesão de cárie cavitada. Conclui-se que o LSB dos pais é influenciado pelas condições socioeconômicas da família e que os serviços odontológicos são mais utilizados por pré-escolares com presença de lesão de cárie cavitada e cujos pais/responsáveis apresentam maiores escores de LSB.

Oral Health Literacy (OHL) is defined as the ability of individuals to obtain, process, and comprehend basic information about oral health, as well as the necessary services to apply this information and make appropriate health choices. Other determinants for the care and maintenance of adequate oral health include oral health perception, utilization of dental services, and socioeconomic aspects of families. The knowledge, perception, and value attributed to this information influence individuals' behavior. Thus, the objectives of this study were to associate parents' OHL with self-perceived and proxy-perceived oral health of their children, as well as socioeconomic conditions, and to assess the impact of early childhood caries (ECC) and parents' OHL on children's dental service utilization. A representative cross-sectional study was conducted with 449 pairs of parents and preschoolers aged 4 to 6 years from Ribeirão das Neves, MG. Parents completed the Brazilian version of the Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P) questionnaire to measure OHL, a sociodemographic questionnaire, and questions about their selfperceived oral health and proxy-perceived oral health of their children, the influence of their child's oral health on general well-being, and their child's dental service utilization. Two trained and calibrated examiners diagnosed ECC using the International Caries Detection and Assessment System (ICDAS). Data from the studies were analyzed using Hierarchical Multivariable Poisson Regression with robust variance and multivariable logistic regression (p<0.05). The analysis of Study 1, using hierarchical multivariable approach, demonstrated that parents with a good perception of their children's oral health status (RR=1.04; 95%CI: 1.00-1.09) and who did not perceive an impact of oral health condition on their children's general well-being (RR=1.03; 95%CI: 1.01-1.10) were more likely to have high OHL. The multiple hierarchical model was adjusted for family income, government assistance, respondent's dental visit history, respondent's perception of preschooler's oral condition, and respondent's perception of the influence of oral condition on preschooler's general well-being. Parents with a family income >2 minimum wages had on average 6% higher OHL scores than those with lower family income (RR=1.06; 95%CI: 1.02-1.10). Parents who did not receive government assistance had on average 9% higher OHL scores than those who received such assistance (RR=1.09; 95%CI: 1.03-1.14). The multivariable logistic regression of Study 2 revealed that children whose parents had lower OHL had 34% lower odds of using dental services compared to those whose parents had higher OHL (OR=0.66; 95%CI: 0.45-0.99). Preschoolers with cavitated carious lesions were 1.82 times more likely to use dental services (OR=1.82; 95%CI: 1.23-2.70) compared to those without cavitated carious lesions. In conclusion, parents' OHL is influenced by the family's socioeconomic conditions, and dental services are more utilized by preschoolers with cavitated carious lesions and whose parents have higher OHL scores.

Impact on oral health-quality of life in infants: Multicenter study in Latin American countries.

To assess the impact of oral conditions on oral health-related quality of life (OHRQoL) in infants in ten Latin America countries (LAC). A cross-sectional study was conducted with 930 pairs of 1-to-3-year-old children/parents from 10 LAC, as a complementary study of the Research Observatory for Dental Caries of the Latin American Region. The scale ECOHIS, previously tested and valid in ten countries, was applied to parents/caregivers of children to measure OHRQoL. Statistical analysis included descriptive data analysis and one-way analysis of variance (ANOVA-One-Way) were performed to compare age groups with OHRQoL. Bootstrapping procedures (1000 re-samplings; 95%CI Bca) were performed. The mean scores of the 'Child Impact' section in the LAC was 4.0(±8.3), in the 'Family Impact' section was 2.0(±4.0), and in overall ECOHIS score was 6.0(±12.0). In the 'Child Impact' section, Argentina 10.0(+2.4) and Venezuela 17.8(±17.5) demonstrated mean scores higher than the LAC total data. In the 'Family Impact' section, the countries with higher mean scores were Argentina 4.9(±2.0), Ecuador 2.1(±3.1) and Venezuela 7.9(±7.8). In the overall ECOHIS score, Argentina 15.1 (±4.1) and Venezuela 25.7(±25.2) has higher mean scores than the values of LAC. There is an association between children's age and parents' report of impact on the OHRQoL (p<0.001). Three-year-olds had a higher mean when compared to one- and two-year-olds, both in the Impact on the Child and Impact on the Family (p<0.001) sections, as well as in the overall ECOHIS (p<0.001). In conclusion, there are differences in OHRQoL among Latin American countries, impacting older children more significantly.

Impact on oral health-quality of life in infants: Multicenter study in Latin American countries

Abstract To assess the impact of oral conditions on oral health-related quality of life (OHRQoL) in infants in ten Latin America countries (LAC). A cross-sectional study was conducted with 930 pairs of 1-to-3-year-old children/parents from 10 LAC, as a complementary study of the Research Observatory for Dental Caries of the Latin American Region. The scale ECOHIS, previously tested and valid in ten countries, was applied to parents/caregivers of children to measure OHRQoL. Statistical analysis included descriptive data analysis and one-way analysis of variance (ANOVA-One-Way) were performed to compare age groups with OHRQoL. Bootstrapping procedures (1000 re-samplings; 95%CI Bca) were performed. The mean scores of the 'Child Impact' section in the LAC was 4.0(±8.3), in the 'Family Impact' section was 2.0(±4.0), and in overall ECOHIS score was 6.0(±12.0). In the 'Child Impact' section, Argentina 10.0(+2.4) and Venezuela 17.8(±17.5) demonstrated mean scores higher than the LAC total data. In the 'Family Impact' section, the countries with higher mean scores were Argentina 4.9(±2.0), Ecuador 2.1(±3.1) and Venezuela 7.9(±7.8). In the overall ECOHIS score, Argentina 15.1 (±4.1) and Venezuela 25.7(±25.2) has higher mean scores than the values of LAC. There is an association between children's age and parents' report of impact on the OHRQoL (p<0.001). Three-year-olds had a higher mean when compared to one- and two-year-olds, both in the Impact on the Child and Impact on the Family (p<0.001) sections, as well as in the overall ECOHIS (p<0.001). In conclusion, there are differences in OHRQoL among Latin American countries, impacting older children more significantly.

Resumo Avaliar o impacto das condições bucais na qualidade de vida relacionada à saúde bucal (QVRSB) em crianças de dez países da América Latina (AL). Foi realizado um estudo transversal com 930 pares de crianças/pais de 1 a 3 anos de 10 países da AL, como estudo complementar do Research Observatory for Dental Caries of the Latin American Region. A escala ECOHIS, previamente testada e validada em dez países, foi aplicada a pais/cuidadores de crianças para mensurar a QVRSB. A análise estatística incluiu análise descritiva de dados e análise de variância unidirecional (ANOVA-One-Way) para comparar grupos etários com QVRSB. Procedimentos de bootstrapping (1000 reamostragens; 95%IC Bca) foram realizados. A pontuação média da seção 'Impacto na Criança' na AL foi 4,0 (±8,3), na seção 'Impacto na Família' foi 2,0 (±4,0) e no escore total do ECOHIS foi 6,0 (±12,0). Na seção 'Impacto na Criança', Argentina 10,0(+2,4) e Venezuela 17,8(±17,5) demonstraram pontuações médias superiores aos dados totais da AL. Na seção 'Impacto na Família', os países com pontuações médias mais altas foram Argentina 4,9(±2,0), Equador 2,1(±3,1) e Venezuela 7,9(±7,8). No escore total do ECOHIS, Argentina 15,1 (±4,1) e Venezuela 25,7(±25,2) apresentaram escores médios superiores aos valores de AL. Houve associação entre a idade das crianças e o relato dos pais de impacto na QVRSB (p<0,001). As crianças de três anos tiveram média maior quando comparadas às de um e dois anos, tanto nas seções 'Impacto na Criança' e 'Impacto na Família' (p<0,001), quanto no escore total ECOHIS (p<0,001). Em conclusão, houveram diferenças na QVRSB entre os países da América Latina, impactando de forma mais significativa as crianças mais velhas.

Impact of Oral Health Literacy on the Clinical Consequences of Untreated Dental Caries in Preschool Children.

Purpose: To evaluate the association between parental oral health literacy (OHL) and untreated early childhood caries and its clinical consequences in children. Methods: Population-based, cross-sectional study was conducted with 449 parent-preschooler dyads (four-to-six-year-olds) in Ribeirão das Neves, Minas Gerais, Brazil. Parents answered a socioeconomic questionnaire and the Brazilian version of the Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P), which measures parental OHL in pediatric dentistry. Preschoolers were examined by two calibrated dentists for the diagnosis of caries (ICDASepi-merged) and its clinical consequences: visible pulp; oral mucosa ulceration due to root fragments; fistula; and abscess (pufa). Data were submitted to univariable and multivariable logistic regression analyses (P<0.05). Results: A multivariable model that adjusted for socioeconomic status showed that parental OHL was not associated with untreated dental caries (P=0.618). Parents with lower OHL had a greater odds of having children with at least one clinical consequence of untreated dental caries (odds ratio equals 0.94; 95 percent confidence interval equals 0.89 to 0.98) than parents with higher OHL. Conclusions: Low parental OHL appears to impact the occurrence of at least one clinical consequence of untreated dental caries in children but not in the simple presence of untreated dental caries.

Early childhood caries and oral health-related quality of life of Brazilian children: Does parents' resilience act as moderator?

BACKGROUND: Early childhood caries (ECC) is the most common chronic disease in childhood. Measures to reduce the prevalence of ECC cannot be taken without recognizing that oral health is influenced by biopsychosocial factors on individual and community levels. AIM: To evaluate the impact of ECC on OHRQoL and moderation effect of parents' resilience. DESIGN: Population-based, cross-sectional study with 497 children (4-6 years old) at preschools in Ribeirão das Neves, MG, Brazil. Parents self-completed the Brazilian version of the early childhood oral health impact scale (B-ECOHIS), the Resilience Scale and questionnaires about socioeconomic and oral health behaviour factors. Calibrated dentists conducted examinations for ECC (ICDASepi) and pulp consequences (pufa). Data analysis used multivariate Poisson regression for complex sample (P < .05). RESULTS: Model#1, adjusted for parents' resilience and socioeconomic factors, revealed that preschoolers with pulp involvement had 2.36 (95% CI: 1.60-3.49) and fistula/abscess had 3.57 (95% CI: 2.23-5.72) more prevalence of negative impact on OHRQoL than preschoolers with ECC without pulp consequences. In Model#2, resilience was removed from the analysis and the strength of associations almost did not change (OHRQoL vs pulp involvement RP = 2.33;95% CI: 1.58-3.43; OHRQoL vs fistula/abscess RP = 3.65;95% CI: 2.22-5.99). CONCLUSION: Early childhood caries with pulp consequences had negative impact on OHRQoL of preschoolers and families, and it is not moderated by parents' resilience.

Impact of untreated dental caries and malocclusion in brazilian adolescents on the quality of life of their families

Objective: The aim of the present study was to evaluate the impact of dentalcaries and malocclusion in Brazilian adolescents on the oral health-related qualityof life (OHRQoL) of their families. Methods: A representative cross-sectional studywas conducted with 1168 adolescents from Belo Horizonte, Minas Gerais, Brazil,and their families. Parents/caregivers answered the Brazilian version of the FamilyImpact Scale (B-FIS) to assess the impact of oral conditions on the OHRQoL of thefamilies. Malocclusion was diagnosed using the Dental Aesthetic Index. Dentalcaries was diagnosed using the DMFT index. Three examiners who had undergonetraining and calibration exercises performed the clinical examinations. Sex, ageand social vulnerability of the adolescents were considered confounding variables.Data analysis was performed using bivariate and multivariate Poisson regressionanalysis with robust variance (p<0.05). Results: The analysis adjusted by sex, ageand social vulnerability demonstrated that families of adolescents with untreateddental caries had 29% more impact on Parental/Family Activity (95% CI: 1.11-1.50), 28% on Parental Emotions (95% CI: 1.09-1.51) and 34% on Family Conflict(95% CI: 1.09-1.65) than those without caries. When adjusted for sex and age,malocclusion was associated with Financial Burden (PR=1.39; 95%CI=1.01-1.65),but this variable lost its significance when social vulnerability was included in themultivariate model (PR=1.27; 95% CI: 0.99-1.64). Conclusion: Untreated dentalcaries in adolescents exerted a negative impact on the OHRQoL of their families.Social vulnerability exerted an influence on the impact of malocclusion on theOHRQoL of the families.

Objetivo: O objetivo do presente estudo foi avaliar o impacto da cárie dentária e damá oclusão em adolescentes brasileiros na qualidade de vida relacionada à saúdebucal (QVRSB) de suas famílias. Métodos: Foi realizado um estudo transversalrepresentativo com 1168 adolescentes de Belo Horizonte, Minas Gerais, Brasil, e suasfamílias. Os pais/responsáveis responderam à versão brasileira da Family ImpactScale (B-FIS) para avaliar o impacto das condições bucais na QVRSB das famílias. Amá oclusão foi diagnosticada pelo Índice de Estética Dental e a cárie dentária peloíndice CPOD. Três examinadores calibrados realizaram exames clínicos. Sexo, idadee vulnerabilidade social dos adolescentes foram coletadas como variáveis de confusão.A análise dos dados foi realizada por meio de análise de regressão de Poisson bivariadae multivariada com variância robusta (p<0,05). Resultados: Resultados ajustados porsexo, idade e vulnerabilidade social demonstraram que famílias de adolescentes comcárie dentária não tratada tiveram 29% mais impacto na Atividade Parental/Familiar(IC95% = 1,11-1,50), 28% nas Emoções Parentais (IC95% = 1,09-1,51) e 34% em ConflitoFamiliar (IC 95% = 1,09-1,65) do que aqueles sem cárie. Quando ajustada para sexo eidade, a má oclusão foi associada ao Encargo Financeiro (RP = 1,39; IC95% = 1,01-1,65); entretanto, perdeu significância quando a vulnerabilidade social foi incluída nomodelo multivariado (RP = 1,27; IC95% = 0,99-1,64). Conclusão: A cárie dentária nãotratada em adolescentes exerceu impacto negativo na QVRSB de suas famílias. Avulnerabilidade social influenciou a ausência de impacto da má oclusão na QVRSBdas famílias.

Traumatismo dentário na dentição decídua e condição socioeconômica: uma revisão crítica da literatura / Traumatic dental injury in primary teeth and socioeconomic factors: a critical literature review

Objetivo: Verificar a associação entre a condição socioeconômica e o traumatismo dentário em crianças na dentição decídua. Métodos: Foi realizada uma busca bibliográfica na base de dados PubMed, seguindo uma estratégia de combinação de palavras-chave. Não houve restrição em relação ao ano de publicação, tipo de estudo e o local em que foi realizado. A seleção dos estudos foi realizada em duas etapas: através do processo de leitura dos títulos e resumos, e em seguida, por meio da obtenção e leitura dos artigos completos selecionados. Resultados: De um total de 94 artigos encontrados, 16 foram selecionados para a revisão de literatura. Desses, 13 preencheram todos os critérios metodológicos analisados. A maioria dos estudos foram realizados no Brasil. A idade das crianças não ultrapassou os seis anos. Associações estatisticamente significantes entre a prevalência do traumatismo dentário na dentição decídua e condição socioeconômica foram encontradas em quatro artigos. Conclusão: A maioria dos estudos não encontrou associação entre o traumatismo dentário na dentição decídua com a condição socioeconômica.

Aim: To verify the association between socioeconomic factors and traumatic dental injuries in preschool children in primary dentitions. Methods: A bibliographic search was made in the PubMed electronic database, following a keyword combination strategy. There were no restrictions regarding the year of publication, type of study, and place where it was performed. The selection of the studies was achieved in two steps: through the process of reading the titles and abstracts and by obtaining and reading the complete selected articles. Results: From the 94 articles that were found, 16 were eligible for inclusion in the literature review. Of these, 13 articles met all of the proposed methodology criteria. Most of the studies were conducted in Brazil. The age of the children did not exceed 6 years. Statistically significant associations between the prevalence of traumatic dental injury in the primary dentition and socioeconomic factors were found in 4 articles. Conclusion:The majority of studies found no association between dental trauma in primary dentition and socioeconomic status.

Malocclusion and social vulnerability: a representative study with adolescents from Belo Horizonte, Brazil. / Má oclusão e vulnerabilidade social: estudo representativo de adolescentes de Belo Horizonte, Brasil.

Malocclusion is public health problem because of its high prevalence, treatment possibility, and impact on the individual's quality of life. This article aims to determining the prevalence of malocclusion in adolescents and to test its association with social vulnerability. A representative transversal study was performed with 1612 adolescents aged between 11 and 14 years old who came from public and private schools in Belo Horizonte, Brazil. The adolescents were examined by three calibrated examiners for diagnosis of malocclusion, using the Dental Aesthetic Index. The Social Vulnerability Index from Belo Horizonte was used to determine the degree of social vulnerability from adolescents. The data were analyzed using Poisson regression with robust variance (p<0,05). Most adolescents presented absence/minor malocclusion (68.7%). Dental crowding was diagnosed in 51.9% from the sample, diastema in 23.7%, anterior open bite in 7.6 %. Malocclusion was associated with social vulnerability (PR=1.25;95% CI=1.01-1.55). Dental crowding was the most prevalent type of malocclusion. The more socially vulnerable adolescents had worse indicators of malocclusion.

A má oclusão é um problema de saúde pública devido à alta prevalência, possibilidade de tratamento e por interferir na qualidade de vida dos indivíduos. O objetivo deste artigo é determinar a prevalência da má oclusão em adolescentes e testar sua associação com indicador de vulnerabilidade social. Foi realizado um estudo transversal representativo com 1.612 adolescentes, entre 11 e 14 anos de idade, de escolas públicas e privadas de Belo Horizonte, Brasil. Os adolescentes foram avaliados por três examinadores calibrados para o diagnóstico de má oclusão, utilizando o Índice Estético Dental. O Índice de Vulnerabilidade Social de Belo Horizonte foi utilizado para determinar o grau de vulnerabilidade social dos adolescentes. Os dados foram analisados através da regressão de Poisson com variância robusta (p < 0,05). A maioria dos adolescentes apresentou má oclusão ausente/leve (68,7%). Diagnosticou-se apinhamento dentário em 51,9% da amostra, diastema em 23,7%, mordida aberta anterior em 7,6 %. A má oclusão mostrou-se associada à vulnerabilidade social (RP = 1,25;95% IC = 1,01-1,55). O apinhamento dentário foi o tipo de má oclusão mais prevalente. Os adolescentes mais vulneráveis socialmente apresentaram piores indicadores de má oclusão.

Má oclusão e vulnerabilidade social: estudo representativo de adolescentes de Belo Horizonte, Brasil / Malocclusion and social vulnerability: a representative study with adolescents from Belo Horizonte, Brazil

Resumo A má oclusão é um problema de saúde pública devido à alta prevalência, possibilidade de tratamento e por interferir na qualidade de vida dos indivíduos. O objetivo deste artigo é determinar a prevalência da má oclusão em adolescentes e testar sua associação com indicador de vulnerabilidade social. Foi realizado um estudo transversal representativo com 1.612 adolescentes, entre 11 e 14 anos de idade, de escolas públicas e privadas de Belo Horizonte, Brasil. Os adolescentes foram avaliados por três examinadores calibrados para o diagnóstico de má oclusão, utilizando o Índice Estético Dental. O Índice de Vulnerabilidade Social de Belo Horizonte foi utilizado para determinar o grau de vulnerabilidade social dos adolescentes. Os dados foram analisados através da regressão de Poisson com variância robusta (p < 0,05). A maioria dos adolescentes apresentou má oclusão ausente/leve (68,7%). Diagnosticou-se apinhamento dentário em 51,9% da amostra, diastema em 23,7%, mordida aberta anterior em 7,6 %. A má oclusão mostrou-se associada à vulnerabilidade social (RP = 1,25;95% IC = 1,01-1,55). O apinhamento dentário foi o tipo de má oclusão mais prevalente. Os adolescentes mais vulneráveis socialmente apresentaram piores indicadores de má oclusão.

Abstract Malocclusion is public health problem because of its high prevalence, treatment possibility, and impact on the individual's quality of life. This article aims to determining the prevalence of malocclusion in adolescents and to test its association with social vulnerability. A representative transversal study was performed with 1612 adolescents aged between 11 and 14 years old who came from public and private schools in Belo Horizonte, Brazil. The adolescents were examined by three calibrated examiners for diagnosis of malocclusion, using the Dental Aesthetic Index. The Social Vulnerability Index from Belo Horizonte was used to determine the degree of social vulnerability from adolescents. The data were analyzed using Poisson regression with robust variance (p<0,05). Most adolescents presented absence/minor malocclusion (68.7%). Dental crowding was diagnosed in 51.9% from the sample, diastema in 23.7%, anterior open bite in 7.6 %. Malocclusion was associated with social vulnerability (PR=1.25;95% CI=1.01-1.55). Dental crowding was the most prevalent type of malocclusion. The more socially vulnerable adolescents had worse indicators of malocclusion.

Impacto do traumatismo dentário na qualidade de vida de crianças, adolescentes e suas famílias: revisão crítica da literatura / Impact of traumatic dental injuries on the quality of life of children, adolescents, and their families: critical review of the literature

Objetivo: Verificar a associação entre o traumatismo em dentes permanentes e o impacto na qualidade de vida relacionada à saúde bucal (QVRSB) de crianças, adolescentes e suas famílias, através de uma revisão crítica da literatura. Métodos: Foi realizada uma busca bibliográfica na base de dados PubMed, com uma combinação de palavras-chave, sem restrições quanto ao ano de publicação ou idioma. Artigos duplicados foram excluídos e a seleção dos estudos foi realizada em duas etapas: leitura do título e resumo, e os artigos que se encaixavam no tema foram selecionados para leitura completa. Logo após, foi realizada extração de dados dos artigos selecionados utilizando uma tabela padronizada. Resultados: Dos 397 artigos encontrados, apenas 14 apresentavam todas as informações exigidas pelos critérios metodológicos. Dentre estes estudos, dois utilizaram o desenho de estudo longitudinal, sete utilizaram o desenho transversal e cinco utilizaram o desenho caso-controle. Onze estudos foram realizados no Brasil, um no Canadá, um no Reino Unido e um na Albânia. Os indivíduos abrangidos pela pesquisa possuíam entre 8 e 19 anos de idade. Foram encontradas associações significativas entre traumatismo dentário e impacto na QVRSB em 13 estudos. Traumatismo dentários mais complexos como de dentina e/ou polpa estiveram associados a dificuldade de mastigar e higienizar a boca, problemas emocionais e de socialização, sentimento de culpa nos pais e estresse familiar. Conclusão: A maioria dos estudos demonstrou que crianças/adolescentes com traumatismo dentário mais grave apresentaram impacto negativo na sua QVRSB e de seus familiares. (AU)

Aim: To verify the association between dental trauma in permanent teeth and its impact on oral health-related quality of life (OHRQoL) of children, adolescents, and their families, using a critical literature review. Methods: A bibliographic study was carried out using the PubMed database, using a combination of key-words, with no restrictions on language or publication date. Duplicate articles were excluded, and the selection of the studies was carried out in two phases. In the first stage, the ttitle and abstract we read, and the articles that fit the theme were selected for further reading of the complete text. In addition, data extraction from the selected studies was conducted using a normalized table. Results: Of the 397 articles encountered in this search, only 14 presented all of the information required by the methodological criteria. Among these studies, two used the longitudinal study method, seven used the cross-sectional study method, and 5 used the case-control study method. Eleven studies had been conducted in Brazil, one in Canada, one in the United Kingdom, and one in Albania. The individuals included in this study ranged from 8 to 19 years of age. Significant associations between dental trauma and its impact on OHRQoL were found in 13 studies. Conclusion: The majority of the studies found an association between dental trauma and the OHRQoL of children/adolescents and their families. (AU)

Ansiedade odontológica autorrelatada pelas crianças atendidas na Faculdade de Odontologia da Universidade Federal de Minas Gerais: fatores associados e correlação com o medo dos pais / Self-reported dental anxiety by children attended in the Dental School of the Universidade Federal de Minas Gerais: associated factors and correlation with parents' dental fear

Objetivo: Avaliar a correlação da ansiedade odontológica das crianças atendidas nas clínicas de Odontopediatria da Faculdade de Odontologia da Universidade Federal de Minhas Gerais (FAO-UFMG) com o medo odontológico de seus pais/responsáveis. Além disso, avaliar a associação entre a presença de ansiedade dessas crianças com tipo de tratamento necessário, o tempo em que faz tratamento na FAO-UFMG e com seu comportamento. Métodos: Foi realizado um estudo transversal com uma amostra de conveniência de 65 crianças de 4 a 11 anos de idade atendidas nas clínicas de Odontopediatria da FAO-UFMG e seus pais/responsáveis. Os Questionários Venham Picture Test Modificado e Dental Fear Survey foram utilizados para mensurar a ansiedade e medo autorrelatados frente o tratamento odontológico das crianças e dos responsáveis, respectivamente. Tipo de tratamento odontológico, tempo em tratamento nas clínicas (FAO-UFMG) e comportamento da criança (escala de Frankl) foram obtidos através da ficha clínica. Sexo e idade (criança) sexo, grau de parentesco e escolaridade (responsável) através de um questionário. Os dados foram analisados através da correlação de Spearman e teste Kruskal-Wallis. Resultados: Não houve correlação significativa entre a ansiedade das crianças e o medo dos pais/responsáveis (r = -0,029; p = 0,820). A ansiedade odontológica foi maior em crianças submetidas à exodontia (média = 3,17; DP = 2,639) do que naquelas submetidas à procedimentos restauradores/endodônticos (média = 0,96; DP = 2,021; p = 0,013) ou sem necessidade de tratamento (média = 0,30; DP = 0,483; p = 0,032). Crianças com 4-21 meses em tratamento apresentaram maior ansiedade comparada àquelas com mais de 21 meses em tratamento (p = 0,045). Não houve associação significativa entre ansiedade odontológica e comportamento da criança (p = 0,221). Conclusão: A ansiedade odontológica das crianças não foi associada ao medo de seus pais/responsáveis. Entretanto, a necessidade de procedimentos mais complexos e o tempo em que a criança estava sob tratamento na clínica foram associados à presença de ansiedade odontológica. (AU)

Aim: To evaluate the presence of dental anxiety in children who receive dental care in the Pediatric Dentistry Clinic of the School of Dentistry at Universidade Federal de Minas Gerais (FAO-UFMG) and their correlation with their parents'/guardians' dental fears. This study also seeks to evaluate the association between these children's dental anxiety with the type of necessary dental treatment, the time needed for treatment at FAO-UFMG, and their behavior. Methods: A cross-sectional convenience study was conducted with 65 children of 4 to 11 years of age who received dental care in the Pediatric Dentistry Clinic of the FAO-UFMG and their parents/guardians. The questionnaires "Modified Venham Picture Test" and "Dental Fear Survey" were used to measure the self-reported dental anxiety and fear concerning the dental treatment of the children and their parents, respectively. The type of dental treatment, length of treatment (FAO-UFMG), and the child's behavior (Frankl scale) were obtained from the clinical record. Gender and age (child), gender, kinship, and education level (responsible) were obtained through a questionnaire. The data were analyzed using Spearman correlation and Kruskal-Wallis tests. Results: There was no significant correlation between children's anxiety and the fear of parents/caregivers (r = -0.029; p = 0.820). Dental anxiety was higher in children undergoing extraction (mean = 3.17; SD = 2.639) than in children undergoing restorative/endodontic procedures (mean = 0.96; SD = 2.021; p = 0.013) or without treatment (mean = 0.30; SD = 0.483; p = 0.032). Children who had been undergoing treatment for 4-21 months presented higher anxiety when compared to children who had been undergoing treatment for more than 21 months (p = 0.045). No significant association was observed between dental anxiety and the child's behavior (p = 0.221). Conclusion: Children's dental anxiety was not associated with their parents'/guardians' dental fear. However, the need for more complex procedures and the time the child had been undergoing treatment at the clinic were associated with the presence of dental anxiety. (AU)

Baixo alfabetismo em saúde bucal de pais/responsáveis está associado à cárie dentária com envolvimento pulpar de seus filhos / Low oral health literacy of parents/caregivers is associated with the pulp-related consequences of dental care

O Alfabetismo em Saúde Bucal é definido como o grau com o qual os indivíduos têm a capacidade de obter, processar e compreender informações básicas sobre saúde bucal, e os serviços necessários para aplicar informações e fazer escolhas de saúde adequadas. Estudos realizados têm evidenciado uma associação entre os níveis mais baixos de alfabetismo em saúde bucal dos pais e piores condições bucais de seus filhos. Diante disso, o objetivo deste estudo foi avaliar a associação do alfabetismo em saúde bucal dos pais/responsáveis com a ocorrência de cárie dentária cavitada e suas consequências clínicas pulpares em pré-escolares de Ribeirão das Neves, MG. Foi realizado um estudo transversal representativo de pré-escolares de 4 a 6 anos de idade de Ribeirão das Neves, MG, e seus pais/responsáveis. Um total de 449 pais/responsáveis respondeu a um questionário socioeconômico e à versão brasileira do Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (BHKOHLAT-P), que mensura o alfabetismo em saúde bucal. A seleção das instituições de ensino e dos pré-escolares foi feito de forma randomizada estratificada, em duplo estágio, respeitando a proporcionalidade de pré-escolares em cada uma das três regionais de Ribeirão das Neves (Distrito de Justinópolis, Regional Centro e Regional Veneza), assim como dos pré-escolares matriculados nas redes de ensino Pública e privada do município. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos da Universidade Federal de Minas Gerais (COEP/UFMG), sob o parecer de número: 2725377. O Termo de Consentimento Livre e Esclarecido (TCLE) foi assinado pelos pais/responsáveis que autorizaram a participação dos seus filhos na pesquisa. Os pré-escolares assentiram por meio do Termo de Assentimento Livre Esclarecido (TALE). Os pré-escolares foram examinados nas dependências da escola, em uma sala reservada, por dois examinadores calibrados, os valores de Kappa variaram de 0,96 a 0,99 para a concordância inter-examinadores e para a concordância intra-examinador, para o diagnóstico de cárie dentária (Índice ICDAS simplificado) e das consequências clínicas pulpares da cárie (Índice pufa), utilizando luz artificial (lanterna de cabeça), espelho clínico e gaze para secagem dos dentes. Os dados foram analisados por meio de estatística descritiva, testes Qui-Quadrado, Exato de Fisher e Linear por Linear para análises bivariadas, e Regressão Logística Multivariada (p<0,05). A prevalência de cárie dentária cavitada foi de 51,0%, e cárie com consequência pulpar de 13,6%. O modelo multivariado ajustado pelas variáveis grau de parentesco, pré-escolares e pais/responsáveis possuírem plano de saúde e já terem ido ao dentista, escolaridade materna, renda familiar mensal, sexo e idade do pré-escolares, demonstrou que o alfabetismo não foi associado à presença da cárie não tratada (OR:0,97; 95%IC:0,65- 1,46; p=0,890). Entretanto, pais/responsáveis com menor alfabetismo em saúde bucal tiveram 93% vezes mais chance de ter filhos com consequências clínicas pulpares da cárie não tratada (OR:1,93; IC95%:1,01-3,69; p=0,046) comparado com aqueles com maior alfabetismo em saúde bucal. Conclui-se que o baixo alfabetismo em saúde bucal de pais/responsáveis está associado a uma maior chance de seus filhos possuírem consequências clínicas pulpares da cárie dentária cavitada. (AU)

Oral health literacy is defined as the degree to which individuals have the ability to obtain, process, and understand basic information about oral health, and the services required to make appropriate health choices, such as the right to access to an oral health service. Studies in other countries have identified an association between low levels of oral health literacy in parents and the worse oral conditions of their children. The objective of the present study was therefore to evaluate the association between the oral health literacy of parents/caregivers and the occurrence of untreated tooth decay and its pulp-related consequences in preschool children from Ribeirão das Neves, Minas Gerais. A cross-sectional study was carried out with preschool children aged 4 to 6 years old from Ribeirão das Neves, Minas Gerais, and their parents/caregivers. A total of 449 parents/caregivers responded to a socioeconomic questionnaire and the Brazilian version of the Hong Kong Oral Health Literacy Assessment Task for Pediatric Dentistry (BHKOHLAT-P) which measures functional oral health literacy. The selection of educational institutions and preschoolers was carried out in a randomized, stratified, double-stage form, respecting the proportionality of students in each of the three regions of Ribeirão das Neves (Justinópolis, the Center and Venice), as well as enrolled schoolchildren in the public and private education networks of the city. This study was submitted to and approved by the Ethics Committee in Research involving Human Beings of the Federal University of Minas Gerais (COEP / UFMG), under opinion number: 86759218.0.0000.5149. A Free and Informed Consent Form was sent to the parents/caregivers of preschool children, through which they authorized the participation of their children in the study, while the preschoolers consented through a FICF for children and adolescents. The children were examined on school premises in a private room by two calibrated examiners, with Kappa values ranging from 0.96 to 0.99 for inter-examiner and intra-examiner agreement, respectively, for the diagnosis of dental caries (simplified ICDAS Index) and the clinical consequences of dental caries (PUFA Index) using artificial light (headlamp), a clinical mirror and gauze for drying teeth. The data were analyzed using descriptive statistics, Chi-square, Fisher's Exact and Linear by Linear tests for bivariate analysis, and Multivariate Logistic Regression (p <0.05). The prevalence of cavitated dental caries was 51.0%, while for caries with pulp-related consequences it was 13.6%. The multivariate model adjusted for the variables kinship, preschoolers and parents/caregivers with health insurance and who have already attended the dentist, maternal education, monthly family income, gender and age of preschoolers, showed that literacy was not associated with the presence of untreated caries (OR: 0.97; 95% CI: 0.65-1.46; p=0.890). However, parents/caregivers with lower oral health literacy were 93% more likely to have children with clinical pulp-related consequences of untreated caries (OR: 1.93; 95% CI: 1.01-3.69; p=0.046) than those with higher oral health literacy. It is concluded that the low oral health literacy of parents/caregivers is associated with a greater chance of their children having clinical pulp-related consequences of cavitated dental caries. (AU)

Negative effect of malocclusion on the emotional and social well-being of Brazilian adolescents: a population-based study.

BACKGROUND/OBJECTIVES: The aesthetic impact of malocclusion can have negative repercussions on quality of life, social interaction, interpersonal relationships, and psychological well-being. The aim of this study was to evaluate the impact of malocclusion on the quality of life of Brazilian adolescents. METHODS: A representative cross-sectional study of 1612 adolescents from Belo Horizonte, Minas Gerais was conducted. The adolescents responded to the Brazilian version of the Child Perception Questionnaire (CPQ11-14-ISF:16) to assess the impact of the condition on quality of life. Cases of malocclusion were diagnosed using the Dental Aesthetic Index while clinical examination was performed by three calibrated examiners. Data regarding traumatic dental injuries, dental caries, gender, type of school, age and social vulnerability was collected. Data analysis was performed using bivariate and multivariate Poisson regression with robust variance (P < 0.05). RESULTS: The prevalence of malocclusion was 31.3%. The presence of definite malocclusion (PR = 1.28; CI = 1.13-1.45), severe malocclusion (PR = 1.24; CI = 1.04-1.47) and handicapping malocclusion (PR = 1.55; CI = 1.31-1.84) was associated with a greater negative impact on Emotional Well-Being. The presence of definite malocclusion (PR = 1.18; CI = 1.02-1.36), severe malocclusion (PR = 1.46; CI = 1.21-1.76) and handicapping malocclusion (PR = 1.61; CI = 1.35-1.94) was also associated with a greater negative impact on Social Well-Being. CONCLUSIONS: Adolescents with handicapping malocclusion, where the need for treatment was mandatory, suffered from a greater negative impact on quality of life, with emotional and social aspects most affected.