Life course social mobility, race and tooth loss in adulthood: The role of dental health services.

OBJECTIVES: To evaluate the extent to which dental care factors in adulthood modify and, at the same time, mediate the association between race/ethnicity and social mobility from childhood to adulthood with two oral health outcomes in adults. METHODS: In 2012, 1222 individuals 20-59 years old participated in the second wave of the Epi-Floripa Study in Florianopolis, Brazil. Exposures included social mobility based on adulthood and childhood events, dental care in previous years, type of dental care coverage, reason for dental visits and race. The number of missing and decayed teeth were dichotomised as MT >0 and DT >0. RESULTS: The prevalence of missing and decayed teeth was 61.9% and 23.0%, respectively. Age-sex adjusted inequalities in decayed and missing teeth among Black and White individuals were 41.2 percentage points (pp) (95% CI: 3.9-78.7) and 53.1 pp (19.5:86.7), respectively. Inequalities between those persistently higher and lower in socioeconomic position were 42.6 pp (14.6-70.7) and 90.0 pp (62.1-100). The Relative Excess of Risk due to Interaction (RERI) was not statistically significant (p < 0.05). Oaxaca-Blinder decomposition analyses showed that dental care variables accounted for a small proportion of inequalities. CONCLUSIONS: This result implies that dental care is unlikely to significantly reduce or increase oral health inequalities in this particular population.

Prevalence and experience of dental caries among Singaporean schoolchildren: A time-trend analysis from 2007 to 2019.

OBJECTIVES: This study aimed to describe caries prevalence and experience trends of permanent teeth among Singapore schoolchildren between 2007 and 2019. METHODS: Anonymized records of all 6-year-old Primary 1 (P1), 11-year-old Primary 6 (P6) and 14-year-old Secondary 3 (S3) before the start of each school year were extracted from the Integrated Dental Electronic Assessment System (IDEAS) by school level, ethnicity and sex. Prais-Winsten regression was used to assess trends of mean decayed, missing and filled teeth (DMFT) and caries prevalence (% DMFT > 0) among the schoolchildren by school level, with reported Average Annual Percentage Change (AAPC) together with respective 95% confidence interval (CI). RESULTS: In total, 519 471 P1, 566 573 P6 and 548 138 S3 were included during the above period, and the majority were comprised of Chinese children (P1: 67.2%, P6: 68.8% and S3: 71.0%, respectively). Overall, the prevalence of caries dropped from 6.9% in 2007 to 3.5% in 2019 among P1, from 34.5% in 2009 to 20.3% in 2019 among P6 and from 41.5% in 2007 to 33.5% in 2019 among S3 schoolchildren. The mean DMFT reduced from 0.11 to 0.05 among P1, 0.72 to 0.35 among P6 and 1.05 to 0.76 among S3 schoolchildren during the same period. Caries prevalence and mean DMFT were consistently higher among girls. On average, caries prevalence decreased 5% per year in P1 (AAPC -5.0 [95% CI: -6.1, -3.9]) and P6 (AAPC -4.9 [95% CI: -5.7, -4.1]) and 2% among S3 (AAPC -2.0 [95% CI: -3.5, -0.4]) schoolchildren. Caries prevalence decreased approximately 4% ~ 5% annually among P1 and P6 schoolchildren regardless of ethnicity. The average decrease in caries prevalence was lower (about 2%) among all ethnicities at S3 school level. CONCLUSION: Dental caries in permanent dentition of Singaporean schoolchildren had decreased from 2007 to 2019. However, the decrease observed among primary school students was more than double that among secondary schoolchildren.

Breastfeeding Protects from Overjet in Adolescence by Reducing Pacifier Use: A Birth Cohort Study.

Increased dental overjet in adolescence is a clinically relevant outcome associated with the complexity and high cost of treatment, indicating the need for prevention strategies. We investigated the long-term impact of breastfeeding and pacifier use on increased overjet (IOVJ) in permanent dentition. A prospective cohort nested in a randomized controlled trial was conducted from birth to 12 years of age (n = 214). Breastfeeding and pacifier use were recorded monthly until 12 months. Overjet was assessed at age 12 years. We employed a causal mediation analysis using parametric regression models assuming no interaction between breastfeeding and pacifier usage. We found a total protective effect of breastfeeding on IOVJ (OR 0.49; 95% CI 0.28-0.96), where 63.1% were mediated by pacifier use (OR 0.61; 95% CI 0.44-0.87). Breastfeeding directly decreased the odds of IOVJ by 20%; however, the confidence interval included the null estimate (OR 0.81; 95% CI 0.41-1.60). In conclusion, breastfeeding protects by half of the IOVJ in adolescence through reducing pacifier use. Oral and general health professionals should collaborate to support WHO breastfeeding guidelines during individual patient counseling. Guidelines for practice, policy or public information require messages that include a common risk approach to oral and general health.

Bathroom Behaviors Regarding Oral Hygiene Items During COVID-19 Home Isolation: A Cross-Sectional Study in Southern Brazil

ABSTRACT Objective: To describe behaviors with oral hygiene items in single-bathroom households during the domiciliary isolation of individuals with positive 'Reverse transcriptase polymerase chain reaction' (RTPCR+) in southern Brazil. Material and Methods: Cross-sectional study was conducted with Research and Monitoring Sector of COVID-19 data from Palhoça, Brazil, of individuals aged ≥18 years, living in a singlebathroom household, who had an RT-PCR positive. A link of Google Forms was used. Socio-demographic information, characteristics during the home isolation, oral hygiene, and behaviors with oral hygiene items in the bathroom were collected. Descriptive stratified analyses according to age were conducted (<40 and ≥40 years). Results: Among 524 individuals, 36% were aged ≥40 years. During isolation, according to the behaviors with oral hygiene items in the household single-bathroom, 70% (95%CI 64.9-75.5) of the youngest participants reported sharing toothbrushes in the same container and 30% (95%CI 24.4-35.1) of the oldest; use of the same toothpaste was reported by 67% (95%CI 62.8-71.7) of the youngest and 33% (95%CI 28.337.3) of the oldest participants. For the outcome of sharing the same toothpaste, the chances for the youngest and the oldest to share the same toothbrush container was 11 times and 6 times more, respectively. Conclusion: The individuals related good oral hygiene habits; however, behaviors with oral hygiene items in the bathroom were neglected, especially by the younger individuals.

[Prevalence rates and inequalities in access to medicines by users of the Brazilian Unified National Health System in 2013 and 2019]. / Prevalências e desigualdades no acesso aos medicamentos por usuários do Sistema Único de Saúde no Brasil em 2013 e 2019.

The study aimed to analyze and compare the prevalence of access to medicines and associated factors among users of the Brazilian Unified National Health System (SUS). The authors analyzed data from the 2013 and 2019 editions of the Brazilian National Health Survey, a nationwide health study, representative of the Brazilian population. The outcomes were: (1) obtaining from the SUS all the medicines prescribed during care received in the SUS itself in the two weeks prior to the interview (2) and obtaining all the medicines, regardless of the source. Demographic and socioeconomic characteristics were included as independent variables. In 2019, 29.7% of the interviewees obtained all the prescribed medicines from the SUS, 81.8% obtained all the medicines in general (considering all sources), and 56.4% paid some amount for the medicines. The proportion who did obtain any medicine from the SUS and that made some out-of-pocket payment increased from 2013 to 2019. The likelihood of obtaining all the medicines in the SUS was higher among the poorest, and that of obtaining the medicines regardless of source was higher among the wealthiest. Approximately two out of three persons that were unable to access all the medicines reported difficulties obtaining them in services funded by the public sector. There was an increase in out-of-pocket expenditure on medicines in Brazil and a reduction in access through the SUS, among users of the system.

O objetivo do estudo foi analisar e comparar a prevalência, a forma de obtenção e os fatores associados ao acesso a medicamentos entre usuários do Sistema Único de Saúde (SUS) no Brasil. Foram analisados os dados das edições 2013 e 2019 da Pesquisa Nacional de Saúde, estudo de abrangência nacional e representativo da população brasileira. Os desfechos foram: (1) a obtenção total, por meio do SUS, dos medicamentos prescritos em atendimentos em saúde realizados no próprio SUS nas duas semanas anteriores à entrevista, e (2) a obtenção total dos medicamentos independentemente da fonte. Características demográficas e socioeconômicas foram incluídas como variáveis independentes. Em 2019, observou-se que 29,7% dos entrevistados obtiveram no SUS todos os medicamentos prescritos, que 81,8% tiveram acesso total aos medicamentos quando consideradas todas as fontes de obtenção e que 56,4% pagaram algum valor pelos medicamentos. A proporção de pessoas que não obtiveram nenhum medicamento no SUS e que efetuaram algum desembolso direto aumentou entre 2013 e 2019. A probabilidade de obter todos os medicamentos no SUS foi maior entre os mais pobres, e de consegui-los, independentemente da fonte, foi maior entre os mais ricos. Dentre as pessoas que não conseguiram acesso a todos os medicamentos, aproximadamente duas em cada três indicaram como principal motivo dificuldades de obtenção encontradas em serviços financiados pelo setor público. Verificou-se ampliação do desembolso direto para compra de medicamentos no Brasil e redução de acesso pelo SUS entre usuários do sistema.

El objetivo de este estudio fue analizar y comparar la prevalencia, la forma de obtención y los factores asociados al acceso a los medicamentos entre los usuarios del Sistema Único de Salud (SUS) en Brasil. Se analizaron los datos de las ediciones 2013 y 2019 de la Encuesta Nacional de Salud, un estudio de cobertura nacional y representativo de la población brasileña. Los resultados fueron: (1) la obtención total, a través del SUS, de los medicamentos prescritos en los servicios de salud realizados en el propio SUS en las dos semanas anteriores a la entrevista, y (2) la obtención total de los medicamentos independientemente de la fuente. Las características demográficas y socioeconómicas se incluyeron como variables independientes. En 2019 se observó que el 29,7% de los entrevistados obtuvo todos los medicamentos prescritos en el SUS, que el 81,8% tuvo acceso total a los medicamentos al considerar todas las fuentes de obtención y que el 56,4% pagó por los medicamentos. La proporción de personas que no obtuvieron ningún medicamento en el SUS y que realizaron algún gasto directo aumentó entre 2013 y 2019. Entre los pobres, la probabilidad de obtener todos los medicamentos del SUS fue mayor, y entre los más ricos también fue mayor esta obtención independientemente de la fuente. Entre las personas que no pudieron acceder a todos los medicamentos, aproximadamente dos de cada tres indicaron como razón principal las dificultades que se encuentran en los servicios financiados con fondos públicos. Hubo un aumento del gasto directo para la compra de medicamentos en Brasil y una reducción del acceso a través del SUS entre los usuarios del sistema.

Counterfactual approach on the effect of metabolic syndrome on tooth loss: A population-based study.

BACKGROUND: This study aimed to investigate the effect of metabolic syndrome (MetS) on tooth loss in adults from a population-based sample. METHODS: Cross-sectional analysis based on data from a cohort study (2009 to 2014) with adults from Southern Brazil. MetS (exposure), lack of functional dentition and number of lost teeth (outcomes) were assessed using self-reported, laboratory and clinical data. Possible confounders included sex, age, family income, education level, smoking status, and sugar consumption. The effect of MetS on the outcomes was estimated using conventional logistic or negative binomial regression models. Marginal structural modeling (MSM) with stabilized weights (a counterfactual analytical method) was also used to enhance group comparability and estimate causal effects. RESULTS: A total of 1,283 participants had available information for the outcomes. Individuals with MetS were more likely to experience a lack of functional dentition than those without MetS (odds ratio [OR] from logistic regression, 1.7; 95% CI, 1.0 to 2.9; OR from MSM, 3.2; 95% CI, 2.3 to 4.6). Moreover, the number of teeth lost was 20% higher in participants with MetS compared with those without MetS in conventional analysis (mean ratio [MR], 1.2; 95% CI, 1.1 to 1.3). The MR increased to 1.7 (95% CI, 1.5 to 2.0) when using MSM. CONCLUSION: Our findings provide evidence on the effect of MetS on tooth loss.

Prevalências e desigualdades no acesso aos medicamentos por usuários do Sistema Único de Saúde no Brasil em 2013 e 2019 / Prevalence rates and inequalities in access to medicines by users of the Brazilian Unified National Health System in 2013 and 2019 / Prevalencias y desigualdades en el acceso a los medicamentos por parte de los usuarios del Sistema Único de Salud en Brasil en 2013 y 2019

O objetivo do estudo foi analisar e comparar a prevalência, a forma de obtenção e os fatores associados ao acesso a medicamentos entre usuários do Sistema Único de Saúde (SUS) no Brasil. Foram analisados os dados das edições 2013 e 2019 da Pesquisa Nacional de Saúde, estudo de abrangência nacional e representativo da população brasileira. Os desfechos foram: (1) a obtenção total, por meio do SUS, dos medicamentos prescritos em atendimentos em saúde realizados no próprio SUS nas duas semanas anteriores à entrevista, e (2) a obtenção total dos medicamentos independentemente da fonte. Características demográficas e socioeconômicas foram incluídas como variáveis independentes. Em 2019, observou-se que 29,7% dos entrevistados obtiveram no SUS todos os medicamentos prescritos, que 81,8% tiveram acesso total aos medicamentos quando consideradas todas as fontes de obtenção e que 56,4% pagaram algum valor pelos medicamentos. A proporção de pessoas que não obtiveram nenhum medicamento no SUS e que efetuaram algum desembolso direto aumentou entre 2013 e 2019. A probabilidade de obter todos os medicamentos no SUS foi maior entre os mais pobres, e de consegui-los, independentemente da fonte, foi maior entre os mais ricos. Dentre as pessoas que não conseguiram acesso a todos os medicamentos, aproximadamente duas em cada três indicaram como principal motivo dificuldades de obtenção encontradas em serviços financiados pelo setor público. Verificou-se ampliação do desembolso direto para compra de medicamentos no Brasil e redução de acesso pelo SUS entre usuários do sistema.

The study aimed to analyze and compare the prevalence of access to medicines and associated factors among users of the Brazilian Unified National Health System (SUS). The authors analyzed data from the 2013 and 2019 editions of the Brazilian National Health Survey, a nationwide health study, representative of the Brazilian population. The outcomes were: (1) obtaining from the SUS all the medicines prescribed during care received in the SUS itself in the two weeks prior to the interview (2) and obtaining all the medicines, regardless of the source. Demographic and socioeconomic characteristics were included as independent variables. In 2019, 29.7% of the interviewees obtained all the prescribed medicines from the SUS, 81.8% obtained all the medicines in general (considering all sources), and 56.4% paid some amount for the medicines. The proportion who did obtain any medicine from the SUS and that made some out-of-pocket payment increased from 2013 to 2019. The likelihood of obtaining all the medicines in the SUS was higher among the poorest, and that of obtaining the medicines regardless of source was higher among the wealthiest. Approximately two out of three persons that were unable to access all the medicines reported difficulties obtaining them in services funded by the public sector. There was an increase in out-of-pocket expenditure on medicines in Brazil and a reduction in access through the SUS, among users of the system.

El objetivo de este estudio fue analizar y comparar la prevalencia, la forma de obtención y los factores asociados al acceso a los medicamentos entre los usuarios del Sistema Único de Salud (SUS) en Brasil. Se analizaron los datos de las ediciones 2013 y 2019 de la Encuesta Nacional de Salud, un estudio de cobertura nacional y representativo de la población brasileña. Los resultados fueron: (1) la obtención total, a través del SUS, de los medicamentos prescritos en los servicios de salud realizados en el propio SUS en las dos semanas anteriores a la entrevista, y (2) la obtención total de los medicamentos independientemente de la fuente. Las características demográficas y socioeconómicas se incluyeron como variables independientes. En 2019 se observó que el 29,7% de los entrevistados obtuvo todos los medicamentos prescritos en el SUS, que el 81,8% tuvo acceso total a los medicamentos al considerar todas las fuentes de obtención y que el 56,4% pagó por los medicamentos. La proporción de personas que no obtuvieron ningún medicamento en el SUS y que realizaron algún gasto directo aumentó entre 2013 y 2019. Entre los pobres, la probabilidad de obtener todos los medicamentos del SUS fue mayor, y entre los más ricos también fue mayor esta obtención independientemente de la fuente. Entre las personas que no pudieron acceder a todos los medicamentos, aproximadamente dos de cada tres indicaron como razón principal las dificultades que se encuentran en los servicios financiados con fondos públicos. Hubo un aumento del gasto directo para la compra de medicamentos en Brasil y una reducción del acceso a través del SUS entre los usuarios del sistema.

Tooth wear and socioeconomic status in childhood and adulthood: Findings from a systematic review and meta-analysis of observational studies.

OBJECTIVES: To evaluate the association and level of evidence between socioeconomic status (SES) and tooth wear (TW) in children, adolescents, and adults. DATA: Eligibility criteria comprised population-based observational studies assessing the association between SES and TW in permanent dentition of adolescents and adults. Interventional and descriptive studies or those without an internal comparison between exposed and nonexposed groups were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied where applicable. Risk of bias (RoB) was assessed using the Newcastle-Ottawa scale. Meta-analyses were conducted to estimate the pooled effect measures. Q-statistic, I2statistic, subgroup and sensitivity analyses assessed study heterogeneity. SOURCES: PubMed/Medline, Embase, Scopus, Web of Science, LILACS, SciELO, Cochrane Library, and Google Scholar databases were searched for articles published in English between 1st January 1980 and 31st March 2021. RESULTS: Sixty-five studies were included, involving 63,893 participants in over 30 countries. A positive association was found between TW and education (OR=1.25 [0.96; 1.62]), family income (OR=1.18 [0.91; 1.53]), and private school (OR= 1.24 [0.90; 1.72]) among adolescents. Higher educated adults had a lower risk for TW (OR=0.70 [0.52; 0.93]). Most included studies had a moderate RoB. Limitations relating to population representation and assessment methodologies were identified in the included studies. CONCLUSIONS: SES was associated with TW with its direction depending on the individuals' age. The overall quality of evidence was moderate. CLINICAL SIGNIFICANC: SES should be included as part of the routine screening and risk assessment for tooth wear.

The influence of breastfeeding and pacifier use on the association between preterm birth and primary-dentition malocclusion: A population-based birth cohort study.

INTRODUCTION: Little is known about the influence of biological characteristics on the occurrence of malocclusion. This study aimed to investigate the association between preterm birth and primary-dentition malocclusion and how breastfeeding and the use of pacifiers are related to this association. METHODS: A representative sample (n = 1129) of children from the 2004 Pelotas, Brazil birth cohort study underwent a dental examination at age 5 years. Malocclusions were diagnosed according to the World Health Organization criteria, and the outcome was considered as the presence of moderate or severe malocclusion (MSM). Questionnaires including the children's oral health information were completed by the mothers. Data on socioeconomic status, breastfeeding, and preterm birth were obtained from previous follow-ups. Poisson regression analysis was conducted, followed by an interaction test. RESULTS: The prevalence of MSM was 26.3% (95% confidence interval [CI], 23.6%-29.1%) in the total sample, 24.1% (95% CI, 21.5%-26.9%) in full-term births, and 42.2% (95% CI, 39.1%-45.3%) in preterm births. After adjustment, the prevalence of MSM was 42% higher in preterm births. Breastfeeding duration and pacifier use up to age 4 years modified the effect of gestational age on MSM. CONCLUSIONS: Preterm birth is associated with the development of MSM. Breastfeeding reduces the effect of preterm birth on MSM, and pacifier use strengthens this association. Dentists should be aware that preterm birth may be a risk factor for malocclusion in primary dentition. The findings reinforce the benefits of breastfeeding on occlusal development and the negative consequences of pacifier use.

COVID-19-Related Challenges in Dental Education: Experiences From Brazil, the USA, and Australia

Abstract Objective: To describe and compare how three dental schools from different countries (Australia, Brazil, and the USA) have managed experiences in dental education during the COVID-19 crisis. Material and Methods: It is a descriptive study reporting the experience that three distinct dental schools faced during the COVID-19 pandemic. They represent countries that adopted different measures to tackle the pandemic and were undergoing different stages of the disease. Results: After the WHO declared the COVID-19 pandemic, the Federal University of Paraíba suspended all on-site teaching, research, and service activities. For the return to teaching activities, the use of information and communications technology resources for distance learning was recommended. At the School of Dental Medicine (University of Pittsburgh), all research activities were suspended or, otherwise, could not be interrupted because of the employment of unique materials or supplies. When the pandemic started, Australia was one of the first countries to introduce strong regulations related to social distancing, travel restrictions, testing and tracking of infected patients. As such, the universities started to be closed from mid-March, cancelling all clinical and pre-clinical activities, maintaining online theoretical activities, such as seminars, lectures, and journal clubs. Conclusion: Numerous and critical difficulties have arisen as a result of the pandemic for individuals, communities and institutions that will have long-lasting effects. Our students face disruption to their education and career; our professional colleagues will be challenged rebuilding their practices, while staff at all Dental Schools are experiencing various hardships.

Reasons for direct restoration failure from childhood to adolescence: A birth cohort study.

OBJECTIVES: The aim of this study was to assess the prevalence of direct restorations in posterior teeth in children aged 12, from a birth cohort, and to test the association between the quality of the restorations and individual variables experienced in the life cycle. METHODS: All live-born children in Pelotas, in 2004, were prospectively investigated and a representative sample was assessed for oral conditions at ages 5 and 12. The outcome was the quality of the restoration (satisfactory/unsatisfactory). Independent variables included socioeconomic, behavioral and oral health characteristics at the individual level and the size of cavity and material at the tooth level. Associations were tested using multilevel logistic regression models. RESULTS: A total of 1,000 participants and 249 restorations in the permanent dentition were examined. Most of the restorations were composites (73.5%), while only 6.8% were amalgam. After adjusted analyses, children whose parents received information on how to prevent their child from developing caries before reaching 5 years of age had 91.0% less chance of having an unsatisfactory restoration compared to children whose parents never received information (OR = 0.09; 95% CI 0.01-0.59). Also, the chances of presenting unsatisfactory restorations were 5.3 higher in children at high-risk for untreated dental caries in the permanent dentition, in comparison with children at low risk (OR = 5.32; 95% CI 1.07-26.6). CONCLUSIONS: Low-risk for untreated dental caries and having received information on preventing dental caries, reduced the chance of presenting failed restorations, showing that factors related to individuals play an important role in the quality of restorations. CLINICAL SIGNIFICANCE: Our findings highlight the role that individual-related factors play in restoration longevity in children, reinforcing the need for a patient-centered approach in restorative dentistry.

Skin color affect the replacement of amalgam for composite in posterior restorations: a birth-cohort study.

The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.

The Controlled Direct Effect of Early-Life Socioeconomic Position on Periodontitis in a Birth Cohort.

This study used data from the 1982 Pelotas Birth Cohort Study, Brazil, to estimate the controlled direct effect of early-life socioeconomic position (SEP) on periodontitis at age 31 years, controlling for adulthood income and education, smoking, and dental hygiene. Sex was included as a covariate. Early-life SEP was measured at participant birth based on income, health services payment mode, maternal education, height, and skin color (lower versus middle/higher SEP). Periodontitis was assessed through clinical examination at age 31 years (healthy, mild periodontitis, or moderate-to-severe disease). Adulthood behaviors (smoking, dental hygiene) were the mediators, and adulthood SEP (education and income) represented the exposure-induced mediator-outcome confounders. A regression-based approach was used to assess the controlled direct effect of early-life SEP on periodontitis. Multinomial regression models were used to estimate risk ratios and their 95% confidence intervals. The prevalences of mild and moderate-to-severe periodontitis were 23.0% and 14.3%, respectively (n = 539). Individuals from the lowest early-life SEP had a higher risk of moderate-to-severe periodontitis controlled for mediators and exposure-induced mediator-outcome confounders: risk ratio = 1.85 (95% confidence interval: 1.06, 3.24), E value 3.1. We found that early-life SEP was associated with the development of periodontitis in adulthood that was not mediated by adulthood SEP and behaviors.

Direct effect of common mental disorders on xerostomia in adults estimated by marginal structural models: A population-based study.

OBJECTIVE: To investigate the controlled direct effect (CDE) of common mental disorders (CMD) on xerostomia which is not mediated by psychoactive medication intake. METHODS: A population-based cross-sectional study was conducted with 1720 individuals aged 20-59 years from Florianópolis, Brazil, in 2009. A two-stage cluster sample design was adopted, with a systematic selection of census tracts, followed by a random selection of households. All inhabitants of the selected households belonging to the age group of interest were considered eligible to participate. CMD were assessed using the Self-Reporting Questionnaire (SRQ > 7). Xerostomia was the outcome assessed by asking: "How often do you feel dry mouth?" with responses "often" and "always" taken as indicating xerostomia. Psychoactive medication intake was set as the mediator. Confounding factors included sex, age, per capita family income, educational attainment and smoking status. Marginal structural models were performed to quantify the CDE of CMD on xerostomia. Missing data were handled by multiple imputation by chained equations, and sensitivity analysis for unmeasured confounding was carried out. RESULTS: The overall prevalence of xerostomia was 8.8% and 15.3% of the individuals presented with CMD. After adjustment, the prevalence of xerostomia among individuals with CMD was 3.2 times higher than that among individuals without CMD (PR = 3.2 [95% CI: 2.3; 4.5]). The CDE of CMD on xerostomia which is not mediated by the medication intake resulted in a three times greater prevalence of xerostomia (PR = 3.0 95% CI: 2.0; 4.5) among those individuals with CMD. CONCLUSIONS: Common mental disorders is directly and negatively associated with xerostomia. Clinicians should bear in mind the emotional state when investigating the underlying factors and managing patients with xerostomia.

Skin color affect the replacement of amalgam for composite in posterior restorations: a birth-cohort study

Abstract The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.

Physical activity moderates the deleterious relationship between cardiovascular disease, or its risk factors, and quality of life: Findings from two population-based cohort studies in Southern Brazil and South Australia.

BACKGROUND: Few studies have investigated the relationship between physical activity (PA) of low intensity and duration with quality of life (QoL) among individuals at risk or with cardiovascular disease (CVD). OBJECTIVES: To investigate whether PA of different intensity and duration moderates the relationship between CVD and its risk factors (obesity, hypertension, diabetes, dyslipidaemia) and QoL in adults. METHODS: Population-based cross-sectional studies using data from the EpiFloripa Cohort Study (Southern Brazil; n = 1,220, 38.8±12.0 years, 48.2% males) and the North West Adelaide Health Study (NWAHS, South Australia; n = 1,661, 43.7±11.1 years, 49.7% males). The physical and psychological domains of QoL were assessed using the WHOQOL-Bref (EpiFloripa) or the SF-36 (NWAHS) questionnaires. The diagnosis of CVD and its risk factors were self-reported. PA was self-reported and quantified by its intensity ["walking" or moderate/vigorous (MVPA)] and duration (none, 1-150, ≥150 min/week). Both studies were analysed separately, and results were adjusted for sociodemographic variables. RESULTS: Participants at risk or with CVD from both studies showed a lower QoL than 'healthy' individuals with a stronger relationship for the physical domain. PA duration showed a direct-trend relationship with QoL, but the associations were stronger for MVPA in both studies. However, when stratified by health status, the magnitude of the association between "walking" duration and a higher physical QoL was greater among those at risk or with CVD compared to 'healthy' individuals. Conversely, among Australians with CVD, MVPA was associated with a better physical QoL only when its duration was ≥150 min/week. All associations were stronger in the NWAHS than in the Brazilian study. CONCLUSIONS: "Walking" was more prevalent than MVPA and was consistently associated with a better physical QoL among those at risk or with CVD. These findings should be considered in the design of public health interventions designed to increase PA and improve QoL.

Income trajectories affect treatment of dental caries from childhood to young adulthood: a birth cohort study.

We aimed to analyze the effects of family income trajectories on the increase in dental caries from childhood to young adulthood. Data from the 1993 Pelotas (Brazil) birth cohort study, in which dental caries was measured at ages 6, 12, and 18 years, were analyzed. Family income of 302 participants was assessed at birth, and at 4, 11, 15, and 18 years of age. Mother's education, toothbrushing frequency, dental visiting, dental caries in primary dentition, and birth weight were covariates. A latent class growth analysis was conducted to characterize trajectories of time-varying variables. The influence of income trajectories on the increase in dental caries from age 6 to age 18 was evaluated by a generalized linear mixed model. After adjustment, the increases in numbers of decayed and missing teeth (DMT) from age 6 to age 18 were associated with family income trajectory. The incident rate ratios (IRR) of DMT compared with the group of stable high incomes were 2.36 for stable low incomes, 1.71 for downward, and 1.64 for upward. The IRR of teeth being filled in stable low-income groups compared with stable high-income groups was 0.55. Family income mobility affected treatment patterns of dental caries. Differences across income trajectory groups were found in the components of dental caries indices rather than in the experience of disease.

Chronic diseases and socioeconomic inequalities in quality of life among Brazilian adults: findings from a population-based study in Southern Brazil.

Background: To evaluate the association between sociodemographic conditions and the quality of life (QoL) in adults and investigate whether these inequalities are greater among individuals with long-lasting chronic health conditions. Methods: Cross-sectional analysis of the second wave (2012) of the EpiFloripa Study, a population-based cohort of 1720 adults living in Southern Brazil. QoL domains (physical, psychological, social relationships and environmental) were evaluated using the WHOQoL-BREF. Unadjusted and adjusted means of QoL according to socioeconomic and demographic variables were estimated and stratified by the presence of long-lasting chronic conditions (heart disease, stroke, diabetes, hypertension, chronic kidney disease, cirrhosis, tendinitis, arthritis, rheumatism and/or fibromyalgia) were peformed in 2016. Results: Among 1222 interviewed adults (56.6% females, mean age 41.7 ± 11.4 years; follow-up rate 71.1%), the prevalence of 1+ long-lasting chronic disease was 37.3% (95%CI: 34.4-40.3). Their effect on the QoL was four times higher on the physical component (-9.6; 95%CI -12.1; -7.1) than on the other domains. Adults aged 40+ years with black skin colour or lower educational level had a lower physical QoL score only when any chronic disease was present. Among those with some chronic illness, the psychological domain was also lower among those aged 40+ years and with a lower family income. No interaction between sociodemographic variables and chronic diseases was observed for the other QoL domains. Conclusions: The occurrence of long-lasting chronic diseases is associated with inequalities in QoL (physical and psychological domains), with stronger adverse effects among older adults, blacks and individuals with lower income or educational levels.

Income trajectories affect treatment of dental caries from childhood to young adulthood: a birth cohort study

Abstract We aimed to analyze the effects of family income trajectories on the increase in dental caries from childhood to young adulthood. Data from the 1993 Pelotas (Brazil) birth cohort study, in which dental caries was measured at ages 6, 12, and 18 years, were analyzed. Family income of 302 participants was assessed at birth, and at 4, 11, 15, and 18 years of age. Mother's education, toothbrushing frequency, dental visiting, dental caries in primary dentition, and birth weight were covariates. A latent class growth analysis was conducted to characterize trajectories of time-varying variables. The influence of income trajectories on the increase in dental caries from age 6 to age 18 was evaluated by a generalized linear mixed model. After adjustment, the increases in numbers of decayed and missing teeth (DMT) from age 6 to age 18 were associated with family income trajectory. The incident rate ratios (IRR) of DMT compared with the group of stable high incomes were 2.36 for stable low incomes, 1.71 for downward, and 1.64 for upward. The IRR of teeth being filled in stable low-income groups compared with stable high-income groups was 0.55. Family income mobility affected treatment patterns of dental caries. Differences across income trajectory groups were found in the components of dental caries indices rather than in the experience of disease.