Oral health of Brazilian individuals with mucopolyssaccaridosis.

PURPOSE: This study described and compared the oral characteristics of Brazilian individuals with mucopolysaccharidosis (MPS) and without MPS. METHODS: A cross-sectional study was performed with 29 individuals with MPS and 29 without MPS and their parents/guardians. The individuals were aged between 3 and 21 years and attended at two hospitals in Belo Horizonte, southeastern Brazil. The dental characteristics were evaluated by clinical examination of dental caries, gingivitis, malocclusion, dental anomalies and developmental defects of enamel. The parents/guardians answered a questionnaire about the sociodemographic and behavioural aspects of their children. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais. RESULTS: The average age of the individuals was 13.9 years (± 7.2). The majority were male (58.6%), had black/brown skin (70.7%) and were from favored economic class (89.7%). Dental caries, gingivitis, malocclusion and dental anomalies were more prevalent in the MPS group (p < 0.05). CONCLUSION: The individuals with MPS had a higher prevalence of oral diseases and dental anomalies than the group without MPS.

Dental caries are more likely to impact on children's quality of life than malocclusion or traumatic dental injuries.

AIM: To measure the impact of dental caries, malocclusion, and traumatic dental injuries (TDI) on the oral health-related quality of life (OHRQoL) of Brazilian children. STUDY DESIGN: population-based cross-sectional study. MATERIALS AND METHODS A representative sample of 1,204 8-to-10-year-old children randomly selected from 19 public and private schools in Belo Horizonte (Brazil) was evaluated. The Decayed, Missing and Filled Teeth Index (DMFT), the Dental Aesthetic Index (DAI), and Andreasen's classification were used by two calibrated examiners to diagnose dental caries, malocclusion, and TDI, respectively. Children were clinically examined at school. The Brazilian version of the Child Perceptions Questionnaire for ages 8 to 10 years (CPQ8-10) was used to assess the impact on OHRQoL. RESULTS: There were statistically significant differences (p<0.001) between groups (dental caries, malocclusion, and TDI) in all subscales and the CPQ8-10 total score. The presence of dental caries alone and its association with TDI and malocclusion were associated with all CPQ8-10 subscales (p<0.05). STATISTICS: the Poisson regression model with a robust variance estimator was utilised for the multivariate analysis. Adjusted prevalence ratios were obtained for the association between oral conditions and the total score on the CPQ8-10 and its subscales. CONCLUSION: Dental caries seems to be the oral condition most commonly associated with a higher impact on the OHRQoL of Brazilian 8-to-10-year-olds.

Is there an association between verbal school bullying and possible sleep bruxism in adolescents?

The aim of this study was to determine the association between verbal school bullying and possible sleep bruxism (SB) in adolescents. A case-control study was carried out at the population level by recruiting 13- to 15-year-old participants among the attendants of schools of Itabira, Brazil. The case group was composed of 103 adolescents with possible SB (i.e. self- or parental-reported), while the control group included 206 adolescents without possible SB. All participants answered a questionnaire on the occurrence of their involvement in verbal school bullying episodes, based on the National School of Health Research (PeNSE) as well as an evaluation of their economic class according to the criteria of the Brazilian Association of Research Companies. Pearson's chi-square, McNemar test and conditional logistic regression were performed to assess the association between possible SB, verbal school bullying and economic class. There were 134 (43·3%) participants who reported involvement in verbal school bullying episodes as a victim, bully or both. The majority of them were males (90·3%). Adolescents with possible SB were more likely to have been involved in episodes of verbal school bullying (OR: 6·20; 95% CI: 3·67-10·48). Based on these findings, it can be suggested that possible SB in young teenagers is associated with a history of episodes of verbal school bullying.

Factors associated with dental caries in Brazilian children: a multilevel approach.

OBJECTIVES: The aims of the present study were to assess caries experience among Brazilian children aged eight to 10 years and determine social factors of this disease, through a multilevel approach. METHODS: This is a cross-sectional study in which a representative sample of 1204 eight-to-ten-year-old children were randomly selected from 19 public and private schools in the city of Belo Horizonte, Brazil. After formal authorization from the parents, the children were clinically examined at school by two calibrated examiners (Kappa=0.78). Individual socioeconomic status was determined using household income, number of residents in the home and parents'/caregivers' schooling. The social vulnerability index and type of school were used as contextual variables. The outcome variables were severity score of dental caries in permanent teeth (DMFT index), dental caries experience in permanent teeth (DMFT = 0 or ≠ 0), severity score of dental caries in primary teeth (dmft index) and dental caries experience in primary teeth (dmft = 0 or ≠ 0). RESULTS: The minority of children (37.2%) had dental caries experience. Chi-squared and Mann-Whitney tests showed that age, parents'/caregivers' schooling, household income and type of school were associated with dental caries experience in permanent and primary teeth (P < 0.05). Mann-Whitney, Kruskal-Wallis tests and Spearman correlation coefficient showed that age, parents'/caregivers' schooling, household income, and type of school were associated with severity score of dental caries in permanent and primary teeth (P < 0.05). In multilevel approach, the individual variables, age and household income demonstrated association with dental caries experience and with severity score of dental caries in primary teeth (P < 0.05). Type of school was also associated with dental caries experience and with severity score of dental caries in these teeth (P < 0.05). In the Poisson multilevel approach, the analysis of the final estimation of variance components of the null model revealed a significant difference among the 19 schools with regard to severity score of dental caries in permanent teeth too (P < 0.001). Younger children and attending private schools showed lower severity score of dental caries in permanent teeth. CONCLUSION: Dental caries experience and severity score of dental caries in primary teeth was influenced by age, household income, and the type of school The dental caries experience in permanent teeth was influenced by age, parents'/caregivers' schooling, household income, and type of school, whereas the severity score of dental caries in permanent teeth was influenced by age and type of school.

Mothers' reports on systemic signs and symptoms associated with teething.

PURPOSE: The purpose of this study was to compare mothers' actual observations of signs and symptoms associated with the eruption of primary incisors in their infants with their own recollections of the same period after eruption was completed. METHODS: A comparative study was carried out with 45 non-institutionalized infants and their mothers. Oral clinical exams were performed daily for detection of tooth eruption. The mothers were also interviewed daily about signs and symptoms they thought were associated with teething in the previous 24 hours. One week after the data collection was done, the mothers answered the same questionnaire. Descriptive analysis and the McNemar test (P<.05) were performed. RESULTS: Statistically significant differences were found between the prospective and retrospective studies. Increased salivation (P<.04) and runny nose (P<.001) were reported less often and fever was reported more often (P<.001) in the retrospective evaluation. CONCLUSIONS: Mothers reported similar manifestations of sleep disturbance, diarrhea, loss of appetite, and irritability in the prospective and retrospective studies. Increased salivation and runny nose were more frequently reported in the prospective study, whereas fever was reported 5 times more often in the retrospective study.

Impact of dental pain on daily living of five-year-old Brazilian preschool children: prevalence and associated factors.

AIM: To assess the impact of dental pain on the daily living of 5-year-old preschool children using reports from parents/guardians. DESIGN AND METHODS: A cross-sectional study was carried out involving 549 five-year-old children randomly selected from preschools in the city of Belo Horizonte, Brazil. Data were collected using a previously validated parent-reported questionnaire. The children received dental examinations from a single calibrated examiner. The following outcome variables were selected: age, gender, dental caries, filled teeth, missing teeth, caries involving pulp and social class. Simple and multiple logistic regression analyses were performed on the data. RESULTS: According to parents' reports, 11.1% of children were affected by dental pain in the previous 4 months and of these 72.6% had their daily activities hampered by pain. The majority of these children had difficulty in eating, brushing teeth, sleeping, playing and going to school. The impact of dental pain had a statistically significant association with gender (p=0.001), social class (p=0.009), dental caries (p<0.001), missing teeth (p<0.001), filled teeth (p<0.001) and caries involving pulp (p<0.001). CONCLUSION: The prevalence of difficulties performing tasks of daily living due to dental pain was relatively high among the children studied.

Prevalence of malocclusion in primary dentition in a population-based sample of Brazilian preschool children.

AIM: The purpose of the present study was to assess the prevalence of malocclusion in the primary dentition in a randomised representative sample of Brazilian preschool children. MATERIALS AND METHODS: A cross-sectional survey was carried out in Belo Horizonte, Brazil, involving 1069 male and female preschool children from 60 to 71 months of age, randomly selected from public and private preschools and daycare centers. A questionnaire addressing demographic data was sent to parents/guardians in order to characterise the sample. The oral examination of the children was performed by a single, previously calibrated dentist (kappa inter-examiner agreement value = 0.82). The criterion for the categorisation of malocclusion was at least one of the following conditions: posterior crossbite, overjet (> 2 mm), anterior crossbite, anterior open bite and deep overbite. Univariate analysis was performed using the SPSS software RESULTS: The prevalence of malocclusion was 46.2%. Deep overbite was the most prevalent alteration (19.7% of the sample). Posterior crossbite was diagnosed in 13.1% of the children; 10.5% had accentuated overjet; 7.9% had anterior open bite; and 6.7% had anterior crossbite. CONCLUSION: Malocclusion in primary dentition is becoming a significant problem. The prevalence in the present study was high, especially vertical and transversal malocclusions.

Prevalence and risk indicators of temporomandibular disorder signs and symptoms in a pediatric population with spastic cerebral palsy.

OBJECTIVE: To determine risk indicators for signs and symptoms of temporomandibular disorders (TMD) in children with cerebral palsy (n = 60) and control subjects (n = 60). STUDY DESIGN: The subjects were assessed by means of questionnaire and clinical exam: 1) signs and symptoms of TMD; 2) malocclusions [Dental Aesthetic Index (DAI)]; 3) harmful habits; and 4) bio-psychosocial characteristics. Statistical analysis involved the chi-square, Fisher's exact tests (p < or = 0.05) and multivariate logistic regression (forward stepwise procedure). Variables that achieved a p-value < or = 0.20 were used as potential predictors of signs and symptoms of TMD and applied as co-variables in the multivariate analysis. RESULTS: The prevalence of at least one sign and/or symptom of TMD in the present sample was 1.7% (n = 1) among the individuals in the control group and 13.3% (n = 8) among the individuals with cerebral palsy. The presence of cerebral palsy (Odds Ratio: 9.08; p = 0.041), male gender (OR: 6.21; p = 0.027), severity of the malocclusion (OR: 4.75; p = 0.031), mouth breathing (OR: 5.40; p = 0.022) and mixed dentition (OR: 4.73; p = 0.035) were identified as risk indicators for signs and symptoms of TMD. CONCLUSIONS: It was concluded that children with cerebral palsy had a significantly greater chance of developing signs and symptoms of TMD.

Prevalence of sleep bruxism in a group of Brazilian schoolchildren.

AIM: This was to investigate the prevalence of sleep bruxism in Brazilian schoolchildren. METHODS: A cross-sectional study was carried out examining 652 randomly selected children aged from 7 to 10 years of age from both public and private schools in Belo Horizonte, Brazil. Sleep bruxism among children was reported by parents by means of a pretested questionnaire based on the criteria of the American Academy of Sleep Disorders. The Social Vulnerability Index from Municipal database was used to determine social classification of families. A chi-square test was used with a significance level of 5%. RESULTS: Sleep bruxism was present in 230 children, showing a prevalence of 35.3%. Among the 652 children, 340 (52.0%) were girls and 312 (48.0%) were boys, predominatly of 8-year-olds (84.2%). Sleep bruxism was present in 56.5% of the girls and 43.5% of the boys. The majority of the families were of a low social vulnerability (54.2%), whereas another 45.8% were of a high social vulnerability. More than half of the children without sleep bruxism (55.2%) were of low socio-economic background. CONCLUSIONS: The high prevalence of 35.3% demonstrates the need for further research on this issue.

Predisposing factors for traumatic dental injuries in Brazilian preschool children.

AIM: The aim of the present study was to assess the prevalence of traumatic dental injury (TDI) in primary teeth and determine predisposing factors. MATERIALS AND METHODS: A cross-sectional study was carried out on 388 male and female Brazilian preschool children between 60 and 71 months of age. A questionnaire addressing demographic data and history of TDI was sent to parents/caregivers. Socioeconomic status was determined using the Social Vulnerability Index (SVI), family income, number of people in the household and parents/caregivers' schooling. The chi-square test was used for the statistical analysis. RESULTS: The prevalence of TDI was 62.1%; 61.7% of the teeth were affected by enamel fracture. Statistically significant associations were found between TDI and increased overjet [OR = 2.24, 95% CI = 1.11- 4.55] and anterior crossbite [OR = 0.38, 95% CI=0.17-0.87]. No statistically significant associations were found between TDI and number of people in the household, family income, social vulnerability, parents/caregivers' schooling, lip competence, overbite, anterior open bite and dental caries (p>0.05). CONCLUSION: The prevalence of TDI was high and enamel fracture was the most common sign of TDI. Children with an increased overjet suffer more TDIs. Socioeconomic factors had no influence over the prevalence of TDI.

Mothers' perceptions concerning oral health of children and adolescents with Down syndrome: a qualitative approach.

AIM: The aim of this qualitative study was to investigate the perceptions of a group of mothers of children and adolescents with Down syndrome (DS) concerning the overall health and oral health of their children. METHODS: The information was collected interviewing in depth 19 mothers using an open-ended orientation form. To investigate the perceptions of the mothers was carried out a thematic content analysis. Two general themes were addressed: mothers' perceptions concerning the health of the child with DS and mothers' opinion on the impact of oral health on the life of the child with DS. RESULTS: According to the interviews, for the mothers, overall health and oral health entail specificities associated mainly with the absence of illness, the performance of daily activities, and feelings of well-being. Mothers tended to hold themselves accountable for their children's health status. Within the situations these women experience, many of the interviewees reported difficulties in caring for their children's oral health. CONCLUSION: Factors linked to financial constraints, time, and access to healthcare referral services hamper the search for specialised dental care for individuals with special needs.

Preliminary validation of the Brazilian version of the Child Perceptions Questionnaire 8-10.

AIM: The aim of the study was to perform a preliminary validation of the Brazilian version of the Child Perceptions Questionnaire 8-10 (CPQ 8-10). METHODS: The sample used to test the measurement equivalence was made up of 59 children from 8 to 10 years of age at the Federal University of Minas Gerais, Brazil. The CPQ 8-10 was administered, and clinical exams were performed by a single examiner, calibrated for the diagnosis of dental caries (Kappa= 0.98) and malocclusion (weighted Kappa and intraclass correlation coefficient = 0.66-1.00). The children were divided into three groups according to their clinical condition (22 with cavitated carious lesions; 20 with malocclusion; 17 with both oral conditions). STATISTICS: The internal consistency of the instrument was assessed by Cronbach's alpha Coefficient. The Intraclass correlation coefficient (ICC) was used for the test-retest reliability (40 children). Discriminant validity was determined using the Kruskal-Wallis test. RESULTS: An assessment of the psychometric properties revealed the instrument to be reliable (Cronbach's alpha=0.92 for the total scale and 0.63-0.85 for the subscales), exhibiting excellent stability (ICC=0.96 for the total scale and 0.79-0.95 for the subscales). Construct validity was demonstrated through the significant correlations between the global indicators and subscales. There were statistically significant differences between the clinical groups regarding the total scale, thereby demonstrating discriminant validity (p=0.03). CONCLUSIONS: The preliminary validation of the Brazilian version of the CPQ 8-10 showed valid and reliable for use on Brazilian children.

Family Impact Scale (FIS): psychometric properties of the Brazilian Portuguese language version.

AIM: Evaluate the psychometric properties of the Brazilian version of the Family Impact Scale (FIS). METHODS: Following translation and cross-cultural adaptation, the FIS was tested on 123 parents-caregivers of children between 11 and 14 years of age with dental caries and malocclusions. The parents were recruited from the Paediatric Dental and Orthodontic clinics where their children were receiving dental care. Psychometric properties were assessed through internal consistency, test-retest reliability, construct validity and discriminant validity. RESULTS: The mean FIS score was 6.97 (SD 7.81) for the dental caries group and 7.25 (SD 7.70) for the malocclusion group. The FIS score was unable to discriminate different family impact caused by children's oral health conditions. Internal consistency was confirmed by a Cronbach's alpha coefficient of 0.79. Test-retest reliability revealed good reproducibility (ICC 0.83). Construct validity was good, demonstrating highly significant correlations between parent's perceptions regarding the overall wellbeing indicator for their children and the total FIS and subscales. Financial burden demonstrated no significant correlation with global indicators. CONCLUSIONS: Overall psychometric results for the Brazilian version of the FIS confirm it as a reliable, valid questionnaire for assessing the family impact caused by children's oral conditions.

Relationship between mothers' sense of coherence and oral health status of preschool children.

OBJECTIVE: The aim of the present study was to investigate the relationship between mothers' sense of coherence (SOC) and oral health status in a representative sample of 5-year-old preschool children. METHODS: A cross-sectional study was conducted in Belo Horizonte (Brazil) on a sample of 546 mothers and their 5-year-old children, randomly selected from preschools. Data were collected through questionnaires (mothers), the short version of Antonovsky's SOC scale (SOC-13) and clinical dental examinations (children). Simple and multiple logistic regression analyses were performed on the data. The following 8 outcome variables were selected: dental caries, filled and missing teeth, dental pulp exposure due to caries, dental root fragment, visible plaque, gingivitis and supragingival calculus. The examination was carried out by 2 trained, calibrated examiners. RESULTS: Mothers with a lower SOC were more likely to have children with decayed teeth (OR = 1.59, 95% CI = 1.01-2.29), dental pulp exposure (OR = 1.99, 95% CI = 1.06-3.77) or filled teeth (OR = 1.85, 95% CI = 1.12-3.06) regardless of the child's social class and gender. CONCLUSION: The data indicate that mothers' SOC is an important psychosocial determinant of the oral health status among preschool children.

Predictive factors for child behaviour in the dental environment.

AIM: This was to evaluate the potential factors that influence behaviour in the paediatric dentistry environment of children aged 48 to 68 months who have never before been to a dentist. STUDY DESIGN: Cross sectional. METHODS: Child behaviour was evaluated using the Frankl scale during both clinical examination procedures and prophylaxis. All mothers of the 118 children investigated underwent a test to assess their anxiety (Manifest Anxiety Scale-MAS) and responded to a questionnaire on the medical history of the child as well as socioeconomic factors. The children were given a test to assess their anxiety (Venham Picture Test-VPT). STATISTICS: The statistical tests adopted were the Chi-squared test and both simple and multiple unconditional logistic regression. RESULTS: Children with high anxiety, those had previously experienced toothache and those had behaved uncooperatively during prior medical experiences, had a greater probability of behaving uncooperatively during their first dental consultation. CONCLUSIONS: Dental professionals can identify the presence of predictive factors for child behaviour prior to the first clinical examination by including relevant questions in the dental and medical history, thereby facilitating a more positive initial contact between paediatric dentists and their patients.

Observing the behavior of senior dental students in relation to infection control practices.

To achieve adequate infection control in the dental practice, dental students should be fully aware and prepared to adopt necessary procedures. But most studies of students' infection control behaviors rely on self-reported data. This study verified, through direct observation, how senior dental students performed basic infection control procedures and assessed how close to reality the reported behavior is to the observed behavior. Eight students were observed in three clinics: pediatric dentistry, minor oral surgery, and primary care promotion. The students were not aware of who was being observed or why. Later all twenty students comprising that clinical subgroup answered a questionnaire. Seventy-two patient-student contacts were observed. Students considered basic infection control procedures as relevant. The reported intention of adoption of these procedures after graduation dropped in relation to their reported relevance. Although the observed behavior in the three clinics was considered satisfactory, when compared to the reported behavior, it was found that the intention was more positive than the behavior itself. Even though the students were conscious about the importance of cross-infection control in the dental practice, the reported intention of future use and mainly the observed behavior should be improved.