Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis.

This review aimed to assess the association between overweight/obesity and dental caries in Brazilian children/adolescents. Searches were performed in the Web of Science, Scopus, Cochrane, PubMed, Embase and SciELO, Lilacs and Open Grey literature databases up to June 2022. The Joanna Briggs Institute checklist for analytical cross-sectional studies, the checklist for cohort studies, and the checklist for case-control studies were used. A total of 41 publications were included, and 15 meta-analyses were performed. The authors analyzed the differences in weighted mean difference (MD) and odds ratios (OR), and their corresponding confidence intervals (CI) (95%) for dental caries among eutrophic and obese and/or overweight children/adolescents. Meta-analyses showed that there was no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI (Body Mass Index). A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve (OR = 2.53, 95% CI;1.49-4.29; p = 0.0006; I2 = 0%) in dichotomous outcome studies, and (MD = 0.61, 95%CI: 0.08-1.15; p = 0.02; I2 = 0%) in continuous studies. The strength of the evidence of the results was classified as very low, low or moderate. It was concluded that there is no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI. A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve.

Changes in Oral Health-Related Behaviors and Oral Health of Children in Early Childhood during Social Isolation Caused by COVID-19

ABSTRACT Objective: To assess changes in oral health-related behavior and oral health status in Brazilian children in early childhood perceived by their parents/caregivers during social isolation caused by COVID-19. Material and Methods: A cross-sectional study with parents/caregivers of children in southeastern Brazil aged 0-5 years who responded to an online questionnaire about sociodemographic data, dietary changes, oral hygiene, and oral health status of children during the COVID-19 pandemic. Results: Of the 119 parents/caregivers, 54.60% did not observe any changes in eating habits, and 81.50% maintained their children's oral hygiene. Associations were observed between the impact of the pandemic on the family income and changes in eating habits (p=0.02) and between lower family income and dental caries perceived by parents/caregivers (p=0.05). Z tests with Bonferroni correction showed that families with drastic income reduction were more likely to consume lower-cost foods (62.50%) than families with no impact or slight reduction on family income. Parents/caregivers did not identify dental caries (89.10%), toothache (92.40%), and dental trauma (92.40%) in their children. Conclusion: Parents/caregivers of children in southeastern Brazil aged 0-5 years observed behavioral changes in the dietary habits of families whose income was impacted by the pandemic, and their perception of dental caries was significantly associated with family income.

Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis

Abstract This review aimed to assess the association between overweight/obesity and dental caries in Brazilian children/adolescents. Searches were performed in the Web of Science, Scopus, Cochrane, PubMed, Embase and SciELO, Lilacs and Open Grey literature databases up to June 2022. The Joanna Briggs Institute checklist for analytical cross-sectional studies, the checklist for cohort studies, and the checklist for case-control studies were used. A total of 41 publications were included, and 15 meta-analyses were performed. The authors analyzed the differences in weighted mean difference (MD) and odds ratios (OR), and their corresponding confidence intervals (CI) (95%) for dental caries among eutrophic and obese and/or overweight children/adolescents. Meta-analyses showed that there was no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI (Body Mass Index). A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve (OR = 2.53, 95% CI;1.49-4.29; p = 0.0006; I2 = 0%) in dichotomous outcome studies, and (MD = 0.61, 95%CI: 0.08-1.15; p = 0.02; I2 = 0%) in continuous studies. The strength of the evidence of the results was classified as very low, low or moderate. It was concluded that there is no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI. A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve.

Traumatic dental injuries in children: experience during the Covid-19 pandemic and parents' knowledge about their management.

The social isolation measures adopted during the critical phase of the COVID-19 pandemic led children to spend most of their time at home. Isolation may alter the pattern of traumatic dental injury occurrences, inasmuch as studies point out that most traumatic accidents occur at home. Considering this scenario and the influence of emergency management on the prognosis of the injury, the aim of this study was to evaluate the experience of traumatic dental injuries in children before and during the pandemic, and the knowledge of this topic by the children's guardians. This cross-sectional study was conducted with guardians of children aged 0 to 6 years, residing in Juiz de Fora, MG, Brazil. The guardians answered an online questionnaire addressing personal information, traumatic dental injury experience before and during the pandemic, and knowledge of this topic. Descriptive and statistical analyses were performed using Pearson's chi-square test at a 5% significance level. The total sample consisted of 343 volunteers. A total of 95 and 92 injuries were reported before and during the pandemic, respectively; the home was the place of greatest occurrence. Most volunteers (88.1%) agreed that traumatic dental injuries are emergency situations, and were aware that the tooth/fragment had to be taken to the dentist after a fracture or avulsion (97.4%). This study revealed that the traumatic dental injury experience was similar before and during the pandemic, and that the volunteers had satisfactory knowledge, especially in recognizing the importance of immediate attention for a more favorable prognosis of these injuries.

Perceptions of Parents/Caregivers About the Impact of Oral Conditions on the Quality of Life of Children and Adolescents with Autism Spectrum Disorder.

PURPOSE: To investigate the perceptions of parents/caregivers about the impact of oral conditions on the oral health-related quality of life (OHRQoL) of children/adolescents with autism spectrum disorder (ASD) compared to the perceptions of parents/caregivers of children/adolescents without ASD. METHODS: A comparative cross-sectional study was conducted involving 80 children/adolescents with ASD three to 16 years of age matched by sex and age with 80 children/adolescents without ASD and their parents/caregivers. Clinical examinations were performed for the diagnosis of dental caries experience (DMFT/dmft), clinical consequences of untreated dental caries (PUFA/pufa), visible plaque (VPI), bleeding on probing (BPI), malocclusion and traumatic dental injury (TDI). Parents/caregivers answered a questionnaire addressing sociodemographic characteristics and the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ), which measures OHRQoL from the perspective of parents/caregivers. Data analysis involved the Wilcoxon test, chi-squared test and Poisson regression. RESULTS: Dental caries experience impacted OHRQoL in the group with ASD regarding the total P-CPQ score (p < 0.001) as well as the "oral symptoms" (p = 0.011) and "wellbeing" (p < 0.011) domains. No differences were found between the perceptions of parents/caregivers of children/adolescents with ASD and perceptions of parents/caregivers of children/adolescents without ASD (p = 0.721). CONCLUSION: Dental caries experience can have a negative impact on the OHRQoL of children/adolescents with ASD.

Oral health characteristics in children and adolescents with Down syndrome.

AIM: To compare oral health indicators of children/adolescents with Down syndrome (DS) with a group of children/adolescents without DS. METHODS AND RESULTS: This cross-sectional study included 144 individuals with DS, ages 4 to 18 years, matched for age and sex with a group of 144 individuals without DS, and their parents/caregivers. Parents/caregivers completed a questionnaire regarding sociodemographic information and habits related to their children's oral health. Clinical examination of the children/adolescents evaluated dental caries experience (DMFT/dmft), bleeding on periodontal probing, presence of visible plaque, clinical consequences of untreated dental caries (PUFA/pufa), and malocclusion (DAI). The chi-square test, linear by linear test, and Mann-Whitney test were used to compare the variables between the groups (p < .05). Children/adolescents without DS brushed their teeth more times per day (p < .001) and had a higher frequency of daily sugar intake (p < .001). The children/adolescents in the DS group had a greater presence of gingival bleeding (p < .001) and had a greater number of cases of "severe malocclusion" and "very severe malocclusion" (p = .001). No difference was found in the prevalence of dental caries between the two groups. CONCLUSION: The children/adolescents in the DS group had a greater presence of gingival bleeding during the clinical examination and had a greater need for orthodontic treatment.

Traumatic dental injuries in children: experience during the Covid-19 pandemic and parents' knowledge about their management

Abstract The social isolation measures adopted during the critical phase of the COVID-19 pandemic led children to spend most of their time at home. Isolation may alter the pattern of traumatic dental injury occurrences, inasmuch as studies point out that most traumatic accidents occur at home. Considering this scenario and the influence of emergency management on the prognosis of the injury, the aim of this study was to evaluate the experience of traumatic dental injuries in children before and during the pandemic, and the knowledge of this topic by the children's guardians. This cross-sectional study was conducted with guardians of children aged 0 to 6 years, residing in Juiz de Fora, MG, Brazil. The guardians answered an online questionnaire addressing personal information, traumatic dental injury experience before and during the pandemic, and knowledge of this topic. Descriptive and statistical analyses were performed using Pearson's chi-square test at a 5% significance level. The total sample consisted of 343 volunteers. A total of 95 and 92 injuries were reported before and during the pandemic, respectively; the home was the place of greatest occurrence. Most volunteers (88.1%) agreed that traumatic dental injuries are emergency situations, and were aware that the tooth/fragment had to be taken to the dentist after a fracture or avulsion (97.4%). This study revealed that the traumatic dental injury experience was similar before and during the pandemic, and that the volunteers had satisfactory knowledge, especially in recognizing the importance of immediate attention for a more favorable prognosis of these injuries.

Occurrence of Dental Trauma in a Group of Children with Autistic Spectrum Disorder

ABSTRACT Objective: To assess the occurrence of dental trauma in a group of children with Autistic Spectrum Disorder (ASD) in comparison to children without the disorder. Material and Methods: This is a cross-sectional study conducted at the Department of Children and Adolescents Health in the Department of Health of Juiz de Fora, Brazil. The study included individuals with and without ASD, between three and 16 years old, and their parents/caregivers. Children/adolescents were assessed for dental trauma by clinical examination. All exams were performed by a trained and calibrated examiner (MCT), and intra-examiner reliability was previously established (Kappa=0.93). The Socio-demographic status was reported by parents/caregivers. Data analysis included descriptive statistics and generation of frequency distributions. Fisher's exact test was used to evaluate the association between groups of children/adolescents with and without ASD about the presence of dental trauma. The significance level was set at p < 0.05. Results: Sixty children of both sexes participated in the study, thirty with a diagnosis of ASD and thirty without. The age ranging from 3 to 13 years, with an average of 7.5 ± 3.2 years. Children with ASD had a higher frequency of dental trauma than children without ASD (p=0.02), and the most frequent type of trauma was enamel fracture (57.10%), followed by enamel/dentin fracture without pulp exposure (42.90%). Conclusion: Children with ASD, when compared to children who did not have ASD, had a higher occurrence of dental trauma.

Early Childhood Caries Experience of Children from Poor Families Living Below and Above Poverty Line

ABSTRACT Objective: To evaluate the role of poverty and its related factors on early childhood caries (ECC) experience among deprived children. Material and Methods: This population-based cross-sectional study surveyed 418 children aged one to six years enrolled in Brazilian public preschools from an area of the country known for its high social deprivation. Intraoral examination of children evaluated dental caries experience (dmft). Parents/caregivers answered a questionnaire with sociodemographic indicators. Family income was dichotomized into below or above poverty line. Data analysis used Chi-square test, Mann-Whitney test, and Multivariate Logistic Regression analysis (p<0.05). Results: Predisposing variables for an increased chance of ECC were: age group 3-4 years (OR: 4.89; 95% CI: 2.32-10.31), age group 5-6-years (OR: 5.60; 95% CI: 2.60-12.04), being part of families living below poverty line (OR: 1.88; 95% CI: 1.04-3.38) and having mothers with less than nine years of schooling (OR: 2.86; 95% CI: 2.77-7.14). Children from families living below poverty line presented higher dmft (2.9 +3.8; p=0.001) and untreated dental caries (d component) (2.7 +3.7; p=0.002). Conclusion: ECC in a poor population was influenced by indicators of social deprivation. The poorest of poor children from mothers with less years of schooling were at higher risk.

Association Between Dental Caries Experience and Socioeconomic Determinants on Oral Health-Related Quality of Life among Children and their Families

ABSTRACT Objective: To assess the association between dental caries experience, severe dental caries experience and socioeconomic determinants on oral health-related quality of life among children and their families. Material and Methods: This is a cross-sectional study whose sample was composed of children aged 4-12 years, who sought dental care in a dentistry school clinic, and their parents/caregivers. Dental caries experience and severe dental caries experience were assessed according to the DMF-T/dmf-t indexes. Parents/caregivers answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ), the Family Impact Scale (FIS) and a questionnaire on socioeconomic and demographic conditions. Data analysis included the chi-square test and Poisson regression (PR). Results: The sample was composed of 105 children and their parents/caregivers. Severe dental caries experience in children was determinant for negative perception of children's OHRQoL by parents/caregivers (PR = 1.22; CI = 1.05-1.41). Negative impact on OHRQoL perceived by family members was determined by severe dental caries experience in children (PR = 1.22; CI = 1.05-1.42) and family income <5 minimum wage (PR = 1.32; CI = 1.08-1.61). Conclusion: Severe dental caries experience was associated with a negative impact on OHRQoL perceived by children and their families. Low family income was associated with a negative impact on the OHRQoL perceived by children and their families.

Caregivers' Perception of Oral Health-Related Quality of Life of Individuals with Down Syndrome.

Purpose: To evaluate the perception of caregivers of individuals with Down syndrome (DS) regarding the impact of oral conditions on their children's oral health-related quality of life (OHRQoL) and compare with the perception of caregivers of children without DS.
Methods: This is a comparative cross-sectional study. Participants were 144 four- to 18-year-old children with DS, matched by sex and age with a group without DS, and their caregivers. The children were assessed for dental caries experience, clinical consequences of untreated dental caries, gingival bleeding, visible plaque, and malocclusion. Caregivers answered a questionnaire on sociodemographic conditions and completed the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Data analysis included the Wilcoxon test, chi-square test, and Poisson regression (PR).
Results: Caregivers of individuals with DS presented more negative perceptions of their children's OHRQoL in the functional limitations domain (P<0.01) and in the total P-CPQ score (P=0.02). The determining factors were clinical consequences of untreated dental caries (PR=1.72; 95 percent confidence interval [95% CI]=1.04 to 2.84) and visible plaque (PR=1.48; 95% CI=1.08 to 2.03).
Conclusion: Caregivers of individuals with DS presented more negative perceptions of the impact of oral conditions on their children's OHRQoL. Clinical consequences of untreated dental caries and visible plaque were the determining factors with the greatest impact on the perception of their children's OHRQoL.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis.

Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.

Classification of the midpalatal suture maturation in individuals older than 15 years: a cone beam computed tomographic study.

PURPOSE: The aim of this study was to classify the maturation of the midpalatal suture (MPS) in a sample of individuals aged 15 years and older. METHODS: Tomographic images in axial sections of the MPS of 289 female individuals and 198 male individuals aged between 15 and 40 years were analyzed and classified in stages of maturation (A, B, C, D, and E), stage A represents the earliest maturation stage of the suture and in stage E the fusion of the MPS has occurred in the maxilla. The Kruskal-Wallis and Student-Newman-Kells tests were used to compare the chronological ages among different maturation stages. Spearman's correlation coefficient was used to assess the correlation between patient's age and the maturation stages of the MPS. RESULTS: Stage A was not observed in the sample. Stages B and C represent, respectively, 1.03% and 34.09% of the sample, stage D was found in 16.63% of the sample while stage E was the most prevalent stage found (48.25%). For females, it was revealed no statistically significant difference in the mean ages among stages C, D and E (p = 0.4753). For males, a statistically significant difference was observed, with the mean age of individuals in stages D and E of the MPS maturation higher than in other stages (p = 0.0001). There was a significant, but weak, correlation between patient's age and the maturation stages of the suture (rs = 0.11/p = 0.01). CONCLUSION: No individuals in stage A of suture maturation were found and stage B was identified in only 1% of the sample. The majority of the patients (64.88%) presented at least partial fusion of the MPS (stages D and E).

Panoramic versus CBCT used to reduce inferior alveolar nerve paresthesia after third molar extractions: a systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review was to verify whether CBCT in comparison with panoramic radiography reduced the cases of temporary paresthesias of the inferior alveolar nerve (IAN) associated with third molar extractions. METHODS: The literature search included five databases (PubMed, Scopus, Web of Science, Cochrane, SciELO), in addition to gray literature and hand search of reference list of included studies. Two reviewers independently screened titles/abstracts, and full texts according to eligibility criteria, extracted data and evaluated risk of bias through Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2.0). Data were meta-analyzed by comparing CBCT versus panoramic radiographs for number of events (temporary paresthesia after third molar surgery). Fixed effect model was used for non-significant heterogeneity; relative risk (RR) and 95% CI were calculated. The certainty of evidence was evaluated by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS: Four randomized controlled trials (RCTs) were included in meta-analysis, and for the majority of domains they presented low risk of bias. RR was 1.23 (95% IC: 0.75-2.02; I2: 0%; p = 0.43) favouring panoramic radiography, but without significant effect, and with moderate certainty of evidence. CONCLUSIONS: We concluded that both interventions had a similar ability to reduce temporary paresthesia of the IAN after third molar surgery with moderate certainty of evidence.

Impact of oral conditions of children/adolescents with Down syndrome on their families' quality of life.

AIMS: To assess the impact of oral conditions among children/adolescents with Down syndrome (DS) on the Oral Health-related Quality of Life (OHRQoL) of their families in comparison with a group without DS. METHODS AND RESULTS: Families of 144 children/adolescents with DS aged 4-18 years were compared with families of individuals without DS. Dental caries experience (DMFT/dmft), clinical consequences of untreated dental caries (PUFA/pufa), gingival bleeding (GBI), visible plaque (VPI), and malocclusion were evaluated. Parents/caregivers answered the Family Impact Scale (FIS) and questionnaires on sociodemographic conditions and the health of children/adolescents. Data analysis included chi-square test and Poisson regression. There was no difference between groups regarding the impact of the children's/adolescents' oral condition on their families' OHRQoL for all domains and the total FIS score (P > 0.05). A negative impact on the OHRQoL of families of children/adolescents with DS was determined by dental caries (PR = 3.95, CI = 2.09-7.46), clinical consequences of untreated dental caries (PR = 1.83, CI = 1.18-2.84), defined malocclusion (PR = 2.75, CI = 1.23-6.13), and severe malocclusion (PR = 2.82, CI = 1.02-7.74). CONCLUSION: There is no difference on the OHRQoL of families of children/adolescents with and without DS. Dental caries experience, clinical consequences of untreated dental caries, defined malocclusion, and severe malocclusion determined the negative impact on the OHRQoL of families of children/adolescents with DS.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis

Abstract Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.

Association between bruxism and temporomandibular disorders in children: A systematic review and meta-analysis.

BACKGROUND: Bruxism in children and its relation to the development of temporomandibular disorders (TMD) has not been clearly determined yet. AIM: The objective of this systematic review was to evaluate the possible association between bruxism and TMD in children. DESIGN: Seven databases were searched, and 497 articles were assessed. Methodological quality was assessed through Newcastle-Ottawa Scale. The meta-analysis was performed with the articles in which extraction of data was possible and the summary effect measure through odds ratio (OR) and respective 95% confidence intervals (CIs). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. RESULTS: Ten cross-sectional studies were included in the systematic review. Of these, 8 showed a statistically significant association between bruxism and TMD. Seven studies however presented a high risk of bias. The meta-analysis was performed with 3 articles and obtained an OR of 2.97 (95% CI ranging from 1.72-5.15), indicating that children with bruxism are 2.97 times more likely to present TMD, with very low level of certainty defined by GRADE. CONCLUSIONS: Although the studies showed high risk of bias, the qualitative analysis of individual studies showed that the children with bruxism have greater chance of developing TMD.

Perception of parents/caregivers on the oral health of children/adolescents with Down syndrome.

INTRODUCTION: Oral health affects the general health of people with Down syndrome (DS), with repercussions on their ability to chew and to communicate. OBJECTIVE: To evaluate the influence of sociodemographic characteristics and clinical indicators on the perceptions of parents/caregivers regarding the oral health of individuals with DS. METHODS: Parents/caregivers completed a questionnaire containing sociodemographic information and answered the 20 questions of the Brazilian version of the Oral Health Scale for People with DS. Intra-oral clinical exam of children/adolescents was performed to assess dental caries, periodontal disease, and malocclusion. Descriptive statistics, bivariate analyses, and Poisson regression model analyses were carried out. RESULTS: In this study, 55.1% of the parents/caregivers showed a positive perception regarding the oral health of their children/adolescents. Parents/caregivers of individuals between 4 and 9 years old (Prevalence Ratio (PR) = 1.13; Confidence Interval (CI), 1.04 - 1.23; p = 0.003) and parents/caregivers of those with definite malocclusion (PR = 1.14; CI, 1.00 - 1.31; p = 0.047) had a higher prevalence of reporting a more negative perception of their children's/adolescents' oral health. CONCLUSION: DS individuals' age and the severity of malocclusion were indicators of a more negative perception of parents/caregivers regarding their sons'/daughters' oral health.

Periodontal disease in patients with Down syndrome: A systematic review.

BACKGROUND: The authors systematically reviewed the scientific evidence of an association between periodontal disease and Down syndrome (DS). TYPES OF STUDIES REVIEWED: In this systematic review, the authors included observational studies in which the investigators assessed the prevalence, incidence, or experience of periodontal disease in patients with DS compared with that in healthy patients. The authors used the Population, Exposure, Comparison, Outcome structure. The population was patients of any age, the exposure was the presence of DS, the comparison was the absence of DS, and the outcome was the presence of periodontal disease. The authors conducted an electronic search in 5 databases through March 2017. Two independent reviewers assessed the risk of bias by using the Fowkes and Fulton scale. The authors performed a meta-analysis to compare periodontal disease among patients with DS and those without DS. The authors calculated a summary effect measure-standard mean difference-when evaluating the means of the oral hygiene index. The authors assessed the strength of evidence from the selected studies by using a modified Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The authors included 23 case-control studies in the systematic review and submitted 3 to meta-analysis. In the qualitative analysis, results from most studies showed that the prevalence of some periodontal parameters was higher among patients with DS than among those without DS. Evaluations of the Fowkes and Fulton scale point to many methodological problems in the studies evaluated. Results of the meta-analysis revealed no differences between groups with regard to the oral hygiene index (standard mean difference, 0.05; 95% confidence interval, -0.55 to 0.65; I2 = 0.0%). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Further research is required, in particular well-designed studies that avoid the deficiencies identified in the studies in this review.

Relationship Between Salivary Cortisol Levels and Children's Behavior During a Dental Examination.

PURPOSE: To correlate the salivary cortisol levels in children attending a university dental clinic with their behavior during the dental appointment. METHODS: A prospective study was conducted with 43 seven- to 10-year-old children whose behavior during the dental appointment was assessed using the Frankl scale. Participants were divided into two groups: (1) cooperative children; and (2) uncooperative children. All children had four saliva samples collected as follows: prior to the dental examination (S1); shortly after the dental examination (S2); 30 minutes after waking up in the morning after the day of the appointment (S3); and in the afternoon, 24 hours after the dental appointment (S4). Salivary cortisol levels were measured by the chemiluminescent assay method. Statistical analysis included the Friedman and the Wilcoxon signed rank tests. RESULTS: For the cooperative group, salivary cortisol levels were significantly lower at S1 (P=0.004), S2 (P=0.006), and S4 (P=0.001) compared to S3. For the uncooperative group, salivary cortisol levels were significantly higher at S1 compared to S2 (P=0.005). CONCLUSIONS: Uncooperative children presented high levels of salivary cortisol prior to and shortly after the dental appointment. The period anticipating the consultation was considered highly stressful.