Immunohistochemistry of resorption and inflammation factors in the periodontal ligament of human deciduous teeth.

The understanding of the biological mechanisms involved in root resorption in deciduous teeth is important to the future development of preventive measures and treatments of this condition. The aim of the present study was to compare the expression and immunostaining of iNOS, MMP-9, OPG and RANKL in the periodontal ligament (PDL) of deciduous teeth with physiologic root resorption (GI), inflammatory pathological root resorption (GII) and permanent teeth (GIII), the negative control. Teeth in GI (n = 10), GII (n = 10) and (GIII) (n = 10) were submitted to immunohistochemical analysis to determine the expression of iNOS, MMP-9, OPG, and RANKL. The immunostaining was analysed by optical density. Statistical analysis included one-way ANOVA, followed by Student-Newman-Keuls post hoc test (p < 0.05). The results showed that iNOS, MMP-9 and RANKL expression in the PDL was higher in GII compared to GI and GIII (p < 0.05). Moreover, RANKL expression was higher in GI compared to GIII (p < 0.001), while OPG immunolabelling was lower in GII compared to GI and GIII (p < 0.001). The PDL of deciduous teeth bearing inflammatory processed exhibited upregulation of resorption-associated factors as well as enzymes related to tissue degradation which, in turn explains the exacerbation and greater susceptibility of those teeth to root resorption process.

Prevalence of malocclusion in public school students in the mixed dentition phase and its association with early loss of deciduous teeth.

OBJECTIVE: To determine the prevalence of malocclusion and its association with the early loss of deciduous teeth and other factors in children in the mixed dentition phase, aged six to eight years, enrolled in public schools in southern Brazil. METHODS: A cross-sectional study was conducted with a representative sample of 528 children from municipal public schools in 2009. Data collection involved a clinical examination for the determination of early tooth loss, dental caries, tongue pressure and malocclusion (outcome), as well as the administration of a questionnaire. Poisson regression analysis with robust variance was used to model the association between malocclusion and the independent variables. RESULTS: The prevalence of malocclusion and early tooth loss was 69.1% and 21.8%, respectively. In the raw data analysis, malocclusion was associated with age, early tooth loss, dental caries and tongue pressure. After the adjustment, the likelihood of malocclusion was greater among children older than eight years, those who exerted tongue pressure on the teeth and those with early tooth loss. The likelihood of malocclusion was 24% greater among children with early tooth loss, compared to those without tooth loss. CONCLUSION: The early loss of deciduous teeth was associated with the occurrence of malocclusion in the children studied.

Prevalence of malocclusion in public school students in the mixed dentition phase and its association with early loss of deciduous teeth

ABSTRACT Objective: To determine the prevalence of malocclusion and its association with the early loss of deciduous teeth and other factors in children in the mixed dentition phase, aged six to eight years, enrolled in public schools in southern Brazil. Methods: A cross-sectional study was conducted with a representative sample of 528 children from municipal public schools in 2009. Data collection involved a clinical examination for the determination of early tooth loss, dental caries, tongue pressure and malocclusion (outcome), as well as the administration of a questionnaire. Poisson regression analysis with robust variance was used to model the association between malocclusion and the independent variables. Results: The prevalence of malocclusion and early tooth loss was 69.1% and 21.8%, respectively. In the raw data analysis, malocclusion was associated with age, early tooth loss, dental caries and tongue pressure. After the adjustment, the likelihood of malocclusion was greater among children older than eight years, those who exerted tongue pressure on the teeth and those with early tooth loss. The likelihood of malocclusion was 24% greater among children with early tooth loss, compared to those without tooth loss. Conclusion: The early loss of deciduous teeth was associated with the occurrence of malocclusion in the children studied.

RESUMO Objetivo: Determinar a prevalência de má oclusão em crianças de seis a oito anos de idade no município de Florianópolis (Santa Catarina, Brasil), e a sua associação com a perda precoce de dentes decíduos. Métodos: Esse estudo transversal avaliou uma amostra representativa de 528 crianças de escolas públicas municipais de Florianópolis, no ano de 2009. Os dados foram coletados por meio de exame clínico (perda dentária precoce, cárie dentária, interposição lingual e má oclusão - que foi o desfecho do estudo) e de um questionário. A regressão de Poisson com variância robusta foi utilizada para modelar a associação entre má oclusão e as variáveis independentes. Resultados: A prevalência de má oclusão e de perda dentária precoce foi, respectivamente, de 66,7% e 21,8%. Na análise dos dados brutos, a má oclusão foi associada com a idade, perda dentária precoce e cárie dentária. Após ser feito o ajuste, crianças com mais de 7 anos, com interposição lingual e perda dentária precoce apresentaram maior probabilidade de ter má oclusão. Crianças com perda dentária precoce apresentaram probabilidade 24% maior de ter má oclusão do que aquelas sem perda dentária. Conclusões: A perda precoce de dentes decíduos foi associada à ocorrência de má oclusão nas crianças estudadas.

Immunohistochemistry of resorption and inflammation factors in the periodontal ligament of human deciduous teeth

Abstract: The understanding of the biological mechanisms involved in root resorption in deciduous teeth is important to the future development of preventive measures and treatments of this condition. The aim of the present study was to compare the expression and immunostaining of iNOS, MMP-9, OPG and RANKL in the periodontal ligament (PDL) of deciduous teeth with physiologic root resorption (GI), inflammatory pathological root resorption (GII) and permanent teeth (GIII), the negative control. Teeth in GI (n = 10), GII (n = 10) and (GIII) (n = 10) were submitted to immunohistochemical analysis to determine the expression of iNOS, MMP-9, OPG, and RANKL. The immunostaining was analysed by optical density. Statistical analysis included one-way ANOVA, followed by Student-Newman-Keuls post hoc test (p < 0.05). The results showed that iNOS, MMP-9 and RANKL expression in the PDL was higher in GII compared to GI and GIII (p < 0.05). Moreover, RANKL expression was higher in GI compared to GIII (p < 0.001), while OPG immunolabelling was lower in GII compared to GI and GIII (p < 0.001). The PDL of deciduous teeth bearing inflammatory processed exhibited upregulation of resorption-associated factors as well as enzymes related to tissue degradation which, in turn explains the exacerbation and greater susceptibility of those teeth to root resorption process.

Association between crack cocaine use and dental caries experience: a cross-sectional study in southern Brazil.

The aim of the present study was to compare the prevalence of dental caries between crack cocaine users and a control group. The study included 106 participants in each group matched for age, sex, and exposure to tobacco. Crack cocaine users were selected from institutions for the treatment of chemical dependency, and the control group was recruited from a public school and among patients who sought dental care. A calibrated examiner determined dental caries experience [Decayed, Missing and Filled Teeth (DMFT) index]. The severity of tooth decay was determined using the Significant Caries Index (SiC). The prevalence of dental caries (DMFT ≥ 1) was 96.2 and 81.1% among the crack cocaine users and nonusers, respectively. Crack users had higher mean DMFT values (7.16 versus 4.92) for the decayed and missing components as well as a higher percentage of individuals with highly severe caries compared to nonusers. After the adjustments in the multivariate model, the prevalence of caries was 18% higher among the crack users (prevalence ratio: 1.18; 95% confidence interval: 1.08-1.30). Age, family income, crack cocaine use, and dental calculus were associated with the occurrence of dental caries. In conclusion, the prevalence of caries was higher among the crack users compared with the control group and remained associated with dental caries in the multivariate analysis.

Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis.

OBJECTIVE: Determine the association between breastfeeding and the development of mouth breathing in children. MATERIALS AND METHODS: Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding. RESULTS: The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18). CONCLUSIONS: Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern. CLINICAL RELEVANCE: The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding. TRIAL REGISTRATION: PROSPERO registry: CRD42017062172.

Apoia: protótipo para aplicativo móvel de apoio social à gestação / Supports: prototype for mobile application of social support to pregnancy / Apoia: prototipo para aplicación de apoyo social móvil al embarazo

Objetivo: elaborar um protótipo para um aplicativo móvel a fim de ampliar a disponibilidade de apoio social para as gestantes. Método: trata-se de um estudo misto, tipo transversal, realizado com gestantes usuárias da atenção básica à saúde de unidades vinculadas ao Sistema Único de Saúde (SUS). Elaborou-se, a partir dos resultados obtidos na pesquisa, um protótipo para aplicativo móvel no modelo SCRUM para sistema operacional Android. Resultados: nominou-se o protótipo de Apoia. Revelam-se as funcionalidades do Apoia de proporcionar a interação entre a gestante e as pessoas por ela escolhidas para comporem a rede social, possibilitar a troca de mensagens de apoio, resgatar a disponibilidade das pessoas em oferecer ajuda, assessorando, dessas formas, a mulher grávida no processo de viabilização do apoio social. Conclusão: acredita-se que o Apoia é um recurso inovador, com o intuito de construir e ampliar o apoio social para gestantes usuárias a partir da construção e flexibilização da rede social com o uso das tecnologias da informação e comunicação na saúde.(AU)

Objective: to develop a prototype for a mobile application in order to increase the availability of social support for pregnant women. Method: this is a cross-sectional, mixed study conducted with pregnant women who use basic health care in units linked to the Unified Health System (UHS). Based on the results obtained in the research, a prototype for a mobile application in the SCRUM model for the Android operating system was elaborated. Results: the prototype of Apoia was named. The functionalities of Apoia are revealed: to provide interaction between the pregnant woman and the people she has chosen to make up the social network, to enable the exchange of support messages, to rescue people's willingness to offer help, thus assisting the pregnant woman in the process of making social support possible. Conclusion: It is believed that Apoia is an innovative resource, with the aim of building and expanding social support for pregnant users from the construction and flexibility of the social network with the use of information and communication technologies in health.(AU)

Objetivo: desarrollar un prototipo de aplicación móvil con el fin de aumentar la disponibilidad de apoyo social para mujeres embarazadas. Método: se trata de un estudio mixto, transversal, realizado con mujeres embarazadas usuarias de atención primaria de salud en unidades vinculadas al Sistema Único de Salud (SUS). A partir de los resultados obtenidos en la investigación se elaboró un prototipo de aplicación móvil en el modelo SCRUM para sistema operativo Android. Resultados: se nombró el prototipo de Apoia. Las características de Apoia se revelan para brindar interacción entre la gestante y las personas elegidas por ella para componer la red social, posibilitar el intercambio de mensajes de apoyo, rescatar la disponibilidad de personas para ofrecer ayuda, asesorando así a la mujer. embarazada en el proceso de habilitar el apoyo social. Conclusión: se cree que Apoia es un recurso innovador, con el objetivo de construir y ampliar el apoyo social a usuarias embarazadas desde la construcción y flexibilización de la red social con el uso de tecnologías de la información y la comunicación en salud. (AU)

Use of crack cocaine increases tooth loss.

PURPOSE: To evaluate the occurrence of tooth loss among crack cocaine users. METHODS: A cross-sectional study was conducted with 106 crack cocaine users and 106 controls matched for age, gender, and tobacco use. Data were collected on socio-demographic characteristics, drug use, use of dental services, dental caries, periodontal disease, and the outcome (tooth loss). RESULTS: Crack cocaine users had a greater frequency of tooth loss (55.7% vs. 36.8%), severity of dental caries and periodontal disease and less use of dental services than the controls (P< 0.05). After adjustments, tooth loss was 46% more frequent among crack cocaine users (PR= 1.46; 95%, CI: 1.10-1.93) as well as significantly more frequent among non-whites, those older than 24 years of age and those with high dental caries severity. Occurrence of tooth loss was significantly higher among crack cocaine users. These findings can contribute to the planning and implementation of prevention strategies and oral health care for individuals with a chemical dependence. CLINICAL SIGNIFICANCE: The use of crack cocaine had a negative impact on the oral health of its users, leading to tooth loss and a greater severity of dental caries. These findings should be considered when planning prevention strategies to improve oral health in individuals addicted to crack cocaine.

Nível socioeconômico, saúde bucal e fatores associados no suporte social de gestantes: estudo transversal / Socioeconomic level, oral health, and associated factors in the social support of pregnant women: a cross-sectional study

Avaliar a associação entre variáveis socioeconômicas e relacionadas a saúde bucal no suporte social percebido por gestantes. Esse estudo transversal incluiu uma amostra obtida em conglomerados de gestantes atendidas no serviço público de saúde no sul do Brasil. As gestantes responderam questionários acerca de características demográficas, socioeconômicas e relacionadas à saúde bucal. O suporte social foi avaliado através da escala Medical Outcomes Study. As variáveis clínicas incluíram cárie dentária não tratada e sangramento gengival. Análise de Regressão de Poisson em multinível foram utilizados para avaliar a influência dos preditores no suporte social. A amostra foi composta por254 gestantes. Gestantes com pior autopercepção de saúde bucal, níveis extensivos de sangramento gengival e com menor nível socioeconômico apresentaram um pior suporte social. Fatores socioeconômicos e relacionados à saúde bucal exerceram impacto no suporte social percebido por gestantes.

To evaluate the association between socioeconomic and oral health-related variables in the social support perceived by pregnant women. This cross-sectional study included a sample obtained from clusters of pregnant women who attended public health services in southern Brazil. The pregnant women answered questionnaires about demographic, socioeconomic, and oral health characteristics. Social support was assessed using the Medical Outcomes Study scale. Clinical variables included untreated dental caries and gingival bleeding. Multilevel Poisson regression analysis was used to assess the influence of predictors on social support. The sample consisted of 254 pregnant women. Those with poorer self-perceived oral health, extensive levels of gingival bleeding, and lower socioeconomic status, presented poor social support. Socioeconomic factors and factors related to oral health had an impact on the social support perceived by pregnant women.

Prevalence of Alcohol and Tobacco Use and Perceptions Regarding Prenatal Care among Pregnant Brazilian Women, 2017 to 2018: A Mixed-Methods Study.

OBJECTIVE: To identify the prevalence of alcohol and tobacco drug use among pregnant women and investigate their perceptions regarding advice from health professionals during prenatal care. METHOD: We used a sequential explanatory mixed-methods design for this cross-sectional study; the study period was January 2017 to December 2018. Multistage random sampling resulted in the selection of 255 pregnant women assisted in primary care units and through the Family Health Strategy in a city in southern Brazil. Trained interviewers collected data on the use of alcohol and tobacco drugs and socioeconomic characteristics via a questionnaire. Qualitative interviews were performed with pregnant women identified as alcohol and tobacco drug users in the quantitative phase. Interviews proceeded consecutively until saturation was reached, followed by a thematic analysis of interview content based on Braun and Clarke. RESULTS: The prevalence of smoking and alcohol use was 12.55% and 14.12%, respectively. From the 14 interviews conducted, five categories emerged from the discourses: prenatal care from the perspective of pregnant women, habits and knowledge regarding smoking during pregnancy, habits and knowledge regarding alcohol use during pregnancy, previous experiences and empirical knowledge, and pregnant women's preferences for talking about their habits. CONCLUSION FOR PRACTICE: Study findings identified smoking and alcohol use as habits among some women during pregnancy and, consequently, the need for improving care because of their superficial knowledge regarding tobacco and alcohol use. The findings underscore the importance of strengthening measures and establishing new strategies that ensure women's understanding, empowerment, and choices-from the beginning of childbearing age-regarding habits during pregnancy.

Upright positions in childbirth and the prevention of perineal lacerations: a systematic review and meta-analysis. / Posições verticalizadas no parto e a prevenção de lacerações perineais: revisão sistemática e metanálise.

OBJECTIVE: To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position. METHOD: A systematic review with meta-analysis. The searches were carried out in the databases: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct and Scopus. Searches in the gray literature were conducted on Google Scholar and OpenGrey databases. Reference lists of included articles were also considered. The Cochrane collaboration tool and ACROBAT-NRSI were used to analyze the methodological quality of the articles. RESULTS: There were 26 studies listed and 8 were selected for the meta-analysis. The level of scientific evidence was classified by the GRADE System and considered high. There was no statistically significant difference between upright positions in relation to horizontal positions. Despite this finding, the upright positions showed reduced rates of severe perineal lacerations. CONCLUSION: Adopting upright positions in normal delivery can be encouraged by professionals as it can prevent severe perineal lacerations; however, it is not possible to accurately affirm their effectiveness to the detriment of horizontal positions for an intact perineum outcome.

Access and use of dental services by pregnant women: an integrative literature review. / Acesso e utilização de serviços odontológicos por gestantes: revisão integrativa de literatura.

The objective of this article is to identify the scientific productions on the access and use of dental services by pregnant women. A search was carried out on the BVS and MEDLINE/PubMed online databases to produce this integrative literature review. In the BVS database, the Portuguese descriptors were: "acesso aos serviços de saúde", "saúde bucal" and "gestantes", and in PubMed: "Health services accessibility", "oral health" and "pregnant women", all associated with each other by the Boolean operator "AND". We identified five studies that met the inclusion and exclusion criteria and were systematized into two empirical and co-related categories: the significant number of pregnant women who do not perform prenatal dental care and the importance of educational measures that signal the need to receive dental care during prenatal visits. Further studies on the subject are required to support public health policies that consider this theme. Existing research shows low adherence to prenatal dental care and that the main factors hindering the access to and use of dental services were related to socioeconomic, cultural and educational aspects.

O objetivo deste artigo é identificar as produções científicas sobre o acesso e utilização de serviços odontológicos por gestantes. Foi realizada uma revisão integrativa de literatura com busca nas bases de dados BVS e MEDLINE/PubMed. Na base BVS os descritores foram: "acesso aos serviços de saúde", "saúde bucal" e "gestantes", e na PubMed: "Health services accessibility", "oral health" e "pregnant women", associados entre si pelo operador booleano AND. Foram encontrados cinco estudos que preencheram os critérios de inclusão e exclusão, sendo sistematizados em duas categorias empiricas e co-relacionadas: número expressivo de gestantes que não realizam o pré-natal odontológico e importância de medidas educativas que sinalizem a necessidade de receberem acompanhamento odontológico durante as consultas de pré-natal. Existe a necessidade de mais estudos, para embasar políticas de saúde pública que contemplem esta temática. As pesquisas existentes demonstram baixa adesão ao pré-natal odontológico e que os principais fatores observados como complicadores do acesso e utilização dos serviços odontológicos foram os relacionados aos aspectos socioeconômicos, culturais e educacionais.

Acesso e utilização de serviços odontológicos por gestantes: revisão integrativa de literatura / Access and use of dental services by pregnant women: an integrative literature review

Resumo O objetivo deste artigo é identificar as produções científicas sobre o acesso e utilização de serviços odontológicos por gestantes. Foi realizada uma revisão integrativa de literatura com busca nas bases de dados BVS e MEDLINE/PubMed. Na base BVS os descritores foram: "acesso aos serviços de saúde", "saúde bucal" e "gestantes", e na PubMed: "Health services accessibility", "oral health" e "pregnant women", associados entre si pelo operador booleano AND. Foram encontrados cinco estudos que preencheram os critérios de inclusão e exclusão, sendo sistematizados em duas categorias empiricas e co-relacionadas: número expressivo de gestantes que não realizam o pré-natal odontológico e importância de medidas educativas que sinalizem a necessidade de receberem acompanhamento odontológico durante as consultas de pré-natal. Existe a necessidade de mais estudos, para embasar políticas de saúde pública que contemplem esta temática. As pesquisas existentes demonstram baixa adesão ao pré-natal odontológico e que os principais fatores observados como complicadores do acesso e utilização dos serviços odontológicos foram os relacionados aos aspectos socioeconômicos, culturais e educacionais.

Abstract The objective of this article is to identify the scientific productions on the access and use of dental services by pregnant women. A search was carried out on the BVS and MEDLINE/PubMed online databases to produce this integrative literature review. In the BVS database, the Portuguese descriptors were: "acesso aos serviços de saúde", "saúde bucal" and "gestantes", and in PubMed: "Health services accessibility", "oral health" and "pregnant women", all associated with each other by the Boolean operator "AND". We identified five studies that met the inclusion and exclusion criteria and were systematized into two empirical and co-related categories: the significant number of pregnant women who do not perform prenatal dental care and the importance of educational measures that signal the need to receive dental care during prenatal visits. Further studies on the subject are required to support public health policies that consider this theme. Existing research shows low adherence to prenatal dental care and that the main factors hindering the access to and use of dental services were related to socioeconomic, cultural and educational aspects.

Posições verticalizadas no parto e a prevenção de lacerações perineais: revisão sistemática e metanálise / Posiciones verticales en el parto y prevención de laceraciones perineales: revisión sistemática y metaanálisis / Upright positions in childbirth and the prevention of perineal lacerations: a systematic review and meta-analysis

RESUMO Objetivo Investigar se a adoção de posições verticalizadas pela mulher, no parto, comparada à posição litotômica, previne lacerações perineais. Método Revisão sistemática com metanálise. As buscas foram realizada nas bases de dados: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct e Scopus. As buscas na literatura cinzenta foram conduzidas nas bases Google Scholar e OpenGrey. Também foram consideradas as listas de referências dos artigos incluídos. Para análise da qualidade metodológica dos artigos, utilizou-se a ferramenta da colaboração Cochrane e a ACROBAT-NRSI. Resultados Foram elencados 26 estudos e 8 foram selecionados para a metanálise. O nível de evidência científica foi classificado pelo Sistema GRADE e considerado alto. Não houve diferença estatística significativa entre posições verticalizadas em relação as posições horizontais. Apesar dessa constatação, as posições verticalizadas apresentaram índices reduzidos de lacerações perineais graves. Conclusão A adoção de posições verticalizadas, no parto normal, pode ser encorajada pelos profissionais, pois pode evitar lacerações perineais graves, porém, não é possível afirmar com precisão a eficácia destas em detrimento das posições horizontais para o desfecho períneo íntegro.

RESUMEN Objetivo Investigar si la adopción de posiciones verticales por parte de la mujer en el parto, en comparación con la posición de litotomía, previene las laceraciones perineales. Método Revisión sistemática con metaanálisis. Se realizaron búsquedas en las siguientes bases de datos: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct y Scopus. Se realizaron búsquedas en la literatura gris en las bases de datos Google Scholar y Opengray. También se examinaron las listas de referencia de los artículos incluidos. La herramienta de colaboración Cochrane y el ACROBAT-NRSI se utilizaron para analizar la calidad metodológica de los artículos. Resultados Se enumeraron 26 estudios y se seleccionaron 8 para el metaanálisis. El nivel de evidencia científica fue clasificado por el Sistema GRADE y considerado alto. No hubo una diferencia estadística significativa entre las posiciones verticales y las horizontales. A pesar de este hallazgo, las posiciones verticales presentaban bajas tasas de laceraciones perineales graves. Conclusión La adopción de posiciones verticales en el parto normal puede ser fomentada por los profesionales, ya que puede evitar desgarros perineales severos, sin embargo, no es posible afirmar con exactitud su eficacia en detrimento de las posiciones horizontales para el resultado perineal completo.

ABSTRACT Objective To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position. Method A systematic review with meta-analysis. The searches were carried out in the databases: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct and Scopus. Searches in the gray literature were conducted on Google Scholar and OpenGrey databases. Reference lists of included articles were also considered. The Cochrane collaboration tool and ACROBAT-NRSI were used to analyze the methodological quality of the articles. Results There were 26 studies listed and 8 were selected for the meta-analysis. The level of scientific evidence was classified by the GRADE System and considered high. There was no statistically significant difference between upright positions in relation to horizontal positions. Despite this finding, the upright positions showed reduced rates of severe perineal lacerations. Conclusion Adopting upright positions in normal delivery can be encouraged by professionals as it can prevent severe perineal lacerations; however, it is not possible to accurately affirm their effectiveness to the detriment of horizontal positions for an intact perineum outcome.

Dental care utilization among children in Brazil: an exploratory study based on data from national household surveys.

Wide availability of access to dental services can be considered a predictor of better oral health outcomes in a population. This article aims to compare data from the Brazilian National Household Sample Surveys (PNAD) on dental services utilization among children aged 4 to 12 years. This cross-sectional study was carried out using data from the 1998, 2003, and 2008 National Household Sample Surveys, involving a total of 61.438, 64.659 and 59.561 children, respectively. Ninety-nine percent confidence intervals were considered for the prevalence of each outcome of interest. In 1998, 60.8% (99%CI: 59.4;62.1) of children had been to a dentist; this prevalence was 65.5% (99%CI: 64.4;66.7) in 2003 and 73.8% (99%CI: 72.1;74.2) in 2008. In 1998, 41.2% (99%CI: 39.1;43.3) of children in the lowest household income quartile had been to a dentist; this value was 61.4% (99%CI: 59.5;63.2) in 2008. Among children from families whose head of household had 4 years of formal education or fewer, 49.5% and 63% had been to a dentist in 1998 and 2008, respectively. The lifetime prevalence of dentist attendance among Brazilian children increased between 1998 and 2008, especially among those from low-income families and those whose head of household had a low educational level.

Dental care utilization among children in Brazil: an exploratory study based on data from national household surveys / Utilização de serviços odontológicos entre crianças no Brasil: estudo exploratório a partir das pesquisas nacionais por amostra de domicílios

Abstract Wide availability of access to dental services can be considered a predictor of better oral health outcomes in a population. This article aims to compare data from the Brazilian National Household Sample Surveys (PNAD) on dental services utilization among children aged 4 to 12 years. This cross-sectional study was carried out using data from the 1998, 2003, and 2008 National Household Sample Surveys, involving a total of 61.438, 64.659 and 59.561 children, respectively. Ninety-nine percent confidence intervals were considered for the prevalence of each outcome of interest. In 1998, 60.8% (99%CI: 59.4;62.1) of children had been to a dentist; this prevalence was 65.5% (99%CI: 64.4;66.7) in 2003 and 73.8% (99%CI: 72.1;74.2) in 2008. In 1998, 41.2% (99%CI: 39.1;43.3) of children in the lowest household income quartile had been to a dentist; this value was 61.4% (99%CI: 59.5;63.2) in 2008. Among children from families whose head of household had 4 years of formal education or fewer, 49.5% and 63% had been to a dentist in 1998 and 2008, respectively. The lifetime prevalence of dentist attendance among Brazilian children increased between 1998 and 2008, especially among those from low-income families and those whose head of household had a low educational level.

Resumo A ampla disponibilidade de acesso aos serviços odontológicos pode ser considerada um fator preditor de melhores resultados na saúde bucal da população. O objetivo deste artigo é comparar os dados obtidos das Pesquisas Nacionais por Amostras de Domicílios (PNADs), em relação a utilização de serviços odontológicos, entre crianças de 4 a 12 anos. Estudo transversal, com dados obtidos a partir das PNADs realizadas em 1998, 2003 e 2008, envolvendo um total de 61.438, 64.659 e 59.561crianças, respectivamente. Considerou-se intervalos de confiança de 99% para os desfechos. No ano de 1998, 60,8% (IC99%: 59,4;62,1) das crianças haviam ido ao dentista, em 2003, 65,5% (IC99%: 64,4;66,7), e em 2008, 73,8% (IC99%: 72,1;74,2). Com relação à renda domiciliar, em 1998, 41,2% (IC99%: 39,1;43,3) das crianças inseridas nas famílias na menor faixa de renda foram ao cirurgião-dentista, em 2003 49,9% (IC99%: 48;51,9) o fizeram e, em 2008, 61,4% (IC99%: 59,5;63,2). Entre as que pertenciam a famílias onde o chefe possuía até 4 anos de estudo, 49,5% e 63%, em 1998 e 2008, foram às consultas odontológicas. A prevalência de crianças brasileiras que já haviam ido ao dentista aumentou entre 1998 e 2008, especialmente entre aquelas pertencentes a famílias com renda domiciliar menor e com chefes possuindo menor escolaridade.

Teaching and Learning Regarding the Dentist-Pediatric Patient Relationship: A Qualitative Study

Objective: To investigate the perceptions of dental students on the learning process regarding the dentist-pediatric patient relationship. Material and Methods: A qualitative study with an exploratory approach was conducted involving semistructured interviews with sixteen dental undergraduate students randomly selected from the thirty-two students in the last semester of the dentistry course. The transcribed interviews were submitted to content analysis. Results: The sample was composed of nine female (56.3%) and seven male (43.7%) students (median age: 23 years). The factors perceived as most influential with regard to learning the dentistpediatric patient relationship were observations of professors, other dentists or colleagues and the regular practice of dental procedures. While half of the participants considered lectures on the subject satisfactory, the other half reported a need for more instruction on how to deal with specific clinical situations. Most of the participants would like to have learned more about the dentist-pediatric patient relationship. Conclusion: The majority of students recognized that the teaching and learning process regarding the dentist-pediatric patient relationship is not easy. They reported having little counseling on the how to develop this relationship. The students suggested that the dentist-patient relationship should be addressed more during the course through the inclusion of lectures or classes on this issue as well as the demonstration of specific clinical situations.

Use of Dental Services Among Brazilian Children Aged Zero to Three Years: Analysis of National Household Surveys

Objective: To describe the use of dental services among children aged zero to three years in Brazil according to socio-demographic characteristics. Material and Methods: A cross-sectional study was carried out using data from the 1998, 2003 and 2008 Brazilian National Household Surveys involving a total of 25,769, 25,644 and 22,237 children, respectively. Prevalence rates and 99% confidence intervals (CI) were calculated. Results: : In 1998, 10.4% (99%CI: 9.7-11.1) of the children had been to the dentist. This figure was 13.4% (99%CI: 12.6-14.3) in 2003 and 16.2% (99%CI: 15.2-17.1) in 2008. In 2008, the prevalence rates of dental appointments in lifetime were respectively 10.2% (99%CI: 9.2-11.4) and 30.6% (99%CI: 27.7-33.6) for children in the lowest and highest income quartiles, 10.2% (99%CI: 8.9-11.7) and 22.4% (99%CI: 20.9- 23.9) for children from families whose head of household had up to four and nine or more years of schooling, 9.6% (99%CI: 2.2-11.1) and 27.5% (99%CI: 24.5-30.8) for those living in the northeast and central west regions of the country. Conclusion: Statistically significant increases in the prevalence rates of the use of dental services among Brazilian children aged zero to three years occurred between 1998 and 2008. The rates were lower among children belonging to socially and ethnically disadvantaged groups.

Anxiety in Children submitted to Dental Appointment

Objective: To determine anxiety in children undergoing dental treatment and to evaluate associated factors. Material and Methods: The sample consisted of 48 children during dental appointment in dental clinics of the Franciscano University Center, 48 caregivers, and 46 dentistry students. The modified Venham Picture Test was used to determine anxiety of children during dental appointment, before and after treatment. For determining anxiety related to dental care among caregivers, the modified Corah's dental anxiety scale was used. The Lipp`s stress symptoms inventory for adults was applied to determine the stress level of dentistry students. In addition, the individual characteristics of participants were recorded to determine their association with the presence of anxiety. Results: Anxiety was observed in 60.4% of children, and it was related to invasive dental procedures (p = 0.021), history of dental pain (p = 0.002), presence of bruxism (p = 0.028), anxious caregivers (p = 0.023), and stress of the dental student that conducted the appointment (p = 0.005). Conclusion: Overall, the majority of pediatric patients showed anxiety, which was directly related to misbehavior during dental care. Moreover, anxiety was related to individual characteristics of children and was influenced by the anxiety level of caregivers, as well as the emotional state of dentistry students during the dental appointment.