Exclusive breastfeeding intention among pregnant women and associated variables: a cross-sectional study in a Brazilian community / Intenção de amamentar entre gestantes e variáveis associadas: estudo transversal em uma comunidade brasileira

ABSTRACT Objective: To investigate exclusive breastfeeding (EBF) intention and associated variables among women in the third trimester of pregnancy. Methods: The data were collected with a questionnaire for the pregnant women (n=653), from December/2018 to November/2019. They answered the Infant Feeding Intentions (IFI) scale, translated and adapted to Brazilian Portuguese, and a questionnaire on sociodemographic, biological, family, pregnancy, breastfeeding, health care, and habits variables. Descriptive statistics and multiple logistic regression analyses were performed with a 5% significance level, following a multilevel hierarchical model that estimated the association between the dependent and independent variables. The outcome EBF intention measured by the IFI score was dichotomized by the median (<16 or =16). Results: Mean±standard deviation score for the IFI scale was 14.4±2.6 (score 0: very strong intention to not breastfeed at all; score 16: very strong EBF intention up to six months). The results from the regression analysis showed that pregnant women who had no intention to bottle feed (OR=4.33; 95%CI 2.79-6.72) or did not know (OR=1.85; 95%CI 1.21-2.82), those who planned the pregnancy (OR=1.52; 95%CI 1.09-2.12), those who believed they would have help to care for the baby (OR=3.60; 95%CI 1.51-8.56) or did not know (OR=3.97; 95%CI 1.26-12.51), and those who reported knowing the World Health Organization recommendations on breastfeeding (OR=1.73; 95%CI 1.13-2.64) were more likely to show a very strong EBF intention. Conclusions: Pregnant women in the third trimester of pregnancy presented a strong EBF intention. The higher EBF intention score was significantly associated with the structural, setting, and individual determinants.

RESUMO Objetivo: Investigar a intenção materna de amamentar exclusivamente (IMA) e variáveis associadas entre as mulheres no terceiro trimestre de gravidez. Métodos: A coleta de dados foi realizada por meio de entrevista e questionário semiestruturado e autoadministrado, entre dezembro/2018 e novembro/2019. As gestantes (n=653) responderam à escala Infant Feeding Intentions (IFI) testada, traduzida e adaptada para o português do Brasil e ao questionário contendo perguntas sobre variáveis sociodemográficas, biológicas e familiares, bem como relacionadas à gestação, ao aleitamento materno, à assistência à saúde e a hábitos. Foram realizadas análises estatísticas descritivas e de regressão logística múltipla hierarquizada, com nível de significância de 5%, para estimar a associação entre as variáveis independentes e o desfecho. A IMA, medida pela escala IFI, foi dicotomizada pela mediana (<16 ou =16). Resultados: A pontuação média±desvio padrão para a escala IFI foi de 14,4±2,6. Os resultados da análise de regressão mostraram que as gestantes que não tinham intenção de oferecer mamadeira (OR=4,33; IC95% 2,79-6,72) ou não sabiam (OR=1,85; IC95% 1,21-2,82), que planejaram a gestação (OR=1,52; IC95% 1,09-2,12), aquelas que acreditavam que teriam ajuda nos cuidados com o bebê (OR=3,60; IC95% 1,51-8,56) ou que não sabiam (OR=3,97; IC95% 1,26-12,51), bem como aquelas que relataram conhecer as recomendações da Organização Mundial de Saúde sobre amamentação (OR=1,73; IC95% 1.13-2.64) tinham mais chances de mostrar uma IMA muito forte. Conclusões: As gestantes no terceiro trimestre de gestação apresentaram forte IMA. A maior IMA esteve significativamente associada aos determinantes estruturais, contextuais e individuais.

Age and Type of Delivery as Risk Indicators for Maternal Mortality.

OBJECTIVE: This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015. METHODS: This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis. RESULTS: Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged ≥ 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death. CONCLUSION: Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries.

OBJETIVO: Esse estudo avaliou a mortalidade materna (MM) e fatores relacionados em um município de grande porte da região sudeste do Brasil (Campinas, São Paulo) no período de 2000-2015. MéTODOS:: Esse estudo consistiu de duas fases: 1. Uma fase analítica de caso-controle que avaliou o impacto de variáveis individuais e contextuais na MM; 2. Uma fase ecológica delineada para contextualizar as mortes maternas por meio de análise espacial. O grupo caso consistiu de 87 mortes maternas e o grupo controle de 348 mulheres que tiveram bebês durante o mesmo período. Os dados foram analisados por estatística descritiva, testes de associação e regressão logística múltipla (RLM) (p < 0,05) assim como análise espacial. RESULTADOS: A taxa de mortalidade materna foi de 37 mortes para cada 100.000 nascidos vivos. As mortes foram dispersas por todo o território urbano e não se observou formação de clusters. Na RLM observou-se que mulheres grávidas com idade ≥ 35 anos (OR = 2,63) ou aquelas que passaram por cesárea (OR = 2,51) foram mais propensas à morte materna. CONCLUSãO:: As mortes maternas foram distribuídas dispersamente entre os diferentes níveis socioeconômicos e mais propensas a ocorrer entre mulheres ≥ 35 anos de idade ou que passaram por cesárea.

Age and Type of Delivery as Risk Indicators for Maternal Mortality / Idade e tipo de parto como indicadores de risco para mortalidade materna

Abstract Objective: This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015. Methods: This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis. Results: Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged > 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death. Conclusion: Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries.

Resumo Objetivo: Esse estudo avaliou a mortalidade materna (MM) e fatores relacionados em um município de grande porte da região sudeste do Brasil (Campinas, São Paulo) no período de 2000-2015. Métodos: Esse estudo consistiu de duas fases: 1. Uma fase analítica de caso-controle que avaliou o impacto de variáveis individuais e contextuais na MM; 2. Uma fase ecológica delineada para contextualizar as mortes maternas por meio de análise espacial. O grupo caso consistiu de 87 mortes maternas e o grupo controle de 348 mulheres que tiveram bebês durante o mesmo período. Os dados foram analisados por estatística descritiva, testes de associação e regressão logística múltipla (RLM) (p < 0,05) assim como análise espacial. Resultados: A taxa de mortalidade materna foi de 37 mortes para cada 100.000 nascidos vivos. As mortes foram dispersas por todo o território urbano e não se observou formação de clusters. Na RLM observou-se que mulheres grávidas com idade > 35 anos (OR = 2,63) ou aquelas que passaram por cesárea (OR = 2,51) foram mais propensas à morte materna. Conclusão: As mortes maternas foram distribuídas dispersamente entre os diferentes níveis socioeconômicos e mais propensas a ocorrer entre mulheres > 35 anos de idade ou que passaram por cesárea.

Evidence-practice gap in treatment decisions about defective composite and amalgam restorations among Brazilian dentists

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). This study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap

Association between Pacifier Use, Bottle-Feeding, and Pre-Postnatal Variables: A Cohort Study

ABSTRACT Objective: To determine the prevalence and analyze the variables associated with the use of pacifiers and/or bottles by infants up to 6 months of age. Material and Methods: Data on sociodemographic characteristics, intention to offer pacifier and bottle-feeding, pregnancy and breastfeeding (BF) variables were collected at baseline by interviews and a self-administered questionnaire among pregnant women in the 3rd trimester. After delivery, mother-baby binomials were followed by phone calls at the 1st, 3rd, and 6th months of the baby's life (n=467) to gather information on the type of delivery, baby's gender, BF in the first hour of the newborn's life, baby's weight, mother's return to work, and oral habits. Association analyses were performed using logistic regression models with a 5% significance level with the pacifier/bottle-feeding use as the outcome. Results: Most mothers (52.5%) reported their babies used bottle-feeding, 48.2% used pacifiers and 33.4% used both of them throughout the 6 months. Intention to offer pacifier and bottle-feeding was reported by 45.0% and 54.8% of the mothers at the 3rd trimester of the pregnancy, respectively. Not living in one's own residence (OR=1.53; 95%CI: 1.05-2.24) and having the prenatal intention of offering a pacifier (OR=2.50; 95%CI: 1.63-3.83) to the baby were significantly associated with pacifier use. Variables significantly associated with bottle-feeding were mother's return to work (OR=2.48; 95%CI: 1.54-3.97), baby's lower birth weight (OR=1.58; IC95%: 1.07-2.33), and prenatal intention to offer bottle-feeding (OR=2.51; 95%CI 1.56-4.04). Conclusion: About half of the babies used pacifiers or were bottle-fed, which were associated with the mother's prenatal intention to offer them to their babies and socioeconomic factors.

Dental trauma and oral health-related quality of life among 7th-grade students of public elementary schools

Dental trauma is a public health problem because of its high prevalence rates and treatment costs and for affecting mainly younger individuals. Aim: This cross-sectional study aimed to investigate the variables associated with dental trauma and its influence on oral health-related quality of life among 7th-grade students of public elementary schools. Methods: The data was collected with semi-structured and self-administered questionnaires and an intraoral clinical examination (n = 204). The variables collected regarded dental trauma, lip coverage, overjet, oral health-related quality of life (Child Perceptions Questionnaire - CPQ11-14 ISF: 8), and sociodemographic profile. Association tests and the Mann-Whitney test were performed at a 5% significance level. Results: Dental trauma occurred in 12.3% of students, 94.6% had adequate lip coverage, and the mean overjet was 2.7 mm (±2.0). Sex was the only variable with a statistically significant association with dental trauma (p = 0.021). There was no statistically significant difference in the CPQ11-14 ISF: 8 score between students with and without dental trauma (p = 0.136). Conclusions: Dental trauma was significantly associated with sex and did not impact the oral health-related quality of life of the students

Evidence-practice gap in treatment recommendations for proximal caries among Brazilian dentists / Lacuna entre a evidência e a prática nas recomendações de tratamento para cárie proximal entre dentistas brasileiros

ABSTRACT Little is known about how Brazilian dentists' treatment decisions for proximal carious lesions are compared to current evidence-based recommendations, so better understanding is needed to close any potential evidence-practice gap. Objectives: This cross-sectional study aimed to quantify the evidence-practice gap about proximal carious lesions treatment and identify dentist factors associated with this evidence-practice gap. Methods: Brazilian dentists (n=214) from Araraquara, São Paulo State, "completed a questionnaire about their dentist and practice characteristics and a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" from the U.S. National Dental Practice-Based Research Network. Five radiographic images of proximal carious lesions in low-risk and high-risk patient scenarios were used. Associations between treatment recommendations and lesion, dentist, and practice characteristics were tested for statistical significance (p<0.05). Results: Lesions confined to the enamel would be restored by 35% and 71% of dentists in the low-risk and high-risk patient scenarios, respectively, suggesting a substantial evidence-practice gap given that surgical intervention of enamel lesions is not consistent with current evidence. The lesion depth threshold to recommend a permanent restoration differed between the low-risk and high-risk patient scenarios (p<0.001). Specific dentist/practice characteristics (dentist gender, graduate of a public dental school, postgraduate training, use of caries risk assessment) were significantly associated with the evidence-practice gap, but the magnitude of these differences was not major Conclusion: A substantial evidence-practice gap in treatment of proximal carious lesions was found for the sample overall, even when clinical scenarios presented low-risk patients. Global strategies are needed to close this substantial evidence-practice gap.

RESUMO Pouco se sabe se as decisões de tratamento dos dentistas brasileiros para lesões cariosas proximais são comparadas às recomendações atuais baseadas em evidências, portanto, é necessário um melhor entendimento para fechar qualquer potencial lacuna entre a evidência e a prática. Purpose: Este estudo transversal teve como objetivo quantificar a lacuna entre a evidência e a prática na decisão de tratamento das lesões cariosas proximais e identificar os fatores associados a essa lacuna entre a evidência e a prática. Methods: Cirurgiões-dentistas brasileiros (n=214) de Araraquara, Estado de São Paulo, preencheram um questionário sobre suas características odontológicas e clínicas e uma versão traduzida do "Assessment of Caries Diagnosis and Caries Treatment" da U.S. National Dental Practice-Based Research Network. Cinco imagens radiográficas de lesões cariosas proximais em cenários de pacientes de baixo risco e alto risco foram usadas. Associações entre recomendações de tratamento e lesão, dentista e características da prática foram testadas (p<0,05). Results: As lesões confinadas ao esmalte seriam restauradas por 35% e 71% dos dentistas nos cenários de pacientes de baixo risco e alto risco, respectivamente, sugerindo uma lacuna entre a evidência e a prática substancial, dado que a intervenção cirúrgica das lesões do esmalte não é consistente com as evidências atuais. O limiar de profundidade da lesão para recomendar uma restauração permanente diferiu entre os cenários de pacientes de baixo risco e alto risco (p<0,001). Características específicas do dentista/prática (sexo do dentista, graduado em uma faculdade pública, pós-graduação, uso da avaliação de risco de cárie) foram significativamente associadas à lacuna entre a evidência e a prática, mas a magnitude dessas diferenças não foi importante. Conclusions: uma lacuna entre a evidência e a prática substancial na decisão de tratamento de lesões cariosas proximais foi encontrada para a amostra como um todo, mesmo quando os cenários clínicos apresentavam pacientes de baixo risco. Estratégias globais são necessárias para fechar essa lacuna entre a evidência e a prática.

Indicators for dental appointment scheduling in primary health care: a national cross-sectional study.

BACKGROUND: Integrated dental services within the Health System, particularly at primary health care, are crucial to reverse the current impact of oral diseases, which are among the most prevalent diseases worldwide. However, the use of dental services is determined by complex phenomena related to the individual, the environment and practices in which care is offered. Therefore, factors associated with dental appointments scheduling can affect positively or negatively the use of dental services. The aim of the present study was to evaluate the indicators for dental appointment scheduling in Primary Health Care (PHC). METHODS: The present is a cross-sectional analytical study that used data from the external assessment of the third cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), carried out between 2017 and 2018, in Brazil. The final sample consisted of 85,231 patients and 22,475 Oral Health teams (OHTs). The outcome variable was the fact that the user sought for a dental appointment at the Primary Health Care Unit. A multilevel analysis was carried out to verify the association between individual variables (related to users) and contextual variables (related to the OHTs) in relation to the outcome. RESULTS: Only 58.1% of the users interviewed at these Primary Health Care Units seek the available dental care. The variables with the greatest effect on the outcome were the patient's age up to 42 years old (OR = 2.03, 95% CI: 1.96-2.10), at individual level, and 'oral health teams that assisted no more than a single family health team (FHT)' (OR = 1.29, 95% CI: 1.23-1.36) at contextual level. Other variables were also associated with the outcome, but with a smaller effect size. CONCLUSION: In conclusion, users' age and work process of OHT were indicators for dental appointment scheduling. Our results suggest that when OHT put the National Oral Health Policy guidelines into practice, by assisting only one FHT, the chance for PHC users seeking dental appointments is higher than OHTs that assist more than one FHT. Regarding age, patients aged up to 42 years are more likely to seek an appointment with a dentist.

Inclusion of oral health teams in primary health care promotes early diagnosis of oral and oropharyngeal cancers: a nationwide study.

BACKGROUND: Oral and oropharyngeal cancers are considered important public health problems worldwide. This study aims to analyze the association between late diagnosis of oral and oropharyngeal cancers in Brazil and the contextual indicators of socioeconomic variables and coverage of Primary Health Care (PHC), and to assess the temporal trend of late diagnosis. METHODS: In this cross-sectional observational study, secondary data were evaluated with a time series analysis. All Brazilian cities that reported at least one case of oral and oropharyngeal cancers each year in the period between 2000 and 2013 were included; and the staging was analyzed by calculating the ratio risk for late diagnosis for each municipality. The association between staging and socioeconomic variables and offer of PHC was calculated using multiple linear regression. The time trend of the risk ratio for late-stage diagnosis was calculated using the Prais-Winsten method. RESULTS: One hundred and sixty Brazilian municipalities had at least one annual case of oral and oropharyngeal cancers notified to the INCA hospital system between 2000 and 2013. The adjusted model showed that the higher the Gini value (greater social inequality) and the lower the HDI value (less human development) was, the higher was the number of tumors diagnosed at a late stage, considering the size of the tumor. A greater risk for late diagnosis was identified, as early as at the stage of lymph node involvement, when there was a higher level of social inequality and lower level of coverage by Oral Health Teams (OHT) in PHC. The greater the social inequality, the greater was the risk of late diagnosis, as early as in the stage of metastasis. CONCLUSIONS: We concluded that, during the evaluated period, there was an increase in the number of cases diagnosed at the most advanced stage. Furthermore, there was association between higher levels of social inequality and an increase in the proportion of late diagnosis of oral and oropharyngeal cancers. In addition, the inclusion of Oral Health Teams in Primary Health Care promoted the early diagnosis of these types of cancers.

Expectation of parental control and the maintenance of bottle-feeding in childhood.

OBJECTIVE: To investigate association between parental locus of control (belief of individuals about what or who has control of the events of their lives) and bottle feeding habits among children from 3 to 5 years of age. METHODOLOGY: Parental locus of control validated in Brazil, and semi-structured questionnaire to obtain sociodemographic, health, and oral habit behaviors was applied to mothers of 992 preschool children. Outcome variable "use of feeding bottle" was studied according to the time of its use (≤36 months and >36 months). Simple logistic regression models were adjusted and raw odds ratios were estimated for variables of distal blocks, which contemplated parental locus of control, socioeconomic characteristics of family, and maternal habits. In the intermediate block, the variables for conditions of the child's birth and place of health care attendance during the prenatal period and early childhood were included. In the proximal block, the time of breastfeeding and pacifier use were reported. Variables were analyzed from the distal to the proximal block, and the individual analyses that presented p≤0.20 remained in each model; included in the subsequent block were the variables with p≤0.10, because this was a study of prevention. RESULTS: Longer time of feeding bottle use was associated with the internal parental locus of control, mothers older than 31 years of age, white race, premature children, who used pacifiers and are treated in the private health system. CONCLUSIONS: Children who maintained the habit of feeding bottle use for a longer time were those whose mother presented an internal locus of control.

Methods for Caries Prevention in Children Reported by Dentists from a Brazilian Community

ABSTRACT Objective: To describe the dental practice patterns related to caries prevention in children aged 6-18 years and associated factors. Material and Methods: Dentists (n=162) from Araraquara, Brazil, completed two paper questionnaires: (1) one about characteristics of their practice and their patient population; and (2) a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the National Dental Practice-Based Research Network. Regression analyses were used for data analysis (p<0.05). Results: Dentists reported using in-office fluoride (IOF) and dental sealants (DS) in 74.2% and 45.1% of their pediatric patients, respectively. Regression analysis showed that female dentists (p=0.035 for DS; p=0.044 for IOF; p=0.011 for non-prescription fluoride rinse), those with advanced degrees (p=0.032 for prescription of fluoride), those who graduated from a private dental school (p=0.018 for chlorhexidine rinse), those who provided caries prevention regimens (p<0.001 for DS; p=0.004 for IOF; p=0.013 for non-prescription fluoride rinse), those with a greater percentage of patients interested in a caries prevention regimen (p=0.007 for non-prescription fluoride rinse), those working in a private practice model (p=0.047 for prescription of fluoride) were more likely to recommend some type of preventive methods to their pediatric patients. Conclusion: Dentists reported recommending IOF to most of their pediatric patients. Certain dentists', practices', and patients' characteristics were associated to some caries prevention regimens recommended by dentists.

Caries risk assessment in dental practices by dentists from a Brazilian community

Abstract Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian dentists. This study aimed to determine the prevalence of CRA use by dentists and factors associated with its use, as well as to quantify dentists' ratings of the importance of specific factors when treatment planning. Dentists registered at the Regional Council of Dentistry of São Paulo State - Araraquara region were sent two paper questionnaires that comprised: a) characteristics of dentists themselves, their practices, and their patients; and b) the translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the U.S. National Dental Practice-Based Research Network. Participants were 206 dentists who currently practiced in Araraquara and treated dental caries. Descriptive statistics and multiple logistic regression analyses were used for data analysis. Thirty-six percent of the dentists reported they perform CRA and, among them, 36% indicated they record the assessment on a special form that is kept in the patient chart. More years since dental school graduation (OR = 1.1, p = 0.002) and holding an advanced academic degree (OR=2.6, p=0.005) were associated with a higher likelihood of performing CRA, whereas exclusively using a private practice model (OR = 0.5, p = 0.016) was associated with a lower likelihood of performing CRA. The current oral hygiene and commitment to return for follow-up were the most important risk factors for treatment planning. In conclusion, CRA was not a routine procedure in daily practice among the majority of participating dentists. Specific demographic, practice and academic education characteristics were associated with performing CRA.

Caries risk assessment in dental practices by dentists from a Brazilian community.

Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian dentists. This study aimed to determine the prevalence of CRA use by dentists and factors associated with its use, as well as to quantify dentists' ratings of the importance of specific factors when treatment planning. Dentists registered at the Regional Council of Dentistry of São Paulo State - Araraquara region were sent two paper questionnaires that comprised: a) characteristics of dentists themselves, their practices, and their patients; and b) the translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the U.S. National Dental Practice-Based Research Network. Participants were 206 dentists who currently practiced in Araraquara and treated dental caries. Descriptive statistics and multiple logistic regression analyses were used for data analysis. Thirty-six percent of the dentists reported they perform CRA and, among them, 36% indicated they record the assessment on a special form that is kept in the patient chart. More years since dental school graduation (OR = 1.1, p = 0.002) and holding an advanced academic degree (OR=2.6, p=0.005) were associated with a higher likelihood of performing CRA, whereas exclusively using a private practice model (OR = 0.5, p = 0.016) was associated with a lower likelihood of performing CRA. The current oral hygiene and commitment to return for follow-up were the most important risk factors for treatment planning. In conclusion, CRA was not a routine procedure in daily practice among the majority of participating dentists. Specific demographic, practice and academic education characteristics were associated with performing CRA.

Methods for caries prevention in adults among dentists from a brazilian community

Little is known about dental practice patterns of caries prevention in adults among Brazilian dentists. Aim: To quantify procedures used for caries prevention for adult patients among dentists from a Brazilian community. Methods: Dentists (n=197) who reported that at least 10% of their patients are more than 18 years old participated in the first Brazilian study that used a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" from the U.S. National Dental Practice-Based Research Network. A questionnaire about characteristics of their practice and patient population were also completed by the dentists. Generalized linear regression models and a hierarchal clustering procedure were used (p<0.05). Results: In-office fluoride application was the preventive method most often reported. The main predictors for recommending some preventive agent were: female dentist (dental sealant; in-office fluoride; non-prescription fluoride) and percentage of patients interested in caries prevention (dental sealant; in-office fluoride; non-prescription fluoride). Other predictors included private practice (dental sealant), percentage of patients 65 years or older (in-office fluoride), graduation from a private dental school (non-prescription fluoride), years since dental school graduation (chlorhexidine rinse) and using a preventive method (recommending sealant/fluoride/chlorhexidine rinse/sugarless, xylitol gum). Cluster analysis showed that dentists in the largest subgroup seldom used any of the preventive agents. Conclusion: Dentists most often reported in-office fluoride as a method for caries prevention in adults. Some practitioner, practice and patients' characteristics were positively associated with more-frequent use of a preventive agent

Influence of caries risk on the retention of a resin-modified glass ionomer used as occlusal sealant: a clinical trial / Influência do risco de cárie na retenção de um ionômero de vidro modificado por resina usado como selante oclusal: ensaio clínico

Introduction: Little is known whether caries risk influence occlusal sealants retention. Objective: To determine the retention rates (RR) of the resin-modified glass ionomer cement used as occlusal sealant in permanent first molars of 6-8-year old schoolchildren and to analyze the influence of caries risk at baseline on the RR of the sealant, over a 24-month period. Material and method: The sealant application was performed in a dental office at the beginning of the study, after children being allocated into high caries risk group (HR) and low caries risk group (LR). The examinations were performed by the same calibrated dentist at 0, 6, 12, 18 and 24 months. Retention rates were estimated, the Kaplan-Meier method was used to estimate the survival probabilities; and the comparison between HR and LR groups was evaluated by Wilcoxon and log-rank test. Result: The results showed that 14% of sealed teeth showed total loss (16% for HR and 12% for LR) and 46% showed partial loss during the study (51% for HR and 41% for LR), in relation to the baseline sample. No difference could be demonstrated by the survival analysis between HR and LR groups (p>0.05). Conclusion: Caries risk did not influence the retention rates of a resin-modified glass ionomer cement used as occlusal sealant in 6-8-year old schoolchildren.

Introdução: Pouco se sabe sobre a influência do risco de cárie na retenção de selantes oclusais. Objetivo: Avaliar as taxas de retenção de um cimento de ionômero de vidro modificado por resina utilizado como selante oclusal em primeiros molares permanentes de escolares de 6-8 anos, e analisar a influência do risco de cárie na taxa de retenção do selante, durante um período de 24 meses. Material e método: A aplicação do selante foi realizada em consultório odontológico no início do estudo, após as crianças serem alocados no grupo de alto risco (AR) ou baixo risco (BR) de cárie. Os exames foram realizados pelo mesmo dentista calibrado em 0, 6, 12, 18 e 24 meses. As taxas de retenção foram estimadas e o método de Kaplan-Meier foi utilizado para estimar as probabilidades de sobrevivência. A comparação entre os grupos AR e BR foi avaliada pelos testes de Wilcoxon e log-rank. Resultado: Os resultados mostraram que 14% dos dentes selados apresentaram perda total (16% para AR e 12% para BR) e 46% apresentaram perda parcial durante o estudo (51% de AR e 41% para BR), em relação a amostra no início do estudo. Nenhuma diferença pode ser demonstrada pela análise de sobrevivência entre os grupos AR e BR (p> 0,05). Conclusão: O risco de cárie não influenciou as taxas de retenção de um cimento de ionômero de vidro modificado por resina usado como selante oclusal em escolares de 6-8 anos de idade.

Examiner's experience and the outcome interpretation of ICDAS and Nyvad's system - a prospective in vitro study.

OBJECTIVE: To evaluate, prospectively, the influence of examiner's experience in interpreting and applying the caries detection systems ICDAS (IC) and Nyvad (NY). MATERIAL AND METHODS: Twelve second-year undergraduate dental students (UG) and 12 postgraduates (PG) MSc level analysed and codified 77 clinical dental caries photographs at three different moments: initially, without any training; after one week of receiving training through a theoretical class; and after two years. Reproducibility and correlation was evaluated; sensitivity, specificity and area under ROC curve (AUC) were dichotomized according to the presence of cavitation (IC) and in relation to disease activity (NY). RESULTS: IC presented good kappa values for the first two evaluations. Both criteria resulted in good Spearman's correlation after two years (IC = UG: 0.89; PG: 0.93/NY = UG: 0.81; PG: 0.82). Sensitivity, specificity and AUC were statistically higher in the third evaluation by UG for Nyvad. CONCLUSIONS: ICDAS criteria seem to be instinctively understood by students without clinical experience. Nyvad's concepts performed better after two years where the students deepened their theoretical knowledge and experienced clinical practice, collaborating with the identification of activity signs.

Tradução e adaptação brasileira do questionário "Assessment of caries diagnosis and caries treatment" / Translation and Brazilian adaptation of the "Assessment of caries diagnosis and caries treatment questionnaire"

Objetivo: O objetivo deste estudo foi traduzir e realizar a adaptação transcultural do questionário "Assessment of Caries Diagnosis and Caries Treatment", da Dental Practice Based Research Network (DPBRN), para a língua portuguesa do Brasil. Métodos: O questionário sobre a prática odontológica relacionada ao diagnóstico, prevenção, tratamento e avaliação de risco de cárie passou por tradução e adaptação cultural seguindo critérios pré-estabelecidos: tradução inicial, retrotradução e comitê de revisão. No pré-teste, o questionário foi preenchido por 21 cirurgiões-dentistas (CDs), cuja finalidade foi identificar erros, desvios das traduções e compreensão das perguntas. Após uma semana, 17 CDs preencheram o questionário novamente para avaliar a reprodutibilidade pelo teste de correlação intra-classe. Resultados: A etapa de tradução mostrou que os termos/sentenças traduzidos de forma destoante pelos diferentes pesquisadores eram, na verdade, sinônimos, e indicaram que o processo de tradução foi facilmente realizado. Em relação à compreensão do questionário, 95% (n=20) dos CDs não mostraram dúvida/dificuldade ao preenchê-lo. Os dados de reprodutibilidade mostraram que 42% (n=22) das questões apresentaram correlação satisfatória e 58% (n=31) correlação excelente. Conclusão: Conclui-se que o processo de tradução e adaptação cultural do questionário foi realizado de forma satisfatória e que a versão brasileira do questionário foi facilmente compreendida pela população estudada.(AU)

Aim: The aim of this study was to translate and cross-culturally adapt the "Assessment of Caries Diagnosis and Caries Treatment" questionnaire from the Dental Practice Based Research Network (DPBRN) into Brazilian Portuguese. Methods: The questionnaire on dental practices related to diagnosis, prevention, treatment, and caries risk assessment underwent translation and cross-cultural adaptation following pre-established criteria: initial translation, back-translation, and committee review. During the pre-test, the questionnaire was filled out by 21 dentists in order to evaluate mistakes, to find deviations in the translations, and to identify the comprehension of the questions. After one week, 17 dentists filled out the questionnaires again to evaluate their reliability by means of the intra-class correlation test. Results: The translation process showed that the term/sentences translated differently by distinct researchers were synonyms and indicated that the process was easily performed. Regarding the comprehension of the questionnaire, 95% (n=20) of the dentists showed no doubts / difficulty when filling it out. Reliability data showed that 42% (n=22) of the questions showed a satisfactory correlation, while 58% (n=31) showed an excellent correlation. Conclusion: In conclusion, the translation and cross-cultural adaptation process of the questionnaire was performed satisfactorily, and the Brazilian version of the questionnaire was easily understood by the studied population.(AU)

Estudo comparativo de indicadores de saúde bucal em município do estado de São Paulo / Comparative study of oral health indicators in primary care of a São Paulo State's city

Comparar indicadores de saúde bucal (Rendimento, Atrição, Ênfase em Prevenção Modificado, Relação Restauração/Extração) e Relação 1ª Consulta/Urgência entre 15 Unidades de Saúde da Família e 11 Unidades Básicas de Saúde de município do interior paulista, de 2008 a 2011. Os dados foram coletados a partir do Sistema de Informações Ambulatoriais do SUS (SIA-SUS) e comparados os modelos de atenção por meio de série histórica, teste não paramétrico (Mann-Whitney) e estatística descritiva. Embora haja o processo de fortalecimento da Estratégia Saúde da Família o modelo assistencial representado pelas Unidades Básica de Saúde se mostra mais efetivo em alguns aspectos da saúde bucal no serviço público.

To compare four oral health indicators (Income, Attrition, Modified Prevention Emphasis, Restoration/Extraction) and the 1st Consultation/Urgency Relationship in 15 Family Health Units and 11 Basic Health Units, in an interior city of São Paulo State, 2008-2011. The data were collected from SIA-SUS and the indicators compared through historical series using the non-parametric test (Mann Whitney) and descriptive statistics. Although there is a strengthening process of the Family Health Strategy, the care model represented by the Basic Health Units still proves more effective in some aspects of oral health in public service.

Quality of life and socio-dental impact among underprivileged Brazilian adolescents.

PURPOSE: To evaluate the influence of clinical variables, individual and contextual characteristics on the quality of life (QL) of underprivileged adolescents in a municipality in the interior of the State of São Paulo, Brazil. METHODS: An analytical cross-sectional study was conducted in Piracicaba, in 2012, with 1,172 adolescents aged 15-19 years, from 21 state schools and 34 Family Health Units. The dependent variables included the socio-dental impact (OIDP) and quality of life (WHOQOL-bref) indices. The dependent variables were classified as individual (DMFT index, CPI Index, age, sex, income, parents' educational level) and contextual (Social Exclusion Index) variable. The multilevel regression model was estimated by the PROC GLIMMIX ("Generalized Linear Models-Mixed") procedure, considering the individuals' variables as being Level 1 and the contextual variables as being Level 2, and the statistical significance was evaluated at level of significance of 5 %. RESULTS: Girls were found to have the worst QL (p < 0.000) and greatest OIDP (p = 0.000). There was an increase in OIDP (p < 0.001) and diminished QL (p < 0.052) with an increase in the periodontal index. This result is marginally significant since the significance probability is marginally greater than 0.05. In turn, there was an increase in QL (p = 0.000) and reduction in OIDP (p < 0.000) with an increase in the family income. Adolescents who resided in areas of greatest social exclusion (p = 0.031) and with greater OIDP (p < 0.000) presented the worst QL. CONCLUSION: Individual and contextual variables were related to the OIDP and QL in underprivileged Brazilian adolescents.

Preval?ncia e severidade da dor orofacial em gestantes / Prevalence and severity of orofacial pain in pregnant women

Objective: To evaluate the prevalence and severity of oral pain in pregnant women. Methods: A cross-sectional study was conducted on a sample of pregnant women who were receiving dental care at a Dental School. A structured questionnaire about self-perception of oral conditions and the presence and severity of orofacial pain in the mouth or teeth in the last 6months was applied. Results: 80 pregnant women participated in the study and, of these, 58.8% reported having a problem with their teeth, 31.3% periodontal problems, 61.3% bad taste in mouth and 62.5% bad breath. Only 22.5% of pregnant women did not exhibit any form of oral pain. The most frequently reported pains were: pain with hot/cold liquids or sweets (56.2%) and spontaneous toothache (38.8%). With regard to severity, mild and moderate pain were the most frequently reported, but there was a group of 23.8% of pregnant women with severe or very severe pain caused by hot or cold liquids and 18.8% in the same condition in relation to spontaneous pain. Conclusion: The results of this study showed that, despite the high prevalence of pain detected in the pregnant women, severity was low and referred to specific situations.

Objetivo: Avaliar a preval?ncia e a severidade da dor orofacial em gestantes. M?todos: O estudo transversal foi realizado em uma amostra de gestantes em atendimento odontol?gico em uma faculdade de odontologia. Foi aplicado question?rio estruturado com perguntas sobre a auto percep??o das condi??es bucais e a presen?a e a severidade da dor orofacial sentida na boca ou dentes nos ?ltimos 6 meses. Resultados: Participaram do estudo 80 gestantes e, destas, 58,8% afirmaram ter algum problema nos dentes, 31,3% problema na gengiva, 61,3% gosto ruim na boca e 62,5% mau h?lito. Apenas 22,5% n?o apresentaram nenhum tipo de dor orofacial. As dores mais relatadas foram: dor com l?quidos quentes, frios ou doces (56,2%) e dor de dente espont?nea (38,8%). Quanto ? severidade, as dores de intensidade leve e moderada foram as mais frequentes, mas havia um grupo de 23,8% das gestantes com dores intensas ou muito intensas provocadas por l?quidos frios ou quentes e 18,8% na mesma condi??o em rela??o ? dor espont?nea. Conclus?o: Os resultados do estudo mostraram que, apesar da alta preval?ncia de dor orofacial encontrada, a severidade foi baixa e relacionada a algumassitua??es espec?ficas.