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.

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.

Relationship between Malocclusion, Bullying, and Quality of Life in Students from Low Social Development Area: A Cross-Sectional Study

ABSTRACT Objective: To analyze the relationship between malocclusion and bullying and its impact on the well-being and quality of life of students from low social development areas. Material and Methods: This cross-sectional study included 243 schoolchildren between 10 and 17 years. Malocclusion was analyzed using Dental Aesthetic Index. Bullying and self-perception of the impact of one's oral condition on quality of life and interpersonal relationships were assessed by questions from National Survey of Schoolchildren's Health and Child Perceptions Questionnaire 11-14 (CPQ11-14). Data were analyzed using the Spearman correlation coefficient and Mann-Whitney tests, considering groups: 10-11, 12-14 and 15-17 years. Results: No correlation was observed between malocclusion and bullying. However, in the 12-14 group, poor correlations were found between malocclusion and the CPQ11-14 (0.226) and between malocclusion and being shy/embarrassed due to oral aspects (0.298). Positive correlations were observed between bullying and the impact on the quality of life in the 10-11 (0.420) and 12-14 (0.425) groups. In the older group, a positive correlation (0.724) was observed between the concern about what others think of their oral health and the impact on their quality of life. Conclusion: There was no evidence of a relationship between malocclusion and bullying. However, the oral conditions negatively affected the interpersonal relationships and the student's quality of life.

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.

Amelogenesis imperfecta: use of cyanoacrylate as a desensitizing agent and its impact on oral health-related quality of life.

Amelogenesis imperfecta (AI) is a rare hereditary condition characterized by abnormal enamel formation and increased tooth sensitivity. There are no defined therapeutic recommendations for tooth sensitivity in patients with AI. The aim of the present case report of a 5-year-old girl with AI is to describe the use of cyanoacrylate as a desensitizing agent on the patient's permanent molars and report the impact of this treatment on her oral health-related quality of life (OHRQoL). After 4 sodium fluoride varnish applications were unsuccessful in relieving sensitivity affecting the molars, cyanoacrylate was applied 5 times (at intervals of 7, 15, 30, and 180 days after the first application). Pain scores were recorded on a visual analog scale before and after each intervention, and the OHRQoL was measured using a questionnaire (Early Childhood Oral Health Impact Scale [ECOHIS]) administered prior to the first cyanoacrylate application and on the last day of the protocol. In this patient, cyanoacrylate seemed to be effective at decreasing tooth sensitivity in immature permanent molars affected by AI, as demonstrated by reductions in the frequency of complaints of dental pain, difficulty in drinking cold beverages, and difficulty in eating some foods.

Experiência de cárie dentária e consequências clínicas de cárie dentária não tratada de crianças e adolescentes com Transtorno do Espectro Autista / Experience and clinical consequences of untreated dental caries in children and adolescents with Autism Spectrum Disorder

O objetivo deste estudo foi verificar a experiência de cárie dentária e as consequências clínicas de cárie dentária não tratada de crianças/adolescentes com Transtorno do Espectro Autista (TEA), bem como identificar as características socioeconômicas e os hábitos de saúde bucal desses indivíduos. O estudo recebeu aprovação do Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (protocolo #3.434.537). Os dados foram coletados entre novembro de 2019 e março de 2020, no Ambulatório do Serviço de Autismo do Departamento de Saúde da Criança e do Adolescente da Prefeitura de Juiz de Fora, Minas Gerais. Participaram desse estudo transversal descritivo 44 crianças/adolescentes com TEA na faixa etária de três a 16 anos e seus pais/cuidadores. Foram incluídas crianças/adolescentes com TEA cadastradas no Ambulatório do Serviço de Autismo, e seus pais/cuidadores consentiram a sua participação e dos filhos por meio da assinatura do Termo de Consentimento Livre e Esclarecido. Os pais/cuidadores responderam um questionário estruturado auto aplicado sobre informações socioeconômicas, incluindo sexo, idade e número de irmãos da criança/adolescente, bem como idade e escolaridade materna e paterna, renda familiar mensal e número de indivíduos no núcleo familiar. Também, responderam um instrumento sobre os comportamentos relacionados à saúde bucal dos filhos, incluindo visita prévia ao dentista, frequência diária de escovação dentária, uso de dentifrício fluoretado e quem realizava a escovação dentária. As crianças/adolescentes foram examinadas clinicamente, em uma sala reservada do ambulatório, por uma única pesquisadora, para avaliar a experiência de cárie dentária, por meio do índice CPO-D/ceo-d e as consequências clínicas de cárie dentária não tratada, utilizando o índice PUFA/pufa. A pesquisadora foi treinada e calibrada para realização do exame clínico. Para cada condição bucal avaliada, foram determinadas as concordâncias interexaminador (k = 0,97 e k = 0,79) e intraexaminador (k = 0,99 a k = 0,82). Os coeficientes Kappa mostraram-se satisfatórios para realização do estudo. Os dados coletados foram armazenados e analisados utilizando o programa Statistical Package for Social Sciences-SPSS e foi realizada a análise descritiva das variáveis coletadas. A maioria das crianças/adolescentes eram do sexo masculino (90,9%) e a média da idade foi de 6,4 (± 3,2) anos. A maioria das famílias (86,4%) possuía renda média familiar mensal menor ou igual a dois salários mínimos. A maioria das crianças/adolescentes (63,6%) nunca visitaram o dentista e possuía frequência de escovação de uma a duas vezes por dia (59,7%) realizada pelos pais/cuidadores (70,5%). A prevalência de cárie dentária foi de 43,2%. O CPO-D/ceo-d médio foi de 1,52 ± 2,46, sendo que a média do componente cariado foi maior (1,2 ± 1,9), seguida pelo componente obturado (0,3 ± 1,1) e pelo componente perdido/com necessidade de extração (0,1 ± 0,5). A maioria das crianças/adolescentes não apresentou consequências clínicas de cárie dentária não tratada (95,5%). Concluiu-se que as crianças/adolescentes com TEA apresentam necessidade de tratamento concentrada em dentes com lesões cavitadas não tratadas e que a maioria desses indivíduos nunca foi ao dentista.

The presented study aimed to assess the dental caries experience and the clinical consequences of untreated dental caries in children/adolescents with Autism Spectrum Disorder (ASD), as well as to identify the socioeconomic characteristics and oral health habits of these individuals. This study received approval from Research Ethics Committee of the Federal University of Minas Gerais (Brazil) (approval #3.434.537) and was developed at the public outpatient clinic for individuals with ASD of the Department of Child's and Adolescent's Health of Juiz de Fora. Data collection was performed between November 2019 and March 2020. Forty-four (44) dyads of patents/caregivers and their children/adolescents with ASD participated in this cross-sectional study, with ages between three and 16 years. Children/adolescents with ASD registered at the outpatient clinic for individuals with ASD were included and whose parents/caregivers consented to their participation and that of their children by signing the Informed Consent Form. Parents/caregivers answered a structured self-administered questionnaire about socioeconomic information including sex, age and number of siblings of the child/adolescent, as well as maternal and paternal age and education, monthly family income and number of individuals in the household. They also answered an instrument about their children's oral health habits including previous visits to the dentist, daily frequency of tooth brushing, use of fluoride toothpaste and who performed tooth brushing. The children/adolescents with ASD were submitted to an intraoral examination, in a private room of the outpatient, by a single researcher, to assess the dental caries experience (DMFT/dmft) and clinical consequences of untreated dental caries (PUFA/pufa). The researcher was trained and calibrated to perform the clinical examination. For each oral condition evaluated, the inter-examiner (k = 0.97 and k = 0.79) and intra-examiner (k = 0.99 to k = 0.82) agreements were determined. Kappa coefficients proved to be satisfactory for the study. The collected data were stored and analyzed using the Statistical Package for Social Sciences-SPSS and a descriptive analysis was done based on the prevalence of the collected variables. Most children/adolescents were male (90.9%) and the average age was 6.4 (± 3.2) years. Most families (86.4%) had an average monthly family income less than or equal to two minimum wages According to information from parents/caregivers, most children/adolescents (63.6%) never visited the dentist and had a daily frequency of tooth brushing of one to two times a day (59.7%) performed by parents/caregivers (70.5%). The prevalence of dental caries experience was 43.2%. The mean DMFT/dmft was 1.52 ± 2.46, with the mean of the decayed component being highest (1.2 ± 1.9), followed by filled (0.3 ± 1.1), and missing (0.1 ± 0.5). Most of the individuals did not present clinical consequences of untreated dental caries (95.5%). It was concluded that children/adolescents with ASD need treatment concentrated on teeth with untreated cavitated lesions and that most of these individuals have never been to the dentist.