Periodontitis and systemic parameters in chronic kidney disease: Systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review with meta-analysis to assess recent scientific evidence on the association between periodontitis and systemic parameters/conditions in individuals with chronic kidney disease (CKD). MATERIALS AND METHODS: The search for studies was performed in MedLine/PubMed, Scopus, Web of Science, and BIREME databases. Reference lists of selected articles were also searched. Studies with different epidemiological designs evaluating the influence of exposure to periodontitis on serum markers and mortality in individuals with CKD were eligible for inclusion. Three independent reviewers performed the article selection and data extraction. The assessment of methodological quality used the adapted Newcastle Ottawa Scale. Random effects meta-analysis was performed to calculate association measurements and 95% confidence intervals. RESULTS: In total, 3053 records were identified in the database search, with only 25 studies meeting the eligibility criteria and, of these, 10 studies contributed data for meta-analysis. Using a random-effects model, periodontitis was associated with hypoalbuminemia (PRunadjusted = 2.47; 95%CI:1.43-4.26), with high levels of C-reactive protein (PRunadjusted = 1.35; 95%CI%:1.12-1.64), death from cardiovascular disease (RRunadjusted = 2.29; 95%CI:1.67-3.15) and death from all causes (RRunadjusted = 1.73; 95%CI:1.32-2.27). CONCLUSIONS: The findings of this review validated a positive association between periodontitis and serum markers and mortality data in individuals with CKD.

Health-Related quality of life of oral health workers in primary health care in Salvador, Brazil / Qualidade de vida relacionada à saúde de trabalhadores de saúde bucal da atenção primária à saúde em Salvador, Brasil / Calidad de vida relacionada con la salud de trabajadores de salud bucal de la atención primaria de salud en Salvador, Brasil

This study aimed to identify and determine the level of factors associated with the health-related quality of life (HRQoL) of oral health professionals working in Primary Health Care (PHC) in Brazil. A cross-sectional survey was carried out among 96 dentists and 65 dental assistants working in the Family Health Strategy (FHS) in six municipalities in the metropolitan area of Salvador (BA), Brazil. The HRQoL was evaluated using the 36-item Short Form Health Survey Questionnaire (SF-36). Higher mean scores in the SF-36 physical component summary were associated with younger age, post-graduate education in public health, and frequent leisure time. The mental component summary was associated with frequent leisure time, > 40 weekly working hours, suitable dental offices, satisfaction with colleagues, and satisfaction with working in PHC. The HRQoL level of oral health professionals working in primary health care in PHC in Brazil was comparable to those found in the available literature and associated with several modifiable factors. Incidentally, a literature search found few studies using the SF-36 to assess the HRQoL of oral health workers, and those found were produced outside the main scientific centers.

O objetivo deste estudo foi identificar e determinar o nível de fatores associados à qualidade de vida relacionada à saúde (QVRS) de profissionais de saúde bucal que atuam na Atenção Primária à Saúde (APS) no Brasil. Foi realizado um estudo de corte transversal com 96 cirurgiões-dentistas e 65 auxiliares em saúde bucal que atuam na Estratégia Saúde da Família (ESF) em seis municípios da região metropolitana de Salvador (BA), Brasil. A QVRS foi avaliada usando o 36-item Short Form Health Survey Questionnaire (SF-36). Escores médios mais altos no resumo do componente físico do SF-36 foram associadas a idade mais jovem, pós-graduação em saúde pública e tempo de lazer frequente. O resumo do componente mental foi associado a tempo de lazer frequente, > 40 horas semanais de trabalho, consultórios odontológicos adequados, satisfação com os colegas e satisfação em trabalhar na APS. O nível de QVRS dos profissionais de saúde bucal que atuam na APS no Brasil foi comparável aos encontrados na literatura disponível e associado a vários fatores modificáveis. Incidentalmente, uma pesquisa bibliográfica encontrou poucos estudos que utilizam o SF-36 para avaliar a QVRS de trabalhadores da saúde bucal; e os encontrados foram produzidos fora dos principais centros científicos.

El objetivo de este estudio fue identificar y determinar el nivel de los factores asociados a la calidad de vida relacionada con la salud (CVRS) de los profesionales de salud bucal que actúan en la Atención Primaria de Salud en Brasil. Se realizó un estudio transversal con 96 cirujano dentista y 65 auxiliares de salud bucal que actúan en la Estrategia Salud de la Familia en seis municipios de la región metropolitana de Salvador, Brasil. La CVRS se evaluó mediante el 36-item Short Form Health Survey Questionnaire (SF-36). Las puntuaciones medias más altas en el resumen del componente físico del SF-36 se asociaron con una edad más joven, títulos de posgrado en salud pública y tiempo libre frecuente. El resumen del componente mental se asoció con tiempo libre frecuente, > 40 horas de trabajo por semana, consultorios dentales adecuados, satisfacción con los colegas y satisfacción con el trabajo en la Atención Primaria de Salud. El nivel de CVRS de los profesionales de la salud bucal que actúan en la Atención Primaria de Salud en Brasil fue comparable a los encontrados en la literatura disponible y se asoció a varios factores modificables. Una búsqueda bibliográfica encontró pocos estudios que utilizan el SF-36 para evaluar la CVRS de los trabajadores de la salud bucal; y los encontrados estaban fuera de los principales centros científicos.

Oral health-care practices and dental assistance management strategies for people with autism spectrum disorder: An integrative literature review.

ABSTRACT: Autism spectrum disorder requires a careful approach from professionals and a favorable clinical environment for dental care and assistance. This article aims To perform a literature review about oral health among people with autism spectrum disorder and dental management strategies for this group. An integrative literature review was carried out in three databases, associating the descriptors: (autism or autism spectrum disorder) with (oral health or oral diseases) and (dental care or dental services). After identification and screening steps, 32 articles were included in the study. The most prevalent subjects were oral health conditions, parents' understanding and practical attitudes about oral health, treatment and management strategies, and the use of technology. The principal barriers to dental care were the scarcity of specialized professionals, unpreparedness in the referral system, poor accessibility of the clinics, and lack of specific care protocols. The world literature on the subject is scarce, and there is still a need for investment and scientific production due to the incidence of autism in the world population and the maintenance of difficulties and barriers in offering quality health care to this group.

Mothers' high glycemic levels and the association between periodontitis and low birth weight.

BACKGROUND: Maternal hyperglycemia, periodontitis, and adverse gestational outcomes are important health problems. The present study investigated the hypothesis that periodontitis and the glycemic level of mothers may have opposing influences on birth weight (BW). This study evaluated the effect of high glycemic levels, albeit within the normal range, on the association between periodontitis and low birth weight (LBW). METHODS: A total of 732 women took part in this case-control study; 172 were mothers of children with LBW <2,500 g, and 560 were mothers of children with BW ≥2,500 g. The BW of newborns was obtained from medical records, and information on socioeconomic-demographic, lifestyle behavior were obtained through interviews. Glycated hemoglobin (HbA1c) levels were evaluated, and full-mouth periodontal examination was carried out within 7 days postpartum. Hierarchical and logistic regression analysis evaluated the effect of glycemic levels on the association between periodontitis and LBW by subgroups, estimating odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: In the group with HbA1c levels <5.6%, a statistically significant relationship existed between periodontitis and LBW. Using the Centre for Disease Control/American Academy of Periodontics criteria, the ORadjusted was 1.55; 95% CI: 1.04 to 2.31; using the Gomes-Filho et al. criteria the ORadjusted was 1.91; 95% CI, 1.06 to 3.45. In the group with higher HbA1c levels but still within the normal range (≥5.6% and <6.5%), the findings showed no association between periodontitis and LBW. CONCLUSION: Higher maternal glycemic levels within the normal range, inferior to those indicative of gestational diabetes, diabetes mellitus, or hyperglycemia, and periodontitis have opposing effects on BW, altering the association magnitude.

Diferentes critérios de definição da periodontite em puérperas jovens e sua associação com o baixo peso ao nascer / Different criteria for periodontitis definition in young mothers and its association with low birth weight

Objetivo: comparar três critérios de definição da periodontite na associação da doença periodontal com o baixo peso ao nascer (BPN) em uma população de puérperas jovens de Salvador, BA. Metodologia: aplicaram-se três diferentes critérios de definição da periodontite a uma amostra de 202 mães de bebês com peso ≥ 2.500g (controles) e de 97 mães de bebês com BPN (casos) pertencentes a uma base de dados de um estudo caso-controle prévio. Para a análise da associação entre periodontite e BPN, construíram-se modelos para os três critérios. A regressão logística não-condicional foi realizada para estimar a Odds Ratio (OR) baseada em Intervalos de Confiança a 95%. Resultados: a idade média das mães foi de 26,29 anos. A maioria declarou-se negra/ parda (92.64%), não fumante (94,65%) e possuir renda de até um salário-mínimo (61,20%). A ocorrência da periodontite variou de 22,41% a 94,31%, segundo o critério usado. Estimando-se a OR ajustada, a periodontite definida pelo critério 1 [ORajust. = 0,94, IC (95%)= 0,56­1,56], critério 2 [ORajust=1,18, IC(95%)= 0,65-2,13] e critério 3 [ORajust= 0,87, IC(95%)=0,37-3,22] não esteve associada com o BPN. Conclusão: flexibilizar o critério de definição interferiu na magnitude das medidas de ocorrência, mas não influenciou a análise de associação entre a periodontite e o BPN.

Objective: to compare three criteria for periodontitis definition and its association with Low Birth Weight (LBW) in a population of young mothers, in the city of Salvador ­ BA. Methods: Three different definitions for periodontitis were applied to sample of 202 mothers of newborns (NB) weighing ≥2.500g (controls) and 97 mothers of NB with LBW (cases) belonging to database from a previous case-control study. For the analysis of the association between periodontitis and LBW, were created models for three criteria. An unconditional logistic regression was used to estimate the odds ratio (OR) with 95% confidence interval. Results: the average age of mothers was 26,29 years. Most respondents identified themselves as black or brown (92.64%), 94,65% nonsmokers (94,65%) and have income up to 1 minimum wage (61.20%). The occurrence of periodontitis varied between 22,41% to 94,31% according to the criteria. When estimating adjusted OR, the periodontitis defined by criterion 1 [ORajus=0,94, IC(95%)=0,56­1,56], criterion 2 [ORajus=1,18, IC(95%)= 0,65-2,13] and criterion 3 [ORajus=0,87, IC(95%)=0,37-3,22] did not demonstrate association with LBW. Conclusion: to flex periodontitis' criteria modified the magnitude of measures of occurrence but did not influence the association analysis between periodontitis and the BPN.

Association between occupational exposure to domestic solid waste and dental caries: a cross-sectional study.

Studies have shown that domestic waste collectors are exposed to toxicants including infectious pathogens, which may be linked to their oral health conditions. This cross-sectional study evaluated the dental caries and its associated factors among domestic waste collectors. A total of 301 adult men who worked for a waste collection corporation were included; 171 men worked in direct contact with domestic solid waste and 130 did not. Sociodemographic data, working, and medical history were assessed. The decayed, missing, and filled permanent teeth (DMFT) index was examined. Logistic regression analysis was used to identify factors associated with dental status with a significance level of 5%. The overall mean DMFT score was 8.36±5.64. The mean DMFT, missing teeth (MT), and filled teeth (FT) were significantly higher in workers who did not have any direct contact with waste (p≤0.04). In the logistic analysis, DMFT ≥8 was only associated with older age (OR=8.41 [95% confidence interval (95%CI), 5.01-14.12], p<0.001). Decayed teeth (DT) ≥2 was associated with no previous oral hygiene instruction (OR=2.70 [1.50-4.81], p=0.001) and no daily dental flossing (OR=4.26 [1.92-9.43], p<0.001). MT ≥9 was associated with lower education level (OR=3.33 [1.57-7.10], p= 0.002). FT≥3 had a negative association with low income (OR= 0.42 [0.25-0.70], p<0.001) and no daily flossing (OR=0.42 [0.23-0.76], p=0.004). In conclusion, occupational exposure to domestic solid waste was not associated with poor dental status. Instead, age, education, income level, and oral hygiene were associated with dental health status. Missing teeth constituted the major component of the DMFT index. Therefore, prevention and oral rehabilitation programs are necessary to improve dental health.

Chronology and sequence of deciduous teeth eruption in children with microcephaly associated to the Zika virus.

INTRODUCTION: Deciduous teeth eruption is connected to children's growth and development. In Brazil, with the increase in the occurrence of children born with microcephaly associated to exposure to Zika virus, studies about orofacial alterations were necessary. OBJECTIVE: Describe the chronology and sequence of deciduous teeth in children with microcephaly due to the fetal exposure to Zika virus. METHODOLOGY: A cross-sectional study involving 74 children of a neuropediatric reference unit in Salvador, Bahia, in 2017 was conducted. Through use of secondary data, interviews with mothers and children's exam, the population was characterized, the chronology and sequence of deciduous teeth eruption was registered, and the analysis of the variables was proceeded. RESULTS: The first eruption happened between 4 and 17 months of age and 52.70% had a delay in the eruption of incisors. The average eruption time for the maxilla varies from 17.92 (16.56-19.28; 95% CI) to 20.43 (19.35-21.51; 95% CI) months, and the jaw from 11.57 (6.85-18.99; 95% CI) to 20.20 (19.09-21.31; 95% CI) months. In 77.94% of population, the eruption of the first teeth was in the lower arch and in 33.82%, molars and/or canines erupted before the incisors. CONCLUSIONS: There were alteration in the chronology and sequence of deciduous teeth eruption.

Association between clinical manifestations of sickle cell anemia in children and the occurrence of dental caries: a cross-sectional study / Associação entre manifestações clínicas da anemia falciforme em crianças e a ocorrência de cárie dentária: um estudo de corte transversal

Objective: The aim of this study was to determine the association between clinical manifestations of sickle cell anemia (including hospitalization and pain crisis) and dental caries in children in Bahia. Material and Methods: The study design was crosssectional, and the population included children aged from 6 to 96 months from August 2007 to July 2008 (N = 686). Interviews were performed to identify the sociodemographic profiles of the participants, and oral examinations were conducted by three examiners who were previously trained and calibrated to identify the presence of dental caries according to World Health Organization (WHO) criteria. Logistic regression analysis was performed for confirmatory analysis and estimation of confidence intervals (CIs). Results: The results showed that pain crises and hospitalizations were positively associated with caries (crude odds ratio (OR) = 2.11 and adjusted OR = 1.24; crude OR = 2.50 and adjusted OR = 1.46, respectively), but these associations were not statistically significant. Conclusion: The severity of the sickle cell condition alone was not sufficient to aggravate the prevalence of caries; thus, there are no major differences in caries prevalence between children with and without sickle cell disease. (AU)

O objetivo deste estudo foi determinar a associação entre as manifestações clínicas da anemia falciforme (incluindo hospitalização e crise de dor) e cárie dentária em crianças na Bahia. Material e Métodos: O desenho do estudo foi transversal e a população incluiu crianças de 6 a 96 meses de agosto de 2007 a julho de 2008 (N = 686). Foram realizadas entrevistas para identificar os perfis sociodemográficos dos participantes, e os exames bucais foram realizados por três examinadores previamente treinados e calibrados para identificar a presença de cárie dentária de acordo com os critérios da Organização Mundial da Saúde (OMS). A análise de regressão logística foi realizada para análise confirmatória e estimativa de intervalos de confiança (IC). Resultados: Os resultados mostraram que as crises de dor e hospitalizações foram positivamente associadas à cárie (razão de chances bruta (OR) = 2,11 e OR ajustado = 1,24; OR bruto = 2,50 e OR ajustado = 1,46, respectivamente), mas essas associações não foram estatisticamente significantes. Conclusão: A gravidade da doença falciforme isoladamente não foi suficiente para agravar a prevalência de cárie; assim, não há grandes diferenças na prevalência de cárie entre crianças com e sem doença falciforme.(AU)

Utilização dos serviços odontológicos por crianças de 0 a 9 anos cadastradas em uma Unidade de Saúde da Família de Salvador, Bahia, Brasil / Use of dental services by children from 0 to 9 years registered in a Health Unit of the Family of Salvador, Bahia, Brazil

Objetivo: o objetivo deste estudo foi verificar a utilização de serviços odontológicos, idade e motivo da primeira consulta odontológica em crianças de 0 a 9 anos cadastradas em uma Unidade de Saúde da Família em Salvador, Bahia, Brasil. Metodologia: realizou-se um estudo descritivo, transversal. Os responsáveis pelas crianças participaram de entrevistas individuais e forneceram informações sobre a idade atual da criança, idade da primeira consulta odontológica, realização de consulta no último ano, tipo de financiamento e motivo da primeira consulta odontológica. As entrevistas foram realizadas durante visitas domiciliares e na respectiva Unidade de Saúde. Os dados foram tabulados e analisados de forma descritiva. Resultados: um total de 151 questionários foram aplicados. Das crianças, 59,6% nunca realizaram nenhum tipo de consulta odontológica e daqueles que já o tinham feito, 62,30% foi no último ano e 83,61% destas realizadas no serviço público. O principal motivo da consulta foi a presença de cárie (36,07%). As crianças do sexo feminino realizaram a primeira consulta odontológica em maior proporção que as do sexo masculino, embora esta tenha ocorrido em uma idade mais tardia. Conclusões: Há necessidade de fomentar a utilização do serviço odontológico de forma precoce, permitindo a implementação de políticas públicas de promoção de saúde de forma a garantir o atendimento às crianças desde o primeiro ano de vida.

Objective: the aim of this study was to verify the use of dental services, age and reason for the first dental visit in children aged 0 to 9 enrolled in a Family Health Unit in Salvador, Bahia, Brazil. Methods: a descriptive, cross-sectional study was carried out. Those responsible for the children participated in individual interviews and provided information on the child's current age, age at the first dental visit, last year's consultation, type of funding and reason for the first dental visit. The interviews were conducted during home visits and at the respective Health Unit. Data were tabulated and analyzed in a descriptive way. Results: a total of 151 questionnaires were applied. 59.6% of the children never performed any type of dental consultation and those who had already done it, 62.30% were in the last year and 83.61% of these were in the public service. The main reason for the consultation was the presence of caries (36.07%). The female children performed the first dental visit in a greater proportion than the male ones, although this occurred at a later age. Conclusions: there Is a need to encourage the use of the dental service in an early manner, allowing the implementation of public health promotion policies in order to ensure care for children from the first year of life.

Low birth weight and the delay on the eruption of deciduous teething in children / Baixo peso ao nascer e atraso na erupção de dentes decíduos em crianças

Abstract Objectives: To analyze the association between low birth weight (LBW) and the occurrence of the delay on the eruption of deciduous teething (DEDT) in children from 04 to 30 months, living in Salvador, Bahia. Methods: A cross-sectional study involved 520 children at four to thirty months of age, from public, private and philanthropic daycares from two districts in Salvador. A descriptive analysis and unconditional logistic regression were done to estimate the odds ratios (ORs), using the Confidence Interval of 95% as a criterion for accepting associations. Poisson regression was used as an analytical strategy to obtain the prevalence ratio. Results: the prevalence of the delay on the eruption was 10.29%. There was a positive association between LBW and occurrence of DEDT among children with less than 24 months, both in the unadjusted model (PR=2.07, 95%CI= 0.96 4.44) as in the adjusted (adjusted PR=2, 27, 95%CI= 1.02 5.07). Conclusions: the variables of development and nutritional at birth and during the early life may be important predictors of the chronology of eruption. Further investigations should be carried out towards the adequate evaluation of the LBW role in the occurrence of the delay on the eruption.

Resumo Objetivos: analisar a associação entre o Baixo Peso ao Nascer (BPN) e a ocorrência de atraso na erupção da dentição decídua (AED) em crianças de 04 a 30 meses, residentes em Salvador-BA. Métodos: estudo transversal envolvendo 520 crianças que frequentavam creches públicas, privadas e filantrópicas de dois Distritos Sanitários de Salvador-Ba. Procedeu-se a análise descritiva e regressão logística não-condicional para estimação da oddsratios (ORs), empregando-se o Intervalo de Confiança a 95% como critério para aceitar as associações. A regressão de Poisson foi utilizada como estratégia analítica para obtenção da Razão de Prevalência. Resultados: a prevalência de atraso na erupção foi de 10,29%. Verificou-se uma associa-ção positiva entre BPN e ocorrência de AED entre as crianças com menos de 24 meses no modelo bruto (RP=2,07, IC95%= 0,96 4,44) e ajustado (RP ajustada=2,27, IC95%= 1,02 5,07). Conclusões: variáveis de desenvolvimento e nutricionais ao nascimento e durante a vida precoce podem ser importantes preditores do tempo de erupção, sendo necessárias outras investigações para uma adequada avaliação desta associação.

Métodos para detectar a doença cárie em populações: uma revisão da literatura / Methods to detect caries disease in populations: a review of the literature

Introdução: métodos para mensurar a cárie são essenciais na produção do conhecimento sobre a doença, na observação da sua distribuição nos diferentes lugares e populações, na investigação dos fatores de risco, bem como no adequado planejamento em saúde bucal. Objetivo: realizar uma revisão de literatura no intuito de atualizar o conhecimento científico produzido sobre este tema nos últimos dez anos de forma a contribuir para a escolha do melhor método para mensurar cárie em populações. Metodologia: pesquisou-se nas bases de dados SciELO e PubMed os descritores, cárie dentária, índice CPO, inquérito epidemiológico de cárie. O critério de seleção dos artigos foi a proposição de um novo método para mensurar cárie. Resultados: foram selecionados 12 estudos que utilizaram diferentes métodos, foram descritas as vantagens e ou desvantagens de cada um deles. Conclusão: a existência na literatura de tantos novos métodos demonstra que não existe um consenso a respeito de qual é o melhor para mensurar a cárie, dificultando a comparação dos resultados entre as populações

Introduction: methods for measuring caries are essential for the detection of caries in epidemiological surveys in population groups. These methods are important in the production of knowledge about the disease, in the investigation of risk factors, as well as in oral health planning. Objective: to carry out a literature review to update the knowledge on the subject with articles produced in the last 10 years. Methodology: the descriptors, DMF index, caries dental; caries health surveys were searched in the SciELO and PubMed databases The criterion of selection of the articles was the proposition of a new method to measure caries. Results: we selected 12 studies and described the advantages and disadvantages of each one. Conclusion: the existence in the literature of so many new methods demonstrates that there is no consensus on the best way to measure caries, making it difficult to compare results among populations

Oral health status of pregnant and puerperal women in the municipality of Feira de Santana, at three different times between 2005 and 2015. / Condição bucal de gestantes e puérperas no município de Feira de Santana, em três diferentes períodos entre os anos de 2005 e 2015.

OBJECTIVE: to evaluate the oral health condition of pregnant/postpartum women attending public services in the city of Feira de Santana, BA, Brazil, at three different times between 2005 and 2015. METHODS: this is a study socioeconomic and demographic characteristics, health condition and health care, lifestyle and oral health status of 1,245 participants obtained from a database of three previous investigations: I Intervention Study (2005-2007); II Case-Control Study (2010-2011); III Case-Control Study (2012-2015). RESULTS: comparing the three periods, the frequency of gingivitis (24.41% versus 8.90% versus 5.77%; p<0.01) and periodontitis (44.64% vs 9.16% vs 11.55%; p<0.01) was found to decrease; the worst dental conditions regarding the number of teeth present, healthy and extracted and the DMFT index were found in period III compared to period II. CONCLUSION: an improvement was seen in the participants' periodontal condition over time, which coincides with the implementation of policies pertaining to women's health, oral health and income redistribution in this city.

The knowledge and use of population-based methods for caries detection.

BACKGROUND: Since the 1980s, a wide variety of methods have been proposed to measure dental caries in the population, demonstrating a lack of consensus regarding the procedure that should be used for this purpose. The current study investigated the methods that are known and used by public oral health researchers and professors as well as the reasons that lead to the choice of a particular method. METHOD: In the context of an interview, a questionnaire was administered to public oral health researchers and professors who used caries indices and worked in Salvador and Feira de Santana, Bahia, Brazil from 2005 to 2015. A quantitative and descriptive approach was applied that adopted the multiple correspondence analysis (MCA) technique to assess the associations among responses. RESULTS: The decayed, missing, and filled index (DMF) was the only measurement known by all respondents, and although 45 of the 47 professors/researchers were dissatisfied with this index, only six had used other methods. This index was chosen because of its comparability and ease of application. The MCA revealed response associations among older, male participants who graduated from the Federal University of Bahia (UFBA) and who continued to use this index because of its comparability and because it is the index recommended by the World Health Organization (WHO) and the Brazilian Ministry of Health (MS). Another group was also observed that consisted of younger females who graduated from the State University of Feira de Santana (UEFS) or another university and who used the DMF because it is well-known, simple, and easy to apply. CONCLUSIONS: The DMF index was the most known and used method. Many respondents demonstrated a desire for change and were critical of the DMF; however, they did not know of and had not used newer methods for measuring dental caries. Greater importance should be placed on the problem of dental caries assessment in the population.

Comparison of caries lesion detection methods in epidemiological surveys: CAST, ICDAS and DMF.

BACKGROUND: Although dental caries is a globally widespread disease, there is no consensus regarding the method that should be used for their detection. In recent decades, a variety of new methods have been proposed for measuring caries in a population. Three caries detection methods, the decayed, missing and filled (DMF) index, the International Caries Detection and Assessment System (ICDAS) and the Caries Assessment Spectrum and Treatment (CAST), were compared to provide information to guide future method choices. METHODS: This was a descriptive, cross-sectional study in which three methods were used to measure caries in students, staff and their dependents at UNEB (State University of Bahia), Salvador, Brazil. We compared the mean application time of each method and the frequencies obtained by each method using the following indicators: the most severe caries lesion per individual; the mean number of missing, filled and decayed teeth; and the disease extent. RESULTS: The mean time taken to apply the DMF was 3.8 min; for ICDAS, it took 8.9 min, and for CAST, 4.7 min. When calculating the indicator the most severe caries lesion per individual, the prevalence rates were as follows: 28.1% for DMF, 84.0% for ICDAS and 75.0% for CAST. The mean numbers of decayed, missing and filled teeth were 6.0 according to the DMF, 6.2 according to ICDAS and 5.9 according to CAST. When the disease extension indicator was used, the following percentages of teeth were affected by caries: DMF 22.12%, ICDAS 49.11% and CAST 33.2%. CONCLUSIONS: The DMF underestimated the occurrence of caries lesions in individuals but was the fastest method to apply. ICDAS obtained detailed information regarding lesion severity, but it was a time-consuming method and difficult to analyse. CAST described disease distributions very well and identified lesion severities and preventive and curative needs in the examined group, and the time required to apply CAST was similar to that of the DMF.

Association between periodontitis and severe asthma in adults: A case-control study.

OBJECTIVE: To evaluate the association between periodontitis and severe asthma, with participants in treatment for severe asthma, controlled by therapy. METHODS: A case-control investigation was performed to compare 130 adults with severe asthma with 130 without asthma. Individuals with periodontitis were those with ≥4 teeth with ≥1 site with probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding upon probing at the same site. Severe asthma diagnosis was based on Global Initiative for Asthma criteria. RESULTS: Association between exposure to periodontitis and severe asthma was found: ORcrude  = 2.98 (95% CI: 1.74-5.11). When confounders were considered, the association between exposure to periodontitis and severe asthma was maintained: ORadjusted  = 3.01-3.25. Individuals with periodontitis had about a threefold increased risk of severe asthma than those without periodontitis. Frequency of periodontitis in participants with severe asthma was greater than that of those without asthma (46.6% vs 22.3%, p ≤ .05). CONCLUSIONS: Association between periodontitis and severe asthma was observed. Further investigation is required to determine the direction of this relationship. It may be causal, but it may also be a consequence of the immunopathological process that characterizes asthma, or else, consequence of the medication used for treatment.

Condição bucal de gestantes e puérperas no município de Feira de Santana, em três diferentes períodos entre os anos de 2005 e 2015 / Condición bucal de gestantes y puérperas en el municipio de Feira de Santana, en tres diferentes momentos entre los años 2005 y 2015 / Oral health status of pregnant and puerperal women in the municipality of Feira de Santana, at three different times between 2005 and 2015

Objetivo: avaliar a condição bucal de gestantes e puérperas, usuárias de serviços públicos de saúde de Feira de Santana, BA, Brasil, em três momentos distintos do período 2005-2015. Métodos: estudo sobre características socioeconômico-demográficas, condição e cuidado com a saúde, estilo de vida e condição bucal de 1.245 participantes, obtidas de banco de dados de três investigações - I Estudo de intervenção (2005-2007), II Estudo caso-controle (2010-2011), III Estudo caso-controle (2012-2015). Resultados: comparando-se os três períodos, as frequências de gengivite (24,41% versus 8,90% versus 5,77%; p<0,01) e periodontite (44,64% vs 9,16% vs 11,55%; p<0,01) diminuíram; relativamente à condição dentária, as piores situações no número de dentes presentes, hígidos, extraídos e índice CPO-D observaram-se no período III, comparativamente ao período II. Conclusão: a condição periodontal melhorou nos anos estudados, coincidentemente com o processo de implantação de políticas de assistência pré-natal, saúde da mulher e saúde bucal, e de redistribuição de renda no município.

Objetivo: evaluar la condición bucal de gestantes y puérperas, usuarias de servicios públicos de salud de la ciudad de Feira de Santana/BA, en tres momentos distintos comprendidos entre 2005 y 2015. Metodos: se trata de un estudio con información sobre características socioeconómicas-demográficas, de condición y cuidado com la salud, de estilo de vida y de condición bucal de 1245 participantes obtenidas en un banco de datos de tres investigaciones previas: I (2005-2007), II (2010-2011), III (2012-2015). Resultados: tanto la frecuencia de gingivitis (24,41% versus 8,90% versus 5,77%; p<0,01) y periodontitis (44,64% vs 9,16% vs 11,55%; p<0,01) disminuyó; em relación a la condición dental, las peores situaciones en cuanto al número de dientes presentes, hígidos, extraídos y el índice CPO-D se observaron en el período III, en comparación con las del período II. Conclusión: se há mejorado la condición periodontal a lo largo de los años, período que coincide com el proceso de implantación de políticas de salud de la mujer, salud bucal, así como redistribución de ingresos en el municipio.

Objective: to evaluate the oral health condition of pregnant/postpartum women attending public services in the city of Feira de Santana, BA, Brazil, at three different times between 2005 and 2015. Methods: this is a study socioeconomic and demographic characteristics, health condition and health care, lifestyle and oral health status of 1,245 participants obtained from a database of three previous investigations: I Intervention Study (2005-2007); II Case-Control Study (2010-2011); III Case-Control Study (2012-2015). Results: comparing the three periods, the frequency of gingivitis (24.41% versus 8.90% versus 5.77%; p<0.01) and periodontitis (44.64% vs 9.16% vs 11.55%; p<0.01) was found to decrease; the worst dental conditions regarding the number of teeth present, healthy and extracted and the DMFT index were found in period III compared to period II. Conclusion: an improvement was seen in the participants' periodontal condition over time, which coincides with the implementation of policies pertaining to women's health, oral health and income redistribution in this city.

Risk factors for caries-free time: longitudinal study in early childhood.

OBJECTIVE: To estimate time in days from the beginning of follow-up up to the development of dental caries in children under 30 months and to assess risk factors potentially affecting the development of the disease. METHODS: The study population of the cohort study were children attending public, private, and charitable day care centers in Salvador, Northeastern Brazil, followed up for fourteen months. We used the multivariate Cox regression to estimate risk and Kaplan-Meier method to estimate the caries-free time. RESULTS: Of the 495 children studied, 112 developed caries (22.6%). Mean caries-free time was 248.6 (SD = 96.2) days. The comparasion of curves by age group (> 24 months) and children attending public day care showed more caries in a shorter period (p < 0.00). The following variables were important risk factors for increased rate of caries: district of origin (HR = 1.88, 95%CI 1.27-2.77), category of day care (HR = 3.88, 95%CI 2.04-7.38), age (HR = 1.77, 95%CI 1.15-2.74), bottle-feeding before sleep time after the age of 12 months (HR = 1.62, 95%CI 1.04-2.51), presence of active white spots (HR = 2.70, 95%CI 1.07-6.80), and living in non-masonry house (HR = 1.68, 95%CI 1.02-2.76). The highest hazard ratio (HR = 4.60, 95%CI 2.80-7.42) was found for previous caries experience. CONCLUSIONS: Social variables were considered as of high risk for the development of dental caries.

Situação de saúde bucal de crianças na primeira infância em creches de Salvador, Bahia / Oral health status of early childhood children fo day care centers in Salvador, Bahia / Situación de salud bucal de niños en la primera infancia en guarderías de Salvador, Bahia

A cárie dental permanece como um grave problema de saúde pública que acomete a primeira infância. Este estudo tem como objetivo descrever a situação de saúde bucal no exame inicial de crianças de quatro a trinta meses de idade, participantes de estudo de coorte prospectivo, realizado para analisar a associação entre fatores de risco sociodemográficos e comportamentais e a ocorrência de cárie dental. Foram incluídos 556 indivíduos matriculados em creches públicas, privadas e filantrópicas do município de Salvador, Bahia. No exame clínico avaliaram-se: defeitos de formação do esmalte (hipoplasia), placa bacteriana visível, mancha branca ativa, cárie e traumatismo dental. Os dados sobre condições familiares de vida, hábitos de higiene bucal e alimentação infantil foram obtidos mediante uso de questionário. A prevalência de cárie foi de 7,9% e a média de dentes acometidos foi de 0,18, com expressivo aumento por faixa etária. As variáveis que apresentaram associação positiva e estatisticamente significante com a experiência de cárie foram: a idade da criança, escolaridade da mãe, e período mais prolongado de aleitamento artificial, noturno e durante o sono. As prevalências de placa bacteriana visível, mancha branca ativa e trauma dental foram respectivamente, 79,4%, 5,6% e 15,1%. A situação de saúde bucal na primeira infância é complexa e envolve aspectos biológicos, comportamentais, sociais e culturais sendo necessário ampliar o conhecimento sobre os fatores potenciais de risco à saúde bucal nos primeiros anos de vida, resultando em ações multidisciplinares de promoção da saúde no próprio ambiente da creche e maior efetividade dos serviços de atenção à saúde bucal.

Dental caries remains a major public health problem that affects early childhood. This study aims to describe the oral health status on the initial exam of a group of children from 4 to 30 months old who took part in a cohort prospective study aimed at analyzing the association between sociodemographic and behavioral risk factors and dental caries occurrence. Five hundred and fifty-six subjects who attended public, private or philanthropic day care centers in Salvador, Bahia. Enamel defects (hypoplasia), visible bacterial plaque, active white spot, caries and dental trauma were evaluated on the clinical exam. Data on family living conditions, oral hygiene habits and child feeding were gathered through questionnaires answered by the subject's mother or legal guardian. Caries prevalence was 7.9%, increasing with age. Statistically significant positive associations were found for caries occurrence and the following variables: children's age, mothers' educational level and longer artificial milk feeding, nocturnal and during sleep. Visible bacterial plaque, active white spot and dental trauma prevalence was found to be respectively 79,4%, 5,6% and 15.1%. Oral health status in early childhood is a complex issue comprising biological, behavioral, social and cultural aspects being necessary to expand the knowledge about potential oral health risk factors in early childhood, resulting in multidisciplinary actions aimed at both promoting health in the day care centers and enhancing effectiveness in oral health services.

La caries dental sigue siendo un problema importante de salud pública que afecta a la primera infancia. Este estudio tiene el objetivo de describir la situación de la salud bucal en el examen inicial de niños de cuatro a treinta meses de edad, participantes de estudio de cohorte prospectivo. Incluyeronse 556 individuos inscritos en las guarderías públicas, privadas y filantrópicas en la ciudad de Salvador, Bahia. En el examen clínico fueron evaluados: defectos de la formación del esmalte (hipoplasia), placa bacteriana visible, mancha blanca activa, caries dentales y trauma dental. Los datos sobre las condiciones familiares de vida, los hábitos de higiene bucal y la alimentación infantil fueron obtenidos por medio del cuestionario. La prevalencia de caries fue del 7,9% y la media de dientes acometidos fue 0.18, con un aumento significativo por grupo de edad. Las variables que mostraron una asociación positiva y estadísticamente significativa con la experiencia de caries fueron: la edad del niño, escolaridad de la madre, y período de lactancia artificial prolongado, nocturno y durante el sueño. Las prevalencias de placa bacteriana visible, mancha blanca activa y traumatismos dentales fueron, respectivamente, 79,4%, 5,6% y el 15,1%. El estado de salud bucal en la primera infancia es complejo e incluye aspectos biológicos, comportamentales, sociales y culturales siendo necesario ampliar el conocimiento sobre los posibles factores de riesgo para la salud bucal en la primera infancia, resultando en acciones multidisciplinarias de promoción de la salud en el propio ambiente de la guardería y mayor eficacia de los servicios de atención a la salud bucal.

Risk factors for caries-free time: longitudinal study in early childhood

ABSTRACT OBJECTIVE To estimate time in days from the beginning of follow-up up to the development of dental caries in children under 30 months and to assess risk factors potentially affecting the development of the disease. METHODS The study population of the cohort study were children attending public, private, and charitable day care centers in Salvador, Northeastern Brazil, followed up for fourteen months. We used the multivariate Cox regression to estimate risk and Kaplan-Meier method to estimate the caries-free time. RESULTS Of the 495 children studied, 112 developed caries (22.6%). Mean caries-free time was 248.6 (SD = 96.2) days. The comparasion of curves by age group (> 24 months) and children attending public day care showed more caries in a shorter period (p < 0.00). The following variables were important risk factors for increased rate of caries: district of origin (HR = 1.88, 95%CI 1.27-2.77), category of day care (HR = 3.88, 95%CI 2.04-7.38), age (HR = 1.77, 95%CI 1.15-2.74), bottle-feeding before sleep time after the age of 12 months (HR = 1.62, 95%CI 1.04-2.51), presence of active white spots (HR = 2.70, 95%CI 1.07-6.80), and living in non-masonry house (HR = 1.68, 95%CI 1.02-2.76). The highest hazard ratio (HR = 4.60, 95%CI 2.80-7.42) was found for previous caries experience. CONCLUSIONS Social variables were considered as of high risk for the development of dental caries.

Fatores de risco para a cárie dental em crianças na primeira infância, salvador - Ba / Risk factors for dental caries in early childhood in salvador, in the brazilian state of bahia

Objetivos: identificar fatores associados a incidência de cárie na primeira infância. Métodos: realizou-se estudo de coorte prospectivo (14 meses) com 495 crianças de 4 a 30 meses de creches públicas, privadas e filantrópicas em Salvador-BA. Resultados: a média de dentes cariados foi de 0,18 (DP=0,75) no início do estudo e 0,55 (DP=1,40) ao final. A incidência em crianças livres de cárie foi 18,5 por cento e no grupo total 22,6 por cento. Na análise de regressão logística, consideraram-se três modelos. Com todas as crianças (N=495), prevaleceu: experiência prévia de cárie (OR=6,8; IC95 por cento= 3,0-15,1), frequentar creche pública (OR=2,9; IC95 por cento= 1,6-5,3), idade maior 24 meses. No segundo, de creches públicas (N=329): idade, aleitamento durante o sono (OR=1,9; IC95 por cento= 1,1-3,2), mancha branca (OR=3,5; IC95 por cento= 1,1-11,3), casa sem revestimento (OR=2,3; IC95 por cento= 1,2-4,1) e experiência prévia de cárie(OR=3,9; IC95 por cento= 1,5-10,6). No terceiro, com crianças sem cárie no início (N=495): frequentar creche pública, idade, cor da pele negra/ parda (OR=5,5; IC95 por cento= 1,3-23,8) e aleitamento durante o sono após um ano (OR= 1,7; IC95 por cento= 1,0-2,8). Conclusões: a vulnerabilidade social foi um forte fator de risco à cárie em crianças menores de dois anos e é necessária melhoria das condições de vida e ações de promoção de saúde bucal para redução da morbidade.

Objectives: to identify factors associated with the incidence of caries in early childhood. Methods: a prospective (14 months) cohort study was conducted with 495 children aged between 4 and 30 months in public, private and philanthropic crèches in Salvador-Bahia. Results: the mean number of teeth with caries was 0.18 (SD=0.75) at the start of the study and 0.55 (SD=1.40) at the end. The incidence in children originally free of caries was 18.5 percent and 22.6 percent in the group as a whole. Three models were considered for logistic regression analysis. In the group as a whole (N=495), the most prevalent factors were prior experience of caries (OR=6.8; CI95 percent= 3.0-15.1), attending a public crèche (OR=2.9; CI95 percent= 1.6-5.3), and age > 24 months. In the second model, attending a public crèche (N=329): age, breastfeeding during sleep (OR=1.9; CI95 percent= 1.1-3.2), white stains (OR=3.5; CI95 percent= 1.1-11.3), a home without adequate shelter (OR=2.3; CI95 percent= 1.2-4.1) and prior experience of caries (OR=3.9; CI95 percent= 1.5-10.6) were the main factors. And, in the third model, children without caries at the start of the study(N=495), the main factors were attending a public crèche, age, dark skin color (OR=5.5; CI95 percent= 1.3-23.8) and breastfeeding during sleep after one year(OR= 1.7; CI95 percent= 1.0-2.8). Conclusions: social vulnerability was found to be a powerful risk factor for caries in children under two years of age. Action needs to be taken to improve living conditions and promote dental health in order to reduce morbidity.