Dental caries and developmental defects of enamel in cerebral palsy: A meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to compare the occurrence of dental caries and developmental defects of enamel (DDE) in individuals with and without cerebral palsy (CP). MATERIALS AND METHODS: We conducted searches across five databases and the grey literature. Data were organized using EndNote 20. Reporting followed the MOOSE checklist. A random-effects model meta-analyses were conducted using RStudio, presenting results as mean difference (MD), odds ratio (OR), and 95% confidence interval (CI). The risk of bias of studies was analyzed using the Newcastle-Ottawa Scale, and the certainty of evidence was assessed using GRADE. RESULTS: Among 1336 identified records, 25 studies involving 59,997 participants (mean age: 11.1 years) were included. Data of 12 were pooled into meta-analyses. No significant differences were found between CP and non-CP individuals across indices: DMFT (k = 7) (MD = 0.31; 95% CI [-0.42-1.05]), dmft (k = 4) (MD = 0.31; 95% CI [-0.50-1.14]), DMFS (k = 2) (MD = -0.61; 95% CI [-20.56-19.33]), dmfs (k = 3) (MD = 0.54; 95% CI [-1.09-2.17]), and DDE (k = 3) (OR = 0.80, 95% CI [0.09-7.31]). The certainty of evidence was very low. CONCLUSION: Individuals with CP do not appear to differ significantly from those without CP in terms of dental caries experience and DDE.

Contextual and individual determinants of oral health-related quality of life among adolescents.

The aim of this study was to assess the factors associated with oral health-related quality of life in adolescents (OHRQoL). Individual data on adolescents were collected from a secondary database. OHRQoL was measured using the oral impact on daily performance (OIDP) scale. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health. The individual covariates analyzed were sex, age, skin color, maternal education, household income, number of people per room in the housing unit, dental attendance, self-perception of dental needs, untreated dental caries, and gingival bleeding. The contextual variables included the allocation factor, the Human Development Index (HDI), Gini coefficient, illiteracy, unemployment, income, average number of emergency dental visits per inhabitant, access to a sanitary sewer system, garbage collection, primary health care coverage, oral health team coverage, and number of tooth extractions between selected dental procedures and supervised toothbrushing. Unadjusted and adjusted multilevel Poisson regression analyses were used to evaluate the relationship between contextual and individual variables with overall OIDP scores (STATA version 16.0) - rate ratio (RR) and 95%CI. The mean OIDP score was 0.72 and the prevalence was 31.8%. There was an association between supervised toothbrushing average and the outcome (RR 0.95; 95%CI 0.91­0.99). Moreover, adolescents who lived in municipalities with the highest average number of emergency dental visits per inhabitant showed a higher OIDP. Sex, maternal education, untreated dental caries, and gingival bleeding were associated with OIDP. In addition, intersectoral public policies focusing on the reduction of social inequalities should be on the agenda of policymakers and stakeholders.

Contextual and individual determinants of oral health-related quality of life among adolescents

Abstract The aim of this study was to assess the factors associated with oral health-related quality of life in adolescents (OHRQoL). Individual data on adolescents were collected from a secondary database. OHRQoL was measured using the oral impact on daily performance (OIDP) scale. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health. The individual covariates analyzed were sex, age, skin color, maternal education, household income, number of people per room in the housing unit, dental attendance, self-perception of dental needs, untreated dental caries, and gingival bleeding. The contextual variables included the allocation factor, the Human Development Index (HDI), Gini coefficient, illiteracy, unemployment, income, average number of emergency dental visits per inhabitant, access to a sanitary sewer system, garbage collection, primary health care coverage, oral health team coverage, and number of tooth extractions between selected dental procedures and supervised toothbrushing. Unadjusted and adjusted multilevel Poisson regression analyses were used to evaluate the relationship between contextual and individual variables with overall OIDP scores (STATA version 16.0) - rate ratio (RR) and 95%CI. The mean OIDP score was 0.72 and the prevalence was 31.8%. There was an association between supervised toothbrushing average and the outcome (RR 0.95; 95%CI 0.91-0.99). Moreover, adolescents who lived in municipalities with the highest average number of emergency dental visits per inhabitant showed a higher OIDP. Sex, maternal education, untreated dental caries, and gingival bleeding were associated with OIDP. In addition, intersectoral public policies focusing on the reduction of social inequalities should be on the agenda of policymakers and stakeholders.

Factors associated with toothache in 12-year-old adolescents in a southeastern state of Brazil.

This cross-sectional study evaluated factors associated with toothache in 12-year-old adolescents from the state of Minas Gerais in Brazil. Secondary data were collected from the SB Minas Gerais 2012 epidemiological survey. The dependent variable was toothache in the past 6 months. The independent variables were grouped into two levels: individual (sex, ethnic group, family income, periodontal condition, dental caries, dental treatment needs, and type of service used) and contextual (allocation factor, Human Development Index, Gini coefficient, gross domestic product, unemployment, illiteracy, basic sanitation, garbage collection, family income, half or a quarter of a minimum wage, primary healthcare coverage, primary oral healthcare team coverage, oral health technician, access to individual dental care, and supervised tooth brushing). A multilevel analysis was performed using the Hierarchical Linear and Nonlinear Modeling Software Program to assess the association of individual and contextual variables with toothache in the last 6 months. The prevalence of toothache in the last six months among the adolescents of this study was 19.1%. An association was found with family income (p <0.001), dental caries (p <0.001), primary oral healthcare team coverage (p = 0.015) and oral health technician (p = 0.008). Socioeconomic conditions and the most prevalent oral diseases, such as dental caries, as well as the use of public services, were related to toothache in adolescents aged 12 years. These findings reinforce the need to develop and implement public policies to address the oral health problems of this population.

Malocclusion characteristics amongst individuals with autism spectrum disorder: a systematic review and meta-analysis.

BACKGROUND: To estimate the prevalence of malocclusion in individuals with autism spectrum disorders (ASD) and to assess the relationship between ASD and malocclusion. METHODS: We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane, Embase, SciELO LILACS, Proquest, OpenGrey and Google Scholar. There were no language or publication dates restrictions. Two researchers independently performed selection, data extraction and quality assessment. Quality assessment and risk of bias were evaluated through the Newcastle-Ottawa scale and ROBINS-E tool. Meta-analyses using random effect models were used to estimate pooled measures of prevalence of malocclusion characteristics in individuals with ASD and pooled odds ratio (OR) on the relationship between ASD and malocclusion characteristics. Subgroup meta-analyses were conducted according to children and adolescents, history of orthodontic treatment, and occurrence of other syndromes and medical conditions. RESULTS: Searching identified 5549 papers with 238 were selected for full assessment. Eighteen cross-sectional studies were included according to inclusion criteria. Of them, eleven studies were considered of moderate quality. A judgement of critical risk of bias occurred for thirteen studies. The most prevalent malocclusion characteristics in individuals with ASD were crowding (33%; 95% CI 22 to 44%) and increased maxillary overjet (39%; 95% CI 23 to 54%). Individuals with ASD had higher odds of Angle's Class II (OR 1.92; 95% CI 1.36 to 2.72), Angle's Class III (OR 2.33; 95% CI 1.29 to 4.23), open bite (OR 1.96; 95% CI 1.21 to 3.16), and increased maxillary overjet (OR 1.53; 95% CI 1.06 to 2.21) than individuals without ASD. CONCLUSIONS: Angle's Class II, Angle's Class III, anterior open bite and increased maxillary overjet were more prevalent in individuals with ASD than those without ASD. Further high-quality studies are needed.

Oral health issues in children and adolescents with vision impairment: A systematic review and meta-analysis.

BACKGROUND: Children and adolescents with vision impairment (VI) may be at increased risk of oral health issues, such as periodontal inflammation, poor oral hygiene, dental caries, and dental trauma, but this is inconclusive in the literature. AIM: To systematically review the literature to determine the main oral health issues of children and adolescents with VI compared to those without VI. DESIGN: Electronic and manual searches were performed to identify observational studies involving children and adolescents with and without VI, to determine and compare their oral health issues. The methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. Studies that had homogeneity of methods were incorporated into meta-analyses. RESULTS: Fifteen cross-sectional studies were included. Overall, most studies presented methodological flaws and high risk of bias. The meta-analysis showed that children and adolescents with VI were 3.86 times as likely to exhibit dental trauma (OR = 3.86, 95% CI = 2.63-5.68, I2  = 0%) and had higher/poorer values for plaque (MD = 0.80, 95% CI = 0.58-1.02, I2  = 96%), gingivitis (MD = 0.69, 95% CI = 0.02-1.37, I2  = 100%), calculus (MD = 0.04, 95% CI = 0.03-0.06, I2  = 0%), and oral hygiene indices (MD = 0.71, 95% CI = 0.24-1.18, I2  = 97%), as well as DMFS (MD = 0.90, 95% CI = 0.68-1.13, I2  = 26%). CONCLUSION: Across a wide array of assessments, children and adolescents with vision impairment had worse oral health outcomes than those without VI.

Occurrence of bruxism in individuals with autism spectrum disorder: A systematic review and meta-analysis.

AIMS: To investigate bruxism in individuals with autism spectrum disorder (ASD) and neurotypical individuals. METHODS AND RESULTS: Searches were conducted in the MedLine via Ovid, Embase via Ovid, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Latin American and Caribbean Health Sciences (LILACS), Brazilian Library of Dentistry (BBO) and SciELO databases, grey literature and a hand search up to December 2020 with no restrictions imposed regarding language or year of publication (CRD42020211307). For the meta-analysis, the frequency of bruxism was extracted, with the calculation of odds ratios (OR) and 95% confidence intervals (CI) using a random effects model in RevManager. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Seventeen case-control studies were included in the qualitative synthesis and 15 were included in the meta-analysis, totaling a population of 3850 individuals. The ASD group was more likely to develop bruxism than the controls (OR: 3.80; 95% CI: 2.06-7.01). The certainty of the evidence was classified as "very low" for the occurrence of bruxism between ASD and control individuals. CONCLUSION: It is uncertain whether individuals with ASD are more likely to have bruxism than healthy controls.

Malocclusion in individuals with osteogenesis imperfecta: A systematic review and meta-analysis.

OBJECTIVE: To evaluate whether individuals with osteogenesis imperfecta (OI) are more affected by malocclusion than individuals without OI. MATERIALS AND METHODS: Searches in PubMed, Ovid, Web of Science, Scopus, Lilacs and gray literature were performed. Data extraction was conducted by two researchers. Risk of bias assessment employing the Newcastle-Ottawa Scale and meta-analysis were conducted. Results were provided with mean difference (MD), odds ratio (OR) and 95% confidence interval (CI). Strength of evidence was determined. RESULTS: Six cross-sectional studies were included. In comparison with individuals without OI, the group with OI had 19.69-fold greater chance of exhibiting Angle Class III malocclusion (OR = 19.69, CI: 9.00-43.09) and presenting anterior crossbite greater (MD = 6.08, CI: 2.40-9.77). Individuals without OI had a significantly greater ANB angle (MD = 3.88, CI: 1.15-6.61) and SNA angle (MD = 2.11, CI: 0.24-3.98) in comparison with those with OI. No difference between groups was found for SNB (MD = -0.50, CI: -2.21 to 1.21) and open bite (MD = 0.98, CI: -0.29 to 2.25). Most studies included had moderate methodological quality. Strength of evidence was low or very low. CONCLUSIONS: The occurrence of Angle Class III malocclusion and anterior crossbite was greater among individuals with OI compared to those without OI. These findings can assist stakeholders about the occlusal abnormalities affecting OI individuals.

Oral mucosal lesions in pregnant women: A population-based study.

OBJECTIVE: To evaluate the prevalence of oral mucosal lesions (OML) and oral self-examination and their associated factors among pregnant women from the 2015 Pelotas Birth Cohort Study, Brazil. METHODS: Pregnant women who would deliver babies in 2015 were included in the antenatal study. Data related to demographic, socio-economic and behavioural conditions were collected using questionnaires. Participants were also clinically assessed for oral health outcomes. The outcomes were the presence of OMLs and oral self-examination. Size, location, time of onset and symptomatology of the lesions were collected. Descriptive and bivariate analysis, and Poisson regression were performed. p-Value <0.05 was set to indicate statistical significance. RESULTS: Data from 2481 pregnant women were analysed. Four hundred and nine (16.5%) had at least one OML. The most prevalent lesions were exostosis (80/16.6%), coated tongue (70/14.5%) and benign oral brownish pigmentation (68/14.1%). Non-white skin colour was associated with a higher prevalence of OMLs (PR 1.3; 95% CI 1.1-1.6), while daily use of dental floss was positively associated with the prevalence of oral self-examination (PR 1.4; 95% CI 1.2; 1.5). CONCLUSIONS: Almost 20% of pregnant women presented OML, which were more prevalent in non-white individuals. Women with better oral care were more likely to perform oral self-examination.

Factors associated with toothache in 12-year-old adolescents in a southeastern state of Brazil

Abstract: This cross-sectional study evaluated factors associated with toothache in 12-year-old adolescents from the state of Minas Gerais in Brazil. Secondary data were collected from the SB Minas Gerais 2012 epidemiological survey. The dependent variable was toothache in the past 6 months. The independent variables were grouped into two levels: individual (sex, ethnic group, family income, periodontal condition, dental caries, dental treatment needs, and type of service used) and contextual (allocation factor, Human Development Index, Gini coefficient, gross domestic product, unemployment, illiteracy, basic sanitation, garbage collection, family income, half or a quarter of a minimum wage, primary healthcare coverage, primary oral healthcare team coverage, oral health technician, access to individual dental care, and supervised tooth brushing). A multilevel analysis was performed using the Hierarchical Linear and Nonlinear Modeling Software Program to assess the association of individual and contextual variables with toothache in the last 6 months. The prevalence of toothache in the last six months among the adolescents of this study was 19.1%. An association was found with family income (p <0.001), dental caries (p <0.001), primary oral healthcare team coverage (p = 0.015) and oral health technician (p = 0.008). Socioeconomic conditions and the most prevalent oral diseases, such as dental caries, as well as the use of public services, were related to toothache in adolescents aged 12 years. These findings reinforce the need to develop and implement public policies to address the oral health problems of this population.

Use and need of removable dental prostheses in an institutionalized Brazilian elderly population: a cross-sectional study.

The aim of this study was to assess the use and need of conventional removable prostheses (total and partial) and their associated factors among institutionalized elders. A cross-sectional study was conducted with 1003 elderly people living in non-profit private long-term care institutions in Belo Horizonte, Brazil. Inclusion criteria required a minimum Mini Mental State of Examination (MMSE) score of 21. After the test, 191 individuals were included. Oral examination and interviews were conducted to identify participants' use (throughout the day/every day) and need (do not have/have but do not use) of removable dental prostheses. Socioeconomic health indicators and behaviours were collected from institutional records and via interviews. Bivariate analysis was performed using chi-square test (p<0.05). Poisson regression with robust variance was used in multivariate analysis. Most elders were female (76.4%) and independent in their daily activities (56.5%). Elderly men (PR 1.26) and those whose dental visit was more than one year ago (PR 1.38) showed higher need of dental prostheses. Elderly women (PR 1.68) and individuals with morbidities (PR 1.33) had higher prostheses use. This study demonstrates how socio-demographic characteristics, health indicators, and oral health services impact the use and need of dental prostheses among elders and how these can contribute to public oral health policy development.

Contextual and individual factors associated with dental pain in adolescents from Southeastern Brazil.

The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Satisfação das gestantes durante a consulta odontológica no Sistema Unico de Saúde, Brasil / Satisfaction of pregnant women during dental consults in Brazilian Unified Health System / Satisfacción de las mujeres embarazadas durante la consulta odontológica en el Sistema Único de Salud de Brasil

RESUMO Objetivo O objetivo do trabalho foi verificar a taxa de gestantes satisfeitas com a consulta odontológica realizada no Sistema Único de Saúde (SUS-Brasil) e fatores associados. Metodologia O estudo foi do tipo transversal. Para coleta de dados foi elaborado um questionário abordando variáveis sociodemográficas e relacionadas a gestação. A coleta de dados foi realizada através de entrevistas face a face em um hospital maternidade da região metropolitana de Porto Alegre-RS-Brasil. O teste de qui-quadrado e a regressão de Poisson com variância robusta (p<0,05) foram utilizados nas análises bi e multivariada. Resultados Das 302 mulheres entrevistadas, 50%(n=151) realizaram consulta odontológica durante a gestação e destas, 86% (n=131) estavam satisfeitas com a consulta. Na análise multivariada verificou-se que a variável avaliação das consultas de pré-natal como boa aumentou em 14% [Razão de Prevalência (RP)=1,14; Intervalo de Confiança (IC) 95%:1,01-1,27] a probabilidade de as mulheres expressarem satisfação com a variável desfecho. Conclusão Conclui-se que foi alta taxa de satisfação com as consultas odontológicas realizadas no SUS pelas gestantes e avaliação das consultas de pré-natal como boa foi fator associado. Estes resultados poderiam ser considerados durante o planejamento estratégico, execução e avaliação das políticas de saúde direcionadas para este grupo operativo.

ABSTRACT Objective The study aimed to verify the rate of satisfaction among pregnant women with dental consults performed in the Brazilian Unified Health System (BUHS), and associated factors. Methodology The design of the study was cross-sectional. To collect data a questionnaire approaching variables sociodemographic and relationship whit pregnancy were used. The data gathering was realized across interviews face to face in a maternity hospital in the metropolitan region of Porto Alegre-RS-Brazil. The chi-square test and Poisson regression with robust variance (p<0.05) were used for the bivariate and multivariate analyses. Results A total of 302 pregnant women were interviewed, 50% (n=151) performed dental consults, and 86% (131) related that they were satisfied with the consult. In the multivariate analysis it was found that the variable evaluating prenatal visits as good increased the likelihood of women expressing satisfaction with the outcome variable by 14% [Prevalence Ratio (PR) =1.14; 95% Confidence Interval (CI): 1.01-1.27]. Conclusions The present study suggests that a high satisfaction rate with dental consult could be due to the highest satisfaction in prenatal consults performed in primary health care units, materializing the relationship of trust/connection between professional and user. This variable can be considered by workers and health managers during estrategic planning, performance, and evaluation of health policies.

RESUMEN Objetivo El objetivo del trabajo fue evaluar la tasa de mujeres embarazadas satisfechas con la consulta odontológica que realiza el Sistema Único de Salud-Brasil (SUS-Brasil) y factores asociados. Metodología Estudio de tipo transversal. Para colección de los dados se elaboró un cuestionario que abordaba las variables sociodemográficas y relacionadas con la gestación. La colección de los datos fue realizada por medio de entrevistas cara a cara en un hospital de maternidad de la región metropolitana del Porto Alegre, Brasil. Para comprobar la asociación de los factores con la satisfacción de las mujeres embarazadas con la consulta odontológica se usó el test de chi-cuadrado y la regresión del Poisson, con varianza robusta (p<0,05). Resultados De las 302 mujeres entrevistadas, 50% (n=151) realizaron consulta odontológica durante de la gestación y estas 86%(n=131) manifestaron estar satisfechas con la consulta. En el análisis multivariado se encontró que la variable que evaluaba las consultas prenatales como buenas aumentaba en un 14% [Razón de Prevalencia (RP)=1,14; Intervalo de Confianza (IC) del 95%:1,01-1,27] la probabilidad de que las mujeres expresaran satisfacción con la variable de resultado. Conclusiones Se concluyó que un alto índice de satisfacción con las consultas odontológicas realizadas en el SUS por parte de las embarazadas y la evaluación de las consultas prenatales como buenas fue un factor asociado. Estos resultados podrían ser considerados durante la planificación estratégica, ejecución y evaluación de las políticas de la salud pública direccionadas para este grupo operativo.

Socioeconomic and intraoral polarization of untreated caries and tooth loss among male adolescents.

The aim of this study was to investigate the intraoral distribution of untreated caries and tooth loss and estimate the impact of different socioeconomic factors on the occurrence of these outcomes. A cross-sectional study was conducted with 652 18-year-old male adolescents from the city of Sapucaia do Sul, Brazil, who conscripted for military service. The participants answered a questionnaire addressing sociodemographic variables. Two trained and calibrated examiners performed the clinical examinations for the diagnosis of dental caries using the criteria of the World Health Organization. Tooth group and adolescent were the units of analysis for the primary outcomes of the study. Poisson regression analysis with robust variance was performed, with the calculation of crude and adjusted prevalence ratios (PR) and 95% confidence intervals (CI). The prevalence of caries experience and untreated caries was 70.2% and 39.3%, respectively, and 9.4% of the adolescents had missing teeth. Sixty-seven percent of the untreated caries and 98.8% of missing teeth were in first molars. The probability of dental caries and tooth loss was significantly higher among adolescents with less schooling (PR = 2.56; 95%CI: 1.97-3.32 and PR = 3.28; 95%CI: 1.61-6.65, respectively) and those whose mothers had less schooling (PR = 1.31; 95%CI: 1.03-1.67 and PR = 2.30; 95%CI: 1.18-4.50, respectively). In conclusion, the occurrence of untreated dental caries and tooth loss was concentrated in the first molars of adolescents. Moreover, the prevalence of both conditions was higher among adolescents with low schooling and whose mothers had low schooling, reflecting the strong intraoral and socioeconomic polarization of these outcomes.

Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren.

This study aimed to identify the prevalence of molar-incisor hypomineralization (MIH) in schoolchildren and its association with dental caries experience. This was a cross-sectional study with a sample of 471 children aged 8 to 10 years. Data were collected via a sociodemographic questionnaire. Intra-oral clinical examination was done to identify and diagnose MIH (EAPD Criteria) as well as dental caries (ICDAS Index). Statistical analyses were performed with Person's Chi-square, Fisher's exact, and Mann-Whitney tests, and Poisson regression models were built. Statistical significance was set at an alpha-level of 0.05. The prevalence of MIH in our participants was 9.8%, with lesions being mostly of the mild form (65.2%) and affecting the first permanent molars but not the incisors in 54.2% of the children. Dental caries was observed in 88.1% of subjects. We observed a significant association between dental caries and the following variables: presence of MIH (p < 0.01; PR = 1.13), dental visit (p < 0.02; PR=0.92), and parents or legal guardians' education level (p < 0.05; PR = 1.07). A MIH diagnosis was also significantly associated with family income (p < 0.05; PR = 4.09). Children with MIH had more caries lesions on molar surfaces (p < 0.01; PR = 4.05). The prevalence of MIH was found to be moderate, based on previous studies, and the presence of enamel defect was associated with dental caries. The teeth most affected by MIH lesions were the first permanent molars.

Contextual and individual determinants of the need for endodontic treatment in adults in Brazil: A multilevel analysis.

AIM: To examine the relationship between contextual and individual determinants with the need for endodontic treatment in Brazilian adults. METHODS: Individual-level data from 6897 adults aged 35-44 years living in the Brazilian state capitals who participated in the Brazilian Oral Health Survey (SBBrasil 2010 Project) were combined with city-level data. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health according to the WHO model of social determinants of health. The association of independent variables with one or more teeth in need of endodontic treatment was evaluated using multilevel logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CI). RESULTS: The prevalence of the need for endodontic treatment was 7.7%. Adults living in cities with better contextual socioeconomic conditions (OR 0.82; 95% CI = 0.72-0.93) and better specialized dental services (OR 0.85; 95% CI = 0.77-0.95) were less likely to need endodontic treatment. Younger age, greater schooling and use of private dental services reduced the odds of need for endodontic treatment. Number of people per room, type of dental service and reason for the last dental visit were also associated with need of endodontic treatment. CONCLUSION: Contextual and individual factors were relevant determinants of endodontic treatment needs in adults.

Pathways to anterior open bite after changing of pacifier sucking habit in preschool children: A cohort study.

BACKGROUND: Pacifier use is a major cause of anterior open bite (AOB), which negatively impacts the quality of life of children affected. AIM: To assess the direct and indirect pathways related to pacifier sucking habit and AOB in preschool children. DESIGN: This 2-year cohort study evaluated a random sample of preschool children (2-5 years of age) from Southern Brazil. Caregivers answered a questionnaire addressing socio-economic and behavioural characteristics. Anterior open bite was recorded following the criteria recommended by Foster and Hamilton. Structural equation model was performed to assess the direct and indirect pathways among variables at baseline (T1) to predict the AOB at follow-up (T2). RESULTS: Regarding the AOB, 407 children were evaluated at T1 and 187 at T2. The prevalence of AOB was 32.9% at baseline and 16.0% at follow-up. The presence of AOB at follow-up was directly affected by the change in pacifier sucking habit from T1 to T2. Considering the indirect paths, the AOB at T1 influenced the AOB in T2 via a change of pacifier sucking habit. CONCLUSION: These findings suggest that the non-habit of sucking pacifiers is a fundamental strategy for the prevention of AOB as well as the promotion of health in childhood.

Top 100 most-cited papers in core dental public health journals: bibliometric analysis.

OBJECTIVE: This quali-quantitative study analysed the 100 most-cited papers in core dental public health (DPH) journals focusing on understanding international knowledge production. METHODS: The DPH journals were selected from titles and scopes at Web of Science Core Collection database up to March 2020. Further comparisons were performed at Scopus and Google Scholar databases. Some bibliometric parameters were extracted as follows: title, number of citations, citation density (number of citations per year), first author's country, year of publication, study design and subject. VOSviewer software was used to create graphical bibliometric maps. RESULTS: Papers were ranked by the total number of citations, which ranged from 104 to 1,019, and six papers were cited more than 400 times. Papers were published from 1974 to 2013, mainly in Community Dentistry and Oral Epidemiology. Most frequent study designs were cross-sectional (30%) and nonsystematic review (25%). Most papers were from Europe (54%) and North America (31%). First authors were predominantly from the United Kingdom (17%), United States of America (17%) and Canada (14%). VOSviewer map of co-authorship demonstrated the existence of clusters in the research collaboration. Although epidemiology was the most frequent subject (84%), health services research presented eight times higher citation density. CONCLUSIONS: Top 100 most-cited papers in core DPH journals were predominantly observational studies from Anglo-Saxon countries. Top 100 most-cited papers in core DPH journals tend to be cross-sectional studies carried out in the United States with highest citation in health services research. Locker D, Petersen PE and Sheiham A are a landmark for DPH field.

Contextual and individual factors associated with dental pain in adolescents from Southeastern Brazil

Abstract The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren

Abstract This study aimed to identify the prevalence of molar-incisor hypomineralization (MIH) in schoolchildren and its association with dental caries experience. This was a cross-sectional study with a sample of 471 children aged 8 to 10 years. Data were collected via a sociodemographic questionnaire. Intra-oral clinical examination was done to identify and diagnose MIH (EAPD Criteria) as well as dental caries (ICDAS Index). Statistical analyses were performed with Person's Chi-square, Fisher's exact, and Mann-Whitney tests, and Poisson regression models were built. Statistical significance was set at an alpha-level of 0.05. The prevalence of MIH in our participants was 9.8%, with lesions being mostly of the mild form (65.2%) and affecting the first permanent molars but not the incisors in 54.2% of the children. Dental caries was observed in 88.1% of subjects. We observed a significant association between dental caries and the following variables: presence of MIH (p < 0.01; PR = 1.13), dental visit (p < 0.02; PR=0.92), and parents or legal guardians' education level (p < 0.05; PR = 1.07). A MIH diagnosis was also significantly associated with family income (p < 0.05; PR = 4.09). Children with MIH had more caries lesions on molar surfaces (p < 0.01; PR = 4.05). The prevalence of MIH was found to be moderate, based on previous studies, and the presence of enamel defect was associated with dental caries. The teeth most affected by MIH lesions were the first permanent molars.