Association between Sense of Coherence and Caries Activity and Caries Experience among Male Adolescents from Southern Brazil: A Cross-Sectional Study.

INTRODUCTION: This cross-sectional study assessed the association between sense of coherence (SoC) and caries activity (number of active caries lesions) and caries experience (DMFT index) among 18-19-year-old male adolescents who joined the Brazilian Army as draftees for mandatory military service (n = 507). METHODS: Data collection included a questionnaire (level of education, family income, and tooth brushing frequency), the Brazilian short version of the SoC scale (SOC-13), and clinical caries examination (noncavitated/cavitated, inactive/active). The main predictor variable was SoC, categorized as low, moderate, or high. Poisson regression models were used for statistical analysis. RESULTS: A high SoC was significantly associated with a lower number of active lesions (adjusted rate ratio = 0.85; 95% CI = 0.74-0.98). No association between SoC and DMFT was detected. CONCLUSION: A high SoC was found to be a protective factor to caries activity in this population.

Association between socioeconomic status and traumatic dental injury in permanent teeth: A systematic review with meta-analysis.

OBJECTIVE: The aim of this study was to systematically review observational studies assessing the association between socioeconomic status (SES) and traumatic dental injuries (TDI) in permanent dentition. METHODS: Electronic searches were performed in PubMed, EMBASE, Web of Science, LILACS, CINAHL, COCHANE Library and ScoINDEX databases for articles published up to February 2023. Two independent reviewers performed the search and critical appraisal of the studies. The inclusion criteria were observational studies that evaluated the association between individual-level socioeconomic indicators and TDI (clinically examined) in permanent teeth. Quality assessment of included articles was conducted using the Newcastle-Ottawa Scale. Global meta-analysis was performed with all studies and different subgroup analysis based on socioeconomic indicators (household income, educational level or any other indicator), age (children, early adolescents, late adolescents or young adults) and economic classification of the country (high, upper-middle or lower-middle). A random-effects model was used to estimate pooled prevalence ratios (PR) and respective 95% confidence intervals (CI) for each study. RESULTS: The search strategy retrieved 11 315 publications. According to eligibility criteria, 17 articles were included in the meta-analysis. Individuals with low SES were 17% more likely to have TDI (PR 1.17; 95% CI 1.05-1.30). The subgroup analysis also revealed that the indicator (household income, PR 1.16; 95% CI 1.00-1.34) and the economic classification of the country (upper-middle, PR 1.19; 95% CI 1.07-1.33) influenced the association of SES with TDI occurrence. CONCLUSIONS: Individuals with lower SES were more likely to present with TDI in permanent dentition than those with higher SES.

Sense of coherence and oral health-related quality of life among southern Brazilian male adolescents.

This study evaluated the association between sense of coherence (SoC) and oral health-related quality of life (OHRQoL) among conscripts of the Brazilian Army, in two cities of southern Brazil. A cross-sectional study included all 18-19-year-old adolescents who joined the Brazilian Army as draftees for mandatory military service in the cities of Itaqui, RS, and Santiago, RS (n = 505). Data collection was conducted from 2019 to 2021, and included the application of questionnaires and a clinical oral examination to record gingivitis, malocclusion, and dental caries. OHRQoL was collected through the Brazilian short version of the Oral Health Impact Profile (OHIP), composed of 14 questions. The adolescents' SoC was assessed using the validated Brazilian version of the SOC-13 scale. The primary outcome of this study was OHRQoL, modeled as a discrete variable (OHIP-14 scores). The main predictor variable was SoC, categorized as low, moderate, or high. The association between predictor variables and OHRQoL was assessed by Poisson regression models using a hierarchical approach. Unadjusted and adjusted rate ratios (RR), and 95% confidence intervals (CI) were estimated. All the analyses were performed using STATA software version 14.2. Adolescents with a moderate and high SoC had 27% (RR = 0.73, 95%CI = 0.64-0.84) and 51% (RR = 0.49, 95%CI = 0.41-0.58) lower mean OHIP-14 scores, respectively, than those with a low SoC score, after the inclusion of behavioral and clinical variables. This study showed a significant association between SoC and OHRQoL among 18-19-year-old southern Brazilian adolescents. Strengthening the SoC as a psychosocial resource may improve the well-being and OHRQoL of adolescents.

Underlying Dentin Shadows (ICDAS 4) in Occlusal Surface of Permanent Teeth Have Low Progression Rate after 1-2 Years.

The aim of this prospective cohort study was to assess the radiographic progression of underlying dentin shadows (UDS) on the occlusal surfaces of permanent posterior teeth of adolescents and young adults over 1-2 years and to identify possible risk factors. A total of 149 UDS lesions (from 101 individuals) were included at baseline. Each participant had to present at least one UDS to be considered eligible for the study. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs, performed at baseline and after 1-2 years. The association between possible predictors and UDS progression (defined radiographically as an increase in the radiographic score from baseline to follow-up) was assessed using Weibull regression models. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated. A total of 81 individuals (mean age: 24.0, standard deviation: 8.03) were reexamined after 1-2 years (742 occlusal surfaces, of which 118 were UDS). The overall progression rate was 8.6% after 1-2 years, being 12.6% for UDS without baseline radiolucency and 20% for UDS with baseline radiolucency. The risk analysis showed that UDS without radiolucency at baseline had a similar likelihood of progression (adjusted HR = 1.71, 95% CI = 0.68-4.32, p = 0.26) while UDS with radiolucency at baseline were more likely to progress (adjusted HR = 2.96, 95% CI = 1.06-8.26, p = 0.04) than the reference category (sound occlusal surfaces without radiolucency). These estimates were adjusted for caries prevalence, tooth type, and arch. This study showed low progression rates of UDS after 1-2 years. The presence of radiolucency at baseline was found to predict UDS progression.

Factors associated with a cariogenic diet among adolescents: a structural equation modeling approach.

OBJECTIVE: To investigate the factors directly and indirectly associated with a cariogenic diet among southern Brazilian adolescents. MATERIALS AND METHODS: This cross-sectional study included 15-19-year-old students attending high schools in Santa Maria, southern Brazil. The participants completed a questionnaire on sociodemographic and behavioral variables. The Oral Health Impact Profile-14 was applied to collect data on oral health-related quality of life (OHRQoL). Clinical examination was used to assess the dental caries status (decayed, missing, and filled teeth index). A cariogenic diet was considered a latent variable measured by the self-perception of a healthy diet and the frequency of consumption of sugary foods and drinks. Structural equation modeling was used to analyze the direct and indirect pathways to a cariogenic diet. RESULTS: A total of 1197 adolescents were included. Low toothbrushing frequency (standardized coefficient (SC), 0.10; p < 0.05), cigarette smoking (SC, 0.15; p < 0.01), and alcoholic beverages (SC, 0.14; p < 0.01) were directly linked to a cariogenic diet, which, in turn, was directly linked to untreated dental caries (SC, 0.18; p < 0.01) and poor OHRQoL (SC, 0.16; p < 0.01). In addition, household income (via toothbrushing frequency) and age (via alcoholic beverages) were indirectly linked to a cariogenic diet. CONCLUSION: A cariogenic diet was consistently associated with a range of unhealthy behaviors during adolescence as well as poor household income. CLINICAL RELEVANCE: Health promotion strategies to restrict sugar consumption and encourage healthier lifestyles should be aware of the synergism observed among unhealthy behaviors during adolescence.

Sense of coherence and oral health-related quality of life among southern Brazilian male adolescents

Abstract This study evaluated the association between sense of coherence (SoC) and oral health-related quality of life (OHRQoL) among conscripts of the Brazilian Army, in two cities of southern Brazil. A cross-sectional study included all 18-19-year-old adolescents who joined the Brazilian Army as draftees for mandatory military service in the cities of Itaqui, RS, and Santiago, RS (n = 505). Data collection was conducted from 2019 to 2021, and included the application of questionnaires and a clinical oral examination to record gingivitis, malocclusion, and dental caries. OHRQoL was collected through the Brazilian short version of the Oral Health Impact Profile (OHIP), composed of 14 questions. The adolescents' SoC was assessed using the validated Brazilian version of the SOC-13 scale. The primary outcome of this study was OHRQoL, modeled as a discrete variable (OHIP-14 scores). The main predictor variable was SoC, categorized as low, moderate, or high. The association between predictor variables and OHRQoL was assessed by Poisson regression models using a hierarchical approach. Unadjusted and adjusted rate ratios (RR), and 95% confidence intervals (CI) were estimated. All the analyses were performed using STATA software version 14.2. Adolescents with a moderate and high SoC had 27% (RR = 0.73, 95%CI = 0.64-0.84) and 51% (RR = 0.49, 95%CI = 0.41-0.58) lower mean OHIP-14 scores, respectively, than those with a low SoC score, after the inclusion of behavioral and clinical variables. This study showed a significant association between SoC and OHRQoL among 18-19-year-old southern Brazilian adolescents. Strengthening the SoC as a psychosocial resource may improve the well-being and OHRQoL of adolescents.

Efficacy of fluoride gel in arresting active non-cavitated caries lesions: a randomized clinical trial.

This study evaluated the efficacy of fluoride gel in arresting active non-cavitated caries lesions in permanent teeth. This randomized, triple-blind, placebo-controlled clinical trial randomized 100 schoolchildren aged 10.7 ± 2.2 years to test treatment (1.23% acidulated phosphate fluoride [APF] gel) or control treatment (placebo gel) for 4-6 applications at weekly intervals. Data collection included the visible plaque index, gingival bleeding index, visible plaque accumulation on the occlusal surfaces, eruption stage, and dental caries. The association between group and lesion arrestment was assessed using logistic regression, and estimates were adjusted for plaque accumulation over the lesion at baseline, surface type, and tooth type. Models were fitted using generalized estimating equations for accounting for the clustering of data (i.e., the same individual contributed > 1 lesion). Ninety-eight children completed the study (48 fluoride and 50 placebo). When all dental surfaces were analyzed, the likelihood of lesion arrestment was similar between both groups (p > 0.05). A secondary analysis including only the occlusal lesions in molars showed that for teeth under eruption, lesions receiving the 1.23% APF gel were about 3-fold more likely to become arrested than lesions receiving the placebo gel (OR = 2.85; 95%CI = 1.23-6.61; p = 0.01). No significant difference was detected for molars with complete eruption (p > 0.05). The benefit of fluoride gel for arresting non-cavitated caries lesions could not be identified by clinical assessment in this short-term trial. Notwithstanding, when the cariogenic challenge was greater (as on the occlusal surfaces of erupting molars), 1.23% APF gel treatment was an important tool for caries control.

Association between the city region and traumatic dental injuries among adolescents from Santa Maria, South Brazil.

This study investigated the association between the city region and traumatic dental injury (TDI) among adolescents from Santa Maria, Rio Grande do Sul, Brazil. A population-based cross-sectional survey was conducted from March to November 2018, which included a representative sample of adolescents (15-19-year-old) attending public and private high schools. A questionnaire on sociodemographic information was sent to the parents/legal guardians of the selected adolescents. TDI in the upper and lower permanent incisors and canines was recorded based on the O'Brien classification. Environmental variables (sociodemographic and structural characteristics of the neighborhoods) were obtained from official publications. Multilevel Poisson regression models were used, and prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. A total of 1,146 adolescents participated in this study. The overall prevalence of TDI was 17.3%, mild trauma was 12.7%, and severe trauma was 5.8%. Adolescents living in the southern region had a prevalence of TDI of 25.3%, compared with 13.6% in the northern region. After adjusting for important cofactors, adolescents living in the southern region were more likely to have TDI than their counterparts in the northern region (PR, 1.91; 95%CI: 1.18-3.11; p = 0.009). Analyzing the number of environmental risk indicators in different regions, the southern region presented a higher mean and median than all other regions. In conclusion, living in the southern region was associated with a higher prevalence and severity of TDI among adolescents from Santa Maria, southern Brazil. Our findings suggest the role of the environment in the epidemiology of TDI.

Self-perceived neighborhood factors and OHRQoL among adolescents: a population-based study in southern Brazil.

This study aimed to assess the relationship between self-perceived neighborhood factors and oral health-related quality of life (OHRQoL) among adolescents from southern Brazil. A representative sample of 15-19-year-old students from Santa Maria, Brazil, was included. The Oral Health Impact Profile (OHIP-14) was used to assess the OHRQoL. Self-perceived neighborhood factors were assessed through a structured questionnaire and included characteristics of the neighborhood where the adolescents lived, such as the presence of paved streets, tap water, community social networks, and availability of dental services and the Family Health Strategy (FHS). In addition, socioeconomic, behavioral, and clinical variables (dental caries and malocclusion) were also evaluated. Multilevel Poisson regression analysis with a hierarchical approach was used to assess the association between predictors and OHIP-14. The rate ratio (RR) and 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included in this study (participation rate: 72.3%). The mean OHIP-14 score was 8.4 (standard error = 0.2), ranging from 0 to 49. Living in residences with unpaved streets (RR = 1.11, 95%CI:1.06-1.17), no tap water (RR = 1.11, 95%CI: 1.02-1.20), absence of the FHS services (RR = 1.15, 95%CI: 1.09-1.20), and the availability of dental services (RR = 1.08, 95%CI: 1.03-1.14) were associated with higher OHIP-14 scores, indicating a poorer OHRQoL. In addition, lower socioeconomic status, visiting the dentist for curative reasons, lower frequency of brushing teeth, and higher sugar consumption were also associated with higher OHIP-14 scores. In conclusion, self-perceived neighborhood characteristics were associated with OHRQoL in adolescents. Adolescents who perceived their neighborhood as deprived had poorer OHRQoL.

Association between the city region and traumatic dental injuries among adolescents from Santa Maria, South Brazil

Abstract This study investigated the association between the city region and traumatic dental injury (TDI) among adolescents from Santa Maria, Rio Grande do Sul, Brazil. A population-based cross-sectional survey was conducted from March to November 2018, which included a representative sample of adolescents (15-19-year-old) attending public and private high schools. A questionnaire on sociodemographic information was sent to the parents/legal guardians of the selected adolescents. TDI in the upper and lower permanent incisors and canines was recorded based on the O'Brien classification. Environmental variables (sociodemographic and structural characteristics of the neighborhoods) were obtained from official publications. Multilevel Poisson regression models were used, and prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. A total of 1,146 adolescents participated in this study. The overall prevalence of TDI was 17.3%, mild trauma was 12.7%, and severe trauma was 5.8%. Adolescents living in the southern region had a prevalence of TDI of 25.3%, compared with 13.6% in the northern region. After adjusting for important cofactors, adolescents living in the southern region were more likely to have TDI than their counterparts in the northern region (PR, 1.91; 95%CI: 1.18-3.11; p = 0.009). Analyzing the number of environmental risk indicators in different regions, the southern region presented a higher mean and median than all other regions. In conclusion, living in the southern region was associated with a higher prevalence and severity of TDI among adolescents from Santa Maria, southern Brazil. Our findings suggest the role of the environment in the epidemiology of TDI.

Efficacy of fluoride gel in arresting active non-cavitated caries lesions: a randomized clinical trial

Abstract: This study evaluated the efficacy of fluoride gel in arresting active non-cavitated caries lesions in permanent teeth. This randomized, triple-blind, placebo-controlled clinical trial randomized 100 schoolchildren aged 10.7 ± 2.2 years to test treatment (1.23% acidulated phosphate fluoride [APF] gel) or control treatment (placebo gel) for 4-6 applications at weekly intervals. Data collection included the visible plaque index, gingival bleeding index, visible plaque accumulation on the occlusal surfaces, eruption stage, and dental caries. The association between group and lesion arrestment was assessed using logistic regression, and estimates were adjusted for plaque accumulation over the lesion at baseline, surface type, and tooth type. Models were fitted using generalized estimating equations for accounting for the clustering of data (i.e., the same individual contributed > 1 lesion). Ninety-eight children completed the study (48 fluoride and 50 placebo). When all dental surfaces were analyzed, the likelihood of lesion arrestment was similar between both groups (p > 0.05). A secondary analysis including only the occlusal lesions in molars showed that for teeth under eruption, lesions receiving the 1.23% APF gel were about 3-fold more likely to become arrested than lesions receiving the placebo gel (OR = 2.85; 95%CI = 1.23-6.61; p = 0.01). No significant difference was detected for molars with complete eruption (p > 0.05). The benefit of fluoride gel for arresting non-cavitated caries lesions could not be identified by clinical assessment in this short-term trial. Notwithstanding, when the cariogenic challenge was greater (as on the occlusal surfaces of erupting molars), 1.23% APF gel treatment was an important tool for caries control.

Self-perceived neighborhood factors and OHRQoL among adolescents: a population-based study in southern Brazil

Abstract This study aimed to assess the relationship between self-perceived neighborhood factors and oral health-related quality of life (OHRQoL) among adolescents from southern Brazil. A representative sample of 15-19-year-old students from Santa Maria, Brazil, was included. The Oral Health Impact Profile (OHIP-14) was used to assess the OHRQoL. Self-perceived neighborhood factors were assessed through a structured questionnaire and included characteristics of the neighborhood where the adolescents lived, such as the presence of paved streets, tap water, community social networks, and availability of dental services and the Family Health Strategy (FHS). In addition, socioeconomic, behavioral, and clinical variables (dental caries and malocclusion) were also evaluated. Multilevel Poisson regression analysis with a hierarchical approach was used to assess the association between predictors and OHIP-14. The rate ratio (RR) and 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included in this study (participation rate: 72.3%). The mean OHIP-14 score was 8.4 (standard error = 0.2), ranging from 0 to 49. Living in residences with unpaved streets (RR = 1.11, 95%CI:1.06−1.17), no tap water (RR = 1.11, 95%CI: 1.02−1.20), absence of the FHS services (RR = 1.15, 95%CI: 1.09−1.20), and the availability of dental services (RR = 1.08, 95%CI: 1.03−1.14) were associated with higher OHIP-14 scores, indicating a poorer OHRQoL. In addition, lower socioeconomic status, visiting the dentist for curative reasons, lower frequency of brushing teeth, and higher sugar consumption were also associated with higher OHIP-14 scores. In conclusion, self-perceived neighborhood characteristics were associated with OHRQoL in adolescents. Adolescents who perceived their neighborhood as deprived had poorer OHRQoL.

Prevalence and risk indicators for underlying dentin shadows among 12-year-old southern Brazilian schoolchildren.

This study aimed to assess the prevalence, extent, and associated factors of underlying dentin shadows (UDS) in the occlusal surfaces of permanent posterior teeth among 12-year-old schoolchildren from southern Brazil. A population-based cross-sectional study that included a representative sample of 1,528 schoolchildren was conducted in Porto Alegre, southern Brazil (participation rate: 83.2%). A questionnaire on sociodemographic characteristics, behavioral habits, and access to dental services was sent to parents/legal guardians of each student selected. Caries examination included the recording of non-cavitated and cavitated lesions, including the presence of UDS, as defined by the ICDAS Group (i.e., a shadow of discolored dentin visible through an apparently intact enamel surface that may or may not show signs of localized breakdown - ICDAS Code 4). The association between predictor variables and UDS prevalence was assessed using survey Poisson regression models. The prevalence of UDS was 6.3% (95%CI = 1.2 -11.3). The mean number of affected teeth among the schoolchildren presenting UDS was 1.51 (95%CI = 1.40 -1.61), ranging from 1 to 6. Type of school (public, PR = 2.23, 95%CI = 1.22 -4.07) and caries experience (DMFT 1-2, PR = 2.41, 95%CI = 1.15 -5.04; DMFT ≥ 3, PR = 3.09, 95%CI = 1.52 -6.27) were significantly associated with UDS prevalence. In conclusion, this population-based cross-sectional study found a low prevalence of UDS in the occlusal surfaces of the permanent posterior teeth of 12-year-old southern Brazilian schoolchildren. Overall caries experience and type of school were associated with UDS in this population.

Radiographic pattern of inactive occlusal enamel lesions and its relationship with caries progression over 4-5 years.

OBJECTIVE: To assess the radiographic pattern of inactive enamel caries lesions (IECL) in the occlusal surfaces of permanent molars and to investigate whether the presence of radiolucency at baseline could predict lesion progression over 4-5 years. METHODS: A prospective cohort study followed 193 schoolchildren from southern Brazil. At baseline, clinical and radiographic examinations were performed. After 4-5 years, clinical examination was repeated following the same protocol. Logistic regression models were used to investigate the relationship between the presence of radiolucency at baseline and caries progression. RESULTS: This study included 916 permanent molars, classified as sound occlusal surfaces (n = 434), non-cavitated IECL (n = 438), or cavitated IECL (n = 44) at baseline. The proportion of lesions with radiolucency increased as lesion severity increased (p<0.001, chi-square test). The proportion of cases that progressed was significantly higher among teeth showing radiolucency at baseline than among teeth without radiolucency (p<0.001, chi-square test). The presence of radiolucency at baseline was found to be a predictor of caries progression (activity criteria, adjusted OR=3.37, 95%CI=1.66-6.82, p<0.001; severity criteria, adjusted OR=4.01, 95%CI=1.85-8.72, p<0.001). CONCLUSION: Occlusal surfaces (either sound or with IECL) presenting radiolucency at baseline were more likely to progress over 4-5 years of monitoring and should be monitored more closely. CLINICAL RELEVANCE: Bitewing radiographs, when available, may be used to identify which surfaces/lesions are more likely to progress and thus, to define proper recall intervals for patient monitoring.

Is Toothbrush Bristle Stiffness Associated with Erosive Tooth Wear in Adolescents? Findings from a Population-Based Cross-Sectional Study.

This population-based cross-sectional study investigated the association between toothbrush bristle stiffness and the occurrence of erosive tooth wear (ETW) among 15- to 19-year-old adolescents from southern Brazil. Data collection included the application of questionnaires and clinical examination. One questionnaire on sociodemographic information (sex, age, and socioeconomic status) was sent to the parents/legal guardians, while the other was applied to students and collected data regarding oral hygiene habits (toothbrushing frequency, toothbrushing after meals, and toothbrush bristle stiffness) and dietary habits (frequency of consumption of soft drinks, citric fruits, and fruit juice). After tooth cleaning and drying, all erupted permanent teeth were clinically assessed and classified according to the Basic Erosive Wear Examination (BEWE) by 2 calibrated examiners. The association between explanatory variables and ETW prevalence was assessed using Poisson regression models. Prevalence ratios (PRs) and their 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included (participation rate 72.3%). The overall prevalence of ETW was 57%. The final model showed that individuals who used toothbrushes with soft (PR = 1.28, 95% CI = 1.02-1.60) or medium (PR = 1.30, 95% CI = 1.01-1.69) bristles presented a higher ETW prevalence than those who used toothbrushes with extra-soft bristles, even after the adjustment for important cofactors. In conclusion, this study found a very weak but significant association between toothbrush bristle stiffness and ETW among Brazilian adolescents. Considering the cross-sectional design of this study and considering that some association was found even in such a young population, future studies using different designs and including different age-groups might elucidate the clinical relevance of this finding.

Traumatic dental injury and oral health-related quality of life among 15 to 19 year old adolescents from Santa Maria, Brazil.

BACKGROUND/AIMS: The literature is scarce on the association between traumatic dental injuries (TDI) and oral health-related quality of life (OHRQoL) among adolescents, and there is no study assessing this relationship using clinical criteria for the assessment of TDI in this age group. The aim of this study was to assess the association between TDI and OHRQoL among 15 to 19yearold adolescents from Santa Maria, Brazil. MATERIALS AND METHODS: A population-based cross-sectional study was conducted including a representative sample of 1197 15 to 19yearold adolescents attending 31 public and private schools. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed to diagnose TDI based on the O'Brien classification. Demographic information, socioeconomic status, and clinical characteristics (caries experience, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between TDI and OHRQoL. Rate ratios (RR) and 95% confidence intervals (95% CI) were estimated. RESULTS: The overall prevalence of TDI was 17%, mild trauma was 12%, and severe trauma was 5%. In the adjusted models, adolescents with TDI had poorer OHRQoL than those without TDI (RR = 1.10; 95% CI = 1.05-1.16). This negative effect was related to the psychological disability domain (RR = 1.16; 95% CI = 1.02-1.32), to the social disability domain (RR = 1.34; 95% CI = 1.13-1.59), and to the handicap domain (RR = 1.35; 95% CI = 1.10-1.66). CONCLUSIONS: Despite its low severity, TDI negatively affected the OHRQoL of 15 to 19yearold adolescents from Santa Maria, Brazil.

Prevalence and risk indicators for underlying dentin shadows among 12-year-old southern Brazilian schoolchildren

Abstract This study aimed to assess the prevalence, extent, and associated factors of underlying dentin shadows (UDS) in the occlusal surfaces of permanent posterior teeth among 12-year-old schoolchildren from southern Brazil. A population-based cross-sectional study that included a representative sample of 1,528 schoolchildren was conducted in Porto Alegre, southern Brazil (participation rate: 83.2%). A questionnaire on sociodemographic characteristics, behavioral habits, and access to dental services was sent to parents/legal guardians of each student selected. Caries examination included the recording of non-cavitated and cavitated lesions, including the presence of UDS, as defined by the ICDAS Group (i.e., a shadow of discolored dentin visible through an apparently intact enamel surface that may or may not show signs of localized breakdown - ICDAS Code 4). The association between predictor variables and UDS prevalence was assessed using survey Poisson regression models. The prevalence of UDS was 6.3% (95%CI = 1.2 -11.3). The mean number of affected teeth among the schoolchildren presenting UDS was 1.51 (95%CI = 1.40 -1.61), ranging from 1 to 6. Type of school (public, PR = 2.23, 95%CI = 1.22 -4.07) and caries experience (DMFT 1-2, PR = 2.41, 95%CI = 1.15 -5.04; DMFT ≥ 3, PR = 3.09, 95%CI = 1.52 -6.27) were significantly associated with UDS prevalence. In conclusion, this population-based cross-sectional study found a low prevalence of UDS in the occlusal surfaces of the permanent posterior teeth of 12-year-old southern Brazilian schoolchildren. Overall caries experience and type of school were associated with UDS in this population.

Association between fixed orthodontic treatment and dental caries: a 1-year longitudinal study.

This longitudinal study aimed to assess the association between the use of fixed orthodontic appliances and the incidence/increment of active caries lesions in adolescents and young adults over a one-year period. A total of 135 10-30-year-old individuals were divided into two groups: Group G0 was composed of individuals who required orthodontic treatment, but who did not undergo fixed orthodontic therapy over the study period (n=70); Group G1 was composed of individuals who used a fixed orthodontic appliance for 1 year (n=65). Data collection included a questionnaire and clinical oral examinations (plaque index, gingival index, and dental caries index), performed at baseline and after 1 year. Caries examination was performed by a single calibrated examiner, after tooth cleaning and drying, and included the recording of non-cavitated and cavitated, inactive and active lesions of all tooth surfaces. Poisson regression models were used to assess the association between the group and the following study outcomes: incidence (binary variable) and increment (counting variable). The incidence of active caries lesions was 4.8% in G0 and 39.6% in G1. The mean increment of active caries lesions was 0.14 in G0 and 0.61 in G1. G1 showed a greater risk of developing active caries lesions than G0 (incidence analysis, adjusted IRR=9.48, 95%CI=2.62-34.30; increment analysis, adjusted IRR=4.13; 95%CI=1.94-8.79). In conclusion, this study showed that individuals undergoing fixed orthodontic therapy for 1 year had a significantly higher incidence and increment of active caries lesions than those without a fixed appliance.

Can We Diagnose a Patient's Caries Activity Based on Lesion Activity Assessment? Findings from a Cohort Study.

This cohort study evaluated the fate of sound surfaces and inactive non-cavitated (INC) and active non-cavitated (ANC) caries lesions in a population-based sample of South Brazilian adolescents, in answer to the question: "Is lesion activity assessment a reliable criterion to diagnose a patient's caries activity?" A total of 801 schoolchildren were examined at baseline (aged 12 years) and after a mean time interval of 2.5 years. Data collection included a questionnaire and clinical examination. Patients were classified as caries-free (patients without any lesion), caries-inactive (patients with only inactive lesions), and caries-active (patients with at least one active lesion). The primary outcome was caries progression (presence of cavity, underlying dentin shadow, filling, or extraction at the follow-up exam). Negative binomial regression models were used to estimate the risk for caries progression. The main predictor variable was status of the surface at baseline: sound, INC, or ANC. Progression rates of 1.0, 9.0, and 12.6% were found for sound surfaces, INC, and ANC, respectively. INC (incidence risk ratio [IRR] 5.37, 95% CI 4.22-6.83) and ANC (IRR 4.96, 95% CI 3.43-7.17) had greater risk for caries progression than sound surfaces. Similar risks for progression were found for ANC and INC (IRR 0.92, 95% CI 0.64-1.32). Progression rates were 0.6, 1.1, and 2.2% for caries-free, caries-inactive, and caries-active individuals, respectively (p < 0.05). The risk for caries progression of sound surfaces was higher among caries-active adolescents (caries-free: IRR 2.78, 95% CI 1.63-4.72; caries-inactive: IRR 2.19, 95% CI 1.65-2.90). Caries-inactive patients behaved similarly to caries-free individuals (IRR 1.27, 95% CI 0.73-2.20). This study demonstrated the possibility of defining a patient's caries activity profile based on lesion features.

Oral health status of schoolchildren living in rural and urban areas in southern Brazil.

This study assessed the effect of area of residence (rural vs. urban) on dental caries experience among southern Brazilian schoolchildren. This cross-sectional survey was conducted in Rosário do Sul, southern Brazil, and included 373 9-14-year-old schoolchildren attending public municipal schools (122 living in the rural area, and 251, in the urban area). Data collection included a questionnaire and a clinical examination. Clinical examination of the permanent dentition involved visible plaque index, gingival bleeding index and dental caries experience (non-cavitated and cavitated, inactive and active lesions). Samples of water were collected to check the fluoride concentration. Caries prevalence and extent using different criteria were compared between rural and urban schoolchildren using the chi-square test and the Mann-Whitney test, respectively. The association between explanatory variables and the extent of caries activity (number of active caries lesions) was assessed using Poisson regression. When caries was recorded at the cavity level (WHO criterion), no difference was observed between rural and urban populations (p ≥ 0.05). Conversely, higher caries prevalence and extent were found among urban schoolchildren when active non-cavitated lesions were also computed (p < 0.05). In the adjusted Poisson regression model, urban schoolchildren were 57% more likely to present more active lesions than rural students (RR = 1.57; 95%CI = 1.29-1.92). Rural communities did not have sufficient fluoride in the water supply, whereas ideal concentrations were detected in the urban areas. In conclusion, this cross-sectional study found that urban schoolchildren showed greater caries experience than rural students, and that this increment was related to active non-cavitated lesions.