Influence of breastfeeding duration on the incidence of dental caries in preschoolers: a cohort study / Influência da duração da amamentação na incidência de cárie dentária em pré-escolares: um estudo de coorte

Abstract Objectives: investigate the association between breastfeeding duration and the incidence of severe caries in preschoolers. Methods: a cohort study was conducted with 132 pairs of mothers and children in the city of Diamantina, Brazil. Data collection was performed in 2 moments: when the children were between two and three years of age (baseline- 2013/2014) and after three years (T1-2016/2017). In both moments, children were evaluated for dental caries (International Caries Detection and Assessment System - ICDAS) and a questionnaire was administered to the mothers addressing socioeconomic aspects and thee habits of children. The outcome evaluated was the incidence of severe caries (Dentin caries - ICDAS Codes 5 and 6). Data analysis involved descriptive statistics, chi-squared test and Poisson hierarchical regression with robust variance. Results: children who breastfed for more than 24 months (RR = 2.24 CI95%= 1.23-4.08), those whose parents were separated (RR = 1.73 CI95%= 1.11-2.69), and those with estab-lished/severe caries (RR = 2.74 CI95%= 1.37-5.49) at baseline were at greater risk of incidence of severe caries after three years. Conclusion: breastfeeding for more than 24 months is a risk factor for incidence of severe caries. In addition, family structure and established or severe baseline caries were associated.

Resumo Objetivos: investigar a associação entre a duração da amamentação e a incidência de cárie grave em pré-escolares. Métodos: foi realizado um estudo de coorte com 132 pares de mães e crianças de Diamantina, Minas Gerais, Brasil. As crianças foram avaliadas em dois momentos: dois e três anos de idade (baseline-2013/2014) e após três anos (T1- 2016/2017). Dados socioeconómicos e relativos aos hábitos das criançasforam obtidos por meio de entrevistas com as mães e a presença de cárie dentária foi diagnosticada segundo o protocolo "International Caries Detection and Assessment System - ICDAS". O desfecho foi a incidência de cárie grave (cárie em dentina - códigos ICDAS 5 e 6). Para análise dos dados empregou-se regressão hierárquica de Poisson com variância robusta. Resultados: crianças que amamentaram por mais de 24 meses (RR = 2,24 IC95%= 1,234,08), cujos pais viviam separados no baseline (RR = 1,73 IC95%= 1,11-2,69) e aquelas com cárie estabelecida ou grave no baseline (RR = 2, 74 IC950%= 1,37-5,49) estavam em maior risco de incidência de cárie grave após 3 anos. Conclusão: a amamentação por mais de 24 meses foi um fator de risco para a incidência de cárie dentária grave em pré-escolares. Além disso, estrutura familiar e cárie estabelecida ou grave no baseline estiveram associados.

Dental caries in schoolchildren: influence of inattention, hyperactivity and executive functions

Abstract Attention-deficit/hyperactivity disorder (ADHD) is characterized by inappropriate levels of hyperactivity, impulsivity, and/or inattention. Individuals with ADHD may present limitations with regard to executive functions and performing activities that involve planning and/or attention/concentration. The aim of the study was to investigate the association between dental caries and signs of ADHD in a representative sample of schoolchildren. A representative sample of 851 schoolchildren aged seven to 12 years was randomly selected from public and private schools. Data acquisition involved a clinical dental examination for cavitated permanent and deciduous teeth using the DMFT/dmft indices. Neuropsychological evaluations, including the assessment of intelligence (Raven's Colored Progressive Matrix Test) and executive functions (Corsi Tapping Blocks tests and Digit Span test) were also performed. Parents/caregivers and teachers answered the SNAP-IV Questionnaire for the investigation of signs of inattention and hyperactivity in the family and school environment. Parents/caregivers also answered questionnaires addressing socioeconomic and socio-demographic characteristics. Descriptive analysis of the variables and Poisson regression with robust variance were performed. Parental reports of signs of inattention (PR: 1.28; p < 0.05) and hyperactivity (PR: 1.15; p < 0.05) were associated with a greater occurrence of caries. A better performance on the backward order of the Corsi Tapping Blocks tests (PR: 0.94; p < 0.05) and higher level of mother's schooling were associated with a lower frequency of caries. A better performance on executive function tasks was a protective factor against dental caries, whereas children considered inattentive and/or hyperactive by their parents had a higher prevalence rate of dental caries.

Inquérito epidemiológico em população idosa (parte II): saúde bucal, ansiedade, depressão, estresse e uso de medicamentos / Epidemiological survey in elderly people (II): oral health, anxiety, depression, stress, and drug utilization

Objetivos: Investigar as correlações existentes entre saúde bucal, ansiedade, depressão, estresse, alterações cognitivas e uso de medicamentos em idosos. Métodos: Os dados foram coletados em domicílio, por meio de questionários sobre dados sociodemográficos e uso de medicações; exames bucais para investigar o índice de dentes cariados, perdidos e obturados; e instrumentos para avaliar a presença de distúrbios psicossociais. Os seguintes instrumentos foram aplicados: Mini Exame do Estado Mental (alterações cognitivas), Escala de Katz (grau de dependência), Inventário de Depressão de Beck, Escala de Depressão Geriátrica (depressão), Inventário de Ansiedade de Beck (ansiedade) e Inventário de Sintomas de Stress para adultos de Lipp (estresse). Também se investigou a quantidade de remédios usados. Foi realizada análise descritiva e teste de correlação de Spearman. Resultados: Foram incluídos 37 idosos com idade média de 73,41 anos. O índice CPO-D médio foi 25,38. Dos 37 idosos, 21,6% foram classificados com depressão leve/moderada, 45,9% apresentavam ansiedade, 78,4% tinham comprometimento cognitivo e 54,1% tinham polifarmácia menor. Foram encontradas correlações estatisticamente significativas de forma positiva e moderada entre idade e saúde bucal; de forma negativa moderada entre idade e alterações cognitivas; e de forma positiva forte entre depressão e estresse resistência e entre ansiedade e estresse resistência. Conclusões: Saúde bucal, ansiedade, depressão, estresse e medicação foram fatores correlacionados na amostra de idosos estudada.

Aims: To investigate the correlation between oral health, anxiety, depression, stress, cognitive impairment, and use of medications in the elderly. Methods: Data were collected using household survey questionnaires on sociodemographic variables and use of medications; oral examinations for detection of decayed, missing, and filled teeth; and questionnaires to verify the presence of psychosocial disorders. The following instruments were applied: mini-mental state examination (cognitive impairment), Katz scale (index of independence), Beck depression inventory, geriatric depression scale (depression), Beck anxiety inventory (anxiety), and Lipp's stress symptom inventory for adults (stress). The quantity of medication used was also investigated. A descriptive analysis and Spearman's correlation test were performed. Results: Thirty-seven elderly individuals, mean age of 73.41 years, were included in the study. The mean DMFT index was 25.38. Mild to moderate depression was detected in 21.6%, anxiety in 45.9%, cognitive impairment in 78.4%, and lower polypharmacy rates in 54.1%. Age and oral health showed a moderate statistically significant positive correlation; age and cognitive impairment revealed a moderate negative correlation; and there was a strong and positive correlation between depression and the resistance stage of stress and between anxiety and the resistance stage of stress. Conclusions: There was correlation between oral health, anxiety, depression, stress, and medication in the investigated elderly sample.

Inquérito epidemiológico em saúde bucal e fatores psicossociais em idosos ­ um estudo piloto / Epidemiological survey on oral health and psychosocial factors in the elderly ­ a pilot study

Objetivos: Realizar um levantamento epidemiológico da saúde bucal e fatores psicossociais associados abrangendo indivíduos com idade igual ou superior a 60 anos. Métodos: Trata-se de um estudo transversal, com a população-alvo constituída de idosos. Foi selecionada uma amostra representativa do município de Diamantina, estado de Minas Gerais, composta por pessoas com mais de 60 anos, cadastradas nos postos da Estratégia Saúde da Família da zona rural e urbana do município. Os dados foram coletados em domicílio, por meio de exames bucais realizados por um único examinador, treinado e calibrado, e de questionários. Foi investigado o índice CPOD (média de dentes cariados, perdidos e obturados em um grupo de indivíduos), assim como dados sociodemográficos. Também foram obtidos dados sobre qualidade de vida relacionada à saúde bucal, locus de controle de saúde, consumo de álcool e drogas na senescência. Os dados obtidos foram submetidos à análise descritiva e ao teste de correlação de Spearman. O nível de significância adotado foi de ≤5%. Resultados: Foram entrevistados 37 idosos com idade média de 73,41±7,25 anos. O índice CPOD encontrado foi de 25,38±5,18. Houve correlação estatisticamente significante entre maior pontuação no domínio limitação funcional e maior idade, maior locus externo e maior locus ao acaso, aumento na limitação funcional e diminuição da renda, maior pontuação no domínio limitação funcional e maior locus interno, maior índice CPOD e menor pontuação no domínio incapacidade social. Conclusões: Pelo presente estudo concluiu-se que a qualidade de vida, locus de controle de saúde e índice CPOD são fatores diretamente correlacionados em idosos. Enfatiza-se a importância da atuação de profissionais de saúde e, mais especificamente, de saúde bucal, na promoção de um envelhecimento saudável.

Aims: To conduct an epidemiological survey on oral health and psychosocial factors in individuals aged 60 years or older. Methods: This is a cross-sectional study with elderly individuals as the target population. A representative sample of Diamantina, a town in Minas Gerais State, southeastern Brazil, was used. The sample consisted of individuals aged over 60 years registered at Family Health Strategy units in the rural and urban areas of Diamantina. Data were collected at home by means of oral examinations performed by a single trained and calibrated examiner, and through questionnaires. The decayed, missing and filled teeth (DMFT) index and sociodemographic data were investigated. Data on oral health-related quality of life, health locus of control, and use of alcohol and drugs in old age were also obtained. Results: Thirty-seven elderly individuals with a mean age of 73.41±7.25 years were interviewed. The average DMFT index was equal to 25.38±5.18. There was a statistically significant correlation between functional limitations and age, external locus and random locus, functional limitation and income, functional limitation and internal locus, and DMFT index and social disability. Conclusions: It can be concluded that quality of life, health locus of control, and DMFT index are correlated factors in the elderly. Health professionals should act in seeking to promote healthy aging.

Influence of clinical and socioeconomic indicators on dental trauma in preschool children

The aim of the present study was to determine the prevalence of traumatic dental injury (TDI) in the primary dentition and investigate associations with clinical and socioeconomic indicators. A population-based, cross-sectional study was carried out with a randomly selected sample of 301 children aged one to five years. Data were collected through clinical oral examinations and interviews with parents/guardians during immunization campaigns. Statistical analysis involved Pearson’s Chi-squared test and Poisson regression with robust variance. The prevalence of TDI was 33.9%. TDI was more prevalent in children with overjet > 3 mm (p < 0.001) and those with inadequate lip coverage (p < 0.001). A statistically significant association was also found between TDI and household income (p = 0.024). According to the adjusted Poisson regression model, greater prevalence rates of TDI were found for children from families with a monthly income ≥ twice the Brazilian minimum monthly wage (PR: 1.52; 95%CI: 1.10-2.12), those with accentuated overjet (PR: 1.53; 95%CI: 1.05-2.22) and those with inadequate lip coverage (PR: 2.00; 95%CI: 1.41-2.84). The prevalence of TDI was high in the present study and was associated with a higher family income, accentuated overjet and inadequate lip coverage.

Association between anterior open bite and impact on quality of life of preschool children

The aim of this study was to evaluate the association between different types of malocclusion and the impact on quality of life among preschoolers and their families. A cross-sectional study was carried out involving 451 children 3-5 years of age. A clinical exam was performed to evaluate the malocclusions according to criteria proposed by Foster and Hamilton. This examination was conducted by a calibrated dentist. Parents/caregivers answered the Early Childhood Oral Health Impact Scale (ECOHIS) for the assessment of Oral Health-Related Quality of Life (OHRQoL) and the questionnaire on socioeconomic and demographic characteristics. Data analysis involved descriptive statistics, chi-square, Mann-Whitney and hierarchically adjusted Poisson regression. The prevalence of malocclusion was 28.4%. The most frequent conditions were posterior crossbite (20.4%), anterior open bite (9.5%) and increased overjet (8.4%). A significant association was found between anterior open bite and OHRQoL (p< 0.001). The adjusted analysis confirmed the association between anterior open bite and a negative impact on quality of life (PR = 2.55; 95%CI: 1.87 to 3.47; p< 0.001). Anterior open bite was associated with a negative impact on the quality of life of preschoolers.

Perinatal factors associated with developmental defects of enamel in primary teeth: a case-control study

The present study was designed to evaluate associations between developmental defects of enamel (DDE) in the primary dentition and aspects related to mothers and preschoolers in the city of Diamantina, Brazil. A case-control study was carried out involving children aged three to five years. The case group was composed of 104 children with at least one dental surface affected by DDE. The control group comprised 105 children without DDE, matched for gender and age. The diagnosis of enamel defects was performed using the Developmental Defects of Enamel Index. Information was collected through interviews investigating socio-demographic aspects, gestation, birth weight, prematurity and breastfeeding. Simple and multiple regression analyses were performed, providing unadjusted and adjusted prevalence ratios (Poisson regression). DDE were more prevalent among children who had not been breastfed (PR = 1.57; 95% CI: 1.1-2.2) and those whose mothers were under 24 years of age at the birth of the child (PR = 1.41; 95% CI: 1.1-1.9). The prevalence of DDE in the primary dentition was higher among children who had not been breastfed and those whose mothers were under 24 years of age at the birth of the child.

Factors associated with the development of early childhood caries among Brazilian preschoolers

The aim of this study was to assess the prevalence of early childhood caries (ECC) in children and investigate the influence of sociodemographic variables, quality of oral hygiene and child-related aspects. A cross-sectional study was carried out with 593 children aged three to five years. Data were collected through clinical examinations and interviews with parents. Interviews with parents of the children were conducted to acquire information on sociodemographic aspects, breastfeeding, bottle feeding and harmful oral habits. Statistical analysis involved the chi-square test and the Poisson regression. The prevalence of ECC was 53.6%. The occurrence of ECC was greater among children with unsatisfactory oral hygiene (PR: 2.95; 95% CI: 2.42-3.60) and those from a family with a lower monthly household income (PR: 1.62; 95% CI: 1.24-2.10). In conclusion, unsatisfactory oral hygiene and monthly income exerted an influence on the occurrence of ECC among preschoolers.

Risk factors associated with facial fractures

The aim of the present study was to identify risk factors for facial fractures in patients treated in the emergency department of a hospital. The medical charts of 1121 patients treated in an emergency ward over a three-year period were analyzed. The independent variables were gender, age, place of residence (urban or rural area) and type of accident. The dependent variables were fractured mandible, zygoma, maxilla, nasal bone and more than one fractured facial bone. Statistical analysis was performed using the chi-square test (a < 0.05), univariate and multivariate Poisson distributions and the logistic regression analysis (p < 0.20). Maxillofacial trauma was recorded in 790 charts (70.5%), with 393 (35.1%) charts reporting facial fractures. Motorcycle accidents were found to be the main risk factor for mandibular fractures (PR = 1.576, CI = 1.402-1.772) and simultaneous fractures of more than one facial bone (OR = 4.625, CI = 1.888-11.329) as well as the only risk factor for maxillary bone fractures (OR = 11.032, CI = 5.294-22.989). Fractures of the zygomatic and nasal bones were mainly associated with accidents involving animals (PR = 1.206, CI = 1.104-1.317) and sports (OR = 8.710, CI = 4.006-18.936), respectively. The determinant for the majority of facial fractures was motorcycle accidents, followed by accidents involving animals and sports.

Signs, symptoms, parafunctions and associated factors of parent-reported sleep bruxism in children: a case-control study

Bruxism is the non-functional clenching or grinding of the teeth that may occur during sleep or less commonly in daytime. The aim of this study was to investigate the association between clinical signs and symptoms, parafunctions and associated factors of sleep bruxism in children. A population-based case-control study was carried out involving 120 children, 8 years of age, with sleep bruxism and 240 children without sleep bruxism. The sample was randomly selected from public and private schools in the city of Belo Horizonte, MG, Brazil. Groups were matched by gender and social class. The Social Vulnerability Index (SVI) drawn up by the city of Belo Horizonte was employed for social classification. Data collection instruments included clinical forms and pre-tested questionnaires. The diagnosis of sleep bruxism was supported by the American Association of Sleep Medicine (AASM) criteria. The McNemar test, binary and multivariate logistic regression models were used for statistical analysis. The risk factors associated with sleep bruxism included: primary canine wear (OR=2.3 IC 95% 1.2-4.3), biting of objects like pencils or pens (OR=2.0 IC 95% 1.2-3.3) and wake-time bruxism (tooth clenching) (OR=2.3 IC 95% 1.2-4.3). Children that present the parafunctions of object biting and wake-time bruxism were more susceptible to sleep bruxism.

Bruxismo é o ato não funcional de ranger os dentes enquanto se dorme ou apertar os dentes em vigília. O objetivo deste estudo foi investigar a associação entre sinais e sintomas clínicos associados ao bruxismo noturno em crianças. Foi desenvolvido um estudo de base populacional com desenho caso-controle, envolvendo 120 crianças, de 8 anos de idade, com bruxismo e 240 crianças sem bruxismo. A amostra foi selecionada de forma randomizada em escolas públicas e particulares da cidade de Belo Horizonte, Brasil. Os grupos caso e controle foram pareados por gênero e classe social. O Índice de Vulnerabilidade Social (IVS) desenvolvido pela prefeitura da cidade de Belo Horizonte foi utilizado para a classificação social. Como instrumentos de coleta foram utilizados: uma ficha clínica e um questionário pré-testados. O diagnóstico de bruxismo noturno foi baseado nos critérios da American Association of Sleep Medicine (AASM). Os testes estatísticos de McNemar, regressão logística binária e multivariada com modelo de regressão foram utilizados para análise dos dados. Foram considerados fatores de risco para o bruxismo noturno: desgaste em caninos decíduos (OR=2,3 IC 95% 1,2-4,3), morder objetos como lápis e canetas (OR=2,0 IC 95% 1,2-3,3) e apertar os dentes em vigília (OR=2,3 IC 95% 1,2-4,3). Crianças que apresentam outras parafunções tais como: morder objetos e apertar os dentes em vigília são mais susceptíveis ao bruxismo noturno.

Oral mucosa alterations in a socioeconomically deprived region: prevalence and associated factors

This study aimed to evaluate the prevalence and factors associated with oral mucosa alterations in patients from Vale do Jequiti-nhonha, Brazil. The sample consisted of 511 patients of both genders. Questionnaires were used to obtain information about patient gender, age, race, systemic disease state, medication use, cigarette use and alcohol consumption. Physical examinations were then performed to identify lesions of the oral mucosa. Descriptive analyses, Chi-squared tests and logistic regressions were then used to analyze the results (p < 0.05, 95 percent CI). In this population, 84.9 percent (434/511) of patients were found to have alterations in their oral mucosa. The most common alterations were melanotic maculae (36.0 percent), linea alba (33.9 percent), traumatic ulcers (21.5 percent), Fordyce's granules (20.4 percent), coated tongue (12.5 percent) and fissured tongue (10.0 percent). Melanotic maculae were more frequently observed in black patients, with an odds ration (OR) of 7.51. Being female was a statistically significant predictive factor for having a visible linea alba (OR: 1.90) and a fissured tongue (OR: 2.11). No statistically significant association was found between the presence of oral lesions and systemic disease, medication use, alcohol use and smoking. The high observed prevalence of melanotic maculae and Fordyce's granules suggests that these alterations could be considered typical characteristics of the population of the Vale do Jequitinhonha. Coated tongue may be related to the socioeconomic deprivation in the region. Furthermore, the high prevalence of traumatic ulcers may be associated with the traumatic agents that caused patients to seek dental care.