Fatores comportamentais e socioeconômicos são fortes preditores de cárie dentária em pré- escolares: um estudo transversal / Behavioral and socioeconomic factors are strong predictors of dental caries in preschoolers: a cross-sectional study

Avaliaram-se possíveis preditores para a cárie dentária em pré-escolares sem experiência odontológica prévia, que buscaram a clínica de odontopediatria de uma universidade pública. Analisaram-se 191 prontuários, dos quais 87 foram incluídos. Coletaram-se dados demográficos, socioeconômicos, histórico de cárie da mãe, orientação prévia sobre cárie, frequência de escovação, uso de dentifrício fluoretado, consumo de doces/biscoitos e/ou líquidos açucarados, ceo-d e a presença ou ausência de defeitos de desenvolvimento do esmalte. Análises descritivas e de regressão logística binária foram realizadas para investigar quais variáveis prediziam um ceod>0. O modelo múltiplo incluiu consumo de doces/biscoitos, dados socioeconômicos, histórico de cárie na mãe e orientação prévia sobre cárie. Das crianças (2,69±1,18 anos), a maioria (67,8%) apresentava ceod>0 (3,78±3,82), sendo 50,6% meninas e 73,3% da classe baixa. A maioria (56,5%) das mães tinha 12 anos de estudos completos, histórico de cárie (78,6%) e receberam orientação prévia sobre cárie (52,9%). A maior parte (80,6%) escova os dentes pelo menos 2 vezes ao dia, utiliza dentifrício fluoretado (75,9%) e consome líquidos açucarados (90,8%), além de doces/biscoitos (86,9%) entre as refeições. Pertencer à classe baixa aumentou em 7 vezes a chance de ceod>0 (OR=7,354; IC 95%=1,951-27,723), histórico de cárie na mãe em 4 vezes (OR=4,131; IC 95%=1,042-16,369) e consumo de doces/biscoitos em quase 2 vezes (OR=1,786; IC 95%=1,072-2,976). Classe econômica baixa, histórico de cárie da mãe e consumo de doces/biscoitos entre as refeições mostraram-se fatores associados ao ceod>0 nos pacientes sem experiência prévia odontológica de uma clínica de odontopediatria de uma universidade pública.

Possible predictors of dental caries in preschool children without previous dental experience, who sought a pediatric dentistry clinic at a public university, were evaluated. Medical records (n=191) were analyzed; 87 were included. Demographic, socioeconomic data, mother's history of caries, previous orientation on caries, brushing frequency, use of fluoridated toothpaste, consumption of sweets/cookies and/or sugary liquids, dmft and the presence or absence of enamel development defects were collected. Descriptive and binary logistic regression analyzes were performed to investigate which variables predicted a dmft>0. The multiple model included consumption of sweets/cookies, socioeconomic data, mother's history of caries and previous orientation on caries. Of the children (2.69±1.18 years), most (67.8%) had dmft>0 (3.78±3.82), with 50.6% girls and 73.3% from the lower class. Most mothers had completed 12 years of schooling (56.5%), reported history of caries (78.6%) and received previous orientation on caries (52.9%). Most of children brush their teeth at least twice a day (80.6%), use fluoridated toothpaste (75.9%) and consume sugary liquids (90.8%), in addition to consumption of sweets/cookies (86 .9%) among the meals. Belonging to the lower class increased the chance of having dmft>0 by 7 times (OR=7,354; 95% CI=1,951-27,723), mother's history of caries by 4 times (OR=4,131;95% CI=1,042-16,369) and consumption of sweets/cookies by almost twice (OR=1,786;95% CI=1,072-2,976). Low economic class, mother's history of caries and consumption of sweets/cookies between meals were factors associated with dmft>0 in the patients without previous dental experience in a pediatric dentistry clinic at a public university.

Dental caries in three-year-old preschool children in Lima, Peru assessed according to the CAST instrument / Caries dental en niños prescolares de 3 años en Lima-Perú evaluados con el instrumento CAST

ABSTRACT The aim of this study was to determine the caries situation of three-year-old preschool children residing in low socioeconomic status districts in Lima, Peru. The study is a crosssectional analysis of the caries situation of suburban areas of Lima. A stratified sampling procedure by geographical distribution, considering healthcare centers with a motherand- child health clinic and surrounding preschools as factors, identified 45 randomly selected preschools, of which 17 accepted to participate. Children from 3-year-old classrooms were examined by two independent calibrated dentists using the Caries Assessment Spectrum and Treatment (CAST) instrument at their premises using artificial light, sterile examination mirrors and gauze for drying each tooth before evaluation. ANOVA and the Tamhane method were used to analyze the data. 308 children, mean age 3.4 years (min: 3 years; max: 3 years, 7 months), were examined. The sample prevalence of enamel and dentine carious lesions (CAST code 3-7) was 91.2% while the prevalence of dentine carious lesions (CAST code 4-7) was 58.8%. The mean number of teeth with cavities that had reached the pulp and those that had an abscess or fistula were 2.0% and 0.5% respectively. The majority of enamel and dentine carious lesions were observed in molars. The CAST severity score was 7.0. Mean examination time was 57 seconds. The burden of dental caries of the children at this young age was high.

RESUMEN El objetivo del presente estudio fue determinar la prevalencia de caries dental en niños en edad preescolar de 3 años residentes en áreas suburbanas de Lima, Perú. Se trata de un análisis transversal de la situación de caries de áreas periféricas de Lima. Un procedimiento de muestreo estratificado por distribución geográfica consideraba a los centros de salud materno-infantiles y centros educativos preescolares de la jurisdicción como factores, identificando 45 centros prescolares aleatoriamente, de los cuales 17 aceptaron la invitación para participar del presente estudio. Dos odontólogas independientes, calibradas examinaron a los niños de las aulas de 3 años utilizando el instrumento Caries Assessment Spectrum and Treatment (CAST) en las instalaciones de cada jardín de infancia, utilizando luz artificial, instrumental estéril y gasas para el secado de las superficies a evaluar. Los datos fueron analizados utilizando ANOVA y el método Tamhane. Se evaluaron 308 niños, quienes tenían una edad media de 3.4 años (min: 3 años; max: 3 años, 7 meses). La prevalencia de lesiones de caries de esmalte y dentina (código CAST 3-7) fue del 91,2%, mientras que la prevalencia de lesiones de caries en dentina (código CAST 4-7) fue de 58,8%. El número promedio de dientes afectados por caries dental con compromiso pulpar y que tenían un absceso o fístula fue de 2.0% y 0.5% respectivamente. La mayoría de las lesiones de caries en esmalte y dentina se observaron en los molares. La valoración de severidad CAST fue 7.0. El tiempo promedio de examinación fue de 57 segundos. La carga de la enfermedad caries dental a estas edades tan tempranas ya es alta en la infancia suburbana de Lima.

Assessment of the Need for Dental Treatment Resulting From Dental Trauma in 12-Year-Old Brazilian Schoolchildren: A Cross-Sectional Study

Abstract Objective: To identify the need for restorative treatment in 12-year-old Brazilian schoolchildren with dental trauma and its association with clinical and socioeconomic factors. Material and Methods: A cross-sectional population-based study was carried out with sample composed of 588 12-year-old students from the city of Diamantina, Minas Gerais, Brazil. Data were collected from August to November 2016 through clinical examination, adopting the Andreasen classification and semi-structured questionnaire to verify the etiology and location of the accident that resulted in dental trauma. Statistical analysis included the frequency distribution and bi and multivariate analysis, with 5% significance level. Results: The presence of 219 traumatized teeth in 176 students was observed (29.9%). The main lesion was enamel fracture (41.4%), followed by enamel and dentin fracture (39.4%). The presence of restorative treatment was observed only in 11.5% of students. Fall (43.5%) was the most frequent etiology, followed by accidents on the streets (35.8%). Need for treatment was present in 53.4% of adolescents. Statistically significant association between males (p=0.010), severe overjet (p<0.0001) and inadequate lip protection (p<0.0001) and presence of dental trauma was observed. Maternal schooling over 8 years of study was statistically associated with need for restorative treatment (OR = 2.047; CI: 1.099-3.813; p=0.023). Conclusion: Prevalence of dental trauma, need for restorative treatment and number of adolescents with no access to restorative treatment in this study were high, point out that the health system is unable to satisfactorily prevent dental trauma and absorb all dental treatment demand resulting from dental trauma.

Diagnóstico y tratamiento integral en pacientes con Amelogénesis Imperfecta: reporte de un caso / Diagnóstico e tratamento integral em pacientes com Amelogênese Imperfeita: relato de um caso / Diagnosis and comprehensive treatment for patients with Amelogenesis Imperfecta. Case report

Objetivo: La Amelogénesis Imperfecta comprende un grupo heterogéneo de defectos del esmalte de origen genético, debidos a alteraciones en la formación del esmalte dentario, en calidad y/o cantidad. El diagnóstico se basa en la observación clínica, exámenes radiográficos, la historia familiar, el árbol genealógico y cuando es posible el diagnóstico genético. Se caracteriza por tener un amplio rango de presentaciones clínicas en ambas denticiones. Esta afección tiene un alto impacto en niños y adolescentes debido a que la carencia estética y la disfunción limitan su calidad de vida. La atención integral se convierte en un aspecto esencial y demanda una inteligente y necesaria interacción profesional, paciente y familia, la cual debe establecerse en forma temprana y de manera interdisciplinaria. Objetivo: Presentar un reporte de casocaso de un paciente de 11 años con Amelogénesis Imperfecta y diagnóstico clínico y radiográfico de tipo hipoplásico, apoyado en su historia familiar. El tratamiento integró varias etapas: uso de agentes remineralizantes a fin de restaurar los tejidos dentarios; ortodoncia para crear espacio para la erupción del canino retenido (13) y alineación de la arcada dentaria superior y rehabilitación dentaria con resinas compuestas y coronas metálicas fenestradas en oclusal. Conclusiones: El seguimiento por cinco años con una actitud muy positiva de la paciente hacia el mantenimiento de su salud, confirma que en el adolescente, una sonrisa saludable es importante en el desarrollo de la autoestima y las relaciones interpersonales.

A Amelogênese Imperfeita compreende um grupo heterogêneo de defeitos de esmalte de origem genética, que ocorre devido a alterações na formação de esmalte dentário, e podendo comprometer em qualidade e/ou quantidade do mesmo. O diagnóstico é baseado em observação clínica e radiográfica, história familiar, padrão genético familiar e quando possível, realização de uma investigação genética. Ela caracteriza-se por ter uma ampla gama de manifestações clínicas em ambas as dentições. Esta condição tem um alto impacto em crianças e em adolescentes, gerando um comprometimento social, a funçáo e consequentemente, limitando a qualidade de vida dos pacientes. O cuidado integral torna-se um aspecto essencial do tratamento, exigindo uma interação do profissional com o paciente e seus familiares, que deve ser estabelecida de forma precoce e interdisciplinar. Os objetivos do plano de tratamento devem abranger três aspectos: prevenção, restauração da estrutura dental e reabilitação estética. Objetivo: Paciente de 11 anos de idade, com amelogênese Imperfeita de tipo hipoplásico, segundo o diagnostico clínico e radiográfico e com base na história familiar. O tratamento foi realizado em diversas etapas: uso de agentes remineralizantes na remineralizacão de tecidos dentais, tratamento ortodóntico para criar espaço para a erupção do canino retido e o alinhamento da arcada dentária superior, e por último, a reabilitação com resinas compostas e coroas metálicas fenestradas na superfície oclusal. Conclusão: Durante cinco anos de acompanhamento, o paciente tem demonstrado uma atitude muito positiva em relação à manutenção de sua saúde, confirmando-se que na adolescência, um sorriso saudável é importante no desenvolvimento da autoestima e das relações interpessoais.

Amelogenesis Imperfecta is a diverse group of hereditary and heterogeneous enamel defects, due to alterations in the formation of dental enamel in quality and/or quantity. Diagnosis is based on clinical and radiological findings, family history, family tree, and genetic diagnosis when it is possible. It is characterized by a wide range of clinical presentations in both dentitions. This condition has a high impact on children and adolescents, generates a very disadvantageous social performance since aesthetic problems and dysfunction limit their quality of life. Comprehensive care becomes an essential aspect and it demands a close and necessary professional, patient and family interaction, which must be established early and in an interdisciplinary way. Objective: We present a patient with Amelogenesis Imperfecta, 11 years old, with a clinical and radiographic diagnosis of hypoplastic type, based on her family history. The treatment integrated several stages: use of remineralizing agents in order to restore Latinoamericanadental tissues, orthodontics to create space for the eruption of the retained canine (13), and the alignment of upper dental arch, and rehabilitation with composite resins and metal crowns fenestrated in occlusal. Conclusion: The five year follow- up, with a very positive attitude of the patient toward the maintenance of her health, suggests that in adolescence, a healthy smile is important in the development of self-esteem and interpersonal relationships.

Factors associated with the development of dental defects acquired in the extrauterine environment

Abstract This study aimed to analyze the association of sociodemographic, child health, healthcare service, and access indicators with developmental defects of enamel (DDE) acquired outside the uterus, based on gestational factors. A cohort of births was carried out, and 982 children aged 12 to 30 months were examined. A total of 1,500 women were followed up as of the 5th month of gestation, and the child's gestational age was evaluated at follow-up. The clinical examination was performed as recommended by the World Health Organization, and defects were classified using the modified DDE index. Six models were considered: presence of DDE (Model 1) or opacities (Model 4), number of teeth with DDE (Model 2) or opacities (Model 5), and incidence rate of DDE (Model 3) or opacities (Model 6). Associations were estimated by relative risk (RR) in Poisson regression models. In the adjusted analysis, the mother's lowest education level was associated with the highest occurrence of DDE in Models 1 (RR = 26.43; p = 0.002), 2 (RR = 9.70; p = 0.009), and 3 (RR = 5.63; p = 0.047). Breastfeeding for over 12 months (RR = 0.45; p = 0.030) and recent use of anti-infection drugs (RR = 0.20; p = 0.039) had a protective effect on DDE (Model 1). The factors associated with the highest incidence of opacities were not having health insurance (RR = 2.00; p = 0.043) (Model 5), and belonging to a family of poor social class (RR = 4.67; p = 0.007) (Model 6). Children in a situation of socioeconomic vulnerability have a higher risk of presenting extrauterine DDE. Breastfeeding was a protection factor for DDE development.

Prevalence and factors associated with enamel defects among preschool children from a southeastern city in Brazil / Prevalência e fatores associados aos defeitos de desenvolvimento de esmalte em crianças pré-escolares de uma cidade do sudeste do Brasil

Abstract This study sought to determine the prevalence of developmental defects of enamel (DDE) among preschool children and investigate associations with sociodemographic and socioeconomic factors and weight status. A cross-sectional study was conducted with 118 children aged 3 to 5 years. Data were collected via clinical examinations and a self-administered questionnaire completed by the parents. The diagnosis of DDE was performed using the modified DDE Index. Information on socioeconomic indicators (mother's schooling, monthly income per capita), child's sex and age, and age of mother at the birth of the child were obtained by questionnaire. The children's weight status was determined based on weight-for-age at the time of the exam. Statistical analysis involved the chi-squared test and Poisson regression with robust variance. The prevalence of DDE was 50.0%. DDE were more frequent in males (p = 0.025) and children whose families were classified as being at poverty line (p = 0.040). In the Poisson model controlled for child's sex and mother's schooling, children whose families were classified as being at the poverty line had a greater prevalence rate of DDE. In conclusion, the prevalence of DDE was high in the present sample and associated with lower household income. Weight status was not associated with DDE.

Resumo Objetivou-se avaliar a prevalência de defeitos de desenvolvimento de esmalte (DDE) em pré-escolares e investigar a associação com fatores sociodemográficos e socioeconômicos e peso da criança. Foi realizado um estudo transversal com 118 crianças de três a cinco anos de idade. Os dados foram coletados por meio de exame clínico e questionário autoaplicável respondido pelos pais. Para o diagnóstico de DDE utilizou-se o Developmental Defects of Enamel Index. Informações sobre indicadores socioeconômicos (escolaridade da mãe e renda familiar per capita), gênero e idade da criança e idade da mãe ao nascimento da criança foram obtidas do questionário. O status de peso foi determinado baseando-se no peso e idade da criança no momento do exame. A análise estatística incluiu teste do qui-quadrado e regressão de Poisson. A prevalência de DDE foi 50.0%, sendo mais frequente em crianças do sexo masculino (p = 0.025) e provenientes de famílias incluídas na linha de pobreza (p = 0.040). No modelo de regressão de Poisson ajustado para gênero e escolaridade da mãe, observou-se que as crianças provenientes de famílias incluídas na linha de pobreza apresentaram maior prevalência de DDE. Conclui-se que a prevalência de DDE foi alta e associada com renda familiar per capita. O peso da criança não foi associado com DDE.

Association Between Presence of Enamel Defects, Dental Caries and Socioeconomic Conditions on Brazilian Children

Objective: To verify the relationship between developmental enamel defects (DED) in permanent incisors and socioeconomic conditions and dental caries in children within the life course context. Material and Methods: A total of 350 children aged 9-11 years from 13 public schools in the city of Bauru, Brazil were examined. Clinical exams were performed to observe the presence of caries and developmental enamel defects using the DMFT and DED indexes, respectively. In addition, information about family income and parental schooling was collected. Statistical analysis used the Spearman Correlation Coefficient and the Chi-square test to verify the association between DED, socioeconomic conditions and dental caries. The significance level adopted was 5%. Results: Association between presence of dental caries and DED (p=0.04), delimited opacity (p=0.02) and opacity (p=0.01) was observed. Inverse correlation for the decayed component with maternal schooling and family income was also verified. Regarding the types of development enamel defect (DED), correlation between delimited opacity, opacity and DED with the DMFT index was observed. Conclusion: The results of this study indicated association between enamel defects and caries, as well as correlation between income and parental schooling and dental caries.

Prevalence of and factors associated with enamel fracture and other traumas in Brazilian children 8-10 years old

Abstract The aim of this study was to assess the prevalence and discriminate the associated factors between enamel fractures and other trauma/trauma sequelae in 8 to 10-year-old Brazilian schoolchildren. A representative sample of 1,201 children from public and private schools were enrolled in this cross-sectional study. Questionnaires about sociodemographic characteristics were answered by parents. The outcome variable (traumatic dental injury, TDI) was multi-categorized. Independent individual variables were sex, age, number of residents in household, parents/caregivers' level of education, family income, dental caries, and overjet. Type of school was considered an independent contextual variable. Multilevel analysis, bivariate, and multivariate multinomial logistic regression models were performed. The prevalence of TDI was 14.0% (2.8% with other trauma/trauma sequelae). The multilevel analysis revealed no significant difference between the type of school and TDI. The multinomial logistic regression showed that boys (OR = 2.3; 95%CI: 1.1-4.8), older children (OR = 1.8; 95%CI: 1.1-3.0) and individuals with an overjet > 3 mm (OR = 2.5; 95%CI: 1.0-6.2) were more likely to present other trauma/trauma sequelae. Enamel fracture was not significantly associated with any variables. The prevalence of TDI in 8 to 10-year-old schoolchildren was 14% but only 2.8% of other trauma/trauma sequelae. Differences regarding the associated factors of TDI involving enamel fracture or other trauma/trauma sequelae were detected, suggesting that the different TDI classification cannot be evaluated as a single category.

Efeito sobre a morfologia do esmalte dental e análise físico-química de medicamentos utilizados por pacientes pediátricos com paralisia cerebral / Effect on dental enamel morphology and physical-chemical analysis of medicines used by pediatric patients with cerebral palsy

Introdução: Muitos medicamentos pediátricos líquidos são considerados fatores de risco para a estrutura dentária. Esse potencial pode aumentar quando ingeridos de forma crônica, como é o caso do tratamento de algumas condições, tal como a paralisia cerebral. Objetivo: Avaliar o efeito sobre a morfologia do esmalte dental e as propriedades físico-químicas de medicamentos de uso contínuo indicados a pacientes infantis com Paralisia Cerebral. Material e método: A amostra foi constituída por quatro medicamentos: Fenobarbital (M1), Carbamazepina (M2), Oxcarbazepina (M3) e Domperidona (M4), todos em suspensão oral. Analisaram-se o pH, o teor de Sólidos Solúveis Totais (SST) e a viscosidade dos medicamentos. Todos os testes foram realizados em duplicata. Para análise em microscopia eletrônica de varredura (MEV), 15 blocos de esmalte bovino foram distribuídos aleatoriamente e imersos em oxcarbamazepina (n=5), carbamazepina (n=5) e saliva artificial (n=5). Os ciclos de imersão foram feitos por seis dias, durante cinco minutos, duas vezes ao dia, com intervalos de 12 horas, quando ficavam mantidos em saliva artificial. O grupo controle permaneceu em saliva artificial. Os dados foram analisados descritivamente. Resultado: Em relação ao pH endógeno, os valores variaram de 2,82 (M3) a 9,60(M1). Para o SST, as médias de maior e menor valor foram, respectivamente, de 20,5% (M3) e 46% (M1). A viscosidade variou de 6,89 mm2/s (M1) a 58 mm2/s (M3). Em MEV, observaram-se alterações sugestivas de perda de estrutura no esmalte dental em oxcarbamazepina e carbamazepina, proveniente da ação dos medicamentos analisados. Conclusão: Concluiu-se que os medicamentos líquidos pediátricos analisados, indicados a pacientes com paralisia cerebral, apresentam potencial cariogênico e erosivo, destacando-se a Oxcarbazepina.

Introduction: Many liquid pediatric medicines are considered risk factors for tooth structure. This potential may increase when taken chronically as is the case of some conditions such as cerebral palsy. Objective: To evaluate the effect on the morphology of dental enamel and the physicochemical properties of continuous use of drugs given to pediatric patients with cerebral palsy. Material and method: The sample consisted of three drugs for epilepsy: Phenobarbital (D1), Carbamazepine (D2), Oxcarbazepine (D3); and one drug for gastroesophageal reflux: Domperidone (D4). All in oral suspension. The pH, content of total soluble solids (TSS), and viscosity of the drugs were analyzed. The tests were made two measurements. For SEM analysis, 15 bovine enamel blocks were randomly distributed and immersed in oxcarbazepine (n=5); carbamazepine (n=5); and artificial saliva (n=5). The immersion cycles were made for 6 days, during 5 minutes, 2 times a day with intervals of 12 hours, when they were kept in artificial saliva. The control group remained in artificial saliva. Data were descriptively analyzed. Result: Regarding endogenous pH, values ranged from 2.82 (D3) to 9.60 (D1). For TSS, the highest and lowest mean values were, respectively, 20.5% (D3) and 46% (D1). Viscosity ranged from 6.89 mm2/s (D1) to 58 mm2/s (D3). In SEM, observed alterations suggestive of loss of structure in the enamel in oxcarbazepine and carbamazepine from the action of the drugs analyzed. Conclusion: It was concluded that the pediatric liquid drugs analyzed, indicated to patients with cerebral palsy, have the potential cariogenic and erosive, especially the Oxcarbazepine.

Associação dos indicadores socioeconômicos, fatores pre e perinatais na ocorrência de defeitos de desenvolvimento de esmalte na dentição decídua: estudo de base populacional / Socioeconomic indicators, pre and perinatal factors associated with developmental defects of enamel in primary teeth: a population-based study

Os defeitos de desenvolvimento de esmalte (DDE) são alterações comuns na dentição decídua e podem estar associados a intercorrências nos períodos pré, peri e pós natais bem como a indicadores socioeconômicos. A literatura é escassa de evidências científicas de base populacional, sendo que a maioria das pesquisas é realizada principalmente com amostras específicas. O objetivo deste estudo foi estimar a prevalência de DDE em crianças de cinco anos de idade e verificar a associação com prematuridade, peso ao nascer, intercorrências na gravidez (síndrome hipertensivo, infeções urinarias e diabetes gestacional) e indicadores socioeconômicos (renda mensal per capita, escolaridade materna, tipo de escola frequentada pela criança). Realizou-se um estudo transversal representativo com uma amostra de 1350 crianças de cinco anos de idade em Belo Horizonte - MG. Brasil. Após o consentimento dos pais, as crianças foram examinadas para o diagnóstico do DDE utilizando os critérios do índice DDE modificado (FDI,1992), e, através de um questionário, as mães forneceram os dados socioeconômicos bem como peso ao nascer, tempo de gestação e às intercorrências durante a gravidez relacionadas a parto pre-termo e baixo peso. A análise dos dados foi realizada utilizando-se o programa SPSS para Windows versão 19.0 e incluiu a distribuição de frequência, qui-quadrado de Pearson e Teste Exato de Fisher e regressão de Poisson com variância robusta adotando um valor de p <0,05. A prevalência de DDE foi de 40,6%. A opacidade demarcada foi o tipo de defeito mais frequente (22,7%) Através da análise bivariada, verificou-se associação estatisticamente significativa entre o DDE e gênero, peso ao nascer, idade da mãe durante a gestação, escolaridade materna, intercorrência na gravidez (síndrome hipertensivo) e tipo de escola da criança. A partir do modelo de regressão de Poisson ajustado, observou-se maior prevalência de DDE entre as crianças do gênero masculino (RP: 1,177, 95% IC 1,033 ­ 1,342), com baixo peso ao nascer (RP: 1,387; 95% IC 1,161 ­ 1,656) e muito baixo peso ao nascer (RP: 1,667; 95% IC: 1,150 ­ 2,416). A partir destes resultados conclui-se que os defeitos de desenvolvimento de esmalte foram mais comuns entre as crianças do gênero masculino, com peso ao nascer baixo ou muito baixo

The developmental defects of enamel (DDE) are common changes in the primary dentition and may be associated with complications in the pre, peri and post-natal care as well as with socioeconomic indicators. Literature is scarce in scientific evidence in population base, once the majority of studies are mainly performed with specific samples. The aim of this cross-sectional study was to estimate the prevalence of DDE in five years old children and the association with premature, complications during pregnancy birth weight and socioeconomic indicators (family income, maternal education, type of preschool attended by children). A cross-sectional study was conducted with a representative sample of 1350 children of five years old of Belo Horizonte - MG. Brazil. After parental consent, children were examined for the diagnosis of DDE using DDE index modificated (FDI, 1992), and through a questionnaire mothers provided socioeconomic data, birth weight and premature and complications during pregnancy. Data analysis was performed using SPSS for Windows 19.0, and included frequency distribution, chi- square test and Fisher's exact test and Poisson regression with robust variance (p < 0.05). The prevalence of DDE was 40.6 %. The demarcated opacity was the most common type of defect (22.7%) by bi-variate analysis; there was also a statistically significant association between developmental defects of enamel and gender, weight birth, complications during pregnancy (Arterial hypertension), mother´s age in the pregnancy, maternal education, type of school of children. The Poisson regression model adjusted showed that there was a higher prevalence of enamel defects among male children (PR: 1.177, 95% CI 1.033 to 1.342), low weight (PR: 1.387, 95% CI 1.61 to 1.656) and very low (PR: 1.667, 95% CI: 1.150 to 2.416). Out of these results it is concluded that the development of enamel defects were more common among male children with low or very low birth weight

Epidemiological study of traumatic dental injuries in 5- to 6-year-old Brazilian children

Monitoring traumatic dental injury (TDI) in primary teeth through epidemiological cross-sectional surveys provides descriptive information relevant to the development of public policies focused on the prevention of such injuries for the target population. The aim of this study was to assess the prevalence of TDI in 5- to 6-year-old Brazilian children and its association with biological and socioeconomic factors. A total of 684 children aged 5 to 6 years old, from 11 public schools in the city of Barueri (Brazil) were evaluated. Clinical examinations were carried out in the schools, by two trained and calibrated examiners. Gauze and a mouth mirror were used for the examinations. The reported TDIs were classified according to the Andreasen (2007) criteria for primary teeth. The results showed that 52.3% of the children had TDI. Enamel fracture (63.4%) was the most frequently observed sign of TDI, and the most affected teeth were the primary maxillary central incisors (26.9% maxillary right central incisor and 24% maxillary left central incisor). There was no association between the presence of TDI and biological or socioeconomic factors. In conclusion, the prevalence of TDI was high and had no statistically significant association with biological and socioeconomic factors.

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.

Hallazgos bucales en niños con enfermedad renal / Buccal finding in children with renal disease

La frecuencia e incidencia de enfermedades renales en niños ha sido documentada, destacándose las disfunciones tubulares, acidosis tubular, insuficiencia renal crónica, litiasis renal, entre otras. El objetivo de la investigación fue caracterizar los hallazgos bucales en niños de 1 a 13 años con enfermedad renal. Se realizó una investigación de tipo descriptiva con diseño transversal durante enero-abril de 2010, en el Servicio de Nefrología Pediátrica de la Ciudad Hospitalaria "Dr. Enrique Tejera", en Valencia-Estado Carabobo, Venezuela, se evaluaron 50 pacientes con edad promedio 6.85 años, con diversas enfermedades renales, la mayoría con hipercalciuria (58%) y sin otro compromiso sistémico. Los hallazgos bucales encontrados fueron hipoplasias de esmalte 30%, caries dental 36%, retardo en la erupción 16%, maloclusiones 10% y lengua geográfica 6%; ningún paciente presentó cálculo dental. Un dato importante fue que 44% de los pacientes nunca habían asistido a consulta odontológica. Se concluye que los hallazgos bucales con mayor frecuencia encontrados en niños con enfermedad renal fueron hipoplasias del esmalte, caries dental y retardo en la erupción dentaria, destacándose el desinterés por parte de los pacientes a la consulta odontológica

The frequency and incidence of renal disease in children had been documented, highlighting tubular dysfunctions, tubular acidosis, renal insufficiency, renal lithiasis, among others. The aim of this investigation was to characterize the buccal findings in children of 1 to 13 years old with renal disease. The investigation was a descriptive type, in a transversal design during january-april of 2010, in the Pediatric Nephrologic Service of the Hospital City "Dr. Enrique Tejera", in Valencia, Carabobo State, Venezuela, there were 50 patients with a mean age 6.85 years old, with hypercalciuria in 56% with no other systemic disease. The buccal findings were enamel hypoplasia 30%, dental caries 36%, delay eruption 16%, maloclussion 10% and geographic tongue 6%; none of the patients presented dental calculus. An important data was that 44% of the patients never had assisted to a dental appointment. The conclusions of this study are that the buccal findings more seen in children with renal disease are enamel hypoplasias, dental caries and delay eruption, underlying the lack of interest of the patients to the dental consult

Etiología de las opacidades severas del esmalte: una evaluación basada en un estudio prospectivo médico y social en 17000 niños / Aetiology of severe demarcated enamel opacities: an evaluation based on prospective medical and social data from 17000 children

Durante los años 70s, los odontólogos describieron una prevalencia creciente de un nuevo tipo de alteración en el esmalte. Este era muy específico, con áreas de demarcado esmalte hipomineralizado y se encontraba en su mayoría en los primeros molares permanentes y en los incisivos. Diferentes estudios trataron de relelar la etiología de estas alteraciones, pero hasta ahora no se han encontrado factores claramente relacionados. El propósito del presente trabajo fue evaluar los factores etiológicos de las opacidades demarcadamente severas (OSD) en los primeros molares permanentes en una gran cohorte de niños incluidos en el proyecto "Todos los niños del sudeste de Suecia" (ABIS). Se llevó a cabo un estudio prospectivo de los niños de 5 condados suecos nacidos entre el 1º de octubre de 1997 y el 1 de octubre de 1999, un total de 17000 niños que fueron seguidos desde su nacimiento y fueron registrados un gran número de factores sobre nutrición, enfermedades, medicación, infecciones, situación social, etc. Con la ayuda de 89 clínicas del Servicio Dental Público, en la misma área, se realizaron exámenes preliminares de los niños nacidos entre octubre 1º de 1997 y octubre 1º de 1999. Se analizaron 595 niños con opacidades severamente marcadas (OSD) en los primeros molares. Estos niños, y un grupo control de 1200 niños seleccionados al azar fueron luego invitados para ser examinados por odontopediatras. En estos exámenes se identificaron 224 casos severos, como así también 253 niños sin ninguna alteración en el esmalte. Fueron analizados estos dos grupos. No hubo ninguna correlación entre OSD y las variables del banco de datos del ABIS. Los análisis muestran que no existe asociación entre OSD y datos pre, peri y neonatales. Sin embargo, hemos encontrado una asociación positiva entre OSD y el alimento a pecho por más de 6 meses.

Association of dental enamel lead levels with risk factors for environmental exposure / Associação de níveis de chumbo no esmalte dentário com fatores de risco para exposição ambiental / Asociación de niveles de plomo en el esmalte dental con factores de riesgo a la exposición ambiental

OBJECTIVE: To analyze household risk factors associated with high lead levels in surface dental enamel. METHODS: A cross-sectional study was conducted with 160 Brazilian adolescents aged 1418 years living in poor neighborhoods in the city of Bauru, southeastern Brazil, from August to December 2008. Body lead concentrations were assessed in surface dental enamel acid-etch microbiopsies. Dental enamel lead levels were measured by graphite furnace atomic absorption spectrometry and phosphorus levels were measured by inductively coupled plasma optical emission spectrometry. The parents answered a questionnaire about their children's potential early (05 years old) exposure to well-known lead sources. Logistic regression was used to identify associations between dental enamel lead levels and each environmental risk factor studied. Social and familial covariables were included in the models. RESULTS: The results suggest that the adolescents studied were exposed to lead sources during their first years of life. Risk factors associated with high dental enamel lead levels were living in or close to a contaminated area (OR = 4.49; 95 percent CI: 1.69;11.97); and member of the household worked in the manufacturing of paints, paint pigments, ceramics or batteries (OR = 3.43; 95 percent CI: 1.31;9.00). Home-based use of lead-glazed ceramics, low-quality pirated toys, anticorrosive paint on gates and/or sale of used car batteries (OR = 1.31; 95 percent CI: 0.56;3.03) and smoking (OR = 1.66; 95 percent CI: 0.52;5.28) were not found to be associated with high dental enamel lead levels. CONCLUSIONS: Surface dental enamel can be used as a marker of past environmental exposure to lead and lead concentrations detected are associated to well-known sources of lead contamination.

OBJETIVO: Analisar fatores de risco no ambiente domiciliar associados com altos níveis de chumbo no esmalte dentário superficial. MÉTODOS: Estudo transversal conduzido com 160 adolescentes brasileiros (14 a 18 anos), residentes em bairros pobres do município de Bauru, SP, de agosto a dezembro de 2008. A concentração de chumbo no esmalte dentário foi avaliada por microbiópsias ácidas do esmalte dentário superficial, quantificada por espectrometria de absorção atômica com forno de grafite e a concentração de fósforo foi medida por espectrometria de absorção óptica com plasma indutivamente acoplado. Os pais dos adolescentes responderam a questionário sobre possível exposição prévia (cinco primeiros anos de vida do adolescente) a chumbo decorrente de fontes de contaminação bem conhecidas. Usou-se regressão logística para identificar associações entre concentração de chumbo no esmalte e fatores de risco ambientais. Covariáveis familiares e sociais foram incluídas nos modelos. RESULTADOS: Os resultados sugerem que os jovens avaliados foram expostos a fontes de chumbo durante seus primeiros anos de vida. Os fatores de risco associados com o desfecho foram residir em área contaminada por chumbo ou nas suas proximidades (OR = 4,49; IC 95 por cento: 1,69;11,97) e ter convivido, no mesmo domicílio, com pessoa que trabalhava em fábrica de tintas, pigmentos, cerâmicas ou baterias (OR = 3,43; IC 95 por cento: 1,31;9,00). Ter usado, em casa, cerâmica vitrificada, brinquedos de baixa qualidade ou piratas, ter aplicado zarcão em portões de ferro sem cobertura esmaltada ou armazenar baterias de carro usadas na residência (OR = 1,31; IC 95 por cento: 0,56;3,03) e hábito de fumar não foram associados com altas concentrações de chumbo no esmalte dentário (OR = 1,66; IC 95 por cento: 0,52;5,28). CONCLUSÕES: O esmalte dentário superficial pode ser utilizado como marcador de exposição ambiental passada ao chumbo e as concentrações encontradas desse metal estão ligadas a fontes bem conhecidas de contaminação por chumbo.

OBJETIVO: Analizar factores de riesgo en el ambiente domiciliar asociados con altos niveles de plomo en el esmalte dental superficial. MÉTODOS: Se realizó estudio transversal con 160 adolescentes brasileros (14 a 18 años), residentes en urbanizaciones pobres del municipio de Bauru, SP, de agosto a diciembre de 2008. La concentración de plomo en el esmalte dental fue evaluada por micro biopsias ácidas del esmalte dental superficial, cuantificada por espectrometría de absorción atómica con horno de grafito y la concentración de fósforo fue medida por espectrometría de absorción óptica con plasma inductivamente acoplado. Los padres de los adolescentes respondieron a cuestionario sobre posible exposición previa (5 primeros años de vida del adolescente) al plomo producto de fuentes de contaminación bien conocidas. Se usó regresión logística para identificar asociaciones entre concentración de plomo en el esmalte y factores de riesgo ambientales. Covariables familiares y sociales fueron incluidas en los modelos. RESULTADOS: Los resultados sugieren que los jóvenes evaluados fueron expuestos a fuentes de plomo durante sus primeros años de vida. Los factores de riesgo asociados con el resultado fueron residir en área contaminada por plomo o en sus proximidades (OR=4,49; IC 95 por ciento: 1,69;11,97) y haber convivido, en el mismo domicilio, con persona que trabajaba en fábrica de tintas, pigmentos, cerámicas o baterías (OR= 3,43; IC 95 por ciento: 1,31;9,00). Haber usado, en casa, cerámica vitrificada, juegos de baja calidad o piratas, haber aplicado zircón en portones de hierro sin cobertura esmaltada o almacenar baterías de carro usadas en la residencia (OR= 1,31; IC 95 por ciento: 0,56-3,03) y hábito de fumar no fueron asociados con altas concentraciones de plomo en el esmalte dental (OR=1,66; IC 95 por ciento: 0,52;5,28). CONCLUSIONES: El esmalte dental superficial puede ser utilizado como marcador de exposición ambiental pasada al plomo y las concentraciones encontradas de dicho metal están relacionadas con fuentes bien conocidas de contaminación por plomo.

Prevalence of dental caries and caries-related risk factors in premature and term children

This study evaluated the prevalence of enamel defects and dental caries and their risk factors on primary and permanent dentitions of prematurely-born children and term children. Eighty children were examined, 40 born prematurely (G1) and 40 born term (G2), in the age group between 5 and 10 years. The demographic variables, medical history and oral health behaviors were recorded on a questionnaire. The teeth were examined for presence of deficiencies of the enamel and caries that were registered. The caries were registered, focusing on the indices dmft (decayed, missing, and filled primary teeth) and DMFT (decayed, missing, and filled permanent teeth). The results showed that 75 percent of the total sample had enamel defects. The logistic regression model showed that other risk factors such as per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases had no correlation with enamel defects and caries. A smaller value of total DMFT (0.95) was found in the group of premature children in comparison to the term children (2.07) p = 0.0164. There was no difference concerning the permanent dentition between the two groups (p = 0.9926). One concludes that prematurity can't be a predisposing factor for the presence of dental caries.

Hipomineralização molar incisivo em escolares de Botelhos, Minas Gerais, Brasil / Molar incisor hypomineralization in schoolchildren from Botelhos, Minas Gerais, Brazil

Devido à característica não remodeladora do esmalte dentário, alterações durante sua formação são permanentemente registradas em sua superfície, caracterizando os defeitos de desenvolvimento do esmalte. Dentre eles, a Hipomineralização Molar Incisivo (HMI) é reconhecida clinicamente por meio de opacidades demarcadas de esmalte, com distribuição assimétrica, que afeta primeiros molares e incisivos permanentes, embora haja relatos de segundos molares decíduos com defeitos semelhantes. Sem etiologia definida, estudos clínicos e epidemiológicos demonstram que a HMI associa-se a maior experiência de cárie dentária. Este estudo teve como objetivo avaliar a prevalência de HMI em escolares 6 a 12 anos de idade de Botelhos/MG e verificar sua associação com a cárie dentária, opacidades demarcadas de esmalte em segundos molares decíduos (OSMD), fatores socioeconômicos e demográficos. Após calibração dos examinadores, as crianças foram examinadas em ambiente escolar, seguindo os critérios da Organização Mundial de Saúde (OMS) para levantamentos epidemiológicos em saúde bucal. Para diagnóstico em HMI, foram utilizados os critérios da Academia Européia de Odontopediatria. Para cárie, foram utilizados os índices CPOD e ceod e para diagnóstico das OSMD, o Índice de Defeitos de Desenvolvimento de Esmalte. Os pais responderam questionários sobre fatores socioeconômicos, e as informações demográficas foram coletadas durante os exames clínicos. Após tabulação dos dados, procedeu-se a estatística não paramétrica no programa SPSS 16.0, com nível de significância de 5%. Dentre as 918 crianças avaliadas, 19.8% (182/918) apresentaram HMI, sendo a maioria dos defeitos caracterizados como leve. Pode-se observar que o grupo de crianças com HMI apresentou valores mais elevados de CPOD, o mesmo não foi observado para ceod. Foi observada associação entre a presença de OSMD e HMI no grupo de crianças com dentição mista. Nenhuma variável socioeconômica esteve associada à experiência do defeito. Dentre os fatores demográficos, a zona de moradia (Rural) esteve relacionada à maior prevalência de HMI, OSMD, maiores valores de CPOD e concentração de piores indicadores socioeconômicos. Pode-se concluir que, mesmo na população do presente estudo, onde mais de 50% das crianças apresentaram pelo menos um dente permanente cariado segundo os critérios da OMS, a HMI esteve associada com maior desenvolvimento de lesões cariosas, revelando maior impacto nas necessidades de tratamento. Apesar de nenhum fator socioeconômico estar associado à experiência de HMI na população estudada, sua maior prevalência na zona rural, que concentra os piores fatores socioeconômicos, indica que dimensões sociais complexas podem estar envolvidas na incidência deste defeito de esmalte

Due to the non-remodeling features of dental enamel, some changes during its formation are often registered on its surface, which characterize the defects of the enamel development. Among them, the Molar-Incisor Hypomineralization (MIH) is clinically recognized by means of enamel demarcated opacities, with asymmetrical distribution, that affects first molars and permanent incisors, although there are accounts of second deciduous molars with similar defects. Without defined etiology, clinical and epidemiological studies show that MIH is associated to a higher incidence of dental caries. This study aimed to evaluate the MIH prevalence among 6 to 12-year-old schoolchildren from Botelhos, Minas Gerais State, Brazil, and verify its association to dental caries, hypomineralized second primary molars (HSPM), demographical and socioeconomic factors. After calibration of the examiners, the children were examined at school environment, by following the criteria of the World Health Organization (WHO) for epidemiological surveys about oral health. For the MIH diagnosis, the criteria of the European Academy of Paediatric Dentistry were used, for caries, the DMFT and dmft indices were used and for the diagnosis of HSPM, the Developmental Defects of Enamel Index (DDEs) were used. Parents answered questionnaires about socioeconomic factors and demographical information about children was collected during clinical exams. After the data tabulation, it was elaborated the non-parametrical statistics at the SPSS 16.0 program, with a significance level of 5%. Among the 918 evaluated children, 19.9% (182/918) present MIH, with the majority of the defects characterized as mild ones. It was noted that the children group with MIH presented more elevated values of DMFT, but the same was not observed for dmft index. It was observed the association between HSPM and MIH in the children group with mixed dentition. No socioeconomic variable was associated to the defect experience. Among the demographical factors, the agricultural housing zone was related to a larger prevalence of MIH, HSPM, higher values of DMFT and the concentration of the worst socioeconomic indicatives. We can conclude that even among the population of this study, where more than 50% of children presented at least one permanent tooth decayed by WHO criteria, the MIH was associated to a larger development of caries lesions, disclosing a impact at the treatment necessities. Although no socioeconomic factor was associated the MIH experience at the studied population, its bigger prevalence at agricultural zone, which concentrates the worst socioeconomic factors, indicates that complex social dimensions can be involved in the enamel defect incidence

Fatores sócio-econômicos relacionados ao risco nutricional e sua associação com a freqüência de defeitos do esmalte em crianças da cidade de João Pessoa, Paraíba, Brasil / Socioeconomic factors, nutritional risk, and enamel defects in children from João Pessoa, Paraíba State, Brazil

O objetivo deste estudo foi verificar fatores associados ao risco nutricional ao longo do primeiro ano de vida em crianças de baixo nível sócio-econômico de João Pessoa, Paraíba, Região Nordeste do Brasil. E determinar a freqüência de defeitos do esmalte, associando-a ao risco nutricional. O estudo foi realizado com 117 crianças, 56 com risco nutricional e 61 eutróficas. Em domicílio, realizaram-se avaliação nutricional, exame clínico dos elementos dentais e entrevistas com as mães. Na maternidade, registraram-se informações dos períodos gestacional e de nascimento. Utilizaram-se os testes qui-quadrado, exato de Fisher e modelos de regressão logística. Os defeitos do esmalte estiveram associados ao risco nutricional após o primeiro ano de vida. O risco nutricional esteve associado à renda per capita, condições de peso ao nascimento e índice de crescimento intra-uterino. Conclui-se que na amostra investigada os defeitos do esmalte estiveram associados ao risco nutricional e este às condições sócio-econômicas desfavoráveis durante a gestação e o nascimento, sugerindo que estes são fatores relevantes na programação nutricional do indivíduo e na formação do esmalte dentário.

This study focused on factors related to nutritional risk in children over one year of age from low-income families in João Pessoa, Paraíba State, Northeast Brazil, and the frequency of related enamel defects. The study included 117 children, 56 at nutritional risk and 61 with normal growth. Nutritional evaluation, clinical dental examination, and interviews with mothers were conducted at the homes. Gestational and birth records were examined in the maternity hospital. Data were analyzed using the chi-square, Fisher's exact tests, and logistic regression. Enamel defects were associated with nutritional risk after the first year of life. Nutritional risk was associated with per capita family income, birth weight, and intrauterine growth index. These are relevant factors for individual nutritional planning and formation of dental enamel.

Prevalencia de fluorosis dental endémica en relación al contenido de fluoruros en las aguas de abasto público / Prevalence of dental endemic fluorosis in relation to fluoride content of comunal drinking water

The prevalence of dental fluorosis, a manifestation of chronic fluoride toxicity on ameloblasts, is increasing in communities with or without fluoride supplementation of drinking water. The aim of this work was to study the prevalence and severity of fluorosis in Chile and its relationship to socioeconomic level and fluoride content of drinking water. Six hundred ninety three children aged 7 to 12 years old, coming from four cities with drinking water fluoride levels of 0, 0.3, 1 and 2.2 ppm were subjected to a standardized odontological examination looking for clinical manifestations of fluorosis. The global prevalence of fluorosis was 32 percent being 61,4 percent in the city with the highest drinking water fluoride concentration and 20 percent in the city without fluoride in the drinking water. Likewise, the prevalence of fluorosis was higher in children of high socioeconomic level. It is concluded that the high prevalence of fluorosis, although generating only mild lesions, should be object of epidemiological surveillance