Social and behavioural associated factors of actinic cheilitis in rural workers.

OBJECTIVE: This cross-sectional study aimed to evaluate the prevalence and factors potentially associated with the development of actinic cheilitis (AC) in Brazilian rural workers. SUBJECTS AND METHODS: A professional performed all physical examinations and evaluations using semi-structured questionnaires in 240 rural workers. RESULTS: Eighty-three participants were diagnosed with AC (34.6%). It was more prevalent among workers older than 45 years (3.29-10.96 95% IC; OR = 3.30; p = .0018), Caucasians (phototypes I and II) (4.78-16.12 95% IC; OR = 10.81; p < .0001), illiterate individuals (2.16-21.59 95% IC; OR = 10.43; p = .0037), those with 6 or fewer years of formal schooling (2.03-7.89 95% IC; OR = 4.63; p = .0013), those regularly using pesticides (1.58-6.64 95% IC; OR = 2.79; p = .0260) and those who used the private health service in their last appointment (1.17-3.54 95% IC; OR = 2.72; p = .0083). CONCLUSION: There was a substantial prevalence of AC among rural workers with advanced age, white skin, and illiteracy, those with lower levels of education, those who regularly use pesticides, and those who utilised private health services in their last appointment. Thus, healthcare strategies that include rural workers are required for the control and prevention of AC in both public and private health services.

Impact of traumatic dental injury treatment on the Oral Health-Related Quality of Life of children, adolescents, and their family: Systematic review and meta-analysis.

BACKGROUND/AIM: Measures of oral health-related quality of life (OHRQoL) are useful in clinical trials to evaluate treatment outcomes. To detect the treatment impact of traumatic dental injuries (TDI) on OHRQoL is extremely relevant. The aim of this study was to assess whether there is scientific evidence of the impact of TDI treatment on OHRQoL of children, adolescents, and their families. MATERIAL AND METHODS: A systematic review and meta-analysis were conducted selecting articles from PubMed, Web of Science, Scopus, Cochrane Library, and Virtual Health Library until May 22nd, 2020. The gray literature, clinical trial registers, and a manual search were performed. Two independent reviewers selected the studies, extracted the data, and assessed the ROBINS-I risk of bias. A meta-analysis was performed using RevMan 5.4 program. The certainty of the evidence was evaluated using the GRADE system. RESULTS: In the electronic search, 413 abstracts and one registered study were found. After removing the duplicates and eligibility application, six studies were included. Individually, the studies presented low to moderate risk of bias and they found that TDI treatment reduces the negative impact on OHRQoL. In the meta-analysis, TDI treatment improved OHRQoL for 8- to 10-year-old children (p = .03; CI 5.19 [0.62, 9.75]) (detected by CPQ 8-10 questionnaire). In the perception of parents, the children, and adolescents who had suffered TDI also had their OHRQoL improved (p = .04; CI 14.77 [0.95, 28.60]) (detected by PPQ and P-CPQ questionnaire) but both evaluations had very low certainty of evidence. CONCLUSION: Treatment of traumatic dental injuries reduces the impact on the OHRQoL of children and adolescents. However, more studies are necessary to detect the TDI treatment influence on OHRQoL of preschoolers and in the family as well to estimate the effects due to outcomes that had a very low certainty of evidence (#CRD42018091210).

Evaluation of the impact of a dental trauma care program on oral health-related quality of life of children and their families.

BACKGROUND/AIM: A traumatic dental injury (TDI) may have physical and psychosocial consequences for children and their families, and it may impact their oral health-related quality of life (OHRQoL). The aim of this study was to assess the OHRQoL of children affected by TDI and their families after enrollment in the Dental Trauma Care Program (DTCP). METHODS: This longitudinal clinical study involved a consecutive sample of 2- to 6-year-old children registered in the DTCP over a period of six years. Parents/caregivers were interviewed and the OHRQoL questionnaire was completed. The Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) was used before and after treatment. The Andreasen criteria were used to classify TDIs. The patients were treated (minimal intervention/invasive intervention) according to TDI severity (uncomplicated/complicated). Based on the Kolmogorov-Smirnov test, the Wilcoxon non-parametric test was used to compare the ECOHIS total scale/subscales/domains before and after enrollment in the DTCP. The longitudinal changes were calculated using effect size measured by the Standardized Response Means (SRM). TDI severity and treatments were also evaluated. RESULTS: The total ECOHIS mean scores were 7.4 ± 9.2 and 0.8 ± 2.5, before and after TDI treatment (p < .001), respectively. ECOHIS scores dropped by 6.6 points after treatment, demonstrating a positive reduction in the impact on OHRQoL, as reflected by the satisfactory responsiveness of ECOHIS (0.9). The changes following treatment, independent of TDI severity and type of treatment, were significant (p < .001) in children and the family section. CONCLUSIONS: The impact of TDI on OHRQoL reduced after the enrollment of patients and their families in the DTCP.

Effects of oral health promotion programmes on adolescents' oral health-related quality of life: A systematic review.

OBJECTIVE: To evaluate the effects of oral health promotion programmes (OHPP) on adolescents' oral health-related quality of life (OHRQoL). METHODS: An electronic search was performed in five databases (MEDLINE via PubMed, Scopus, Virtual Health Library, Web of Science, Cochrane, Grey Literature databases), and specific indexers were used in the manual search. Clinical/community trials, cross-sectional or cohort studies, published in any language, were included. Studies meeting the inclusion criteria were analysed for quality and bias risk. RESULTS: From a total of 2343 abstracts, 4 articles were selected for quality evaluation including 2 studies classified with low, 1 with moderate and 1 with high methodological quality. The qualitative synthesis showed some methodological biases and heterogeneous interventions. Effective OHPP improve OHRQoL. The association of educational and dental care strategies generated greater positive effects on OHRQoL than those related only to treatment or isolated educational practices. CONCLUSION: Although studies showed positive effects of OHPP on adolescents' OHRQoL, both their shortage and low methodological quality indicates the need for developing other well-designed studies to investigate the present question. Record number in PROSPERO database (CRD42018084434).

Educational strategies for oral assistance for the disabled and their effects on dentistry students' formation: A systematic review.

AIMS: This systematic review aimed to analyze the influence of educational strategies for oral health care for Persons with disabilities (PwDs) on the technical, ethical, and social training of undergraduate dental students. METHODS AND RESULTS: An extensive search was performed in the following databases: Cochrane, Embase, PubMed, Scopus, Web of Science, LILACS/BBO and OpenGrey database. Observational, nonrandomized, and quantitative comparisons before and after some type of educational strategy in undergraduate dentistry was included. The risk of bias was assessed using the risk of bias in nonrandomized intervention studies (ROBINS-I) tool. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Nine were included and suggested that a significant improvement was observed in the technical training of undergraduate dental students although there was no consensus on the acquisition of ethical/social competences after the application of educational strategies. The included studies presented a moderate to serious risk of bias, and the certainty of evidence for both, technical and ethical/social evaluative constructs, as very low. CONCLUSION: Although studies show that awareness regarding PwD significantly increases technical skills in dental students, the evidence is poor due to the high risk of bias and inconsistency observed in both the technical and ethical/social constructs; further studies on this topic are therefore essential. Prospero: (CRD42021288463).

Educational strategies in oral healthcare for the disabled and their effects on dental students' training.

PURPOSE: To evaluate the effects of didactic and clinical training of dental students in treating Persons with Disabilities (PwD) on their self-perceptions about treating PWD. METHODS: A pre-and postevaluation of a didactic-clinical educational strategy targeting oral health care of PwD was conducted among fourth-year undergraduate dental students at a Brazilian dental school. Semi-structured questionnaires were used to assess the following work environment parameters: technical, organizational, social, ethical, and managerial acumen. Data were analyzed using Fisher's exact and chi-square tests, with a significance level of 5% (p < 0.05), to verify possible associations between the quantitative variables. A qualitative analysis was conducted through collective subject discourse. RESULTS: Significant differences were found in the self-perception of students' knowledge and abilities in providing low-complexity care for PwD before and after the training program (p = 0.025). Students were more confident about managing and organizing the work environment (p = 0.007) and providing humanized care to PwD (p = 0.042) posttraining program. Additionally, a decrease in the feeling of insecurity (p = 0.014) and feelings of pity, fear, or prejudice toward PwD (p < 0.001) were observed posttraining program. CONCLUSIONS: Didactic and clinical training interventions for treating PwD improved the work environment of undergraduate dental students in technical, managerial, organizational, and ethical/social dimensions.

Longitudinal study for dental caries calibration of dentists unexperienced in epidemiological surveys.

This study aimed to make a longitudinal analysis of interexaminer calibration reproducibility in diagnosing dental caries in posterior teeth, by examiners without previous experience in epidemiological studies. A group of 11 inexperienced examiners underwent theoretical-practical training and calibration assessments, assisted by a standard examiner. An examiner who did not participate directly in the research selected 5-year-old children with and without caries. The D3 diagnostic threshold was used to evaluate dental caries, based on the World Health Organization (WHO) criteria. The initial calibration (baseline) was performed after the theoretical-practical training session, and consisted of examining 20 children; the second calibration occurred three months later, and involved evaluating another 18 children. The interexaminer agreement was obtained by kappa statistics, and by overall percentage agreement. The paired t-test was applied to compare the values for kappa means and overall percentage agreement between the time points studied. At baseline, the values for kappa (> 0.81) and overall percentage agreement (> 95.63%) were considered high. At the 3-month calibration assessment, all the examiners showed some decrease in both kappa (p < 0.0001) and overall percentage agreement (p = 0.0102). The calibration process currently proposed by the WHO is effective. However, reproducibility was not maintained over time for inexperienced examiners evaluating the posterior teeth of 5-year-old children, under epidemiological conditions.

Two years of COVID-19 pandemic: Framework of health interventions in a Brazilian city.

The COVID-19 pandemic and its effects on public health have urgently demanded effective health policies to avoid the spread of COVID-19. Thus, public administrators have implemented non-pharmacological and pharmacological interventions to mitigate the pandemic's impacts and strengthen health services. The aim of this ecological study is to describe the scenario of COVID-19 pandemic in a Brazilian city, during 2 years. This ecological study was carried out in Nova Friburgo, a Brazilian city, for 105 weeks (two years), from March 29, 2020 (week 1) to April 02, 2022 (week 105). Data on COVID-19 cases and COVID-19 deaths, occupation of COVID-19 exclusive beds in hospitals, community mobility, vaccination, government regulation on the opening of city establishments and city risk assessment were collected from public datasets. Four waves of COVID-19 cases and deaths were observed during this period. The first case occurred in week 1 and first death in week 3 of this study. The highest peaks of cases and deaths were observed during the third wave with 1,131 cases (week 54) and 47 deaths (week 55) and where the highest occupation of COVID-19 exclusive beds in local hospitals occurred. Interventions from more restrictive to more flexible, were implemented throughout this study, including lockdown and gradual return in economic and social strata levels. Vaccination began on week 43 and at the end of this study 89.91% of the total population was vaccinated with at least one dose, being 83.22% fully vaccinated. A deep description of several interventions used to avoid COVID-19 spread in a Brazilian city during 2 years of this pandemic can help promote better decision-making in the future while it exposes the challenges of conducting public health policies in a pandemic scenario.

Validity of caries-detection methods under epidemiological setting.

PURPOSE: To evaluate the validity of the visual exam and adjunct diagnostic technologies for posterior permanent teeth under epidemiological conditions. METHODS: A probabilistic sample of 165 12-year-old schoolchildren from Piracicaba, São Paulo, Brazil, was examined by visual exam (VI1), visual exam + artificial lighting (VI2), bitewing (BW), fiber optic transillumination (FOTI), DIAGNOdent and the associations among them. The D1+D3 and D3 diagnostics criteria, under epidemiological conditions, were adopted. The sensitivity, specificity and accuracy were calculated to determine the validity of the exams. RESULTS: The most accurate diagnostic method was VI2+BW exam for all dental surfaces under both diagnostic criteria. It was concluded that the BW was the best adjunct diagnostic technology on epidemiological dental caries surveys, increasing the validity of the dental exams.

Reproducibility of adjunct techniques for diagnosis of dental caries in an epidemiological situation.

PURPOSE: To evaluate the reproducibility of visual exams under natural light (VE1), visual exams under artificial light (VE2), radiographic bitewing exams (BW), fibre optic transillumination exams (FOTI) and DIAGNOdent exams (DD) in epidemiological settings. MATERIALS AND METHODS: Three examiners and one benchmark examiner examined thirteen 12-year-old schoolchildren under epidemiological conditions for the D3 (carious lesions in dentin) and D1+D3 (carious lesions in enamel or dentin) diagnostic criteria. RESULTS: The reproducibility (intra/interexaminer agreement) under both diagnostic criteria was 'almost perfect' for the exams VE1 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.89/κinter = 0.84), VE2 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.88/κinter = 0.83), BW (D3: κintra = 0.95/κinter = 0.92; D1+D3: κintra = 0.99/κinter = 0.90) and FOTI (D3: κintra = 0.97/κinter = 0.93; D1+D3: κintra = 0.87/κinter = 0.83) exams and 'fair' for the DD exam (D3: κintra = 0.36/κinter = 0.35; D1+D3: κintra = 0.30/κinter = 0.32). CONCLUSION: It was concluded that the VE1, VE2, BW, and FOTI exams presented good reproducibility under epidemiological conditions, and can be used accurately in epidemiological surveys.

The influence of the Brazilian school health program on the oral-health-related quality of life of adolescents.

The aim of this study was to evaluate the influence of the Brazilian School Health Program (SHP) on dental clinical disorders such as caries, gingivitis, and dental trauma as well as on the oral-health-related quality of life (OHRQoL) of adolescents in Nova Friburgo, RJ, Brazil. The study consisted of a non-probabilistic (convenience) sample comprising 319 12-year-old adolescents, both participants and non-participants of the SHP, for at least two years. Socio-demographic and OHRQoL questionnaires (CPQ11-14, the Child Perceptions Questionnaire) were applied as well as clinical examinations for caries, periodontal disease, and dental trauma following the World Health Organization (WHO) criteria by calibrated researchers. Mann-Whitney, chi-square tests, and multiple logistic regression models were used for the data analysis. Statistically significant differences were observed between the groups covered and not covered by the SHP for gingivitis (p = 0.0373) and OHRQoL on the social welfare subscale (p = 0.0265) and total scale (p = 0.0449) of CPQ11-14. Multivariate analysis showed that female adolescents were 1.74 times more likely to present a lower OHRQoL (OR = 1.74, 95%IC = 1.10-2.77, p = 0.0183) than males. In addition, non-SHP subjects were 1.56 times more likely to have poor OHRQoL (OR = 1.56, 95%IC = 0.94-2.59, p = 0.0873) than program participants. In conclusion, SHP positively influenced the OHRQoL of adolescents. However, follow-up studies are needed to verify the continued effectiveness of this Brazilian SHP in improving the oral health levels and quality of life of adolescents.

A atenção e as condições de saúde bucal na população brasileira em situação de privação de liberdade / Oral health care and conditions of brazilian population in a liberty privation situation

A população em situação de privação de liberdade por motivos judiciais no Brasil é composta por homens e mulheres adultos inseridos no sistema prisional e jovens que cumprem medidas socioeducativas. O direito à saúde dessa população é garantido por políticas ministeriais regulamentadas por portarias normativas, que integram esta parcela da população ao Sistema Único de Saúde (SUS), com foco no cuidado integral, resolutividade e atenção contínua e de qualidade. No entanto, existem expressivos fatores que obstaculizam a promoção efetiva de saúde, como a deficiência estrutural, superlotação, ambientes insalubres e estressantes, má alimentação e hábitos não saudáveis. Diante disso, o presente estudo se propôs a analisar, através de uma revisão narrativa da literatura, o panorama da saúde bucal dessa população. A pesquisa para compor essa revisão foi realizada nas bases de dados bibliográficos PubMed, Biblioteca Virtual em Saúde, contemplando LILACS, Periódicos CAPES e SciELO. Foram utilizados critérios de inclusão como parâmetro linguístico (inglês e português), temático e cronológico, publicados entre 2010 e 2020, abrangendo estudos qualitativos e quantitativos, e revisões de literatura, totalizando ao final 12 artigos. Foi possível observar uma alta demanda por atenção à saúde bucal neste grupo, tanto na assistência como na promoção e prevenção, e déficit na oferta dos serviços, expresso pelas limitações na infraestrutura, fragilidades nos recursos humanos, e pelo perfil curativista da assistência, evidenciando a necessidade da reformulação e fortalecimento da oferta de serviços odontológicos a esses indivíduos.

The population in a liberty privation situation, for legal reasons in Brazil, it's composed of men and women adults in the prisional system and young people in educational measures. The right to health of this population is guaranteed by ministerial policies regulated by normative ordinances, which integrate this part of population to the Sistema Único de Saúde (SUS), with focus on comprehensive, resolutive and continuous quality care. However, there are significant factors that hinder the effective promotion of health, such as structural deficiency, overcrowding, unhealthy and stressful environments, poor diet and unhealthy habits. Therefore, the present study proposed to verify, through a narrative review of the literature, the oral health panorama of this population. The research to compose this review was made in the bibliographic databases PubMed, Biblioteca Virtual em Saúde, including LILACS, Periódicos CAPES and SciELO. Inclusion criteria were used as a linguistic (English and Portuguese), thematic and chronological parameter, published between 2010 and 2020, covering qualitative and quantitative studies, and literature reviews, totalizing 12 articles. It was possible to observe a high demand for oral health care in this group, in promotion and prevention, and a deficit in the provision of services, expressed by limitations in infrastructure, weaknesses in human resources, and by the curative profile of care, evidencing the need to reformulate and strengthen the offer of dental services to these individuals.

Longitudinal study for dental caries calibration of dentists unexperienced in epidemiological surveys

Abstract This study aimed to make a longitudinal analysis of interexaminer calibration reproducibility in diagnosing dental caries in posterior teeth, by examiners without previous experience in epidemiological studies. A group of 11 inexperienced examiners underwent theoretical-practical training and calibration assessments, assisted by a standard examiner. An examiner who did not participate directly in the research selected 5-year-old children with and without caries. The D3 diagnostic threshold was used to evaluate dental caries, based on the World Health Organization (WHO) criteria. The initial calibration (baseline) was performed after the theoretical-practical training session, and consisted of examining 20 children; the second calibration occurred three months later, and involved evaluating another 18 children. The interexaminer agreement was obtained by kappa statistics, and by overall percentage agreement. The paired t-test was applied to compare the values for kappa means and overall percentage agreement between the time points studied. At baseline, the values for kappa (> 0.81) and overall percentage agreement (> 95.63%) were considered high. At the 3-month calibration assessment, all the examiners showed some decrease in both kappa (p < 0.0001) and overall percentage agreement (p = 0.0102). The calibration process currently proposed by the WHO is effective. However, reproducibility was not maintained over time for inexperienced examiners evaluating the posterior teeth of 5-year-old children, under epidemiological conditions.

Comparison of epidemiological evaluations under different caries diagnostic thresholds.

OBJECTIVE: To investigate the influence of different settings, epidemiological and clinical, and different diagnostic thresholds on caries detection in a group of 7-10-year-old children in Brazil. MATERIALS AND METHODS: In total, 983 children aged 7-10 years old and enrolled in four public schools were randomly selected. Three examiners performed epidemiological examinations followed by an examination of the same children in a clinical setting. The examinations of cleaned and dried teeth in both settings were carried out using a dental mirror and ball-ended probe, under natural light in the epidemiological setting examinations and under artificial light during the clinical setting examinations. For the analysis of results, comparisons were focused on WHO (World Health Organization) diagnostic thresholds versus WHO+IL (initial lesions) diagnostic thresholds, both under epidemiological conditions, in order to demonstrate the influence of the inclusion of IL in the study; and WHO+IL in the epidemiological setting versus WHO+IL in the clinical setting, aiming to demonstrate the importance of examination setting. Outcome measures were dmfs, DMFS, ds, Ds, sealants and number of children 'free' of caries. Paired t-test and McNemar's test were used to test the difference between means and proportions for each age group. RESULTS: Epidemiological examinations, under the WHO diagnostic threshold, showed significant differences for all outcome measures when compared with the WHO +IL threshold. Statistical differences were also detected when comparingthe WHO+IL threshold under different settings. CONCLUSION: The choice of a diagnostic threshold (WHO or WHO+IL) and the conditions of examination (epidemiological or clinical) were important for caries detection.

Análise do teor de fluoretos nas águas de abastecimento público em um município da região metropolitana de Curitiba/PR: doze meses de heterocontrole / Analysis of fluoride content in the public water supply in a city of the metropolitan region of Curitiba/PR: twelve months of external control

Resumo Introdução A fluoretação das águas de abastecimento tem sido apontada em estudos nacionais e internacionais como a mais eficiente e equânime forma de acesso a fluoretos na prevenção da cárie dentária. Objetivo Relatar os resultados do heterocontrole nas águas de abastecimento público do município de Colombo/PR, no período de dezembro de 2013 a novembro de 2014. Método Foram coletadas amostras mensais em 15 Unidades Básicas de Saúde, em dias da semana aleatórios, no período de 12/2013 a 11/2014. As amostras foram analisadas pelo método eletrométrico na Faculdade de Odontologia da Universidade Federal Fluminense. Resultados Foram analisadas 180 amostras, que variaram de <0,001 a 1,480 mg/L (média 0,715±0,232 mg/L). De acordo com o critério estabelecido pelo Centro Colaborador do Ministério da Saúde em Vigilância da Saúde Bucal, 51,11% das amostras apresentavam níveis de fluoretos adequados, 13,34% concentrações de flúor acima do ideal, e 35,56% abaixo do ideal. Conclusão O heterocontrole representa uma das principais estratégias de vigilância em saúde bucal, e, dessa forma, deve ser implementado e efetuado em todas as regiões que utilizam água fluoretada, a fim de garantir a manutenção de níveis ótimos de fluoretos.

Abstract Background The fluoridation of water supply has been pointed out in national and international studies as the most efficient and equal way of accessing fluorides in the prevention of dental caries. Objective To report the results of heterocontrol in public water supply in the municipality of Colombo/PR, from December 2013 to November 2014. Method The samples were monthly collected in 15 Basic Health Units, on random days of the week, from 12/2013 to 11/2014. The samples were analyzed by the electrometric method at the Faculty of Dentistry of Fluminense Federal University. Results 180 samples were analyzed, ranging from <0.001 to 1.480 mg/L (mean 0.715 ± 0.232 mg/L). According to the criteria established by the Collaborating Center of the Ministry of Health in Oral Health Surveillance, 51.11% of the samples had adequate fluoride levels, 13.34% above ideal fluoride levels, and 35.56% below ideal levels. Conclusion Heterocontrol could represent one of the main strategies of oral health surveillance, and, therefore, it should be implemented and carried out in all regions that use fluoridated water, in order to guarantee the maintenance of optimal fluoride levels.

Effect of different diagnostic thresholds on dental caries calibration - a 12 month evaluation.

OBJECTIVE: To analyze the reproducibility of a calibration trial, at different diagnostic thresholds of dental caries, in a 12-month evaluation. METHODS: A group of dental examiners (n = 11), who had previous experience in epidemiological surveys, participated in the study. An initial training phase (theoretical and clinical) and five calibration exercises (baseline, 3, 6, 9 and 12 months) were arranged. World Health Organization (WHO) criteria, including the active initial lesions (IL) were used. Six- to 7-year-old children took part in the study. They were selected according to past history and dental caries activity. The data were analyzed at WHO and WHO + IL diagnostic thresholds in accordance with tooth and dental surfaces. RESULTS: Excellent mean intra- and inter-examiner Kappa values were obtained for both diagnostic thresholds, in accordance with tooth and surface, during the calibration phases. However, the most relevant errors were related to the decayed component and to IL diagnosis. CONCLUSION: It was possible to use the methodology proposed in this study in epidemiological surveys when examining the mixed dentition, although new strategies to improve training in IL diagnosis and calibration are necessary.

Effect of different diagnostic thresholds on dental caries calibration.

OBJECTIVES: (a) To analyze the intra- and inter-examiner reproducibility (reliability) of a calibration trial, at different diagnostic thresholds of dental caries; (b) to verify the accuracy (benchmark validity) though sensitivity (S), specificity (SP), positive (PPV) and negative predictive (NPV) values. PARTICIPANTS: A group of dental examiners (n=11), who had previous experience in epidemiological surveys and six to seven-year-old children. Children were selected according to the dmft and dental caries activity. METHODS: Theoretical and clinical training and calibration exercises were arranged for a total of 28 hours. WHO criteria including the active initial lesions (IL) were used. MAIN OUTCOME MEASURES: WHO and WHO+IL diagnostic thresholds according to tooth and dental surface. RESULTS: Excellent mean results of intra and inter-examiner Kappa values were found for both diagnostic thresholds, according to tooth and surface, during the calibration phase. The most relevant errors were related to IL diagnosis and to the first permanent molars. When assessed against a benchmark examiner, moderate to high validity values were observed (0.71-1.00), with some loss mainly for sensitivity and positive predictive value, when including IL. CONCLUSION: It was possible and feasible to use the proposed methodology of this study in epidemiological surveys, even with the inclusion of IL. However, further examiner calibration studies are still needed in order to improve and establish a methodology of calibration with this new diagnostic threshold.

Trends in caries experience and fluorosis prevalence in 11- to 12-year-old Brazilian children between 1991 and 2004.

UNLABELLED: Investigating dental caries and fluorosis prevalence over time is an important measure for monitoring trends in oral health. PURPOSE: This work aimed to describe the prevalence of dental caries and dental fluorosis of 11- to 12-year-old schoolchildren from Iracemapolis, Brazil, in 2004 (n=236) and to compare the current prevalence rates with those from previous surveys carried out in 1991 (n=200), 1995 (n=160), 1997 (n=314) and 2001 (n=244). MATERIALS AND METHODS: The schoolchildren of both genders from all public schools were examined by two calibrated dentists (Kappa > 0.81), using dental probes and buccal mirrors under natural light in an outdoor setting. Dental caries and fluorosis were measured using the DMFT and Thylstrup-Fejerskov (T-F) indexes, respectively. The variation of DMFT index over time was assessed by analysis of regression and the fluorosis prevalence (T-F>1) was compared over time by the Chi-square test at 5% significance level. RESULTS: In 2004, the mean value for DMFT was 1.2; 50% of the children were caries-free, and 15.7% presented dental fluorosis (T-F>1). A significant caries reduction (82.1%) and a significant increase (685%) of fluorosis prevalence have been observed from 1991 to 2004 (p < 0.01). CONCLUSION: The results suggest a continuous decrease of dental caries experience and an increase of dental fluorosis prevalence in 11-to 12-year-old schoolchildren from this Brazilian town as well as indicate that further epidemiological surveys should be carried out in order to monitor these trends.

[Comparison of reproducibility measurements for calibration of dental caries epidemiological surveys]. / Comparação entre medidas de reprodutibilidade para a calibração em levantamentos epidemiológicos da cárie dentária.

This study compares three measurements (Kappa, general agreement percentage, or GAP, and dice index) used to determine the reproducibility of caries diagnosis in epidemiological surveys under different clinical diagnostic thresholds. Eleven examiners with previous experience in epidemiological surveys were submitted to a theoretical and clinical calibration process. Data analysis used two caries detection thresholds: World Health Organization (WHO) and WHO with the inclusion of initial enamel lesions (WHO + IL). Twenty-three children 6-7 years of age were examined, with and without caries. Mean values for Kappa index, GAP, and Dice were considered high (> 0.90), except for the dice index for the WHO + IL threshold (0.69). Since Kappa is an adjusted agreement index, it can be considered the instrument of choice for calibration of examiners. However, when it is impossible to use, the GAP is recommended together with the dice index in order to orient and improve examiners when examining caries lesions.

Analysis of clinical, demographic, socioeconomic, and psychosocial determinants of quality of life of persons with intellectual disability: a cross-sectional Study.

AIMS: To evaluate the perception of parents about the impact of oral problems in their children, and of demographic, socioeconomic and psychosocial factors on the oral health-related quality of life (OHRQoL) of Brazilian adolescents and young adults with intellectual disability (ID), in 2014. METHODS: The sample consisted of 119 individuals. Data collection was performed in stages: calibration and pilot study; Application of questionnaires; Exam of caries, periodontal and need for dental prostheses, in accordance with the World Health Organization criteria. The data were subjected to both bivariate and multivariate analyses to test the association of independent variables with the dependent variable (QoL). RESULTS: Worse QoL was associated with the presence of periodontal pocket (p = 0.03; OR = 2.50; 95% CI 1.06 to 5.90), treatment need (p = 0.01; OR = 5.00; 95% CI 1.37 to 18.31), and need for dental prostheses (p = 0.03; OR = 2.89; 95% CI 1.13 to 7.37). CONCLUSION: It was concluded that clinical determinants had the greatest influence on OHRQoL of individuals with ID.