The Impact of Socio-Environmental, Individual, and Biological Factors on Oral Health-Related Quality of Life among Preschool Children: A Cohort Study with 3-Year Follow-Up.

This study assessed impact of socio-environmental, individual, and biological factors on the worsening and severe worsening of oral health-related quality of life (OHRQoL) among preschoolers and their families. A cohort study was conducted in Diamantina, Brazil, with 151 children between 1 and 3 years of age and their mothers, who were evaluated at baseline (2014) and re-evaluated after 3 years (2017). The children were clinically examined to assess the presence of dental caries, malocclusion, dental trauma, and enamel defects. The mothers answered the Early Childhood Oral Health Impact Scale (B-ECOHIS) and a questionnaire addressing individual characteristics of the child and socio-environmental factors. Extensive caries found in the follow-up (relative risk [RR] = 1.91; 95% confidence interval [CI] = 1.26-2.91) and failure to undergo the dental treatment recommended at baseline (RR = 2.49; 95% CI = 1.62-3.81) were associated with worsening of OHRQoL over 3 years. An increase in the number of children in the household (RR = 2.95; 95% CI = 1.06-8.25), occurrence of extensive caries in the follow-up (RR = 2.06; 95% CI = 1.05-4.07), and failure to undergo the dental treatment recommended at baseline (RR = 3.68; 95% CI = 1.96-6.89) were associated with a severe worsening of OHRQoL. In conclusion, the risk of worsening and severe worsening of OHRQoL was higher in preschoolers with extensive caries at follow-up and among those who did not undergo dental treatment. Furthermore, severe worsening of OHRQoL was also impacted by an increase in the number of children in the household.

Family income modifies the association between frequent sugar intake and dental caries.

AIM: The aim of this cross-sectional study was to investigate whether family income modifies associations between dental caries and sex, age, mother's education, type of preschool, sugar intake, and toothbrushing. BACKGROUND: Dental caries is a multifactorial dyanamic disease primarily mediated by biofilm and sugar. DESIGN: A randomly selected sample of 308 Brazilian preschool children aged 1-3 years underwent a clinical oral examination for the assessment of moderate/extensive dental caries using codes 3-6 of the International Caries Detection and Assessment System. Mothers were asked to fill out a form addressing the child's demographic and socioeconomic characteristics as well as the frequency of sugar intake. Statistical analysis involved descriptive statistics, the chi-squared test, and Poisson regression models. RESULTS: The prevalence of moderate/extensive dental caries was 42.5%. The adjusted model revealed that within low-income families (<2 times the monthly minimum wage), the prevalence of dental caries was higher among children with a high frequency of sugar intake (≥ twice per day) than in those with a low frequency of sugar intake (< twice a day) (RR = 1.79; CI: 1.38-2.33). In families with higher income (≥2 times the monthly wage), no significant association between sugar intake and dental caries was, however, found. CONCLUSIONS: In conclusion, monthly family income can modify the association between the high frequency of sugar intake and dental caries.

Association between child's behaviour during first dental appointment and effectiveness of dental plaque removal by caregivers.

OBJECTIVE: To evaluate the association between the behaviour of children aged 1 to 4 years during their dental appointment and the effectiveness of dental plaque removal by caregivers. METHODS: This longitudinal study with intervention had the participation of 146 children (mean age = 34.89 months), 75 of whom (51.4%) showed positive behaviour (+ and ++) and 71 (48.6%), negative behaviour (- and - -). The children were evaluated at the first dental appointment, according to the Frankl scale. They were subjected to an assessment of oral conditions, and their plaque level was recorded (Quigley-Hein Index modified by Turesky) using the Evince® device. Caregivers received oral hygiene guidance. The dental plaque assessment was performed before giving the oral hygiene guidance and 14 days later. The statistical analysis included a descriptive assessment and the Wilcoxon test (p < 0.05). RESULTS: Mean dental plaque levels dropped significantly from the first to the second assessment (p < 0.001). The sample was divided according to the child's behaviour, observing that only the group of children with positive behaviour showed significantly less dental plaque in the second assessment (p < 0.001). CONCLUSION: The positive behaviour of children aged 1 to 4 years during the first dental appointments is associated with more effective dental plaque removal by caregivers.

Association of the prevalence and severity of untreated traumatic dental injuries with body mass index among Brazilian preschool children.

BACKGROUND/AIM: Children with excess weight may be more predisposed to traumatic dental injuries (TDI). The aim of this study was to investigate the association between overweight/obesity and TDI presence and severity in Brazilian preschool children. MATERIAL AND METHODS: A cross-sectional study was conducted of 347 children aged three to five years. The main exposure was evaluated based on the body mass index (BMI). Socioeconomic-demographic characteristics and harmful oral habits were investigated using a questionnaire sent to the parents/guardians. Oral clinical examinations were performed to determine overjet (criteria proposed by Foster and Hamilton), and the presence and severity of TDI (criteria proposed by Andreassen). Descriptive statistics were performed. Univariate and multivariate Poisson regression analyses were conducted for each outcome. RESULTS: The prevalence of TDI in the sample was 41.5% and 16% of the children had enamel and dentin fractures. In the multivariate analysis, BMI and overjet were associated with the presence and severity of TDI (PR: 2.04 and 1.78, respectively) of TDI (PR: 2.27 and 2.24, respectively) (p < .001 for all associations). CONCLUSION: Overweight/obesity was associated with both the presence and severity of TDI in early childhood.

Association between obesity and traumatic dental injuries in pre-school children-A case-control study.

BACKGROUND/AIM: Obese children are more prone to accidents due to poorer motor skills which increase the likelihood of falls and the occurrence of traumatic dental injuries (TDIs). The aim of this study was to determine the association between overweight/obesity and TDI in pre-school children. MATERIAL AND METHODS: The case group was formed by children with TDI identified during a clinical examination (n = 262). Each pre-school child identified as a case was matched by a peer of the same age, gender and pre-school but without TDI to form the control group (n = 262). TDI was evaluated using the criteria proposed by Andreasen. The weight and height of the children were measured for the calculation of the body mass index which was plotted on the growth curve established by the World Health Organization. Socio-demographic variables were collected through questionnaires sent to the parents/guardians. Data analysis involved the determination of frequency distribution, the chi-square test and logistic regression analysis. RESULTS: The sample was composed of 253 children in each group. Among the children in the case group, 15.4% (n = 39) were overweight and 15.8% (n = 40) were obese. In the control group, 13.8% (n = 35) were overweight and 8.3% (n = 21) were obese. Children with trauma were more likely to be obese than children without trauma (OR = 2.05; 95%CI: 1.14 to 3.67; p = .016). In contrast, TDI was not associated with being overweight. A greater odds of TDI was also associated with an open bite (OR = 3.61; 95% CI: 1.64 to 7.96; p = .001) and accentuated overjet (OR = 2.19; 95% CI: 1.37 to 3.50; p = .001). CONCLUSIONS: Pre-school children with a history of dental trauma were more likely to be obese than those without a history of dental trauma whereas being overweight was not associated with TDI.

Untreated dental caries and visible plaque of mothers are not determinant for the incidence of caries in dentin among children: evidence from a 3-year prospective cohort study.

OBJECTIVES: To evaluate whether characteristics related to mother's oral health, trajectory of family income, and maternal education are associated with the incidence of caries in dentin in preschool children. MATERIALS AND METHODS: One hundred fifty-eight mothers and their children were evaluated at baseline and re-evaluated after 3 years. Sociodemographic variables, dental caries, and biofilm of the mothers and children and daily sugar intake of the children were evaluated. Poisson regression was used to evaluate what factor represents risk for the incidence of caries in dentin at four to 6 years of age. RESULTS: The risk of the incidence of caries in dentin was 54% higher in children whose mothers had a low level of education at both baseline and follow-up. Children from families with an income lower at baseline and follow-up (RR 2.49; 95% CI 1.62-3.83) and those whose families experienced a reduction in income in this period (RR 2.05; 95% CI 1.29-3.26) had a greater risk of the incidence of caries in dentin. Moreover, children who increased their daily sugar intake (RR 1.67; 95% CI 1.09-2.52), those that maintained high sugar intake (RR 1.81; 95% CI 1.14-2.87), and those with cavitated caries at baseline (RR 1.53; 95% CI 1.19-1.97) had a greater risk of the incidence of caries in dentin. CONCLUSIONS: Low mother's education, a lower family income, a reduction in family income, a high frequency of daily sugar intake, and a history of cavitated caries were risk factors for the incidence of caries in dentin. CLINICAL RELEVANCE: The results could help in the targeting of improved prevention and control strategies for dental caries.

The prevalence of malocclusion is higher in schoolchildren with signs of hyperactivity.

INTRODUCTION: Attention deficit-hyperactivity disorder is a behavioral disorder characterized by a lack of focus, impulsive behavior, and or excessive activity. This research aimed to evaluate the association between signs of attention deficit-hyperactivity disorder and malocclusion in schoolchildren. METHODS: A cross-sectional study was conducted with a representative sample of 633 children aged 7-12 years. The children were clinically examined for malocclusion using the Dental Aesthetic Index. The predominant breathing pattern was also determined. Parents answered a questionnaire addressing socioeconomic characteristics and the presence of nonnutritive sucking habits. The Swanson, Nolan, and Pelham Scale-IV was filled out by both parents and teachers to compare behavioral patterns. The children were submitted to a neuropsychological evaluation using the Raven's Colored Progressive Matrix Test. Data analysis involved the chi-square test and Poisson regression analysis. RESULTS: The prevalence of malocclusion was 42% higher among children with signs of hyperactivity reported by both parents and teachers (prevalence ratio [PR], 1.42; 95% confidence interval [CI], 1.11-1.81; P = 0.004). In the final Poisson regression model, the prevalence of malocclusion was lower among schoolchildren aged 11 and 12 years (PR, 0.62; 95% CI. 0.52-0.73; P <0.001) and higher among those who used a pacifier for at least 4 years (PR, 1.25; 95% CI, 1.02-1.54; P = 0.029) as well as those classified as mouth breathers (PR, 1.28; 95% CI, 1.09-1.51; P = 0.003). CONCLUSIONS: The prevalence of malocclusion was higher among children with signs of hyperactivity independently of age, pacifier use, and mouth breathing.

Acidic food choice among adolescents with bulimic symptomatology: a major risk factor for erosive tooth wear?

PURPOSE: Evaluate dietary habits and the presence of erosive tooth wear (ETW) among female adolescents with varying severity of bulimic symptomatology. METHODS: An explanatory study was conducted with 72 female school adolescents with bulimic symptomatology, aged 15-18 years in Southeastern Brazil. Dietary habits were evaluated through a food frequency questionnaire. Bulimic symptomatology was evaluated and classified (mild, moderate and severe) according to the Bulimic Investigatory Test of Edinburgh. ETW examinations were performed. Data analysis involved descriptive statistics, bivariate analysis, Kruskal-Wallis/Mann-Whitney tests and Poisson regression. Ethical approval and informed consents were obtained. RESULTS: The final population consisted of 62 participants. The prevalence of ETW differed among adolescents with mild, moderate and severe bulimic symptomatology (p = 0.001), corresponding to 5.9%, 8.0% and 45.0%, respectively. Adolescents with severe bulimic symptomatology presented higher daily consumption of acidic food: citric fruits (p < 0.005), diet soda (p < 0.009) and ketchup (p = 0.004). No difference related to vomiting practices was observed between groups (p = 0.060). The adjusted regression model showed that a higher prevalence of ETW was associated with self-induced vomit at least once a week (PR = 2.42, 95% CI = 1.00-5.86, p = 0.05) and higher frequencies of consumption of citric fruits (PR = 7.96, 95% CI = 1.50-42.11, p = 0.015) and diet soda (PR = 2.32, 95% CI = 1.09-4.91, p = 0.029). CONCLUSION: It was the food choices (acidic food) and not purging practices that differed among adolescents with varying severity of bulimic symptomology. Likewise, higher consumption of citric fruits was the main factor associated with higher prevalence of ETW. LEVEL OF EVIDENCE: III case-control analytic study.

Do family functioning and mothers' and children's stress increase the odds of probable sleep bruxism among schoolchildren? A case control study.

OBJECTIVE: To investigate the association between probable sleep bruxism (PSB) and associated factors in schoolchildren. MATERIALS AND METHODS: A case-control study was conducted with a representative sample of 320 schoolchildren aged 8 to 10 years. The case group (160 children with PSB) and the control group (160 children without PSB) were matched for sex and age at a proportion of 1:1. Information on audible characteristics of PSB, harmful oral habits, and socio-demographic characteristics as collected through questionnaires answered by the parents/caregivers. The family functioning of children was measured through The Family Adaptability and Cohesion Evaluation Scales (FACES III). Mothers self-administered the Lipp Stress Symptoms Inventory (LSSI) for adults to measure mothers' stress and the children filled out the Child Stress Scale (CSS) to measure the children stress. Data analysis used descriptive and logistic regression analyses (p < 0.05). RESULTS: Among the children with stress, 67.3% had PSB. Children with stress (OR = 2.22, 95% CI 1.18-4.19), those with a history of nail biting (OR = 2.22, 95% CI 1.39-3.55), and biting objects (OR = 1.77, 95% CI 1.09-2.87) were more likely to have PSB. CONCLUSION: Childhood stress and a history of nail biting or biting objects are important signs to be considered in schoolchildren with PBS. CLINICAL RELEVANCE: These results alert that the PBS might be a sign of stress and other psychological problems such as tension and anxiety related to the presence of harmful oral habits. Furthermore, the results could help in the targeting of anamnesis, improved prevention and treatment strategies for sleep bruxism which should involve an interdisciplinary approach.

Amelogenesis imperfecta: use of cyanoacrylate as a desensitizing agent and its impact on oral health-related quality of life.

Amelogenesis imperfecta (AI) is a rare hereditary condition characterized by abnormal enamel formation and increased tooth sensitivity. There are no defined therapeutic recommendations for tooth sensitivity in patients with AI. The aim of the present case report of a 5-year-old girl with AI is to describe the use of cyanoacrylate as a desensitizing agent on the patient's permanent molars and report the impact of this treatment on her oral health-related quality of life (OHRQoL). After 4 sodium fluoride varnish applications were unsuccessful in relieving sensitivity affecting the molars, cyanoacrylate was applied 5 times (at intervals of 7, 15, 30, and 180 days after the first application). Pain scores were recorded on a visual analog scale before and after each intervention, and the OHRQoL was measured using a questionnaire (Early Childhood Oral Health Impact Scale [ECOHIS]) administered prior to the first cyanoacrylate application and on the last day of the protocol. In this patient, cyanoacrylate seemed to be effective at decreasing tooth sensitivity in immature permanent molars affected by AI, as demonstrated by reductions in the frequency of complaints of dental pain, difficulty in drinking cold beverages, and difficulty in eating some foods.

Association between occlusal characteristics and the occurrence of dental trauma in preschool children: a case-control study.

BACKGROUND/AIMS: Occlusal features may increase the risk of dental trauma. The aim of the present study was to evaluate the association between occlusal characteristics and the occurrence of dental trauma in preschool children. MATERIALS AND METHODS: A population-based case-control study was conducted with a representative sample of 200 children 3-5 years of age enrolled at private and public preschools in the city of Diamantina, Brazil. The case and control groups were matched for gender, age and type of preschool (public or private) at a ratio of 1:1 (100 cases and 100 controls). Independent variables of interest to the study (occlusal characteristics) and potential confounders (sociodemographic characteristics, sucking habits and lip coverage) were investigated. Intra-examiner and inter-examiner kappa values were higher than 0.80 for all oral conditions evaluated. The SPSS 22.0 program was used to analyse the data. Descriptive and univariate analyses as well as simple and multiple logistic regression analyses were performed. RESULTS: The occlusal feature most strongly associated with trauma was anterior open bite (OR = 3.80; 95% CI: 1.42-10.16). Maxillary anterior crowding (OR = 2.14, 95% CI: 1.00-4.63) and overjet (OR = 1.12, 95% CI: 0.58-2.17) were associated with the occurrence of trauma independently of the confounding variables (sociodemographic characteristics, sucking habits and lip coverage), but these variables lost their significance when adjusted for other types of malocclusion. Anterior open bite remained strongly associated with dental trauma, regardless of confounding variables and other types of malocclusion. CONCLUSION: Anterior open bite was the main variable associated with dental trauma in the preschool children analysed independently of the confounding variables and the presence of other malocclusions.

Do Signs of Attention-Deficit/Hyperactivity Disorder Increase the Odds of Dental Caries? A Case-Control Study.

Attention-deficit/hyperactivity disorder (ADHD) is a behavioural disorder that can affect one's performance in activities of daily living and can exert a negative impact on the oral health of children. OBJECTIVE: The aim of this work was to determine the association between ADHD (signs and executive functions) and dental caries in children aged 7-12 years. METHODS: A case-control study was conducted with 532 children in the city of Diamantina, Brazil. The case group was composed of children with caries and the control group was composed of children without caries. The children were submitted to a clinical oral examination for the determination of caries and neuropsychological evaluations of intellectual function and executive function. Other signs of attention deficit and hyperactivity were investigated using the Swanson, Nolan, and Pelham scale administered to parents/guardians and teachers. Socioeconomic and demographic characteristics were also evaluated. Statistical analysis involved the McNemar χ2 test and conditional logistic regression. RESULTS: The multivariate logistic regression model demonstrated that monthly household income and parental reports of signs of attention deficit were significantly associated with the occurrence of dental caries. CONCLUSION: Children considered by their parents/guardians to have attention deficit have a greater chance of exhibiting dental caries, independently of household income.

Prevalence of probable sleep bruxism and associated factors in Brazilian schoolchildren.

AIM: To determine the prevalence of probable sleep bruxism (PSB) and associated factors among schoolchildren. DESIGN: This cross-sectional study was carried out with a representative sample of 440 schoolchildren. The children were submitted to a clinical oral examination for the evaluation of tooth wear and/or muscle discomfort. Parents/caregivers filled out a questionnaire with information related to characteristic sounds of sleep bruxism, sociodemographic factors, and the presence of harmful oral habits of children. The stress of the mothers was measured through the Lipp's Stress Symptoms Inventory for Adults (LSSI) instrument. The child's stress was measured through the Child Stress Scale (CSS). Data analysis included descriptive analysis and hierarchical Poisson regression (95% CI, P < 0.05). RESULTS: The prevalence of PSB was 40.0% (n = 176). The final Poisson regression model showed that PSB was significantly more prevalent in children with a history of nail biting (PR: 1.50; 95% CI: 1.19-1.90; P = 0.001) and biting objects (PR: 1.30; 95% CI: 1.03-1.63; P = 0.025) and less prevalent among girls (PR: 0.78; 95% CI: 0.63-0.98; P = 0.033). CONCLUSIONS: The prevalence of PSB in schoolchildren was high. Schoolchildren with a history of nail biting and biting objects had a higher prevalence of PSB.

Respiratory disorders and the prevalence of sleep bruxism among schoolchildren aged 8 to 11 years.

PURPOSE: The aim of this study was to evaluate the association between respiratory disorders and sleep bruxism, with an evaluation of demographic/socioeconomic factors and childhood stress as confounding variables. METHODS: A cross-sectional study was performed in the city of Diamantina, Brazil, with 448 randomly selected schoolchildren aged 8 to 11 years. The schoolchildren underwent an oral examination for the evaluation of bruxism. Parents/caregivers answered a questionnaire for the assessment of sleep bruxism; socioeconomic-demographic factors; and respiratory disorders, such as rhinitis, sinusitis, and bronchitis. The schoolchildren filled out the Children's Stress Scale. Poisson regression models were constructed separately for each respiratory disorder to determine prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: Sleep bruxism was more prevalent among children with rhinitis (PR = 1.45; 95%CI 1.08-1.93; p = 0.012) and sinusitis (PR = 1.58; 95%CI 1.06-2.36; p = 0.023). No significant association was found between sleep bruxism and bronchitis. A greater frequency of sleep bruxism was found among children whose mothers had a higher level of schooling and those who reported stress in the resistance/exhaustion phase. CONCLUSION: Rhinitis and sinusitis were associated with sleep bruxism. Moreover, sleep bruxism was more prevalent among children whose mothers had a higher level of schooling and those with higher degrees of stress.

Factors associated with masticatory performance among preschool children.

OBJECTIVE: The aim of the present study was to evaluate the influence of the body mass index (BMI), food consistency, and oral problems on masticatory performance among preschool children. METHODS: A cross-sectional study was conducted with a sample composed of 279 children between 3 and 5 years of age allocated to three groups (underweight, ideal weight, and overweight) based on the BMI. Moreover, eating habits, malocclusion, breathing type, masticatory units, and untreated dental caries were investigated. For the evaluation of masticatory performance, the masticatory function test (Optocal) and Rosin-Rammler equation were used for the determination of median size (X50) of shredded food particles for each child. Data analysis involved the description of the frequency of the variables as well as both simple and multiple linear regression analysis. RESULTS: A larger median participle size was associated with a greater number of cavitated teeth (p < 0.001), greater frequency of the daily ingestion of liquid foods (p = 0.001), and a higher BMI (p < 0001). A greater number of masticatory units (p < 0.001), older age (p = 0.007), and greater frequency of the daily intake of solid foods (p = 0.019) were factors that contributed to a smaller median food particle size. CONCLUSION: BMI, number of cavitated teeth, number of masticatory units, child's age, and food consistency exerted an influence on masticatory performance among preschool children. CLINICAL RELEVANCE: Mastication is important for craniofacial growth and development. Thus, dentists should know the factors that affect the masticatory performance among children with primary teeth.

Effects of attention deficit hyperactivity disorder signs and socio-economic status on sleep bruxism and tooth wear among schoolchildren: structural equation modelling approach.

BACKGROUND: The prevalence of both bruxism and attention deficit hyperactivity (ADHD) has increased in recent years. AIM: This study evaluated the direct and indirect effects of signs of ADHD, reported by parents/caregivers and teachers, with sleep bruxism. In addition, this study explores the effects of socio-economic status (SES) on sleep bruxism. DESIGN: This cross-sectional study was performed in Diamantina, Brazil, with 851 randomly selected schoolchildren aged 6-12 years. The schoolchildren were underwent an oral examination for the evaluation of bruxism. Moreover, parents/caregivers fill out a form for the assessment of sleep bruxism and sociodemographic factors. Parents/caregivers and teachers responded to the Swanson, Nolan and Pelham scale - version IV (SNAP-IV) for the assessment of ADHD signs. The structural equation modelling approach was used, and standardized coefficients to direct, indirect and total effects were calculated. RESULTS: ADHD signs had a significant moderate (SC = -0.19, P < 0.01) effect on sleep bruxism. SES had a significant indirect effect on bruxism via sucking habits. Moreover, SES had a significant direct (SC = -0.16, P = 0.01) and total effect on tooth wear (SC = -0.17, P < 0.01). CONCLUSION: This study concluded that signs of ADHD and SES have a complex direct and indirect effects on sleep bruxism among schoolchildren.

Impact of untreated dental caries and its clinical consequences on the oral health-related quality of life of schoolchildren aged 8-10 years.

OBJECTIVE: This study aims to evaluate the impact of untreated dental caries and its clinical consequences on the quality of life of Brazilian schoolchildren aged 8-10 years. METHODS: A randomly selected sample of 587 children underwent a clinical oral examination for the assessment of untreated dental caries and clinical consequences. The WHO criteria (decayed component of the decayed, missing, and filled teeth--D-DMFT in permanent teeth or d-dfmt in primary teeth) and the PUFA index, which records the presence of severely decayed permanent (upper case) and primary (lower case) teeth with visible pulpal involvement (P/p), as well as ulceration caused by dislocated tooth fragments (U/u), fistula (F/f), and abscesses (A/a), were used for the oral examination. Oral health-related quality of life (OHRQoL) was evaluated using the Child's Perception Questionnaire (CPQ8-10). Poisson regression was employed to test unadjusted and adjusted associations between untreated dental caries/clinical consequences and OHRQoL. RESULTS: The prevalence of untreated dental caries was 64.6% (D/d component of DMFT/dmft > 0) and 17.9% of children exhibited clinical consequences of caries (PUFA/pufa index >0). In the adjusted models, untreated caries was significantly associated with the total CPQ8-10 score and all subscale scores. The clinical consequences of dental caries (PUFA/pufa index >0) were significantly associated with the total CPQ8-10 as well as the oral symptoms and functional limitations' subscales. CONCLUSION: Untreated dental caries and its clinical consequences exerted a negative impact on the OHRQoL of the schoolchildren analyzed.

Signs of attention deficit/hyperactivity disorder as a risk factor for traumatic dental injury among schoolchildren: a case-control study.

BACKGROUND: The determination of risk factors for traumatic dental injury (TDI) is important to the implementation of preventive measures. AIM: The aim of this study was to evaluate the association between signs of attention deficit/hyperactivity disorder (ADHD) and TDI. MATERIAL AND METHODS: A case-control (1 : 1) study involved a population-based sample of 230 schoolchildren aged seven to 12 years. The case and control groups were composed of children with (n = 115) and without (n = 115) TDI, respectively. The groups were matched for age and sex. The outcome variable (TDI) was detected using the O'Brien criteria. The main independent variable (signs of ADHD) was evaluated using the Swanson, Nolan and Pelham scale (version IV) administered to parents and teachers. Socio-demographic characteristics and accentuated overjet were analyzed as confounding factors. Statistical analysis involved the McNemar's test as well as the bivariate and multivariate conditional logistic regression. RESULTS: The multivariate regression demonstrated that schoolchildren with the signs of hyperactivity (parental reports) had a 2.33-fold greater chance of exhibiting TDI (95% CI: 1.10-4.94) than those without this condition, as well as those with accentuated overjet (OR = 3.13, 95% CI: 1.70-5.77). CONCLUSION: Schoolchildren whose parents reported signs suggestive of hyperactivity had a greater chance of exhibiting TDI than those without such signs.

Nickel-free vs conventional braces for patients allergic to nickel: Gingival and blood parameters during and after treatment.

INTRODUCTION: Allergic and inflammatory reactions have commonly been associated with the release of metal ions during orthodontic treatment. Our objective was to evaluate prospectively gingival and blood status in patients allergic to nickel. METHODS: Allergy to nickel was diagnosed using a patch test. Two groups were established: conventional braces (n = 21) and nickel-free braces (n = 21). The gingival index was used to determine gingival status before treatment, periodically for 12 months (evaluations every 3 months), and 1 month after the removal of the braces. Blood status was evaluated with a complete blood count, including the quantification of nickel and immunoglobin E before treatment, during treatment, and 1 month after removal of the braces. The data were analyzed using Mann-Whitney, Student t, Wilcoxon, repeated measures analysis of variance, Friedman, and chi-square tests. Either the Pearson or the Spearman correlation coefficients were calculated, when appropriate. RESULTS: The number of basophils increased significantly among the evaluations in both groups (conventional, P = 0.002; nickel-free, P = 0.001), whereas the number of eosinophils and the immunoglobin E levels decreased significantly in the conventional group (P = 0.004). Plasma nickel levels were increased before and during treatment, and decreased 1 month after removing the braces in both groups, but the differences were significant only in the nickel-free group (P = 0.002). No correlations were found between the concentrations of nickel and immunoglobin E, basophils, or eosinophils, or between the gingival index and either bands or segmented neutrophils (P ≥ 0.05). CONCLUSIONS: Patients treated with nickel-free braces had better gingival health and smaller blood changes than did those treated with conventional braces. All abnormalities tended to be eliminated after the removal of the braces.

Impact of dental caries on quality of life among preschool children: emphasis on the type of tooth and stages of progression.

The aim of this cross-sectional study was to evaluate the impact of dental caries on the quality of life of preschool children and their parents/caretakers, with an emphasis on the type of tooth and stage of progression. A randomly selected sample of preschool children, 3-5 yrs of age, underwent an oral examination for the assessment of dental caries using the International Caries Detection and Assessment System II (ICDAS II) criteria. Parents/caretakers answered two questionnaires, one on the oral health-related quality of life (OHRQoL) of the child [the Early Childhood Oral Health Impact Scale (ECOHIS)], and the other on the socio-economic characteristics of the family. Statistical analyses were performed using the chi-square test, Kruskal-Wallis test, Mann-Whitney U-test, and Poisson regression. A total of 451 preschool children participated in the study. The majority of carious lesions exhibited severe decay (60.6%) and were found in both anterior (incisors/canines) and posterior (molars) teeth. The final Poisson model revealed negative impacts on quality of life from more advanced stages of dental caries, both in incisors/canines and molars. Child's age and household income were also associated with impact on quality of life. Carious lesions in more advanced stages of progression in anterior and posterior teeth were associated with a negative impact on the quality of life of preschool children.