Alexandre Emidio Ribeiro Silva

Sugar Consumption and Changes in Dental Caries from Childhood to Adolescence

There are no prospective studies investigating the effects of sugar-related feeding practices on changes in dental caries from early childhood to young adulthood. The aim of this study was to assess whether sugar-related feeding practices affect dental caries between the ages of 6 and 18 y. This birth cohort study was initiated in 1993 in Pelotas, Brazil. There were 3 dental clinical assessments; at ages 6 y (n = 359), 12 y (n = 339), and 18 y (n = 307). Sugar-related feeding practices were assessed at ages 4, 15, and 18 y. Covariates included sex and life course variables, such as family income, breast-feeding, mother’s education, regularity of dental visit, and child’s toothbrushing habits. Group-based trajectory analysis was performed to characterize trajectories of time-varying independent variables that had at least 3 time points. We fitted a generalized linear mixed model assuming negative binomial distribution with log link function on 3-time repeated dental caries assessments. One in 5 participants was classified as “high” sugar consumers, and nearly 40% were “upward consumers.” “Low consumers” accounted for >40% of the sample. High and upward sugar consumers had higher dental caries prevalence and mean DMFT in all cohort waves when compared with low sugar consumers. Caries occurred at a relatively constant rate over the period of study, but in all sugar consumption groups, the increment of dental caries was slightly higher between ages 6 and 12 y than between 12 and 18 y. Adjusted analysis showed that dental caries increment ratio between ages 6 and 18 y was 20% and 66% higher in upward and high sugar consumer groups as compared with low consumers. The higher the sugar consumption along the life course, the higher the dental caries increment. Even the low level of sugar consumption was related to dental caries, despite the use of fluoride.

Obesity and dental caries: systematic review

OBJETIVO Analisar evidencias da associacao entre obesidade e carie dentaria. METODOS Foi realizada revisao sistematica de artigos indexados nas bases de dados Medline/PubMed, Web of Sciences e LILACS, no periodo entre 2005 e janeiro de 2012, para identificar associacao existente entre obesidade e carie dentaria. A qualidade da evidencia cientifica dos artigos selecionados foi verificada pelos itens propostos para estudos observacionais do instrumento Downs & Black. RESULTADOS Inicialmente foram encontradas 537 referencias apos a verificacao dos titulos e resumos por dois pesquisadores independentes. Foram selecionados 27 artigos para leitura completa. Destes, dez avaliaram denticao decidua e/ou permanente e observaram uma associacao positiva entre obesidade e carie dentaria, sendo que um estudo encontrou uma associacao inversa. Segundo a classificacao de Downs & Black, treze artigos foram considerados com boa evidencia cientifica. CONCLUSOES A presente revisao nao encontrou evidencias suficientes quanto a associacao entre obesidade e carie, assim como nao esclareceu o possivel papel da dieta e de outros possiveis modificadores de efeito nessa associacao.OBJECTIVE Identifying, through a systematic literature review, evidence of a possible association between obesity and dental caries. METHODS A search of articles published between 2005 and January 2012 was performed in the Medline/PubMed, LILACS and Web of Science databases. The quality of scientific evidence of the selected articles was assessed by the items proposed for observational studies in the Downs & Black instrument. RESULTS Initially, 537 references were found; after checking the titles and abstracts by two independent researchers, twenty-eight articles were selected for complete reading. Ten of them that assessed the primary and/or permanent dentition observed a positive association between obesity and dental caries and one study found an inverse association. According to the Downs & Black classification, thirteen articles with good scientific evidence were found. CONCLUSIONS The present review did not find sufficient evidence regarding the association between obesity and dental caries, and it did not clarify the possible role of diet and other possible effect modifiers on this association.

Problemas de saúde mental e tabagismo em adolescentes do sul do Brasil

OBJETIVO: Analisar a associacao entre problemas de saude mental e uso de tabaco em adolescentes. METODOS: Foram analisados 4.325 adolescentes de 15 anos da coorte de nascimentos de 1993 da cidade de Pelotas, RS. Tabagismo foi definido como fumar um ou mais cigarros nos ultimos 30 dias. Saude mental foi avaliada de acordo com o escore total do questionario Strengths and Difficulties Questionnaire e escore maior ou igual a 20 pontos foi considerado como positivo. Os dados foram analisados por regressao de Poisson, com ajuste robusto para variância. RESULTADOS: A prevalencia de tabagismo foi 6,0% e cerca de 30% dos adolescentes apresentaram algum tipo de problema de saude mental. Na analise bruta, a razao de prevalencias para tabagismo foi de 3,3 (IC95% 2,5; 4,2). Apos ajuste (para sexo, idade, cor da pele, renda familiar, escolaridade da mae, grupo de amigos fumantes, trabalho no ultimo ano, repetencia escolar, atividade fisica de lazer e uso experimental de bebida alcoolica), diminuiu para 1,7 (IC95% 1,2; 2,3) entre aqueles com problemas de saude mental. CONCLUSOES: Problemas de saude mental na adolescencia podem ter relacao com o consumo de tabaco.OBJECTIVE To analyze the association between mental health problems and smoking in adolescents. METHODS A total of 4,325 adolescents aged 15 from the 1993 birth cohort of the city of Pelotas, Southern Brazil, was studied. Smoking was defined as having smoked one or more cigarettes in the previous 30 days. Mental health was assessed according to the total score of the Strengths and Difficulties Questionnaire. Score > 20 points was considered positive. Data were analyzed using Poisson regression with adjustment for robust variance. RESULTS Smoking prevalence was 6.0% and about 30% of the adolescents presented some mental health problem. In the crude analysis, the prevalence ratio for smoking was 3.3 (95%CI 2.5; 4.2). After the adjusted analysis (for sex, age, skin color, family income, mothers level of schooling, group of friends who smoke, employment in the previous year, school failure, physical activity during leisure time and experimental use of alcohol), it decreased to 1.7 (95%CI 1.2; 2.3) among those with mental health problem. CONCLUSIONS Mental health problems in adolescence may be related to tobacco consumption.

Validation of self-reported information on dental caries in a birth cohort at 18 years of age

Objective Estimate the prevalence of dental caries based on clinical examinations and self-reports and compare differences in the prevalence and effect measures between the two methods among 18-year-olds belonging to a 1993 birth cohort in the city of Pelotas, Brazil. Method Data on self-reported caries, socio-demographic aspects and oral health behaviour were collected using a questionnaire administered to adolescents aged 18 years (n = 4041). Clinical caries was evaluated (n = 1014) by a dentist who had undergone training and calibration exercises. Prevalence rates of clinical and self-reported caries, sensitivity, specificity, positive and negative predictive values, absolute and relative bias, and inflation factors were calculated. Prevalence ratios of dental caries were estimated for each risk factor. Results The prevalence of clinical and self-reported caries (DMFT>1) was 66.5% (95%CI: 63.6%–69.3%) and 60.3% (95%CI: 58.8%–61.8%), respectively. Self-reports underestimated the prevalence of dental caries by 9.3% in comparison to clinical evaluations. The analysis of the validity of self-reports regarding the DMFT index indicated high sensitivity (81.8%; 95%CI: 78.7%–84.7%) and specificity (78.1%; 95%CI: 73.3%–82.4%) in relation to the gold standard (clinical evaluation). Both the clinical and self-reported evaluations were associated with gender, schooling and self-rated oral health. Clinical dental caries was associated with visits to the dentist in the previous year. Self-reported dental caries was associated with daily tooth brushing frequency. Conclusions Based on the present findings, self-reported information on dental caries using the DMFT index requires further studies prior to its use in the analysis of risk factors, but is valid for population-based health surveys with the aim of planning and monitoring oral health actions directed at adolescents.

Accuracy of linear measurements before and after digitizing periapical and panoramic radiography images

The aim of this study was to evaluate the accuracy of linear measurements made on conventional and digitized periapical and panoramic radiographic images of dry human hemi-mandibles. Images from the posterior region of 22 dry human hemi-mandibles were obtained by conventional panoramic and periapical radiography technique. Using a digital caliper, 3 vertical measurements were marked directly on the dry hemi-mandibles (reference measurements) as well as on the tracing from the conventional radiographic images of the specimens made onto acetate paper sheet: Distance 1: between the upper limit of the alveolar ridge and the lower limit at the mandible base; Distance 2: between the upper limit of the alveolar ridge and the upper limit of the mandibular canal; Distance 3: between the lower limit of the mandibular canal and the lower limit of the mandible base. Next, the radiographs were digitized and the three measurements were made on the digital images using UTHSCSA Image Tool software. Data were analyzed statistically by one-way ANOVA (α=0.05). There was no statistically significant differences (p>0.05) between periapical and panoramic radiographs or between the measurements recorded using the digital caliper and UTHSCSA software compared with dry mandible specimens for Distances 1 (p=0.783), 2 (p=0.986) and 3 (p=0.129). In conclusion, the radiographic techniques evaluated in this study are reliable for vertical bone measurements on selected areas and the UTHSCA Image Tool software is an appropriate measurement method.

Edentulism, Severe Tooth Loss and Lack of Functional Dentition in Elders: A Study in Southern Brazil

The aim of this study was to estimate self-reported prevalence of edentulism, severe tooth loss and lack of functional dentition in elders, and to identify potential associated factors. A population based cross-sectional study was carried out with 1,451 elders (≥60 years), in Pelotas, RS, Brazil. Crude and adjusted prevalence ratios were estimated using Poisson regressions. The prevalence of edentulism, severe tooth loss and lack of functional dentition was 39.3%, 60.9% and 82.7%, respectively. The factors positively associated with tooth loss in the three-degree severity were sex (females), older individuals, low familial income, low level of schooling and having the last dental visit longer than 24 months ago. The high prevalence of tooth loss in its different degrees of severity and the association with preventable factors highlight the need of programs focused on elders, emphasizing the prevention of tooth loss and need for prosthetic rehabilitation.

Association between dental caries and obesity evaluated by air displacement plethysmography in 18-year-old adolescents in Pelotas, Brazil.

OBJECTIVES To investigate the association between dental caries and obesity, evaluated by air displacement plethysmography, among 18-year-old adolescents from a birth cohort in the city of Pelotas, Brazil. METHODS A cross-sectional study nested in a birth cohort study was conducted in Pelotas, Brazil. A random sample of 986 18-year-old adolescents was selected. The outcome variable was the occurrence of dental caries (DMFT ≥ 1) according to clinical examination by a trained and calibrated dentist. For the exposure variable (obesity), body fat percentage was measured using air displacement plethysmography and classified as normal weight (P95). Sociodemographic and behavior variables were collected using a questionnaire. We performed multivariable Poisson regression analyses with robust variance to examine the association between dental caries and obesity. RESULTS DMFT ranged from 0 to 19; mean (SD) was 2 (2.3), and median (P25-P75) was 1 (0-3). Body fat percentage ranged from 0.9 to 57.6%; mean (SD) percentage was 24.4% (11.6%), and median (P25-P75) was 25.1% (14.0-32.9%). The prevalence of dental caries was 66.5% (95% CI 63.6-69.5%), being significantly higher in female adolescents with lower maternal education, lower education, and sugar intake more than once a day. There were no differences in the probability of dental caries among individuals with normal weight, overweight, or obesity in the unadjusted model (P = 0.846) or after adjustment for sociodemographic (P = 0.864) variables. CONCLUSIONS Overweight and obesity were not associated with the occurrence of dental caries in 18-year-old adolescents.

Avaliação da associação entre os indicadores de saúde bucal, os aspectos socioeconômicos e crianças com sinais clínicos orofaciais indicativos de respiração oral crônica

Purpose To evaluate whether clinical and sociodemographic indicators of oral health in school-age children (from 8 to 12 years) with mixed dentition are associated with oral breathing. Methods Fifity-five children selected from a public school in the city of Cachoeira do Sul (RS) were evaluated. After obtaining parental consent, a trained speech pathologist performed examinations to identify children with orofacial clinical signs indicative of oral breathing. For the oral health exams, dental students underwent training and calibration according to the criteria of the World Health Organization for epidemiological surveys. In addition to the intra-oral examinations, socioeconomic and demographic data were collected from the parents of the children using a questionnaire. Results Although the prevalence of children with mouth breathing symptoms was notable, it was lower than that reported in the literature. No difference was observed between the groups (mouth breathers and nose breathers) regarding socioeconomic variables associated with the tested dental aspects. Conclusion Oral breathing was not associated with clinical indicators of oral health such as caries, visible plaque, and gingival bleeding. Further, no association was found between sociodemographic variables and oral breathing.

Mental health problems and smoking among adolescents from Southern Brazil

OBJETIVO: Analisar a associacao entre problemas de saude mental e uso de tabaco em adolescentes. METODOS: Foram analisados 4.325 adolescentes de 15 anos da coorte de nascimentos de 1993 da cidade de Pelotas, RS. Tabagismo foi definido como fumar um ou mais cigarros nos ultimos 30 dias. Saude mental foi avaliada de acordo com o escore total do questionario Strengths and Difficulties Questionnaire e escore maior ou igual a 20 pontos foi considerado como positivo. Os dados foram analisados por regressao de Poisson, com ajuste robusto para variância. RESULTADOS: A prevalencia de tabagismo foi 6,0% e cerca de 30% dos adolescentes apresentaram algum tipo de problema de saude mental. Na analise bruta, a razao de prevalencias para tabagismo foi de 3,3 (IC95% 2,5; 4,2). Apos ajuste (para sexo, idade, cor da pele, renda familiar, escolaridade da mae, grupo de amigos fumantes, trabalho no ultimo ano, repetencia escolar, atividade fisica de lazer e uso experimental de bebida alcoolica), diminuiu para 1,7 (IC95% 1,2; 2,3) entre aqueles com problemas de saude mental. CONCLUSOES: Problemas de saude mental na adolescencia podem ter relacao com o consumo de tabaco.OBJECTIVE To analyze the association between mental health problems and smoking in adolescents. METHODS A total of 4,325 adolescents aged 15 from the 1993 birth cohort of the city of Pelotas, Southern Brazil, was studied. Smoking was defined as having smoked one or more cigarettes in the previous 30 days. Mental health was assessed according to the total score of the Strengths and Difficulties Questionnaire. Score > 20 points was considered positive. Data were analyzed using Poisson regression with adjustment for robust variance. RESULTS Smoking prevalence was 6.0% and about 30% of the adolescents presented some mental health problem. In the crude analysis, the prevalence ratio for smoking was 3.3 (95%CI 2.5; 4.2). After the adjusted analysis (for sex, age, skin color, family income, mothers level of schooling, group of friends who smoke, employment in the previous year, school failure, physical activity during leisure time and experimental use of alcohol), it decreased to 1.7 (95%CI 1.2; 2.3) among those with mental health problem. CONCLUSIONS Mental health problems in adolescence may be related to tobacco consumption.

Intervenções educativas em serviços de saúde e saúde bucal: revisão sistemática

OBJETIVO Analisar a efetividade de intervencoes educativas realizadas em servicos de saude na melhoria de comportamentos e desfechos clinicos em saude bucal. METODOS Foi realizada uma revisao sistematica da literatura com busca nas bases de dados PubMed, Lilacs e SciELO. Foram incluidos estudos que investigaram intervencoes realizadas por profissionais de saude atuantes em servicos de […]ABSTRACT OBJECTIVE To analyze the effectiveness of educational interventions performed in health services in the improvement of clinical behaviors and outcomes in oral health. METHODS We have carried out a systematic review of the literature searching the PubMed, Lilacs, and SciELO databases. We have included studies that have investigated interventions performed by health professionals working in health services and who have used educational actions as main approach to improve behavioral and clinical outcomes in oral health. RESULTS The search amounted to 832 articles and 14 of them met all the inclusion criteria. Five studies have only exclusively evaluated the effectiveness of interventions on caries reduction, three have exceptionally evaluated oral health behaviors, and the other articles have evaluated the effectiveness of interventions for both clinical outcomes (dental caries and periodontal conditions) and behaviors in oral health. Most of the studies (n = 9) were based on randomized controlled trials; the other ones have evaluated before and after the intervention. Five studies have reported a significant reduction of dental caries, and five of the six studies evaluating behavioral outcomes have found some positive change. CONCLUSIONS Most studies evaluating behavioral and periodontal outcomes have shown significant improvements in favor of interventions. All studies evaluating caries have shown a reduction in new lesions or cases of the disease in the groups receiving the interventions, although only five of the eleven articles have found a statistically significant difference. Educational interventions carried out by health professionals in the context of their practice have the potential to promote oral health in the population.