Andréa Videira Assaf

Inequalities in dental caries of 5-year-old children in Scotland, 1993-2003

BACKGROUND Previous research suggests there are significant differences between socio-economic groups in prevalence and amount of decayed missing and filled primary teeth (d3mft). The aim of this study was to describe the variation in obvious tooth decay experience amongst 5-year olds in Scotland and to look at the association between d3mft and deprivation in Scotland. METHODS Data derived from 1993 to 2003 National Dental Inspection Programme were modelled using Bayesian multilevel zero-inflated Negative Binomial models, adjusting for age, sex and the deprivation. RESULTS Deprivation is positively and significantly associated with having d3mft; the odds of a child in DepCat 7 (most deprived) having d3mft in 1993 were 7.49 (5.03-11.15) that of a child in DepCat 1 (most affluent). Inequalities in the prevalence of d3mft have reduced and in 2003 the odds of a child in DepCat 7 having d3mft were 4.60 (3.47-6.14) that of a child in DepCat 1. However, socio-economic inequalities in the amount of d3mft for those with d3mft have seen no reduction and have in fact increased between 1993 and 2003, with this increase approaching significance. CONCLUSION While socio-economic inequalities in prevalence of children with d3mft have decreased in recent years, socio-economic inequalities in the amount of d3mft for those with d3mft persist. This suggests that improvements are only seen for those children with the potential for low d3mft. High d3mft persists among children from more deprived areas. The national target conceals this apparent inconsistency.

Influência de variáveis socioeconômicas, clínicas e demográfica na experiência de cárie dentária em pré-escolares de Piracicaba, SP

OBJETIVO: Avaliar a influencia de variaveis socioeconomicas, clinicas e demografica na experiencia de carie em pre-escolares de 5 anos de idade da cidade de Piracicaba. METODOLOGIA: A amostra consistiu de 728 criancas matriculadas em 22 pre-escolas publicas (n = 428) e 18 pre-escolas privadas (n = 300). A carie dentaria foi avaliada pelos indices ceo-d e ceo-s e pela deteccao de lesao inicial (LI). Outras variaveis clinicas como gengivite, apinhamento, espacamento, fluorose e respiracao bucal tambem foram coletadas. As variaveis socioeconomicas (renda familiar mensal, numero de residentes na mesma casa, escolaridade do pai e da mae, habitacao e posse de automovel) foram obtidas por meio de um questionario semi-estruturado enviado aos pais. RESULTADOS: As medias (desvio-padrao) do ceo-d e ceo-s foram de 1,30 (2,47) e 3,08 (7,55), respectivamente, sendo que 62,2% da amostra estava livre de carie. As medias (desvio-padrao) do ceo-d+LI e ceo-s+LI foram 1,72 (3,36) e 3,45 (7,94), respectivamente e 59,7% estavam livres de caries. Por meio da analise de regressao logistica multipla, as criancas com fluorose (Odds Ratio-OR=0,40) ou de familias com renda superior a 4 salarios minimos (OR = 0,49) apresentaram menor probabilidade de ter experiencia de carie. Aquelas com gengivite (OR = 1,87) tiveram maior chance de ter a doenca. Para o criterio de diagnostico de carie com a inclusao de LI, as criancas com fluorose (OR = 0,39) ou de familias com renda superior a 4 salarios minimos (OR = 0,52) tiveram menor chance de ter carie. Aquelas com gengivite (OR=1,80), apinhamento (OR = 2,63 e OR = 1,01) ou respiracao bucal (OR = 1,37) apresentaram maior probabilidade de ter a doenca. CONCLUSAO: Os pre-escolares que apresentaram gengivite, apinhamento, respiracao bucal ou renda familiar mensal inferior a 4 salarios minimos tiveram maior probabilidade de ter experiencia de carie. Assim, o planejamento de acoes de prevencao e intervencao direcionadas a este publico seria essencial para o controle da doenca.

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.

A new approach for interexaminer reliability data analysis on dental caries calibration

Objectives a) to evaluate the interexaminer reliability in caries detection considering different diagnostic thresholds and b) to indicate, by using Kappa statistics, the best way of measuring interexaminer agreement during the calibration process in dental caries surveys. Methods Eleven dentists participated in the initial training, which was divided into theoretical discussions and practical activities, and calibration exercises, performed at baseline, 3 and 6 months after the initial training. For the examinations of 6-7-year-old schoolchildren, the World Health Organization (WHO) recommendations were followed and different diagnostic thresholds were used: WHO (decayed/missing/filled teeth – DMFT index) and WHO + IL (initial lesion) diagnostic thresholds. The interexaminer reliability was calculated by Kappa statistics, according to WHO and WHO+IL thresholds considering: a) the entire dentition; b) upper/lower jaws; c) sextants; d) each tooth individually. Results Interexaminer reliability was high for both diagnostic thresholds; nevertheless, it decreased in all calibration sections when considering teeth individually. Conclusion The interexaminer reliability was possible during the period of 6 months, under both caries diagnosis thresholds. However, great disagreement was observed for posterior teeth, especially using the WHO+IL criteria. Analysis considering dental elements individually was the best way of detecting interexaminer disagreement during the calibration sections.

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.

Temporomandibular disorders and relationship with socio-demographic and clinical variables in a University of the state of Rio de Janeiro

Universidade Federal Fluminense Instituto de Saude de Nova Friburgo Departamento de Formacao Especifica

Interexaminer agreement dental caries epidemiological surveys: the importance of disease prevalence in the sample

OBJECTIVE To identify desirable characteristics, including different sample sizes and dental caries prevalences, in virtual samples that allow, at the same time, higher values of general agreement percentage (GPA) and Kappa coefficient (κ), under a low confidence interval (CI), in reproducibility studies. METHOD A total of 384 statistical simulations of inter-examiner calibration, varying sample size (12, 15, 20, 60, 200 and 500 individuals), caries prevalence (30, 50, 60 and 90%) and percentages of positive (PA) and negative (NA) agreement (30, 50, 60 and 90%) were undertaken. GPA and κ were used to measure reproducibility and define deviation between them. RESULTS The sample of 60 individuals, under caries prevalence of 50%, PA and NA of 90%, presented a GPA and Kappa values of 90 and 80%, respectively, a relative small confidence interval (95%CI 0.65 - 0.95) and a GPA/Kappa deviation of 10.00. CONCLUSION A virtual sample of 60 individuals, under caries prevalence of 50%, seems feasible to produce a satisfactory interexaminer agreement at epidemiological conditions. However, epidemiological studies to corroborate or refute this assertion are necessary.

Dental Care for an adolescent with chromosome pentasomy: rare case report with a two year follow-up

Pentasomy of the x chromosome is a rare syndrome of unknown incidence and there are few reports in the scientific literature, especially in terms of dental care for patients with this syndrome. The aim of this study was to report the dental care given to an adolescent with pentasomy of the X chromosome. The patient presented a cleft palate, impacted teeth, malocclusion, high caries activity, gingivitis and multiple tooth loss due to caries. Despite the difficulties of carrying out the dental work due to involuntary movements and the initial lack of collaboration from the patient the overall dental care was completed on an outpatient basis. The therapeutic success of the treatment was strongly supported by the significant cooperation and relationship that grew up along the period of the treatment, as well as the desire to have the treatment done by both the patient and her parents. Indexing terms: Genetic nondisjunction; Chromosomes; Psychomotor impairment; Oral healthPentasomy of the x chromosome is a rare syndrome of unknown incidence and there are few reports in the scientific literature, especially in terms of dental care for patients with this syndrome. The aim of this study was to report the dental care given to an adolescent with pentasomy of the X chromosome. The patient presented a cleft palate, impacted teeth, malocclusion, high caries activity, gingivitis and multiple tooth loss due to caries. Despite the difficulties of carrying out the dental work due to involuntary movements and the initial lack of collaboration from the patient the overall dental care was completed on an outpatient basis. The therapeutic success of the treatment was strongly supported by the significant cooperation and relationship that grew up along the period of the treatment, as well as the desire to have the treatment done by both the patient and her parents.

Avaliação clínica do sistema de laser fluorescente no diagnóstico de lesões de cárie oclusal

The aim of this study was to evaluate the effectiveness of the laser fluorescence device Diag- nodent for the correct diagnosis of occlusal lesions, validating the results through cavity opening. The sample consisted of 153 per- manent molars with microcavi- ties in school children aged 6 to 8 years, enrolled in public schools in the city of Piracicaba. The exams were carried out in a dental office using artificial light, plane mirror, and an explorer probe was used only when the biofilm needed to be removed. The study validation was performed through the cavity opening with round burs until the carious tissue was completely re- moved. The results showed that the sensitivity values and positive predictive values for Diagnodent were high when the enamel caries validation criterion was used, with the following sensitivity values: 0.99 at cut-point 20 and 0.98 at cut-point 30. The positive predicti- ve values were 0.97 and 1.00, res- pectively, for the two established cut-off thresholds. Concerning the dentin validation, the sensitivity values were 0.84 at cut-point 30 and 0.99 at cut-point 20. The posi- tive predictive values for cut-point 20 and cut-point 30 were 0.80 and 0.89, respectively. Therefore, it may be concluded that the Diagno- dent laser device is highly capable of identifying early alterations in dental enamel; however, it sho- wed a high number of false-posi- tive diagnosis when dentin lesions were used as dentin lesions valida- tion criterion. Key words: methods, preventive dentistry, diagnosis, occlusal ca- ries, laser fluorescence.