Anna Thereza Thomé Leão

Equivalência semântica da versão em português do instrumento Early Childhood Oral Health Impact Scale

The North American instrument Early Childhood Oral Health Impact Scale (ECOHIS) was created to assess the oral health-related quality of life of preschool children and their families. Its use in Brazil requires prior cultural adaptation, and semantic equivalence is one step in this process. The objective of this study was to evaluate the semantic equivalence between the ECOHIS and its Brazilian version. The methodology included six steps: translation of the ECOHIS into Portuguese, done by two translators; a pre-test, in which the two translations were tested in a group of 20 parents/guardians of children 2-5 years of age; unification of the two versions; two back-translations done independently by two translators; review of the translations and back-translations; and production of a final version of the questionnaire. The two translated versions were very similar, and after completion of all steps a final version of the ECOHIS was obtained. The use of translations and back-translations carefully evaluated by experts and incorporating suggestions from the target population allowed the development of a Brazilian version of the ECOHIS that is semantically equivalent to the original instrument.

The Relationship between Periodontitis and Preterm Low Birthweight

There is no consensus about the influence of periodontal disease on preterm low birthweight. The objective was to investigate the relationship between periodontal disease and preterm low birthweight. A case-control study with 542 post partum women aged over 30 yrs was conducted. Three groups of cases were compared with non-preterm and non-low-birthweight control individuals (n = 393): low birthweight (n = 96), preterm (n = 110), and preterm and low birthweight (n = 63). Periodontal clinical parameters and covariates were recorded. Periodontal disease levels were higher in control individuals than in cases. The extent of periodontal disease did not increase risk of preterm low birthweight according to 15 measures of periodontal disease. Mean periodontal pocket depth and frequency of periodontal sites with clinical attachment level ≥ 3 mm in preterm low birthweight cases were lower than in control individuals. Periodontal disease was not more severe in women with preterm low birthweight babies.

Psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS)

BackgroundOral disorders can have a negative impact on the functional, social and psychological wellbeing of young children and their families and cause pain/discomfort for the child. Oral health-related quality of life (OHRQoL) has emerged as an important health outcome in clinical trials and healthcare research. The Early Childhood Oral Health Impact Scale (ECOHIS) is a proxy measure of childrens OHRQoL designed to assess the negative impact of oral disorders on the quality of life of preschool children. The objective of this study was to evaluate the psychometric properties of the Brazilian version of the ECOHIS (B-ECOHIS).MethodsThis investigation was carried out in preliminary and field studies. The preliminary study comprised a cross-sectional study carried out in the city of Petropolis, Brazil. A sample of 150 children from two to five years of age was recruited at a public hospital. In the field study, an epidemiological survey was carried out in public and private preschools of Belo Horizonte, Brazil. The B-ECOHIS was answered by 1643 parents/caregivers of five-year-old male and female preschool children. In both phases, oral examinations were performed by a single previously calibrated dentist. Reliability was determined through test-retest reliability and internal consistency. Validity was determined through convergent and discriminant validities. The correlation between the scores obtained on the child and family impact sections was assessed.ResultsIn the preliminary (P) and field (F) study, test-retest reliability correlation values were 0.98 and 0.99 for the child impact section and 0.97 and 0.99 for the family impact section, respectively. The B-ECOHIS demonstrated internal consistency: child impact section (P: α = 0.74; F: α = 0.80) and family impact section (P: α = 0.59; F: α = 0.76). The correlation between the scores obtained on the child and family impact sections was statistically significant (P: rs = 0.54; F: rs = 0.62; p ≤ 0.001). In both phases of the study, B-ECOHIS scores were significantly associated with the decayed, missing and filled teeth index, decayed teeth and discolored upper anterior teeth (p < 0.05).ConclusionThe B-ECOHIS proved reliable and valid for assessing the negative impact of oral disorders on the quality of life of preschool children.

Child-OIDP index in Brazil: Cross-cultural adaptation and validation

BackgroundOral health-related quality of life (OHRQoL) measures are being increasingly used to introduce dimensions excluded by normative measures. Consequently, there is a need for an index which evaluates childrens OHRQoL validated for Brazilian population, useful for oral health needs assessments and for the evaluation of oral health programs, services and technologies. The aim of this study was to do a cross-cultural adaptation of the Child Oral Impacts on Daily Performances (Child-OIDP) index, and assess its reliability and validity for application among Brazilian children between the ages of eleven and fourteen.MethodsFor cross-cultural adaptation, a translation/back-translation method integrated with expert panel reviews was applied. A total of 342 students from four public schools took part of the study.ResultsOverall, 80.7% of the sample reported at least one oral impact in the last three months. Cronbachs alpha was 0.63, the weighted kappa 0.76, and the intraclass correlation coefficient (ICC) 0.79. The index had a significant association with self-reported health measurements (self-rated oral health, satisfaction with oral health, perceived dental treatment needs, self-rated general health; all p < 0.01).ConclusionIt was concluded that the Child-OIDP index is a measure of oral health-related quality of life that can be applied to Brazilian children.

Mensuração do impacto dos problemas bucais sobre a qualidade de vida de crianças: aspectos conceituais e metodológicos

Children are subject to oral health problems that can impact their own quality of life and that of their families. The need for measurements to assess the impact of oral health on childrens quality of life has been emphasized, and questionnaires have been developed or adapted to this specific group. The aim of this study was to describe such instruments (identified in the literature) and discuss their inherent difficulties. Among such instruments, we highlight the Child Oral Health Quality of Life Questionnaire, for children aged 6-7, 8-10, and 11-14, the Child-Oral Impacts on Daily Performances, for children aged 11-12, and the Early Childhood Oral Health Impact Scale for children aged 2-5. Although progress was observed in this area, more research is needed to develop measurements that apply to children in their dynamic health/disease process, encompassing their psychosocial, family, and social context. The use of such instruments should be encouraged in clinical practice and research.

The relationship of alcohol dependence and alcohol consumption with periodontitis: a systematic review.

OBJECTIVES The aim of this systematic review was to evaluate the studies about the relationship of alcohol dependence and alcohol consumption with periodontitis. DATA AND SOURCES A comprehensive search was performed in the Systematic Eletronic (PUBMED Medline, Latin American and Caribean Health Science-LILACS, Scientific electronic library online-SciELO and Cochrane Central Register of Controlled Trials-CCRT literature databases) from January 1965 to July 2008. The reference lists of the identified studies were also searched. RESULTS Of the 1530 papers identified, 11 cross-sectional and 5 longitudinal observational studies met the inclusion criteria. Seven of the 12 studies on alcohol consumption and 4 of the 4 studies on alcohol dependence reported positive associations between alcohol intake and periodontitis. There was heterogeneity among studies concerning the methods of assessment of alcohol dependence, alcohol consumption and periodontitis. Therefore no meta-analysis was performed. Although smoking was properly addressed in all selected studies, the confounding effect of dental plaque was taken into account in only 6 studies. CONCLUSION Alcohol consumption can be considered a risk indicator for periodontitis. Longitudinal studies on the association of alcohol dependence and alcohol consumption with periodontitis are needed to confirm the association or not.

Periodontal infection and adverse pregnancy outcomes: a systematic review of epidemiological studies

The objective of this systematic review was to evaluate analytical studies on periodontal disease as a possible risk factor for adverse pregnancy outcomes. A literature search of the MEDLINE, SciELO, and LILACS bibliographic databases and CAPES thesis database was conducted up to December 2005, covering epidemiological studies of periodontal disease and adverse pregnancy outcomes. Of the 964 papers identified, 36 analytical studies met the inclusion criteria. Twenty-six epidemiological studies reported associations between periodontal disease and adverse pregnancy outcomes. There was a clear heterogeneity between studies concerning measurement of periodontal disease and selection of type of adverse pregnancy outcome. Therefore no meta-analysis was performed. Most studies did not control for confounders, thus raising serious doubts about their conclusions. The methodological limitations of most studies did not allow conclusions concerning the effects of periodontal disease on adverse pregnancy outcomes. Larger and methodologically rigorous analytical studies using reliable outcomes and exposure measures are recommended.

Oral health-related quality of life of 11- and 12-year-old public school children in Rio de Janeiro.

OBJECTIVES The objective of this study was to assess the association between oral health-related quality of life (OHRQoL), measured through the Child-OIDP, and demographic characteristics, self-reported oral problems, and clinical oral health measures, among 11- to 12-year-old school children in the city of Rio de Janeiro, Brazil. METHODS A cross-sectional study was conducted, having as its target population 11- and 12-year-old students of both sexes, formally enrolled in 6- and 7-year school classes at public schools. A probabilistic sample with complex design was used. OHRQoL was assessed by the Brazilian version of Child-OIDP. Oral exams were conducted, and the presence of dental biofilm, gingival bleeding, DMFT, fluorosis, enamel defects, dental trauma, and malocclusion were recorded. RESULTS A total of 571 school children participated with a mean age of 12.0 years and 95% confidence interval (95% CI) from 11.9 to 12.1. A total of 88.7% of the school children presented the impact of oral problems in at least one of the eight daily performances. The activities that had most impacts were eating (81.3%), cleaning mouth (40.5%), and smiling (32.2%). The mean Child-OIDP index was 7.1 with 95% CI from 6.2 to 8.1. The highest scores were in relation to eating (mean = 25.0; 95% CI from 22.4 to 27.6), cleaning mouth (mean = 12.0; 95% CI from 9.1 to 14.9), and smiling (mean = 10.0; 95% CI from 7.5 to 12.5). In the logistic regression model, the Child-OIDP was associated with dental caries experience and with the perception of sensitive teeth, perception of gingival bleeding, and perception of inadequate position of the teeth. In the multinomial regression, we found that the odds of having higher levels of Child-OIDP were positively associated with dental caries experience. Self-reported dental caries, mobile milk teeth, tooth position, bleeding gums, and bad breath were associated with worst OHRQoL. CONCLUSIONS It can be concluded that there is an association between dental caries experience and the Child-OIDP index. This association indicates the impact of this condition on the quality of life of school children. Moreover, the Child-OIDP index is explained more by self-reported oral problems than by clinical normative measures.

The effect of periodontal therapy on preterm low birth weight: a meta-analysis.

OBJECTIVE: To systematically review the randomized controlled trials that evaluated the effect of periodontal therapy on preterm birth and low birth weight (LBW). DATA SOURCES: A systematic search was conducted of the PubMed, Bireme, LILACS, and Cochrane databases. METHODS OF STUDY SELECTION: Only randomized controlled trials on the effect of periodontal therapy on preterm birth and LBW were included. The Consolidated Standards of Reporting Trials statement was used in quality assessment and meta-analysis was carried out using random-effects methods. TABULATION, INTEGRATION, AND RESULTS: The search resulted in 14 clinical studies. Ten articles met the inclusion criteria for preterm birth and four for LBW. Five meta-analyses on preterm birth were performed according to different criteria: 1) use of probing depth and attachment loss for periodontitis definition, relative risk (RR) 0.58 (95% confidence interval [CI] 0.29–1.12) (four studies); 2) controlling for multiparity, RR 0.92 (95% CI 0.72–1.17) (eight studies); 3) controlling for previous preterm birth, RR 0.88 (95% CI 0.67–1.16) (seven studies); 4) controlling for genitourinary infections, RR 0.75 (95% CI 0.57–1.05) (six studies); and 5) all the previous criteria, RR 0.63 (95% CI 0.32–1.22) (three studies). Three meta-analysis on LBW were conducted according to controlling for multiparity, RR 1.03 (95% CI 0.76–1.40) (four studies); controlling for previous preterm birth, RR 0.93 (95% CI 0.65–1.30) (three studies); and use of probing depth and attachment loss for periodontitis definition, controlling for multiparity, previous preterm birth, and genitourinary infections, RR 0.52 (95% CI 0.10–2.60) (two studies). In all meta-analyses, the effect of periodontal treatment on preterm birth and LBW was not statistically significant. CONCLUSION: Results of this meta-analysis do not support the hypothesis that periodontal therapy reduces preterm birth and LBW indices.

Partial recording protocols for periodontal disease assessment in epidemiological surveys

The objective of the present study was to compare the reliability of four partial-mouth protocols for assessing shallow, moderate, and deep sites for periodontal pocket depth and clinical attachment levels. Periodontal pocket depth and clinical attachment level measurements were recorded for 156 subjects (age > or = 30). The four models of partial-mouth protocols compared were: Model I: all sites per tooth in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model II: buccal sites in a full-mouth protocol, Model III: buccal sites in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model IV: all sites per tooth using Community Periodontal Index teeth. In comparison with full mouth examination, Model I did not show significant differences for periodontal pocket depth and clinical attachment level parameters. Models II and III were different for some periodontal pocket depth means, and Model IV significantly overestimated all clinical parameters related to periodontal disease. Model I appears to be adequate to substitute for the full-mouth examination to assess the prevalence and severity of chronic periodontal disease in adults.