Carolina Castro Martins

A Systematic Review of Socioeconomic Indicators and Dental Caries in Adults

Increasing evidence suggests that socioeconomic factors may be associated with an increased risk of dental caries. To provide better evidence of the association between dental caries in adults and socioeconomic indicators, we evaluated the relation between these two conditions in a thorough review of the literature. Seven databases were systematically searched: Pubmed, Cochrane, Web of Science, Bireme, Controlled Trials, Clinical Trials and the National Institute for Health and Clinical Excellence. No restrictions were placed on the language or year of publication. The search yielded 41 studies for systematic review. Two independent reviewers screened the studies for inclusion, extracted data and evaluated quality using the Newcastle-Ottawa scale. The following socioeconomic indicators were found: educational level, income, occupation, socio-economic status and the community index. These indicators were significantly associated with a greater occurrence of dental caries: the subject’s education, subject’s income, subject’s occupation and the Gini coefficient. A high degree of heterogeneity was found among the methods. Quality varied across studies. The criteria employed for socioeconomic indicators and dental caries should be standardized in future studies. The scientific evidence reveals that educational level, income, occupation and the Gini coefficient are associated with dental caries.

Impact of oral health conditions on the quality of life of preschool children and their families: a cross-sectional study.

BackgroundDental caries, traumatic dental injury (TDI) and malocclusion are common oral health conditions among preschool children and can have both physical and psychosocial consequences. Thus, it is important to measure the impact these on the oral health-related quality of life (OHRQoL) of children. The aim of the present study was to assess the impact of oral health conditions on the OHRQoL of preschool children and their families.MethodsA preschool-based, cross-sectional study was carried out with 843 preschool children in the city of Campina Grande, Brazil. Parents/caregivers answered the Brazilian Early Childhood Oral Health Impact Scale and a questionnaire addressing socio-demographic data as well as the parent’s/caregiver’s perceptions regarding their child’s health. Clinical exams were performed by three researchers who had undergone a calibration process for the diagnosis of dental caries, TDI and malocclusion (K = 0.83-0.85). Hierarchical Poisson regression was employed to determine the strength of associations between oral health conditions and OHRQoL (α = 5%). The multivariate model was run on three levels obeying a hierarchical approach from distal to proximal determinants: 1) socio-demographic data; 2) perceptions of health; and 3) oral health conditions.ResultsThe prevalence of impact from oral health conditions on OHRQoL was 32.1% among the children and 26.2% among the families. The following variables were significantly associated with a impact on OHRQoL among the children: birth order of child (PR = 1.430; 95% CI: 1.045-1.958), parent’s/caregiver’s perception of child’s oral health as poor (PR = 1.732; 95% CI: 1.399-2.145), cavitated lesions (PR = 2.596; 95% CI: 1.982-3.400) and TDI (PR = 1.413; 95% CI: 1.161-1.718). The following variables were significantly associated with a impact on OHRQoL among the families: parent’s/caregiver’s perception of child’s oral health as poor (PR = 2.116; 95% CI: 1.624-2.757), cavitated lesions (PR = 2.809; 95% CI: 2.009-3.926) and type of TDI (PR = 2.448; 95% CI: 1.288-4.653).ConclusionCavitated lesions and TDI exerted a impact on OHRQoL of the preschool children and their families. Parents’/caregivers’ perception of their child’s oral health as poor and the birth order of the child were predictors of a greater impact on OHRQoL.

Available fluoride in toothpastes used by Brazilian children

Toothpastes should have a minimum concentration of 1000 ppm of fluoride (F) to control caries and also the active F agent must be chemically free (soluble) in the formulation. Thus, the aim of this study was to evaluate the concentration of soluble F in dentifrices used by 206 Brazilian children. The concentrations of total fluoride (TF), total soluble fluoride (TSF) and fluoride ion were determined. From these analyses, the concentrations of F as sodium monofluorophosphate (MFP) and % of insoluble F were calculated. F was analyzed with an ion specific electrode in duplicates. The majority of dentifrices used (96%) contained F and in 84% of them, TF concentration was according to that declared by the manufacturers. In the F-toothpastes, 78% showed TSF concentration ≥ 1000 ppm, varying from 422.3 to 1432.3 ppm F (mean ± SD of 1017.6 ± 239.4). These findings suggest that most dentifrices used by Brazilian children present available fluoride concentration for caries control.

Prospective Study of the Association between Fluoride Intake and Dental Fluorosis in Permanent Teeth

Objective: To evaluate the relationship between fluoride intake and dental fluorosis in permanent central incisors and first molars. Methods: Fluoride intake (mg F/kg body weight/day) from diet, dentifrice and both combined was determined on a single occasion in 1998 among children aged 19–39 months living in two fluoridated Brazilian communities (0.6–0.8 ppm F). Six years later, when the permanent teeth of these children had erupted (central incisors and first molars), 49 children aged 7–9 years [20 girls (40.8%) and 29 boys (58.2%)] were evaluated for dental fluorosis. To test the association between fluorosis and fluoride intake, children were dichotomized into two groups, cases (children with dental fluorosis on at least two teeth, TFI ≧1) and noncases (children without dental fluorosis, TFI = 0). Results: Among the case group (n = 29), median fluoride doses from diet, dentifrice and combined were 0.031, 0.050 and 0.083 mg F/kg/day, respectively. Among the noncase group (n = 20), median fluoride doses were 0.029, 0.049, 0.084 mg F/kg/day, respectively. There was no association between dental fluorosis in permanent teeth and fluoride intake from diet, dentifrice and combined (p > 0.05). Conclusions: There was no difference between children with and without fluorosis in the permanent central incisors and first molars regarding fluoride intake. However, this study has limitations that must be recognized: fluoride intake was only measured once, and there were no children in the sample with severe degrees of dental fluorosis.

Breast and Bottle Feeding as Risk Factors for Dental Caries: A Systematic Review and Meta-Analysis.

Understanding the role that breastfeeding and bottle feeding play in the development of dental caries during childhood is essential in helping dentists and parents and care providers prevent the disease, and also for the development of effective public health policies. However, the issue is not yet fully understood. The aim of this systematic review and meta-analysis was to search for scientific evidence in response to the question: Do bottle fed children have more dental caries in primary dentition than breastfed children? Seven electronic databases and grey literature were used in the search. The protocol number of the study is PROSPERO CRD 42014006534. Two independent reviewers selected the studies, extracted data and evaluated risk of bias by quality assessment. A random effect model was used for meta-analysis, and the summary effect measure were calculated by odds ratio (OR) and 95% CI. Seven studies were included: five cross-sectional, one case-control and one cohort study. A meta-analysis of cross-sectional studies showed that breastfed children were less affected by dental caries than bottle fed children (OR: 0.43; 95%CI: 0.23–0.80). Four studies showed that bottle fed children had more dental caries (p<0.05), while three studies found no such association (p>0.05). The scientific evidence therefore indicated that breastfeeding can protect against dental caries in early childhood. The benefits of breastfeeding until age two is recommended by WHO/UNICEF guidelines. Further prospective observational cohort studies are needed to strengthen the evidence.

Tooth erosion and eating disorders: a systematic review and meta-analysis.

Background Eating disorders are associated with the highest rates of morbidity and mortality of any mental disorders among adolescents. The failure to recognize their early signs can compromise a patients recovery and long-term prognosis. Tooth erosion has been reported as an oral manifestation that might help in the early detection of eating disorders. Objectives The aim of this systematic review and meta-analysis was to search for scientific evidence regarding the following clinical question: Do eating disorders increase the risk of tooth erosion? Methods An electronic search addressing eating disorders and tooth erosion was conducted in eight databases. Two independent reviewers selected studies, abstracted information and assessed its quality. Data were abstracted for meta-analysis comparing tooth erosion in control patients (without eating disorders) vs. patients with eating disorders; and patients with eating disorder risk behavior vs. patients without such risk behavior. Combined odds ratios (ORs) and a 95% confidence interval (CI) were obtained. Results Twenty-three papers were included in the qualitative synthesis and assessed by a modified version of the Newcastle-Ottawa Scale. Fourteen papers were included in the meta-analysis. Patients with eating disorders had more risk of tooth erosion (OR = 12.4, 95%CI = 4.1–37.5). Patients with eating disorders who self-induced vomiting had more risk of tooth erosion than those patients who did not self-induce vomiting (OR = 19.6, 95%CI = 5.6–68.8). Patients with risk behavior of eating disorder had more risk of tooth erosion than patients without such risk behavior (Summary OR = 11.6, 95%CI = 3.2–41.7). Conclusion The scientific evidence suggests a causal relationship between tooth erosion and eating disorders and purging practices. Nevertheless, there is a lack of scientific evidence to fulfill the basic criteria of causation between the risk behavior for eating disorders and tooth erosion.

Perceived Impact of Dental Pain on the Quality of Life of Preschool Children and Their Families.

The aim of the present study was to evaluate the perceived impact of dental caries and dental pain on oral health-related quality of life (OHRQoL) among preschool children and their families. A cross-sectional study was conduct with 843 preschool children in Campina Grande, Brazil. Parents/caregivers answered a questionnaire on socio-demographic information, their child’s general/oral health and history of dental pain. The Brazilian version of the Early Childhood Oral Health Impact Scale was administered to determine the perceived impact of caries and dental pain on OHRQoL. The children underwent an oral examination. Logistic regression for complex sample was used to determine associations between the dependent and independent variables (OR: Odds ratio, α = 5%). The independents variables that had a p-value <0.20 in the bivariate analysis were selected for the multivariate model. The prevalence of dental caries and dental pain was 66.3% and 9.4%, respectively. Order of birth of the child, being the middle child (OR: 10.107, 95%CI: 2.008-50.869) and youngest child (OR: 3.276, 95%CI: 1.048-10.284) and dental pain (OR: 84.477, 95%CI: 33.076-215.759) were significant predictors of the perceived impact on OHRQOL for children. Poor perception of oral health was significant predictor of the perceived impact on OHRQOL for family (OR=7.397, 95%CI: 2.190-24.987). Dental caries was not associated with a perceived impact on the ORHQoL of either the children or their families. However, order of child birth and dental pain were indicators of impact of OHRQoL on preschool children and poor perception of oral health was indicators of impact on families.

The association between occlusal factors and noncarious cervical lesions: A systematic review

OBJECTIVES This study aimed to systematically review the scientific evidence for the association between noncarious cervical lesions (NCCL) and occlusal risk factors (ORF) [occlusal interferences in excursive movements; occlusal force; premature contacts; type of guidance; skid of centric occlusion to maximum intercuspidation] in adults. SOURCES Pubmed, Web of Science, Cochrane, Lilacs, Clinical Trials, National Research Register and National Institute for Health were searched. STUDY SELECTION From 1082 potentially eligible studies, 106 were selected for full text analysis. Two independent reviewers (Kappa=0.8; p<0.001) selected the studies, abstracted information and assessed quality based on standardised scales. Six cross-sectional, two case-controls and one clinical trial were included. Several occlusal variables were analysed among the studies, but there was no standardisation of the units used in the analysis of occlusal factors. The majority of studies did not find significant associations between NCCL and ORF. Three studies found associations between NCCL and some variables (occlusal contact area, right canine guidance, premature contacts in centric relation and working side) (p<0.05). The methodological quality varied across studies, and there was high heterogeneity among them. CONCLUSION Current scientific evidence does not support an association between ORF and NCCL. Further prospective studies with standardised methods are vital to strengthen the evidence. CLINICAL SIGNIFICANCE Understanding the risk factors for NCCL is important to control the causes and to help the dentist choose the best approach for the patient. The evidence does not support intervention to alter some occlusal factors for the prevention or control of the progression of NCCL.

Determinant Factors of Untreated Dental Caries and Lesion Activity in Preschool Children Using ICDAS

The aim of the present study was to investigate determinant factors associated with the presence of dental caries and lesion activity in preschool children. A population-based, cross-sectional study was carried out with 843 children of aged three to five years enrolled at public and private preschools in the city of Campina Grande, Brazil. A questionnaire addressing socio-demographic data and oral health care was self-administered by parents/caregivers. Three dentists previously calibrated examined the children for the diagnosis of dental caries and lesion activity using the International Caries Detection and Assessment System (ICDAS). Nutritional status was evaluated based on the body mass index. Logistic regression analysis for complex samples was performed (α = 5%). The prevalence of dental caries was 66.3%. Among the children with caries, 88.0% had active lesions. Dental caries was more prevalent in girls (OR = 1.53, 95%CI: 1.05–2.23), in children from families with a monthly household income ≤US

Prevalence and Associated Factors for the Development of Anterior Open Bite and Posterior Crossbite in the Primary Dentition

312.50 (OR = 2.38, 95%CI: 1.65–3.43) and those whose mothers had up to eight years of schooling (OR = 1.55, 95%CI: 1.07–2.23). Lesion activity was significantly associated with mother’s schooling ≤ 8 years (OR = 2.15, 95%CI: 1.15–4.00). The prevalence rates of dental caries and lesion activity were high and mainly associated with a lower socioeconomic status and mother’s schooling.