Chaiana Piovesan

Socioeconomic and psychosocial predictors of dental healthcare use among Brazilian preschool children

BackgroundDisparities in utilization of oral healthcare services have been attributed to socioeconomic and individual behavioral factors. Parents’ socioeconomic status, demographics, schooling, and perceptions of oral health may influence their children’s use of dental services. This cross-sectional study assessed the relationships between socioeconomic and psychosocial factors and the utilization of dental health services by children aged 1–5xa0years.MethodsData were collected through clinical exams and a structured questionnaire administered during the National Day of Children’s Vaccination. A Poisson regression model was used to estimate prevalence ratios and 95% confidence intervals.ResultsData were collected from a total of 478 children. Only 112 (23.68%) were found to have visited a dentist; 67.77% of those had seen the dentist for preventive care. Most (63.11%) used public rather than private services. The use of dental services varied according to parental socioeconomic status; children from low socioeconomic backgrounds and those whose parents rated their oral health as “poor” used dental services less frequently. The reason for visiting the dentist also varied with socioeconomic status, in that children of parents with poor socioeconomic status and who reported their child’s oral health as “fair/poor” were less likely to have visited the dentist for preventive care.ConclusionThis study demonstrated that psychosocial and socioeconomic factors are important predictors of the utilization of dental care services.

Assessing individual and neighborhood social factors in child oral health-related quality of life: a multilevel analysis

AbstractPurposenIt has been suggested that subjective measures of oral health are influenced by both individual and contextual characteristics. This study assessed the relationship between neighborhood and individual social networks and child oral health-related quality of life (COHRQoL).Methods This study followed a cross-sectional design using a multistage sample of 478 children aged 1–5xa0years old. Caregivers completed the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) and answered questions related to socioeconomic status and social network. The dental examination provided information on the prevalence of dental caries, dental trauma, and occlusion. Contextual social determinants included the presence of cultural community centers and of workers’ association in the neighborhood. Data analysis considered the total ECOHIS scores as the outcome and neighborhood/individual social networks as the independent variables. A multilevel Poisson regression model was used to investigate the association among individual and contextual characteristics and COHRQoL.ResultsTotal ECOHIS scores ranged from 0 to 41 (possible range 0–52). The mean ECOHIS score was low (meanxa0=xa01.8, SDxa0=xa03.9), and the functional domain presented the highest mean impact on COHRQoL (meanxa0=xa00.5, SDxa0=xa01.4). Following adjusted analysis, low household income, visiting a neighbor less than once a month, the presence of anterior open bite, dental trauma, and dental caries were identified as individual determinants of negative impact on a child’s quality of life. These variables remained associated with the outcome even after adding the contextual-level variables in the model. At the contextual level, the presence of community cultural centers was associated with overall mean ECOHIS score; higher impacts on COHRQoL were observed in those living in neighborhoods without cultural community centers.ConclusionThere is a significant association between individual and contextual social determinants and COHRQoL; unfavorable social conditions and poor socioeconomic status have a negative impact on caregiver reports of children’s oral health-related quality of life.

Desigualdades na prevalência de cárie dentária não tratada em crianças pré-escolares no Brasil

OBJECTIVEnTo evaluate the influence of social inequalities of individual and contextual nature on untreated dental caries in Brazilian children.nnnMETHODSnThe data on the prevalence of dental caries were obtained from the Brazilian Oral Health Survey (SBBrasil 2010) Project, an epidemiological survey of oral health with a representative sample for the country and each of the geographical micro-regions. Children aged five (n = 7,217) in 177 municipalities were examined and their parents/guardians completed a questionnaire. Contextual characteristics referring to the municipalities in 2010 (mean income, fluorodized water and proportion of residences with water supply) were supplied by the Fundação Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Multilevel Poisson regression analysis models were used to assess associations.nnnRESULTSnThe prevalence of non-treated dental caries was 48.2%; more than half of the sample had at least one deciduous tooth affected by dental caries. The index of dental caries in deciduous teeth was 2.41, with higher figures in the North and Northeast. Black and brown children and those from lower income families had a higher prevalence of untreated dental caries. With regards context, the mean income in the municipality and the addition of fluoride to the water supply were inversely associated with the prevalence of the outcome.nnnCONCLUSIONSnInequalities in the prevalence of untreated dental caries remain, affecting deciduous teeth of children in Brazil. Planning public policies to promote oral health should consider the effect of contextual factors as a determinant of individual risk.OBJETIVO: Avaliar a influencia de desigualdades sociais de ordem individual e contextual na experiencia de carie dentaria nao tratada em criancas no Brasil. METODOS: Os dados sobre a prevalencia de carie dentaria foram obtidos do Projeto Pesquisa Nacional de Saude Bucal – SBBrasil 2010, levantamento epidemiologico de saude bucal com amostra representativa para o pais e cada uma de suas macrorregioes geograficas. Criancas de cinco anos de idade (n = 7.217) em 177 municipios foram examinadas e seus responsaveis responderam ao questionario. Caracteristicas contextuais referentes aos municipios em 2010 (renda mediana, fluoretacao da agua e proporcao de domicilios com abastecimento de agua) foram informadas pela Fundacao Instituto Brasileiro de Geografia e Estatistica. O estudo de associacao utilizou modelos multinivel de analise de regressao de Poisson. RESULTADOS: A prevalencia de carie nao tratada foi de 48,2%; mais da metade da amostra apresentou ao menos um dente deciduo com experiencia de carie. O indice de carie na denticao decidua ceo-d medio foi 2,41, sendo maior para as regioes Norte e Nordeste. Criancas de cor da pele preta e parda, e aquelas com renda familiar menos elevada tiveram maior prevalencia de carie nao tratada. No nivel contextual, renda mediana no municipio e adicao de fluor na agua de abastecimento associaram-se inversamente com a prevalencia do desfecho. CONCLUSOES: Desigualdades na prevalencia de carie nao tratada persistem, afetando as criancas com denticao decidua no Brasil. O planejamento de medidas publicas para a promocao de saude bucal deve considerar o efeito de fatores contextuais como determinante de riscos individuais.

Inequality in dental caries distribution at noncavitated and cavitated thresholds in preschool children

OBJECTIVEnTo evaluate the inequality in dental caries distribution according to different thresholds assessed using the International Caries Detection and Assessment System (ICDAS) and to investigate the associations of socioeconomic factors with caries lesions at both noncavitated and cavitated thresholds.nnnMETHODSnStudy subjects were recruited in Santa Maria, Brazil, during the National Day of Childrens Vaccination, and 639 children aged 12-59 months were included. Fifteen calibrated examiners performed the examinations using ICDAS criteria. Inequality in dental caries distribution was measured using the Gini coefficient, and the Significant Caries Index was calculated for several thresholds of ICDAS. Poisson regression analysis was used to assess the associations of socioeconomic factors with the highest caries scores.nnnRESULTSnThe inequality in the distribution of dental caries was lower when precavitated caries were included; the Gini coefficient decreased from 0.77 to 0.60 when noncavitated caries lesions were included in the analyses. Moreover, the inequalities were higher in the younger than in the older children for all thresholds. Socioeconomic factors were significantly (Pu2009<u20090.001) associated with caries when an ICDAS score of 3 was considered as the cut-off point. Children whose mothers did not complete primary education (Pu2009<u20090.001) and those with low household income (Pu2009<u20090.001) were more likely to have increased dental caries.nnnCONCLUSIONnCaries lesions were more equally distributed when noncavitated lesions were included in the dental survey. Socioeconomic factors are found to be associated with the inequalities in caries distribution in this age group.

Inequalities in untreated dental caries prevalence in preschool children in Brazil

OBJECTIVEnTo evaluate the influence of social inequalities of individual and contextual nature on untreated dental caries in Brazilian children.nnnMETHODSnThe data on the prevalence of dental caries were obtained from the Brazilian Oral Health Survey (SBBrasil 2010) Project, an epidemiological survey of oral health with a representative sample for the country and each of the geographical micro-regions. Children aged five (n = 7,217) in 177 municipalities were examined and their parents/guardians completed a questionnaire. Contextual characteristics referring to the municipalities in 2010 (mean income, fluorodized water and proportion of residences with water supply) were supplied by the Fundação Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Multilevel Poisson regression analysis models were used to assess associations.nnnRESULTSnThe prevalence of non-treated dental caries was 48.2%; more than half of the sample had at least one deciduous tooth affected by dental caries. The index of dental caries in deciduous teeth was 2.41, with higher figures in the North and Northeast. Black and brown children and those from lower income families had a higher prevalence of untreated dental caries. With regards context, the mean income in the municipality and the addition of fluoride to the water supply were inversely associated with the prevalence of the outcome.nnnCONCLUSIONSnInequalities in the prevalence of untreated dental caries remain, affecting deciduous teeth of children in Brazil. Planning public policies to promote oral health should consider the effect of contextual factors as a determinant of individual risk.OBJETIVO: Avaliar a influencia de desigualdades sociais de ordem individual e contextual na experiencia de carie dentaria nao tratada em criancas no Brasil. METODOS: Os dados sobre a prevalencia de carie dentaria foram obtidos do Projeto Pesquisa Nacional de Saude Bucal – SBBrasil 2010, levantamento epidemiologico de saude bucal com amostra representativa para o pais e cada uma de suas macrorregioes geograficas. Criancas de cinco anos de idade (n = 7.217) em 177 municipios foram examinadas e seus responsaveis responderam ao questionario. Caracteristicas contextuais referentes aos municipios em 2010 (renda mediana, fluoretacao da agua e proporcao de domicilios com abastecimento de agua) foram informadas pela Fundacao Instituto Brasileiro de Geografia e Estatistica. O estudo de associacao utilizou modelos multinivel de analise de regressao de Poisson. RESULTADOS: A prevalencia de carie nao tratada foi de 48,2%; mais da metade da amostra apresentou ao menos um dente deciduo com experiencia de carie. O indice de carie na denticao decidua ceo-d medio foi 2,41, sendo maior para as regioes Norte e Nordeste. Criancas de cor da pele preta e parda, e aquelas com renda familiar menos elevada tiveram maior prevalencia de carie nao tratada. No nivel contextual, renda mediana no municipio e adicao de fluor na agua de abastecimento associaram-se inversamente com a prevalencia do desfecho. CONCLUSOES: Desigualdades na prevalencia de carie nao tratada persistem, afetando as criancas com denticao decidua no Brasil. O planejamento de medidas publicas para a promocao de saude bucal deve considerar o efeito de fatores contextuais como determinante de riscos individuais.

Toothache, Associated Factors, and Its Impact on Oral Health-Related Quality of Life (OHRQoL) in Preschool Children

The aim of this study was to assess the prevalence of toothache, associated factors and impact of this condition on the Child Oral Health Related Quality of Life (COHRQoL) in preschoolers. The study was carried out in Santa Maria, Brazil, during the National Childrens Vaccination Day, and 534 children aged 0 to 5 years were included. Clinical variables included dental caries and dental trauma. A questionnaire was responded by the parents and provided information about several socioeconomic indicators, dental service use and toothache. Toothache was collected by the question: Has your child ever had a toothache - Yes or no?. Data on COHRQoL were assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Multivariable Logistic regression models were performed to assess the association between the predictor variables and outcomes. The prevalence of toothache was 10.11% (95% CI: 7.55% - 12.68%). Older children had a higher chance of presenting dental pain (OR 2.72; 95% CI: 1.01 - 7.56), as well as children with caries experience (OR 3.43; 95% CI: 1.81 - 6.52). Moreover, children who had not visited the dental service in the last 6 months were less likely to present toothache (OR 0.51; 95% CI: 0.28 - 0.95). The presence of dental pain negatively affects the COHRQoL; those with toothache presented a higher chance of having higher impact on the total scores of ECOHIS (OR 4.18; 95% CI: 1.76 - 9.95) than those without toothache. Similar observation was found for the child section of the questionnaire (OR 5.54; 95% CI: 2.15 - 14.24). Toothache negatively affects COHRQoL and is associated with caries experience, age and use of dental service.

In vitro performance of QLF system and conventional methods for detection of occlusal caries around tooth-colored restorations in primary molars

BACKGROUNDnSecondary caries is the main reason for restoration replacement, and therefore, an accurate detection of this type of condition is fundamental.nnnAIMnTo compare in vitro the performance of different conventional and quantitative light-induced fluorescence-based (QLF) methods in detecting occlusal caries around resin composite restorations in primary molars.nnnDESIGNnTwo examiners evaluated independently 42 sites adjacent to tooth-colored restorations using visual inspection (ICDAS-CARS), radiographic examination, and QLF. Histological examination was used as reference standard method. Area under the ROC curve (Az), sensitivity, specificity, and accuracy of the methods were calculated at enamel (D1) and dentin caries (D3) lesions thresholds. Intra- and interexaminer reproducibility were calculated using intraclass correlation coefficient (ICC) and kappa statistics.nnnRESULTSnThere was no difference among the methods considering Az at D1 threshold. Visual inspection, radiograph, and QLF (scores) methods presented similar sensitivities and significantly higher than those obtained with the QLF (∆F%). At D3 threshold, there were no differences among the methods regarding sensitivities, specificities, and accuracy, except for the examiner 2 with the QLF (∆F%) who achieved a very low sensitivity value.nnnCONCLUSIONnConventional methods are similar to QLF methods for detecting caries around tooth-colored restorations in primary teeth.

Impact of malocclusion on oral health-related quality of life of preschool children

OBJECTIVE: This study assessed the relationship of dental malocclusion with COHRQoL considering socioeconomic backgrounds and clinical factors. METHODS: A survey was carried out in Santa Maria, Brazil, during the National Childrens Vaccination Day. The sample comprised 478 children aged 12 to 59 months. Fifteen trained and calibrated examiners evaluated the presence of anterior malocclusion traits (AMT) - anterior open bite, overjet and sealing lip. COHRQoL was measured through overall scores of the Brazilian version of ECOHIS (Early Childhood Oral Health Impact Scale). The assessment of association used adjusted Poisson regression models. RESULTS: The unadjusted assessment observed age, untreated dental caries and anterior open bite as the main covariates of the overall ECOHIS score. After the adjustment, the presence of anterior open bite had a negative impact on COHRQoL. There was no association between overjet and sealing lip with COHRQoL. CONCLUSION: In conclusion, anterior open bite present a negative impact on COHRQoL.

Desigualdades en la prevalencia de caries dentaria no tratada en niños pre-escolares en Brasil

OBJECTIVEnTo evaluate the influence of social inequalities of individual and contextual nature on untreated dental caries in Brazilian children.nnnMETHODSnThe data on the prevalence of dental caries were obtained from the Brazilian Oral Health Survey (SBBrasil 2010) Project, an epidemiological survey of oral health with a representative sample for the country and each of the geographical micro-regions. Children aged five (n = 7,217) in 177 municipalities were examined and their parents/guardians completed a questionnaire. Contextual characteristics referring to the municipalities in 2010 (mean income, fluorodized water and proportion of residences with water supply) were supplied by the Fundação Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Multilevel Poisson regression analysis models were used to assess associations.nnnRESULTSnThe prevalence of non-treated dental caries was 48.2%; more than half of the sample had at least one deciduous tooth affected by dental caries. The index of dental caries in deciduous teeth was 2.41, with higher figures in the North and Northeast. Black and brown children and those from lower income families had a higher prevalence of untreated dental caries. With regards context, the mean income in the municipality and the addition of fluoride to the water supply were inversely associated with the prevalence of the outcome.nnnCONCLUSIONSnInequalities in the prevalence of untreated dental caries remain, affecting deciduous teeth of children in Brazil. Planning public policies to promote oral health should consider the effect of contextual factors as a determinant of individual risk.OBJETIVO: Avaliar a influencia de desigualdades sociais de ordem individual e contextual na experiencia de carie dentaria nao tratada em criancas no Brasil. METODOS: Os dados sobre a prevalencia de carie dentaria foram obtidos do Projeto Pesquisa Nacional de Saude Bucal – SBBrasil 2010, levantamento epidemiologico de saude bucal com amostra representativa para o pais e cada uma de suas macrorregioes geograficas. Criancas de cinco anos de idade (n = 7.217) em 177 municipios foram examinadas e seus responsaveis responderam ao questionario. Caracteristicas contextuais referentes aos municipios em 2010 (renda mediana, fluoretacao da agua e proporcao de domicilios com abastecimento de agua) foram informadas pela Fundacao Instituto Brasileiro de Geografia e Estatistica. O estudo de associacao utilizou modelos multinivel de analise de regressao de Poisson. RESULTADOS: A prevalencia de carie nao tratada foi de 48,2%; mais da metade da amostra apresentou ao menos um dente deciduo com experiencia de carie. O indice de carie na denticao decidua ceo-d medio foi 2,41, sendo maior para as regioes Norte e Nordeste. Criancas de cor da pele preta e parda, e aquelas com renda familiar menos elevada tiveram maior prevalencia de carie nao tratada. No nivel contextual, renda mediana no municipio e adicao de fluor na agua de abastecimento associaram-se inversamente com a prevalencia do desfecho. CONCLUSOES: Desigualdades na prevalencia de carie nao tratada persistem, afetando as criancas com denticao decidua no Brasil. O planejamento de medidas publicas para a promocao de saude bucal deve considerar o efeito de fatores contextuais como determinante de riscos individuais.