Elaine Pereira da Silva Tagliaferro

Risk indicators and risk predictors of dental caries in schoolchildren

The purpose of this study was to identify risk indicators of high caries level at baseline (HCLB) based on cross-sectional data and predictors of high caries increment (HCI) based on a 7-year-follow-up examination in 6-8-year-old schoolchildren. Two hundred and six schoolchildren were examined in 1997 and in 2004 by the same two calibrated dentists, in Piracicaba, Brazil. At baseline, dental caries, presence of sealants, fluorosis, and oral hygiene status were recorded. The childrens parents completed a questionnaire concerning socioeconomic level, fluoride use, dental service utilization, dietary and oral hygiene habits. HCLB and HCI were defined considering the upper quartile of the total caries experience distribution (dmfs+DMFS) and caries increment distribution, respectively. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals and p-values. Having white spot lesions (OR=5.25) was found to be a risk indicator of HCLB. Schoolchildren with dental fluorosis (OR=0.17) or those who brushed the teeth more than two times a day (OR=0.37) presented less probability of HCLB. The predictors of HCI were: dmfs>0 (OR=2.68) and mothers educational level up to 8 years of schooling (OR=2.87). Clinical and socioeconomic variables were found to be risk indicators and/or predictors of dental caries in schoolchildren.

Epidemiological assessment of predictors of caries increment in 7-10- year-olds: a 2-year cohort study

Objective The aim of this 2-year cohort study (2003 to 2005) was to investigate how caries experience, at initial lesions (early or non-cavited lesions) and cavited stages, predicts caries increment in permanent teeth in 7-10- year-olds. Material and Methods The random sample of 765 children attending public schools in the city of Piracicaba, SP, Brazil, was divided into two groups: 423 children aged 7-8 years and 342 children aged 9-10 years. All subjects were examined by a calibrated examiner, using dental mirror and ball-ended probes, after tooth brushing and air-drying in an outdoor setting, based on the World Health Organization criteria. Active caries with intact surfaces were also recorded as initial lesion (IL). Univariate analysis was used for statistical analysis (Odds Ratios and Chisquare). Results The association between the DMFT (decayed, missing and filled teeth) increment and the presence of IL was significant only for 9-10-year-old children. The children with DMFT>0 at baseline were more prone to have DMFT increment, with the highest risk for caries increment occurring in children aged 7-8 years. Conclusion The predictors of caries increment were the presence (at baseline) of caries experience in permanent teeth for both age groups (7-8; 9-10-year-olds) and the presence of the IL (at baseline) for 9-10-year-olds.

Dental status of Portuguese HIV+ patients and related variables: a multivariate analysis.

OBJECTIVEnThe aim of this cross-sectional study was to evaluate the dental status of 101 Portuguese HIV+ subjects aged 22-71 years (mean = 39) and its association with clinical, socioeconomic, and behavioral variables.nnnMATERIALS AND METHODSnA calibrated dentist performed clinical examination and collected data on dental caries, periodontal status, dental plaque levels, prosthetic conditions, and need. The volunteers completed questionnaires on socioeconomic and behavioral variables as well as the Oral Health Impact Profile (OHIP-14) questionnaire. Univariate and multiple logistic regression (MLR) analyses were performed.nnnRESULTSnThe mean number of decayed, missing or filled teeth index (DMFT index) was 16.44, standard deviation (s.d.) = 8.42. MLR demonstrated that salaried employee and those with OHIP-14 <or=4.22, or any/no dental plaque were less prone to have DMFT > median (=17). As regards prosthetic status, 28.8% of the examined individuals used dental prosthesis. MLR demonstrated that HIV+ with DMFT >17 or those who knew they were HIV-positive for longer than 5 years were more prone to need dental prostheses. The mean OHIP-14 index was 5.83 (s.d. = 7.79).nnnCONCLUSIONSnThe dental health status of HIV-infected Portuguese patients was unsatisfactory and related to clinical, socioeconomic, and behavioral variables.

Use of occlusal sealant in a community program and caries incidence in high- and low-risk children

Objective The aims of this study were to investigate the effectiveness of sealant placement under the guidelines of the Oral Health Promotion Program for Children and Adolescents (Portugal), and to test the influence of clinical and socioeconomic variables on the DMFT increment in 277 children, born in 1997. Material and Methods A dental hygienist performed the initial examinations and sealant placement (Helioseal, Vivadent) on the permanent first molars in 2005. These activities were registered in dental records that were assessed in 2007. Children were classified according to caries risk at baseline [high (HR: DMFT+dmft>0); low (LR: DMFT+dmft=0) risk] and sealant placement as follows: HR-S and LR-S Groups (with sealant placement); HR-NS and LR-NS Groups (without sealant placement). A calibrated dentist performed the final examination in 2007 at school, based on the World Health Organization recommendations. The variables collected were: dental caries, visible dental plaque, malocclusions, and socioeconomic level (questionnaire sent to childrens parents). For univariate (Chi-square or Fisher tests) and multivariate (Multiple logistic regression) analyses the DMFT increment >0 was selected as dependent variable. Results Approximately 17.0% of the children showed DMFT increment>0 (mean=0.25). High-risk children presented a significant increase in the number of decayed and/or filled teeth. These children had 7.94 more chance of developing caries. Children who did not receive sealant were 1.8 more prone to have DMFT increment >0. Conclusion It appears that sealant placement was effective in preventing dental caries development. Moreover, the variables risk and sealant placement were predictors for DMFT increment in the studied children.

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.

Caries experience among schoolchildren in relation to community fluoridation status and town size

The objective of the present study was to determine the caries experience of schoolchildren aged 7–12 years from the Southeast area of São Paulo State, Brazil, in 1998, according to town size and fluoridation status. Data for this cross‐sectional study were based on the data bank from the Epidemiological Survey of São Paulo State provided by the State Health Department. After stratification by fluoridation status and town size, 29 towns were randomly selected to represent the Southeast area of São Paulo State, Brazil, and a total of 13,480 schoolchildren were randomly selected for this study. Calibrated dentists performed clinical examinations according to the WHO criteria. Caries experience and prevalence were significantly lower in fluoridated areas (1.9 DMFT, 2.1 dmft, 20% caries free) than in non‐fluoridated areas (2.4 DMFT, 2.4 dmft, 13% caries free). According to town size, DMFT and caries prevalence were significantly higher in small towns (2.3 DMFT, 13% caries free), followed by medium‐sized (2.1 DMFT, 17% caries free) and large cities (1.6 DMFT, 27% caries free). Among 12‐year‐old children, caries prevalence was predominantly moderate or high in small and medium‐sized municipalities, whereas in large cities it was moderate or low. The results suggest that water fluoridation is an essential public health measure and that town size may affect caries distribution in the Southeast area of São Paulo State.

Geographic Information Systems (GIS) in Assessing Dental Health

The present study investigated the distribution profile of dental caries and its association with areas of social deprivation at the individual and contextual level. The cluster sample consisted of 1,002 12-year-old schoolchildren from Piracicaba, SP, Brazil. The DMFT Index was used for dental caries and the Care Index was used to determine access to dental services. On the individual level, variables were associated with a better oral status. On the contextual level, areas were not associated with oral status. However, maps enabled determining that the central districts have better social and oral conditions than the deprived outlying districts.

Estimate of DMFT index using teeth most affected by dental caries in twelve-year-old children

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.O objetivo do estudo foi desenvolver modelos de regressao para delinear o perfil epidemiologico da carie dentaria em localidade com baixa prevalencia de carie aos 12 anos de idade. Foram examinadas duas amostras probabilisticas (n=1.763) de individuos de escolas publicas e privadas de Piracicaba,(SP). Dados sobre os dentes mais afetados foram coletados em 2005 e validados utilizando um banco de dados (2001). A media (dp) do CPOD foi de 1,7 (2,08) em 2001 e os modelos de regressao desenvolvidos estimaram um CPOD de 1,67 (1,98) em 2005, o qual representa 98,2% do CPOD em 2001. Os resultados apresentaram detalhes do perfil da carie dentaria aos 12 anos, usando uma abordagem analitica atual. Os modelos de regressao poderiam ser considerados como uma forma acurada e factivel no auxilio do planejamento e avaliacao dos servicos em saude bucal.

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.

Estimativa do Índice CPOD usando os dentes mais afetados pela cárie dentária aos doze anos

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.O objetivo do estudo foi desenvolver modelos de regressao para delinear o perfil epidemiologico da carie dentaria em localidade com baixa prevalencia de carie aos 12 anos de idade. Foram examinadas duas amostras probabilisticas (n=1.763) de individuos de escolas publicas e privadas de Piracicaba,(SP). Dados sobre os dentes mais afetados foram coletados em 2005 e validados utilizando um banco de dados (2001). A media (dp) do CPOD foi de 1,7 (2,08) em 2001 e os modelos de regressao desenvolvidos estimaram um CPOD de 1,67 (1,98) em 2005, o qual representa 98,2% do CPOD em 2001. Os resultados apresentaram detalhes do perfil da carie dentaria aos 12 anos, usando uma abordagem analitica atual. Os modelos de regressao poderiam ser considerados como uma forma acurada e factivel no auxilio do planejamento e avaliacao dos servicos em saude bucal.