Fábio Luiz Mialhe

Validity of caries detection on occlusal surfaces and treatment decisions based on results from multiple caries‐detection methods

The aim of this in vitro study was to evaluate whether having results available from multiple detection methods influences dentists treatment decisions for incipient caries lesions on occlusal surfaces. The occlusal surface of 96 extracted permanent molars without frank cavitation was examined by three examiners initially by visual examination alone, following which they chose one of three treatment options: (i) no treatment, (ii) preventive or non-invasive treatment (sealants), and (iii) invasive treatment. Four weeks later the examiners again selected one of the three treatment options for the surfaces, but this time were able to refer to the results from additional caries-detection methods [bitewing radiographs, electric conductance measurement (ECM), quantitative light fluorescence (QLF), and DIAGNOdent] that had been performed in the interim time. Stereomicroscopy was used to evaluate sensitivity, specificity, accuracy, and area under the Receiver Operating Characteristic (ROC) curve (AUC) for the detection methods at the D1 diagnostic threshold. Slight improvement was obtained in the percentage of sites correctly diagnosed, and in the AUC, when referring to the results obtained from all detection methods compared with visual examination alone. However, a drastic effect on the selection of treatment options was observed by having results available from multiple methods, with the choice of invasive treatment increasing substantially. In conclusion, having data available from multiple methods did not improve the accuracy of examiners in detecting early occlusal caries lesions, but it had a great influence on the number of surfaces indicated for operative treatment. The potential decrease in overall specificity while using multiple methods of detection may be of concern in populations with a low prevalence of occlusal caries lesions.

Increase in severity of molar–incisor hypomineralization and its relationship with the colour of enamel opacity: a prospective cohort study

BACKGROUND Predicting risk of posteruptive enamel breakdown (PEB) of molar-incisor hypomineralization (MIH) opacity is a difficult but important clinical task. Therefore, there is a need to evaluate these aspects through longitudinal studies. OBJECTIVE The aim of this longitudinal study was to analyse the relationship between colours of MIH opacity of children aged 6-12 (baseline) and other clinical and demographic variables involved in the increase in severity of MIH. MATERIALS AND METHODS A blinded prospective 18-month follow-up was conducted with 147 individuals presenting mild MIH. Tooth-based incidence of increase in severity of MIH (PEB or atypical restorations) was used as dependent measurement. Enamel opacities were recorded according to colour shades of white, yellow and brown, allowing assessment of susceptibility to structural loss over time, according to colour of MIH opacity. Poisson regression models were used to adjust the results for demographic and clinical variables. RESULTS Brown and yellow MIH opacities were at higher risk for PEB and atypical restorations than those of white ones, even after adjustment for clinical and demographic variables. CONCLUSION Teeth presenting mild MIH severity associated with yellow and brown enamel opacities were at high risk for increase in severity of MIH than lighter ones. This result could help clinicians determine a risk-based treatment for children with MIH.

Educação em saúde: uma reflexão histórica de suas práticas

This text aims to contextualize the transformations occurred in the practice of health education since the political scenario in the end of 19th century, when the first extended initiatives of the Brazilian State in the health field were organized, until the creation of the Brazilian Unified Health System.

The impact of socioenvironmental characteristics on domains of oral health-related quality of life in Brazilian schoolchildren

BackgroundRecent researches have pointed out the need to consider the functional and psychosocial dimensions of oral health, such as Oral Health-related Quality of Life (OHRQoL). The aim of this study was to investigate the influence of oral health status, socioeconomic factors and home environment of children on the four health domains of Child Perceptions Questionnaire (CPQ11-14).MethodsA cross-sectional study was conducted in Brazil with a sample of 286 schoolchildren aged 12 years and their parents. The schoolchildren were clinically examined, and participants were asked to complete the CPQ11-14, as well as a questionnaire about home environment. In addition, a questionnaire was sent to each child’s parents asking them about family socioeconomic status. The chi-square test and Poisson’s regression analysis were performed.ResultsAfter adjusting for potential confounders, variables sex, monthly family income, mothers’ education showed a statistically significant association with all health domains of the CPQ11-14. The family structure and presence of bleeding impacted on emotional (p = 0.0135), and social (p = 0.0010) well-being health domain scores. Orthodontic treatment need showed a strong negative effect on functional limitations domain score (p = 0.0021).ConclusionsClinical and socio-environmental factors had different impacts on domains of oral health-related quality of life, demonstrating the need to consider these conditions in planning strategies for the oral health of schoolchildren.

Evaluation of the effectiveness of a voice training program for teachers.

OBJECTIVES To investigate the effects of a voice education program to teachers on vocal function exercise and voice hygiene and compare a pre- and post-vocal exercise for the teachers voice quality. METHODS A random sample of 102 subjects was divided into two groups: experimental group (29 women and seven men) with vocal hygiene and training exercises and control group (52 women and 14 men) with vocal hygiene. Two sessions were held about voice hygiene for the control group and five sessions for the experimental group, one being with reference to the vocal hygiene habit and four vocal exercise sessions. Acoustic analysis of the vowel [i] was made pre- and post-vocal exercise and for the situations of initial and final evaluation of the educational program. Student t test (paired) and Proc MIXED (repeated measures) were used for analyses with level of significance (α = 0.05). RESULTS The training exercises, posture and relaxation cervical, decreased the mean of fundamental frequency (f(0)) for men (P = 0.04), and for the phonation, intensity, and frequency exercises, there was a significant increase for f(0) in woman (P = 0.02) and glottal to noise excitation ratio (P = 0.04). There was no statistically significant difference intergroup evaluations after 3 months. The control group presented increased mean voice intensity in the final evaluation (P = 0.01). CONCLUSIONS Voice training exercises showed a positive and immediate impact on the teachers quality of voice, but it was not sustained longitudinally, suggesting that actions for this purpose should be continued at schools.

The relative diagnostic yields of clinical, FOTI and radiographic examinations for the detection of approximal caries in youngsters

BACKGROUND The detection of carious lesions in the initial stages of development is very important in order to prevent the occurrence of cavitation. AIMS AND OBJECTIVES The aim of the present study was to compare three methods-visual examination, FOTI, and bitewing radiographic examination-for the detection of noncavitated and cavitated approximal carious lesions. MATERIALS AND METHODS Seventy students (mean age 14 years) with low caries prevalence were examined by three examiners. The tooth surfaces judged as having caries by at least one examiner or one diagnostic method were scheduled for tooth separation. RESULTS The results showed that the incorporation of FOTI and radiographic examination represented an additional diagnostic yield of 50% and about 110%, respectively, compared to clinical examination alone. CONCLUSION We conclude that FOTI or radiographic examination, or both, used as adjuncts to clinical examination, could improve the detection of noncavitated and cavitated approximal carious lesions. Although FOTI should not replace bitewing radiographic examination, it does seem to have additional value for the detection of carious lesions on approximal surfaces of the posterior teeth in school children with low caries prevalence.

Longitudinal evaluation of the impact of dental caries treatment on oral health-related quality of life among schoolchildren

This study aimed to evaluate the impact of dental caries treatment on oral health-related quality of life (OHRQoL) among schoolchildren and the responsiveness of the Child Perceptions Questionnaire (CPQ8-10 ) instrument. Brazilian schoolchildren, 8-10 yr of age, were randomly selected and assigned to two groups--dental caries treatment (DCT) and caries-free (CF)--according to their caries experience [decayed, missing, or filled primary teeth (dmft) and decayed, missing or filled secondary teeth (DMFT) values of ≥ 0]. The CPQ8-10 instrument was administered at baseline and at 4 wk of follow-up (i.e. 4 wk after completion of dental treatment). In the DCT group, increases in CPQ8-10 scores were observed between the baseline and follow-up results. However, longitudinal evaluation of the CF group demonstrated no statistically significant difference in CPQ8-10 scores. Responsiveness of the CPQ8-10 instrument (magnitude of change in CPQ8-10 scores) in the DCT group was greater (effect size >0.7) than in the CF group. The findings of this study show that dental caries treatment has an important impact on OHRQoL of children. The CPQ8-10 was considered an acceptable instrument for longitudinal measurement of changes in OHRQoL.

Avaliação dos fatores de risco para distúrbios de voz em professores e análise acústica vocal como instrumento de avaliação epidemiológica

OBJETIVO: avaliar fatores de risco para disfonia em professores e associa-los compresenca de alteracao vocal. METODO: 102 professores(81 mulheres e 21 homens) selecionados aleatoriamente de 11 escolas do municipio de Piracicaba/SP, com media de idade de 42,48 anos. Um questionario sobre aspectos do ambiente e organizacao do trabalho, comportamento vocal, estilo de vida e sinais e sintomas de alteracoes vocais foi aplicado.Uma analise acustica da voz foi realizada e as variaveis avaliadas dependentes foram Frequencia Fundamental e a Intensidade media vocal. Foram realizadas associacoes entre as variaveis do questionario com a frequencia fundamental e a intensidade media e utilizaram-se os testes estatisticos: Qui-quadrado, Exato de Fisher e calculo do OddsRatio e este e um estudo clinico prospectivo. RESULTADOS: os individuos do sexo masculino tiveram menos chance de apresentarem frequencia fundamental da voz alterada do que o genero feminino (p<0,0001). As professoras que lecionavam para o ensino fundamental II e medio tiveram menos chance de apresentar alteracao da frequencia fundamental da voz do que aquelas que lecionavam para o ensino fundamental (p=0,04). O ruido ambiente teve associacao significante com a alteracao da intensidade media da voz (p=0,02). CONCLUSAO: fatores como o sexo feminino lecionar para o ensino primario e estar exposto ao ruido do ambiente de trabalho foram considerados indicadores de risco para disturbios da voz em professores.

School performance and oral health conditions: analysis of the impact mediated by socio-economic factors

BACKGROUND Oral problems can cause strong impact on functional, emotional, and social aspects of children and adolescents, as well as changes in school performance. AIM To evaluate the associations of subjective perceptions of parents, socio-economic factors, and oral clinical conditions of children with their school performance. DESIGN A case-control design was used with a sample of 1411 schoolchildren aged 8-10 years from city of Piracicaba, São Paulo, Brazil. Clinical conditions were evaluated using the DMFT and dmft indexes. Socio-economic data were obtained using a questionnaire sent to schoolchildrens parents. School performance was evaluated by the final scores of each schoolchild at the end of the 2011 school year. RESULTS According to the final logistic regression model, the schoolchildren who had carious lesions and underwent curative dental treatment at the beginning of the academic year presented 1.51 more chance of having low performance compared with schoolchildren who had no caries lesions. In addition, socio-economic and demographic variables were associated with a greater chance of poor school performance. CONCLUSION Socio-economic factors and presence of caries lesions, even if treated, were risk indicators for poor school performance.

O agente comunitário de saúde e suas práticas educativas em saúde bucal: uma avaliação qualiquantitativa

Among the activities performed by the community health agent (CHA), the educational actions are of fundamental importance for the provision of healthcare. Therefore, the scope of this study was to evaluate these aspects in a random sample of 80 CHAs, drawn from 16 Family Health Program Units in Piracicaba, Sao Paulo State, representing 51.3% of the population studied. The data was collected through semi-structured interviews, which were recorded and transcribed, using a script with questions about dental health education practices conducted by the agents. For the data analysis, the answer processing technique of the Collective Subject Discourse (CSD) was used. It was established that dental health education activities are performed sporadically by CHAs and addressed mainly to pregnant women, mothers and children, in a vertical model of information transmission, seeking changes in individual behavior and the incorporation of healthy habits. The results suggest the need of CHAs to rethink the way they are developing their educational practices in dental health. However, for this to become a reality, it is indispensable to count on the support of the health manager in processes of permanent education directed to these professionals and to the whole team.