Fernando José Herkrath

Parental age as a risk factor for non-syndromic oral clefts: A meta-analysis

OBJECTIVES A meta-analysis was conducted to assess the relationship between parental age and the occurrence of non-syndromic oral clefts. The questions addressed if younger or older mothers and fathers have an increased risk of having a child with non-syndromic oral clefts. DATA Data from cohort studies, case-control, cross-sectional and prevalence studies in which the association between parental age and oral clefts was investigated were analysed. Only studies on oral clefts not associated with syndromes or other anomalies were considered. SOURCES An electronic literature search were conducted in Medline, Embase, LILACS, SciELO, SCOPUS and the Cochrane library databases to identify original research published until November 2010. References of the selected articles were also searched. STUDY SELECTION The initial database search identified 4623 citations and according to eligibility criteria 80 articles were submitted to quality assessment. In 13 studies measures of association could be extracted for meta-analysis. CONCLUSION Our findings suggest that fathers forty years of age or older had a 58% higher probability of having a child with cleft palate compared to those aged between 20 and 39 years. The probability of mothers aged between 35 and 39 years having a child with cleft palate was 20% higher in comparison with those between 20 and 29 years-old, whilst for those aged 40 years or more this probability was 28% higher compared to those aged between 20 and 29 years. Mothers aged 40 years or over were 1.56 times more likely to have a newborn with cleft lip with or without palate compared to those aged between 20 and 29 years. No evidence of association between early maternal and paternal age with occurrence of oral clefts was observed.

Measurement of health-related and oral health-related quality of life among individuals with nonsyndromic orofacial clefts: a systematic review and meta-analysis.

Objective To compare health-related quality of life and oral health–related quality of life between nonsyndromic individuals with and without cleft lip and/or cleft palate and to identify the most affected quality of life dimensions in individuals with cleft lip and/or palate. Design Systematic review and meta-analysis were conducted. Of the 314 identified citations, 23 articles were submitted to quality assessment. Data from nine studies on health-related quality of life and six on oral health–related quality of life were extracted for meta-analysis. Main Outcome Measures Pooled mean differences of health-related quality of life between adults with and without cleft lip and/or palate, pooled means of health-related quality of life dimensions of children and adults with cleft lip and/or palate and oral health–related quality of life dimensions of children and adolescents with cleft lip and/or palate with a 95% confidence interval were calculated. Results Quality assessment revealed methodological differences between studies. Lack of subgroup stratification and absence of control for confounders were the main limitations. Heterogeneity was detected on the comparison of oral health–related quality of life and health-related quality of life between children with and without cleft lip and/or palate, and oral health–related quality of life between adolescents with and without cleft lip and/or palate. A random-effect model showed a significant difference on health-related quality of life between adults with and without cleft lip and/or palate (mean difference = 0.10; 95% confidence interval, 0.16 to 0.05). Psychological health (mean, 78.9; 95% confidence interval, 70.1 to 87.7) and vitality (mean, 68.1; 95% confidence interval, 48.0 to 88.1) were the most affected health-related quality of life dimensions in children and adults with cleft lip and/or palate, respectively. Means of health-related quality of life dimensions in children and adults with cleft lip and/or palate and oral health–related quality of life in children and adolescents with cleft lip and/or palate varied yet did not differ in indirect comparisons. Conclusion The presence of cleft lip and/or palate negatively affected the health-related quality of life of adults, mainly on psychosocial dimensions.

Comparison of normative methods and the sociodental approach to assessing orthodontic treatment needs in 12-year-old schoolchildren.

PURPOSE To compare normative methods of orthodontic treatment need with the sociodental approach in 12-year-old students and correlate the normative measures of malocclusion with the impact of oral health on daily activities. MATERIALS AND METHODS A cross-sectional study of 201 12-year-old students was conducted in the city of Manaus, Brazil. The normative orthodontic treatment need was determined by oral clinical examination using two occlusal indices, the Index of Orthodontic Treatment Need (IOTN), comprising the Dental Health Component (DHC) and Aesthetic Component (AC ), and the Dental Aesthetic Index (DAI). The sociodental approach combined normative measures (IOTN and DAI), the impact of malocclusion on daily activities (Child-Oral Impacts on Daily Performances index, Child-OIDP) and propensity- related orthodontic treatment assessment. The normative method and the sociodental approach of orthodontic treatment needs assessment were compared using the McNemar test. The association between the impact of malocclusion on daily activities and normative orthodontic need was tested using χ2 and Kruskal-Wallis tests. RESULTS The frequency of individuals with normative need according to IOTN/DHC (24.9%) and DAI (42.3%) was statistically higher when compared with the sociodental approach (<= 4.5%) (P < 0.001). The sociodental approach provided different results using IOTN/DHC (1.5%) and DAI (4.5%) (P < 0.001). The magnitude of normative need was associated with the impact of malocclusion on childrens daily activities. CONCLUSION Substantial reductions in normative need estimates for orthodontic treatment were observed using the sociodental approach. The sociodental approach for orthodontic treatment needs can optimise the use of resources in oral health services.

Desempenho dos Centros de Especialidades Odontológicas frente ao quadro sociodemográfico dos municípios do Amazonas, Brasil, 2009

O estudo avaliou o cumprimento das metas de desempenho dos Centros de Especialidades Odontologicas (CEO) do estado do Amazonas, utilizando dados secundarios do SIA-SUS, considerando as variaveis estruturais dos estabelecimentos, cobertura da atencao basica e indicadores sociodemograficos dos municipios. Treze CEO foram avaliados. Um estabelecimento de Manaus e os de Maues e Parintins apresentaram melhor desempenho em relacao ao Cumprimento Global das Metas. A cobertura das Equipes de Saude Bucal na atencao basica parece nao acompanhar o desempenho dos estabelecimentos. Os resultados sugerem que o desempenho dos CEO esta relacionado as caracteristicas sociodemograficas dos municipios.

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

Background Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model. Methods Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Results Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Conclusions Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.

Determinants of health-related and oral health-related quality of life in adults with orofacial clefts: a cross-sectional study

Objectives: To investigate the structural and intermediary determinants of health-related quality of life (HRQoL) and oral health–related quality of life (OHRQoL) among adults with cleft lip and/or palate (CL/P). Design and Participants: A cross-sectional study was conducted with patients enrolled at the referral center for craniofacial anomalies in Manaus, Brazil. Adults aged 18 years or more with nonsyndromic CL/P were selected. Main Outcome Measures: Both HRQoL and OHRQoL were assessed using the 36-item Short-Form Health Survey and the Oral Impacts on Daily Performance, respectively. Individual interviews and oral examinations were conducted to collect data on socioeconomic and demographic characteristics, social ties, health-related behaviors, compliance of CL/P protocol, chronic diseases, type of CL/P, oral clinical measures, and CL/P-related measures. Poisson regression was used to test the association of independent variables with HRQoL and OHRQoL outcomes. Results: The mean age of the 96 participants was 29.4 ± 9.1 years. Low family income, female sex, low social support, type of CL/P, and dental caries were associated with poor HRQoL and poor OHRQoL (P < .05). Poor HRQoL was also associated with chronic diseases (P < .05). Adults with low education, low social network, and smokers were more likely to have worse OHRQoL (P < .05). Conclusions: Structural and intermediary determinants were related to HRQoL and OHRQoL in adults with CL/P, suggesting the need for interdisciplinary approaches to improve the management of CL/P and intersectoral actions to reduce the impact of social inequalities.

Need of dental prosthesis in older people and the offer of specialized care in the unified health system, Brazil

Objective: To analyze the offer of dental prosthesis by Centers of Dental Specialties (CEO) considering the need by individuals aged 65-74 years in state capitals and other regions of the country. Material and Methods: The study was conducted with data from the external evaluation of the Improving Access and Quality Program (AVE/PMAQ CEO) and with data from the SBBRASIL 2010 project. AVE / PMAQ CEO is an evaluative investigation using a cross-sectional research design, performed in all CEOs of Brazil, totaling 932 services evaluated. The analysis of data and distribution of CEOs that offered dental prosthesis was described by maps, using TabWin (DATASUS) and quantitative description of the following variables: need for total and partial dentures, CEO, Regional Prosthodontic Laboratories (RLDP), average monthly number of delivered prostheses and the proportion of capitals with RLDP, number of CEOs, RLDP and prostheses delivered per 100,000 inhabitants in state capitals and other regions. Results: Of the 5,570 municipalities in the country, 780 have CEO, mainly located on municipalities with larger populations. Most CEOs were located in the northeastern (38.3%) and southeastern regions of Brazil (36.2%) with the northern and mid-western regions presenting the lowest absolute number of units. Low offer of prostheses was observed, considering the high need of dentures, as well as an unequal distribution among Brazilian regions. A high percentage of older adults aged 65-74 years require total (74.6%) or partial (99.8%) prosthetic rehabilitation, more critical situation is observed in the northern and northeastern regions. Conclusion: The provision of dental services in CEOs is still limited and unevenly distributed, especially for PPR, compromising the universality and integrality of oral health care.