Helena Silveira Schuch

Are there universal restorative composites for anterior and posterior teeth

OBJECTIVE This retrospective, longitudinal clinical study investigated the longevity up to 20 years of posterior restorations placed with 3 universal composites (Charisma, Herculite XR, Z100) and of anterior restorations placed with 2 universal composites (Charisma, Herculite XR). METHODS Records from 90 patients were retrieved from a private practice (374 posterior, 219 anterior restorations). Clinical evaluation was performed by the FDI criteria. Survival analysis was assessed using Kaplan-Meier method and Log-Rank test, and factors associated with failure by multivariate Cox regression with shared frailty. RESULTS In the first 10 years, almost 95% of the restorations were satisfactory, showing increased failure thereafter. Charisma showed the most failures in anterior and posterior areas. Annual failure rates varied between 0.3% and 2.5%, with slightly better performance for anterior restorations. Fracture (posterior) and aesthetics (anterior) were the main reasons for failure. CLINICAL SIGNIFICANCE Differences were observed between restorative materials with different properties, but these became apparent only after more than 10 years of clinical service. The present study provides evidence that in a patient group with low caries risk, anterior and posterior restorations placed with universal composites may have excellent long-term clinical performance.

Oral health‐related quality of life of schoolchildren: impact of clinical and psychosocial variables

BACKGROUND Besides the clinical aspects, the patients perspective of oral health-related quality of life (OHRQoL) may be influenced by a series of individual characteristics. AIM The aim was to investigate the impact of clinical and psychosocial variables on the OHRQoL of Brazilian schoolchildren. DESIGN A school-based cross-sectional study was conducted with children of 8-10 year old attending public (15) and private (5) schools (n = 749). Questionnaires were applied to parents to obtain socioeconomic characteristics, and children were interviewed. Assessment of OHRQoL was performed using the Child Perceptions Questionnaire 8-10 (CPQ). Oral health examinations included periodontal condition, dental caries, dental trauma, and malocclusion assessment. Unadjusted analyses were undertaken using t-tests and one-way analysis of variance. Multiple linear regression was used to assess the effects of independent variables on CPQ scores. RESULTS Factors associated with higher CPQ scores in the linear regression analysis after adjustments were family income, presence of decayed teeth, self-reported dental trauma, dental fear, and dental pain. CONCLUSION Oral health-related quality of life was influenced by psychosocial and clinical variables.

Prevalence and treatment demand after traumatic dental injury in South Brazilian schoolchildren

BACKGROUND Evaluation of the frequency and need for treatment of dental trauma is critical for both planning and establishing dental services and preventive programs. AIM This cross-sectional study evaluated the prevalence of dental trauma, need for treatment and factors associated with dental visits after an injury. SUBJECTS AND METHODS A multistage sample of children aged 8-12 years, from 20 private and public schools in Pelotas/Southern Brazil, was considered. Socioeconomic information was collected from parents, and data regarding traumatic events were obtained from the children. Clinical examinations were conducted using validated criteria. Descriptive analysis and logistic regression were used to assess the factors associated with search for treatment after injury. RESULTS A total of 1210 children were included, 153 (12.6%, 95% CI 10.8-14.6) of whom suffered dental trauma, with a total of 175 traumatized teeth. The most frequently observed type of injury was enamel fracture, affecting 129 (73.7%) teeth, of which 107 did not require restorative treatment. A total of 68 (38.8%) teeth required care, of which 24 (13.7%) received treatment. Of the children who recalled the trauma, 39 (36.5%) sought treatment, which was significantly associated with both higher maternal education (OR 2.75; 95% CI 1.18-6.41) and trauma severity (OR 7.71; 95% CI 3.17-18.75). CONCLUSIONS The prevalence of traumatic injuries was relatively high in this population. Although most of the traumatized teeth did not require treatment, dental care was neglected, as most of the children were not taken to a dentist for evaluation. Also, there was a considerable demand for treatment, most of them of low complexity. Special attention should be given to children whose mothers have completed fewer years of education, as the mothers level of education was an important predictor of evaluation by a dentist after injury.

Nutritional status and physical activity level as risk factor for traumatic dental injuries occurrence: a systematic review

Aim To systematically review epidemiological articles assessing traumatic dental injuries (TDI) rates according to the physical activity habits and nutritional status. Methods A search was conducted using PubMed, ISI, Scopus, SciELO, LILACS, and gray literature in Brazilian Theses Databank. We searched for dental trauma, traumatic dental injuries, tooth injuries, tooth fractures, physical activity, motor activity, exercise, sedentary lifestyle, sports, obesity, body mass index (BMI), overweight, and fatness. Databases were searched in duplicate from their earliest records until 2012. Additional studies were identified by searching bibliographies of the articles. Two reviewers performed data extraction and analyzed study procedural quality using the Newcastle–Ottawa scale. PRISMA guidelines for reporting systematic reviews were followed. Results We found 1159 articles, of whom 14 reports involving 13 studies were selected. One article was a birth cohort, one had a case–control design, and the others were cross-sectional. The quality of evidence varied across the studies and was high (9) in 3. Eleven of the studies included assessed influence of nutritional status: five show a positive association between dental trauma and overweight and six do not show any association. Regarding physical activity level, five studies assessed its effect on trauma occurrence: two detected that physical activity acts as a protective factor and two that physical active increases the risk of dental injuries, and one showed no differences in TDI occurrence. Physical activity estimated from questionnaires and BMI were the most frequently used measures, but methodological differences prevent the comparison of results. Conclusion The results suggest that no truly causal relationship exists between dental trauma and physical activity and nutritional status. Due to the relatively low level of evidence currently present, studies with more robust design, for example, prospective cohort should address this question, especially in view of the epidemic of obesity.

Socioeconomic position during life and periodontitis in adulthood: a systematic review

Socioeconomic position (SEP) is a well-known risk indicator for chronic periodontitis. However, it is still unclear how SEP during the life course influences periodontal outcomes in adulthood. This study aimed to systematically review longitudinal studies investigating the influence of individual-level SEP during the life course on subsequent periodontitis in adulthood. Inclusion criteria were epidemiological longitudinal observational studies, in which indicators of relative SEP were assessed prior to clinical assessment of periodontitis. Six electronic databases (PubMed, EMBASE, Web of Science, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS) and ScieLO) were searched. The methodological quality of the studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). The search identified 1720 papers. After removal of duplicates (n=697), title and abstract screening (n=996), and full-text review (n=19), eight original manuscripts from seven studies were finally included. Sample sizes ranged from 167 to 2806, and the follow-up time from exposure to outcome ranged from 2 to 28 years. Studies evaluated education, occupation or income as SEP indicators. Prevalence, extent and severity of periodontal attachment loss, probing pocket depth and alveolar bone loss were the studied outcomes. Based on NOS, studies presented low risk of bias. Six of eight papers reported that relatively low SEP earlier in life was associated with poorer periodontal health in adulthood. The available scientific evidence demonstrates potential longitudinal impact of earlier lower SEP on later periodontal health. The findings were consistent despite differences in study methods.

Impact of Malocclusion on Oral Health-Related Quality of Life of 8-12 Years Old Schoolchildren in Southern Brazil

The aim of this study was to estimate the impact of malocclusion on the oral health-related quality of life (OHRQoL) of schoolchildren aged 8-12 years old in Southern Brazil. A two-stage cluster procedure was used to select 1,199 children in 20 public and private schools in Pelotas/Brazil. Cross-sectional data was collected, consisting of a socioeconomic questionnaire to parents, childrens interview and clinical oral examination. The clinical variables were obtained from clinical examination, and the Child Perceptions Questionnaire (CPQ) was assessed during childrens interview. To measure malocclusion and orthodontic treatment need the Dental Aesthetic Index was used. For data analysis multiple Poisson regression models estimating the rate ratios (RR) and their respective confidence intervals (95%CI) were used. Among 1,206 participants, 789 were aged 8-10 years and 417 between 11-12 years. The orthodontic treatment need was higher among the younger children (44.6%) than in the older ones (35.0%) (p value ≤0.05). There was a significant association in the CPQ social and emotional domains with malocclusion in the older schoolchildren. In the adjusted analysis (for socioeconomics and clinical variables) the effect of very severe malocclusion on OHRQoL was confirmed in both 8-10 and 11-12 age groups (RR(95%CI) of 1.24(1.02;1.51) and 1.28(1.01;1.62), respectively). The findings demonstrated that children with very severe malocclusion experienced greater negative impact on OHRQoL compared to those with mild or no malocclusion. The results suggest that malocclusion impacts the quality of life. The higher impact occurs in the social and emotional well-being domains.

Perceived dental pain: determinants and impact on brazilian schoolchildren.

AIMS To assess reports of dental pain in a school-based sample of children in South Brazil and test its association with socioeconomic, demographic, psychosocial, and clinical variables. Also, the consequences of dental pain on oral health perception and its impact on daily life were investigated. METHODS A two-stage cluster procedure was used to select 1,199 children in 20 public and private schools in Pelotas, Brazil. Children were interviewed to obtain selfreports of dental pain. They were also asked about perception of their oral health and dental fear. Mothers answered a questionnaire on socioeconomic characteristics. A clinical oral examination was conducted to assess dental caries, malocclusion, and dental trauma. Multivariate Poisson regression analysis was used to investigate factors associated with dental pain in the previous 6 months and its effect on oral health perception. RESULTS The prevalence of dental pain was 35.7% (95% confidence interval [CI] 33.0-38.5) in the previous 6 months. A higher prevalence of dental pain was observed for children from lower-income families (prevalence ratio [PR] 1.39; 95% CI 1.10-1.76), for girls (PR 1.24; 95% CI 1.06-1.46), for those living in overcrowded houses (PR 1.23; 95% CI 1.01-1.49), for those who reported dental fear (PR 1.19; 95% CI 1.00-1.42), and for those with caries experience (PR 1.57; 95% CI 1.34- 1.84), after adjustments. Dental pain presence influenced oral health perception (PR 2.56; 95% CI 1.55-3.29) and impacted the childrens daily life (PR 1.89; 95% CI 1.64-2.17). CONCLUSION A high percentage of schoolchildren suffered from dental pain, which was influenced by demographic, socioeconomic, psychosocial, and clinical characteristics, causing a negative impact on oral health perception.

Impact of dental anxiety and fear on dental care use in Brazilian women

OBJECTIVES This study investigated the relationship between dental anxiety and fear, demographic and socioeconomic characteristics, and dental attendance patterns in a sample of women in Brazil. METHODS A cross-sectional study of women in healthcare centers was conducted during an immunization campaign in the city of Pelotas in southern Brazil. Interviews were conducted to assess dental anxiety and fear, education level, family income, marital status, and the use of dental services. Data were analyzed by Poisson regression models, with estimation of the prevalence ratio and the rate ratio (RR). RESULTS A total of 608 women aged 16-50 years (mean age 29.3 ± 7.2 years) were included in the study. Dental anxiety and fear scores (according to Corahs Dental Anxiety Scale) ranged from 4 to 20. Of the 608 participants, 59.5 percent displayed low dental fear, 18.1 percent had moderate dental fear, and 22.4 percent displayed high dental fear. A total of 60.2 percent of the women exhibited irregular dental attendance patterns, characterized by never visiting a dentist, or only visiting when experiencing pain. After adjustments, the presence of at least moderate dental anxiety and fear was associated with low education levels (RR 1.43; 95 percent CI 1.11-1.84), low family income (RR 1.33; 95 percent CI 1.06-1.68), and irregular dental attendance patterns (RR 1.83; 95 percent CI 1.41-2.37). CONCLUSIONS In this sample of Brazilian women, dental anxiety and fear were strongly associated with socioeconomic characteristics and dental attendance patterns.

Tooth loss and associated factors in elders: results from a national survey in Uruguay

OBJECTIVES This study evaluated the prevalence and severity of tooth loss in Uruguayan elders, assessing its association with demographic, socioeconomic, and behavioral factors; the use of health services; and self-reported dental treatment need. METHODS A population-based cross-sectional study was done among Uruguayan individuals of ages 65-74 years. Data were collected through questionnaires and clinical examinations. The dependent variable, tooth loss, was classified into three distinct outcomes: functional dentition (≥20 teeth), severe tooth loss (<9 teeth), and edentulism. The independent variables were: sex, socioeconomic status, use of health services, hypertension, diabetes mellitus, tobacco use, frequent consumption of alcohol, hygiene habits, and need for dental care. RESULTS The sample comprised 341 individuals, and the mean number of teeth present was 9.73 (95% confidence interval, 8.77-10.69) for each individual. After multivariate analysis, lack of a functional dentition, severe tooth loss, and edentulism were found to be associated with lower socioeconomic level, frequent consumption of alcohol, and receiving treatment from the public health system (P < 0.05). Individuals with self-reported dental treatment need had more severe tooth loss and presented a higher degree of edentulism (P < 0.05). CONCLUSIONS There is a high and severe prevalence of tooth loss in elderly Uruguayans, especially among those from lower socioeconomic levels. Our findings highlight the importance of public health policies to prevent and treat tooth loss.

Theoretical basis and explanation for the relationship between area-level social inequalities and population oral health outcomes - A scoping review

This study was conducted to review the evidence on the association between area-level social inequalities and population oral health according to type and extent of social theories. A scoping review was conducted of studies, which assessed the association between area-level social inequality measures, and population oral health outcomes including self-rated oral health, number of teeth, dental caries, periodontal disease, tooth loss, oral health-related quality of life (OHRQoL) and dental pain. A search strategy was applied to identify evidence on PubMed, MEDLINE (Ovid), EMBASE, Web of Science, ERIC, Sociological Abstracts, Social Services Abstracts, references of selected studies, and further grey literature. A qualitative content analysis of the selected studies was conducted to identify theories and categorize studies according to their theoretical basis. A total of 2892 studies were identified with 16 included in the review. Seven types of social theories were used on 48 occasions within the selected studies including: psychosocial (n=13), behavioural (n=10), neo-material (n=10), social capital (n=6), social cohesion (n=4), material (n=3) and social support (n=2). Of the selected studies, four explicitly tested social theories as pathways from inequalities to population oral health outcomes, three used a theoretical construct, seven used theories for post-hoc explanation and two did not have any use of theory. In conclusion, psychosocial theories were used most frequently. Although theories were often mentioned, majority of these studies did not test a social theory.