Joana Ramos-Jorge

Validations of the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS)

This study aimed to evaluate the psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A total of 247 children aged 2 to 5 years and their parents/guardians participated in this study. A clinical oral examination was performed and the parents/guardians completed the ECOHIS questionnaire. Within a period of four-weeks, 20% of the participants repeated the ECOHIS questionnaire. Construct validity was determined using Spearmans rank correlation. Discriminant validity, internal consistency and test-retest reliability were also evaluated. The children were divided into 2 groups: group 1 (with dental caries) and group 2 (caries-free). Children with caries showed higher mean ECOHIS scores than the caries-free children. The child impact section (p < 0.01), family impact section (p < 0.01) and total ECOHIS scores (p < 0.01) were significantly correlated with tooth decay. Cronbachs alpha coefficients demonstrated satisfactory internal consistency. The Brazilian version of the ECOHIS is a valid instrument for assessing oral health-related quality of life in preschool children with Brazilian Portuguese-speaking primary caregivers.

Impact of dental pain on daily living of five-year-old Brazilian preschool children: prevalence and associated factors

AIM: To assess the impact of dental pain on the daily living of 5-year-old preschool children using reports from parents/guardians. DESIGN SND METHODS: A cross-sectional study was carried out involving 549 five-year-old children randomly selected from preschools in the city of Belo Horizonte, Brazil. Data were collected using a previously validated parent-reported questionnaire. The children received dental examinations from a single calibrated examiner. The following outcome variables were selected: age, gender, dental caries, filled teeth, missing teeth, caries involving pulp and social class. Simple and multiple logistic regression analyses were performed on the data. RESULTS: According to parents’ reports, 11.1% of children were affected by dental pain in the previous 4 months and of these 72.6% had their daily activities hampered by pain. The majority of these children had difficulty in eating, brushing teeth, sleeping, playing and going to school. The impact of dental pain had a statistically significant association with gender (p=0.001), social class (p=0.009), dental caries (p<0.001), missing teeth (p<0.001), filled teeth (p<0.001) and caries involving pulp (p<0.001). CONCLUSION: The prevalence of difficulties performing tasks of daily living due to dental pain was relatively high among the children studied.

Prospective Longitudinal Study of Signs and Symptoms Associated With Primary Tooth Eruption

OBJECTIVE: To assess the association between primary tooth eruption and the manifestation of signs and symptoms of teething in infants. METHODS: An 8-month, longitudinal study was conducted with 47 noninstitutionalized infants (ie, receiving care at home) between 5 and 15 months of age in the city of Diamantina, Brazil. The nonrandomized convenience sample was based on the registry of infants in this age range provided by the Diamantina Secretary of Health. Eligible participants were infants with up to 7 erupted incisors and no history of chronic disease or disorders that could cause an increase in the signs and symptoms assessed in the study. Tympanic and axillary temperature readings and clinical oral examinations were performed daily. A daily interview with the mothers was conducted to investigate the occurrence of 13 signs and symptoms associated with teething presented by the infants in the previous 24 hours. RESULTS: Teething was associated with a rise in tympanic temperature on the day of the eruption (P = .004) and with the occurrence of other signs and symptoms. Readings of maximal tympanic and axillary temperatures were 36.8°C and 36.6°C, respectively. The most frequent signs and symptoms associated with teething were irritability (median: 0.60; P < .001), increased salivation (median: 0.50; P < .001), runny nose (median: 0.50; P < .001), and loss of appetite (median: 0.50; P < .001). CONCLUSIONS: Irritability, increased salivation, runny nose, loss of appetite, diarrhea, rash, and sleep disturbance were associated with primary tooth eruption. Results of this study support the concept that the occurrence of severe signs and symptoms, such as fever, could not be attributed to teething.

Impact of dental caries on quality of life among preschool children: emphasis on the type of tooth and stages of progression.

The aim of this cross-sectional study was to evaluate the impact of dental caries on the quality of life of preschool children and their parents/caretakers, with an emphasis on the type of tooth and stage of progression. A randomly selected sample of preschool children, 3-5 yrs of age, underwent an oral examination for the assessment of dental caries using the International Caries Detection and Assessment System II (ICDAS II) criteria. Parents/caretakers answered two questionnaires, one on the oral health-related quality of life (OHRQoL) of the child [the Early Childhood Oral Health Impact Scale (ECOHIS)], and the other on the socio-economic characteristics of the family. Statistical analyses were performed using the chi-square test, Kruskal-Wallis test, Mann-Whitney U-test, and Poisson regression. A total of 451 preschool children participated in the study. The majority of carious lesions exhibited severe decay (60.6%) and were found in both anterior (incisors/canines) and posterior (molars) teeth. The final Poisson model revealed negative impacts on quality of life from more advanced stages of dental caries, both in incisors/canines and molars. Childs age and household income were also associated with impact on quality of life. Carious lesions in more advanced stages of progression in anterior and posterior teeth were associated with a negative impact on the quality of life of preschool children.

Level of agreement between self-administered and interviewer-administered CPQ8–10 and CPQ11–14

OBJECTIVES The aim of the present study was to assess the psychometric properties and level of agreement between the self-administered and interviewer-administered Child Perceptions Questionnaire (CPQ) for children between 8 and 10 years of age (CPQ(8-10) ) and between 11 and 14 (CPQ(11-14) ) years of age. METHODS A randomized cross-over study was carried out, involving 180 children (Group 1 - 90 children between 8 and 10; Group 2 - 90 children between 11 and 14 years of age) in the state of Minas Gerais, Brazil. All children completed both administration modes of the CPQ; half of each group received interviewer-administered mode first [Subgroup A (CPQ(8-10) n = 45) and Subgroup C (CPQ(11-14) n = 45)], and the other half performed the self-administered mode first [Subgroup B (CPQ(8-10) n = 45) and Subgroup D (CPQ(11-14) n = 45)]. Test-retest reliability of each mode of administration was tested on 60 children (30 for CPQ(8-10) ; 30 for CPQ(11-14) ), who were not included in the other analyses. The level of agreement between scores on the self-administered and interviewer-administered versions of the CPQ(8-10) and CPQ(11-14) was established using the intraclass correlation coefficient (ICC). The order of presentation of both instruments was tested considering the four subgroups (A, B, C and D). The calculation of effect size proposed by Cohen (1992) was used to test the clinical significance of the findings. RESULTS Both the self-administered and interviewer-administered versions of CPQ(8-10) and CPQ(11-14) demonstrated acceptable psychometric properties. Agreement between the administration modes for the CPQ(8-10) and CPQ(11-14) was 0.90 and 0.88 (ICC), respectively. With the exception of the functional limitation subscale, the scores of the subscales and overall score on the CPQ(8-10) were significantly higher in the group of children who responded to the interviewer-administered measure first. With the CPQ(11-14) , statistically significant differences were found only for the emotional well-being subscale. CONCLUSIONS Both administration modes of the CPQ(8-10) and CPQ(11-14) demonstrated satisfactory psychometric properties and a high level of agreement. Although statistically significant differences were observed for oral symptoms, emotional well-being and social well-being, with the first administration of the interviewer-administered version, the effect of the order of administration had small to medium effects on the CPQ scores.

Association between anterior open bite and impact on quality of life of preschool children

The aim of this study was to evaluate the association between different types of malocclusion and the impact on quality of life among preschoolers and their families. A cross-sectional study was carried out involving 451 children 3-5 years of age. A clinical exam was performed to evaluate the malocclusions according to criteria proposed by Foster and Hamilton. This examination was conducted by a calibrated dentist. Parents/caregivers answered the Early Childhood Oral Health Impact Scale (ECOHIS) for the assessment of Oral Health-Related Quality of Life (OHRQoL) and the questionnaire on socioeconomic and demographic characteristics. Data analysis involved descriptive statistics, chi-square, Mann-Whitney and hierarchically adjusted Poisson regression. The prevalence of malocclusion was 28.4%. The most frequent conditions were posterior crossbite (20.4%), anterior open bite (9.5%) and increased overjet (8.4%). A significant association was found between anterior open bite and OHRQoL (p < 0.001). The adjusted analysis confirmed the association between anterior open bite and a negative impact on quality of life (PR = 2.55; 95%CI: 1.87 to 3.47; p < 0.001). Anterior open bite was associated with a negative impact on the quality of life of preschoolers.

Non-accidental collision followed by dental trauma: associated factors

The aim of the present cross-sectional survey was to assess factors associated with non-accidental collision followed by dental trauma among adolescents in the city of Diamantina, Brazil. A total of 387 students from 12 to 15 years of age (mean = 14 SD = 0.9) were randomly selected. The study was carried out in two stages. Firstly, data were collected through dental examinations of permanent incisors. Secondly, a thorough interview was held with 85 adolescents who exhibited dental trauma in the dental examinations. The interview consisted of a detailed description of the incident and physical environment in which it occurred. Descriptive analysis and the chi-square test (P < 0.05) were performed. The prevalence of dental injury was 22% (n = 85). Dental trauma was more prevalent in boys (P = 0.001) and individuals with overjet >3 mm (P = 0.007) and inadequate lip coverage (P = 0.013). Analysis of the event revealed that 22.3% of the cases of dental trauma occurred because of non-accidental collision. Non-accidental collision followed by injury occurred mainly at school (P < 0.001) and in an environment with a concrete, tiled or ceramic floor (P = 0.001). No statistically significant associations were found between non-accidental collision and gender, age or mothers schooling. It was concluded that the non-accidental collisions happened especially at school and in indoor environments with a concrete, tiled or ceramic floor.

Association and comparison between visual inspection and bitewing radiography for the detection of recurrent dental caries under restorations

PURPOSE The aim of the present study was to investigate, in posterior teeth, the association between the characteristics of the margins of a restoration visually inspected and the presence, under restorations, of recurrent or residual dental caries detected by radiographic examination. Furthermore, the agreement between visual inspection and radiographs to detect dental caries was assessed. METHODS Eighty-five permanent molars and premolars with resin restorations on the interproximal and/or occlusal faces, from 18 patients, were submitted for visual inspection and radiographic examination. The visual inspection involved the criteria of the International Caries Detection and Assessment System (ICDAS). Bitewing radiographs were used for the radiographic examination. Logistic regression was used to analyse the association between the characteristics of the margins of a restoration assessed by visual inspection (absence of dental caries, or early, established, inactive and active lesions) and the presence of recurrent caries detected by radiographs. Kappa coefficients were calculated for determining agreement between the two methods. RESULTS The Kappa coefficient for agreement between visual inspection and radiographic examination was 0.19. Established lesions [odds ratio (OR) = 9.89; 95% confidence interval (95% CI): 2.94-33.25; P < 0.05] and lesion activity (OR = 2.57; 95% CI: 0.91-7.27; P < 0.05) detected by visual inspection, were associated with recurrent or residual dental caries detected by radiographs. Restorations with established and active lesions at the margins had a greater chance of exhibiting recurrent or residual lesions in the radiographic examination. CLINICAL SIGNIFICANCE The present findings demonstrate that restorations with established and active lesions at the margins when visually inspected often require removal and retreatment.

Influence of masticatory function, dental caries and socioeconomic status on the body mass index of preschool children

OBJECTIVE The objective of this study was to determine the influence of masticatory function, dental caries and socioeconomic status on the body mass index (BMI) of preschool children. METHODS A cross-sectional study was conducted with a sample of 285 children aged three to five years allocated to three groups based on the BMI: underweight, ideal weight and overweight/obesity. Socioeconomic status was determined based on the responses of parents/caregivers to a specific form. Cavitated lesions were diagnosed using the criteria of the International Caries Detection and Assessment System. Masticatory function was assessed based on masticatory performance (MP) and the swallowing threshold (ST), which were evaluated based on the results of a test food. Data analysis involved the employment of the Kruskal-Wallis, Mann-Whitney and chi-square tests as well as simple and multiple linear regression analyses. RESULTS In the final multiple regression model, BMI was influenced by monthly household income (β=0.234; 95%CI: 1.014 to 1.647), number of cavitated teeth (β=-0.180; 95%CI: -0.293 to -0.054) and X50 of the ST (β=0.304; 95%CI: 0.213-0.498). CONCLUSION Children whose food test resulted in large particles and those from families with a higher monthly income had a higher BMI. Children with a greater number of teeth with cavitated dental caries had a lower BMI.

Prospective evaluation of the psychosocial impact of the first 6 months of orthodontic treatment with fixed appliance among young adults

OBJECTIVE To evaluate the psychosocial impact of the first 6 months of orthodontic treatment with a fixed appliance among young adults and compare the results with those of a control group of patients awaiting treatment for malocclusion. MATERIALS AND METHODS A study was conducted with a sample of 120 patients on a waiting list for orthodontic treatment at a university. The participants were allocated to an experimental group submitted to treatment and a control group awaiting treatment. The groups were matched for sex and age. All participants were instructed to answer the Brazilian version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) at baseline and after 6 months. Statistical analysis involved the Wilcoxon test for the total PIDAQ score and the score of each subscale. All patients participated until the end of the study. RESULTS Significant differences between baseline and the 6-month evaluation were found for the total PIDAQ score as well as the dental self-confidence and social impact subscales in both groups. No differences between baseline and the 6-month evaluation were found regarding the psychological impact or esthetic concern subscales in the control group. The patients in the experimental group reported greater esthetic impact 6 months after beginning treatment (P < .001). The first 6 months of orthodontic treatment seem to improve psychosocial impact. CONCLUSION The first 6 months of orthodontic treatment seem to improve the psychosocial impact of malocclusion. The patients analyzed in the present study reported a greater esthetic impact and less psychological impact after 6 months of using an orthodontic appliance.