Lilian Berta Rihs

Factors associated with maintenance of teeth in adults in the State of São Paulo, Brazil

This cross-sectional study investigated the association between the presence of 20 or more teeth and sociodemographic and economic variables, use of dental care, and self-perceived oral health in adults. The sample consisted of 1,612 individuals aged 35 to 44 years, representative of the State of São Paulo, Brazil. In addition to the dental examination, subjects answered a questionnaire. Analysis in this study was limited to dentate individuals, divided into two groups (1 to 19 versus 20 or more teeth). The chi-square test and logistic regression were used (p < 0.05). Most individuals (72.1%) had more than 20 teeth. Less schooling was heavily associated with tooth loss, as were female gender, older age, rural residence, 5 or more people in the same household, low income, seeking treatment in the public health system, and seeking care due to toothache.

Risk indicators for tooth loss in adult workers

Tooth loss continues to be a prevalent condition in Brazilian adults and elderly individuals. The aim of this cross-sectional study, conducted among workers in a wholesale grocery chain in the State of São Paulo, was to identify risk indicators for tooth loss in adults. The presence of caries and periodontal status were examined in 387 adults aged 20-64 years, according to World Health Organization criteria. Two outcomes were analyzed: loss of one or more teeth, and loss of four or more teeth. Independent variables analyzed were demographic and socioeconomic factors, clinical conditions, use of dental services, and self-perceived oral health. Poisson regression models were used for multivariate statistical analysis. Participants were missing a mean of 5.38 teeth, and 76.9% (n = 297) had lost at least one tooth; the most frequently lost teeth were permanent molars. Older age and the presence of visible dental biofilm were associated significantly with the two tooth loss outcomes (p < 0.05). Individuals who had visited the dentist 3 or more years previously showed a lower prevalence of tooth loss (prevalence ratio = 0.79; 95% confidence interval, 0.68-0.91). Those with lower household incomes were significantly more likely to have lost four or more teeth (prevalence ratio = 1.35; 95% confidence interval, 1.07-1.70). Study results indicated that age and dental biofilm were risk indicators for tooth loss, independently of socioeconomic factors. These risk indicators should be considered when planning oral health programs for adults.

Dental caries in an elderly population in Brazil

This study evaluated dental caries according to the presence of natural teeth and sociodemographic conditions of an elderly population in the state of São Paulo, Brazil. Examinations were performed according to the World Health Organizations guidelines. The sample of 1,192 elderly individuals aged 65 to 74 years was stratified according to the presence of teeth and the following variables: gender, race, age, city size and Human Development Index (HDI). The Mann Whitney and Kruskal Wallis tests were applied at a confidence level of 95% for analysis of results. In the total sample, 68.9% (n=822) were edentulous; the mean of present teeth was 3.5 and the DMFT was 30.2, being 28.5 of missing teeth. Among dentate individuals (n=370), the mean of present teeth was 11.3, the DMFT was 26.2 and the missing component accounted for 20.7 teeth. The differences observed in the evaluated conditions should be highlighted: the mean number of present teeth was higher among younger individuals (from 65 to 69 years) [12.1] and among those living in cities with high HDI [12.9]; the DMFT was lower among men [24.9] and non-Caucasians [25.1]. Based on these findings, it may be concluded that specific dental programs should be established, with emphasis on oral health promotion and dental caries control, as well as public health policies that may enhance the access to the services provided.

Cárie dentária e necessidades de tratamento em adolescentes do estado de São Paulo, 1998 e 2002

OBJETIVO: Avaliar indicadores de prevalencia e severidade de carie em adolescentes e as necessidades de tratamento. METODOS: Os dados foram obtidos a partir de levantamentos epidemiologicos em saude bucal realizados no Estado de Sao Paulo em 1998 e 2002, com adolescentes de 12 e 18 anos de idade. A experiencia de carie foi medida pelo indice de dentes permanentes cariados, perdidos e restaurados (CPOD) e a necessidade de tratamento foi avaliada segundo criterios da Organizacao Mundial de Saude. O significant caries index foi empregado para definir a experiencia de carie de um terco do grupo que apresentou maior experiencia da doenca. Para a idade de 12 anos, os exames ocorreram em escolas publicas e privadas, em 1998 (N=9.327) e 2002 (N=5.782), enquanto que os adolescentes de 18 anos, em 2002, foram examinados em seus domicilios (N=5195, em 1998 e N=257 em 2002). RESULTADOS: Aos 12 anos de idade, o indice CPOD foi de 3,72 em 1998 e de 2,52 em 2002, enquanto que aos 18 anos foi de 8,64 e 7,13, respectivamente. O significant caries index aos 12 anos foi de 7,40 (1998) e 5,62 (2002), aos 18 anos foi de 15,05 e 12,19, respectivamente. Aos 12 anos observou-se aumento de necessidades de restauracoes de uma superficie (p<0,0001) e de selantes aos 18 anos (p<0,0001). CONCLUSOES: Verificou-se que houve declinio da carie entre os adolescentes e a maioria das necessidades de tratamento odontologicas foram de baixa complexidade.

Saúde bucal dos pré-escolares, Piracicaba, Brasil, 1999

OBJETIVO: Verificar a prevalencia de carie, doenca gengival e fluorose e dimensionar as necessidades de tratamento dos pre-escolares. METODOS: Estudo transversal realizado a partir de um levantamento epidemiologico de saude bucal em 2.805 criancas de 5 e 6 anos, matriculadas em pre-escolas municipais de Piracicaba, SP. As criancas foram examinadas por uma equipe de dez dentistas, treinados e calibrados. Foi empregada a tecnica de consenso, aferindo-se o erro intra e inter examinadores pelo calculo de percentagem de concordância. RESULTADOS: Obteve-se 44,3% de criancas livres de carie aos 5 anos e 38,5% aos 6 anos de idade. O indice de carie para a denticao decidua (ceo-d) foi 2,64 aos cinco anos e 3,07 aos seis anos, sendo que 31,9% e 37,9%, respectivamente, apresentaram ceo-d maior que 3. O maior percentual de necessidade de tratamento (45,3%) foi a indicacao de restauracao de uma superficie dentaria. Quanto a saude gengival, 68,6% e 72,6% das criancas aos 5 e 6 anos apresentaram sangramento gengival. A prevalencia de fluorose observada foi de 2,6% aos 5 e 6,1% aos 6 anos. CONCLUSOES: Ha necessidade da implementacao de acoes e estrategias adequadas aos grupos de maior risco.

Root caries in areas with and without fluoridated water at the Southeast region of São Paulo State, Brazil

This study aimed to investigate root caries prevalence in areas with and without water fluoridation at the Southeast region of São Paulo State, in the adult population, employees of public and private schools, and elderly population. Epidemiological surveys were conducted according to the World Health Organization guidelines (1997), including 1,475 dentate individuals aged 35 to 44 years and 65 to 74 years, living in cities representing the southeast of São Paulo State, with (n=872) or without (n=603) fluoridated water supply. Statistical analysis was performed by Mann-Whitney and Chi-square tests at a significance level of 5%. The prevalence of root caries was 15.6% for the 35-44-year-old age group and 31.8% for the 65-74-year-old age group. There were no statistically significant differences (p>0.05) in the occurrence of root caries according to water fluoridation, although individuals living at non-fluoridated areas presented higher percentage of missing teeth; also, there was higher mean number of intact roots at fluoridated areas (p<0.05). Most individuals with gingival recession, both adults and elderly, did not have root caries experience. In this study, root caries prevalence was lower in areas with fluoridated water. Due to the reduced prevalence of edentulism and increased number of people keeping their natural teeth for a longer period, a future increase in root caries is expected, highlighting the importance of studies related to water fluoridation and its relationship with the oral health of adults and elderly, especially referring to tooth root.

Prevalência de cárie radicular em adultos e idosos na região sudeste do Estado de São Paulo, Brasil

In recent decades there has been an increase in the occurrence of dental root surface caries, especially among adults and senior citizens. This study aimed to identify root surface caries prevalence in adults and seniors from southeast Sao Paulo State, Brazil. An epidemiological survey was carried out among 1,475 dentate adults, ages 35 to 44 and 65 to 74, respectively, according to WHO criteria. Root surface caries prevalence was 15.6% and 31.8%, for the 35-44 and 65-74-year groups, respectively. The average rate for decayed and/or filled roots was 0.36 for the middle-aged adult group and higher in males (p < 0.01), as compared to 0.82 for seniors, with no difference by gender. The average rate of decayed roots was 0.18 and 0.53 for middle-aged adults and seniors, respectively; in both groups the levels were higher among men (p < 0.01). Further studies on oral health, mainly on root surface conditions, are essential in both middle-aged adults and senior citizens.

Desigualdades na distribuição da cárie dentária em adolescentes de Indaiatuba (SP), 2004

The objectives of this work was to know the dental caries prevalence and treatment need, besides the distribution of the dental caries in a population of 12 year-old teenagers with high incidence of dental caries. 309 adolescents of public schools of Indaiatuba, Sao Paulo State, in 2004, were examined. They were selected by process systematic random and the exams followed the World Health Organization criteria. The percentile of school caries free was of 38.8%. Among the adolescents examined, 36.6% (n=113) presented dental caries. DMFT was of 2.50 (IC95%=2.07-2.93). The decayed component was the highest (61.0%). The coefficient of Gini was 0.602 and SiC value was of 5.97 (IC95%=5.32-6.62); in this group especially, 74.7% (n=74) presented dental caries activity in the moment of the exam. Thus, it can be concluded that the adolescents of this city presented low dental caries experience; however, their needs were not assisted, once most of DMFT was formed of the decayed component at 12 years old. In the group SiC, it was verified that this came quite high, being recommended actions addressed to this specific group of adolescents.The objectives of this work was to know the dental caries prevalence and treatment need, besides the distribution of the dental caries in a population of 12 year-old teenagers with high incidence of dental caries. 309 adolescents of public schools of Indaiatuba, São Paulo State, in 2004, were examined. They were selected by process systematic random and the exams followed the World Health Organization criteria. The percentile of school caries free was of 38.8%. Among the adolescents examined, 36.6% (n=113) presented dental caries. DMFT was of 2.50 (IC95%=2.07-2.93). The decayed component was the highest (61.0%). The coefficient of Gini was 0.602 and SiC value was of 5.97 (IC95%=5.32-6.62); in this group especially, 74.7% (n=74) presented dental caries activity in the moment of the exam. Thus, it can be concluded that the adolescents of this city presented low dental caries experience; however, their needs were not assisted, once most of DMFT was formed of the decayed component at 12 years old. In the group SiC, it was verified that this came quite high, being recommended actions addressed to this specific group of adolescents.

Atividade de cárie na dentição decídua, Indaiatuba, São Paulo, Brasil, 2004

Os objetivos deste trabalho foram verificar a atividade de carie, alem de conhecer a experiencia de carie (ceod), necessidades de tratamento e defeitos de esmalte em pre-escolares de cinco anos de idade. Examinaram-se 624 criancas de Indaiatuba, Sao Paulo, Brasil, em 2004, selecionadas por meio de processo amostral aleatorio sistematico. Para medir a experiencia de carie e necessidade de tratamento adotou-se os criterios da OMS. Para a atividade de carie, optou-se por uma simplificacao dos criterios de diagnostico de Nyvad et al. Na analise estatistica utilizaram-se os testes Mann Whitney e qui-quadrado com nivel de significância de 5%. 40,5% dos pre-escolares apresentaram atividade de carie. O ceod foi de 1,62 (IC95%: 1,35-1,89). Entre os doentes (ceod > 0) o ceod foi 3,81 (IC95%: 3,36-4,26), ainda neste grupo, 91,4% das criancas apresentaram atividade de carie. O indice de cuidados foi de 12,3%. Sugere-se que medidas de prevencao e tratamento direcionadas a essa populacao continuem sendo priorizadas, uma vez que as medidas de controle e paralisacao da carie em seus estagios iniciais sao bem conhecidas. Alem disso, recomenda-se cuidado direcionado aos pre-escolares com maior experiencia de caries.

Workers oral health: a cross-sectional study

Adults and elderly usually present an expressive tooth loss in household epidemiologic studies. Few studies were found to report oral health conditions in economically active adults. AIM: To describe the oral health status of adult workers in an extended range age (20-64 years old) of a supermarket chain. METHODS: This cross-sectional survey was conducted in a company in the state of Sao Paulo. A total of 386 workers aged 20 to 64 years old were examined following the guidelines recommended by the World Health Organization (1997) with respect to caries, treatment needs for caries, and need and use of dental prostheses. Age was stratified into groups for analysis. A descriptive analysis was performed and tooth loss rate was calculated. Kruskal Walis and Tukeys tests were used for the evaluation of differences in DMTF and chi-square test was used for treatment needs. RESULTS:The mean DMFT was 14.6 (± 8.3), and differences were found among the 3 groups, mainly due to missing teeth. DMFT was 10.8 (±6.95) in the 20-34year-old group, 19.6 (±6.13) in the 35-44-year-old group and 22.1(±7.32) in the 45-64-yearold group. Significant differences in tooth loss rate were observed between the age groups (tooth loss rate ranged from 18% to 81%). Among the adults, 53.5% had treatment needs for caries. CONCLUSIONS: The younger adult workers in this study showed better oral conditions and an increase in tooth loss was observed in the older individuals. Considering common risk approach, dentistry should work together with health promotion for the studied population of workers in order to meet the oral treatment needs and prevent new tooth losses.