Luciana Butini Oliveira

Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children

The main objective of this study was to assess whether dental caries status was related to nutritional status in preschool urban Brazilian children aged 12-59 months. Dental and anthropometric examinations were conducted on 1,018 12-59-month-old children during the National Day of Children Vaccination. Dental caries prevalence and severity were measured using the decayed, missing or filled surfaces (dmfs) index. The World Health Organization (WHO) Child Growth Standards Reference was used to evaluate nutritional status. Results on nutritional status were presented as Z-scores. The data collected included socio-economic conditions. Multilevel linear regression was applied to investigate the effect of nutritional, socio-economic, and demographic factors on the status of childrens dental caries. Caries was present in 23.4% of children. The final hierarchical logistic model showed a significant association between nutritional status and caries experience. Children with low Z-scores in some indexes had an increased risk of having caries. In addition, children whose mothers had < 8 yr of education and were from lower-income families had an increased risk of high levels of dental caries. There was an association between nutritional and socio-economic factors, and dental caries. In conclusion, underweight children and those with adverse socio-economic conditions were more likely to have caries experience.

In vivo effectiveness of laser fluorescence compared to visual inspection and radiography for the detection of occlusal caries in primary teeth.

The purpose of this study was to evaluate the in vivo effectiveness of laser fluorescence compared to visual inspection and radiography for the detection of occlusal caries in primary teeth. Fifty sites from 30 molars in 29 patients were selected and evaluated under standardized conditions by 2 previously trained examiners according to the 3 diagnostic methods. Histological examination served as gold standard after exfoliation or extraction. Values obtained for sensitivity, specificity and accuracy were 0.60, 0.90 and 0.73 for laser fluorescence, 0.82, 0.85 and 0.84 for visual inspection and 0.62, 0.73 and 0.67 for radiography, respectively. Considering only dentinal caries, values were 0.73, 0.95 and 0.90 for laser fluorescence, 0.61, 1.00 and 0.90 for visual inspection and 0.96, 0.81 and 0.85 for radiography, respectively. We conclude that for the detection of occlusal caries in primary molars laser fluorescence presents a similar accuracy when compared to visual inspection and radiography, although visual inspection showed better values for sensitivities for both enamel and dentin lesions.

Risk Indicators for Erosive Tooth Wear in Brazilian Preschool Children

The aim of this study was to assess the prevalence and risk indicators for erosive tooth wear (ETW) in Brazilian preschool children. A total of 967 children aged 3–4 years were examined. ETW was assessed using a modified version of the index recommended by O’Brien [London, Her Majesty’s Stationary Office, 1994]. The 16 examiners were trained and calibrated. Hierarchical logistic regression was applied to investigate the association between ETW and socio-economic, environmental, nutritional and behavioural factors, as well as factors related to the child’s characteristics. ETW was present in 51.6% of children. Most lesions were confined to enamel (93.9%) and involved over two thirds of the tooth surface’s area (82%). There were no significant associations between ETW and socio-economic, environmental and nutritional variables. ETW was significantly associated with soft drink intake twice or 3 or more times a day (p = 0.043 and 0.023, respectively), frequent reported gastro-oesophageal reflux (p = 0.005) and age (p = 0.003). In conclusion, there was a high prevalence of ETW in the preschool children examined, and the risk indicators were frequent consumption of soft drinks, reported gastro-oesophageal reflux and age.

Trends in dental caries in 1- to 4-year-old children in a Brazilian city between 1997 and 2008

OBJECTIVE The objective of this study was to assess trends in dental caries prevalence and severity in 1- to 4 year-old children living in Diadema, Brazil, over a 11-year period, from 1997 to 2008. METHODS In 2008 an epidemiological oral health survey was carried out and the results on caries were compared with five cross-sectional studies carried out using the same methods and criteria in 1997, 1999, 2002, 2004, and 2006 in the same city. In all surveys, children were randomly selected from those attending a National Day of Childrens Vaccination. Calibrated dentists carried out the clinical examination using WHO criteria. Caries trends were assessed by time-lag analysis. In total, 5348 children were examined in the six surveys over the 11-year period. RESULTS Time-lag analysis showed a marked and statistically significant decline in the prevalence (chi(2) for trends: P < 0.001) and severity (Kruskal-Wallis: P < 0.001) of dental caries between 1997 and 2008. CONCLUSION In conclusion, the last cohort of preschool children in Diadema had much better dental caries status than those in 1997.

Caries prevalence and severity, and quality of life in Brazilian 2- to 4-year-old children

OBJECTIVE The purpose of this study was to assess the impact of caries and severe caries on preschool childrens quality of life. METHODS Data from 765 2- to 4-year-old children attending a statutory National Day of Childrens Vaccination in Macapá (Northern Brazil) were analysed. Caries and severe caries were indicated by the dmfs and pufa indices, respectively. Parents completed a questionnaire including questions on socioeconomic factors and the impact of oral conditions on their childrens quality of life using the Brazilian version of the Parental Perceptions Questionnaire for preschool children. Logistic regression was used to test the unadjusted and adjusted associations of caries and severe caries with different aspects of childrens quality of life. RESULTS Sixty-two and five per cent of children had dental caries (dmfs index > 0) and severe caries (pufa index > 0), respectively. In the adjusted models, having caries was significantly related to toothache and problems eating certain foods as well as to be absent from school and ashamed to smile, whereas having severe caries was significantly related to toothache and problems eating certain foods only. Neither caries nor severe caries was related to stop playing with other children. CONCLUSIONS This study shows that caries and severe caries may have a considerable impact on some aspects of preschool childrens quality of life.

Discriminant validity of the International Caries Detection and Assessment System (ICDAS) and comparability with World Health Organization criteria in a cross-sectional study.

OBJECTIVES The aim of this cross-sectional study in preschool children was to assess the ability of International Caries Detection and Assessment System (ICDAS) in discriminating socioeconomic factors associated with the presence of caries lesions at both noncavitated and cavitated thresholds and to compare with the standard World Health Organization (WHO) criteria. METHODS The study was carried out in Amparo, Brazil, during the National Day of Childrens Vaccination including 252 children aged 36-59 months. The same child was independently examined by two calibrated examiners, one using the ICDAS and the other using WHO criteria. Socioeconomic information was also recorded. Associations between socioeconomic factors and presence of caries assessed as binary (caries prevalence) and count outcome (actual dmfs values) obtained by WHO criteria and by ICDAS at noncavitated and cavitated thresholds were evaluated by Poisson regression analysis with robust variance. RESULTS Some covariates were significantly associated with the presence of caries evaluated by the WHO criteria and by ICDAS (using score 3 as cut-off point). When noncavitated scores of ICDAS were used to calculate the presence of caries, the discriminant power decreased. When dmfs values were used as outcome, no differences in the associations were observed between two systems or using noncavitated caries lesions. CONCLUSION Cavitated scores of ICDAS present similar discriminant validity compared with WHO criteria when presence of caries is used as outcome; however, when actual dmfs values are used, no differences are observed in using noncavitated or cavitated caries lesions.

Impact of dental caries on preschool children's quality of life: an update

The literature reports that dental caries can cause functional, physical and aesthetic impairment, often with repercussions on childrens general health at an early age. Moreover, recent studies have investigated how caries lesions can compromise childrens quality of life. This paper aims to describe the current situation of dental caries prevalence in children and how this oral health disease can impact their quality of life.

Accuracy assessment of the axial images obtained from cone beam computed tomography

OBJECTIVE The aim of this study was to evaluate accuracy of linear measurements assessed from axial tomograms and the influence of the use of different protocols in two cone beam CT (CBCT) units. METHODS A cylinder object consisting of Nylon® (Day Brazil, Sao Paulo, Brazil) with radiopaque markers was radiographically examined applying different protocols from NewTom 3G(TM) (Quantitative Radiology s.r.l, Verona, Veneto, Italy) and i-CAT(TM) (Imaging Sciences International, Hatfield, PA) units. Horizontal (A-B) and vertical (C-D) distances were assessed from axial tomograms and measured using a digital calliper that provided the gold standard for actual values. RESULTS There were differences when considering acquisition protocols to each CBCT unit. Concerning all analysed protocols from i-CAT(TM) and Newtom 3G(TM), both A-B and C-D distances presented underestimated values. Measurements of the axial images obtained from NewTom 3G(TM) (6 inch 0.16 mm and 9 inch 0.25 mm) were similar to the ones obtained from i-CAT(TM) (13 cm 20 s 0.3 mm, 13 cm 20 s 0.4 mm and 13 cm 40 s 0.25 mm). CONCLUSION The use of different protocols from CBCT machines influences linear measurements assessed from axial images. Linear distances were underestimated in both equipments. Our findings suggest that the best protocol for the i-CAT(TM) is 13 cm 20 s 0.3 mm and for the NewTom 3G(TM), the use of 6 inch or 9 inch is recommended.

Trends in the prevalence of traumatic crown injuries and associated factors in Brazilian preschool children: 10-year observational data

OBJECTIVE To assess trends in the prevalence of traumatic crown injuries (TCI) in children aged 1-4 years living in Diadema city (Brazil) and to investigate whether TCI were associated with socio-demographic and clinical variables. METHODS Six cross-sectional surveys with representative samples were carried out from 2002 to 2012 following the same criteria and methodology. A total of 6389 children were evaluated and systematically selected on the National Childrens Vaccination day. Calibrated examiners performed the childrens oral examination for TCI according to Andreasens criteria. Chi-square test for trends was used to perform comparative analysis. Poisson regression was used to associate TCI to socio-demographic and clinical variables. RESULTS The prevalence of TCI in 2002 for preschool children aged 1, 2, 3 and 4 years was 4.5%, 11.4%, 14% and 13.9%, respectively, and the prevalence in 2012 for the same age groups was 10.4%, 15.9%, 25.7% and 28.1%, respectively. There was a significant increase in the prevalence of TCI for all age groups and for the total sample (P < 0.05). Childrens age was associated with TCI in all the surveys. Male gender, presence of anterior open bite and inadequate lip coverage were associated with TCI in some surveys along the years (P < 0.05). CONCLUSION This study has shown an increase of TCI prevalence in Brazilian preschool children in the last 10 years and its association with childrens age, male gender, presence of anterior open bite and inadequate lip coverage. However, this increase does not seem to be relevant to decisions on public policy.

Cryosurgery as an Effective Alternative for Treatment of Oral Lesions in Children

Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.