Marcelo Bönecker

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.

Impact of oral diseases and disorders on oral health-related quality of life of preschool children.

BACKGROUND The presence of oral diseases and disorders can produce an impact on the quality of life of preschool children and their parents, affecting their oral health and well-being. However, socioeconomic factors could confound this association, but it has not been yet tested at this age. OBJECTIVE To assess the impact of early childhood caries (ECC), traumatic dental injuries (TDI) and malocclusions on the oral health-related quality of life (OHRQoL) of children between 2 and 5 years of age adjusted by socioeconomic factors. METHODS Parents of 260 children answered the Early Childhood Oral Health Impact Scale (ECOHIS) (six domains) on their perception of the childrens OHRQoL and socioeconomic conditions. Two calibrated dentists (κ>0.8) examined the severity of ECC according to dmft index, and children were categorized into: 0=caries free; 1-5=low severity; ≥6=high severity. TDI and malocclusions were examined according to Andreasen & Andreasen (1994) classification and for the presence or absence of three anterior malocclusion traits (AMT), respectively. OHRQoL was measured through ECOHIS domain and total scores, and poisson regression was used to associate the different factors with the outcome. RESULTS In each domain and overall ECOHIS scores, the severity of ECC showed a negative impact on OHRQoL (P<0.001). TDI and AMT did not show a negative impact on OHRQoL nor in each domain (P>0.05). The increase in the childs age, higher household crowding, lower family income and mother working out of home were significantly associated with OHRQoL (P<0.05). The multivariate adjusted model showed that the high severity of ECC (RR=3.81; 95% CI=2.66, 5.46; P<0.001) was associated with greater negative impact on OHRQoL, while high family income was a protective factor for OHRQoL (RR=0.93; 95% CI=0.87, 0.99; P<0.001). CONCLUSIONS The severity of ECC and a lower family income had a negative impact on the OHRQoL of preschool children and their parents.

Impact of traumatic dental injuries and malocclusions on quality of life of young children

BackgroundThe presence of traumatic dental injuries and malocclusions can have a negative impact on quality of life of young children and their parents, affecting their oral health and well-being. The aim of this study was to assess the impact of traumatic dental injuries and anterior malocclusion traits on the Oral Health-Related Quality of Life (OHRQoL) of children between 2 and 5 years-old.MethodsParents of 260 children answered the six domains of the Early Childhood Oral Health Impact Scale (ECOHIS) on their perception of the OHRQoL (outcome). Two calibrated dentists assessed the types of traumatic dental injuries (Kappa = 0.9) and the presence of anterior malocclusion traits (Kappa = 1.0). OHRQoL was measured using the ECOHIS. Poisson regression was used to associate the type of traumatic dental injury and the presence of anterior malocclusion traits to the outcome.ResultsThe presence of anterior malocclusion traits did not show a negative impact on the overall OHRQoL mean or in each domain. Only complicated traumatic dental injuries showed a negative impact on the symptoms (p = 0.005), psychological (p = 0.029), self image/social interaction (p = 0.004) and family function (p = 0.018) domains and on the overall OHRQoL mean score (p = 0.002). The presence of complicated traumatic dental injuries showed an increased negative impact on the childrens quality of life (RR = 1.89; 95% CI = 1.36, 2.63; p < 0.001).ConclusionsComplicated traumatic dental injuries have a negative impact on the OHRQoL of preschool children and their parents, but anterior malocclusion traits do not.

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.

Effect of fluoride varnish and gel on dental erosion in primary and permanent teeth

OBJECTIVE To assess the effect of a fluoride varnish and gel on the erosive wear of primary and permanent teeth. DESIGN Sixty human primary (n=30) and permanent (n=30) enamel specimens were randomly assigned to one of the following groups: APF gel (1.23% F), NaF varnish (2.26% F), and control (no treatment). Fluoride gel was applied for 4 min and fluoride varnish for 24 h. Six daily demineralisation-remineralization cycles of 5 min of immersion in a cola drink (pH 2.3) and 30 min in artificial saliva were conducted during 7 days. All specimens were stored in artificial saliva between and after cycles. Surface Knoop microhardness (%SMHC) readings were performed at baseline, 48 h and 7 days. Data were tested using ANOVA and Tukeys tests (p<0.05). RESULTS For primary enamel, the mean %SMHC (+/-SD) after 48 h and 7 days was, respectively: gel (31.0+/-14.4 and 36.9+/-7.5), varnish (26.7+/-9.5 and 38.3+/-8.7), and control (35.8+/-8.6 and 45.0+/-8.6). For permanent enamel, such values were: gel (37.5+/-7.7 and 27.8+/-7.5), varnish (31.7+/-9.6 and 27.4+/-11.1) and control (48.6+/-6.4 and 43.1+/-6.4). In primary enamel, erosion inhibition by fluoride was not significant at 48 h (p=0.203) and 7 days (p=0.082). In permanent specimens, both products showed a significant effect (p<0.001). CONCLUSIONS Both fluoride varnish and gel were able to inhibit erosive enamel loss but mainly in the permanent experimental groups. Primary and permanent enamel substrates reacted differently to both demineralization by a cola drink and remineralization by fluoridated compounds.

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.

Impact of dental caries and trauma on quality of life among 5- to 6-year-old children: perceptions of parents and children.

OBJECTIVE To assess the impact of dental caries and traumatic dental injuries (TDI) on the oral health-related quality of life (OHRQoL) of 5- to 6-year-olds according to both self- and parental reports. METHODS A total of 335 pairs of parents and children who sought dental screening at the Dental School, University of São Paulo, completed the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5), which consists of a child self-report and a parental proxy-report version. Three calibrated examiners assessed the experience of caries according to primary teeth that were decayed, indicated for extraction due to caries, or filled (def-t). TDI were classified into uncomplicated and complicated injuries. Poisson regression models were used to associate the different clinical and sociodemographic factors to the outcome. RESULTS Overall, 74.6% of children reported an oral impact, and the corresponding estimate for parental reports was 70.5%. The mean (standard deviation) SOHO-5 scores in child self-report and parental versions were 3.32(3.22) and 5.18(6.28), respectively. In both versions, caries was associated with worse childrens OHRQoL, for the total score and all SOHO-5 items (P < 0.001). In contrast, TDI did not have a negative impact on childrens OHRQoL, with the exception of two items of the parental version and one item of the child self-report version. In the final multivariate adjusted models, there was a gradient in the association between caries experience and childs OHRQoL with worse SOHO-5 score at each consecutive level with more severe caries experience, for both child and parental perceptions [RR (CI 95%) = 6.37 (4.71, 8.62) and 10.81 (7.65, 15.27)], respectively. A greater family income had a positive impact on the childrens OHRQoL for child and parental versions [RR (CI 95%) = 0.68 (0.49, 0.94) and 0.70 (0.54, 0.90)], respectively. CONCLUSIONS Dental caries, but not TDI, is associated with worse OHRQoL of 5- to 6-year-old children in terms of perceptions of both children and their parents. Families with higher income report better OHRQoL at this age, independent of the presence of oral diseases.

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.