Marco Aurélio Peres

Perdas dentárias e fatores sociais, demográficos e de serviços associados em adultos brasileiros: uma análise dos dados do Estudo Epidemiológico Nacional (Projeto SB Brasil 2002-2003)

The aim of this study was to estimate the prevalence of tooth loss among Brazilian adults aged 35 to 44 years. The study also tested the association between tooth loss and demographic, socioeconomic, and dental-care utilization variables. Data were analyzed from 13,431 individuals submitted to dental examination and interviewed in the National Oral Health Survey in 2002-2003. The number of lost teeth (<or=12 and > 12) was the outcome. Exploratory variables included geographic area, gender, skin color, age, per capita income, schooling, time since last dental appointment, and type of dental service used. Crude and adjusted prevalence ratios were estimated using a Poisson regression model. The prevalence of edentulism was 9%, while median tooth loss was 11. Tooth loss was strongly associated with living in rural areas, female gender, poor socioeconomic status, low schooling, and older age. Individuals who attended public dental care services and those with more time elapsed since their last dental appointment showed a higher prevalence of tooth loss than their counterparts after controlling for demographic and socioeconomic factors.

Effects of breastfeeding and sucking habits on malocclusion in a birth cohort study

OBJECTIVE To estimate the prevalence of malocclusion and to examine the effects of breastfeeding and non-nutritive sucking habits on dentition in six-year-old children. METHODS A cross-sectional study was carried out nested into a birth cohort conducted in Pelotas, Southern Brazil, in 1999. A sample of 359 children was dentally examined and their mothers interviewed. Anterior open bite and posterior cross bite were recorded using the Foster & Hamilton criteria. Information regarding breastfeeding and non-nutritive sucking habits was collected at birth, in the first, third, sixth and 12th months of life, and at six years of age. Control variables included maternal schooling and childs birthweight, cephalic perimeter, and sex. Data were analyzed by Poisson regression. RESULTS Prevalence of anterior open bite was 46.2%, and that of posterior cross bite was 18.2%. Non-nutritive sucking habits between 12 months and four years of age and digital sucking at age six years were the main risk factors for anterior open bite. Breastfeeding for less than nine months and regular use of pacifier between age 12 months and four years were risk factors for posterior cross bite. Interaction between duration of breastfeeding and the use of pacifier was identified for posterior cross bite. CONCLUSIONS Given that breastfeeding is a protective factor for other diseases of infancy, our findings indicate that the common risks approach is the most appropriate for the prevention of posterior cross bite in primary or initial mixed dentition.

The relation between family socioeconomic trajectories from childhood to adolescence and dental caries and associated oral behaviours

Objectives: To investigate the influence of family socioeconomic trajectories from childhood to adolescence on dental caries and associated behaviours. Design: Population-based birth cohort. Setting: Representative sample of the population of subjects born in 1982 in Pelotas, Brazil. Participants: Adolescents (n = 888) aged 15 years old were dentally examined and interviewed. Main outcome measures: Dental caries index (DMFT), care index (F/DMFT), tooth brushing, flossing and pattern of dental services use. Main results: Adolescents who were always poor showed, in general, a worse pattern of dental caries, whereas adolescents who never were poor had a better pattern of dental caries. Adolescents who had moved from poverty in childhood to non-poverty in adolescence and those who had moved from non-poverty in childhood to poverty in adolescence had similar dental pattern to those who were always poor except for the pattern of dental services use, which was higher in the first group. In all groups girls had fewer carious teeth, better oral hygiene habits and higher dental services use than boys. Conclusion: Poverty in at least one stage of the lifespan has a harmful effect on dental caries, oral behaviours and dental services use. Belonging to upwardly mobile families between childhood and adolescence only contributed to improved dental care.

Calibração de examinadores para estudos epidemiológicos de cárie dentária

The aim of this study was describe a training and calibration exercise for dental caries and to discuss the use of validity and reliability statistical tests. Eight dentists examined seventeen 12 year-old schoolchildren using World Health Organization (1997) criteria. Data analysis included calculation of the DMF-T index, the percent agreement, and the kappa scores on a tooth-by-tooth basis. Inter-examiner agreement was tested against a gold standard examiner. Scores for measures of agreement calculated on a tooth-by-tooth basis were lower than those calculated for the whole mouth. The training and calibration exercise is a crucial step in cross-sectional epidemiological surveys, and the kappa test calculated on a tooth-by-tooth basis is the appropriate measurement to test agreement between examiners for dental caries.

Associação entre atenção básica em saúde bucal e indicadores socioeconômicos municipais

OBJECTIVE To test associations between primary dental care indicators and municipal socioeconomic and dental service provision indicators. METHODS An ecological study was carried out in the 293 municipalities of the State of Santa Catarina, Brazil, between 2000 and 2003. The primary dental care indicators utilized were: (1) coverage; (2) the ratio between preventive dental procedures and the size of the population aged zero to 14 years; and (3) the ratio between the numbers of extractions of permanent teeth and individual dental procedures within primary dental care. The variables investigated were: number of dentists per 1,000 inhabitants; number of dentists within the public health service per 1,000 inhabitants; fluoridation of the water supply; child development index; human development index; and the size of the population in the municipality. Analyses were performed using the Kruskall-Wallis and Chi-square tests. The Spearman test was used to evaluate correlations between the variables. RESULTS The coverage was 21.8%, the ratio of preventive dental procedures among the population aged zero to 14 years was 0.37 and the proportion of tooth extractions in relation to the total number of individual dental procedures was 11.9 %. Lower rates of tooth extraction were associated with higher numbers of dentists within the public health service (p<0.01). Higher rates of tooth extraction were associated with lower human development indices for the municipalities (p<0.01). CONCLUSIONS Greater coverage was associated with higher numbers of dentists within the public health system. Municipalities with worse socioeconomic conditions were associated with greater tooth extraction rates. Oral health policies must target municipalities that present worse socioeconomic indicators.

Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the countrys five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

The association between socioeconomic development at the town level and the distribution of dental caries in Brazilian children

OBJECTIVE To investigate the association between dental caries among children in the state of São Paulo, Brazil, and town-level indices of socioeconomic development. METHODS We examined 15 385 oral-examination records from children aged 5 or 6 years old from 129 towns and cities in the state of São Paulo. We studied two outcomes: (1) the mean number of decayed, missing, and filled deciduous teeth (dmft index) and (2) the care index, which is the proportion of decayed teeth that have already been filled. The explanatory variables were the child development index, human development index, illiteracy rate among subjects older than 20 years, household income, Gini coefficient, insufficient income, fluoridated water supply, number of dentists per 10 000 inhabitants, number of dentists in the public service per 10 000 inhabitants, and number of weekly hours of dentist work in the public service per 10 000 inhabitants. Multiple linear regression models were fitted to the two outcome variables (dmft index and care index). RESULTS The multiple linear regression analysis showed that a higher dmft index was associated with a low child development index, a high illiteracy rate, and an unfluoridated water supply. The child development index was significantly associated with the care index, and the number of dentists in the public service per 10 000 inhabitants showed borderline statistical significance. CONCLUSIONS Our results indicate that town-level indices of socioeconomic status are significantly correlated with caries indices. Our results also emphasize the beneficial effect that fluoridating water has on reducing the prevalence of dental caries and the fact that strategies for treating and preventing oral diseases should be emphasized within the context of overall health promotion for children.

Dental pain prevalence and association with dental caries and socioeconomic status in schoolchildren, Southern Brazil, 2002

The objective of this study was to assess the relation between dental pain, dental caries and socioeconomic status among 12- and 13-year-old schoolchildren enrolled in a public school in Florianópolis, SC, Brazil in 2002. This study was a cross-sectional study involving 181 schoolchildren. Dental pain experience was the dependend variable analyzed. Socioeconomic data of the childrens families were obtained through a questionnaire. Dental caries experience was registered according to the DMFT index (WHO, 1997). The field workteam consisted of an examiner and a recorder. The statistical analysis was performed using the chi-square test and the non-conditional multiple logistic regression. The response rate was 93.4%. The intraexaminer agreement measured on a tooth by tooth basis was high (kappa > 0.73). Dental pain prevalence was 33.7% (CI95% 26.0-42.0). The multiple regression analysis, adjusted by sex and other variables, showed that children with DMFT > 1 presented 2.9 (OR CI95% 1.4-6.1, p < 0.01) more chances of having dental pain when compared with those with DMFT < or = 1. Children whose mothers schooling level was equal or less than 4 years presented 2.5 (OR CI95% 1.2-5.6, p = 0.02) more chances of having dental pain when compared with others whose mothers had more than 5 years of schooling and, finally, children whose family income was up to U

Redução das desigualdades sociais na utilização de serviços odontológicos no Brasil entre 1998 e 2008

67.00 showed 3.2 (OR CI95% 1.2-8.4, p = 0.02) more chances of having dental pain when compared with the ones whose families had higher income. High levels of caries attack, low mother schooling level and low family income were associated to dental pain.

Caries Is the Main Cause for Dental Pain in Childhood: Findings from a Birth Cohort

OBJETIVO: Analisar o acesso e utilizacao de servicos odontologicos no Brasil. METODOS: Foram utilizados os dados da Pesquisa Nacional por Amostra de Domicilios de 2003 e 2008, comparando-os com os de 1998. Investigaram-se as variaveis de acesso e uso de servicos odontologicos nas idades de tres, seis, nove, 12, 15 e 19 anos e no primeiro (Q1) e no quinto (Q5) quintis de renda familiar per capita. As analises consideraram o desenho amostral complexo. RESULTADOS: A proporcao de pessoas que nunca consultaram o dentista diminuiu (18,7% em 1998, 15,9% em 2003 e 11,7% em 2008). Houve importante reducao na diferenca absoluta de nao utilizacao do servico odontologico a partir dos nove anos entre Q1 e Q5 de 1998 a 2008, diminuindo para cerca de metade aos 15 (30,3 pontos percentuais - pp para 16,1 pp) e aos 19 anos (20,4 pp para 9,9 pp). As razoes entre Q1 e Q5 para consulta recente ao dentista diminuiram em todas as idades, principalmente entre zero e seis anos (Q5/Q1 de 3,2 para 2,6); a utilizacao do Sistema Unico de Saude para atendimento odontologico aumentou nos Q1 e Q5, com reducao na razao entre os grupos Q1/Q5 de cerca de 20%. A utilizacao do Sistema Unico de Saude para atendimento odontologico aumentou cerca de 8% no Q1 e 35% no Q5 entre 2003 e 2008. CONCLUSOES: Houve avanco consideravel na reducao das desigualdades no acesso e aumento na utilizacao de servicos odontologicos no Brasil entre 1998 e 2008. Entretanto, as iniquidades entre os grupos sociais ainda e expressiva.OBJECTIVE To analyze access to and utilization of dental care services in Brazil. METHODS We used data from the 2003 and 2008 Brazilian National Household Surveys, which we compared to data from the 1998 survey. We investigated access and utilization variables at ages three, six, nine, 12, 15, and 19 years in the first (Q1) and fifth (Q5) quintiles of per capita family income. All analyses took into account the complex sampling strategy. RESULTS The proportion of subjects that had never seen a dentist decreased during the period (18.7% in 1998, 15.9% in 2003 and 11.7% in 2008). There was an important reduction in the absolute difference in failure to use dental care services after age nine years between Q1 and Q5 from 1998 to 2008, which decreased to about half its value at 15 (30.3 percentage points - pp to 16.1 pp) and 19 years (20.4 pp to 9.9 pp). Q5/Q1 ratios for recent dental appointments fell across all age groups, especially between zero and six years (Q5/Q1 from 3.2 to 2.6); utilization of the National Health Care System for dental care increased in Q1 and Q5, with a reduction in the Q1/Q5 ratio of approximately 20%. Use of the National Health Care System for dental care increased by approximately 8% in Q1 and 35% in Q5 between 2003 and 2008. CONCLUSIONS There have been considerable advances in terms of reducing inequalities in access to, and increasing the utilization of, dental care services in Brazil between 1998 and 2008. However, inequality between social groups remains substantial.