Maria Gabriela Haye Biazevic

Trends and spatial distribution of oral cancer mortality in São Paulo, Brazil, 1980–1998

We assessed oral cancer mortality data in São Paulo to study trends of the disease and its distribution by areas of the city. We standardized death rates by gender and age group, and also supplied complementary information regarding oral cancer incidence. Oral cancer mortality remained stationary at high levels during the study period. Site-specific death rates revealed high figures for two categories of site: tongue and unspecified parts of mouth. Gum cancer death rates--the most easily diagnosed site-specific oral cancer at a routine dental examination--fell sharply, possibly as a consequence of the recent expansion in community dental health services in the city. In spite of this observation, the increase of death rates related to unspecified parts of the mouth points to the deficiencies of health services in detecting most of oral cancer cases early. Spatial data analysis enabled indication of areas and socio-economic factors associated with poorer profile in oral cancer mortality, important information for the targeting of health resources directed to the screening, prevention and education in oral cancer.

Relationship between oral health and its impact on quality of life among adolescents

The aim of this study was to assess oral health status and its relationship with quality of life. A household population, cross-sectional study was carried out; participants were between 15 and 17 years of age (n = 247) and were examined by two calibrated dentists. Socio-economic status was classified according to ANEP-ABIPEME criteria. Clinical examinations to observe DMFT, CPI and Dean indices were performed as per WHO criteria. The Significant Caries Index (SiC) was used to evaluate polarization of the occurrence of caries among participants of the tercile with higher DMF-T. The OHIP instrument was used to measure quality of life. The Spearman and Mann-Whitney tests were used for assessing correlations (5% significance level). Examinations were carried out in 117 (47.37%) females and in 130 (52.63%) males. Of the examined participants, 45.75% were classified as belonging to socio-economic class C. Caries occurrence was observed in 218 subjects (88.26%); the mean DMFT was 5.40. The SiC index was 9.97. Almost half (47.77%) of the participants examined did not present sextants affected by periodontal disease. Of the participants examined, 80.16% presented absence of fluorosis. The mean OHIP was 3.95. The following correlations were observed: a positive and statistically significant correlation between the highest score in the OHIP and decayed teeth; a positive correlation with threshold significance between OHIP and DMFT; an inverse correlation between intact teeth and OHIP; and a positive and non statistically significant correlation between SiC and OHIP (correlation coefficient = 0.13, p = 0.245). Association between the mean OHIP and the terciles was not significant (p = 0.146); there were also no associations between periodontal condition and OHIP nor were there associations between the presence of fluorosis and mean OHIP.

Joint and independent effects of alcohol drinking and tobacco smoking on oral cancer: a large case-control study.

Alcohol drinking and tobacco smoking are assumed to have significant independent and joint effects on oral cancer (OC) development. This assumption is based on consistent reports from observational studies, which, however, overestimated the independent effects of smoking and drinking, because they did not account for the interaction effect in multivariable analyses. This case-control study sought to investigate the independent and the joint effects of smoking and drinking on OC in a homogeneous sample of adults. Case patients (N = 1,144) were affected by invasive oral/oropharyngeal squamous cell carcinoma confirmed histologically, diagnosed between 1998 and 2008 in four hospitals of São Paulo (Brazil). Control patients (N = 1,661) were not affected by drinking-, smoking-associated diseases, cancers, upper aero-digestive tract diseases. Cumulative tobacco and alcohol consumptions were assessed anamnestically. Patients were categorized into never/ever users and never/level-1/level-2 users, according to the median consumption level in controls. The effects of smoking and drinking on OC adjusted for age, gender, schooling level were assessed using logistic regression analysis; Model-1 did not account for the smoking-drinking interaction; Model-2 accounted for this interaction and included the resultant interaction terms. The models were compared using the likelihood ratio test. According to Model-1, the adjusted odds ratios (ORs) for smoking, drinking, smoking-drinking were 3.50 (95% confidence interval –95CI, 2.76–4.44), 3.60 (95CI, 2.86–4.53), 12.60 (95CI, 7.89–20.13), respectively. According to Model-2 these figures were 1.41 (95CI, 1.02–1.96), 0.78 (95CI, 0.48–1.27), 8.16 (95CI, 2.09–31.78). Analogous results were obtained using three levels of exposure to smoking and drinking. Model-2 showed statistically significant better goodness-of-fit statistics than Model-1. Drinking was not independently associated with OC, while the independent effect of smoking was lower than expected, suggesting that observational studies should be revised adequately accounting for the smoking-drinking interaction. OC control policies should focus on addictive behaviours rather than on single lifestyle risk factors.

Saúde gengival de adolescentes e a utilização de serviços odontológicos, Estado de São Paulo

OBJETIVO: Avaliar a associacao de condicoes de saude gengival com a utilizacao de servico odontologico. METODOS: Realizou-se levantamento epidemiologico de saude bucal de 1.799 adolescentes, em 35 cidades do Estado de Sao Paulo, em 2002. A saude gengival foi avaliada pela prevalencia de sangramento na gengiva a sondagem e calculo dentario (indice periodontal comunitario) e oclusao dentaria (indice de estetica dentaria). A utilizacao de servicos odontologicos foi medida pelo indice de cuidado (O/CPO) para cada cidade. Analise multinivel de regressao logistica ajustou modelos explicativos para fatores associados aos desfechos de interesse. RESULTADOS: A prevalencia de sangramento gengival a sondagem foi 21,5%; de calculo dentario foi 19,4%. Os participantes do sexo masculino, negros e pardos, moradores em areas rurais, residentes em domicilios aglomerados e com atraso escolar apresentaram chance significantemente mais elevada para os agravos que seus respectivos pares de comparacao. Caracteristicas de oclusao dentaria tambem associaram com gengiva nao-saudavel: apinhamento dos segmentos incisais, mordida aberta vertical anterior, relacao molar antero-posterior. Cidades com maior utilizacao de servico odontologico tiveram menor proporcao de adolescentes com sangramento gengival e calculo. CONCLUSOES: A utilizacao de servicos odontologicos foi significativamente associada a melhores condicoes de saude gengival (sangramento e calculo). Essa associacao independeu das caracteristicas sociodemograficas individuais e contextuais, e de oclusao dentaria.OBJECTIVE To evaluate the association between gingival health conditions and dental service utilization. METHODS An epidemiological survey of the oral health of 1,799 adolescents was carried out in 35 cities of the state of São Paulo, in 2002. Gingival health was assessed through the prevalence of gingival bleeding on probing and dental calculus (community periodontal index), and dental occlusion was assessed through the dental aesthetic index. The utilization of dental services was measured by means of the dental care index (F/DMFT) for each city. Multilevel logistic regression analysis was used to adjust explanatory models to factors associated with the outcome variables of interest. RESULTS The prevalence of gingival bleeding on probing was 21.5%, whereas dental calculus was prevalent in 19.4%. Male participants, who were either black or dark-skinned, lived in crowded homes, in rural areas, and showed schooling delay, were at a significantly higher risk than their respective counterparts. The following dental occlusion characteristics were also associated with unhealthy gum: incisor segment crowding, vertical anterior open bite, and antero-posterior molar relationship. Cities with a higher utilization of dental services showed a smaller proportion of adolescents with gingival bleeding and dental calculus. CONCLUSIONS The utilization of dental services was significantly associated with better gingival health conditions (gingival bleeding and dental calculus). This association did not depend on contextual and individual sociodemographic characteristics or dental occlusion.

Immediate Impact of Primary Surgery on Health-Related Quality of Life of Hospitalized Patients With Oral and Oropharyngeal Cancer

PURPOSE Oral and oropharyngeal tumor resection may be associated with disfigurement and dysfunctions that affect essential domains of life. This study aimed at assessing the immediate impact of primary surgery on the health-related quality of life for these patients. PATIENTS AND METHODS Forty-seven patients with squamous cell carcinoma of the lips, oral cavity, or oropharynx, and undergoing treatment in the head and neck surgery center of a large general hospital in the city of São Paulo, Brazil, from October 2005 to September 2006, completed the University of Washington Quality of Life questionnaire pre- and postoperatively (before hospital discharge). A paired t test evaluated differences between assessments; Poisson regression estimated ratios of ratings attributed to each domain (pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder pain, taste, saliva, mood, and anxiety) per patient stratified by sociodemographic, clinical, and behavioral characteristics. RESULTS The immediate impact of surgery on health-related quality of life corresponded to a 31.1% reduction in the overall rating. The most affected domains were chewing (-73.5%), taste (-61.4%), swallowing (-57.3%), speech (-46.0%), and pain (-42.3%). Anxiety (+65.5%) was the sole domain that improved immediately after surgery. Comparisons involving subgroups of patients indicated that different clinical conditions (regional metastasis, tumor size, and location) were not associated with discrepant health-related quality of life immediately after surgery. CONCLUSIONS The routine pre- and postoperative assessment of health-related quality of life may contribute to evaluate treatment effectiveness, which would otherwise rely exclusively on assessing end-point results such as survival and tumor relapse. This information is relevant to attenuate the prejudicial impact of surgery on the physical and psychosocial functioning of patients.

Survival and quality of life of patients with oral and oropharyngeal cancer at 1-year follow-up of tumor resection.

Objective This study aimed to assess the survival and life quality evolution of patients subjected to surgical excision of oral and oropharyngeal squamous cell carcinoma. Material and Methods Forty-seven patients treated at a Brazilian healthcare unit specialized in head and neck surgery between 2006 and 2007 were enrolled in the study. The gathering of data comprised reviewing hospital files and applying the University of Washington Quality of Life (UW-QOL) questionnaire previously and 1 year after the surgery. Comparative analysis used Poisson regression to assess factors associated with survival and a paired t-test to compare preoperative and 1-year postoperative QOL ratings. Results 1 year after surgery, 7 patients were not found (dropout of the cohort); 15 had died and 25 fulfilled the UW-QOL again. The risk of death was associated with having regional metastasis previously to surgery (relative risk=2.18; 95% confidence interval=1.09-5.17) and tumor size T3 or T4 (RR=2.30; 95%CI=1.05-5.04). Survivors presented significantly (p<0.05) poorer overall and domain-specific ratings of quality of life. Chewing presented the largest reduction: from 74.0 before surgery to 34.0 one year later. Anxiety was the only domain whose average rating increased (from 36.0 to 70.7). Conclusions The prospective assessment of survival and quality of life may contribute to anticipate interventions aimed at reducing the incidence of functional limitations in patients with oral and oropharyngeal cancer.

Tendências de mortalidade por câncer de boca e orofaringe no Município de São Paulo, Brasil, 1980/2002

The current study assessed trends in oral cancer mortality in the city of Sao Paulo, Brazil, from 1980 to 2002. The official mortality information system supplied data on deaths whose underlying cause was classified as oral cancer, stratified by sex, age, and anatomic site. Death rates were estimated and adjusted by the direct method, using population data supplied by national censuses from 1980, 1991, and 2000 and a population count performed in 1996. There was an upward trend in overall cancer mortality, at a yearly rate of 0.72%. Accounting for more than one third of these deaths, tongue cancer was the main mortality category. Labial, gengival, and retromolar cancer showed a downward trend, while oropharyngeal cancer and cancer in unspecified parts of the mouth and oropharynx showed increasing mortality. Monitoring the magnitude and trends in cancer mortality can assist the planning of health initiatives aimed at reducing the disease burden from oral cancer in Brazil.

Cameriere's third molar maturity index in assessing age of majority

Estimation of chronological age of an individual is one of the main challenges in forensic science. Legally to be able to treat a person as a minor or an adult, it is necessary to determine whether their age of majority (if they are older or younger than 18, in most countries). Methods for estimating age are especially important when an individual in question lacks personal documents or other means of identification. As the dental age differs in various populations, the aim of this study was to evaluate applicability of third molar method for assessing age of majority in Croatia. Camerieres third molar maturity index (I3M) value of 0.08, measured by the open apices of the teeth, was verified in sample of 1336 panoramic images aged between 14 and 23 years. Chronological age gradually decreased as I3M increased in both genders. Males showed statistically significant advanced maturation when I3M was between 0.0 and 0.3 value. The results indicate that the sensitivity of the test for 0.08 value was 84.3% (95%CI 80.6%, 87.5%) for females and 91.2% (95%CI 88.7%, 93.1) for males. Specificity was 95.4% (95%CI 92.5%, 97.5%) and 91.9% (95%CI 88.8%, 94.3%). The proportions of accurately classified males were 88.8% and that of females 91.5%. The estimated post-test probabilities, of individuals, in other word the probability that a Croatian individual with an I3M<0.08 is 18 years or older is 94.5% for females, and 96.5% for males. With high accuracy, the third molar maturity index should be used as a determinant of the age of majority in Croatia.

Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation

Oral mucositis (OM) is one of the side effects of hematopoietic stem cell transplantation (HSCT), resulting in major morbidity. The aim of this study was to determine the cost‐effectiveness of the introduction of a specialized oral care program including laser therapy in the care of patients receiving HSCT with regard to morbidity associated with OM. Clinical information was gathered on 167 patients undergoing HSCT and divided according to the presence (n = 91) or absence (n = 76) of laser therapy and oral care. Cost analysis included daily hospital fees, parenteral nutrition (PN) and prescription of opioids. It was observed that the group without laser therapy (group II) showed a higher frequency of severe degrees of OM (relative risk = 16.8, 95% confidence interval −5.8 to 48.9, p < 0.001), with a significant association between this severity and the use of PN (p = 0.001), prescription of opioids (p < 0.001), pain in the oral cavity (p = 0.003) and fever > 37.8°C (p = 0.005). Hospitalization costs in this group were up to 30% higher. The introduction of oral care by a multidisciplinary staff including laser therapy helps reduce morbidity resulting from OM and, consequently, helps minimize hospitalization costs associated with HSCT, even considering therapy costs. Copyright

Estimating ages by third molars: Stages of development in Brazilian young adults

The purpose of this study was to estimate age through the analysis of third molar stages of development in Brazilian young adults. A cross-sectional study was conducted by analyzing 659 panoramic X-rays. Two techniques were used to establish the stages: Modified Scoring (MST) and Demirjian (DT). Regression formulas were calculated. Statistical analyses were conducted by t, Kappa tests, and simple and multiple linear regressions (5% level of significance). Out of the participants, 40.7% were female and 59.3% were male, with ages from 15-22 years. The Kappa test showed good results for intra-observer (0.84 for MST and 0.95 for DT) and inter-observer examination (0.81 for MST and 0.92 for DT). Differences were found in the stages of tooth formation between male and female, but differences were not observed between the left and right sides. We found that both DT and MST underestimated the ages in about 6 months, depending on the used classification and number of teeth. These methods are appropriate for assessing the ages of young Brazilians, although the DT showed better reproducibility.