Maria Isabel Pereira Vianna

Doença periodontal materna como fator associado ao baixo peso ao nascer

OBJETIVO: Estudos recentes tem apresentado evidencias de que a doenca periodontal em gestantes pode ser um dos determinantes do baixo peso ao nascer. Realizou-se estudo para verificar a existencia de associacao entre doenca periodontal materna e baixo peso ao nascer. METODOS: Estudo do tipo caso-controle com 302 mulheres, sendo 102 maes de nascidos vivos de baixo peso (grupo caso) e 200 maes de nascidos vivos com peso normal (grupo controle). A existencia de associacao entre doenca periodontal e baixo peso ao nascer foi avaliada mediante modelo multivariado de regressao logistica, considerando outros fatores de risco para o baixo peso. RESULTADOS: Ambos os grupos de maes eram comparaveis no que se refere a idade, altura, peso pre-gestacional, tabagismo, alcoolismo, doencas previas, estado civil, situacao socioeconomica, numero de escovacoes e uso de fio dental, numero de refeicoes diarias, e visitas ao dentista. A doenca periodontal foi diagnosticada em 57,8% das maes do grupo caso e 39,0% do grupo controle. A analise de regressao logistica indicou associacao positiva entre doenca periodontal e baixo peso ao nascer (ORbruto=2,15; IC 95%: 1,32-3,48), especialmente entre as maes com escolaridade menor ou igual a quatro anos (ORajustada=3,98; IC 95%: 1,58-10,10). CONCLUSOES: A doenca periodontal e um possivel fator de risco para o baixo peso ao nascer.OBJECTIVE Recent studies have presented evidence that periodontal disease in pregnant women may be a determining factor for low birth weight. The present investigation was carried out to verify whether or not there is an association between maternal periodontal disease and low birth weight. METHODS This was a case-control study on 302 women, of whom 102 were the mothers of live newborns of low weight (case group) and 200 were the mothers of live newborns of normal birth weight (control group). The existence of an association between periodontal disease and low birth weight was evaluated by means of a multivariate logistic regression model that considered other risk factors for low weight. RESULTS The two groups were comparable with regard to age, height, pre-gestational weight, smoking, alcohol use, previous diseases, marital status, socioeconomic status, frequency of tooth-brushing and use of dental floss, number of meals per day and visits to the dentist. Periodontal disease was diagnosed in 57.8% of the mothers in the case group and 39.0% in the control group. Logistic regression analysis indicated a positive association between periodontal disease and low birth weight (unadjusted OR=2.15; 95% CI: 1.32-3.48), especially among the mothers with schooling of less than or equal to four years (ORadjusted=3.98; 95% CI: 1.58-10.10). CONCLUSIONS Periodontal disease is a possible risk factor for low birth weight.

Contribution of periodontal disease in pregnant women as a risk factor for low birth weight

UNLABELLED Starting in the 1990s, several authors sought to investigate the hypothesis that periodontitis during pregnancy may contribute towards the birth of low-weight children. However, this relationship is still not well established. The aim of this study was to evaluate whether this oral infection is associated with this gestational event. METHODS This was a case-control study among 548 puerperae, of whom 164 were the mothers of low-weight live births (case group) and 384 were the mothers of live births of normal gestational weight (control group). They were selected at two public hospital units in two municipalities in the State of Bahia. From interviews and data gathered using live birth cards or birth certificates, information was obtained regarding age, height, previous diseases, marital status, socioeconomic situation, smoking and alcohol use. Mothers who presented at least four teeth on which one or more sites had a probing depth of greater than or equal to 4 mm, clinical attachment loss of greater than or equal to 3 mm and bleeding on probing, at the same site, were deemed to present periodontal disease. The data were analysed by stratification from logistic regression. RESULTS Periodontal disease was diagnosed in 42.7% of the case group and 30% of the control group. A statistically significant association was found between periodontal disease and low birth weight (unadjusted OR = 1.74; 95% CI: 1.19-2.54), particularly among mothers with low schooling levels (adjusted OR = 2.30; 95% CI: 1.14-4.6). CONCLUSION The findings suggest an association between periodontal disease and low birth weight among mothers with low education levels.

Outcome measurements in studies on the association between osteoporosis and periodontal disease.

BACKGROUND The present study aims to compare different diagnostic criteria for periodontal disease that were used to study the association between periodontal disease and osteoporosis. METHODS A database from a case-control study was used. The present study included sociodemographic, lifestyle, and health-condition data; panoramic radiographs; and clinical measurements on periodontal conditions from 139 postmenopausal women. Each participant was classified with regard to the diagnosis of periodontal disease using five different criteria for the outcome measurement (OM) found in the literature in studies on the association between osteoporosis and periodontal disease (OM1 through OM5). The frequency of periodontal disease and diagnostic values were calculated taking OM5 as the gold standard and the main association measurement for all criteria using odds ratios. RESULTS The frequency of periodontal disease varied from 24.5% to 98.6% depending on the OM used. OM4 and OM3 presented the highest specificity (98.9% and 94.5%, respectively), whereas OM2 and OM1 presented the highest sensitivity (100% and 77.1%, respectively). The association measurements with adjustments for age and smoking varied significantly according to the OM over a range from 1.87 to 3.75, and there were also variations in the statistical significance of the associations found. CONCLUSIONS The results of this study emphasize that the frequency of periodontal disease may be influenced by different OMs and indicated variations outside of the association between osteoporosis and periodontal disease. Therefore, there is a need for prior selection of a precise measurement of periodontal disease in investigations on this topic.

Factors related to periodontal disease in a rural population

To estimate the prevalence and related aspects of periodontitis in a rural area of the State of Bahia, Brazil, this cross-sectional study was carried out in the village of Matinha dos Pretos, Feira de Santana County, Bahia, among 172 subjects ranging from 20 to 60 years of age. During household visits, a full-mouth periodontal exam was performed on each subject, who also answered a questionnaire about socio-demographic, economic and health-related issues. The factors assessed were plaque index, bleeding on probing index, probing depth, gingival recession or hyperplasia measurements. Clinical attachment loss was also calculated. The multivariate logistic regression method was used to evaluate the relative contribution of these factors to the periodontitis condition. The prevalence of periodontitis was 24.4%. The following factors were all positively associated with the presence of periodontitis: being male (OR = 1.58; 1.00 - 2.53), being 30 years of age or older (OR = 2.80; 1.00 - 7.39), living in a house where there was more than one person per room (OR = 1.53; 0.96 - 2.45), being a cigarette or pipe smoker or ex-smoker (OR = 1.49; 0.92 - 2.39), having a plaque index of over 65% (OR = 2.97; 2.72 - 7.39) and more than four missing teeth (OR = 1.51; 0.82 - 2.78). The authors concluded that socioeconomic and biological factors, especially poor oral hygiene and older age, are positively associated with periodontitis in the rural population of a small village in the county of Feira de Santana, State of Bahia, Brazil.

Family context and incidence of dental caries in preschool children living in areas covered by the Family Health Strategy in Salvador, Bahia State, Brazil.

Psychosocial factors influence family care and can jeopardize child development. This study aimed to analyze the association between maternal common mental disorders and incidence of early dental caries in preschool-age children living in areas covered by the Family Health Strategy in Salvador, Bahia State, Brazil, in a cohort design. A total of 472 children were examined and their mothers were interviewed from 2007 to 2008. Incidence of at least one tooth with caries was 21.19%, while 7.84% of the children showed high risk of caries. The results after adjusting for the childs age and maternal schooling showed that maternal common mental disorders were associated with high caries risk in deciduous teeth (adjusted RR = 2.41, 95%CI: 1.05-5.56, among children with 6 or fewer home appliances in the household; adjusted RR = 3.44, 95%CI: 1.06-11.17, among those that brushed twice or less per day). Maternal mental problems were associated with the development of caries in preschoolers.

Disfunção familiar referida pela presença de depressão materna e/ou alcoolismo na família e ocorrência de cárie dentária em crianças de dois e três anos de idade

OBJECTIVES: identify the association between family dysfunction related to the presence of alcoholism in the family and/or maternal depression symptoms and dental cavities/caries in children from two to three years old. METHODS: population comprised of 74 families in Salvador, Bahia. Data collection consisted of the cli-nical examination of the children and interviews of their mothers at home. Criteria of the World Health Organization were used to diagnose dental cavities/caries followed by disease prevalence classification. To identify symptoms of maternal depression and/or alcoholism in the family the Self-Report Questionnaire (SRQ-20) was used as well as the adapted CAGE scale, respectively. Descriptive analysis and adjusted prevalence ratio for confusion variables were estimated through non-conditional logistic regression. RESULTS: populations social and economic profile was homogenous. Caries/cavities in children prevalence was of 20.2%. A positive association between family dysfunction and caries was determined (PAgross= 3.06; 95%CI: 1.07-8.75). When this model was adjusted through confusion co-variables, family leadership and maternal job situation in the last two years, an increment of the association was noted (PAadjusted= 7.35; 95%CI: 1.50-36.07). CONCLUIONS: an association between family dysfunction and dental caries in small children is suggested.

O Papel da epidemiologia no planejamento das ações de saúde bucal do trabalhador

Este e um estudo de revisao que sistematiza achados de pesquisas sobre exposicoes ocupacionais e seus efeitos na saude bucal, destacando a importância dos dados epidemiologicos no planejamento de programas de saude bucal do trabalhador. Existem relatos de associacao potencial entre exposicoes ocupacionais e alteracoes bucais; entretanto, sao escassos os estudos sobre as condicoes de saude bucal dos trabalhadores em paises em desenvolvimento como o Brasil. Entre as exposicoes ocupacionais presentes na literatura odontologica, observa-se uma predominância de estudos sobre substâncias acidas e tambem exposicoes relacionadas com o acucar, como a poeira de acucar. As alteracoes bucais podem manifestar-se tanto nos tecidos duros (carie, erosao dental, etc.) como nos tecidos moles (lesoes da mucosa oral, doencas periodontais, etc). Por outro lado, observa-se que os programas de saude bucal do trabalhador, quando existem, muitas vezes nao consideram as especificidades dessa parcela da populacao que, alem de exposta aos fatores de risco mais conhecidos das principais doencas bucais, esta submetida a outros fatores relacionados ao ambiente de trabalho. Assim, considera-se relevante a discussao sobre a necessidade de maior producao de conhecimento nessa area, de capacitacao de recursos humanos e de implementacao de programas mais efetivos, baseados nos principios da vigilância em saude do trabalhador.

Occupational exposure to acid mists and periodontal attachment loss

This study investigated the hypotheses that occupational exposure to acid mists is positively associated with periodontal disease, assessed by periodontal attachment loss. The study sample included 530 male workers at a metal processing factory. Data were obtained from interviews and oral examinations. Periodontal attachment loss was defined as >or= 4mm at probing, in at least one tooth. A job exposure matrix was utilized for exposure evaluation. Exposure to acid mists was positively associated with periodontal attachment loss >or= 4mm at any time (prevalence ratio, PR(adjusted) = 2.17), past (PR(adjusted) = 2.11), and over 6 years of exposure (PR(adjusted) = 1.77), independently of age, alcohol consumption, and smoking, and these results were limited to workers who did not use dental floss. Exposure to acid mists is a potential risk factor for periodontal attachment loss, and further studies are needed, using longitudinal designs and more accurate exposure measures.

Association between osteoporosis treatment and severe periodontitis in postmenopausal women.

Objective: To estimate the association between osteoporosis treatment and severe periodontitis in postmenopausal women. Methods: This cross-sectional study comprised of 492 postmenopausal women, 113 women in osteoporosis treatment, and 379 not treated. Osteoporosis treatment consisted of systemic estrogen alone, or estrogen plus progestin, and calcium and vitamin D supplements, for at least 6 months. Severe periodontitis was defined as at least two interproximal tooth sites with clinical attachment loss of at least 6 mm, and at least one interproximal site with probing depth of at least 5 mm; and dental caries experience was measured using the decayed, missing, and filled teeth (DMFT) index. Analysis included descriptive statistics and Poisson multivariate analysis with robust variance. Results: Women receiving osteoporosis treatment had less periodontal probing depth, less clinical attachment loss, and less gingival bleeding than women not receiving treatment for osteoporosis (P ⩽ 0.05). In the osteoporosis treatment group, the estimated mean DMFT index score was approximately 20, the most frequent component being the number of missing teeth, and in the nontreated group, the DMFT index was approximately 19. The prevalence of severe periodontitis was 44% lower in the osteoporosis treatment group than in the nontreatment group. The prevalence ratioadjusted was 0.56, 95% confidence interval was 0.31 to 0.99 (P = 0.05), after adjustments for smoking, age, family income, and visit to the dentist. Conclusions: The results suggest that women treated with estrogen for postmenopausal osteoporosis have a lower prevalence of severe periodontitis than women not receiving treatment.

Severity of Periodontitis and Metabolic Syndrome: Is There an Association?

BACKGROUND Metabolic syndrome (MetS) is a major factor for the occurrence of cardiovascular events. Causal factors for MetS are not well defined or yet unidentified. Preliminary investigations suggest that infections and inflammation may be involved in the etiology of this syndrome. This study aims to estimate the association between the severity of periodontitis (exposure) and MetS (outcome). METHODS A cross-sectional study was conducted with 419 participants recruited from the Diabetes and Hypertensive Treatment Center, Feira de Santana, Bahia, Brazil. After administration of a questionnaire, general and oral clinical examination and laboratory tests were performed. Diagnosis of periodontitis and MetS was performed according to various criteria. The analysis of the effect of periodontitis on MetS used logistic regression analysis with adjustment for confounders. RESULTS The prevalence of periodontitis was found to be between 34.61% and 55.37%, depending on the classification definitions used, and the prevalence of MetS ranged from 60.86% to 67.06%. In the group with periodontitis, 14.08% had severe and 41.29% had moderate levels of periodontitis. There was an association between severe periodontitis and MetS after adjustment for sex, age, household density, alcoholic beverage consumption, smoking habit, and cardiovascular disease (odds ratio ORadjusted_6 = 2.11, 95% confidence interval = 1.01 to 4.40, P = 0.05). CONCLUSIONS The results suggest that periodontitis is associated with MetS, and that MetS prevalence is related to severe periodontitis.