Mario Vianna Vettore

The relationship of alcohol dependence and alcohol consumption with periodontitis: a systematic review.

OBJECTIVES The aim of this systematic review was to evaluate the studies about the relationship of alcohol dependence and alcohol consumption with periodontitis. DATA AND SOURCES A comprehensive search was performed in the Systematic Eletronic (PUBMED Medline, Latin American and Caribean Health Science-LILACS, Scientific electronic library online-SciELO and Cochrane Central Register of Controlled Trials-CCRT literature databases) from January 1965 to July 2008. The reference lists of the identified studies were also searched. RESULTS Of the 1530 papers identified, 11 cross-sectional and 5 longitudinal observational studies met the inclusion criteria. Seven of the 12 studies on alcohol consumption and 4 of the 4 studies on alcohol dependence reported positive associations between alcohol intake and periodontitis. There was heterogeneity among studies concerning the methods of assessment of alcohol dependence, alcohol consumption and periodontitis. Therefore no meta-analysis was performed. Although smoking was properly addressed in all selected studies, the confounding effect of dental plaque was taken into account in only 6 studies. CONCLUSION Alcohol consumption can be considered a risk indicator for periodontitis. Longitudinal studies on the association of alcohol dependence and alcohol consumption with periodontitis are needed to confirm the association or not.

Periodontal infection and adverse pregnancy outcomes: a systematic review of epidemiological studies

The objective of this systematic review was to evaluate analytical studies on periodontal disease as a possible risk factor for adverse pregnancy outcomes. A literature search of the MEDLINE, SciELO, and LILACS bibliographic databases and CAPES thesis database was conducted up to December 2005, covering epidemiological studies of periodontal disease and adverse pregnancy outcomes. Of the 964 papers identified, 36 analytical studies met the inclusion criteria. Twenty-six epidemiological studies reported associations between periodontal disease and adverse pregnancy outcomes. There was a clear heterogeneity between studies concerning measurement of periodontal disease and selection of type of adverse pregnancy outcome. Therefore no meta-analysis was performed. Most studies did not control for confounders, thus raising serious doubts about their conclusions. The methodological limitations of most studies did not allow conclusions concerning the effects of periodontal disease on adverse pregnancy outcomes. Larger and methodologically rigorous analytical studies using reliable outcomes and exposure measures are recommended.

Partial recording protocols for periodontal disease assessment in epidemiological surveys

The objective of the present study was to compare the reliability of four partial-mouth protocols for assessing shallow, moderate, and deep sites for periodontal pocket depth and clinical attachment levels. Periodontal pocket depth and clinical attachment level measurements were recorded for 156 subjects (age > or = 30). The four models of partial-mouth protocols compared were: Model I: all sites per tooth in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model II: buccal sites in a full-mouth protocol, Model III: buccal sites in the random half-mouth protocol randomly selecting one maxillary and mandibular quadrant, Model IV: all sites per tooth using Community Periodontal Index teeth. In comparison with full mouth examination, Model I did not show significant differences for periodontal pocket depth and clinical attachment level parameters. Models II and III were different for some periodontal pocket depth means, and Model IV significantly overestimated all clinical parameters related to periodontal disease. Model I appears to be adequate to substitute for the full-mouth examination to assess the prevalence and severity of chronic periodontal disease in adults.

Malocclusion characteristics of patients with cleft lip and/or palate.

This study aimed to evaluate the malocclusions of patients with a cleft lip and/or palate (CLP) and to compare malocclusion characteristics between subjects with a pre-foramen incisor cleft (PIC) and a trans-foramen incisor cleft (TIC). A cross-sectional study was conducted of 117 cleft patients (53 per cent male) aged 6-37 years (mean age 14.7 ± 7.4 years) who attended the Dental Specialty Center in the city of Fortaleza, Brazil, between 2004 and 2007. Oral clefts were classified and radiographic examinations and dental casts were analysed to determine malocclusions and facial patterns. Malocclusion measurements were compared between the PIC and TIC groups by Mann-Whitney and Fishers exact tests. The percentage of subjects with PIC, TIC, post-foramen incisor cleft, and rare cleft were 20.5, 73.5, 5.1, and 0.9 per cent, respectively. The prevalence of malocclusions in subjects with a CLP was 82.1 per cent (molar relationships Classes II and III) in 6- to 12-year-olds, and a severe malocclusion [dental aesthetic index (DAI)] was observed in all patients aged 13 years and above. The frequency of patients with a normal canine relationship, open bite, and anterior crossbite was higher in the PIC group than in the TIC group (6-12 years). Patients aged 13 years and above in the PIC group showed lower means for the largest anterior maxillary irregularity, higher means for positive anterior mandibular overjet, a lower frequency of crowding in the anterior incisal segments, and a normal antero-posterior molar relationship compared with the TIC group. Severe malocclusions were prevalent in subjects with a CLP. Subjects with a TIC have higher prevalence of malocclusions than those with a PIC.

The association between low-socioeconomic status mother’s Sense of Coherence and their child’s utilization of dental care

OBJECTIVES The objective of this study was to investigate the relationship of low-socioeconomic status mothers Sense of Coherence (SOC) and their childs utilization of dental care services in a city of Southeast Brazil. METHODS A cross-sectional study was conducted on a sample of 190 schoolchildren aged 11-12 and their mothers in Sao João de Meriti-RJ, Southeast Brazil. The outcome variables were childrens use of dental care services and visiting dentists mainly for check-ups. Demographic and socioeconomic characteristics and data regarding childrens dental care use were collected through interviews with mothers. Childrens oral health-related behaviours as well as dental status (DMFS index), dental pain, Visible Dental Plaque and Bleeding on Probing Index were registered. Mothers SOC was assessed through the validated short version (13-item) of Antonovskys scale. Multiple logistic regression was used in the data analysis. RESULTS Of the mothers, 81.1% reported on their childs utilization of dental care services. Of them, 42.9% considered check-ups as the main reason for taking their children to dental services. Children whose mothers had higher levels of SOC were more likely to utilize dental care services (OR=2.08 95%CI=1.17-3.64) and visit a dentist mainly for check-ups (except for dental treatment) (OR=2.02 95%CI=1.06-3.81) than those whose mothers had lower levels of SOC. These findings were adjusted for socioeconomic status, childrens oral health-related behaviours and oral health measures. CONCLUSIONS Mothers SOC was a psychosocial factor associated with their childs pattern of use of dental care services in low-socioeconomic status families.

A salutogenic approach to oral health promotion

Theoretical frameworks on health promotion focusing on social determinants of oral health have highlighted promising approaches for improving the oral health of populations and reducing inequities in oral health. In the last two decades the salutogenic theory has gained ground in the field of health promotion, but not in oral health promotion. Instead of focusing on risk factors and behavior change, the theory highlights the importance of resources and the ability to use them. The models central construct, sense of coherence (SOC), suggests explanations of the relationship between life stressors and health status. The stronger the SOC, the more successfully people will cope with stressors and thus maintain their health. This paper discusses the potential of the salutogenic theory to guide the development of actions in the five fields of oral health promotion: creating supportive environments; promoting health through public policy; strengthening community action; developing personal skills; and reorienting health services. The theory can serve as a framework for oral health promotion measures that strengthen the available resources, create better ones, and enable people to identify and benefit from them.

Periodontal disease and cardiovascular disease

Data sources Medline (1980–present) and bibliographic citations from each article were consulted to find relevant studies.Study selection Analyses were restricted to cohort studies published between 1980 and February 2001 so that any effects of secular trends could be minimised. Studies were included if sample size was over 100 and if the ascertainment of exposure before outcome provided relative risk (RR) and confidence intervals (CI), or enough information to calculate these.Data extraction and synthesis Studies were reviewed by two dentists and two physicians. The RR, CI and standard errors were extracted or calculated. The quality of studies was assessed with a combination of modified Liddles criteria. Homogeneity was assessed with Q statistics and the data were analysed using a random-effects model.Results The summary RR was 1.19 (95% CI, 1.08–1.32), indicating a higher risk of future cardiovascular events in individuals who had periodontal disease than in those who did not. In an analysis stratified to individuals of ⩽65 years of age, the RR was 1.44 (95% CI, 1.20–1.73).Conclusions Periodontal disease appears to be associated with a 19% increase in the risk of future cardiovascular disease (CVD). This increase in RR is more prominent (44%) in individuals under 65 years of age. The increment of risk between subjects with or without periodontal disease in the general population is modest, at around 20%, because nearly 40% of population has periodontal disease. This modest increase may have a profound public health impact, however.

Condição de saúde bucal em idosos residentes no município de Manaus, Amazonas: estimativas por sexo

OBJETIVO: Caracterizar, segundo o sexo, as condicoes de saude bucal em idosos residentes no municipio de Manaus, AM. METODOS: Estudo seccional de base populacional com 667 individuos com idade entre 65-74 anos, aleatoriamente selecionados. As informacoes demograficas e socioeconomicas foram obtidas atraves de entrevista. O exame bucal para carie, edentulismo, uso e necessidade de proteses foi conduzido de acordo com as normas da OMS. RESULTADOS: Participaram do estudo 206 homens e 461 mulheres, com idade media de 69,2 anos, e 71,8% se declararam de cor parda. Em media, os sujeitos apresentaram 4,6 anos de estudo e renda familiar de R

Reviews in epidemiology: current lines of research and future prospects

1586,27. O indice de dentes cariados, perdidos e obturados foi de 29,0 ± 4,3, com predominio do componente perdido (95%). A media de dentes por individuo foi de 4,1 ± 5,7 e a prevalencia de edentulismo foi de 52,2%, sendo que apenas 3% dos idosos apresentaram 20 dentes ou mais. O uso de protese total superior e inferior foi observado em 79,2% e 37,1%, respectivamente, e a necessidade de protese total foi de 42,6% para o arco superior e 34,7% para o inferior. Idosos do sexo masculino apresentaram menor indice de dentes cariados, perdidos e obturados, mais dentes e menos edentulismo em comparacao com o sexo feminino. O uso de protese total superior e inferior foi maior nas idosas, enquanto a necessidade de protese unitaria ou parcial superior e inferior foi maior nos idosos. CONCLUSAO: As condicoes de saude bucal dos idosos em Manaus caracterizaram-se pela elevada ocorrencia de perda dentaria, especialmente entre as mulheres. As taxas de uso e a necessidade de protese total foram elevadas e diferentes segundo sexo.

Sociodemographic and clinical aspects of quality of life related to oral health in adolescents = Aspectos sociodemográficos e clínicos da qualidade de vida relacionada à saúde bucal em adolescentes

Cad. Saúde Pública, Rio de Janeiro, 24 Sup 4:S472-S473, 2008 More than 150 years after the pioneering study by John Snow, more than 50 years since the Framingham longitudinal studies, and more than 30 years since the British civil servants cohort (the Whitehall Study), the improvement of methods and the growing output in epidemiology have led to the creation of epidemiological subspecialties like clinical epidemiology, environmental epidemiology, social epidemiology, and nutritional epidemiology. The list of subspecialties is virtually unlimited, since the epidemiological method has proven highly flexible in its dialogue with other scientific fields, as demonstrated by its partnership with genomic research. The volume of research and publications in epidemiology has reached such numerical levels that it becomes impossible even for specialists to read a representative set of studies. More specifically, when the target public consists of professionals working directly in health services, there is a notorious incompatibility between the amount of information produced and the capacity to access and process it in sufficient time to back evidencebased policies and interventions. In the 20th century, the perception of this mismatch between scientific output and its utilization in the populations that need it (the ultimate target for such applied science) fostered the development of systematic reviews and later meta-analyses. First employed in 1904 by Karl Pearson to combine observations from different clinical trials on the efficacy of the typhoid vaccine in British soldiers, these methods proposed the summarization of epidemiological studies pertaining to a specific object within the vast field of epidemiology. The methodological delimitations vis-a-vis the study object, including specificities of exposures/interventions and outcomes/health problems have fostered important advances in knowledge. Despite acknowledgement that systematic reviews and meta-analyses provide a significant source of scientific information, the publishing space devoted to this type of academic output can still be considered limited and incapable of meeting the various demands, especially in the public health area. This international trend is mirrored in the Brazilian academic community. The initiative of publishing this special Supplement of Cadernos de Saúde Pública/Reports in Public Health results from these considerations and coincides with the 7th Brazilian Congress of Epidemiology and 18th IEA World Congress of Epidemiology in September 2008 in Porto Alegre, Rio Grande do Sul State, Brazil. The articles in this Supplement have resulted from a careful selection of papers by the Editorial Board of CSP in recent months. The overall orientation was to attempt to contemplate various relevant themes and approaches to epidemiology in public health. The journal’s goal is to publish an annual supplement dedicated to reviews in epidemiology, summarizing the state-of-the-art in the field and covering its different subspecialties. We hope that this inaugural supplement featuring reviews in epidemiology will reach its main objective, offering CSP readers a set of in-depth and representative articles in the field’s current watersheds. We further hope that the journal’s annual supplements in epidemiology will be consolidated as a tradition in the future, thus contributing to continuous updating for members of the field. Reviews in epidemiology: current lines of research and future prospects EDITORIAL