Patrícia Maria Zarzar

Cross-cultural adaptation of the Child Perceptions Questionnaire 11–14 (CPQ11–14) for the Brazilian Portuguese language

BackgroundOral-Health-Related Quality of Life (OHRQoL) instruments are being used with increasing frequency in oral health surveys. However, these instruments are not available in all countries or all languages. The availability of cross-culturally valid, multi-lingual versions of instruments is important for epidemiological research. The Child Perceptions Questionnaire 11–14 (CPQ11–14) is an OHRQoL instrument that assesses the impact of oral conditions on the quality of life of children and adolescents. The objective of the current study was to carry out the cross-cultural adaptation of CPQ11–14 for the Brazilian Portuguese language.MethodsAfter translation and cross-cultural adaptation, the CPQ 11–14 was tested on 160 11-to-14-year-old children who were clinically and radiographically examined for the presence or absence of dental caries. The children were receiving dental care at the Pediatric Dental and Orthodontic clinics of the Federal University of Minas Gerais, Brazil. To test the quality of the translation, 17 children answered the questionnaire. The internal consistency of the instrument was assessed by Cronbachs Alpha Coefficient and the test-retest reliability by Intraclass Correlation Coefficient (ICC).ResultsThe mean CPQ11–14 score were 24.5 [standard deviation (SD) 18.27] in the group with caries and 12.89 [SD 10.95] in the group without caries. Median scores were 20 and 10 in the groups with and without caries, respectively (p < 0.001). Significant associations were identified between caries status and all CPQ domains (p < 0.05). Internal reliability was confirmed by a Cronbachs alpha coefficient of 0.86. Test-retest reliability revealed satisfactory reproducibility (ICC = 0.85). The questionnaire proved to be a valid instrument. Construct validity was satisfactory, demonstrating highly significant correlations with global indicators for the total scale and subscales. The CPQ11–14 score was able to discriminate between different oral conditions (groups without and with untreated caries).ConclusionThe present study demonstrated that the CPQ11–14 is applicable to children in Brazil. It has satisfactory psychometric properties, but further research is required to evaluate these properties in a population study.

Prevalence and factors associated to dental trauma in infants 1–3 years of age

The aims of this study were to assess the epidemiology of traumatic dental injuries (TDI) to primary teeth in infants and toddlers between 1 and 3 years of age and investigate whether TDI was related to biological and social factors. A representative sample of infants and toddlers in the city of Belo Horizonte, Minas Gerais, Brazil (n = 519) was examined during a vaccination campaign. The evaluation of clinical signs of previous dental trauma was performed by nine previously calibrated examiners (intra-examiner Kappa = 0.95%; inter-examiner Kappa = 0.88%). Data were analysed through descriptive analysis, the chi-squared test (P < 0.050) and logistic regression. The prevalence of dental trauma was 41.6%. Among the 519 children examined, 193 (37.2%) had enamel fractures, 30 (5.7%) had enamel-dentin fractures and only three (0.6%) had enamel-dentin fractures involving the pulp. Dental care had been performed within the first 24 h in 4.1% of the sample and after 36 h in 0.8% of the sample. There was no statistically significant difference between genders. The most reported aetiologies were falls (28.8%) and collisions (6.8%). There were no statistically significant associations between the prevalence of dental trauma and non-nutritive sucking habits, dental caries or lip incompetence (P > 0.050). Children of mothers with low levels of schooling (0-6 years of study) had a greater prevalence of TDI (P = 0.001). The results of the logistic regression also demonstrated a significant association between dental injury and the Social Vulnerability Index (P = 0.045). Children from families with high social vulnerability (worse living conditions) had a 1.51 (95% confidence interval 1.0-2.2) greater chance of exhibiting TDI. These results can help guide the implementation of health promotion policies.

Correlation between socioeconomic indicators and traumatic dental injuries: a qualitative critical literature review

BACKGROUND/AIM Traumatic dental injuries are widespread and have become a serious dental public health problem in childhood. Despite its importance, very few studies have correlated the prevalence of permanent tooth injury and socioeconomic indicators. The aim of the present study was to evaluate just such a correlation. MATERIALS AND METHODS Electronic searches were performed in the following bibliographical databases: Brazilian Bibliography of Dentistry, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, The Cochrane Library, ISI Web of Knowledge, International Database for Medical Literature and PubMed Central. Reference lists from articles that fulfilled the inclusion criteria in this review were searched for additional relevant articles. The Brazilian Coordination of Higher Education Personnel Improvement Theses Databank was also included. Selection and analysis of the articles were performed independently by two authors of the present literature review. RESULTS A total of 21 of 98 articles were eligible for inclusion in the review. However, only nine articles performed all the methodology criteria analyzed. Seven of the surveys were carried out in Brazil and two in Thailand. The age of children was 9-14 years. Statistically significant associations between permanent tooth injuries and high economic status were found in four studies. CONCLUSION There were few studies correlating traumatic injuries in permanent teeth and socioeconomic indicators and the majority found no such association. It is suggested that the association between traumatic dental injuries and socioeconomic factors may be related to the indicators used, considering differences in their individual components. Furthermore, the heterogeneity of the methodologies hinders the comparison of the studies.

Measuring parental-caregiver perceptions of child oral health-related quality of life

The Parental-Caregiver Perceptions Questionnaire (P-CPQ) is an instrument that assesses a parents or a caregivers perceptions regarding the impact of childrens oral health status on quality of life. The aim of this study was to evaluate the psychometric properties of the Brazilian version of the P-CPQ. Following translation and cross-cultural adaptation, the P-CPQ was tested on 123 parents and caregivers of children between 11 and 14 years of age with dental caries and malocclusions. The parents/caregivers were recruited at dental clinics of the Federal University of Minas Gerais, where their children were receiving dental care. Psychometric properties were assessed through internal consistency, test-retest reliability, construct validity and discriminant validity. The mean P-CPQ score was 13.01 (SD=12.14) for the dental caries group and 16.57 (SD=13.13) for the malocclusion group. Internal reliability was confirmed by a Cronbachs alpha coefficient of 0.84. Test-retest reliability revealed satisfactory reproducibility (ICC=0.83). Construct validity was satisfactory, demonstrating significant correlations between global indicators and the total scale. The P-CPQ score was able to discriminate between different parental/caregiver perceptions of oral conditions in their children (dental caries and malocclusion). The results for the Brazilian version of the P-CPQ confirm that this questionnaire is a reliable and valid instrument to assess parental perceptions on the impact that oral health status has on childrens life quality.

Knowledge of teachers and students in physical education’s faculties regarding first-aid measures for tooth avulsion and replantation

The aim of the present cross-sectional study was to investigate the knowledge of undergraduate students and teachers at all physical education courses in the city of Belo Horizonte (Brazil) regarding first-aid measures to be taken following tooth avulsion as well as the need for the preventative use of mouth guards. The sample consisted of 442 individuals (Group 1: 53 teachers; Group 2: 389 undergraduate students). Data collection was carried out with the administration of a questionnaire with both objective and subjective questions addressing definitions, first-aid measures in cases of avulsion and tooth replantation, together with an assessment of the use and indication of mouth guards. Data analysis involved descriptive statistics and the chi-square test. The results revealed that 45.1% of the participants in both groups knew what a tooth replantation was. However, 91.6% judged themselves incapable of performing an immediate replantation. Among the overall sample, 45.9% has no knowledge on first-aid measures regarding tooth avulsion; sending the patient with an avulsed tooth to the dentist was the most often cited measure (42.3%). Immediate replantation was cited by 20.6% of the individuals in Group 1 and 5.9% of the individuals in Group 2 (P = 0.009). Regarding the storage medium, 17.1% of the individuals would keep the avulsed tooth in a dry medium. The majority of participants (58.3%) stated that the ideal extra-alveolar time for replantation was more than 360 min. Although 74% of the overall sample stated having knowledge of mouth guards, few reported making use or indicating the use of this piece of equipment. The present study revealed that the majority of teachers and undergraduate students of physical education courses do not have adequate knowledge regarding first-aid measures for tooth avulsion and do not use or indicate the use of mouth guards during sports activities.

Development and Validation of a Social Capital Questionnaire for Adolescent Students (SCQ-AS)

Objectives Social capital has been studied due to its contextual influence on health. However, no specific assessment tool has been developed and validated for the measurement of social capital among 12-year-old adolescent students. The aim of the present study was to develop and validate a quick, simple assessment tool to measure social capital among adolescent students. Methods A questionnaire was developed based on a review of relevant literature. For such, searches were made of the Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, The Cochrane Library, ISI Web of Knowledge, International Database for Medical Literature and PubMed Central bibliographical databases from September 2011 to January 2014 for papers addressing assessment tools for the evaluation of social capital. Focus groups were also formed by adolescent students as well as health, educational and social professionals. The final assessment tool was administered to a convenience sample from two public schools (79 students) and one private school (22 students), comprising a final sample of 101 students. Reliability and internal consistency were evaluated using the Kappa coefficient and Cronbachs alpha coefficient, respectively. Content validity was determined by expert consensus as well as exploratory and confirmatory factor analysis. Results The final version of the questionnaire was made up of 12 items. The total scale demonstrated very good internal consistency (Cronbachs alpha: 0.71). Reproducibility was also very good, as the Kappa coefficient was higher than 0.72 for the majority of items (range: 0.63 to 0.97). Factor analysis grouped the 12 items into four subscales: School Social Cohesion, School Friendships, Neighborhood Social Cohesion and Trust (school and neighborhood). Conclusions The present findings indicate the validity and reliability of the Social Capital Questionnaire for Adolescent Students.

Association between dental trauma and alcohol use among adolescents

AIM To investigate the association between dental trauma and alcohol use among adolescents between 14 and 19 years of age. MATERIALS AND METHODS A cross-sectional study was carried out involving a clinical exam performed by a calibrated researcher (intra-examiner Kappa = 0.93) and a self-administered questionnaire. The sample was representative of schoolchildren from the city of Diamantina (Brazil) and was made up of 738 adolescents. The type of school (public or private) was used as a socioeconomic indicator. Information on alcohol use (high risk and hazardous use) was acquired through the administration of the Alcohol Use Disorders Identification Test, which has been validated for use in Brazil. RESULTS The prevalence of dental trauma was 26.6%, and the prevalence of dangerous alcohol use was 44.3%. Dental trauma was significantly associated with a high risk of problems related to alcohol intake (P = 0.031), hazardous alcohol use (P = 0.009) and binge drinking (P = 0.036). The results of the Poisson logistic regression revealed that hazardous alcohol use [PR = 1.30 (95% CI: 1.01-1.66) P = 0.042] remained associated with dental trauma independently from age, gender, overjet, and type of school. CONCLUSIONS The high prevalence of dental trauma found among adolescents in the city of Diamantina (Brazil) was greater among those at high risk for problems related to alcohol intake and was significantly associated with hazardous alcohol use.

Prevalence of traumatic dental injuries and its association with binge drinking among 12-year-olds: a population-based study

OBJECTIVE To determine the prevalence of traumatic dental injuries and its association with binge drinking among 12-year-old schoolchildren. METHODS A cross-sectional study was carried out involving 588 students from a medium-sized city in Brazil. Data were collected through a clinical examination and self-administered questionnaires. Andreasens classification was used for the determination of traumatic dental injuries. The consumption of alcoholic beverages and binge drinking were evaluated using the Alcohol Use Disorders Identification Test--Consumption. Socio-economic status, overjet, and inadequate lip seal were also analysed. Associations were tested using the multivariate logistic regression analysis. RESULTS The prevalence rates of traumatic dental injuries, alcohol consumption in ones lifetime, and binge drinking were 29.9%, 45.6%, and 23.1%, respectively. The prevalence of traumatic dental injuries was significantly higher among those who engaged in binge drinking (PR = 1.410; 95% CI: 1.133-1.754) and even higher among those with inadequate lip protection and accentuated overjet (PR = 3.288; 95% CI: 2.391-4.522 and PR = 1.838; 95% CI: 1.470-2.298, respectively). CONCLUSIONS A higher prevalence rate of traumatic dental injuries was found among 12-year-olds who engaged in binge drinking. The high rate of alcohol intake among adolescents is worrisome considering the vulnerability of this population due to the intense transformations that occur in the transition from childhood to adulthood.

Is There an Association between Traumatic Dental Injury and Social Capital, Binge Drinking and Socioeconomic Indicators among Schoolchildren?

Objectives Traumatic dental injury is defined as trauma caused by forces on a tooth with variable extent and severity. The aim of the present study was to investigate the prevalence of traumatic dental injury and its association with overjet, lip protection, sex, socioeconomic status, social capital and binge drinking among 12-year-old students. Research Design and Method A cross-sectional study was conducted with a sample of 633 12-year-old students. Data were collected through a clinical exam and self-administered questionnaires. Socioeconomic status was determined based on mother’s schooling and household income. The Social Capital Questionnaire for Adolescent Students and Alcohol Use Disorders Identification Test (AUDIT-C) were used to measure social capital and binge drinking, respectively. Results The prevalence of traumatic dental injury was 29.9% (176/588). Traumatic dental injury was more prevalent among male adolescents (p = 0.010), those with overjet greater than 5 mm (p < 0.001) and those with inadequate lip protection (p < 0.001). In the multiple logistic regression analysis, overjet [OR = 3.80 (95% CI: 2.235–6.466), p < 0.0001], inadequate lip protection [OR = 5.585 (95% CI: 3.654–8.535), p < 0.0001] and binge drinking [OR = 1.93 (95% CI: 1.21–3.06), p = 0.005] remained significantly associated with traumatic dental injury. Conclusions The present findings suggest that a high level of total social capital and trust are not associated with TDI in adolescents, unlike binge drinking. The effects of social and behavioral factors on TDI are not well elucidated. Therefore, further research involving other populations and a longitudinal design is recommended.

Association between Molar Incisor Hypomineralization in Schoolchildren and Both Prenatal and Postnatal Factors: A Population-Based Study

Background Although studies throughout the world have investigated potential factors involved in the occurrence of molar incisor hypomineralization (MIH), the findings are varied and inconclusive. Objective The aim of the present study was to evaluate the prevalence of MIH and identify associated prenatal, perinatal and postnatal factors among Brazilian schoolchildren aged 8 and 9 years. Methods A cross-sectional study was conducted with a randomly selected population-based sample of 1181 schoolchildren. Information on demographic and socioeconomic characteristics as well as prenatal, perinatal and postnatal aspects was obtained through questionnaires. The clinical examination included the investigation of MIH based on the criteria of the European Academy of Paediatric Dentistry. Dental caries in the permanent dentition and developmental defects of enamel (DDE) on the primary second molars were also recorded. Data analysis involved descriptive statistics, bivariate tests and Poisson regression with robust variance. Results The prevalence of MIH was 20.4%. MIH was more frequent among children with dental caries in the permanent dentition (PR: 2.67; 95% CI: 1.98–3.61), those with DDE on the primary second molars (PR: 2.54; 95% CI: 1.87–3.45) and those who experienced asthma/bronchitis in the first four years of life (PR: 1.93; 95% CI: 1.45–2.56). Conclusions The prevalence of MIH was high and was associated with dental caries, the presence of DDE on primary second molars and the experience of asthma/bronchitis in early life. These findings could be useful in the identification of children in need of shorter recall intervals to prevent the consequences of MIH, such as enamel breakdown dental caries.