Paulo Floriani Kramer

Utilização de serviços odontológicos por crianças de 0 a 5 anos de idade no Município de Canela, Rio Grande do Sul, Brasil

The aim of this study was to assess the use of dental services and age at first dental visit in preschool children in Canela, Rio Grande do Sul State, Brazil. A representative sample of under-five children was surveyed on National Childrens Vaccination Day. Childrens parents completed questionnaires containing socio-demographic data and age at first dental visit. Data were analyzed using multiple logistic regression. 192 children were examined. 13.3% of the sample had already visited the dentist at least once, but only 4.3% had their first dental visit by one year of age. The number of children who had already visited a dentist increased with age. Girls showed higher odds of having visited a dentist (OR = 1.46; 95%CI: 1.01-2.1). Public health strategies are needed to determine the effectiveness of health promotion and improve the use of dental services by preschool children.

Exploring factors associated with traumatic dental injuries in preschool children: a Poisson regression analysis.

OBJECTIVE This cross-sectional study aimed to investigate the factors associated with dental trauma in preschool children using Poisson regression analysis with robust variance. SUBJECTS AND METHODS The study population comprised 888 children aged 3- to 5-year-old attending public nurseries in Canoas, southern Brazil. Questionnaires assessing information related to the independent variables (age, gender, race, mothers educational level and family income) were completed by the parents. Clinical examinations were carried out by five trained examiners in order to assess traumatic dental injuries (TDI) according to Andreasens classification. One of the five examiners was calibrated to assess orthodontic characteristics (open bite and overjet). Multivariable Poisson regression analysis with robust variance was used to determine the factors associated with dental trauma as well as the strengths of association. Traditional logistic regression was also performed in order to compare the estimates obtained by both methods of statistical analysis. RESULTS 36.4% (323/888) of the children suffered dental trauma and there was no difference in prevalence rates from 3 to 5 years of age. Poisson regression analysis showed that the probability of the outcome was almost 30% higher for children whose mothers had more than 8 years of education (Prevalence Ratio = 1.28; 95% CI = 1.03-1.60) and 63% higher for children with an overjet greater than 2 mm (Prevalence Ratio = 1.63; 95% CI = 1.31-2.03). Odds ratios clearly overestimated the size of the effect when compared with prevalence ratios. CONCLUSIONS These findings indicate the need for preventive orientation regarding TDI, in order to educate parents and caregivers about supervising infants, particularly those with increased overjet and whose mothers have a higher level of education. Poisson regression with robust variance represents a better alternative than logistic regression to estimate the risk of dental trauma in preschool children.

Polarização da cárie em município sem água fluoretada

Increased overall exposure of the Brazilian population to fluoridated water and fluoridated dentifrices has been identified as the main factor in the reduction of caries prevalence. Thus, the objective of the present study was to evaluate the distribution of caries in a group of 437 children ranging from 6 to 12 years of age, residing in a city without a water supply fluoridation system and without a preventive dentistry program, with the aim of orienting future health measures towards improved cost-effectiveness. Clinical examination was performed on all the children, focusing on the indices defs (decayed, extracted, and filled primary dentition surfaces) and DMFS (decayed, missing, and filled permanent dentition surfaces), representing the number of dental surfaces that were either decayed, missing or with extraction indicated, or restored. Analysis of accumulated disease frequency in relation to the population showed that 37% of the children presented 70% of all the tooth disease, with a mean defs + DMFS of 28.6. This distribution demonstrates the phenomenon of polarization, in which most of the disease and treatment needs are concentrated in a small portion of the population.A maior exposicao da populacao brasileira ao fluor da agua e dos dentifricios fluoretados tem sido apontada como principal responsavel pela reducao da prevalencia de carie. Dessa forma, o objetivo do presente trabalho foi avaliar a distribuicao da carie em uma populacao de 437 criancas, com idades entre 6 e 12 anos, residentes em uma cidade sem sistema de fluoretacao da agua de abastecimento e sem programa odontologico preventivo, podendo, com isso, orientar futuras acoes de saude com melhor desempenho no que diz respeito a relacao custo-efetividade. Para tanto, foi realizado exame clinico em todas as criancas para avaliacao dos indices CPO-S e ceo-s, o que representa o numero de superficies dentarias cariadas, perdidas ou com extracao indicada e restauradas. A analise de frequencia acumulada da doenca em relacao a frequencia acumulada da populacao mostrou que 37% das criancas concentravam 70% da doenca, com um ceo-s + CPO-S medio de 28,6. Essa distribuicao evidencia o fenomeno da polarizacao, no qual uma pequena parcela da populacao concentra a maior parte da doenca e das necessidades de tratamento.

Dental anomalies and associated factors in 2- to 5-year-old Brazilian children

BACKGROUND Dental anomalies in primary teeth may lead to functional and aesthetic disorders, and their recognition contributes to early diagnosis and long-term treatment planning. OBJECTIVE This study investigated the prevalence of dental anomalies in primary dentition and associated factors in Brazilian preschoolers. METHODS The study population of this cross-sectional study comprised 1260 2- to 5-year-old children from public nurseries in Canoas, southern Brazil. Dental anomalies were recorded by five trained examiners according to Kreiborg criteria; classification included double teeth, hypodontia, supernumerary, and microdontia. RESULTS Dental anomalies as a group were found in 2.5% of children, although no significant difference occurred between genders and races. All the anomalies were observed in the anterior region, with no significant differences between the arches. However, supernumerary teeth were significantly more frequent among the non-white racial group (Fisher; P = 0.025) and double teeth on the lower arch (McNemar; P = 0.020). Individual anomaly frequencies were: double teeth, 1.3%; hypodontia, 0.6%; supernumerary, 0.3%; and microdontia, 0.3%. CONCLUSIONS The frequency of primary dentition anomalies as a group was greater than that reported in other populations; the findings of this study provide a clear vision of the distribution of this oral condition and may well contribute to early detection and treatment planning.

Maternal education is an independent determinant of cariogenic feeding practices in the first year of life

AIM: To identify risk factors for cariogenic feeding practices in the first year of life. STUDY DESIGN: Cohort study. METHODS: 500 children born within the public health care system in São Leopoldo, Brazil, were recruited in a follow-up program. Anthropometric and demographic data were collected soon after birth; data on feeding practices were assessed at 12 months of age using a standardised questionnaire; clinical examination at 4 years of age allowed identification of cariogenic feeding practices in the first year of life and to quantify their relative risks. In the present study, the attributable risks of each child were summed, and the outcome was assessed for the upper quartile of scores for cariogenic feeding practices. STATISTICS: Adjusted relative risks for the outcome were estimated using robust Poisson regression models. RESULTS: A total of 327 children comprised the final study sample, i.e. were followed from birth to 4 years of age. Multivariate analysis showed that the risk of cariogenic feeding practices doubled in children from mothers with less than 5 years of education (RR 2.19, 95%CI 1.26–3.82) and was 70% higher in children from mothers with 5–8 years of education when compared with maternal education >8 years. The other independent variables were not associated with the outcome. CONCLUSIONS: Low maternal education is a risk factor for cariogenic feeding practices, independently of other factors. Mothers with low educational levels should be the focus of child health promotion interventions, especially those aimed at controlling dental caries.

Association between occlusal anomalies and dental caries in 3‐ to 5 year‐old Brazilian children

Objective To investigate the association between certain occlusal anomalies and the occurrence and severity of dental caries in Brazilian preschool children. Design Cross‐sectional study. Setting Twenty‐eight public nursery schools in Canoas, southern Brazil. Subjects and methods The study population comprised 890 three‐ to five‐year‐old children. Five trained and calibrated observers examined children for determination of decayed, missing and filled tooth (dmft) index (World Health Organization criteria including white spots) and orthodontic variables. Outcome measures Caries severity (dmft) and caries occurrence (dmft⩾1). Statistical analysis Multivariable analysis was performed using Poisson regression with robust variance in order to determine the occlusal anomalies which represent risk factors for the occurrence of the binary outcome. Results Caries severity was significantly higher among children without spacing in the maxillary anterior teeth (P = 0·001) and mandibular anterior teeth (P = 0·003) and among children without accentuated overjet (P = 0·023). The multivariable analysis demonstrated that children without spacing in maxillary anterior teeth had an increased risk of dental caries (prevalence ratio = 1·43; 95% CI, 1·05–1·93). Open bite, accentuated overjet and posterior cross‐bite were not associated with this outcome in the final model. Conclusions Absence of spacing in the maxillary labial segment represents a risk factor for dental caries in preschool children.

Gains in children's dental health differ by socioeconomic position: evidence of widening inequalities in southern Brazil

UNLABELLED Oral health inequalities are the measures by which equity in oral health is tracked. Despite widespread improvement in childrens dental health globally, substantial socio-economic disparities persist and may be worsening. OBJECTIVES Quantify 10-year changes in child caries occurrence by socio-economic position in a Southern Brazilian city and compare oral health inequalities over time. METHODS Representative surveys of dental caries in children (age <6 years) in Canoas, Brazil, were conducted in 2000 and 2010 following standardized methods. For each survey year, we calculated disparities by socio-economic position (maternal education and family income) in age- and sex-standardized caries occurrence (prevalence: dmft > 0; severity: mean dmft) using absolute measures (difference and Slope Index of Inequality) and relative measures (ratio and Relative Index of Inequality). RESULTS Comparing 2010 to 2000, caries occurrence was lower in all socio-economic strata. However, reductions were more pronounced among socio-economically advantaged groups, yielding no improvement in childrens oral health disparities. Some disparity indicators were consistent with increasing inequality. CONCLUSIONS Overall, dental caries levels among children in Canoas improved, but inequalities in disease distribution endured. Concerted public health efforts targeting socio-economically disadvantaged groups are needed to achieve greater equity in childrens oral health.

Exploring the profile of articles on traumatic dental injuries in pediatric dental journals

AIM To explore the profile of articles on traumatic dental injuries (TDI) published in leading pediatric dental journals between 2000 and 2010 via bibliometric analysis. METHODS A search was conducted on the PubMed database to find the six pediatric dental journals with the highest numbers of articles on TDI published between January 2000 and December 2010. All titles and abstracts of full-length articles were reviewed by two examiners. Studies focusing on TDI were independently categorized according to the following aspects: (i) year of publication; (ii) country where the study was carried out; (iii) study design; (iv) topic addressed; (v) type of TDI; and (vi) type of dentition. Data were analyzed in terms of frequency distribution. RESULTS Of a total of 3720 articles published in the six selected journals, only 119 (3.2%) focused on TDI, with no significant variations across the journals or years. The countries with the greatest number of publications on TDI were India (19.3%), followed by the USA (15.1%), Brazil (13.4%), and Italy (11.8%). Case report and case series were the dominant study design (53%). Most studies addressed treatment of TDI (63%) and described injuries to permanent teeth (68%), especially avulsion and crown fractures. CONCLUSIONS There is an urgent need for expanding the number and quality of research on TDI in pediatric dental journals, especially with better quality study designs. Cohort studies and investigations focusing on the assessment of health services and technologies are important targets for future research.

Oral health-related quality-of-life scores differ by socioeconomic status and caries experience

OBJECTIVES (i) Quantify the relative association between child dental caries experience and maternal-reported child oral health-related quality of life (OHRQoL); (ii) examine whether that association differed according to family socioeconomic status (SES); and (iii) explore whether absolute OHRQoL varied by family SES at similar levels of child caries experience. METHODS This study was a cross-sectional analysis of children in southern Brazil (n=456, mean age: 38 months) participating in an existing health centre-based intervention study. OHRQoL impact was quantified as mean score on the Brazilian Early Childhood Oral Health Impact Scale (ECOHIS) and compared over categories of caries experience (dmft: 0, dmft: 1-4, dmft: ≥5). Adjusted ECOHIS ratios between caries categories were calculated using regression modelling, overall and within socioeconomic strata defined by maternal education, social class and household income. RESULTS Caries prevalence (dmft >0) was 39.7%, mean ECOHIS score was 2.0 (SD: 3.5), and 44.3% of mothers reported OHRQoL impact (ECOHIS score >0). Increasing child caries experience was associated with worsening child and family quality of life: ECOHIS scores were 3.0 times greater (95% CI: 2.0, 4.4) for children with dmft ≥5 vs dmft=0, a pattern that persisted regardless of family socioeconomic status (P for interaction: all >0.3). However, adjusted for dental status and sociodemographic characteristics, mean ECOHIS scores were lower when reported by mothers of less educational attainment (ratio: 0.7; 95% CI: 0.5, 1.0), lower social class (ratio: 0.7; 95% CI: 0.5, 1.0) or in lower income households (ratio: 0.8; 95% CI: 0.6, 1.3). CONCLUSION Dental caries was associated with negative child and family experiences and lower OHRQoL across all social groups; yet, families facing greater disadvantage may report lesser quality-of-life impact at the same level of disease experience. Thus, subjective quality-of-life measures may differ under varying social contexts, with possible implications for service utilization, evaluating oral health interventions, or quantifying disease morbidity in low-SES groups.

Impact of traumatic dental injuries on oral health-related quality of life of preschool children: A systematic review and meta-analysis

Background Observational studies have suggested that traumatic dental injuries (TDI) can lead to pain, loss of function and esthetic problems, with physical, emotional and social consequences for children and their families. However, population-based studies that investigate the impact of TDI on oral health-related quality of life (OHRQoL) among preschool children are scarce and offer conflicting results. The aim of the systematic review and meta-analysis was to evaluate the impact of TDI on OHRQoL among preschool children (PROSPERO-CRD42015032513). Methods An electronic search of six databases was performed in PubMed (MEDLINE), ISI Web of Science, Scopus, Science Direct, EMBASE and Google Scholar, with no language or publication date restrictions. The eligibility criteria were TDI as the exposure variable, OHRQoL as the outcome and a population of children up to six years of age. RevMan software was used for data analysis. Results are expressed as odds ratios with 95% confidence intervals for the total score of the Early Childhood Oral Health Impact Scale (ECOHIS) as well as the scores of the Child Impact Section (CIS) and Family Impact Section (FIS). The random effect model was chosen and heterogeneity was evaluated using the I2 test. Results 2,013 articles were initially retrieved; 1,993 articles were excluded based on title and abstracts; 10 articles excluded after full-text analysis. Ten studies comprising a population of 7,461 preschool children were included in the systematic review and nine studies were included in the meta-analysis. TDI caused a negative impact on OHRQoL based on the overall ECOHIS (OR: 1.24; 95% CI: 1.08–1.43) and CIS (OR: 1.23; 95% CI: 1.07–1.41), but not the FIS (OR: 1.09; 95% CI: 0.90–1.32). Conclusions TDI negatively impacted on OHRQoL of preschool children. The present findings indicate the need for TDI prevention and treatment programs in early childhood.