Saul Martins Paiva

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 determining factors of traumatic injuries to primary teeth in preschool children

The objective of the study was to assess the prevalence of dental injuries and the influence of determining factors in preschool children from Belo Horizonte, Brazil. A cross-sectional survey was carried out through clinical examinations and the application of a questionnaire to the parents of 419 children aged 0 to 5 years attending preschool. The sample was stratified by region, type of institution and age. The eighteen preschools visited were chosen randomly. The prevalence of traumatic injury to primary teeth was 39.1%. Enamel fractures were the most common traumatic injury (49.7%). Boys were 1.62 times more likely to have dental injuries than girls. Children with inadequate lip coverage were 3.75 times more likely to have a traumatic dental injury than those with adequate lip coverage. Children attending state preschools had nearly two times greater chances of having dental trauma than children attending private preschools. It was concluded that the prevalence of dental injuries in preschool children is high in Belo Horizonte, Brazil and constitutes a public health problem.

Psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS)

BackgroundOral disorders can have a negative impact on the functional, social and psychological wellbeing of young children and their families and cause pain/discomfort for the child. Oral health-related quality of life (OHRQoL) has emerged as an important health outcome in clinical trials and healthcare research. The Early Childhood Oral Health Impact Scale (ECOHIS) is a proxy measure of childrens OHRQoL designed to assess the negative impact of oral disorders on the quality of life of preschool children. The objective of this study was to evaluate the psychometric properties of the Brazilian version of the ECOHIS (B-ECOHIS).MethodsThis investigation was carried out in preliminary and field studies. The preliminary study comprised a cross-sectional study carried out in the city of Petropolis, Brazil. A sample of 150 children from two to five years of age was recruited at a public hospital. In the field study, an epidemiological survey was carried out in public and private preschools of Belo Horizonte, Brazil. The B-ECOHIS was answered by 1643 parents/caregivers of five-year-old male and female preschool children. In both phases, oral examinations were performed by a single previously calibrated dentist. Reliability was determined through test-retest reliability and internal consistency. Validity was determined through convergent and discriminant validities. The correlation between the scores obtained on the child and family impact sections was assessed.ResultsIn the preliminary (P) and field (F) study, test-retest reliability correlation values were 0.98 and 0.99 for the child impact section and 0.97 and 0.99 for the family impact section, respectively. The B-ECOHIS demonstrated internal consistency: child impact section (P: α = 0.74; F: α = 0.80) and family impact section (P: α = 0.59; F: α = 0.76). The correlation between the scores obtained on the child and family impact sections was statistically significant (P: rs = 0.54; F: rs = 0.62; p ≤ 0.001). In both phases of the study, B-ECOHIS scores were significantly associated with the decayed, missing and filled teeth index, decayed teeth and discolored upper anterior teeth (p < 0.05).ConclusionThe B-ECOHIS proved reliable and valid for assessing the negative impact of oral disorders on the quality of life of preschool children.

Influence of Nonnutritive Sucking Habits, Breathing Pattern and Adenoid Size on the Development of Malocclusion

OBJECTIVE To investigate the association of finger and pacifier-sucking habits, breathing pattern, and adenoid size with the development of malocclusion in primary dentition. MATERIALS AND METHODS A case-control study was carried out involving 300 preschool children, ages 3 to 6 years, randomly selected from 10 public and 10 private preschools from a large representative sample of 745 children. The study was developed to identify risk factors associated with the development of malocclusion. The case group (n = 150) was composed of individuals with at least one of the following malocclusions: anterior open bite, posterior crossbite, or overjet of more than 3 mm. The control group (n = 150) was made up of individuals without malocclusions. Other variables were assessed through questionnaires about oral habits, including the use of a dummy, finger sucking, duration of these habits; mouth-breathing analysis; and a lateral cephalometric radiograph to evaluate the airway obstruction related to the adenoids. Multiple logistic regression analyses were performed. Statistical significance was P < .05. RESULTS The risk factors for the occurrence of malocclusion in preschool children were duration of pacifier-sucking after 2 years of age (OR = 14.7) and mouth-breathing pattern (OR = 10.9). No significant associations were found between hypertrophied adenoids or finger-sucking habits and the occurrence of malocclusion. CONCLUSIONS The malocclusion in the primary dentition in preschool children was directly related to the duration of pacifier-sucking after 2 years of age and the mouth-breathing pattern.

A Systematic Review of Socioeconomic Indicators and Dental Caries in Adults

Increasing evidence suggests that socioeconomic factors may be associated with an increased risk of dental caries. To provide better evidence of the association between dental caries in adults and socioeconomic indicators, we evaluated the relation between these two conditions in a thorough review of the literature. Seven databases were systematically searched: Pubmed, Cochrane, Web of Science, Bireme, Controlled Trials, Clinical Trials and the National Institute for Health and Clinical Excellence. No restrictions were placed on the language or year of publication. The search yielded 41 studies for systematic review. Two independent reviewers screened the studies for inclusion, extracted data and evaluated quality using the Newcastle-Ottawa scale. The following socioeconomic indicators were found: educational level, income, occupation, socio-economic status and the community index. These indicators were significantly associated with a greater occurrence of dental caries: the subject’s education, subject’s income, subject’s occupation and the Gini coefficient. A high degree of heterogeneity was found among the methods. Quality varied across studies. The criteria employed for socioeconomic indicators and dental caries should be standardized in future studies. The scientific evidence reveals that educational level, income, occupation and the Gini coefficient are associated with dental caries.

Psychometric properties of the Brazilian version of the Child Perceptions Questionnaire (CPQ11–14) – short forms

BackgroundThe need to evaluate the impact of oral health has led to the development of instruments for measuring oral health-related quality of life (OHQoL). One such instrument is the Child Perceptions Questionnaire (CPQ11–14), developed specifically for 11-to-14-year-old children. As this questionnaire was considered long (37 items), shorter forms were developed with 8 (Impact Short Form: 8 – ISF:8) and 16 items (Impact Short Form: 16 – ISF:16) to facilitate use in the clinical setting and population-based health surveys. The aim of the present study was to translate and cross-culturally adapt these CPQ11–14 short forms for Brazilian Portuguese and evaluate the measurement properties of these versions for use on Brazilian children.MethodsFollowing translation and cross-cultural adaptation, the ISF:8 and ISF:16 were tested on 136 children from 11 to 14 years of age in the city of Belo Horizonte, Brazil. The instrument was administered by a trained researcher who also performed clinical examinations. The measurement properties (i.e. criterion validity, construct validity, internal consistency reliability, test-retest reliability) were determined. Discriminant validity was tested between groups, which were divided into children with no cavities and no malocclusion; children with cavities and without malocclusion; and children with malocclusion and without cavities.ResultsThe mean total score was 6.8 [standard deviation (SD) 4.2] for the ISF:8 and 11.9 (SD 7.6) for the ISF:16 (p < 0.001). Statistically significant associations were found between oral abnormalities and the subscales of the ISF:8 and ISF:16 (p < 0.05). Both test-retest stability and internal consistency, as measured by the intra-class correlation coefficient (ICC) (ISF:8 = 0.98 and ISF:16 = 0.97) and Cronbachs alpha (ISF:8 = 0.70 and ISF:16 = 0.84) proved to be adequate. Construct validity was confirmed from the correlation between the short form scores and oral health and overall well-being ratings. The score on the short forms of the CPQ11–14 was able to discriminate between different oral conditions. Criterion validity was satisfactory (p < 0.05).ConclusionThe Brazilian versions of CPQ11–14 ISF:8 and ISF:16 have satisfactory psychometric properties, similar to those of the original instrument.

Influence of psychosocial factors on the development of sleep bruxism among children

BACKGROUND Bruxism is described as an orofacial parafunction that affects both children and adults. The maintenance of the childhood habit into adulthood may compromise health. As there are few studies on this issue, there is a need for further research on sleep bruxism among children. AIM The aim of this study was to assess the prevalence of sleep bruxism in children and the influence of psychosocial factors. METHODS A cross-sectional study was carried out on 652 randomly selected children aged 7-10 years at public and private schools in Belo Horizonte, Brazil. The instruments used were: questionnaire for parents, Child Stress Scale, and the scales on neuroticism and responsibility from the prevalidated Big Five Questionnaire for Children. Psychological tests were administered and evaluated by psychologists. Sleep bruxism among children was reported by parents. The Social Vulnerability Index from the city hall database was used to determine the social classification of the families. The chi-squared test, binary and multivariate logistic regressions were used, with the significance level set at 5%. RESULTS A 35.3% prevalence of bruxism was found. No association was found between bruxism and stress, gender, age, or social vulnerability. The adjusted logistic model determined that children with high levels of neuroticism (OR = 1.9, CI 1.3-2.6) and responsibility (OR = 2.2, CI 1.0-5.0) are twice as likely to have the habit of sleep bruxism when compared to those who have low levels of these personality traits. CONCLUSIONS A high degree of responsibility and neuroticism, which are individual personality traits, are determinant factors for the development of sleep bruxism among children.

Relationship between Mothers’ Sense of Coherence and Oral Health Status of Preschool Children

Objective: The aim of the present study was to investigate the relationship between mothers’ sense of coherence (SOC) and oral health status in a representative sample of 5-year-old preschool children. Methods: A cross-sectional study was conducted in Belo Horizonte (Brazil) on a sample of 546 mothers and their 5-year-old children, randomly selected from preschools. Data were collected through questionnaires (mothers), the short version of Antonovsky’s SOC scale (SOC-13) and clinical dental examinations (children). Simple and multiple logistic regression analyses were performed on the data. The following 8 outcome variables were selected: dental caries, filled and missing teeth, dental pulp exposure due to caries, dental root fragment, visible plaque, gingivitis and supragingival calculus. The examination was carried out by 2 trained, calibrated examiners. Results: Mothers with a lower SOC were more likely to have children with decayed teeth (OR = 1.59, 95% CI = 1.01–2.29), dental pulp exposure (OR = 1.99, 95% CI = 1.06–3.77) or filled teeth (OR = 1.85, 95% CI = 1.12–3.06) regardless of the child’s social class and gender. Conclusion: The data indicate that mothers’ SOC is an important psychosocial determinant of the oral health status among preschool children.

Impact of oral health conditions on the quality of life of preschool children and their families: a cross-sectional study.

BackgroundDental caries, traumatic dental injury (TDI) and malocclusion are common oral health conditions among preschool children and can have both physical and psychosocial consequences. Thus, it is important to measure the impact these on the oral health-related quality of life (OHRQoL) of children. The aim of the present study was to assess the impact of oral health conditions on the OHRQoL of preschool children and their families.MethodsA preschool-based, cross-sectional study was carried out with 843 preschool children in the city of Campina Grande, Brazil. Parents/caregivers answered the Brazilian Early Childhood Oral Health Impact Scale and a questionnaire addressing socio-demographic data as well as the parent’s/caregiver’s perceptions regarding their child’s health. Clinical exams were performed by three researchers who had undergone a calibration process for the diagnosis of dental caries, TDI and malocclusion (K = 0.83-0.85). Hierarchical Poisson regression was employed to determine the strength of associations between oral health conditions and OHRQoL (α = 5%). The multivariate model was run on three levels obeying a hierarchical approach from distal to proximal determinants: 1) socio-demographic data; 2) perceptions of health; and 3) oral health conditions.ResultsThe prevalence of impact from oral health conditions on OHRQoL was 32.1% among the children and 26.2% among the families. The following variables were significantly associated with a impact on OHRQoL among the children: birth order of child (PR = 1.430; 95% CI: 1.045-1.958), parent’s/caregiver’s perception of child’s oral health as poor (PR = 1.732; 95% CI: 1.399-2.145), cavitated lesions (PR = 2.596; 95% CI: 1.982-3.400) and TDI (PR = 1.413; 95% CI: 1.161-1.718). The following variables were significantly associated with a impact on OHRQoL among the families: parent’s/caregiver’s perception of child’s oral health as poor (PR = 2.116; 95% CI: 1.624-2.757), cavitated lesions (PR = 2.809; 95% CI: 2.009-3.926) and type of TDI (PR = 2.448; 95% CI: 1.288-4.653).ConclusionCavitated lesions and TDI exerted a impact on OHRQoL of the preschool children and their families. Parents’/caregivers’ perception of their child’s oral health as poor and the birth order of the child were predictors of a greater impact on OHRQoL.

Validations of the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS)

This study aimed to evaluate the psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A total of 247 children aged 2 to 5 years and their parents/guardians participated in this study. A clinical oral examination was performed and the parents/guardians completed the ECOHIS questionnaire. Within a period of four-weeks, 20% of the participants repeated the ECOHIS questionnaire. Construct validity was determined using Spearmans rank correlation. Discriminant validity, internal consistency and test-retest reliability were also evaluated. The children were divided into 2 groups: group 1 (with dental caries) and group 2 (caries-free). Children with caries showed higher mean ECOHIS scores than the caries-free children. The child impact section (p < 0.01), family impact section (p < 0.01) and total ECOHIS scores (p < 0.01) were significantly correlated with tooth decay. Cronbachs alpha coefficients demonstrated satisfactory internal consistency. The Brazilian version of the ECOHIS is a valid instrument for assessing oral health-related quality of life in preschool children with Brazilian Portuguese-speaking primary caregivers.