Thiago Machado Ardenghi

Inequalities in the distribution of dental caries among 12-year-old Brazilian schoolchildren

We assessed the inequality in the distribution of dental caries and the association between indicators of socioeconomic status and caries experience in a representative sample of schoolchildren. This study followed a cross-sectional design, with a sample of 792 schoolchildren aged 12 years, representative of this age group in Santa Maria, RS, Brazil. Guardians answered questions on socioeconomic status and a dental examination provided information on the dental caries experience (DMF-T). Inequality in dental caries distribution was measured by the Gini coefficient and the Significant Caries Index (SiC). The assessment of association used Poisson regression models. Socioeconomic factors were associated with prevalence of dental caries for the whole sample and also for individuals with a high-caries level. Children from low-income households had the highest prevalence of dental caries. The Gini coefficient was 0.7 and the SiC Index 2.5. The percentage of caries prevalence was 39.3% (95% CI: 35.8%-42.8%) and the mean for DMF-T was 0.9 (± SD 1.5). Inequalities in the distribution of dental caries were observed and socioeconomic factors were found to be strong predictors of the prevalence of oral disease in children of this age group.

Children's use of dental services: influence of maternal dental anxiety, attendance pattern, and perception of children's quality of life

OBJECTIVES The purpose of the study was to investigate the influence of a childs clinical condition; maternal characteristics such as dental anxiety and dental visit pattern; socioeconomic conditions; and maternal perception of the childs oral health-related quality of life (OHRQoL) on a childs use of dental care services. METHODS A cross-sectional study of 608 mother-child dyads was conducted during the Childrens Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire regarding their use of dental services, dental anxiety (Dental Anxiety Scale), socioeconomic status, and perception of their childrens OHRQoL (the Early Childhood Oral Health Impact Scale). Clinical examination of the children was performed to assess dental caries (dmf-t). Associations between the above-mentioned factors and child use of dental services were assessed using Poisson regression models (prevalence ratio [PR]; 95% CI; P ≤ 0.05). RESULTS The majority of children (79.3%) had never had a dental appointment and of the children who had visited a dentist, 55 (43.65%) presented with untreated dental caries at the time of examination. More than half the mothers (60.2%) did not visit a dentist regularly. In the final model, low schooling level of mothers (PR, 0.64) and irregular visits to a dentist by the mother (PR, 0.48) were factors because of which a child did not have a dental appointment. Children who had experienced pain (PR, 1.56), those who had poor OHRQoL (PR, 1.49), and older children (PR, 2.14) visited a dentist with higher frequency. CONCLUSIONS Use of dental care services by preschool children was low, and treatment was neglected even among children who had visited a dentist. Children of mothers with low schooling level who do not visit a dentist regularly were at greater risk of not receiving dental care. Maternal perception of their childs oral health motivated visits to the dentist.

Socioeconomic inequalities in the distribution of dental caries in Brazilian preschool children

OBJECTIVES This study assessed the inequality in caries distribution and the association between socioeconomic indicators and caries experience of preschool children in a city in Brazil. METHODS A cross-sectional study in a multistage random sample of 455, 1-5-year-old children was conducted on National Childrens Vaccination Day in Santa Maria, Brazil. Calibrated examiners evaluated the prevalence of dental caries and parents provided information about several socioeconomic indicators by means of a semistructured questionnaire. Data were analyzed using Poisson regression model. RESULTS The caries prevalence was 23.5 percent and the means for the decayed, missing and filled primary teeth was 0.8. A high inequality in the caries distribution with Gini coefficient of 0.8 and Significant Caries Index of 2.8 was observed. The oldest children, non-white, with mothers having low level of education and from low household income had the highest prevalence of dental caries. CONCLUSION Socioeconomic factors are strong predictors for the inequality in caries distribution in Brazilian preschool children.

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.

Trends in dental caries in 1- to 4-year-old children in a Brazilian city between 1997 and 2008

OBJECTIVE The objective of this study was to assess trends in dental caries prevalence and severity in 1- to 4 year-old children living in Diadema, Brazil, over a 11-year period, from 1997 to 2008. METHODS In 2008 an epidemiological oral health survey was carried out and the results on caries were compared with five cross-sectional studies carried out using the same methods and criteria in 1997, 1999, 2002, 2004, and 2006 in the same city. In all surveys, children were randomly selected from those attending a National Day of Childrens Vaccination. Calibrated dentists carried out the clinical examination using WHO criteria. Caries trends were assessed by time-lag analysis. In total, 5348 children were examined in the six surveys over the 11-year period. RESULTS Time-lag analysis showed a marked and statistically significant decline in the prevalence (chi(2) for trends: P < 0.001) and severity (Kruskal-Wallis: P < 0.001) of dental caries between 1997 and 2008. CONCLUSION In conclusion, the last cohort of preschool children in Diadema had much better dental caries status than those in 1997.

Discriminant validity of the International Caries Detection and Assessment System (ICDAS) and comparability with World Health Organization criteria in a cross-sectional study.

OBJECTIVES The aim of this cross-sectional study in preschool children was to assess the ability of International Caries Detection and Assessment System (ICDAS) in discriminating socioeconomic factors associated with the presence of caries lesions at both noncavitated and cavitated thresholds and to compare with the standard World Health Organization (WHO) criteria. METHODS The study was carried out in Amparo, Brazil, during the National Day of Childrens Vaccination including 252 children aged 36-59 months. The same child was independently examined by two calibrated examiners, one using the ICDAS and the other using WHO criteria. Socioeconomic information was also recorded. Associations between socioeconomic factors and presence of caries assessed as binary (caries prevalence) and count outcome (actual dmfs values) obtained by WHO criteria and by ICDAS at noncavitated and cavitated thresholds were evaluated by Poisson regression analysis with robust variance. RESULTS Some covariates were significantly associated with the presence of caries evaluated by the WHO criteria and by ICDAS (using score 3 as cut-off point). When noncavitated scores of ICDAS were used to calculate the presence of caries, the discriminant power decreased. When dmfs values were used as outcome, no differences in the associations were observed between two systems or using noncavitated caries lesions. CONCLUSION Cavitated scores of ICDAS present similar discriminant validity compared with WHO criteria when presence of caries is used as outcome; however, when actual dmfs values are used, no differences are observed in using noncavitated or cavitated caries lesions.

Prevalence of tooth erosion and associated factors in 11-14-year-old Brazilian schoolchildren.

OBJECTIVE Prevalence data about tooth erosion has attracted increasing attention in the dental community; however, population-based studies that assessed the impact of demographic, socioeconomic, and dietetic predictors on tooth erosion are scarce. This investigation assessed the prevalence of this condition of a sample of 11-14-year-old schoolchildren and the etiological factors. METHOD A cross-sectional study in a multistage random sample of 944, 11-14-year-old Brazilian schoolchildren was conducted in Santa Maria, Brazil. We recorded the prevalence and severity of tooth erosion, dental caries, and dental enamel hypoplasia. Socioeconomic and habits/dietetic data were collected by a structured questionnaire. Data were analyzed using Poisson regression model taking into account the cluster sample. RESULTS Prevalence of tooth erosion was low (7.2%). The most affected teeth were the maxillary incisors. Labial surfaces were more often affected than palatal ones. All the erosive lesions observed were confined to the enamel. Older children [prevalence ratio (PR) = 1.71; 95% confidence interval (CI): 1.06-2.76] with dental enamel hypoplasia (PR = 1.98; 95% CI: 1.21-3.22) were more likely to have tooth erosion. No significant association was observed between tooth erosion, dental caries, habits and dietary patterns, and socioeconomic factors. CONCLUSION The data suggest that tooth erosion was associated with age and presence of hypoplasia. It may indicate the need of strategies to diagnose in early stages and to minimize consequences.

Validation of Visual Caries Activity Assessment A 2-yr Cohort Study

We evaluated the predictive and construct validity of a caries activity assessment system associated with the International Caries Detection and Assessment System (ICDAS) in primary teeth. A total of 469 children were reexamined: participants of a caries survey performed 2 yr before (follow-up rate of 73.4%). At baseline, children (12-59 mo old) were examined with the ICDAS and a caries activity assessment system. The predictive validity was assessed by evaluating the risk of active caries lesion progression to more severe conditions in the follow-up, compared with inactive lesions. We also assessed if children with a higher number of active caries lesions were more likely to develop new lesions (construct validity). Noncavitated active caries lesions at occlusal surfaces presented higher risk of progression than inactive ones. Children with a higher number of active lesions and with higher caries experience presented higher risk of developing new lesions. In conclusion, the caries activity system associated with the ICDAS presents predictive and construct validity in primary teeth in the assessment of occlusal caries lesions, but predictive validity was not observed in smooth surfaces.

Developmental enamel defects and their impact on child oral health-related quality of life

This cross-sectional study assessed the impact of Developmental Enamel Defects (DED) on Child Oral Health-Related Quality of Life (COHRQoL). A sample of 944 11- to 14-year-old Brazilian schoolchildren was examined for the prevalence and severity of DED. The children completed the Child Perceptions Questionnaire (CPQ11-14), and socioeconomic status was also collected using a questionnaire. Poisson regression models were used to assess the association between DED and overall and domain-specific CPQ11-14 scores. The prevalence of DED was 19.7%. In general, children with DED did not indicate any decrease in self-perception. However, this condition was associated with an impact on the functional limitation domain. The presence of DED may cause negative impacts on a childs perception of oral health and on their daily performance.

Socioeconomic and clinical factors associated with traumatic dental injuries in Brazilian preschool children

The aim of this paper was to assess the epidemiology of traumatic dental injury (TDI) in preschool children and its relation to socioeconomic and clinical factors. This study was carried out in Santa Maria, Brazil, during National Childrens Vaccination Day, and 441 children aged 12 to 59 months were included. Data about socioeconomic status were collected through a semi-structured questionnaire administered to parents. Calibrated examiners evaluated the prevalence of TDI, overjet, and lip coverage. Data were analyzed with a Poisson regression model (PR; 95% confidence intervals). The TDI prevalence was 31.7%. The maxillary central incisors were the most frequently traumatized teeth. The most common TDI was enamel fracture. No association was found between TDI prevalence and the socioeconomic status of children. After adjustments were performed, the eldest children with an overjet > 3 mm were more likely to have TDI than their counterparts. The data indicated a high prevalence of TDI. Only overjet was a strong predictor for TDI, whereas socioeconomic factors were not associated with TDI in this age group.