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Background Evidence regarding the feelings evoked, distress caused, and the best way to conduct protective stabilization for the management of young children is lacking. Aim Describe the perceptions of mothers, psychologists, and pediatric dentists regarding the use of protective stabilization during the dental care of children up to three years of age attending a University Dental Clinic in southern Brazil. Design After watching a video of dental care involving the protective stabilization technique, individualized qualitative interviews were held with three groups [mothers (n = 5), psychologists (n = 7), and pediatric dentists (n = 4)] to investigate four categories of interest: importance of the technique, affective attitude, distress caused to the child, and participation of parents. After the transcription of the recorded comments, qualitative content analysis was performed. Results Protective stabilization generated emotional discomfort but was well accepted by all groups. All expressed the need to create a bond between the dentist and caregiver; and the active participation of the caregiver was considered fundamental. The mothers and psychologists rejected other options, such as passive restraint, general anesthesia, and sedation. Conclusion The three groups admitted having negative feelings, recognized the importance of protective stabilization, and suggested conditions for its use.

Early Childhood Caries (ECC) is prevalent around the world, but in particular the disease is growing rapidly in low- and middle-income countries in parallel with changing diet and lifestyles. In many countries, ECC is often left untreated, a condition which leads to pain and adversely affects general health, growth and development, and quality of life of children, their families and their communities. Importantly, ECC is also a global public health burden, medically, socially and economically. In many countries, a substantial number of children require general anaesthesia for the treatment of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on "Public Health Intervention against Early Childhood Caries" was held on 26-28 January 2016 in Bangkok (Thailand) to identify public health solutions and to highlight their applicability to low- and middle-income countries. After a 3-day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC. These should align with existing international initiatives such as the Sixtieth World Health Assembly Resolution WHA 60.17 Oral health: action plan for promotion and integrated disease prevention, WHO Guideline on Sugars and WHO breastfeeding recommendation. ECC prevention and control interventions should be integrated into existing primary healthcare systems. WHO public health principles must be considered when tackling the effect of social determinants in ECC. Initiatives aimed at modifying behaviour should focus on families and communities. The involvement of communities in health promotion, and population-directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost-effectiveness studies, should be conducted to evaluate interventions aimed at preventing ECC in different population groups.

Objective To compare counts of Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis and Fusobacterium nucleatum between crack users and non-users. Materials and methods A cross-sectional study was conducted involving seventy-four crack cocaine users and eighty-one non-users matched for age, gender and tobacco use. Demographic and clinical variables were analysed. Subgingival bacterial samples were collected from four sites with the greatest probing depths and were analysed using real-time polymerase chain reaction. Results No significant difference was found in the prevalence of total counts for each bacterial species analysed between groups. However, crack users had a 1.85 (95% CI: 1.03–3.31), 2.19 (95% CI 1.24–3.88), 2.53 (95% CI 1.27–5.04) and 2.40 (95% CI 1.22–4.75) greater probability of having the higher counts (≥75th percentile) for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum, respectively. Conclusion Although some crack users had higher (>75th percentile) bacterial counts for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum, total counts did not differ between crack users and non-users, leading to the hypothesis that the higher occurrence of periodontitis on crack users may be related to other non-bacterial factors.

Crack cocaine can alter functions related to the immune system and exert a negative influence on progression and severity of periodontitis. The aim of this study is to compare periodontal status between crack cocaine users and crack cocaine non-users and investigate the association between crack cocaine and periodontitis after adjustments for confounding variables.This cross-sectional study evaluated 106 individuals exposed to crack cocaine and 106 never exposed, matched for age, sex, and tobacco use. An examiner determined visible plaque index (VPI), marginal bleeding index, supragingival dental calculus, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Logistic regression was used to model associations between crack cocaine and periodontitis (at least three sites with CAL4 mm and at least two sites with PD3 mm, not in the same site or tooth).Prevalence of periodontitis among crack non-users and crack users was 20.8% and 43.4%, respectively. Crack users had greater VPI, BOP, PD ≥3 mm, and CAL ≥4 mm than crack non-users. Periodontitis was associated with age24 years, schooling ≤8 years, smoking, moderate/heavy alcohol use, and plaque rate ≥41%. Crack users had an approximately three-fold greater chance (odds ratio: 3.44; 95% confidence interval: 1.51 to 7.86) of periodontitis than non-users.Occurrence of periodontitis, visible plaque, and gingival bleeding was significantly higher among crack users, and crack use was associated with occurrence of periodontitis.

Background Early-life feeding behaviors foretell later dietary habits and health outcomes. Few studies have examined infant dietary patterns and caries occurrence prospectively. Objective Assess whether patterns in food and drink consumption before age 12 months are associated with caries incidence by preschool age. Methods We collected early-life feeding data within a birth cohort from low-income families in Porto Alegre, Brazil. Three dietary indexes were defined, based on refined sugar content and/or previously reported caries associations: a count of sweet foods or drinks introduced

Objectives To investigate the association between dental caries and obesity, evaluated by air displacement plethysmography, among 18-year-old adolescents from a birth cohort in the city of Pelotas, Brazil. Methods A cross-sectional study nested in a birth cohort study was conducted in Pelotas, Brazil. A random sample of 986 18-year-old adolescents was selected. The outcome variable was the occurrence of dental caries (DMFT ≥1) according to clinical examination by a trained and calibrated dentist. For the exposure variable (obesity), body fat percentage was measured using air displacement plethysmography and classified as normal weight ( P95). Sociodemographic and behavior variables were collected using a questionnaire. We performed multivariable Poisson regression analyses with robust variance to examine the association between dental caries and obesity. Results DMFT ranged from 0 to 19; mean (SD) was 2 (2.3), and median (P25–P75) was 1 (0–3). Body fat percentage ranged from 0.9 to 57.6%; mean (SD) percentage was 24.4% (11.6%), and median (P25–P75) was 25.1% (14.0–32.9%). The prevalence of dental caries was 66.5% (95% CI 63.6–69.5%), being significantly higher in female adolescents with lower maternal education, lower education, and sugar intake more than once a day. There were no differences in the probability of dental caries among individuals with normal weight, overweight, or obesity in the unadjusted model (P = 0.846) or after adjustment for sociodemographic (P = 0.864) variables. Conclusions Overweight and obesity were not associated with the occurrence of dental caries in 18-year-old adolescents.

AIM: To investigate risk factors for the occurrence of traumatic dental injuries (TDI) at 4 years of age. DESIGN: Prospective cohort study. METHODS: A birth cohort (n = 500) was recruited from the public healthcare system in Sao Leopoldo, Brazil. Demographic, socioeconomic, anthropometric, and behavioral variables were collected at 6 months, 1 year, and 4 years of age. Clinical examinations at 4 years of age were carried out by a single examiner using the Andreasen classification. Poisson regression was used to determine risk factors for the occurrence of TDI at 4 years of age. RESULTS: A total of 23.7% of the children (80/337) exhibited TDI at 4 years of age. The risk of TDI was 35% lower among children who had been breastfeed for ≥6 months relative risk (RR 0.65; 95% CI 0.43-0.97) and more than twofold higher among those who were bottle fed ≥ three times a day (RR 2.37; 95% CI 1.10-5.11) at 12 months of age. Higher household income in the first year of life and greater height at 4 years of age were significantly associated with the outcome. CONCLUSIONS: The identification of behavioral, socioeconomic, and anthropometric risk factors for TDI in early childhood can contribute to the elaboration of prevention strategies. Language: en

OBJECTIVE: To assess the effectiveness of home visits for advising mothers about breastfeeding and weaning on pacifier use in the first year of life. METHOD: A randomized field trial was conducted on mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo (intervention group = 200; controls = 300). The intervention group received the advice 10 days after the childs birth monthly up to 6 months at 8 10 and 12 months based on the Ten Steps for Healthy Feeding a Brazilian national health policy for primary care which follows WHO guidelines. Relative risk (RR) was used to estimate the effects of the intervention on the risk of using a pacifier. RESULTS: 55.4% of the children in the intervention group and 66.1% of the controls used a pacifier in the first year of life. The risk of using a pacifier was 16% lower for the intervention group (RR = 0.84; 95% CI 0.71-0.99). A multivariable Poisson regression model showed higher adjusted risk of using a pacifier for children who had breastfeeding interrupted in the first month of life (RR = 1.43; 95% CI 1.21-1.69) and whose mothers presented higher level of depression (RR = 1.40; 95% CI 1.17-1.66). CONCLUSIONS: Pacifier use is highly prevalent in the population studied. The home visits for dietary advice appear to help in reducing pacifier use in infants. These findings suggest the need for public health strategies that address early advice on pacifier use to promote child oral and general health. (c) 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Background The assessment of the factors that influence children's diets is important for supporting the development of public health policies for the prevention of diet-related diseases. The present study aimed to evaluate the diet quality of preschoolers by using the Healthy Eating Index (HEI) and to identify maternal and family characteristics associated with this score and its components. Methods The present study comprised a cohort study conducted with 345 low socioeconomic status children from Sao Leopoldo in southern Brazil aged 6 months and 3–4 years old. Dietary data were collected through 24-h recalls and diet quality was evaluated according to the HEI. Results The mean (SD) total HEI score was 65.7 (11.2). Only 9.6% (n = 33) of the children had a good diet. No significant association was detected between the overall diet quality of children and the characteristics. The prevalence of children who achieved the 75th percentile of the scores for grains [prevalence ratio (PR) = 0.65; 95% confidence interval (CI) = 0.43–0.98] and total fat (PR = 0.80; 95% CI = 0.69–0.93) was lower among children whose families had higher incomes, whereas the prevalence for grains was lower in those whose fathers were employed (PR = 0.53; 95% CI = 0.34–0.81). The prevalence for diet variety (PR = 1.44; 95% CI = 1.01–2.05) and milk (P = 1.18; 95% CI = 1.04–1.35) was higher and for total fat (PR = 0.83; 95% CI = 0.70–0.98) and saturated fat (PR = 0.76; 95% CI = 0.59–0.98) was lower among children whose mothers had higher levels of education. Conclusions The total HEI score in these children indicates that compliance with dietary guidelines is generally poor. Although the overall diet quality did not show variation across maternal and family characteristics, some components of the diet were affected by these features.

Feldens CA, Giugliani ERJ, Duncan BB, Drachler ML, Vitolo MR. Long-term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial. Community Dent Oral Epidemiol 2010; 38: 324–332. © 2010 John Wiley & Sons A/S Abstract – Objectives: To investigate the effectiveness of home visits advising mothers about healthy feeding practices during the first year of life on the occurrence of early childhood caries and severe early childhood caries at 4 years of age. Methods: We conducted a parallel randomized trial of mothers of single, full-term children with birthweight ≥ 2500g in Sao Leopoldo, Brazil. The intervention group received monthly advice up to 6 months and then at 8, 10 and 12 months by undergraduate nutrition students, based on the ``Ten Steps for Healthy Feeding'', a Brazilian national health policy for primary care based on World Health Organization guidelines. The primary outcome was the occurrence of early childhood caries at age four. Secondary outcomes included the occurrence of severe early childhood caries and the number of affected teeth: decayed (white spots and cavities), missing and filled teeth (d1+mft). Blinded observers ascertained feeding habits in the home and one blinded dentist performed dental examinations in a municipal clinic. This study is registered with ClinicalTrials.gov, number NCT00629629. Results: Of 500 mother-child pairs (200 intervention, 300 control) enrolled, 340 (141 intervention, 199 control) completed 4 year follow-up. As 138 (69.3%) controls but only 76 (53.9%) intervention children had early childhood caries, home counseling reduced incidence by 22% (RR 0.78; 95% CI 0.65-0.93). Severe early childhood caries incidence was reduced by 32% (RR 0.68; 95% CI 050-0.92). The mean number of affected teeth was lower for the intervention group (3.25) compared with the control group (4.15) (Mann Whitney U-test; p=0.023). No adverse effects were noted. Conclusions: Home nutritional advice during the first year of life decreases caries incidence and severity at four years of age in a low income community.

– 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, mother’s 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 Andreasen’s 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.

– Background: Traumatic dental injuries frequently occur at school environment. However, teachers are not prepared to provide the adequate emergency management. Aim: The objectives of this study were to identify the factors associated with teachers’ knowledge about dental trauma and to describe school managers’ perception of possible strategies to change the scenario. Subjects and methods: Our sample comprised 405 teachers from 17 public schools in Canoas, state of Rio Grande do Sul, Brazil, whose data were collected regarding demographic variables, training and professional experience information. The outcome was completely inadequate knowledge regarding trauma measured based on the answers to a structured questionnaire about dental fractures and tooth avulsion. The sample also included 14 school managers who answered a semi-structured questionnaire about the causes of teachers’ inadequate knowledge and possible strategies to change the scenario. Results: The multivariate analysis demonstrated that the probability of completely inadequate knowledge was higher among male teachers, with less professional experience, who had not achieved a graduate degree, who had not witnessed at least one dental trauma case at school and who had not been trained in first-aid. School managers identified the following causes of inadequate knowledge: the fact that the topic is not approached during the teachers’ training and continual education and lack of experience involving dental trauma at school. In addition, they suggested that lectures and courses including written and visual communication should be offered, as well as training workshops. Conclusions: Strategies to improve the teachers’ knowledge about dental trauma must take into consideration the results of the present study and optimize the inclusion of this topic in the teachers’ curricular training and pedagogical education in a continuous manner.

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.

AIMS: To examine the effects of the home environment on unintentional domestic injuries and related health care attendance in infants from deprived families. METHODS: Ten mechanisms that caused unintentional domestic injury during the first year were investigated in a population-based study of 1-year-old children in southern Brazil. Odds ratios of injury-related health care attendance were estimated by number of injury mechanisms reported. Variation in number of mechanisms (in the whole sample) and odds ratios of care attendance (in children with reported injuries) were estimated for socioeconomic and psychosocial variables. RESULTS: Among all children (394) 86% had injuries; 10.9% care attendance and 0.5% hospitalisation were reported, and 14.5% presented dental trauma. Injury-related care attendance increased with the number of injury mechanisms (linear trend OR = 1.34, 95% CI = 1.09-1.66). In multivariable linear regression, injury mechanisms increased with the number of home hazards (p = 0.047) and decreased with duration of exclusive breastfeeding (p = 0.039), maternal involvement-responsiveness (p = 0.037) and mother's paid work (p = 0.018). Injury-related health care attendance among children with reported injuries was positively associated with maternal involvement-responsiveness (OR = 2.27, 95% CI = 1.11-4.67) and home organization (OR = 2.25, 95% CI = 1.09-4.65). CONCLUSION: Injury control can benefit from policy and practice that improve housing, reduce home hazards and promote breastfeeding, maternal bonds, safety practices and injury care. Language: en

– The purpose of this study was to determine the prevalence and distribution of traumatic injuries to primary anterior teeth in children from zero to 6 years old, all attendees in 28 public nursery schools in Canoas (Brazil). A total of 1545 boys and girls participated in the study. The children were clinically examined for signs of trauma according to Andreasen's classification. Traumatic injuries were identified in 35.5% of children. The largest percentage of injuries was demonstrated by 3–4-year-old child, with no significant difference between boys and girls. The maxillary central incisor was the most vulnerable to injury, without differences between the right and the left side. Single tooth injury was predominant in all age groups. Crown fractures represented 83% of all traumatic injuries. Our findings emphasize the importance of encouraging parents to visit the dentist with their child at an early stage. Furthermore, parents and educators should be advised about prevention of traumatic injuries and actions to be taken in case of an accident.