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Objectives: To evaluate the extent to which dental care factors in adulthood modify and, at the same time, mediate the association between race/ethnicity and social mobility from childhood to adulthood with two oral health outcomes in adults. Methods: In 2012, 1222 individuals 20–59 years old participated in the second wave of the Epi‐Floripa Study in Florianopolis, Brazil. Exposures included social mobility based on adulthood and childhood events, dental care in previous years, type of dental care coverage, reason for dental visits and race. The number of missing and decayed teeth were dichotomised as MT >0 and DT >0. Results: The prevalence of missing and decayed teeth was 61.9% and 23.0%, respectively. Age–sex adjusted inequalities in decayed and missing teeth among Black and White individuals were 41.2 percentage points (pp) (95% CI: 3.9–78.7) and 53.1 pp (19.5:86.7), respectively. Inequalities between those persistently higher and lower in socioeconomic position were 42.6 pp (14.6–70.7) and 90.0 pp (62.1–100). The Relative Excess of Risk due to Interaction (RERI) was not statistically significant (p < 0.05). Oaxaca‐Blinder decomposition analyses showed that dental care variables accounted for a small proportion of inequalities. Conclusions: This result implies that dental care is unlikely to significantly reduce or increase oral health inequalities in this particular population. [ABSTRACT FROM AUTHOR]

Objectives: To examine trends in incidence and mortality and evaluate overall survival (OS) of oral cancer in Singapore between 1968 and 2017. Methods: All diagnosed oral cancers by anatomical sites and population size were extracted from the Singapore Cancer Registry and the Department of Statistics Singapore. The trend of age‐standardized incidence rate (ASIR) and mortality rate (ASMR) (per 100 000 person‐years) of the lip, oral cavity and salivary gland cancers were evaluated by Prais‐Winsten regressions for each ethnicity and gender. Kaplan–Meier curves were performed to evaluate the OS by anatomical sites in each age group by ethnicity and sex. Results: Overall, 49, 3494 and 1066 people were diagnosed, and 28, 2310 and 476 died from lip, oral cavity and salivary gland cancers, respectively. The oral cavity cancer ASIR and ASMR reduced from 3.07 (1968–1972) to 2.01(2008–2012) and from 2.06 (1978–1982) to 1.21 (2013–2017) per 100 000 person‐years, respectively, with both highest in Indians throughout the whole period. Male:Female ratio ranged from 3.43 (1973–1977) to 1.75 (2013–2017) and from 3.41 (1978–1982) to 2.40 (2013–2017) for ASIR and ASMR, respectively. However, both salivary gland cancer ASIR and ASMR increased from 0.50 (1968–1972) to 0.80 (2008–2012) and from 0.18 (1968–1982) to 0.42 (1988–1992) per 100 000 person‐years, respectively, with both higher in males since 1993. Oral cavity cancer ASIR decreased for males aged ≥60, and Indian females ≥25, but increased among Chinese females aged ≥60. Oral cavity cancer ASMR decreased among Chinese aged 25–59, and among Malay males and Indian females. Salivary gland cancer ASIR increased among Chinese males aged ≥60 and Malay males aged 25–59; while ASMR increased among Chinese males aged ≥60. The median OS for oral cavity, lip and salivary gland cancers were 3.0, 9.3 and 18.1 years, respectively, with females surviving longer than males. Conclusions: Singapore has experienced a decline in the incidence and mortality of lip, oral cancer, an increase in in the incidence and mortality of salivary gland cancer, with an increase in the median overall survival rate. Monitoring the magnitude of oral cancer burden and the demographic, and temporal variations is necessary for tailoring health planning and setting priorities for future clinical care and research. [ABSTRACT FROM AUTHOR]

Aim: Investigating the association between sugar‐sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship. Materials and Methods: Cross‐sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30–50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC‐AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self‐reported diabetes. Results: Among 4473 cases analysed, 198 self‐reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval [CI] = 1.30–2.06), ≥7 (OR 1.92; 95% CI = 1.50–2.46) and ≥14 (OR 2.19; 95% CI = 1.50–3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self‐reported diabetes had less impact than the cumulative effect. Conclusions: SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to describe caries prevalence and experience trends of permanent teeth among Singapore schoolchildren between 2007 and 2019. Methods: Anonymized records of all 6‐year‐old Primary 1 (P1), 11‐year‐old Primary 6 (P6) and 14‐year‐old Secondary 3 (S3) before the start of each school year were extracted from the Integrated Dental Electronic Assessment System (IDEAS) by school level, ethnicity and sex. Prais–Winsten regression was used to assess trends of mean decayed, missing and filled teeth (DMFT) and caries prevalence (% DMFT > 0) among the schoolchildren by school level, with reported Average Annual Percentage Change (AAPC) together with respective 95% confidence interval (CI). Results: In total, 519 471 P1, 566 573 P6 and 548 138 S3 were included during the above period, and the majority were comprised of Chinese children (P1: 67.2%, P6: 68.8% and S3: 71.0%, respectively). Overall, the prevalence of caries dropped from 6.9% in 2007 to 3.5% in 2019 among P1, from 34.5% in 2009 to 20.3% in 2019 among P6 and from 41.5% in 2007 to 33.5% in 2019 among S3 schoolchildren. The mean DMFT reduced from 0.11 to 0.05 among P1, 0.72 to 0.35 among P6 and 1.05 to 0.76 among S3 schoolchildren during the same period. Caries prevalence and mean DMFT were consistently higher among girls. On average, caries prevalence decreased 5% per year in P1 (AAPC −5.0 [95% CI: −6.1, −3.9]) and P6 (AAPC −4.9 [95% CI: −5.7, −4.1]) and 2% among S3 (AAPC −2.0 [95% CI: −3.5, −0.4]) schoolchildren. Caries prevalence decreased approximately 4% ~ 5% annually among P1 and P6 schoolchildren regardless of ethnicity. The average decrease in caries prevalence was lower (about 2%) among all ethnicities at S3 school level. Conclusion: Dental caries in permanent dentition of Singaporean schoolchildren had decreased from 2007 to 2019. However, the decrease observed among primary school students was more than double that among secondary schoolchildren. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between self‐reported periodontitis and the senses of taste and smell among employees of one Danish and two American universities. Materials and Methods: Data were collected through a digital survey. A total of 1239 individuals from Aarhus University – Denmark, the University of Iowa, and the University of Florida – USA were included. Self‐reported periodontitis was the exposure. The perceived senses of taste and smell were the outcomes and were measured through a visual analog scale (VAS). Self‐perceived halitosis was the mediator. Confounders were age, sex, income, education, xerostomia, COVID‐19, smoking, body mass index, and diabetes. The total effect was decomposed into direct and indirect using a counterfactual approach. Results: The total effect of periodontitis on an impaired sense of taste was OR 1.56 (95% CI [1.02, 2.09]), of which 23% was mediated by halitosis (OR 1.13; 95% CI [1.03, 1.22]). Additionally, individuals with self‐reported periodontitis had a 53% higher chance of having impaired smell (OR 1.53; 95% CI [1.00, 2.04]), with halitosis mediating 21% of the total effect (OR 1.11; 95% CI [1.02, 1.20]). Conclusion: Our findings suggest that periodontitis is associated with distorted senses of taste and smell. Additionally, this association appears to be mediated by halitosis. [ABSTRACT FROM AUTHOR]

Objectives: Oral health inequalities exist worldwide, and cross‐country comparisons can provide valuable insights into country‐level characteristics contributing to such inequalities. However, comparative studies in Asian countries are limited. This study examined the magnitude of education‐related oral health inequalities in older adults in Singapore and Japan. Methods: Longitudinal data for older adults, aged ≥65 years, from the Panel on Health and Ageing of Singaporean Elderly (PHASE; 2009, 2011–2012, and 2015) and Japan Gerontological Evaluation Study (JAGES; 2010, 2013, and 2016) were used. Dependent variables were being edentate and having a minimal functional dentition (MFD; i.e. ≥20 teeth). The absolute and relative inequalities were calculated using the slope index of inequality (SII) and relative index of inequality (RII) for educational level [low (<6 years); middle (6–12 years); high (>12 years)] in each country. Results: A total of 1032 PHASE participants and 35 717 JAGES participants were included. At baseline among PHASE participants, 35.9% were edentate and 24.4% had MFD, while among JAGES participants, 8.5% were edentate and 42.4% had MFD. The prevalence of low, middle and high educational levels for PHASE was 76.5%, 18.0% and 5.5%, and for JAGES were 0.9%, 78.1% and 19.7%, respectively. Older adults in Japan had lower education‐related inequalities for being edentate [for both SII (−0.53, 95% CI = −0.55 to −0.50) and RII (0.40, 95% CI = 0.33–0.48)] and for not having MFD for both SII (−0.24, 95% CI = −0.27 to −0.20) and RII (0.83, 95% CI = 0.79–0.87) compared to Singapore. Conclusions: Education‐related inequalities for being edentate and not having MFD were higher among older adults in Singapore compared to Japan. [ABSTRACT FROM AUTHOR]

Aim: To assess the effect of cognition on the loss of functional dentition. Materials and Methods: We used data from the three waves of the Panel on Health and Ageing of Singaporean Elderly study (n = 4990 at baseline, 774 complete cases analysed) over 6 years (2009–2015). The outcome was the loss of functional dentition (<21 teeth). The exposure was cognitive impairment, while baseline confounders included age, sex, education, and ethnicity. Time‐varying confounders included income, living arrangements, smoking, diabetes, depressive symptoms, cardiovascular disease, and body mass index. We used marginal structural mean models with inverse probability treatment weighted. Results: The mean age of the participants was 70.2 years at baseline. The proportion of participants with loss of functional dentition increased from 74.6% to 89.9% over 6 years. Women, ethnic Chinese, less educated, smokers, people with diabetes, and individuals with depression had a higher proportion of loss of functional dentition than their counterparts. Loss of functional dentition was 1.8 times higher (odds ratio 1.80; 95% confidence interval 0.88–3.69) among those with cognitive impairment after taking well‐known confounders into account. Conclusions: After accounting for the time‐varying exposure and confounding evidence, the association between cognition and functional dentition among the elderly in Singapore remains uncertain. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. Methods: The socioeconomic data to this study were collected at the 48‐month follow‐up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality–SII and Concentration Index–CIX) were used. Results: The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro‐poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. Conclusions: Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children. [ABSTRACT FROM AUTHOR]

To analyze the effect of a comprehensive program of cognitive stimulation with digital inclusion, physical activity and social interaction, called "Oficina da Lembrança" (OL), on the cognitive status and concentration of biomarkers of neuroplasticity, neurodegeneration in adults aged 50 years and over attending a Memory Clinic. In this pilot randomized controlled study, 64 patients without dementia aged 45 to 79 years, seen at a University Memory Clinic in Southern Brazil, were randomly allocated to the intervention and control groups. The intervention consisted of participation in OL for 12 weeks. Serum biomarkers (brain-derived neurotrophic factor [BDNF], S100β, and neuron-specific enolase [NSE]) and cognitive status were analyzed as primary and secondary outcomes. The Wilcoxon test and Generalized Estimating Equations (GEE) were applied. Of the 64 patients invited to participate in the study, 33 (intervention: 17, control: 16) completed the study with all data. Improvement of cognitive status was significant in the intervention group (22.6 to 24.5) but not in the control group (20.1 to 21.1). There was a significant reduction of BDNF in OL participants, but no significant change was observed in the neurodegenerative biomarkers S100β or NSE. The concentration of BDNF decreased significantly post-OL in the intervention group (-288.1, 95%CI −362.1 to −94.1), even after adjusting for sex, age, and educational level. Cognitive status was significantly improved in OL participants. The OL program improved cognitive status, reduced serum BDNF levels, and empowered digitally excluded older adults. There was no effect of this intervention on S100β or NSE. This study has a Universal Trial Number (UTN) U1111-1195-2642 and was registered in the Brazilian Clinical Trials Registry (ReBEC), number RBR-38X665. [ABSTRACT FROM AUTHOR]

Objectives: This cross‐sectional study tested the presence of collider bias in the relationship between periodontitis and the carotid intima‐media thickness (cIMT). Methods: Data from 480 members of the 1982 Pelotas Birth Cohort, Brazil, were used. Periodontitis at the age of 24 years was determined as the main exposure. cIMT at the age of 30 years was set as the outcome. High‐sensitivity C‐reactive protein (hsCRP) was considered the mediator (collider). Confounding variables included sex, income, BMI and smoking. The association between cIMT and periodontitis was tested in conventional logistic regression stratified on hsCRP levels, marginal structural modelling and sensitivity analysis for collider stratification bias. Results: Conventional adjusted logistic regression analysis showed a positive association between periodontitis and cIMT (OR 1.5; 95% CI 1.1; 2.3). Stratified analysis according to the hsCRP levels revealed that the magnitude of the association was even higher among participants with hsCRP ≥ 3 mg/L (OR 2.2, 95% CI 1.1; 4.2) with 36% collider bias probability. No association between periodontitis and cIMT was found among participants with hsCRP < 3 mg/L (OR 1.3; 95% CI 0.8; 2.1). The association was not detected using marginal structural modelling (OR 1.3, 95% CI 0.8; 2.0). Conclusions: The association between periodontitis and surrogate markers of cardiovascular disease might be induced by collider bias stratification using conventional regression analysis. [ABSTRACT FROM AUTHOR]

Objective: To analyse trends in dental pain prevalence among Brazilian adolescent students over 6 years, focusing on inequalities by maternal education. Methods: Data from the National Adolescent School‐Based Health Survey (PeNSE) carried out in 2009 (n = 45 239), 2012 (n = 46 482) and 2015 (n = 35 592) were analysed, including ninth grade students from the 27 state capitals in Brazil who were of ages 11‐17 years or older. Variables analysed were dental pain within the last 6 months (yes/no) and the following sociodemographic factors: age, sex, race, type of school and maternal schooling (years of study: ≤8; 9‐11; ≥12). The prevalence of dental pain in the 3 years was compared using the Rao‐Scott test. Relative and absolute measures of socioeconomic (maternal education) inequalities in dental pain were applied using the slope index of inequality (SII) and the relative concentration index (RCI). Results: The prevalence of dental pain increased from 17.5% (95% CI = 16.9‐18.2) in 2009 to 20.4% (95% CI = 19.7‐21.1) in 2012, then to 21.8% (95% CI = 21.1‐22.5) in 2015. All sociodemographic factors investigated were associated with dental pain in all survey years. There was an increasing proportion of the outcome in all categories of maternal education over the years studied. Absolute (SII) and relative (RCI) inequalities regarding of maternal education were found; these indicate higher levels of dental pain in the lower socioeconomic group in each study year. However, no significant changes in inequalities were found from 2009 to 2015. Conclusions: The prevalence of dental pain increased in the 2009‐2012 and 2012‐2015 periods, and social inequalities were found. Higher levels of dental pain persisted in the lower maternal education group. Inequalities remained stable over time. Broader actions to reduce the existing inequalities are needed and should be a priority for public policies. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to test associations between a municipal social development indicator and indicators of public dental services; examine differences in the achievement of public dental services goals between fluoridated and nonfluoridated municipalities; and, quantify contribution of a municipal social development indicator in estimated mean differences in the public dental services indicators between fluoridated and nonfluoridated municipalities. Methods: A secondary analysis of data from 293 municipal dental health services records from Southern Brazil between 2010 and 2015 was conducted. Multivariable log‐binomial regression models were fitted to test the associations between municipal Human Development Index (HDI) and multiple public dental services indicators (proportion of public dental health service coverage, the proportion of tooth extraction among all clinical procedures, and monthly participation in supervised tooth brushing). Cut‐off points for outcomes were based on state goals for public dental services. Blinder‐Oaxaca decomposition analyses were performed to quantify the relative contribution of HDI in the differences in outcomes according to the municipal water fluoridation status. Results: Municipalities within the lowest tertile of HDI had 66% lower prevalence of having insufficient public dental health service coverage (less than state goals)than those in the highest tertile of HDI (PR: 0.44; 95% CI: 0.24, 0.50). Municipalities with lowest HDI had nearly 30% higher prevalence of failing the state goals regarding the proportion of extraction and supervised tooth brushing (PR: 1.30; 95% CI: 1.20, 1.40 and PR: 1.34; 95% CI: 1.23, 1.45, respectively). Mean public dental health service coverage was higher in nonfluoridated municipalities than fluoridated municipalities, and municipal HDI explained 36% of the total estimated mean difference. Conclusions: This study found associations between municipal social development and public dental services indicators in Southern Brazil. However, higher HDI was associated with lower public dental health service coverage, lower proportion of extraction and higher coverage of supervised tooth brushing [Correction added on 2 April 2019, after first online publication: In the preceding sentence, the text "but with a higher proportion of extraction and supervised tooth brushing" was changed to "lower proportion of extraction and higher coverage of supervised tooth brushing"]. Municipal HDI contributed significantly towards the gap in public dental coverage between fluoridated and nonfluoridated municipalities, favoring nonfluoridated municipalities. These findings have important policy implications for reducing oral health inequalities as it highlights the interplay between key oral health policies and their distribution according to municipal social development. [ABSTRACT FROM AUTHOR]

Objective: To investigate the controlled direct effect (CDE) of common mental disorders (CMD) on xerostomia which is not mediated by psychoactive medication intake. Methods: A population‐based cross‐sectional study was conducted with 1720 individuals aged 20‐59 years from Florianópolis, Brazil, in 2009. A two‐stage cluster sample design was adopted, with a systematic selection of census tracts, followed by a random selection of households. All inhabitants of the selected households belonging to the age group of interest were considered eligible to participate. CMD were assessed using the Self‐Reporting Questionnaire (SRQ > 7). Xerostomia was the outcome assessed by asking: "How often do you feel dry mouth?" with responses "often" and "always" taken as indicating xerostomia. Psychoactive medication intake was set as the mediator. Confounding factors included sex, age, per capita family income, educational attainment and smoking status. Marginal structural models were performed to quantify the CDE of CMD on xerostomia. Missing data were handled by multiple imputation by chained equations, and sensitivity analysis for unmeasured confounding was carried out. Results: The overall prevalence of xerostomia was 8.8% and 15.3% of the individuals presented with CMD. After adjustment, the prevalence of xerostomia among individuals with CMD was 3.2 times higher than that among individuals without CMD (PR = 3.2 [95% CI: 2.3; 4.5]). The CDE of CMD on xerostomia which is not mediated by the medication intake resulted in a three times greater prevalence of xerostomia (PR = 3.0 95% CI: 2.0; 4.5) among those individuals with CMD. Conclusions: Common mental disorders is directly and negatively associated with xerostomia. Clinicians should bear in mind the emotional state when investigating the underlying factors and managing patients with xerostomia. [ABSTRACT FROM AUTHOR]

This study used data from the 1982 Pelotas Birth Cohort Study, Brazil, to estimate the controlled direct effect of early-life socioeconomic position (SEP) on periodontitis at age 31 years, controlling for adulthood income and education, smoking, and dental hygiene. Sex was included as a covariate. Early-life SEP was measured at participant birth based on income, health services payment mode, maternal education, height, and skin color (lower versus middle/higher SEP). Periodontitis was assessed through clinical examination at age 31 years (healthy, mild periodontitis, or moderate-to-severe disease). Adulthood behaviors (smoking, dental hygiene) were the mediators, and adulthood SEP (education and income) represented the exposure-induced mediator-outcome confounders. A regression-based approach was used to assess the controlled direct effect of early-life SEP on periodontitis. Multinomial regression models were used to estimate risk ratios and their 95% confidence intervals. The prevalences of mild and moderate-to-severe periodontitis were 23.0% and 14.3%, respectively (n = 539). Individuals from the lowest early-life SEP had a higher risk of moderate-to-severe periodontitis controlled for mediators and exposure-induced mediator-outcome confounders: risk ratio = 1.85 (95% confidence interval: 1.06, 3.24), E value 3.1. We found that early-life SEP was associated with the development of periodontitis in adulthood that was not mediated by adulthood SEP and behaviors. [ABSTRACT FROM AUTHOR]

Background To evaluate the association between sociodemographic conditions and the quality of life (QoL) in adults and investigate whether these inequalities are greater among individuals with long-lasting chronic health conditions. Methods Cross-sectional analysis of the second wave (2012) of the EpiFloripa Study, a population-based cohort of 1720 adults living in Southern Brazil. QoL domains (physical, psychological, social relationships and environmental) were evaluated using the WHOQoL-BREF. Unadjusted and adjusted means of QoL according to socioeconomic and demographic variables were estimated and stratified by the presence of long-lasting chronic conditions (heart disease, stroke, diabetes, hypertension, chronic kidney disease, cirrhosis, tendinitis, arthritis, rheumatism and/or fibromyalgia) were peformed in 2016. Results Among 1222 interviewed adults (56.6% females, mean age 41.7 ± 11.4 years; follow-up rate 71.1%), the prevalence of 1+ long-lasting chronic disease was 37.3% (95%CI: 34.4–40.3). Their effect on the QoL was four times higher on the physical component (−9.6; 95%CI −12.1; −7.1) than on the other domains. Adults aged 40+ years with black skin colour or lower educational level had a lower physical QoL score only when any chronic disease was present. Among those with some chronic illness, the psychological domain was also lower among those aged 40+ years and with a lower family income. No interaction between sociodemographic variables and chronic diseases was observed for the other QoL domains. Conclusions The occurrence of long-lasting chronic diseases is associated with inequalities in QoL (physical and psychological domains), with stronger adverse effects among older adults, blacks and individuals with lower income or educational levels. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To test whether maternal education has a direct effect on gingival bleeding in adolescents aged 12 and to assess whether oral health behaviours over time mediate that association. Methods: Two oral health studies nested in the 1993 Pelotas (Brazil) birth cohort study were carried out in participants aged 6 (n = 359) and 12 years (n = 339). The proportion of teeth with bleeding on probing (BOP) and the median number of teeth with gingivitis at age 12 were recorded. Maternal education at birth was the exposure. Toothbrushing frequency and dental visit at ages 6 and 12 years were investigated as mediators of the association between maternal education at birth and gingival bleeding. Time‐varying family income through childhood and adolescence was included as later confounder. Paternal education was taken as baseline confounder. The controlled direct effect (CDE) of maternal education at child's birth on gingival bleeding at age 12 was estimated using marginal structural models (MSM). Additionally, path analysis was employed to estimate standardized direct, indirect and total effects of maternal education at birth on gingival bleeding. Results: Adjusted analyses using MSM showed that adolescents whose mothers had <8 years of education had 3.82 higher risk of having teeth with gingival bleeding above the median (rate ratio RR 3.82; 95% CI: 1.68‐8.19). Low maternal education doubled the proportion of gingival bleeding at age 12 not mediated by dental visit and toothbrushing frequency (RR 1.99; 95% CI: 1.52‐2.60). Path analysis revealed that maternal education had a direct effect on gingival bleeding independently of the mediators. Conclusions: The pattern of oral health behaviours does not explain the association between mother's education and adolescent's gingival bleeding. Individual‐based approaches focused on oral health‐related behaviours tend to fail to prevent gingival bleeding. [ABSTRACT FROM AUTHOR]

We aimed to estimate hypothetical effects of habits (smoking, alcohol consumption, and fat and carbohydrates consumption) combined with diet-induced overweight/obesity on the risk of periodontitis. The risk of any periodontitis, moderate/severe periodontitis, and the combination of bleeding on probing (BOP) and clinical attachment loss (CAL) was estimated using the parametric g-formula in adults aged 31 years from the 1982 Pelotas Birth Cohort in Brazil. Individuals in this cohort have been followed since birth. Hypothetical conditions were set independently for each risk factor and in combination for the entire population. A total of 539 participants had oral examinations in 2013. The cumulative 31-year risk under no intervention was 33.3% for any periodontitis, 14.3%, for moderate/severe periodontitis, and 14.7%, for BOP and CAL. According to our statistical approach, diet-induced overweight/obesity increased the risk of all outcomes: 11% (overweight) and 22% (obesity) higher risk of periodontitis; 12% (overweight) and 27% (obesity) higher risk of moderate/severe periodontitis; 21% (overweight) and 57% (obesity) higher risk of CAL and BOP. When overweight/obesity was combined with other unhealthy habits, the risk was even greater. Our findings suggest that the combination of diet-induced obesity with other risk factors may increase the risk of periodontitis. Further research in the field is required to corroborate our study. [ABSTRACT FROM AUTHOR]

Objective To assess whether short-term changes in income (IC) in adulthood were associated with self-rated oral health (SROH) and chewing difficulties (CD). Methods Secondary analysis of a longitudinal study in Florianópolis, Southern Brazil ( EpiFloripa); a total of 1720 adults participated in 2009 and 1223 in 2012. Logistic regression analysed the variation of SROH and CD according to short-term changes in income (IC) groups ('high income-stable', 'increased income', 'decreased income' and 'low income-stable') and adjusted for covariates (age, sex, marital status, skin colour, self-reported number of teeth and education). Results After adjusting for covariates, participants in the 'decreased income' were more likely to have poor SROH and CD than those at the 'high income-stable' group (OR: 1.78, 95% CI: 1.23, 2.58; OR: 2.76, 95% CI: 1.61, 4.74, respectively). Significant differences were also found between the 'low income-stable' and 'high income-stable' groups, but these differences were explained when adjusted for potential confounders. There were no significant differences in SROH and CD between the 'increased income' and the 'high income-stable' groups. Conclusions Overall, SROH and CD were adversely influenced by negative changes in income during adulthood in a short period of 3 years. [ABSTRACT FROM AUTHOR]

Background. The aim of this systematic review was to answer the focused question, "What are the prevalence and the epidemiological characteristics of trigeminal neuralgia in the general population?" Types of Studies Reviewed. This systematic review included observational population-based studies reporting the prevalence of trigeminal neuralgia (TN). The authors developed specific search strategies for LILACS, PubMed, ScienceDirect, Scopus, Web of Science, and Google Scholar. The authors evaluated the methodological quality of the included studies using criteria from the Agency for Healthcare Research and Quality. Results. Among 728 studies, the authors selected only 3 for inclusion. Two studies were classified as having low risk of bias and 1 as having moderate risk. The sample size ranged from 1,838 to 13,541 adults. This review identified a higher prevalence of TN in women, ranging from 0.03% (95% confidence interval [CI], 0.01-0.08) to 0.3% (95% CI, 0.16-0.55). The maxillary and mandibular branches of the trigeminal nerve were the most affected. The proportion between women and men who had TN was 3 to 1, and those in the age bracket between 37 and 67 years were the most affected. Conclusions and Practical Implications. The authors of this review identified a higher prevalence of TN in women older than 40 years that usually affected the maxillary and mandibular branches. Further research is required to validate the prevalence of TN in a well-structured, population-based study without a convenience sample. [ABSTRACT FROM AUTHOR]

This study tested whether the pattern of dental services utilization and the reason for the last dental visit mediate the association between educational attainment and dental pain. This is a cross-sectional analysis ( n = 1099) based on data from a prospective cohort study in adults, southern Brazil. The mediating effects were assessed by including interaction terms in logistic regression models and by the KHB method, which estimated the direct, mediated, and total effects of education on dental pain. The prevalence of dental pain was 17.5%. Individuals with less than 12 yr of study who visited the dentist to solve dental problems had a 20% higher odds of reporting dental pain than those with 12 or more years of study, who sought the dentist for preventive reasons. Dental services should also focus on preventive measures, especially if less-educated individuals visit the dentist only to treat problems; this may help reduce the frequency of negative oral health outcomes, including dental pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of this systematic review and meta-analysis was to assess the prevalence of clinical signs of temporomandibular joint (TMJ) disorders in children and adolescents. TYPE OF STUDIES REVIEWED: The authors selected only studies in which the investigators' primary objective was to evaluate the prevalence of signs of TMJ disorders according to the international Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) in children and adolescents. The authors performed electronic searches without language restriction in 5 databases. The authors also assessed quality. RESULTS: In this review and meta-analysis, the authors included 11 articles that described studies in which 17,051 participants had been enrolled. The overall prevalence of clinical signs of intra-articular joint disorders was 16% (95% confidence interval [CI], 11.59-19.94; n = 17,051). The prevalence of TMJ sounds (click and crepitation) was 14% (95% CI, 9.67-19.79; n = 11,316). The most prevalent sign was clicking (10.0%; 95% CI, 7.97-12.28; n = 9,665) followed by jaw locking (2.3%; 95% CI, 0.56-5.22; n = 5,735). CONCLUSIONS AND PRACTICAL IMPLICATIONS: One in 6 children and adolescents have clinical signs of TMJ disorders. The results of this systematic research study can alert dentists about the importance of looking for signs of TMD in children and adolescents. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to assess the prevalence of oral mucosal lesions and their impact on oral health-related quality of life ( OHRQoL) in children aged 5 years. Methods A sample of 1118 children from Pelotas' birth cohort, born in 2004 (response rate of 85.8%), were selected to participate in the study. Data were collected using a questionnaire applied to mothers and from the oral examinations of the children. OML were identified by type, site, and size. Early Childhood Oral Health Impact Scale ( ECOHIS) was used to assess caregivers' perception on children's OHRQoL. Descriptive, bivariate, and multivariate Poisson regression analyses were carried out, considering the impact on OHRQoL (total ECOHIS score) as the outcome. Results The prevalence of the OML was 30.1% (95% CI 27.5-32.9). Ulcers were the more prevalent type of lesion (29.4%), and the most affected site was the gums (31.0%). In bivariate analysis, there was a positive association between the presence of OML and OHRQoL impact measured by the following: mean overall score of ECOHIS ( P < 0.001); extent ( P < 0.001); prevalence ( P = 0.030); and intensity ( P = 0.010). After adjustments for sociodemographic and oral health variables, children with OML presented higher impact on OHRQoL [rate ratio ( RR) 1.38 95% CI 1.11; 1.72] comparing with their counterparts. Analyzing specific domains, children with OML also presented higher impact on children symptoms ( RR 1.46 95% CI 1.20; 1.66) and family functional ( RR 3.14 95% CI 1.59; 6.22) domains. Conclusion Almost one-third of children presented with oral mucosal lesions, and these lesions impaired children's oral health-related quality of life. [ABSTRACT FROM AUTHOR]

Background:A consistent and low-to-moderate association between markers of oral infection and loss of cognitive function has been demonstrated in the literature. However, such evidence comes from population studies carried out mainly in the USA. Objectives:To assess the association between tooth loss and loss of cognitive function in older people from Southern Brazil, with particular interest on how age may modify such association. In addition, we also test the association between loss of cognition (exposure) and tooth loss (outcome). Methods:Data from a baseline population-based cohort study were cross-sectionally analyzed, including tooth loss, cognitive impairment, sex, income, educational attainment, color/race, smoking status and a range of self-reported chronic diseases. Participants (n= 1705) were 60 years of age and over, from a midsized Southern Brazilian city. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using multivariable logistic and partial ordinal logistic analyses. Results:Edentate status was associated (OR 3.3; 95%CI 1.2–9.3) with severe cognitive impairment in the fully adjusted model. Moreover, there was an interaction between number of teeth and age on severe cognitive impairment. A weak association between severe cognitive impairment (exposure) and tooth loss (outcome) was identified after the adjustment for potential covariates. Conclusions:This study lends support to hypothesized association between tooth loss and severe cognitive impairment. Older adults seem to be particularly vulnerable to such effects. However, the bidirectional association between tooth loss and severe cognitive impairment cannot be ruled out. [ABSTRACT FROM PUBLISHER]

Objective To assess changes over time of the absolute and relative household income-related inequalities in inadequate dentition (ID) among Australians, Brazilians and USA adults. Methods This study used nationwide oral health survey data from Australia ( n = 1200 in 1999; n = 2729 in 2005), Brazil ( n = 13 431 in 2003; n = 9779 in 2010) and USA ( n = 2542 in 1999; n = 1596 in 2005). Absolute income inequalities were calculated using Absolute Concentration Index (ACI) and Slope Index of Inequality (SII), while relative inequalities were calculated using Relative Concentration Index (RCI) and Relative Index of Inequality (RII). Results Prevalence of ID in the studied period dropped from 8.7% to 3.1% in Australia; from 42.1% to 22.4% in Brazil; and remained stable in USA, nearly 8.0%. Absolute income inequalities were highest in Brazil, followed by the USA and Australia; relative inequalities were lower in Brazil than in Australia and the USA. ID was higher among Brazilian females (2010) and for the poorest group in all countries and periods. A remarkable reduction in absolute inequalities were found in Australia [Slope Index of Inequality (SII) and AIC 60%] and in Brazil (SII 25%; ACI 33%) while relative inequalities increased both in Australia (RCI and RII 40%) and in Brazil (RCI 24%; RII 38%). No changes in absolute and relative income inequalities were found in the USA. Conclusion There were still persistent absolute and relative income inequalities in ID in all examined countries. There has been a reduction in absolute income inequalities in ID but an increase in relative income inequalities. [ABSTRACT FROM AUTHOR]

Objective To test whether people with shortened dental arches ( SDA) have impaired oral health-related quality of life than those with more natural teeth. Method We analysed data from the 2004-2006 Australian National Survey of Adult Oral Health (including telephone interview, oral epidemiological examinations and mailed questionnaire). Participants aged ≥15 years and with intact anterior teeth were eligible in this study. We used multivariable negative binomial regression analyses to test the association of SDA, according to two alternative definition (1. having intact teeth and 3-5 natural occlusal units; 2. having intact anterior teeth and four natural occlusal units), with OHIP-14 severity and extent, adjusting for potential confounders, including demographic variables (age and sex), socioeconomic variables (income and education), behaviour characteristics (time since last visit, reason for the last dental visit, difficult in paying $100 dental bill and dental insurance possession), and dental outcomes (coronal and root caries, and periodontal disease). Result We analysed on 2,750 dentate participants that were eligible for the study. When SDA was classified as intact anterior teeth, four occlusal units and no dental prosthesis, no statistical difference in OHIP-14 severity or extent was identified compared with those with intact anterior teeth, over four occlusal units and no dental prosthesis. Participants who presented intact anterior teeth, 3-5 occlusal units and no prosthesis showed 50% higher rates of OHIP-14 severity than those with intact anterior teeth, over five occlusal units and no prosthesis while their OHIP-14 extent was similar to that of the reference group. Conclusion SDA is not associated with negative impacts on quality of life, according to both OHIP-14 severity and extent, when SDA is defined as four occlusal units and no dental prosthesis. When SDA is defined as 3-5 occlusal units and no dental prosthesis, it is only associated with OHIP-14 severity, but not OHIP-14 extent. [ABSTRACT FROM AUTHOR]

Objective To investigate the association of direct posterior restorations with gingival bleeding and dental calculus in young adults from a birth cohort. Methods A representative sample ( n = 720) of 5914 infants born live in Pelotas, Brazil, in 1982, were prospectively investigated, and posterior restorations and periodontal health outcomes assessed when they were 24 years of age. Tooth-level exploratory variables included the presence and number of restoration's surfaces. Demographic and socio-economic characteristics, oral health instructions, dental floss usage, dental caries presence and smoking were also considered whilst gingival bleeding and dental calculus were the outcomes. Multilevel logistic regression was carried out. Results Class I cavities were found in 15.2% (95% CI 14.5-15.9) of the teeth and class II in 3.6% (3.3-4.0). Percentage of teeth with gingival bleeding was 6.1% (5.6-6.6) and that with dental calculus 22% (21.2-22.8). Even after all the individual variables were controlled for, the presence of a class I [ OR1.51 (1.14-2.00)] and class II [ OR 1.76 (1.04-2.97)] cavities was positively associated with gingival bleeding. Class I [ OR1.36 (1.13-1.65)] and Class II [ OR1.80 (1.28-2.53)] cavities were associated with dental calculus also. Conclusions Posterior restoration and higher number of restored surfaces was associated with a higher prevalence of gingival bleeding and dental calculus around the restoration. [ABSTRACT FROM AUTHOR]

Objective To assess the impact of oral health outcomes on Oral Health-Related Quality of Life ( OHRQoL) in a school-based sample of Brazilian preschool children and their families. Methods A cross-sectional study was conducted in 1036 children aged 2-5 years attending all the public nurseries in Canoas, Brazil. Caregivers were asked to complete questionnaire on socioeconomic status and the Early Childhood Oral Health Impact Scale ( ECOHIS) on their perception of the children's OHRQoL. Clinical assessment included dental caries, traumatic dental injuries ( TDI) and malocclusion. Multivariable Poisson regression models with robust variance were fitted to assess covariates for the prevalence of impacts on OHRQoL following a theoretical hierarchical framework. Results 17.4% of the caregivers reported that their child had an impact on at least one ECOHIS item. Negative impacts were more prevalent on items related to pain, difficult drinking and eating some foods. The multivariable Poisson regression analysis showed that dental caries, TDI and malocclusion were associated with the outcome. The prevalence of having any impact on OHRQoL was almost three times higher for children with dental caries ( PR 2.74 95% CI 2.02-3.72) compared to those who were caries free; and approximately 1.5 times higher for those who presented TDI ( PR 1.70 95% CI 1.27-2.27) and malocclusion ( PR 1.42 95% CI 1.04-1.94). Conclusions The findings showed that caregivers of young children with oral disease and disorders perceived that both the children and other family members had poorer quality of life. Oral health policies should be included into general health programs based on common risk approach. [ABSTRACT FROM AUTHOR]

Purpose: This study proposes to examine the accuracy of four anthropometric indexes of obesity to identify the presence of hypertension and assess differences in the estimation and strength of effect measures of the association between each anthropometric measure and hypertension in Brazilian adults. Methods: A population-based cross-sectional study was carried out with a sample of 1,720 adults from Florianópolis, Brazil. Receiver operating characteristic (ROC) curves were performed to identify the sensitivity and specificity of the best cutoff values for anthropometric indexes (body mass index-BMI, waist circumference-WC, waist-to height ratio-WHtR and conicity index-C-index) for prediction of hypertension. The associations between anthropometric indexes and hypertension were analyzed by Poisson regression expressed as Prevalence Ratios (95% CI) adjusted for socio-demographic variables, health behavior, height, and anthropometric indexes. Results: Of the four anthropometric indexes studied, BMI, WC, and WHtR were found to have the largest areas under the ROC curve relative to hypertension in both sexes. The cutoff values in women and men associated with presence of hypertension were BMI of 24.9 and 24.6 kg/m², WC of 86.2 and 89.5 cm, WHtR of 0.49 and 0.50, and C-index of 1.15 and 1.18, respectively. WC and BMI had greater magnitude of association with presence of hypertension, adjusting for socio-demographic variables, health behavior, height, and anthropometric indexes in women and men, respectively. Conclusions: Anthropometric indexes provide an effective, simple, inexpensive, and non-invasive means for a first-level screening for hypertension. [ABSTRACT FROM AUTHOR]

Objectives To assess socio-demographic and behavioural inequalities in the impact of dental pain on daily activities, as well as to estimate the prevalence and intensity of dental pain. Methods A population-based cross-sectional study was carried out in Florianopolis, Southern Brazil, with 1720 adults aged 20-59 years in 2009-2010. Interviews were performed at adults' households, which included socio-demographics and behavioural characteristics, such as smoking status and alcohol abuse, along with mental health, self-reported health, number of retained teeth, dental pain occurrence (including its intensity and its impact on daily life). The association between the impact of dental pain and the covariates was tested using multinomial logistic regression. Results The global prevalence of dental pain was 14.8% (95% CI, 12.9-16.7). Adjusted analysis showed that women, those who self-classified as dark-skinned Blacks, those with low family income, current smokers and those with common mental disorders reported a higher impact of dental pain than their counterparts. Among subjects reporting dental pain, 12.7% indicated the maximum intensity, whereas 6.0% had some daily activity disrupted by it, such as difficulties in chewing certain foods (38.0%), sleep disturbance (21.0%), difficulty to work (21.0%) and difficulty in performing household tasks (8.0%). Prevalence ratios of impact of dental pain between the poorest income group and richest income group (2.4), between the highest and lowest schooling group (2.6), and between dark-skinned Blacks and Whites (2.1) were of higher magnitude than the dental pain prevalence ratios among the same groups (1.7, 1.3 and 1.4, respectively). Conclusions The impact of dental pain showed a social gradient. Inequalities between socio-economic groups found in this study should be taken into account, as the impact of dental pain leads to reduced daily activities and poor quality of life. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether tooth loss is associated with increased blood pressure among adults after controlling for socioeconomic, health, and lifestyle confounders. We also assessed the interactions between tooth loss and smoking status and tooth loss and age on systolic blood pressure ( SBP). Material and Methods A population-based cross-sectional study was carried out with 1720 adults from Florianópolis, Brazil. Data collection included blood pressure, anthropometric measures, and a questionnaire on socio-demographics, self-rated health, diabetes, self-reported number of natural teeth, and dental prosthesis. We used linear multivariable regression models for the association of blood pressure with tooth loss adjusting for potential confounders. Results Edentulous subjects had a SBP 8.3 mmHg (95% CI 0.1; 16.7) higher than those with more than 10 teeth in both arches after adjustment for potential confounders. We found interaction between tooth loss and smoking status. Moderate/heavy smokers were associated with considerably higher SBP than light, former or non-smokers among edentulous and also partly among dentate with less than 10 teeth in at least one arch, but there was no real association between smoking and SBP among those with 10 or more teeth in both arches. Conclusions Total tooth loss is associated with increased levels of SBP in this adult population. [ABSTRACT FROM AUTHOR]

Aim To evaluate the association between obesity and periodontal disease and the mediating effect of oral hygiene, systemic inflammation and carbohydrate intake. Material and methods Subjects born in 1982 in Pelotas, Brazil ( n = 5,914), have been followed for several times. Oral health was assessed in a representative sample of 720 individuals at 24 years. Obesity, waist circumference and number of episodes with obesity between 15 and 23 years of age were the main exposures. Mediating effect of oral hygiene, C-reactive protein level and carbohydrate consumption was also assessed. Results Obese individuals were more likely to have ≥2 teeth with gingival bleeding. However, after adjusting for confounders, the association was not statistically significant [ OR (obese × 2 or more teeth) 1.72 (95% CI: 0.95, 3.11)] and adjustment for potential mediators decreased the OR ( OR = 1.38). The risk of presenting calculus in obese subjects was 10% higher [ PR 1.10 (95% CI: 1.02, 1.18)]. The number of episodes of obesity between 15 and 23 years was associated with dental calculus. Periodontal pockets were not associated with obesity. Conclusion Systemic inflammation and oral hygiene may be mediating the association between obesity and gingivitis. Obesity was not associated with periodontal pockets in young adults in this cohort. [ABSTRACT FROM AUTHOR]

This study estimated the lifetime prevalence of toothache at ages 6 and 12 yr, the prevalence of toothache during the last month, and their association with social, behavioural and clinical exposures in the course of life of 339 12-yr-old children from a birth cohort in Pelotas, Brazil. Exploratory variables were collected in the perinatal study and during several follow-up studies. Prevalence ratios were calculated using Poisson regression, following a hierarchical conceptual model. The lifetime prevalence of toothache at ages 6 and 12 yr were 39% [95% confidence interval (CI) = (34;45)] and 63% [95% CI = (58;69)], respectively. Toothache during the last month was reported by 11% [95% CI = (8;15)]. Children who did not live with their biological father at birth, and children with higher dmf-t counts, reported a higher lifetime prevalence of toothache at age 6 yr. Children experiencing poverty between ages 0 and 4 yr, with higher dmf-t and DMF-T indexes presented a greater lifetime prevalence of toothache at 12 yr. Toothache within the last month was more likely to be reported by girls and by children who did not live with their biological father at birth. Preventive strategies should be implemented in early stages of the life cycle, taking into account the socio-economic and family context in which pain mostly occurs. [ABSTRACT FROM AUTHOR]

The authors conducted a systematic review and meta-analysis to verify the existence and level of scientific evidence concerning the association between metabolic syndrome (MetS), as the main exposure, and tooth loss (TL), as the outcome. Through electronic databases and partially through gray literature, the authors identified observational studies in adults. The authors used no date or language restrictions. The authors evaluated the studies' methodological quality by using the Newcastle-Ottawa Scale. The authors conducted a random-effects model meta-analysis. The authors assessed the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation criteria. Twelve studies met the eligibility criteria, and 9 were retained for the meta-analysis. Most were cross-sectional studies with good methodological quality. Participants with MetS had fewer teeth (standardized mean difference, −2.77; 95% confidence interval, −4.56 to −0.98) and an increased likelihood of lacking functional dentition (odds ratio, 2.37; 95% confidence interval, 1.89 to 2.96) than did those without MetS. The overall quality of evidence was very low. Better-conducted longitudinal studies are necessary to establish a causal relationship between MetS and TL to inform the best strategies to prevent TL in populations with MetS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Few studies have assessed the effect of breastfeeding, bottle feeding, and sugar consumption on children's dental caries. We investigated whether the duration of breastfeeding is a risk factor for dental caries in the primary dentition, independently of sugar consumption. METHODS: An oral health study (n = 1303) nested in a birth cohort study was carried out in southern Brazil. The average number of decayed, missing, and filled primary tooth surfaces (dmfs) and severe early childhood caries (S-ECC: dmfs ≥6) were investigated at age 5 years. Breastfeeding was the main exposure collected at birth and at 3, 12, and 24 months of age. Data on sugar consumption were collected at 24, 48, and 60 months of age. Marginal structural modeling was used to estimate the controlled direct effect of breastfeeding (0-12, 13--23, and ≥24 months) on dmfs and on S-ECC. RESULTS: The prevalence of S-ECC was 23.9%. The mean number of dmfs was 4.05. Children who were breastfed for ≥24 months had a higher number of dmfs (mean ratio: 1.9; 95% confidence interval: 1.5-2.4) and a 2.4 times higher risk of having S-ECC (risk ratio: 2.4; 95% confidence interval: 1.7-3.3) than those who were breastfed up to 12 months of age. Breastfeeding between 13 and 23 months had no effect on dental caries. CONCLUSIONS: Prolonged breastfeeding increases the risk of having dental caries. Preventive interventions for dental caries should be established as early as possible because breastfeeding is beneficial for children's health. Mechanisms underlying this process should be investigated more deeply. [ABSTRACT FROM AUTHOR]