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Background and Rationale: Dental care systems have the potential to influence population oral health and patterns of socioeconomic inequalities. Therefore, understanding the impact of the ways in which countries fund, provide, and organize their dental care services is key in the analysis of determinants of oral health. In this commentary we offer a synopsis of recent typologies of healthcare systems, based on a rapid review, and highlight that none of them fit dental care services given the separation of dental care from general healthcare provision in many countries. The paper also summarizes evidence on dental care systems as determinants of population oral health and argues why a new typology of dental care systems is needed., Challenges and Ways Forward: We argue that a typology must consider institutional arrangements, structures, and processes behind the provision of dental care, and that specific dimensions/variables that inform the typology should result from a process of discussion and consensus. Some methodological considerations for developing typologies are also discussed, including the challenges in the collection and analysis of data followed by an advanced cluster analysis. Despite their limitations, typologies have evolved into an essential tool for comparing the similarities and differences of healthcare systems across countries. Therefore, a dental specific typology for health systems will be useful for researchers, policymakers, and dental professionals to characterize the provision of dentalcare services in different countries. This will also enable examining their potential role as determinants of population oral health and inequalities., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

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., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This study aimed to evaluate the quality of posterior restorations (amalgam or composite) placed in adults from a birth cohort and its association with clinical and socioeconomic determinants experienced during their life course., Methods: A representative sample (n=539) of all 5914 births occurring in Pelotas (Brazil) in 1982 was prospectively investigated. Quality of posterior restorations (satisfactory or unsatisfactory) was assessed at 31 yrs-old, using modified USPHS criteria. Trained and calibrated dentists performed clinical examination. Explanatory variables included demographic and socioeconomic, oral health and dental service utilization patterns during the life course. Tooth related variables (type of tooth, material, size of cavity) were also analyzed. Untreated caries and socioeconomic status were assessed by group-based trajectories analyses. Multilevel Regression models were used to determine factors associated with restoration outcomes., Results: In total 2123 restorations (53% composite) were evaluated of which 107 (5%) were assessed as failed. The main reasons for failure were tooth/restoration fracture (50.5%) and secondary caries (30.7%). Failures in posterior restorations showed a significant association with socioeconomic aspects (lower tertile of income at age 30 - prevalence ratio (PR) 2.21 [95% CI 1.19-4.09]), clinical variables (trajectory of higher untreated caries - PR 2.11 [95% CI 1.23-3.61]) and also with tooth-related factors (Restorations involving three or more surfaces - PR 5.51 [95% CI 3.30-9.19]) after adjustment for each other., Conclusions: These findings suggest that, although tooth-related variables have an important role in restoration longevity, patient-related factors, such as socioeconomic variables and untreated caries are also associated with failure and should be taken into account when evaluating longevity of posterior restorations., Clinical Significance: This was the first study assessing long-term trajectory of untreated caries, showing an association between higher experience of caries during the life-course and unsatisfactory restorations. The findings suggest that individual related factors should be considered when planning treatment and in future research evaluating the longevity of dental restorations., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This study aimed to evaluate access to and utilization of various types of dental services by individuals 18 years or older in Brazil's State capitals. We gathered data from the Telephone Survey Surveillance System for Risk and Protective Factors for Chronic Diseases (VIGITEL) in 2009 (n = 54,367). More than half of the target population reported the need for dental treatment in the previous year; of these, 15.2% lacked access to dental services when needed. The private sector provided 61.1% of all dental appointments. The share of services provided by the Unified National Health System (SUS) ranged from 6.2% in the Federal District to 35.2% in Boa Vista, in the North. Multivariate Poisson regression models showed higher prevalence of dental treatment needs among women, middle-aged adults, and individuals with more schooling. Lack of access to dental care was more frequent among women, young adults, less educated individuals, and among lightener-skinned blacks. Our findings highlight sharp inequalities in the use of and access to dental services in the Brazilian State capitals.

Objectives: We assessed whether 3 models of life course socioeconomic status (critical period, accumulation of risk, and social mobility) predicted unsound teeth in adulthood among a Brazilian cohort., Methods: Life course data were collected on the 5914 live-born infants in the 1982 Pelotas Birth Cohort study. Participants' oral health was assessed at 15 (n = 888) and 24 (n = 720) years of age. We assessed family income trajectories and number of episodes of poverty in the life course through Poisson regressions, yielding unadjusted and adjusted prevalence ratios for number of unsound teeth at age 24 years., Results: The adjusted prevalence ratio for participants born into poverty was 30% higher than for those who were not. Participants who were always poor had the highest prevalence of unsound teeth; those who were downwardly or upwardly mobile also had more unsound teeth than did other participants, after adjustment for confounders. More episodes of poverty were associated with greater prevalence of unsound teeth in adulthood., Conclusions: Poverty at birth and during the life course was correlated with the number of unsound teeth at 24 years of age.

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: This study aimed to assess the association between affordability in terms of difficulty paying dental bills in Australian dollars and dental service use in the presence of sociodemographic confounders, and to assess the role of dental anxiety and satisfaction with dental professionals as mediators. The second aim was to investigate how dental anxiety and satisfaction with dental professionals modify the association between affordability and use of dental services in Australian adults. Methods: Longitudinal data from the Australian National Study of Adult Oral Health (2004–06 and 2017–18) was used. Poisson regression and path analysis were conducted to determine the association between affordability and frequency of use of dental services. Effect measure modification (EMM) analysis was performed by stratification of dental anxiety and satisfaction with dental professionals. Results: The study included 1698 Australian adults and identified that the prevalence of low frequency of dental visits was 20% more for those who had difficulty paying dental bills. Adults with dental anxiety (prevalence ratio [PR] = 1.14) and those who were dissatisfied with dental professionals (PR = 1.17) had a higher prevalence of low frequency of dental visits in the presence of difficulty paying dental bills. This indicated that dental anxiety and dissatisfaction with dental professionals were effect modifiers on this pathway. Conclusions: Adults who experience dental anxiety and dissatisfaction with dental professionals are more likely to avoid dental visits when faced with difficulty paying dental bills. However, it is important to note that these associations do not necessarily imply a causal relationship. [ABSTRACT FROM AUTHOR]

Purpose: To appraise the association between dental care utilisation and gingival status in the Brazilian context, controlling for covariates on socio-demographic characteristics and dentofacial anomalies (12-year-old children).Materials and Methods: A survey of oral health comprising 5780 schoolchildren in 35 towns of the state of São Paulo, Brazil, provided primary information regarding the assessment of the community periodontal index. The survey also provided information on socio-demographic characteristics and the dental aesthetic index of participants. The utilization of dental services was measured at the town-level, in terms of the dental care index (F/DMFT ratio). Multilevel models of logistic regression fitted the adjustment of covariates for gingival bleeding on probing and calculus.Results: Almost 32% of the children examined presented unhealthy gingival conditions, with a significantly poorer profile for boys, black children and those enrolled in public schools than for their counterparts. Several dentofacial anomalies associated with unhealthy gingival status: crowding of the incisal segments, maxillary and mandibular irregularity, antero posterior molar relation, maxillary overjet and vertical anterior openbite. Towns with a higher dental care index presented a lower proportion of children with gingival bleeding and calculus.Conclusion: This study confirmed previous observations of boys, blacks and children enrolled in public schools as presenting poorer oral health status than their counterparts in the Brazilian context. The utilization of dental services was significantly associated with improved profile of gingival status of participating towns, and this association is unlikely to be due to insufficient control of confounding on socio-demographic characteristics and dentofacial anomalies. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the pattern of decision-making by southern Brazilian dentists regarding the use of restorations in the treatment of dental caries.Materials and Methods: A cross-sectional survey involving 840 dentists, randomly selected in three southern Brazilian states, was performed. Telephone interviews were conducted by three previously trained dentists, in which clinical situations with different-depth radiolucencies, based upon bitewing radiographs, were described. Two other situations, including dark fissures and white spots, were also described. The main outcome measures were the tendency in clinical decision-making in comparison with the number of years elapsed since qualification and attendance on postgraduate courses.Results: The overall response rate was 89.4%: 31.5% of dentists would restore cavities in the outer half of the enamel; 54.5% when the cavity reached the inner half of the enamel, but not the enamel-dentine junction (EDJ); 79.0% when cavities reached the EDJ; and 96.9% when cavities reached the outer half of the dentine. Furthermore, 21.8% of dentists would restore dark fissures without signs of demineralization. Dentists qualified for less than 10 years and those who had attended postgraduate courses were less interventionist.Conclusion: It was concluded that dentists have an interventionist attitude in the making of treatment decisions for dental caries and may be over-treating in several situations. [ABSTRACT FROM AUTHOR]

Background: The provision of dental services for children with special health care needs (CSHCN) needs to be considered by policymakers. This study is aimed to explore the determinant factors affecting dental and oral services provision for this vulnerable group.Methods: A review was conducted applying the 9-steps approach. Five scientific databases of PUBMED, SCOPUS, Web of Science and PROQUEST and EMBASE were searched up to 10.07.2021, applying appropriate keywords. Thematic analysis was used to analyse the extracted data, and a conceptual map was developed according to JBI manual for evidence synthesis.Results: From the abstracts of the 136 articles that fulfilled the inclusion criteria, 56 articles were included. Five main themes were identified as determinants affecting the provision of dentistry services for CSHCN, including needs assessment, policy advice, oral health interventions, providers' perception and access barriers. According to the developed conceptual map, assessing the needs of CSHCN can lead to particular policy advice. Regarding the policies, appropriate oral health interventions can be presented. These interventions, along with providers' perception about service delivery to CSHCN and the barriers to access them, determine the provision of dentistry services for CSHCN.Conclusions: An effective needs assessment of CSHCN and their parents/carers can lead to evidence-informed policymaking and applicable policy advice according to the needs. Then policymakers should develop interventions to improve the community's health literacy, as well as support the seeking behaviours for appropriate services. Policymakers should also consider how to limit the barriers to accessing oral and dental health by CSHCN to decrease disparities. [ABSTRACT FROM AUTHOR]

The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Toothlevel variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations. [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]

Abstract: Objectives: Dental diseases are the most common chronic diseases worldwide. Healthy teeth are vital for quality of life, particularly diet and nutrition. However, little information exists to inform health policymakers about potentially long‐lasting influences of early‐life conditions. The purpose of this study was to investigate the relation between early‐life socioeconomic conditions and number of natural teeth at age 50 and above. Methods: Analyses were conducted on cross‐sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE wave 5), which includes information on 41 560 respondents aged 50 years or older from 14 European countries and Israel. Using SHARE life history information, a series of regression models (OLS, Tobit) were estimated to analyse the relationship between socioeconomic conditions in earlier life and the number of teeth at age 50+. Results: Childhood socioeconomic background was associated with the number of natural teeth at age 50 and above, even after controlling for current determinants of oral health. Respondents who had had more than 25 books in their childhood household had a mean 1.4 (95% CI: 1.2‐1.5) more teeth than respondents with fewer books. Respondents who reported poor financial conditions during childhood had a mean 0.6 (95% CI: 0.3‐0.9) fewer teeth than respondents who reported better financial conditions in childhood. Conclusion: These findings substantiate the association between socioeconomic conditions in the early years of life and tooth retention to older adulthood and highlight the long‐lasting relation between childhood living conditions and oral health through the lifecourse. [ABSTRACT FROM AUTHOR]

Objective: To explore whether having less than 21 teeth is associated with poorer general health in a representative population sample of South Australians.Methods: Data were from a cross-sectional state-based survey, conducted from September to December 2013. Complete data were available for 2,908 participants (58 percent response rate). General health-related quality of life (HrQOL), as measured by the EuroQol instrument (EQ-5D-5L), was the main outcome measure. Total disutility scores were calculated, with the five individual EQ-5D dimensions then dichotomized into "no problems" and "at least one problem." The main explanatory variable was self-reported missing teeth, as assessed by having <21 teeth versus 21+ teeth in a questionnaire.Results: Overall, disutility was low (0.09) (ranges from 0 to 1, with high scores indicating poorer general health). In multivariable analysis, total disutility was positively associated with older age, lower annual household income, lower levels of physical activity, being a current tobacco smoker, receiving mental health treatment and <21 teeth. When individual dimensions were considered, missing teeth remained significantly associated with mobility problems (PR 1.26, 95 percent CI 1.06, 1.50) and pain/discomfort (PR 1.16, 95 percent CI 1.06, 1.27).Conclusions: Missing teeth was associated with poor general health status as measured by EQ-5D-5L disutility. The relationship was especially evident with respect to mobility and pain/discomfort. The findings emphasize the importance of oral health as predictors of general health. [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]

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 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]

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Toothache is a dental public health problem and one of the predictors of dental attendance and it is strongly associated with the life quality of individuals. In spite of this, there are few population-based epidemiological studies on this theme. Objective: To estimate the prevalence of toothache and associated factors in adults of Lages, Southern Brazil. Methods: A cross-sectional population-based study was carried out in a sample of 2,022 adults aged 20 to 59 years living in the urban area of a medium sized city in Southern Brazil. A questionnaire including socioeconomic, demographic, smoking, alcohol, and use of dental service variables was applied at adults household. Toothache occurred six months previous of the interview was considered the outcome. Poisson regression analyses were performed following a theoretical hierarchical framework. All analysis was adjusted by the sample design effect. Results: The response rate was 98.6%. The prevalence of toothache was 18.0% (95% CI 16.0; 20.1). The following variables were associated with toothache after adjustment: female (PR = 1.3 95% CI 1.3; 2.0), black skin colour vs. whites (PR = 1.5 95% CI 1.1, 1.9), low per capita income (PR = 1.7 95% CI 1.2, 2.3), smokers (PR = 1.5 95% CI 1.2, 1.9) and those who reported alcohol problems (PR = 1.4 95% CI 1.1; 1.9). To be 40 years of age (PR = 0.5 95% CI 0.4, 0.7) and use dental service in the last year (RR = 0.5 95% CI 0.4, 0.6) were protective factors for toothache. Conclusion: The prevalence of toothache in adults of Lages can be considered a major problem of dental public health. [ABSTRACT FROM AUTHOR]

Objective: To examine contextual and individual determinants of dental caries experience, documenting levels of the disease in Brazil. Methods: The dental status of 34 550 12-year-old schoolchildren was informed by a country-wide survey of oral health comprising 250 towns and performed in 2002–2003. Indices assessing dental caries experience were compared by sociodemographic characteristics of examined children (gender, ethnic group, localization and type of school), and geographic characteristics of participating towns [the human development index (HDI), and access to fluoridated tap water]. A multilevel model fitted the adjustment of untreated caries to individual and contextual covariates. Results: Better-off Brazilian regions presented an improved profile of dental health, besides having a less unequal distribution of restorative dental treatments between blacks and whites, rural and urban areas, and public and private schools. Girls [odds ratio (OR) = 1.1; 95% confidence interval (CI): 1.0–1.1], blacks (OR = 1.6; 95% CI: 1.5–1.7), and children studying in rural areas (OR = 1.9; 95% CI: 1.7–2.0) and public schools (OR = 1.7; 95% CI: 1.6–1.9) presented higher odds of having untreated decayed teeth. The multilevel model identified the fluoride status of tap water ( β = −0.3), the proportion of households linked to the water network ( β = −0.3), and the HDI ( β = −0.2), as town-level variables associated with caries levels. Conclusion: Dental caries experience is prone to sociodemographic and geographic inequalities. The monitoring of contrasts in dental health outcomes is relevant for programming socially appropriate interventions aimed both at overall improvements and at the targeting of resources for groups of population presenting higher levels of needs. [ABSTRACT FROM AUTHOR]

Peres MA, Latorre MRDO, Sheiham A, Peres KGA, Barros FC, Hernandez PG, Maas AMN, Romano AR, Victora CG. Social and biological early life influences on severity of dental caries in children aged 6 years. Community Dent Oral Epidemiol 2005; 33: 53–63.© Blackwell Munksgaard, 2005To investigate the relationship between social and biological conditions experienced in very early life and dental caries in children aged 6 years.The design was a dental caries cross-sectional study nested in a birth cohort study started in Pelotas, Brazil, in 1993. The cross-sectional study was carried out in 1999. A random sample of 400 6-year-old children was selected from among 5249 live births in 1993. The World Health Organization (1997) criteria were used to diagnose dental caries. Results from the oral health study were linked to the data concerning perinatal and childhood health and illnesses and family social conditions collected at birth, 1, 3, 6 and 12 months, and in the sixth year of life. Dental caries was the outcome measured at two levels of severity (very low: dmft ≤ 1; high: dmft ≥ 4). Unconditional univariate and multiple logistic regression analysis were performed.Self-employed and employees/unemployed, fathers with<8 years of education at time child was born, child's height deficit for age at 12 months; child who did not attend day care centre in sixth year of life; brushing teeth less than once a day, and children with sweet consumption of at least once a day at 6 years were risk factors for high dental caries after controlling for possible confounders.Harmful social and biological risk factors accumulated in early life contributed to the development of a high level of dental caries in childhood. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Saúde Pública is the property of Faculdade de Educacao da Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)