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A systematic review and network meta-analysis was conducted to compare different bone-substitute materials used for alveolar ridge preservation after tooth extraction. The electronic search was carried out on Embase, PubMed, Cochrane Library, Web of Science, Scopus, LILACS, and grey literature up to March 22, 2020 (registration number INPLASY202030005). Only randomized controlled trials were included to answer the following PICOS question: ‘What grafting materials produce greater alveolar ridge preservation after tooth extraction?’ The primary outcomes were the alveolar width resorption 1 mm below the alveolar crest and buccal height resorption in millimeters. Of the 4379 studies initially identified, 31 studies involving 1088 patients were included in the quantitative analyses. Out of 25 revised biomaterials, eight showed a statistically significant difference compared with unassisted healing in both alveolar width and height measurements (mean width differences: ApatosⓇ, 2.27 [1.266–3.28]; Bio-OssⓇ, 0.88 [0.33–1.42]; Bio-Oss CollⓇ, 0.53 [0.04–1.01]; Bond-apatiteⓇ, 2.20 [1.30–3.11]; freeze-dried bone allograft, 1.35 [0.44–2.26]; Gen-OsⓇ, 1.90 [0.60–3.20]; platelet-rich fibrin, 1.66 [0.66–2.67]; and MP3Ⓡ, 2.67 [1.59–3.75]). Overall, xenograft materials should be considered as among the best of the available grafting materials for alveolar preservation after tooth extraction.

Summary Background/objectives To evaluate the relationships between individual, environmental, clinical factors and oral health-related quality of life (OHRQoL) in patients with cleft lip and palate (CLP) following orthognathic surgery. Materials and methods A follow-up study was conducted involving 69 adults with unilateral and bilateral CLP under orthodontic treatment. Interviews and oral examinations were conducted prior to orthognathic surgery (T0) to evaluate age, gender, psychological well-being, dental caries, malocclusion, social support, social networks, family income and education and OHRQoL. All participants were reviewed after 6 months (T1) to re-assess psychological well-being, malocclusion and OHRQoL. Structural equation modeling estimated the associations between the variables. Results OHRQoL total scores reduced following orthognathic surgery, from 11.7 to 6.9 (P < 0.01). Occlusal characteristics and psychological well-being improved between T0 and T1. In the structural equation modeling, reduction of malocclusion (β = 0.02) between T0 and T1 directly predicted poor OHRQoL at T1. Improvement of psychological well-being between T0 and T1 was associated with better OHRQoL at T1 (β = −0.07). Dental caries and malocclusion at T0 were indirectly linked to poor OHRQoL at T1 (β = 0.02). Limitations The short follow-up period of 6 months after orthognathic surgery. Conclusions/implications This represents the first prospective study examining the interrelationships of predictors of OHRQoL in patients with CLP after orthognathic surgery. OHRQoL and psychological well-being improved after orthognathic surgery. Clinical and psychological characteristics were important determinants of OHRQoL. These findings suggest the importance of the biopsychosocial model of health and the patient-centered approach in oral health care in individuals with CLP.

Background: The link between oral diseases and school performance and school attendance remains unclear among Middle Eastern children.Aim: To investigate the relationship of oral conditions with schoolchildren's school performance and attendance using the life- course approach.Design: A cross- sectional study was conducted with 466 schoolchildren aged 7- 8 years from Kingdom of Bahrain (KoB) and their parents. Questionnaire data on children's current and at- birth environmental characteristics were completed by their parents. Children's oral health measures, including ICDAS (International Caries Detection and Assessment System), PUFA (pulp, ulcer, fistula, abscess), and DDE (developmental defects of enamel) indices, were the exposure variables. School performance and school attendance data obtained from the school register were the outcome variables. The data were analysed using multivariate ordinal logistic regression.Results: The odds of excellent school performance were significantly lower for children with untreated dentinal caries (OR = 0.98; 95% CI: 0.96- 0.99). Children with caries- treated teeth showed greater odds of excellent school performance (OR = 1.41; 95% CI: 1.15- 1.74). Disease Control and PreventionNone of the den-tal conditions were significantly associated with children’s school attendance. A permissive parental style was associated with poor school attendance (OR = 2.63; 95% CI: 1.08- 6.42).Conclusion: Dental caries was associated with poor school performance but not with school attendance. Treated caries was associated with good school performance.

Objectives Understanding the possible risk factors of noncarious cervical lesion (NCCL) is important for prevention and clinical management of the condition. The aim of this study was to investigate the factors associated with the prevalence of NCCL among adolescents, adults, and elderly people. Materials and Methods A cross-sectional study involving 501 participants aged 15 years or older was conducted. Participants were examined to assess the number of natural teeth and the prevalence and severity of NCCL by calibrated examiners. Data on age, gender, harmful toothbrushing habits, and acidogenic diet were collected through individual interviews. Multivariate Poisson’s regression models were used to evaluate the association between the independent variables and the prevalence of NCCL according to the three age groups: 15 to 39, 40 to 64, and 65 years or older. Results The prevalence of NCCL among participants was 62.5% (95% confidence interval: 58.2–66.7). Among 15- to 39-year-old participants, the mean of NCCL was higher in males, those with lower number of teeth and acidogenic diet intake. Males aged 40 to 64 years and those with harmful brushing habits were more likely to present higher mean of NCCL. Elderly people with harmful toothbrushing habits had a greater mean of NCCL. Conclusion Demographic (age and gender), clinical (number of teeth), and behavioral characteristics (harmful brushing habits and acidogenic diet) were meaningful factors associated with NCCL severity. The above-mentioned relationships varied between age groups.

BACKGROUND The possible link between dental status and school performance has been investigated. The influence of the clinical consequences of untreated dental caries in this association, however, has been minimally explored. AIM To assess the relationship between clinical consequences of untreated dental caries and school performance in adolescents, and to examine the demographics and socioeconomic status pathways by which clinical consequences of untreated dental caries is associated with school performance. DESIGN A cross-sectional study involving 363 low-income school adolescents was conducted in the city of Manaus, Brazil. Dental clinical measures were registered by five calibrated examiners to evaluate dental caries experience (decayed, missing, and filled teeth index [DMFT]) and clinical sequelae of dental caries (PUFA/pufa index). School performance was assessed using school grade history obtained from official records. Statistical analysis was conducted using pathway analysis to estimate beta coefficients (β) of the direct and indirect effects between variables. RESULTS DMFT and PUFA/pufa mean were 1.93 and 0.30, respectively. PUFA/pufa scores (β = -0.19) and male sex (β = 0.35) directly predicted poor school performance. DMFT was indirectly linked to poor school performance via PUFA/pufa scores (β = -0.03). CONCLUSIONS Dental caries and clinical consequences of dental caries were important predictors of poor school performance in low-income adolescents via direct and indirect effects.

Aim To examine the relationship between contextual and individual determinants with the need for endodontic treatment in Brazilian adults. Methods Individual-level data from 6897 adults aged 35-44 years living in the Brazilian state capitals who participated in the Brazilian Oral Health Survey (SBBrasil 2010 Project) were combined with city-level data. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health according to the WHO model of social determinants of health. The association of independent variables with one or more teeth in need of endodontic treatment was evaluated using multilevel logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CI). Results The prevalence of the need for endodontic treatment was 7.7%. Adults living in cities with better contextual socioeconomic conditions (OR 0.82; 95% CI = 0.72-0.93) and better specialized dental services (OR 0.85; 95% CI = 0.77-0.95) were less likely to need endodontic treatment. Younger age, greater schooling and use of private dental services reduced the odds of need for endodontic treatment. Number of people per room, type of dental service and reason for the last dental visit were also associated with need of endodontic treatment. Conclusion Contextual and individual factors were relevant determinants of endodontic treatment needs in adults.

Background The utilisation of health services is determined by complex interactions. In this context, rural populations face greater barriers in accessing dental services than do urban populations, and they generally have poorer oral health status. The evaluation of the determinants of health services utilisation is important to support planning and management of dental services. The aim of this study was to evaluate the predictors of dental services utilisation of Brazilian adults living in rural and urban areas. Methods Data from 60,202 adults aged 18 years or older who took part in the Brazilian National Health Survey carried out in 2013 were analysed. Predisposing (age, sex, education, social networks), enabling financing (income, durable goods and household’s crowding), enabling organisation (health insurance, registration in primary health care [PHC]) and need variables (eating difficulties, self-perceived tooth loss and self-perceived oral health) were selected based upon the Andersen behavioural model. Multi-group structural equation modeling assessed the direct and indirect associations of independent variables with non-utilisation of dental services and the interval since the last dental visit for individuals living in rural and urban areas. Results Adults living in urban areas were more likely to use dental services than those living in rural areas. Lower enabling financing, lower perceived dental needs and lack of PHC registration were directly associated with lower utilisation of dental services (non-utilisation, β = − 0.36, β = − 0.16, β = − 0.03, respectively; and interval since last dental visit, β = 1.25, β = 0.82, β = − 0.12, respectively). The enabling financing (non-utilisation, βrural = − 0.02 [95%CI: − 0.03 to − 0.02], βurban = 0.00 [95%CI: − 0.01 to 0.00]) and PHC registration (non-utilisation, βrural = − 0.03 [95%CI: − 0.04 to − 0.02], βurban = − 0.01 [95%CI, − 0.01 to − 0.01]) non-standardised total effects were stronger in rural areas. Enabling organisation (β = 0.16) and social network (β = − 2.59) latent variables showed a direct effect on the interval since last dental visit in urban areas. Education and social networks influenced utilisation of dental services through different pathways. Males showed less use of dental services in both urban and rural areas (non-utilisation, βrural = − 0.07, βurban = − 0.04; interval since last dental visit, βrural = − 0.07, βurban = − 0.07) and older adults have used dental services longer than younger ones, mainly in rural areas (βrural = 0.26, βurban = 0.17). Conclusion Dental services utilisation was lower in rural areas in Brazil. The theoretical model was supported by empirical data and showed different relationships between the predictors in the two geographical contexts. In rural areas, financial aspects, education, primary care availability, sex and age were relevant factors for the utilisation of services.

Background The possible association between obesity, underweight, and dental caries remains in debate. In addition, the role of sugar consumption on the abovementioned relationship was little explored. Aim This study aimed to investigate the relationship between nutritional status and dental caries in 12-year-old low-income children. Design This cross-sectional school-based study involved 406 12-year-old children living with limited economic resources. Dental caries was assessed using the decayed component of DMFT and PUFA/pufa index. Children were weighed and measured to assess nutritional status according to z-score/body mass index. Data on socio-economic and demographic characteristics, sugar consumption, sedentary behaviour, and psychosocial factors were collected through validated questionnaires. Multivariable multilevel Poisson regression was performed. Results Underweight children had 60% (RR = 1.60; 95% CI 1.13-2.57) higher mean of decayed teeth and had mean PUFA/pufa 2.8 times higher than children with normal nutritional status. Underweight children with high annual sugar intake had a greater mean of decayed teeth (RR = 2.72; 95% CI 1.46-5.06) than underweight children with low sugar intake. Conclusions Our findings suggest that malnutrition is associated with dental caries among children from low-income families.

Background/Aims: This study evaluated the relationships of clinical consequences of untreated dental caries, individual characteristics, and environmental factors on self-reported oral health measures in adolescents. Methods: A follow-up prevalence study was conducted involving 406 twelve-year-old adolescents selected from public schools in the eastern area of the city of Manaus, Brazil. Baseline data included clinical consequences of untreated caries (PUFA/pufa index), DMFT, sociodemographic characteristics (sex, parental schooling, and family income), psychosocial factors (sense of coherence [SOC-13 scale], oral health beliefs and self-esteem [Rosenberg Self-Esteem Scale]), and social support (SSA questionnaire). Oral health-related quality of life (OHRQoL [CPQ11–14]) and self-rated oral health were assessed at the 6-month follow-up. Structural equation modelling was used to explore the relationships between variables according to the Wilson and Cleary model. Results: The prevalence of PUFA/pufa was 17.8% and mean DMFT was 1.5. The number of teeth with clinical consequences of untreated caries predicted poor self-rated oral health at the 6-month follow-up. Low parental schooling predicted low family income and clinical consequences of untreated dental caries. Psychosocial factors predicted OHRQoL directly and self-rated oral health indirectly. OHRQoL was linked to self-rated oral health. Clinical consequences of untreated dental caries mediated the relationship of parental schooling with OHRQoL and self-rated oral health. OHRQoL mediated the relationship of psychosocial factors and sex with self-rated oral health. Clinical consequences of untreated dental caries was associated with adolescents’ self-rated oral health. Furthermore, the former was an important mediator on the link between low parental education and adolescents’ self-reported oral health measures. Conclusions: Socioeconomic status, psychosocial factors, and social support were related to OHRQoL and self-rated oral health via direct and indirect pathways.

Background Several factors can influence the oral health. Aim To explore the clinical factors, individual characteristics, and environmental factors (religious-spiritual coping-RSC, sense of coherence [SOC], and socio-economic status) related to oral status and impact on oral health-related quality of life (OHRQoL) of children/adolescents (C/A). Design This study evaluated C/A up to 15 years old and their caregivers. Number of decayed (NDT) and missing teeth (NMT); history of dental trauma; caregiver's RSC and SOC, socio-economic factors, and OHRQoL were evaluated. Theoretical model exploring the direct and indirect effects was tested using a structural equation analysis. Results For younger group (0-6 years), having more NDT or more NMT had a greater impact on the OHRQoL (β = 0.382, β = 0.203, respectively). In the oldest group (7-15 years), a higher SOC had an inverse relationship with the impact on the family OHRQoL (β=-0.201). The higher the age of the C/A, the lower the NDT (β=-0.235), and the higher the family income the lower, the need for social benefit (β = 0.275). Indirect relationships were observed between schooling with social benefit and OHRQoL in younger group. The family income indirectly influenced the OHRQoL in oldest group. Conclusions Quality of life is affected directly and indirectly by environmental characteristics, oral status, and the age of patients.

The article examines the common determinants of childhood dental caries and obesity. Longitudinal data from the Born in Bradford cohort study (BiB1000) (n = 1735) and dental data (dental general anaesthetics (GA) and oral health survey 2014/15) (n = 171) were used to test a framework on the social determinants of childhood dental caries (decayed, missing, filled teeth (dmft) index) and obesity (body mass index (BMI)). The BiB1000 data were collected at pregnancy week 26–28 and after birth at 6, 12, 18, 24 and 36 months. The determinants were demographics, wellbeing, socio-economic status (SES), dietary behaviours and physical activity behaviour of the children. Missing data were accounted for through multiple imputation (MI). The framework was tested through structural equation modelling. Overall, the model fit was adequate. No alcohol consumption of the mother after giving birth, higher frequency of child drinking sugar-sweetened beverages, emotional and behavioural difficulties of the child and being male were directly associated with both BMI and dental caries. Caregivers uninvolved or indulgent feeding style were associated with higher BMI and less dental caries. Social deprivation was associated with lower BMI and higher dmft. Five determinants were directly associated with BMI only. Fifteen indirect paths were significant for both child dental caries and BMI. The findings suggest common determinants for both childhood obesity and dental caries. Common risk factor approach seems appropriate for planning future health promotion programmes.

Background: Critically ill patients are vulnerable to corneal injury and the incidence of this adverse event remains high in these patients. Randomized clinical trials have been assessing different types of interventions, hindering nurses' clinical practice for the prevention of corneal injury in critically ill patients. The aim of this systematic review is to identify the most effective nursing interventions to prevent corneal injury in critically ill sedated and mechanically ventilated patients.Methods: A systematic review of intervention studies will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses 2020, in the following electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Central, Embase, Latin American and Caribbean Literature in Health Sciences, Livivo, PubMed, Scopus and Web of Science. The search of the grey literature will be undertaken on Google Scholar. No language or year of publication restrictions will be applied for the selection of primary studies. Study selection and data extraction will be performed by two independent reviewers who will screen the titles and abstracts of the retrieved papers to assess the studies for inclusion. Disagreements between reviewers, during study selection, will be resolved by discussion with a third reviewer. The inclusion criteria will be epidemiologic intervention studies evaluating nursing interventions to prevent or decrease the occurrence of corneal injury in critically ill sedated and mechanically ventilated patients. Methodological quality of the studies will be assessed using the Risk of Bias and Robins-2 tools. Quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Discussion: this study has a potencial to identify the most effective nursing interventions for prevention corneal injury in critically ill sedated and mechanically ventilated patients.Systematic review registration: The protocol of this research is approved in PROSPERO under protocol No. 253289.

BACKGROUND Children with molar incisor hypomineralisation (MIH) frequently seek aesthetic treatment for incisor opacities. Surprisingly few studies have evaluated the clinical success of such interventions. AIM To quantify the effectiveness of minimally invasive treatments in reducing enamel opacity visibility in children with MIH. DESIGN This in-vitro study used digital clinical images of 23 children aged 8-16 years with MIH who underwent microabrasion and/or resin infiltration for management of incisor opacities. Standard images were taken pre- and six-months post-treatment. Image software (Image-Pro Plus®V7) was employed to convert 24-bit RGB images to 16-bit grey-scale and 45% magnification. Measurement repeatability was assessed using Intra-class Correlation Coefficients (ICC). Post-treatment changes in visible opacity area (mm2 ) and brightness (greyscale value) were tested using Wilcoxon Signed Rank Test for Related-Samples. RESULTS Mean total opacity surface area significantly reduced from 14.3mm2 (SD=7.5) to 9.4mm2 (SD=9.0) post-treatment. The proportion of tooth surface affected by the opacity also significantly reduced from 22.5% (SD=10.5) to 14.7% (SD=12.7). Mean maximum opacity brightness significantly reduced from 53066 greyscale value (SD=4740) to 49040 (SD=3796). ICC was good/excellent (0.75-1.0). CONCLUSION Minimally invasive treatment is effective in reducing size and brightness of discrete incisor opacities. Future research should compare objective findings with patient-reported outcomes.

The COVID-19 pandemic impacted on academic routine because of the social distancing measures. This study examined the relationships of sociodemographic characteristics, social distancing aspects and psychosocial factors on psychosocial well-being among undergraduate students during the social distancing period due to COVID-19. A web-based survey was conducted of undergraduate students at a public university in Brazil (n = 620). Demographics, socioeconomic status (SES), social distancing factors, negative affectivity (DASS-21), sense of coherence (SOC-13), social support and psychosocial well-being (GHQ-12) were measured. The direct and indirect links between was variables was tested using structural equation modelling. The estimated model showed that greater social support, higher sense of coherence and lower negative affectivity were directly associated with better psychological well-being. Female gender, higher SES, not working during the social distancing period and availability of online modules were indirectly associated with psychological well-being through psychosocial factors. Working during the social distancing period and availability of online modules mediated the link of age, gender, SES with psychological well-being. Our findings suggest the need to provide psychological support, online teaching and financial aid to undergraduate students during the social distancing period due to COVID-19 pandemic to improve their psychological well-being.

Background Evidence on the possible influence of social and psychosocial factors on gingival status in socially disadvantaged children is scarce. The aim of this study is to assess the relationships among socioeconomic status, pattern of dental visits, self-esteem, oral health beliefs, toothbrushing frequency, oral hygiene effectiveness, and gingivitis in low social status adolescents. Methods A cross-sectional study was performed involving 406 12-year-old students recruited in Manaus, Brazil. Socioeconomic status (family income, parent's schooling, number of goods, and household crowding), self-esteem, oral health beliefs, and frequency of toothbrushing were collected through self-completed questionnaires. Gingival status (bleeding on probing) and oral hygiene effectiveness (dental calculus) were evaluated by calibrated dentists through oral examinations. Structural equation modeling assessed the direct and indirect relationships between variables guided by a theoretical model. Results The prevalence of gingivitis was 77.6%. Worse socioeconomic status and poor oral hygiene effectiveness directly predicted gingival bleeding. Socioeconomic status was also linked to toothbrushing frequency. Positive oral health beliefs and higher self-esteem predicted higher frequency of toothbrushing. The latter was directly linked to greater oral hygiene effectiveness. Oral health beliefs and self-esteem indirectly predicted gingival bleeding via toothbrushing frequency and oral hygiene effectiveness. Conclusion The present findings suggest the importance of socioeconomic status and psychosocial factors on gingival status in underprivileged adolescents. Poor oral hygiene mediated the associations between psychosocial factors and gingival status.

To explore the range of impacts relating to incisor opacities as described by children, their general dental practitioners and paediatric dentists. Participants included 50 children, aged 7–16 years, referred to a UK hospital paediatric dentistry service for management of incisor opacities. All children were subsequently diagnosed with molar incisor hypomineralisation. Following ethical approval, data were recorded as follows: patient demographics, distance travelled, waiting times, nature of any impacts relating to incisor opacities documented in referral letters and/or in subsequent paediatric dentistry assessment records. Additionally, children completed the short form Child Oral Health Impact Profile questionnaire (COHIP-SF19) as a self-report measure of their oral health-related quality of life (OHRQoL). Nearly, half (48%, n = 24) of the referral letters mentioned that the child was experiencing one or more negative social and/or functional impacts. Mean COHIP score was significantly lower (indicating poorer OHRQoL) for children whose referring dentist had identified a negative impact (COHIP = 42.9) compared to those with no documented impact (COHIP = 50.5; p = 0.018, independent t test). At the hospital consultation, negative impacts were elicited by a paediatric dentist in 86% (n = 43) of cases. Again, mean COHIP score was significantly lower for children whose assessment records noted a negative impact (COHIP = 44.5) compared to those with no recorded impact (COHIP = 60.2; p = 0.001). Families travelled a mean distance of 57 km (range 3–218 km) to the hospital service, with an average waiting time of 75 days from referral. It is encouraging that dental professionals seem to be aware of the negative psychosocial impacts experienced by some children with enamel opacities, and that children feel able to describe them.

Aim: To evaluate whether socioeconomic position exerts a mediating and/or moderating effect on the association between oral clinical measures and oral health-related quality of life (OHRQoL) in adolescents. Materials and methods: The study analysed data on 5,445 adolescents aged 15–19 years from the Brazilian Oral Health Survey (SBBrasil Project). The numbers of decayed and missing teeth, number of sextants with gingivitis and malocclusion were assessed through oral clinical examinations. Participant’s age, sex, OHRQoL and socioeconomic position were also collected. Monthly family income was used to indicate the participant’s socioeconomic position, and OHRQoL was assessed using the Oral Impacts on Daily Performance. Moderation was tested using Poisson regression models. Structural equation modelling and Sobel’s test assessed the mediation effects. Results: Oral clinical measures, OHRQoL and socioeconomic position were significantly correlated (P < 0.001). The moderator effect of socioeconomic position on the association between all oral clinical measures and OHRQoL was observed. The impact of all oral clinical conditions on adolescents’ OHRQoL was lower in the low-family-income groups compared with those with a better income. Socioeconomic position partially mediated the relationship between the four oral clinical measures and OHRQoL. Sobel’s test confirmed these findings (P < 0.001). Conclusions: The findings suggest the importance of socioeconomic position as a moderator and mediator factor between oral clinical measures and OHRQoL. Disadvantaged adolescents are likely to experience poor OHRQoL due to oral conditions. The reduction of the impact of oral conditions on quality of life in adolescents may be enhanced by addressing social inequalities related to oral health.

The aim of this study was to investigate the association between orthodontic treatment need and oral health-related quality of life (OHRQoL) among 12-yr-old children. The study also assessed whether self-esteem modifies and/or moderates this relationship. Cross-sectional data on 406 schoolchildren aged 12 yr were analyzed. Data on socio-economic and demographic characteristics, dental pain, self-esteem, and OHRQoL were collected using validated questionnaires. Orthodontic treatment need was assessed, through dental examinations, using the dental aesthetic index (DAI). Multiple negative binomial regression and path analysis were used to estimate the association of orthodontic treatment need and self-esteem with OHRQoL. A modifying effect of self-esteem on the relationship between DAI and OHRQoL was observed. Self-esteem did not mediate the abovementioned relationship. Children with lower scores of self-esteem had worse OHRQoL among those with lower orthodontic treatment need (a DAI score of < 31). However, self-esteem did not influence the association between DAI and OHRQoL in children with greater orthodontic treatment need (a DAI score of ≥ 31). Self-esteem attenuated the impact of malocclusion on OHRQoL in children with minor or definite malocclusion, but not among those with severe or very severe malocclusion. Self-esteem appears to buffer the impact of malocclusion on OHRQoL in children with minor orthodontic treatment need.

Evidence of the effectiveness of oral health promotion strategies among children from different socioeconomic backgrounds is necessary to support the implementation of public health interventions.This study aimed to test the effectiveness of a school-based intervention to enhance the sense of coherence (SOC) and oral health-related quality of life (OHRQoL) of socially vulnerable Brazilian children. Furthermore, we explored the pathways by which the intervention may improve OHRQoL and SOC, assessing the direct and indirect pathways among demographic, clinical, socioeconomic, behavioral, and psychosocial variables.In this cluster-randomized trial, 5 primary schools in Brazil were randomly allocated into intervention and control groups. The intervention comprised 7 sessions of SOC-based activities over 2 mo, which focused on making the school environment a place to develop children's SOC through involving teachers, school staff, and children. Trained teachers delivered the intervention. OHRQoL and SOC data were collected at baseline, 2 wk after the intervention, and at 3-mo follow-up.Information about oral clinical conditions, socioeconomic status, OHRQoL, and SOC was obtained from 356 children aged 8 to 14 y (165 in the intervention group and 191 in the control group). Children from the SOC-based intervention group reported fewer impacts of their oral health on their daily lives (Child Perceptions Questionnaire mean, 7.22) than those from the control group (9.14). The intervention group also reported greater improvement of SOC at 2 wk (SOC mean, 52.98) and 3 mo (52.75) than the control group (52.21 and 51.65, respectively).The intervention was effective in improving SOC and OHRQoL among socially vulnerable Brazilian children. Moreover, SOC was a relevant predictor for oral symptom and functional status in this population (Brazilian Clinical Trials Registry RBR-2N9NHJ).Clinicians and policy makers can use the results of this study to decide which approach to use when planning public health policy to improve the SOC and OHRQoL of socially vulnerable children. Our findings can assist policy makers in making more appropriate community health decisions in school environments that will improve community empowerment.

OBJECTIVES: To examine the association of contextual and individual determinants with non-utilization of dental services among Brazilian adults. METHODS: Data were from adults aged 35-44 years (N = 7,265) from the 2010 Brazilian Oral Health Survey (SB Brasil Project). Non-utilization of dental services was assessed whether the individual has never had a dental visit over the whole life time. Independent variables were selected according to Andersen's behavioral model. Contextual variables included Human Development Index-longevity (HDI-Longevity) (predisposing demographic), HDI-Education and Gini index (predisposing social), integration of oral health teams into Primary Care (enabling health policy), and HDI-Income (enabling financing). Individual data were age and sex (predisposing demographic), ethnicity and schooling (predisposing social), family monthly income (predisposing enabling), perceived dental treatment (perceived need), and decayed teeth (evaluated need). The relationship of contextual and individual variables with non-utilization of dental services was assessed through multilevel logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (95% CI). RESULTS: The prevalence of non-utilization of dental services was 4.7 percent. Adults living in cities with high HDI-Income were less likely to never have a dental visit. The odds of non-utilization of dental services were lower for adults living in cities with high HDI-Longevity. Sex, skin color, dental treatment needs, poor socioeconomic characteristics, perceived dental treatment needs, and decayed teeth were also associated with non-utilization of dental services. CONCLUSIONS: The results suggest that contextual enabling and predisposing factors, individual sociodemographic, and needs-related characteristics influence non-utilization of dental services by Brazilian adults.

Aims: To determine changes in OHRQoL and clinical status after periodontal treatment and the factors predicting these changes.Methods: Cohort of 140 patients with chronic periodontitis receiving non-surgical treatment. Participants self-completed questionnaires: Sense of Coherence, Locus of Control, Self-esteem and Task-specific Self-efficacy before treatment, and Oral Health Impact Profile at treatment, oral hygiene review and end of study. Relationships between OHRQoL, clinical data, individual and environmental characteristics were analysed with structural equation modelling guided by the Wilson and Cleary model.Results: OHRQoL and the periodontal status improved after treatment. Greater sense of coherence and age, better periodontal status, lower DMFT and being male predicted better OHRQoL after treatment. Better task-specific self-efficacy and self-esteem, but worse plaque score predicted better end periodontal status. Conclusions: OHRQoL and periodontal status improved after periodontal treatment, and this was predicted by individual demographic and psychological factors. These factors may assist with case selection and as possible points for intervention to improve clinical and subjective outcomes of periodontal treatment.

Periodontal diseases are infectious inflammatory chronic diseases of a multifactorial nature. They are primarily caused by dysbiotic ecological changes in dental biofilm, which may be influenced by risk factors. The prevention of periodontal diseases may involve different strategies focused on reducing distal, intermediate, and proximal risk factors at both the population and individual levels. Effective prevention depends on interdisciplinary and common risk factor approaches. Also, patient-centered preventive models are more effective than professional-centered models in the management of periodontal diseases. Regular and periodic control of dental biofilm is an essential measure for the different levels of prevention of periodontal diseases. The effectiveness of periodontal disease prevention largely depends on positive modifications of behavior, knowledge, health literacy, patient empowerment, motivation, and compliance.

Aims To determine psychological factors predicting changes in OHRQoL and clinical status after periodontal treatment. Methods Cohort of 140 patients with chronic periodontitis receiving non-surgical treatment consisting of scaling, root surface debridement and instruction in plaque control. Participants self-completed questionnaires enquiring about sense of coherence, locus of control, self-esteem and task-specific self-efficacy before treatment, and the Oral Health Impact Profile-14 before treatment, at oral hygiene review and end of study. Relationships among OHRQoL, clinical changes, individual factors (demographic and psychological) and environmental characteristics were analysed using latent growth curve modelling guided by the Wilson and Cleary model. Results OHRQoL and periodontal status improved after treatment. Being male and having a greater sense of coherence predicted better OHRQoL before treatment. Stronger internal dimension of locus of control predicted a greater rate of improvement in OHRQoL, whereas greater external dimensions predicted a slower rate of improvement. Greater task-specific self-efficacy predicted less gains in probing attachment and reductions in probing depth. Conclusions Knowledge of psychological factors may be helpful in explaining individual differences in OHRQoL and clinical responses to periodontal treatment, and in identifying where health-promoting interventions may strengthen relevant factors to improve these outcomes.

OBJECTIVES To systematically review observational studies assessing the association between socioeconomic status (SES) and oral health-related quality of life (OHRQoL) in children, adolescents and adults. METHODS Electronic searches were performed in the PubMed, Embase, Web of Science, LILACS and Scopus databases for articles published up to September 2020. Two independent reviewers performed the search and critical appraisal of the studies. The inclusion criteria were observational studies that evaluated the effect of SES on the OHRQoL in all age groups using validated methods. Quality assessment was conducted using the Newcastle-Ottawa Scale. Data were extracted for meta-analysis followed by a meta-regression analysis. A random-effects model was used to estimate the pooled calculate prevalence ratio (PR) and respective 95% confidence intervals (CI) for each study. RESULTS The search strategy retrieved 6114 publications. Some 139 articles met the eligibility criteria and were included in the systematic review. Of those, 75 were included in the general meta-analysis they represented a total sample of 109 269 individuals. People of lower SES had worse OHRQoL (PR 1.30; 95% CI 1.26-1.35). In the meta-analyses of different subgroups, an association was found between low SES and worse OHRQoL in countries of all economic classifications, in all age groups and irrespective of the socioeconomic indicator used. A socioeconomic gradient in OHRQoL was also observed, in which the lower the individuals' socioeconomic position, the poorer their OHRQoL. CONCLUSIONS Individuals of low SES had poorer OHRQoL, regardless of the country's economic classification, SES indicator and age group. Public policies aiming to reduce social inequalities are necessary for better OHRQoL throughout life.

This study aimed to test the association of contextual and individual socioeconomic status with tooth loss among Brazilian elderly people aged 65&ndash, 74 years. Data from 5435 elderly participants from the Brazilian National Oral Health Survey (2010) were linked to city-level data for 27 state capitals and the Federal District. Tooth loss was clinically assessed according to the number of missing natural teeth. Contextual social variables included Human Development Index income (HDI-income) and HDI-education. Individual socioeconomic measures were monthly family income and years of schooling. Covariates included sex, skin colour, number of residents per room and number of goods. Multilevel Negative Binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals between contextual and individual variables and tooth loss. Contextual and individual income and education measures were consistently associated with tooth loss. Elderly people living in cities with low HDI-income and low HDI-education were respectively 21% and 33% more likely to present tooth loss. Cross-level interaction suggested that the relationship of lower income and lower schooling with tooth loss is different across levels of city-level income and city-level education inequality, respectively. Public policies aiming to reduce the income and education gaps and preventive dental interventions are imperative to tackle tooth loss among elderly people.

Background Health-related quality of life (HQoL) indicators are considered valid measures of patient assessment in physical, mental and oral healthcare. This study aimed to examine the evidence on the relationship of oral health status, demographic and socioeconomic characteristics with oral health-related quality of life (OHRQoL) in children. Methods Studies in English published up to December 2019 were searched on PsycINFO, PubMed, SciELO, Scopus, and Web of Science databases. Epidemiological studies simultaneously assessing sociodemographic factors related to oral health (age, income, gender, maternal education), oral health measures (orthodontic treatment needs, dental caries and periodontal disease) and OHRQoL in children aged 3–12 years were included. Methodological quality was assessed using a Critical Appraisal Checklist. Meta-analysis was used to estimate pooled measures between sociodemographic factors and oral health measures with OHRQoL. Results Eleven articles were included. Lower children’s age (3–5 years vs > 5), gender (girls vs boys), lower income ( 6 years) were associated with poor OHRQoL among children. Orthodontic treatment needs, dental caries and periodontal diseases were also associated with poor children’s OHRQoL. Meta-regression showed that Human Development Index, sample size, year of publication and participant’s age were relevant aspects that influenced the above mentioned relationships. Conclusions Our findings suggest that oral health promotion strategies to improve children’s OHRQoL should consider the social and environmental where they live as well their oral health status. Further longitudinal studies are needed to explore the determinants of OHQoL in children.

BackgroundTo examine the relationships of rare genetic diseases affecting skeletal development, socio‐demographic characteristics, and oral health‐related behaviours with dental clinical measures in children and adolescents.MethodsA cross‐sectional study paired by age, gender and social class included 61 children and adolescents with osteogenesis imperfecta (n = 40) or mucopolysaccharidoses (n = 21) and those without genetic rare diseases (n = 60). Participants were selected at two referral hospitals for rare genetic diseases in the city of Belo Horizonte, Brazil. Caregivers completed a questionnaire to obtain age, gender, caregiver’s schooling, social class, patterns of dental attendance and duration of breastfeeding. Oral hygiene, dental caries, dental anomalies and malocclusion were assessed through dental examinations. The relationships between variables were estimated through Pathway analysis using the maximum likelihood method.ResultsRare genetic diseases affecting skeletal development were directly associated with dental caries (β = 0.22), dental anomalies (β = 0.36) and malocclusion (β = 0.29). They were also inversely linked to a preventive pattern of dental attendance (β = −0.25). Rare genetic diseases affecting skeletal development were associated with poor oral hygiene (β = 0.28) and shorter breastfeeding duration (β = −0.21). Rare genetic diseases affecting skeletal development were linked indirectly with dental caries, a reduced pattern of dental attendance and poor oral hygiene (β = 0.43). Patterns of dental attendance mediated the link between rare genetic diseases affecting skeletal development and malocclusion (β = −0.05).ConclusionRare genetic diseases affecting skeletal development were associated with poor oral health. Patterns of dental attendance and poor oral hygiene mediated the link between rare genetic diseases affecting skeletal development and dental clinical measures.

Objectives Dental implant treatment (DIT) improves peoples’ oral health-related quality of life (OHQoL). Assessment of longitudinal changes in OHRQoL may be undermined by response shift (RS). RS is the process by which quality of life changes, independent of health status as a result recalibration, reprioritization or reconceptualization. Thus, this study aimed to describe RS in the OHRQoL and perceived oral health of individuals receiving DIT and to compare the then-test, a self-anchored scale and the classification and regression trees (CRT) approaches for assessing RS. Methods OHRQoL was assessed in 100 patients receiving DIT using the OHIP-Edent (n = 100) and a self-anchored scale (n = 45) before placement of the final restoration and 3 to 6 months after treatment was completed. The OHIP-Edent was also used as a retrospective assessment at follow-up. CRT examined changes in the OHIP-Edent total score as a dependent variable with global changes in oral health and each OHIP-Edent subscale score as independent variables. Results OHRQoL and perceived oral health improved after treatment. The OHIP-Edent score decreased from 36.4 at baseline to 12.7 after treatment. On average, participants recalibrated their internal standard downwards (− 4.0 OHIP-Edent points). CRT detected downwards recalibration in 5% of participants and upwards in 15%. Reprioritization was observed in the social disability and psychological discomfort aspects of OHRQoL. Conclusions RS affects longitudinal assessments of OHRQoL in DIT, reducing the apparent magnitude of change. The then-test and CRT are valid and complementary methods to assess RS.

BACKGROUND: Psychosocial protective factors include dispositional and family attributes that may reduce the occurrence of dental caries. AIM: This review analysed the evidence on the relationship between protective psychosocial factors and dental caries in children and adolescents. DESIGN: Primary studies involving children and adolescents were searched in the following electronic databases: Medline, SCOPUS, LILACS, SciELO, and Web of Science. The reference lists were also screened. Protective psychosocial factor descriptors were in accordance with the salutogenic theory. The outcome was clinical measure of dental caries. Quality assessments were performed using the Newcastle-Ottawa scale. RESULTS: The final search resulted in 35 studies, including 7 cohort, one case-control, and 27 cross-sectional studies. Most studies were of moderate quality. Meta-analyses revealed that low parental internal locus of control (cohort studies: OR = 1.42, 95% CI: 1.20-1.64; cross-sectional studies: OR = 1.30, 95% CI: 1.19-1.41), high parental external chance (OR = 1.20, 95% CI: 1.10-1.29), and high maternal sense of coherence (OR = 0.77, 95% CI: 0.62-0.93) were associated with dental caries in children. High social support (OR = 0.81, 95% CI: 0.68-0.93) and greater self-efficacy (OR = 1.50, 95% CI: 1.12-1.22) were also associated with dental caries in adolescents. CONCLUSIONS: The current evidence suggests that some salutogenic factors are important protective factors of dental caries during childhood and adolescence.

Objectives: To investigate the structural and intermediary determinants of health-related quality of life (HRQoL) and oral health–related quality of life (OHRQoL) among adults with cleft lip and/or palate (CL/P). Design and Participants: A cross-sectional study was conducted with patients enrolled at the referral center for craniofacial anomalies in Manaus, Brazil. Adults aged 18 years or more with nonsyndromic CL/P were selected. Main Outcome Measures: Both HRQoL and OHRQoL were assessed using the 36-item Short-Form Health Survey and the Oral Impacts on Daily Performance, respectively. Individual interviews and oral examinations were conducted to collect data on socioeconomic and demographic characteristics, social ties, health-related behaviors, compliance of CL/P protocol, chronic diseases, type of CL/P, oral clinical measures, and CL/P-related measures. Poisson regression was used to test the association of independent variables with HRQoL and OHRQoL outcomes. Results: The mean age of the 96 participants was 29.4 ± 9.1 years. Low family income, female sex, low social support, type of CL/P, and dental caries were associated with poor HRQoL and poor OHRQoL ( P < .05). Poor HRQoL was also associated with chronic diseases ( P < .05). Adults with low education, low social network, and smokers were more likely to have worse OHRQoL ( P < .05). Conclusions: Structural and intermediary determinants were related to HRQoL and OHRQoL in adults with CL/P, suggesting the need for interdisciplinary approaches to improve the management of CL/P and intersectoral actions to reduce the impact of social inequalities.

Few studies have evaluated oral health promotion (OHP) programs in nursery schools. This research aimed to assess whether there were differences in oral health knowledge between preschoolers and carers who received or did not receive an OHP program in nursery schools. A post-intervention observational study involving 5-6 years-old preschoolers and 169 carers was carried out in 10 nursery schools. The preschoolers in the OHP program group (N=93) received information on oral health and recreational activities relating to oral health, whereas in the control group (N=90), no OHP activity was provided. Children's age and sex, carer's age, child kinship, education and family income were collected via questionnaire. Children and carer's oral health knowledge scores were assessed through structured interviews. Independent variables were compared between groups by t-test, Chi-square and Mann-Whitney test. The association between children and carer's oral health knowledge and the OHP program group was tested using multivariate Poisson regression. Children's oral health knowledge was significantly associated with the OHP program group. Carer's oral health knowledge did not differ between intervention and control groups. Children attending nursery schools provided with OHP programs had greater oral health knowledge than those attending nursery schools without OHP activities. Introdução. Poucos estudos avaliaram os programas de promoção em saúde bucal (PSB) em préescolas. Objetivo. Essa pesquisa objetivou avaliar se houve diferenças no conhecimento de saúde bucal entre pré-escolares e seus cuidadores que receberam e que não receberam o programa de PSB no ambiente escolar. Métodos. Este estudo observacional retrospectivo envolveu pré-escolares, de 5 a 6 anos, e 169 cuidadores, pertencentes a 10 Escolas Municipais de Educação Básica. Os pré-escolares pertencentes ao grupo do programa de PSB (n = 93) receberam informações e atividades recreativas relacionadas à saúde bucal, enquanto que, no grupo controle (n = 90), nenhuma atividade de promoção em saúde foi fornecida. As informações sobre idade, sexo, idade dos cuidadores, grau de parentesco, escolaridade, renda familiar foram coletadas através de questionário. O conhecimento sobre saúde bucal das crianças e cuidadores foram colhidos por meio de entrevistas estruturadas. As variáveis independentes foram comparadas entre grupos através do teste-T, Qui-quadrado e Mann-Whitney. Foi utilizado o modelo multivariado de regressão de Poisson com a finalidade de identificar a associação da aplicação do programa de PSB com o conhecimento de saúde bucal dos pré-escolares e seus cuidadores. Resultados. O conhecimento em saúde bucal das crianças foi significativamente maior no grupo que recebeu as atividades do programa. O conhecimento em saúde bucal dos cuidadores não diferiu entre os grupos intervenção e controle. Conclusões. As crianças que pertenciam às escolas que receberam o programa de PSB possuíam maior conhecimento em saúde bucal do que aquelas alocadas em escolas sem as atividades do programa.