Search

Abstract Objective: This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015. Methods: This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis. Results: Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged > 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death. Conclusion: Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries.

Objective: To determine the prevalence and analyze the variables associated with the use of pacifiers and/or bottles by infants up to 6 months of age. Material and Methods: Data on sociodemographic characteristics, intention to offer pacifier and bottle-feeding, pregnancy and breastfeeding (BF) variables were collected at baseline by interviews and a self-administered questionnaire among pregnant women in the 3rd trimester. After delivery, mother-baby binomials were followed by phone calls at the 1st, 3rd, and 6th months of the baby's life (n=467) to gather information on the type of delivery, baby’s gender, BF in the first hour of the newborn’s life, baby’s weight, mother’s return to work, and oral habits. Association analyses were performed using logistic regression models with a 5% significance level with the pacifier/bottle-feeding use as the outcome. Results: Most mothers (52.5%) reported their babies used bottle-feeding, 48.2% used pacifiers and 33.4% used both of them throughout the 6 months. Intention to offer pacifier and bottle-feeding was reported by 45.0% and 54.8% of the mothers at the 3rd trimester of the pregnancy, respectively. Not living in one’s own residence (OR=1.53; 95%CI: 1.05-2.24) and having the prenatal intention of offering a pacifier (OR=2.50; 95%CI: 1.63-3.83) to the baby were significantly associated with pacifier use. Variables significantly associated with bottle-feeding were mother’s return to work (OR=2.48; 95%CI: 1.54-3.97), baby’s lower birth weight (OR=1.58; IC95%: 1.07-2.33), and prenatal intention to offer bottle-feeding (OR=2.51; 95%CI 1.56-4.04). Conclusion: About half of the babies used pacifiers or were bottle-fed, which were associated with the mother’s prenatal intention to offer them to their babies and socioeconomic factors.

ABSTRACT Objective: To investigate exclusive breastfeeding (EBF) intention and associated variables among women in the third trimester of pregnancy. Methods: The data were collected with a questionnaire for the pregnant women (n=653), from December/2018 to November/2019. They answered the Infant Feeding Intentions (IFI) scale, translated and adapted to Brazilian Portuguese, and a questionnaire on sociodemographic, biological, family, pregnancy, breastfeeding, health care, and habits variables. Descriptive statistics and multiple logistic regression analyses were performed with a 5% significance level, following a multilevel hierarchical model that estimated the association between the dependent and independent variables. The outcome EBF intention measured by the IFI score was dichotomized by the median (

ABSTRACT Little is known about how Brazilian dentists’ treatment decisions for proximal carious lesions are compared to current evidence-based recommendations, so better understanding is needed to close any potential evidence-practice gap. Objectives: This cross-sectional study aimed to quantify the evidence-practice gap about proximal carious lesions treatment and identify dentist factors associated with this evidence-practice gap. Methods: Brazilian dentists (n=214) from Araraquara, São Paulo State, “completed a questionnaire about their dentist and practice characteristics and a translated version of the “Assessment of Caries Diagnosis and Caries Treatment” from the U.S. National Dental Practice-Based Research Network. Five radiographic images of proximal carious lesions in low-risk and high-risk patient scenarios were used. Associations between treatment recommendations and lesion, dentist, and practice characteristics were tested for statistical significance (p

Abstract Background Brazil experienced an expansion of the population's access to oral health policies after the creation of the Unified Health System (SUS, Sistema Único de Saúde). Through public policies, the consolidation of Primary Health Care (PHC) and the incorporation of dental care into primary and hospital care took place. The objective of this study was to identify epidemiological aspects, including the temporal trend, of hospital morbidity from oral and oropharyngeal cancer in Brazil, considering hospitalizations for this neoplasm in a hospital network linked to the public care system. Methods Observational study based on information on hospital admissions for oral cancer throughout Brazil. The research used data from the Brazilian Cancer Registry Information System. For the temporal series analysis, generalized linear regression model was used with the Prais-Winsten method. Results Of the 121,971 patients hospitalized with oral and oropharyngeal cancers, 76.40% were male and 23.60% were female, resulting in a M:F ratio of 3.24:1. Regarding the anatomical region of involvement among hospitalized patients with oral cavity neoplastic lesions, there was a predominance in non-specific places in the mouth, such as the floor of the mouth, soft and hard palate, among others (32.68%), followed by lesions in the region of tongue (28.89%). In this population, the predominant age group was between the fifth decade (31.09%) and sixth decade of life (24.99%); men presented neoplastic lesions of oral and oropharyngeal cancers at an earlier age than women. In all regions of the country, the staging of cases diagnosed in the tertiary health network accredited to the José Alencar Gomes da Silva National Cancer Institute (INCA) was late, with higher tendency for metastasis. The temporal trend of the adjusted in-hospital morbidity rates showed to be increasing in the Northeast, South and Midwest regions for the male gender. For females, they were increasing in the Northeast and South regions. Conclusions It is concluded that the distribution of in-hospital morbidity rates of oral and oropharyngeal cancers in the country is irregular. There is a greater number of cases identified by the study in male patients and in the Southeast and South regions; with an increasing tendency of this coefficient in both genders.

Abstract Background Integrated dental services within the Health System, particularly at primary health care, are crucial to reverse the current impact of oral diseases, which are among the most prevalent diseases worldwide. However, the use of dental services is determined by complex phenomena related to the individual, the environment and practices in which care is offered. Therefore, factors associated with dental appointments scheduling can affect positively or negatively the use of dental services. The aim of the present study was to evaluate the indicators for dental appointment scheduling in Primary Health Care (PHC). Methods The present is a cross-sectional analytical study that used data from the external assessment of the third cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), carried out between 2017 and 2018, in Brazil. The final sample consisted of 85,231 patients and 22,475 Oral Health teams (OHTs). The outcome variable was the fact that the user sought for a dental appointment at the Primary Health Care Unit. A multilevel analysis was carried out to verify the association between individual variables (related to users) and contextual variables (related to the OHTs) in relation to the outcome. Results Only 58.1% of the users interviewed at these Primary Health Care Units seek the available dental care. The variables with the greatest effect on the outcome were the patient’s age up to 42 years old (OR = 2.03, 95% CI: 1.96–2.10), at individual level, and ‘oral health teams that assisted no more than a single family health team (FHT)’ (OR = 1.29, 95% CI: 1.23–1.36) at contextual level. Other variables were also associated with the outcome, but with a smaller effect size. Conclusion In conclusion, users’ age and work process of OHT were indicators for dental appointment scheduling. Our results suggest that when OHT put the National Oral Health Policy guidelines into practice, by assisting only one FHT, the chance for PHC users seeking dental appointments is higher than OHTs that assist more than one FHT. Regarding age, patients aged up to 42 years are more likely to seek an appointment with a dentist.

Abstract Background Oral and oropharyngeal cancers are considered important public health problems worldwide. This study aims to analyze the association between late diagnosis of oral and oropharyngeal cancers in Brazil and the contextual indicators of socioeconomic variables and coverage of Primary Health Care (PHC), and to assess the temporal trend of late diagnosis. Methods In this cross-sectional observational study, secondary data were evaluated with a time series analysis. All Brazilian cities that reported at least one case of oral and oropharyngeal cancers each year in the period between 2000 and 2013 were included; and the staging was analyzed by calculating the ratio risk for late diagnosis for each municipality. The association between staging and socioeconomic variables and offer of PHC was calculated using multiple linear regression. The time trend of the risk ratio for late-stage diagnosis was calculated using the Prais–Winsten method. Results One hundred and sixty Brazilian municipalities had at least one annual case of oral and oropharyngeal cancers notified to the INCA hospital system between 2000 and 2013. The adjusted model showed that the higher the Gini value (greater social inequality) and the lower the HDI value (less human development) was, the higher was the number of tumors diagnosed at a late stage, considering the size of the tumor. A greater risk for late diagnosis was identified, as early as at the stage of lymph node involvement, when there was a higher level of social inequality and lower level of coverage by Oral Health Teams (OHT) in PHC. The greater the social inequality, the greater was the risk of late diagnosis, as early as in the stage of metastasis. Conclusions We concluded that, during the evaluated period, there was an increase in the number of cases diagnosed at the most advanced stage. Furthermore, there was association between higher levels of social inequality and an increase in the proportion of late diagnosis of oral and oropharyngeal cancers. In addition, the inclusion of Oral Health Teams in Primary Health Care promoted the early diagnosis of these types of cancers.

Objective: To investigate association between parental locus of control (belief of individuals about what or who has control of the events of their lives) and bottle feeding habits among children from 3 to 5 years of age. Methodology: Parental locus of control validated in Brazil, and semi-structured questionnaire to obtain sociodemographic, health, and oral habit behaviors was applied to mothers of 992 preschool children. Outcome variable “use of feeding bottle” was studied according to the time of its use (≤36 months and >36 months). Simple logistic regression models were adjusted and raw odds ratios were estimated for variables of distal blocks, which contemplated parental locus of control, socioeconomic characteristics of family, and maternal habits. In the intermediate block, the variables for conditions of the child's birth and place of health care attendance during the prenatal period and early childhood were included. In the proximal block, the time of breastfeeding and pacifier use were reported. Variables were analyzed from the distal to the proximal block, and the individual analyses that presented p ≤ 0.20 remained in each model; included in the subsequent block were the variables with p ≤ 0.10, because this was a study of prevention. Results: Longer time of feeding bottle use was associated with the internal parental locus of control, mothers older than 31 years of age, white race, premature children, who used pacifiers and are treated in the private health system. Conclusions: Children who maintained the habit of feeding bottle use for a longer time were those whose mother presented an internal locus of control.

Objective: To describe the dental practice patterns related to caries prevention in children aged 6-18 years and associated factors. Material and Methods: Dentists (n=162) from Araraquara, Brazil, completed two paper questionnaires: (1) one about characteristics of their practice and their patient population; and (2) a translated version of the “Assessment of Caries Diagnosis and Caries Treatment” Questionnaire from the National Dental Practice-Based Research Network. Regression analyses were used for data analysis (p

Abstract Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian dentists. This study aimed to determine the prevalence of CRA use by dentists and factors associated with its use, as well as to quantify dentists’ ratings of the importance of specific factors when treatment planning. Dentists registered at the Regional Council of Dentistry of São Paulo State – Araraquara region were sent two paper questionnaires that comprised: a) characteristics of dentists themselves, their practices, and their patients; and b) the translated version of the “Assessment of Caries Diagnosis and Caries Treatment” Questionnaire from the U.S. National Dental Practice-Based Research Network. Participants were 206 dentists who currently practiced in Araraquara and treated dental caries. Descriptive statistics and multiple logistic regression analyses were used for data analysis. Thirty-six percent of the dentists reported they perform CRA and, among them, 36% indicated they record the assessment on a special form that is kept in the patient chart. More years since dental school graduation (OR = 1.1, p = 0.002) and holding an advanced academic degree (OR=2.6, p=0.005) were associated with a higher likelihood of performing CRA, whereas exclusively using a private practice model (OR = 0.5, p = 0.016) was associated with a lower likelihood of performing CRA. The current oral hygiene and commitment to return for follow-up were the most important risk factors for treatment planning. In conclusion, CRA was not a routine procedure in daily practice among the majority of participating dentists. Specific demographic, practice and academic education characteristics were associated with performing CRA.

Abstract Introduction Little is known whether caries risk influence occlusal sealants retention. Objective To determine the retention rates (RR) of the resin-modified glass ionomer cement used as occlusal sealant in permanent first molars of 6-8-year old schoolchildren and to analyze the influence of caries risk at baseline on the RR of the sealant, over a 24-month period. Material and method The sealant application was performed in a dental office at the beginning of the study, after children being allocated into high caries risk group (HR) and low caries risk group (LR). The examinations were performed by the same calibrated dentist at 0, 6, 12, 18 and 24 months. Retention rates were estimated, the Kaplan-Meier method was used to estimate the survival probabilities; and the comparison between HR and LR groups was evaluated by Wilcoxon and log-rank test. Result The results showed that 14% of sealed teeth showed total loss (16% for HR and 12% for LR) and 46% showed partial loss during the study (51% for HR and 41% for LR), in relation to the baseline sample. No difference could be demonstrated by the survival analysis between HR and LR groups (p>0.05). Conclusion Caries risk did not influence the retention rates of a resin-modified glass ionomer cement used as occlusal sealant in 6-8-year old schoolchildren.

The aim of this cross-sectional study was to verify the importance of including initial carious lesions (IL) in the oral health planning of a public health service. The sample comprised 692 schoolchildren at the ages of 5 (n=171), 6 (n=203), 12 (n=236) and 15 (n=82), enrolled in state schools in Iracemapolis, SP, Brazil. Clinical examination was performed, using dental mirror and CPI (Community Periodontal Index) probe, after tooth brushing and drying. Two diagnostic thresholds were used for measuring the outcome: diagnostic threshold based on cavitated lesions and diagnostic threshold based on the inclusion of IL. The mean value for dmft was 1.56 for 5-year-olds and 1.98 for 6-yearolds. The mean value for DMFT was 1.19 for the age of 12 and 2.90 for the age of 15. The dmft and DMFT indexes increased significantly for all ages (paired t test, p

O objetivo do presente estudo foi analisar como a prevalência e a distribuição da cárie dentária influenciam o tamanho da amostra em levantamentos epidemiológicos, e os custos para sua realização. Foram utilizados dados de levantamentos realizados em escolares de 12 anos em Bauru nos anos de 1976, 1984, 1990, 1994 e 2001, e em Piracicaba nos anos de 2001 e 2005. Os tamanhos amostrais foram dimensionados considerando-se a média e o desvio padrão obtidos, fixando-se erro amostral em 1%, 2%, 5% e 10%. Os custos foram estimados considerando material permanente, de consumo e recursos humanos. Verificou-se aumento no tamanho das amostras em ambos os municípios, variando de 119 em 1976 para 1.118 em 2001 em Bauru, e de 954 em 2001 para 1.252 em 2005 em Piracicaba, considerando-se um erro amostral de 10%. Considerando-se diferentes erros amostrais, verificou-se o custo para o levantamento, sendo que o mesmo depende do quanto o pesquisador se permite errar em relação ao verdadeiro valor da média da população. Conclui-se que a diminuição da prevalência da cárie dentária determinou o aumento no tamanho das amostras e a elevação dos custos para realização dos levantamentos.This study aimed to analyze how the prevalence and the distribution of dental caries influence the sample size in epidemiological surveys, and how much are the costs. Secondary data of oral health surveys in 12-year-old schoolchildren from Bauru in 1976, 1984, 1990, 1994, and 2001, and from Piracicaba in 2001 and 2005 were studied. Sample sizes were estimated taking into account the mean DMFT and standard deviation of each survey, establishing sampling errors of 1%, 2%, 5%, and 10%. Costs were estimated considering permanent material, consumption material and human resources. The sample size in both towns needed to be increased, ranging from 119 in 1976 to 1,118 in 2001 in Bauru, and from 954 in 2001 to 1,252 in 2005 in Piracicaba, when a sampling error of 10% was considered. The cost of dental caries surveys was verified considering different sampling errors. This cost depends on how acceptable is the margin of difference between the true mean and the one found in the survey. In conclusion, the reduction in the prevalence of dental caries has determined the need for increase in sample size and in costs for conducting the surveys.

This study aimed to review the dental literature about caries risk assessment over the last 10 years in order to show which variables have been considered risk predictors and risk factors of dental caries in infants, preschool-, schoolchildren and adolescents. A Medline search of the published English language literature from 1997 to 2007 was made for papers of longitudinal studies that reported on caries risk assessment. A total of 39 papers were included in this review. Most studies were conducted in schoolchildren (n=19), followed by preschool children (n=9), adolescents (n=7) and infants (n=4). Variables such as caries experience, gingival status, microbiological counts, oral hygiene, plaque mineral concentration, fluoride history, socioeconomic and educational level, demographic, anthropometrical, oral, dietary and toothbrushing habits were studied. Past caries experience has been the predominant predictor for future caries in 0-18- year-old subjects. Other variables, such as dietary habits, including sugar intake, and toothbrushing habits may also help identifying high-risk individuals. In conclusion, the variables related to caries experience continue to be the main predictor of caries increment.

O conhecimento do risco de cárie na gravidez é essencial para um correto plano de tratamento com ações educativas e preventivas às mães para que possam cuidar adequadamente de sua saúde bucal e de seus filhos. Este estudo retrospectivo teve como objetivo identificar o risco de cárie de gestantes (15-44 anos; média= 25 anos) que frequentaram a clínica de odontologia preventiva da Faculdade de Odontologia de Araraquara, Universidade Estadual Paulista de 1999 a 2007. Um total de 166 prontuários, preenchidos por alunos do 3º ano do Curso de Graduação, seguindo orientações pré-estabelecidas, foram utilizados. Coletou-se informação sobre: classificação do diagnóstico de risco de cárie, trimestre gestacional, consumo de carboidratos (entre ou durante as refeições), placa corada (registro de controle de placa de O'Leary), número e grupo de dentes com experiência de cárie. Para análise estatística foram utilizados o teste de qui-quadrado e ANOVA. A maioria das gestantes (92,1 %) apresentou 25 % ou mais das superfícies dentárias com placa dental. A média (desvio-padrão) de dentes obturados e cariados foi 7,9 (5,1) e 4,0 (3,4), respectiva emente. Os dentes posteriores foram os mais acometidos por cárie/restaurações. Quanto ao diagnóstico de risco à cárie, a classificação alta foi observada em 38,5 % das gestantes, moderada em 47,6 % e baixa em 13,9 %. Houve associação estatisticamente significativa (p= 0,001) entre o consumo de carboidratos e o diagnóstico de risco de cárie. O índice de placa foi semelhante nos diferentes trimestres gestacionais (f= 0,223; p= 0,803). Portanto pode-se concluir que o risco de cárie da grande maioria das gestantes foi alto ou moderado e esteve estatisticamente associado ao consumo de carboidratos.El conocimiento del riesgo de padecer de caries dental durante el periodo de embarazo es esencial para un correcto plan de tratamiento con las acciones educativas y preventivas necesarias para que las madres puedan cuidar adecuadamente de su salud bucal y la de sus hijos. Este estudio retrospectivo tuvo como objetivo identificar el riesgo de caries dental en las mujeres en periodo de gestación con edades comprendidas entre 15 y 44 años, con una media de 25 años, que acudieron a la clínica de odontología preventiva de la Facultad de Odontología de Araraquara, Universidad Estadual Paulista, del año 1999 al 2007. Se utilizaron 166 historias clínicas hechas por los estudiantes de tercer año de pregrado, según las directrices preestablecidas. La información recogida fue: clasificación del diagnóstico de riesgo de caries, trimestre de embarazo, la ingesta de hidratos de carbono entre o durante las comidas, placa dental (registro de control de placa de O'Leary) y el número de grupo de dientes con caries. El análisis estadístico utilizó el Chi cuadrado y ANOVA. La mayoría de los pacientes mostraron el 25 % o más de las superficies de los dientes con la placa dental con un valor de 92,1 % e hidratos de carbono consumidos entre comidas con un valor de 89,2 %. La media (desviación estándar) de los dientes cariados y restaurados fue de 7,9 (5,1) y 4,0 (3,4) respectivamente; los dientes posteriores se vieron más afectados por la caries o restauraciones. En cuanto al diagnóstico de riesgo de caries, la clasificación de alto riesgo se observó en 38,5 % de las mujeres embarazadas, moderado en 47,6 % y bajo en 13,9 %. Existió una asociación estadísticamente significativa (p= 0,001) entre el consumo de hidratos de carbono y el riesgo de caries. El índice de placa fue similar en los diferentes trimestres del embarazo (f= 0,223 y p= 0,803). El riesgo de padecer caries dental en la gran mayoría de las mujeres embarazadas fue alto o moderado y se asoció significativamente con el consumo de hidratos de carbono.The knowledge of risk of carried during pregnant is essential for an appropriate treatment using educational and preventives actions to mother for a good care of their oral health and that of children. The main objective of present retrospective study was to identify the risk of caries of pregnants (aged 15-44, mean= 25 years) came to clinic of Preventive Odontology of Araraquara-UNSEP from 1999 to 2007, using 166 medical records obtained by the third pregraduate year students, following the pre-established guidelines. The information collected includes: classification of caries risk diagnosis, pregnancy trimester, carbohydrates ingestion (between or during foods), dental plaques (O'Leary's plaque control registry) and the number of teeth with caries. The statistical analysis used the Chi² and ANOVA tests. Most of patients showed a 25 % or more of teeth surfaces with dental plaques (92.1 %) and carbohydrates consumption among foods (89.2 %). The mean (SD) of carried and restores teeth was of 7.9 (5.1) and 4.0 (3.4), respectively and the posterior teeth were the more involved by caries/restorations. As regards the diagnosis of caries risk, classification of high risk was observed in the 38.5 % of pregnants, moderate in the 47.6 %) and low in the 13.9 %. There was a statistically significant association (p= 0.001) between the carbohydrates consumption and the diagnosis of caries risk. The plaque's rate was similar in the different trimesters of pregnancy (f= 0.223; p= 0.803). The caries risk of most pregnant women was high or moderate and it was associated with the consumption of carbohydrates.

OBJECTIVE: The aims of this study were to investigate the effectiveness of sealant placement under the guidelines of the Oral Health Promotion Program for Children and Adolescents (Portugal), and to test the influence of clinical and socioeconomic variables on the DMFT increment in 277 children, born in 1997. MATERIAL AND METHODS: A dental hygienist performed the initial examinations and sealant placement (Helioseal, Vivadent) on the permanent first molars in 2005. These activities were registered in dental records that were assessed in 2007. Children were classified according to caries risk at baseline [high (HR: DMFT+dmft>0); low (LR: DMFT+dmft=0) risk] and sealant placement as follows: HR-S and LR-S Groups (with sealant placement); HR-NS and LR-NS Groups (without sealant placement). A calibrated dentist performed the final examination in 2007 at school, based on the World Health Organization recommendations. The variables collected were: dental caries, visible dental plaque, malocclusions, and socioeconomic level (questionnaire sent to children's parents). For univariate (Chi-square or Fisher tests) and multivariate (Multiple logistic regression) analyses the DMFT increment >0 was selected as dependent variable. RESULTS: Approximately 17.0% of the children showed DMFT increment>0 (mean=0.25). High-risk children presented a significant increase in the number of decayed and/or filled teeth. These children had 7.94 more chance of developing caries. Children who did not receive sealant were 1.8 more prone to have DMFT increment >0. CONCLUSION: It appears that sealant placement was effective in preventing dental caries development. Moreover, the variables "risk" and "sealant placement" were predictors for DMFT increment in the studied children.

OBJECTIVE: The aim of this 2-year cohort study (2003 to 2005) was to investigate how caries experience, at initial lesions (early or non-cavited lesions) and cavited stages, predicts caries increment in permanent teeth in 7-10- year-olds. MATERIAL AND METHODS: The random sample of 765 children attending public schools in the city of Piracicaba, SP, Brazil, was divided into two groups: 423 children aged 7-8 years and 342 children aged 9-10 years. All subjects were examined by a calibrated examiner, using dental mirror and ball-ended probes, after tooth brushing and air-drying in an outdoor setting, based on the World Health Organization criteria. Active caries with intact surfaces were also recorded as initial lesion (IL). Univariate analysis was used for statistical analysis (Odds Ratios and Chi-square). RESULTS: The association between the DMFT (decayed, missing and filled teeth) increment and the presence of IL was significant only for 9-10-year-old children. The children with DMFT>0 at baseline were more prone to have DMFT increment, with the highest risk for caries increment occurring in children aged 7-8 years. CONCLUSIONS: The predictors of caries increment were the presence (at baseline) of caries experience in permanent teeth for both age groups (7-8; 9-10-year-olds) and the presence of the IL (at baseline) for 9-10-year-olds.

OBJETIVO: estimar a frequência de oclusopatias e suas associações com o tipo e o período de amamentação, hábitos bucais deletérios e informações recebidas pelas mães no pré-natal, em crianças com cinco anos de idade que frequentavam creches municipais. MÉTODOS: a amostra consistiu de 162 crianças residentes no município de São Pedro, SP. Em entrevista com cada mãe, informações sobre o tempo e a forma de aleitamento, a presença de hábitos deletérios, e orientações recebidas pela mãe durante o pré-natal foram coletadas. O exame epidemiológico foi realizado nas dependências das creches, por um único examinador, previamente calibrado, sob iluminação direta. As seguintes variáveis foram avaliadas: presença e severidade de oclusopatias [ligeiro apinhamento e espaçamento (AE), mordida aberta (MA), sobremordida (SM), mordida cruzada uni ou bilateral (MC), overjet positivo (OV) e relação terminal dos segundos molares decíduos (RTM)]. A análise dos dados consistiu de análise univariada (teste qui-quadrado) e de regressão logística múltipla. RESULTADOS: a prevalência de oclusopatias foi de 95,7% (AE = 22,8%; MA = 24,7%; SM = 20,4%; MC = 14,8%; e OV = 13,0%). Na RTM, o terminal reto foi predominante (85,0%). Dentre os hábitos bucais deletérios, o uso de chupeta foi o único indicador de risco (OR = 5,25; p = 0,001) para mordida aberta em crianças que a utilizaram por mais de três anos, detectado nas regressões logísticas. CONCLUSÃO: a prevalência de oclusopatias e de hábitos bucais deletérios na amostra estudada foi alta. As crianças que usavam chupeta por mais de três anos mostraram maior probabilidade de apresentar mordida aberta.OBJECTIVE: To estimate the frequency of malocclusion and their associations with the type and period of breastfeeding, deleterious oral habits, and information received by mothers during the pre-natal period, in 5-year-old children attending municipal daycare centers. METHODS: The sample consisted of 162 children resident in the municipality of São Pedro, SP, Brazil. In an interview with each of the mothers, information was collected about the time and form of breastfeeding, presence of deleterious habits, and information the mother received during the pre-natal period. The epidemiological exam was performed at the daycare center facilities by a single, previously calibrated examiner, under direct lighting. The following variables were evaluated: presence and severity of malocclusion [slight overcrowding and spacing (OS)], open occlusal relationship (open bite) (OPB), vertical overlap (over bite) (OVB), uni- or bilateral cross bite (CB), positive overjet (OV) and the primary second molar terminal plane relationship (TPR)]. Data analysis consisted of univariate analysis (chi-square test) and multiple logistic regressions. RESULTS: The prevalence of malocclusions was 95.7% (OS = 22.8%; OPB = 24.7%; OVB = 20.4%; CB = 14.8%; and OV = 13.0%). In TPR the straight terminal plane was predominant (85.0%). Among the deleterious oral habits, the use of a pacifier was the only risk indicator (OR = 5.25; p = 0.001) for open occlusal relationship (open bite) in children that used it for over three years, detected in the logistic regressions. CONCLUSION: The prevalence of malocclusions and deleterious oral habits in the studied sample was high. Children that used a pacifier for over three years showed greater probability of presenting with open occlusal relationship (open bite).

OBJETIVO: Avaliar a influência de variáveis socioeconômicas, clínicas e demográfica na experiência de cárie em pré-escolares de 5 anos de idade da cidade de Piracicaba. METODOLOGIA: A amostra consistiu de 728 crianças matriculadas em 22 pré-escolas públicas (n = 428) e 18 pré-escolas privadas (n = 300). A cárie dentária foi avaliada pelos índices ceo-d e ceo-s e pela detecção de lesão inicial (LI). Outras variáveis clínicas como gengivite, apinhamento, espaçamento, fluorose e respiração bucal também foram coletadas. As variáveis socioeconômicas (renda familiar mensal, número de residentes na mesma casa, escolaridade do pai e da mãe, habitação e posse de automóvel) foram obtidas por meio de um questionário semi-estruturado enviado aos pais. RESULTADOS: As médias (desvio-padrão) do ceo-d e ceo-s foram de 1,30 (2,47) e 3,08 (7,55), respectivamente, sendo que 62,2% da amostra estava livre de cárie. As médias (desvio-padrão) do ceo-d+LI e ceo-s+LI foram 1,72 (3,36) e 3,45 (7,94), respectivamente e 59,7% estavam livres de cáries. Por meio da análise de regressão logística múltipla, as crianças com fluorose (Odds Ratio-OR=0,40) ou de famílias com renda superior a 4 salários mínimos (OR = 0,49) apresentaram menor probabilidade de ter experiência de cárie. Aquelas com gengivite (OR = 1,87) tiveram maior chance de ter a doença. Para o critério de diagnóstico de cárie com a inclusão de LI, as crianças com fluorose (OR = 0,39) ou de famílias com renda superior a 4 salários mínimos (OR = 0,52) tiveram menor chance de ter cárie. Aquelas com gengivite (OR=1,80), apinhamento (OR = 2,63 e OR = 1,01) ou respiração bucal (OR = 1,37) apresentaram maior probabilidade de ter a doença. CONCLUSÃO: Os pré-escolares que apresentaram gengivite, apinhamento, respiração bucal ou renda familiar mensal inferior a 4 salários mínimos tiveram maior probabilidade de ter experiência de cárie. Assim, o planejamento de ações de prevenção e intervenção direcionadas a este público seria essencial para o controle da doença.AIM: To evaluate the influence of socioeconomic, clinical and demographic variables on caries experience in 5-year-old preschool children from Piracicaba. METHODS: The sample consisted of 728 children attending 22 public (n=428) and 18 private (n=300) preschools. Dental caries were measured using the dmft/dmfs indexes and by detecting initial caries lesion (IL). Gingivitis, crowding, spacing, fluorosis, and mouth breathing were also recorded. Socioeconomic variables (monthly family income, number of people living in the household, parents' schooling, home ownership, and car ownership) were collected by means of a parental semi structured questionnaire. RESULTS: The mean (standard deviation) values for dmft and dmfs indexes were 1.30 (2.47) and 3.08 (7.55) respectively; and 62.2% of the children were caries-free. The mean (standard deviation) values for dmft+LI and dmfs+LI were 1.72 (3.36) and 3.45 (7.94), respectively and 59.7% were caries-free. By means of multiple logistic regression analyses, children with fluorosis (OR=0.40) or family income > 4 minimum wages (OR=0.49) were less likely to experience caries. Those with gingivitis (OR=1.87) were more prone to have the disease. Considering the diagnostic threshold including IL, the multiple logistic regression analyses showed that children with fluorosis (OR=0.39) or family income > 4 minimum wages (OR=0.52) were less likely to have caries. Those with gingivitis (OR=1.80), crowding (OR=2.63 e OR=1.01) or mouth breathing (OR=1.37) were more likely to have the disease. CONCLUSION: The preschool children who presented gingivitis, crowding, mouth breathing or monthly family income < 4 minimum wages were more likely to experience caries. In this way, planning preventive and operative actions targeted at these children would be essential for caries control.

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.El objetivo de este estudio fue desarrollar modelos de regresión para describir el perfil epidemiológico de caries dentales en niños de 12 años en un área de baja prevalencia de caries. Fueron estudiados dos muestras distintas aleatorias y probabilísticas de niños escolares (n= 1.763) que estudiaban en colegios públicos y privados en Piracicaba, Sureste de Brasil. Modelos de regresión fueron estimados como una función de los dientes más afectados usando datos colectados en 2005 y fueron validados usando una base de datos del 2001. El índice promedio (SD) de DMFT fue 1,7 (2,08) en 2001 y las ecuaciones de regresión estimaron un índice de DMFT de 1,67 (1,98), lo cual corresponde a 98,2% del índice en 2001. El estudio provee datos detallados sobre el perfil de caries en niños de 12 años usando una aproximación analítica. Los modelos de regresión pueden ser un método confiable y factible que puede proporcional información valiosa para la planificación y evaluación de servicios de cuidado oral.O objetivo do estudo foi desenvolver modelos de regressão para delinear o perfil epidemiológico da cárie dentária em localidade com baixa prevalência de cárie aos 12 anos de idade. Foram examinadas duas amostras probabilísticas (n=1.763) de indivíduos de escolas públicas e privadas de Piracicaba,(SP). Dados sobre os dentes mais afetados foram coletados em 2005 e validados utilizando um banco de dados (2001). A média (dp) do CPOD foi de 1,7 (2,08) em 2001 e os modelos de regressão desenvolvidos estimaram um CPOD de 1,67 (1,98) em 2005, o qual representa 98,2% do CPOD em 2001. Os resultados apresentaram detalhes do perfil da cárie dentária aos 12 anos, usando uma abordagem analítica atual. Os modelos de regressão poderiam ser considerados como uma forma acurada e factível no auxílio do planejamento e avaliação dos serviços em saúde bucal.

The purpose of this study was to identify risk indicators of high caries level at baseline (HCLB) based on cross-sectional data and predictors of high caries increment (HCI) based on a 7-year-follow-up examination in 6-8-year-old schoolchildren. Two hundred and six schoolchildren were examined in 1997 and in 2004 by the same two calibrated dentists, in Piracicaba, Brazil. At baseline, dental caries, presence of sealants, fluorosis, and oral hygiene status were recorded. The children's parents completed a questionnaire concerning socioeconomic level, fluoride use, dental service utilization, dietary and oral hygiene habits. HCLB and HCI were defined considering the upper quartile of the total caries experience distribution (dmfs+DMFS) and caries increment distribution, respectively. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals and p-values. Having white spot lesions (OR=5.25) was found to be a risk indicator of HCLB. Schoolchildren with dental fluorosis (OR=0.17) or those who brushed the teeth more than two times a day (OR=0.37) presented less probability of HCLB. The predictors of HCI were: dmfs>0 (OR=2.68) and mothers' educational level up to 8 years of schooling (OR=2.87). Clinical and socioeconomic variables were found to be risk indicators and/or predictors of dental caries in schoolchildren.

O objetivo deste estudo transversal foi descrever a prevalência de cárie dentária, hipoplasia, fluorose e opacidade demarcada de esmalte, assim como relatar as necessidades de tratamento em pré-escolares de 5 anos e de escolares de 12 anos, do município de Araras, em 2004. A amostra probabilística consistiu de 381 indivíduos, sendo 186 pré-escolares de 5 anos e 195 escolares de 12 anos. Os exames epidemiológicos foram realizados por quatro examinadores previamente calibrados, sob luz natural, utilizando-se espelho bucal sonda “ball point”, seguindo as recomendações da OMS. Cárie dentária foi registrada utilizando-se os índices ceod e CPOD. As lesões sem cavidades ativas, necessidades de tratamento, hipoplasia e opacidade demarcada também foram avaliadas. A fluorose foi registrada seguindo o Índice de Dean nos escolares de 12 anos. Os resultados mostraram que o índice ceod aos 5 anos foi 2,07 (dp=3,21) e o CPOD aos 12 anos foi de 2,14 (dp=2,56). Dentre as crianças de 5 e 12 anos examinadas, 52,2% e 42,3% estavam livres de cárie, respectivamente. Aproximadamente um terço dos examinados apresentaram sinais de atividade de cárie. As restaurações de uma face foram as necessidades de tratamento predominantes tanto nos pré-escolares (42,1%) quanto nos escolares (39,0%). A opacidade demarcada esteve presente em 65,1% dos pré-escolares e 14,4% dos escolares; a hipoplasia em 5,9% e 1,5%, respectivamente e 18% dos escolares de 12 anos apresentaram fluorose. Pode-se concluir que os pré-escolares e os escolares examinados apresentaram necessidades de baixa complexidade, uma vez que a proporção de livres de cárie foi alta e a atividade da doença foi baixa.

Objectives: a) to evaluate the interexaminer reliability in caries detection considering different diagnostic thresholds and b) to indicate, by using Kappa statistics, the best way of measuring interexaminer agreement during the calibration process in dental caries surveys. Methods: Eleven dentists participated in the initial training, which was divided into theoretical discussions and practical activities, and calibration exercises, performed at baseline, 3 and 6 months after the initial training. For the examinations of 6-7-year-old schoolchildren, the World Health Organization (WHO) recommendations were followed and different diagnostic thresholds were used: WHO (decayed/missing/filled teeth - DMFT index) and WHO + IL (initial lesion) diagnostic thresholds. The interexaminer reliability was calculated by Kappa statistics, according to WHO and WHO+IL thresholds considering: a) the entire dentition; b) upper/lower jaws; c) sextants; d) each tooth individually. Results: Interexaminer reliability was high for both diagnostic thresholds; nevertheless, it decreased in all calibration sections when considering teeth individually. Conclusion: The interexaminer reliability was possible during the period of 6 months, under both caries diagnosis thresholds. However, great disagreement was observed for posterior teeth, especially using the WHO+IL criteria. Analysis considering dental elements individually was the best way of detecting interexaminer disagreement during the calibration sections.

Este estudo apresenta o resultado de uma avaliação de custo-efetividade conduzida ao longo de um ensaio clínico controlado para avaliar a efetividade do selamento com ionômero de vidro modificado por resina (Vitremer, 3M ESPE) e da aplicação de verniz fluoretado (Duraphat, Col-gate) em superfícies oclusais de primeiros molares permanentes, em crianças de 6 a 8 anos (N = 268), segundo o risco de cárie (alto risco; baixo risco). As crianças foram examinadas semestralmente, ao longo de 24 meses, pelo mesmo dentista calibrado, após alocação em seis grupos: controle alto risco e baixo risco (educação em saúde bucal trimestral); verniz alto risco e baixo risco (educação em saúde bucal trimestral + aplicação semestral de verniz); e selante alto risco e baixo risco (educação em saúde bucal trimestral + única aplicação do selante). A análise mostrou que o selamento de primeiros molares permanentes em crianças de alto risco apresentou razão de C/E de R$ 225,21(US$ 119,80) por superfície oclusal salva, e razão incremental de C/E de R$ 203,71(US$ 108,36) por superfície oclusal adicional salva. Conclui-se que uma única aplicação de selante, em escolares de alto risco, foi a intervenção mais custo-efetiva.

Comparar indicadores de saúde bucal (Rendimento, Atrição, Ênfase em Prevenção Modificado, Relação Restauração/Extração) e Relação 1ª Consulta/Urgência entre 15 Unidades de Saúde da Família e 11 Unidades Básicas de Saúde de município do interior paulista, de 2008 a 2011. Os dados foram coletados a partir do Sistema de Informações Ambulatoriais do SUS (SIA-SUS) e comparados os modelos de atenção por meio de série histórica, teste não paramétrico (Mann-Whitney) e estatística descritiva. Embora haja o processo de fortalecimento da Estratégia Saúde da Família o modelo assistencial representado pelas Unidades Básica de Saúde se mostra mais efetivo em alguns aspectos da saúde bucal no serviço público.