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Objectives: The primary aim of this study was to evaluate if children's oral health and oral health-related quality of life (OHRQoL) were associated with school performance. Moreover, the study aimed to examine whether school environment factors influenced this association., Methods: This cross-sectional study was based on a population-based sample of 998 12-year-old schoolchildren from 31 public schools in Quito, Ecuador. Trained and calibrated examiners conducted clinical exams for dental caries, dental trauma and malocclusion. Furthermore, children completed the Spanish version of the Child Perception Questionnaire (CPQ 11-14 ), and their parents answered questions about socio-economic status. School coordinators provided information on the physical environment, promotion of health practices and the occurrence of negative episodes in the school. There were three outcomes: grades obtained in Spanish language and mathematics and the number of missed school days. Multilevel linear and Poisson regression models were conducted using a hierarchical approach to include the variables guided by a previously created direct acyclic graph., Results: Children with dental trauma and higher CPQ 11-14 scores showed lower grades and school attendance. Schoolchildren from schools with episodes of vandalism had more school days missed., Conclusion: The school performance of 12-year-old children is affected by dental trauma and by a worse OHRQoL, as well as a negative school environment. Therefore, supportive environments and promoting health measures in schools could overcome this worse academic performance in children with oral health problems., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study aimed to estimate the prevalence and extent of bleeding on probing and calculus in 12-year-old schoolchildren of Quito, Ecuador, and evaluate the associated factors. We conducted an epidemiological survey with a representative sample of 1,100 12-year-old schoolchildren from public schools in the urban area of Quito, Ecuador. We assessed the periodontal health using the Community Periodontal Index (CPI). The prevalence and extent of the periodontal condition was based on the presence of at least one site with bleeding on probing (BOP), and the presence of dental calculus was also evaluated. We used univariate and multiple multilevel Poisson regression analyses to verify the association between the independent variables and the number of sextants with BOP and calculus. The prevalence of BOP and calculus was 92% and 69.9%, respectively. The adjusted mean of the affected sextants was 4.3 and 2.2 for BOP and calculus, respectively. The mother's schooling and malocclusion were associated with the number of sextants with bleeding. The mother's schooling and dental caries experience were associated with calculus. Gingival bleeding and the presence of dental calculus are highly prevalent in 12-year-old schoolchildren from Quito. Gingival bleeding is associated with maternal education and malocclusion, and dental calculus is associated with maternal education and dental caries.

Purpose: Evaluate the impact of gingivitis on oral health-related quality of life (OHRQoL) amongst 12-year-old schoolchildren from Quito, Ecuador., Methods: We evaluated 998 school children using the Community Periodontal Index for gingival bleeding and calculus. OHRQoL was assessed with the Child Perceptions Questionnaire 11-14 (CPQ 11-14 ) questionnaire., Results: Of the 998 schoolchildren, 93% had gingival bleeding and 73% had dental calculus. Schoolchildren with more than one sextant with gingival bleeding had 1.18 times higher mean CPQ 11-14 (RR 1.18, 95% CI 1.11-1.27) than those with none or just one affected sextant. Male schoolchildren presented a 15% lower mean Child Perceptions Questionnaire (CPQ) (RT 0.85; 95% CI 0.76-0.96). Children whose parents had incomplete secondary education had a 15% lower mean CPQ (RT 0.85; 95% CI 0.77-0.94). Bleeding in more than one sextant was significantly associated with worse quality of life in the emotional well-being (RT 1.40, 95% CI 1.03-1.90) and social well-being domains (RT 1.76, 95% CI 1.32-2.34)., Conclusion: Gingival bleeding negatively impacted the OHRQoL of 12-year-old Ecuadorian schoolchildren living in Quito., (© 2023. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

The aim of this cross-sectional study was to assess whether favorable factors related to school characteristics have a positive effect on the impact of traumatic dental injury (TDI) on oral health-related quality of life (OHRQoL). An epidemiological survey of oral health was conducted with 12-year-old schoolchildren from Quito, Ecuador. Children were examined for TDI, dental caries, and malocclusion. Individual socioeconomic data were also collected. Information on the physical environment, health practices, and occurrence of negative episodes at school was collected from the school coordinators. The Child Perceptions Questionnaire 11-14 (CPQ11-14) was used to evaluate the OHRQoL (outcome variable). Multilevel Poisson regression analysis was conducted. Severe TDI was associated with higher CPQ11-14 scores, even in the multiple model adjusted for oral health conditions, sex, individual socioeconomic variables, and school-related variables. Children from schools that had an appropriate tooth-brushing environment for their students exhibited a lower impact on OHRQoL, even after adjustment for the occurrence of TDI and other variables. A favorable school environment may exert a positive effect on OHRQoL, independent of the occurrence of TDI.

Objective: To analyze the association between the coverage by oral health teams in the Family Health Strategy (FHS-OH) and the use of dental services among 12-year-old adolescents in the state of Mato Grosso do Sul, Brazil, 2019., Methods: This is a cross-sectional study involving school-based research, which adopted the use of dental services as its outcome. Structural equation modeling was used to test the association between covariates and the outcome., Results: Of the 615 participants, 74.0% used dental services in the last three years. ESF-SB (oral health coverage by family health strategy, acronym in Portuguese) ≥50% was associated with a greater use of public dental services [standardized coefficient (SC) = 0.10 -95%CI 0.01;0.18], a lower use of these services for prevention (SC = -0.07 -95%CI -0.17;0.01) and higher unhealthy food consumption (SC = 0.19 -95%CI 0.11;0.26)., Conclusion: Higher ESF-SB coverage was associated with a lower use of dental services for prevention and higher unhealthy food consumption. Teams must organize the access to oral health service and qualify the work process.

Background: Population ageing in Brazil is rapid and is likely to place additional pressure over the Brazilian public health system., Objective: This study aims to examine the factors associated with utilisation of dental services in the previous year among a representative sample of older adults from São Paulo, Brazil., Methods: The sample included 5951 older adults who participated in the SBSP-15 study, an epidemiological survey conducted in 2015 in the State of São Paulo, Brazil. The outcome "utilisation of dental services" was defined as having visited a dentist in the previous year. Chi-square tests were employed in the bivariate analyses and Poisson regressions with robust variance in the multilevel analysis., Results: Only 30.5% of the participants had their last dental appointment within the previous year. Number of teeth and dental pain presented the strongest effects on the investigated outcome. Education, income, age, ethnicity, living alone, higher Family Health Strategy coverage and the Metropolitan area were associated with having visited a dentist in the previous year. Older adults who rated their oral health as positive did not report treatment need nor prosthodontic need, presented negative oral health-related quality of life, had their last dental appointment in the public health system and sought treatment due to pain or extraction also were more likely to report the utilisation of dental services in the previous year., Conclusion: Regional, sociodemographic and subjective factors are associated with utilisation of dental services in the previous year among the elders from the State of São Paulo, Brazil., (© 2020 Gerodontology Association. John Wiley & Sons Ltd.)

Robust epidemiological data allow for logical interventions taken in the interest of public health. Dental caries is a major public health problem driven by increased sugar consumption and various biological, behavioral, and psychosocial factors, and is known to strongly affect an individual's quality of life. This study aims to critically review epidemiological data on the prevalence of dental caries in Latin American and Caribbean countries (LACC) and its impact on the oral health-related quality of life (OHRQoL) of the population. Although the majority of national surveys did not include all age groups and several countries reported a reduction in the prevalence of cavitated carious lesions, most nations still exhibited a high burden of decayed teeth. OHRQoL evaluation was limited to children and older adults only, and was not included in any national survey. Study heterogeneity and methodological issues hindered comparison of evidence between studies and over time, and updating national level data on caries prevalence and its impact on OHRQoL should be prioritized in LACCs.

This study analyzed the association between sedentary behavior (SB), unhealthy food consumption, and dental caries amongst 12-year-old schoolchildren. An epidemiological survey was carried out in the five largest cities (> 80,000 inhabitants) of the State of Mato Grosso do Sul, Brazil. Data were collected on decayed, missing and filled teeth index (DMFT), sociodemographic characteristics, SB, unhealthy food consumption, and water fluoridation status. The analysis was based on the theoretical framework established by J Sisson. Structural equation models were performed to test the association of dental caries experience with sociodemographic, contextual, and behavioral factors. The mean DMFT index in the five cities was 1.02 (95%CI: 0.39-1.66). Higher sedentary behavior (more than 2 hours/day) [standardized coefficient (SC) = 0.21 95%CI: 0.07-0.39] and higher unhealthy food consumption (more than 4 times/week) [SC = 0.23 (0.10-0.45)] were associated with higher DMFT index than their counterparts. Also, cities with fluoridated water were associated with lower DMFT index [SC = -0.85 (-1.20--0.50)]. Families who had a per capita income above the poverty line had a direct association with unhealthy food consumption [SC = -0.24 (-0.38--0.11)]. Unhealthy food consumption mediated the association of sedentary behavior on DMFT index [SC=0.07 (0.02-0.13)]. Sensitivity analysis confirmed the findings. Sedentary behavior mediated by unhealthy food consumption had a significant association with dental caries experience. Public policies must address transdisciplinary actions to reduce sedentary behavior and unhealthy food consumption and promote water fluoridation.

Background/aim: Since children spend most of their time in school, some environmental characteristics of the schools may influence the occurrence of traumatic dental injuries (TDI). Therefore, the aim of this cross-sectional study was to assess the prevalence of TDI in 12 years old children in Quito, Ecuador, and its association with some school environmental aspects., Material and Methods: Six calibrated examiners evaluated 998 children from 31 public schools of Quito, to evaluate the occurrence of TDI in anterior teeth. School coordinators answered questionnaires on school physical conditions, promotion of health practices and the occurrence of negative episodes in school. The occlusion and socioeconomic status of the participants were also evaluated. Prevalence of TDI, unadjusted and adjusted by the design effect was calculated. Association between individual and contextual explanatory variables and presence of TDI were evaluated using multilevel Poisson regression analysis (P < .05)., Results: TDI prevalence adjusted by design effect was 20.7%. Children studying in schools with patio floor of grass and with access ramps had significantly lower prevalence of TDI than children studying in schools with patio floor of cement and with only stairs, respectively. The prevalence of TDI was also lower in children from schools that offered healthy meals or that had a proper place for oral hygiene., Conclusions: Schools with adequate physical structures and that promote health practices to their students have a lower prevalence of TDI., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To analyze association between prevalence and severity of dental caries and demographic, socioeconomic, behavioral and oral health status in adolescents., Methods: This was a cross-sectional study with secondary data on 5,558 adolescents examined in the São Paulo State Oral Health Survey in 2015. The zero-inflated negative binomial regression model was used, considering sample weights. Prevalence ratios (PR), ratios of mean (RM) and confidence intervals (CI) were estimated., Results: Caries prevalence was 71.7%, and was higher in females (PR=1.09 - 95%CI 1.04;1.15), associated with being behind at school (PR=1.11 - 95%CI 1.03;1.18), dental calculus (PR=1.10 - 95%CI 1.01;1.20) and no access to fluoridated water (PR=1.21 - 95%CI 1.01;1.45)., Conclusion: Identification of factors associated with dental caries can instruct the programming of health services aimed at controlling the disease.

Objective: To assess the association between the impact of oral health on daily life and sociodemographic variables with oral parameters in adolescents living in the State of São Paulo, Brazil., Methods: A cross-sectional study was conducted with data from 5,409 adolescents who participated in the "State Oral Health Survey of São Paulo - OH", 2015. The impact of oral health on daily life was assessed by the oral impacts on daily performances (OIDP) index, prevalence (presence or absence of impact) and severity of impact (OIDP scores). The negative binomial regression model (zeros-inflated) was used, considering the complex sampling and the sample weights. Prevalence ratio (PR), ratio of means (ROM) and confidence intervals (CI) were calculated., Results: The prevalence of impact was 37.4%. After adjusting for the model, the impact was more prevalent (PR = 1.59; 95%CI 1.22 ‒ 1.81) and more severe (RR = 1.49; 95%CI 1.22 ‒ 1.81) among females. Compared to white-skin people, all remaining groups had a higher prevalence of impact. Among socioeconomic characteristics, family income higher than R$ 2,501 (RR = 0.79; 95%CI 0.64 ‒ 0.98) and household crowding (RR = 1.18; 95%CI 1.00 ‒ 1.39) were associated with the severity of impact. In the oral health conditions, untreated caries (PR = 1.46; 95%CI 1.23 ‒ 1.74) and gingival bleeding (PR = 1.35; 95%CI 1.14 ‒ 1.60) were associated with higher prevalence of impact., Conclusion: Females, non-whites, with untreated caries and gingival bleeding were associated with higher impact of oral health on daily life. Family income higher than R$ 2,500 and living in less crowded households were factors associated with less impact.

This study aimed to identify factors associated with the need for complete dentures in one dental arch or both, among the elderly population. The cross-sectional household study was conducted with a representative sample of elderly people (65 years or older) in the state of São Paulo, Brazil, in 2015. The dependent variable was the need for complete dentures (in one arch or both), and independent variables were socioeconomic and demographic conditions, social capital, self-perception of oral health and access to dental services. Simple and multinomial logistic regression models tested effect measures (p < 0.05). A total of 5,948 elderly people participated. Results indicated that those with greater chances of needing a complete denture in one arch were male (OR = 1.54; CI95%:1.04-2.29), with fewer household goods (OR = 2.25; CI95%:1.50-3.38), lower monthly household income: R$501-1500 (OR = 3.44; CI95%:1.27-9.35), R$1501-2500 (OR = 4.11; CI95%:1.50-11.27), R$2501-4500 (OR = 2.76; CI95%:1.10-6.95), self-reported need for a complete denture (OR = 4.75; CI95%:3.08-7.35), ≥3 years since last dental appointment (OR = 1.80; CI95%:1.06-3.05), and dissatisfaction with last dental appointment (OR = 1.80; CI95%:1.06-3.05). There were more chances of the need for complete dentures in both arches among older elders (OR = 1.44; CI95%:1.06-1.88), with lower monthly household income: R$ < 501 (OR = 4.45; CI95%:1.71-11.60), R$501-1500 (OR = 4.01; CI95%:2.14-7.51), R$1501-2500 (OR = 2.95; CI95%:1.64-5.32), < 3 years of education (OR = 1.45; CI95%:1.13-1.85), feeling unhappy (OR = 2.74; CI95%:1.35-5.57), self-reported need for a complete denture (OR = 8.48; CI95%:5.75-12.50), dissatisfaction with their mouth (OR = 2.38; CI95%:1.64-3.46), ≥3 years since last dental appointment (OR = 4.28; CI95%:2.85-6.43), and dissatisfaction with last dental appointment (OR = 4.28; CI95%:2.85-6.43). The several dimensions of the determinants of the need for a complete denture reflect the influence of both demographic and socioeconomic aspects, social capital, self-perception of oral health and access to dental services.

Objectives: The aim of the present study was to analyse the factors associated with self-perceived need for dental treatment among adolescents., Methods: A representative sample in the state of São Paulo, Brazil, comprising 5558 adolescents, was evaluated in 2015. The adolescents were selected by probabilistic sampling by conglomerates in two stages. The outcome evaluated was self-perceived treatment need measured via a validated questionnaire. Independent variables included sociodemographic factors, type, frequency and reason for last dental visit, and examination of oral conditions. Statistical analysis was based on the multiple hierarchical logistic regression model., Results: Of the total sample, 3340 (62.6%) adolescents reported needing dental treatment. After fitting the model, the self-perceived need for treatment was associated with adolescents with family income of up to $1,500 BRL (OR 1.39; [95% CI = 1.20-1.60]; P < .001), who sought dental services solely for curative treatment (OR 1.58; [95% CI = 1.46-1.72]; P < .001), reported toothaches in the previous six months (OR 2.88; [95% CI = 2.53-3.28]; P < .001), were dissatisfied with the appearance of their teeth and mouth (OR 5.94; [95% CI = 5.03-7.01]; P < .001), had caries in the posterior teeth only (OR 3.04; [95% CI = 2.77-3.33]; P < .001) or had caries in the anterior teeth (OR 4.75; [95% CI = 4.05-5.56]; P < .001)., Conclusions: The self-perceived need for dental treatment among Brazilian adolescents was associated with normative and subjective needs, and sociodemographic context factors. This finding provides important evidence for collective health planning., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To investigate factors that influence the oral health-related quality of life of older people (65 years and over) in Brazil., Background: Population-based studies should be conducted to support health-planning interventions., Materials and Methods: Data from the São Paulo State Survey on Oral Health (SBSP-2015), which consisted of 5951 individuals, were used. A theoretical-conceptual model was built based on the impact of family socio-economic characteristics, individual social-demographic features and self-perceived and clinical oral health status on the oral impact on daily performance (OIDP). Multivariate binary logistic regression analysis was conducted at 5% significance level. Statistically significant variables included within the adjusted logistic regression model entered the multiple correspondence analysis (MCA)., Results: Oral health impact on daily activities was observed in 34.6% of older people. Characteristics significantly related to impact on OIDP score were as follows: family income up to R$ 500 (OR = 2.73), self-perceived treatment need (OR = 1.33), self-perceived toothache (OR = 1.52), self-perception of denture replacement need (OR = 1.27), dissatisfaction (OR = 1.50) or very dissatisfied (OR = 2.57) with own oral health, partial lower denture use (OR = 1.34) and needing partial lower dentures (OR = 1.28). Increased number of people living in the same house (B = 0.05, OR = 1.06), number of bedrooms in the house (B = -0.10, OR = 0.90), age (B = -0.03, OR = 0.97) and number of teeth needing treatment (B = 0.08, OR = 1.08) contributed significantly to OIDP., Conclusion: Prevalence of OIDP of older people in the state of São Paulo was related to factors other than their clinical and self-perceived oral health status., (© 2019 Gerodontology Association and John Wiley & Sons Ltd.)

The objective of this study was to investigate the experience of caries related to social capital and associated factors in adults in large-scale population-based study. A Cross-sectional study was performed in 163 municipalities in the State of São Paulo, Brazil (SBSP-2015). 17,560 people were evaluated, of which 6051 were adults aged 35-44 years. Hierarchical logistic regression analysis was proposed. Outcome variables (decayed teeth, missing teeth and DMFT) and independent variables were included in the model, considering the distal (income and schooling); intermediate (social capital) and proximal levels (sex and ethnicity). Results showed that income up to 1,500 reais - US$ 367.6 in 11/11/2019 - (OR = 1.91;1.75-2.08), schooling up to 8 years (OR = 1.32;1.12-1.56) and non-white ethnicity (OR = 1.54;1.35-1.76) were more likely to have decayed teeth. Income up to 1500 reais (OR = 1.29;1.15-1.44), schooling up to 8 years (OR = 2.13;1.90-2.38), low social capital (OR = 1.84;1.65-2.04), medium social capital (OR = 1.15;1.01-1.30) and females were more likely to have lost teeth (OR = 1.13;1.03-1.23). Schooling up to 8 years (OR = 1.51;1.35-1.69), low social capital (OR = 1.25; 1.14-1.37) and female (OR = 1.40,1.19-1.53) were associated with DMFT. It was concluded that sociodemographic factors and low social capital were associated with the experience of caries, which should be taken into account in the formulation of public policies.

Objective: To evaluate the factors associated with tooth loss in adults from the position and number of teeth lost in the dental arches., Methods: This is a cross-sectional, population-based study with adults participating in the epidemiological survey of oral health of São Paulo in 2015. The outcome of the study was tooth loss, assessed by the proposed classification, namely: I) lost up to 12 back teeth; II) lost up to 12 teeth (including front teeth); and III) lost more than 12 teeth. A four-block analysis was conducted, supported by a conceptual theoretical model adapted for tooth loss. For the multinomial logistic regression, "individuals who did not lose teeth due to caries or periodontal disease" was used as reference (p < 0.05)., Results: Of 6,051 adults evaluated, 25.3% (n = 1,530) were classified in category I, 32.7% (n = 1,977) in II, 9.4% (n = 568) in III, and 1.9% (n = 117) were edentulous. Lower income and schooling, the perception of need for treatment and the last appointment motivated by routine, pain or extraction were associated with tooth loss, regardless of the classification. The negative evaluation of the dental service was associated with individuals who lost up to 12 teeth, both front and back. The presence of women and periodontal pocket were associated with tooth loss of up to 12 teeth, including front, and more than 12 teeth. Caries were associated with adults who lost up to 12 teeth, including front teeth., Conclusion: The proposed classification allowed the identification of differences between the associated factors. Thus, the need to consider such classification in future studies is evident.

Objective: To evaluate the association of school failure among Brazilian adolescents with social conditions and aspects of oral health through hierarchical analysis., Methods: A state-wide survey of 5,558 adolescents from the state of São Paulo, Brazil, inquired about the sociodemographic and social capital of participants by using a structured questionnaire. Trained and calibrated professionals performed intraoral examinations and interviews in the households. Questions about the access to dentist, reason for and frequency of using dental services, toothache episodes and impact of oral conditions on daily activities (OIDP) were applied. Oral examinations evaluated caries experience, tooth losses, periodontal problems, presence of open bite, and maxillary and mandibular overjet. School failure was estimated according to the teenagers' years of schooling. The independent variables were grouped into three blocks: sociodemographic and economic characteristics, social capital and oral health aspects. The multiple hierarchical logistic regression model was used to identify the factors associated with school failure., Results: Of the total sample, information about schooling of 5,162 adolescents was obtained, of whom 29.6% presented school failure. We found that adolescents over the age of 16 years who did not declare themselves as white, female, with feelings of insecurity, unhappiness, with toothache, caries, tooth losses, affected by dentofacial and/or periodontal changes, were more likely to fail at school., Conclusion: Oral disorders and social factors were associated with school failure in adolescents. A successful school trajectory was a strong determinant of health, therefore actions between the educational and health sectors must be developed for adolescents, especially those with this profile.

Introduction: The epidemiological profile of dental caries for Indigenous Peoples is complex and heterogeneous. The oral health of the Kaingang people, third largest Indigenous population from Brazil, has not been investigated so far., Objective: The purpose of this study was to assess the prevalence and severity of dental caries, in addition to the associated factors of the need of dental extraction among Kaingang adult Indigenous., Methods: A cross-sectional oral health survey was conducted among Kaingang adults aged from 35 to 44 years old living in the Guarita Indigenous Land, Rio Grande do Sul. Clinical exams were performed to analyze the conditions of dental crown and treatment needs., Results: A total of 107 Indigenous adults were examined. Mean DMFT score was 14.45 (± 5.80). Two-thirds of the DMFT score accounted for missing teeth. Anterior lower dentition presented the highest rates of sound teeth, whereas the lower first molars had the lowest. Need for dental extraction was observed in 34.58% and was associated with village location, time of last dental visit, and higher number of decayed teeth., Conclusion: The high frequencies of caries and missing teeth observed in this population indicate a lack of adequate assistance. It is essential to discuss health care models in order to combat avoidable social and health injustices.

Background: There is a paucity of population-based surveys on oral health conditions in Ecuador. Thus, the aim of this study was to conduct an epidemiological survey with a representative sample of children aged 12 years from public schools of Quito, Ecuador. The aim of this initial report was to describe the methodology used in the survey, as well to present results regarding calibration procedures and prevalence of oral-health related outcomes., Methods: We invited 33 public schools' coordinators from the urban area of Quito, and 1100 children (12 years old) to take part in this study. Six trained and calibrated examiners conducted clinical examinations using oral mirrors and ball-ended probes to assess: dental caries, traumatic dental injuries, malocclusion, gingival bleeding, presence of calculus and fluorosis. Children also responded a questionnaire on Oral Health-Related Quality of Life (OHRQoL). Individual sociodemographic data was collected through a questionnaire sent to parents. Moreover, some contextual data on school environment (infrastructure conditions, promotion of health practices and negative episodes) were also evaluated. Prevalence values, crude and weighted by sampling weights, and 95% confidence intervals (95%CI) were calculated., Results: Nine hundred and ninety-eight children from 31 schools were examined from March to May 2017. The adjusted prevalence values (95%CI) for the six outcomes evaluated were: dental caries = 60.3% (55.3 to 65.0%); traumatic dental injuries = 20.7% (17.2 to 24.8%); dental fluorosis = 63.7% (58.5 to 68.5%); gingival bleeding = 92.0% (87.1 to 95.2%); presence of calculus = 69.9 (60.5 to 77.9%); and malocclusion = 25.8% (21.8 to 30.3%). Adjusted mean of number of decayed, missed or filled permanent teeth (DMF-T) was 1.61 (1.37 to 1.84). Results on OHRQoL and other contextual variables will be reported in other articles., Conclusion: The prevalence of the majority of oral health problems in 12-year-old children from public schools in Quito-Ecuador was compatible with those observed in other similar cities. However, periodontal health and fluorosis seem to be highly prevalent in children from Quito.

Introduction: The objective of the present study was to evaluate the association of socioeconomic status (SES) as a latent variable on oral health-related quality of life (OHRQoL) using four definitions of functional dentition (FD) for elderly people., Methods: Four sets of multilevel generalised structural equation models (GSEM) were used: (i) WHO Functional Dentition (FDWHO); (ii) Well-distributed teeth (WDT); (iii) FD class5 ; and (iv) FD class6 . The indirect effects of SES on OHRQoL were measured in 5951 elderly participants in the São Paulo Oral Health 2015 (SBSP-15) survey. The latent variable (OHRQoL) was extracted from the Oral Impacts on Daily Performances questionnaire, and GSEM was used to estimate the direction of association among the variables., Results: SES was directly and strongly associated with FDWHO (Total effects [SC] = 0.56, P < .001); WDT (Total Effects [SC] = 0.55, P < .001); FD class5 (Total effects [SC] = 0.07, P < .001); and FD class6 (Total effects [SC] = 0.05, P = .001). All FD outcomes mediate effects of SES on OHRQoL (P < .05). SES had a direct effect on happiness which, in turn, had a direct effect on OHRQoL ([SC] = 0.05, P < .001)., Conclusions: All definitions of FD were good at mediating the effects of SES on OHRQoL, showing the importance of occlusal and periodontal statuses of elderly individuals., (© 2018 Gerodontology Association and John Wiley & Sons Ltd.)

The objective of the present study was to analyze individual, contextual and social support factors associated with periodontal condition among 2332 dentate elderly Brazilian participants from the São Paulo State Oral Health Survey 2015 (SBSP-15)., Methods: This study used the database compiled by the SBSP-15, conducted from January to December in 2015. The associations were made by relative risk (RR), with Multilevel Poisson Regressions, among individual, contextual and social support variables, and had periodontal diseases as outcomes., Results: The mean age of elders was 70.13 years (SD 5.67). The risk factors for all outcomes of periodontal diseases were male gender and self-perceived color of non-white skin. Regarding social support, feeling unhappy was a risk factor for the presence of shallow periodontal pockets (3-5mm) RR 1.43(CI 95% 1.10-1.86). The coverage of the Family Health Strategy (FHS) was a protective factor for gingival bleeding RR = 0.7(CI 95% 0.44-0.99) and calculus RR = 0.75(CI 95% 0.60-0.95), and a risk factor for the number of lost sextants (sextants with only one tooth or without any teeth) RR = 1.12(CI 95% 1.00-1.28). Living in municipalities with more than 90% fluoridation coverage was a protective factor for the number of lost sextants RR = 0.89(CI 95% 0.78-0.99)., Conclusions: The study showed evidence that individual (gender and self-perceived skin color), contextual (coverage of the family health strategy and water fluoridation) and social support factors (feeling unhappy) are associated with the clinical outcomes of periodontal diseases in Brazilian elders. This reinforces the need for transdisciplinary actions in the FHS, stimulating work together and intersectoral collaboration between FHS and NASF (Family Health Support Center)., Competing Interests: The authors have declared that no competing interests exist.

Objective: This study aimed to assess the oral impact on daily performance and its association with sociodemographic characteristics, tooth pain, need for prosthesis, and periodontal disease of adults in the state of São Paulo, Brazil., Methods: This was a cross-sectional epidemiological study with secondary data obtained from the Oral Health Conditions Project- 2015 conducted in 163 municipalities in the state of São Paulo with the participation of 17,560 individuals. This study evaluated adults in the age-range between 35-44 years (n = 5,855), selected by means of probabilistic cluster sampling in two stages. The outcome variable was the OIDP (Oral Impacts on Daily Performances), obtained by using this instrument to assess daily activities (eating, speaking, oral hygiene, relaxation, sports practice, smile, study/work, social contact, and sleep). The independent variables were collected and grouped into three blocks: Block 1 (sex, age group, and ethnic group); Block 2 (household income and education); and Block 3 (tooth pain, need for prosthesis, bleeding, calculus, and periodontal pockets). A hierarchical multiple logistic regression analysis was performed considering the complex cluster sampling plan. Each observation was assigned a specific weight, depending on the location, which resulted in weighted frequencies adjusted for the effect of outlining., Results: the female sex (p<0.0001), ethnic group black/mulatto (p<0.0001), low household income (p = 0.0112), up to 8 years of education (p<0.0001), tooth pain (p<0.0001), presence of bleeding (p<0.0001), and presence of periodontal pockets (p<0.0001) had greater oral impact on daily performance., Conclusion: sociodemographic characteristics, tooth pain, and presence of periodontal disease were associated with oral impact on daily performance of the adult population in the state of São Paulo, Brazil., Competing Interests: The authors have declared that no competing interests exist.

Objective: Analyze if clinical, sociodemographic and access to dental services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults., Methods: A cross-sectional study with secondary data from the State Oral Health Survey (SB São Paulo 2015) conducted in 163 cities of São Paulo. A total of 17,560 individuals from three age groups: 15-19-year-old (n = 5,558), 35-44-year-old (n = 6,051), and older people of 65 years or more (n = 5,951) participated in the survey. The selection was made by probabilistic sample by conglomerates in two stages. The endpoint variable was the impact of oral health on daily activities, evaluated by the Oral Impacts on Daily Performances questionnaire, containing questions about eating, talking, oral hygiene, relaxation, sports practice, smile, study or work, social contact, and sleep. Oral Impacts on Daily Performances was dichotomized with and without impact. The independent variables were sociodemographic, clinical and access variables, divided into three blocks. A hierarchical multiple logistic regression analysis was performed considering the complex sampling plan of clusters. Each observation received a specific weight, depending on the location that resulted in weighted frequencies and adjusted for the design effect., Results: The presence of oral health impact was observed in 27.9% of the individuals. In block 1, female gender and black/brown ethnic group had a greater chance of impact of oral health on quality of life, as well as the adults and the older adults in relation to adolescents. In block 2, family income up to R$1,500 was associated with the presence of impact. In block 3, individuals who reported toothache, used the public service and sought dental treatment had a greater chance of impact., Conclusions: Sociodemographic, clinical and access to health services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults.

Purpose: To evaluate the relationship between decayed, missing and filled teeth (DMF index) and body mass index (BMI)., Materials and Methods: This was a cross-sectional, population-based study developed in 2015 at a primary health care (PHC) unit in the city of Sao Paulo, Brazil. Participants completed a form including sociodemographic and socioeconomic characteristics, nutritional, general health and oral health data. An anthropometric oral assessment was performed, and the association of DMFT and its components with not-categorised and categorised BMI was tested through simple and multiple logistic analysis, trend test and Spearman correlation., Results: The sample consisted of 239 individuals aged 18 to 70 years. The prevalence of caries was 84.5%, the mean DMFT was 14.6 and the mean BMI was 27.46. There was positive association for DMFT with BMI and age, sex, formal education, hypertension, diabetes and use of dental floss. A positive association is also suggested between BMI and missing teeth., Conclusion: A correlation was observed between DMFT (missing teeth) and BMI. This can help to identify at-risk groups, plan progammes and treatment of overweight and obese individuals in primary health care.

Objectives: We investigated the factors associated with no dental visit within the last two years by adolescents in the state of São Paulo, Brazil, by using data from the Oral Health Conditions of São Paulo state population Project (SBSP-2015) conducted in 2015., Methods: This was a cross-sectional epidemiological study with a representative sample of adolescents aged 15 to higher years residing in São Paulo State. The examiners were calibrated and dental visits were measured categorically as 1- Less than 1 year, 2- One to two years, 3 - Three years or more, 4- I have never visited the dentist. Based on the literature we dichotomized the outcome in two groups: response 1 plus 2 against response 3 plus 4. Then, Multilevel Poisson Regression (MPR) was used to estimate the prevalence ratios of last dental visit three years or had never been to a dentist by adolescents compared with those who had visited the dentist within the past two years, with contextual variables as the distal level; sociodemographic variables, mesial; and individual variables, proximal level., Results: A high percentage of adolescents (84.9%) reported visiting the dentist in the last 2 years. Whereas, 626 (11.6%) had not visited the dentist for over 3 years and 188 (3.4%) had never been. A significantly higher proportion of females than males reported visiting the dentist in the past 2 years (p = 0.003). The oral and dental condition was reported as satisfactory by 4,350 respondents (80.6%), and when they accessed the health service, 2,286 (42.3%) went to the public service. Lower mean family income (1.62PR;95%CI;1.36-1.94); ≥ 1,000 inhabitant/Dental Surgeons (1.25PR;95%IC;1.03-1.56);male (1.26PR;95%CI; 1.11-1.43) non-Caucasian ethnicity (Mulatto:1.30PR;95%CI;1.13-1.50 and Black:1.58PR;95%CI;1.29-1.93); dissatisfaction with the oral health condition (1.20PR;95%CI;1.01-1.45),last visit to the public service versus private service (2.26PR; 95%CI;1.91-2.65) and presenting with periodontal disease in the form of dental calculus as the worst situation (1.38PR; 95%CI; 1.16-1.53) were associated with last visit to the dentist., Conclusions: A high proportion of adolescents had visited the dentist in the last two years. No dental visit within the last two years by adolescents were associated with contextual, health care system, sociodemographic, personal and oral health status, demonstrating that this is a complex phenomenon. Actions to promote regular dental visits by adolescents in Brazil should take these factors into consideration.

Background: Oral disorders may negatively affect the quality of life (QoL) of adolescents. To investigate how social vulnerability and oral-health status factors affect QoL in 15-19 years olds who participated in the "SB São Paulo 2015" state survey., Methods: The relationship of several independent variables, namely Paulista Social Vulnerability Index (PSVI) score, gender, skin color, family income, age, untreated caries, tooth loss [determined by the Decayed, Missing, Filled-Teeth (DMF-T) index], toothache, periodontal condition [determined by the Community Periodontal Index (CPI)], and malocclusion (maxillary overjet, cross bite, or open bite) affect daily life, measured by the Oral Impacts on Daily Performance (OIDP) instrument. Logistic regression analyses were carried out based on a hierarchical model., Results: The final sample consisted of 5402 adolescents. The prevalence of at least one negative impact of oral health on QoL was 37.3%. After adjustment, demographic factors that were found to influence this impact significantly (p < 0.01) were female gender [odds ratio (OR) 1.78, 95% confidence interval (CI) = 1.59-2.0], non-white skin color (OR 1.66, 95% CI = 1.47-1.88), and a low family income (OR 1.28, 95% CI = 1.28-1.29). Additionally, oral conditions associated with oral health impact on QoL included the presence of at least one untreated tooth decay lesion (OR 1.42, 95% CI = 1.25-1.61), loss of at least one tooth (OR 1.49; 95% CI = 1.25-1.78), toothache (OR 4.87, 95% CI = 4.25-5.59), bleeding on probing (OR 1.45, 95% CI = 1.25-1.68), and severe maxillary overjet (OR 1.68, 95% CI = 1.15-2.45)., Conclusion: Social vulnerability (PSVI score) was not associated with the OIDP score, but oral health conditions and socio-demographic variables, including gender, skin color, and income, were found to affect adolescents' daily activities. Strategies that consider the perceptions of this segment of the population should be implemented to strengthen their autonomy and totality of care.

This study evaluates the prevalence and risk factors of non-carious cervical lesions (NCCLs) in a Brazilian population of workers exposed and non-exposed to acid mists and chemical products. One hundred workers (46 exposed and 54 non-exposed) were evaluated in a Centro de Referência em Saúde do Trabalhador - CEREST (Worker's Health Reference Center). The workers responded to questionnaires regarding their personal information and about alcohol consumption and tobacco use. A clinical examination was conducted to evaluate the presence of NCCLs, according to WHO parameters. Statistical analyses were performed by unconditional logistic regression and multiple linear regression, with the critical level of p < 0.05. NCCLs were significantly associated with age groups (18-34, 35-44, 45-68 years). The unconditional logistic regression showed that the presence of NCCLs was better explained by age group (OR = 4.04; CI 95% 1.77-9.22) and occupational exposure to acid mists and chemical products (OR = 3.84; CI 95% 1.10-13.49), whereas the linear multiple regression revealed that NCCLs were better explained by years of smoking (p = 0.01) and age group (p = 0.04). The prevalence of NCCLs in the study population was particularly high (76.84%), and the risk factors for NCCLs were age, exposure to acid mists and smoking habit. Controlling risk factors through preventive and educative measures, allied to the use of personal protective equipment to prevent the occupational exposure to acid mists, may contribute to minimizing the prevalence of NCCLs.

Objectives: To evaluate the prevalence, clinical features, and risk factors of dentin hypersensitivity (DH) in a Brazilian population., Materials and Methods: 300 patients at the Dentistry Clinic of the University of São Paulo participated in this study. The subjects completed a questionnaire regarding their personal information, the presence of DH, and some of its risk factors. Following completion of the questionnaire, a clinical examination was undertaken. To confirm the presence of DH, the subjects were evaluated with the use of a probe and cold air from a triple syringe. Statistical analysis was performed with the chi-square test and odds ratio, with the critical level p <0.05., Results: The prevalence of DH was 46%. Females presented a higher prevalence than males (p <0.05). The left posterior region was affected by DH the most (maxilla = 41% and mandible = 36%). Cold was reported as the most common pain-inducing stimulus (88%). The pain was described as "discomfort" by 51% of the subjects with DH. Toothbrushing four times a day (p <0.05), toothbrushing with excessive force (p <0.05), bruxism (p <0.05), and gastroesophageal reflux (p <0.05) were strongly correlated with DH., Conclusions: The prevalence of DH was particularly high. The risk factors for DH were gender (female), toothbrushing four times a day, toothbrushing with excessive force, bruxism, and gastroesophageal reflux., Clinical Relevance: DH was a common finding in this population suggesting that preventive measures considering its risk factors must be implemented in order to reduce or control the symptoms.

Objective: To estimate the prevalence of dental caries and treatment needs in 12-year-olds and adolescents., Methods: Cross-sectional study based on results from the epidemiological surveys: Oral Health Conditions in the State of Sao Paulo, 2002 and the Brazilian Oral Health Survey (SBBrasil) 2010. Secondary data for 5,782 (2002) and 369 (2010) 12-year-olds and 880 (2002) and 300 (2010) 15- to 19-year-olds were analyzed. Dental caries attack was evaluated using the DMFT (decayed, missing or filled teeth) index and the need for treatment verified using the criteria proposed by the World Health Organization. The Significant Caries Index was used to measure the severity of the decay in the tercile of the group with the highest prevalence of the disease. In order to analyze the results, the Chi-squared and Mann-Whitney tests were used, with a 5% significance., Results: There was a decrease of 39.3 percentage points in the DMFT index for 12-year-olds (p < 0.001) and of 41.1 percentage points for the adolescents (p < 0.001) between 2002 and 2010, and an increase of around 161.0 and 303.0 percentage in the group which was free from dental caries respectively. The percentage of restored teeth decreased in both age groups, although the prevalence of dental caries did not change in the group more affected by dental caries. In the group with few dental caries, there was a decrease in the component 'tooth loss' for adolescents and increase in the component 'decayed teeth' for the 12-years-old and the adolescents. There was an increase in the need for dental treatment in the group as a whole and in the group of 12-year-olds more affected by dental caries; and among the adolescents, the need for restoration on two or more surface decreased in the group as a whole and also in the group which suffered least from dental caries., Conclusions: The decreasing need for non-complex treatment in adolescents suggests that promotion and prevention activities are having a positive effect on this group. Moreover, the two epidemiological surveys in the state of Sao Paulo show improvements in oral health conditions in both age groups studied and calls for monitoring aimed also at the group least affected by dental caries.

Objective: To assess the trend of dental fluorosis prevalence in 12-year-old children, in the context of exposure to multiple sources of fluoride., Methods: An analysis was carried out of the trends in prevalence of dental fluorosis in the city of São Paulo, Southeastern Brazil, between 1998 and 2010. The rates of prevalence were calculated for different years (1998, 2002, 2008 and 2010) using secondary data obtained from epidemiological surveys of representative samples of 12-year-old children. Occurrence of fluorosis was assessed in natural light using the Dean index, recommended by the World Health Organization and categorized into normal, questionable, very mild, mild, moderate and severe. In 1998, 125 children were examined, 249 in 2002, 4,085 in 2008 and 231 in 2010., Results: In 1998 the prevalence of fluorosis was 43.8% (95%CI 35.6;52.8) in 2002 it was 33.7% (95%CI 28.2;39.8), it was 40.3% (95%CI 38.8;41.8) in 2008 and 38.1% (95%CI 32.1;44.5) in 2010.The categories very mild + mild totaled 38.4% (95%CI 30.3;47.6) in 1998, 32.1% (95%CI 26.6;38.2) in 2002, 38.0% (95%CI 36.5;39.5) in 2008 and 36.4% (95%CI 30.4;42.7) in 2010. Severe fluorosis was not observed, with statistical significance, in the analyzed period., Conclusions: The prevalence of dental fluorosis in children from São Paulo can be classified as stationary between 1998 and 2010, both when considering all categories, and when considering only the categories very mild + mild.

The aim of the study was to analyze what sociodemographic and economic variables were associated with the presence of untreated caries in 12-year-old children in the city of São Paulo. This cross-sectional study had a complex sample design. It was based on secondary data generated by the Levantamento epidemiológico em saúde bucal (Epidemiological Oral Health Survey) in the city of São Paulo, conducted in 2008, whose sample comprised 4,246 12-year-old children from the public and private schools of all the administrative districts of the city. A questionnaire was applied and an epidemiological exam was performed in accordance with the World Health Organization's (WHO) recommendations. The variables of interest were categorized into a dependent variable of untreated dental caries (carious component of the DMFT index that corresponds to carious, missing and filled teeth) and independent variables related to the socioeconomic and demographic conditions of the children and their families, and to their access to dental services. The EPI-INFO 06 and STATA 10 programs were used for the analysis; the prevalence ratio and a confidence interval of 95% were applied to the population parameters. The Poisson regression model was used, adjusted for sampling of the complex type. Caries was associated with ethnicity (higher rate in black people, p=0.042), attending public school (p=0.000), lower average family income (p=0.002), overcrowded dwellings (p=0.000) and presence of pain (p=0.000). Caries is a multifactorial disease influenced by social health determinants that intensify its risk.

The Health Department of São Paulo, Brazil, has developed a Health Necessities Index (HNI) to identify priority areas for providing health assistance. In 2008, a survey of the status of oral health was conducted. The objective of this ecological study was to analyze the status of oral health in relation to the HNI. The variables, stratified by the age of 5, 12 and 15 years old were: percentage of individuals with difficulty of access to dental care services; DMFT and DMFS; prevalence of the need for tooth extraction and treatment of dental caries. Data were analyzed for the 25 Health Technical Supervision Units (HTS). The Statistical Covariance Test was used as well as the Pearson correlation coefficient and linear regression model. A positive correlation was observed between high scores of the HNI and difficulty of access to services. In the HTS with high scores of HNI a higher incidence of dental caries was observed, a greater need for tooth extractions and low caries-free incidence. In order to improve health conditions of the population it is mandatory to prioritize actions in areas of social deprivation.

This study presents the strategies for prevention and early detection of oral cancer by means of screening in the elderly population of São Paulo, the richest and the most populous state of Brazil. This research was a retrospective longitudinal study based on the analysis of secondary data. The variables - number of participating cities, coverage of screening, and number of suspicious and confirmed cases of oral cancer - were divided into two periods: 2001-2004 and 2005-2008. Data were analyzed statistically by the chi-square test at 5% significance level. The implementation of a nationwide public oral health policy in 2004 and the reorganization of the secondary and tertiary health care were evaluated as mediator factors able to interfere in the achieved outcomes. From 2001 to 2008, 2,229,273 oral examinations were performed. There was an addition of 205 participating cities by the end of the studied period (p<0.0001). The coverage of oral cancer screening increased from 4.1% to 16% (p<0.0001). There was a decrease in the number of suspicious lesions (from 9% in 2005 to 5% in 2008) (p<0.0001) and in the rate of confirmed oral cancer cases per 100,000 examinations (from 20.89 in 2001 to 10.40 in 2008) (p<0.0001). After 8 years of screening, there was a decrease in the number of suspicious lesions and confirmed cases of oral cancer in the population. The reorganization of secondary and tertiary health care levels of oral care seems to have contributed to modify these numbers, having a positive impact on the outcomes of oral cancer screening in the São Paulo State.

The aim of this study was to describe the incidence of caries among children and adolescents who have cerebral palsy. The authors conducted baseline and follow-up dental examinations of 118 children and adolescents with cerebral palsy in a specialized healthcare unit in São Paulo, Brazil. Family care-givers completed a questionnaire that provided socioeconomic and behavioral information. The analysis used multivari-ate Poisson regression models adjusted for age. More than half (52.5%) of the subjects had at least one permanent or deciduous tooth affected by new caries during the longitudinal assessment (2004-2008). The incidence of caries was associated with the baseline prevalence of caries (incidence ratio = 1.92), a higher frequency of sugar intake (IR = 1.56), and having at least one sibling (IR = 1.64). Participants whose family care-givers had more education had a significantly lower incidence (IR = 0.68). The factors associated with a higher incidence of caries are similar to those in the general population. This evidence can potentially be used to develop an effective oral health promotion program for these patients., (© 2011 Special Care Dentistry Association and Wiley Periodicals, Inc.)

Objective: This study described the prevalence of periodontal conditions and assessed its association with social, economical and behavioral variables in adults aged 35 to 44 years old, residents in the city of Guarulhos, State of Sao Paulo, 2006., Methods: This study was a population based survey with cluster sampling. Data collecting and exams were done at houses drew at random. The Community Periodontal Index was used to assess the periodontal condition. Data analysis used EPIINFO 6 and STATA 10 softwares. The assessment of association used the prevalence ratio (PR), as calculated by Poisson regression models with complex sampling and weighted sample adjustments., Results: The total number of people was 263 in 237 domiciles. In the multivariate model, the prevalence of gingival bleeding and dental calculus was significantly associated to being male (PR=1.12, p=0.04), smoking (PR=1.11, p=0.01), school level of less than eight years of study (PR=1.14, p=0.01), and who have not received dental care for more than two years (PR=1.19, p<0.01). As for the presence of periodontal pocket, associated factors were smoking (PR=1.71, p=0.02) and who have not received dental care for more than 2 years (PR=1.97, p=0.03)., Conclusion: We observed a higher prevalence (62.7%) of individuals with gingival bleeding and dental calculus in relation to the presence of shallow or deep periodontal pockets (26,6%). As shallow pockets are reversible, their treatment may be resolute in programs of primary dental care.

Background: Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level., Objectives: To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics., Methods: The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed., Results: Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics., Conclusions: Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

Objective: To evaluate the association between gingival health conditions and dental service utilization., Methods: An epidemiological survey of the oral health of 1,799 adolescents was carried out in 35 cities of the state of São Paulo, in 2002. Gingival health was assessed through the prevalence of gingival bleeding on probing and dental calculus (community periodontal index), and dental occlusion was assessed through the dental aesthetic index. The utilization of dental services was measured by means of the dental care index (F/DMFT) for each city. Multilevel logistic regression analysis was used to adjust explanatory models to factors associated with the outcome variables of interest., Results: The prevalence of gingival bleeding on probing was 21.5%, whereas dental calculus was prevalent in 19.4%. Male participants, who were either black or dark-skinned, lived in crowded homes, in rural areas, and showed schooling delay, were at a significantly higher risk than their respective counterparts. The following dental occlusion characteristics were also associated with unhealthy gum: incisor segment crowding, vertical anterior open bite, and antero-posterior molar relationship. Cities with a higher utilization of dental services showed a smaller proportion of adolescents with gingival bleeding and dental calculus., Conclusions: The utilization of dental services was significantly associated with better gingival health conditions (gingival bleeding and dental calculus). This association did not depend on contextual and individual sociodemographic characteristics or dental occlusion.

Objective: To describe the prevalence of untreated caries among adolescents in Brazil and to analyze the association between caries and individual and contextual factors in the municipalities where these adolescents live., Methods: A Ministry of Health database (projeto SB-Brasil) provided health records on 16 833 adolescents from 15-19 years of age. The study variable used was the presence of at least one permanent tooth having been lost to caries. The individual variables considered were: sex, ethnic group, living in an urban versus a rural area, and being a student or not. Contextual variables related to the municipality were: municipal human development index (MHDI), proportion of households connected to the water system, and water fluoridation for 5 years or more. Multilevel logistic regression analysis was carried out to adjust the outcome to the individual and contextual variables., Results: Individual determinants related to a higher probability of untreated caries were: the ethnic group described as "black or brown," (adjusted odds ratio, OR(adjust) = 1.79; 1.68 to 1.92); and living in a rural area (OR(adjust) = 1.31; 1.19 to 1.45). Being a student was identified as a protective factor (OR(adjust) = 0.67; 0.62 to 0.73). Secondary variables identified as contextual determinants of caries were MHDI (adjusted coefficient beta = -0.213), water fluoridation (beta = -0.201), and households connected to the water system (beta = -0.197)., Conclusions: The results show inequalities in the distribution of health services in the various Brazilian regions, and suggest that inequalities may also be present in the effectiveness of the services provided. Policies to increase access to fluoride-treated water and school enrollment may contribute to preventing caries in adolescents.

The aim of this study was to estimate the cost of fluoridating the public water supply in the city of São Paulo, Brazil, from 1985 to 2003. Cost calculation for fluoridation of the public water supply used the following: capital cost of initial installation, chemical product (hydrofluosilicic acid), system's operational cost (maintenance, electricity, and human resources), and monitoring fluoride levels. Fluoridation was effective, since there was a decrease of 73% in dental caries in 12-year-olds--mean DMF was 6.47 (6.12-6.82) in 1986, having decreased to 1.75 (1.48-2.92) in 2002. In this age group, 40% of children presented DMF = 0 in 2002. Average cost per inhabitant/year for 2003 was R$ 0.08 (USD 0.03). The accumulated cost for 18 years of implementation and maintenance of the fluoridation system was R$ 1.44 (USD 0.97) per capita.

The effects of guar gum derived from the endosperm of Cyamopsis tetragonoloba (75% soluble fiber, 7.6% insoluble fiber, 2.16% crude protein, 0.78% total lipids, 0.54% ash and 9.55% moisture) on food intake, levels of blood serum cholesterol, triacylglycerols, glucose and LDL and HDL-cholesterol were studied. The effects of guar gum on indices of protein absorption and utilization were also investigated. Diets containing 0%, 10% and 20% (w/w) guar gum or 10% and 20% cellulose powder (reference) were fed to normal rats for 60 days. The rats fed the guar gum diets showed significantly (p < or = 0.05) lower levels of blood serum cholesterol, triacylglycerols, reduced food intake and body weight gain. Furthermore, a concomitant increase in HDL-cholesterol with a substantial elevation of the HDL/LDL cholesterol ratio were noted. Guar gum decreased blood serum glucose only during the first month of the experiment, and no changes in the indices of protein absorption and utilization were found. The guar gum caused a 10% increase in the small intestine length and a 25% retardation in the intestinal transit. The results of this research suggested that guar gum could potentially be effective in the treatment of hypercholesterolemia and obesity in humans.