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OBJECTIVE This study analysed the association between caesarean section and early childhood caries (ECC), estimating the effects using regression and causal inference models. METHODS This was a historical cohort study of 697 mother-child dyads, conducted in Sao Luis, Brazil. The caesarean section was the exposure, and the severity of ECC (dmft) was the outcome. Covariates household income, maternal schooling, maternal hypertension, maternal obesity and birth weight were adjusted for in the models. The effects were estimated by Poisson regression (Means Ratio-MR) and causal inference using a marginal structural model (MSM) (MR and Average Treatment Effect-ATE coefficients), weighted by the inverse probability (IPW) of exposure. RESULTS Caesarean section was protective against caries in the bivariate (MR 0.81; CI 0.70-0.94; P = 0.005) and multivariate (MR 0.78; CI 0.67-0.91; P = 0.002) models. In MSM analyses, the caesarean section had no effect on ECC (ATE = -0.35; P = 0.107), controlling for IPW of exposure. CONCLUSION The apparent association between caesarean section and ECC severity seems spurious, as it did not persist after employing a superior approach to estimating causality.

Hypothesis: Proinflammatory cytokines are increased in saliva of mother/children pairs with caries. Design: Case-control study involving caries-free children (n = 20) and children with early childhood caries (ECC) (n = 20), and their mothers (n = 40). The maternal variables analyzed were waist circumference (WC), decayed, missing and filled teeth (DMFT) and sugar intake; and in the children were body mass index (BMI), def-t and sugar intake. Salivary levels of VEGF, IL-6 and TNF-α were analyzed of mother/children pairs. Results: In the mothers, salivary VEGF levels were correlated with DMFT (r = 0.35; p = .03), WC (r = 0.35; p = .02), and sugar intake (r = 0.32; p = .04). Higher salivary IL-6 levels were also correlated with maternal DMFT (r = 0.45; p = .004) and WC (r = 0.32; p = .04). In the children, higher salivary VEGF levels were correlated with higher def-t scores (r = 0.42; p = .008). Children with caries had a 63% higher median salivary VEGF and twofold higher mean IL-6 levels compared to caries-free children. Mothers of children with ECC showed higher mean of salivary IL-6 levels compared to those of children without ECC (p = .03). Conclusion: Salivary proinflammatory cytokines are correlated with the severity of caries in the mother-children pair. Obesity and excessive sugar consumption seem to underlie the associations between proinflammatory cytokines and caries in the family environment.

Anacardium occidentale L., Anacardiaceae, is frequently used to treat infections. We evaluated the antimicrobial and antioxidant activity of extracts obtained from aerial parts of the plant in comparison with the extract prepared with the flowers. Ethanol extracts of the leaves (EEL), stem bark (EEB), and flowers (EEF) were prepared separately. The antimicrobial activity was evaluated by agar diffusion and broth dilution methods. The minimum bactericidal and fungicidal concentrations were determined against: Streptococcus mutans, Lactobacillus acidophilus, Staphylococcus aureus, MRSA, Enterococcus faecalis, Streptococcus pyogenes, Pseudomonas aeruginosa, Proteus mirabilis, Escherichia coli, Klebsiella pneumoniae, Helicobacter pylori, Salmonella choleraesuis, Candida albicans, and Candida tropicalis. The antioxidant activity of the extracts was evaluated based on their scavenger capacity of 2,2-diphenyl-1-picrylhydrazyle. The phytochemical profile was analyzed by colorimetric methods and by HPLC with UV detection. All extracts exhibited antioxidant and antimicrobial activity. Although, the EEF was the most effective since it inhibited the growth of all 14 microorganisms tested. Anacardic and galic acids were identified in all extracts as well phenolic compounds, triterpenes, flavones and xanthones. In conclusion, the extracts obtained from the aerial parts of A. occidentale, mainly the extract of flowers that was the most effective, are rich in bioactive metabolites that exert a potent antioxidant and antimicrobial effect. Taken together, the results indicate an important biotechnological potential of A. occidentale as a source of compounds with broad-spectrum antimicrobial and of antioxidant activity to be used in the food and cosmetics industry.

OBJETIVO: Avaliar o conhecimento sobre saúde bucal de mães participantes de um programa educativo-preventivo para lactentes. MÉTODOS: Estudo de coorte com 112 mães e seus bebês de 0 a 18 meses, cadastrados no projeto "Promoção de Saúde Bucal na Primeira Infância", da Universidade Federal do Maranhão. Inicialmente, entrevistas semiestruturadas que contemplavam o nível de conhecimento das mães sobre a saúde bucal dos bebês foram realizadas. Também foi examinada a cavidade bucal dos bebês a fim de detectar o nível de placa bacteriana, sangramento gengival e presença de cárie. Em seguida, palestras educativo-preventivas foram ministradas e, após um ano de acompanhamento, novas entrevistas foram realizadas, bem como o exame clínico. Para analisar os dados, foram utilizados os testes de qui-quadrado e exato de Fisher com nível de significância de 5%. RESULTADOS: Antes das palestras educativas, 93% das mães executavam a higiene bucal de seus bebês e 57,3% a realizavam nos períodos diurno e noturno. Após as palestras, todas responderam executar os cuidados (p=0,02), sendo 74,7% nos períodos diurno e noturno (p=0,01). Não houve diferença quanto ao consumo de alimentos cariogênicos nos questionários inicial e final. Notou-se que, inicialmente, 5,6% das faces dentais apresentaram cárie; 29,7%, placa bacteriana; e 11,9%, sangramento gengival. Após as palestras, apenas 0,4% das faces dentais apresentaram cárie (p0.02) and 74.7% performed it at daytime and nighttime (p=0.01). There were no differences regarding the consumption of cariogenic food in the initial and final questionnaires (p>0.05). Initially, 5.6% of dental surfaces had caries; 29.7%, plaques; and 11.9%, gingival bleeding. After the lectures, only 0.4% of the dental surfaces had caries (p

OBJETIVO: Avaliar o conhecimento sobre saúde bucal de mães participantes de um programa educativo-preventivo para lactentes. MÉTODOS: Estudo de coorte com 112 mães e seus bebês de 0 a 18 meses, cadastrados no projeto "Promoção de Saúde Bucal na Primeira Infância", da Universidade Federal do Maranhão. Inicialmente, entrevistas semiestruturadas que contemplavam o nível de conhecimento das mães sobre a saúde bucal dos bebês foram realizadas. Também foi examinada a cavidade bucal dos bebês a fim de detectar o nível de placa bacteriana, sangramento gengival e presença de cárie. Em seguida, palestras educativo-preventivas foram ministradas e, após um ano de acompanhamento, novas entrevistas foram realizadas, bem como o exame clínico. Para analisar os dados, foram utilizados os testes de qui-quadrado e exato de Fisher com nível de significância de 5%. RESULTADOS: Antes das palestras educativas, 93% das mães executavam a higiene bucal de seus bebês e 57,3% a realizavam nos períodos diurno e noturno. Após as palestras, todas responderam executar os cuidados (p=0,02), sendo 74,7% nos períodos diurno e noturno (p=0,01). Não houve diferença quanto ao consumo de alimentos cariogênicos nos questionários inicial e final. Notou-se que, inicialmente, 5,6% das faces dentais apresentaram cárie; 29,7%, placa bacteriana; e 11,9%, sangramento gengival. Após as palestras, apenas 0,4% das faces dentais apresentaram cárie (pOBJETIVO: Evaluar el conocimiento sobre salud bucal de madres participantes de un programa educativo-preventivo para lactantes. MÉTODOS: Se realizó un estudio caso-control anidado a una cohorte. Se evaluaron a 112 madres y a sus bebés con edades de 0 a 18 meses, registrados en el proyecto «Promoción de Salud Bucal en la Primera Infancia», de la Universidad Federal de Maranhão. Inicialmente, se realizaron entrevistas semiestructuradas que contemplaban el nivel de conocimiento de las madres sobre la salud bucal de los bebés. También se examinó la cavidad bucal de los bebés a fin de detectar el nivel de la placa bacteriana, sangrado gingival y presencia de caries. Enseguida, se realizaron charlas educativo-preventivas y, tras un año de seguimiento, se realizaron nuevas entrevistas, así como el examen clínico. Para analizar los datos, se utilizaron las pruebas de chi-cuadrado y Exacto de Fisher, con nivel de significancia de 5%. RESULTADOS: Antes de las charlas educativas, el 93% de las madres ejecutaba la higiene bucal de sus bebés, y el 57,3% la realizaban en los periodos diurno y nocturno. Después de las charlas, todas contestaron ejecutar los cuidados (p=0,02), siendo el 74,7% en los periodos diurno y nocturno (p=0,01). No hubo diferencia respecto al consumo de alimentos cariogénicos en los cuestionarios inicial y final. Se notó que, inicialmente, el 5,6% de las caras dentales presentaba caries; el 29,7%, placa bacteriana; y el 11,9% sangrado gingival. Después de las charlas, solamente el 0,4% de las caras dentales presentó caries (pOBJECTIVE: To evaluate mothers who participated in an educational and preventive program for infants in relation to their knowledge on oral health practices. METHODS: A cohort study was performed with 112 mothers and their babies aged 0 to 8 months and registered in the project "Promotion of Oral Health in Early Childhood" from the Federal University of Maranhão (Northeast Brazil). Initially, semi-structured interviews on the level of mothers' knowledge as to their babies' oral health were conducted. The oral cavities of the infants were also examined regarding: level of plaque, gingival bleeding, and dental caries. Then, educational lectures were ministered and, after a year of follow-up, new interviews and clinical examination were performed. For statistical analysis, the chi-square and Fisher exact tests were applied, being significant p0.02) and 74.7% performed it at daytime and nighttime (p=0.01). There were no differences regarding the consumption of cariogenic food in the initial and final questionnaires (p>0.05). Initially, 5.6% of dental surfaces had caries; 29.7%, plaques; and 11.9%, gingival bleeding. After the lectures, only 0.4% of the dental surfaces had caries (p

The association between socioeconomic position (SEP) and serum lipids has been little studied and the results have been controversial. A total of 2063 young adults born in 1978/79 were evaluated at 23-25 years of age in the fourth follow-up of a cohort study carried out in Ribeirao Preto, SP, Brazil, corresponding to 31.8% of the original sample. Total serum cholesterol (TC), triglycerides, high-density cholesterol (HDL cholesterol) and low-density cholesterol (LDL cholesterol) were analyzed according to SEP at birth and during young adulthood. SEP was classified into tertiles of family income and a cumulative score of socioeconomic disadvantage was created. TC was 11.85 mg/100 mL lower among men of lower SEP in childhood (P < 0.01) but no difference was found in women, whereas it was 8.46 lower among men (P < 0.01) and 8.21 lower among women of lower SEP in adulthood (P < 0.05). Individuals of lower SEP had lower LDL and HDL cholesterol, with small differences between sexes and between the two times in life. There was no association between SEP and triglyceride levels. After adjustment of income at one time point in relation to the other, some associations lost significance. The greater the socioeconomic disadvantage accumulated along life, the lower the levels of TC, LDL and HDL cholesterol (P < 0.05). The socioeconomic gradient of TC and LDL cholesterol was inverse, representing a lower cardiovascular risk for individuals of lower SEP, while the socioeconomic gradient of HDL cholesterol indicated a lower cardiovascular risk for individuals of higher SEP.

Few studies are available about racial inequalities in perinatal health in Brazil and little is known about whether the existing inequality is due to socioeconomic factors or to racial discrimination per se. Data regarding the Ribeirão Preto birth cohort, Brazil, whose mothers were interviewed from June 1, 1978 to May 31, 1979 were used to answer these questions. The perinatal factors were obtained from the birth questionnaire and the ethnic data were obtained from 2063 participants asked about self-reported skin color at early adulthood (23-25 years of age) in 2002/2004. Mothers of mulatto and black children had higher rates of low schooling (or = 4 years, 27.2 and 38.0%) and lower family income (or = 1 minimum wage, 28.6 and 30.4%). Mothers aged less than 20 years old predominated among mulattos (17.0%) and blacks (14.0%). Higher rates of low birth weight and smoking during pregnancy were observed among mulatto individuals (9.6 and 28.8%). Preterm birth rate was higher among mulattos (9.5%) and blacks (9.7%) than whites (5.5%). White individuals had higher rates of cesarean delivery (34.9%). Skin color remained as an independent risk factor for low birth weight (P0.001), preterm birth (P = 0.01), small for gestational age (P = 0.01), and lack of prenatal care (P = 0.02) after adjustment for family income and maternal schooling, suggesting that the racial inequalities regarding these indicators are explained by the socioeconomic disadvantage experienced by mulattos and blacks but are also influenced by other factors, possibly by racial discrimination and/or genetics.

This study sought to investigate dentists' experiences, attitudes, and knowledge in recognizing and reporting suspected cases of child abuse. It was designed as a cross-sectional study across dental practices. Data were collected through a self-administered questionnaire, which was distributed randomly to 500 dentists. The questionnaire investigated characteristics of the population, education concerning child abuse, experience and attitudes in reporting suspected cases, and the ability to recognize signs of abuse. Approximately 60% of the dentists responded to the survey. Among the dentists who participated in the survey, 87% believed that recognizing child abuse is important, however, 63.2% reported that they did not know how to act in such situations, and 44.2% were unaware of the proper child protection authorities to contact. Among the dentists surveyed, 94.7% reported they did not receive enough education concerning child abuse in their undergraduate studies. While 31.3% of dentists suspected child abuse among their patients, 84% reported their suspicions to the proper authorities. The reason cited most often (33.3%) for not reporting suspected abuse was the fear of litigation and its potential impact on their practice. Only 34.2% of dentists demonstrated knowledge about the potential signs of child abuse.

To evaluate mothers who participated in an educational and preventive program for infants in relation to their knowledge on oral health practices.A cohort study was performed with 112 mothers and their babies aged 0 to 8 months and registered in the project "Promotion of Oral Health in Early Childhood" from the Federal University of Maranhão (Northeast Brazil). Initially, semi-structured interviews on the level of mothers' knowledge as to their babies' oral health were conducted. The oral cavities of the infants were also examined regarding: level of plaque, gingival bleeding, and dental caries. Then, educational lectures were ministered and, after a year of follow-up, new interviews and clinical examination were performed. For statistical analysis, the chi-square and Fisher exact tests were applied, being significant p0.05.Before the educational lectures, 93% of the mothers performed oral hygiene of their babies and 57.3% performed it at daytime and nighttime. After the lectures, all mothers performed the oral hygiene (p0.02) and 74.7% performed it at daytime and nighttime (p=0.01). There were no differences regarding the consumption of cariogenic food in the initial and final questionnaires (p0.05). Initially, 5.6% of dental surfaces had caries; 29.7%, plaques; and 11.9%, gingival bleeding. After the lectures, only 0.4% of the dental surfaces had caries (p0.0001); 2.4%, plaque (p0.0001); and 10.61%, gingival bleeding (p0.0001).Knowledge acquisition is essential to improve oral health conditions.

Purpose: To survey oral and maxillofacial lesions biopsied in a Brazilian pediatric hospital. Methods: Biopsy records over a 16-year period (1992-2008) were retrieved from the files of the Anatomy and Pathology Service, Hospital Presidente Dutra, Federal University of Maranhão, Brazil. Pediatric cases patients aged 16 years old or younger were selected. Oral and maxillofacial diagnoses were grouped into 10 categories, and lesions were evaluated for age, gender, anatomic location and pathological diagnosis. Data were analyzed using descriptive statistics. Results: Of a total of 3,550 pediatric biopsies, 88 cases (2.48%) were located in oral or maxillofacial sites. Similar incidence rates were observed between the genders and the prevalence of lesions was highest in the permanent dentition period (>12-16 years old). Maxilla was the most commonly affected anatomic location. As regards the diagnostic categories, the highest number of lesions was in the hyperplastic/reactive category. The most frequently encountered lesions were inflammatory fibrous hyperplasia and mucocele. Malignant lesions were rarely described. Conclusion: This study shows a similar trend to that reported in previous studies on the most frequent oral and maxillofacial lesions found in the pediatric population. The majority of lesions detected were benign, and malignant lesions were diagnosed in a very low number of patients. Objetivo: Realizar levantamento das lesões orais e maxilo-faciais biopsiadas em um hospital pediátrico brasileiro. Metodologia: Biópsias registradas ao longo de um período de 16 anos (1992-2008) foram recuperadas dos arquivos do Serviço de Anatomia e Patologia do Hospital Presidente Dutra, Universidade Federal do Maranhão, Brasil. Pacientes com até 16 anos de idade foram selecionados. Os diagnósticos de lesões orais e maxilo-faciais foram agrupados em 10 categorias e as lesões foram avaliadas quanto a idade, sexo, localização anatômica e diagnóstico. Os dados foram analisados usando estatística descritiva. Resultados: De um total de 3.550 biópsias registradas, 88 casos (2,48%) estavam localizadas na região oral ou maxilo-facial. Taxas de incidência similares foram observadas entre os sexos e a prevalência de lesões foi maior na dentição permanente (> 12-16 anos). A maxila foi a localização anatômica mais acometida. Quanto às categorias de diagnóstico, o maior número de lesões foi encontrado na hiperplásica/reativo. As lesões mais freqüentemente encontradas foram a hiperplasia fibrosa inflamatória e mucocele. Lesões malignas foram raramente descritas. Conclusão: Este estudo mostra uma tendência semelhante à relatada em estudos anteriores sobre as lesões mais freqüentes na região oral e maxilo-facial na população pediátrica. A maioria das lesões detectadas foram benignas, enquanto as malignas foram diagnosticadas em um número muito reduzido de pacientes.