Contributions of school context to caries on anterior teeth: a multilevel analysis

OBJECTIVE To investigate whether oral health literacy (OHL) and school context are associated with untreated dental caries on the anterior teeth of adolescents. METHODS A representative cross-sectional study was conducted with 746 students aging 15 to 19 in the city of Campina Grande, Brazil. The guardians answered a questionnaire addressing sociodemographic data and the absence/presence of private health insurance. Two examiners were trained for the diagnosis of dental caries using the Nyvad criteria and the measurement of OHL using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) (Kappa > 0.80). Contextual aspects of the schools were obtained from the 2017 National School Census. Descriptive statistics were conducted, followed by unadjusted and adjusted robust negative binomial regression for complex samples (p < 0.05). RESULTS The average number of anterior teeth with untreated caries was 0.95 (SD = 1.77). Among individual factors, the male sex (RR = 1.64; 95%CI: 1.24–2.16), inadequate level of OHL (RR = 2.03; 95%CI: 1.13–1.63), marginal level of OHL (RR = 1.87; 95%CI: 1.05–3.33) and not having private health insurance (RR = 1.34; 95%CI: 1.07–1.68) were associated with untreated caries on anterior teeth. Among school contextual factors, the number of students in the classroom (RR = 2.64; 95%CI: 1.78–3.93), number of public oral health services in the district (RR = 0.14; 95%CI: 0.05–0.39) and average income of the district in which the school is located (RR = 0.99; 95%CI: 0.98–0.99) were associated with the outcome. CONCLUSIONS Sociodemographic factors, having private health insurance, OHL, and school context exerted an influence on the occurrence of untreated dental caries on anterior teeth in adolescents aging 15 to 19

Socioeconomic status and family functioning influence oral health literacy among adolescents

OBJECTIVE: Evaluate socio-demographic, family and behavioral factors associated with oral health literacy (OHL) in adolescents. METHODS: Cross-sectional study conducted with adolescents aged 15 to 19 years in Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing socio-demographic data. The adolescents answered validated instruments on family cohesion and adaptability (family adaptability and cohesion evaluation scale), drug use (alcohol, smoking and substance involvement screening test), type of dental service used for last appointment and OHL (Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry). Two dentists were trained to evaluate OHL (K = 0.87–0.88). Descriptive analysis was performed, followed by Poisson regression analysis (α = 5%). A directed acyclic graph was used to select independent variables in the study. RESULTS: The following variables remained associated with better OHL: high mother’s schooling level (RR = 1.07; 95%CI: 1.03–1.12), high income (RR = 1.04; 95%CI: 1.01–1.09), white ethnicity/skin color (RR = 1.05; 95%CI: 1.01–1.10), married parents (RR = 1.04; 95%CI: 1.01–1.09), “enmeshed” family cohesion (RR = 1.21; 95%CI: 1.12–1.30), “structured” (RR = 1.06; 95%CI: 1.01–1.12) or “rigid” (RR = 1.11; 95%CI: 1.04–1.19) family adaptability, having more than five residents in the home (RR = 1.07; 95%CI: 1.01–1.14) and having used a private dental service during the last appointment (RR = 1.08; 95%CI: 1.03–1.13). CONCLUSION: Family functioning and socio-demographic factors influence the level of oral health literacy among adolescents

Psychometric properties of BREALD-30 for assessing adolescents’ oral health literacy

OBJECTIVE: To evaluate the psychometric properties of the Brazilian Portuguese version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) administered to adolescents. METHODS: The study included 750 adolescents: 375 aged 12 years and 375 aged 15–19 years, attending public and private schools in Campina Grande, state of Paraíba, Brazil, in 2017. Reliability was measured based on internal consistency and test-retest reliability. Convergent validity was measured based on correlations between BREALD-30 and Functional Literacy Indicator scores. Divergent validity was measured by comparing BREALD-30 scores with sociodemographic variables. For predictive validity, the association between BREALD-30 scores and the presence of cavitated carious lesions was tested using a multiple logistic regression model. All statistical tests were performed with a significance level of 5%. RESULTS: BREALD-30 showed good internal consistency for the 12 year olds and 15 to19 year olds (Cronbach’s alpha = 0.871 and 0.834, respectively) and good test-retest reliability [intraclass correlation coefficient (ICC) = 0.898 and 0.974; kappa = 0.804 and 0.808, respectively]. Moreover, item-total correlation was satisfactory for all items. BREALD-30 had convergent validity with the Functional Literacy Indicator for 12 year olds (rs = 0.558, p < 0.001) and for 15 to 19 year olds (rs = 0.652, p < 0.001). Participants with higher oral health literacy levels who attended private schools (p < 0.001), belonged to economic classes A and B2 (p < 0.001), and who had parents with higher education levels (p < 0.001) were included, indicating the divergent validity of the BREALD-30. Participants with lower BREALD-30 scores were more likely to have cavitated carious lesions [12 year olds: odds ratio (OR) = 2.37; 95% confidence interval (95%CI): 1.48–3.80; 15 to 19 year olds: OR = 1.96; 95%CI 1.24–3.11]. CONCLUSIONS: BREALD-30 shows satisfactory psychometric properties for use on Brazilian adolescents and can be applied as a fast, simple, and reliable measure of oral health literacy

Premature Primary Tooth Loss and Oral Health-Related Quality of Life in Preschool Children

The present study aimed to evaluate the association between premature primary tooth loss and oral health-related quality of life (OHRQoL) in preschool children. A cross-sectional study was conducted in 769 5-year-old preschool children. The children and their parents or guardians answered the Brazilian version of the Scale of Oral Health Outcomes for 5-Year-Old Children for the assessment of OHRQoL. Meanwhile, clinical examinations were performed for the assessment of premature primary tooth loss. Unadjusted and adjusted multilevel Poisson regression models were utilized to investigate the associations between the variables. In the parental version of the scale, premature posterior primary tooth loss (rate ratio [RR] = 2.65; 95% confidence interval [CI] = 1.51–4.68), weak sense of coherence (RR = 2.25; 95% CI = 1.62–3.11), and visit to a dentist (RR = 1.61; 95% CI = 1.04–2.52) were associated with OHRQoL. Based on the children’s perceptions, only the preschool type was associated with OHRQoL (RR = 1.92; 95% CI = 1.21–3.05). Premature posterior primary tooth loss had a greater impact on OHRQoL based on the parents’ perception, whereas only the preschool type was associated with OHRQoL based on the children’s perception

Cirurgião-dentista na Equipe de Saúde da Família: perfil profissional e diagnóstico de cárie

Objetivo: verificar o perfil profissional dos cirurgiões-dentistas das Equipes de Saúde da Família (ESF's) e avaliar a adequação dos diagnósticos das lesões cariosas. Metodologia: foi realizado um estudo transversal, com 97 cirurgiões-dentistas das Unidades da Saúde da Família (USF's) da cidade de João Pessoa, Paraíba. Foi utilizado um questionário dividido em duas partes. A primeira parte, abordava o perfil profissional dos participantes, e a segunda, o registro do diagnóstico da cárie dentária para dois casos clínicos. O caso clínico I correspondeu a uma lesão cariosa inativa limitada ao esmalte, e o caso clínico II, foi referente a uma cárie dentária ativa com envolvimento pulpar. Os diagnósticos foram categorizados em adequados e inadequados de acordo com critérios pré-determinados. Os dados foram analisados por meio de estatística descritiva e inferencial uni e bivariada, pelo teste Qui-Quadrado, Exato de Fischer e coeficiente de correlação de Cramer, adotando-se p < 0,05. Resultados: Os resultados mostraram a ocorrência de formados em universidades federais (89,7%), graduados há mais de 20 anos (63,9%), com pós-graduação (74,7%) e possuindo como principal local de trabalho o setor público (84,5%). O diagnóstico foi adequado em apenas 35,0% e 40,5% para os casos clínicos I e II, respectivamente. O diagnóstico de cárie dentária apenas apresentou associação com o distrito sanitário no caso clínico I. Conclusão: Poucos cirurgiões-dentistas diagnosticaram adequadamente os casos clínicos, não havendo associação com o perfil profissional.       PALAVRAS-CHAVES Cárie dentária; diagnóstico; odontólogos; saúde pública; odontopediatria.

Sociodemographic and behavioral factors associated with dental caries in preschool children: Analysis using a decision tree

Background: Untreated dental caries can result a negative impact on oral health-related quality of life. Aims: The aim of the present study was to determine the prevalence of dental caries and associated factors in children enrolled in public preschools in the city of Recife, Brazil. Settings and Design: A descriptive, analytical, cross-sectional study was conducted with a representative random sample of 556 children aged 3–5 years. Materials and Methods: Data were collected through clinical examinations using the International Caries Detection and Assessment System. The parents answered a questionnaire addressing sociodemographic and behavioral characteristics. Two examiners underwent training and calibration exercise for the calculation of interexaminer agreement (Kappa index of 0.83). Statistical Analysis Used: In addition to descriptive data, an inductive decision tree was constructed to analyze the results (Algorithm J48; α = 5%). Results: The prevalence of dental caries was 92.1%. The following factors were associated with dental caries: brushing performed by the child (prevalence ratio [PR] = 4.39, 95% confidence interval [CI]: 2.57–7.51 P < 0.001), household income less than the minimum wage (PR = 1.79; 95% CI: 1.18–2.72, P = 0.005), brushing frequency (PR = 1.50; CI 95%: 0.50–4.49; P = 0.001), and parent's/caregiver's school equal to an incomplete elementary school education (PR = 1.65, 95% CI: 1.56–1.74, P < 0.001). Conclusions: The occurrence of dental caries in children was high and was associated with brushing performed by the child, household income less than the monthly minimum wage, low brushing frequency, and low parent's/caregiver's schooling

Adolescents with worse levels of oral health literacy have more cavitated carious lesions.

The aim of the present study was to investigate whether the ability to recognize and read oral health terms is associated with the number of teeth with cavitated carious lesions in adolescents. A population-based cross-sectional study was conducted involving a sample of 746 adolescents representative of students aged 15 to 19 years at the public and private school systems in a city in northeast Brazil. Two examiners who had undergone a training and calibration exercise (inter-examiner and intra-examiner Kappa coefficient: 0.87 to 0.93) performed the diagnosis of caries using the Nyvad Index and evaluated the level of OHL (BREALD-30) of the adolescents. The participants answered questions regarding their history of visits to the dentist and the parents/caregivers answered a questionnaire addressing socioeconomic characteristics. A directed acyclic graph was created to direct the selection of covariables for adjustments in the Poisson multiple regression analysis to test the association between dental caries and OHL (α = 5%). Cavitated carious lesions (codes 3 to 6 on the Nyvad index) were found in 41.6% of the adolescents. Only 29.4% had a high level of OHL (BREALD-30 scores between 23 and 30); 42.3% of the families belonged to the A-B social class and 93% of the adolescents had been to the dentist at least once in their lifetimes. In the multivariate analysis, adolescents with inadequate (PR: 1.69; 95% CI: 1.18-2.41; p = 0.004) and marginal (PR; 1.42; 95% CI: 1.01-1.99; p = 0.042) OHL and those in the lower social classes (C-D-E) (PR: 1.85; 95% CI: 1.39-2.47; p<0.001) had more teeth with cavitated carious lesions. In conclusion, adolescents aged 15 to 19 years with poorer levels of OHL had a larger number of teeth with cavitated carious lesions, independently of their socioeconomic status and history of visiting a dentist