Malocclusion, dental appearance and impact on daily performance in Brazilian adolescents

Orientador: Karine Laura Cortellazzi MendesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo deste estudo foi avaliar a relação entre a má oclusão com a aparência dental e o impacto da saúde bucal no desempenho das atividades diárias em adolescentes brasileiros. Trata-se de um estudo transversal analítico em adolescentes de 13 a 19 anos de idade procedentes de 21 escolas estaduais do município de Piracicaba e 34 Unidades de Saúde da Família. As variáveis dependentes foram satisfação com aparência dental e o impacto oral nas atividades diárias (OIDP). As variáveis independentes a nível individual foram, sexo, idade, componentes do Índice de Estética Dental (DAI) e a nível contextual foi utilizado o Índice de Exclusão Social (SEI). A análise estatística utilizada foi o modelo de regressão multinível estimado pelo procedimento PROC GLIMMIX (``Generalized Linear Models-Mixed¿¿), considerando as variáveis individuais como nível 1 e a contextual como nível 2, com nível de significanância de 5%. No capítulo 1, participaram da pesquisa 882 adolescentes, sendo que os participantes do sexo feminino mostraram-se mais satisfeitos com a aparência dos dentes. A insatisfação com a aparência dental foi encontrada no overjet maxilar, diastema, irregularidade anterior maxilar, irregularidade mandibular anterior, mordida aberta anterior e na relação molar. A satisfação com a aparência dental foi influenciada pelo sexo e por componentes do DAI. No capítulo 2, dos 877 entrevistados no presente estudo, a prevalência de impacto sócio dental foi 39,6%. A atividade diária que apresentou maior impacto foi comer (31,7 %). A dor (57,2%) foi o sintoma mais relatado no momento da entrevista quando relacionado com a atividade de comer. Os voluntários do sexo masculino apresentaram maior impacto nas atividades diárias. Houve um aumento no OIDP com uma maior perda de dentes no arco dental superior, overjet maxilar e idade. Existe relação entre as características individuais e o OIDP em adolescentes brasileiros.O SEI avaliado no capítulo 1 e 2 não foram significativos no modelo. Pode-se concluir que a má oclusão apresentou um impacto significativo na avaliação da aparência dental e no OIDP, porém não apresentou significância quando relacionados com a variável do Índice de Exclusão SocialAbstract: The aim of this study was to evaluate the relationship between malocclusion, dental appearance, and impact of oral health on daily performance in Brazilian adolescents. It is an analytical cross-sectional study in 13 to 19 year-old adolescents from 21 state schools and 34 Family Health Units in Piracicaba. The dependent variable was satisfaction about dental appearance and Oral Impact on Daily Performance (OIDP), and the independent variables were classified as individual (gender, age and the components of DAI - Dental Aesthetic Index) and contextual (Social Exclusion Index ¿ SEI). The statistical analysis used was multilevel regression model estimated by PROC GLIMMIX procedure (''Generalized Linear Mixed Models''), considering the individual variables such as level 1 and contextual as Level 2, and the level of significance of 5%. In chapter 1, 882 adolescents participated in the survey, and females showed to be more satisfied with their dental appearance. The dissatisfaction with dental appearance was related to maxillary overjet, diastema, anterior maxillary irregularity, anterior mandibular irregularity, anterior open bite, and molar relationship. Satisfaction with dental appearance was influenced by gender and by DAI components. In Chapter 2, the prevalence of OIDP was 39.6% in the 877 subjects of the study. Among the daily performance activities, eating was the one with the greatest impact (31.7%). Pain was the symptom most reported to be related with the activity of eating (57.2%). The male volunteers presented greater impact on their daily performance. There was an increase in the OIDP as the increase of missing teeth in the upper jaw, jaw overjet and age. There is a relationship between individual characteristics and the OIDP in Brazilian adolescents. The SEI assessed in Chapter 1 and 2 were not significant in the model. In this context, the general conclusion of this study is that malocclusion has a significant impact on dental appearance and on OIDP, but not in Social Exclusion IndexDoutoradoSaude ColetivaDoutor em Odontologia141654/2013-9CNP

Efeitos cefalométricos do Aparelho Bimetric de Wilson na correção da Classe II de Angle

Objetivo: avaliar a distalização e inclinação dos primeiros molares superiores além de analisar o efeito sobre a altura facial ântero-inferior, durante o tratamento da má oclusão de Classe II com o aparelho Bimetric de Wilson. Metodologia: foram avaliados os cefalogramas obtidos das telerradiografias laterais antes e após distalização de molares em 25 pacientes, tratados com o aparelho Bimetric de Wilson. A idade média inicial foi de 13,4 anos (+1,4). O tempo médio de distalização foi de 4,2 meses. As medidas foram testadas e repetidas quando dois fatores foram considerados, tratamento/aparelho (Bimetric) e avaliações (antes e depois) no mesmo paciente, por meio do teste estatístico ANOVA. Foi utilizado nível de significância de 5% (p 0,05). Resultados: a avaliação cefalométrica antes (T1) e pós distalização (T2) mostrou que o aparelho Bimetric de Wilson promoveu uma distalização dos primeiros molares superiores de 1,82mm, uma inclinação distal de 4,5° e um aumento da AFAI de 1,04mm. Conclusão: houve alterações nas medidas, embora sem significância estatística, nas quais a AFAI aumentou em 1,04mm. Os primeiros molares superiores distalizaram 0,43mm/mês e inclinaram-se distalmente 4,5°. Palavras-chave: Má Oclusão de Angle Classe II; Ortodontia Corretiva; Ortodontia/classificação

Índices de má oclusão utilizados em estudos : revisão da literatura

A má oclusão possui etiologia multifatorial e reflete em diversos graus e funções do aparelho estomatognático, na aparência e na auto-estima dos indivíduos. A utilização dos índices é importante para priorizar o tratamento aos que apresentam maior problema, além de possibilitar um melhor planejamento no uso dos recursos. O presente estudo buscou identificar os índices oclusais mais utilizados além de descrever seus métodos afim de auxiliar os profissionais quanto ao seu uso. Os índices estudados foram o DAI, IOTN, ICON, TPI, Índice Par, Índice de Irregularidade de Little e o OIDP. A má oclusão é um problema de saúde pública, e sua abordagem deve ser baseada em ações que prevenção e promoção em saúde de maneira a garantir de modo integral e com equidade. Portanto torna-se importante conhecer os diversos índices relatados na literatura, pois cada uma possui uma peculiaridade que pode ser importante para uma determinada análise. A utilização dos índices oclusais fornece a prevalência das más oclusões e isso pode auxiliar em um planejamento de tratamento para a saúde pública com uma melhor alocação de recursos humanos, materiais e financeiros.Malocclusion has a multifactorial etiology and reflects varying degrees and functions of the stomatognathic system, in appearance and self-esteem of individuals. The use of indexes is interesting to prioritize treatment to those with greatest problem, and enable better planning of resource use. The present study sought to identify the most occlusal indices used to describe their methods in order to help professionals as to its use. The indices studied were the DAI, IOTN, ICON, TPI Index Par, Little irregularity index and OIDP. A malocclusion is a public health problem, and its approach must be based on actions that prevention and health promotion in order to ensure the full and equitable manner. It is important to know the different rates reported in the literature, though each has a peculiarity that may be interesting for a given analysis. The use of occlusal indices provides the prevalence of malocclusion and this may assist in treatment planning for public health with better allocation of human, material and financial resources

Bolton ratio in subjects with normal occlusion and malocclusion

Aim: To verify the presence of Bolton anterior and total discrepancy in Brazilian individuals with natural normal occlusion and Angle’s Class I and Class II, division 1 malocclusions. Methods: The sample was divided in three groups (n=35 each): natural normal occlusion; Class I malocclusion; Class II, division 1 malocclusion. Of the 105 Caucasian Brazilian individuals, 24 were boys and 81 were girls aged from 13 to 17 years and 4 months. The mesiodistal width of the maxillary and mandibular teeth, from the left first molar to the right first molar, was measured on each pre-treatment dental plaster cast using a digital caliper accurate to 0.01 mm resolution. Values were tabulated and the Bolton ratio was applied. The Kolmogorov-Smirnov test was used to verify if data were normally distributed (p>0.2). For comparison between the values obtained and those from the Bolton standard, Student’s t test was used and one-way ANOVA was used for comparisons among the 3 groups, with a significance level of 5% (p<0.05). Results: For groups 1, 2 and 3, respectively, the total ratio found was 90.36% (SD 1.70), 91.17% (SD±2.58) and 90.76% (SD±2.45); and the anterior ratio was 77.73% (SD 2.39), 78.01% (SD 2.66) and 77.30% (SD 2.65). Conclusions: There was no significant difference among the groups regarding the values indicated in the Bolton ratio

Bolton ratio in subjects with normal occlusion and malocclusion

verify the presence of Bolton anterior and total discrepancy in Brazilian individuals with natural normal occlusion and Angles Class I and Class II, division 1 malocclusions. Methods: The sample was divided in three groups (n=35 each): natural normal occlusion; Class I malocclusion; Class II, division 1 malocclusion. Of the 105 Caucasian Brazilian individuals, 24 were boys and 81 were girls aged from 13 to 17 years and 4 months. The mesiodistal width of the maxillary and mandibular teeth, from the left first molar to the right first molar, was measured on each pre-treatment dental plaster cast using a digital caliper accurate to 0.01 mm resolution. Values were tabulated and the Bolton ratio was applied. The Kolmogorov-Smirnov test was used to verify if data were normally distributed (p>0.2). For comparison between the values obtained and those from the Bolton standard, Students t test was used and one-way ANOVA was used for comparisons among the 3 groups, with a significance level of 5% (p<0.05). Results: For groups 1, 2 and 3, respectively, the total ratio found was 90.36% (SD 1.70), 91.17% (SD±2.58) and 90.76% (SD±2.45); and the anterior ratio was 77.73% (SD 2.39), 78.01% (SD 2.66) and 77.30% (SD 2.65). Conclusions: There was no significant difference among the groups regarding the values indicated in the Bolton ratio

Malocclusion and dental appearance in underprivileged Brazilian adolescents

Abstract Satisfaction with dental aesthetics is a subjective indicator used in epidemiological studies and is related to health behaviours. Little is known about the factors that influence this indicator, particularly among adolescents who live in a situation of social vulnerability. The aim of this study was to investigate the relationship between malocclusion and dental appearance in underprivileged Brazilian adolescents. This analytical cross-sectional study was conducted in Piracicaba, Brazil, and evaluated 884 adolescents from 13 to 19 years of age. The dependent variable was satisfaction with dental appearance, and the independent variables were classified as individual (components of the Dental Aesthetic Index - DAI, sex and age) and contextual (social exclusion index). For statistical analysis, multilevel regression models were estimated. The individual variables were considered Level 1, and the contextual variable was considered Level 2, with a level of significance of 5%. The mean age of the adolescents was 15.3 years. Female adolescents more frequently affirmed that they were satisfied with their dental appearance than did male individuals. There was an increase in dissatisfaction with oral health with the increase in anterior maxillary overjet, midline diastema, larger anterior irregularity in the maxilla, larger anterior irregularity in the mandible, anterior open bite and antero-posterior molar relation. Satisfaction with dental appearance was associated with individual factors such as sex and DAI components

Quality of life and socio-dental impact among underprivileged brazilian adolescents

Purpose to evaluate the influence of clinical variables, individual and contextual characteristics on the quality of life (QL) of underprivileged adolescents in a municipality in the interior of the State of Sa˜o Paulo, Brazil. Methods An analytical cross-sectional study was conducted in Piracicaba, in 2012, with 1,172 adolescents aged 15–19 years, from 21 state schools and 34 Family Health Units. The dependent variables included the socio-dental impact (OIDP) and quality of life (WHOQOL-bref) indices. The dependent variables were classified as individual (DMFT index, CPI Index, age, sex, income, parents’ educational level) and contextual (Social Exclusion Index) variable. The multilevel regression model was estimated by the PROC GLIMMIX (‘‘Generalized Linear ModelsMixed’’) procedure, considering the individuals’ variables as being Level 1 and the contextual variables as being Level 2, and the statistical significance was evaluated at level of significance of 5 %. Results Girls were found to have the worst QL (p\0.000) and greatest OIDP (p = 0.000). There was an increase in OIDP (p\0.001) and diminished QL (p\0.052) with an increase in the periodontal index. This result is marginally significant since the significance probability is marginally greater than 0.05. In turn, there was an increase in QL (p = 0.000) and reduction in OIDP (p\0.000) with an increase in the family income. Adolescents who resided in areas of greatest social exclusion (p = 0.031) and with greater OIDP (p\0.000) presented the worst QL. Conclusion Individual and contextual variables were related to the OIDP and QL in underprivileged Brazilian adolescents.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Individual and contextual factors related to dental caries in underprivileged brazilian adolescents

Investigate the individual and contextual variables related to caries in underprivileged adolescents, and the disparity in distribution of the disease. Methods Cross-sectional analytical study, conducted in the city of Piracicaba, SP, Brazil, in 2012. The probabilistic sample was composed of 1,179 adolescents from 15–19 years of age, randomly selected from 21 state schools and 34 Primary Health Units – Family Health (PHU-FH). The dependent variables studied were number of decayed teeth and caries experience (DMFT). The independent variables were classified into individual (clinical, sociodemographic, psychosocial, self-perception, impact on oral health, access to services, and quality of life) and contextual (social exclusion index, total number of residents in suburb, literacy rate, and the following variables given in percentages: residences in the home ownership category, provision of domestic sewerage, trash collection, families with income of over 1 minimum wage per month, and families without monthly income) variables. The multilevel regression model was estimated by the PROC GLIMMIX (Generalized Linear Models-Mixed) procedure, considering the individual variables as Level 1 and the contextual variables of the suburbs as Level 2. Adjustment of the model was evaluated by -2 Res Log Likelihood with α = 0.05. Results As regards the individual variables, adolescents who declared having a prison inmate in the Family and resided in homes with a larger number of persons, showed a higher number of decayed teeth. There were a larger number of decayed teeth, a higher DMFT value, and worse self-perception as regards the health of their teeth and mouth. Other variables, such as being of the female gender, age and time since last visit to the dentist were related to the DMFT index. As regards the contextual variables, the DMFT was lower in suburbs with greater access to domestic sewage, and the number of decayed teeth was higher in suburbs with the worst social exclusion indices. Conclusion Individual and contextual variables were associated with the presence of caries and DMFT index in underprivileged adolescents, indicating that they must be taken into consideration in the formulation of policies directed towards oral health promotion and prevention activities in this group15FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP#2011/03657-5; #2011/01768-