Prevalência de defeitos de desenvolvimento de esmalte na dentição decídua e fatores materno - infantis associados

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Pública.Os defeitos de desenvolvimento do esmalte dental (D.D.E.) são utilizados em antropologia para revelar informações sobre distúrbios ocorridos durante o período neonatal. Prematuridade e baixo peso ao nascer são os melhores preditores das condições de saúde na infância, compreendendo aproximadamente 10 por cento de todos os nascimentos no Brasil e em muitos outros países. Os DDE são preditores de cárie dental sendo, portanto, importantes estudá-los numa perspectiva de saúde pública. O objetivo desse estudo foi estimar a prevalência de DDE na dentição decídua de pré-escolares de Itajaí, Santa Catarina. Além disso, procurou-se verificar se a prematuridade e baixo peso ao nascer foram associados aos DDE. Este estudo foi desenvolvido em duas etapas. Na primeira estimou-se a prevalência de D.D.E. na dentição decídua de 431 pré-escolares de 3 a 5 anos de idade de Itajaí, Santa Catarina. Na segunda etapa foram testadas associações entre DDE na dentição decídua e crianças nascidas de baixo peso e prematuras através de um estudo de caso-controle. Casos (n=102) foram àquelas crianças que apresentaram pelo menos uma superfície dentária com D.D.E. segundo o Índice Modificado de Defeitos de Desenvolvimento de Esmalte (FDI, 1992), no estudo transversal. Controles (n= 113) foram selecionados entre àquelas sem D.D.E., pareadas por sexo, idade e creche. Todos os dentes foram examinados clinicamente por uma única cirurgiã-dentista calibrada. Um questionário foi aplicado para obter informações sócio-demográficas e de saúde das mães e crianças. Além disso, a idade gestacional e o peso da criança ao nascimento foram coletados de registros oficiais. Variáveis explanatórias foram prematuridade (< 37 semanas de idade gestacional), baixo peso ao nascimento (< 2.500 g.) e amamentação. Fatores de confusão, tais como: escolaridade da mãe, problemas de saúde da mãe durante a gravidez e da criança durante o primeiro ano de vida, foram controlados. Análises de regressão logística condicional simples e múltipla foram realizadas. Foi encontrado uma prevalência de D.D.E. de 24,4% (IC(95%)= 20,3-28,5). Crianças prematuras foram associadas com D.D.E. (OR= 2,6, IC(95%)= 1,0-6,4) após o ajuste por possíveis fatores de confusão. Um achado não esperado foi a associação entre D.D.E. e crianças que não foram amamentadas (OR=3,2, IC(95%)=1,2-8,4). Interações entre prematuridade e baixo peso ao nascimento e entre prematuridade e amamentação não foram identificadas. Uma alta prevalência de D.D.E. foi encontrada na população estudada. Crianças nascidas prematuramente e aquelas que não foram amamentadas foram mais acometidas por D.D.E

The Influence of the First Thousand Days of Life on Establishing Determinant Behaviors for Dental Caries in Childhood

Objective: To study the influence of the first thousand days of life on establishing determinant behaviors for dental caries in childhood. Material and Methods: Longitudinal retrospective study involving 664 children born in 2009 living in a southern Brazilian municipality was carried out. Data was collected through interviews with mothers and through child’s health card. Dependent variables were 1) tooth brushing onset after two years of age; 2) absent tooth brushing or once a day; 3) tooth brushing without adult supervision; 4) not having gone to the dentist until the age of 6; and 5) seek for dental services due to toothache at 6 years of age, over the last 30 days. Bivariate and multivariate analyses were performed using Poisson Regression to estimate relative risks (RR) and respective confidence intervals at the 95% accuracy level. Results: Mothers with lower schooling at child’s birth presented a higher risk of “child’s tooth brushing onset only after two years of age”, “brushing the teeth once a day only or not brushing” and with “child not having gone to the dentist until the age of 6”. Mothers who did not have a job when the child was born were associated with “not having gone to the dentist until the age 6”. Children with gastroesophageal reflux who underwent hospitalization for more than 2 days under age 2 were associated with “seeking dental services because of pain at 6 years of age over the last 30 days”. Conclusion: Higher risks of some determinant behaviors related to dental caries were associated with variables of the period of the first thousand days of life

Prevalence and Associated Factors of Dental Trauma in Six-Year-Old School-Children

Objective: To estimate the prevalence and associated factors of dental trauma in 6-year-old school children in the city of Palhoça, Brazil. Material and Methods: Cross-sectional study nested in a cohort study. It involved a representative sample of school children born in 2009, residing in the municipality and regularly enrolled in public and private schools (n = 1,102). Clinical data were obtained through oral exams. To evaluate the incisal overjet, the distance in millimeters was measured horizontally from the labial surface of the lower central incisor to the labial surface of the upper incisor. Bivariate analyses were performed using the Chi-square test, with a p-value &lt;0.05 considered statistically significant. Multivariate analyses using Poisson Regression were performed to identify independent associations between the prevalence and the independent variables studied. Results: Prevalence of dental trauma was 4.2% (95% CI 3.0-5.4). Dental trauma was statistically associated with studying in a private school (PR = 1.03; 95% CI 1.01-1.06) (p=0.016) and with inadequate lip coverage (PR = 1.08; 95% CI 1.01-1.14) (p=0.016). Conclusion: The prevalence of 4.2% of dental trauma in six-year-old children, associated with inadequate and greater lip coverage in children from private schools should be taken into account, since most teeth at this stage are newly erupted

First Thousand Days of Child Life and the Development of Risk Factors for Malocclusions

Objective: To identify the association between individual and socioeconomic factors during the first thousand days of the child\u27s life and the occurrence of risk behaviors for the development of malocclusions. Material and Methods: Cross-sectional study. A sample of 655 6-year-old schoolchildren and families was included. Interviews with mothers were performed at home. The dependent variables were risk behaviors to the development of malocclusions. Independent variables were socioeconomic conditions, aspects of gestation, birth and health of the child up to two years of age. Bivariate and multivariate analyzes were performed through Poisson regression. Results: Maternal education of less than eight years was independently associated with the interruption of exclusive breastfeeding until the fourth month (PR=1.58 CI 95%; 1.07; 2.37). Occupation of the mother with income [PR=1.26; 1.02; 1.56)], occupation of the father without income [PR=1.46 (1.01; 2.14)] were associated fwith interruption of breastfeeding until the sixth month. Pregnancy in adolescence [PR=0.83 (0.70; 0.98)] and nursery attendance [PR=1.15 (1.02; 1.28)] were associated with bottle use. Nursery attendance [PR=1.27 (1.01; 1.59)], hospitalization in the first 29 days of life [PR=1.34 (1.01; 1.80)], occurrence of reflux [PR=1.30 (1.01; 1.70)] were associated with pacifier using. Conclusion: Variables related to the period of the first thousand days of life are associated with higher risk behaviors for the occurrence of malocclusions

Prevalence and Associated Factors of Dental Trauma in Six-Year-Old School-Children

Objective: To estimate the prevalence and associated factors of dental trauma in 6-year-old school children in the city of Palhoça, Brazil. Material and Methods: Cross-sectional study nested in a cohort study. It involved a representative sample of school children born in 2009, residing in the municipality and regularly enrolled in public and private schools (n = 1,102). Clinical data were obtained through oral exams. To evaluate the incisal overjet, the distance in millimeters was measured horizontally from the labial surface of the lower central incisor to the labial surface of the upper incisor. Bivariate analyses were performed using the Chi-square test, with a p-value &lt;0.05 considered statistically significant. Multivariate analyses using Poisson Regression were performed to identify independent associations between the prevalence and the independent variables studied. Results: Prevalence of dental trauma was 4.2% (95% CI 3.0-5.4). Dental trauma was statistically associated with studying in a private school (PR = 1.03; 95% CI 1.01-1.06) (p=0.016) and with inadequate lip coverage (PR = 1.08; 95% CI 1.01-1.14) (p=0.016). Conclusion: The prevalence of 4.2% of dental trauma in six-year-old children, associated with inadequate and greater lip coverage in children from private schools should be taken into account, since most teeth at this stage are newly erupted

First Thousand Days of Child Life and the Development of Risk Factors for Malocclusions

Objective: To identify the association between individual and socioeconomic factors during the first thousand days of the child's life and the occurrence of risk behaviors for the development of malocclusions. Material and Methods: Cross-sectional study. A sample of 655 6-year-old schoolchildren and families was included. Interviews with mothers were performed at home. The dependent variables were risk behaviors to the development of malocclusions. Independent variables were socioeconomic conditions, aspects of gestation, birth and health of the child up to two years of age. Bivariate and multivariate analyzes were performed through Poisson regression. Results: Maternal education of less than eight years was independently associated with the interruption of exclusive breastfeeding until the fourth month (PR=1.58 CI 95%; 1.07; 2.37). Occupation of the mother with income [PR=1.26; 1.02; 1.56)], occupation of the father without income [PR=1.46 (1.01; 2.14)] were associated fwith interruption of breastfeeding until the sixth month. Pregnancy in adolescence [PR=0.83 (0.70; 0.98)] and nursery attendance [PR=1.15 (1.02; 1.28)] were associated with bottle use. Nursery attendance [PR=1.27 (1.01; 1.59)], hospitalization in the first 29 days of life [PR=1.34 (1.01; 1.80)], occurrence of reflux [PR=1.30 (1.01; 1.70)] were associated with pacifier using. Conclusion: Variables related to the period of the first thousand days of life are associated with higher risk behaviors for the occurrence of malocclusions

A influência dos primeiros mil dias de vida da criança na incidência de defeitos de desenvolvimento de esmalte dentário

Introduction: The development and growth of a child are strongly influenced by demographic, socioeconomic and maternal-infant factors occurring during the first thousand days of life, which comprise the nine-month gestation up to two years of age. Defects of enamel development are changes in the structure of the dental enamel generated by local or systemic aggressions occurred during its formation. Objective: To study the association between pre, neo and postnatal conditions in the first thousand days of life, in the incidence of developmental defects of dental enamel in schoolchildren of six years old. Methods: Retrospective longitudinal study involving 655 six-year-old schoolchildren born and residing in Palhoça/SC. Sociodemographic and health data were collected through interviews with mothers in the homes and oral examinations of children in schools. Multivariate analyzes were performed using Cox regression. Results: The incidence of enamel development defects was 44.0% (95% CI 40.2, 47.8). Demarcated opacities were the most incident types 31.1% (95% CI 27.5, 34.6) followed by diffuse opacities 19.1% (CI 95% 16.1, 22.1). The variables late pregnancy (age between 35 and 44 years), maternal schooling (less than eight years of schooling), female gender and the child's white skin color were independently associated with the incidence of demarcated opacities. Conclusions: Demographic and socioeconomic factors that occurred in the first thousand days of life influenced the incidence of enamel development defects, especially in demarcated opacities.Introdução: O desenvolvimento e crescimento de uma criança são fortemente influenciados por fatores demográficos, socioeconômicos e materno-infantis, ocorridos nos seus primeiros mil dias de vida, que compreendem os nove meses de gestação até os dois anos de idade. Defeitos de desenvolvimento de esmalte são alterações na estrutura do esmalte dentário gerados por agressões locais ou sistêmicas ocorridas durante a sua formação. Objetivo: Estudar associação entre condições pré, neo e pós-natais nos primeiros mil dias de vida, na incidência de defeitos de desenvolvimento de esmalte dentário em escolares de seis anos de idade. Métodos: Estudo longitudinal retrospectivo envolvendo 655 escolares de seis anos, nascidos e residentes em Palhoça/SC. Dados sociodemográficos e de saúde foram coletados por entrevistas com as mães nos domicílios e exames bucais das crianças nas escolas. Foram realizadas análises multivariadas por meio da regressão de Cox. Resultados: A incidência de defeitos de desenvolvimento de esmalte foi de 44,0 % (IC 95% 40,2; 47,8). Opacidades demarcadas foram os tipos mais incidentes 31,1% (IC 95% 27,5; 34,6) seguidos das opacidades difusas 19,1% (IC 95% 16,1; 22,1). As variáveis gravidez tardia (idade entre 35 a 44 anos), escolaridade materna (menos de oito anos de estudo), sexo feminino e a cor de pele branca da criança mostraram-se associadas de forma independente com a incidência de opacidades demarcadas. Conclusões: Fatores demográficos e socioeconômicos ocorridos nos primeiros mil dias de vida influenciaram na incidência de defeitos de desenvolvimento de esmalte, notadamente nas opacidades demarcadas

Prevalence and distribution of developmental enamel defects in the primary dentition of pre-school children Prevalência e distribuição de defeitos de desenvolvimento de esmalte na dentição decídua de pré-escolares

Developmental defects of the enamel (D.D.E.) are changes in the deciduous dentition that have been little studied in Brazil, although they lead to aesthetic problems, dental sensitivity and may be predictors of dental caries. The objective of this study was to estimate the prevalence and distribution of D.D.E. in the deciduous dentition of pre-school children in the municipality of Itajaí, Santa Catarina, in 2003. A cross-sectional study was carried out with a sample of 431 children aged 3 to 5 enrolled in public day care centres. All of the teeth were examined and the enamel defects were assessed according to the Modified DDE Index (FDI, 1992). The prevalence of D.D.E. was 24.4% (CI 95% 20.3-28.5). Diffuse opacities were the most common defects found (17.9%), followed by hypoplasia (11.1%) and demarcated opacities (6.1%). The most affected teeth were the second molars (44.4%), followed by the first molars (23.5%). Defects were observed more frequently in the upper arch (58.2%). Assessing enamel hypoplasia separately, a prevalence of 15.1% (CI 95% 11.7-18.5) was observed, with the most affected teeth being the canines (33.6%) and second molars (33.6%). One quarter of the pre-school children presented enamel defects, with diffuse opacities being the most prevalent ones.No Brasil, os defeitos de desenvolvimento de esmalte (D.D.E.) são alterações pouco estudadas na dentição decídua apesar de acarretarem problemas estéticos, de sensibilidade dentária e serem fatores predisponentes da cárie dental. O objetivo deste estudo foi estimar a prevalência e distribuição de D.D.E. na dentição decídua de pré-escolares do município de Itajaí, Santa Catarina em 2003. Foi realizado um estudo transversal com uma amostra de 431 crianças de 3 a 5 anos de idade matriculadas em creches públicas. Todos os dentes foram examinados e os defeitos de esmalte foram avaliados segundo o "Modified DDE Index" (FDI, 1992). A prevalência de D.D.E. foi 24,4% (IC 95% 20,3-28,5). As opacidades difusas foram os defeitos mais encontrados (17,9%), seguidos das hipoplasias (11,1%) e opacidades demarcadas (6,1%). Os dentes mais acometidos foram os segundos molares (44,4%); seguidos pelos primeiros molares (23,5%). Os defeitos foram observados com maior freqüência na arcada superior (58,2%). Avaliando isoladamente as hipoplasias de esmalte, observou-se uma prevalência de 15,1% (IC 95% 11,7-18,5); sendo que os dentes mais atingidos foram os caninos (33,6%) e segundos molares (33,6%). Um quarto dos pré-escolares apresentou defeitos de esmalte, sendo que as opacidades difusas foram os mais prevalentes

Adverse birth outcomes and oral health

It is vital to improve the understandingof early child’s oral health determinants and conse-quent identification of interventions and behaviorsthat can be modified with health promotion activi-ties since birth. Authors have suggested that proper fetal growth and adequate development in the first two years of life are determinants ofhealth, not only at childhood but also in later life.David Barker’s studies conducted in the 1980s have suggested that the events of the intrauterineperiod or during early childhood have long-termeffects on morbidity and mortality from chronicdiseases.On the other hand, the Life-Course Theory emphasizes the infancy period, based on the accu-mulation of environmental, social, and behavioralrisks in life, without disregarding Barker’s pre-mises, to strengthen the interaction between bio-logical and social factors of the different stages of life, more than the current adult lifestyle. However, little research has been carried outfocusing on these ideas to determine children’s oralhealth. There is a scarcity of longitudinal studies,such as population-based cohort studies, that aimto understand the determination of the oral health-disease process and the complex interactionbetween social environment and biological and behavioral aspects. The study published by thisimportant journal has contributed to bring thisissue to the agenda