Social capital and oral health promotion: Past, present, and future challenges

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Desigualdades na prevalencia de carie dentaria nao tratada em criancas pre-escolares no Brasil

OBJETIVO: Avaliar a influência de desigualdades sociais de ordem individual e contextual na experiência de cárie dentária não tratada em crianças no Brasil. MÉTODOS: Os dados sobre a prevalência de cárie dentária foram obtidos do Projeto Pesquisa Nacional de Saúde Bucal – SBBrasil 2010, levantamento epidemiológico de saúde bucal com amostra representativa para o país e cada uma de suas macrorregiões geográficas. Crianças de cinco anos de idade (n = 7.217) em 177 municípios foram examinadas e seus responsáveis responderam ao questionário. Características contextuais referentes aos municípios em 2010 (renda mediana, fluoretação da água e proporção de domicílios com abastecimento de água) foram informadas pela Fundação Instituto Brasileiro de Geografia e Estatística. O estudo de associação utilizou modelos multinível de análise de regressão de Poisson. RESULTADOS: A prevalência de cárie não tratada foi de 48,2%; mais da metade da amostra apresentou ao menos um dente decíduo com experiência de cárie. O índice de cárie na dentição decídua ceo-d médio foi 2,41, sendo maior para as regiões Norte e Nordeste. Crianças de cor da pele preta e parda, e aquelas com renda familiar menos elevada tiveram maior prevalência de cárie não tratada. No nível contextual, renda mediana no município e adição de flúor na água de abastecimento associaram-se inversamente com a prevalência do desfecho. CONCLUSÕES: Desigualdades na prevalência de cárie não tratada persistem, afetando as crianças com dentição decídua no Brasil. O planejamento de medidas públicas para a promoção de saúde bucal deve considerar o efeito de fatores contextuais como determinante de riscos individuais.OBJETIVO: Evaluar la influencia de desigualdades sociales de orden individual y contextual en la experiencia de caries dentaria no tratada en niños en Brasil. MÉTODOS: Los datos sobre la prevalencia de caries dentaria fueron obtenidos del Proyecto Investigación Nacional de Salud Bucal – SBBrasil 2010, pesquisa epidemiológica de salud bucal con muestra representativa para el país y cada una de sus macro regiones geográficas. Niños de cinco años de edad (n= 7.217) en 177 municipios fueron examinados y sus responsables respondieron el cuestionario. Características contextuales referentes a los municipios en 2010 (renta mediana, fluororación del agua y proporción de domicilios con abastecimiento de agua) fueron informadas por la Fundación Instituto Brasileño de Geografía y Estadística. El estudio de asociación utilizó modelos multinivel de análisis de regresión de Poisson. RESULTADOS: La prevalencia de caries no tratada fue de 48,2%; más de la mitad de la muestra presentó al menos un diente deciduo con experiencia de caries. El índice de caries en la dentición decidua ceo-d promedio fue 2,41, siendo mayor para las regiones Norte y Noreste. Niños con color de piel negra y parda, y aquellas con renta familiar menos elevada tuvieron mayor prevalencia de caries no tratada. En el nivel contextual, renta mediana en el municipio y adición de flúor en el agua de abastecimiento se asociaron inversamente con la prevalencia del resultado. CONCLUSIONES: Desigualdades en la prevalencia de caries no tratada persisten, afectando a los niños con dentición decidua en Brasil. La planificación de medidas públicas para la promoción de salud bucal debe considerar el efecto de factores contextuales como determinante de riesgos individuales.OBJECTIVE: To evaluate the influence of social inequalities of individual and contextual nature on untreated dental caries in Brazilian children. METHODS: The data on the prevalence of dental caries were obtained from the Brazilian Oral Health Survey (SBBrasil 2010) Project, an epidemiological survey of oral health with a representative sample for the country and each of the geographical micro-regions. Children aged five (n = 7,217) in 177 municipalities were examined and their parents/guardians completed a questionnaire. Contextual characteristics referring to the municipalities in 2010 (mean income, fluorodized water and proportion of residences with water supply) were supplied by the Fundação Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Multilevel Poisson regression analysis models were used to assess associations. RESULTS: The prevalence of non-treated dental caries was 48.2%; more than half of the sample had at least one deciduous tooth affected by dental caries. The index of dental caries in deciduous teeth was 2.41, with higher figures in the North and Northeast. Black and brown children and those from lower income families had a higher prevalence of untreated dental caries. With regards context, the mean income in the municipality and the addition of fluoride to the water supply were inversely associated with the prevalence of the outcome. CONCLUSIONS: Inequalities in the prevalence of untreated dental caries remain, affecting deciduous teeth of children in Brazil. Planning public policies to promote oral health should consider the effect of contextual factors as a determinant of individual risk

Influence of self-perceived oral health and socioeconomic predictors on the utilization of dental care services by schoolchildren

The influence of socioeconomic factors and self-rated oral health on children's dental health assistance was assessed. This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. A dental examination provided information on the prevalence of dental caries (DMFT index). Data about the use of dental service, socioeconomic status, and self-perceived oral health were collected by means of structured interviews. These associations were assessed using Poisson regression models (prevalence ratio; 95% confidence interval). The prevalence of regular use of dental service was 47.8%. Children from low socioeconomic backgrounds and those who rated their oral health as "poor" used the service less frequently. The distribution of the kind of oral healthcare assistance used (public/private) varied across socioeconomic groups. The better-off children were less likely to have used the public service. Clinical, socioeconomic, and psychosocial factors were strong predictors for the utilization of dental care services by schoolchildren

Impact of Oral Conditions and Subjective Factors on Academic Performance

Objective: To evaluate the influence of oral health clinical and non-clinical indicators on adolescents’ academic performance. Material and Methods: A longitudinal design was performed with a random sample of 1,134 12-year-old Brazilian adolescents. In 2012, the adolescents were clinically assessed by calibrated dentists and investigated about demographics, socioeconomic factors, dental service use, toothache, and verbal bullying related to oral condition via structured questionnaires. The contextual variable was obtained from the city’s official database. After two years, 771 adolescents were reassessed. The outcome adolescent’s academic performance (good or poor) was collected through official school’s register. Multilevel logistic regression analyses were performed to assess associated factors for adolescents’ academic performance. Results: Adolescents with toothache (OR 1.74; CI 95%: 1.05-2.89), who have been a victim of bullying (OR 2.23; CI 95%: 1.21-4.09), and were male (OR 1.92; CI 95%: 1.19-3.09) had a lower academic performance. On the other hand, adolescents whose mothers had higher educational levels (OR 1.79; CI 95%: 1.08-2.97) and belonged to higher-income households (OR 1.95; CI 95%: 1.18-3.23) had higher academic performance when compared to their peers. Conclusion: Adverse oral conditions, as well as subjective and socioeconomic factors, impacted on adolescents’ academic performance

Differences in responses to the Oral Health Impact Profile (OHIP14) used as a questionnaire or in an interview

The objective of this study was to compare the completion rates and performance of the Brazilian version of the Oral Health Impact Profile (OHIP14) when applied as an interview or in its original self-reported form. A convenience sample of 74 adult patients was selected in a Dental Clinic (University of Araras, Brazil). One examiner administered the instrument in both formats to participants with an interval of 2 weeks between each administration. Data about dental health condition and socioeconomic status were collected and associated with total OHIP14 scores in both formats using linear regression analyses. No differences were found in the total scores and in each subscale of the OHIP14 according to the form of administration. Higher values of completion were found in the interview format. More severe impacts were recorded in the interview format than in the questionnaire format. Higher values of total OHIP-14 scores in both formats were related to the presence of dental caries. Total OHIP14 scores were not influenced by the method of administration. However, the use of the OHIP14 in the questionnaire format may result in lower completion rates and loss of data

Impact of community and individual social capital during early childhood on oral health-related quality of life: a 10-year prospective cohort study

Author's accepted manuscriptAim: To evaluate the impact of community and individual social capital during early childhood on oral healthrelated quality of life (OHRQoL) over a 10-year follow-up period. Methods: A prospective cohort study was conducted in the southern Brazil. Baseline (T1) data collection occurred in 2010 with preschool children aged 1-5 years. Participants were assessed in 2012 (T2), 2017 (T3), and 2020 (T4). OHRQoL was assessed using the B-ECOHIS at T1 and T2 and through CPQ8-10 at T3 and CPQ11-14 at T4. Community social capital was evaluated through the presence of formal institutions in the neighbourhood and individual social capital by social networks, both at T1. Demographic and socioeconomic characteristics were also evaluated. Multilevel Poisson regression analysis was performed to estimate the impact of social capital measures on OHRQoL. Results: Of the 639 children assessed at T1, 469 were followed at T2 (73.3% response rate), 449 at T3 (70.3% response rate), and 429 at T4 (67.1% response rate). Individuals living in neighbourhoods with the presence of social class associations at T1 had higher OHRQoL at T3 and T4. Individuals whose families visit friends and neighbours less than once a month or never at T1 had lower OHRQoL at T1, T3 and T4. Attending religious meetings less than once a month or never at T1 was associated with lower OHRQoL at T2 and T4. Conclusion: Social capital at the community level had a long-term effect on OHRQoL, especially during adolescence, while individual social capital levels impacted OHRQoL across the assessments. Clinical Significance: The findings indicate that psychosocial variables can impact OHRQoL, a fundamental aspect of clinical practice.acceptedVersio

Association between gingival bleeding and gingival enlargement and oral health-related quality of life (OHRQoL) of subjects under fixed orthodontic treatment : a cross-sectional study

Background: There are scarce evidences that evaluated the impact of periodontal disease on oral health-related quality of life (OHRQoL) taking marginal gingival alterations into consideration. Thus, this study aimed to verify the association between OHRQoL and gingival enlargement and gingival bleeding in subjects under fixed orthodontic treatment (FOT). Methods: 330 participants under FOT for at least 6 months were examined by a single, calibrated examiner for periodontal variables and dental aesthetic index. Socio-economic background, body mass index, time with orthodontic appliances, and use of dental floss were assessed by oral interviews. OHRQoL was evaluated using the oral health impact profile (OHIP-14) questionnaire. The assessment of associations used unadjusted and adjusted Poisson regression models. Results: Higher impacts on the OHIP-14 overall were observed in subjects who presented higher levels of anterior gingival enlargement (RR 2.83; 95% CI 2.60-3.09), were non-whites (RR 1.29; 95% CI 1.15-1.45), had household income lower than five national minimum wages (RR 1.85; 95% CI 1.30-2.61), presented body mass index > 25 (RR 1.14; 95% CI 1.01-1.29), and showed a dental aesthetic index > 30 (RR 1.32; 95% CI 1.20-1.46). Conclusions: Anterior gingival enlargement seems to influence the OHRQoL in subjects receiving orthodontic treatment

Brazilian dentistry research productivity : state level socioeconomic, educational and structural factors

Aim: To explore socioeconomic, educational and research factors associated with dental research productivity at the state level in Brazil. Methods: The authors used the Scopus database to identify dental articles published from 2006 to 2016 associated with Brazilian universities at the state level. Several social, economic, educational and research structure variables were obtained from the census and National Research Council to predict the rate of articles per 100 thousand inhabitants among the 27 Brazilian states. Rates were fitted in linear weighted least-squared regression with stepwise technique. Twenty-two variables were grouped in six blocks (social, economic, general education, dental education, research workforce and structure). Results: A total of 21189 articles were published, and the state of São Paulo accounted for 46%, followed by Rio Grande do Sul with 9.4%; four states did not publish any articles. There were an average (± standard deviation) of 2.6 (±1.98) published articles per 100 researchers and 13.4 (±9.6) articles per 100 thousand inhabitants. Research structure and workforce explained 92.4% and 87.2% of state variability, respectively, while the final model explained 94.5%. One extra PhD and one extra undergraduate researcher per 100 thousand inhabitants were associated with 11.3 more and 3.5 fewer articles, respectively, while every 10 points (range 0-100) on the Human Development Index (Education Component) was associated with 3.3 more articles. Conclusion: State scientific output has several associated factors, but research workforce and general education variables seem to be good predictors. Large disparities among state research outputs have been described and must be addressed by research and development policies

Impact of pulpectomy versus tooth extraction in children's oral health-related quality of life: A randomized clinical trial

AIM: The aim of this randomized clinical trial was to compare the impact of two management options for primary molars with pulp necrosis (pulpectomy or extraction) on children's oral health-related quality of life (OHRQoL). DESIGN: A total of 100 children aged 3-5 years with at least one necrotic primary molar were selected and randomized into the study groups. The Brazilian version of early childhood oral health impact scale (B-ECOHIS) was completed by the parent proxy reports at baseline and after 4, 8 and 12 months. Differences between the trial groups were assessed through bootstrap linear regression for B-ECOHIS scores, logistic regression for dental pain self-reports and anxiety scores (α = 5%). RESULTS: The mean (SD) B-ECOHIS scores at baseline and after 12 months were 17.7 (6.5) and 3.0 (4.0) in the pulpectomy group and 18.8 (7.7) and 7.9 (7.7) in the extraction group. Both treatments significantly improved OHRQoL, but tooth extraction group showed higher scores in total B-ECOHIS (p < .001) and most domains, indicating lower OHRQoL. Furthermore, higher anxiety levels were reported for dental extraction compared to pulpectomy (OR = 2.52; p = .008). CONCLUSION: Pulpectomy resulted in an improved OHRQoL scores after 12 months when compared to tooth extraction and should be considered as the treatment of choice for necrotic primary molars

External control of fluoridation in public water supply of Canoas/RS

The aim of this study was to evaluate the concentration of fluoride in public water supplies in Canoas/RS. Samples of drinking water were collected in duplicates for eight months on 22 different points grouped into three water treatment plants of the city. The measurement of fluoride concentration was performed using the electrometric method. The analysis of samples collected in the study period showed that there was oscillation in fluoride concentrations in accordance with the sampling months (from 0.185 to 1.605 ppm /L). Of the samples, 96 (54.5%) were inadequate (0.6 ppm 0.9 ppm) as the fluoride concentration. Of inadequate samples, the majority showed concentrations above the maximum acceptable concentration for drinking water standard. There was statistically significant difference among the three water treatment plants regarding the suitability of the fluoride concentration (p 0.001). The large variation in relation to fluoride concentration as well as the high percentage of inadequate samples revealed the need to implement measures of external control to ensure continuous effectiveness of water fluoridation