Decline in dental caries among 12-year-old children in Brazil, 1980-2005

Objectives This study was conducted to determine changes in values on the decayed, missing and filled teeth (DMFT) index in 12-year-old children in Brazil between 1980 and 2005, and to correlate DMFT values with human development index (HDI) values, time, population size of municipality and fluoridation of the water supply. Methods The present study represents a retrospective ecological study using secondary data from epidemiological surveys published in indexed journals, as well as data obtained from epidemiological official surveys carried out in Brazil in 1986, 1996 and 2003, and in the State of Sao Paulo in 1998 and 2002. Units of study were represented by Brazilian municipalities holding average DMFT index values for 12-year-old children. Multiple regression analysis was used to examine the correlations among DMFT and HDI values, and time, population size and fluoridation of the water supply. Results The final database included 550 records of DMFT values in 428 different towns. Regression analysis showed statistically significant correlations between DMFT index values and time (P < 0.001), fluoridation of the water supply (P < 0.001) and size of municipality (P < 0.001). Estimated mean DMFT index values were 8.36 in 1980, 6.08 in 1985, 4.45 in 1990, 3.29 in 1995, 2.46 in 2000 and 1.86 in 2005. Conclusions Data showed a significant decrease in dental caries across the entire country, with an average reduction of 25% occurring every 5 years. General trends indicated that a reduction in DMFT index values occurred over time, that a further reduction in DMFT index values occurred when a municipality fluoridated its water supply, and mean DMFT index values were lower in larger than in smaller municipalities.

Dental caries related to quality of life in two Brazilian adolescent groups: a cross-sectional randomised study

Objectives: To analyse dental caries-related quality of life (QoL) in adolescent (1519-year-old) subjects in a suburban area (SA) and a downtown area (DA) of Bauru, Sao Paulo, Brazil, in 2009. Methods: This was a cross-sectional, randomised study. The sample consisted of 185 and 147 adolescents from the SA and DA, respectively. The caries index used was that for decayed, missing and filled teeth (DMFT) (World Health Organization criteria). The 14-item Oral Health Impact Profile (OHIP-14) was used to assess QoL. The non-parametric MannWhitney test, Spearmans correlation coefficient and chi-squared test were used in the statistical analysis. Results: The DMFT index, Significant Caries (SiC) Index and percentage of caries-free students were similar (P > 0.05) between these populations, but findings on the Care Index differed (P < 0.05). There was a correlation between the DMFT index and OHIP-14 score in SA subjects (mean DMFT index = 3.01) in the dimensions of physical pain (r = 0.25; P < 0.01) and psychological disability (r = 0.17; P = 0.02). The DMFT index in DA subjects (mean DMFT index = 2.95) showed a correlation with functional limitation (r = 0.19; P = 0.02). The correlation in SA subjects between the caries component (mean = 1.22) of the DMFT index and OHIP-14 was significant only for the physical pain dimension (r = 0.16; P = 0.03). In DA subjects, correlations between the caries component (mean = 0.37) and all dimensions of OHIP-14 were statistically significant (P < 0.05). Conclusions: Despite the similarities in means in the DMFT index, the SiC Index and the caries-free percentage of subjects in both localities, access to dental treatment proved to be less effective for SA adolescents. Physical pain and psychological disability were the most frequent negative manifestations of impact on QoL. The SA adolescents were more negatively affected by dental caries in terms of QoL.

The impact of dental caries and trauma in children on family quality of life

Objectives: To assess the impact of childrens dental caries (DC) and traumatic dental injuries (TDI) on parents quality of life (QoL), adjusted by family income. Methods: Parents of 219 children aged 5 and 6 years answered the Family Impact Scale (FIS) on their perception of QoL and data about income. Three calibrated dentists examined the severity of DC according to decayed, missing and filled permanent teeth index, and children were categorized into: 0 = caries free; 15 = low severity; and =6 = high severity. TDI were classified into uncomplicated and complicated injuries. QoL was measured through FIS items and total score, and Poisson regression was used to associate the variables with the outcome. Results: Severity of DC showed a negative impact on the total score and subscales on parental/family activities, parental emotions and financial burden (P < 0.001). TDI showed a negative impact on total score and in some FIS items. The multivariate-adjusted model showed that only the increase in the severity of childrens DC (RR = 3.19; 95% CI = 2.36, 4.31; P < 0.001) was associated with a greater negative impact on parents QoL, while high family income was a protective factor (RR = 0.68; 95% CI = 0.48, 0.95; P < 0.001). Conclusions: The severity of childrens DC has a negative impact on parents QoL, whereas TDI do not. A lower family income might have a negative impact on parents QoL.

Dental caries-related quality of life and socioeconomic status of preschool children, Bauru, SP

AIM: To evaluate oral health-related quality of life of preschool children of Bauru, State of São Paulo, Brazil, and associate it with socioeconomic profile of households. METHODS: The sample consisted of 229 preschool children between 3 and 5 years and the dmft (decayed, missing due to caries, filled teeth) index was adopted for assessment children's dental caries in accordance with the standards recommended by the World Health Organization. Questionnaires were used for evaluation oral health-related quality of life (Early Childhood Oral Health Impact Scale) and socioeconomic profile of parents or guardians of the preschool children. Statistical analysis was performed descriptively by relative and absolute frequencies and by Spearman's correlation and Kruskal-Wallis test (p <0.05). RESULTS: A dmft of 1.65 (± 2.87) and a Sic Index 4.88 (± 3.20) were found, indicating the polarization of dental caries in the studied group. It was verified low influence of oral health on quality of life of the children examined. With respect to socioeconomic classification, 66.38% of families were in the lower middle class. Linear and statistically significant correlation was found between dmft and oral health-related quality of life for the overall score and domains of the questionnaire (p<0.001). CONCLUSIONS: It was found low influence of oral health on quality of life of the preschool children and the assessment of socioeconomic conditions of the children's families may guide practices aiming to reducing inequalities in the distribution of dental caries in the population.

Dental caries associated factors in 12 year-old schoolchildren from a municipality in the state of São Paulo, Brazil

Objective To analyze the possible association between dental caries, fluorosis and the need for treatment in 12 year-old schoolchildren and the socioeconomic conditions of parents/guardians in the city of Franca, in the state of São Paulo. Methods A random sample of schoolchildren aged 12 was obtained from the school records in Franca, using a systematic random technique. The epidemiological survey was carried out by a single calibrated examiner, on 258 public and private schoolchildren in order to obtain the prevalence of dental caries, the need for treatment and the severity of dental fluorosis. Parents/guardians were also interviewed to assess their socioeconomic conditions (education and per capita income). We used multiple correlation analysis to investigate associations between category variables. Results It was possible to identify two distinct groups, with associations between the variables: the first group, represented by schoolchildren with average prevalence of caries, need for treatment, low level of parental education and income; and a second group represented by schoolchildren with low prevalence of caries, no need for treatment, high parental education and income. The two dimensions explained approximately 35% of total inertia. The factors within each group are related. Conclusion High income and parental education are associated with the low prevalence of dental caries but there is no association with dental fluorosis.

Influence of dental materials used for sealing caries lesions on laser fluorescence measurements

The aim of this study was to determine the influence of thickness and aging on the intrinsic fluorescence of sealing materials and their ability to block fluorescence from the underlying surface as assessed using a laser fluorescence device. Cavities of 0.5 mm and 1 mm depth were drilled into acrylic boards which were placed over two surfaces with different fluorescence properties: a low-fluorescence surface, to assess the intrinsic fluorescence of the sealing materials, and a high-fluorescence surface, to assess the fluorescence-blocking ability of the sealing materials. Ten cavities of each depth were filled with different sealing materials: Adper Scotchbond Multi-Purpose, Adper Single Bond 2, FluroShield, Conseal f and UltraSeal XT Plus. Fluorescence was measured with a DIAGNOdent pen at five different time points: empty cavity, after polymerization, and 1 day, 1 week and 1 month after filling. The individual values after polymerization, as well as the area under the curve for the different periods were submitted to ANOVA and the Tukey test (p < 0.05). At 0.5 mm, Scotchbond, FluroShield and UltraSeal showed insignificant changes in intrinsic fluorescence with aging and lower fluorescence after polymerization than Single Bond and Conseal. At 1 mm, Scotchbond and FluroShield showed the lowest intrinsic fluorescence, but only Scotchbond showed no chagnes in fluorescence with aging. At both depths, Scotchbond blocked significantly less fluorescence. All sealing materials blocked more fluorescence when applied to a depth of 1 mm. At 0.5 mm, fissure sealants blocked more fluorescence than adhesives, and did not show significant changes with aging. Scotchbond had the least affect on the fluorescence from the underlying surface and would probably have the least affect on the monitoring of sealed dental caries by laser fluorescence.

Radiographic and Laser Fluorescence Methods Have No Benefits for Detecting Caries in Primary Teeth

Clinical guidelines advise that dentists take radiographs in children to detect caries lesions missed by visual inspection; however, due to the current low caries prevalence in most countries, we hypothesized that the adjunct methods of caries detection would not significantly improve the detection of primary molar lesions in comparison to visual inspection alone. We evaluated the performance of visual inspection, alone or in combination with radiographic and laser fluorescence pen (LFpen) methods, in detecting occlusal and approximal caries lesions in primary molars. Two examiners evaluated children who had sought dental treatment with these diagnostic strategies. The reference standard involved the temporary separation of approximal and operative interventions for occlusal surfaces. The sensitivity, specificity, accuracy and utility of diagnostic strategies were calculated. Simultaneous combined strategies increased sensitivities but decreased specificities. Furthermore, no differences were observed in accuracy and utility, parameters more influenced by caries prevalence. In conclusion, adjunct radiographic and laser fluorescence methods offer no benefits to the detection of caries in primary teeth in comparison to visual inspection alone; hence, present clinical guidelines should be re-evaluated. Copyright (C) 2012 S. Karger AG, Basel

The influence of interdental spacing on the detection of proximal caries lesions in primary teeth

The aim of this study was to investigate the influence of interdental spacing on the performance of proximal caries detection methods in primary molars. In addition, aspects related to temporary tooth separation with orthodontic separators were evaluated. The proximal spaces between the posterior primary teeth (n = 344) of 76 children (4-12 years old) were evaluated before and after temporary separation. Stainless steel strips with different standardized thicknesses were used to measure the presence of biological spacing and the spacing obtained after temporary separation with orthodontic rubber rings. First, the presence of proximal caries lesions was assessed by visual inspection, bitewing radiographs and a pen-type laser fluorescence device (DIAGNOdent pen). Visual inspection after temporary separation with separators was the reference standard method in checking the actual presence of caries. Multilevel analyses were performed considering different outcomes: the performance of the methods in detecting caries lesions and the spacing after temporary separation. The spacing did not influence the performance of the caries detection methods. The maximum spacing obtained with temporary tooth separation was 0.80 mm (mean +/- standard deviation = 0.46 +/- 0.13 mm). The temporary separation was more effective in the upper arch and less effective when an initial biological interdental spacing was present. The biological interdental spacing does not influence the performance of proximal caries detection methods in primary molars, and temporary tooth separation provides spacing narrower than 1.0 mm.

LACK OF A SIGNIFICANT RELATIONSHIP BETWEEN TOENAIL FLUORIDE CONCENTRATIONS AND CARIES PREVALENCE

The relationship between fluoride (F) concentrations in toenails and prevalence of caries using the International Caries Detection and Assessment System (ICDAS-II) criteria was evaluated. Fifty-four children (4-13 years of age) from Rio de Janeiro, Brazil, had their teeth surfaces examined and toenails clipped and analyzed for F. Toenail F concentrations in children presenting ICDAS-II <= 10 or >10 were compared by unpaired t test with Welch correction. Dichotomized data were analyzed by Fisher's exact test. Children presenting ICDAS-II <= 10 (n=23) had 1.85 +/- 1.32 (Mean +/- SD) mu g/g [F]; these values were higher than children having ICDAS-II>10 (n=31), whose toenails had 1.58 +/- 0.78 mu g/g [F], a nonsignificant difference. The sensitivity and specificity of toenail F concentrations in identifying children with ICDAS-II <= 10 were 0.22 and 0.77, respectively. We conclude that children with low caries prevalence tend to have higher toenail F concentrations, but the validity of this biomarker as a diagnostic tool for caries prevalence is low, possibly owing to the fact that the mechanism of action of F on caries control appears to be essentially topical.

Xylitol concentrations in artificial saliva after application of different xylitol dental varnishes

Objective: The present study analyzed xylitol concentrations in artificial saliva over time after application of varnishes containing 10% and 20% xylitol. Material and Methods: Fifteen bovine enamel specimens (8x4 mm) were randomly allocated to 3 groups (n=5/group), according to the type of varnish used: 10% xylitol, 20% xylitol and no xylitol (control). After varnish application (4 mg), specimens were immersed in vials containing 500 mu L of artificial saliva. Saliva samples were collected in different times (1, 8, 12, 16, 24, 48 and 72 h) and xylitol concentrations were analyzed. Data were assessed by two-way repeated-measures ANOVA (p<0.05). Results: Colorimetric analysis was not able to detect xylitol in saliva samples of the control group. Salivary xylitol concentrations were significantly higher up to 8 h after application of the 20% xylitol varnish. Thereafter, the 10% xylitol varnish released larger amounts of that polyol in artificial saliva. Conclusions: Despite the results in short-term, sustained xylitol releases could be obtained when the 10% xylitol varnish was used. These varnishes seem to be viable alternatives to increase salivary xylitol levels, and therefore, should be clinically tested to confirm their effectiveness.

Cost-effectiveness of conventional and modified supervised toothbrushing in preventing caries in permanent molars among 5-year-old children

The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of 18 months. The incidence density (ID) ratio was estimated using Poisson's regression model. The ID was 50% lower among boys in the test group (p = 0.016). The cost of the modified program was US$ 1.79 per capita. The marginal cost-effectiveness ratio among boys was US$ 6.30 per avoided carie. The modified supervised toothbrushing program was shown to be cost-effective in the case of boys.

Age of First Dental Visit and Predictors for Oral Healthcare Utilisation in Preschool Children

Purpose: To assess the age the of the first dental visit and the association of self-perceived oral health, socioeconomic and clinical indicators with healthcare utilisation in Brazilian preschool children. Materials and Methods: An epidemiological survey with 455 5- to 59-month-old children was conducted on National Children's Vaccination Day in Santa Maria, RS, Brazil. Data about age and reasons for the first dental visit, healthcare utilisation, socioeconomic status and self-perceived oral health were collected by means of a parental semi-structured questionnaire. Calibrated examiners evaluated the prevalence of dental caries (WHO) and dental trauma. The assessment of the association used Poisson regression models (prevalence ratio; 95% confidence interval [Cl]). Results: A total of 24.2% (95% Cl: 20.3% to 28.4%) of the study sample had already had a first dental visit. Older children, those with dental caries and dental trauma and whose mothers had a higher level of education were more likely to have gone to the dentist. Children of low socioeconomic status were more likely to have visited public than private healthcare services. The reasons for the first dental visit were associated with clinical indicators of the sample. The distribution of utilisation of the types of oral healthcare services (public or private) varied across the socioeconomic groups. Non-white children with dental caries and dental trauma tended to visit a dentist only for treatment reasons. Conclusion: Socioeconomic and clinical indicators are associated with the use of dental services, indicating the need for strategies to promote public health and reorientation of services that facilitate dental access for preschool children.

Performance of fluorescence-based and conventional methods of occlusal caries detection in primary molars - an in vitro study

International Journal of Paediatric Dentistry 2012; 22: 459466 Aim. This in vitro study aimed to test the performance of fluorescence-based methods in detecting occlusal caries lesions in primary molars compared to conventional methods. Design. Two examiners assessed 113 sites on 77 occlusal surfaces of primary molars using three fluorescence devices: DIAGNOdent (LF), DIAGNOdent pen (LFpen), and fluorescence camera (VistaProof-FC). Visual inspection (ICDAS) and radiographic methods were also evaluated. One examiner repeated the evaluations after one month. As reference standard method, the lesion depth was determined after sectioning and evaluation in stereomicroscope. The area under the ROC curve (Az), sensitivity, specificity, and accuracy of the methods were calculated at enamel (D1) and dentine caries (D3) lesions thresholds. The intra and interexaminer reproducibility were calculated using the intraclass correlation coefficient (ICC) and kappa statistics. Results. At D1, visual inspection presented higher sensitivities (0.970.99) but lower specificities (0.180.25). At D3, all the methods demonstrated similar performance (Az values around 0.90). Visual and radiographic methods showed a slightly higher specificity (values higher than 0.96) than the fluorescence based ones (values around 0.88). In general, all methods presented high reproducibility (ICC higher than 0.79). Conclusions. Although fluorescence-based and conventional methods present similar performance in detecting occlusal caries lesions in primary teeth, visual inspection alone seems to be sufficient to be used in clinical practice.

Influence of moisture and plaque on the performance of a laser fluorescence device in detecting caries lesions in primary teeth

The aim of this study was to evaluate the influence of dental plaque and moisture on performance of a laser fluorescence device in detecting occlusal and proximal caries lesions in primary teeth. Fifty-five occlusal and 58 proximal sites on primary molars were evaluated using a DIAGNOdent pen (LFpen) device. For the drying time study, the evaluations were performed in: (I) moist teeth; (II) teeth dried for 3 s, or (III) dried for 15 s. For the plaque study, the evaluations were done in sites: (I) without plaque; (II) with plaque, and (III) after cleaning. Evaluation of the teeth sections in stereomicroscope was the reference standard method. LF pen values, sensitivity, specificity, and accuracy were compared. The values obtained after 15 s of drying were higher than those obtained with moist teeth or dried for 3 s at both occlusal and proximal surfaces. However, there was no change in the performance in detecting caries lesions. With regard to the presence of plaque, there was no significant change in the readings of the device, but specificity was decreased in occlusal surfaces with plaque. At proximal surfaces, however, no significant differences were observed. In conclusion, the moisture conditions do not influence significantly the performance of the LFpen, but the presence of plaque can affect its performance in detecting occlusal caries lesions in primary teeth.

Assessment of cavitated and active non-cavitated caries lesions in 3-to 4-year-old preschool children: a field study

Background. The prevalence of early childhood caries (ECC) is high in developing countries; thus, sensitive methods for the early diagnosis of ECC are of prime importance to implement the appropriate preventive measures. Aim. To investigate the effects of the addition of early caries lesions (ECL) into WHO threshold caries detection methods on the prevalence of caries in primary teeth and the epidemiological profile of the studied population. Design. In total, 351 3-to 4-year-old preschoolers participated in this cross-sectional study. Clinical exams were conducted by one calibrated examiner using WHO and WHO + ECL criteria. During the exams, a mirror, a ball-ended probe, gauze, and an artificial light were used. The data were analysed by Wilcoxon and Mc-Nemar's tests (a = 0.05). Results. Good intra-examiner Kappa values at tooth /surface levels were obtained for WHO and WHO + ECL criteria (0.93 /0.87 and 0.75 /0.78, respectively). The dmfs scores were significantly higher (P < 0.05) when WHO + ECL criteria were used. ECLs were the predominant caries lesions in the majority of teeth. Conclusions. The results strongly suggest that the WHO + ECL diagnosis method could be used to identify ECL in young children under field conditions, increasing the prevalence and classification of caries activity and providing valuable information for the early establishment of preventive measures.