Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006

NORO, Luiz Roberto Augusto et al. Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006, Cadernos de Saúde Pública, Rio de Janeiro, v. 25, n. 4, p. 783-790, abr. 2009.

Acesso aos serviços odontológicos e incidência de cárie em adolescentes e fatores de risco em município do Nordeste Brasileiro, 2006

The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Ceará and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Ceará . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Ceará, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health

Avaliação in vitro da atividade antimicrobiana de diferentes soluções a base de hidróxido de cálcio

The science of Dentistry wishes obtains the ideal solution for the dental plaque chemical control. This research evaluated antimicrobial action capacity in calcium hydroxide and tergentol various solutions starting for the CHD 20, a root canals irrigating solution with a reason of 80% calcium hydroxide saturated solution and 20% tergentol detergent with the aim of evaluate this drug mouth rinse indication with prevention or combat objective for dental caries and periodontal diseases. Antibiogram disks and biofilm tests were accomplished for the microorganisms: Streptococcus mutans, Streptococcus sanguis, Streptococcus sobrinus and Lactobacillus casei. Different reasons of detergent for the calcium hydroxide saturated solution, tergentol and distillated water solution, 0,12% clorhexydine digluconate solution was positive control and distillated water was negative control. The results showed better performance of clorhexydine in relation to calcium hydroxide directing to not accept this (CHD20) as mouth rinse solution

Avaliação clínica e microbiológica das condições de saúde oral dos receptores de transplante renal do Hospital Universitário Onofre Lopes, Natal RN

Introduction: The chronic immunosuppression promotes the development of changes in the oral cavity of the kidney transplant recipients (KTR), however with the exception of gingival overgrowth, little is known regarding the prevalence of oral lesions in this population. Objective: To evaluate the prevalence of clinical and microbiological conditions of the oral cavity of the recipients of kidney transplantation and the associated factors. Methods: This was a cross-sectional study which examined 96 clinical KTR and experimental where collected saliva stimulated them to identify Candida sp. Data collection consisted of evaluation stomatologic, socio-demographic, clinical aspects of transplantation, condition of oral hygiene and dental caries, yonder to questions about knowledge of oral alteration after transplantation. Results: Of the total, 66.7% of KTR had some type of oral manifestation. The most common was saburral tongue, followed by gingival overgrowth, with both oral manifestations related to gender and concomitant use of cyclosporine and nifedipine (p <0.05). Tacrolimus showed a protective effect for gingival overgrowth (OR = 0.13). The oral hygiene was associated with saburral tongue(p = 0.03) and severity of gingival overgrowth (p = 0.0001). Oral candidiasis was diagnosed in 17.7% of patients and Candida albicans was isolated most frequently in the saliva of RTR with a colonization of 58.3%. The average DMF-T increased with age. The method of oral hygiene was most used brush and toothpaste to 61.5%. Changes in the oral cavity was seen in 54.2% of KTR, citing as the main growth and gingival ulcers. Instructions for oral hygiene after transplantation were neglected for 61.5% of RTR. Dry mouth and halitosis were reported in 30.2% and 36.5% respectively. Conclusions: More the half of the KTR had at least one injury of the mouth, the immunosuppressive drugs and oral hygiene are associated with these alterations. Prospective cohort studies are needed to elucidate the relationship between oral manifestations and levels of drug and risk of oral manifestations occur over time. The kidney transplant recipients showed to be aware of oral alterations occurred after transplantation and uninformed about the oral hygiene instructions. With regard to hygiene, the incidence of caries was considered high, conditions of risk were identified and improvements in primary attention should be encouraged and reflected in the monitoring of renal transplant

Assistência odontológica diferenciada para crianças de 0 a 3 anos: avaliação de impacto no Serviço Público Municipal em Natal-RN

In Brazil, 0-5 years old children just have an oral health care system since 1990 s. Innumerable experiences of implantation of the attendance to the babies in the cities had appeared throughout the years, but it hasn´t been evaluated the comparative effect between children displayed and not displayed to the program. In this regard, the main of this research was describe the Early Childhood Oral Health Care in public health service in Natal, Rio Grande do Norte, Brazil and evaluate the impact of this specific oral health care for babies by comparison of indicators between exposed and non-exposed children. It was created an experimental group, formed by children covered by program which was paired, based on sex, age and socioeconomic status, with a control group, formed by uncovered children. After filling ethical application, the parents of children were questioned about some risk factors to dental caries and, in sequence, it was accomplish an oral examination in the child. It was verified the Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), dmf-s and verification of caries activity. The sample was 40 children in each group. The results showed, for VPI, a difference of 7 percentile points for the experimental group, however this difference had no statistical significance, obtained by Student s t test (p=0.314). In relation to GBI, the control group showed a low mean (0.8%) comparing with experimental group (2.77%) and this difference was statistically significant (p=0.003). The results for dmf-s and evaluation of caries activity showed no statistical difference between groups. Among the probable reasons for absence of impact of intervention, could be included: (a) the practice model was the same in two groups, or the difference was very weak and (b) the oral health care has intrinsic limitations for to impact on oral health in low income populations

Programa de odontologia para bebês: uma avaliação quantitativa e qualitativa

The objective of this study was to evaluate a baby dentistry program which has been in the city of Natal for five years. The research was based on two analysis: a quantitative one, which tried to check caries prevalence in 52 children supported by the program and a qualitative one, which, through interviews carried out with the mothers, using the focus group technique, tried to realize the effect of the program their attitudes related to the care of their children´s oral health. For the quantitative analyses of caries prevalence there was the use of def-s and knutson rates and the values obtained were shown in a descritive and analytical way.The results showed that 4.2% of babies ranging 24 to 36 months old presented carie disease. Children from 36 to 48 months old and above 48 months old presented 18.2% and 16.7% carie prevalence respectively.The def-s averages found in ages 24 to 36, 36 to 48 and 48 to 60 months old were 0.08; 0.40 and 1.16 respectively, considered as being equally low, going along with Knutson rates. The qualitative analyses showed a high level of the mothers` satisfaction, considering the access,practitioner-patient relationship and opportunity to keep the oral health. Children supported by the program showed a low carie prevalence and the program turned out to be effective under the mothers` point of view

Avaliação de lesões brancas de cáries: um estudo de prognóstico

Objective: The aim of the present study is to assess the current situation of white enamel lesions on vestibular surfaces of permanent upper incisors, diagnosed 6 years ago, without clinical intervention. Methods: A prospective study reassessed 53 students of both sexes, aged between 13 and 18 years old, all attending the public school system in Natal, Brazil. Data collection was performed by duly calibrated examiners, and a clinical chart consisting of demographic data on dental caries, oral hygiene, and gingival condition was prepared. A tactile-visual examination was conducted using a clinical mirror and periodontal probe. Data compilation and analysis were carried out using a SPSS software. In this analysis the chi-squared test was used for qualitative independent variables. To identify the net effect of treatment, multiple logistic analysis with forward stepwise model selection was performed. Results: The final sample was composed of 106 lesions in the 53 individuals, with mean age of 15.02 years, visible plaque index (VPI) of 23.34%, and gingival blood indices (GBI) of 25.92%. A statistically significant relationship (p = 0.003) was found between initial DMFS and prognosis of white enamel lesion. Conclusions: We observed that past caries experience and dental plaque were the main predictive factors for negative lesion outcomes, demonstrating the need for oral hygiene control through continuing preventive measures

Condições de saúde bucal e capacidade funcional em idosos

Population aging is one of the greatest challenges to contemporary public health and, in this perspective, the functional capacity emerges as an important feature in geriatric assessment. The oral health of elderly, in turn, deserves special attention because, historically, in the dental services, this population group was not considered a priority for attention, which is verified by high rates of edentulism found even among these individuals. The present study proposes to examine the relationship between oral health status and functional capacity in an elderly population. To this end, intra-oral epidemiological examination was performed to assess the degree of dental caries, periodontal status, use and need of prosthesis and the presence of lesions. Functional capacity was assessed by the Independence in Activities of Daily Living, which considers the independence or not in the performance of six self-care functions. Socioeconomic and demographic characteristics and general health status were also investigated, in view of the possibility of intervention of these variables in the investigated relation. An factor analysis of the principal components was conducted which resulted four indicators of oral health conditions, representative of the population studied. 441 seniors were enrolled with mean age of 71.7 (± 8.7) years, the majority being female (68%). Functional capacity was dichotomized into completely independent individuals (89.6%) and dependent on at least one of the functions considered (10.4%). There was an association between functional capacity and the indicators related to the presence of many teeth and dental caries, and to that associated with the use and need of prostheses. These associations in turn, lost statistical significance when adjusting for confounding variables, combined in separate models for each indicator. Some of these variables, however, remained associated with functional capacity. It is considered that the study of oral health status of elderly, associeted with the search for an association with functional capacity is important in the construction of indicators necessary for planning preventive and therapeutic interventions that reduce the risk for loss of ability in daily physical functions and their consequences, as the harm in the oral self-care

Efeito in vitro da terapia fotodinâmica sobre bactérias orais em suspensão e na formação de biofilme : ensaio com azul de metileno e toluidina ativados por luz halógena

Photodynamic therapy (PDT) has been proposed as an alternative method for the treatment of biofilm-dependent oral diseases like dental caries. This therapy consists of simultaneous action of a visible light (L) and a photosensitizer (FS) in the presence of oxygen, which leads to production of different reactive oxygen species that can interact with the bacterial cell components, and promote cell death. This study aims to evaluate the antimicrobial action of PDT on oral bacteria in suspension, as well as the formation of mono and multi-species biofilms, in vitro, from a standard strain of Streptococcus mutans (ATCC 25175) and saliva samples, respectively. The dye methylene blue (MB) and toluidine blue (TB) were used at a concentration of 100 mg/ L and activated by halogen light (600 to 750 nm) from a modified hand held photopolymerizer (Ultralux ®, Dabi Atlante, Ribeirão Preto , São Paulo, Brazil.). Planktonic cultures were prepared and submitted to different experimental conditions: 1. PDT using TB 2. PDT using MB, 3. L+ FS- , 4. TB + L - ; 5. MB+ L-; 6. L- FS- (negative control) and 7. administration of 0.12% chlorhexidine digluconate (positive control) (Periogard ®, Colgate-Palmolive Company, New York, USA). The immediate and mediated action of PDT on bacterial suspensions, as well as its effect on biofilm formation were observed from the number of colony-forming units per milliliter (CFU/mL) and measures optical density (OD). The data were statistically analyzed using the Kruskal-Wallis and Mann-Whitney test for the significance level of 5%. According to the results, the PDT showed no antibacterial action on suspensions of S. mutans, regardless of the dye used. PDT with MB activated by halogen light was able to reduce 86.6% CFU/mL multi-species planktonic cultures, however, this reduction was not significant (p > 0.05). PDT showed antibacterial effect, mediate on multi-species planktonic cultures with TB (p < 0.001) and MB (p < 0.001), activated by halogen light. PDT was able to prevent the formation of multispecies biofilm, through the activation of TB by halogen light (p = 0.01). We conclude that activation of the dye toluidine blue and methylene blue, by halogen light (PDT) showed antimicrobial activity, compared to multi-species planktonic cultures prepared from saliva samples

Eficácia do cimento de ionômero de vidro como selante oclusal sobre a paralisação de lesões cariosas em dentina

Dental caries consists in a multifactorial and dynamic process. The knowledge of the ionic interactions among dental tissues and dental biofilm make possible its understanding as a process that can be stopped. Recently, the use of sealants have lost its function as preventive agent and passed to be argued as a possible therapeutical agent. This happens by hindering the substratum flow to the lesion inner and, therefore, controls the advance of the process. This study aimed to evaluate glass ionomer cement as a not invasive technique of treatment in occlusal caries without clinical cavitation, but with dentinal involvement. The research was accomplished using a controlled clinical trial with two groups (experimental and control) in 38 subjects (8-18 years) with 51 molars. The teeth of the experimental group were sealed with glass ionomer cement (Vidrion-R, S.S.White, Juiz de Fora, Brazil) and the molars control did not suffer intervention. The experimental group was followed by a year and the control by 8 months due the progression of the carious injury. Both groups were reevaluated to each 4 months with the use of clinical, radiographic and laser fluorescence (DIAGNOdent®) examination. The analysis of the clinical evaluation did not observe a significant difference between experimental and control groups. However, analysis with radiographic and laser fluorescence (DIAGNOdent®) examination observed a significant difference (p> 0,05) between groups, demonstrating a wors condition to the group without intervention. The results suggest that glass ionomer cement as sealant can be efficient to paralyze dentinal caries without clinical cavitation

Impacto da cárie precoce severa na infância na qualidade de vida relacionada à saúde bucal de pré-escolares sob privação social

Early childhood caries, especially in its severe form, which is characterized by an acute and aggressive nature, can have negative impacts on thequality of life of a child, due to effects such as difficulty in chewing, decreased appetite, weight loss, insomnia, changes in behavior and a decreased performance in school, among others. Moreover, the quality of life of the child`s family can also be affected, as the pain and discomfort caused by this type of caries result in loss of working days of parents, spending on dental treatments, changes in sleep patterns and stress. The aim of this study was to evaluate the impact of severe early childhood caries in the Oral Health-Related Quality of Life (OHRQoL) of public daycares`s preschool children through the Escala de Impacto da Saúde Bucal na Primeira Infância, a Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A single calibrated examiner (kappa=1.0) evaluated, through the dmfs index, the oral health of 116 children aged between 3 and 5, which were included in one of three study groups: "caries-free", "not-severe early childhood caries" and "severe early childhood caries". The parents responded to ECOHIS, to assess their perception regarding the OHRQoL of their children, and a questionnaire on socioeconomic conditions. The OHRQoL was measured through the total scores and domains of ECOHIS. Descriptive analysis, Mann-Whitney test, Kruskal-Wallis test, chi-square test and Poisson multiple regression with robust variance were used. Among the children observed, 38.8% were caries-free, 27.6% showed not-severe early childhood caries and 33.6% showed severe early childhood caries. Regarding the total score of ECOHIS, severe early childhood caries had a greater negative impact on OHRQoL, compared to caries-free and not-severe early childhood caries groups (p <0.001). Regarding the child subscale, there was significant difference between the "severe early childhood caries" group and the other groups in all domains, except for theone of self-image / social interaction. In the family subscale domains, there was statistical significance between the severe early childhood caries and the caries-free groups in all domains (p <0.001), whereas between the "severe early childhood caries and not-severe early childhood caries groups there was a statistically significant difference only in the domain of parental anguish (p <0.001). Multivariate analysis showed that early childhood caries and the parent`s age were significantly associated to OHRQoL (p <0.05), independently of the other variables in the model. The presence of severe early childhood caries resulted in greater negative impact on OHRQoL (AdjPR= 6.016; 95%CI = 3.12 11.56; p<0.001), while older parents reported better OHRQoL (AdjPR = 0.603; 95%CI = 0.428 - 0.850; p = 0.004). The presence of severe early childhood caries had a negative impact on OHRQoL of preschool children and their families.

Fatores socioeconômicos contextuais associados à condição bucal de adolescentes no Brasil

Many surveys are conducted comparing oral health conditions with individual variables, such as socioeconomic and demographic factors. However, in the same way that individuals differ among themselves, the groups also have their own characteristics and the effects of this differentiation must be researched. Brazil, despite being one of the major economic powers of the world and shows an improvement in the average value of its health indicators, is also one of the most unequal and remains among the countries with the greatest health inequities. The purpose of this study was to investigate the importance of social determinants on the contextual level oral health among Brazilian adolescents, population not much researched by the literature. The research was made using an ecological approach in order to identify possible inequalities between cities and capitals. Using data from SBBrasil 2010 it was evaluated less common outcomes (loss of first molar, dental care index and T-Health) which provide information on the degree of morbidity of caries and health level of dental tissues, in addition to analyze the related services. The association of these oral health indicators with socioeconomic factors such as income, employment, education and inequality, collected from Census 2010, was analyzed by simple and multiple linear regressions. The study included the 27 state capitals and four clusters representing the municipalities of the country. It was possible to see better access to services in locations with better income distribution. However, the strong association of contextual factors related to poverty, low levels of education and poor housing and jobs with poorer levels of oral health in adolescents seems to overshadow the effects of income inequalities on dental caries in the country. In some locations, particularly within the North and Northeast, whichever one keeps dentistry mutilating, whose effects are already noticeable in its adolescent population. Access to restorative services in Brazil remains limited and unequal. The results of this study highlight the inequities in oral health in the country and show the need of the inclusion of new perspectives on the traditional approach of Preventive Dentistry and education models in Dentistry. Tackling health inequalities in oral health in the country requires the cooperation of various actors involved in the process and the inclusion of oral health in the context of overall health. The social determinants approach, as well as evaluating the distribution of oral diseases in the country and its inclusion in the context of overall health, should guide the implementation of programs and oral health practices in order to contribute to the reduction of inequalities

Influência do pré-aquecimento na adaptação marginal de dois materiais seladores de fóssulas e fissuras, analisada através de tomografia de coerência ótica

Among the non-invasive techniques employed in the prevention of caries highlights the sealing pits and fissures which is a conservative maneuver, in order to obliterate them to protect them from attack acid bacteria. Influenced by the studies of pre-heating composite resin, which has experienced great improvement in some of their physical properties, this study aimed to evaluate in vitro the superficial and internal marginal adaptation of different materials and sealants in pre-heating or not. A total of 40 extracted human third molars (n=10) that had their occlusal surfaces prepared to receive sealant. We tested two types of sealing materials: resin sealant (Fluoroshield) and low-viscosity resin (Permaflo), where 50% of previously received heated material and the other half received sealant material at room temperature. All samples were subjected to thermal cycling and pH, simulating a cariogenic oral environment, and later were analyzed appliance OCT (optical coherence tomography). The images obtained alterations were recorded and analyzed statistically. Change was considered as the emergence of bubbles, gaps and cracks in the sealant. Comparisons of the same material, assessing the fact that it is not sealed or preheated material, as well as comparisons between different materials subjected to the same temperature were carried out. The nonparametric Tukey test was used (p < 0,05). The results showed that there was statistically significant difference between both the materials analyzed, as between the situations in which the sealant material was submitted (preheated or not). On the issue of marginal adaptation and internal surface, seen through Optical coherence tomography, may suggest that there is a difference between the use of one type or another of the sealing material analyzed, with superiority attributed to resin Permaflo compared to sealant Fluroshield, telling is the same for the different techniques used

Toothache and social and economic conditions among adolescents in Northeastern Brazil

O objetivo deste estudo foi relacionar dor de dente com condição socioeconômica, acesso aos serviços de saúde bucal e estilo de vida em adolescentes do município de Sobral, Ceará, desenvolvido com delineamento transversal analítico, com amostra composta por 688 indivíduos. A prevalência de dor de dente no grupo pesquisado foi de 31,8%. Para avaliar a relação entre as variáveis independentes e a dor de dente, realizou-se teste de associação pelo qui-quadrado, estimando-se a razão de prevalências por meio da regressão de Poisson. Os fatores que mais demonstraram relação com a dor de dente foram severidade da cárie, motivo do atendimento odontológico relacionado com urgência, frequência ao dentista e recebimento de escova na escola. Observou-se que a alta prevalência de dor de dente em adolescentes está diretamente relacionada às condições de acesso, assim como às características das ações desenvolvidas pelos serviços de saúde. Assim como há necessidade da implantação de serviços vinculados à promoção de saúde, pautados pela equidade e integralidade, é necessária a implantação de serviços de urgência que não simplesmente intervenham na dor de forma mutiladora, mas a encarem como mecanismo de estímulo ao desenvolvimento de procedimentos de prevenção das doenças bucais.

Padrão epidemiológico das oclusopatias muito graves em adolescentes brasileiros

OBJECTIVE: To describe the distribution of malocclusion and its associated factors in Brazilian adolescents. METHODS: Data from 7,328 subjects aged 12 years and 5,445 adolescents aged 15-19 years were analyzed. The adolescents took part in the Brazilian Oral Health Survey (SBBrasil 2010). The outcome was severe malocclusion according to the dental aesthetic index. The independent variables were sex, skin color, monthly household income, possessions, number of individuals in the household, untreated dental caries, missing teeth and dental appointments or lack thereof, frequency, and reason. Logistical regression analysis was carried out, considering the complex sampling cluster design, based on a hierarchical model. RESULTS: The prevalence of severe malocclusion was 6.5% and 9.1% in the 12-year-olds and the 15-19-year-olds, respectively. After adjustment, those with lighter- skinned black or black skin were 1.59 (95%CI 1.08;2.34) times more likely to present the outcome compared with those with white skin. The loss of one or more first molars increased 2.66 (95%CI 1.26;5.63) the chance to present severe malocclusion by the age of 12. Adolescents aged 15-19 whose household income was below R$ 1,500.00 (OR 2.69 [95%CI 1.62; 4.47]) and those who had seen a dentist for treatment (OR 2.59 [95%CI 2.55;4.34]) had the greatest chance of having severe malocclusion compared with those with higher incomes and those who visited the dentist for prevention.