Oral health in transition: the case of Indigenous peoples from Brazil

The objective of this paper is to summarise epidemiological information about the distribution of dental caries among Indigenous peoples in Brazil. The authors also present a case study of a specific group of Xavante Indians, one of the most numerous of Brazil`s Indigenous peoples, describing how their oral health has deteriorated over recent decades, and showing how an oral health programme is attempting to reverse the present trend of increase in caries. The programme at Etenheritipa Xavante village incorporated three principal components: educational, preventive, and clinical. From the beginning, the programme included epidemiological record keeping for monitoring the level of caries in the population. Transversal studies of the condition of oral health among the Xavante of Etenheritipa were undertaken in 1999, 2004, and 2007. In the period from 2004 to 2007 the DMFS values in the 11-15 age cohort had a significant reduction in caries experience. The mean DMFS score fell from 4.95 in 2004 to 2.39 in 2007 (p<0.01). An increase in the percent of individuals who were free from caries was also noted: in 1999, 20% of adolescents 11-15 had no caries; in 2007, the proportion had risen to 47%. The Xavante case is a prime example of the transition in oral health that is taking place among the Indigenous peoples of the Americas, and it highlights the importance of oral health promotion through preventive measures such as access to fluoridation and basic care in reducing the inequality between Indians and non-Indians.

Impact of socioeconomic and clinical factors on child oral health-related quality of life (COHRQoL)

Child oral health-related quality of life (COHRQoL) has been increasingly assessed; however, few studies appraised the influence of socioeconomic status on COHRQoL in developing countries. This study assessed the relationship of COHRQoL with socioeconomic backgrounds and clinical factors. This study followed a cross-sectional design, with a multistage random sample of 792 schoolchildren aged 12 years, representative of Santa Maria, a southern city in Brazil. Participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ(11-14)), their parents or guardians answered questions on socioeconomic status, and a dental examination provided information on the prevalence of caries, dental trauma and occlusion. The assessment of association used hierarchically adjusted Poisson regression models. Higher impacts on COHRQoL were observed for children presenting with untreated dental caries (RR 1.20; 95% CI 1.07-1.35) and maxillary overjet (RR 1.19; 95% CI 1.02-1.40). Socioeconomic factors also associated with COHRQoL; poorer scores were reported by children whose mothers have not completed primary education (RR 1.30; 95% CI 1.17-1.44) and those with lower household income (RR 1.13; 95% CI 1.02-1.26). Poor socioeconomic standings and poor dental status have a negative impact on COHRQoL; reducing health inequalities may demand dental programmes and policies targeting deprived population.

Scientific output trends in oral health in Brazil

Objective. To describe dental research trends in Brazil (especially population-based oral health) in the early Twenty-first Century. Methods. The abstracts of studies presented at meetings of the Brazilian Society for Dental Medicine Research (Sociedade Brasileira de Pesquisa Odontologica) from 2001-2006 were assessed in terms of methodological design (aggregate or population-based and individual-based studies, observational and intervention studies, cross-sectional and longitudinal studies); general type (literature review, studies with human subjects, and laboratory studies); and classification into one of the 19 specialty categories recognized by the Brazilian Federal Dentistry Council. Of the 10 406 abstracts presented in this period, 5 203 (50%) were reviewed. Results. Concerning methodological design, 87.5% of the abstracts referred to individual-based studies, whereas 12.5% were of aggregate studies. Concerning the general category, 41.7% referred to studies with human subjects. The remaining abstracts (58.3%) described in vitro (31.1%) or in vivo (23.6%) laboratory research and literature reviews (3.6%). Concerning the Council`s specialty categories, only five had a frequency higher than 10.0%: esthetic dentistry, periodontics, endodontics, pediatric dentistry, and population-based oral health. Conclusions. Brazil`s scientific output in the field of oral health for the period 2001-2006 was balanced, with increasing interest in the area of population-based oral health.

Self-rated oral health and associated factors in Brazilian elders

Objective: Self-rating provides a simple direct way of capturing perceptions of health. The objective of this study was to estimate the prevalence and associated factors of poor self-rated oral health among elders. Methods: National data from a cross-sectional population-based study with a multistage random sample of 4786 Brazilian older adults (aged 65-74) in 250 towns were analysed. Data collection included oral examinations (WHO 1997) and struct-ured interviews at elderly households. The outcome was measured by a single five-point-response-scale question dichotomized into `poor` (fair/poor/very poor) and `good` (good/very good) self-rated oral health. Data analyses used Poisson regression models stratified by sex. Results: The prevalence of poor self-rated oral health was 46.6% (95% CI: 45.2-48%) in the whole sample, 50.3% (48-52.5) in men and 44.2% (42.4-46) in women. Higher prevalence ratios (PR) were found in elders reporting unfavourable dental appearance (PR = 2.31; 95% CI: 2.02-2.65), poor chewing ability (PR = 1.64; CI: 1.48-1.8) and dental pain (PR = 1.44; CI: 1.04-1.23) in adjusted analysis. Poor self-perception was also associated with being men, black, unfavourable socioeconomic circumstances, unfavourable clinical oral health and with not using or needing a dental prosthesis. Conclusion: Assessment and understanding of self-rated oral health should take into account social factors, subjective and clinical oral symptoms.

Hard tissue formation adjacent to implants of various size and configuration immediately placed into extraction sockets: an experimental study in dogs

Objectives To evaluate the influence of implant size and configuration on osseointegration in implants immediately placed into extraction sockets. Material and methods Implants were installed immediately into extraction sockets in the mandibles of six Labrador dogs. In the control sites, cylindrical transmucosal implants (3.3 mm diameter) were installed, while in the test sites, larger and conical (root formed, 5 mm diameter) implants were installed. After 4 months of healing, the resorptive patterns of the alveolar crest were evaluated histomorphometrically. Results With one exception, all implants were integrated in mineralized bone, mainly composed of mature lamellar bone. The alveolar crest underwent resorption at the control as well as at the test implants. This resorption was more pronounced at the buccal aspects and significantly greater at the test (2.7 +/- 0.4 mm) than at the control implants (1.5 +/- 0.6 mm). However, the control implants were associated with residual defects that were deeper at the lingual than at the buccal aspects, while these defects were virtually absent at test implants. Conclusions The installment of root formed wide implants immediately into extraction sockets will not prevent the resorption of the alveolar crest. In contrast, this resorption is more marked both at the buccal and lingual aspects of root formed wide than at standard cylindrical implants. To cite this article:Caneva M, Salata LA, de Souza SS, Bressan E, Botticelli D, Lang NP. Hard tissue formation adjacent to implants of various size and configuration immediately placed into extraction sockets: an experimental study in dogs.Clin. Oral Impl. Res. 21, 2010; 885-895.doi: 10.1111/j.1600-0501.2010.01931.x.

Prevalence and severity of dental caries in schoolchildren of Porto, Portugal

Objectives: To measure the prevalence and severity of dental caries in adolescents of the city of Porto, Portugal, and to assess socioeconomic and behavioural covariates of dental caries experience. Methods: A sample of 700 thirteen-year-old schoolchildren was examined. Results from the dental examination were linked to anthropometric information and to data supplied by two structured questionnaires assessing nutritional factors, socio-demographic characteristics and behaviour related to health promotion. Dental caries was measured using the DMFT index, and two dichotomous outcomes, one assessing the prevalence of dental caries (DMFT>0); the other assessing the prevalence of a high level of dental caries (DMFT=4). Results: Consuming soft drinks derived from cola (irrespective of sugared or diet) two or more times per week, attending a public school, being female and having parents with low educational attainment were identified as risk factors both for having dental caries and for having a high level of dental caries. Conclusion: Caries levels were positively associated with frequency of intake of sweetened foods and drinks.

Oral colonization by Candida species in AIDS pediatric patients

The aim of this study was to assess the prevalence of factors associated with oral colonization by Candida spp. in pediatric patients with AIDS. The sample comprised of 117 children. Clinical status, medicines in use, and laboratory findings were obtained from hospital records; sociodemographic data were given by relatives. A dental examination assessed the prevalence of dental caries. The prevalence of oral colonization by Candida was 62%. Only seven children presented clinical manifestation of oral candidosis despite their high viral load index and low-for-age CD4 count. Candida colonization was directly associated with frequent use of antibiotics (prevalence ratio [PR] = 1.44), sulfa drugs (PR = 1.23), alteration in the oral mucosa (PR = 1.55), and untreated dental caries (PR = 1.93). It was inversely associated with the use of antiretroviral therapies (PR = 0.65). Candida albicans was the most frequently detected species (80%); phenotypic tests did not detect C. dubliniensis strains. This study observed a low prevalence of Candida-related oral lesions in these patients, which is compatible with the hypothesis that antiretroviral medicines may have contributed to reducing oral manifestations from Candida infection. The high prevalence of Candida colonization in HIV+/AIDS children with untreated dental caries reinforces the importance of oral health care in interdisciplinary health units that assist these patients.

Barriers to interventions aimed at promoting the health of health care workers in Brazil

Objective. To search the literature for circumstances that impede injury and disease prevention and other activities intended to improve the health of the health care worker. Methods. The SciELO database was searched for articles published in 1967-2008. This was supplemented by a PubMed search for the period 1950-2008. The following key words were used to identify articles in English, Portuguese, and Spanish: work, health personnel, occupational, risks, diseases, ergonomics, work ability, quality of life, organization, accidents, work conditions, intervention, and administration. Articles on injury and disease prevention and occupational health in a health care setting in Latin America were selected, along with articles focused on health promotion in the health sector. Results. The following shortcomings were identified: activities lacked a sound theoretical foundation and were not integrated with the health services management; a failure to evaluate the effectiveness of the activity; health surveillance focused solely on a specific disease or injury; management not committed to the proposed activity; miscommunication; inability of workers to participate, or control the work environment; and, programs or efforts that were limited to changing the workers` behaviors. Conclusions. The literature shows that all the barriers identified by this study affect both the health care workers` health as well as their productivity.