ABSTRACT Objective: To investigate exclusive breastfeeding (EBF) intention and associated variables among women in the third trimester of pregnancy. Methods: The data were collected with a questionnaire for the pregnant women (n=653), from December/2018 to November/2019. They answered the Infant Feeding Intentions (IFI) scale, translated and adapted to Brazilian Portuguese, and a questionnaire on sociodemographic, biological, family, pregnancy, breastfeeding, health care, and habits variables. Descriptive statistics and multiple logistic regression analyses were performed with a 5% significance level, following a multilevel hierarchical model that estimated the association between the dependent and independent variables. The outcome EBF intention measured by the IFI score was dichotomized by the median (<16 or =16). Results: Mean±standard deviation score for the IFI scale was 14.4±2.6 (score 0: very strong intention to not breastfeed at all; score 16: very strong EBF intention up to six months). The results from the regression analysis showed that pregnant women who had no intention to bottle feed (OR=4.33; 95%CI 2.79-6.72) or did not know (OR=1.85; 95%CI 1.21–2.82), those who planned the pregnancy (OR=1.52; 95%CI 1.09–2.12), those who believed they would have help to care for the baby (OR=3.60; 95%CI 1.51–8.56) or did not know (OR=3.97; 95%CI 1.26–12.51), and those who reported knowing the World Health Organization recommendations on breastfeeding (OR=1.73; 95%CI 1.13–2.64) were more likely to show a very strong EBF intention. Conclusions: Pregnant women in the third trimester of pregnancy presented a strong EBF intention. The higher EBF intention score was significantly associated with the structural, setting, and individual determinants.

RESUMO Objetivo: Investigar a intenção materna de amamentar exclusivamente (IMA) e variáveis associadas entre as mulheres no terceiro trimestre de gravidez. Métodos: A coleta de dados foi realizada por meio de entrevista e questionário semiestruturado e autoadministrado, entre dezembro/2018 e novembro/2019. As gestantes (n=653) responderam à escala Infant Feeding Intentions (IFI) testada, traduzida e adaptada para o português do Brasil e ao questionário contendo perguntas sobre variáveis sociodemográficas, biológicas e familiares, bem como relacionadas à gestação, ao aleitamento materno, à assistência à saúde e a hábitos. Foram realizadas análises estatísticas descritivas e de regressão logística múltipla hierarquizada, com nível de significância de 5%, para estimar a associação entre as variáveis independentes e o desfecho. A IMA, medida pela escala IFI, foi dicotomizada pela mediana (<16 ou =16). Resultados: A pontuação média±desvio padrão para a escala IFI foi de 14,4±2,6. Os resultados da análise de regressão mostraram que as gestantes que não tinham intenção de oferecer mamadeira (OR=4,33; IC95% 2,79-6,72) ou não sabiam (OR=1,85; IC95% 1,21–2,82), que planejaram a gestação (OR=1,52; IC95% 1,09–2,12), aquelas que acreditavam que teriam ajuda nos cuidados com o bebê (OR=3,60; IC95% 1,51–8,56) ou que não sabiam (OR=3,97; IC95% 1,26–12,51), bem como aquelas que relataram conhecer as recomendações da Organização Mundial de Saúde sobre amamentação (OR=1,73; IC95% 1.13–2.64) tinham mais chances de mostrar uma IMA muito forte. Conclusões: As gestantes no terceiro trimestre de gestação apresentaram forte IMA. A maior IMA esteve significativamente associada aos determinantes estruturais, contextuais e individuais.

Abstract Objective: This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015. Methods: This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis. Results: Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged > 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death. Conclusion: Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries.

Resumo Objetivo: Esse estudo avaliou a mortalidade materna (MM) e fatores relacionados em um município de grande porte da região sudeste do Brasil (Campinas, São Paulo) no período de 2000-2015. Métodos: Esse estudo consistiu de duas fases: 1. Uma fase analítica de caso-controle que avaliou o impacto de variáveis individuais e contextuais na MM; 2. Uma fase ecológica delineada para contextualizar as mortes maternas por meio de análise espacial. O grupo caso consistiu de 87 mortes maternas e o grupo controle de 348 mulheres que tiveram bebês durante o mesmo período. Os dados foram analisados por estatística descritiva, testes de associação e regressão logística múltipla (RLM) (p < 0,05) assim como análise espacial. Resultados: A taxa de mortalidade materna foi de 37 mortes para cada 100.000 nascidos vivos. As mortes foram dispersas por todo o território urbano e não se observou formação de clusters. Na RLM observou-se que mulheres grávidas com idade > 35 anos (OR = 2,63) ou aquelas que passaram por cesárea (OR = 2,51) foram mais propensas à morte materna. Conclusão: As mortes maternas foram distribuídas dispersamente entre os diferentes níveis socioeconômicos e mais propensas a ocorrer entre mulheres > 35 anos de idade ou que passaram por cesárea.

Dental trauma is a public health problem because of its high prevalence rates and treatment costs and for affecting mainly younger individuals. Aim This cross-sectional study aimed to investigate the variables associated with dental trauma and its influence on oral health-related quality of life among 7th-grade students of public elementary schools. Methods The data was collected with semi-structured and self-administered questionnaires and an intraoral clinical examination (n = 204). The variables collected regarded dental trauma, lip coverage, overjet, oral health-related quality of life (Child Perceptions Questionnaire - CPQ11-14 ISF: 8), and sociodemographic profile. Association tests and the Mann-Whitney test were performed at a 5% significance level. Results Dental trauma occurred in 12.3% of students, 94.6% had adequate lip coverage, and the mean overjet was 2.7 mm (±2.0). Sex was the only variable with a statistically significant association with dental trauma (p = 0.021). There was no statistically significant difference in the CPQ11-14 ISF: 8 score between students with and without dental trauma (p = 0.136). Conclusions Dental trauma was significantly associated with sex and did not impact the oral health-related quality of life of the students.

ABSTRACT Little is known about how Brazilian dentists’ treatment decisions for proximal carious lesions are compared to current evidence-based recommendations, so better understanding is needed to close any potential evidence-practice gap. Objectives: This cross-sectional study aimed to quantify the evidence-practice gap about proximal carious lesions treatment and identify dentist factors associated with this evidence-practice gap. Methods: Brazilian dentists (n=214) from Araraquara, São Paulo State, “completed a questionnaire about their dentist and practice characteristics and a translated version of the “Assessment of Caries Diagnosis and Caries Treatment” from the U.S. National Dental Practice-Based Research Network. Five radiographic images of proximal carious lesions in low-risk and high-risk patient scenarios were used. Associations between treatment recommendations and lesion, dentist, and practice characteristics were tested for statistical significance (p<0.05). Results: Lesions confined to the enamel would be restored by 35% and 71% of dentists in the low-risk and high-risk patient scenarios, respectively, suggesting a substantial evidence-practice gap given that surgical intervention of enamel lesions is not consistent with current evidence. The lesion depth threshold to recommend a permanent restoration differed between the low-risk and high-risk patient scenarios (p<0.001). Specific dentist/practice characteristics (dentist gender, graduate of a public dental school, postgraduate training, use of caries risk assessment) were significantly associated with the evidence-practice gap, but the magnitude of these differences was not major Conclusion: A substantial evidence-practice gap in treatment of proximal carious lesions was found for the sample overall, even when clinical scenarios presented low-risk patients. Global strategies are needed to close this substantial evidence-practice gap.

RESUMO Pouco se sabe se as decisões de tratamento dos dentistas brasileiros para lesões cariosas proximais são comparadas às recomendações atuais baseadas em evidências, portanto, é necessário um melhor entendimento para fechar qualquer potencial lacuna entre a evidência e a prática. Purpose: Este estudo transversal teve como objetivo quantificar a lacuna entre a evidência e a prática na decisão de tratamento das lesões cariosas proximais e identificar os fatores associados a essa lacuna entre a evidência e a prática. Methods: Cirurgiões-dentistas brasileiros (n=214) de Araraquara, Estado de São Paulo, preencheram um questionário sobre suas características odontológicas e clínicas e uma versão traduzida do “Assessment of Caries Diagnosis and Caries Treatment” da U.S. National Dental Practice-Based Research Network. Cinco imagens radiográficas de lesões cariosas proximais em cenários de pacientes de baixo risco e alto risco foram usadas. Associações entre recomendações de tratamento e lesão, dentista e características da prática foram testadas (p<0,05). Results: As lesões confinadas ao esmalte seriam restauradas por 35% e 71% dos dentistas nos cenários de pacientes de baixo risco e alto risco, respectivamente, sugerindo uma lacuna entre a evidência e a prática substancial, dado que a intervenção cirúrgica das lesões do esmalte não é consistente com as evidências atuais. O limiar de profundidade da lesão para recomendar uma restauração permanente diferiu entre os cenários de pacientes de baixo risco e alto risco (p<0,001). Características específicas do dentista/prática (sexo do dentista, graduado em uma faculdade pública, pós-graduação, uso da avaliação de risco de cárie) foram significativamente associadas à lacuna entre a evidência e a prática, mas a magnitude dessas diferenças não foi importante. Conclusions: uma lacuna entre a evidência e a prática substancial na decisão de tratamento de lesões cariosas proximais foi encontrada para a amostra como um todo, mesmo quando os cenários clínicos apresentavam pacientes de baixo risco. Estratégias globais são necessárias para fechar essa lacuna entre a evidência e a prática.

ABSTRACT Objective: To determine the prevalence and analyze the variables associated with the use of pacifiers and/or bottles by infants up to 6 months of age. Material and Methods: Data on sociodemographic characteristics, intention to offer pacifier and bottle-feeding, pregnancy and breastfeeding (BF) variables were collected at baseline by interviews and a self-administered questionnaire among pregnant women in the 3rd trimester. After delivery, mother-baby binomials were followed by phone calls at the 1st, 3rd, and 6th months of the baby's life (n=467) to gather information on the type of delivery, baby’s gender, BF in the first hour of the newborn’s life, baby’s weight, mother’s return to work, and oral habits. Association analyses were performed using logistic regression models with a 5% significance level with the pacifier/bottle-feeding use as the outcome. Results: Most mothers (52.5%) reported their babies used bottle-feeding, 48.2% used pacifiers and 33.4% used both of them throughout the 6 months. Intention to offer pacifier and bottle-feeding was reported by 45.0% and 54.8% of the mothers at the 3rd trimester of the pregnancy, respectively. Not living in one’s own residence (OR=1.53; 95%CI: 1.05-2.24) and having the prenatal intention of offering a pacifier (OR=2.50; 95%CI: 1.63-3.83) to the baby were significantly associated with pacifier use. Variables significantly associated with bottle-feeding were mother’s return to work (OR=2.48; 95%CI: 1.54-3.97), baby’s lower birth weight (OR=1.58; IC95%: 1.07-2.33), and prenatal intention to offer bottle-feeding (OR=2.51; 95%CI 1.56-4.04). Conclusion: About half of the babies used pacifiers or were bottle-fed, which were associated with the mother’s prenatal intention to offer them to their babies and socioeconomic factors.

Abstract Objective: To investigate association between parental locus of control (belief of individuals about what or who has control of the events of their lives) and bottle feeding habits among children from 3 to 5 years of age. Methodology: Parental locus of control validated in Brazil, and semi-structured questionnaire to obtain sociodemographic, health, and oral habit behaviors was applied to mothers of 992 preschool children. Outcome variable “use of feeding bottle” was studied according to the time of its use (≤36 months and >36 months). Simple logistic regression models were adjusted and raw odds ratios were estimated for variables of distal blocks, which contemplated parental locus of control, socioeconomic characteristics of family, and maternal habits. In the intermediate block, the variables for conditions of the child's birth and place of health care attendance during the prenatal period and early childhood were included. In the proximal block, the time of breastfeeding and pacifier use were reported. Variables were analyzed from the distal to the proximal block, and the individual analyses that presented p ≤ 0.20 remained in each model; included in the subsequent block were the variables with p ≤ 0.10, because this was a study of prevention. Results: Longer time of feeding bottle use was associated with the internal parental locus of control, mothers older than 31 years of age, white race, premature children, who used pacifiers and are treated in the private health system. Conclusions: Children who maintained the habit of feeding bottle use for a longer time were those whose mother presented an internal locus of control.

Abstract Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian dentists. This study aimed to determine the prevalence of CRA use by dentists and factors associated with its use, as well as to quantify dentists’ ratings of the importance of specific factors when treatment planning. Dentists registered at the Regional Council of Dentistry of São Paulo State – Araraquara region were sent two paper questionnaires that comprised: a) characteristics of dentists themselves, their practices, and their patients; and b) the translated version of the “Assessment of Caries Diagnosis and Caries Treatment” Questionnaire from the U.S. National Dental Practice-Based Research Network. Participants were 206 dentists who currently practiced in Araraquara and treated dental caries. Descriptive statistics and multiple logistic regression analyses were used for data analysis. Thirty-six percent of the dentists reported they perform CRA and, among them, 36% indicated they record the assessment on a special form that is kept in the patient chart. More years since dental school graduation (OR = 1.1, p = 0.002) and holding an advanced academic degree (OR=2.6, p=0.005) were associated with a higher likelihood of performing CRA, whereas exclusively using a private practice model (OR = 0.5, p = 0.016) was associated with a lower likelihood of performing CRA. The current oral hygiene and commitment to return for follow-up were the most important risk factors for treatment planning. In conclusion, CRA was not a routine procedure in daily practice among the majority of participating dentists. Specific demographic, practice and academic education characteristics were associated with performing CRA.

ABSTRACT Objective: To describe the dental practice patterns related to caries prevention in children aged 6-18 years and associated factors. Material and Methods: Dentists (n=162) from Araraquara, Brazil, completed two paper questionnaires: (1) one about characteristics of their practice and their patient population; and (2) a translated version of the “Assessment of Caries Diagnosis and Caries Treatment” Questionnaire from the National Dental Practice-Based Research Network. Regression analyses were used for data analysis (p<0.05). Results: Dentists reported using in-office fluoride (IOF) and dental sealants (DS) in 74.2% and 45.1% of their pediatric patients, respectively. Regression analysis showed that female dentists (p=0.035 for DS; p=0.044 for IOF; p=0.011 for non-prescription fluoride rinse), those with advanced degrees (p=0.032 for prescription of fluoride), those who graduated from a private dental school (p=0.018 for chlorhexidine rinse), those who provided caries prevention regimens (p<0.001 for DS; p=0.004 for IOF; p=0.013 for non-prescription fluoride rinse), those with a greater percentage of patients interested in a caries prevention regimen (p=0.007 for non-prescription fluoride rinse), those working in a private practice model (p=0.047 for prescription of fluoride) were more likely to recommend some type of preventive methods to their pediatric patients. Conclusion: Dentists reported recommending IOF to most of their pediatric patients. Certain dentists’, practices’, and patients’ characteristics were associated to some caries prevention regimens recommended by dentists.

Resumo Introdução Pouco se sabe sobre a influência do risco de cárie na retenção de selantes oclusais. Objetivo Avaliar as taxas de retenção de um cimento de ionômero de vidro modificado por resina utilizado como selante oclusal em primeiros molares permanentes de escolares de 6-8 anos, e analisar a influência do risco de cárie na taxa de retenção do selante, durante um período de 24 meses. Material e método A aplicação do selante foi realizada em consultório odontológico no início do estudo, após as crianças serem alocados no grupo de alto risco (AR) ou baixo risco (BR) de cárie. Os exames foram realizados pelo mesmo dentista calibrado em 0, 6, 12, 18 e 24 meses. As taxas de retenção foram estimadas e o método de Kaplan-Meier foi utilizado para estimar as probabilidades de sobrevivência. A comparação entre os grupos AR e BR foi avaliada pelos testes de Wilcoxon e log-rank. Resultado Os resultados mostraram que 14% dos dentes selados apresentaram perda total (16% para AR e 12% para BR) e 46% apresentaram perda parcial durante o estudo (51% de AR e 41% para BR), em relação a amostra no início do estudo. Nenhuma diferença pode ser demonstrada pela análise de sobrevivência entre os grupos AR e BR (p> 0,05). Conclusão O risco de cárie não influenciou as taxas de retenção de um cimento de ionômero de vidro modificado por resina usado como selante oclusal em escolares de 6-8 anos de idade.

Abstract Introduction Little is known whether caries risk influence occlusal sealants retention. Objective To determine the retention rates (RR) of the resin-modified glass ionomer cement used as occlusal sealant in permanent first molars of 6-8-year old schoolchildren and to analyze the influence of caries risk at baseline on the RR of the sealant, over a 24-month period. Material and method The sealant application was performed in a dental office at the beginning of the study, after children being allocated into high caries risk group (HR) and low caries risk group (LR). The examinations were performed by the same calibrated dentist at 0, 6, 12, 18 and 24 months. Retention rates were estimated, the Kaplan-Meier method was used to estimate the survival probabilities; and the comparison between HR and LR groups was evaluated by Wilcoxon and log-rank test. Result The results showed that 14% of sealed teeth showed total loss (16% for HR and 12% for LR) and 46% showed partial loss during the study (51% for HR and 41% for LR), in relation to the baseline sample. No difference could be demonstrated by the survival analysis between HR and LR groups (p>0.05). Conclusion Caries risk did not influence the retention rates of a resin-modified glass ionomer cement used as occlusal sealant in 6-8-year old schoolchildren.

Comparar indicadores de saúde bucal (Rendimento, Atrição, Ênfase em Prevenção Modificado, Relação Restauração/Extração) e Relação 1ª Consulta/Urgência entre 15 Unidades de Saúde da Família e 11 Unidades Básicas de Saúde de município do interior paulista, de 2008 a 2011. Os dados foram coletados a partir do Sistema de Informações Ambulatoriais do SUS (SIA-SUS) e comparados os modelos de atenção por meio de série histórica, teste não paramétrico (Mann-Whitney) e estatística descritiva. Embora haja o processo de fortalecimento da Estratégia Saúde da Família o modelo assistencial representado pelas Unidades Básica de Saúde se mostra mais efetivo em alguns aspectos da saúde bucal no serviço público.

To compare four oral health indicators (Income, Attrition, Modified Prevention Emphasis, Restoration/Extraction) and the 1st Consultation/Urgency Relationship in 15 Family Health Units and 11 Basic Health Units, in an interior city of São Paulo State, 2008-2011. The data were collected from SIA-SUS and the indicators compared through historical series using the non-parametric test (Mann Whitney) and descriptive statistics. Although there is a strengthening process of the Family Health Strategy, the care model represented by the Basic Health Units still proves more effective in some aspects of oral health in public service.

Comparar indicadores de saúde bucal (Rendimento, Atrição, Ênfase em Prevenção Modificado, Relação Restauração/Extração) e Relação 1ª Consulta/Urgência entre 15 Unidades de Saúde da Família e 11 Unidades Básicas de Saúde de município do interior paulista, de 2008 a 2011. Os dados foram coletados a partir do Sistema de Informações Ambulatoriais do SUS (SIA-SUS) e comparados os modelos de atenção por meio de série histórica, teste não paramétrico (Mann-Whitney) e estatística descritiva. Embora haja o processo de fortalecimento da Estratégia Saúde da Família o modelo assistencial representado pelas Unidades Básica de Saúde se mostra mais efetivo em alguns aspectos da saúde bucal no serviço público.

To compare four oral health indicators (Income, Attrition, Modified Prevention Emphasis, Restoration/Extraction) and the 1st Consultation/Urgency Relationship in 15 Family Health Units and 11 Basic Health Units, in an interior city of São Paulo State, 2008-2011. The data were collected from SIA-SUS and the indicators compared through historical series using the non-parametric test (Mann Whitney) and descriptive statistics. Although there is a strengthening process of the Family Health Strategy, the care model represented by the Basic Health Units still proves more effective in some aspects of oral health in public service.

OBJETIVO: Avaliar a prevalência e a severidade da dor orofacial em gestantes. MÉTODOS: O estudo transversal foi realizado em uma amostra de gestantes em atendimento odontológico em uma faculdade de odontologia. Foi aplicado questionário estruturado com perguntas sobre a auto percepção das condições bucais e a presença e a severidade da dor orofacial sentida na boca ou dentes nos últimos 6 meses. RESULTADOS: Participaram do estudo 80 gestantes e, destas, 58,8% afirmaram ter algum problema nos dentes, 31,3% problema na gengiva, 61,3% gosto ruim na boca e 62,5% mau hálito. Apenas 22,5% não apresentaram nenhum tipo de dor orofacial. As dores mais relatadas foram: dor com líquidos quentes, frios ou doces (56,2%) e dor de dente espontânea (38,8%). Quanto à severidade, as dores de intensidade leve e moderada foram as mais frequentes, mas havia um grupo de 23,8% das gestantes com dores intensas ou muito intensas provocadas por líquidos frios ou quentes e 18,8% na mesma condição em relação à dor espontânea. CONCLUSÃO: Os resultados do estudo mostraram que, apesar da alta prevalência de dor orofacial encontrada, a severidade foi baixa e relacionada a algumas situações específicas.

OBJECTIVE: To evaluate the prevalence and severity of oral pain in pregnant women. METHODS: A cross-sectional study was conducted on a sample of pregnant women who were receiving dental care at a Dental School. A structured questionnaire about self-perception of oral conditions and the presence and severity of orofacial pain in the mouth or teeth in the last 6 months was applied. RESULTS: 80 pregnant women participated in the study and, of these, 58.8% reported having a problem with their teeth, 31.3% periodontal problems, 61.3% bad taste in mouth and 62.5% bad breath. Only 22.5% of pregnant women did not exhibit any form of oral pain. The most frequently reported pains were: pain with hot/cold liquids or sweets (56.2%) and spontaneous toothache (38.8%). With regard to severity, mild and moderate pain were the most frequently reported, but there was a group of 23.8% of pregnant women with severe or very severe pain caused by hot or cold liquids and 18.8% in the same condition in relation to spontaneous pain. CONCLUSION: The results of this study showed that, despite the high prevalence of pain detected in the pregnant women, severity was low and referred to specific situations.

Este estudo apresenta o resultado de uma avaliação de custo-efetividade conduzida ao longo de um ensaio clínico controlado para avaliar a efetividade do selamento com ionômero de vidro modificado por resina (Vitremer, 3M ESPE) e da aplicação de verniz fluoretado (Duraphat, Col-gate) em superfícies oclusais de primeiros molares permanentes, em crianças de 6 a 8 anos (N = 268), segundo o risco de cárie (alto risco; baixo risco). As crianças foram examinadas semestralmente, ao longo de 24 meses, pelo mesmo dentista calibrado, após alocação em seis grupos: controle alto risco e baixo risco (educação em saúde bucal trimestral); verniz alto risco e baixo risco (educação em saúde bucal trimestral + aplicação semestral de verniz); e selante alto risco e baixo risco (educação em saúde bucal trimestral + única aplicação do selante). A análise mostrou que o selamento de primeiros molares permanentes em crianças de alto risco apresentou razão de C/E de R$ 225,21(US$ 119,80) por superfície oclusal salva, e razão incremental de C/E de R$ 203,71(US$ 108,36) por superfície oclusal adicional salva. Conclui-se que uma única aplicação de selante, em escolares de alto risco, foi a intervenção mais custo-efetiva.

This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US$ 119.80 per saved occlusal surface and an incremental C/E ratio of US$ 108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.

En este estudio se presentan los resultados de una evaluación de costo-efectividad (C/E) durante un ensayo clínico controlado para evaluar la efectividad de la obturación con ionómero de vidrio modificado con resina (Vitremer, 3M ESPE) y la aplicación de barniz de flúor (Duraphat, Colgate) en las superficies oclusales de los primeros molares permanentes, para niños de 6-8 años (N = 268) de edad, de acuerdo con el riesgo de caries (alto riesgo-bajo riesgo). Los niños fueron examinados cada seis meses por el mismo dentista calibrado, durante 24 meses, después de haberle sido asignados seis grupos: control alto riesgo y bajo riesgo (educación de salud bucal cada tres meses); barniz alto riesgo y bajo riesgo (educación de salud bucal cada tres meses + barniz semestralmente); obturación alto riesgo y bajo riesgo (educación de salud bucal cada tres meses + una sola aplicación de ionómero de vidrio). El análisis económico mostró que la obturación de los primeros molares permanentes de escolares de alto riesgo presenta una relación C/E de US$ 119.80 de ahorro por superficie oclusal y una ratio C/E incremental de US$ 108.36 de ahorro adicional por superficie oclusal.

Este estudo apresenta o resultado de uma avaliação de custo-efetividade conduzida ao longo de um ensaio clínico controlado para avaliar a efetividade do selamento com ionômero de vidro modificado por resina (Vitremer, 3M ESPE) e da aplicação de verniz fluoretado (Duraphat, Col-gate) em superfícies oclusais de primeiros molares permanentes, em crianças de 6 a 8 anos (N = 268), segundo o risco de cárie (alto risco; baixo risco). As crianças foram examinadas semestralmente, ao longo de 24 meses, pelo mesmo dentista calibrado, após alocação em seis grupos: controle alto risco e baixo risco (educação em saúde bucal trimestral); verniz alto risco e baixo risco (educação em saúde bucal trimestral + aplicação semestral de verniz); e selante alto risco e baixo risco (educação em saúde bucal trimestral + única aplicação do selante). A análise mostrou que o selamento de primeiros molares permanentes em crianças de alto risco apresentou razão de C/E de R$ 225,21(US$ 119,80) por superfície oclusal salva, e razão incremental de C/E de R$ 203,71(US$ 108,36) por superfície oclusal adicional salva. Conclui-se que uma única aplicação de selante, em escolares de alto risco, foi a intervenção mais custo-efetiva.

This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US$ 119.80 per saved occlusal surface and an incremental C/E ratio of US$ 108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.

En este estudio se presentan los resultados de una evaluación de costo-efectividad (C/E) durante un ensayo clínico controlado para evaluar la efectividad de la obturación con ionómero de vidrio modificado con resina (Vitremer, 3M ESPE) y la aplicación de barniz de flúor (Duraphat, Colgate) en las superficies oclusales de los primeros molares permanentes, para niños de 6-8 años (N = 268) de edad, de acuerdo con el riesgo de caries (alto riesgo-bajo riesgo). Los niños fueron examinados cada seis meses por el mismo dentista calibrado, durante 24 meses, después de haberle sido asignados seis grupos: control alto riesgo y bajo riesgo (educación de salud bucal cada tres meses); barniz alto riesgo y bajo riesgo (educación de salud bucal cada tres meses + barniz semestralmente); obturación alto riesgo y bajo riesgo (educación de salud bucal cada tres meses + una sola aplicación de ionómero de vidrio). El análisis económico mostró que la obturación de los primeros molares permanentes de escolares de alto riesgo presenta una relación C/E de US$ 119.80 de ahorro por superficie oclusal y una ratio C/E incremental de US$ 108.36 de ahorro adicional por superficie oclusal.

OBJECTIVE: The aims of this study were to investigate the effectiveness of sealant placement under the guidelines of the Oral Health Promotion Program for Children and Adolescents (Portugal), and to test the influence of clinical and socioeconomic variables on the DMFT increment in 277 children, born in 1997. MATERIAL AND METHODS: A dental hygienist performed the initial examinations and sealant placement (Helioseal, Vivadent) on the permanent first molars in 2005. These activities were registered in dental records that were assessed in 2007. Children were classified according to caries risk at baseline [high (HR: DMFT+dmft>0); low (LR: DMFT+dmft=0) risk] and sealant placement as follows: HR-S and LR-S Groups (with sealant placement); HR-NS and LR-NS Groups (without sealant placement). A calibrated dentist performed the final examination in 2007 at school, based on the World Health Organization recommendations. The variables collected were: dental caries, visible dental plaque, malocclusions, and socioeconomic level (questionnaire sent to children's parents). For univariate (Chi-square or Fisher tests) and multivariate (Multiple logistic regression) analyses the DMFT increment >0 was selected as dependent variable. RESULTS: Approximately 17.0% of the children showed DMFT increment>0 (mean=0.25). High-risk children presented a significant increase in the number of decayed and/or filled teeth. These children had 7.94 more chance of developing caries. Children who did not receive sealant were 1.8 more prone to have DMFT increment >0. CONCLUSION: It appears that sealant placement was effective in preventing dental caries development. Moreover, the variables "risk" and "sealant placement" were predictors for DMFT increment in the studied children.