Abstract This study aimed to evaluate trends in the prevalence of dental caries in preschool children and associated factors considering different time variations. This is a time series study performed using data from three cross-sectional studies with pre-school children from southern Brazil in 2008, 2013 and 2019. This children group was born between the years of 2003 to 2018. Dental caries was evaluated by decayed, missing and filled deciduous teeth (dmft index). Demographic, socioeconomic, behavioural and psychosocial variables were also collected. Chi-square test for trends and a hierarchical age-period-cohort (HAPC) analysis using multilevel Poisson regression model for testing the associations between predictor variables and dental caries experience were used. A total of 1,644 pre-school children participated in all surveys. There was a significant difference in caries experience considering all APC effects. The prevalence of dental caries was 25.0% in 2008, 16.3% in 2013, and 19.4% in 2019 (p < 0.01) and no statistical difference was observed. An age effect showed that older children were more likely to experience dental caries. Considering the cohort effect, there is a significant difference between the generations, mainly between 2003 and 2018. Household income, use of dental services, and parent’s perception of child oral health were associated with dental caries experience no matter the time variation. Despite recent declines in dental caries prevalence among preschool children, caries levels increased with age and social inequalities persisted through the years, indicating a need of reviewing the policies to reduce the burden of this oral disease.

Abstract This study aimed to explore the pathways that can influence cigarette smoking among adolescents. This population-based cohort followed a random sample of 12-year-old adolescents from southern Brazil for 6 years. Regular cigarette smoking was assessed through a self-reported question, previously used in the Brazilian National Survey of Scholar Health. We also gathered data on bullying, dental caries at baseline, incidence of caries, sex, friend network, and Sense of Coherence (SOC). Socioeconomic and demographic characteristics were also collected. Structural equation modeling was used to evaluate the pathways. Of the 1,134 adolescents examined at baseline, 768 were re-evaluated (67.7% retention rate). The prevalence of smoking was 37.6%. This prevalence was directly affected by low SOC (SC: -0.14, p < 0.01), low household income (SC: -0.12, p < 0.01), and male sex (SC: 0.15, p < 0.01). Presence of dental caries at baseline indirectly influenced the occurrence of dental bullying at follow-up via the incidence of dental caries (SC: 0.01, p < 0.05). Dental bullying indirectly influenced cigarettes consumption via SOC (SC: 0.62, p < 0.05). Friend network also indirectly influenced the consumption of cigarettes via SOC (SC: 0.32, p < 0.05). Psychosocial factors influence adolescent cigarette consumption through its higher direct and indirect effects (via bullying). In addition, behavioral, sociodemographic, and clinical factors also influence the occurrence of smoking.

Abstract: This study assessed the association between self-reported oral health and the normative indices of dental caries in an adolescent population. This study is based on a 6-year data from a cohort, beginning in 2012, with 1,134 twelve-year-old adolescents. After three phases of data collection, 68% of the samples were followed up. Self-reported oral health was evaluated through the question: “Would you say that the health of your teeth, lips, jaws, and mouth is …?”, and answers were categorized as “good” or “poor.” Calibrated dentists examined clinical conditions using the decayed, missing, and filled teeth (DMFT) index. Statistical analysis was performed using multilevel logistic regression models, considering the dependence of those observed thrice and adjusted for demographic, socioeconomic, and dental visit variables. Adolescents who evaluated their oral health as poor had higher mean DMFT (OR: 1.35; CI95% 1.22–1.50). When evaluated separately, decayed (OR: 2.43; CI95% 1.83–3.23) and missing (OR: 3.94; CI95% 1.26–12.26) teeth also presented significant results, showing poor self-reported oral health associated with a higher mean. Adolescents’ self-perceived oral health was associated with normative dental caries indices, and this association was maintained throughout adolescence.

ABSTRACT BACKGROUND: Dry mouth syndrome or xerostomia is defined as decreased salivary flow or hypofunction of salivary glands. Its origins are multicausal and might be the result of a change in the salivary glands or a systemic imbalance. OBJECTIVE: To ascertain the prevalence of self-reported xerostomia and to identify associated factors. DESIGN AND SETTING: Cross-sectional study on the entire population of 293 elderly people over 60 years of age living in a Brazilian municipality. METHODS: Data were gathered from a questionnaire that asked about demographic data, chronic diseases and use of continuous medications, and which used the Xerostomia Inventory (XI) to evaluate dry mouth sensation. Our analysis consisted of multivariate regression and estimation of odds ratios (OR) and their respective 95% confidence intervals (CI) in binary logistic regression models. RESULTS: The prevalence of self-reported xerostomia was 19.1%. Elderly people with diabetes had higher odds of having self-reported xerostomia (OR: 3.59; 95% CI: 1.48-8.68; P < 0.001) as did those who had chronic diseases and used continuous medication (OR: 2.3; 95% CI: 1.19-4.67; P = 0.009). Elderly people who used continuous medication for the gastrointestinal tract were more likely to have xerostomia (OR: 2.14; 95% CI: 1.03-1.44; P = 0.030). CONCLUSIONS: Elderly people with diabetes and chronic diseases who were using continuous medication were more likely to have dry mouth. Use of continuous medications for the gastrointestinal tract led to a greater chance of having self-reported xerostomia.

Abstract This study aimed to assess whether the reductions in serum urea and creatinine levels are different from the reductions in salivary urea and creatinine levels that occur after hemodialysis in chronic renal patients. The systematic review protocol was registered in the PROSPERO database. Eight databases were searched to identify pretest-posttest studies of chronic kidney disease patients undergoing hemodialysis, with no language or year restrictions. The JBI Critical Appraisal Tool was used to assess the risk of bias. Meta-analyses using random-effect models were conducted to compare salivary and serum correlations and to pooled mean and proportion differences from pre- to posthemodialysis urea and creatinine levels by subgroup analysis. The I2 test was used to assess heterogeneity, and a meta-regression was performed to statistically assess correlations and differences in the pooled effects pre- and postdialysis. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. The search resulted in 1404 records, and only six studies (n = 252 participants) fulfilled the eligibility criteria and were included. The studies were published between 2013 and 2018. All studies showed a significant reduction in both salivary and serum urea/creatinine levels. All eligible studies presented a low risk of bias. The meta-analysis shows a moderate to high correlation between salivary and blood levels of urea (r: 0.79; 95% CI: 0.56-1.00) and creatinine (r: 0.64; 95%CI: 0.16–1.00), with a very low level of certainty. The reductions in salivary urea and creatinine levels are similar to and correlated with the reductions in blood urea and creatine levels after hemodialysis among chronic kidney disease patients.

Abstract: This study aimed to assess the survival of glass ionomer cement (GIC) restorations performed using the atraumatic restorative treatment (ART) in elderly patients. The systematic review protocol was registered in the PROSPERO database. The records were searched until August 2020 in eight electronic bibliographic databases, and included randomized and non-randomized clinical trials and observational studies, with no restrictions on the language or year of publication. Study selection and data extraction were performed independently by two reviewers. Data were extracted, summarized, collected for qualitative analysis, and evaluated for individual risk of bias using the Joanna Briggs Institute's Critical Appraisal Tool. The literature search retrieved 5,186 records; however, only seven studies fulfilled the eligibility criteria and were included. The studies were published between 2002 and 2019. A total of 1,239 restorations were investigated at intervals of 6, 12, 24, and 60 months of follow-up. Some studies had a low risk of bias, while others had moderate and high risk of bias. In general, GIC restorations placed using ART were considered satisfactory. The 6-month, 12-month, and 24-month survival rates ranged from 81.3% to 97.2%, 72.2% to 94%, and 63% to 87%, respectively; additionally, the survival rate for the longest follow-up period (60 months) was 85%. Given the best evidence-based information regarding caries removal, we highlight the need to provide a conservative and effective technique for use in elderly patients. ART is a promising and viable alternative that guarantees the survival of restorations in elderly patients.

ABSTRACT BACKGROUND: Elderly men have been characterized as a group vulnerable to suicide, motivated by loneliness, loss of loved ones and feelings of uselessness to family members. OBJECTIVES: To ascertain the prevalence of different mental disorders among elderly men who attempted suicide. DESIGN AND SETTING: Systematic review of observational studies developed as a result of a partnership between two postgraduate schools (Lagarto and Uberlândia). METHODS: An electronic search was performed in eight electronic databases, including “grey literature”, in January 2019. Observational studies that assessed mental disorders among men older than 60 years who attempted suicide were eligible for inclusion. RESULTS: Among the disorders evaluated, mood disorders had the highest prevalence (42.0%; 95% confidence interval, CI: 31.0-74.0%; I2: 0.0%; P = 0.763), followed by substance use-related disorders (41.0%; 95% CI: 8.0-74.0%; I2: 96.4; P < 0.001) and, lastly, schizophrenic disorders (5.0%; 95% CI: 0.0%-14.0%; I2: 80.3%; P = 0.024). CONCLUSIONS: It seems that mood disorders and substance use-related disorders are quite prevalent among elderly men with mental disorders who attempted suicide. It is important to consider the role of healthcare services in making early diagnoses of mental disorders among elderly men, in order to diminish the chances of suicide attempts among them. SYSTEMATIC REVIEW REGISTRATION: CRD42018105981.

Resumo O objetivo do estudo é revisar sistematicamente a literatura afim de estimar a prevalência global de xerostomia/hiposalivação em estudos epidemiológicos. Uma busca eletrônica foi conduzida até Fevereiro de 2018 sem restrições de linguagem. Um total de 5760 títulos foram inicialmente identificados e somente vinte e nove artigos foram incluídos na revisão e meta-análise após dois revisores independentes aplicarem os critérios de seleção. Os artigos foram extraídos das bases de dados PubMed/Medline e Web of Science. Os critérios de elegibilidade incluíram investigações originais de estudos observacionais de base populacional os quais reportaram a prevalência de xerostomia ou dados que permitissem o cálculo da prevalência de xerostomia e/ou hiposalivação. Estudos realizados em populações com condições de saúde específicas, revisões de literatura, relato de casos e estudos antropológicos, assim como, conferências ou comentários foram excluídos. Tamanho amostral, localização geográfica aonde foi realizado o estudo, desenho do estudo, idade da população estudada, métodos de diagnóstico e o critério de avaliação para determiner xerostomia e/ou hiposalivação foram extraídos para a meta-análise e metaregressão. Análise de meta-regressão multípla foi realizada para explorar a heterogeneidade entre os estudos. A prevalência global estimada de boca seca foi de 22.0% (95%IC 17.0-26.0%). Uma maior prevalência de xerostomia foi observada em estudos realizados exclusivamente em populações idosas. Apesar de diferentes abordagens utilizadas para mensurar as condições de interesse, cerca de uma em quatro pessoas é acometida por xerostomia, com taxas mais elevadas sendo observadas na população idosa. Além disso, os métodos de mensuração podem ter super- ou subestimado os valores de xerostomia. Os achados do presente estudo salientam a necessidade de mais estudos acerca das existentes e novas formas de avaliação clínica, os quais serão úteis para determinar qual é a mais confiável para as perspectivas clínicas e epidemiológicas.

Abstract The aim of this paper is to systematically review the literature to estimate the overall prevalence of xerostomia/hyposalivation in epidemiological studies. An electronic search was carried out up to February 2018 with no language restrictions. A total of 5760 titles were screened and just twenty-nine papers were included in review and the meta-analysis after a two independently reviewers applied the selection criteria. Data were extracted from PubMed and Web of Science databases. Eligibility criteria included original investigations from observational population-based studies that reported the prevalence of xerostomia or data that allowed the calculation of prevalence of xerostomia and/or hyposalivation. Studies conducted in samples with specific health conditions, literature reviews, case reports and anthropological studies, as conferences or comments were excluded. Sample size, geographic location of the study, study design, age of the studied population, diagnosis methods, and evaluation criteria used to determine xerostomia e/or hyposalivation were extracted for meta-analysis and meta-regression. Multivariate meta-regression analysis was performed to explore heterogeneity among studies. The overall estimated prevalence of dry mouth was 22.0% (95%CI 17.0-26.0%). Higher prevalence of xerostomia was observed in studies conducted only with elderly people. Despite diverse approaches to the condition’s measurement, just over one in four people suffer from xerostomia, with higher rates observed among older people. Moreover, the measurement methods used currently may over- or underestimate xerostomia. These findings highlight the need for further work on existing and new clinical measure and will be useful to determine which one is more reliable in clinical and epidemiological perspectives.

Abstract The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children’s Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children’s dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers’ associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children’s ages, family income, parents’ schooling, mothers’ participation in their children’s school activities, dental caries, and presence of workers’ associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.

Resumo O objetivo deste estudo foi comparar a administração da versão brasileira do questionário Early Childhood Oral Health Impact Scale (ECOHIS), aplicado através de entrevista pessoal e por telefone. Uma amostra randomizada de 76 pais/responsáveis de crianças de até 6 anos de idade foi selecionada na Clínica de Odontopediatria da Universidade Federal de Santa Maria, Brasil. Os pacientes foram selecionados aleatoriamente para 2 grupos diferentes, de acordo com a sequência de administração: E-T (Entrevista Pessoal-Telefone) e T-E (Telefone-Entrevista Pessoal). Dois entrevistadores aplicaram o questionário ECOHIS com um intervalo de 2 semanas entre os métodos. A confiabilidade entre as seções dos diferentes métodos de administração foi avaliada pelo Alfa de Cronbach e Coeficiente de Correlação Intraclasse (ICC). Houve diferenças nas médias do ECOHIS entre os métodos de entrevista pessoal e telefone. No entanto, os valores de Alfa de Cronbach foram entre 0,94-0,96 e ICC entre 0,91-0,93, mostrando valores aceitáveis. O gráfico de Blant-Altman confirmou os resultados dos testes de confiabilidade, suportando a acurácia dos métodos. Embora exista uma pequena diferença nos escores, o uso de ambos os métodos de administração do ECOHIS produz dados confiáveis quando um único método é utilizado do início até o final do estudo. Os resultados forneceram evidências para usar tanto entrevista pessoal quanto por telefone como métodos de administração do ECOHIS.

Abstract The aim of this study was to compare the administration of the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire, applied by face-to-face and telephone format. A randomized sample of 76 parents/guardians of children up to 6 years old was selected in a Pediatric Dentistry Clinic of the Federal University of Santa Maria, Brazil. Patients were randomly selected for 2 different groups, according to administration sequence: F-T (Face-to-face-Telephone) and T-F (Telephone-Face-to-face). Two interviewers administered the ECOHIS questionnaire with 2 week interval between the methods. The reliability between sections of the different methods of administration was assessed by Cronbach's alpha and Intraclass Correlation Coefficient (ICC). There were differences in means of the ECOHIS between face-to-face and telephone methods. However, the value Cronbach's alpha were between 0.94-0.96, and value ICC ranged from 0.91-0.93, proving to be acceptable values. The Bland-Altman plots confirmed the results of reliability tests, supporting the accuracy of the methods. Although there is a slight difference in the scores, the use of both mode of administration of the ECOHIS yields reliable data when single method is used from the beginning to the end of the study. The results provided evidence to use either Face-to-face or Telephone method of administration of the ECOHIS

Abstract The aim of this study was to assess trends in traumatic crown injuries (TCIs), their prevalence, and association with socioeconomic and clinical factors in preschool children over a 5-year period. A series of cross-sectional surveys was conducted in Santa Maria, Brazil, on children attending a National Day of Children’s Vaccination. The same protocol was used in all surveys conducted in 2008, 2010, and 2013. Clinical examinations were performed to evaluate types of traumatic crown injuries using the O’brien index. A semi-structured questionnaire was answered by the parents. It provided information about several socioeconomic factors as well as the parents’ perception of their child’s oral health. The chi-square for trends test was used to verify changes in TCI prevalence throughout the years. The association between socioeconomic and clinical factors with TCI was assessed by the Poisson regression analysis. A total of 1,640 children were examined. The prevalence of TCIs decreased significantly from 2008 to 2013 (10.12%; p < 0.001). Central incisors were the most vulnerable to injury, independent of the year. Moreover, older children and those with inadequate lip coverage were more likely to present with some traumatic dental injury (p < 0.001). prevalence of traumatic crown injuries decreased following the years, however TCI remain an important subject to consider when planning oral health policies.

Resumo Este estudo transversal avaliou a influência da raça/etnia na qualidade de vida relacionada à saúde bucal (QVRSB) de crianças brasileiras. O processo de amostragem aleatório selecionou uma amostra representativa de 1.134 crianças de 12 anos de idade de escolas públicas de Santa Maria, uma cidade do sul do Brasil. Os participantes foram examinados por 4 clínicos calibrados (valor mínimo de Kappa para concordância inter-examinador de 0,8) e a versão brasileira reduzida do questionário Child Perception Questionnaire (CPQ 11-14) foi aplicada a cada um. Os pais ou responsáveis pelos crianças responderam a questões relacionadas à suas características demográficas e socioeconômicas. As associações foram analisadas utilizando modelos multiníveis com regressão de Poisson. Crianças de grupos étnico/raciais minoritários tiveram pior QVRSB. O escore médio do CPQ 11-14 foi 1,08 maior para crianças não-brancos do que o escore dos seus pares. Os domínios "Bem-Estar Social" e "Bem-Estar Emocional" foram os mais afetados para crianças não-brancos, com escores médios significativamente maiores quando comparados aos crianças brancos (RR 1,19, 95% IC, 1,07-1,33; e RR 1,14; 95% IC 1,04-1,24). Essa associação permaneceu significante mesmo após ajustes por covariáveis individuais e contextuais. Disparidades na QVRSB são prevalentes entre crianças de grupos étnico/raciais minoritários. Crianças não-brancas tiveram pior QVRSB comparados aos crianças brancos.

This cross-sectional study aimed to assess the influence of race/ethnicity on Brazilian children' oral health-related quality of life (OHRQoL). A multistage random sampling selected a representative sample of 1,134 twelve-years-old children from public schools of Santa Maria, a city in Southern Brazil. Participants were examined by 4 calibrated clinicians (minimum Kappa-value for inter-examiner agreement of 0.8) and the Brazilian short version of the Child Perceptions Questionnaire (CPQ11-14) was administered. The children's parents or guardians answered questions regarding their demographics and socioeconomic status. Associations were analyzed using multilevel Poisson regression models. Children from racial/ethnic minority groups had poorer OHRQoL. The mean CPQ11-14 score was 1.08 times higher for non-white children than their white counterparts' score. "Social" and "Emotional well-being" were the most affected domains for non-white children, with significantly higher mean scores as compared to white children (RR 1.19, 95% CI, 1.07-1.33; and RR 1.14; 95% CI 1.04-1.24). This association remained significant even after adjusting for individual and contextual covariates. OHRQoL disparities are prevalent among children from racial/ethnic minority groups. Non-white children have lower OHRQoL compared to white children.

O estudo avaliou a influência de fatores socioeconômicos, clínicos e a percepção dos pais quanto à saúde de seus filhos na frequência de escovação de pré-escolares de 0 a 5 anos de Santa Maria-RS, Brasil. O estudo foi realizado em Santa Maria, Brasil, durante o Dia Nacional de Vacinação das Crianças e 478 crianças de 0 - 5 anos foram incluídas. Os dados foram coletados por meio de exames clínicos e por um questionário estruturado, realizados por 15 examinadores calibrados e 30 auxiliares. Os responsáveis forneceram informações sobre diversos indicadores socioeconômicos, auto-percepção de saúde bucal e frequência de escovação dentária. O principal desfecho foi coletado pela pergunta "Quantas vezes por dia você escova os dentes de seu filho?". Os dados foram analisados utilizando modelo de regressão de Poisson, considerando pesos relativos à amostragem complexa. Pais que relataram pior percepção de saúde bucal dos seus filhos em relação às outras crianças apresentavam uma menor frequência de escovação (RP 0,23; IC: 1,06 - 1,43). Crianças mais novas escovavam menos os dentes que as de idade mais elevada (RP 0,90; IC: 0,84 - 0,96) e a não-procura pelo dentista foi preditor para menor frequência de escovação (RP 1,29; IC: 1,05 - 1,59). A percepção dos pais influencia hábitos saudáveis da criança, suportando a evidência de que aspectos psicossociais são fortes preditores de saúde bucal na infância

This study assessed the influence of socioeconomic and clinical factors, as well as parent's perception of child's oral health on the toothbrushing frequency of 0-5-year-old children. The study was carried out in Santa Maria, RS, Brazil, during the National Children's Vaccination Day, and 478 children aged 0 - 5 years were included. Data were collected by clinical examinations and a structured questionnaire, conducted by 15 calibrated examiners and 30 supports. A questionnaire was filled out by the parents with information about several socioeconomic indicators, perception of child's oral health and frequency of tooth brushing. The main outcome was collected by the question: "How many times a day do you brush your child's teeth?". Multivariable Poisson regression model taking into account the cluster sample was performed to assess the association between the predictors and outcome. Children whose parents related worse perception of child's oral health showed less tooth brushing frequency (PR 1.23; 1.06 - 1.43). Young children brush their teeth less than the older ones (PR 0.90; 0.84 - 0.96); and lack of visit to a dentist was predictor for less tooth brushing frequency (PR 1.29; 1.05 - 1.59). Parent's perception of child oral health influence children's healthy behaviors, supporting the evidence that psychosocial factors are strong predictors of children's oral health.