RESUMO Objetivo: O presente estudo teve como objetivo investigar associações entre os motivos da busca por serviços odontológicos, considerando a última consulta odontológica de adolescentes, e suas características escolares, status socioeconômico e bucal e alfabetização em saúde bucal. Métodos: Foi realizado um estudo transversal com 746 adolescentes de 15–19 anos em Campina Grande (Paraíba), Brasil. Os pais/responsáveis responderam a um questionário socioeconômico. Os adolescentes responderam a um questionário de saúde bucal e à versão brasileira do Rapid Estimate of Adult Literacy in Dentistry (rápida estimativa de alfabetização de adultos em odontologia). As características do contexto escolar foram investigadas por meio de análise de cluster, utilizando tipo de escola e taxa de retenção escolar. Os adolescentes foram examinados clinicamente para diagnóstico de cárie dentária por dois dentistas (κ>0,80), usando os critérios de Nyvad, nas instalações das escolas. Os dados foram submetidos à regressão logística multinível robusta para amostras complexas (α=5%). Resultados: No nível individual, a baixa escolaridade da mãe (razão de probabilidade [OR] 1,06; IC95% 1,01–1,10), alfabetização em saúde bucal inferior (OR 0,99; IC95% 0,98–0,99) e cárie dentária (OR 1,09; IC95% 1,01–1,18) permaneceram associados ao motivo da última consulta odontológica. O ambiente escolar também foi associado ao desfecho (OR 1,07; IC95% 1,00–1,15). Conclusão: Escolaridade materna com menos de oito anos de estudo, baixa literacia em saúde bucal, cárie cavitada e ambiente escolar desfavorável foram associados à procura por tratamento odontológico.

ABSTRACT Objective: The present study aimed to investigate associations between reasons for seeking dental services, considering the last dental appointment of adolescents, and their educational features, socioeconomic and oral health status, and oral health literacy. Methods: A cross-sectional study was conducted with 746 adolescents aged 15–19 years in Campina Grande (Paraíba), Brazil. Parents/guardians answered a socioeconomic questionnaire. Adolescents answered a questionnaire on oral health and the Brazilian Rapid Estimate of Adult Literacy in Dentistry. Features of the school environment were investigated through cluster analysis, using type of school and school grade retention. Adolescents were clinically examined for dental caries diagnosis by two dentists (κ>0.80), using the Nyvad criteria, in school facilities. Data were submitted to robust multilevel logistic regression for complex samples (α=5%). Results: At the individual level, low maternal schooling (odds ratio [OR] 1.06; 95%CI 1.01–1.10), low oral health literacy (OR 0.99; 95%CI 0.98–0.99), and dental caries (OR 1.09; 95%CI 1.01-1.18) remained associated with the reasons for the last dental appointment. The school environment was also associated with the outcome (OR 1.07; 95%CI 1.00–1.15). Conclusion: Maternal schooling of less than eight years of study, low oral health literacy, cavitated caries, and unfavorable school environment were associated with seeking dental treatment.

RESUMO Objetivo: O presente estudo teve como objetivo investigar associações entre os motivos da busca por serviços odontológicos, considerando a última consulta odontológica de adolescentes, e suas características escolares, status socioeconômico e bucal e alfabetização em saúde bucal. Métodos: Foi realizado um estudo transversal com 746 adolescentes de 15–19 anos em Campina Grande (Paraíba), Brasil. Os pais/responsáveis responderam a um questionário socioeconômico. Os adolescentes responderam a um questionário de saúde bucal e à versão brasileira do Rapid Estimate of Adult Literacy in Dentistry (rápida estimativa de alfabetização de adultos em odontologia). As características do contexto escolar foram investigadas por meio de análise de cluster, utilizando tipo de escola e taxa de retenção escolar. Os adolescentes foram examinados clinicamente para diagnóstico de cárie dentária por dois dentistas (κ>0,80), usando os critérios de Nyvad, nas instalações das escolas. Os dados foram submetidos à regressão logística multinível robusta para amostras complexas (α=5%). Resultados: No nível individual, a baixa escolaridade da mãe (razão de probabilidade [OR] 1,06; IC95% 1,01–1,10), alfabetização em saúde bucal inferior (OR 0,99; IC95% 0,98–0,99) e cárie dentária (OR 1,09; IC95% 1,01–1,18) permaneceram associados ao motivo da última consulta odontológica. O ambiente escolar também foi associado ao desfecho (OR 1,07; IC95% 1,00–1,15). Conclusão: Escolaridade materna com menos de oito anos de estudo, baixa literacia em saúde bucal, cárie cavitada e ambiente escolar desfavorável foram associados à procura por tratamento odontológico. Objetivo odontológicos escolares Métodos 74 1519 15 19 15–1 Paraíba, Paraíba , (Paraíba) Brasil paisresponsáveis pais responsáveis rápida odontologia. odontologia . odontologia) cluster κ>0,80, κ080 κ κ>0,80 0 80 (κ>0,80) Nyvad escolas α=5%. α5 α α=5% 5 (α=5%) Resultados individual razão OR [OR 1,06 106 1 06 IC95 IC 1,01–1,10, 101110 1,01–1,10 01 10 1,01–1,10) 0,99 099 99 0,98–0,99 098099 98 1,09 109 09 1,01–1,18 101118 18 1,07 107 07 1,00–1,15. 100115 1,00–1,15 00 1,00–1,15) Conclusão odontológico 7 151 15– (Paraíba κ08 κ>0,8 8 (κ>0,80 α=5 (α=5% 1,0 IC9 10111 1,01–1,1 0,9 9 0,98–0,9 09809 10011 1,00–1,1 κ0 κ>0, (κ>0,8 α= (α=5 1, 1011 1,01–1, 0, 0,98–0, 0980 1001 1,00–1, κ>0 (κ>0, (α= 101 1,01–1 0,98–0 098 100 1,00–1 κ> (κ>0 (α 1,01– 0,98– 1,00– (κ> 1,01 0,98 1,00 (κ

ABSTRACT Objective: The present study aimed to investigate associations between reasons for seeking dental services, considering the last dental appointment of adolescents, and their educational features, socioeconomic and oral health status, and oral health literacy. Methods: A cross-sectional study was conducted with 746 adolescents aged 15–19 years in Campina Grande (Paraíba), Brazil. Parents/guardians answered a socioeconomic questionnaire. Adolescents answered a questionnaire on oral health and the Brazilian Rapid Estimate of Adult Literacy in Dentistry. Features of the school environment were investigated through cluster analysis, using type of school and school grade retention. Adolescents were clinically examined for dental caries diagnosis by two dentists (κ>0.80), using the Nyvad criteria, in school facilities. Data were submitted to robust multilevel logistic regression for complex samples (α=5%). Results: At the individual level, low maternal schooling (odds ratio [OR] 1.06; 95%CI 1.01–1.10), low oral health literacy (OR 0.99; 95%CI 0.98–0.99), and dental caries (OR 1.09; 95%CI 1.01-1.18) remained associated with the reasons for the last dental appointment. The school environment was also associated with the outcome (OR 1.07; 95%CI 1.00–1.15). Conclusion: Maternal schooling of less than eight years of study, low oral health literacy, cavitated caries, and unfavorable school environment were associated with seeking dental treatment. Objective services features status Methods crosssectional cross sectional 74 1519 15 19 15–1 Paraíba, Paraíba , (Paraíba) Brazil Parentsguardians Parents guardians Dentistry analysis retention κ>0.80, κ080 κ κ>0.80 0 80 (κ>0.80) criteria facilities α=5%. α5 α α=5% . 5 (α=5%) Results level odds OR [OR 1.06 106 1 06 95CI CI 95 1.01–1.10, 101110 1.01–1.10 01 10 1.01–1.10) 0.99 099 99 0.98–0.99, 098099 0.98–0.99 98 0.98–0.99) 1.09 109 09 1.011.18 101118 1.01 1.18 18 1.01-1.18 1.07 107 07 1.00–1.15. 100115 1.00–1.15 00 1.00–1.15) Conclusion treatment 7 151 15– (Paraíba κ08 κ>0.8 8 (κ>0.80 α=5 (α=5% 1.0 9 10111 1.01–1.1 0.9 09809 0.98–0.9 011 1.011.1 101 118 1.1 1.01-1.1 10011 1.00–1.1 κ0 κ>0. (κ>0.8 α= (α=5 1. 1011 1.01–1. 0. 0980 0.98–0. 1.011. 11 1.01-1. 1001 1.00–1. κ>0 (κ>0. (α= 1.01–1 098 0.98–0 1.011 1.01-1 100 1.00–1 κ> (κ>0 (α 1.01– 0.98– 1.01- 1.00– (κ> 0.98 1.00 (κ

Resumo Investigar fatores individuais e contextuais associados à busca de tratamento para lesões dentárias traumáticas. Foi realizado um estudo transversal com 739 pares de responsáveis e crianças. Os responsáveis responderam a um questionário abordando características sociodemográficas, busca por tratamento para traumatismo dentário na criança e o Questionário de alfabetização em saúde bucal para adulto. Análise descritiva e análise de regressão de Poisson multinível não ajustada e ajustada (p<0,05) foram realizadas. A prevalência de busca de tratamento para lesão dentária traumática foi de 44,7%. As variáveis sociodemográficas associadas foram a pele branca da criança (RP = 1,30; IC 95%: 1,08-1,76), idade da mãe maior que 35 anos (RP = 1,70; IC 95%: 1,50-1,90), os responsáveis casados (RP = 1,93; IC 95%: 1,70-2,23), com mais de oito anos de estudo (RP = 2,00; IC 95%: 1,76-2,23), com alfabetização adequada em saúde bucal (RP = 2,00; IC 95%: 1,76-2,23) e uso diário de dispositivos eletrônicos pela criança (RP = 1,26; IC 95%: 1,02-1,50). No nível contextual, frequentar uma escola particular (PR = 1,77; IC 95%: 1,02-3,05) e a quantidade de unidades básicas de saúde com equipes de saúde bucal no distrito sanitário da escola (PR = 1,78; IC 95%: 1,12-2,38) permaneceram associados. Entre as crianças que sofreram TDI, a alfabetização em saúde bucal adequada dos pais foi um fator que se destacou na busca por tratamento. traumáticas 73 adulto p<0,05 p005 p 0 05 (p<0,05 realizadas 447 44 7 44,7% RP 1,30 130 1 30 95% 95 1,081,76, 108176 1,08 1,76 , 08 76 1,08-1,76) 3 1,70 170 70 1,501,90, 150190 1,50 1,90 50 90 1,50-1,90) 1,93 193 93 1,702,23, 170223 2,23 2 23 1,70-2,23) 2,00 200 00 1,762,23, 176223 1,762,23 1,76-2,23 1,26 126 26 1,021,50. 102150 1,02 . 02 1,02-1,50) contextual PR 1,77 177 77 1,023,05 102305 3,05 1,02-3,05 1,78 178 78 1,122,38 112238 1,12 2,38 12 38 1,12-2,38 TDI p<0,0 p00 (p<0,0 4 44,7 1,3 13 9 081 1,081,76 10817 108 1,0 176 1,7 1,08-1,76 17 501 1,501,90 15019 150 1,5 190 1,9 5 1,50-1,90 19 702 1,702,23 17022 223 2,2 1,70-2,23 2,0 20 762 17622 1,762,2 1,76-2,2 1,2 021 1,021,50 10215 102 1,02-1,50 023 1,023,0 10230 305 3,0 1,02-3,0 122 1,122,3 11223 112 1,1 238 2,3 1,12-2,3 p<0, p0 (p<0, 44, 1, 1,081,7 1081 10 1,08-1,7 1,501,9 1501 15 1,50-1,9 1,702,2 1702 22 2, 1,70-2,2 1762 1,762, 1,76-2, 1,021,5 1021 1,02-1,5 1,023, 1023 3, 1,02-3, 1,122, 1122 11 1,12-2, p<0 (p<0 1,081, 1,08-1, 1,501, 1,50-1, 1,702, 1,70-2, 1,762 1,76-2 1,021, 1,02-1, 1,023 1,02-3 1,122 1,12-2 p< (p< 1,081 1,08-1 1,501 1,50-1 1,702 1,70-2 1,76- 1,021 1,02-1 1,02- 1,12- (p 1,08- 1,50- 1,70-

ABSTRACT To investigate individual and contextual factors associated with seeking treatment for traumatic dental injuries. A cross-sectional study was conducted with 739 pairs of guardians and children. Guardians answered a questionnaire addressing sociodemographic characteristics, seeking treatment for a tooth injury in the child, and the Oral Health Literacy-Adult Questionnaire. Descriptive analysis and unadjusted and adjusted multilevel Poisson regression analysis (p<0.05). The prevalence of seeking treatment for traumatic dental injury was 44.7%. Sociodemographic variables associated were white skin of the child (PR = 1.30; 95% CI: 1.08-1.76), mother’s age older than 35 years (PR = 1.70; 95% CI: 1.50-1.90), married parents (PR = 1.93; 95% CI: 1.70-2.23), guardians with more than eight years of schooling (PR = 2.00; 95% CI: 1.76-2.23), with adequate oral health literacy (PR = 3.33; 95% CI: 3.01-3.62) and the daily use of electronic devices by the child (PR = 1.26; 95% CI: 1.02-1.50). On the contextual level, attending a private school (PR = 1.77; 95% CI: 1.02-3.05) and the number of primary care units with oral health teams in the school district (PR = 1.78; 95% CI: 1.12-2.38) remained associated. Among the children who suffered TDI, adequate oral health literacy on the part of the parents stood out among the factors associated with seeking treatment. injuries crosssectional cross sectional 73 characteristics LiteracyAdult Literacy Adult Questionnaire p<0.05. p005 p p<0.05 . 0 05 (p<0.05) 447 44 7 44.7% PR 1.30 130 1 30 95 CI 1.081.76, 108176 1.08 1.76 , 08 76 1.08-1.76) mothers mother s 3 1.70 170 70 1.501.90, 150190 1.50 1.90 50 90 1.50-1.90) 1.93 193 93 1.702.23, 170223 2.23 2 23 1.70-2.23) 2.00 200 00 1.762.23, 176223 1.76-2.23) 3.33 333 33 3.013.62 301362 3.01 3.62 01 62 3.01-3.62 1.26 126 26 1.021.50. 102150 1.02 02 1.02-1.50) level 1.77 177 77 1.023.05 102305 3.05 1.02-3.05 1.78 178 78 1.122.38 112238 1.12 2.38 12 38 1.12-2.38 TDI p00 p<0.0 (p<0.05 4 44.7 1.3 13 9 081 1.081.76 10817 108 1.0 176 1.7 1.08-1.76 17 501 1.501.90 15019 150 1.5 190 1.9 5 1.50-1.90 19 702 1.702.23 17022 223 2.2 1.70-2.23 2.0 20 762 1.762.23 17622 1.76-2.23 3.3 013 3.013.6 30136 301 3.0 362 3.6 6 3.01-3.6 1.2 021 1.021.50 10215 102 1.02-1.50 023 1.023.0 10230 305 1.02-3.0 122 1.122.3 11223 112 1.1 238 2.3 1.12-2.3 p0 p<0. (p<0.0 44. 1. 1.081.7 1081 10 1.08-1.7 1.501.9 1501 15 1.50-1.9 1.702.2 1702 22 2. 1.70-2.2 1.762.2 1762 1.76-2.2 3. 3.013. 3013 36 3.01-3. 1.021.5 1021 1.02-1.5 1.023. 1023 1.02-3. 1.122. 1122 11 1.12-2. p<0 (p<0. 1.081. 1.08-1. 1.501. 1.50-1. 1.702. 1.70-2. 1.762. 1.76-2. 3.013 3.01-3 1.021. 1.02-1. 1.023 1.02-3 1.122 1.12-2 p< (p<0 1.081 1.08-1 1.501 1.50-1 1.702 1.70-2 1.762 1.76-2 3.01- 1.021 1.02-1 1.02- 1.12- (p< 1.08- 1.50- 1.70- 1.76- (p

Abstract The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43–2.86), mouth breathing (OR = 1.04; 95%CI: 1.02–1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37–4.85), and obesity (OR = 1.54; 95%CI: 1.02–2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

ABSTRACT Background Sleep bruxism (BS) is defined as involuntary jaw movements characterized by grinding and clenching teeth. Objective To verify the association between chronotype, sleep quality, and self-reporting of BS in dental students. Method A cross-sectional study was conducted with 214 undergraduate dental students at a public university in northeast Brazil. The participants answered the Munich Chronotype Questionnaire for the identification of chronotype and another questionnaire regarding daily aspects to collect information about sleep quality, self-reported sleep bruxism, the use of sleeping pills, snoring, concentration during daily activities and energy upon waking. Results The prevalence of self-reported sleep bruxism was 11.0%. In the final model, the eveningness chronotype (OR = 23.00; 95% CI: 2.36-223.84, p = 0.007), habitual snoring (OR = 3.12; 95% CI: 1.31-7.39, p = 0.01) and low energy upon waking in the morning (OR = 2.37; 95% CI: 1.96-5.58, p = 0.040) were associated with self-reported sleep bruxism. Conclusion The evening chronotype, presence of snoring, and low energy when waking up in the morning influenced self-reporting of sleep bruxism among undergraduate dental students.

RESUMO Introdução O bruxismo do sono (BS) é definido como movimentos involuntários da mandíbula caracterizados por ranger e apertar os dentes. Objetivo Verificar se o cronotipo e a qualidade do sono estão associados ao autorrelato de BS em graduandos de Odontologia. Método Um estudo transversal com 214 estudantes de uma universidade pública do Nordeste do Brasil. Os participantes responderam ao Morningness-Eveningness Questionnaire para identificar os cronotipos e outro questionário sobre aspectos diários em que foram coletadas informações sobre qualidade do sono, autorrelato de bruxismo do sono, uso de pílulas para dormir, ronco, concentração nas atividades diárias, energia ao acordar. Resultados A prevalência de autorrelato do bruxismo do sono foi de 11,0%. No modelo final, o cronotipo noturno (OR = 23,00; 95% IC: 2.36-223.84, p = 0,007), o hábito de roncar (OR = 3,12; 95% IC: 1.31-7.39, p = 0,01) e o baixo nível de energia ao acordar pela manhã (OR = 2,37; 95% IC: 1.96-5.58, p = 0,04) estiveram associados com o autorrelato de BS. Conclusão O cronotipo noturno, a presença do ronco e a baixa energia ao se levantar pela manhã influenciaram o autorrelato de bruxismo do sono entre os estudantes de graduação em Odontologia.

ABSTRACT OBJECTIVE To investigate whether oral health literacy (OHL) and school context are associated with untreated dental caries on the anterior teeth of adolescents. METHODS A representative cross-sectional study was conducted with 746 students aging 15 to 19 in the city of Campina Grande, Brazil. The guardians answered a questionnaire addressing sociodemographic data and the absence/presence of private health insurance. Two examiners were trained for the diagnosis of dental caries using the Nyvad criteria and the measurement of OHL using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) (Kappa > 0.80). Contextual aspects of the schools were obtained from the 2017 National School Census. Descriptive statistics were conducted, followed by unadjusted and adjusted robust negative binomial regression for complex samples (p < 0.05). RESULTS The average number of anterior teeth with untreated caries was 0.95 (SD = 1.77). Among individual factors, the male sex (RR = 1.64; 95%CI: 1.24–2.16), inadequate level of OHL (RR = 2.03; 95%CI: 1.13–1.63), marginal level of OHL (RR = 1.87; 95%CI: 1.05–3.33) and not having private health insurance (RR = 1.34; 95%CI: 1.07–1.68) were associated with untreated caries on anterior teeth. Among school contextual factors, the number of students in the classroom (RR = 2.64; 95%CI: 1.78–3.93), number of public oral health services in the district (RR = 0.14; 95%CI: 0.05–0.39) and average income of the district in which the school is located (RR = 0.99; 95%CI: 0.98–0.99) were associated with the outcome. CONCLUSIONS Sociodemographic factors, having private health insurance, OHL, and school context exerted an influence on the occurrence of untreated dental caries on anterior teeth in adolescents aging 15 to 19.

ABSTRACT OBJECTIVE To evaluate the psychometric properties of the Brazilian Portuguese version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) administered to adolescents. METHODS The study included 750 adolescents: 375 aged 12 years and 375 aged 15–19 years, attending public and private schools in Campina Grande, state of Paraíba, Brazil, in 2017. Reliability was measured based on internal consistency and test-retest reliability. Convergent validity was measured based on correlations between BREALD-30 and Functional Literacy Indicator scores. Divergent validity was measured by comparing BREALD-30 scores with sociodemographic variables. For predictive validity, the association between BREALD-30 scores and the presence of cavitated carious lesions was tested using a multiple logistic regression model. All statistical tests were performed with a significance level of 5%. RESULTS BREALD-30 showed good internal consistency for the 12 year olds and 15 to19 year olds (Cronbach’s alpha = 0.871 and 0.834, respectively) and good test-retest reliability [intraclass correlation coefficient (ICC) = 0.898 and 0.974; kappa = 0.804 and 0.808, respectively]. Moreover, item-total correlation was satisfactory for all items. BREALD-30 had convergent validity with the Functional Literacy Indicator for 12 year olds (rs = 0.558, p < 0.001) and for 15 to 19 year olds (rs = 0.652, p < 0.001). Participants with higher oral health literacy levels who attended private schools (p < 0.001), belonged to economic classes A and B2 (p < 0.001), and who had parents with higher education levels (p < 0.001) were included, indicating the divergent validity of the BREALD-30. Participants with lower BREALD-30 scores were more likely to have cavitated carious lesions [12 year olds: odds ratio (OR) = 2.37; 95% confidence interval (95%CI): 1.48–3.80; 15 to 19 year olds: OR = 1.96; 95%CI 1.24–3.11]. CONCLUSIONS BREALD-30 shows satisfactory psychometric properties for use on Brazilian adolescents and can be applied as a fast, simple, and reliable measure of oral health literacy.