Abstract This study aimed to investigate the association between bullying at school and tooth loss in southern Brazilian adolescents. This population-based cross-sectional study included a representative sample of 15–19-year-old students attending high schools in Santa Maria, southern Brazil. Data on sociodemographic and behavioral variables were collected through questionnaires. Contextual data on bullying at school was provided by educational institutions (bullying episodes in the previous year: ‘no,’ ‘sometimes,’ or ‘often’). Tooth loss was clinically assessed by the M component of the DMFT index, modeled as a discrete variable. Multilevel Poisson regression was used, and rate ratios (RR) and 95% confidence intervals (CI) were estimated. The prevalence of tooth loss was 9.2% (95%CI = 7.5–10.8). Adolescents who attended the schools where bullying events often occurred had 0.39 (95%CI = 0.33–0.45) missing teeth, on average, in contrast to an average of 0.14 (95%CI = 0.08–0.19) among those whose schools did not experience bullying in the previous year. After adjusting for important cofactors, the contextual variable of bullying at school remained significantly associated with the study outcome. Adolescents who attended schools where bullying frequently occurred were 2.49-fold more likely to have an additional missing tooth than those whose school did not experience bullying in the previous year (RR = 2.49, 95%CI = 1.37–4.51, p = 0.003). In conclusion, the frequent bullying episodes at school were associated with more permanent teeth lost due to caries in this population. Hence, improving the school environment may improve the oral health of adolescents. adolescents populationbased population based crosssectional cross sectional 15–19yearold 1519yearold yearold 15–19 old 15 19 Maria Brazil questionnaires ‘no, no ‘sometimes, sometimes ‘often. ‘often . ‘often’) index used RR 95 CI (CI estimated 92 9 2 9.2 95CI 7.5–10.8. 75108 7.5–10.8 7 5 10 8 7.5–10.8) 039 0 39 0.3 0.33–0.45 033045 33 45 014 14 0.1 0.08–0.19 008019 08 cofactors outcome 2.49fold 249fold fold 2.49 49 249 137451 1 37 4 51 1.37–4.51 0.003. 0003 0.003 003 0.003) conclusion Hence 19yearold 1519 15–1 ‘no ‘sometimes ‘often’ 9. 7510 7.5–10. 03 3 0. 0.33–0.4 03304 01 0.08–0.1 00801 49fold 2.4 24 13745 1.37–4.5 000 0.00 00 151 15– 751 7.5–10 0.33–0. 0330 0.08–0. 0080 2. 1374 1.37–4. 0.0 75 7.5–1 0.33–0 033 0.08–0 008 137 1.37–4 7.5– 0.33– 0.08– 13 1.37– 7.5 0.33 0.08 1.37 7. 1.3 1.

Abstract This study aimed to assess the association between underlying dentin shadows (UDS) and oral health-related quality of life (OHRQoL) among 15-19-year-old adolescents from southern Brazil. This population-based cross-sectional study included a representative sample of 1,197 15–19-year-old adolescents attending 31 public and private schools from Santa Maria, Brazil. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed by two calibrated examiners (intra/interexaminer kappa values for caries examination ≥ 0.80) to diagnose UDS (ICDAS code 4 caries lesions). Sociodemographic information and clinical characteristics (overall caries experience, traumatic dental injury, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between UDS and OHRQoL. Rate ratios (RR) and 95% confidence intervals (CI) were estimated. The UDS prevalence was 8.8% (n = 106 adolescents). In the adjusted models, adolescents with UDS had poorer OHRQoL than those without UDS, and the strength of the association was dependent on the number of lesions per individual. Individuals with 1-2 UDS had a mean OHIP-14 score 8% higher (RR = 1.08; 95%CI: 1.01–1.17) than adolescents without UDS, while those with 3-4 UDS had a mean score 35% higher (RR = 1.35; 95%CI: 1.12–1.63). This negative association was related to physical disability, psychological disability, social disability, and handicap domains. This study showed that UDS was associated negatively with OHRQoL among 15–19-year-old adolescents from southern Brazil. The negative effect of UDS on OHRQoL emphasizes the importance of addressing issues regarding OHRQoL even in the posterior teeth of adolescents. (UDS healthrelated health (OHRQoL 1519yearold yearold 15 19 year old Brazil populationbased population based crosssectional cross sectional 1197 1 197 1,19 15–19yearold 15–19 3 Maria Profile14 Profile 14 Profile-1 OHIP14 OHIP (OHIP-14 intra/interexaminer intrainterexaminer intra interexaminer 0.80 080 0 80 ICDAS lesions. . lesions) overall experience injury malocclusion gingivitis variables RR 95 CI (CI estimated 88 8 8.8 n 10 adolescents) individual 12 2 1- OHIP-1 1.08 108 08 95%CI 95CI 1.01–1.17 101117 01 17 34 3- 35 1.35 135 1.12–1.63. 112163 1.12–1.63 63 1.12–1.63) disability domains 119 1,1 19yearold 1519 15–1 Profile1 Profile- OHIP1 (OHIP-1 0.8 9 8. OHIP- 1.0 1.01–1.1 10111 1.3 13 11216 1.12–1.6 6 11 1, 151 15– (OHIP- 0. 1. 1.01–1. 1011 1121 1.12–1. (OHIP 1.01–1 101 112 1.12–1 1.01– 1.12– 1.01 1.12 1.1

Abstract This study evaluated the association between sense of coherence (SoC) and oral health-related quality of life (OHRQoL) among conscripts of the Brazilian Army, in two cities of southern Brazil. A cross-sectional study included all 18-19-year-old adolescents who joined the Brazilian Army as draftees for mandatory military service in the cities of Itaqui, RS, and Santiago, RS (n = 505). Data collection was conducted from 2019 to 2021, and included the application of questionnaires and a clinical oral examination to record gingivitis, malocclusion, and dental caries. OHRQoL was collected through the Brazilian short version of the Oral Health Impact Profile (OHIP), composed of 14 questions. The adolescents’ SoC was assessed using the validated Brazilian version of the SOC-13 scale. The primary outcome of this study was OHRQoL, modeled as a discrete variable (OHIP-14 scores). The main predictor variable was SoC, categorized as low, moderate, or high. The association between predictor variables and OHRQoL was assessed by Poisson regression models using a hierarchical approach. Unadjusted and adjusted rate ratios (RR), and 95% confidence intervals (CI) were estimated. All the analyses were performed using STATA software version 14.2. Adolescents with a moderate and high SoC had 27% (RR = 0.73, 95%CI = 0.64–0.84) and 51% (RR = 0.49, 95%CI = 0.41–0.58) lower mean OHIP-14 scores, respectively, than those with a low SoC score, after the inclusion of behavioral and clinical variables. This study showed a significant association between SoC and OHRQoL among 18–19-year-old southern Brazilian adolescents. Strengthening the SoC as a psychosocial resource may improve the well-being and OHRQoL of adolescents. (SoC healthrelated health related (OHRQoL Brazil crosssectional cross sectional 1819yearold yearold 18 19 year old Itaqui Santiago n 505. 505 . 505) 201 2021 gingivitis malocclusion caries OHIP, OHIP , (OHIP) 1 questions SOC13 SOC 13 SOC-1 scale OHIP14 (OHIP-1 scores. scores scores) approach RR, RR (RR) 95 CI (CI estimated 142 2 14.2 27 073 0 73 0.73 95CI 0.64–0.84 064084 64 84 51 049 49 0.49 0.41–0.58 041058 41 58 OHIP-1 respectively score 18–19yearold 18–19 wellbeing well being 50 20 202 (OHIP SOC1 SOC- OHIP1 (OHIP- 9 14. 07 7 0.7 0.64–0.8 06408 6 8 5 04 4 0.4 0.41–0.5 04105 OHIP- 19yearold 1819 18–1 0. 0.64–0. 0640 0.41–0. 0410 181 18– 0.64–0 064 0.41–0 041 0.64– 06 0.41– 0.64 0.41 0.6

Abstract This study investigated the association between the city region and traumatic dental injury (TDI) among adolescents from Santa Maria, Rio Grande do Sul, Brazil. A population-based cross-sectional survey was conducted from March to November 2018, which included a representative sample of adolescents (15-19-year-old) attending public and private high schools. A questionnaire on sociodemographic information was sent to the parents/legal guardians of the selected adolescents. TDI in the upper and lower permanent incisors and canines was recorded based on the O’Brien classification. Environmental variables (sociodemographic and structural characteristics of the neighborhoods) were obtained from official publications. Multilevel Poisson regression models were used, and prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. A total of 1,146 adolescents participated in this study. The overall prevalence of TDI was 17.3%, mild trauma was 12.7%, and severe trauma was 5.8%. Adolescents living in the southern region had a prevalence of TDI of 25.3%, compared with 13.6% in the northern region. After adjusting for important cofactors, adolescents living in the southern region were more likely to have TDI than their counterparts in the northern region (PR, 1.91; 95%CI: 1.18-3.11; p = 0.009). Analyzing the number of environmental risk indicators in different regions, the southern region presented a higher mean and median than all other regions. In conclusion, living in the southern region was associated with a higher prevalence and severity of TDI among adolescents from Santa Maria, southern Brazil. Our findings suggest the role of the environment in the epidemiology of TDI.

Abstract This study aimed to assess the relationship between self-perceived neighborhood factors and oral health-related quality of life (OHRQoL) among adolescents from southern Brazil. A representative sample of 15-19-year-old students from Santa Maria, Brazil, was included. The Oral Health Impact Profile (OHIP-14) was used to assess the OHRQoL. Self-perceived neighborhood factors were assessed through a structured questionnaire and included characteristics of the neighborhood where the adolescents lived, such as the presence of paved streets, tap water, community social networks, and availability of dental services and the Family Health Strategy (FHS). In addition, socioeconomic, behavioral, and clinical variables (dental caries and malocclusion) were also evaluated. Multilevel Poisson regression analysis with a hierarchical approach was used to assess the association between predictors and OHIP-14. The rate ratio (RR) and 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included in this study (participation rate: 72.3%). The mean OHIP-14 score was 8.4 (standard error = 0.2), ranging from 0 to 49. Living in residences with unpaved streets (RR = 1.11, 95%CI:1.06−1.17), no tap water (RR = 1.11, 95%CI: 1.02−1.20), absence of the FHS services (RR = 1.15, 95%CI: 1.09−1.20), and the availability of dental services (RR = 1.08, 95%CI: 1.03−1.14) were associated with higher OHIP-14 scores, indicating a poorer OHRQoL. In addition, lower socioeconomic status, visiting the dentist for curative reasons, lower frequency of brushing teeth, and higher sugar consumption were also associated with higher OHIP-14 scores. In conclusion, self-perceived neighborhood characteristics were associated with OHRQoL in adolescents. Adolescents who perceived their neighborhood as deprived had poorer OHRQoL.

Abstract: This study evaluated the efficacy of fluoride gel in arresting active non-cavitated caries lesions in permanent teeth. This randomized, triple-blind, placebo-controlled clinical trial randomized 100 schoolchildren aged 10.7 ± 2.2 years to test treatment (1.23% acidulated phosphate fluoride [APF] gel) or control treatment (placebo gel) for 4–6 applications at weekly intervals. Data collection included the visible plaque index, gingival bleeding index, visible plaque accumulation on the occlusal surfaces, eruption stage, and dental caries. The association between group and lesion arrestment was assessed using logistic regression, and estimates were adjusted for plaque accumulation over the lesion at baseline, surface type, and tooth type. Models were fitted using generalized estimating equations for accounting for the clustering of data (i.e., the same individual contributed > 1 lesion). Ninety-eight children completed the study (48 fluoride and 50 placebo). When all dental surfaces were analyzed, the likelihood of lesion arrestment was similar between both groups (p > 0.05). A secondary analysis including only the occlusal lesions in molars showed that for teeth under eruption, lesions receiving the 1.23% APF gel were about 3-fold more likely to become arrested than lesions receiving the placebo gel (OR = 2.85; 95%CI = 1.23–6.61; p = 0.01). No significant difference was detected for molars with complete eruption (p > 0.05). The benefit of fluoride gel for arresting non-cavitated caries lesions could not be identified by clinical assessment in this short-term trial. Notwithstanding, when the cariogenic challenge was greater (as on the occlusal surfaces of erupting molars), 1.23% APF gel treatment was an important tool for caries control.

Abstract This study aimed to assess the prevalence, extent, and associated factors of underlying dentin shadows (UDS) in the occlusal surfaces of permanent posterior teeth among 12-year-old schoolchildren from southern Brazil. A population-based cross-sectional study that included a representative sample of 1,528 schoolchildren was conducted in Porto Alegre, southern Brazil (participation rate: 83.2%). A questionnaire on sociodemographic characteristics, behavioral habits, and access to dental services was sent to parents/legal guardians of each student selected. Caries examination included the recording of non-cavitated and cavitated lesions, including the presence of UDS, as defined by the ICDAS Group (i.e., a shadow of discolored dentin visible through an apparently intact enamel surface that may or may not show signs of localized breakdown – ICDAS Code 4). The association between predictor variables and UDS prevalence was assessed using survey Poisson regression models. The prevalence of UDS was 6.3% (95%CI = 1.2 –11.3). The mean number of affected teeth among the schoolchildren presenting UDS was 1.51 (95%CI = 1.40 –1.61), ranging from 1 to 6. Type of school (public, PR = 2.23, 95%CI = 1.22 –4.07) and caries experience (DMFT 1-2, PR = 2.41, 95%CI = 1.15 –5.04; DMFT ≥ 3, PR = 3.09, 95%CI = 1.52 –6.27) were significantly associated with UDS prevalence. In conclusion, this population-based cross-sectional study found a low prevalence of UDS in the occlusal surfaces of the permanent posterior teeth of 12-year-old southern Brazilian schoolchildren. Overall caries experience and type of school were associated with UDS in this population.

Abstract: This longitudinal study aimed to assess the association between the use of fixed orthodontic appliances and the incidence/increment of active caries lesions in adolescents and young adults over a one-year period. A total of 135 10-30-year-old individuals were divided into two groups: Group G0 was composed of individuals who required orthodontic treatment, but who did not undergo fixed orthodontic therapy over the study period (n=70); Group G1 was composed of individuals who used a fixed orthodontic appliance for 1 year (n=65). Data collection included a questionnaire and clinical oral examinations (plaque index, gingival index, and dental caries index), performed at baseline and after 1 year. Caries examination was performed by a single calibrated examiner, after tooth cleaning and drying, and included the recording of non-cavitated and cavitated, inactive and active lesions of all tooth surfaces. Poisson regression models were used to assess the association between the group and the following study outcomes: incidence (binary variable) and increment (counting variable). The incidence of active caries lesions was 4.8% in G0 and 39.6% in G1. The mean increment of active caries lesions was 0.14 in G0 and 0.61 in G1. G1 showed a greater risk of developing active caries lesions than G0 (incidence analysis, adjusted IRR=9.48, 95%CI=2.62-34.30; increment analysis, adjusted IRR=4.13; 95%CI=1.94-8.79). In conclusion, this study showed that individuals undergoing fixed orthodontic therapy for 1 year had a significantly higher incidence and increment of active caries lesions than those without a fixed appliance.

Abstract This study assessed the effect of area of residence (rural vs. urban) on dental caries experience among southern Brazilian schoolchildren. This cross-sectional survey was conducted in Rosário do Sul, southern Brazil, and included 373 9–14-year-old schoolchildren attending public municipal schools (122 living in the rural area, and 251, in the urban area). Data collection included a questionnaire and a clinical examination. Clinical examination of the permanent dentition involved visible plaque index, gingival bleeding index and dental caries experience (non-cavitated and cavitated, inactive and active lesions). Samples of water were collected to check the fluoride concentration. Caries prevalence and extent using different criteria were compared between rural and urban schoolchildren using the chi-square test and the Mann-Whitney test, respectively. The association between explanatory variables and the extent of caries activity (number of active caries lesions) was assessed using Poisson regression. When caries was recorded at the cavity level (WHO criterion), no difference was observed between rural and urban populations (p ≥ 0.05). Conversely, higher caries prevalence and extent were found among urban schoolchildren when active non-cavitated lesions were also computed (p < 0.05). In the adjusted Poisson regression model, urban schoolchildren were 57% more likely to present more active lesions than rural students (RR = 1.57; 95%CI = 1.29–1.92). Rural communities did not have sufficient fluoride in the water supply, whereas ideal concentrations were detected in the urban areas. In conclusion, this cross-sectional study found that urban schoolchildren showed greater caries experience than rural students, and that this increment was related to active non-cavitated lesions.

Abstract The aim of this study was to assess the occurrence of erosive tooth wear (ETW) among 15–19-year-old South Brazilian adolescents, regarding prevalence, extent, severity, intraoral distribution, and sociodemographic risk indicators. A population-based cross-sectional survey was conducted in Santa Maria, southern Brazil, and included a representative sample of 15–19-year-old adolescents. Data collection included the application of a questionnaire and a clinical examination. A questionnaire was sent to the parents/legal guardians of the selected students, containing questions on demographic information, socioeconomic characteristics, and living conditions. After tooth cleaning and drying, all erupted permanent teeth were clinically assessed by two calibrated examiners, and classified according to the Basic Erosive Wear Examination (BEWE). The association between explanatory variables and the outcomes (ETW prevalence and extent) was assessed using Poisson regression models (both unadjusted and adjusted). A total of 1,197 adolescents were included in the study (participation rate of 72.3%). The overall prevalence of ETW was 57%. Severe ETW affected 16% of the sample. Overall, this adolescent population presented 13.3 affected surfaces, and 8.34 affected teeth. In the risk assessment analysis, gender, skin color, socioeconomic status, and family income were significantly associated with ETW. Boys, white adolescents, and those with higher socioeconomic status were more affected by ETW. This population-based cross-sectional study revealed that the prevalence of ETW was high, and that it was associated with sociodemographic variables in this South Brazilian population of adolescents.

The aim of this study was to assess the frequency of routine use of dental prophylaxis prior to visual inspection, in order to diagnose caries, by dentists with different lapses of time after graduating time. One hundred and fifty one Brazilian dentists were interviewed in 3 Brazilian cities to determine if they usually remove dental plaque prior to visual inspection for caries diagnosis. The dentists were stratified according to year of graduation. The association between the lapse of time after graduating and the practice of routinely removing dental plaque before clinical examination was tested using the chi-square test with a significance level of 5%. Only 28.5% of the dentists reported that they usually remove dental plaque prior to clinical examination. The dentists who graduated in the last 15 years presented the lowest percentages of plaque removal prior to clinical examination (15.1%), whereas the more experienced dentists reported that they perform prophylaxis more frequently. Of the professionals who graduated from 1960-1975, 23.9% reported that they performed dental plaque removal prior to diagnosis, whereas the figure for those graduating from 1976-1990 was 46.2%. Most of the dentists interviewed reported that they did not remove dental plaque prior to performing visual diagnosis of caries.