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 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 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 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 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.