To compare normative methods of orthodontic treatment need with the sociodental approach in 12-ye... more To compare normative methods of orthodontic treatment need with the sociodental approach in 12-year-old students and correlate the normative measures of malocclusion with the impact of oral health on daily activities. A cross-sectional study of 201 12-year-old students was conducted in the city of Manaus, Brazil. The normative orthodontic treatment need was determined by oral clinical examination using two occlusal indices, the Index of Orthodontic Treatment Need (IOTN), comprising the Dental Health Component (DHC) and Aesthetic Component (AC ), and the Dental Aesthetic Index (DAI). The sociodental approach combined normative measures (IOTN and DAI), the impact of malocclusion on daily activities (Child-Oral Impacts on Daily Performances index, Child-OIDP) and propensity- related orthodontic treatment assessment. The normative method and the sociodental approach of orthodontic treatment needs assessment were compared using the McNemar test. The association between the impact of malo...
Background: There is limited evidence on possible associations between social determinants and de... more Background: There is limited evidence on possible associations between social determinants and dental pain. This study investigated the relationship of neighborhood and individual social capital with dental pain in adolescents, adults and the elderly. Methods: A population-based multilevel study was conducted involving 624 subjects from 3 age groups: 15–19, 35–44 and 65–74 years. They were randomly selected from 30 census tracts in three cities in the State of Paraíba, Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. The outcome of study was the presence of dental pain in the last 6 months. Information on dental pain, demographic, socio-economic, health-related behaviors, use of dental services, self-perceived oral health and social capital measures was collected through interviews. Participants underwent a clinical examination for assessment of dental caries. Neighborhood social capital was evaluated using aggregated measures of social trust, social control, empowerment, political efficacy and neighborhood safety. Individual social capital assessment included bonding and bridging social capital. Multilevel logistic regression was used to test the relationship of neighborhood and individual social capital with dental pain after sequential adjustment for covariates. Results: Individuals living in neighborhoods with high social capital were 52% less likely to report dental pain than those living in neighborhoods with low social capital (OR = 0.48, 95% CI = 0.27-0.85). Bonding social capital (positive interaction) was independently associated with dental pain (OR = 0.88, 95% CI = 0.80-0.91). Last dental visit, self-perceived oral health and number of decayed teeth were also significantly associated with dental pain. Conclusions: Our findings suggest that contextual and individual social capital are independently associated with dental pain.
Background: Social conditions, social relationships and neighbourhood environment, the components... more Background: Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum. Methods: A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two groups: 1. Good SRH – good SRH at baseline and follow-up, and, 2. Poor SRH – poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable), individual social capital (social support and social networks), demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates. Results: The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37- 0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house. Conclusions: Low individual social capital during pregnancy, considered here as social support and social network, was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women’s SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of individual social capital explained better the consistency of SRH over time than neighbourhood social capital.
Objective: This study assesses the association among factors related with specific clinical
forms... more Objective: This study assesses the association among factors related with specific clinical forms of oral candidiasis (OC) in HIV-infected Brazilian adults. Design: This study was conducted with 590 HIV-infected adults from 1997 to 2004. The OC diagnosis was based in accordance with the EC-Clearinghouse classification. Multivariate logistic regression analyses were performed to measure the association between HAART and OC, with pseudomembranous [PC], erythematous [EC], and angular cheilitis [AC]) adjusted for HIV-related diseases, smoking, alcohol consumption, injecting and non-injecting drug use. Results: Two hundred and eighteen (37.0%) individuals were undergoing HAART. The prevalence of PC, EC and AC was 21.2%, 15.7% and 8.8%, respectively. Approximately 64% of the individuals with PC and EC, and 76.5% with AC had absolute CD4 levels 200 cells/mm3. The results of the multivariate analysis showed that subjects not undergoing HAART had a significantly higher odds ratio for PC [OR 3.67 (95% CI: 1.97–6.80)] and EC [OR 1.88 (95% CI: 1.04–3.39)], and AC [OR 4.56 (95% CI: 1.58–13.19)]. In addition, smoking [OR 2.58 (95% CI: 1.43–4.68)] and pneumocystis pneumonia [OR 1.92 (95% CI: 1.07–3.42)] were associated with PC, while high alcohol consumption [OR 3.40 (95% CI: 1.13–10.18)] and cytomegalovirus infection [OR 2.34 (95% CI: 1.06–5.15)] were associated with EC. Conclusion: The data indicates that the odds of having all clinical forms of OC are higher in HIV-infected adults not receiving HAART.
Aim: The aim of this systematic review and meta-analysis was to assess and compare
peri-implant m... more Aim: The aim of this systematic review and meta-analysis was to assess and compare peri-implant marginal bone loss in cement- and screw-retained prostheses. Material and Methods: Electronic database and manual searches were undertaken to identify trials, prospective or retrospective studies reporting on radiographic marginal bone loss around dental implants restored with cement- and/or screwretained prostheses. Two reviewers independently conducted the article selection and data extraction. Random-effects models were used to obtain estimates of peri-implant marginal bone loss [mean, 95% confidence intervals (CI)]. Results: Of the 1217 identified studies, nine finally met the inclusion criteria. Only two studies included both cement- and screw-retained prostheses, three assessed only screw-retained prostheses, and four evaluated only cement-retained prostheses. Pooled mean marginal bone loss was 0.53 mm (CI 95%, 0.31–0.76 mm) for cementretained prostheses and 0.89 mm (CI 95%, 0.45–1.33 mm) for screw-retained prostheses. Conclusion: There is no evidence to support differences in the marginal bone loss through indirect comparison between cement and screw-retained restorations.
OBJECTIVE: To estimate the prevalence and to identify sociodemographic and
oral health factors as... more OBJECTIVE: To estimate the prevalence and to identify sociodemographic and oral health factors associated with the negative impact of oral health conditions on the quality of life in adolescents. METHODS: Data from 5,445 adolescents aged 15-19, who took part in the Brazilian Oral Health Survey (SBBrasil 2010) were analyzed, using a multistage sampling design. The outcome was quality of life related to oral health, which was assessed using the Oral Impacts on Daily Performance questionnaire and analyzed as a discrete variable. The independent variables were sex, skin color, schooling, household income, age, untreated dental caries, malocclusion.,gingival bleeding, dental calculus, and periodontal pocket. Poisson regression analysis was carried out and mean ratios (MR) with their respective 95% confi dence intervals (95%CI) were presented. RESULTS: Of the total, 39.4% reported at least one negative impact on their quality of life. After adjustment, the mean negative impact was 1.52 (95%CI 1.16;2.00) times higher in females and 1.42 (95%CI 1.01;1.99), 2.66 (95%CI 1.40;5.07) and 3.32 (95%CI 1.68;6.56) higher in those with brown, yellow, and indigenous skin color, respectively, when compared to those with white skin. The lower the level of schooling, the greater the negative impact (MR 2.11, 95%CI 1.30;3.41), likewise for individuals with household income below R$ 500.00 (MR 1.84, 95%CI 1.06;3.17) compared with those with higher incomes. The greatest impact on quality of life was found among adolescents with four or more teeth with untreated dental caries (MR 1.53, 95%CI 1.12;2.10), one or more missing teeth (MR 1.44. 95%CI 1.16;1.80). those with dental pain (RM 3.62, 95%CI 2.93;4.46) and with severe (MR 1.52, 95%CI 1.04;2.23) and very severe malocclusion (MR 1.32, 95%CI 1.01;1.72). CONCLUSIONS: Brazilian adolescents reported a high negative impact of oral health on their quality of life. Inequalities in distribution should be taken into account when planning preventive, monitoring and treatment strategies for oral health problems in groups with the highest impact on their quality of life.
Abstract – Objective: Social capital incorporates neighbourhood and individual
levels of interact... more Abstract – Objective: Social capital incorporates neighbourhood and individual levels of interactions and influences health. The objective of this was to assess the association of neighbourhood and individual social capital with oral health–related quality of life (OHRQoL) in pregnant and postpartum women. Methods: This was a follow-up prevalence multilevel study on a representative sample of 1248 women grouped into 55 neighbourhoods. OHRQoL was assessed in the postpartum period using the Oral Health Impact Profile questionnaire (OHIP-14). Exploratory variables were gathered during the first trimester of pregnancy and included neighbourhood social capital (neighbourhood-level measure), individual social capital (social support and social networks), demographic and socio-economic variables, oral health measures, and health-related behaviours. Results: The multilevel ordered multinomial logistic regression showed that neighbourhood social capital did not significantly affect women’s OHRQoL during pregnancy and postpartum period. Individual social capital measures were independently associated with high OHRQoL. Lack of family social network increased the odds for high OHRQoL (OR = 1.44, 95% CI: 1.08–1.92). Individuals with high levels of positive social interaction were less likely to report high scores of OHRQoL (OR = 0.90, 95% CI: 0.82–0.98). Conclusion: Individual social capital was of greater relevance to women’s OHRQoL in and after pregnancy than neighbourhood social capital. These findings suggest that quality of personal and social resources of pregnant women are more important for OHRQoL than the neighbourhoods where the women live.
PURPOSE:
The objective of this systematic review and meta-analysis was to assess and compare the... more PURPOSE:
The objective of this systematic review and meta-analysis was to assess and compare the marginal bone loss around implants supporting single fixed prostheses and multiple-unit screw-retained prostheses. MATERIALS AND METHODS:
The literature was searched manually and electronically to identify studies in which the marginal peri-implant bone loss around single-implant prostheses and screw-retained multiple-implant prostheses was evaluated radiographically. Two reviewers independently selected the literature and extracted the data. The random-effects method was used to obtain estimates of marginal peri-implant bone loss (means and 95% confidence intervals [CIs]). RESULTS:
Of the 2,107 studies identified by a preliminary search, 17 fulfilled the inclusion criteria; 7 were related to single-implant prostheses and 10 to multiple-implant screw-retained fixed prostheses. The mean marginal peri-implant bone loss was 0.9 mm (95% CI, 0.49 to 1.32 mm) for multiple-implant screw-retained prostheses and 0.58 mm (95% CI, 0.37 to 0.80 mm) for single-implant prostheses. CONCLUSION:
This indirect comparison provided no evidence to support the assertion that there are differences in marginal peri-implant bone loss between single implant prostheses and multiple screw-retained prostheses.
Background. The capacity to overcome social disadvantages
and maintain oral health through psycho... more Background. The capacity to overcome social disadvantages and maintain oral health through psychosocial processes remains poorly understood in children. Aim. This study assessed the relationship of children’s resilience and maternal sense of coherence (SOC) with gingival status in children from lowincome families. Methods. A cross-sectional study was conducted on 190 schoolchildren aged 11–12 years and their mothers. Family socioeconomic characteristics and housing conditions, maternal and children’s oral cleanliness behaviours (tooth brushing and dental floss use), maternal SOC, children’s resilience, and demographic data were collected through interviews with children and their mothers. Validated versions of Antonovsky’s scale and the resilience scale were used to assess mother’s SOC and children’s resilience. Gingival status and dental plaque of children were evaluated through clinical examinations using bleeding on probing index and plaque index. Statistical analysis included Pearson’s correlation and hierarchical multinomial ordinal logistic regression analyses. Results. The mean frequency of gingival bleeding in the sample was 8.4% (SD: 8.5). Children with higher levels of resilience showed 31% lower odds of gingival bleeding (OR: 0.7; 95% CI: 0.4–0.9) after adjustment for socioeconomic characteristics, children’s and mothers’ use of dental floss. Conclusions. Children’s resilience was a psychosocial factor associated with gingival conditions.
Objective: To investigate the relationship of contextual social capital (neighborhood empowerment... more Objective: To investigate the relationship of contextual social capital (neighborhood empowerment) and individual social capital (social support and social network) with dental caries experience in adolescents and adults. Methods: A population-based multilevel study was conducted involving 573 subjects, 15-19 and 35-44 years of age, from 30 census tracts in three cities of Paraíba, Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. Caries experience was assessed using the DMFT index (decayed, missing and filled teeth) and participants were divided into two groups according to the median of the DMFT index in low and high caries experience. Demographic, socioeconomic, behaviors, use of dental services and social capital measures were collected through interviews. Neighborhood empowerment was obtained from the mean scores of the residents in each census tract. Multilevel multivariate logistic regression was used to test the relationship between neighborhood empowerment and caries experience. Results: High caries experience was inversely associated with neighborhood empowerment (OR = 0.58; 95%CI 0.33 – 0.99). Individual social capital was not associated with caries experience. Other associated factors with caries experience were age (OR = 1.15; 95%CI 1.12 – 1.18) and being a female (OR = 1.72; 95%CI 1.08 – 2.73). Conclusion: The association between neighborhood empowerment and caries experience suggests that the perception of features of the place of residence should be taken into account in actions of oral health promotion.
OBJECTIVE: To estimate the prevalence and geographical distribution of
periodontal disease in the... more OBJECTIVE: To estimate the prevalence and geographical distribution of periodontal disease in the Brazilian adult population and its associations with contextual and individual social inequalities. METHODS: Data from adults aged 35 to 44 who participated in the 2010 Brazilian Brazilian Oral Health Survey (SBBrasil 2010) (n = 9,564) were used. The Community Periodontal Index (CPI) and clinical attachment loss (CAL) were used to defi ne “moderate to severe” periodontal disease (CPI > 2 and CAL > 0) and “severe” periodontal disease (CPI > 2 and CAL > 1). Contextual social inequalities assessed were Human Development Index and income inequalitiy (Gini Index). Other contextual variables were integration of oral health teams in the Family Health Programme and the percentage of adult smokers. Multilevel logistic regression models for participants with complete data (n = 4,594) were used to estimate odds ratios (OR) and 95% confi dence intervals (95%CI) between social inequalities and periodontal disease. RESULTS: The prevalence of “moderate to severe” and “severe” periodontal disease in Brazilian adults was 15.3% and 5.8%, respectively, with considerable variation across municipalities. Of the contextual variables, income inequality was independently associated with “severe” periodontal disease (OR = 3.0, 95%CI 1.5;5.9). Lower oral health teams coverage was associated with both defi nitions of periodontal disease whereas the percentage of smokers remained associated with “moderate to severe” periodontal disease. Older adults, brown skin color, males and those with lower family income and less schooling were more likely to both periodontal conditions. CONCLUSIONS: In Brazil, the prevalence of periodontal disease varied across the municipalities and according to defi nition of periodontal disease. Income inequality played a signifi cant role in the occurrence of “severe” periodontal disease. Individual characteristics of social position were associated with both forms of periodontal disease.
Objective: To compare health-related quality of life and oral health–related quality of life
betw... more Objective: To compare health-related quality of life and oral health–related quality of life between nonsyndromic individuals with and without cleft lip and/or cleft palate and to identify the most affected quality of life dimensions in individuals with cleft lip and/or palate. Design: Systematic review and meta-analysis were conducted. Of the 314 identified citations, 23 articles were submitted to quality assessment. Data from nine studies on health-related quality of life and six on oral health–related quality of life were extracted for meta-analysis. Main Outcome Measures: Pooled mean differences of health-related quality of life between adults with and without cleft lip and/or palate, pooled means of health-related quality of life dimensions of children and adults with cleft lip and/or palate and oral health–related quality of life dimensions of children and adolescents with cleft lip and/or palate with a 95% confidence interval were calculated. Results: Quality assessment revealed methodological differences between studies. Lack of subgroup stratification and absence of control for confounders were the main limitations. Heterogeneity was detected on the comparison of oral health–related quality of life and healthrelated quality of life between children with and without cleft lip and/or palate, and oral health– related quality of life between adolescents with and without cleft lip and/or palate. A randomeffect model showed a significant difference on health-related quality of life between adults with and without cleft lip and/or palate (mean difference¼0.10; 95% confidence interval, 0.16 to 0.05). Psychological health (mean, 78.9; 95% confidence interval, 70.1 to 87.7) and vitality (mean, 68.1; 95% confidence interval, 48.0 to 88.1) were the most affected health-related quality of life dimensions in children and adults with cleft lip and/or palate, respectively. Means of healthrelated quality of life dimensions in children and adults with cleft lip and/or palate and oral health–related quality of life in children and adolescents with cleft lip and/or palate varied yet did not differ in indirect comparisons. Conclusion: The presence of cleft lip and/or palate negatively affected the health-related quality of life of adults, mainly on psychosocial dimensions.
Purpose This study investigated the relationship between
contextual and individual social determi... more Purpose This study investigated the relationship between contextual and individual social determinants of oral health-related quality of life (OHRQoL) in Brazilian adults. Methods Data of 4594 Brazilian adults aged 35–44 years from the 2010 Brazilian Oral Health Survey were analysed. OHRQoL was measured using the Oral Impacts on Daily Performance (OIDP). Contextual socio-economic characteristics at city level assessed in 1991 and 2000 included social deprivation measured by Human Development Index (HDI) and income inequality (Gini index). Individual socio-economic characteristics included family income, schooling and number of goods. Covariates were age, sex, ethnicity and clinical oral measures. Multilevel multivariable Poisson regression analysis was carried to investigate the association of contextual and individual social characteristics with OIDP extent and with each OIDP item. Results Eating and cleaning teeth were the most reported daily activities influenced by oral conditions. In the adjusted analysis, low HDI 1991 and individual social characteristics (lower family income and lower schooling) were associated with OIDP extent. Sex (females) and all clinical oral measures were also associated with OIDP. Adults living in the cities with low HDI 1991 were more likely to have impact on eating and sleeping, whereas living in cities with high Gini index 1991 increased the prevalence of impact on emotional status, work and social contact. Low income was associated with all OIDP items. Conclusion Poor contextual social determinants and lower individual socio-economic position are associated with worse OHRQoL among Brazilian adults, even after adjusting for individual socio-demographic and clinical oral health variables.
Objectives: To assess whether Brazilianmiddle-aged adults living in cities that experienced
a rel... more Objectives: To assess whether Brazilianmiddle-aged adults living in cities that experienced a relative increase on income inequalityweremore likely to have severe tooth loss and lack a functional dentition. Methods: Data on Brazilian adults aged 35-44 years from state capitals and Federal District from the 2010 Brazilian Oral Health Survey (SBBrasil 2010) were analyzed. Clinically assessed tooth loss outcomes were severe tooth loss (<9 remaining natural teeth) and lack of functional dentition (<21 natural teeth). Income inequality was assessed by Gini Index in 1991, 2000, and 2003 using tertiles of distribution.Variation in Gini Index was assessed by changes in the tertiles distribution between years. Multilevel logistic regression models were used to estimate odds ratios (ORs) and 95 percent confidence intervals (95 percent CI) between variation in income inequality and tooth loss outcomes adjusting for individual socio-demographic characteristics. Results: Prevalence of severe tooth loss and lack of functional dentition was 4.8 percent and 21.2 percent, respectively. Individuals living in cities withmoderate and high increase in income inequality between 1991 and 2003 weremore likely to have severe tooth loss and lack a functional dentition in 2010 compared with those living in citieswith stable income inequality in the same period.Relationships between low family income and both tooth loss outcomeswere significantly attenuated by relative increases in income inequality. Conclusions: Relative increases in income inequality were significantly associated with severe tooth loss and lack of a functional dentition in Brazilian middle-aged adults.
There is limited evidence concerning the role of social networks
on the oral health of adolescent... more There is limited evidence concerning the role of social networks on the oral health of adolescents. This study assessed the association between the participation of adolescents in community groups and dental caries. A cross-sectional household-based study was carried out involving 200 subjects aged 15–19 years living in a deprived area in the state of Amazon, Brazil. Dental caries was assessed through dental examinations using the DMFT index conducted by a single examiner who was previously calibrated. Four dental caries outcomes were investigated, including caries experience (DMFT score), current caries (number of current decayed teeth), missing teeth due to caries, and the care index (ratio between number of filled teeth and DMFT score). Details of participation of adolescents in community groups, demographic and socioeconomic data and information on dental visiting were obtained through individual interviews. All caries measures were significantly higher in adolescents who did not participate in community groups compared to their counterparts. Multivariate Poisson regression showed that participation of adolescents in community groups was independently associated with all dental caries outcomes. After adjusting for confounders, participation in community groups was statistically associated with lower DMFT score (ratio of mean, RM: 0.33, 95% CI: 0.24–0.46), fewer decayed teeth (RM: 0.23, 95% CI: 0.11–0.47), fewer missing teeth (RM: 0.28, 95% CI: 0.17–0.47), and higher care index (RM: 1.69, 95% CI: 1.24–2.29) than those who did not participate. Participation of adolescents in community activities was related to lower levels of dental caries.
Background: This study assessed clustering of three health-compromising behaviours and explored t... more Background: This study assessed clustering of three health-compromising behaviours and explored the association of neighbourhood and individual social capital with simultaneous health-compromising behaviours and patterns of those behaviours in women in the first trimester of pregnancy (baseline) and during the second and third trimesters of pregnancy (follow-up). Methods: A longitudinal study was conducted on a representative sample of women recruited in antenatal care units grouped in 46 neighbourhoods from Brazil. Neighbourhood-level measures (social capital and socioeconomic status), individual social capital (social support and social networks) and socio-demographic variables were collected at baseline. Smoking, alcohol consumption and inadequate diet were assessed at baseline and follow-up. Clustering was assessed using an observed to expected ratio method. The association of contextual and individual social capital with the health-compromising behaviours outcomes was analyzed through multilevel multivariate regression models. Results: Clustering of the three health-compromising behaviours as well as of smoking and alcohol consumption were identified at both baseline and follow-up periods. Neighbourhood social capital did not influence the occurrence of simultaneous health-compromising behaviours. More health-compromising behaviours in both periods was inversely associated with low levels of individual social capital. Low individual social capital predicted smoking during whole pregnancy, while high individual social capital increased the likelihood of stopping smoking and improving diet during pregnancy. Maintaining an inadequate diet during pregnancy was influenced by low individual and neighbourhood social capital. Conclusions: Three health-compromising behaviours are relatively common and cluster in Brazilian women throughout pregnancy. Low individual social capital significantly predicted simultaneous health-compromising behaviours and patterns of smoking and inadequate diet during pregnancy while low neighbourhood social capital was only relevant for inadequate diet. These findings suggest that interventions focusing on reducing multiple behaviours should be part of antenatal care throughout pregnancy. Individual and contextual social resources should be considered when planning the interventions.
Background: Oral health care needs assessment is frequently restricted to clinical measures. Comb... more Background: Oral health care needs assessment is frequently restricted to clinical measures. Combining normative assessment, behavioural propensity, oral health-related quality of life and information of family living conditions may provide a better comprehensive approach of adolescent’s oral health needs assessment. The aim of this study was to compare normative methods of dental caries need with the sociodental approach in 12-year-old adolescents according to family’s living conditions in a deprived community in Brazil. In addition, dental caries need assessment using the normative method and the sociodental approach was compared between adolescents living in different living conditions. Methods: A cross-sectional survey was conducted in the Manguinhos community in the city of Rio de Janeiro, Brazil. A weighted sample of 159 participants was randomly selected to represent the population of 2004 12-year-old adolescents. Socioeconomic characteristics and living conditions of the family were assessed using the Family Development Index (FDI). Oral health-related quality of life (OHRQoL) was assessed using the generic and CS-Child-OIDP, and adolescent’s propensity to adopt oral health promoting behaviours was verified through interviews. Dental caries and treatment need were assessed normatively by clinical oral examinations (DMFT Index) and adolescents were classified into two groups (non severe or severe caries). The sociodental approach included clinical measures of caries, propensity to adopt oral health promoting behaviors and OHRQoL. Families were classified based on the FDI as ‘not severe’, ‘severe’ and ‘very severe’. Measures of caries, OHRQoL and propensity outcomes were compared between FDI groups using Chi-square and Kruskal–Wallis tests. In addition, dental treatment needs using normative method and sociodental approach were compared for the whole sample and according to FDI groups. Results: Dental caries, OHRQoL and lower propensity needs were positively associated with FDI severity. The percentages of adolescents with normative dental needs from families with ‘very severe’, ‘severe’ and ‘not severe’ FDI were 59.3, 48.4 and 17.2 % (P < 0.05). Using the sociodental approach, the treatment needs for the three FDI groups decreased to 8.8, 13.6 and 8.6 %, respectively (P < 0.05). Conclusions: Using a combination of sociodental approach and the index of family living conditions was useful for defining dental care priorities in adolescents living in deprived communities and can optimise the use of resources in dental services.
Community dentistry and oral epidemiology, Jan 21, 2014
The aim of this study was to investigate the association between intermediary social determinants... more The aim of this study was to investigate the association between intermediary social determinants, namely social support and social network with dental caries in adolescents. An adapted version of the WHO social determinants of health conceptual framework was used to organize structural and intermediary social determinants of dental caries into six blocks including perceived social support and number of social networks. A cross-sectional study was conducted with a representative sample of 542 students between 12 and 14 years of age in public schools located in the city of Dourados, Brazil in 2012. The outcome variables were caries experience (DMFT ≥ 1) and current dental caries (component D of DMFT ≥ 1) recorded by a calibrated dentist. Individual interviews were performed to collect data on perceived social support and numbers of social networks from family and friends and covariates. Multivariate Poisson regressions using hierarchical models were conducted. The prevalence of adole...
To compare normative methods of orthodontic treatment need with the sociodental approach in 12-ye... more To compare normative methods of orthodontic treatment need with the sociodental approach in 12-year-old students and correlate the normative measures of malocclusion with the impact of oral health on daily activities. A cross-sectional study of 201 12-year-old students was conducted in the city of Manaus, Brazil. The normative orthodontic treatment need was determined by oral clinical examination using two occlusal indices, the Index of Orthodontic Treatment Need (IOTN), comprising the Dental Health Component (DHC) and Aesthetic Component (AC ), and the Dental Aesthetic Index (DAI). The sociodental approach combined normative measures (IOTN and DAI), the impact of malocclusion on daily activities (Child-Oral Impacts on Daily Performances index, Child-OIDP) and propensity- related orthodontic treatment assessment. The normative method and the sociodental approach of orthodontic treatment needs assessment were compared using the McNemar test. The association between the impact of malo...
Background: There is limited evidence on possible associations between social determinants and de... more Background: There is limited evidence on possible associations between social determinants and dental pain. This study investigated the relationship of neighborhood and individual social capital with dental pain in adolescents, adults and the elderly. Methods: A population-based multilevel study was conducted involving 624 subjects from 3 age groups: 15–19, 35–44 and 65–74 years. They were randomly selected from 30 census tracts in three cities in the State of Paraíba, Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. The outcome of study was the presence of dental pain in the last 6 months. Information on dental pain, demographic, socio-economic, health-related behaviors, use of dental services, self-perceived oral health and social capital measures was collected through interviews. Participants underwent a clinical examination for assessment of dental caries. Neighborhood social capital was evaluated using aggregated measures of social trust, social control, empowerment, political efficacy and neighborhood safety. Individual social capital assessment included bonding and bridging social capital. Multilevel logistic regression was used to test the relationship of neighborhood and individual social capital with dental pain after sequential adjustment for covariates. Results: Individuals living in neighborhoods with high social capital were 52% less likely to report dental pain than those living in neighborhoods with low social capital (OR = 0.48, 95% CI = 0.27-0.85). Bonding social capital (positive interaction) was independently associated with dental pain (OR = 0.88, 95% CI = 0.80-0.91). Last dental visit, self-perceived oral health and number of decayed teeth were also significantly associated with dental pain. Conclusions: Our findings suggest that contextual and individual social capital are independently associated with dental pain.
Background: Social conditions, social relationships and neighbourhood environment, the components... more Background: Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum. Methods: A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two groups: 1. Good SRH – good SRH at baseline and follow-up, and, 2. Poor SRH – poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable), individual social capital (social support and social networks), demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates. Results: The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37- 0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house. Conclusions: Low individual social capital during pregnancy, considered here as social support and social network, was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women’s SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of individual social capital explained better the consistency of SRH over time than neighbourhood social capital.
Objective: This study assesses the association among factors related with specific clinical
forms... more Objective: This study assesses the association among factors related with specific clinical forms of oral candidiasis (OC) in HIV-infected Brazilian adults. Design: This study was conducted with 590 HIV-infected adults from 1997 to 2004. The OC diagnosis was based in accordance with the EC-Clearinghouse classification. Multivariate logistic regression analyses were performed to measure the association between HAART and OC, with pseudomembranous [PC], erythematous [EC], and angular cheilitis [AC]) adjusted for HIV-related diseases, smoking, alcohol consumption, injecting and non-injecting drug use. Results: Two hundred and eighteen (37.0%) individuals were undergoing HAART. The prevalence of PC, EC and AC was 21.2%, 15.7% and 8.8%, respectively. Approximately 64% of the individuals with PC and EC, and 76.5% with AC had absolute CD4 levels 200 cells/mm3. The results of the multivariate analysis showed that subjects not undergoing HAART had a significantly higher odds ratio for PC [OR 3.67 (95% CI: 1.97–6.80)] and EC [OR 1.88 (95% CI: 1.04–3.39)], and AC [OR 4.56 (95% CI: 1.58–13.19)]. In addition, smoking [OR 2.58 (95% CI: 1.43–4.68)] and pneumocystis pneumonia [OR 1.92 (95% CI: 1.07–3.42)] were associated with PC, while high alcohol consumption [OR 3.40 (95% CI: 1.13–10.18)] and cytomegalovirus infection [OR 2.34 (95% CI: 1.06–5.15)] were associated with EC. Conclusion: The data indicates that the odds of having all clinical forms of OC are higher in HIV-infected adults not receiving HAART.
Aim: The aim of this systematic review and meta-analysis was to assess and compare
peri-implant m... more Aim: The aim of this systematic review and meta-analysis was to assess and compare peri-implant marginal bone loss in cement- and screw-retained prostheses. Material and Methods: Electronic database and manual searches were undertaken to identify trials, prospective or retrospective studies reporting on radiographic marginal bone loss around dental implants restored with cement- and/or screwretained prostheses. Two reviewers independently conducted the article selection and data extraction. Random-effects models were used to obtain estimates of peri-implant marginal bone loss [mean, 95% confidence intervals (CI)]. Results: Of the 1217 identified studies, nine finally met the inclusion criteria. Only two studies included both cement- and screw-retained prostheses, three assessed only screw-retained prostheses, and four evaluated only cement-retained prostheses. Pooled mean marginal bone loss was 0.53 mm (CI 95%, 0.31–0.76 mm) for cementretained prostheses and 0.89 mm (CI 95%, 0.45–1.33 mm) for screw-retained prostheses. Conclusion: There is no evidence to support differences in the marginal bone loss through indirect comparison between cement and screw-retained restorations.
OBJECTIVE: To estimate the prevalence and to identify sociodemographic and
oral health factors as... more OBJECTIVE: To estimate the prevalence and to identify sociodemographic and oral health factors associated with the negative impact of oral health conditions on the quality of life in adolescents. METHODS: Data from 5,445 adolescents aged 15-19, who took part in the Brazilian Oral Health Survey (SBBrasil 2010) were analyzed, using a multistage sampling design. The outcome was quality of life related to oral health, which was assessed using the Oral Impacts on Daily Performance questionnaire and analyzed as a discrete variable. The independent variables were sex, skin color, schooling, household income, age, untreated dental caries, malocclusion.,gingival bleeding, dental calculus, and periodontal pocket. Poisson regression analysis was carried out and mean ratios (MR) with their respective 95% confi dence intervals (95%CI) were presented. RESULTS: Of the total, 39.4% reported at least one negative impact on their quality of life. After adjustment, the mean negative impact was 1.52 (95%CI 1.16;2.00) times higher in females and 1.42 (95%CI 1.01;1.99), 2.66 (95%CI 1.40;5.07) and 3.32 (95%CI 1.68;6.56) higher in those with brown, yellow, and indigenous skin color, respectively, when compared to those with white skin. The lower the level of schooling, the greater the negative impact (MR 2.11, 95%CI 1.30;3.41), likewise for individuals with household income below R$ 500.00 (MR 1.84, 95%CI 1.06;3.17) compared with those with higher incomes. The greatest impact on quality of life was found among adolescents with four or more teeth with untreated dental caries (MR 1.53, 95%CI 1.12;2.10), one or more missing teeth (MR 1.44. 95%CI 1.16;1.80). those with dental pain (RM 3.62, 95%CI 2.93;4.46) and with severe (MR 1.52, 95%CI 1.04;2.23) and very severe malocclusion (MR 1.32, 95%CI 1.01;1.72). CONCLUSIONS: Brazilian adolescents reported a high negative impact of oral health on their quality of life. Inequalities in distribution should be taken into account when planning preventive, monitoring and treatment strategies for oral health problems in groups with the highest impact on their quality of life.
Abstract – Objective: Social capital incorporates neighbourhood and individual
levels of interact... more Abstract – Objective: Social capital incorporates neighbourhood and individual levels of interactions and influences health. The objective of this was to assess the association of neighbourhood and individual social capital with oral health–related quality of life (OHRQoL) in pregnant and postpartum women. Methods: This was a follow-up prevalence multilevel study on a representative sample of 1248 women grouped into 55 neighbourhoods. OHRQoL was assessed in the postpartum period using the Oral Health Impact Profile questionnaire (OHIP-14). Exploratory variables were gathered during the first trimester of pregnancy and included neighbourhood social capital (neighbourhood-level measure), individual social capital (social support and social networks), demographic and socio-economic variables, oral health measures, and health-related behaviours. Results: The multilevel ordered multinomial logistic regression showed that neighbourhood social capital did not significantly affect women’s OHRQoL during pregnancy and postpartum period. Individual social capital measures were independently associated with high OHRQoL. Lack of family social network increased the odds for high OHRQoL (OR = 1.44, 95% CI: 1.08–1.92). Individuals with high levels of positive social interaction were less likely to report high scores of OHRQoL (OR = 0.90, 95% CI: 0.82–0.98). Conclusion: Individual social capital was of greater relevance to women’s OHRQoL in and after pregnancy than neighbourhood social capital. These findings suggest that quality of personal and social resources of pregnant women are more important for OHRQoL than the neighbourhoods where the women live.
PURPOSE:
The objective of this systematic review and meta-analysis was to assess and compare the... more PURPOSE:
The objective of this systematic review and meta-analysis was to assess and compare the marginal bone loss around implants supporting single fixed prostheses and multiple-unit screw-retained prostheses. MATERIALS AND METHODS:
The literature was searched manually and electronically to identify studies in which the marginal peri-implant bone loss around single-implant prostheses and screw-retained multiple-implant prostheses was evaluated radiographically. Two reviewers independently selected the literature and extracted the data. The random-effects method was used to obtain estimates of marginal peri-implant bone loss (means and 95% confidence intervals [CIs]). RESULTS:
Of the 2,107 studies identified by a preliminary search, 17 fulfilled the inclusion criteria; 7 were related to single-implant prostheses and 10 to multiple-implant screw-retained fixed prostheses. The mean marginal peri-implant bone loss was 0.9 mm (95% CI, 0.49 to 1.32 mm) for multiple-implant screw-retained prostheses and 0.58 mm (95% CI, 0.37 to 0.80 mm) for single-implant prostheses. CONCLUSION:
This indirect comparison provided no evidence to support the assertion that there are differences in marginal peri-implant bone loss between single implant prostheses and multiple screw-retained prostheses.
Background. The capacity to overcome social disadvantages
and maintain oral health through psycho... more Background. The capacity to overcome social disadvantages and maintain oral health through psychosocial processes remains poorly understood in children. Aim. This study assessed the relationship of children’s resilience and maternal sense of coherence (SOC) with gingival status in children from lowincome families. Methods. A cross-sectional study was conducted on 190 schoolchildren aged 11–12 years and their mothers. Family socioeconomic characteristics and housing conditions, maternal and children’s oral cleanliness behaviours (tooth brushing and dental floss use), maternal SOC, children’s resilience, and demographic data were collected through interviews with children and their mothers. Validated versions of Antonovsky’s scale and the resilience scale were used to assess mother’s SOC and children’s resilience. Gingival status and dental plaque of children were evaluated through clinical examinations using bleeding on probing index and plaque index. Statistical analysis included Pearson’s correlation and hierarchical multinomial ordinal logistic regression analyses. Results. The mean frequency of gingival bleeding in the sample was 8.4% (SD: 8.5). Children with higher levels of resilience showed 31% lower odds of gingival bleeding (OR: 0.7; 95% CI: 0.4–0.9) after adjustment for socioeconomic characteristics, children’s and mothers’ use of dental floss. Conclusions. Children’s resilience was a psychosocial factor associated with gingival conditions.
Objective: To investigate the relationship of contextual social capital (neighborhood empowerment... more Objective: To investigate the relationship of contextual social capital (neighborhood empowerment) and individual social capital (social support and social network) with dental caries experience in adolescents and adults. Methods: A population-based multilevel study was conducted involving 573 subjects, 15-19 and 35-44 years of age, from 30 census tracts in three cities of Paraíba, Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. Caries experience was assessed using the DMFT index (decayed, missing and filled teeth) and participants were divided into two groups according to the median of the DMFT index in low and high caries experience. Demographic, socioeconomic, behaviors, use of dental services and social capital measures were collected through interviews. Neighborhood empowerment was obtained from the mean scores of the residents in each census tract. Multilevel multivariate logistic regression was used to test the relationship between neighborhood empowerment and caries experience. Results: High caries experience was inversely associated with neighborhood empowerment (OR = 0.58; 95%CI 0.33 – 0.99). Individual social capital was not associated with caries experience. Other associated factors with caries experience were age (OR = 1.15; 95%CI 1.12 – 1.18) and being a female (OR = 1.72; 95%CI 1.08 – 2.73). Conclusion: The association between neighborhood empowerment and caries experience suggests that the perception of features of the place of residence should be taken into account in actions of oral health promotion.
OBJECTIVE: To estimate the prevalence and geographical distribution of
periodontal disease in the... more OBJECTIVE: To estimate the prevalence and geographical distribution of periodontal disease in the Brazilian adult population and its associations with contextual and individual social inequalities. METHODS: Data from adults aged 35 to 44 who participated in the 2010 Brazilian Brazilian Oral Health Survey (SBBrasil 2010) (n = 9,564) were used. The Community Periodontal Index (CPI) and clinical attachment loss (CAL) were used to defi ne “moderate to severe” periodontal disease (CPI > 2 and CAL > 0) and “severe” periodontal disease (CPI > 2 and CAL > 1). Contextual social inequalities assessed were Human Development Index and income inequalitiy (Gini Index). Other contextual variables were integration of oral health teams in the Family Health Programme and the percentage of adult smokers. Multilevel logistic regression models for participants with complete data (n = 4,594) were used to estimate odds ratios (OR) and 95% confi dence intervals (95%CI) between social inequalities and periodontal disease. RESULTS: The prevalence of “moderate to severe” and “severe” periodontal disease in Brazilian adults was 15.3% and 5.8%, respectively, with considerable variation across municipalities. Of the contextual variables, income inequality was independently associated with “severe” periodontal disease (OR = 3.0, 95%CI 1.5;5.9). Lower oral health teams coverage was associated with both defi nitions of periodontal disease whereas the percentage of smokers remained associated with “moderate to severe” periodontal disease. Older adults, brown skin color, males and those with lower family income and less schooling were more likely to both periodontal conditions. CONCLUSIONS: In Brazil, the prevalence of periodontal disease varied across the municipalities and according to defi nition of periodontal disease. Income inequality played a signifi cant role in the occurrence of “severe” periodontal disease. Individual characteristics of social position were associated with both forms of periodontal disease.
Objective: To compare health-related quality of life and oral health–related quality of life
betw... more Objective: To compare health-related quality of life and oral health–related quality of life between nonsyndromic individuals with and without cleft lip and/or cleft palate and to identify the most affected quality of life dimensions in individuals with cleft lip and/or palate. Design: Systematic review and meta-analysis were conducted. Of the 314 identified citations, 23 articles were submitted to quality assessment. Data from nine studies on health-related quality of life and six on oral health–related quality of life were extracted for meta-analysis. Main Outcome Measures: Pooled mean differences of health-related quality of life between adults with and without cleft lip and/or palate, pooled means of health-related quality of life dimensions of children and adults with cleft lip and/or palate and oral health–related quality of life dimensions of children and adolescents with cleft lip and/or palate with a 95% confidence interval were calculated. Results: Quality assessment revealed methodological differences between studies. Lack of subgroup stratification and absence of control for confounders were the main limitations. Heterogeneity was detected on the comparison of oral health–related quality of life and healthrelated quality of life between children with and without cleft lip and/or palate, and oral health– related quality of life between adolescents with and without cleft lip and/or palate. A randomeffect model showed a significant difference on health-related quality of life between adults with and without cleft lip and/or palate (mean difference¼0.10; 95% confidence interval, 0.16 to 0.05). Psychological health (mean, 78.9; 95% confidence interval, 70.1 to 87.7) and vitality (mean, 68.1; 95% confidence interval, 48.0 to 88.1) were the most affected health-related quality of life dimensions in children and adults with cleft lip and/or palate, respectively. Means of healthrelated quality of life dimensions in children and adults with cleft lip and/or palate and oral health–related quality of life in children and adolescents with cleft lip and/or palate varied yet did not differ in indirect comparisons. Conclusion: The presence of cleft lip and/or palate negatively affected the health-related quality of life of adults, mainly on psychosocial dimensions.
Purpose This study investigated the relationship between
contextual and individual social determi... more Purpose This study investigated the relationship between contextual and individual social determinants of oral health-related quality of life (OHRQoL) in Brazilian adults. Methods Data of 4594 Brazilian adults aged 35–44 years from the 2010 Brazilian Oral Health Survey were analysed. OHRQoL was measured using the Oral Impacts on Daily Performance (OIDP). Contextual socio-economic characteristics at city level assessed in 1991 and 2000 included social deprivation measured by Human Development Index (HDI) and income inequality (Gini index). Individual socio-economic characteristics included family income, schooling and number of goods. Covariates were age, sex, ethnicity and clinical oral measures. Multilevel multivariable Poisson regression analysis was carried to investigate the association of contextual and individual social characteristics with OIDP extent and with each OIDP item. Results Eating and cleaning teeth were the most reported daily activities influenced by oral conditions. In the adjusted analysis, low HDI 1991 and individual social characteristics (lower family income and lower schooling) were associated with OIDP extent. Sex (females) and all clinical oral measures were also associated with OIDP. Adults living in the cities with low HDI 1991 were more likely to have impact on eating and sleeping, whereas living in cities with high Gini index 1991 increased the prevalence of impact on emotional status, work and social contact. Low income was associated with all OIDP items. Conclusion Poor contextual social determinants and lower individual socio-economic position are associated with worse OHRQoL among Brazilian adults, even after adjusting for individual socio-demographic and clinical oral health variables.
Objectives: To assess whether Brazilianmiddle-aged adults living in cities that experienced
a rel... more Objectives: To assess whether Brazilianmiddle-aged adults living in cities that experienced a relative increase on income inequalityweremore likely to have severe tooth loss and lack a functional dentition. Methods: Data on Brazilian adults aged 35-44 years from state capitals and Federal District from the 2010 Brazilian Oral Health Survey (SBBrasil 2010) were analyzed. Clinically assessed tooth loss outcomes were severe tooth loss (<9 remaining natural teeth) and lack of functional dentition (<21 natural teeth). Income inequality was assessed by Gini Index in 1991, 2000, and 2003 using tertiles of distribution.Variation in Gini Index was assessed by changes in the tertiles distribution between years. Multilevel logistic regression models were used to estimate odds ratios (ORs) and 95 percent confidence intervals (95 percent CI) between variation in income inequality and tooth loss outcomes adjusting for individual socio-demographic characteristics. Results: Prevalence of severe tooth loss and lack of functional dentition was 4.8 percent and 21.2 percent, respectively. Individuals living in cities withmoderate and high increase in income inequality between 1991 and 2003 weremore likely to have severe tooth loss and lack a functional dentition in 2010 compared with those living in citieswith stable income inequality in the same period.Relationships between low family income and both tooth loss outcomeswere significantly attenuated by relative increases in income inequality. Conclusions: Relative increases in income inequality were significantly associated with severe tooth loss and lack of a functional dentition in Brazilian middle-aged adults.
There is limited evidence concerning the role of social networks
on the oral health of adolescent... more There is limited evidence concerning the role of social networks on the oral health of adolescents. This study assessed the association between the participation of adolescents in community groups and dental caries. A cross-sectional household-based study was carried out involving 200 subjects aged 15–19 years living in a deprived area in the state of Amazon, Brazil. Dental caries was assessed through dental examinations using the DMFT index conducted by a single examiner who was previously calibrated. Four dental caries outcomes were investigated, including caries experience (DMFT score), current caries (number of current decayed teeth), missing teeth due to caries, and the care index (ratio between number of filled teeth and DMFT score). Details of participation of adolescents in community groups, demographic and socioeconomic data and information on dental visiting were obtained through individual interviews. All caries measures were significantly higher in adolescents who did not participate in community groups compared to their counterparts. Multivariate Poisson regression showed that participation of adolescents in community groups was independently associated with all dental caries outcomes. After adjusting for confounders, participation in community groups was statistically associated with lower DMFT score (ratio of mean, RM: 0.33, 95% CI: 0.24–0.46), fewer decayed teeth (RM: 0.23, 95% CI: 0.11–0.47), fewer missing teeth (RM: 0.28, 95% CI: 0.17–0.47), and higher care index (RM: 1.69, 95% CI: 1.24–2.29) than those who did not participate. Participation of adolescents in community activities was related to lower levels of dental caries.
Background: This study assessed clustering of three health-compromising behaviours and explored t... more Background: This study assessed clustering of three health-compromising behaviours and explored the association of neighbourhood and individual social capital with simultaneous health-compromising behaviours and patterns of those behaviours in women in the first trimester of pregnancy (baseline) and during the second and third trimesters of pregnancy (follow-up). Methods: A longitudinal study was conducted on a representative sample of women recruited in antenatal care units grouped in 46 neighbourhoods from Brazil. Neighbourhood-level measures (social capital and socioeconomic status), individual social capital (social support and social networks) and socio-demographic variables were collected at baseline. Smoking, alcohol consumption and inadequate diet were assessed at baseline and follow-up. Clustering was assessed using an observed to expected ratio method. The association of contextual and individual social capital with the health-compromising behaviours outcomes was analyzed through multilevel multivariate regression models. Results: Clustering of the three health-compromising behaviours as well as of smoking and alcohol consumption were identified at both baseline and follow-up periods. Neighbourhood social capital did not influence the occurrence of simultaneous health-compromising behaviours. More health-compromising behaviours in both periods was inversely associated with low levels of individual social capital. Low individual social capital predicted smoking during whole pregnancy, while high individual social capital increased the likelihood of stopping smoking and improving diet during pregnancy. Maintaining an inadequate diet during pregnancy was influenced by low individual and neighbourhood social capital. Conclusions: Three health-compromising behaviours are relatively common and cluster in Brazilian women throughout pregnancy. Low individual social capital significantly predicted simultaneous health-compromising behaviours and patterns of smoking and inadequate diet during pregnancy while low neighbourhood social capital was only relevant for inadequate diet. These findings suggest that interventions focusing on reducing multiple behaviours should be part of antenatal care throughout pregnancy. Individual and contextual social resources should be considered when planning the interventions.
Background: Oral health care needs assessment is frequently restricted to clinical measures. Comb... more Background: Oral health care needs assessment is frequently restricted to clinical measures. Combining normative assessment, behavioural propensity, oral health-related quality of life and information of family living conditions may provide a better comprehensive approach of adolescent’s oral health needs assessment. The aim of this study was to compare normative methods of dental caries need with the sociodental approach in 12-year-old adolescents according to family’s living conditions in a deprived community in Brazil. In addition, dental caries need assessment using the normative method and the sociodental approach was compared between adolescents living in different living conditions. Methods: A cross-sectional survey was conducted in the Manguinhos community in the city of Rio de Janeiro, Brazil. A weighted sample of 159 participants was randomly selected to represent the population of 2004 12-year-old adolescents. Socioeconomic characteristics and living conditions of the family were assessed using the Family Development Index (FDI). Oral health-related quality of life (OHRQoL) was assessed using the generic and CS-Child-OIDP, and adolescent’s propensity to adopt oral health promoting behaviours was verified through interviews. Dental caries and treatment need were assessed normatively by clinical oral examinations (DMFT Index) and adolescents were classified into two groups (non severe or severe caries). The sociodental approach included clinical measures of caries, propensity to adopt oral health promoting behaviors and OHRQoL. Families were classified based on the FDI as ‘not severe’, ‘severe’ and ‘very severe’. Measures of caries, OHRQoL and propensity outcomes were compared between FDI groups using Chi-square and Kruskal–Wallis tests. In addition, dental treatment needs using normative method and sociodental approach were compared for the whole sample and according to FDI groups. Results: Dental caries, OHRQoL and lower propensity needs were positively associated with FDI severity. The percentages of adolescents with normative dental needs from families with ‘very severe’, ‘severe’ and ‘not severe’ FDI were 59.3, 48.4 and 17.2 % (P < 0.05). Using the sociodental approach, the treatment needs for the three FDI groups decreased to 8.8, 13.6 and 8.6 %, respectively (P < 0.05). Conclusions: Using a combination of sociodental approach and the index of family living conditions was useful for defining dental care priorities in adolescents living in deprived communities and can optimise the use of resources in dental services.
Community dentistry and oral epidemiology, Jan 21, 2014
The aim of this study was to investigate the association between intermediary social determinants... more The aim of this study was to investigate the association between intermediary social determinants, namely social support and social network with dental caries in adolescents. An adapted version of the WHO social determinants of health conceptual framework was used to organize structural and intermediary social determinants of dental caries into six blocks including perceived social support and number of social networks. A cross-sectional study was conducted with a representative sample of 542 students between 12 and 14 years of age in public schools located in the city of Dourados, Brazil in 2012. The outcome variables were caries experience (DMFT ≥ 1) and current dental caries (component D of DMFT ≥ 1) recorded by a calibrated dentist. Individual interviews were performed to collect data on perceived social support and numbers of social networks from family and friends and covariates. Multivariate Poisson regressions using hierarchical models were conducted. The prevalence of adole...
Uploads
study investigated the relationship of neighborhood and individual social capital with dental pain in adolescents,
adults and the elderly.
Methods: A population-based multilevel study was conducted involving 624 subjects from 3 age groups: 15–19,
35–44 and 65–74 years. They were randomly selected from 30 census tracts in three cities in the State of Paraíba,
Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. The
outcome of study was the presence of dental pain in the last 6 months. Information on dental pain, demographic,
socio-economic, health-related behaviors, use of dental services, self-perceived oral health and social capital
measures was collected through interviews. Participants underwent a clinical examination for assessment of dental
caries. Neighborhood social capital was evaluated using aggregated measures of social trust, social control,
empowerment, political efficacy and neighborhood safety. Individual social capital assessment included bonding
and bridging social capital. Multilevel logistic regression was used to test the relationship of neighborhood and
individual social capital with dental pain after sequential adjustment for covariates.
Results: Individuals living in neighborhoods with high social capital were 52% less likely to report dental pain than
those living in neighborhoods with low social capital (OR = 0.48, 95% CI = 0.27-0.85). Bonding social capital
(positive interaction) was independently associated with dental pain (OR = 0.88, 95% CI = 0.80-0.91). Last dental visit,
self-perceived oral health and number of decayed teeth were also significantly associated with dental pain.
Conclusions: Our findings suggest that contextual and individual social capital are independently associated with
dental pain.
capital, are important determinants of health. The objective of this study was to investigate the association of
neighbourhood and individual social capital with consistent self-rated health in women between the first trimester
of pregnancy and six months postpartum.
Methods: A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at
antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st
trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two
groups: 1. Good SRH – good SRH at baseline and follow-up, and, 2. Poor SRH – poor SRH at baseline and follow-up.
Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable),
individual social capital (social support and social networks), demographic and socioeconomic characteristics,
health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to
test the association between neighbourhood and individual social capital and SRH, adjusted for covariates.
Results: The Good SRH group reported higher scores of social support and social networks than the Poor SRH
group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association
was not significant when individual socio-demographic variables were included in the model. In the final model,
women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social
interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-
0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of
schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house.
Conclusions: Low individual social capital during pregnancy, considered here as social support and social network,
was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women’s
SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of
individual social capital explained better the consistency of SRH over time than neighbourhood social capital.
forms of oral candidiasis (OC) in HIV-infected Brazilian adults.
Design: This study was conducted with 590 HIV-infected adults from 1997 to 2004. The OC
diagnosis was based in accordance with the EC-Clearinghouse classification. Multivariate
logistic regression analyses were performed to measure the association between HAART
and OC, with pseudomembranous [PC], erythematous [EC], and angular cheilitis [AC])
adjusted for HIV-related diseases, smoking, alcohol consumption, injecting and non-injecting
drug use.
Results: Two hundred and eighteen (37.0%) individuals were undergoing HAART. The
prevalence of PC, EC and AC was 21.2%, 15.7% and 8.8%, respectively. Approximately
64% of the individuals with PC and EC, and 76.5% with AC had absolute CD4 levels
200 cells/mm3. The results of the multivariate analysis showed that subjects not undergoing
HAART had a significantly higher odds ratio for PC [OR 3.67 (95% CI: 1.97–6.80)] and EC
[OR 1.88 (95% CI: 1.04–3.39)], and AC [OR 4.56 (95% CI: 1.58–13.19)]. In addition, smoking [OR
2.58 (95% CI: 1.43–4.68)] and pneumocystis pneumonia [OR 1.92 (95% CI: 1.07–3.42)] were
associated with PC, while high alcohol consumption [OR 3.40 (95% CI: 1.13–10.18)] and
cytomegalovirus infection [OR 2.34 (95% CI: 1.06–5.15)] were associated with EC.
Conclusion: The data indicates that the odds of having all clinical forms of OC are higher in
HIV-infected adults not receiving HAART.
peri-implant marginal bone loss in cement- and screw-retained prostheses.
Material and Methods: Electronic database and manual searches were undertaken
to identify trials, prospective or retrospective studies reporting on radiographic
marginal bone loss around dental implants restored with cement- and/or screwretained
prostheses. Two reviewers independently conducted the article selection
and data extraction. Random-effects models were used to obtain estimates of
peri-implant marginal bone loss [mean, 95% confidence intervals (CI)].
Results: Of the 1217 identified studies, nine finally met the inclusion criteria. Only
two studies included both cement- and screw-retained prostheses, three assessed
only screw-retained prostheses, and four evaluated only cement-retained prostheses.
Pooled mean marginal bone loss was 0.53 mm (CI 95%, 0.31–0.76 mm) for cementretained
prostheses and 0.89 mm (CI 95%, 0.45–1.33 mm) for screw-retained
prostheses.
Conclusion: There is no evidence to support differences in the marginal bone loss
through indirect comparison between cement and screw-retained restorations.
oral health factors associated with the negative impact of oral health conditions
on the quality of life in adolescents.
METHODS: Data from 5,445 adolescents aged 15-19, who took part in
the Brazilian Oral Health Survey (SBBrasil 2010) were analyzed, using a
multistage sampling design. The outcome was quality of life related to oral
health, which was assessed using the Oral Impacts on Daily Performance
questionnaire and analyzed as a discrete variable. The independent variables
were sex, skin color, schooling, household income, age, untreated dental caries,
malocclusion.,gingival bleeding, dental calculus, and periodontal pocket.
Poisson regression analysis was carried out and mean ratios (MR) with their
respective 95% confi dence intervals (95%CI) were presented.
RESULTS: Of the total, 39.4% reported at least one negative impact on
their quality of life. After adjustment, the mean negative impact was 1.52
(95%CI 1.16;2.00) times higher in females and 1.42 (95%CI 1.01;1.99), 2.66
(95%CI 1.40;5.07) and 3.32 (95%CI 1.68;6.56) higher in those with brown,
yellow, and indigenous skin color, respectively, when compared to those with
white skin. The lower the level of schooling, the greater the negative impact
(MR 2.11, 95%CI 1.30;3.41), likewise for individuals with household income
below R$ 500.00 (MR 1.84, 95%CI 1.06;3.17) compared with those with higher
incomes. The greatest impact on quality of life was found among adolescents
with four or more teeth with untreated dental caries (MR 1.53, 95%CI 1.12;2.10),
one or more missing teeth (MR 1.44. 95%CI 1.16;1.80). those with dental pain
(RM 3.62, 95%CI 2.93;4.46) and with severe (MR 1.52, 95%CI 1.04;2.23) and
very severe malocclusion (MR 1.32, 95%CI 1.01;1.72).
CONCLUSIONS: Brazilian adolescents reported a high negative impact of
oral health on their quality of life. Inequalities in distribution should be taken
into account when planning preventive, monitoring and treatment strategies for
oral health problems in groups with the highest impact on their quality of life.
levels of interactions and influences health. The objective of this was to assess
the association of neighbourhood and individual social capital with oral
health–related quality of life (OHRQoL) in pregnant and postpartum women.
Methods: This was a follow-up prevalence multilevel study on a representative
sample of 1248 women grouped into 55 neighbourhoods. OHRQoL was
assessed in the postpartum period using the Oral Health Impact Profile
questionnaire (OHIP-14). Exploratory variables were gathered during the first
trimester of pregnancy and included neighbourhood social capital
(neighbourhood-level measure), individual social capital (social support and
social networks), demographic and socio-economic variables, oral health
measures, and health-related behaviours. Results: The multilevel ordered
multinomial logistic regression showed that neighbourhood social capital did
not significantly affect women’s OHRQoL during pregnancy and postpartum
period. Individual social capital measures were independently associated with
high OHRQoL. Lack of family social network increased the odds for high
OHRQoL (OR = 1.44, 95% CI: 1.08–1.92). Individuals with high levels of
positive social interaction were less likely to report high scores of OHRQoL
(OR = 0.90, 95% CI: 0.82–0.98). Conclusion: Individual social capital was of
greater relevance to women’s OHRQoL in and after pregnancy than
neighbourhood social capital. These findings suggest that quality of personal
and social resources of pregnant women are more important for OHRQoL than
the neighbourhoods where the women live.
The objective of this systematic review and meta-analysis was to assess and compare the marginal bone loss around implants supporting single fixed prostheses and multiple-unit screw-retained prostheses.
MATERIALS AND METHODS:
The literature was searched manually and electronically to identify studies in which the marginal peri-implant bone loss around single-implant prostheses and screw-retained multiple-implant prostheses was evaluated radiographically. Two reviewers independently selected the literature and extracted the data. The random-effects method was used to obtain estimates of marginal peri-implant bone loss (means and 95% confidence intervals [CIs]).
RESULTS:
Of the 2,107 studies identified by a preliminary search, 17 fulfilled the inclusion criteria; 7 were related to single-implant prostheses and 10 to multiple-implant screw-retained fixed prostheses. The mean marginal peri-implant bone loss was 0.9 mm (95% CI, 0.49 to 1.32 mm) for multiple-implant screw-retained prostheses and 0.58 mm (95% CI, 0.37 to 0.80 mm) for single-implant prostheses.
CONCLUSION:
This indirect comparison provided no evidence to support the assertion that there are differences in marginal peri-implant bone loss between single implant prostheses and multiple screw-retained prostheses.
and maintain oral health through psychosocial
processes remains poorly understood in
children.
Aim. This study assessed the relationship of children’s
resilience and maternal sense of coherence
(SOC) with gingival status in children from lowincome
families.
Methods. A cross-sectional study was conducted
on 190 schoolchildren aged 11–12 years and their
mothers. Family socioeconomic characteristics and
housing conditions, maternal and children’s oral
cleanliness behaviours (tooth brushing and dental
floss use), maternal SOC, children’s resilience, and
demographic data were collected through interviews
with children and their mothers. Validated
versions of Antonovsky’s scale and the resilience
scale were used to assess mother’s SOC and children’s
resilience. Gingival status and dental plaque
of children were evaluated through clinical examinations
using bleeding on probing index and plaque
index. Statistical analysis included Pearson’s
correlation and hierarchical multinomial ordinal
logistic regression analyses.
Results. The mean frequency of gingival bleeding
in the sample was 8.4% (SD: 8.5). Children with
higher levels of resilience showed 31% lower odds
of gingival bleeding (OR: 0.7; 95% CI: 0.4–0.9)
after adjustment for socioeconomic characteristics,
children’s and mothers’ use of dental floss.
Conclusions. Children’s resilience was a psychosocial
factor associated with gingival conditions.
and individual social capital (social support and social network) with dental caries experience in adolescents and
adults. Methods: A population-based multilevel study was conducted involving 573 subjects, 15-19 and 35-44 years
of age, from 30 census tracts in three cities of Paraíba, Brazil. A two-stage cluster sampling was used considering
census tracts and households as sampling units. Caries experience was assessed using the DMFT index (decayed,
missing and filled teeth) and participants were divided into two groups according to the median of the DMFT
index in low and high caries experience. Demographic, socioeconomic, behaviors, use of dental services and
social capital measures were collected through interviews. Neighborhood empowerment was obtained from
the mean scores of the residents in each census tract. Multilevel multivariate logistic regression was used to test
the relationship between neighborhood empowerment and caries experience. Results: High caries experience
was inversely associated with neighborhood empowerment (OR = 0.58; 95%CI 0.33 – 0.99). Individual social
capital was not associated with caries experience. Other associated factors with caries experience were age
(OR = 1.15; 95%CI 1.12 – 1.18) and being a female (OR = 1.72; 95%CI 1.08 – 2.73). Conclusion: The association
between neighborhood empowerment and caries experience suggests that the perception of features of the
place of residence should be taken into account in actions of oral health promotion.
periodontal disease in the Brazilian adult population and its associations with
contextual and individual social inequalities.
METHODS: Data from adults aged 35 to 44 who participated in the 2010
Brazilian Brazilian Oral Health Survey (SBBrasil 2010) (n = 9,564) were
used. The Community Periodontal Index (CPI) and clinical attachment
loss (CAL) were used to defi ne “moderate to severe” periodontal disease
(CPI > 2 and CAL > 0) and “severe” periodontal disease (CPI > 2 and CAL > 1).
Contextual social inequalities assessed were Human Development Index and
income inequalitiy (Gini Index). Other contextual variables were integration of
oral health teams in the Family Health Programme and the percentage of adult
smokers. Multilevel logistic regression models for participants with complete
data (n = 4,594) were used to estimate odds ratios (OR) and 95% confi dence
intervals (95%CI) between social inequalities and periodontal disease.
RESULTS: The prevalence of “moderate to severe” and “severe” periodontal
disease in Brazilian adults was 15.3% and 5.8%, respectively, with considerable
variation across municipalities. Of the contextual variables, income inequality
was independently associated with “severe” periodontal disease (OR = 3.0,
95%CI 1.5;5.9). Lower oral health teams coverage was associated with both
defi nitions of periodontal disease whereas the percentage of smokers remained
associated with “moderate to severe” periodontal disease. Older adults, brown
skin color, males and those with lower family income and less schooling were
more likely to both periodontal conditions.
CONCLUSIONS: In Brazil, the prevalence of periodontal disease varied across
the municipalities and according to defi nition of periodontal disease. Income
inequality played a signifi cant role in the occurrence of “severe” periodontal
disease. Individual characteristics of social position were associated with both
forms of periodontal disease.
between nonsyndromic individuals with and without cleft lip and/or cleft palate and to identify the
most affected quality of life dimensions in individuals with cleft lip and/or palate.
Design: Systematic review and meta-analysis were conducted. Of the 314 identified citations,
23 articles were submitted to quality assessment. Data from nine studies on health-related
quality of life and six on oral health–related quality of life were extracted for meta-analysis.
Main Outcome Measures: Pooled mean differences of health-related quality of life between
adults with and without cleft lip and/or palate, pooled means of health-related quality of life
dimensions of children and adults with cleft lip and/or palate and oral health–related quality of
life dimensions of children and adolescents with cleft lip and/or palate with a 95% confidence
interval were calculated.
Results: Quality assessment revealed methodological differences between studies. Lack of
subgroup stratification and absence of control for confounders were the main limitations.
Heterogeneity was detected on the comparison of oral health–related quality of life and healthrelated
quality of life between children with and without cleft lip and/or palate, and oral health–
related quality of life between adolescents with and without cleft lip and/or palate. A randomeffect
model showed a significant difference on health-related quality of life between adults with
and without cleft lip and/or palate (mean difference¼0.10; 95% confidence interval, 0.16 to 0.05).
Psychological health (mean, 78.9; 95% confidence interval, 70.1 to 87.7) and vitality (mean, 68.1;
95% confidence interval, 48.0 to 88.1) were the most affected health-related quality of life
dimensions in children and adults with cleft lip and/or palate, respectively. Means of healthrelated
quality of life dimensions in children and adults with cleft lip and/or palate and oral
health–related quality of life in children and adolescents with cleft lip and/or palate varied yet did
not differ in indirect comparisons.
Conclusion: The presence of cleft lip and/or palate negatively affected the health-related
quality of life of adults, mainly on psychosocial dimensions.
contextual and individual social determinants of oral
health-related quality of life (OHRQoL) in Brazilian adults.
Methods Data of 4594 Brazilian adults aged 35–44 years
from the 2010 Brazilian Oral Health Survey were analysed.
OHRQoL was measured using the Oral Impacts on Daily
Performance (OIDP). Contextual socio-economic characteristics
at city level assessed in 1991 and 2000 included
social deprivation measured by Human Development Index
(HDI) and income inequality (Gini index). Individual
socio-economic characteristics included family income,
schooling and number of goods. Covariates were age, sex,
ethnicity and clinical oral measures. Multilevel multivariable
Poisson regression analysis was carried to investigate
the association of contextual and individual social characteristics
with OIDP extent and with each OIDP item.
Results Eating and cleaning teeth were the most reported
daily activities influenced by oral conditions. In the adjusted
analysis, low HDI 1991 and individual social characteristics
(lower family income and lower schooling) were associated
with OIDP extent. Sex (females) and all clinical oral measures
were also associated with OIDP. Adults living in the
cities with low HDI 1991 were more likely to have impact on
eating and sleeping, whereas living in cities with high Gini
index 1991 increased the prevalence of impact on emotional
status, work and social contact. Low income was associated
with all OIDP items.
Conclusion Poor contextual social determinants and lower
individual socio-economic position are associated with
worse OHRQoL among Brazilian adults, even after adjusting
for individual socio-demographic and clinical oral health
variables.
a relative increase on income inequalityweremore likely to have severe tooth
loss and lack a functional dentition.
Methods: Data on Brazilian adults aged 35-44 years from state capitals and Federal
District from the 2010 Brazilian Oral Health Survey (SBBrasil 2010) were analyzed.
Clinically assessed tooth loss outcomes were severe tooth loss (<9 remaining natural
teeth) and lack of functional dentition (<21 natural teeth). Income inequality was
assessed by Gini Index in 1991, 2000, and 2003 using tertiles of distribution.Variation
in Gini Index was assessed by changes in the tertiles distribution between years.
Multilevel logistic regression models were used to estimate odds ratios (ORs) and 95
percent confidence intervals (95 percent CI) between variation in income inequality
and tooth loss outcomes adjusting for individual socio-demographic characteristics.
Results: Prevalence of severe tooth loss and lack of functional dentition was 4.8
percent and 21.2 percent, respectively. Individuals living in cities withmoderate and
high increase in income inequality between 1991 and 2003 weremore likely to have
severe tooth loss and lack a functional dentition in 2010 compared with those living
in citieswith stable income inequality in the same period.Relationships between low
family income and both tooth loss outcomeswere significantly attenuated by relative
increases in income inequality.
Conclusions: Relative increases in income inequality were significantly associated
with severe tooth loss and lack of a functional dentition in Brazilian middle-aged
adults.
on the oral health of adolescents. This study assessed
the association between the participation of adolescents
in community groups and dental caries. A cross-sectional
household-based study was carried out involving 200 subjects
aged 15–19 years living in a deprived area in the state
of Amazon, Brazil. Dental caries was assessed through dental
examinations using the DMFT index conducted by a single
examiner who was previously calibrated. Four dental caries
outcomes were investigated, including caries experience
(DMFT score), current caries (number of current decayed
teeth), missing teeth due to caries, and the care index (ratio
between number of filled teeth and DMFT score). Details of
participation of adolescents in community groups, demographic
and socioeconomic data and information on dental
visiting were obtained through individual interviews. All caries
measures were significantly higher in adolescents who
did not participate in community groups compared to their
counterparts. Multivariate Poisson regression showed that
participation of adolescents in community groups was independently associated with all dental caries outcomes. After
adjusting for confounders, participation in community
groups was statistically associated with lower DMFT score
(ratio of mean, RM: 0.33, 95% CI: 0.24–0.46), fewer decayed
teeth (RM: 0.23, 95% CI: 0.11–0.47), fewer missing teeth (RM:
0.28, 95% CI: 0.17–0.47), and higher care index (RM: 1.69, 95%
CI: 1.24–2.29) than those who did not participate. Participation
of adolescents in community activities was related to
lower levels of dental caries.
of neighbourhood and individual social capital with simultaneous health-compromising behaviours and patterns of
those behaviours in women in the first trimester of pregnancy (baseline) and during the second and third trimesters of
pregnancy (follow-up).
Methods: A longitudinal study was conducted on a representative sample of women recruited in antenatal care units
grouped in 46 neighbourhoods from Brazil. Neighbourhood-level measures (social capital and socioeconomic status),
individual social capital (social support and social networks) and socio-demographic variables were collected
at baseline. Smoking, alcohol consumption and inadequate diet were assessed at baseline and follow-up. Clustering
was assessed using an observed to expected ratio method. The association of contextual and individual social capital
with the health-compromising behaviours outcomes was analyzed through multilevel multivariate regression models.
Results: Clustering of the three health-compromising behaviours as well as of smoking and alcohol consumption were
identified at both baseline and follow-up periods. Neighbourhood social capital did not influence the occurrence of
simultaneous health-compromising behaviours. More health-compromising behaviours in both periods was inversely
associated with low levels of individual social capital. Low individual social capital predicted smoking during whole
pregnancy, while high individual social capital increased the likelihood of stopping smoking and improving diet during
pregnancy. Maintaining an inadequate diet during pregnancy was influenced by low individual and neighbourhood
social capital.
Conclusions: Three health-compromising behaviours are relatively common and cluster in Brazilian women
throughout pregnancy. Low individual social capital significantly predicted simultaneous health-compromising
behaviours and patterns of smoking and inadequate diet during pregnancy while low neighbourhood social
capital was only relevant for inadequate diet. These findings suggest that interventions focusing on reducing
multiple behaviours should be part of antenatal care throughout pregnancy. Individual and contextual social
resources should be considered when planning the interventions.
assessment, behavioural propensity, oral health-related quality of life and information of family living conditions may
provide a better comprehensive approach of adolescent’s oral health needs assessment. The aim of this study was to
compare normative methods of dental caries need with the sociodental approach in 12-year-old adolescents according
to family’s living conditions in a deprived community in Brazil. In addition, dental caries need assessment using
the normative method and the sociodental approach was compared between adolescents living in different living
conditions.
Methods: A cross-sectional survey was conducted in the Manguinhos community in the city of Rio de Janeiro, Brazil.
A weighted sample of 159 participants was randomly selected to represent the population of 2004 12-year-old adolescents.
Socioeconomic characteristics and living conditions of the family were assessed using the Family Development
Index (FDI). Oral health-related quality of life (OHRQoL) was assessed using the generic and CS-Child-OIDP, and
adolescent’s propensity to adopt oral health promoting behaviours was verified through interviews. Dental caries and
treatment need were assessed normatively by clinical oral examinations (DMFT Index) and adolescents were classified
into two groups (non severe or severe caries). The sociodental approach included clinical measures of caries, propensity
to adopt oral health promoting behaviors and OHRQoL. Families were classified based on the FDI as ‘not severe’,
‘severe’ and ‘very severe’. Measures of caries, OHRQoL and propensity outcomes were compared between FDI groups
using Chi-square and Kruskal–Wallis tests. In addition, dental treatment needs using normative method and sociodental
approach were compared for the whole sample and according to FDI groups.
Results: Dental caries, OHRQoL and lower propensity needs were positively associated with FDI severity. The
percentages of adolescents with normative dental needs from families with ‘very severe’, ‘severe’ and ‘not severe’ FDI
were 59.3, 48.4 and 17.2 % (P < 0.05). Using the sociodental approach, the treatment needs for the three FDI groups
decreased to 8.8, 13.6 and 8.6 %, respectively (P < 0.05).
Conclusions: Using a combination of sociodental approach and the index of family living conditions was useful for
defining dental care priorities in adolescents living in deprived communities and can optimise the use of resources in
dental services.
study investigated the relationship of neighborhood and individual social capital with dental pain in adolescents,
adults and the elderly.
Methods: A population-based multilevel study was conducted involving 624 subjects from 3 age groups: 15–19,
35–44 and 65–74 years. They were randomly selected from 30 census tracts in three cities in the State of Paraíba,
Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. The
outcome of study was the presence of dental pain in the last 6 months. Information on dental pain, demographic,
socio-economic, health-related behaviors, use of dental services, self-perceived oral health and social capital
measures was collected through interviews. Participants underwent a clinical examination for assessment of dental
caries. Neighborhood social capital was evaluated using aggregated measures of social trust, social control,
empowerment, political efficacy and neighborhood safety. Individual social capital assessment included bonding
and bridging social capital. Multilevel logistic regression was used to test the relationship of neighborhood and
individual social capital with dental pain after sequential adjustment for covariates.
Results: Individuals living in neighborhoods with high social capital were 52% less likely to report dental pain than
those living in neighborhoods with low social capital (OR = 0.48, 95% CI = 0.27-0.85). Bonding social capital
(positive interaction) was independently associated with dental pain (OR = 0.88, 95% CI = 0.80-0.91). Last dental visit,
self-perceived oral health and number of decayed teeth were also significantly associated with dental pain.
Conclusions: Our findings suggest that contextual and individual social capital are independently associated with
dental pain.
capital, are important determinants of health. The objective of this study was to investigate the association of
neighbourhood and individual social capital with consistent self-rated health in women between the first trimester
of pregnancy and six months postpartum.
Methods: A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at
antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st
trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two
groups: 1. Good SRH – good SRH at baseline and follow-up, and, 2. Poor SRH – poor SRH at baseline and follow-up.
Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable),
individual social capital (social support and social networks), demographic and socioeconomic characteristics,
health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to
test the association between neighbourhood and individual social capital and SRH, adjusted for covariates.
Results: The Good SRH group reported higher scores of social support and social networks than the Poor SRH
group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association
was not significant when individual socio-demographic variables were included in the model. In the final model,
women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social
interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-
0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of
schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house.
Conclusions: Low individual social capital during pregnancy, considered here as social support and social network,
was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women’s
SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of
individual social capital explained better the consistency of SRH over time than neighbourhood social capital.
forms of oral candidiasis (OC) in HIV-infected Brazilian adults.
Design: This study was conducted with 590 HIV-infected adults from 1997 to 2004. The OC
diagnosis was based in accordance with the EC-Clearinghouse classification. Multivariate
logistic regression analyses were performed to measure the association between HAART
and OC, with pseudomembranous [PC], erythematous [EC], and angular cheilitis [AC])
adjusted for HIV-related diseases, smoking, alcohol consumption, injecting and non-injecting
drug use.
Results: Two hundred and eighteen (37.0%) individuals were undergoing HAART. The
prevalence of PC, EC and AC was 21.2%, 15.7% and 8.8%, respectively. Approximately
64% of the individuals with PC and EC, and 76.5% with AC had absolute CD4 levels
200 cells/mm3. The results of the multivariate analysis showed that subjects not undergoing
HAART had a significantly higher odds ratio for PC [OR 3.67 (95% CI: 1.97–6.80)] and EC
[OR 1.88 (95% CI: 1.04–3.39)], and AC [OR 4.56 (95% CI: 1.58–13.19)]. In addition, smoking [OR
2.58 (95% CI: 1.43–4.68)] and pneumocystis pneumonia [OR 1.92 (95% CI: 1.07–3.42)] were
associated with PC, while high alcohol consumption [OR 3.40 (95% CI: 1.13–10.18)] and
cytomegalovirus infection [OR 2.34 (95% CI: 1.06–5.15)] were associated with EC.
Conclusion: The data indicates that the odds of having all clinical forms of OC are higher in
HIV-infected adults not receiving HAART.
peri-implant marginal bone loss in cement- and screw-retained prostheses.
Material and Methods: Electronic database and manual searches were undertaken
to identify trials, prospective or retrospective studies reporting on radiographic
marginal bone loss around dental implants restored with cement- and/or screwretained
prostheses. Two reviewers independently conducted the article selection
and data extraction. Random-effects models were used to obtain estimates of
peri-implant marginal bone loss [mean, 95% confidence intervals (CI)].
Results: Of the 1217 identified studies, nine finally met the inclusion criteria. Only
two studies included both cement- and screw-retained prostheses, three assessed
only screw-retained prostheses, and four evaluated only cement-retained prostheses.
Pooled mean marginal bone loss was 0.53 mm (CI 95%, 0.31–0.76 mm) for cementretained
prostheses and 0.89 mm (CI 95%, 0.45–1.33 mm) for screw-retained
prostheses.
Conclusion: There is no evidence to support differences in the marginal bone loss
through indirect comparison between cement and screw-retained restorations.
oral health factors associated with the negative impact of oral health conditions
on the quality of life in adolescents.
METHODS: Data from 5,445 adolescents aged 15-19, who took part in
the Brazilian Oral Health Survey (SBBrasil 2010) were analyzed, using a
multistage sampling design. The outcome was quality of life related to oral
health, which was assessed using the Oral Impacts on Daily Performance
questionnaire and analyzed as a discrete variable. The independent variables
were sex, skin color, schooling, household income, age, untreated dental caries,
malocclusion.,gingival bleeding, dental calculus, and periodontal pocket.
Poisson regression analysis was carried out and mean ratios (MR) with their
respective 95% confi dence intervals (95%CI) were presented.
RESULTS: Of the total, 39.4% reported at least one negative impact on
their quality of life. After adjustment, the mean negative impact was 1.52
(95%CI 1.16;2.00) times higher in females and 1.42 (95%CI 1.01;1.99), 2.66
(95%CI 1.40;5.07) and 3.32 (95%CI 1.68;6.56) higher in those with brown,
yellow, and indigenous skin color, respectively, when compared to those with
white skin. The lower the level of schooling, the greater the negative impact
(MR 2.11, 95%CI 1.30;3.41), likewise for individuals with household income
below R$ 500.00 (MR 1.84, 95%CI 1.06;3.17) compared with those with higher
incomes. The greatest impact on quality of life was found among adolescents
with four or more teeth with untreated dental caries (MR 1.53, 95%CI 1.12;2.10),
one or more missing teeth (MR 1.44. 95%CI 1.16;1.80). those with dental pain
(RM 3.62, 95%CI 2.93;4.46) and with severe (MR 1.52, 95%CI 1.04;2.23) and
very severe malocclusion (MR 1.32, 95%CI 1.01;1.72).
CONCLUSIONS: Brazilian adolescents reported a high negative impact of
oral health on their quality of life. Inequalities in distribution should be taken
into account when planning preventive, monitoring and treatment strategies for
oral health problems in groups with the highest impact on their quality of life.
levels of interactions and influences health. The objective of this was to assess
the association of neighbourhood and individual social capital with oral
health–related quality of life (OHRQoL) in pregnant and postpartum women.
Methods: This was a follow-up prevalence multilevel study on a representative
sample of 1248 women grouped into 55 neighbourhoods. OHRQoL was
assessed in the postpartum period using the Oral Health Impact Profile
questionnaire (OHIP-14). Exploratory variables were gathered during the first
trimester of pregnancy and included neighbourhood social capital
(neighbourhood-level measure), individual social capital (social support and
social networks), demographic and socio-economic variables, oral health
measures, and health-related behaviours. Results: The multilevel ordered
multinomial logistic regression showed that neighbourhood social capital did
not significantly affect women’s OHRQoL during pregnancy and postpartum
period. Individual social capital measures were independently associated with
high OHRQoL. Lack of family social network increased the odds for high
OHRQoL (OR = 1.44, 95% CI: 1.08–1.92). Individuals with high levels of
positive social interaction were less likely to report high scores of OHRQoL
(OR = 0.90, 95% CI: 0.82–0.98). Conclusion: Individual social capital was of
greater relevance to women’s OHRQoL in and after pregnancy than
neighbourhood social capital. These findings suggest that quality of personal
and social resources of pregnant women are more important for OHRQoL than
the neighbourhoods where the women live.
The objective of this systematic review and meta-analysis was to assess and compare the marginal bone loss around implants supporting single fixed prostheses and multiple-unit screw-retained prostheses.
MATERIALS AND METHODS:
The literature was searched manually and electronically to identify studies in which the marginal peri-implant bone loss around single-implant prostheses and screw-retained multiple-implant prostheses was evaluated radiographically. Two reviewers independently selected the literature and extracted the data. The random-effects method was used to obtain estimates of marginal peri-implant bone loss (means and 95% confidence intervals [CIs]).
RESULTS:
Of the 2,107 studies identified by a preliminary search, 17 fulfilled the inclusion criteria; 7 were related to single-implant prostheses and 10 to multiple-implant screw-retained fixed prostheses. The mean marginal peri-implant bone loss was 0.9 mm (95% CI, 0.49 to 1.32 mm) for multiple-implant screw-retained prostheses and 0.58 mm (95% CI, 0.37 to 0.80 mm) for single-implant prostheses.
CONCLUSION:
This indirect comparison provided no evidence to support the assertion that there are differences in marginal peri-implant bone loss between single implant prostheses and multiple screw-retained prostheses.
and maintain oral health through psychosocial
processes remains poorly understood in
children.
Aim. This study assessed the relationship of children’s
resilience and maternal sense of coherence
(SOC) with gingival status in children from lowincome
families.
Methods. A cross-sectional study was conducted
on 190 schoolchildren aged 11–12 years and their
mothers. Family socioeconomic characteristics and
housing conditions, maternal and children’s oral
cleanliness behaviours (tooth brushing and dental
floss use), maternal SOC, children’s resilience, and
demographic data were collected through interviews
with children and their mothers. Validated
versions of Antonovsky’s scale and the resilience
scale were used to assess mother’s SOC and children’s
resilience. Gingival status and dental plaque
of children were evaluated through clinical examinations
using bleeding on probing index and plaque
index. Statistical analysis included Pearson’s
correlation and hierarchical multinomial ordinal
logistic regression analyses.
Results. The mean frequency of gingival bleeding
in the sample was 8.4% (SD: 8.5). Children with
higher levels of resilience showed 31% lower odds
of gingival bleeding (OR: 0.7; 95% CI: 0.4–0.9)
after adjustment for socioeconomic characteristics,
children’s and mothers’ use of dental floss.
Conclusions. Children’s resilience was a psychosocial
factor associated with gingival conditions.
and individual social capital (social support and social network) with dental caries experience in adolescents and
adults. Methods: A population-based multilevel study was conducted involving 573 subjects, 15-19 and 35-44 years
of age, from 30 census tracts in three cities of Paraíba, Brazil. A two-stage cluster sampling was used considering
census tracts and households as sampling units. Caries experience was assessed using the DMFT index (decayed,
missing and filled teeth) and participants were divided into two groups according to the median of the DMFT
index in low and high caries experience. Demographic, socioeconomic, behaviors, use of dental services and
social capital measures were collected through interviews. Neighborhood empowerment was obtained from
the mean scores of the residents in each census tract. Multilevel multivariate logistic regression was used to test
the relationship between neighborhood empowerment and caries experience. Results: High caries experience
was inversely associated with neighborhood empowerment (OR = 0.58; 95%CI 0.33 – 0.99). Individual social
capital was not associated with caries experience. Other associated factors with caries experience were age
(OR = 1.15; 95%CI 1.12 – 1.18) and being a female (OR = 1.72; 95%CI 1.08 – 2.73). Conclusion: The association
between neighborhood empowerment and caries experience suggests that the perception of features of the
place of residence should be taken into account in actions of oral health promotion.
periodontal disease in the Brazilian adult population and its associations with
contextual and individual social inequalities.
METHODS: Data from adults aged 35 to 44 who participated in the 2010
Brazilian Brazilian Oral Health Survey (SBBrasil 2010) (n = 9,564) were
used. The Community Periodontal Index (CPI) and clinical attachment
loss (CAL) were used to defi ne “moderate to severe” periodontal disease
(CPI > 2 and CAL > 0) and “severe” periodontal disease (CPI > 2 and CAL > 1).
Contextual social inequalities assessed were Human Development Index and
income inequalitiy (Gini Index). Other contextual variables were integration of
oral health teams in the Family Health Programme and the percentage of adult
smokers. Multilevel logistic regression models for participants with complete
data (n = 4,594) were used to estimate odds ratios (OR) and 95% confi dence
intervals (95%CI) between social inequalities and periodontal disease.
RESULTS: The prevalence of “moderate to severe” and “severe” periodontal
disease in Brazilian adults was 15.3% and 5.8%, respectively, with considerable
variation across municipalities. Of the contextual variables, income inequality
was independently associated with “severe” periodontal disease (OR = 3.0,
95%CI 1.5;5.9). Lower oral health teams coverage was associated with both
defi nitions of periodontal disease whereas the percentage of smokers remained
associated with “moderate to severe” periodontal disease. Older adults, brown
skin color, males and those with lower family income and less schooling were
more likely to both periodontal conditions.
CONCLUSIONS: In Brazil, the prevalence of periodontal disease varied across
the municipalities and according to defi nition of periodontal disease. Income
inequality played a signifi cant role in the occurrence of “severe” periodontal
disease. Individual characteristics of social position were associated with both
forms of periodontal disease.
between nonsyndromic individuals with and without cleft lip and/or cleft palate and to identify the
most affected quality of life dimensions in individuals with cleft lip and/or palate.
Design: Systematic review and meta-analysis were conducted. Of the 314 identified citations,
23 articles were submitted to quality assessment. Data from nine studies on health-related
quality of life and six on oral health–related quality of life were extracted for meta-analysis.
Main Outcome Measures: Pooled mean differences of health-related quality of life between
adults with and without cleft lip and/or palate, pooled means of health-related quality of life
dimensions of children and adults with cleft lip and/or palate and oral health–related quality of
life dimensions of children and adolescents with cleft lip and/or palate with a 95% confidence
interval were calculated.
Results: Quality assessment revealed methodological differences between studies. Lack of
subgroup stratification and absence of control for confounders were the main limitations.
Heterogeneity was detected on the comparison of oral health–related quality of life and healthrelated
quality of life between children with and without cleft lip and/or palate, and oral health–
related quality of life between adolescents with and without cleft lip and/or palate. A randomeffect
model showed a significant difference on health-related quality of life between adults with
and without cleft lip and/or palate (mean difference¼0.10; 95% confidence interval, 0.16 to 0.05).
Psychological health (mean, 78.9; 95% confidence interval, 70.1 to 87.7) and vitality (mean, 68.1;
95% confidence interval, 48.0 to 88.1) were the most affected health-related quality of life
dimensions in children and adults with cleft lip and/or palate, respectively. Means of healthrelated
quality of life dimensions in children and adults with cleft lip and/or palate and oral
health–related quality of life in children and adolescents with cleft lip and/or palate varied yet did
not differ in indirect comparisons.
Conclusion: The presence of cleft lip and/or palate negatively affected the health-related
quality of life of adults, mainly on psychosocial dimensions.
contextual and individual social determinants of oral
health-related quality of life (OHRQoL) in Brazilian adults.
Methods Data of 4594 Brazilian adults aged 35–44 years
from the 2010 Brazilian Oral Health Survey were analysed.
OHRQoL was measured using the Oral Impacts on Daily
Performance (OIDP). Contextual socio-economic characteristics
at city level assessed in 1991 and 2000 included
social deprivation measured by Human Development Index
(HDI) and income inequality (Gini index). Individual
socio-economic characteristics included family income,
schooling and number of goods. Covariates were age, sex,
ethnicity and clinical oral measures. Multilevel multivariable
Poisson regression analysis was carried to investigate
the association of contextual and individual social characteristics
with OIDP extent and with each OIDP item.
Results Eating and cleaning teeth were the most reported
daily activities influenced by oral conditions. In the adjusted
analysis, low HDI 1991 and individual social characteristics
(lower family income and lower schooling) were associated
with OIDP extent. Sex (females) and all clinical oral measures
were also associated with OIDP. Adults living in the
cities with low HDI 1991 were more likely to have impact on
eating and sleeping, whereas living in cities with high Gini
index 1991 increased the prevalence of impact on emotional
status, work and social contact. Low income was associated
with all OIDP items.
Conclusion Poor contextual social determinants and lower
individual socio-economic position are associated with
worse OHRQoL among Brazilian adults, even after adjusting
for individual socio-demographic and clinical oral health
variables.
a relative increase on income inequalityweremore likely to have severe tooth
loss and lack a functional dentition.
Methods: Data on Brazilian adults aged 35-44 years from state capitals and Federal
District from the 2010 Brazilian Oral Health Survey (SBBrasil 2010) were analyzed.
Clinically assessed tooth loss outcomes were severe tooth loss (<9 remaining natural
teeth) and lack of functional dentition (<21 natural teeth). Income inequality was
assessed by Gini Index in 1991, 2000, and 2003 using tertiles of distribution.Variation
in Gini Index was assessed by changes in the tertiles distribution between years.
Multilevel logistic regression models were used to estimate odds ratios (ORs) and 95
percent confidence intervals (95 percent CI) between variation in income inequality
and tooth loss outcomes adjusting for individual socio-demographic characteristics.
Results: Prevalence of severe tooth loss and lack of functional dentition was 4.8
percent and 21.2 percent, respectively. Individuals living in cities withmoderate and
high increase in income inequality between 1991 and 2003 weremore likely to have
severe tooth loss and lack a functional dentition in 2010 compared with those living
in citieswith stable income inequality in the same period.Relationships between low
family income and both tooth loss outcomeswere significantly attenuated by relative
increases in income inequality.
Conclusions: Relative increases in income inequality were significantly associated
with severe tooth loss and lack of a functional dentition in Brazilian middle-aged
adults.
on the oral health of adolescents. This study assessed
the association between the participation of adolescents
in community groups and dental caries. A cross-sectional
household-based study was carried out involving 200 subjects
aged 15–19 years living in a deprived area in the state
of Amazon, Brazil. Dental caries was assessed through dental
examinations using the DMFT index conducted by a single
examiner who was previously calibrated. Four dental caries
outcomes were investigated, including caries experience
(DMFT score), current caries (number of current decayed
teeth), missing teeth due to caries, and the care index (ratio
between number of filled teeth and DMFT score). Details of
participation of adolescents in community groups, demographic
and socioeconomic data and information on dental
visiting were obtained through individual interviews. All caries
measures were significantly higher in adolescents who
did not participate in community groups compared to their
counterparts. Multivariate Poisson regression showed that
participation of adolescents in community groups was independently associated with all dental caries outcomes. After
adjusting for confounders, participation in community
groups was statistically associated with lower DMFT score
(ratio of mean, RM: 0.33, 95% CI: 0.24–0.46), fewer decayed
teeth (RM: 0.23, 95% CI: 0.11–0.47), fewer missing teeth (RM:
0.28, 95% CI: 0.17–0.47), and higher care index (RM: 1.69, 95%
CI: 1.24–2.29) than those who did not participate. Participation
of adolescents in community activities was related to
lower levels of dental caries.
of neighbourhood and individual social capital with simultaneous health-compromising behaviours and patterns of
those behaviours in women in the first trimester of pregnancy (baseline) and during the second and third trimesters of
pregnancy (follow-up).
Methods: A longitudinal study was conducted on a representative sample of women recruited in antenatal care units
grouped in 46 neighbourhoods from Brazil. Neighbourhood-level measures (social capital and socioeconomic status),
individual social capital (social support and social networks) and socio-demographic variables were collected
at baseline. Smoking, alcohol consumption and inadequate diet were assessed at baseline and follow-up. Clustering
was assessed using an observed to expected ratio method. The association of contextual and individual social capital
with the health-compromising behaviours outcomes was analyzed through multilevel multivariate regression models.
Results: Clustering of the three health-compromising behaviours as well as of smoking and alcohol consumption were
identified at both baseline and follow-up periods. Neighbourhood social capital did not influence the occurrence of
simultaneous health-compromising behaviours. More health-compromising behaviours in both periods was inversely
associated with low levels of individual social capital. Low individual social capital predicted smoking during whole
pregnancy, while high individual social capital increased the likelihood of stopping smoking and improving diet during
pregnancy. Maintaining an inadequate diet during pregnancy was influenced by low individual and neighbourhood
social capital.
Conclusions: Three health-compromising behaviours are relatively common and cluster in Brazilian women
throughout pregnancy. Low individual social capital significantly predicted simultaneous health-compromising
behaviours and patterns of smoking and inadequate diet during pregnancy while low neighbourhood social
capital was only relevant for inadequate diet. These findings suggest that interventions focusing on reducing
multiple behaviours should be part of antenatal care throughout pregnancy. Individual and contextual social
resources should be considered when planning the interventions.
assessment, behavioural propensity, oral health-related quality of life and information of family living conditions may
provide a better comprehensive approach of adolescent’s oral health needs assessment. The aim of this study was to
compare normative methods of dental caries need with the sociodental approach in 12-year-old adolescents according
to family’s living conditions in a deprived community in Brazil. In addition, dental caries need assessment using
the normative method and the sociodental approach was compared between adolescents living in different living
conditions.
Methods: A cross-sectional survey was conducted in the Manguinhos community in the city of Rio de Janeiro, Brazil.
A weighted sample of 159 participants was randomly selected to represent the population of 2004 12-year-old adolescents.
Socioeconomic characteristics and living conditions of the family were assessed using the Family Development
Index (FDI). Oral health-related quality of life (OHRQoL) was assessed using the generic and CS-Child-OIDP, and
adolescent’s propensity to adopt oral health promoting behaviours was verified through interviews. Dental caries and
treatment need were assessed normatively by clinical oral examinations (DMFT Index) and adolescents were classified
into two groups (non severe or severe caries). The sociodental approach included clinical measures of caries, propensity
to adopt oral health promoting behaviors and OHRQoL. Families were classified based on the FDI as ‘not severe’,
‘severe’ and ‘very severe’. Measures of caries, OHRQoL and propensity outcomes were compared between FDI groups
using Chi-square and Kruskal–Wallis tests. In addition, dental treatment needs using normative method and sociodental
approach were compared for the whole sample and according to FDI groups.
Results: Dental caries, OHRQoL and lower propensity needs were positively associated with FDI severity. The
percentages of adolescents with normative dental needs from families with ‘very severe’, ‘severe’ and ‘not severe’ FDI
were 59.3, 48.4 and 17.2 % (P < 0.05). Using the sociodental approach, the treatment needs for the three FDI groups
decreased to 8.8, 13.6 and 8.6 %, respectively (P < 0.05).
Conclusions: Using a combination of sociodental approach and the index of family living conditions was useful for
defining dental care priorities in adolescents living in deprived communities and can optimise the use of resources in
dental services.