This study describes the scientific production on oral health diffused in Revista de Saúde Pública, in the 50 years of its publication. A narrative review study was carried out using PubMed, as it is the search database that indexes all issues of the journal. From 1967 to 2015, 162 manuscripts specifically focused on oral health themes were published. This theme was present in all volumes of the journal, with increasing participation over the years. Dental caries was the most studied theme, constantly present in the journal since its first issue. Periodontal disease, fluorosis, malocclusions, and other themes emerged even before the decline of dental caries indicators. Oral health policy is the most recurring theme in the last two decades. Revista de Saúde Pública has been an important vehicle for dissemination, communication, and reflection on oral health, contributing in a relevant way to the technical-scientific interaction between professionals in this field.
Dental Caries; Oral Health; Public Health; Review; Historical Article
To analyze if differences according to gender exists in the association between tooth loss and obesity among older adults.
We analyzed data on 1,704 older adults (60 years and over) from the baseline of a prospective cohort study conducted in Florianopolis, SC, Southern Brazil. Multivariable logistic regression models were used to assess the association between tooth loss and general and central obesity after adjustment for confounders (age, gender, skin color, educational attainment, income, smoking, physical activity, use of dentures, hypertension, and diabetes). Linear regressions were also assessed with body mass index and waist circumference as continuous outcomes. Interaction between gender and tooth loss was further assessed.
Overall mean body mass index was 28.0 kg/m2. Mean waist circumference was 96.8 cm for males and 92.6 cm for females. Increasing tooth loss was positively associated with increased body mass index and waist circumference after adjustment for confounders. Edentates had 1.4 (95%CI 1.1;1.9) times higher odds of being centrally obese than individuals with a higher number of teeth; however, the association lost significance after adjustment for confounders. In comparison with edentate males, edentate females presented a twofold higher adjusted prevalence of general and central obesity. In the joint effects model, edentate females had a 3.8 (95%CI 2.2;6.6) times higher odds to be centrally obese in comparison with males with more than 10 teeth present in both the arches. Similarly, females with less than 10 teeth in at least one arch had a 2.7 (95%CI 1.6;4.4) times higher odds ratio of having central obesity in comparison with males with more than 10 teeth present in both the arches.
Central obesity was more prevalent than general obesity among the older adults. We did not observe any association between general obesity and tooth loss. The association between central obesity and tooth loss depends on gender – females with tooth loss had greater probability of being obese.
Aged; Tooth Loss, epidemiology; Obesity, epidemiology; Gender and Health; Socioeconomic Factors; Risk Factors; Cross-Sectional Studies
To analyze oral health behaviors changes over time in Brazilian adolescents concerning maternal educational inequalities.
Data from the Pesquisa Nacional de Saúde do Escolar (Brazilian National School Health Survey) were analyzed. The sample was composed of 60,973 and 61,145 students from 26 Brazilian state capitals and the Federal District in 2009 and 2012, respectively. The analyzed factors were oral health behaviors (toothbrushing frequency, sweets consumption, soft drink consumption, and cigarette experimentation) and sociodemographics (age, sex, race, type of school and maternal schooling). Oral health behaviors and sociodemographic factors in the two years were compared (Rao-Scott test) and relative and absolute measures of socioeconomic inequalities in health were estimated (slope index of inequality and relative concentration index), using maternal education as a socioeconomic indicator, expressed in number of years of study (> 11; 9-11; ≤ 8).
Results from 2012, when compared with those from 2009, for all maternal education categories, showed that the proportion of people with low toothbrushing frequency increased, and that consumption of sweets and soft drinks and cigarette experimentation decreased. In private schools, positive slope index of inequality and relative concentration index indicated higher soft drink consumption in 2012 and higher cigarette experimentation in both years among students who reported greater maternal schooling, with no significant change in inequalities. In public schools, negative slope index of inequality and relative concentration index indicated higher soft drink consumption among students who reported lower maternal schooling in both years, with no significant change overtime. The positive relative concentration index indicated inequality in 2009 for cigarette experimentation, with a higher prevalence among students who reported greater maternal schooling. There were no inequalities for toothbrushing frequency or sweets consumption.
There were changes in the prevalences of oral health behaviors during the analyzed period; however, these changes were not related to maternal education inequalities.
Adolescent Behavior; Oral Hygiene; Health Knowledge, Attitudes, Practice; Dental Health Surveys; Socioeconomic Factors; Health Inequalities
Currently, diabetes mellitus (DM) and systemic arterial hypertension (SAH) are among the top five global risks for mortality. Among the modifiable factors, careful dietary practice is one of the essential elements for the control of NCDs, since these diseases are often the result of unhealthy lifestyles. Thus, this study aimed to assess the frequency of dietary practices among adult males and females with DM and/or SAH, and compare whether or not they are more frequent than in healthy adults, through a population-based study conducted in the city of Florianópolis, southern Brazil.
Cross-sectional population-based study, using as exposure self-reported DM and/or SAH status. Dietary practices were assessed using a semiquantitative food consumption questionnaire. The following were considered as adequate: regular intake (≥ 6 times/week) of fruit and vegetables, daily intake of fruit (≥ 3 times/day) and vegetables (≥ 2 times/day), intake lower than 2 times/week of meat fat, fried foods, and soda. Bivariate and adjusted analysis for sociodemographic variables were conducted using Poisson regression, stratified by gender.
Location: Florianópolis, southern Brazil, 2009.
Subjects: Representative sample of 20 to 59 year-old adults (n=1720).
A total of 16.6% participants were diagnosed with DM and/or SAH. The most frequently consumed unhealthy foods were fried food (51.0%, 95% CI: 48.8–53.5) and soda (57.9% 95%CI: 55.5–60.2). Of healthy foods, fruit was the less consumed on a daily basis (11.1% 95%CI 9.6-12.5). In general, women showed better dietary practices than men. In adjusted analysis none of dietary practices was more frequent among diabetic and/or hypertensive adults compared with healthy individuals, regardless of gender. No differences were found between healthy and unhealthy adults, when the number of dietary practices was assessed.
The frequency of dietary practices was low and did not differ between individuals with or without DM and/or SAH. It is fundamental to reinforce the need of healthy dietary practices as one of the essential elements for the control of chronic diseases and their complications.
The objective of this study was to analyze whether socioeconomic conditions and the period of availability of fluoridated water are associated with the number of teeth present.
This cross-sectional study analyzed data from 1,720 adults between 20 and 59 years of age who resided in Florianópolis, SC, Southern Brazil, in 2009. The outcome investigated was the self-reported number of teeth present. The individual independent variables included gender, age range, skin color, number of years of schooling, and per capita household income. The duration of residence was used as a control variable. The contextual exposures included the period of availability of fluoridated water to the households and the socioeconomic variable for the census tracts, which was created from factor analysis of the tract’s mean income, education level, and percentage of households with treated water. Multilevel logistic regression was performed and inter-level interactions were tested.
Residents in intermediate and poorer areas and those with fluoridated water available for less time exhibited the presence of fewer teeth compared with those in better socioeconomic conditions and who had fluoridated water available for a longer period (OR = 1.02; 95%CI 1.01;1.02). There was an association between the period of availability of fluoridated water, per capita household income and number of years of education. The proportion of individuals in the poorer and less-educated stratum, which had fewer teeth present, was higher in regions where fluoridated water had been available for less time.
Poor socioeconomic conditions and a shorter period of availability of fluoridated water were associated with the probability of having fewer teeth in adulthood. Public policies aimed at reducing socioeconomic inequalities and increasing access to health services such as fluoridation of the water supply may help to reduce tooth loss in the future.
Adult; Tooth Loss; epidemiology; Water Supply; Fluoridation; Socioeconomic Factors; Health Inequalities
Estimate the prevalence of dental caries based on clinical examinations and self-reports and compare differences in the prevalence and effect measures between the two methods among 18-year-olds belonging to a 1993 birth cohort in the city of Pelotas, Brazil.
Data on self-reported caries, socio-demographic aspects and oral health behaviour were collected using a questionnaire administered to adolescents aged 18 years (n = 4041). Clinical caries was evaluated (n = 1014) by a dentist who had undergone training and calibration exercises. Prevalence rates of clinical and self-reported caries, sensitivity, specificity, positive and negative predictive values, absolute and relative bias, and inflation factors were calculated. Prevalence ratios of dental caries were estimated for each risk factor.
The prevalence of clinical and self-reported caries (DMFT>1) was 66.5% (95%CI: 63.6%–69.3%) and 60.3% (95%CI: 58.8%–61.8%), respectively. Self-reports underestimated the prevalence of dental caries by 9.3% in comparison to clinical evaluations. The analysis of the validity of self-reports regarding the DMFT index indicated high sensitivity (81.8%; 95%CI: 78.7%–84.7%) and specificity (78.1%; 95%CI: 73.3%–82.4%) in relation to the gold standard (clinical evaluation). Both the clinical and self-reported evaluations were associated with gender, schooling and self-rated oral health. Clinical dental caries was associated with visits to the dentist in the previous year. Self-reported dental caries was associated with daily tooth brushing frequency.
Based on the present findings, self-reported information on dental caries using the DMFT index requires further studies prior to its use in the analysis of risk factors, but is valid for population-based health surveys with the aim of planning and monitoring oral health actions directed at adolescents.
The aim of this study was to estimate the prevalence of chewing impairment
according to sex, and its associated factors in adults.
A cross-sectional population-based study was carried out with 2,016 subjects
aged between 20 and 59 years in Florianopolis, SC, Southern Brazil, in 2009.
The sampling was undertaken in two stages, census tracts and households. The
outcome 'chewing impairment' was obtained from the question "How often do
you have chewing impairment due to teeth or denture problems?". Analyses
were carried out with demographics and socioeconomic factors, dental
services utilization, and self-related oral health using multivariable
logistic regression and stratified by sex.
The response rate was 85.3% (1,720 adults). The prevalence of chewing
impairment was 13,0% (95%CI 10.3;15.8) and 18,0% (95%CI 14.6;21.3) among men
and women, respectively. Women and men fifty years old and over, who had ten
or fewer natural teeth and those who reported toothache were more likely to
have chewing impairment. The combination of tooth loss and toothache on
chewing impairment was almost four times higher among women.
The magnitude of the associations among socioeconomic, demographics and
self-related oral health factors was different according to sex, in general
higher for women, with emphasis on toothache. The findings suggest that the
impact of oral conditions varies by sex.
Adult; Mastication; Socioeconomic Factors; Gender and Health; Oral Health; Dental Health Surveys
Physical attributes of the places in which people live, as well as their perceptions of them, may be important health determinants. The perception of place in which people dwell may impact on individual health and may be a more telling indicator for individual health than objective neighborhood characteristics. This paper aims to evaluate psychometric and ecometric properties of a scale on the perceptions of neighborhood problems in adults from Florianopolis, Southern Brazil.
Individual, census tract level (per capita monthly familiar income) and neighborhood problems perception (physical and social disorders) variables were investigated. Multilevel models (items nested within persons, persons nested within neighborhoods) were run to assess ecometric properties of variables assessing neighborhood problems.
The response rate was 85.3%, (1,720 adults). Participants were distributed in 63 census tracts. Two scales were identified using 16 items: Physical Problems and Social Disorder. The ecometric properties of the scales satisfactory: 0.24 to 0.28 for the intra-class correlation and 0.94 to 0.96 for reliability. Higher values on the scales of problems in the physical and social domains were associated with younger age, more length of time residing in the same neighborhood and lower census tract income level.
The findings support the usefulness of these scales to measure physical and social disorder problems in neighborhoods.
Residence characteristics; Epidemiologic methods; Self report; Data collection
The aim of this study was to describe oral health follow-up studies nested in a birth cohort. A population-based birth cohort was launched in 1993 in Pelotas, Rio Grande do Sul State, Brazil. Two oral health follow-up studies were conducted at six (n = 359) and 12 (n = 339) years of age. A high response rate was observed at 12 years of age; 94.4% of the children examined at six years of age were restudied in 2005. The mean DMF-T index at age 12 was 1.2 (SD = 1.6) for the entire sample, ranging from 0.6 (SD = 1.1) for children that were caries-free at age six, 1.3 (SD = 1.5) for those with 1-3 carious teeth at six years, and 1.8 (SD = 1.8) for those with 4-19 carious teeth at six years (p < 0.01). The number of individuals with severe malocclusions at 12 years was proportional to the number of malocclusions at six years. Oral health problems in early adolescence were more prevalent in individuals with dental problems at six years of age.
Oral Health; Cohort Studies; Child; Adolescent
Most studies comparing prevalence of periodontal disease and risk factors by using partial protocols were performed in adult populations, with several studies being conducted in clinical settings. The aim of this study is to assess the accuracy of partial protocols in estimating the prevalence of periodontal outcomes in adolescents and young adults from two population-based birth cohorts from Pelotas, Brazil, and to assess differences in the estimation and strength of the effect measures when partial protocols are adopted compared to full-mouth examination.
Gingival bleeding at probing among adolescents (n = 339) and young adults (n = 720) and dental calculus and periodontal probing depth among young adults were assessed using full-mouth examinations and four partial protocols: Ramfjord teeth (RT), community periodontal index (CPI), and two random diagonal quadrants (1 and 3, 2 and 4). Socioeconomic, demographic, and periodontal health-related variables were also collected. Sensitivity, absolute and relative bias, and inflation factors were calculated. Prevalence ratio for each periodontal outcome for the risk factors was estimated.
Two diagonal quadrants showed better accuracy; RT had the worst, whereas CPI presented an intermediate pattern when compared to full-mouth examination. For bleeding assessment in adolescence, RT and CPI underestimated by 18.4% and 16.2%, respectively, the true outcome prevalence, whereas among young adults, all partial protocols underestimated the prevalence. All partial protocols presented similar magnitude of association measures for all investigated periodontal potential risk factors.
Two diagonal quadrants protocol may be effective in identifying the risk factors for the most relevant periodontal outcomes in adolescence and in young adulthood.
Data collection; epidemiologic studies; periodontal index
The aim of this study was to assess the predictive capacity of body fat percentage (%BF) estimated by equations using body mass index (BMI) and waist circumference (WC) to identify hypertension and estimate measures of association between high %BF and hypertension in adults.
This is a cross-sectional population-based study conducted with 1,720 adults (20–59 years) from Florianopolis, southern Brazil. The area under the ROC curve, sensitivity, specificity, predictive values, and likelihood ratios of cutoffs for %BF were calculated. The association between %BF and hypertension was analyzed using Poisson regression, estimating the unadjusted and adjusted prevalence ratios and 95% CI.
The %BF equations showed good discriminatory power for hypertension (area under the ROC curve > 0.50). Considering the entire sample, the cutoffs for %BF with better properties for screening hypertension were identified in the equation with BMI for men (%BF = 20.4) and with WC for women (%BF = 34.1). Adults with high %BF had a higher prevalence of hypertension.
The use of simple anthropometric measurements allowed identifying the %BF, diagnosing obesity, and screening people at risk of hypertension in order to refer them for more careful diagnostic evaluation.
Anthropometry; Risk factors; Obesity; Hypertension; Adults
Undoped self-assembled GaN quantum dots (QD) stacked in superlattices (SL) with AlN spacer layers were submitted to thermal annealing treatments. Changes in the balance between the quantum confinement, strain state of the stacked heterostructures and quantum confined Stark effect lead to the observation of GaN QD excitonic recombination above and below the bulk GaN bandgap. In Eu-implanted SL structures, the GaN QD recombination was found to be dependent on the implantation fluence. For samples implanted with high fluence, a broad emission band at 2.7 eV was tentatively assigned to the emission of large blurred GaN QD present in the damage region of the implanted SL. This emission band is absent in the SL structures implanted with lower fluence and hence lower defect level. In both cases, high energy emission bands at approx. 3.9 eV suggest the presence of smaller dots for which the photoluminescence intensity was seen to be constant with increasing temperatures. Despite the fact that different deexcitation processes occur in undoped and Eu-implanted SL structures, the excitation population mechanisms were seen to be sample-independent. Two main absorption bands with maxima at approx. 4.1 and 4.7 to 4.9 eV are responsible for the population of the optically active centres in the SL samples.
Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.
To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.
The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.
Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.
Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.
dental pain; epidemiology; oral health; socioeconomic factors; multilevel analysis
To investigate the influence of family socioeconomic trajectories from childhood to adolescence on dental caries and associated behaviours.
Population‐based birth cohort.
Representative sample of the population of subjects born in 1982 in Pelotas, Brazil.
Adolescents (n = 888) aged 15 years old were dentally examined and interviewed.
Main outcome measures
Dental caries index (DMFT), care index (F/DMFT), tooth brushing, flossing and pattern of dental services use.
Adolescents who were always poor showed, in general, a worse pattern of dental caries, whereas adolescents who never were poor had a better pattern of dental caries. Adolescents who had moved from poverty in childhood to non‐poverty in adolescence and those who had moved from non‐poverty in childhood to poverty in adolescence had similar dental pattern to those who were always poor except for the pattern of dental services use, which was higher in the first group. In all groups girls had fewer carious teeth, better oral hygiene habits and higher dental services use than boys.
Poverty in at least one stage of the lifespan has a harmful effect on dental caries, oral behaviours and dental services use. Belonging to upwardly mobile families between childhood and adolescence only contributed to improved dental care.
Harmful social conditions in early life might predispose individuals to dental status which in turn may impact on adolescents' quality of life.
To estimate the prevalence of oral health impacts among 12 yr-old Brazilian adolescents (n = 359) and its association with life course socioeconomic variables, dental status and dental services utilization in a population-based birth cohort in Southern Brazil.
Exploratory variables were collected at birth, at 6 and 12 yr of age. The Oral Impacts on Daily Performances index (OIDP) was collected in adolescence and it was analyzed as a ranked outcome (OIDP from 0 to 9). Unadjusted and adjusted multivariable Poisson regression with robust variance was performed guided by a theoretical determination model.
The response rate was of 94.4% (n = 339). The prevalence of OIDP = 1 was 30.1% (CI95%25.2;35.0) and OIDP ≥ 2 was 28.0% (CI95%23.2;32.8). The most common daily activity affected was eating (44.8%), follow by cleaning the mouth and smiling (15.6%, and 15.0%, respectively). In the final model mother schooling and mother employment status in early cohort participant's life were associated with OIDP in adolescence. As higher untreated dental caries at age 6 and 12 years, and the presence of dental pain, gingival bleeding and incisal crowing in adolescence as higher the OIDP score. On the other hand, dental fluorosis was associated with low OIDP score.
Our findings highlight the importance of adolescent's early life social environmental as mother schooling and mother employment status and the early and later dental status on the adolescent's quality of life regardless family income and use of dental services.
Toothache is a dental public health problem and one of the predictors of dental attendance and it is strongly associated with the life quality of individuals. In spite of this, there are few population-based epidemiological studies on this theme. Objective: To estimate the prevalence of toothache and associated factors in adults of Lages, Southern Brazil.
A cross-sectional population-based study was carried out in a sample of 2,022 adults aged 20 to 59 years living in the urban area of a medium sized city in Southern Brazil. A questionnaire including socioeconomic, demographic, smoking, alcohol, and use of dental service variables was applied at adults household. Toothache occurred six months previous of the interview was considered the outcome. Poisson regression analyses were performed following a theoretical hierarchical framework. All analysis was adjusted by the sample design effect.
The response rate was 98.6%. The prevalence of toothache was 18.0% (95% CI 16.0; 20.1). The following variables were associated with toothache after adjustment: female (PR = 1.3 95% CI 1.3; 2.0), black skin colour vs. whites (PR = 1.5 95% CI 1.1, 1.9), low per capita income (PR = 1.7 95% CI 1.2, 2.3), smokers (PR = 1.5 95% CI 1.2, 1.9) and those who reported alcohol problems (PR = 1.4 95% CI 1.1; 1.9). To be 40 years of age (PR = 0.5 95% CI 0.4, 0.7) and use dental service in the last year (RR = 0.5 95% CI 0.4, 0.6) were protective factors for toothache.
The prevalence of toothache in adults of Lages can be considered a major problem of dental public health.
The objective of this study was to evaluate the incidence of adverse effects reported by adolescents following 14 days of use of a mouthrinse containing 0.05% NaF+0.12% chlorhexidine.
This double-blind study was developed as part of a randomized clinical trial. The adolescents enrolled to the study were randomly divided into two groups to use either: 0.05% NaF+0.12% chlorhexidine (G1, n=85) or 0.05% NaF (G2, n=85). Both groups used a 10mL solution of the mouthwash during 1 minute daily for 2 weeks under supervision. After that period, the subject's acceptance of taste was measured using a verbal descriptive scale (Labeled Magnitude Scale - LMS)11. Participants were also interviewed regarding the occurrence of possible adverse effects during treatment (temporary palate disorders, tooth staining or unpleasant taste). The proportional differences between the groups were tested using the chi-square test.
Palate changes were reported by 26% of participants of each group; 17.7% of G1 and 32% of G2 reported an unpleasant taste (p = 0.062), while staining was reported by 55% of G1 and 68.9% of G2 (p = 0.117). Absenteeism rates were similar in both groups (G1= 2.58 ± 2.69; G2=2.81 ± 2.39), p=0.362.
adherence was high in both groups and side effects reported by subjects were not perceived by them as being important. Since subjects' acceptance and compliance is fundamental to the success of an oral health program, chlorhexidine-fluoride could be a useful resource in a program of plaque control.
Mouthwashes; Chlorhexidine, adverse effects; Randomized clinical trials
To evaluate the association between obesity and periodontal disease and the mediating effect of oral hygiene, systemic inflammation and carbohydrate intake.
Material and methods
Subjects born in 1982 in Pelotas, Brazil (n = 5,914), have been followed for several times. Oral health was assessed in a representative sample of 720 individuals at 24 years. Obesity, waist circumference and number of episodes with obesity between 15 and 23 years of age were the main exposures. Mediating effect of oral hygiene, C-reactive protein level and carbohydrate consumption was also assessed.
Obese individuals were more likely to have ≥2 teeth with gingival bleeding. However, after adjusting for confounders, the association was not statistically significant [OR (obese × 2 or more teeth) 1.72 (95% CI: 0.95, 3.11)] and adjustment for potential mediators decreased the OR (OR = 1.38). The risk of presenting calculus in obese subjects was 10% higher [PR 1.10 (95% CI: 1.02, 1.18)]. The number of episodes of obesity between 15 and 23 years was associated with dental calculus. Periodontal pockets were not associated with obesity.
Systemic inflammation and oral hygiene may be mediating the association between obesity and gingivitis. Obesity was not associated with periodontal pockets in young adults in this cohort.
body mass index; cohort studies; C-reactive protein; periodontal diseases; waist circumference