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1.  Validation of Self-Reported Information on Dental Caries in a Birth Cohort at 18 Years of Age 
PLoS ONE  2014;9(9):e106382.
Objective
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.
Method
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.
Results
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.
Conclusions
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.
doi:10.1371/journal.pone.0106382
PMCID: PMC4159228  PMID: 25202969
2.  Chewing impairment and associated factors among adults 
Revista de Saúde Pública  2013;47(6):1028-1038.
OBJECTIVE
The aim of this study was to estimate the prevalence of chewing impairment according to sex, and its associated factors in adults.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
doi:10.1590/S0034-8910.2013047004789
PMCID: PMC4206107  PMID: 24626541
Adult; Mastication; Socioeconomic Factors; Gender and Health; Oral Health; Dental Health Surveys
3.  Perceived neighborhood problems: multilevel analysis to evaluate psychometric properties in a Southern adult Brazilian population 
BMC Public Health  2013;13:1085.
Background
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.
Methods
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.
Results
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.
Conclusions
The findings support the usefulness of these scales to measure physical and social disorder problems in neighborhoods.
doi:10.1186/1471-2458-13-1085
PMCID: PMC4225501  PMID: 24256619
Residence characteristics; Epidemiologic methods; Self report; Data collection
4.  Oral health follow-up studies in the 1993 Pelotas (Brazil) birth cohort study: methodology and principal results 
Cadernos de saude publica  2010;26(10):1990-1999.
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.
PMCID: PMC3794421  PMID: 20963297
Oral Health; Cohort Studies; Child; Adolescent
5.  Validity of Partial Protocols to Assess the Prevalence of Periodontal Outcomes and Associated Sociodemographic and Behavior Factors in Adolescents and Young Adults 
Journal of periodontology  2011;83(3):369-378.
Background
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.
Methods
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.
Results
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.
Conclusion
Two diagonal quadrants protocol may be effective in identifying the risk factors for the most relevant periodontal outcomes in adolescence and in young adulthood.
doi:10.1902/jop.2011.110250
PMCID: PMC3605763  PMID: 21859320
Data collection; epidemiologic studies; periodontal index
6.  Is high body fat estimated by body mass index and waist circumference a predictor of hypertension in adults? A population-based study 
Nutrition Journal  2012;11:112.
Background
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1186/1475-2891-11-112
PMCID: PMC3545980  PMID: 23244669
Anthropometry; Risk factors; Obesity; Hypertension; Adults
7.  Effect of Eu-implantation and annealing on the GaN quantum dots excitonic recombination 
Nanoscale Research Letters  2011;6(1):378.
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.
doi:10.1186/1556-276X-6-378
PMCID: PMC3211471  PMID: 21711897
8.  Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach 
BMC Oral Health  2010;10:20.
Background
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.
Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1186/1472-6831-10-20
PMCID: PMC2928166  PMID: 20707920
dental pain; epidemiology; oral health; socioeconomic factors; multilevel analysis
9.  The relation between family socioeconomic trajectories from childhood to adolescence and dental caries and associated oral behaviours 
Objectives
To investigate the influence of family socioeconomic trajectories from childhood to adolescence on dental caries and associated behaviours.
Design
Population‐based birth cohort.
Setting
Representative sample of the population of subjects born in 1982 in Pelotas, Brazil.
Participants
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.
Main results
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.
Conclusion
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.
doi:10.1136/jech.2005.044818
PMCID: PMC2465630  PMID: 17234873
10.  Social and dental status along the life course and oral health impacts in adolescents: a population-based birth cohort 
Background
Harmful social conditions in early life might predispose individuals to dental status which in turn may impact on adolescents' quality of life.
Aims
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.
Methods
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.
Results
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.
Conclusion
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.
doi:10.1186/1477-7525-7-95
PMCID: PMC2785763  PMID: 19930601
11.  Toothache and associated factors in Brazilian adults: a cross-sectional population-based study 
BMC Oral Health  2009;9:7.
Background
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.
Methods
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.
Results
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.
Conclusion
The prevalence of toothache in adults of Lages can be considered a major problem of dental public health.
doi:10.1186/1472-6831-9-7
PMCID: PMC2653019  PMID: 19243630
12.  Association between obesity and periodontal disease in young adults: a population-based birth cohort 
Aim
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.
Results
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.
Conclusion
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.
doi:10.1111/j.1600-051X.2012.01906.x
PMCID: PMC3468720  PMID: 22671969
body mass index; cohort studies; C-reactive protein; periodontal diseases; waist circumference

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