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INTRODUCTION: There is an inconclusive causal association between asthma symptoms and dental caries in the primary dentition. This study aimed to investigate, using SEM (structural equation modeling), a possible causal relation between asthma and dental caries in the primary dentition. METHODS: Using data from the 2004 Pelotas Birth Cohort Study, a sub-sample of 1,303 individuals was selected. Dental caries was clinically evaluated at 5 years old based on decayed, missing, and filled tooth (dmft) index criteria. Asthma-related symptoms (wheezing and shortness of breath) at 1- and 4-year-olds composed a latent variable and were the main exposures to caries occurrence. SEM was used to identify possible direct, indirect, and mediated effects of asthma in primary dentition dental caries. RESULTS: The general prevalence of caries at age 5 was 1.95 (SD: 3.56). When comparing the dmft values for children with asthma symptoms and those without, they presented similar values in both periods where asthma symptoms were evaluated (1- and 4-year-old). SEM analysis showed that asthma was neither directly nor indirectly related to dental caries. CONCLUSION: Asthma, using a latent variable constructed based on asthma symptoms, showed no causal effect on dental caries occurrence in the primary dentition.
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Asma , Cárie Dentária , Criança , Humanos , Pré-Escolar , Lactente , Cárie Dentária/complicações , Cárie Dentária/epidemiologia , Estudos de Coortes , Brasil/epidemiologia , Índice CPO , Asma/complicações , Asma/epidemiologia , PrevalênciaRESUMO
OBJECTIVES: To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. METHODS: The socioeconomic data to this study were collected at the 48-month follow-up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality-SII and Concentration Index-CIX) were used. RESULTS: The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro-poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. CONCLUSIONS: Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children.
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Cárie Dentária , Criança , Pré-Escolar , Humanos , Cárie Dentária/epidemiologia , Disparidades nos Níveis de Saúde , Coorte de Nascimento , Brasil/epidemiologia , Prevalência , Fatores SocioeconômicosRESUMO
OBJECTIVES: The understanding of how subjective socioeconomic status (SSS) relates to objective socioeconomic status (OSS), and how both conditions act together in oral health outcomes is still unclear. This study aims to test the independent and joint association between OSS and SSS with oral health, to assess the role of socioeconomic status discrepancies, and to evaluate the role of SSS in the association between OSS and oral health. METHODS: Data from 1140 adults from a population-based study in Southern Brazil were used. We applied diagonal reference models DRM to disentangle the effects of OSS (education) and SSS (MacArthur Scale) to oral health outcomes. The outcomes were functional dentition clinically evaluated (FD ≥20 teeth) and self-reported oral health SROH. We also examined the discrepancy between OSS and SSS to oral health indicators and the effect measure modification (EMM) of SSS on the association between OSS and oral health. RESULTS: Subjective socioeconomic status and OSS contributed equally to SROH, while OSS explained a substantially higher amount of FD than SSS (0.85 vs 0.15). An EMM of SSS was found on the association between OSS and fair/poor SROH, with a relative excess risk due to interaction (RERI) of 1.08. Less evidence of EMM was found for FD (RERI = 0.14). Individuals with lower SSS and OSS had four times the risk of the outcomes than the reference group. CONCLUSIONS: Adults with concordant lower SSS and OSS have a worse oral health than those with concordant higher status. There was evidence that the association between OSS and SROH is modified by SSS.
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Saúde Bucal , Classe Social , Adulto , Humanos , Brasil/epidemiologia , Escolaridade , Nível de Saúde , Autorrelato , Fatores Socioeconômicos , Perda de DenteRESUMO
OBJECTIVES: This cross-sectional study tested the presence of collider bias in the relationship between periodontitis and the carotid intima-media thickness (cIMT). METHODS: Data from 480 members of the 1982 Pelotas Birth Cohort, Brazil, were used. Periodontitis at the age of 24 years was determined as the main exposure. cIMT at the age of 30 years was set as the outcome. High-sensitivity C-reactive protein (hsCRP) was considered the mediator (collider). Confounding variables included sex, income, BMI and smoking. The association between cIMT and periodontitis was tested in conventional logistic regression stratified on hsCRP levels, marginal structural modelling and sensitivity analysis for collider stratification bias. RESULTS: Conventional adjusted logistic regression analysis showed a positive association between periodontitis and cIMT (OR 1.5; 95% CI 1.1; 2.3). Stratified analysis according to the hsCRP levels revealed that the magnitude of the association was even higher among participants with hsCRP ≥ 3 mg/L (OR 2.2, 95% CI 1.1; 4.2) with 36% collider bias probability. No association between periodontitis and cIMT was found among participants with hsCRP < 3 mg/L (OR 1.3; 95% CI 0.8; 2.1). The association was not detected using marginal structural modelling (OR 1.3, 95% CI 0.8; 2.0). CONCLUSIONS: The association between periodontitis and surrogate markers of cardiovascular disease might be induced by collider bias stratification using conventional regression analysis.
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Espessura Intima-Media Carotídea , Periodontite , Brasil/epidemiologia , Proteína C-Reativa/análise , Estudos Transversais , Humanos , Periodontite/complicações , Periodontite/epidemiologia , Fatores de RiscoRESUMO
AIM: To investigate the association between depression and periodontitis among adults enrolled in the 1982 Pelotas Birth Cohort, Brazil. MATERIALS AND METHODS: Major depressive episode (MDE) and severity of depressive symptoms obtained in 2012 were considered the exposure of this study. In 2013, periodontitis, the outcome of interest, was clinically assessed and two different case definitions were used: the CDC/AAP and a combination of clinical attachment loss (CAL) and bleeding on probing (BOP) simultaneously. Serum levels of C-reactive protein and frequency of dental flossing were defined as mediators while confounders comprised a set of variables collected throughout the life-course of the participants. The parametric g-formula was used to test the direct, indirect and total effects of depression on periodontitis. RESULTS: 539 participants were clinically examined. Individuals with depressive symptoms presented higher risk of periodontitis (risk ratio [RR] 1.19). The presence of depressive symptoms was also associated with moderate/severe periodontitis (total effect RR 1.18). None of the associations was mediated by flossing or C-reactive protein levels. Finally, neither the presence of depressive symptoms nor the presence of major depression was associated with the combination of CAL+BOP. CONCLUSIONS: A positive association between depressive symptoms and periodontitis and moderate/severe periodontitis was found. MDE was not associated with periodontitis.
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Transtorno Depressivo Maior , Periodontite , Adulto , Brasil , Estudos de Coortes , Depressão , Humanos , Índice PeriodontalRESUMO
BACKGROUND: This study aimed to investigate the association between metabolic syndrome (MetS) and periodontitis among young adults, and also to compare results using observed and latent variables for MetS and periodontitis. METHODS: Data from the 1982 Pelotas Birth Cohort, Brazil, were used. Metabolic syndrome at the age of 23 years was measured using clinical and biochemical analysis and set as the main exposure. Periodontitis at the age of 31 years was clinically measured and set as the outcome. Confounding variables included sex and maternal education, assessed at birth, family income at 23 years, and smoking status at the age of 23 and 30 years. Factor analyses (exploratory and confirmatory) were performed to define latent variables for MetS and periodontitis. In addition, both conditions were also defined as categorical observed variables. The association between MetS and periodontitis was tested in structural equation models. RESULTS: Two latent periodontal variables were identified: "initial" and "advanced" periodontitis, while one latent variable was identified for MetS. Metabolic syndrome is positively associated with "advanced" (coefficient 0.11; P value < 0.01), but not with "initial" (coefficient -0.01; P value = 0.79) periodontitis. When MetS and periodontitis were set as observed variables in the structural equation models, no association was found irrespective of the criteria used for periodontitis classification. CONCLUSIONS: There was a positive association between metabolic syndrome and "advanced" periodontitis, when the multiple dimensions of both diseases were accounted in latent variables. Nevertheless, when MetS and periodontitis were treated as observed variables, no association was detected irrespective of the criteria used for periodontitis classification.
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Síndrome Metabólica , Periodontite , Brasil , Humanos , Análise de Classes Latentes , Fatores de Risco , Fumar , Adulto JovemRESUMO
OBJECTIVES: This study adopted an intergenerational approach, aiming to answer the following research questions: (a) Are maternal oral health-related behaviours and oral health associated with dental caries in preschool children?; (b) Do maternal caregiving behaviours mediate the association between maternal oral health-related behaviours and dental caries in preschool children. METHODS: Children aged 5 years, enrolled in the 2004 Pelotas (Brazil) Birth Cohort, were investigated (n = 1303). Children were dentally examined using WHO criteria to assess the number of decayed, missing and filled surfaces (dmfs), and their mothers were interviewed. Standardized direct, indirect and total effects of maternal characteristics (frequency of toothbrushing, dental anxiety, the pattern of dental attendance, self-perception about oral health and self-reported dental caries) on maternal caregiving behaviours and children's dmfs were assessed using path analysis. RESULTS: Mean dmfs was 4.1 (95% CI 3.6;4.5). Maternal oral health-related behaviours had no direct effect on children's dental caries: child dental attendance pattern partially mediates the effect of maternal dental attendance pattern on dental caries (87.8%; P < 0.05) and partially mediates the effect of maternal dental anxiety (39.9%; P < 0.001). Child frequency of toothbrushing mediates 28.0% (P < 0.001) of the effect of maternal frequency of toothbrushing on dental caries. CONCLUSIONS: Socioeconomic factors directly influenced children's caries experience, whereas maternal oral health-related behaviours had no direct effect. It was observed an indirect effect of maternal dental anxiety and dental attendance pattern on children's dental caries mediated by caregiving behaviours, such as child dental attendance pattern and frequency of toothbrushing.
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Cárie Dentária/etiologia , Comportamentos Relacionados com a Saúde , Mães/estatística & dados numéricos , Poder Familiar , Pré-Escolar , Estudos Transversais , Índice CPO , Ansiedade ao Tratamento Odontológico/epidemiologia , Cárie Dentária/epidemiologia , Feminino , Humanos , Saúde Bucal/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Escovação Dentária/estatística & dados numéricosRESUMO
AIMS: To quantify the impact of life course income trajectories on periodontitis in adulthood. MATERIALS AND METHODS: Data from the 1982 Pelotas Birth Cohort Study, Brazil, were used. Information on family income was collected at birth and ages 15, 19, 23 and 30 years. Group-based trajectory modelling was used to identify income trajectories. Periodontal measures were assessed through clinical examination at age 31. Log-Poisson regression models were used to estimate prevalence ratios (PRs) of any and moderate/severe periodontitis, as outcomes. RESULTS: Prevalence of any periodontitis and moderate/severe periodontitis was 37.3% and 14.3% (n = 539). Income trajectories were associated with prevalence of moderate/severe periodontitis. Adjusted PR in participants in low and variable income trajectory was 2.1 times higher than in participants in stable high-income trajectory. The unadjusted association between income trajectories and prevalence of any periodontitis was explained by the inclusion of behavioural and clinical variables in the model. CONCLUSIONS: Low and variable life course income increased the prevalence of moderate/severe periodontitis at age 31 years. The findings may inform programmes in identifying and targeting potentially at-risk groups during the life course to prevent periodontitis.
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Escolaridade , Renda , Periodontite/economia , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Mães , Análise Multivariada , Índice Periodontal , Periodontite/epidemiologia , Prevalência , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVES: This study aimed to evaluate the quality of posterior restorations (amalgam or composite) placed in adults from a birth cohort and its association with clinical and socioeconomic determinants experienced during their life course. METHODS: A representative sample (n=539) of all 5914 births occurring in Pelotas (Brazil) in 1982 was prospectively investigated. Quality of posterior restorations (satisfactory or unsatisfactory) was assessed at 31 yrs-old, using modified USPHS criteria. Trained and calibrated dentists performed clinical examination. Explanatory variables included demographic and socioeconomic, oral health and dental service utilization patterns during the life course. Tooth related variables (type of tooth, material, size of cavity) were also analyzed. Untreated caries and socioeconomic status were assessed by group-based trajectories analyses. Multilevel Regression models were used to determine factors associated with restoration outcomes. RESULTS: In total 2123 restorations (53% composite) were evaluated of which 107 (5%) were assessed as failed. The main reasons for failure were tooth/restoration fracture (50.5%) and secondary caries (30.7%). Failures in posterior restorations showed a significant association with socioeconomic aspects (lower tertile of income at age 30 - prevalence ratio (PR) 2.21 [95% CI 1.19-4.09]), clinical variables (trajectory of higher untreated caries - PR 2.11 [95% CI 1.23-3.61]) and also with tooth-related factors (Restorations involving three or more surfaces - PR 5.51 [95% CI 3.30-9.19]) after adjustment for each other. CONCLUSIONS: These findings suggest that, although tooth-related variables have an important role in restoration longevity, patient-related factors, such as socioeconomic variables and untreated caries are also associated with failure and should be taken into account when evaluating longevity of posterior restorations. CLINICAL SIGNIFICANCE: This was the first study assessing long-term trajectory of untreated caries, showing an association between higher experience of caries during the life-course and unsatisfactory restorations. The findings suggest that individual related factors should be considered when planning treatment and in future research evaluating the longevity of dental restorations.
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Assistência Odontológica/economia , Cárie Dentária/economia , Cárie Dentária/terapia , Restauração Dentária Permanente/normas , Renda , Determinantes Sociais da Saúde/classificação , Adulto , Brasil , Estudos de Coortes , Resinas Compostas/química , Amálgama Dentário/química , Cárie Dentária/classificação , Preparo da Cavidade Dentária/classificação , Materiais Dentários/classificação , Falha de Restauração Dentária , Escolaridade , Feminino , Seguimentos , Disparidades em Assistência à Saúde , Humanos , Seguro Saúde , Masculino , Análise Multinível , Saúde Bucal , Satisfação do Paciente , Fatores Socioeconômicos , Análise de SobrevidaRESUMO
OBJECTIVES: To test whether maternal education has a direct effect on gingival bleeding in adolescents aged 12 and to assess whether oral health behaviours over time mediate that association. METHODS: Two oral health studies nested in the 1993 Pelotas (Brazil) birth cohort study were carried out in participants aged 6 (n = 359) and 12 years (n = 339). The proportion of teeth with bleeding on probing (BOP) and the median number of teeth with gingivitis at age 12 were recorded. Maternal education at birth was the exposure. Toothbrushing frequency and dental visit at ages 6 and 12 years were investigated as mediators of the association between maternal education at birth and gingival bleeding. Time-varying family income through childhood and adolescence was included as later confounder. Paternal education was taken as baseline confounder. The controlled direct effect (CDE) of maternal education at child's birth on gingival bleeding at age 12 was estimated using marginal structural models (MSM). Additionally, path analysis was employed to estimate standardized direct, indirect and total effects of maternal education at birth on gingival bleeding. RESULTS: Adjusted analyses using MSM showed that adolescents whose mothers had <8 years of education had 3.82 higher risk of having teeth with gingival bleeding above the median (rate ratio RR 3.82; 95% CI: 1.68-8.19). Low maternal education doubled the proportion of gingival bleeding at age 12 not mediated by dental visit and toothbrushing frequency (RR 1.99; 95% CI: 1.52-2.60). Path analysis revealed that maternal education had a direct effect on gingival bleeding independently of the mediators. CONCLUSIONS: The pattern of oral health behaviours does not explain the association between mother's education and adolescent's gingival bleeding. Individual-based approaches focused on oral health-related behaviours tend to fail to prevent gingival bleeding.