Showing papers by "Flávio Fernando Demarco published in 2022"

Trajectories of Sugar Consumption and Dental Caries in Early Childhood

Abstract: This study verifies the association between the trajectory of sugar consumption and dental caries in the 2015 Pelotas Birth Cohort in Pelotas, Brazil. It was conducted with data from the follow-ups at 3, 12, 24, and 48 mo from the 2015 Birth Cohort, which included 4,275 children born alive in hospitals in Pelotas. Data collection included standardized questionnaires for first caregivers applied by trained interviewers at all follow-ups. Exposure was the trajectory of sugar consumption from 3 to 48 mo (always low, always intermediate, increasing, and always high), obtained by group-based trajectory modeling. The outcome of this study was dental caries, obtained through clinical examination performed by calibrated dentists at 48 mo of age. Socioeconomic conditions and oral health instruction from a health professional during the first 4 y of life were included in the analysis as potential confounders. Prevalence ratios and their 95% confidence intervals were provided from generalized estimating equations with a log-Poisson with robust variance specification. In total, 3,654 (91.1%) children participated in the survey at 48 mo, and 2,806 children had complete data for the analyzes performed. Of these, 1,012 (36.1%; 95% confidence interval [CI], 34.3–37.8) experienced caries, and 723 (25.8%; 95% CI, 24.2–27.4) had cavitated caries. Regarding cavitated caries, the prevalence was 1.48 times higher in the group with increasing sugar consumption than children with always low consumption. There is an association between the trajectory of sugar consumption and dental caries at 48 mo. Children with increasing and always high sugar consumption have the highest prevalence of caries.

A multi-country survey on the impact of COVID-19 on dental practice and dentists’ feelings in Latin America

Abstract: Abstract Background The COVID-19 pandemic has significantly influenced the routine of healthcare workers. This study investigated the impact of the pandemic on dental practice and dentists’ feelings in Latin America. Methods: A survey was conducted with dentists from 11 Spanish-speaking Latin American countries in September–December 2020. Professionals were invited by email and via an open campaign promoted on social media. The questions investigated dental care routines, practice changes, and feelings about the pandemic. Descriptive statistics were used to identify frequencies and distributions of variables. Proportions were compared using chi-square tests. Results A total of 2127 responses were collected from a sample with diverse demographic, sex, work, and education characteristics. The impact of COVID-19 was considered high/very high by 60% of respondents. The volume of patients assisted weekly was lower compared with the pre-pandemic period (mean reduction = 14 ± 15 patients). A high rate of fear to contracting the COVID-19 at work was observed (85%); 4.9% of participants had a positive COVID-19 test. The main professional challenges faced by respondents were reduction in the number of patients or financial gain (35%), fear of contracting COVID-19 (34%), and burden with or difficulty in purchasing new personal protective equipment (22%). The fear to contracting COVID-19 was influenced by the number of weekly appointments. A positive test by the dentists was associated with their reports of having assisted COVID-19 patients. The most cited feelings about the pandemic were uncertainty, fear, worry, anxiety, and stress. Negative feelings were more prevalent for professionals who did not receive training for COVID-19 preventive measures and those reporting higher levels of fear to contract the disease. Conclusion This multi-country survey indicated a high impact of the pandemic on dental care routines in Latin America. A massive prevalence of bad feelings was associated with the pandemic.

Periodontitis Is Associated with Consumption of Processed and Ultra-Processed Foods: Findings from a Population-Based Study

Abstract: The association between periodontitis and lifestyle factors has been widely investigated. However, an association between periodontitis and dietary patterns has not been explored. Therefore, this study investigated the association between periodontitis and food consumption among a Southern Brazil population. Data from the 1982 Pelotas Birth Cohort were used (n = 537). The exposure, periodontitis, was clinically measured and classified using the AAP/CDC system, then two latent variables were defined: ‘initial’ and ‘moderate/severe’ periodontitis. The consumption of in natura, processed, and ultra-processed foods (NOVA classification) was the outcome and measured in calories using the food frequency questionnaire (FFQ). Confounders were sex, maternal education, smoking status, xerostomia, and halitosis. Data were analyzed by structural equation modeling. ‘Initial’ periodontitis was associated with a higher consumption of in natura food (standardized coefficient (SC) 0.102; p-value = 0.040), versus processed (SC 0.078; p-value = 0.129) and ultra-processed (SC 0.043; p-value = 0.400) foods. ‘Moderate/severe’ periodontitis was associated with higher consumption of ultra-processed foods (SC 0.108; p-value = 0.024), versus processed (SC 0.093; p-value = 0.053) and in natura (SC 0.014; p-value = 0.762) foods. ‘Moderate/severe’ periodontitis appears to be associated with the consumption of processed and ultra-processed foods.

Two decades of socioeconomic inequalities in the prevalence of untreated dental caries in early childhood: Results from three birth cohorts in southern Brazil.

Abstract: 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.

Alcohol Intake Influences the Occurrence and Progression of Periodontitis Differently According to Sex and Country Sociodemographic Development: A Two-Stage Systematic Review.

Abstract: AIMS To conduct an overview and systematic evaluation of prospective cohort studies on whether alcohol intake is associated with the incidence and progression of periodontitis. METHODS Nine databases were searched by two independent reviewers up to November 2021 according to prespecified eligibility criteria. Risk of Bias in Systematic Reviews and Risk of Bias in Non-Randomized Studies of Interventions were used for risk of bias assessment and certainty of evidence was assessed using the GRADE approach. Random-effects pair-wise meta-analyses were performed with data from cohort studies on the effects of higher levels of alcohol intake compared with current non-drinking to determine risk ratios (RR) and confidence intervals of periodontitis. RESULTS The four systematic reviews were at high risk of bias and concluded that alcohol intake is associated with periodontitis regardless of the study design. Five reports from seven cohort studies contributed to the meta-analyses and no statistically significant differences were found for higher levels of consumption regarding the risk of periodontitis, except for men from countries with low- and high-middle socio-demographic index (RR = 1.30, 95% CI: 1.13-1.46), with low certainty evidence. CONCLUSION Higher levels of alcohol consumption seem to be part of the causal mechanism of periodontitis when cooccurring with male sex in underdeveloped countries. No conclusion can be drawn regarding alcohol use disorders or patterns of consumption.

Impact of COVID-19 on gender gap in dental publications: a retrospective cohort with three Brazilian journals.

Abstract: This was a retrospective cohort study to investigate the impact of COVID-19 pandemic on the gender gap in articles submitted to three international dental journals based in Brazil. All submissions performed to Brazilian Dental Journal, Brazilian Oral Research, and Journal of Applied Oral Science before (2019) and during the pandemic (2020) were assessed. Gender of the first, last, and corresponding authors were collected. Other variables collected were journal, continent studied by authors and stage of their careers (classified according to authors' highest degree), and final decision reached in the article. Absolute and relative frequencies with 95% confidence intervals, Pearson's Chi-square tests, and Fisher's Exact test were used (α = 0.05). In total, 4,726 unique submissions were analyzed. A higher proportion of early-career authors was observed during the pandemic (44.8% to 49.3%, p = 0.021). Most articles were rejected but without association with gender. Increased proportion of male first authors from before to during the pandemic was observed (39% to 42.1%, p = 0.034). Drop in the proportion of articles with women as first authors was observed for researchers in their early- (65.9% to 58.8%, p = 0.02) and mid-career stages (63% to 55.8%, p = 0.014). Reduction in women as first authors was observed during the pandemic in South and Central Americas (66.7% to 61.5%, p = 0.010), and when the last author was a female, or the corresponding author was a male. In conclusion, a disproportionate impact on female dental researchers in submitting articles in the period from before to during the pandemic was observed when considering first authorship, suggesting that the COVID-19 may have increased the gender inequality in dental science.

Relation between anxiety disorders in adolescent mothers and dental fear in children.

Abstract: BACKGROUND Maternal anxiety disorders can cause adverse consequences in the child's health, cognitive development and behavior. AIM to investigate the association of maternal anxiety disorders with the occurrence of dental fear in children aged 24-36 months. DESIGN This cross-sectional study is part of a cohort of adolescent mothers and their children in the city of Pelotas- RS/Brazil. Anxiety disorders in mothers were assessed using MINI (DSM IV), and the Dental Anxiety Question (DAQ) was used to assess children's dental fear. Mothers and children (n= 527) clinical oral examinations were performed. The analysis used to determine association was Poisson regression (p<0.05). RESULTS Prevalence of dental fear in children was 21.7% (n=114) and maternal age, agoraphobia, social phobia and maternal caries experience (P<0.05) were associated with presence of dental fear. After adjusted analysis, children of mothers presenting agoraphobia (PR=1.52; 95%CI= 1.00-2.32) and social phobia (PR= 1.69; 95% CI=1.06-2.71) had higher prevalence of dental fear compared to children whose mothers did not have these conditions. CONCLUSIONS In this population of young mothers, agoraphobia and social phobia were associated with children's dental fear. Detection and treatment of maternal mental disorders may aid in the prevention of dental fear and its oral health-related consequences.

Are maternal factors predictors of a child's first dental visit? A birth cohort study in Brazil.

Abstract: The purpose of this study was to investigate the association between maternal factors and dental visits of children within their first year of life. This study used data from the 2015 Pelotas Birth Cohort and included pregnant women and their children at 12 months of age, followed-up between May 2014 and December 2015. Socioeconomic and demographic data, information on the use of dental services during the last year, and information on dental fear were collected by interviewing the mothers. Information regarding dental caries and periodontal disease were collected during the mother's clinical examination. The date of each child's first visit to the dentist was recorded. Crude and adjusted Poisson regression models with robust variance were used. The sample comprised 2,287 mother-child dyads, of which 10.1% of children visited the dentist during the first year of life. Children whose mothers visited the dentist within the last year for preventive reasons (RR: 1.51; 95%CI: 1.12-2.03) or curative reasons (RR: 1.47; 95%CI: 1.08-2.01) were more likely to have visited the dentist during the first year of life compared to those whose mothers had not used dental services during this period. Maternal tooth loss was inversely associated with a child's visit to the dentist during the first year of life (RR: 0.69; 95%CI: 0.54-0.89). Considering the mother's history of using dental services, as well as their dental caries history, is necessary to understand and improve patterns of dental health care utilization and implement public oral health policies for young children.

Social and racial inequity in self-rated oral health in adults in Southern Brazil.

Abstract: This study aimed to estimate social and racial inequalities in self-rated oral health in adults from the Brazilian birth cohort study. This study belongs to 1982 Pelotas (Brazil) birth cohort study. Data from this study was collected for oral health conditions 31 years old (Oral Health Study). The outcome was self-rated oral health, dichotomized into positive (good/very good) and negative (regular/bad/very bad). Analyses were stratified by gender, racial/skin color groups, schooling level and income. For statistical analysis, the slope index of inequality (SII) and the concentration index (CIX) were used. The prevalence of negative self-rated oral health was 36.1%. Social inequalities were observed in self-rated oral health in both absolute and relative terms. A SII of -30.0 (95%CI: -43.6; -16.4) was observed for income, and -27.7 (95%CI: -41.9; -13.4) for schooling level. Both the individuals' income and the schooling level had negative CIX (CIXincome -14.6 [95%CI: -21.2; -8.0] and CIXschooling level -14.1 [95%CI: -20.7; -7.5]). Furthermore, the prevalence of negative self-rated oral health in black/brown/indigenous individuals from the highest income/schooling level was comparable to prevalence of the outcome in the white individuals belonging to the lowest income/schooling levels. This study results demonstrate racial disparities in oral health regardless of income and schooling levels. Furthermore, a higher concentration of negative self-rated oral health was identified among the most socioeconomically vulnerable individuals. Our findings reinforce the presence of racial and socioeconomic inequalities in oral health.

Is the effect of COVID-19 on periodontal treatment similar to that in general dental care and primary medical care? an observational study in Brazil

Abstract: ABSTRACT The present study aimed to analyze the effect of the COVID-19 pandemic on the rates of periodontal procedures, and provide a comparison with general dental care and primary medical care procedures carried out in the Brazilian Public Health System. The study had an ecological, retrospective design with data from 5,564 Brazilian municipalities (99.9%). A multilevel mixed-effects linear regression was used to analyze the longitudinal associations between the COVID-19 pandemic and the rate of procedures. There was a significant reduction in the number of periodontal procedures (Coef. −428.6 [95%CI −774.3/-82.9]) during the COVID-19 pandemic, although this reduction was no greater than that of medical and general dental procedures. Medical procedures witnessed the sharpest drop in procedures (Coef. −2831.5 [95%CI −3964.1/-1699.0]). A lower rate of general dental procedures was also identified during the pandemic (Coef. −2,110.6 [95%CI −3,400.8/-820.4]). The COVID-19 pandemic has had a negative effect on the rate of periodontal procedures carried out in the Brazilian Public Health System. The highest recutions were observed in general dental and medical procedures.

Objective and Self-Reported Physical Activity and Risk of Falling Among Community-Dwelling Older Adults From Southern Brazil.

Abstract: This study evaluated prospective associations between self-reported and objectively measured physical activity (PA) and risk of falls among older adults. A cohort study started in 2014 with 1,451 community-dwelling older adults living in Pelotas, Brazil. Leisure-time PA was obtained by the International Physical Activity Questionnaire and 7-day raw accelerometer data evaluated for total, light PA, and moderate to vigorous PA. In 2016-2017, participants recorded their falls in the previous 12 months. Around 23% of the 1,161 participants followed-up in 2016-2017 experienced a fall in the last 12 months. Participants who did not spend any time in self-reported leisure-time PA at baseline had on average 34% higher risk of falls, and individuals in the lowest tertile for moderate to vigorous PA had on average 51% higher risk of falls compared to those in the highest tertile. Low levels of self-reported and objectively measured moderate to vigorous PA were related to higher risk of falling among Brazilian older adults.

COVID-19 incidence, severity, medication use, and vaccination among dentists: Staggering body of evidence obtained from a survey during the second wave in Brazil

Abstract: This cross-sectional survey investigated the pandemic impact on dental practice in May 2021 (second wave in Brazil). COVID-19 incidence and severity among respondents, vaccination status, and level of confidence in vaccines were surveyed, in addition to medications used for preventing or treating COVID-19, including controversial drugs/substances (vitamin D, ivermectin, zinc, and chloroquine). Dentists were recruited by email and responded to a pretested questionnaire until May 31, 2021. In total, 1,907 responses were received (21.2% return rate). Bivariate and multivariate regression analyses were performed (α=0.05). Prevalence Ratios were calculated for the association between professional characteristics and two outcomes: report of SARS-CoV-2 infection and use of controversial drugs. One third of dentists reported intermediate levels of confidence in safety/efficacy of vaccines, but 96% received at least one vaccine dose, mainly CoronaVac. The impact of the pandemic on dental practice was rated as lower/much lower compared with one-year before (first wave) by 46% of respondents;27% of dentists reported to have had a positive COVID-19 test, ~50% had relatives or friends who had been hospitalized or died from COVID-19. At least one medication was used by 59% of respondents, 43% used two or more drugs and substances. Vitamin D (41%), (35%), and zinc (29%) were the most frequent drugs/substances. More experienced dentists (≥21 years in practice) were 42% more likely to use controversial medications than less experienced respondents. Dentists with residency/advanced training as postgraduate education had 30% higher prevalence of controversial medication use than respondents holding MSc/PhD degrees. Respondents with low confidence in vaccines were 2.1 times more likely to use controversial medications than participants with very high confidence. The overall findings of this survey highlight the high severity of the pandemic in Brazil, and raised questions about the use of scientific evidence by dentists in their decision to take controversial COVID-19 medications.

COVID-19 incidence, severity, medication use, and vaccination among dentists: survey during the second wave in Brazil

Abstract: Abstract Objective This cross-sectional study with dentists in Brazil assessed the COVID-19 incidence and severity, its vaccination status, and the level of confidence in vaccines in May 2021 (COVID-19 second wave). The medications used to prevent or treat COVID-19, including controversial substances (vitamin D, ivermectin, zinc, and chloroquine), were analyzed. Methodology Dentists were recruited by email and responded to a pretested questionnaire until May 31, 2021. Bivariate and multivariate regression analyses were performed (α=0.05). Prevalence ratios were calculated for the association between professional characteristics and two outcomes: SARS-CoV-2 infection and use of controversial substances. Results In total, 1,907 responses were received (return rate of 21.2%). One third of dentists reported intermediate levels of confidence in the safety and efficacy of COVID-19 vaccines, but 96% had received at least one vaccine dose, mainly CoronaVac. The effect of the pandemic on dental practice was classified as lower/much lower, in comparison with the first wave, by 46% of participants. Moreover, 27% of dentists had already tested positive for SARS-CoV-2 and about 50% had relatives or friends who had been hospitalized or died from COVID-19. At least one medication was used by 59% of participants and 43% used two or more substances. Vitamin D (41%), ivermectin (35%), and zinc (29%) were the most frequent substances. More experienced dentists (≥21 years of professional experience) were 42% more likely to use controversial substances than less experienced dentists. The prevalence of use of controversial substances was 30% higher among dentists with residency or advanced training, such as postgraduate degrees, in comparison with participants holding MSc or PhD degrees. Participants with low confidence in vaccines were 2.1 times more likely to use controversial substances than participants with a very high confidence. Conclusion The results of this study show the high severity of the COVID-19 pandemic in Brazil and raised questions about the use of scientific evidence by dentists in their decision to use controversial substances.

Number of erupted teeth at the age of 12 and 24 months

Abstract: Aim: To verify the validity of maternal reports on the number of deciduous teeth erupted in their children. Methods: This cross-sectional study was performed with children enrolled in a Birth Cohort at the age of 12 months in the first stage and 24 months in the second stage. At both stages, children were clinically examined, and mothers reported the number of teeth of their children. Comparison between groups was performed using the Mann-Whitney non-paired Wilcoxon test. Level of agreement between two methods were estimated by the Observed Agreement, Weighted Kappa and Intraclass Correlation coefficients. Results: A total of 125 children were examined in the first stage, with mean number of reported teeth of 6.2. In the second stage, 149 children were examined, with mean number of reported teeth of 15.9. High level of agreement, kappa values and intraclass correlation coefficients were observed for both arches in both periods (p<0.001). Conclusions: Maternal report on the number of teeth erupted in children was reliable and valid. Thus, it seems to be a useful instrument for collecting data in population-based epidemiological studies targeting young children.

How COVID-19 pandemic impacted the students and staff physical activity? A study in a Southern Brazilian University

Abstract: Physical activity and its positive effects on coronavirus have been extensively discussed in the literature. However, there is still lack of evidence on the effects of the coronavirus pandemic on the health-related behaviors of the Brazilian university community. The aim of the present study is to describe physical activity practice during the coronavirus pandemic among students and staff of a southern Brazilian university, as well as its association with sociodemographic characteristics. This was a self-administered web-based cross-sectional study, carried out among a southern Brazilian community. The main outcome for this study was leisure time physical activity during the coronavirus pandemic. Considering only leisure-time, 21.0% and 24.0% of the students and staff, respectively, reported achieving physical activity recommendations ([≥]150 minutes per week). There was a decline of more than 15 percentage points in physical activity practice comparing pre- and during the pandemic, and those following the protocols of staying at home presented lower levels of leisure-time physical activity. Physical activity practice was mainly performed at home and without any professional help. Leisure-time physical activity prevalence during the pandemic was relatively low among students and staff, and participants that followed staying at home protocols presented lower levels of physical activity.

Socioeconomic inequalities related to maternal perception of children's oral health at age 4: Results of a birth cohort.

Abstract: OBJECTIVES To estimate socioeconomic inequalities in the maternal perception of children's oral health from a birth cohort study in Brazil. METHODS The data from this study were collected through perinatal interviews and at the 48-month follow-up from the 2015 Pelotas Birth Cohort Study. The main outcome was the maternal perception of children's oral health, dichotomized into positive (good/very good) and negative (fair/bad/very bad). The secondary outcome was untreated dental caries (absence and presence, according to the ICDAS index - International Caries Detection and Assessment System). For the statistical analysis, the absolute inequality index (Slope Index of Inequality - SII) and the relative concentration index (Concentration Index - CIX) were used. Analyses were stratified by maternal educational level, family income and wealth index. RESULTS The prevalence of outcomes was 19.4% (95% CI 18.2; 20.7) for the negative maternal perception of children's oral health and 15.6% (95% CI 14.4; 16.8) for untreated dental caries. Socioeconomics inequalities were observed in negative maternal perception of children's oral health in both absolute and relative terms. A SII of -16.6 (95% CI -20.8; -12.5) was observed for family income, with higher prevalence in poor families. A higher prevalence of the negative maternal perception of children's oral health was observed in mothers without any educational level or a few years of study (CIX -21.1 [95% CI -24.5; -17.7]). CONCLUSIONS This study demonstrates socioeconomics disparities in the maternal perception of children's oral health and in the prevalence of untreated caries in children. A higher concentration of negative maternal perception of children's oral health was identified among the most socioeconomically vulnerable individuals. The findings reinforce the presence of socioeconomic inequalities in subjective measures about children's oral health.

The alcohol harm paradox and tooth loss among Brazilian older adults.

Abstract: OBJECTIVE To investigate whether the association between alcohol consumption and tooth loss is modified across socioeconomic positions (SEP) in Brazilian older adults. METHODS We conducted a secondary analysis using data of The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015 - 2016). Effect Measure Modification (EMM) analyses using multivariable Poisson regression models tested whether the association between heavy drinking and lack of functional dentition (FD) varies in magnitude and direction according to levels of Household Wealth index (HWI) and educational attainment, assessed by the Relative Excess Risk due to Interaction (RERI). Sensitivity analyses using the lifetime exposure to alcohol were performed. RESULTS The analytical sample comprised 8078 participants. Heavy drinkers living in low-wealth households and with lower education presented 7% (95% CI: 1.01 - 1.14) and 36% (95% CI: 1.28 - 1.44) higher prevalence of lack of FD, respectively, than their counterparts, and super-additive associations were detected [RERI for HWI: 0.12 (95% CI: 0.02 - 0.21); RERI for educational attainment: 0.20 (95% CI: 0.09 - 0.30)]. The associations were also super-additive in the sensitivity analyses when controlling for abstainer reference group bias. CONCLUSION We suggest that alcohol consumption disproportionately impacts the prevalence of tooth loss of Brazilian older adults from lower SEP groups.