Associação entre cárie dentária e defeitos de desenvolvimento de esmalte não fluoróticos em escolares

Abstract

Despite improvement of oral health (lower prevalence and incidence) between children and adolescents, dental caries is still the main public oral health problem and the major cause of pain, tooth loss and chewing difficulties in children and adolescents; and it impacts negatively on oral health-related quality of life. Investigations have showed controversial findings in relation to the risk factors for dental caries, mainly, concerning the influence of developmental enamel defects (DDE), such as opacities or enamel hypoplasia. Thus, this theses aimed to first to assess likely risk or protective factors for enamel defects in permanent dentition; to systematically review literature and meta-analytic approach regarding the effect of enamel defects on dental caries experience and, assess the association between caries and DDE according to the type of teeth (anterior or posterior). A cross-sectional study with a sample of 1,210 8-12-year-old schoolchildren was carried out in 20 public and private schools. Data collection included questionnaire applied to mothers, to obtain demographic, socioeconomic and child variables (concerning the first three years of child); and oral clinical examination of to assess enamel defects (FDI) and dental caries (WHO). Data were entered twice in an EpiData 3.1 database and analyses were performed in Stata 12.0and Rev Man version 5.2 for meta-analysis. Descriptive analysis was performed to obtain the prevalence of the dependent variable. Then, bivariate analyses were performed to test the association between enamel defects and independent variables. To investigate the independent effect of independent variables on enamel defects, Poisson regression analysis was performed. For the outcome dental caries and its association with enamel defects according to the teeth, it was performed logistic regression, estimating the odds ratio (OR) and respective confidence intervals (95% CI). The systematic review and the meta-analysis showed that individuals with enamel defects had higher odds of having had dental caries experience [OR 1.23 (95% CI 1.10-1.38)].The prevalence of any enamel defects was 64,0%, being the diffuse opacity the most frequent (35,0%), and for dental caries was 32,4% with mean DMFT of 0.6 (SD, 1.2).Dental caries experience was more common among children who had enamel hypoplasia in their posterior teeth [OR 2.79 (95% CI 1.05, 6.51)] than among those with none. In anterior teeth, there was no association. For the outcome enamel defects, there was not any association with maternal-child factors. It is possible to consider that the presence of enamel defects is associated with occurrence of dental caries.