Análise do risco à atividade de cárie em crianças de 0 a 36 meses: protocolo de avaliação, acompanhamento longitudinal e efetividade de estratégias para controle da cárie na primeira infância.

Abstract

Early childhood caries represents a public health problem in our country. Although the superiority of some methods over others to control this disease are observed, the evidence is still limited. Thus, a scoping review was developed to evaluate the scientific evidences registered in the period from 2002 to 2017 on methods/strategies to control early childhood caries. It was verified that, among the several methods studied (fluorides, chlorhexidine, silver fluoride, xylitol, probiotics, sealant, nutritional and educational methods, and methods together), the child insertion into a program with maternal and/or family counseling on general health, oral hygiene and diet, emphasizing periodic monitoring and management based on risk assessment proved to be the strategy that most favored the control of caries risk and early childhood dental caries. The protocol for assessing caries activity risk used in the Maternal and Child Dental Care Extension Project (AOMI) of FO-UFPel was described and was analyzed if any parameter would be superior in the identification of this risk. A cross-sectional analysis of medical records from 476 two-year-old children was carried out, conducting a multivariate analysis using Poisson regression with robust variance to estimate the prevalence ratio and 95% confidence interval (CI) and significance level of 5%. After adjustments, it can be observed that the behavioral parameters (nocturnal suckling, consumption of sucrose more than seven times a day, late beginning of oral hygiene, absence of family participation in oral hygiene, maternal schooling less than eight years of study, presence of bacterial biofilm and maternal and poor maternal self-care) were more important than the physiological ones (chronic disease, age of eruption of the 1st molar deciduous, interdental space in the arch and dental alteration). When using this same protocol, in a longitudinal evaluation data of 344 children followed up in the AOMI project from the first to the third year of life, it was possible to trace the risk trajectory of the caries activity of these children and to verify that, using preventive strategies, it was possible to maintain the majority of the children of this sample (88.9%) in oral health situation over three years. In the bivariate analysis (Fisher's exact) it was evidenced that maternal schooling> 8 years of schooling, sucrose frequency ≤ 7 times a day, presence of family participation in baby's oral hygiene, presence of interdental space in the arcade, absence of visible plaque and good/satisfactory maternal self-care had a significant relationship with the child having maintained a caries-free and risk-free condition during the evaluation period. These findings reinforce the importance of children insertion into an oral health program and management based on caries activity risk assessment conducted in the AOMI project.