Maria Augusta Bessa Rebelo

Children and adolescents often spend substantial time engaged in screen-based activities for both educational and recreational purposes. Excessive screen time has been associated with adverse health outcomes, potentially mediated by shared unhealthy behaviors such as poor dietary habits and inadequate toothbrushing. The aim of this study was to examine the direct and indirect pathways linking screen time to adolescents’ oral clinical conditions and oral health–related quality of life (OHRQoL), considering contextual, family, and individual factors within a comprehensive theoretical framework. An observational longitudinal study was conducted in Manaus, Brazil, from 2024 to 2025, including 610 twelve-year-old adolescents enrolled in urban public schools. The theoretical model, adapted from Fisher-Owens et al (2007), incorporated community, family, and individual-level variables. Data were collected through self-administered questionnaires completed by participants and their parents/guardians, alongside clinical oral examinations conducted in private settings within schools. Structural equation modeling (SEM) was used to estimate direct and indirect effects. A hierarchical structure of associations across contextual, socioeconomic, relational, and individual levels influencing oral health outcomes was observed. Screen time was not directly associated with oral clinical conditions but was linked to a higher impact on OHRQoL (β = 0.202, P = 0.002) and lower toothbrushing frequency (β = −0.139, P = 0.031). A higher impact on OHRQoL was also related to higher sugar consumption (β = 0.142, P = 0.004) and poorer clinical oral condition (β = 0.174, P = 0.005). Socioeconomic status played a major role, contributing to multiple direct and indirect pathways linking contextual and relational factors to the outcomes. In conclusion, screen-related behaviors are embedded within broader familial and social contexts, with socioeconomic conditions influencing multiple pathways to adolescents’ oral health outcomes. Interventions targeting family environments, parental practices, and behavioral habits, alongside strategies addressing socioeconomic disparities, may reduce behavioral risks and improve adolescent oral health.

Objectives: To examine the influence of screen time and behavioural pathways on the incidence of dental caries and oral health‐related quality of life (OHRQoL) among adolescents living in deprived neighbourhoods. Methods: A 2‐year prospective cohort study involving 323 12‐year‐old adolescents enrolled in public schools was conducted in the East region of Manaus, Brazil. Baseline data encompassing sex, socioeconomic status (family income, parents' education and household crowding), social support (SSA questionnaire), screen time (number of hours spent on screen‐based activities), behaviours (sugar consumption and frequency of toothbrushing) and dental caries (DMFT index) was collected through self‐administered questionnaires and clinical examinations. OHRQoL (Child Perceptions Questionnaire—CPQ11–14) and dental caries incidence were measured at baseline and 2‐year follow‐up. Structural equation modelling, guided by the Wilson and Cleary conceptual framework, was employed to examine both direct and indirect associations among the study variables. Results: Increased screen time directly predicted higher dental caries incidence and poor OHRQoL after 2 years. Sugar consumption mediated the association between screen time and dental caries incidence. Incidence of dental caries mediated the association between screen time and OHRQoL. Poor OHRQoL was also directly predicted by dental caries incidence and female sex. Screen time and sugar consumption mediated the association of socioeconomic status and social support with dental caries incidence and OHRQoL. Conclusions: The findings of this study indicate that spending more time on screen‐based activities is significantly associated with a greater consumption of sugar, higher incidence of dental caries and negative impact on OHRQoL among adolescents. These findings underscore the need for targeted strategies aimed at reducing screen time and sugar consumption to mitigate its detrimental effects on oral health and overall quality of life.

To investigate the association of sociodemographic characteristics and dental service utilisation with clusters of oral health conditions among Brazilian five-year-old children. Secondary data on five-year-old children (N = 4354) from the Brazilian National Oral Health Survey (SB Brasil 2023) were analysed. Sociodemographic variables included sex, skin colour, family income, conditional cash transfer programme, household crowding, number of durable goods, and maternal education. Oral health measures included dental caries (measured using dmft), clinical consequences of untreated dental caries (measured using pufa index), malocclusion, and perceived oral health. Dental service utilisation was assessed based on dental service seeking, reason for the last dental visit, and satisfaction with dental care. Latent Profile Analysis was performed to identify clusters of oral health conditions. Associations between the study variables were evaluated through multinomial regression analysis. Four distinct clusters emerged. Two clusters with greater levels of dental caries and worst perceived oral health (24.9% and 9.9%) were associated with poor family income, conditional cash transfer programme, higher household crowding, and lower maternal education. Children in clusters with greater oral health needs were more likely to have never visited a dentist, to seek care due to pain, and to report poorer experiences with dental services. Preventive dental care was more common among clinically healthy children, whereas toothache and elective dental treatment were associated with clusters comprising children with higher levels of caries and more restored teeth. Clusters of oral health conditions in early childhood were socially patterned. Poor dental service utilisation was linked to worst clusters of oral health conditions.

This systematic review and meta-analysis aimed to synthesise the evidence on the association between sense of coherence (SOC) and the utilisation of dental services among children and adolescents. Children and adolescents aged 0–18 years and/or their parents were included. The outcome was utilisation of dental services (regular attendance and preventive-oriented use), in relation to individual or parental SOC (assessed using the SOC-13 instrument). This systematic review (PROSPERO No CRD42024626799) was conducted in accordance with the PRISMA guidelines. A comprehensive search of electronic databases (PubMed, Web of Science, EMBASE, LILACS, Scopus, and APA PsycINFO), and grey literature was conducted on January 14, 2025, and updated on September 30, 2025. No language restrictions were applied. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Meta-analyses using random-effects were performed. Eleven studies (one cohort study and ten cross-sectional studies) were included. Of these, 10 were eligible for meta-analysis. The pooled results showed a significant association between higher parents’ SOC and more regular use and preventive-oriented utilisation of dental services among children and adolescents. No statistically significant association was observed between adolescents’ SOC and dental service utilisation. Considerable heterogeneity was identified across studies. In conclusion, higher parental SOC was associated with more regular dental attendance and preventive dental care patterns during childhood and adolescence. These results underscore the relevance of psychosocial determinants within the family context and support public health strategies that incorporate family-centred and salutogenic approaches to promote preventive oral health behaviours.

Aim: Traumatic dental injuries (TDIs) among children and adolescents have been acknowledged as of public health concern worldwide. The aim of the study was to assess the relationship between contextual and individual characteristics and TDIs in 12‐year‐old schoolchildren.Materials and Methods: A cohort study was conducted with 355 schoolchildren living in deprived communities in the city of Manaus, Brazil. Contextual factors (place of residence and socio‐economic indicators) and individual characteristics, including sex, family income, parents/guardians years of schooling, overjet and open bite (Dental Aesthetic Index), self‐esteem (Rosenberg Self‐Esteem Scale), sense of coherence (Sense of Coherence Scale), oral health beliefs, social support (Social Support Appraisals) were assessed at baseline. TDIs were measured at baseline and at 2‐year follow‐up using the O'Brien Index. Data were analysed through confirmatory factor analysis and structural equation modeling.Results: The baseline prevalence of TDIs was 17.6% and the incidence of TDIs at 2‐year follow‐up was 26.8%. Better psychosocial status had a direct protective effect on the incidence of TDIs (β = −.184). Better contextual characteristics (β = −.135) and greater overjet (β = −.203) were directly associated with poor psychosocial status. Higher schooling of parents/guardians directly predicted better psychosocial status (β = .154). Psychosocial status mediated the relationship of greater overjet (β = .036), contextual factors (β = .024) and parental/guardian schooling (β = −.027) with TDIs.Conclusions: Contextual factors and individual characteristics predicted TDIs. Psychosocial status was a relevant individual attribute in the causal network of TDIs, due to the direct effect on the incidence of TDIs as well as a mediator on the influence of contextual factors, overjet and parents/guardians schooling on the incidence of TDIs.

This study investigated the role of oral health‐related functional limitations and social well‐being, self‐perceived health, psychosocial factors, and social support in mediating the impact of malocclusion on health‐related quality of life (HRQoL). A school‐based 6‐month cohort study was conducted with 376 12‐year‐old deprived adolescents. Measures at baseline included malocclusion (DAI score), dental caries, sociodemographic characteristics, psychosocial traits (self‐esteem, sense of coherence, oral health beliefs), and social support. The oral health‐related functional limitations and symptoms (social well‐being) domains of the CPQ_11‐14, self‐perceived health, and HRQoL (Kiddo‐KINDL) were evaluated at the 6‐month follow‐up. Associations between observed and latent variables (social support, psychosocial factors, and HRQoL) were evaluated using structural equation modelling, according to the Wilson and Cleary theoretical model. Malocclusion was indirectly associated with worse HRQoL, mediated by functional limitations, social well‐being, and self‐perceived health. Better psychosocial status was directly associated with better HRQoL, and higher social support was indirectly associated with better HRQoL via psychosocial factors. Dental caries experience, female sex, and lower family income were indirectly associated with worse HRQoL. The impact of malocclusion on HRQoL was mediated by oral health‐related functional limitations, social well‐being, and self‐perceived health. Sociodemographic and psychosocial factors, and social support also impacted HRQoL.

Aim: The aim of this study was to evaluate the association between the sense of coherence (SOC) of parents/guardians and the use of dental services by children who are 12 years old. Methods: This is a cross-sectional study conducted in the eastern zone of the city of Manaus, with 358 children enrolled in the 7th grade in the municipal public school system. Data collection was performed through self-administered questionnaires sent to parents/guardians, which contained questions about socioeconomic conditions, use of dental services by children and Antonovsky’s SOC-13 scale. Data were examined by descriptive and bivariate analysis, using the Chi-square test, with a 5% significance level. Results: Of the 358 children, 58.4% were female; in addition, 75.4% of the parents/guardians self-reported to be brown and 39.9% of them had a family income of ½ to 1 minimum wage. SOC was categorized as strong SOC and weak SOC by the median. The association between strong or weak SOC and the use of dental services in terms of frequency (p= 0.839) and reason for last visit (p= 0.384), was not significant. Conclusion: It was concluded that SOC of parents/guardians and utilization of dental services by children were not associated.

Background: Oral health needs assessment is important for oral health care planning. This study compared dental treatment needs between normative and sociodental needs. We also longitudinally examined the relationships of baseline sociodental needs measures and socioeconomic status with one-year follow up measures of use of dental services, dental caries, filled teeth, and oral health-related quality of life (OHRQoL). Methods: A prospective study was conducted with 12-year-old adolescents from public schools in deprived communities in the city of Manaus, Brazil. Validated questionnaires were used to collect adolescents’ sex and socioeconomic status, OHRQoL (CPQ_{11 − 14}) and behaviours (sugar intake, frequency of toothbrushing, regular use of fluoridated toothpaste and pattern of dental attendance). Normative need was assessed according to decayed teeth, clinical consequences of untreated dental caries, malocclusion, dental trauma, and dental calculus. The relationships between variables were tested thorough Structural equation modelling. Results: Overall 95.5% of adolescents had normative dental treatment needs. Of these, 9.4% were classified as high level of propensity. Higher normative/impact need and greater propensity-related need directly predicted use of dental services at one-year follow up. The latter mediated the association of normative/impact need and propensity-related need with incidence of dental caries and filled teeth. Normative/impact need and use of dental services were directly associated with filled teeth at one-year follow up. Poor OHRQoL at one-year follow-up was directly predicted by higher normative/impact need at baseline and less filled teeth at one-year follow up. Greater socioeconomic status was directly associated with better propensity-related need. Socioeconomic status indirectly predicted incidence of dental caries and filled teeth via propensity-related need and use of dental services. Conclusions: Sociodental needs measures were related to use of dental services, dental caries, filled teeth and OHRQoL after one year among adolescents living in deprived communities. Adolescents with dental needs treatment priorities according to the sociodental approach had more filled teeth via use of dental services. Dental services utilisation did not attenuate the impact of normative and impact-related need on dental caries incidence and poor OHRQoL after one year. Our findings suggest the importance of developing oral health promotion and enhancing access to dental care to improve oral health of adolescents living in deprived communities.