Fernando Neves Hugo

Introduction: Although preventable, dental caries remains a global public health challenge due to its multifactorial nature and the deep influence of socio-structural determinants. This study evaluates the performance of artificial intelligence (AI) models as decision-support frameworks for population-level risk stratification, screening, and public health planning. Methods: We analyzed a representative sample (N = 23,726) from the SB Brasil 2023 national survey, stratified into three age cohorts: children (12 years), adolescents (15–19 years), and adults (35–44 years). Eleven predictors, encompassing socioeconomic (wealth score via PCA, household density, race, water access), psychosocial (self-rated oral health status), behavioral, and clinical domains, were used to predict caries presence (≥1 untreated decayed tooth) and severity (DMFT index regression). To account for overdispersion and the high frequency of zero counts, we utilized advanced count-based regressions, including Zero-Inflated Negative Binomial (ZINB) and Negative Binomial models. Performance was assessed using AUC, mean absolute error (MAE), and decision curve analysis (DCA) via 5-fold cross-validation. Results: Caries prevalence increased progressively with age (36.8–52.7%). The non-clinical triage models demonstrated significant net benefit in DCA across all groups, effectively identifying high-risk individuals for prioritization without requiring clinical examination. For severity prediction, the ZINB model identified structural signals of inequity, particularly in late adolescence (15–19 years), where socio-structural determinants explained a meaningful proportion of clinical variance (R2 = 0.1010; MAE = 2.79). Across all stages, SHAP analysis reinforced that wealth score and household density are the primary structural predictors of caries risk. Conclusion: AI provides a feasible framework for population-level risk stratification and public health planning. The findings suggest that AI-driven frameworks should be utilized for managerial triage and resource allocation, enabling proportional universalism by identifying high-risk clusters through structural determinants rather than individual-level clinical diagnostics.

Introduction: The aim of the study was to examine differences in the occurrence of consequences of untreated dental caries (pulpal involvement, ulceration, fistula, and abscess-PUFA) across intersectional social positions defined by sex, skin color, and household income among adolescents. Methods: This study analyzed data from the Brazilian National Oral Health Survey (SB Brasil 2023), using a multistage stratified probability sampling design to represent adolescents aged 15–19 years. Social variables were combined into 8 intersectional groups based on sex, skin color, and family income. Outcomes included PUFA prevalence ≥1 and counts of its components. Survey-adjusted Poisson regression with robust variance and a three-way interaction term was applied. Results: The sample comprised 4,892 adolescents. Compared to high-income White males, prevalence was higher among low-income Black males (PR = 5.93; 95% CI: 2.60–13.51) and low-income Black females (PR = 4.06; 95% CI: 1.85–8.90). The predicted prevalence of PUFA ≥1 ranged from 4.0% (95% CI: 2.0–7.0) among high-income White males to 21.0% (95% CI: 11.0–32.0) among low-income Black males. Among females, prevalence estimates were 15.0% (95% CI: 9.0–20.0) in high-income Black, 16.0% (95% CI: 5.0–28.0) in low-income White, and 18.0% (95% CI: 12.0–24.0) in low-income Black individuals. Conclusion: Marked differences in PUFA occurrence were observed across intersectional social positions, with the highest burden observed among low-income Black adolescents, particularly males for prevalence ratios, although females also presented high absolute prevalence. These findings reinforce the need for policies addressing structural social inequalities in oral health.

Objective: Investigate whether depressive symptoms are linked to a higher likelihood of reporting poorer oral health conditions in older adults. The Background Data Discussing the Present Status of the Field: Understanding the potential negative effects of depressive symptoms on the perception of oral health in older adults is crucial for implementing tailored interventions and improving overall well‐being in this demographic. Materials and Methods: This is a cross‐sectional study using data from the 2019 Brazilian National Health Survey (PNS), conducted between 2019 and 2020. A total of 22,728 Brazilian older adults were analysed. A Poisson regression model was employed to examine the relationship between depressive symptoms and self‐reported oral health. The selection of independent variables for statistical modelling was guided by a conceptual framework of social determinants. All analyses were performed using Stata 14.0. Results: The unadjusted findings suggest that individuals with 9 or more depressive symptoms had a 68% higher prevalence (PR: 1.68 [95% CI: 1.67–1.69]) of reporting poor self‐perceived oral health compared to those with fewer depressive symptoms. After adjusting for confounding factors, it was observed that individuals with 9 or more depressive symptoms had an 11% higher prevalence (PR: 1.11 [95% CI: 1.08–1.13]) compared to individuals with fewer depressive symptoms. Conclusion: Even after adjusting for factors, those with nine or more depressive symptoms were more likely to report poor oral health. This highlights the role of mental health in older adults' oral health, emphasising integrated approaches for overall well‐being and addressing emotional and physical aspects.

Objective To assess self and parental body image perception, as well as body image discrepancy, among schoolchildren in four public schools in Southern Brazil. Methods Cross-sectional study with schoolchildren enrolled in the public school system and their parents. Sociodemographic and nutritional data were collected, and anthropometric measurements were obtained. Body image perception and discrepancy were evaluated using the Stunkard Scale for both children and parents. Body image dissatisfaction was defined as the difference between ideal and current body image. Results A total of 89 children (47.2% girls), aged 9 to 15 years, and their parents were included. Neither children nor parents perceived the children as obese although 17.6% had obesity based on anthropometric assessment. Among children with obesity, parents classified them as overweight (93.33%) or as having normal weight (6.67%), and none recognized obesity. Overall, 74.2% of children reported body image dissatisfaction, with no significant differences by sociodemographic characteristics, sex, or age. Conclusion Many parents remain unable to accurately identify overweight or obesity in their children, highlighting the need for strategies that enhance parental awareness and engagement.

Resumo Introdução: Um possível impacto de Programa Bolsa Família pouco descrito é sobre o uso de serviços odontológicos. Objetivo: Descrever características sociodemográficas, comportamentos em saúde bucal e uso de serviços odontológicos da população de baixa renda, incluindo beneficiários do Programa Bolsa Família (PBF) em São Leopoldo/RS, 2018. Métodos: Estudo transversal com 180 famílias inscritas no Cadastro Único do governo federal, selecionadas aleatoriamente, totalizando 658 sujeitos (69,4% de taxa de resposta). Resultados: Dentre os entrevistados, 22,6% já não recebiam mais o benefício do Bolsa Família, 39,5% nunca haviam recebido e 37,8% recebiam o benefício no momento da entrevista. Os beneficiários foram predominantemente mulheres (64,3%) abaixo de 15 anos de idade (45,8%). Observou-se menor percentual de pessoas que visitaram o dentista no último ano no grupo beneficiado pelo PBF (39% contra 40,9% para os que nunca haviam recebido e 51,7% para os que já haviam recebido; p=0,03). Outras variáveis não apresentaram diferenças estatisticamente significativas (p>0,05). Conclusão: Foram encontradas diferenças no uso e acesso a serviços de saúde bucal entre os beneficiários, ex-beneficiários e não beneficiários do PBF.

The aim is to assess the current level of evidence of the association between community water fluoridation and intelligence. The method used for the study was a systematic review and meta-analysis of observational studies, to evaluate evidence of an association between exposure to community water fluoridation and intelligence using intelligence quotient (IQ) tests. Indexed databases PubMed/Medline, Embase, Scopus, Web of Science and reference lists of included articles were used. A meta-analysis with random effects models was performed and beta coefficients and pooled standardized mean differences (SMDs) and 95% confidence intervals of IQ scores were estimated in relation to water fluoridation. Of the 941 studies identified by the database search, three studies were included in the meta-analysis that used adjusted beta linear regression coefficients. There is no meta-analysis for adults because there is only one study for them. In the joint analysis, there was no association between exposure to fluoride in the water supply and IQ, for a linear regression coefficient (called β) of 1.01. Heterogeneity between studies was low. This meta-analysis underlines the safety of community water fluoridation concerning IQ’s intelligence assessment.

Background: Aging is associated with a decline in physiological functions. Dysphagia, a disorder among older adults, impairs feeding and is related to morphological and functional changes in the stomatognathic system, which worsen with age‐related physiological decline, particularly among institutionalised older adults. Objective: To systematically review the association between oral health conditions, dental status, xerostomia, and dysphagia among institutionalised older adults. Methods: This systematic review followed PRISMA guidelines and included a search of PubMed / MEDLINE and Embase for observational and randomised clinical trial studies published up to December 2024, with an update in January 2025. Results: From 1761 identified articles, 44 were reviewed, and 11 met the inclusion criteria. These studies employed subjective measures such as dysphagia questionnaires, the Eating Assessment Tool‐10 ( EAT ‐10), the Dysphagia Risk Evaluation Protocol ( PARD ), and interviews using the Minimum Data Set for Nursing Home Resident Assessment ( MDS ‐ NH ). Objective assessments included clinical evaluations, indirect and direct swallowing tests, and video analyses of feeding behaviour. Findings indicate that older individuals with fewer functional teeth, absent occlusal pairs, compromised natural teeth, gingivitis, or dental caries have a higher risk of dysphagia. In contrast, occlusal contact, natural teeth, or well‐fitted dentures are associated with reduced swallowing difficulties. Neither denture use alone nor oral hygiene showed a direct association with dysphagia. However, severe xerostomia and reduced salivary flow were associated with a higher risk of dysphagia. Conclusion: Dysphagia is associated with poor oral health and xerostomia in institutionalised older adults, though further research is needed to clarify these relationships.

Purpose To describe the prevalence and the variables associated with TDIs in schoolchildren aged 8 to 14 years in Estância Velha city in southern Brazil, placing emphasis on molar incisor hypomineralization. Methods Students enrolled in public schools of a medium-sized city in the southern Brazil were selected using cluster random sampling. Clinical examinations assessed molar incisor hypomineralization-MIH (European Academy of Pediatric Dentistry criteria), dental caries (DMFT index), and TDIs (O’Brien’s criteria). Socioeconomic and demographic variables were assessed using a standardized questionnaire. Prevalence ratios were estimated using Poisson regression (p < 0.05). Results 513 students (54.8% female), with a mean age of 11.6 (± 1.9) years, participated in the study. The prevalence of TDIs was 11.3%, with enamel fracture representing 90.4%. The high prevalence of traumatic dental injuries was associated with MIH (PR: 2.22 CI: 1.27; 3.87; p < 0.01) and overjet > 3 mm (PR: 2.03 CI 1.19; 3.45; p < 0.01). Conclusion The sample of schoolchildren from southern Brazil had a low prevalence of traumatic dental injuries. Molar incisor hypomineralization and increased overjet were associated with the higher prevalence of traumatic dental injuries.

Objective: This cross-sectional study aimed to evaluate the psychometric properties of the reduced version of the Primary Care Assessment Tool (PCATool) for adult patients in the Brazilian National Health Survey 2019, a nationally representative population-based study.