Jessica Klöckner Knorst

Objectives: This study aimed to investigate the influence of income trajectories on dental service utilization patterns during the transition from childhood to adolescence in a Southern Brazilian birth cohort. Materials and methods: Children were followed over 13 years (T1, T2, and T3). Income trajectories (stable low/decreasing vs. stable high/increasing) were identified using group-based trajectory modeling based on finite mixture models. Outcomes included frequency of dental visits and reason for the last visit (preventive vs. curative). Socioeconomic disparities were explored using the non-linear Blinder–Oaxaca decomposition method. Results: From 639 children at baseline (T1), 449 were followed at T2 and 429 at T3 (67.1% retention). Adolescents from stable high or increasing-income trajectories had a lower prevalence of dental visits for curative reasons (OR = 0.29; 95% CI 0.09–0.90). Decomposition analysis showed that maternal education (9%) and skin color (12.5%) explained only a small portion of these inequalities, suggesting an independent effect of income over time. Conclusions: Individuals with increasing income were less likely to use dental services for curative purposes, regardless of race, dental caries, and maternal education, highlighting the impact of economic stability on oral health behaviors. Clinical relevance: Income trajectories over time influence the pattern of dental service utilization in adolescence. Identifying individuals in disadvantaged socioeconomic trajectories may support targeted preventive strategies and improve access to care.

Purpose: To evaluate the association between cognitive social capital and patient-reported saliva-related quality of life among head and neck cancer survivors. Methods: This cross-sectional study included adults treated with curative intent for squamous cell carcinoma of the lip/oral cavity, oropharynx, hypopharynx, or larynx at a referral hospital in southern Brazil. The outcome was patient-reported saliva-related quality of life, assessed using the saliva domain of the University of Washington Quality of Life questionnaire (UW-QOL); higher scores indicate better outcomes. Cognitive social capital was assessed using a brief three-item proxy index; participants were classified as scoring 3 (the maximum) or below 3. Hierarchical multiple linear regression estimated unstandardised coefficients ( B ) and 95% confidence intervals (95% CI), adjusting for education, tumour location, radiotherapy (yes vs. no), and time since treatment completion. Sensitivity analyses tested alternative operationalisations and adjustments. Results: A total of 105 adults participated (response rate 84.7%). The mean UW-QOL saliva-domain score was 61.85 ± 33.90, and 18 participants (17.1%) scored below 3. In the fully adjusted model, a score below 3 was associated with poorer saliva-related quality of life ( B = −18.53; 95% CI −33.85 to −3.21; p = 0.018); sensitivity analyses were consistent. Conclusion: In this exploratory study, lower scores on a three-item cognitive social capital proxy index were associated with poorer saliva-related quality of life among head and neck cancer survivors. Perceived social resources may be relevant to this burden, but these preliminary findings require confirmation in larger longitudinal studies.

Aim: The aim of this study is to evaluate the association between sleep bruxism (SB) and general quality of life (QoL) among adults. Methods: This cross‐sectional study was conducted with a sample of 692 adults who completed the WHOQOL‐Bref questionnaire (mean age of 50.1 years; 385 female and 307 male) from a total of 712 individuals of the Sao Paulo Epidemiological Sleep Study (EPISONO) follow‐up performed in 2015. SB was assessed using (1) self‐reported SB, based on participants' self‐report; (2) PSG‐based SB, based on polysomnographic findings; and (3) a combined definition requiring positive self‐report and PSG. QoL was assessed using the WHOQOL‐Bref scale. Sociodemographic, behavioural, psychosocial, and clinical variables were considered as confounders. The association between SB and QoL (rate of QoL, satisfaction with health and overall), as well as its specific domains (physical health, psychological, social relationships, and environment), was analysed using adjusted Poisson regression models. Results were presented in Rate Ratio (RR) and 95% confidence interval (95% CI). Results: The mean score for the rate of QoL question was 16.6 ± 5.1, whereas satisfaction with health had a mean score of 15.4 ± 6.3. The overall WHOQOL‐Bref score was 14.2 ± 3.0. In the adjusted analysis, individuals who self‐reported SB had lower satisfaction with their health (RR 0.93; 95% CI 0.88–0.98) and lower QoL levels in the social relationships' domain (RR 0.95; 95% CI 0.92–0.99). The presence of PSG‐based and self‐report+PSG SB were not significantly associated with QoL scores nor with the specific domains. Conclusions: The presence of self‐report SB was associated with general satisfaction with health and with individual social relationships.

Introduction: The aim of this study was to evaluate the prevalence of use of dental flossing and associated factors over time. Methodology: This two‐wave longitudinal observational study was conducted using an online questionnaire, which included adolescents and young adults who participated in a cross‐sectional study in 2012. Dental flossing was assessed using the question ‘Do you use dental floss?’ Sociodemographic factors, use of dental services, self‐perception of oral health and need for dental care were also evaluated. Data were analysed using adjusted Poisson regression analysis. Results are presented in prevalence ratio (PR) and 95% confidence intervals (95% CIs). Results: A total of 202 individuals were followed over time. Of these, 49.01% reported using dental floss at least twice a week and 23.27% used it daily. Individuals who used dental floss daily in childhood had a 69% higher prevalence of flossing over time (PR 1.69; 95% CI 1.12–2.45). Those who had visited the dentist in the last year (PR 1.34; 95% CI 1.02–1.77), who used private oral health services (PR 1.54; 95% CI 1.15–2.06) and who reported excellent/good self‐perceived oral health (PR 1.51; 95% CI 1.14–2.00) also showed a higher prevalence of flossing. Conclusion: The use of dental floss in childhood is positively associated with its continuation into adulthood, reinforcing the importance of establishing oral hygiene habits early in life.

Objective: To analyze intersectional inequalities in dental service utilization and functional dentition among Brazilian adults aged 18–49 years, considering sex, skin color, and income. Methods: Cross-sectional analysis of 64,811 adults reporting dental service use and 64,513 reporting functional dentition. Age-adjusted prevalences were estimated using Poisson regression with robust variance for combined sex/skin color/income strata. Absolute differences were calculated relative to White men with income above one minimum wage. Interaction contrasts on the additive scale (RERI) assessed departures from additivity. Results: Black/Brown men with low income had the lowest utilization (33.6% vs. 57.8%; −24.2% points [p.p.], p < 0.001), while White women with high income had the highest (+ 6.3 p.p., p < 0.001). For absence of functional dentition, White women with low income had the highest prevalence (19.1% vs. 8.9%; +10.2 p.p., p < 0.001), followed by Black/Brown women with low income (14.8%; +5.9 p.p., p < 0.001). Income was the strongest predictor: service use decreased (− 12.8 to − 24.2 p.p.) and tooth loss increased (+ 4.6 to + 10.2 p.p.) across low-income groups, regardless of sex or skin color. Both outcomes showed sub-additive interaction contrasts, with joint effects not exceeding the sum of individual contributions (RERI for dental service use: −3.27 [95% CI: −6.52 to − 0.02]; RERI for non-functional dentition: −2.45 [95% CI: −5.18 to 0.28]). Conclusion: Intersectional inequalities were concentrated in low-income groups, with distinct patterns for women. The high burden of tooth loss among low-income White women suggests that socioeconomic and gender-related vulnerabilities may override racial privilege, rather than reflecting simple cumulative disadvantage.

Background: Adverse childhood experiences (ACEs) are associated with poorer general and oral health outcomes, but the psychosocial mechanisms underlying these associations remain unclear. Aim: The aim of this study is to assess whether perceived social support and sense of coherence (SOC) moderate the association between ACEs and oral health‐related quality of life (OHRQoL) among adolescents. Design: A cross‐sectional study nested within a cohort of 406 adolescents aged 14–18 years from southern Brazil. OHRQoL was measured using the Child Perceptions Questionnaire (CPQ11‐14), ACEs by the Adverse Childhood Experiences–International Questionnaire (ACE‐IQ), perceived social support by a proxy question, and SOC by the 13‐item Sense of Coherence Scale (SOC‐13). Sociodemographic and behavioral variables were included as covariates. Poisson regression was conducted. Results: Adolescents exposed to ACEs and reporting low perceived social support had CPQ11‐14 scores 1.48 (95% CI 1.26–1.74) times higher than peers without ACEs and with high support. Those with ACEs and low SOC had scores 2.5 times higher (95% CI 2.22–2.80). Adolescents with ACEs but higher perceived social support or SOC levels also exhibited higher CPQ11‐14 scores, although with smaller impacts. Conclusion: These findings emphasize that psychosocial factors, such as perceived social support and SOC, may buffer the impact of ACEs on OHRQoL in adolescents.

Purpose: To evaluate the association between fermentable carbohydrate consumption and occurrence of dental caries according to the level of food insecurity (FI) at home. Methods: Cross-sectional study nested within a population-based cohort that began in 2010 with Brazilian preschoolers. Data were from the fifth follow-up wave, including adolescents aged 14–18 years. Dental caries was assessed using the International Caries Detection and Assessment System (ICDAS), considering the number of cavitated teeth. FI was measured with the Brazilian Food Insecurity Scale (EBIA). Fermentable carbohydrate consumption was categorized by self-reported frequency of cariogenic food intake. Demographic and socioeconomic variables were collected as confounders. Associations were estimated using Poisson regression, overall and stratified by FI status, and presented as Mean Ratios (MR) with 95% confidence intervals (CI). A non-linear Blinder-Oaxaca decomposition was applied to explore the FI impact. Results: The sample comprised 300 adolescents. After adjustment, daily fermentable carbohydrates consumption was associated with more cavitated lesions (MR 2.02; 95% CI 1.46–2.81). In the stratified analysis, the association was stronger among those with FI (MR 4.88; 95% CI 1.99–11.96), but not significant in adolescents without FI (MR 1.18; 95% CI 0.75–1.86). The decomposition showed a 95% difference in caries levels between fermentable carbohydrates intake groups; 16% was explained by observed variables mainly household income (9.5%) and FI (6.5%) and 72% by unmeasured factors. Conclusion: Daily fermentable carbohydrates consumption in FI adolescents is associated with higher rates of cavitated carious lesions, reinforcing the need for policies integrating dietary habits and food security to improve oral health outcomes.

Objective: The aim of this study was to assess the impact of xerostomia, the subjective perception of dry mouth, on the oral health-related quality of life of older adults. Methods: This study involved 131 individuals who participated in the AcampaVida extension project between 2015 and 2018 in the city of Santa Maria, Rio Grande do Sul, Brazil. A structured questionnaire obtained demographic, socioeconomic, behavioral, and self-reported information about xerostomia. Also, the Brazilian version of the Oral Health Impact Profile-14 (OHIP-14) was used to assess oral health-related quality of life. Data were analyzed in STATA 14.0, and the association of xerostomia with predictive quality of life variables was performed using unadjusted and adjusted Poisson regression. Results: OHIP-14 scores were 28% higher in individuals with xerostomia. Regarding the questionnaire domains, the highest scores comprised physical pain and psychological discomfort in individuals with xerostomia. Conclusion: The results indicate that xerostomia had a negative impact on the oral health-related quality of life of the assessed older adults.

Objective: To investigate the prevalence of early childhood caries (ECC) and its association with demographic, socioeconomic, behavioral, and psychosocial factors in preschool children aged 0-5 years old in Brazil. Material and Methods: This cross-sectional study was conducted in 2019 in Santa Maria, a Southern city in Brazil. 545 children aged 0-5 years old were evaluated for ECC through the decayed, missing, and filled deciduous teeth dmft index in 15 health centres. Demographic, socioeconomic, behavioural, and psychosocial characteristics were measured through a questionnaire applied to parents. Poisson regression models with a hierarchical approach, accounting for sample weights, were used to estimate the association between children's dental caries and predictor variables. Results: 545 of the 653 children invited to participate in the study were evaluated (response rate of 83.5%). The prevalence of ECC was 19.4% (dmft ≥ 1). Living only with the father or another family member, having gone to the dentist before or after the first year of life, having routine exams as the reason for the last dental attendance, and the lack of paternal perception regarding the child's need for dental treatment showed a significant association with ECC (p<0.05). Conclusion: The prevalence of ECC remains significantly high among children from an emerging country. Demographic, socioeconomic, behavioral, and psychosocial factors continue to influence the development and establishment of the disease.