Roosevelt Silva Bastos

Four contributions examine the relationships between oral health, nutritional vulnerability, and broader dimensions of health in later life. Lowenstein et al. propose a clinical framework linking polypharmacy, xerostomia, and nutrition, drawing attention to the potential consequences of medication-related oral dryness for eating and nutritional well-being. This framework provides a useful perspective alongside the population-based analysis by Pereira et al. Among community-dwelling older adults in Brazil, greater xerostomia symptom severity was associated with higher frailty scores, but the surveyweighted structural equation model did not support an indirect association through nutritional vulnerability. Considered together, these contributions highlight the clinical relevance of oral dryness while leaving open questions about the pathways connecting it with broader health outcomes. Da et al. and Ulema extend this discussion to patient-reported and psychosocial dimensions. Among older adults in Shanghai, Da et al. found results consistent with a potential indirect association between the number of remaining teeth and frailty through oral health-related quality of life. In rural older adults in Türkiye, Ulema identified associations of oral frailty, food insecurity, and malnutrition with depressive symptoms, with exploratory analyses suggesting that malnutrition may contribute to the observed relationships. These proposed pathways remain hypotheses requiring longitudinal investigation, but they broaden the discussion by examining how oral conditions intersect with perceived impacts, access to food, and mental health.These articles support attention to oral symptoms, dentition, nutritional status, and psychosocial circumstances within comprehensive assessment of older adults. The findings also suggest that nutritional vulnerability may not account for all observed associations between oral health and frailty. Their practical contribution is to encourage coordinated assessment across professional disciplines, while recognizing that older adults differ in their resources to obtain appropriate food, manage oral symptoms, and access continuing care.Three contributions examine complementary dimensions of prosthetic rehabilitation, emphasizing functional adaptation, variation in outcomes over time, and patients' experiences. In their systematic review, Shetty Ganesh et al. report preliminary findings suggesting that neuromuscular re-education, oral motor exercises, and biofeedback may support adaptation and masticatory performance in complete denture wearers. Zhang et al. add a longitudinal perspective by identifying three oral frailty trajectories during the year following implant-supported prosthesis delivery: rapid improvement followed by stability, gradual improvement followed by a plateau, and persistently elevated scores. Older age, a greater medication burden, and more missing teeth were associated with the persistent high-risk trajectory. These findings highlight variation in patients' needs after rehabilitation and the potential value of continued assessment and individualized support.Ceraulo et al. complement these functional perspectives by examining the experiences of complete denture wearers across functional, psychological, and social dimensions. Their findings draw attention to social difficulties that may receive insufficient attention when rehabilitation is evaluated primarily through technical or clinical criteria. Together, these contributions suggest that assessment of rehabilitation should encompass comfort, oral function, adaptation, and participation in daily life. They also identify questions for future research about which supportive strategies improve outcomes and how affordability, access to follow-up, and patients' social circumstances influence the experience of rehabilitation.Three contributions situate oral health within the social resources and circumstances of later life. Song et al. identified distinct active ageing profiles among rural older adults in China, with poorer oral health-related quality of life in profiles characterized by lower overall active ageing, limited social integration, or reduced financial security. In nursing homes, Zhao et al. found heterogeneous oral health literacy profiles associated with oral frailty, drawing attention to differences in understanding, communication, and economic resources. Among older people in an underpopulated area of Japan, Zhu et al. observed an association between the number of remaining teeth and higher-level functional capacity that was attenuated after adjustment for social participation. Although this attenuation does not establish mediation, it invites further investigation of how oral health and social participation relate to the capacity for independent living. These studies emphasize the relevance of accessible communication, opportunities for participation, and services responsive to social disadvantage.Two further contributions extend the collection beyond older populations. Asadollahi et al. examined oral health profiles and quality of life among men aged 40 years and older with andropause symptoms, identifying cross-sectional associations involving oral conditions, education, and socioeconomic context. Talwar et al. documented differences in caries experience across adults aged 21-50 years, with higher cumulative disease experience in older age groups. These studies broaden the discussion to oral health before old age and encourage investigation of how earlier disease experience and unequal opportunities for prevention and care relate to later outcomes. A life-course perspective also places responsibility for healthy oral aging within health services and social policy, alongside support for individual health practices.Several limitations define the conclusions that can be drawn from the collection. Most empirical contributions are cross-sectional, leaving temporal ordering, reverse...

Objective: To investigate the direct and indirect associations between xerostomia symptom severity and frailty among community-dwelling older adults, considering nutritional vulnerability as a potential mediator using structural equation modeling. Methods: This cross-sectional population-based study analyzed 398 community-dwelling older adults from two municipalities in southeastern Brazil. Xerostomia was assessed using the Summated Xerostomia Inventory (SXI-5), nutritional status using the Mini Nutritional Assessment–Short Form (MNA-SF), and frailty using the Edmonton Frail Scale (EFS). Xerostomia, nutritional vulnerability, and frailty were modeled as continuous scores. Nutritional vulnerability was calculated as 14 minus the MNA-SF score, with higher values indicating poorer nutritional status. Survey-weighted structural equation modeling estimated direct, indirect, and total associations, adjusting for age, sex, and educational attainment and accounting for clustering in the sampling design. Results: The weighted prevalence of high xerostomia symptoms was 24.5% (95% CI: 16.2–35.3), nutritional risk or malnutrition was 35.5% (95% CI: 29.7–41.8), and frailty was 12.3% (95% CI: 6.5–22.1). Xerostomia symptom severity was not significantly associated with nutritional vulnerability ( B = 0.146; 95% CI: −0.073 to 0.364; standardized β = 0.179; P = 0.177). Nutritional vulnerability was associated with higher EFS scores ( B = 0.226; 95% CI: 0.046–0.405; β = 0.206; P = 0.017). Xerostomia symptom severity showed a significant direct association with the EFS score ( B = 0.130; 95% CI: 0.008–0.252; β = 0.145; P = 0.039) and a significant total association ( B = 0.163; 95% CI: 0.012–0.313; β = 0.182; P = 0.036). However, the indirect association through nutritional vulnerability was not statistically significant ( B = 0.033; 95% CI: −0.022 to 0.088; β = 0.037; P = 0.225). The model explained 9.2% of the variance in nutritional vulnerability and 15.3% of the variance in frailty. Conclusions: Greater xerostomia symptom severity was directly associated with higher frailty scores, but there was no evidence of an indirect association through nutritional vulnerability. These findings indicate that the relationship between xerostomia and frailty may involve pathways beyond nutritional status and reinforce the potential value of integrating oral health assessment into comprehensive care for older adults.

Objective: To evaluate the association between self-reported history of malaria and tooth loss in a malaria-endemic population of the Brazilian Amazon. Methods: This cross-sectional study included 290 individuals from urban and rural areas of Monte Negro and the riverside community of Calama (Rondônia, Brazil), recruited during university-led humanitarian expeditions in 2018–2019. Tooth loss was clinically assessed using the Caries Assessment Spectrum and Treatment (CAST) instrument. An ordinal outcome was constructed based on the number of missing teeth (0, 1–9, 10–19, and ≥ 20 teeth). The main exposure was self-reported history of malaria infection. Associations were examined using ordered logistic regression models, with results expressed as odds ratios (OR), 95% confidence intervals (CI), and p-values. Multivariable models were adjusted for age, educational attainment, and sanitation conditions. Results: Overall, 76.6% of participants (95% CI: 71.3–81.1) had lost at least one tooth, 25.5% (95% CI: 20.8–30.9) had lost ≥ 10 teeth, and 8.3% (95% CI: 5.6–12.1) had lost ≥ 20 teeth. Half of the sample (50.0%; 95% CI: 44.3–55.8) reported a history of malaria. In adjusted analyses, malaria history was associated with higher odds of more severe tooth loss (OR = 1.97; 95% CI: 1.13–3.43; p = 0.017). Age showed a strong gradient, with significantly higher odds of tooth loss severity across older age groups ( p < 0.001). Conclusions: In this malaria-endemic population, a history of malaria was associated with greater tooth loss severity. Although age remained the strongest determinant, malaria history may represent an indicator of increased risk for poor long-term oral health outcomes in endemic populations. These findings highlight the importance of integrating oral health into broader public health strategies in malaria-endemic settings.

Pregnancy increases susceptibility to gingival inflammation, and saliva may help characterize associated host-response profiles. This cross-sectional study compared nine salivary proteins and inflammatory mediators between pregnant women with high and low gingival bleeding burdens. Twenty-four women were classified by bleeding on probing (BOP) into G1 (BOP ≥ 50%; n = 12) and G2 (BOP < 30%; n = 12). Unstimulated saliva was collected, and RBP4, β2-microglobulin, clusterin, cystatin C, IL-1β, IL-6, IL-8, IL-10, and TNF-α were quantified using multiplex bead-based immunoassays. Primary comparisons used ANCOVA adjusted for maternal age and total protein concentration, with additional adjustment for visible biofilm in sensitivity analyses. In the primary adjusted analyses, G1 showed higher RBP4 (FDR-adjusted p = 0.004; partial η² = 0.466) and clusterin (FDR-adjusted p = 0.006; partial η² = 0.413), and lower IL-10 (FDR-adjusted p = 0.032; partial η² = 0.285). In the sensitivity analyses, significant group effects were observed for RBP4 (FDR-adjusted p = 0.026; partial η² = 0.381) and IL-8 (FDR-adjusted p = 0.044; partial η² = 0.303). These findings demonstrate associations between high gingival bleeding burden and a salivary profile involving inflammatory/chemotactic, regulatory, and stress-response signals.

Introducción: La rehabilitación integral de la fisura labio-palatina (FLP) incluye tratamientos odontológicos complejos, sin embargo, el acceso a estas intervenciones puede estar determinado no solo por indicaciones clínicas, sino también por determinantes sociales. Objetivo: Evaluar las desigualdades socioeconómicas relacionadas con la rehabilitación de pacientes con fisura labiopalatinas en Brasil. Materiales y Métodos: Estudio epidemiológico observacional transversal retrospectivo de 40 expedientes de pacientes del Hospital de Rehabilitación de Anomalías Craneofaciales de la Universidad de São Paulo (HRAC/USP) entre diciembre de 2012 y diciembre de 2013. Se observaron dos grupos: pacientes con rehabilitación completada mediante cirugía ortognática (CO, n = 20) y pacientes tratados con prótesis “overlay” (OV, n = 20). Se analizaron los expedientes médicos para recopilar datos sobre sexo, edad, edad de la primera visita al hospital, nivel educativo y nivel socioeconómico. Se aplicó la prueba de Mann-Whitney. Resultados: El análisis estadístico reveló una diferencia significativa (p = 0,024) en la condición socioeconómica, con el grupo OV presentando una situación más desfavorable que el grupo CO. Esto comprometió el resultado de la rehabilitación y aumentó la carga para el Sistema Único de Salud (SUS). Conclusiones: Los resultados confirman que las condiciones socioeconómicas desfavorables están asociadas con un acceso tardío y resultados de rehabilitación menos satisfactorios en pacientes con fisura labio-palatina, lo que contribuye a poner de manifiesto las desigualdades persistentes en el sistema público de salud y refuerza la urgencia de políticas intersectoriales que garanticen la equidad en el acceso a la atención especializada.

Periodontal disease affects not only clinical status but also oral-health–related quality of life (OHRQoL). Socioeconomic context, pregnancy-related

Background: Oral health problems, particularly tooth loss, may impair nutrition and reduce oral health-related quality of life (OHRQoL) in older adults. However, the pathways linking these conditions remain unclear. Methods: We analyzed data from 112 older adults (≥60 years). We measured OHRQoL using the Geriatric Oral Health Assessment Index (GOHAI) and nutritional status using the Mini Nutritional Assessment (MNA), and used tooth loss as a clinical indicator. Bivariate analyses used Spearman’s correlation, and structural equation modeling (SEM) with robust estimation was applied to assess direct and indirect pathways. Mediation was evaluated with bootstrap resampling. Results: The prevalence of impaired OHRQoL (GOHAI > 0) was 25.9% (95% CI: 18.6 to 34.9). Tooth loss correlated with worse nutrition (ρ = −0.32; 95% CI: −0.48 to −0.15), and poorer nutrition was associated with worse OHRQoL (ρ = −0.22; 95% CI: −0.40 to −0.03). SEM showed that tooth loss negatively affected nutrition (β = −0.21; 95% CI: −0.43 to 0.00) and that nutrition was directly associated with OHRQoL (β = −0.21; 95% CI: −0.34 to −0.08). Bootstrap analyses confirmed a direct effect of tooth loss on OHRQoL (β = 0.19; 95% CI: 0.02 to 0.36), while the indirect pathway through nutrition did not reach statistical significance. Conclusions: Tooth loss and poor nutrition independently reduce OHRQoL in older adults. Although mediation by nutrition was not statistically significant, the findings highlight the interdependence of oral and general health and support integrated public health strategies for aging populations.

Objective: This observational, cross‐sectional, and analytical study aimed to explore the pathophysiological mechanisms of gingivitis in pregnancy by analyzing the salivary proteomic profile according to gingival bleeding status. Materials and Methods: Pregnant women at the 27th week of gestation or beyond were categorized into two groups: those with excessive gingival bleeding on probing (BOP > 50%; G1) and those without generalized gingivitis (BOP < 30%; G2). A comprehensive full‐mouth periodontal examination was performed. Unstimulated whole‐mouth saliva samples were collected and individually processed using Nano Liquid Chromatography Electron Spray Ionization Tandem Mass Spectrometry (nLC‐ESI‐MS/MS). Results: Proteomic analysis identified 187 salivary proteins, with 75 shared between groups. Sixty proteins were upregulated and seven were downregulated in G1. The most upregulated were Protein S100‐A9 (16‐fold), Neutrophil Defensins 1 and 3 (7‐fold), Protein S100‐A8 (5‐fold), Beta‐2‐Microglobulin (4‐fold), and multiple immunoglobulin isoforms. Histatin‐3 was the only protein downregulated by more than 2‐fold. Gene Ontology analysis revealed significant enrichment in processes related to antimicrobial humoral response, bacterial defense mechanisms, and immune regulation, reflecting the inflammatory state. Conclusion: These findings provide insights into the salivary proteomic alterations associated with generalized gingivitis in pregnancy, particularly highlighting immune and antimicrobial pathways linked to excessive gingival inflammation.

Objective: To evaluate the association between intermittent water supply, Family Health Unit (FHU) coverage, and COVID-19 spread among older adults (≥70 years) in Bauru, São Paulo, and to provide insights for targeted public policies. Methods: This retrospective cohort study was conducted from March 2020 to July 2021 using secondary data. Variables included age (60–69, 70–79, 80–104), gender (female, male), FHU coverage (present, absent), water supply (continuous, intermittent), and geographic region (South, Center, East, North, West). Poisson regression models were used to estimate relative risks (RR). Findings: A total of 7,540 COVID-19 cases were recorded. The West region accounted for 42.45% of cases, while the South region had the lowest proportion (14.20%). Individuals aged 60–69 years comprised 41.34% of cases, followed by 70–79 (32.11%) and 80–104 (26.58%). Lack of FHU coverage was associated with 83.51% of cases. Intermittent water supply increased infection risk by 17.5% (RR = 1.18; 95% CI: 1.08–1.28). After adjustment, the Center region showed higher transmissibility (RR = 1.85; 95% CI: 1.54–2.22), whereas the West region had lower transmissibility (RR = 0.53; 95% CI: 0.47–0.60). Conclusions : Insufficient FHU coverage and intermittent water supply were key determinants of COVID-19 spread, particularly among older adults. These findings underscore the importance of strengthening urban infrastructure and ensuring consistent water access to mitigate public health challenges in medium-sized cities.

Background and objectives: Dengue is an arbovirus with significant socioeconomic impact worldwide and in Brazil. This scenario led the Brazilian Ministry of Health to launch a preventive manual in 2009, and a treatment manual in 2016 to deal with this disease. Between the year of these publications and today, numerous therapeutic options emerged and were discussed in the literature. So, this independent research aims to investigate dengue treatment methods presented in the literature. Methods: A scoping review was forged following the Problem, Concept, and Context (PCC) strategy, following the guiding questions: “What methods for preventing dengue have been presented in scientific literature in the last 14 years?” “What methods for treating dengue have been presented in scientific literature in the last 8 years? The literature search was performed in PubMed, LILACS, Cochrane, and Scielo using the descriptors "Dengue AND Prevention" and "Dengue AND treatment". Results: Almost 18 thousand studies were evaluated. Of these, 7474 discussed dengue preventive measures, as only 17 were included in the final text. In parallel, 10.462 were focused on dengue treatment, as only 28 articles were included in the final text. Interpretation and conclusions: Numerous preventive and therapeutic measures have emerged in recent years; however, further comprehensive studies are imperative to substantiate their effectiveness on a large scale and assess their viability for widespread implementation. In this sense, vaccines and supportive measures, such as fluid therapy, remain primary interventions in dengue prevention and treatment, serving as cornerstones in mitigating the impact of this disease. KEY WORDS: Dengue; arboviroses; prevention; treatment; epidemiology.