Échiley da Silva Rios

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 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.