Dental caries and treatment needs in adolescents from the state of Sao Paulo, Brazil

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1 Rev Súde Púlic 2013;47(Supl 3):1-8 Originl Articles DOI: /S Mri d Luz Rosário de Sous I Mri Pul Mciel Rndo- Meirelles I Luís Helen do Nscimento Tôrres I Dentl cries nd tretment needs in dolescents from the stte of So Pulo, Brzil Antonio Crlos Fris II ABSTRACT OBJECTIVE: To estimte the prevlence of dentl cries nd tretment needs in 12-yer-olds nd dolescents. METHODS: Cross-sectionl study sed on results from the epidemiologicl surveys: Orl Helth Conditions in the Stte of So Pulo, nd the Brzilin Orl Helth Survey (SBBrsil). Secondry dt for 5,782 () nd 369 () 12-yer-olds nd 880 () nd 300 () 15- to 19-yer-olds were nlyzed. Dentl cries ttck ws evluted using the DMFT (decyed, or filled teeth) index nd the need for tretment verified using the criteri proposed y the World Helth Orgniztion. The Significnt Cries Index ws used to mesure the severity of the decy in the tercile of the group with the highest prevlence of the disese. In order to nlyze the results, the Chi-squred nd Mnn-Whitney tests were used, with 5% significnce. RESULTS: There ws decrese of 39.3 percentge points in the DMFT index for 12-yer-olds (p < 0.001) nd of 41.1 percentge points for the dolescents (p < 0.001) etween nd, nd n increse of round nd percentge in the group which ws free from dentl cries respectively. The percentge of teeth decresed in oth ge groups, lthough the prevlence of dentl cries did not chnge in the group more ffected y dentl cries. In the group with few dentl cries, there ws decrese in the component tooth loss for dolescents nd increse in the component decyed teeth for the 12-yersold nd the dolescents. There ws n increse in the need for dentl tretment in the group s whole nd in the group of 12-yer-olds more ffected y dentl cries; nd mong the dolescents, the need for restortion on two or more surfce decresed in the group s whole nd lso in the group which suffered lest from dentl cries. I Deprtmento de Odontologi Socil. Universidde Estdul de Cmpins. Cmpins, SP, Brsil II Deprtmento de Odontologi Socil. Universidde de São Pulo. São Pulo, SP, Brsil Correspondence: Mri d Luz Rosário de Sous Universidde Estdul de Cmpins Av. Limeir, 901- Areião Pircic, SP, Brsil E-mil: luzsous@fop.unicmp.r CONCLUSIONS: The decresing need for non-complex tretment in dolescents suggests tht promotion nd prevention ctivities re hving positive effect on this group. Moreover, the two epidemiologicl surveys in the stte of So Pulo show improvements in orl helth conditions in oth ge groups studied nd clls for monitoring imed lso t the group lest ffected y dentl cries. DESCRIPTORS: Adolescent. Dentl Cries, epidemiology. DMF Index. Orl Helth. Dentl Helth Surveys. Received: 05/03/2012 Approved: 04/18/2013 Article ville from:

2 2 Dentl cries nd tretment needs, São Pulo, nd Sous MLR et l INTRODUCTION Monitoring orl helth over the yers, through collecting epidemiologicl dt contriutes to verifying trends nd ids in helth cre plnning nd decision mking. 19 Thus, nlyzing epidemiologicl dt enles it to e seen whether the ctions crried out re effective in decresing the pthologies, especilly when they re crried out with ge groups not trditionlly included in pulic helth mesures. With the chnge in distriution ptterns of dentl cries, the DMFT (Decyed, Missing nd Filled Teeth) index hs ecome less significnt popultion descriptor thn when this distriution ws more homogenous. 9 One of the indices which demonstrtes this chnge is the Significnt Cries Index (SiC), which llows the polriztion of dentl cries 4 nd socio-economic disprities in suffering from dentl cries etween popultion groups to e identified. Using these two indictors together mens tht inequlities in orl helth etween different popultion groups within the sme community cn e highlighted, identifying the needs of ech group nd guiding helth cre ctivities. 9 Epidemiologicl surveys in different countries hve shown significnt decrese in the numer of 12 to 18-yers-old suffering from dentl cries over the lst few decdes. However, from 2000 onwrds, this trend chnged for certin popultion groups. In ntionl survey in Chin nd locl survey in Zurich, Switzerlnd, it ws oserved tht the prevlence of the disese remined stle or incresed in groups of 12 to 14-yers-old etween 2000 nd ,24 The sme ws oserved in the stte of Nevd in the United Sttes, where the prevlence incresed in the 12 to 14 nd 16 to 19-yers old ge groups, oth overll nd in the groups who suffered most from dentl cries, in 2007 nd Popultion surveys hve een crried out in Brzil since The first study in the stte of So Pulo ws in In, nother popultion sed study ws crried out in the stte of São Pulo, c prt of the Brzilin Orl Helth Survey (SBBrsil) 2003 smple. In d the Brzilin Ministry of Helth crried out nother ntionl survey smpling the stte cpitls nd the mcro regions. The 2008 study y Gushi et l 15 showed mrked reduction in the occurrence of dentl cries in 12-yers-old children in the stte of So Pulo over four yer period (1998 to ), oth in the group which suffered most from dentl cries nd in the groups which suffered lest. However, in the sme period, the percentge of components with cries in the group with low levels of cries nd the percentge of restortions in the group with the highest levels of cries oth incresed, showing the importnce of the SiC nlysis. On tht occsion there ws no comprtive dt on dentl cries for the 15 to 19-yers-old ge group in the stte of So Pulo. The im of this study is to estimte the prevlence of dentl cries nd need for tretment in 12-yers-old children nd dolescents in the stte of So Pulo METHODS This ws cross-sectionl study. The dt used re the results from the epidemiologicl survey Orl Helth Conditions in the Stte of São Pulo Condições de Súde Bucl no Estdo de São Pulo, nd the SBBrsil. The proilistic smpling process nd the methodology used in were descried y Gushi et l 14 (2005). In, the smple size ws defined sed on dt on dentl cries otined in the SBBrsil For ech ge group the men nd respective stndrd devition of the decyed, nd filled teeth index ws used s the sis for the clcultion. Considering tht the reserch ws crried out in the home, set numer of residences were selected to e visited, from which the smple size nd respective mrgin of error were clculted. In, 15 municiplities in the interior were rndomly selected, plus the stte cpitl, nd 5, yers-old children nd 880 dolescents ged 15 to 19 were exmined. In, 15 municiplities were rndomly selected in ech stte, plus the cpitl, nd the secondry dt of yers-old nd 300 dolescents were nlyzed. The field work tems were trined nd instructed; 16-hour trining workshops imed to discuss the opertionliztion of the stges, the ttriutes of ech prticipnt nd to ensure the cceptle level of conformity with the procedures. The exminers prticipted in 32-hour trining workshops, contining theoreticl nd prcticl content, which took plce in vrious cities round the country. In order to stndrdize the tem, the consensus technique ws used. 13 The model proposed y the World Helth Orgniztion (WHO) 26 ws used s reference, with only those exminers who otined kpp sttistic for inter-oserver concordnce of 0.65 or ove pproved to prticipte in the survey. Ministério d Súde (BR). Divisão Ncionl de Súde Bucl. Levntmento Epidemiológico em Súde Bucl: Brsil, zon urn. Brsíli (BR); Secretri de Estdo d Súde de São Pulo. Levntmento epidemiológico em súde ucl: Estdo de São Pulo, São Pulo; c Ministério d Súde (BR). Secretri de Atenção à Súde. Deprtmento de Atenção Básic. Projeto SB Brsil 2003: condições de súde ucl d populção rsileir Resultdos principis. Brsíli (BR); d Ministério d Súde (BR). Coordenção Gerl de Súde Bucl. Bnco de ddos d Pesquis Ncionl de Súde Bucl Projeto SBBrsil. Brsíli (BR); [cited 2011 Nov 23]. Aville from:

3 Rev Súde Púlic 2013;47(Supl 3):1-8 3 The orthodontic exmintions followed the methodology proposed y the WHO. 26 A dentl mirror nd WHO dentl proe (CPI type) were used in nturl light with oth exminer nd individul seted. The SiC index ws used to define the severity of the dentl cries in the tercile of the group who hd the highest levels of the disese. The smple ws divided into two groups for the sttisticl nlysis: the first group contined the tercile of individuls who suffered most from dentl cries (SiC group, highest experience of cries group) nd the other mde up of the rest of the individuls who suffered lest (low levels of dentl cries). In ddition to levels of dentl cries, evluted using the DMFT index, during the exm need for orthodontic tretment ccording to the criteri proposed y the WHO were lso verified: restortion of one surfce, restortion of two or more surfces, crown, veneers, endodontics, extrction, reminerliztion nd use of selnts. The STATA version 12 sttisticl progrm ws used to nlyze the dt from the nd surveys. To nlyze the results, the chi-squred nd Mnn-Whitney tests were used, with 5% level of significnce. Descriptive nlyses of the conditions in question were crried out considering the weighting, s in complex smpling ws used nd the primry smpling unit nd the weighting were tken into considertion when nlyzing the dt. The SBBrsil Projects followed the stndrds set y the Declrtion of Helsinki nd ws pproved y the Conselho Ncionl de Étic em Pesquis, record no. 15,498, 7 th Jnury. The Condições de Súde Bucl no Estdo de São Pulo project ws pproved y the Reserch Ethics Committee (Process no. 581/2000). RESULTS There ws decrese of 39.3 percentge points in the DMFT t ge 12 (p < 0.001) nd of 41.1 percentge points in the dolescents (p < 0.001) etween nd. The decrese in the groups who suffered most from dentl cries ws similr for the 12-yers-old (37.7%) nd the 15 to 19-yers-old (33.0%). In the group who suffered lest from dentl cries, the DMFT decresed y nd 62.1% respectively for ech ge group (Figures 1 nd 2). In, 32.9% of the 12-yers-oldnd 9.6% of the dolescent hd no dentl cries. In this percentge ws 53.0% nd 29.1% respectively, n increse of pproximtely 161% nd 303% in the group which with no dentl cries. Figures 3 nd 4 show the percentge differences for ech component of the DMFT index in ech ge group in nd. In, for those ged 12, there ws decrese in the percentge of the component in the group overll nd in the group who suffered most from dentl cries (p < 0.001); etween 1998 nd there hd een n increse. In the group with the lowest experience of cries, in ddition to the decrese in this component, dentl cries incresed, the difference eing sttisticlly significnt Index men DMFT SiC Low experience Note: numers for the sme vrile followed y different letters differ t the 5% level of significnce. DMFT: Decyed, Missing nd Filled Teeth SiC: Significnt Cries Index. Figure 1. Comprison of the decyed, nd filled teeth index in the group overll, in the tercile with severe dentl cries (Significnt Cries Index) nd in the two terciles with those with low levels of dentl cries t 12-yers-old. Stte of São Pulo, nd.

4 4 Dentl cries nd tretment needs, São Pulo, nd Sous MLR et l Index men DMFT SiC 1.43 Low levels Note: numers for the sme vrile followed y different letters differ t the 5% level of significnce. DMFT: Decyed, Missing nd Filled Teeth SiC: Significnt Cries Index Figure 2. Comprison of the decyed, nd filled teeth index in the group overll, in the tercile with severe dentl cries (Significnt Cries Index) nd in the two terciles with those with low levels of dentl cries in dolescents. Stte of São Pulo, nd. For the dolescents, the decyed component incresed for the group overll nd in the group who suffered lest from dentl cries. The component decresed in ll three groups etween nd. The only group which showed ny difference in the extrct component ws the group who suffered lest from dentl cries, in which the percentge decresed in the period studied. The tle shows the needs for tretment which were sttisticlly different etween nd : need for endodontics nd ppliction of selnt t ge 12, nd for the dolescents, the need for restortion on one surfce nd on two or more surfces. The percentge of the other needs (crowns, veneers, extrction nd reminerliztion of white spots) did not chnge in the period in question. DISCUSSION Epidemiologicl surveys re key in monitoring orl helth trends. In the lst few decdes, there hs een reduction in the numer of children nd dolescents suffering from dentl cries in the stte of São Pulo, nd n increse in the percentge with no dentl cries. 15 The results of this study show tht this trend continues s, etween 1998 nd the men DMFT index in 12-yers-old decresed from 3.72 to 3.53 nd in it ws In the sme ge group, the percentge of those with no dentl cries incresed y 20% to 32.9% (1998-) nd in this percentge ws 53%. For the dolescents, the dt ville for the period etween 1986 nd for the stte of So Pulo lso suggest tendency for levels of dentl cries to decrese. Between nd the men DMFT index decresed from 6.44 to 3.29, nd the percentge of individuls with no dentl cries incresed from 9.6% to 29.1%. Studies of this trend in vrious countries hve lso shown reductions in the numers suffering from dentl cries. This decrese occurred in countries on different continents nd with different socioeconomic conditions, such s Englnd, the United Sttes, Chin, Itly nd Brzil. 5,7,12,24 The studies in Chin nd the United Sttes were crried out every two yers nd showed tht, even with notle reduction in the condition of children nd dolescents orl helth, t the end of long period, 14 yers nd 8 yers respectively, the tendency to decrese ws inverted nd n increse in prevlence occurred, oth in the group overll nd in the group of those hd the highest experience of cries (SiC). In study of Nigerin children with DMFT elow 1.5 t ge 12, tendency for the prevlence of dentl cries to increse ws lso oserved. 25 For Bgrmin et l 3 (2009), in review of the epidemiologicl literture in vrious countries, the cuses of this increse in prevlence re still uncler, lthough the findings suggest tht the enefits of prevention re not ville to ll, nd tht coordinted eduction nd progrms promoting orl helth re necessry in order to counter the thret of n explosion in levels of dentl cries. 25

5 Rev Súde Púlic 2013;47(Supl 3): decyed decyed decyed DMFT Low levels SiC Note: numers for the sme vrile followed y different letters differ t the 5% level of significnce. DMFT: Decyed, Missing nd Filled Teeth SiC: Significnt Cries Index Figure 3. Frequency of the decyed,, components for the decyed, nd filled index, the low level group nd the Significnt Cries Index t ge 12. Stte of São Pulo, nd. According to our results, the tendency to decrese continued even when the DMFT mens for the groups with the highest nd lowest experience of dentl cries were verified. This suggests tht, in the stte of So Pulo, the enefits re reching ll groups homogenously, oth those ged 12 nd those ged These results decyed decyed decyed DMFT Low levels SiC Note: numers for the sme vrile followed y different letters differ t the 5% level of significnce. DMFT: Decyed, Missing nd Filled Teeth SiC: Significnt Cries Index Figure 4. Frequency of the decyed,, components for the decyed, nd filled index, the low level group nd the Significnt Cries Index for dolescents. Stte of São Pulo, nd.

6 6 Dentl cries nd tretment needs, São Pulo, nd Sous MLR et l Tle. Percentge of tretment needs in children nd dolescents. Stte of São Pulo, Brzil, nd. Age group Need for tretment % (95%CI) % (95%CI) 12 yers old Endodontics DMFT 4.3 (3.2;5.2) 7.0 (4.2;9.9) Highest experience 6.6 (4.6;8.6) 10.0 (2.3;17.7) Lowest experience 3.1 (2.2;4.0) 1.6 (0.0;3.1) Selnt DMFT 0.5 (0.2;0.8) 0.5 (0.0;1.3) Highest experience 0.6 (0.2;0.9) 0.3 (0.0;0.9) Lowest experience 0.5 (0.2;0.8) 0.4 (0.0;1.1) p 15 to 19 yers old Restortion of 1 surfce DMFT 41.4 (35.1;47.7) 31.4 (21.9;40.9) Highest experience 49.5 (41.4;57.6) 46.8 (31.7;61.9) Lowest experience 37.3 (30.6;44.0) 25.3 (15.8;34.8) Restortion of 2 or more surfces DMFT 22.6 (16.9;28.3) 14.4 (9.6;19.4) Highest experience 37.2 (26.2;48.2) 27.6 (17.0;38.1) Lowest experience 15.3 (11.5;19.2) 9.3 (3.4;15.1) corroorte those of Ditmyer et l 9 (2011) in Nevd (USA) for nd yers-old, nd Steiner et l 23 () in Zurich (Switzerlnd) t ge 12. The ltter study showed 90% reduction in the DMFT for the whole group nd n 83% reduction in the group who suffered most form dentl cries over period of 45 yers. Over 25 yer period in Austrli (1977 to ), Armfield et l 2 (2009) oserved decrese of pproximtely 79.6% in the DMFT nd 68% in the SiC in the permnent teeth of schoolchildren ged 11 nd 12. The study oserved greter reductions over this period nd detected growing inequlities in suffering from dentl cries. Likewise, Constnte et l 6 () reported the experience of 12 to 13-yers-old school children in pulic school in Florinópolis, SC, with 91.5% descrese in the DMFT men, in other words, from 9.2 in 1971 to 0.78 in 2009 nd SiC of 3.4 in to 2.8 in 2009, representing 47% decrese. In Bilc, in the interior of So Pulo, decrese in the DMFT nd n increse in those free of dentl cries ws verified etween 1998 nd 2004, even though the municiplity did not fluoridte the pulic wter supply. 17 In ddition to the decrese in the disese in the sme ge group, this study showed tht the percentge of the DMFT decrese ws similr etween the ge groups (41.1% for dolescents nd 39.3% for 12-yers-old). The nturl history of dentl cries suggests tht incresing ge is ccompnied y n incresed numer of lesions, lthough it ws oserved tht the decrese ws proportionl etween the ge groups in question. Once gin, orl helth cre ctivities pper not to distinguish etween the ge groups, t lest with regrds to the ge groups studied here, in contrst to former models of helth cre which prioritized specific ge groups. When the components re nlyzed in isoltion, decrese in the percentge of the component is noted t ge 12 in ll groups. In the group overll nd in tht with the highest experience of dentl cries the percentge of the decy component underwent no chnge in the period in question lthough it incresed in the group with the lowest experience of dentl cries, s lso occurred in the study y Gushi et l 15 (2008). In other words, the findings of the study indicte tht, t ge 12, there ws n increse in the numer of teeth with dentl cries nd decrese in restortions in the group with the lowest dentl cries score. On tht occsion, there ws decrese in the percentge of teeth with dentl cries nd n increse in those which were oth for the group overll nd for the group which suffered most from dentl cries, which differs from the results of this study. Constnte et l 6 (), in longitudinl study of schoolchildren ged 12 to 13, oserved tht in the ltter yers of 38 yers of monitoring, there ws n increse in component D, suggesting tht the use of orthodontic services in the region of Florinópolis hd declined, or tht professionls were dopting less invsive pproch. At first glnce, the results of the DMFT components in this study my suggest tht neither curtive nor preventtive tretments were effectively crried out. The increse in the component decyed in just the group with the lowest dentl cries experience in the two periods (1998- nd -) suggests tht ttention should e directed primrily t the group with the highest prevlence (SiC) in n effort to reduce the disese in the stte of So Pulo. Contrry to wht might hve hppened in Florinopolis, where use of services my hve declined. This effort in So Pulo hd positive results, shown in the nlyses in this study, ut the importnce of integrted orl helth cre ctions which link the individul with the collective, promotion nd prevention with tretment nd recovering the helth of the popultion needs to e highlighted. Thus, ctivities promoting helth cre should lso e imed t those groups deemed to e t low risk of developing the disese ecuse, if they re not cred for, they will ecome prt of the high risk group. In the three groups, there ws decrese in the component; however, only the group with the highest experience of dentl cries showed no increse in the decyed component. In the group with the lowest

7 Rev Súde Púlic 2013;47(Supl 3):1-8 7 experience of dentl cries, there ws decrese in the component. Even so, it should e emphsized tht the component, in this ge group, represents more thn 60% of the DMFT in oth the group s whole nd those who suffered most nd lest from dentl cries. Between 1998 nd, n increse in the need for restortions nd decrese in selnts were oserved, nd, etween nd there ws n increse in the need for endodontic tretment in the group s whole nd in the group with the highest experience of cries, nd the need for selnt continued to decrese in ll groups t ge 12. Indictions of selnt use chnged during this period, which my hve een rought out y chnges in the exminers ehvior. This indiction my hve een underestimted due to difficulties in detecting erlystge dentl cries in epidemiologicl studies, especilly in the in posterior teeth. 21 The increse in the percentge of indictions of endodontics my e relted to decreses in the quntity of teeth in the DMFT, in other words, t some point these teeth re no longer nd now need less conservtive tretment. On the other hnd, it could e speculted tht, with greter ccess to informtion nd to specilist orl helth cre services, there my hve een culturl chnge in this popultion with regrds the type of tretment chosen, voiding the extrction of teeth which could e sved. A study in young people ged 11 to 15 showed greter need for restortion tretment (pproximtely 60%) on one surfce, demonstrting n initil stge with regrds tretment. However, it cn e oserved tht the needs to pply selnts decresed nd tht of endodontics nd extrction incresed with in the older ge group, reveling distriution of dentl cries tht increses with ge nd progression of lredy estlished lesions. 16 In the Yemen, children ged 6 to 14 showed higher need for restortion on one or more surfces, followed y the need for extrction. This finding ws ttriuted to possile low levels of knowledge nd/or eliefs, to poverty nd/or reduced ccess. 1 In the dolescent group, the need for restortion on one surfce decresed in the group with the lowest experience of dentl cries nd the need for restortion on two or more surfces decresed in the group s whole nd lso in the group with the lowest experience of dentl cries. The other needs studied, such s extrction, endodontics nd dentl prostheses hve remined unchnged over the lst eight yers. These dt reinforce those of REFERENCES 1. Al-Hddd KA, Al-Heshi NN, Ak hli MS. Orl helth sttus nd tretment needs mong school children in Sn City, Yemen. Int J Dent Hyg. ;8(2): DOI: /j x 2. Pesquis Ncionl de Súde Bucl (SBBrsil) Armfield JM, Spencer AJ, Slde GD. Chnging inequlities in the distriution of cries ssocited previous studies, in which orl helth cre ctivities hve positively ffected this group, s the decresing need for non-complex tretment suggests tht promotion nd prevention ctivities re chieving their ojective. Dsh et l 8 () showed tht the need for restortion on one or more surfces nd extrctions were responsile for 81.2% nd 16% of 15-yers-old dolescents totl tretment needs in n Indin stte. Another study with group of Indin workers ged 15 to 24 found decresed need for restortion on one surfce s ge incresed. 11 The decresing prevlence of dentl cries in Brzil nd worldwide hs een reported; 18,19 however, considerle inequlities in orl helth re found etween regions of Brzil, within other countries 10,20,22 nd in the stte of So Pulo. However, due to the design of the study, it ws not possile to infer the resons for the decrese in dentl cries. Moreover, lthough the SBBrsil smple ws only representtive of the stte cpitls nd the regions, the use of the dt for the stte of So Pulo s whole enles the findings to e discussed, lthough this limittion should e orne in mind when evluting the results. Although the WHO ojective of DMFT elow 1.0 for 12-yers-old ws not met, there ws notle progress in the stte of So Pulo. The dt found should e used to guide orl helth cre ctivities, iming to meet the needs of ll, oth those who suffer most from the disese nd hve greter need for tretment s well s those with lower prevlence of dentl cries. Another gol, proposed for 2015, is hving DMFT elow 3 for 12-yers-old in the SiC group. 4 However, the finding for the stte of São Pulo in ws 3.5, which reinforces the fct tht mesures still need to e tken to provide more equl ccess to orthodontic services, s well s preventtive mesures nd those promoting helth cre, imed t the popultion with the highest concentrtion of the disese. There re significnt vritions over time etween popultions with levels of socil nd economic development 11 in the levels of dentl cries. Ultimtely, inequlities in orl helth cre will lwys exist while children still suffer from dentl cries. 2 To conclude, there ws decrese in the prevlence of dentl cries in the popultions studied, ut lso the group with the lowest experience of dentl cries still needs to e monitored. Thus, the spects of this reduction should e nlyzed in order for effective mesures to e designed, iming not only t etter orl helth ut lso t decresing the inequlities which ffect children nd dolescents qulity of life. with improving child orl helth in Austrli. J Pulic Helth Dent. 2009;69(2): DOI: /j x 3. Bgrmin RA, Frnklin GG, Anthony RV. The glol increse in dentl cries. A pending pulic helth crisis. Am J Dent. 2009;22(1):3-8.

8 8 Dentl cries nd tretment needs, São Pulo, nd Sous MLR et l 4. Brtthll D. Introducing the Significnt Cries Index together with proposl for new glol orl helth gol for 12-yer- olds. Int Dent J. 2000;50(6): DOI: /j X.2000.t00572.x 5. Cmpus G, Scco G, Cgetti M, Ati S. Chnging trend of cries from 1989 to 2004 mong 12-yer old Srdinin children. BMC Pulic Helth. 2007;7: Constnte HM, Bstos JL, Peres MA. Trends in dentl cries in 12- nd 13-yer-old schoolchildren from Florinópolis etween 1971 nd Brz J Orl Sci. ;9(3): Dvies GM, Jones CM, Monghn N, Morgn MZ, Neville JS, Pitts NB. The cries experience of 11 to 12 yer-old children in Scotlnd nd Wles nd 12 yer-olds in Englnd in : reports of co-ordinted surveys using BASCD methodology. Community Dent Helth. 2012;29(1):8-13. DOI: /j x 8. Dsh JK, Shoo PK, Bhuyn SK, Shoo SK. Prevlence of dentl cries nd tretment needs mong children of Cuttck (Oriss). J Indin Soc Pedo Prev Dent. ;20(4): Ditmyer M, Dounis G, Moley C, Schwrz E. Inequlities of cries experience in Nevd youth expressed y DMFT index vs. Significnt Cries Index (SiC) over time. BMC Orl Helth. 2011;11:12. DOI: / Do LG. Distriution of cries in children: Vritions etween nd within Popultions. J Dent Res. 2012;91(6): DOI: / Duriswmy P, Kumr TS, Dgli RJ, Chndrknt, Kulkrni S. Dentl cries experience nd tretment needs of green mrle mine lorers in Udipur district, Rjsthn, Indi. Indin J Dent Res. 2008;19(4): DOI: / Dye BA, Arevlo O, Vrgs CM. Trends in peditric dentl cries y poverty sttus in the United Sttes, nd Int J Peditr Dent. ;20(2): DOI: /j X x 13. Fris AC, Antunes JLF, Nrvi PC. Precisão e vlidde de levntmentos epidemiológicos em súde ucl: cárie dentári n Cidde de São Pulo,. Rev Brs Epidemiol. 2004;7(2): DOI: /S X Gushi LL, Sores MC, Forni TIB, Vieir V, Wd RS, Sous MLR. Cárie dentári em dolescents de nos de idde no Estdo de São Pulo, Brsil,. Cd Sude Pulic. 2005;21(5): DOI: /S X Gushi LL, Rihs LB, Sores MC, Forni TIB, Vieir V, Wd RS, et l. Cárie dentári e necessiddes de trtmento em dolescentes do estdo de São Pulo, 1998 e. Rev Sude Pulic. 2008;42(3): DOI: /S Kulkmi SS, Deshpnde SD. Cries prevlence nd tretment needs in yer old children of Belgum city. J Indin Soc Prev Dent. ;20(1): Mrtins RJ, Grin CAS, Grin AJI, Moimz SAS, Sli O. Declínio d cárie em um município d região noroeste do Estdo de São Pulo, Brsil, no período de Cd Sude Pulic. 2006;22(5): DOI: /S X Mshoto KO, Astrom AN, Skeie MS, Mslu JR. Socio-demogrphic disprity in orl helth mong the poor: cross sectionl study of erly dolescentes in Kilw district, Tnzni. BMC Orl Helth. ;10:7. DOI: / Nrvi PC, Frzão P, Ronclli AG, Antunes JLF. Cárie dentári no Brsil: declínio, iniqüidde e exclusão socil. Rev Pnm Slud Pulic. 2006;19(6): DOI: /S Piovesn C, Mendes FM, Antunes JPF, Ardenghi TM. Inequlities in the distriution of dentl cries mong 12-yer-old Brzilin schoolchildren. Brz Orl Res. 2011;25(1): DOI: /S Rihs LB, Sous MLR, Cyprino S, Adll NM. Desigulddes n distriuição d cárie dentári em dolescents de Inditu (SP), Cienc Sude Coletiv. ;15(4): DOI: /S Schulte AG, Momeni A, Pieper K. Cries prevlence in 12-yer-old children from Germny. Results of the 2004 ntionl survey. Community Dent Helth. 2006;23(4): DOI: /S Steiner M, Menghini G, Mrthler TM, Imfeld T. Chnges in dentl cries in Zurich school-children over period of 45 yers. Schweiz Montsschr Zhnmed. ;120(12): Tng J, Yu Y, M Y. The Epidemic Tendency of Dentl Cries Prevlence of School Students from 1991 to 2005 in Chin. J Huzhong Univ Sci Technol. ;30(1): DOI: /s Umesi-Koleoso DC, Ayndejo PO, Oremosu OA. Dentl cries trend mong dolescents in Lgos, Southwest Nigeri. WAJM. 2007;26(3): World Helth Orgniztion. Orl helth surveys: sic methods. 4. ed. Genev, The Pesquis Ncionl de Súde Bucl (SBBrsil, Brzilin Orl Helth Survey) ws finnced y the Generl Coordintion of Orl Helth/Brzilin Ministry of Helth (COSAB/MS), through the Centro Colordor do Ministério d Súde em Vigilânci d Súde Bucl, Fculdde de Súde Púlic t Universidde de São Pulo (CECOL/USP), process no /. This rticle underwent the peer review process dopted for ny other mnuscript sumitted to this journl, with nonymity gurnteed for oth uthors nd reviewers. Editors nd reviewers declre tht there re no conflicts of interest tht could ffect their judgment with respect to this rticle. The uthors declre tht there re no conflicts of interest.