Prevalence and impact of dental caries and consequences of non-treatment on the quality of life of schoolchildren.

doi:10.21203/rs.3.rs-2097455/v1

Background: Several oral alterations such as dental caries can affect the quality of life of children, adolescents and their families. The objective of the present study was to identify the prevalence of dental caries and the consequences of non-treatment and the impact on the quality of life of schoolchildren 8-10 years of age.

Methods: The sample was comprised of 1,315 schoolchildren belonging to 24 municipal schools. The prevalence of caries and the consequences of untreated caries were obtained by the DMFT/deft and PUFA/pufa indexes, respectively, and categorized in schoolchildren as: caries free, caries history, carious and consequences of untreated caries. Quality of life was assessed by the Child Perceptions Questionnaire (CPQ8-10). Data were analyzed descriptively and by logistic regression analysis with a 95% level of significance.

Results: The DMFT / deft was 1.43 (± 1.958) / 0.28 (± 0.693) and PUFA / pufa was 0.22 (± 0.689) / 0.01 (± 0.106) with a prevalence of 44 2% and 13.6%, respectively. The oral condition related to dental caries has an impact on the quality of life (p <0.001), children with caries (OR = 1.75; 95% CI: 1.301 to 2.367) and consequences of non- treatment (OR = 2.33; 95% CI: 1.599 to 3.418) is more likely to have a worse impact on the quality of life.

Conclusion: It is concluded that the prevalence of dental caries is 44.2%, and the consequence of untreated caries is 13.6%. The oral condition related to dental caries has an impact on the quality of life, dental caries and the consequences of untreated caries increase the chances of a negative impact.

Oral health

Quality of life

Dental caries

The distribution and severity of oral diseases vary in different parts of the world, and even within a country or region [1]. Dental caries has been historically considered one of the most important oral health problems. In Brazil, dental caries has shown a consistent decline over the years, which corresponds to a national decline observed in all regions [2], evidenced by national surveys [3].

Together with the decline of caries, there is polarization, where a large number of cases are concentrated in a small group of individuals [1]. However, the lack of treatment brings significant morbidity associated with pain [4, 5], which can lead to nutritional and sleep deficits [6], and restrict the activities in school, generate absenteeism [7, 8] and affect the quality of life [9–13].

The assessment of the impact of oral diseases in the everyday life of children is important, since these may interfere with the psychosocial well-being and cause functional limitations and compromise future development [14]. The impact that the oral amendments have on the functional and psychosocial aspects of children and adolescents can affect systemic health, self-esteem and cognitive aspects. Authors also emphasize the evidence of the impact of socioeconomic factors and dental caries, even if treated as risk factors for poor school performance for a population of 8–10 year olds [8].

As essential clinical indicators in the assessment of oral health, the quality of life measures are accepted in the scientific community for clinical decision making, evaluation of dental procedures, services and programs. Thus, the present study associated the clinical variables to the quality of life context through the Child Perceptions Questionnaire (CPQ8-10) [15], exploring beyond the DMFT/deft, the index PUFA / pufa the presence of treatment and consequences of non-treatment of dental caries.

The aim of the present study was to identify the prevalence of dental caries, the consequences of untreated dental caries and the impact of oral health related to dental caries in the quality of life of schoolchildren 8–10 years old.

Ethical considerations

The present study was approved by the Ethics Committee in Research with Human Beings (CEP) of the State University of Santa Catarina (UDESC), in the opinion No. 902,663 and the Florianópolis Education Department. The legal guardians signed the Informed Consent Form (IC) and the children signed a consent term after clarification of the same.

Study population

A cross-sectional population-based study was conducted with children in public schools in the city of Florianopolis, Brazil. According to the latest census, Florianópolis has a population of 469,690 inhabitants [16] and 5,450 schoolchildren, predominantly aged 8–10 years, enrolled in 36 public schools distributed throughout the city.

The study population consisted of schoolchildren aged 8 to 10 years, a randomly selected sample according to conglomerates, considering the health districts of Florianópolis, following the Unified Health System (SUS) for local organization. The draw of schools followed the proportionality of the number of schools and school districts for a total of 24 schools. Subsequently, the call for participation of all enrolled students who met the study inclusion criteria was conducted.

The sample size was calculated using a prevalence rate of 50%, with a confidence interval (CI) of 95% and standard error of 3%. The minimum sample was defined as 1,067 schoolchildren, 20% was added to compensate for possible losses, totaling 1,280 children. Since the total number of students was known, it was passed to the population correction, resulting in 1,035 schoolchildren, and this was applied to a 1.5 design effect to increase the accuracy considering the conglomerate totaling 1,553 schoolchildren. The overall weight of each child was done so that the information would obey the proportionality within the sample and then the sample plan.

Eligibility criteria

To participate in the study, the schoolchildren should be enrolled in public schools in Florianópolis, be 8 to 10 years of age, at least one erupted permanent tooth, a CI signature and the complete filling of the socioeconomic questionnaire and assenting to participation in the study. The excluded students did not complete the questionnaire on oral health-related quality of life (OHRQoL), and they refused a clinical examination or were using orthodontic appliances.

Calibration and pilot study

To ensure the reliability of the study, a process of training and calibration was performed with the examiners. Four examiners received theoretical and practical training before the calibration exercise. Twenty students from 8–10 years of age were examined, the consensus among examiners resulted in a kappa intra and inter examiner of > 0.7 for the variables. A pilot study was conducted and indicated adjustments of conduct and organization, with no need to change the methods proposed. Children of the pilot study and calibration were not included in the sample.

Data collection

Data collection was done in three steps, the first by means of a questionnaire to parents to obtain the socioeconomic characteristics [16, 17], the second with the application of a questionnaire to the schoolchildren to assess the oral health-related quality of life (OHRQoL), the CPQ8-10 [15], and the third by clinical examination.

Non-clinical data

Socioeconomic characteristics

The socioeconomic characteristics were obtained through a questionnaire sent to the parents [17]. From this, income data were extracted, considered in minimum wages, where each Brazilian minimum wage is equivalent to approximately US $ 310.00 and the education of the household head. The skin color was classified as white, black, yellow, brown or indigenous [16].

Oral health-related quality of life

The OHRQoL was measured using a multiple choice questionnaire, the CPQ8-10, translated and validated in Brazil [11] for children 8–10 years of age. The CPQ8-10 consists of 25 questions related to oral health, 5 relating to oral symptoms, 5 to functional limitations, 5 to emotional well-being and 10 to social welfare. It also has questions related to general health issues and identification [15].

The questionnaire was collectively administered by an interviewer. In the present study, the questionnaire was evaluated by the Item Response Theory (IRT), considering the peculiarity of each item in the construct, based on a set of mathematical models that allows measuring a latent trait, in function of a set of responses to items of an evaluation or research instrument [18], in this case, the CPQ8-10. These mathematical models relate the observable variables (items) to the unobservable characteristics (skills), resulting in observable variables (responses). In general, the parameters of (values that represent the breakdown of the item and the response level of difficulty of each category) and the latent trait of the individual, determine the probability of response to a specific category for a given item [19]. According to the standard commitment of respondents, a OHRQoL scale was created by the IRT.

Clinical data

Clinical examinations were performed with the child comfortably sitting in a regular chair, facing the examiner, by direct visual observation of the oral cavity and artificial lighting (LED light flashlight - Emitting Diode Light), individually in a reserved location. Clinical mirrors, WHO probes and gauze were used.

The examination for dental caries was performed according to the criteria of the WHO [20]. The evaluation of the consequences of untreated dental caries was performed according to the Monse et al. [21] proposal, which considers exposed pulp, ulceration, fistula and abscess for primary teeth (pufa) and permanent (PUFA). Lesions in the surrounding tissues that were not related to a tooth with visible pulp involvement as a result of decay were not considered. Detected was more than one clinical consequence of dental caries for a particular tooth, the most severe condition was recorded, the abscess, followed by fistula, ulceration and pulp involvement.

The calculation of the DMFT/ deft and PUFA / pufa indexes was carried out by the sum of the components that meet the diagnostic criteria for each index and divided by the total school.

To assess the association of oral health related to dental caries and the OHRQoL, the students were classified as caries free, caries history, carious and consequences of untreated caries, as seen in Chart 1.

Dental trauma and malocclusion were evaluated as possible control variables, according to the WHO [20].

Statistical analysis

The statistical analysis included descriptive statistics to demonstrate the characteristics and distribution of the sample, the prevalence of dental caries and the consequences of untreated caries, in addition to the PUFA / pufa and DMFT/deft. The dependent variable was the OHRQoL, measured by the CPQ8-10, according to the standard of commitment of the respondents created a OHRQoL scale by the IRT, divided into four categories: no impact [1.0 to 3.0] little impact [3.0 to 5.0], impact [5.0–7.0] and great impact [7.0 to 11.0], because the distribution of the sample was considered: no impact [1.0–3.0] / impacting [3.0 to 11.0]. For the application of the Item Response Theory, the SKF Software Multilog (Multilog® - San Diego, CA) was used. The significance level was set at p < 0.05 (5%) for all statistical tests. The DMFT/deft and PUFA / pufa indexes were included with the descriptive statistics to demonstrate the characteristics and distribution of the sample, the prevalence of dental caries and the consequences of untreated caries. The dependent variable was the OHRQoL, measured by the CPQ8-10, according to the standard of commitment of respondents, creating a OHRQoL scale by the IRT.

The independent variables were: oral condition related to dental caries (caries free / caries history / carious / consequences of untreated caries), age (8/9/10 years), gender (male / female), color (white / other / undeclared), schooling of the head of household (≤ 8 years /> 8 years), income (≤ 2 Brazilian minimum wages /> 2 Brazilian minimum wages). The malocclusion (absent / present) and dental trauma (absent / present) were used as control variables.

The adjusted logistic regression analysis was performed after the exclusion of variables with p > 0.20. In the final regression model, the variables remained at p ≤ 0.05. The level of significance was set at 5% and the sample weights were used to adjust the sample complexity. Weighted data were obtained using a sampling plan complex and subjected to analysis of complex samples in the SPSS version 21.0 for Windows (SPSS Inc., Chicago, IL, USA).

Evaluated were 1,589 schoolchildren belonging to 24 public schools, being 17% excluded for not meeting the eligibility criteria, totaling 1,315 students with a mean age of 8.96 (± 0.803). Most of the children were girls (57.3%) and had heads of households with more than eight years of education (50.5%) and income higher than two minimum wages (59.8%) (Table 1).

Table 1

Descriptive analysis of demographic, socioeconomic and clinical variables of schoolchildren, Brazil. 2015.
Variables
Demographic/Socioeconomic			Clinical/QLROH
	n	%		n	%
Gender			Oral condition related to dental caries
Male	561	42,7	Caries free	546	41,5
Female	754	57,3	Caries history	188	14,3
			Carious	403	30,6
Age			Consequences of untreated caries	178	13,6
8 years	450	34,2
9 years	465	35,4	Malocclusion
10 years	400	30,4	Absent	325	24,7
			Present	990	75,3
Color
White	947	72,0	Dental trauma
Other	287	21,8	Absent	1179	89,7
Undeclared	81	6,2	Present	136	10,3
Schooling of the head of household			QLROH (CPQ_8 − 10)
≤ 8 years	651	49,5	No impact	602	45,8
> 8 years	664	50,5	With impact	713	54,2
Income
≤ 2 Brazilian minimum wages	529	40,2
> 2 Brazilian minimum wages	786	59,8

The DMFT/ deft index was 1.43 (± 1.958) / 0.28 (± 0.693), and the prevalence of dental caries was 44.2%. The PUFA / pufa index was 0.22 (± 0.689) / 0.01 (± 0.106), respectively, with a prevalence of 13.6%.

Of the primary dental elements affected by caries, 16.2% also had one of the consequences of non-treatment, such as the exposed pulp, ulceration, fistula or abscess. In the permanent dentition, the prevalence was 20.8%.

The primary teeth with consequences of untreated caries showed the exposed pulp component with a higher prevalence, representing 79.9% of the affected teeth, followed by fistula and abscess, both with 8.8% and ulceration in only 7 cases (2.5%). Already in the permanent teeth, there were 12 (92.3%) cases of exposed pulp and only 1 (7.7%) of fistula without registration for the other components.

To assess the quality of life, a scale was developed by the IRT, according to the pattern of responses for the questions of the CPQ8-10 questionnaire. The categories of impact on the quality of life were divided according to the severity, based on responses to questions, regardless of the distribution of the sample and associations with the variables (Table 2).

The sample was subsequently distributed in a scale (Table 3). An uneven distribution was noted, which indicates that there is a reduced number of children with impact (3.6%) and great impact (0.1%). For representation purposes, the quality of life was analyzed according to the interval "no impact" [1.0 to 3.0] and "with impact" [3.0 to 11.0].

Table 3

Descriptions of QLROH categories from the CPQ 8–10 according to the IRT and the sample distribution of schoolchildren from Florianópolis, Brazil, 2015.
Category	Sample Interval %	Description of categories
No impact	[1.0–3.0) 44.6	At this level, the child does not present oral symptoms and functional limitations. Moreover, there are no emotional and social impacts.
Little impact	[3.0–5.0) 51.7	At this level, the child presents pain one or two times a month in the teeth when eating or drinking something cold; the food is gripped in the teeth which causes a bad smell in the mouth.
Impact	[5.0–7.0) 3.6	At this level, the child has trouble speaking once or twice a month; misses class; presents trouble doing homework; stays out of games and activities; other children mock them or call them nicknames; they feel pain in the teeth or mouth sometimes in the month; have mouth sores; feel pain in the teeth when they eat or drink something cold; the food is gripped in the teeth which causes a bad smell in the mouth; spend more time than others to eat; have difficulty biting or chewing harder foods such as apples, bread, corn or meat; find it difficult to eat anything they want; have trouble sleeping at night; have trouble paying attention in class; do not speak or read aloud in the classroom; ceases to smile or laugh when they are with other children; do not talk with other children; do not stay close to other children and; other children ask questions about their teeth or mouths; many times a month they get upset; feel sad; are ashamed of their teeth or mouths; feel concerned about what people think about their teeth or mouths and; think of themselves not as beautiful as other people because of their teeth or mouths.
Great Impact	[7.0–11.0] 0.1	At this level, the child presents oral symptoms and functional limitations nearly every day of the month. In addition, they present high emotional and social impacts nearly every day of the month.

The oral condition related to dental caries is associated with the impact on the quality of life (p < 0.001), children with carious teeth are 1.7 times more likely to have an impact on the quality of life when compared to caries-free with healthy teeth. For children with consequences of untreated caries, the chances increase, being 2.3 times higher compared to the caries-free, controlled by the other variables. There was no difference in the impact on quality of life among children with a history of caries and caries-free (Table 4).

Table 4

Results of gross and adjusted logistical regression of the association between the quality of life, CPQ8-10 and the demographic, socioeconomic and clinical variables, Brazil, in 2015.
Variáveis	Quality of life
	Impact		Bruta		Ajustada
	Absent	Present	Bruta		Ajustada
	n (%)	n (%)	OR 95% CI	p valor	OR 95% CI	p valor
Gender
Male	290 (51,7)	271 (48,3)	1	< 0,001	1	< 0,001
Female	312 (41,4)	442 (58,6)	1,465 (1,216-1,766)	< 0,001	1,490 (1,227-1,809)	< 0,001
Age
8 years	207 (46)	243 (54)	1	0,208
9 years	206 (44,3)	259 (55,7)	1,122 (0,906-1,388)
10 years	189 (47,3)	211 (52,8)	0,880 (0,678-1,144)
Color
White	453 (47,8)	494 (52,2)	1	0,021	1	0,160
Other	113 (39,4)	174 (60,6)	1,433 (1,131-1,815)		1,274 (0,996-1,630)
Undeclared	36 (44,4)	45 (55,6)	1,024 (0,635-1,653)		1,008 (0,626-1,623)
Schooling of the head of household
≤ 8 years	255 (39,2)	396 (60,8)	1	< 0,001	1	0,009
> 8 years	347 (52,3)	317 (47,7)	0,581 (0,456-0,741)	< 0,001	0,680 (0,514-0,899)	0,009
Income
≤ 2 Brazilian minimum wages	201 (38)	328 (62)	1	0,001	1	0,252
> 2 Brazilian minimum wages	401 (51)	385 (49)	0,619 (0,486-0,789)	0,001	0,851 (0,640-1,132)	0,252
Oral condition related to dental caries
Caries free	288 (52,7)	258 (47,3)	1	< 0,001	1	< 0,001
Caries history	98 (52,1)	90 (47,9)	1,034 (0,784-1,365)		1,059 (0,802-1,399)
Carious	163 (40,4)	240 (59,6)	1,737 (1,291-2,336)		1,754 (1,301-2,367)
Consequences of untreated caries	53 (29,3)	125 (70,2)	2,729 (1,832-4,066		2,337 (1,599-3,418)
Malocclusion
Absent	155 (47,7)	170 (52,3)	1	0,824
Present	447 (45,2)	543 (54,8)	1,031 (0,777-1,369)	0,824
Dental trauma
Absent	534 (45,3)	645 (54,7)	1	0,417
Present	68 (50)	68 (50)	0,865 (0,599-1,247)	0,417
OR - Odds Ratio. CI 95%. QLROH Reference Category - “No impact”. Brazilian minimum wages - US$310.00.

The education of the head of household also influences the quality of life of children (p < 0.01), the impact reduces 32% when the study time is more than 8 years. The girls are 1.5 times more likely to have an impact on the quality of life when compared to boys, controlled by the other variables (Table 4).

In the present study, the DMFT/ deft index of 1.43 / 0.28 observed is in line with national surveys [3], with 44.2% of the students presenting dental caries. A study in Brazil, which also assessed the OHRQoL, demonstrated caries prevalence of 64.6% [13]. Different parts of the world may have different prevalences [1]. In Germany, the prevalence of primary teeth in children 8 years old was 48.8% and 3.9% in the permanent and the DMFT/deft was 0.9 / 0.1 [22]. In the Philippines, almost all children 6 years of age presented caries (97%), with a DMFT/deft of 8.4 / 0.7 [21]. In South Africa, children 6–8 years old had a mean DMFT / deft of 2.4 / 0.1 respectively, with caries prevalence of 46% [23]. In Nigeria, the prevalence in children aged 7 to 12 years old was 10.1%, with a DMFT/deft of 0.14 / 0.06 [24].

Considering the different socioeconomic contexts, comparisons with other countries may be limited. In the present study, the PUFA / pufa index was 0.22 / 0.01, with low prevalence (13.6%). In this age group, there is a study that reports prevalence in Germany (16.6%) [22] and Brazil (17.9%) [13]. In Brazil, children 6 and 7 years old had a PUFA/pufa of 1.7 and a prevalence of 23.7% [25]. A study in Nigerian children aged 7 to 12 years showed a prevalence of 4% with a PUFA / pufa of 0.03 / 0.02 [24]. In young children in the Philippines (85%), the PUFA / pufa was 3.4 / 0.1 [21]; South Africa (44%) PUFA of 3.4 [23.]; Poland (72.4%) pufa of 2.44 [26] and also in older children from orphanages in India, the PUFA prevalence was 37.7% [27].

In the present study, approximately 37% of teeth with caries also presented exposed pulp, ulcers, abscess, or fistula, very similar to a previous report [21, 22]. The vast majority of carious dental elements, with consequence of untreated caries, presented exposed pulp, consistent with other studies [21, 22, 27]. For the other components, there are differences in patterns of odontogenic infection [21, 22, 24, 26, 27]. In addition to the age difference limitation in the mentioned studies, these differences can be attributed to the temporal pattern of the effects of abscess, fistula and ulcers, because from the remission, the clinical condition would be exposed pulp.

In the present work, the classification of dental caries was based on the oral condition related to dental caries, categorizing children as caries free, caries history, carious and consequences of untreated caries, modifying the proposal by Alves et al. [28], which considers the status of the treatment. Studies on the relationship between the number of carious teeth and the OHRQoL may be subject to criticism as a result of the conceptual distinction between health and disease [29].

The oral condition related to dental caries demonstrated an impact on the quality of life, other studies that also used the CPQ8-10 found impact, but differ in the evaluation methodology of dental caries, considering the number of surfaces by the DMFT/deft [9], the DMFT/deft [14] of the untreated caries or carious teeth through the DMFT/ deft being C / c > 0 [10, 12, 13], also reported in older children [30,, 31, 32]. For the consequences of untreated caries through the PUFA / pufa index, the studies were unanimous in reporting the impact on the OHRQoL, both for children 8 to 10 years old [13], as well as the other age ranges [4, 31, 33].

Children with caries history, those with teeth already treated, show no differences in the impact on the quality of life when compared to caries free. However, a longitudinal follow-up with children 8–10 years of age undergoing dental treatment revealed that access to dental treatment can have a positive impact on the OHRQoL of children with caries experience. Children without caries experience reported fewer problems in social and emotional areas of the CPQ8-10 compared to children with experience [8]. A cross-sectional study in adolescents already undergoing treatment, revealed a better OHRQoL, justified by the functional, emotional damage that dental caries experience can generate [28]. This divergence may be relative, influenced by the time of exposure to dental caries and severity, requiring better clarification.

Contradicting evidence of negative impact of dental caries in the OHRQoL, a study in a school in North Carolina, with use of the CPQ8-10, found no relationship and attributes the weak associations to a number of factors, such as the children's stage of development, the low prevalence and impact of the disease, access to treatment, the difficulties of understanding and responding to the questionnaire [34]. Reviewed in different studies, the CPQ demonstrated reliability and validity of appropriate construct [35], as well as responsiveness of the CPQ8-10 as also suitable, detecting changes in the OHRQoL of children even in longitudinal measures [8].

In the present study, the CPQ8-10 questionnaire was calculated by the IRT, not yet reported in the literature, in order to consider the particularity of each item in the construct, unlike the classical test theory (CTT) [18]. The reported works to our knowledge [9, 10, 12–14] are based on the CTT as proposed by Jokovik et al. [15].

The IRT has the potential to solve some problems incurred by the CTT, such as equality in consideration of issues; dependence on properties of the sample; the interval scale of presumption to categories of ordered response [36], bringing more specificity to the analysis [18].

The child's response pattern is considered in the calculation of the IRT, two children with the same score on the CTT may receive different scores in the IRT. The child responds more coherently to items when receiving higher scores. The IRT presupposes that students respond negatively to items that are related to less impact on the OHRQoL and only students with dental problems respond positively to items that are related to greater impact. There is a report of the application of the IRT validation tools [37, 38], including evaluation of two short forms of the CPQ11-14 [36].

The precarious socioeconomic classification and bad dental condition is associated with a negative impact on the OHRQoL [12, 30]. The family income in the present study demonstrated an association with the OHRQoL, but with no impact on the OHRQoL when in an adjusted model, corroborating with Freire-Maia et al., [39]. Locker [40] explains that the reduction of access to property, services, resources for health promotion and exposure to different risk factors and health behaviors reflects on the child's quality of life and the family and services. The discrepancy results between studies may derive the statistical methods used for the comparison of the effect of family income or parental education [41].

The education level is an important marker of socioeconomic status, the higher education in general is predictive of better jobs, higher wages and better living conditions and socioeconomic status [42]. Children with a head of household with eight years or less of study reported a worse OHRQoL, compared to more than eight years of study, as demonstrated in other studies of maternal education [12, 30, 37, 43, 44, 45].

In the present study, the skin color had no impact on the quality of life when in the adjusted model, as found in another study [12], as Emmanuelli et al. [44] reported that non-white children from 11 to 14 years old showed a worse OHRQoL compared to white children in public schools, measured by the CPQ11-14. Also, when using the CPQ11-14 in public schools, no relationship was found between skin color and the impact on the quality of life [30], corroborating with our findings. There was no difference between the age groups, but the girls have a greater impact on the quality of life, as reported in adolescents [30], and for Alsumait et al. [31], the girls reported an impact on the emotional well-being. Schuch et al. [12] found an association between girls and a worse OHRQoL, but in an adjusted model, this feature was not maintained.

Some of the limitations in the results of the present study are derived from cross-sectional design, although it is an important tool for identifying risk factors to be included in future longitudinal assessments.

The descriptive aspects that the IRT provided were limited due to the characteristic of the sample, fewer subjects exhibited higher degrees of impact on the OHRQoL, therefore, studies in populations with different profiles are recommended, so that they further explore the power rating that this tool provides.

It is pertinent to consider that dental caries lesions are reversible in the early stages and proven preventive measures are available [9]. It is important to establish programs that direct their prevention and immediate treatment, since the treatment of deciduous and permanent teeth in children may still be overlooked.

Thus, it can be concluded that the prevalence of dental caries is 44.2%, and the consequence of untreated carious is 13.6%. The oral condition related to dental caries has an impact on the quality of life, dental caries and the consequences of untreated caries increase the chances of a negative impact.

Funding: This study was non-funding.

Author Contribuition: All authors contributed to the study conception and design. Recruitment of participants, material preparation, data collection were performed by Giacomin A, Miroski B, Klein D, Torres F. Konrath A was responsible for data analysis and data interpretation. The first draft of the manuscript was written by Giacomin A. Bolan M and Cardoso M were responsible for study design,critical revision, and final approval of the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The study was approved by the Ethics Committee in Research with Human Beings (CEP) of the State University of Santa Catarina (UDESC), No. 902,663. Informed consent was obtained from all individual participants included in the study.

Availability of data and materials: The dataset used and analysed during the current study is available from the corresponding author on reasonable request.

Consent for publication: Not applicable.

Competing interests: The authors declare no competing interests.

Author details: Faculty of Dentistry, The University of Santa Catarina

Acknowledgement: Not applicable.

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Chart 1 is available in the Supplementary Files section.

No competing interests reported.

Chart.docx

Prevalence and impact of dental caries and consequences of non-treatment on the quality of life of schoolchildren.

Status:

Version 1

Abstract

Background

Materials And Methods

Ethical considerations

Study population

Eligibility criteria

Calibration and pilot study

Data collection

Non-clinical data

Socioeconomic characteristics

Clinical data

Statistical analysis

Results

Discussion

Declarations

References

Charts

Additional Declarations

Supplementary Files

Status:

Version 1