Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis

Vieira, Walbert de Andrade; Pecorari, Vanessa Gallego Arias; Figueiredo-de-Almeida, Rodolfo; Carvas Junior, Nelson; Vargas-Neto, Júlio; Santos, Eduardo César Almada; Gomes, Brenda Paula Figueiredo de Almeida; Almeida, José Flávio Affonso de; de-Jesus-Soares, Adriana

doi:10.1590/0102-311X00015920

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REVIEW • Cad. Saúde Pública 37 (12) • 2021 • https://doi.org/10.1590/0102-311X00015920 copy

Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis

Prevalência de lesões dentárias traumáticas em crianças e adolescentes brasileiros: uma revisão sistemática e metanálise

Prevalencia de lesiones dentales traumáticas en niños brasileños y adolescentes: una revisión sistemática y metaanálisis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

This study aimed to investigate the prevalence of dental trauma in Brazilian children and adolescents. A systematic review was conducted considering eight databases: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations, and OpenThesis. Only prevalence studies that used a probabilistic sampling method were included, without restriction on year or language of publication. The JBI critical appraisal tools for prevalence studies were used to assess the individual risk of bias. The individual studies were combined in the meta-analysis using the random-effects model. The heterogeneity between the studies was analyzed by Cochran’s Q and the I-square statistics. A meta-regression analysis was performed to evaluate the sources of heterogeneity. The GRADE approach assessed the certainty of evidence across included studies. The search resulted in 2,069 records, of which 36 were included in the study. The eligible studies were published from 2000 to 2021, with a total sample of 40,194 children and adolescents. Most studies (75%) had a low risk of bias. In permanent teeth, the prevalence of dental trauma was 21% (95%CI: 16.0; 26.0) and in deciduous teeth; 35% (95%CI: 26.0; 44.0). The prevalence of dental trauma among boys was higher than among girls for both dentitions. Based on a low certainty, the prevalence of traumatic dental injuries in Brazilian children and adolescents is higher than that found worldwide both in deciduous and permanent teeth. Also, the prevalence of dental trauma among boys is higher than among girls.

Keywords:
Tooth Injuries; Child; Adolescent; Systematic Review

Region/Study (year of publication)	City (State)	Sampling method	Representativity	Sample analyzed (n)	Setting	Number of raters	Dental trauma diagnostic classification criteria	Year of data collection	Prevalence of dental trauma	Funding source
Northeast
Soriano et al. ²⁴24. Soriano EP, Caldas Jr. AF, Carvalho MV, Caldas KU. Relationship between traumatic dental injuries and obesity in Brazilian schoolchildren. Dent Traumatol 2009; 25:506-9. (2009)	Recife (PE)	Single-phase random sampling *	12 years-old school children living in the whole city	1,046 (520♀ 526♂)	Public and private schools	1	Andreasen	2002	10.5% (110/1,046)	+
Siqueira et al. ²⁵25. Siqueira MB, Gomes MC, Oliveira AC, Martins CC, Granville-Garcia AF, Paiva SM. Predisposing factors for traumatic dental injury in primary teeth and seeking of post-trauma care. Braz Dent J 2013; 24:647-54. (2013)	Campina Grande (PB)	Two-phase random sampling **	3-5 years-old preschool children living in the whole city	814 (392♀ 422♂)	Public and private schools	3	Andreasen	2012	34.5% (281/814)	CAPES, FAPEMIG and CNPq
Gomes et al. ²⁶26. Gomes MC, Pinto-Sarmento TC, Costa EM, Martins CC, Granville-Garcia AF, Paiva SM. Impact of oral health conditions on the quality of life of preschool children and their families: a cross-sectional study. Health Qual Life Outcomes 2014; 12:55. (2014)	Campina Grande (PB)	Two-phase random sampling **	3-5 years-old preschool children living in the whole city	843 (405♀ 434♂)	Public and private schools	3	Andreasen	+	34.1% (286/843)	CAPES, FAPEMIG and CNPq
Neves et al. ²⁷27. Neves ETB, Perazzo MF, Gomes MC, Martins CC, Paiva SM, Granville-Garcia AF. Perception of parents and self-reports of children regarding the impact of traumatic dental injury on quality of life. Dental Traumatol 2017; 33:444-50. (2017)	Campina Grande (PB)	Two-phase random sampling **	5 years-old preschool children living in the whole city	769 (366♀ 403♂)	Public and private schools	2	Andreasen	2015	54.3% (407/769)	CAPES, FAPEMIG and CNPq
Carvalho et al. ²⁸28. Carvalho B, Almeida H, Andrade ESS, Zarzar P, Vieira SCM, Heimer MV, et al. Prevalence of dental trauma in 1,485 Brazilian adolescents aged between 15 and 19 years old and associated factors. Oral Health Prev Dent 2020; 18:707-12. (2020)	Recife (PE)	Two-phase random sampling **	15-19 years-old school adolescents living in the whole city	1,485 (823♀ 662♂)	Public and private schools	1	Andreasen	2009	17.8% (264/1,485)	CAPES
Central-West
Freire et al. ²⁹29. Freire MC, Vasconcelos DN, Vieira AS, Araujo JA, Moreira RS, Nunes MF. Association of traumatic dental injuries with individual-, sociodemographic- and school-related factors among schoolchildren in Central-West Brazil. Int J Environ Res Public Health 2014; 11:9885-96. (2014)	Goiania (GO)	Two-phase random sampling **	12 years-old school children living in the whole city	2,075 (1,053♀ 1,022♂)	Public and private schools	6	O’Brien	2010	17.2% (358/2,075)	FAPEG
Southeastern
Cortes et al. ³⁰30. Cortes MI, Marcenes W, Sheiham A. Prevalence and correlates of traumatic injuries to the permanent teeth of schoolchildren aged 9-14 years in Belo Horizonte, Brazil. Dent Traumatol 2001; 17:22-6. (2001)	Belo Horizonte (MG)	Two-phase random sampling ***	9-14 years-old school children living in the whole city	3,702 (1,973♀ 1,729♂)	Public and private schools	1	O’Brien	+	12.1% (448/3,702)	CNPq
Dutra et al. ³¹31. Dutra FT, Marinho AM, Godoi PF, Borges CM, Ferreira EF, Zarzar PM. Prevalence of dental trauma and associated factors among 1- to 4-year-old children. J Dent Child (Chic) 2010; 77:146-51. (2010)	Matozinhos (MG)	Single-phase random sampling ^#	1-4 years-old preschool children living in the whole city	407 (202♀ 205♂)	National Child Vaccination Day	5	Andreasen	2008	45.9% (187/407)	+
Jorge et al. ³²32. Jorge KO, Oliveira Filho PM, Ferreira EF, Oliveira AC, Vale MP, Zarzar PM. Prevalence and association of dental injuries with socioeconomic conditions and alcohol/drug use in adolescents between 15 and 19 years of age. Dent Traumatol 2012; 28:136-41. (2012)	Belo Horizonte (MG)	Two-phase random sampling ^##	15-19 years old school adolescents living in the whole city	891 (539♀ 352♂)	Public and private schools	2	Andreasen	2009	24.7% (220/891)	+
Bonini et al. ³³33. Bonini GC, Bönecker M, Braga MM, Mendes FM. Combined effect of anterior malocclusion and inadequate lip coverage on dental trauma in primary teeth. Dent Traumatol 2012; 28:437-40. (2012)	Amparo (SP)	Single-phase random sampling ^###	3-4 years old preschool children living in the city	376 (191♀ 185♂)	National Child Vaccination Day	11	Andreasen	+	27.7% (104/376)	+
Ramos-Jorge et al. ³⁴34. Ramos-Jorge ML, Ramos-Jorge J, Mota-Veloso I, Oliva KJ, Zarzar PM, Marques LS. Parents' recognition of dental trauma in their children. Dent Traumatol 2013; 29:266-71. (2013)	Belo Horizonte (MG)	Single-phase random sampling ^#	1-3 years old preschool children living in the whole city	519 (249♀ 270♂)	National Child Vaccination Day	18	Andreasen	+	41.2% (214/519)	+
Castro et al. ³⁵35. Castro FC, Raggio DP, Imparato JCP, Piovesan C, Bonini GC. Impact of oral problems on the quality of life of preschool children. Pesqui Bras Odontopediatria Clín Integr 2013; 13:361-9. (2013)	Casa Branca (SP)	All target population was included	0-6 years old preschool children living in the whole city	61 (29♀ 32♂)	+	1	Andreasen	2011-2012	1.6 (1/61)	+
Bendo et al. ³⁶36. Bendo CB, Paiva SM, Abreu MH, Figueiredo LD, Vale MP. Impact of traumatic dental injuries among adolescents on family's quality of life: a population-based study. Int J Paediatr Dent 2014; 24:387-96. (2014)	Belo Horizonte (MG)	Three-phase random sampling ^§	11-14 years old school children living in the whole city	1,122 (667♀ 455♂)	Public and private schools	3	Andreasen	2009	14.8% (166/1,122)	CAPES and FAPEMIG
Oliveira Filho et al. ³⁷37. Oliveira Filho PM, Jorge KO, Paiva PCP, Ferreira EFE, Ramos-Jorge ML, Zarzar PM. The prevalence of dental trauma and its association with illicit drug use among adolescents. Dent Traumatol 2014; 30:122-7. (2014)	Diamantina (MG)	Single-phase random sampling ^§§	14-19 years old school adolescents living in the whole city	687 (389♀ 298♂)	Public and private schools	1	Andreasen	2010	26.6% (183/687)	+
Viegas et al. ³⁸38. Viegas CM, Paiva SM, Carvalho AC, Scarpelli AC, Ferreira FM, Pordeus IA. Influence of traumatic dental injury on quality of life of Brazilian preschool children and their families. Dent Traumatol 2014; 30:338-47. (2014)	Belo Horizonte (MG)	Two-phase random sampling **	5 years old preschool children living in the whole city	1,632 (795♀ 837♂)	Public and private schools	1	Andreasen	2009	49.4% (806/1,632)	CAPES, CNPq and FAPEMIG
Ramos-Jorge et al. ³⁹39. Ramos-Jorge J, Paiva SM, Tataounoff J, Pordeus IA, Marques LS, Ramos-Jorge ML. Impact of treated/untreated traumatic dental injuries on quality of life among Brazilian schoolchildren. Dent Traumatol 2014; 30:27-31. (2014)	Diamantina (MG)	Two-phase random sampling **	11-14 years old school children living in the whole city	668 (394♀ 274♂)	Public and private schools	2	O’Brien	2012	34.3% (229/668)	CAPES and FAPEMIG
Corrêa-Faria et al. ⁴⁰40. Corrêa-Faria P, Paiva SM, Pordeus IA, Ramos-Jorge ML. Influence of clinical and socioeconomic indicators on dental trauma in preschool children. Braz Oral Res 2015; 29:1-7. (2015)	Diamantina (MG)	Single-phase systematic sampling ^§§§	1-5 years old preschool children living in the whole city	301 (145♀ 156♂)	National Child Vaccination Day	10	Andreasen	+	33.9% (102/301)	CNPq and FAPEMIG
Tello et al. ⁴¹41. Tello G, Bonini GC, Murakami C, Abanto J, Oliveira LB, Bonecker M. Trends in the prevalence of traumatic crown injuries and associated factors in Brazilian preschool children: 10-year observational data. Dent Traumatol 2016; 32:274-80. (2016)	Diadema (SP)	Single-phase random sampling ^†	1-4 years-old preschool children living in the whole city	2002: 779 2004: 925 2006: 1,014 2008: 1,198 2010: 1,258 2012: 1,215	National Child Vaccination Day	+	Andreasen	2002, 2004, 2006, 2008, 2010, 2012	2002: 10.9% (85/779) 2004: 15.8% (146/925) 2006: 17.2% (174/1,014) 2008: 17.1% (205/1,198) 2010: 19.4% (244/1,258) 2012: 20.1% (244/1,215)	FAPESP, CNPq and CAPES
Freire-Maia et al. ¹⁴14. Freire-Maia FB, Auad SM, Abreu MHNG, Sardenberg F, Martins MT, Paiva SM, et al. Prevalence of and factors associated with enamel fracture and other traumas in Brazilian children 8-10 years old. Braz Oral Res 2018; 32:e89. (2018)	Belo Horizonte (MG)	Three-phase random sampling ^††	8-10 years-old school children living in the whole city	1.201 (536♀ 665♂)	Public and private schools	2	Andreasen	2010	14.1% (169/1,201)	+
South
Marcenes et al. ⁴²42. Marcenes W, Alessi ON, Traebert J. Causes and prevalence of traumatic injuries to the permanent incisors of school children aged 12 years in Jaragua do Sul, Brazil. Int Dent J 2000; 50:87-92. (2000)	Jaraguá do Sul (SC)	Two-phase random sampling ^†††	12 years-old school children living in the whole city	476 (225♀ 251♂)	Public and private schools	1	O’Brien	1998	15.3% (73/476)	+
Marcenes et al. ⁴³43. Marcenes W, Zabot NE, Traebert J. Socio-economic correlates of traumatic injuries to the permanent incisors in schoolchildren aged 12 years in Blumenau, Brazil. Dent Traumatol 2001; 17:222-6. (2001)	Blumenau (SC)	Two-phase random sampling ^†††	12 years-old school children living in the whole city	652 (329♀ 323♂)	Public and private schools	1	O’Brien	1998	58.6% (382/652)	+
Nicolau et al. ⁴⁴44. Nicolau B, Marcenes W, Sheiham A. The relationship between traumatic dental injuries and adolescents' development along the life course. Community Dent Oral Epidemiol 2003; 31:306-13. (2003)	Cianorte (PR)	All target population was included	All 13 years-old children living in the whole city	652 (328♀ 324♂)	Public and private schools	1	O’Brien	1999	20.4% (133/652)	CAPES
Traebert et al. ⁴⁵45. Traebert J, Almeida IC, Garghetti C, Marcenes W. Prevalence, treatment needs, and predisposing factors for traumatic injuries to permanent dentition in 11-13-year-old schoolchildren. Cad Saúde Pública 2004; 20:403-10. (2004)	Biguaçu (SC)	All target population was included	11-13 years-old children living in the whole city	2,260 (1,087♀ 1,173♂)	Public and private schools	1	O’Brien	2001	10.7% (242/2,260)	+
Trabert et al. ⁴⁶46. Traebert J, Bittencourt DD, Peres KG, Peres MA, Lacerda JT, Marcenes W. Aetiology and rates of treatment of traumatic dental injuries among 12-year-old school children in a town in southern Brazil. Dent Traumatol 2006; 22:173-8. (2006)	Herval D’Oeste (SC)	All target population was included	12 years-old children living in the whole city	260 (135♀ 125♂)	Public and private schools	1	O’Brien	2000	17.3% (45/260)	+
Traebert et al. ⁴⁷47. Traebert J, Hemkemeier I, Lacerda JT. Traumatismo em dentes permanentes recém-irrompidos: prevalência e fatores associados em escolares do município de Tubarão - SC. Rev Odont UNESP 2008; 37:363-9. (2008)	Tubaração (SC)	Two-phase random sampling **	7-8 years-old school children living in the whole city	385 (194♀ 191♂)	Public and private schools	3	O’Brien	2003	9.6% (37/385)	+
Kramer et al. ⁴⁸48. Kramer PF, Gomes CS, Ferreira SH, Feldens CA, Viana EdS. Traumatismo na dentição decídua e fatores associados em pré- escolares do município de Canela/RS. Pesqui Bras Odontopediatria Clín Integr 2009; 9:95-100. (2009)	Canela (RS)	Single-phase random sampling ^‡	0-5 years-old preschool children living in the whole city	1,095 (544♀ 515♂)	National Child Vaccination Day	+	Andreasen	2004	23.6% (258/1,095)	+
Carvalho et al. ⁴⁹49. Carvalho ML, Moyses SJ, Bueno RE, Shimakura S, Moyses ST. A geographical population analysis of dental trauma in school-children aged 12 and 15 in the city of Curitiba-Brazil. BMC Health Serv Res 2010; 10:203. (2010)	Curitiba (PR)	Two-phase random sampling ^‡‡	12-15 years-old children living in the whole city	1,581 (832♀ 749♂)	Public and private schools	+	O’Brien	2005 - 2008	37.1% (587/1,581)	CNPq
Traebert et al. ⁵⁰50. Traebert J, Marcon KB, Lacerda JT. Prevalence of traumatic dental injuries and associated factors in schoolchildren of Palhoça, Santa Catarina State. Ciênc Saúde Colet 2010; 15 Suppl 1:1849-55. (2010)	Palhoça (SC)	Two-phase random sampling ^‡‡	12 years-old children living in the whole city	405 (194♀ 211♂)	Public and private schools	7	O’Brien	2003	23.5% (95/405)	+
Wendt et al. ⁵¹51. Wendt FP, Torriani DD, Assunção MC, Romano AR, Bonow ML, Costa CT, et al. Traumatic dental injuries in primary dentition: epidemiological study among preschool children in South Brazil. Dent Traumatol 2010; 26:168-73. (2010)	Pelotas (RS)	Two-phase random sampling ^‡‡‡	1-5 years-old preschool children living in the whole city	571 (278♀ 293♂)	Public and private schools	3	Andreasen	2009	36.6% (209/571)	CNPq
Goettems et al. ⁵²52. Goettems ML, Azevedo MS, Correa MB, Costa CT, Wendt FP, Schuch HS, et al. Dental trauma occurrence and occlusal characteristics in Brazilian preschool children. Pediatr Dent 2012; 34:104-7. (2012)	Pelotas (RS)	Two-phase random sampling ^‡‡‡	2-5 years-old preschool children living in the whole city	501 (242♀ 259♂)	Public and private schools	3	Andreasen	2007	39.5% (198/501)	+
Damé-Teixeira et al. ⁵³53. Damé-Teixeira N, Alves LS, Susin C, Maltz M. Traumatic dental injury among 12-year-old South Brazilian schoolchildren: prevalence, severity, and risk indicators. Dent Traumatol 2013; 29:52-8. (2013)	Porto Alegre (RS)	Two-phase random sampling ^&	12 years-old children living in the whole city	1,528 (758♀ 770♂)	Public and private schools	1	O’Brien	2010	34.8% (531/1,528)	CAPES
Goettems et al. ⁵⁴54. Goettems ML, Torriani DD, Hallal PC, Correa MB, Demarco FF. Dental trauma: prevalence and risk factors in schoolchildren. Community Dent Oral Epidemiol 2014; 42:581-90. (2014)	Pelotas (RS)	Two-phase random sampling ^‡‡‡	8-12 years-old children living in the whole city	1,210 (636♀ 574♂)	Public and private schools	6	O’Brien	2010	12.6% (153/1,210)	CNPq
Guedes et al. ⁵⁵55. Guedes RS, Piovesan C, Antunes JL, Mendes FM, Ardenghi TM. Assessing individual and neighborhood social factors in child oral health-related quality of life: a multilevel analysis. Qual Life Res 2014; 23:2521-30. (2014)	Santa Maria (RS)	Two-phase random sampling ^&&	1-5 preschool children living in the whole city	478 (246♀ 232♂)	National Child Vaccination Day	15	O’Brien	+	14.1% (66/478)	FAPESP
Agostini et al. ⁵⁶56. Agostini BA, Pinto LT, Koehler M, Emmanuelli B, Piovesan C, Ardenghi TM. Trend of traumatic crown injuries and associated factors in preschool children. Braz Oral Res 2016; 30:e112. (2016)	Santa Maria (RS)	Two-phase random sampling ^&&	1-5 preschool children living in the whole city	2008: 455 (210♀ 245♂) 2010: 639 (318♀ 321♂) 2013: 556 (263♀ 283♂)	National Child Vaccination Day	15 (per year)	O’Brien	2008, 2010 and 2013	2008: 31.5% (139/441) 2010: 13.0% (83/639) 2013: 22.5% (123/546)	CAPES and CNPq
Comim et al. ⁵⁷57. Comim LD, Dalla Nora A, Knorst JK, Racki DNO, Zenkner JEDA, Alves LS. Traumatic dental injury and oral health-related quality of life among 15 to 19 year old adolescents from Santa Maria, Brazil. Dent Traumatol 2021; 37:58-64. (2021)	Santa Maria (RS)	Single-phase random sampling *	15-19 years-old children living in the whole city	1,197 (684♀ 513♂)	Public and private schools	2	O’Brien	2018	17.0% (203/1,197)	CAPES
All regions
Bomfim et al. ⁵⁸58. Bomfim RA, Herrera DR, De-Carli AD. Oral health-related quality of life and risk factors associated with traumatic dental injuries in Brazilian children: a multilevel approach. Dent Traumatol 2017; 33:358-68. (2017)	All Brazilian states	Stratified multi-phase cluster sampling ^&&&	12 years old children of whole country	7,240,(3,642♀ 3,598♂)	Home	10 per capital and 2 to 6 per countryside municipalities	Andreasen	2010	23.9% (1735/7,240)	+

♀: female; ♂: male; +: not cited by author; CAPES: Brazilian Graduate Studies Coordinating Board; CNPq: Brazilian National Research Council; FAPEG: Goiás State Research Foundation; FAPEMIG: Minas Gerais State Research Foundation; FAPESP: São Paulo State Research Foundation; GO: Goiás; MG: Minas Gerais; PB: Paraíba; PE: Pernambuco; PR: Paraná; SC: Santa Catarina; SP: São Paulo; RS: Rio Grande do Sul.
* Schoolchildren from all public and private schools were randomly selected using a list provided by the local education authorities;
** Preschools/schools were randomly selected from each health district in the first phase and children were randomly selected from each preschool/school in the second phase. Sample distribution was proportional to the total population enrolled in private and public preschools in each administrative district of the city;
*** First, the schools were grouped into sampling units of approximately the same size, according to their location, and were chosen by a systematic sampling technique. Then, a second-stage sampling frame including all school classes of the selected sampling units (grouped schools) was created. A total of 114 classes, 19 for each age, was selected using a systematic sampling technique. All the children attending class on the day the researcher visited the school were invited to participate;
^# One municipal health clinics from each region of the city were randomly selected. All children present in the selected health clinic were invited to participate;
^## The authors only cited that a stratified cluster sampling method was performed;
^### Participants were randomly selected using a systematic sampling procedure, in all 11 health centers of the city. The sample was stratified according to the number of children who had attended each health center in the previous year;
^§ The sample of schoolchildren was selected in three stages: (1) a sample was randomly selected proportionally to the distribution of the number of schoolchildren in each administrative district of the city; (2) the number of schoolchildren in public and private schools within each administrative district was then used for the estimation of a representative sample; and (3) classes were randomly chosen at each selected school;
^§§ Students in the ninth year of secondary school education and in high school participated in the study. Each class was coded and submitted to randomization using an automated statistics program, thereby ensuring proportionality by grade;
^§§§ Randomization was performed using systematic sampling. Accordingly, the children were arranged in a line, with the first child examined, the second not examined, the third child examined, and so on;
^† All municipal health centers (one of each district of the city) were included. Then, each fifth child in the queue was invited to participate. If parents did not agree to participate, the next child in the queue was selected;
^†† The sample was stratified according to the nine administrative districts. The first stage was the randomization of public and private schools in each administrative district of the city. In the second and third stages, classes and children were randomly chosen from the selected schools (proportionally to the total number of children
enrolled in the schools);
^†
^†† The first-stage units comprised all private and public primary schools in the city. As the number of children differed from school to school, an equal probability scheme was adopted by sampling with probability proportional to size of schools. All children enrolled in the selected schools were invited to participate in the survey;
^‡
The health centers were randomly selected, and all children were invited to participate;
^‡
^‡ First, the schools were grouped into sampling units of approximately the same size and were chosen by a systematic sampling technique. Then, the school children of the selected schools were randomly selected;
^‡
^‡‡ The sampling strategy was stratified by type of school: private or public. In each stratum, schools were randomly sampled in a simple way within each stratum. All enrolled children from the selected schools within the age group studied were initially eligible for the study;
^&
The sampling strategy was stratified by type of school: private or public. In each stratum, schools were randomly sampled in a simple way within each stratum. Schoolchildren were then randomly selected proportional to the number of schoolchildren in each school;
^&
^& 15 health centers that are equally distributed in the five administrative regions of the city were randomly selected. During the survey, every fifth child in the queue for vaccination was invited to participate. If parents did not agree to participate, then the parents of the next child were invited;
^&
^&& The sample of the SB Brasil Project was obtained using a stratified multistage cluster sampling method. Primary sampling units were census tracts for state capitals and the Federal District. Cities were the primary sampling units for interior municipalities. Households within the census tracts for the state capitals and the Federal District and households for the interior municipalities were selected in the second sampling stage.

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[1] Correspondence
W. A. Vieira Departamento de Odontologia Restauradora, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Rua Prudente de Morais 261, Piracicaba, SP 13400-310, Brasil walbert.vieira18@gmail.com