title: Factors associated with active white enamel lesions.
abstract: OBJECTIVE
  The aim of this study was to assess the factors associated with the presence of active white enamel lesions among public school students in the city of Natal, Brazil.
  
  
  METHODS
  A convenience sample of 300 boys and girls aged between 7 and 12 years was selected among the pupils attending public schools in the city of Natal. Only those children presenting with opaque and rough-surface white lesions in a region of biofilm accumulation on the vestibular surface of permanent upper incisors were included. The investigation took the form of a cross-sectional study. A chart containing individual data was used, and a clinical examination was performed to determine the oral health status of the children, including caries (DMF-s(1), DMF-s(2), DMFdmf, dmf and total number of teeth with caries) and oral hygiene status (Gingival Bleeding Index and Visible Plaque Index). Data underwent descriptive analysis and analysis of variance, and chi-square tests were used for the comparison of continuous and dichotomous variables between groups with one, two, or three or more white lesions.
  
  
  RESULTS
  On average, each child presented with 2.3 teeth affected by white lesions, relatively high indices of dental caries and poor oral hygiene, with an 85% rate of localized plaque on the surfaces of teeth with lesions. The presence of visible plaque was statistically significant between the three groups, based on the number of lesions (P = 0.006), indicating a positive association between the number of lesions and the presence of biofilm.
  
  
  CONCLUSIONS
  There is a strong association between the presence of dental biofilm, high indices of caries and active white enamel lesions. Full professional effort is needed in order to motivate children to carry out oral hygiene sufficient for the adequate control of dental biofilm.
authors.affiliation: Department of Dentistry, Federal University of Rio Grande do Norte, Natal/Rio Grande do Norte, Brazil. angelaferreira@matrix.com.br
authors.forename: M A F
authors.initials: MA
authors.lastname: Ferreira
authors.forename: N S
authors.initials: NS
authors.lastname: Mendes
mesh_terms: D000704:Analysis of Variance; D002648:Child; D003430:Cross-Sectional Studies; D004245:DMF Index; D003743:Dental Enamel / Q000473:pathology; D003773:Dental Plaque / Q000150:complications*; D003774:Dental Plaque Index; D005260:Female; D005884:Gingival Hemorrhage / Q000150:complications; D006801:Humans; D008297:Male; D010512:Periodontal Index; D012307:Risk Factors; D012494:Sampling Studies; D017001:Tooth Demineralization / Q000209:etiology*