title: Oral Health Problems and Smile Avoidance Among Preschool Children.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the influence of oral health problems on the avoidance of smiling among preschool children.
  
  
  METHODS
  A cross-sectional study was conducted with 835 three- to five-year-old children. Caregivers answered the Brazilian version of the Early Childhood Oral Health Impact Scale and a questionnaire on sociodemographic data. The avoided smiling item of the child section was the dependent variable. An oral examination was performed by three dentists who had undergone calibration exercises (Kappa=0.85 to 0.90). Poisson hierarchical regression (PR) was used to determine the significance of associations between the avoidance of smiling and oral health problems (α equals five percent). The multivariate model was constructed with two hierarchical levels: (1) sociodemographic aspects and (2) oral health problems.
  
  
  RESULTS
  Seven percent of the children avoided smiling, which was associated with cavitated lesions and five years of age (PR=5.070; 95 percent confidence interval=1.57 to 16.39).
  
  
  CONCLUSIONS
  Age and cavitated lesions on the maxillary incisors were determinant factors for the avoidance of smiling.
authors.affiliation: Department of Dentistry, Paraíba State University, Campina Grande, Paraíba, Brazil.
authors.forename: Monalisa Cesarino
authors.initials: MC
authors.lastname: Gomes
authors.affiliation: Department of Dentistry, Paraíba State University, Campina Grande, Paraíba, Brazil.
authors.forename: Matheus de França
authors.initials: Mde F
authors.lastname: Perazzo
authors.affiliation: Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Carolina Castro
authors.initials: CC
authors.lastname: Martins
authors.affiliation: Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Saul Martins
authors.initials: SM
authors.lastname: Paiva
authors.affiliation: Department of Dentistry, Paraíba State University, Campina Grande, Paraíba, Brazil. anaflaviagg@hotmail.com.
authors.forename: Ana Flávia
authors.initials: AF
authors.lastname: Granville-Garcia
mesh_terms: D001362:Avoidance Learning; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D012904:Smiling / Q000523:psychology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014076:Tooth Diseases / Q000523:psychology*