Investigación original / Original research

Dental caries and treatment needs among indigenous people of the Indian reservation in

Fábio Correia Sampaio,1 Cláudia Helena Soares de Morais Freitas,1 Matilde Barbosa de Farias Cabral,2 and Ana Thereza de Azevedo Britto Machado 3

Suggested citation Sampaio FC, Freitas CHSM, Cabral MBF, Machado ATAB. Dental caries and treatment needs among indigenous people of the Potiguara Indian reservation in Brazil. Rev Panam Salud Publica. 2010;27(4):246–51.

ABSTRACT Objective. The aim of this study was to assess the caries prevalence and treatment needs of Brazilian indigenous residents on an Indian reservation. Methods. This cross-sectional study comprised 1 461 individuals of ages 18–36 months and 5, 12, 15–19, 35–44, and 65–74 years living in the Potiguara Indian villages of Brazil. De- cayed, missing, or filled permanent teeth (DMFT) and deciduous teeth (dmft) were determined by calibrated examiners using the methodology recommended by the World Health Organiza- tion. Treatment needs were assessed with the guidelines of the 2003 Brazilian Oral Health Survey. Results. Means ± standard deviations (SD) for dmft of 18- to 36-month-old and 5-year-old children were 2.5 ± 3.7 and 5.8 ± 4.3, respectively. For the age groups 12, 15–19, 35–44, and 65–74 years, mean ± SD values of DMFT were 3.6 ± 3.1, 7.1 ± 4.9, 16.4 ± 7.5, and 22.8 ± 8.6. The mean ± SD number of deciduous teeth requiring treatment varied from 2.4 ± 3.5 to 5.0 ± 4.0 in the 18- to 36-month and 5-year-old age groups, respectively. Among adolescents and adults, it was observed that on average at least three permanent teeth required dental treatment such as fillings, crowns, endodontic treatment, and extractions. Conclusions. High prevalence of caries and many teeth needing treatment were observed in all age groups of the Potiguara Indians.

Key words Dental caries; DMF index; dental health surveys; dental health services; indigenous population; Brazil.

Data on oral health conditions among available indicated that caries prevalence remote areas indicate that they present a South American indigenous people is among Brazilian and Venezuelan Indians higher caries burden than those in urban scarce. Until the 1970s, the few reports was lower than in the urban population areas of the country, where improve- (1–4). Recently, some reports observed ments in oral health are taking place (6). that processed foodstuffs, such as white The high caries prevalence might be a 1 Departamento de Clínica e Odontologia Social, Uni- versidade Federal da Paraíba, João Pessoa, Brasil. sugar and soft drinks, have been incorpo- strong trend in several Indian reserva- Send correspondence to: Fábio Correia Sampaio, rated into the regular diet of many Brazil- tions of Brazil, and this situation might be Departamento de Clínica e Odontologia Social, Universidade Federal da Paraíba, Centro de Ciên- ian Indians (5). As a result of their chang- related to the level of contact with non- cias da Saúde, Campus I, João Pessoa, Brasil; e-mail: ing dietary habits, an increase in the indigenous groups. Certainly, cultural [email protected] caries experience is expected for many and geographic characteristics of each 2 Fundação Nacional de Saúde, João Pessoa, Brasil. 3 Secretaria de Saúde do Estado da Paraíba, João Brazilian indigenous groups. Recent data particular indigenous community may Pessoa, Brasil. from indigenous people living in rather dictate the strength of this process (7, 8).

246 Rev Panam Salud Publica 27(4), 2010 Sampaio et al. • Dental caries on Potiguara Indian reservation in Brazil Original research

Since 1999, the Brazilian Indigenous Ethical issues kappa values for dental caries and treat- Health Care system has been centrally ment needs scores were higher than 0.89. coordinated by the National Health Following Brazilian regulations, the The international standards given by Foundation (FUNASA). In order to pro- study protocol was approved by the in- the World Health Organization were vide more information on indigenous stitutional ethical committee at the Uni- used to perform the epidemiologic sur- oral health status, FUNASA had stimu- versidade Federal da Paraíba. As indige- vey (14). The decayed, missing, or filled lated the development of epidemiologic nous people are the subject of this permanent teeth (DMFT) and deciduous surveys on many Brazilian indigenous research, the protocol was also submit- teeth (dmft) were assessed under indi- reservations. In 2001, the Special Indige- ted to the Potiguara Indigenous District rect natural daylight with dental mir- nous Health District in Paraíba, a north- in Paraíba and the National Commission rors, wood spatulas, and community pe- eastern state of Brazil, carried out a pre- of Research Ethics of the Brazilian Na- riodontal index probes throughout the liminary epidemiologic survey on the tional Health Committee for approval study. Tooth surfaces were dried with Potiguara Indian reservation aiming to (protocol number 12309/1700-05). gauze. The oral examinations were car- implement an oral health program. All subjects taking part in this research ried out in the selected houses and using These preliminary data showed a very signed an informed consent document. regular chairs. No specific position was high number of extracted teeth among Local leaders and parents signed for chil- applied because beds and sofas are not all age groups. Hence, it seems that oral dren and schoolchildren selected to par- available and most of the people sleep in health promotion was a neglected strat- ticipate in the study. hammocks. egy in that population. Dental treatment needs included the So far, there is no updated informa- Subjects and data collection assessment of fillings (one and two or tion about the caries experience in this more surfaces, crown, endodontic treat- population. Therefore, the aim of this For this cross-sectional study, the sam- ment, dental extraction, and sealants). study was to assess the caries preva- pling procedures and the age groups These criteria were based on the guide- lence and treatment needs related to were the same as those established by lines established for the 2003 Brazilian dental caries of the Brazilian indigenous the 2003 Brazilian Oral Health Survey Oral Health Survey (12). After data col- residents from the Potiguara Indian (12): 18–36 months and 5, 12, 15–19, lection, 10% of the subjects had oral reservation. 35–44, and 65–74 years of age. Also fol- exams in order to assess intraexaminer lowing the guidelines of the national variability. MATERIALS AND METHODS survey, the 26 Indian villages were clas- For those subjects 15–19, 35–44, and sified as rural areas and 12 of them were 65–74 years of age, a simple question- Area of study selected by using a systematic sampling naire was applied to collect information procedure that took into account the about the estimated date (in months) of The Potiguara (also known as Po- population distribution. The villages se- the last visit to a dentist and frequency of tyguara) are a nation of indigenous peo- lected in the municipalities were distrib- visits to a dentist per year; if they visited ple living on a reservation area located in uted as follows: Marcação (n = 2), Baía a dentist, they were requested to classify the Northeast Region, Brazil. The popu- da Traição (n = 5), and Rio Tinto (n = 5). the type of service (private or public). lation is estimated at 8 000 permanent in- All houses within a radius of 500 m from habitants distributed in 26 villages of the center of the selected village were Statistical analysis three municipalities (Marcação, Baía da visited. A minimal required sample size Traição, and Rio Tinto) in the state of of 1 138 individuals was calculated Mean ± standard deviation (SD) of Paraíba (9). based on the reference population for DMFT and dmft indexes were calculated The villages of the reservation lie on each age group. For sampling, a z value with the help of the SPSS software pack- the northern Atlantic coastal area of of 1.96 was applied to provide 5% signif- age (Statistics Package for the Social Sci- Paraíba, where many rivers support fish- icance. Furthermore, a 25% increase was ences, version 11.0). The chi-square test ing and local agriculture (corn, beans, included, aiming to compensate for pos- was used to verify whether the caries fre- rice, cassava) (10). The local temperature sible refusals, and resulted in a minimal quency observed was significantly differ- (mean annual values around 28°C) is target number of 1 425 individuals (13). ent from that expected for selected vari- favorable for tropical fruits, which are Finally, the sample of examined subjects ables (gender and geographic location). frequently consumed. The Potiguara In- was 1 461 individuals because of the un- A significance of 5% was set a priori. dians have been subjected to a strong ac- expected additional number of subjects One hundred and forty-five subjects culturation process and they have daily in the houses located in the 500-m area were reexamined for the intraexaminer direct contact with citizens from the established in some villages. kappa value. These subjects were ran- neighboring cities. In Baía da Traição, the Before the epidemiologic survey, cali- domly selected in accordance with their most populated urban area near the bration exercises comprising practical age group. This procedure resulted in reservation, water fluoridation is avail- and theoretical activities were carried 15–50 subjects in each age group, which able but the water pipes do not reach the out by dentists (n = 3). After 20 hours of provided a representative number of Potiguara reservation area. All residents training with volunteers belonging to the 10% of the total sample. The calculation of the Potiguara Indian reservation drink same age groups, interexaminer reliabil- of the kappa coefficient for intraexam- water with a very low fluoride concen- ity was assessed and 90% agreement was iner reliability for carious lesions tration (11). reached. After training sessions, the showed values ranging from 0.68 to 1.00.

Rev Panam Salud Publica 27(4), 2010 247 Original research Sampaio et al. • Dental caries on Potiguara Indian reservation in Brazil

The kappa values for treatment needs (yes versus no) according to gender (one ing dental treatment due to caries is scores were higher than 0.93. degree of freedom) and municipality (two shown in Table 3. degrees of freedom) showed no signifi- Figure 1 shows the percentage distri- RESULTS cant differences (P > 0.05). bution of DMFT scores of 12-year-old Table 1 presents the number of indi- and 15- to 19-year-old children. A total of 1 461 individuals were exam- viduals regarded as caries-free according Considering all deciduous teeth exam- ined, providing a representative sample. to age group. The mean DMFT ± SD and ined (n = 5 505), it was observed that There were a few cases of refusals (n = 20). dmft ± SD values are presented in Table 21.8% were affected by caries. More A chi-square test comparing dental caries 2, and the mean number of teeth requir- specifically, the classifications for these teeth were as follows: 1 106 teeth had carious lesions, 20 were properly re- TABLE 1. Frequency of caries-free subjects per age group on Potiguara Indian stored, and 76 had indications for extrac- reservations, Brazil, 2007 tion. The figures for all permanent teeth examined (n = 34 378) showed that 38.2% dmfta or DMFTb > 0 dmft or DMFT = 0 of these teeth were affected by caries, in- Age group n No. % No. % cluding teeth that were not examined be- cause of extraction due to dental caries. dmft index The raw numbers were 5 366 teeth with 18–36 months 146 86 45.21 80 54.79 5 years 142 124 87.32 18 12.68 carious lesions, 218 teeth restored, and 7 DMFT index 543 teeth extracted due to caries or with 12 years 159 132 83.02 27 16.98 indication for extraction. 15–19 years 507 476 93.89 31 6.11 With regard to the questionnaire data, 35–44 years 394 392 99.49 2 0.51 65–74 years 113 112 99.12 1 0.88 of the 1 014 subjects selected 21 adults Total 1 461 1 302 89.20 159 10.80 did not respond to the interview. Re- spondents were classified in three cate- a dmft = decayed, missing, or filled deciduous teeth. gories: (1) subjects who reported never b DMFT = decayed, missing, or filled permanent teeth.

TABLE 2. Mean number of sound teeth and of decayed, missing, or filled deciduous teeth and permanent teeth and components per age group on Potiguara Indian reservations, Brazil, 2007

Tooth category Mean dmft a 95% or DMFTb confidence Age group Sound Decayed Missing Filled ± SDc interval

dmft index 18–36 months 16.66 2.34 0.07 0.05 2.53 ± 3.76 1.92–3.15 5 years 13.22 5.04 0.46 0.36 5.87 ± 4.31 5.14–6.57 DMFT index 12 years 22.58 2.60 0.38 0.56 3.68 ± 3.18 3.18–4.18 15–19 years 21.83 3.47 1.44 1.94 7.13 ± 4.95 6.70–7.57 35–44 years 14.35 3.37 11.81 1.12 16.43 ± 7.56 15.62–17.13 65–74 years 6.47 2.94 19.85 0.06 22.86 ± 8.63 19.79–23.38

a dmft = decayed, missing, or filled deciduous teeth. b DMFT = decayed, missing, or filled permanent teeth. c SD = standard deviation.

TABLE 3. Mean number of teeth requiring treatment due to dental caries per age group on Potiguara Indian reservations, Brazil, 2007

Fillings Two or 95% One more Endodontic Mean ± confidence Age group surface surfaces Crown treatment Extraction Sealant SDa interval

Deciduous teeth 18–36 months 1.14 1.16 0.00 0.10 0.01 0.04 2.45 ± 3.50 1.87–3.01 5 years 1.63 2.73 0.02 0.61 0.06 0.03 5.08 ± 4.00 4.42–5.74 Permanent teeth 12 years 1.61 0.98 0.00 0.13 0.15 0.03 2.90 ± 2.87 2.45–3.35 15–19 years 1.88 1.33 0.01 0.16 0.40 0.00 3.78 ± 3.64 3.47–4.11 35–44 years 1.35 1.15 0.01 0.06 1.02 0.00 3.59 ± 4.01 3.18–3.98 65–74 years 0.66 0.43 0.01 0.00 2.05 0.00 3.15 ± 3.98 2.43–3.91

a SD = standard deviation.

248 Rev Panam Salud Publica 27(4), 2010 Sampaio et al. • Dental caries on Potiguara Indian reservation in Brazil Original research

FIGURE 1. Percentage distribution of decayed, missing, or filled permanent teeth (DMFT) scores of 12- and 15- to 19-year-old individuals on Potiguara Indian reservations, Brazil, 2007

20 18 16 12 years 14 15–19 years 12

% 10 8 6 4 2 0 0 12 3 45678 9 10 11 >12 DMFT

having been to a dentist (n = 72), (2) sub- in the villages of the Potiguara lands the long acculturation process in the Po- jects who visited a dentist more than one comes from lakes and wells with a very tiguara lands, it is possible that the caries year before the date of the interview (n = low content of fluoride (11). burden in the Potiguara lands took place 462), and (3) subjects who visited a den- According to the local Special Indige- many years earlier than in the indige- tist within a year from the date of the in- nous Health District, a regular oral nous groups of the Amazonia and cen- terview (n = 459). The mean values of health program was only recently imple- tral regions of Brazil (6). Unfortunately, DMFT ± SD for categories 1, 2, and 3 mented in the Potiguara lands. The low the most recent national oral epidemio- were 7.65 ± 8.73, 14.06 ± 9.53, and 11.49 ± percentage of caries-free children and logic survey, performed in 2003, in- 7.04, respectively. Most respondents adults gives the dimension of the chal- cluded only 1% of the Brazilian Indians who reported having visited a dentist lenging caries problem. As shown in this (15). Thus, most Brazilian indigenous stated that services were public and report, there is a clear increase in caries communities do not have a complete were located in the neighboring cities prevalence according to age for both de- and updated oral health investigation. (95%, n = 873). ciduous and permanent dentition. Actu- Nevertheless, it can be highlighted that ally, in the group of 65- to 74-year-olds, our findings have DMFT values similar DISCUSSION the mean number of carious teeth is less to those of the Indians in the than in 15- to 19-year-olds and 35- to 44- Tunuí-Cachoeira region in the North- Unlike Amazonian Indians, who are year-olds. However, this effect is due to western Amazon, Brazil, located at least more isolated from European culture, the the very high number of extracted teeth 5 000 kilometers from the Potiguara Potiguara Indians in the coastal lands of related to progression of the carious reservation lands. The mean dmft in 5- Brazil have had contact with European lesions. year-olds in that population was 5.3, and people (Portuguese, French, and Dutch) The contrast in the number of perma- for Potiguara children the mean was 5.8; since 1586. However, in spite of the long nent restored teeth compared with ex- for the 15- to 19-year-olds and for those process of acculturation, the Potiguara tracted teeth in the adult population older than 50 years the values were 8.2 still preserve cultural and dietary habits (ratio of 1:34) suggests that dental extrac- and 22.1, whereas our data show 7.1 and (10). The availability of processed food- tion was the main, if not the only, dental 22.8 for similar age groups, respectively. stuffs was not investigated in this study procedure available for many years. This Our findings do not indicate that the but seems to play an important role in the assumption is supported by the lower caries prevalence in the Potiguara Indi- high incidence of caries experienced by value of DMFT for subjects who have ans is heading in a direction opposite this population. In addition, the lack of never been to a dentist compared with that of the prevalence in urban areas of oral health care instructions cannot be higher values for those who visit a den- Brazil where a decline in caries can be disregarded (5, 6). The absence of water tist seldom or once a year. Our data sup- observed (16, 17). First, the caries decline fluoridation programs and low exposure port the information that regular dental effect in urban areas of the Northeast Re- to topical fluoride may contribute to the treatment was not available for indige- gion is slower than in other parts of the high prevalence of caries in this popula- nous people in urban areas. Although no country. The slower decline in caries is tion. Considering the three municipali- previous DMFT data are available from probably related to socioeconomic status ties surveyed, fluoridated drinking water this population, the mean DMFT values (SES) and the availability of organized is available only in the city of Baia da in all age groups indicate that caries is al- oral health programs (17, 18). For in- Traição. Hence, this anticarious benefi- most ubiquitous in that population and stance, the most updated mean DMFT cial effect does not reach the nearby in- that the widespread caries activity is not for 12-year-old children in the Northeast digenous rural areas. The drinking water a recent event. In addition, considering Region is 3.2. This value is higher than

Rev Panam Salud Publica 27(4), 2010 249 Original research Sampaio et al. • Dental caries on Potiguara Indian reservation in Brazil the national mean value of 2.7. A similar cohort studies are warranted in order to the near future when new roads and difference in these values was previ- present the real trend in caries incre- new links will be established. To date, ously observed (15). ments between these two age groups. there is no doubt that cariogenic food- Ten years ago, the mean DMFT of 12- The amount of treatment needs is very stuffs (sugar, candies, soft drinks) can be year-old children in nonfluoridated rural high. Actually, the large amount of dental purchased by the Potiguara Indians. The areas from Paraíba was 3.9 (18). A very treatment demanded in these areas sup- magnitude of this variable for caries similar value of 3.7 was found in the pre- ports the evidence that the World Health development among Potiguara people sent study. Recently, it was observed Organization goals for the year 2000 were is still a matter of investigation. Finally, that DMFT at the age of 12 years in not achieved regardless of the age group. there is clear evidence that high caries Paraiba’s urban areas is strongly related Because dental caries can be connected to activity is taking place, resulting in to SES. For nonfluoridated cities, the other variables, an oral health program many unrestored teeth, endodontic DMFT at this age is estimated to be 3.3 in based on social and health inequalities treatment, and extractions in all age public schools (low SES) and 1.3 in pri- must be implemented. Culture habits groups examined. vate schools (high SES) (19). Thus, in must be protected, but oral hygiene in- spite of considering the low SES of the structions can be introduced under care- indigenous 12-year-old children, their ful guidance in order to increase the DMFT is slightly higher than that in the value of a good oral health program. Acknowledgments. The authors thank urban areas of Paraíba. Overall, the present study shows that the Conselho Nacional de Desenvolvi- Most 12-year-old Potiguara children indigenous children and adults living in mento Científico e Tecnológico (CNPq) have a DMFT of 3.0, whereas for the 15- Potiguara lands have higher levels of and Fundação de Apoio à Pesquisa do to 19-year-old age group the most fre- dental caries than their nonindigenous Estado da Paraíba (FAPESQ) for financial quent DMFT values observed were counterparts. Unfortunately, no scientif- support. We are also grateful to the higher than 12.0. These data clearly indi- ically validated data on dietary habits Brazilian National Health Foundation cate that caries activity speeds up among are available for this population. The cul- (FUNASA) and all Indians living on the adolescents. Because caries incidence tural differences between rural and Potiguara reservations for their willing- does not level off easily with time, future urban communities will be reduced in ness to cooperate with the study.

REFERENCES

1. Neel JV, Salzano FM, Junqueira PC, Keiter F, 8. Lyon P. Native South American: ethnology of 15. Brasil, Ministério da Saúde, Secretaria de Maybury-Lewis D. Studies on the In- the least known continent. Boston: Little and Atenção à Saúde, Departamento de Atenção dians of the Brazilian . Am J Brown; 1974. Básica, Coordenação Nacional de Saúde Hum Genet. 1964;16:52–140. 9. Instituto de Pesquisa Econômica Aplicada, Bucal. Projeto SB BRASIL 2003: condições de 2. Niswander JD. Further studies on the Xa- Programa das Nações Unidas para o Desen- saúde bucal da população brasileira 2002– vante Indians. VII. The oral status of the Xa- volvimento (PNUD), Fundação João Pinheiro. 2003. Resultados principais. Brasília: Min- vantes of Simões Lopes. Am J Hum Genet. Atlas do desenvolvimento humano no Brasil. istério da Saúde; 2004. 1967;19:543–53. Brasília: Instituto de Pesquisa Econômica 16. Narvai PC, Frazão P, Roncalli AG, Antunes 3. Tumang AJ, Piedade EF. Cárie dental, Aplicada; 2007. JL. Dental caries in Brazil: decline, polariza- doenças peridontais e higiene oral em indíge- 10. Vieira JG. Somos índios misturados: o tion, inequality and social exclusion. Rev nas brasileiros. Bol Oficina Sanit Panam. sangue, a terra e a concepção de tempo e de Panam Salud Publica. 2006;19(6):385–93. 1968;64:103–9. espaço dos Potiguara da Paraíba. Raízes. 17. Souza ML, Bastos JL, Peres MA. Trends in 4. Donnelly CJ, Thomson LA, Stiles HM, Brewer 2002;21:81–90. dental caries rates in 12- and 13-year-old C, Neel JV, Brunelle JA. Plaque, caries, peri- 11. Sampaio FC, von der Fehr FR, Arneberg P, schoolchildren from Florianópolis (Brazil) be- odontal diseases, and acculturation among Gigante DP, Hatløy A. Dental fluorosis and tween 1971 and 2005. Oral Health Prev Dent. Indians, Venezuela. Community nutritional status of 6- to 11-year-old children 2006;4:187–92. Dent Oral Epidemiol. 1977;5:30–9. living in rural areas of Paraíba, Brazil. Caries 18. Sampaio FC, Hossain AN, von der Fehr FR, 5. Rigonatto DDL, Antunes JLP, Frazão P. Den- Res. 1999;33:66–73. Arneberg P. Dental caries and sugar intake of tal caries experience in Indians of the Upper 12. Brasil, Ministério da Saúde. Projeto SB2000: children from rural areas with different water Xingu, Brazil. Rev Inst Med Trop Sao Paulo. Condições de Saúde Bucal da população fluoride levels in Paraíba, Brazil. Community 2001;43:93–8. brasileira no ano 2000: manual do coorde- Dent Oral Epidemiol. 2000;28(4):307–13. 6. Carneiro MCG, Santos RV, Garnelo L, nador. Brasília: Ministério da Saúde; 2001. 19. Moreira PV, Rosenblatt A, Passos IA. Preva- Rebelo MAB, Coimbra CEA Jr. Cárie den- Série C; Projetos, Programas e Relatórios 51. lence of cavities among adolescents in public tária e necessidade de tratamento odon- Available from: http://bvsms.saude.gov.br/ and private schools in João Pessoa, Paraíba tológico entre os índios Baniwa do Alto bvs/publicacoes/condSB_man_coord.pdf. State, Brazil. 1: Ciên Saúde Colet. 2007;12: Rio Negro, Amazonas. Ciên Saúde Colet. Accessed 10 March 2009. 1229–36. 2008;13: 1985–92. 13. Lwanga SK, Lemeshow S. Sample size deter- 7. Salzano FM. Parasitic load in South American mination in health studies. A practical man- tribal populations. In: Swedlund AC, Armela- ual. Geneva: World Health Organization; gos GJ, eds. Disease in populations in transi- 1991. tion: anthropological and epidemiological 14. World Health Organization. Oral health sur- perspectives. New York: Bergin and Garvey; veys: basic methods. 4th ed. Geneva: WHO; Manuscript received on 17 May 2009. Revised version ac- 1990. Pp. 201–21. 1997. cepted for publication on 20 September 2009.

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RESUMEN Objetivo. El objetivo de este estudio fue evaluar la prevalencia de caries y las nece- sidades de tratamiento en los residentes indígenas brasileños de una reserva india. Métodos. En este estudio transversal se incluyó a 1 461 personas de 18 a 36 meses de Caries dental y necesidades edad, y de 5, 12, 15–19, 35–44, y 65–74 años, que vivían en aldeas indias Potiguara de de tratamiento en los Brasil. Se determinaron los dientes permanentes cariados, perdidos y obturados indígenas de la reserva india (CPO) y los dientes deciduos mediante examinadores calibrados, con ayuda del mé- todo recomendado por la Organización Mundial de la Salud. Las necesidades de tra- Potiguara de Brasil tamiento se evaluaron con las directrices de la Encuesta Brasileña de Salud Bucoden- tal de 2003. Resultados. Las medias ± desviaciones estándar (DE) de los dientes deciduos de los niños de 18 a 36 meses, y de cinco años fueron 2,5 ± 3,7 y 5,8 ± 4,3, respectivamente. En los grupos de edad de 12, 15–19, 35–44, y 65–74 años, los valores de la media ± DE de los dientes CPO fueron 3,6 ± 3,1, 7,1 ± 4,9, 16,4 ± 7,5, y 22,8 ± 8,6. La media ± DE del número de dientes deciduos que precisaron tratamiento varió de 2,4 ± 3,5 a 5,0 ± 4,0 en los grupos de edad de 18 a 36 meses, y 5 años, respectivamente. En los adoles- centes y adultos, se observó que, en promedio, por lo menos tres dientes permanen- tes precisaron tratamiento dental en forma de obturaciones, coronas, endodoncia y extracciones. Conclusiones. En todos los grupos de edad de los indios Potiguara se observaron una prevalencia alta de caries y muchos dientes que precisaban tratamiento.

Palabras clave Caries dental; índice CPO; encuestas de salud bucal; servicios de salud dental; pobla- ción indígena; Brasil.

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