Contextual and individual determinants of tooth loss in adults: a multilevel study.

BACKGROUND: Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35-44 years of age), in accordance with individual and contextual social characteristics. METHODS: This was a multilevel cross-sectional study with data from 9564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. RESULTS: Brazilian adults lost a mean of 7.57 (95% CI 7.1-8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males. CONCLUSIONS: The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

[Lack of access to information on oral health problems among adults: an approach based on the theoretical model for literacy in health]. / Falta de acesso a informações sobre problemas bucais entre adultos: abordagem baseada no modelo teórico de alfabetização em saúde.

This study sought to investigate factors associated with the lack of access to information on oral health among adults. It is a cross-sectional study, carried out among 831 adults (35-44 years of age). The dependent variable was access to information on how to avoid oral problems, and the independent variables were gathered into subgroups according to the theoretical model for literacy in health. Binary logistic regression was carried out, and results were corrected by the design effect. It was observed that 37.5% had no access to information about dental problems. The lack of access was higher among adults who had lower per capita income, were dissatisfied with the dental services provided, did not use dental floss, had unsatisfactory physical control of the quality of life, and self-perceived their oral health as fair/poor/very poor. The likelihood of not having access to information about dental problems among those dissatisfied with the dental services used was 3.28 times higher than for those satisfied with the dental services used. Thus, decreased access to information was related to unfavorable conditions among adults. Health services should ensure appropriate information to their users in order to increase health literacy levels and improve satisfaction and equity.

Objetivou-se investigar os fatores associados à falta de acesso à informação em saúde bucal entre adultos. Trata-se de um estudo transversal, conduzido entre 831 adultos (35-44 anos). A variável dependente foi o acesso a informações sobre como evitar problemas bucais e as independentes foram reunidas em subgrupos conforme modelo teórico de Alfabetização em saúde. Conduziu-se Regressão Logística Binária com correção pelo efeito de desenho. Observou-se que 37,5% não tiveram acesso a informações sobre problemas bucais. A falta de acesso foi maior entre os adultos que possuíam renda per capita menor, estavam insatisfeitos com os serviços odontológicos utilizados, não utilizavam fio dental, apresentavam o domínio físico da qualidade de vida insatisfatório e que autopercebiam a saúde bucal como regular/ruim/péssima. A chance de não ter recebido informações sobre com evitar problemas bucais entre os insatisfeitos com os serviços odontológicos utilizados foi 3,28 vezes aquela observada entre os satisfeitos com os serviços odontológicos utilizados. Assim, o menor acesso esteve relacionado a condições desfavoráveis entre adultos. Os serviços de saúde devem garantir informações adequadas a seus usuários, a fim de aumentar os níveis de Alfabetização em saúde, maior satisfação e equidade.

Falta de acesso a informações sobre problemas bucais entre adultos: abordagem baseada no modelo teórico de alfabetização em saúde / Lack of access to information on oral health problems among adults: an approach based on the theoretical model for literacy in health

Resumo Objetivou-se investigar os fatores associados à falta de acesso à informação em saúde bucal entre adultos. Trata-se de um estudo transversal, conduzido entre 831 adultos (35-44 anos). A variável dependente foi o acesso a informações sobre como evitar problemas bucais e as independentes foram reunidas em subgrupos conforme modelo teórico de Alfabetização em saúde. Conduziu-se Regressão Logística Binária com correção pelo efeito de desenho. Observou-se que 37,5% não tiveram acesso a informações sobre problemas bucais. A falta de acesso foi maior entre os adultos que possuíam renda per capita menor, estavam insatisfeitos com os serviços odontológicos utilizados, não utilizavam fio dental, apresentavam o domínio físico da qualidade de vida insatisfatório e que autopercebiam a saúde bucal como regular/ruim/péssima. A chance de não ter recebido informações sobre com evitar problemas bucais entre os insatisfeitos com os serviços odontológicos utilizados foi 3,28 vezes aquela observada entre os satisfeitos com os serviços odontológicos utilizados. Assim, o menor acesso esteve relacionado a condições desfavoráveis entre adultos. Os serviços de saúde devem garantir informações adequadas a seus usuários, a fim de aumentar os níveis de Alfabetização em saúde, maior satisfação e equidade.

Abstract This study sought to investigate factors associated with the lack of access to information on oral health among adults. It is a cross-sectional study, carried out among 831 adults (35-44 years of age). The dependent variable was access to information on how to avoid oral problems, and the independent variables were gathered into subgroups according to the theoretical model for literacy in health. Binary logistic regression was carried out, and results were corrected by the design effect. It was observed that 37.5% had no access to information about dental problems. The lack of access was higher among adults who had lower per capita income, were dissatisfied with the dental services provided, did not use dental floss, had unsatisfactory physical control of the quality of life, and self-perceived their oral health as fair/poor/very poor. The likelihood of not having access to information about dental problems among those dissatisfied with the dental services used was 3.28 times higher than for those satisfied with the dental services used. Thus, decreased access to information was related to unfavorable conditions among adults. Health services should ensure appropriate information to their users in order to increase health literacy levels and improve satisfaction and equity.

[Validity of self-perceived dental caries as a diagnostic test and associated factors in adults]. / Validade da autopercepção da presença de cárie dentária como teste diagnóstico e fatores associados entre adultos.

This study aimed to analyze the validity of self-perceived dental caries and associated factors in a sample of 795 adults (35-44 years). The dependent variable was self-perceived dental caries, and the independent variables were combined in blocks. Three logistic models were performed: (1) all adults; (2) adults with a formal diagnosis of caries; and (3) adults without such caries. Self-perceived dental caries showed 77.7% sensitivity, 58% specificity, 65% accuracy, 52% positive predictive value, and 81% negative predictive value. In Model 1, self-perceived dental caries was associated with time of use of dental services, access to information, flossing, formal diagnosis of caries, self-perceived need for treatment, toothache, and dissatisfaction with oral health and general health. In Model 2, self-perceived dental caries was associated with time of use of dental services, self-perceived need for treatment, and dissatisfaction with oral health and general health. In Model 3, self-perceived dental caries was associated with time of use of dental services, access to information, flossing, self-perceived need for treatment, and dissatisfaction with oral health. Self-perceived dental caries showed limited utility as a diagnostic method.

Validade da autopercepção da presença de cárie dentária como teste diagnóstico e fatores associados entre adultos / Validity of self-perceived dental caries as a diagnostic test and associated factors in adults / Validez de la autopercepción de la presencia de caries dental como test diagnóstico y factores asociados entre adultos

Resumo: Objetivou-se investigar a validade da autopercepção da presença da cárie dentária e fatores associados, mediante estudo com 795 adultos (35-44 anos). A variável dependente foi autopercepção da presença da cárie dentária, as independentes reunidas em blocos. Três modelos logísticos foram conduzidos: (1) todos os adultos; (2) adultos com lesões de cárie normativa; e (3) adultos sem tais lesões. A autopercepção da presença da cárie dentária apresentou sensibilidade de 77,7%, especificidade de 58%, acurácia de 65%, valor preditivo positivo de 52% e valor preditivo negativo de 81%. No Modelo 1, a autopercepção da presença da cárie dentária foi associada ao tempo de uso dos serviços odontológicos, acesso à informação, uso de fio dental, lesões normativas, percepção da necessidade de tratamento, dor, insatisfação com a saúde bucal e geral. No Modelo 2, a autopercepção da presença da cárie dentária foi associada ao tempo de uso dos serviços odontológicos, percepção da necessidade de tratamento e insatisfação com a saúde bucal e geral. No Modelo 3, autopercepção da presença da cárie dentária foi associada ao tempo de uso dos serviços odontológicos, acesso à informação, percepção da necessidade de tratamento, insatisfação com a saúde bucal e uso de fio dental. A autopercepção da presença da cárie dentária mostrou utilidade limitada como método de diagnóstico.

Abstract: This study aimed to analyze the validity of self-perceived dental caries and associated factors in a sample of 795 adults (35-44 years). The dependent variable was self-perceived dental caries, and the independent variables were combined in blocks. Three logistic models were performed: (1) all adults; (2) adults with a formal diagnosis of caries; and (3) adults without such caries. Self-perceived dental caries showed 77.7% sensitivity, 58% specificity, 65% accuracy, 52% positive predictive value, and 81% negative predictive value. In Model 1, self-perceived dental caries was associated with time of use of dental services, access to information, flossing, formal diagnosis of caries, self-perceived need for treatment, toothache, and dissatisfaction with oral health and general health. In Model 2, self-perceived dental caries was associated with time of use of dental services, self-perceived need for treatment, and dissatisfaction with oral health and general health. In Model 3, self-perceived dental caries was associated with time of use of dental services, access to information, flossing, self-perceived need for treatment, and dissatisfaction with oral health. Self-perceived dental caries showed limited utility as a diagnostic method.

Resumen: Se tuvo como objetivo investigar la validez de la autopercepción de la presencia de la caries dental y factores asociados, mediante un estudio con 795 adultos (35-44 años). La variable dependiente fue autopercepción de la presencia de la caries dental, las independientes se reunieron en bloques. Se realizaron tres modelos logísticos: (1) todos los adultos; (2) adultos con lesiones de caries conforme a la norma; y (3) adultos sin tales lesiones. La autopercepción de la presencia de la caries dental presentó sensibilidad de un 77,7%, especificidad de un 58%, precisión de un 65%, valor predictivo positivo de un 52% y valor predictivo negativo de un 81%. En el Modelo 1, la autopercepción de la presencia de la caries dental se asoció al tiempo de uso de los servicios odontológicos, acceso a la información, uso de hilo dental, lesiones conforme a la norma, percepción de la necesidad de tratamiento, dolor, insatisfacción con la salud bucal y general. En el Modelo 2, la autopercepción de la presencia de la caries dental se asoció al tiempo de uso de los servicios odontológicos, percepción de la necesidad de tratamiento e insatisfacción con la salud bucal y general. En el Modelo 3, la autopercepción de la presencia de la caries dental se asoció al tiempo de uso de los servicios odontológicos, acceso a la información, percepción de la necesidad de tratamiento, insatisfacción con la salud bucal y uso de hilo dental. La autopercepción de la presencia de la caries dental mostró utilidad limitada como método de diagnóstico.

Dissatisfaction with the dental services and associated factors among adults. / Insatisfação com os serviços odontológicos e fatores associados entre adultos.

This study aimed to identify factors associated with dissatisfaction with dental services among adults. It analyzed 830 adult participants of an epidemiological survey of oral health. The dependent variable was dissatisfaction with the dental service, and the independent ones were selected according to the theoretical model set forth by Andersen and Davidson (1997). Estimates were corrected by the sample design effect, and Binary Logistic Regression was carried out. It was found that about 11% of adults were dissatisfied with the dental service. In the final model, dissatisfaction with dental services was lower among older adults (OR = 0.559) and among smokers (OR = 0.332). On the other hand, it was higher among adults who self-perceived their chewing as negative (OR = 2,804), who self-perceived some discomfort in the mouth and head and neck region (OR = 2.065), and among those who did not have access to information on how to avoid oral problems (OR = 3.020). Therefore, the services need to access the perceptions and expectations expressed by users, and provide information in appropriate quantity and quality, in the context of "health literacy" in order to achieve greater satisfaction among its users.

Insatisfação com os serviços odontológicos e fatores associados entre adultos / Dissatisfaction with the dental services and associated factors among adults

Resumo Objetivou-se identificar fatores associados à insatisfação com os serviços odontológicos utilizados entre adultos. Foram analisados os dados de 830 adultos participantes de um levantamento epidemiológico em saúde bucal. A variável dependente foi insatisfação com o serviço odontológico e as independentes foram reunidas conforme modelo teórico de Andersen e Davidson. As estimativas foram corrigidas pelo efeito de desenho amostral e foi conduzida Regressão Logística Binária. Cerca de 11% dos adultos encontravam-se insatisfeitos com o serviço odontológico utilizado. No modelo final, a insatisfação com os serviços odontológicos foi menor entre os adultos mais velhos (OR = 0,559) e entre os fumantes (OR = 0,332). Por outro lado, foi maior entre adultos que autopercebiam sua mastigação negativamente (OR = 2,804), que autopercebiam algum incômodo na região da boca, cabeça e pescoço (OR = 2,065) e que não tiveram acesso à informação sobre como evitar problemas bucais (OR = 3,020). Assim, os serviços precisam acessar as percepções e as expectativas manifestadas pelos usuários, além de prover informações em quantidade e qualidade adequadas, no contexto da “alfabetização em saúde”, a fim de se alcançar maior satisfação entre seus usuários.

Abstract This study aimed to identify factors associated with dissatisfaction with dental services among adults. It analyzed 830 adult participants of an epidemiological survey of oral health. The dependent variable was dissatisfaction with the dental service, and the independent ones were selected according to the theoretical model set forth by Andersen and Davidson (1997). Estimates were corrected by the sample design effect, and Binary Logistic Regression was carried out. It was found that about 11% of adults were dissatisfied with the dental service. In the final model, dissatisfaction with dental services was lower among older adults (OR = 0.559) and among smokers (OR = 0.332). On the other hand, it was higher among adults who self-perceived their chewing as negative (OR = 2,804), who self-perceived some discomfort in the mouth and head and neck region (OR = 2.065), and among those who did not have access to information on how to avoid oral problems (OR = 3.020). Therefore, the services need to access the perceptions and expectations expressed by users, and provide information in appropriate quantity and quality, in the context of “health literacy” in order to achieve greater satisfaction among its users.

Factors associated with dental caries in the primary dentition of children with cerebral palsy

The aim of this study was to investigate factors associated with caries experience in the primary dentition of one- to five-year-old children with cerebral palsy. A total of 266 dental records were examined, and caries experience was measured by dmft. The following variables were also analyzed: gender, oral hygiene, history of gastroesophageal reflux, use of medications for gastroesophageal reflux, gingival status, sugar intake and reports of polyuria, excessive thirst and xerostomia. For analysis purposes, the individuals were categorized as those with and without caries experience and subcategorized into the following age groups: one year; two to three years; and four to five years. After bivariate analysis, variables with a p-value < 0.25 were selected for incorporation into the Poisson regression models. Considering the limitations of the protocol, the level of oral hygiene perceived on the first appointment was the only factor associated with caries experience among two-to-fiveyear-old children with cerebral palsy.

Factors associated with dental caries in the primary dentition of children with cerebral palsy.

The aim of this study was to investigate factors associated with caries experience in the primary dentition of one- to five-year-old children with cerebral palsy. A total of 266 dental records were examined, and caries experience was measured by dmft. The following variables were also analyzed: gender, oral hygiene, history of gastroesophageal reflux, use of medications for gastroesophageal reflux, gingival status, sugar intake and reports of polyuria, excessive thirst and xerostomia. For analysis purposes, the individuals were categorized as those with and without caries experience and subcategorized into the following age groups: one year; two to three years; and four to five years. After bivariate analysis, variables with a p-value < 0.25 were selected for incorporation into the Poisson regression models. Considering the limitations of the protocol, the level of oral hygiene perceived on the first appointment was the only factor associated with caries experience among two-to-five-year-old children with cerebral palsy.