Contextual and individual determinants of oral health-related quality of life among adolescents.

The aim of this study was to assess the factors associated with oral health-related quality of life in adolescents (OHRQoL). Individual data on adolescents were collected from a secondary database. OHRQoL was measured using the oral impact on daily performance (OIDP) scale. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health. The individual covariates analyzed were sex, age, skin color, maternal education, household income, number of people per room in the housing unit, dental attendance, self-perception of dental needs, untreated dental caries, and gingival bleeding. The contextual variables included the allocation factor, the Human Development Index (HDI), Gini coefficient, illiteracy, unemployment, income, average number of emergency dental visits per inhabitant, access to a sanitary sewer system, garbage collection, primary health care coverage, oral health team coverage, and number of tooth extractions between selected dental procedures and supervised toothbrushing. Unadjusted and adjusted multilevel Poisson regression analyses were used to evaluate the relationship between contextual and individual variables with overall OIDP scores (STATA version 16.0) - rate ratio (RR) and 95%CI. The mean OIDP score was 0.72 and the prevalence was 31.8%. There was an association between supervised toothbrushing average and the outcome (RR 0.95; 95%CI 0.91­0.99). Moreover, adolescents who lived in municipalities with the highest average number of emergency dental visits per inhabitant showed a higher OIDP. Sex, maternal education, untreated dental caries, and gingival bleeding were associated with OIDP. In addition, intersectoral public policies focusing on the reduction of social inequalities should be on the agenda of policymakers and stakeholders.

Contextual and individual determinants of oral health-related quality of life among adolescents

Abstract The aim of this study was to assess the factors associated with oral health-related quality of life in adolescents (OHRQoL). Individual data on adolescents were collected from a secondary database. OHRQoL was measured using the oral impact on daily performance (OIDP) scale. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health. The individual covariates analyzed were sex, age, skin color, maternal education, household income, number of people per room in the housing unit, dental attendance, self-perception of dental needs, untreated dental caries, and gingival bleeding. The contextual variables included the allocation factor, the Human Development Index (HDI), Gini coefficient, illiteracy, unemployment, income, average number of emergency dental visits per inhabitant, access to a sanitary sewer system, garbage collection, primary health care coverage, oral health team coverage, and number of tooth extractions between selected dental procedures and supervised toothbrushing. Unadjusted and adjusted multilevel Poisson regression analyses were used to evaluate the relationship between contextual and individual variables with overall OIDP scores (STATA version 16.0) - rate ratio (RR) and 95%CI. The mean OIDP score was 0.72 and the prevalence was 31.8%. There was an association between supervised toothbrushing average and the outcome (RR 0.95; 95%CI 0.91-0.99). Moreover, adolescents who lived in municipalities with the highest average number of emergency dental visits per inhabitant showed a higher OIDP. Sex, maternal education, untreated dental caries, and gingival bleeding were associated with OIDP. In addition, intersectoral public policies focusing on the reduction of social inequalities should be on the agenda of policymakers and stakeholders.

Factors associated with toothache in 12-year-old adolescents in a southeastern state of Brazil

Abstract: This cross-sectional study evaluated factors associated with toothache in 12-year-old adolescents from the state of Minas Gerais in Brazil. Secondary data were collected from the SB Minas Gerais 2012 epidemiological survey. The dependent variable was toothache in the past 6 months. The independent variables were grouped into two levels: individual (sex, ethnic group, family income, periodontal condition, dental caries, dental treatment needs, and type of service used) and contextual (allocation factor, Human Development Index, Gini coefficient, gross domestic product, unemployment, illiteracy, basic sanitation, garbage collection, family income, half or a quarter of a minimum wage, primary healthcare coverage, primary oral healthcare team coverage, oral health technician, access to individual dental care, and supervised tooth brushing). A multilevel analysis was performed using the Hierarchical Linear and Nonlinear Modeling Software Program to assess the association of individual and contextual variables with toothache in the last 6 months. The prevalence of toothache in the last six months among the adolescents of this study was 19.1%. An association was found with family income (p <0.001), dental caries (p <0.001), primary oral healthcare team coverage (p = 0.015) and oral health technician (p = 0.008). Socioeconomic conditions and the most prevalent oral diseases, such as dental caries, as well as the use of public services, were related to toothache in adolescents aged 12 years. These findings reinforce the need to develop and implement public policies to address the oral health problems of this population.

Contextual and individual determinants of the need for endodontic treatment in adults in Brazil: A multilevel analysis.

AIM: To examine the relationship between contextual and individual determinants with the need for endodontic treatment in Brazilian adults. METHODS: Individual-level data from 6897 adults aged 35-44 years living in the Brazilian state capitals who participated in the Brazilian Oral Health Survey (SBBrasil 2010 Project) were combined with city-level data. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health according to the WHO model of social determinants of health. The association of independent variables with one or more teeth in need of endodontic treatment was evaluated using multilevel logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CI). RESULTS: The prevalence of the need for endodontic treatment was 7.7%. Adults living in cities with better contextual socioeconomic conditions (OR 0.82; 95% CI = 0.72-0.93) and better specialized dental services (OR 0.85; 95% CI = 0.77-0.95) were less likely to need endodontic treatment. Younger age, greater schooling and use of private dental services reduced the odds of need for endodontic treatment. Number of people per room, type of dental service and reason for the last dental visit were also associated with need of endodontic treatment. CONCLUSION: Contextual and individual factors were relevant determinants of endodontic treatment needs in adults.

Contextual and individual factors associated with dental pain in adolescents from Southeastern Brazil

Abstract The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Socioeconomic and intraoral polarization of untreated caries and tooth loss among male adolescents

Abstract The aim of this study was to investigate the intraoral distribution of untreated caries and tooth loss and estimate the impact of different socioeconomic factors on the occurrence of these outcomes. A cross-sectional study was conducted with 652 18-year-old male adolescents from the city of Sapucaia do Sul, Brazil, who conscripted for military service. The participants answered a questionnaire addressing sociodemographic variables. Two trained and calibrated examiners performed the clinical examinations for the diagnosis of dental caries using the criteria of the World Health Organization. Tooth group and adolescent were the units of analysis for the primary outcomes of the study. Poisson regression analysis with robust variance was performed, with the calculation of crude and adjusted prevalence ratios (PR) and 95% confidence intervals (CI). The prevalence of caries experience and untreated caries was 70.2% and 39.3%, respectively, and 9.4% of the adolescents had missing teeth. Sixty-seven percent of the untreated caries and 98.8% of missing teeth were in first molars. The probability of dental caries and tooth loss was significantly higher among adolescents with less schooling (PR = 2.56; 95%CI: 1.97-3.32 and PR = 3.28; 95%CI: 1.61-6.65, respectively) and those whose mothers had less schooling (PR = 1.31; 95%CI: 1.03-1.67 and PR = 2.30; 95%CI: 1.18-4.50, respectively). In conclusion, the occurrence of untreated dental caries and tooth loss was concentrated in the first molars of adolescents. Moreover, the prevalence of both conditions was higher among adolescents with low schooling and whose mothers had low schooling, reflecting the strong intraoral and socioeconomic polarization of these outcomes.

Assistive technologies for improving the oral hygiene of leprosy patients residing in a former leprosy colony in Betim, Minas Gerais, Brazil.

BACKGROUND: This study deals with management of a group of elderly patients with a history of leprosy and hand deformities by a multidisciplinary team of dentists and occupational therapists. Assistive technology devices have been developed to allow such patients to obtain independence in oral self-care and can be a cost-effective approach to improving oral care in this population. The objective of this study was to describe the development of assistive devices to facilitate daily oral hygiene in older people with enduring leprosy-related impairments. METHODOLOGY: Case study realized among elders with a history of leprosy residents in a former isolation colony in Betim, Minas Gerais, Brazil. The elders were evaluated for dependence on others for denture hygiene and mouthwash using the Daily Oral Hygiene Activity Index (ADOH). Those deemed partially or completely dependent on others were eligible for an intervention based on assistive technology. We adopted a personalized approach to each case, taking into account medical history, physical impairment and living environment. Six months after the intervention, the participants were assessed again using the ADOH and an unstructured interview about use of the devices. PRINCIPAL FINDINGS: Assistive devices for denture hygiene and mouthwash were developed for 16 elders. These devices facilitated oral hygiene in most patients and there was no worsening in any of the cases. Patients' report suggested they were satisfied with the devices provided. CONCLUSIONS: This study demonstrated that assistive devices can facilitate oral hygiene activities in leprosy patients. It also reinforces the importance of using a multidisciplinary team for the rehabilitation of these patients.

Tooth Erosion Association with Obesity: Findings from a Brazilian Survey in Schoolchildren

Objective: To evaluate a possible association between tooth erosion and weight status in Brazilian schoolchildren. Material and Methods: 1211 children aged 8-12-year-old from public and private schools in Southern Brazil were selected by a two-stage cluster method. Oral conditions were assessed by six trained and calibrated examiners. Tooth erosion assessment was determined by using the O´Sullivan index. Anthropometric measures were taken in order to obtain the body mass index. Socio-demographic and behavioral data were collected using questionnaires in children and parents. Multivariate Poisson regression model considering the cluster sample was used for data analysis (Prevalence ratio - PR; 95% Confidence Interval - CI). Results: Tooth erosion was observed in 25.1% of the children. Obesity and overweight prevalence was 34.6%. In the multivariate adjusted model, tooth erosion was associated with children from private schools (PR 1.68; 95%CI 1.05-2.68) and higher frequency of physical activity weekly (PR 1.48; 95%CI 1.04-2.09), whereas dental crowding in both arches was considered a protective effect (PR 0.55; 95%CI 0.34-0.89). In the stratified analysis regarding the type of school, children from private schools presented a positive association between tooth erosion and obesity (PR 3.26; 95%CI 1.38-7.69). Conclusion: Tooth erosion was not associated with obesity in the total sample. Socioeconomic differences seem to influence the relationship tooth erosion and obesity.

Traumatismos alveolodentários e fatores associados em crianças assistidas em um curso de Odontologia no sul do Brasil / Traumatic dental injuries and associated factors in children assisted in a school of Dentistry in Southern Brazil

Aim: To estimate the prevalence of traumatic dental injuries (TDI) and investigate demographic and socioeconomic factors associated among children attending at School of Dentistry, Southern Brazil. Methods: A cross-sectional study was carried out with 374 children attending the Pediatric Clinic, from School of Dentistry at the Universidade Luterana do Brasil, Canoas, Southern Brazil. Information from parents/caregivers on socioeconomic factors were obtained with an structured questionnaire. Children were clinically examined and TDI was recorded following Andreasen criteria. Poisson regression with robust variance was employed to determine factors associated with TDI. Results: A total of 15.0% of children exhibited TDI (95% CI 11.5-19.0%). The most common dental injuries involved hard tissues (enamel fracture, enamel and dentine fracture). Adjusted analysis revealed that the probability of TDI was almost 90% higher in older children (10 to 12 years) compared to children who were 7 to 9 years old; (PR 1.89; 95% CI 1.05­3.43), two fold higher in children from older mothers (≥ 35 years) (PR 2.01; 95% CI 1.23­3.30), and 66% higher in children from mothers with lower education (≤8 years) (PR 1.66; 95% CI 1.02­2.70). Conclusion: Our findings showed a high prevalence of TDI. Moreover, sociodemographic factors, specially, maternal schooling and aging were associated with the outcome. Epidemiological studies of specific groups allowed in the organization of health services and elaboration of preventive and curative strategies.

Objetivo: estimar a prevalência de traumatismos alveolodentários (TAD) e investigar fatores sociodemográficos associados em crianças assistidas em um Curso de Odontologia no Sul do Brasil. Métodos: Um estudo transversal foi realizado com 374 crianças atendidas na Clínica Infantil do Curso de Odontologia da Universidade Luterana do Brasil, Canoas, Brasil. Informações sobre fatores sociodemográficos foram obtidas com pais ou cuidadores por meio de um questionário estruturado. As crianças foram clinicamente examinadas e TAD foram registrados, conforme critério de Andreasen. Regressão de Poisson com variância robusta foi empregada para determinar os fatores associados com o desfecho. Resultados: A prevalência de TAD foi de 15,0% (IC 95% 11,0-19,0%). As lesões mais comuns foram lesões aos tecidos duros (fratura de esmalte e de esmalte e dentina), especialmente na dentição permanente. A análise ajustada mostrou que a probabilidade de TAD foi quase 90% maior em crianças de maior idade (10 a 12 anos) em relação a crianças de 7 a 9 anos (RP 1,89; IC 95% 1,05­3,43), duas vezes maior em filhos de mães com maior idade (≥ 35 anos) (RP 2,01; IC 95% 1,23­3,30) e 66% maior em crianças de mães com menor escolaridade (≤8 anos) (RP 1,66; IC 95% 1,02­2,70). Conclusão: Observou-se uma alta prevalência de TAD. Além disso, fatores sociodemográficos, especialmente escolaridade e idade materna, estiveram associados ao desfecho. Estudos epidemiológicos de grupos específicos permitem a organização de serviços de saúde e a elaboração de estratégias preventivas e curativas.

Methods and logistics of a multidisciplinary survey of schoolchildren from Pelotas, in the Southern Region of Brazil.

This paper describes the methods of a multidisciplinary epidemiological survey conducted in schools in Pelotas, in the Southern Region of Brazil. This cross-sectional study evaluated a representative sample (n = 1,211) of eight to 12-year-old children attending public (15) and private (5) schools. Questionnaires were applied to parents to obtain information about socioeconomic and sociocultural characteristics. Children were interviewed to provide information on demographic characteristics, oral health behavior and physical activity habits. Oral health examinations were performed on the children and anthropometric data was collected to assess nutritional status. School principals responded a questionnaire about the social and physical environment of the school. A total of 1,744 children were eligible for the study; a response rate of 69.4% was achieved, with no significant differences between schools. The method used allowed investigators to obtain data on several health outcomes as well as on possible risk factors. This strategy optimizes the use of financial resources for research and promotes interprofessional collaboration.

Methods and logistics of a multidisciplinary survey of schoolchildren from Pelotas, in the Southern Region of Brazil / Métodos e logística de um estudo multidisciplinar com escolares de Pelotas, Sul do Brasil / Métodos y logística de un estudio multidisciplinar con escolares de Pelotas, sur de Brasil

This paper describes the methods of a multidisciplinary epidemiological survey conducted in schools in Pelotas, in the Southern Region of Brazil. This cross-sectional study evaluated a representative sample (n = 1,211) of eight to 12-year-old children attending public (15) and private (5) schools. Questionnaires were applied to parents to obtain information about socioeconomic and sociocultural characteristics. Children were interviewed to provide information on demographic characteristics, oral health behavior and physical activity habits. Oral health examinations were performed on the children and anthropometric data was collected to assess nutritional status. School principals responded a questionnaire about the social and physical environment of the school. A total of 1,744 children were eligible for the study; a response rate of 69.4% was achieved, with no significant differences between schools. The method used allowed investigators to obtain data on several health outcomes as well as on possible risk factors. This strategy optimizes the use of financial resources for research and promotes interprofessional collaboration.

O artigo detalha os métodos de um estudo epidemiológico multidisciplinar conduzido em escolas em Pelotas, Sul do Brasil. O estudo transversal incluiu uma amostra representativa (n = 1.211) de crianças de 8 a 12 anos, em escolas públicas (15) e privadas (5). Questionários foram aplicados aos pais para obter informações socioeconômicas e culturais. As crianças foram entrevistadas, fornecendo informações demográficas, comportamentos de saúde bucal e prática de atividade física. Exame de saúde bucal foi realizado e medidas antropométricas aferidas para avaliação da condição nutricional. Diretores das escolas forneceram informações sobre o ambiente físico e social das escolas. Das 1.744 crianças elegíveis, a taxa de resposta foi 69,4% sem diferenças entre escolas. A metodologia proposta permitiu a obtenção de dados sobre diversos desfechos de saúde bem como sobre possíveis fatores de risco. Esta estratégia otimiza recursos financeiros de pesquisa e favorece a colaboração interprofissional.

El artículo detalla los métodos de un estudio epidemiológico multidisciplinar llevado a cabo en escuelas en Pelotas, sur de Brasil. El estudio transversal incluyó una muestra representativa (n = 1.211) de niños de 8 a 12 años, en escuelas públicas (15) y privadas (5). Los cuestionarios fueron administrados a los padres para obtener información socioeconómica y cultural. Los niños fueron entrevistados, proporcionando información demográfica, comportamientos de salud bucal y práctica de actividad física. Se realizaron un examen de salud bucal y medidas antropométricas para la evaluación de la condición nutricional. Directores de escuelas proporcionaron información sobre el ambiente físico y social de las escuelas. De los 1.744 niños elegibles, la tasa de respuesta fue de un 69,4% sin diferencias entre escuelas. La metodología propuesta permitió la obtención de datos sobre diversas soluciones de salud, así como sobre posibles factores de riesgo. Esta estrategia optimiza recursos financieros de investigación y favorece la colaboración interprofesional.

Age of first dental visit and predictors for oral healthcare utilisation in preschool children.

PURPOSE: To assess the age the of the first dental visit and the association of self-perceived oral health, socioeconomic and clinical indicators with healthcare utilisation in Brazilian preschool children. MATERIALS AND METHODS: An epidemiological survey with 455 5- to 59-month-old children was conducted on National Children's Vaccination Day in Santa Maria, RS, Brazil. Data about age and reasons for the first dental visit, healthcare utilisation, socioeconomic status and self-perceived oral health were collected by means of a parental semi-structured questionnaire. Calibrated examiners evaluated the prevalence of dental caries (WHO) and dental trauma. The assessment of the association used Poisson regression models (prevalence ratio; 95% confidence interval [CI]). RESULTS: A total of 24.2% (95% CI: 20.3% to 28.4%) of the study sample had already had a first dental visit. Older children, those with dental caries and dental trauma and whose mothers had a higher level of education were more likely to have gone to the dentist. Children of low socioeconomic status were more likely to have visited public than private healthcare services. The reasons for the first dental visit were associated with clinical indicators of the sample. The distribution of utilisation of the types of oral healthcare services (public or private) varied across the socioeconomic groups. Non-white children with dental caries and dental trauma tended to visit a dentist only for treatment reasons. CONCLUSION: Socioeconomic and clinical indicators are associated with the use of dental services, indicating the need for strategies to promote public health and reorientation of services that facilitate dental access for preschool children.