[Characteristics associated with use of dental services by dentate and edentulous elders: the SB Brazil Project]. / Características associadas ao uso de serviços odontológicos entre idosos dentados e edentados no Sudeste do Brasil: Projeto SB Brasil.

This study focused on the characteristics associated with use of dental services during the previous year by Brazilian elderly (with and without teeth) participating in the Brazilian oral health survey (Ministry of Health, 2002/2003). 345 were dentate and 669 edentulous. Prevalence of use was 32% and 11%, respectively. Multivariate logistic regression showed that for dentate elders, use of dental services was more frequent among those who perceived their voices as influenced by oral health. Less frequent use was associated with: residence in rural areas; low income; current oral problems; fewer than two teeth in at least one sextant of the arch; need for dentures; and worse self-perceived appearance. Among edentulous elders, more frequent use was associated with: 5 to 8 years of schooling; pain; and poor self-perceived appearance. Use was less frequent among elders with current oral problems and those who perceived that their personal relations were influenced by oral health. The analysis reviewed the differences between dentate and edentulous individuals. Use of dental services was less common among individuals who needed them the most, suggesting inequality in access to such services among the Brazilian elderly.

[Routine use of dental services by the elderly in Brazil: the SB Brazil Project]. / Uso de serviços odontológicos por rotina entre idosos brasileiros: Projeto SB Brasil.

The routine use of dental services by elderly participants in a representative survey of Brazilians (the SB Brazil Project) was investigated. 2,305 were dentate and 2,704 edentulous. Prevalence of use was 20% and 17%, respectively. Poisson regression showed that for dentate individuals, use was lower among residents who: lived in rural areas; had not received preventive oral health information; had lower incomes; needed a dental prosthesis; had periodontal problems; perceived their chewing as fair, bad, or terrible; felt that oral health affected their social interaction; and reported tooth pain. Among edentulous individuals, use was higher among those who paid out-of-pocket for dental services and was lower among those who: lived in rural areas; had used dental services more than a year previously; self-identified as non-white; had not received preventive oral health information; had less schooling; needed a dental prosthesis; and felt that oral health affected their social interaction. Inequalities, economic barriers, and lack of information jeopardized the routine use of dental services. Targeted public policies are required to correct these problems.

[Factors associated to self perceived need of dental care among Brazilian elderly]. / Fatores relacionados à autopercepção da necessidade de tratamento odontológico entre idosos.

OBJECTIVE: To analyze factors associated with the self-perceived need for dental treatment among elderly people. METHODS: A total of 5,326 individuals who were included in a sample of Brazilian elderly people aged 65-74 years in a home survey on oral health conducted by the Brazilian Ministry of Health in 2002/2003 were investigated. The analysis was based on the model of Gift, Atchison & Drury, and Poisson regression for analysis of surveys with complex samples was used. RESULTS: Out of the whole sample, 2,928 (55%) of the elderly people said they needed dental treatment. This need was perceived less frequently among those aged 70 years or over (PR=0.94; 95% CI: 0.89;0.99), those who had not received information on how to avoid oral problems (PR=0.89; 95% CI: 0.83;0.95) and those who were edentate (PR=0.68; 95% CI: 0.62;0.74). The perceived need was greater among those who self;rated their oral health as regular (PR=1.31; 95% CI: 1.21;1.41) or poor/very poor (PR=1.29; 95% CI: 1.19;1.41), their appearance as regular (PR=1.23; 95% CI: 1.15;1.32) or poor/very poor (PR=1.28; 95% CI: 1.18;1.39) and their chewing as regular (PR=1.08; 95% CI: 1.01;1.15) or poor/very poor (PR=1.13; 95% CI: 1.05;1.21). It was also greater among those who reported pain in their teeth or gums over the six months prior to the survey (PR=1.27; 95% CI: 1.18;1.36) and among those who needed a prosthesis in one arch (PR=1.29; 95% CI: 1.19;1.39) or both (PR=1.27; 95% CI: 1.16;1.40). CONCLUSIONS: Information, oral health conditions and subjective questions were associated with self-perceived need for dental treatment. The results reinforce the need to capacitate individuals to carry out oral self-examination and identify non-painful signs and symptoms of mucosal lesions, caries and periodontal disease at an early stage.

Greater access to information on how to prevent oral cancer among elderly using primary health care.

Educative actions are an important component of health promotion in Brazil's primary healthcare program, the Family Health Strategy (FHS). The efficacy of these actions is evidenced by compliance with healthy behaviors and in the reduction of rates of mortality and morbidity. The objective of this study was to identify whether access to information regarding the prevention of oral cancer is greater among elders whose residences are registered with the FHS. SPSS® was utilized to obtain estimates that were corrected for sample design, considering the magnitude of the associations between access to such information with personal determinants, the use and cost of healthcare, health-related behaviors and health outcomes. 58.9% of the 492 participating elders reported having access to such information. We verified that there was a greater chance for access among residents of houses registered by the FHS; those with greater per capita income (2.01/1.183.43); non-smokers (2.00/1.16-3.46); those that realized oral self-examination (6.35/3.46-11.64); and those that did not perceive discomfort in the mouth, head or neck (2.06/1.02-4.17). Access was greater among residents of homes registered by the FHS. Personal determinants of health, health-related behaviors and health outcomes are influenced or influence access to information regarding the prevention and management of oral diseases.

[Hepatitis B vaccination among dentists surgeons]. / Vacinação contra a hepatite B entre cirurgiões dentistas.

OBJECTIVE: Serological studies in several countries have found a higher prevalence of hepatitis B virus (HBV) among dentists when compared to the general population, especially among surgical specialties. The present study was carried out to determine the prevalence of hepatitis B (HB) vaccination and factors associated with no vaccination and incomplete vaccination among dentists. METHODS: A survey was conducted among 299 dentists living in Montes Claros, southeast Brazil, using a self-administered questionnaire. HBV vaccination prevalence was determined according to the number of doses of vaccine and factors associated with no vaccination or incomplete HBV vaccination were investigated using multinomial logistic regression analysis. RESULTS: Participation rate in the study was very high (296/299). Of the participants, 74.9% received three doses of HBV vaccine, 14% two doses, 2% a single dosis and 10% were not vaccinated. Complete vaccination rate was higher among surgeons and periodontists (89%). The main reason reported for not being vaccinated or incomplete vaccination was the need of more information. No vaccination was significantly higher among dentists aged 40 years and over (OR=8.62; 95%CI: 1.88-39.41) and those who did not attend refreshment courses in the last two years prior to the survey (OR=2.72; 95%CI: 1.02-7.22). Incomplete vaccination was positively associated with non-use of gloves during work (OR=2.32; 95%CI: 1.08-4.97). CONCLUSIONS: Lack of information, possibly associated to lower attendance to refreshment courses, seems to be one of the main factors affecting the vaccination rate.

Association between self-rated oral appearance and the need for dental prostheses among elderly Brazilians.

We investigated the association between poor self-rated oral appearance and the need for dental prostheses among elderly Brazilians. National data from an epidemiological survey on oral health in Brazil conducted from 2002 to 2003 by the Ministry of Health (SB, Brazil) with a multistage random sample of 4,839 individuals aged 65-74 years in 250 towns were analyzed. The dependent variable was self-rated oral appearance, dichotomized into "poor" (poor/very poor) and "good" (fair/good/very good). The main independent variable was the need for an upper or lower dental prosthesis. Other variables included sociodemographic characteristics, approach to dental care, oral health conditions, and self-reported oral disadvantage. Data were analyzed using the chi-square test and Poisson regression models at a 95% significance level. The prevalence of poor self-rated oral appearance was 20.6% and was higher in the elderly who needed a partial or complete upper or lower prosthesis, independent of other variables. This prevalence was associated with age, the use of dental services, access to information about oral disease prevention, number of decayed teeth, self-perception of the need for treatment, dental pain, chewing ability, and the perception that oral health affects relationships with other people. The elderly who needed dental prostheses had a higher prevalence of poor self-rated oral appearance than those who did not need any.

[Poor self-rated mastication and associated factors in Brazilian adults]. / Autopercepção da mastigação e fatores associados em adultos brasileiros.

This study estimated the prevalence of bad/very bad self-rated mastication and investigated associated factors among Brazilian adults. The sample included 13,431 adults examined and interviewed in the SBBrazil project. Self-rated mastication was combined in three categories: good/ very good (the reference), fair, and bad/very bad. Multinomial logistic regression was performed to measure the association between fair and bad/very bad self-rated mastication and all independent variables included in the analysis, with significance set at p < 0.05. 55.6% of participants rated their mastication as good/very good, 24.9% as fair, and 19.5% as bad/very bad. In the final multivariate analysis, factors associated with bad or fair self-rated mastication were: receiving no information on how to avoid oral problems; presenting fewer than 23 remaining teeth; requiring total or partial prosthesis; bad/very bad self-rated oral health; gingival pain and/or toothache in the previous year; and need of dental treatment. In conclusion, various factors were associated with self-rated mastication, especially subjective conditions, thus emphasizing its importance as an oral health indicator.

[Labor market status and the use of healthcare services in Brazil]. / Situação no mercado de trabalho e utilização de serviços de saúde no Brasil.

This study compares the use of health services among economically active men according to labor market status in the years 1998, 2003, 2008 and investigates whether both are associated after adjustment for socio-demographic characteristics and health indicators. All males aged 15 to 64, participating in the National Household Survey 1998, 2003 and 2008 were included. The association between labor market status and use of services in 2008 was estimated by Poisson regression. 33,726 males were surveyed and the prevalence of medical and dental care use was found to be higher among workers with social protection. The frequency of health care use increased over the period, but remained significantly higher among formally employed workers. Unemployment and work without social protection were negatively associated with medical and dental care visits. The socio-economic structure that establishes different social groups with unequal health conditions also affects the use of health services. Further investigation into the social and physical barriers to health care use by the unemployed and informal workers is required in order to reduce perceived health inequities.

Self-perceived oral health among Brazilian elderly individuals.

OBJECTIVE: To identify factors associated with self-perceived oral health among Brazilian elderly individuals. METHODS: Data from the Projeto SB Brasil (Brazilian Oral Health Project), conducted in 2002-2003, were used. A probabilistic sample of 5,349 elderly individuals, aged between 65 and 74 years, was analyzed, interviewed and subsequently grouped into dentate and edentate individuals. The dependent variable was self-perceived oral health condition, while independent variables were as follows: place of residence, individual characteristics, health-related behavior, objective health conditions and subjective health conditions. Descriptive and hierarchical multiple linear regression analyses were performed. RESULTS: In both groups, self-perceived oral health was considered positive, despite the poor oral health conditions found among the elderly. In the final model, place of residence and individual characteristics contributed little to explain the variability of self-perception. The use of dental services was associated with the outcome in dentate individuals, while objective and subjective conditions were associated in both groups. Among dentate and edentate individuals, R² for the external environment was 0.00; with the inclusion of individual characteristics, 0.05 and 0.02, respectively; with the inclusion of health-related behavior, 0.06 and 0.03, respectively; with the inclusion of objective health conditions, 0.11 and 0.04 respectively; and with the inclusion of subjective health conditions, 0.50 and 0.43, respectively. It was possible to explain 50% of the variability of self-perception in dentate individuals, and 43% in edentate ones. CONCLUSIONS: The main factors associated with self-perceived oral health in both groups were excellent self-perceived appearance, followed by positive self-perceived mastication. The third associated factor was reporting no need for dental treatment in dentate individuals, and self-perceived speech in edentate ones.

Maior acesso à informação sobre como prevenir o câncer bucal entre idosos assistidos na atenção primária à saúde / Greater access to information on how to prevent oral cancer among elderly using primary health care

Resumo Na promoção de saúde, as ações educativas são prioridade na Estratégia de Saúde da Família (ESF). Evidencia-se a eficácia dessas ações na adesão a comportamentos saudáveis e na redução nas taxas de morbimortalidade por câncer bucal. Objetivou-se identificar se o acesso a informações sobre como prevenir o câncer bucal é maior entre idosos residentes em domicílios cadastrados na ESF. Utilizou-se o SPSS® na obtenção de estimativas corrigidas pelo efeito do desenho amostral, considerando as magnitudes das associações do acesso a tais informações com os determinantes pessoais, uso dos serviços/custos com a saúde, comportamentos relacionados à saúde e desfechos da saúde. Dentre os 492 idosos, 58,9% relataram ter tido acesso a tais informações. Verificaramse maiores chances de acesso entre residentes em domicílios cadastrados na ESF; com maior renda per capita (2,01/1,18-3,43); não tabagistas (2,00/1,16-3,46); que realizaram autoexame bucal (6,35/3,46-11,64); e que não autoperceberam incômodo na boca, cabeça ou pescoço (2,06/1,024,17). O acesso foi maior entre os residentes em domicílios cadastrados na ESF. Determinantes pessoais, comportamentos relacionados à saúde e desfechos de saúde sofrem influência ou influenciam a oferta e o acesso a essas informações.

Abstract Educative actions are an important component of health promotion in Brazil's primary healthcare program, the Family Health Strategy (FHS). The efficacy of these actions is evidenced by compliance with healthy behaviors and in the reduction of rates of mortality and morbidity. The objective of this study was to identify whether access to information regarding the prevention of oral cancer is greater among elders whose residences are registered with the FHS. SPSS® was utilized to obtain estimates that were corrected for sample design, considering the magnitude of the associations between access to such information with personal determinants, the use and cost of healthcare, health-related behaviors and health outcomes. 58.9% of the 492 participating elders reported having access to such information. We verified that there was a greater chance for access among residents of houses registered by the FHS; those with greater per capita income (2.01/1.183.43); non-smokers (2.00/1.16-3.46); those that realized oral self-examination (6.35/3.46-11.64); and those that did not perceive discomfort in the mouth, head or neck (2.06/1.02-4.17). Access was greater among residents of homes registered by the FHS. Personal determinants of health, health-related behaviors and health outcomes are influenced or influence access to information regarding the prevention and management of oral diseases.

[Objective and subjective factors related to self-rated oral health among the elderly]. / Auto-avaliação de saúde bucal em idosos: análise com base em modelo multidimensional.

The aim of this study was to investigate factors associated with negative self-rated oral health. Elderly subjects from the Brazilian Ministry of Health's oral health survey (2002-2003) who rated their own oral health as bad or very bad were compared to those who rated their oral health as excellent, good, or fair, using prevalence ratios based on Poisson regression. The minority (870; 17%) gave their own oral health a negative rating. Negative self-rated oral health was less prevalent among those with 1-9 teeth and the edentulous, and more prevalent among blacks, mixed-race, and indigenous, those who had never used dental service, with soft tissue alterations, who reported little pain or medium to intense pain, rated their own appearance and chewing as fair or bad or very bad, reported that their oral health limited their social interaction a little or considerably, and reported needing dental treatment (PR = 1,47; 95%CI: 1.20-1.79). Despite their precarious oral conditions, the majority gave their oral health a positive rating. Subjective conditions were more heavily associated with self-rated oral health than were objective conditions. The findings suggest unequal oral health conditions and allow orienting public policies aimed at oral health and quality of life.

Association between self-rated oral appearance and the need for dental prostheses among elderly Brazilians

We investigated the association between poor self-rated oral appearance and the need for dental prostheses among elderly Brazilians. National data from an epidemiological survey on oral health in Brazil conducted from 2002 to 2003 by the Ministry of Health (SB, Brazil) with a multistage random sample of 4,839 individuals aged 65–74 years in 250 towns were analyzed. The dependent variable was self-rated oral appearance, dichotomized into “poor” (poor∕very poor) and “good” (fair∕good∕very good). The main independent variable was the need for an upper or lower dental prosthesis. Other variables included sociodemographic characteristics, approach to dental care, oral health conditions, and self-reported oral disadvantage. Data were analyzed using the chi-square test and Poisson regression models at a 95% significance level. The prevalence of poor self-rated oral appearance was 20.6% and was higher in the elderly who needed a partial or complete upper or lower prosthesis, independent of other variables. This prevalence was associated with age, the use of dental services, access to information about oral disease prevention, number of decayed teeth, self-perception of the need for treatment, dental pain, chewing ability, and the perception that oral health affects relationships with other people. The elderly who needed dental prostheses had a higher prevalence of poor self-rated oral appearance than those who did not need any.

[Utilization of dental services among the elderly in Brazil]. / Uso de serviços odontológicos entre idosos brasileiros.

OBJECTIVE: To investigate the pattern of dental services use and its determinants among the elderly in Brazil. METHODS: The study included the elderly participating in the Ministry of Health of Brazil's oral health survey carried out in 2002 and 2003 who had used dental services at least once in their lifetime. Dentulous and edentulous individuals were compared and analyzed separately using multiple logistic regression. RESULTS: Of 5,009 participants, 46.0% were dentulous and 54.0% edentulous. The prevalence of dental services use in the year right before the survey was 26.6% and 10.4%, respectively. Among dentulous participants, the utilization rate was higher in those with more years of schooling, those who perceived their chewing as poor/very poor, and those who reported feeling oral pain; and lower in those who did not have information on oral health, who perceived their oral health as poor/very poor, those with lower per capita income, those who required prostheses and used them, and who required prostheses and did not use them, those with periodontal problems, and with a higher number of extracted teeth. Among edentulous participants, the utilization rate was higher in those with more years of schooling and those reporting oral pain; and lower in non-whites and in those who did not have information on oral health. CONCLUSIONS: The oral health of the elderly in Brazil is deficient and the use of dental services was lower among those who needed them most. The factors associated with dental services utilization differ for dentulous and edentulous individuals. The only similarities are schooling, having information on oral health, and having experienced pain in the teeth and gums in the previous three months. Public investment in oral health is needed to turn around this scenario.

Autopercepção da mastigação e fatores associados em adultos brasileiros / Poor self-rated mastication and associated factors in Brazilian adults

Propôs-se estimar a prevalência da autopercepção da mastigação e investigar os fatores relacionados à autopercepção regular e ruim. Foram entrevistados e examinados 13.431 adultos, participantes do projeto SBBrasil. Foram realizadas análises descritiva, bivariada (χ2; p < 0,20) e multivariada por meio de regressão logística multinomial (p < 0,05), com IC95%. 55,6% classificaram a mastigação como boa; 24,9%, como regular; e 19,5%, como ruim. Na analise bivariada, todos os fatores foram associados à autopercepção da mastigação regular ou ruim (p < 0,20). No modelo final, os fatores associados tanto com a percepção regular como ruim foram: não receber informações sobre como evitar problemas bucais, apresentar menos de 23 dentes remanescentes, necessitar de prótese parcial ou total, perceber a saúde bucal como regular ou ruim/péssima, relatar dor em dentes e gengivas e necessidade de tratamento odontológico. Conclui-se que diversos fatores associam-se à autopercepção da mastigação, principalmente as condições subjetivas, reforçando sua importância como indicador em saúde bucal.

This study estimated the prevalence of bad/very bad self-rated mastication and investigated associated factors among Brazilian adults. The sample included 13,431 adults examined and interviewed in the SBBrazil project. Self-rated mastication was combined in three categories: good/ very good (the reference), fair, and bad/very bad. Multinomial logistic regression was performed to measure the association between fair and bad/very bad self-rated mastication and all independent variables included in the analysis, with significance set at p < 0.05. 55.6% of participants rated their mastication as good/very good, 24.9% as fair, and 19.5% as bad/very bad. In the final multivariate analysis, factors associated with bad or fair self-rated mastication were: receiving no information on how to avoid oral problems; presenting fewer than 23 remaining teeth; requiring total or partial prosthesis; bad/very bad self-rated oral health; gingival pain and/or toothache in the previous year; and need of dental treatment. In conclusion, various factors were associated with self-rated mastication, especially subjective conditions, thus emphasizing its importance as an oral health indicator.

Situação no mercado de trabalho e utilização de serviços de saúde no Brasil / Labor market status and the use of healthcare services in Brazil

Este estudo compara a utilização de serviços de saúde segundo a situação no mercado de trabalho em três anos e investiga se estão associados após ajuste por características sócio-demográficas e presença de doença crônica. Foram estudados homens de 15 a 64 anos, incluídos na PNAD de 1998, 2003 e 2008 de acordo com a utilização de consulta médica e internação nos últimos 12 meses e visita ao dentista há menos de três anos. A associação entre a situação no mercado de trabalho e o uso de serviços de saúde em 2008 foi estimada pela regressão de Poisson. Foram estudados 33.726 homens. As prevalências de consulta médica e odontológica aumentaram ao longo do período, mas mantiveram-se mais elevadas entre os trabalhadores com proteção social. Desemprego e trabalho sem proteção social foram independente e negativamente associados à menor prevalência de consulta médica e odontológica em 2008. Conhecer as barreiras e aumentar a oferta de serviços com perfil de funcionamento adequado para quem trabalha é fundamental para tentar reduzir as iniquidades observadas. Por outro lado, promover a inserção no trabalho com garantias dos direitos sociais pode contribuir para a melhoria dos indicadores de saúde pública.

This study compares the use of health services among economically active men according to labor market status in the years 1998, 2003, 2008 and investigates whether both are associated after adjustment for socio-demographic characteristics and health indicators. All males aged 15 to 64, participating in the National Household Survey 1998, 2003 and 2008 were included. The association between labor market status and use of services in 2008 was estimated by Poisson regression. 33,726 males were surveyed and the prevalence of medical and dental care use was found to be higher among workers with social protection. The frequency of health care use increased over the period, but remained significantly higher among formally employed workers. Unemployment and work without social protection were negatively associated with medical and dental care visits. The socio-economic structure that establishes different social groups with unequal health conditions also affects the use of health services. Further investigation into the social and physical barriers to health care use by the unemployed and informal workers is required in order to reduce perceived health inequities.

Autopercepção da saúde bucal entre idosos brasileiros / Self-perceived oral health among Brazilian elderly individuals

OBJETIVO: Identificar os fatores associados à autopercepção da saúde bucal entre idosos brasileiros. MÉTODOS: Utilizaram-se dados do Projeto SB Brasil, realizado em 20022003. Foi examinada e entrevistada amostra probabilística de 5.349 idosos de 65 a 74 anos agrupados em dentados e edentados. A variável dependente foi autopercepção da condição de saúde bucal e as independentes foram: local de moradia, características individuais, comportamentos relacionados à saúde, condições objetivas de saúde e condições subjetivas relacionadas à saúde. Foram conduzidas análises descritivas e análises de regressão linear múltipla hierárquica. RESULTADOS: Nos dois grupos a autopercepção da saúde bucal foi considerada positiva, apesar das precárias condições de saúde bucal entre os idosos. No modelo final, o local de moradia e as características individuais pouco contribuíram para explicar a variabilidade da autopercepção. Entre dentados, o uso de serviços odontológicos esteve associado ao desfecho, e as condições objetivas e subjetivas se mostraram associadas nos dois grupos. Entre dentados e edentados, o R² para o ambiente externo foi de 0,00; com o acréscimo das características individuais, respectivamente, 0,05 e 0,02; incluindo o comportamento relacionado à saúde, 0,06 e 0,03; acrescentando as condições objetivas de saúde, 0,11 e 0,04; adicionando as condições subjetivas relacionadas à saúde foram 0,50 e 0,43. Foi possível explicar 50 por cento da variabilidade da autopercepção entre dentados e 43 por cento entre edentados. CONCLUSÕES: Os principais fatores associados à autopercepção da saúde bucal como positiva nos dois grupos foram a autopercepção da aparência como ótima seguida pela autopercepção da mastigação como positiva. O terceiro fator associado, entre dentados, foi o relato de nenhuma necessidade de tratamento odontológico e, entre edentados, a autopercepção da fala.

Auto-avaliação de saúde bucal em idosos: análise com base em modelo multidimensional / Objective and subjective factors related to self-rated oral health among the elderly

Propôs-se investigar fatores associados à auto-avaliação negativa da saúde bucal. Idosos, participantes do inquérito de saúde bucal do Ministério da Saúde, 2002-2003, que auto-avaliaram sua saúde bucal como ruim/péssima foram comparados aos que a auto-avaliaram como ótima/boa/regular usando-se razões de prevalências (RP) com base na regressão de Poisson. A minoria (870 - 17 por cento) auto-avaliou sua saúde bucal negativamente. A auto-avaliação negativa foi menor entre aqueles com 1-9 dentes e edentados, maior entre pardos/negros/índios, que nunca usaram serviços, que apresentavam alterações de tecidos moles, que relataram pouca e média/muita dor, que auto-avaliaram sua aparência e mastigação como regular ou ruim/péssima, entre os que relataram seus relacionamentos sociais pouco ou muito afetados pelas condições bucais e entre os que avaliavam necessitar de tratamento bucal. Apesar das precárias condições bucais, a maioria auto-avaliou positivamente sua saúde bucal. Condições subjetivas estiveram mais fortemente associadas do que as objetivas. Os resultados sugerem iniqüidade e permitem orientar políticas públicas que objetivem saúde bucal e qualidade de vida.

The aim of this study was to investigate factors associated with negative self-rated oral health. Elderly subjects from the Brazilian Ministry of Health's oral health survey (2002-2003) who rated their own oral health as bad or very bad were compared to those who rated their oral health as excellent, good, or fair, using prevalence ratios based on Poisson regression. The minority (870; 17 percent) gave their own oral health a negative rating. Negative self-rated oral health was less prevalent among those with 1-9 teeth and the edentulous, and more prevalent among blacks, mixed-race, and indigenous, those who had never used dental service, with soft tissue alterations, who reported little pain or medium to intense pain, rated their own appearance and chewing as fair or bad or very bad, reported that their oral health limited their social interaction a little or considerably, and reported needing dental treatment (PR = 1,47; 95 percentCI: 1.20-1.79). Despite their precarious oral conditions, the majority gave their oral health a positive rating. Subjective conditions were more heavily associated with self-rated oral health than were objective conditions. The findings suggest unequal oral health conditions and allow orienting public policies aimed at oral health and quality of life.

Características associadas ao uso de serviços odontológicos entre idosos dentados e edentados no Sudeste do Brasil: Projeto SB Brasil / Characteristics associated with use of dental services by dentate and edentulous elders: the SB Brazil Project

Investigou-se o uso de serviços odontológicos entre idosos dentados e edentados residentes na Região Sudeste do Brasil, participantes do inquérito saúde bucal realizado pelo Ministério da Saúde em 2002/2003. Os idosos que usaram serviço há menos de um ano foram comparados aos que usaram há mais de um ano. Do total, 345 eram dentados e 669 edentados, sendo a prevalência de uso, 32 por cento e 11 por cento, respectivamente. Na regressão logística multivariada entre dentados, o uso foi maior entre idosos que percebiam a fala influenciada pela saúde bucal e menor entre residentes rurais; com menor renda; que usaram por problema bucal; que tinham sextante excluído; que necessitavam de prótese e que percebiam a aparência como péssima. Entre edentados, o uso foi maior entre idosos com 5-8 anos de escolaridade; que relatavam sensibilidade dolorosa; que percebiam a aparência como péssima; e menor entre idosos que usaram por problema bucal e que percebiam o relacionamento afetado pela condição bucal. A análise mostrou diferenças entre dentados e edentados. O menor uso entre idosos que mais necessitam sugere iniqüidade no acesso aos serviços odontológicos.

This study focused on the characteristics associated with use of dental services during the previous year by Brazilian elderly (with and without teeth) participating in the Brazilian oral health survey (Ministry of Health, 2002/2003). 345 were dentate and 669 edentulous. Prevalence of use was 32 percent and 11 percent, respectively. Multivariate logistic regression showed that for dentate elders, use of dental services was more frequent among those who perceived their voices as influenced by oral health. Less frequent use was associated with: residence in rural areas; low income; current oral problems; fewer than two teeth in at least one sextant of the arch; need for dentures; and worse self-perceived appearance. Among edentulous elders, more frequent use was associated with: 5 to 8 years of schooling; pain; and poor self-perceived appearance. Use was less frequent among elders with current oral problems and those who perceived that their personal relations were influenced by oral health. The analysis reviewed the differences between dentate and edentulous individuals. Use of dental services was less common among individuals who needed them the most, suggesting inequality in access to such services among the Brazilian elderly.

Fatores relacionados à autopercepção da necessidade de tratamento odontológico entre idosos / Factors associated to self perceived need of dental care among Brazilian elderly

OBJETIVO: Analisar fatores associados à autopercepção da necessidade de tratamento odontológico entre idosos. MÉTODOS: Foram pesquisados 5.326 indivíduos incluídos em amostra dos idosos (65-74 anos) brasileiros do inquérito domiciliar de saúde bucal realizado em 2002/2003 pelo Ministério da Saúde. A análise foi baseada no modelo de Gift, Atchison & Drury e foi utilizada a regressão de Poisson para análise de inquéritos com amostras complexas. RESULTADOS: Do total da amostra, 2.928 (55 por cento) idosos relataram necessitar tratamento odontológico. A autopercepção dessa necessidade foi menor entre aqueles com 70 anos ou mais (RP=0,94; IC 95 por cento: 0,89;0,99), que não receberam informações sobre como evitar problemas bucais (RP=0,89; IC 95 por cento: 0,83;0,95) e que eram edentados (RP=0,68; IC 95 por cento: 0,62;0,74). Foi maior entre aqueles que autoperceberam: saúde bucal regular (RP=1,31; IC 95 por cento: 1,21;1,41) ou ruim/péssima (RP=1,29; IC 95 por cento: 1,19;1,41); aparência como regular (RP=1,23; IC 95 por cento: 1,15;1,32) ou ruim/péssima (RP=1,28; IC 95 por cento:1,18;1,39); mastigação como regular (RP=1,08; IC 95 por cento: 1,01;1,15) ou ruim péssima (RP=1,13; IC 95 por cento:1,05;1,21); os que relataram dor nos dentes ou gengivas nos seis meses anteriores ao inquérito (RP=1,27; IC 95 por cento: 1,18;1,36); os que necessitavam de prótese em uma arcada (RP=1,29; IC 95 por cento: 1,19-1,39) ou em ambas (RP=1,27; IC 95 por cento: 1,16;1,40). CONCLUSÕES: Informação, condições de saúde bucal e questões subjetivas estiveram associadas à autopercepção da necessidade de tratamento odontológico. Os resultados reforçam a necessidade de capacitar os indivíduos para realizarem o auto-exame bucal e identificar precocemente os sinais e sintomas não dolorosos das lesões da mucosa, da cárie e da doença periodontal.

Uso de serviços odontológicos por rotina entre idosos brasileiros: Projeto SB Brasil / Routine use of dental services by the elderly in Brazil: the SB Brazil Project

Investigou-se o uso de serviços odontológicos por rotina entre idosos brasileiros participantes do Projeto SB Brasil. Desses, 2.305 eram dentados, 2.704, edentados, a prevalência do uso foi de 20 por cento e 17 por cento, respectivamente. A regressão logística mostrou que, entre dentados, o uso foi maior entre aqueles com maior escolaridade e menor entre residentes no Norte e Nordeste; na zona rural; que não usaram no último ano; que não foram informados sobre como evitar problemas bucais; que relataram dor; que necessitavam de próteses e de tratamento periodontal; que autoperceberam sua mastigação regular; cuja condição bucal afetava o relacionamento; que autoperceberam sua fala ruim/péssima. Entre edentados, o uso por rotina foi maior entre aqueles com maior escolaridade e entre usuários de serviços pagos. Foi menor entre não brancos; residentes no nordeste; na zona rural; que não usaram no último ano; que não foram informados sobre como evitar problemas bucais; os com menor renda; que necessitavam de prótese; cuja condição bucal afetava o relacionamento. Iniqüidades, barreiras financeiras e falta de informações parecem prejudicar o uso rotineiro, indicando necessidade de políticas públicas.

The routine use of dental services by elderly participants in a representative survey of Brazilians (the SB Brazil Project) was investigated. 2,305 were dentate and 2,704 edentulous. Prevalence of use was 20 percent and 17 percent, respectively. Poisson regression showed that for dentate individuals, use was lower among residents who: lived in rural areas; had not received preventive oral health information; had lower incomes; needed a dental prosthesis; had periodontal problems; perceived their chewing as fair, bad, or terrible; felt that oral health affected their social interaction; and reported tooth pain. Among edentulous individuals, use was higher among those who paid out-of-pocket for dental services and was lower among those who: lived in rural areas; had used dental services more than a year previously; self-identified as non-white; had not received preventive oral health information; had less schooling; needed a dental prosthesis; and felt that oral health affected their social interaction. Inequalities, economic barriers, and lack of information jeopardized the routine use of dental services. Targeted public policies are required to correct these problems.