Association between frailty and oral health services use in Brazilian older adults.

OBJECTIVES: To assess the association between frailty and oral health services use in Brazilian older adults. METHODS: This cross-sectional study analysed the baseline data from the Longitudinal Study on Brazilian Ageing (ELSI-Brazil) representative of Brazilians aged 50 or over. The outcome was oral health services used in the year prior to the interview. The main exposure variable was Frailty defined by the frailty phenotype. Age, skin colour, wealth, sex, education, type of service, health insurance, number of teeth and self-perceived oral health were included as covariates. Prevalence ratios (PR) with their respective 95% confidence intervals (CI) were estimated using Poisson regression with robust variance. RESULTS: 8405 individuals were included in this study. The prevalence of frailty was 7.5%. Regarding frailty status, the prevalence of dental service use was 47.0%, 48.5% and 4.5% for robust, pre-frail and frail individuals, respectively. Frail individuals had a 7% higher prevalence of not using dental (PR: 1.07; 95% CI: 1.01-1.13) than robust individuals. Frailty was independently associated with not using oral health services. CONCLUSION: Given the complexity of the determinants of dental service use, frailty adds another dimension to be examined in older adults. Public health strategies considering a common risk factor approach should be endorsed.

Preventive dental service use and oral health-related quality of life in Brazilian older adults.

BACKGROUND: Information on the use of preventive dental services and associated variables is needed to guide policy for the old adult population and consequently promote better oral health-related quality of life (OHRQoL). OBJECTIVE: To investigate the association between preventive dental service use and OHRQoL by older Brazilians. MATERIALS AND METHODS: This cross-sectional study was carried out using the baseline data of participants of the Brazilian Longitudinal Stud of Aging (ELSEI-Brazil) who were aged 60 years or more. Associations with the use of preventive dental services were carried out using Poisson regression models with robust variance, adjusting for confounders. RESULTS: The final sample consisted of 5432 older adults. Almost all (90.7%) participants reported not having sought preventive dental services in the last year. Individuals who used dental services for prevention had fewer impacts on their OHRQoL (RR: 0.74; [95% CI: 0.57-0.97]). CONCLUSION: Preventive dental service use is associated with a better OHRQoL in older Brazilians. Policies to improve access to preventive dental services may result in improved OHRQoL in this age group.

Psychosocial aspects associated with self-reported oral health in Brazilians older adults.

OBJECTIVES: Oral health conditions can be determined by a series of factors that include psychosocial aspects. Therefore, this study aimed to investigate the association between psychosocial aspects and self-reported oral health in Brazilian older adults. METHODS: The Brazilian Longitudinal Study of Ageing (ELSI-Brazil) baseline data was analysed to develop this cross-sectional study. The outcome was self-reported oral health, and the psychosocial aspects included neighbourhood trust, life satisfaction and depressive symptoms. The associations were determined through Poisson regression models, controlling for socioeconomic, demographic and behavioural characteristics. RESULTS: A total of 9365 individuals with aged 50 years or over were included in this study. Individuals with good life satisfaction had 16% (PR: 0.84; 95% CI: 0.78-0.90) lower prevalence of having poor self-reported oral health. Individuals who have depressive symptoms and do not trust in the neighbourhood presented 17% (PR: 1.17; 95% CI: 1.09-1.25) and 12% (PR: 1.12; 95% CI: 1.04-1.21) higher prevalence of poor self-report oral health compared to those who did not show depressive symptoms and trust the neighbourhood. CONCLUSION: Our findings suggest that positive psychosocial aspects are moderately associated with better self-reported oral health. Therefore, we suggest that psychological health and social interaction should be present in public health policy actions.

Social capital and dental service use in older Brazilians.

OBJECTIVES: To estimate the prevalence of dental services use and its association with social capital among Brazilian older adults. BACKGROUND: Health inequities can be explained by the social determinants of health, which are the social, environmental, cultural and behavioural factors that directly or indirectly affect people's health. Among these determinants is social capital, that seem to affect health behaviours, such as use of dental services among older adults. MATERIALS AND METHODS: This was a cross-sectional study using baseline data from the Longitudinal Study of the Health of the Brazilian Elderly, nationally representative of people aged 50 years or older. The baseline survey was carried out between 2015 and 2016, using structured questionnaires. The dependent variable was use of dental services in the last year. The main exposure variable was social capital, assessed through two dimensions: structural and cognitive. The covariates used were sex, skin colour, age, education, wealth, need for dental treatment, self-perception of oral health, tooth loss, type of dental services used, reason for dental care, smoking and alcohol consumption. Descriptive analyses and Poisson regression modelling were used. RESULTS: The sample consisted of 9323 individuals. The prevalence of dental services use was 32.6% (95% CI: 30.7-34.5). No associations were found between social capital and the use of dental services. CONCLUSION: This study did not find an association between structural and cognitive social capital and dental services use in Brazilian older adults. Further researches using instruments with different assessments of social capital are needed.

Pathways Between Religiosity and Tooth Loss in Older Adults in Brazil.

The aim of this cross-sectional study was to evaluate the direct and indirect pathways between religiosity and tooth loss in older adults from Brazil. We analyzed the data of the Brazilian Longitudinal Study of Aging, a nationally representative study of individuals aged 50 years or older. The pathways were analyzed through structural equation modeling. A total of 9073 individuals were evaluated. It was observed that oral hygiene and smoking were mediators of the relationship between religiosity and tooth loss, through spirituality and social support, respectively. Spirituality also directly influenced the tooth loss.

Discrimination due to sexual orientation and oral health-related quality of life among adolescents.

To evaluate the association between discrimination based on sexual orientation and oral health-related quality of life (OHRQoL) in adolescents. This was a cross-sectional study nested in a cohort performed in southern Brazil. The baseline assessment was carried out in 2010 with a sample of preschoolers (1 to 5 years). Subsequently, these individuals were reassessed, and for the present study, only the data from the final follow-up in 2020 were considered. OHRQoL was assessed by the short version of the Child Perceptions Questionnaire 11-14 (CPQ11-14). The discrimination due to sexual orientation was measured using item 10 of the Olweus Bully/Victim Questionnaire. Sociodemographic (sex, age, skin color, maternal education, household income) psychosocial (sense of coherence), and clinical variables (untreated dental caries) were also evaluated. Multilevel Poisson regression analysis was performed to verify the associations. Results are present as rate ratio (RR) and 95% confidence interval (95% CI). A total of 429 adolescents were evaluated - about 67.1% of those assessed at baseline. The prevalence of discrimination due to sexual orientation was 3.3%. Adolescents who reported suffering episodes of discrimination due to sexual orientation presented overall CPQ11-14 scores 16% higher (RR 1.16, 95%CI 1.01-1.36) than their counterparts. Adolescents who reported suffering episodes of discrimination due to sexual orientation presented poorer OHRQoL.

Distribution of Edentulism by the Macro Determinants of Health in 204 Countries and Territories: An Analysis of the Global Burden of Disease Study.

OBJECTIVE: To carry out a comprehensive description of edentulism estimates by the macro determinants of health in 2000, 2010 and 2019 worldwide. METHODS: This ecological study analyzed data from the Global Burden of Disease Study (GBD) to describe the incidence rate, prevalence rate and years lived with disability (YLDs) rate due to edentulism by macro determinants of health (governance, macroeconomic policy, social policy, public policies, societal values), for 204 countries and territories. The estimates were reported as rates (cases/100,000 people), for people of both sexes aged 55 years or older. RESULTS: Countries belonging to the least privileged categories of the macro determinants showed the lowest prevalence rate, incidence rate, and YLD rate due to edentulism for all exposures. Countries with low government expenditure on health showed the lowest prevalence rate of edentulism in 2000 (18,972.1; 95 %CI 15,960.0 - 21,984.3) and 2010 (16,646.8; 95 %CI: 14,218.3-19,075.4) than those with high government expenditure on health in 2000 (25,196.6; 95 %CI: 23,226.9 - 27,166.2) and 2010 (21,014.7; 95 %CI: 19,317.9 - 22,711.5). Countries with low SDI showed the lowest YLDs in 2000 (321.0, 95 %CI: 260.1- 381.9), 2010 (332.0; 95 %CI: 267.7-396.3), and 2019 (331.6; 95 %CI: 266.6-396.5). CONCLUSION: The findings point to persistent inequalities in the distribution of edentulism between countries worldwide. The most privileged countries, with higher economic development, better governance, and better social and public policies, have shown higher rates of edentulism. CLINICAL SIGNIFICANCE: This model must be reconsidered by advancing toward upstream and midstream strategies, beyond its conventional downstream clinical interventions.

The mediating role of social capital in socioeconomic inequalities of oral health behaviours among Brazilian older adults.

OBJECTIVES: Knowledge of the possible pathways linking socioeconomic status (SES) to oral health-related behaviours can improve the understanding of inequalities in oral health. Therefore, in this study, it was investigated whether social capital mediates the relationship between SES and oral health behaviours. METHODS: Through a cross-sectional study, data were analysed from participants aged ≥60 years from the Brazilian National Health Survey 2019 (n = 21 575). Structural equation modelling was used to test the direct and indirect pathways from a latent variable for SES to a latent variable for oral health behaviours: daily flossing, toothbrushing frequency and the use of dental care services. RESULTS: The maximum likelihood estimator was used for complex samples with robust standard errors, and the final model demonstrated an adequate fit. The findings demonstrated that a higher SES was directly associated with better oral health-related behaviours (standardized coefficient [SC]: 0.82; [90% CI: 0.78-0.85]) and indirectly via structural social capital (SC: 0.05; [90% CI: 0.02-0.07]). The total effect of SES on oral health-related behaviours was (SC: 0.87, [90% CI: 0.85-0.89]). CONCLUSION: The findings demonstrate that structural social capital in older Brazilian adults might partly mediate the pathways to socioeconomic inequalities in oral health behaviours. However, there is a direct effect on oral health behaviours, reinforcing the hypothesis that SES is associated with oral health, based on paths that link income inequality to oral health.

Wealth index association with self-reported oral health between white and non-white older Brazilians.

This cross-sectional study aimed to identify the association between self-reported oral health status and a wealth index among white and non-white older adults in Brazil. Data from individual assessments of 9,365 Brazilians aged 50 years or older were analyzed. Poisson regression models were performed to estimate the prevalence ratio between wealth index and self-reported oral health among whites and non-whites adjusted for intermediate and proximal determinants. The total prevalence of poor self-reported oral health on white and non-white individuals was 41.6% (95%CI: 40.0-43.4) and 48% (95%CI: 47.1-49.8) respectively. The adjusted analysis showed that, for whites, the wealth index is associated with self-reported oral health since individuals in the 3rd, 4th, and 5th quintiles have 25% (PR = 0.75; 95%CI: 0.65-0.88), 20% (PR = 0.80; 95%CI: 0.67-0.95), and 39% (PR = 0.61; 95%CI: 0.50-0.75) lower prevalence of poor self-reported oral health than those in the poorest quintile. For non-white individuals, the wealth index is associated with self-reported oral health only for those in the 5th quintile, with 25% (PR = 0.85; 95%CI: 0.72-0.99) lower prevalence of poor self-reported oral health than those in the poorest quintile. The wealth index showed different effects on self-reported oral health among whites and non-whites. Socioeconomic status indicators may reflect racial inequalities due to the historical legacy of institutional discrimination. This study highlights the importance of developing policies to combat racial inequities and how these can contribute to better oral health conditions for the older Brazilian population.

Dental visits and depression mediating the association of socioeconomic status with oral health behaviors.

Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the "Patient Health Questionnaire-9") and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.

Pathways that explain racial differences on edentulism among older adults: 2019 Brazil National Health Survey.

This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3-52.6), and 36.8% (95%CI: 35.7-37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

Measuring health inequalities: implications of choosing different socioeconomic indicators.

We aimed to verify the association between different socioeconomic indicators and self-rated health in a nationally representative sample of older adults. This cross-sectional study analyzed the baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a population-based cohort study of persons aged 50 years or older. Data was collected using a household and an individual questionnaire at participants' households. Self-rated health was assessed by a global self-rating item. Three socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression models were performed to estimate the prevalence ratio (PR) and 95% confidence intervals (95%CI) of self-rated health and each socioeconomic indicator, adjusting for covariates. In total, 9,390 older adults answered the outcome question. Whilst for the individual income indicator only the richest quintile showed a statistically significant association with the outcome (PR: 0.90; 95%CI: 0.87; 0.93), for the per capita household income, the fourth (PR: 0.95; 95%CI: 0.91; 0.98) and the fifth quintiles (PR: 0.90; 95%CI: 0.86; 0.94) remained associated with the outcome. Regarding the wealth index, only the second quintile was not associated with the outcome, with lower prevalence of poor self-rated health as richer was the quintile, showing a social gradient. The wealth index seems to be a more adequate indicator, as it reflects resources accumulated over the life course.

Association between perceived discrimination in health services and oral health-related quality of life in older adults.

OBJECTIVE: To verify the association between perceived discrimination in health services and oral health-related quality of life (OHRQoL) in Brazilian older adults. METHODS: In this cross-sectional study, it was analyzed the baseline data from the "Longitudinal Study of the Health of Elderly Brazilians" (ELSI-Brazil), which included a representative sample of individuals aged ≥ 60 years. The dependent variable was the impact on OHRQoL, assessed using the Oral Impacts on Daily Performances (OIDP) questionnaire. The association between perceived discrimination and OHRQoL was verified using Poisson regression models adjusted for socioeconomic and demographic factors. Owing to the complexity of the sample, the sample weight was considered in all analyses. RESULTS: Data from 5432 individuals were analyzed. In both the crude [rate ratio (RR): 1.92, 95% confidence interval (CI): 1.70-2.16] and adjusted analyses (RR: 1.85, 95% CI: 1.62-2.11), the mean impact on OHRQoL was higher in individuals who experienced discrimination in health services than in those who did not. CONCLUSION: The findings suggest that perceived discrimination in health services has a negative impact on OHRQoL in older adults. To combat intrinsic social behaviors, such as discrimination, it is essential to eliminate health inequities and to promote social justice. CLINICAL SIGNIFICANCE: Participation in health-related behaviors is paramount for promoting health and preventing oral diseases. However, discrimination may erode an individual's protective resources and increase vulnerability to disease onset. Therefore, perceived discrimination may potentially decrease participation in healthy behaviors, leading to worse oral health outcomes.

Association between integrative and complementary health practices and use of dental services among older adults in Brazil: a cross-sectional study, 2019. / Associação entre práticas integrativas e complementares em saúde e uso de serviços odontológicos em idosos no Brasil: estudo transversal, 2019.

OBJECTIVE: To analyze association between participation in integrative practices and regular use of dental services in Brazilian older adults. METHODS: This was a cross-sectional study based on secondary data from the 2019 National Health Survey. All older adults aged 60 years and over were included. The study outcome was regular dental service use. Poisson regression models were used to estimate crude and adjusted prevalence ratios (PRs) and their respective at confidence intervals 95% (95%CI). RESULTS: A total of 22,728 older adults were analyzed. Most were female (55.5%), reported that they were White (51.3%), had incomplete primary education (47.0%); 7.0% (95%CI 6.8;7.5) had used some form of integrative practice and 34.3% (95%CI 33.2;35.4) had used their dental service regularly. Individuals who used integrative practices had higher prevalence of dental service use even after adjusting the model (PR = 1.15; 95%CI 1.07;1.23). CONCLUSION: Among Brazilian older adults use of integrative practices was associated with regular use of dental services.

Factors associated with self-perceived oral health in different age groups.

OBJECTIVES: To determine the factors associated with self-perceived oral health (SPOH) in different age groups. METHODS: This cross-sectional study used probabilistic samples of adolescents, adults and older adults from São Paulo State, Brazil. SPOH was assessed using a global self-rating item. Hierarchical Poisson regression models were used to determine the estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for poor SPOH and demographic and socio-economic variables, social capital, dental attendance and clinical measures. The analyses for each age group were performed separately. RESULTS: Data from 5314 adolescents, 5815 adults and 5556 older adults were analysed. Female adolescents and adults, non-White adults and older adults with a higher educational level had worse SPOH. Adolescents, adults and older adults with lower social capital showed higher rates of poor SPOH (PR = 1.58; 95% CI: 1.27-1.97, PR = 1.20; 95% CI: 1.10-1.31 and PR = 1.26; 95% CI: 1.06-1.49, respectively). Those whose reason for last dental attendance was treatment had worse SPOH, regardless of age group. Adolescents, adults and older adults with greater number of decayed teeth had worse SPOH (PR = 1.56; 95% CI: 1.37-1.77, PR = 1.30; 95% CI: 1.22-1.38, and PR = 1.29; 95% CI: 1.17-1.42, respectively). Adolescents and adults with more missing teeth presented higher rates of poor SPOH (PR = 1.23; 95% CI: 1.04-1.44 and PR = 1.09; 95% CI: 1.02-1.16, respectively). Older adults needing a dental prosthesis had worse SPOH (PR = 2.13; 95% CI: 1.88-2.41). CONCLUSION: There are differences in the factors associated with SPOH between age groups, and these differences reflect social inequalities in health.

Pathways of socioeconomic inequalities in self-perceived oral health.

Although there is a large body of evidence of the influence of social determinants on oral health, information on the mechanisms by which these determinants operate is poorly documented. Therefore, we aimed to investigate the pathways through which socioeconomic inequalities may influence self-perceived oral health (SPOH) in Brazilian adults. This cross-sectional study used data from the National Health Survey (NHS) of 2019, with a representative sample of adults aged 18 to 59 years (n = 65,803). The outcome was SPOH, assessed by a global self-item. Structural equation modeling was used to test direct and indirect pathways connecting a latent variable for socioeconomic position (SEP) to SPOH via psychosocial, behavioral, and biological factors. Higher SEP was directly associated with better SPOH [standardized coefficient (SC) = 0.069; p < 0.01)] fewer depressive symptoms (SC = -0.059; p < 0.01), fewer missing teeth (SC = 0.131; p < 0.01), and more healthy behaviors (SC = 0.643; p < 0.01). Fewer depressive symptoms (SC = -0.141; p < 0.01), more healthy behaviors (SC = 0.242; p < 0.01), and fewer missing teeth (SC = 0.058; p < 0.01) were directly associated with good SPOH. Among specific indirect effects of SEP on SPOH, the behavioral pathway was the one that best explained this association (SC = 0.155). Socioeconomic inequities in SPOH are mediate by psychosocial, behavioral, and biological factors. This has implications for positioning health strategies in the social context in which people live, to facilitate healthy choices and promote good oral health.

Impact of adopting different socioeconomic indicators in older adults' oral health research.

This study aimed to evaluate the influence of choosing different socioeconomic status indicators in research regarding older adults' oral health. This is a cross-sectional study that analyzed baseline data from the Brazilian Longitudinal Study on Aging (ELSI-Brazil). The outcomes were edentulism (n = 9,073) and self-reported oral health (n = 9,365). The following socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression analysis with robust variance was performed to estimate prevalence ratios (PR), with their respective 95% confidence intervals (CI), after adjusting for socioeconomic and oral health behavior variables. Absolute inequality measures were also estimated. The individual income indicator was not statistically associated with the results after adjustments. When using per capita household income indicator, individuals in the richest quintile showed a 12% lower prevalence of poor self-reported oral health [PR: 0.88 (CI: 0.78-0.98)], relative to the poorest, and there was no association with edentulism. When the wealth index was chosen, there was a 22% lower prevalence of edentulism [PR: 0.78 (CI: 0.64-0.94)] and 15% lower prevalence of self-reported poor oral health [PR: 0.85 (CI: 0.78-0.93)] in individuals of the richest quintile, both relative to the poorest quintile. Regarding absolute inequality measures, for edentulism, the wealth index showed the highest absolute inequality. When considering self-reported oral health, per capita household income showed the greatest absolute inequality. Despite scientific challenges and the difficulty of socioeconomic indicator metrics, further investments in its development are critical to measure, promote, and improve population oral health.

Social capital and self-reported oral health at baseline of the brazilian longitudinal study of aging.

OBJECTIVES: This cross-sectional study aimed to estimate the association between the structural and cognitive dimensions of social capital and self-reported oral health. METHODS: This study conducted individual assessments of 9,365 individuals aged 50 years or older from Brazil. Four individual variables based on structural and cognitive dimensions of social capital were assessed. We used hierarchical Poisson regression models to estimate the prevalence ratio of self-reported oral health with individual structural and cognitive social capital variables adjusted for associated factors. RESULTS: Cognitive social capital was associated with self-reported oral health. Individuals who reported lack of neighbourhood trust and not having friends presented 14% (RP: 1.14; 95% CI: 1.07-1.21) and 9% (RP: 1.09; 95% CI: 1.01-1.19), respectively, higher prevalence of poor self-reported oral health, relative to those who trust in their neighbourhood and reported having friends. CONCLUSION: The cognitive dimension of social capital may be linked with self-reported oral health. Therefore, social capital can be stimulated in the context of social policies as its encouragement can be an efficient tool for improving individuals' health and, consequently, the oral health of the older people.

Socioeconomic inequalities in the use of dental services in Brazil: an analysis of the 2019 National Health Survey.

OBJECTIVE: To describe the prevalence of use of dental services in Brazil according to states and the Federal District and its relationship with socioeconomic variables and types of services, based on the 2019 National Health Survey. METHODS: This is a cross-sectional population-based study using data from the 2019 National Health Survey, which included 88,531 participants aged 18 or older. We assessed variables related to the use of dental health services according to sociodemographic and behavioral characteristics through multivariate analysis, using a Poisson regression model with robust variance. RESULTS: The use of dental services in the year prior to the interview was higher among adults (53.2%, confidence interval - 95%CI 52.5-53.9) than older adults (34.3%, 95%CI 33.2-34.4). The multivariate analysis revealed that the use of dental services was greater in people with better schooling (prevalence ratio - PR=2.02, 95%CI 1.87-2.18) and higher income (PR=1.54, 95%CI 1.45-1.64). States from the Southeast, Midwest, and South regions presented the highest percentages of individuals who visited a dentist in the previous year - between 49.0 and 57.6% of the population. CONCLUSION: Inequalities were found in the use of dental health services among the adult and older adult population, with regional differences; the use was higher among women, younger individuals, those with better schooling, higher income, healthier behaviors, better self-perceived oral health status, and who paid for their last dental treatment.

Gingivitis influences oral health-related quality of life in adolescents: findings from a cohort study.

INTRODUCTION: Oral health-related quality of life (OHRQoL) is affected by different clinical conditions. The aim of this study was to evaluate the impact of gingivitis on OHRQoL in adolescents. METHODOLOGY: This cohort study consisted of a random sample of 1,134 schoolchildren enrolled during 2012, in Santa Maria, Brazil. After two years, 743 adolescents were follow-up (response rate: 65.5%). Clinical, socioeconomic and OHRQoL data were collected. OHRQoL was assessed by the short Brazilian version of the Child Perceptions Questionnaire 11-14 (CPQ11-14), and gingival bleeding through Community Periodontal Index. Gingivitis was considered with the presence of 15% or more bleeding sites. Poisson regression models were used to evaluate the association between gingivitis and overall and domain-specific CPQ11-14 scores. Prevalence of gingivitis at baseline was considered the main predictor for the OHRQoL at follow-up. RESULTS: Gingivitis at baseline was associated with higher overall CPQ 11-14 score (RR = 1.07; 95%CI 1.01 - 1.14), and emotional well-being (RR = 1.17; 95%CI 1.04 - 1.31), independently of other oral conditions and socioeconomic variables. CONCLUSIONS: The findings indicate that gingivitis negatively impacts the adolescents' OHRQoL. Moreover, gender, maternal schooling and household income were also associated with OHRQoL.