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

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.

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.

Fatores contextuais e individuais associados à dor dentária em adolescentes de 15 a 19 anos de idade do sudeste do Brasil / Contextual and individual factors associated with dental pain in adolescents aged 15 to 19 years in southeastern Brazil

A dor dentária em adolescentes tem sido descrita como uma experiência comum, que resulta em restrições substanciais na vida diária e é considerada um problema de Saúde Pública. A adolescência é uma fase transicional caracterizada por intensas mudanças físicas e psicológicas, em que indivíduos podem apresentar comportamentos que comprometem sua saúde, incluindo saúde bucal. Adolescentes são, portanto, um grupo vulnerável que requer atenção adequada baseada no contexto individual, familiar e social. O objetivo deste estudo transversal foi avaliar quais os fatores individuais e contextuais foram associados à dor dentária em adolescentes (15-19 anos de idade) do Sudeste Brasileiro, além de elaborar, como produtos técnicos, material educativo e um aplicativo, para os dentistas e adolescentes, sobre tópicos relevantes para prevenção da dor dentária. Para avaliação da dor dentária foram utilizados dados secundários obtidos do levantamento epidemiológico SB Minas 2012. A variável dependente foi dor dentária reportada nos últimos seis meses. As covariáveis foram: domínio (capital, Interior I e Interior II), sexo, cor da pele, renda familiar, prevalência de cárie dentária não tratada, condição periodontal, necessidade de tratamento dentário e tempo da última consulta odontológica. Variáveis contextuais foram: Índice de Desenvolvimento Humano (IDH), Coeficiente de Gini, analfabetismo, desemprego, renda de até metade do salário mínimo, renda de até um quarto do salário mínimo, cobertura de Atenção Primária à Saúde, cobertura das equipes de Saúde Bucal, acesso ao serviço dentário individual e taxa de escovação; essas covariáveis foram analisadas no nível regional do Estado. Um modelo de regressão logística (Razão de Chances ­ RC/IC95%) multinível foi usado para inferir associação entre os diferentes níveis, considerando ao final uma significância de 5%. Os dados foram analisados no programa IBM SPSS Software versão 22.0. A prevalência de dor dentária foi de 23,1% (277/1200). Adolescentes do sexo masculino apresentaram menor chance de ocorrência do desfecho (RC IC95% 0,53 0,37-0,75). Além disso, adolescentes cujas famílias ganham até R$1,500 reais tiveram 1,58 vezes maior chance de pertencer ao grupo com dor dentária (IC95% 1,07-2,33). Indivíduos com cárie dentária não tratada e com profundidade de sondagem acima de 3mm apresentaram maior chance de dor dentária, respectivamente, (p<0,001 e 0,034). E os adolescentes com necessidade de tratamento dentário mostraram quase sete vezes mais chance de ter o desfecho (RC IC95% 6,93 3,96-12,14). Não houve associação com variáveis contextuais. Concluiu-se que fatores socioeconômicos e clínicos estão associados à dor dentária. É necessário reforçar a formulação de políticas de saúde públicas mais efetivas. Três produtos técnicos foram elaborados: (uso de tecnologia digital - aplicativo, folheto informativo e banner), que intencionam informar com linguagem acessível conhecimentos da Odontologia para a prevenção da dor dentária. Concluise que o uso de tecnologias digitais interativas pode ser de grande valia para educação, prevenção e promoção de saúde.

Dental pain in adolescents has been described as a common experience that results in substantial restrictions on daily living and it is considered a public health problem. Adolescence is a transitional phase characterised by intense physical and psychological changes, in which individuals may show behaviours that can compromise their health, including oral health. Adolescents are therefore a vulnerable group, which require adequate attention based on their individual, family and social context. The main of this cross-sectional study was to assess which individual and contextual factors are associated with toothache in adolescents (15 to 19 years old) in Southern Brazil, besides the elaboration of three technical products, on relevant topics to prevent toothache. Regarding toothache, secondary data from SB Minas 2012 epidemiological databank were collected. Dependent variable was toothache reported in the last six months. The covariates were: domains (capital, Interior I and Interior II, sex, skin color, family income, prevalence of untreated dental caries, periodontal condition, need for dental treatment and last dental appointment (time). The contextual variables were Human Development Index (HDI), Gini Coefficient, illiteracy, unemployment, Half and quarter Brazilian monthly minimum wage, Primary Health Care Coverage, oral health team coverage, access to individual health care and supervised tooth brushing; these covariates were analyzed at the regional level of the State. A multilevel logistic regression statistical model (OR ­95%CI) was carried out to assess the association between the different levels, considering 5% significance. Data were analyzed in the IBM SPSS Software version 22.0 program. The prevalence of toothache was 23.1% (277/1200). Male adolescents showed lower chance of having the outcome (OR 95%CI 0.53 0.37- 0.75). In addition, adolescents whose families earned until R$1,500 had 1.58-fold higher chance of belonging to the group with toothache. Individuals with untreated dental caries and probing depth above 3mm shower higher chance of having toothache, respectively, (p<0.001 and 0.034). And adolescents with dental treatment need showed almost seven times more chance of having the outcome (OR 95%CI 6.93 3.96-12.14). No association with contextual variables. In conclusion, socioeconomic and clinical factors are associated with toothache. It's necessary to reinforce the formulation of more effective public health actions. Three technical products were developed: (the use of interactive digital technologies ­ app, information leaflet and banner), which intend to inform with accessible language knowledge on Dentistry to prevent toothache. In conclusion, the use of interactive digital technologies can be of great value for education, prevention and health promotion.