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.

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.

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.

Impact of dental bullying on bruxism associated with poor sleep quality among adolescents.

This study aimed to investigate the impact of school bullying and oral health-related verbal bullying on the occurrence of bruxism associated with poor sleep quality among adolescents. This cross-sectional study was nested in a cohort study performed with a sample of children from southern Brazil. Possible sleep bruxism was determined by the question: "Has anyone told you that you grind your teeth in your sleep?" Sleep quality was determined by answering the following question: "How would you classify the quality of your sleep?". The outcome was created by combining occurrence of sleep bruxism and poor sleep quality. The Sense of Coherence (SOC) was assessed using the SOC-13 scale. Bullying was investigated using the victim scale of the Olweus Bullying Questionnaire and oral health-related verbal bullying using an item from the Child Perceptions Questionnaire-11-14. Demographic, socioeconomic, psychosocial, and clinical data were also collected. Poisson regression models with robust variance were used. Results were expressed as prevalence ratio (PR) and 95% confidence intervals (95% CI). A total of 429 adolescents with a mean age of 12.6 (standard deviation 1.3) years were evaluated. The prevalence of bruxism associated with poor sleep quality was 23.7%. Victims of school bullying (PR 2.06; 95%CI: 1.01-4.22) and oral health-related verbal bullying (PR 1.87; 95%CI: 1.18-2.95) presented higher prevalence of bruxism associated with poor sleep quality. Factors such as skin color and SOC were also associated with the outcome. These findings suggest an association between episodes of bullying and bruxism related to poor sleep quality.

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.

Dental caries prediction and the indication of pit and fissure sealant in children first permanent molars: A prospective study.

OBJECTIVES: To evaluate predictors for caries incidence on first permanent molars and to assess the accuracy and efficiency of these predictors for the indication of pit and fissure sealants. METHODS: This 7-y cohort study started in 2010 with a sample of 639 children (1-5 years) from Southern Brazil. Dental caries was assessed using the ICDAS. Maternal education, family income, parental perception on child oral health and severe dental caries experience were collected at baseline and used to test the prediction of dental caries. Predictive values, accuracy and efficiency were estimated for each possible predictor. RESULTS: 449 children were re-assessed at follow-up (70.3% retention rate). The baseline characteristics showed similar risks for dental caries incidence in first permanent molars. Low family income and poor parental perception of child oral health were moderately accurate in correctly identifying sound children who would not need to receive pit and fissure sealant. However, all the adopted criteria have lower accuracy incorrectly identifying children who later developed dental caries in first permanent molars. CONCLUSIONS: Distal and intermediate factors were relatively accurate in determining caries risk incidence on children's first permanent molars. The criteria adopted were more accurate in identifying sound children than those who need to receive pit and fissure sealant. CLINICAL RELEVANCE: Our findings reinforce the idea that investing in strategies that take into account common risk factors still represents the best option for dental caries prevention. However, adopting only these parameters is not enough to indicate pit and fissure sealants.

Pathways between oral health conditions and bullying on adolescents: A 10-year cohort study.

OBJECTIVE: To assess the pathways in which oral health conditions, socioeconomic, and psychosocial factors in childhood can lead to the occurrence of bullying in adolescence. METHODS: This is a 10-year cohort study conducted with a sample of 639 children in southern Brazil. Oral health conditions (dental caries, dental trauma and malocclusion), sociodemographic and psychosocial characteristics were obtained at baseline (T1) and at follow-up (T2). General and dental bullying were assessed at T2 using the Bullying Olweus questionnaire and through a question contained in the Child Perception Questionnaire 11-14. Structural equation modelling was used to evaluate the pathways between oral health measures and bullying episodes over time. RESULTS: A total of 429 students were evaluated at follow-up. Untreated dental caries were direct and indirectly related with the occurrence of dental bullying at follow-up and indirectly associated with general bullying at T2. Low socioeconomic status, low sense of coherence and dental bullying presented a direct impact on the occurrence of general bullying at T2. CONCLUSIONS: Untreated dental caries are presented as the main oral health predictor of the occurrence of bullying episodes in adolescence.

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.

Early childhood factors in the development of oral health behaviours in adolescence: A structural equation modelling approach.

OBJECTIVES: Oral health behaviour is a learning process that begins in the early years of an individual's life. The aim of this study was to evaluate the associations between demographic, socioeconomic, and psychosocial factors and oral health behaviours during the transition period from childhood to adolescence. METHODS: This was a cohort study with a follow-up of 7 years. The baseline assessment occurred in 2010 with a random sample of 639 preschool children from southern Brazil. Demographic, socioeconomic and psychosocial oral health conditions were assessed at baseline. Oral health habit variables were collected at follow-up and included questions regarding dental care and oral hygiene behaviours. Structural equation modelling was performed to assess the direct and indirect relationships between predictors at baseline in oral health behaviours at follow-up. RESULTS: A total of 449 children were re-examined at follow-up (70.3% cohort retention rate). Factors directly related to poorer oral health behaviours (lower use of dental services, dental visits for emergency reasons and lower frequency of toothbrushing) were lower household income, lower maternal education, lower frequency of visits to neighbours or friends, and male sex. Considering indirect pathways, the household income and maternal education at baseline influenced oral health behaviours at follow-up via visits to neighbours or friends. CONCLUSIONS: Our findings suggest that household income, maternal education and social capital play an important role in the development of oral health behaviours during the transition from childhood to adolescence. Acquisition of healthy oral behaviours is an important factor to consider in childhood. With this knowledge, public health policies can be developed to intervene in specific causal factors and improve oral health during this transitional period.

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.

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

Abstract 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.

Impact of dental bullying on bruxism associated with poor sleep quality among adolescents

Abstract This study aimed to investigate the impact of school bullying and oral health-related verbal bullying on the occurrence of bruxism associated with poor sleep quality among adolescents. This cross-sectional study was nested in a cohort study performed with a sample of children from southern Brazil. Possible sleep bruxism was determined by the question: "Has anyone told you that you grind your teeth in your sleep?" Sleep quality was determined by answering the following question: "How would you classify the quality of your sleep?". The outcome was created by combining occurrence of sleep bruxism and poor sleep quality. The Sense of Coherence (SOC) was assessed using the SOC-13 scale. Bullying was investigated using the victim scale of the Olweus Bullying Questionnaire and oral health-related verbal bullying using an item from the Child Perceptions Questionnaire-11-14. Demographic, socioeconomic, psychosocial, and clinical data were also collected. Poisson regression models with robust variance were used. Results were expressed as prevalence ratio (PR) and 95% confidence intervals (95% CI). A total of 429 adolescents with a mean age of 12.6 (standard deviation 1.3) years were evaluated. The prevalence of bruxism associated with poor sleep quality was 23.7%. Victims of school bullying (PR 2.06; 95%CI: 1.01-4.22) and oral health-related verbal bullying (PR 1.87; 95%CI: 1.18-2.95) presented higher prevalence of bruxism associated with poor sleep quality. Factors such as skin color and SOC were also associated with the outcome. These findings suggest an association between episodes of bullying and bruxism related to poor sleep quality.

Wealth index association with self-reported oral health between white and non-white older Brazilians / Associação entre índice de riqueza e saúde bucal autorreferida entre idosos brasileiros brancos e não brancos / Asociación del índice de riqueza con la salud bucal autorreportada en adultos mayores brasileños blancos y no blancos

Abstract: 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.

Resumo: Este estudo transversal teve como objetivo identificar a associação entre o estado de saúde bucal autorreferida e o índice de riqueza entre idosos brancos e não brancos no Brasil. Foram analisados dados de avaliações individuais de 9.365 brasileiros com 50 anos ou mais. Foram utilizados modelos de regressão de Poisson para estimar a razão de prevalência entre o índice de riqueza e a saúde bucal autorreferida entre brancos e não brancos, ajustada para determinantes intermediários e proximais. A prevalência total de autopercepção de saúde bucal ruim em indivíduos brancos e não brancos foi de 41,6% (IC95%: 40,0-43,4) e 48% (IC95%: 47,1-49,8), respectivamente. A análise ajustada mostrou que, para indivíduos brancos, o índice de riqueza está associado à saúde bucal autorreferida para indivíduos do 3º, 4º e 5º quintis com 25% (RP = 0,75; IC95%: 0,65-0,88), 20% (PR = 0,80; IC95%: 0,67-0,95) e 39% (PR = 0,61; IC95%: 0,50-0,75) menor prevalência de saúde bucal autorreferida ruim do que aqueles no quintil mais pobre. Para indivíduos não brancos, o índice de riqueza está associado à saúde bucal autorreferida apenas para aqueles no 5º quintil, com 25% (RP = 0,85; IC95%: 0,72-0,99) menor prevalência de saúde bucal autorreferida ruim do que aqueles no quintil mais pobre. O índice de riqueza mostrou diferentes efeitos sobre a saúde bucal autorreferida entre indivíduos brancos e não brancos. Os indicadores de status socioeconômico podem refletir desigualdades raciais devido ao legado histórico da discriminação institucional. Este estudo destaca a importância do desenvolvimento de políticas de combate às iniquidades raciais e como elas podem contribuir para melhores condições de saúde bucal na população brasileira idosa.

Resumen: Este estudio transversal tuvo como objetivo identificar la asociación entre el estado de salud bucal autorreportada y el índice de riqueza entre ancianos blancos y no blancos en Brasil. Se analizaron datos de evaluaciones individuales de 9.365 brasileños de 50 años o más. Se utilizaron modelos de regresión de Poisson para estimar la relación de prevalencia entre el índice de riqueza y la salud bucal autorreportada entre blancos y no blancos, ajustada para determinantes intermedios y proximales. La prevalencia total de autopercepción de mala salud bucal en individuos blancos y no blancos fue de 41,6% (IC95%: 40,0-43,4) y 48% (IC95%: 47,1-49,8), respectivamente. El análisis ajustado mostró que, para los individuos blancos, el índice de riqueza está asociado con salud bucal autorreportada para individuos en los quintiles 3, 4 y 5 con 25% (RP = 0,75; IC95%: 0,65-0,88), 20% (RP = 0,80; IC95%: 0,67-0,95) y 39% (RP = 0,61; IC95%: 0,50-0,75) menor prevalencia de salud bucal autorreportada mala que aquellos en el quintil más pobre. Para las personas que no son blancas, el índice de riqueza se asocia con salud bucal autorreportada solo para aquellos en el quintil 5, con un 25% (PR = 0,85; IC95%: 0,72-0,99) de menor prevalencia de salud bucal autorreportada mala que aquellos en el quintil más pobre. El índice de riqueza mostró diferentes efectos sobre la salud bucal autorreportada entre individuos blancos y no blancos. Los indicadores de estatus socioeconómico pueden reflejar desigualdades raciales debido al legado histórico de la discriminación institucional. Este estudio destaca la importancia del desarrollo de políticas de combate a las inequidades raciales y cómo ellas pueden contribuir para mejores condiciones de salud bucal en la población brasileña anciana.

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.

Association between complementary and integrative practices in health and dental services use among older adults in Brazil: crosssectional study, 2019 / Asociación entre prácticas integrativas y complementarias en salud y uso de servicios odontológicos en idosos en Brasil: estudio transversal, 2019 / Associação entre práticas integrativas e complementares em saúde e uso de serviços odontológicos em idosos no Brasil: estudo transversal, 2019

Objective: To analyze the association between participation in integrative practices and the regular dental services use in Brazilian older adults. Methods: Cross-sectional study with secondary data from the 2019 National Health Survey. All older adults aged 60 years and over were included. The outcome was the regular dental services use. Poisson regression models were used to estimate crude and adjusted prevalence ratios (PR) and their respective confidence intervals at 95% (CI95%). Results: A total of 22,728 older adults were analysed. Most were female (55.5%), self-declared white (51.3%), with incomplete primary education (47.0%); 7.0% (CI95% 6.8;7.5) used some integrative practice and 34.3% (CI95% 33.2;35.4) used the dental service regularly. Individuals who used integrative practices had a higher prevalence of dental service use even after adjusting the model (PR=1.15 ­ 95%CI 1.07;1.23). Conclusion: The use of integrative practices was associated with the regular use of dental services by Brazilian older adults.

Objetivo: Analizar la asociación entre la participación en prácticas integradoras y el uso regular de servicios odontológicos en ancianos brasileños. Métodos: Estudio transversal con datos secundarios de la Encuesta Nacional de Salud 2019. Se incluyeron todos aquellos de 60 años o más. El resultado fue el uso regular de servicios odontológicos. Se utilizó regresión de Poisson para estimar razones de prevalencia (RP) crudas y ajustadas y sus respectivos intervalos de confianza del 95% (IC95%). Resultados: Se analizaron 22.728 ancianos. La mayoría eran mujeres (55,5%), blancas (51,3%), con primaria incompleta (47,0%); 7,0% (IC95% 6,8;7,5) utilizaba alguna práctica integradora y 34,3 % (IC95% 33,2 ;35.4) usaba el servicio dental regularmente. Aquellos que utilizaron prácticas integradoras tuvieron una mayor prevalencia de uso de servicios dentales incluso después de ajustar el modelo (RP=1,15 ­ IC95% 1,07;1,23). Conclusión: El uso de prácticas integradoras se asoció con el uso regular de servicios odontológicos en ancianos brasileños.

Objetivo: Analisar a associação entre participação em práticas integrativas e uso regular de serviços odontológicos em idosos brasileiros. Métodos: Estudo transversal, com dados secundários da Pesquisa Nacional de Saúde de 2019. Foram incluídos todos os idosos com 60 anos ou mais. O desfecho foi o uso regular de serviços odontológicos. Modelos de regressão de Poisson foram utilizados para estimar as razões de prevalências (RPs) brutas e ajustadas, e seus respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram analisados 22.728 idosos. A maioria era do sexo feminino (55,5%), autodeclarados brancos (51,3%), com ensino fundamental incompleto(47,0%); apenas 7,0% (IC95% 6,8;7,5) utilizaram alguma prática integrativa e 34,3% (IC95% 33,2;35,4) utilizaram o serviço odontológico de forma regular. Indivíduos que participaram de práticas integrativas apresentaram maior frequência de uso do serviço odontológico (RP=1,15 ­ IC95% 1,07;1,23). Conclusão: O uso de práticas integrativas foi associado ao uso regular de serviços odontológicos por idosos brasileiros.

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.

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.

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.

Individual social capital and dental pain in older adults.

OBJECTIVES: To investigate the association between the structural and cognitive dimensions of social capital and dental pain in Brazilian adults aged 50 years and over. METHODS: This cross-sectional study conducted individual assessments of 6154 Brazilians aged 50 years or older. Four individual variables based on structural and cognitive dimensions of social capital were assessed. We used hierarchical logistic regression models to estimate the odds ratio for dental pain with individual structural and cognitive social capital variables adjusted for associated factors. The model followed hypothetical pathways linking social capital to oral health. RESULTS: Cognitive social capital was associated with dental pain. Participants who did not trust their neighbourhood had a 28% greater chance (OR, 1.28; 95% CI, 1.02-1.60) of dental pain than those who did. CONCLUSION: Elements of cognitive dimension of social capital, particularly trust, reciprocity and support, as part of a common risk factor approach, should be considered when planning oral health promotion and preventive activities for older people.