Associação entre determinantes individuais e do contexto escolar na cárie dentária, dor de dente e qualidade de vida relacionada à saúde bucal em crianças de 5 anos de idade

Abstract

Oral health problems, especially dental caries, present a high prevalence which frequently often result in dental pain and impact on oral health-related quality of life (OHRQoL). The understanding of contextual factors involved with the health-disease process allows the identification of risk areas and appropriate planning of health promotion strategies at the community level. School context is considered an important place for the intellectual development of children, as well as the development of health programs. OBJECTIVE: The purpose of this study was to evaluate the influence of individual and school context determinants on dental caries, history of dental pain and impact on the OHRQoL in five-year-old children. METHODS: A cross-sectional study based on a representative sample of 769 five-year-old children was conducted in public and private preschools in the city of Campina Grande, Brazil. Parents/caregivers answered questionnaires concerning socio-demographic data, child's oral health, sense of coherence and locus of control. Children answered the Scale of Oral Health Outcomes for five-year-old children (SOHO- 5). After the application of the questionnaires, children were examined for dental caries, traumatic dental injuries, malocclusion and dental wear according to criteria established in the literature. Dental caries was diagnosed through the International Caries Detection and Assessment System (ICDAS-II) and pufa index. The examiners were previously calibrated and obtained good inter- examiner and intra-examiner results. Variables related to social context were collected at the preschools and official municipal publications. Unadjusted and adjusted multilevel Poisson regression models were employed to investigate associations between individual and contextual characteristics with the outcome variable of each analysis plan. RESULTS: The prevalence of cavitated lesions was 58.8% and history of dental pain was reported in 23.8% of all children. The mean SOHO-5 scores were 2.37 (± 3.35). After adjusting for individual and contextual variables, the presence cavitated lesion was associated with visit to the dentist (PR = 0.73, 95% CI: 0.58-0.93), less tooth brushing frequency (<2x/day) (PR = 2.05, 95% CI: 1.18- 3.60), public preschool (PR = 1.66, 95% CI: 1.16-2.36) and smaller size of the preschool (PR = 1.01, 95% CI: 1.01-1.02). In relation to the history of dental pain, the variables associated with the final model were female children (PR = 1.37, 95% CI: 1.02-1.85), being a middle child (PR = 1.73, 95% CI: 1.08-2.77), lower parent‟s/caregiver‟s schooling (PR = 1.65, 95% CI: 1.14-2.39) and private preschool (protection factor) (PR = 0.58, 95% CI: 0.40-0.84). Regarding OHRQoL, in the multilevel analysis, there was an association with higher monthly family income (protection factor) (RR = 0.99, 95% CI: 0.99-0.99), younger parent's/caregiver‟s (RR = 1.01, 95% CI: 1.01- 1.02), history of dental pain (RR = 1.52, 95% CI: 1.35-1.72), presence white spot lesion (RR = 1.43, 95% CI: 1.11-1.85), presence cavitated lesion (PR = 1.42, 95% CI: 1.11-1.82), presence consequence of untreated caries (RR = 1.20, 95% CI: 1.04-1.38), presence traumatic dental injuries (RR = 1.20, 95% CI: 1.09-1.33) and private preschool (RR = 1.51, 95% CI: 1.17-1.93). CONCLUSION: The preschool context had an influence on the presence for dental caries, history of dental pain and OHRQoL. Children of public preschools had the worst outcomes related to oral health conditions. In addition, the size of the preschool was also an important factor for cavitated lesion. Regarding individual determinants, after adjusting for the context, the socioeconomic and health-related variables were also associated with the outcomes analyzed.