Determinantes individuais e do contexto escolar associados à cárie dentária e ao alfabetismo funcional em saúde bucal em adolescentes de 12 anos

Abstract

The aim of this study was to evaluate the association of individual and school determinants with dental caries and oral health literacy in adolescents. This is a cross sectional and analytical observational study conducted in public and private schools in Campina Grande-PB, with a representative sample of 740 12-year-old adolescents. Two dentists participated in theoretical/practical training and calibration process for the diagnosis of dental caries and oral health literacy (K>0.80). Parents/caregivers answered a sociodemographic questionnaire and adolescents answered validated instruments about dental services utilization, family functioning (FACES-III) and functional oral health literacy (BREALD-30). Cavitated dental caries was evaluated according to Nyvad and Baelum criteria (2018) and the examiners were calibrated for clinical examinations, obtaining high inter and intra-examiner agreement. The contextual variables of the school were the educational indicators available in the Integrated Educational Information System of the National Institute of Studies and Research Anísio Teixeira (INEP) in 2017. Individual and multilevel models of Poisson regression and robust negative binomial regression for complex samples were used to evaluate the association between independent variables and dental caries and oral health literacy (p<0.05). The prevalence of untreated dental caries in the sample was 38.5%. Adolescents oral health literacy scores mean was 17.03 (SD = 5.87). In the first manuscript, considering only the individual aspects associated with untreated dental caries, the following variables remained in the adjusted model: maternal education less than eight years (RR=1.58; CI95%:1.12-2.24), non-white adolescents (RR=1.64; CI95%: 1.08-1.48), low social class (RR=1.89; CI95%: 1.28-2.80), more than six people at home (RR=1.87; 95% CI: 1.25-2.81), low oral health literacy (RR=2.02; CI95%: 1.28-3.18) and connected (RR=4.72; CI95%: 1.17-18.90), separated (RR=4.09; CI95%: 1.05-15.86) and disengaged (RR=4.20; 95% CI: 1.09-16.18) types of family cohesion. The second manuscript evaluated the factors associated with cavitated dental caries considering the school context and the aspects that remained associated in the final model were: non-white adolescents (RR=1.92 95% CI: 1.27- 2.91), low social class (RR=1.82; 95% CI: 1.12-2.94), low satisfaction with the last dental consultation (RR=2.07; 95% CI: 1.47-2.91), low oral health literacy scores (RR=0.95; CI95%: 0.91-0.98) and public schools with higher student retention rates (RR=2.20; 95% CI: 1.27-3.80). In the third manuscript, this study considered the aspects associated with oral health literacy and found the following associations: female sex (RR=1.05; 95% CI: 1.01-1.10), maternal education older than eight years (RR=1.13; CI95%: 1.08-1.19), younger parents (RR=0.94; 95% CI: 0.90-0.97), balanced family functioning (RR=1.08; CI95%: 1.01-1.14) and school retention rate (RR=0.99; 95% CI: 0.98-0.99). Adolescents with higher functional oral health literacy had a lower number of untreated dental caries. In addition, sociodemographic, family and school context factors were associated with untreated dental caries and oral health literacy in 12-year-old adolescents.