Saúde bucal em contexto de vulnerabilidade social: análise epidemiológica dos agravos bucais na população em situação de rua

Abstract

This study aimed to assess the prevalence of oral health problems and associated factors among homeless individuals. This is a cross-sectional study conducted in the municipality of Campina Grande, state of Paraíba, Brazil, using a non-probabilistic convenience sample of 133 homeless individuals. Data collection was conducted by two previously trained and calibrated examiners at assistance and shelter institutions for the homeless population (PSR), as well as at street gathering locations, in line with the operating procedures of Street Clinic (“Consultório na Rua”) teams. A structured questionnaire administered through interviews was used to collect sociodemographic and behavioral data. Dental caries was diagnosed using the DMFT index, while the consequences of untreated caries were investigated using the PUFA index. The Community Periodontal Index (CPI) and the Clinical Attachment Loss index (PIP) were used to record periodontal changes. Descriptive and bivariate analyses of data were performed using the IBM SPSS software, applying Pearson's chi-square or Fisher's exact tests to verify possible associations between the independent variables and the investigated outcomes. Significance level of 5% was adopted. The sample was predominantly composed of males (82.7%), aged 35 - 44 years (31.6%), non-white (77.4%), without a partner (88%), and with 8 years of schooling or less (72.4%). Most participants reported practicing oral hygiene (67.7%), had visited the dentist at least once in their lives (89.5%), and 75.9% reported not having access to dental services. Self-perception of the need for treatment reached 95.5%, and more than half (53.4%) reported toothache in the last 6 months. All participants had experience with caries and periodontal changes. The median DMFT index was 16, ranging from 2 to 32, with emphasis on the missing component (93.2%). Dental caries affected 87.2% of participants, and only 16.1% did not have consequences of untreated caries. Regarding periodontal condition, dental calculus was predominant (91%), followed by bleeding on probing (60.9%) and attachment loss (48.1%). Dental caries was associated with self-perceived need for treatment (p=0.028) and presence of fractured teeth (p<0.001), the latter variable being also related to the consequences of untreated caries (p=0.003). Dental calculus, bleeding on probing, and periodontal attachment loss demonstrated individual associations with demographic variables, oral hygiene, and self-perception of oral health. The high prevalence of oral health problems in the assessed group, as well as the association with social and behavioral factors, reinforce the priority nature of this population regarding the need for dental care.