Fatores associados à necessidade do tratamento ortodôntico em escolares de 8 a 10 anos

Abstract

This study aimed to evaluate factors associated with malocclusion and the need for orthodontic treatment in schoolchildren aged eight to ten years, through multinomial analysis and structural equation modeling. An observational, cross-sectional, analytical study was carried out with a representative sample of 739 children aged eight to ten years, enrolled in public and private schools in Campina Grande-PB, Brazil. Parents/guardians answered the sociodemographic questionnaires, Sleep Disturbance Scale for Children (SDSC) and Oral Health Literacy Adults Questionnaire (OHL-AQ). And the participating children answered the Revised Children's Manifest Anxiety Scale (RCMAS). Four examiners were trained and calibrated to diagnose malocclusion and the need for orthodontic treatment using the Dental Aesthetic Index (DAI), and dental caries according to the International Caries Detection and Assessment System (ICDAS) (K>0.80). Unadjusted and adjusted Multinomial Logistic Regression analysis was performed to obtain associations between the independent variables and the dependent variable (need for orthodontic treatment), according to analysis plan I (α = 5%). For analysis plan II, structural equation modeling was performed to assess which paths explain the associations between the main independent variable (oral health literacy) and the need for orthodontic treatment (95% CI) using Mplus software version 8.8. The need for orthodontic treatment was identified in 55.2% of the sample, with 22.7% requiring elective treatment and 32.5% requiring mandatory treatment. The results of analysis plan I showed that children with anxiety were 53% more likely to need mandatory orthodontic treatment (OR = 1.53; 95% CI: 1.16-2.57; p = 0.04), the presence of sleep disorders was 1.94 times more associated with children needing mandatory orthodontic treatment (OR = 1.94; 95% CI: 1.29-2.91; p = 0.01). Children of parents/guardians with insufficient oral health literacy were 77% more likely to need mandatory orthodontic treatment (OR = 1.77; 95% CI: 1.04-2.99; p = 0.03). For analysis plan II, the results highlighted that the final model presented an adequate fit: RMSEA = 0.03 (0.00-0.07), CFI = 0.97, TLI = 0.92 and SRMR = 0.03. The need for orthodontic treatment was directly influenced by dental caries (β: -0.011; p=0.04). While the oral health literacy of those responsible was directly impacted by the monthly family income (β: 0.36; p<0.001) and maternal education (β: -0.041; p<0.001). It is concluded that the need for orthodontic treatment was greater among children who had sleep and anxiety disorders, members of families with lower income, who lived with more than 4 people, children of younger mothers, who had insufficient oral health literacy. Therefore, the need for orthodontic treatment in children aged 8 to 10 years was influenced only by the presence of cavitated caries lesions. And the oral health literacy of those responsible did not impact the need for treatment of their children.