Fatores associados à experiência de cárie dentária, ao alfabetismo em saúde bucal e à ida ao dentista em adolescentes

Abstract

Adolescence is a phase characterized by physical, social and emotional changes that result in certain independence from parental care. These changes may contribute to neglected behavior in relation to oral health and little is known about the influence of psychosocial factors on dental caries experience, oral health literacy (OHL) and visit to the dentist in early adolescence. Understanding factors involved in these contexts allow the planning of oral health promotion and preventive strategies directed for this population. OBJECTIVE: The objective of this study was to evaluate the factors associated with dental caries experience, OHL and visit to the dentist in adolescents. METHODOLOGY: A cross-sectional study with a representative sample of 448 12- years-old adolescents was performed in public and private schools in the city of Cajazeiras-PB, Brazil. Parents/guardians and teachers answered the Brazilian version of the inattention and hyperactivity/impulsivity subscales (SNAP IV) for the evaluation of clinical signs of attention deficit/hyperactivity disorder (ADHD). Parents/guardians also answered to a questionnaire concerning sociodemographic data. Adolescents answered validated questionnaires about family cohesion and adaptability (FACES III), an instrument measuring OHL (BREALD-30) and a questionnaire concerning history of visit to the dentist once in the lifetime and previous experience of dental pain in the previous six months. Clinical exams for dental caries (WHO) were performed by a calibrated examiner (K>0.80). Adjusted Poisson regression analysis was performed to investigate the association between independent variables and the outcome variable of each analysis plan. The study was divided in three analysis plans, in which the outcome variables were dental caries experience, oral health literacy and visit to the dentist. RESULTS: The mean DMFT was 1.02 (SD=1.5), the mean BREALD-30 score was 20.3 (SD=4.5) and 93% of adolescents visited the dentist at some point in their life. A greater caries experience was associated with signs of ADHD (teachers' reports) (RR: 1.73; IC95%: 1.31-2.28), lower OHL (RR: 1.59; IC95%: 1.01- 2.51), lower family income (RR: 1.38; IC95%: 1.03-1.83) and greater number of residentes in the home (RR: 1.18; IC95%: 1.06-1.31). Regarding OHL, the variables associated with greater OHL were low (RR: 1.12; 95% CI: 1.04-1.22) and medium (RR: 1.11; 95% CI: 1.03-1.19) family adaptability, mothers that had more than eight years of schooling (RR: 1.07; 95% CI: 1.03-1.12) and family income higher than the Brazilian monthly minimum wage (RR: 1.08; 95% CI: 1.03- 1.12). Lower OHL was associated with low family cohesion (RR: 0.88; 95% CI: 0.82-0.95) and more signs of ADHD (teachers' reports) (RR: 0.94; 95% CI: 0.91-0.98). Regarding visit to the dentist, in the final analysis it was associated with adolescents from enmeshed (PR: 1.08; IC95%: 1.01- 1.15) and connected families(PR: 1.06; IC95%: 1.01- 1.13), attention-deficit (parent’sreport) (PR: 1.06; IC95%: 1.01-1.12) and dental pain in the previous six months (RP: 1.05; IC95%: 1.01- 1.11). CONCLUSION: Dental caries experience among adolescents was associated with signs of ADHD, OHL level and sociodemographic factors. Adolescents’ OHL was associated with family cohesion and adaptability, signs of ADHD, maternalschooling and family income. Finally, visiting the dentist was associated with family cohesion, attention-deficit according to parental report, family income and dental pain.