Determinantes individuais e contextuais associados à cárie dentária e à ida ao dentista em crianças de 8 a 10 anos: Estudo de base populacional

Abstract

Dental caries is the most prevalent chronic disease in childhood and represents an important public health problem worldwide. Thus, it is important to recognize the biopsychosocial and contextual factors in the experience of carious lesions and in the frequency of visits to the Dentist in order to devise oral health promotion and prevention strategies aimed at this population. Objective: The objective of this research is to analyze individual factors and the school context associated with dental caries and the use of dental services in schoolchildren aged 8 to 10 years. Materials and Methods: An analytical cross-sectional observational study was carried out in public and private schools in Campina Grande-PB with 739 children in this age group. Four dentists were calibrated for the diagnosis of dental caries (ICDAS), orofacial dysfunction and trained to apply questionnaires on sleep disorders, oral health literacy (ASB), anxiety and family functioning, and anthropometric data measurement (Kappa> 0.80). A pilot study was carried out with the objective of adapting the developed methodology. Parents/guardians answered the self-administered sociodemographic questionnaires, Circadian Energy Scale (CIRENS), Sleep Disturbance Scale for Children (SDSC), Oral Health Literacy Adults Questionnaire (OHL-Aq) and Family Adaptability and Cohesion Evaluation Scales (FACES III). The children responded to the Revised Children's Manifest Anxiety Scale (RCMAS) and the Nordic Orofacial Test-Screening (NOT-S). The contextual variables of the school were the educational indicators available in the Educational Information of the Instituto Nacional de Estudos e Pesquisas Anísio Teixeira (INEP), namely: type of school, income in the school district and number of oral health teams (ESB) in the school. school geographic district. Confounding variables were selected to fit the statistical model using a Directed Acyclic Graph (DAG). Adjusted Poisson regression models, negative binomial regression for complex samples (P<0.05) and Structural Equations Model were performed to assess the association of independent variables with the outcome variable of each analysis plan. The study was divided into three analysis plans, whose outcome variables were the number of cavitated dental caries lesions (Article 1 and 3) and dental visits in the last year (Article 2). SPSS Statistics version 25 and MPLus version 8.8 were used for the statistical analyses. All ethical parameters established by the Declaration of Helsinki and Resolution 466/2012 were respected. Results: The prevalence of dental caries was 52.8%. The mean number of dental surfaces with untreated caries was 2.2(2.8). In article 1, considering only the individual aspects associated with untreated dental caries, the following variables remained in the adjusted model: younger children (RR=1.49; 95% CI, 1.14-1.94); lower maternal schooling (RR=1.36; 95% CI, 1.06-1.84), lower income (RR=1.47; 95% CI, 1.17-2.04), sleep disorder( RR=1.38; 95% CI, 1.05-1.83), anxiety (RR=1.71; 95% CI, 1.32-2.21), obesity (RR=1.48; CI 95 %, 1.17-1.86) and dry mouth (RR=1.36; 95% CI, 1.12-1.65). In article 2, which evaluated the factors associated with going to the dentist in the last year, the following remained associated in the final model: more cavitated caries lesions (PR=2.23; 95%CI: 1.16-2.80), toothache (PR=2.80), =7.22; 95%CI: 6.62-7.82), higher education maternal (PR:3.20; 95%CI:2.23-4.62), higher monthly family income (PR:5.18;95%CI:4.54-5.82), private school (PR=2, 20; 95%CI: 1.22-3.79), family with high adaptability (PR=1.15; 95%CI: 1.01-1.31), adequate ASB (PR=9.42; 95%CI: 8.70-10 .17), higher monthly income in the school district (PR=2.91; 95%CI: 1.98-3.45) plus ESB in the school health district (PR=2.74; 95%CI: 1.95-4, 54). In article 3, the variables directly associated with a higher prevalence of carious lesions were age of the mother (standardized coefficient (CP: -0.08; p<0.01), Education of the responsible person (CP: -0.22; p<0 .01), obesity (CP: 0.13; p<0.01) and toothbrushing frequency (CP: -0.09; p<0.01), while the ASB, the monthly family income and the amount of ESB in the geographic district of the child exerted an indirect influence on the clinical outcome. Conclusion: A worse socioeconomic condition, the presence of sleep disorders, anxiety and childhood obesity, as well as the frequency of tooth brushing influenced the experience of dental caries in schoolchildren aged 8 to 10 In addition, school context factors and the parents'/guardians' ASB were associated with dental caries and the use of dental services by children in the mixed dentition phase.