Uso dos serviços de saúde bucal, morbidade bucal autorreferida e seu impacto na qualidade de vida: um estudo em uma população em situação de dependência química

Abstract

Introduction: The misuse of psychoactive substances is a serious public health problem that causes harm not only to the physical and mental health of the individual, as well as to the family, occupational and community context, with negative repercussions throughout society. Objective: To investigate the oral health condition, use of health services, orofacial disability and oral health-related quality of life of drug addicts. Methodology: (i) Systematic review and meta-analysis: This systematic review followed the PRISMA guidelines. Its protocol was registered on the PROSPERO platform (CRD42021253510). The research's guiding question was formulated through the PECO strategy, where: P= chemical dependents over 18 years old; E= oral health; C= non-drug dependent adults; O= repercussions for the chemical dependent (oral health and quality of life). The search was carried out by two examiners independently in the Pubmed, Scopus and Web of Science databases and culminated in the identification of 398 articles, of which 17 were selected to compose the review. ACROBAT-NRSI was used to assess the methodological quality of selected articles and Review Menanger software (RevMan 5) to perform meta-analysis calculations. (ii) Cross-sectional study: cross-sectional, quantitative and analytical study. The research instrument involved the socioeconomic characterization, the severity of chemical dependency, self-reported oral health morbidity, use of oral health services, impact of oral health on quality of life (OHIP-14) and Manchester Orofacial Disability Scale (Brazil -MOPDS). Data tabulation and analysis was performed using the SPSS software version 21.0 for Windows, with the installation of the additional PROCESS tool. Verifying the normality of the data, descriptive statistics, bivariate analysis using the chi-square test and multivariate analysis using the Decision Tree model using the CHAID algorithm and regression analysis with moderation were performed. The work followed all the assumptions for research with human beings, having been submitted and approved by the Research Ethics Committee of the State University of Paraíba under opinion nº 4.169.644 and CAAE 34592220.2.0000.5187. Results: (i) Systematic review and meta-analysis: The articles included were published between 1991 and 2021. The most prevalent drug was heroin, followed by cocaine and crack and the association between illicit drugs, alcohol and nicotine. The higher prevalence of oral alterations was associated with socioeconomic characteristics and those related to chemical dependency. The meta-analysis carried out 15 supported the study hypothesis, that chemical dependents have a greater experience of caries than non-users, suggesting the importance of public policies in oral health aimed at this target audience. The results also suggest that worse oral health conditions negatively impact the quality of life of drug users. Furthermore, there was evidence of an incipient number of studies that sought to assess orofacial pain, the use of health services and the quality of life related to oral health of this public, which motivated the second stage of the work, which consisted of a study transverse. (ii) Cross-sectional study: Most participants were male (n=51, 85%), with a mean age of 47 years, with a basic education level (n=36, 60%), income of up to one minimum wage (n=33, 55%), unemployed (n=44, 73.3%), without enrollment in a minimum income program and claimed to live in their own home. A low use of health services was evidenced in the last three years, with a high self-reported need for treatment (n=54, 90%), essentially regarding the use of prostheses. This study presented two dependent variables (DV): the impact of oral morbidity on quality of life and the degree of orofacial disability. For the first DV, the low impact of oral health on quality of life prevailed (n=43, 71.6%), however, an association was identified with the reason why they believe they currently need dental treatment (extraction) (p=0.004) and the intensity of orofacial pain felt in the last six months (p=0.032). As for the second DV, the results suggested a low degree of orofacial disability, however, higher degrees were associated with education and age at first use of the addictive substance. The relationships between oral morbidity and quality of life and between oral morbidity and orofacial disability were moderated by age at first use of the addictive substance. Conclusion: (i) It can be concluded that chemical dependents have a higher caries experience than the general population; (ii) the relationship between oral morbidity and its impact on quality of life and oral morbidity and degree of orofacial disability are moderated by the severity of chemical dependency.