ABSTRACT
The aim of this study was to assess the factors associated with oral health-related quality of life in adolescents (OHRQoL). Individual data on adolescents were collected from a secondary database. OHRQoL was measured using the oral impact on daily performance (OIDP) scale. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health. The individual covariates analyzed were sex, age, skin color, maternal education, household income, number of people per room in the housing unit, dental attendance, self-perception of dental needs, untreated dental caries, and gingival bleeding. The contextual variables included the allocation factor, the Human Development Index (HDI), Gini coefficient, illiteracy, unemployment, income, average number of emergency dental visits per inhabitant, access to a sanitary sewer system, garbage collection, primary health care coverage, oral health team coverage, and number of tooth extractions between selected dental procedures and supervised toothbrushing. Unadjusted and adjusted multilevel Poisson regression analyses were used to evaluate the relationship between contextual and individual variables with overall OIDP scores (STATA version 16.0) - rate ratio (RR) and 95%CI. The mean OIDP score was 0.72 and the prevalence was 31.8%. There was an association between supervised toothbrushing average and the outcome (RR 0.95; 95%CI 0.910.99). Moreover, adolescents who lived in municipalities with the highest average number of emergency dental visits per inhabitant showed a higher OIDP. Sex, maternal education, untreated dental caries, and gingival bleeding were associated with OIDP. In addition, intersectoral public policies focusing on the reduction of social inequalities should be on the agenda of policymakers and stakeholders.
ABSTRACT
Abstract The aim of this study was to assess the factors associated with oral health-related quality of life in adolescents (OHRQoL). Individual data on adolescents were collected from a secondary database. OHRQoL was measured using the oral impact on daily performance (OIDP) scale. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health. The individual covariates analyzed were sex, age, skin color, maternal education, household income, number of people per room in the housing unit, dental attendance, self-perception of dental needs, untreated dental caries, and gingival bleeding. The contextual variables included the allocation factor, the Human Development Index (HDI), Gini coefficient, illiteracy, unemployment, income, average number of emergency dental visits per inhabitant, access to a sanitary sewer system, garbage collection, primary health care coverage, oral health team coverage, and number of tooth extractions between selected dental procedures and supervised toothbrushing. Unadjusted and adjusted multilevel Poisson regression analyses were used to evaluate the relationship between contextual and individual variables with overall OIDP scores (STATA version 16.0) - rate ratio (RR) and 95%CI. The mean OIDP score was 0.72 and the prevalence was 31.8%. There was an association between supervised toothbrushing average and the outcome (RR 0.95; 95%CI 0.91-0.99). Moreover, adolescents who lived in municipalities with the highest average number of emergency dental visits per inhabitant showed a higher OIDP. Sex, maternal education, untreated dental caries, and gingival bleeding were associated with OIDP. In addition, intersectoral public policies focusing on the reduction of social inequalities should be on the agenda of policymakers and stakeholders.
ABSTRACT
Adolescência é um período entre 10 e 19 anos de idade, que é constituída por inúmeras mudanças biológicas, psicológicas, cognitivas e comportamentais. A literatura tem mostrado uma prevalência significativa de cárie dentária, gengivite, má oclusão, perda dentária e dor dentária durante esta fase. A qualidade de vida relacionada à saúde bucal (QVRSB) é um constructo multidimensional usado para mensurar o impacto das condições de saúde bucal no dia a dia, e, consequentemente, isso afeta a percepção do indivíduo sobre sua vida de forma geral. O impacto dos aspectos contextuais sobre a saúde bucal enfatiza a natureza multinível de desfechos em saúde. Atenção deve ser dada para as complexas interações entre determinantes individuais e contextuais de saúde bucal. O objetivo do estudo transversal foi avaliar quais fatores estão associados à QVRSB em adolescentes (n= 1202; 15-19 anos de idade) de Minas Gerais, Brasil. O desfecho QVRSB foi mensurado pelo questionário "Bucal Impacts on Daily Performance". As covariáveis individuais foram: sexo, cor da pele, idade, renda familiar, educação materna, aglomeração domiciliar, prevalência de cárie dentária não tratada, sangramento gengival, necessidade de tratamento dentário e uso de serviço regular odontológico. Variáveis contextuais foram: Índice de Desenvolvimento Humano (IDH), Coeficiente de Gini, analfabetismo, desemprego, renda de até metade do salário mínimo, , cobertura de Atenção Primária à Saúde, cobertura das equipes de Saúde Bucal, taxa de escovação supervisionada, fator de alocação, número de extração dentária entre todos os procedimentos selecionados, produto interno bruto, saneamento básico e número de consultas de emergência odontológica por habitante; essas covariáveis foram analisadas no nível regional do Estado. Um modelo de regressão de poisson (Razão de Médias RM/IC95%) multinível foi usado para inferir associação entre os diferentes níveis, considerando ao final uma significância de 5%. Os dados foram analisados no programa STATA versão 16.0. A média (DP) de OIDP foi 0,72 (0,05) e a prevalência do desfecho (OIDP≥1) foi de 31,8%. Houve associação entre escovação dentária supervisionada e o desfecho (RR 0,95; IC95% 0,91-0,99). Além disso, adolescentes que vivem em municípios com mais alta média de consulta de emergência odontológica mostrou pior QVRSB. Sexo, educação materna, aglomeração domiciliar, cárie não tratada e sangramento gengival foram associadas ao desfecho. Variáveis contextuais e individuais foram determinantes da QVRSB.
Adolescence is the period between 10 and 19 years of age, which is constituted by innumerable biological, psychological social, cognitive, and behavibucal changes. The literature has shown a significant prevalence of dental caries, gingivitis, malocclusion, tooth loss, and toothache during this phase. Bucal health-related quality of life (OHRQoL) is a multidimensional construct used to measure the impact of bucal health conditions on everyday life and consequently, it affects the individual's perception of their life overall. The impact of the contextual aspects on bucal health emphasizes the multilevel nature of health outcomes. Attention must be taken to the complex interaction between individual and contextual determinants of bucal health. The main of this cross-sectional study was to assess which factors are associated with OHRQoL involving adolescents (n=1202; 15 to 19 years old) in Minas Gerais, Brazil. The outcome OHRQoL was measured by questionnaire "Bucal Impacts on Daily Performance". The covariates were: sex, skin color, age, family income, maternal education, household crowding, prevalence of untreated dental caries, gingival bleeding, need for dental treatment and regular use of dental service. The contextual variables were Human Development Index (HDI), Gini Coefficient, illiteracy, unemployment, Half quarter Brazilian monthly minimum wage, Primary Health Care Coverage, bucal health team coverage, supervised tooth brushing, allocation factor, gross domestic product, number of emergency dental visits per inhabitant, sanitary sewer, number of tooth extraction between selected dental procedures - these covariates were analyzed at the regional level of the State. A multilevel poisson regression model (rate ratio RR/95%CI) was carried out to assess the association between the different levels, considering 5% significance. Data were analyzed in the STATA version 16.0 program. The mean (SD) OIDP score was 0.72 (0.05) and the prevalence of outcome was 31.8%. There was an association between supervised tooth brushing average and the outcome (RR 0.95; CI95% 0.91-0.99). Moreover, adolescents who lived in municipalities with the highest average number of emergency dental visits per inhabitant showed a higher OIDP. Sex, maternal education, household crowding untreated dental caries and gingival bleeding were associated with OIDP. Contextual and individual factors were determinants of OHRQoL.
