Functional Dentition in Brazilian Adults: An Investigation of Social Determinants of Health (SDH) Using a Multilevel Approach.

OBJECTIVES: Estimate the prevalence of functional dentition among Brazilian adults using four different definitions and identify associated factors. METHODS: A cross-sectional study was conducted involving 9564 Brazilian adults aged 35-44 years who participated in the 2010 National Oral Health Survey. Data collection involved oral examinations and the administration of questionnaires. The following definitions were used: 1-WHO Functional Dentition (FDWHO: ≥ 20 teeth present); 2-well-distributed teeth (WDT: ≥ 10 teeth in each arch); 3 -Functional dentition classified by esthetics and occlusion (FDClass5: dentitions that sequentially exhibit at least one tooth in each arch, at least 10 teeth in each arch, all maxillary and mandibular anterior teeth, three or four premolar posterior occluding pairs [POPs], and at least one molar POP bilaterally); 4-Functional dentition classified by esthetics, occlusion and periodontal status (FDClass6: corresponds to FDClass5 with the addition of periodontal status of all sextants in the oral cavity with, at most, shallow pockets and/or clinical attachment level of 5 mm (CPI ≤ 3 and/or CAL ≤ 1). The independent variables were individual factors (gender, self-declared skin color, schooling, monthly household income, age group, self-rated treatment need, dental pain, dental appointment in the previous 12 months and dental services) and contextual factors (Municipal Human Development Index [MHDI]), Gini coefficient, fluoridated water supply and oral health coverage). Multilevel mixed-effect Poisson regression analyses were performed. RESULTS: The prevalence of functional dentition based on the FDWHO, WDT, FDClass5 and FDClass6 definitions was 77.9%, 72.9%, 42.6% and 40.3%, respectively. Adults with ≥12 years of schooling and monthly household income from US$ 853 to 2557 had higher prevalence rates of FDWHO (PR: 1.41 and 1.10, respectively), WDT (PR: 1.58 and 1.14, respectively), FDClass5 (PR: 2.03 and 1.27, respectively) and FDClass6 (PR: 2.15 and 1.35, respectively). These values in the final models were adjusted for gender, self-declared skin color (FDClass5), age group, self-rated treatment need (FDWHO, FDClass5 and FDClass6), dental appointment in the previous 12 months (FDWHO and WDT), dental services (FDWHO and WDT) and contextual factors. A very high MHDI and presence of fluoridated water supply were associated with higher prevalence rates of the four outcomes. CONCLUSIONS: The incorporation of the criteria of new definitions of functional dentition led to a lower prevalence rate among Brazilian adults. Striking individual and contextual inequalities were identified with regard to the four definitions analyzed, which need to be addressed through inter-sector efforts.

Functional, esthetical, and periodontal determination of the dentition in 35- to 44-year-old Brazilian adults.

AIMS: The aims of the present study were to evaluate oral health status among Brazilian adults aged 35 to 44 years with regard to functional dentition based on four different definitions and classify dentition configurations using a dental functional status classification system. METHODS: The sample was composed of 9564 individuals who participated in the 2010 National Oral Health Survey. The definitions were "well-distributed teeth" concept (WDT), the World Health Organization functional dentition concept (FDWHO), functional dentition classified by esthetics and occlusion (FDClass5), and functional dentition classified by esthetics, occlusion, and periodontal status (FDClass6). Dentitions were classified on six sequential, accumulative levels (anyone reaching level VI necessarily met the criteria on all previous levels): I-≥one tooth in each arch; II-≥10 teeth in each arch (WDT) or ≥20 teeth present (FDWHO); III-all 12 anterior teeth present; IV-≥3 premolar posterior occluding pairs (POPs) present; V-≥one molar POP bilaterally (FDClass5); VI-all sextants with Community Periodontal Index <3 and/or loss of attachment ≤1 (FDClass6). RESULTS: The prevalence rates of the different definitions of functional dentition ranged from 42.6 % (FDClass5) and 40.3 % (FDClass6) to 72.9 % (WDT) and 77.9 % (FDWHO). CONCLUSIONS: The oral health status of Brazilian adults exhibited considerable variation due to the different definitions of functional dentition, and less than half of Brazilian adults met all the criteria of function. CLINICAL RELEVANCE: The indication and planning of prosthetic rehabilitation should not only be based on the absence of teeth but also the distribution and periodontal status of the teeth present.

Validity and reproducibility of the revised oral assessment guide applied by community health workers.

OBJECTIVE: To determine the validity and reproducibility of the Revised Oral Assessment Guide (ROAG) as pre-diagnostic tool used in elderly citizens by community health workers (CHWs) of the Family Health Strategy (FHS). MATERIAL AND METHODS: Initially, we adjusted the English version to Portuguese and then developed a training program for use of ROAG, with the participation of CHWs, in selected districts that had the highest enrolled number of elderly people in the city. The elderly persons were distributed among 10 previously trained CHWs. To assess the validity of the ROAG, a CHW and a dentist (considered as the gold standard) independently evaluated the same individual. The reproducibility of the ROAG was evaluated by each of the CHWs examining 5-6 elderly individuals twice with a 7-day interval. RESULTS: The sensitivity ranged from 0.17 for evaluation of saliva to 0.80 for voice. The specific ranged from 0.69 for teeth/dentures to 0.98 for saliva using mirror and the accuracy ranged from 0.92 for swallow to 0.64 for mucosa. The intra-rater reproducibility of the ROAG was perfect for evaluation of voice, lips and swallow (κ=1.000). CONCLUSION: When used by trained CHWs, the ROAG is a tool with high sensitivity and specificity to assess voice, swallowing, tongue and teeth/dentures. Moreover, it can efficiently detect patients showing no alteration in lips, saliva, mucosa and gums. High reproducibility was observed in almost all the categories. Trained CHWs can use this tool to improve the access of elderly patients to dental services.