A resiliência dos pais afeta o impacto da cárie dentária e suas consequências pulpares na qualidade de vida de pré-escolares?

Abstract

Dental caries is the oral condition that most affects the quality of life of preschool children, and their presence can have pulp-related consequences, such as pulp involvement, fistulas and abscesses. These may be more harmful to the health and well-being of the child than the carious lesions themselves. It is therefore important to explore oral health outcomes using a broader framework, including contextual factors such as resilience. This can change the attitude of parents/caregivers, and can influence oral health and the perception of its impact on the oral health-related quality of life (OHRQoL) of their children. There are no studies in literature that test whether the resilience of parents and/or caregivers affects the OHRQoL of their children. The aim of the present study was therefore to evaluate the impact of dental caries and their pulp-related consequences on the OHRQOL of preschoolers, as well as whether caregiver resilience acts as a moderator, affecting how they perceive and report this impact. A representative cross-sectional study with 4-6-year-old preschool children from Ribeirão das Neves, Minas Gerais, Brazil was carried out. Parents/caregivers responded to the Brazilian versions of the Early Childhood Oral Health Impact Scale (ECOHIS) and the Resilience Scale, as well as a questionnaire with socioeconomic data and child’s oral health behavior. A total of 497 preschool children were examined by two calibrated dentists to diagnose dental caries, using the simplified ICDAS index: initial stage caries (first or distinct visual changes in enamel), moderate stage caries (localized enamel breakdown or an underlying dentin shadow), extensive stage caries (distinct cavity with visible dentin); and their pulp-related consequences, through the pufa index: pulp involvement, ulceration caused by root fragments, fistulas or abscesses. Descriptive analyses, bivariate and multivariate Poisson regression with a hierarchical approach, and sensitivity testing were used for data analyses (p<0.05). The final multivariate model was adjusted for resilience and socioeconomic and behavioral conditions and showed that the presence of carious lesions does not impact the OHRQoL of preschool children, independent of ICDAS stage (p>0.05). However, when the pulp-related consequences of carious lesions were considered, it was observed that pulp involvement (PR=2.01; 95%CI:1.47-2.74) and fistulas/abscesses (PR=3.18; 95%CI:2.05-4.92) are associated with higher ECOHIS scores, compared with carious lesions that do not exhibit pulp-related consequences. The ECOHIS Sections Impact on the Child and Impact on the Family were also associated with the presence of pulp involvement (PR=2.11;95%CI:1.48-3.00; PR=1.99; 95%CI:1.36-2.91) and fistulas/abscesses (PR=3.38; 95%CI:2.14-5.33; PR=2.85; 95%CI:1.73-4.67), respectively. In addition, the sensitivity test showed that there was almost no difference in strength of association, without resilience in the model, between the presence of pulp involvement and fistulas/abscesses and the sections Child Impact (PR=2.10; 95%CI:1.48-2.98; p<0.001; PR=1.99; 95%CI:1.37-2.87; p <0.001) and Family Impact (PR=3.43; 95% CI:2.16-5.45; p<0.001; PR=2.88; 95%CI:1.75-4.75; p<0.001), respectively. In conclusion, the presence of the clinical pulp-related consequences of caries, and not the presence of carious lesions per se, had a negative repercussion on the OHRQoL of preschool children and their families, and parental resilience did not act as a moderating factor for this association.