Dentição funcional em adultos brasileiros: avaliação da funcionalidade e associação com determinantes sociais da saúde e qualidade de vida

Abstract

Aim: Evaluate functional dentition (FD) in Brazilian adults and associations with social determinants of health (SDH) and quality of life (QoL). Methods: A cross-sectional study was conducted with 9564 individuals (35-44 yr). Oral health was evaluated using the decayed, missing and filled teeth index, community periodontal index (CPI) and clinical attachment loss (CAL). Number of teeth, posterior occluding pairs (POPs) and maximum CPI and CAL of the sextants were counted. Dentitions were classified using the following levels: I- one tooth each arch; II- 10 teeth each arch; III- 12 anterior teeth; IV- three premolar POPs; V- one molar POP bilaterallly; VI- all sextants with CPI3 and/or CAL1. FD definitions were compared: well-distributed teeth (WDT= 10 teeth each arch); World Health Organization definition of FD (FDWHO= 20 teeth); FD classified by esthetics and occlusion (FDClass5= level V) and FD classified by esthetics, occlusion and periodontal status (FDClass6= level VI). The SDH evaluated were contextual and individual. QoL was evaluated based on self-perceptions and the Oral Impacts on Daily Performance (OIDP) index. Prevalence ratios (PR) of the multi-level (individual and municipal) regression models were estimated. Percentages of individuals satisfied with oral health, with no overall impact (OIPD=0) and with no impacts on daily performance were determined, for the presence/absence of the criterion of each level of the classification system, considering their sequential character. Multiple models were created for each dependent variable regarding QoL, with dental conditions as independent variables. Results: The prevalence rates of WDT, FDWHO, FDClass5 and FDClass6 were 72.9, 77.9, 42.6 and 40.3%, respectively. Adults with higher levels of schooling and income respectively had higher prevalence rates of FDWHO (PR: 1.42 and 1.15), WDT (PR: 1.58 and 1.20) and FDClass5 (PR: 2.16 and 1.59). A very high municipal human development index and fluoridated water were associated with higher prevalence rates of the three outcomes. Percentages of individuals satisfied with oral health, with OIPD=0 and with no impacts on eating or smiling/speaking were higher among individuals with 10 teeth each arch (44, 48, 70 and 77%, respectively) than those without this criterion (30, 34, 57 and 56%, respectively). Percentages of adults satisfied with oral health and unashamed to smile/speak were higher among those with all levels of the system (53 and 85%, respectively) compared to those without level VI (28 and 59%, respectively). Satisfaction with oral health showed a positive association with FDClass5 (PR = 1.21) and FDClass6 (PR = 1.24). The same was observed for overall impact related to WDT (OR = 1.14) and FDClass6 (OR = 1.21) and for impact on smiling/speaking in relation to all definitions of DF. Conclusion: Different definitions of FD exerted an influence on prevalence estimates among Brazilian adults. SDH and QoL were associated with functional dentition.