Traumatismo dentário e impacto na qualidade de vida de adolescentes brasileiros e suas famílias

Abstract

The objective of the study was to evaluate the impact of traumatic dental injuries (TDI) on oral health-related quality of life (OHRQoL) among Brazilian adolescents and their families. A population-based study was carried out with adolescents aged 11-14 years and their families from Belo Horizonte, Brazil. The study is presented into two manuscripts. The first manuscript describes a case-control study, nested to a cross-sectional study with a sample of 1,215 adolescents. OHRQoL was measured by the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) - Impact Short Form (ISF:16), self-reported by adolescents. Two Step Cluster analysis was performed to define cases and controls based on CPQ11-14-ISF:16 scores. The case group included adolescents who presented higher negative impact on OHRQoL (n=405), and the control group included those with lower negative impact (n=810). Two controls for each case were individually matched from the same school and gender. The second manuscript has a cross-sectional design, and involved a sample of 1,122 families. To assess the impact on familys OHRQoL, parents/caregivers answered the Brazilian version of the Family Impact Scale (B-FIS), which consists of 14 items. For both manuscripts, the main independent variable was TDI, diagnosed by the Andreasen classification, by three calibrated examiners. Dental caries, malocclusion and age were confounding variables. Conditional logistic regression analysis (for case-control study) and Poisson regression model with robust variance (for crosssectional study) were performed with the significance level set at 5%. Multiple conditional logistic regression model demonstrated that adolescents diagnosed with fractures involving dentin and/or pulp had 2.40 more chances to present high negative impact on QHRQoL (95% confidence interval [CI] = 1.26-4.58; p = 0.008) than those without evidence of fractures. Enamel fracture only (p=0.065) and restored fractures (p = 0.072) were not statistically associated with OHRQoL. The multivariate Poisson regression analysis demonstrated that families of adolescents diagnosed with fracture involving the dentine and/or pulp were more likely to report a negative impact on the overall B-FIS (rate ratio [RR] = 1.44; 95% confidence interval [CI] = 1.10-1.88) as well on the Parental/Family Activity (RR = 1.45; 95% CI = 1.09-1.94), Parental Emotions (RR = 1.45; 95% CI = 1.03-2.04) and Family Conflict (RR = 1.46; 95% CI = 1.01-2.11) subscales. In summary, adolescents with more severe untreated TDI such as fractures involving dentin and/or pulp were more likely to self-report a higher negative impact on their OHRQoL and more likely to present negative impact on families OHRQoL than those without TDI.