Evolução da cárie dentária da infância à adolescência: um estudo de acompanhamento

Abstract

This study aimed to analyze the development of dental caries from childhood to adolescence, during a period of 9 years, in a rural area of Minas Gerais, Brasil (COEP-UFMG, ETIC 447/07) A follow-up study for dental caries based on data collected in 1999 was performed. Of the 90 students examined at baseline-1999 (7 year-olds), 60 adolescents, aged 15-16, were re-examined (2008) by one single examiner properly calibrated (Kappa 0,8 a 0,9). To collect epidemiological data related to dental caries, the same indices (DMFT and DMFS) from the first exam were used, following the same diagnostic criteria (WHO), with artificial light (spotlight) and compressed air, after tooth brushing. New data was included to this second data collection by applying an interview questionnaire, which considered skin color, occupation/job, education, eating habits, lifestyle, social life, self care, access to health services, and retrospective assessment of aspects of life and health perception. The Significant Caries Index (SiC) was used to identify the polarization of the disease. The incidence of dental caries was calculated by the difference of DMFT, DMFS, and SiC 1999-2008.The relationship between the dependant variable (prevalence of dental caries) and the independent variables was initially performed by bivariate analysis (2 test, p<0.10) following the multivariate analysis (p<0.25). Based on the homogeneity of the sample, cluster analysis was performed (segmentation) through the Two Step Cluster method. The incidence of dental caries, calculated by the difference DMFT and DMFS, 1999-2008, was the outcome variable used for comparison between clusters (Mann-Whitney test, with significance level of 5%). The average age between the adolescents was 15.4 years (+0.4). It was verified that 80% of the adolescents had two or more teeth with caries (IC95%: 70.0-90.0). For the examination of 2008, a mean DMFT of 4.72 (± 3.55), mean DMFS of 8.07 (± 7.46) and SiC mean of 8.7 (± 2.45) were obtained. Within the period of nine years, there was an increase in DMFT (12 times), DMFS (16 times) and SiC (7.4 times). The mean incidence of caries in the period of nine years was 7.53 ± 7.19 (DMFS), 4.35 ± 3.44 (DMFT) and 7.53 (±2.51) SiC. Only the access to health service showed to be statistically significant when the prevalence of caries was related to the independent variables. Individuals identified with less accessibility showed about three times more caries than those with more access {PR = 3.2 (90% CI [1.07 to 9.78])}. Two clusters were formed in the segmentation of the sample. The first cluster, consisting mostly of white female adolescents, having good performance in the study, with the worst eating habits showed higher incidence of caries observed in the largest mean differences in DMFT and DMFS, within this period, (5.5 and 9.3), respectively), with statistically significant difference in cluster 2 (p = 0.014), on DMFT. There was a high incidence of dental caries in the study period as demonstrated by a significant increase of DMFT. This phenomenon of polarization is present in the group, and a part of it (third SiC) concentrated 62% of the total burden of the disease. Of the variables studied, only the accessibility showed association with dental caries. In this study, eating habits was the feature of the greatest epidemiological plausibility to explain the phenomenon of disease growth. After these results, if nothing is done, we can foresee an adult population with problems like those presented now.