Determinantes sociais da cárie dentária em adultos de municípios do entorno de Belo Horizonte, Minas Gerais, Brasil

Abstract

Introduction: In recent decades, studies in public health have increasingly focused on social determinants in the health and illness process. In this sense, epidemiology considers oral health to be a reflection of socioeconomic and environmental aspects, with particular influence from the social context. Objective: The aim of this study was to describe, through literature review,different explanatory models for dental caries, to perform evidence between socioeconomic indicators and the occurrence of dental caries and to associate the severity of dental caries in adults, residing in cities around Belo Horizonte, with the socioeconomic and demographics aspects and habits. Method: The methods adopted in this thesis were the literature and field research. For the literature search used the narrative and systematic review. A narrative review was based on publications on epidemiological models and context to current models of dental caries, a historical perspective. As for the development of a systematic review adopted to search for articles, which dealt with caries and socioeconomic factors in seven databases without restriction to the date and language, but with limits to adulthood in 19-60 years. Finally, field research was a cross-sectional and home base, involving a sample of 1150 adults (35 to 44 years of age) residing in metropolitan Belo Horizonte, Brazil. The sample was selected through probabilistic conglomerate sampling. From the database, the main study, was elaborated case-control study with 180 cases and 180 controls, and this sample set after a new sample size for this specific study design. To collect data we used a semi-structured questionnaire and the DMFT index were used for the diagnosis of dental caries. The exams were performed by five previously calibrated dentists (Kappa from 0.80 to 1.00), in 2010. The questionnaire was tested in a pilot study, test-retest method. For the definition of the severity of dental caries, DMFT . 14 was considered high severity. The statistical involved bivariate and multivariate analyses were carried out using the Poisson regression model for the study analytical cross and the Logistic regression on case-control study, with those achieving a pvalue . 0.05 considered significant and confidence interval 95%. This study received approval from the Human Research Ethics Committee. Results: The explanatory model of dental caries has undergone changes over time. The decay began to be understood also by interactions between the general conditions of social structures and individuals. Moreover, a systematic review suggested there was evidence that a worse socioeconomic indicator was associated with increased severity of dental caries in the adult population. The field research showed that the greater prevalence of high caries severity was found among those who frequently visited the dentist (PR=1.18; CI: 1.07-1.30), those with a lower income (PR= 1.11; CI: 1.01-1.23), those who reported that their neighborhood did not come together in the previous year to petition political leaders for benefits (PR=1.16; CI: 1.05-1.28) and those unable to make decisions (without empowerment) (PR=1.12; CI: 1.01-1.24). The results of casecontrol study confirmed the influence of social context in the severity of dental caries. Those who reported that the community did not get together in the previous year to petition authorities for community benefits had a 2.1-fold (95%CI: 1.2 to 3.6) greater chance of having high caries severity than those who resided in regions in which authorities were petitioned for community benefits Conclusion: Scientific studies suggest evidence of caries and socioeconomic factors. The field study revealed high dental caries severity in adults, which was associated with individual characteristics, health-related behavior and social structure and context variables. Research indicates the need for interventions into new perspectives, which provide community development skills to discuss problems, make decisions (empowerment) and to develop collective petitions. Thus, the results reinforce the importance of social cohesion in search of formulating local public health policies, as community participation may have influenced the setting of priorities in health and lower caries burden among adults.