Associação entre determinantes sociais da saúde e dentição funcional em adultos de 35 a 44 anos

Abstract

This study aimed to identify the social determinants of health, composed by individual and contextual factors, associated with functional dentition in adults aged 35 to 44 years old, residing in metropolitan areas of Minas Gerais. . This cross-sectional study sampled 831 adults obtained by cluster sampling design. From among 33 cities, eightwere randomly selected, and this was followed by equally random selection of the census sectors and city blocks. All of the selected households were visited, and the adults who agreed to participate in the study were examined by five previously calibrated researchers (kappainter=0.88; kappaintra=0.85) between May and September 2010. Dental crown condition of all teeth was registered according adapted OMS criteria; excepting for third molars. Interviews were based on aquestionnaire addressing individual factors related to health; DMFT were calculated for each tooth. Participants with incomplete clinical exams and full edentulous were excluded from analysis. Sample size comprised adults that resided in 5 of 8 drawn municipalities. The counting of missing teeth per participant resulted in an outcome of functional dentition (presence of 20 or more teeth in the mouth). The association ofthis condition with the fixed factors (demographic characteristics); proximal (lifestyle and behaviors); intermediate (schooling, income, housing conditions, access to services) and distal (contextual factors characteristic of cities illiteracy rate, average income, rate of extraction, number of dentists / 1,000 inhabitants, time in years of water fluoridation, FIRJAN index of municipal development) social determinants of health, based on Dahlgren and Whiteheads model; were tested using logisticregression and multilevel analysis using STATA®11.0. The average age of participants was 39.4 ±3.2 years old, and the average household income per capita was US$188.1±8.3. Female, brown-skinned, and married individuals prevailed in the sample (67.7%, 56.3%, and 71.1%, respectively). Functional dentition was frequent among the adults in the sample (80.9%; 95% CI from 78.1 to 83.5%). The fixed factors, proximal and intermediate social determinants of health exhibited associations with functional dentition. Multilevel analysis did not identify significantassociations between the distal determinants and the outcome. Younger males with monthly incomes higher than US$147.00, with higher education, who used dental floss, preferred salty foods, and did not visit the dentist due to extraction or prosthesis exhibited higher odds of having functional dentition. The results show that functional dentition is associated with sociodemographic conditions, lifestyle of adults, and the reasons to look for health services.