Má oclusão em crianças e adolescentes brasileiros: modelo multinível

Abstract

This study is composed of two papers that aimed to evaluate the association between the prevalence and severity of malocclusion in 12-year-old children and Brazilian adolescents aged 15-19 years, with individual and contextual variables. This is a cross-sectional study in which were used data of national epidemiological survey of oral health, SB Brazil 2010. The outcome was malocclusion, measured by the Dental Aesthetic Index (DAI), classified as absent; defined, severe and very severe. The independent variables were classified into individual (demographic, oral health diseases, socioeconomic, educational, morbidity and utilization of dental services, self-perception and impact on health) and contextual (Human Development Index-IDH; Performance Index of the Health System-IDSUS; Bolsa Familia, GDP per capita; fluoridated water). Data were analyzed using the chi-square test and the multilevel model in SAS software (2008) with a significance level of 5%. In the multilevel model three models was used: The intercept was used in Model 1. In model 2, individual variables were introduced and contextual variables in model 3 were used in order to explain the variability of malocclusion. Article 1: A total of 1 to 250 children / the city in 172 cities in Brazil totaling 7,328 children aged 12 years. It was observed no statistical association between the Brazilian region related to prevalence of severe and very severe malocclusion. In the first model, the variation of malocclusion between the cities was significant (p<0.001). The second model showed that the children who presented a higher gravity of malocclusion were male (p=0.033), lower income (p=0.051), reported consulation (p=0.009), affirmed less satisfaction with the mouth and teeth (p<0.001) and being ashamed of smiling (p<0.001). In the third model, the variables of the second level (cities) were included, showing that the characteristics of cities influenced the gravity of malocclusion. Cities with more families with social benefit per 1000 inhabitants, with lower notes of the IDSUS and lower GDP per capita were significantly associated with malocclusion. Article 2: Were evaluated from 1 to 402 adolescents/city in 174 cities in Brazil, totaling 5,445 adolescents aged 15-19 years old. It was observed no statistical association between the Brazilian region related to prevalence of severe and very severe malocclusion. In model 1, the variation of malocclusion between the cities was statistically significant (p=0.008), with low coefficient of variation (3%). In model 2, the adolescents who showed a high severity of malocclusion had lower income (p=0.010), consultation (p=0.003), less satisfaction with mouth and teeth (p<0.001), difficulty to speak (p=0.036) and ashamed to smile (p<0.001). In model 3, the variables of the second level (cities) have been included and it was observed that higher severity of malocclusion was identified in cities with more families with social benefit per 1000 population (p=0.001) and lower GDP per capita (p=0.016). It is concluded that malocclusion showed a significant association with the individual and contextual variables.