Condições de saúde bucal e fatores associados à perda dentária entre adultos de Montes Claros - MG

Abstract

Introduction: It has been reported an increasing interest in epidemiological informations about oral health of adults. Adults constitute the majority of the population, their behavior could decisively influence the behavior of the dependents and they exhibit some epidemiological particularities regarding oral health conditions. Tooth loss is as importantindicator of oral health among adults. Aims: i) describe the sociodemographical profiles, use of dental services, behavior andsubjective conditions related to oral health of adults; ii) describe the oral health normative conditions of adults; iii) to estimate the prevalence of tooth loss due to caries among adults and to test the association between these variables according to access to oral health informations; iv) assess the impact of design effect correction in estimates resulting from cluster sampling among adults.. Methods: A probabilistic sample by two-stage cluster consisted of 841 adults aged from 35 to 44 years of the Montes Claros municipality, Brazil. Household interviews and oral examinations were conducted by oral health professionals calibrated, following WHO guidelines for oral exams. Data were collected by using a palmtop and analyzed by using a statistical software. Descriptive analysis of the profile of adults and their oral conditions were also performed. The factors related to tooth loss due to caries was considered the dependentvariable. We also tested the association between tooth loss due to caries and variables related to the access to oral health informations by using hierarchical multiple linear regression analysis. The independent variables were grouped in four blocks: demographic and socioeconomic characteristics, use of dental services, access to oral health information(information about how to prevent oral problems, oral hygiene, and diet) and behavioral aspects. To assess the impact of correction of the design effect on estimates, we presented both uncorrected and corrected estimates by the sample design, the relative differences between the two measures in proportion, the average, confidence intervals (95% CI) ,standard error (SE), odds ratio (OR), and coefficients of linear and logistic regressions (). Results: The sociodemographical profiles of adults of this study, it was revealed an average of 9.5 years of study; with a predominance of women (54%); non-white skin color (51%); with stable relationship (75%); low per capita income (70%); without car ownership (69%) and with home ownership (81%). Concerning to behavior, 25% of adults reported smoking habits, 41% reported alcohol consumption, and 61% did not made physical exercise. The majority of adults reported to be satisfied with life (85%); despite they believed have caries lesions (55%) but reported no pain (61%). They stated the need for dental treatment (78%) and about a half of adults evaluated their oral health positively (49%). Only 11 (1.4%) of adults reported never having used dental services. Among those who have used dental services, it was found that 35% used public dental services, 46% used such services during less than one year and 66% used for oral treatment. The majority of adults reported satisfaction with the use of such dental services (75%). In regards to oral health normative conditions, about 4% of adults were edentulous. Among the dentate, 57.2% had dental plaque and 57% had calculus. Approximately 10% had periodontal disease. The mean DMFT was 17.7 (SE = 0.4) and COR of 0.47 (SE = 0.05). The average number of teeth per individual were 23.2 (SE = 0.37). The majority examined teeth (91.4%) showed no need of treatment, although 52% of adults have shown that need. Also, 13.4% had some type of soft tissue injuries. The prevalence of tooth loss due to caries among adults was 83%, with average number of 7.03 (SE = .31). The access to the oral hygiene informations from dental services showed a linear relationship with total tooth loss, even after controlling for demographic and socioeconomic variables, use of dental services, and behavioral aspects. The tooth loss due to caries were higher among older, less educated, women, adults who rarely or never received oral hygiene informations in dental service, those who brushed their teeth once a day or less, and those who do not used dental floss. The impact of the design effect correction showed relative differences between the analyzes with and without correction (up to 10% in the point estimates of proportion and medium; up to 122% in the amplitude of the IC-95%; and up to 128 % underestimation with the EP in unadjusted analyzes). The relative differences in the values ranged up to 516% in the multiple logistic regression and up to 119% in multiple linear regression. The Deff values, as well as the errors associated with the estimated measurements, were higher in descriptive analysis than those obtained with inferential analysis. The multiplelinear regression model showed a variable with diference in the significance statistical between the corrected and uncorrected analyzes.Conclusions: Our findings revealed a high prevalence of tooth loss due to caries among adults. This oral problem is related to access to information about how to prevent oral problems. Tooth loss due to caries showed up related to an unfavorable environmental conditions such as low education level, misinformation, and a low self-health care. Dentalservices must ensure better access for oral health informations in the context of the health promotion, being the knowledge the background for the search for a greater equity to the oral health. It is recommended to correct the effect of design and to present the Deff values in analysis of sampling clusters in epidemiological studies of the oral health. However, it must be emphasized that this correction is insufficient to compensate typical problems that may have occurred with the sample during the collection of data.