Desfechos em saúde bucal de indivíduos com síndrome de Down relatados por seus pais e cuidadores

Abstract

Oral conditions such as agenesis, conoid teeth, malocclusion, dental trauma, halitosis, periodontal diseases, tongue changes, drooling habits and keeping the mouth open may be present in individuals with Down syndrome (DS) and mobilize attitudes of rejection Social. Parents/caregivers of individuals with DS face a great demand for care directed at the child with a disability and may experience high stress and impaired quality of life. This study aimed to analyze the association of sociodemographic and biopsychosocial factors with the oral health of individuals with DS in 4 main outcomes: 1) halitosis in DS reported by parents/caregivers; 2) gingival bleeding in DS reported by parents/caregivers; 3) perceived stress and perceived general self-efficacy of parents/caregivers; 4) access to dental care for individuals with DS. A cross-sectional observational study was developed (COEP UFMG protocol CAAE #22814919.5.0000.5149), with a group of parents/caregivers of individuals with DS enrolled in the Associaçãos de Pais e Amigos dos Excepcionais (APAEs) in the state of Minas Gerais. Parents/caregivers answered a structured online questionnaire addressing their children's oral health issues, socioeconomic, individual, behavioral and impact of the COVID-19 pandemic variables. In addition, the short version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ), the short version of the Perceived Stress Scale (PSS) and the General Perceived Self-Efficacy Scale (GPSS) were also applied. The association of variables of interest and the outcomes of interest in the study were evaluated by univariate and multivariate analyzes (Statistical Package for Social Science - SPSS® version 22.0). The total sample comprised 257 parents/caregivers (mean age 48.69±13.26 years) of individuals with DS [mean age 18.71±14.01 (0–56)]. The main results showed that: 1) The occurrence of halitosis (34.4%; n=78) was associated with: (a) in individuals with DS ≤18 years – negative perception of oral health (OR=3.09; p =0.015); (b) in individuals with DS >18 years – gingival bleeding (OR=4.53; p=0.001), lack of tongue brushing (OR=4.50; p=0.004), negative perception of oral health (OR=2, 72;p=0.012); 2) The occurrence of gingival bleeding (34.4%; n=85) was associated with: halitosis (OR=4.69; p=0.001), negative perception of oral health (OR=7.72; p=0.033) and a protective effect of flossing (OR=0.16; p=0.005) and visiting the dentist in the last 6 months (OR=0.12; p=0.015); 3) Perceived stress of parents/caregivers (score 17.84±5.75) was associated with: (a) average stress – habit of biting fingers / biting nails by individuals with DS (OR=2.05; p=0.038 ), difficulties in oral hygiene (OR=2.39; p=0.011) and a protective effect of medium (OR=0.12; p<0.001) and high (OR=0.38; p=0.046) self-efficacy ); (b) high stress – negative impact of the COVID-19 pandemic on family finances (OR=3.00; p=0.005) and a protective effect of medium self-efficacy (OR=0.25; p=0.006) and high (OR=0.05; p<0.001). 4) Access to dental care (82.61%; n=209) was associated with age >18 years (OR=0.17; p=0.02), higher family income (OR=2.65; p= 0.010), less parental education (OR=0.47; p=0.009) and use of dental floss (OR=4.94; p=0.001). It can be concluded that halitosis and gingival bleeding reported by parents/caregivers had a considerable occurrence in individuals with DS and were mainly associated with oral hygiene practices and a negative perception of oral health. The perceived stress of parents/caregivers can be considered medium and mainly associated with difficulties in oral hygiene practices, with self-efficacy having a protective effect. Hygiene practices should be guided in this group to improve oral health. Access to dental care was high and associated with good oral hygiene practices. Social characteristics such as low family income and low education of parents/caregivers can act as a barrier to this service.