Individual and contextual factors associated to the self-perception of oral health in Brazilian adults

Use of dental services among adults from a birth cohort in the South region of Brazil

OBJECTIVE

Measure the prevalence of use of dental services in the previous year and associated factors among 31-year-old adults from a birth cohort of 1982.

METHODS

This is a cross-sectional study that analyzed a birth cohort of 1982 from the city of Pelotas. In 1997, a systematic sample of 27% of the city's census sectors was defined and all households in these sectors were visited, where 1,076 15-year-old adolescents were interviewed. For the oral health studies, 900 of these individuals were randomly selected and followed up at 24 and 31 years of age. The study used data collected from 523 individuals in 2013 (at 31 years old). The outcome was visit to the dentist (use of dental services) in the previous year. Demographic factors (sex), socioeconomic factors (income, education), and oral health factors (reason and type of service, self-perception of oral health, dental pain and caries experience - DMFT) were used as independent variables. Prevalence ratios were estimated using Poisson regression.

RESULTS

The prevalence of use of dental services in the previous year was 55.3% (95%CI: 51.0-59.5%). In the adjusted analysis, the reason and type of service, self-perception of oral health, and DMFT were associated with the outcome. A stronger association was found with use of dental services in individuals who visited for prevention and used the private service, who were satisfied with their oral health, and who had more caries experiences.

CONCLUSION

55.3% of the cohort sample used dental services in the previous year. Individuals who visited the dentist of private service for preventive reasons, who were very satisfied with their oral health, used these services in a higher proportion. In addition, a higher DMFT index also led to higher use of services.

Oral Health Status of Outpatients with Schizophrenia in Ankara, Türkiye: A Descriptive Study

OBJECTIVES

To evaluate the oral health status and denture treatment needs of a group of outpatients with schizophrenia.

METHODS

One hundred and eighty-eight patients diagnosed with schizophrenia were evaluated. Socio-demographic characteristics, eating habits, alcohol consumption, smoking status, oral hygiene attitudes, medical status, medications and the data related to dental visit were obtained via structured questionnaire of 45 questions. Medication information were confirmed from hospital records. The DMFT score (the Total of decayed, missing and filled teeth), denture status, Community Periodontal Index of Treatment (CPITN) and attachment loss were recorded in accordance with the criteria defined by the WHO.

RESULTS

The mean DMFT score was 11.1±8.6. Total number of teeth decreased, while the number of decayed teeth and DMFT scores increased with age (p<0.001). There was no relationship between the anticholinergic effects of antipsychotics and the teeth count, number of decayed, filled and missing teeth, and the DMFT scores. The CPITN assessment revealed that 71.6% of the patients had healthy periodontium, 7.4% exhibited gingival bleeding upon probing, and 21% had dental calculus. Psychotropic medication and tooth brushing habits were associated with CPITN scores. Male sex was associated with higher frequency of denture need (p<0.001), while no association was observed with the education level and antipsychotic use (p>0.001).

CONCLUSION

Physicians and dentists have to work in coordination to maintain good oral health of patients with schizophrenia. Patients should be encouraged for regular dental check-ups and dentist should take utmost care of the oral hygiene maintenance.

Factors associated with self-perceived oral health in different age groups

OBJECTIVES

To determine the factors associated with self-perceived oral health (SPOH) in different age groups.

METHODS

This cross-sectional study used probabilistic samples of adolescents, adults and older adults from São Paulo State, Brazil. SPOH was assessed using a global self-rating item. Hierarchical Poisson regression models were used to determine the estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for poor SPOH and demographic and socio-economic variables, social capital, dental attendance and clinical measures. The analyses for each age group were performed separately.

RESULTS

Data from 5314 adolescents, 5815 adults and 5556 older adults were analysed. Female adolescents and adults, non-White adults and older adults with a higher educational level had worse SPOH. Adolescents, adults and older adults with lower social capital showed higher rates of poor SPOH (PR = 1.58; 95% CI: 1.27-1.97, PR = 1.20; 95% CI: 1.10-1.31 and PR = 1.26; 95% CI: 1.06-1.49, respectively). Those whose reason for last dental attendance was treatment had worse SPOH, regardless of age group. Adolescents, adults and older adults with greater number of decayed teeth had worse SPOH (PR = 1.56; 95% CI: 1.37-1.77, PR = 1.30; 95% CI: 1.22-1.38, and PR = 1.29; 95% CI: 1.17-1.42, respectively). Adolescents and adults with more missing teeth presented higher rates of poor SPOH (PR = 1.23; 95% CI: 1.04-1.44 and PR = 1.09; 95% CI: 1.02-1.16, respectively). Older adults needing a dental prosthesis had worse SPOH (PR = 2.13; 95% CI: 1.88-2.41).

CONCLUSION

There are differences in the factors associated with SPOH between age groups, and these differences reflect social inequalities in health.

Association between clinical oral health status and perceived oral health in different age groups

Objective

The perceived oral health refers to the very own perception of a person's oral health (OH). This study aims to explore the association of perceived oral health status (PSR-OHS) with clinically determined OHS in three age groups: young adults, adults and older adults. This study also aims to identify demographic, socio-economic and/or clinical factors that influence PSR-OHS.

Methods

A cross-sectional study was conducted in ten different dental hospitals of Pakistan. The one-way ANOVA test was used to analyze patient's demographic distribution with PSR-OHS and oral functions. The complex sample general linear model was used to determine association between clinical OH and PSR-OHS. Analyses of each age group were conducted separately.

Results

A total of 1,804 outdoor patients participated in the study, out of which 660 were young adults, 685 adults and 459 were older adults. Overall self-perception of all age groups about their oral health was 'good' (mean = 3.71). Female gender and education status were a significant factor in young adults and adults. Family income affected PSR-OHS of only the adult age group. Frequent visit to dental clinic and preventive reason of dental attendance were associated with good PSR-OHS. DMFT score, prosthesis score and periodontal score also affected the PSR-OHS of individuals. Association between PSR-OHS and clinical examination was confirmed by complex general linear model.

Conclusion

There are differences in the perceived oral health status of young adults, adults and older adults. The variables, age, education, family income, DMFT score, prosthesis score and periodontal score directly influence the self-perception of individuals.

[Changes in the prevalence of decayed permanent teeth in Brazil and upper-middle income countries in the years 1990 and 2017]

The distribution of caries is uneven and strongly associated with the different socioeconomic profiles of countries. The scope of this study was to describe the changes in the prevalence of decayed permanent teeth in Brazil and in upper-middle income countries for the years 1990 and 2017. It is a descriptive study based on secondary data extracted from the Global Burden of Disease. The 53 countries included in the upper-middle income group were included. Caries prevalence estimates were collected for the years 1990 and 2017. The percentage change in prevalence was calculated between the two years. The values of the Human Development Index (HDI) for each country were also collected. The results show the trend of a reduction in the prevalence of decayed permanent teeth in Brazil and in most upper-middle income countries. The prevalence of untreated caries in Brazil was 38.17% in 1990 and 37.46% in 2017. Brazil occupies the 41st position in the ranking of the reduction in the prevalence of caries among the 53 countries evaluated. The countries that achieved the greatest reductions in the prevalence of caries were those with an improvement in their HDI. In this respect, the need to review public oral health policies is revealed, as well as a reflection on addressing the inequities present in the countries surveyed.

Satisfaction with oral health and associated factors among homeless people in Midwest Brazil

BACKGROUND

Self-perceived oral health has been extensively investigated, but studies on homeless people are scarce, and there is currently no evidence from Latin America.

OBJECTIVE

To investigate the prevalence and factors associated with satisfaction with the oral health of homeless individuals in one Brazilian capital of the Midwest region.

SUBJECT AND METHODS

A cross-sectional study was carried out with 351 adult individuals attending a temporary public shelter who were interviewed about sociodemographic and psychosocial aspects, drugs use and oral health. The outcome was satisfaction with oral health (satisfied/dissatisfied). Pearson's chi-square test and Poisson regression with robust variance were used for statistical analysis.

RESULTS

The prevalence of dissatisfaction with oral health was 68.9% (95% CI = 63.9-73.6). After adjusting for covariates, dissatisfaction was more frequent among individuals who were married/in a stable relationship (PR = 1.18; 95% CI = 1.02-1.36), with felt need for treatment (PR = 2.27; 95% CI = 1.23-4.17) or complete prosthesis (PR = 1.35; 95% CI = 1.18-1.55), and those who used illicit drugs in the past six months (PR = 1.22; 95% CI = 1.06-1.39).

CONCLUSION

The prevalence of dissatisfaction with oral health in the homeless individuals studied was high and associated with their marital status, use of illicit drugs and self-reported need for dental treatment and complete prosthesis.

Does the implementation of a national oral health policy reduce inequalities in oral health services utilization? The Brazilian experience

Background

This study aimed to assess the trend in income-related inequalities in oral health services utilization by the Brazilian population from 1998 to 2013. This period represents a timeline that includes different stages of implementation of the National Oral Health Policy.

Methods

The design was based on repeated cross-sectional surveys using secondary data from household-based studies carried out in Brazil in 1998, 2003, 2008, and 2013. The dependent variable was “having access to a dentist appointment at least once in a lifetime (yes/no).” Monthly household per capita income, based on Brazil’s minimum wage, was included as the main independent variable. To measure the inequalities in oral health access related to economic position, the following complex indexes based on regression were used: (a) the slope index of inequality (SII) and (b) the relative index of inequality (RII).

Results

There was a reduction in the percentage of individuals who never had a dentist appointment for all age groups and income classifications. In general, there was a reduction trend in absolute inequality for all age groups (p < 0.001). The relative inequality and reduction trend were different between the age groups studied.

Conclusions

The National Oral Health Policy was very important for expanding free of charge, public access to dental appointment. However, despite policy implementation, there continues to be high levels of inequality in access to dental consultation. Assessing which strategies are necessary to overcome this challenge is discussed.

A multilevel assessment of the social determinants associated with the late stage diagnosis of breast cancer

The advanced-stage diagnosis of breast cancer reveals the inequalities associated with socioeconomic conditions and the offer of health services. This study analyzes the prevalence of advanced breast cancer and its relationship with individual and contextual socioeconomic indicators and offer of health service. A cross-sectional study is presented herein, on the assessment of malignant breast neoplasms in women diagnosed between 2006 and 2015 (n = 195,201). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A multilevel Poisson Regression was carried out with random intercept. The prevalence of advanced breast cancer diagnosis was 40.0%. Advanced staging was associated with younger age groups (PR 1.41), race/nonwhite (PR 1.13), lower education levels (PR 1.38), and public access to health services (PR 1.25). There was also an association with a low density of mammographic equipment (PR 1.08), and with low indices of local social inequality (PR 1.33) and human development (PR 0.80). This study maps and highlights the causes related to inequalities in the diagnosis of advanced breast cancer in Brazil, and presents essential data to reorient public policies and health-related actions to strengthen the control of breast cancer in Brazil.

Oral Health Related Quality of Life in an Adult Jamaican Population

Objectives The aim of this study is to evaluate the impact of sociodemographic characteristics, oral health status and behaviours on Oral Health Related Quality of Life (OHRQoL) on an adult Jamaican population. Methods Adults who presented for treatment at the UWI Mona Dental Polyclinic participated in this cross-sectional study. Participants responded to a structured questionnaire consisting of sociodemographic and oral hygiene habits and were also examined for the presence of decayed, missing and filled teeth (DMFT). OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14) questionnaire. Descriptive statistical analysis, univariate and multiple Poisson Regression with robust variance were performed to identify the factors impacting OHRQoL. Results The study sample consisted of 120 adults between the ages of 18-59 years. The mean OHIP-14 score was 9.81 (±9.06), 24% presented impaired OHRQoL and 76% presented frequent impaired OHRQoL. The most prevalent domain was physical pain (80%) followed by psychological discomfort (59%) and the mean DMFT score was 9.92 (±8.78). In the adjusted logistic regression, participants aged between 29-46 years (PR 0.58, CI 0.37-0.90, p= 0.016) and the use of fluoride toothpaste (PR 0.52, 95%, CI 0.35- 0.77, p = 0.001) were negatively associated with OHRQoL. Conclusion Physical pain was the dimension that most impacted domain in OHRQoL. The most negative OHRQoL was associated with the 29 to 46 years age-group and the use of fluoride toothpaste. These findings are important for oral health strategies in this population.

Relationship between the Human Development Index and its Components with Oral Cancer in Latin America

To evaluate the relationship between the Human Development Index (HDI) and its components with oral cancer (OC) in Latin America. Ecological study in 20 Latin American countries in 2010 and 2017, which evaluated the relationship between the Age-Standardized Rates (ASRs) of incidence and mortality from oral cancer and the following indicators: HDI, with its components (income, education, and health indexes); and the Gini and Theil-L indexes. Among the countries with the highest HDI, men from Brazil and Cuba had the highest incidence and mortality ASRs per 100,000 inhabitants (ASR incidence >7.5 and mortality >4.5). Among those with the lowest HDI, Haiti was the most affected country (ASR incidence >4.1 and mortality >3.0). The highest male:female ratio was in Paraguay in both years (incidence >3.5 and mortality >4.0). Mortality from oral cancer is negatively related to the global HDI in both years, with regression coefficients (95% confidence interval) being −5.78 (−11.77, 0.20) in 2010 and −5.97 (−11.38, −0.56) in 2017; and separate (independent) from the income [−4.57 (−9.92, 0.77) in 2010 and −4.84 (−9.52, −0.17) in 2017] and health indexes [−5.81 (−11.10, −0.52) and −6.52 (−11.32, −1.72) in 2017] (p < 0.05) in the countries with lower HDI. Oral cancer incidence and mortality rates vary both among and within Latin American countries according to sex, with a greater burden on men. The HDI is negatively related to mortality from oral cancer in the countries of medium and low HDI.