[Factors associated with tooth loss among adults in rural areas in the state of Pernambuco, Brazil]

Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey

BACKGROUND

Tooth loss is an oral health condition with high prevalence and negative impact on quality of life. It is the result of the history of oral diseases and their treatment as well as provision of dental care and access to dental services. Socioeconomic characteristics are determinants of tooth loss and living in rural areas is also a risk factor for its incidence.

OBJECTIVE

To identify contextual and individual factors associated with self-reported tooth loss among adults and elderly people living in rural riverside areas.

METHODS

A cross-sectional household-based survey was conducted in 2019 with rural riverside communities on the left bank of the Rio Negro River, Manaus, Amazonas. These communities are covered by a fluvial health team and two riverside health teams. Interviews were conducted in a representative random sample of dwellers aged ≥ 18 years, using electronic forms to obtain information on oral health conditions, demographic and socioeconomic characteristics, and use of and access to health services. The outcome was self-reported tooth loss. After the descriptive analysis of the data, a multilevel Poisson regression analysis was performed to estimate the prevalence ratio for the outcome. Variables with p-value ≤0.20 in the bivariate analyses were included in the multiple analysis considering the hierarchy between individual and contextual variables in the multilevel model. Variables with p-value ≤0.10 were kept in the final model and the significance level adopted was 0.05.

RESULTS

603 individuals from 357 households were assessed (mean age 44.1 years). The average number of missing teeth was 11.2 (±11.6); 27.4% of individuals had lost more than 20 teeth (non-functional dentition) and 12.1% were completely edentulous. Contextual characteristic of primary healthcare offered was associated with the outcome. The tooth loss was lower in territories covered by riverside health teams. At individual level, tooth loss was greater in older individuals who had experienced dental pain over the past six months and whose sugar consumption was high. Black or brown individuals, individuals whose household income was higher, those who were on the Bolsa Família cash transfer program, those who consulted a dentist over the past year, and those who reported satisfaction with their teeth/oral health reported less tooth loss.

CONCLUSION

Tooth loss was associated with contextual territorial factors related to the healthcare service and individual demographic, behavioral, socioeconomic, and service-related characteristics as well as self-perceived oral health conditions. The findings suggest that actions focused on the oral health of these populations involve not only changes in the healthcare service organization, but also intersectoral policies that contribute to reducing social inequalities.

Tooth loss in adults: factors associated with the position and number of lost teeth

OBJECTIVE

To evaluate the factors associated with tooth loss in adults from the position and number of teeth lost in the dental arches.

METHODS

This is a cross-sectional, population-based study with adults participating in the epidemiological survey of oral health of São Paulo in 2015. The outcome of the study was tooth loss, assessed by the proposed classification, namely: I) lost up to 12 back teeth; II) lost up to 12 teeth (including front teeth); and III) lost more than 12 teeth. A four-block analysis was conducted, supported by a conceptual theoretical model adapted for tooth loss. For the multinomial logistic regression, "individuals who did not lose teeth due to caries or periodontal disease" was used as reference (p < 0.05).

RESULTS

Of 6,051 adults evaluated, 25.3% (n = 1,530) were classified in category I, 32.7% (n = 1,977) in II, 9.4% (n = 568) in III, and 1.9% (n = 117) were edentulous. Lower income and schooling, the perception of need for treatment and the last appointment motivated by routine, pain or extraction were associated with tooth loss, regardless of the classification. The negative evaluation of the dental service was associated with individuals who lost up to 12 teeth, both front and back. The presence of women and periodontal pocket were associated with tooth loss of up to 12 teeth, including front, and more than 12 teeth. Caries were associated with adults who lost up to 12 teeth, including front teeth.

CONCLUSION

The proposed classification allowed the identification of differences between the associated factors. Thus, the need to consider such classification in future studies is evident.

The impact of oral health on quality of life of urban and riverine populations of the Amazon: A multilevel analysis

Few studies and epidemiological surveys are carried out in populations geographically and culturally isolated, such as rural and riverine communities. Riverine populations represent one of the typical populations of the Amazon region. This study aimed to evaluate the impact of dental caries and periodontal disease on the quality of life of adolescents and young adults from an urban area and from two riverine communities of the Amazon region located at different distances from the urban area. The occurrence of dental caries and periodontal disease was examined through the Decayed, Missing, Filled (DMFT) Index and the Community Periodontal Index (CPI). The impact of oral health conditions on quality of life was examined through the Oral Health Impact Profile (OHIP-14) questionnaire. The data were collected from 564 individuals (15-25 years old): 212 residents of the urban area of Abaetetuba-Pará-Brazil, were compared to 186 inhabitants of the nearest riverine community (Maracapucu) and 166 of another riverine community (Tucumanduba River) located further from the city. The OHIP-14 was analyzed as a dependent outcome, while dental caries, bleeding, calculus, the presence of periodontal pockets, as well as sex and age were analyzed as independent variables through Poisson analysis in a multilevel model. The worst indicators of OHIP-14 and the highest DMFT scores were found in the riverine populations, especially those from the riverine community farthest from the urban area. Based on the adjusted multivariate model, variables such as the contextual variable (location, RR 1.31), and individual demographic variables (sex and age), DMFT (RR 1.53), and the presence of periodontal pockets (RR 1.15) were significantly related to the OHIP (p<0.001). Our results confirm that dental caries and periodontal disease negatively impact oral health-related quality of life; however, these diseases seem to impact the individuals from remote communities more significantly.

Oral health condition and reasons for tooth extraction among an adult population (20-64 years old)

The study characterized the oral health condition and main self-reported reasons for tooth extraction in an adult population. The cross-sectional study examined 248 adults aged 20-64 years, representative of the population of Piracicaba, São Paulo, Brazil. The oral examination conducted in households used the DMFT and CPI indexes, use and necessity of prosthodontics according to the WHO criteria and the presence of visible biofilm. Demographic and socioeconomic data were collected along with reasons for tooth extraction through a questionnaire. Descriptive analysis was stratified by age in groups: 20-44 and 45-64 years old. The average DMFT was 20.37 (EP = 0.50), P = 3.34 (EP = 0.33) for young adults and P = 13.41 (EP = 1.45) for the older adults. Gingival pockets (CPI ≥ 3) were found on 20.5% of young adults and 53.0% of the older ones. While 38.8% used upper prosthesis, 46.7% needed lower prosthesis. Pain was the most prevalent self-reported reason for tooth extraction (37.5%), being this choice primarily because of lack of another treatment option (52%) and done in the private sector (47.2%). We concluded that young adults (20-44 years old) showed less missing teeth, periodontal diseases, and need for prosthetic use. Pain and lack of options of other treatments were the main self-reported reasons for performing tooth extractions.