Hábitos de higiene bucal e utilização de serviços odontológicos em escolares de uma cidade da Região Sul do Brasil

[The use of dental services in the past year in the brazilian population: a systematic review with meta-analysis]

The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

The influence of change on sense of coherence on dental services use among adolescents: a two-year prospective follow-up study

BACKGROUND

To investigate the influence of change on sense of coherence (SOC) on dental services use in adolescents over a two-year period.

METHODS

A prospective follow-up study was conducted involving 334 12-year-old adolescents from public schools in the city of Manaus, Amazonas, Brazil. The predictors of use of dental services in the last 12 months were selected according to the Andersen's behavioural theoretical model. The predisposing factors included sex, self-reported skin colour and SOC. The enabling factors were dental insurance, monthly family income and parents/guardians schooling. Dental pain, perceived oral health status, dental caries and gingival status were used to assess need factors. Multivariable Poisson regression with robust variance was used to estimate incidence-rate ratios (IRR) and 95% confidence intervals between the independent variables and use of dental services.

RESULTS

Adolescent's SOC scores decreased significantly between baseline and one-year follow-up. SOC decline decreased the likelihood of using dental services in the last 12 months (IRR = 0.96 95%CI 0.92-0.99). Dental caries (IRR = 1.03 95%CI 1.01-1.04) and gingival bleeding (IRR = 1.01 95%CI 1.01-1.02) remained associated with use of dental services in the last 12 months. Adolescents with dental pain were more likely to have visited a dentist in the last year (IRR = 1.03, 95%CI 1.01-1.06).

CONCLUSION

SOC decrease over one-year period was a meaningful factor of dental services use among 12-year-old adolescents. Dental pain and clinical conditions were also relevant factors that can influence use of dental services in this group.

Associations between Individual-level and Area-level social disadvantage and oral health behaviours in Australian adolescents

BACKGROUND

Oral health behaviours are significant determinants of oral health. There is evidence that socioeconomic position influences oral health behaviours, but little is known about this association during adolescence. This study aims to investigate the association between social disadvantage (individual and area level) and oral health behaviours among Australian adolescents.

METHODS

This study utilized data from the Longitudinal Study of Australian Children (LSAC). The sample consisted of 2877 adolescents. Exposure measures were area-level social disadvantage (Socioeconomic Indexes for Areas) and parent-reported household income from Wave 5. Outcomes, measured in Wave 6, were three different adolescent-reported oral health behaviours: frequency of brushing, consumption of sugar-sweetened beverages (SSB) and dental visits. Associations between quintiles of each exposure and each oral health behaviour were tested by fitting multivariable logistic regression models.

RESULTS

Household income and area-level disadvantage were associated with dental visits and brushing frequency. Associations between social disadvantage and consumption of SSBs were less apparent, with only the least disadvantaged adolescents having lower odds of consumption of SSBs compared to the most disadvantaged group.

CONCLUSION

Individual and area-level socioeconomic factors are associated with dental visits, and frequency of brushing.Broad population-based strategies must be adopted to reduce intake of SSBs, however, targeted strategies are needed among more disadvantaged populations to address infrequent toothbrushing and irregular dental visits among adolescents.

Oral health of quilombola and non-quilombola rural adolescents: a study of hygiene habits and associated factors

This study evaluated oral hygiene habits and their association with sociocultural, environmental factors and factors related to the use of dental services among Quilombola and non-Quilombola rural adolescents from inland Bahia. Thiswas a cross-sectional study conducted in 2015. Prevalence and prevalence ratios were estimated for the outcomes and multiple Poisson regression analysis with robust variance was performed. We interviewed 390 adolescents, of which 42.8% were Quilombola. Poor tooth brushing and non-flossing were found in 33.3% and 46.7% of adolescents, respectively. Poor tooth brushing was increased by male gender (PR = 1.45), not living with both parents (PR = 1.45), lower hand hygiene habit (PR = 1.72) and worse oral health self-assessment (PR = 1.38). Non-flossing was associated with economic level E (PR = 1.54), older age (PR = 0.91), lower hand hygiene habit (PR = 1.53) and worse oral health self-assessment (PR = 1.33). Different associated factors were observed between Quilombola and non-Quilombola. It is necessary to consider the specificities of the populations for the promotion of adolescent oral health and the importance of the intersectoriality between education and health and care to families.

Sociodemographic factors associated with oral health in 12-year-old adolescents: hygiene behaviours and health appointments. A cross-sectional national study in Portugal

OBJECTIVES

The aim of this study was to characterise the daily oral hygiene behaviours and the frequency of, and reasons for, oral health appointments, among 12-year-old adolescents in Portugal. We also investigated whether there were any associations between these behaviours and sociodemographic factors.

METHODS

We conducted an observational descriptive study based on 1,309 Portuguese adolescents from rural, peri-urban and urban populations. Data were drawn from the III National Prevalence Study of Oral Health Diseases. After descriptive analyses, binary logistic regression models were used.

RESULTS

In this study, 70.6% (n = 924) of adolescents reported that they brushed 'twice a day or more', and this behaviour was associated with all sociodemographic variables. Multivariate analysis revealed that male gender [odds ratio (OR) = 2.124; 95% confidence interval (95% CI): 1.616-2.793], rural residence (OR = 1.647; 95% CI: 1.169-2.321), peri-urban residence (OR = 1.926; 95% CI: 1.319-2.812), low level of maternal educational (OR = 2.139; 95% CI: 1.446-3.164) and father's unemployment (OR = 1.671; 95% CI: 1.127-2.478) were associated with not brushing at least twice a day (P < 0.05). Approximately 94% (n = 1,217) of participants had already visited an oral health professional, and 74.5% (n = 860) did so in the last 12 months.

CONCLUSION

Our results are in agreement with the literature; the oral health behaviours of 12-year-old Portuguese adolescents can be regarded as satisfactory, although there are important variations across different subpopulations. The influence of sociodemographic factors suggests that tailored strategies must be developed for specific subpopulations, at both individual and community levels.

Reliability of self-reported toothbrushing frequency as an indicator for the assessment of oral hygiene in epidemiological research on caries in adolescents: a cross-sectional study

Background

In the present state of knowledge regarding the etiology of dental caries, it is unacceptable for studies addressing factors associated with this outcome to disregard oral hygiene. Simple, valid methods are needed for the assessment of oral hygiene in adolescents to allow this condition to be properly investigated in epidemiological studies on caries and assist in the establishment of health promotion measures. The aim of the present study was to test the hypothesis that the self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices in epidemiological studies on dental caries in adolescents.

Methods

A cross-sectional study was conducted with a representative sample (n = 589) of 12-year-old school children in a medium-sized city in southern Brazil. A detailed questionnaire addressing socio-demographic and economic characteristics was sent to primary caregivers. Adolescents answered a brief self-administered questionnaire on behavioral characteristics, including toothbrushing frequency and sugar intake. Samples of stimulated saliva were collected from the adolescents and evaluated for levels of mutans streptococci and lactobacilli using Dentacult kits I and II, respectively. Examiners who had undergone a training and calibration exercise (kappa > 0.81) performed the clinical examination of the adolescents. Caries experience was assessed using the decayed, missing and filled teeth index. Oral hygiene was determined using the Simplified Oral Hygiene Index and the Visible Plaque Index.

Results

When the oral hygiene variables were used alone in the multiple models, significant associations with dental caries were found. When Simplified Oral Hygiene Index and/or Plaque Index were used together with toothbrushing frequency in the same model, only the latter was significantly associated with dental caries. A significant association was also found between self-reported toothbrushing frequency and the clinical indices.

Conclusion

Based on the present findings, self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices, which facilitates data collection in epidemiological studies addressing dental caries in adolescents.

[Access to information about how to prevent oral problems among school children in the public school network]

The scope of this study is to identify the prevalence of access to information about how to prevent oral problems among schoolchildren in the public school network, as well as the factors associated with such access. This is a cross-sectional and analytical study conducted among 12-year-old schoolchildren in a Brazilian municipality with a large population. The examinations were performed by 24 trained dentists and calibrated with the aid of 24 recorders. Data collection occurred in 36 public schools selected from the 89 public schools of the city. Descriptive, univariate and multiple analyses were conducted. Of the 2510 schoolchildren included in the study, 2211 reported having received information about how to prevent oral problems. Access to such information was greater among those who used private dental services; and lower among those who used the service for treatment, who evaluated the service as regular or bad/awful. The latter use toothbrush only or toothbrush and tongue scrubbing as a means of oral hygiene and who reported not being satisfied with the appearance of their teeth. The conclusion drawn is that the majority of schoolchildren had access to information about how to prevent oral problems, though access was associated with the characteristics of health services, health behavior and outcomes.

Acesso a orientações de higiene bucal entre escolares da rede pública de ensino

Introdução: O acesso à educação em saúde bucal é considerado um importante preditor para avaliação das condições e dos comportamentos em saúde bucal. Crianças com 12 anos estão, em sua maioria, inseridas no ambiente escolar, sendo a escola um ambiente educacional e social propício para que conhecimentos e mudanças de comportamento sejam trabalhados. Objetivo: Propõe-se identificar a prevalência do acesso a orientações de higiene bucal entre escolares da Rede Pública de Ensino e os fatores associados a esse acesso. Metodologia: Trata-se de um estudo transversal, analítico, conduzido entre escolares de 12 anos de idade de um município brasileiro de grande porte populacional. Os exames foram realizados por 24 Cirurgiões-Dentistas treinados e calibrados com auxílio de 24 anotadores. A coleta de dados ocorreu em 36 escolas públicas, sorteadas dentre as 89 escolas do município. Foram conduzidas análises descritivas, univariadas e múltiplas (OR/IC95%). Resultado: Dos 2.755 escolares avaliados, 2.510 foram incluídos. Destes, 2.173 (86,6%) receberam orientações de higiene bucal. O acesso a orientações de higiene bucal foi maior entre escolares do sexo masculino e dentre os que utilizaram serviços odontológicos privados ou por convênio. Foi menor entre os que usaram o serviço odontológico para tratamento e há mais de um ano, dentre os que não recebiam assistência odontológica na escola e entre aqueles que relataram uma frequência de higiene bucal de uma vez por dia. Conclusão: A maioria dos escolares teve acesso a orientações de higiene bucal, estando este acesso associado a variáveis referentes aos determinantes pessoais, ao serviço de saúde e aos comportamentos.

Oral health behaviour and social and health factors in university students from 26 low, middle and high income countries

Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that 67.2% of students reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. In a multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, depression and PTSD symptoms, tobacco use and frequent gambling, low physical activity, and low daily meal and snacks frequency were associated with inadequate tooth brushing (<twice daily). Further, being a male, older age, coming from a not well off or poor family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, PTSD symptoms, illicit drug use, low physical activity, and low daily snacks frequency, skipping breakfast and inadequate fruit and vegetables consumption were associated with less than one annual dental care visit. Oral health behaviour among the students was found to be low. Various risk factors identified can be used to guide interventions to improve oral health behaviour among university students.

Fatores associados ao uso dos serviços de saúde bucal: estudo de base populacional em municípios do Maranhão, Brasil

Objetivou-se avaliar a utilização dos serviços de saúde bucal (SSB) e fatores associados nos municípios com mais de 100 mil habitantes do Maranhão. A amostra de base populacional incluiu 1214 crianças e 1059 adultos. Estimaram-se razões de prevalência (RP) por regressão de Poisson hierarquizada, segundo modelo teórico de Andersen. Mais de 91% das crianças e 71,9% dos adultos não utilizaram os SSB nos seis meses anteriores à entrevista. Dos que utilizaram 48,5% foram atendidos no SUS. Procedimentos preventivos foram mais frequentes que os curativos. Em crianças e adultos fatores predisponentes, facilitadores e de necessidade explicaram o uso de SSB. Em crianças, idade > 2 anos (RP = 5,29), maior escolaridade do chefe da família (RP = 2,37), > 6 consultas pré-natais (RP = 1,69) e necessidade de tratamento dentário (RP = 9,54) associaram-se ao maior uso dos SSB. Nos adultos, maior uso associou-se à maior escolaridade (RP = 2,26), classe econômica A/B (RP = 1,38), autopercepção da saúde boa/muito boa (RP = 1,72) e necessidade de tratamento (RP = 18,25). A utilização dos SSB não é universal, nem equânime e há deficiência na atenção integral, pois serviços de maior complexidade são utilizados por poucos. Menor número de consultas pré-natais parece ser preditor da não utilização dos SSB por crianças.

[Socioeconomic status, toothbrushing frequency, and health-related behaviors in adolescents: an analysis using the PeNSE database]

This study investigated the association between oral and general health-related behaviors and socioeconomic status, and the relationship between health-related behaviors and toothbrushing among adolescents. The database used here was the National School-Based Health Survey (PeNSE), a cross-sectional population-based study in 2009 with students from 27 Brazilian State capitals. Socio-demographic and health-related behavior data were collected. The survey included 49,189 adolescents (47.5% males), the majority of whom were 14 years of age and enrolled in public schools. The associations between toothbrushing frequency and other health-related behaviors and socioeconomic status varied between boys and girls. Associations were observed between health-related habits and toothbrushing frequency in both sexes, but with variations according to socioeconomic status. Planning health promotion interventions for adolescents should take their individual characteristics and family and social context into account.

Consumo de dentifrício e fatores associados em um grupo populacional brasileiro

Este estudo transversal avaliou o consumo de dentifrício fluoretado e fatores associados em Passo Fundo, Rio Grande do Sul, Brasil. Seiscentos e oitenta e oito domicílios foram selecionados. Um questionário estruturado foi respondido pela mãe para obter dados demográficos, hábitos e consumo de dentifrício. O consumo foi avaliado por intermédio da duração de um tubo de dentifrício e considerado baixo (duração > 1 mês) e alto (duração < 1 mês). Modelos de regressão logística avaliaram a associação do consumo com variáveis independentes. Foi observado que 61,2% dos domicílios apresentaram alto consumo de dentifrício. No modelo multivariado, idade da mãe > 50 anos (OR = 1.62; IC95% 1,02-2,61), frequência de escovação da mãe (OR = 2,53; IC95%: 1,53-4,16), número de moradores que utilizam escova (OR = 5,69; IC95%: 3,68-8,81) e motivo cosmético para escolha do dentifrício (OR = 1,64; IC95%:1,03-2,61) representaram maior chance de alto consumo de dentifrício. Conclui-se que a maioria dos domicílios apresenta consumo elevado de dentifrício, associado com idade e frequência de escovação da mãe, número de moradores e motivos de escolha.