Use of oral health services among elderly Brazilians: mediation by tooth loss

Santos, Aline Soares Figueiredo; Lima, Renata Francine Rodrigues; Ferreira, Raquel Conceição; Alencar, Gizelton Pereira; Carreiro, Danilo Lima; Silveira, Marise Fagundes; Trezena, Samuel; Martins, Andrea Maria Eleutério de Barros Lima

doi:10.1590/1413-81232022277.22122021EN

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FREE THEMES • Ciênc. saúde coletiva 27 (7) • July 2022 • https://doi.org/10.1590/1413-81232022277.22122021EN copy

Use of oral health services among elderly Brazilians: mediation by tooth loss

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The present study analyzed factors associated with the use of oral health services among elderly Brazilians. This was a cross-sectional study with data from the latest National Oral Health Survey (SB Brazil 2010), which considered a sample of 7,619 elderly individuals (65-74 years) for analysis. Structural Equation Modeling (SEM) was used, investigating the association between latent or observed variables, directly or mediated, in relation to the use of oral health services. Least squares estimators adjusted by mean and variance, were used by means of standardized coefficients, and standard error and confidence intervals, by applying the bootstrapping method with 1,500 iterations. Elderly individuals with a higher socioeconomic status, fewer missing teeth, and the presence of impacts of oral health conditions on their lives were directly associated with the outcome. Other factors associated with the mediated use of oral health services among elderly Brazilians included socioeconomic status, gender, age, and the use of prostheses, in addition to finding a correlation between prosthesis use and missing teeth. Tooth loss, along with other factors, played a prominent role in this study regarding the use of oral health services among elderly Brazilians, pointing to the need to expand access to dental prostheses in primary care.

Key words:
Oral health; Dental health services; Elderly; Structural equation modeling

Variables		n* (%)/Mean [SD]
Use of Services
	No	1,058 (13.9)
	Yes	6,561 (86.1)
Individual Primary Determinants
Age (in years)		69.01 [3.13]
Gender
	Female	4,716 (61.9)
	Male	2,903 (38.1)
Skin color (self-reported race)
	White	3,577 (46.9)
	Yellow/Black/Brown/Indigenous	4,042 (53.1)
Socioeconomic Condition
Level of Education (years studied)		5.08 [4.35]
No. of household goods		6.41 [2.66]
Family Income (in reais)
	>1,500.00	2,460 (29.5)
	≤1,500.00	5,159 (70.5)
Normative oral health conditions
No. of missing teeth		24.52 [9.46]
Use of prosthesis
	Do not use in any arch	1,810 (23.8)
	Use in one arch	2,094 (27.5)
	Use in two arches	3,715 (48.8)
Subjective oral health condition
Dissatisfaction with teeth and mouth
	Very good/Good	605 (7.9)
	Good	3,345 (43.9)
	Regular	1,394 (18.3)
	Bad	2,050 (26.9)
	Very bad	225 (3.0)
Impact of oral disorders
Difficulties eating
	No	5,326 (69.9)
	Yes	2,293 (30.1)
Discomfort when brushing
	No	6,723 (88.2)
	Yes	896 (11.8)
Feeling nervous or irritated
	No	6,574 (86.3)
	Yes	1,045 (13.7)
Recreational activities restrictions
	No	6,967 (91.4)
	Yes	652 (8.6)
Sports restrictions
	No	7,388 (97.0)
	Yes	231 (3.0)
Speech difficulty
	No	6,411 (84.1)
	Yes	1,208 (15.9)
Feeling of shame
	No	6,269 (82.3)
	Yes	1,350 (17.7)
Interference with daily activities
	No	7,259 (95.3)
	Yes	360 (4.7)
Sleep impairment
	No	6,995 (91.8)
	Yes	624 (8.2)

Effects on the use		Β	EP	p
Effect on socioeconomic condition
	Direct	0.19	0.04	0.000*
	Indirect	0.03	0.02	0.120
	Indirect through number of missing teeth	0.05	0.01	0.000*
	Total	0.22	0.03	0.000*
Effect on subjective condition
	Direct	0.12	0.03	0.002*
Gender effect
	Direct	-0.06	0.02	0.005*
	Indirect	0.02	0.01	0.035
	Indirect through number of missing teeth	0.02	0.00	0.000*
	Total	-0.04	0.02	0.026
Age effect
	Direct	0.02	0.02	0.528
	Indirect	-0.01	0.00	0.000*
	Indirect through number of missing teeth	0.01	0.00	0.002*
	Total	0.01	0.02	0.939
Effect of number of missing teeth
	Direct	-0.15	0.03	0.000*
	Indirect	-0.01	0.00	0.112
	Indirect through subjective oral health condition	-0.01	0.00	0.112
	Total	-0.16	0.03	0.000*
Effect of using prosthesis
	Direct	0.00	0.03	0.943
	Indirect	-0.01	0.07	0.009*
	Indirect through subjective oral health condition	-0.01	0.01	0.009*
	Total	-0.01	0.03	0.698

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[1] Collaborations

All authors participated in the article’s design, planning and definition of the methodology, data analysis and interpretation, and writing of the manuscript.