Impacto de la salud oral en las dimensiones física y psicosocial: un análisis de modelos de ecuaciones estructurales

Silveira, Marise Fagundes; Marôco, João P.; Freire, Rafael Silveira; Martins, Andréa Maria Eleutério de Barros Lima; Marcopito, Luiz Francisco

doi:10.1590/0102-311X00072013

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ARTICLE • Cad. Saúde Pública 30 (6) • Jun 2014 • https://doi.org/10.1590/0102-311X00072013 linkcopiar

Impacto de la salud oral en las dimensiones física y psicosocial: un análisis de modelos de ecuaciones estructurales

Autoría SCIMAGO INSTITUTIONS RANKINGS

El objetivo de este estudio fue evaluar el impacto de las condiciones de salud bucal en sus dimensiones físicas y psicosociales entre adolescentes. La gravedad del impacto fue tratada como variable latente, medida por medio de un cuestionario Oral Health Impact Profile (OHIP-14). Las covariables fueron: el nivel socioeconómico, los hábitos y el cuidado de la salud, utilización de servicios dentales y condiciones de salud bucal. Se realizó un modelado de ecuaciones estructurales y los modelos fueron estimados por máxima verosimilitud. El efecto del número de dientes con necesidad de tratamiento, número de dientes restaurados y el CPI de la gravedad del impacto fue significativo. En esta población, las condiciones socioeconómicas desfavorables se asocian con una menor frecuencia de uso de los servicios dentales, que están asociadas con malas condiciones de salud oral, y que a su vez se correlacionaban con una mayor gravedad del impacto.

Salud Bucal; Evaluación en Salud; Análisis Multivariante; Adolescente

In the last six months, because of problems with your teeth, mouth, or dentures	Frequency of responses (%)
	0	1	2	3	4	% (95%CI)
Functional limitation						0.9 (0.3-2.8)
Item 1. Have you had trouble pronouncing any words?	92.9	3.3	3.3	0.3	0.3
Item 2. Have you felt that your sense of taste has worsened?	95.0	2.1	2.4	0.2	0.3
Physical pain						6.6 (4.0-10.8)
Item 3. Have you had painful aching in your mouth or teeth?	69.6	10.0	16.1	2.3	2.0
Item 4. Have you found it uncomfortable to eat any foods?	75.6	8.5	11.8	1.9	2.4
Psychological discomfort						11.8 (7.5-18.2)
Item 5. Have you felt self-conscious?	63.6	9.9	16.0	2.5	8.0
Item 6. Have you felt tense?	82.9	4.5	7.3	1.6	3.7
Physical limitation						2.8 (1.6-4.8)
Item 7. Has your diet been unsatisfactory?	86.3	5.3	6.1	0.8	1.5
Item 8. Have you had to interrupt meals?	88.5	3.9	6.5	0.8	0.3
Psychological limitation						4.1 (2.3-7.3)
Item 9. Have you found it difficult to relax?	87.6	5.8	4.9	1.0	0.7
Item 10. Have you been a bit embarrassed?	83.4	5.6	8.0	0.7	2.2
Social limitation						2.2 (1.0-4.7)
Item 11. Have you been a bit irritable with other people?	89.8	4.3	4.1	0.3	1.5
Item 12. Have you had difficulty doing your usual jobs?	93.1	3.3	2.6	0.5	0.5
Handicap						0.7 (0.3-1.6)
Item 13. Have you felt that life in general was less satisfying?	93.4	2.8	3.3	0.2	0.3
Item 14. Have you been totally unable to function?	96.6	1.7	1.5	0.2	0.0
Total						15.6 (10.4-22.8)
	Mean	SD	Min	Max	S_K	K_U
Socioeconomic characteristics and habits and care
Years of schooling	9.9	2.0	2	16	0.32	0.36
Number of rooms in household	6.3	2.3	1	20	1.26	3.83
Household crowding	0.8	0.5	0.2	6.0	3.88	21.79
Per capita income	243.6	282.9	23.0	3000.0	4.97	23.61
Cigarettes per day	0.5	0.8	0	40	5.31	24.18
Frequency of brushing [times/day] (%)
None	0.4
1	3.4
2	25.2
≥ 3	71.0
Normative conditions of oral health and use of services
Number of decayed teeth	0.8	1.5	0	12	2.98	9.56
Number of teeth needing dental treatment	1.1	2.1	0	25	4.23	21.51
Number of filled teeth	2.4	3.2	0	19	1.70	3.39
Number of missing teeth	0.2	0.9	0	7	2.47	8.46
Dental aesthetic index (DAI)	23.4	6.9	13	61	1.55	3.74
Community periodontal index (CPI)	0.5	0.8	0	4	1.52	1.84
Time since last visit to dentist [years] (%)
Never visited	6.0
> 3	21.2
1-2	22.5
< 1	50.3

Effects	Standardized coefficient	Non-standardized coefficient	Standard error	Bootstrap standard error	p-value
Time since last visit to dentist← socioeconomic status	-0.25	-0.15	0.03	0.05	< 0.001
Number of teeth needing dental care←socioeconomic status	-0.16	-0.21	0.06	0.06	< 0.001
Number of filled teeth← socioeconomic status	-0.02	-0.04	0.09	0.08	0.600
CPI← socioeconomic status	-0.14	-0.07	0.02	0.03	0.004
Cigarettes/day← socioeconomic status	-0.14	-0.25	0.08	0.17	0.003
Severity of impact← socioeconomic status	-0.06	-0.005	0.004	0.005	0.193
Number of teeth needing dental care← time since last visit to dentist	0.14	0.29	0.08	0.10	< 0.001
Number of filled teeth← time since last visit to dentist	-0.21	-0.70	0.12	0.11	< 0.001
CPI← time since last visit to dentist	0.07	0.06	0.03	0.04	0.050
Severity of impact← number of teeth needing dental care	0.22	0.02	0.003	0.005	< 0.001
Severity of impact← number of filled teeth	0.08	0.003	0.002	0.002	0.050
Severity of impact← CPI	0.16	0.03	0.007	0.009	< 0.001
Severity of impact← cigarettes/day	0.03	0.001	0.002	0.003	0.413

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[tfn01t01] SD: standard deviation; Min: minimum value; Max: maximum value; K_U: kurtosis; S_K: asymmetry.

[tfn02t01] Note: 0 = never; 1 = rarely; 2 = sometimes; 3 = repeatedly; 4 = always.