Family risk as adjunct for organizing the demand for oral health service
               in the Family Health Strategy

Kobayashi, Henri Menezes; Pereira, Antonio Carlos; Meneghim, Marcelo de Castro; Ferreira, Rívea Inês; Ambrosano, Glaucia Maria Bovi

doi:10.1590/1807-2577.0003

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Original Articles • Rev. odontol. UNESP 44 (2) • Mar-Apr 2015 • https://doi.org/10.1590/1807-2577.0003 copy

Family risk as adjunct for organizing the demand for oral health service in the Family Health Strategy

Risco familiar como elemento para organização da demanda em saúde bucal na Estratégia Saúde da Família

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction

One of the main problems of the public health services, in which the family oral health team is included, is access by users to dental treatment in primary care, with particular reference to caries disease.

Objective

The aim of this study was to evaluate the relationship between family risk, for prioritization of home visits and oral health conditions, with a view to providing evidence about the first indicator for organizing the demand for oral health in the Family Health Strategy (FHS).

Method

The application of family health is based on Form A of the primary care information database SIAB ("Sistema de Informação de Atenção Básica"), used for registering families with the FHS. Eleven dentists examined the oral health conditions of 1165 persons (608 from 12 to 19 years; and 557 from 35 to 44 years of age), classifying them into six codes from A to F. Multinomial logistic regression was used (α=0.05) to analyze the association between family risk variables and oral health situation.

Result

There was significant association between family risk and presence of caries disease with treatment needs (OR: 2.08, p<0.0001).

Conclusion

Persons who have family risk would have twice as much chance of presenting caries disease in comparison with those without risk, corroborating the relevance of this element in organizing the demand for oral health.

Primary health care; oral health; risk; family health

Dental Caries Risk Classification
Code	Criteria
A	Absence of carious lesion, absence of restored teeth, absence of tooth loss and absence of large amounts of biofilm.
B	Absence of dental caries in activity, presence of restored tooth, absence of tooth loss, and absence of large amounts of biofilm.
C	Absence of dental caries in activity, presence of chronic dental caries, and temporary restorative material (IRM, ZOE or ionomer in permanent teeth), presence of tooth loss and absence of large amounts of biofilm
D	Presence of initial caries lesions without cavitation (white spot lesions in activity), and presence of large amounts of biofilm.
E	Presence of one or more dental caries cavities.
F	Presence of pain, abscess, fistula, visible pulp involvement and root fragments

Data on Form A		Score
Bedridden		3
Physical disability		3
Mental deficiency		3
Low sanitation conditions		3
Malnutrition (Severe)		2
Drug addiction		2
Unemployment		1
Illiteracy		1
Children under six months of age		1
Person older than seventy years		1
Systemic arterial hypertension		1
Diabetes Mellitus		1
Resident/Room ratio	If greater than 1	3
	If equal to 1	2
	If less than 1	0
Total score	Risk Classification
Score 5 or 6	R1
Score 7 or 8	R2
Score higher than 9	R3

Variable	Category	Total	%	Oral Health						Simple Multinomial Logistic Regression
				Healthy		Risk		Sick		SickvsHealthy			SickvsRisk
				n	%	n	%	n	%	OR	CI	p	OR	CI	p
Gender	Female	727	62.4	221	30.4	44	6.1	462	63.5	1.22	0.94-1.57	0.1376	1.22	0.75-1.99	0.4237
Gender	Male	438	37.6	150	34.2	30	6.8	258	58.9	Ref.
Age (years)	12- 19	608	52.2	252	41.4	42	6.9	314	51.6	Ref.
Age (years)	35- 44	557	47.8	119	21.4	32	5.7	406	72.9	2.74	2.10-3.56	<0.0001	1.70	1.05-2.75	0.0320
Physical Disability	No	1148	98.5	369	32.1	73	6.4	706	61.5	Ref.
Physical Disability	Yes	17	1.5	2	11.8	1	5.9	14	82.4	3.66	0.83-16.21	0.0876	1.45	0.19-11.20	0.7230
Mental Deficiency	No	1145	98.3	369	32.2	71	6.2	705	61.6	Ref.
Mental Deficiency	Yes	20	1.7	2	10.0	3	15.0	15	75.0	3.93	0.89-17.28	0.0705	0.50	0.14- 1.78	0.2878
Low Sanitaion Conditions	No	1140	97.9	367	32.2	71	6.2	702	61.6	Ref.
Low Sanitaion Conditions	Yes	25	2.1	4	16.0	3	12.0	18	72.0	2.35	0.79-7.01	0.1246	0.61	0.17-2.11	0.4328
Drug addicion	No	1132	97.2	366	32.3	74	6.5	692	61.1	Ref.
Drug addicion	Yes	33	2.8	5	15.2	0	0.0	28	84.8	2.96	1.13- 7.74	0.0268	-	-	-
Unemployment	No	1046	89.8	340	32.5	71	6.8	635	60.7	Ref.
Unemployment	Yes	119	10.2	31	26.1	3	2.5	85	71.4	1.47	0.95- 2.26	0.0816	3.17	0.97-10.30	0.0552
Illiteracy	No	1149	98.6	367	31.9	73	6.4	709	61.7	Ref.
Illiteracy	Yes	16	1.4	4	25.0	1	6.3	11	68.8	1.42	0.45-4.51	0.5481	1.13	0.14-8.92	0.9059
Children Under Six Months of age	No	1124	96.5	359	31.9	72	6.4	693	61.7	Ref.
Children Under Six Months of age	Yes	41	3.5	12	29.3	2	4.9	27	65.9	1.17	0.58-2.33	0.6645	1.40	0.33-6.03	0.6494
Person Older Than Seventy Years	No	1117	95.9	362	32.4	72	6.4	683	61.1	Ref.
Person Older Than Seventy Years	Yes	48	4.1	9	18.8	2	4.2	37	77.1	2.18	1.04-4.57	0.0392	1.95	0.46-8.27	0.3650
Systemic Arterial Hypertension	No	813	69.8	271	33.3	49	6.0	493	60.6	Ref.
Systemic Arterial Hypertension	Yes	352	30.2	100	28.4	25	7.1	227	64.5	1.25	0.94-1.65	0.1189	0.90	0.54-1.50	0.6918
Diabetes Mellitus	No	1066	91.5	348	32.6	67	6.3	651	61.1	Ref.
Diabetes Mellitus	Yes	99	8.5	23	23.2	7	7.1	69	69.7	1.60	0.98-2.62	0.0589	1.01	0.45-2.30	0.9725
Resident/Room Ratio	≤ 1	471	40.4	175	37.2	30	6.4	266	56.5	Ref.
Resident/Room Ratio	> 1	694	59.6	196	28.2	44	6.3	454	65.4	1.52	1.18-1.96	0.0012	1.16	0.71-1.90	0.5432
Family Risk (R1 + R2 + R3)	No	907	77.9	321	35.4	58	6.4	528	58.2	Ref.
Family Risk (R1 + R2 + R3)	Yes	258	22.1	50	19.4	16	6.2	192	74.4	2.33	1.66-3.28	<0.0001	1.32	0.74-2.35	0.3500

Variable	Category	Multiple Multinomial Logistic Regression
		SickvsHealthy					SickvsRisk
		Estimate	Standard-Error	OR	CI	P	Estimate		Standard-Error	OR	CI	p
Age (years)	12 - 19	Ref.
Age (years)	35 - 44	1.06	0.14	2.88	2.20-3.78	<0.0001	0.55	0.25		1.74	1.07-2.83	0.0250
Resident/room Ratio	≤ 1	Ref.
Resident/room Ratio	> 1	0.37	0.14	1.45	1.10-1.91	0.0092	0.15	0.26		1.16	0.70-1.94	0.5600
Family Risk (R1 + R2 + R3)	No	Ref.
Family Risk (R1 + R2 + R3)	Yes	0.73	0.19	2.08	1.44-2.99	<0.0001	0.25	0.31		1.29	0.71-2.35	0.4100

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[1] CONFLICTS OF INTERESTS: The authors declare no conflicts of interests.