Oral health outcomes: the association of clinical and socio-dental indicators to evaluate dental caries in preschool children

Antunes, Lívia Azeredo Alves; Ornellas, Giulia; Fraga, Renato Silva; Antunes, Leonardo Santos

doi:10.1590/1413-81232018232.21022015

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Free Themes • Ciênc. saúde colet. 23 (2) • Feb 2018 • https://doi.org/10.1590/1413-81232018232.21022015 copy

Oral health outcomes: the association of clinical and socio-dental indicators to evaluate dental caries in preschool children

Desfechos em saúde bucal: associação de indicadores clínicos e sociodentais para avaliar cárie dentária em pré-escolares

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Dental caries is a public health problem that impacts oral health related to quality of life (OHRQoL). This study aimed to evaluate the outcome of dental caries in children by associating clinical and socio-dental indicators. A cross-sectional study was carried out with 2 to 6-year-old children who attended public day care centers in a city in the Southeast Region of Brazil. After sample calculation, 446 children were randomly selected by eligibility criteria. Two professionals evaluated dental caries using WHO (2013) criteria and classified subjects according to early childhood caries (ECC) severity. Parents/care- givers answered a characterization questionnaire and self-reported socio-dental indicator (B-ECO-HIS). The prevalence of dental caries was 33.7%. The children with high severity of ECC had 5 times higher chance of suffering an impact on OHRQoL. The one way ANOVA test showed that the impact on OHRQoL (ECOHIS scores) was associated with ECC. The outcome dental caries in oral health presented high prevalence as clinical indicator and high impact on OHRQoL as socio dental indicator. Clinical and socio-dental indicators should be evaluated together.

Key words
Children; Dental caries; Quality of life; Oral health

Independent Variable		Clinical indicator
		ECC Severity
		Total N = 446	Caries-free N = 296	Low severity N = 113	High severity N = 37	P-value
Mean age (SD)^* * One-way-ANOVA test;		3.63 (1.27)	3.18 (1.45)	4.21 (0.99)	4.40 (0.95)	<0.001
Age (%)^ chi-square test;bold indicates statistical significance;
	24 to 36 months	212 (47.5)	175 (59.1)	31 (27.4)	6 (16.2)	<0.001
	37 to 60 months	234 (52.5)	121 (40.9)	82 (72.6)	31 (83.8)
Gender (%)^ chi-square test;bold indicates statistical significance;
	Male	224 (50.2)	143 (48.3)	59 (52.2)	22 (59.5)	0.39
	Female	222 (49.8)	153 (51.7)	54 (47.8)	15 (40.5)
Nursery location (%)^ chi-square test;bold indicates statistical significance;
	Urban	307 (68.8)	205 (69.3)	80 (70.8)	22 (59.5)	0.41
	Rural	139 (31.2)	91 (30.7)	33 (29.2)	15 (40.5)
Ethnicity (%)^ chi-square test;bold indicates statistical significance; , ^* ***** no answer (n = 17);
	Caucasian	296 (69.0)	203 (70.5)	74 (68.5)	19 (57.6)	0.31
	Afro-descendent	133 (31.0)	85 (29.5)	34 (31.5)	14 (42.4)
Parents’/caregivers’ Years of study (%)^ chi-square test;bold indicates statistical significance; , ^** ****** no answer (n = 24).
	≤ 8	143 (33.9)	97 (34.5)	34 (31.2)	12 (37.5)	0.75
	≥ 9	279 (66.1)	184 (65.5)	75 (68.8)	20 (62.5)

Impacts			ECC Severity
			Total (N = 446)		Caries-free (N = 296)
			B-ECOHIS = 0 (%)	B-ECOHIS ≥ 1 (%)	B-ECOHIS = 0	B-ECOHIS ≥ 1 (%)
Child impacts section
How often has your child… because of dental problems or dental treatments?
	Child symptoms domain
		1) Had pain in the teeth, mouth or jaws?	335 (75.1)	111(24.9)	253 (85.5)	43 (14.5)
	Child function domain
		2) Had difficulty drinking hot or cold beverages?	372 (83.4)	74 (16.6)	262 (88.5)	34 (11.5)
		3) Had difficulty eating some foods?	360 (80.7)	86 (19.3)	255 (86.1)	41 (13.9)
		4) Had difficulty pronouncing any words?	299 (67.0)	147 (33.0)	201 (67.9)	95 (32.1)
		5) Missed preschool, daycare or school?	307 (68.8)	139 (31.2)	205 (69.3)	91 (30.7)
	Child psychological domain
		6) Had trouble sleeping?	344 (77.1)	102 (22.9)	226 (76.4)	70 (23.6)
		7) Been irritable?	285 (63.9)	161 (36.1)	192 (64.9)	104 (35.1)
	Child self-image / social interaction domain
		8) Avoided smiling or laughing?	403 (94.4)	43 (5.6)	271 (91.6)	25 (8.4)
		9) Avoided talking?	418 (93.7)	28 (6.3)	280 (94.6)	16 (5.4)
Family impacts section
How often have you or another family member… because of your child's dental problems or treatments?
	Parent distress domain
		10) Been upset?	340 (76.2)	106 (23.8)	233 (78.7)	63 (21.3)
		11) Felt guilty?	349 (78.3)	57 (21.7)	248 (83.8)	48 (16.2)
	Family function domain
		12) Taken time off from work?	369 (87.2)	77 (12.8)	248 (83.8)	48 (16.2)
		13) Had a financial impact on your family?	331 (74.2)	115 (25.8)	234 (79.1)	62 (20.9)

Impacts			ECC Severity				P-value
			Low severity (N = 113)		High severity (N = 37)
			B-ECOHIS = 0 (%)	B-ECOHIS ≥ 1 (%)	B-ECOHIS = 0 (%)	B-ECOHIS ≥ 1 (%)
Child impacts section
How often has your child… because of dental problems or dental treatments?
	Child symptoms domain
		1) Had pain in the teeth, mouth or jaws?	68 (60.2)	45 (39.8)	14 (37.8)	23 (62.2)	<0.001
	Child function domain
		2) Had difficulty drinking hot or cold beverages?	88 (77.9)	25 (22.1)	22 (59.5)	15 (40.5)	<0.001
		3) Had difficulty eating some foods?	88 (77.9)	25 (22.1)	17 (45.9)	20 (54.1)	<0.001
		4) Had difficulty pronouncing any words?	72 (63.7)	41 (36.3)	26 (70.3)	11 (29.7)	0.65
		5) Missed preschool, daycare or school?	80 (70.8)	33 (29.2)	22 (59.5)	15 (40.5)	0.41
	Child psychological domain
		6) Had trouble sleeping?	90 (79.6)	23 (20.4)	28 (75.7)	9 (24.3)	0.75
		7) Been irritable?	72 (63.7)	41 (36.3)	21 (56.8)	16 (43.2)	0.62
	Child self-image / social interaction domain
		8) Avoided smiling or laughing?	101 (89.4)	12 (10.6)	31 (83.8)	6 (16.2)	0.29
		9) Avoided talking?	103 (91.2)	10 (8.8)	35 (94.6)	2 (5.4)	0.42
Family impacts section
How often have you or another family member… because of your child's dental problems or treatments?
	Parent distress domain
		10) Been upset?	83 (73.5)	30 (26.5)	24 (64.9)	13 (35.1)	0.12
		11) Felt guilty?	82 (72.6)	31 (24.7)	19 (51.4)	18 (48.6)	<0.001
	Family function domain
		12) Taken time off from work?	91 (80.5)	22 (19.5)	30 (81.1)	7 (18.9)	0.71
		13) Had a financial impact on your family?	80 (70.8)	33 (29.2)	17 (45.9)	20 (54.1)	<0.001

Socio-dental indicator		Clinical indicator								One-Way-ANOVA	Tukey Pos Hoc
Scale/Subscale/Domain(variation)		Total (n = 446)				ECC severity
		Mean (SD)	Median	Caries-free^A (N = 296)		Low severity^B (N = 113)		High severity^C (N = 37)
		Mean (SD)	Median	Mean (SD)	Median	Mean (SD)	Median	Mean (SD)	Median	P-Value	AxBxC (P-Value)
Child subscale (0-36)		3.72 (3.98)	2.50	3.19 (3.60)	2.00	4.42 (4.65)	3.00	5.81 (3.71)	6.00	<0.001	AxB (p = 0.010) AxC (p < 0.001) BxC (p = 0.148)
	Symptoms domain (0-4)	0.45 (0.84)	0.00	0.23 (0.61)	0.00	0.79 (1.05)	0.00	1.16 (1.01)	1.00	<0.001	AxB (p < 0.001) AxC (p < 0.001) BxC (p = 0.038)
	Function domain (0-16)	1.85 (2.12)	1.00	1.57 (1.93)	1.00	2.15 (2.40)	2.00	3.13 (2.09)	3.00	<0.001	AxB (p = 0.030) AxC (p < 0.001) BxC (p = 0.036)
	Psychological domain (0-8)	1.15 (1.63)	0.00	1.17 (1.67)	0.00	1.11 (1.57)	0.00	1.16 (1.51)	0.00	0.95	AxB (p = 0.946) AxC (p = 0.999) BxC (p = 0.987)
	Self-image/social interaction domain (0-8)	0.26 (0.86)	0.00	0.21 (0.75)	0.00	0.35 (1.09)	0.00	0.35 (0.82)		0.28	AxB (p = 0.318) AxC (p = 0.641) BxC (p = 1.000)
Family subscale (0-16)		1.86 (2.92)	0.00	1.50 (2.71)	0.00	2.32 (3.06)	0.00	3.29 (3.55)	2.00	<0.001	AxB (p = 0.027) AxC (p = 0.001) BxC (p = 0.179)
	Parental distress domain (0-8)	0.93 (1.68)	0.00	0.73 (1.51)	0.00	1.18 (1.83)	0.00	1.81 (2.14)	1.00	<0.001	AxB (p = 0.039) AxC (p = 0.001) BxC (p = 0.117)
	Family function domain (0-8)	0.92 (1.60)	0.00	0.76 (1.51)	0.00	1.14 (1.74)	0.00	1.48 (1.69)	1.00	<0.01	AxB (p = 0.086) AxC (p = 0.027) BxC (p = 0.488)
Total ecohis score (0-52)		5.58 (6.03)	4.00	4.70 (5.54)	3.00	6.75 (6.78)	5.00	9.10 (6.04)	8.00	<0.001	AxB (p = 0.050) AxC (p < 0.001) BxC (p = 0.089)

Variables		Total (n = 446)	B-ECOHIS = 0 (n = 129)	B-ECOHIS ≥ 1 (n = 317)	Odds Ratio Brute (95% CI)	P-value
Age (%) ^* * Chi-square test; bold indicates statistical significance;
	24 to 36 months	212 (47.5)	67 (52.0)	145 (45.7)	1.28 (0.83- 1.97)	0.23
	37 to 60 months	234 (52.5)	62 (48.0)	172 (54.3)
Gender ^* * Chi-square test; bold indicates statistical significance;
	Male	224 (50.2)	69 (53.5)	155 (48.9)	1.20 (0.78-1.85)	0.37
	Female	222 (49.8)	60 (46.5)	162 (51.1)
Nursery location ^* * Chi-square test; bold indicates statistical significance;
	Urban	307 (68.8)	85 (65.9)	222 (70.0)	0.83 (0.52-1.31)	0.39
	Rural	139 (31.2)	44 (34.1)	95 (30.0)
Ethnicity% ^ no answer (n = 17);
	Caucasian	296 (69.0)	82 (65.6)	214(70.4)	0.80 (0.50-1.28)	0.32
	Afro-descendent	133 (31.0)	43 (34.4)	90 (29.6)
Parents’/caregivers’ Years of study ^* ***** no answer (n = 24)
	≤ 8	143 (33.9)	47 (39.2)	96 (31.8)	1.38 (0.87-2.19)	0.14
	≥ 9	279 (66.1)	73 (60.8)	206 (68.2)
Dental Caries ^* * Chi-square test; bold indicates statistical significance;
	Caries Free	296 (66.4)	100 (77.5)	196 (61.8)	Reference
	Low severity	113 (25.3)	26 (20.2)	87 (27.5)	1.71 (1.01-2.91)	0.03
	High severity	37 (8.3)	3 (2.3)	34 (10.7)	5.78 (1.65-24.22)	0.001

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[1] Colaborations

LAA Antunes made the first and the final draft of the manuscript. LAA Antunes, G Ornellas, RS Fraga and LS Antunes, designed the study. LAA Antunes and G Ornellas performed the Data collection. LAA Antunes, RS Fraga and LS Antunes analyzed the data. LAA Antunes, G Ornellas, RS Fraga and LS Antunes, reviewed critically the final draft of the paper.