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

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) • Fev 2018 • https://doi.org/10.1590/1413-81232018232.21022015 copiar

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

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

A cárie dentária é um problema de saúde pública com impacto na qualidade de vida relacionada à saúde bucal (QVRSB). Este estudo teve como objetivo avaliar a cárie dentária como desfecho em saúde bucal em pré-escolares, por meio da associação de indicadores clínicos e sociodentais que avaliam a QVRSB. Um estudo transversal foi realizado com crianças de 2 a 6 anos de idade que frequentavam creches públicas de um município do sudeste do Brasil. Após o cálculo da amostra, 446 crianças foram selecionadas aleatoriamente por critérios de elegibilidade. A avaliação foi feita por dois profissionais, usando critérios da OMS, que classificaram os sujeitos de acordo com a gravidade de cárie precoce na infância (CPI). Os pais/cuidadores responderam um questionário auto- aplicado de caracterização da amostra e um indicador sociodental (B-ECOHIS). A prevalência de cárie dentária foi de 33,7%. As crianças com alta gravidade de CPI tinha cinco vezes mais chance de sofrer impacto sobre QVRSB. O teste one way ANOVA apresentou associação entre impacto na QVRSB (ECOHIS escores) e CPI. O desfecho cárie em saúde bucal apresentou alta prevalência como indicador clínico e alto impacto sobre a QVRSB como o indicador sociodental. Indicadores clínicos e sociodentais devem ser avaliados em conjunto.

Palavras-chave
Crianças; Cárie dentária; Qualidade de vida; Saúde bucal

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.