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Brazilian Oral Research

On-line version ISSN 1807-3107

Braz. oral res. vol.31  São Paulo  2017  Epub Dec 18, 2017

http://dx.doi.org/10.1590/1807-3107bor-2017.vol31.0115 

Original research

Determinants of oral self-care in the Brazilian adult population: a national cross-sectional study

Danielle Bordin(a) 

Cristina Berger Fadel(b) 

Celso Bilynkievycz dos Santos(c) 

Cléa Adas Saliba Garbin(a) 

Suzely Adas Saliba Moimaz(a) 

Nemre Adas Saliba(a) 

(a)Universidade Estadual Paulista “Júlio de Mesquita Filho” – Unesp, Araçatuba School of Dentistry, Department of Pediatric and Social Dentistry, Araçatuba, SP, Brazil

(b)Universidade Estadual de Ponta Grossa – UEPG, Department of Dentistry, Ponta Grossa, PR, Brazil

(c)Universidade Tecnoógica Federal do Paraná – UTFPR, Ponta Grossa, PR, Brazil


Abstract:

This study aims to investigate variables related to adherence to oral self-care in the Brazilian adult population. It is an exploratory study, using secondary data from a population-based survey on a representative sample of the adult population of the entire Brazilian territory (n=60202). The sample was selected using a multiple stage approach. The oral self-care indicator was defined by grouping the variables: periodicity of dentist appointments, use of dental floss, toothbrush and toothpaste, frequency of brushing and replacement of the toothbrush. The scores obtained from the indicator were categorized into adequate, partially adequate, and inadequate care. Statistical analysis consisted of dimensionality reduction, and oral self-care-related variables were submitted to logistic regression. The variables mostly related to inadequate or partially adequate oral self-care were: illiteracy (OR = 11.20, OR = 4.81), low educational level (OR = 3.50, OR = 1.96), negative oral health self-concept (OR=3.73, OR=1.74), absence of natural teeth (OR = 4.98, OR=2.60), edentulous lower arch (OR = 3.09; _____), number of missing upper teeth (OR=1.14, OR=1.05), absence of health insurance (OR=2.23, OR=2.07), sedentary lifestyle (OR=2.77, OR=1.51), and smoking (OR=2.18, OR=1.40). It was concluded that the individual's level of education is one of the main factors for adherence to adequate oral self-care, followed by level of oral health self-concept and tooth loss. Likewise, lifestyle also bears a significant influence.

Keywords: Self Care; Oral Health; Knowledge; Health Knowledge; Attitudes; Practice; Cross-Sectional Studies

Introduction

The World Health Organization (WHO) defines self-care as the ability of individuals, families, and communities to promote quality of life, prevent disease and maintain health, and cope with disease and disability with or without the support of a healthcare practitioner.1,2 Generally speaking, self-care can be defined simply as the practice of voluntary and intentional activities that individuals perform for their own benefit and for the purpose of preserving life, health, and wellbeing.3

Authors advocate that self-care should assume a central role in the field of social and preventive healthcare, since the current objective of health interventions is more related to the response given to life processes than to the disease itself.4,5

Self-care may be affected by basal factors such as age, sex, education, income, health condition and support network,6 and by distal factors such as sociocultural orientation, family issues and environment, lifestyle, and adequacy and availability of public resources6. In the field of oral health, the recognition and analysis of the process of acquiring individual autonomy is under construction, and studies predominantly show an association between oral self-care and isolated factors.7,8,9,10,11

The literature points out that appropriate oral health depends on maintaining certain practices, including periodic dental visits,12,13,14,15 tooth brushing frequency,7,10,12,16,17 toothbrush replacement frequency,17,18 dental flossing, and use of auxiliary techniques,7,12,17,19 and that all these factors together represent oral self-care. However, the studies usually evaluate oral self-care in a segmented manner, relating it specifically to dental flossing, toothbrushing or regular visits to the dentist.7,8,10,16,17 Therefore, the factors that actually infer oral self-care cannot be predicted accurately.

The objective of this study was to investigate multiple variables related to adherence to oral self-care in the Brazilian adult population, using an indicator that encompasses several factors representing oral healthcare. Knowing these variables makes it possible to identify health standards and behaviors, which can influence the development of oral healthcare policies focusing on self-care determinants, and the introduction of supported strategies to strengthen oral self-care.

Methods

This was a cross-sectional, quantitative study carried out with data from the last National Health Survey (PNS), developed in 2013, and financed by the Brazilian Ministry of Health20, with the approval of the National Human Research Ethics Committee, Resolution # 328.159/2013.

The National Health Survey was conducted by the Brazilian Institute of Geography and Statistics (IBGE), which is the main provider of data and information in the country, and which carefully followed all the statistical and methodological steps recommended for this type of research, in order to obtain concise and representative data on the entire Brazilian territory.20

The PNS was developed in households covering the entire Brazilian territory,20 using a cluster sampling20 to obtain estimated data of the proportion of people in the different categories of the indicators of interest. The data were collected from 64,348 homes, and interviews with 60,202 adults. Details on the sampling and deliberation process are available in the PNS report.20

Calibrated researchers performed the data collection, and the interviews were recorded on handheld computers. After explaining the objectives, procedures, and importance of participating in the research to the interviewees, the accepting participants were identified, that is, the individuals who answered the questionnaire and all the residents of the home, as well as the adults who were selected by drawing, and who answered the individual questionnaire, and also continued on to the other stages of the research.20

The survey was composed of three forms: the home form, referring to the characteristics of the home; the home resident form; and the individual form, answered by the residents who were selected by the drawing, and who were aged 18 years or older.20 In this study, the individual and the home resident forms were used; however, only the answers provided by the interviewed participants were entered in the home resident form.

The forms were presented in thematic modules. Each module composed a set of variables that made it possible to characterize several topics of interest in greater detail.21

Processing of data

Variable outcome

The broad oral self-care indicator was considered a variable outcome, and was created by grouping together preexisting variables in the form.21 The variables were selected to represent the oral self-care indicator as closely as possible, and comprised: the time since the last dental appointment (response pattern: in the last 12 months, over 1 and under 2 years, over 2 years, and never went to the dentist); brushing frequency (response pattern: twice a day or more, once a day, does not brush every day, never brushed); materials used for oral-health (toothbrush, toothpaste and dental floss - yes and no for the response pattern), and toothbrush replacement frequency (response pattern: less than 3 months, between 3 and 6 months, between 6 months and 1 year, more than once a year, and never replaced).

In this stage in which the variable was created, each variable was dichotomized and evaluated as appropriate oral self-care (score 1), according to the conditions considered acceptable by the literature, namely: dental appointment made at least once a year,12,16 tooth brushing twice a day or more,18 use of toothbrush, toothpaste and floss, and replacement of toothbrush within less than 6 months;22 or inadequate self-care (score 0), considered as consisting of the worst conditions.

In creating the oral self-care indicator, the variables were grouped together according to the sum of the scores obtained. When the sum was equal to 0 or 1, the oral self-care was considered entirely inadequate, 2 to 5 meant partially adequate, and equal to 6 meant entirely adequate (Figure 1).

Figure 1 Process of forming the dependent variable of ‘oral self-care’. 

The accuracy of the indicator was verified by applying a decision tree test, where the indicator was considered a variable outcome, and the training variables as explanatory variables. In so doing, we achieved an explanatory capacity (99.99%) of the variables under the broad indicator of oral self-care, with an error estimate of 0.0087%. In the model created, the variable with the greatest explanatory capacity was use of dental paste, followed by use of dental floss and toothbrush replacement frequency.

Independent variables

The following variables related to the thematic modules were selected: general characteristics of the residents, education, work, health insurance coverage, health services used, lifestyle, health perceptions, chronic diseases, and oral health,21 totaling 66 variables of interest. After exploring these data, 40 variables were included in the study, all of which were treated according to the pertinent literature. The numerical variables were categorized, and some categorical variables were dichotomized or re-categorized. In the next step, the variables underwent descriptive analysis, as presented in the results section (Tables 1, 2, 3).

Table 1 Description of the sample, according to sociodemographic and work characteristics. Brazil. 2013. (n = 60202). 

Variables Total Entirely inadequate Partially adequate Entirely adequate
Dependent variable Class n % n % n % n %
Oral self-care 60202 100 1392 2 36696 61 22114 37
Independent variables
Sociodemographic characteristics
Gender Male 25920 43 667 48 17232 47 8021 36
Female 34282 57 725 52 19464 53 14093 64
Age 18≤30 15750 26 16 1 8654 24 7080 32
31≤40 14139 23 35 3 7666 21 6438 29
41≤50 11160 19 73 5 6724 18 4363 20
51≤60 10426 17 244 18 5945 16 4237 19
> 60 8727 14 1024 74 7707 21 0 0
Ethnicity White 24106 40 481 35 12913 35 10712 48
Black 5631 9 159 11 3831 10 1641 7
Asian 533 1 11 1 287 1 235 1
Mixed-race 29512 49 735 53 19371 53 9406 43
Indian 417 1 6 0 292 1 119 1
Ignored 3 0 0 0 2 0 1 0
Living with spouse or partner Yes 34522 57 556 40 20992 57 12974 59
No 25680 43 836 60 15704 43 9140 41
Marital status Married 23741 39 485 35 13882 38 9374 42
Separated or Divorced 4727 8 106 8 2759 8 1862 8
Widow (er) 4708 8 440 32 3413 9 855 4
Single 27026 45 361 26 16642 45 10023 45
Literacy Yes 54335 90 710 51 31795 87 21830 99
No 5867 10 682 49 4901 13 284 1
Level of education Literacy 7630 13 532 38 6259 17 839 4
Primary School 15288 25 190 14 11382 31 3716 17
Secondary School 18589 31 91 7 9927 27 8571 39
Undergraduate 8109 13 13 1 2805 8 5291 24
Graduate 487 1 0 0 117 0 370 2
Not applicable 10099 17 566 41 6206 17 3327 15
Region of residence North 12536 21 205 15 8266 23 4065 18
Northeast 18305 30 614 44 12482 34 5209 24
Southeast 14294 24 352 25 7741 21 6201 28
South 7548 13 107 8 3973 11 3468 16
Midwest 7519 12 114 8 4234 12 3171 14
Work characteristics
Has a paid job Yes 33990 56 241 17 19043 52 14706 67
No 26212 44 1151 83 17653 48 7408 33
Occupation Domestic Work 2784 5 30 2 1885 5 869 4
Private sector employee 16267 27 67 5 8692 24 7508 34
Public sector employee 5841 10 13 1 2364 6 3464 16
Employer 1023 2 1 0 459 1 563 3
Free-lancer 10092 17 155 11 6878 19 3059 14
Unpaid worker 435 1 10 1 305 1 120 1
Not answered 23760 39 1116 80 16113 44 6531 30
Number of jobs One 34776 58 270 19 19843 54 14663 66
Two or more 1666 3 6 0 740 2 920 4
Not applicable 23760 39 1116 80 16113 44 6531 30
Income ≤ 216 dollars 11661 19 166 12 8276 23 3219 15
216 > 421 dollars 12319 20 62 4 7096 19 5161 23
420 > 841 dollars 6988 12 30 2 3330 9 3628 16
> 840 dollars 5027 8 8 1 1566 4 3453 16
Not applicable 24207 40 1126 81 16428 45 6653 30
Number of hours worked per week ≤ 20 hours 4264 7 63 5 2282 6 1919 9
20 > 41 hours 16576 28 120 9 8323 23 8133 37
> 40 hours 15602 26 93 7 8702 24 6807 31
Not applicable 23760 39 1116 80 17389 47 5255 24
Works at night Yes 5419 9 22 2 2834 8 2563 12
No 31023 52 254 18 17749 48 13020 59
Not applicable 23760 39 1116 80 16113 44 6531 30

Table 2 Description of the sample, according to overall health conditions. Brazil. 2013. (n = 60202). 

Independent variable Class Total Entirely inadequate Partially adequate Entirely adequate
n % n % n % n %
Oral health condition
Self-concept of oral health condition Positive 39572 66 613 44 21712 59 17247 78
Negative 20630 34 779 56 14984 41 4867 22
Difficulty eating None 53336 89 984 71 34282 93 18070 82
Some 6866 11 408 29 2414 7 4044 18
Upper arch dental loss None 22387 37 30 2 11359 31 10998 50
Some 26806 45 157 11 16528 45 10121 46
All teeth missing 11009 18 1205 87 8809 24 995 4
Lower arch dental loss None 21133 35 42 3 10944 30 10147 46
Some 32121 53 186 13 20271 55 11664 53
All teeth missing 6948 12 1164 84 5481 15 303 1
Number of natural teeth present None 6606 11 1144 82 5226 14 236 1
> 10 3413 6 100 7 2895 8 418 2
≤10 50183 83 148 11 28575 78 21460 97
Use of dental prosthesis No 24431 41 769 55 14731 40 8931 40
Yes, but needs to replace some teeth 14932 25 129 9 9619 26 5184 23
Yes, but needs to replace all teeth 5558 9 470 34 4733 13 355 2
Not answered 15281 25 24 2 7613 21 7644 35
General health condition
Self-concept of general health condition Positive 39141 65 492 35 21541 59 17108 77
Negative 21061 35 900 65 15155 41 5006 23
Limited mobility Yes 1567 3 222 16 1101 3 244 1
No 58635 97 1170 84 35595 97 21870 99
Difficulty seeing Yes 23859 40 557 40 13961 38 9341 42
No 36343 60 835 60 22735 62 12773 58
Alcohol consumption Yes 23002 38 1146 82 23410 64 12644 57
No 37200 62 246 18 13286 36 9470 43
Practice of physical activity Yes 17896 30 101 7 8432 23 9363 42
No 42306 70 1291 93 28264 77 12751 58
Tobacco use Yes 8729 14 344 25 6340 17 2045 9
No 51473 86 1048 75 30356 83 20069 91
Presence of chronic diseases Yes 27250 45 470 34 19377 53 7403 33
No 32952 55 922 66 17319 47 14711 67

Table 3 Description of the sample, according to use of oral health services. Brazil. 2013. (n = 60202). 

Independent variable Class Total Entirely inadequate Partially adequate Entirely adequate
n % n % n % n %
Use of oral health services
Reason for last dental appointment Prevention or checkup 14048 23 21 2 4078 11 9949 45
Treatment 11144 19 83 6 5018 14 6043 27
Other reasons 464 1 1 0 188 1 275 1
Not answered 34546 57 1287 92 27412 75 5847 26
Duration of dental appointment ≤30 minutes 17088 28 81 6 6690 18 10317 47
30 < 61 minutes 7439 12 22 2 2220 6 5197 24
> 60 minutes 1129 2 2 0 374 1 753 3
Not applicable 34546 57 1287 92 27412 75 5847 26
Dental appointment by Health insurance 4744 8 9 1 1149 3 3586 16
Private 14042 23 43 3 4444 12 9555 43
SUS 6451 11 53 4 3405 9 2993 14
Didn't know/ not answered 34965 58 1287 92 27412 75 6266 28
Evaluation of the service received Positive 23248 39 91 7 8116 22 15041 68
Negative 2408 4 14 1 1168 3 1226 6
Not answered 34546 57 1287 92 27412 75 5847 26
Individual health insurance Yes 4744 8 5 1 1149 3 3590 16
No 20912 35 100 7 8135 22 12677 57
Not answered 34546 57 1287 92 27412 75 5847 26

The variables related to chronic diseases, such as diabetes, hypertension, high cholesterol, stroke, chronic spinal problems, arthritis, work-related osteomuscular disturbances, depression, chronic obstructive pulmonary disease, cancer and chronic renal failure were analyzed with the variable outcome, but presented no associations. Hence, a new variable was created, called the presence of chronic disease (s), which groups all diseases aiming at increasing the representativeness of the presence or absence of some chronic diseases. In the results section, only the variable presence of chronic disease (s) was addressed.

The variable of number of natural teeth in the mouth was also created. In constructing this variable, we considered the totality of natural teeth present in the individual's whole mouth (32), subtracted from the sum of upper and lower missing teeth. Then, the variable was dichotomized according to the parameters of a previous study23, into more than 10 natural teeth and 10 or fewer natural teeth in the mouth.

After categorizing the results, an unbalance was observed in the classes of the outcome variable. To avoid bias of the results, the classes from the outcome variable were balanced for each independent variable, applying the Resample Weka Filter, using the supervised method.24

Data analysis

Once the database was delimited, the first statistical analysis was made, consisting of the dimensionality reduction test, performed using the Correlation-based Feature Selection (CFS) algorithm, according to the cross-validation method of 10-fold in the WEKA environment.24 This algorithm prioritizes different sets of attributes (independent variables) that are closely related to the outcome variable and little related to each other. Thus, the close relationship of the dependent variables with the independent variables can be verified with much greater precision than with other tests commonly used in the literature, since the researcher wields no influence during the analysis.

Next, the variables related to ‘oral self-care’ were evaluated by logistic regression, so that the magnitudes of the associations from the odds ratios could be verified, also performed in the WEKA environment.24 The confidence interval was set at 95%, and statistical significance, at p>0.05. The model had an explanatory capacity of 70.4%.

Results

Tables 1, 2 and 3 describe the sample, according to ‘oral self-care’ and sociodemographic and work characteristics, overall health conditions and use of dental services, respectively.

The majority of the Brazilian population have partially adequate oral self-care (61%), followed by totally adequate (37%). The descriptive data show that the majority of individuals who presented entirely adequate oral self-care are young, white and mixed-race adults, married and single, with good schooling and good work conditions (Table 01). However, they are individuals who have positive conditions and self-perceptions of oral and general health, without experiencing pain and tooth loss, and without diseases and limitations, who practice regular physical activity and do not smoke (Table 02). In addition, individuals with fully satisfactory self-care usually seek more oral health services for prevention or checkup, with quick consultations, have an individual health insurance plan, and evaluate the service received positively (Table 3).

In the results of the attribute selection analysis, the variables most strongly related to oral self-care were literacy, level of education, self-concept of oral health, number of natural teeth, lower arch dental loss, number of missing upper teeth, use of health insurance, physical activity and smoking status. The reasons for the individual presenting inadequate or partially adequate oral self-care, according to the variables listed above, can be observed in Table 4.

Table 4 Reasons for entirely inadequate and partially adequate oral self-care according to independent variables. 

Variable Entirely Inadequate (OR) Partially Adequate (OR)
Literacy
Yes 1.00 1.00
No 11.20 4.81
Level of Education
Literacy 3.50 1.96
Primary School 1.68 1.42
Secondary School 1.36 ––––
Graduate School 1.00 1.00
Self-concept of oral health condition
Positive 1.00 1.00
Negative 3.73 1.74
Number of Natural Teeth
All natural teeth 1.00 1.00
No natural teeth 4.98 2.60
Lower Arch Dental Loss
No missing teeth 1.00 1.00
All missing teeth 3.09 ––––
Number of missing upper teeth 1.14* 1.05*
Use of health insurance
Yes 1.00 1.00
No 2.23 2.07
Practice of Physical Activity
Yes 1.00 1.00
No 2.77 1.51
Tobacco use
Yes 1.00 1.00
No 2.18 1.40

*Refers to each missing tooth

Discussion

The present study is the first to address the oral self-care of the Brazilian adult population using a broad approach and data from a national survey, with a representative sample of the entire Brazilian territory. Survey results showed that there is a strong relationship between oral self-care and educational attainment, self-perception of oral health, number of natural teeth, lower arch dental loss, number of missing upper teeth, health insurance coverage, habit of practicing physical activity and tobacco use.

Some of the relevant aspects of this approach are the sample size, the instrument quality, and the information variability, represented by a significant number of validated questions about individual, sociodemographic, behavioral and lifestyle factors, as well objective and subjective factors related to oral health.

In addition, the creation of a variable that represents all the elements considered as characterizing oral self-care by the literature7,8,10,12,17 is what makes this study so very distinct. As observed in the methodological description, the grouping of factors shows a high explanatory capacity, and the variable created can be used in other studies and in health planning involving more concrete strategies for self-care.

In contrast to this unprecedented broad indicator, oral self-care was found in the literature only in a segmented manner. Studies have shown that the higher frequency of tooth brushing was more commonly related to the female sex,7,12,19,16 better economic conditions,10,19 better educational level,16 absence of drinking alcohol10,16 and smoking,10,16 practicing physical activities regularly,8,10 and the type of health service used, whether public or private.7

One of the variables with greater explanatory capacity of oral self-care characterization was the use of dental floss. In this regard, people of high socioeconomic status reported using dental floss more than people of lower socioeconomic status.12,19 This finding may be related to the high cost of the product in Brazilian stores, and to the more limited knowledge about flossing among the lower classes12,19. Individuals who attend private dental offices also tend to use dental floss more often than those who do not use this type of service,7 a finding whose explanation lies in the greater probability that an individual receives oral hygiene instructions in the dental office. In addition, an individual with the purchasing power to go to a private dentist can also afford to buy dental floss and use it regularly.7 Notably, women tend to floss more than men.11,25

The type of health service used is considered an important element in the study of health habits, since it is related to treatment and self-care.7 Regarding the periodicity of visits to the dentist, low socioeconomic status,7,10,12 low level of education,13 men,13 self-perception of oral health,7,13 bad oral health condition,13,15 risky behavior,10 reduced physical activity10,12 and eating behavior10,12 were associated with large intervals between dental appointments, represented here by the last time the individual went to the dentist.

In relation to toothbrush replacement, which is another variable with a high explanatory capacity for characterizing the oral self-care variable, no patterns were found for a specific replacement time.17 Studies with university students have shown that residents in countries with better socioeconomic conditions replace their toothbrush more frequently26 than in countries with lower conditions.17 This finding could reflect the influential role played by recommendations from dentists, toothbrush manufacturers, and sellers.17

As mentioned above, females were found to take greater care than males in relation to practically all the variables forming the oral self-care indicator. Among the explanations for this finding is that preventive habits are more common among women, mainly due to aesthetic or social patterns.7,10,12 Although these variables are part of the characterization of the oral self-care indicator, no relation with gender was found in the present study, denoting that oral healthcare, in its broadest sense, is not influenced by gender. In addition, it has been suggested that a change in health patterns is taking place in the men's group, where there is increasing recognition of the importance of healthcare.

Greater recognition of the role of oral health was also observed among individuals with a better socioeconomic status. Although the literature points to socioeconomic status as one of the most important social determinants of oral health,7,10,12;13,19 based on the purchasing power needed to purchase oral hygiene instruments12,19 and on regular dental visits,10,13 this association was not ascertained in the present study. The present study found that the level of education of the individual bears greater influence than purchasing power, inasmuch as educational level may reflect having knowledge about the importance and maintenance of healthy oral habits.

This assumption is reinforced by the results found in the present study. The individual's level of education was the variable most strongly associated with self-care. Illiterate, primary school and secondary school individuals were 11.20, 3.50, and 1.68 times, respectively, more likely to present inadequate oral health than individuals with higher educational levels.

The level of education plays an important role in oral self-care, because it provides greater access to information that supports the understanding of the health disease process, and the importance of using mechanisms to prevent oral problems and of regular dental services.7,10,13 In addition, education enhances the individual's ability to use such information efficiently, which is the basis for health empowerment.14

Bearing this in mind, it is important to invest in actions and services that offer and expand access to information, and in supporting health promoters, focused on improving individual experiences and overcoming health barriers.14,27,28 The development of personal skills and attitudes needs to be conducive to the acquisition of technical knowledge, which is the guiding axis for pursuing greater oral health equality.14,27,28,29

Self-perception of oral health is considered a multidimensional measure that reflects the individual's experience and the oral health condition in functional, social, and cultural terms.30 As investigated here, self-perception was also considered an important explanatory factor for oral self-care. This finding can be attributed to the fact that individuals with a positive self-perception of oral health are more predisposed to using health services regularly15,30 and to practicing adequate oral hygiene.31

In addition, tooth loss and the number of natural teeth in the mouth were also strongly associated with oral self-care. Individuals with large dental losses presented higher odds of inappropriate health habits.7,14,32 This situation seems to produce a cascade effect, where the more inadequate the oral care, the greater the chances of tooth loss.7,14,32 As shown, dental loss triggers a certain carelessness about health, leading to reduced self-esteem and feelings of rejection and isolation, thus interfering with personal relationships and the desire to seek care.7,31

Dental loss is considered a marker of health inequalities, since it affects more individuals with a lower educational level and income, who have less access to dental and health promotion services.31,33,34 In this sense, broad-ranging strategies should be taken to minimize inequality in oral healthcare and offer the population a better quality of life.

Individuals with supplementary healthcare are more likely to have adequate oral self-care. The literature shows that people with dental insurance tend to use dental services more frequently,35 present better oral health conditions,36 and use more preventive methods than individuals without health insurance.7 Therefore, having health insurance may be related to greater access to dental services, and, consequently, to oral health information, resulting in healthier behaviors.

This indicates that strategies for public health services should be reviewed not only to increase access to dental care, but also to put forth health-promoting strategies that allow users to have full and assisted oral healthcare.

In addition, the absence of regular physical activity and the smoking habit increase the chances of the individual presenting inadequate oral care by 2.77 and 2.18, respectively. Studies have shown that a sedentary lifestyle8,12,16 and tobacco use12 have been considered indicators of unhealthy habits. It is evident that lifestyle is directly related to oral habits, which must be taken into consideration in developing oral health promotion programs.

The findings of the present study should be used to guide the planning of preventive oral programs, aiming to enhance oral self-care in the Brazilian population. However, in addition to health promotion actions that focus on risk factors and self-care, public policies committed to improving socioeconomic conditions should be developed, especially regarding schooling, guaranteeing access to oral health services and the continuous qualification thereof. These measures are indispensable to bringing about changes in the oral health situation of the Brazilian population.7

Limitations

The results of the present study should be interpreted taking into account the type of research design, since cross-sectional studies allow hypotheses only about the associations found and not the cause-and-effect relationship.

In addition, the dependent variable was measured by self-report, a condition that can overestimate the positive results, since individuals may report what they believe to be ideal and not what they actually practice. However, this limitation is likely to occur in any survey in which information is obtained by self-report.13

Conclusion

It was concluded that the level of education of the individual is one of the main factors for adherence to adequate oral self-care, followed by certain oral conditions, such as tooth loss. In addition, lifestyle seems to bear a significant influence.

References

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Received: April 23, 2017; Revised: October 10, 2017; Accepted: November 23, 2017

Corresponding Author: Danielle Bordin E-mail: daniellebordin@hotmail.com

Declaration of Interest: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript.

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