Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach

Abstract

BackgroundDespite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.ObjectivesTo assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.MethodsThe study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.ResultsDental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.ConclusionsGirls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

Desigualdades contextuais e individuais da prevalência de dor dentária em adultos e idosos no Brasil

“…As variáveis associadas à dor no modelo múl-tiplo confirmam achados anteriores 4,14,16 . Residentes nas regiões Norte e Nordeste, mulheres, os mais jovens, pessoas que se autoclassificaram como de pele parda e preta, os que mais consomem refrigerantes e os fumantes apresentaram maiores prevalências do que os grupos de comparação.…”

“…Piores condições socioeconômicas, aferidas por renda, escolaridade e tipo de escola foram associadas à dor dentária em estudos anteriores realizados entre adolescentes 14,28,29,30,31 . Neste estudo a escolaridade não foi associada à dor.…”

“…Maior prevalência de dor dentária em mulheres foi verificada no presente estudo e em outros estudos com adolescentes 14,28 e adultos 4,16 . Outros pesquisadores, entretanto, não encontraram esta associação 8,29,30,33 .…”

“…Além disso, a prevalência de dor de dente tem sido relatada como sendo mais elevada em meninas e mulheres 2,5 , nas pessoas de menor esco-laridade e renda 10,11,12 , em adultos jovens 5 e em indivíduos com menor acesso a cuidados bási-cos de saúde 13 . O lugar de residência (urbano ou rural), o grau de desenvolvimento social (maior ou menor Índice de Desenvolvimento Humano -IDH) e a frequência de escovação dentária também interferem na prevalência de dor dentária 11,14 , assim como o tabagismo, o consumo de ál-cool, hábitos alimentares não saudáveis e a presença de cáries dentárias 2,15,16 . Embora a diferença de prevalência da dor dentária entre raças não seja muito explorada, esta parece ser maior entre os negros 4,17 , nos quais o agravo apresenta maior impacto, como por exemplo, uma maior redução das atividades cotidianas e maior motivação pela procura de resolução da dor 9 .…”

Emergency Dental Care of Children and Adolescents in Basic Health Unit and Emergency Care Unit

“…This finding is similar to the ones obtained in the present study, which indicated that several children and adolescents had received emergency care during their last dental appointment. This could be associated with unequal access to regular dentists [21][22][23], since the main problem related to toothache [8,[24][25][26][27] and to the use of emergency services [11,28,29], the so-called dental caries, is a disease that can be easily prevented and treated when it is diagnosed early on during primary health care. Another important aspect concerns the type of intervention made at UPAs, as such interventions are predominantly palliative [11] and decayed teeth are left untreated, which could quickly lead to a new acute or infectious event.…”