Socio-economic factors associated with periodontal conditions among Brazilian elderly people - Multilevel analysis of the SBSP-15 study

Abstract

The objective of the present study was to analyze individual, contextual and social support factors associated with periodontal condition among 2332 dentate elderly Brazilian participants from the São Paulo State Oral Health Survey 2015 (SBSP-15). Methods: This study used the database compiled by the SBSP-15, conducted from January to December in 2015. The associations were made by relative risk (RR), with Multilevel Poisson Regressions, among individual, contextual and social support variables, and had periodontal diseases as outcomes. Results: The mean age of elders was 70.13 years (SD 5.67). The risk factors for all outcomes of periodontal diseases were male gender and self-perceived color of non-white skin. Regarding social support, feeling unhappy was a risk factor for the presence of shallow periodontal pockets (3–5mm) RR 1.43(CI 95% 1.10–1.86). The coverage of the Family Health Strategy (FHS) was a protective factor for gingival bleeding RR = 0.7(CI 95% 0.44–0.99) and calculus RR = 0.75(CI 95% 0.60–0.95), and a risk factor for the number of lost sextants (sextants with only one tooth or without any teeth) RR = 1.12(CI 95% 1.00–1.28). Living in municipalities with more than 90% fluoridation coverage was a protective factor for the number of lost sextants RR = 0.89(CI 95% 0.78–0.99). Conclusions: The study showed evidence that individual (gender and self-perceived skin color), contextual (coverage of the family health strategy and water fluoridation) and social support factors (feeling unhappy) are associated with the clinical outcomes of periodontal diseases in Brazilian elders. This reinforces the need for transdisciplinary actions in the FHS, stimulating work together and intersectoral collaboration between FHS and NASF (Family Health Support Center).

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

“…Gingivitis was noted in six different types of disadvantaged individuals, two of which showed the highest prevalence, such as alcohol and drug abusers with 82% ([95% CI 43–100%]; 357 patients, three studies, I 2 98.8%) [ 71 , 72 , 75 ] and prisoners with 63% ([95% CI 54–72%]; 802 patients, three studies) [ 22 , 23 , 24 ]. High prevalence values were also found in pregnant women with 41% ([95% CI 34–49%]; 2242 participants, nine studies) [ 53 , 54 , 55 , 83 , 84 , 85 , 86 , 87 , 88 ] ( Figure 3 ) and the elderly with 41% ([95% CI 29–52%];11,048 participants, 15 studies) [ 26 , 28 , 35 , 39 , 43 , 47 , 65 , 66 , 81 , 89 , 90 , 91 , 92 , 93 , 94 ]. Lower prevalence values were found in subjects with low levels of education (19% [95% CI 18–19%]; 75,095 participants, two studies, I 2 = not assessable) [ 95 , 96 ] and low income (19% [95% CI 18–19]; 54,593 participants, two studies, I 2 = 0.00) [ 93 , 94 ] and in immigrants (15% [95% CI 12–18%]; 746 participants, two studies, I 2 = 0.00) [ 39 , 51 ].…”

“…The prevalence of periodontitis has been reported in seven types of vulnerable individuals. Considering the number of published studies, most of them (12 studies) were focused on the elderly, who showed a prevalence value of 53% ([95% CI 42–63]; 6832 participants, 12 studies, I 2 = 98.5%) [ 28 , 43 , 47 , 66 , 81 , 89 , 90 , 91 , 92 , 94 , 97 , 98 ] ( Figure 4 ). Five studies described the prevalence of this disease in pregnant women with a value of 34% ([95% CI 13–58%]; 1757 participants, five studies, I 2 = 97.6%) [ 54 , 83 , 84 , 87 , 88 ].…”

Factors associated with utilisation of dental services by the elders from São Paulo, Brazil

“…Previous studies have reported higher utilisation of public dental services and better oral health among individuals registered in the FHS. [52][53][54] Based on our findings, the expansion of the FHS through consistent public investment is key to tackling persisting inequalities in access to dental treatment among older adults. This argument for fairness in financial contribution is supported by documented evidence.…”

“…Our analysis indicates that this policy resulted in real advances in the access to dental services by increasing the availability of dental teams throughout the public health system. Previous studies have reported higher utilisation of public dental services and better oral health among individuals registered in the FHS 52‐54 …”

Condiciones modificadoras del riesgo de enfermedad periodontal: una revisión narrativa sobre la evidencia en américa latina

“…El número de personas y habitaciones del hogar, no se asoció con la severidad de la periodontitis (56). Finalmente en una muestra de 2332 ancianos brasileros, se observó que sentirse infeliz era un indicador de riesgo para la presencia de bolsas periodontales de 3-5mm (RR= 1.43, CI= 1,10-1,86), proponiendo que el entendimiento de la enfermedad periodontal podría ser más complejo de un entendimiento biológico (57).…”