O papel das condições socioeconômicas, apoio social e fatores psicossociais na relação entre má oclusão e qualidade de vida relacionada à saúde: um estudo longitudinal

Abstract

The assessment of oral health should consider the functional and psychosocial impacts of oral diseases and oral conditions perceived by the individual. Malocclusion is an oral health condition that can have a negative impact on health-related quality of life (HRQoL). Since this relationship can be influenced by environmental and individual factors, the objective of this study was to investigate the mediating role of psychosocial factors (self-esteem, sense of coherence, oral health beliefs), social support, oral symptoms (social well-being) and functional limitation related to oral health and self-perception of health on the impact of malocclusion on HRQoL, as well as the effect of family income, sex and dental caries on these relationships, based on the theoretical model of Wilson and Cleary. The study was observational, longitudinal and analytical. A total of 376 12-year-old adolescents, both sexes, enrolled in the municipal education network of an administrative area of the city of Manaus, Amazonas, were included. In the baseline, malocclusion (through Dental Aesthetics Index), dental caries (CPO-D index), sociodemographic factors (sex and family income), self-esteem (Rosenberg Self-esteem Scale), sense of coherence of Coherence Sense), beliefs in oral health and social support (Social Support Appraisals). After six months, symptoms (social welfare) and functional limitation related to oral health (domains of CPQ11-14), self-perception of general health and HRQoL (using Kiddo-KINDL) were analyzed. Data analysis was performed using structural equation modeling (SEM), using SPSS (Statistical Package for Social Sciences), version 22.0 and AMOS 22.0. Malocclusion had a direct effect on symptoms related to oral health (social well-being) (β = 0.115). Malocclusion was indirectly associated with poor HRQoL (β = -0.068), with functional limitation, social well-being (symptoms) and self-perception of health as mediators. Being female (Β = -0.101), having lower family income (β = 0.031), untreated dental caries (β = -0.019), worse social support (β = 0.567), worse psychosocial condition (β = 0.111) and worse social well-being (β = -0.095) were indirect predictors for worse HRQoL. The impact of malocclusion on HRQoL was mediated by functional and social factors related to oral health and self-perception of health. Socio-demographic and psychosocial factors negatively impacted the HRQoL, but they were not mediators in this relationship. Understanding the complex relationships between environmental, individual and clinical variables and HRQoL has been shown to be important for clinical practice and the orientation of public health interventions that reduce the negative impact of oral health conditions on the quality of life of the population.