Fatores associados à incidência da sequela da cárie não tratada: um estudo longitudinal

Abstract

The aim of this study was to investigate the association between structural determinants (socioeconomic status - SES) and intermediary determinants (frequency of dental services utilization, brushing frequency, social support, sense of coherence - SOC, belief and number of decayed teeth) in incidence of untreated dental caries sequelae, based on the WHO conceptual model of Social Determinants of Health. This longitudinal study encompassed 329 students from public schools in the eastern zone of Manaus city (Amazon, Brazil), born in 2004, with data collected from 2016 to 2018. In the baseline, socioeconomic data (parents' education, family income, number of rooms and assets), psychosocial factors (sense of coherence of parents / guardians - Sense of Coherence Scale - and beliefs in oral health of parents / guardians) and social support (Social Support Appraisal) through self-administered questionnaires for participants and those responsible. In follow-up collections, brushing frequency and the frequency of dental services utilization were obtained using standardized forms. After supervised brushing at school, students were examined to obtain the DMFT (decayed- missing- filled teeth) and PUFA (Pulpar involvement, Ulceration, Fistula and Abscess) index to investigate the incidence of sequel of untreated caries in 2 years. After data distribution, statistical analysis was performed using Structural Equation Modeling (SEM). The high incidence of the PUFA / pufa index was indirectly related to worse conditions of SES (β = -0.019), low social support (β = -0.038) and weak SOC of parents / guardians (β= -0.28) and directly related higher values of the decayed component of the DMFT index (β = 0.338). A higher frequency of use of services (β = -0.069) had a direct effect on the lower incidence of PUFA. The structural (NSE) and intermediate determinants (frequency dental services utilization, social support and decayed teeth) were directly or indirectly associated with the occurrence of clinical consequences of untreated caries.