Relação entre má oclusão e qualidade de vida relacionada à saúde em adolescentes: um estudo longitudinal a partir do modelo teórico de Wilson e Cleary

Abstract

For aesthetic and functional implications, malocclusion is an oral health condition capable of negatively affecting health-related quality of life (HRQoL). Since this relationship can be influenced by individual and environmental factors, the aim of the study was to assess, based on Wilson and Cleary's theoretical model, the impact of malocclusion on the HRQoL of adolescents, considering a possible mediating role of self-esteem, social well-being, functional limitations, and self-rated health as well as a predictive role of social support, socioeconomic conditions, and gender. This observational, longitudinal, and prospective study included 415 adolescents aged 12 at baseline, of both genders, enrolled in the municipal education system of an administrative region with low social indicators in the city of Manaus, Amazonas. Socioeconomic and demographic conditions were measured at baseline. Malocclusion (Dental Aesthetics Index), self-esteem (Rosenberg Self-Esteem Scale), health self-perception, social well-being, and functional limitations (CPQ11-14 domains) were measured at baseline and at 2-year follow-up. Social support (social support appraisals) was measured at 2-year follow-up. HRQoL (Kiddo-KINDL) was assessed at baseline, 6-month, 1-year and 2-year follow-up. Data analysis was performed through structural equation modeling (SEM), with the HRQoL variation evaluated by a latent growth model, using the SPSS (Statistical Package for Social Sciences) version 22.0 and AMOS 22.0 programs. The more severe the initial malocclusion, the worse the evolution of social well-being (β=0.110) and functional limitation (β=0.107). Malocclusion had an indirect effect on HRQoL through social well-being (β=-0.030). A positive evolution of self-esteem (β = 0.375), social support (β = 0.735) and health self-perception (β = -0.217) had a protective effect on HRQoL variation. Female sex (β=-0.222) was associated with worse HRQoL at baseline, but it had no predictive role in the construct variation. Better socioeconomic condition showed an indirect effect on worse evolution of HRQoL (β=-0.054). Considering personal experiences, individual and environmental factors in health assessments enables the development of interdisciplinary and intersectoral approaches capable of reducing the negative impact of malocclusion on the quality of life of adolescents.