Relação entre condição socioeconômica, apoio social, fatores psicossociais, comportamentos relacionados à saúde bucal e condição periodontal em adolescentes: um estudo longitudinal

Abstract

The oral health of individuals is not influenced only by biological determinants. The role of other factors such as environmental, psychosocial and behavioral factors in the development of diseases and oral conditions has been investigated. This study aims to longitudinally evaluate the relationship between socioeconomic condition, social support, psychosocial factors, frequency of dental brushing, smoking and periodontal condition (gingivitis and dental calculus) in adolescents. A sample of 359 adolescents from public schools located in an urban area characterized by low social indicators, in Manaus, Amazonas, Brazil, was evaluated in 12 months using a theoretical conceptual model through structural equation modeling with 2 latent variables and 16 observed variables. Socioeconomic status and sense of coherence were evaluated using the sense of coherence (SOC-13) and oral health beliefs of adolescents and their parents at baseline; the social support, through the social support appraisals questionnaire, the frequency of dental brushing and smoking among adolescents at six months; and the periodontal condition of the students, after 12 months. To evaluate the periodontal condition, an upper quadrant and the diagonal lower quadrant of the dental arch of each student were randomly examined. The presence of gingival bleeding of the dental element was recorded when at least one of the six sites examined in each tooth presented bleeding. For dental calculus, its presence or absence was recorded per tooth. The descriptive analysis of the data revealed that the female sex represented 56.5% of the sample, 40.1% presented monthly family income between R $ 441.00 and R $ 880.00 and that 73% of those in charge had 8 to 11 years of age. study. The prevalence of gingival bleeding and dental calculus was 94.5% and 71.6%, respectively. Most of the students (91.9%) reported that they were brushing their teeth three or more times a day and 5.3% of them had smoked or smoked. The confirmatory factorial analysis of the measurement model and the modeling of structural equations confirmed the adequacy of the proposed theoretical model. A worse socioeconomic condition was a direct predictor of a higher frequency of smoking. Smoking and the higher frequency of dental calculus were direct predictors for a higher occurrence of gingival bleeding. Most unfavorable beliefs in oral health and weak sense of coherence among adolescents were indirectly associated with a higher frequency of gingival bleeding, through social support and smoking. Likewise, more unfavorable beliefs and weak sense of coherence of those responsible was an indirect predictor for greater bleeding, via smoking alone. The dental calculus was another possible route in the indirect effect of the sense of coherence of those responsible for gingival bleeding. Less social support was an indirect predictor for a greater frequency of gingival bleeding, via smoking. The findings showed that there was a direct and inverse association between socioeconomic status and smoking behavior, but the influence of this factor on the clinical outcomes evaluated was not demonstrated. The protective role of social support and psychosocial factors - sense of coherence and oral health beliefs - in the periodontal health of adolescents living in conditions of social deprivation were evidenced.