Efetividade de um programa de saúde bucal com ênfase na escovação diária supervisionada no controle da atividade de cárie em escolares de sete a dez anos: estudo longitudinal de seis meses

Abstract

The effectiveness of nonoperative oral health practices on the control of dental caries, using a strategy of toothbrushing associated with fluoride toothpaste applied at the population level, such as in school oral health programs, still need further studies, in particular, using clinical variables as outcome variables. Thus, the aim of this study was to test the effectiveness of an oral health program with emphasis on supervised daily brushing compared to the distribution of toothbrushes and toothpaste in the control of caries activity, on the occlusal surface of the first permanent molars of schoolchildren of seven to ten years old from Boa Vista, Roraima. In all, from one thousand one hundred forty-four children eligible for the study, 1074 children were divided into two distinct groups: the test group (n = 530) and control group (n = 544) and followed for a period of six months. The intervention in the test group consisted of an oral health program that included supervised daily toothbrushing with fluoride toothpaste, toothbrushes access to directly support classroom, replace brush as needed, developing student leaders and the immediate replacement of toothpaste at its end, while the control group received at quarterly intervals distribution of toothbrushes and toothpastes. Both groups received classroom guidance on oral hygiene. Initially, after signing an informed consent, it was applied to the children’s guardians a socioeconomic questionnaire. In two stages, beginning and end of the study, the first permanent molars were examined by 3 calibrated examiners regarding the biofilm accumulation, chewing function and activity of occlusal caries. The data were submitted to descriptive statistics and then estimated the relative risks for no improvement in caries activity, through the hierarchical Poisson multiple regression model. Crude analyzes and variables with p ≤ 0.20 were tested in the model, remaining that with p ≤ 0,10 (α = 10%). At the end of the intervention, the control group had 2.14 higher crude relative risk for no improvement in active caries than the test group (p <0.0001). There was no statistically significant association between no improvement in active caries and socioeconomic variables. The teeth 16 (p = 0.0005) and 26 (p = 0.0088) had lower adjusted relative risk of no improvement in the caries activity than the 46 tooth. Volunteers from the test group with easily detectable biofilm at baseline had lower adjusted relative risk of no improvement in active caries than volunteers with barely detectable biofilm (p <0.0001). Regardless of the biofilm level, the volunteers in the control group had a higher relative risk of no improvement in active caries than the volunteers of the group test with barely detectable biofilm. It is concluded that the school oral health program with emphasis on supervised daily toothbrushing was more effective in preventing caries activity when compared to the distribution of toothbrushes and fluoride dentifrice within six months of intervention.