Influência de determinantes individuais e contextuais na ocorrência de cárie dentária em escolares de 8 a 12 anos do município de Pelotas/RS

Abstract

The knowledge regarding occurrence and risk factors for dental caries is important to help establish preventive strategies, to identify treatment needs in a population and to compare the results with other studies worldwide. Thus, this cross-sectional study aimed to determine the prevalence and distribution of dental caries in Brazilian school children aged 8-12 years and to test the association between dental caries and a series of factors that could possibly be associated with its occurrence, nutritional status and physical activity at individual level, and social school context at the community level. A sample of children from 20 private and public schools (n=1.211) was selected. Socioeconomic data were collected from parents and data regarding children characteristics were collected from children using a questionnaire and anthropometric measures. The Body Mass Index was obtained, and children were classified as overweight/obese considering age and sex. Dental examinations were performed to assess the presence of gingival inflammation; dental caries experience (DMFT=1) and dental caries severity (mean dmf-t + DMF-T). The social school environment was assessed by a questionnaire administered to schools coordinators. Data analyses were carried out in Stata 11.0 (StataCorp, College Station, TX, USA). Descriptive statistics were used to characterize the sample by outcomes and independent variables. Multivariate Poisson Regression and multilevel Poisson Regression were used to assess the association between individual factors and school social environment and dental caries experience and severity, respectevely. Dental caries prevalence was 32.4% (95% CI 29.7-35.2) and the mean dmf-t + DMF-T was 1.84 (± SD 2.2). Children with obesity or overweight were negatively associated with dental caries experience [(PR) 0.74; CI 95% 0.62-0.89] while children who practice less than 300 minutes per week of physical activity were associated with dental caries prevalence [PR = 0.73; CI 95% 0.57-0.93]. Multilevel models showed that (dmf-t + DMF-T) and (DMFT=1) were associated with lower maternal schooling and higher levels of gingival inflammation. For contextual variables, schools with sports activities out of the time were associated with lower (dmf-t + DMF-T) and (DMFT=1), while the occurrence of violence and theft episodes were positively associated with dental caries. In conclusion,this study showed an inverse relationship between obesity/overweight and dental caries experience and less active children had lower caries prevalence. There are significant effects of social context on dental caries experience and prevalence. The results suggest that strategies focused on promotion of healthier environments should be stimulated to reduce inequalities in dental caries .