Necessidade de prótese dentária em adultos no Sul do Brasil : estudo numa coorte de nascimentos

Abstract

This study aimed to evaluate, in a prospective birth cohort initiated in 1982, in the urban area of Pelotas: 1) prevalence of normative need for dental prosthesis (NN) comparing it with subjective need, self-reported; 2) ocurrence of need for dental prosthesis from 24 to 31 y; 3) socioeconomic and dental caries trajectory, use and type of health service used, as well as association of these with need for dental prosthesis. In 1982, all children born alive (n=5914) in urban area of Pelotas and their mothers were weighed, measured and answered questions about socioeconomic, demographic, reproductive, behavioral, care and morbidity variables. A randomized probabilistic sample of 900 adolescents was calculated for the first oral health study, carried out in 1997. A questionnaire and dental examination were applied. 720 individuals from this sample were located and revisited in their homes for the second oral health study (2006). Participants of the both oral health study were included in this study, in 2013. Exposure variables were derived from data of various surveys previously performed in our study sample. The examiners and interviewers were trained and calibrated and the diagnostic reproducibility, measured by Kappa index. Data were grouped in a database. Kappa index between normative and subjective need as well as estimates of sensitivity, specificity, negative predictive value and positive predictive value were obtained for all the mouth and dichotomized by mandibular and maxillary arch. Data analysis was performed using STATA 12.0 statistical package. 539 volunteers were evaluated (60.7%). Inappropriate subjective need validity was observed in relation to normative need [Kappa: 0.43; sensitivity: 56.5 (50.3, 62.6); specificity: 85.8 (81.1, 89.7); positive predictive value: 79.1 (72.6, 84.7); negative predictive value: 67.3 (62.1; 72.2)], except for anterior losses [Kappa: 0.82; sensitivity: 93.3 (68.1, 99.8); specificity: 88.9 (51.8, 99.7); positive predictive value: 93.3 (68.1, 99.8); negative predictive value: 88.9 (51.8, 99.7)]. Need for dental prosthesis at age 24 was 28.9% (95% CI 24.9 - 33.2) and 49% (95% CI 44.7 - 53.3) at age 31. Need for dental prosthesis was higher in users of public services. Socioeconomic and dental caries trajectory from birth to 31y was associated with need for dental prosthesis, with lower and descending socioeconomic trajectory causing increased need for dental prosthesis risk. We conclude that normative need differs from subjective need in adults, except when anterior losses are present. Socioeconomic and dental caries trajectory during the life-course were associated with need for dental prosthesis during adulthood.