O efeito da depressão na saúde bucal e no uso dos serviços odontológicos nas populações.

Abstract

Depression is among the most prevalent chronic diseases in the world, and it is considered as an important risk factor for many chronic systemic conditions. In last years, studies have investigated a contribution of depression to the development of oral diseases and the use of dental services. However, these issues still remain uncertain. Thus, this thesis aimed to investigate the effect of depression on population oral health through two systematic reviews, and a cross-sectional study in the 2015 Pelotas Birth Cohort study. The first study investigated the bidirectional association between depression and oral health outcomes, and the second study investigated the association of depression and anxiety and the use of dental services. The two systematic reviews and meta-analysis were developed according to PRISMA statements. After electronic searches in six databases, exclusion of duplicates was carried out and selection of articles by title and abstract according to inclusion and exclusion criteria. Second screening included full reading of studies. Methodological quality assessment was performed using The Critical Appraisal Checklist tool of The Joanna Briggs Institute. The third article investigated association of depression and dental caries experience among pregnant women belonging to the 2015 Pelotas Birth Cohort study. Data were collected through a home interview and oral examination. Depression was measured using the Edinburgh Postnatal Scale. Dental caries experience was evaluated using the DMF Index considering tooth surfaces. Statistical analyzes were performed in the Stata 12.0 Program. A hierarchical model was designed to guide adjustments of analyzes. Poisson Regression models were employed, and magnitudes of associations were estimated (Prevalence Ratio, 95% confidence interval). In the first study, 19 studies were included: 16 studies considered oral health as outcome, and three oral health studies as exposure. It was possible to observe that depressive individuals presented 19% (OR 1.19; 95% CI 1.00-1.41), 33% (OR 1.33; 95% CI 1.18-1.50) and 21% (OR 1.21; 95% CI 1.09-1.34) more chance to have dental caries, tooth loss and edentulism, respectively. However, when depression was considered as outcome, no association was found. In the second study, seven studies were included in the metaanalysis. Considering depression (RO 0.96, 95% CI 0.85-1.09) and anxiety (RO 1.00, 95% CI 0.90-1.12), an association with the use of dental services was not possible to observe. The third study included 2,496 pregnant women. Depression was not associated with dental caries experience (RP 1.02, 95% CI 0.98-1.07). However, when the DMF-S components were considered in separate, depression was associated with high levels of caries (RP 1.19, 95% CI 1.06-1.35) and tooth loss (RP 1.17, 95% CI % 1.08-1.26), and lower levels of filled surfaces (RP 0.91, 95% CI 0.84-0.99). The findings of this thesis indicate an association between depression and oral diseases in population, including pregnant women. Conversely, it was not possible to observe an association between depression/anxiety and the use of dental services in general population.