Associação entre multimorbidade e perda dentária/edentulismo em uma coorte de idosos no sul do Brasil

Abstract

Life expectancy has been increasing for many years. Overall, life expectancy at birth increased from 48.1 years in 1950 to 70.5 years in 2017 for men and from 52.9 years in 1950 to 75.6 years in 2017 for women. As life expectancy increases, the prevalence of chronic diseases in the population also increases and the grouping of health conditions in the individual is perceived, called multimorbidity. Oral health problems have been associated with worse general health, as they compromise healthy aging, affect quality and health, cause pain, are costly to the health system and can result in malnutrition, worsening chronic conditions in elderly patients. Among the most prevalent morbidities in the elderly, depression has been an important problem. According to the WHO, depression and anxiety are among the most prevalent chronic diseases in the world. In 2015, these two mental disorders were classified as the third and ninth main global causes of disabilities, respectively. Therefore, this dissertation aimed to investigate the association between multimorbidities and oral health outcomes in an elderly cohort in southern Brazil.The elderly cohort includes non-institutionalized individuals aged 60 years or over, living in the urban area of the municipality of Pelotas / RS and contains three epidemiological surveys: the baseline in 2014, the follow-up in 2016 and the third survey in 2020 Two articles were the products of this dissertation. The first article investigated the association between multimorbidities and different oral health outcomes. Data were collected through home interviews conducted from January to August 2014. Thirty multimorbidities were evaluated based on the interviewee's report of the medical diagnosis of the disease. Multimorbidities were categorized as none or morbidity; 2 to 4 morbidities; 5 to 7 morbidities and 8 or more morbidities. The oral health outcomes evaluated were the presence of functional dentition, severe tooth loss, edentulism. The analyzes included descriptive analysis and crude and adjusted analyzes of the association using Poisson regression. Regarding the presence of multimorbidities, 33.8% of the elderly had 8 or more associated morbidities. Most of the elderly (82.7%) did not have functional dentition. The prevalence of tooth loss and edentulism were 45.5% and 39.3%, respectively. As the concentration of multimorbidities increases in an elderly person, the prevalence of missing teeth increases, culminating in the absence of functional dentition and edentulism. The second article investigated to investigate a possible effect modification caused by the use of dental services in the association between depression and tooth loss / edentulism in a cohort of elderly people in southern Brazil. Data were collected through home interviews and the study used data from two follow-ups: the baseline in 2014 and the 2019/2020 follow-up. Oral health outcomes (2019/20) were investigated through self-report and depression (2014) was assessed using the Geriatric Depression Scale-10 (EDG-10). There was a majority of women (65.4%) among the participants, with an average age between 60 and 69 years (58.4%). Severe tooth loss and edentulism were identified in 59.9% and 39.3% of the participants, respectively. Most elderly people reported having gone to the dentist in the last 2 years (53.2%). As for depression, the prevalence was 14.5%. Depressed elderly people who have been to the dentist for more than two years are at greater risk of tooth loss when compared to those depressed elderly people who have been to the dentist in the past two years. The findings of this dissertation demonstrate that the accumulation of morbidities is associated with worse outcomes in oral health, including tooth loss, absence of functional dentition and edentulism. Visiting the dentist for more than two years modifies the effect of depression on tooth loss, increasing the risk of its occurrence. These results should assist in the planning of health policies, technical and multidisciplinary diagnosis in the elderly.