Abstract The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43–2.86), mouth breathing (OR = 1.04; 95%CI: 1.02–1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37–4.85), and obesity (OR = 1.54; 95%CI: 1.02–2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age. model crosssectional cross sectional 73 Parentsguardians Parents guardians Children Family Scale. . Scale) Index α 5%. 5 5% 5%) OR 2.61 261 2 61 95%CI 95CI CI 95 2.43–2.86, 243286 2.43–2.86 , 43 86 2.43–2.86) 1.04 104 1 04 1.02–1.99, 102199 1.02–1.99 02 99 1.02–1.99) nonnutritive non nutritive 2.45 245 45 2.37–4.85, 237485 2.37–4.85 37 4 85 2.37–4.85) 1.54 154 54 1.02–2.33. 102233 1.02–2.33 33 1.02–2.33) functioning 7 2.6 26 6 9 24328 2.43–2.8 8 1.0 10 0 10219 1.02–1.9 2.4 24 23748 2.37–4.8 3 1.5 15 10223 1.02–2.3 2. 2432 2.43–2. 1. 1021 1.02–1. 2374 2.37–4. 1022 1.02–2. 243 2.43–2 102 1.02–1 237 2.37–4 1.02–2 2.43– 1.02– 23 2.37– 2.43 1.02 2.37 2.3

Abstract: The authors developed and validated a short form of the Brazilian Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P). Data included responses from 200 parents of preschoolers to sociodemographic and oral health service access questions on the BOHLAT-P, the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), and the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS). Data on the preschoolers’ dental caries experience (ICDAS-II) were also included. An item response theory-based approach was employed to develop the short form, while confirmatory factor analysis evaluated the instrument dimensionality. The validity and reliability of the short form were tested by statistical analysis using BREALD-30, B-ECOHIS, and sociodemographic and dental caries experience data. The short form (BOHLAT-P-30) comprises 30 items, is unidimensional, and presents better model fit estimates (TLI = 0.94; CFI = 0.94; RMSEA = 0.05) than those of the BOHLAT-P. Moreover, BOHLAT-P-30 demonstrated excellent reliability (Cronbach's alpha = 0.91; intraclass correlation coefficient [ICC] = 0.95). BOHLAT-P-30 scores were positively correlated with BREALD-30 scores (r = 0.71), with the number of years of schooling (r = 0.60), and with the number of hours spent reading (r = 0.33). BOHLAT-P-30 scores were negatively correlated with B-ECOHIS scores (r = -0.21), and with the number of teeth with cavitated caries (r = -0.18). After controlling for confounding factors, BOHLAT-P-30 scores were not found to be associated with caries presence, or with the number of teeth with cavitated caries. The BOHLAT-P-30 had properties similar to those of the BOHLAT-P, and proved to be a valid measure to assess the OHL of Brazilian parents.

Abstract Objective: To verify and compare the sociodemographic data and caregivers’ self-perception of children’s oral health condition, hygiene habits and seek for dental services among family units of deaf and normalhearing children. Material and Methods: A comparative cross-sectional study was conducted with 64 parents/caregivers of 16 deaf and 48 normal-hearing children of 3-14 years old, belonging to reference centers in Belo Horizonte, southeastern Brazil. Deaf and hearing children were matched according to their sex and age. Sociodemographic characteristics of the family units and self-report of oral health conditions and care were assessed using a structured questionnaire, including information regarding seeking pediatric dental services. Descriptive analysis and chi-square test were performed (p<0.05). Results: Most individuals in the sample were mothers (84.4%). Low family income (p=0.024) and higher education level of guardians (p=0.018) were associated with families of hearing children. The report of clinical treatment or toothache as the main reason for the children’s last dental appointment was associated with families of deaf children (p=0.047). Conclusion: Based on caregivers’ reports, hearing-impaired children demonstrated greater vulnerability to present dental pain or clinical treatment as the main reasons for their last access to dental appointments.

Abstract Objective: To assess the association between temporomandibular disorder (TMD) with sociodemographic factors, health-related factors, and oral conditions in adolescents. Material and Methods: This cross-sectional study was developed with 89 adolescents between 13 to 18 years. TMD diagnosis was obtained by the Research Diagnostic Criteria for Temporomandibular Disease (RDC/TMD) Axis I. Diagnoses of chronic pain, depression, presence of non-specific physical symptoms, including pain and anxiety, were obtained by the RDC/TMD Axis II. The feeling of happiness was measured by the Subjective Happiness Scale. Socio-economic and demographic characteristics were collected through self-administered questionnaires. Patients were examined for dental caries, dental trauma, malocclusion, and tooth wear. Parents answered a sociodemographic, economic, and general health questionnaire. Data were submitted to descriptive statistics, and a logistic regression model was used to assess the association between TMD and the socio-economic, demographic, health-related, and clinical variables. Results: TMD prevalence was 42%. TMD was associated to skin color (p=0.040), use of medications in the past year (p = 0.020) and previous dental trauma (p=0.030). Also, it tended to be associated with the presence of probable awake bruxism (p=0.053). Conclusion: Sociodemographic factors, health-related factors, and oral conditions play a role in TMD, with nonwhite adolescents, those who had used medications in the past year and/or had previous dental trauma having a greater chance of present this disorder.

Resumo Este estudo avaliou a associação de fatores sociodemográficos, familiares e do tipo de serviço odontológico utilizado ao alfabetismo em saúde bucal em pré-adolescentes. Trata-se de um estudo transversal com 740 escolares. Foram avaliados o alfabetismo em saúde bucal (BREALD-30), fatores sociodemográficos, tipo de serviço odontológico e funcionalidade familiar (FACES III) por meio de questionários validados. A associação entre as variáveis foi avaliada por meio de regressão de Poisson robusta (α=5%). Um maior alfabetismo em saúde bucal foi associado ao sexo feminino (RR=1.09; IC95%: 1.03-1.14), coesão familiar do tipo conectada (RR=1.12; IC95%: 1.05-1.20), adaptabilidade familiar dos tipos rígida (RR=1.14; IC95%: 1.04-1.25) e estruturada (RR=1.11; IC95%: 1.04-1.20), escolaridade materna superior a oito anos de estudo (RR=1.16; IC95%: 1.10-1.22), idade do responsável superior a 38 anos (RR=1.07; IC95%: 1.02-1.13) e uso de serviços odontológicos privados (RR=1.06; IC95%: 1.01-1.12). O nível de alfabetismo em pré-adolescentes foi associado ao sexo, estrutura familiar, idade e escolaridade do responsável e tipo de serviço odontológico utilizado.

Abstract The aim of this study was to evaluate associations between oral health literacy and family, sociodemographic and dental service characteristics in early adolescents. A cross-sectional study was conducted with 740 schoolchildren. The following variables were investigated using validated questionnaires: oral health literary (BREALD-30), sociodemographic characteristics, type of dental service and family functioning (FACES III). Associations were tested using robust Poisson regression analysis (α=5%). Higher oral health literacy was associated with the female sex (RR=1.09; 95%CI: 1.03-1.14), connected type of family cohesion (RR=1.12; 95%CI: 1.05-1.20), rigid (RR=1.14; 95%CI: 1.04-1.25) and structured (RR=1.11; 95%CI: 1.04-1.20) types of family adaptability, more than eight years of mother’s schooling (RR=1.16; 95%CI: 1.10-1.22), age of caregiver more than 38 years (RR=1.07; 95%CI: 1.02-1.13) and the use of private dental services (RR=1.06; 95%CI: 1.01-1.12). The level of oral health literacy in early adolescents was associated with sex, family structure, mother’s schooling, caregiver’s age and type of dental service used.

Resumo Este estudo avaliou a associação de fatores sociodemográficos, familiares e do tipo de serviço odontológico utilizado ao alfabetismo em saúde bucal em pré-adolescentes. Trata-se de um estudo transversal com 740 escolares. Foram avaliados o alfabetismo em saúde bucal (BREALD-30), fatores sociodemográficos, tipo de serviço odontológico e funcionalidade familiar (FACES III) por meio de questionários validados. A associação entre as variáveis foi avaliada por meio de regressão de Poisson robusta (α=5%). Um maior alfabetismo em saúde bucal foi associado ao sexo feminino (RR=1.09; IC95%: 1.03-1.14), coesão familiar do tipo conectada (RR=1.12; IC95%: 1.05-1.20), adaptabilidade familiar dos tipos rígida (RR=1.14; IC95%: 1.04-1.25) e estruturada (RR=1.11; IC95%: 1.04-1.20), escolaridade materna superior a oito anos de estudo (RR=1.16; IC95%: 1.10-1.22), idade do responsável superior a 38 anos (RR=1.07; IC95%: 1.02-1.13) e uso de serviços odontológicos privados (RR=1.06; IC95%: 1.01-1.12). O nível de alfabetismo em pré-adolescentes foi associado ao sexo, estrutura familiar, idade e escolaridade do responsável e tipo de serviço odontológico utilizado.

Abstract The aim of this study was to evaluate associations between oral health literacy and family, sociodemographic and dental service characteristics in early adolescents. A cross-sectional study was conducted with 740 schoolchildren. The following variables were investigated using validated questionnaires: oral health literary (BREALD-30), sociodemographic characteristics, type of dental service and family functioning (FACES III). Associations were tested using robust Poisson regression analysis (α=5%). Higher oral health literacy was associated with the female sex (RR=1.09; 95%CI: 1.03-1.14), connected type of family cohesion (RR=1.12; 95%CI: 1.05-1.20), rigid (RR=1.14; 95%CI: 1.04-1.25) and structured (RR=1.11; 95%CI: 1.04-1.20) types of family adaptability, more than eight years of mother’s schooling (RR=1.16; 95%CI: 1.10-1.22), age of caregiver more than 38 years (RR=1.07; 95%CI: 1.02-1.13) and the use of private dental services (RR=1.06; 95%CI: 1.01-1.12). The level of oral health literacy in early adolescents was associated with sex, family structure, mother’s schooling, caregiver’s age and type of dental service used.

Resumo O objetivo deste estudo foi avaliar o efeito de um nanocomplexo recém-desenvolvido formado entre hidroxipropil-β-ciclodextrina e 1% de tetrafluoreto de titânio (TiF4) após distintos períodos de complexação (12/72 horas) na desmineralização do esmalte bovino in vitro. Blocos de esmalte (n = 60) foram alocados para cada grupo: água Mili-Q, hidroxipropil-β-ciclodextrina, TiF4 a 1%, hidroxipropil-β-ciclodextrina + TiF4 1% após 12 horas de complexação e hidroxipropil-β-ciclodextrina + TiF4 1% após 72 horas de complexação. As amostras foram avaliadas pela microdureza superficial, microdureza transversal e micro-CT. Microscopia eletrônica de varredura / espectrometria de raios X por dispersão de energia (MEV / EDX) foram obtidas. A hidroxipropil-β-ciclodextrina + TiF4 1% após 12h de complexação resultou em um menor percentual de perda de microdureza superficial em comparação com água Mili-Q, hidroxipropil-β-ciclodextrina, TiF4 a 1% e hidroxipropil-β-ciclodextrina + TiF4 1% após 72 horas de complexação com uma ampla magnitude de efeito (de 1,307 a 2,943) e alto poder (84,9 a 99%). Todos os grupos resultaram em similar perda integrada de minerais (ΔZ) obtida por ambas as técnicas de microdureza e micro-CT. O esmalte tratado com os grupos TiF4 e TiF4 + hidroxipropil-β-ciclodextrina apresentou camada de esmalte TiO2, enquanto a avaliação de EDX identificou Ti. A solução contendo o complexo de inclusão de hidroxipropil-β-ciclodextrina + TiF4 com 12 horas de período de complexação demonstrou uma capacidade significativa para reduzir a desmineralização superficial do esmalte hígido sob um desafio cariogênico artificial.

Abstract This study aimed to evaluate the association of contextual and individual factors with Oral Health literacy (OHL) in early adolescence. This is a population-based cross-sectional study carried out with 740 12-year-old adolescents randomly selected by a two-stage probabilistic cluster sampling process from schools in Campina Grande, Brazil. The guardians provided sociodemographic information. Adolescents answered the Brazilian version of the Family Adaptability and Cohesion Scales (FACES III) to measure family functioning, and the Brazilian Rapid Estimate of Literacy in Dentistry (BREALD-30) to measure OHL. Descriptive analysis was conducted, followed by robust Poisson’s regression analysis for complex samples with a multilevel approach (p<0.05). Rate ratio (RR) and 95% confidence intervals (CI) were calculated. The two levels of the analysis were students and schools. Adolescents enrolled at schools with higher grade-retention rate had slightly worse OHL scores (RR = 0.99; 95% CI: 0.98 to 0.99). The following individual factors were associated with the level of OHL: the female sex (RR = 1.05; 95% CI: 1.01 to 1.10), mother’s schooling more than eight years (RR = 1.13; 95% CI: 1.08 to 1.19), younger guardians (RR = 0.94; 95% CI: 0.90 to 0.97) and a balanced family functioning (RR = 1.08; 95% CI: 1.01 to 1.14). Individual and contextual factors were associated with OHL in early adolescence.

ABSTRACT Objective: To investigate the correlation between human development and dental caries in 12-year-old schoolchildren from the twenty-seven Brazilian states and to analyze the spatial distribution of these variables. Material and Methods: This was an ecological study using secondary data from the National Epidemiological Oral Health Survey 2010 and from the United Nations Development Program. Human development was measured by the Human Development Index (HDI) and dental caries by the Decayed, Missing and Filled Teeth index (DMFT). Dental caries prevalence and experience at the age of 12, and state HDI were entered into Google Sheets® and Google My Maps® for map creation. Data were analyzed by Pearson’s correlation (HDI and DMFT, DMFT individual components, prevalence of dental caries and prevalence of dental pain) (p<0.05). Results: Prevalence of dental caries ranged from 37.3% to 78.2% among the states. Dental caries was more prevalent in Rondônia (78.2%) and less prevalent in Santa Catarina (37.3%). Mean DMFT ranged from 1.06 to 4.81, with the highest value in Rondônia (4.81) and the lowest in Distrito Federal (1.06). HDI ranged from 0.631 (Alagoas) to 0.863 (Distrito Federal). There were negative correlations between HDI and dental caries (r=-0.504), dental caries experience (r=-0.459), decayed (r=-0.441) and missing (r=-0.441) components of the DMFT (p<0.05). Conclusion: Higher human development of the region lower dental caries experience and prevalence in 12-year-old Brazilian schoolchildren.

ABSTRACT Objective: To investigate the influence de two instruments for evaluation of cariogenic foods consumption by schoolchildren. Material and Methods: The convenience sample comprised of 30 active-caries children (7-10 years old) attended in a public dental clinic and their mothers, who have not received dietary orientation before study. A trained evaluator administered the Previous Day Food Questionnaire (PDFQ) to children and other examiner applied the 24-hour dietary recall with mothers. Internal consistency between PDFQ and 24-hour dietary recall regarding frequency of sugar intake was calculated using intraclass correlation coefficient. Bivariate analyses (Mann-Whitney test) were performed to investigate the factors associated with frequency of sugar intake when using both instruments (α=0.05). Results: A moderate correlation (ICC = 0.51; 95%CI: -0.04-0.77; p=0.03) was found between instruments. Mean frequency of sugar intake reported by mothers and children was 3.5 (± 1.8) and 3.7 (± 1.5) times a day, respectively. When using the PDFQ, the frequency of cariogenic foods consumption varied depending on frequency of toothbrushing, i.e., children that had higher frequency of sugar intake brushed their teeth at least two times a day (p=0.016). Conclusion: Previous Day Food Questionnaire applied with schoolchildren could substitute the mothers' reports of cariogenic foods consumption when dietary interventions for controlling dental caries are necessary. If doubts remain regarding the children's response, mothers should be consulted.

ABSTRACT OBJECTIVE: TO evaluate the family and contextual factors associated with licit drug use among 15 to 19-year-old adolescents in the school context. METHODS: This is a representative, school-based, cross-sectional study conducted with 746 adolescents from 15 to 19 years old enrolled in public and private schools. Parents/guardians reported on the sociodemographic variables, while adolescents answered questionnaires on drug use, family cohesion and adaptability, oral health literacy and visits to the dentist. Information on school context was obtained at the institution and via municipal publications. Associations between variables were analyzed using unadjusted and adjusted multilevel Poisson regression models. RESULTS: Prevalence of licit drug use at least once and a pattern indicative of harmful drug use were 39.8% and 15.1%, respectively. After the adjusted analysis of licit drug use at least once, the variables gender (PR = 1.26; 95%CI: 1.01–1.59), family cohesion (PR = 9.81; 95%CI: 1.23–72.54), and average income of the school district (PR = 0.72; 95%CI: 0.57–0.91) remained in the final model. As for drug abuse, only the detached type (PR = 23.01; 95%CI: 2.46–214.87) and separated type (PR = 13.54; 95%CI: 1.40–130.97) of family cohesion remained in the final model. CONCLUSION: Experience with licit drug use was associated with family and contextual factors among the adolescents, while family cohesion was the main factor related to harmful drug use.

ABSTRACT OBJECTIVE: TO evaluate the family and contextual factors associated with licit drug use among 15 to 19-year-old adolescents in the school context. METHODS: This is a representative, school-based, cross-sectional study conducted with 746 adolescents from 15 to 19 years old enrolled in public and private schools. Parents/guardians reported on the sociodemographic variables, while adolescents answered questionnaires on drug use, family cohesion and adaptability, oral health literacy and visits to the dentist. Information on school context was obtained at the institution and via municipal publications. Associations between variables were analyzed using unadjusted and adjusted multilevel Poisson regression models. RESULTS: Prevalence of licit drug use at least once and a pattern indicative of harmful drug use were 39.8% and 15.1%, respectively. After the adjusted analysis of licit drug use at least once, the variables gender (PR = 1.26; 95%CI: 1.01–1.59), family cohesion (PR = 9.81; 95%CI: 1.23–72.54), and average income of the school district (PR = 0.72; 95%CI: 0.57–0.91) remained in the final model. As for drug abuse, only the detached type (PR = 23.01; 95%CI: 2.46–214.87) and separated type (PR = 13.54; 95%CI: 1.40–130.97) of family cohesion remained in the final model. CONCLUSION: Experience with licit drug use was associated with family and contextual factors among the adolescents, while family cohesion was the main factor related to harmful drug use.

ABSTRACT OBJECTIVE To investigate whether oral health literacy (OHL) and school context are associated with untreated dental caries on the anterior teeth of adolescents. METHODS A representative cross-sectional study was conducted with 746 students aging 15 to 19 in the city of Campina Grande, Brazil. The guardians answered a questionnaire addressing sociodemographic data and the absence/presence of private health insurance. Two examiners were trained for the diagnosis of dental caries using the Nyvad criteria and the measurement of OHL using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) (Kappa > 0.80). Contextual aspects of the schools were obtained from the 2017 National School Census. Descriptive statistics were conducted, followed by unadjusted and adjusted robust negative binomial regression for complex samples (p < 0.05). RESULTS The average number of anterior teeth with untreated caries was 0.95 (SD = 1.77). Among individual factors, the male sex (RR = 1.64; 95%CI: 1.24–2.16), inadequate level of OHL (RR = 2.03; 95%CI: 1.13–1.63), marginal level of OHL (RR = 1.87; 95%CI: 1.05–3.33) and not having private health insurance (RR = 1.34; 95%CI: 1.07–1.68) were associated with untreated caries on anterior teeth. Among school contextual factors, the number of students in the classroom (RR = 2.64; 95%CI: 1.78–3.93), number of public oral health services in the district (RR = 0.14; 95%CI: 0.05–0.39) and average income of the district in which the school is located (RR = 0.99; 95%CI: 0.98–0.99) were associated with the outcome. CONCLUSIONS Sociodemographic factors, having private health insurance, OHL, and school context exerted an influence on the occurrence of untreated dental caries on anterior teeth in adolescents aging 15 to 19.

ABSTRACT OBJECTIVE To investigate whether oral health literacy (OHL) and school context are associated with untreated dental caries on the anterior teeth of adolescents. METHODS A representative cross-sectional study was conducted with 746 students aging 15 to 19 in the city of Campina Grande, Brazil. The guardians answered a questionnaire addressing sociodemographic data and the absence/presence of private health insurance. Two examiners were trained for the diagnosis of dental caries using the Nyvad criteria and the measurement of OHL using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) (Kappa > 0.80). Contextual aspects of the schools were obtained from the 2017 National School Census. Descriptive statistics were conducted, followed by unadjusted and adjusted robust negative binomial regression for complex samples (p < 0.05). RESULTS The average number of anterior teeth with untreated caries was 0.95 (SD = 1.77). Among individual factors, the male sex (RR = 1.64; 95%CI: 1.24–2.16), inadequate level of OHL (RR = 2.03; 95%CI: 1.13–1.63), marginal level of OHL (RR = 1.87; 95%CI: 1.05–3.33) and not having private health insurance (RR = 1.34; 95%CI: 1.07–1.68) were associated with untreated caries on anterior teeth. Among school contextual factors, the number of students in the classroom (RR = 2.64; 95%CI: 1.78–3.93), number of public oral health services in the district (RR = 0.14; 95%CI: 0.05–0.39) and average income of the district in which the school is located (RR = 0.99; 95%CI: 0.98–0.99) were associated with the outcome. CONCLUSIONS Sociodemographic factors, having private health insurance, OHL, and school context exerted an influence on the occurrence of untreated dental caries on anterior teeth in adolescents aging 15 to 19.

Resumo Este trabalho estudou a descontinuidade do cuidado (DC) em saúde bucal entre crianças e adolescentes que acessaram os serviços de urgência nas unidades básicas de saúde (UBS) e de pronto atendimento (UPA). Foram avaliados prontuários de indivíduos de 0 a 17 anos vinculados ao Sistema Único de Saúde de Curitiba. Considerou-se DC quando não houve o registro de consulta eletiva na UBS nos 6 meses subsequentes ao atendimento de urgência. A amostra foi estratificada pelo Índice de Desenvolvimento Humano Municipal (IDHM) da Unidade de Desenvolvimento Humano em que o paciente residia em ≤0,799 ou ≥0,800. A associação entre DC e demais covariáveis foi analisada através de regressão de Poisson com variância robusta uni e multivariada (α=0,05). A incidência de DC foi de 42,2%. No estrato de IDHM≤0,799, o risco de DC foi maior para as crianças com menos de 5 anos de idade e aqueles que não visitaram o dentista no último ano. Nos dois estratos, o risco de DC foi maior para aquelas que utilizaram a UPA para o atendimento de urgência quando comparadas com as que receberam atendimento na UBS. A DC em saúde bucal apresentou alta incidência, sendo que entre os residentes em regiões com menor IDHM, sofreu uma maior influência das características de uso dos serviços.

Abstract The aim of the present study was to investigate the discontinuity of oral health care among children and adolescents who accessed emergency services at primary care units and urgent care units. Records were reviewed of patients aged 0 to 17 years treated in the public healthcare system in city of Curitiba, Brazil. Discontinuity was considered when elective treatment was not registered at the primary care unit within six months after urgent care. The sample was stratified based on the Municipal Human Development Index (MHDI) (≤0.799 or ≥0.800). The association between discontinuity and covariables was assessed using univariate and multivariate Poisson regression models with robust variance (α=0.05). The incidence of discontinuity was 42.2%. In the MHDI≤0.799 stratum, the risk of discontinuity was greater among children younger than five years of age and individuals who had not had a dental appointment in the previous year. In both MHDI strata, the risk of discontinuity was higher in patients who received urgent care at an urgent care unit than those treated at a primary care unit. The incidence of the discontinuity of oral health care was high and was strongly influenced by the characteristics of dental service utilization among individuals living in regions with a lower MHDI.

ABSTRACT OBJECTIVE Evaluate socio-demographic, family and behavioral factors associated with oral health literacy (OHL) in adolescents. METHODS Cross-sectional study conducted with adolescents aged 15 to 19 years in Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing socio-demographic data. The adolescents answered validated instruments on family cohesion and adaptability (family adaptability and cohesion evaluation scale), drug use (alcohol, smoking and substance involvement screening test), type of dental service used for last appointment and OHL (Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry). Two dentists were trained to evaluate OHL (K = 0.87–0.88). Descriptive analysis was performed, followed by Poisson regression analysis (α = 5%). A directed acyclic graph was used to select independent variables in the study. RESULTS The following variables remained associated with better OHL: high mother’s schooling level (RR = 1.07; 95%CI: 1.03–1.12), high income (RR = 1.04; 95%CI: 1.01–1.09), white ethnicity/skin color (RR = 1.05; 95%CI: 1.01–1.10), married parents (RR = 1.04; 95%CI: 1.01–1.09), “enmeshed” family cohesion (RR = 1.21; 95%CI: 1.12–1.30), “structured” (RR = 1.06; 95%CI: 1.01–1.12) or “rigid” (RR = 1.11; 95%CI: 1.04–1.19) family adaptability, having more than five residents in the home (RR = 1.07; 95%CI: 1.01–1.14) and having used a private dental service during the last appointment (RR = 1.08; 95%CI: 1.03–1.13). CONCLUSION Family functioning and socio-demographic factors influence the level of oral health literacy among adolescents.