Abstract Background The level of health literacy can be a factor that influences the behaviors and health of individuals. Objective To analyze the perception of adults and the elderly on their behaviors and their oral health conditions according to their level of health literacy (HL). Method The qualitative study was carried out with adults and the elderly who participated in the “Piracicaba Adult Oral Health Cohort” and had been classified into three tooth loss profiles: 1) never having lost teeth; 2) incidence of tooth loss ≥ 4 teeth; 3) total toothlessness and the level of health literacy dichotomized in the median at high and low HL. There was a new home interview recorded using a script, and after transcription, content analysis was performed. Results The individuals, regardless of the HL level, identified risk and protective factors that were decisive in the oral health-disease process. However, individuals with low HL were more adept at risky behavior. The individual factors were preponderant for the understanding of his oral condition, either by the feeling of carelessness or by the feeling of responsibility for the lack of access to dental services, either by the socioeconomic or geographical aspect. Conclusion Individuals with high HL showed greater argumentative capacity and understanding of healthy behaviors, such as oral hygiene and regular use of dental services, regardless of the type of service used. . (HL) Piracicaba Cohort profiles 1 teeth 2 3 script transcription performed healthdisease disease process However behavior condition services aspect used (HL

Resumo Introdução O nível da literacia em saúde pode ser um fator que influencia os comportamentos e a saúde dos indivíduos. Objetivo Analisar a percepção de adultos e idosos sobre os seus comportamentos e sua condição de saúde bucal segundo o seu nível de literacia em saúde (LS). Método O presente estudo qualitativo foi realizado com adultos e idosos que que participaram da ‘Coorte de Saúde Bucal de Adultos de Piracicaba’, sendo classificados conforme os três perfis de perda dentária seguintes: 1) nunca ter perdido dentes; 2) incidência de perda dentária ≥ 4 dentes; 3) edêntulo total e com nível de literacia em saúde alta e baixa de acordo com a variável LS dicotomizada a partir da mediana. Para a coleta dos dados, foi feita uma nova entrevista domiciliar gravada com uso de roteiro-guia e após a transcrição foi realizada a análise de conteúdo. Resultados Independente do nível de LS, os indivíduos identificaram fatores de risco e proteção determinantes para o processo saúde-doença bucal. No entanto, os entrevistados com baixa LS apresentaram uma maior propensão aos comportamentos de risco. Os fatores individuais foram preponderantes para o entendimento de sua condição bucal, seja pelo sentimento de descuido ou de responsabilidade pela falta de acesso aos serviços odontológicos, seja pelo aspecto socioeconômico ou geográfico. Conclusão Os indivíduos com alta LS apresentaram uma capacidade argumentativa e um entendimento maiores sobre os comportamentos saudáveis, como higiene bucal e uso regular do serviço odontológico, independente do tipo de serviço utilizado. LS. . (LS) Coorte Piracicaba, Piracicaba , Piracicaba’ seguintes 1 dentes 2 3 mediana dados roteiroguia roteiro guia conteúdo saúdedoença doença entanto odontológicos geográfico saudáveis odontológico utilizado (LS

Resumo Objetivo Verificar se a perda de função mastigatória aumenta o risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo. Métodos Foi adotado um delineamento de coorte prospectivo sobre a base de dados do estudo FIBRA (Fragilidade em Idosos Brasileiros), com linha de base realizada em 2008-2009 e seguimento em 2016-2018, transcorrendo em média 100,2 ± 9,2 meses. A variável desfecho foi a incidência de fragilidade, a variável de exposição foi a função mastigatória conforme a condição de edentulismo e autorrelato de dificuldade mastigatória. As variáveis de ajuste foram condições sociodemográficas, comportamentais e de saúde geral. Foi utilizado um modelo de regressão de Poisson, com variância robusta, estimando o risco relativo Resultados a incidência acumulada de fragilidade aos oito anos em média foi de 30 casos a cada 100 participantes edêntulos com dificuldade mastigatória, que apresentaram maior risco de desenvolver fragilidade (RR:1,75 IC 95% 1,09-2,81) do que os idosos dentados sem dificuldade mastigatória, independentemente de tabagismo (RR: 1,71 IC 95% 1,07-2,73) e de condição socioeconômica (RR: 1,72 IC 95% 1,13-2,62). Conclusão A perda de função mastigatória aumentou o risco de fragilidade em idosos.Futuras pesquisas deverão estudar se a reabilitação da função mastigatória contribui para diminuir esse risco.

Abstract Objective To verify if the loss of masticatory function increases the risk of frailty in community-dwelling older people in the state of São Paulo. Methods A prospective cohort design was adopted based on the FIBRA study database (Fragility in Brazilian Elderly), with a baseline performed in 2008-2009 and follow-up in 2016-2018, elapsed on average 100.2 ± 9.2 months. The outcome variable was the incidence of frailty. The exposure variable was masticatory function according to edentulism and self-reported chewing difficulty. Adjustment variables were sociodemographic, behavioral, and general health conditions. A Poisson regression model with robust variance was used to estimate the relative risk. Results the cumulative incidence of frailty over eight years was 30 cases per 100 edentulous participants with chewing difficulties, who had a higher risk of developing frailty (RR: 1.75 95% CI 1.09-2.81) than the dentate elderly without chewing difficulties, regardless of smoking (RR: 1.71 95% CI 1.07-2.73) and socioeconomic status (RR: 1.72 95% CI 1.13-2.62) Conclusion Loss of masticatory function increases the risk of frailty in older people. Future research should study whether the rehabilitation of oral function reduces this risk.

Aim This study analyzes factors associated with dimensions of health literacy (HL) functional, communicative and critical among public health service users with chronic non-communicable diseases. Methods A cross-sectional analytical research was carried out in Piracicaba, São Paulo, Brazil, with adults and older adults attending Family Health Units (FHU). Data were collected by oral exam (CPOD and CPI) and a questionnaire on systemic conditions, sociodemographic factors, health behaviors and HLS (HLS-14). The outcomes consisted of functional, communicative, and critical HL dimensions dichotomized by median (high and low), which were analyzed by chi-square test (p<0.05) to find associations with the variables studied. Results The study sample comprised 238 FHU users with 62.7 (± 10.55) mean age, of which 47.5% (n=113) showed high functional HL, 50.0% (n=119) high communicative HL, and 46.2% (n=110) high critical HL. High functional HL was associated with men (p<0.05). Functional and communicative HL were associated with having higher education (p<0.001 and p=0.018, respectively). High communicative and critical HL were associated with regular use of dental and medical services (p<0.05). Individuals with low functional HL were more likely to present poor tooth brushing (p=0.020). High HL (in all three dimensions) was associated with regular flossing and having more teeth (p<0.05). Conclusion Functional, communicative and critical HL were associated with health behaviors and clinical outcomes, whereas the functional dimension was also associated with sociodemographic factors. HL dimensions allowed to differentiate health-related factors.

ABSTRACT OBJETIVE To investigate the relationship between the masticatory function and the frailty of older people. METHODS Exploratory cross-sectional study using secondary data from the FIBRA Project on the frailty conditions of older people living in urban areas of six Brazilian municipalities, from 2008 to 2009. The population consisted of older adults aged 65 and over with no cognitive impairment. A single session identification questionnaire and the Mini-Mental State Examination (MMSE) were applied, followed by collecting sociodemographic data and data on the participants’ self-assessment of masticatory function, general health, and oral health. RESULTS 2,341 older people (164 frail older adults), of whom 63.2% reported not having seen a dentist in the last year, and approximately 26% of them had three or more functional feeding problems. Older participants (OR = 2.88; 95%CI: 2.01–4.13), who are retired (OR = 2.31; 95%CI: 1.18–5.53), those who were depressed (OR = 2.31; 95%CI: 1.58–3.38), and those who self-assessed their general health as worse compared to others of the same age (OR = 3.91; 95%CI: 2.39–6.40) were at higher risk of frailty. Three or more problems related to the functional aspects of mastication were associated with a greater chance of frailty (OR = 2.06; 95%CI: 1.25–3.41). CONCLUSION This study found an association between masticatory function and a greater chance of frailty among the studied population.

ABSTRACT OBJETIVE To investigate the relationship between the masticatory function and the frailty of older people. METHODS Exploratory cross-sectional study using secondary data from the FIBRA Project on the frailty conditions of older people living in urban areas of six Brazilian municipalities, from 2008 to 2009. The population consisted of older adults aged 65 and over with no cognitive impairment. A single session identification questionnaire and the Mini-Mental State Examination (MMSE) were applied, followed by collecting sociodemographic data and data on the participants’ self-assessment of masticatory function, general health, and oral health. RESULTS 2,341 older people (164 frail older adults), of whom 63.2% reported not having seen a dentist in the last year, and approximately 26% of them had three or more functional feeding problems. Older participants (OR = 2.88; 95%CI: 2.01–4.13), who are retired (OR = 2.31; 95%CI: 1.18–5.53), those who were depressed (OR = 2.31; 95%CI: 1.58–3.38), and those who self-assessed their general health as worse compared to others of the same age (OR = 3.91; 95%CI: 2.39–6.40) were at higher risk of frailty. Three or more problems related to the functional aspects of mastication were associated with a greater chance of frailty (OR = 2.06; 95%CI: 1.25–3.41). CONCLUSION This study found an association between masticatory function and a greater chance of frailty among the studied population.

Studying the different indicators of functional dentition classification can contribute to the understanding of the associated factors, and thus help in the definition of strategies associated with oral health care. This approach has been little explored in the literature, especially when considering the older age group. Aim The aim of this study is to evaluate the factors associated with three distinct functional dentition classification. Methods Cross-sectional exploratory study using secondary data from the Frailty in Older Brazilians (FIBRA) Project of 876 older adults living in Campinas, Brazil. The indicators of dental function assessed was number of natural teeth present, occluding pairs of teeth and the Eichner index, which were verified by trained dentists, following the World Health Organization criteria for epidemiological studies in oral health. The explanatory variable assessed was the self-perception of oral health-related quality of life measured by the Geriatric Oral Health Assessment Index (GOHAI) and its dimensions. It was also collected sociodemographic information such as age, gender, race/ethnicity, schooling, family income, smoking behavior and frailty status. The association was verified through Poisson regressions for number of teeth and pairs of teeth in occlusion and multinomial regression for the Eichner index, adjusted by sociodemographic and health variables. Results Lower prevalence of participants with less than 21 teeth who negatively perceived GOHAI´s pain and discomfort dimension and higher prevalence of having less teeth among the ones that negatively perceived GOHAI´s physical and functional dimensions. No association was found between the perception of quality of life and occlusion pairs of teeth and the Eichner Index. Conclusion Two out of three indicators assessed were associated with quality of life. Therefore, it is important to select sensitive indicators to be able to identify and better comprehend this relationship.

Abstract BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients. Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey’s post-hoc tests were used for analysis, considering a=0.05. Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

Abstract Objective: To analyze the role of an individual’s perception of their partner’s oral health in heterosexual couples. Material and Methods: The exploratory study with a qualitative and quantitative approach and data were collected in households in 2015. The quantitative data were analyzed using simple and multivariate binary logistic regression (p<0.05), and the qualitative using Thematic Content Analysis. Results: Of 143 participants, 113 (79.0%) were in a relationship and made up the final sample of the present study. Both women and men reported a small percentage of discomfort in relation to their partners’ oral health (23.1% vs. 14.8%; p=0.199), and only a few had received complaints about their own oral health (20.7% vs. 10.7%; p=0.179). However, almost half of the sample had been told by their partner to see the dentist (47.6% vs. 31.0%; p=0.156), and of these, most were men (48.3% vs. 25.0%; p=0.022). The men that were more likely to be told by their partners to see the dentist (OR=5.82; 95% CI: 1.71-19.80) were upper-class (OR=3.35; 95% CI: 1.05-10.67), workers (OR=7.45; 95% CI: 1.62-34.20) who were dissatisfied with their oral health (OR=3.45; 95% CI: 1.13-10.51). The participants’ reasons for complaining of their partners’ oral health or for telling them to see the dentist were related to physiopathological clinical aspects and healthcare habits. Conclusion: The women told their male partners to seek dental services more often, and future studies should explore whether women are predictors of care and the validity of this information as an indicator of the oral health condition of their male partners.

Resumo O objetivo deste estudo foi analisar a relação de um instrumento de vulnerabilidade familiar com fatores sociodemográficos e odontológicos e sua distribuição espacial em determinado território. A variável dependente foi a classificação de vulnerabilidade familiar, proposta por Coelho e Savassi. As variáveis independentes foram selecionadas baseadas no modelo teórico proposto por Andersen. Foram estimados modelos de regressão logística múltipla hierarquizada. O estimador de densidade de Kernel foi utilizado para análise espacial. Indivíduos que residiam com mais de quatro pessoas (OR = 3,46; IC 95%), que estavam insatisfeitos com a saúde bucal (OR = 2,38; IC 95%) e que tinham vergonha ao sorrir e falar (OR = 3,03; IC 95%) apresentavam mais chances de estar “em risco” familiar. A análise espacial possibilitou a visualização de uma área de maior concentração de famílias “em risco”. A relação do instrumento de vulnerabilidade analisado com fatores sociodemográficos e odontológicos, além do auxílio na visualização e identificação de áreas mais vulneráveis, auxilia no conhecimento do território para o planejamento das ações em saúde bucal, de modo que concluímos que tal instrumento pode ser adotado para um acesso mais equânime por parte das equipes de saúde bucal.

Abstract The scope of this study was to analyze the relationship of an instrument of family vulnerability with sociodemographic, dental, and spatial distribution in a given territory. The dependent variable was the classification of family vulnerability, proposed by Coelho and Savassi. The independent variables were selected on the basis of the theoretical model proposed by Andersen. Hierarchical multiple logistic regression models were estimated. Kernel density estimation was used for spatial analysis. Subjects who lived with more than 4 people (OR = 3.46; 95% CI), who were dissatisfied with their oral health (OR = 2.38; 95% CI), who were ashamed to smile and talk (OR = 3.03, 95% CI) were more likely to be “at risk” in the family. Spatial analysis enabled the visualization of an area of higher concentration of families “at risk”. The relationship of the instrument of vulnerability analyzed with sociodemographic and dental factors, as well as the assistance in the visualization and identification of more vulnerable areas, are useful in the knowledge of the territory for the planning of actions in oral health, and the conclusion drawn is that the tool can be adopted for more equitable access by the oral health teams.

Resumo O objetivo deste estudo foi analisar a relação de um instrumento de vulnerabilidade familiar com fatores sociodemográficos e odontológicos e sua distribuição espacial em determinado território. A variável dependente foi a classificação de vulnerabilidade familiar, proposta por Coelho e Savassi. As variáveis independentes foram selecionadas baseadas no modelo teórico proposto por Andersen. Foram estimados modelos de regressão logística múltipla hierarquizada. O estimador de densidade de Kernel foi utilizado para análise espacial. Indivíduos que residiam com mais de quatro pessoas (OR = 3,46; IC 95%), que estavam insatisfeitos com a saúde bucal (OR = 2,38; IC 95%) e que tinham vergonha ao sorrir e falar (OR = 3,03; IC 95%) apresentavam mais chances de estar “em risco” familiar. A análise espacial possibilitou a visualização de uma área de maior concentração de famílias “em risco”. A relação do instrumento de vulnerabilidade analisado com fatores sociodemográficos e odontológicos, além do auxílio na visualização e identificação de áreas mais vulneráveis, auxilia no conhecimento do território para o planejamento das ações em saúde bucal, de modo que concluímos que tal instrumento pode ser adotado para um acesso mais equânime por parte das equipes de saúde bucal.

Abstract The scope of this study was to analyze the relationship of an instrument of family vulnerability with sociodemographic, dental, and spatial distribution in a given territory. The dependent variable was the classification of family vulnerability, proposed by Coelho and Savassi. The independent variables were selected on the basis of the theoretical model proposed by Andersen. Hierarchical multiple logistic regression models were estimated. Kernel density estimation was used for spatial analysis. Subjects who lived with more than 4 people (OR = 3.46; 95% CI), who were dissatisfied with their oral health (OR = 2.38; 95% CI), who were ashamed to smile and talk (OR = 3.03, 95% CI) were more likely to be “at risk” in the family. Spatial analysis enabled the visualization of an area of higher concentration of families “at risk”. The relationship of the instrument of vulnerability analyzed with sociodemographic and dental factors, as well as the assistance in the visualization and identification of more vulnerable areas, are useful in the knowledge of the territory for the planning of actions in oral health, and the conclusion drawn is that the tool can be adopted for more equitable access by the oral health teams.

RESUMO OBJETIVO O objetivo foi analisar o papel da Literacia em Saúde (LS) como fator associado às perdas dentárias entre usuários do Sistema Único de Saúde com doenças crônicas não transmissíveis. MÉTODOS O estudo transversal e analítico foi conduzido com usuários adultos e idosos selecionados em dez Unidades de Saúde da Família sorteadas, em Piracicaba – SP, Brasil. Foi aplicado um questionário com dados sociodemográficos (sexo, idade, cor da pele e escolaridade), comportamentais (escovação e uso de fio dental), determinantes em saúde (tipo e frequência de uso de serviço de saúde médico e odontológico) e clínica (dor). As condições bucais foram coletadas por exame intrabucal do biofilme dental visível e Índice Pediodontal Comunitário. As condições clínicas sistêmicas (glicemia, hemoglobina glicada e pressóricas) foram extraídas dos prontuários. A variável explanatória foi a LS (baixa, média e alta), medida pelo Health Literacy Scale (HLS-14). RESULTADOS O desfecho foi à perda dentária medida pelo Índice de dentes permanentes cariados, perdidos e obturados. Foi realizada regressão logística com uso de um modelo conceitual para a LS (p < 0,05). Para os 238 indivíduos, a média de idade foi 62,7 anos (± 10,55). A perda dentária esteve associada à LS nos modelos de regressão ajustados por tipo de serviço odontológico, frequência odontológica e uso de fio dental. No modelo final, a perda dentária teve como fatores associados a maior idade (OR = 1,12; IC95% 1,07–1,17), menor escolaridade (OR = 3,43; IC95% 1,17–10,10), ao uso irregular de fio dental (OR = 4,58; IC95% 1,75–7,31), uso irregular do serviço odontológico (OR = 2,60; IC95% 1,32–5,12), bolsa periodontal (> 4mm) (OR = 0,31; IC95% 0,01–0,08), ter biofilme dental visível (OR = 7,23; IC95% 3,19–16,41) e maior índice de glicemia (OR = 1,98; IC95% 1,00–3,92). CONCLUSÕES A perda dentária esteve associada à LS quando ajustada por comportamentos em saúde, a partir da inclusão das variáveis sociodemográficas e condições clínicas ela perdeu a significância. No modelo final, comportamentos, determinantes em saúde e condições clínicas foram indicadores de risco da perda dentária, demonstrando a multifatorialidade envolvida neste fenômeno.

ABSTRACT OBJECTIVE The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases. METHODS The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14). RESULTS The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07–1,17), a lower education (OR = 3,43; 95%CI: 1,17–10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in–7,31), irregular use of dental services (n = 2,60; 95% 1,32–5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01–0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19–16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00–3,92). CONCLUSIONS tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.

RESUMO OBJETIVO O objetivo foi analisar o papel da Literacia em Saúde (LS) como fator associado às perdas dentárias entre usuários do Sistema Único de Saúde com doenças crônicas não transmissíveis. MÉTODOS O estudo transversal e analítico foi conduzido com usuários adultos e idosos selecionados em dez Unidades de Saúde da Família sorteadas, em Piracicaba – SP, Brasil. Foi aplicado um questionário com dados sociodemográficos (sexo, idade, cor da pele e escolaridade), comportamentais (escovação e uso de fio dental), determinantes em saúde (tipo e frequência de uso de serviço de saúde médico e odontológico) e clínica (dor). As condições bucais foram coletadas por exame intrabucal do biofilme dental visível e Índice Pediodontal Comunitário. As condições clínicas sistêmicas (glicemia, hemoglobina glicada e pressóricas) foram extraídas dos prontuários. A variável explanatória foi a LS (baixa, média e alta), medida pelo Health Literacy Scale (HLS-14). RESULTADOS O desfecho foi à perda dentária medida pelo Índice de dentes permanentes cariados, perdidos e obturados. Foi realizada regressão logística com uso de um modelo conceitual para a LS (p < 0,05). Para os 238 indivíduos, a média de idade foi 62,7 anos (± 10,55). A perda dentária esteve associada à LS nos modelos de regressão ajustados por tipo de serviço odontológico, frequência odontológica e uso de fio dental. No modelo final, a perda dentária teve como fatores associados a maior idade (OR = 1,12; IC95% 1,07–1,17), menor escolaridade (OR = 3,43; IC95% 1,17–10,10), ao uso irregular de fio dental (OR = 4,58; IC95% 1,75–7,31), uso irregular do serviço odontológico (OR = 2,60; IC95% 1,32–5,12), bolsa periodontal (> 4mm) (OR = 0,31; IC95% 0,01–0,08), ter biofilme dental visível (OR = 7,23; IC95% 3,19–16,41) e maior índice de glicemia (OR = 1,98; IC95% 1,00–3,92). CONCLUSÕES A perda dentária esteve associada à LS quando ajustada por comportamentos em saúde, a partir da inclusão das variáveis sociodemográficas e condições clínicas ela perdeu a significância. No modelo final, comportamentos, determinantes em saúde e condições clínicas foram indicadores de risco da perda dentária, demonstrando a multifatorialidade envolvida neste fenômeno.

ABSTRACT OBJECTIVE The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases. METHODS The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14). RESULTS The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07–1,17), a lower education (OR = 3,43; 95%CI: 1,17–10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in–7,31), irregular use of dental services (n = 2,60; 95% 1,32–5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01–0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19–16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00–3,92). CONCLUSIONS tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.

Resumo Foram avaliadas as propriedades psicométricas da versão brasileira do 14-item Health Literacy Scale (HLS-14). No estudo metodológico com delineamento transversal realizou-se tradução, adaptação transcultural e avaliação das propriedades psicométricas. Depois de passar por comitê de especialistas, traduzido e adaptado, o instrumento foi pré-testado em 52 adultos, e aplicado em 143 adultos e idosos de Piracicaba-SP. A consistência interna foi avaliada através do coeficiente de correlação de Kendall e α de Cronbach (>0,70) e a análise fatorial confirmatória (AFC) por meio do teste de qui-quadrado, raiz quadrada média residual padronizada (SRMR), raiz da média dos quadrados dos erros de aproximação (RMSEA) (<0,05), índice de ajuste comparativo (CFI) (>0,95) e índice de Tucker-Lewis (TLI) (>0,95). A equivalência operacional apresentou concordância entre as questões, com exceção das questões 6, 8, 9 e 14. O coeficiente α de Cronbach foi 0,82. Houve ajuste razoável na AFC, CFI=0,886, TLI=0,86, RMSEA=0,085 (IC90%: 0,065-0,105), SRMR=0,071, qui-quadrado (74 graus de liberdade) =149,510, p<0,001. A exclusão da questão 5 elevou os índices de ajuste a níveis satisfatórios. A versão brasileira do HLS-14 foi considerada válida para mensurar literacia em saúde.

Abstract We evaluated the psychometric properties of the Health Literacy Scale - 14 (HLS-14), the Brazilian Portuguese version. In the methodological study with a cross-sectional design, the following were performed: translation, cross-cultural adaptation and evaluation of the psychometric properties. After being subjected to a committee of experts, translated and adapted, the instrument was pre-tested with 52 adults and applied to 143 adults and older people of Piracicaba-SP. Internal consistency was assessed based on the Kendall correlation coefficient and Cronbach’s alpha (>0.70), and the confirmatory factor analysis (CFA) was conducted using the chi-square test, the Standardized Residual Mean Square Root (SRMR), the Root Mean Square Error of Approximation (RMSEA) (<0.05), the Comparative Fit Index (CFI) (>0.95) and the Tucker-Lewis Index (TLI) (>0.95). The analysis of operational equivalence showed agreement between most of the questions, exception questions 6, 8, 9 and 14. Cronbach’s alpha was 0.82. There was reasonable adjustment in the CFA: CFI=0.886, TLI=0.86, RMSEA=0.085 (90%CI: 0.065-0.105), SRMR=0.071, chi-square (74 degrees of freedom) = 149.510, p<0.001. The exclusion of question 5 increased the adjustment level to satisfactory. The Brazilian Portuguese version of HLS-14 can be considered a valid health literacy assessment instrument.

Resumo Foram avaliadas as propriedades psicométricas da versão brasileira do 14-item Health Literacy Scale (HLS-14). No estudo metodológico com delineamento transversal realizou-se tradução, adaptação transcultural e avaliação das propriedades psicométricas. Depois de passar por comitê de especialistas, traduzido e adaptado, o instrumento foi pré-testado em 52 adultos, e aplicado em 143 adultos e idosos de Piracicaba-SP. A consistência interna foi avaliada através do coeficiente de correlação de Kendall e α de Cronbach (>0,70) e a análise fatorial confirmatória (AFC) por meio do teste de qui-quadrado, raiz quadrada média residual padronizada (SRMR), raiz da média dos quadrados dos erros de aproximação (RMSEA) (<0,05), índice de ajuste comparativo (CFI) (>0,95) e índice de Tucker-Lewis (TLI) (>0,95). A equivalência operacional apresentou concordância entre as questões, com exceção das questões 6, 8, 9 e 14. O coeficiente α de Cronbach foi 0,82. Houve ajuste razoável na AFC, CFI=0,886, TLI=0,86, RMSEA=0,085 (IC90%: 0,065-0,105), SRMR=0,071, qui-quadrado (74 graus de liberdade) =149,510, p<0,001. A exclusão da questão 5 elevou os índices de ajuste a níveis satisfatórios. A versão brasileira do HLS-14 foi considerada válida para mensurar literacia em saúde.

Abstract We evaluated the psychometric properties of the Health Literacy Scale - 14 (HLS-14), the Brazilian Portuguese version. In the methodological study with a cross-sectional design, the following were performed: translation, cross-cultural adaptation and evaluation of the psychometric properties. After being subjected to a committee of experts, translated and adapted, the instrument was pre-tested with 52 adults and applied to 143 adults and older people of Piracicaba-SP. Internal consistency was assessed based on the Kendall correlation coefficient and Cronbach’s alpha (>0.70), and the confirmatory factor analysis (CFA) was conducted using the chi-square test, the Standardized Residual Mean Square Root (SRMR), the Root Mean Square Error of Approximation (RMSEA) (<0.05), the Comparative Fit Index (CFI) (>0.95) and the Tucker-Lewis Index (TLI) (>0.95). The analysis of operational equivalence showed agreement between most of the questions, exception questions 6, 8, 9 and 14. Cronbach’s alpha was 0.82. There was reasonable adjustment in the CFA: CFI=0.886, TLI=0.86, RMSEA=0.085 (90%CI: 0.065-0.105), SRMR=0.071, chi-square (74 degrees of freedom) = 149.510, p<0.001. The exclusion of question 5 increased the adjustment level to satisfactory. The Brazilian Portuguese version of HLS-14 can be considered a valid health literacy assessment instrument.

Abstract The aim of this study was to verify the association between sociodemographic, general health, and oral health data with self-rated general health (SRGH) and self-rated oral health (SROH) in independent-living older Brazilians. This cross-sectional study was part of a larger study with older individuals living independently in the city of Campinas, Brazil – the “Rede FIBRA” Study (the Frailty in Brazilian Elderly Study). A random sample of 688 older individuals responded the SRGH and 673, the SROH. SRHG and SROH were both assessed using a single item. The questionnaire included sociodemographic, general, and oral health data. The mean age was 72.28 ± 5.4 years. The adjusted analysis revealed that the probability of rating general health as bad was higher for illiterate participants (PR: 1.77, 95%CI: 1.13–2.77) or with low educational level (PR: 1.76, 95%CI: 1.17–2.65), those with depressive symptoms (PR: 1.45, 95%CI:1.21–1.74), participants that self-reported food limitation due to problems with denture or lack of it (PR: 1.29, 95%CI: 1.05–1.56), and those with xerostomia (PR 1.40, 95%CI: 1.17–1.67). The probability of rating general health as bad was lower for participants that presented 0-2 chronic diseases (PR: 0.64, 95%CI: 0.53–0.78) and were pre-frail (PR: 0.76, 95%CI: 0.61-0.96). With regard to SROH, the probability of rating oral health as bad was higher for participants with natural teeth (PR:1.61, 95%CI: 1.24–2.08), that reported xerostomia (PR: 1.44, 95%CI: 1.13–1.84), and food limitation due to problems with denture or lack of it (PR: 1.43, 95%CI: 1.07–1,91), and lower for participants that reported having enough money to cover daily expenses (PR: 0.78, 95%CI: 0.61–0.99). Oral health data and income seem to be related to self-perceptions of general and oral health.