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.

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.

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 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 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.

RESUMO OBJETIVO Avaliar os fatores associados à perda dentária em adultos a partir da posição e do número de dentes perdidos nos arcos dentários. MÉTODOS Estudo transversal, populacional, com adultos participantes do levantamento epidemiológico de saúde bucal de São Paulo em 2015. O desfecho do estudo foi a perda dentária, avaliada pela classificação proposta, a saber: I) perdeu até 12 dentes posteriores; II) perdeu até 12 dentes (incluindo dentes anteriores); e III) perdeu acima de 12 dentes. Realizou-se uma análise em quatro blocos, apoiada em um modelo teórico conceitual adaptado para perdas dentárias. Para a regressão logística multinominal, usou-se “indivíduos que não tenham perdido dentes por cárie ou doença periodontal” como referência (p < 0,05). RESULTADOS De 6.051 adultos avaliados, 25,3% (n = 1.530) foram classificados na categoria I, 32,7% (n = 1.977) na II, 9,4% (n = 568) na III e 1,9% (n = 117) eram desdentados totais. A menor renda e escolaridade, a percepção de necessidade de tratamento e última consulta motivada por rotina, dor ou extração foram associados à perda dentária, independentemente da classificação. A avaliação negativa do serviço odontológico esteve associada aos indivíduos que perderam até 12 dentes, tanto anteriores quanto posteriores. O sexo feminino e a presença de bolsa periodontal foram associados a perdas dentárias de até 12 dentes, incluindo anteriores, e acima de 12 dentes. A presença de cárie foi associada aos adultos que perderam até 12 dentes, incluindo dentes anteriores. CONCLUSÃO A classificação proposta permitiu a identificação de diferenças entre os fatores associados. Assim, fica evidente a necessidade de considerá-la em estudos futuros.

ABSTRACT OBJECTIVE To evaluate the factors associated with tooth loss in adults from the position and number of teeth lost in the dental arches. METHODS This is a cross-sectional, population-based study with adults participating in the epidemiological survey of oral health of São Paulo in 2015. The outcome of the study was tooth loss, assessed by the proposed classification, namely: I) lost up to 12 back teeth; II) lost up to 12 teeth (including front teeth); and III) lost more than 12 teeth. A four-block analysis was conducted, supported by a conceptual theoretical model adapted for tooth loss. For the multinomial logistic regression, “individuals who did not lose teeth due to caries or periodontal disease” was used as reference (p < 0.05). RESULTS Of 6,051 adults evaluated, 25.3% (n = 1,530) were classified in category I, 32.7% (n = 1,977) in II, 9.4% (n = 568) in III, and 1.9% (n = 117) were edentulous. Lower income and schooling, the perception of need for treatment and the last appointment motivated by routine, pain or extraction were associated with tooth loss, regardless of the classification. The negative evaluation of the dental service was associated with individuals who lost up to 12 teeth, both front and back. The presence of women and periodontal pocket were associated with tooth loss of up to 12 teeth, including front, and more than 12 teeth. Caries were associated with adults who lost up to 12 teeth, including front teeth. CONCLUSION The proposed classification allowed the identification of differences between the associated factors. Thus, the need to consider such classification in future studies is evident.

Abstract It has been postulated that oral health-related quality of life (OHRQoL) may be affected by the sense of coherence (SOC), but there are no epidemiological studies investigating this association in Brazilian adults. The present study was conducted among adults of a mid-sized Brazilian city, with the aim of looking into this association. The probability sampling consisted of 342 adults aged 35-44 years old, from a mid-sized Brazilian city, who were examined at their homes for caries (Decayed, Missing and Filled Teeth [DMFT] Index) and periodontal disease (Community Periodontal Index - CPI), according to WHO criteria. The questionnaire applied included demographic factors, socioeconomic information, use of dental services, behavior, SOC and the Oral Health Impact Profile (OHIP). The OHIP outcome, measured by prevalence of the impact, was analyzed by binary logistic regression using a hierarchical approach, a conceptual model, and a 5% significance level. A total of 67.9% of the respondents had one or more impacts on OHRQoL, and 54.4% showed a high SOC. The impact on OHRQoL was more prevalent in adults who had a manual occupation (PR = 2.47, 95%CI 1.24–4.93), those who perceived the need for dental treatment (PR = 2.93, 95%CI 1.67–5.14), and those who had untreated caries (PR = 1.93, 95%CI 1.07–3.47). Those with a low SOC had a twofold higher prevalence of impact on OHRQoL (PR = 2.19, 95%CI 1.29–3.71). This impact on OHRQoL was associated with a low SOC, even after adjusted by socioeconomic, behavioral and clinical factors. Future studies should consider the SOC in determining the oral health impact on quality of life.

RESUMO Objetivo: Analisar a distribuição espacial dos dentes cariados e restaurados em adultos segundo o Índice de Exclusão Social (IEX) e a proximidade de serviço odontológico público. Metodologia: Este estudo ecológico utilizou-se de dados secundários de um levantamento epidemiológico de saúde bucal e do Instituto de Pesquisa e Planejamento de Piracicaba (IPPLAP). Os exames bucais do índice de dentes permanentes cariado perdidos e obturados (CPOD) examinou em domicílios por um único examinador calibrado em 2011, por amostragem probabilística, 248 adultos (20 a 64 anos) representativos dos residentes em Piracicaba-SP, Brasil. Os dados sobre exclusão social e as unidades de saúde com serviço odontológico foram extraídos do IPPLAP. Realizou-se o georreferenciamento dos setores censitários sorteados no levantamento epidemiológico e seus respectivos bairros, além das unidades de saúde com serviço odontológico em um raio de 500m e 1000m. Foi realizada a análise de correlação de Spearman (p<0.05). Resultados: O menor valor do IEX, ou seja, maior exclusão social, não apresentou correlação com dentes cariados (p=0,09), mas teve correlação positiva forte com dentes restaurados (r=0,79; p<0,0001). A presença de serviço odontológico público em proximidade de 500 e 1000m não apresentou correlação, respectivamente, com a média de dentes cariados (p=0,07 e p=0,58) e restaurados (p=0,26 e p=0,56). Conclusão: Apesar de não ser verificada correlação entre cárie e exclusão social em adultos, sua resolutividade, ou seja, os dentes restaurados apresentaram correlação com as desigualdades sociais. A presença de serviço odontológico público não apresentou correlação com os componentes de experiência de cárie avaliados nesse estudo.

ABSTRACT Objective To analyze the spatial distribution of decayed and restored teeth in adults according to the Social Exclusion Index (SEI) and the proximity of public dental service. Methods: This ecological study used secondary data from an epidemiological survey of oral health and from the Piracicaba Research and Planning Institute (IPPLAP). The oral examinations of the DMFT index examined in households by a single examiner calibrated in 2011, by probability sampling, 248 adults (aged 20 to 64 years) representing the residents in Piracicaba-SP, Brazil. Data on social exclusion and health units with dental service were extracted from IPPLAP. We performed georeferencing of the census tracts selected by draw in the epidemiological survey and their respective districts, in addition to the health units with dental service in a radius of 500 m and 1000 m. Spearman’s rank correlation coefficient was analyzed (p<0.05). Results: The smallest value of SEI, that is, the highest social exclusion, showed no correlation with decayed teeth (p=0.09), but had strong positive correlation with restored teeth (r=0.79; p<0.0001). Presence of public dental service in the vicinity of 500 m and 1,000 m showed no correlation, respectively, with the average number of decayed (p=0.07 and p=0.58) and restored (p=0.26 and p=0.56) teeth. Conclusion: Although the correlation between social exclusion and caries in adults was not observed, its case management, namely, the restored teeth, showed correlation with social inequalities. Presence of public dental service showed no correlation with components of caries experience evaluated in this study.

RESUMO OBJETIVO Avaliar os fatores associados à perda dentária em adultos a partir da posição e do número de dentes perdidos nos arcos dentários. MÉTODOS Estudo transversal, populacional, com adultos participantes do levantamento epidemiológico de saúde bucal de São Paulo em 2015. O desfecho do estudo foi a perda dentária, avaliada pela classificação proposta, a saber: I) perdeu até 12 dentes posteriores; II) perdeu até 12 dentes (incluindo dentes anteriores); e III) perdeu acima de 12 dentes. Realizou-se uma análise em quatro blocos, apoiada em um modelo teórico conceitual adaptado para perdas dentárias. Para a regressão logística multinominal, usou-se “indivíduos que não tenham perdido dentes por cárie ou doença periodontal” como referência (p < 0,05). RESULTADOS De 6.051 adultos avaliados, 25,3% (n = 1.530) foram classificados na categoria I, 32,7% (n = 1.977) na II, 9,4% (n = 568) na III e 1,9% (n = 117) eram desdentados totais. A menor renda e escolaridade, a percepção de necessidade de tratamento e última consulta motivada por rotina, dor ou extração foram associados à perda dentária, independentemente da classificação. A avaliação negativa do serviço odontológico esteve associada aos indivíduos que perderam até 12 dentes, tanto anteriores quanto posteriores. O sexo feminino e a presença de bolsa periodontal foram associados a perdas dentárias de até 12 dentes, incluindo anteriores, e acima de 12 dentes. A presença de cárie foi associada aos adultos que perderam até 12 dentes, incluindo dentes anteriores. CONCLUSÃO A classificação proposta permitiu a identificação de diferenças entre os fatores associados. Assim, fica evidente a necessidade de considerá-la em estudos futuros.

ABSTRACT OBJECTIVE To evaluate the factors associated with tooth loss in adults from the position and number of teeth lost in the dental arches. METHODS This is a cross-sectional, population-based study with adults participating in the epidemiological survey of oral health of São Paulo in 2015. The outcome of the study was tooth loss, assessed by the proposed classification, namely: I) lost up to 12 back teeth; II) lost up to 12 teeth (including front teeth); and III) lost more than 12 teeth. A four-block analysis was conducted, supported by a conceptual theoretical model adapted for tooth loss. For the multinomial logistic regression, “individuals who did not lose teeth due to caries or periodontal disease” was used as reference (p < 0.05). RESULTS Of 6,051 adults evaluated, 25.3% (n = 1,530) were classified in category I, 32.7% (n = 1,977) in II, 9.4% (n = 568) in III, and 1.9% (n = 117) were edentulous. Lower income and schooling, the perception of need for treatment and the last appointment motivated by routine, pain or extraction were associated with tooth loss, regardless of the classification. The negative evaluation of the dental service was associated with individuals who lost up to 12 teeth, both front and back. The presence of women and periodontal pocket were associated with tooth loss of up to 12 teeth, including front, and more than 12 teeth. Caries were associated with adults who lost up to 12 teeth, including front teeth. CONCLUSION The proposed classification allowed the identification of differences between the associated factors. Thus, the need to consider such classification in future studies is evident.

Abstract The objective of this study was to evaluate the association between social inequality indicators and oral health conditions in an adult population. This prospective cohort study assessed a probabilistic sampling of adults (aged 20–64 years) living in Piracicaba, São Paulo, Brazil. Oral examinations were performed in 2011 and 2015, conducted at home, and used the decay-missing-filled (DMFT) index of permanent teeth, the Community Periodontal Index (CPI), and the visible biofilm criterion. A questionnaire was administered to determine demographic and socioeconomic aspects and dental services used, and collect oral health-related quality of life (OHRQoL) data. Social inequality indicators were evaluated according to social class (high, middle or low) and type of dental service used (public, health insurance or private), and compared with oral health conditions (visible biofilm, DMFT and incidence of tooth loss, periodontal pockets and bleeding, and OHRQoL), evaluated between 2011 and 2015. Analysis using chi-squared or Fisher tests (p < 0.05) and Cochran’s Q test was conducted separately for each category analyzed between 2011 and 2015 (p < 0.05). A total of 143 adults who participated in an earlier study were examined after four years of follow-up. Although the occurrence of oral disease did not decrease over the study period (4 years), there was a reduction in inequality among lower social classes in regard to presence of tooth decay and oral health impact on self-perceived quality of life between 2011 and 2015 (p < 0.05). These results suggest that the Brazilian National Oral Health Policy has achieved its principles, especially that of greater equity.

RESUMO Objetivo: Avaliar a prevalência e a intensidade de odontalgia em crianças segundo porte populacional do município, fatores associados e absenteísmo. Métodos: A amostra constituiu-se de crianças de 12 anos provenientes de escolas públicas e privadas, sorteadas em oito cidades da região de Campinas (SP). Foi aplicado um questionário com dados de odontalgia, demográficos, socioeconômicos bem como foi realizado exame clínico para avaliar a experiência de cárie. Ter dor foi o desfecho para análise de regressão logística e a intensidade da dor para a regressão log-binomial negativa. Adotou-se nível de significância de 5%. Resultados: A amostra foi constituída de 1.233 crianças, sendo que 16,7% relataram dor nos últimos seis meses. A odontalgia foi causa de 46,4% do absenteísmo escolar nesse período. A prevalência de dor foi menor entre os de alta renda familiar (p=0,023) e maior entre não brancos (p=0,027). A intensidade da dor foi menor nos municípios de médio (p=0,02) e pequeno porte (p=0,004) e maior nas crianças cujos pais tinham menor nível de escolaridade (p=0,003), que procuraram o dentista por dor (p=0,04) e que apresentavam cárie não tratada (p=0,04). Conclusões: A prevalência e a intensidade da dor de dente em crianças de 12 anos estão relacionadas com aspectos socioeconômicos da família, como baixa renda e menor escolaridade dos pais, e causam impacto na atividade diária por meio do absenteísmo escolar. A intensidade foi menor em municípios de médio e pequeno porte. Estratégias de promoção de saúde bucal nessa faixa etária devem ser estimuladas para evitar a odontalgia.

ABSTRACT Objective: The aim of this study was to evaluate the prevalence and intensity of dental pain in children according to size of municipality, associated factors and absenteeism. Methods: The sample consisted of children aged 12 years old from public and private schools drawn from eight cities in the region of Campinas (SP). A questionnaire was applied to obtain dental pain, demographic, socioeconomic data, and a clinical examination was carried out to evaluate the experience of having a cavity. The outcome for the logistic regression analysis was having pain and the outcome for the negative log-binomial regression was the intensity of pain. The significance level was 5%. Results: The sample consisted of 1,233 children, and 16.7% reported pain in the last six months. Dental pain was the cause of 46.4% of school absenteeism during this period. The prevalence of pain was lower among households with high income (p=0.023) and higher among nonwhites (p=0.027). Pain intensity was lower in medium-sized cities (p=0.02) and small cities (p=0.004), and higher in children whose parents had a lower educational level (p=0.003), children who sought out a dentist for the pain (p=0.04) and who had untreated cavities (p=0.04). Conclusions: The prevalence and intensity of dental pain in children aged under 12 are related to socioeconomic aspects of the family, such as low-income and parents with a low level of education, which impact daily activities as seen through school absenteeism. Pain intensity was lower in medium and small cities. Oral health promotion strategies in this age group should be encouraged to avoid dental pain.

Resumo O presente estudo caracterizou a condição de saúde bucal e os principais motivos autorrelatados da extração dentária em uma população de adultos. Estudo transversal que examinou 248 adultos de 20-64 anos, representativos da população de Piracicaba (SP). O exame bucal domiciliar utilizou os índices CPOD, CPI, uso e necessidade de prótese dentária segundo critérios da OMS e presença de biofilme visível. Foram coletados dados demográficos, socioeconômicos e motivos da extração dentária por meio de questionário. A análise descritiva foi estratificada pela idade em 20-44 e 45-64 anos. O CPOD médio foi 20,37, P = 3,34 nos adultos jovens e P = 13,41 nos mais velhos. Bolsa periodontal (CPI ≥ 3) foi encontrada em 20,5% dos adultos jovens e 53,0% dos mais velhos. Enquanto 38,8% usavam prótese superior, 46,7% necessitavam de prótese inferior. A dor foi o motivo autorrelatado mais prevalente para realização da extração dentária, sendo esta escolha principalmente pela falta de outra opção de tratamento e no serviço privado. Conclui-se que os adultos jovens (20-44 anos) apresentaram menos dentes perdidos e doença periodontal, uso e necessidade de prótese. Dor e falta de opção de outros tratamentos foram os principais motivos autorrelatados para realização das extrações dentárias.

Abstract The study characterized the oral health condition and main self-reported reasons for tooth extraction in an adult population. The cross-sectional study examined 248 adults aged 20-64 years, representative of the population of Piracicaba, São Paulo, Brazil. The oral examination conducted in households used the DMFT and CPI indexes, use and necessity of prosthodontics according to the WHO criteria and the presence of visible biofilm. Demographic and socioeconomic data were collected along with reasons for tooth extraction through a questionnaire. Descriptive analysis was stratified by age in groups: 20-44 and 45-64 years old. The average DMFT was 20.37 (EP = 0.50), P = 3.34 (EP = 0.33) for young adults and P = 13.41 (EP = 1.45) for the older adults. Gingival pockets (CPI ≥ 3) were found on 20.5% of young adults and 53.0% of the older ones. While 38.8% used upper prosthesis, 46.7% needed lower prosthesis. Pain was the most prevalent self-reported reason for tooth extraction (37.5%), being this choice primarily because of lack of another treatment option (52%) and done in the private sector (47.2%). We concluded that young adults (20-44 years old) showed less missing teeth, periodontal diseases, and need for prosthetic use. Pain and lack of options of other treatments were the main self-reported reasons for performing tooth extractions.

Resumo O presente estudo caracterizou a condição de saúde bucal e os principais motivos autorrelatados da extração dentária em uma população de adultos. Estudo transversal que examinou 248 adultos de 20-64 anos, representativos da população de Piracicaba (SP). O exame bucal domiciliar utilizou os índices CPOD, CPI, uso e necessidade de prótese dentária segundo critérios da OMS e presença de biofilme visível. Foram coletados dados demográficos, socioeconômicos e motivos da extração dentária por meio de questionário. A análise descritiva foi estratificada pela idade em 20-44 e 45-64 anos. O CPOD médio foi 20,37, P = 3,34 nos adultos jovens e P = 13,41 nos mais velhos. Bolsa periodontal (CPI ≥ 3) foi encontrada em 20,5% dos adultos jovens e 53,0% dos mais velhos. Enquanto 38,8% usavam prótese superior, 46,7% necessitavam de prótese inferior. A dor foi o motivo autorrelatado mais prevalente para realização da extração dentária, sendo esta escolha principalmente pela falta de outra opção de tratamento e no serviço privado. Conclui-se que os adultos jovens (20-44 anos) apresentaram menos dentes perdidos e doença periodontal, uso e necessidade de prótese. Dor e falta de opção de outros tratamentos foram os principais motivos autorrelatados para realização das extrações dentárias.

Abstract The study characterized the oral health condition and main self-reported reasons for tooth extraction in an adult population. The cross-sectional study examined 248 adults aged 20-64 years, representative of the population of Piracicaba, São Paulo, Brazil. The oral examination conducted in households used the DMFT and CPI indexes, use and necessity of prosthodontics according to the WHO criteria and the presence of visible biofilm. Demographic and socioeconomic data were collected along with reasons for tooth extraction through a questionnaire. Descriptive analysis was stratified by age in groups: 20-44 and 45-64 years old. The average DMFT was 20.37 (EP = 0.50), P = 3.34 (EP = 0.33) for young adults and P = 13.41 (EP = 1.45) for the older adults. Gingival pockets (CPI ≥ 3) were found on 20.5% of young adults and 53.0% of the older ones. While 38.8% used upper prosthesis, 46.7% needed lower prosthesis. Pain was the most prevalent self-reported reason for tooth extraction (37.5%), being this choice primarily because of lack of another treatment option (52%) and done in the private sector (47.2%). We concluded that young adults (20-44 years old) showed less missing teeth, periodontal diseases, and need for prosthetic use. Pain and lack of options of other treatments were the main self-reported reasons for performing tooth extractions.