Universidade Federal da Paraíba - UFPB, Postgraduate Program in Dentistry, João Pessoa, PB, Brazil.
Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Social Dentistry, Piracicaba, SP, Brazil.
Braz Oral Res. 2020 Feb 7;34:e010. doi: 10.1590/1807-3107bor-2020.vol34.0010. eCollection 2020.
Relevant public policies in oral health have been implemented in Brazil since 2004. Changes in the epidemiological status of dental caries are expected, mainly in the child population. This study aimed to assess the dental caries experience and associated factors among 12-year-old children in the state of São Paulo, Brazil. A cross-sectional population-based study was conducted with data obtained from 415 cities, including a total of 26,325 schoolchildren who were included by the double-stage cluster technique, by lot and by systematic sampling. The statistical model included data from the São Paulo Oral Health Survey (SBSP 2015), the Human Development Index (HDI) and the Social Vulnerability Index (SVI). A theoretical-conceptual model categorized the variables into three blocks, namely, contextual (HDI, SVI, region of residence and fluoridation of water), individual (sex and ethnicity) and periodontal conditions (gingival bleeding, dental calculus and the presence of periodontal pockets), for association with the experience of caries (DMFT). Statistically significant associations were verified by hierarchical multivariate logistic (L) and Poisson (P) regression analyses (p < 0.05). The results showed that 57.7% of 12-year-old children had caries experience. Factors that determined a greater prevalence of dental caries in both models were nonwhite ethnicity (ORL = 1.113, ORP = 1.154) and the presence of gingival bleeding (ORL = 1.204, ORP = 1.255). Male children (ORL = 0.920 ORP = 0.859) and higher HDI (ORL = 0.022), ORP = 0.040) were associated with a lower prevalence of dental caries experience. Water fluoridation was associated with a lower DMFT index (ORP = 0.766). Dental caries experience is still associated with social inequalities at different levels. Policymakers should direct interventions towards reducing inequalities and the prevalence of dental caries among 12-year-old children.
自 2004 年以来，巴西一直在实施相关的口腔健康公共政策。预计龋齿的流行病学状况将发生变化，主要是在儿童人群中。本研究旨在评估巴西圣保罗州 12 岁儿童的龋齿患病情况及相关因素。本研究是一项基于人群的横断面研究，数据来自 415 个城市，共纳入了 26325 名采用两阶段聚类技术、随机抽样和系统抽样的学龄儿童。统计模型纳入了圣保罗口腔健康调查（SBSP 2015）、人类发展指数（HDI）和社会脆弱性指数（SVI）的数据。理论概念模型将变量分为三个模块，即背景（HDI、SVI、居住地和水的氟化）、个体（性别和种族）和牙周状况（牙龈出血、牙石和牙周袋的存在），与龋齿（DMFT）患病情况相关。采用分层多变量逻辑（L）和泊松（P）回归分析（p<0.05）验证了统计学意义上的关联。结果显示，57.7%的 12 岁儿童有龋齿患病情况。在两个模型中，决定龋齿更高患病率的因素是非白色人种（ORL=1.113，ORP=1.154）和牙龈出血的存在（ORL=1.204，ORP=1.255）。男孩（ORL=0.920，ORP=0.859）和更高的 HDI（ORL=0.022，ORP=0.040）与龋齿患病情况较低相关。水的氟化与较低的 DMFT 指数（ORP=0.766）相关。龋齿患病情况仍与不同层次的社会不平等相关。决策者应将干预措施的重点放在减少不平等和降低 12 岁儿童的龋齿患病率上。
