The aim of this study was to determine whether a high degree of dental caries severity is associated with the distal and proximal determinants of caries in a group of Brazilian adults aged 35 to 44 years. A population-based case-control study was conducted using two groups—a case group with high caries severity (DMFT ≥ 14) and a control group without high caries severity (DMFT < 14). The sample comprised adults from metropolitan Belo Horizonte, Brazil (180 cases and 180 controls matched for gender and age). The exam was performed by calibrated dentists using the DMFT index. The statistical analysis used the Mann-Whitney test and bivariate and multivariate logistic regression (the conditional backward stepwise method). The mean DMFT was 8.4 ± 3.9 in the control group and 20.1 ± 4.5 in the case group. High caries severity was associated with regular visits to the dentist, low income, use of private/supplementary dental service and not petitioning the authorities for community benefits. The results of the study underscore the importance of considering distal and proximal factors in the assessment of the severity of dental caries. Greater caries severity persists among low-income families and among groups with a low degree of social cohesion.
References
[1]
Kelsey, J.L.; Whittemore, A.S.; Evans, A.S.; Thompson, W.D. Methods in Observacional Epidemiology, 2nd ed.; Oxford University Press: New York, NY, USA, 1996.
[2]
Greenland, S. Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies. Am. J. Epidemiol. 2004, 160, 301–305, doi:10.1093/aje/kwh221.
[3]
Petersen, P.E. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century—The approach of the WHO Global Oral Health Programme. Community Dent. Oral Epidemiol. 2003, 31 (Suppl.1), 3–24, doi:10.1046/j..2003.com122.x.
[4]
Petersen, P.E. Sociobehavioural risk factors in dental caries—International perspectives. Community Dent. Oral Epidemiol. 2005, 33, 274–279, doi:10.1111/j.1600-0528.2005.00235.x.
[5]
Costa, S.M.; Martins, C.C.; Bonfim, M.L.C.; Zina, L.G.; Paiva, S.M.; Pordeus, I.A.; Abreu, M.H.N.G. A systematic review of socioeconomic indicators and dental caries in adults. Int. J. Environ. Res. Public Health 2012, 9, 3540–3574, doi:10.3390/ijerph9103540.
[6]
Costa, S.M.; Vasconcelos, M.; Haddad, J.P.; Abreu, M.H. The severity of dental caries in adults aged 35 to 44 years residing in the metropolitan area of a large city in Brazil: A cross-sectional study. BMC Oral Health 2012, 12, 25, doi:10.1186/1472-6831-12-25.
[7]
Brazilian Institute of Geography and Statistics. IBGE 2010. Available online: www.ibge.gov.br/cidadesat/topwindow.htm?1 (accessed on 20 August 2011).
[8]
Petersen, P.E.; Bourgeois, D.; Ogawa, H.; Day-Estupinan, S.; Ndiaye, C. The global burden of diseases and risk to oral health. Bull. WHO 2005, 83, 661–669.
[9]
Oral Health Surveys: Basic Methods, 4th; World Health Organization: Geneva, Switzerland, 1997.
[10]
Fleck, M.P.A.; Louzada, S.; Xavier, M.; Chachamovich, E.; Vieira, G.; Santos, L.; Pinzon, V. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev. Saude Publica 2000, 34, 178–183, doi:10.1590/S0034-89102000000200012.
[11]
Grootaert, C.; Narayan, D.; Jones, V.N.; Woolcock, M. Questionário Integrado para Medir Capital Social (QI-MCS); Banco Mundial: Washington, DC, USA, 2003.
[12]
Condi??es de saúde bucal da popula??o brasileira: 2002–2003: Resultados principais; Ministry of Health: Brasília, Brazil, 2004.
[13]
Griep, R.H.; Chor, D.; Faerstein, E.; Lopes, C. Test-retest reliability of measures of social network in the “Pró-Saúde” Study. Rev .Saúde Publica 2003, 37, 379–385, doi:10.1590/S0034-89102003000300018.
[14]
Hosmer, D.W.; Lemeshow, S. Applied Logistic Regression; Wiley: New York, NY, USA, 1989.
[15]
Maldonado, G.; Greenland, S. Simulation study of confounder-selection strategies. Amer. J. Epidemiol 1983, 138, 923–936.
[16]
Petry, P.C.; Victora, C.G.; Santos, I.S. Adults free of caries: A case-control study about wareness/consciousness, attitudes and preventive practices. Cad. Saúde Pública 2000, 16, 145–153, doi:10.1590/S0102-311X2000000100015.
Busato, I.M.S.; Gabardo, M.C.L.; Fran?a, B.H.S.; Moysés, S.J.; Moysés, S.T. Evaluation of the perception of the oral health teams of the municipal health department of Curitiba, Paraná State, regarding atraumatic restorative treatment (ART). Cienc Saude Colet 2011, 16 (Suppl.1), 1017–1022.
[19]
Elderton, R.J. Changing the course of dental education to meet future requirements. J. Can. Dent. Assoc. 1997, 63, 633–639.
[20]
Skudutyte-Rysstad, R.; Sandvik, L.; Aleksejuniene, J.; Eriksen, H.M. Dental health and disease determinants among 35-year-old in Oslo, Norway. Acta Odontol. Scand. 2009, 67, 50–56, doi:10.1080/00016350802572322.
[21]
Geyer, S.; Schneller, T.; Micheelis, W. Social gradients and cumulative effects of income and education on dental health in the Fourth German Oral Health Study. Community Dent. Oral Epidemiol. 2010, 38, 120–128, doi:10.1111/j.1600-0528.2009.00520.x.
[22]
Gilbert, G.H.; Duncan, R.P.; Dolan, T.A.; Foerster, U. Twenty-four month incidence of root caries among a diverse group of adults. Caries Res. 2001, 35, 366–375, doi:10.1159/000047476.
[23]
Bernabe, E.; Sheiham, A.; Sabbah, W. Income, income inequality, dental caries and dental care levels: An ecological study in rich countries. Caries Res. 2009, 43, 294–301, doi:10.1159/000217862.
[24]
Pattussi, M.P.; Hardy, R.; Sheiham, A. The potential impact of neighborhood empowerment on dental caries among adolescents. Community Dent. Oral Epidemiol. 2006, 34, 344–350, doi:10.1111/j.1600-0528.2006.00283.x.
[25]
Provides for Community Participation in the Management of the Unified Health System and on Intergovernmental Transfers of Financial Resources in the Health and Other Measures, Official Gazette, Brasília, Brazil, 1990.
[26]
Bastos, F.A.; Santos, E.; Tovo, M.F. Social capital and the National Health System (SUS) in Brazil. Saude Soc. 2009, 18, 177–188.
[27]
Bower, E.; Gulliford, M.; Eteele, J.; Newton, T. Area deprivation and oral health in Scottish adults: a multilevel study. Community Dent. Oral Epidemiol. 2007, 35, 118–129, doi:10.1111/j.1600-0528.2007.00308.x.
[28]
Aida, J.; Ando, Y.; Oosaka, M.; Niimi, K.; Morita, M. Contributions of social context to inequality in dental caries: A multilevel analysis of Japanese 3-year-old children. Community Dent. Oral Epidemiol. 2008, 36, 149–156, doi:10.1111/j.1600-0528.2007.00380.x.
[29]
Ismail, A.I.; Sohn, W.; Tellez, M.; Amaya, A.; Sen, A.; Hasson, H.; Pitts, N.B. The system for measuring dental caries. Community Dent. Oral Epidemiol. 2007, 35, 170–178, doi:10.1111/j.1600-0528.2007.00347.x.
[30]
Lukacs, J.R. Sex differences in dental caries experience: Clinical evidence, complex etiology. Clin. Oral Invest. 2011, 15, 649–656, doi:10.1007/s00784-010-0445-3.