Traumatismo dentário em crianças de 8 a 10 anos de idade: fatores associados e impacto na qualidade de vida

Abstract

Traumatic dental injury in children 8-10 years of age: associated factors and impact on quality of life Traumatic dental injury (TDI) can negatively impact the quality of life- related to the oral health (OHRQoL) of children. A cross-sectional study was carried out to assess the prevalence of TD, associated factors and their impact on OHRQoL of children. This study will be presented by two scientific papers. A representative sample of1201 children, all between the ages of 8-10 years old, enrolled in public and private schools in the city of Belo Horizonte, Minas Gerais, were examined at the schools, according to the criteria of Andreasen et al. (2007), for two previously calibrated examiners (intra-examiner Kappa = 0.91 and 0.89 and Kappa inter-examiner = 0.85). To analyze the OHRQoL, CPQ8-10was applied to children, and their scores dichotomized by the technique of "two-step cluster" in low and high impact. The collection of demographic data was conducted through a questionnaire sent to parents. The following were considered as individual variables: gender, age, the number of residents in the household, parents/caregiverslevel of education, family income and TDI (categorized into: no trauma, with enamel fracture and severe trauma to the article 1 and, without trauma and / or enamel fracture and severe trauma to article 2). Dental caries and malocclusion were considered covariates. The type of school (public and private) was considered a contextual variable for article 1. For article 2, contextual variables were the Social Vulnerability Index and school type. The approval of the Research Ethics Committee in Human Beings and Terms of Consent were obtained (n. ETIC 0465.0.203.000-09). Data were analyzed using SPSS for Windows version 19.0 and HLM 6:06, using descriptive and bivariate analyzes for both articles, complemented by multinomial logistic analysis in article 1 and multilevel analysis in article 1 and 2, adopting p <0.05. The prevalence of TDI was 14%, with 2.8% considered severe trauma. In article 1, the multinomial logistic analysis revealed that severe trauma occurrence was statistically associated with male children (OR = 2.37; 95% CI: 1.15 to 4.87), with higher age (OR = 1 77; 95% CI: 1.01 to 2.87), lower income (OR = 2.79; 95% CI: 1.28 to 6.09) and increased overjet (OR = 2.59; 95% CI: 1.07 to 6.26). Enamel fracture was not significantly associated with any of the evaluated factors. The multilevel analysis showed no statistically significant difference between the type of school and the TDI (null-model p> 0.05). In article 2, multilevel analysis was needed (null-model p <0.001) revealing the influence of context on OHRQoL. Students from public schools (OR = 2.70; 95% CI: 1.22 to 5.94), girls (OR = 1.46; 95% CI: 1.10 to 1.92), younger children (OR = 0.81; 95% CI: .67-.97), whose parents had a lower education (OR = 1.72; 95% CI: 1.26 to 2.35) and with severe trauma (OR = 2.54; 95% CI: 1.21 to 5.31) showed greater negative impact on OHRQoL. The emotional and social areas of OHRQoL were significantly associated with female gender (OR = 1.60; 95% CI: 1.19 to 2.15; OR = 1.38; 95% CI: 1.01 to 1.89), whose parents had a lower education(OR = 1.70; 95% CI: 1.22 to 2.34; OR = 1.75; 95% CI: 1.24 to 2.46), severe trauma (OR = 2, 12; 95% CI: 1.01 to 4.43; OR = 2.18; 95% CI: 1.02 to 4.64) and public school (OR = 2.63; 95% CI: 1,37- 5.06; OR = 2.92; 95% CI: 1.10 to 7.79). It follows that the prevalence of TDI in this age group was relatively high when enamel fracture were included, compared to when only severe trauma was considered. Enamel fracture was not associated with any of the studied factors.It is suggested that, in researchs, the enamel fracture should be analyze separately or in the category of no TDI.The contextual dimensionadds information to the individual variability to explain the impact on OHRQoL, especially socioeconomic inequalities. The severe TDI impacts OHRQoL and their emotional and social domain in children 8-10 years of age, which should be considered in public health strategies.