Influência da experiência odontológica negativa na infância e do conhecimento em saúde bucal no medo odontológico na idade adulta

Abstract

The objectives of the present study were to investigate the association between negative dental experience in childhood and high dental fear among undergraduates of the Universidade Federal de Minas Gerais (UFMG), Brazil, and to evaluate the effect of oral health education on dental fear among dental students after five years of university study. The study is divided into two manuscripts. The first manuscript describes a case-control study, nested to a cross-sectional study, whose participantswere dentistry, psychology and mathematics undergraduate students. The second manuscript describes a 5-year longitudinal study of dental students. The present study was approved by the Human Research Ethics Committee of UFMG (COEP / UFMG) under protocol number # 0201.0.203.000-10. The instruments used for data collection were the Dental Fear Survey (DFS) and a self-reported questionnaire about previous dental experiences. The outcome variable for both manuscripts was dental fear. In the first manuscript, the students were allocated into two dental fear groups, and matched for gender, undergraduate course and sociodemographic condition (1 case group: 4 controls). The case group included students with high fear (n = 65) and the control group included those with low fear (n = 260), as defined by cluster analysis. The second manuscript included 48 dental students who responded to the same instruments at the beginning of the course in 2010 and at the end of the course in 2015. Statistical analysis of the case-control study included descriptive analysis, bivariate and multivariate conditional logistic regression with a 5% significance level. The Wilcoxon test and the Chi-square McNemars test with a 5% significance level were used in the longitudinal study. The case-control study showed that students with a greater chance of presenting high dental fear reported a negative dental experience in childhood (OR = 2.97; 95% CI: 1.44 - 6.14), having experienced toothache the last 12 months (OR = 11.31; 95% CI: 4.79 - 26.68), discomfort during dental treatment (OR = 5.36; 95% CI: 2.53 - 11.36) and poor oral health self-assessmet (OR = 3.62; 95% CI: 1.61- 8.11). The longitudinal study found that there was a reduction in visits to the dentist per year among dental students by the end of the course (p = 0.012). The mean total DFS scores were similar at both the beginning of the course (31.7 ± 9.3) and the end of the course (29.6 ± 6.6) (p =0.318). At the end of the course dental students had lower mean scores for the DFS structural factor of "fear of specific situations and dental treatment stimuli" (12.3 ± 3.5) than when they started the course (14.0 ± 5 4) (p = 0.042). It was concluded that negative dental experiences in childhood influence high dental fear among undergraduates, even in the presence of other factors. The curricular pathway in dentistry course decreased fear of specific dental treatment stimuli, but did not contribute to the reduction of general dental fear levels. Dental schools should emphasize the study of human behavior to the understanding of dental fear.