Traumatismo dentário em adolescentes de Santa Maria, RS

Abstract

The presente dissertation is composed of two manuscripts whose objetives were to assess the association between traumatic dental injuries (TDI) and oral health-related quality of life (OHRQoL) among 15-19-year-old adolescents from Santa Maria, Brazil (Article 1) and to investigate the association between city region and prevalence and severity of TDI as well as the region that clustered a higher number of environmental risk indicators as an attempt to explain the association found (Article 2). A population-based cross-sectional survey was carried out in 2018 and included a representative sample composed of 1,197 15-19-year-old adolescents. A structured questionnaire was sent to parents/legal guardians of the adolescents containing questions on demographic and socioeconomic characteristics. The OHIP-14 (Oral Health Impact Profile-14) was used to evaluate the OHRQoL. TDI was recorded based on the O’Brien classification. Environmental variables were obtained through official publications by the Brazilian Institute of Geography and Statistics (IBGE). In Article 1, the outcome were overall and domain-specific scores of OHIP-14 and the main predictor variable was TDI experience, dichotomized as present (at least one tooth with TDI index≥1), or absent (all teeth with TDI index=0). The outcomes of Article 2 were prevalence and severity of TDI and the main predictor variable was city region. Poisson regression models were used to assess the associations under investigation. The overall prevalence of TDI was 17% (n=203), being mild trauma 12% and severe trauma 5%. In the adjusted models, adolescents with TDI had a poorer OHRQoL than those without TDI (Rate Ratio[RR]=1.10; 95% Confidence Interval[CI]=1.05-1.16). This negative effect was related to the psychological disability domain (RR=1.16; 95%CI=1.02-1.32), to the social disability domain (RR=1.34; 95%CI=1.13-1.59), and to the handicap domain (RR=1.35; 95%CI=1.10-1.66). Article 2 included 1,146 adolescents and observed a prevalence of TDI of 25.3% in the southern region of the city, contrasting with a prevalence of 13.6% in the northern region. In the risk analysis, adolescents living in the southern region were more likely to have TDI than their counterparts living in the northern region (Prevalence Ratio[PR]=1.83, 95%CI=1.24-2.70). This association was consistently found in the severity analysis (mild trauma, PR=1.82, 95%CI=1.09-3.05; severe trauma, PR=2.25, 95%CI=1.02-4.93). Analyzing the number of environmental risk indicators in the different regions, the southern region presented a greater mean/median than all the other regions. Despite the low severity, TDI was associated with a poor OHRQoL in 15-19-year-old adolescents from Santa Maria, RS, Brazil. Therefore, even mild TDI should not be neglected in this population. To live in the southern region was associated with a greater prevalence and severity of TDI. Whereas this region clustered a greater number of environmental risk indicators, the findings of this survey show the role of the social environment in the epidemiology of TDI.