Oral Health-Related Quality of Life and Traumatic Dental Injuries in Young Permanent Incisors in Brazilian Schoolchildren: A Multilevel Approach

<div><p>Background</p><p>Traumatic dental injury (TDI) during childhood may negatively impact the quality of life of children.</p><p>Objective</p><p>To describe the association of oral health-related quality of life (OHRQoL) and domains (oral symptons, functional limitation, emotional- and social-well-being) of children with individual and contextual variables.</p><p>Methods</p><p>A cross-sectional study was performed using a representative sample of 1,201 schoolchildren, 8–10 years-old, from public and private schools of Belo Horizonte, Brazil. The CPQ_8–10 was used to assess OHRQoL, dichotomized in low and high impact. Sociodemographic information was collected through questionnaires to parents. Children were examined at schools, using the Andreasen criteria. Individual variables were gender, age, number of residents in home, parents/caregivers’ level of education, family income, and TDI (dichotomized into without trauma/mild trauma and severe trauma). Dental caries and malocclusion were considered co-variables. Contextual variables were the Social Vulnerability Index and type of school. Ethical approval and consent forms were obtained. Data were analyzed using SPSS for Windows 19.0 and HLM 6.06, including frequency distribution, chi-squared test and multilevel approach (p < 0.05).</p><p>Results</p><p>The prevalence of a negative impact on OHRQoL in children with severe trauma was 55.9%. The TDI negatively impacted emotional and social domains of OHRQoL. A multilevel analysis revealed a significant difference in OHRQoL according to the type of school and showed that 16% of the total variance was due to contextual characteristics (p < 0.001; ICC = 0.16). The negative impact on OHRQoL was higher in girls (p = 0.009), younger children (p = 0.023), with severe TDI (p = 0.014), those from public schools (p = 0.017) and whose parents had a lower education level (p = 0.001).</p><p>Conclusion</p><p>Severe trauma impacts OHRQoL on emotional and social domains. Contextual dimensions add information to individual variability to explain higher impact, emphasizing socioeconomic inequalities.</p></div

Explanatory variables: individual and contextual variables.

<p>Explanatory variables: individual and contextual variables.</p

Bivariate multilevel models for individual and contextual variables associated with OHRQoL in children (n = 1,156): Belo Horizonte, 2010.

<p>Bivariate multilevel models for individual and contextual variables associated with OHRQoL in children (n = 1,156): Belo Horizonte, 2010.</p

Final estimation of variance components in the multilevel analysis (“null-model”).

<p>^aIntraclass correlation coefficient (ICC): fraction of the total variance that is due to the contextual level</p><p>Final estimation of variance components in the multilevel analysis (“null-model”).</p

Final multilevel model for individual and contextual variables associated with impact on domains OS, FL, EWB, SWB of OHRQoL in children (n = 1,156): Belo Horizonte, 2010.

<p>Final multilevel model for individual and contextual variables associated with impact on domains OS, FL, EWB, SWB of OHRQoL in children (n = 1,156): Belo Horizonte, 2010.</p

Frequency distribution of sample (n = 1,201) according to variables: Belo Horizonte, 2010.

<p>Some data is missing for a number of variables. Dental caries: n = 1,200; Residents in home: n = 1,184; Family income: n = 1,189; Parents/caregivers’ level of education: n = 1,197</p><p>Frequency distribution of sample (n = 1,201) according to variables: Belo Horizonte, 2010.</p

Bivariate analyses of individual and contextual variables associated with impact on OHRQoL in children (n = 1,201): Belo Horizonte, 2010.

<p>^a Chi-squared test</p><p>^b Mann-Whitney</p><p>OR, Odds Ratio; CI, Confidence Interval</p><p>Bivariate analyses of individual and contextual variables associated with impact on OHRQoL in children (n = 1,201): Belo Horizonte, 2010.</p