Relationship between oral health conditions and quality of life in elderly with different fragility levels

Orientador: Maria da Luz Rosario de SousaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Tendo em vista a escassez de trabalhos que avaliem as condições bucais relacionadas à qualidade de vida em idosos com diferentes níveis de fragilidade, os objetivos deste estudo foram: Avaliar as condições de saúde bucal em uma população idosa não institucionalizada que apresentava diferentes graus de fragilidade (capítulo 1); apresentar a prevalência de xerostomia e sua associação com variáveis sócio-demográficas, clínicas e de autopercepção em saúde bucal (capítulo 2); verificar a autopercepção sobre as condições de saúde bucal em idosos, segundo a fragilidade (capítulo 3); verificar o impacto das condições bucais na qualidade de vida em idosos com diferentes níveis de fragilidade (capítulo 4). Este trabalho é parte integrante de um projeto temático e multidisciplinar: "Qualidade de vida em idosos fragilizados: indicadores de saúde e bem estar subjetivo", realizado em freqüentadores de um ambulatório de geriatria. Foram realizados um exame bucal segundo recomendações da Organização Mundial de Saúde (OMS, 1997) e uma entrevista com questões relativas à: sua autopercepção de saúde bucal, a sensação de boca seca e Geriatric Oral Health Assessment Índex (GOHAI). A avaliação da fragilidade foi feita após a aplicação de 5 critérios clínicos propostos por Fried et al. (2001). Os idosos fragilizados foram divididos em: pré-frágeis e frágeis. A análise dos dados foi realizada através do programa SPSS 17. No capítulo 1(n=67) obtiveram-se como resultados que 61,2% (n=41) dos examinados eram edêntulos; a média de dentes presentes foi de 4,8 (DP=7,5) e o CPOD de 28,8 (DP=5,1), sendo a maior parte do índice composta pelo componente perdido (94,4%). 50,7% (n=34) foram considerados pré-frágeis e 49,3% (n=33), frágeis. Quando as variáveis odontológicas foram comparadas com a condição de fragilidade, todas foram melhores nos indivíduos pré-frágeis. No capítulo 2 (n=150), a prevalência de xerosotmia foi de 68%. Verificou-se que os idosos considerados não brancos apresentaram menos sensação de boca seca (p=0,017/RP=0,68 [IC95%=0,49-0,93]). Dentre os idosos frágeis, quem era analfabeto tinha mais xerostomia (p=0,03/RP=1,31 [IC95%=1,02-1,68]). No capítulo 3 (n=57), para as variáveis clínicas em que a autopercepção foi comparada entre os diferentes níveis de fragilidade, apenas para os que apresentavam necessidade de qualquer tipo de prótese observou- se que os pré-frágeis classificaram sua saúde bucal de forma negativa. No capítulo 4 (n=66), nos indivíduos que obtiveram uma autopercepção da sua saúde bucal negativa, apenas a média de dentes presentes foi menor entre os indivíduos frágeis. Pode-se concluir que, apesar deste grupo de idosos apresentar condições de saúde bucal precárias, com extensas perdas dentárias e alta prevalência de xerostomia, não foi verificada relação entre a condição de fragilidade e autopercepção de saúde bucal. Considera-se que outras condições sistêmicas de maior impacto no cotidiano destes idosos tiveram um peso maior que as condições bucais na sua autopercepção e, para reverter esta realidade, torna-se necessário o direcionamento de programas odontológicos específicos para adultos, voltados para promoção de saúde e controle da cárie e doença periodontal, evitando-se assim a perda dos elementos dentários em idosos, o que consequentemente melhorará sua ualidade de vida.Abstract: Given the scarcity of studies to assess the oral health conditions related to quality of life in elderly people with different frailty levels, the objectives of this study were: to evaluate the oral health conditions in a non-institutionalized elderly population with different frailty levels (Chapter 1), to present the xerostomy prevalence and its association with socio-demographic and clinical variables, as well as the self-perceived oral health (Chapter 2); to verify the self-perception on the oral health conditions in elderly people, compared with the frailty level (Chapter 3) and to verify oral health-related quality of life impact elderly people with different frailty levels (Chapter 4). This work is part of a thematic and multidisciplinary project: "Quality of life in frail elders: health indicators and subjective well-being". Non-institutionalized elderly aged 60 or more that presented different frailty levels were examined, being attended at the geriatric clinic of the State University of Campinas (UNICAMP). An oral examination following the recommendations from WHO (1997) was carried out, as well as an interview with questions relating to: self-perceived oral health, dry mouth sensation and GOHAI. The frailty condition evaluation was made after the application of 5 clinical criteria proposed by Fried et al. (2001). The frail elders were divided into two groups: pre-frail and frail. Data analysis was performed using SPSS 17. Chapter 1 shows that 61.2% (n=41) of those examined were edentulous; the mean of present teeth was 4.8 (SD=7.5) and DMFT of 28.8 (SD=5.1), and most of the index was composed of the lost component (94.4%). 50.7% (n=34) were considered pre-frail and 49.3% (n=33), frail. When dental variables were compared with the frailty condition, all were better in pre-frail individuals. In Chapter 2, it was found that older people considered as non-white were less likely to experience dry mouth (p=0.017/RP=0.68 [IC95%=0.49-0.93]). Among the frail elderly, who were illiterate had more dry mouth (p=0.03/RP=1.31 [IC95%=1.02-1.68]). In chapter 3, for the clinical variables in which the self-perception was compared between the different frailty levels, only for those who had need of any type of prosthesis it was observed that pre-frails rated their oral health in a negative way. In Chapter 4, in individuals who have obtained a negative self-perception of their oral health, only the mean present teeth was worse among frail individuals. It could be concluded that although this group of elderly people presented poor oral health conditions, with extensive tooth loss and high dry mouth prevalence, no relationship was found between the frailty and selfperceived oral health. It was considered that other systemic conditions of greater impact on the daily life of these elderly individuals had a greater weight than the oral self-perceived oral conditions, and to reverse this situation, it is necessary targeting dental programs specific for adults aimed at promoting health and control of dental caries and periodontal disease, thus avoiding the loss of teeth in the elderly, which in turn will improve their quality of life.DoutoradoSaude ColetivaDoutor em Odontologi

Dental caries and tooth loss in adults in a Brazilian southeastern state

OBJECTIVE: The purpose of this study was to analyze dental caries experience of adults living in the southeastern state of São Paulo, Brazil, according to some socio-demographic conditions of this population. MATERIAL AND METHODS: The sample consisted of 1,159 school teachers and workers (35 to 44 years old) from 29 cities of the state of São Paulo, Brazil. RESULTS: 92.3% were dentate and the DMFT index (number of decayed, missing and filled teeth) was 21.0 and the mean number of decayed teeth was 1.1, with no significant difference among adults from regions with and without fluoridation. Male subjects presented the highest mean values of "D" (decayed teeth) and "M" (missing teeth) components. The percentage of caries-free subjects was higher among white subjects, as well as the mean number of teeth present in the mouth. The mean values of the "F" component (filled teeth) [9.81] and present teeth [19.3] were higher for adults from fluoridated water regions. CONCLUSIONS: In this study, the worse condition observed was the early tooth loss in all groups. In addition, people with worse socio-demographic conditions had worse oral health conditions. It is expected that oral health programs targeted to this population could be established with the goal of improving the oral health conditions of this population and hence the maintenance of the teeth for a longer period in function

Dental caries in an elderly population in Brazil

This study evaluated dental caries according to the presence of natural teeth and sociodemographic conditions of an elderly population in the state of São Paulo, Brazil. Examinations were performed according to the World Health Organization's guidelines. The sample of 1,192 elderly individuals aged 65 to 74 years was stratified according to the presence of teeth and the following variables: gender, race, age, city size and Human Development Index (HDI). The Mann Whitney and Kruskal Wallis tests were applied at a confidence level of 95% for analysis of results. In the total sample, 68.9% (n=822) were edentulous; the mean of present teeth was 3.5 and the DMFT was 30.2, being 28.5 of missing teeth. Among dentate individuals (n=370), the mean of present teeth was 11.3, the DMFT was 26.2 and the missing component accounted for 20.7 teeth. The differences observed in the evaluated conditions should be highlighted: the mean number of present teeth was higher among younger individuals (from 65 to 69 years) [12.1] and among those living in cities with high HDI [12.9]; the DMFT was lower among men [24.9] and non-Caucasians [25.1]. Based on these findings, it may be concluded that specific dental programs should be established, with emphasis on oral health promotion and dental caries control, as well as public health policies that may enhance the access to the services provided

Inequalities in distribution of dental caries in teenagers of Indaiatuba, São Paulo State, 2004

The objectives of this work was to know the dental caries prevalence and treatment need, besides the distribution of the dental caries in a population of 12 year-old teenagers with high incidence of dental caries. 309 adolescents of public schools of Indaiatuba, São Paulo State, in 2004, were examined. They were selected by process systematic random and the exams followed the World Health Organization criteria. The percentile of school caries free was of 38.8%. Among the adolescents examined, 36.6% (n=113) presented dental caries. DMFT was of 2.50 (IC95%=2.07-2.93). The decayed component was the highest (61.0%). The coefficient of Gini was 0.602 and SiC value was of 5.97 (IC95%=5.32-6.62); in this group especially, 74.7% (n=74) presented dental caries activity in the moment of the exam. Thus, it can be concluded that the adolescents of this city presented low dental caries experience; however, their needs were not assisted, once most of DMFT was formed of the decayed component at 12 years old. In the group SiC, it was verified that this came quite high, being recommended actions addressed to this specific group of adolescents.Os objetivos deste trabalho foram conhecer a prevalência da cárie dentária e a necessidade de tratamento odontológico, além da distribuição da cárie dentária na população que apresenta índices de cárie mais elevados em escolares de doze anos. Foram examinados 309 adolescentes, de escolas públicas de Indaiatuba (SP), em 2004, selecionados mediante processo amostral aleatório sistemático e os exames seguiram os critérios da Organização Mundial de Saúde. O percentual de escolares livres de cárie foi de 38,8%. Dentre os escolares examinados, 36,6% (n=113) apresentaram atividade de cárie. O CPOD foi de 2,50 (IC95%=2,07-2,93). O componente cariado foi o mais prevalente (61,0%). O coeficiente de Gini foi 0,602 e o valor do índice SiC foi de 5,97 (IC95%=5,32-6,62); neste grupo em especial, 74,7% (n=74) apresentaram atividade de cárie no momento do exame. Desta forma, pode-se concluir que os escolares deste município apresentaram baixa experiência de cárie; entretanto, não apresentaram suas necessidades atendidas, uma vez que a maior parte do CPOD era formada do componente cariado, aos doze anos de idade. No grupo SiC, verificou-se que este apresentou-se bastante elevado, sendo recomendadas ações direcionadas a este grupo específico de adolescentes.2173218

Oral health among preschool children in Brazil, 1999

OBJECTIVE: To assess dental decay, gum diseases and fluorosis prevalence and evaluate treatment needs of public preschool children. METHODS: A cross-sectional epidemiological survey on oral health was conducted in 2,805 public preschool children aged 5 and 6 years in Piracicaba, Brazil. Children were examined by a team of ten trained dentists. It was applied a consensus technique and intra and inter agreement among examiners was assessed using the percentage of agreement. RESULTS: Of the total, 44.3% children were free of dental decay at the age of 5 and 38.5% at the age of 6. The deciduous decay teeth index (dmf-t) was 2.64 at the age of 5 and 3.07 at the age of 6, and 31.9% and 37.9%, respectively, presented dmf-t greater than 3. The largest percent of treatment need (45.3%) was surface restoration. Regarding gum health, 68.6% and 72.6% of children aged 5 and 6 years presented gum bleeding. The prevalence of fluorosis was 2.6% at the age of 5 and 6.1% at the age of 6. CONCLUSIONS: It is necessary to develop appropriate actions and strategies for higher risk groups.OBJETIVO: Verificar a prevalência de cárie, doença gengival e fluorose e dimensionar as necessidades de tratamento dos pré-escolares. MÉTODOS: Estudo transversal realizado a partir de um levantamento epidemiológico de saúde bucal em 2.805 crianças de 5 e 6 anos, matriculadas em pré-escolas municipais de Piracicaba, SP. As crianças foram examinadas por uma equipe de dez dentistas, treinados e calibrados. Foi empregada a técnica de consenso, aferindo-se o erro intra e inter examinadores pelo cálculo de percentagem de concordância. RESULTADOS: Obteve-se 44,3% de crianças livres de cárie aos 5 anos e 38,5% aos 6 anos de idade. O índice de cárie para a dentição decídua (ceo-d) foi 2,64 aos cinco anos e 3,07 aos seis anos, sendo que 31,9% e 37,9%, respectivamente, apresentaram ceo-d maior que 3. O maior percentual de necessidade de tratamento (45,3%) foi a indicação de restauração de uma superfície dentária. Quanto à saúde gengival, 68,6% e 72,6% das crianças aos 5 e 6 anos apresentaram sangramento gengival. A prevalência de fluorose observada foi de 2,6% aos 5 e 6,1% aos 6 anos. CONCLUSÕES: Há necessidade da implementação de ações e estratégias adequadas aos grupos de maior risco.24725

[oral Health Among Preschool Children In Brazil, 1999].

To assess dental decay, gum diseases and fluorosis prevalence and evaluate treatment needs of public preschool children. A cross-sectional epidemiological survey on oral health was conducted in 2,805 public preschool children aged 5 and 6 years in Piracicaba, Brazil. Children were examined by a team of ten trained dentists. It was applied a consensus technique and intra and inter agreement among examiners was assessed using the percentage of agreement. Of the total, 44.3% children were free of dental decay at the age of 5 and 38.5% at the age of 6. The deciduous decay teeth index (dmf-t) was 2.64 at the age of 5 and 3.07 at the age of 6, and 31.9% and 37.9%, respectively, presented dmf-t greater than 3. The largest percent of treatment need (45.3%) was surface restoration. Regarding gum health, 68.6% and 72.6% of children aged 5 and 6 years presented gum bleeding. The prevalence of fluorosis was 2.6% at the age of 5 and 6.1% at the age of 6. It is necessary to develop appropriate actions and strategies for higher risk groups.37247-5

Saúde bucal dos pré-escolares, Piracicaba, Brasil, 1999

OBJECTIVE: To assess dental decay, gum diseases and fluorosis prevalence and evaluate treatment needs of public preschool children. METHODS: A cross-sectional epidemiological survey on oral health was conducted in 2,805 public preschool children aged 5 and 6 years in Piracicaba, Brazil. Children were examined by a team of ten trained dentists. It was applied a consensus technique and intra and inter agreement among examiners was assessed using the percentage of agreement. RESULTS: Of the total, 44.3% children were free of dental decay at the age of 5 and 38.5% at the age of 6. The deciduous decay teeth index (dmf-t) was 2.64 at the age of 5 and 3.07 at the age of 6, and 31.9% and 37.9%, respectively, presented dmf-t greater than 3. The largest percent of treatment need (45.3%) was surface restoration. Regarding gum health, 68.6% and 72.6% of children aged 5 and 6 years presented gum bleeding. The prevalence of fluorosis was 2.6% at the age of 5 and 6.1% at the age of 6. CONCLUSIONS: It is necessary to develop appropriate actions and strategies for higher risk groups.OBJETIVO: Verificar a prevalência de cárie, doença gengival e fluorose e dimensionar as necessidades de tratamento dos pré-escolares. MÉTODOS: Estudo transversal realizado a partir de um levantamento epidemiológico de saúde bucal em 2.805 crianças de 5 e 6 anos, matriculadas em pré-escolas municipais de Piracicaba, SP. As crianças foram examinadas por uma equipe de dez dentistas, treinados e calibrados. Foi empregada a técnica de consenso, aferindo-se o erro intra e inter examinadores pelo cálculo de percentagem de concordância. RESULTADOS: Obteve-se 44,3% de crianças livres de cárie aos 5 anos e 38,5% aos 6 anos de idade. O índice de cárie para a dentição decídua (ceo-d) foi 2,64 aos cinco anos e 3,07 aos seis anos, sendo que 31,9% e 37,9%, respectivamente, apresentaram ceo-d maior que 3. O maior percentual de necessidade de tratamento (45,3%) foi a indicação de restauração de uma superfície dentária. Quanto à saúde gengival, 68,6% e 72,6% das crianças aos 5 e 6 anos apresentaram sangramento gengival. A prevalência de fluorose observada foi de 2,6% aos 5 e 6,1% aos 6 anos. CONCLUSÕES: Há necessidade da implementação de ações e estratégias adequadas aos grupos de maior risco

Dental caries activity in adolescents of city with very low dental caries prevalence: Paulínia, São Paulo, 2004

Os objetivos deste trabalho foram verificar a atividade de cárie, além de conhecer a prevalência de cárie e fluorose e as necessidades de tratamento em escolares de 12 anos de idade do município de Paulínia. Foram examinadas 413 crianças, de escolas públicas e particulares de Paulínia, São Paulo, em 2004, selecionadas mediante processo amostral aleatório sistemático. Para medir a experiência de cárie, necessidades de tratamento e fluorose dentária adotou-se os critérios da OMS (1997). Para a atividade de cárie, optou-se por uma simplificação dos critérios de diagnóstico de Nyvad et al. (1999). Os índices utilizados para cárie dentária foram: CPOD e Significant Caries Index (SiC). Os livres de cárie representaram 60,8% dos escolares. O CPOD foi de 0,9 (IC95%=0,8-1,1). O maior componente do CPOD foi o obturado (52,3%) seguido pelo componente cariado (47,2%). Nas crianças que apresentaram atividade de cárie o CPOD foi de 1,37 (IC95%=1,1-1,7) e nas sem atividade de cárie o CPOD foi de 0,57 (IC95%=0,4-0,7) (pThe objectives of this work were to verify the caries activity and to know the caries and fluorosis prevalence among 12-year-old schoolboys and girls in the municipality of Paulinia. Four hundred and thirteen children from public and private schools selected by means of systematic random sampling process were investigated. In order to assess the caries experience, treatment necessities and dental flourosis, the WHO criteria were adopted (1997). For caries activity, the Nyvad et al. (1999) simplified diagnosis criteria were adopted. The indexes used for dental caries were: CPOD and Significant caries Index (SiC). Those free from caries represented 60.8% of students. The CPOD index was of 0.9 (IC95% = 0.8-1.1). The obturated component (52.3%) was the first for CPOD, followed by the decayed component (47.2%). In children presenting caries activity, the COPD was of 1.37 (IC95%=1.1-1.7) and in those without caries activity, the COPD was of 0.57 (IC95%=0.4-0.7) (

Dental caries activity in primary dentition, Indaiatuba, São Paulo, Brazil, 2004

This study aimed to verify caries activity and analyze caries experience, treatment needs, and enamel defects in 5-year-old preschool children in Indaiatuba, São Paulo State, Brazil. 624 children were selected by systematic random sampling in 2004. WHO criteria were used to measure caries experience and treatment needs. Nyvad et al. diagnostic criteria were used to analyze caries activity. Mann-Whitney and qui-square tests were used to analyze the results, with 5% significance. 40.5% of schoolchildren displayed caries activity. The dfmt was 1.62 (95%CI: 1.35-1.89). Among children with dfmt > 0, the index was 3.81 (95%CI: 3.36-4.26), and 91.4% of these children presented caries activity. Care Index was 12.3%. These results suggest that treatment measures and health promotion should continue to be prioritized, since the control measures and caries interruption during the initial stages are well known. Dental care should especially target schoolchildren with more significant caries experience.Os objetivos deste trabalho foram verificar a atividade de cárie, além de conhecer a experiência de cárie (ceod), necessidades de tratamento e defeitos de esmalte em pré-escolares de cinco anos de idade. Examinaram-se 624 crianças de Indaiatuba, São Paulo, Brasil, em 2004, selecionadas por meio de processo amostral aleatório sistemático. Para medir a experiência de cárie e necessidade de tratamento adotou-se os critérios da OMS. Para a atividade de cárie, optou-se por uma simplificação dos critérios de diagnóstico de Nyvad et al. Na análise estatística utilizaram-se os testes Mann Whitney e qui-quadrado com nível de significância de 5%. 40,5% dos pré-escolares apresentaram atividade de cárie. O ceod foi de 1,62 (IC95%: 1,35-1,89). Entre os doentes (ceod > 0) o ceod foi 3,81 (IC95%: 3,36-4,26), ainda neste grupo, 91,4% das crianças apresentaram atividade de cárie. O índice de cuidados foi de 12,3%. Sugere-se que medidas de prevenção e tratamento direcionadas a essa população continuem sendo priorizadas, uma vez que as medidas de controle e paralisação da cárie em seus estágios iniciais são bem conhecidas. Além disso, recomenda-se cuidado direcionado aos pré-escolares com maior experiência de cáries.59360