OBJECTIVE:To assess the association between the prevalence of malocclusion in Brazilian 12 years-olds with individual and contextual variables.
METHODS:A cross-sectional, analytical study was conducted with data from the Brazilian Oral Health Survey -SBBrazil 2010. The outcome studied was malocclusion, categorized as absent, set, severe and very severe. The independent variables were classifi ed as individual and contextual. Data were analyzed using a multilevel model with a 5% signifi cance level.
RESULTS:It was found that the prevalence of severe and very severe malocclusion in 12-year-olds did not differ between the Brazilian regions, although variation between the cities was signifi cant (p < 0.001). Male children (p = 0.033), those on lower income (p = 0.051), those who had visited a dentist (p = 0.009), with lower levels of satisfaction with mouth and teeth (p < 0.001) and embarrassed to smile (p < 0.001) had more severe malocclusion. The characteristics of the cities also affected the severity of malocclusion; cities with more families on social benefi ts per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were signifi cantly associated with malocclusion.
CONCLUSION:Signifi cant associations between the presence and severity of malocclusion were observed at the individual and contextual level. The epidemiological profi le of oral health problems has changed, especially in children aged 12. In Brazil, tooth decay has shown a decrease in the DMFT index (decayed, missing and fi lled teeth) from 6.7 in 1986 to 2.07 in 2010 and, currently, a signifi cant number of those children are free of caries (43.5%). a Therefore, other problems related to the oral cavity have begun to receive attention, among them, occlusal changes stand out.
DESCRIPTORS:14 Due to its high prevalence, the World Health Organization (WHO) now considers malocclusion to be the third largest public health problem in dentistry. 9,10 National data relating to malocclusion indicate a prevalence of 40.0% for the index age of 12 years. For severe, and very severe malocclusion, the prevalence is 10.4% and 7.1% respectively.a In many cases, malocclusion can impact on the quality of life of this part of the population. It can produce aesthetic deviations in the teeth and/or face and functional disturbances of occlusion, chewing, swallowing, pronunciation and breathing. It can also cause psychosocial disorders with potential repercussions on the self-esteem and interpersonal relationships of severely affected individuals.
5In the face of this reality, there is a need for a clearer picture in order to understand the disease process in relation to malocclusion. Thus, in addition to individual factors, other factors, called modifi ers or modulators (social, economic, cultural, ethnic/racial, psychological and behavioral factors), are related to the health of the population. Currently, these factors are known as social determinants of health.