Functional Dentition in Brazilian Adults: An Investigation of Social Determinants of Health (SDH) Using a Multilevel Approach

Abstract

ObjectivesEstimate the prevalence of functional dentition among Brazilian adults using four different definitions and identify associated factors.MethodsA cross-sectional study was conducted involving 9564 Brazilian adults aged 35–44 years who participated in the 2010 National Oral Health Survey. Data collection involved oral examinations and the administration of questionnaires. The following definitions were used: 1—WHO Functional Dentition (FDWHO: ≥ 20 teeth present); 2—well-distributed teeth (WDT: ≥ 10 teeth in each arch); 3 –Functional dentition classified by esthetics and occlusion (FDClass5: dentitions that sequentially exhibit at least one tooth in each arch, at least 10 teeth in each arch, all maxillary and mandibular anterior teeth, three or four premolar posterior occluding pairs [POPs], and at least one molar POP bilaterally); 4—Functional dentition classified by esthetics, occlusion and periodontal status (FDClass6: corresponds to FDClass5 with the addition of periodontal status of all sextants in the oral cavity with, at most, shallow pockets and/or clinical attachment level of 5 mm (CPI ≤ 3 and/or CAL ≤ 1). The independent variables were individual factors (gender, self-declared skin color, schooling, monthly household income, age group, self-rated treatment need, dental pain, dental appointment in the previous 12 months and dental services) and contextual factors (Municipal Human Development Index [MHDI]), Gini coefficient, fluoridated water supply and oral health coverage). Multilevel mixed-effect Poisson regression analyses were performed.ResultsThe prevalence of functional dentition based on the FDWHO, WDT, FDClass5 and FDClass6 definitions was 77.9%, 72.9%, 42.6% and 40.3%, respectively. Adults with ≥12 years of schooling and monthly household income from US$ 853 to 2557 had higher prevalence rates of FDWHO (PR: 1.41 and 1.10, respectively), WDT (PR: 1.58 and 1.14, respectively), FDClass5 (PR: 2.03 and 1.27, respectively) and FDClass6 (PR: 2.15 and 1.35, respectively). These values in the final models were adjusted for gender, self-declared skin color (FDClass5), age group, self-rated treatment need (FDWHO, FDClass5 and FDClass6), dental appointment in the previous 12 months (FDWHO and WDT), dental services (FDWHO and WDT) and contextual factors. A very high MHDI and presence of fluoridated water supply were associated with higher prevalence rates of the four outcomes.ConclusionsThe incorporation of the criteria of new definitions of functional dentition led to a lower prevalence rate among Brazilian adults. Striking individual and contextual inequalities were identified with regard to the four definitions analyzed, which need to be addressed through inter-sector efforts.

Functional dentition and associated factors in Brazilian elderly people: A multilevel generalised structural equation modelling approach

“…in the oral cavity with shallow pockets and/or clinical attachment level of 5 mm (CPI 3 and/or CAL 1). 6 Class5 (1.2%, 95% CI: 1.02-1.59) and FD Class6 (0.7%, 95% CI: 0.5-0.9) (data not shown). Table 2 shows the multilevel logistic regression model.…”

“… WHO functional dentition (FDWHO): presence of 20 or more teeth Well‐distributed teeth (WDT): presence of at least 10 teeth in each arch. FD class5 : Presence of FDWHO, WDT, and all maxillary and mandibular anterior teeth, three or four premolar POPs, and at least one molar POP bilaterally. FD class6 : presence of FD class5 and periodontal status of all sextants in the oral cavity with shallow pockets and/or clinical attachment level of 5 mm (CPI 3 and/or CAL 1) …”

“…FD has been investigated in the adult population, and it has been related to both individual (female gender, levels of income and education, smoking habit and dental floss use) and contextual variables (fluoridation). Some studies have reported the influence of social support on FD outcome in Japanese elderly people.…”

Influence of functional dentition on satisfaction with oral health and impacts on daily performance among Brazilian adults: a population-based cross-sectional study

“…A complete description and evaluation of this system for Brazilian adults can be found in previous publications [17, 18]. …”

Investigating societal determinants of oral health—Opportunities and challenges in multilevel studies

“…Predominantly, multilevel studies on societal determinants of oral health are of two kinds. Some studies have simultaneously examined the role of multiple societal determinants (Human Development, access to fluoridated tap water, oral health coverage and income inequality) and oral health outcome/s consistent with a more exploratory approach using the social determinant framework . Others have tested specific associations between one societal determinant (eg area‐level income inequality, neighbourhood deprivation) and oral health outcome/s consistent with a causal approach.…”