Davide Carlos Joaquim1
Letícia Pereira Felipe2
Arthur Castro de Lima3
Karina Gonzaga da Costa4
Mohamed Saido Balde5
Leilane Barbosa de Sousa6
Ana Caroline Rocha de Melo Leite7
1Universidade Federal do Ceará (UFC). Fortaleza, Ceará – Brasil.
Orcid: https://orcid.org/0000-0003-0245-3110
2Universidade da Integração Internacional da Lusofonia
Afro-Brasileira – (UNILAB). Redenção, Ceará – Brasil. Orcid: https://orcid.org/0000-0003-2551-9143
3Universidade da Integração Internacional da Lusofonia
Afro-Brasileira – (UNILAB). Redenção, Ceará – Brasil. Orcid: https://orcid.org/0000-0003-1826-2247
4Universidade da Integração Internacional da Lusofonia
Afro-Brasileira – (UNILAB). Redenção, Ceará – Brasil. Orcid: https://orcid.org/0000-0002-4127-0424
5Universidade da Integração Internacional da Lusofonia
Afro-Brasileira – (UNILAB). Redenção, Ceará – Brasil.
6Universidade da Integração Internacional da Lusofonia
Afro-Brasileira – (UNILAB). Redenção, Ceará – Brasil. Orcid: https://orcid.org/0000-0003-0266-6255
7Universidade da Integração Internacional da Lusofonia
Afro-Brasileira – (UNILAB). Redenção, Ceará – Brasil. Orcid: https://orcid.org/0000-0002-9007-7970
Autor correspondente
Ana Caroline Rocha de Melo Leite
Universidade
da Integração Internacional da Lusofonia Afro-Brasileira – UNILAB, Campus das
Auroras – Rua José Franco de Oliveira, s/n CEP – 62.790-970 - Redenção, Ceará –
Brasil. E-mail – acarolmelo@unilab.edu.br. Telefone: +55 (85) 99168-0679.
ABSTRACT
Introduction: Social and
economic aspects and oral health behaviors trigger oral diseases with systemic
repercussions. Objective: This study aimed to
characterize and associate sociodemographic and economic aspects and
self-perception, habits, and behavior in the oral health of users of the Dental
Specialties Center (DSC) of a municipality in Ceará. Method: This is
a cross-sectional analytical observational study with a quantitative approach,
conducted in 2019, with patients seen at the Regional DSC of Baturité – CE.
After consent, we completed a questionnaire, drafted based on the literature
and validated. Results:
Of
the 388 participants, 63.14% had an income of up to one minimum wage, 54.64%
had good self-perception of oral health, and 61.08% brushed at least 3 times a
day. An association was observed between being a patient over the age of 40 and
using toothpaste, toothbrush, and other means of hygiene and having a good
self-perception of oral health, brushing teeth more than twice a day, and
having sought dental care 6 months earlier. Conclusion: Despite
the unfavorable demographic and economic profile, the population studied showed
good self-perception and adequate oral health behaviors. In addition, their
socioeconomic aspects and self-perception, habits, and oral health behaviors
were related to each other.
Keywords: Oral Health. Health
Behavior. Oral Hygiene. Dental Health Services.
RESUMEN
Introducción: Los aspectos
sociales, económicos y los comportamientos de salud bucal pueden desencadenar
enfermedades bucodentales con repercusiones sistémicas. Objetivo:
Caracterizar y asociar aspectos sociodemográficos, económicos y autopercepción,
hábitos y comportamientos en salud bucal de usuarios del Centro de
Especialidades Odontológicas de un municipio de Ceará. Metodología:
Estudio observacional analítico transversal con abordaje cuantitativo,
realizado en 2019, con pacientes atendidos en la Dirección General Regional de
Baturité - CE. Después del consentimiento, se completó un cuestionario, basado
en la literatura y validado. Resultados: De los 388 participantes, el
63,14% tenía ingresos de hasta un salario mínimo, el 54,64% tenía una buena
autopercepción de salud bucal y el 61,08% se cepillaba al menos 3 veces al día.
Hubo asociación entre ser un paciente mayor de 40 años y usar dentífrico,
cepillo de dientes y otros medios de higiene y tener una buena autopercepción
de salud bucal, cepillarse los dientes más de 2 veces al día y haber buscado
atención odontológica durante 6 meses. Conclusión: La población
estudiada, a pesar del perfil demográfico y económico desfavorable, presentó
una buena autopercepción y comportamientos de salud bucal adecuados. Aún así,
sus aspectos socioeconómicos y su autopercepción, hábitos y comportamientos en
salud bucal se relacionaron entre sí.
Palabras clave: Salud Bucal. Comportamientos Relacionados
con la Salud. Higiene Bucal. Servicios de Salud Bucal.
RESUMO
Introdução: Aspectos sociais
e econômicos e comportamentos em saúde bucal podem
desencadear doenças orais com repercussão sistêmica. Objetivo:
Caracterizar e associar os aspectos sociodemográficos e econômicos e a
autopercepção, hábitos e comportamentos em saúde bucal dos usuários do Centro
de Especialidades Odontológicas de um município cearense. Metodologia:
Estudo observacional analítico transversal e de abordagem quantitativa,
realizado em 2019, com pacientes atendidos no CEO Regional de Baturité – CE.
Após consentimento, foi preenchido um questionário, construído com base na
literatura e validado. Resultados: Dos 388 participantes, 63,14% tinham
renda de até um salário mínimo, 54,64% tinham boa autopercepção da saúde bucal
e 61,08% realizavam a escovação pelo menos 3 x por dia. Observou-se associação
entre ser paciente com idade acima de 40 anos e utilizar dentifrício, escova
dental e outros meios de higienização e ter boa autopercepção da saúde bucal,
escovar os dentes mais de 2 x por dia e ter buscado atendimento odontológico há 6 meses. Conclusão:
A população estudada, apesar do perfil demográfico e econômico desfavorável,
apresentou uma boa autopercepção e comportamentos adequados em saúde oral. Ainda, seus aspectos socioeconômicos e a sua
autopercepção, hábitos e comportamentos em saúde bucal se relacionaram entre
si.
Palavras-chave: Saúde Bucal. Comportamentos Relacionados
com a Saúde. Higiene Bucal. Serviços de Saúde Bucal.
INTRODUCTION
The concept of health accompanied the
evolution of humankind and society, reflecting the social, political, religious
and cultural conditions of each time(1). From this perspective, it
is accepted that health derives from the performance of exogenous and
endogenous factors, represented, especially, by social and environmental
aspects, health behavior, and lifestyle(2).
In the context of oral health,
especially regarding dental caries disease, a condition associated with pain,
suffering and impairment of organic functions, whose complications involve local,
systemic, psychological, social and economic effects(3), theories
related to its etiopathogenesis involve since the main contribution of the
microorganism (biological agent) up to individual and collective experiences
and the ecosystem approach. In organicist models (Microbial Theory), carious lesion
results from the action of genetic and environmental factors, such as bacterial
flora, eating habits, dental structure, time, salivary flow and composition,
and oral hygiene(4).
In social models, caries results from
the action of individual biological factors and social determinants,
represented by social, economic, cultural, behavioral and ethnic factors. For
ecosystem models, carious lesion results from the interaction of the individual
with the environment, involving since the interrelationship between the general
and particular conditions of the social structure and the individual conditions
up to the interdependence of people and their links to biological, historical,
physical and social contexts(3).
Despite the diversity of these
theories, it is thought that the emergence and development of the carious
process derives from the action of determining factors and modulating or
confounding factors. The former induce the demineralization of the dental structure,
with subsequent cavitation and destruction, represented by the microbiota,
susceptible host, cariogenic diet, time and saliva. As for modulating factors,
which are related to determining factors, we can mention knowledge, behavior,
oral hygiene, attitudes and income, among others(4).
In terms of strategies to combat
caries, the emergence of the National Oral Health Policy in 2004 and its
subsequent restructuring allowed the increase of the offer of public dental
services, specialized or not, to the population. Thus, the Dental Specialties Centers
(DSC) were established, aiming to increase access to dental services of medium
complexity, offering specialties such as diagnosis, periodontics, endodontics,
surgery, and special needs care.
Given the theories that seek to
explain caries disease, the importance it takes on in the global scenario and
the policies instituted for its combat, it is necessary to know the different
factors that influence the oral health of patients assisted in the DSCs, in
order to enable a greater understanding of the action of these factors among
the population already assisted by services focused on oral health and,
consequently, adequately plan policies and programs aimed at the maintenance,
prevention and restoration of health.
Based on the above, this study aimed
to characterize and associate the sociodemographic and economic aspects and the
self-perception, habits and behaviors in oral health of DSC patients in a
municipality of Ceará.
METHODS
This is a cross-sectional analytical
observational study with a quantitative approach, conducted with patients of
DSC Dr. José Marcelo de Holanda (Regional DSC of Baturité), located in the
municipality of Baturité – CE, from August to September 2019.
Were included in the study patients treated
in all specialties offered by the Regional DSC of Baturité, represented by
endodontics, dental prosthesis, bucomaxillofacial surgery, orthodontics,
periodontics, and special needs. Patients under 18 years of age unaccompanied
by their legal guardian were excluded from the study, since, in this situation,
it was not possible to obtain the signature of the Informed Consent Form.
To determine the sample size, we used as
a basis the number of patients treated
in 2018, in all the clinics of this institution, which corresponded to 15,212.
Thus, to describe the population estimate, the following formula was used to calculate the sample – infinite
population (n > 10,000):
DISCUSSION
Through the development of this research,
it was possible to understand, in addition to the socioeconomic and demographic
profile and aspects related to self-perception, habits and oral health
behaviors of patients assisted in the Regional DSC of Baturité, the connections
between these factors, which may contribute to the adoption of health promotion
measures more directed to this public.
Evaluating the profile of the
participants, the study showed a predominance of women, a result that
corroborated Rosendo et al.(7), who reported, in a study conducted
in a DSC of a municipality in the state of Paraíba, a greater participation of
women. This finding reinforces the greater demand of the female population for
health services(8).
As for the greater number of participants
aged 35 years or older, data which resembled that of Rosendo et al.(7),
it may suggest that these individuals are more affected by oral diseases and/or
greater demand for specialized dental services. In particular, the assumption
of higher occurrence of oral disorders in this public may be linked to the
action of infectious agents, presence of traumas and adoption of certain habits
and lifestyle, in addition to the possibility of deriving from manifestations
of systemic diseases(9).
Regarding the predominance of
self-reported brown people, a result supported by the literature(8),
it may be related to the significant miscegenation that occurred in the
Brazilian population(10). About marital status, the highest number
of patients married or in a common-law marriage, a phenomenon also observed by
Bordin et al.(11), may result from the high number of adults and
elderly people included in this research. Regarding schooling, the
preponderance of participants with complete high school was a relevant finding,
since the literature indicates that the education level of a population is
directly associated with quality and knowledge in relation to oral health(12).
Regarding the significant number of participants
who reported having a family income lower than or equal to one minimum wage,
which reinforces Carreiro et al.(13), it can be understood if we
analyze the data of the Government of the State of Ceará(14) and the
Brazilian Institute of Geography and Statistics (IBGE)(15).
According to these institutions, 86.56% of households in the Baturité Region
and 49.6% of the population of the municipality of Baturité have an income of
up to one or half minimum wage, respectively. Concerning residence, the fact
that more than half of the participants live in the rural area is in accordance
with the information presented by the Institute of Research and Economic
Strategy of Ceará (IPECE)(16), which indicate a greater presence of
inhabitants in this area of the Massif.
Regarding self-perception of oral health,
a condition that can be determined by the action of biological factors and
social determinants, the positive evaluation by a significant percentage of the
studied population may result from their adequate attitudes towards the health
of the oral cavity, such as the frequency of toothbrushing, tongue hygiene and
time since seeking dental care. It is also possible that this self-perception
is linked to masticatory function, self-image and the absence of experience of
pain and discomfort, as reported by Santos et al.(17).
Evaluating the frequency of toothbrushing,
its accomplishment at least 3 times a day by a large number of patients,
particularly those aged less than or equal to 40 years, is consistent with the
literature, which states that dental hygiene should be performed after each
meal, as a strategy to reduce biofilm and dental calculus(18).
For the relationship between the
education level and the frequency of toothbrushing, the fact that patients who
have a higher education level than complete elementary school brush their teeth
more than twice a day can be understood if it is assumed that the higher schooling
implies greater access to information and, consequently, greater knowledge and
access to health services(12).
Concerning the association between being
a participant with an income of less than or equal to 1 minimum wage and
brushing teeth at least 3 times a day, this piece of data was unexpected, since
a higher socioeconomic status is linked not only to a more effective dental
hygiene and use of more auxiliary means during that hygiene(19), but
also to more frequent toothbrushing.
Regarding toothbrushing times, the habit
of brushing upon waking, as reported by most patients, can be explained by the
occurrence of morning halitosis. However, it is worth mentioning that it is
mainly recommended brushing after breakfast and before bedtime(20).
As for the means used in oral hygiene,
the use of toothbrush and toothpaste by more than half of the participants, a
result similar to Thapa et al.(21), although it is in line with the
dictated recommendations, may result from the lack of access to information
and/or higher cost associated with flossing and mouthwash. In particular, these
justifications can be conceived based on the fact that patients in this study
with an income of less than or equal to 1 minimum wage used only toothpaste and
toothbrush in the hygiene of the oral cavity.
Despite this result, the use of toothbrush,
toothpaste and auxiliary means of oral hygiene was observed among participants
over 40 years of age, a result that corroborates Roberto et al.(22)
and that may be linked to an awareness regarding the development of oral
pathologies and their possible prevention by the use of these devices.
Specifically, for the association between
being a non-single participant and using toothpaste, toothbrush and other means
of oral hygiene, this finding can be explained by the influence that the figure
of the partner exerts on self-care(23). In addition, if we consider
that the non-single individual constitutes a family, the responsibility they take
on over the oral health of their children, in addition to being a model of
behavior and health habits(24), may justify the use of appropriate means
of oral hygiene for the prevention of oral diseases. However, research
conducted by Najafi et al.(19) indicated higher DMFT indices among
divorced and widowed individuals, which may result from the non-use or
inappropriate use of means of oral hygiene.
Regarding the significant relationship
between being a participant with an education level lower than or equal to
complete elementary school and using toothpaste, toothbrush and other means of
oral hygiene, this result was surprising, since the level of schooling has been
directly proportional to positive oral hygiene habits(19,21).
For the low number of the population
studied that replaced toothbrushes every 3 months, this result is worrisome,
since the American Dental Association (ADA) advises that this practice should
occur every 3 or 4 months or earlier, when the bristles are worn(25).
Regarding the sanitization of the tongue,
most participants had this habit. This finding reinforces the importance that
the practice of tongue hygiene exerts on the reduction of biofilm and
prevention of halitosis(26). About the association between being a
single patient and not having the habit of brushing the tongue, it may be
linked to a lower commitment of this individual to oral health, particularly if
assumed that they do not have the role of father or mother. We can also suppose,
as an influencing factor in this relationship, the lack of information on the
part of these individuals(27).
On access to dental services, the
significant number of participants who reported using the public health system
can be easily explained based on the low socioeconomic level presented by the
population included here. Regarding the high number of participants who sought
dental care 6 months earlier, especially those aged less than or equal to 40
years, this finding was unexpected if we consider that adults and the elderly,
in general, seek the dentist due to the presence of pain(28).
Concerning the relation between having
sought dental care 6 months earlier and toothbrushing at a frequency greater
than twice a day, this finding highlights the importance of the dentist as an
agent that educates, informs and enables the dissemination of knowledge,
inducing the patient to perform appropriate self-care practices(29).
Although the search for dental care at least 1 year earlier was associated with
the use of toothpaste, toothbrush and other means of oral hygiene by patients,
this result highlights the importance of the dentist in conducting measures
aimed at maintaining, preventing and restoring oral health.
Regarding the relation between good
perception of oral health, toothbrushing at a frequency of more than twice a day
and search for dental care 6 months earlier by participants, this finding
highlights the influence of appropriate oral health habits and behaviors on the
positive self-assessment of this type of health. If it is considered that a
greater number of teeth present in the oral cavity results from satisfactory
oral health-related attitudes and practices, it is possible to better
understand the influence of these factors in determining a positive perception
of oral condition(30).
Based on these findings, services,
actions, programs and policies that interfere with determinant and modulating
health factors can be instituted in order to raise awareness among individuals
and the community about the influence of these factors in disease prevention
and maintenance and restoration of oral and systemic health. This awareness
should extend to the role that every citizen, professional and manager assumes
in the face of this challenge.
CONCLUSION
Based on the results obtained, we can conclude
that the population studied, despite the unfavorable demographic and economic
profile, presented a good self-perception and adequate oral health behaviors.
Furthermore, the age of the participants and self-perception in oral health
were associated with oral health behaviors, as well as marital status,
educational level, income and the search for dental care were related to oral
health habits.
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Submission:
2021-10-28
Approval:
2022-01-21
