Abstract

This study aims to analyze the index of decayed, missing and filled teeth (DMFT) at age 12 in the Midwest Region and to identify associated factors, according to the National Oral Health Survey “SB Brasil 2010”. This is a cross-sectional population-based study from the SB Brasil 2010 database, conducted in the capitals of Mato Grosso, Mato Grosso do Sul, Goiás, Federal District and a sample of municipalities in the region. Data were analyzed by the chi-square test and prevalence ratios with their respective confidence intervals, at a significance level of 5%. The Poisson regression was used in the multiple analysis to study the association between the outcome variable and the explanatory variables. The independent variables that were associated with the DMFT were: the state of residence in Mato Grosso, Goiás and Mato Grosso do Sul; the per capita income ≤ R$500.00; difficulties eating and sleeping, and reason for the visit was Pain/Extraction/Treatment/Other. Mean DMFT was 2.14 and the prevalence of dental caries affected 41% of adolescents.

Key words
Oral health; Dental caries; DMFT; Adolescent

Introduction

Oral health is an integral and inseparable part of general health and is related to the biological, psychic and social aspects of individuals and can, therefore, have a significant impact on their quality of life¹1 World Health Organization (WHO). The World Oral Health Report 2003. Geneva: WHO; 2003.^,22 Masoe AV, Blinkhorn AS, Taylor J, Blinkhorn F. Factors that influence the preventive care offered to adolescents accessing Public Oral Health Services, NS W, Australia. Adolesc Health Med Ther 2015; 6:101-113..

Dental caries and periodontal disease are still a major global concern regarding oral health, especially in industrialized countries¹1 World Health Organization (WHO). The World Oral Health Report 2003. Geneva: WHO; 2003.^,33 Freire MCM, Bahia SCG, Figueiredo N, Peres KG, Moreira RS, Antunes JLF. Determinantes individuais e contextuais da cárie em crianças brasileiras de 12 anos em 2010. Rev Saúde Pública 2013; 47(3):40-49.. Caries disease has a higher prevalence in Asian and Latin American countries, and is less frequent and severe in African countries, probably due to the lower consumption of sugar in this region⁴4 World Health Organization (WHO). Oral health surveys: basic methods. Geneva: WHO; 1997..

The low prevalence of dental caries can be considered an indicator of a better quality of life¹1 World Health Organization (WHO). The World Oral Health Report 2003. Geneva: WHO; 2003.. The DMFT index is the most widely used indicator of dental caries in oral health epidemiological surveys and expresses the mean number of decayed, missing and filled teeth in a group of individuals at a given age. The age of 12 is one of the index ages for the oral health epidemiological survey, and is appropriate for the global monitoring of dental caries in permanent dentition, allowing international comparisons of this disease⁴4 World Health Organization (WHO). Oral health surveys: basic methods. Geneva: WHO; 1997..

Oral health epidemiological surveys provide a solid basis for assessing the current state of oral health of a population, allowing the investigation of their determinants and the implementation of actions aimed at their control⁵5 Pereira MG. Epidemiologia: teoria e prática. Rio de Janeiro: Guanabara-Koogan; 1995.^,66 Brasil. Ministério da Saúde (MS). Secretaria de Atenção a Saúde. Departamento de Atenção Básica. Projeto SB Brasil 2010: Pesquisa Nacional de Saúde Bucal - Resultados Principais. Brasília: MS; 2012.. In Brazil, oral health epidemiological surveys were recorded in 1986, 1996, 2003, and the last one in 2010⁶6 Brasil. Ministério da Saúde (MS). Secretaria de Atenção a Saúde. Departamento de Atenção Básica. Projeto SB Brasil 2010: Pesquisa Nacional de Saúde Bucal - Resultados Principais. Brasília: MS; 2012.^,77 Roncalli AG. Epidemiologia e saúde bucal coletiva: um caminhar compartilhado. Cien Saude Colet 2006; 11(1):105-114..

Although dental caries fell in the Brazilian population, the decline of their prevalence occurs unevenly. This was evidenced in the Midwest region of the country, where the average DMFT index at age 12, obtained in the SB Brasil 2003 survey, was higher than in the South and Southeast regions. This may be a result of the care model of each region, as well as socioeconomic factors, collective measures used to combat dental caries, such as water fluoridation and access to dental services, among other factors⁶6 Brasil. Ministério da Saúde (MS). Secretaria de Atenção a Saúde. Departamento de Atenção Básica. Projeto SB Brasil 2010: Pesquisa Nacional de Saúde Bucal - Resultados Principais. Brasília: MS; 2012..

Thus, this study aimed to analyze the DMFT index of 12-year-olds from the Brazilian Midwest and to identify associated factors, according to data from the National Oral Health Survey, namely, SB Brasil 2010.

Methods

This study analyzed data from the National Oral Health Survey - SB Brasil 2010 for the state capitals of Mato Grosso, Mato Grosso do Sul, Goiás and the Federal District, as well as a sample of 30 municipalities in inland Brazilian Midwest Region. The participants of this study were 12-year-olds of both genders, interviewed and examined in their homes to investigate the DMFT index, as well as demographic, socioeconomic characteristics, use of dental services and self-perception of oral health and oral health impact.

The SB Brasil 2010 carried out a probabilistic sampling considering stratified and cluster sampling methods. The primary source of reference for these procedures was SB Brasil 2003. Thus, the sample size was calculated for the index ages and age groups, with caries as a standard problem, totaling 1,250 adolescents aged 12 years in the region considered. However, 1,192 adolescents participated in the study. The Informed Consent Form was signed by the person in charge. The SB Brasil 2010 project was approved by the Research Ethics Committee of the Ministry of Health and was registered at the National Research Ethics Commission (CONEP), CNS. This study was approved by the Human Research Ethics Committee of the Júlio Müller University Hospital, to ensure compliance with all the terms of Resolution CNS 466/12.

Institutionalized adolescents (hospitals, etc.) and those with physical and mental limitations that prevented the clinical examination and the application of the questionnaire were not included in the study.

The questionnaire used to evaluate socioeconomic conditions, dental services and health self-perception was shown in three parts: (a) demographic and socioeconomic characterization; (b) use of dental services and reported oral morbidity; and (c) self-perception of oral health and OIDP (Oral Impacts on Daily Performance), which measures the impact of oral health on daily activities. The first block (questions 1-4) was answered by the head of the household, and the second and third blocks were directed to the individuals who participated in the study⁸8 Brasil. Ministério da Saúde (MS). Departamento de Atenção Básica. Coordenação Nacional de Saúde Bucal. Projeto SB Brasil 2010: Pesquisa Nacional de Saúde Bucal. Manual da Equipe de Campo. Brasília: MS; 2009..

Clinical examinations were performed using the flat mouth mirror and the clinical probe for oral epidemiological examination under natural light, with both the examiner and the person examined sitting⁸8 Brasil. Ministério da Saúde (MS). Departamento de Atenção Básica. Coordenação Nacional de Saúde Bucal. Projeto SB Brasil 2010: Pesquisa Nacional de Saúde Bucal. Manual da Equipe de Campo. Brasília: MS; 2009.. The codes and criteria used to perform the clinical examination were those recommended by the World Health Organization⁴4 World Health Organization (WHO). Oral health surveys: basic methods. Geneva: WHO; 1997.. The index used in the research was DMFT (permanent dentition), which is recommended by the WHO and expresses the sum of decayed, missing and filled teeth⁴4 World Health Organization (WHO). Oral health surveys: basic methods. Geneva: WHO; 1997.. The mean DMFT index was calculated by the sum (total) of decayed, missing and filled teeth, divided by the number of individuals examined⁴4 World Health Organization (WHO). Oral health surveys: basic methods. Geneva: WHO; 1997..

In this study, the dependent variable was the caries index, namely, DMFT, which was categorized as follows: DMFT = 0 (absence of decayed, missing and filled teeth) and DMFT ≥ 1 (presence of one or more decayed, missing and filled teeth)⁶6 Brasil. Ministério da Saúde (MS). Secretaria de Atenção a Saúde. Departamento de Atenção Básica. Projeto SB Brasil 2010: Pesquisa Nacional de Saúde Bucal - Resultados Principais. Brasília: MS; 2012..

The independent variables of the study were gender (female or male), ethnicity/skin color (white, black, yellow, brown, indigenous), number of people in the household, household income (per capita), years of study (≤ median (6) and > median (6)), state, the use of dental service (visit to the dentist, frequency of visits, place of visit, reason for the visit, evaluation of the visit), self-perception of oral health concerning teeth (very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied and very dissatisfied), and the OIDP index (presence and absence of impact).

The data of the present study were analyzed using statistical packages SPSS version 17 and Stata Version 13. Initially, a descriptive analysis of the data was performed through proportions, means, median and measures of variation. The quantitative variables, number of people and years of study were categorized using the median as a cutoff point since they did not show symmetrical distribution. In the inferential analysis, the associations were analyzed using the chi-square test and prevalence ratios with their respective confidence intervals, considering a significance level of 5%. The Poisson regression model was employed to perform multiple analysis. In this model, we considered the independent variables with a p-value < 0.20 in the bivariate analysis. Variables with p-values < 0.05 remained in the final model⁹9 Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: na empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003; 3:21..

Results

SB Brazil 2010 analyzed 1,192 12-year-olds from the Midwest region, of whom 51.01% were female. Regarding skin color, white and brown totaled 39.68% and 47.40%, respectively.

Most of the families of adolescents reported a per capita income from R$ 501.00 and R$ 1,500.00 reais (58.82%), that is, up to three minimum wages for the year 2010. Income greater than R$ 2,501.00, was found in 8.87% of households, and income less than R$ 500.00 was found in 15.93% of the respondents.

The mean DMFT index rates of the states of the Midwest region were as follows: Mato Grosso (2.41), Goiás (1.75), Mato Grosso do Sul (1.58), Federal District (1.06). When comparing every two of these means by the Tukey test considering a level of significance of 5%, we observed that Mato Grosso state mean was statistically different from the other states, and Goiás also showed a difference compared to the Federal District.

In the bivariate analysis (Table 1), the DMFT index showed significant results (p-value < 0.05) with the following demographic and socioeconomic variables: state of the federation (Mato Grosso, Goiás, Mato Grosso do Sul), race (brown skin color), per capita income (≤ 500 and that of 501 to 1,500).

The DMFT index showed a significant association with all OIDP variables, except for the variable difficulty speaking (Table 2). Regarding the self-perceived oral health variable, there was a significant difference between the categories “Very dissatisfied/ dissatisfied” and “Neither satisfied nor dissatisfied” compared to the reference category (Satisfied/very satisfied) (Table 2).

In the analysis between the DMFT index and the dental service use variables, the variables that showed a significant association were visit to the dentist, place of visit and reason for the visit (Table 3).

Table 4 shows the results adjusted by the robust Poisson multiple regression model, where all the variables with p < 0.20 values were considered in the bivariate analysis. The variables that remained associated to DMFT after adjustments were state (Mato Grosso, Goiás, Mato Grosso Sul), ethnicity/skin color (yellow), household income (≤ 500), difficulty eating (yes), difficulty sleeping (yes) and reason for visit (Pain/Extraction/Treatment/Others).

Discussion

This study showed that the Brazilian Midwest region has been following the worldwide trend of a decreased prevalence of dental caries¹1 World Health Organization (WHO). The World Oral Health Report 2003. Geneva: WHO; 2003.^,66 Brasil. Ministério da Saúde (MS). Secretaria de Atenção a Saúde. Departamento de Atenção Básica. Projeto SB Brasil 2010: Pesquisa Nacional de Saúde Bucal - Resultados Principais. Brasília: MS; 2012.^,1010 Organização Pan-Americana da Saúde (OPAS). A Política Nacional de Saúde Bucal do Brasil: Registro de uma conquista histórica. Série Técnica - Desenvolvimento de Sistemas e Serviços de Saúde. Brasília: OPAS; 2006.. The DMFT index for age 12 in this region in 2003 (SB Brasil, 2003) was the highest in the country (DMFT=3.16), and for 2010 (SB Brasil, 2010), the DMFT index was 2.14⁶6 Brasil. Ministério da Saúde (MS). Secretaria de Atenção a Saúde. Departamento de Atenção Básica. Projeto SB Brasil 2010: Pesquisa Nacional de Saúde Bucal - Resultados Principais. Brasília: MS; 2012.. According to the World Health Organization, the rate of 2.14 is a low level of dental caries¹1 World Health Organization (WHO). The World Oral Health Report 2003. Geneva: WHO; 2003..

The establishment of the National Oral Health Policy, the Brasil Sorridente (Smiling Brazil), was responsible for the improved DMFT index of adolescents in the Midwest, resulting from higher investment in oral health-promoting measures, such as implantation of oral health in primary care via the Family Health Team and in secondary care, through the creation of the Dental Specialties Centers (CEO)⁶6 Brasil. Ministério da Saúde (MS). Secretaria de Atenção a Saúde. Departamento de Atenção Básica. Projeto SB Brasil 2010: Pesquisa Nacional de Saúde Bucal - Resultados Principais. Brasília: MS; 2012.^,1111 Pucca Jr., Gilberto A. A política nacional de saúde bucal como demanda social. Cien Saude Colet 2006; 11(1):243-246.

12 Narvai PC. Cárie dentária e flúor: Uma relação do século XX. Cien Saude Colet 2000; 5(2):381-392.^-1313 Antunes JLF, Narvai PC. Políticas de saúde bucal no Brasil e seu impacto sobre as desigualdades em saúde. Rev Saúde Pública 2010; 44(2):360-365..

Despite the lower prevalence of dental caries in the Midwest region of the country, there was a significant association of risk of the DMFT index with the states of Mato Grosso, Mato Grosso do Sul and Goiás when compared to the Federal District. This association could be explained by the Human Development Index (HDI) of the Federal District, which was the highest in the country¹⁴14 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios (PNAD 2010). Rio de Janeiro: IBGE; 2010. in 2010, and also by the dental service visited, which was public¹⁵15 Costa SM, Abreu MHNG, Vasconcelos M, Lima RCGS, Verdi M, Ferreira EF. Desigualdades na distribuição da cárie dentária no Brasil: uma abordagem bioética. Cien Saude Colet 2013; 18(2):461-470.. Also, the Federal District was the only one to reach a shallow level in the DMFT index, as recommended by the World Health Organization¹1 World Health Organization (WHO). The World Oral Health Report 2003. Geneva: WHO; 2003.^,1010 Organização Pan-Americana da Saúde (OPAS). A Política Nacional de Saúde Bucal do Brasil: Registro de uma conquista histórica. Série Técnica - Desenvolvimento de Sistemas e Serviços de Saúde. Brasília: OPAS; 2006..

The DMFT index showed a significant association with low per capita income ≤ 500 and 501 to 1,500 reais and with brown skin color adolescents, suggesting that the socioeconomic disadvantages of a low-income household and brown skin color could be determining factors in the experience with the disease³3 Freire MCM, Bahia SCG, Figueiredo N, Peres KG, Moreira RS, Antunes JLF. Determinantes individuais e contextuais da cárie em crianças brasileiras de 12 anos em 2010. Rev Saúde Pública 2013; 47(3):40-49.^,1616 Narvai PC, Frazão P, Roncalli AG, Antunes JLF. Cárie dentária no Brasil: declínio, iniqüidade e exclusão social. Rev Panam Salud Pública 2006; 19(6):385-393.

17 Piovesan C, Mendes FM, Antunes JL, Ardenghi TM. Inequalities in the distribution of dental caries among 12-year-old Brazilian schoolchildren. Braz Oral Res 2011; 25(1):69-75.

18 Lopes RM, Domingues GG, Junqueira SR, Araujo ME, Frias AC. Conditional factors for untreated caries in 12-year-old children in the city of São Paulo. Braz Oral Res 2013; 27(4):376-381.

19 Barbato PR, Peres MA. Tooth loss and associated factors in adolescents: a Brazilian population based oral health survey. Rev Saúde Pública 2009; 43(1):13-25.^-2020 Fisher-Owens SA, Isong IA, Soobader MJ, Gansky SA, Weintraub JA, Platt LJ, Newacheck PW. An Examination of Racial/Ethnic Disparities in Children's Oral Health in the United States. J Public Health Dent 2013, 73(2):166-174., and also influence in the difficulty of using the services, as well as the lack of knowledge about the importance of maintenance and oral health rights²¹21 Massoni ACLT, Vasconcelos FMN, Katz CRT, Rosenblatt A. Utilização de serviços odontológicos e necessidades de tratamento de crianças de 5 a 12 anos, na cidade de Recife, Pernambuco. Rev Odontol UNESP 2009; 38(2):73-78..

About the impact of oral health conditions on quality of life, evaluated by the OIDP index, 41.11% of 12-year-olds in the Midwest had at least one negative impact on the performance of their daily activities. In this study, all OIDP-related variables, except for the variable difficulty speaking, showed statistical significance in the analyses related to the CPO-D index. That is, adolescents had at least one impact on their quality of life, which may be related to social, psychological and functional factors²²22 Gomes AS, Abegg C. O impacto odontológico no desempenho diário dos trabalhadores do Departamento Municipal de Limpeza Urbana de Porto Alegre, Rio Grande do Sul, Brasil. Cad Saúde Pública 2007; 23(7):1707-1714.^,2323 Peres KG, Cascaes AM, Leão ATT, Côrtes MIS, Vettore MV. Aspectos sociodemográficos e clínicos da qualidade de vida relacionada à saúde bucal em adolescentes. Rev Saúde Pública 2013; 47(3):19-28..

For the variables of the dental service use, the condition of not visiting the dentist was a protective factor when associated with the DMFT, which could be explained by some studies due to the lack of knowledge of the individual regarding the need for control and maintenance of the oral health and also for seeking treatment only when the oral problem becomes severe or when they feel some discomfort or pain²¹21 Massoni ACLT, Vasconcelos FMN, Katz CRT, Rosenblatt A. Utilização de serviços odontológicos e necessidades de tratamento de crianças de 5 a 12 anos, na cidade de Recife, Pernambuco. Rev Odontol UNESP 2009; 38(2):73-78.^,2424 Borges CM, Cascaes AM, Fischer TK, Boing AF, Peres MA, Peres KG. Dor nos dentes e gengivas e fatores associados em adolescentes brasileiros: análise do inquérito nacional de saúde bucal SB-Brasil 2002-2003. Cad Saúde Pública 2008; 24(8):1825-1834.. The public service had a significant association with the DMFT, probably caused by unequal care models, constraints in the distribution of resources in each region, or even lack of quality in services¹³13 Antunes JLF, Narvai PC. Políticas de saúde bucal no Brasil e seu impacto sobre as desigualdades em saúde. Rev Saúde Pública 2010; 44(2):360-365.^,1515 Costa SM, Abreu MHNG, Vasconcelos M, Lima RCGS, Verdi M, Ferreira EF. Desigualdades na distribuição da cárie dentária no Brasil: uma abordagem bioética. Cien Saude Colet 2013; 18(2):461-470.^,2121 Massoni ACLT, Vasconcelos FMN, Katz CRT, Rosenblatt A. Utilização de serviços odontológicos e necessidades de tratamento de crianças de 5 a 12 anos, na cidade de Recife, Pernambuco. Rev Odontol UNESP 2009; 38(2):73-78.^,2525 Peres MA, Iser BPM, Boing AF, Yokota RTC, Malta DC, Peres KG. Desigualdades no acesso e na utilização de serviços odontológicos no Brasil: análise do Sistema de Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico (VIGITEL 2009). Cad Saúde Pública 2012; 28:90-100.. The reason for the visit for pain/extraction/ treatment/other also showed a significant association with the DMFT index, this can be explained by the fact that the adolescents may have little knowledge about the need to control and maintain oral health and seek treatment only when the oral problem becomes severe and when they feel some discomfort or pain²¹21 Massoni ACLT, Vasconcelos FMN, Katz CRT, Rosenblatt A. Utilização de serviços odontológicos e necessidades de tratamento de crianças de 5 a 12 anos, na cidade de Recife, Pernambuco. Rev Odontol UNESP 2009; 38(2):73-78.^,2626 Machado GCM, Daher A, Costa LR. Factors Associated with No Dental Treatment in Preschoolers with Toothache: A Cross-Sectional Study in Outpatient Public Emergency Services. Int J Environ Res Public Health 2014; 11(8):8058-8068..

The multiple analysis of the DMFT index using the robust Poisson regression model (PRa) showed a significant association with the state variables (Mato Grosso, Goiás and Mato Grosso Sul), which probably require more substantial and better investments and resources for oral health, improved access to the service and expanded artificial fluoridation system of public water supply¹⁵15 Costa SM, Abreu MHNG, Vasconcelos M, Lima RCGS, Verdi M, Ferreira EF. Desigualdades na distribuição da cárie dentária no Brasil: uma abordagem bioética. Cien Saude Colet 2013; 18(2):461-470.^,2727 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saneamento Básico 2008. Rio de Janeiro: IBGE; 2010.^,2828 Chaves SCL, Botazzo C. Prevenção, Atenção e Vigilância da Saúde Bucal. In: Paim JS, Almeida-Filho N. Saúde Coletiva: teoria e prática. Rio de Janeiro: Medbook; 2014. p. 465-477., but more studies are required in the region for better confirmation.

The yellow skin color variable had a significant association with dental caries after multiple analysis, which may be a result of socioeconomic disadvantages and lack of knowledge about oral hygiene practices⁴4 World Health Organization (WHO). Oral health surveys: basic methods. Geneva: WHO; 1997.^,2929 Shen A, Zeng X, Cheng M, Tai B, Huang R, Bernabé E. Inequalities in dental caries among 12-year-old Chinese children. J Public Health Dent 2015; 75(3):210-217.. Therefore, the Midwest region requires further studies concerning this association for a better understanding of this condition.

Twelve-year-olds from the Midwest who belonged to low-income households (≤ 500) had a significant association with the DMFT index in the multiple analysis. Economic disadvantages show difficulties accessing dental services, influence the lack of knowledge about their rights and the relevance of oral health on general health and quality of life, thus increasing the risk of dental caries disease¹⁶16 Narvai PC, Frazão P, Roncalli AG, Antunes JLF. Cárie dentária no Brasil: declínio, iniqüidade e exclusão social. Rev Panam Salud Pública 2006; 19(6):385-393.^,1717 Piovesan C, Mendes FM, Antunes JL, Ardenghi TM. Inequalities in the distribution of dental caries among 12-year-old Brazilian schoolchildren. Braz Oral Res 2011; 25(1):69-75.^,2121 Massoni ACLT, Vasconcelos FMN, Katz CRT, Rosenblatt A. Utilização de serviços odontológicos e necessidades de tratamento de crianças de 5 a 12 anos, na cidade de Recife, Pernambuco. Rev Odontol UNESP 2009; 38(2):73-78.^,2323 Peres KG, Cascaes AM, Leão ATT, Côrtes MIS, Vettore MV. Aspectos sociodemográficos e clínicos da qualidade de vida relacionada à saúde bucal em adolescentes. Rev Saúde Pública 2013; 47(3):19-28..

The principal daily activities that showed a significant association with the DMFT index in the multiple analysis were the difficulty eating and sleeping, those related to problems of functional and biological aspects, which cause negative social impacts on the quality of life of adolescents, affecting themselves as well as the people around them³⁰30 Bonecker M, Abanto J, Tello G, Oliveira LB. Impact of dental caries on preschool children's quality of life: an update. Braz Oral Res 2012; 26(1):103-107..

Another significant association with the DMFT index, after multiple analysis, was the reason for the visit for Pain/Extraction/Treatment/Other, probably caused by the lack of information by adolescents regarding the relevance of oral health prevention and maintenance²¹21 Massoni ACLT, Vasconcelos FMN, Katz CRT, Rosenblatt A. Utilização de serviços odontológicos e necessidades de tratamento de crianças de 5 a 12 anos, na cidade de Recife, Pernambuco. Rev Odontol UNESP 2009; 38(2):73-78.^,2626 Machado GCM, Daher A, Costa LR. Factors Associated with No Dental Treatment in Preschoolers with Toothache: A Cross-Sectional Study in Outpatient Public Emergency Services. Int J Environ Res Public Health 2014; 11(8):8058-8068..

One of the limitations of this study was the non-association of the DMFT index with the artificial fluoridation variable of public water supply since this variable was not considered in the questionnaire of the National Oral Health Survey – SB Brazil 2010. Thus, it was not possible to identify the states/cities of the Midwest region that have this service. Therefore, further studies are required to investigate this relationship, since the artificial fluoridation system of public water supply is one of the most efficient collective methods for the reduction of dental caries¹⁵15 Costa SM, Abreu MHNG, Vasconcelos M, Lima RCGS, Verdi M, Ferreira EF. Desigualdades na distribuição da cárie dentária no Brasil: uma abordagem bioética. Cien Saude Colet 2013; 18(2):461-470.^,2727 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saneamento Básico 2008. Rio de Janeiro: IBGE; 2010.^,2828 Chaves SCL, Botazzo C. Prevenção, Atenção e Vigilância da Saúde Bucal. In: Paim JS, Almeida-Filho N. Saúde Coletiva: teoria e prática. Rio de Janeiro: Medbook; 2014. p. 465-477..

Conclusions

In this study, approximately 41% of the adolescents aged 12 in the Brazilian Midwest region were affected by dental caries, but a mean decline in the DMFT index (2.14) was observed in this population when compared to the previous epidemiological survey, namely, the SB Brasil 2003 (DMFT = 3.16). In the adjusted final model, a higher prevalence of caries disease was found in the state of Mato Grosso, followed by the states of Goiás and Mato Grosso do Sul. Dental caries was more prevalent in families with a household income ≤ R$ 500.00, who self-reported as being yellow and caused difficulties eating and sleeping. There was also an association between the DMFT index and the reason for visiting the dentist. Therefore, the information obtained in this study may help in the construction of future public policies aimed at planning strategies for care and oral health care, which may positively affect the quality of life of the population studied.

References

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