Self-reported tooth extractions and associated factors in quilombola communities in the semi-arid region of Bahia state, Brazil, 2016

Araújo, Roberta Lima Machado de Souza; Araújo, Edna Maria de; Miranda, Samilly Silva; Chaves, Janaína Nascimento Teixeira; Araújo, Josivene Antônio de

doi:10.5123/s1679-49742020000200011

Abstract

Objective:

to estimate the prevalence of self-reported tooth extractions and analyze associated factors in quilombola communities in Feira de Santana, Bahia, Brazil.

Methods:

this was a cross-sectional study, with 864 quilombolas; association between self-reported tooth extractions (no experience of extraction; ≤5 extracted teeth; >5 extracted teeth), and possible associated factors was estimated using multinomial logistic regression, with a 95% confidence interval (95%CI).

Results:

tooth extractions were self-reported by 82.0% of quilombolas, 49.8% of whom had ≤5 teeth extracted and 32.2% of whom had >5 teeth extracted; greater likelihood of tooth extraction was associated with being male (adjusted OR = 1.7 - 95%CI1.1;2.7), working as an unregistered worker (adjusted OR = 2.7 - 95%CI1.3;5.7), being ≥60 years old (adjusted OR = 5.2 - 95%CI1.9;14.1) and reporting having dental caries (adjusted OR = 4.1 - 95%CI2.5;6.7).

Conclusion:

tooth extractions are associated with social vulnerability conditions experienced by the quilombolas of the semi-arid region of Bahia state.

Keywords:
African Continental Ancestry Group; Health Vulnerability; Oral Health; Rural Population; Ethnicity and Health

Introduction

Tooth loss is a sign of social inequities. Tooth loss is one of the worst oral health conditions, given its high prevalence, its relationship with living condition vulnerabilities, and because it represents a potential risk of development of psychological and functional harm in different population groups.¹1. Peres MA, Barbato PR, Reis SCGB, Freitas CHSM, Antunes JLF. Perdas dentárias no Brasil: análise da Pesquisa Nacional de Saúde Bucal 2010. Rev Saúde Pública [Internet]. 2013 dez [citado 2020 fev 10];47(Suppl 3):78-89. Disponível em: https://doi.org/10.1590/S0034-8910.2013047004226^,²2. Barbato PR, Nagano HCM, Zanchet FN, Boing AF, Peres MA. Perdas dentárias e fatores sociais, demográficos e de serviços associados em adultos brasileiros: uma análise dos dados do Estudo Epidemiológico Nacional (Projeto SB Brasil 2002- 2003). Cad Saúde Pública [Internet]. 2007 ago [citado 2020 fev 10];23(8):1803-14. Disponível em: Disponível em: https://doi.org/10.1590/S0102-311X2007000800007
https://doi.org/10.1590/S0102-311X200700... Notwithstanding progress made with dentistry and the efforts of the Brazilian National Health System (SUS) to guarantee its principles and action guidelines for improving the oral health of the Brazilian population, tooth extraction reflects the existence and negative experiences of mouth diseases, as well as aspects related to delayed seeking of dental services.³3. Silva-Junior MF, Sousa ACC, Batista MJ, Sousa MLR. Condição de saúde bucal e motivos para extração dentária entre uma população de adultos (20-64 anos). Ciênc Saúde Coletiva [Internet]. 2017 ago [citado 2020 fev 10];22(8):2693-702. Disponível em: Disponível em: https://doi.org/10.1590/1413-81232017228.22212015
https://doi.org/10.1590/1413-81232017228... Hence why the World Health Organization (WHO) considers oral health inequalities to be a priority thematic area for health research and intervention.⁴4. Petersen PE. The world oral health report 2003: continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programme [Internet]. Geneva: World Health Organization; 2003 [citado 2020 Feb 10]. 38 p. Available from: Available from: https://www.who.int/oral_health/media/en/orh_report03_en.pdf
https://www.who.int/oral_health/media/en...

A study conducted in 2012, based on data from a national survey of the oral health status of the Brazilian population, identified racial inequities in oral health in all the indicators it analyzed - dental caries, tooth loss, pain and need for prosthesis -, associated with greater social insecurity of the Black population in relation to the White population. Income distribution and access to health care policies are conditions which, probably, contribute considerably to the characterization of the vulnerability of population groups to adverse oral health.⁵5. Guiotoku SK, Moysés ST, Moysés SJ, França BHS, Bisinelli JC. Iniquidades raciais em saúde bucal no Brasil. Rev Panam Salud Pública [Internet]. 2012 [citado 2020 fev 10];31(2):135-41. Disponível em: Disponível em: http://iris.paho.org/xmlui/bitstream/handle/123456789/9364/a07v31n2.pdf?sequence=1&isAllowed=y
http://iris.paho.org/xmlui/bitstream/han...

Recognizing and certifying Black communities as belonging to quilombos (settlements originally formed by escaped slaves) is not an easy task, in view of the parameters adopted to do so. Nevertheless, the principal criterion of these measures can be seen to consist of self-definition and perception of belonging to the history of the struggle of quilombola (maroon) populations, a fact that results in many discussions and opposing views. In view of this, it is common for the legal classification to be used, as per Article 68 of the transitory constitutional provisions of Decree No. 4887/2003, namely, ¨surviving quilombo communities are considered to be those racial/ethnic groups, according to self-attributed criteria, who have their own historical trajectory, specific territorial relations and whose ancestry is presumed to be Black.¨ ⁶6. Brasil. Presidência da República. Casa Civil. Decreto nº 4.887, de 20 de novembro de 2003. Regulamenta o procedimento para identificação, reconhecimento, delimitação, demarcação e titulação das terras ocupadas por remanescentes das comunidades dos quilombos de que trata o art. 68 do Ato das Disposições Constitucionais Transitórias [Internet]. Diário Oficial da União, Brasília (DF), 2003 nov 21 [citado 2020 fev 10]; Seção 1(227):4. Disponível em: Disponível em: http://www.planalto.gov.br/ccivil_03/decreto/2003/D4887.htm
http://www.planalto.gov.br/ccivil_03/dec...

This is a more comprehensive concept chosen to represent groups with similar forms of social organization and similar histories related to the fight for rights, such as quilombola communities or ‘Black rural communities’.⁷7. Arruti JMA. As comunidades negras rurais e suas terras: a disputa em torno de conceitos e números. Dimensões. Rev História UEFS. 2002;14:243-6. It should be emphasized that, given the process of slavery experience by quilombolas, their rural properties are generally located in very remote regions, since the Black slaves who rebelled against that perverse system chose remote places in which to take refuge.

The populations of these rural communities, when compared to populations forming urban communities, have a higher percentage of decayed and lost teeth,⁸8. Figueiredo MC, Benvegnú BP, Silveira PPL, Silva AM, Silva KVCL. Saúde bucal e indicadores socioeconômicos de comunidades quilombolas rural e urbana do Estado do Rio Grande do Sul, Brasil. Faculd Odontol Lins/Unimep [Internet]. 2016 jul-dez [citado 2020 fev 10];26(2):61-73. Disponível em: Disponível em: http://dx.doi.org/10.15600/2238-1236/fol.v26n2p61-73
http://dx.doi.org/10.15600/2238-1236/fol... which suggests vulnerabilities related to this group, their formal education and income distribution, access to oral health care policies⁶6. Brasil. Presidência da República. Casa Civil. Decreto nº 4.887, de 20 de novembro de 2003. Regulamenta o procedimento para identificação, reconhecimento, delimitação, demarcação e titulação das terras ocupadas por remanescentes das comunidades dos quilombos de que trata o art. 68 do Ato das Disposições Constitucionais Transitórias [Internet]. Diário Oficial da União, Brasília (DF), 2003 nov 21 [citado 2020 fev 10]; Seção 1(227):4. Disponível em: Disponível em: http://www.planalto.gov.br/ccivil_03/decreto/2003/D4887.htm
http://www.planalto.gov.br/ccivil_03/dec... and to benefits arising from the supply of fluoridated, within a context of lower access to health services.⁸8. Figueiredo MC, Benvegnú BP, Silveira PPL, Silva AM, Silva KVCL. Saúde bucal e indicadores socioeconômicos de comunidades quilombolas rural e urbana do Estado do Rio Grande do Sul, Brasil. Faculd Odontol Lins/Unimep [Internet]. 2016 jul-dez [citado 2020 fev 10];26(2):61-73. Disponível em: Disponível em: http://dx.doi.org/10.15600/2238-1236/fol.v26n2p61-73
http://dx.doi.org/10.15600/2238-1236/fol... ^,⁹9. Gomes KO, Reis EA, Guimarães MD, Cherchiglia ML. Utilização de serviços de saúde por população quilombola do Sudoeste da Bahia, Brasil. Cad Saúde Pública [Internet]. 2013 set [citado 2020 fev 10];29(9):1829-42. Disponível em: Disponível em: https://doi.org/10.1590/0102-311X00151412
https://doi.org/10.1590/0102-311X0015141... Esta situación termina dificultando ofrecer atención de salud bucal a estas comunidades, especialmente, afectando el acceso a los ancianos, que terminan con una mayor cantidad de dientes cariados y pérdida de dientes.¹⁰10. Mendonça HLC, Szwarcwald CL, Damacena GN. Autoavaliação de saúde bucal: resultados da Pesquisa Mundial de Saúde - Atenção Básica em quatro municípios do Estado do Rio de Janeiro, Brasil, 2005. Cad Saúde Pública [Internet]. 2012 out [citado 2020 fev 10];28(10):1927-38. Disponível em: Disponível em: https://doi.org/10.1590/S0102-311X2012001000011
https://doi.org/10.1590/S0102-311X201200...

Otro indicador importante en el proceso de análisis de salud de una comunidad es la salud autoevaluada. Los estudios han demostrado que la salud autoevaluada es un predictor independiente de mortalidad en casi todos los estudios de salud de la población.¹¹11. dler E, Benyamini Y. Self-rated health and mortality: a review of twenty-seven studies. J Health Soc Behav. 1997 Mar;38(1):21-37.

With regard to oral health, research has demonstrated that self-assessment of one’s health status, as well as other indicators of perceived morbidity, has differentiated impacts, depending on the variables used.¹²12. Ozkan Y, Özcan M, Kulak Y, Kazazoglu E, Arikan A. General health, dental status and perceived dental treatment needs of an elderly population in Istanbul. Gerodontology [Internet]. 2011 Mar [cited 2020 Feb 10];28(1):28-36. Available from: Available from: https://doi.org/10.1111/j.1741-2358.2010.00363.x
https://doi.org/10.1111/j.1741-2358.2010... ^-¹³13. Locker D, Jokovic A. Three-year changes in self-perceived oral health status in older Canadian population. J Dent Res [Internet]. 1997 Jun [cited 2020 Feb 10];76(6):1292-7. Available from: Available from: https://doi.org/10.1177/00220345970760060901
https://doi.org/10.1177/0022034597076006...

Studies on quilombola oral health are scarce; ¹⁴14. Bidinotto AB, D’ÁvilaII OP, Martins AB, Hugo FN, Neutzling MB, Bairros FS, et al. Autopercepção de saúde bucal em comunidades quilombolas no Rio Grande do Sul: um estudo transversal exploratório. Rev Bras Epidemiol [Internet]. 2017 jan-mar [citado 2020 fev 10];20(1):91-101. Disponível em: Disponível em: https://doi.org/10.1590/1980-5497201700010008
https://doi.org/10.1590/1980-54972017000... there are no publications in the literature on this theme in the semi-arid region of Bahia state, for example. In view of the this gap in scientific knowledge and as this is a study of a vulnerable and specific population that lives distant from urban centers and, therefore, tends to have limited access to health services, its objective was to estimate prevalence of self-reported tooth extractions and analyze related factors in quilombola communities in the semi-arid region of Bahia state.

Methods

This was a cross-sectional study using a database from the project entitled ‘Social determinants of diseases and health conditions in the quilombola communities of Feira de Santana, Bahia’.

The study was conducted in the semi-arid region of Bahia state where there are currently 665 surviving quilombo communities recognized by the Palmares Foundation.¹⁵15. Fundação Cultural Palmares (BR). Quadro geral por estados de comunidade remanescentes de quilombo [internet]. Brasília: Fundação Cultural Palmares; 2014 [citado 2014 set 22]. Disponível em: Disponível em: http://www.palmares.gov.br
http://www.palmares.gov.br... Specifically with regard to Feira de Santana, the following communities involved in this study have been certified: Lagoa Grande (recognized in 2007) and Matinha dos Pretos (recognized in 2014). Both communities are located in the rural area of this municipality.¹⁵15. Fundação Cultural Palmares (BR). Quadro geral por estados de comunidade remanescentes de quilombo [internet]. Brasília: Fundação Cultural Palmares; 2014 [citado 2014 set 22]. Disponível em: Disponível em: http://www.palmares.gov.br
http://www.palmares.gov.br... The formation of quilombola communities in Feira de Santana has links with the experiences of slavery dating back to the late 19^th century and early 20^th century. The two communities were created by Black Africans as an alternative involving resistance and survival from the suffering and violence they had experienced.¹⁶16. Souza EB. Terra, território, quilombo: à luz do povoado de matinha dos pretos (BA). [Dissertação]. Salvador: Universidade Federal da Bahia; 2010. Disponível em: https://repositorio.ufba.br/ri/handle/ri/19769
https://repositorio.ufba.br/ri/handle/ri...

The Lagoa Grande quilombola community is located in the district of Maria Quitéria, close to the BR116 highway, to the north of Feira de Santana. It is estimated that 12,077 people live in this community.¹⁷17. Instituto Brasileiro de Geografia e Estatística. Censo demográfico [internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010 [citado 2016 jan 22]. Disponível em: Disponível em: https://www.ibge.gov.br/home/estatistica/populacao/censo2010/default.shtm
https://www.ibge.gov.br/home/estatistica... Lagoa Grande was the first quilombola community to be officially recognized in Feira de Santana, in 2007 by the Palmares Cultural Foundation.¹⁵15. Fundação Cultural Palmares (BR). Quadro geral por estados de comunidade remanescentes de quilombo [internet]. Brasília: Fundação Cultural Palmares; 2014 [citado 2014 set 22]. Disponível em: Disponível em: http://www.palmares.gov.br
http://www.palmares.gov.br...

In turn, the Matinha dos Pretos community has a population of 8,855 people,¹⁷17. Instituto Brasileiro de Geografia e Estatística. Censo demográfico [internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010 [citado 2016 jan 22]. Disponível em: Disponível em: https://www.ibge.gov.br/home/estatistica/populacao/censo2010/default.shtm
https://www.ibge.gov.br/home/estatistica... is also located close to the BR116 highway and was recognized and registered with the Palmares Cultural Foundation for also having originally been a place of refuge for Black people who had acted in resistance to slavery.¹⁶16. Souza EB. Terra, território, quilombo: à luz do povoado de matinha dos pretos (BA). [Dissertação]. Salvador: Universidade Federal da Bahia; 2010. Disponível em: https://repositorio.ufba.br/ri/handle/ri/19769
https://repositorio.ufba.br/ri/handle/ri...

It should be noted that the human development indicators (HDI) of the quilombola communities in the semi-arid region of Bahia state do not differ from those of this specific group in Brazil as a whole. Eighty thousand of Brazil’s 214,000 quilombola families are registered with the social assistance protection program known as Cadastro Único; and 79.8% of these families are beneficiaries of the Bolsa Família Program, but even so 74.7% are in a situation of extreme poverty.¹⁸18. Secretaria de Promoção de Igualdade Racial (BR). Programa Brasil quilombola: diagnóstico de ações realizadas [Internet]. Brasília: Secretaria de Promoção de Igualdade Racial; 2012 [citado 2020 fev 10]. 34 p. Disponível em: Disponível em: https://www.mdh.gov.br/biblioteca/igualdade-racial/diagnostico-de-acoes-realizadas-programa-brasil-quilombola/view
https://www.mdh.gov.br/biblioteca/iguald...

The study population included individuals 18 years old or over who lived in the two communities in question. Individuals in this age range were chosen because they were adults and had legal autonomy to take part in the study. The subjects of the study were selected using systematic probabilistic sampling, whereby the household was the sample unit. The sample size calculation took into consideration the heterogeneity of the expected outcomes and the simultaneity of the multiple events to be measured. The sample size was calculated taking 50% prevalence as a parameter, with estimated accuracy of 5 percentage points and 95% confidence intervals (95%CI), in line with another population-based study conducted in similar communities.¹⁹19. Medeiros DS, Moura CS, Guimaraes MDC, Acurcio FA. Utilização de medicamentos pela população quilombola: inquérito no Sudoeste da Bahia. Rev Saúde Pública [Internet]. 2013 out [citado 2020 fev 10];47(5):905-13. Disponível em: Disponível em: https://doi.org/10.1590/S0034-8910.2013047004817
https://doi.org/10.1590/S0034-8910.20130... Although the sample was stratified by household, the questionnaire was administered individually with those who agreed to take part, even if they lived in the same household.

As such, based on the population size of the two quilombola communities, Matinha (N=8,855) and Lagoa Grande (N=12,077), the final calculated sample size was 369 people in Matinha and 373 in Lagoa Grande, resulting in a minimum sample of 742 people. An additional 10% was added to the sample to account for possible losses, resulting in a total final sample of 816 individuals. This number was calculated using OpenEpi statistical software, developed for statistical calculations including sample sizes. Notwithstanding, a total of 864 individuals were interviewed.

A pilot study was conducted beforehand in a Black rural community, known as Olhos D’Água da Formiga, located near to the Matinha dos Pretos quilombola community. The pilot study involved 74 adults over 18 years old (10% of the initial sample size of this study) in June 2016, with the aim of assessing the need for changes to the data collection process, so as to minimize the possibility of bias in the main study.

The data used in this study were obtained from a primary source by administering an instrument intended to enable socio-economic, demographic and health status characterization of the study subjects, as well as possible identification of diseases and health conditions. This data collection instrument was based on that used by the survey conducted by the COMQUISTA Project,²⁰20. Bezerra VB, Medeiros DS, Gomes KO, Souzas R, Giatti L, Steffens AP, et al. Inquérito de Saúde em comunidades Quilombolas de Vitória da Conquista, Bahia, Brasil (Projeto COMQUISTA): aspectos metodológicos e análise descritiva. Cad Saúde Pública [Internet]. 2014 jun [citado 2020 fev 10];19(6):1835-84. Disponível em: Disponível em: https://doi.org/10.1590/1413-81232014196.01992013
https://doi.org/10.1590/1413-81232014196... the objective of which was to describe the living and health conditions of quilombola communities in the municipality of Vitória da Conquista. It should be emphasized that the COMQUISTA Project survey used an adapted version of a semi-structured questionnaire for quilombola populations from the National Health Survey, duly validated in the survey conducted in the Integrated Region of the Federal District when the model questionnaire was tested. The questionnaire was administered during household interviews with all adult quilombolas who agreed to take part in the study.

Self-reported extraction of at least one tooth was the dependent variable defined as the outcome, based on the following question asked of the respondent:

“Have you ever had a tooth extracted? How many?”

The dependent variable was later organized into three categories: no experience of extraction; ≤5 teeth extracted; and >5 teeth extracted.

The independent variables were categorized into two levels.

a) socio-economic and demographic variables
- age (in years: 18-29; 30-39; 40-49; 50-59; 60 or more);
- sex (female; male);
- marital status (with partner; without partner);
- years of schooling (≤8; >8);
- monthly per capita income (minimum national wage in force at the time of the study: BRL 880.00);
- has a job (yes; no); and
- situation at work (registered worker; unregistered worker).
b) health status variables
- self-rated health (good; regular; poor); and
- having had dental caries (yes; no).

Descriptive statistics were used when analyzing the data, with mean values, standard deviation, absolute and relative frequency and confidence intervals. Multinomial logistic regression was used to analyze factors associated with tooth extractions, since the outcome - tooth extractions - was subdivided into three categories. The reference category was ‘no tooth extractions’. In the statistical analysis, in the case of variables considered to be possible exposure factors, the best condition was always taken as the reference basis, whereby the best condition was defined based on theoretical knowledge obtained prior to the analyses.

Odds ratios and confidence intervals were estimated for the crude analysis and also for the adjusted analysis. All the variables were assessed in the adjusted analysis, with the ‘age’ and ‘sex’ variables being included in the final model, selected based on theoretical assessment and when they showed statistically significant differences between the groups (p value less than 0.05). In all the analyses, a 95% confidence interval and a p value ≤0.05 were used.

The estimates were obtained using version 14.0 of the Stata statistical package (Stata Corporation, United States).

In compliance with ethical principles, the study project was submitted to and approved by the Feira de Santana State University Research Ethics Committee on August 7^th 2016 - Protocol No. 57412416.4.0000.0053 -, in accordance with the requirements of National Health Council Resolution No. 466, dated December 12^th 2012.

Results

Eight hundred and sixty four adults took part in the study, 484 (56%) of whom lived in Matinha dos Pretos and 380 (44.0%) in Lagoa Grande. All invited individuals agreed to take part and no participants were lost to the study. Mean age in both communities was found to be 42.6±16.9 years. However, mean years of schooling differed: 7 years in Matinha dos Pretos and 6 years in Lagoa Grande.

In both communities over 70.0% of workers had informal jobs, especially those working as plantation hands and farmers. All 864 participants referred to themselves as being quilombolas and Black. With regard to monthly per capita income, 81.8% (95%CI79.0;84.3) of respondents had income under one minimum wage (Table 1).

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Table 1
- Distribution of socio-economic, demographic and self-perception of health variables among quilombolas of the semi-arid region of Bahia state (N=864), 2016

In relation to self-reported tooth extractions, 82.0% stated having had at least one tooth extracted: 49.8% reported having extracted ≤5 teeth, and 32.2% >5 teeth; 18.0% (95%CI15.5;20.8) reported no tooth loss/experience of tooth extraction (Table 1).

The results of the multinomial analysis indicated that being a male adult (adjusted OR = 1.7 - 95%CI1.1;2.7), being over 60 years old (adjusted OR = 5.2 - 95%CI1.9;14.1) or between 50 and 59 years old (adjusted OR = 5.9 - 95%CI2.2;15.9) were factors that showed statistically significant association with self-reported extraction of up to 5 teeth, while unregistered workers (adjusted OR = 2.7; 95%CI1.3;5.7) were associated with extractions of more than 5 teeth. The fact of not working was a protection factor for having lost fewer teeth (adjusted OR = 0.6 - 95%CI0.4;0.9). The odds of individuals with dental caries having 5 or more teeth extracted was four times greater (adjusted OR = 4.1 - 95%CI2.5;6.7) (Table 2).

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Table 2
- Multinomial regression analysis, odds ratio (OR), p value and 95% confidence intervals for tooth extractions (reference category ‘no tooth loss’) and associated factors, among quilombolas from Matinha dos Pretos and Lagoa Grande (N=864), 2016

Discussion

The majority of the quilombolas from the semi-arid region of Bahia state self-reported loss of at least one tooth due to extraction. Male quilombolas, aged ≥60 or 50-59 years old, who worked without formal job registration, and those who reported having had dental caries, were more likely to have had teeth extracted. Lower prevalence rates have been reported in other studies with quilombolas in Goiás state (45.0%)²¹21. Soares EF, Freire MCM, Araújo AC. Kalunga - GO: primeiro relato sobre experiência de cárie e comportamentos em saúde bucal. Rev Paul Odontol [Internet]. 2002 set-out [citado 2020 fev 10];24(5):21-5. Disponível em: Disponível em: http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&src=google&base=ADOLEC&lang=p&nextAction=lnk&exprSearch=329434&indexSearch=ID
http://bases.bireme.br/cgi-bin/wxislind.... and Rio Grande do Sul state (18.0%),⁸8. Figueiredo MC, Benvegnú BP, Silveira PPL, Silva AM, Silva KVCL. Saúde bucal e indicadores socioeconômicos de comunidades quilombolas rural e urbana do Estado do Rio Grande do Sul, Brasil. Faculd Odontol Lins/Unimep [Internet]. 2016 jul-dez [citado 2020 fev 10];26(2):61-73. Disponível em: Disponível em: http://dx.doi.org/10.15600/2238-1236/fol.v26n2p61-73
http://dx.doi.org/10.15600/2238-1236/fol... although their oral health status was measured by means of clinical examination. In another study involving adolescents, adults and elderly people based on the National Oral Health Survey (SBBrasil 2010) database, overall tooth loss prevalence was approximately 32.76%,¹1. Peres MA, Barbato PR, Reis SCGB, Freitas CHSM, Antunes JLF. Perdas dentárias no Brasil: análise da Pesquisa Nacional de Saúde Bucal 2010. Rev Saúde Pública [Internet]. 2013 dez [citado 2020 fev 10];47(Suppl 3):78-89. Disponível em: https://doi.org/10.1590/S0034-8910.2013047004226 reflecting the unfavorable oral health status of quilombola communities when compared to the oral health status of Brazil’s general population.

Furthermore, scientific evidence has demonstrated that rural communities, when compared to urban communities, have a higher percentage of decayed teeth (50.3% versus 43.7%), possibly associated with lack of fluoridated water supply and lack of preventive, educative and restorative dentistry.⁸8. Figueiredo MC, Benvegnú BP, Silveira PPL, Silva AM, Silva KVCL. Saúde bucal e indicadores socioeconômicos de comunidades quilombolas rural e urbana do Estado do Rio Grande do Sul, Brasil. Faculd Odontol Lins/Unimep [Internet]. 2016 jul-dez [citado 2020 fev 10];26(2):61-73. Disponível em: Disponível em: http://dx.doi.org/10.15600/2238-1236/fol.v26n2p61-73
http://dx.doi.org/10.15600/2238-1236/fol... In this study, strong association was found between the age of people in rural communities in the semi-arid region of Bahia state and tooth extractions, demonstrating that older quilombolas have more odds of having tooth loss due to extraction. However, age was not statistically significant in quilombolas in Rio Grande do Sul state, with regard to self-perception of overall oral health.¹⁴14. Bidinotto AB, D’ÁvilaII OP, Martins AB, Hugo FN, Neutzling MB, Bairros FS, et al. Autopercepção de saúde bucal em comunidades quilombolas no Rio Grande do Sul: um estudo transversal exploratório. Rev Bras Epidemiol [Internet]. 2017 jan-mar [citado 2020 fev 10];20(1):91-101. Disponível em: Disponível em: https://doi.org/10.1590/1980-5497201700010008
https://doi.org/10.1590/1980-54972017000... It is known that tooth loss prevalence among the elderly in Brazil is high, and among the highest worldwide,¹1. Peres MA, Barbato PR, Reis SCGB, Freitas CHSM, Antunes JLF. Perdas dentárias no Brasil: análise da Pesquisa Nacional de Saúde Bucal 2010. Rev Saúde Pública [Internet]. 2013 dez [citado 2020 fev 10];47(Suppl 3):78-89. Disponível em: https://doi.org/10.1590/S0034-8910.2013047004226 which may be explained by the cumulative effect of mouth diseases, as a result of difficulty in accessing dental services to prevent and treat these health conditions, above all in the past. Notwithstanding, it should be emphasized that elderly quilombolas, differently to non-quilombola elderly, have a higher percentage of decayed and lost teeth, reflecting their greater difficulty in accessing health services, in addition to there being no fluoridated water supply in most quilombola communities.⁸8. Figueiredo MC, Benvegnú BP, Silveira PPL, Silva AM, Silva KVCL. Saúde bucal e indicadores socioeconômicos de comunidades quilombolas rural e urbana do Estado do Rio Grande do Sul, Brasil. Faculd Odontol Lins/Unimep [Internet]. 2016 jul-dez [citado 2020 fev 10];26(2):61-73. Disponível em: Disponível em: http://dx.doi.org/10.15600/2238-1236/fol.v26n2p61-73
http://dx.doi.org/10.15600/2238-1236/fol...

9. Gomes KO, Reis EA, Guimarães MD, Cherchiglia ML. Utilização de serviços de saúde por população quilombola do Sudoeste da Bahia, Brasil. Cad Saúde Pública [Internet]. 2013 set [citado 2020 fev 10];29(9):1829-42. Disponível em: Disponível em: https://doi.org/10.1590/0102-311X00151412
https://doi.org/10.1590/0102-311X0015141... ^-¹⁰10. Mendonça HLC, Szwarcwald CL, Damacena GN. Autoavaliação de saúde bucal: resultados da Pesquisa Mundial de Saúde - Atenção Básica em quatro municípios do Estado do Rio de Janeiro, Brasil, 2005. Cad Saúde Pública [Internet]. 2012 out [citado 2020 fev 10];28(10):1927-38. Disponível em: Disponível em: https://doi.org/10.1590/S0102-311X2012001000011
https://doi.org/10.1590/S0102-311X201200...

Among the quilombolas studied, males were identified as being almost twice as likely to have tooth loss than their female peers. Other studies of periodontitis and unsatisfactory tooth brushing, based both on self-reporting²²22. Silva EKP, Santos PR, Chequer TPR, Melo CMA, Santana KC, Amorim MM, et al. Saúde bucal de adolescentes rurais quilombolas e não quilombolas: um estudo dos hábitos de higiene e fatores associados. Ciênc Saúde Coletiva [Internet]. 2008 set [citado 2020 fev 10];23(9):2963-78. Disponível em: Disponível em: https://doi.org/10.1590/1413-81232018239.02532018
https://doi.org/10.1590/1413-81232018239... and clinical examination,²³23. Macêdo TCN, Costa MCN, Gomes-Filho IS, Vianna MIP, Santos CT. Factors related to periodontal disease in a rural population. Braz Oral Res [Internet]. 2006 Jul-Sep [cited 2020 Feb 10];20(3):257-62. Available from: https://doi.org/10.1590/S1806-83242006000300014 showed their association with males, which may be explained by women being more concerned about their own health.

A study conducted using the SBBrasil 2010 database did not reach the same conclusions.¹1. Peres MA, Barbato PR, Reis SCGB, Freitas CHSM, Antunes JLF. Perdas dentárias no Brasil: análise da Pesquisa Nacional de Saúde Bucal 2010. Rev Saúde Pública [Internet]. 2013 dez [citado 2020 fev 10];47(Suppl 3):78-89. Disponível em: https://doi.org/10.1590/S0034-8910.2013047004226 That analysis, conducted on a national level for the year 2010, with the aim of verifying tooth loss in the Brazilian population, found high tooth loss prevalence among females in all age ranges. This discrepancy may be related to quilombola women seeking health services more frequently, a fact which, depending on the type of professional practice, may result in overtreatment;¹1. Peres MA, Barbato PR, Reis SCGB, Freitas CHSM, Antunes JLF. Perdas dentárias no Brasil: análise da Pesquisa Nacional de Saúde Bucal 2010. Rev Saúde Pública [Internet]. 2013 dez [citado 2020 fev 10];47(Suppl 3):78-89. Disponível em: https://doi.org/10.1590/S0034-8910.2013047004226 geographic differences between the studies may also have influenced this lack of agreement, given that the national study was conducted in urban areas, while this study took place in rural communities.

Quilombolas working without formal job registration were more likely to have had teeth extracted, compared to those with formal job registration. The pay of informal workers tends to be below the legal minimum wage and, generally, they take less care or precarious care of their health, especially when they return to work early or continue working before their health is fully recovered, either for fear of losing their job or because they need the money.²⁴24. Iriart JAB, Oliveira RP, Xavier SS, Costa AMS, Araújo GR, Santana VS. Representações do trabalho informal e dos riscos à saúde entre trabalhadoras domésticas e trabalhadores da construção civil. Ciênc Saúde Coletiva [Internet]. 2008 fev [citado 2020 fev 10];13(1):165-74. Disponível em: Disponível em: https://doi.org/10.1590/S1413-81232008000100021
https://doi.org/10.1590/S1413-8123200800...

It was found, however, that not working was a protection factor for having lost fewer teeth. This result was not discussed directly in similar studies.⁸8. Figueiredo MC, Benvegnú BP, Silveira PPL, Silva AM, Silva KVCL. Saúde bucal e indicadores socioeconômicos de comunidades quilombolas rural e urbana do Estado do Rio Grande do Sul, Brasil. Faculd Odontol Lins/Unimep [Internet]. 2016 jul-dez [citado 2020 fev 10];26(2):61-73. Disponível em: Disponível em: http://dx.doi.org/10.15600/2238-1236/fol.v26n2p61-73
http://dx.doi.org/10.15600/2238-1236/fol... ^,¹⁴14. Bidinotto AB, D’ÁvilaII OP, Martins AB, Hugo FN, Neutzling MB, Bairros FS, et al. Autopercepção de saúde bucal em comunidades quilombolas no Rio Grande do Sul: um estudo transversal exploratório. Rev Bras Epidemiol [Internet]. 2017 jan-mar [citado 2020 fev 10];20(1):91-101. Disponível em: Disponível em: https://doi.org/10.1590/1980-5497201700010008
https://doi.org/10.1590/1980-54972017000... Only the study conducted by Kochergin et al.,²⁵25. Kochergin CN, Proietti FA, Comini César C. Comunidades quilombolas de Vitória da Conquista, Bahia, Brasil: autoavaliação de saúde e fatores associados. Cad Saúde Pública [Internet]. 2014 jul [citado 2020 fev 10];30(7):1487-501. Disponível em: Disponível em: https://doi.org/10.1590/0102-311X00141213
https://doi.org/10.1590/0102-311X0014121... when considering the ‘has a source of income’ variable, which could be indirectly related to having a job and working, did not reveal statistically significant association between the ‘has a source of income’ variable and tooth loss. New studies which take these aspects into consideration are needed.

It is recognized that tooth extraction can be an indicator of social inequity between population groups, given that it expresses a reality of living and health condition vulnerabilities. A study conducted by Guiotoku et al.,⁵5. Guiotoku SK, Moysés ST, Moysés SJ, França BHS, Bisinelli JC. Iniquidades raciais em saúde bucal no Brasil. Rev Panam Salud Pública [Internet]. 2012 [citado 2020 fev 10];31(2):135-41. Disponível em: Disponível em: http://iris.paho.org/xmlui/bitstream/handle/123456789/9364/a07v31n2.pdf?sequence=1&isAllowed=y
http://iris.paho.org/xmlui/bitstream/han... based on data from the national survey of the oral health status of the Brazilian population, found higher presence of health conditions and need for dental treatment, such as dentures and pain relief, among Black individuals when compared to White individuals.

This study found that individuals with dental caries had greater odds of having tooth loss. Strong association was expected between self-reported dental caries and tooth extraction given that, according to the specific literature, the main determining factors of high rates of tooth loss, either partial or total, are dental caries and periodontitis.²⁶26. Steele JG, Sanders AE, Slade GD, Allen PF, Lahti S, Nuttall AJ, et al. How do age and tooth loss affect oral health impacts and quality of life? A studycomparing two national samples. Community Dent Oral Epidemiol [Internet]. 2004 Apr [cited 2020 Feb 10];32(2):107-14. Available from: Available from: https://doi.org/10.1111/j.0301-5661.2004.00131.x
https://doi.org/10.1111/j.0301-5661.2004... ^,²⁷27. Mendonça TC. Mutilação dentária: concepções de trabalhadores rurais sobre a responsabilidade pela perda dentária. Cad Saúde Pública [Internet]. 2001 dez [citado 2020 fev 10];17(6):1545-47. Disponível em: Disponível em: https://doi.org/10.1590/S0102-311X2001000600027
https://doi.org/10.1590/S0102-311X200100...

In many countries, dental caries prevalence in different population groups is becoming increasingly lower. However, socio-economically deprived population groups have been shown to have the highest concentrations of dental caries.²⁸28. Mello TRC, Antunes JLF, Waldman EA. Áreas rurais: pólos de concentração de agravos à saúde bucal? Arq Med [Internet]. 2005 jan [citado 2020 fev 10];19(1-2):67-74. Disponível em: Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_abstract&pid=S0871-34132005000100010&lng=pt&nrm=iso
http://www.scielo.mec.pt/scielo.php?scri... In this setting, it is valid to highlight that according to diagnosis performed by the Brasil Quilombola Program in 2012,¹⁸18. Secretaria de Promoção de Igualdade Racial (BR). Programa Brasil quilombola: diagnóstico de ações realizadas [Internet]. Brasília: Secretaria de Promoção de Igualdade Racial; 2012 [citado 2020 fev 10]. 34 p. Disponível em: Disponível em: https://www.mdh.gov.br/biblioteca/igualdade-racial/diagnostico-de-acoes-realizadas-programa-brasil-quilombola/view
https://www.mdh.gov.br/biblioteca/iguald... 75.6% of the country’s quilombola familes live in extreme poverty. This explains to a great extent the association between high rates of dental caries in this population and their vulnerable living conditions. Despite government investment targeting quilombola communities and despite the creation of 1,536 Oral Health teams, as part of the Brasil Quilombola Program, supported by the Health Ministry’s Brasil Sorridente (Smiling Brazil) initiative, dental care, prevention and rehabilitation services provided to this population are still insufficient.¹⁸18. Secretaria de Promoção de Igualdade Racial (BR). Programa Brasil quilombola: diagnóstico de ações realizadas [Internet]. Brasília: Secretaria de Promoção de Igualdade Racial; 2012 [citado 2020 fev 10]. 34 p. Disponível em: Disponível em: https://www.mdh.gov.br/biblioteca/igualdade-racial/diagnostico-de-acoes-realizadas-programa-brasil-quilombola/view
https://www.mdh.gov.br/biblioteca/iguald... Furthermore, although the supply of fluoridated water is obligatory in Brazil, it has not yet reached all Brazilians, above all those who live in rural and peripheral areas, leaving many people without this benefit that is of recognized efficacy and significant effectiveness.²⁹29. Antunes JLF, Narvai PC. Políticas de saúde bucal no Brasil e seu impacto sobre as desigualdades em saúde. Rev Saúde Pública [Internet]. 2010 abr [citado 2020 fev 10];44(2):360-5. Disponível em: Disponível em: https://doi.org/10.1590/S0034-89102010005000002
https://doi.org/10.1590/S0034-8910201000...

Low use of oral health services by quilombolas demonstrates the need to increase their availability and quality. As evidence of this reality, a study demonstrated less access to health services and, consequently, less health service use by rural populations.³⁰30. Cavalcanti RP, Gaspar GS, Goes PSA. Utilização e acesso aos serviços de saúde bucal do sus - uma comparação entre populações rurais e urbanas. Pesq Bras Odontoped Clin Integr [Internet]. 2012 jun-mar [citado 2020 fev 10];12(1):121-26. Disponível em: Disponível em: http://revista.uepb.edu.br/index.php/pboci/article/viewFile/1128/805
http://revista.uepb.edu.br/index.php/pbo... In the case of rural quilombola communities, this condition is associated with less availability of services, inexistence of Family Health Strategy teams, large distances to be covered and transport difficulties.⁹9. Gomes KO, Reis EA, Guimarães MD, Cherchiglia ML. Utilização de serviços de saúde por população quilombola do Sudoeste da Bahia, Brasil. Cad Saúde Pública [Internet]. 2013 set [citado 2020 fev 10];29(9):1829-42. Disponível em: Disponível em: https://doi.org/10.1590/0102-311X00151412
https://doi.org/10.1590/0102-311X0015141... This study did not find significant association between self-reported tooth loss and the ‘years of schooling’ and ‘income’ variables. Diverging results have however been found by other studies, which found that the more income and schooling decreased, the greater the prevalence of tooth loss.¹1. Peres MA, Barbato PR, Reis SCGB, Freitas CHSM, Antunes JLF. Perdas dentárias no Brasil: análise da Pesquisa Nacional de Saúde Bucal 2010. Rev Saúde Pública [Internet]. 2013 dez [citado 2020 fev 10];47(Suppl 3):78-89. Disponível em: https://doi.org/10.1590/S0034-8910.2013047004226 However, low schooling and low income cannot be taken as a basis, since among the quilombola populations of Feira de Santana no comparison was made between people with high and low income: all individuals interviewed had low income, some with a little more and others with a bit less. Despite self-assessment of health being a good indicator of population group health status, this variable was not significant in the adjusted multinomial analysis, although the same indicator has expressed important associations with socio-economic, social support and health condition dimensions in epidemiological studies with other quilombola communities.²⁵25. Kochergin CN, Proietti FA, Comini César C. Comunidades quilombolas de Vitória da Conquista, Bahia, Brasil: autoavaliação de saúde e fatores associados. Cad Saúde Pública [Internet]. 2014 jul [citado 2020 fev 10];30(7):1487-501. Disponível em: Disponível em: https://doi.org/10.1590/0102-311X00141213
https://doi.org/10.1590/0102-311X0014121...

In view of the scarcity of scientific evidence regarding factors associated with tooth loss in quilombola populations, this study has contributed to the advancement of knowledge on the issue, and can inform and be used for comparison with future epidemiological investigations of the oral health status of Brazil’s quilombola population.

We recognize that a limitation of this study is the absence of dental examination and this fact reduces the robustness of the data collected, in addition to the limitations inherent to analysis of variables generated via self-reporting. Oral health status, when self-reported, may underestimate or overestimate associations, to the extent that the need exists for participating individuals to have prior knowledge of what dental caries and periodontal disease are, for example. A more accurate assessment, undertaken by a dental surgeon, or based on the participants’ dental records, could generate more concrete results about tooth loss resulting from tooth extraction.

Tooth extraction among quilombolas in the semi-arid region of Bahia state appears to be related to the social vulnerability of these communities. The results found point to the conditions to which surviving quilombo communities are exposed - and vulnerable - in the semi-arid region of Bahia state with regard to their oral health. As such, even with the evident progress made following the implementation of public policies, such as the Brasil Quilombola Program, much still needs to be done for the preventive and rehabilitative oral health of this population.

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²²
Silva EKP, Santos PR, Chequer TPR, Melo CMA, Santana KC, Amorim MM, et al. Saúde bucal de adolescentes rurais quilombolas e não quilombolas: um estudo dos hábitos de higiene e fatores associados. Ciênc Saúde Coletiva [Internet]. 2008 set [citado 2020 fev 10];23(9):2963-78. Disponível em: Disponível em: https://doi.org/10.1590/1413-81232018239.02532018
» https://doi.org/10.1590/1413-81232018239.02532018
²³
Macêdo TCN, Costa MCN, Gomes-Filho IS, Vianna MIP, Santos CT. Factors related to periodontal disease in a rural population. Braz Oral Res [Internet]. 2006 Jul-Sep [cited 2020 Feb 10];20(3):257-62. Available from: https://doi.org/10.1590/S1806-83242006000300014
²⁴
Iriart JAB, Oliveira RP, Xavier SS, Costa AMS, Araújo GR, Santana VS. Representações do trabalho informal e dos riscos à saúde entre trabalhadoras domésticas e trabalhadores da construção civil. Ciênc Saúde Coletiva [Internet]. 2008 fev [citado 2020 fev 10];13(1):165-74. Disponível em: Disponível em: https://doi.org/10.1590/S1413-81232008000100021
» https://doi.org/10.1590/S1413-81232008000100021
²⁵
Kochergin CN, Proietti FA, Comini César C. Comunidades quilombolas de Vitória da Conquista, Bahia, Brasil: autoavaliação de saúde e fatores associados. Cad Saúde Pública [Internet]. 2014 jul [citado 2020 fev 10];30(7):1487-501. Disponível em: Disponível em: https://doi.org/10.1590/0102-311X00141213
» https://doi.org/10.1590/0102-311X00141213
²⁶
Steele JG, Sanders AE, Slade GD, Allen PF, Lahti S, Nuttall AJ, et al. How do age and tooth loss affect oral health impacts and quality of life? A studycomparing two national samples. Community Dent Oral Epidemiol [Internet]. 2004 Apr [cited 2020 Feb 10];32(2):107-14. Available from: Available from: https://doi.org/10.1111/j.0301-5661.2004.00131.x
» https://doi.org/10.1111/j.0301-5661.2004.00131.x
²⁷
Mendonça TC. Mutilação dentária: concepções de trabalhadores rurais sobre a responsabilidade pela perda dentária. Cad Saúde Pública [Internet]. 2001 dez [citado 2020 fev 10];17(6):1545-47. Disponível em: Disponível em: https://doi.org/10.1590/S0102-311X2001000600027
» https://doi.org/10.1590/S0102-311X2001000600027
²⁸
Mello TRC, Antunes JLF, Waldman EA. Áreas rurais: pólos de concentração de agravos à saúde bucal? Arq Med [Internet]. 2005 jan [citado 2020 fev 10];19(1-2):67-74. Disponível em: Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_abstract&pid=S0871-34132005000100010&lng=pt&nrm=iso
» http://www.scielo.mec.pt/scielo.php?script=sci_abstract&pid=S0871-34132005000100010&lng=pt&nrm=iso
²⁹
Antunes JLF, Narvai PC. Políticas de saúde bucal no Brasil e seu impacto sobre as desigualdades em saúde. Rev Saúde Pública [Internet]. 2010 abr [citado 2020 fev 10];44(2):360-5. Disponível em: Disponível em: https://doi.org/10.1590/S0034-89102010005000002
» https://doi.org/10.1590/S0034-89102010005000002
³⁰
Cavalcanti RP, Gaspar GS, Goes PSA. Utilização e acesso aos serviços de saúde bucal do sus - uma comparação entre populações rurais e urbanas. Pesq Bras Odontoped Clin Integr [Internet]. 2012 jun-mar [citado 2020 fev 10];12(1):121-26. Disponível em: Disponível em: http://revista.uepb.edu.br/index.php/pboci/article/viewFile/1128/805
» http://revista.uepb.edu.br/index.php/pboci/article/viewFile/1128/805

*
Article derived from the Master’s Degree thesis entitled ‘Social determinants of diseases and health conditions in the quilombola communities of Feira de Santana, Bahia’, defended by Roberta Lima Machado de Souza Araújo at the Feira de Santana State University (UEFS) Public Health Postgraduate Program in 2017. The study received financial support from the National Scientific and Technological Development Council/Ministry of Science, Technology, Innovation and Communications (CNPq/MCTIC), via Call for Proposals CNPq/MS/SCTIE/DECIT/SGEP/DAGEP No. 21/2014 - Black People’s Health in Brazil; Process No. 466874/2014-6, as per UEFS Teaching, Research and Extension Council (CONSEPE) Resolution No. 007/2015.

Publication Dates

Publication in this collection
20 May 2020
Date of issue
2020

History

Received
28 Feb 2019
Accepted
27 Jan 2020

Este é um artigo publicado em acesso aberto sob uma licença Creative Commons

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» https://doi.org/10.1590/S0034-8910.2013047004817

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[22] ²²
Silva EKP, Santos PR, Chequer TPR, Melo CMA, Santana KC, Amorim MM, et al. Saúde bucal de adolescentes rurais quilombolas e não quilombolas: um estudo dos hábitos de higiene e fatores associados. Ciênc Saúde Coletiva [Internet]. 2008 set [citado 2020 fev 10];23(9):2963-78. Disponível em: Disponível em: https://doi.org/10.1590/1413-81232018239.02532018
» https://doi.org/10.1590/1413-81232018239.02532018

[23] ²³
Macêdo TCN, Costa MCN, Gomes-Filho IS, Vianna MIP, Santos CT. Factors related to periodontal disease in a rural population. Braz Oral Res [Internet]. 2006 Jul-Sep [cited 2020 Feb 10];20(3):257-62. Available from: https://doi.org/10.1590/S1806-83242006000300014

[24] ²⁴
Iriart JAB, Oliveira RP, Xavier SS, Costa AMS, Araújo GR, Santana VS. Representações do trabalho informal e dos riscos à saúde entre trabalhadoras domésticas e trabalhadores da construção civil. Ciênc Saúde Coletiva [Internet]. 2008 fev [citado 2020 fev 10];13(1):165-74. Disponível em: Disponível em: https://doi.org/10.1590/S1413-81232008000100021
» https://doi.org/10.1590/S1413-81232008000100021

[25] ²⁵
Kochergin CN, Proietti FA, Comini César C. Comunidades quilombolas de Vitória da Conquista, Bahia, Brasil: autoavaliação de saúde e fatores associados. Cad Saúde Pública [Internet]. 2014 jul [citado 2020 fev 10];30(7):1487-501. Disponível em: Disponível em: https://doi.org/10.1590/0102-311X00141213
» https://doi.org/10.1590/0102-311X00141213

[26] ²⁶
Steele JG, Sanders AE, Slade GD, Allen PF, Lahti S, Nuttall AJ, et al. How do age and tooth loss affect oral health impacts and quality of life? A studycomparing two national samples. Community Dent Oral Epidemiol [Internet]. 2004 Apr [cited 2020 Feb 10];32(2):107-14. Available from: Available from: https://doi.org/10.1111/j.0301-5661.2004.00131.x
» https://doi.org/10.1111/j.0301-5661.2004.00131.x

[27] ²⁷
Mendonça TC. Mutilação dentária: concepções de trabalhadores rurais sobre a responsabilidade pela perda dentária. Cad Saúde Pública [Internet]. 2001 dez [citado 2020 fev 10];17(6):1545-47. Disponível em: Disponível em: https://doi.org/10.1590/S0102-311X2001000600027
» https://doi.org/10.1590/S0102-311X2001000600027

[28] ²⁸
Mello TRC, Antunes JLF, Waldman EA. Áreas rurais: pólos de concentração de agravos à saúde bucal? Arq Med [Internet]. 2005 jan [citado 2020 fev 10];19(1-2):67-74. Disponível em: Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_abstract&pid=S0871-34132005000100010&lng=pt&nrm=iso
» http://www.scielo.mec.pt/scielo.php?script=sci_abstract&pid=S0871-34132005000100010&lng=pt&nrm=iso

[29] ²⁹
Antunes JLF, Narvai PC. Políticas de saúde bucal no Brasil e seu impacto sobre as desigualdades em saúde. Rev Saúde Pública [Internet]. 2010 abr [citado 2020 fev 10];44(2):360-5. Disponível em: Disponível em: https://doi.org/10.1590/S0034-89102010005000002
» https://doi.org/10.1590/S0034-89102010005000002

[30] ³⁰
Cavalcanti RP, Gaspar GS, Goes PSA. Utilização e acesso aos serviços de saúde bucal do sus - uma comparação entre populações rurais e urbanas. Pesq Bras Odontoped Clin Integr [Internet]. 2012 jun-mar [citado 2020 fev 10];12(1):121-26. Disponível em: Disponível em: http://revista.uepb.edu.br/index.php/pboci/article/viewFile/1128/805
» http://revista.uepb.edu.br/index.php/pboci/article/viewFile/1128/805

Variables	N	%	95%CI^a
Age (in years)
18-29	220	25.5	(22.6;28.5)
30-39	226	26.2	(23.2;29.2)
40-49	150	17.4	(14.9;20.0)
50-59	100	11.5	(9.5;13.9)
≥60	168	19.4	(16.8;22.2)
Sex
Female	544	63.0	(59.6;66.2)
Male	320	37.0	(33.8;40.3)
Marital status
With partner	443	51.3	(47.9;54.6)
Without partner	421	48.7	(45.3;52.1)
Years of schooling
≤8	667	77.2	(74.2;79.9)
>8	197	22.8	(20.0;25.7)
Has a job
Yes	520	60.2	(56.8;63.5)
No	344	39.8	(36.5;43.2)
Situation at work
Registered worker	139	26.7	(22.9;30.7)
Unregistered worker	382	73.3	(69.3;77.1)
Monthly per capita income^b
≥1 minimum wage	157	18.2	(15.6;20.9)
<1 minimum wage	707	81.8	(79.0;84.3)
Self-assessment of health
Good	439	50.8	(47.4;54.2)
Regular	385	44.6	(41.2;47.9)
Poor	40	4.6	(3.3;6.2)
Having had dental caries
Yes	502	58.1	(54.7;61.4)
No	362	41.9	(38.9;45.3)
Tooth extractions (in number of teeth extracted)
≤5	430	49.8	(46.4;53.1)
>5	278	32.2	(29.1;35.4)
No tooth loss	156	18.0	(15.5;20.8)

Variables	Tooth extractions
	Up to 5 extractions				More than 5 extractions
	Crude OR (95%CI^c)	p-value^b	Adjusted OR^a (95%CI)^c	p-value^b	Crude OR (95%CI)^c	p-value^b	Adjusted OR^a (95%CI)^c	p-value^b
Age (in years)		<0.001		<0.001		<0.001		<0.001
18-29	1.0		1.0	-	1.0	-	1.0	-
30-39	3.2 (2.0;5.0)		3.2 (2.0;5.0)		7.0 (3.2;15.2)		7.0 (3.2;15.2)
40-49	5.7 (3.0;10.8)		5.5 (2.9;10.5)		30.2 (12.5;72.6)		29.8 (12.4;71.8)
50-59	5.8 (2.2;15.5)		5.9 (2.2;15.9)		100.8 (33.3;304.7)		101.5 (33.5;307.0)
≥60	5.3 (2.0;14.3)		5.2 (1.9;14.1)		222.1 (74.7;660.7)		220.4 (74.1;655.7)
Sex
Female	1.0	-	1.0	-	1.0	-	1.0	-
Male	1.8 (1.2;2.7)	0.003	1.7 (1.1;2.7)	0.006	1.3 (0.9;2.1)	0.177	1.3 (0.7;2.1)	0.369
Marital status
With partner	1.0	-	1.0	-	1.0	-	1.0	-
Without partner	1.5 (1.1;2.2)	0.034	1.1 (0.7;1.6)	0.693	1.3 (0.9;1.9)	0.195	0.79 (0.5;1.3)	0.357
Years of schooling
>8	1.0	-	1.0	-	1.0	-	1.0	-
≤8	1.1 (0.7;1.8)	0.505	1.0 (0.7;1.6)	0.850	0.8 (0.5;1.3)	0.456	0.8 (0.5;1.5)	0.574
Has a job
Yes	1.0	-	1.0	-	1.0	-	1.0	-
No	0.5 (0.3;0.7)	0.002	0.6 (0.4;0.9)	0.008	1.6 (1.1;2.3)	0.019	0.8 (0.5;1.4)	0.498
Situation at work
Registered worker	1.0	-	1.0	-	1.0	-	1.0	-
Unregistered worker	1.5 (0.9;2.5)	0.072	1.7 (1.1;2.3)	0.050	3.5 (1.8;6.7)	<0.001	2.7 (1.3;5.7)	0.008
Monthly per capita income^d
≥1 minimum wage	1.0	-	1.0	-	1.0	-	1.0	-
<1 minimum wage	1.2 (0.7;2.0)	0.424	1.0 (0.6;1.7)	0.912	0.6 (0.3;1.0)	0.093	0.8 (0.4;1.5)	0.418
Self-rated health		0.660		0.897		<0.001		0.383
Good	1.0		1.0		1.0		1.0
Regular	1.0 (0.7;1.5)		0.9 (0.6;1.4)		1.8 (1.2;2.7)		1.0 (0.6;1.6)
Poor	1.2 (0.3;4.6)		0.9 (0.2;3.7)		7.4 (2.1;25.2)		2.3 (0.5;9.0)
Having had dental caries
No	1.0	-	1.0	-	1.0	-	1.0	-
Yes	3.0 (1.9;4.3)	<0.001	2.8 (1.8;4.1)	0.000	4.3 (2.8;6.4)	<0.001	4.1 (2.5;6.7)	<0.001