Abstract

INTRODUCTION

Over the last ten years. the World Health Organization has made great efforts to emphasize the importance of oral health conditions as an important and integral part of an individual’s general health and quality of life. ²⁰20 . 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. Community Dent Oral Epidemiol. 2003;31Suppl1:3-23. DOI: 10.1046/j..2003.com122.x
https://doi.org/10.1046/j..2003.com122.x... Studies have shown the significant role played by oral health disorders such as dental pain and tooth loss. as well as problems related to severe malocclusion. in absenteeism both at school ¹⁶16 . Moure-Leite FR, Ramos-Jorge J, Ramos-Jorge ML, Paiva SM, Vale MP, Pordeus IA. Impact of dental pain on daily living of five-year-old Brazilian preschool children: prevalence and associated factors. Eur Arch Paediatr Dent. 2011;12(6):293-7. DOI: 10.1007/BF03262826
https://doi.org/10.1007/BF03262826... and at work. ²²22 . Reisine S, Miller J. A longitudinal study of work loss related to dental diseases. Soc Sci Med. 1985;21(12):1309-14. DOI: 10.1016/0277-9536(85)90433-2
https://doi.org/10.1016/0277-9536(85)904... Moreover. problems related to dental appearance have been associated with bullying in schoolchildren. ²⁴24 . Seehra J, Newton JT, DiBiase AT. Bullying in schoolchildren - its relationship to dental appearance and psychosocial implications: an update for GDPs. Br Dent J. 2011;210(9):411-5. DOI: 10.1038/sj.bdj.2011.339
https://doi.org/10.1038/sj.bdj.2011.339...

In addition to clinical measures. epidemiological studies on oral health have used self-perceived oral health and the impact of oral health disorders on day-to-day life in order to estimate the impact of oral health problems on the individual’s quality of life. ²2 . Adulyanon S, Vourapukjaru J, Sheiham A. Oral impacts affecting daily performance in a low dental disease Thai population. Community Dent Oral Epidemiol. 1996;24(6):385-9. DOI: 10.1111/j.1600-0528.1996.tb00884.x
https://doi.org/10.1111/j.1600-0528.1996... Specific instruments have been developed for this purpose. such as structured questionnaires validated for the Brazilian population and for other countries. which have provided support in prioritizing the allocation of resources for promoting health care and dental treatment as well as in the assessment and monitoring of sick individuals. ¹³13 . Leao A, Sheiham A. Relation between clinical dental status and subjective impacts on daily living. J Dent Res. 1995;74(7):1408-13. DOI: 10.1177/00220345950740071301
https://doi.org/10.1177/0022034595074007...

Oral health disorders. dental pain. ¹⁶16 . Moure-Leite FR, Ramos-Jorge J, Ramos-Jorge ML, Paiva SM, Vale MP, Pordeus IA. Impact of dental pain on daily living of five-year-old Brazilian preschool children: prevalence and associated factors. Eur Arch Paediatr Dent. 2011;12(6):293-7. DOI: 10.1007/BF03262826
https://doi.org/10.1007/BF03262826... untreated dental caries. ¹²12 . Leal SC, Bronkhorst EM, Fan M, Frencken JE. Untreated cavitated dentine lesions: impact on children’s quality of life. Caries Res. 2012;46(2):102-6. DOI: http://dx.doi.org/10.1159/000336387
https://doi.org/10.1159/000336387... gingival bleeding ¹⁹19 . Peres KG, Peres MA, Araujo CL, Menezes AM, Hallal PC. Social and dental status along the life course and oral health impacts in adolescents: a population-based birth cohort. Health Qual Life Outcomes. 2009;7:95. DOI: 10.1186/1477-7525-7-95
https://doi.org/10.1186/1477-7525-7-95... and dental crowding in anterior teeth ¹1 . Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bonecker M, Raggio DP. Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Community Dent Oral Epidemiol. 2011;39(2):105-14. DOI: 10.1111/j.1600-0528.2010.00580.x
https://doi.org/10.1111/j.1600-0528.2010... have been associated with negative impacts on the quality of life in children and adolescents. The adverse effects of these health conditions may be seen through different dimensions. such as: daily performance in eating and speaking. problems in relating with others as well as other functional. social and psychological limitations. ^7.19

Although there has been a significant increase in the number of studies which have investigated the impact of oral health conditions on the adolescent’s quality of life. these studies have. in general. been limited to a specific population such as schoolchildren. and they are rare in the Brazilian context. The majority of these studies investigated the psychometric properties of the questionnaires on quality of life related to oral health and its correlation with clinical oral health parameters; there are few studies which investigate the role of demographic and socioeconomic characteristics on the quality of life scores related to oral health.

The Oral Health Surveillance of the Ministry of Health carried out the Brazilian Oral Health Survey (SBBrasil 2010) which was pioneering in Brazil as it incorporated data collection. which enabled the impact of oral health on Brazilians’ quality of life to be measured. These data. associated with other socioeconomic characteristics. allows social inequalities related to quality of life to be analyzed. The aim of this study was to estimate prevalence and identify sociodemographic factors and oral health problems associated with the negative impacts of oral health conditions on the quality of life of Brazilian adolescents.

METHODS

Data from the Brazilian Oral Health Survey (SBBrasil) 2010 were used. A representative sample of the Brazilian population was interviewed and examined in the participants’ homes in order to investigate the main oral health disorders as well as demographic and socioeconomic characteristics. This study included a sample of adolescents aged 15 to 19 who participated in the SBBrasil 2010 project.

All of the state capitals and the Federal District were included in the sample. Each region was represented by 30 municipalities in the interior (North, Northeast, Central-West, Southeast and South) being considered as domains in the study. A two-stage sampling scheme was adopted for the 26 state capitals and the Federal District and a three-stage sampling scheme for the municipalities in the interior of the five Brazilian macro regions. The primary sample units were: (a) municipality. for the interior. and (b) census tract for the state capitals. Individuals were randomly selected according to the number of permanent private urban residences in each census tract. This information was provided by the Instituto Brasileiro de Geografia e Estatística (IBGE, Brazilian Institute of Geography and Statistics) – from the 2007 national census and through the count of residences carried out in the SBBrasil 2010 considering data from 2000, as well as the proportion of individuals within each age group in the Brazilian age group pyramid. This process produced a sample interval which allowed individuals to be randomly selected in each age group. A total of 5,445 individuals aged 15 to 19 were interviewed and examined. Further information on the sampling procedure can be found elsewhere. ²³23 . Roncalli AG, da Silva NN, Nascimento AC, Freitas CHSM, Casotti E, Peres KG, et al. Aspectos metodológicos do projeto SB Brasil 2010 de interesse para Inquéritos Nacionais de Saúde. Cad Saude Publica. 2012;28Suppl:40-57. DOI: 10.1590/S0102-311X2012001300006
https://doi.org/10.1590/S0102-311X201200...

Clinical dental examinations and interviews through a structured questionnaire were performed. The questionnaire was designed especially for the research and a handheld Personal Digital Assistant, model P550, provided by the IBGE was used to collect the data. Prior to the field work. two pilot studies were carried out (one in Florianópolis, SC, and the other in João Pessoa, PB), in order to verify the coherence, logistics and feasibility of the study’s instruments and the methodology. The consensus technique was used to train and calibrate the team. ¹⁰10 . Frias AC, Antunes JLF, Narvai PC. Precisão e validade de levantamentos epidemiológicos em saúde bucal: cárie dentária na cidade de São Paulo, 2002. Rev Bras Epidemiol. 2004;7(2):144-54. DOI: 10.1590/S1415-790X2004000200004
https://doi.org/10.1590/S1415-790X200400... The inter-observer reliability was obtained through the weighted kappa coefficient. The kappa equal to 0.65 was considered the minimum acceptable value for all conditions under study.

Field work teams were formed of one examiner (dentist) and one interviewer. both of them from the Sistema Único de Saúde (public health care system). with a total of ten teams in each state capital and from two to six teams for municipalities. Teams undertook 40 hours of training in regional workshops. All of the appropriate biosafety procedures were duly followed, such as using personal equipment, sterilizing instruments and proper disposal of materials.

Quality of life was investigated using the Oral Impacts on Daily Performance (OIDP) instrument. ²2 . Adulyanon S, Vourapukjaru J, Sheiham A. Oral impacts affecting daily performance in a low dental disease Thai population. Community Dent Oral Epidemiol. 1996;24(6):385-9. DOI: 10.1111/j.1600-0528.1996.tb00884.x
https://doi.org/10.1111/j.1600-0528.1996... The OIDP is composed of nine items related to day-to-day activities which could be affected by oral health conditions. The instrument includes physical, psychological and social aspects, and dimensions concerning eating, smiling, studying, speaking, doing sport, cleaning teeth, sleeping, and emotional aspects and social contact. Each item was preceded by the question, “ Some people have problems which may have been caused by their teeth. Out of the following concerns, which apply to you in the last six months ?”. The response options were: none (code 0) and yes (code 1) and don’t know or do not want to reply (code 9). Code 9 was treated as missing information for each OIDP question. Simple counting of the score was carried out using nine dummy variables (yes/no). OIDP (dependent variable) was analyzed as a discrete variable ranging from zero (no impact) to nine (impact in all nine dimensions).

The independent variables involved were demographic, socioeconomic, oral conditions and dental pain characteristics. Demographic data included, race/skin color and socioeconomic data referred to, schooling and household income. Race/skin color was classified according to IBGE (white, brown, black, yellow/asiatic and indigenous). The participants’ level of schooling was measured in terms of the number of successfully completed school years and categorized 0-4. 5-8. 9-11. and 12 or more years. Household income. reported by the head of family. was categorized as ≤ R$ 500.00, R$ 501.00 to R$ 2.500.00 and ≥ R$ 2.501.00. Oral health disorders evaluated were: dental caries, malocclusion, tooth loss and periodontal conditions. They were assessed according to their prevalence based on the indices proposed by the WHO for oral health care surveys. ²⁷27 . World Health Organization. Oral Health Surveys: basic methods. Genebra; 1997. Dental caries was assessed using the ‘decay’ component of the decayed, missing, filled teeth index (DMFT) categorized as none, 1 to 3 and ≥ 4. Malocclusion was assessed by the Dental Aesthetic Index (DAI) categorized according to need for treatment (none, defined malocclusion, severe and very severe). ⁹9 . Cons NC, Jenny J, Kohout FJ. DAI: the dental aesthetic index. Iowa: Iowa College of Dentistry; 1986. The ‘missing’ component of the DMFT index, dichotomized as 0 and ≥ 1, was used to assess tooth loss. The presence of gingival bleeding on probing (yes/no), dental calculus (yes/no) and some degree of periodontal pocket (yes/no) was obtained through six examinations sites of the index teeth of the Community Periodontal Index (CPI). ²⁷27 . World Health Organization. Oral Health Surveys: basic methods. Genebra; 1997. Dental pain was recorded using the question “Have you experienced dental pain in the last 6 months?” (yes/no).

Data analysis was carried out using STATA 11.0 statistical software, considering the complex sampling cluster design and sampling weight using the svyset command. Statistical analysis included the sample distribution according to the levels of OIDP index (0. 1 and ≥ 2 impacts) and the categories of the independent variables. The association between the independent variables and the OIDP index (outcome), analyzed as a discrete variable, was tested using Poisson regression, providing estimates of mean ratios (MR), crude and adjusted analysis with respective 95% confidence intervals. In order to analyze potential predictive factors for OIDP, a hierarchical model was performed for multivariable analysis. ²⁶26 . Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26(1):224-7. DOI: 10.1093/ije/26.1.224
https://doi.org/10.1093/ije/26.1.224... The independent variables were introduced into the model based on most distal to proximal variables, according to the adopted theoretical model ( Figure 1 ). The first level of the model included demographic variables (sex, race/skin color and age), the second level socio-economic variables (adolescents’ household income and schooling) and the third level oral health disorders ( Figure 1 ). All variables with p value ≤ 0.20 (Wald statistics) in the crude analysis were included in the multivariable model. The cutoff point of p ≤ 0.20 was used to maintain the variables in the model considering the potential confounders. In the final model, those variables with values of p < 0.05 after adjusting for variables at the same level and those in the upper levels. were considered to be statistically significant.

The SBBrasil 2010 Project followed the requirements of the Declaration of Helsinki and was approved by the Conselho Nacional de Ética em Pesquisa, record no. 15,498, 7 ^th January 2010.

RESULTS

A total of 5,445 adolescents aged 15 to 19 took part in the SBBrasil 2010 survey, with a response rate equal to 92.5%.

Table 1 shows the distribution of the sample and the OIDP in three categories, according to the independent variables studied. Slightly over half of the participants were female (51.4%), the majority self-reported as white (46.1%) or brown (40.5%) and the most frequent age was 15 (26.6%). with similar percentages for the remaining ages. The majority of the sample (71.5%) reported household income between R$ 501.00 and R$ 2,500.00, and approximately 80.0% had eight or more years of schooling. Regarding oral health disorders, slightly over half of the adolescents (53.4%) had no dental caries, while 15.2% had four or more untreated dental caries. At least 17.4% of the sample had lost one or more teeth due to dental caries and 25.0% reported having suffered from dental pain in the 6 months preceding the interview. Severe or very severe malocclusion was detected in 15.0% of the adolescents. When periodontal conditions were investigated, gingival bleeding after probing and dental calculus were observed in nearly 35.0% of the sample; and 10.0% of the adolescents presented periodontal pockets with four or more millimeters.

The prevalence of negative oral health impact was approximately 40.0%. and 22.5% of adolescents reported the presence of two or more negative impacts on their quality of life (Table 1). The prevalence of OIDP varied according to the investigated characteristics, being higher in females; those who were brown, yellow skinned or indigenous when compared with individuals who reported white skin; among adolescents with lower household income and lower levels of schooling when compared with those with higher incomes and higher levels of schooling. In adolescents who had oral health problems. the prevalence of negative OIDP was also higher than in adolescents with no oral health disorders.

Figure 2 shows, in descending order, the frequency distribution of the nine items included in the OIDP index. The three most commonly reported negative impacts on quality of life were: difficulty in eating (20.9), discomfort when brushing teeth (16.1%) and anxiety or irritation due to dental disorders (14.7%). The less common negative impacts reported were difficulty in studying (4.7%) and those related to doing sport (4.4%).

Figure 3 shows the overall distribution of the OIDP by domain as well as according to the oral health conditions investigated, The domain with the most overall negative impact and also for the oral health conditions investigated. was the physical, followed by the psychological and the social domains. The highest prevalence of negative impact was found in adolescents who reported dental pain – 65.8%, 57.0% and 24.7% for the physical, psychological and social domains. respectively.

Table 2 shows results from crude and adjusted Poisson regression analysis. Regarding crude analysis, all of the variables except age were associated with higher OIDP scores and were included in the adjusted model. After adjusted analysis, all variables remained associated with the outcome with the exception of presence of dental calculus and periodontal pockets (p-value > 0.2). Among variables in block 1, sex and race/skin color, showed a small change after the adjusted analysis – the mean OIDP score was 1.52 (95%CI 1.16;2.00) times higher in females than in males. The negative impact on quality of life was higher for brown (1.42, 95%CI 1.01;1.99), those with yellow skin (RM 2.66, 95%CI 1.40;5.07), and indigenous (RM 3.32, 95%CI 1.68;6.56) as compared to those with white skin. Variables in block 2, household income and schooling, showed a higher association with the outcome after the adjusted analysis: 1.84 (95%CI 1.06;3.17) for adolescents from lower income households and 2.11 (95%CI 1.30;3.41) for those with lower levels of schooling when compared with their respective reference categories. Oral health disorders in the third level of analysis, showed the highest impact on adolescents’ quality of life among those with four or more teeth with untreated dental caries (RM 1.53, 95%CI 1.12;2.10), those with one or more missing teeth (RM 1.44, 95% CI 1.6;1.80), dental pain (RM 3.62, 95%CI 2.93;4.46) and those with severe (RM 1.52, 95%CI 1.04;2.23) or very severe malocclusion (RM 1.32, 95%CI 1.01;1.72).

DISCUSSION

In the 2010 Brazilian National Oral Health Survey (SBBrasil 2010), 39.4% of the adolescents aged 15-19 experienced at least one impact of oral conditions on quality of life. Females, those with black, brown, yellow skin and the indigenous, those with fewer years of schooling and who were economically disadvantaged, reported significantly poorer quality of life than those who were more socioeconomically advantaged, revealing a picture of social inequality. In addition, individuals with untreated dental caries, missing teeth, dental pain, malocclusion, and bleeding on probing presented more impact on quality of life compared to those without these outcomes.

The SBBrasil 2010 was the first representative nationwide survey which included aspects of oral health-related quality of life of participants along with other self-reported and clinical oral health conditions. Moreover, the impact of oral health conditions on quality of life and the distribution of the impacts on adolescents are not well known. Studying the impact of oral health on quality of life in young people is particularly important. This age group is more sensitive to different impacts, such as, for instance, the perception of appearance and pain than adults. Oral conditions may affect not only adolescents’ quality of life but also their psychological development and social interactions. ⁸8 . Chen MS, Hunter P. Oral health and quality of life in New Zealand: a social perspective. Soc Sci Med. 1996;43(8):1213-22. DOI: 10.1016/0277-9536(95)00407-6
https://doi.org/10.1016/0277-9536(95)004...

Similar results regarding the prevalence of oral health impacts on quality of life in adolescents have been reported in other studies in Brazil. ⁶6 . Biazevic MG, Rissotto RR, Michel-Crosato E, Mendes LA, Mendes MO. Relationship between oral health and its impact on quality of life among adolescents. Braz Oral Res. 2008;22(1):36-42. DOI: 10.1590/S1806-83242008000100007 ^{, 19}19 . Peres KG, Peres MA, Araujo CL, Menezes AM, Hallal PC. Social and dental status along the life course and oral health impacts in adolescents: a population-based birth cohort. Health Qual Life Outcomes. 2009;7:95. DOI: 10.1186/1477-7525-7-95
https://doi.org/10.1186/1477-7525-7-95... Yet, a higher prevalence was found in schoolchildren aged 11-12 years in Rio de Janeiro (88.7%), ⁷7 . Castro RA, Portela MC, Leao AT, Vasconcellos MT. Oral health-related quality of life of 11- and 12-year-old public school children in Rio de Janeiro. Community Dent Oral Epidemiol. 2011;39(4):336-44. DOI: 10.1111/j.1600-0528.2010.00601.x
https://doi.org/10.1111/j.1600-0528.2010... and in studies in other countries involving 12 year-old children in Sudan ¹⁷17 . Nurelhuda NM, Ahmed MF, Trovik TA, Astrom AN. Evaluation of oral health-related quality of life among Sudanese schoolchildren using Child-OIDP inventory. Health Qual Life Outcomes. 2010;8(1):152. DOI: 10.1186/1477-7525-8-152
https://doi.org/10.1186/1477-7525-8-152... (54.6%) and school children aged between 11 and 16 in Catanzaro, Italy (66.8%). ⁵5 . Bianco A, Fortunato L, Nobile CG, Pavia M. Prevalence and determinants of oral impacts on daily performance: results from a survey among school children in Italy. Eur J Public Health. 2010;20(5):595-600. DOI: 10.1093/eurpub/ckp179
https://doi.org/10.1093/eurpub/ckp179...

The findings of this study are similar to others with regards the domains of oral health-related quality of life with more impacts. The physical domain, composed of items regarding difficulties eating and brushing teeth.,the latter with a very similar pattern to those concerning feeling nervous or angry and feeling embarrassed when smiling were also the most affected daily tasks. Similar findings were observed in adolescents in Uganda. ³3 . Astrom AN, Okullo I. Validity and reliability of the Oral Impacts on Daily Performance (OIDP) frequency scale: a cross-sectional study of adolescents in Uganda. BMC Oral Health. 2003;3(1):5. DOI: 10.1186/1472-6831-3-5
https://doi.org/10.1186/1472-6831-3-5... school children aged 11-12 in Rio de Janeiro (eating), ⁷7 . Castro RA, Portela MC, Leao AT, Vasconcellos MT. Oral health-related quality of life of 11- and 12-year-old public school children in Rio de Janeiro. Community Dent Oral Epidemiol. 2011;39(4):336-44. DOI: 10.1111/j.1600-0528.2010.00601.x
https://doi.org/10.1111/j.1600-0528.2010... adults in Thailand ²2 . Adulyanon S, Vourapukjaru J, Sheiham A. Oral impacts affecting daily performance in a low dental disease Thai population. Community Dent Oral Epidemiol. 1996;24(6):385-9. DOI: 10.1111/j.1600-0528.1996.tb00884.x
https://doi.org/10.1111/j.1600-0528.1996... and children in Sudan (eating and brushing teeth). ¹⁷17 . Nurelhuda NM, Ahmed MF, Trovik TA, Astrom AN. Evaluation of oral health-related quality of life among Sudanese schoolchildren using Child-OIDP inventory. Health Qual Life Outcomes. 2010;8(1):152. DOI: 10.1186/1477-7525-8-152
https://doi.org/10.1186/1477-7525-8-152... Moreover, the epidemiological profile of oral health conditions may significantly influence the pattern of these impacts.

In this study, the most affected domains among individuals with dental pain, tooth loss and untreated dental caries were the physical and psychological ones, without significance between them. Around one-quarter of the adolescents reported dental pain, almost 20.0% had experienced tooth loss and almost half of them had untreated dental caries, revealing a population with a high prevalence of these health outcomes. Therefore, it is expected that the greatest impacts were difficulty in eating and brushing teeth, as well as irritability, In contrast, studies carried out in countries with low prevalence of oral health problems, the psychological domain, which is related to problems smiling. was one of the most prevalent. ⁵5 . Bianco A, Fortunato L, Nobile CG, Pavia M. Prevalence and determinants of oral impacts on daily performance: results from a survey among school children in Italy. Eur J Public Health. 2010;20(5):595-600. DOI: 10.1093/eurpub/ckp179
https://doi.org/10.1093/eurpub/ckp179...

This study considered the adolescents’ family income and schooling as a proxy measure of socioeconomic conditions. The lower the income and level of schooling, the more the impact of oral health on quality of life. Adolescents from low income families were also more likely to report difficulties in chewing and psychosocial problems in their daily life compared with those from high income families, after taking into account the presence of oral health problems such as dental caries, periodontal disease and tooth loss. ¹⁴14 . Locker D. The burden of oral disorders in a population of older adults. Community Dent Health. 1992;9(2):109-24. This finding reinforces the results of this study regarding social inequalities in oral health. Studies on social inequality and non-normative oral health measures have increased in Brazil ²¹21 . Piovesan C, Antunes JL, Guedes RS, Ardenghi TM. Impact of socioeconomic and clinical factors on child oral health-related quality of life (COHRQoL). Qual Life Res. 2010;19(9):1359-66. DOI: 10.1007/s11136-010-9692-7
https://doi.org/10.1007/s11136-010-9692-... and internationally, ²⁵25 . Tsakos G, Sheiham A, Iliffe S, Kharicha K, Harari D, Swift CG, et al. The impact of educational level on oral health-related quality of life in older people in London. Eur J Oral Sci. 2009;117(3):286-92. DOI: 10.1111/j.1600-0722.2009.00619.x
https://doi.org/10.1111/j.1600-0722.2009... reinforcing the need to incorporate new approaches into this field of knowledge. Schooling is an important marker of social position. High levels of schooling is associated with better job opportunities, higher income and better housing which, in turn, have a positive influence on attitudes towards health, access to healthier food and use of oral hygiene products. ¹⁵15 . Marmot M, Bell R. Social determinants and dental health. Adv Dent Res. 2011;23(2):201-6. DOI: 10.1177/0022034511402079
https://doi.org/10.1177/0022034511402079...

This research also identified most of the health problems associated with the impact of oral health on quality of life in adolescents. Health conditions that related to a high level of suffering, such as toothache, stood out, which is a similar result to that obtained in another study. ¹⁸18 . Pau A, Khan SS, Babar MG, Croucher R. Dental pain and care-seeking in 11-14-yr-old adolescents in a low-income country. Eur J Oral Sci. 2008;116(5):451-7. DOI: 10.1111/j.1600-0722.2008.00563.x
https://doi.org/10.1111/j.1600-0722.2008... Clinical characteristics associated with aesthetics, such as severe malocclusion, also stood out. This finding was similar to other national ¹⁹19 . Peres KG, Peres MA, Araujo CL, Menezes AM, Hallal PC. Social and dental status along the life course and oral health impacts in adolescents: a population-based birth cohort. Health Qual Life Outcomes. 2009;7:95. DOI: 10.1186/1477-7525-7-95
https://doi.org/10.1186/1477-7525-7-95... ^{, 21}21 . Piovesan C, Antunes JL, Guedes RS, Ardenghi TM. Impact of socioeconomic and clinical factors on child oral health-related quality of life (COHRQoL). Qual Life Res. 2010;19(9):1359-66. DOI: 10.1007/s11136-010-9692-7
https://doi.org/10.1007/s11136-010-9692-... and international studies. ⁴4 . Bernabe E, Sheiham A, Oliveira CM. Impacts on daily performances attributed to malocclusions by British adolescents. J Oral Rehabil. 2009;36(1):26-31. DOI: 10.1111/j.1365-2842.2008.01899.x
https://doi.org/10.1111/j.1365-2842.2008... ^{, 11}11 . Johal A, Cheung MY, Marcene W. The impact of two different malocclusion traits on quality of life. Br Dent J. 2007;202(2):E2. DOI: 10.1038/bdj.2007.33
https://doi.org/10.1038/bdj.2007.33...

Although the SBBrasil 2010 was a representative survey using appropriate methodology, further analyses based on the data are not exempt from limitations. The cross-sectional design implies that causality cannot be inferred from the associations found in this study. Methodological diversity. including the questionnaires used to assess quality of life, as well as the age groups studied, do not allow direct comparisons between this and other studies. The origin of the impacts and their magnitude may vary across populations with different cultural backgrounds both within and between countries.

Studies on the importance of the SBBrasil may significantly contribute to understanding the population’s oral health problems in Brazil as they provide information to support the development of public policies. Moreover, regularly conducted representative national surveys such as SBBrasil, gathering detailed socioeconomic data, allow the expansion of strategies that consider the social gradient in the distribution of this phenomenon, in addition to preventive strategies and those related to monitoring and treatment of oral health problems that cause the most impact on quality of life. The distribution of inequalities should also be taken into account when planning the aforementioned strategies.

References

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History