Camila Mello dos Santos

Resilience and Self-Perceived Oral Health: A Hierarchical Approach

OBJECTIVES: To determine whether positive self‐perceived oral health is associated with sociodemographic health variables, with an emphasis on resilience, in community‐dwelling older adults in southern Brazil.

Four-year incidence and predictors of tooth loss among older adults in a southern Brazilian city

BACKGROUND Tooth loss is still prevalent among older adults and may negatively affect their health and well-being. Previous evidence has shown that oral disease-related factors are the more consistent predictors of tooth loss. Although certain models have considered oral health behaviour as a key construct in explaining oral health inequalities, others have favoured the role of social structure and the social environment in determining oral health outcomes. OBJECTIVE To determine the tooth loss incidence and its predictors among community-living older adults in a southern Brazilian city. METHODS A cohort study was conducted using a simple random sample of 388 older people evaluated in 2004. The follow-up was carried out during 2008, with 273 older persons examined. Interviews and oral examinations were conducted. The incidence of tooth loss was modelled through a conceptual framework with the use of negative binomial regression. RESULTS Some 67.8% of people lost one or more teeth, whereas 12.5% became edentulous during the follow-up period. In the multivariate model that controlled for baseline predictors, older age; male gender; living in a rural area; being married; less schooling; current smoking; and dissatisfaction with the access to health services were associated with tooth loss. Among the clinical variables, the use of partial dentures and gingival bleeding index were predictors, whereas higher saliva flow rate was a protective factor for the outcome. DISCUSSION As proposed in the conceptual framework, demographic factors; primary determinants of health; behavioural; and clinical variables were predictors of tooth loss. These results are important, because understanding the causal association between lifestyle practices such as oral hygiene or smoking with tooth loss does not elucidate why individuals and communities engage in such practices. CONCLUSION Interventions aiming to reduce tooth loss and edentulism in the elderly should account for social and environmental factors, in combination with clinical and behavioural components.

The Oral Health Impact Profile-14:: a unidimensional scale?

The aim of this study was to investigate the dimensional structure of the Oral Health Impact Profile-14: (OHIP-14). Data was obtained from studies carried out in Rio de Janeiro (N = 504) and Carlos Barbosa (N = 872), in the State of Rio Grande do Sul, Brazil. Exploratory factor analysis (EFA) was performed to identify the latent dimensions of the OHIP-14. Confirmatory factor analysis (CFA) was carried out of both samples to compare the one-dimensional structure found by the EFA and the proposed three-dimensional structure. This factorial structure was assessed using goodness-of-fit indices. In the Rio de Janeiro study, the eigenvalue was 9.2 and this one factor explained 65.6% of total variance, while in the Carlos Barbosa study the eigenvalue was 7.9 and this one factor explained 56.6% of variance. CFA indicated an adequate fit of the one-factor model for the Rio de Janeiro study (RMSEA = 0.04; CFI = 0.98; TLI = 0.98) and for the Carlos Barbosa study (RMSEA = 0.05; CFI = 0.97; TLI = 0.97). Our findings suggest that the OHIP-14 measures one single construct.

Comparison of two assessment instruments of quality of life in older adults

OBJECTIVE To investigate if there is convergent validity between the dimensions of the World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-Bref) and the Oral Health Impact Profile-14 (OHIP-14) questionnaire. METHODS In this cross-sectional study, a random sample of 872 elderly Southern-Brazilians was evaluated. Questionnaires assessing socio-demographic data and quality of life in general (WHOQOL-Bref) and oral health-related quality of life (OHIP-14) were used. Analysis of the WHOQOL-Bref and OHIP-14 questionnaires used descriptive statistics. The dimensions of the WHOQOL-Bref and OHIP-14 questionnaires were correlated by affinity. The convergence between WHOQOL-Bref and OHIP-14 dimensions was analyzed by Spearmans correlation coefficients. RESULTS The social relations dimension of the WHOQOL-Bref presented the greatest mean (18.24 ± 2.30). The physical pain dimension of the OHIP-14 presented a median of 1.0 (0.0 - 3.0). All correlations between the WHOQOL-Bref and OHIP-14 dimensions were significant, negative and associated with a low magnitude. The correlation between WHOQOL-physical and OHIP-functional limitation, OHIP-physical pain, OHIP-physical disability and OHIP-handicap were - 0.164, - 0.262, - 0.196 and - 0.125 respectively. WHOQOL-psychological was associated with OHIP-psychological discomfort and OHIP-psychological disability, and WHOQOL-social showed an association with OHIP-social disability. CONCLUSIONS All correlations analyzed had a positive association of low magnitude. Despite the fact that the WHOQOL-Bref and OHIP-14 instruments have related dimensions, they measure physical, psychological and social relations differently.

Assessing changes in oral health-related quality of life and its factors in community-dwelling older Brazilians.

OBJECTIVE To describe changes in oral health-related quality of life and to evaluate the associations of these changes in community-dwelling older people. MATERIALS AND METHODS In this longitudinal study a representative sample of 872 older people, living in Brazil, was evaluated during 2004. The follow-up was carried out during 2008, with 587 older persons evaluated. A questionnaire assessing socio-demographic information, health history, oral health-impact profile and number of natural teeth was used. Changes in oral health-related quality of life were categorized as improvement or deterioration. Data analysis was performed using a hierarchical approach based in a conceptual framework. A hierarchal approach was carried out using Poisson regressions. RESULTS Older persons living in rural areas, those who reported brushing once a day or less and older persons with fewer natural teeth had an increased chance of reporting deterioration in oral health-related quality of life. Women and participants who received a minimum wage of less than US

The prevalence of elder abuse in the Porto Alegre metropolitan area

219.50 were more likely to report improvement in oral health-related quality of life. CONCLUSION The results of this study suggest that changes in the oral health-related quality of life are influenced by many of the variables that were included in the conceptual framework.

Testing the applicability of a model of oral health-related quality of life

Abuse of the elderly is a form of violence to come to the publics attention. Dental professionals are in an ideal position to identify physical abuse. The aim of this study was to assess the prevalence of elderly abuse and analyze the database of injury reports that can be identified by dental teams. A documentary analysis study developed by the Elderly Protection Police Station of Porto Alegre, Rio Grande do Sul, was carried out. The information used came from 2,304 complaints filed at the aforementioned institution between the years of 2004 and 2006. The records of abuse are categorized as injury, neglect, mistreatment, theft, financial abuse, threat, disturbing the peace, atypical fact, and others. The injuries that could be identified by the dental team were classified according to the injurys location in the area of the head, face, mouth and neck. Descriptive analysis was performed, and chi-square tests were used to evaluate the distributions of the types of elder abuse in relation to sex and age. The most frequent of the different types of abuse was theft, with a prevalence of 17.8%, followed by disturbing the peace at 11.8%. Disturbing the peace, threat, and bodily injury were significantly associated with women. Elder abuse among women and men declines with age. The prevalence of head injury was 25% of the total injuries, most often in females, and in those aged < 70 years. Based on these results, it is necessary that the dental team observe the elderly persons appearance for suspicious physical signs.

Change in Quality of Life and Its Association with Oral Health and Other Factors in Community-Dwelling Elderly Adults—A Prospective Cohort Study

El objetivo fue probar vias directas y medidores de Wilson & Cleary para establecer las variables clinicas y no clinicas, en relacion con la calidad de vida referente a la salud oral. Se evaluo una muestra aleatoria de 578 personas de edad avanzada. El modelo de Wilson & Cleary fue probado usando modelos de ecuaciones estructurales, incluyendo: variables biologicas, sintomas, estado funcional, percepcion de salud oral, calidad de vida relacionada con la salud oral. La calidad de vida se evaluo con el Oral Health Impact Profile-14 (OHIP-14). En el modelo final, el edentulismo se correlaciono negativamente con la insatisfaccion de la aparicion de las protesis dentales(r = -0.25). El peor estado funcional se correlaciono con una peor salud oral percibida (r = 0,24). Tener 68 anos o mas (r = 0,25), ser mujer (r = 0,39) y vivir en un area rural (r = 0,15) tuvo un efecto directo sobre edentulismo. La edad tuvo un efecto directo sobre la OHIP-14 (r = -0.15). El sexo tuvo un efecto indirecto sobre la OHIP-14, a traves del estado funcional (r = 0,12). Los resultados del estudio corroboran parcialmente el modelo.O objetivo foi testar as vias diretas e mediadas do modelo de Wilson & Cleary entre as variaveis clinicas e nao clinicas em relacao a qualidade de vida relacionada a saude bucal. Uma amostra aleatoria de 578 idosos foi avaliada. O modelo de Wilson & Cleary foi testado usando-se a modelagem de equacoes estruturais, incluindo: variaveis biologicas, sintomas, estado funcional, percepcao da saude bucal, qualidade de vida relacionada a saude bucal. Qualidade de vida relacionada a saude bucal foi avaliada com o Oral Health Impact Profile-14 (OHIP-14). No modelo final, o edentulismo foi negativamente correlacionado com a insatisfacao da aparencia das proteses dentarias (r = -0,25). O pior estado funcional foi correlacionado com a pior percepcao de saude bucal (r = 0,24). Ter 68 ou mais anos de idade (r = 0,25), ser do sexo feminino (r = 0,39) e viver em areas rurais (r = 0,15) sao fatores para um efeito direto sobre o edentulismo. A idade apresentou um efeito direto no OHIP-14 (r = -0,15). O sexo apresentou um efeito indireto no OHIP-14 via estado funcional (r = 0,12). Os resultados do estudo corroboram parcialmente com o modelo.The aim of this study was to test Wilson & Clearys conceptual model of the direct and mediated pathways between clinical and non-clinical variables in relation to oral health-related quality of life. A random sample of 578 older people was evaluated. Wilson & Clearys conceptual model was tested using structural equations modeling including: biological variables, symptom status, functional health, oral health perceptions, oral health-related quality of life. Oral health-related quality of life was assessed with the Oral Health Impact Profile-14 (OHIP-14). In the final model, edentulism was negatively correlated to dissatisfaction of appearance of their dental prostheses (r = -0.25). Worse functional status was correlated with poor oral health perception (r = 0.24). Being aged over 68 (r = 0.25), being a female (r = 0.39) and living in rural areas (r = 0.15) had a direct effect on the edentulism. Age had a direct effect on OHIP-14 (r = -0.15). There was an indirect effect of sex on OHIP-14 via functional status (r = 0.12). The present findings partially support Wilson & Clearys model framework.

Four‐year incidence and predictors of coronal caries in south Brazilian elderly

To determine whether changes in oral health status were associated with decline in quality of life (QoL).

Teste da aplicabilidade de um modelo de qualidade de vida relacionada à saúde bucal

OBJECTIVES To determine the incidence and predictors of coronal caries among community-dwelling elderly in a southern Brazilian city. METHODS A cohort study was conducted using a simple random sample of persons aged 60 years or older in Carlos Barbosa city, southern Brazil. Interviews and oral examinations were conducted among 388 dentate individuals at baseline and among 273 at 4-year follow-up. The incidence of coronal caries was modeled by means of negative binomial regression. RESULTS Some 184 (76.7%) participants presented with new coronal caries lesions or restorations, whose mean number was 2.2 ± 2.1, whereas the 4-year mean coronal caries incidence rate was 0.28 ± 0.29. In the multivariate model that controlled for baseline predictors, older age, male gender, living in a rural area, current smoking, and negative self-perception of oral health were associated with coronal caries incidence. Among clinical variables, the use of partial dentures was a predictor, whereas higher saliva flow rate was a protective factor for the outcome. CONCLUSIONS Demographic factors, primary determinants of health, behavioral, and clinical variables were predictors of the incidence of coronal caries. As people enter old age, even stronger emphasis should be put on preventive strategies.