Rui Arantes

Saúde bucal na população indígena Xavánte de Pimentel Barbosa, Mato Grosso, Brasil

This study presents the results of an oral health epidemiological survey conducted in 1997, based on WHO criteria, in the Xavante indigenous community of Pimentel Barbosa (or Etenitepa), Mato Grosso State, Central Brazil. The study included 228 individuals (85% of the population) over two years of age. In about half the sample, the DMF index was less than 2, and in the 12-14-year age bracket it was 3.7. The low frequency of fillings in permanent and deciduous teeth suggests limited access to dental care services. Despite the number of sextants with bleeding and tartar, no cases of severe periodontal disease were detected (CPITN). In the community, comparison of the results of this survey with two previous surveys (1962 and 1991) showed a deterioration in oral health conditions over time and alterations in the occlusal pattern (increase in Angle class II and III). Dietary changes due to environmental and socioeconomic alterations resulting from interaction with the surrounding society, along with the lack of preventive programs, are among the causes of this deterioration in oral health among the Xavante.

Caries, gender and socio-economic change in the Xavante Indians from Central Brazil

Background: The oral health conditions of indigenous peoples in Amazonia are closely associated with ecological and dietary changes related to interaction with non-Indians. Aim: The study investigated the incidence of caries in an indigenous community from Central Brazil focusing on gender differences. Subjects and methods: The research was conducted among the Xavante Indians and was based on longitudinal data collected in two surveys (1999 and 2004). The study included 128 individuals, 63 (49.2%) males and 65 (50.8%) females, divided in four age brackets (6–12, 13–19, 20–34, 35–60 years of age). The DMFT (decayed, missing and filled teeth) index and incidences (difference between 1999 and 2004) were calculated for each individual. The proportion of incidence was also calculated. Differences in caries risk between gender and age brackets were compared by parametric and non-parametric tests. Results: There were statistically significant differences in relation to caries incidence between age brackets and gender. The greatest incidence was observed in the 20–34 age bracket, which presented 3.30 new decayed teeth, twice the risk of the 6–12 age bracket (p<0.01), chosen as reference. While females in most age groups did not show higher risk for caries when compared to males, there was a 4.04-fold risk in the 20–34 age bracket (p<0.01). Conclusion: It is concluded that factors related to the social functions of each sex (gender issues) and differential access to information, health services, and education may help to understand the differences observed in the incidence of caries.

Diferenciais de cárie dentária entre os índios Xavante de Mato Grosso, Brasil

O objetivo do estudo foi avaliar niveis de experiencia de carie entre subgrupos Xavante que vivem em diferentes Terras Indigenas (T.I.) no Estado de Mato Grosso, Brasil, a fim de investigar a presenca de desigualdades no interior de uma mesma etnia indigena. Os dados foram coletados atraves de um censo de saude bucal realizados em 2004. Das sete T.I. Xavante existentes, foram investigadas quatro (Pimentel Barbosa, Sangradouro, Areoes e Marechal Rondon), nas quais foram selecionadas a maior aldeia de cada. Foram adotados os criterios preconizados pela Organizacao Mundial da Saude, e utilizado o indice CPOS. Para mensurar as diferencas entre as T.I. foi estimada a razao de prevalencia (RP) por meio de analise de regressao de Poisson, efetuada na faixa etaria entre 6 e 34 anos para cada sexo, incluindo a idade como covariavel. Nesta faixa etaria, as perdas variaram entre 26 a 30%. Pimentel Barbosa foi considerada como referencia para comparacoes por apresentar menor prevalencia de carie em todas as faixas etarias analisadas. A maior disparidade foi notada entre as T.I. Pimentel Barbosa e Sangradouro, tanto em homens (RP 2,68- IC95% 2,41 a 2,97) como em mulheres (RP 2,03- IC95% 1,85 a 2,23). A RP do componente obturado em Areoes e Marechal Rondon (diferenca relativa a Pimentel Barbosa) e muito pequena em relacao a carga de doenca total nestas T.I., indicando menor presenca de servico odontologico restaurador. Conclui-se que a transicao em saude bucal nao e homogenea entre os Xavante e que as diferencas podem estar associadas a particularidades do processo historico de interacao com a sociedade nao-indigena. Determinantes locais e regionais, incluindo fatores demograficos, caracteristicas economicas e socio-culturais especificas, acesso e utilizacao de servicos de saude, podem ter determinado as desigualdades de ataque de carie observadas entre os Xavante.

Reducing Indigenous Oral Health Inequalities: A Review from 5 Nations:

Indigenous populations around the world experience a disproportionate burden in terms of oral diseases and conditions. These inequalities are likely due to a complex web of social determinants that includes poverty, historical consequences of colonialism, social exclusion, government policies of assimilation, cultural annihilation, and racism in all its forms (societal, institutional). Despite documented oral health disparities, prevention interventions have been scarce in Indigenous communities. This review describes oral health interventions and their outcomes conducted for Indigenous populations of the United States, Canada, Brazil, Australia, and New Zealand. The review includes research published since 2006 that are available in English in electronic databases, including MEDLINE. A total of 13 studies were included from the United States, Canada, Brazil, and Australia. The studies reviewed provide a wide range of initiatives, including interventions for prevention and treatment of dental disease, as well as interventions that improve oral health knowledge, behaviors, and other psychosocial factors. Overall, 6 studies resulted in improved oral health in the study participants, including improvements in periodontal health, caries reduction, and oral health literacy. Preferred intervention methodologies included community-based research approaches, culturally tailored strategies, and use of community workers to deliver the initiative. Although these studies were conducted with discrete Indigenous populations, investigators reported similar challenges in research implementation. Recommendations for future work in reducing oral health disparities include addressing social determinants of health in various Indigenous populations, training future generations of dental providers in cultural competency, and making Indigenous communities true partners in research.

Income as a Protective Factor for Dental Caries among Indigenous People from Central Brazil

The objective of this paper was to evaluate the association between eligibility for a conditional cash transfer program, based on household income, and dental caries in 12-year-old children from three Indigenous ethnic groups living in Mato Grosso do Sul state, Central Brazil. A population-based cross-sectional study was performed in three ethnic groups: Kaiwoá, Guarani, and Terena. The study population was drawn by stratified sampling according to each ethnic group with a probability proportional to the village size. The number of untreated decayed permanent teeth as a count variable was the outcome measure. Ethnic group and eligibility for the conditional cash transfer program showed significant association with untreated caries. Children from Guarani and Terena presented respectively two-fold and 2.8-fold higher caries rate (p<.001) compared with Kaiwoá in the adjusted model, while children from no eligible cash transfer program households had a 40% lower caries rate (p=.034).