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ABSTRACT OBJECTIVE To evaluate the factors associated with tooth loss in adults from the position and number of teeth lost in the dental arches. METHODS This is a cross-sectional, population-based study with adults participating in the epidemiological survey of oral health of São Paulo in 2015. The outcome of the study was tooth loss, assessed by the proposed classification, namely: I) lost up to 12 back teeth; II) lost up to 12 teeth (including front teeth); and III) lost more than 12 teeth. A four-block analysis was conducted, supported by a conceptual theoretical model adapted for tooth loss. For the multinomial logistic regression, “individuals who did not lose teeth due to caries or periodontal disease” was used as reference (p < 0.05). RESULTS Of 6,051 adults evaluated, 25.3% (n = 1,530) were classified in category I, 32.7% (n = 1,977) in II, 9.4% (n = 568) in III, and 1.9% (n = 117) were edentulous. Lower income and schooling, the perception of need for treatment and the last appointment motivated by routine, pain or extraction were associated with tooth loss, regardless of the classification. The negative evaluation of the dental service was associated with individuals who lost up to 12 teeth, both front and back. The presence of women and periodontal pocket were associated with tooth loss of up to 12 teeth, including front, and more than 12 teeth. Caries were associated with adults who lost up to 12 teeth, including front teeth. CONCLUSION The proposed classification allowed the identification of differences between the associated factors. Thus, the need to consider such classification in future studies is evident.

ABSTRACT OBJECTIVE: Analyze if clinical, sociodemographic and access to dental services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults. METHODS: A cross-sectional study with secondary data from the State Oral Health Survey (SB São Paulo 2015) conducted in 163 cities of São Paulo. A total of 17,560 individuals from three age groups: 15–19-year-old (n = 5,558), 35–44-year-old (n = 6,051), and older people of 65 years or more (n = 5,951) participated in the survey. The selection was made by probabilistic sample by conglomerates in two stages. The endpoint variable was the impact of oral health on daily activities, evaluated by the Oral Impacts on Daily Performances questionnaire, containing questions about eating, talking, oral hygiene, relaxation, sports practice, smile, study or work, social contact, and sleep. Oral Impacts on Daily Performances was dichotomized with and without impact. The independent variables were sociodemographic, clinical and access variables, divided into three blocks. A hierarchical multiple logistic regression analysis was performed considering the complex sampling plan of clusters. Each observation received a specific weight, depending on the location that resulted in weighted frequencies and adjusted for the design effect. RESULTS: The presence of oral health impact was observed in 27.9% of the individuals. In block 1, female gender and black/brown ethnic group had a greater chance of impact of oral health on quality of life, as well as the adults and the older adults in relation to adolescents. In block 2, family income up to R$1,500 was associated with the presence of impact. In block 3, individuals who reported toothache, used the public service and sought dental treatment had a greater chance of impact. CONCLUSIONS: Sociodemographic, clinical and access to health services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults.

OBJETIVO: Estimar a prevalência de cárie dentária e necessidades de tratamento em crianças de 12 anos e adolescentes. MÉTODOS: Estudo transversal com base nos resultados dos levantamentos epidemiológicos Condições de Saúde Bucal no Estado de São Paulo em 2002 e Pesquisa Nacional de Saúde Bucal (SBBrasil) 2010. Foram analisados os dados secundários de 5.782 crianças (2002) de 12 anos e outras 369 (2010); e para a faixa de 15 a 19 anos foram analisados 880 jovens (2002) e 300 jovens em 2010. A experiência de cárie foi avaliada pelo índice CPOD (dentes cariados, perdidos e obturados) e foram verificadas as necessidades de tratamento odontológico segundo os critérios propostos pela Organização Mundial da Saúde. O índice Significant Caries Index foi empregado para medir a severidade da cárie no terço do grupo que apresentou maior prevalência da doença. Para a análise dos resultados utilizaram-se os testes de Qui-quadrado e Mann-Whitney, com nível de 5% de significância. RESULTADOS: Houve diminuição de 39,3 pontos percentuais no índice CPOD aos 12 anos (p < 0,001) e de 41,1 pontos percentuais nos adolescentes (p < 0,001) entre 2002 e 2010, e aumento de aproximadamente 161,0 pontos percentuais e 303,0 pontos percentuais no grupo livres de cárie, respectivamente. A porcentagem de dentes restaurados diminuiu nos dois grupos etários, mas a prevalência de dentes cariados não se alterou para o grupo de alta experiência de cárie. No grupo de baixa experiência de cárie ocorreu diminuição do componente perdido para os adolescentes e aumento do componente cariado aos 12 anos e adolescentes. Houve aumento da necessidade de tratamento endodôntico no grupo total e no de alta experiência de cárie aos 12 anos; e entre os adolescentes a necessidade de restauração de duas ou mais faces diminuiu no grupo todo e também no de baixa experiência. CONCLUSÕES: A diminuição da necessidade de tratamento de baixa complexidade entre adolescentes sugere que as ações de promoção e prevenção estão afetando positivamente esse grupo. Além disso, os dois levantamentos epidemiológicos no estado de São Paulo mostram melhorias na condição de saúde bucal dos grupos etários estudados e que se faz necessário o monitoramento direcionado também para o grupo de baixa experiência de cárie.

OBJETIVO: Analisar a tendência de prevalência de fluorose dentária em crianças de 12 anos em contexto de exposição a múltiplas fontes de flúor. MÉTODOS: Realizou-se análise de tendência da prevalência de fluorose dentária no período de 1998 a 2010 na cidade de São Paulo, SP. As prevalências foram calculadas para diferentes anos (1998, 2002, 2008 e 2010), a partir de dados secundários obtidos em levantamentos epidemiológicos com amostras representativas da população de 12 anos de idade. A ocorrência de fluorose foi avaliada sob luz natural utilizando o índice de Dean, preconizado pela Organização Mundial da Saúde e categorizada em normal, questionável, muito leve, leve, moderada e severa. Em 1998 foram examinadas 125 crianças; 249 em 2002; 4.085 em 2008; e 231 em 2010. RESULTADOS: Em 1998 a prevalência de fluorose foi de 43,8% (IC95%35,6;52,8), em 2002 de 33,7% (IC95% 28,2;39,8), de 40,3% (IC95% 38,8;41,8) em 2008 e de 38,1% (IC95% 32,1;44,5) em 2010. As categorias muito leve + leve registraram 38,4% (IC95%30,3;47,6) em 1998, 32,1% (IC95% 26,6;38,2) em 2002, 38,0% (IC95% 36,5;39,5) em 2008 e 36,4% (IC95%30,4;42,7) em 2010. Não se observou fluorose severa com significância estatística. CONCLUSÕES: A prevalência de fluorose dentária em crianças paulistanas pode ser classificada como estacionária no período de 1998 a 2010, tanto em geral quanto ao se considerarem apenas as categorias muito leve + leve.

OBJETIVO: Avaliar a associação de condições de saúde gengival com a utilização de serviço odontológico. MÉTODOS: Realizou-se levantamento epidemiológico de saúde bucal de 1.799 adolescentes, em 35 cidades do Estado de São Paulo, em 2002. A saúde gengival foi avaliada pela prevalência de sangramento na gengiva à sondagem e cálculo dentário (índice periodontal comunitário) e oclusão dentária (índice de estética dentária). A utilização de serviços odontológicos foi medida pelo índice de cuidado (O/CPO) para cada cidade. Análise multinível de regressão logística ajustou modelos explicativos para fatores associados aos desfechos de interesse. RESULTADOS: A prevalência de sangramento gengival à sondagem foi 21,5%; de cálculo dentário foi 19,4%. Os participantes do sexo masculino, negros e pardos, moradores em áreas rurais, residentes em domicílios aglomerados e com atraso escolar apresentaram chance significantemente mais elevada para os agravos que seus respectivos pares de comparação. Características de oclusão dentária também associaram com gengiva não-saudável: apinhamento dos segmentos incisais, mordida aberta vertical anterior, relação molar antero-posterior. Cidades com maior utilização de serviço odontológico tiveram menor proporção de adolescentes com sangramento gengival e cálculo. CONCLUSÕES: A utilização de serviços odontológicos foi significativamente associada a melhores condições de saúde gengival (sangramento e cálculo). Essa associação independeu das características sociodemográficas individuais e contextuais, e de oclusão dentária.OBJECTIVE: To evaluate the association between gingival health conditions and dental service utilization. METHODS: An epidemiological survey of the oral health of 1,799 adolescents was carried out in 35 cities of the state of São Paulo, in 2002. Gingival health was assessed through the prevalence of gingival bleeding on probing and dental calculus (community periodontal index), and dental occlusion was assessed through the dental aesthetic index. The utilization of dental services was measured by means of the dental care index (F/DMFT) for each city. Multilevel logistic regression analysis was used to adjust explanatory models to factors associated with the outcome variables of interest. RESULTS: The prevalence of gingival bleeding on probing was 21.5%, whereas dental calculus was prevalent in 19.4%. Male participants, who were either black or dark-skinned, lived in crowded homes, in rural areas, and showed schooling delay, were at a significantly higher risk than their respective counterparts. The following dental occlusion characteristics were also associated with unhealthy gum: incisor segment crowding, vertical anterior open bite, and antero-posterior molar relationship. Cities with a higher utilization of dental services showed a smaller proportion of adolescents with gingival bleeding and dental calculus. CONCLUSIONS: The utilization of dental services was significantly associated with better gingival health conditions (gingival bleeding and dental calculus). This association did not depend on contextual and individual sociodemographic characteristics or dental occlusion.

ABSTRACT OBJECTIVE To evaluate the association of school failure among Brazilian adolescents with social conditions and aspects of oral health through hierarchical analysis. METHODS A state-wide survey of 5,558 adolescents from the state of São Paulo, Brazil, inquired about the sociodemographic and social capital of participants by using a structured questionnaire. Trained and calibrated professionals performed intraoral examinations and interviews in the households. Questions about the access to dentist, reason for and frequency of using dental services, toothache episodes and impact of oral conditions on daily activities (OIDP) were applied. Oral examinations evaluated caries experience, tooth losses, periodontal problems, presence of open bite, and maxillary and mandibular overjet. School failure was estimated according to the teenagers’ years of schooling. The independent variables were grouped into three blocks: sociodemographic and economic characteristics, social capital and oral health aspects. The multiple hierarchical logistic regression model was used to identify the factors associated with school failure. RESULTS Of the total sample, information about schooling of 5,162 adolescents was obtained, of whom 29.6% presented school failure. We found that adolescents over the age of 16 years who did not declare themselves as white, female, with feelings of insecurity, unhappiness, with toothache, caries, tooth losses, affected by dentofacial and/or periodontal changes, were more likely to fail at school. CONCLUSION Oral disorders and social factors were associated with school failure in adolescents. A successful school trajectory was a strong determinant of health, therefore actions between the educational and health sectors must be developed for adolescents, especially those with this profile.

A redução na prevalência de cárie em crianças no Estado de São Paulo é explicada pela fluoretação das águas de abastecimento, uso de dentifrícios fluoretados e ampliação do acesso às ações coletivas de saúde bucal, na qual se inserem os procedimentos coletivos (PC), desenvolvidos pelo Sistema Único de Saúde. Nos PC incluem-se atividades anuais preventivas e educativas. Sobre as últimas, espera-se que os participantes adquiram e mantenham hábitos saudáveis de higiene bucal. O objetivo deste trabalho foi investigar a percepção, o conhecimento e as práticas em saúde bucal e a avaliação das atividades educativas e preventivas de 219 estudantes do 1º ano do ensino médio, egressos de escolas públicas, que receberam os PC de 1ª a 4ª série, de 1ª a 8ª série ou que não receberam os PC, no município de Embu (SP) 2005. Analisou-se associação entre os grupos pelo teste qui-quadrado. A percepção, o conhecimento e as práticas em saúde bucal não foram estatisticamente diferentes entre os três grupos. A maioria dos jovens acredita ser importante falar sobre saúde bucal nas escolas e, mesmo os que não participaram dos PC, afirmaram ter recebido algum ensinamento na escola, o que reforça que o conhecimento e a conseqüente prática em saúde bucal são influenciados por outros fatores. Neste estudo, ter participado ou não dos PC quando criança não causou impacto diferente em relação aos cuidados em saúde bucal na adolescência.The decline in tooth decay in the children of the State of São Paulo is explained by fluoridation of the water supply, the use of fluoridated toothpaste and access to collective actions promoting oral health, such as the "collective procedures" (CPs). CPs are educational and preventive annual programs developed in public schools by the Brazilian public health system. It is expected that the participants will acquire and maintain healthy oral hygiene practices. The purpose of this study was to investigate perception, knowledge and practices/behavior related to oral health, as well as the evaluation of the educational and preventive activities of 219 students of the 1st grade of high school in the city of Embu, São Paulo, in 2005. The first group of students had received the CPs in elementary public school from grades 1st to 4th; the second group had received them from grades 1st to 8th; and the third one had not received the CPs. The students were interviewed after consent had been obtained. Analyses were performed using the Chi-square test. No significant differences were found between groups. The majority of the students believe it is important to speak about oral health at school. The ones who had not participated in the CPs said that they had received some instructions at school, which strengthens the theory according to which oral health is influenced by other factors. In this study, children's participation in the CPs did not seem to have an impact on oral health care/practices in adolescence.