Oral Health and related inequalities among visual impairment people in a Brazil municipality

ABSTRACT Objective: To evaluate the oral health and related factors among people with visual impairment in a municipality in southeastern Brazil. Methods: A cross-sectional and descriptive household study was carried out on a representative sample of people with visual impairments in a medium-sized...

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Published inRGO - Revista Gaúcha de Odontologia Vol. 71
Main Authors MOREIRA, Geovane Evangelista, OLIVEIRA, Eduardo José Pereira, GASQUE, Kellen Cristina da Silva, LEMOS, Najara Nadiege Ferreira Barbosa, FERNANDES, Leandro Araújo, GONÇALVES, Lísia Aparecida Costa, LIMA, Daniela Coêlho
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Published Faculdade São Leopoldo Mandic 2023
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Abstract ABSTRACT Objective: To evaluate the oral health and related factors among people with visual impairment in a municipality in southeastern Brazil. Methods: A cross-sectional and descriptive household study was carried out on a representative sample of people with visual impairments in a medium-sized city in Brazil. A clinical-dental examination was performed (evaluating tooth loss, caries, periodontal health, dental plaque use and need of prosthesis) and a semistructured questionnaire was applied, investigating the socioeconomic conditions (sex, age, marital status, skin color and income) and the use of dental services (reason, time since, and type of service used [private/public] in last dental visit). Descriptive and bivariate analysis were performed to asses the factors related to oral health. Results: The mean age of participants was 65 years (±15.05), with the majority women (70.9%). 53.1% of the interviewees were edentulous, but 58.2% had a good perception of oral health. The blind ones use less public services (p=0.038) and with a lower frequency (p=0.014) than subjects with low vision. Those with less schooling had higher tooth loss and lower periodontal problems (p <0.05). There was a reduction of dental plaque six months after the educational action (30.7%; p=0.01), especially among the low vision participants (p=0.01). Conclusion: Severe tooth loss and unsatisfactory hygiene contrast with self-perception of oral health. Visual acuity and schooling were related to access and oral health. Actions for promotion and equity are necessary to overcome the inequalities encountered. RESUMO Objetivo: Avaliar a saúde bucal e fatores relacionados entre deficientes visuais em município do sudeste brasileiro. Métodos: Foi realizado um estudo domiciliar, transversal e descritivo em uma amostra representativa de pessoas com deficiência visual em uma cidade de médio porte do Brasil. Realizou-se o exame clínico bucal (avaliando perda dentária, cárie, saúde periodontal, placa dentária, uso e necessidade de prótese) e aplicou-se um questionário semiestruturado, investigando as condições socioeconômicas (sexo, idade, estado civil, cor da pele e renda) e o uso de serviços odontológicos (motivo, tempo decorrido e tipo de serviço utilizado [privado/público] na última consulta odontológica). Foram realizadas análises descritivas e bivariadas para avaliar os fatores associados à saúde bucal. Resultados: A idade média dos participantes foi de 65 anos (±15,05), com maioria de mulheres (70,9%). 53,1% dos entrevistados eram edêntulos, porém, 58,2% apresentaram percepção de saúde bucal boa. Os cegos usam menos os serviços públicos (p=0,038) e em menor frequência (p=0,014) que os sujeitos com baixa visão. Os menos escolarizados apresentam maiores perdas dentárias e menores problemas periodontais (p<0,05). Houve redução de placa dentária seis meses após ação educativa (30,7%; p=0,01), sobretudo entre os sujeitos com baixa visão (p=0,01). Conclusão: Elevada perda dentária e higienização insatisfatória contrastaram com autopercepção dos agravos bucais. Acuidade visual e escolaridade relacionaram-se ao acesso e saúde bucal. Ações de promoção e equidade são necessários para superar desigualdades encontradas.
AbstractList ABSTRACT Objective: To evaluate the oral health and related factors among people with visual impairment in a municipality in southeastern Brazil. Methods: A cross-sectional and descriptive household study was carried out on a representative sample of people with visual impairments in a medium-sized city in Brazil. A clinical-dental examination was performed (evaluating tooth loss, caries, periodontal health, dental plaque use and need of prosthesis) and a semistructured questionnaire was applied, investigating the socioeconomic conditions (sex, age, marital status, skin color and income) and the use of dental services (reason, time since, and type of service used [private/public] in last dental visit). Descriptive and bivariate analysis were performed to asses the factors related to oral health. Results: The mean age of participants was 65 years (±15.05), with the majority women (70.9%). 53.1% of the interviewees were edentulous, but 58.2% had a good perception of oral health. The blind ones use less public services (p=0.038) and with a lower frequency (p=0.014) than subjects with low vision. Those with less schooling had higher tooth loss and lower periodontal problems (p <0.05). There was a reduction of dental plaque six months after the educational action (30.7%; p=0.01), especially among the low vision participants (p=0.01). Conclusion: Severe tooth loss and unsatisfactory hygiene contrast with self-perception of oral health. Visual acuity and schooling were related to access and oral health. Actions for promotion and equity are necessary to overcome the inequalities encountered.
ABSTRACT Objective: To evaluate the oral health and related factors among people with visual impairment in a municipality in southeastern Brazil. Methods: A cross-sectional and descriptive household study was carried out on a representative sample of people with visual impairments in a medium-sized city in Brazil. A clinical-dental examination was performed (evaluating tooth loss, caries, periodontal health, dental plaque use and need of prosthesis) and a semistructured questionnaire was applied, investigating the socioeconomic conditions (sex, age, marital status, skin color and income) and the use of dental services (reason, time since, and type of service used [private/public] in last dental visit). Descriptive and bivariate analysis were performed to asses the factors related to oral health. Results: The mean age of participants was 65 years (±15.05), with the majority women (70.9%). 53.1% of the interviewees were edentulous, but 58.2% had a good perception of oral health. The blind ones use less public services (p=0.038) and with a lower frequency (p=0.014) than subjects with low vision. Those with less schooling had higher tooth loss and lower periodontal problems (p <0.05). There was a reduction of dental plaque six months after the educational action (30.7%; p=0.01), especially among the low vision participants (p=0.01). Conclusion: Severe tooth loss and unsatisfactory hygiene contrast with self-perception of oral health. Visual acuity and schooling were related to access and oral health. Actions for promotion and equity are necessary to overcome the inequalities encountered. RESUMO Objetivo: Avaliar a saúde bucal e fatores relacionados entre deficientes visuais em município do sudeste brasileiro. Métodos: Foi realizado um estudo domiciliar, transversal e descritivo em uma amostra representativa de pessoas com deficiência visual em uma cidade de médio porte do Brasil. Realizou-se o exame clínico bucal (avaliando perda dentária, cárie, saúde periodontal, placa dentária, uso e necessidade de prótese) e aplicou-se um questionário semiestruturado, investigando as condições socioeconômicas (sexo, idade, estado civil, cor da pele e renda) e o uso de serviços odontológicos (motivo, tempo decorrido e tipo de serviço utilizado [privado/público] na última consulta odontológica). Foram realizadas análises descritivas e bivariadas para avaliar os fatores associados à saúde bucal. Resultados: A idade média dos participantes foi de 65 anos (±15,05), com maioria de mulheres (70,9%). 53,1% dos entrevistados eram edêntulos, porém, 58,2% apresentaram percepção de saúde bucal boa. Os cegos usam menos os serviços públicos (p=0,038) e em menor frequência (p=0,014) que os sujeitos com baixa visão. Os menos escolarizados apresentam maiores perdas dentárias e menores problemas periodontais (p<0,05). Houve redução de placa dentária seis meses após ação educativa (30,7%; p=0,01), sobretudo entre os sujeitos com baixa visão (p=0,01). Conclusão: Elevada perda dentária e higienização insatisfatória contrastaram com autopercepção dos agravos bucais. Acuidade visual e escolaridade relacionaram-se ao acesso e saúde bucal. Ações de promoção e equidade são necessários para superar desigualdades encontradas.
Author LEMOS, Najara Nadiege Ferreira Barbosa
FERNANDES, Leandro Araújo
GASQUE, Kellen Cristina da Silva
GONÇALVES, Lísia Aparecida Costa
MOREIRA, Geovane Evangelista
OLIVEIRA, Eduardo José Pereira
LIMA, Daniela Coêlho
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10.15600/2238-1236/fol.v27n1p21-28
10.1590/1414-462x201900030098
10.2174/1874210602115010033
10.1590/0102-311x00202017
10.1590/S1413-81232010000300027
10.1590/S1413-81232011000800031
10.21727/rpu.v12i2.2627
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References (ref6) 2008
Paulo JR (ref7) 2017; 27
Marmot M. (ref29) 2018; 362
Da Silveira ER (ref3) 2015; 21
Carvalho AC (ref8) 2010; 19
Helgeson M (ref13) 2013; 33
(ref1) 2010
Haikal DSA (ref17) 2011; 16
(ref16) 2010
(ref18) 2013
Oliveira EJP (ref26) 2018; 23
Oliveira EJP (ref19) 2018; 23
Alshatrat S (ref14) 2021; 15
(ref15) 2018
Juzbašić M (ref4) 2021; 5
Silva MEDS (ref27) 2010; 15
Watson E (ref11) 2010; 208
Silva Izaque V (ref24) 2021; 12
Ortega MM (ref9) 2019; 27
Souza Filho MD (ref12) 2010; 46
Santana TS (ref2) 2021; 7
Amorim Monteiro LP (ref10) 2018; 4
Peres MA (ref20) 2013; 47
Andrade FB (ref23) 2018; 34
Oliveira EJP (ref25) 2020; 19
(ref5) 2010
Landmann-Szwarcwald C (ref28) 2016; 15
Oliveira EJP (ref22) 2020; 34
Chaves SCL (ref21) 2016; 22
References_xml – year: 2010
  ident: ref5
– volume: 33
  start-page: 177
  issue: 4
  year: 2013
  ident: ref13
  article-title: Oral health delivery systems for older adults and people with disabilities
  publication-title: Spec Care Dent
  doi: 10.1111/scd.12038
– volume: 15
  start-page: 174
  year: 2016
  ident: ref28
  article-title: A panorama of health inequalities in Brazil
  publication-title: Int J Equity Health
  doi: 10.1186/s12939-016-0462-1
– volume: 46
  start-page: 66
  issue: 2
  year: 2010
  ident: ref12
  article-title: Avaliação da saúde bucal de deficientes visuais em Teresina-PI
  publication-title: Arq Odontol
– volume: 208
  start-page: 1
  issue: 8
  year: 2010
  ident: ref11
  article-title: The oral health status of adults with a visual impairment, their dental care and oral health information needs
  publication-title: Br Dent J
  doi: 10.1038/sj.bdj.2010.395
– start-page: 1
  year: 2010
  ident: ref1
– volume: 4
  start-page: 44
  issue: 1
  year: 2018
  ident: ref10
  article-title: O conhecimento de deficientes visuais em relação à saúde bucal
  publication-title: Rev Cienc Plural
  doi: 10.21680/2446-7286.2018v4n1ID14476
– volume: 21
  start-page: 289
  issue: 2
  year: 2015
  ident: ref3
  article-title: Educação em saúde bucal direcionada aos deficientes visuais
  publication-title: Rev Bras Educ Espec
  doi: 10.1590/S1413-65382115000200009
– volume: 19
  year: 2020
  ident: ref25
  article-title: Oral health-related quality of life among 12-year-olds: results from SB-Minas Gerais
  publication-title: Braz J Oral Sci
– year: 2010
  ident: ref16
– volume: 5
  start-page: 170
  issue: 1
  year: 2021
  ident: ref4
  article-title: Importance of Oral Hygiene and Maintaining Oral Health in Persons With Disabilities
  publication-title: Southeast. Eur Med J
– volume: 47
  start-page: 78
  issue: suppl 3
  year: 2013
  ident: ref20
  article-title: Tooth loss in Brazil: analysis of the 2010 Brazilian Oral Health Survey
  publication-title: Rev Saude Publica
– volume: 23
  start-page: 3695
  issue: 11
  year: 2018
  ident: ref19
  article-title: Relationship between the perception of dental care and Oral Health conditions in hypertensive and diabetic patients
  publication-title: Ciênc Saúde Colet
– volume: 27
  start-page: 21
  issue: 1
  year: 2017
  ident: ref7
  article-title: Experiência de pacientes com deficiências na utilização de serviços públicos odontológicos
  publication-title: Rev Fac Odontol Lins
  doi: 10.15600/2238-1236/fol.v27n1p21-28
– volume: 27
  start-page: 331
  year: 2019
  ident: ref9
  article-title: Assistência em saúde bucal na percepção das pessoas com deficiência visual
  publication-title: Cad Saúde Colet
  doi: 10.1590/1414-462x201900030098
– year: 2018
  ident: ref15
– volume: 7
  start-page: 45852
  issue: 5
  year: 2021
  ident: ref2
  article-title: Enfermeiro na reabilitação visual: uma nova área de atuação
  publication-title: Braz J Develop
– volume: 23
  start-page: 763
  issue: 3
  year: 2018
  ident: ref26
  article-title: Quality of life and oral health among hypertensive and diabetic people in a Brazilian Southeastern city
  publication-title: Cienc Saude Colet
– volume: 34
  year: 2020
  ident: ref22
  article-title: Edentulism and all–cause mortality among Brazilian older adults: 11–years follow–up
  publication-title: Braz Oral Res
– volume: 362
  issue: k3216
  year: 2018
  ident: ref29
  article-title: An inverse care law for our time
  publication-title: BMJ
– year: 2013
  ident: ref18
– volume: 19
  start-page: 97
  issue: 49
  year: 2010
  ident: ref8
  article-title: Considerações no tratamento odontológico e periodontal do paciente deficiente visual
  publication-title: ROBRAC
– year: 2008
  ident: ref6
– volume: 15
  start-page: 33
  issue: 1
  year: 2021
  ident: ref14
  article-title: Oral Health Knowledge, Behaviour, and Access to Dental Care in Visually Impaired Individuals in Jordan: A Case-Control Study
  publication-title: Open Dent J.
  doi: 10.2174/1874210602115010033
– volume: 34
  year: 2018
  ident: ref23
  article-title: Trends in socioeconomic inequalities in the prevalence of functional dentition among older people in Brazil
  publication-title: Cad Saude Publica
  doi: 10.1590/0102-311x00202017
– volume: 15
  start-page: 841
  issue: 3
  year: 2010
  ident: ref27
  article-title: Impacto da perda dentária na qualidade de vida
  publication-title: Cienc Saude Colet
  doi: 10.1590/S1413-81232010000300027
– volume: 16
  start-page: 3317
  issue: 7
  year: 2011
  ident: ref17
  article-title: Autopercepção da saúde bucal e impacto na qualidade de vida do idoso: uma abordagem quanti-qualitativa
  publication-title: Cienc Saude Colet
  doi: 10.1590/S1413-81232011000800031
– volume: 12
  start-page: 48
  issue: 2
  year: 2021
  ident: ref24
  article-title: O impacto do edentulismo na qualidade de vida: autoestima e saúde geral do indivíduo
  publication-title: Rev Pró-univerSUS
  doi: 10.21727/rpu.v12i2.2627
– volume: 22
  start-page: 1791
  issue: 6
  year: 2016
  ident: ref21
  article-title: Oral health policy in Brazil between 2003 and 2014: scenarios, proposals, actions, and outcomes
  publication-title: Cienc Saude Colet
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Snippet ABSTRACT Objective: To evaluate the oral health and related factors among people with visual impairment in a municipality in southeastern Brazil. Methods: A...
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SubjectTerms Dental care for disabled
Dental health surveys
Oral health
Socioeconomic factors
Visually impaired persons
Title Oral Health and related inequalities among visual impairment people in a Brazil municipality
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