Ana Paula Corrêa de Queiroz Herkrath

Objectives: To examine the extent to which socioeconomic and environmental characteristics are associated with oral health outcomes among adults and elderly people living in rural riverside communities in the Brazilian Amazon. The study also examined the mediating role of self‐reported dental status and reason for the last dental visit in these associations. Methods: A household‐based cross‐sectional study included 569 residents from seven riverside communities along the Negro River, Manaus, Brazil. Data on age, sex, family income, conditional and unconditional social cash transfer programmes, housing conditions and sanitation, self‐reported dental status, reason for the last dental visit, dental pain and satisfaction with oral health were collected through structured interviews. Structural equation modelling was used in the data analysis. Results: Poorer self‐reported dental status was directly associated with non‐enrolment in conditional cash transfer programme, lower income, greater age and female sex. Non‐enrolment in conditional cash transfer programme and problem‐oriented dental care‐seeking behaviour was linked to dental pain. Worse self‐reported dental status and inadequate household sanitation were directly associated with problem‐oriented dental care‐seeking behaviour. Poor satisfaction with oral health was linked to dental pain and problem‐oriented dental care‐seeking behaviour. Several indirect relationships were detected. Family income, self‐reported dental status, reason for the last dental visit and dental pain mediated the relationships between demographics, cash transfer programmes and satisfaction with oral health. Conclusions: Participation in income transfer programmes and family income emerged as relevant factors in reducing inequalities in oral health among adults and elderly people living in rural riverside communities. Improving the regularity and frequency of dental services can have a direct impact on satisfaction with oral health. Inter‐sectoral actions targeting social and financial protection should be on the political agenda to improve the oral health of people living in rural riverside communities.

Introduction: Strengthening oral health promotion in remote riverine populations is essential for reducing persistent inequities in oral health. This study evaluated the outcomes of a community-based participatory intervention designed to enhance oral health knowledge, behaviors, and conditions among residents of a remote riverine community in the Brazilian Amazon. Methods: A community-based participatory intervention was implemented based on the five action areas of the Ottawa Charter. Data were collected at baseline (T0) and after 8 months (T1) through face-to-face interviews using the Health Literacy in Dentistry-14 (HeLD-14) and Oral Health Impact Profile-14 instruments, for oral health literacy and oral health-related quality of life, complementary questionnaires on health behaviors and service use, and clinical oral examinations. Differences between T0 and T1 were analyzed using Wilcoxon paired, McNemar, and Cochran’s Q tests. Results: Following the intervention, participants demonstrated improvements in oral health literacy and oral health beliefs (p<0.001), oral health-related quality of life (p<0.001), and periodontal conditions, with significant reductions in gingival bleeding and dental calculus (p≤0.001). Dental service utilization increased (p=0.004), although economic barriers persisted. No change was observed in the DMFT (decayed, missing, and filled teeth) index. Conclusion: The intervention positively influenced key oral health outcomes in this remote riverine population. These findings highlight the potential of participatory, community-driven strategies to strengthen oral health promotion in rural and remote settings.

Objective: To estimate the probability of dental services utilisation according to demographics, socioeconomic characteristics, and social networks of Brazilians aged 15 years and above. Methods: The study used data from the 2019 Brazilian National Health Survey, a household‐based representative nationwide survey. Individual interviews collected information on time interval since the last dental appointment, residential setting, sex, race/skin colour, years of school completed with approval, family income and social networks. Predicted probabilities and 95% confidence intervals (CIs) of time since last dental visit were estimated using a multinomial logistic regression model. Estimates were obtained using the post‐estimation commands of Stata MP, version 17.0, considering the complex sampling design and sampling weights. Results: Prevalence of last dental visit in the last 12 months was 48.4% (47.8%–49.0%). The projected scenarios showed a significant effect of sex, socioeconomic characteristics and social networks on dental services utilisation. The worst scenario was observed for male individuals living in rural areas, with lower schooling, lower income and lower social networks. In this group, the prevalence of dental visit in the previous 12 months was 14.7% (13.1%–16.2%) and 23.1% (19.3%–26.9%) reported never having had a dental visit. Individuals with low social networks exhibited lower dental services utilisation than those with high social networks, across both better and worse socioeconomic status scenarios. Conclusion: Individuals aged 15 years and above with poor socioeconomic status, living in rural areas, and those with low social networks had lower use of dental services.

The study evaluated the prevalence of actinic cheilitis and associated factors in fishermen living in a rural riverside community in the Amazon, Brazil. A cross-sectional study was conducted with male artisanal fishermen. Demographic, socioeconomic, behavioral, and occupational characteristics were assessed using a questionnaire. Actinic cheilitis was evaluated by a clinical examination of the lips, and lesions were classified as grades I (mild), II (moderate), or III (severe). Factors associated with actinic cheilitis were identified by Poisson regression. Fifty-six fishermen were evaluated (mean age = 41.7 years). The average time spent fishing was 27.9 years, with 9.8 hours per day. The majority did not use sunscreen (75%) or lip balm (89.3%) and used uncovered boats (85.7%). Overall, 67.8% had not used dental health services in the last year and 35.7% had their last consultation more than three years ago. The prevalence of actinic cheilitis was 3.5% in grade I, 28.6% in grade II, and 28.6% in grade III. Having white skin and not having visited the dentist in the last three years was associated with a higher prevalence of the lesion while using lip balm was a protective factor. The study showed that riverside fishermen living in a location with a high incidence of ultraviolet radiation had a high prevalence and severity of actinic cheilitis, indicating the need to ensure the use of health services and the adoption of preventive strategies to reduce the occurrence of this potentially malignant oral disorder in these locations.

Aim: Traumatic dental injuries (TDIs) among children and adolescents have been acknowledged as of public health concern worldwide. The aim of the study was to assess the relationship between contextual and individual characteristics and TDIs in 12‐year‐old schoolchildren.Materials and Methods: A cohort study was conducted with 355 schoolchildren living in deprived communities in the city of Manaus, Brazil. Contextual factors (place of residence and socio‐economic indicators) and individual characteristics, including sex, family income, parents/guardians years of schooling, overjet and open bite (Dental Aesthetic Index), self‐esteem (Rosenberg Self‐Esteem Scale), sense of coherence (Sense of Coherence Scale), oral health beliefs, social support (Social Support Appraisals) were assessed at baseline. TDIs were measured at baseline and at 2‐year follow‐up using the O'Brien Index. Data were analysed through confirmatory factor analysis and structural equation modeling.Results: The baseline prevalence of TDIs was 17.6% and the incidence of TDIs at 2‐year follow‐up was 26.8%. Better psychosocial status had a direct protective effect on the incidence of TDIs (β = −.184). Better contextual characteristics (β = −.135) and greater overjet (β = −.203) were directly associated with poor psychosocial status. Higher schooling of parents/guardians directly predicted better psychosocial status (β = .154). Psychosocial status mediated the relationship of greater overjet (β = .036), contextual factors (β = .024) and parental/guardian schooling (β = −.027) with TDIs.Conclusions: Contextual factors and individual characteristics predicted TDIs. Psychosocial status was a relevant individual attribute in the causal network of TDIs, due to the direct effect on the incidence of TDIs as well as a mediator on the influence of contextual factors, overjet and parents/guardians schooling on the incidence of TDIs.

Objetivo Avaliar a qualidade de vida relacionada à saúde e fatores associados em pessoas trans.

Objective To assess health-related quality of life and associated factors among trans people.

This study investigated the role of oral health‐related functional limitations and social well‐being, self‐perceived health, psychosocial factors, and social support in mediating the impact of malocclusion on health‐related quality of life (HRQoL). A school‐based 6‐month cohort study was conducted with 376 12‐year‐old deprived adolescents. Measures at baseline included malocclusion (DAI score), dental caries, sociodemographic characteristics, psychosocial traits (self‐esteem, sense of coherence, oral health beliefs), and social support. The oral health‐related functional limitations and symptoms (social well‐being) domains of the CPQ_11‐14, self‐perceived health, and HRQoL (Kiddo‐KINDL) were evaluated at the 6‐month follow‐up. Associations between observed and latent variables (social support, psychosocial factors, and HRQoL) were evaluated using structural equation modelling, according to the Wilson and Cleary theoretical model. Malocclusion was indirectly associated with worse HRQoL, mediated by functional limitations, social well‐being, and self‐perceived health. Better psychosocial status was directly associated with better HRQoL, and higher social support was indirectly associated with better HRQoL via psychosocial factors. Dental caries experience, female sex, and lower family income were indirectly associated with worse HRQoL. The impact of malocclusion on HRQoL was mediated by oral health‐related functional limitations, social well‐being, and self‐perceived health. Sociodemographic and psychosocial factors, and social support also impacted HRQoL.