Abstract

INTRODUCTION

The concept of quality of life is closely related to self-perception which, in health care, can be understood as the interpretation of experiences and the state of health in the context of everyday life. It is based on information and knowledge of health and disease, modified by the experience and social and cultural norms of each individual. ⁴4 . Bombarda-Nunes FF, Miotto MHMB, Barcellos LA. Autopercepção de saúde bucal do agente comunitário de saúde de Vitória, ES, Brasil. Pesq Bras Odontopediatria Clin Integr. 2008;8(1):7-14. DOI: 10.4034/1519.0501.2008.0081.0003
https://doi.org/10.4034/1519.0501.2008.0... ^{, 11}11 . Martins AMEBL, Barreto SM, Silveira MF, Santa-Rosa TTA, Pereira RD. Self-perceived oral health among Brazilian elderly individuals. Rev Saude Publica. 2010;44(5):912-22. DOI: 10.1590/S0034-89102010005000028
https://doi.org/10.1590/S0034-8910201000... ^{, 22}22 . Vasconcelos LCA, Prado Jr RR, Teles JBM, Mendes RF. Autopercepção da saúde bucal de idosos de um município de médio porte do Nordeste brasileiro. Cad Saude Publica. 2012;28(6):1101-10. DOI: 10.1590/S0102-311X2012000600009
https://doi.org/10.1590/S0102-311X201200...

The importance of social and psychological aspects is recognized and interest is growing in understanding the impact of these factors on the individual’s oral health. Thus, many research tools, such as questionnaires, are being developed to study the influence of the condition of the individual’s teeth on their quality of life. Such evaluations, carried out using self-perception, are very important for health care professionals as each patient’s behavior is conditioned by this perception, by the importance given to it and by their cultural values and previous experience of the health care system. ¹⁹19 . Silva SRC, Rosell FL, Valsecki Jr A. Percepção das condições de saúde bucal por gestantes atendidas em uma unidade de saúde no município de Araraquara, São Paulo, Brasil. Rev Bras Saude Matern Infant. 2006;6(4):405-10. DOI: 10.1590/S1519-38292006000400007
https://doi.org/10.1590/S1519-3829200600...

Some authors ¹⁸18 . Silva SRC, Castellanos Fernandes RA. Autopercepção das condições de saúde bucal por idosos. Rev Saude Publica. 2001;35(4):349-55. DOI: 10.1590/S0034-89102001000400003
https://doi.org/10.1590/S0034-8910200100... ^{, 19}19 . Silva SRC, Rosell FL, Valsecki Jr A. Percepção das condições de saúde bucal por gestantes atendidas em uma unidade de saúde no município de Araraquara, São Paulo, Brasil. Rev Bras Saude Matern Infant. 2006;6(4):405-10. DOI: 10.1590/S1519-38292006000400007
https://doi.org/10.1590/S1519-3829200600... state that self-perceived oral health has multi-dimensional aspects, associated with physical and subjective conditions related to the mouth. Self-perceived oral health is directly influenced by social, economic and psychological motives, which can only be explained and understood when the patients are listened to and when their self-diagnoses and opinions are taken into consideration.

Thus, in order to understand the multi-dimensional aspects of self-perceived oral health, models were created which seek to understand the factors related to this perception, as well as the inter-relationship between these factors. For example, Gift et al ⁶6 . Gift HC, Atchison KA, Drury TF. Perceptions of the natural dentition in the context of multiple variables. J Dent Res. 1998;77(7):1529-38. DOI: 10.1177/00220345980770070801
https://doi.org/10.1177/0022034598077007... (1998) conjectured a theoretical conceptual model in which self-perceived oral health is a function of multiple factors, including individual demographic characteristics (age and skin color), predisposition and facilitating factors (schooling, income, overall self-perceived health and guidance perceived), factors related to oral health conditions and self-perceived need for treatment. ²²22 . Vasconcelos LCA, Prado Jr RR, Teles JBM, Mendes RF. Autopercepção da saúde bucal de idosos de um município de médio porte do Nordeste brasileiro. Cad Saude Publica. 2012;28(6):1101-10. DOI: 10.1590/S0102-311X2012000600009
https://doi.org/10.1590/S0102-311X201200...

They also noted that in order for self-perceived oral health to be observed, as well as the multiple factors which affect this process, a variety of indices have also been created to evaluate functional, social and psychological problems due to oral health problems. As examples they cite the Geriatric Oral Health Assessment Index, ²2 . Atchison KA, Dolan TA. Development of the Geriatric Oral Health Assessment Index. J Dent Educ. 1990;54(11):680-7. the Oral Health Impact Profile ²⁰20 . Slade GD, Spencer AJ. Social impact of oral conditions among older adults. Aust Dent J. 1994;39(6):358-64. DOI: 10.1111/j.1834-7819.1994.tb03106.x
https://doi.org/10.1111/j.1834-7819.1994... and the Dental Impact of Daily Living. ⁹9 . Leão A, Sheiham A. Relation between clinical dental status and subjective impacts on dally living. J Dent Res. 1995;74(7):1408-13. DOI: 10.1177/00220345950740071301
https://doi.org/10.1177/0022034595074007... The Oral Impacts on Daily Performances (OIDP) a socio-dental indicator which assesses the frequency and severity of impacts on daily life through nine questions, giving an individual impact score. ⁷7 . Gomes AS, Abegg C. O impacto odontológico no desempenho diário dos trabalhadores do Departamento Municipal de Limpeza Urbana de Porto Alegre, Rio Grande do Sul, Brasil. Cad Saude Publica. 2007;23(7):1707-14. DOI: 10.1590/S0102-311X2007000700023
https://doi.org/10.1590/S0102-311X200700... In 2010, a national survey was carried out on the oral health conditions of the Brazilian population, making use of the OIDP. ¹⁷17 . Roncalli AG, Silva NN, Nascimento AC, Freitas CHSM, Casotti E, Peres KG et al. Aspectos metodológicos do Projeto SB Brasil 2010 de interesse para inquéritos nacionais de saúde. Cad Saude Publica . 2012;28Suppl:40-57. DOI: 10.1590/S0102-311X2012001300006
https://doi.org/10.1590/S0102-311X201200...

The aim of this article was to prevent the self-perceived oral health of adults living in the Northeast and to identify associated factors.

METHODS

The study used primary data from the National Oral Health Survey - Pesquisa Nacional de Saúde Bucal (SBBrasil 2010), carried out by the Ministério da Saúde, with the aim of describing the oral health conditions of the Brazilian population.

The SBBrasil 2010 analyzed a sample of individuals in 177 municipalities from five age groups: Age five, 12, 15-19, 35-44 and 65-74 years old. A total of 37,519 individuals were examined, of which 10,390 were resident in the Northeast. ^aaMinistério da Saúde (BR). Projeto SBBrasil 2010 – Pesquisa Nacional de saúde bucal. Resultados principais. Brasília: Ministério da Saúde; 2011. The sampling plan contained domains in the state capitals and municipalities in the interior. The primary sampling units were: (a) municipality, for the interior of the regions and (b) census tract, for the state capitals. ¹⁷17 . Roncalli AG, Silva NN, Nascimento AC, Freitas CHSM, Casotti E, Peres KG et al. Aspectos metodológicos do Projeto SB Brasil 2010 de interesse para inquéritos nacionais de saúde. Cad Saude Publica . 2012;28Suppl:40-57. DOI: 10.1590/S0102-311X2012001300006
https://doi.org/10.1590/S0102-311X201200...

Oral examinations were carried out to assess the prevalence and severity of the main oral health problems, and questionnaires were used to collect data on socio-economic conditions, use of dental services and perceived health. These examinations were carried out within the homes selected by a field work team formed of an examiner and a note taker, who had been through a training and calibration process. ¹⁷17 . Roncalli AG, Silva NN, Nascimento AC, Freitas CHSM, Casotti E, Peres KG et al. Aspectos metodológicos do Projeto SB Brasil 2010 de interesse para inquéritos nacionais de saúde. Cad Saude Publica . 2012;28Suppl:40-57. DOI: 10.1590/S0102-311X2012001300006
https://doi.org/10.1590/S0102-311X201200...

For this study, all individuals from the SBBrasil 2010 resident in municipalities in the Northeast of Brazil (in state capitals and interior) and aged between 35 and 44 were selected. The dependent variable was self-perceived oral health, determined by the following question: “ With regards your teeth and mouth, are you…? ” with five options: Very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, very dissatisfied . However, in order to understand and organize the results of this article better, there responses were grouped into three categories: 1) satisfied (very satisfied + satisfied) 2) neither satisfied nor dissatisfied, and 3) dissatisfied (dissatisfied, very dissatisfied).

The independent variables were selected based on the theoretical model of Gift et al ⁶6 . Gift HC, Atchison KA, Drury TF. Perceptions of the natural dentition in the context of multiple variables. J Dent Res. 1998;77(7):1529-38. DOI: 10.1177/00220345980770070801
https://doi.org/10.1177/0022034598077007... (1998), with some adaptations, resulting in a model composed of four blocks of variables ( Figure ).

It is important to emphasize the OIDP index, used as one of the variables in block 4 (variables related to self-perceived need for treatment), was analyzed using a questionnaire ^aaMinistério da Saúde (BR). Projeto SBBrasil 2010 – Pesquisa Nacional de saúde bucal. Resultados principais. Brasília: Ministério da Saúde; 2011. containing the nine functions assessed in the OIDP. There were questions on whether everyday tasks were affected by the teeth: eating, brushing teeth, speaking, smiling, sleeping, working or studying, going out and doing sport. The responses were 0 = no impact and 1 = impact on one or more.

Need for a prosthesis was assessed by the professional examiner. The consumer goods taken into account were: television, fridge, stereo, microwave, telephone, mobile phone, washing machine, dishwasher, laptop and number of cars. The need for treatment was that reported by the interviewee.

Analysis of the initial data was carried out by distributing the independent variables according to the dependent variable, and the Rao & Scott ¹⁵15 . Rao JNK, Scott AJ. On simple adjustments to chi-squared test with sample survey data. Ann Stat. 1987;15(1):385-97. DOI: 10.1214/aos/1176350273
https://doi.org/10.1214/aos/1176350273... test was used to test the association between them. This test is specifically for complex samples and only tests the association between qualitative variables, without providing information as to whether the category has greater effect on the outcome.

To test the effect of the independent variables on the event, a multinomial logistic regression model was used according to the hierarchical model proposed by Victora et al ²³23 . Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26(1):224-7. DOI: 10.1093/ije/26.1.224
https://doi.org/10.1093/ije/26.1.224... (1997). The hierarchical analysis follows the levels in which the four blocks of variables were organized as in the model shown in the Figure . Thus, this analysis had two stages: simple and multiple hierarchical.

The simple analysis verified whether there was an association between each independent variable and the outcome, with “dissatisfied” as the reference category of the dependent variable. At this stage, the odds ratio (OR) and the respective 95% confidence interval were calculated, and 5% was adopted as the level of significance.

Next, the multiple analysis was carried out. At this stage, within each level of the hierarchy, variables with p < 0.25 were tested in multiple models. At the end of the multiple analysis, variables with p < 0.05 were kept in the final model for each level and were considered factors of adjustment for the subsequent blocks.

The criterion was the hierarchical model and the inter-relationships between the various groups of factors. It is worth pointing out that the objective of adopting an a priori theoretical model meant that the modeling process was true to the relationships shown in the model. Thus, the simple exercise of finding associations between variables was renounced in favor of an explanatory focus directed at the theoretical – methodological framework of the study.

The analyses were carried out using the SPSS 13.0 software, considering the complex design of the sample. This adjustment was necessary as the sample in the SBBrasil 2010 was a cluster sample, and estimates which do not take into account the cluster organization of the sample tent to overestimate and lose accuracy. ¹⁰10 . Martins AMEBL, Barreto SM, Pordeus IA. Auto-avaliação de saúde bucal em idosos: análise com base em modelo multidimensional. Cad Saude Publica. 2009;25(2):421-35. DOI: 10.1590/S0102-311X2009000200021
https://doi.org/10.1590/S0102-311X200900...

The SBBrasil 2010 Project followed the standard set by the Declaration of Helsinki and was approved by the National Research Ethics Council, record no. 15,498, on 7 ^th January 2010.

RESULTS

Of the 10,390 individuals in the study resident in the Northeast, 2,456 were aged between 35 and 44. Of these, 64.9% were female, 74.8% had an income below R$ 1,500.00 and 51.1% had fewer than nine years of schooling. Of the interviewees, 37.0% stated that they were satisfied (very satisfied + satisfied) with their oral health, 17.5% reported that they were neither satisfied nor dissatisfied and 44.7% said they were dissatisfied (dissatisfied + very dissatisfied).

Table 1 shows the descriptive analysis of the prevalence rates of responses for the question on self-perceived oral health, according to the selected independent variables. With regards demographic variables, only skin color had an association with the outcome (p < 0.05).

All of the variables concerning predisposition/facilitating were associated (p < 0.05) with self-perceived oral health; the highest dissatisfaction was observed among those on low incomes (50.8%) and 56.2% of those on higher incomes (over R$ 2,500.00) were satisfied.

Of the variables related to oral health conditions, the following had a statistical association with the outcome: dissatisfaction among those who had fewer than average healthy teeth (50.6%), bleeding (52.6%) and those needing a prosthesis (50.3%).

Of the variables associated with self-perceived need for treatment, only dental consultations were not statistically associated; the other variables presented dissatisfaction according to: frequency of visiting the dentist (every three years or more 55.8%), type of dental services last used (public 49.4%), motive for most recent visit (pain 59.6%), need for treatment (52.5%), toothache (59.6%) and OIDP ≥ 1 (60.2%).

Table 2 shows the results of the simple analysis. Of the variables which were statistically significant, it was noted that in block 1, whites were more satisfied with their oral health than non-whites. In block 2, those who reported they were satisfied with their oral health had more years of schooling (11-15 years), income > R$ 2,500.00, lived in households with the number of individuals per bedroom below the mean (≤ 1.5) and had more than the mean number of consumer goods (>6). In Block 3, it was observed that those who were most satisfied had more healthy teeth, lower mean DMFT (decayed, missing, filled teeth), did not suffer bleeding and did not need a dental prosthesis. In block 4, those who were most satisfied with their oral health were those who had seen the dentist within the last year, whose most recent appointment had been through their health insurance, had other motives for their last appointment, who were not in need of treatment, did not suffer from toothache and had an OIDP value = 0.

In the multiple analysis ( Table 3 ), it was observed that, after adjustment, the following variables were directly associated with self-perceived oral health: skin color, household income, number of consumer goods, number of healthy teeth, prevalence of bleeding, needing a prosthesis, OIDP, needing treatment, frequency of visiting the dentist and motive for most recent visit.

DISCUSSION

The prevalent self-perception of oral health was negative (44.7%) in the age group analyzed. The highest levels of dissatisfaction observed were strongly associated with variables related to conditions of predisposition/facilitating, to oral health conditions which the individuals presented during their examinations and those related to self-perceived need for treatment. Of the demographic variables, only skin color proved to be associated with dissatisfaction.

Thus, with regards to socioeconomic conditions (block 2 variables), the following were directly associated with dissatisfaction: low levels of schooling, low income, poor housing (living in households with many people in the rooms) and having few consumer goods. It is known that each individual’s socioeconomic aspects directly influence their oral health conditions, as such factors are associated with greater or lesser knowledge of healthy lifestyle habits and, consequently, recognizing greater or lesser need for orthodontic treatment. Moreover, they are conditions which directly influence the individual’s way of life. Working and living conditions qualify, each in a different way, the way in which individuals think, feel and act with respect to their health. ¹1 . Araújo CS, Lima RC, Peres MA, Barros AJD. Utilização de serviços odontológicos e fatores associados: um estudo de base populacional no Sul do Brasil. Cad Saude Publica. 2009;25(5):1063-72. DOI: 10.1590/S0102-311X2009000500013
https://doi.org/10.1590/S0102-311X200900... Studies ¹1 . Araújo CS, Lima RC, Peres MA, Barros AJD. Utilização de serviços odontológicos e fatores associados: um estudo de base populacional no Sul do Brasil. Cad Saude Publica. 2009;25(5):1063-72. DOI: 10.1590/S0102-311X2009000500013
https://doi.org/10.1590/S0102-311X200900... ^{, 7}7 . Gomes AS, Abegg C. O impacto odontológico no desempenho diário dos trabalhadores do Departamento Municipal de Limpeza Urbana de Porto Alegre, Rio Grande do Sul, Brasil. Cad Saude Publica. 2007;23(7):1707-14. DOI: 10.1590/S0102-311X2007000700023
https://doi.org/10.1590/S0102-311X200700... show that low levels of schooling and income are related to a higher prevalence of negative impacts from oral health and that lower income is associated with level of education, the value placed on health, lifestyle and access to health care information.

Regarding the variables related to oral health conditions (block 3), all of them were observed to have an association with self-perceived oral health and that negative conditions – such as fewer healthy teeth, higher DMFT, bleeding and needing a prosthesis – were factors directly related to negative perception of oral health. These findings can be explained by the fact that such conditions, in addition to producing discomfort in the individuals, often compromise chewing and can also be responsible for producing negative self-perceptions of oral aesthetics, resulting in dissatisfaction when smiling and speaking. Haikal et al ⁸8 . Haikal DS, Paula AMB, Martins AMEBL, Moreira NA, Ferreira EF. Autopercepção da saúde bucal e impacto na qualidade de vida do idoso: uma abordagem quanti-qualitativa. Cienc Saude Coletiva. 2011;16(7):3317-29. DOI: 10.1590/S1413-81232011000800031
https://doi.org/10.1590/S1413-8123201100... (2011) also observed that, the lower the mean number of teeth and the higher the DMFT values, the more negative the self-perceived oral health.

Individuals needing dental prosthesis tend to evaluate the own oral health negatively. It can be seen that the need for prosthetic rehabilitation is a clinical situation which directly impacts on chewing, as well as on self-perception of smiling and often produces embarrassment when smiling and talking, as well as difficulties in interpersonal relationships. Thus, the results found here corroborate the findings of another study carried out in Brazil ⁴4 . Bombarda-Nunes FF, Miotto MHMB, Barcellos LA. Autopercepção de saúde bucal do agente comunitário de saúde de Vitória, ES, Brasil. Pesq Bras Odontopediatria Clin Integr. 2008;8(1):7-14. DOI: 10.4034/1519.0501.2008.0081.0003
https://doi.org/10.4034/1519.0501.2008.0... which also found that needing a dental prosthesis is directly related to a negative self-perception of oral health.

The clinical conditions showed a strong association with negative self-perceived oral health. Other surveys ²2 . Atchison KA, Dolan TA. Development of the Geriatric Oral Health Assessment Index. J Dent Educ. 1990;54(11):680-7. ^{, 19}19 . Silva SRC, Rosell FL, Valsecki Jr A. Percepção das condições de saúde bucal por gestantes atendidas em uma unidade de saúde no município de Araraquara, São Paulo, Brasil. Rev Bras Saude Matern Infant. 2006;6(4):405-10. DOI: 10.1590/S1519-38292006000400007
https://doi.org/10.1590/S1519-3829200600... ^{, 21}21 . Soares GB, Batista RM, Zandonade E, Oliveira AE. Associação da autopercepção de saúde bucal com parâmetros clínicos orais. Rev Bras Odontol. 2011;68(2):268-73. also report a link between perception of oral conditions and some clinical variables, although this association was relatively weak. These studies justify that finding as many of the diseases detected in the clinical examinations are asymptomatic and the individual is probably unaware of them. Moreover, studies ¹1 . Araújo CS, Lima RC, Peres MA, Barros AJD. Utilização de serviços odontológicos e fatores associados: um estudo de base populacional no Sul do Brasil. Cad Saude Publica. 2009;25(5):1063-72. DOI: 10.1590/S0102-311X2009000500013
https://doi.org/10.1590/S0102-311X200900... ^{, 18}18 . Silva SRC, Castellanos Fernandes RA. Autopercepção das condições de saúde bucal por idosos. Rev Saude Publica. 2001;35(4):349-55. DOI: 10.1590/S0034-89102001000400003
https://doi.org/10.1590/S0034-8910200100... also show that the majority of individuals view their oral condition favorably, even when clinical conditions are dissatisfactory, probably as the clinical measurements of health used by professionals are relatively poor predictors of the individual’s perception of their oral health.

Regarding the variables related to self-perceived need for treatment (block 4), having visited (or not) the dentist before the interview was not associated with self-perceived oral health. However, variables such as frequency of visits to the dentist, type of service used on the most recent visit, reason for most recent visit, need for treatment, toothache and OIDP were strongly related to the outcome. It was noted that longer intervals without visiting the dentist was most strongly associated with dissatisfaction, in other words, 55.8% of individuals who went to the dentist fewer than once in three years were dissatisfied with their oral health. This finding corroborates the results found in Matos & Lima-Costa ¹²12 . Matos DL, Lima-Costa MF. Auto-avaliação da saúde bucal entre adultos e idosos residentes na Região Sudeste: resultados do Projeto SB-Brasil, 2003. Cad Saude Publica. 2006;22(8):1699-07. DOI: 10.1590/S0102-311X2006000800018
https://doi.org/10.1590/S0102-311X200600... (2006), which used data from the SBBrasil 2003 and also reported that not visiting the dentist for three years or more was significant in increasing the chances of the adult self-evaluating their oral health as very bad.

It was observed that there was an association between the last visit to the dentist being to a public service and dissatisfaction with oral health. This finding is of great importance as it creates the need for greater reflection on how oral health public policies are being carried out in Brazil, especially in the Northeast where, historically, there has been less provision of orthodontic care to the population. Difficulties and delays in getting orthodontic care has direct repercussions on individuals’ satisfaction with their oral health, as well as possibly aggravating existing problems. Camargo et al ⁵5 . Camargo MBJ, Dumith SC, Barros AJD. Uso regular de serviços odontológicos entre adultos: padrões de utilização e tipos de serviços. Cad Saude Publica. 2009;25(9):1894-906. DOI: 10.1590/S0102-311X2009000900004
https://doi.org/10.1590/S0102-311X200900... (2009) also noted that those who sought care in public services reported less frequent use compared with those who used the private network, and that regular use is lower among those with lower levels of income and education. The stated that, although the public health care system – Sistema Único de Saúde played an important part in reducing inequalities (principle of equality), it seems that that function is not being developed. However, it is not possible to affirm whether this delay is due to difficulties in getting an orthodontic appointment or to lack of interest on the part of the interviewee in seeking an appointment. Therefore, more detailed studies of this aspect need to be undertaken. The fact that it is a cross-sectional study being analyzed effectively means that temporal causal relationships between the independent variables and the outcome in question cannot be established. Thus, dissatisfaction may precede or follow the type of service used.

In this study, pain and toothache were observed to be directly associated with dissatisfaction with oral health conditions, something that, in other studies ¹1 . Araújo CS, Lima RC, Peres MA, Barros AJD. Utilização de serviços odontológicos e fatores associados: um estudo de base populacional no Sul do Brasil. Cad Saude Publica. 2009;25(5):1063-72. DOI: 10.1590/S0102-311X2009000500013
https://doi.org/10.1590/S0102-311X200900... ^{, 3}3 . Atchison KA, Gift HC. Perceived oral health in a diverse sample. Adv Dent Res. 1997;11(2):272-80. DOI: 10.1177/08959374970110021001
https://doi.org/10.1177/0895937497011002... ^{, 5}5 . Camargo MBJ, Dumith SC, Barros AJD. Uso regular de serviços odontológicos entre adultos: padrões de utilização e tipos de serviços. Cad Saude Publica. 2009;25(9):1894-906. DOI: 10.1590/S0102-311X2009000900004
https://doi.org/10.1590/S0102-311X200900... ^{, 14}14 . Pinellia C, Turrionib APS, Loffredoa LCM. Autopercepção em higiene bucal de adultos: reprodutibilidade e validade. Rev odontol UNESP. 2008;37(2):163-9. has also been observed as one of the factors which create dissatisfaction and lead individuals to seek orthodontic care. This should be highlighted, as it suggests that the interviewees’ use of orthodontic services is often limited to emergencies. It is possible that there is not a culture of using orthodontic services for preventative purposes, which is a fairly negative aspect for the population’s oral health. According to a study ¹⁴14 . Pinellia C, Turrionib APS, Loffredoa LCM. Autopercepção em higiene bucal de adultos: reprodutibilidade e validade. Rev odontol UNESP. 2008;37(2):163-9. in Araraquara, Southeastern Brazil, of the adult population aged 35 to 44, when seeking relief, little patient-dentist interaction is expected with regards information and advice and plaque control. Therefore, oral health care activities need to emphasize approaches which encourage the individual to value preventative actions and which enable a stronger link to be made between patients and orthodontic services and professionals, in the private or public network, so that they are more aware of healthy habits and the health-disease process. Needing treatment was also noted, by Soares et al ²¹21 . Soares GB, Batista RM, Zandonade E, Oliveira AE. Associação da autopercepção de saúde bucal com parâmetros clínicos orais. Rev Bras Odontol. 2011;68(2):268-73. (2011) to be a factor strongly associated with self-perceived oral health.

It was observed that individuals who reported being dissatisfied with their oral health were those who had OIDP index scores ≥ 1. The high prevalence of impact on daily tasks in the population in question was also observed by Gomes & Abegg ⁷7 . Gomes AS, Abegg C. O impacto odontológico no desempenho diário dos trabalhadores do Departamento Municipal de Limpeza Urbana de Porto Alegre, Rio Grande do Sul, Brasil. Cad Saude Publica. 2007;23(7):1707-14. DOI: 10.1590/S0102-311X2007000700023
https://doi.org/10.1590/S0102-311X200700... (2007) in their study of adults in the same age group. The authors state that this is the age group with the highest prevalence of oral health conditions impacting on daily life and that this finding may be related to the increased presence of unmet need for treatment, due to this age groups difficulties in accessing treatment.

With regards to the demographic (block 1) variables analyzed, only skin color proved to be significantly associated with the outcome, as non-white individuals were more dissatisfied with their oral health. Studies in the United States ⁵5 . Camargo MBJ, Dumith SC, Barros AJD. Uso regular de serviços odontológicos entre adultos: padrões de utilização e tipos de serviços. Cad Saude Publica. 2009;25(9):1894-906. DOI: 10.1590/S0102-311X2009000900004
https://doi.org/10.1590/S0102-311X200900... ^{, 13}13 . Matthias RE, Atchison KA, Lubben JE, De Jong F, Schweitzer SO. Factors affecting self-ratings of oral health. J Public Health Dent. 1995;55(4):197-04. DOI: 10.1111/j.1752-7325.1995.tb02370.x
https://doi.org/10.1111/j.1752-7325.1995... report that whites have better perceived oral health than non-whites. However, a study ⁵5 . Camargo MBJ, Dumith SC, Barros AJD. Uso regular de serviços odontológicos entre adultos: padrões de utilização e tipos de serviços. Cad Saude Publica. 2009;25(9):1894-906. DOI: 10.1590/S0102-311X2009000900004
https://doi.org/10.1590/S0102-311X200900... of the adult population in the city of Pelotas, RS, observed that the unadjusted effect of the skin color variable disappeared after controlling for this variables. Although studies ⁶6 . Gift HC, Atchison KA, Drury TF. Perceptions of the natural dentition in the context of multiple variables. J Dent Res. 1998;77(7):1529-38. DOI: 10.1177/00220345980770070801
https://doi.org/10.1177/0022034598077007... ^{, 16}16 . Reisine ST, Bailit HL. Clinical oral health statusn and adult perceptions of oral health. Soc Sci Med Med Psychol Med Sociol. 1980;14A(6):597-605. DOI: 10.1016/0160-7979(80)90063-6
https://doi.org/10.1016/0160-7979(80)900... report that negative self-perceived oral health increases with age and that sex is also related to self-perceived oral health, no statistically significant association with these factors was found in this study.

Indeed, the results of the final hierarchical analysis model show that self-perceived oral health in adults in the Northeast is directly associated with a multi-dimensional structure of factors. The model proposed by Gift et al ⁶6 . Gift HC, Atchison KA, Drury TF. Perceptions of the natural dentition in the context of multiple variables. J Dent Res. 1998;77(7):1529-38. DOI: 10.1177/00220345980770070801
https://doi.org/10.1177/0022034598077007... (1998) functioned as a measuring stick in the modelling process, establishing relationships between the independent variables distal and proximal to the outcome. Moreover, it was observed that, after adjusting the variables in logistic regression, conditions such as: household income, number of healthy teeth, needing a prosthesis, higher OIDP index and needing treatment were those which most strongly affected the outcome (p < 0.001). The poor economic conditions associated with the poor clinical oral health conditions of the adult population in the Northeast has a great impact on the self-perceived oral health of these individuals, thus showing that public policies aimed at improving this notably disadvantaged population’s quality of life need to be strengthened and possibly redirected.

ACKNOWLEDGEMENTS

To the National Oral Health Coordination of the Brazilian Ministry of Health for providing the SBBrasil 2010 database.

References

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