Dental caries in the permanent dentition and health-related quality of life among children and adolescents with sickle cell disease

Mendes, Vera Lúcia Duarte da Costa; Risso, Patrícia A.; Santos, Marcia Pereira Alves dos

doi:10.1590/1413-81232024293.06752023

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THEMATIC ARTICLE • Ciênc. saúde coletiva 29 (3) • Mar 2024 • https://doi.org/10.1590/1413-81232024293.06752023 copy

Dental caries in the permanent dentition and health-related quality of life among children and adolescents with sickle cell disease

Cáries dentárias na dentição permanente e qualidade de vida relacionada à saúde entre crianças e adolescentes com doença falciforme

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim was to associate living, health and oral health conditions with the quality of life (QL) of children and adolescents (CA) with sickle cell disease (SCD). Of the 120 eligible users of a public hematological service, 106 CA with SCD from 6 to 18 years of age, and their caregivers, answered semi-structured questions about socio-demographic, health and oral health conditions. For QL, we used the validated instrument PedsQLSCD™. The oral clinical examination occurred according to the guidelines of WHO and SB Brazil 2010. The majority of CA were non-white people (88%), mean age of 10.4 (±2.9) years, family income of up to two monthly minimum wages, for 03 to 05 members, with diagnosis of sickle cell anemia by neonatal screening, hospitalizations were due allergic crises, polypharmacy and dental caries (51%) were present. “About the Impact of My Pain” was the best-fit model for the QLSCD (adjusted R²=56%; AIC=28.67; p=0.04). Dental caries in permanent dentition worsened the QLSCD (OR=0.53; IC95%=0.35-0.78; p<0.05) and was associated with the type of school, car ownership, number of family members, of complications and of the medications. To overcome this scenario, programmatic actions are required, and implementation of public policies specifically directed towards these groups.

Key words:
Anemia sickle cell; Oral health; Quality of Life

Dimensions	Variables	Categories	Frequency
Dimensions	Variables	Categories	Absolute (N=106)	Relative (100%)
Living conditions	Gender	Female	53	50
	Gender	Male	53	50
	Self-reported race	Black	48	45
		Pardo	45	43
		Indigenous	1	1
		White	12	11
	School system	Free-Public sector	85	80
	School system	Private sector	21	20
	Years of formal education completed	0<2	24	23
		2<7	57	54
		7<11	25	23
	Number of family members	2	06	6
		3-5	85	80
		6-9	15	14
	Number of rooms per residence	<1	42	39
		>1<2	57	54
		>2	07	7
	Car owner	Yes	24	23
	Car owner	No	82	77
	Monthly Family income (reference - US$ 256.97)	<2	98	92
		2<4	06	6
		4≤10	01	1
		Not informed	01	1
	Type of housing	Own home	86	81
	Type of housing	Does not own home	20	19
Health status	Diagnosis of SCD	Early (neonatal screening)	94	89
	Diagnosis of SCD	Late (out of neonatal screening)	12	11
	Genotype of SCD	Hb SS	89	84
		Hb SC	15	14
		Hb S/Beta thalassemia	02	2
	Number of hospitalizations per year*	0	37	34
		1-3	56	53
		4-9	06	6
		≥10	07	7
	Reasons for hospitalizations per year*	Not applicable	37	--
		Pain crisis	42	61
		Pneumonia	11	16
		Pain crisis+Pneumonia	07	10
		Anemia	03	4
		Others	06	9
	Number of transfusions per year*	None	39	36
		1-3	40	38
		4-6	04	4
		7-9	05	5
		≥10	18	17
	Number of acute or chronic complications per year*	1-3	36	34
		4-5	55	52
		6-8	15	14
	Recent history of pain**	Mild	76	72
		Moderate	18	17
		Intense	12	11
	Number of medications per day	1-2	45	43
		3-4	46	43
		5-6	15	14
Oral health status	Dental Caries	0	52	49
	Dental Caries	1≤10	54	51
	Missing	0	91	86
	Missing	1≤2	15	14
	Filling	0	81	76
	Filling	1≤5	25	24
	DED	0	34	32
	DED	1≤24	72	68
	Periodontal Status (CPI)***	0	31	80
	Periodontal Status (CPI)***	1	08	20
	Malocclusion***	0	10	26
	Malocclusion***	1	29	74

Participants (n=106)
Index		Group of ages in years
		6-11 (n=71)		12 (n=11)		13-18 (n=24)
		Median	SD	Median	SD	Median	SD
Healthy teeth		18.23	4.39	19.64	7.61	22.17	3.14
DMFT		2.92	2.97	1.18	2.31	2.21	2.85
	Missing	0.23	0.56	0	0	0.17	0.38
	Filled	0.55	1.13	0.18	0.60	0.29	0.75
	Decayed	2.14	2.65	1.0	2.32	1.75	2.28
DED*		2.44	3.24	6.09	8.11	3.83	3.00

Domains	Participants
	Children/Adolescents (N=106)		Guardians/Caregivers (N=106)		Spearman´s correlation	p-value*
	Mean	SD	Mean	SD
About my pain	69.86	18.67	66.69	18.90	0.59	<0.01
About the impact of my pain	36.37	29.78	49.22	25.43	0.48
About my pain management and control	35.02	37.54	47.17	33.42	0.45
About my concerns I	61.46	36.68	61.60	33.60	0.41
About my concerns II	73.94	39.38	73.35	38.54	0.45
About my emotions	58.25	37.44	55.54	34.72	0.41
About my treatment	74.92	21.93	77.67	20.36	0.33
About communication I	73.98	31.41	75.79	22.84	0.24	0.01
About communication II	57.63	38.87	68.32	32.05	0.33	<0.01
Global score	60.15	36.11	63.93	31.37	0.49	<0.01

Domains	Constructs	Predictor	Estimated parameters					Goodness-of-Fit Test
Domains	Constructs	Predictor	β	SE	OR	OR - Lower	OR - Upper	P value (β)	Deviance R-Sq	Deviance R-Sq (adj)	AIC	P value (Hosmer-Lemeshow test)
About my pain management and control	Living conditions	Number of family members	0.57	0.37	1.76	1.20	2.59	a	51%	43%	74.00	0.80
		Type of housing	2.43	0.83	11.31	4.80	26.66	b
		Number of rooms per residence	-1.27	0.44	0.28	0.18	0.44
	Health Status	Number of transfusions per year	-0.90	0.32	0.41	0.29	0.56
		Recent history of pain	0.30	0.18	1.35	1.12	1.63	a
		Number of medications per day	2.24	0.60	9.41	5.08	17.44	b
	Oral health status	Number of teeth with DED	0.28	0.14	1.32	1.15	1.52
	Oral health status	Missing teeth	2.26	0.95	9.58	3.57	25.76
About my concerns II	Living conditions	Gender	-1.61	0.61	0.20	0.11	0.38		36%	30%	98.88	0.25
		Years of formal education	0.29	0.13	1.33	1.16	1.53
		School system	-2.71	1.03	0.07	0.02	0.19
	Health Status	Number of hospitalizations per year	-0.81	0.36	0.45	0.31	0.65
	Health Status	Number of acute or chronic complications per year	0.89	0.26	2.44	1.87	3.18
	Oral health status	Number of teeth with DED	0.19	0.08	1.21	1.11	1.31
	Oral health status	Missing teeth	1.82	0.57	6.14	3.39	11.13
About my emotions	Living conditions	School system	-0.64	0.31	0.53	0.38	0.73		27%	22%	122.28	0.81
	Living conditions	Number of rooms per residence	-0.83	0.26	0.44	0.33	0.57
	Health Status	Number of acute chronic or complications per year	0.59	0.21	1.75	1.41	2.16	a
		Recent history of pain	0.21	0.10	1.23	1.11	1.36	b
		Number of medications per day	0.34	0.22	1.41	1.12	1.77	a
	Oral health status	Number of teeth with DED	0.10	0.07	1.11	1.04	1.19	a
	Oral health status	Missing teeth	1.57	0.69	4.81	2.35	9.85	b
About communication II	Living conditions	Self-reported race	1.51	0.78	4.53	2.01	10.21		18%	14%	133.48	0.32
		School system	-1.56	0.61	0.21	0.11	0.40
		Number of rooms per residence	-0.43	0.20	0.65	0.53	0.81
	Health status	Number of acute or chronic complications per year	0.41	0.19	1.50	1.24	1.82
	Health status	Number of medications per day	0.28	0.19	1.32	1.08	1.61	a
	Oral health status	Number of teeth with DED	0.16	0.06	1.18	1.10	1.26	b
About the impact of my pain	Living conditions	School system	-8.88	4.37	0.00	0.00	0.01	b	69%	56%	28.67	0.04
		Number of family members	3.86	2.10	47.47	5.38	418.43	a
		Car owner	4.47	3.18	87.36	3.24	2358.68
	Health Status	Number of acute or chronic complications per year	1.83	0.99	6.26	2.26	17.37
	Health Status	Number of medications per day	3.24	1.85	25.53	3.75	173.71
	Oral health status	Dental caries (permanent dentition)	-0.64	0.38	0.53	0.35	0.78

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[1] Collaborations

All authors participated equally in all stages of preparation of the manuscript.