Association between underlying dentin shadows (ICDAS 4) and OHRQoL among adolescents from southern Brazil

MARQUEZAN, Patrícia Kolling; COMIM, Letícia Donato; RACKI, Débora Nunes de Oliveira; DALLA NORA, Ângela; ALVES, Luana Severo; ZENKNER, Julio Eduardo do Amaral

doi:10.1590/1807-3107bor-2024.vol38.0046

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Original Research/Cariology • Braz. oral. res. 38 • 2024 • https://doi.org/10.1590/1807-3107bor-2024.vol38.0046 copy

Association between underlying dentin shadows (ICDAS 4) and OHRQoL among adolescents from southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to assess the association between underlying dentin shadows (UDS) and oral health-related quality of life (OHRQoL) among 15-19-year-old adolescents from southern Brazil. This population-based cross-sectional study included a representative sample of 1,197 15–19-year-old adolescents attending 31 public and private schools from Santa Maria, Brazil. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed by two calibrated examiners (intra/interexaminer kappa values for caries examination ≥ 0.80) to diagnose UDS (ICDAS code 4 caries lesions). Sociodemographic information and clinical characteristics (overall caries experience, traumatic dental injury, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between UDS and OHRQoL. Rate ratios (RR) and 95% confidence intervals (CI) were estimated. The UDS prevalence was 8.8% (n = 106 adolescents). In the adjusted models, adolescents with UDS had poorer OHRQoL than those without UDS, and the strength of the association was dependent on the number of lesions per individual. Individuals with 1-2 UDS had a mean OHIP-14 score 8% higher (RR = 1.08; 95%CI: 1.01–1.17) than adolescents without UDS, while those with 3-4 UDS had a mean score 35% higher (RR = 1.35; 95%CI: 1.12–1.63). This negative association was related to physical disability, psychological disability, social disability, and handicap domains. This study showed that UDS was associated negatively with OHRQoL among 15–19-year-old adolescents from southern Brazil. The negative effect of UDS on OHRQoL emphasizes the importance of addressing issues regarding OHRQoL even in the posterior teeth of adolescents.

Dental Caries; Adolescent; Quality of Life; Cross-Sectional Study; Epidemiology

Variables	n (%)	Mean (SE)**	Range
Socio–demographics
Sex
Boys	513 (42.9)	7.36 (0.40)^a	0–38
Girls	684 (57.1)	9.10 (0.32)^b	0–49
Age
15	276 (23.2)	7.67 (0.56)^abc	0–36
16	379 (31.7)	7.51 (0.31)^b	0–49
17	367 (30.7)	8.58 (0.38)^cd	0–43
18–19	175 (14.6)	10.2 (0.76)^d	0–40
Skin color*
White	384 (33.0)	9.01 (0.40)^a	0–49
Non–white	779 (67.0)	7.90 (0.26)^b	0–43
Mother’s education*
≤ Primary school	577 (50.2)	8.74 (0.35)^a	0–49
High school	380 (33.1)	8.20 (0.36)^a	0–34
University	192 (16.8)	6.53 (0.54)^b	0–33
Socioeconomic status*
Low	201 (17.4)	10.35 (0.53)^a	0–40
Mid–Low	320 (27.6)	8.70 (0.45)^b	0–43
Mid–High	302 (26.1)	8.26 (0.24)^b	0–38
High	335 (29.0)	6.88 (0.47)^c	0–49
Clinical variables
Malocclusion
Absent (DAI ≤ 25)	293 (24.5)	7.01 (2.50)^a	0–32
Present (DAI > 25)	904 (75.5)	8.66 (0.33)^b	0–49
Gingivitis
Absent (<10% bleeding sites)	1,031 (86.1)	8.07 (0.27)^a	0–49
Present (≥10% bleeding sites)	166 (13.9)	9.35 (0.70)^a	0–37
Traumatic dental injuries
Absent	993 (83.0)	8.07 (0.30)^a	0–49
Present	204 (17.0)	9.10 (0.54)^a	0–43
Dental caries experience
Absent (DMFT = 0)	641 (53.5)	6.81 (0.32)^a	0–43
Present (DMFT ≥ 1)	556 (46.4)	9.95 (0.39)^b	0–49
Underlying dentin shadow
0	1,091 (91.1)	8.20 (0.24)^a	0–49
1–2	95 (8.0)	9.00 (1.20)^a	0–43
3–4	11 (0.9)	10.90 (3.18)^a	0–36
Total	1,197 (100)	8.24 (0,25)	0–49

Variables	Unadjusted			Adjusted^†

	RR	95%CI	p-value	RR	95%CI	p-value
Functional limitation
0 UDS	1.00				1.00
1–2 UDS	1.16	0.91–1.48	0.24	1.12	0.87–1.44	0.39
3–4 UDS	1.12	0.55–2.28	0.75	1.22	0.60–2.49	0.58
Physical pain
0 UDS	1.00				1.00
1–2 UDS	1.15	1.00–1.32	0.05	1.12	0.97–1.29	0.12
3–4 UDS	1.15	0.78–1.70	0.47	1.22	0.82–1.82	0.32
Psychological discomfort
0 UDS	1.00				1.00
1–2 UDS	1.13	0.99–1.28	0.07	1.07	0.94–1.23	0.30
3–4 UDS	0.91	0.61–1.37	0.66	0.94	0.62–1.42	0.76
Physical disability
0 UDS	1.00				1.00
1–2 UDS	0.87	0.68–1.12	0.28	0.84	0.66–1.09	0.19
3–4 UDS	1.64	1.00–2.72	0.05	1.74	1.04–2.91	0.03
Psychological disability
0 UDS	1.00				1.00
1–2 UDS	1.10	0.92–1.31	0.29	1.06	0.88–1.27	0.54
3–4 UDS	1.58	1.04–2.41	0.03	1.72	1.13–2.64	0.01
Social disability
0 UDS	1.00				1.00
1–2 UDS	1.36	1.08–1.71	0.01	1.30	1.02–1.64	0.03
3–4 UDS	1.76	0.98–3.16	0.06	1.82	1.00–3.30	0.047
Handicap
0 UDS	1.00				1.00
1–2 UDS	1.25	0.93–1.66	0.14	1.19	0.88–1.61	0.25
3–4 UDS	2.06	1.12–3.82	0.02	2.32	1.24–4.34	0.008
OHIP-14
0 UDS	1.00				1.00
1–2 UDS	1.12	1.122–1.125	< 0.001	1.08	1.01–1.17	0.03
3–4 UDS	1.28	1.10–1.54	0.008	1.35	1.12–1.63	0.002

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[1] Corresponding Author: Luana Severo Alves E-mail: luanaseal@gmail.com