Oral health of quilombola and non-quilombola rural adolescents: a study of hygiene habits and associated factors

Silva, Etna Kaliane Pereira da; Santos, Patrícia Reis dos; Chequer, Tatiana Praxedes Rodrigues; Melo, Camila Moreira de Almeida; Santana, Katiuscy Carneiro; Amorim, Maise Mendonça; Medeiros, Danielle Souto de

doi:10.1590/1413-81232018239.02532018

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ARTICLES • Ciênc. saúde colet. 23 (9) • Sept 2018 • https://doi.org/10.1590/1413-81232018239.02532018 copy

Oral health of quilombola and non-quilombola rural adolescents: a study of hygiene habits and associated factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study evaluated oral hygiene habits and their association with sociocultural, environmental factors and factors related to the use of dental services among Quilombola and non-Quilombola rural adolescents from inland Bahia. Thiswas a cross-sectional study conducted in 2015. Prevalence and prevalence ratios were estimated for the outcomes and multiple Poisson regression analysis with robust variance was performed. We interviewed 390 adolescents, of which 42.8% were Quilombola. Poor tooth brushing and non-flossing were found in 33.3% and 46.7% of adolescents, respectively. Poor tooth brushing was increased by male gender (PR = 1.45), not living with both parents (PR = 1.45), lower hand hygiene habit (PR = 1.72) and worse oral health self-assessment (PR = 1.38). Non-flossing was associated with economic level E (PR = 1.54), older age (PR = 0.91), lower hand hygiene habit (PR = 1.53) and worse oral health self-assessment (PR = 1.33). Different associated factors were observed between Quilombola and non-Quilombola. It is necessary to consider the specificities of the populations for the promotion of adolescent oral health and the importance of the intersectoriality between education and health and care to families.

Oral health; Adolescent; Rural health; Ethnicity and health

Variables	Total		Non-Quilombola		Quilombola		P- Value ^‡

	n*	(%) ^†	n ^*	(%) ^†	n ^*	(%) ^†
Use of toothbrush							1.000
No	1	0.3	1	0.4	0	0.0
Yes	389	99.7	222	99.6	167	100.0
Use of toothpaste							1.000
No	1	0.3	1	0.4	0	0.0
Yes	389	99.7	222	99.6	167	100.0
Toothbrush replacement							0.156
Less than 3 months	193	49.5	119	53.4	74	44.3
Between 3 months andless than 6 months	155	39.7	84	37.7	71	42.5
Between 6 months and more / Never replaced	42	10.8	20	9.0	22	13.2
Oral health self-assessment							0.375
Very good / good	245	63.0	144	64.9	101	60.5
Fair / poor / very poor	144	37.0	78	35.1	66	39.5
Dental treatment required							0.577
No	202	51.9	118	53.1	84	50.3
Yes	187	48.1	104	46.9	83	49.7
Total dental prosthesis required							0.855
No	380	97.4	217	97.3	163	97.6
Yes	10	2.6	6	2.7	4	2.4
Dental pain in the last six months							0.521
No	312	80.4	181	81.5	131	78.9
Yes	76	19.6	41	18.4	35	21.1
Satisfaction with teeth/mouth							0.251
Very satisfied / Satisfied	285	73.1	165	74.0	120	71.9
Neither satisfied nor dissatisfied	71	18.2	43	19.3	28	16.8
Dissatisfied / Very dissatisfied	34	8.7	15	6.7	19	11.4
Dental consultation in lifetime							0.001
Yes	329	84.4	200	89.7	129	77.3
No	61	15.6	23	10.3	38	22.7
Dental consultation in the last year							0.431
Yes	260	66.8	152	68.5	108	64.7
No	129	33.2	70	31.5	59	35.3
Type of service last dental consultation							0.706
Private service	106	32.2	66	33.0	40	31.0
Public service	223	67.8	134	67.0	89	69.0
Locationof last dental consultation							0.231
Family Health Facility	219	66.8	126	63.3	93	72.1
Private practice or private clinic	88	26.8	58	29.2	30	23.3
Other	21	6.4	15	7.5	6	4.6
Reasonfor last dental consultation							0.227
Cleaning, maintenance, review or prevention	167	50.8	106	53.0	61	47.3
Toothache / Extraction / Gum Problems / Dental Treatment	138	41.9	77	38.5	61	47.3
Orthodontic appliance / Budget / Other	24	7.3	17	8.5	7	5.4
Assessmentof last dental consultation							0.730
Very good / Good	281	85.4	170	85.0	111	86.0
Fair	35	10.6	23	11.5	12	9.3
Poor / Very poor	13	4.0	7	3.5	6	4.7

Variables	Total sample				Non- Quilombola				Quilombola

	n ^*	P (%) ^†	RP ^‡	IC95% ^§	n ^*	P (%) ^†	RP ^‡	IC95% ^§	n ^*	P (%) ^†	RP ^‡	IC95% ^§
Sociocultural factors
Economic level
B and C	46	30.5	1.00	-	34	30.6	1.00	-	12	30.0	1.00	-
D	64	35.0	1.15	0.84 – 1.59	33	35.9	1.17	0.79 – 1.73	31	34.1	1.13	0.65 – 1.98
E	20	35.8	1.17	0.76 – 1.80	6	30.0	0.97	0.47 – 2.02	14	38.9	1.29	0.69 – 2.43
Gender
Female	56	28.0	1.00	-	25	22.9	1.00	-	31	34.1	1.00	-
Male	74	38.9	1.39	1.04 – 1.85	48	42.1	1.83	1.22 – 2.75	26	34.2	1.00	0.65 – 1.53
Skin color
Non-black	31	33.7	1.00	-	22	33.8	1.00	-	9	33.3	1.00	-
Black	99	33.2	0.98	0.70 – 1.37	51	32.3	0.95	0.63 – 1.44	48	34.3	1.03	0.57 – 1.84
Age	130	-	0.98	0.93 – 1.03	73	-	0.99	0.93 – 1.06	57	-	0.95	0.88 – 1.03
Schooling	130	-	0.98	0.93 – 1.03	73	-	0.98	0.91 – 1.05	57	-	0.98	0.90 – 1.07
Experimentation of alcoholic beverage
No	88	31.4	1.00	-	48	31.4	1.00	-	40	31.5	1.00	-
Yes	42	38.2	1.21	0.90 – 1.63	25	35.7	1.13	0.77 – 1.69	17	42.5	1.34	0.86 – 2.10
Experimentation of tobacco
No	124	33.5	1.00	-	68	32.3	1.00	-	56	35.2	1.00	-
Yes	6	30.0	0.89	0.45 – 1.78	5	41.8	1.29	0.64 – 2.60	1	12.5	0.35	0.05 – 2.25
Experimentation of illicit drugs
No	127	33.2	1.00	-	70	32.1	1.00	-	57	34.5	-	-
Yes	3	42.9	1.29	0.54 – 3.07	3	60.0	1.86	0.89 – 3.93	0	0.00	-	-
Physical activity
Higher or equal to 300 min/week	63	35.2	1.00	-	37	36.6	1.00	-	26	33.3	1.00	-
Less than 300 min/week	67	31.7	0.90	0.68 – 1.19	36	29.5	0.80	0.55 – 1.17	31	34.8	1.04	0.68 – 1.60
Close friends
Up to 2 friends	18	27.3	1.00	-	12	30.7	1.00	-	6	22.2	1.00	-
3 or more	112	34.6	1.26	0.83 – 1.93	61	33.1	1.07	0.64 – 1.80	51	36.4	1.63	0.78 – 3.44
Household composition
Living with father and mother	77	29.2	1.00	-	44	28.0	1.00	-	33	30.8	1.00	-
Living only with father or mother / Not living with parents	53	42.1	1.44	1.09 – 1.90	29	43.9	1.57	1.08 – 2.27	24	40.0	1.30	0.85 – 1.98
Feeling of loneliness
Never or rarely	77	31.2	1.00	-	44	31.4	1.00	-	33	30.9	1.00	-
Sometimes / Most of the time / Always	53	37.1	1.19	0.89 – 1.58	29	34.9	1.11	0.76 – 1.63	24	40.0	1.30	0.85 – 1.98
Parents understand problems
Most of the time or always	56	34.4	1.00	-	36	38.7	1.00	-	20	28.6	1.00	-
Sometimes	35	28.3	0.82	0.58 – 1.17	15	21.1	0.54	0.32 – 0.92	20	37.7	1.32	0.79 – 2.19
Never or rarely	37	37.8	1.09	0.79 – 1.53	21	38.2	0.99	0.64 – 1.51	16	37.2	1.30	0.79 – 2.23
Environmental factors
Water supply by the general distribution network
Yes	101	31.5	1.00	-	61	31.6	1.00	-	40	31.2	1.00	-
No	28	41.2	1.30	0.94 – 1.81	12	40.0	1.26	0.78 – 2.06	16	42.1	1.35	0.85 – 2.12
Hand hygiene before meals
Most of the time or always	74	27.2	1.00	-	42	26.2	1.00	-	32	28.6	1.00	-
Sometimes / never / rarely	56	47.5	1.74	1.33 – 2.29	31	49.2	1.87	1.30 – 2.69	25	45.5	1.59	1.05 – 2.40
Use of dental services
Oral health self-assessment
Very good / good	67	27.3	1.00	-	41	28.5	1.00	-	26	25.7	1.00	-
Fair / poor / very poor	62	43.1	1.57	1.19 – 2.09	31	39.8	1.39	0.95 – 2.03	31	47.0	1.82	1.20 – 2.78
Dental treatment required
No	69	34.2	1.00	-	41	34.7	1.00	-	28	33.3	1.00	-
Yes	60	32.1	0.94	0.71 – 1.25	31	29.8	0.86	0.58 – 1.26	29	34.9	1.04	0.69 – 1.60
Dental pain in the last six months
No	107	34.3	1.00	-	63	34.8	1.00	-	44	33.6	1.00	-
Yes	21	27.6	0.80	0.54 – 1.20	9	21.9	0.63	0.34 – 1.16	12	34.3	1.02	0.60 – 1.72
Dental consultation in the last year
Yes	79	30.4	1.00	-	41	27.0	1.00	-	38	35.2	1.00	-
No	51	39.5	1.30	0.98 – 1.73	32	45.7	1.69	1.17 – 2.44	19	32.2	0.92	0.58 – 1.44

Variables	Total Sample				Non-Quilombola				Quilombola

	n ^*	P (%) ^†	PR ^‡	CI95% ^§	n ^*	P (%) ^†	PR ^‡	CI95% ^§	n ^*	P (%) ^†	PR ^‡	CI95% ^§
Sociocultural factors
Economic level
B and C	64	42.4	1.00	-	47	42.3	1.00	-	17	42.5	1.00	-
D	81	44.3	1.04	0.81 – 1.34	42	45.6	1.08	0.79 – 1.47	39	42.9	1.01	0.65 – 1.55
E	37	66.1	1.56	1.20 – 2.03	14	70.0	1.65	1.15 – 2.37	23	63.9	1.50	0.97 – 2.33
Gender
Female	89	44.5	1.00	-	47	43.1	1.00	-	42	46.1	1.00	-
Male	93	48.9	1.10	0.89 – 1.36	56	49.1	1.14	0.85 – 1.52	37	48.7	1.05	0.76 – 1.45
Skin color
Non-black	49	53.3	1.00	-	34	52.3	1.00	-	15	55.6	1.00	-
Black	133	44.6	0.84	0.66 – 1.05	69	43.7	0.83	0.62 – 1.12	64	45.7	0.82	0.56 – 1.21
Age	182	-	0.91	0.88 – 0.95	103	-	0.91	0.86 – 0.96	79	-	0.91	0.86 – 0.97
Schooling	182	-	0.92	0.89 – 0.96	103	-	0.91	0.87 – 0.96	79	-	0.94	0.88 – 1.00
Experimentation of alcoholic beverage
No	131	46.8	1.00	-	72	47.1	1.00	-	59	46.5	1.00	-
Yes	51	46.4	0.99	0.78 – 1.25	31	44.3	0.94	0.69 – 1.29	20	50.0	1.08	0.75 – 1.55
Experimentation of tobacco
No	173	46.8	1.00	-	98	46.4	1.00	-	75	47.2	1.00	-
Yes	9	45.0	0.96	0.58 – 1.58	5	41.7	0.90	0.45 – 1.78	4	50.0	1.06	0.52 – 2.16
Experimentation of illicit drugs
No	178	46.5	1.00	-	100	45.8	1.00	-	78	47.3	1.00	-
Yes	4	57.1	1.23	0.64 – 2.36	3	60.0	1.31	0.63 – 2.72	1	50.0	1.06	0.26 – 4.29
Physical activity
Higher or equal to 300 min/week	81	45.3	1.00	-	47	46.5	1.00	-	34	43.6	1.00	-
Less than 300 min/week	101	47.8	1.05	0.85 – 1.31	56	45.9	0.99	0.74 – 1.31	45	50.6	0.43	0.84 – 1.61
Close friends
Up to 2 friends	26	39.4	1.00	-	18	46.1	1.00	-	8	29.6	1.00	-
3 or more	156	48.1	1.22	0.89 – 1.68	85	46.2	1.00	0.69 – 1.45	71	50.7	1.71	0.94 – 3.13
Household composition
Living with father and mother	128	48.5	1.00	-	75	47.8	1.00	-	53	49.5	1.00	-
Living only with father or mother / Not living with parents	54	42.9	0.88	0.69 – 1.12	28	42.4	0.89	0.64 – 1.23	26	43.3	0.87	0.62 – 1.24
Feeling of loneliness
Never or rarely	113	45.7	1.00	-	62	44.3	1.00	-	51	47.7	1.00	-
Sometimes / Most of the time / Always	69	48.2	1.05	0.85 – 1.31	41	49.4	1.12	0.84 – 1.49	28	46.6	0.98	0.70 – 1.37
Parents understand problems
Most of the time or always	75	46.0	1.00	-	49	52.7	1.00	-	26	37.1	1.00	-
Sometimes	56	45.2	0.98	0.76 – 1.27	28	38.4	0.74	0.53 – 1.06	28	52.8	1.42	0.95 – 2.11
Never or rarely	50	51.2	1.10	0.86 – 1.43	25	45.4	0.86	0.61 – 1.22	25	58.1	1.56	1.05 – 2.33
Environmental factors
Water supply by the general distribution network
Yes	140	43,6	1,00	-	87	45,1	1,00	-	53	41,4	1,00	-
No	41	60,3	1,38	1,10 – 1,74	16	53,3	1,18	0,82 – 1,71	25	65,8	1,59	1,17 – 2,16
Hand hygiene before meals
Most of the time or always	111	40,8	1,00	-	62	38,7	1,00	-	49	43,7	1,00	-
Sometimes / never / rarely	71	60,2	1,47	1,20 – 1,81	41	65,1	1,68	1,29 – 2,19	30	54,5	1,25	0,90 – 1,72
Use of dental services
Oral health self-assessment
Very good / good	103	42,0	1,00	-	61	41,4	1,00	-	42	41,6	1,00	-
Fair / poor / very poor	78	54,2	1,29	1,04 – 1,59	41	52,6	1,24	0,93 – 1,65	37	56,1	1,35	0,98 – 1,85
Dental treatment required
No	92	45,5	1,00	-	51	43,2	1,00	-	41	48,8	1,00	-
Yes	89	47,6	1,04	0,84 – 1,29	51	49,0	1,13	0,85 – 1,51	38	45,8	0,94	0,68 – 1,29
Dental pain in the last six months
No	148	47,4	1,00	-	86	47,5	1,00	-	62	47,3	1,00	-
Yes	32	42,1	0,89	0,66 – 1,18	16	39,0	0,82	0,54 – 1,24	16	45,7	0,96	0,64 - 1,45
Dental consultation in the last year
Yes	119	45,8	1,00	-	61	40,1	1,00	-	58	53,7	1,00	-
No	62	48,1	1,05	0,84 – 1,31	41	58,6	1,45	1,11 – 1,93	21	35,6	0,66	0,45 – 0,97

Unsatisfactory dental brushing

Variables	Total Sample		Non-Quilombola		Quilombola

	PR*	CI95%†	PR*	CI95%†	PR*	CI95%†
Gender
Female	1.00	-	1.00	-	-	-
Male	1.45	1.10 – 1.92	1.96	1.32 – 2.91	-	-
Household composition
Living with father and mother	1.00	-	1.00	-	-	-
Living only with one of the parents or not living with parents	1.45	1.11 – 1.90	1.57	1.12 – 2.21	-	-
Hand hygiene before meals
Most of the time or always	1.00	-	1.00	-	1.00	-
Sometimes / never / rarely	1.72	1.32 – 2.24	1.91	1.36 – 2.68	1.59	1.05 – 2.40
Oral health self-assessment
Very good / good	1.00	-	-	-	1.00	-
Fair / poor / very poor	1.38	1.05 – 1.82	-	-	1.72	1.12 – 2.62
Dental consultation in the last year
Yes	-	-	1.00	-	-	-
No	-	-	1.50	1.04 – 2.16	-	-

Non-use of dental floss

Variables	Total Sample		Non-Quilombola		Quilombola

	PR*	CI95%†	PR*	CI95%†	PR*	CI95%†

Economic level
B and C	1.00	-	1.00	-	-	-
D	1.03	0.82 – 1.31	1.04	0.78 – 1.40	-	-
E	1.54	1.19 – 2.01	1.57	1.12 – 2.22	-	-
Age	0.91	0.88 – 0.95	0.91	0.86 – 0.95	0.91	0.86 – 0.97
Parents understand problems
Most of the time or always	-	-	-	-	1.00	-
Sometimes	-	-	-	-	1.51	1.04 – 2.20
Never or rarely	-	-	-	-	1.64	1.11 – 2.42
Water supply by the general distribution network
Yes	-	-	-	-	1.00	-
No	-	-	-	-	1.46	1.07 – 2.00
Hand hygiene before meals
Most of the time or always	1.00	-	1.00	-	-	-
Sometimes / never / rarely	1.53	1.25 – 1.88	1.71	1.31 – 2.23	-	-
Oral health self-assessment
Very good / good	1.00	-	-	-	1.00	-
Fair / poor / very poor	1.33	1.09 – 1.64	-	-	1.51	1.12 – 2.05
Dental consultation in the last year
Yes	-	-	1.00	-	-	-
No	-	-	1.31	<1.00 – 1.71	-	-

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[1] Collaborations

The authors DS Medeiros and KC Santana participated in the conception of the study. The authors DS Medeiros and EKP Silva participated in the implementation of the study, analysis and interpretation of the results and writing of the article. The authors PR Santos, TPR Checker, CMA Melo and KC Santana participated in the interpretation of the results and writing of the article. The author MM Amorim participated in the interpretation of the results and carried out a relevant critical analysis of the intellectual content. All authors have read and approved the final version of this manuscript.