The influence of protective psychosocial factors on the incidence of dental pain

Alvarenga, Mariana Guimarães Jorge de; Rebelo, Maria Augusta Bessa; Lamarca, Gabriela de Almeida; Paula, Janice Simpson de; Vettore, Mario Vianna

doi:10.11606/s1518-8787.2022056004061

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Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056004061 copy

The influence of protective psychosocial factors on the incidence of dental pain

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To investigate the influence of protective psychosocial factors on the incidence of dental pain in the last six months among 12-year-old children living in Manaus (AM).

METHODS

A prospective school-based cohort study was conducted with 210 12-year-old students enrolled in public schools in the eastern zone of Manaus (AM). Students were followed up for two years. Validated questionnaires were used to assess sociodemographic characteristics, protective psychosocial factors, including sense of coherence, social support, and self-esteem at baseline and after two years. Calibrated examiners clinically assessed dental caries and gingival bleeding. Multivariate multilevel Poisson regression was used to estimate the relative risk (RR) and 95% confidence interval (95%CI) between the changes on psychosocial factors scores and incidence of dental pain, adjusted for psychosocial factors scores at baseline, dental health insurance, frequency of tooth brushing, and dental caries.

RESULTS

Mean scores for sense of coherence and social support reduced significantly from baseline to 2-year follow-up. The incidence of dental pain along the two-year follow-up was 28.6%. The risk of dental pain was 14% higher for every 10 points in the mean reduction of sense of coherence score (RR = 1.14; 95%CI: 1.02–1.20), and 6% higher for every 10 points of the mean reduction in social support score (RR = 1.06; 95%CI: 1.01–1.11). Change on self-esteem was not associated with risk of dental pain.

CONCLUSION

Change on sense of coherence and social support over the two-year period influenced the incidence of dental pain among children, suggesting that protective psychosocial factors, health behaviours, dental health insurance, and clinical oral condition have an important role in the incidence of dental pain.

Child; Toothache, epidemiology; Sense of Coherence; Psychosocial Support Systems; Health Education, Dental; Longitudinal Studies

Variable	Baseline data from the study sample (n = 210)	Dental pain in the last 6 months at 2-year follow-up
	Baseline data from the study sample (n = 210)	Yes (n = 60)	No (n = 150)
	Mean (95%CI)	Mean	Mean (95%CI)
Dental pain at 2-year follow-up	28.6 (22.9–35.1)	100.0	0.0
Demographic characteristics
Sex
Male	45.2 (38.6–52.1)	40.0 (28.3–52.6)	47.3 (39.4–55.4)
Female	54.8 (47.9–61.4)	60.0 (47.0–71.7)	52.7 (44.6–60.6)
Skin color
White	16.1 (11.8–21.9)	13.3 (6.7–24.7)	17.3 (12.0–24.3)
Black	9.1 (5.8–13.8)	5.0 (1.6–14.6)	10.7 (6.6–16.7)
Yellow	3.8 (1.9–7.5)	5.0 (1.6–14.6)	3.3 (1.4–7.8)
Brown	68.1 (61.4–74.1)	73.3 (60.6–83.1)	66.0 (58.0–73.2)
Indigenous	2.9 (1.3–6.3)	3.4 (0.8–12.6)	2.7 (0.9–7.0)
Socioeconomic characteristics
Monthly family income
≤ ½ MW	25.8 (20.3–32.3)	21.7 (12.9–34.0)	27.5 (20.9–35.3)
> ½ to 1 MW	41.6 (35.1–48.5)	45.0 (32.8–57.8)	40.3 (32.6–48.4)
> 1 MW	32.5 (26.5–39.2)	33.3 (22.5–46.3)	32.2 (25.1–40.2)
Parents’ education, mean	11.1 (9.9–12.3)	11.9 (8.9–14.8)	10.8 (9.5–12.0)
Dental care
Dental health insurance
Yes	11.4 (7.8–16.5)	21.6 (12.9–34.0)	7.3 (4.1–12.8)
No	88.6 (81.4–95.2)	90.0 (84.0–93.9)	75.0 (62.4–84.4)
Dental visit in the last 12 months	44.3 (37.7–51.1)	0.60 (0.47–71.7)	47.3 (39.4–55.4)
Tooth brushing
Frequency of tooth brushing
< 3 times a day	35.7 (29.5–42.5)	51.7 (39.0–64.1)	29.3 (22.6–37.2)
≥ 3 times a day	64.3 (57.5–70.5)	48.3 (35.9–61.0)	70.7 (62.8–77.5)
Protective psychosocial factors
Sense of coherence, mean	45.8 (45.1–46.5)	47.0 (45.4–48.7)	46.1 (45.2–47.1)
Social support, mean	144.1 (141.8–146.5)	145.8 (141.3–150.3)	143.5 (140.8–146.2)
Self-esteem, mean	31.7 (30.9–31.9)	31.5 (30.5–32.4)	31.2 (30.8–31.9)
Clinical oral measurements
Dental caries, mean	0.5 (0.4–0.7)	0.8 (0.5–1.1)	0.4 (0.2–0.6)
Gingival bleeding, mean	3.3 (3.0–3.7)	3.3 (2.5–4.1)	3.4 (2.9–3.8)

Variables	Baseline	2-year follow-up	p
Variables	Mean (95%CI)	Mean (95%CI)	p
Dental brushing
Frequency of tooth brushing			0.002 ^a
< 3 times a day	35.7 (29.5–42.5)	43.3 (36.7–50.2)
≥ 3 times a day	64.3 (57.5–70.5)	56.7 (49.8–63.3)
Psychosocial protective factors
Sense of coherence, mean	45.8 (45.1–46.5)	42.9 (41.7–44.0)	< 0.001 ^b
Social support, mean	144.1 (141.8–146.5)	138.5 (135.6–141.3)	0.001 ^b
Self-esteem, mean	31.7 (30.9–31.9)	30.8 (30.2–31.3)	0.298 ^b
Clinical oral measurements
Dental caries, mean	0.5 (0.4–0.7)	1.3 (1.0–1.5)	< 0.001 ^b
Gingival Bleeding, mean	3.3 (3.0–3.7)	8.2 (7.8–8.6)	< 0.001 ^b

Variable	RR	95%CI	p
Demographic characteristics
Sex (ref.: Male)
Female	1.24	0.74–2.10	0.416
Skin colour (ref.: White)
Black	0.70	0.18–2.69	0.606
Yellow	1.69	0.44–6.54	0.449
Brown	1.34	0.63–2.88	0.449
Indigenous	1.49	0.31–7.18	0.621
Socioeconomic characteristics
Monthly family income (ref.: > 1 MW
> ½ to 1 MW	1.08	0.60–1.94	0.797
≤ ½ MW	0.83	0.41–1.69	0.609
Parents’ education	1.01	0.99–1.03	0.512
Dental care
Dental health insurance (ref.: No)
Yes	0.46	0.25–0.87	0.017 ^b
Dental visit in the last 12 months (ref: No)
Yes	0.96	0.57–1.60	0.864
Tooth brushing
Frequency of tooth brushing (2 years) (ref.: < 3 times a day)
≥ 3 times a day	0.88	0.53–1.47	0.616
Change on the frequency of tooth brushing	1.52	0.95–2.44	0.078 ^b
Protective psychosocial factors
Sense of coherence (baseline) ^a	1.15	0.86–1.19	0.449
Sense of coherence (2 years) ^a	0.87	0.69–1.03	0.111
Change in Sense of Coherence ^a	1.13	1.01–1.19	0.035 ^b
Social Support (baseline) ^a	1.03	0.95–1.09	0.488
Social Support (2 years) ^a	0.96	0.89–1.02	0.153
Change in Social Support ^a	1.05	1.00–1.10	0.053 ^b
Self-esteem (baseline) ^a .	1.04	0.63–1.21	0.825
Self-esteem (2 years) ^a	0.84	0.51–1.12	0.312
Change in self-esteem ^a	1.11	0.87–1.20	0.319
Clinical oral measurements
Dental caries (baseline)	1.14	0.97–1.34	0.109
Dental caries (2 years)	1.11	0.99–1.24	0.075 ^b
Change in dental caries	1.08	0.91–1.29	0.369
Gingival bleeding (baseline)	0.99	0.90–1.09	0.824
Gingival bleeding (2 years)	0.96	0.89–1.05	0.377
Change in gingival bleeding	1.02	0.95–1.09	0.579

Variable	RR	95%CI	p
Sense of coherence (adjusted model)
Dental health insurance (ref.: No)
Yes	0.49	0.26–0.91	0.024
Change on the frequency of tooth brushing	1.61	1.01–2.57	0.046
Sense of coherence at baseline ^a	0.96	0.68–1.15	0.745
Change on sense of coherence ^a	1.14	1.02–1.20	0.030
Dental caries at 2-year follow-up	1.10	0.99–1.22	0.087
Social support (adjusted model)
Dental health insurance (ref.: No)
Yes	0.47	0.25–0.87	0.017
Change on the frequency of tooth brushing	1.69	1.04–2.76	0.035
Social Support at baseline ^a	0.99	0.90–1.06	0.780
Change in social support ^a	1.06	1.01–1.11	0.038
Dental caries at 2-year follow-up	1.08	0.97–1.20	0.172

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[1] Correspondence: Mario Vianna Vettore University of Agder Department of Health and Nursing Sciences Universitetsveien 25, 4630 Kristiansand, Norway E-mail: mario.vettore@uia.no