Analysis of the combined risk of oral problems in the oral health-related quality of life of Brazilian adolescents: multilevel approach

Objectives The objective of this study was to evaluate the combined risk of oral problems in the oral health-related quality of life (OHRQoL) of adolescents aged 15 to 19 years in Sao Paulo state (Brazil) in the year of 2015. Materials and methods Data from the Sao Paulo State Oral Health Survey (SBSP-15) and the contextual characteristics of the cities of Sao Paulo state, evaluated in the year 2015 were accessed. Correlations were made between contextual factors (i.e., coverage of the family health team, average supervised tooth brushing, number of first dental appointments, and average income), individual sociodemographic variables (i.e., ethnicity, gender, and schooling) and dental problems (dental pain, caries, overjet, open bite, indication for endodontic and exodontic treatment, gingival bleeding, and dental trauma). These variables were correlated with the quality of life of the adolescents using the Oral Impacts on Daily Performance (OIDP) index. Multilevel Poisson regressions were performed to calculate the rate ratio (RR) with 95% confidence interval (CI). Results According to the bivariate analysis, the presence of low (RR, 1.62; 95% CI 1.07-2.46) and very intense (RR, 2.53, 95% CI 1.92-3.34) dental pain, indication for endodontic (RR, 1.31; 95% CI 1.05-1.63) or for exodontic (RR, 1.31; 95% CI 1.06-1.63) treatment, and gingival bleeding (RR, 1.41; 95% CI 1.11-1.80) reduced the quality of life of adolescents. All domains of OIDP scores were associated between healthy and unhealthy individuals (p < 0.001) increasing mean scores with combined oral health problems. Higher impact on quality of life was associated with simultaneous presence of dental pain, gingival bleeding, and indication for exodontic treatment (RR, 6.03; 95% CI, 4.02-9.04) in the adolescents. Conclusion Individual and contextual factors and the various dental problems are independently associated with the quality of life of Brazilian adolescents aged 15 to 19 years, especially when they are associated with the perception of intense dental pain, gingival bleeding, and indication for exodontic treatment, with up to six times greater impact on OIDP.