Association between sense of coherence and untreated dental caries in preschoolers: a cross-sectional study

Abstract

Objective: The aim of the present study was to evaluate factors associated with the clinical consequences of untreated dental caries in children attending public and private preschools.

Methods: A cross-sectional study was conducted with a complex, preschool-based sample of 769 children, 5 years of age, from public and private preschools in the city of Campina Grande, Brazil. Clinical examinations to diagnose the consequences of untreated caries were performed using the criteria of the pufa index (p - pulp exposure; u - ulceration caused by movement of tooth fragments; f - fistula; a - abscess). The psychological factor evaluated was parental/caregiver sense of coherence (SOC), which was determined using a validated assessment tool. Sociodemographic characteristics and the use of dental services were also considered. Two examiners were trained to examine the clinical consequences of untreated dental caries. The kappa statistic demonstrated a high level of agreement for the conditions evaluated. Descriptive analysis was performed, followed by the use of an inductive decision tree (J48 algorithm; α = 5%).

Results: The factors associated with the clinical consequences of untreated dental caries were toothache [prevalence ratio (PR) = 12.34; 95% confidence interval (95% CI): 7.87-19.35; P < 0.001], attending a public preschool (PR = 2.38; 95% CI: 1.83-3.09; P < 0.001), parents/caregivers younger than 30 years of age (PR = 1.45; 95% CI: 1.26-1.68; P < 0.001), parents/caregivers with more than two children (PR = 1.47; 95% CI: 1.28-1.69; P < 0.001) and parents/caregivers with a weak SOC (PR = 1.13; 95% CI: 1.01-1.28; P = 0.043).

Conclusion: The prevalence of clinical consequences of untreated dental caries was low in the present sample and was associated with sociodemographic factors (type of preschool, caregiver's age and number of children in the family) as well as psychological factors (SOC).

Keywords: Dental caries; decision trees; preschool children; sense of coherence.

Figure 1.

Basic elements of a decision tree: RN, root node (main attribute); IN, inner node (problems generate internally); LF, leaf node (solutions or terminal attributes); P, probability of occurrence of an event.

Figure 2.

Decision tree modelled for consequences of untreated dental caries (pufa index) in preschoolers. The pufa index is calculated according to the presence/absence of the following: pulp exposure (p), ulceration caused by movement of tooth fragments (u), fistula (f) and abscess (a).