Στοματική υγεία και ψυχοκοινωνικοί παράγοντες: μελέτη σε δείγμα Θεσσαλονικέων εφήβων

Abstract

ObjectivesTo examine:a) whether psychosocial factors, such as Sense of Coherence (SoC), SocioEconomic Status (SES), life-course experiences, and within-family relationships, have an effect on dental caries experience of adolescents, via oral health behaviorb) whether oral health behavior has a direct effect on dental cariesexperiencec) whether psychosocial factors have an indirect effect on dental cariesexperience, via SoC and oral health behaviord) whether adolescents’ SoC has an effect on dental caries experience, via oral health behaviore) whether psychosocial factors have an effect on adolescents’ SoCf) whether the adolescents’ life-course experiences are associated with SESg) whether the adolescents’ perception of parental support is associated to parental punishmenth) the association of traumatic dental injuries (TDI) and psychosocial factors, such as adolescents’ SoC, SES, life-course experiences, gender, behavioral characteristics, mothers’ SoC, and within-family relationships, in adolescentsi) identify, and associate psychological profiles of adolescents with TDIprevalenceMaterials and methodsA cross-sectional study was conducted including 531 consented schoolchildren (Mean age = 13.5, Standard Deviation - SD = 0.5), and their mothers. The metropolitan area of Thessaloniki was divided into 4 economic xivstrata using data for property prices. Depending on the number of schools in each stratum, 4-7 schools were randomly chosen. In total 21 high-schools were selected. Data were collected through a questionnaire completed by the mothers, and an oral exam conducted with their adolescent children, in the schools; the adolescents also completed a structured interview with the author. Through oral examination were recorded two dental diseases (dental caries experience, TDI), and the number of dental sealants. Dental caries experience was recorded in permanent teeth, using the ICDAS-IIindex, converted to DMFS index, using the WHO conversion criteria and the D3 as the cut-off score. TDI was recorded in permanent incisors, using a modified version of Ellis classification. The dental examination was followed by a sort history of the disease, if needed. In addition, the students provided information which comprised psychosocial and behavioral variables, including: a) the 13-item SoC questionnaire, b) the 4-item Family Affluence Scale (FAS-II) questionnaire, c) the 12-item questionnaires for the level of support and punishment they perceive from each parent, d) the number of complaints they made to the school director related to their schoolmates behavior, last school year, e) their last school year grade, f) the toothbrushing frequency, per day, g) the number of days per week they are physically active, and h) the number of days per week they consume sweetened carbonated soft drinks and confectionary sweets. The mothers of the students provided additional information, concerning: a) the education level of each parent, b) the home ownership (Yes-No), c) the home crowding (the number of bedrooms in the family residence, divided by the number of residents), d) the employment status of each parent, e) the 13-item SoC questionnaire, f) the family structure (nuclear-noncluear), and g) the birth order of the adolescent (firstborn-nonfirstborn). Two different statistical multivariate approaches were followed for analyzing the xvtwo dental diseases. For the dental caries experience, a Categorical Principal Component Analysis (CatPCA) was initially applied, in order to build 6 composite variables (SES, life-course experiences, parental support, parental punishment, sugar intake, preventive measures) and one latent variable(oral health behavior), which included in the conceptual model. The model was examined with a Structural Equation Modeling (SEM) analysis. For the TDI, a model based approach (logistic regression) was initially adopted which was followed by a data based approach (Hierarchical Cluster Analysis -HCA). In the latter, 4 psychological factors were included in the analysis of the adolescents’ profile (own and mother’s SoC, paternal and maternal support).ResultsDental caries experience was estimated 2.74 (Range = 0-40, SD = 4.27). A total of 228 (42.9%) of the adolescents were caries free. The mean number of sealants was 0.54 (Range = 0-16, SD = 1.69). Τhe data fit the proposed conceptual model (P > 0.05), and the significant effects were found in the expected direction. The direct effect of oral health behavior on dental caries experience was significant (Standardized Regression Coefficient – Std R.C. =0.472, P < 0.05). The two composite variables (sugar intake, preventive measures) contributed about equally strong to the building of the latent variable of oral health behavior (P < 0.05). Among all psychosocial factors the strongest effect observed on oral health behavior was that ofadolescent’s SoC (Std. R.C. = -0.378, P < 0.05). Apart from perceived parental punishment, all other psychosocial variables had an indirect effect on dental caries via oral health behavior (P < 0.05), and, among these variables, the adolescents’ SoC had the strongest effect (Std. R.C. = -0.178, P < 0.05).Moreover, the adolescents’ SoC was statistically affected by all psychosocial composite variables tested (P < 0.05). The life-course experiences were xviassociated to SES (P < 0.05), while the parental support was not associated to parental punishment (P > 0.05).In the case of TDI, the prevalence (Yes-No) was found 15,8%. The stepwise logistic regression revealed that boys and non-firstborns were more likely to have a TDI than girls and firstborns. In addition, adolescents frequently complaining about the behavior of their peer group, reporting lower paternal support and whose mother reports lower SoC, were more likely to have a TDI (P < 0.05). The HCA revealed three discrete Clusters of adolescents relative to their psychological profile. The Cluster 1 that was having the higher scores in all 4 psychosocial variables, appeared to have statistical significant lower prevalence of TDI, compared to Clusters 2 and 3 (P < 0.05).Conclusions: The hypotheses that psychosocial factors relate to the oral health status of adolescents was confirmed. Psychosocial factors showed to be related todental caries experience, via oral health behavior and the strongest statistical effect was that of adolescents SoC. Moreover, psychosocial factors, including SoC, associated to TDI prevalence. Support was also provided to the Antonovsky’s conceptual framework, by which SoC directly relates to psychosocial factors and indirectly to chronic diseases, through health behavior adaptation.

Η διερεύνηση της σχέσης μεταξύ στοματικής υγείας και ψυχο-κοινωνικώνπαραγόντων σε δείγμα Θεσσαλονικέων εφήβων.Υλικό και ΜέθοδοςΕξετάστηκαν 531 μαθητές της Β’ τάξης Γυμνασίου στα σχολεία. Καταγράφηκε η τερηδονική εμπειρία με μετατροπή του δείκτη ICDAS-IIστον δείκτη DMFS (D = 3-6) και τα οδοντικά τραύματα στους μόνιμους τομείς. Ψυχο-κοινωνικοί και συμπεριφορικοί παράγοντες συλλέχθηκαν με συνέντευξη των μαθητών και με ερωτηματολόγια από τις μητέρες. Η στατιστική ανάλυση περιλάμβανε ένα θεωρητικό μοντέλο για την τερηδονική εμπειρία και ομοιογενείς Συστάδες μαθητών για τα οδοντικά τραύματα. Αποτελέσματα: Ο δείκτης τερηδονικής εμπειρίας υπολογίστηκε 2,74. Το θεωρητικό μοντέλο βρέθηκε ότι ισχύει (P > 0,05). Η τερηδονική εμπειρία δέχτηκε στατιστική επίδραση από ψυχο-κοινωνικούς παράγοντες, μέσω της συμπεριφοράς υγείας (P < 0,05). Τα οδοντικά τραύματα υπολογίστηκε σε 15,8% και συσχετίστηκαν με ψυχο-κοινωνικούς παράγοντες (P < 0,05). Συμπεράσματα: Οι ψυχο-κοινωνικοί παράγοντες συσχετίζονται με την τερηδονική εμπειρία μέσω της συμπεριφοράς στοματικής υγείας και με τον επιπολασμό των οδοντικών τραυμάτων.