title: The use of dental care facilities and oral health: a multilevel approach of schoolchildren in the Brazilian context.
abstract: OBJECTIVE
  To appraise the association between dental care utilisation and gingival status in the Brazilian context, controlling for covariates on socio-demographic characteristics and dentofacial anomalies (12-year-old children).
  
  
  METHODS
  A survey of oral health comprising 5780 schoolchildren in 35 towns of the state of São Paulo, Brazil, provided primary information regarding the assessment of the community periodontal index. The survey also provided information on socio-demographic characteristics and the dental aesthetic index of participants. The utilization of dental services was measured at the town-level, in terms of the dental care index (F/DMFT ratio). Multilevel models of logistic regression fitted the adjustment of covariates for gingival bleeding on probing and calculus.
  
  
  RESULTS
  Almost 32% of the children examined presented unhealthy gingival conditions, with a significantly poorer profile for boys, black children and those enrolled in public schools than for their counterparts. Several dentofacial anomalies associated with unhealthy gingival status: crowding of the incisal segments, maxillary and mandibular irregularity, antero posterior molar relation, maxillary overjet and vertical anterior openbite. Towns with a higher dental care index presented a lower proportion of children with gingival bleeding and calculus.
  
  
  CONCLUSIONS
  This study confirmed previous observations of boys, blacks and children enrolled in public schools as presenting poorer oral health status than their counterparts in the Brazilian context. The utilization of dental services was significantly associated with improved profile of gingival status of participating towns, and this association is unlikely to be due to insufficient control of confounding on socio-demographic characteristics and dentofacial anomalies.
authors.affiliation: School of Dentistry, University of São Paulo, São Paulo, SP, Brazil. leopoldo@usp.br
authors.forename: José Leopoldo
authors.initials: JL
authors.lastname: Antunes
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Peres
authors.forename: Graciela Medeiros Jabôr
authors.initials: GM
authors.lastname: Jahn
authors.forename: Bárbara Bianca da Silva
authors.initials: BB
authors.lastname: Levy
mesh_terms: D044383:Black People; D001938:Brazil; D002648:Child; D003728:Dental Calculus / Q000517:prevention & control; D003752:Dental Health Services / Q000706:statistics & numerical data*; D005260:Female; D005882:Gingival Diseases / Q000517:prevention & control*; D006801:Humans; D016018:Least-Squares Analysis; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010512:Periodontal Index; D017150:Public Sector; D012574:Schools; D012737:Sex Factors; D012923:Social Class; D044465:White People