title: Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach.
abstract: BACKGROUND
  Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.
  
  
  OBJECTIVE
  To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.
  
  
  METHODS
  The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.
  
  
  RESULTS
  Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.
  
  
  CONCLUSIONS
  Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.
authors: Oral Epidemiology and Public Health Dentistry, Post-graduate Program in Public Health, Department of Public Health, Universidade Federal de University of Santa Catarina, Florianópolis, Brazil. mperes@ccs.ufsc.br
authors: Marco A
authors: MA
authors: Peres
authors: Karen G
authors: KG
authors: Peres
authors: Antônio C
authors: AC
authors: Frias
authors: José Leopoldo F
authors: JL
authors: Antunes
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008399:Mass Behavior; D055361:Multilevel Analysis; D010146:Pain; D000297:Psychology, Adolescent; D012737:Sex Factors; D012959:Socioeconomic Factors; D014098:Toothache / Q000453:epidemiology* / Q000523:psychology