title: Association between social determinants of health and functional dentition in 35-year-old to 44-year-old Brazilian adults: a population-based analytical study.
abstract: OBJECTIVE
  To verify the association between functional dentition and social determinants of health in 35-year-old to 44-year-old adults residing in the metropolitan municipalities of Minas Gerais, Brazil.
  
  
  METHODS
  This cross-sectional study assessed a sample of 850 adults obtained using a cluster sampling scheme. Five of 33 municipalities were randomly selected, followed by the random selection of census tracts and neighborhood blocks. Every household in the randomly selected blocks was visited and every resident adult was interviewed and examined by five previously calibrated researchers (κinter , 0.8-0.9; κintra , 0.8-1.0) between May and December 2010. The condition of the dental crown was recorded using the World Health Organization (WHO) criteria, with the exception of the third molars. The dependent variable functional dentition was defined as the presence of 20 or more teeth in the mouth and obtained by counting the number of teeth lost due to any reason, followed by subtraction of this number from the total of 28 teeth. Independent variables were grouped, according to a theoretical model adapted from those proposed by Dahlgren and Whitehead and Petersen, into distal factors (contextual, socioeconomic, and housing conditions), intermediate factors (availability and use of oral health services), and proximal factors (lifestyle, risk behaviors, and demographic conditions). The association between functional dentition and the independent variables was investigated using simple and multiple Poisson regression with robust variance, which followed a modeling strategy in accordance with the hierarchy outlined by the theoretical model. The analyses were processed on SPSS 17.0.
  
  
  RESULTS
  The average age of the participants was 39.4 ± 3.2 years, and the average per capita monthly family income was US$214.52 ± 261.11. Most adults presented functional dentition (80.6%; 95% CI: 77.3-83.5). Independently of marital status, age group and sex, the prevalence ratio (PR) of subjects with a per capita monthly family income ≥US$168.54 was 1.09 (P = 0.048); the PR of adults with at least an undergraduate degree was 1.14 (P = 0.001), and the PR of the participants who most often used a dental service other than a public service supplementary healthcare plan or private service was 1.13 (P = 0.021). The prevalence of functional dentition was 17% higher among nonsmokers (P = 0.012) and 16% higher among those who used dental floss (P = 0.006).
  
  
  CONCLUSIONS
  Income, education, type of dental service most often used, lifestyle, risk behaviors and demographic conditions are distal, intermediate and proximal social determinants of health associated with functional dentition in adults, demonstrating the need for public policies aimed to promoting oral health including intersectoral actions.
authors.affiliation: Department of Community and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais (Universidade Federal de Minas Gerais), Belo Horizonte, Brazil.
authors.forename: Loliza Luiz Figueiredo Houri
authors.initials: LL
authors.lastname: Chalub
authors.forename: Carolina Marques
authors.initials: CM
authors.lastname: Borges
authors.forename: Raquel Conceição
authors.initials: RC
authors.lastname: Ferreira
authors.forename: João Paulo Amaral
authors.initials: JP
authors.lastname: Haddad
authors.forename: Efigênia
authors.initials: E
authors.lastname: Ferreira e Ferreira
authors.forename: Andréa Maria Duarte
authors.initials: AM
authors.lastname: Vargas
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009909:Oral Health; D012307:Risk Factors; D064890:Social Determinants of Health; D016388:Tooth Loss / Q000453:epidemiology*
keywords: epidemiology; health promotion; oral health; tooth loss