Desigualdades na percepção dos pais sobre a saúde bucal da criança: uma revisão de escopo e um estudo de caráter transversal

Abstract

Parents' perception of their children's oral health can be influenced by clinical factors such as the presence of cavities, dental pain, trauma, malocclusion, and socioeconomic factors such as family income, education, and race/ethnicity. Additionally, it can be considered a proxy for pediatric oral health, aiding in the identification of groups of children who require greater attention. The ability to assess this perception through a single-item question makes it a rapid and cost-effective alternative, particularly useful in settings where dental examinations are not feasible.. The general objective of this dissertation was to evaluate the effects of intersections between child’s sex, maternal education, wealth, and race/skin color on maternal perception of children’s oral health. Specifically, the study aimed to: (I) Investigate, through a scoping review, the existing literature on parental/caregiver perception of children's oral health, measured through single-item questions; and (II) Assess the impact of social inequalities and their intersections on the perception of children’s oral health in a cross-sectional study, using data from a birth cohort in the city of Rio Grande, RS, Brazil. The scoping review included 30 observational studies identified in seven databases up to January 2024. The findings highlighted significant gaps in the literature regarding the use of singleitem measures to assess parental perception of children’s oral health. Only thirteen of the included studies met all methodological quality criteria. Furthermore, extensive heterogeneity was observed, along with a lack of standardization and validation of the questions and response options, preventing the recommendation of a specific instrument and emphasizing the need for further research on the validity and reliability of such measures.The cross-sectional study analyzed data from 735 participants of the 2019 Rio Grande birth cohort. It was found that 11% of mothers perceived their child’s oral health as poor, a perception that was concentrated in the poorest wealth quintile, with a 12-percentage point difference between the poorest and wealthiest quintiles (SII: -0.12; 95%CI -0.19; -0.04). Regarding maternal education, a 9- percentage point difference was observed between mothers with higher and lower educational levels, with less-educated mothers more frequently perceiving their child’s oral health negatively (SII: -8.8; 95%CI -0.17; -0.2). The decision tree analysis identified two high-risk groups. The group with the highest prevalence of negative perception (44%) represented 4% of all children and included those whose mothers perceived their own oral health as poor, belonged to the second and third wealth quintiles, and were 30 years or older. In conclusion, this dissertation gathered critical evidence on the use of single-item questions to assess parental perception of children’s oral health and highlighted inequities in maternal perception, considering the intersecting factors that influence it. Identifying groups that exhibit negative health outcomes can guide public policies and contribute to addressing oral health disparities.