Associação entre maus-tratos infantis e traumatismos dentários aos quatro anos de idade: um estudo de coorte no Sul do Brasil

Abstract

Any act or omission by the parents or person in a position of responsibility, trust or power over the child that results in potential or actual harm, whether physical, sexual, psychological or negligence, is identified as child maltreatment (CM) and is a global problem of public health and human rights. Exposure to CM can be an important predictor of oral health problems, as well as oral health can be a marker of CM. Signs of CM can manifest in this region as dental trauma (DT). In view of this, the objective of this study was to evaluate the association between CM and DT at 4 years of age in children from the 2015 birth cohort, in the city of Pelotas/RS . This cross-sectional nested cohort study used data obtained from perinatal and 48-month follow-up. CM were evaluated using the Juvenile Victimization Questionnaire (JVQ) obtaining the following exposure variables: CM, sexual, psychological, physical abuse, negligence and custodial interference. The outcome was DT at 48 months, assessed using the criteria established by the United Kingdom Children's Health Survey (1993) classification system. The child was categorized into “with trauma” and “without trauma”. Descriptive analyzes were performed and relative and absolute frequencies were obtained. Association analyzes were performed using the Chi-square test and crude and adjusted analyzes were performed using Poisson regression, with a 95% confidence interval. For adjustment, the variables gender, overbite and overjet were used. Of the 4,275 eligible children, 3,740 constituted the sample for this study. The prevalence of DT was 20.2% and 11.4% had some CM experience. The prevalence of DT was higher among those with a positive report for CM, physical and emotional abuse, neglect and custodial interference, with no statistically significant association. There are no reports of sexual abuse. In the adjusted analysis, in relation to CM and DT exposure, the prevalence ratio (PR) was 1.19 with a 95% Confidence Interval (95%CI) equal to 0.91-1.57. Regarding the CM subtypes, the values were for physical abuse (PR=1.23, 95% CI: 0.64-2.40), psychological abuse (PR=1.20, 95% CI: 0.87-1 .66), negligence (PR=0.95, 95% CI: 0.47-1.93) and custodial interference (PR=1.15, 95% CI: 0.66-2.00). In this sample, no DT association was found in the primary dentition and ITM. A direction towards higher prevalence was observed in children with reports of abuse and in the subtypes of physical abuse, psychological abuse and custodial interference. More studies are needed in order to better understand this relationship.