Percepção cognitiva e emocional da cárie na primeira infância: impacto do letramento em saúde bucal, lócus de controle, senso de coerência dos pais e comportamentos de saúde da criança

Abstract

This study aimed to (1) develop and validate a food frequency questionnaire to evaluate the cariogenicity of children's diets, (2) evaluate parents' cognitive and emotional perception regarding early childhood caries and (3) verify the factors related to this perception. Two studies (called articles) were carried out for this. The first article (Objective 1) consisted of 5 stages: I-Establishment of the conceptual structure and definition of the objectives of the instrument and the population involved; IIConstruction of items and response scales; III-Selection and organization of items and structuring of the instrument; IV-Content validity (first and second phase); and V-Pretest. The development of the FFQ involved teachers and students in the area of Dentistry (n=3) and in the area of Nutrition (n=2), a committee of experts (n=6), and parents/guardians of children aged between four and six years, in the pre-test (n=10). In the second article (Objectives 2 and 3), the sample consisted of 50 pairs of parents and children, aged four to six years old, attending a private dental clinic in Santos Dumont, MG. Parents' cognitive and emotional perception of caries disease was assessed using the Brazilian version of the Illness Perception Questionnaire-Revised for Dental (IPQ-RD). To assess oral health literacy, the Brazilian version of the Oral Health Literacy Assessment – Brazilian (OHLA-B) was used, applied to parents. Parents' locus of control (LOC) and sense of coherence (SOC) were measured using the Brazilian versions of the Multidimensional Health LOC Scale and the SOC-13 scale, respectively. The child's health behaviors were assessed by: (1) eating habits (Food Frequency Questionnaire - FFQ), (2) oral hygiene (Simplified Oral Hygiene Index - IHO-S); (3) experience of tooth decay (dmft index) and (4) quality of life related to oral health (Brazilian version of the Scale of Oral Health Outcomes for 5-year-old children – SOHO-5, for parents and children) . The data were analyzed using descriptive statistics, correlation test and binomial logistic regression to verify the independent variables associated with the total IPQ-RD models and domains. The significance level considered was 5%. In the content validity of the FFQ, all domains received a score lower than 90%, when the average of the scores of the six judges was calculated, in the first phase. The items and domains were reevaluated by the instrument organizers and the judges' comments were considered, resulting in version nº2. In the pre-test, all items were understood by all participants. The final version of the FFQ consisted of 37 items divided into four domains not specified in the instrument. In the second article, all parents reported a relationship between eating habits and oral health and showed high oral health literacy (p<0.0001). Regarding the frequency of food consumption, most children weekly intake of foods rich in simple sugars (86%, p<0.0001), foods rich in starch (82%, p=0.0003), acidogenic foods (92 %, p<0.0001) and protective foods (72%, p=0.016). Almost all parents reported external LOC (96%, p<0.0001). The domain “consequences of parents/guardians” correlated positively with the OHLA-B scores (r=0.38, p=0.006) and negatively with the SOHO-5 parents (r=- 0.47, p<0.001 ) and SOHO-5 child (r=-0.46, p<0.0001). There was a negative correlation between the “parent/guardian control” domain and the OHLA-B scores (r=- 0.38, p=0.005), and a positive correlation with SOHO-5 parents (r=0.48, p<0. 0001) and SOHO-5 child (r=0.52, p<0.0001). Bivariate analysis showed an association between the total score and domains of the IPQ-RD above the median with most independent variables, with the exception of mother's age, number of residents at home, frequency of brushing, previous experience of toothache, impact in OHRQoL reported by parents/guardians and the child, SOC and OHI-S. In the binomial logistic regression, three variables were associated with a worse congestive perception of dental caries: the greater number of decayed teeth (OR=10.49) with the child's control domain; daily intake of protective foods (OR=15.29) with the chronic cycle domain; and daily intake of starchy foods (OR=12.02) with the disease coherence domain. Ose scores of emotional dimensions above the median were independently associated with the daily intake of protective foods (OR=9.86). The FFQ proved to be suitable for evaluating the cariogenicity of children's diets. A worse cognitive and emotional perception of parents/guardians about early childhood caries was influenced by the greater experience of caries and the daily consumption of foods rich in starch and protective foods.