Saúde bucal de crianças e adolescentes vítimas de violência

Abstract

Maltreatment of children and adolescents represents a social problem with a broad impact on health conditions and is therefore considered a public health problem by the World Health Organization. In Chapter I, “Child maltreatment and oral health: A systematic review and meta analysis”, to assess whether children and adolescents who are victims of child maltreatment show worse oral health outcomes than non-maltreated individuals, electronic databases (PubMed/MEDLINE, Web of Science, Scopus, Embase, LILACS, SciELO, and Google Scholar) were searched up to March 2021, without language restrictions. Cross-sectional and case-control studies that evaluated oral health outcomes in child and adolescent victims of maltreatment were included. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias. The oral health outcomes considered were dental caries, tooth loss, dental pain, dental trauma, dental plaque, gingivitis, malocclusion, and oral health-related quality of life. A meta-analysis was carried out using a random-effects model. A total of 2,509 studies were found and 13 were included in the analysis. The maltreated group showed a higher prevalence of dental caries [mean difference (MD): 0.55, 95% CI -0.33;0.77; p<0.00001, I 2=0%] and a higher prevalence of dental trauma (PR: 2.09, 95%CI 1.26-3.44; p=0.004, I 2=33%) compared to control. There was no significant difference in mean dmft index (MD: 0.95, 95% CI -0.51;2.41; p=0.20, I 2=81%) or gingival bleeding (PR: 1.28, 95%CI 0.81- 2.02; p=0.28, I 2=87%) between the abused group and the control group. Maltreatment of children and adolescents was positively associated with dental trauma and dental caries in permanent teeth. In Chapter II, “Oral health in abused children and adolescents: a cross-sectional study”, evaluated the association between the occurrence of abuse in childhood and the presence of oral diseases in children and adolescents with a history of violence. Cross-sectional study, carried out in two Brazilian cities, with a sample composed of children and adolescents who were victims of domestic violence and with no history of violence. The outcomes evaluated were dental caries (dmft and DMFT indexes), malocclusions, visible plaque, bleeding on probing and dental trauma. In the bivariate analysis, the Pearson and Mann-Whitney chi-square tests were used to compare the groups. Subsequently, the crude and adjusted odds ratio (OR), with respective 95% confidence intervals (CI), adopted a significance level of 0.05. The sample consisted of 278 children and adolescents, 138 (49.7%) female and 140 (50.3%) male. There was an association between the occurrence of violence and bleeding on probing (p=0.001) and posterior crossbite (0.035). There was no difference between groups regarding DMFT-D (p=0.39), DMFT-D (p=0.47), as well as the presence of anterior open bite (p=0.68), visible plaque (p=0.72) and dental trauma (p=0.14). Children who were victims of child abuse had a worse oral health status, only in relation to posterior crossbite.