O Impacto das consequências clínicas de envolvimento pulpar devido a cárie dentária na qualidade de vida de crianças e adolescentes

Abstract

This thesis investigated the impact of the presence of clinical consequences of pulpal involvement due to dental caries on the quality of life of children and adolescents, consisting of two studies: a systematic review with meta-analysis and a cross-sectional study. In the systematic review with meta-analysis, unrestricted systematic searches were conducted in the main databases. Observational studies that assessed children and adolescents (P) with clinical consequences of pulpal involvement due to dental caries (E) compared to individuals without this condition (C) regarding the impact on oral health-related quality of life (OHRQoL)(O) were included. The methodological quality assessment of the studies was carried out using the Joanna Briggs Institute (JBI) Critical Appraisal Tool for cross-sectional studies. Random effects meta-analyses were performed to synthesize data on the impact on OHRQoL. The certainty of the evidence was assessed by GRADEpro. Twenty-nine cross-sectional studies were included in the systematic review. Five studies met all JBI criteria. The remaining 24 studies failed in one or more criteria. The meta-analysis of studies with outcomes in continuous variables found SMD = -2.24; 95% CI: -3.34, -1.14; I2 = 99. The meta-analysis with studies reporting outcomes in dichotomous data found OR: 0.52; 95% CI: 0.30, 0.90; I2 = 78%. The certainty of the evidence was very low. The evidence suggests that the presence of pulpal involvement negatively impacted the OHRQoL of the studied population. The results should be interpreted with caution due to the very low certainty of the evidence. In the cross-sectional study, the sample included 1,054 students aged 5, 8, and 12 from public schools in Petrópolis. Parents answered a questionnaire on socioeconomic information, report of tooth pain and the impact on their children's OHRQoL, through the C-OIDP (Child Oral Impact on Daily Performances). In the clinical examination, the presence of dental caries was assessed using the dmft/DMFT indexes, and clinical consequences of pulpal involvement were assessed using the pufa/PUFA index. The children were categorized into three groups of caries severity: group without caries, group with caries without pulp involvement, and group with caries and pulp involvement. Statistical analysis was performed using Chi-square tests, Mann-Whitney, Kruskal-Wallis. Robust Poisson Regression, with the impact on OHRQoL considered a categorical dependent variable, and Negative Binomial Regression, with the impact on OHRQoL considered a numerical dependent variable. Five-year-old children with pulp involvement had a 2.08 times higher prevalence (95% CI: 1.12-3.86) of impact, and their C-OIDP scores were 2.41 (95% CI: 1.04-5.59) higher, while eight-year-old children with pulp involvement had C-OIDP scores 2.06 higher (95% CI: 1.23-3.43) than those without caries. In the 12-year-old group, the presence of pulp involvement was not significantly associated with a negative impact on OHRQoL (p = 0.09). This study concluded that the presence of consequences of pulp involvement was associated with a negative impact on OHRQoL of children with 5 and 8 years old. The report of tooth pain was the variable most significantly associated with a higher negative impact on OHRQoL in children and adolescents.