December 2007

Community Dental Health (2007) 24, 217-224 Received 1 June 2005; Accepted 19 March 2006 © BASCD 2007 The prevalence and severity of dental pain in 14-15 year old Brazilian schoolchildren P.S.A. Goes1,2, R.G. Watt1 R. Hardy1 and A. Sheiham1 1 Department of Epidemiology and Public Health, University College London, London WC1E 6BT, England. 2Department of Preventive and Social Dentistry, University of Pernambuco Dental School, Recife, Brazil. Objective To assess the prevalence and severity of dental pain and associated factors in Brazilian schoolchildren. Methods The study was a cross-sectional survey conducted in Recife, Brazil. The data were collected through questionnaires, personal interviews and clinical dental examinations of a random sample of 14-15 years old schoolchildren. The prevalence of dental pain and its characteristics were recorded using standard measures of pain. Dental caries, dental trauma and dental plaque were assessed using WHO criteria. Multiple logistic and ordinal polytomous regression were used to assess which factors were associated with the dental pain outcomes. Results 1,052 individuals participated in the study. The prevalence of reported toothache in schoolchildren in the last six months was 33.6% (31.1-36.8, 95% CI). The fully adjusted regression models showed a significant relationship between lower social class, later birth order, failure at school and attendance at the dentist only when in trouble with both the prevalence and severity of dental pain. The major predictor of the prevalence and severity of pain was pattern of dental attendance (p<0.001). Conclusions The prevalence of toothache in 14-15 years old schoolchildren was high. The major predictor of the prevalence and severity of pain was the pattern of dental attendance. Key words: Dental attendance, dental pain, epidemiology, prevalence, socio-economic status. Introduction Dental pain is a common outcome of untreated dental diseases. However, despite the high prevalence of untreated dental caries, there is surprisingly little research on the prevalence and severity of dental pain in children. The highest prevalence of dental pain is in young age groups (Locker and Grushka, 1987a; Locker and Grushka, 1987b; Bassols et al. 1999; Vargas et al 2005). There are gender differences in the distribution of various types of pain, but no gender differences have consistently been reported for dental pain. Population based pain research has shown that women are more likely than men to report a variety of temporary and persistent pains and to report more severe pain, more frequent pain and pain of longer duration than men (Unruh, 1996). The majority of studies of dental pain did not find a significant gender difference (Locker and Grushka, 1987a; Locker and Grushka, 1987b; Unruh, 1996; Bassols et al. 1999; Jaafar, 1999; Shepherd et al 1999; Honkala et al., 2001; Vargas et al 2005). The association between socio-economic position and prevalence of dental pain is equivocal. A higher prevalence of dental pain was reported in those from low socio-economic backgrounds (Miller and Swallow, 1970; Bailit, 1987; Honkala et al., 2001). On the other hand, few studies have reported a lack of association between socio-economic position and dental pain (Bassols et al. 1999). Among the variables that have been associated with dental pain are untreated dental caries, pattern of dental attendance and frequency of toothbrushing. Dental pain has been consistently associated with untreated dental decay or caries experience. However, these studies did not control for the potential confounding effects of important variables such as pattern of dental attendance (Treasure and Dever, 1992; Jaafar, 1999; Vargas et al 2005). Pioneering work on the association between pattern of dental attendance and reported dental pain started in the United Kingdom (Miller and Swallow, 1970). There was more dental pain among those with a poorer pattern of dental attendance. This has been supported by more recent studies carried out on dental emergencies (Blinkhorn et al., 1991). A common finding from these studies was that the majority of people who sought emergency dental care, had a poor pattern of dental attendance and consequently had high levels of untreated dental decay and dental pain. However, other studies found that dental pain was still common in countries with a high coverage of dental service or in groups considered dentally fit by dental professionals (Jaafar, 1999; Honkala et al., 2001). Other oral health related factors and the exposure to preventive methods have also been associated with dental pain. For example, frequency of toothbrushing was considered the main predictor of the prevalence of dental pain in Finland (Honkala et al., 2001). The exposure of children to fluoridated water was associated with a low prevalence of dental pain (Treasure and Dever, 1992). The association between dental pain and oral health status and oral health behaviour appears to be straightforward, as dental pain is a typical disease related pain. Correspondence to: Prof. R G Watt, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, Email [email protected]