824 resultados para Iniquidade Social. Desigualdades em Saúde. Saúde Bucal. Indicadores Sociais


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Despite the improvement of Brazilian s living conditions in recent decades, this improvement occurred in a polarized way between groups of better social position. Then, there is still a health inequity´s panorama in Brazil which encompasses the oral health state. This panorama instigated the attainment of this ecological study that aimed to evaluate the relationship of socioeconomic conditions, and public health policies with oral health status in Brazilian capitals. Thus, we performed factor analysis and linear regression using oral health indicators collected from SB Brasil 2010, of socioeconomic conditions from Brazilian Census 2010 and related to water´s supply fluoridation from SISAGUA. Factor analysis with indicators of living conditions revealed two common factors, economic deprivation and socio-sanitary condition. Economic deprivation showed statistically significant positive correlation with DMFT 12 years (p= 0,03) and mean missing teeth (p = 0,002) and negative correlation with caries-free population (p=0,012). Socio-sanitary negatively correlated with DMFT (p <0,0001) and a positive correlation with caries-free population (p = 0.002). Fluoridated water had a significant association with DMFT (p <0,0001), mean missing teeth (p <0,0001) and caries free population (p <0.0001). Multiple linear regression analysis for the DMFT of capital was estimated by socio-sanitary condition and fluoridation, adjusted by economic deprivation, whereas the model for the mean missing teeth was estimated only by fluoridation and economic deprivation, and finally the model the rate for the population free of caries in Brazilian capitals was estimated by economic and socio-sanitary status adjusted fluoridated water supply. Therefore, factors related to living conditions and public policies are intrinsically linked to tooth decay issues. Thus, actions, beyond dental care assistance, must be development to impact positively in social and economic conditions, especially, between the most vulnerable populations

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Esta tese tem como foco os efeitos da desigualdade de renda na saúde bucal e as tendências em desigualdades socioeconômicas em saúde bucal. Qualquer injustiça social, pelo caráter moral é digna de estudo, porém nem toda desigualdade de renda é socialmente injusta. Ela se torna injusta quando as pessoas com menos recursos são aquelas que permitem que as desigualdades econômicas afetem direitos humanos, como o direito a um nível de vida que assegure ao indivíduo e a sua família uma vida saudável. As desigualdades de renda foram estudadas em duas vertentes:a) efeitos contextuais da desigualdade de renda na saúde bucal ; b) tendências na diferença de saúde bucal entre pessoas com maior e menor renda. A primeira parte contém quatro artigos originais que estudaram a associação e os mecanismos contextuais p elos quais a desigualdade de renda afeta a saúde bucal. Para isso, foram utilizados dados do inquérito em saúde bucal SBBrasil de 2002. Os resultados mostraram que: a) a associação entre desigualdade de renda e saúde bucal é mais forte em relação à cárie dental do que outras doenças bucais (e.g. doenças periodontais e maloclusões); b)seus efeitos estão mais fortemente associados à doenças bucais de menor latência; c) os efeitos associados à cárie dental afetam pobres e ricos igualmente; e d) a ausência de políticas públicas parece ser a melhor explicação para os efeitos da excessiva desigualdade de renda no Brasil. Ainda em relação às políticas públicas, foi encontrados que os ricos beneficiam-se mais de políticas públicas municipais do que os pobres. A segunda parte desta tese contém dois artigos originais que descrevem as tendências em saúde bucal e o uso dos serviços odontológicos em grupos de maior e menor renda, no Brasil e na Suécia. Para essas análises, foram usados dados dos inquéritos em saúde bucal no Brasil dos anos de 1986 e 2002, e para Suécia foram obtidos dados do "Swedish Level of Living Survey" para 1968, 1974, 1981, 1991 e 2000. As tendências relacionadas à prevalência de edentulismo mostraram que houve uma redução das desigualdade em percentuais absolutos nos dois países, porém, no Brasil houve um aumento das diferenças quando o desfecho foi a prevalência de nenhum dente perdido. As reduções das disparidades em edentulimo estiveram associadas à presença de uma diferença inicial significativa ,já o aumento das desigualdade na prevalência de nenhum dente perdido esteve relacionado a uma pequena desigualdade no início da coleta de dados. Em relação às desigualdades de uso dos serviços, ressalta-se que o grupo mais pobre permanece utilizando menos os serviços odontológicos em ambos os países e as diferenças continuam significantes através dos tempos. Entretanto, tanto no Brasil como na Suécia, essas diferenças reduziram levemente nas coortes jovens em função do declínio no percentual de pessoas mais ricas que visitam o dentista. Nossos dados permitem concluir que as desigualdades, em saúde bucal, mesmo em países altamente igualitários, como a Suécia.

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Esta dissertação analisou a atenção à saúde bucal nos trinta municípios que compõem a 15 Regional de Saúde do Estado do Paraná, a partir do processo de descentralização, das políticas públicas de saúde e das diretrizes da Política Nacional de Saúde Bucal (PNSB). Neste trabalho buscou-se contextualizar a implantação das Estratégias de Agentes Comunitários de Saúde, Saúde da Família e Saúde Bucal. Para que tal objetivo fosse alcançado foram feitas pesquisas junto às bases de nacionais, estaduais e municipais, além de entrevistas com os Coordenadores Municipais de Saúde Bucal (CMSB) para conhecer a realidade de cada um dos municípios. Foram entregues questionários contendo questões a respeito dos modelos de prática, de organização, de gestão e de formação dos profissionais envolvidos na atenção à saúde bucal. A metodologia utilizada inicialmente por Mendes-Silva (2007), na Regional de Saúde de Bauru SP, serviu de base para compararmos os resultados obtidos nas duas Regionais com relação aos principais indicadores sociais, a organização da atenção à saúde e o perfil profissional dos CMSB. Sem perder de vista as diferenças regionais e também o panorama nacional, conclui-se que os indicadores sociais, o percentual de gastos com a saúde e o perfil dos CMSB são muito parecidos. Com relação à PNSB, a 15 RS-PR apresenta números maiores de cobertura populacional nas três estratégias (ACS, SF e SB) e, ainda que com limitações, a análise dos dados provenientes do DATASUS mostra melhores indicadores de saúde bucal no Pacto de Atenção Básica.

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Este estudo tem como objetivo compreender a autopercepção das condições de saúde bucal do grupo etário de 65-74 anos da Região da Serra/RS. Utilizou dados do SBBrasil, coletados pela SES/RS. A população final da amostra foi constituída de 618 idosos, sendo 57% de mulheres. Esta coleta foi realizada através de um questionário com questões fechadas sobre dados sócio-demográficos e questões de autopercepção em saúde bucal, bem como de um exame bucal. A análise dos dados foi feita através da regressão logística multinomial. O exame clínico revelou que quase a metade dos idosos está desdentada e classificou sua saúde bucal como boa ou ótima. Em relação a presença de dor, 28,8% dos indivíduos relataram que sentiram dor nos seis meses que antecederam a entrevista. A dor permaneceu estatisticamente associada à classificação da saúde bucal (OR= 2,3; IC95%: 1,24-4,44) e da mastigação (OR=1,9; IC%95: 1,07-3,24). A necessidade de prótese total permaneceu associada, após o ajuste, com a classificação da aparência dos dentes e gengiva (OR=0,3; IC95%: 0,11-0,78), da mastigação (OR=0,2; IC95%: 0,09- 0,46) e da autopercepção da influência da saúde bucal nos relacionamentos (OR=3,4; IC95%: 1,47-7,75). A renda pessoal manteve associação, após o ajuste, com a classificação da fala (OR=4,5; IC95%: 1,34- 15,12). A escolaridade, após o ajuste, manteve associação com a autopercepção da influência da saúde bucal nos relacionamentos (OR=1,9; IC95%: 1,06-3,43). Conclui-se que a dor e a necessidade de prótese total têm forte relação com as questões de autopercepção em saúde bucal.

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Pós-graduação em Odontologia Preventiva e Social - FOA

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This anthropological study investigates the lived-experience of oral diseases in the context of poverty in Northeast Brazil. During six months in 2004???, ethnographic interviews, narratives and participant-observation with 31 residents of the low-income community, Dendê, located in Fortaleza, Ceará were conducted and analyzed utilizing a hermeneutic-dialetic method. It is revealed that precarious life conditions make prioritizing caretaking a difficult task. Despite suffering tooth pain, seeking a dentist's care is perceived as "a luxury" not a citzens' right. Difficulties in accessing services and poor quality restorations, favor tooth extractions as the most effective intervention. The deterioration of one's oral health is lamented by community members who seek help from popular clinics, politicians and traditional healers. The experience of dental disease differs according to social class, leaves oral scars of inequity, harms self-esteem and inhibits social inclusion. In this context, "treating" the Teeth of Inequity demands that we deepen our comprehension of the social determinants of health, reduce injustice in the access to quality care, remove demoralizing stigmas and empower the community to confront structural forces which affect its life

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This study examined in municipalities of Northeast of Brazil with more than one hundred thousand people who incorporation of Oral Health Teams (OHT) into the Family Health Strategy (FHE) the possible impact on oral health indicators. Sought to answer whether implementation OHT brought the best indicators of health problems and coverage, compared to areas without coverage by the FHE through a community trial in parallel, quasi-randomized. In each of the municipalities surveyed were 20 census tracts, 10 were located in areas covered by oral health teams in the ESF and 10 industries in areas not covered. The final sample consisted of 59.221 individuals. We compared oral health indicators related to health problems, access to services and coverage of oral health actions. The analysis strategy was based on the calculation of prevalence ratios and confidence intervals, adjusted for confounding factors through Poisson regression with robust variance. It also has measured the association between an indicator of social inequality for comparison between areas. The best results are associated with indicators of access and coverage of oral health actions at the expense of the indicators of health problems, suggesting a possible maintenance of a traditional model of practice yet. The results also suggest a possible effect of a specific policy in the area of primary care on inequality in access. From the discussions presented throughout this work, we can see that the impact analysis of public policy, obtained by comparing areas with and without the intervention, not only captures the effect on the target population, but other dimensions of organization service and therefore should be understood as one of the analytical possibilities related to the management

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The aim of this study was to assess the impact of the Family Health Program (FHP) on a number of oral health indicators in the population of Natal, Brazil. The study is characterized as a quasi-random community intervention trial. The intervention is represented by the implementation of an Oral Health Team (OHT) in the FHP prior to the study. A total of 15 sectors covered by the FHP with OHT were randomly drawn and paired with another 15 sectors, based on socioeconomic criteria, not covered by the teams. A few sectors were lost over the course of the study, resulting in a final number of 22 sectors, 11 covered and 11 not covered. We divided the non-covered areas into two conditions, one in which we considered areas that had some type of assistance program such as the Community Agents Program (CAP), FHP without OHT, BHU (Basic Health Unit) or no assistance, and the other, in which we considered areas that had only BHU or no assistance. Community Health Agents (CHAs) and Dental Office Assistants (DOAs) applied a questionnaire-interview to the most qualified individual of the household and the data obtained per household were transformed into the individual data of 7186 persons. The results show no statistical difference between the oral health outcomes analyzed in the areas covered by OHT in the FHP and in non-covered areas that have some type of assistance program, with a number of indicators showing better conditions in the non-covered areas. When we considered the association between covered and non-covered areas under the second condition, we found a statistical difference in the coverage indicators. Better conditions were found in covered areas for indicators such as I have not been to the dentist in the last year with p < 0.001 and OR of 1.64 and I had no access to dental care with p < 0.001 and OR of 2.22. However, the results show no impact of FHP with OHT on preventive action indicators under both non-covered conditions. This can be clearly seen when we analyze the toothache variable, which showed no significant difference between covered and non-covered areas. This variable is one of the most sensitive when assessing oral health programs, with p of 0.430 under condition 1 and p of 0.038 under condition 2, with CI = 0.70-0.90. In the analysis of health indicators in children where the proportion of deaths in children under age 1, the rate of hospitalization for ARI (Acute Respiratory Infections) in those under age 5 and the proportion of individuals born underweight were considered, a better condition was found in all the outcomes for areas with FHP. Therefore, we can conclude that oral health in the FHP has little effect on oral health indicators, even though the strategy improves the general health conditions of the population, as, for example child health

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Antecedentes: As desigualdades na saúde estão associadas às desigualdades socioeconómicas, o que está demonstrado em farta literatura seja em comparações entre países, seja em comparações de populações e grupos sociais dentro dos países, evidenciando-se o triângulo fundamental riqueza-educação-saúde. Objectivos: Analisar a relação existente entre a mortalidade prematura da população nos municípios portugueses e alguns determinantes socioeconómicos Metodologia: Estudo ecológico transversal, utilizando indicadores publicados pelo INE para os 308 Municípios portugueses. Mediu-se a desigualdade das variáveis pelo rácio entre decis extremos (D10/D1) e testaram-se as associações existentes entre a mortalidade prematura e indicadores de rendimento, de educação e de desigualdade social pela correlação de ordem de Spearman. Resultados: Os resultados revelam que existe desigualdade entre municípios para todas as variáveis estudadas. Entre o nível de educação e o rendimento e entre estes e a mortalidade prematura foram encontradas correlações estatisticamente significativas (p<0,01 e p<0,05) e de sinal consistente com as hipóteses colocadas de que a mortalidade varia inversamente com o nível de rendimento e com o nível de educação. A educação é a variável com maior efeito na mortalidade prematura, em especial sobre a mortalidade abaixo dos 65 anos, resistente ao controle do rendimento. A dimensão da população parece ter um efeito sobre todas as outras variáveis.

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Ações promotoras de saúde e independência para pessoas idosas são indispensáveis. Compreender essa construção no cotidiano da provisão dos cuidados talvez estimule o desenvolvimento de capacitações ao bem estar nesta população. O objetivo deste estudo foi Identificar a repercussão da provisão do cuidado formal em saúde bucal na percepção de senescentes. Desenvolvemos uma pesquisa de base qualitativa com abordagem fenomenológica, onde realizamos entrevistas semiestruturadas e individuais com 30 pessoas de idade superior a 50 anos (22 mulheres e 08 homens), em um Centro de Convivência na cidade de Natal/Rio Grande do Norte, no nordeste do Brasil. Os relatos obtidos foram analisados em cinco estágios: transcrição dos discursos sem preocupação interpretativa; limpeza de erros linguísticos e repetições; leitura repetitiva e exaustiva para apreensão do sentido das informações coletadas; seleção das unidades significativas dos discursos, correspondendo aos trechos relevantes no horizonte do fenômeno em estudo; e compreensão da ideografia elaborada pelos participantes por grupos temáticos simbólicos. Assim, identificamos as essências temáticas de: determinante social e iniquidade em saúde bucal; e provisão de cuidados de saúde bucal e mal-estar físico, mental e social. Concluímos que a prestação de cuidados agregando abordagem humanístico-ética pode levar a vivências dignificantes no processo de envelhecimento, destacadamente quando estimula a promoção da segurança pessoal. O âmago desse trabalho descortina uma vertente multidisciplinar que perpassa a saúde, a educação e a ética

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The contents introduction concerning the individual health cares reveals important since the school education. In this direction, the present study objectified to know an effect of Oral Health education intervention in the oral hygiene and in the schools children information level, of 4º e 5º basic education years. The study was composed by two groups, chosen of random form: control group (n = 115) and experimental group (n = 132), with 247 public net school children in total sample. The experimental group participated of some educative activities in Oral Health, with biweekly frequency, during the 4 months period, given for a surgeon-dentistry. Both the groups were submitted to a clinical examination for a previous verification of the Plaque Index (PI) and of Loe Silness Gingival Index (GI). A questionnaire with closed questions on Oral Health was applied before and after to verify the school children rightness index. After the intervention, the final data, represented for the PI, GI and Rightness Index verification, has been collected for statistical analyses through the chi-square test to a 95 % of reliable level, using the SPSS 10,0 software. The PI and GI were categorized in high and low on the initials index basis medium; already the Rightness Index was categorized in inadequate (< 50%) and adequate (≥ 50%). It was verified that the PI (p = 0,014; IC 0.24-0.86) and the GI (p = 0,013; IC 0,28-0,84) presented differences statistically significant, after the education activities, when compared to with the control, favoring the experimental group. It was verified too the experimental group got greater rightness index, presenting difference highly significant (p<0,0001; IC 3,73-26,81). It was still observed that there was no association between the oral hygiene indicators and the school children information level. Ahead the results, it can been concluded that education activities related in the school routine were capable to give positives effects in the oral hygiene control and in the information level about Oral Health, however, not necessarily, the individual with bigger information is that one who has practiced an oral hygiene more adjusted. One become necessary, however, that the education in Oral Health occurs of permanent and integrated form with others school actors, for the positive effect does not lose the student s life longterm

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The Health Family Program (HFP) was founded in the 1990s with the objective of changing the health care model through a restructuring of primary care. Oral health was officially incorporated into HFP mainly through the efforts of dental professionals, and was seen as a way to break from oral health care models based on curative, technical biological and inequity methods. Despite the fast expansion of HFP oral health teams, it is essential to ask if changes are really occurring in the oral health model of municipalities. Therefore, the purpose of this study is to evaluate the incorporation of oral health teams into the Health Family Program by analyzing the factors that may interfere positively or negatively in the implementation of this strategy and consequently in the process of changing oral health care models in the National Health System in the state of Rio Grande do Norte, Brazil. This evaluation involves three dimensions: access, work organization and strategies of planning. For this purpose,19 municipalities, geographically distributed according to Regional Public Health Units (RPHU), were randomly selected. The data collection instruments used were: structured interview of supervisors and dentists, structured observation, documental research and data from national health data banks. It was possible to identify critical points that may be impeding the implementation of oral health into HFP, such as, low incomes, no legal employment contract, difficulty in referring patients for high-complexity procedures, in developing intersectoral actions and program strategies such as epidemiologic diagnosis and evaluation of the new actions. The majority of municipalities showed little or no improvement in oral health care after incorporating the new model into HFP. All of them had failures in most of the aspects mentioned above. Furthermore, these municipalities are similar in other areas, such as low educational levels in children from 7 to 14 years of age, high child mortality rates and wide social inequalities. On the other hand, the five municipalities that had improved oral health, according to the categories analyzed, offered better living conditions to the population, with higher life expectancy, low infant mortality rates, per capita income among the highest in the state as well as high Human Development Index (HDI) means. Therefore, it is possible to conclude that public policies that include aspects beyond the health sector are decisive for a real change in health care models

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Population aging is one of the greatest challenges to contemporary public health and, in this perspective, the functional capacity emerges as an important feature in geriatric assessment. The oral health of elderly, in turn, deserves special attention because, historically, in the dental services, this population group was not considered a priority for attention, which is verified by high rates of edentulism found even among these individuals. The present study proposes to examine the relationship between oral health status and functional capacity in an elderly population. To this end, intra-oral epidemiological examination was performed to assess the degree of dental caries, periodontal status, use and need of prosthesis and the presence of lesions. Functional capacity was assessed by the Independence in Activities of Daily Living, which considers the independence or not in the performance of six self-care functions. Socioeconomic and demographic characteristics and general health status were also investigated, in view of the possibility of intervention of these variables in the investigated relation. An factor analysis of the principal components was conducted which resulted four indicators of oral health conditions, representative of the population studied. 441 seniors were enrolled with mean age of 71.7 (± 8.7) years, the majority being female (68%). Functional capacity was dichotomized into completely independent individuals (89.6%) and dependent on at least one of the functions considered (10.4%). There was an association between functional capacity and the indicators related to the presence of many teeth and dental caries, and to that associated with the use and need of prostheses. These associations in turn, lost statistical significance when adjusting for confounding variables, combined in separate models for each indicator. Some of these variables, however, remained associated with functional capacity. It is considered that the study of oral health status of elderly, associeted with the search for an association with functional capacity is important in the construction of indicators necessary for planning preventive and therapeutic interventions that reduce the risk for loss of ability in daily physical functions and their consequences, as the harm in the oral self-care

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As a result of the financial incentive provided by the GM / MS 1.444, since 2000, Brazil has experienced a substantial increase in the number of oral health services at the Family Health Strategy. There is, however, evidence that these teams have produced qualitatively different experiences which do not translate necessarily into improved quality of life and health. Thus, evaluative research of great importance. This study aims to assess the impact of the Family Health Strategy in oral health in a longitudinal perspective natalense the years 2006 and 2009. This is an intervention study whose design is a community trial in parallel, nearly randomized. The sample consisted of census tracts covered by oral health teams in the Family Health and the Traditional Model (Basic Health Units and non-FHS Program of Community Health Agents and areas not covered.) The sample was determined by drawing ten census tracts to form the experimental group and ten other sectors for the control group by pairing intentional based on socio-economic and geographic. To check the net effect of the intervention was performed multivariate analysis by Poisson regression. As a result of cross-sectional analysis of year 2009, it was found that the effects of the ESF in Natal were satisfactory only for the variables of injuries and for other purposes without and with negative impact on stock coverage reclaimers. However, the longitudinal analysis revealed that the ESB / ESF improved their performance in dealing with grievances, access and coverage of the type of actions and this fact is independent of age, sex and social and economic conditions. In other employees' words are related to the presence of the Family Health Strategy in the region. However it does not say that both models under study (the Family Health Strategy Model and Traditional) are different in terms of performance and it is pertinent to reflect on the need for further development of evaluation studies that use other approaches able to clarify the dynamics of the process whose results can come to the knowledge of the actors responsible for leading the ESF and encourage them to incorporate the assessment in their routine

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Early childhood caries, especially in its severe form, which is characterized by an acute and aggressive nature, can have negative impacts on thequality of life of a child, due to effects such as difficulty in chewing, decreased appetite, weight loss, insomnia, changes in behavior and a decreased performance in school, among others. Moreover, the quality of life of the child`s family can also be affected, as the pain and discomfort caused by this type of caries result in loss of working days of parents, spending on dental treatments, changes in sleep patterns and stress. The aim of this study was to evaluate the impact of severe early childhood caries in the Oral Health-Related Quality of Life (OHRQoL) of public daycares`s preschool children through the Escala de Impacto da Saúde Bucal na Primeira Infância, a Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A single calibrated examiner (kappa=1.0) evaluated, through the dmfs index, the oral health of 116 children aged between 3 and 5, which were included in one of three study groups: "caries-free", "not-severe early childhood caries" and "severe early childhood caries". The parents responded to ECOHIS, to assess their perception regarding the OHRQoL of their children, and a questionnaire on socioeconomic conditions. The OHRQoL was measured through the total scores and domains of ECOHIS. Descriptive analysis, Mann-Whitney test, Kruskal-Wallis test, chi-square test and Poisson multiple regression with robust variance were used. Among the children observed, 38.8% were caries-free, 27.6% showed not-severe early childhood caries and 33.6% showed severe early childhood caries. Regarding the total score of ECOHIS, severe early childhood caries had a greater negative impact on OHRQoL, compared to caries-free and not-severe early childhood caries groups (p <0.001). Regarding the child subscale, there was significant difference between the "severe early childhood caries" group and the other groups in all domains, except for theone of self-image / social interaction. In the family subscale domains, there was statistical significance between the severe early childhood caries and the caries-free groups in all domains (p <0.001), whereas between the "severe early childhood caries and not-severe early childhood caries groups there was a statistically significant difference only in the domain of parental anguish (p <0.001). Multivariate analysis showed that early childhood caries and the parent`s age were significantly associated to OHRQoL (p <0.05), independently of the other variables in the model. The presence of severe early childhood caries resulted in greater negative impact on OHRQoL (AdjPR= 6.016; 95%CI = 3.12 11.56; p<0.001), while older parents reported better OHRQoL (AdjPR = 0.603; 95%CI = 0.428 - 0.850; p = 0.004). The presence of severe early childhood caries had a negative impact on OHRQoL of preschool children and their families.