A Normal dentition is made up of 32 teeth, but it is still considered functional when at least 20 natural teeth are preserved, with an occlusion that allows adequate chewing and speaking. The survey called Oral Health Conditions in the State of São Paulo, carried out in 2002, showed that 10,8% of the adults examined were edentulous (without any teeth), a percentage that reached 59,9% in the elderly.

Survey substantiated
doctoral research

This survey supported Débora Dias da Silva's doctoral thesis, presented at the Faculty of Dentistry of Piracicaba (FOP) at Unicamp, under the guidance of professor Maria da Luz Rosário de Sousa. The author, however, focused only on adults and elderly people who had natural teeth, with the aim of associating the greater or lesser presence of teeth with socio-demographic, economic variables, access to dental services and self-perception of oral health.

“As it was a household survey carried out in 35 municipalities, using methodological criteria, it is representative of the State. Coordinated by the Ministry of Health and the Faculty of Public Health at USP, researchers from the FOP and six other dental schools participated. 1.612 adults were evaluated – between 35 and 44 years old – and 781 elderly people – between 65 and 74 years old”, age groups recommended by the World Health Organization, explains Débora Dias.

Excluding edentulous people from her sample (174 adults and 468 elderly people), the author divided the individuals into those with 1 to 19 teeth and those who preserved 20 to 32 teeth. Of the 1.428 adults with natural teeth, 402 (27,9%) had 1 to 19 teeth and 1.036 (72,1%) had 20 to 32 teeth. In the 313 elderly people, the percentages were reversed, with 235 (75,1%) in the first group and 78 (24,9%) in the second.

Among adults with up to 19 teeth, the average number of teeth present was 11,9 and, in the group with 20 teeth or more, this average was 26,4. In the elderly, in the first group the average number of teeth present was 9,5 and, in the second group, 25.

“Although it is very close, the percentage of adults with functional teeth (72,1%) did not reach the WHO target of 75% for 2000, as the survey was carried out in 2002. For the elderly, the target was that 50 % preserved 20 or more natural teeth, but only 24,9% enjoyed this condition”, observes the researcher.

The survey in São Paulo included a questionnaire covering aspects such as education and family income, frequency of visits to the dentist, reason for consultation, current need for treatment and the individual's opinion about their oral health - chewing, diction, appearance of teeth and gums, and whether such problems affected their social relationships.

“The presence of more teeth in the mouth in adults is strongly associated with higher education, better family income, living in urban areas and, because of these advantages, greater awareness of oral problems and frequent visits to the dentist. The variables show that people with fewer years of education are almost four times more likely to have fewer teeth”, comments Débora Dias.

On the other hand, the author also associated the presence of fewer teeth with being from a rural area, living with five or more people, and longer periods without going to the dentist. In this group of adults, those with fewer teeth were dissatisfied with their speech, a problem that is also highly noticeable for elderly people with major tooth loss.

Caries and edentulism – The Ministry of Health's report on research at a national level was released in 2003, a year after that of São Paulo, a state with a better oral health situation. This is demonstrated by Débora Dias through the caries index. “Of the 32 teeth, adults had on average 19 that were or were affected by cavities. Of these 19, nine had already been extracted, equivalent to 47% of lost teeth.”

In terms of regions, the percentages of teeth extracted due to cavities are 74,3% in the North, 71,9% in the Northeast, 61,2% in the Central-West, 57,3% in the Southeast and 61,9% % in the South. “In the case of the elderly, there are no differences in the national panorama, with a percentage of lost teeth above 90% across the country”.

Although socioeconomic conditions have a decisive influence on this situation, the researcher is aware of the need for policies to raise awareness among the population about the importance of taking care of their oral health. “Professionals themselves should not escape this awareness work, as we must act to control the disease, avoiding extractions and prioritizing tooth maintenance work.”

According to the author, other works in the literature denounce tooth extractions as a hegemonic dental practice to alleviate pain, especially in populations of low socioeconomic status. In 1986, it was estimated that 10% of the Brazilian population at the age of 34 was edentulous (without teeth), a figure that rose to 30% at the age of 48.

Edentulism is prevalent in elderly people in various parts of the world, with percentages ranging from 11% to 44%, which increases the lower the socioeconomic status. “The loss of teeth is still seen by many as a natural consequence of aging. Even in industrialized countries where there has been a decline in tooth loss in adults, the proportion of edentulous people over the age of 65 remains high.”

In Brazil, the last national survey found that 5,8% of elderly people have never been to the dentist; Among those who went, 65,7% had not consulted a professional for more than three years. In Sweden, a survey of elderly people in 2004 showed that 96% of them visited the dentist regularly. Another study from 2004, in the United States, indicated that 71% of elderly people had been to the dentist in the last year.

In Débora Dias' opinion, edentulism should be seen as a reflection of the lack of preventive oral health policies aimed at the adult population, aiming to maintain teeth until advanced ages. “I hope that the adults interviewed in this research, when they reach 65 years of age, will have their teeth preserved.”

Most are unaware of dental services provided by the SUS

Many people from the lower social strata are unaware that the SUS offers dental services in most municipalities in the State of São Paulo. Or that the government has been implementing specialty centers where citizens receive care not found in basic units, such as root canal treatment and prosthetics.

“Currently, the Family Health Program (PSF) is being restructured, with the hiring of more dentists. Each dentist is responsible for part of the population of a region, knowing the reality better in order to change it. It is a strategy that has proven effective in several cities”, informs Débora Dias.

The researcher recognizes the government's efforts to improve oral health conditions in the country, with a dentistry representative in the Ministry of Health. However, she suggests that information and education be prioritized, demonstrating the importance of good teeth for quality of life. “There are people who don’t know what a toothbrush is and many others who can’t afford one.”

The author of the thesis recalls that missing teeth is not only a functional problem – which impairs speech and chewing – but also has social and psychological implications, as it involves aesthetics. “Unfortunately, many people still fail to give due value to oral health, separating the mouth from the body, as if it were not part of general health.”

By the way, Débora Dias also mentions those who only go to the dentist when they feel pain. “In a public service, the demand is obviously high and, even if informed that they need root canal treatment, the person will not face the waiting list or for it. You will prefer that the dentist extract the tooth.”