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Bachelor’s Thesis approaches the relationship between family environment and children’s oral health

Mariél Goulart investigated the influence of educational parenting practices on children’s health, using data from an epidemiologic inquiry done in Rio Grande do Sul’s countryside
Bachelor’s Thesis approaches the relationship between family environment and children’s oral health

Study emphasizes the importance of early intervention in oral health problems - Photo: Thiago Cruz / UFRGS

By Camila Raposo

Mariél Goulart, in her UFRGS Bachelor thesis in dentistry, analyzed the relation between the oral health of children and teenagers and educational practices adopted by the parents. To this end, the student made an epistemological survey - a type of census - about the oral health conditions of children and teenagers’ between the ages of 9 and 18 of Pejuçara, a town of about 3,900 inhabitants located in the northeast of Rio Grande do Sul, the southmost state of Brazil.

For this research, 329 of the 411 students aged 9 to 19 years old from two schools, a municipal and a state school, were examined. We excluded those that did not fill the prerequisite of the research, those that did not come to class in the days that the data was collected, those that did not want to participate, and those that did not have parental authorization. The exams taken included dental evaluation of permanent and deciduous teeth, cavities, lost teeth, or obturation.

Furthermore, a socioeconomic survey, that included questions about the access to and usage of odontological services, was sent to parents along with the term of consent. The children and teenagers answered questions related to their experiences and usage of odontological services. For the descriptions of the practices adopted by the parents, we applied the Inventário de Estilos Parentais (Parenting Styles Inventory). The instrument assesses the practices in seven categories: positive monitoring (practices that involve attention and knowledge of the parents about where their children are and what they do); moral behavior (teaching of values such as honesty, empathy, and sense of justice, helping in the distinction between right and wrong); negligence (lack of attention to the children’s needs, omission of aid or responsibilities); inconsistent punishment (associated with the parents’ change of mood and not with the child’s attitude); negative review (stressful supervision or excess of parental supervision over the children); relaxed discipline (the responsible adults forget or disrespect the rules they established themselves); and physical abuse (with the excuse of trying to educate, parents hurt or cause pain to their children). Each student answered to one survey on maternal practices and another on paternal ones.

According to Goulart, this was the first research on the oral health conditions of children and teenagers related to the educational parenting practices. “I was always interested in this psychological aspect of health services and while  searching for topics for my Bachelor thesis and between conversations with professionals I decided to research why people start to have problems with oral health. I, therefore, started with their upbringing, so that we could understand how the way the family is structured can be reflected on oral health”, she says.

Pejuçara was chosen  because they were familiar with the town and had easy access: “I  lived my whole life in Pejuçara, so I had contacts in the local Secretary of Health and City Hall. As it is a small town, we get to know everyone. The initial idea was to do it in Porto Alegre, the state's capital, but the contact with the Secretary of State for Health was too difficult, and we also didn’t get enough students… So we decided to do it in Pejuçara since the access was easier”, she explains.

The project was presented to the Mayor and to the Secretary of Health. “They gave me a lot of support, especially because the research is of their interest”, says Goulart, indicating that the town did not have a census for oral health of their children and teenagers. The necessity to have inquiries, such as support to the epidemiological vigilance, to the establishment of priorities and allocations of resources is established by federal law. “It is important so that we can have an idea of what is happening to the health of the community. Especially regarding children, because childhood is the time in which we can prevent the development of harmful behaviors. In adult life, other things occur and make it difficult to change habits. The earlier we start providing good health care, the better the results, even more so because oral health problems are cumulative”, says the researcher.

In addition to helping intermediate between the schools and the City Hall, The Secretary of Health provided a dentist, an oral health technician and two community health agents for the research development, who assisted with data recording and the supervision of the children. A psychologist participated in this research, applying the Parenting Styles Inventory, as well as a Master’s degree student from UFRGS.

There were two main results of the survey: the first refers to the oral health level of the population of Pejuçara - better than the state of Rio Grande do Sul and national averages; the second is the finding that, in fact, the oral health of the child is related to the socioemotional family environment, as well as to the practices performed by the parents during the education process.


Health in Pejuçara

The average number of decayed, missing and obturated teeth in children and teenagers in Pejuçara was 1.4, with a mean of 0.8 for 12 year olds and 2.1 for 15-19 year olds. The data obtained by SB Brazil 2010 - National Research on Oral Health indicate that the Brazilian average is two teeth at the age 12 and 4.2 for the 15 to 19 year age group. The values ​​were lower even when compared to the countryside of the South Region (2.1 teeth at age 12 and 4.3 between 15 and 19 years old) and Porto Alegre (1.4 teeth at age 12 and 2.9 from 15 to 19 years old).

Goulart points out that the existence of a cohort effect cannot be discarded since the data obtained by the researcher in 2016 are compared to those of individuals examined in 2010. "This is already a different generation from the current population, so it may have an effect of the research itself when compared to a study from so long ago. But we know that the population has good access because we studied the proportion of restored over decayed teeth, and that is also higher here", she says. In Pejuçara, this proportion, in the range of 15 to 19 years old, is 78.5%, while in Brazil it is 50%. In addition, 85% of participants reported having consulted with the dentist less than a year ago, while only 0.9% had never been to the dentist.

"They have very good health practices in the county. And this is achieving a positive result," emphasizes the researcher. "I think these data serve as a supplement for the maintenance of municipal policies. It is a supplement so that what they already have is not withdrawn, even more so now, in times of crisis and spending cuts", she adds.

The Health on School program is one of the actions aimed at promoting oral health in Pejuçara. Focusing on basic care and the adequacy of school meals, it is carried out by local city professionals, with a balanced menu for both the meals provided by the government and by canteens. In addition, the two schools in the town have dental offices, which facilitate student access to dental care.


Educative practices and oral health

Regarding the association of family dynamics and children’s and teenagers’ oral health, in general, in all variables evaluated, the results were similar: the more negative the practices adopted by the parents, the higher the probability of the children having oral health issues. One of the most significant statistic results was regarding the positive monitoring: parents’ interest and support can protect their children against diseases and lower the probability of dental cavities. Goulart explains that “Based on the literature, that can be explained by the fact that parents’ love and support is the basis for positive monitoring, which lessens the need for constantly monitoring the child, and also makes it possible for the environment to be more harmonious”.

On the other hand, it was found that relaxed discipline and being physically abused by the mother considerably increases the possibility of dental cavities in children. What was found by the researcher was that “the more the mother beat the child, or manifested any attitude that hurt or caused him pain, the bigger were the chances of the said child developing oral diseases. That situation is very common here in Pejuçara because there is this culture of beating children up in order to make them behave. “If the child is misbehaving it’s because it was not beaten up enough”, they say. So much so that the average of maternal physical abuse there was higher than the average pattern of the study. Physical abuse can make the child apathetic, fearful, uninterested, and that also reflects in their health”.

As it is explained in the research, the mistakes made during the process of educating a child can trigger health issues. It is important to identify the problems early on so that the child can have an adequate development. In that sense, it is essential to observe the family and its dynamics. The way parents raise their children can indicate new actions. Ultimately,  it is in the family that oral health care starts, and “we have to take a look at the family if we want to make this early intervention to try to avoid consequences of bad oral health care later on”, says Goulart.


Throughout this process of collecting data, all of the children who were diagnosed with oral health issues were immediately referred to the public health center. After speaking to the Secretary of Health, it had been previously agreed that the health center would take care of the needs reported by the researchers. Furthermore, regarding the results in the Parenting Styles Inventory, some of the children were put under observation and will be submitted to analyses to verify if they will need referral to be seen by an appropriate professional. Currently, Goulart is preparing a report with the data gathered in the census, which should be handed to the town hall soon.


Bachelor Thesis

Title: Oral health inquiry and its relation with educational parenting practices in children and teenagers in South Brazil.

Author: Mariél de Aquino Goulart

Thesis Advisor: Roger Keller Celeste

Unit: Dental School.

Translated by Caroline Vargas, Débora Barros and Marina Klafke

Translation revised by Prof. Márcia Moura da Silva (UFRGS)

Text in Portuguese available at:

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