School academic climate and oral health (tooth loss) in adolescents

RESEARCH ARTICLE School academic climate and oral health (tooth loss) in adolescents Carolina da Franca Bandeira Ferreira SantosID1*, Fabiana Godoy1, Valdenice Aparecida Menezes1, Viviane Colares1, Patrı´cia Maria Zarzar2, Raquel Conceic¸ão Ferreira3, Ichiro Kawachi4 1 School of Dentistry, Graduate Program in Hebiatrics, University of Pernambuco, Recife, PE, Brazil, 2 Department of Paediatric Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, 3 Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, 4 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America * carolina.franca@upe.br Abstract Background Preventing tooth loss depends on oral health maintenance behaviors. This study hypothe- sized that adolescents with educational aspirations have greater motivation to invest in the future, including maintenance of oral health status. Aim To analyze the association between a school academic climate of educational aspirations and tooth loss (first permanent molars) among adolescents. Methods A cross-sectional study was designed to include 2,500 adolescents (aged 14–19 years) enrolled in public high schools of Olinda located in Northeast Brazil. Multilevel Poisson regression random intercept models were conducted with tooth loss (first per- manent molars) as the outcome. The primary cohort of interest was school academic

climate, as measured by the proportion of students taking the national high school exams. Results Tooth loss of the first permanent molars (assessed by clinical exam) was more prevalent in adolescents from more disadvantaged backgrounds (receiving family allowance, low mater- nal education). However, after controlling for a wide range of individual characteristics, ado- lescents enrolled in schools with lower academic climate had a higher prevalence of tooth loss (PR 1.42, 95%CI: 1.09,1.85). PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone.0233505 May 21, 2020 1 / 11 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: da Franca Bandeira Ferreira Santos C, Godoy F, Menezes VA, Colares V, Zarzar PM, Ferreira RC, et al. (2020) School academic climate and oral health (tooth loss) in adolescents. PLoS ONE 15(5): e0233505. https://doi.org/10.1371/ journal.pone.0233505 Editor: JJ Cray, Jr., Ohio State University, UNITED STATES Received: October 17, 2019 Accepted: May 6, 2020 Published: May 21, 2020 Copyright: © 2020 da Franca Bandeira Ferreira Santos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist.