Orientador: Marcelo de Castro Meneghim / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-24T16:16:41Z (GMT). No. of bitstreams: 1 Oliveira_ArleteMariaGomes_D.pdf: 1603074 bytes, checksum: d9795e329abd5970a9362ee169c569fe (MD5) Previous issue date: 2014 / Resumo: O objetivo do estudo foi analisar o impacto na determinação do diagnóstico da necessidade de prótese em idosos institucionalizados, utilizando-se como critérios os indicadores sócio-dentais e clínicos de diagnóstico. Trata-se de um estudo com desenho epidemiológico, observacional e transversal. A amostra foi composta por idosos institucionalizados (n=208), de 60 anos ou mais, ambos os gêneros, independentes ou parcialmente dependentes segundo critérios de Katz, selecionados aleatoriamente de duas instituições (asilos) de Piracicaba/SP. O tamanho da amostra foi calculado de acordo com Demidenko (2007, 2008), considerando-se o poder do teste de 0,80, nível de significância de 0,05 e odds ratio = 2. Os instrumentos de pesquisas utilizados para a avaliação sócio-dental foram: questionário de autopercepção (GOHAI), avaliação de qualidade de vida (IODD) e auto-avaliação da saúde bucal. Os instrumentos para avaliação clínica, para o uso e necessidade de prótese, seguiu-se a metodologia utilizada por Colussi (2004), adaptado para esse estudo. Após a coleta, os dados foram agrupados e inseridos em modelo para a avaliação conjunta entre o padrão de necessidades percebidas pelo paciente (autodeclaração da necessidade de prótese), as variáveis sóciodemográficas, critérios de avaliação clínicos e sócio-dentais. Os resultados foram avaliados pela análise bivariada pelo Qui-quadrado e multivariada para verificar a necessidade de tratamento. As variáveis com p<0,20 foram testadas na análise de regressão logística múltipla, permanecendo no modelo aquelas com p<0,05. De acordo com os resultados obtidos, 52,88% (110) dos participantes eram edêntulos, 68,75% usavam algum tipo de prótese e 64,91% necessitavam de prótese, 60,58% dos participantes auto avaliaram a saúde bucal (SB) como boa e excelente e 39,42% como regular e ruim. Na análise bivariada, as variáveis que se associaram com a autodeclaração de necessidade de prótese foram: edentulismo (p=0,003), necessidade de prótese (p=0,03), auto avaliação SB (p=0,0024), religião, (p<0,0001) e qualidade de vida (p<0,0001). A prevalência de impactos severo na qualidade de vida associou-se a autodeclaração de necessidade de prótese. Os impactos mais relatados foram "comer e sentir o sabor dos alimentos", "falar ou pronunciar as palavras corretamente" e "sorrir e mostrar os dentes sem constrangimento". Na análise de regressão logística múltipla para autodeclaração de necessidade de prótese, as variáveis com associação significante (p<0,05) foram qualidade de vida (p<0,0001, OR=0,14, IC95%=0,06 - 0,30) e necessidade de prótese (p=0,0254, OR=0,39, IC95%=0,21-0,71). O estudo mostrou que a necessidade de prótese foi elevada na avaliação clínica. Para os idosos que avaliaram sua saúde bucal como ruim, os resultados apontam uma maior necessidade de uso de próteses. Concluiu-se que a medida subjetiva auto declaração de necessidade de prótese esteve fortemente associada à avaliação com os critérios de diagnóstico clínicos para a necessidade de uso de próteses / Abstract: The aim of this study was to analyze the impact on determining the diagnosis of the need to wear dentures in institutionalized and non institutionalized elderly persons, using socio-dental and clinical diagnostic indicators as criteria. This was a study with an epidemiological, observational and cross-sectional design. The sample was composed of elderly persons 9n=208) over 60 years of age, of both genders, independent or partially dependent - according to the criteria of Katz, randomly selected from two old-age home institutions in Piracicaba, SP, Brazil. The sample size was calculated in accordance with Demidenko (2007, 2008), considering a power of test of 0,80, level of significance of 0,05 and odds ratio=2. The research instruments used for socio-dental evaluation were: self-perception questionnaire (GOHAI), quality of life evaluation (IODD) and self evaluation of oral health. The instruments for clinical evaluation of the use of and need for dental prostheses, were in accordance with the methodology proposed by the WHO (1999) and used by Colussi (2004), adapted to this study. After collection, the data were grouped and inserted into a model for the joint evaluation between the pattern of needs perceived by the patient (self-declared need for dental prostheses), the sociodemographic variables, clinical and socio-dental evaluation criteria. The results were evaluated by bivariate analysis, the Chi-square and multivariate testing to verify treatment need. The variables with p<0,20 were tested in multiple logistic regression analysis, and only those with p<0,05 remained in the model. According to the results obtained, 52,88% (110) of the participants were edentulous, 68,75% wore some type of denture, and 64,91% needed dental prostheses. Of the participants, 60,58% self-evaluated their oral health (OH) as being good and excellent and 39,42% as being regular and poor. In the bivariate analysis, the variables that were associated with the self-declaration of the need for dental prostheses were: edentulism (p=0,003), need for dentures (p=0,03), self evaluation OH (p=0,0024), religion, (p<0,0001) and quality of life (p<0,0001). The prevalence of severe impacts on quality of life were associated with self-delcaration of the need for dentures. The most frequently reported impacts were "to eat and taste the flavor of foods", "speak or pronounce words correctly" and "smile and show one¿s teeth without embarrassment". In the multiple logistic regression analysis for self-declaration of the need for dentures, the variables with significant association (p<0,05) were quality of life (p<0,0001, OR=0,14, IC95%=0,06 ¿ 0,30) and need for dentures (p=0,0254, OR=0,39, IC95%=0,21-0,71). The study showed that the clinical evaluation revealed a high need for dentures. For the elderly who evaluated their oral health as poor, the results pointed toward greater necessity and less use dentures. It was concluded that the subjective measure of self-declaration of the need for dentures was strongly associated with the evaluation made by means of the clinical diagnostic criteria, to necessity of the use to prostheses / Doutorado / Saude Coletiva / Doutor em Odontologia

Abstract The aim of this study was to describe the planning, implementation and evaluation of a community-wide programme of oral health promotion that begun in 1993 in the Pitkäranta district of Russian Karelia. Baseline analysis of the community included clinical dental examinations and questionnaire surveys which were carried out in the same way as in the Finnish reference areas, Kuopio and Jyväskylä, in 1992. In addition, interviews of stomatologists and dentists, observations at local shops, kiosks, schools and dental clinics, and determinations of fluoride levels in drinking water were carried out in the Pitkäranta district. Previous information on oral health and its determinants among children in the Republic of Karelia was sought in the literature, from local statistics and from patient documents in the Pitkäranta district. Community analysis at baseline revealed that in the Pitkäranta district the occurrence of dental diseases was high. Behaviours related to oral health were generally unfavourable, and professional prevention at dental offices was practically non-existent. Therefore, the results of the baseline analysis of the community in 1993 called for an intervention with emphasis on enhancing healthy lifestyles, reorienting the methods of action of the system of oral health care towards health promotion and prevention of diseases, creating a supportive environment and empowering community actions as suggested in the Ottawa Charter. The goal was to achieve at least the same level of oral health as that found among children in the Finnish reference areas. In the 2001 follow-up, community oral health was analysed with the methods used in 1993. The results of the follow-up community analysis were used to monitor the changes in 1993–2001 and to assess the strengths and weaknesses of the programme. The improvements in oral health and in oral health-related behaviours among children as well as other developments in the community were impressive. Some oral health-related behaviours, such as frequent use of sugary snacks, non-daily use of fluoridated toothpaste and increasing smoking among adolescents, called for further actions.

Magister Scientiae Dentium - MSc(Dent) / A qualitative study was carried out to assess the role of traditional healers in oral health care in Kwa-Zulu Natal province, South Africa. The aim and objectives of the study were to assess the oral care knowledge and practices among traditional healers, to determine the extent to which traditional healers can diagnose oral conditions and how they could be used in the provision of primary health care and prevention of the spread of HIV infection. Another objective was to use the information collected to serve as a guide for collaborative oral disease prevention programme development.Three categories of traditional healers were identified in the sample: Isangomas, Nyangas and Umthandezelis. The average age of the sample was 45 years and the majority was female. Most healers were in training for between eight months and ten years. All traditional healers reported seeing patients with oral diseases and 93% reported that they referred patients elsewhere for additional help. All healers treated their patients with natural remedies. Seventy three per cent of the sample reported that they treated patients with HIV/AIDS. Less than 30% of the sample knew that AIDS was caused by a virus and 47% reported being &lsquo;told&rsquo; by the ancestors whether an oral disease was HIV/AIDS.In this study traditional healers were shown a series of ten photographs of common oral diseases and oral HIV lesions and asked to identify as many lesions as possible. Following basic training and education about the causes and diagnostic features of the lesions, 100% of traditional healers were then able to identify aphthous ulcers, 80% Kaposi's sarcoma and 73% could recognize cancer of the tongue. These results showed that given proper education, traditional healers could play an important role in early detection of not only the common oral diseases but also the oral manifestations of HIV/AIDS. In addition, most traditional healers are skilled in interpersonal relations and if provided with the correct information they could be very effective as AIDS councilors.The traditional healers demonstrated good knowledge of the transmission, risk groups and prevention strategies for HIV/AIDS and they could serve as an important resource of information and should be incorporated in community based AIDS prevention and other programmes. / South Africa

In this paper, the impact of caffeinated beverages on oral and systemic health was evaluated bringing to light a variety of outcomes. Coffee, tea and energy drinks are beverages that so many individuals around the globe consume in their daily lives yet the potential beneficial or adverse effects are rarely taking into consideration as drinks are consumed. These beverages cause positively influence antimicrobial, anti-cariogenic and anti-inflammatory responses on oral health yet there are also negative consequences that can arise. Society leads individuals to believe that these beverages are a necessity in people’s lives. Therefore, this thesis is written in hope to better understand the effects and impact these beverages have on the human body specifically the oral cavity. Some of these beverages, such as coffee and energy drinks, can have detrimental effects on oral health, teeth and systemic health. Outcomes from excessive intake of these drinks include dental erosion, cavities, and systemic health consequences. These types of beverages should be taken in moderation, otherwise negative effects can arise. On the other hand, sometimes caffeinated beverages can be beneficial to oral health such as when green or black tea are consumed. Considerable research has been performed to better understand the relationship between caffeinated beverages and how they influence the oral cavity. This thesis will evaluate this literature including both the positive and negative effects. With moderate intake, these types of beverages can play a beneficial role in oral and systemic health. In summary, studied have documented the significant beneficial effects of caffeinated beverages including tea, coffee and energy drinks on oral and systemic health. These benefits include antibacterial and anti-cariogenic effects in the oral cavity and improvement in cardiovascular health, metabolism, overcoming fatigue and anti-inflammatory properties with respect to systemic health. As with many things, high or excess intake of caffeinated products can lead to negative consequences such as increased risk of cardiovascular disease, loss of tooth integrity due to sugar and staining leading to tooth discoloration. Research has made great strides in understanding the oral and systemic effects of such beverages. However, there are still unanswered questions that should be pursued in order to truly elucidate the mechanism of action specifically related to the ingredients seen in caffeinated beverages

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Goal and Objectives. The main goal of this study is to assess childcare center directors (CCCDs) oral health literacy, knowledge, and attitudes towards pediatric oral health. We also determined the associations between CCCDs oral health literacy, knowledge, attitudes towards pediatric oral health, and 1) number of oral health preventive strategies (OHPS) implemented in their child care center (CCC), and 2) intent to adopt OHPS in the future. Background. Childcare utilization has substantially increased over the past decade with children enrolled in these centers spending substantial amount of time. CCCs, a non-traditional setting, can be used to actively promote pediatric oral health. However, before this setting can be used to promote oral health, a better understanding of Florida CCCDs' oral health literacy, knowledge, and attitudes on pediatric oral health is needed. Methods. In this cross-sectional study we used a 45-item pre-tested questionnaire to survey Florida CCCDs working primarily in licensed CCCs through survey monkey online portal. Descriptive, bivariate statistics and multivariate regression analyses were conducted using SAS analysis software. Results. Of the 877 CCCD participants, 90% did not train staff about traumatic dental injuries, 87% did not have an oral health consultant, and 82% did not promote enrollees to brush their teeth after meals or snacks. Mean oral health literacy (12.3±2.3) and attitude levels (16.8±2.7) were high, however mean oral health knowledge (1.6±2.0) was low. CCCDs with more years of experience (p=0.01), who work at Head Start CCCs ( p<0.0001), and have more positive attitudes (p<0.0001), were more likely to have implemented OHPS in their centers compared to their counterparts. Non-White CCCDs (p=0.03), those with more positive attitudes(p=0.001), and who reported to have already implemented one or more OHPS (p=0.002) were more willing to implement OHPS in the future compared to their counterparts. Conclusions. No significant associations between oral health literacy, knowledge and number of OHPS implemented were observed. Similarly, oral health literacy, oral health knowledge was not associated with intent to implement OHPS in the future. CCCDs with more positive attitudes towards pediatric oral health had implemented more OHPS within their CCCs, and also were willing to implement more OHPS in the future compared to their counterparts.

The oral health knowledge, attitudes and practices of primary school children and teachers in Mofolo, Soweto were determined. The enabling and inhibiting factors for oral health promotion in the school environment were also assessed. The aim of the study was to determine if there was any difference in knowledge, attitudes and, practices in learners and teachers and their environment at schools that were exposed to a preventive, educational and tooth brushing programme and those learners and teachers that were not exposed to the programme. Three hundred and thirty-six primary school children six to twelve years of age from four primary schools in Mofolo, i.e. Itekeng, Vukani, Emsebeni and Tshedimoso completed questionnaires. Itekeng and Vukani primary schools were part of an existing tooth brushing, educative and preventive programme, and Emsebeni and Tshedimoso primary schools were not. Four focus group discussions (one from each school) were held with regard to knowledge of oral health and hygiene and the school environment. Seven teachers from two of the four schools and eight teachers from each of the other two schools attended the discussions. Both the learners and teachers at all the schools had little knowledge of dental care, like tooth brushing with fluoridated toothpaste. Frequency of brushing was poor. Most of the learners (61 percent) for the exposed learners and 50 perecent from the unexposed learners reported brushing their teeth once a day. Dietary habits of the learners revealed a high consumption of sugary snacks in between meals and sugar. Fifty-five percent of the exposed learners bought sweets and cakes and 56 percent of the unexposed learners bought fizzy drinks and fruit juices at school. Forty-six percent of the exposed and 58 percent of the unexposed learners said they took more than three spoons of sugar with their breakfast. . Utilisation of primary dental health services in the community by both teachers and learners was poor. More learners from the exposed schools (97 percent) than the unexposed (82 percent) had been to a dentist because they had a toothache. Only 1 percent from the exposed schools and 8 percent from the unexposed had been for a routine check up. Learners from both school categories and teachers had no knowledge of fluoride or benefits of water fluoridation. Over 98 percent of learners from both school categories had never heard of fluoride. The teachers believed it was their responsibility to teach learners and parents about oral health and showed willingness to participate in oral health promotion programmes. The main source of oral health knowledge among the learners was home. Several inhibiting factors to oral health promotion like poverty, lack of adequate oral health knowledge and poor school environment were identified in all the schools.There was no school policy regarding oral health promotion In conclusion, there were no significant differences in the reported knowledge, attitudes and practices between the learners and teachers from the two schools that were part of the preventive, educational and brushing programme and those from the other schools that were not part of the programme. This therefore shows that while preventive and educational programmes are an important component of oral health promotion, they are not adequate in changing knowledge, attitudes and oral health practices.

Early childhood caries (ECC) is a rampant, infectious dental disease that affects children up to age six, with effects lasting well into their adulthood. ECC predicts high rates of morbidity in adulthood, is one of the most frequently found childhood illnesses, and is theoretically preventable. Lesion formation follows a particular pattern based in part on the pattern of primary tooth eruption, and is similar to caries formation at any age, with the balance of demineralization and remineralization. Commonly observed effects of ECC include failure to thrive due to pain and discomfort with eating, decreased attentiveness and socialization, and increased number of missed school days. The lesions associated with ECC are often very painful and frequently remain untreated in high-risk populations. Unfortunately, children’s oral health needs are often overlooked in research and public health practices, leaving many untreated and suffering. Risk indicators for ECC include socioeconomic status and race or ethnicity. One of the most critical risk factors for the disease is dietary quality, which has been studied to some extent in attempts to discern the epidemiology of ECC, and which has been shown to have causative effects on the disease process. What has not been studied, however, is how these risk indicators and risk factors interrelate to contribute to the high prevalence of ECC in the United States. Without studying the effect that an overlap in associated risks for these problems has, it is not possible to create a truly comprehensive public health prevention program that will efficaciously decrease the incidence of early childhood caries. Multiple studies have shown the effects of poor diet quality on the development of ECC. When studying nutritional intake alone, ECC is far more common in groups consuming a less healthful diet. Not only does dietary intake affect the formation of caries, caries experience also affects the ability to consume a nutritious diet. Socioeconomic status has also been cited as a crucial determinant of risk for developing ECC. Those children living at or below the Federal Poverty Line are at high risk for disease, regardless of their race or ethnicity. This is hypothesized to relate to nutrition, as healthier diets are frequently found to be more costly than cariogenic diets, which rely heavily on refined and processed grain products. Nutrition is the single risk factor that bridges the risk indicators of socioeconomic status and race or ethnicity. For this reason, improving dietary quality and nutritional status may prove to be the most effective method of decreasing the prevalence of ECC in the United States. Future studies should focus on effective methods to educate the population to alter the quality of the American diet as a whole. By doing so, the prevalence of this disease can be reduced, and more children can have successful, happier, and healthier childhood years. Creating better oral health in children will decrease morbidity for both oral and systemic disease in adulthood, ultimately improving the overall health of the population of the United States.

No description available.

Objetivo: investigar a associação entre estresse no trabalho e a autopercepção de saúde bucal. Método: Os dados analisados foram obtidos por meio de questionário de autopreenchimento de 3253 funcionários técnicos administrativos da Universidade Estadual do Rio de Janeiro um Estudo do Pró-Saúde. O estresse no trabalho foi medido através de um questionário elaborado por Karasek 1970 e reduzido por Theorell 1988. O instrumento é composto pelas seguintes dimensões: alta exigência no trabalho (alta demanda e baixo controle), baixa exigência (baixa demanda e alto controle), trabalho ativo (altos níveis de demanda e controle) e passivo (baixos níveis de demanda e controle). Autopercepção de saúde bucal foi obtida pela pergunta: “De um modo geral, como você considera o seu estado de saúde bucal (dentes e gengiva)?”, com opções de resposta variando entre, “muito bom” e “muito ruim”. Para a análise dos dados utilizou-se regressão logística ordinal, posteriormente ajustada para três blocos de variáveis: 1) saúde bucal (perda de dentes e dor de dentes nas duas últimas semanas) e uso e utilização serviço de saúde (frequência de visita ao dentista) 2) sociodemográficas (idade, sexo, escolaridade e renda) e 3) comportamentais em saúde (fumo e autopercepção de saúde geral). Resultados: Trabalhadores expostos à alta exigência e pouco controle no trabalho (OR=1,67; IC95%: 1,38-2,03) e ao trabalho passivo (OR=1,31; IC95%: 1,12-1,54), tiveram maiores chances de perceber pior saúde bucal, quando comparados àqueles expostos a baixa exigência no trabalho, não se observando associação com aqueles expostos ao trabalho ativo (OR=1,05; IC95%: 0,90-1,23). Entretanto, no modelo de regressão múltipla estas estimativas reduziram em magnitude e perderam significância estatística, a saber: alta exigência (OR=1,19; IC95%: 0,95-1,49), trabalho passivo (OR=1,09; IC95%: 0,91-1,31). Conclusão: Funcionários expostos a alta exigência no trabalho apresentaram pior saúde bucal autorreferida (modelo bruto e ajustado para os três blocos de variáveis) que parece ser parcialmente explicada pelas comportamentais em saúde, presença de problemas de saúde bucal (dor e perda dentária) e uso de serviços odontológicos com uma frequência maior do que uma vez ao ano. / Objective: To investigate the association between occupational stress and oral health self-perception. Method: Data obtained through a self-completion questionnaire with 3253 administrative technicians from a university in Rio de Janeiro, in the Pro-Health Study, were analyzed. Occupational stress was measured through a questionnaire prepared by Karasek, 1970, and reduced by Theorell, 1988. Oral health self-perception was obtained through the question: “In general, how do you consider your oral health state (teeth and gums)?”, with answer options ranging from “very good” to “very bad”. For data analysis, ordinal logistic regression was used, subsequently adjusted to three blocks of variables: 1) oral health (loss of teeth and toothache in the past two weeks) and use of the health service (frequency at which the dentist is attended); 2) socio-demographic (age, sex, schooling, and income); and 3) health-related behavior (smoking and general health self-perception). Results: Workers exposed to high strain and little control at work (OR=1.67; 95%CI: 1.38-2.03) and to passive work (OR=1.31; 95%CI: 1.12-1.54) had greater chances of perceiving worse oral health, when compared with those exposed to high-strain work, and no association was observed with those exposed to active work (OR=1.05; 95%CI: 0.90-1.23). However, in the multiple regression model, these estimates declined in magnitude and lost statistical significance, namely: high strain (OR=1.19; 95%CI: 0.95-1.49), passive work (OR=1.09; 95%CI: 0.91-1.31). Conclusion: Workers exposed to high-strain work presented worse self-reported oral health (raw model and adjusted to the three blocks of variables), which seems to be partially explained by health-related behavior, presence of oral health problems (toothache and dental loss), and use of dental services at greater frequency than once a year.

Poucos estudos têm avaliado a estrutura dimensional do Oral Health Impact Profile-14 (OHIP-14). Análise sobre a dimensionalidade e a adequação do OHIP-14 pode ajudar a melhorar a interpretação deste instrumento. Os objetivos desta tese foram avaliar a dimensionalidade e testar um modelo conceitual de qualidade de vida relacionada à saúde bucal utilizando a escala OHIP-14. A tese foi organizada em 3 manuscritos. O primeiro manuscrito "Comparison of two assessment instruments of the quality of life in older adults" teve como objetivo investigar se existe convergência entre as dimensões da versão abreviada do questionário da Organização Mundial da Saúde sobre Qualidade de vida (WHOQOL-Bref) e do questionário Perfil do Impacto de Saúde Bucal-14 (OHIP-14). Neste estudo, foram avaliados 872 idosos do sul do Brasil. As dimensões dos questionários WHOQOL-Bref e OHIP-14 foram correlacionas por afinidade. Todas as correlações analisadas apresentaram baixa magnitude. Apesar dos questionários WHOQOL-Bref and OHIP-14 apresentarem dimensões relacionadas, eles medem as relações físicas, sociais e psicológicas de maneira diferente. O segundo manuscrito "Oral Health Impact Profile-14: a Unidimensional Scale?" teve como objetivo investigar a estrutura dimensional do OHIP-14. As amostras foram provenientes de dois estudos realizados no Brasil, um no Rio de Janeiro (N=504) e o outro em Carlos Barbosa (N=872). Análises Fatoriais Confirmatória e Exploratória foram realizadas para identificar as dimensões do OHIP-14. As análises fatoriais confirmaram um fator para ambos os estudos. Nossos resultados sugerem que o OHIP-14 é uma escala unidimensional. O terceiro manuscrito "Testing the applicability of a conceptual model of oral health-related quality of life in community-dwelling older people" teve como objetivo testar o modelo conceitual de Wilson e Cleary em relação à qualidade de vida relacionada à saúde bucal. Uma amostra aleatória de 578 idosos do sul do Brasil foi avaliada.O modelo conceitual de Wilson e Cleary foi testado usando a modelagem de equações estruturais, incluindo: edentulismo, sintomas, estado funcional, percepção de saúde bucal, qualidade de vida relacionada à saúde bucal e variáveis sociodemográficas. No modelo final, o edentulismo foi correlacionado com a insatisfação da aparência dos dentes (r = -0,25). O pior estado funcional foi correlacionado com pior percepção de saúde bucal (r = 0,24). A idade teve um efeito direto no OHIP-14 (r = -0,15). Houve um efeito indireto do sexo no OHIP-14 através do estado funcional (r = 0,12).Os resultados apresentados mostram que, para idosos brasileiros, variáveis como sexo e idade desempenham um papel importante para o entendimento conceitual de qualidade de vida relacionada à saúde bucal. Nossos resultados sugerem que o OHIP-14 não avalia o impacto das condições bucais na qualidade de vida numa perspectiva multidimensional, mas em uma única dimensão. A presente tese demonstrou que há caminhos diretos e mediados entre as variáveis clínicas e não clínicas em relação à qualidade de vida relacionada à saúde bucal. / A few studies have evaluated the dimensional structure of Oral Health Impact Profile-14. Further analysis on the dimensionality and the adequacy of OHIP-14 can help improve the interpretation of this instrument. The objectives of this thesis were to assess the dimensionality and testing a conceptual model of oral health-related quality of life using the OHIP-14 scale. The thesis was organized in three manuscripts. The first manuscript "Comparison of two assessment instruments of the quality of life in older adults" aimed to investigate if there is convergent validity between the dimensions of World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-Bref) and Oral Health Impact Profile-14 (OHIP-14) questionnaires. In this study, 872 elderly Southern-Brazilians were evaluated. The dimensions of WHOQOL-Bref and OHIP-14 questionnaires were correlated by affinity. All correlations analyzed had a low magnitude. Despite the fact that WHOQOL-Bref and OHIP-14 instruments have related dimensions, they measure physical, psychological and social relations differently. The second manuscript "Oral Health Impact Profile-14: a Unidimensional Scale?" aimed to investigate the dimensional structure of the OHIP-14. Subjects were from Rio de Janeiro (N=504) and Carlos Barbosa (N=872) Studies in Brazil. Exploratory and Confirmatory Factor Analysis were performed to identify the dimensions of OHIP-14. The factor analysis confirmed one factor in both studies. Our findings suggest that the OHIP-14 is a unidimensional scale. The third manuscript "Testing the applicability of a conceptual model of oral health-related quality of life in community-dwelling older people" aimed to test Wilson and Cleary's conceptual model in relation to oral health-related quality of life. A random sample of 578 elderly Southern-Brazilians was evaluated. Wilson and Cleary's conceptual model was tested using structural equations modeling including: edentulism, symptom status, functional health, oral health perceptions, oral health-related quality of life, and sociodemographic variables. In the final model, edentulism was negatively correlated to dissatisfaction of appearance of their dental prostheses (r= -0.25). The worse functional status was correlated with poor oral health perception (r= 0.24). Age had a direct effect on OHIP-14 (r= -0.15). There was an indirect effect of sex on OHIP-14 via functional status (r= 0.12). The results showed that for elderly Brazilians variables such as sex and age are important in the conceptual understanding of oral health-related quality of life. Our findings suggest that the OHIP-14 may not evaluate the oral impact on quality of life on a multidimensional perspective, but in a single dimension. The present thesis demonstrates that there are direct and mediated pathways between clinical and nonclinical variables in relation to oral health-related quality of life.