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Open Access Research article

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach

Marco A Peres1*, Karen G Peres1, Antônio C Frias2 and José Leopoldo F Antunes3

Author Affiliations

1 Oral Epidemiology and Public Health Dentistry, Post-graduate Program in Public Health, Department of Public Health, Universidade Federal de University of Santa Catarina, Florianópolis, Brazil

2 Department of Social Dentistry, Faculty of Dentistry, Universidade de São Paulo, São Paulo, Brazil

3 Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, Brazil

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BMC Oral Health 2010, 10:20  doi:10.1186/1472-6831-10-20

Published: 13 August 2010



Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.


To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.


The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.


Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.


Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

dental pain; epidemiology; oral health; socioeconomic factors; multilevel analysis