Vulnerabilidad social y salud oral en la Cañada Real Galiana y El Gallinero. Un análisis crítico sobre la salud oral de este colectivo como expresión de la desigualdad

Resumen

The latest regional and national oral health surveys performed in Spain show a trend of improvement in the oral health indices of minors residing in our country. The oral health programs implemented in recent decades have managed to improve these values, but they may not be reaching everyone equally. Between 2011 and 2013, the Community of Madrid launched the Health Promotion and Prevention Plan, prioritizing the area of the Ensanche de Vallecas where the marginal settlements of Cañada Real Galiana (Sector VI) and El Gallinero were located. The conditions of substandard housing, the lack of adequate sanitation, limited access to water and electricity, the lack of public transport, educational and health centres, among others, were causing a situation of social vulnerability that greatly conditioned the vital development of the children who lived there. One of the biggest problems detected was the high prevalence of oral pathology suffered by these children. Given that this population is changing and so are the living conditions, the present study was designed to know, at the time of data collection, the oral health status of children living in that area. It was considered that the knowledge of the oral health status of these children could help to plan activities and adapt resources to improve the health of the population under study. The proposed study could also contribute to visualizing the influence that belonging to a low social status has on oral health, considering that populations like this are often not included in oral health surveys. Therefore, the working hypothesis was "the socioeconomic factor plays an important role in oral health". It would be analysed whether the children living in that area at the time the data were collected had oral health similar to that found in the general Spanish population and in the autonomous community where the children under study were located. The aim of this study was to analyse whether the socioeconomic factor could be one of the factors that determine the oral health conditions of the children studied The main objective was to determine the oral health status of children at risk of social exclusion residing in Sector VI of Cañada Real Galiana and El Gallinero de Madrid, and to compare them with their peers at regional, national level and worldwide. Methodology. A cross-sectional observational study was conducted following the recommendations proposed in the World Health Organization's manual "Oral Health Surveys. Basic Methods", 1997 and 2013 editions. The study was approved by the Clinical Research Ethics Committee of the Severo Ochoa University Hospital in Madrid. The following variables were evaluated: dental caries, periodontal disease, oral hygiene, and accessibility to dental care. In 2018, children aged 5 to 16 years living in Sector VI of Cañada Real Galiana and El Gallinero in Madrid who provided written informed consent to participate in the study were examined. In 2018, children aged 5 to 16 years living in Sector VI of Cañada Real Galiana and El Gallinero in Madrid who provided written informed consent to participate in the study were examined. Clinical examinations were performed by a calibrated dentist, with a Kappa score of 1.00 intra-examiner consistency. The data obtained were analysed using the IBM SPSS v.27 statistical program. A 95% confidence level was applied in all statistical studies. Results. A total of 188 children aged 5 to 16 years living in Sector Vi of Cañada Real Galiana and El Gallinero in Madrid were examined, 50% of whom were of each sex. 91% of the children were born in Spain. The mean dft at the age of 5-7 years was 5.38. At that age, the prevalence of caries in the primary dentition was very high, affecting 89.7% of children, and remained high until the age of 8-10 years (83.9%). Most of the caries lesions detected were active. The restoration index (ri) was between 9.5% and 16.8% in the 5-7- and 8-10- year cohorts respectively. The mean DMFT increased quickly as age did, from a 1.67 at 8- 10 years to a 4.11 at 14-16 years. Caries in permanent dentition affected 66.7% of children aged 8-10 years, 70.7% aged 11-13 and 92.6% aged 14-16. The RI was between 35-50% in these age groups. The percentage of children affected by caries in at least one first permanent molar was 11.5% at 5-7 years, 62.9% at 8-10 years, 63.4% at 11-13 years and 88.9% at 14-16 years. Of the children examined, the percentage with a sealed permanent molar was low, highlighting that at 14-16 years of age it was found in 3.7%. Of the children that were 12 or over, 57.4% had gingivitis and 38.3% had dental calculus, with only a 4.3% of them presented gingival health. 38% of the subjects reported no pain or discomfort from their teeth or gums and 51.8% had never had problems eating. 29.4% brushed less than once a day and 30% said they never brushed. Despite the high levels of pathology they present, only 32% of the subjects had visited the dentist less than a year ago. In addition, 12.3% had never been there. The most frequently used dental care resource was the public oral health units (USBDs), in 46% of cases. Conclusions. In practically all the variables measured, the situation of the children aged 5 to 16 years living in the Sector VI of Cañada Real Galiana and El Gallinero in Madrid was worse than if we compared it with the data found in the literature, even if they were compared with children of low socioeconomic status. The results obtained were similar to those found in other contexts of social exclusion in various countries of the world, being in many cases even worse. As in other studies, it was observed that the social gradient determined the oral health of the group studied. The oral health programmes implemented in the country were not managing to alleviate this situation. To achieve health improvements in these groups, it is necessary to develop specific oral health strategies that are more equitable and adapted to the life circumstances of these children.