The role of social cohesion in gingival bleeding levels among adolescents: a cross-sectional study.

Abstract

This study aimed to evaluate the relationship between social cohesion and gingival bleeding levels in adolescents from Santa Maria, southern Brazil. This cross-sectional study was nested within a cohort study initiated in 2010 with a representative sample of preschool children aged 1 to 5 years in the city. Participants were re-evaluated at ages 11 and 15 years, resulting in a 10-year follow-up period. The current study used data from this follow-up. Social cohesion was assessed at an individual level through questions about perceptions of neighborhood relationships and the frequency of participation in neighborhood gatherings. Gingival bleeding was evaluated clinically using the Community Periodontal Index (CPI). Sociodemographic and clinical variables were considered as potential confounders. Multilevel adjusted Poisson regression was used to assess associations, and results were expressed as rate ratios (RR) with 95% confidence intervals (95%CI). A total of 429 adolescents were included. In the adjusted model, poor perception of neighborhood relationships was associated with higher gingival bleeding levels (RR = 1.08; 95%CI: 1.03-1.13). Adolescents who did not attend local gatherings had even higher bleeding levels (RR = 1.45; 95%CI: 1.34-1.47). Additionally, non-white adolescents, those with lower income, irregular dental visits, and higher plaque levels also showed greater bleeding. Girls had lower gingival bleeding levels compared to boys. Lower social cohesion, reflected by negative neighborhood perceptions and lack of community participation, was associated with higher gingival bleeding in adolescents. Public health strategies aiming to improve adolescent oral health should focus on strengthening neighborhood relationships and promoting active community engagement as key social determinants.