Individual and contextual determinants of dental pain in adolescents: evidence from a national survey.

Objective To investigate the prevalence of dental pain among adolescent students and its association with individual, school and city variables, using a multilevel approach. Subjects and Methods Individual and school data were obtained from the National Adolescent School-Based Health Survey (PeNSE) conducted in Brazil in 2015 in a sample of 34,776 students from 1,339 schools in the 27 Brazilian capital cities. Secondary data on socioeconomic, structural and health indicators of the cities were obtained from public databases. The outcome was the prevalence of dental pain in the last six months (yes/no). Independent variables, consisting of potential social and behavioural determinants of dental pain, were structured in three levels: individual, school and city. Multilevel logistic regression was performed. Results Prevalence of dental pain was 21.8% (95% CI = 21.0-22.7). Unadjusted analysis showed significant associations between the outcome and most of the factors in the individual and in the contextual levels. In the final adjusted model, adolescents who reported unfavourable health-related behaviours, adverse socioeconomic or psychosocial characteristics, as well as those attending public schools and living in cities with high caries prevalence (DMFT) at age 12, were more likely to report dental pain. Conclusions Prevalence of dental pain was high and associated with adverse individual and contextual factors in the school and city levels.