Associação entre o uso de prótese dentária total e o tipo de serviço odontológico utilizado entre idosos edêntulos totais

Racial inequality in complete dental prosthesis delivered: can public services reduce inequities?

OBJECTIVES

To investigate the association between access and delivery of complete dental prosthesis according to the proportion of the black population in Brazilian municipalities and to oral health policies.

MATERIALS AND METHODS

Ecological data from 2017 to 2021 relating to the delivery of complete dentures stratified by race was collected in all Brazilian cities. We calculated a racial inequality indicator by subtracting the percentage of the black population from the percentage of complete dental prostheses that were delivered to blacks in each municipality. Logistic and linear regression models were carried out.

RESULTS

We found that 49.2% (2737) of municipalities delivered complete prostheses. The service was more frequently available in municipalities where black individuals made up 20-80% (odds ratio [OR] = 1.45, 95% confidence interval [CI] 1.15; 1.81), those with dental specialty centers (DSC) (OR = 3.04, 95%CI 2.50; 3.68), and those with more oral health teams (OHTs) (OR = 3.43, 95%CI 2.81; 4.18). Where dental prostheses were available, racial inequities favored the white population by 7.7 percentage points (p < 0.01). Increased inequality was observed in municipalities with more OHTs and/or a higher proportion of black individuals (>80%).

CONCLUSIONS

Although municipalities with a DSC, and with more OHTs offer better access to complete dental prosthesis for blacks, racial inequality still impacts the delivery of the service. Primary and secondary healthcare services may even exacerbate this.

CLINICAL RELEVANCE

Policymakers should monitor racial inequities in healthcare services. The currently unmet needs of black people are critical, especially in cities with more OHTs and/or increased proportions of black people.

Use of dental implants among older adults of two southern Brazilian cities: A population-based cross-sectional study

AIM

To assess the prevalence and associated factors with use of dental implants among older adults.

METHODS

This cross-sectional study was performed with home dwelling older adults from the cities Cruz Alta and Veranópolis, Brazil. The main outcome was obtained by a clinical oral examination, considering those with at least one dental implant. Independent variables were collected by a structured questionnaire. Crude and adjusted analysis was performed by Poisson regression with robust variance estimation; results are presented in prevalence ratio (PR) and 95% confidence interval.

RESULTS

It was included 569 participants. The overall prevalence of using at least one dental implant was 16.7%. Higher PR for the use of dental implants was observed in white individuals (PR:5.147; 95% CI:2.033-3.034), in those with at least medium income (PR:3.202; 95% CI:1.196-5.572) and in those with access to dental care in the last 12 months (RP:1.595; 95% CI:1.087-2.340). Older adults with a medium level of education (RP:0.484; 95% CI:0.240-0.978) and those that did not use dental floss (RP:0.627; 95% CI:0.240-0.978) demonstrated a significantly lower PR for use of dental implants.

CONCLUSION

A substantial prevalence of use of dental implants was observed among older adults. In addition, white ones, those with a better financial situation and users of dental floss presented higher use of dental implants.

Factors associated with the use of dental services in the previous 12 and 36 months by Brazilian older people residing in rural areas

OBJECTIVES

To describe the use of dental services in two periods and associated factors in older people residing in the rural area of a municipality in southern Brazil.

METHODS

This was a cross-sectional study nested in a cohort study. A standardised questionnaire was used to collect the variables of interest. The dependent variables were the use of dental services in the 12 and 36 months prior to the interview.

RESULTS

A total of 863 older people were interviewed, 24.7% of whom had visited a dentist in the previous year and 38.7% had visited a dentist in the previous 3 years. Skin colour, health insurance and self-rated health were associated with both outcomes. Individuals with non-white skin, those who did not have health insurance and those who considered their health to be poor or very poor were more likely to take a long time before seeking oral health services. Differences between the two outcomes were observed in oral health and the use of tobacco. The likelihood of having gone more than 3 years without visiting a dentist was greater among smokers and lower among those with dental caries.

CONCLUSIONS

The prevalence of dental service use was low. Variables related to the adoption of unhealthy behaviours and the occurrence of oral diseases were only related to the use of dental services 36 months prior to the interview. Public policies must be reorganised to prioritise population groups with greater difficulties in the use of dental services.

Inter-examiner agreement in the application of an oral health assessment instrument in hospitalized elderly

OBJECTIVES

to analyze the correspondence between nurse and dental surgeon assessments in the application of an Oral Health Assessment in dental screening of elderly hospitalized patients.

METHODS

cross-sectional study with elderly patients (n = 54) admitted to University Hospital from the Federal University of São Paulo. Data were collected through the assessment of oral cavity. Descriptive statistical techniques were used to analyze them, using tables and graphs.

RESULTS

there was correlation and agreement between nurse and dental surgeon assessments referring to application of an Oral Health Assessment in dental screening of hospitalized elderly.

CONCLUSIONS

oral Health Assessment in dental screening for hospitalized elderly by nurses demonstrated excellent reproducibility and may be a resource to identify buccal alteration, helping the planning and execution of nurse care associated to oral health.

Use of dental services by the Brazilian elderly: latent class analysis

OBJECTIVE

To analyze the different profiles of dental service use by the Brazilian elderly and their possible association with sociodemographic factors, comorbidities, functionality and self-perception of oral health.

METHODS

Cross-sectional population-based study, using secondary data from the National Health Survey (PNS) of 2013. The sample size was 2,969 elderly individuals. Latent Class Analysis was used to construct the dependent variable "profile of dental service use" from questions related to this profile. The independent variables formed 3 blocks: sociodemographic; comorbidities; functionalities and self-perception of oral health. The Rao-Scott Test and Standardized Residue Analysis tested the association. To measure the effect of covariates, Odds Ratio was estimated using a multiple hierarchical model of multinomial logistic regression. Significance level was 5%.

RESULTS

Three latent classes were identified: Direct Disbursement Profile, Health Plan Profile and the Unified Health System (SUS) Profile. White elderly people were associated with the Direct Disbursement and Health Plans profile. The Health Plan profile was more associated with the married marital status or living with a spouse. In the multiple model, low schooling was associated with the profile of SUS users and elderly people diagnosed with cancer with the Health Plan profile. Self-perceiving oral health as bad or very bad increased the chances of belonging to the SUS profile.

CONCLUSION

Latent Class Analysis proved to be a powerful strategy for a subtle and detailed understanding of the profile of dental service use and its relationship with associated factors.