Uso de serviços odontológicos públicos entre idosos brasileiros: uma análise multinível

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.

Indicators for dental appointment scheduling in primary health care: a national cross-sectional study

Background

Integrated dental services within the Health System, particularly at primary health care, are crucial to reverse the current impact of oral diseases, which are among the most prevalent diseases worldwide. However, the use of dental services is determined by complex phenomena related to the individual, the environment and practices in which care is offered. Therefore, factors associated with dental appointments scheduling can affect positively or negatively the use of dental services. The aim of the present study was to evaluate the indicators for dental appointment scheduling in Primary Health Care (PHC).

Methods

The present is a cross-sectional analytical study that used data from the external assessment of the third cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), carried out between 2017 and 2018, in Brazil. The final sample consisted of 85,231 patients and 22,475 Oral Health teams (OHTs). The outcome variable was the fact that the user sought for a dental appointment at the Primary Health Care Unit. A multilevel analysis was carried out to verify the association between individual variables (related to users) and contextual variables (related to the OHTs) in relation to the outcome.

Results

Only 58.1% of the users interviewed at these Primary Health Care Units seek the available dental care. The variables with the greatest effect on the outcome were the patient’s age up to 42 years old (OR = 2.03, 95% CI: 1.96–2.10), at individual level, and ‘oral health teams that assisted no more than a single family health team (FHT)’ (OR = 1.29, 95% CI: 1.23–1.36) at contextual level. Other variables were also associated with the outcome, but with a smaller effect size.

Conclusion

In conclusion, users’ age and work process of OHT were indicators for dental appointment scheduling. Our results suggest that when OHT put the National Oral Health Policy guidelines into practice, by assisting only one FHT, the chance for PHC users seeking dental appointments is higher than OHTs that assist more than one FHT. Regarding age, patients aged up to 42 years are more likely to seek an appointment with a dentist.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12319-x.

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.

Saúde bucal e acesso aos serviços odontológicos em idosos quilombolas: um estudo de base populacional

Resumo Objetivo: investigar a condição de saúde bucal, o acesso a serviços odontológicos e fatores sociodemográficos associados a essa acessibilidade em idosos quilombolas rurais do norte do estado de Minas Gerais, Brasil. Método: trata-se de um estudo analítico e transversal de base populacional, no qual foi utilizada uma amostragem por conglomerados com probabilidade proporcional ao tamanho (n=406). A coleta de dados envolveu a realização de entrevistas estruturadas e exames clínicos odontológicos. Resultados: verificou-se que a maioria dos idosos possuía baixa renda e baixa escolaridade. Observou-se que parcela expressiva dos indivíduos relatou acesso a um cirurgião-dentista (97,5%) e que havia realizado a última consulta odontológica há três anos ou mais (60,4%). Foi verificado ainda que a maior parte dos idosos era edêntula (52,0%) e que a maioria dos pesquisados necessitava de próteses (88%). Um alto índice CPO-D foi constatado nos indivíduos estudados (valor médio de 27,25). Idade avançada, ausência de companheiro e aposentadoria se mostraram associadas ao acesso irregular aos serviços odontológicos. Conclusão: os idosos quilombolas locais possuíam uma condição precária de saúde bucal e tinham acesso restrito aos serviços odontológicos. Idade, estado conjugal e situação laboral demonstraram associação com baixa acessibilidade aos serviços de saúde bucal nos idosos investigados.