Determinantes individuais da utilização de serviços odontológicos por adultos e idosos de baixa renda

Use of dental services among adults from a birth cohort in the South region of Brazil

OBJECTIVE

Measure the prevalence of use of dental services in the previous year and associated factors among 31-year-old adults from a birth cohort of 1982.

METHODS

This is a cross-sectional study that analyzed a birth cohort of 1982 from the city of Pelotas. In 1997, a systematic sample of 27% of the city's census sectors was defined and all households in these sectors were visited, where 1,076 15-year-old adolescents were interviewed. For the oral health studies, 900 of these individuals were randomly selected and followed up at 24 and 31 years of age. The study used data collected from 523 individuals in 2013 (at 31 years old). The outcome was visit to the dentist (use of dental services) in the previous year. Demographic factors (sex), socioeconomic factors (income, education), and oral health factors (reason and type of service, self-perception of oral health, dental pain and caries experience - DMFT) were used as independent variables. Prevalence ratios were estimated using Poisson regression.

RESULTS

The prevalence of use of dental services in the previous year was 55.3% (95%CI: 51.0-59.5%). In the adjusted analysis, the reason and type of service, self-perception of oral health, and DMFT were associated with the outcome. A stronger association was found with use of dental services in individuals who visited for prevention and used the private service, who were satisfied with their oral health, and who had more caries experiences.

CONCLUSION

55.3% of the cohort sample used dental services in the previous year. Individuals who visited the dentist of private service for preventive reasons, who were very satisfied with their oral health, used these services in a higher proportion. In addition, a higher DMFT index also led to higher use of services.

[The use of dental services in the past year in the brazilian population: a systematic review with meta-analysis]

The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

Analysis of access to health services in Brazil according to sociodemographic profile: National Health Survey, 2019

OBJECTIVE

to describe the access to and utilization of health services among the Brazilian population according to sociodemographic characteristics, based on the 2019 National Health Survey (Pesquisa Nacional de Saúde - PNS).

METHODS

this was a cross-sectional descriptive study based on a PNS sample; the prevalence and respective confidence intervals of data stratified by sex, schooling, age and national macro-region of residence were calculated; data were analyzed using Stata software version 16.1.

RESULTS

a total of 293,725 individuals were interviewed; males showed lower proportion of medical consultations (66.6%) and were less likely to seek care (17.6%); among those living in the North region, 69.1% had medical consultations; 16.5% of individuals with low level of education obtained medication through the Brazilian Popular Pharmacy Program.

CONCLUSION

the results reinforce iniquities in access to and utilization of health services, in addition to the need for monitoring indicators in order to guide health policies in Brazil.

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.

Use of oral health services among elderly Brazilians: mediation by tooth loss

The present study analyzed factors associated with the use of oral health services among elderly Brazilians. This was a cross-sectional study with data from the latest National Oral Health Survey (SB Brazil 2010), which considered a sample of 7,619 elderly individuals (65-74 years) for analysis. Structural Equation Modeling (SEM) was used, investigating the association between latent or observed variables, directly or mediated, in relation to the use of oral health services. Least squares estimators adjusted by mean and variance, were used by means of standardized coefficients, and standard error and confidence intervals, by applying the bootstrapping method with 1,500 iterations. Elderly individuals with a higher socioeconomic status, fewer missing teeth, and the presence of impacts of oral health conditions on their lives were directly associated with the outcome. Other factors associated with the mediated use of oral health services among elderly Brazilians included socioeconomic status, gender, age, and the use of prostheses, in addition to finding a correlation between prosthesis use and missing teeth. Tooth loss, along with other factors, played a prominent role in this study regarding the use of oral health services among elderly Brazilians, pointing to the need to expand access to dental prostheses in primary care.

Use of oral health services among elderly Brazilians: mediation by tooth loss

Abstract The present study analyzed factors associated with the use of oral health services among elderly Brazilians. This was a cross-sectional study with data from the latest National Oral Health Survey (SB Brazil 2010), which considered a sample of 7,619 elderly individuals (65-74 years) for analysis. Structural Equation Modeling (SEM) was used, investigating the association between latent or observed variables, directly or mediated, in relation to the use of oral health services. Least squares estimators adjusted by mean and variance, were used by means of standardized coefficients, and standard error and confidence intervals, by applying the bootstrapping method with 1,500 iterations. Elderly individuals with a higher socioeconomic status, fewer missing teeth, and the presence of impacts of oral health conditions on their lives were directly associated with the outcome. Other factors associated with the mediated use of oral health services among elderly Brazilians included socioeconomic status, gender, age, and the use of prostheses, in addition to finding a correlation between prosthesis use and missing teeth. Tooth loss, along with other factors, played a prominent role in this study regarding the use of oral health services among elderly Brazilians, pointing to the need to expand access to dental prostheses in primary care.

Coprescription Trends in Western Medicine, Chinese Herbal Medicine and Dental Medicine among Older Adults in Taiwan from 1997 to 2013

BACKGROUND

Coprescription is a potential medical problem for older adults that could induce polypharmacy and subsequent complications. In Taiwan, Chinese herbal medicine (CHM) is popular among the older adults. Investigating the coprescription trends in Western medicine, CHM and dental medicine is important to avoid possible polypharmacy.

METHODS

We analyzed data from the Longitudinal Health Insurance Database 2000 (LHID 2000) in Taiwan. Patients ≥ 60 years old who received coprescription of Western medicine, CHM and drugs for dental care from 1997 to 2013 were included. The odds ratio (OR) and 95% confidence interval (95% CI) were estimated by a logistic regression model for evaluating the correlation between baseline characteristics and coprescription.

RESULTS

A total of 266,034 patients were included for the analysis. Most patients receiving coprescriptions lived in the northern Taiwan and with a monthly income lower than 20,000 new Taiwan dollars. The trends in older adults using Western medicine alone or CHM alone decreased over time, but the cohort using dental medicine alone had the opposite result. Decreased trends in coprescription with age were noted. The trends in the proportion of coprescription and the number of days of coprescription increased with the calendar year. Increased trends in the proportion of patients with coprescription were also found, except for the cohort of patients who used both Western medicine and CHM. Patients who were female, and aged 70-79 years were prone to receive coprescription.

CONCLUSIONS

Coprescription in older patients is not uncommon in Taiwan. Healthcare providers and policymakers should be aware of the complex coprescription pattern in the older adults.

Oral health access in Brazil: analysis of inequities and non-access from the service user's perspective, according to the National Primary Care Access and Quality Improvement Program, 2014 and 2018

OBJECTIVE

To investigate factors associated with non-access to oral health in Brazil.

METHODS

This was a cross-sectional study of data from external evaluations of the National Primary Care Access and Quality Improvement Program (2014 and 2018), using hierarchical multivariate logistic regression. 'Non-access' was defined as the service user not being able to make an appointment with a dentist.

RESULTS

We analyzed data on 37.262 individuals (2014 sample) and on a further 117.570 individuals (2018 sample). Greater likelihood of non-access was found for those who live in municipalities with greater inequalities and with less oral health coverage, those whose travel time to the health center is more than 11 minutes, being female, being aged between 25 and 39 years and those whose income was up to 1 minimum wage.

CONCLUSION

Non-access was associated with municipal factors such as greater inequality; organizational factors such as less oral health coverage and travel time to the health center; and individual factors such as sex, age and income.

[Organization of demand in oral health and family vulnerability]

The scope of this study was to analyze the relationship of an instrument of family vulnerability with sociodemographic, dental, and spatial distribution in a given territory. The dependent variable was the classification of family vulnerability, proposed by Coelho and Savassi. The independent variables were selected on the basis of the theoretical model proposed by Andersen. Hierarchical multiple logistic regression models were estimated. Kernel density estimation was used for spatial analysis. Subjects who lived with more than 4 people (OR = 3.46; 95% CI), who were dissatisfied with their oral health (OR = 2.38; 95% CI), who were ashamed to smile and talk (OR = 3.03, 95% CI) were more likely to be "at risk" in the family. Spatial analysis enabled the visualization of an area of ​​higher concentration of families "at risk". The relationship of the instrument of vulnerability analyzed with sociodemographic and dental factors, as well as the assistance in the visualization and identification of more vulnerable areas, are useful in the knowledge of the territory for the planning of actions in oral health, and the conclusion drawn is that the tool can be adopted for more equitable access by the oral health teams.

Use of dental services by disability status in Brazil in 2013

OBJECTIVE

To describe the prevalence and factors associated with the use of oral health services in people with and without disabilities in Brazil.

METHODS

A cross-sectional study was used with the secondary data of 60,202 individuals from the Brazilian National Health Survey of 2013. The main exposure variable was 'Disability', and the main outcome was 'Dental service use'. Independent variables were selected using the modified Andersen and Davidson model, according to four groups: exogenous variables, primary determinants of oral health, health behaviours and oral health conditions. The analysis was based on a hierarchical approach stratified by 'disability (yes/no)', with multiple logistic regression incorporating sampling design. Interaction terms between the disability variable and covariates were tested in logistic regression models.

RESULTS

A total of 45.5% of the people without disabilities and 34.1% of those with disabilities visited the dentist in the last year. In the crude model, the nondisabled group used dental services more (OR = 1.61, 95%CI = 1.45-1.79), but the difference was no longer significant (OR = 1.18, 95%CI = 0.93-1.51) when adjusted by the health behaviour and oral health condition blocks. Determinants of dental use were similar among people with and without a disability.

CONCLUSIONS

No difference in dental service use according to disability status was found after adjusting for oral health conditions. Although edentulism is more prevalent among disabled people, they do not go to the dentist as regularly as nondisabled people. Health services should actively schedule maintenance visits to ensure that the needs of disabled individuals are fully addressed.

Absenteísmo de usuários

Introdução: O absenteísmo dos usuários aos serviços de saúde é um fenômeno que vem impactando a atenção à saúde. Objetivo: Identificar a evidência científica disponível sobre as possíveis causas do absenteísmo dos usuários aos serviços de saúde. Métodos: Este estudo analisou 34 publicações, classificadas em três unidades temáticas: barreiras do acesso; impacto dos serviços como determinante da saúde dos usuários; fatores condicionantes e facilitadores do acesso. Resultados: Enfrentar o absenteísmo exige a compreensão das desigualdades sociais, requer conhecimento sobre a organização dos serviços de saúde, dos determinantes sociais e das relações que ocorrem entre os grupos no contexto social. As principais razões para o absenteísmo são evitáveis e pode se beneficiar de intervenções para melhoria dos serviços de saúde. Conclusões: O conhecimento das barreiras e determinantes do acesso permite compreender as possíveis causas do absenteísmo e suas consequências, a fim de fundamentar a tomada de decisões que possibilitem a correção ou minimização de riscos e de prejuízos econômicos, na administração dos serviços públicos de saúde.

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

Resumo Avaliou-se, entre idosos brasileiros, se o uso dos serviços odontológicos provenientes do Sistema Único de Saúde (SUS) é equânime. Utilizaram-se dados individuais de exames conduzidos por profissionais calibrados do levantamento nacional de saúde bucal (2010) e dados contextuais originários do DATASUS e do IBGE. A variável dependente foi o tipo de serviço utilizado: SUS e Outros. Foram conduzidas análises multiníveis através de regressão logística (α = 5%) (OR/IC 95%), através do SPSS 24.0. Participaram 6.303 idosos, a prevalência do uso no SUS foi de 30%, os fatores contextuais associados foram o acesso a banheiro e a água encanada (1,54/1,19-2,00) e o índice de cuidados odontológicos (1,41/1,10-1,81); já os individuais: idade (0,77/0,66-0,90), anos de estudo (1,83/1,53-2,20), renda familiar (2,57/2,20-3,01), motivo da última consulta (0,75/0,60-0,93), no de dentes cariados (1,26/1,08-1,48), no de dentes obturados (0,63/0,54-0,74), uso de próteses (2,23/1,91-2,59), dor de dente (1,36/1.11-1,67), autopercepção da necessidade de tratamento odontológico (1,20/1,12-1,51) e da necessidade de próteses (1,38/1,20-159). O uso no SUS tem sido equânime, porém é preciso organizar o processo de trabalho, viabilizando tal uso de forma regular e preventiva buscando a universalidade e a integralidade.

Condição de saúde bucal e utilização de serviços odontológicos entre idosos em área rural no sul do Brasil

Resumo Este artigo objetiva avaliar a saúde bucal, a utilização de serviços odontológicos e os fatores associados entre indivíduos com 60 anos, ou mais, residentes em área rural. Estudo transversal, de base populacional, realizado na zona rural de um município de porte médio do extremo sul do Brasil. O desfecho foi ter utilizado serviços odontológicos nos 12 meses anteriores à data da entrevista. A análise abrangeu descrição da amostra, prevalência da utilização de serviços odontológicos para cada categoria das variáveis independentes e análise multivariada através da Regressão de Poisson. Foram entrevistados 1.030 idosos, sendo 49,9% edêntulos totais e tendo 13,9% consultado com dentista no último ano. A probabilidade de consultar foi maior em idosos do sexo feminino, com companheiros(as), com maior escolaridade, pertencentes aos melhores níveis econômicos e que referiram ter algum problema de saúde bucal. Por sua vez, idosos que relataram ser ex-fumantes ou fumantes consultaram menos. Planejamentos em saúde devem ser reorganizados com o intuito de priorizar grupos populacionais com maiores dificuldades na utilização dos serviços odontológicos.

Tooth loss in adults: factors associated with the position and number of lost teeth

OBJECTIVE

To evaluate the factors associated with tooth loss in adults from the position and number of teeth lost in the dental arches.

METHODS

This is a cross-sectional, population-based study with adults participating in the epidemiological survey of oral health of São Paulo in 2015. The outcome of the study was tooth loss, assessed by the proposed classification, namely: I) lost up to 12 back teeth; II) lost up to 12 teeth (including front teeth); and III) lost more than 12 teeth. A four-block analysis was conducted, supported by a conceptual theoretical model adapted for tooth loss. For the multinomial logistic regression, "individuals who did not lose teeth due to caries or periodontal disease" was used as reference (p < 0.05).

RESULTS

Of 6,051 adults evaluated, 25.3% (n = 1,530) were classified in category I, 32.7% (n = 1,977) in II, 9.4% (n = 568) in III, and 1.9% (n = 117) were edentulous. Lower income and schooling, the perception of need for treatment and the last appointment motivated by routine, pain or extraction were associated with tooth loss, regardless of the classification. The negative evaluation of the dental service was associated with individuals who lost up to 12 teeth, both front and back. The presence of women and periodontal pocket were associated with tooth loss of up to 12 teeth, including front, and more than 12 teeth. Caries were associated with adults who lost up to 12 teeth, including front teeth.

CONCLUSION

The proposed classification allowed the identification of differences between the associated factors. Thus, the need to consider such classification in future studies is evident.

Periodontal disease: Repercussions in pregnant woman and newborn health-A cohort study

The periodontal disease during pregnancy triggers an exacerbated immune response with high local and systemic concentrations of inflammatory markers.

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

Resumo A reabilitação protética foi prevista pela política nacional de saúde bucal em função da alta prevalência de perda de todos os dentes e do baixo uso de prótese dentária entre idosos. Há necessidade de se avaliar o impacto dessa política de reabilitação. Portanto, objetivou-se investigar se o tipo de serviço odontológico utilizado foi um dos fatores associados ao uso de prótese dentária total entre idosos. Trata-se de um estudo transversal conduzido em uma amostra probabilística de idosos (60 anos ou mais) residentes na zona urbana de um município brasileiro de pequeno porte populacional por examinadores calibrados. Realizaram-se análises descritiva, bivariada e múltipla (Regressão logística - odds ratio - OR). Participaram 287 idosos, destes, 186 (64,8%) faziam uso de prótese dentária total. O uso de prótese dentária total foi associado a maiores chances de uso de serviços odontológicos supletivos ou particulares (OR = 4,19; p < 0,001) e a presença de lesão no palato (OR = 7,52; p = 0,002) e, também, a menores chances em idades maiores ou iguais a 73 anos (OR = 0,52; p = 0,023) e entre os com comprometimento na dimensão incapacidade física do OHIP-14 (OR = 0,20; p = 0,002). O uso de prótese dentária total foi associado ao tipo de serviço odontológico entre idosos, sendo maior o uso entre usuários dos serviços supletivos ou particulares.

Risk factors for tooth loss in adults: A population-based prospective cohort study

The aim of this study was to identify the risk factors for tooth loss in an extended age group of adults over 4 years. The prospective cohort study assessed adults (20–64 years old) in 2011 and 2015, from Piracicaba, São Paulo, Brazil. The sample selection was planned based on the adult population in the city. The inclusion criteria were randomly selected residences per census tract unit (one adult per household). The exclusion criteria comprised of a physical or psychological state that prevented the achievement of clinical procedures or understanding of the questionnaire. The home oral examination was performed using the index of decayed, missing, and filled teeth (DMFT), the Community Periodontal Index according to the World Health Organization, and visible biofilm. Demographic and socio-economic data, information on health habits, and the use of dental services were obtained by questionnaire. The outcome was a presence incidence of tooth loss, assessed by the difference between Missing teeth (M>0) from DMFT in 2011 and that in 2015. The conceptual theoretical model ‘Ethnicity, aging and oral health outcomes’ was adapted for tooth loss and used in a Hierarchical multivariate Poisson Regression analysis (p<0.20). The reference category for the Poisson regression were individuals who had no missing teeth (M) due to caries or periodontal disease (p<0.05). There were a total of 143 (follow-up rate = 57.7%) participants in the four-year study, and there was incidence of tooth loss in 51 (35.7%) adults over this period. The risk factors for tooth loss were reason for seeking dental services by pain (RR = 2.72; 95.0% CI: 1.04–7.37), previous tooth loss (RR = 3.01; 95.0% CI: 1.18–7.73) and decayed teeth (RR = 2.87; 95.0% CI: 1.22–6.73). The risk factors for tooth loss were: reason for seeking dental services by pain, previous tooth loss and dental caries.

Is there a fair distribution of the structure of dental services in the capitals of the Brazilian Federative Units?

Background

Brazilian Primary Care Facilities (PCF) provide primary care and must offer dental services for diagnosis, prevention, and treatment of diseases. According to a logic of promoting equity, PCF should be better structured in less developed places and with higher need for oral health services.

Objective

To analyze the structure of dental caries services in the capitals of the Brazilian Federative Units and identify whether socioeconomic factors and caries (need) are predictors of the oral health services structure.

Methods

This is an ecological study with variables retrieved from different secondary databases, clustered for the level of the federative capitals. Descriptive thematic maps were prepared, and structural equations were analyzed to identify oral health service structure’s predictors (Alpha = 5%). Four models with different outcomes related to dental caries treatment were tested: 1) % of PCF with a fully equipped office; 2) % of PCF with sufficient instruments, and 3) % of PCF with sufficient supplies; 4) % of PCF with total structure.

Results

21.6% of the PCF of the Brazilian capitals had a fully equipped office; 46.9% had sufficient instruments, and 30.0% had sufficient supplies for caries prevention and treatment. The four models evidenced proper fit indexes. A correlation between socioeconomic factors and the structure of oral health services was only noted in model 3. The worse the socioeconomic conditions, the lower the availability of dental supplies (standard factor loading: 0.92, P = 0.012). Estimates of total, direct and indirect effects showed that dental caries experience observed in the Brazilian population by SB-Brasil in 2010 did not affect the outcomes investigated.

Conclusion

Material resources are not equitably distributed according to the socioeconomic conditions and oral health needs of the population of the Brazilian capitals, thus contributing to persistent oral health inequities in the country.

Saúde bucal de idosos com 80 anos ou mais: condição, autopercepção e utilização de serviços odontológicos

Resumo Introdução Idosos mais velhos têm saúde bucal precária, procuram pouco os serviços odontológicos e apresentam autopercepção sobre saúde bucal discordante das necessidades de tratamento. Objetivo Comparar a condição e autopercepção de saúde bucal e padrão de utilização de serviços odontológicos de idosos com 80 anos ou mais de um município do sul brasileiro. Método Estudo descritivo com 59 idosos, em 2011 e 2015, no município de Antônio Carlos, Santa Catarina. Foram coletados dados demográficos, uso dos serviços, Oral Health Impact Profile – 14 item, hábitos e algumas condições bucais. Resultado Em ambos os anos, constatou-se mais de 70% de idosos necessitando de prótese total superior, embora mais de 80% se apresentassem satisfeitos com dentes/próteses. Mais de 60% relataram que haviam consultado o dentista há mais de 3 anos. Houve aumento significativo da necessidade de prótese total inferior, boca seca, placa, desconforto para comer; diminuição de consulta odontológica de rotina e extração dentária. Conclusão Embora tenha havido diminuição das extrações, no período, os idosos mantiveram necessidade de prótese e relataram problemas para comer. Tais resultados reafirmam a importância da inclusão do idoso com 80 anos ou mais na rede de serviços de saúde bucal.

Factors associated with public dental service use by adults in the state of São Paulo, Brazil, 2016

The aim of this study was to investigate the factors associated with public dental care use by adults in the State of São Paulo, Brazil. A cross-sectional study was conducted with a representative sample of adults aged 35 to 44 years using data from the 2015 Epidemiological Survey of the Oral Health Status of the Population of the State of São Paulo (SBSP-2015). Multivariate logistic regression was performed using variables based on a model proposed by Andersen for predicting access to public dental services. Results: 3,421 (59.9%) adults visited private services and 2,288 (40.1%) visited public services. Prevalence of the use of public dental services was greatest among women (41.8%) and adults with a lower education level (50.2%). Being non-white (OR = 1.32, 95% CI: 1.16, 1.50), lower household income (OR = 2.37, 95% CI: 2.11, 2.65), having had toothache (OR = 1.60, 95% CI: 1.39, 1.83), and need for endodontic treatment (OR = 1.44, 95% CI: 1.12, 1.85) were associated with public dental service use. Predisposing, enabling, and need factors were associated with public dental care use.

[Lack of access to information on oral health problems among adults: an approach based on the theoretical model for literacy in health]

This study sought to investigate factors associated with the lack of access to information on oral health among adults. It is a cross-sectional study, carried out among 831 adults (35-44 years of age). The dependent variable was access to information on how to avoid oral problems, and the independent variables were gathered into subgroups according to the theoretical model for literacy in health. Binary logistic regression was carried out, and results were corrected by the design effect. It was observed that 37.5% had no access to information about dental problems. The lack of access was higher among adults who had lower per capita income, were dissatisfied with the dental services provided, did not use dental floss, had unsatisfactory physical control of the quality of life, and self-perceived their oral health as fair/poor/very poor. The likelihood of not having access to information about dental problems among those dissatisfied with the dental services used was 3.28 times higher than for those satisfied with the dental services used. Thus, decreased access to information was related to unfavorable conditions among adults. Health services should ensure appropriate information to their users in order to increase health literacy levels and improve satisfaction and equity.

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

Background

Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model.

Methods

Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes.

Results

Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics.

Conclusions

Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.

Validade da autopercepção da presença de cárie dentária como teste diagnóstico e fatores associados entre adultos

Resumo: Objetivou-se investigar a validade da autopercepção da presença da cárie dentária e fatores associados, mediante estudo com 795 adultos (35-44 anos). A variável dependente foi autopercepção da presença da cárie dentária, as independentes reunidas em blocos. Três modelos logísticos foram conduzidos: (1) todos os adultos; (2) adultos com lesões de cárie normativa; e (3) adultos sem tais lesões. A autopercepção da presença da cárie dentária apresentou sensibilidade de 77,7%, especificidade de 58%, acurácia de 65%, valor preditivo positivo de 52% e valor preditivo negativo de 81%. No Modelo 1, a autopercepção da presença da cárie dentária foi associada ao tempo de uso dos serviços odontológicos, acesso à informação, uso de fio dental, lesões normativas, percepção da necessidade de tratamento, dor, insatisfação com a saúde bucal e geral. No Modelo 2, a autopercepção da presença da cárie dentária foi associada ao tempo de uso dos serviços odontológicos, percepção da necessidade de tratamento e insatisfação com a saúde bucal e geral. No Modelo 3, autopercepção da presença da cárie dentária foi associada ao tempo de uso dos serviços odontológicos, acesso à informação, percepção da necessidade de tratamento, insatisfação com a saúde bucal e uso de fio dental. A autopercepção da presença da cárie dentária mostrou utilidade limitada como método de diagnóstico.

Basic income guarantee: a review of implications for oral health

OBJECTIVES

To: a) Familiarize readers with the concept of a basic income guarantee (BIG) and its different forms; b) Consider how BIG could improve oral health and decrease oral health disparities; c) Motivate readers to advocate for the evaluation of oral health outcomes in BIG experiments.

METHODS

Published articles and book chapters that have analyzed and reviewed data from past BIG pilot projects were examined for their findings on health and socioeconomic outcomes.

RESULTS

Our findings suggest various areas and mechanisms whereby BIG can influence oral health-related outcomes, whether through impacts on work, illness and injury, education, a social multiplier effect, expenditure behavior, and/or mental illness and other health outcomes.

CONCLUSION

Our findings illustrate the importance of assessing oral health-related outcomes in future BIG pilot projects.

Measuring socioeconomic inequalities in the use of dental care services among older adults in Brazil

OBJECTIVES

The primary objectives are to assess socioeconomic inequality in the use of dental care among older Brazilian adults and to analyse the extent to which certain determinants contribute to that inequality.

METHODS

A cross-sectional study using data from the National Oral Health Survey conducted in 2010. All individuals answered a structured questionnaire containing questions on their use of dental care and socioeconomic conditions and underwent a clinical oral examination by a dentist. Concentration indices were decomposed to determine the contribution of socioeconomic factors to inequalities.

RESULTS

Being in the fifth wealth, quintile was associated with higher odds of having recently visited a dentist (reference: 1st quintile, odds-ratio (OR) 2.26, 95% confidence interval (CI) 1.51-3.38). In addition, being in the top two quintiles of wealth was negatively associated with the use of public dental services. Having eight or more years of schooling was associated with higher odds of both having a recent dental visit and receiving preventive care (relative to having 0-3 years of education), and negatively associated with using public dental services. Results indicate pro-rich inequalities in recent dental visits and preventive dental care. Further, there was a pro-poor inequality in the use of public dental care services.

CONCLUSIONS

The recent use of dental care and the use of preventive care are disproportionately concentrated among wealthier older adults, whereas the use of public services is more common among poorer individuals. Wealth inequalities in dental care use were mainly explained by socioeconomic factors, such as wealth and education, rather than oral health factors, such as needing treatment or a dental prosthesis.

Incidence of Tooth Loss in Adults: A 4-Year Population-Based Prospective Cohort Study

Objective

To verify the incidence of tooth loss in extended age group of adults in 4 years.

Materials and Methods

The prospective cohort study assessed adults (20–64 years old) between 2011 and 2015, from Piracicaba, São Paulo, Brazil. The dependent variable was cumulative incidence of tooth loss, assessed by difference between missing teeth (M) of decayed, missing, and filled tooth index (DMFT) in 2011 and 2015. Participants were stratified into young (20–44 years old) and older (45–64 years old) adults. Mann–Whitney U test (p < 0.05) was used to compare the means of incidence of tooth loss between age groups.

Results

After four years, 57.7% (n = 143) of adults were followed up and the mean incidence of tooth loss was 0.91 (SD = 1.65); among these, 51 adults (35.7%) who lost their teeth showed mean tooth loss of 2.55 (SD = 1.86). In older adults, incidence of tooth loss was higher (p = 0.008), but no difference between age groups was found when only adults with incidence of tooth loss were assessed (p = 0.844).

Conclusion

There was higher incidence of tooth loss in older adults after four years, however, without difference between age groups when only those who lost teeth were evaluated.

Equidade no uso de serviços odontológicos provenientes do SUS entre idosos: estudo de base populacional

Resumo Propõe-se caracterizar os idosos usuários de serviços odontológicos ofertados pelo Sistema Único de Saúde, considerando o princípio da equidade. Trata-se de um estudo transversal analítico com modelagem hierarquizada, conduzido a partir de uma amostra probabilística, complexa, por conglomerados de idosos (65-74 anos) residentes em um município brasileiro de grande porte populacional. Foram incluídas variáveis independentes referentes a: características sociodemográficas, acesso a informações em saúde, comportamentos/sistema de atenção à saúde e desfechos em saúde. Realizou-se análises descritivas, bivariadas e múltiplas hierarquizadas. Dos 480 idosos incluídos, 138 (31,2%) utilizaram serviços odontológicos provenientes do SUS. O uso desses serviços foi maior à medida que diminuíam a renda per capita e a escolaridade dos idosos, menor entre os que não haviam realizado o autoexame da boca e maior entre os que usavam os serviços odontológicos para procedimentos que não fossem rotina. Além disso, verificou-se que utilizaram mais o SUS pessoas que tiveram o relacionamento afetado pela saúde bucal e uma autopercepção negativa da sua aparência. Conclui-se que o uso dos serviços odontológicos no SUS foi predominante entre os idosos que vivem sob condições de vulnerabilidade.

Intermunicipal inequities in access and use of secondary health services in the metropolitan area of Curitiba

The aim of this study was to identify and analyze inequities in the access to specialized services in the municipalities of the metropolitan area of Curitiba, Paraná, Brazil. This is an ecological study. In its preparatory stage, this study focused on the socioeconomic, epidemiologic, healthcare network and sectoral financing network profiles of the 26 municipalities comprising this area. Factor analysis was employed to obtain the six principal components, and a synthetic index was calculated from them, allowing municipalities to be ranked according to living conditions and health situation. Primary data was collected from 24 municipalities, regarding their capacity, directed and repressed demand of specialized healthcare services. The context analysis revealed accentuated intermunicipal inequities. The synthetic index allowed municipalities to be classified in four relatively homogeneous groups regarding living and health conditions. Municipalities located in Vale do Ribeira obtained the worse outcomes for the Living Conditions and Health Situation Synthetic Index, as well as the higher repressed demand for specialized healthcare services. The geographical distance from the capital showed to contribute to worse living and health conditions and greater difficulties in access to healthcare services.

Changes in socioeconomic inequalities in the use of dental care following major healthcare reform in Chile, 2004-2009

The study examines changes in the distribution and socioeconomic inequalities of dental care utilization among adults after the major healthcare reform in Chile, 2004-2009. We evaluated the proportion of people who visited the dentist at least once in the previous two years, and the mean number of visits. These outcome variables were stratified by sex, age (20-39, 40-59, 60-63; ≥64 years), educational level (primary, secondary, higher), type of health insurance (public, private, uninsured), and socioeconomic status (quintiles of an asset-index). We also used the concentration index (CIndex) to assess the extent of socioeconomic inequalities in the use of dental care, stratified by age and sex as a proxy for dental care needs. The use of dental care significantly increased between 2004 and 2009, especially in those with public health insurance, with lower educational level and lower socioeconomic status. The CIndex for the total population significantly decreased both for the proportion who used dental care, and also the mean number of visits. Findings suggest that the use of dental care increased and socioeconomic-related inequalities in the utilization of dental care declined after a Major Health Reform, which included universal coverage for some dental cares in Chile. However, efforts to ameliorate these inequalities require an approach that moves beyond a sole focus on rectifying health coverage.

Acessibilidade a serviços de saúde bucal por pessoas idosas: uma revisão integrativa

OBJETIVO: Analisar as evidências científicas publicadas relacionadas à acessibilidade de pessoas idosas aos serviços de saúde bucal. METODOLOGIA: Utilizaram-se as bases de dados MEDLINE, LILACS e BBO, empregando como descritores: "idoso", "saúde bucal" e "acesso aos serviços de saúde". A busca ocorreu de forma online em pares, incluindo artigos originais na língua portuguesa, inglesa ou espanhola abordando o tema proposto, publicados no período de janeiro de 2005 a novembro de 2012. RESULTADOS: Mostram estudos em diversos países, os quais referem que a fonte regular de cuidados odontológicos é identificada como fator facilitador para a utilização recente dos serviços. Portanto, apontam a necessidade de ampliar o acesso da população idosa a ações e serviços de saúde bucal, associados principalmente a questões socioeconômicas e culturais. CONCLUSÃO: É fundamental garantir o acesso e motivar a procura pelo serviço entre idosos, esclarecendo à população a necessidade e a importância do uso de serviços odontológicos.

Estratégias para o enfrentamento do absenteísmo em consultas odontológicas nas Unidades de Saúde da Família de um município de grande porte: uma pesquisa-ação

O objetivo deste trabalho foi analisar os motivos das faltas às consultas odontológicas em Unidades de Saúde da Família (USF) e implementar estratégias para sua redução por meio da pesquisa-ação. O estudo foi realizado em 12 USF de Piracicaba/SP, de 01 de janeiro a 31 de dezembro de 2010. A amostra se consistiu de 385 usuários, entrevistados por telefone, sobre os motivos das faltas, além de 12 cirurgiões-dentistas e 12 enfermeiras. Realizaram-se duas oficinas com os profissionais: uma para problematização dos dados coletados nas entrevistas e elaboração de estratégias; e outra após 4 meses, para avaliação. O maior motivo de faltas foi a coincidência do horário de funcionamento das unidades com o de trabalho dos usuários. Dentre as estratégias ressaltou-se a realização de palestras sobre saúde bucal, educação permanente nas reuniões de equipe, capacitação dos Agentes Comunitários de Saúde, participação em grupos terapêuticos e parcerias entre Equipe de Saúde Bucal e equipamentos sociais da comunidade. A adoção de prontuário único foi a estratégia desafiadora encontrada pelos profissionais. Concluiu-se que as estratégias implementadas levaram à diminuição das faltas em 66,6% e o caráter motivador das oficinas possibilitou a reflexão crítica para o redirecionamento da prática em saúde.

Is the negative evaluation of dental services among the Brazilian elderly population associated with the type of service?

This study aimed at identifying the prevalence of the negative evaluation of dental services among elderly Brazilians and at investigating whether the prevalence was higher among those using public or philanthropic provider services than among those paying privately or using private health plans. Additionally, factors associated with this negative assessment were identified. Interview and survey data were collected in the residences of participants by trained and calibrated examiners as part of a national epidemiological survey of oral health conditions of the Brazilian population in 2002/2003. The dependent variable was obtained in response to questions regarding whether the participant had ever used dental services, the frequency of use, and the quality of this service. Potential responses to the questions regarding the quality of service were very poor or poor, fair, and good or very good. The main independent variable was the system of health care used with potential responses being health plan or private, public, and philanthropic services. We conducted univariate (linear tendency χ2 test) and multiple descriptive analyses, and the partial proportional Odds model for ordinal logistic regression. Among the elderly, 196 (3.7%) evaluated the provided services negatively (very poor or poor). Participants with the following responses were more likely to evaluate the services negatively: those who had used public or philanthropic services, men, those with higher education, the ones who had not received information about preventing dental problems, those who perceived pain in their teeth and gums in the last six months, and those who self-reported their oral health and speech was poor. In conclusion, elderly Brazilian users of public and philanthropic services were more likely than users of private or insurance-based plans to evaluate their dental services negatively, regardless of the other investigated variables.

Fatores associados à utilização dos serviços odontológicos por idosos brasileiros

OBJETIVO: Avaliar a associação entre a utilização recente de serviços odontológicos, fatores socioeconômicos e condições de saúde bucal entre idosos no Brasil. MÉTODOS: A amostra foi composta pelos indivíduos de 65-74 anos (n = 6.702) que participaram da Pesquisa Nacional de Saúde Bucal em 2010 (SBBrasil 2010). A variável dependente foi a utilização recente de serviços odontológicos (última consulta há dois anos ou menos). As variáveis independentes foram: fatores sociodemográficos, medidas clínicas de saúde bucal e medida subjetiva de saúde bucal. A análise estatística foi feita por meio da descrição das medidas de frequência, análise bivariada e múltipla utilizando-se regressão de Poisson. RESULTADOS: Observou-se que 46,5% dos idosos foram ao dentista há dois anos ou menos. A partir da análise múltipla observou-se que a escolaridade, a renda e a macrorregião foram independentemente associadas ao desfecho. Indivíduos com zero a 20 dentes e necessidade de prótese apresentaram menor prevalência de consulta odontológica recente. Maiores prevalências de consulta recente foram observadas entre os indivíduos com necessidade de tratamento odontológico e usuários de prótese. CONCLUSÕES: A utilização recente de serviços odontológicos foi associada a fatores socioeconômicos (escolaridade, renda e macrorregião do País) e a medidas clínicas de saúde bucal (número de dentes, uso e necessidade de prótese e necessidade de tratamento).

Men's health: a population-based study on social inequalities

This study evaluates social inequalities in health according to level of schooling in the male population. This was a cross-sectional, population-based study with a sample of 449 men ranging from 20 to 59 years of age and living in Campinas, São Paulo State, Brazil. The chi-square test was used to verify associations, and a Poisson regression model was used to estimate crude and adjusted prevalence ratios. Men with less schooling showed higher rates of alcohol consumption and dependence, smoking, sedentary lifestyle during leisure time, and less healthy eating habits, in addition to higher prevalence of bad or very bad self-rated health, at least one chronic disease, hypertension, and other health problems. No differences were detected between the two schooling strata in terms of use of health services, except for dental services. The findings point to social inequality in health-related behaviors and in some health status indicators. However, possible equity was observed in the use of nearly all types of health services.

Reduction of social inequalities in utilization of dental care in Brazil from 1998 to 2008

OBJECTIVE

To analyze access to and utilization of dental care services in Brazil.

METHODS

We used data from the 2003 and 2008 Brazilian National Household Surveys, which we compared to data from the 1998 survey. We investigated access and utilization variables at ages three, six, nine, 12, 15, and 19 years in the first (Q1) and fifth (Q5) quintiles of per capita family income. All analyses took into account the complex sampling strategy.

RESULTS

The proportion of subjects that had never seen a dentist decreased during the period (18.7% in 1998, 15.9% in 2003 and 11.7% in 2008). There was an important reduction in the absolute difference in failure to use dental care services after age nine years between Q1 and Q5 from 1998 to 2008, which decreased to about half its value at 15 (30.3 percentage points - pp to 16.1 pp) and 19 years (20.4 pp to 9.9 pp). Q5/Q1 ratios for recent dental appointments fell across all age groups, especially between zero and six years (Q5/Q1 from 3.2 to 2.6); utilization of the National Health Care System for dental care increased in Q1 and Q5, with a reduction in the Q1/Q5 ratio of approximately 20%. Use of the National Health Care System for dental care increased by approximately 8% in Q1 and 35% in Q5 between 2003 and 2008.

CONCLUSIONS

There have been considerable advances in terms of reducing inequalities in access to, and increasing the utilization of, dental care services in Brazil between 1998 and 2008. However, inequality between social groups remains substantial.

Toothaches in the daily lives of Brazilian adults

The aim of the present study was to estimate the prevalence of toothaches and to evaluate its effects on the daily lives of adults living in an industrialised region of southeastern Brazil. A questionnaire was administered to a sample of 744 individuals. The variables related to toothache were grouped into three components: access to dental service, pain severity, and social/functional impacts. The present study found that 68.0% of the subjects had limited access to oral health care, 39.7% presented high toothache severity, and 47.3% reported that toothache greatly affected their daily lives. Nervousness (87.2%) and chewing difficulty (72.6%) were the most commonly reported toothache-related effects. Through correspondence analysis, four groups with separate profiles for toothache and associated factors were identified. Two groups reported greater effects of toothaches in their daily lives. One group consisted of individuals who had less access to dental services (women and individuals who were multiracial, married, had a middle school education, or a low family income). The other group consisted of individuals who reported a high toothache severity and high degree of social/functional impacts (individuals who were 40 to 44 years old, married or widowed, black or multiracial, and had a middle school education). The other two groups were those whose daily lives were less affected by toothaches. One group consisted of individuals who had greater access to dental services (men and individuals who were divorced, had a college degree, or had incomes greater than R$ 300.01). The final group consisted of individuals who had low toothache severity and a low degree of associated social/functional impacts (individuals who were 35 to 39 years old, white, single, or had a high school education).

Uso regular de serviços odontológicos entre adultos e idosos em região vulnerável no sul do Brasil

OBJETIVO: Estimar a prevalência do uso regular de serviços odontológicos por adultos e idosos em comunidade vulnerável e identificar fatores associados. MÉTODOS: Estudo transversal de base populacional com 3.391 adultos e idosos de áreas de vulnerabilidade social de Porto Alegre, RS, de julho a dezembro de 2009. Foi utilizada amostragem sistemática com probabilidade proporcional ao tamanho de cada um dos 121 setores censitários. O desfecho "utilização regular de serviços odontológicos" foi definido consultar com o dentista regularmente, tendo ou não problemas de saúde bucal. Foi aplicado questionário padronizado, que incluiu variáveis demográficas, socioeconômicas, tipo de local procurado, autopercepção de saúde bucal e necessidades autopercebidas. Utilizou-se teste qui-quadrado para heterogeneidade na análise bivariada e na análise ajustada regressão de Poisson, com variância robusta e teste de heterogeneidade de Wald. RESULTADOS: A prevalência do uso regular de serviços odontológicos foi de 25,7%. A prevalência foi maior entre os indivíduos com escolaridade > 12 anos (RP 2,48 [IC95% 1,96;3,15]), mais ricos (RP: 1,95 [IC95% 1,03;1,53]), que utilizaram serviços privados de saúde (RP1,43 [IC95% 1,20;1,71]), com ótima autopercepção de saúde bucal (RP 4,44 [IC95% 3,07;6,42]) e autopercepção de necessidade de consultas para fins de revisão (RP 2,13 [IC95% 1,54;2,96]). CONCLUSÕES: Observam-se desigualdades na utilização regular de serviços odontológicos. Ações que contribuam para aumentar o conhecimento sobre a saúde bucal e melhoria do autocuidado, além de acesso a serviços odontológicos que visem à integralidade da atenção, podem contribuir para o aumento do uso regular dos serviços odontológicos.

Inequalities in access and utilization of dental services: a cross-sectional study in an area covered by the Family Health Strategy

This cross-sectional study aimed to investigate the presence of inequalities in the access and use of dental services for people living in the coverage area of the Family Health Strategy (FHS) in Ponta Grossa, Paraná State, Brazil, and to assess individual determinants related to them. The sample consisted of 747 individuals who answered a pre-tested questionnaire. Data analysis was performed by chi-square test and Poisson regression analysis, obtaining explanatory models for recent use and, by limiting the analysis to those who sought dental care, for effective access. Results showed that 41% of the sample had recent dental visits. The lowest visit rates were observed among preschoolers and elderly people. The subjects who most identified the FHS as a regular source of dental care were children. Besides age, better socioeconomic conditions and the presence of a regular source of dental care were positively associated to recent dental visits. We identified inequalities in use and access to dental care, reinforcing the need to promote incentives to improve access for underserved populations.

Desigualdades no acesso e na utilização de serviços odontológicos no Brasil: análise do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL 2009)

Pretendeu-se descrever o padrão de utilização, acesso e tipo de serviço odontológico utilizado por adultos e idosos das capitais brasileiras segundo características sociodemográficas. Foram utilizados dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) de 2009 (n = 54.367). Mais da metade da população revelou necessitar de tratamento odontológico no último ano e desta, 15,2% não conseguiram atendimento. O uso de serviço odontológico privado foi de 61,1%. A participação do Sistema Único de Saúde variou de 6,2% no Distrito Federal a 35,2% em Boa Vista. Análises multivariáveis de Poisson revelaram que as maiores prevalências de percepção de necessidades de tratamento ocorreram nas mulheres, nos adultos de meia idade e nos mais escolarizados. Falta de acesso aos serviços odontológicos foram mais prevalentes em mulheres, nos mais jovens, nos menos escolarizados e nos pardos. Os resultados deste estudo revelam a existência de marcantes iniquidades na utilização e acesso de serviços odontológicos nas capitais brasileiras.