[Socioeconomic determinants of dental care during pregnancy in Cali, Colombia]

Factors related to orientation of search for dental care in high risk pregnancy

Abstract Objectives: to relate the search for dental care during pregnancy to sociodemographic, gestational and dental characteristics. Methods: quantitative approach study with cross-sectional design carried out with high-risk pregnant women, from January to May 2018. Statistical analysis was performed using Pearson's chi-square association test and Fisher's exact test, followed by logistic regression analysis and odds ratio calculation. Results: the final sample was composed of 190 pregnant women and the guidance for seeking dental care was significantly related to issues related to Prenatal Dental Care, regarding safety (p = 0.025), effective search (p < 0.0001) and the Unit Basic Health Care as a place of assistance (p = 0.0018). Pregnant women who did not receive search guidance are 19.6 more likely to not seek this service (p <0.001), when they seek it without guidance, they have 6.3 more chances to seek private services (p = 0.014) and when they do not receive guidance, they are 4.5 more likely to not feel secure in relation to this assistance (p = 0.005). Conclusion: the guidance and encouragement provided by the health team is paramount in pregnant woman's decision to seek assistance, especially in the context of Primary Health Care, and is characterized as a strategic tool in reducing insecurities related to dental treatment during pregnancy.

Satisfação das gestantes durante a consulta odontológica no Sistema Único de Saúde, Brasil

Objetivo O objetivo do trabalho foi verificar a taxa de gestantes satisfeitas com a consulta odontológica realizada no Sistema Único de Saúde (SUS-Brasil) e fatores associados. Metodologia O estudo foi do tipo transversal. Para coleta de dados foi elaborado um questionário abordando variáveis sociodemográficas e relacionadas a gestação. A coleta de dados foi realizada através de entrevistas face a face em um hospital maternidade da região metropolitana de Porto Alegre-RS-Brasil. O teste de qui-quadrado e a regressão de Poisson com variância robusta (p<0,05) foram utilizados nas análises bi e multivariada. Resultados Das 302 mulheres entrevistadas, 50%(n=151) realizaram consulta odon- tológica durante a gestação e destas, 86% (n=131) estavam satisfeitas com a consulta. Na análise multivariada verificou-se que a variável avaliação das consultas de pré-natal como boa aumentou em 14% [Razão de Prevalência (RP)=1,14; Intervalo de Confiança (IC) 95%:1,01-1,27] a probabilidade de as mulheres expressarem satisfação com a variável desfecho. Conclusão Conclui-se que foi alta taxa de satisfação com as consultas odontológicas realizadas no SUS pelas gestantes e avaliação das consultas de pré-natal como boa foi fator associado. Estes resultados poderiam ser considerados durante o planejamento estratégico, execução e avaliação das políticas de saúde direcionadas para este grupo operativo.

Inequalities in dental prenatal control in Colombia: An analysis based on the IV National Oral Health Study, 2013-2014

Introduction: Dental care is essential in guaranteeing the right to healthy motherhood. In Colombia, prenatal care policies incorporate the promotion, prevention, and care in oral health as part of the comprehensive care that pregnant women must receive within the health system. However, there is no systematic monitoring of compliance with these guidelines. Objective: To explore effective care and social inequalities in the provision and use of prenatal dental control in Colombia. Materials and methods: This was a descriptive study with data on pregnant women reported in the Fourth National Oral Health Study, 2013-2014. Absolute and relative social inequalities were estimated according to the area of residence, ethnicity, education level, health affiliation regime, and socioeconomic stratum. Results: We analyzed the data from 1,050 pregnant women. In total, 88.37% received prenatal control and 57.19%, dental control. We observed a general pattern of social gaps in the effective use of the latter, mainly due to the health insurance regime. The pregnant women with the greatest possibility of having some prenatal dental control, were those with some health insurance (prevalence ratio [RP]=2.62; CI 95%: 2.12-3.12), residents in urban areas (RP= 1,37; CI95%: 1.18-1.56), with higher and/or technical education level (RP=1.20; CI95%: 1.02-1.38) or from mid-high social strata (RP=1.15; CI95%: 1.01-1.29). Conclusions: In Colombia, the effective provision of dental control to pregnant women as part of comprehensive prenatal care continues to be a challenge. Significant efforts are required to comply with regulations and reduce social inequalities in access to this service.

The Interprofessional Role in Dental Caries Management: Ways Medical Providers Can Support Oral Health (Perspectives from a Physician)

Medical providers are important allies in the prevention of dental caries. Through raising the issue by asking about risks and strengths, offering anticipatory guidance and counseling, encouraging and following up on referrals, and applying preventive fluoride, medical providers can have a direct, positive impact on oral health. Further, improving communication with referrals, bidirectionally, benefits patient care as well as provider satisfaction. By collaborating on advocacy efforts, medical and dental providers can broaden their impact while building relationships, with the end goal of improved health for patients throughout their lifetime. Reintegrating the mouth into the body and oral health into systemic health has benefits for patients and providers alike, and can and should be accomplished in the medical home.

Relación de las mujeres en embarazo, parto y postparto (EPP) con los servicios de salud según la clase social

El objetivo de esta revisión narrativa de la literatura es comprender los aspectos teóricos y los antecedentes que dan cuenta de la relación de las mujeres en embarazo, parto y postparto con los servicios de salud, según la clase social. Esta relación se delimitará en los siguientes cuatros aspectos: clase social y mujeres, acceso que tienen las mujeres a los servicios de salud, prácticas de salud que se realizan en el proceso de atención institucional, y relaciones que tienen las mujeres con el personal de salud. En los resultados se encontraron las siguientes necesidades en salud pública: desarrollar modelos teóricos sobre el acceso a los servicios de salud basados en el derecho a la salud (comprendido este como un derecho fundamental), tener en cuenta aspectos relacionados con la calidad en la prestación de los servicios de salud y desarrollar investigaciones con posturas crítico-reflexivas relacionadas con los cuatro temas anteriormente descritos.

Barriers and facilitators to dental care during pregnancy: a systematic review and meta-synthesis of qualitative studies

Some barriers to dental treatment during pregnancy are poorly understood, especially those related to psychosocial factors, which are better explored in qualitative studies. The aim of this systematic review was to explore the barriers and facilitators to dental care during pregnancy through a thematic synthesis of qualitative studies. Qualitative or mixed-methods studies published in English, Portuguese, Spanish and French, from 2000 to 2016, were included. The search strategies were conducted in PubMed, Scopus, Web of Science, LILACS, BBO and CINAHL. To evaluate the quality of the studies, we used the Critical Appraisal Skills Programme tool. Thematic synthesis was performed in order to interpret and summarize the results. From 2,581 screened studies, ten were included in the synthesis. We found 14 analytical themes related to barriers and facilitators to dental care during pregnancy that interacted in complex ways: physiological conditions, low importance of oral health, negative stigma regarding dentistry, fear of/anxiety toward dental treatment, mobility and safety, financial barriers, employment, time constraints, social support, lack of information, health professionals' barriers, family and friends' advice, beliefs and myths about the safety of dental treatment. Myths and beliefs about oral health and dental treatment during pregnancy appear to be the most frequent barriers, both to pregnant women and to dentists or other health professionals. The findings of this review may support new studies, especially to test intervention protocols and to guide effective public policies for the promotion of oral health during pregnancy.

Determinants of Dental Care Attendance during Pregnancy: A Systematic Review

Despite the fact that dental care attendance during pregnancy has been recommended by guidelines and institutions, the demand for dental services is still low among pregnant women. The aim of this study was to identify and analyze the determinants of dental care attendance during pregnancy. We performed a systematic literature search in the electronic databases PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Library in Dentistry, Cumulative Index to Nursing and Allied Health Literature, and Medline using relevant keywords. Studies were filtered by publication year (2000-2016) and language (English, Portuguese, Spanish, and French). The included studies were assessed for quality. Their characteristics and statistically significant factors were reported. Fourteen papers were included in the review. The prevalence of dental service usage during pregnancy ranged from 16 to 83%. Demographic factors included women's age, marital status, parity, and nationality. The socioeconomic factors were income, educational level, and type of health insurance. Many psychological and behavioral factors played a role, including oral health practices, oral health and pregnancy beliefs, and health care maintenance. Referred symptoms of gingivitis, dental pain, or dental problems were perceived need. Demographic, socioeconomic, psychological, behavioral factors and perceived need were associated with the utilization of dental services during pregnancy. More well-designed studies with reliable outcomes are required to confirm the framework described in this review.

Aspectos relacionados con el número de citas odontológicas a las que asisten las mujeres embarazadas en Santander

Introducción. La salud bucal es más que recibir atención odontológica. Por eso, si la mujer embarazada registra patologías bucales, es fundamental atenderlas estas condiciones para evitar complicaciones en la mujer y su bebé.Objetivo. Describir el número de citas odontológicas a las que asisten las mujeres embarazadas en Santander según factores sociales, demográficos y patologías orales.Materiales y métodos. Estudio observacional descriptivo de corte transversal que involucró a 8 695 mujeres embarazadas. Se estableció una relación entre el número de consultas odontológicas a las que estas mujeres asistieron y variables demográficas, patologías orales, municipio, zona de residencia y vinculación al sistema atención en salud. Para ello, se aplicó prueba t de Student, test Rangos de Wilcoxón, ANOVA y test de Kruskal-Wallis dependiendo de la distribución de los datos y considerando un nivel de significancia de α≤0.01.Resultados. Se registraron bajos promedios de asistencia a la consulta odontológica en las embarazadas menores de 20 años y las mayores de 40, las que residen en municipios de bajo nivel económico, en zona rural y las atendidas en el régimen subsidiado o vinculadas.Conclusión. El número de citas odontológicas a las que asisten las mujeres embarazadas puede estar influido por las patologías que afectan a las mujeres y por factores sociales y demográficos.