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

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 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.

Factors associated with utilisation of dental services by the elders from São Paulo, Brazil

BACKGROUND

Population ageing in Brazil is rapid and is likely to place additional pressure over the Brazilian public health system.

OBJECTIVE

This study aims to examine the factors associated with utilisation of dental services in the previous year among a representative sample of older adults from São Paulo, Brazil.

METHODS

The sample included 5951 older adults who participated in the SBSP-15 study, an epidemiological survey conducted in 2015 in the State of São Paulo, Brazil. The outcome "utilisation of dental services" was defined as having visited a dentist in the previous year. Chi-square tests were employed in the bivariate analyses and Poisson regressions with robust variance in the multilevel analysis.

RESULTS

Only 30.5% of the participants had their last dental appointment within the previous year. Number of teeth and dental pain presented the strongest effects on the investigated outcome. Education, income, age, ethnicity, living alone, higher Family Health Strategy coverage and the Metropolitan area were associated with having visited a dentist in the previous year. Older adults who rated their oral health as positive did not report treatment need nor prosthodontic need, presented negative oral health-related quality of life, had their last dental appointment in the public health system and sought treatment due to pain or extraction also were more likely to report the utilisation of dental services in the previous year.

CONCLUSION

Regional, sociodemographic and subjective factors are associated with utilisation of dental services in the previous year among the elders from the State of São Paulo, Brazil.

Regular use of dental services among university students in southern Brazil

OBJECTIVE

To verify the prevalence and factors associated with regular use of dental services in university students of the Universidade Federal de Pelotas (UFPel).

METHODS

This cross-sectional study interviewed 1,865 students aged 18 years or older, starting bachelor’s degrees in 2017, enrolled in the second academic semester of 2017 and in the first of 2018 in classroom courses at UFPel. We considered regular users those who reported regularly going to the dentist with or without perceived dental problems. To test factors associated with regular use of dental services, demographic, socioeconomic and oral health variables were collected. Statistical analyses were based on Poisson regression models.

RESULTS

The prevalence of regular use of dental services was 45.0% (95%CI 42.7–47.3). University students of high economic class (PR = 1.47; 95%CI 0.91–2.36), with last private dental appointment (PR = 1.29; 95%CI 1.03–1.61), positive self-perception of oral health (PR = 2.33; 95%CI 1.79–3.03) and no report of toothache in the last six months (PR = 1.22; 95%CI 1.03–1.45) showed higher prevalence of regular use of dental services.

CONCLUSION

The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life among these young adults.

Potential years of life lost due to oropharyngeal cancer in Brazil: 1979 to 2013

OBJECTIVE

To estimate the years of life lost by the Brazilian population due to mouth and pharynx cancer from 1979 to 2013, and analyze the temporal trends in the studied period, according to the country's region, sex and anatomical site.

METHODS

The death records were obtained from the Mortality Information System and the data referring to the population, from the censuses of the Brazilian Institute of Geography and Statistics of 1980, 1991, 2000, 2010, and from intercensal estimates for the other years. The rates of potential years of life lost were calculated by applying the method suggested by Romeder and McWhinnie, and their trends were calculated using the Prais-Winsten method with first-order autocorrelation. The historical series were smoothed with the centered moving average technique of third order for white noise reduction.

RESULTS

In the period from 1979 to 2013 in Brazil, there were a total of 107,506 premature deaths due to mouth and pharynx cancer, which generated a total of 1,589,501 potential years of life lost, the equivalent to a rate of 3.6 per 10,000 inhabitants. Males, whose rate was six times higher than for females, contributed with 85% of the years lost. The trends in the rates of years of life lost showed an annual 0.72% increase for men, 1.13% for women and 1.05% for pharynx cancer.

CONCLUSIONS

The rate of potential years of life lost due to mouth and pharynx cancer in the country showed an upward trend within the studied period for both sexes, as well as for pharynx cancer and for the North, Northeast and Midwest regions.

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.

Trend of oral and pharyngeal cancer mortality in Brazil in the period of 2002 to 2013

OBJECTIVE

To analyze the trend of oral and pharyngeal cancer mortality rates in the period of 2002 to 2013 in Brazil according to sex, anatomical site, and macroregion of the country.

METHODS

The mortality data were obtained from the Mortality Information System and the population data were obtained from the Brazilian Institute of Geography and Statistics. The trend of the rates standardized by sex and age was calculated using the Prais-Winsten estimation, and we obtained the annual percentage change and the respective 95% confidence intervals, analyzed according to sex, macroregion, and anatomical site.

RESULTS

The average coefficient of oral cancer mortality was 1.87 per 100,000 inhabitants and it remained stable during the study period. The coefficient of pharyngeal cancer mortality was 2.04 per 100,000 inhabitants and it presented an annual percentage change of -2.6%. Approximately eight in every 10 deaths occurred among men. There was an increase in the rates of oral cancer in the Northeast region (annual percentage change of 6.9%) and a decrease in the Southeast region (annual percentage change of -2.9%). Pharyngeal cancer mortality decreased in the Southeast and South regions with annual percentage change of -4.8% and -5.1% respectively. Cancer mortality for tonsil, other major salivary glands, hypopharynx, and other and unspecified parts of mouth and pharynx showed a decreasing trend while the other sites presented stability.

CONCLUSIONS

Pharyngeal cancer mortality decreased in the period of 2002 to 2013. Oral cancer increased only in the Northeast region. Mortality for tonsil cancer, other major salivary glands, hypopharynx, and other and ill-defined sites in the lip, oral cavity, and pharynx decreased.

Factores asociados a la utilización de servicios de salud odontológicos

Resumen El presente trabajo se propone analizar los factores asociados a la utilización de servicios de salud odontológicos (USSO) en individuos adultos de la Ciudad de Corrientes; Argentina. Se realizó un estudio transversal. A través de una encuesta domiciliaria se recolectó información de las variables de estudio. Se determinó el tamaño de la muestra estableciéndose un nivel de confianza del 95% (381 individuos). Se aplicó un diseño muestral aleatorio simple, que se complementó con un muestreo no probabilístico por cuotas. Se analizaron los datos con los programas SPSS 21.0. y Epidat 3.1. El nivel socioeconómico, la cobertura social odontológica, la percepción sobre la salud bucal, los conocimientos de salud bucal y los hábitos de higiene bucal se asociaron significativamente a la USSO en los últimos 12 meses. Los mismos factores, a excepción de la cobertura social odontológica y de los conocimientos de salud bucal, se asocian a la USSO por motivos de control/chequeo dental de rutina. Se deben implementar medidas tendientes a aumentar la USSO con fines de prevención en individuos de ambos sexos, de todos los niveles socioeconómicos, especialmente en aquellos menos favorecidos.

[The use of dental services on a regular basis in the population of Montes Claros in the State of Minas Gerais, Brazil]

The use of dental services on a regular basis by residents of Montes Claros (MG) was assessed, as well as related aspects. Cross-sectional study was conducted with a complex probabilistic sample by conglomerates. Logistic regression was used (OR/CI95%) with a significance level of 5. Of the 2582 study participants, 761 required and obtained access to the services for less than a year. Of these, 262 (35.8%) used the services in a regular/routine manner. The use of dental services on a regular basis was greatest among individuals in the age group "≥ 18 ≤ 37"; with schooling "equal to or greater than 9 years"; who classified their oral health, general health and appearance of teeth and gums as "excellent/good"; who reported no pain" on teeth and gums over the last six months; They reported that the "assistance provider had adequate skills"; that they "always/often" received information about oral hygiene and diet/nutrition. In addition, this use was lower among those who rated the time to ask questions about the dental problem or treatment as "regular/bad/terrible." The conclusion drawn is that the use of dental services on a regular basis was relatively low, being associated with personal traits, subjective health conditions and characteristics related to the services.

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.

Use of Public Oral Health Services by the Adult Population: A Multilevel Analysis

Background

It is important to assess context to explain inequalities in oral health, particularly with regard to the type of service used; thus, this study aimed to identify the social determinants of public dental service use by adults and to assess whether, beyond the level individual, existing inequalities are also expressed in the context in which individuals are embedded.

Methods

A multilevel analysis with three levels of aggregation of variables was performed. The individual variables were derived from the database of the SB Minas Gerais project—a survey of oral health status of the population of Minas Gerais, a state of the Brazilian Southeast region. The variable at the neighborhood level came from the Census of 2010. The variables at the municipal level were obtained from available public databases relating to oral health services. At the municipal level, the Human Development Index (HDI) variable was chosen to represent quality of life in the municipalities.

Results

In the final model, the following individual variables were associated with greater use of public dental services: lower income (PR = 1.98, 95% CI = 1.53; 2.58), higher number of residents at home (PR = 1.37, 95% CI = 1.11; 1.68) and higher number of teeth requiring treatment (PR = 1.49, 95% CI = 1.20; 1.84). With regard to context variables, a poorer infrastructure (PR = 0.62, 95% CI = 0.40; 0.96) leads to a lower use of public services.

Conclusion

The use of public services is associated with family income, how this income is divided in households, the need for treatment presented by the individual and the organization of the existing oral health service infrastructure in the municipality.

Access to information on how to avoid oral health problems among elderly persons registered with the Family Health Strategy

Objectives : To identify the level of access to information regarding how to prevent oral health problems among the elderly, and verify if such levels were higher among members of households registered with the Family Health Strategy Program. Methods : An analytic cross-sectional study was conducted of a probabilistic complex sample of elderly (65-74 years old) members of the population of a large city. The level of access was estimated with adjustment for the design effect, as well as the magnitudes of association. Descriptive, bivariate and logistic regression (OR/CI95%) analysis was performed. Variables related to personal determinants, health services, health-related behavior and health outcomes were considered. Results : Of the 490 participants, 53.4% reported they had access to information about how to prevent oral health problems. This access was higher among elderly persons living in a household registered with the Family Health Strategy Program (2.04/1.14-3.67), and who had at least five years of schooling (2.53/1.67-3.83), regularly used dental services (1.84/1.07-3.17), did not smoke either now or in the past (1.79/1.13-2.82), did not suffer from chronic diseases (2.14/1.34-3.42) and had not suffered social impacts because of their oral health conditions (1.77/1.08-2.91). Conclusion : Most of the elderly persons had access to information about how to prevent oral health problems, with such access being greater among those registered with the Family Health Strategy Program.

Comparing adult users of public and private dental services in the state of Minas Gerais, Brazil

BACKGROUND

Studying the factors associated with the use of dental services can provide the necessary knowledge to understand the reasons why individuals seek out public healthcare services and the formulation of more appropriate public policies for the present-day reality.

METHODS

This work was a cross-sectional epidemiological study consisting of a sample of adults found in a research databank concerning the conditions of the oral health of the population of the state of Minas Gerais, Brazil. This study examined both main oral health disorders and relevant socioeconomic aspects. The dependent variable was defined as the type of service used, categorized under public and private use. The independent variables were selected and grouped to be inserted in the analysis model according to an adaptation of the behavioral model described by Andersen and Davidson. A hierarchical model was used to analyze the data. The description of variables and bivariate analyses were performed in an attempt to verify possible associations. For each group of variables at each hierarchical level, the gross and adjusted odds ratios (OR) and the respective 95% confidence intervals (CI) were estimated by means of logistic regression. The Complex Samples model from the SPSS statistics program, version 19.0, was used to analyze the sample framework.

RESULTS

In the final model, the factors associated with the use of public healthcare services by adults were directly related to the socioeconomic and demographic conditions of the individuals, including: being of a dark-skinned black race/color, belonging to families with more than four household residents and with a lower income level, residing in small towns, having more teeth that need treatment.

CONCLUSIONS

According to the findings from this study, socioeconomic and demographic factors, as well as normative treatment needs, are associated with the use of public dental services.

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).