Toothache and tooth extraction as reasons for dental visits: an analysis of the 2019 National Health Survey

Abstract: The aim of this study was to analyze the prevalence of dental visits due to toothache and tooth extraction in Brazil and its association with individual and contextual variables. This two-step cross-sectional study included persons aged 18 years and older in the 2019 National Health Survey who had visited a dentist in the 12 months prior to the interview (n = 40,369). The individual-level outcome was having a dental visit due to toothache or tooth extraction. The ecological-level outcome was the proportion of dental visits for these reasons relative to all dental visits by Brazilian state. Associations with individual - sociodemographic characteristics, number of teeth, and type of health service used - and ecological variables - HDI and dental service coverage - were assessed using Poisson regressions. The prevalence of dental visits due to toothache or extraction was higher among individuals with no formal education, household income < 25% of the minimum wage, of black and brown skin color, living in rural areas, who consulted in the public health system, with 10-19 and 1-9 teeth, and men. The proportion of dental visits due to toothache/extraction in Brazilian states was negatively associated with the HDI and the rate of dental emergency team/100,000 inhabitants and positively associated with primary dental care coverage. The prevalence of dental visits due to toothache/extraction was associated with individual and ecological characteristics, indicating inequities in reasons for dental visits in Brazil. The potential of a well-structured oral health care network to overcome these inequities is suggested and needs to be better explored.

Dental visits and depression mediating the association of socioeconomic status with oral health behaviors

Abstract Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the "Patient Health Questionnaire-9") and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.

Pathways of socioeconomic inequalities in self-perceived oral health

Abstract Although there is a large body of evidence of the influence of social determinants on oral health, information on the mechanisms by which these determinants operate is poorly documented. Therefore, we aimed to investigate the pathways through which socioeconomic inequalities may influence self-perceived oral health (SPOH) in Brazilian adults. This cross-sectional study used data from the National Health Survey (NHS) of 2019, with a representative sample of adults aged 18 to 59 years (n = 65,803). The outcome was SPOH, assessed by a global self-item. Structural equation modeling was used to test direct and indirect pathways connecting a latent variable for socioeconomic position (SEP) to SPOH via psychosocial, behavioral, and biological factors. Higher SEP was directly associated with better SPOH [standardized coefficient (SC) = 0.069; p < 0.01)] fewer depressive symptoms (SC = -0.059; p < 0.01), fewer missing teeth (SC = 0.131; p < 0.01), and more healthy behaviors (SC = 0.643; p < 0.01). Fewer depressive symptoms (SC = -0.141; p < 0.01), more healthy behaviors (SC = 0.242; p < 0.01), and fewer missing teeth (SC = 0.058; p < 0.01) were directly associated with good SPOH. Among specific indirect effects of SEP on SPOH, the behavioral pathway was the one that best explained this association (SC = 0.155). Socioeconomic inequities in SPOH are mediate by psychosocial, behavioral, and biological factors. This has implications for positioning health strategies in the social context in which people live, to facilitate healthy choices and promote good oral health.

Socioeconomic inequalities in the use of dental services in Brazil: an analysis of the 2019 National Health Survey / Desigualdades socioeconômicas no uso de serviços odontológicos no Brasil: uma análise da Pesquisa Nacional de Saúde de 2019

ABSTRACT: Objective: To describe the prevalence of use of dental services in Brazil according to states and the Federal District and its relationship with socioeconomic variables and types of services, based on the 2019 National Health Survey. Methods: This is a cross-sectional population-based study using data from the 2019 National Health Survey, which included 88,531 participants aged 18 or older. We assessed variables related to the use of dental health services according to sociodemographic and behavioral characteristics through multivariate analysis, using a Poisson regression model with robust variance. Results: The use of dental services in the year prior to the interview was higher among adults (53.2%, confidence interval — 95%CI 52.5-53.9) than older adults (34.3%, 95%CI 33.2-34.4). The multivariate analysis revealed that the use of dental services was greater in people with better schooling (prevalence ratio — PR=2.02, 95%CI 1.87-2.18) and higher income (PR=1.54, 95%CI 1.45-1.64). States from the Southeast, Midwest, and South regions presented the highest percentages of individuals who visited a dentist in the previous year — between 49.0 and 57.6% of the population. Conclusion: Inequalities were found in the use of dental health services among the adult and older adult population, with regional differences; the use was higher among women, younger individuals, those with better schooling, higher income, healthier behaviors, better self-perceived oral health status, and who paid for their last dental treatment.

RESUMO: Objetivo: Descrever a prevalência do uso de serviços odontológicos no Brasil segundo as Unidades Federadas, sua relação com variáveis socioeconômicas e tipos de serviços, com base na Pesquisa Nacional de Saúde de 2019. Métodos: Trata-se de um estudo transversal de base populacional com dados da PNS 2019, que incluiu 88.531 participantes de 18 anos ou mais. Foram analisadas variáveis referentes ao uso de serviços de saúde bucal, segundo características sociodemográficas e comportamentais, por meio de análise multivariada, utilizando modelo regressão de Poisson com variância robusta. Resultados: A utilização de serviços odontológicos no ano anterior à entrevista foi maior entre os adultos (53,2%, intervalo de confiança — IC95% 52,5-53,9) do que entre os idosos (34,3%, IC95% 33,2-34,4). Na análise multivariada, o uso de serviços odontológicos foi maior em pessoas com maior nível educacional (razão de prevalência — RP=2,02, IC95% 1,87-2,18) e maior renda (RP=1,54, IC95% 1,45-1,64). Os estados das regiões Sudeste, Centro-Oeste e Sul apresentaram as maiores porcentagens de indivíduos que consultaram um dentista no último ano, entre 49,0 e 57,6% da população. Conclusão: Desigualdades no uso dos serviços de saúde bucal foram observadas na população adulta e idosa, com diferenças entre as regiões do país; foi identificado maior uso entre mulheres, indivíduos mais jovens, escolarizados e de maior renda, entre a população com melhores comportamentos relacionados à sua saúde, melhor percepção do seu estado de saúde, e aqueles que pagaram pelo último atendimento odontológico.

Access to dental services and oral health-related quality of life in the context of primary health care

Abstract The aim of the present study was to evaluate the association between access to oral health care in the Primary Health Care (PHC) and Oral Health-Related Quality of Life (OHRQoL). The present study was a cross-sectional study, and the sample was composed of 412 users living in the areas covered by the public PHC services who visited a health unit for an oral exam or treatment in the last 24 months. Participants in the study responded to a home-based interview with questions that addressed socioeconomic status, behavioral, general health, dental prostheses, access to dental services in the PHC and their OHRQoL as measured by the Oral Health Impact Profile (OHIP-14) instrument. After the interview, a dental examination was performed to count the number of teeth. Chi-square tests, Student's t tests and multivariate analyses were performed using a hierarchical model and a Poisson regression with robust variance to evaluate the association between independent variables and OHRQoL. Access to oral health services in the PHC was statistically associated with OHRQoL, and the estimated prevalence rate was PR = 1.17 (CI 95% 1.00-1.37). In this study, the definition of access was based on the availability of dental consultations on demand. The study identified that lack of access to oral health services offered by the PHC was associated with a higher prevalence of impact on the quality of life of individuals.

Qualidade de vida relacionada à saúde bucal de usuários atendidos na Atenção Primária à Saúde de Porto Alegre / Quality of life related to oral health of users treated in Primary Health Care in Porto Alegre

Introdução: A Atenção Primária à Saúde (APS) é compreendida como coordenadora da rede assistencial da saúde e constitui a principal estratégia de organização da atenção à saúde. A qualidade de vida é uma importante medida de impacto em saúde, sendo um conceito amplamente utilizado nas pesquisas em saúde. Neste sentido, diversos estudos avaliaram a qualidade de vida relacionada à saúde bucal (QVRSB) em diferentes contextos, porém poucos estudos abordaram a relação da QVRSB com usuários que receberam cuidados de saúde bucal na APS. Objetivo: avaliar a QVRSB em usuários atendidos na APS de Porto Alegre/RS. Metodologia: trata-se de um estudo transversal de base em serviços. Foram entrevistados usuários residentes nas áreas cobertas pela rede pública de APS de quinze unidades de saúde de Porto Alegre. A amostra foi composta de 412 indivíduos, com idade mínima de 18 anos e que utilizaram a unidade de saúde para exame ou tratamento odontológico nos últimos 24 meses. Os usuários participantes do estudo responderam a uma entrevista realizada no domicílio com perguntas que abordavam questões socioeconômicas, demográficas, comportamentais, saúde geral, uso de prótese dentária, acesso aos serviços odontológicos na APS e o questionário Oral Health Impact Profile (OHIP-14). Após a entrevista, foi realizado exame bucal para contagem do número de dentes. Foram realizados testes quiquadrado, teste t-student e análise multivariada através de regressão de Poisson com variância robusta. Resultados: a maioria dos participantes era do sexo feminino (79,8%), com média de idade de 48,3 (±16,7) anos, cor/raça branca (59,7%), possuíam até 8 anos de ensino (61,4%), renda mensal menor ou igual a um salário mínimo (58,3%), relataram não ter atendimento no mesmo dia na sua unidade de saúde quando apresentavam algum problema na sua boca ou dentes (56,6%), não usavam prótese dentária superior (55,8%) nem inferior (80,8%) e tinham vinte dentes ou menos na boca (59,3%). Os participantes que faziam uso do tabaco e que relataram possuir alguma doença crônica representaram 25,5% e 37,9% da amostra, respectivamente. A variável acesso aos serviços de saúde bucal na APS foi estatisticamente associada ao desfecho impacto QVRSB após a análise do modelo ajustada e a razão de prevalência estimada foi de RP= 1,17, 95% IC (1,00-1,37). Conclusão: Este estudo permitiu conhecer a qualidade de vida relacionada à saúde bucal dos usuários atendidos nos serviços de saúde bucal da APS de Porto Alegre. Além disso, este estudo avaliou a relação entre acesso em saúde bucal na APS com a QVRSB. Evidenciou-se que na falta de acesso aos serviços de saúde bucal da APS houve maior chance de impacto na qualidade de vida.

Introduction: Primary Health Care (PHC) is therefore understood as the coordinator of the health care network and is the main strategy for the organization of health care. Quality of life is an important measure of health impact, being a concept widely used in health research. In this sense, several studies evaluated Oral Health-Related Quality of Life (OHRQOL) in different contexts, but few studies have addressed the relationship of OHRQOL in users attended at the PHC services. Objective: to evaluate the OHRQOL in users attended at the PHC services in Porto Alegre/RS. Methodology: Cross-sectional study. Users were interviewed in the areas covered by the PHC services of fifteen health units in Porto Alegre. The sample consisted of 412 individuals, with a minimum age of 18 years and who used the health unit for examination or dental treatment in the last 24 months. Data collection was performed through an interview and clinical examination at home visits. Users answered questionnaires with socio-demographic information, behavioral, general health, use of dental prostheses, access to dental services in PHC and the Oral Health Impact Profile (OHIP-14). After the interview, a dental examination was performed to count the number of teeth. We performed the chi-square test, t-student test and a multivariate analysis was carried out using the Poisson regression with robust variance. Results: Most of the participants were female (79,8%), with a mean age of 48,3 (±16,7) years, color/white race (59,7%), had up to 8 years of education (61,4%), monthly income less than or equal to a minimum wage (58,3%), reported not being able to attend the same day in the health service when they presented a problem in their mouth or teeth (56,6%), did not use upper dentures (55,8%) or lower dentures (80,8%) and had twenty teeth or less in the mouth (59,3%). Participants who used tobacco and who reported having a chronic illness were 25,5% and 37,9% of the sample, respectively. The variable access to oral health services in PHC was statistically associated with the OHRQOL impact after analysis of the adjusted model and the estimated prevalence rate was PR= 1,17, 95% CI (1,00-1,37). Conclusion: This study allowed us to know the Oral Health-Related Quality of Life of the individuals assisted in the oral health services of the PHC in Porto Alegre. In addition, this study evaluated the relationship between access to oral health in PHC and OHRQOL. It was evidenced that in the lack of access to the oral health services of PHC there was a greater chance of impact on quality of life.