Dental status and dental treatment demands in preschoolers from urban and underprivileged urban areas in Mendoza city, Argentina

ABSTRACT

The aim of this study was to establish the association between dental status and demand for dental care in preschoolers at urban and underprivileged urban schools in the city of Mendoza. Dental status was diagnosed in a purposive sample of preschoolers at urban schools (Group U n = 148) and underprivileged urban schools (Group UnU n = 155) in Greater Mendoza city, by determining the following indicators (a) caries-free children (%), and (b) dmft/DMFT and its discriminated components, including active non-cavitated enamel caries. The characteristics of demand for care were determined using an ad hoc structured questionnaire. The following were determined frequency distributions and confidence intervals for categorical variables, measures of central tendency and dispersion, tests for differences in means (Student's t test), association (chi squared) and correlation among variables (Pearson's r), at a significance level p<0.05. Comparison of dental status variables between groups showed significantly higher values in group UnU for d+D tooth (ẋ = 5.4} 3.8; t = 2.887; p = 0.004); dmft+DMFT (ẋ = 5.7}4.1; t = 0.466; p = 0.020); d+D surface (ẋ = 7.62} 6.2; t = 0.956; p = 0.014); f+F surface (ẋ = 0.12}4.5; t = 2.71; p = 0.007) and percentage of caries-free children (x2= 25.377; p= 0.018). The following trends were found in this group higher demand on the government subsystem, fewer visits to the dentist (x2 = 7.02, p = 0.008) and greater difficulty in getting appointments (x2 = 19.91, pẋ0.001). Frequency of visits was associated to the severity of dental status (x2 = 19.412; pẋ0.001), but no correlation was found between frequency of visits during the past year and dmft+DMFT (Pearson's r coefficient = 0.091; p = 0.0426) Group U showed preferential demand for the private or "obra social" (trade union managed health insurance) systems (x2 = 78.85 p = 0.00) and there was no statistically significant association between visits to the dentist and dmft+DMFT categories (x2 = 2.781; p = 0.427), although there was direct correlation between frequency of visits during the past year and dmft+DMFT (Pearson's r coefficient = 0.486, p = 0.000). Preschoolers at UnU schools had higher caries indicators than preschoolers at U schools. For UnU the demand for care was related to the severity of dental status and situations of urgency, while U preschoolers demanded dental care in both health and disease, with a tendency to greater adherence to treatment. Actions to promote oral health in preschoolers should take into account both internal and external barriers to access to and use of oral health services.

RESUMEN

El objetivo de este estudio fue establecer la asociacion existente entre el estado dentario y la demanda de atencion en alumnos de nivel inicial asistentes a escuelas del ambito urbano y urbano-marginal de la ciudad de Mendoza. Material y metodos: Sobre una muestra intencionada de alumnos/ as asistentes a cuatro escuelas de nivel inicial de ambito urbano (Grupo AU n=148) y de ambito urbano-marginal (Grupo AUM n=155) del Gran Mendoza, se realizo el diagnostico del estado dentario determinando los siguientes indicadores (a) ninos libres de caries (%), (b) ceod/CPOD y sus componentes discriminados, incluyendo caries adamantinas activas no cavitadas. Las caracteristicas de la demanda de atencion fueron establecidas mediante una encuesta estructurada ad hoc. Se establecieron distribuciones de frecuencias e intervalos de confianza para varaibles categoricas, medidas de tendencia central y dispersion, pruebas de diferencias de medias (t de Student), de asociacion (chi cuadrado) y de correlacion entre las variables (r de Pearson), con un nivel de significacion de p<0.05. Resultados: Al comparar las variables del estado dentario entre ambos grupos se encontraron valores significativamente mayores en el grupo AUM para c+C diente (ẋ=5,4} 3,8; t= 2,887; p=0,004); ceod+CEOD (ẋ=5,7} 4,1; t=0,466; p=0,020); c+C superficie (ẋ=7,62} 6,2; t=0,956; p= 0,014); o+O superficie (ẋ=0,12} 4,5; t=2,71; p=0,007) y porcentajes de ninos libres de caries (x2= 25,377; p= 0,018). En este grupo, se registraron las siguientes tendencias mayor demanda al subsistema estatal, menor asistencia a la consulta dental (x2=7.02, p= 0,008) y mayor dificultad para obtener turno (x2=19,91, pẋ0,001). La frecuencia de las consultas estuvo asociada con la gravedad del estado dentario (x2=19,412; pẋ0,001), pero no se registro correlacion entre la frecuencia de las consultas durante el ultimo ano y ceod+CPOD (coeficiente r de Pearson =0,091; p=0,0426) El grupo AU demando preferentemente en los subsistemas privado o de seguridad social (x2=78,85 p=0,00) y no existio asociacion estadisticamente significativa entre la concurrencia del nino a la consulta odontologica y las categorias de ceod+CPOD (x2=2,781; p=0,427), pero si correlacion directa entre la frecuencia de consulta durante el ultimo ano y el ceod+CPOD (coeficiente r de Pearson =0,486, p=0,000). Los preescolares asistentes a escuelas de AUM presentaron indicadores de caries mas elevados respecto a los encontrados en el grupo AU. La demanda de atencion para AUM se relaciono con la gravedad del estado dentario y con situaciones de urgencia. Los preescolares de AU demandaron atencion dental tanto en salud como en enfermedad, con tendencia a mayor adherencia al tratamiento. Las acciones tendientes a promover la salud bucal en los preescolares deberan tomar en cuenta tanto las barreras internas como las externas en el acceso y utilizacion de los servicios de salud bucal.