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

Abstract

BackgroundBrazilian 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.ObjectiveTo 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.MethodsThis 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.Results21.6% 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.ConclusionMaterial 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.

The global prevalence of early childhood caries: A systematic review with meta‐analysis using the WHO diagnostic criteria

“…54 During data extraction of individual papers, in common with other studies, 107 we could not identify any clear definitions of rurality/urbanity, so were unable to carry out a subgroup analysis to investigate caries prevalence differences related to rurality. Nevertheless, the variations within different countries (for example Brazil) are so wide, it could be speculated as being indicative of more structural causes, such as the distribution of dental services, 108 socio-economic, cultural, or geo-political. An alternative explanation that the variation is driven by methodological artefacts seems less likely to explain the large differences, especially as all studies used the WHO criteria in order to be eligible for the review, although these could contribute.…”

“…Nevertheless, the variations within different countries (for example Brazil) are so wide, it could be speculated as being indicative of more structural causes, such as the distribution of dental services, 108 socio‐economic, cultural, or geo‐political. An alternative explanation that the variation is driven by methodological artefacts seems less likely to explain the large differences, especially as all studies used the WHO criteria in order to be eligible for the review, although these could contribute.…”

Public oral health services performance in Brazil: Influence of the work process and service structure

“…The structure of the OHT was assessed based on the availability (code 1) or unavailability (code 0) of a set of equipment, instruments, and supplies considered necessary for clinical dental care. For analysis, a methodology adapted from Queiroz et al [16] was adopted, obtaining the sum of all available items for each aspect of the structure.…”

Oral Health of Rural Cameroonian Children: A Pilot Study in Bamendou

“…This may be explained by the numerous barriers that persist in developing countries that prevent any improvement of children’s oral health. Access to dental services and sometimes to appropriate oral hygiene products can be a challenge, often resulting from shortcomings of the national health system [ 8 ], particularly in rural and socially deprived urban areas [ 22 ], and, when available, financial barriers could jeopardize the affordability of these facilities [ 23 ]. The presence of disabilities or congenital deformities could also entail additional difficulties to achieve an appropriate level of oral health [ 24 ].…”