Oral health indicators and sociodemographic factors in Brazil from 2008 to 2015

Abstract

OBJECTIVE: To evaluate the annual variation of oral health and primary care coverage, the tooth extraction ratio, and the average of supervised toothbrushing in Brazilian municipalities according to social development and population size. METHODS: Public secondary data were analyzed. The outcomes were health service indicators (oral health coverage, primary health care coverage, tooth extraction ratio, and average of supervised tooth brushing) estimated for all Brazilian municipalities annually from 2008 to 2015. Mixed-effect multilevel regression models with random intercept and slopes were fitted with a cross-interaction term to estimate the annual percent variation according to the Municipal Human Development Index (MHDI) and population size. RESULTS: Municipalities with low MHDI presented an annual increase in oral health and primary care coverage of 2.65% and 2.23%, respectively, which was significantly higher than municipalities with medium and high MHDI. Oral health and primary care coverage were 69.26% and 35.00% lower among municipalities with a large population. Municipalities with medium and high MHDI showed an annual decrease in tooth extractions of 5.15% and 5.02%, respectively. An annual decrease was observed in the average of supervised toothbrushing of 9.81% and 4.57% in municipalities with low and medium MHDI, respectively. The tooth extraction ratio was higher among larger municipalities; the relation is inverse for supervised toothbrushing. CONCLUSIONS: The access to primary care and oral health services increased in Brazil, while a decrease occurred in mutilating treatment and provision of preventive actions, with disparities among municipalities with different MHDI levels over time.

Teorização sobre os limites à inserção da saúde bucal na Estratégia Saúde da Família

“…Os municípios, proporcionalmente, têm maior gasto em saúde dentre as três esferas de governo 34 . O subfinanciamento crônico do SUS impacta na manutenção da oferta do cuidado em saúde onde se inclui a remuneração dos profissionais 4 , com diminuição significativa nas perspectivas de ampliação de serviços de saúde bucal no país 6,33,35 .…”

“…Com a PNSB 7 , a gestão da saúde bucal no município teve a oportunidade de obter incentivos financeiros para implementação e expansão dos serviços de saúde bucal 8,9,34 . Ao passo que muitos municípios brasileiros inseriram a saúde bucal na ESF com qualificação da atenção básica 9,10,16,34 , o município em estudo direcionou recursos para o fortalecimento e implementação dos CEO e consolidação das UOR, apesar de haver uma proposta oriunda do DSB, com apoio do CMS, para a inserção da saúde bucal na ESF.…”

Theorization about the limits to the inclusion of oral health teams in the Family Health Strategy

“…The municipalities, proportionally, have greater expenses within the three spheres of government 34 . The chronic under-funding of SUS impacts the maintenance of the providing of health care where dental professionals' salaries are included 4 , with a significant reduction in the perspectives of the expansion of oral health services throughout the country 6,33,35 .…”

“…With the PNSB 7 , the municipality's oral health management had the opportunity to obtain financial incentives to implement and expand their oral health services 8,9,34 . While many Brazilian munici-palities included oral health within the FHS with qualifications in basic care 9,10,16,34 , the municipality under study here allocated resources for the strengthening and implementation of DSCs and the consolidation of RDUs, even though there was a proposal from the OHD, backed by the MHC, for the inclusion of oral health within the FHS.…”