Performance of Primary Dental Care Services: An Ecological Study in a Large Brazilian City

Abstract

This study explored the association between area-level primary dental care performance and area-level demographics, dental treatment need, and health care service indicators. An ecological cross-sectional study was performed in Belo Horizonte, Brazil, in 2010. The 142 primary health care (PHC) units were grouped based on the following variables: access to individual dental treatment, frequency of dental emergencies, and frequency of individual preventive procedures. The independent variables analyzed were demographic variables, dental treatment need, and health care service indicators. The data were obtained from the information systems of the Brazilian Ministry of Health and the city of Belo Horizonte. We explored the associations between membership in a specific PHC cluster type and the independent variables using multinomial logistic regression with a significance level of 5%. Variables such as the high/very high vulnerability of population, rate of completed treatment, and rate of referrals of users to secondary care were independently associated with the clusters (P < 0.05). The performance of primary dental care services was associated with patient demographics, dental treatment need, and referrals. The results of this study have implications for the planning of public policies.

Dental emergency: scoping review

“…In DEC, the majority of those attended originated from the service’s coverage area (n=1), there is a higher chance of use by people from neighborhoods deemed as having greater social exclusion rate (n=1)[24] and rural residents accessed it less often (n=2)[16,25]. In the contextual analysis of the PHC, the group of services with the greatest ratio of dental emergency was not the one whose area was the most vulnerable to health (n=1)[26]. The health predispositions described the fear of going to the dentist (n=1)[20], depression (n=1)[20], allergies (n=2) 19,28 and systemic health conditions, with hypertension being the most frequent (n=1)[17].…”

“…Nevertheless, the monthly variation was high and, although there was a reduction in the total number of emergency visits, in the vast majority of the months studied, the target of less than 20% of the total number of appointments was not reached[27]. In the ecological study, the differences between the group of services with the highest ratio of emergency and preventive procedures could not be explained by the population coverage provided by the family health team and the ESB[26].…”

Regional differences in infection control conditions in a sample of primary health care services in Brazil

“…Without sufficient personal protective equipment, the oral health team might opt not to treat patients rather than to put clinicians at risk. These conditions may limit the access of patients to the already insufficiently accessible dental treatment in the Brazilian health system 29,30,31 , or put professionals and patients at biological risks 1,24 , if they treat patients without proper protection.…”

A Survey About Dental Instruments at the Primary Health Care in Brazil

“…The lack of instruments necessary for the clinical diagnosis of periodontal disease in more than half of the oral health services is troubling. One of the principles of PHC is first contact (18), and in this regard, oral health care in the SUS provides the first scheduled dental appointment, which defines the clinical diagnosis to perform a preventive and therapeutic treatment plan (19). The diagnosis and treatment of periodontal disease in PHC is therefore important, given the disease burden and its interrelationships with systemic conditions (20).…”

“…The regional differences identified in this study are similar to those found in other Brazilian oral health service evaluations (23) and likely reflect the social and economic diversity of the country. Previous studies have shown that social differences, including those identified at the municipal level, are key to the organization of oral health services and should be considered when formulating organizational strategies for these services (19).…”