Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality?

Abstract

Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p≤0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly. Conclusions: No collaboration was observed between the Bolsa Família Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Família Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil.

The association of the Bolsa Familia Program with children’s oral health in Brazil

“…Further, Oliveira et al (2013) [ 28 ] in a study conducted in the South of Brazil (one of the richest regions of the country) showed that schoolchildren aged 8 to 12 years old who receive BF had worse oral health outcomes than their counterparts. Petrola et al (2016) [ 29 ], who investigated dental care and oral health promotion activities provided by FHT to children and caregivers enrolled in the BFP, identified that most dentists performed no systematic effort to promote oral health care to BFP children, and that, in general, family health professionals did not develop any oral health activities with these children. Nevertheless, the impact of BFP on children’s dental caries remains largely unknown.…”

Four-level evaluation of health promotion intervention for preventing early childhood caries: a randomized controlled trial

“…In an article by Tootooni et al (2015) the prevalence of ECC among children between 2 and 3 years old was reported to be very high, with 61.1% of samples displaying pitted caries [ 7 ]. Despite the improvement in dentistry practice, ECC still remains as remains a serious challenge for health care providers [ 8 ].…”

Early Childhood Caries Update

“…ECC still remains a serious challenge for health care providers, despite the improvement in dentistry practice and decline in the prevalence of dental caries [11]. The prevalence of ECC differs according to the examined groups' age, affected teeth, socioeconomic status, lifestyle, dietary pattern, oral hygiene practices, behavioral factors, race, culture, and ethnicity which differ from country to country [2].…”

“…Johnston T, Messer LB, classified ECC based on the pattern of ECC presentation. Lesions that are associated with developmental defects (pit and fissure defects and hypoplasia) are classified as Type I; smooth surface lesions (labial-lingual lesions, approximal molar lesions) are classified as Type II; rampant caries-having caries in 14 out of 20 primary teeth, including at least one mandibular incisor-are classified as Type III [2,[9][10][11]].…”