Urgent dental care in the Brazilian public health system: learning lessons from the COVID-19 pandemic for future situations

Abstract

This ecological study described the effect of the COVID-19 pandemic and socioeconomic development on the use and profile of urgent dental care (UDC). UDC rates per 100,000 inhabitants before (from March to June 2019) and during (from March to June 2020) the COVID-19 pandemic in 4,062 Brazilian municipalities were compared. Data were collected from official sources. COVID-19 mortality and hospitalization rates were indicative of levels of lockdown and Human Development Index (HDI) indicated socioeconomic development. Multiple logistic regression and relative excess risk due to interaction (RERI) were used for statistical analyses. The Student t-test was used to compare changes in the profile of UDC causes and procedures in the two periods. Lower UDC rates were found in 69.1% of municipalities and were associated with higher HDI (OR = 1.20; 95%CI: 1.01; 1.42). Mortality had OR = 0.88 (95%CI: 0.73; 1.06) for municipalities with HDI < 0.70 and OR = 1.45 (95%CI: 1.07; 1.97) for municipalities with HDI > 0.70. RERI between HDI and COVID-19 was 0.13 (p < 0.05). Municipalities with greater primary health care coverage had a smaller reduction in emergency rates. Endodontic treatment and dental pain were the most frequent factors both before and during the pandemic. The percentage of UDCs due to pain and soft tissue damage, as well as temporary sealing and surgical procedures, increased. Socioeconomic variables affected UDC rates during the most restrictive period of the COVID-19 pandemic and should be considered in the planning of health actions in future emergencies.

Frequency, inequalities and spatial distribution of oral health services utilization in Peruvian children under twelve years of age: a population-based comparative analysis of the years 2017 and 2021

“…In 2021, the probability of oral health services utilization by Peruvian children under 12 years of age decreased by 45% compared to 2017. A similar trend of reduced oral health services utilization has been identified in some ecological studies, encompassing the majority of municipalities in Brazil as well [ 33 , 34 ]. This problem could be due to the fact that during the COVID-19 pandemic the World Health Organization issued a series of recommendations to reduce the application of aerosol-generating procedures in the context of oral health care as a measure to prevent the spread of the virus [ 35 ].…”

“…Nonetheless, we hypothesize that individuals with higher socioeconomic status may have sought oral health services less frequently for preventive or cosmetic purposes, while those with lower socioeconomic standing, who may have poorer overall health, may have sought dental care due to genuine emergencies or urgent needs more frequently. Indeed, another study conducted in Brazil, reported greater reductions in urgent dental care during the most stringent period of the pandemic in municipalities with higher human development indices compared to 2019 [ 34 ]. In the Peruvian context, the pandemic scenario could have created a temporary and deceptive reduction in inequalities in oral health services utilization.…”

Impact of COVID-19 pandemic on pediatric dental procedures in primary healthcare settings in Piracicaba, Brazil: an ecological study

“…In fact, comparing the months of March to June 2019 and 2020, municipalities with a higher Human Development Index and greater coverage of PHC presented a lower reduction in emergency appointments at this level of care [ 32 ]. Therefore, it can be considered that living conditions and service structuring in the study’s scenario may have helped children access emergency treatments.…”

The access carried out in oral health services post-COVID-19 pandemic: a temporal analysis of the SIA-SUS in Jaboatão dos Guararapes

“…Other care would be the responsibility of primary care. 23 In this way, primary care professionals-including family health units and basic health units-are responsible for providing emergency care in cases where there is a potential for the situation to worsen, but which do not pose a risk of death or where it may lead to the limitation of the individual's usual activities. 24 As such, the following are considered emergency care acute odontogenic pain; pericoronaritis or pain related to infectious processes involving the retained third molars; alveolitis; dental or periodontal abscesses or bacterial infection, resulting in localized pain and edema; dental fracture resulting in pain or trauma to oral soft tissues; cementation of crowns or fixed prostheses; biopsies; adjustments of orthoses and prostheses that are causing pain and compromising masticatory function; opening or changing intracanal medication; removal of extensive caries lesions/restorations that are causing pain; treatment of tissue necrosis with pain and presence of purulent secretion; mucositis; dental trauma with avulsion or luxation.…”

“…Extended elective services, on the other hand, are those which, if postponed, do not cause great harm to the user. 23 The federal council of dentistry (CFO) states that nonemergency dental procedures include the restoration of teeth, including the treatment of asymptomatic carious lesions, and dental procedures for aesthetic purposes. 26 Elective surgeries, tooth extraction and asymptomatic periodontal surgeries, implant dentistry, orthognathic surgeries and other surgeries that are not listed under urgencies and emergencies are procedures in which care can be scheduled without risk to the user's health.…”