Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil

Soares, A.L.F.H.; Ribeiro, C.C.C.; Thomaz, E.B.A.F.; Queiroz, R.C.S.; Alves, C.M.C.; Ferraro, A.A.; Silva, A.A.M.; Bettiol, H.; Barbieri, M.A.; Saraiva, M.C.P.

doi:10.1590/1414-431X202010161

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Medical and Biological Research

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Research Article • Braz. J. Med. Biol. Res. 54 (1) • 2021 • https://doi.org/10.1590/1414-431X202010161 copy

Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

The objective of this study was to describe the timing of the first dental visit and investigate the association of socioeconomic and behavioral factors with dental visit delay among 10/11-year-old children from two live-birth population cohorts with extremely contrasting socioeconomic profiles. Follow-up data (2004-2005) from cohorts of Ribeirão Preto (RP) (n=790) and São Luís (SL) (n=673) were evaluated. Delay in dental visit was defined as not visiting a dentist before the age of 7. Covariates included family socioeconomic characteristics, mother-related health behavior, and child-related characteristics. Prevalence ratios with robust standard errors were estimated. In both cohorts, less than 5% of children had visited a dentist before the age of two and about 35% of them had not visited a dentist before the age of seven. Lower mother’s schooling and lack of private health insurance were associated with the delay in first dental visit for both cohorts. A small number of mother's prenatal care visits and being from a single-father family or a family without parents were only associated in the RP cohort, while having ≥4 siblings and lifetime dental pain were associated in the SL cohort. The association with dental pain probably reveals a preventive care-seeking behavior. Therefore, the percentage of delayed first dental visit of children was very high even among those with the most educated mothers. Further studies are necessary to analyze recent changes and underlying factors related to access to first dental visit after the implementation of the National Oral Health Policy in 2006.

First dental visit; Epidemiology; Children's oral health; Health service utilization; Cohort study

	Ribeirão Preto				São Luís
	Total	%^*	SE^†	P^‡	Total	%^*	SE^†	P^‡
Gender
Male	402	10.7	1.7	0.3642	348	18.0	2.2	0.2954
Female	388	8.6	1.5		325	21.4	2.4
Skin Color^§
White	455	10.7	1.6	0.2854	158	23.6	3.5	0.1804
Black/dark skin	335	8.3	1.6		513	18.3	1.8
Family structure^§
Mother & father	545	9.2	1.3	0.5960	346	21.0	2.3	0.8151
Single mother	142	9.0	2.7		165	17.3	3.1
Mother & stepfather	63	9.2	4.1		60	17.6	4.9
Single father	20	28.8	11.2		33	23.7	7.8
Without parents	20	12.8	8.3		67	20.1	5.1
Oral health^§
Excellent	215	11.2	2.3	0.7385	60	25.4	5.8	0.4363
Good	305	9.1	1.8		174	17.1	3.0
Fair/poor	270	9.2	1.9		439	19.8	2.0
Lifetime dental pain^§
No	540	10.0	1.4	0.7154	292	21.6	2.5	0.2062
Yes	245	9.2	2.0		376	17.5	2.0
Mother's age
<20	131	12.0	3.1	0.5662	199	15.8	2.7	0.0786
20-35	563	8.9	1.3		442	20.2	2.0
≥35	94	11.5	3.5		32	36.8	9.1
Mother schooling^§
<Primary school	62	13.8	4.7	0.8538	42	28.5	7.3	0.2887
Primary school	283	10.2	1.9		181	15.5	2.8
Middle school	164	8.3	2.4		154	20.2	3.4
High school	194	8.8	2.3		266	18.2	2.5
Bachelor degree +	79	8.7	3.2		12	41.4	15.6
Prenatal care visits
0-3	215	11.2	2.3	0.7385	60	25.4	5.8	0.4363
4-5	305	9.1	1.8		174	17.1	3.0
≥6	270	9.2	1.9		439	19.8	2.0

	Ribeirão Preto			São Luís
	n	%^* (SE)^†	P^‡	n	% (SE)^†	P^‡
Mother's schooling
<Primary school	76	63.1 (5.9)		54	45.5 (6.9)
Primary school	251	41.9 (3.3)	<0.001	191	46.2 (3.7)	<0.001
Middle school	148	25.2 (3.8)		153	35.7 (4.0)
Secondary school	93	15.2 (4.0)		132	15.1 (3.1)
Bachelor's degree +	83	7.7 (3.2)		13	28.0 (12.1)
Household occupation
Non-manual worker	138	10.8 (2.8)	<0.001	71	24.1 (5.3)	0.0286
Skilled manual	265	35.9 (3.1)		153	31.2 (3.8)
Unskilled manual	309	42.9 (3.0)		316	39.1 (2.8)
Family structure
Mother & father	495	32.1 (2.2)		274	33.8 (2.9)
Single mother	131	32.4 (4.3)	0.0769	137	33.4 (4.1)	0.8684
Mother & stepfather	58	56.6 (7.0)		50	37.1 (6.9)
Single father	14	60.4 (14.1)		26	40.7 (6.7)
Without parents	17	61.2 (12.3)		54	38.7 (9.8)
Number of siblings
0	125	29.9 (4.4)		140	30.3 (4.0)
1	278	28.1 (2.8)	0.0075	212	28.5 (3.2)	0.0013
2	193	36.2 (3.7)		125	41.0 (4.5)
3	63	46.1 (6.7)		37	48.5 (8.4)
4+	56	51.4 (7.0)		29	65.4 (8.9)
Skin color
White	388	27.6 (2.4)	0.0004	120	33.9 (4.4)	0.0994
Non-white	324	41.2 (2.9)		421	35.5 (2.4)
Gender
Female	360	33.8 (2.7)	0.8365	287	39.3 (4.4)	0.0388
Male	355	34.7 (2.7)		256	30.6 (3.0)
Health insurance
Never	234	14.3 (2.5)	<0.001	33	10.2 (5.6)	<0.0001
One period	198	39.4 (3.6)		58	14.1 (4.6)
Continuous	282	46.2 (3.1)		275	39.4 (2.3)
Oral Health
Excellent/very good	191	26.4 (3.4)		45	22.4 (6.2)
Good	279	31.1 (2.9)	0.0014	145	33.9 (4.0)	0.0988
Fair/poor	245	43.2 (3.4)		353	37.4 (2.6)
Life-time dental pain
No	488	29.4 (2.2)	0.0007	354	40.5 (3.3)	0.0281
Yes	222	43.6 (3.5)		309	31.1 (2.7)
Prenatal care visits^§
6+	508	29.5 (2.1)	0.0002	273	31.1 (2.9)	0.0697
4-5	98	41.3 (5.4)		141	35.9 (4.1)
0-3	42	66.6 (7.9)		117	43.8 (4.7)
Mother's smoking
No	581	31.8 (2.1)	0.0122	508	35.3 (2.2)	0.0311
Yes	134	44.7 (4.6)		35	33.8 (8.3)

Factors	Ribeirão Preto			São Luís
	PR	95%CI^†	P^‡	PR	95%CI^†	P^‡
Predisposing factors
Mother's schooling
<Primary school	1.00			1.00		0.0019
Primary school	0.67	0.62-1.00	<0.0001	1.03	0.73-1.47
Middle school	0.43	0.36-0.82		0.92	0.61-1.37
Secondary school	0.29	0.23-0.88		0.39	0.23-0.68
Bachelor's degree +	0.20	0.35-0.85		0.71	0.24-2.10
Household occupation
Non-manual worker	1.00		0.0894	1.00		0.4020
Skilled manual	1.79	1.00-3.21		1.24	0.76-2.03
Unskilled manual	1.92	1.07-3.44		1.34	0.86-2.10
Family structure
Mother & father	1.00		0.0079	1.00		0.6501
Single mother	0.96	0.71-1.23		1.01	0.75-1.38
Mother & stepfather	1.22	0.85-1.77		1.04	0.71-1.53
Single father	1.47	0.86-2.51		1.38	0.90-2.12
Without parents	2.16	1.37-3.41		1.11	0.66-1.86
Number of siblings
0	1.00		0.5965	1.00		0.0057
1	1.24	0.88-1.75		0.93	0.64-1.34
2	1.25	0.88-1.78		1.31	0.90-1.94
3	1.44	0.91-2.27		1.39	0.87-2.22
4+	1.22	0.79-1.87		1.80	1.19-2.73
Gender
Female	1.00		0.5894	1.00		0.0846
Male	1.06	0.85-1.33		0.81	0.64-1.03
Skin color
White	1.00		0.2842	1.00		0.8633
Non-white	1.14	0.89-1.33		0.98	0.74-1.29
Enabling factor
Health insurance
Never	1.00		<0.0001	1.00		<0.0001
For some period	0.85	0.68-1.07		0.36	0.19-0.69
Continuously	0.52	0.21-0.45		0.26	0.09-0.76
Need factors
Oral Health
Excellent/very good	0.88	0.64-1.22	0.0025	0.67	0.37-1.22	0.2000
Good	1.00			1.00
Fair/poor	1.21	1.02-1.87		1.33	1.00-1.78
Life-time dental pain
No	1.00		0.0162	1.00		0.0013
Yes	1.37	1.03-1.69		0.67	0.52-0.85
Behavior factors
Prenatal care visits^§
6+	1.00		<0.0001	1.00		0.0487
4-5	1.38	1.03-1.55		1.16	0.87-1.54
0-3	2.18	1.66-2.87		1.42	1.09-1.87
Mother's smoking
No	1.00		0.0430	1.00		0.4855
Yes	1.31	1.01-1.69		0.82	0.46-1.44

Factors	Ribeirão Preto			São Luís
	PR	95%CI^†	P^‡	PR	95%CI^†	P^‡
Predisposing factors
Mother’s schooling^§
<Primary school	1.00			1.00		0.0264
Primary school	0.82	0.62-1.00	0.0135	1.09	0.74-1.63
Middle school	0.54	0.36-0.82		0.99	0.64-1.52
Secondary school	0.45	0.23-0.88		0.50	0.28-0.89
Bachelor’s degree +	0.35	0.35-0.85		1.07	0.36-3.16
Household occupation^§
Non-manual worker	1.00		0.2763	1.00		0.7849
Skilled manual	1.61	0.90-2.89		1.11	0.68-1.82
Unskilled manual	1.52	0.85-2.72		1.16	0.75-1.81
Family structure^§
Mother & father	1.00		0.0004	1.00		0.7401
Single mother	0.90	0.66-1.24		1.06	0.64-1.44
Mother & stepfather	1.01	0.66-1.53		0.96	0.86-2.07
Single father	1.77	1.12-2.79		1.33	0.64-1.98
Without parents	2.34	1.52-3.60		1.12	0.86-2.07
Number of siblings
0	1.00		0.7189	1.00		0.0227
1	1.24	0.86-1.78		0.93	0.65-1.33
2	1.22	0.85-1.77		1.28	0.87-1.88
3	1.20	0.71-2.04		1.42	0.89-2.07
4+	1.05	0.67-1.64		1.65	1.09-2.51
Gender
Female	1.00		0.2935	1.00		0.0886
Male	1.19	0.89-1.45		0.81	0.64-1.03
Skin color
White	1.0		0.2582	1.00		0.9846
Non-white	1.14	0.89-1.47		1.00	0.75-1.33
Enabling factor
Health insurance
Never	1.00		0.0391	1.00		0.0227
For some period	1.00	0.77-1.31		0.43	0.22-0.85
Continuously	0.52	0.32-0.84		0.34	0.12-0.98
Need factors
Oral health
Excellent/very good	1.34	0.96-1.86	0.1817	0.75	0.42-1.32	0.2909
Good	1.00			1.00
Fair/poor	1.21	0.91-1.60		1.14	0.85-1.52
Life-time dental pain
No	1.00		0.3761	1.00		0.0014
Yes	1.13	0.86-1.45		0.66	0.52-0.85
Behavior factors
Prenatal care visits^§
6+	1.00		0.0405	1.00		0.5391
4-5	0.91	0.65-1.27		0.90	0.68-1.19
0-3	1.45	1.05-2.00		1.07	0.81-1.41
Mother’s smoking
No	1.00		0.0528	1.00		0.9796
Yes	1.30	1.00-1.69		0.99	0.55-1.78

Associação Brasileira de Divulgação Científica Av. Bandeirantes, 3900, 14049-900 Ribeirão Preto SP Brazil, Tel. / Fax: +55 16 3315-9120 - Ribeirão Preto - SP - Brazil
E-mail: bjournal@terra.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: M.C.P. Saraiva: <mdsaraiv@umich.edu>