A Framework for Equity Access to Primary Dental Care

Antunes, Denise Silveira; Naidoo, Sudeshni; Myburgh, Neil; Hilgert, Juliana Balbinot; Fisher, Paul Douglas; Hugo, Fernando Neves

doi:10.1590/1413-81232020259.29832018

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FREE THEMES • Ciênc. saúde coletiva 25 (9) • Sept 2020 • https://doi.org/10.1590/1413-81232020259.29832018 copy

A Framework for Equity Access to Primary Dental Care

Equidade de Acesso à Atenção Básica em Saúde Bucal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective of this study was to demonstrate face validity with a novel resource allocation framework designed to maximize equity into dental booking systems. The study was carried out in 2014. Eleven experts in primary dental care practice in Southern Brazil participated, using a three-round consensus group technique. First, the experts reached consensus on the items to be included in a 5-level diagnostic scale. They identified 21 clinical conditions and categorized them according to the oral health intervention required. Then, they described workload and activity standards for dental staff to carry out health promotion, oral disease prevention, dental treatment, dental rehabilitation, and urgent dental care. Finally, they agreed upon a set of wait times for primary dental care, establishing maximum waits from 2 to 365 days, according to the diagnostic classification. The framework demonstrated potential ability to promote more equitable access to primary dental services, since equal diagnostic classifications share the same waiting times for the dental care they require.

Key words
Health Equity; Health Resource Allocation; Oral health

Categorize clinical status of the dental quadrant	Rank	Intervention streams
Categorize clinical status of the dental quadrant	Rank	Health promotion	Disease prevention	Dental treatment	Oral rehabilitation	Dental Recall	Urgent Care
		Set maximum waiting times (in days)
Conditions requiring urgent care	5
Severe loss of hard tissue or severe dysfunction/disability or a condition preventing the commence/progress of a medical treatment	4
Moderate loss of dental hard tissue or moderate dysfunction/disability	3
Minimal loss of dental hard tissue or minimal dental dysfunction/disability	2
Healthy conditions	1

Rank	Description
5	1. Pain or discomfort of any intensity originating in the oral cavity, spontaneously reported by the examinee
5	2. Change in colour/shape of soft tissue, including trauma, bleeding, edema, etc.
4	3. Anterior cross bite should be registered in the upper quadrant of the affected side, only if the second permanent molar is absent
	4. Severe loss of hard dental tissue, involving more than half of a posterior tooth crown or reaching the contact surface of anterior tooth
	5. Intra or extra-oral fistula
	6. Severe dental mobility of a permanent tooth
	7. Residual tooth root
	8. Plaque retentive iatrogenic factors
	9. Retention of the homologous tooth, when the timing and/or sequence of tooth eruption is altered
	10. Need of tooth extraction for orthodontic reasons
3	11. Moderate loss of dental hard tissue, involving more than half of either the posterior tooth crown or the incisal edge of anterior tooth
	12. Provisional sealing
	13. Dental calculus (present in any amount)
	14. Moderate dental mobility of permanent tooth
	15. Anterior open bite in the deciduous dentition
2	16. Minimal loss dental hard tissue, involving only fissure area or small smooth surface, or reaching less than half of incisal edge of anterior teeth
	17. Mature dental plaque
	18. Emerged deciduous or permanent teeth in eruption process
1	19. Restored teeth
	20. Sound and fully erupted teeth; teeth with normal anatomical details resulted from controlled cavities, abduction, retraction, abrasion or fractures
	21. Perioral skin and oral mucosa with normal consistency, colour and keratinization pattern

Intervention stream	Dental staff	Workload components
Health promotion	Community Health Worker	home visit, education activity in the community or at homes, toothbrush training groups
Disease prevention	Dental Hygienist	fluoride therapy for school groups or community groups
Curative procedures	Dental Hygienist	home assistance, application of cariostatic agents, teeth scaling, cleanings and polishing (prophylaxis), application of dental sealants
Operative dentistry, Oral rehabilitation and Urgent care	Dentist	home visit for rehabilitation, tooth fillings, periodontal scaling and root planning, tooth extractions, restoration; pulpectomy, frenectomy, abscess drainage, pulpotomy, installation of dental prosthesis, shaping of dental prosthesis

Health personnel	Diagnostic rank	Time (min) for procedures per quadrant	Time (hours) for activities per group of people
Dentist	5	30	n/a
	4	60	n/a
	3	30	n/a
	2	15	n/a
	1	10	n/a
Dental Hygienist	4	n/a	2 (groups of 8)
	3	45	3 (groups of 10)
	2	n/a	4 (groups of 12)
Community Health Worker	1	n/a	2 (groups of 4)

Diagnostic rank	Health promotion	Disease prevention	Dental treatment	Oral Rehabilitation	Dental Check-up	Urgent Care
Diagnostic rank	CHW^a a Community Health Worker;	DHG^b b Dental Hygienist; n/a (not applicable).	DHG^b b Dental Hygienist; n/a (not applicable).	Dentist	Dentist	Dentist
5	n/a	n/a	n/a	n/a	n/a	2
4	n/a	2	n/a	60	n/a	n/a
3	2	60	120	180	n/a	n/a
2	30	90	180	365	n/a	n/a
1	60	n/a	n/a	n/a	365	n/a

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

DS Antunes: conceptualization, original draft preparation, investigation, methodology, formal analysis and writing. S Naidoo: conceptualization, supervision, writing-reviewing and editing. NG Myburgh: conceptualization, supervision, writing-reviewing and editing. PD Fisher: supervision, data curation, writing-reviewing and editing. JB Hilgert: supervision, methodology, formal analysis, writing-reviewing and editing. FN Hugo: conceptualization, supervision, methodology, formal analysis, writing-reviewing and editing.