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Revista de Saúde Pública

Print version ISSN 0034-8910On-line version ISSN 1518-8787

Rev. Saúde Pública vol.54  São Paulo  2020  Epub Aug 21, 2020

https://doi.org/10.11606/s1518-8787.2020054001935 

Original Article

Regular use of dental services among university students in southern Brazil

Mariana Silveira EcheverriaI 
http://orcid.org/0000-0002-2045-4232

Alexandre Emidio Ribeiro SilvaII 
http://orcid.org/0000-0001-6402-0789

Bernardo Antônio AgostiniIII 
http://orcid.org/0000-0003-4480-1873

Helena Silveira SchuchII 
http://orcid.org/0000-0001-9932-9698

Flávio Fernando DemarcoI  II 
http://orcid.org/0000-0003-2276-491X

IUniversidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil

IIUniversidade Federal de Pelotas. Faculdade de Odontologia. Programa de Pós-Graduação em Odontologia. Pelotas, RS, Brasil

IIIIMED. Faculdade de Odontologia. Passo Fundo, RS, Brasil


ABSTRACT

OBJECTIVE

To verify the prevalence and factors associated with regular use of dental services in university students of the Universidade Federal de Pelotas (UFPel).

METHODS

This cross-sectional study interviewed 1,865 students aged 18 years or older, starting bachelor’s degrees in 2017, enrolled in the second academic semester of 2017 and in the first of 2018 in classroom courses at UFPel. We considered regular users those who reported regularly going to the dentist with or without perceived dental problems. To test factors associated with regular use of dental services, demographic, socioeconomic and oral health variables were collected. Statistical analyses were based on Poisson regression models.

RESULTS

The prevalence of regular use of dental services was 45.0% (95%CI 42.7–47.3). University students of high economic class (PR = 1.47; 95%CI 0.91–2.36), with last private dental appointment (PR = 1.29; 95%CI 1.03–1.61), positive self-perception of oral health (PR = 2.33; 95%CI 1.79–3.03) and no report of toothache in the last six months (PR = 1.22; 95%CI 1.03–1.45) showed higher prevalence of regular use of dental services.

CONCLUSION

The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life among these young adults.

Key words: Young Adult; Dental Care; Oral Health; Health Services Accessibility; Socioeconomic Factors; Health Status Disparities

RESUMO

OBJETIVO

Verificar a prevalência e os fatores associados ao uso regular de serviços odontológicos em acadêmicos da Universidade Federal de Pelotas (UFPel).

MÉTODOS

Este estudo transversal entrevistou 1.865 estudantes de 18 anos ou mais de idade, ingressantes em 2017, matriculados no segundo semestre letivo de 2017 e no primeiro de 2018 em cursos presenciais da UFPel. Consideraram-se usuários regulares os indivíduos que relataram ir regularmente ao dentista com ou sem problemas dentários percebidos. A fim de testar fatores associados ao uso regular de serviços odontológicos, foram coletadas variáveis demográficas, socioeconômicas e de saúde bucal. As análises estatísticas foram baseadas em modelos de regressão de Poisson.

RESULTADOS

A prevalência de uso regular de serviços odontológicos foi de 45,0% (IC95% 42,7–47,3). Os universitários de classe econômica elevada (RP = 1,47; IC95% 0,91–2,36), com última consulta odontológica particular (RP = 1,29; IC95% 1,03–1,61), autopercepção positiva da saúde bucal (RP = 2,33; IC95% 1,79–3,03) e sem relato de dor de dente nos últimos seis meses (RP = 1,22; IC95% 1,03–1,45) apresentaram maiores prevalências de uso regular dos serviços odontológicos.

CONCLUSÃO

Os resultados apontam para desigualdades no uso regular dos serviços odontológicos relacionadas a fatores socioeconômicos e um menor uso entre os universitários com piores condições de saúde bucal. Esses resultados sugerem que políticas públicas de prevenção e promoção em saúde em instituições de ensino superior devem ser realizadas para garantir qualidade de vida entre esses jovens.

Palavras-Chave: Adulto Jovem; Assistência Odontológica; Saúde Bucal; Acesso aos Serviços de Saúde; Fatores Socioeconômicos; Disparidades nos Níveis de Saúde

INTRODUCTION

In recent years, there has been an expansion of federal higher education institutions in Brazil. Federal universities are present in all units of the federation, with more than 1.1 million students enrolled1. Included in this scenario is the Universidade Federal de Pelotas (UFPel), which receives students from all Brazilian regions, with different demographic and socioeconomic backgrounds. These young adults are characterized as individuals undergoing transformation, entering adulthood and moving from their birth regions, and contextual factors can significantly influence their oral health2.

The social and racial quota policies introduced in Brazilian public universities in 2012 significantly increased the entry of young adults from more disadvantaged socioeconomic classes3. Considering this expansion, many of these individuals may have had difficulties in accessing health services, particularly oral health services, during their life trajectory.

Most studies addressing the use of dental services are based on Andersen’s4theoretical model, which aims to verify the association of contextual and individual social characteristics with different patterns of use of dental services5. The literature indicates that men, of black or brown skin color or indigenous people and individuals with lower education and socioeconomic class use oral health services less6. This fact can be explained, according to Hart7, by the “law of reverse care,” a phenomenon in which those who need health care most are the least likely to use it.

Besides the pattern of use of oral health services, the literature has underlined the importance of assessing the regularity of the habit of attending the dentist, identifying those who consult this professional when they present a problem or not and those who visit the dentist when still asymptomatic, for preventive reasons8. Regular use provides greater contact between patient and dentist, contributing to the knowledge, self-care and early detection of oral health problems9. There is already evidence of a positive association between regular use of dental services and better oral health condition9. In Brazil, the prevalence of regular use of these services ranged from 25.7% to 35.8% from 2009 to 2016 among adults12,13.

Considering that the majority of dental care expenses incurred by Brazilian families concern specialized procedures14 and that regular use of dental services results in less complex procedures9, we must encourage the use of dental services with adequate regularity and frequency, especially in a young population, to consolidate healthy behaviors. Thus, the present study aims to verify the prevalence and factors associated with the regular use of dental services in undergraduates entering UFPel in 2017.

METHODS

This is a cross-sectional study that interviewed 1,865 students aged 18 years or older out of the 2,706 new students in 2017 enrolled in the second semester of 2017 and in the first semester of 2018 in classroom courses at UFPel. The university is located in the city of Pelotas (RS), in southern Brazil, and receives about 3,000 students annually, having 80 classroom courses with admission in the first semester of each year. Given this context, the present study is part of a census conducted at UFPel that sought information on the health and behaviors of university students.

This study is linked to the research consortium of the 2017 and 2018 Master’s students from the UFPel Graduate Program in Epidemiology. This strategy facilitates data collection, which occurs in a sole way with all master’s students conducting one common field work15. Data collection occurred between November 2017 and July 2018, by self-administered standardized questionnaires using RedCap software installed on tablets, answered in classrooms or other environments within the university.

The outcome “regular use of dental services” was measured by the question: “Which of the statements below describes your access to dental care? (0) I never go to the dentist. (1) I go to the dentist when I have a problem or when I know I need to have something fixed. (2) I go to the dentist occasionally, whether or not I have some kind of problem. (3) I go to the dentist regularly”8. Regular use was considered when the interviewee replied going to the dentist occasionally, with or without some kind of problem, or when they reported going to the dentist regularly.

To verify possible associated factors, we considered as demographic variables: gender (female and male) and self-declared skin color according to the Brazilian Institute of Geography and Statistics (white, black, brown or other). Regarding socioeconomic level, maternal education (illiterate, some elementary school, elementary school or some high school, high school or some college, college or some graduate studies and graduate studies) and economic class according to the Brazilian Economic Classification Criterion of the Brazilian Association of Research Companies – ABEP (A, B, C and D or E) were evaluated. To assess questions about students, we inquired on the region of residence prior to joining UFPel (South, Southeast or Midwest and North or Northeast), current housing situation (alone; with parents or other family members; with friends or colleagues; and with spouse, partner or significant other) and the area of knowledge of the course in which they were enrolled (exact and earth sciences, agrarian sciences and engineering; health and biological sciences; applied social and human sciences; linguistics, language and literature and arts). Finally, self-perceived oral health conditions – self-perceived oral health (excellent, very good or good and reasonable or poor) and presence of dental pain (yes or no) – and location of the last dental appointment (public or private) were considered to test factors associated with regular use of dental services.

The variables studied are based on Andersen’s classic theoretical model4. This model addresses the complexity of health services use in a comprehensive way, categorizing the determinants of service use into predisposing characteristics, enabling resources and factors related to the individual’s need. Predisposing factors, in turn, are divided into demographics, social structure and health beliefs. The present study included the participant’s gender as a demographic variable. Factors of social structure were considered: skin color, maternal education, economic class, region of origin and housing situation. The knowledge area variable aimed to reflect the differences in health beliefs, as it relates to the individuals’ values and knowledge about health and health services. As a enabling resource, related to the possibility of accessing the service, information on the location of the last dental appointment was used. Finally, to assess the need for treatment, which is the condition most proximal to services use, self-perceived oral health and dental pain were included.

Data were analyzed using the Stata® 15.0 statistical package. Initially, descriptive analyses were performed using absolute and relative frequencies conducted according to the hierarchical analysis model described in Figure 1, by Poisson regression models. Adjustment modeling was performed by backward stepwise and all variables with p-value less than or equal to 0.2 were kept in the model. The significance level considered for all analyses was 5%. Missing data were estimated by the multiple imputation technique16.

Figure 1 Analysis model.UFPel: Universidade Federal de Pelotas 

The research project was submitted and approved by the Ethics and Research Committee of the Faculdade de Medicina of the Universidade Federal de Pelotas under protocol no. 79250317.0.0000.5317. All participants were previously informed about the study, signing an informed consent form, and the confidentiality of the information provided was guaranteed.

RESULTS

Of the 2,706 eligible university students, 1,865 participated in the study, which corresponded to a response rate of 69%. Of these, the majority were female (54.8%), between 18 and 19 years old (41.5%) and white (72.1%). Most students reported their mother has high school (32.1%) and, according to ABEP, most students were classified as belonging to economic class B (44.2%). Half of the undergraduates live with their parents and/or siblings (50.4%) and many already lived in the country’s southern region prior to joining UFPel (83.3%). Most are currently enrolled in applied social and human sciences courses (34.4%). In 79.8% of the sample, university students perceived their oral health as excellent, very good or good; 71.9% had no toothache in the last six months, and most used private oral health services (82.8%). Descriptive analyses performed on the sample with multiple imputation showed similar percentages to those of the study sample, as presented in Tables 1 and 2.

Table 1 Description of the university students sample entering the Universidade Federal de Pelotas in 2017 according to demographic, socioeconomic and oral health characteristics. Pelotas, Rio Grande do Sul, Brazil, 2018. 

Variables (n) n %
Gender (1,862)
Female 1,021 54.83
Male 841 45.17
Age (1,852)
18 to 19 years 768 41.47
20 to 22 years 603 32.56
23 years or older 481 25.97
Skin color (1,863)
White 1,343 72.09
Black, brown or other 520 27.91
Mother’s schooling level (1,854)
Illiterate 15 0.81
Elementary school 400 21.57
Elementary school/some high school 222 11.97
High school/some higher education 595 32.09
College/some graduate studies 410 22.11
Graduate studies 212 11.43
Region of origin (1,859)
South 1,549 83.32
Southeast/Midwest 272 14.63
North/Northeast 38 2.04
Economic class (1,780)
A 266 14.94
B 787 44.21
C 649 36.46
D/E 78 4.38
Knowledge area (1,865)
Exact and earth sciences, agrarian sciences and engineering 544 29.17
Health and biological sciences 332 17.80
Applied social and human sciences 641 34.37
Linguistics, language and literature, and arts 348 18.66
Housing situation (1,861)
Alone 234 12.57
With parents (father and/or mother and/or siblings) 937 50.35
With friends or colleagues 480 25.79
With spouse/partner/significant other 210 11.28
Regular use of dental services (1,854)
No 1,020 55.02
Yes 834 44.98
Location of the last appointment (1,715)
Public 295 17.20
Private 1,420 82.80
Self-perceived oral health (1,854)
Excellent/very good/good 1,479 79.77
Moderate/poor 375 20.23
Toothache over the last six months (1,804)
No 1,297 71.90
Yes 507 28.10

Table 2 Description of the imputed sample of university students enrolling at the Universidade Federal de Pelotas in 2017 according to demographic, socioeconomic and oral health characteristics. Pelotas, Rio Grande do Sul, Brazil, 2018. 

Variables % 95%CI
Gender
Female 54.85 52.59–57.11
Male 45.15 42.88–47.41
Age
18 to 19 years 41.45 39.20–43.70
20 to 22 years 32.56 30.42–34.70
23 years or older 25.99 23.99–27.99
Skin color
White 72.07 70.00–74.10
Black, brown or other 27.93 25.89–29.97
Mother’s schooling level
Illiterate 0.81 0.40–1.23
Some elementary school 21.58 19.70–23.45
Elementary school/some high school 11.98 10.50–13.46
High school/some college 32.10 29.97–34.23
College/some graduate studies 22.10 20.21–23.98
Graduate studies 11.42 9.97–12.87
Region of origin
South 83.27 81.57–84.97
Southeast/Midwest 14.66 13.05–16.27
North/Northeast 2.06 1.41–2.71
Economic class
A 14.81 13.17–16.45
B 43.95 41.63–46.26
C 36.71 34.45–38.97
D/E 4.53 3.57–5.50
Knowledge area
Exact and earth sciences, agrarian sciences and engineering 29.17 27.10–31.23
Health and biological sciences 17.80 16.06–19.54
Applied social and human sciences 34.37 32.21–36.53
Linguistics, language and literature, and arts 18.66 16.89–20.43
Housing situation
Alone 12.57 11.06–14.07
With parents (father and/or mother and/or siblings) 50.34 48.07–52.61
With friends or colleagues 25.77 23.78–27.76
With spouse/partner/significant other 11.32 9.88–12.76
Regular use of dental services
No 55.05 52.78–57.32
Yes 44.95 42.68–47.21
Location of the last appointment
Public 17.62 15.82–19.42
Private 82.38 80.58–84.18
Self-perceived oral health
Excellent/very good/good 79.75 77.91–81.58
Moderate/poor 20.25 18.42–22.09
Toothache over the last six months
No 71.75 69.66–73.83
Yes 28.25 26.17–30.34

95%CI: 95% confidence interval.

Regarding the regular use of dental services, the prevalence was 45.0% [95% confidence interval (95%CI) 42.7–47.3]. The demographic and socioeconomic variables positively associated with the regular use of dental services that showed statistical differences in the crude analysis were the high maternal education, living in the Southern region prior to joining UFPel, upper economic class and being enrolled in health or biological sciences courses. Regarding oral health variables, the absence of toothache, positive self-perceived oral health and use of private dental health services in the last appointment were associated with greater regular use of dental services. In the multiply imputed sample, besides the variables mentioned above, being white was associated with greater use of dental services on the crude analysis.

After adjustment for possible confounders, economic class, location of the last dental appointment, self-perceived oral health and toothache, remained associated with the outcome. The prevalence of regular use of dental services was 1.47 times higher among the wealthier than among the poorest. Among university students who consulted in private oral health services, the prevalence of regular use was 1.29 times higher than those who consulted with a dentist in public services. For self-perceived oral health, the prevalence of regular use of dental services was 2.33 times higher in those who reported good oral health compared with those who perceived their own oral health as negative. University students who did not report dental pain had a 1.22 times higher prevalence of regular use of dental services than students who had dental pain in the last six months. Table 3 presents the crude and adjusted analysis of the factors associated with the regular use of dental services in the actual study sample. In the adjusted analysis using the imputed data sample, all variables that showed statistically significant association in the study sample remained after imputation. Table 4 shows the association analyses performed on the imputed sample.

Table 3 Prevalence ratios (PR) and 95% confidence intervals (95%CI) of the crude and adjusted analysis of regular use of dental services according to demographic, socioeconomic and oral health variables of the study participants. Pelotas, Rio Grande do Sul, Brazil, 2018. 

Variables Regular use of dental services
Crude analysis Adjusted analysis*
PR (95%CI) p PR (95%CI) p
Gender
Male 1.00 0.780
Female 1.02 (0.89–1.170)
Skin color
Black, brown or other 1.00 0.055
White 1.17 (1.00–1.33)
Mother’s schooling level
Illiterate 1.00 0.002
Some elementary school 1.43 (0.53–3.85)
Elementary school/some high school 1.53 (0.56–4.15)
High school/some college 1.42 (0.53–3.81)
College/some graduate studies 1.81 (0.67–4.87)
Graduate studies 1.95 (0.72–5.28)
Region of origin
North/Northeast 1.00 0.006 1.00 0.085
South 1.98 (1.02–3.81) 1.50 (0.78–2.90)
Southeast/Midwest 1.60 (0.81–3.17) 1.32 (0.67–2.62)
Economic class
D/E 1.00 < 0.001 1.00 0.025
A 2.12 (1.36–3.31) 1.47 (0.91–2.36)
B 1.66 (1.08–2.55) 1.27 (0.80–2.00)
C 1.41 (0.91–2.18) 1.19 (0.75–1.88)
Knowledge area
Linguistics, language and literature, and arts 1.00 0.003 1.00
Exact and earth sciences, agrarian sciences and engineering 1.33 (1.08–1.65) 1.24 (0.99–1.55) 0.080
Health and biological sciences 1.50 (1.20–1.89) 1.25 (0.98–1.60)
Applied social and human sciences 1.18 (0.96–1.47) 1.17 (0.93–1.46)
Housing situation
With friends or colleagues 1.00 0.125
Alone 1.19 (0.94–1.50)
With parents (father and/or mother and/or siblings) 1.16 (0.98–1.38)
With spouse/partner/significant other 1.06 (0.83–1.36)
Location of the last appointment
Public 1.00 < 0.001 1.00 0.027
Private 1.46 (1.19–1.81) 1.29 (1.03–1.61)
Self-perceived oral health
Negative 1.00 < 0.001 1.00 < 0.001
Positive 2.57 (2.02–3.25) 2.33 (1.79–3.03)
Toothache
Yes 1.00 < 0.001 1.00 0.023
No 1.38 (1.17–1.63) 1.22 (1.03–1.45)

* Analysis adjusted for gender, skin color, economic class, maternal education, region of origin, area of knowledge, current housing situation, location of last dental appointment, dental pain and self-perceived oral health.

Table 4 Prevalence ratios (PR) and 95% confidence intervals (95%CI) of the crude and adjusted analysis of regular use of dental services according to demographic, socioeconomic and oral health variables of the study participants (imputed sample). Pelotas, Rio Grande do Sul, Brazil, 2018. 

Variables Regular use of dental services
Crude analysis Adjusted analysis*
PR (95%CI) p PR (95%CI) p
Gender
Male 1.00 0.691
Female 1.02 (0.92–1.13)
Skin color
Black, brown or other 1.00 0.014
White 1.16 (1.03–1.31)
Mother’s schooling level
Illiterate 1.00 < 0.001
Some elementary school 1.45 (0.62–3.38)
Elementary school/some high school 1.56 (0.66–3.64)
High school/some college 1.44 (0.62–3.35)
College/some graduate studies 1.84 (0.79–4.27)
Graduate studies 1.98 (0.85–4.62)
Region of origin
North/Northeast 1.00 0.003 1.00 0.021
South 2.00 (1.12–3.55) 1.80 (0.93–3.49)
Southeast/Midwest 1.62 (0.90–2.93) 1.54 (0.78–3.06)
Economic class
D/E 1.00 < 0.001 1.00 0.003
A 2.08 (1.44–3.00) 1.65 (1.06–2.58)
B 1.63 (1.14–2.33) 1.38 (0.90–2.12)
C 1.39 (0.97–2.00) 1.28 (0.83–1.96)
Knowledge area
Linguistics, language and literature, and arts 1.00 < 0.001 1.00
Exact and earth sciences, agrarian sciences and engineering 1.34 (1.13–1.58) 1.22 (0.99–1.52) 0.062
Health and biological sciences 1.51 (1.27–1.79) 1.30 (1.03–1.63)
Applied social and human sciences 1.19 (1.01–1.41) 1.15 (0.93–1.42)
Housing situation
With friends or colleagues 1.00 0.092
Alone 1.18 (1.00–1.41)
With parents (father and/or mother and/or siblings) 1.16 (1.02–1.32)
With spouse/partner/significant other 1.05 (0.87–1.28)
Location of the last appointment
Public 1.00 < 0.001 1.00 0.016
Private 1.50 (1.26–1.78) 1.30 (1.05–1.61)
Self-perceived oral health
Negative 1.00 < 0.001 1.00 < 0.001
Positive 2.57 (2.09–3.17) 2.28 (1.79–2.90)
Toothache
Yes 1.00 < 0.001 1.00 0.028
No 1.38 (1.20–1.57) 1.20 (1.02–1.43)

* Analysis adjusted for gender, skin color, economic class, maternal education, region of origin, area of knowledge, current housing situation, location of last dental appointment, dental pain and self-perceived oral health.

DISCUSSION

The 45.0% prevalence of regular use of dental services found in this university-based study was higher than that reported in other population-based surveys conducted in Brazil in the same age group. The authors are unaware of other studies that have addressed the issue of regular use of dental services specifically in the Brazilian university population. In Pelotas, city where UFPel is located, a population-based study conducted by Camargo et al.17 in 2009 used the same question to measure regular use of dental services and found a prevalence of 32.8% in adults. In a more recent study, also population-based, conducted in Minas Gerais, the prevalence was 35.8% for regular use of dental services among individuals over 18 years of age13. In this study, students who had their last dental appointment more than a year ago were classified as irregular users of dental services. Among those who had their last dental appointment less than a year ago, the regular use of dental services was defined based on two questions: one on the frequency/regularity of appointments and the other on the reason for the consultation. Students who visited the dentist in the last year and reported regular use in both subsequent questions were classified as regularly using dental services.

It is important to note that previous studies used population-based samples, while our study sample comprises university students. Despite the university inclusion policies adopted in recent years, our study does not reflect the Brazilian population profile in this age group, as it excludes populations in greater social vulnerability, which have the greatest oral health problems and less access to health services18. However, in Brazil, there was an expansion of policies for higher education in the last two decades, with the inclusion of groups historically excluded from this educational level, which significantly changed the profile of undergraduate students. Although the democratization process of Brazilian higher education can be observed, its access system remains elitist3. The higher prevalence found in the present study may reflect this inclusion and change in the profile of Brazilian university students, highlighting a policy favoring social equity.

The association between economic class and regular use of dental services observed in this study agrees with the current literature, according to which poorer individuals show less use and greater difficulties in accessing dental services11. In a study conducted with 18 selected countries from the Organization for Economic Cooperation and Development (OECD), all of them presented significant inequalities in access to dental services related to income19. Thus, economic class is an important predictor in accessing information about preventive health habits and behaviors20. Additionally, higher income results in the possibility of purchasing health services14. When analyzing the global data on health expenditures, the countries with the highest income per capita are those with the highest expenditures on oral health21. The same process that occurs between countries occurs between individuals22. As such, regular use of dental services among the most economically vulnerable individuals becomes even more difficult.

Demographic factors such as gender and skin color were associated with regular use of dental services in several parts of the world, according to the systematic review and meta-analysis conducted by Reda et al11. However, our study found a statistical association with skin color in the crude analysis only when dealing with losses by multiple imputation of missing data, which shows that this association possibly exists, but we were unable to find it. For gender, not even the imputation analysis yielded in a positive statistical association, which suggests that particularities in the university population’s characteristics may justify the absence of association between gender and regular use of dental services.

Regarding self-reported oral health conditions, a positive perception and absence of dental pain were associated with regular use of dental services in this study. Corroborating these findings, the literature shows that positive self-perceived oral health12,13,17 and the absence of dental pain13 were associated with greater regular use of dental services. These results can be explained by the fact that health perception may act as a determinant for understanding the importance of regular dentist visits and, consequently, more preventive actions result in fewer episodes of pain and a positive self-perceived oral health.

The greater regular use of oral services was associated with the location of the last dental appointment. In Brazil, Machado12 found a higher prevalence of regular use in those who used private oral health services than in users of public institutions. After a reform in public oral health services, Finland saw an increase in the use of these services in the last 12 months, besides an increase in public care in relation to the private market23.

The differential losses and refusals, higher among older males enrolled in courses in the area of exact and earth sciences, agrarian sciences and engineering and who lived in the southern region prior to joining UFPel, which could result in selection bias, are limitations of the present study. Due to its cross-sectional design, reverse causality bias may occur for the associations between regular use of dental services and oral health variables, which can be two-way. Another possible limitation concerns obtaining self-reported information on the regularity of dentist appointments. Considering that this is a socially desirable behavior, there is the possibility of overestimating the report of dentist appointments for preventive reasons.

The way regular use of oral health services was assessed is a strength of this study, since most studies addressing the issue only investigate the recall time of the last appointment to characterize regularly visiting the dentist, without distinguishing between the individual’s motivation. In addition, the originality of the studied population stands out as a strong point.

Finally, in this study, students reported using dental services more to solve oral health problems and not regularly to prevent them, as would be desirable. The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life for this population.

REFERENCES

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2. Nobrega JBM, Dantas ELA, Ferreira Filho JC, Limão N, Rodrigues-de-Melo AC, Protasio AP, et al. Contextual social inequities and occurrence of dental caries in adolescents: a systematic review. Oral Health Prev Dent. 2017;15(4):329-36. https://doi.org/10.3290/j.ohpd.a38744Links ]

3. Ristoff D. O novo perfil do campus brasileiro: uma análise do perfil socioeconômico do estudante de graduação. Avaliação (Campinas). 2014;19(3):723-47. https://doi.org/10.1590/S1414-40772014000300010Links ]

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Funding

This study was funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil (CAPES) – funding code 001. MSE has a doctoral scholarship linked to the ACADEMIC EXCELLENCE PROGRAM – PROEX of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), process 88882.346942/2019-01. HSS has a postdoctoral scholarship (Young Talent) linked to the Institutional Internationalization Program of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil (CAPES PrInt), process #88887.363970/2019-00.

Received: August 8, 2019; Accepted: November 10, 2019

Correspondence: Mariana Silveira Echeverria Rua Marechal Deodoro, 1160 3º piso 96020-220 Pelotas, RS, Brasil E-mail: mari_echeverria@hotmail.com

Authors’ Contribution: Study design and planning: MSE, AERS, BAA, FFD. Data collection, analysis and interpretation: MSE, AERS, BAA, HSS, FFD. Manuscript development or review: MSE, AERS, BAA, HSS, FFD. Approval of the final version: MSE, AERS, BAA, HSS, FFD. Public responsibility for the content of the article: MSE, AERS, BAA, HSS, FFD.

Conflict of Interest: The authors declare no conflict of interest.

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