Toothache and tooth extraction as reasons for dental visits: an analysis of the 2019 National Health Survey

Cunha, Amanda Ramos da; Bastos, Lucelen Fontoura; Iser, Betine Pinto Moehlecke; Malta, Deborah Carvalho; Goes, Paulo Sávio Angeiras de; Hugo, Fernando Neves

doi:10.1590/1807-3107bor-2022.vol36.0070

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Original Research, Community Dental Health • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0070 copy

Toothache and tooth extraction as reasons for dental visits: an analysis of the 2019 National Health Survey

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

The aim of this study was to analyze the prevalence of dental visits due to toothache and tooth extraction in Brazil and its association with individual and contextual variables. This two-step cross-sectional study included persons aged 18 years and older in the 2019 National Health Survey who had visited a dentist in the 12 months prior to the interview (n = 40,369). The individual-level outcome was having a dental visit due to toothache or tooth extraction. The ecological-level outcome was the proportion of dental visits for these reasons relative to all dental visits by Brazilian state. Associations with individual – sociodemographic characteristics, number of teeth, and type of health service used – and ecological variables – HDI and dental service coverage – were assessed using Poisson regressions. The prevalence of dental visits due to toothache or extraction was higher among individuals with no formal education, household income < 25% of the minimum wage, of black and brown skin color, living in rural areas, who consulted in the public health system, with 10–19 and 1–9 teeth, and men. The proportion of dental visits due to toothache/extraction in Brazilian states was negatively associated with the HDI and the rate of dental emergency team/100,000 inhabitants and positively associated with primary dental care coverage. The prevalence of dental visits due to toothache/extraction was associated with individual and ecological characteristics, indicating inequities in reasons for dental visits in Brazil. The potential of a well-structured oral health care network to overcome these inequities is suggested and needs to be better explored.

Keywords:
Toothache; Tooth Extraction; Oral Health; Healthcare Disparities

Variable	Year	Data Source	Calculation
Human Development Index	2010^a a The most recent year with available data;	United Nations Development Program	This variable was collected directly from the data source^b b http://www.atlasbrasil.org.br/; , by State.
Coverage by primary dental care teams	2019	Information System on Primary Health Care	This variable was collected directly from the data source^c c https://egestorab.saude.gov.br/; , by State. It considered the percentage of the State's population covered by this type of health care.
Rate of Dental Specialty Centers/100,000 inhabitants	2019	National Program for the Improvement of Access and Quality of Primary Care (PMAQ-CEO)	The number of DSCs per State was collected from the PMAQ-CEO dataset. This number was divided by the population of each State in 2019 and multiplied by 100,000^d d Data on the population residing in each State in 2019 were collected from the inter census projection of the IBGE. .
Rate of dental emergency services/100,000 inhabitants	2019	National Register of Health Establishments	The number of dental emergency services per State was collected from the National Register of health care services. Only public services were included. This amount was divided by the population of each State in 2019 and multiplied by 100,000^d d Data on the population residing in each State in 2019 were collected from the inter census projection of the IBGE. .

Variable		All dental visits^a a All individuals ≥ 18 years who had dental visits in the last year;	Dental visits due to toothache or extraction	Dental visits due to other reasons	p-value^c c Resulting of chi-square to assess the difference in the distribution of dental visits due to toothache or tooth extraction and dental visits for other reasons;
Variable		%	% (CI_95%^b b 95% confidence interval; )	% (CI_95%^b b 95% confidence interval; )
Total		100	16.46 (15.82–17.12)	83.54 (82.88–84.18)	-
Sex
	Male	43.05	44.28 (42.3–46.29)	42.8 (41.87–43.74)	0.19
	Female	56.95	55.72 (53.71–57.70)	57.2 (56.26–58.13)
Age group
	18–39	48.47	46.78 (44.79–48.79)	48.8 (47.77–49.84)	0.08
	40–59	36.21	38.12 (36.23–40.05)	35.84 (34.92–36.76)
	60 and older	15.32	15.10 (13.96–16.31)	15.36 (14.64–16.11)
Skin color^d d ”Indigenous” and “yellow” skin color categories not shown due to insufficient number of interviews in the PNS 2019;
	White	47.95	35.69 (33.69–37.74)	50.36 (49.21–51.51)	< 0.01
	Black	10.40	13.65 (12.41–15.00)	9.76 (9.19–10.36)
	Brown	40.27	49.23 (47.20–51.26)	38.51 (37.45–39.58)
Education
	No formal education	2.49	6.60 (5.83–7.47)	1.68 (1.51–1.88)	< 0.01
	Incomplete elementary school	20.10	32.27 (30.44–34.15)	17.71 (16.96–18.48)
	Complete elementary school	7.45	8.54 (7.48–9.73)	7.24 (6.77–7.75)
	Incomplete high school	6.62	7.97 (6.90–9.18)	6.35 (5.88–6.86)
	Complete high school	33.55	29.07 (27.24–30.97)	34.43 (33.52–35.36)
	Incomplete university education	6.64	3.79 (2.98–4.82)	7.21 (6.69–7.75)
	Complete university education	23.14	11.76 (10.49–13.17)	25.38 (24.35–26.44)
Zone
	Urban	89.41	82.10 (80.80–83.32)	90.84 (90.36–91.31)	< 0.01
	Rural	10.59	17.90 (16.68–19.20)	9.16 (8.69–9.64)
Household income (per capita)
	Up to ¼ of (MW^e e Minimum wage; )	5.70	11.37 (10.33–12.51)	4.58 (4.26–4.93)	< 0.01
	More than ¼ up to ½	11.39	18.23 (16.82–19.72)	10.04 (9.46–10.65)
	More than ½ up to 1	25.34	31.50 (29.71–33.35)	24.13 (23.2–25.08)
	More than 1 up to 2	29.21	24.51 (22.76–26.36)	30.13 (29.19–31.09)
	More than 2 up to 3	11.66	7.58 (6.51–8.81)	12.46 (11.82–13.12)
	More than 3 up to 5	8.86	4.35 (3.50–5.39)	9.75 (9.14–10.39)
	More than 5	7.85	2.46 (1.94–3.12)	8.91 (8.22–9.65)
Number of teeth
	20–32	94.56	90.10 (89.02–91.09)	95.44 (95.01–95.83)	< 0.01
	10–19	3.89	7.10 (6.25–8.06)	3.25 (2.94–3.60)
	1–9	1.06	2.23 (1.80–2.76)	0.82 (0.63–1.08)
	Edentulous	0.50	0.56 (0.35–0.90)	0.48 (0.37–0.64)
Type of health system^f f In the last dental visit.
	Private	75.6	57.04 (55.16–58.91)	79.25 (78.33–80.14)	< 0.01
	Public	24.4	42.96 (41.09–44.84)	20.75 (19.86–21.67)
Type of service^f f In the last dental visit.
	Primary dental care service	19.12	33.88 (32.12–35.69)	16.21 (15.46–17.00)	< 0.01
	Public clinic	1.97	2.99 (2.44–3.65)	1.77 (1.51–2.06)
	Public emergency services	0.83	2.27 (1.67–3.09)	0.54 (0.43–0.69)
	Specialized dental care center	1.27	2.01 (1.43–2.81)	1.12 (0.93–1.36)
	Public hospital outpatient clinic	1.21	1.80 (1.30–2.49)	1.1 (0.85–1.42)
	Private dental care service	74.66	56.17 (54.26–58.05)	78.3 (77.35–79.23)
	Private emergency services	0.37	0.31 (0.18–0.54)	0.38 (0.31–0.48)
	Other type of service	0.57	0.57 (0.37–0.87)	0.57 (0.44–0.73)

Variable		Crude	Adjusted^a a Adjusted for all variables with p < 0.20 in the bivariate analysis;
Variable		PR (CI_95%)^b b Prevalence ratio and its 95%CI;	PR (CI_95%)^b b Prevalence ratio and its 95%CI;
Sex
	Male	1(ref.)	1(ref.)
	Female	0.95 (0.88–1.02)	0.92 (0.86–0.99)
Age group
	18–39	1(ref.)	1(ref.)
	40–59	1.09 (1.00–1.18)	1.04 (0.95–1.13)
	60 and older	1.02 (0.93–1.12)	0.97 (0.87–1.09)
Skin color^c c “Indigenous” and “yellow” skin color categories not shown due to insufficient number of interviews in the PNS 2019;
	White	1(ref.)	1(ref.)
	Black	1.76 (1.58–1.97)	1.34 (1.20–1.50)
	Brown	1.64 (1.51–1.79)	1.23 (1.13–1.34)
Education
	Complete university education	1(ref.)	1(ref.)
	Incomplete university education	1.12 (0.87–1.45)	0.90 (0.70–1.15)
	Complete high school	1.70 (1.49–1.94)	1.14 (1.00–1.30)
	Incomplete high school	2.37 (2.00–2.81)	1.35 (1.13–1.61)
	Complete elementary school	2.25 (1.91–2.66)	1.34 (1.12–1.59)
	Incomplete elementary school	3.16 (2.78–3.59)	1.68 (1.45–1.94)
	No formal education	5.21 (4.51–6.03)	2.38 (2.02–2.80)
Zone
	Urban	1(ref.)	1(ref.)
	Rural	1.84 (1.71–1.98)	1.12 (1.04–1.21)
Household income (per capita)
	More than 5 (MW)^d d Minimum wage;	1(ref.)	1(ref.)
	More than 3 up to 5	1.57 (1.18–2.08)	1.41 (1.06–1.89)
	More than 2 up to 3	2.08 (1.58–2.73)	1.70 (1.28–2.26)
	More than 1 up to 2	2.68 (2.10–3.42)	1.88 (1.45–2.45)
	More than ½ up to 1	3.97 (3.13–5.03)	2.33 (1.79–3.03)
	More than ¼ up to ½	5.11 (4.02–6.50)	2.60 (1.98–3.42)
	Up to ¼	6.37 (4.99–8.12)	2.84 (2.15–3.76)
Number of teeth
	20–32	1(ref.)	1(ref.)
	10–19	1.92 (1.70–2.16)	1.42 (1.25–1.61)
	1–9	2.22 (1.78–2.76)	1.63 (1.36–1.96)
	Edentulous	1.19 (0.83–1.71)	0.94 (0.67–1.32)
Type of health system^e e In the last dental visit.
	Private	1(ref.)	1(ref.)
	Public	2.33 (2.17–2.50)	1.56 (1.43–1.69)

Contextual variables	Mean	Median	sd^b b standard deviation.
Proportion of dental visit due to toothache or extraction^a a The proportion of dental visits due to toothache or extraction concerning all dental visits in the year prior to the data collection – considering the adjustment for the sample's weight; (%)	18.89	19.48	5.08
Human Development Index	0.70	0.70	0.05
Primary dental care coverage (% of the population)	60.43	59.66	18.45
Dental specialty centers (per 100 000 inhabitants)	0.56	0.46	0.35
Dental emergency team (per 100 000 inhabitants)	0.39	0.34	0.25

Exposure variables	Crude	Adjusted^a a Adjusted for all variables with p<0.20 in the bivariate analysis;
Exposure variables	β (CI_95%)^b b Regression coefficient and its 95%CI;	β (CI_95%)^b b Regression coefficient and its 95%CI;
HDI^c c Human Development Index; ^d d At the states level.	-4.61 (-5.72;-3.49)	-3.75 (-4.99;-2.51)
Primary oral health care coverage (% of the population)^d d At the states level.	0.01 (0.01;0.01)	0.00 (0.00;0.01)
Public specialized dental care center (per 100,000 inhab.)^d d At the states level.	0.17 (0.04;0.31)	-0.08(-0.19;0.02)
Dental emergency team (per 100,000 inhab.)^d d At the states level.	-0.27 (-0.59;0.04)	-0.21(-0.34;-0.07)

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[1] Corresponding Author: Amanda Ramos da Cunha, E-mail: amandaracunha@yahoo.com.br