Oral health coverage in the Family Health Strategy and use of dental services in adolescents in Mato Grosso do Sul, Brazil, 2019: cross-sectional study

Martinelli, Danieli Laguna Francisco; Cascaes, Andreia Morales; Frias, Antonio Carlos; Souza, Luciana Bronzi de; Bomfim, Rafael Aiello

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 30 (4) • 2021 • https://doi.org/10.1590/S1679-49742021000400010 copy

Oral health coverage in the Family Health Strategy and use of dental services in adolescents in Mato Grosso do Sul, Brazil, 2019: cross-sectional study^* * Article derived from the master’s degree dissertation entitled ‘Factors associated with the use of dental services among school adolescents in the state of Mato Grosso do Sul’, submitted by Danieli Laguna Francisco Martinelli to the Postgraduate Program in Family Health/Instituto Integrado de Saúde, da Universidade Federal de Mato Grosso do Sul, 2020.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the association between the coverage by oral health teams in the Family Health Strategy (FHS-OH) and the use of dental services among 12-year-old adolescents in the state of Mato Grosso do Sul, Brazil, 2019.

Methods

This is a cross-sectional study involving school-based research, which adopted the use of dental services as its outcome. Structural equation modeling was used to test the association between covariates and the outcome.

Results

Of the 615 participants, 74.0% used dental services in the last three years. ESF-SB (oral health coverage by family health strategy, acronym in Portuguese) ≥50% was associated with a greater use of public dental services [standardized coefficient (SC) = 0.10 -95%CI 0.01;0.18], a lower use of these services for prevention (SC = -0.07 -95%CI -0.17;0.01) and higher unhealthy food consumption (SC = 0.19 -95%CI 0.11;0.26).

Conclusion

Higher ESF-SB coverage was associated with a lower use of dental services for prevention and higher unhealthy food consumption. Teams must organize the access to oral health service and qualify the work process.

Keywords:
Health Services Accessibility; Public Health; Family Health Strategy; Cross-sectional Studies; Oral Health

Variables	Sampling distribution		Use of dental services
Variables	n=615	%	N	(95%IC^a)
Individual
Race/skin color
White	270	43.9	202	75.4 (54.2;85.1)
Brown	266	43.3	193	71.7 (52.2;83.1)
Asian	24	3.9	23	97.4 (86.2;99.6)
Black	32	5.3	21	62.4 (42.4;78.9)
Indigenous	6	0.9	5	76.7 (72.5;80.3)
Had no information	17	2.8	11	64.7 (38.9;84.0)
Sex
Female	315	51.2	237	75.6 (50.6;89.4)
Male	300	48.8	218	72.9 (46.4;88.4)
Household income per capita
Below the poverty line	216	35.1	177	87.6 (78.3;93.2)
Above the poverty line	376	61.1	278	61.8 (41.3;78.8)
Mather’s education level (in years of study)
1 to 4	381	62.0	239	57.0 (38.1;74.0)
Over 4	234	38.0	216	91.8 (83.0;96.3)
Contextual
ESF-SB^b
Less than 50%	340	55.3	217	56.8 (37.4;74.4)
Equal to or greater than 50%	275	44.7	238	90.8 (84.6;94.6)
Unhealthy food
Low (up to 2 times/week)	168	27.3	73	30.8 (16.0;50.9)
Moderate (2 to 4 times/week)	197	32.0	179	91.9 (80.0;97.1)
High (4 to 7 times/week)	217	35.3	187	85.4 (77.5;90.8)
Had no information	33	5.4	16	46.8 (34.5;59.5)

Use of dental services	N	(95%IC^a)
Used in the last three years
Yes	455	74.0 (70.4;77.3)
No	160	26.0 (22.7;29.6)
Type of service (among those who used the service in the last three years)
Public	258	56.7 (52.1;61.2)
Private	197	43.3 (38.8;47.9)
Reason for its use
Prevention	210	46.2 (41.6;50.8)
Treatment	245	53.8 (49.2;58.4)

Effects	SC^a (robust standard errors)	(95%IC^b)	p-value
Direct effects
Sociodemographic
Sex → Use	0.04 (0.03)	(-0.02;0.09)	0.563
SS^c → Use	0.49 (0.16)	(0.35;0.62)	<0.001
SS^c → Inadequate food intake	-0.02 (0.05)	(-0.09;0.05)	0.534
White → Use	0.14 (0.06)	(0.07;0.20)	<0.001
White → Checkups	0.24 (0.08)	(0.14;0.32)	0.023
White → Public	-0.22 (0.10)	(-0.32;-0.12)	<0.001
Latent variable SS^c
Income → SS^c	0.79 (0.10)	(0.69;0.89)	<0.001
Schooling → SS^c	0.69 (0.10)	(0.59;0.89)	<0.001
Health behaviors
Inadequate food intake → Use	0.30 (0.10)	(0.20;0.40)	<0.001
Inadequate food intake → Checkups	-0.18 (0.06)	(-0.38;-0.07)	0.001
Contextual
ESF-SB^d → Use	-0.02 (0.05)	(-0.09;0.08)	0.904
ESF-SB^d → Inadequate food intake	0.19 (0.07)	(0.11;0.26)	<0.001
ESF-SB^d → Public	0.10 (0.07)	(0.01;0.18)	0.045
ESF-SB^d → Checkups	-0.07 (0.05)	(-0.17;0.01)	0.067
Public → Checkups	-0.06 (0.03)	(-0.15;0.03)	0.185
Indirect effects
Via inadequate food intake
ESF-SB^d → Use of services	0.05 (0.02)	(0.02;0.07)	<0.001
ESF-SB^d → Checkups	-0.04 (0.02)	(-0.07;-0.02)	0.005
Total effect
ESF-SB^d → Use	0.04 (0.06)	(-0.04;0.12)	0.297
ESF-SB^d → Checkups	-0.11 (0.06)	(-0.21;-0.03)	0.007
Covariance
SS^c ↔ White	0.11 (0.05)	(0.04;0.20)	0.005
Model fitting quality
AIC^e	7110
BIC^f	7300
Log likelihood	-3512
Coefficient of determination	0.80
CFI^g	0.88
TLI^h	0.85
RMSEAⁱ	0.08

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[1] Correspondence:
Rafael Aiello Bomfim - Av. Senador Filinto Muller, S/N, Cidade Universitária, Campo Grande, MS, Brazil. CEP: 79070-900. E-mail: aiello.rafael@gmail.com