Abstract
Introduction
The COVID-19 pandemic has significantly impacted healthcare systems globally, emphasizing the importance of understanding its effects on the provision of dental care.
Objective
To assess the impact of the COVID-19 pandemic on the procedures conducted by the Specialized Dental Centers (CEOs) in Brazil from 2019 to 2022 and its relationship with Primary Health Care (PHC).
Material and method
An ecological study using secondary data from the Outpatient Production of the SUS (SIA/SUS). The variable of interest was the production of CEOs, including accredited CEOs in Brazil from January 2019 to December 2022, of types I, II, or III. The independent variables included: a) time period; b) region of Brazil; c) CEO type; and d) the percentage of coverage of primary care (PCP). Descriptive statistics, control charts, and negative binomial regression analysis were used. Spearman correlation analyses were applied between CEOs production and PCP.
Result
A decline in production was observed in April 2020 across all regions of the country. CEOs production decreased from 327,206 procedures in March 2020 to 37,742 in April of the same year. National CEOs production remained low until December 2020. The recovery of specialized dental procedure quantities above the average began in early 2022. In the years 2021 and 2022, there was a significant but very weak positive correlation between CEOs production and PCP (p<0.05).
Conclusion
The period of reduced CEOs production in 2020, followed by a gradual recovery, reflects the impact of the COVID-19 pandemic on specialized dental care production.
Descriptors:
Unified Health System; Brazil; COVID-19; secondary health care
Resumo
Introdução
A pandemia de COVID-19 impactou significativamente os sistemas de saúde globalmente, destacando-se assim a importância de compreender seus efeitos na oferta de cuidados odontológicos.
Objetivo
Avaliar o impacto da pandemia de COVID-19 nos procedimentos realizados pelos Centros de Especialidades Odontológicas (CEOs) no Brasil de 2019 a 2022 e sua relação com a Atenção Primária à Saúde (APS).
Material e método
Estudo ecológico utilizando dados secundários da Produção Ambulatorial do SUS (SIA/SUS). A variável de interesse foi a produção dos CEOs, incluindo CEOs habilitados no Brasil de janeiro de 2019 a dezembro de 2022, dos tipos I, II ou III. As variáveis independentes incluíram: a) período de tempo; b) região do Brasil; c) tipo de CEO; e d) porcentagem de cobertura da atenção primária (PCP). Foram utilizadas estatísticas descritivas, gráficos de controle e análise de regressão binomial negativa. Análises de correlação de Spearman foram aplicadas entre a produção dos CEOs e a PCP.
Resultado
Observou-se uma queda na produção em abril de 2020 em todas as regiões do país. A produção dos CEOs diminuiu de 327.206 procedimentos em março de 2020 para 37.742 em abril do mesmo ano. A produção nacional dos CEOs permaneceu baixa até dezembro de 2020. A recuperação das quantidades de procedimentos odontológicos especializados acima da média começou no início de 2022. Nos anos de 2021 e 2022, houve uma correlação positiva significativa, mas muito fraca, entre a produção dos CEOs e a PCP (p<0,05).
Conclusão
O período de redução na produção dos CEOs em 2020, seguido por uma recuperação gradual, reflete o impacto da pandemia de COVID-19 na produção de cuidados odontológicos especializados.
Descritores:
Sistema Único de Saúde; Brasil; COVID-19; atenção secundária à saúde
INTRODUCTION
Oral diseases are characterized by their high prevalence and substantial burden on both public health and the economy11 Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019 Jul;394(10194):249-60. http://doi.org/10.1016/S0140-6736(19)31146-8. PMid:31327369.
http://doi.org/10.1016/S0140-6736(19)311...
. Before the COVID-19 pandemic, it was estimated that globally, there were 3.5 billion people with oral health issues, including 2.3 billion with untreated dental caries in permanent teeth, 796 million affected by severe periodontitis, and 267 million with missing teeth22 Bernabe E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, Alipour V, et al. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the global burden of disease 2017 study. J Dent Res. 2020 Apr;99(4):362-73. http://doi.org/10.1177/0022034520908533. PMid:32122215.
http://doi.org/10.1177/0022034520908533...
.
In Brazil, these numbers also reveal a concerning reality. Data from a national epidemiological survey unveiled the widespread prevalence of oral diseases in the population33 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. SB Brasil 2010: Pesquisa Nacional de Saúde Bucal: principais resultados. Brasília: Ministério da Saúde; 2012.. As an illustrative example, the National Health Survey reported an alarming figure of 16 million Brazilians affected by tooth loss. Additionally, the National Oral Health Survey (SB Brazil 2012), conducted by the Ministry of Health, revealed that a significant 56% of 12-year-old children had experienced, at least once, dental caries, tooth loss, or dental restoration (DMFT)44 Freire MCM, Reis SCGB, Figueiredo N, Peres KG, Moreira RS, Antunes JLF. Individual and contextual determinants of dental caries in Brazilian 12-year-olds in 2010. Rev Saude Publica. 2013 Dec;47(Suppl 3):40-9. http://doi.org/10.1590/S0034-8910.2013047004322. PMid:24626580.
http://doi.org/10.1590/S0034-8910.201304...
. Given the substantial impact of dental caries over time on tooth loss, the unimpeded access to dental care becomes unquestionably important.
In the Unified Health System (SUS) of Brazil, access to oral health care is facilitated through a multi-level care system55 Silva HECD, Gottems LBD. Interface entre a Atenção Primária e a Secundária em odontologia no Sistema Único de Saúde: uma revisão sistemática integrativa. Cien Saude Colet. 2017 Aug;22(8):2645-57. http://doi.org/10.1590/1413-81232017228.22432015. PMid:28793079.
http://doi.org/10.1590/1413-81232017228....
. The primary level includes Primary Health Care (PHC), mobile care units, and emergency services. The secondary and tertiary levels encompass specialized care, including Specialized Dental Care Centers (CEOs) and hospitals, respectively66 Brasil. Ministério da Saúde. Guidelines for the national oral health policy. Brasília; 2004.. CEOs primarily aim to expand and enhance the population's access to specialized dental treatments, including oral diagnosis with an emphasis on oral cancer detection, periodontics, endodontics, minor oral surgery, and care for individuals with special needs, thereby contributing to the comprehensive oral care of the served population77 Brasil. Ministério da Saúde. Portaria nº 1.570, de 29 de julho de 2004. Estabelece critérios, normas e requisitos para a implantação e habilitação de Centros de Especialidades Odontológicas e Laboratórios Regionais de Próteses Dentárias. Diário Oficial da União. Brasília, 2004..
In 2020, in response to the COVID-19 pandemic, the World Health Organization advised the suspension of dental procedures due to aerosol production and the risk of SARS-CoV-2 virus transmission, coupled with a shortage of personal protective equipment, necessitating the postponement of elective dental procedures while maintaining only emergency care88 World Health Organization – WHO. Considerations for the provision of essential oral health services in the context of COVID-19 [Internet]. Geneva: WHO; 2020 [cited 2024 May 29]. Available from: https://www.who.int/publications-detail-redirect/who-2019-nCoV-oral-health-2020.1
https://www.who.int/publications-detail-...
. Consequently, dental health services were compelled to reorganize.
There was a drastic reduction in dental procedures in Brazil99 Chisini LA, Costa FDS, Demarco GT, da Silveira ER, Demarco FF. COVID-19 pandemic impact on paediatric dentistry treatments in the Brazilian Public Health System. Int J Paediatr Dent. 2021 Jan;31(1):31-4. http://doi.org/10.1111/ipd.12741. PMid:33197102.
http://doi.org/10.1111/ipd.12741...
10 Chisini LA, Costa FDS, Sartori LRM, Corrêa MB, D’Avila OP, Demarco FF. COVID-19 Pandemic impact on Brazil’s Public Dental System. Braz Oral Res. 2021 Jul;35:e082. http://doi.org/10.1590/1807-3107bor-2021.vol35.0082. PMid:34287465.
http://doi.org/10.1590/1807-3107bor-2021...
11 Cunha ARD, Velasco SRM, Hugo FN, Antunes JLF. The impact of the COVID-19 pandemic on the provision of dental procedures performed by the Brazilian Unified Health System: a syndemic perspective. Rev Bras Epidemiol. 2021 May;24:e210028. http://doi.org/10.1590/1980-549720210028. PMid:34076147.
http://doi.org/10.1590/1980-549720210028...
-1212 Santos MBF, Pires ALC, Saporiti JM, Kinalski MA, Marchini L. Impact of COVID-19 pandemic on oral health procedures provided by the Brazilian public health system: COVID-19 and oral health in Brazil. Health Policy Technol. 2021 Mar;10(1):135-42. http://doi.org/10.1016/j.hlpt.2021.02.001. PMid:33585171.
http://doi.org/10.1016/j.hlpt.2021.02.00...
, with notable repercussions on PHC1313 Danigno JF, Echeverria MS, Tillmann TFF, Liskoski BV, Silveira MGSES, Fernandez MDS, et al. Factors associated with the reduction of dental care in Primary Health Care in Brazil after the emergence of COVID-19: a cross-sectional study, 2020. Epidemiol Serv Saude. 2022;31(1):e2021663. http://doi.org/10.1590/s1679-49742022000100015. PMid:35544869.
http://doi.org/10.1590/s1679-49742022000...
, including a reduction in preventive and oral health promotion activities1414 Lucena EHG, Freire AR, Freire DEWG, de Araújo ECF, Lira GNW, Brito ACM, et al. Offer and use of oral health in primary care before and after the beginning of the COVID-19 Pandemic in Brazil. Pesqui Bras Odontopediatria Clin Integr. 2020;20(Suppl 1):e0139. http://doi.org/10.1590/pboci.2020.163.
http://doi.org/10.1590/pboci.2020.163...
, potentially contributing to an increase in untreated oral diseases. Additionally, the need to implement strict biosafety protocols altered the routine of dental offices1515 Deana NF, Seiffert A, Aravena-Rivas Y, Alonso-Coello P, Muñoz-Millán P, Espinoza-Espinoza G, et al. Recommendations for safe dental care: a systematic review of clinical practice guidelines in the first year of the COVID-19 Pandemic. Int J Environ Res Public Health. 2021 Sep;18(19):10059. http://doi.org/10.3390/ijerph181910059. PMid:34639363.
http://doi.org/10.3390/ijerph181910059...
, limiting their capacity to provide care.
As for CEOs, it is plausible to assume that specialized services faced similar challenges, with cancellations and rescheduling of procedures due to the prioritization of resources for pandemic response. This situation may have led to a decrease in procedures, and it is necessary to investigate its extent and the time required for a return to normal activities. Monitoring the continuity of specialized dental care provided in the country will help identify the adaptability of CEOs and suggest ways to minimize the negative impacts of the COVID-19 pandemic on oral health.
Therefore, the aim of this study is to evaluate the impact of the pandemic on access to dental services in CEOs from 2019 to 2022 and its relationship with PHC.
METHODOLOGY
This is an ecological study that utilized secondary data from the SUS database1616 Brasil. Outpatient Information System of SUS (SIA/SUS) [Internet]. Brasília; 2023 [cited 2024 May 29]. Available from: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sia/cnv/qauf
http://tabnet.datasus.gov.br/cgi/deftoht...
for the period 2019 to 2022. The production data were obtained from the Outpatient Production of the SUS (SIA/SUS) records, available on the Datasus-Tabnet website1616 Brasil. Outpatient Information System of SUS (SIA/SUS) [Internet]. Brasília; 2023 [cited 2024 May 29]. Available from: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sia/cnv/qauf
http://tabnet.datasus.gov.br/cgi/deftoht...
, based on the location of service, with quantities presented by state and year of data processing in the system.
The study variable was the production of Specialized Dental Care Centers (CEOs), with inclusion criteria covering both accredited and disaccredited CEOs in Brazil, from January 2019 to December 2022, including types I, II, or III. The independent variables considered were: a) time period; b) region of Brazil; c) type of CEO; and d) the percentage of Primary Health Care coverage (PHC). To calculate the Primary Health Care coverage, data from the Primary Care Information System (SIAB) and the Information System in Health for Primary Care (SISAB) were used, covering the period from 2019 to 2022.
The data were analyzed using the R program1717 R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2019.. Descriptive statistics, control charts, and negative binomial regression analysis were employed. To study the pattern of variation in the production of Specialized Dental Care Centers (CEOs) over time, control zones (A), alert zones (B), and central zones (C) were graphically defined. The limits of each of these zones were calculated considering the negative binomial distribution. The CEO production was then analyzed over time, examining the following aspects of control chart methodology: months with production above the upper or lower control lines, at least six consecutive months with increasing or decreasing production, at least nine consecutive months on the same side (above or below) of the mean, two out of three consecutive months in any of the A zones, and four out of five consecutive months in any of the B zones or beyond1818 Arantes A, Carvalho ES, Medeiros EA, Farhat CK, Mantese OC. Uso de diagramas de controle na vigilância epidemiológica das infecções hospitalares. Rev Saude Publica. 2003 Dec;37(6):768-74. http://doi.org/10.1590/S0034-89102003000600012. PMid:14666307.
http://doi.org/10.1590/S0034-89102003000...
.
These characteristics indicate non-random patterns, signaling a trend of variation over time. Additionally, Spearman correlation analyses were conducted between CEOs production and PHC coverage over the four years analyzed. The correlation coefficients were interpreted following Mukaka1919 Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012 Sep;24(3):69-71. PMid:23638278.. Moreover, negative binomial regression models were adjusted to analyze the relationship between Specialized Dental Care Centers production and Primary Health Care coverage (PHC). The model fit quality was evaluated using the deviance. The research obtained an ethics committee exemption since the data used is from a publicly accessible system.
RESULTS
The analysis of national production over time, using the control chart (Figure 1), reveals a pattern of variation. A significant drop in CEO production in April 2020 is visible, followed by a period of very low production until May 2020 and subsequently low production until February 2021.
Control chart of the production of Specialized Dental Centers (SDC) in Brazil, between the years 2019 and 2022. Data source: Information System of the Unified Health System (SIA/SUS)2020 Brasil. Sistemas de Informações Ambulatoriais do SUS [Internet]. Brasília: Ministério da Saúde; 2024 [cited 2024 May 29]. Available from: http://sia.datasus.gov.br
http://sia.datasus.gov.br... .
When analyzing the trend of CEO production by region of the country (Figure 2), it can be noted that in the Northern region, there was a decline in CEO production in April 2020, remaining below the average until October 2021. In the Northeast region, a drop in CEO production is observed in April 2020, staying below the average until July 2021. The graphical analysis of the South region indicates a considerable drop in production in April 2020, which remained low until July 2020 and below the average until July 2021. Subsequently, there was a recovery, with production returning to values above the average from March to December 2022. Regarding the Southeast region, the results point to a decline in production in April 2020, followed by a recovery, with production returning to values above the average from March 2022. For the Central-West region, the results indicate a drop in production in April 2020, remaining below the average until May 2021, followed by a subsequent recovery, returning to values above the average in February 2022.
Control chart of the production of Specialized Dental Centers (SDC) in Brazil, between the years 2019 and 2022, by region of the country. Data source: Outpatient Information System of the Unified Health System (SIA/SUS)2020 Brasil. Sistemas de Informações Ambulatoriais do SUS [Internet]. Brasília: Ministério da Saúde; 2024 [cited 2024 May 29]. Available from: http://sia.datasus.gov.br
http://sia.datasus.gov.br... .
Table 1 displays the production of Specialized Dental Care Centers (CEOs) for each region and the entire Brazil, covering the period from 2019 to 2022. Notably, there was a substantial drop in production recorded in April 2020 across all regions of the country. It was observed that CEO production in the country decreased from 327,206 procedures in March 2020 to 37,742 in April of the same year.
Production of Specialized Dental Centers (CEOs) in each region and across Brazil, between the years 2019 and 2022
Table 2 presents the descriptive analysis of Primary Health Care coverage (PHC) data and the production of Specialized Dental Care Centers (CEOs) in the federal units of Brazil between 2019 and 2020. It can be observed that the average PHC coverage was 78.3% in 2019 and 75.9% in 2022. As for the average production of CEOs, there were 18,530 procedures on average in 2019, decreasing to 4,546 procedures in 2020, and subsequently resuming growth, reaching 20,290 procedures in 2022. However, the adjusted regression models did not show evidence of a relationship between CEO production and PHC (p>0.05), as presented in Table 3.
Descriptive analysis of data on Primary Care Coverage (PCC) and the production of Specialized Dental Centers (SDC) in the Federative Units of Brazil, between the years 2019 and 2020
Results of negative binomial regression analyses between Primary Care Coverage (PCP) in the Federative Units of Brazil (%) and the production of Specialized Dental Centers (CEOs), for each year and overall
DISCUSSION
The study's hypothesis regarding the considerable impact of the COVID-19 pandemic on CEO procedures in Brazil was confirmed. It was observed that in all regions of the country, there was a significant drop in CEO production in April 2020, followed by a subsequent recovery in production. National CEO production remained very low until May 2020 and remained low until December 2020. The recovery of procedure quantities above the average began at the beginning of 2022.
Dental procedures within the SUS decreased from 47 million in the first half of 2019 to 15 million in the same period of 2020. Among specialized dental procedures, endodontics and periodontics experienced close to a 52% and 54% decline, respectively1212 Santos MBF, Pires ALC, Saporiti JM, Kinalski MA, Marchini L. Impact of COVID-19 pandemic on oral health procedures provided by the Brazilian public health system: COVID-19 and oral health in Brazil. Health Policy Technol. 2021 Mar;10(1):135-42. http://doi.org/10.1016/j.hlpt.2021.02.001. PMid:33585171.
http://doi.org/10.1016/j.hlpt.2021.02.00...
. Comparing the period from March to August 2019 with the respective period in 2020, a reduction rate of 88% in dental procedures was observed99 Chisini LA, Costa FDS, Demarco GT, da Silveira ER, Demarco FF. COVID-19 pandemic impact on paediatric dentistry treatments in the Brazilian Public Health System. Int J Paediatr Dent. 2021 Jan;31(1):31-4. http://doi.org/10.1111/ipd.12741. PMid:33197102.
http://doi.org/10.1111/ipd.12741...
. An investigation into the impact of COVID-19 on national dental consultations identified a significant decrease from 574,221 specialized dental consultations in 2018 to 191,703 in 20201111 Cunha ARD, Velasco SRM, Hugo FN, Antunes JLF. The impact of the COVID-19 pandemic on the provision of dental procedures performed by the Brazilian Unified Health System: a syndemic perspective. Rev Bras Epidemiol. 2021 May;24:e210028. http://doi.org/10.1590/1980-549720210028. PMid:34076147.
http://doi.org/10.1590/1980-549720210028...
. Regarding prosthetic procedures, 92,499 dental prostheses were delivered in 2019, decreasing to 59,504 in 20202121 Vieira MF, Marques PSA, Figueiredo DR, Carcereri DL, Cascaes AM. Production of dental prosthetics in the SUS in Brazilian older population and impact of the covid-19 pandemic. Rev Saude Publica. 2023 Aug;57:51. http://doi.org/10.11606/s1518-8787.2023057004828. PMid:37585950.
http://doi.org/10.11606/s1518-8787.20230...
. There was also an 89% reduction in pediatric procedures (restoration, tooth extraction, and endodontics in deciduous teeth) for April 2019, compared to the respective month in 20202222 Chisini LA, Costa FDS, Demarco GT, da Silveira ER, Demarco FF. COVID-19 pandemic impact on paediatric dentistry treatments in the Brazilian Public Health System. Int J Paediatr Dent. 2021 Jan;31(1):31-4. http://doi.org/10.1111/ipd.12741. PMid:33197102.
http://doi.org/10.1111/ipd.12741...
. These findings reinforce the substantial drop in the numbers of specialized dental procedures, as seen in the present study.
The utilization of CEO services is mediated by referrals from professionals within the PHC55 Silva HECD, Gottems LBD. Interface entre a Atenção Primária e a Secundária em odontologia no Sistema Único de Saúde: uma revisão sistemática integrativa. Cien Saude Colet. 2017 Aug;22(8):2645-57. http://doi.org/10.1590/1413-81232017228.22432015. PMid:28793079.
http://doi.org/10.1590/1413-81232017228....
. Therefore, it was expected that high PHC coverage would contribute to maintaining access to specialized dental care, which was not confirmed in the analysis. Only in the years 2021 and 2022, there was a significant positive but very weak correlation between CEO production and PHC (p<0.05). A study that analyzed the quantity of dental emergency procedures in the country before the pandemic (from March to June 2019) and after (from March to June 2020) identified a close likelihood that high PHC coverage in municipalities reduced the chances of reducing dental emergency procedures2323 Silva HG, Móra PMPK, Zajkowski LA, Celeste RK, Scarparo RK. Urgent dental care in the Brazilian public health system: learning lessons from the COVID-19 pandemic for future situations. Cad Saude Publica. 2022;38(11):e00013122. http://doi.org/10.1590/0102-311xen013122.
http://doi.org/10.1590/0102-311xen013122...
.
Indeed, dental actions and offerings in PHC were compromised during the pandemic period2222 Chisini LA, Costa FDS, Demarco GT, da Silveira ER, Demarco FF. COVID-19 pandemic impact on paediatric dentistry treatments in the Brazilian Public Health System. Int J Paediatr Dent. 2021 Jan;31(1):31-4. http://doi.org/10.1111/ipd.12741. PMid:33197102.
http://doi.org/10.1111/ipd.12741...
,2424 Medina MG, Giovanella L, Bousquat A, Mendonça MHM, Aquino R. Primary healthcare in times of COVID-19: what to do? Cad Saude Publica. 2020;36(8):e00149720. http://doi.org/10.1590/0102-311x00149720. PMid:32813791.
http://doi.org/10.1590/0102-311x00149720...
, subsequently affecting the quantity of specialized dental procedures. However, activities at this level of care were resumed based on the epidemiological situation of COVID-19 in each state. In the state of São Paulo, for instance, elective procedures resumed with recommendations to start with priority groups, vulnerable individuals, and compliance with protocol-based risk criteria. CEO activities were resumed and directly guided by referrals from PHC units starting in October 20202525 São Paulo. Coordenadoria de Planejamento de Saúde. Technical Note CIB: guidelines for the resumption of elective oral health care in the context of COVID-19 [Internet]. 2020 [cited 2024 May 29]. Available from: https://site.crosp.org.br/uploads/arquivo/bf2a1967ba797c68cfbd46e337599912.pdf?_gl=1*68bduv*_ga*MTM3ODA2OTQzOS4xNjkyMzk2OTE0*_ga_6WQQ5TNDSW*MTY5MjM5NjkxMy4xLjAuMTY5MjM5NjkxMy42MC4wLjA.*_ga_76GCH16N17*MTY5MjM5NjkxMy4xLjAuMTY5MjM5NjkxMy4wLjAuMA.&_ga=2.177398375.354158780.1692396914-1378069439.1692396914
https://site.crosp.org.br/uploads/arquiv...
.
In light of the above, it is noteworthy that it was in 2022 that CEOs regained their productivity and operated above the average, as the results revealed. The new biosafety protocols, such as administering health questionnaires before scheduling dental appointments, temperature measurement, the use of absolute isolation, thorough room and reception area sanitization, and terminal decontamination at the end of the day, and thirty minutes later after high-speed use, were suggested2525 São Paulo. Coordenadoria de Planejamento de Saúde. Technical Note CIB: guidelines for the resumption of elective oral health care in the context of COVID-19 [Internet]. 2020 [cited 2024 May 29]. Available from: https://site.crosp.org.br/uploads/arquivo/bf2a1967ba797c68cfbd46e337599912.pdf?_gl=1*68bduv*_ga*MTM3ODA2OTQzOS4xNjkyMzk2OTE0*_ga_6WQQ5TNDSW*MTY5MjM5NjkxMy4xLjAuMTY5MjM5NjkxMy42MC4wLjA.*_ga_76GCH16N17*MTY5MjM5NjkxMy4xLjAuMTY5MjM5NjkxMy4wLjAuMA.&_ga=2.177398375.354158780.1692396914-1378069439.1692396914
https://site.crosp.org.br/uploads/arquiv...
,2626 Cabrera-Tasayco FDP, Rivera-Carhuavilca JM, Atoche-Socola KJ, Peña-Soto C, Arriola-Guillén LE. Biosafety measures at the dental office after the appearance of COVID-19: a systematic review. Disaster Med Public Health Prep. 2021 Dec;15(6):e34-8. http://doi.org/10.1017/dmp.2020.269. PMid:32713385.
http://doi.org/10.1017/dmp.2020.269...
. These are some of the critical aspects for reducing the risk of COVID-19 infection, which also extend the intervals between appointments.
It is important to note that trust in the safety of health services may have increased, encouraging patients to seek treatments that were postponed during the most critical periods of the pandemic, as COVID-19 immunization gained traction and reduced morbidity and mortality from the disease in Brazil2727 Percio J, Cabral CM, Fantinato FFST, de Assis DM, Guzmán-Barrera LS, de Araújo WN. Effect of vaccination against Covid-19 one year after its introduction in Brazil. Trop Dis Travel Med Vaccines. 2022 Nov;8(1):25. http://doi.org/10.1186/s40794-022-00183-5. PMid:36401301.
http://doi.org/10.1186/s40794-022-00183-...
. The reduction in restrictions and social distancing measures also played an essential role, allowing for a gradual resumption of daily activities2828 Silva LLSD, Lima AFR, Polli DA, Razia PFS, Pavão LFA, Cavalcanti MAFH, et al. Social distancing measures in the fight against COVID-19 in Brazil: description and epidemiological analysis by state. Cad Saude Publica. 2020 Sep;36(9):e00185020. http://doi.org/10.1590/0102-311x00185020. PMid:32965378.
http://doi.org/10.1590/0102-311x00185020...
, including dental care. Moreover, the improvement in the epidemiological situation may have reduced anxiety regarding virus exposure during visits to CEOs, promoting a more favorable environment for care. Therefore, vaccination progress and pandemic control may have been catalysts for the recovery of CEOs, restoring public and professional trust and providing more favorable operational conditions for specialized dental services.
Despite the significant recovery of CEO procedures in 2022, further studies are needed to monitor this progress and assess how well they are meeting the population's needs and the pent-up demand caused by the pandemic period. In general, before the health crisis, the production and performance of CEOs in Brazil varied depending on various factors, including geographical location and the population size of municipalities2929 Andrade FB, Pinto RDS, Antunes JLF. Tendências nos indicadores de desempenho e monitoramento de produção dos Centros de Especialidades Odontológicas do Brasil. Cad Saude Publica. 2020 Sep;36(9):e00162019. http://doi.org/10.1590/0102-311x00162019. PMid:32965377.
http://doi.org/10.1590/0102-311x00162019...
,3030 Rios LRF, Colussi CF. Normative evaluation of Dental Specialties Centers, Brazil, 2014. Saúde Debate. 2019 Jan-Mar;43(120):122-36. http://doi.org/10.1590/0103-1104201912009.
http://doi.org/10.1590/0103-110420191200...
, with poorer performance identified in the Northern and Northeastern regions of the country2929 Andrade FB, Pinto RDS, Antunes JLF. Tendências nos indicadores de desempenho e monitoramento de produção dos Centros de Especialidades Odontológicas do Brasil. Cad Saude Publica. 2020 Sep;36(9):e00162019. http://doi.org/10.1590/0102-311x00162019. PMid:32965377.
http://doi.org/10.1590/0102-311x00162019...
. Poor performances were also identified in the Southeast, where, out of 151 CEOs evaluated, only 66.9% met the primary care target, 61.6% the periodontics target, 25.8% the endodontics target, and 36.4% the surgery target3131 Cabral DCR, Flório FM, Zanin L. Performance analysis of the specialized dental centers of the Brazilian southeast region. Cad Saude Colet. 2019 Apr-Jun;27(2):241-7. http://doi.org/10.1590/1414-462x201900020205.
http://doi.org/10.1590/1414-462x20190002...
. In this scenario, the return of the National Program for Improving Access and Quality of Specialized Dental Care Centers (PMAQ-CEO), instituted by Ordinance No. 261 of February 21, 2013, which proposed cycles of evaluation for all CEOs in Brazil and provided incentives for those with better performance, would be a possibility for the continuous monitoring and evaluation of these services, essential for the post-pandemic period.
Finally, this study has some limitations to consider. Firstly, due to its quantitative approach and reliance on secondary data, clarification of crucial nuances related to actions carried out in CEOs is restricted. It would be beneficial to include a qualitative assessment to complement the information obtained, exploring other aspects that may influence the results found. Additionally, it is relevant to mention that the study is of an ecological nature, which may limit the ability to establish direct causal relationships between variables, as the results reflect trends observed in larger groups or populations, rather than individual analyses. It is also worth noting that despite the use of secondary data, which may be subject to underreporting or overreporting, national databases demonstrate quality and have been widely used in studies following this approach.
The results presented can be used by SUS for the development of strategic plans aimed at strengthening the provision of specialized dental services, ensuring greater resilience in the face of disruptions such as pandemics, and promoting continuous improvements in the oral health of the population served.
CONCLUSION
In conclusion, the intensive recovery of procedures above average after two years of the pandemic's onset may reflect dental procedures postponed or canceled due to restrictions and health concerns. The extensive resumption of services could be a result of the need to address pent-up demand, suggesting a certain flexibility in the oral healthcare system to deal with adverse situations and resume normal operations, but in the long run.
-
How to cite: Moraes JSN, Cunha IP, Vedovello SAS, Ramos ACA, Meneghim MC. Impact of COVID-19 on the production of Dental Specialty Centers in Brazil. Rev Odontol UNESP. 2024;53:e20240004. https://doi.org/10.1590/1807-2577.00424
REFERENCES
-
1Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019 Jul;394(10194):249-60. http://doi.org/10.1016/S0140-6736(19)31146-8 PMid:31327369.
» http://doi.org/10.1016/S0140-6736(19)31146-8 -
2Bernabe E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, Alipour V, et al. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the global burden of disease 2017 study. J Dent Res. 2020 Apr;99(4):362-73. http://doi.org/10.1177/0022034520908533 PMid:32122215.
» http://doi.org/10.1177/0022034520908533 -
3Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. SB Brasil 2010: Pesquisa Nacional de Saúde Bucal: principais resultados. Brasília: Ministério da Saúde; 2012.
-
4Freire MCM, Reis SCGB, Figueiredo N, Peres KG, Moreira RS, Antunes JLF. Individual and contextual determinants of dental caries in Brazilian 12-year-olds in 2010. Rev Saude Publica. 2013 Dec;47(Suppl 3):40-9. http://doi.org/10.1590/S0034-8910.2013047004322 PMid:24626580.
» http://doi.org/10.1590/S0034-8910.2013047004322 -
5Silva HECD, Gottems LBD. Interface entre a Atenção Primária e a Secundária em odontologia no Sistema Único de Saúde: uma revisão sistemática integrativa. Cien Saude Colet. 2017 Aug;22(8):2645-57. http://doi.org/10.1590/1413-81232017228.22432015 PMid:28793079.
» http://doi.org/10.1590/1413-81232017228.22432015 -
6Brasil. Ministério da Saúde. Guidelines for the national oral health policy. Brasília; 2004.
-
7Brasil. Ministério da Saúde. Portaria nº 1.570, de 29 de julho de 2004. Estabelece critérios, normas e requisitos para a implantação e habilitação de Centros de Especialidades Odontológicas e Laboratórios Regionais de Próteses Dentárias. Diário Oficial da União. Brasília, 2004.
-
8World Health Organization – WHO. Considerations for the provision of essential oral health services in the context of COVID-19 [Internet]. Geneva: WHO; 2020 [cited 2024 May 29]. Available from: https://www.who.int/publications-detail-redirect/who-2019-nCoV-oral-health-2020.1
» https://www.who.int/publications-detail-redirect/who-2019-nCoV-oral-health-2020.1 -
9Chisini LA, Costa FDS, Demarco GT, da Silveira ER, Demarco FF. COVID-19 pandemic impact on paediatric dentistry treatments in the Brazilian Public Health System. Int J Paediatr Dent. 2021 Jan;31(1):31-4. http://doi.org/10.1111/ipd.12741 PMid:33197102.
» http://doi.org/10.1111/ipd.12741 -
10Chisini LA, Costa FDS, Sartori LRM, Corrêa MB, D’Avila OP, Demarco FF. COVID-19 Pandemic impact on Brazil’s Public Dental System. Braz Oral Res. 2021 Jul;35:e082. http://doi.org/10.1590/1807-3107bor-2021.vol35.0082 PMid:34287465.
» http://doi.org/10.1590/1807-3107bor-2021.vol35.0082 -
11Cunha ARD, Velasco SRM, Hugo FN, Antunes JLF. The impact of the COVID-19 pandemic on the provision of dental procedures performed by the Brazilian Unified Health System: a syndemic perspective. Rev Bras Epidemiol. 2021 May;24:e210028. http://doi.org/10.1590/1980-549720210028 PMid:34076147.
» http://doi.org/10.1590/1980-549720210028 -
12Santos MBF, Pires ALC, Saporiti JM, Kinalski MA, Marchini L. Impact of COVID-19 pandemic on oral health procedures provided by the Brazilian public health system: COVID-19 and oral health in Brazil. Health Policy Technol. 2021 Mar;10(1):135-42. http://doi.org/10.1016/j.hlpt.2021.02.001 PMid:33585171.
» http://doi.org/10.1016/j.hlpt.2021.02.001 -
13Danigno JF, Echeverria MS, Tillmann TFF, Liskoski BV, Silveira MGSES, Fernandez MDS, et al. Factors associated with the reduction of dental care in Primary Health Care in Brazil after the emergence of COVID-19: a cross-sectional study, 2020. Epidemiol Serv Saude. 2022;31(1):e2021663. http://doi.org/10.1590/s1679-49742022000100015 PMid:35544869.
» http://doi.org/10.1590/s1679-49742022000100015 -
14Lucena EHG, Freire AR, Freire DEWG, de Araújo ECF, Lira GNW, Brito ACM, et al. Offer and use of oral health in primary care before and after the beginning of the COVID-19 Pandemic in Brazil. Pesqui Bras Odontopediatria Clin Integr. 2020;20(Suppl 1):e0139. http://doi.org/10.1590/pboci.2020.163
» http://doi.org/10.1590/pboci.2020.163 -
15Deana NF, Seiffert A, Aravena-Rivas Y, Alonso-Coello P, Muñoz-Millán P, Espinoza-Espinoza G, et al. Recommendations for safe dental care: a systematic review of clinical practice guidelines in the first year of the COVID-19 Pandemic. Int J Environ Res Public Health. 2021 Sep;18(19):10059. http://doi.org/10.3390/ijerph181910059 PMid:34639363.
» http://doi.org/10.3390/ijerph181910059 -
16Brasil. Outpatient Information System of SUS (SIA/SUS) [Internet]. Brasília; 2023 [cited 2024 May 29]. Available from: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sia/cnv/qauf
» http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sia/cnv/qauf -
17R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2019.
-
18Arantes A, Carvalho ES, Medeiros EA, Farhat CK, Mantese OC. Uso de diagramas de controle na vigilância epidemiológica das infecções hospitalares. Rev Saude Publica. 2003 Dec;37(6):768-74. http://doi.org/10.1590/S0034-89102003000600012 PMid:14666307.
» http://doi.org/10.1590/S0034-89102003000600012 -
19Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012 Sep;24(3):69-71. PMid:23638278.
-
20Brasil. Sistemas de Informações Ambulatoriais do SUS [Internet]. Brasília: Ministério da Saúde; 2024 [cited 2024 May 29]. Available from: http://sia.datasus.gov.br
» http://sia.datasus.gov.br -
21Vieira MF, Marques PSA, Figueiredo DR, Carcereri DL, Cascaes AM. Production of dental prosthetics in the SUS in Brazilian older population and impact of the covid-19 pandemic. Rev Saude Publica. 2023 Aug;57:51. http://doi.org/10.11606/s1518-8787.2023057004828 PMid:37585950.
» http://doi.org/10.11606/s1518-8787.2023057004828 -
22Chisini LA, Costa FDS, Demarco GT, da Silveira ER, Demarco FF. COVID-19 pandemic impact on paediatric dentistry treatments in the Brazilian Public Health System. Int J Paediatr Dent. 2021 Jan;31(1):31-4. http://doi.org/10.1111/ipd.12741 PMid:33197102.
» http://doi.org/10.1111/ipd.12741 -
23Silva HG, Móra PMPK, Zajkowski LA, Celeste RK, Scarparo RK. Urgent dental care in the Brazilian public health system: learning lessons from the COVID-19 pandemic for future situations. Cad Saude Publica. 2022;38(11):e00013122. http://doi.org/10.1590/0102-311xen013122
» http://doi.org/10.1590/0102-311xen013122 -
24Medina MG, Giovanella L, Bousquat A, Mendonça MHM, Aquino R. Primary healthcare in times of COVID-19: what to do? Cad Saude Publica. 2020;36(8):e00149720. http://doi.org/10.1590/0102-311x00149720 PMid:32813791.
» http://doi.org/10.1590/0102-311x00149720 -
25São Paulo. Coordenadoria de Planejamento de Saúde. Technical Note CIB: guidelines for the resumption of elective oral health care in the context of COVID-19 [Internet]. 2020 [cited 2024 May 29]. Available from: https://site.crosp.org.br/uploads/arquivo/bf2a1967ba797c68cfbd46e337599912.pdf?_gl=1*68bduv*_ga*MTM3ODA2OTQzOS4xNjkyMzk2OTE0*_ga_6WQQ5TNDSW*MTY5MjM5NjkxMy4xLjAuMTY5MjM5NjkxMy42MC4wLjA.*_ga_76GCH16N17*MTY5MjM5NjkxMy4xLjAuMTY5MjM5NjkxMy4wLjAuMA.&_ga=2.177398375.354158780.1692396914-1378069439.1692396914
» https://site.crosp.org.br/uploads/arquivo/bf2a1967ba797c68cfbd46e337599912.pdf?_gl=1*68bduv*_ga*MTM3ODA2OTQzOS4xNjkyMzk2OTE0*_ga_6WQQ5TNDSW*MTY5MjM5NjkxMy4xLjAuMTY5MjM5NjkxMy42MC4wLjA.*_ga_76GCH16N17*MTY5MjM5NjkxMy4xLjAuMTY5MjM5NjkxMy4wLjAuMA.&_ga=2.177398375.354158780.1692396914-1378069439.1692396914 -
26Cabrera-Tasayco FDP, Rivera-Carhuavilca JM, Atoche-Socola KJ, Peña-Soto C, Arriola-Guillén LE. Biosafety measures at the dental office after the appearance of COVID-19: a systematic review. Disaster Med Public Health Prep. 2021 Dec;15(6):e34-8. http://doi.org/10.1017/dmp.2020.269 PMid:32713385.
» http://doi.org/10.1017/dmp.2020.269 -
27Percio J, Cabral CM, Fantinato FFST, de Assis DM, Guzmán-Barrera LS, de Araújo WN. Effect of vaccination against Covid-19 one year after its introduction in Brazil. Trop Dis Travel Med Vaccines. 2022 Nov;8(1):25. http://doi.org/10.1186/s40794-022-00183-5 PMid:36401301.
» http://doi.org/10.1186/s40794-022-00183-5 -
28Silva LLSD, Lima AFR, Polli DA, Razia PFS, Pavão LFA, Cavalcanti MAFH, et al. Social distancing measures in the fight against COVID-19 in Brazil: description and epidemiological analysis by state. Cad Saude Publica. 2020 Sep;36(9):e00185020. http://doi.org/10.1590/0102-311x00185020 PMid:32965378.
» http://doi.org/10.1590/0102-311x00185020 -
29Andrade FB, Pinto RDS, Antunes JLF. Tendências nos indicadores de desempenho e monitoramento de produção dos Centros de Especialidades Odontológicas do Brasil. Cad Saude Publica. 2020 Sep;36(9):e00162019. http://doi.org/10.1590/0102-311x00162019 PMid:32965377.
» http://doi.org/10.1590/0102-311x00162019 -
30Rios LRF, Colussi CF. Normative evaluation of Dental Specialties Centers, Brazil, 2014. Saúde Debate. 2019 Jan-Mar;43(120):122-36. http://doi.org/10.1590/0103-1104201912009
» http://doi.org/10.1590/0103-1104201912009 -
31Cabral DCR, Flório FM, Zanin L. Performance analysis of the specialized dental centers of the Brazilian southeast region. Cad Saude Colet. 2019 Apr-Jun;27(2):241-7. http://doi.org/10.1590/1414-462x201900020205
» http://doi.org/10.1590/1414-462x201900020205
Publication Dates
-
Publication in this collection
09 Aug 2024 -
Date of issue
2024
History
-
Received
19 Feb 2024 -
Accepted
29 May 2024