Abstract
BackgroundBrazilian Primary Care Facilities (PCF) provide primary care and must offer dental services for diagnosis, prevention, and treatment of diseases. According to a logic of promoting equity, PCF should be better structured in less developed places and with higher need for oral health services.ObjectiveTo analyze the structure of dental caries services in the capitals of the Brazilian Federative Units and identify whether socioeconomic factors and caries (need) are predictors of the oral health services structure.MethodsThis is an ecological study with variables retrieved from different secondary databases, clustered for the level of the federative capitals. Descriptive thematic maps were prepared, and structural equations were analyzed to identify oral health service structure’s predictors (Alpha = 5%). Four models with different outcomes related to dental caries treatment were tested: 1) % of PCF with a fully equipped office; 2) % of PCF with sufficient instruments, and 3) % of PCF with sufficient supplies; 4) % of PCF with total structure.Results21.6% of the PCF of the Brazilian capitals had a fully equipped office; 46.9% had sufficient instruments, and 30.0% had sufficient supplies for caries prevention and treatment. The four models evidenced proper fit indexes. A correlation between socioeconomic factors and the structure of oral health services was only noted in model 3. The worse the socioeconomic conditions, the lower the availability of dental supplies (standard factor loading: 0.92, P = 0.012). Estimates of total, direct and indirect effects showed that dental caries experience observed in the Brazilian population by SB-Brasil in 2010 did not affect the outcomes investigated.ConclusionMaterial resources are not equitably distributed according to the socioeconomic conditions and oral health needs of the population of the Brazilian capitals, thus contributing to persistent oral health inequities in the country.
Highlights
In Brazil, the access to oral health services happens through the public or private services providers; the latter directly paid by the users or by health insurance companies [1]
The insertion of oral health primary care teams (OHT) in the Family Health Strategy established a new paradigm of Primary Health Care (PHC) planning and programming
Florianópolis had the smallest part of the population that has or had experience of caries (73.3% of the population – that means 26.7% of the surveyed population of this capital were caries free), while Porto Velho was the capital with the highest caries population (93.5%)
Summary
In Brazil, the access to oral health services happens through the public or private services providers; the latter directly paid by the users or by health insurance companies [1]. Public dental services are mainly provided through oral health primary care teams (OHT). OHT are publicly funded healthcare providers offering care free of charge to prevent diseases and promote oral health [2]. Despite the increased oral health actions and higher use of dental services, both organizational and geographical access barriers are still a significant challenge [5, 6, 11,12,13]. Aspects related to users’ perceived need about services provided, as well as the number, geographical location, and type of health equipment are important factors that highlight the inequality between supply and demand [13], revealing persistent social inequities in oral health. According to a logic of promoting equity, PCF should be better structured in less developed places and with higher need for oral health services
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