The impact of the COVID-19 pandemic on the provision of dental procedures performed by the Brazilian Unified Health System: a syndemic perspective.

Amanda Ramos Da Cunha,Fernando Neves Hugo,José Leopoldo Ferreira Antunes,Sofia Rafaela Maito Velasco

doi:10.1590/1980-549720210028

Abstract

This study investigated the impact of the COVID-19 pandemic on the provision of dental care procedures performed by the Brazilian Unified Health System (SUS) nationally and by regions. Considering that the most underprivileged population disproportionately suffers with the reduction in dental care provision, the study hypothesis suggests the presence of a syndemic nature. The SUS Outpatient Information System (SIA-SUS) was assessed to gather data on dental care activities and procedures performed between April and July 2018, 2019, and 2020 by dentists registered in the SUS. The 30 most frequent activities and procedures performed by dentists were selected and classified into three categories (urgent dental care, nonemergency dental care, and case-dependent urgency procedures), based on the guidance for dental care during the pandemic published by the American Dental Association. Results demonstrated a reduction in the provision of dental care of all categories during the pandemic. Urgency dental consultations and procedures in primary and specialized dental care services decreased by 42.5 and 44.1%, respectively, between 2020 and 2019. Non-urgent procedures decreased by 92.3%. Although decreases in dental care activities and procedures were reported in all Brazilian regions, the largest relative decreases in urgent procedures - that should have been maintained during the pandemic - occurred in the North and Northeast regions, which are the poorest regions of the country. These results suggest that the COVID-19 pandemic has a syndemic behavior. Further investigation into the pandemic-syndemic impacts on oral disease burden is necessary.

Highlights

The COVID-19 pandemic has been impacting healthcare services and systems worldwide[1]
Objectives: This study investigated the impact of the COVID-19 pandemic on the provision of dental care procedures performed by the Brazilian Unified Health System (SUS) nationally and by regions
The 30 most frequent activities and procedures performed by dentists were selected and classified into three categories, based on the guidance for dental care during the pandemic published by the American Dental Association

Summary

Introduction

The COVID-19 pandemic has been impacting healthcare services and systems worldwide[1]. Dental care and oral medicine face a dilemma: considering the high risk of infection in the dental environment2 – that adds up to the baseline risk of the pandemic – and the elective character of most procedures, should dental care be postponed?. In August 2020, the World Health Organization (WHO) published a set of guidelines entitled Considerations for the provision of essential oral health services in the context of COVID-19, in which it advises that routine non-urgent oral healthcare and aesthetic treatments should be delayed until there has been sufficient reduction in COVID-19 transmission rates or according to official recommendations. According to the American Dental Association (ADA), dental emergencies are potentially life-threatening situations, and urgent dental care is focused on the relief of severe pain or risk of infection and on alleviating the burden on hospital emergency departments; both require immediate care[5]

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Conclusion