Dental Specialty Centers Research Articles

Factors associated with the performance and achieving goals of specialized periodontal procedures in Brazilian dental specialties centers

BackgroundThe Brazilian Dental Specialty Centers (CEO, in Portuguese) represent the strategy of the National Oral Health Policy to provide secondary-level dental care. They offer more complex procedures, such as the treatment of periodontitis. This study aims to investigate the factors associated with the performance and the achievement goals of specialized procedures and the achievement gols of periodontics in CEO.MethodologyAnalytical and cross-sectional study using secondary data. The database of the second cycle of the External Evaluation of the National Program for Improving Access and Quality in CEO (PMAQ-CEO, in Portuguese), was utilized, which assessed 1,042 CEO on-site in 2018. The data were analyzed using multiple Poisson regression, estimating the prevalence ratio (PR) (p < 0.05).ResultsA third of the CEO (n = 305) performed all specialized procedures, with a higher prevalence observed in those with more than one bicarbonate jet prophylaxis unit (RP = 2.12; 95% CI: 1.160–3.881; p = 0.015) and when they had a higher percentage of specialist professionals (RP = 1.004; 95% CI: 1.002–1.006; p < 0.001). The periodontics goal was achieved by 617 (59.2%) CEO, with a higher prevalence among those who had a manager with supplementary training (PR = 1.21; 95% CI: 1.100-1.335; p < 0.001) and with a higher workload for the periodontist dentist (PR = 1.15; 95% CI: 1.103–1.201; p < 0,001).ConclusionAlthough most CEOs do not perform allspecialized periodontics procedures, more than half achieved the established goals. The provision of specialized periodontics services in CEO and the achievement of goals are influenced by the quantity and professional qualifications, as well as the availability of equipment.

Profile and satisfaction of patients with special health care needs assisted in dental specialty centers.

This study aimed to analyze the profile and level of satisfaction of users served in the dental specialty for patients with special healthcare needs (SHCN), based on the Brazilian Program for Improving Access and Quality ("PMAQ") of the Centers for Dental Specialties ("CEO"). This observational, quantitative study used a national secondary database in the public domain. Data were analyzed using the chi-squared test with Bonferroni correction, Student's t-test, and log-linear Poisson regression. Most users of the specialty "SHCN" interviewed were female (74.1% in 2014 and 68.8% in 2018), with a mean age of 41.7 (2014) and 44.9 (2018) years. For every 100 respondents who considered it regular or bad, 171 considered it good, and 199 considered it very good. Regarding satisfaction with the host of the "CEO," there were differences between the regions of Brazil (Midwest, Northeast, Southeast, and South). There has been an increase in the number of "CEO" that serve users with autism spectrum disorder. Generally, the "CEO" network provides humanized and welcoming services, presenting better performance in the second evaluation cycle, according to user perception.

Impact of COVID-19 on the production of Dental Specialty Centers in Brazil

Impact of COVID-19 on the production of Dental Specialty Centers in Brazil

Model Proposal for Equity Production in Access to Dental Specialty Centers

Model Proposal for Equity Production in Access to Dental Specialty Centers

Evaluation of the availability of secondary dental care within the Brazilian public health system: a cross-sectional study

To achieve the goal of comprehensive care provided between primary and secondary care, the interface must be without barriers. This cross-sectional study evaluated the availability of secondary dental care services in public health services in Brazil. This study focused on reference Dental Specialty Centers (DSCs) with 18,114 Oral Health Teams (OHTs) that adhered to the second cycle of the “National Program for Improving Access and Quality of Primary Care” (PMAQ-AB). Questions about the availability of DSCs for patient referrals by OHTs and the type of dental specialties provided by municipalities in DSCs were analyzed descriptively and compared per Brazilian macro-region. Seventy-five percent of OHTs reported the existence of DSCs for patient referral. The most available specialties at DSCs included minor oral surgery (90.1%), endodontics (82.0%), patients with special needs (81.5%), and periodontics (80.5%). The OHTs presented a mean of 5.77 (±2.08) referable specialties. OHTs from the South and Southeast regions reported the availability of more specialized consultations. The most available specialties in all regions included minor oral surgery, endodontics, patients with special needs, and periodontics. The best results were found in the Southeast, followed by the Northeast and South regions. Brazilian public oral health shows a structure of secondary oral health care, however, a difference was observed among the OHTs, especially as regards the frequency and availability of specialties. More investments in public oral health care in Brazil are required to improve the availability of secondary dental care in regions with lower economic development.

Regulation of dental consultations in primary health care and performance of services in dental speciality centers

ObjectiveThis study analyzed the regulation of dental specialty centers (CEOs) coordinated exclusively by Primary Health Care (PHC) in four primary outcomes: access and dental consultation, reception services, bonding and responsibility, and social participation.MethodsA cross-sectional study was carried out using secondary data from the National Program for the Improvement of Access and Quality of Dental Specialty Centers (PMAQ-CEO): second cycle, using multilevel logistic regression to calculate the odds ratio (OR) and individual covariates.ResultsThe analytical sample consisted of 9,599 CEO users who had completed all the variables analyzed. Of these, 63.5% were referred to the CEO by PHC. Dental care regulated by PHC was related to better access (OR 1.36, CI 95% 1.10–1.68), better reception (OR 1.33, CI 95% 1.03–1.71), better bonding and responsibility (OR 1.36, CI 95% 0.91–2.04), and social participation (OR 1.13, CI 95% 0.93–1.35) compared to those not regulated by primary health care as the exclusive pathway.ConclusionThe regulation of access to the CEO coordinated by PHC presented the best performance. It is suggested that this form of PHC regulation, as a route for dental specialty centers, can be established in the national oral health care policy for better service performance.

Factors Associated with Avoiding Referrals by Dental Teleconsulting Sessions in Brazil.

This cross-sectional analytical study assessed the frequency of avoided referrals of primary care to other care levels by dental teleconsulting and its association with individual and contextual variables using a multilevel approach. It appraised asynchronous dental teleconsulting sessions from the secondary database of the Monitoring and Evaluation System of the Telehealth Results during 2020, during the COVID-19 pandemic. The outcome was "whether referral to secondary care was avoided". Individual variables were related to teleconsulting and professionals that requested it: sex, dental specialty, and dentistry field. Contextual variables were related to each municipality that requested responses: Municipal Human Development Index, oral health teams (OHTs) in primary health care coverage, dental specialty centers coverage, illiteracy rate, Gini index, longevity, and per capita income. A descriptive analysis was made using the Statistical Package for the Social Sciences. Hierarchical Linear and Nonlinear Modeling software was used to perform multilevel analyses to assess the association of individual and contextual variables with avoiding patient referral to other care levels. Most teleconsulting sessions avoided patient referral to other care levels (65.1%). Contextual variables explained 44.23% of the variance in the outcome. Female dentists were more likely to avoid patient referrals than male dentists (OR = 1.74; CI = 0.99-3.44; p = 0.055). In addition, an increase of one percentage point in OHT/PHC coverage of municipalities increased the likelihood of avoiding patient referral by 1% (OR = 1.01; CI = 1.00-1.02; p = 0.02). Teleconsulting sessions efficiently avoided patient referral to other care levels. Both contextual and individual factors were associated with avoided referrals by teleconsulting sessions.

Evaluation of managers’ perspectives on secondary dental care in Endodontic in Minas Gerais, Brazil

The aim of this study was to evaluate the perceptions of Municipal Oral Health Coordinators (MOHCs) of endodontic services in Dental Specialty Centers (DSCs) of Minas Gerais, Brazil. A questionnaire was sent to the MOHCs of municipalities that had DSCs. Endodontic productivity data were collected from the Health System database. Descriptive analysis and Spearman’s correlation were performed (p≤0.05). Most cities had one DSC operating (92.4%) with two endodontists (30.3%). Endodontic treatments (ETs) were performed exclusively in a DSC (87.9%). There were referral protocols for primary to secondary care in endodontics in 87.9%. Most of the DSCs had a target (84.8%); 60.6% followed the targets recommended by the Brazilian Ministry of Health (MofH), but 53.0% complied with the goal in less than 25% of the months. Technological auxiliary resources for endodontics were not present in 42.0% of the DSCs. Positive correlation was found between the number of dentists who performed ETs in DSCs with fulfillment of monthly targets (p=0.029), and a negative correlation between the availability of technological resources for the fulfillment of monthly targets (p=0.012). Some MOHCs were unaware of the principles of the MofH, suggesting that management measures and targets should be reevaluated.

SURGICAL TREATMENT OF AN ABNORMAL UPPER LABIAL FRENUM IN PEDIATRIC DENTISTRY

Introduction: The superior labial frenum corresponds to a thin and triangular anatomical structure that has its formation during the third month of intrauterine life, located from the tubercle of the upper lip to the alveolar process. Abnormal insertion of the roof-labial frenulum is usually indicated for surgical removal. If the surgical procedure is not performed, the frenum causes instability, the main problem being the diastema between the incisors, which many times cannot be treated only by orthodontics. The purpose of correction of the upper labial frenum consists of eliminating excess free tissue between the teeth, in addition to the purpose of improving aesthetics. Objective: To describe a case report of surgical treatment of the upper labial frenum performed on a pediatric patient at a Dental Specialties Center. Case report: Female patient, 11 years old, referred by the orthodontist with indication for surgical treatment of the upper labial frenum. On intraoral physical examination, the presence of persistent roof-labial frenum and diastema between the upper central incisors was observed. In view of the data obtained in the anamnesis and physical examination, we opted for the frenotomy technique with the repositioning of the brake. Intraoral antisepsis and facial antisepsis were performed, followed by terminal infiltrative anesthesia in the anterior superior alveolar nerves, bilaterally. Two oblique incisions were made close to the insertion of the roof-labial frenum and then the repositioning of the. Friction movements were performed between the incisors and simple stitches were used for suturing. After two weeks, the patient returned and the presence of tissue remnant was observed, which was removed using the same anesthetic technique and with the aid of Metzenbaum scissors, without the need for a new suture. Conclusion: Surgical treatments for labial frenum present excellent results and should be chosen according to the individual needs of each patient, always evaluating the risks, benefits and advantages and disadvantages.

Spatial-temporal analysis of hospitalizations with death caused by oral cancer in Brazil and its correlation with the expansion of healthcare coverage

Oral cancer (OC) is a growing public health problem worldwide. In Brazil, the National Oral Health Policy, implemented in 2004, expanded access to oral health services and prioritized OC care. However, it is not known whether this expansion resulted in a reduction in hospital admissions with death. This study aimed to analyze the proportion of hospital admissions who progressed to death due to OC in Brazil from 2007 to 2019 and its correlation with the coverage of health services. This study is an ecological, longitudinal, and analytical study of hospital admissions with death due to OC recorded in the Brazilian Hospital Information System. The following analyses were performed: descriptive, spatial (choropleth maps and Moran index), and negative binomial regression, with a hierarchical approach, estimating crude and adjusted regression coefficients (β) and respective 95% confidence intervals (95% CI) (alpha=5%). In 2019, Moran's index (I) of spatial autocorrelation showed a negative association between hospital admissions with death and dentist surgeon/inhabitant rate (I=-0.176), physician/inhabitant rate (I=-0.157), family health strategy (FHS) coverage (I=-0.080), oral health team (OHT) coverage (I= -0.129), dental specialty centers (DSC)/inhabitant rate (I= -0.200), and oncology bed/inhabitant rate (I= -0.101). In the adjusted regression analysis, the proportion of hospitalizations with deaths caused by OC was higher in Brazilian states with a lower medical ̸inhabitant ratio (β= -0.014; p=0.040), a lower dentists/inhabitant ratio (β= -0.720; p=0.045), a lower number of DSC (β= -0.004; p<0.000), a lower amount paid per hospitalization (β= -10.350; p<0.001), and a lower number of biopsies (β= -0.00008; p=0.010). The proportion of hospitalizations that progressed to death showed a positive association with the number of days of hospitalization (β= 0.00002; p=0.002). Increased health care coverage has decreased serious hospital admissions with deaths caused by OC in Brazil.

Integrality, absenteeism and resolubility of specialized care for pediatric patients: a cross-sectional study.

Dental Specialties Centers (CEOs) are clinics representing part of the secondary oral health care system of the Brazilian Unified Health System (SUS). Pediatric dentistry is not a requirement for service accreditation. However, the CEO of the Federal University of Rio Grande do Sul (CEO-UFRGS) has provided dental care for children aged 3-11 years since 2017. The utilization rates of health services are influenced by absenteeism. Therefore, evaluation of absences for dental appointments is of primary importance. This study aimed to evaluate referral characteristics, absenteeism, and resolubility of pediatric dentistry appointments at the CEO-UFRGS. This retrospective cross-sectional study was conducted at the Dental Teaching Hospital of the university and analyzed secondary data from referrals and medical records. From August 2017 to December 2019, 167 referrals and 96 medical records were reviewed, from which data of individual variables related to the referral process and treatment were collected. Data were collected by a single trained examiner and analyzed using SPSS software. The main reasons for referral to secondary care were dental caries and pulpal or periapical diseases associated with difficult-to-manage behavior. An absenteeism rate of 28.1% at the first pediatric dental visit and a resolution rate of 65.6% were found. Binary logistic regression analysis indicated that each day of waiting for specialized care resulted in a 0.3% of higher chance of absence for appointment. This also increased the chance by 0.7% in child who attended the first visit to complete treatment, suggesting that the waiting time for attendance was associated with absenteeism and resolubility. Public policies that expand providing child dental care in secondary care are recommended to improve access to and resolubility of services.

Association between management, human resources, and care provided to patients with special healthcare needs in dental specialty centers in Brazil: A cross-sectional study.

This study aimed to identify the association between management and human resource factors with the performance of dental care provided to patients with special health care needs (SHCN) in secondary care in Brazil in the second cycle of the Program for Quality Improvement and Access to Dental Specialty Centers (PMAQ-CEO). This study is a secondary data analysis from the second cycle from PMAQ-CEO, which evaluated 1097 Dental Specialty Centers (DSCs), conducted in 2018. Seventeen independent variables taken from dentists' training, and dental team management characteristics were analyzed to assess their influence on the reported "Performance of care for SHCN patients". An estimated score was generated from their performance on 23 questions related to the physical and human structure and work processes in the oral health care of SHCN patients in the DSCs. Negative binomial regression model with values p ≤ 0.05 were considered significant. Data analysis included residual deviation to the degree of freedom and the chi-square test. The patient care performance score with SHCN increases significantly when the DSC has a manager (RR=1.019; CI=1.011-1.026) and goal monitoring and analysis (RR=1.012; CI=1.007-1.005). By contrast, the DSCs in which the dentist is a statutory public servant (RR=0.998; CI=0.997-1.000) and performs additional unhealthy or hazardous duties (RR=0.998; CI=0.996-0.999) are less likely to provide a higher quality care. The heterogeneity and low-performance scores for dental care provided to SHCN was identified in Brazilian health services. It was possible to verify that management and human resource factors of the DSCs were associated with the performance of dental care provided to SHCN patients.

Factors associated with the municipal provision of orthodontics in the Brazilian Unified Health System.

The Brazilian federal government issued Ministerial Ordinance No. 718 in 2010 to expand the funding of orthodontic treatment provided by Brazilian municipalities via the Unified Health System (SUS in Portuguese). To identify social and structural factors associated with Brazilian municipalities that provide fixed orthodontic appliance therapy and interceptive orthodontic therapy. Official Brazilian government databases were used for data collection. Poisson regression with robust variance was used for statistical analysis. Municipalities hosting Dental Specialty Centers (DSCs) with greater installed capacity (type III DSC with 7 dental chairs or over), which employed dentists specializing in pediatric dentistry and orthodontics, were more likely to offer orthodontic services via SUS. Federal, state, and municipal managers need to review the funding of orthodontic services via SUS, which can be used for creating DSCs and hiring professionals with expertise in orthodontics.

Association between Sociodemographic Factors, Coverage and Offer of Health Services with Mortality Due to Oral and Oropharyngeal Cancer in Brazil: A 20-Year Analysis.

To investigate the association between sociodemographic factors and variables related to oral health services in oral and oropharyngeal cancer mortality in Brazil, between 2000 and 2019. This study had an ecological design. Standardized mortality rates were compared between age group, sex, and regions. Age–Period–Cohort analysis was applied. Oral health services variables were analyzed in correlation tests. Survival analysis included Kaplan–Meier estimators, log-rank tests, and Cox regression. The mortality rate increased with age and was higher in men. Southeast and south regions had the highest rates for men, and the northeast and southeast had it for women. Age–Period–Cohort analysis showed a slight increase in female deaths and an increasing trend in the annual percent change in mortality for men over age 55. In survival analysis, males, Black individuals and southern residents were more strongly associated with death. The correlation between oral health teams’ coverage was high and negative, while the number of dental specialty centers and soft tissue biopsies had a high and positive correlation. Mortality and survival patterns were dependent on sex, age, geographic region and race/ethnicity. It was observed that preventive and diagnostic procedures were not being performed, which may be related to the increase in mortality.

Factors associated with the use of a public information system of dentist-prescribed antibiotics in Minas Gerais, Brazil.

This article aims to investigate the association between socioeconomic factors, health care organizations, and the use of a management and monitoring system for the dispensing of antibiotics prescribed by dentists in public health services in Minas Gerais, Brazil. This is an ecological-epidemiological study that analyzed secondary data from the Integrated Pharmaceutical Care Management System (SIGAF) of the Department of Health of the state of MG, Brazil, in 2017. Thirteen independent variables were analyzed to assess their influence on municipal adherence to SIGAF system considering dental prescriptions of antibiotics. Descriptive statistical analyses were performed, and the Classification and Regression Tree technique was used to identify the municipal variables associated with the outcome. A total of 57,279 antibiotic courses prescribed by dentists and recorded in SIGAF were examined. Socioeconomic factors were not associated with the use of SIGAF to record these prescriptions. Oral healthcare coverage was positively associated with the use of SIGAF for the dispensing of antibiotics prescribed by dentists. Dental Specialties Center were negatively associated with the outcome. Municipalities with high oral healthcare coverage and those without a Dental Specialties Center were more likely to use SIGAF.

Factors associated with the absence of Brazilians in specialized dental centers

AimTo identify the individual and contextual factors associated with the absence of Brazilians at a scheduled appointment in Dental Specialties Centers (DSC).MethodsThis cross-sectional design uses the National Program for Improving Access and Quality of Dental Specialties Centers database, 2018. The outcome was the users' lack of at least one of the scheduled appointments. Contextual and individual independent variables were used, considering Andersen's behavioural model. The analyses were performed with the R Core Team and SAS (Studio 3.8, Institute Inc, North Carolina, U.S, 2019) programs.ResultsOf the 10,391 patients interviewed, 27.7% missed at least one of the consultations. In the adjusted multivariate model, the interpretation based on the effect size and 95% CI showed that the behaviour individual predisposing factors such as age ≤ 42 years (OR = 1.10; 95%CI:1.01–1.21), individual need factors such as participation in the “Bolsa Família” program (OR = 1,14; 95%CI:1.02–1.27), not being covered by the Family Health Strategy (OR = 1.15; 95% CI:1.02–1.30), and users of periodontics services (OR = 1.22;95%CI:1.05–1.40) were associated with absences. The behavioural factor associated with the outcome was that the DSC facilities were not in good condition (OR = 1.18; 95%CI:1.03–1.34). DSC located in the capital (OR = 1.12; 95% CI: 0.92–1.48) were 12% more likely to have dental absences than those in the interior region.ConclusionThere are individual and contextual barriers associated with patients not attending specialised public dental consultations. DSC should offer adequate hours to patients, especially young adults and vulnerable people.

RETROSPECTIVE ANALYSIS OF POTENTIALLY MALIGNAL ORAL INJURIES DIAGNOSED IN A DENTAL SPECIALTY CENTER

<h3>Objectives</h3> Perform a retrospective analysis of the prevalence of potentially malignant oral lesions (LOPMs) in a dental specialties center. <h3>Study Design</h3> Retrospective quantitative survey of patients seen in the stomatology sector from 2010 to 2019. <h3>Results</h3> In this period, 818 biopsies were performed and 706 cases of benign lesions, 58 LOPM, and 54 malignant neoplasms were diagnosed. Among the LOPMs, there was a predominance of females, with 51.72% over 50 years of age and 74.14% smokers. Among LOPMs, leukoplakia stood out, with 79.31% prevalence, followed by actinic cheilitis with 18.97% and erythroplasia with 1.72%. The most prevalent site of potentially malignant lesions was the lower lip (31.03%), followed by the buccal mucosa (27.59%) and the tongue (12.07%). Regarding histopathologic changes, mild epithelial dysplasia was present in 82.76% of cases, followed by moderate (12.07%) and intense (5.15%). <h3>Conclusions</h3> Among LOPMs, leukoplakia was present in the greatest number of cases, most commonly affecting females over 50 years of age and found predominantly in the lower lip. These studies are relevant to provide indicators that can be used to plan actions aimed at health prevention campaigns.

RETROSPECTIVE ANALYSIS OF MALIGNANT ORAL INJURIES DIAGNOSED IN A DENTAL SPECIALTY CENTER

<h3>Objectives</h3> To carry out a retrospective analysis of the prevalence of malignant oral lesions in a dental specialties center. <h3>Study Design</h3> A retrospective quantitative study of patients seen in the stomatology sector from 2010 to 2019. <h3>Results</h3> In this period, 818 biopsies were performed, with 706 cases of benign lesions, 58 potentially malignant oral lesions, and 54 malignant lesions. Of the patients diagnosed with malignant oral lesions, males were more affected (77.78%), the predominant age group was over age 50 years, and the most prevalent anatomic site was the tongue (29, 63%), followed by the lower lip (22, 22%). Regarding habits, 72.22% were smokers and 5.56% used tobacco and alcohol. Among the lesions, the prevalence of squamous cell carcinoma (SCC) was 88.89%, carcinoma in situ and basal cell 3.70%, and mucoepidermoid and leiomyosarcoma carcinoma 1.85%. Regarding the histopathologic changes in the differentiation of SCC, 48.15% were differentiated, 31.48% were well differentiated, and 9.26% were poorly differentiated. <h3>Conclusions</h3> This research agrees with the studies already published, finding a higher prevalence of malignant lesions in men over 40 years old, with SCC in the tongue being the most common and associated with risk factors such as smoking.

ORAL SQUAMOUS CELL CARCINOMA WITH MANDIBULAR BONE INVASION: CASE REPORT

Oral squamous cell carcinoma (OSCC) is the most common oral malignancy. Bone invasion by OSCC can have different clinical behavior and a variable prognosis. A 58-year-old man was referred to the Dental Specialties Center with complaint of a rapidly developing oral wound. On intraoral examination, leukoplakia associated with ulcerated areas on the lateral tongue and lower right alveolar ridge was observed. Computed tomography revealed a hypodense and infiltrative lesion in the mandibular bone and disruption of the cortical bone. After biopsy, microscopic examination showed malignant epithelial neoplasia composed of islands of neoplastic cells with intense pleomorphism, nuclear hyperchromatism, atypical mitoses, and prominent nucleoli. The final diagnosis of OSCC with mandibular bone invasion was obtained. The patient underwent surgical resection with an adequate tumor margin and neck dissection. Currently, the patient is in follow-up without recurrence. Oral squamous cell carcinoma (OSCC) is the most common oral malignancy. Bone invasion by OSCC can have different clinical behavior and a variable prognosis. A 58-year-old man was referred to the Dental Specialties Center with complaint of a rapidly developing oral wound. On intraoral examination, leukoplakia associated with ulcerated areas on the lateral tongue and lower right alveolar ridge was observed. Computed tomography revealed a hypodense and infiltrative lesion in the mandibular bone and disruption of the cortical bone. After biopsy, microscopic examination showed malignant epithelial neoplasia composed of islands of neoplastic cells with intense pleomorphism, nuclear hyperchromatism, atypical mitoses, and prominent nucleoli. The final diagnosis of OSCC with mandibular bone invasion was obtained. The patient underwent surgical resection with an adequate tumor margin and neck dissection. Currently, the patient is in follow-up without recurrence.

Evaluation of Endodontic Productivity in Oral Public Healthcare Services in Minas Gerais, Brazil

The aim of this study was to evaluate the factors associated with the average monthly productivity in endodontic services at Dental Specialty Centers (DSCs) of Minas Gerais. Secondary data were collected: the dependent variable was the average monthly productivity in endodontic services at DSCs, and the independent variables: population size, Human Development Index (HDI), Gini Index, Family Health Program’s (FHP) population coverage rate, DSC type, and accreditation time. 76 DSCs were included. Median values for population size, HDI, Gini Index, FHP coverage, and accreditation service time were, respectively, 67,442.50, 0.732, 0.410, 77.945, and 8.00. The endodontic treatment of single-rooted teeth exhibited the highest median production. Most of the DSCs (61.7%) did not reach the targets set. Population size (p=0.001) and DSC type (p=0.025) were associated with the average monthly productivity. The average monthly productivity in endodontic services at these DSCs was low, which was positively associated with population size and accredited DSC type.