Prevalence of dental visits and its associated factors during prenatal care: a cross-sectional study with puerperal women in hospitals covered by the Brazilian National Health System, Santa Catarina State, Brazil, 2019

Wagner, Katia Jakovljevic Pudla; Reses, Manoela de Leon Nobrega; Boing, Antonio Fernando

doi:10.1590/s1679-49742021000400019

Abstract

Objective

To assess the prevalence of dental visits and its associated factors during prenatal care.

Methods

This was a cross-sectional study based on interviews conducted with puerperal women in 31 hospitals covered by the Brazilian National Health System (SUS) in Santa Catarina, Brazil, 2019. Sociodemographic, economic and prenatal-related data were collected. Multivariate analyses were performed using logistic regression to calculate odds ratios (OR).

Results

3,580 puerperal women and 41.4% (95% confidence interval [95%CI] 39.7;43%) underwent dental visits during prenatal care. Higher chance of dental visits was associated with higher education level (OR=1.35 - 95%CI 1.06;1.71) and a higher number of medical/nursing consultations (OR= 1.97 - 95%CI 1.47;2.65); this chance decreased when the puerperal women did not have paid work (OR=0.82 - 95%CI 0.70;0.96) and did not take part in education activities offered by the SUS (OR=0.63 - 95%CI 0.52;0.77).

Conclusion

Factors related to schooling, employment, prenatal care and education activities increased the chance of dental visits during pregnancy in Santa Catarina State.

Keywords:
Dental Care; Prenatal Care; Dental health education; Delivery of Health Care; Healthcare Disparities; Cross-sectional studies

Introduction

Dental care during pregnancy has potential positive results for mother and child health, such as the reduction in preterm births and low birth weight.¹1. Silveira JLGC, Abraham MW, Fernandes CH. Gestação e saúde bucal: significado do cuidado em saúde bucal por gestantes não aderentes ao tratamento. Rev APS. 2016;19(4):568-74.

2. Ministério da Saúde (BR). Atenção ao pré-natal de baixo risco. Brasília, DF: MS; 2012.^-³3. Xiao J, Alkhers N, Kopycka-Kedzierawski DT, Billings RJ, Wu TT, Castillo DA, et al. Prenatal oral health care and early childhood caries prevention: a systematic review and meta-analysis. Caries Res. 2019;53(4):411-21. doi: https://doi.org/10.1159/000495187.
https://doi.org/10.1159/000495187... Educational and health promotion activities, including guidance on the importance of breastfeeding, eating habits and oral health, are suggested in the context of prenatal care.²2. Ministério da Saúde (BR). Atenção ao pré-natal de baixo risco. Brasília, DF: MS; 2012.

Receiving information about dental care during pregnancy can also help prevent dental caries in early childhood.⁴4. Riggs E, Kilpatrick N, Slack-Smith L, Chadwick B, Yelland J, Muthu MS, et al. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev. 2019 Nov 20;(11):CD012155. doi: https://doi.org/10.1002/14651858.CD012155.pub2.
https://doi.org/10.1002/14651858.CD01215... In addition, treatment of symptoms and common health problems during pregnancy such as pain, oral infection and bleeding gums is essential for pregnant women during health care process.³3. Xiao J, Alkhers N, Kopycka-Kedzierawski DT, Billings RJ, Wu TT, Castillo DA, et al. Prenatal oral health care and early childhood caries prevention: a systematic review and meta-analysis. Caries Res. 2019;53(4):411-21. doi: https://doi.org/10.1159/000495187.
https://doi.org/10.1159/000495187...

Despite possible benefits, not all women have access to dental services during pregnancy. In Brazil, data from the National Program for Improving Primary Care Access and Quality (PMAQ-AB) showed that access to dental care during pregnancy provided by the Brazilian National Health System (SUS) increased between cycles I (2011-2012) and II (2013-2014), when the prevalence of 45.9% and 51.9% could be observed, respectively.⁵5. Gonçalves KF, Giordani JMA, Bidinotto AB, Ferla AA, Martins AB, Hilgert JB. Utilização de serviço de saúde bucal no pré-natal na atenção primária à saúde: dados do PMAQ-AB. Cien Saude Colet. 2020;25(2):519-32. doi: https://doi.org/10.1590/1413-81232020252.05342018.
https://doi.org/10.1590/1413-81232020252... Thus, in general, only half of the women had dental visits during pregnancy.⁵5. Gonçalves KF, Giordani JMA, Bidinotto AB, Ferla AA, Martins AB, Hilgert JB. Utilização de serviço de saúde bucal no pré-natal na atenção primária à saúde: dados do PMAQ-AB. Cien Saude Colet. 2020;25(2):519-32. doi: https://doi.org/10.1590/1413-81232020252.05342018.
https://doi.org/10.1590/1413-81232020252...

Determinants of dental care during pregnancy have been investigated, especially in North America, therefore their results cannot be automatically inferred to different regions and realities.⁶6. Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
https://doi.org/10.1159/000481407... In Brazil, the pattern of use of dental services during pregnancy has already been analyzed, based on specific samples of pregnant women from municipalities in some states other than Santa Catarina.⁷7. Konzen Júnior DJ, Marmitt LP, Cesar JA. Não realização de consulta odontológica entre gestantes no extremo sul do Brasil: um estudo de base populacional. Cien Saude Colet. 2019;24(10):3889-96. doi: https://doi.org/10.1590/1413-812320182410.31192017.
https://doi.org/10.1590/1413-81232018241...

8. Ruiz LF, Uffermann G, Vargas-Ferreira F, Bavaresco CS, Neves M, Moura FRR. Use of dental care among pregnant women in the Brazilian unified health system. Oral Health Prev Dent. 2019;17(1):25-31. doi: https://doi.org/10.3290/j.ohpd.a41980.
https://doi.org/10.3290/j.ohpd.a41980... ^-⁹9. Schwab FCBS, Ferreira L, Martinelli KG, Esposti CDD, Pacheco KTS, Oliveira AE, Santos-Neto ET. Fatores associados à atividade educativa em saúde bucal na assistência pré-natal. Cien Saude Colet. 2021;26(3):1115-23. doi: https://doi.org/10.1590/1413-81232021263.12902019.
https://doi.org/10.1590/1413-81232021263...

Given that disparities in oral health care make disadvantaged groups less likely to have access to this service,¹⁰10. Northridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annu Rev Public Health. 2020 Apr 2;41:513-35. doi: https://doi.org/10.1146/annurev-publhealth-040119-094318.
https://doi.org/10.1146/annurev-publheal... and that population-based studies can support the planning and development of the service network, based on the hypothesis that oral health care for most pregnant women has not been a reality in the context of Primary Health Care yet, the objective of this study was to assess the prevalence of dental visits and its associated factors during prenatal care, in puerperal women attended at SUS hospitals in the state of Santa Catarina, Brazil, in 2019.

Methods

Study design and setting

This research is part of Rede Cegonha assessment study, a strategy launched by the federal government in 2011, aimed at providing women with health, quality of life and well-being during pregnancy, childbirth and postpartum period, and so on. In 2019, the study was conducted in 30 different municipalities in Santa Catarina State where the participating hospitals were located. They served women who were admitted to give birth and lived in hundreds of municipalities in the state.¹¹11. Boing AF, Lacerda JT, Boing AC, Calvo MCM, Saraiva S, Tomasi YT, et al. Methods and operational aspects of an epidemiological study and evaluation of Rede Cegonha. Rev Bras Epidemiol. 2021 Feb 15;24:e210010. doi: https://doi.org/10.1590/1980-549720210010.
https://doi.org/10.1590/1980-54972021001... This was a cross-sectional study, conducted with puerperal women living in the state of Santa Catarina whose children were born between January and August 2019, in one of the 31 hospitals in which more than 500 childbirths have been performed per year via SUS. Together, those hospitals accounted 86.2% of all SUS-funded births in the state in 2016.¹²12. Ministério da Saúde (BR). Sistema de informações sobre nascidos vivos [Internet]. Brasília, DF: MS; 2020 [acesso 12 maio 2020]. Disponível em: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.def
http://tabnet.datasus.gov.br/cgi/deftoht...

Participants

We included women who lived in Santa Catarina throughout the entire gestational period, underwent prenatal care on the SUS or did not have prenatal care visits, whose children were born alive, weighting more than 500 g, and having at least 22 weeks gestation, or stillborn or dead within 48 hours postpartum.

The interviewers, responsible for data collection, approached all the puerperal women who met the inclusion criteria and, at that moment, were hospitalized after giving birth.

Sample size

To calculate the sample size, we started estimating 50,000 births per year, based on data from the Live Birth Information System (Sinasc) in 2016, 95% confidence level, 1.6% margin of error and prevalence of 50%, we added 5% to the value obtained to allow for possible losses and refusals. The final sample was estimated at 3,665 puerperal women.¹¹11. Boing AF, Lacerda JT, Boing AC, Calvo MCM, Saraiva S, Tomasi YT, et al. Methods and operational aspects of an epidemiological study and evaluation of Rede Cegonha. Rev Bras Epidemiol. 2021 Feb 15;24:e210010. doi: https://doi.org/10.1590/1980-549720210010.
https://doi.org/10.1590/1980-54972021001...

Variables

The research outcome was self-reported dental visit (yes; no).

The independent variables investigated were:

a) age group (in years: 13-17; 18-34; ≥35);
b) self-reported race/skin color (white; black and brown);
c) marital status (with a partner, without a partner);
d) schooling (in years of study: ≤9; 10-12; ≥13);
e) household income per capita (in tertile: 1^st; 2^nd; 3^rd);
f) current paid work (yes; no);
g) parity [with other children; without other children];
h) trimester when prenatal care started (1^st; 2^nd; 3^rd);
i) number of medical/nursing consultations (1-5; 6-7; 8-9; ≥10);
j) participation in educational activity offered by SUS (yes; no); and
h) reason for dental visits (routine dental check-up [cleaning, maintenance or prevention]; toothache; orthodontic treatment; tooth extraction; root canal treatment; gum disease; other reasons).

Data source and measurement

Data were obtained from face-to-face interviews. The puerperal women were approached by 35 interviewers in 31 participating hospitals, located in the cities of Joinville, Florianópolis, São José, Lages, Itajaí, Blumenau, Chapecó, Balneario Cambour, Jaraguá do Sul, Criciúma, Tubarão, Araranguá, Rio do Sul, Mafra, Brusque, Caçador, Curitibanos, Xanxerê, Joaçaba, Içara, São Miguel do Oeste, São Bento do Sul, Indaial, Ibirama, Canoinhas, Concordia, Ituporanga, Imbituba, Videira and Timbó, in Santa Catarina State.¹¹11. Boing AF, Lacerda JT, Boing AC, Calvo MCM, Saraiva S, Tomasi YT, et al. Methods and operational aspects of an epidemiological study and evaluation of Rede Cegonha. Rev Bras Epidemiol. 2021 Feb 15;24:e210010. doi: https://doi.org/10.1590/1980-549720210010.
https://doi.org/10.1590/1980-54972021001...

The interviews were conducted in each hospital, proportionally to the number of births in 2016, between January and August 2019, the defined period for data collection. The interviewers had at least complete high school and had been previously trained. The interviews were conducted every day - including weekends and holidays - in the morning and afternoon. All births that occurred in each hospital during data collection period were included in this study. Birth volume in each unit was initially assessed and, based on this assessment, visit and hospital stay scales were organized in order to ensure complete coverage of births.

Bias

Before data collection a pilot study had been conducted with 5% of the total sample, in three hospitals that were taking part in the study, with puerperal women who had met the same inclusion criteria. These interviews were used to verify the need for adjustments in the questionnaire, the time of application of the research questions and the logistics of sending the collected data. The portion of the sample that had taken part in the pilot study did not compose the final group of participants.

For data quality control, we drew a random sample that was comprised of 10% of the interviewees. They were once again contacted via phone call to answer a reduced questionnaire composed of eight questions. No possible interview simulations (invented, non-existent) conducted by the interviewers were identified, and all quality control variables showed good or almost perfect agreement: six of the eight variables analyzed presented Cohen’s Kappa greater than 0.68. These interviews, which comprised quality control, were part of the final sample of the study.

Statistical methods

The sample was described with its proportion and 95% confidence interval (95%CI). The multivariate analysis was performed using logistic regression, and the odds ratio (OR) adjusted by the independent variables was calculated. The results were considered statistically significant when they presented p-value <0.05. Multicollinearity was tested in the model through the analysis of the variance inflation factor (VIF). The analyses were performed using the statistical program Stata version 15.1.

Ethical aspects

The research project was approved by the Human Research Ethics Committee of the Federal University of Santa Catarina: Opinion No. 1,599,464, issued on June 20, 2016 (Certificate of Submission for Ethical Appreciation No. 53671016.1.1001.0121). All participants signed a Free and Informed Consent Form, a requirement to grant interviews.

Results

A total of 3,580 puerperal women took part in the study, which shows a response rate of 97.7%. The sample flow, from the invitation to participate in the study to the outcome, is shown in Figure 1. The sample was comprised mostly of women aged between 18 and 34 years (80.8%), of white race/skin color (63.4%), who lived with a partner (80.5%), had 10 to 12 years of schooling (52.5%), with other children (60.8%), without paid work at the time of the study (54.0%). Most of the participants underwent ten or more prenatal consultations (41.7%), started prenatal care in the first trimester (81.8%) and did not take part in educational activity in Primary Health Care in the SUS (84.4%) (Table 1).

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Figure 1
Selection process and inclusion of puerperal women in the study, Santa Catarina State, Brazil, 2019

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Table 1
Main characteristics of study’s participants (n=3,580), Santa Catarina State, Brazil, 2019

During prenatal care, 41.4% (95%CI 39.7;43%) of the women underwent dental consultations. Among the socioeconomic variables that showed an association with access to the dental care, women who had 13 or more years of schooling were more likely to access this service (OR=1.35 - 95%CI 1.06;1.71), compared to those with low education level, and women who had paid work were inversely associated with dental care, compared to those who had a different condition (OR=0.82 - 95%CI 0.70;0.96). As the number of medical/nursing consultations increased, there was a greater chance of having a dental consultation: those who underwent ten or more prenatal consultations were more likely to receive dental care (OR=1.97 - 95%CI 1.47;2.65), compared to those who had one to five consultations. Another characteristic associated with access to dental care was the fact of having taken part in educational activities offered by the SUS: those who did not take part in those activities were less likely (OR=0.63 - 95%CI 0.52;0.77) to have had dental visits (Table 2). The results of the VIF ranged between 1.02 and 1.25, discarding the presence of multicollinearity between the variables of the model.

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Table 2
Prevalence and crude and adjusted odds ratio (OR) for dental consultation per pregnant women (n=3,580) during prenatal care, Santa Catarina State, Brazil, 2019

Most consultations were motivated by routine dental check-ups, cleaning, maintenance or prevention (72.1%). Toothache (9.1%) and orthodontic consultation and treatment (6.7%) (Table 3) were also cited.

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Table 3
Reason for dental consultation by pregnant women (n=1,467) during prenatal care, Santa Catarina State, Brazil, 2019

Discussion

Less than half of the parturient who received care in the 31 hospitals of Santa Catarina and who took part in this study underwent dental consultations during prenatal care. The chance of undergoing dental consultation was higher among women with higher education level, who had a paid work, underwent more medical or nursing consultations during prenatal care and took part in an education activity offered by the SUS. Most dental consultations were motivated by routine dental check-up, cleaning and maintenance, or prevention of dental problems.

Self-reported data collection performed during postpartum hospitalization is among the limitations of this study. The information obtained is subject to recall bias, since women were questioned about events that occurred during pregnancy. However, data collection in the immediate postpartum period, sought to compensate for this fragility. Among the strengths of this study is the fact that the puerperal women who composed the sample were from different municipalities of Santa Catarina and gave birth and underwent prenatal care exclusively on the SUS.¹¹11. Boing AF, Lacerda JT, Boing AC, Calvo MCM, Saraiva S, Tomasi YT, et al. Methods and operational aspects of an epidemiological study and evaluation of Rede Cegonha. Rev Bras Epidemiol. 2021 Feb 15;24:e210010. doi: https://doi.org/10.1590/1980-549720210010.
https://doi.org/10.1590/1980-54972021001...

Less than half of the women used dental service during pregnancy. In countries in North America, Asia, Europe and Latin America, dental visits ranged between 17% and 83%.⁶6. Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
https://doi.org/10.1159/000481407... Lower prevalence was observed in Greece in 2006 (27%), and in Malaysia in 2008 (29%).⁶6. Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
https://doi.org/10.1159/000481407... In the United States and Canada, the prevalence of dental visits during pregnancy ranged from 33% to 68% between 2005 and 2015, while in France, it was 44% in 2013.⁶6. Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
https://doi.org/10.1159/000481407... The highest prevalence observed was 83% in Colombia in 2012.⁶6. Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
https://doi.org/10.1159/000481407... However, it is difficult to make a comparison of this prevalence among different countries, taking into consideration methodological differences (primary or secondary data; interviews with women in different pregnancy trimesters or puerperal women) and their health services or systems (public or private; hospitals, vaccination center or maternal and child health center).⁶6. Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
https://doi.org/10.1159/000481407... ^,¹³13. Committee on Health Care for Underserved Women. Committee Opinion n. 569: oral health care during pregnancy and through the lifespan. Obstet Gynecol. 2013;122(2 Pt 1):417-22. doi: https://doi.org/10.1097/01.AOG.0000433007.16843.10.
https://doi.org/10.1097/01.AOG.000043300...

There was an increase in the prevalence of dental visits during prenatal care in Brazil, when comparing data from 2011-2012 with 2013-2014, from 46% to 52% in pregnant women who also received care on the SUS.⁵5. Gonçalves KF, Giordani JMA, Bidinotto AB, Ferla AA, Martins AB, Hilgert JB. Utilização de serviço de saúde bucal no pré-natal na atenção primária à saúde: dados do PMAQ-AB. Cien Saude Colet. 2020;25(2):519-32. doi: https://doi.org/10.1590/1413-81232020252.05342018.
https://doi.org/10.1590/1413-81232020252... In the city of Canoas, in the state of Rio Grande do Sul, 50% of pregnant women underwent dental consultations during prenatal care.⁸8. Ruiz LF, Uffermann G, Vargas-Ferreira F, Bavaresco CS, Neves M, Moura FRR. Use of dental care among pregnant women in the Brazilian unified health system. Oral Health Prev Dent. 2019;17(1):25-31. doi: https://doi.org/10.3290/j.ohpd.a41980.
https://doi.org/10.3290/j.ohpd.a41980... In Rio Grande, also in the state of Rio Grande do Sul, in 2013, this proportion was 40%.⁷7. Konzen Júnior DJ, Marmitt LP, Cesar JA. Não realização de consulta odontológica entre gestantes no extremo sul do Brasil: um estudo de base populacional. Cien Saude Colet. 2019;24(10):3889-96. doi: https://doi.org/10.1590/1413-812320182410.31192017.
https://doi.org/10.1590/1413-81232018241... It is worth noting that there was a difference in this prevalence regarding prenatal care in the public or private health network: pregnant women assisted in the public health system were less likely to have dental visits, compared to those assisted in the private health network.⁷7. Konzen Júnior DJ, Marmitt LP, Cesar JA. Não realização de consulta odontológica entre gestantes no extremo sul do Brasil: um estudo de base populacional. Cien Saude Colet. 2019;24(10):3889-96. doi: https://doi.org/10.1590/1413-812320182410.31192017.
https://doi.org/10.1590/1413-81232018241...

In Brazil, the access of the population to health and dental services,¹⁵15. Araújo CS, Lima RC, Peres MA, Barros AJD. Use of dental services and associated factors: a population-based study in southern Brazil. Cad Saude Publica. 2009;25(5):1063-72. doi: https://doi.org/10.1590/S1413-81232012001100022.
https://doi.org/10.1590/S1413-8123201200... including pregnant women,⁵5. Gonçalves KF, Giordani JMA, Bidinotto AB, Ferla AA, Martins AB, Hilgert JB. Utilização de serviço de saúde bucal no pré-natal na atenção primária à saúde: dados do PMAQ-AB. Cien Saude Colet. 2020;25(2):519-32. doi: https://doi.org/10.1590/1413-81232020252.05342018.
https://doi.org/10.1590/1413-81232020252... ^,⁷7. Konzen Júnior DJ, Marmitt LP, Cesar JA. Não realização de consulta odontológica entre gestantes no extremo sul do Brasil: um estudo de base populacional. Cien Saude Colet. 2019;24(10):3889-96. doi: https://doi.org/10.1590/1413-812320182410.31192017.
https://doi.org/10.1590/1413-81232018241... ^,¹⁴14. Santos Neto ET, Oliveira AE, Zandonade E, Leal MC. Acesso à assistência odontológica no acompanhamento pré-natal. Cien. Saude Colet. 2012;17(11):3057-68. doi: https://doi.org/10.1590/S1413-81232012001100022.
https://doi.org/10.1590/S1413-8123201200... is associated with higher income, education level and socioeconomic status. In this study, the variable ‘income’ did not have statistical significance in the adjusted analysis; however, women with higher education level and a paid work had greater access to dental services during prenatal care. Oral health conditions among pregnant women with higher educational level are better,¹⁶16. Deghatipour M, Ghorbani Z, Ghanbari S, Arshi S, Ehdayivand F, Namdari M, et al. Oral health status in relation to socioeconomic and behavioral factors among pregnant women: a community-based cross-sectional study. BMC Oral Health. 2019 Jun 17;19(1):117. doi: https://doi.org/10.1186/s12903-019-0801-x.
https://doi.org/10.1186/s12903-019-0801-... and greater access to dental services is one of the variables associated with this fact.¹⁰10. Northridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annu Rev Public Health. 2020 Apr 2;41:513-35. doi: https://doi.org/10.1146/annurev-publhealth-040119-094318.
https://doi.org/10.1146/annurev-publheal... Lower socioeconomic groups use less health services and present a higher burden of disease, making them doubly penalized due to their oral health.¹⁷17. Batista MJ, Lawrence HP, Sousa MLR. Oral health literacy and oral health outcomes in an adult population in Brazil. BMC Public Health. 2018 Jul 26;18(1):60. doi: https://doi.org/10.1186/s12889-017-4443-0.
https://doi.org/10.1186/s12889-017-4443-... ^,¹⁸18. Cheng ML, Xu MR, Xie YY, Gao XL, Wu HJ, Wang X, et al. Utilisation of oral health services and economic burden of oral diseases in China. Chin J Dent Res. 2018;21(4):275-84. doi: https://doi.org/10.3290/j.cjdr.a41086.
https://doi.org/10.3290/j.cjdr.a41086... The present study did not find an association between pregnant woman’s age and dental visits. In Rio Grande, according to the same study in 2013,⁷7. Konzen Júnior DJ, Marmitt LP, Cesar JA. Não realização de consulta odontológica entre gestantes no extremo sul do Brasil: um estudo de base populacional. Cien Saude Colet. 2019;24(10):3889-96. doi: https://doi.org/10.1590/1413-812320182410.31192017.
https://doi.org/10.1590/1413-81232018241... younger pregnant women underwent dental consultations most frequently, while in Hangzhou city, China, in 2011, older pregnant women had the highest number of dental visits.¹⁹19. Sun W, Guo J, Li X, Zhao Y, Chen H, Wu G. The routine utilization of dental care during pregnancy in eastern China and the key underlying factors: a Hangzhou City study. PLoS One. 2014 Jun 5;9(6):e98780. doi: https://doi.org/10.1371/journal.pone.0098780.
https://doi.org/10.1371/journal.pone.009... The association between the variable age and the use of dental services is not clear, and the different cut-off points used for its classification are one of the reasons for this difference.⁶6. Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
https://doi.org/10.1159/000481407...

A higher number of medical/nursing consultations during prenatal period and participation in education activities increased the chances of dental visits during pregnancy. This result corroborates those of other studies with the same theme,⁷7. Konzen Júnior DJ, Marmitt LP, Cesar JA. Não realização de consulta odontológica entre gestantes no extremo sul do Brasil: um estudo de base populacional. Cien Saude Colet. 2019;24(10):3889-96. doi: https://doi.org/10.1590/1413-812320182410.31192017.
https://doi.org/10.1590/1413-81232018241... ^,¹⁴14. Santos Neto ET, Oliveira AE, Zandonade E, Leal MC. Acesso à assistência odontológica no acompanhamento pré-natal. Cien. Saude Colet. 2012;17(11):3057-68. doi: https://doi.org/10.1590/S1413-81232012001100022.
https://doi.org/10.1590/S1413-8123201200... showing that the greater the access to health services, the greater the possibility of access to dental care. In the city of Rio Grande, it could be seen that when there was a lower number of prenatal consultations, pregnant woman were less likely to seek dental care during this period.⁷7. Konzen Júnior DJ, Marmitt LP, Cesar JA. Não realização de consulta odontológica entre gestantes no extremo sul do Brasil: um estudo de base populacional. Cien Saude Colet. 2019;24(10):3889-96. doi: https://doi.org/10.1590/1413-812320182410.31192017.
https://doi.org/10.1590/1413-81232018241... In Grande Vitória, in the state of Espírito Santo, in 2010, it could be seen that prenatal care and the number of consultations, at different gestational ages, were statistically associated with dental care, allowing us to infer that the more pregnant women go to the healthcare center for prenatal check-ups, the greater the possibility of undergoing adequate dental care.⁹9. Schwab FCBS, Ferreira L, Martinelli KG, Esposti CDD, Pacheco KTS, Oliveira AE, Santos-Neto ET. Fatores associados à atividade educativa em saúde bucal na assistência pré-natal. Cien Saude Colet. 2021;26(3):1115-23. doi: https://doi.org/10.1590/1413-81232021263.12902019.
https://doi.org/10.1590/1413-81232021263... ^,¹⁴14. Santos Neto ET, Oliveira AE, Zandonade E, Leal MC. Acesso à assistência odontológica no acompanhamento pré-natal. Cien. Saude Colet. 2012;17(11):3057-68. doi: https://doi.org/10.1590/S1413-81232012001100022.
https://doi.org/10.1590/S1413-8123201200... Oral health education activities and access to useful information are associated with greater use of dental services during pregnancy, and they are related to these two variables analyzed in this study.⁶6. Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
https://doi.org/10.1159/000481407... Individual and/or collective education activities influence the quality of dental care during pregnancy, reinforcing the importance of health education actions offered by the SUS during prenatal care.⁹9. Schwab FCBS, Ferreira L, Martinelli KG, Esposti CDD, Pacheco KTS, Oliveira AE, Santos-Neto ET. Fatores associados à atividade educativa em saúde bucal na assistência pré-natal. Cien Saude Colet. 2021;26(3):1115-23. doi: https://doi.org/10.1590/1413-81232021263.12902019.
https://doi.org/10.1590/1413-81232021263... ^,¹⁴14. Santos Neto ET, Oliveira AE, Zandonade E, Leal MC. Acesso à assistência odontológica no acompanhamento pré-natal. Cien. Saude Colet. 2012;17(11):3057-68. doi: https://doi.org/10.1590/S1413-81232012001100022.
https://doi.org/10.1590/S1413-8123201200... Oral health promotion actions based on the common risk factor approach may ensure further improvement in oral health conditions, given the discussion about the ineffectiveness of isolated educational interventions.²⁰20. Sheiham A, Watt RG. The common risk factor Approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000;28(6):399-406. doi: https://doi.org/10.1034/j.1600-0528.2000.028006399.x.
https://doi.org/10.1034/j.1600-0528.2000... Education activities aimed at pregnant women can address a series of themes related to maternal and newborn health, including oral health, and they represent a concrete example of the viability of this strategy.

The most cited reason for seeking dental care was routine dental check-ups for cleaning, maintenance or prevention. In Espírito Santo, data from 1,032 women assisted on the SUS, between April and September 2010, pointed out that the professional prophylaxis performed by the dentist was the most frequently reported activity by puerperal women, and that the percentage of women who received care for dental problems, such as pain and tooth extraction, was lower, in line with the results of this study.¹⁴14. Santos Neto ET, Oliveira AE, Zandonade E, Leal MC. Acesso à assistência odontológica no acompanhamento pré-natal. Cien. Saude Colet. 2012;17(11):3057-68. doi: https://doi.org/10.1590/S1413-81232012001100022.
https://doi.org/10.1590/S1413-8123201200... Worldwide, studies that analyze routine consultations or dental cleaning during pregnancy have reported prevalence between 17% and 37%, and dental cleaning one of the most frequent of dental consultations in pregnancy.⁶6. Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
https://doi.org/10.1159/000481407...

In conclusion, factors such as schooling, current paid work, medical and nursing consultations and education activities increased the chance of dental consultation among pregnant women who underwent prenatal care at Primary Health Care within the SUS in 2019. Taking into consideration that access to dental consultation during prenatal care has not been a reality for most women yet, and that disparities in access to this health service can be seen among different groups, it is necessary to recognize its importance for comprehensive prenatal care in the scope of SUS in Santa Catarina State.

References

¹
Silveira JLGC, Abraham MW, Fernandes CH. Gestação e saúde bucal: significado do cuidado em saúde bucal por gestantes não aderentes ao tratamento. Rev APS. 2016;19(4):568-74.
²
Ministério da Saúde (BR). Atenção ao pré-natal de baixo risco. Brasília, DF: MS; 2012.
³
Xiao J, Alkhers N, Kopycka-Kedzierawski DT, Billings RJ, Wu TT, Castillo DA, et al. Prenatal oral health care and early childhood caries prevention: a systematic review and meta-analysis. Caries Res. 2019;53(4):411-21. doi: https://doi.org/10.1159/000495187.
» https://doi.org/10.1159/000495187
⁴
Riggs E, Kilpatrick N, Slack-Smith L, Chadwick B, Yelland J, Muthu MS, et al. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev. 2019 Nov 20;(11):CD012155. doi: https://doi.org/10.1002/14651858.CD012155.pub2.
» https://doi.org/10.1002/14651858.CD012155.pub2
⁵
Gonçalves KF, Giordani JMA, Bidinotto AB, Ferla AA, Martins AB, Hilgert JB. Utilização de serviço de saúde bucal no pré-natal na atenção primária à saúde: dados do PMAQ-AB. Cien Saude Colet. 2020;25(2):519-32. doi: https://doi.org/10.1590/1413-81232020252.05342018.
» https://doi.org/10.1590/1413-81232020252.05342018
⁶
Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
» https://doi.org/10.1159/000481407
⁷
Konzen Júnior DJ, Marmitt LP, Cesar JA. Não realização de consulta odontológica entre gestantes no extremo sul do Brasil: um estudo de base populacional. Cien Saude Colet. 2019;24(10):3889-96. doi: https://doi.org/10.1590/1413-812320182410.31192017.
» https://doi.org/10.1590/1413-812320182410.31192017
⁸
Ruiz LF, Uffermann G, Vargas-Ferreira F, Bavaresco CS, Neves M, Moura FRR. Use of dental care among pregnant women in the Brazilian unified health system. Oral Health Prev Dent. 2019;17(1):25-31. doi: https://doi.org/10.3290/j.ohpd.a41980.
» https://doi.org/10.3290/j.ohpd.a41980
⁹
Schwab FCBS, Ferreira L, Martinelli KG, Esposti CDD, Pacheco KTS, Oliveira AE, Santos-Neto ET. Fatores associados à atividade educativa em saúde bucal na assistência pré-natal. Cien Saude Colet. 2021;26(3):1115-23. doi: https://doi.org/10.1590/1413-81232021263.12902019.
» https://doi.org/10.1590/1413-81232021263.12902019
¹⁰
Northridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annu Rev Public Health. 2020 Apr 2;41:513-35. doi: https://doi.org/10.1146/annurev-publhealth-040119-094318.
» https://doi.org/10.1146/annurev-publhealth-040119-094318
¹¹
Boing AF, Lacerda JT, Boing AC, Calvo MCM, Saraiva S, Tomasi YT, et al. Methods and operational aspects of an epidemiological study and evaluation of Rede Cegonha. Rev Bras Epidemiol. 2021 Feb 15;24:e210010. doi: https://doi.org/10.1590/1980-549720210010.
» https://doi.org/10.1590/1980-549720210010
¹²
Ministério da Saúde (BR). Sistema de informações sobre nascidos vivos [Internet]. Brasília, DF: MS; 2020 [acesso 12 maio 2020]. Disponível em: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.def
» http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.def
¹³
Committee on Health Care for Underserved Women. Committee Opinion n. 569: oral health care during pregnancy and through the lifespan. Obstet Gynecol. 2013;122(2 Pt 1):417-22. doi: https://doi.org/10.1097/01.AOG.0000433007.16843.10.
» https://doi.org/10.1097/01.AOG.0000433007.16843.10
¹⁴
Santos Neto ET, Oliveira AE, Zandonade E, Leal MC. Acesso à assistência odontológica no acompanhamento pré-natal. Cien. Saude Colet. 2012;17(11):3057-68. doi: https://doi.org/10.1590/S1413-81232012001100022.
» https://doi.org/10.1590/S1413-81232012001100022
¹⁵
Araújo CS, Lima RC, Peres MA, Barros AJD. Use of dental services and associated factors: a population-based study in southern Brazil. Cad Saude Publica. 2009;25(5):1063-72. doi: https://doi.org/10.1590/S1413-81232012001100022.
» https://doi.org/10.1590/S1413-81232012001100022
¹⁶
Deghatipour M, Ghorbani Z, Ghanbari S, Arshi S, Ehdayivand F, Namdari M, et al. Oral health status in relation to socioeconomic and behavioral factors among pregnant women: a community-based cross-sectional study. BMC Oral Health. 2019 Jun 17;19(1):117. doi: https://doi.org/10.1186/s12903-019-0801-x.
» https://doi.org/10.1186/s12903-019-0801-x
¹⁷
Batista MJ, Lawrence HP, Sousa MLR. Oral health literacy and oral health outcomes in an adult population in Brazil. BMC Public Health. 2018 Jul 26;18(1):60. doi: https://doi.org/10.1186/s12889-017-4443-0.
» https://doi.org/10.1186/s12889-017-4443-0
¹⁸
Cheng ML, Xu MR, Xie YY, Gao XL, Wu HJ, Wang X, et al. Utilisation of oral health services and economic burden of oral diseases in China. Chin J Dent Res. 2018;21(4):275-84. doi: https://doi.org/10.3290/j.cjdr.a41086.
» https://doi.org/10.3290/j.cjdr.a41086
¹⁹
Sun W, Guo J, Li X, Zhao Y, Chen H, Wu G. The routine utilization of dental care during pregnancy in eastern China and the key underlying factors: a Hangzhou City study. PLoS One. 2014 Jun 5;9(6):e98780. doi: https://doi.org/10.1371/journal.pone.0098780.
» https://doi.org/10.1371/journal.pone.0098780
²⁰
Sheiham A, Watt RG. The common risk factor Approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000;28(6):399-406. doi: https://doi.org/10.1034/j.1600-0528.2000.028006399.x.
» https://doi.org/10.1034/j.1600-0528.2000.028006399.x

*
The study received financial support from Fundação de Amparo à Pesquisa of the state of Santa Catarina (Fapesc): Process No 2017TR1364.

Publication Dates

Publication in this collection
19 Nov 2021
Date of issue
Jan-Dec 2021

History

Received
25 Mar 2021
Accepted
30 July 2021

Este é um artigo publicado em acesso aberto sob uma licença Creative Commons

[1] ¹
Silveira JLGC, Abraham MW, Fernandes CH. Gestação e saúde bucal: significado do cuidado em saúde bucal por gestantes não aderentes ao tratamento. Rev APS. 2016;19(4):568-74.

[2] ²
Ministério da Saúde (BR). Atenção ao pré-natal de baixo risco. Brasília, DF: MS; 2012.

[3] ³
Xiao J, Alkhers N, Kopycka-Kedzierawski DT, Billings RJ, Wu TT, Castillo DA, et al. Prenatal oral health care and early childhood caries prevention: a systematic review and meta-analysis. Caries Res. 2019;53(4):411-21. doi: https://doi.org/10.1159/000495187.
» https://doi.org/10.1159/000495187

[4] ⁴
Riggs E, Kilpatrick N, Slack-Smith L, Chadwick B, Yelland J, Muthu MS, et al. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev. 2019 Nov 20;(11):CD012155. doi: https://doi.org/10.1002/14651858.CD012155.pub2.
» https://doi.org/10.1002/14651858.CD012155.pub2

[5] ⁵
Gonçalves KF, Giordani JMA, Bidinotto AB, Ferla AA, Martins AB, Hilgert JB. Utilização de serviço de saúde bucal no pré-natal na atenção primária à saúde: dados do PMAQ-AB. Cien Saude Colet. 2020;25(2):519-32. doi: https://doi.org/10.1590/1413-81232020252.05342018.
» https://doi.org/10.1590/1413-81232020252.05342018

[6] ⁶
Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res. 2018;52(1-2):139-52. doi: https://doi.org/10.1159/000481407.
» https://doi.org/10.1159/000481407

[7] ⁷
Konzen Júnior DJ, Marmitt LP, Cesar JA. Não realização de consulta odontológica entre gestantes no extremo sul do Brasil: um estudo de base populacional. Cien Saude Colet. 2019;24(10):3889-96. doi: https://doi.org/10.1590/1413-812320182410.31192017.
» https://doi.org/10.1590/1413-812320182410.31192017

[8] ⁸
Ruiz LF, Uffermann G, Vargas-Ferreira F, Bavaresco CS, Neves M, Moura FRR. Use of dental care among pregnant women in the Brazilian unified health system. Oral Health Prev Dent. 2019;17(1):25-31. doi: https://doi.org/10.3290/j.ohpd.a41980.
» https://doi.org/10.3290/j.ohpd.a41980

[9] ⁹
Schwab FCBS, Ferreira L, Martinelli KG, Esposti CDD, Pacheco KTS, Oliveira AE, Santos-Neto ET. Fatores associados à atividade educativa em saúde bucal na assistência pré-natal. Cien Saude Colet. 2021;26(3):1115-23. doi: https://doi.org/10.1590/1413-81232021263.12902019.
» https://doi.org/10.1590/1413-81232021263.12902019

[10] ¹⁰
Northridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annu Rev Public Health. 2020 Apr 2;41:513-35. doi: https://doi.org/10.1146/annurev-publhealth-040119-094318.
» https://doi.org/10.1146/annurev-publhealth-040119-094318

[11] ¹¹
Boing AF, Lacerda JT, Boing AC, Calvo MCM, Saraiva S, Tomasi YT, et al. Methods and operational aspects of an epidemiological study and evaluation of Rede Cegonha. Rev Bras Epidemiol. 2021 Feb 15;24:e210010. doi: https://doi.org/10.1590/1980-549720210010.
» https://doi.org/10.1590/1980-549720210010

[12] ¹²
Ministério da Saúde (BR). Sistema de informações sobre nascidos vivos [Internet]. Brasília, DF: MS; 2020 [acesso 12 maio 2020]. Disponível em: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.def
» http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.def

[13] ¹³
Committee on Health Care for Underserved Women. Committee Opinion n. 569: oral health care during pregnancy and through the lifespan. Obstet Gynecol. 2013;122(2 Pt 1):417-22. doi: https://doi.org/10.1097/01.AOG.0000433007.16843.10.
» https://doi.org/10.1097/01.AOG.0000433007.16843.10

[14] ¹⁴
Santos Neto ET, Oliveira AE, Zandonade E, Leal MC. Acesso à assistência odontológica no acompanhamento pré-natal. Cien. Saude Colet. 2012;17(11):3057-68. doi: https://doi.org/10.1590/S1413-81232012001100022.
» https://doi.org/10.1590/S1413-81232012001100022

[15] ¹⁵
Araújo CS, Lima RC, Peres MA, Barros AJD. Use of dental services and associated factors: a population-based study in southern Brazil. Cad Saude Publica. 2009;25(5):1063-72. doi: https://doi.org/10.1590/S1413-81232012001100022.
» https://doi.org/10.1590/S1413-81232012001100022

[16] ¹⁶
Deghatipour M, Ghorbani Z, Ghanbari S, Arshi S, Ehdayivand F, Namdari M, et al. Oral health status in relation to socioeconomic and behavioral factors among pregnant women: a community-based cross-sectional study. BMC Oral Health. 2019 Jun 17;19(1):117. doi: https://doi.org/10.1186/s12903-019-0801-x.
» https://doi.org/10.1186/s12903-019-0801-x

[17] ¹⁷
Batista MJ, Lawrence HP, Sousa MLR. Oral health literacy and oral health outcomes in an adult population in Brazil. BMC Public Health. 2018 Jul 26;18(1):60. doi: https://doi.org/10.1186/s12889-017-4443-0.
» https://doi.org/10.1186/s12889-017-4443-0

[18] ¹⁸
Cheng ML, Xu MR, Xie YY, Gao XL, Wu HJ, Wang X, et al. Utilisation of oral health services and economic burden of oral diseases in China. Chin J Dent Res. 2018;21(4):275-84. doi: https://doi.org/10.3290/j.cjdr.a41086.
» https://doi.org/10.3290/j.cjdr.a41086

[19] ¹⁹
Sun W, Guo J, Li X, Zhao Y, Chen H, Wu G. The routine utilization of dental care during pregnancy in eastern China and the key underlying factors: a Hangzhou City study. PLoS One. 2014 Jun 5;9(6):e98780. doi: https://doi.org/10.1371/journal.pone.0098780.
» https://doi.org/10.1371/journal.pone.0098780

[20] ²⁰
Sheiham A, Watt RG. The common risk factor Approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000;28(6):399-406. doi: https://doi.org/10.1034/j.1600-0528.2000.028006399.x.
» https://doi.org/10.1034/j.1600-0528.2000.028006399.x

Variable	n	% (95%IC^a)
Age group (years)
13-17	173	4.9 (4.2;5.7)
18-34	2,847	80.8 (79.4;82.1)
≥35	504	14.3 (13.2;15.5)
Race/skin color
White	2,205	63.4 (61.8;65.0)
Black and brown	1,271	36.6 (35.0;38.2)
Marital status
With a partner	2,864	80.5 (79.1;81.7)
Without a partner	695	19.5 (18.2;20.9)
Schooling (years of study)
≤9	1,218	34.5 (33.0;36.1)
10-12	1,853	52.5 (50.8;54.1)
≥13	458	13.0 (11.9;14.1)
*Household income per capita* (tercile)**
1^st	1,134	33.4 (31.8;35.0)
2^nd	1,147	33.8 (32.2;35.4)
3^rd	1,114	32.8 (31.2;34.4)
Parity
With other children	1,732	60.8 (59.0;62.6)
Without other children	1,117	39.2 (37.4;41.0)
Trimester when prenatal care started
1^st	2,829	81.8 (80.5;83.0)
2^nd	576	16.7 (15.4;17.9)
3^rd	52	1.5 (1.1;2.0)
Number of medical/nursing consultations
1-5	382	11.1 (10.1;12.2)
6-7	659	19.2 (17.9;20.6)
8-9	958	28.0 (26.5;29.5)
≥10	1,429	41.7 (40.0;43.3)
Current paid work
Yes	1,630	46.0 (44.3;47.6)
No	1,914	54.0 (52.4;55.6)
Participation in education activities offered by Primary health care within SUS^b
Yes	553	15.6 (14.4;16.8)
No	2,991	84.4 (83.2;85.5)

Variable	Total	Dental consultation n (%)	Crude OR^a (95%IC^b)	p-value^c	Adjusted OR^a (95%IC^b)	p-value^c
Age group (years)				0.633		0.453
13-17	173	68 (38.7)	1.00		1.00
18-34	2,847	1,200 (41.7)	1.13 (0.83;1.55)		0.91 (0.65;1.29)
≥35	504	200 (40.2)	1.06 (0.75;1.52)		0.81 (0.55;1.20)
Race/skin color				0.289		0.275
White	2,205	888 (40.6)	1.00		1.00
Black and Brown	1,271	569 (42.4)	1.08 (0.94;1.24)		1.08 (0.93;1.25)
Marital status				0.941		0.836
With a partner	2,864	1,179 (41.5)	1.00		1.00
Without a partner	695	283 (41.3)	0.99 (0.94;1.18)		1.02 (0.85;1.22)
Schooling (years of study)				<0.001		0,048
≤9	1,218	453 (37.6)	1.00		1.00
10-12	1,853	773 (42.1)	1.21 (1.04;1.40)		1.09 (0.92;1.28)
≥13	458	222 (48.5)	1.56 (1.26;1.94)		1.35 (1.06;1.71)
*Household income per capita* (tercile)**				<0.001		0.163
1^st	1,134	438 (39.1)	1.00		1.00
2^nd	1,147	456 (40.0)	1.04 (0.88;1.23)		0.98 (0.82;1.18)
3^rd	1,114	513 (46.3)	1.35 (1.14;1.59)		1.16 (0.96;1.41)
Current paid work				<0.001		0.014
Yes	1,630	731 (45.2)	1.00		1.00
No	1,914	727 (38.3)	0.75 (0.66;0.86)		0.82 (0.70;0.96)
Parity				0.027		0.774
With other children	1,732	492 (44.1)	1.00		1.00
Without other children	1,117	975 (40.9)	0.88 (0.75;1.02)		0.97 (0.82;1.16)
Trimester when prenatal care started				<0.001		0.166
1^st	2,829	1,228 (43.5)	1.00		1.00
2^nd	576	197 (34.3)	0.68 (0.56;0.81)		0.83 (0.67;1.3)
3^rd	52	10 (19.2)	0.31 (0.15;0.62)		0.67 (0.31;1.40)
Number of medical/nursing consultations				<0.001		<0.001
1-5	382	96 (25.1)	1.00		1.00
6-7	659	249 (38.2)	1.83 (1.38;2.41)		1.72 (1.26;2.35)
8-9	958	406 (42.6)	2.21 (1.69;2.87)		1.91 (1.41;2.58)
≥10	1,429	655 (45.9)	2.52 (1.96;3.25)		1.97 (1.47;2.65)
Participation in education activities offered by Primary Health care within SUS^d				<0.001		<0.001
Yes	553	293 (53.0)	1.00		1.00
No	2,991	1,171 (39.3)	0.57 (0.48;0.69)		0.63 (0.52;0.77)

Reason for dental consultation	n	% (95%IC^a)
Routine dental check-up (cleaning, maintenance or prevention)	1,057	72.1 (69.8;74.3)
Toothache	134	9.1 (7.8;10.7)
Orthodontic treatment	99	6.8 (5.6;8.1)
Tooth extraction	31	2.1 (1.5;3.0)
Root canal treatment	26	1.8 (1.2;2.6)
Gum disease	39	2.6 (1.9;3.5)
Other reasons	81	5.5 (4.5;6.8)

Saúde Pública

Saúde Pública

Abstract

Objective

Methods

Results

Conclusion

Introduction

Methods

Study design and setting

Participants

Sample size

Variables

Data source and measurement

Bias

Statistical methods

Ethical aspects

Results

Discussion

References

Publication Dates

History