Changes in oral health inequalities in adults in Chile.

The adult population in Chile has a high prevalence of dental caries and non-functional dentition. Fifteen years after the Health Reform, aimed to reduce health inequalities, it is necessary to analyse changes in social inequalities in oral health in Chilean adults. METHODS: A secondary analysis of data from 2003 and 2016-2017 National Health Surveys (NHS) in Chile was performed on seven oral health outcomes in adults: prevalence of untreated caries, prevalence of severe untreated caries, number of teeth with untreated caries, prevalence of functional dentition, prevalence of edentulism, number of remaining natural teeth and utilization of dental services. Inequalities were measured with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) by education level. RESULTS: A decrease of caries inequalities measured with SII was observed from 2003 to 2016-17 NHS but an increase of remaining teeth inequalities was measured. The SII of the remaining teeth increased from 6.6 [95% CI = 5.0, 8.2] in 2003 to 8.8 [95% CI = 7.3, 10.3] in 2016-17. The SII of functional dentition by education increased from 29.0 [95% CI = 22.0, 36.0] in 2003 to 38.8 [95% CI = 32.6, 45.0]) in 2016-17. The utilization of dental services ≤1 year was the only outcome that showed a decrease in absolute and relative inequality, the SII was 33.9 [95% CI = 23.3, 45.6] in 2003 and 26.2 [95% CI = 16.6, 35.8] in 2016-17 and the RII decreased from 2.5 [95% CI = 1.7, 3.3] in 2003 to RII = 1.8 [95% CI = 1.4, 2.3] in 2016-17. CONCLUSION: The increase of tooth loss inequalities in contrast to the decrease of inequalities in dental services utilization show the need to re-evaluate the current dental programmes for adults in Chile. This may include establishing a stronger oral health promotion strategy and greater dental treatment coverage focusing on avoiding tooth extractions in vulnerable social groups.

Desafíos de la Odontología Chilena en el Contexto del Nuevo Pacto Social / Challenges of Chilean Dental Profession in the Context of a New Social Contract

La actual crisis política y social derivada en un proceso constituyente, ha despertado el interés hacia importantes discusiones de las cuáles la profesión odontológica no es ajena. La salud orales un claro marcador de desventaja social, reflejando las inequidades en salud en todo su esplendor. La falta de aseguramiento de la salud bucal, sobre todo para la población adulta, lleva a la postergación de necesidades con el consecuente deterioro a la salud que esto implica. Por otro lado, la sobreoferta de odontólogos no viene a solucionar el problema de acceso, bajo un panorama de completa desregulación; el desempleo y la precariedad laboral es cada vez común entre profesionales jóvenes, quienes deben aceptar las condiciones de sus empleadores cuyas metas económicas incentivan la intervención por sobre la prevención, aumentando el riesgo de sobretratamiento y iatrogenia. El actual proceso constituyente representa una oportunidad para repensar el rol formador de las universidades y el rol social de la profesión ante el agudo escenario de inequidades en salud oral.

The current political and social crisis which derived in a constituent process, has aroused interest in important discussions that also include the dental profession. Oral health is a clear marker of social disadvantage, reflecting health inequities in every aspect. The lack of public oral health policies, particularly with regard to the adult population, whose needs when postponed, suffer the consequent deterioration of their oral health. On the other hand, the oversupply of dentists does not solve the problem in a scenario of total deregulation. Unemployment and job insecurity are increasingly common among young professionals, who must accept conditions imposed by their employers, whose financial objectives often encourage intervention rather than prevention, thereby increasing the risk of overtreatment and iatrogenesis. The current process represents an opportunity to reevaluate the educational role of universities, and the social role of dentists in a scenario with serious oral health inequities.