Dental care utilization among children in Brazil: an exploratory study based on data from national household surveys / Utilização de serviços odontológicos entre crianças no Brasil: estudo exploratório a partir das pesquisas nacionais por amostra de domicílios

Abstract Wide availability of access to dental services can be considered a predictor of better oral health outcomes in a population. This article aims to compare data from the Brazilian National Household Sample Surveys (PNAD) on dental services utilization among children aged 4 to 12 years. This cross-sectional study was carried out using data from the 1998, 2003, and 2008 National Household Sample Surveys, involving a total of 61.438, 64.659 and 59.561 children, respectively. Ninety-nine percent confidence intervals were considered for the prevalence of each outcome of interest. In 1998, 60.8% (99%CI: 59.4;62.1) of children had been to a dentist; this prevalence was 65.5% (99%CI: 64.4;66.7) in 2003 and 73.8% (99%CI: 72.1;74.2) in 2008. In 1998, 41.2% (99%CI: 39.1;43.3) of children in the lowest household income quartile had been to a dentist; this value was 61.4% (99%CI: 59.5;63.2) in 2008. Among children from families whose head of household had 4 years of formal education or fewer, 49.5% and 63% had been to a dentist in 1998 and 2008, respectively. The lifetime prevalence of dentist attendance among Brazilian children increased between 1998 and 2008, especially among those from low-income families and those whose head of household had a low educational level.

Resumo A ampla disponibilidade de acesso aos serviços odontológicos pode ser considerada um fator preditor de melhores resultados na saúde bucal da população. O objetivo deste artigo é comparar os dados obtidos das Pesquisas Nacionais por Amostras de Domicílios (PNADs), em relação a utilização de serviços odontológicos, entre crianças de 4 a 12 anos. Estudo transversal, com dados obtidos a partir das PNADs realizadas em 1998, 2003 e 2008, envolvendo um total de 61.438, 64.659 e 59.561crianças, respectivamente. Considerou-se intervalos de confiança de 99% para os desfechos. No ano de 1998, 60,8% (IC99%: 59,4;62,1) das crianças haviam ido ao dentista, em 2003, 65,5% (IC99%: 64,4;66,7), e em 2008, 73,8% (IC99%: 72,1;74,2). Com relação à renda domiciliar, em 1998, 41,2% (IC99%: 39,1;43,3) das crianças inseridas nas famílias na menor faixa de renda foram ao cirurgião-dentista, em 2003 49,9% (IC99%: 48;51,9) o fizeram e, em 2008, 61,4% (IC99%: 59,5;63,2). Entre as que pertenciam a famílias onde o chefe possuía até 4 anos de estudo, 49,5% e 63%, em 1998 e 2008, foram às consultas odontológicas. A prevalência de crianças brasileiras que já haviam ido ao dentista aumentou entre 1998 e 2008, especialmente entre aquelas pertencentes a famílias com renda domiciliar menor e com chefes possuindo menor escolaridade.

Use of Dental Services Among Brazilian Children Aged Zero to Three Years: Analysis of National Household Surveys

Objective: To describe the use of dental services among children aged zero to three years in Brazil according to socio-demographic characteristics. Material and Methods: A cross-sectional study was carried out using data from the 1998, 2003 and 2008 Brazilian National Household Surveys involving a total of 25,769, 25,644 and 22,237 children, respectively. Prevalence rates and 99% confidence intervals (CI) were calculated. Results: : In 1998, 10.4% (99%CI: 9.7-11.1) of the children had been to the dentist. This figure was 13.4% (99%CI: 12.6-14.3) in 2003 and 16.2% (99%CI: 15.2-17.1) in 2008. In 2008, the prevalence rates of dental appointments in lifetime were respectively 10.2% (99%CI: 9.2-11.4) and 30.6% (99%CI: 27.7-33.6) for children in the lowest and highest income quartiles, 10.2% (99%CI: 8.9-11.7) and 22.4% (99%CI: 20.9- 23.9) for children from families whose head of household had up to four and nine or more years of schooling, 9.6% (99%CI: 2.2-11.1) and 27.5% (99%CI: 24.5-30.8) for those living in the northeast and central west regions of the country. Conclusion: Statistically significant increases in the prevalence rates of the use of dental services among Brazilian children aged zero to three years occurred between 1998 and 2008. The rates were lower among children belonging to socially and ethnically disadvantaged groups.

Anxiety in Children submitted to Dental Appointment

Objective: To determine anxiety in children undergoing dental treatment and to evaluate associated factors. Material and Methods: The sample consisted of 48 children during dental appointment in dental clinics of the Franciscano University Center, 48 caregivers, and 46 dentistry students. The modified Venham Picture Test was used to determine anxiety of children during dental appointment, before and after treatment. For determining anxiety related to dental care among caregivers, the modified Corah's dental anxiety scale was used. The Lipp`s stress symptoms inventory for adults was applied to determine the stress level of dentistry students. In addition, the individual characteristics of participants were recorded to determine their association with the presence of anxiety. Results: Anxiety was observed in 60.4% of children, and it was related to invasive dental procedures (p = 0.021), history of dental pain (p = 0.002), presence of bruxism (p = 0.028), anxious caregivers (p = 0.023), and stress of the dental student that conducted the appointment (p = 0.005). Conclusion: Overall, the majority of pediatric patients showed anxiety, which was directly related to misbehavior during dental care. Moreover, anxiety was related to individual characteristics of children and was influenced by the anxiety level of caregivers, as well as the emotional state of dentistry students during the dental appointment.

Access to dental services among 6-to-12-year-old children in Brazil: an exploratory study based on the national household sample survey, 2008

Objective:To analyze the access and use of dental services among 6-to-12-year-old childrenin Brazil. Material and Methods:A cross-sectional study was conducted based on micro-data from the National Household Sample Survey carried out by the Brazilian Institute of Geography and Statistics in 2008. A total of 48,854 children were included and confidence intervals of 99% (CI 99%) were considered for the prevalence rates of the outcomes. The statistical significance of differences was analyzed using these intervals, level of 1%.Results:A total of 79.3% (CI 99%: 79.3%-79.3%) of children had been to the dentist at least once in their lives. A total of 62.1% (99% CI: 62.1%-62.1%) of children from families earning up to one quarter the monthly per capita household income and 95.5% (99% CI: 95.4-95.5) of those from families earning two or more times the minimum wage were among the 25,161 children that had been to the dentist in the previous year. Regarding region of residence, 68.2% (CI 99%: 68.2%-68.2%) of children from the northeastern region of the country and 89.5% (CI 99%: 89.5%-89.6%) of those from the southern region had been to the dentist. Conclusion:A considerable number of Brazilian children had never been to the dentist by the year 2008. In addition, individuals living in the southern region and from families with greater monthly household income were among those who had already been to the dentist. These data provide evidence for guiding public policies and actions aimed at minimizing the lack of dental follow up among Brazilian children