Increase in dental caries and change in the socioeconomic profile of families in a child cohort of the primary health care in Northeast Brazil.

BACKGROUND: Factors associated with increases in dental caries and changes in the family socioeconomic profile were investigated in a paediatric primary health care (PHC) cohort in Northeast Brazil during the implementation of social and income transfer programmes. METHOD: A prospective analytical study compared data from two surveys on caries in primary dentition conducted in 2006 (age: 18-36 months, n = 1045) and 2010 (age: 5-7 years). Data from the sample recruited and re-examined in 2010 (n = 469) were analysed. Prevalences (P) and the mean primary decayed, missing and filled teeth (dmft) index, cumulative incidence and mean increase were calculated. Differences (p ≤ 0.05 and 95% CI) in dmft ≥1 were identified via McNemar's test. Differences in the mean dmft were evaluated according to socioeconomic variables (Kruskal-Wallis test and p ≤ 0.05). Multivariate analysis with a negative binomial model was used for the risk factors associated with increasing dmft. In the univariate analyses, nonparametric methods (Kruskal-Wallis test) were used to compare subsamples. Variables with p ≤ 0.20 were included in the multivariate model and retained when p ≤ 0.05. RESULTS: The prevalence and mean dmft (18-36 months and 5-7 years: p = 28.6 and 68.9%, mean = 1.01 and 3.46, respectively) and variation in mean dmft changed significantly (p < 0.005) with the education level and occupation of the mother; the prevalence and mean dmft were lower for higher maternal education level and maternal participation in the labour market. The cumulative incidence and mean increase in dmft were 8.71% and 2.45, respectively. Common risk predictors for increases in caries were consumption of sweets (RR = 1.53, 95% CI 1.09-2.14) and attendance at public schools (RR = 1.49, 95% CI: 1.81-1.89). Use of private clinical services was a protective factor (RR = 0.68, 95% CI 0.54-0.87). CONCLUSION: Increases in caries were observed despite positive changes in the distribution of socioeconomic indicators for the analysed children's families. The risk factors identified for the increase in caries suggest ongoing problems regarding the effectiveness of intersectoral and health measures for controlling caries in populations exposed to PHC programmes.

Factors for the Use of Dental Services Associated with Untreated Caries in Children of a Cohort and the Care Offered in the Primary Health Care of Recife, Brazil

Objective: To analyze factors of use of dental services associated with untreated caries in children from a cohort in the Primary Health Care of Recife and the integral care offered to oral health of children in the areas studied. Material and Methods: 1st step: Analytic study with secondary data from the dental caries inquiry conducted with the cohort in Health District II and IV in 2010. 425 records of children aged 5-7 year were included. The Dependent variable was carious component of the dmft (d≥1) index and independent variables were sociodemographic and use of dental services. Data were analyzed using descriptive and inferential statistics. Variables associated with p≤0.20 outcomes were included in the logistic regression multivariate model with permanency criteria of p≤0.05. 2nd step: Descriptive study with 15 key individuals: (03) managers, (01) central level, (02) district level, (12) members of 2 health family teams from the selected districts. The validation of the data collection instrument was performed (semi structured questionnaire). Data were processed by a descriptive analysis in Excel spreadsheet. Results: The prevalence of untreated caries was high (58.1%). The factors associated with use of dental service was: age: 7 years old (OR: 1.62; p<0.001), toothache in the last 6 months (OR: 9.63; p<0.001), unsatisfactory care (OR: 3.57; p<0.014). There was valuation of epidemiological knowledge to plan integral and integrated oral health actions for children, but deficiencies in inter-professional actions were identified to perform these actions, which are recommended by family health teams. Conclusion: The factors associated with the outcome evidenced fragilities in the dental care directed to children and the structuring of the integral care to the oral health offered, although it indicates inter-professional action, it has not been effective to positively impact the d≥1 levels observed.