Revista brasileira de epidemiologia = Brazilian journal of epidemiology · 2026
Greater municipal oral healthcare coverage is associated with lower odds of poor oral health among 5-year-old children in Brazil.
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Piovesan Érica Torres de Almeida, Barbosa Luiza de Marilac Meireles, Escalda Patrícia Maria Fonseca, Bernabe Eduardo
Аннотация
OBJECTIVE: To investigate the association between municipal oral healthcare coverage and poor oral health among pre-school children.
METHODS: Individual-level data from 5-year-old children who participated in the National Oral Health Survey - SB Brasil 2023 were merged with municipal-level data on oral healthcare coverage, retrieved from the e-Gestor Atenção Primária à Saúde (e-Gestor APS). Poor oral health was determined by the presence of primary teeth with pulp involvement, ulceration, fistula and abscess (pufa prevalence) and the need for urgent dental care according to the World Health Organization (WHO) criteria. Four trajectories of municipal oral health coverage were identified using group-based trajectory modelling, namely always-low (reference group), medium-low, medium-high and always-high coverage. Multilevel logistic regression models were used to estimate associations adjusting for municipality and individual-level covariates.
RESULTS: The variance partition coefficient of the empty model (no predictors) indicated that 18.3 and 18.0% of the total individual variance in pufa prevalence and urgent dental care need, respectively, was due to differences between municipalities. Compared to children in municipalities with always-low coverage, those in municipalities with medium-high (odds ratio: 0.59, 95% confidence interval - 95%CI 0.35-0.98) and medium-low (0.63, 95%CI 0.40-0.99) coverage had lower odds of experiencing clinical consequences of untreated dental caries. Likewise, children in municipalities with always-high coverage (OR 0.49; 95%CI 0.27-0.89) had lower odds of needing urgent dental care than those in municipalities with always-low coverage.
CONCLUSION: Greater municipal oral healthcare coverage was associated with lower odds of poor oral health among Brazilian pre-school children.
METHODS: Individual-level data from 5-year-old children who participated in the National Oral Health Survey - SB Brasil 2023 were merged with municipal-level data on oral healthcare coverage, retrieved from the e-Gestor Atenção Primária à Saúde (e-Gestor APS). Poor oral health was determined by the presence of primary teeth with pulp involvement, ulceration, fistula and abscess (pufa prevalence) and the need for urgent dental care according to the World Health Organization (WHO) criteria. Four trajectories of municipal oral health coverage were identified using group-based trajectory modelling, namely always-low (reference group), medium-low, medium-high and always-high coverage. Multilevel logistic regression models were used to estimate associations adjusting for municipality and individual-level covariates.
RESULTS: The variance partition coefficient of the empty model (no predictors) indicated that 18.3 and 18.0% of the total individual variance in pufa prevalence and urgent dental care need, respectively, was due to differences between municipalities. Compared to children in municipalities with always-low coverage, those in municipalities with medium-high (odds ratio: 0.59, 95% confidence interval - 95%CI 0.35-0.98) and medium-low (0.63, 95%CI 0.40-0.99) coverage had lower odds of experiencing clinical consequences of untreated dental caries. Likewise, children in municipalities with always-high coverage (OR 0.49; 95%CI 0.27-0.89) had lower odds of needing urgent dental care than those in municipalities with always-low coverage.
CONCLUSION: Greater municipal oral healthcare coverage was associated with lower odds of poor oral health among Brazilian pre-school children.