Factors Associated with No Dental Treatment in Preschoolers with Toothache: A Cross-Sectional Study in Outpatient Public Emergency Services

Abstract

Many parents rely on emergency services to deal with their children’s dental problems, mostly pain and infection associated with dental caries. This cross-sectional study analyzed the factors associated with not doing an oral procedure in preschoolers with toothache attending public dental emergency services. Data were obtained from the clinical files of preschoolers treated at all nine dental emergency centers in Goiania, Brazil, in 2011. Data were children’s age and sex, involved teeth, oral procedures, radiography request, medications prescribed and referrals. A total of 531 files of children under 6 years old with toothache out of 1,108 examined were selected. Children’s mean age was 4.1 (SD 1.0) years (range 1–5 years) and 51.6% were girls. No oral procedures were performed in 49.2% of cases; in the other 50.8%, most of the oral procedures reported were endodontic intervention and temporary restorations. Primary molars were involved in 48.4% of cases. With the exception of “sex”, the independent variables tested in the regression analysis significantly associated with non-performance of oral procedures: age (OR 0.7; 95% CI 0.5–0.8), radiography request (OR 3.8; 95% CI 1.7–8.2), medication prescribed (OR 7.5; 95% CI 4.9–11.5) and patient referred to another service (OR 5.7; 3.0–10.9). Many children with toothache received no oral procedure for pain relief.

Dental emergencies in public health services: what is the role of the Dental Surgeon?

“…Another study, carried out in the PEDS of the same municipality where the present study was conducted, also demonstrated the restriction of dental emergency care in children only to prescriptions, without any effective clinical intervention [8]. It is emphasized that the professional who attends these services must be able to treat dental odontalgias, abscesses, dental trauma, haemorrhages and alveolitis.…”

“…Strategies for coping with conditions that require immediate attention in the Unified Health System (SUS) include the Emergency Public Dental Services (PEDS) [5][6][7][8][9][10]. These types of services provide prompt care to dental emergencies, representing an important part of the oral health services system, which is especially reachable to low level social vulnerable people who can't access regular dental treatment [5,6,11,12].…”

Emergency Dental Care of Children and Adolescents in Basic Health Unit and Emergency Care Unit

“…This finding is similar to the ones obtained in the present study, which indicated that several children and adolescents had received emergency care during their last dental appointment. This could be associated with unequal access to regular dentists [21][22][23], since the main problem related to toothache [8,[24][25][26][27] and to the use of emergency services [11,28,29], the so-called dental caries, is a disease that can be easily prevented and treated when it is diagnosed early on during primary health care. Another important aspect concerns the type of intervention made at UPAs, as such interventions are predominantly palliative [11] and decayed teeth are left untreated, which could quickly lead to a new acute or infectious event.…”

“…This fact should be carefully analyzed, especially among preschool children, because when they receive care at an UPA they might not be submitted to procedures that relieve their pain right away [11], allowing pain to persist and interfere with daily activities such as playing, eating, sleeping, and going to school [6,8,9]. Children whose last dental appointment occurred more than 1 year before should be monitored by primary oral healthcare team, thus reducing their use of UPAs.…”

“…UPAs operate as intermediate health facilities between UBSs and hospitals, are an integral part of the SUS emergency network and, through local and regional demand based on epidemiological and assistance aspects, they can offer treatment for dental emergencies [10]. In this treatment modality, the dental procedures usually performed in children consist mainly of pulp therapies and provisional restorations [11,12]. UBSs are linked to the healthcare network, in which primary healthcare team works as close as possible to people's homes, and are characterized by a contiguous territory and an affiliated population with which they establish a connection and co-responsibility, ensuring the maintenance of health strategies and longitudinality in healthcare.…”