The role of municipal public policies in oral health socioeconomic inequalities in Brazil: A multilevel study

Aguiar, Violeta Rodrigues; Pattussi, Marcos Pascoal; Celeste, Roger Keller

doi:10.1111/cdoe.12356

Cited by 24 publications

(38 citation statements)

References 37 publications

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“…The long‐term effect of fluoridation cannot therefore be assessed. However, this variable can be used as a proxy for better organisation of oral health services at the local level . Approximately 92% of municipalities in the state of São Paulo have fluoridated water, and this rate is not significant for the presence of FD.…”

Section: Discussionmentioning

confidence: 99%

Functional dentition and associated factors in Brazilian elderly people: A multilevel generalised structural equation modelling approach

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Functional dentition and associated factors in Brazilian elderly people: A multilevel generalised structural equation modelling approach

et al. 2018

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“…Dental caries prevalence among 12-year-old children has decreased over the last several decades in Brazil. 1,2 However, the prevalence of untreated dental caries is still considered high 3 and is still higher Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript.…”

Section: Introductionmentioning

confidence: 99%

“…5 The epidemiology of dental caries in Brazil was reported in two national epidemiological surveys conducted in 2003 and 2010, which demonstrated an improvement in epidemiological data. 1,2,3 In addition, epidemiological surveys have demonstrated the impact of inequalities on the prevalence of dental caries in Brazil. 3,6,7 Although the epidemiology of dental caries has improved, factors associated with dental caries experience among 12-year-old children did not change during the period between 2003 and 2010.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,3 In addition, epidemiological surveys have demonstrated the impact of inequalities on the prevalence of dental caries in Brazil. 3,6,7 Although the epidemiology of dental caries has improved, factors associated with dental caries experience among 12-year-old children did not change during the period between 2003 and 2010. 6,7 Multivariate and multilevel statistical models have indeed investigated factors associated with dental caries prevalence in the 12-year-old population.…”

Section: Introductionmentioning

confidence: 99%

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Dental caries experience and associated factors in 12-year-old-children: a population based-study

et al. 2020

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Relevant public policies in oral health have been implemented in Brazil since 2004. Changes in the epidemiological status of dental caries are expected, mainly in the child population. This study aimed to assess the dental caries experience and associated factors among 12-year-old children in the state of São Paulo, Brazil. A cross-sectional population-based study was conducted with data obtained from 415 cities, including a total of 26,325 schoolchildren who were included by the double-stage cluster technique, by lot and by systematic sampling. The statistical model included data from the São Paulo Oral Health Survey (SBSP 2015), the Human Development Index (HDI) and the Social Vulnerability Index (SVI). A theoretical-conceptual model categorized the variables into three blocks, namely, contextual (HDI, SVI, region of residence and fluoridation of water), individual (sex and ethnicity) and periodontal conditions (gingival bleeding, dental calculus and the presence of periodontal pockets), for association with the experience of caries (DMFT). Statistically significant associations were verified by hierarchical multivariate logistic (L) and Poisson (P) regression analyses (p < 0.05). The results showed that 57.7% of 12-year-old children had caries experience. Factors that determined a greater prevalence of dental caries in both models were nonwhite ethnicity (OR L = 1.113, OR P = 1.154) and the presence of gingival bleeding (OR L = 1.204, OR P = 1.255). Male children (OR L = 0.920 OR P = 0.859) and higher HDI (OR L = 0.022), OR P = 0.040) were associated with a lower prevalence of dental caries experience. Water fluoridation was associated with a lower DMFT index (OR P = 0.766). Dental caries experience is still associated with social inequalities at different levels. Policymakers should direct interventions towards reducing inequalities and the prevalence of dental caries among 12-year-old children.

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“…Studies about the effect of interventions on social disparities tend to show those targeted at individuals may increase socioeconomic gap . Traditional education interventions were shown ineffective, and studies on contextual factors were not conclusive regarding their effect on the size of inequalities . This study aimed to investigate the differential preventive effect of MI on ECC according to socioeconomic variables, in a community‐based trial in a primary healthcare (PHC) setting.…”

Section: Introductionmentioning

confidence: 99%

Motivational interviewing effects on caries prevention in children differ by income: A randomized cluster trial

Faustino-Silva

Colvara

Meyer

et al. 2019

Comm Dent Oral Epid

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Objectives:This study aimed to investigate the differential preventive effect of motivational interviewing (MI) on early childhood caries (ECC) according to socioeconomic variables, using a community-based trial in a public healthcare setting. Methods:A cluster-randomized, double-blind study with two parallel groups in healthcare clinical settings (HCCs) comparing conventional oral health education (CE) and MI aimed at mothers of children born in 2013 and 2014. The oral health team of 6 of the 12 HCCs were trained in MI. This training was intensive for active learning of the basic MI principles, conducted by a psychologist who is a PhD in psychiatry and has extensive experience in conducting MI training workshops. It was held in an experiential format divided into two 4-hour shifts, with a 1-week interval. Children who attended at least one dental visit in the first year of life at their HCC were clinically evaluated by trained examiners and parents responded to a questionnaire. The effect of MI on the caries outcome compared with CE was evaluated in different subgroups: family income, mother's education and skin colour. Results:One hundred and eighty-six were included in the CE group and 228 in the MI group. The caries rate per 100 surface-year was 1.29 (95%CI: 0.92-1.80) in the CE group and 0.46 (95%CI: 0.29-0.73) in the MI group. The effect of MI was statistically significant in the lower-income category (P = .03); MI prevented 57% of carious lesions (IRR = 0.43, 95% CI 0.22-0.83) and reduced the occurrence of the disease on more than one surface per 100 followed surface-year in this same category in the equivalent income subgroup (IRD = −1.37, P = .04). Conclusions:Motivational interviewing had a greater preventive effect against caries in children whose families are of lower income.

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The role of municipal public policies in oral health socioeconomic inequalities in Brazil: A multilevel study

Abstract: Fluoridation and policies about sanitation, education and dental care were similarly associated with oral health in different social strata. Other policies on social and economic fields may be further explored.

Cited by 24 publications

References 37 publications

Functional dentition and associated factors in Brazilian elderly people: A multilevel generalised structural equation modelling approach

Functional dentition and associated factors in Brazilian elderly people: A multilevel generalised structural equation modelling approach

Dental caries experience and associated factors in 12-year-old-children: a population based-study

Motivational interviewing effects on caries prevention in children differ by income: A randomized cluster trial

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