EPIDEMIOLOGICAL ANALYSIS OF PATIENTS SERVED IN A PUBLIC DENTAL SERVICE FOR PATIENTS WITH SPECIAL NEEDS IN BELÉM

Objective: In view of the scarcity of research aimed at patients with special needs in our region, this study aims to identify the pathologies, such as age, gender, place of origin and prevalence of caries and periodontal disease in patients enrolled in a public dental service in Belém aimed at the care of people with special needs. Method: Retrospective cross-sectional study, where the data collected in the medical records of the patients enrolled in SIDOPE-UFPA were analyzed. Results: At the end of the data collection, 219 medical records of patients eligible to participate in the study were divided into groups, such as Behavioral Disorder (27.85%), Non-Progressive Brain Encephalopathy (10.5%), Syndromes and malformations (8.7%), Intellective deficit (7.76%), among others. The prevalence of caries was 71.23% and Periodontal Disease was 23.7%; (61.6%) and Belém (62.5%) were the most prevalent place of origin. Conclusion: According to the research, most patients still need treatment, due to the high caries index found, and mainly preventive measures so that these numbers can be reduced in the future. It was also observed the complexity and variety of diseases in the patients enrolled, and the incidence of rare syndromes that should and should be studied more specifically, not only by dentistry, but also by professionals from other areas, emphasizing the importance of care multiprofessional approach to these patients.

Using Theoretical Domains Framework (TDF) to understand implementation of a pragmatic clinical trial in Public Dental Service in Norway

Background Most dental research in Norway has traditionally been conducted by universities, and the involvement of clinicians in research projects has not been a common practice. The aim of the present study was to identify behavioral factors that influence effective implementation of a pragmatic clinical trial in the Public Dental Service (PDS) in Norway and to understand which of these factors result in higher patient recruitment. Methods Dentists, dental hygienists, and dental assistants at nine Public Dental Service clinics in three counties in Norway involved in an ongoing pragmatic clinical trial were asked to complete an electronically distributed questionnaire based on the Theoretical Domains Framework (TDF). Results Thirty-seven out of 69 dentists and dental hygienists (54 %) and seventeen out of 57 dental assistants (30 %) answered the questionnaire. “Knowledge” was the domain with the highest mean response, suggesting strong confidence in personal knowledge and practical skills among the clinicians. Together with “beliefs about consequences,” “organizational resources,” and “environmental context,” “knowledge” was the one of five domains identified as important behavioral determinants in patient recruitment to clinical trials by dental professionals. Conclusions The findings suggest that TDF was useful to understand factors affecting implementation of clinical trials in PDS and that several factors such as clinical relevance of trial to be implemented, organizational resources, and communication with the research team require more attention when planning and implementing clinical trials in PDS.

Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis

Background This study verified the association between contextual and individual factors and public dental services utilisation in Brazil. Methods The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey– 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was ‘public dental service utilisation’, and Andersen’s behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level. Results The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care. Conclusions Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.

Twelve years with a capitation payment system in Swedish dental care: longitudinal development of oral health

Background Since 2007, patients receiving oral health care within the Public Dental Service in Sweden have had the possibility to choose between the traditional fee-for-service (FFS) payment system or the new capitation payment system, ‘Dental Care for Health’ (DCH). Payment models are believed to involve different incentive structures for patients and caregivers. In theory, different incentives may lead to differences in health-related outcomes, and the research has been inconclusive. This 12-year longitudinal prospective cohort study of patients in regular dental care analyzes oral health development and self-reported oral health in relation to the patients’ level of education in the two payment systems, and compares with the results from an earlier 6-year follow-up. Methods Information was obtained through a questionnaire and from a register from n = 5877 individuals who kept their original choice of payment model for 12 years, 1650 patients in DCH and 4227 in FFS, in the Public Dental Service in Region Västra Götaland, Sweden. The data comprised manifest caries prevalence, levels of self-reported oral health and education, and choice of dental care payment model. Analyses were performed with chi square and multivariable regression analysis. Results The findings from the 6-year follow-up were essentially maintained at the 12-year examination, showing that the pre-baseline caries prevalence is the most influential factor for less favorable oral health development in terms of the resulting caries prevalence. Educational level (≥ university) showed an increased influence on the risk of higher caries prevalence after 12 years and differed between payment models with regard to the relation to self-rated oral health. Conclusions Differences in health and health-influencing properties between payment models were sustained from 6 to 12 years. Strategies for making use of potential compensatory mechanisms within the capitation payment system to increase oral health equality should be considered.