{"title":"市政口腔保健覆盖范围和巴西儿童龋齿问题。","authors":"Erica Torres de Almeida Piovesan, Eduardo Bernabe","doi":"10.1159/000548560","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Universal coverage for oral healthcare is expected to improve population oral health. However, empirical evidence to substantiate this expectation is scarce and inconsistent. This study investigated the association between municipal oral healthcare coverage and dental caries among 5-year-old children.</p><p><strong>Methods: </strong>This study pooled together individual-level data from 7185 five-year-old children who participated in the National Oral Health Survey - SB Brasil 2023 and monthly data on municipal oral healthcare coverage from January 2019 to December 2023. Dental caries was determined at cavity level in clinical examinations and summarised using the numbers of decayed teeth (dt), missing and filled teeth (mft) and decayed, missing and filled teeth (dmft). Group-based trajectory modelling was used to identify four distinct classes of municipal oral healthcare coverage: always-low, medium-low, medium-high and always-high. Multilevel negative binomial regression models, with children nested within municipalities, were fitted to test the association between municipal oral healthcare coverage and each caries measure, adjusting for demographic factors, socioeconomic conditions and oral healthcare-seeking behaviour.</p><p><strong>Results: </strong>The variance partition coefficient of the empty model (no predictors) indicated that 4.1%, 3.1% and 4.4% of the variance in the dmft, dt and mft scores was attributable to differences between municipalities. Greater municipal oral healthcare coverage was not associated with the dmft and dt scores after adjusting for covariates. In contrast, municipal oral healthcare coverage was associated with the mft score after adjustments. Children in municipalities with medium-low (1.09, 95%CI: 0.72-1.66), medium-high (1.45, 95% CI: 0.93-2.26) and always-high coverage (1.50, 95%CI: 0.88, 2.56) had on average higher mft scores compared to those in municipalities with always-low coverage (p-value for trend=0.047).</p><p><strong>Conclusion: </strong>This study shows that greater oral healthcare coverage was positively associated with more caries treatment experience but not with current untreated disease.</p>","PeriodicalId":9620,"journal":{"name":"Caries Research","volume":" ","pages":"1-16"},"PeriodicalIF":2.6000,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Municipal oral healthcare coverage and dental caries among Brazilian children.\",\"authors\":\"Erica Torres de Almeida Piovesan, Eduardo Bernabe\",\"doi\":\"10.1159/000548560\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Universal coverage for oral healthcare is expected to improve population oral health. However, empirical evidence to substantiate this expectation is scarce and inconsistent. This study investigated the association between municipal oral healthcare coverage and dental caries among 5-year-old children.</p><p><strong>Methods: </strong>This study pooled together individual-level data from 7185 five-year-old children who participated in the National Oral Health Survey - SB Brasil 2023 and monthly data on municipal oral healthcare coverage from January 2019 to December 2023. Dental caries was determined at cavity level in clinical examinations and summarised using the numbers of decayed teeth (dt), missing and filled teeth (mft) and decayed, missing and filled teeth (dmft). Group-based trajectory modelling was used to identify four distinct classes of municipal oral healthcare coverage: always-low, medium-low, medium-high and always-high. Multilevel negative binomial regression models, with children nested within municipalities, were fitted to test the association between municipal oral healthcare coverage and each caries measure, adjusting for demographic factors, socioeconomic conditions and oral healthcare-seeking behaviour.</p><p><strong>Results: </strong>The variance partition coefficient of the empty model (no predictors) indicated that 4.1%, 3.1% and 4.4% of the variance in the dmft, dt and mft scores was attributable to differences between municipalities. Greater municipal oral healthcare coverage was not associated with the dmft and dt scores after adjusting for covariates. In contrast, municipal oral healthcare coverage was associated with the mft score after adjustments. Children in municipalities with medium-low (1.09, 95%CI: 0.72-1.66), medium-high (1.45, 95% CI: 0.93-2.26) and always-high coverage (1.50, 95%CI: 0.88, 2.56) had on average higher mft scores compared to those in municipalities with always-low coverage (p-value for trend=0.047).</p><p><strong>Conclusion: </strong>This study shows that greater oral healthcare coverage was positively associated with more caries treatment experience but not with current untreated disease.</p>\",\"PeriodicalId\":9620,\"journal\":{\"name\":\"Caries Research\",\"volume\":\" \",\"pages\":\"1-16\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-09-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Caries Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000548560\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Caries Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000548560","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
引言：口腔保健的普遍覆盖有望改善人口的口腔健康。然而，证实这一期望的经验证据是稀缺和不一致的。摘要本研究旨在探讨城市口腔保健覆盖率与5岁儿童龋病的关系。方法：本研究汇总了参加国家口腔健康调查- SB Brasil 2023的7185名5岁儿童的个人数据，以及2019年1月至2023年12月城市口腔医疗保险的月度数据。在临床检查中，在蛀牙水平上确定龋病，并使用蛀牙（dt），缺牙和补牙（mft）和蛀牙，缺牙和补牙（dmft）的数量进行总结。使用基于群体的轨迹模型来确定四种不同类型的城市口腔保健覆盖率：始终低、中低、中高和始终高。采用多水平负二项回归模型，将儿童嵌套在城市内，对人口因素、社会经济条件和口腔保健寻求行为进行调整，以检验城市口腔保健覆盖率与每项龋齿措施之间的关系。结果：空模型的方差分割系数（无预测因子）表明，dmft、dt和mft得分的方差分别为4.1%、3.1%和4.4%，可归因于城市之间的差异。在调整协变量后，更大的市政口腔保健覆盖率与dmft和dt评分无关。相比之下，市政口腔保健覆盖率与调整后的mft评分相关。中低覆盖率（1.09,95%CI: 0.72-1.66）、中高覆盖率（1.45,95%CI: 0.93-2.26）和始终高覆盖率（1.50,95%CI: 0.88, 2.56）的城市儿童的平均mft得分高于始终低覆盖率城市的儿童（趋势p值=0.047）。结论：本研究表明，更大的口腔保健覆盖率与更多的龋齿治疗经验呈正相关，但与目前未治疗的疾病无关。
Municipal oral healthcare coverage and dental caries among Brazilian children.
Introduction: Universal coverage for oral healthcare is expected to improve population oral health. However, empirical evidence to substantiate this expectation is scarce and inconsistent. This study investigated the association between municipal oral healthcare coverage and dental caries among 5-year-old children.
Methods: This study pooled together individual-level data from 7185 five-year-old children who participated in the National Oral Health Survey - SB Brasil 2023 and monthly data on municipal oral healthcare coverage from January 2019 to December 2023. Dental caries was determined at cavity level in clinical examinations and summarised using the numbers of decayed teeth (dt), missing and filled teeth (mft) and decayed, missing and filled teeth (dmft). Group-based trajectory modelling was used to identify four distinct classes of municipal oral healthcare coverage: always-low, medium-low, medium-high and always-high. Multilevel negative binomial regression models, with children nested within municipalities, were fitted to test the association between municipal oral healthcare coverage and each caries measure, adjusting for demographic factors, socioeconomic conditions and oral healthcare-seeking behaviour.
Results: The variance partition coefficient of the empty model (no predictors) indicated that 4.1%, 3.1% and 4.4% of the variance in the dmft, dt and mft scores was attributable to differences between municipalities. Greater municipal oral healthcare coverage was not associated with the dmft and dt scores after adjusting for covariates. In contrast, municipal oral healthcare coverage was associated with the mft score after adjustments. Children in municipalities with medium-low (1.09, 95%CI: 0.72-1.66), medium-high (1.45, 95% CI: 0.93-2.26) and always-high coverage (1.50, 95%CI: 0.88, 2.56) had on average higher mft scores compared to those in municipalities with always-low coverage (p-value for trend=0.047).
Conclusion: This study shows that greater oral healthcare coverage was positively associated with more caries treatment experience but not with current untreated disease.
期刊介绍：
''Caries Research'' publishes epidemiological, clinical and laboratory studies in dental caries, erosion and related dental diseases. Some studies build on the considerable advances already made in caries prevention, e.g. through fluoride application. Some aim to improve understanding of the increasingly important problem of dental erosion and the associated tooth wear process. Others monitor the changing pattern of caries in different populations, explore improved methods of diagnosis or evaluate methods of prevention or treatment. The broad coverage of current research has given the journal an international reputation as an indispensable source for both basic scientists and clinicians engaged in understanding, investigating and preventing dental disease.
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