Relation between primary and secondary health care coverage with periodontal disease in Brazil: a multilevel study

To evaluate the independent and combined effects of the presence of Dental Specialty Centers (Centros de Especialidades Odontológicas - CEOs) and primary health care coverage on Periodontal Disease (PD) among adults and older adults in Brazil.

Data from the SB Brasil 2023 survey were obtained for 7,851 individuals who used public services. Contextual variables were obtained from health information systems and the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). The outcome variable was PD, defined as having >1 tooth with probing depth >3 mm. The main exposures were the presence of CEOs and the coverage of Primary Oral Health Care (PHC-OH). Multilevel logistic regression analyses were performed.

The weighted prevalence of PD was 17.4%; and, respectively, 19.4% and 11.9% (p=0.03) in municipalities with and without CEOs. Municipalities with PHC-OH population coverage of ≤50, 50-74, 75-99%, and 100% showed prevalences of 19.3, 21.1, 18.1, and 7.7%, respectively (p=0.01). Individuals in municipalities with CEOs had higher odds of developing PD [OR 1.12 (95% CI 0.75-1.68)]. Individuals in municipalities with 100% PHC-OH coverage had OR 0.57 (95% CI 0.29-1.12), indicating lower odds of PD compared to municipalities with <50% coverage in the presence of CEOs. In the absence of CEOs, the corresponding OR was 0.43 (95%CI 0.19-0.97), but the interaction between CEO and PHC-OH was not significant (p=0.90).

Greater coverage of primary oral health care appears to be independently associated with a lower prevalence of PD in small- and medium-sized cities. Future studies should investigate barriers in the referral system.