Oral health care for people with disabilities in Brazil: Transition from the specialized dental services between 2014 and 2018

Abstract

Objective: To identify changes in the dental service provision to people with disabilities (PD) in the Dental Specialties Centers (acronym CEO in Portuguese-Centro de Especialidades Odontológicas) between the first and second cycles of the Program for the Improvement of Access and Quality of CEO and analyse factors associated with any changes.

Methods: This nationwide ecological time series study adopted the CEO as the analysis unit. The 827 CEO who participated in the two program's cycles (2014 and 2018) were included. Data on the structure and the work process were considered to identify features of providing services to PD in both cycles. Latent transition analysis (LTA) was performed to identify latent status (LS) with similar features and model the transition between LS over time. Models with five variables and with two to five LS were tested, considered best conceptual interpretability and best model fit parameters: human resources structure (dentist working exclusively with PD) and work process that identified guarantee of PD treatment at the CEO, the CEO's interface with primary care, and the interface with tertiary care. Spatial analysis was performed to identify spatial patterns of LS in the Brazilian territory with choropleth maps. A multinomial logistic regression model was performed to identify factors associated with changes in the provision of CEO (improved, remained or worsened).

Findings: The best-fit model identified four LS: 'Better', 'Medium better', 'Medium worse' and 'Worse'. CEO remained in the LS 'Better' (94%), LS 'Medium' (5.3%) and LS 'Worse' (78.4%). It is noteworthy that the highest proportion of CEO, in both cycles, was in the LS 'Better', featured by the CEO, characterized by all the CEO guaranteeing treatment to users with PD, high proportions of professionals working exclusively with PD, and most CEO articulated with primary care and with tertiary care. However, there is a decrease in the number of postgraduate professionals specializing in this service profile (1.3%). The higher the population growth, the greater the likelihood of the CEO achieving 'improved' in the LS. Moreover, the higher the number of goals, the lower the likelihood of the CEO getting 'worse' in the LS.

Conclusion: Advances in dental service provision were observed, with more significant transitions to the 'Better' class, with improvements mainly in the interface with primary and tertiary care. Disability will be an even more significant concern as the population ages. Initiatives that can remove barriers and empower PD are potent in the provision of oral health services.

Keywords: delivery of dental care; disabled persons; people with disability; public health dentistry.