Relação do contexto familiar no padrão de utilização e no tempo da última consulta odontológica entre escolares da zona leste de Manaus - AM

Abstract

The use of health services is considered a complex behavior, which has been studied using theoretical models. During adolescence, the use of dental services is a decision that is not made by the individual alone, as it depends on the actions of parents/guardians. Therefore, the aim of this study was to evaluate the relationship between the family context and the pattern of use of dental services and the time of the last visit among 12-year-old students from the public school system in a socially vulnerable area of the city of Manaus - Amazonas. This is a cross-sectional study whose data was collected using self-administered questionnaires and clinical oral examinations carried out by calibrated researchers. Andersen's behavioral model was used as a basis, considering gender, guardians' sense of coherence and family context as predisposing factors, monthly family income and dental health insurance as enabling factors, and self-perception and number of decayed teeth as need factors. The outcomes observed were utilization patterns and time of last dental visit. Data were analyzed using Multinomial Logistic Regression and multiplicative interaction was tested in the final models. The final sample consisted of 259 participants, of whom 53.3% were female and 62.2% were brown. The mean (SD) DMFT was 1.01 (1.51), with the carious component predominating at 0.74 (1.28). 84.9% of the students used dental services for pain or tooth extraction, and 41.3% had been to the dentist for more than 1 year. In the multivariate analysis, the odds of having been to the dentist between 2 and 3 years ago compared to having been to the dentist in the last year were 84% lower among those who ate more meals with their parents (OR= 0.16 CI 95% [0.03 - 0.81]) compared to those who ate fewer meals with their parents. In addition, adolescents with poorer self-perceived oral health were 2.8 times more likely to have been to the dentist more than 3 years ago than those who had been to the dentist in the past year (OR= 2.88 95% CI [1.19 - 6.9]). There was an interaction between dental caries and greater number of days missed from school without parental permission. Adolescents with more decayed teeth and who missed more days of school without parental permission were more likely to have gone to their last visit for treatment rather than prevention (OR=1.49 95% CI [1.46-1.53]). Dental caries was associated with the most recent visit being for toothache or extraction (OR=1.02 95% CI [1.01 - 1.912]). Therefore, predisposing characteristics related to the family context (missing school without permission and eating meals with parents/guardians) and assessed and perceived needs (decayed teeth and self-perceived oral health) were associated with the frequency and pattern of dental service utilization among schoolchildren.