Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil

The objective of this study was to describe the timing of the first dental visit and investigate the association of socioeconomic and behavioral factors with dental visit delay among 10/11-year-old children from two live-birth population cohorts with extremely contrasting socioeconomic profiles. Follow-up data (2004-2005) from cohorts of Ribeirão Preto (RP) (n=790) and São Luís (SL) (n=673) were evaluated. Delay in dental visit was defined as not visiting a dentist before the age of 7. Covariates included family socioeconomic characteristics, mother-related health behavior, and child-related characteristics. Prevalence ratios with robust standard errors were estimated. In both cohorts, less than 5% of children had visited a dentist before the age of two and about 35% of them had not visited a dentist before the age of seven. Lower mother’s schooling and lack of private health insurance were associated with the delay in first dental visit for both cohorts. A small number of mother's prenatal care visits and being from a single-father family or a family without parents were only associated in the RP cohort, while having ≥4 siblings and lifetime dental pain were associated in the SL cohort. The association with dental pain probably reveals a preventive care-seeking behavior. Therefore, the percentage of delayed first dental visit of children was very high even among those with the most educated mothers. Further studies are necessary to analyze recent changes and underlying factors related to access to first dental visit after the implementation of the National Oral Health Policy in 2006.

本研究旨在描述来自两个社会经济背景差异极大的活产人群队列的10/11岁儿童的首次牙科就诊时间分布，并探讨社会经济与行为因素与牙科就诊延迟的关联。本研究对里贝朗普雷图（Ribeirão Preto, RP）队列（n=790）与圣路易斯（São Luís, SL）队列（n=673）2004-2005年的随访数据进行了分析。牙科就诊延迟被定义为7岁前未就诊过牙医。协变量涵盖家庭社会经济特征、母亲相关健康行为及儿童自身特征，研究采用稳健标准误估算患病率比。结果显示，两个队列中仅不到5%的儿童在2岁前就诊过牙医，约35%的儿童在7岁前未接受过牙科就诊。母亲受教育程度较低、未拥有私人医疗保险，与两个队列的首次牙科就诊延迟均存在显著关联。产前检查次数较少、来自单亲父亲家庭或无父母家庭的关联仅在RP队列中显著；而拥有≥4名兄弟姐妹及曾有牙科疼痛史的关联仅在SL队列中显著。与牙科疼痛的关联或反映了预防性就医行为。即使在母亲受教育程度最高的儿童群体中，首次牙科就诊延迟的比例仍处于较高水平。因此，有必要开展进一步研究，分析2006年国家口腔卫生政策实施后，首次牙科就诊可及性相关的最新变化及潜在影响因素。