Secondary care in oral health in small municipalities: a cross-sectional evaluation of demand x access

ABSTRACT Objective: To know the demand and access to specialized procedures in Oral Health in 10 municipalities in the region of Guanhães, Minas Gerais, Brazil, which do not have a Dental Specialty Center. Methods: Cross-sectional study was conducted with 30 dental surgeons of the Primary Care system. These dentists recorded all the patients who were treated from July to November 2016, and who were shown to be in need of being assigned to specialized procedures in oral health. The descriptive analysis was developed in the software SPSS for Windows version 18.0. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (ruling 1.615.701). Results: 1085 patients assigned for specialized procedures in Oral Health were evaluated. The majority of these patients were women (56.6%), within an age-range from 13-34 years (51.9%). Among the specialties evaluated, 61% of the patients presented the need for endodontic treatment, with the most compromised tooth being the first permanent molar (33.2%). The outcomes were recorded for 435 (40.1%) patients. Among these, 19.8% of the procedures were performed in the health unit itself and in 45.5% extractions were performed. Conclusion: Limited access to specialized Oral Health procedures was verified. To enable the Oral Health National Policy to consider the specificities of such regions, it is suggested that the scope of action of the oral health teams in primary care is expanded, or that less expensive specialized services are created, so that the access to this level of oral health is assured to all referred patients.

摘要
研究目的：了解巴西米纳斯吉拉斯州瓜尼昂斯（Guanhães）地区10个未设置口腔专科中心的市镇居民对口腔健康专科诊疗服务的需求与可及性。
研究方法：本研究为横断面研究，共纳入30名基层医疗体系的牙科医师。上述医师记录了2016年7月至11月期间接诊的、经评估需接受口腔健康专科诊疗服务的所有患者。本研究采用SPSS 18.0 Windows版统计软件进行描述性分析。本研究已通过米纳斯吉拉斯联邦大学研究伦理委员会审批（审批编号：1.615.701）。
研究结果：本研究共评估1085名需接受口腔健康专科诊疗服务的转诊患者。其中多数为女性（56.6%），年龄介于13~34岁之间者占比51.9%。在所评估的专科诊疗项目中，61%的患者需接受牙髓治疗（endodontic treatment），受累最严重的牙齿为第一恒磨牙（33.2%）。最终有435名（40.1%）患者完成了诊疗追踪记录。其中19.8%的诊疗操作在基层医疗单位内完成，45.5%的患者接受了拔牙手术。
研究结论：本研究证实该地区居民口腔健康专科诊疗服务可及性有限。为推动国家口腔卫生政策充分考量此类地区的特殊性，建议扩大基层口腔卫生团队的服务范畴，或增设低成本的专科诊疗服务，以保障所有转诊患者均能获得该层级的口腔健康服务。