Dental Caries Spectrum Profile and Dental Visits by Preschool Children: Application of Andersen’s Model

Fernanda Vieira Almeida; Laís Anschau Pauli; Marina Sousa Azevedo; Vanessa Polina Pereira Costa; Marília Cunha Maroneze; Marília Leão Goettems

Authors

Fernanda Vieira Almeida
Laís Anschau Pauli
Marina Sousa Azevedo
Vanessa Polina Pereira Costa
Marília Cunha Maroneze
Marília Leão Goettems

Keywords:

Cross-Sectional Studies, Dental Care, Dental Caries, Epidemiology

Abstract

Objective: To estimate the frequency of preschool children who attended a dental visit and identify associated factors. Material and Methods: A cross-sectional study was conducted with children aged 2-5 years enrolled in preschools (n=200) in southern Brazil. Parents/guardians completed a questionnaire, and oral exams were performed using the CAST instrument. The outcome was whether the children had consulted a dentist in their lifetime. Andersen's behavioral model was applied to assess associated factors, including predisposing factors (sex, age, maternal education), enabling factors (family income), need factors (dental caries severity, dental pain, oral health-related quality of life (OHRQoL), and oral hygiene habits), and psychosocial factors (dental fear). Associations were tested using Poisson's regression, obtaining the prevalence ratio (PR) and 95% confidence interval (CI). Results: The majority of the children had never visited a dentist (71%; n=141), while 15% (30) had done so for prevention and 14% (29) for oral health problems. Need factors associated with having consulted a dentist included severe dental caries (PR=3.11; 95%CI=1.85-5.20), dental pain (PR=2.04; 95%CI=1.32-2.17), toothbrushing performed by parents (PR=1.99; 95%CI=1.05-3.77), and presence of an impact on OHRQoL (PR=1.87; 95%CI=1.21-2.89). The psychosocial factor of the absence of dental fear (PR=2.28; 95%CI=1.45-3.59) was also associated with the outcome. Conclusion: Most preschool children have never visited a dentist. Using a dental service was associated with both need and psychosocial factors.

References

Lee JY, Bouwens TJ, Savage MF, Vann JRWF. Examining the cost-effectiveness of early dental visits. Pediatr Dent 2006; 28(2):102-105.

Menegazzo GR, Knorst JK, Emmanuelli B, Mendes FM, Ardenghi DM, Ardenghi TM. Effect of routine dental attendance on child oral health-related quality of life: A cohort study. Int J Paediatr Dent 2020; 30:459-467. https://doi.org/10.1111/ipd.12625

American Academy of Pediatric Dentistry. Periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Pediatr Dent 2018; 40(6):194-204.

Miller E, Lee JY, Dewalt DA, Vann WFJ. Impact of caregiver literacy on children's oral health outcomes. Pediatrics 2010; 126(1):107-114. https://doi.org/10.1542/peds.2009-2887

Bernabe E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, Kassebaum NJ. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: A systematic analysis for the Global Burden of Disease 2017 study. J Dent Res 2020; 99(4):362-373. https://doi.org/10.1177/0022034520908533

Boeira GF, Correa MB, Peres KG, Peres MA, Santos IS, Matijasevich A, et al. Caries is the main cause for dental pain in childhood: Findings from a birth cohort. Caries Res 2012; 46:488-495. https://doi.org/10.1159/000339491

Goettems ML, Ardenghi TM, Demarco FF, Romano AR, Torriani DD. Children’s use of dental services: Influence of maternal dental anxiety, attendance pattern, and perception of children’s quality of life. Community Dent Oral Epidemiol 2012; 40(5):451-458. https://doi.org/10.1111/j.1600-0528.2012.00694.x

Hartwig A, Azevedo M, Romano A, Cenci M. Prevalence and disparities in the first dental visit of preschool children aged 12-18 months in southern Brazil. RFO 2018; 23(1):31-36. https://doi.org/10.5335/rfo.v26i2.11299

Hajek A, Kretzler B, König HH. Factors associated with dental service use based on the Andersen model: A systematic review. Int J Environ Res Public Health 2021; 18(5):2491. https://doi.org/10.3390/ijerph18052491

Andersen RM. National health surveys and the behavioral model of health services use. Medcare 2008; 46(07):647-653. https://doi.org/10.1097/MLR.0b013e31817a835d

Flennert M, König HH, Hajek A. The association between voluntary work and health care use among older adults in Germany. BMC Health Serv Res 2019; 19(1):1-10. https://doi.org/10.1186/s12913-019-3867-x

Hajek A, König HH. Beyond symptoms: Why do patients see the doctor? BJGP Open 2020; 4(2):bjgpopen20X101088. https://doi.org/10.3399/bjgpopen20X101088

Leal SC, Ribeiro APD, Frencken JE. Caries Assessment Spectrum and Treatment (CAST): A novel epidemiological instrument. Caries Res 2017; 51(5):500-506. https://doi.org/10.1159/000479042

Ardenghi TM, Vargas-Ferreira F, Piovesan C, Mendes FM. Age of first dental visit and predictors for oral healthcare utilisation in preschool children. Oral Health Prev Dent 2012; 10(1):17-27.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J Clin Epidemiol 2008; 61(4):344-349. https://doi.org/10.1016/j.jclinepi.2007.11.008

Pauli LA, Costa VPPD, Azevedo MS, Leal SC, Goettems ML. Discriminant validity of the CAST instrument compared to the dmf index in the deciduous dentition: A cross sectional study. Braz Oral Res 2021; 35:e078. https://doi.org/10.1590/1807-3107bor-2021.vol35.0078

Galvão MHR, Roncalli AG. Does the implementation of a national oral health policy reduce inequalities in oral health services utilization? The Brazilian experience. BMC Public Health 2021; 21(1):541. https://doi.org/10.1186/s12889-021-10586-2

Martins-Junior PA, Ramos-Jorge J, Paiva SM, Marques LS. Validations of the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Cad Saúde Pública 2012; 28(2):367-374. https://doi.org/10.1590/s0102-311x2012000200015

Pahel BT, Rozier RG, Slade GD. Parental perceptions of children’s oral health: the early childhood oral health impact scale (ECOHIS). Health Qual Life Outcomes 2007; 5(1):1-10. https://doi.org/10.1186/1477-7525-5-6

Frencken JE, de Souza AL, Van der Sanden WJM, Bronkhorst EM, Leal SC. The Caries Assessment and Treatment (CAST) instrument. Community Dent Oral Epidemiol 2013; 41(1):71-77. https://doi.org/10.1111/cdoe.12027

Frencken JE, de Souza HAL, Bronkhorst EM, Leal SC. CAST Manual: Caries Assessment Spectrum and Treatment. Nijmegen: Department of Global Oral Health 2015; 51(5):500-506.

Neverlien PO. Assessment of a single-item dental anxiety question. Acta Odontol Scand 1990; 48(6):365-369. https://doi.org/10.3109/00016359009029067

Oliveira MM, Colares V. The relationship between dental anxiety and dental pain in children aged 18 to 59 months: A study in Recife, Pernambuco State, Brazil. Cad Saúde Pública 2009; 25(4):743-750. https://doi.org/10.1590/s0102-311x2009000400005

Feldens CA, Fortuna MJ, Kramer PF, Ardenghi TM, Vítolo MR, Chaffee BW. Family health strategy associated with increased dental visitation among preschool children in Brazil. Int J Paediatr Dent 2018; 28(6):624-632. https://doi.org/10.1111/ipd.12421

Kramer PF, Ardenghi TM, Ferreira S, Fisher LA, Cardoso L, Feldens CA. Use of dental services by preschool children in Canela, Rio Grande do Sul State, Brazil. Cad Saúde Pública 2008; 24(1):150-156. https://doi.org/10.1590/S0102-311X2008000100015 [In Portuguese].

Hartwig AD, Cademartori MG, Demarco FF, Bertoldi AD, Corrêa MB, Azevedo MS. Are maternal factors predictors of a child's first dental visit? A birth cohort study in Brazil. Braz Oral Res 2022; 36:e092. https://doi.org/10.1590/1807-3107bor-2022.vol36.0092

Yun Q, Liu M, Zhao M, Yang L, Miao J, Chang C. The willingness to attend the first dental visit within 1 year of age: An analysis applying Andersen's behavioral model of health service utilization. Int J Paediatr Dent 2022; 32(3):324-333. https://doi.org/10.1111/ipd.12888

Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: Exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health 2007; 7(1):1-15. https://doi.org/10.1186/1472-6831-7-1

Gilbert GH, Rose JS, Shelton BJ. A prospective study of the validity of data on self-reported dental visits. Commun Dent Oral Epidemiol 2002; 30(5):352-362. https://doi.org/10.1034/j.1600-0528.2002.00062.x

Sen B, Blackburn J, Morrisey MA, Kilgore ML, Becker DJ, Caldwell C. Effectiveness of preventive dental visits in reducing non preventive dental visits and expenditures. Pediatrics 2013; 131(6):1107-1113. https://doi.org/10.1542/peds.2012-2586