Impacto da estratégia saúde da família na qualidade de vida relacionada à saúde bucal de pré-escolares

Abstract

Important improvements have been made in healthcare in recent decades, including the decline in dental caries, the most prevalent oral disease. However, tooth decay continues disproportionally affecting different age groups of the population. It negatively impacts the quality of life of those who are the most vulnerable. In this context, the Family Health Strategy (FHS) can contribute to the reduction of these inequalities, as it is implemented in places of greater social vulnerability. The purpose of this thesis was to present two longitudinal studies. The first evaluated the impact of the FHS on children´s oral health related quality of life (COHRQoL). The second evaluated the association of the increase of caries with the availability of dental services. Initially, a study was conducted with 459 children between the ages of 2 and 5 years (96.3% response rate) that regularly attended the urban public preschools in the municipality of Santa Cruz do Sul (RS). After 2 years, the oral health of 419 children was evaluated (91.3% cohort retention rate). In both stages, trained and calibrated examiners evaluated the children’s oral conditions (dental caries, trauma and occlusal changes) and the parents of these children were questioned about the impact of these conditions on their child's and family's quality of life through the B-ECOHIS questionnaire (Brazilian Early Childhood Oral Health Impact Scale), and a questionnaire addressing socio-demographic aspects and oral health care and the use of dental services. Data were analyzed using multilevel regression models. The results showed that the children with FHS coverage presented a lower impact on OHRQoL only in the family function domain. They showed no association with the impact on the total score and other domains. Apart from previous caries experience, older children who went to the dentist for dental treatment, without a regular dentist in the primary care unit, and who were from a lower family income and beneficiaries of the Bolsa Família Program presented a greater impact on OHRQoL. The increase of caries was shown not to be associated with the availability of dentists in the public health system. Children with lower family income, beneficiaries of the Bolsa Familia Program, who went to the dentist for treatment, who used public dental services and had a previous experience of caries had higher caries incidence. These results show the importance of early identification of vulnerable individuals with a experience of caries in order to avoid the progression of tooth decay and its impact on OHRQoL. In addition, these studies show the difficulty of the current health model in the country in overcoming the impact of social determinants on oral health. Thus, the evidence obtained from the follow-up evaluations of these children can contribute to the elaboration of strategies that strengthen the equity and integrality of care, principles of the Unified Health System, through approaches that go beyond the biomedical model.