Compliance Analysis of the Dental Care Service Provided to Pregnant Women in Primary Health Care

Nogueira, Paula Molina; Fonseca, Isabela Oliveira Mourão; Ferreira, Raquel Conceição; Vasconcelos, Mara; Zina, Lívia Guimarães

doi:10.1590/pboci.2024.069

Paula Molina Nogueira

Conceptualization

Methodology

Formal Analysis

Investigation

Writing - Original Draft

Writing - Review and Editing

critical review of intellectual content and approval of the final version to be published

Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

https://orcid.org/0000-0003-0041-0408

Isabela Oliveira Mourão Fonseca

Methodology

Data Curation

Writing - Original Draft

critical review of intellectual content and approval of the final version to be published

Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

https://orcid.org/0000-0003-2312-528X

Raquel Conceição Ferreira

Methodology

Formal Analysis

Writing - Review and Editing

Project Administration

critical review of intellectual content and approval of the final version to be published

Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

https://orcid.org/0000-0001-8897-9345

Mara Vasconcelos

Conceptualization

Methodology

Formal Analysis

Data Curation

Writing - Review and Editing

Supervision

Project Administration

critical review of intellectual content and approval of the final version to be published

Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

https://orcid.org/0000-0002-0316-4591

Lívia Guimarães Zina

Conceptualization

Methodology

Formal Analysis

Writing - Review and Editing

Project Administration

critical review of intellectual content and approval of the final version to be published

Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

https://orcid.org/0000-0003-1842-2300

Corresponding author: Paula Molina Nogueira E-mail: molnog@gmail.com

Conflict of Interest

The authors declare no conflicts of interest.

Academic Editor: Wilton Wilney Nascimento Padilha

Domains	Variables	Compliance	Noncompliance
Access	Monthly average for PW* one dental appointment	One to four PW; Five to ten PW; More than ten PW	No PW; Do not treat PW
	Strategy that facilitates scheduling dental appointments for PW	Yes	No; Do not treat PW
Treatment Adherence	Adherence to dental treatment	Always; Frequently; Sometimes	Rarely; Never; Do not treat PW
Collective Activity	There are collective activities for PW at the health center	Yes	No
	Dental surgeon participates in collective activities for PW	Yes	No; There is no collective activity
	Professionals at the health center who participate in collective activities for PW	Selection of at least one of the options: Dental surgeon; Oral health assistant; Oral health technician	No professional from the oral health team; There is no collective activity
	Frequency at which dental surgeon participates in collective activities for PW	Always; Sometimes; Only when invited	Never; There is no collective activity
Individual Care	Procedures	Group of minimum procedures: Emergency care (dental pain management); Restorations; Prophylaxis (cleaning); Supragingival scaling; Self-care instructions	Not having selected all minimum procedures; Do not treat PW
	Medications	Selection of at least one of the options: Amoxicillin; Dipyrone; Chlorhexidine;	Selection of at least one of the options: Acetylsalicylic acid; Acyclovir; Do not treat PW
		Metronidazole; Paracetamol; Ibuprofen; Nystatin
	Anesthetics	2% Lidocaine + Epinephrine 1:100.000	Selection of one of the options: 3% Prilocaine + Felypressin 0.03 IU; 3% Mepivacaine without vasoconstrictor; Do not treat PW
	Referral to X-ray	Yes	No; Do not treat PW

Domains	Variables	Recommendation
Access	Monthly average for PW’s* one dental appointment	Values equal to or greater than one PW were considered “Compliance”.
	Strategy that facilitates scheduling dental appointments for PW	Public policies establish that teams should adopt strategies for scheduling dental appointments for PW, aimed at facilitating access to treatment [¹⁴14 Bradburn NM, Sudman S, Wansink B. Asking questions. The definitive guide to questionnaire design - For market research, political polls, and social and health questionnaires. San Francisco: Jossey-Bass; 2004. 426p.,¹⁵15 Rakchanok N, Amporn D, Yoshida Y, Harun-Or-Rashid M, Sakamoto J. Dental caries and gingivitis among pregnant and non-pregnant women in Chiang Mai, Thailand. Nagoya J Med Sci 2010; 72(1-2):43-50.].
Treatment Adherence	Adherence to dental treatment	Mean frequencies (sometimes) and high frequencies (always and frequently) were considered “Compliance”.
Collective Activity	There are collective activities for PW at the health center	Public policies recommend that collective health education measures should be conducted at health centers to provide PW with guidance and clear up any doubts and beliefs [⁷7 Achtari MD, Georgakopoulou EA, Afentoulide N. Dental care throughout pregnancy: What a dentist must know. Oral Health Dent Manag 2012; 11(4):169-176.,⁸8 Silva FWGP, Stuani AS, Queiroz AL. Atendimento odontológico a gestante – Parte 2: A consulta. Rev Fac Odontol Porto Alegre 2006; 47(3):5-9. [In Portuguese].,⁹9 Vieira DR, de Oliveira AE, Lopes FF, Lopes Maia Mde F. Dentists' knowledge of oral health during pregnancy: A review of the last 10 years' publications. Community Dent Health 2015; 32(2):77-82.].
	Dental surgeon participates in collective activities for PW	Public policies recommend the participation of dental surgeons in collective health education activities as a member of a multiprofessional team [⁷7 Achtari MD, Georgakopoulou EA, Afentoulide N. Dental care throughout pregnancy: What a dentist must know. Oral Health Dent Manag 2012; 11(4):169-176.,⁸8 Silva FWGP, Stuani AS, Queiroz AL. Atendimento odontológico a gestante – Parte 2: A consulta. Rev Fac Odontol Porto Alegre 2006; 47(3):5-9. [In Portuguese].,⁹9 Vieira DR, de Oliveira AE, Lopes FF, Lopes Maia Mde F. Dentists' knowledge of oral health during pregnancy: A review of the last 10 years' publications. Community Dent Health 2015; 32(2):77-82.].
	Professionals at the health center who participate in collective activities for PW	The presence of at least one of the professionals from the oral health team was considered “Compliance”.
	Frequency at which the dental surgeon participates in collective activities for PW	Mean frequencies (sometimes and only when invited) and high frequencies (always) were considered “Compliance”.
Individual Care	Procedures	Minimum procedures were those considered essential for the dental treatment of PW, based on studies that assessed the patterns of oral health needs and dental care protocols [⁷7 Achtari MD, Georgakopoulou EA, Afentoulide N. Dental care throughout pregnancy: What a dentist must know. Oral Health Dent Manag 2012; 11(4):169-176.,¹²12 Codato LAB, Nakama L, Melchior R. The beliefs of pregnant women about dental care during gestation. Ciênc Saúde Coletiva 2008; 13(3):1075-1080. https://doi.org/10.1590/S1413-81232008000300030 https://doi.org/10.1590/S1413-8123200800... ,¹³13 Belo Horizonte. Secretaria Municipal de Saúde. Relatório Anual de Gestão - 2021. Belo Horizonte (MG); 2022. Available from: https://prefeitura.pbh.gov.br/sites/default/files/estrutura-de-governo/saude/2022/rag2021.pdf [Accessed on July 15, 2023]. [In Portuguese]. https://prefeitura.pbh.gov.br/sites/defa... , ¹⁴14 Bradburn NM, Sudman S, Wansink B. Asking questions. The definitive guide to questionnaire design - For market research, political polls, and social and health questionnaires. San Francisco: Jossey-Bass; 2004. 426p.]. Surveys indicate that PW seek care when they have dental pain [¹⁴14 Bradburn NM, Sudman S, Wansink B. Asking questions. The definitive guide to questionnaire design - For market research, political polls, and social and health questionnaires. San Francisco: Jossey-Bass; 2004. 426p.], described in the questionnaire as emergency care (dental pain management). Among the major dental disorders detected in PW are cavitated carious lesions [¹²12 Codato LAB, Nakama L, Melchior R. The beliefs of pregnant women about dental care during gestation. Ciênc Saúde Coletiva 2008; 13(3):1075-1080. https://doi.org/10.1590/S1413-81232008000300030 https://doi.org/10.1590/S1413-8123200800... ,¹³13 Belo Horizonte. Secretaria Municipal de Saúde. Relatório Anual de Gestão - 2021. Belo Horizonte (MG); 2022. Available from: https://prefeitura.pbh.gov.br/sites/default/files/estrutura-de-governo/saude/2022/rag2021.pdf [Accessed on July 15, 2023]. [In Portuguese]. https://prefeitura.pbh.gov.br/sites/defa... ], treatable with restorations [⁵5 Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Saúde da Família. Nota técnica nº 3/2022. Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Saúde da Família. Brasília: Ministério da Saúde; 2022. [In Portuguese].], and gingivitis [⁷7 Achtari MD, Georgakopoulou EA, Afentoulide N. Dental care throughout pregnancy: What a dentist must know. Oral Health Dent Manag 2012; 11(4):169-176.,¹³13 Belo Horizonte. Secretaria Municipal de Saúde. Relatório Anual de Gestão - 2021. Belo Horizonte (MG); 2022. Available from: https://prefeitura.pbh.gov.br/sites/default/files/estrutura-de-governo/saude/2022/rag2021.pdf [Accessed on July 15, 2023]. [In Portuguese]. https://prefeitura.pbh.gov.br/sites/defa... ,¹⁴14 Bradburn NM, Sudman S, Wansink B. Asking questions. The definitive guide to questionnaire design - For market research, political polls, and social and health questionnaires. San Francisco: Jossey-Bass; 2004. 426p.], in which treatment includes prophylaxis or supragingival scaling [⁵5 Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Saúde da Família. Nota técnica nº 3/2022. Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Saúde da Família. Brasília: Ministério da Saúde; 2022. [In Portuguese].].
	Medications	The Food and Drug Administration (FDA) [¹⁵15 Rakchanok N, Amporn D, Yoshida Y, Harun-Or-Rashid M, Sakamoto J. Dental caries and gingivitis among pregnant and non-pregnant women in Chiang Mai, Thailand. Nagoya J Med Sci 2010; 72(1-2):43-50.] classifies medications according to their teratogenic effects. Medications classified as category B and C were among the answer options for this question [¹⁵15 Rakchanok N, Amporn D, Yoshida Y, Harun-Or-Rashid M, Sakamoto J. Dental caries and gingivitis among pregnant and non-pregnant women in Chiang Mai, Thailand. Nagoya J Med Sci 2010; 72(1-2):43-50.]. Dental surgeons who chose category B (amoxicillin, metronidazole, dipyrone, paracetamol, ibuprofen, nystatin, chlorhexidine) [⁵5 Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Saúde da Família. Nota técnica nº 3/2022. Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Saúde da Família. Brasília: Ministério da Saúde; 2022. [In Portuguese].,¹⁶16 Belo Horizonte. Secretária Municipal de Saúde. Manual de Saúde Bucal. Belo Horizonte: Secretária Municipal de Saúde; 2022. [In Portuguese].] were considered “Compliance” and those who chose at least one medication from category C (acyclovir and acetylsalicylic acid) [¹⁶16 Belo Horizonte. Secretária Municipal de Saúde. Manual de Saúde Bucal. Belo Horizonte: Secretária Municipal de Saúde; 2022. [In Portuguese].] were considered “Noncompliance”.
	Anesthetics	Answer options included local anesthetics available from the public health system: 2% lidocaine + epinephrine 1:100.000, 3% prilocaine + felypressin 0.03 IU and 3% mepivacaine without vasoconstrictor. The literature recommends the use of 2% lidocaine + epinephrine 1:100.000, considered to be safe for PW [⁷7 Achtari MD, Georgakopoulou EA, Afentoulide N. Dental care throughout pregnancy: What a dentist must know. Oral Health Dent Manag 2012; 11(4):169-176.,¹⁶16 Belo Horizonte. Secretária Municipal de Saúde. Manual de Saúde Bucal. Belo Horizonte: Secretária Municipal de Saúde; 2022. [In Portuguese].,¹⁷17 Rocha JS, Arima LY, Werneck RI, Moysés SJ, Baldani MH. Determinants of dental care attendance during pregnancy: A systematic review. Caries Res 2018; 52(1-2):139-152. https://doi.org/10.1159/000481407 https://doi.org/10.1159/000481407... ].
	Referral to X-ray	Radiographs during pregnancy are not contraindicated because the radiation dose that reaches the fetus in the uterus is not enough to cause congenital malformations [⁵5 Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Saúde da Família. Nota técnica nº 3/2022. Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Saúde da Família. Brasília: Ministério da Saúde; 2022. [In Portuguese].,⁷7 Achtari MD, Georgakopoulou EA, Afentoulide N. Dental care throughout pregnancy: What a dentist must know. Oral Health Dent Manag 2012; 11(4):169-176.,¹⁶16 Belo Horizonte. Secretária Municipal de Saúde. Manual de Saúde Bucal. Belo Horizonte: Secretária Municipal de Saúde; 2022. [In Portuguese].]. Given the benefits to diagnosis and treatment, referral to X-ray was considered “Compliance”.

Strategies for Scheduling Dental Appointments	N	%
Scheduling and/or referral from the first prenatal care visits	118	49.6
Scheduling priority	87	36.5
Dental appointment scheduled for the same day as the prenatal visit	10	4.2
Active search	8	3.4
Appointment scheduled in group of pregnant women	6	2.5
Immediate care	5	2.1
Other strategies	4	1.7
Total^† † Total number of dental surgeons who adopted strategies for scheduling dental appointments for pregnant women.	238	100.0

Domains	Analyzed Aspects	Compliance		Noncompliance
Domains	Analyzed Aspects	N	%	N	%
Access	Monthly average for PW’s 1st dental appointment	245	95.7	11	4.3
	Strategy that facilitates scheduling dental appointments for PW	244	94.6	14	5.4
Treatment Adherence	Adherence to dental treatment	249	95.8	11	4.2
Collective Activity	There are collective activities for PW at the health center	141	55.3	114	44.7
	Dental surgeon participates in collective activities for PW	94	37.3	158	62.7
	Professionals at the health center who participate in collective activities for PW	137	61.7	85	38.3
	Frequency at which dental surgeon participates in collective activities for PW	146	62.4	88	37.6
Individual Care	Procedures	241	92.7	19	7.3
	Medications	253	97.3	7	2.7
	Anesthetics	190	73.9	67	26.1
	Referral to X-ray	92	36.2	162	63.8

District	Access^* * No statistical difference in relation to the domains per health district (p>0.05).		Treatment Adherence^* * No statistical difference in relation to the domains per health district (p>0.05).		Collective Activity^* * No statistical difference in relation to the domains per health district (p>0.05).		Individual Care^* * No statistical difference in relation to the domains per health district (p>0.05).
District	N	%	N	%	N	%	N	%
Barreiro	34	94.4	35	97.2	12	33.3	12	33.3
Mid-Southern	11	73.3	14	93.3	8	53.3	1	06.7
Eastern	20	95.2	21	100.0	9	42.9	6	28.6
Northeastern	43	93.5	46	100.0	21	45.6	13	28.3
Northwestern	22	84.6	22	84.6	7	26.9	6	23.1
Northern	19	76.0	25	100.0	8	32.0	9	36.0
Western	29	82.9	31	88.6	7	20.0	4	11.4
Pampulha	23	100.0	23	100.0	5	21.7	5	21.7
Venda Nova	30	90.9	32	97.0	10	30.3	5	15.2
Municipality	231	88.8	249	95.8	87	33.5	61	23.5

[1] Corresponding author: Paula Molina Nogueira E-mail: molnog@gmail.com

Brasil

Brasil

Compliance Analysis of the Dental Care Service Provided to Pregnant Women in Primary Health Care

ABSTRACT

Objective:

Material and Methods:

Results:

Conclusion: