Características individuais relacionadas à utilização de serviços odontológicos por adolescentes: um estudo longitudinal a partir do modelo comportamental de Andersen

Abstract

Adolescence has long been considered a phase of life with less disease involvement, but this reality has been modified by the increase in health risk factors in our society. As it is a phase of transition to adulthood and a period of profound changes, individuals are vulnerable to the onset of diseases, including oral diseases. Therefore, understanding the factors that influence the process of using dental services is essential to reduce the prevalence of these diseases. The objective of the present study was to evaluate the influence of predisposing, enabling and needs characteristics in the use of dental services by adolescents living in a socially disadvantaged urban area, using the theoretical model of Andersen and Davidson. The prospective longitudinal observational study included 334 adolescents regularly enrolled in public schools, followed up over two years. Data were collected using validated self-administered instruments and clinical examinations of adolescents. The data included information about gender, self-reported skin color, sense of coherence (SOC) dental health plan, family income, educational level of parents or guardians, self-perceived oral health, toothache, experience of dental caries and bleeding gingival, as well as the outcome, the use of dental services. Poisson regression with robust adjustment of variance was used to estimate prevalence ratios and 95% confidence intervals. Of the adolescents who completed the follow-up, 43.4% were male and 68.3% were brown. As for the prevalence of the use of dental services, it was 58.4% in the last year. The baseline SOC corresponded to an average of 45.8, while in the two-year follow-up, an average of 42.4. About 90% of the accompanied adolescents did not have a dental health plan, and almost 40% lived with a monthly family income of ½ to 1 minimum wage and the parents' average education level was 10.3 years. The decline in the sense of consistency in follow-up reduced the likelihood of using dental services in the past 12 months (IRR = 0.96, 95% CI 0.92-0.99). Dental caries (IRR = 1.02, 95% CI 1.01-1.04) and gingival bleeding (IRR = 1.01, 95% CI 1.01-1.02) were statistically associated with the outcome. Adolescents with dental pain were more likely to use dental services in the past year (IRR = 1.03, 95% CI 1.01-1.06). It was concluded that not only oral clinical conditions, but also factors such as a sense of coherence, have an influence on the use of dental services, and social and emotional aspects should be considered in actions aimed at improving the use of dental services by the aforementioned group populational.