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OBJECTIVE: To evaluate the annual variation of oral health and primary care coverage, the tooth extraction ratio, and the average of supervised toothbrushing in Brazilian municipalities according to social development and population size. METHODS: Public secondary data were analyzed. The outcomes were health service indicators (oral health coverage, primary health care coverage, tooth extraction ratio, and average of supervised tooth brushing) estimated for all Brazilian municipalities annually from 2008 to 2015. Mixed-effect multilevel regression models with random intercept and slopes were fitted with a cross-interaction term to estimate the annual percent variation according to the Municipal Human Development Index (MHDI) and population size. RESULTS: Municipalities with low MHDI presented an annual increase in oral health and primary care coverage of 2.65% and 2.23%, respectively, which was significantly higher than municipalities with medium and high MHDI. Oral health and primary care coverage were 69.26% and 35.00% lower among municipalities with a large population. Municipalities with medium and high MHDI showed an annual decrease in tooth extractions of 5.15% and 5.02%, respectively. An annual decrease was observed in the average of supervised toothbrushing of 9.81% and 4.57% in municipalities with low and medium MHDI, respectively. The tooth extraction ratio was higher among larger municipalities; the relation is inverse for supervised toothbrushing. CONCLUSIONS: The access to primary care and oral health services increased in Brazil, while a decrease occurred in mutilating treatment and provision of preventive actions, with disparities among municipalities with different MHDI levels over time.

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ABSTRACT OBJECTIVE: To evaluate the annual variation of oral health and primary care coverage, the tooth extraction ratio, and the average of supervised toothbrushing in Brazilian municipalities according to social development and population size. METHODS: Public secondary data were analyzed. The outcomes were health service indicators (oral health coverage, primary health care coverage, tooth extraction ratio, and average of supervised tooth brushing) estimated for all Brazilian municipalities annually from 2008 to 2015. Mixed-effect multilevel regression models with random intercept and slopes were fitted with a cross-interaction term to estimate the annual percent variation according to the Municipal Human Development Index (MHDI) and population size. RESULTS: Municipalities with low MHDI presented an annual increase in oral health and primary care coverage of 2.65% and 2.23%, respectively, which was significantly higher than municipalities with medium and high MHDI. Oral health and primary care coverage were 69.26% and 35.00% lower among municipalities with a large population. Municipalities with medium and high MHDI showed an annual decrease in tooth extractions of 5.15% and 5.02%, respectively. An annual decrease was observed in the average of supervised toothbrushing of 9.81% and 4.57% in municipalities with low and medium MHDI, respectively. The tooth extraction ratio was higher among larger municipalities; the relation is inverse for supervised toothbrushing. CONCLUSIONS: The access to primary care and oral health services increased in Brazil, while a decrease occurred in mutilating treatment and provision of preventive actions, with disparities among municipalities with different MHDI levels over time.

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A pesquisa e o conhecimento sobre o desempenho das equipes de saúde bucal fornecem subsídios à gestão em saúde visando à orientação da tomada de decisões, acarretando melhorias dos resultados dos serviços públicos de saúde bucal em nível nacional e/ou local. Este estudo objetivou avaliar o desempenho das equipes de saúde bucal na atenção primária à saúde de acordo com indicadores de acesso, resolutividade e abrangência dos serviços e a variação temporal de indicadores de serviços da atenção primária à saúde e de saúde bucal entre as unidades federativas brasileiras e avaliar diferenças nos indicadores de acordo com o Índice de Desenvolvimento Humano municipal e o porte populacional. Foi desenvolvido um estudo do tipo ecológico de abrangência nacional a partir do uso de dados secundários. Foi realizada uma análise descritiva dos indicadores disponíveis no período de 2008 a 2015, agregando os dados por município dos 27 estados brasileiros. Os indicadores utilizados foram Cobertura de saúde bucal, Escovação dental supervisionada, proporção de exodontia e cobertura de atenção primária à saúde. Observou-se que ocorreu aumento médio de 5,7% e de 6,9% na cobertura de Saúde Bucal e Cobertura de atenção Primária, independente do Índice de Desenvolvimento Humano e porte populacional. Municípios com Índice de Desenvolvimento Humano alto apresentaram e Cobertura de atenção Primária, em média 2,2% e 2,1% menor do que aqueles com Índice de Desenvolvimento Humano baixo. Observou-se uma redução média na proporção de exodontias de 1,42 em 2008 a 4,03 em 2015. A proporção de exodontias foi menor em municípios de Índice de Desenvolvimento Humano médio e alto e maior entre municípios com porte populacional entre 10 a 100 mil habitantes. Aumento médio significativo da Escovação Dental Supervisionada foi observado até 2011. Foi evidenciado aumento na Cobertura de atenção Primária e cobertura de Saúde; redução de exodontias; oscilação de Escovação Dental Supervisionada com tendência à estabilização e desigualdade na expansão de cobertura de Saúde Bucal e Cobertura de atenção Primária que variou de acordo com o IDH e porte populacional. Avalia-se que, no geral, houve ampliação da cobertura dos serviços de atenção primária e de saúde bucal nos municípios brasileiros e que as diretrizes pró-equidade das políticas públicas devem ser incentivadas. O Brasil apresentou entre 2008 a 2015 aumento na cobertura da Atenção Primária e da Saúde Bucal; redução nas proporções de exodontia e oscilação da média da escovação dental supervisionada com tendência à estabilização. Municípios com maior IDH apresentaram os melhores desempenhos nos indicadores exodontias e Escovação Dental Supervisionada revelando a persistência da iniquidade no acesso e na organização dos serviços.

Research and knowledge about the performance of oral health teams (OHT) provide subsidies to health management aimed at guiding decision making, resulting in improvements in the results of public oral health services at national and / or local level. This study aimed to evaluate the performance of OHT in primary health care according to indicators of access, resolution and coverage of services and the temporal variation of indicators of primary health care and oral health services between Brazilian municipalities and evaluate differences in indicators according to the municipal Human Development Index (HDI) and population size. A national type ecological study was developed based on the use of secondary data. A descriptive analysis of the indicators available from 2008 to 2015 was carried out, aggregating the data by municipality of the 27 Brazilian states. The indicators used were coverage of oral health care (COHC), supervised tooth brushing (STB), proportion of tooth extraction (TE) and coverage of primary health care (CPHC). It was observed that there was an average increase of 5.7% and 6.9% in CSB and CAPS, regardless of the Human Development Index (HDI) and population size (PS). Municipalities with high HDI had COHC and CPHC, on average 2.2% and 2.1% lower than those with low HDI. There was an average reduction in the proportion of TE from 1.42 in 2008 to 4.03 in 2015. The proportion of TE was lower in municipalities with medium and high HDI and higher among municipalities with a population size between 10 and 100 thousand inhabitants. Significant average increase in STB was observed until 2011. There was an increase in CPHC and COHC; TE reduction; oscillation of STB with a tendency to stabilize and inequality in the expansion of COHC and CPHC, which varied according to the HDI and PS. It is estimated that, in general, there was an expansion of the coverage of primary care and oral health services in Brazilian municipalities and that the pro-equity guidelines of public policies should be encouraged. New time series studies of oral health indicators should be carried out to follow trends in service performance. Between 2008 and 2015, Brazil presented an increase in the coverage of Primary Care and Oral Health; reduction in the proportions of tooth extraction and oscillation of the average of supervised tooth brushing with a tendency to stabilization. Municipalities with the highest HDI presented the best performances in the TE and STB indicators, revealing the persistence of inequity in access and in the organization of services.

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