Covid-19: Repercussões na odontologia e impacto de uma intervenção educativa na prática de profissionais das equipes de saúde bucal do Maranhão

Abstract

More than four years have passed since the World Health Organization (WHO) declared the Covid-19 pandemic a global pandemic on March 11, 2020. Since then, it has become a historic milestone with impacts on the provision of health services, the education system, the global economy and other fields of human life. Evidence has shown that the pandemic has profoundly impacted public and private dental activities, generating changes in current dentistry and future trends. CHAPTER I of this thesis was the original article "Economic impact of the Covid-19 pandemic among dentists in one of Brazil's poorest states: a cross-sectional study" which aimed to analyze the impact of the Covid-19 pandemic on dentists' income and identify associated factors in a northeastern Brazilian state. A cross-sectional study was carried out with dentists from Maranhão who volunteered to answer an electronic questionnaire. Multinomial logistic regression analyses with hierarchical modeling were carried out, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). In the adjusted regression analysis, the negative impact of income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 40 years of age (OR=6.43; 95%CI: 2.39-17.25), family income of less than 2 minimum wages (OR=4.63; 95%CI: 1.50-14.30) or 2 to 4.9 minimum wages (OR=2.80; 95%CI: 1.25-6.27) compared to those earning five or more wages, and who worked in the private sector (OR=31.43; 95%CI: 11.59-85.22). The negative impact on income was 2.21 times greater for professionals working on the mainland compared to those working only on the big island (OR=2.21; 95%CI: 1.14-4.29). This pioneering study showed that during the Covid-19 pandemic, there was a negative impact on the income of DCs working in the state of Maranhão, especially those who were older, male, had lower family incomes and worked in the private sector. The original article "Economic Impact of the COVID-19 Pandemic among Dentists in One of the Poorest Brazilian States: A Cross-Sectional Study" was published in the journal Pesquisa Brasileira em Odontopediatria e Clínica Integrada, Impact Factor 0.6, Qualis A4, doi: 10.1590/pboci.2023.086, 2023, and involved researchers from the public universities of Maranhão, Pernambuco and Paraíba. CHAPTER II of this thesis was the original article "An intervention to improve oral health indicators to pre-Covid-19 levels", which aimed to analyze the impact of an educational intervention on flu syndromes on indicators of the use of oral health services in Primary Health Care (PHC) after the Covid-19 pandemic . Methods: Non-randomized community trial with controlled interrupted time series analysis in four municipalities in the state of Maranhão, Brazil, from March/2020 to September/2023; Grajaú being the intervention municipality; Barra do Corda (control 1), Presidente Dutra (control 2) and Porto Franco (control 3). The municipalities were selected intentionally, as they are inland municipalities with low development indicators; they represent an important portion of Brazilian municipalities and are located in one of the states most impacted by the Covid-19 pandemic in terms of reductions in indicators. A training course on flu-like syndromes using active methodologies, over 11 months (starting in October/2022), was the variable that interrupted the series. The outcomes, obtained from SUS information systems, were the ratio of procedures carried out by PHC oral health teams (OHT) per thousand inhabitants, grouped into: 1) Ratio of prevention/health promotion procedures (RPPP); 2) Ratio of dental emergency procedures (RPUO); and 3) Ratio of curative and rehabilitation procedures (RPCR). The analyses were carried out in the R programming language for statistical calculations, using RStudio, and the regression coefficients (Xreg) were calculated considering an alpha of 5%. Training was associated with an increase of 1.01 RPCR per thousand inhabitants per month (Xreg=1.01; p-value=0.0091) and a reduction of 1.28 RPUO per thousand inhabitants per month (Xreg=-1.28; p-value<0.0001), but did not alter RPPP (Xreg=1.47 p-value=0.7998). In the control municipality, there was a reduction of 4.19 PPPRs per thousand inhabitants per month (Xreg=-4.19; p-value=0.0040). Training on flu-like syndromes is important for the safe return of PHC OHTs to dental clinic activities, helping to guarantee comprehensive and resolutive access to the SUS after the Covid-19 pandemic. The original article " An intervention to improve oral health indicators to pre-COVID-19 levels" will be submitted for publication in The Lancet Regional Health – Americas, Impact Factor 7.0 (JIF), Qualis/CAPES – A1. The two chapters of this thesis provide evidence on the economic impacts of Covid-19 on dentists in the private sector (Chapter I), as well as on dental care, assessed by analyzing the indicators of the procedures performed, using interrupted time series (Chapter II).