Resolution of Endodontic Treatments in Municipalities with Brazilian Dental Specialty Centers - CEO: Ecological Study

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Abstract
Objective: To identify the factors associated with the resolution of endodontic treatments in Brazilian municipalities with Brazilian Dental Specialty Centers (CEO). Material and Methods: Ecological study with 684 municipalities participating in the second cycle of the National Program for Improving Access and Quality of Specialty Dental Centers (PMAQ‑CEO) in 2018. Data were obtained from the health information systems of the Brazilian Unified Health System (SUS), the PMAQ-CEO, and additional sources. The dependent variable, resolution, was the ratio of completed endodontic treatments to endodontic access procedures. For the bivariate analysis, Pearson's chi-square test was applied, considering contextual and health system-related municipal factors as independent variables. These included the Municipal Human Development Index (MHDI), resident population size, national macro-region, dental insurance coverage, oral health team coverage, number of dentists affiliated with the SUS, coverage of initial dental consultations, existence of an Urgent Care Center, number of CEO, and PMAQ-CEO certification. Multivariate analysis was performed using ordinal logistic regression, adopting a two-level hierarchical model. Results: The median of the dependent variable was 0.33; that is, for every 10 teeth opened for pain relief due to deep dental caries, approximately 3 teeth had completed endodontic treatment. The adjusted analysis showed greater chance of resolution in municipalities with the following characteristics: Northeastern region (OR=1.9; 1.1-3.4); medium population size (OR=2.0; 104-2.9); second HDI-M quartile (OR=2.5; 1.6-4.0); lower dental plan coverage (OR=2.4; 1.5-4.0); classified as good, very good or excellent in the PMAQ-CEO certification (OR=1.4; 1.1-1.9). Conclusion: There was low resolution in endodontic treatments performed in SUS. Municipalities of both small and large sizes demonstrate greater fragility in care continuity, as reflected in a low proportion of completed endodontic treatments within the SUS.

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