A oferta do pré-natal odontológico no serviço público do município de Mariana (MG)

Abstract

Women are vulnerable to a series of physiological changes during pregnancy, which temporarily put them at risk for oral health problems. Despite being considered a priority group, the rates of dental care for pregnant women remain low. The aim of this study was to evaluate the factors related to the low proportion of pregnant women with completed dental consultations (Prenatal Dental Care - PNO) in the municipality of Mariana (MG) and propose strategies to address this issue. A literature review of the past 40 years was conducted on the main aspects involving PNO, aiming to guide dentists and other health professionals in providing dental care to pregnant women. To capture the multiple perspectives of those involved in offering PNO, this study included dentists (n=28), nurses (n=14), doctors (n=11), and pregnant women (with and without dental care) (n=20) linked to the public health service of Mariana (MG), through representative and convenience samples. A sequential explanatory mixed-method design was used. In the first, quantitative phase, a semi-structured questionnaire was administered to health professionals. The second phase complemented the quantitative phase through face-to-face semi-structured interviews with the same professional categories. Simultaneously, pregnant women undergoing prenatal care were also interviewed. The interviews were recorded and transcribed. Descriptive statistical analysis of the quantitative data was performed (using SPSS software), as well as content analysis of the qualitative data, with joint display of some information. The results indicated that all health professionals considered PNO safe, although some dentists mentioned the importance of having a medical report authorizing dental care. The main access route is through referrals from the health team. While 75% of the dentists had received some training on PNO during their undergraduate courses, more than half of the doctors (81.8%) and nurses (78.6%) had never been trained on the subject. Barriers influencing the use of dental services were categorized according to emerging themes: lack of interest among pregnant women, myths and misconceptions, clinical practice errors, dentists’ reluctance to treat pregnant women, organizational and management issues within the health service (such as difficulties in interprofessional work), pregnancy-related health conditions that limit the use of dental services, social conditions, lack of information, anxiety related to dental treatment, and preference for dental care in the private sector. Facilitating factors include: health education, organizational strategies to improve access and adherence by pregnant women, interest from pregnant women, care by the health team, social and community networks, embodiment of the doctrinal principles of the SUS, and training for PNO. A technical product (flow and care protocol) was developed through social technology, collectively built by the actors involved in the research. This study provided a broad understanding of the multiple aspects involved in offering and using dental services during pregnancy. In the SUS, oral health services are structured to prioritize pregnant women; however, cultural difficulties, professional training gaps, and the lack of effective interprofessional work still prevail.