Provision of Oral Health Care to Children under Seven Covered by Bolsa Familia Program. Is This a Reality?

Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Familia Program, the Brazilian conditional cash transfer program (Bolsa Familia Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Familia Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Familia Program health conditionalities (Bolsa Familia Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Familia Program. A pretested questionnaire included socio-demographic, Bolsa Familia Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Familia Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Familia Program because they felt it was beyond their responsibilities. Nearly all Bolsa Familia Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Familia Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Familia Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p <= 0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly. Conclusions: No collaboration was observed between the Bolsa Familia Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Familia Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil.