This study aimed to evaluate the impact of the use of dental services on dental pain according to the skin colour among adolescents. Our findings confirm the conceptual hypothesis that non-white individuals of who used dental services over time or that used the service for preventive reasons were more likely to present dental pain over time than white individuals with the same pattern of use. These results reinforce the idea that there are differences in dental attendance between white and non-white individuals.
Our findings evidenced a disparity in the odds of occurrence of dental pain among individuals of different skin colour who have used dental services at least once during the ten- year follow-up period. Non-white individuals were more likely to have dental pain, even when compared with white individuals who used the dental services at least once over time. These results agree with some published studies that report a higher prevalence of dental pain among individuals declared to be non-white, regardless of other factors [43-45].
In this sense, we observed a racial inequity in solving the occurrence of dental pain from using dental services. A possible explanation for this finding is that professionals plan, execute and indicate different treatments according to the skin colour, as shown in previous studies [19, 46, 47]. Thus, professionals tend to indicate more mutilating, lower cost, and less advanced or resolutive treatments for patients with non-white skin colour, without considering economic conditions, revealing a difference in the form of care provided according to the skin colour of the patients. This approach disfavours those belonging to the non-white portion of the population and justifies the finding that, even after undergoing a dental appointment, non-white individuals presented more dental pain than their counterparts [19, 46, 47].
Considering the reason for last dental appointment, our results showed that non-white individuals who have used the service for routine reason over time were more likely to present dental pain than white individuals with the same pattern of use. This finding confirms the information previously discussed regarding the inequities in dental treatment according to skin colour, which may impact oral health outcomes, such as dental pain [13, 19, 48, 49]. These results have proven importance and answer the research question. In addition, not only the use of dental services, but also when considering the way in which the services are used, individuals with non-white skin colour are still more likely to have dental pain over time relative to its comparators. This finding highlights the potential of the “skin colour” variable to influence the occurrence of dental pain.
Comparing our findings with those found in previous studies, it is possible to observe that the prevalence of use of dental services our sample was higher, in both whites (97.1%) and non-whites (97.9%). Some authors report a prevalence of use of 59.8% for white individuals and 44.1% for non-white individuals in similar age groups [50]. Another study, when investigated the prevalence of use among adolescents, found that 58.4% of those evaluated reported having had at least one dental appointment in the last year [51]. This high rate in our study is due to the way the variable was categorized, comprising the use of service in all cohort waves. This result is in line with data from another study that collected this variable in
adolescents from the question “have you ever had a dentist appointment in your life?”, and pointed to a prevalence of positive response in 90.9% of respondents [48].
Regarding the reason for the last dental appointment, a study shows that 61.1% of adolescents sought dental service for non-preventive reasons. Other surveys in a similar age group, showed that less than half of the individuals reported seeking dental care for preventive reasons, revealing the curative character that dentistry still has at national and international levels [48, 52]. In comparison, our study showed that 88.5% of the individuals always used it in a preventive reasons or have gone to preventive reasons during the follow-up to do so over time. The possible explanation for this high level of individuals using the services in a preventive way is given by the way in which the variable was treated, since it always considered the last consultations prior to the data collection stages, not taking into account possible non- preventive appointments between the periods. In addition, considering the trajectory of the form of use, individuals who initially used it in a curative way and started to do so in a preventive way over time, were also part of the allocated portion in the “routine” group.
Regarding dental pain, our study showed a total prevalence of 60.7% in the follow-ups (T2 and T3). A previous systematic review presented occurrences of dental pain from 1.33% to 87.8% among individuals of similar age groups, reinforcing that the prevalence tends to vary according to the different methodologies used in the data gathering [53]. When comparing with another study with a similar age group and methodology developed in Brazil, our study showed a significantly higher prevalence of dental pain, and these differences can be explained due to the subjective nature of the variable and by the report by the parents or guardians [54].
This study has some limitations: it is possible that a selection bias arouses since some individuals were evaluated at T3 before and others during the COVID-19 pandemic. It may also t have introduced a response bias regarding some behavioral factors, as well as in the occurrence of dental caries, since it has been demonstrated the impact of the COVID-19 pandemic on oral health in this age group [55]. However, sensitivity analysis showed that this concern might not affect our findings. ur. Furthermore, the measures regarding the use of dental services and dental pain were self-reported by participants' parents or guardians, which may be subject to information bias.
Among the potential of the study, this is a longitudinal study with a long follow-up period and non-significant losses over time, as well as presented good response rates through the evaluation periods. In addition, the monitoring of a sample from early childhood to adolescence is of paramount importance since that provides relevant data regarding structural, behavioural ans subjective variables collected during an important biopsychosocial period,
which can generate impacts during adulthood and persist during the years. Thus, studying these aspects during adolescence, a transitional phase characterized by a time of intense physical, psychological, affective, and behavioral changes, is essential in order to provide evidence of the factors that affect this age group in general and specific groups, as belonging to the same socioeconomic class or with similar behaviors. These data can be of great value for health planning for these populations and should guide policies aimed at reducing inequalities in oral health.
Our findings concluded that among individuals who used the dental service, those who were of non-white skin colour were more likely to presented dental pain, even if the reason for using the dental service was for routine-preventive treatments. These findings reinforce the inequality present in the provision of dental services to individuals with different racial characteristics.