Prospective Association Between Brazilian Primary Oral Health Care Models and Preventive Dental Visits and Risk Behaviours: A 5‐Year Cohort Study Among Young Adults

OBJECTIVE: To evaluate the prospective association between the absence and different models of primary oral health care in Brazil (traditional units and Family Health Strategy [FHS] teams) and preventive dental visits and risk behaviours (smoking initiation and increase in alcohol consumption) among young individuals. METHODS: This 5-year prospective cohort study derived from a population-based cross-sectional survey conducted in 2018 that evaluated the oral health conditions of 1197 15- to 19-year-old adolescents from southern Brazil. In 2022-2024, follow-up assessments were conducted (mean time interval 5 ± 0.5 years). Socio-demographic characteristics, the use of dental services (including the reason for the last dental visit), behavioural habits (smoking and alcohol consumption) and participants' address were collected at baseline and follow-up. The outcomes were last dental visit for prevention, smoking initiation and increase in alcohol consumption. The main predictor variable was public dental services coverage in the neighbourhood (absent, primary health care or FHS including a dental team) obtained from official data. Unadjusted and adjusted multilevel Poisson regression models were performed to estimate relative risk (RR) and 95% confidence intervals (CI). RESULTS: Five hundred and seventy individuals were re-evaluated (47.6% retention). After adjusting for individual-level variables, participants residing in neighbourhoods with FHS including a dental team were more likely to visit a dentist for preventive purposes (RR: 1.59; 95% CI: 1.29-1.97), and had a lower risk for smoking initiation (RR: 0.45; 95% CI: 0.21-0.97), and an increase in alcohol consumption (RR: 0.80; 95% CI: 0.67-0.97) compared to areas without coverage. Coverage by traditional primary health care showed no significant association with the study outcomes. CONCLUSION: Brazil's FHS model with integrated oral health teams outperforms traditional dental services in promoting preventive care and reducing risk behaviours among young adults.