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rev port estomatol med dent cir maxilofac . 2026;67(1):2-10 5

Figure 2. Changes in toothbrushing habits during pregnancy and dental visit frequency

ally, 26.3% only sought care when experiencing problems, tioner (47.4%) and personal contacts (13.2%) (Figure 5). Finally,
and 92.1% continued to visit the dentist throughout their 65.8% knew their children were also entitled to dental vouchers.
pregnancy. Analysis of national data from the SNS Transparency Por-
While 89.5% of respondents agreed that oral health af- tal and INE revealed important trends in program utiliza-
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fects overall health, 23.7% were unaware of its impact on tion between 2008 and 2024 (Table 2 and Figure 6). Voucher
pregnancy outcomes (Figure 3). Only 52.6% of the participants issuance for pregnant women increased substantially from
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reported having received information about oral health approximately 33,004 in 2008 to over 115,073 in 2024. From
during pregnancy. 2008 to 2010, there was rapid growth in both voucher issuance
The awareness of the Dental Voucher program was high and redemption, accompanied by parallel increases in the
(81.6%, n=31), yet only 39.5% (n=15) used the vouchers (Figure 4). number of treatments performed. After 2010, the system sta-
Among users, 23.7% indicated that the dental vouchers did not bilized with gradual growth but a persistent surplus of issued
meet their needs. The reasons for not using the dental vouchers over redeemed vouchers.
included structural barriers, such as the absence of clinics in Voucher utilization rates peaked at 85% in 2009 but subse-
their town or residential area that accepted the voucher; provid- quently declined, plateauing around 70-80% from 2011 to 2019.
er-related concerns, described as “dentist incompetence”; pref- The trend remained stable until 2019, followed by a decline in
erence for attending their regular dentist, who did not partici- 2020, coinciding with the COVID-19 pandemic. After 2021, us-
pate in the voucher program; and informational shortcomings, age and treatments recovered toward pre-pandemic levels.
such as not receiving the voucher or not knowing how to use it. However, utilization rates in recent years (2021−2024) have
The primary sources of information were their General Practi- remained around 73%.

Figure 3. Awareness of the impact of oral health on general health and pregnancy outcomes