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rev port estomatol med dent cir maxilofac . 2026;67(1):2-10 7

Table 2. Evolution of dental vouchers for pregnant women in Portugal (2008–2024)
Year Vouchers Issued Vouchers Used Number of Births Utilization Rate (%) Coverage (%)
2008 33,004 23,706 – 72% –
2009 72,099 60,971 – 85% –
2010 81,322 68,118 – 84% –
2011 80,415 67,626 – 84% –
2012 85,048 71,261 – 84% –
2013 82,641 67,963 – 82% –
2014 88,190 71,625 – 81% –
2015 97,609 78,489 – 80% –
2016 100,804 80,548 – 80% –

2017 104,032 82,402 – 79% –
2018 107,138 83,153 – 78% –
2019 108,212 84,357 – 78% –
2020 93,316 67,532 – 72% –
2021 99,457 73,094 – 73% –
2022 99,457 73,094 82,696 73% 40%
2023 111,652 81,191 84,833 73% 44%
2024 115,073 83,697 83,772 73% 46%
The column Vouchers Issued represents the total number of vouchers distributed annually, and Vouchers Used corresponds to the number of
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vouchers effectively redeemed . The Number of Births is reported by Statistics Portugal (INE) . Utilization Rate indicates the proportion of
vouchers used relative to those issued. Coverage reflects the proportion of pregnant women (estimated from birth data) who use vouchers.
that General Practitioners served as the primary information
Discussion
source, suggesting inconsistent messaging across prenatal
This study provides the first national evaluation of Portugal’s care touchpoints.
Dental Voucher program for pregnant women, combining in- Indeed, a systematic review concluded that while prenatal
dividual experiences with administrative data. Our findings care practitioners recognize the importance of oral health
reveal an implementation gap: despite the program’s expan- during pregnancy, they frequently fail to translate this knowl-
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sion, coverage remains below 50%, with only 40-46% of preg- edge into clinical practice. This finding highlights the urgent
nant women using at least one voucher in recent years. This need for two complementary interventions: (i) ensuring foun-
gap between policy expansion and population coverage war- dational oral health knowledge among prenatal care practi-
rants investigation. tioners, and (ii) developing standardized pamphlets and clin-
When looking at utilization patterns, among our sample, ical guidelines for dissemination during prenatal and
program awareness was high (81.6%), yet utilization was mark- postnatal appointments at health centers.
edly lower (39.5%). Participants who did not use vouchers de- Improved information delivery may empower pregnant
spite awareness cited concrete barriers, such as a lack of par- women to make informed decisions regarding oral health-
ticipating dentists in their area, concerns about provider care utilization. This is particularly relevant as the literature
quality, preference for their established dentist who did not identifies several persistent barriers to dental care-seeking
accept vouchers, insufficient voucher value to cover treatment during pregnancy, including concerns about fetal safety
costs, and confusion about redemption procedures. Notably, during dental procedures, beliefs about inevitable pregnan-
23.7% of users reported that the vouchers did not meet their cy-related dental deterioration, and general lack of aware-
needs, suggesting that even successful access does not guar- ness regarding the importance of oral health maintenance
antee adequate care. during gestation. 7,15
The data also reveal challenges related to information and The national data reveal an intriguing pattern that under-
literacy. Only 52.6% of participants received oral health infor- scores the importance of understanding utilization determi-
mation during pregnancy, despite maintaining regular dental nants. Voucher utilization rates—measuring vouchers re-
visits throughout this period. Furthermore, 23.7% were un- deemed as a percentage of vouchers issued—have remained
aware that maternal oral health can affect pregnancy out- relatively high, stabilizing around 70-80% throughout most of
comes. This knowledge gap is particularly concerning given the program’s years. At face value, these figures suggest rea-