Access to pediatric dental care in the uruguayan military health system: situational diagnosis, barriers, and improvement proposal for beneficiaries aged 0–12 years of the DNSFFAA

Abstract

Access to pediatric dental care is a sensitive indicator of health equity. In Uruguay, the National Directorate of Armed Forces Health (DNSFFAA) is an autonomous health subsystem funded by the Ministry of National Defense, operating outside the National Health Fund (FONASA) and the National Integrated Health System (SNIS). It provides comprehensive coverage to active and retired military personnel and their immediate families, including children aged 0–12 years. Unlike SNIS providers, the DNSFFAA is not subject to the MSP's mandatory benefit plans, creating a specific healthcare reality that has not been systematically studied in the field of pediatric oral health.

Objective: To design and validate a prospective research protocol to diagnose access to pediatric dental care, identify barriers, and propose improvement strategies for DNSFFAA beneficiaries aged 0–12 years, Montevideo, 2026–2027

Methods: A mixed-methods (quantitative-qualitative) prospective cross-sectional study. The quantitative phase involves review of dental records (2024–2025) and a structured caregiver survey (n≈200), with variables including caries prevalence (dmft/DMFT), sealant and fluoride coverage, type of consultations, waiting time, and distance to care center. The qualitative phase includes semi-structured interviews with DNSFFAA dentists (n=8–10) and focus groups with caregivers (n=2). Analysis combines descriptive and inferential statistics with Braun & Clarke thematic analysis. Institutional ethics approval, informed consent, and data anonymization will be obtained.

Expected Results: The first systematized diagnosis of pediatric oral health access within the Uruguayan military subsystem is expected, identifying gaps, barriers specific to the military context, and protective factors. Results will guide DNSFFAA internal health policies and serve as a comparative reference for other special subsystems, contributing to the debate on universal pediatric oral health coverage.