Saúde bucal no contexto do Programa Saúde da Família: práticas de prevenção orientadas ao indivíduo e ao coletivo

Association of Oral Health Teams implantation with collective actions and extractions in Paraná State, Brazil

This article aims to monitor the indicators of outpatient production of Dentistry and to evaluate the association of collective action and extraction indicators with the number of Oral Health Teams (OHT) between 2006 and 2015 in Paraná. In this longitudinal ecological study, consolidated secondary data were analyzed (collective actions of supervised brushing-SB, topical application of fluoride-TAF, fluoride mouthwash-FM, oral examination for epidemiological purposes-OE and extractions of permanent teeth-EX) from the Ambulatory Information System (SIA-SUS) and OHT numbers from the National Registry System of Health Establishments. Descriptive analyzes and Pearson's correlation were performed, with significance level of p<0.05. It was verified the increase of the OHT implantation over time and a strong positive correlation with collective procedures of SB (r=0.78; p=0.007) and FM (r=0.76; p=0.011) and moderate negative correlation with EX (r=-0.53). It was concluded that the evaluated indicators showed that the implementation of Oral Health Teams may have contributed to changes to the healthcare model, with an increase in preventive collective procedures and reduction of tooth loss in Paraná.

Performance of the oral health team in home care in the context of the Family Health Strategy: an integrative review

This is an integrative review that aimed to analyze the performance of the oral health team in home care within the Family Health Strategy, after the publication of the National Oral Health Policy Guidelines. Databases PubMed, Lilacs and SciELO were used in the 2004-2018 period. The selected papers (n=17) were organized in Excel sheet with data: author, year of publication, title, objectives, publishing journal, study location, type of study and thematic category. Two categories emerged from the thematic analysis: "Oral health practices in the household context and the work process of the oral health team" (n=11) and "Instruments for the management and evaluation of home care by the oral health team" (n=6). The scientific production showed low frequency of home visits, lack of prioritization and systematization of home care actions and weak interaction with the family health team. The home care protocols and instruments for the prioritization of home visits indicate the potential to overcome the clinical approach restricted to the dental office. Fourteen years into the publication of the National Oral Health Policy guidelines, the household is a territory to be conquered by the oral health team.

Oral Health in the Family Health Strategy: analysis of articles published in the period 2004-2014

Abstract This study aimed to conduct an integrative review of scientific literature on the topic of Oral Health in the Family Health Strategy in the period 2004-2014. Articles published in national and international journals (n = 141) were consulted and selected from the electronic Library the Scientific Electronic Library Online (SciELO) and from electronic databases PubMed, Lilacs, BBO and Cochrane. The implementation process of oral health teams in the Family Health Strategy was the most frequent thematic variable (18%) of the 15 variables identified. The Northeast was the Brazilian macro-region where the largest number of published articles originated (n = 61). The studies were predominantly quantitative, and the highest number of publications occurred in 2010 (n = 26). We concluded that there is an increasing interest in investigating the context of oral health implementation in the Family Health Strategy, with particular emphasis on theme categories related to the micro-process work and the redefinition of professional identities arising from multidisciplinary work in primary care.

Oral primary care: an analysis of its impact on the incidence and mortality rates of oral cancer

Background

Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables.

Methods

An ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002–2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%).

Results

The oral cancer incidence rate was positively association with the proportion of of adults over 60 years (β = 0.59; p = 0.010) and adult smokers (β = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (β = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (β = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (β = −0.01; p < 0.006) and PHC financing (β = −0.52⁻⁹; p = 0.014).

Conclusions

In Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths.

Electronic supplementary material

The online version of this article (10.1186/s12885-017-3700-z) contains supplementary material, which is available to authorized users.

Advances and challenges in oral health after a decade of the "Smiling Brazil" Program

OBJECTIVE

To analyze oral health work changes in primary health care after Brazil's National Oral Health Policy Guidelines were released.

METHODS

A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care.

RESULTS

Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people's participation and social control; and intersectorial actions.

CONCLUSIONS

Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Visita domiciliar: estratégia de aproximação à realidade social?

O estudo teve por objetivo conhecer a percepção dos alunos do curso de Odontologia sobre o aprendizado na área da saúde bucal coletiva e seu envolvimento com a comunidade, vivenciado nas atividades práticas. A população do estudo, de natureza quantitativa transversal e descritiva, correspondeu a 104 alunos cursando o último ano do curso de Odontologia da Universidade de Fortaleza, em 2008. Dados foram coletados por meio de questionário semiestruturado, aplicado em entrevista. Para 36,2% dos alunos, as visitas domiciliares contribuem para o reconhecimento da realidade social. O benefício para a comunidade seria resultante das ações de educação em saúde, segundo 19,2% dos alunos. Entretanto, 36,2% dos alunos não reconheceram nas visitas domiciliares qualquer importância para sua formação e 53,2% apontaram que estas atividades têm pouca contribuição para os moradores da comunidade. As visitas domiciliares devem prover atividades que extrapolem a coleta de dados, permitindo que o vínculo do aluno com a família se desenvolva na lógica da humanização do atendimento. Professores de todas as áreas de conhecimento devem pensar em propostas que extrapolem o atendimento clínico como conjunto de procedimentos técnicos para uma proposta em que essas atividades causem efetivamente impacto na saúde bucal, primando por um maior vínculo com essa população.

Percepção dos profissionais quanto à pertinência dos indicadores de saúde bucal em uma metrópole do Nordeste brasileiro

Estudo exploratório-descritivo, com abordagem quali-quantitativa, que buscou analisar a percepção dos profissionais quanto à pertinência dos indicadores de saúde bucal do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) em Fortaleza, Ceará. A desmotivação, a descontinuidade no fornecimento de insumos odontológicos, o abandono do tratamento por parte do paciente, a cultura popular de que a gestante não pode realizar tratamento odontológico e a insegurança do profissional no manejo clínico relacionado à prótese dentária, ao atendimento à gestante, ao atendimento à urgência odontológica e ao diagnóstico de alteração da mucosa oral dos usuários foram problemas identificados na operacionalização desses indicadores e mencionados como interferência para o cumprimento de suas metas.

Evolution of post-deployment indicators of oral health on the Family Health Strategy

Objective

To evaluate the evolution of indicators after the implementation of 21 Oral Healthcare Teams in the Family Health Strategy.

Methods

We used data from outpatient services of Oral Healthcare Teams to evaluate efficiency, access, percentage of absences and emergencies of oral healthcare professionals who worked in the partnership between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo, during the period 2009-2011.

Results

Percentages of emergencies, income, and access showed a significant difference during the period analyzed, but no difference for percentage of absences was found. When monthly analysis was made, it is noteworthy that at the beginning of service implementation a fluctuation occurred, which may indicate that the work was consolidated over the months, becoming capable of receiving new professionals and increasing the population served. Comparison of the indicators in that period with the goals agreed upon between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo made it possible to notice that the Oral Health Teams had a good performance.

Conclusion

The results showed that the goals were achieved reflecting the increasing number of professionals, the maturing of work processes in the Oral Health Teams, and optimization of the manpower available to perform the activities. Understanding these results will be important to guide the actions of Oral Health Teams for the following years and to assess the achievement of goals.

Atendimento odontológico domiciliar aos idosos: uma necessidade na prática multidisciplinar em saúde: revisão de literatura

O atendimento odontológico domiciliar direcionado aos idosos semi e dependentes é conjunto de ações preventivas e de mínima intervenção que visam promover a saúde bucal e orientar familiares e cuidadores. É considerada uma estratégia educativa e assistencial de saúde cuja finalidade é intervir, de maneira multidisciplinar, no processo saúde-doença de idosos vulneráveis. Este estudo tem como objetivo abordar a prática odontológica domiciliar, enfatizando as principais alterações sistêmicas e possíveis repercussões na cavidade bucal, a necessidade de participação efetiva do cirurgião-dentista e orientações de promoção de saúde bucal que possam auxiliar nas condutas dos familiares, cuidadores e profissionais envolvidos com esse tipo de atendimento. Foram realizadas busca e análise de artigos científicos e bases de dados bibliográficos sobre a prática odontológica domiciliar em idosos. Na estratégia de busca foram empregados os termos: assistência domiciliar, odontogeriatria, odontologia domiciliar, idoso fragilizado e saúde bucal. Adotaram-se como critérios de inclusão: artigos publicados em português; artigos indexados nas bases de dados LILACS e SciELO; artigos publicados no período de 2000 a 2011 e legislação federal sobre o assunto, totalizando 36 referências. Concluiu-se que existe grande necessidade dessa atividade odontológica em domicílio a ser executada de maneira capacitada por odontogeriatras com formação gerontológica que possam contribuir na humanização do atendimento e promoção do bem-estar e qualidade de vida desses idosos.

[Assessment of educational actions on the oral health of adolescents within the Family Health Strategy]

OBJECTIVE

to evaluate the actions of education on the oral health of adolescents within the scope of the Family Health Strategy.

METHODOLOGY

A questionnaire was applied and a clinical exam conducted evaluating biofilm and gingival inflammation in 80 adolescents before and after interventions. A qualitative study of the brushing technique was also performed on 15 adolescents in the sample.

RESULTS

there was an improvement in oral hygiene of adolescents who participated in actions at school and an increase in the number of adolescents who had healthy gums or only mild inflammation in the second test in school groups and home visits. With respect to the consumption of candies, both the weekly group and the school group saw a decrease in candy consumption between the first and second tests. There was an increased frequency of brushing in the school group.

CONCLUSION

considering the importance of educational activities observed in this study, the process of training and joint planning of activities among the school staff and health professionals would appear to be important.

[Impact of the Family Health Strategy: an analysis in cities in Northeast Brazil with more than 100,000 inhabitants]

This study aimed to analyze the impact of the Family Health Strategy (FHS) on oral health in Northeast Brazil, in 12 municipalities with more than 100 thousand inhabitants. The reference was 20 census tracts, 10 of which in areas with oral health covered by the FHS for at least a year, matched with 10 census tracts without oral health coverage. The total sample included 59,221 individuals. Three possible effects were considered: negative, positive, and absence of effect on the outcomes, based on the prevalence ratio adjusted by Poisson regression. The outcomes "access to collective preventive measures" and "treatment of toothache" indicate a positive effect in the FHS oral health model. However, the outcomes "coverage of tooth extraction" and "restorative treatment" showed either a negative effect or no effect in the majority of the municipalities in the sample. Evidence indicates that within the FHS, the results reflect the local organizational models for oral health care.

Pacto pela saúde no Brasil: uma análise descritiva da progressão dos indicadores de saúde bucal

INTRODUÇÃO: Desde a implantação do Sistema Único de Saúde (SUS) no Brasil, inúmeras e constantes são as tentativas de ampliação de mecanismos que levem à otimização dos serviços públicos de saúde. Nesta perspectiva de avanço estratégico das ações e dos serviços de saúde pública no Brasil, é divulgado o Pacto pela Saúde - Consolidação do SUS, sendo aprovadas as diretrizes operacionais inerentes a ele. OBJETIVO: Analisar e interpretar a evolução temporal dos indicadores de saúde bucal, consolidados no Pacto pela Saúde, considerando-se as cinco grandes regiões brasileiras. MÉTODO: Análise descritiva de dados coletados dos bancos do Sistema Único de Saúde (DATASUS) referentes aos anos de 2008 a 2010 foi realizada, por meio de indicadores de saúde bucal: indicador 41 - Cobertura Populacional estimada das Equipes de Saúde Bucal na Estratégia Saúde da Família e indicador 42 - Média da Ação Coletiva de Escovação Dental Supervisionada, ambos disponibilizados no Pacto pela Saúde. RESULTADO: O indicador 41 apresentou um desenvolvimento progressivo ao longo do triênio estudado, embora lento e desigual, entre as grandes regiões brasileiras. No que se refere ao indicador 42, este apresentou oscilações em seus valores de referência durante o período analisado, também de forma díspar entre as regiões analisadas. CONCLUSÃO: Distintas são as justificativas que podem levar ao entendimento destes resultados, desde o perfil da prestação dos serviços públicos de saúde e o porte populacional dos municípios que compõem as diferentes regiões, a aspectos que se relacionam à fragilidade da gestão pública e à falta de política de recursos humanos.

Atuação da equipe de saúde bucal na estratégia saúde da família: análise dos estudos publicados no período 2001-2008

O objetivo do presente estudo foi revisar as publicações no período de 2001 a 2008 sobre a atuação da Equipe de Saúde Bucal (ESB) na Estratégia Saúde da Família (ESF), buscando conhecer o perfil das publicações e os estudos que possam subsidiar a avaliação da inserção da saúde bucal na estratégia. As fontes de publicação consultadas foram artigos publicados em periódicos nacionais e internacionais incluídos nas bases de dados LILACs, MEDLINE e BBO, além de periódicos não indexados. Foram selecionados apenas os artigos que abordavam algum tipo de avaliação da atuação da ESB na ESF (N=20). Os estudos publicados no período analisado apresentam informações importantes, porém as metodologias de avaliação utilizadas na maioria destes não permitem conhecer o impacto das ações da ESB no acesso e na condição de saúde bucal das populações beneficiadas. Os achados indicam ainda que os municípios não têm realizado suas ações de saúde bucal plenamente da forma preconizada pelo Ministério da Saúde. Além disso, barreiras e avanços têm sido identificados no processo de construção em que ainda predominam as práticas do modelo tradicional.