[Dental loss and prosthetic replacement expectation: qualitative study]

Reasons for and consequences of tooth loss in adults and elderly people in Brazil: a qualitative metasynthesis

The objective was to analyze and systematize evidence reported in qualitative studies on the reasons and consequences of tooth loss in adults and elderly people in Brazil. A systematic review of the literature on qualitative research methods and a meta synthesis of the results were performed. The study population consisted of adults over 18 years of age and elderly people in Brazil. Searches were performed in the BVS, PubMed, Scopus, Web of Science, BBO, Embase, EBSCO and SciELO databases. The thematic synthesis identified 8 analytical themes regarding reasons for tooth loss and 3 analytical themes regarding consequences of tooth loss. Dental pain, care model, financial situation and desire for prosthetic rehabilitation were determining factors for extractions. There was recognition of negligence in oral care, and the naturalness of tooth loss was linked to old age. Missing teeth caused psychological and physiological impacts. It is imperative to verify whether the factors that cause tooth loss persist, and how much those factors influence decisions to extract teeth among current young and adult populations. It is necessary to change the care model through the inclusion and qualification of oral health care for the young and elderly adult populations; otherwise, the model of dental mutilation and the culture of edentulism will persist.

Use of dental implants among older adults of two southern Brazilian cities: A population-based cross-sectional study

AIM

To assess the prevalence and associated factors with use of dental implants among older adults.

METHODS

This cross-sectional study was performed with home dwelling older adults from the cities Cruz Alta and Veranópolis, Brazil. The main outcome was obtained by a clinical oral examination, considering those with at least one dental implant. Independent variables were collected by a structured questionnaire. Crude and adjusted analysis was performed by Poisson regression with robust variance estimation; results are presented in prevalence ratio (PR) and 95% confidence interval.

RESULTS

It was included 569 participants. The overall prevalence of using at least one dental implant was 16.7%. Higher PR for the use of dental implants was observed in white individuals (PR:5.147; 95% CI:2.033-3.034), in those with at least medium income (PR:3.202; 95% CI:1.196-5.572) and in those with access to dental care in the last 12 months (RP:1.595; 95% CI:1.087-2.340). Older adults with a medium level of education (RP:0.484; 95% CI:0.240-0.978) and those that did not use dental floss (RP:0.627; 95% CI:0.240-0.978) demonstrated a significantly lower PR for use of dental implants.

CONCLUSION

A substantial prevalence of use of dental implants was observed among older adults. In addition, white ones, those with a better financial situation and users of dental floss presented higher use of dental implants.

The course from tooth loss to successful rehabilitation with denture: Feelings influenced by socioeconomic status

Objective:

This study evaluated the perception of users of complete dentures (successful cases) provided by the public health service throughout the course from tooth loss to rehabilitation.

Methods:

A total of 11 individuals who received their complete dentures through the public health service were interviewed according to a qualitative approach based on three pre-established topics: (1) tooth loss, (2) living without teeth, and (3) living with dentures. The obtained material was submitted to content analysis.

Results:

Individuals associated the socioeconomic status with lifelong oral health experiences and difficulty to access oral treatment. Tooth loss was the solution to pain and sometimes perceived as a natural event of life. Living without teeth was a negative surprise that resulted in physical and psychological impairments. The period of adaptation to dentures represented suffering and required psychological efforts to be successful.

Conclusion:

The dentures represented a reward for the suffering and recovered normal function, appearance, and socialization.

Associação entre o uso de prótese dentária total e o tipo de serviço odontológico utilizado entre idosos edêntulos totais

Resumo A reabilitação protética foi prevista pela política nacional de saúde bucal em função da alta prevalência de perda de todos os dentes e do baixo uso de prótese dentária entre idosos. Há necessidade de se avaliar o impacto dessa política de reabilitação. Portanto, objetivou-se investigar se o tipo de serviço odontológico utilizado foi um dos fatores associados ao uso de prótese dentária total entre idosos. Trata-se de um estudo transversal conduzido em uma amostra probabilística de idosos (60 anos ou mais) residentes na zona urbana de um município brasileiro de pequeno porte populacional por examinadores calibrados. Realizaram-se análises descritiva, bivariada e múltipla (Regressão logística - odds ratio - OR). Participaram 287 idosos, destes, 186 (64,8%) faziam uso de prótese dentária total. O uso de prótese dentária total foi associado a maiores chances de uso de serviços odontológicos supletivos ou particulares (OR = 4,19; p < 0,001) e a presença de lesão no palato (OR = 7,52; p = 0,002) e, também, a menores chances em idades maiores ou iguais a 73 anos (OR = 0,52; p = 0,023) e entre os com comprometimento na dimensão incapacidade física do OHIP-14 (OR = 0,20; p = 0,002). O uso de prótese dentária total foi associado ao tipo de serviço odontológico entre idosos, sendo maior o uso entre usuários dos serviços supletivos ou particulares.

Tooth loss experiences in adult and elderly users of Primary Health Care

From the theoretical perspective of phenomenology, this article seeks to understand the experiences of tooth loss in adult and elderly users of Primary Health Care in Porto Alegre, Rio Grande do Sul. Tooth loss was identified by the analysis of dental records of users that attended the oral health service at the Health Unit under study. Following this identification, individual household interviews were carried out. The sample was intentional. Data were interpreted by content analysis using the software ATLAS.ti (Visual Qualitative Data Analysis). The study had ethical approval. Losing teeth was an experience that expresses subjectivities, showing plural narratives and highlighting the social function of the mouth. Besides the number of missing teeth, the understanding of how people perceived themselves without their teeth determined how much tooth loss affected their lives. Wearing prostheses adds significance to individuals' perceptions of their body, restoring the balance between their body and the world. Qualitative approach studies in health services should be considered in order to plan interventions which prioritize people's individual needs in their own territories, thus reducing stigmas and social inequalities.

Oral health condition and reasons for tooth extraction among an adult population (20-64 years old)

The study characterized the oral health condition and main self-reported reasons for tooth extraction in an adult population. The cross-sectional study examined 248 adults aged 20-64 years, representative of the population of Piracicaba, São Paulo, Brazil. The oral examination conducted in households used the DMFT and CPI indexes, use and necessity of prosthodontics according to the WHO criteria and the presence of visible biofilm. Demographic and socioeconomic data were collected along with reasons for tooth extraction through a questionnaire. Descriptive analysis was stratified by age in groups: 20-44 and 45-64 years old. The average DMFT was 20.37 (EP = 0.50), P = 3.34 (EP = 0.33) for young adults and P = 13.41 (EP = 1.45) for the older adults. Gingival pockets (CPI ≥ 3) were found on 20.5% of young adults and 53.0% of the older ones. While 38.8% used upper prosthesis, 46.7% needed lower prosthesis. Pain was the most prevalent self-reported reason for tooth extraction (37.5%), being this choice primarily because of lack of another treatment option (52%) and done in the private sector (47.2%). We concluded that young adults (20-44 years old) showed less missing teeth, periodontal diseases, and need for prosthetic use. Pain and lack of options of other treatments were the main self-reported reasons for performing tooth extractions.

[Association between tooth root remains and self-reported oral health among the elderly]

The presence of tooth root remains is a common clinical finding among elderly patients and may reflect a need for treatment. The scope of this study sought to explore the association between the presence of tooth root remains and self-reported oral health among the elderly. Secondary data from two sanitary districts of Porto Alegre, State of Rio Grande do Sul, were analyzed. A conceptual theoretical model was used in the analysis to assess factors related to self-perceived oral health: gender, age, education, marital status, smoking habit, alcohol consumption, demand for oral health care, participation in community groups, family economic self-sufficiency, oral health service accessed, number of teeth and the presence of tooth root remains. The statistical data were analyzed using Chi-square and Poisson Regression tests (95% CI analysis; α 5%). The sample consisted of 849 elderly individuals with a mean age of 69.7 years (± 7.2); 14.5% of the elderly had tooth root remains and 60.7% reported good self-perceived oral health. According to the hierarchical analysis, the absence of tooth root remains was associated with good oral health perception. The qualification and expansion of health care provided should be considered in order to allow planning actions to ensure the maintenance of good oral health for the elderly.

[The social value of teeth and access to dental health services]

Oral healthcare provided by the Unified Health System (SUS) faces the challenge of attending the epidemiological profile of Brazil's adult population. Qualitative research using semi-structured interviews was conducted to understand the experiences, expectations and perception of SUS users to services in Diamantina, State of Minas Gerais, and content analysis was used to assess the data. Discussion of the results was based on dialogue between the symbolic interactionism of Goffman and Bourdieu's concept of habitus. The results show that the users did not give importance to dental care during childhood and adolescence because care was unknown to them. There was no offer of treatment besides dental extraction. Today, they value teeth and suffer the embarrassment caused by rotten teeth. However, access to dental restoration via SUS is not possible. For their children, they perceive better access to information and care, but for specialized procedures there are barriers. They express resignation both in relation to the poor state of the teeth and the difficulties of access to dental care, which can be understood by the constant exclusion experienced by them in the past, shaping their actions in the present. It was concluded that oral health in SUS should incorporate the social value and the aesthetic dimension of teeth as a social right.

Locked mouths: Tooth loss in a women's prison in northeastern Brazil

Background. Prisoners, in general, exhibit unsatisfactory oral conditions, especially with regard to the large number of missing teeth and with untreated caries. The aim of this study was to assess tooth loss, use of and need for prosthetic rehabilitation, and use of dental services among inmates. A cross-sectional study involving 65 inmates was developed at the Regional Women's Prison of Campina Grande, Brazil. Data regarding sociodemographic and sentencing profile, use of dental services, dental morbidity, and self-perceived oral health impacts were investigated. Chi-square, Pearson, and Kruskal-Wallis (P < 0.05) statistical tests were used. The mean tooth loss was 11.3 teeth. Significant association between tooth loss and oral health satisfaction (P = 0.049), self-perceived need for dental prosthesis (P < 0.001), uncomfortable teeth brushing (P = 0.005), difficult speaking (P = 0.002), and difficulty in performing routine tasks (P = 0.025) was observed. It was observed that 29.2% of inmates were using some type of prosthesis, all deemed unsuitable for use, and 78.5% of inmates needed prosthetic rehabilitation. The oral health condition of the population studied was found to be poor, and prisoners showed significant tooth loss and need for dentures, with the aggravation of having tooth extraction as the major reason for seeking dental care.

Exploring motivations to seek and undergo prosthodontic care: an empirical approach using the Theory of Planned Behavior construct

Motivations for seeking and undergoing prosthodontic care are poorly understood and are not often explored for clinical purposes when determining treatment need and understanding the factors related to the demand for health care and effective use. This article uses the Theory of Planned Behavior construct to identify factors related to the motivations of edentulous subjects to seek and undergo prosthodontic treatment. The conceptual framework of the Theory of Planned Behavior includes attitude toward behavior, an individual's positive or negative evaluation of self-performance of the particular behavior; the subjective norm, an individual's perception of social normative pressures or relevant others' beliefs that he or she should or should not perform such behavior; and perceived behavioral control, or an individual's perceived ease or difficulty in performing the particular behavior, determined by the total set of accessible control beliefs. These components mediate a subject's intention and behavior toward an object and may also explain health-related behaviors, providing strong predictions across a range of health behaviors. This study suggests categories for each component of the Theory of Planned Behavior, based on clinical evidence and practical reasoning. Attitudes toward behavior include perceived consequences of no treatment, perceived potential benefits and risks of treatment, dental anxiety, previous experiences, and interpersonal abilities of the health care providers. The subjective norm includes the opinions of relevant others, advertisement, professionally defined normative need, perceived professional skills, and technical quality of care. Perceived behavioral control includes subject's time, availability and opportunity, treatment costs, subject's perceived need, and accessibility to dental care. This conceptual model represents a theoretical multidimensional model that may help clinicians better understand the patient's treatment behaviors and provide additional information for clinical research on patient's adherence to interventions in prosthodontics.

Desempenho dos Centros de Especialidades Odontológicas frente ao quadro sociodemográfico dos municípios do Amazonas, Brasil, 2009

O estudo avaliou o cumprimento das metas de desempenho dos Centros de Especialidades Odontológicas (CEO) do estado do Amazonas, utilizando dados secundários do SIA-SUS, considerando as variáveis estruturais dos estabelecimentos, cobertura da atenção básica e indicadores sociodemográficos dos municípios. Treze CEO foram avaliados. Um estabelecimento de Manaus e os de Maués e Parintins apresentaram melhor desempenho em relação ao Cumprimento Global das Metas. A cobertura das Equipes de Saúde Bucal na atenção básica parece não acompanhar o desempenho dos estabelecimentos. Os resultados sugerem que o desempenho dos CEO está relacionado às características sociodemográficas dos municípios.

Percepções de um grupo de idosos frente ao fato de não consultarem regularmente o cirurgião-dentista

Ainda existe no imaginário coletivo a ideia de que idosos não necessitam de assistência odontológica, pois são em sua maioria desdentados e usuários de dentaduras. Assim, a pergunta desta pesquisa é: Qual o motivo que faz com que muitos idosos não consultem regularmente o cirurgião-dentista? O objetivo foi levantar e analisar os motivos que fazem com que idosos cadastrados em uma Unidade de Saúde da Família não consultem regularmente o dentista. Trata-se de uma pesquisa descritiva exploratória de abordagem metodológica quanti-qualitativa realizada por meio de entrevistas domiciliares semiestruturadas aplicadas em 149 idosos cadastrados em uma Unidade de Saúde da Família na cidade de Ribeirão Preto,SP. Os dados foram analisados e sistematizados por meio da técnica da Análise de Conteúdo, e para a análise quantitativa foram realizadas análises bivariadas com associações significantes baseadas em valor de p<0,05. Houve associação estatisticamente significante entre visita ao dentista e idade (p=0,025), e observou-se que idosos com idades mais avançadas relataram ir menos ao dentista. Alguns dos motivos alegados foram: medo, dificuldade financeira, falta de tempo, além de falta de sintomatologia dolorosa nos dentes devido ao uso de dentaduras. Concluiu-se que os motivos alegados estão associados a aspectos sociais e culturais que devem ser analisados frente ao cuidado na atenção primária à saúde.