Intermunicipal inequities in access and use of secondary health services in the metropolitan area of Curitiba

The aim of this study was to identify and analyze inequities in the access to specialized services in the municipalities of the metropolitan area of Curitiba, Paraná, Brazil. This is an ecological study. In its preparatory stage, this study focused on the socioeconomic, epidemiologic, healthcare network and sectoral financing network profiles of the 26 municipalities comprising this area. Factor analysis was employed to obtain the six principal components, and a synthetic index was calculated from them, allowing municipalities to be ranked according to living conditions and health situation. Primary data was collected from 24 municipalities, regarding their capacity, directed and repressed demand of specialized healthcare services. The context analysis revealed accentuated intermunicipal inequities. The synthetic index allowed municipalities to be classified in four relatively homogeneous groups regarding living and health conditions. Municipalities located in Vale do Ribeira obtained the worse outcomes for the Living Conditions and Health Situation Synthetic Index, as well as the higher repressed demand for specialized healthcare services. The geographical distance from the capital showed to contribute to worse living and health conditions and greater difficulties in access to healthcare services.

Chronic conditions policies: oral health, a felt absence

The global health scenario shows an epidemic of non-communicable diseases that lead to long-term chronic conditions, some of which are incurable. Many infectious diseases, owing to their development and length, also generate chronic conditions. Similarly, non-morbid states, such as pregnancy, and some life cycles such as adolescence and ageing, follow the same logic. Among all these chronic conditions there is a significant interrelationship with oral health, both in parallel events and common risk factors. This article presents cross-sectional qualitative research into World Health Organisation recommended health policies to address chronic conditions. Several documents published by the organisation were analysed to verify the presence of references to oral health in relation to chronic conditions, particularly cardiovascular diseases and diabetes as these most frequently have oral manifestations. The analysis showed no significant references to oral health or its indicators within the published texts. The study recognises the value of the work developed by the World Health Organisation, as well as its worldwide leadership role in the development of health policies for chronic conditions. This article proposes a coalition of dentistry organisations that could, in a more forceful and collective way, advocate for a greater presence of oral health in drafting policies addressing chronic conditions.

Prevalence and impact of xerostomia on the quality of life of people living with HIV/AIDS from Brazil

OBJECTIVE

To evaluate the impact of xerostomia on the quality of life (QOL) of people living with HIV/AIDS (PLWHA) from Brazil.

STUDY DESIGN

A cross-sectional study was performed on 195 PLWHA. Xerostomia was detected by asking a question about the sensation of having "dry mouth," and Oral Health Impact Profile 14 (OHIP-14) was used to measure the impact of xerostomia on QOL. Time of diagnosis of HIV/AIDS was assessed.

RESULTS

A total of 78 (40.0%) subjects presented with xerostomia. Xerostomia was associated with female gender, low amount of saliva perceived (p ≤ .01), difficulty in swallowing food (p ≤ .05), and showed to have a negative impact on QOL as measured by OHIP-14 (p ≤ .01).

CONCLUSION

Xerostomia was frequent and showed to have a negative impact on the QOL of PLWHA.

[Racial inequity in oral health in Brazil]

OBJECTIVE

To identify racial inequities in oral health between groups of adults selfdeclared as white, black, or mixed in Brazil.

METHODS

Secondary data were obtained from the national oral health survey of the Brazilian population (SB-Brasil 2002-2003) database. Initially, a cross-sectional study was conducted to compare the following outcome variables: caries, tooth loss, pain of dental origin, and need for prostheses according to race/color in a sample of 12 811 adults of both sexes, aged 35 to 44 years. In the second stage, an ecologic study was carried out with data aggregated by Brazilian state to contextualize racial inequity in a population of 6 918 black individuals (black and mixed). For that, the oral health outcomes studied in the first stage were correlated with human development and income distribution indicators.

RESULTS

Significant differences were observed between the race/color groups for all oral health outcomes examined (P < 0.01). Correlations were found between oral health outcomes and indicators related to the human development profile, average family income, and income inequality by state for the group of Brazilian blacks.

CONCLUSIONS

The results show racial inequity in oral health in Brazil for all the indicators analyzed (caries, tooth loss, pain, and need for prostheses), with greater vulnerability among the black population compared to whites. Contextual factors related to the human development profile, income distribution, and access to health care policies appear to play a key role in describing the vulnerability of populations to oral health problems.

HIV infection induces morphometrical changes on the oral (buccal mucosa and tongue) epithelial cells

The aim of this study was to assess morphological and morphometrical alterations of oral squamous epithelial cells in type 1 HIV infected individuals. Oral smears were collected from tongue and buccal mucosa of 30 HIV infected (experimental) and 30 non-infected (control) individuals by liquid-based exfoliative cytology. The cells were morphologically analyzed and the nuclear area (NA), the cytoplasmic area (CA) and the nucleus-to-cytoplasm area ratio (NA/CA) were calculated. No morphological differences were found between the groups. The mean values of CA were decreased in tongue (P=.00006) and buccal mucosa (P=.00242) in HIV infected individual, while mean values of NA were increased (P=.00308 and .00095, respectively) in the same group. NA/CA ratio for experimental group was increased in both collected places, with P=.00001 (tongue) and P=.00000 (buccal mucosa). This study revealed that HIV infection was able to induce morphometrical changes on the oral epithelial cells.

[Evaluation of the perception of the oral health teams of the municipal health department of Curitiba, Paraná State, regarding atraumatic restorative treatment (ART)]

An evaluation was made of the perception of oral health teams regarding Atraumatic Restorative Treatment (ART) as a primary oral healthcare strategy used by the Municipal Health Department of Curitiba, Paraná State. A study was made both of Health Units (HU) that operate using the Family Health Strategy (FHSHU) and those that do not (Basic Healthcare Units--BHU). The sample involved 191 oral health professionals proportionally (CI=95%, e=6%). A questionnaire was used to collect data. The information was analyzed using the SPSS 13.0 program. The response rate was 82%. Chi-square testing did not reveal a statistically significant difference between the FHSHU (83.1%) and the BHU (74.3%) with regard to knowledge about the technique (p>0.05). A difference was found as to training in ART among the different HU (p<0.01) and the use of the technique by the services (p<0.01). The length of training and the length of service of dental health professionals at the municipal health service were relevant in relation to knowledge of the technique and the taking of clinical decisions as to ART. The conclusion was reached that training on ART is needed at the primary healthcare level as a result of the different perceptions revealed.

[Analysis of water fluoride concentration in Curitiba, Brazil: comparison of techniques]

OBJECTIVE

To evaluate the adequacy of fluoride levels in the public water system in Curitiba, state of Paraná, Brazil, as determined by two techniques (colorimetric and electrometric).

METHODS

Data from independent measurements of fluoride in the public water system in Curitiba routinely performed by the city government were obtained for the period between January 2000 and July 2008. Mean levels of fluoride concentration were calculated for each of these years. After that, fluoride concentrations measured in 1 470 samples by the state water utility (SANEPAR) using the electrometric technique in 2006 and 2007 were compared with the corresponding levels measured by the city using the colorimetric method. The rate of samples meeting the standard for the city (0.8 ppmF), and below and above the standard, was calculated for both methods. Fluoride levels were compared between sanitary districts, months for the period between December 2007 and July 2008, and water treatment facilities.

RESULTS

The overall mean fluoride level between 2000 and 2008 was 0.7 ppmF based on the independent measurements. The comparison between techniques showed a higher mean fluoride level with the electrometric technique (0.743 ppmF ± 0.133) vs. the colorimetric technique (0.637 ppmF ± 0.164). The rate of samples meeting the ideal standard of 0.8 ppmF was 15.05% for the colorimetric and 63.97% for the electrometric technique; 62.03% and 22.85% of the samples were below that standard and 21.10% and 13.18% were above that standard, respectively. Fluoride levels were statistically significant (P < 0.001) for the comparison between sanitary districts and months.

CONCLUSIONS

The choice of technique significantly influences the resulting levels of fluoride. Independent monitoring of fluoride levels should employ the same technique used by the water utility. Further studies should aim at defining which technique is the most adequate to determine fluoride concentration in public water systems.

Fanconi's anemia: clinical and radiographic oral manifestations

BACKGROUND

Fanconi's anemia (FA) is a rare autosomal recessive disorder characterized by progressive bone marrow failure, congenital abnormalities, and predisposition to malignancies. There are 11 genetic subtypes characterized by complementation groups - FA- A, B, C, D1, D2, E, F, G, I, J, and L.

OBJECTIVE

To evaluate and describe clinical, oral and radiographic manifestations of patients with FA.

METHODS

A quantitative analysis of clinical manifestations, oral lesions and panoramic radiographs was performed in 33 patients.

RESULTS

Clinical manifestations included melanin skin pigmentation, skin vascular and ocular anomalies. Melanin pigmentation on oral mucosa, traumatic lesions, gingival bleeding, dental biofilm and gingival alterations were the main oral manifestations that were found. Oral and clinical manifestations were not dependent on patient's sex. No significant statistical difference between females and males was detected. Dental anomalies were not remarkable either at clinical or at radiographic examinations. Although several dental anomalies were observed in patients with FA, the correlation between this disease was not established from this study. Panoramic radiographs showed agenesis, taurodontism, radicular anomalies such as dilaceration, tapering, and foreshortening.

CONCLUSION

This study suggests that gingival alterations are associated with defective oral hygiene but not with hematologic conditions. It also helps elucidate oral manifestations of FA. These patients are living longer and need special dental care.

Cirurgia ortognática: orientações legais aos ortodontistas e cirurgiões bucofaciais

Os autores entrevistaram especialistas em Ortodontia e em Cirurgia Bucomaxilofacial, elaboraram uma lista de ocorrências específicas do dia-a-dia do exercício da especialidade, redigindo, com base na legislação vigente e na literatura, uma série de orientações, atitudes e comportamentos que sugerem como rotina aos profissionais.

Tratamento das ulcerações traumáticas bucais causadas por aparelhos ortodônticos

As lesões de aspecto ulcerado na mucosa bucal são um achado comum na clínica odontológica e geralmente são ocasionados por trauma mecânico devido a próteses mal adaptadas, aparelhos ortodônticos e dentes com coroas ou restaurações fraturadas. Contudo, os indivíduos nos quais a lesão persiste por mais de três semanas deverão ser submetidos à biopsia ou outros exames para excluir algumas lesões de caráter neoplásico ou outras condições, tais como as infecções crônicas e as doenças de caráter imunológico. Durante o tratamento ortodôntico, a dor e o desconforto da mucosa bucal podem acontecer como resultado do traumatismo mecânico dos aparelhos, ocasionado pela fricção aumentada entre o tecido da mucosa e a superfície dos braquetes. Atualmente, o ortodontista possui poucos recursos para prevenir ou aliviar esta irritação na mucosa. O objetivo deste artigo é orientar o ortodontista para o manejo mais adequado destas lesões visando o seu diagnóstico correto, o alívio dos sintomas que estas costumam provocar e o tratamento mais adequado para cada tipo de caso.