Impact of COVID-19 pandemic on pediatric dental procedures in primary healthcare settings in Piracicaba, Brazil: an ecological study

BACKGROUND

The COVID-19 pandemic brought significant changes to dental care, which may have affected pediatric dental care offered in primary healthcare settings. Therefore, the aim of this study was to analyze the quantity of dental procedures performed in primary healthcare for children aged 6 to 12 years, before and during the COVID-19 pandemic.

METHODS

This is an ecological study using data from the health information system of Piracicaba, São Paulo, Brazil. The variables considered were: coverage of first programmed dental consultation, restoration of permanent and deciduous teeth, topical fluoride application (individual per session), emergency care, and deciduous tooth extraction. Two periods were considered: period I (March 1, 2019 to February 29, 2020) and period II (April 1, 2020 to March 31, 2021), before and during the pandemic, respectively. Comparisons between periods were made using the paired nonparametric Wilcoxon test with a significance level of 5%.

RESULTS

There was an increase in emergency care from 15.4 to 32.4% (p = 0.0095) and a decrease in the number of restorations of deciduous teeth from 32.8 to 20.2% (p = 0.0217). The first programmed consultation showed a decrease of 9.60% (p = 0.0930) in period II.

CONCLUSIONS

The COVID-19 pandemic has hindered access to primary dental care for children, impacting the quantity of emergency care, reducing restorations of deciduous teeth, and first programmed dental consultations. These findings highlight the need for strategies to ensure that pediatric dental care is not neglected during pandemics.

[Malocclusion in adolescents in the State of São Paulo: spatial and hierarchical analysis]

The scope of this study was to analyze the spatial distribution of malocclusion (MO), estimate the prevalence and evaluate the associated factors in adolescents. It was a study with results of 5,558 adolescents aged 15 to 19 from the São Paulo Oral Health (SB) 2015 survey. The outcome was MO. Sociodemographic aspects, access to dental services, dental caries and tooth loss were the independent variables. A total of 162 municipalities in the state of São Paulo were included and spatial statistics techniques were applied. Hierarchical logistic regression models were performed. The prevalence of MO was 29.3%. There was a spread pattern between the types of MO and positive detachment (p<0,05). Non-white adolescents (OR=1.32, 95%CI: 1.24-1.42), with less years of schooling (OR=1.30, 95%CI: 1.22-1.42), with teeth extracted due to caries (OR=1.40, 95%CI: 1.03-1.88) were more likely to have MO. Adolescent access to dental consultation did not contribute to reducing the chance of developing MO, regardless of whether the dental consultation occurred less (OR=2.02, 95%CI: 1.65-2.47) or more than one year before (OR=1.63, 95%CI: 1.31-2.03). Thus, the occurrence of MO is unequally distributed in the state of São Paulo and associated with sociodemographic conditions, access to consultations and tooth loss due to caries.

Size effect in observational studies in Public Oral Health: importance, calculation and interpretation

Abstract The objective of this study was to analyze the scientific literature in public oral health regarding calculation, presentation, and discussion of the effect size in observational studies. The scientific literature (2015 to 2019) was analyzed regarding: a) general information (journal and guidelines to authors, number of variables and outcomes), b) objective and consistency with sample calculation presentation; c) effect size (presentation, measure used and consistency with data discussion and conclusion). A total of 123 articles from 66 journals were analyzed. Most articles analyzed presented a single outcome (74%) and did not mention sample size calculation (69.9%). Among those who did, 70.3% showed consistency between sample calculation used and the objective. Only 3.3% of articles mentioned the term effect size and 24.4% did not consider that in the discussion of results, despite showing effect size calculation. Logistic regression was the most commonly used statistical methodology (98.4%) and Odds Ratio was the most commonly used effect size measure (94.3%), although it was not cited and discussed as an effect size measure in most studies (96.7%). It could be concluded that most researchers restrict the discussion of their results only to the statistical significance found in associations under study.

Size effect in observational studies in Public Oral Health: importance, calculation and interpretation

The objective of this study was to analyze the scientific literature in public oral health regarding calculation, presentation, and discussion of the effect size in observational studies. The scientific literature (2015 to 2019) was analyzed regarding: a) general information (journal and guidelines to authors, number of variables and outcomes), b) objective and consistency with sample calculation presentation; c) effect size (presentation, measure used and consistency with data discussion and conclusion). A total of 123 articles from 66 journals were analyzed. Most articles analyzed presented a single outcome (74%) and did not mention sample size calculation (69.9%). Among those who did, 70.3% showed consistency between sample calculation used and the objective. Only 3.3% of articles mentioned the term effect size and 24.4% did not consider that in the discussion of results, despite showing effect size calculation. Logistic regression was the most commonly used statistical methodology (98.4%) and Odds Ratio was the most commonly used effect size measure (94.3%), although it was not cited and discussed as an effect size measure in most studies (96.7%). It could be concluded that most researchers restrict the discussion of their results only to the statistical significance found in associations under study.

Should midline diastema in mixed dentition be an aesthetic concern?

BACKGROUND

Mixed dentition determines an important period of occlusion development in childhood.

OBJECTIVE

This study aimed to evaluate the aesthetic impact of the midline diastema cut-off point in mixed dentition.

DESIGN

A cross-sectional study was performed with 257 children aged 8 to 10 years in late mixed dentition, with midline diastema of 1mm to 5mm and normal maxillary overjet. Orthodontic Aesthetic Subjective Impact Score (OASIS) determined the aesthetic impact of the midline diastema. Four quartiles of diastema measurements and impact scores were considered as cut-off points. ROC (Receiver Operating Characteristic) curves were constructed, and the distances representing the distances to the ideal point were calculated. The Yuden index determined the efficiency of measuring the diastema to assess the aesthetic impact. The Kruskal Wallis test compared the groups of participants classified according to the diastema cut-off by the sample quartile regarding the impact score. The analyzes were performed with a significance level of 5%.

RESULTS

There was no significant difference between the four groups of measurement quartiles of the diastema regarding the aesthetic impact (p>0.05).

CONCLUSIONS

The perception of dental esthetics in mixed dentition children was not affected by the midline diastema, regardless of the cut-off point.

Uso de álcool associado aos transtornos mentais em homens adultos

Introdução: Do ponto de vista da saúde pública, a população masculina adulta mostra-se vulnerável ao uso de álcool e as suas consequências. A detecção precoce, assim como a busca por fatores associados são necessárias e as unidades de Saúde da Família são importantes locais para esta abordagem. Objetivo: Este estudo teve como objetivo identificar o uso de álcool em homens adultos e verificar sua associação com fatores socioeconômicos, demográficos e transtornos mentais (episódio depressivo maior e transtorno de ansiedade generalizada). Métodos: Foi realizado um estudo transversal em adultos de 20 a 59 anos do município de Piracicaba, cadastrados nas Unidades de Saúde da Família (USF) no ano 2018. Após análises descritivas, as variáveis com p<0,20 nas análises simples foram estudas em modelos de regressão binomial negativa múltipla. Pelo modelo final, estimaram-se as razões de médias ajustadas com os intervalos de 95% de confiança. Resultados: Observou-se prevalência de 26,9% de consumo de álcool na população estudada. O escore do The Alcohol Use Disorders Identification Test (AUDIT) apresentou relação direta com a idade (razões de médias — RM=1,02; intervalo de confiança — IC95% 0,99–1,03). Quanto à religião, protestantes e evangélicos apresentaram escore médio de AUDIT menor que os demais (RM=1,78; IC95% 1,14–2,79). Pessoas com transtorno mental apresentam escore médio de AUDIT maior que os sem transtorno (RM=2,30; IC95% 1,28–4,11). Conclusões: Concluímos que o consumo de álcool na população adulta masculina é bastante prevalente, que seu consumo aumenta com a idade, que a religião tem efeito protetor e que pessoas com depressão e ansiedade apresentam maior propensão ao uso. Com base nesses dados, destacamos a importância da USF no desenvolvimento de estratégias que rastreiem as condições de risco de sua população, bem como discutam abordagens e possíveis intervenções.

Impact of facial profile on young adults' oral health-related quality-of-life item levels: A hierarchical analysis

Objective:

To assess the impact of facial profile on young adults’ oral health-related quality of life (OHRQoL) item levels.

Methods:

A cross-sectional study was carried out with a population-based sample of 205 young adults, with a mean age of 23.1 years. The individuals answered questions about OHRQoL (OHIP-14) and self-esteem (Global Negative Self-Evaluation). The Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) was used to evaluate normative orthodontic treatment needs and define dental malocclusion clinically. Facial profile was analyzed using photographs and dichotomized into two levels: normal (straight) and altered facial profile (convex or concave). A calibrated researcher performed the clinical examination. Association between the independent variables and the outcome (OHRQoL) was established by hierarchical multiple linear regression analysis for each item level. Considering the variable of interest (facial profile), the psychological incapacity domain was the most affected item.

Results:

Individuals with changed facial profile had 2.47 (1.04-5.85) times higher chances of reporting impacts on psychological incapacity than those with a normal profile (p> 0.05). The association was modulated by dental malocclusion and self-esteem.

Conclusions:

The convex and concave facial profile showed a negative impact on the psychological aspects of young adults’ quality of life.

Esthetic impact of maxillary midline diastema and mandibular crowding in children in the mixed dentition

INTRODUCTION

This study aimed to investigate the esthetic impact of mandibular crowding and maxillary midline diastema in children in the mixed dentition.

METHODS

The sample for this cross-sectional study comprised 785 children, aged 8-10 years, in the late mixed dentition. Mandibular crowding and maxillary midline diastema were evaluated clinically with the Dental Aesthetic Index. Mandibular crowding and maxillary midline diastema were evaluated to determine tooth size-arch length discrepancies. The sample was stratified as group 1, children without maxillary midline diastema or mandibular crowding (n = 177); group 2, children with maxillary midline diastema (n = 256); group 3, children with mandibular crowding (n = 208); and group 4, children with maxillary midline diastema and mandibular crowding (n = 144). The subjective esthetic impact was evaluated using the Orthodontic Aesthetic Subjective Impact Score. Descriptive and exploratory analyses of the data were performed. A generalized linear model was applied, adjusted for the possible confounding variables (age, gender, and race) with a significance level of 5% because the Orthodontic Aesthetic Subjective Impact Score did not meet the assumptions of analysis of variance.

RESULTS

Children in groups 2 and 3 showed greater esthetic concern than group 1 (P <0.05). Children in groups 2 and 3 did not show a significant difference with children in group 4 (P >0.05).

CONCLUSIONS

Children with mixed dentition with mandibular crowding or maxillary median diastema reported significantly more esthetic concern than children without these conditions.

Perceptions about the Therapeutic Itinerary after stroke: a qualitative research

OBJECTIVES

to analyze the understanding of the Therapeutic Itinerary of people affected by stroke in the Unified Health System context of a medium-sized city in the state of São Paulo.

METHODS

this is a clinical-qualitative, using in-depth semi-structured interviews, conducted in 2019 with 6 patients, a number determined by theoretical saturation.

RESULTS

qualitative content analysis allowed the construction of four categories that emerged from the data: a) You are having a stroke! - Identifying the problem; b) Anguish and expectations in waiting for assistance; c) Helplessness and guidance for rehabilitation after hospital discharge; d) Spirituality in rehabilitation after stroke.

FINAL CONSIDERATIONS

the affected people expressed feelings and meanings, such as fear, anguish, sadness, beliefs and uncertainties, in order to shed light on the complexity inherent to the experiences of Therapeutic Itinerary of stroke.

Condições de Saúde bucal e acuidade visual dos estudantes em um município do Baixo Amazonas

Resumo Objetivo Avaliar a prevalência da cárie dentária e da deficiência visual nos escolares do ensino fundamental da rede pública de ensino de Barreirinha-AM e verificar os fatores associados a estas condições. Método Estudo transversal, com 1.828 estudantes entre 06 e 17 anos, da rede pública de ensino, Barreirinha. A avaliação da cárie dentária seguiu as recomendações da Organização Mundial da Saúde utilizando os critérios estabelecidos para as condições dentárias, tanto para dentes decíduos, quanto para permanentes: cariados, perdidos e obturados. O índice Significant Caries Index mediu a severidade da cárie dentária nos indivíduos mais afetados com a doença. Realizou-se avaliação para acuidade visual e analisou-se idade, sexo e escola. Resultados Evidenciou-se elevada prevalência de cárie dentária, desigualdade em sua distribuição e associação entre esta doença e sexo (p = 0,005). A prevalência de dificuldades visuais entre os escolares foi baixa. Conclusão e implicações para prática O estudo sugere carência de tratamento odontológico restaurador e elevada prevalência de cárie dentária, evidenciando a necessidade de planejamento e desenvolvimento de ações de promoção de saúde bucal, com o intuito de minimizar os agravos provocados pela doença.

Financial impact of the change in the vulnerability profile of More Doctors Program

OBJECTIVE

To estimate the flow of professionals and the financial impact of the Programa Mais Médicos para o Brasil (PMMB - More Doctors for Brazil Program) within the More Doctors Program (MDP) for the Brazilian Ministry of Health and the participating municipalities of the state of São Paulo, from January 2019 to March 2022.

METHODS

A financial impact study was conducted in the state of São Paulo based on public secondary databases. The number of PMMB vacancies per municipality, of physicians and vulnerability profiles were described to measure the loss of replacement of professionals in the period.

RESULTS

In the specified period, the number of PMMB physicians in participating cities will decrease from 2,533 to 320, and the number of participating municipalities from 373 to 86. The municipalities that will need to replace the physicians will have a financial impact of R$ 929,487,904.77 (with sensitivity analysis, ranging from R$ 650,641,533.34 to R$ 1,208,334,276.20).

CONCLUSION

The change of vulnerability methodology adopted for the PMMB will represent serious consequences, that is, less population assistance and high financial impact for the municipalities of the state of São Paulo in a scenario of budget limitations.

DOES DENTAL TRAUMA IN EARLY CHILDHOOD HAVE THE POTENTIAL TO AFFECT THE QUALITY OF LIFE OF CHILDREN AND FAMILIES?

OBJECTIVE

To evaluate the influence of dental trauma on oral health-related quality of life (OHRQoL) of children and their families.

METHODS

A total of 571 children aged five years were randomly selected at public schools. Trauma was clinically evaluated in accordance with the Andreasen classification. Caries experience in the anterior region and increased overjet were determined according to the World Health Organization criteria. The Early Childhood Oral Health Impact Scale (ECOHIS) was answered by the parents and used to evaluate OHRQoL. In addition, this questionnaire has aspects related to socioeconomic status. Simple logistic regression was performed, and the raw Odds Ratios with the respective 95% confidence intervals (95%CI) were estimated. The variables with p<0.20 were tested in multiple logistic regression models, and those with p≤0.05 remained in the model and the adjusted odds ratio with respective 95%CI was estimated.

RESULTS

Income showed a magnitude of association of 1.56 and 2.70 with the OHRQoL of children and families, respectively. The avulsion variable showed 9.65- and 8.25-times greater chance of influencing the OHRQoL of children and families, respectively. The experience of caries showed 3.80- and 2.42-times greater chance of influencing the OHRQoL of children and families, respectively.

CONCLUSIONS

Dental trauma did not influence OHRQoL of children and their families negatively. However, avulsion and caries experience in low-income families was associated with a negative perception of OHRQoL.

Dental caries and oral health behavior assessments among portuguese adolescents

Introduction: Adolescents have a high risk of developing caries in Portugal. The present study is designed to assess dental caries experience among the adolescents by the application of DMFT index, characterize the oral health risk factors and to determine the association between caries experience and socio-demographic variables. The characterization of the oral health behaviors of adolescents of the central region of Portugal will help in the development of specific oral health education strategies to improve oral health among the local communities. Material and methods: A cross-sectional study was conducted among a convenient sample of 694 adolescents aged 12 to 18 years attending public schools in two Portuguese districts using a structured questionnaire designed to investigate oral health and behavior of participants. In addition, a clinical examination was carried out noting the decayed, missing and filled teeth. A descriptive analysis of the variables was performed using the Chi-square, Mann-Whitney and Kruskal-Wallis tests (p<0.05). A multivariate analysis was applied for analysis of the association between variables. Results: The mean DMFT index score of 2.91±2.9 was obtained. Of the total sample, 73% consumed sugary food daily, 50.1% considered having good oral health and 70.8% did not report pain in the last 12 months. Most adolescents (79.4%) brushed their teeth daily and 60% did not use dental floss. Of the total sample, 96.4% had a dental appointment in the last 12 months, 46.4% of which was for preventive purposes. Applying the Chi-square statistical test, we verified that the adolescents who brush their teeth daily presented a good perception about their oral health (p<0.001), the DMFT index scores were associated with the residence area (p=0.01) and the presence of dental caries was associated with the perception of oral health (p=0.049) and sugary food intake (p=0.029).Conclusion: Portuguese adolescents presented a low DMFT index. The DMFT index was associated with residence area, perception of oral health and sugary food intake. Daily toothbrushing was associated with self-perception of oral health. It is suggested that oral health promotion and prevention programs should aim to reduce the risks of oral disease development.

Factors associated with the need for a complete denture in one arch or both arches among the elderly population

This study aimed to identify factors associated with the need for complete dentures in one dental arch or both, among the elderly population. The cross-sectional household study was conducted with a representative sample of elderly people (65 years or older) in the state of São Paulo, Brazil, in 2015. The dependent variable was the need for complete dentures (in one arch or both), and independent variables were socioeconomic and demographic conditions, social capital, self-perception of oral health and access to dental services. Simple and multinomial logistic regression models tested effect measures (p < 0.05). A total of 5,948 elderly people participated. Results indicated that those with greater chances of needing a complete denture in one arch were male (OR = 1.54; CI95%:1.04-2.29), with fewer household goods (OR = 2.25; CI95%:1.50-3.38), lower monthly household income: R$501-1500 (OR = 3.44; CI95%:1.27-9.35), R$1501-2500 (OR = 4.11; CI95%:1.50-11.27), R$2501-4500 (OR = 2.76; CI95%:1.10-6.95), self-reported need for a complete denture (OR = 4.75; CI95%:3.08-7.35), ≥3 years since last dental appointment (OR = 1.80; CI95%:1.06-3.05), and dissatisfaction with last dental appointment (OR = 1.80; CI95%:1.06-3.05). There were more chances of the need for complete dentures in both arches among older elders (OR = 1.44; CI95%:1.06-1.88), with lower monthly household income: R$ < 501 (OR = 4.45; CI95%:1.71-11.60), R$501-1500 (OR = 4.01; CI95%:2.14-7.51), R$1501-2500 (OR = 2.95; CI95%:1.64-5.32), < 3 years of education (OR = 1.45; CI95%:1.13-1.85), feeling unhappy (OR = 2.74; CI95%:1.35-5.57), self-reported need for a complete denture (OR = 8.48; CI95%:5.75-12.50), dissatisfaction with their mouth (OR = 2.38; CI95%:1.64-3.46), ≥3 years since last dental appointment (OR = 4.28; CI95%:2.85-6.43), and dissatisfaction with last dental appointment (OR = 4.28; CI95%:2.85-6.43). The several dimensions of the determinants of the need for a complete denture reflect the influence of both demographic and socioeconomic aspects, social capital, self-perception of oral health and access to dental services.

Influence of social capital on self-perception related to orthodontic treatment need

Aim: To evaluate the influence of social capital on self-perception related to orthodontic treatment need. Methods: A cross-sectional study was conducted with a sample of 578 11-16 years-old adolescents from a city in southern Brazil. Social capital was evaluated using the Social Capital Questionnaire for Adolescent Students (SCQ-AS). Index of Orthodontic Treatment Need (IOTN) assessed malocclusion and self-perception related to orthodontic treatment need. Sociodemographic aspects of adolescents were also evaluated. Individual analyses were performed, relating the study variables to the outcome, estimating the odds ratio with the respective confidence intervals of 95%. The variables with p<0.20 in the individual analyses were tested in the multiple logistic regression models, and those with p<0.10 remained in the model. Results: Social capital did not influence the self-perception related to orthodontic treatment need. Adolescents with high orthodontic needs were 5.35 (CI 95%: 2.68 to 10.65) times more likely to perceived orthodontic treatment need (p <0.05). Crowding and dental absence were associated with self-perception related to orthodontic treatment need (p <0.05). Conclusions: Social capital did not influence the self-perception related to orthodontic treatment need.

Exploring the impact of oral health-related quality of life on the child’s family structure

Aim: The aim of this study was to explore the impact of oral health-related quality of life (OHRQoL) on the child’s family structure. Methods: A representative sample of 613 children from public preschools, in a city in southeastern Brazil, were enrolled in this cross-sectional study. The sample was determined through probabilistic sampling in two stages (preschools and children). The outcome variable (Early Childhood Oral Health Impact Scale [ECOHIS]) was multi-categorized in children and family. Independent individual variables were sex, race, family income, parents’/caregivers’ level of education, family income, dental caries, and malocclusion. Initially, individual analyses were performed, relating the study variables to the outcome variables, estimating the raw odds ratio with the respective confidence intervals of 95%. The variables with p < 0.20 in the individual analyses were tested in the multiple logistic regression models, and those with p < 0.10 remained in the model. Results: Impact on OHRQoL was reported by 40.9% of the children and 17% of their families. Children with low family income and caries experience had, respectively, 1.53 (95% CI: 1.00-2.32) (p = 0.0465) and 2.96 (95% CI: 1.81-4.84) (p < 0.0001) more chance of presenting negative impact on OHRQoL. Conclusions: The aspects that most affected the OHRQoL of child’s family structure were low income and dental caries experience.

Self-perceived dental treatment need among adolescents: A hierarchical analysis

OBJECTIVES

The aim of the present study was to analyse the factors associated with self-perceived need for dental treatment among adolescents.

METHODS

A representative sample in the state of São Paulo, Brazil, comprising 5558 adolescents, was evaluated in 2015. The adolescents were selected by probabilistic sampling by conglomerates in two stages. The outcome evaluated was self-perceived treatment need measured via a validated questionnaire. Independent variables included sociodemographic factors, type, frequency and reason for last dental visit, and examination of oral conditions. Statistical analysis was based on the multiple hierarchical logistic regression model.

RESULTS

Of the total sample, 3340 (62.6%) adolescents reported needing dental treatment. After fitting the model, the self-perceived need for treatment was associated with adolescents with family income of up to $1,500 BRL (OR 1.39; [95% CI = 1.20-1.60]; P < .001), who sought dental services solely for curative treatment (OR 1.58; [95% CI = 1.46-1.72]; P < .001), reported toothaches in the previous six months (OR 2.88; [95% CI = 2.53-3.28]; P < .001), were dissatisfied with the appearance of their teeth and mouth (OR 5.94; [95% CI = 5.03-7.01]; P < .001), had caries in the posterior teeth only (OR 3.04; [95% CI = 2.77-3.33]; P < .001) or had caries in the anterior teeth (OR 4.75; [95% CI = 4.05-5.56]; P < .001).

CONCLUSIONS

The self-perceived need for dental treatment among Brazilian adolescents was associated with normative and subjective needs, and sociodemographic context factors. This finding provides important evidence for collective health planning.

Association between social conditions and oral health in school failure

OBJECTIVE

To evaluate the association of school failure among Brazilian adolescents with social conditions and aspects of oral health through hierarchical analysis.

METHODS

A state-wide survey of 5,558 adolescents from the state of São Paulo, Brazil, inquired about the sociodemographic and social capital of participants by using a structured questionnaire. Trained and calibrated professionals performed intraoral examinations and interviews in the households. Questions about the access to dentist, reason for and frequency of using dental services, toothache episodes and impact of oral conditions on daily activities (OIDP) were applied. Oral examinations evaluated caries experience, tooth losses, periodontal problems, presence of open bite, and maxillary and mandibular overjet. School failure was estimated according to the teenagers' years of schooling. The independent variables were grouped into three blocks: sociodemographic and economic characteristics, social capital and oral health aspects. The multiple hierarchical logistic regression model was used to identify the factors associated with school failure.

RESULTS

Of the total sample, information about schooling of 5,162 adolescents was obtained, of whom 29.6% presented school failure. We found that adolescents over the age of 16 years who did not declare themselves as white, female, with feelings of insecurity, unhappiness, with toothache, caries, tooth losses, affected by dentofacial and/or periodontal changes, were more likely to fail at school.

CONCLUSION

Oral disorders and social factors were associated with school failure in adolescents. A successful school trajectory was a strong determinant of health, therefore actions between the educational and health sectors must be developed for adolescents, especially those with this profile.

Senso de coerência e fatores associados ao desempenho escolar de adolescentes

Resumo O desempenho escolar é um aspecto fundamental para o futuro sucesso profissional e social. O objetivo do presente estudo foi investigar os fatores associados ao desempenho escolar dos adolescentes, incluindo o Senso de Coerência (SOC) e o estado de saúde bucal. Foram incluídos, no estudo, 381 escolares entre 15 e 18 anos de idade da cidade de Campo Grande, Mato Grosso do Sul, Brasil. O desfecho foi o desempenho escolar avaliado por meio das notas finais das disciplinas de Português e Matemática em 2013. As variáveis independentes foram dados sociodemográficos, autopercepção de saúde bucal, uso de serviços odontológicos e Senso de Coerência, obtidos por um questionário autoaplicado. Além disso, avaliou-se o número de dentes cariados, perdidos e obturados (índice de CPO-D). Análises de regressão logística foram realizadas, com base em um modelo hierárquico. A idade média dos alunos foi de 16 anos; valor médio do CPO-D 4,1 e SOC 44,5. No ajuste final, os indivíduos do sexo masculino (p = 0,0021); aqueles com o maior número de pessoas que moravam em casa (p = 0,0021) e o SOC fraco (p = 0,0005) mostraram associação com o menor desempenho escolar. Em conclusão, o desempenho escolar é um fenômeno complexo, associado ao SOC e às características bucais.

Budgetary Impact of Oral Rehabilitation With Complete Dentures: An Economical Evaluation From São Paulo State, Brazil

OBJECTIVE

To develop a budgetary impact analysis regarding the possibility of offering complete upper and lower dentures to an eligible population of elderly people (above 65 years) in the São Paulo state, Brazil.

METHODS

The proportion of eligible population was calculated by assessing the prevalence of edentulous (upper and lower arch) and by defining the eligible group (public health system users). The budgetary impact analysis was designed under the following scenario: 5-year time horizon (2018-2022), prospect of municipal expenses with prostheses, and additional progressive incorporation of technology (upper and lower dentures) at an annual rate of 10%, 15%, 20%, 25%, and 30%. Sensibility analysis was performed in 3 different situations (reference, more pessimistic, and more optimistic) based on the calculation of spending through assessed demand and epidemiological demand.

RESULTS

The municipal cost for each denture, already discounted the value transferred by the union for this procedure, was R$50.97. The incremental impact on the budget measured by the epidemiological demand relative to assessed demand was approximately R$59 141 510 over 5 years, meaning an impact of 0.08% (0.01% more optimistic; 0.13% more pessimistic) of the "medium and high complexity care" budget and 0.09% (0.03%-0.14%) of the primary care budget.

CONCLUSION

The budgetary impact of increasing the oral rehabilitation with complete dentures for elderly population in the São Paulo state is low relative to the expenses with primary or specialized care budgets. In addition, incorporation of denture rehabilitation would be feasible, according to the financial availability and priorities of each municipality.

Variables associated with the oral impact on daily performance of adults in the state of São Paulo: A population-based study

OBJECTIVE

This study aimed to assess the oral impact on daily performance and its association with sociodemographic characteristics, tooth pain, need for prosthesis, and periodontal disease of adults in the state of São Paulo, Brazil.

METHODS

This was a cross-sectional epidemiological study with secondary data obtained from the Oral Health Conditions Project- 2015 conducted in 163 municipalities in the state of São Paulo with the participation of 17,560 individuals. This study evaluated adults in the age-range between 35-44 years (n = 5,855), selected by means of probabilistic cluster sampling in two stages. The outcome variable was the OIDP (Oral Impacts on Daily Performances), obtained by using this instrument to assess daily activities (eating, speaking, oral hygiene, relaxation, sports practice, smile, study/work, social contact, and sleep). The independent variables were collected and grouped into three blocks: Block 1 (sex, age group, and ethnic group); Block 2 (household income and education); and Block 3 (tooth pain, need for prosthesis, bleeding, calculus, and periodontal pockets). A hierarchical multiple logistic regression analysis was performed considering the complex cluster sampling plan. Each observation was assigned a specific weight, depending on the location, which resulted in weighted frequencies adjusted for the effect of outlining.

RESULTS

the female sex (p<0.0001), ethnic group black/mulatto (p<0.0001), low household income (p = 0.0112), up to 8 years of education (p<0.0001), tooth pain (p<0.0001), presence of bleeding (p<0.0001), and presence of periodontal pockets (p<0.0001) had greater oral impact on daily performance.

CONCLUSION

sociodemographic characteristics, tooth pain, and presence of periodontal disease were associated with oral impact on daily performance of the adult population in the state of São Paulo, Brazil.

Bayesian model and spatial analysis of oral and oropharynx cancer mortality in Minas Gerais, Brazil

The objective of this study was to determine of oral and oropharynx cancer mortality rate and the results were analyzed by applying the Spatial Analysis of Empirical Bayesian Model. To this end, we used the information contained in the International Classification of Diseases (ICD-10), Chapter II, Category C00 to C14 and Brazilian Mortality Information System (SIM) of Minas Gerais State. Descriptive statistics were observed and the gross rate of mortality was calculated for each municipality. Then Empirical Bayesian estimators were applied. The results showed that, in 2012, in the state of Minas Gerais, were registered 769 deaths of patients with cancer of oral and oropharynx, with 607 (78.96%) men and 162 (21.04%) women. There was a wide variation in spatial distribution of crude mortality rate and were identified agglomeration in the South, Central and North more accurately by Bayesian Estimator Global and Local Model. Through Bayesian models was possible to map the spatial clustering of deaths from oral cancer more accurately, and with the application of the method of spatial epidemiology, it was possible to obtain more accurate results and provide subsidies to reduce the number of deaths from this type of cancer.

Did the Family Health Strategy have an impact on indicators of hospitalizations for stroke and heart failure? Longitudinal study in Brazil: 1998-2013

INTRODUCTION

The objective was to analyze whether socioeconomic factors related to the context and those related to the model of care-specifically the coverage of primary care by the Family Health Strategy (ESF)-had an impact on hospitalizations due to heart failure (HF) and stroke, in the State of São Paulo/Brazil between 1998 and 2013.

METHODS

A longitudinal ecological study involving 645 municipalities was conducted in the state of São Paulo/Brazil from 1998 to 2013, using the Hospital Information System (SIH-DataSUS database). The hospitalizations for primary care sensitive conditions: Stroke and heart failure (HF) that correspond to the International Classification of Diseases (ICD 10): I50, I63 to I67; I69, G45 to G46 were analyzed longitudinally during the period indicated regarding the percentage of people covered by the Family Health Program (PSF) adjusted for confounders (population size, gross domestic product -GDP and human development index- HDI).

RESULTS

There was a significant decrease in the number of hospitalizations for heart failure and stroke per 10000 (inhabitants) in the period (p <0.0001), with a significant relationship with increased proportion of ESF (p <0.0001), and this remained significant even when possible confounders (population size, GDP and HDI) were included in the model (p <0.0001).

CONCLUSIONS

GDP per capita was close to or higher than that if many European countries, which shows the relevance of the study. The health care model based on the Family Health Strategy positively impacted hospitalization indicators for heart failure and stroke, indicating that this model is effective in the prevention of primary care sensitive conditions.

Factors associated with public dental service use by adults in the state of São Paulo, Brazil, 2016

The aim of this study was to investigate the factors associated with public dental care use by adults in the State of São Paulo, Brazil. A cross-sectional study was conducted with a representative sample of adults aged 35 to 44 years using data from the 2015 Epidemiological Survey of the Oral Health Status of the Population of the State of São Paulo (SBSP-2015). Multivariate logistic regression was performed using variables based on a model proposed by Andersen for predicting access to public dental services. Results: 3,421 (59.9%) adults visited private services and 2,288 (40.1%) visited public services. Prevalence of the use of public dental services was greatest among women (41.8%) and adults with a lower education level (50.2%). Being non-white (OR = 1.32, 95% CI: 1.16, 1.50), lower household income (OR = 2.37, 95% CI: 2.11, 2.65), having had toothache (OR = 1.60, 95% CI: 1.39, 1.83), and need for endodontic treatment (OR = 1.44, 95% CI: 1.12, 1.85) were associated with public dental service use. Predisposing, enabling, and need factors were associated with public dental care use.

Factors associated with preventable infant death: a multiple logistic regression

OBJECTIVE

To identify and analyze factors associated with preventable child deaths.

METHODS

This analytical cross-sectional study had preventable child mortality as dependent variable. From a population of 34,284 live births, we have selected a systematic sample of 4,402 children who did not die compared to 272 children who died from preventable causes during the period studied. The independent variables were analyzed in four hierarchical blocks: sociodemographic factors, the characteristics of the mother, prenatal and delivery care, and health conditions of the patient and neonatal care. We performed a descriptive statistical analysis and estimated multiple hierarchical logistic regression models.

RESULTS

Approximatelly 35.3% of the deaths could have been prevented with the early diagnosis and treatment of diseases during pregnancy and 26.8% of them could have been prevented with better care conditions for pregnant women.

CONCLUSIONS

The following characteristics of the mother are determinant for the higher mortality of children before the first year of life: living in neighborhoods with an average family income lower than four minimum wages, being aged ≤ 19 years, having one or more alive children, having a child with low APGAR level at the fifth minute of life, and having a child with low birth weight.

Factors influencing the impact of oral health on the daily activities of adolescents, adults and older adults

OBJECTIVE:

Analyze if clinical, sociodemographic and access to dental services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults.

METHODS:

A cross-sectional study with secondary data from the State Oral Health Survey (SB São Paulo 2015) conducted in 163 cities of São Paulo. A total of 17,560 individuals from three age groups: 15–19-year-old (n = 5,558), 35–44-year-old (n = 6,051), and older people of 65 years or more (n = 5,951) participated in the survey. The selection was made by probabilistic sample by conglomerates in two stages. The endpoint variable was the impact of oral health on daily activities, evaluated by the Oral Impacts on Daily Performances questionnaire, containing questions about eating, talking, oral hygiene, relaxation, sports practice, smile, study or work, social contact, and sleep. Oral Impacts on Daily Performances was dichotomized with and without impact. The independent variables were sociodemographic, clinical and access variables, divided into three blocks. A hierarchical multiple logistic regression analysis was performed considering the complex sampling plan of clusters. Each observation received a specific weight, depending on the location that resulted in weighted frequencies and adjusted for the design effect.

RESULTS:

The presence of oral health impact was observed in 27.9% of the individuals. In block 1, female gender and black/brown ethnic group had a greater chance of impact of oral health on quality of life, as well as the adults and the older adults in relation to adolescents. In block 2, family income up to R$1,500 was associated with the presence of impact. In block 3, individuals who reported toothache, used the public service and sought dental treatment had a greater chance of impact.

CONCLUSIONS:

Sociodemographic, clinical and access to health services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults.

Spatial analysis of the death associated factors due oral cancer in Brazil: an ecological study

BACKGROUND

Oral cancer (OC) is among the ten most common cancers and the seventh most frequent cause of death worldwide. It has been reported that these incidence rates are higher in developed country and these mortality rates are higher in less developed areas. So, the objective of the present study was to analyze the spatial joint distribution and to explore possible associations of the epidemiological aspects with mortality rates due to OC in the Brazil.

METHODS

An exploratory ecological study investigated the global spatial autocorrelation of epidemiological aspects with mortality rates due to OC from the Brazilian Federative Units (FUs) (n = 27) in the period 2005-2014, using the "global" and "local" Moran statistic method and a multiple spatial regression, having as variables of exposure the habits and lifestyle, sociodemographic indicators, the consumption of pesticides, the presence of comorbidities, the use of health services and food consumption; and, as a variable response, mortality rates due to OC. The software used was Stata 11.0, SPSS 18.0 and GeoDa 0.95-i.

RESULTS

The spatial distribution of OC mortality rates to age-standard was not random and showed high spatial autocorrelation and predominance of significant spatial groupings in the Central-South region of Brazil. In the multiple regression, statistically negative associations were observed between the Human Development Index (HDI) and OC age-standardized in the studied period (p < 0.05) and positive associations among the proportion of the population with dental appointment within last year, percentage of consumption of oils and fats, percentage of consumption of ready-to-eat foods and industrial mixtures and percentage of overweight adults with this type of cancer (p < 0.05).

CONCLUSION

This is the first study that analyzed the factors associated to the spatial clusters of mortality due to oral cancer in the Brazilian FUs. A fairly unequal distribution of OC mortality rates was found, being that these rates presented inverse association with HDI and direct association with dental appointment, consumption of oils and fats, ready-to-eat foods and industrial mixtures consumption and overweight these rates. It suggests the need to redirect Brazilian public policies aimed at combating them so that they cease to be temporary and become permanent.

Fatores associados às faltas em tratamentos ortodônticos em centro de especialidades odontológicas

Resumo O objetivo deste estudo foi identificar os fatores associados ao não comparecimento dos usuários ao tratamento ortodôntico, em três centros de especialidades odontológicas regionais (CEO-R) localizados no estado do Ceará. Metodologia: Os dados foram extraídos de prontuários de pacientes que concluíram o tratamento ortodôntico. Foi calculada a taxa de ausências, com o objetivo de estabelecer um coeficiente de faltas entre os municípios. A fim de descrever o padrão geográfico da ocorrência, foram construídos mapas temáticos baseados nas distribuições. Para as associações entre a variável desfecho (falta ao tratamento) e as independentes (sexo, idade, quebra de aparelho, mudança de profissional, renda e local de residência do usuário), utilizou-se a análise de regressão logística múltipla com p ≤ 0,05. Resultados: Foram examinados 237 prontuários em 20 municípios, com 8.283 consultas ortodônticas realizadas e 2.665 (32,17%) faltas. Apresentou diferença estatisticamente significativa a variável mudança de profissional. Conclusão: O maior número de faltas foi associado à mudança de profissional.

Factors associated with the use of dental care by elderly residents of the state of São Paulo, Brazil

Abstract Objective: To investigate factors associated with the use of dental care services. Methods: A cross-sectional study with a representative sample of elderly individuals aged 65 years or older residing in the state of São Paulo in 2015 was performed. Hierarchical multivariate logistic regression analysis was used based on the theoretical model of access determination proposed by Andersen (1995) to predict dental care visits. Results: The prevalence of public service use by the elderly was 1.981 (37.8%), while 3.253 (62.2%) used the private service/ health plan/ other type of service. Hierarchical multiple analysis (p≤0.05) identified that less schooling or never having studied, non-white, lower income and motivated by pain/extraction were associated with the use of public dental services. The study showed a reduced use of public dental care among elderly persons who required some type of upper dentures (except complete dentures), need for some type of lower dentures (including complete dentures) and demonstrated a positive self-perception of oral health condition. Conclusions: A higher prevalence of the use of private dental care/health plan/other type of service was identified. Less schooling or never having studied, non-white skin color, lower income and seeking the dentist with pain or to extract teeth were factors associated with the use of public dental services by the elderly.

Social vulnerability and factors associated with oral impact on daily performance among adolescents

Background

Oral disorders may negatively affect the quality of life (QoL) of adolescents.

To investigate how social vulnerability and oral-health status factors affect QoL in 15–19 years olds who participated in the “SB São Paulo 2015” state survey.

Methods

The relationship of several independent variables, namely Paulista Social Vulnerability Index (PSVI) score, gender, skin color, family income, age, untreated caries, tooth loss [determined by the Decayed, Missing, Filled-Teeth (DMF-T) index], toothache, periodontal condition [determined by the Community Periodontal Index (CPI)], and malocclusion (maxillary overjet, cross bite, or open bite) affect daily life, measured by the Oral Impacts on Daily Performance (OIDP) instrument. Logistic regression analyses were carried out based on a hierarchical model.

Results

The final sample consisted of 5402 adolescents. The prevalence of at least one negative impact of oral health on QoL was 37.3%. After adjustment, demographic factors that were found to influence this impact significantly (p < 0.01) were female gender [odds ratio (OR) 1.78, 95% confidence interval (CI) = 1.59–2.0], non-white skin color (OR 1.66, 95% CI = 1.47–1.88), and a low family income (OR 1.28, 95% CI = 1.28–1.29). Additionally, oral conditions associated with oral health impact on QoL included the presence of at least one untreated tooth decay lesion (OR 1.42, 95% CI = 1.25–1.61), loss of at least one tooth (OR 1.49; 95% CI = 1.25–1.78), toothache (OR 4.87, 95% CI = 4.25–5.59), bleeding on probing (OR 1.45, 95% CI = 1.25–1.68), and severe maxillary overjet (OR 1.68, 95% CI = 1.15–2.45).

Conclusion

Social vulnerability (PSVI score) was not associated with the OIDP score, but oral health conditions and socio-demographic variables, including gender, skin color, and income, were found to affect adolescents’ daily activities. Strategies that consider the perceptions of this segment of the population should be implemented to strengthen their autonomy and totality of care.

Impact of a dental care program on the quality of life of children with and without caries

The aim of the present study was to evaluate the long-term effects of the caries treatment provided by a dental care program on changes in schoolchildren's OHRQoL. A one-year follow-up was conducted with a sample of 372 children aged 8 to 10 years which were clinically examined and divided into two matched groups according to their caries experience: dental treatment group (DTG) and group without caries (GWC). Both groups were assessed three times (at baseline, at 4 weeks, and at 1 year) using the Child Perceptions Questionnaire (CPQ8-10). The normality test was performed for the statistical analyses; the Friedman test was used for the dependent variables (longitudinal assessment repeated three times for the same group); and the Mann-Whitney test was used for the independent variables (test and control groups in each time period). There was improvement in all domains and in overall CPQ8-10 (p < 0.0001) in the DTG over time, but no significant changes (p > 0.05) were observed at baseline for overall CPQ8-10 and for the emotional well-being domain in the GWC. The comparison between groups demonstrated that OHRQoL was persistently better for the GWC (p < 0.05) over time. In conclusion, dental caries treatment has a long-term positive impact on schoolchildren's OHRQoL, highlighting the importance of health policies that promote access to dental care for this population.

Interexaminer agreement dental caries epidemiological surveys: the importance of disease prevalence in the sample

Abstract: Objective: To identify desirable characteristics, including different sample sizes and dental caries prevalences, in virtual samples that allow, at the same time, higher values of general agreement percentage (GPA) and Kappa coefficient (κ), under a low confidence interval (CI), in reproducibility studies. Method: A total of 384 statistical simulations of inter-examiner calibration, varying sample size (12, 15, 20, 60, 200 and 500 individuals), caries prevalence (30, 50, 60 and 90%) and percentages of positive (PA) and negative (NA) agreement (30, 50, 60 and 90%) were undertaken. GPA and κ were used to measure reproducibility and define deviation between them. Results: The sample of 60 individuals, under caries prevalence of 50%, PA and NA of 90%, presented a GPA and Kappa values of 90 and 80%, respectively, a relative small confidence interval (95%CI 0.65 - 0.95) and a GPA/Kappa deviation of 10.00. Conclusion: A virtual sample of 60 individuals, under caries prevalence of 50%, seems feasible to produce a satisfactory interexaminer agreement at epidemiological conditions. However, epidemiological studies to corroborate or refute this assertion are necessary.

[Referencing and counter-referencing in specialized dental health procedures in Campinas in the state of São Paulo, Brazil]

This article aims to evaluate the referencing of the demand for specialized care in oral health in Campinas in relation to the distribution of treatment and the influence of socio-economic variables in addition to the perception and information available to users in relation to counter-referencing. It is an observational exploratory study, selecting two Health Administrative Regions: one with a Center for Dental Specialties and one without, divided into two phases: 1) all referrals to secondary care were collected from all Oral Health teams as well as population and socio-economic data and distribution of referrals; 2) interview with 331 users, checking the counter-referencing, quality of service and reasons for absences or withdrawals. Regarding the counter-referencing, the majority of users who received the specialized treatments were well attended, and waited less than one month for appointment scheduling. The management model did not statistically influence access to secondary care in oral health. It was found that in a given Health Administrative Region the discrepancies were less evident and there was a correlation coefficient of demand attended with socio-economic variables, in addition to a lower percentage of non-attendance, demonstrating a greater commitment to integrity and fairness.

School performance and oral health conditions: analysis of the impact mediated by socio-economic factors

BACKGROUND

Oral problems can cause strong impact on functional, emotional, and social aspects of children and adolescents, as well as changes in school performance.

AIM

To evaluate the associations of subjective perceptions of parents, socio-economic factors, and oral clinical conditions of children with their school performance.

DESIGN

A case-control design was used with a sample of 1411 schoolchildren aged 8-10 years from city of Piracicaba, São Paulo, Brazil. Clinical conditions were evaluated using the DMFT and dmft indexes. Socio-economic data were obtained using a questionnaire sent to schoolchildren's parents. School performance was evaluated by the final scores of each schoolchild at the end of the 2011 school year.

RESULTS

According to the final logistic regression model, the schoolchildren who had carious lesions and underwent curative dental treatment at the beginning of the academic year presented 1.51 more chance of having low performance compared with schoolchildren who had no caries lesions. In addition, socio-economic and demographic variables were associated with a greater chance of poor school performance.

CONCLUSION

Socio-economic factors and presence of caries lesions, even if treated, were risk indicators for poor school performance.

Undergraduate dental students' perspectives about experiences in primary care for their education in the field of health

Supervised training periods in primary care have been used as spaces for teaching and extension in the area of health, making it feasible to include undergraduates in concrete teaching-learning scenarios. The aim of this study was to analyze the perceptions of dental students about the importance of supervised training periods in Family Health Units to their professional education. The sample consisted of 185 students who answered the question: What is your opinion about the importance of this training period in SUS to your professional education? Comment on this experience and its positive and negative aspects The responses were analyzed by the quali-quantitative Collective Subject Discourse (CSD) technique. The students appreciated learning through practice in the service; contact with professionals from other areas; opportunity for technical-operative improvement and demonstrated sensitivity in the face of social reality, although they appeared to be concerned about being absent from the faculty, arguing that they were being prejudiced as regards their intramural clinical productivity, exhaustively demanded of them. It was concluded that students placed value on the extramural experience, however, it was perceived that there was still a predominant influence of focus on intramural clinical training.

[Cost-effectiveness analysis of preventive methods for occlusal surface according to caries risk: results of a controlled clinical trial]

This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US$ 119.80 per saved occlusal surface and an incremental C/E ratio of US$ 108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.

Family risk as adjunct for organizing the demand for oral health service in the Family Health Strategy

Introduction One of the main problems of the public health services, in which the family oral health team is included, is access by users to dental treatment in primary care, with particular reference to caries disease. Objective The aim of this study was to evaluate the relationship between family risk, for prioritization of home visits and oral health conditions, with a view to providing evidence about the first indicator for organizing the demand for oral health in the Family Health Strategy (FHS). Method The application of family health is based on Form A of the primary care information database SIAB ("Sistema de Informação de Atenção Básica"), used for registering families with the FHS. Eleven dentists examined the oral health conditions of 1165 persons (608 from 12 to 19 years; and 557 from 35 to 44 years of age), classifying them into six codes from A to F. Multinomial logistic regression was used (α=0.05) to analyze the association between family risk variables and oral health situation. Result There was significant association between family risk and presence of caries disease with treatment needs (OR: 2.08, p<0.0001). Conclusion Persons who have family risk would have twice as much chance of presenting caries disease in comparison with those without risk, corroborating the relevance of this element in organizing the demand for oral health.

The impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of addicted persons

BACKGROUND

The aim of this cross-sectional study was to evaluate the impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of alcohol and drug addicted persons, receiving care at outpatient treatment facilities in Brazil.

METHODS

A random sample of 262 participants, mean age 37 years, from Psychosocial Care Centers for Alcohol and Drugs (CAPS AD) located in three cities in the state of São Paulo, Brazil, were clinically examined for caries experience (DMFT index) by a calibrated examiner. They were asked to complete a series of questionnaires, including the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), socioeconomic characteristics, and the World Health Organization Quality of Life assessment (WHOQOL), which were considered the outcome variables of the study. Associations between oral health status, socioeconomic characteristics, substance involvement with WHOQOL were investigated by means of the chi-square test and multiple logistic regression analysis with a level of significance α < 0.05.

RESULTS

The mean DMF index of the group was 13.0. Subjects with DMFT >14 (OR = 2.25; CI 95% = 1.30-3.89); low-income (OR = 2.41; CI 95% = 1.22-4.77) and users of cocaine/crack (OR = 2.02; CI 95% = 1.15-3.59) were more likely to have poor general quality of life.

CONCLUSION

This study demonstrated that the general quality of life of addicted persons was associated with caries experience, low income and cocaine/crack use.

[Impact of the activation of intention to perform physical activity in type II diabetics: a randomized clinical trial]

Type II diabetes mellitus is a highly prevalent disease among the adult Brazilian population, and one that can be controlled by interventions such as physical activity, among others. The aim of this randomized controlled study was to evaluate the impact of a traditional motivational strategy, associated with the activation of intention theory, on adherence to physical activity in patients with type II, diabetes mellitus who are part of the Unified Health System (SUS). Participants were divided into a control group (CG) and an intervention group (IG). In both groups, the traditional motivational strategy was applied, but the activation of intention strategy was only applied to the IG Group. After a two-month follow-up, statistically significant differences were verified between the groups, related to the practice of walking (p = 0.0050), number of days per week (p = 0.0076), minutes per day (p = 0.0050) and minutes walking per week (p = 0.0015). At the end of the intervention, statistically significant differences in abdominal circumference (p = 0.0048) between the groups were observed. The conclusion drawn is that the activation of intention strategy had greater impact on adherence to physical activity and reduction in abdominal circumference in type II diabetics, than traditional motivational strategy.

Individual and contextual factors related to dental caries in underprivileged Brazilian adolescents

Background

Investigate the individual and contextual variables related to caries in underprivileged adolescents, and the disparity in distribution of the disease.

Methods

Cross-sectional analytical study, conducted in the city of Piracicaba, SP, Brazil, in 2012. The probabilistic sample was composed of 1,179 adolescents from 15–19 years of age, randomly selected from 21 state schools and 34 Primary Health Units – Family Health (PHU-FH). The dependent variables studied were number of decayed teeth and caries experience (DMFT). The independent variables were classified into individual (clinical, sociodemographic, psychosocial, self-perception, impact on oral health, access to services, and quality of life) and contextual (social exclusion index, total number of residents in suburb, literacy rate, and the following variables given in percentages: residences in the home ownership category, provision of domestic sewerage, trash collection, families with income of over 1 minimum wage per month, and families without monthly income) variables. The multilevel regression model was estimated by the PROC GLIMMIX (Generalized Linear Models-Mixed) procedure, considering the individual variables as Level 1 and the contextual variables of the suburbs as Level 2. Adjustment of the model was evaluated by -2 Res Log Likelihood with α = 0.05.

Results

As regards the individual variables, adolescents who declared having a prison inmate in the Family and resided in homes with a larger number of persons, showed a higher number of decayed teeth. There were a larger number of decayed teeth, a higher DMFT value, and worse self-perception as regards the health of their teeth and mouth. Other variables, such as being of the female gender, age and time since last visit to the dentist were related to the DMFT index. As regards the contextual variables, the DMFT was lower in suburbs with greater access to domestic sewage, and the number of decayed teeth was higher in suburbs with the worst social exclusion indices.

Conclusion

Individual and contextual variables were associated with the presence of caries and DMFT index in underprivileged adolescents, indicating that they must be taken into consideration in the formulation of policies directed towards oral health promotion and prevention activities in this group.

Variáveis de impacto na queda da mortalidade infantil no Estado de São Paulo, Brasil, no período de 1998 a 2008

Trata-se de estudo ecológico analítico, retrospectivo, composto pelos 645 municípios do Estado de São Paulo, cujo objetivo foi verificar a relação entre variáveis socioeconômicas, demográficas e modelo de atenção, em relação ao coeficiente de mortalidade infantil, no período de 1998 a 2008. Foi calculada a proporção de variação média anual para cada indicador por estrato de cobertura. A mortalidade infantil foi analisada segundo modelo de medidas repetidas no tempo, ajustado para as variáveis de correção: população do município, proporção de PSF implantado, proporção de PACS implantado, PIB per capita e IPRS (índice paulista de responsabilidade social). A análise foi realizada por modelos lineares generalizados, considerando a distribuição gama. Comparações múltiplas foram realizadas pela razão de verossimilhança com distribuição aproximada qui-quadrado, considerando-se nível de significância de 5%. Houve diminuição da mortalidade infantil no decorrer dos anos (p < 0,05), não havendo diferença significativa de 2004 a 2008 (p > 0,05). A proporção de PSF implantado (p < 0,0001) e o PIB per capita (p < 0,0001) foram significativos no modelo. A queda da mortalidade infantil no período analisado foi influenciada pelo crescimento do PIB per capita e pelo modelo Saúde da Família.

Evaluation of ionic degradation and slot corrosion of metallic brackets by the action of different dentifrices

OBJECTIVE

To evaluate the in vitro ionic degradation and slot base corrosion of metallic brackets subjected to brushing with dentifrices, through analysis of chemical composition by Energy Dispersive Spectroscopy (EDS) and qualitative analysis by Scanning Electron Microscopy (SEM).

METHODS

Thirty eight brackets were selected and randomly divided into four experimental groups (n = 7). Two groups (n = 5) worked as positive and negative controls. Simulated orthodontic braces were assembled using 0.019 x 0.025-in stainless steel wires and elastomeric rings. The groups were divided according to surface treatment: G1 (Máxima Proteção Anticáries®); G2 (Total 12®); G3 (Sensitive®); G4 (Branqueador®); Positive control (artificial saliva) and Negative control (no treatment). Twenty eight brushing cycles were performed and evaluations were made before (T0) and after (T1) experiment.

RESULTS

The Wilcoxon test showed no difference in ionic concentrations of titanium (Ti), chromium (Cr), iron (Fe) and nickel (Ni) between groups. G2 presented significant reduction (p < 0.05) in the concentration of aluminium ion (Al). Groups G3 and G4 presented significant increase (p < 0.05) in the concentration of aluminium ion. The SEM analysis showed increased characteristics indicative of corrosion on groups G2, G3 and G4.

CONCLUSION

The EDS analysis revealed that control groups and G1 did not suffer alterations on the chemical composition. G2 presented degradation in the amount of Al ion. G3 and G4 suffered increase in the concentration of Al. The immersion in artificial saliva and the dentifrice Máxima Proteção Anticáries® did not alter the surface polishing. The dentifrices Total 12®, Sensitive® and Branqueador® altered the surface polishing.

Geographic information system and multilevel analysis: gingival status among 12-year-old schoolchildren in São Paulo, Brazil

OBJECTIVE

To evaluate gingival and calculus status among schoolchildren 12 years of age using a geographic information system and multilevel analysis.

METHODS

A total of 1 002 schoolchildren were selected from 18 municipal districts by means of cluster sampling, from among 25 public and private schools in Piracicaba, São Paulo, Brazil, in 2005. Examinations were carried out by a single calibrated examiner utilizing the criteria of the World Health Organization, as well as the Community Periodontal Index. Social, economic, and behavioral variables were recorded with the use of a questionnaire and were used in the individual analysis (first level). The variables "percentage of heads of families without income" and "percentage of illiterate heads of families" were used in the contextual analysis (second level).

RESULTS

A geographic information system was constructed for mapping the distribution of gingival bleeding. The variables were visually distinguished in the maps and demonstrated a tendency toward better gingival health in the central areas of the city, which are recognized as more privileged. On the contextual level, only the "percentage of illiterate heads of families" was significantly associated to gingival bleeding.

CONCLUSIONS

The study confirms better oral health status among schoolchildren from privileged families, but does not confirm the data regarding "income." The individuals from areas in which the heads of family did not have income were not associated to a higher prevalence of gingival problems. This suggests that these individuals are reasonably protected from the impact of social privation due to the actions of public health care services in the municipality.

A resolutividade em saúde bucal na atenção básica como instrumento para avaliação dos modelos de atenção

Este estudo teve como objetivo avaliar qual modelo de atenção, Estratégia Saúde da Família (ESF) ou modelo tradicional instituído nas Unidades Básicas de Saúde (UBS) apresenta maior efetividade em relação às necessidades em saúde bucal da população de Marília (SP) durante o período de 2007 a 2009. Estudo ecológico do tipo retrospectivo com uma amostra aleatória estratificada de 50% do universo da área de estudo para as 12 UBS e 37% das 29 Unidades de Saúde da Família (USF) do município, sendo sorteadas aleatoriamente 6 UBS e 11 USF, respectivamente. Os dados coletados para observação foram levantados através dos relatórios gerenciais dos sistemas de informação, SIAB e Relatório de Avaliação de Saúde Bucal. Para analisar a resolutividade dos diferentes modelos de atenção à saúde, realizou-se análise exploratória dos dados e o teste t de Student. Observou-se que os coeficientes relativos ao Tratamento Odontológico Inicial não foram estatisticamente diferentes. Já no que se refere ao coeficiente Tratamento Completado Inicial sobre a população estimada maior que dois anos, verificaram-se valores de 16,74 para o modelo USF e 6,93 para o modelo UBS, havendo uma diferença estatisticamente significativa de 40,97% de resolutividade na UBS em relação aos 83,56% da USF.

[Influence of the organization of primary care and the socio-demographic characteristics of the population on the demand for municipal emergency dental care]

The scope of this study was to evaluate the influence of the social determinants and the provision of primary care services in relation to the use of emergency dental care services in a medium-sized municipality. Data recorded for the 57,231 users of emergency care between 2007 and 2009, in accordance with age, gender, date and period of dental care, social exclusion indices of the suburb in which they live and the existence of a benchmark oral health team, were used to perform the analysis. Of the total population, 5.24% on average per year used the service during the period under scrutiny, with the 20-49 year age group (63.84%) showing the highest demand and equality between genders for such care. Surgical procedures (54.90%) were the most prevalent with an increasing trend for restorative procedures (62,8%). Users living in areas of greater social exclusion were 4.15 times more likely to seek dental care (p < 0.05). No statistically significant association was found between gender or the existence of an oral health team of the suburb in which they live and the demand for emergency dental care. In conclusion, there was greater recourse to emergency municipal dental care by individuals living in vulnerable areas, proving the importance of such care in diminishing oral health inequality.