A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em saúde bucal coletiva

RONCALLI, Angelo Giuseppe. A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em Saúde Bucal Coletiva. raçatuba, 2000. 238p. Tese (Doutorado em Odontologia Preventiva e Social). Faculdade de Odontologia, Universidade Estadual Paulista “Júlio de Mesquita Filho”

Epidemiologia e saúde bucal coletiva: um caminhar compartilhado.

The public health dentistry is a way to bring oral health to Brazilian National Health System (SUS) and vice-versa. Thus, the epidemiology, in this context, it is one of the most important allies. In this article we intend to discuss the "shared walkway" between epidemiology and public health dentistry, through two views: first, we analyzed the efforts to establish methodological models for oral health sectional studies and the possibilities to construct a national data base. Second, we discussed how this knowledge has been transformed in a qualified scientific production presented in meetings and papers, which reflects, at the same time, about the contribution of this process in the consolidation of public health dentistry field. We concluded that this "shared walkway" was (and still is), influenced by political aspects, which, in different moments, leads to an improvement of public health dentistry. The oral health epidemiology has been established as a knowledge area, with regard to the scientific production in Brazil. At the same time, provide a tool that contributes to make oral health care models more appropriate to National Health System principles and, in other hand, make better the discussions about the social determinants of oral diseases.

Epidemiologia e saúde bucal coletiva: um caminhar compartilhado.

The public health dentistry is a way to bring oral health to Brazilian National Health System (SUS) and vice-versa. Thus, the epidemiology, in this context, it is one of the most important allies. In this article we intend to discuss the "shared walkway" between epidemiology and public health dentistry, through two views: first, we analyzed the efforts to establish methodological models for oral health sectional studies and the possibilities to construct a national data base. Second, we discussed how this knowledge has been transformed in a qualified scientific production presented in meetings and papers, which reflects, at the same time, about the contribution of this process in the consolidation of public health dentistry field. We concluded that this "shared walkway" was (and still is), influenced by political aspects, which, in different moments, leads to an improvement of public health dentistry. The oral health epidemiology has been established as a knowledge area, with regard to the scientific production in Brazil. At the same time, provide a tool that contributes to make oral health care models more appropriate to National Health System principles and, in other hand, make better the discussions about the social determinants of oral diseases.

A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em saúde bucal coletiva

RONCALLI, Angelo Giuseppe. A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em Saúde Bucal Coletiva. raçatuba, 2000. 238p. Tese (Doutorado em Odontologia Preventiva e Social). Faculdade de Odontologia, Universidade Estadual Paulista “Júlio de Mesquita Filho”

Relação das condições socioeconômicas com as condições de saúde bucal em capitais brasileiras

Despite the improvement of Brazilian s living conditions in recent decades, this improvement occurred in a polarized way between groups of better social position. Then, there is still a health inequity´s panorama in Brazil which encompasses the oral health state. This panorama instigated the attainment of this ecological study that aimed to evaluate the relationship of socioeconomic conditions, and public health policies with oral health status in Brazilian capitals. Thus, we performed factor analysis and linear regression using oral health indicators collected from SB Brasil 2010, of socioeconomic conditions from Brazilian Census 2010 and related to water´s supply fluoridation from SISAGUA. Factor analysis with indicators of living conditions revealed two common factors, economic deprivation and socio-sanitary condition. Economic deprivation showed statistically significant positive correlation with DMFT 12 years (p= 0,03) and mean missing teeth (p = 0,002) and negative correlation with caries-free population (p=0,012). Socio-sanitary negatively correlated with DMFT (p <0,0001) and a positive correlation with caries-free population (p = 0.002). Fluoridated water had a significant association with DMFT (p <0,0001), mean missing teeth (p <0,0001) and caries free population (p <0.0001). Multiple linear regression analysis for the DMFT of capital was estimated by socio-sanitary condition and fluoridation, adjusted by economic deprivation, whereas the model for the mean missing teeth was estimated only by fluoridation and economic deprivation, and finally the model the rate for the population free of caries in Brazilian capitals was estimated by economic and socio-sanitary status adjusted fluoridated water supply. Therefore, factors related to living conditions and public policies are intrinsically linked to tooth decay issues. Thus, actions, beyond dental care assistance, must be development to impact positively in social and economic conditions, especially, between the most vulnerable populations

Impacto da cárie precoce severa na infância na qualidade de vida relacionada à saúde bucal de pré-escolares sob privação social

Early childhood caries, especially in its severe form, which is characterized by an acute and aggressive nature, can have negative impacts on thequality of life of a child, due to effects such as difficulty in chewing, decreased appetite, weight loss, insomnia, changes in behavior and a decreased performance in school, among others. Moreover, the quality of life of the child`s family can also be affected, as the pain and discomfort caused by this type of caries result in loss of working days of parents, spending on dental treatments, changes in sleep patterns and stress. The aim of this study was to evaluate the impact of severe early childhood caries in the Oral Health-Related Quality of Life (OHRQoL) of public daycares`s preschool children through the Escala de Impacto da Saúde Bucal na Primeira Infância, a Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A single calibrated examiner (kappa=1.0) evaluated, through the dmfs index, the oral health of 116 children aged between 3 and 5, which were included in one of three study groups: "caries-free", "not-severe early childhood caries" and "severe early childhood caries". The parents responded to ECOHIS, to assess their perception regarding the OHRQoL of their children, and a questionnaire on socioeconomic conditions. The OHRQoL was measured through the total scores and domains of ECOHIS. Descriptive analysis, Mann-Whitney test, Kruskal-Wallis test, chi-square test and Poisson multiple regression with robust variance were used. Among the children observed, 38.8% were caries-free, 27.6% showed not-severe early childhood caries and 33.6% showed severe early childhood caries. Regarding the total score of ECOHIS, severe early childhood caries had a greater negative impact on OHRQoL, compared to caries-free and not-severe early childhood caries groups (p <0.001). Regarding the child subscale, there was significant difference between the "severe early childhood caries" group and the other groups in all domains, except for theone of self-image / social interaction. In the family subscale domains, there was statistical significance between the severe early childhood caries and the caries-free groups in all domains (p <0.001), whereas between the "severe early childhood caries and not-severe early childhood caries groups there was a statistically significant difference only in the domain of parental anguish (p <0.001). Multivariate analysis showed that early childhood caries and the parent`s age were significantly associated to OHRQoL (p <0.05), independently of the other variables in the model. The presence of severe early childhood caries resulted in greater negative impact on OHRQoL (AdjPR= 6.016; 95%CI = 3.12 11.56; p<0.001), while older parents reported better OHRQoL (AdjPR = 0.603; 95%CI = 0.428 - 0.850; p = 0.004). The presence of severe early childhood caries had a negative impact on OHRQoL of preschool children and their families.

Influência das condições de saúde bucal no desempenho das atividades diárias de adolescentes escolares

Instruments are used in odontology to measure the Quality of Life Related to Oral Health (OHRQoL) to scale how the oral condition interferes with functional areas, of the people s psychological and social life. This cross-sectional study, held in Natal/RN, with 215 students from the Federal Institute of Education, Science and Technology of Rio Grande do Norte (IFRN) has investigated the association between the performance of daily activities and oral health status of school adolescents from 15 to 19 years of age, through the normative index DMFT (permanent teeth decayed, missing and filled), CPI (Community Periodontal Index) and DAI (dental Aesthetic Index) and subjective questionnaire assessment of quality of life related oral health OIDP index (oral impacts on daily performance). It was also carried out the socioeconomic characteristics of students through IFRN own data. Concerning the analysis of data was performed a descriptive analysis of the variables by their absolute and relative frequencies and measures of central tendency. The chi-square test was used to assess the association between the dependent variable and the independent categorical variables and the Student t test for quantitative. It was also conducted a further multiple analysis out using Poisson regression with robust variance between the outcome "presence of impact" and the independent variables that showed p <0.20. It was used for all the statistical tests a significance level of 5%. Among the adolescents surveyed, 51.16% reported that at least one activity assessed by OIDP had hampered its implementation due to some dental problem. The difficulties were more pronounced in the activities of eating (31.6%), oral hygiene (25.6%) and smile (25.1%).The tooth position, followed by toothache, were the causes of the impacts reported by most teenagers. There was a significant association between the presence and impact of the presence of one or more decayed teeth (p = 0.012), the presence of gum bleeding (p = 0.012) and for orthodontic treatment (p = 0.003), independently of other variables. There was no significant association between oral health status and socioeconomic and demographic characteristics of the adolescents. The survey results showed that there is an association between oral health status of the population studied and reports of difficulties in carrying out daily activities evaluated. The worse the oral health status, the greater the impact of this condition on the adolescents quality of life

Produção e validação de um indicador de saúde bucal para idosos a partir de dados secundários do SB Brasil 2010

Dentre os vários aspectos da saúde do idoso, a saúde bucal merece atenção especial pelo fato de que, historicamente, nos serviços odontológicos, não se considera esse grupo populacional como prioridade de atenção. Por isso, se faz necessária a produção de um indicador multidimensional capaz de mensurar todas as alterações bucais encontradas em um idoso, facilitando a categorização da saúde bucal como um todo. Tal indicador representará um importante instrumento capaz de elencar prioridades de atenção voltadas à população idosa. Portanto, o estudo em questão propõe a produção e validação de um indicador de saúde bucal a partir dos dados secundários coletados pelo projeto SB Brasil 2010 referente ao grupo etário de 65 a 74 anos. A amostra foi representada pelos 7619 indivíduos do grupo etário de 65 a 74 anos que participaram da pesquisa nas 5 (cinco) regiões do Brasil. Tais indivíduos foram submetidos à avaliação epidemiológica das condições de saúde bucal, a partir dos índices CPO-d, CPI e PIP. Além disso, verificou-se o uso e necessidade de prótese, bem como características sociais, econômicas e demográficas. Uma análise fatorial identificou um número relativamente pequeno de fatores comuns, através da análise de componentes principais. Após a nomenclatura dos fatores, foi realizada a soma dos escores fatoriais por indivíduo. Por último, a dicotomização dessa soma nos forneceu o indicador de saúde bucal proposto. Para esse estudo foram incluídas na análise fatorial 12 variáveis de saúde bucal oriundas do banco de dados do SB Brasil 2010 e, também 3 variáveis socioeconômicas e demográficas. Com base no critério de Kaiser, observa-se que foram retidos cinco fatores que explicaram 70,28% da variância total das variáveis incluídas no modelo. O fator 1 (um) explica sozinho 32,02% dessa variância, o fator 2 (dois) 14,78%, enquanto que os fatores 3 (três), 4 (quatro) e 5 (cinco) explicam 8,90%, 7,89% e 6,68%, respectivamente. Por meio das cargas fatoriais, o fator um foi denominado dente hígido e pouco uso de prótese , o dois doença periodontal presente , o três necessidade de reabilitação , já o quarto e quinto fator foram denominados de cárie e condição social favorável , respectivamente. Para garantir a representatividade do indicador proposto, realizou-se uma segunda análise fatorial em uma subamostra da população de idosos investigados. Por outro lado, a aplicabilidade do indicador produzido foi testada por meio da associação do mesmo com outras variáveis do estudo. Por fim, Cabe ressaltar que, o indicador aqui produzido foi capaz de agregar diver sas informações a respeito da saúde bucal e das condições sociais desses indivíduos, traduzindo assim, diversos dados em uma informação simples, que facilita o olhar dos gestores de saúde sobre as reais necessidades de intervenções em relação à saúde bucal de determinada população

A inserção do técnico em saúde bucal na estratégia saúde da família no estado do Rio Grande do Norte

An oral health technician is a profession in odontology whose own functions are defined in FEDERAL LAW NUMBER 11889, which can act for prevention, recovery and promotion of oral health. According to the web site, Of Primary Health Attention Department. Health Ministry Of Brazilian Federal Republic, you can see through historical cover, as regards Health Family Strategy that, in Rio Grande Do Norte, There are nowadays eight TSB equipments in use. Objective: The aim of this study is to find out the reasons of the inclusion of those technicians in public service, no matter the importance of this work. Method: It is about a quantitive study and a kind of exploring type, taking into account that there are not any similar previous ones. We divide it into two parts: as regards the first one, these technicians were registered in a map using the information of the Formation Schools and Class Counsel to know how and where they are. During the moment of this study, an application (or no application) of the mouth health equipments was done. They tried to discover in this process which elements contribute to the efficiency (or not) of this technical work done all together in equipment work. As regards the second part, the coordinators of Municipal Mouth Health answered to a survay that contained open and closed questions through telephone calls. The sample was defined by a raffle taking into account the work contained in municipalities. Results: There are 1053 technicians.94,3% of them are women, devided in all the health regions. As regards interview, 96,9% of oral health coordinators considered that it is very important to have an oral health technician in odontology. 92,2% would reccomend its inclusion in equipments related to mouth health, dealing to familly health . 76% have never talked before to the Health Secretary in this municipality. this spreading out could be related to financial resources and 51,6% mentioned the importance of improving the physical structure to make this spreading out possible. Conclusions: Oral Health technicians in Rio Grande Do Norte are not being adequatly used by public service, because they do not introduce themselves or act as Oral Health auxiliaries. It is important to increase concience about the importance of this category in odontology. we also say it is necesasary to invert money in a reform of the Basic Health Unities and the inclusion of these workers. On the other hand the role of the state and the public health militancy is questioned in the fulfilment of this process

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Impacto da Estratégia Saúde da Família com equipe de saúde bucal sobre a utilização de serviços odontológicos

PEREIRA, C. R. S. et al. Impacto da estratégia saúde da família com equipe de saúde bucal sobre a utilização de serviços odontológicos. Cad. Saúde Pública, v. 25, n. 5, p.985-996. Maio, 2009. ISSN 0102-311X.

Validade científica de conhecimento epidemiológico gerado com base no estudo Saúde Bucal Brasil 2003

NARVAI, Paulo Capel et al. Validade científi ca de conhecimento epidemiológico gerado com base no estudo Saúde Bucal Brasil 2003. Caderno de saúde pública, Rio de Janeiro, v. 26, n. 4, p. 647-670, abr. 2010.

Impacto da Estratégia Saúde da Família com equipe de saúde bucal sobre a utilização de serviços odontológicos

PEREIRA, Carmen Regina dos Santos et al. Impacto da Estratégia Saúde da Família com equipe de saúde bucal sobre a utilização de serviços odontológicos. Cadernos de Saúde Pública, Rio de Janeiro, v. 25, n. 5, p. 985-996, maio 2009.

Saúde bucal no programa de saude da família: o caso do distrito sanitário norte em Natal - RN

The inclusion of the dentist in the Family Health Program (FHP) teams designates a reorganization of the mouth health care in your country and establishes a new scenario in Brazilian odontology, through of a new way to organize the basic health care, creating conditions to consolidate in mouth health practice actions, in the level of the basic attention, the validation of Unique Health System (UHS) constitutional principles. The purpose of this research is to verify if the actuation of mouth health teams (MHT) dentists, in Natal city north sanitary district, is tuned with FHP goals.The target research population was composed by all dentists working in Basic Health Units (BHU) of Natal north sanitary district. Fifth-eight questionnaires were applied and using open and closed questions we look for identify the functional characteristics of each BHU, the dentists professional attributions on each BHU, as well as the clinical procedures that they execute. This research also searched to identify the factors that facilitate and/or difficult the inclusion process and the dentists activities performance on these BHUs, as well as the necessary actions to north sanitary district MHTs to fulfill the objectives proposed by FHP. The results point that the inclusion of mouth health actions in north sanitary district FHPs brought the incorporation of new values to the used practices. Whoever, its necessary a more frequent evaluation of the carried actions, in a way they can be adapted to the real community necessities, and, is fundamental the data accompaniment, for that these serve of base for planning and redirecting activities, in a way that we do not have only a reproduction of traditional practices, fragmented and isolated, but a truly substitution of the traditional practices and a new way of promoting health