Violence against children and adolescents: awareness and attitudes of Brazilian dentists

Violence against children and adolescents, ranging from negligence to sexual abuse, is an imperative public health problem. The ill treatments are considered as nonaccidental traumas, actions or omissions against children, who suffer physical or emotional violence. The main perpetrators are fathers, mothers, guardians, family, friends or the children‘s primary caretaker. It is very important to identify abuse cases, because this allows proper medical and legal intervention. In Brazil, the law n. 8.069, of July 13, 1990, known as the ECA -Statute for Children and Adolescents (SCA), stipulates the obligation to report suspected or confirmed cases of ill treatment against a child or adolescent to the Guardianship Council of the respective locality. The health professionals play a crucial role with regard to identifying cases of violence, collecting information, making early diagnosis of suspect cases and reporting such cases to the authorities. The dentists can contribute significantly, as most injuries occur in the orofacial region. Bite marks, burns, bruising, among others, are easily identified during a dental consultation. The aim of this work was to verify the awareness and attitudes of Brazilian dentists concerning violence against children and adolescents. This research was approved by the Research Ethics Committee of the Faculty of Dentistry of Araraquara – São Paulo State University (FOAr – UNESP). Sixty-three dentists answered an open and closed questionnaire concerning their formation, knowledge, experience and attitudes towards ill-treated children and adolescents. Among other results, thirty-nine dentists (61.9%) affirmed to have the means to identify illtreatment cases, 13 (20.6%) reported having some experience on this matter, but only 8 reported the cases to the Council of Guardianship, as determined by Brazilian law. Twenty percent of the reasons presented for not notifying the Council were fear of reprisal, and 60.0% were uncertain concerning the ethical and legal implications. Physical violence was the most reported form of identified violence (76.9%), followed by negligence (38.5%). Among the 13 professionals that had experience with violence cases, in 10 cases the perpetrators were identified – in 70.0% of the cases, the parents were the originators of such violence. It was concluded that further formation and orientation are necessary, in order to prepare dentists to act correctly when, during their professional activities, they encounter cases of violence against children and adolescents.

Health professionals ethical and legal liability on patient’s inadequate clarification in order to obtain free and informed consent

It is required that patients are provided information about therapeutic possibilities, showing the risks, benefits, prognosis and costs of each possible and indicated alternative. This is an ethical and legal resolution. However, health professionals possess the clinical/technical/scientific knowledge and determine what information will be (or not) provided. The patient in question decides to undergo a treatment, providing his/her free and informed consent on the basis of the data presented. Unfortunately, some professionals may not provide all the information necessary for making an informed decision or, after obtaining the consent of the patient, may provide him information that causes the patient to give up on the treatment initially accepted. Such information, if relevant, and not a supervening fact, should have been provided initially. However, the information may not be entirely true, and bring the patient, for instance, to decide based on inadequately presented risks. The craniofacial rehabilitation of the temporomandibular joint (TMJ) by means of TMJ prosthesis, is indicated in many situations. Often, patients in need of such prostheses have aesthetic and functional problems and the rehabilitation expectations run high. This work presents a case and discusses ethical and legal issues, including the liability of partial and inadequate information to a patient.

Violence against children and adolescents: the importance of knowledge of the spectrum of bruise colors in its diagnosis

Introduction: One of the violence types more observed against children is the physical abuse, which produces many types of traumatic injuries. Contusions are common trauma signs and may indicate aggression when frequently present in locations where accidental injuries are rare. Contusions in skin undergo color changes with the passage of time, and such change in color is called “spectrum of bruise colors of Legrand du Saulle”. Thus, it is possible to estimate the age of the lesion based on the evaluation of color. Injuries caused by child abuse often reach regions of head, face and neck, because they are exposed and easily accessible. Therefore, the dentist is responsible with regard to the diagnosis and the actions to be undertaken against the cases of child abuse. Objective: To present and discuss the significance of the spectrum of bruise colors as a considerable visible trace in suspicion of violence against children and adolescents, during dentists’ clinical routine. Literature review: The study of the “spectrum of bruise colors of Legrand du Saulle” refers to the estimation of the age of the injury, in respect to the color change. The application of this study is of great value for identify if a lesion occurred from a single incident or from multiple incidents, especially in cases where it occurs in the same region of the body, indicative of repetitive trauma. Conclusion: The spectrum of bruise colors is very important for health professionals, such as dentists, for the identification or suspicion of cases of abuse against children and adolescents. As great part of the lesions originated of abuse involve the areas of head and neck, it is unacceptable that these professionals are unaware of the basic signs to help in early diagnosis, which is the case of the colors of the lesions. However, concerning the chronology of the spectrum of bruise colors, it is not possible to establish rigorous times.

Lesões bucomaxilofaciais: estudo dos casos periciados de 2007 a 2013 no Instituto Médico Legal Nina Rodrigues - Salvador / BA

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Occurrences of anti-Toxoplasma gondii and anti-Neospora caninum antibodies in sheep from four districts of Tocantins state, Brazilian Legal Amazon Region

Toxoplasmosis and neosporosis have been recognized as economically important diseases with considerable impact on the livestock industry. Little is known concerning the occurrence of Toxoplasma gondii and Neospora caninum in sheep from Tocantins state, Brazil. Here, we investigated antibodies against these parasites and associated factors in 182 sheep from Araguaina, Santa Terezinha do Tocantins, Arguianopolis and Palmeiras do Tocantins districts, Tocantins. Sheep sera were assayed for T. gondii and N. caninum IgG antibodies by indirect fluorescence antibody test (IFAT), using cut-off point at a dilution of 1: 40 and 1: 25 respectively. The prevalence of seropositive animal for T. gondii was 13.74% and 13.74% for N. caninum. None of the characteristics studied including reproductive problems, presence of cats, presence of dogs and veterinary care (p>0.05) was associated with occurrence of T. gondii or N. caninum infection. Only breed was identified as associated factor for the occurrence of toxoplasmosis in sheep (p<0.05). The present study is the first report on serum occurrence of T. gondii and N. caninum in sheep from the state of Tocantins, Brazil.

Visualisation and reconstruction in dentistry

Visualisation in the field of dentistry has nor, thus far, reached the same development as other medical fields. Potential applications of visualisation techniques in this area, however, are many, ranging from educational displays to training for delicate procedures. This paper reports on the investigation of techniques for handling three-dimensional models of teeth, aiming at investigation of dental structures. An algorithm was implemented for this purpose, which reconstructs three-dimensional teeth models from two-dimensional contour slices. Results employing various data sets are presented, including the output of VRML models for exploration.

Management of accidental swallowing in implant dentistry

This report describes a protocol for managing the accidental swallowing of dental instruments in implant dentistry, illustrated by a patient who accidentally swallowed a hexagonal wrench. The first step was to refer the patient to the medical emergency hospital service for radiographic and clinical evaluation. The hexagonal wrench was located in the stomach and was immediately removed with an endoscopic procedure. The gastric mucosa was sampled via biopsy and the sample submitted to the urease test, which was positive for Helicobacter pylori. Triple treatment was instituted for gastritis caused by H pylori to avoid exposing the patient to unnecessary risk. Removal of a foreign body by means of an endoscopic procedure constitutes a safe and effective treatment.

Aspectos legais e éticos na implantodontia

There are few studies that evaluate the legal aspects, consent forms and ethical considerations facing implantology. This paper reviews and discusses the most important criteria in relation to the care of patients needing dental implants. Used the following databases: Medline (Pubmed), Dentistry Oral Science , Scielo, Athenas (Dissertation / Thesis), Digital Library of UNICAMP (Dissertation / Thesis), Digital Library of USP (Dissertation / Thesis) over the past 15 years . The inclusion and exclusion criteria were clinical articles, resulting from expert opinion on the subject of review and longitudinal follow-up who have studied or reported on the ethical aspects in implant dentistry; were excluded studies whose language was not English or Portuguese. Of a total of 52 articles and theses, after an analysis according to inclusion and exclusion criteria, 26 were selected. The literature shows that the safe practice of implantology is indispensable for the success of therapy. Respect the ethical, legal and make it explicit relationship with the patient (informed consent, information) are an important factor in the success of rehabilitative treatment. Since this treatment is long term, professional dental implant requires all documentation and clarity in time to offer treatment to the patient and professional expectations are met.

Sexual haressement in dentistry: prevalence in dental school

OBJECTIVE: Sexual harassment is unlawful in all work and educational environments in most nations of the world. The goals of this study were to describe the sexual harassment prevalence and to evaluate the experiences and attitudes of undergraduate students in one dental school in Brazil. MATERIAL AND METHODS: An 18-item questionnaire was administered to 254 dental students with a completion rate of 82% (208). Students were requested to respond to questions about their background and academic level in dental school, their personal experiences with sexual harassment and their observation of someone else being sexually harassed. Bivariate statistical analyses were performed. RESULTS: Fifteen percent of the students reported being sexually harassed by a patient, by a relative of a patient or by a professor. Male students had 3 times higher probability of being sexually harassed than female student [OR=2.910 (1.113-7.611)]. Additionally, 25.4% of the students reported witnessing sexual harassment at the school environment. The majority of students did not feel professionally prepared to respond to unwanted sexual behaviors. CONCLUSION: These findings demonstrate that sexual harassment can occur in a dental school setting. There is a need for ongoing sexual harassment education programs for students and university staff. Increased knowledge of sexual harassment during graduation can better prepare dental professionals to respond to sexual harassment during their practice.

Brazilian dentistry profiles and workforce

The aim of this study was to assess the dentistry profile, based on social and demographic data, post-graduation formation, and to verify the insertion of dental graduates in the labour force. The participants were professionals graduated from a Brazilian Public Dental School, between 2000 and 2010. An instrument was sent by mail and/or e-mail to them. It was used Kruskal Wallis Test. Among 1047 questionnaires, 189 returned and 65.6% were answered by female. In relation to post-graduation course, 57.7% of professionals performed it, however 56.9% not attended only in their area; 66.6% of professionals are concentrated in cities larger than 100 thousand habitants. There was association between income and gender, and others. The predominant work modality was self-employed. Among the total, 36.5% want to work part-time in dentistry. The female gender was predominant and there was wage discrepancy between genders. The professionals have been concentrated in largest cities.

Qualitative methodogy: revealing a new path for research in dentistry

Currently, it is easy to find health professionals who not only attach importance to qualitative methods, but also recognize their help to better understand their patients' lives. However, its use in dentistry is still incipient, either due to ignorance or because of technical / operational difficulties in identifying possibilities for their use in research. Thus, the purpose of this study was to review the literature on the characteristics and peculiarities of the qualitative methodology, demonstrating their techniques of collecting, recording and analyzing data. For this, we performed a descriptive literature, from a survey in the "LILACS", "BBO" and "PUBMED" databases, by keywords related to the theme, selecting only the papers that mentioned the "importance" of qualitative research, the "characteristics and fundamentals," and the "techniques of collecting, recording and data analysis" involving this methodology. It was found that all studies have highlighted the importance of qualitative research to the construction of new knowledge that cannot be achieved by quantitative data. We found many different techniques to gather, record and analyze qualitative data applied to the dentistry field. It was concluded that qualitative research represents a new path to be followed by dentistry, so that we are able to plan actions in ethical and humane public health dentistry, bringing better results to the population, because of the depth of knowledge that your date can.

Nível de conhecimento dos cirurgiões dentistas sobre a qualidade dos prontuários odontológicos para fins de identificação humana

Objective: The aim of this research was to determine the knowledge level of 400 dentists registered in the Regional Dental Council of Cuiabá, through a questionnaire about the importance of records in the process of human identification. Results: We observed that 48.36% of them dispense between 10 and 20 minutes. Only 13.1% of the surveyed dentists did not have the habit of writing down the oral conditions of their patients before starting treatment and 42.62% have only one odontogram filled. From the 122 participants, 11.11% reported that the documentation had no utility to establish the patients identity. To make the situation worse, 33.6% of them said they did not keep the records of patients updated. Conclusion: We conclude that the dentist of Cuiabá has enough knowledge on preparing, maintaining and importance of dental records before the death in the identification process for establishing the patient identity. But, always he did not properly fills the dental records, thus it has been reducing their clinical, administrative and legal value.

Actitud de los docentes de las facultades de Odontologia Brasilenas ante los aspectos bioeticos, eticos y legales del tratamiento odontológico

The study consist on an analysis of attitude by professors of Brazilian Dental Schools before the aspects bioethical, ethic and legal dental treatment aspects. The data collect occurred by semi-structured questioners send by e-mail and correspondence. It was applied the content analysis, by categorical analysis technique, according to Bardin. About bioethical aspects, 94,6% cited that the decision of treatment should be realized between professional and patient, because it don t interfere on negative form (100%). Everybody consider important the interaction professional/patient, because it establishes the respect and mutual agreement between them (61,8%). Tangent at ethic aspects, 95,5% show all alternatives for determined case, even knowing that can lost patient, explaining on the technique and laical form to clear doubts(61,9%). About legal aspects, 82,4% allege that dental surgeon should treat his patient like consumer whereas offer techniques, materials and know through profession. And, like legal prove on occasional lawsuit, 57,1% mentioned that professional don t need of contract necessarily, but a good documentation about patient and e assigned by him. It concluded that these aspects should be teached always to Dentistry academics, whereas they re inherent at profession, to not stay vulnerable at future ethic, judges and other problems.