Saúde bucal e educação infantil: avaliação do desgaste e do acondicionamento de escovas dentárias utilizadas por pré-escolares

Introduction: Early childhood is an essential phase of life for the future of oral health. The link between educational and health sectors can facilitate incorporating educational and preventive oral health practices in daily teaching in pre-schools. The main measure is manual tooth-brushing, which is the most accessible method for most of the population. Objective: The objective of this study is to evaluate macroscopically the wear on the bristles, form of storage, and identification of tooth brushes. Material and method: 345 toothbrushes used by children between the ages of 2 and 5 were evaluated in 4 pre-schools, by 2 participants from the oral health program. The Rawls et al. index was used to evaluate the bristles. Result: There were statistically significant differences (p = 0.020 - Mann-Whitney U test) between the frequency of toothbrushes, with the highest being (n = 205) stored at participating school; and, between adequate and inadequate brushes (p < 0.05 - X2 test) with 31.7 and 60%, respectively, classified as unfit for tooth-brushing. Of the toothbrush holders evaluated 100% were used collectively. Regarding identification, 18% of the toothbrushes were not identified in participating schools, and 37% in the others. Conclusion: The toothbrushes exhibited marked wear, and storage was inadequate; however, the schools participating in the oral health program showed toothbrushes with bristles less worn. It is suggested that training of educators regarding correct storage and evaluation of toothbrushes for wear of the bristles should be undertaken in all early childhood schools.

Prevalência de cárie dentária em pré-escolares de escolas de educação infantil de Araçatuba, São Paulo

Epidemiological data on the conditions of oral health are essential for professionals in the health care plan, execute and evaluate dental programs. In Brazil, most oral health programs directs its resources to middle schools, leaving the preschool children in a secondary plan. The objective of this study was to identify the prevalence of dental caries in preschool children from 4-6 years of age from schools of child education (EMEIs) of the city of Araçatuba-SP. The study was conducted on a sample of 275 children of both genders, representative of the population of preschool children in the city of Araçatuba-SP. In order to assess the prevalence and severity of dental caries indices we used the dmft and DMFT indexes, according to the codes and standards recommended by the World Health Organization (WHO).The average dmft of 1.88 was found, comprising 78% of decayed teeth, 21% of restaured teeth and 1% with indicated extraction teeth. Regarding the permanent dentition, the average DMFT was 0.08, consisting of 71% of decayed teeth, 29% restored and 0% of missing teeth. Based on results found, there was a high caries prevalence in deciduous and permanent teeth, demonstrating the need for more dental care to the group studied.

A relevância do periodontista na prevenção da doença periodontal em pacientes ortodônticos: relato de caso clínico

The increase of the retentive areas of bacterial plaque can be observed in patients who use dental braces in the mouth. The difficulty of making hygienic is one of the problems that this particular group of patients faces day by day, and consequently, the establishment of gingival inflammation becomes more frequent. The objective of this case report is to show the importance of the periodontist in preventing and promoting health to the users of dental braces, aimed at education and motivation as one of the priorities of this treatment. The ESA patient, 29 years old, male, attended the dental office of a periodontist, sent by the orthodontist, due to the extensive area of gingival hyperplasia and gingivitis, in both arches. The possibility of taking out the dental braces was considered by the orthodontist, but after the periodontist evaluation, this step was procrastinated. Thus, the periodontist started the adequacy of the oral environment together with the work of education and promotion of health, which lasted until the complete recovery of the healthy gingival condition of the patient. In this way, it is possible to observe the relevance of the work of the periodontist in the application of preventive methods in oral health for orthodontic patients. The motivation of these patients in relation to the orientations of buccal hygienic, maintenance of oral health and diet should not be considered as secondary and should be prioritized, because only in this way it would be possible to reach a good occlusion, without esthetic and functional prejudice.

A importância da integração universidade e serviços de saúde

Brazilian Curricular Directrix demand changes on teaching dental surgeon, proposing new scenes of learning and study other than the classroom. So, pedagogic projects should search for integral and adequate education by relating teaching, research and extension/assistance. This paper discusses the importance of university extension activities on teaching Odontology students and relates the experience of Araçatuba Dental School of São Paulo State University. This school develops some university extension activities since the 60s by Dental Service Beyond School (SEMO, in portuguese). Among the activities included by SEMO there are several projects, such as: “Program of Dental Attention for Pregnant Women”, “Program of Dental Attention to Juvenile Foundation at Araçatuba”, “Always Smiling – Health Promotion for Institutionalized Elderlies”, “Santa Clara de Assis Nursery School Program of Dental Attention”, and "Promotion of oral health in Araçatuba public kindergarten schools”. These programs give the student knowledge of structure dimensions of public health services; chance to participate on attendance for the population, comprehension of oral health politics, and the role of dental surgeon in social context, where these students will work in the future. The positive impact obtained with these services is perceived by students return. Most of them feel satisfied about the experience lived there.

Projeto Sempre Sorrindo: 10 anos de atenção ao idoso institucionalizado

Introduction: To correctly attend the health needs of the elderly population, it is necessary to invest in training of human resources. Thus, it becomes indispensable to insert the geriatric dentistry content into graduation courses. Objective: To describe the experiences and the results obtained during 10 years of an university extension project focused on oral health care of institutionalized elderly. Methodology: This is a documental and descriptive work, which was analyzed the institutional process of ten years of the University Extension Program, “Always Smiling - Dental Care for the Elderly Institutionalized of Araçatuba, “ developed at the Araçatuba Dental School, FOA/ UNESP. It were collected quantitative and qualitative data, and these were classified and interpreted according to the technique of categorizing the content. Results: In ten years of implementation, the project “Always Smiling” involved undergraduate students, professors and post-graduate students, who together have developed practical activities such as health education, hygiene supervision, recreational and educational activities, epidemiological surveys of oral health conditions and consequently, dental care according to the need of the treatment. Conclusion: The project “Always Smiling” serves as a working model for elderly health care, because it acts involves many aspects, from the prevention of diseases, even to the training of elderly caregivers, benefiting the institutionalized elderly and health professionals.

Avaliação dos alunos do programa de pós-graduação em odontologia da UNESP (Araçatuba) na elaboração e execução de programas de saúde bucal em seus municípios

The design of oral health has as its most important to bring knowledge, prevention and treatment for the population of municipalities that have this important means of promoting health in general. These programs are based on socio-educational projects, such as tooth brushing, educational lectures, projects, preventive and, fluoride use, application of sealants in pits and even the prevention of oral cancer. In the area of healing, the centers of dental specialties (CEO) associated with the PSF are responsible for implementing treatment of periodontal diseases, trauma, restoration of teeth affected by dental caries, prosthesis design for functional rehabilitation of the patient, biopsies of oral lesions , among other specialties. This study aims to evaluate the students of the Graduate Program in Dentistry, Universidade Estadual Paulista Julio de Mesquita Filho, Campus de Araçatuba, in order to coordinate a program to promote health in their communities. The result based on parameters in the OMS showed that the majority of graduate students of the Faculty of Dentistry Araçatuba acquired knowledge to a reasonable oral health program in their city as a coordinator.

Muskuloskeletal disorders in upper limbs in dental students: exposure level to risk factors

Aim: This study assessed the risk factors of undergraduate students to develop musculoskeletaldisorders (MSD) in the upper limbs, regarding gender, type of dental clinical procedure, mouthregion treated, and the four-handed dentistry practice. Methods: Dental students enrolled in the8th semester in the Araraquara School of Dentistry, UNESP, Brazil, were photographed whilepracticing 283 dental procedures. The Rapid Upper Limb Assessment (RULA) method was usedto evaluate the working postures of each student. The photographs were evaluated and a finalrisk score was attributed to each analyzed procedure. The prevalence of risk factors of developingMSD was estimated by point and by 95% confidence interval. The association between the riskfactor of developing disorders and variables of interest were assessed by the chi-square test witha significance level of 5%. Results: The risk factors of developing MSD were high, regardingmost dental procedures performed by the undergraduate students (score 5: 7.07%, CI95%: 4.08-10.06%; score 6: 62.54%, CI95%: 56.90-68.18%). There was no significant association betweenthe RULA final score and gender (p=0.559), and type of dental procedure (p=0.205), and mouthregions by arch (p=0.110) or hemi-arch (p=0.560), and the use of four-handed dentistry (p=0.366).Conclusions: It can be concluded that gender, type of dental clinical procedure, mouth regiontreated, and practice of four-handed dentistry did not influence the risk of developing MSD in theupper limbs among the dental students evaluated; however, they are at a high risk of developingsuch disorders.(AU).

Saúde bucal e qualidade de vida em indivíduos com paralisia cerebral e Síndrome de Down: percepção dos cuidadores

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Dental caries related to quality of life in two Brazilian adolescent groups: a cross-sectional randomised study

Objectives: To analyse dental caries-related quality of life (QoL) in adolescent (1519-year-old) subjects in a suburban area (SA) and a downtown area (DA) of Bauru, Sao Paulo, Brazil, in 2009. Methods: This was a cross-sectional, randomised study. The sample consisted of 185 and 147 adolescents from the SA and DA, respectively. The caries index used was that for decayed, missing and filled teeth (DMFT) (World Health Organization criteria). The 14-item Oral Health Impact Profile (OHIP-14) was used to assess QoL. The non-parametric MannWhitney test, Spearmans correlation coefficient and chi-squared test were used in the statistical analysis. Results: The DMFT index, Significant Caries (SiC) Index and percentage of caries-free students were similar (P > 0.05) between these populations, but findings on the Care Index differed (P < 0.05). There was a correlation between the DMFT index and OHIP-14 score in SA subjects (mean DMFT index = 3.01) in the dimensions of physical pain (r = 0.25; P < 0.01) and psychological disability (r = 0.17; P = 0.02). The DMFT index in DA subjects (mean DMFT index = 2.95) showed a correlation with functional limitation (r = 0.19; P = 0.02). The correlation in SA subjects between the caries component (mean = 1.22) of the DMFT index and OHIP-14 was significant only for the physical pain dimension (r = 0.16; P = 0.03). In DA subjects, correlations between the caries component (mean = 0.37) and all dimensions of OHIP-14 were statistically significant (P < 0.05). Conclusions: Despite the similarities in means in the DMFT index, the SiC Index and the caries-free percentage of subjects in both localities, access to dental treatment proved to be less effective for SA adolescents. Physical pain and psychological disability were the most frequent negative manifestations of impact on QoL. The SA adolescents were more negatively affected by dental caries in terms of QoL.

Contextual and individual inequalities in dental pain prevalence among Brazilian adults and elders

This study aimed to assess the prevalence of dental pain among adults and older people living in Brazil's State capitals. Information was gathered from the Telephone Survey Surveillance System for Risk and Protective Factors for Chronic Diseases (VIGITEL) in 2009 (n = 54,367). Dental pain was the outcome. Geographic region, age, gender, race, schooling, private health coverage, smoking, and soft drink consumption were the explanatory variables. Multilevel Poisson regression models were performed. Prevalence of dental pain was 15.2%; Macapa and Sao Luis had prevalence rates greater than 20%; all capitals in the South and Southeast, plus Cuiaba, Campo Grande, Maceio, Recife, and Natal had prevalence rates less than 15%. Factors associated with increased prevalence of dental pain were the North and Northeast regions, female gender, black/brown skin color, lack of private health insurance, smoking, and soft drink consumption. Dental pain is a public health problem that should be monitored by health surveillance systems.

Private and Public Dental Care in the City of Sao Paulo in the First Decade of the XXI Century

Two concomitant movements occur in the first decade of the XXI century within the private and public dental services in Brazil: the entrance of oral health on the agenda of political priorities of the federal government and the vigorous growth of additional dental care. We analyzed the occurrence of these phenomena in the city of Sao Paulo, by seeking information in official documents and electronic databases in the Municipality of Sao Paulo, the Ministry of Health and National Health Agency (ANS), and also in scientific literature. During the studied period - January 2000 to December 2009 - and with basis on indicators such as coverage of First Consultation Program and Dental coverage Population Potential, percentages were found that characterize low public assistance and a situation far short of the constitutional principle of universal access to dental care. The growing number of beneficiaries of additional services through exclusively dental coverage insurance plans and other types of private insurance plans in the same period was significant, accounting for a major expansion of population coverage in this mode of care. It was found that, compared to the overall national framework, the city of Sao Paulo offers poor access to public dental care, with reduced supply of services to adults and aged people. Furthermore, considering the limitations of market additional services to provide dental care to all Brazilians, it reinforces the need for continuity and expansion of Brasil Sorridente, which is the programmatic expression of the National Oral Health Politics.

Effectiveness of Tooth Wipes in Removing Babies' Dental Biofilm

Purpose: To assess the effectiveness of tooth wipes in removing dental biofilm from babies' anterior teeth, as well as to evaluate the babies' behaviour and the guardians' preference concerning hygiene methods. Materials and Methods: In this random blind cross-over study, 50 high caries risk babies, from 8 to 15 months old, were divided into two groups: babies with oral hygiene performed by caregivers (n = 25) or by their mothers (n = 25). The caregivers and mothers removed biofilm using three methods of oral hygiene (tooth wipes, toothbrushes and gauze), one in each experimental phase. Professional cleaning was done before each phase, which had 2 days of biofilm accumulation and 1 experimental day, when caregivers and mothers used one method to remove biofilnn. Examiners blinded to the study design assessed the biofilm index at baseline, prior to and following biofilm removal using each method. The babies' behaviour and the mothers'/caregivers' preference were assessed. Results: The tooth wipes, toothbrushes and gauze significantly reduced the amount of biofilm (P < 0.001). The mothers' group removed more biofilm than the caregivers' group, using toothbrushes or tooth wipes (P < 0.05). Babies in the mothers' group had better behaviour using tooth wipes than toothbrushes (P < 0.05). Mothers and caregivers preferred to use tooth wipes. Conclusions: Tooth wipes are effective in removing biofilrn from babies' anterior teeth and are the method best accepted by mothers, caregivers and babies.

Relevant methodological issues from the SBBrasil 2010 Project for national health surveys

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

Accuracy of Screening for Potentially Malignant Disorders of the Oral Mucosa by Dentists in Primary Care

Purpose: To examine the accuracy of a screening programme for potentially malignant disorders of the oral mucosa by visual inspection in primary health care. Materials and Methods: The study was based on secondary data from the Primary Care Information System maintained by seven units of family health in Sao Paulo City managed by a non-governmental agency. The reference population was composed of 15,072 residents 50 years old or more of both genders. The study population comprised 2,980 individuals. During screening in community settings, the oral mucosa was examined by trained dentists and distributed into two categories: (a) screen negative (b) screen positive. All participants underwent comprehensive clinical exams by a general dental practitioner supervised by a specialist. Individual records were grouped in a working dataset. Point and 95% confidence interval estimates were calculated regarding measures of sensitivity (Se), specificity (Sp) and positive and negative predictive values (PPV and NPV, respectively). Results: 18.0% of the population was considered screen positive. A total of 133 lesions (4.5%) were identified and 8 cases of oral cancer were confirmed, which corresponded to a prevalence rate of 27 cases in 10,000 people, a much higher rate than expected. The measures found were Se: 91.7% (85.3-95.6), Sp: 85.4% (84.1-86.7), PPV: 22.7% (19.3-26.5), NPV: 99.5% (99.2-99.8). The visual screen presented high accuracy. Conclusion: The test presented high sensibility and specificity values. From a public health point of view, the high accuracy levels showed the importance of oral health teams on family health strategy for more comprehensive primary care. Targeting risk groups and delegating the screening to community health agents may improve PPV and coverage.

Oral manifestations in patients with hypogammaglobulinemia

Objective. The overall objective of this study was to assess the oral manifestations and their association with immunologic status and health history, of individuals with hypogammaglobulinemia. Study Design. A case-controlled study of 100 subjects with hypogammaglobulinemia and 93 control individuals was performed. All participants were examined for dental caries, periodontal disease, mucosal lesions/infections, and general oral health problems. Decayed, missing, filled teeth and community periodontal index were recorded. Complete blood count, serum immunoglobulins, and lymphocyte immunophenotyping were measured on the same day of the oral health assessment. Results. Individuals with hypogammaglobulinemia showed higher prevalence of enamel hypoplasia and complaints of dry mouth, and lower prevalence of dental caries and periodontal disease. Conclusions. The systemic conditions associated with hypogammaglobulinemia were not associated with enhanced susceptibility to caries, gingivitis, or periodontitis; however, individuals with hypogammaglobulinemia were more likely to report more episodes of recurrent aphthous ulcers compared with control individuals. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:e19-e24)