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.

Associação entre as narrativas em saúde bucal e condições socioeconômico-culturais: a dentição como reflexo da desigualdade social

This anthropological study investigates the lived-experience of oral diseases in the context of poverty in Northeast Brazil. During six months in 2004???, ethnographic interviews, narratives and participant-observation with 31 residents of the low-income community, Dendê, located in Fortaleza, Ceará were conducted and analyzed utilizing a hermeneutic-dialetic method. It is revealed that precarious life conditions make prioritizing caretaking a difficult task. Despite suffering tooth pain, seeking a dentist's care is perceived as "a luxury" not a citzens' right. Difficulties in accessing services and poor quality restorations, favor tooth extractions as the most effective intervention. The deterioration of one's oral health is lamented by community members who seek help from popular clinics, politicians and traditional healers. The experience of dental disease differs according to social class, leaves oral scars of inequity, harms self-esteem and inhibits social inclusion. In this context, "treating" the Teeth of Inequity demands that we deepen our comprehension of the social determinants of health, reduce injustice in the access to quality care, remove demoralizing stigmas and empower the community to confront structural forces which affect its life

Avaliação da atenção à saúde de portadores de HIV no centro de referência para o tratamento da Aids em Natal/RN por profissionais e usuários do serviço

Objective: The aim of this study was to evaluate the health care of HIV/AIDS Reference Center for treatment of AIDS in Natal/RN for professionals and service users. Methods: This is an evaluative study with a quantitative approach, performed in the outpatient Giselda Trigueiro Hospital, in Natal (RN). The target population consisted of 313 patients with HIV and 34 professionals of the center. Data collection occurred from august 2007 to july 2008, with a structured form of interview, validated through a pilot study. The data were analyzed by descriptive and inferential statistics. Results: The evaluation of the service was considered unsatisfactory by 85.6% users. However, 58.8% of professionals considered it satisfactory. There was difference in the evaluation of the following indicators: the relationship professional users, offering support, timeliness of professional guidelines on the treatment. There was similarity in the following indicators: physical structure, respect for privacy, opportunity to make complaints, hospitality, convenience of schedules, availability of ARVs and laboratory tests, and ease of access. Conclusion: The results point to dissatisfaction of the users and professional satisfaction with the health care of people with HIV / AIDS in the service searched. It was found that the indicators used in this study may be considered relevant to evaluate the service in question, as well as monitoringparameters provide acceptable quality of health care by the National STD/AIDS

Saúde bucal de idosos institucionalizados no Brasil

O propósito dessa investigação foi o de estudar as situações objetivas e de auto-percepção em saúde bucal de idosos residentes em Instituições de Longa Permanência de Idosos (ILPIS) distribuídos em 11 municípios pertencentes as 5 regiões geográficas do Brasil. Metodologia: Trata-se de estudo seccional através de um censo com idosos institucionalizados no Brasil. Foram avaliados 1192 indivíduos, residentes em 36 Instituições de Longa Permanência de Idosos (ILPIS), distribuídas em 11 municípios. Deste universo, 587 (49,2%) responderam ao GOHAI. Foi aplicado questionário com questões subjetivas e sobre o comportamento em saúde bucal, além de levantamento epidemiológico seguindo critérios da Organização Mundial da Saúde (OMS). Foram realizados os testes de Mann-Whitney, Kruskal-Wallis, Exato de Fisher, Qui-quadrado e Regressão logística múltipla. Resultados: A idade média foi de 74,98 (+ 9,5). Destes, 51,4% (302) eram do sexo masculino e 152 (25,9) apresentavam alguma dependência. A média do CPOD foi de 28,8 (+ 5,5) e 54,5% (320) dos idosos eram edêntulos. Constatouse que 54,2% (318) e 74,1% (435) não usam nenhum tipo de prótese superior e inferior, respectivamente. O CPI e PIP mostraram que 64,4% (378) apresentaram todos os sextantes excluídos. O GOHAI mostrou que 75% (440) dos indivíduos apresentava auto-percepção positiva em saúde bucal. As variáveis última visita ao dentista (RP ajust=4,058; IC=1,526-10,789), presença de problemas gengivais (RP ajust=5,703; IC=1,754-18,544) e opinião sobre os dentes, as gengivas ou prótese (RP ajust=19,514; IC=5,075-75,041) permaneceram significativas no modelo após regressão logística múltipla. Conclusões: Observou-se predomínio da auto-percepção positiva em saúde bucal em detrimento das precárias condições bucais. Assim, para a população institucionalizada, o presente estudo recomenda a aplicação de levantamentos epidemiológicos e de auto-percepção para assegurar adequado planejamento nas ações de saúde bucal

Meios de resgatar a saúde bucal e autoestima de idosos

O presente estudo objetivou analisar as características epidemiológicas das condições de saúde bucal de 98 idosos de uma Instituição de Longa Permanência para Idosos (ILPI) e de 125 participantes de Grupos de Convivência, de bairros periféricos, socialmente semelhantes, de Fortaleza, Ceará, Brasil, para orientação do tratamento odontológico. Investigou-se a autopercepção em saúde bucal desses idosos a fim de realizar uma avaliação comparativa entre eles e com os levantamentos epidemiológicos de base nacional (SB Brasil) e de base estadual (SB Ceará). Devido a alguns idosos da ILPI recusarem o tratamento dentário e a identificação do elevado percentual de demenciados, optou-se por realizar uma avaliação cognitiva, o Mini Exame do Estado Mental (MEEM) visando identificar os aptos à reabilitação oral. Métodos: abordagem epidemiológica do tipo transversal, sendo a coleta de dados realizada por cinco examinadores, utilizando os critérios recomendados pela OMS (1997). Resultados: O CPO-D médio encontrado na ILPI, foi de 29,88, com predomínio do componente perdido (93,27%) enquanto o CPO-D médio dos não institucionalizados fixou-se em 30,17, com predomínio do componente perdido (63,70%). Também se avaliou o uso e a necessidade de prótese dentária: dos residentes na ILPI, 10,20% usavam prótese superior e 3,06%, inferior; 94,90% necessitavam de prótese superior e 97,96% de inferior; sendo a prótese total foi o tipo mais prevalente, 88,78% para ambos os arcos. O percentual do uso de prótese dos não institucionalizados foi 71,20% no arco superior, sendo 66,40% prótese total; já para o arco inferior, 32,80%, das quais 31,20% era prótese total. No presente estudo, tanto para uso quanto para necessidade, considerando ambos os arcos, a diferença entre os idosos institucionalizados e não institucionalizados foi estatisticamente significativa pelo teste Qui - quadrado (p<0,001). Como resultado do MEEM, observou-se deterioração cognitiva (escore ≤ 12) em 37,25% dos entrevistados, bem como um declínio cognitivo com o avanço da idade. Conclusões: Os resultados apontam que há um maior percentual de uso de prótese total no arco superior e maior frequência quanto à ausência de próteses de qualquer tipo no arco inferior. Evidenciou-se que os idosos pesquisados foram submetidos a tratamento mutilador e, como consequência necessitam de reabilitação oral, o que pressupõe a necessidade de políticas públicas para que isso ocorra efetivamente. Os participantes deste estudo caracterizam-se por uma autopercepção positiva da sua saúde bucal, a despeito das condições clínicas insatisfatórias e de precária saúde bucal, com acentuada prevalência de cárie dentária e edentulismo. O MEEM revelou deficiência cognitiva na maioria dos idosos, confirmando que a sua aplicação, previamente à reabilitação oral pode evitar desperdícios financeiros.Tais achados refletem a necessidade de implantação de políticas reabilitadoras em saúde bucal voltadas para o idoso; baseadas na perspectiva da integralidade como princípio doutrinário do Sistema Único de Saúde, o que redundaria numa melhor qualidade de vida, tanto pela melhor mastigação, digestão e nutrição, pelo maior aproveitamento dos alimentos, quanto pelo favorecimento à comunicação, pela dicção e fala, contribuindo para a socialização e consequente elevação da autoestima dessa clientela.

Cuidado formal em saúde bucal: percepção de senescentes

Ações promotoras de saúde e independência para pessoas idosas são indispensáveis. Compreender essa construção no cotidiano da provisão dos cuidados talvez estimule o desenvolvimento de capacitações ao bem estar nesta população. O objetivo deste estudo foi Identificar a repercussão da provisão do cuidado formal em saúde bucal na percepção de senescentes. Desenvolvemos uma pesquisa de base qualitativa com abordagem fenomenológica, onde realizamos entrevistas semiestruturadas e individuais com 30 pessoas de idade superior a 50 anos (22 mulheres e 08 homens), em um Centro de Convivência na cidade de Natal/Rio Grande do Norte, no nordeste do Brasil. Os relatos obtidos foram analisados em cinco estágios: transcrição dos discursos sem preocupação interpretativa; limpeza de erros linguísticos e repetições; leitura repetitiva e exaustiva para apreensão do sentido das informações coletadas; seleção das unidades significativas dos discursos, correspondendo aos trechos relevantes no horizonte do fenômeno em estudo; e compreensão da ideografia elaborada pelos participantes por grupos temáticos simbólicos. Assim, identificamos as essências temáticas de: determinante social e iniquidade em saúde bucal; e provisão de cuidados de saúde bucal e mal-estar físico, mental e social. Concluímos que a prestação de cuidados agregando abordagem humanístico-ética pode levar a vivências dignificantes no processo de envelhecimento, destacadamente quando estimula a promoção da segurança pessoal. O âmago desse trabalho descortina uma vertente multidisciplinar que perpassa a saúde, a educação e a ética

Percepção e realidade da política de atenção à saúde do idoso nas equipes de profissionais do programa de saúde da família do estado da Paraíba

Investigar os fatores relacionados á percepção que os profissionais das equipes do Programa de Saúde da Família (PSF) possuem frente à realidade da política de atenção à saúde do idoso nas Unidades Básicas de Saúde dos municípios litorâneos do Estado da Paraíba. Trata-se de um estudo observacional descritivo com uma amostra constituída por 120 profissionais de saúde de três categorias distintas (enfermeiro, médico e odontólogo), sendo 104 respondentes como profissionais e 16 respondentes como coordenadores de equipes. A coleta de dados foi realizada através de um questionário auto-aplicável de avaliação fechada e de questões de múltiplas escolhas. Os dados foram processados e armazenados no Programa Estatístico SPSS versão 15.0 e analisados à luz da estatística descritiva. Os resultados indicaram que os profissionais tiveram dificuldade em perceber a realidade da política integral e integrada de saúde do idoso junto aos serviços de saúde em que atuam. O estudo revelou ainda a necessidade de uma definição de estratégias para qualificação dos profissionais garantindo à atenção integral à saúde do idoso sob uma nova visão de atuação

Atividades educativas aos portadores de periodontite crônica: escuta e troca de saberes no autocuidado em saúde bucal

This research aimed at evaluating oral health education activities for Periodontitis carriers, emphasizing the motivation for self-care and understanding the cultural aspects involved. This was a qualitative and quantitative study. Based on the qualitative referential, 20 interviews were done, in which differences between scientific and popular explicative models of the health-illness process were verified, besides the increased knowledge and motivation in relation to the use of preventive measures and also the fails in the understanding of the chronic character of periodontitis, enhancing frustration and guilty feelings in the patients. Two groups were structured: intervention and control. The intervention group was submitted to clinical attendance and education activities, while the control group undergone the traditional clinical attendance only. The sample consisted of 51 participants of intervention group and 47 of control group. Structured interviews were conducted at the beginning and at the end of the treatment in order to evaluate the knowledge and motivation for self-care in both groups. For comparison between the previous and post moments in both groups, there were applied McNemar tests with a probability of p < 0.05. In intervention group there was an increase in knowledge related to the name, the causes and related factors of the disease (p < 0.05). In control group there wasn t a rise in the understanding of the diseases chronic character, unlike in intervention group. However, in what concerns self-care, a greatest frequency in medium and high scores was observed in both groups. By this study, it is conclude that there is a common sense knowledge about the importance of preventive techniques and poor oral health as causing periodontitis; clinical interventions for bearers of chronic Periodontitis do not add values to the patients, regarding the illness, its causes and its chronic character; popular beliefs stay in their imagination, and the patients have a increased motivational capacity for self-care

Política de atenção à saúde do idoso em Mossoró/RN: potencialidades e possibilidades para promoção do envelhecimento saudável no estado do Rio Grande do Norte

It discusses the Health Care of the Elderly in the town of Mossoró, traversing the paths that discussed the history of health care, which has been altered by the new (con) formation and required adjustments of society which led the development and implementation of the National Health Care for the Elderly with the backdrop of the guiding principles of the Health System - SUS. The goals outlined were: To map the implementation of the policy of health care for the elderly in Mossoró considering whether this is based on the principles and guidelines of the NHS and National Health Policy of the Elderly; Check if health promotion is seen as a strategy that favors the elderly mossoroenses the possibility of healthy aging; identify the discourse of the elderly about the aging process and the strategies you use to take care of your needs. Applies as a methodological strategy BOAS, complemented by interviews with twenty (20) elderly residents of Mossoró with a view to understand the objective elements, and the political and subjective traits that express a regularity which marks the area of health care mossoroense elderly. The data were tabulated and the BOAS divided into nine sections for analysis. The speeches were transcribed seized and subjected to a thorough reading that allowed the visualization of issues that have been examined with theoretical and methodological support to the model proposed by Boaventura de Souza Santos (2006) designated this cosmopolitan reason being supported by three meta-sociological procedures, namely, the sociology of absences, the sociology of translation work and emergencies. It appears as a result the exclusion and discrimination of the elderly in different social settings, a condition that prevents them from being aware of their importance as citizens deserving of decent treatment and respect for the family, society and the government, when addressing health the elderly said the need to propose alternative models of care that has the paradigm of health promotion. We conclude that in these areas, meetings are held, to draw lines that were heterogeneous because they were built by the dissimilarities that engender incessantly and show that although we have advanced regarding the attention of the elderly in Mossoró there is still a long way to go in order to meet the needs revealed by the elderly. It is suggested that the practice of trial-creation-differentiation, while highlighting the historical and procedural dimension, deconstructions and negotiations with collective effects. A democratic paradigm and analytical creeps: the constitution are moments of Health Care for the Elderly shaping a new landscape in the town of Mossoró.

Reinternações psiquiátricas no Rio Grande do Norte: implicações e impacto das novas estratégias de atenção à saúde mental

The Brazilian Psychiatric Reform based on the desinstitucionalization of the assistance, translated to the emphasis on community/territorial treatment and in the social inclusion of the mental suffering, promoted advances in the psychiatric restructuring. In the Rio Grande do Norte (RN), we can enumerate as advances of the Brazilian Psychiatric Reform the expansion of the mental health care chain and the implementation of some strategies that, together, aims to further the psychosocial attention of the individual with psych suffering and to reduce the indices of psychiatrics readmissions in the state. In the current Brazilian‟s mental health situation we were interesting in answered the following question: what the impact of the substitutes services‟ extension in the revolving door phenomenon? This search aims to analyze the revolving door phenomenon occurrences based on the news strategies of mental health care in the Rio Grande do Norte. This is a descriptive-exploratory study with a qualitative approach, oriented by the theoretical framework of critical-dialectical approach about the Brazilian Psychiatric Reform and using the thematic oral history as method of information collects. The search was realized on the Hospital João Machado (HJM), estate reference in psychiatric treatment, and the participants was 20 professionals that work on it. The collection of information had started after the approval of the UFRN Research Ethics Committee with the opinion number 216/2011 and CAAE number 0021.0.051.000-11 and was realized using the direct observation and semi-structured interview. The study‟s results were categorized in two categories and five subcategories of analysis. CATEGORY 1) Current situation of the mental health care chain in the RN, with the subcategories: 1.1 Impact of the new services of mental health care in the revolving door phenomenon in the RN; 1.2 Implications of the new services of mental health care in assisting user to the HJM; 1.3 Issues the permeate the mental health care chain in the RN. CATEORY 2) Main causes of the revolving door phenomenon in HJM, with the categories: 2.1 Family problems; 2.2 Lack of assistance after discharge from psychiatric hospital. In summary, we conclude that the extension of the mental health care chain contributed for the reduction of the psychiatrics re-hospitalization‟s indices in RN. However, we realized that territorial services of mental health care are not the only responsible for the revolving door phenomenon. Factors as family problems and the disarticulation of the assistance after the discharge from hospital influence on the perpetuation of hospitalizations and re-hospitalizations in the local scenario. To study the revolving door phenomenon that occur in the psychiatrics‟ assistance considering the news strategies of mental health care allowed us to approach the advances and challenges brought by the RPb and by the desinstitucionatization in the state, indicating the need for further discussions and problem-solving strategies of psychosocial care.

Atenção à saúde da pessoa idosa na estratégia saúde da família no município de Santo Antônio/RN: um estudo de caso

According to demographic estimates, by the year 2025 Brazil will be the sixth country in the world in number of elderly. For this reason, it is a purpose of public policies to help people to reach that age being healthier. The current health care model of health surveillance through the Family Health Strategy (EFS, in portuguese) is configured as a gateway into the care of the elderly in the Unified Health System (SUS, in portuguese). It is also an area of development of practices to promote health, prevention and control of chronic nondegenerative diseases. The aim of this study was to analyze the health care of the elderly provided by ESF professionals for the achievement of a full care. The study is descriptive case study with a quantitative approach, performed in the city of Santo Antônio/RN. The population included all health professionals, who are FHS members of the city that agreed to participate of the survey, a total of 80 professionals. Data were collected using a structured questionnaire, having mostly closed questions and divided into two parts: one containing sociodemographic information of health professionals and vocational training and the other, the activities carried on by the professionals in senior care, being analyzed from a database tabulated in a spreadsheet and discussed according to the descriptive statistics in tables, graphs and charts using frequencies, medians and values of central tendency. It was verified a predominance of professionals who finished highschool, mostly female, aged from 30 to 34 years old, with training completed in the last 10 years, without being graduated in the field of geriatrics or gerontology and mostly without training in gerontology. Family members and caregivers were the components of the social support network most identified by the professionals (66.3%).The elderly access to the Family Health Basic Unit was considered by83.8% of professionals as the most important factor that interferes in the activities of health care of the elderly. Considering the inclusion of the family in care: 98.8% of professionals consider the family as one of the goals of care, but 82.5% assist the family to know their role and participate in the care of the elderly, emphasizing that no professional makes use of tools for evaluating the functionality of the family. Regarding the actions taken to assist the elderly, 91.25% have home visits program to the elderly, 88.75% use the host program; 77.5% know the habits of life, cultural, ethical and religious values of the elderly, their families and their community ;51.25% complement the activities through intersectoral actions, 50%participate in groups of living with the elderly; 33.75% keeps track and maintain updated the health information of the elderly; 11.25% of the professionals perform the Single Therapy Planning (PTS, in portuguese) and few implement the actions to promote health according to PTS; there is a deficit in the number of professional categories in the identification and monitoring of the frail older people in their households. It is concluded that the health care of the elderly developed by ESF professionals differs among the professional categories. It was identified weaknesses in the promotion of an active and healthy aging and also in the establishment of an integrated and full care of the elderly. It is recommended the adoption of permanent educational activities by the City Management, initially for ESF professionals in the the perspective of the guidelines of the National Policy of Health Care for the Elderly and later to the other professionals that are part of the health care network of the elderly, at all levels of care in the city for the development of strategies and practices that promote the improvement of the quality of healthcare for the elderly, expecting concrete and effective results in terms of promoting health within Brazilian reality

Fatores associados à condição de saúde bucal de pacientes internados em hospitais públicos do município de Natal-RN

The hospitalization is an event that can attack any person, independent of gender, race, social and economical condition. Last year, the prevalence of hospitalization was 8.1 for 100 inhabitants and the average time of hospitalization was 8.5 days for each patient one in Natal city. Therefore, an important point is whether the attention to the patients during the permanence in these health establishments incorporates the health integral model suggested by the principles proposed by the National Health System in Brazil (SUS), with actions of promotion and protection by different kinds of professionals, beside those called convalescence. Then, the aim of this study was to evaluate the patient s oral health conditions hosted in public hospitals of the Natal city, looking for to establish its relationship with several risk factors by two dimensions: the characteristics of the hospitalization and the patient s general and economical conditions. We accomplished a cross-sectional study with 205 patients distributed among the hospitals Onofre Lopes, Giselda Trigueiro and Monsenhor Walfredo Gurgel, looking for to know the socio-demographic characteristics, the food habits and of oral hygiene and the conditions of oral health, through the Visible Plaque Index and Gingival Bleeding Index. We observed that the conditions of the patient s oral health interned at public hospitals of reference of the municipal district of Natal is bad, existing accumulation of dental plaque and, consequently, a great number of patients with gingival bleeding. However, the time of hospitalization and its reason, the type of medicine used in this time and the toothbrush frequency were not configured as risk factors for this oral health condition

Atividades educativas na rede pública de ensino: efeitos sobre a higiene oral e o nível de informação em Saúde Bucal

The contents introduction concerning the individual health cares reveals important since the school education. In this direction, the present study objectified to know an effect of Oral Health education intervention in the oral hygiene and in the schools children information level, of 4º e 5º basic education years. The study was composed by two groups, chosen of random form: control group (n = 115) and experimental group (n = 132), with 247 public net school children in total sample. The experimental group participated of some educative activities in Oral Health, with biweekly frequency, during the 4 months period, given for a surgeon-dentistry. Both the groups were submitted to a clinical examination for a previous verification of the Plaque Index (PI) and of Loe Silness Gingival Index (GI). A questionnaire with closed questions on Oral Health was applied before and after to verify the school children rightness index. After the intervention, the final data, represented for the PI, GI and Rightness Index verification, has been collected for statistical analyses through the chi-square test to a 95 % of reliable level, using the SPSS 10,0 software. The PI and GI were categorized in high and low on the initials index basis medium; already the Rightness Index was categorized in inadequate (< 50%) and adequate (≥ 50%). It was verified that the PI (p = 0,014; IC 0.24-0.86) and the GI (p = 0,013; IC 0,28-0,84) presented differences statistically significant, after the education activities, when compared to with the control, favoring the experimental group. It was verified too the experimental group got greater rightness index, presenting difference highly significant (p<0,0001; IC 3,73-26,81). It was still observed that there was no association between the oral hygiene indicators and the school children information level. Ahead the results, it can been concluded that education activities related in the school routine were capable to give positives effects in the oral hygiene control and in the information level about Oral Health, however, not necessarily, the individual with bigger information is that one who has practiced an oral hygiene more adjusted. One become necessary, however, that the education in Oral Health occurs of permanent and integrated form with others school actors, for the positive effect does not lose the student s life longterm

Percepção dos idosos sobre saúde bucal

The assessment of oral health status in elderly patients is essential for the development of specific health policies. The prevalence of oral diseases is high in this population. The self-perception of oral health conditions influences the demand for oral care and quality of life for seniors. The aim of this study was to assess self-perception of oral health status in 100 elderly of both sexes, aged 60 years or older and functionally independent the Basic Health Unit of Felipe Camarão II, Natal, Brazil. For comparison of self-perception data was collected in Bom Pastor, Natal / RN. In this research data were collected a questionnaire grouped into two parts. The first part with the socio-demographic data, subjective and objective condition of oral health and access to the service, the second part GOHAI Index. This index consists of 12 items that make it possible to obtain information involving aspects of chewing, speech, phonation, and self-assessed oral health. The results were subjected to statistical tests of Mann-Whitney and Kruskal-Wallis test (α = 0.05), to identify possible predictors of self-evaluation. As a result, 69% were female, ages ranged from 60 to 86 years, with a median of 65 years. In relation to marital status 48% were married. For the years of study, the sample had an average of 3 years. For the last visit to the dentist, only 27% of seniors had visited the Dentist for less than a year. Regarding the questions about the presence of gingival and dental problems were answered by 46% and 21% respectively. The data on the perception of your teeth and gums, 44%. The index showed GOHAI value for self-perception of 30 points to Felipe Camarão and 28 points for the Bom Pastor, both considered a low perception. We identified predictors of self-rated number of people in the room, participate in any associational activity, there is problems with your teeth and your gums. Concluded a negative self-perception of oral health condition by Gone in both areas, influenced by socioeconomic and cultural issues, although they realize the importance given to oral health, but by the misfortunes of other prominent favored little valuing of oral health