Antonio Carlos Frias

Saúde gengival de adolescentes e a utilização de serviços odontológicos, Estado de São Paulo

OBJETIVO: Avaliar a associacao de condicoes de saude gengival com a utilizacao de servico odontologico. METODOS: Realizou-se levantamento epidemiologico de saude bucal de 1.799 adolescentes, em 35 cidades do Estado de Sao Paulo, em 2002. A saude gengival foi avaliada pela prevalencia de sangramento na gengiva a sondagem e calculo dentario (indice periodontal comunitario) e oclusao dentaria (indice de estetica dentaria). A utilizacao de servicos odontologicos foi medida pelo indice de cuidado (O/CPO) para cada cidade. Analise multinivel de regressao logistica ajustou modelos explicativos para fatores associados aos desfechos de interesse. RESULTADOS: A prevalencia de sangramento gengival a sondagem foi 21,5%; de calculo dentario foi 19,4%. Os participantes do sexo masculino, negros e pardos, moradores em areas rurais, residentes em domicilios aglomerados e com atraso escolar apresentaram chance significantemente mais elevada para os agravos que seus respectivos pares de comparacao. Caracteristicas de oclusao dentaria tambem associaram com gengiva nao-saudavel: apinhamento dos segmentos incisais, mordida aberta vertical anterior, relacao molar antero-posterior. Cidades com maior utilizacao de servico odontologico tiveram menor proporcao de adolescentes com sangramento gengival e calculo. CONCLUSOES: A utilizacao de servicos odontologicos foi significativamente associada a melhores condicoes de saude gengival (sangramento e calculo). Essa associacao independeu das caracteristicas sociodemograficas individuais e contextuais, e de oclusao dentaria.OBJECTIVE To evaluate the association between gingival health conditions and dental service utilization. METHODS An epidemiological survey of the oral health of 1,799 adolescents was carried out in 35 cities of the state of São Paulo, in 2002. Gingival health was assessed through the prevalence of gingival bleeding on probing and dental calculus (community periodontal index), and dental occlusion was assessed through the dental aesthetic index. The utilization of dental services was measured by means of the dental care index (F/DMFT) for each city. Multilevel logistic regression analysis was used to adjust explanatory models to factors associated with the outcome variables of interest. RESULTS The prevalence of gingival bleeding on probing was 21.5%, whereas dental calculus was prevalent in 19.4%. Male participants, who were either black or dark-skinned, lived in crowded homes, in rural areas, and showed schooling delay, were at a significantly higher risk than their respective counterparts. The following dental occlusion characteristics were also associated with unhealthy gum: incisor segment crowding, vertical anterior open bite, and antero-posterior molar relationship. Cities with a higher utilization of dental services showed a smaller proportion of adolescents with gingival bleeding and dental calculus. CONCLUSIONS The utilization of dental services was significantly associated with better gingival health conditions (gingival bleeding and dental calculus). This association did not depend on contextual and individual sociodemographic characteristics or dental occlusion.

Determinantes individuais e contextuais da prevalência de cárie dentária não tratada no Brasil

OBJETIVO: Descrever a prevalencia de carie dentaria nao tratada em adolescentes no Brasil e analisar a associacao da carie com fatores individuais e contextuais nos municipios onde esses adolescentes residem. METODOS: Utilizou-se um banco de dados gerado pelo Ministerio da Saude (projeto SB-Brasil) que inclui informacoes de 16 833 adolescentes (15 a 19 anos). A presenca de ao menos um dente permanente com carie nao tratada foi a variavel de estudo. As variaveis explicativas, em nivel individual, foram: sexo, grupo etnico, local de residencia e situacao escolar. As variaveis referentes ao municipio foram: indice de desenvolvimento humano municipal (IDH-M), proporcao de domicilios com ligacao de agua e presenca de fluor na agua de abastecimento ha 5 anos ou mais. Para ajustar o desfecho as condicoes individuais e municipais de interesse, foi realizada uma analise multinivel para estimacao em modelos multivariados de regressao logistica. RESULTADOS: Ser negro ou pardo (razao de chances ajustada, ORajust = 1,79; 1,68 a 1,92) e residir em area rural (ORajust = 1,31; 1,19 a 1,45) foram determinantes individuais de maior probabilidade de apresentar carie nao tratada. Ser estudante foi identificado como fator de protecao (ORajust = 0,67; 0,62 a 0,73). As variaveis de segundo nivel, IDH-M (coeficiente ajustado beta = -0,213), fluor na rede de agua (beta = -0,201) e proporcao de domicilios com ligacao de agua (beta = -0,197) foram identificadas como determinantes contextuais de carie. CONCLUSAO: Os resultados mostram que existe desigualdade na distribuicao dos servicos de saude nas diferentes regioes brasileiras e sugerem que pode haver desigualdade tambem na efetividade dos servicos prestados. Politicas de expansao do acesso a agua fluoretada e inclusao escolar podem contribuir para evitar a doenca carie em adolescentes.

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach

BackgroundDespite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.ObjectivesTo assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.MethodsThe study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.ResultsDental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.ConclusionsGirls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

Custo da fluoretação das águas de abastecimento público, estudo de caso ­ Município de São Paulo, Brasil, período de 1985-2003

O objetivo do artigo e estimar o custo da fluoretacao das aguas de abastecimento publico no Municipio de Sao Paulo no periodo de 1985-2003. Para o calculo da composicao de custos da fluoretacao das aguas levou-se em conta os seguintes custos: (a) capital inicial de instalacao; (b) produto quimico (acido fluorsilicico); (c) operacionalizacao do sistema (manutencao do sistema, energia eletrica e recursos humanos); e (d) controle dos teores de fluor. A acao do fluor mostrou-se efetiva, pois para a idade de 12 anos observou-se reducao de 73% na experiencia de carie dentaria, sendo que em 1986 a media do indice CPO-D era de 6,47 (6,12-6,82) e em 2002 foi de 1,75 (1,48-2,92). Nesta idade-indice 40% das criancas apresentaram CPO-D = 0 em 2002. O custo medio per capita/ano na Cidade de Sao Paulo foi de R

Color/race inequalities in oral health among Brazilian adolescents

0,08 (US

Saúde gengival de adolescentes e a utilização de serviços odontológicos, Estado de São Paulo = Gingival health of adolescents and the utilization of dental services, state of São Paulo, Brazil

0,03) em 2003. O custo acumulado em 18 anos de implantacao do sistema de fluoretacao foi de R

Avaliação dos procedimentos coletivos em saúde bucal: percepção de adolescentes de Embu, SP

1,44 (US

Conditional factors for untreated caries in 12-year-old children in the city of Sao Paulo

0,97) per capita.

Saúde bucal e uso dos serviços odontológicos em função do Índice de Necessidades em Saúde: São Paulo, 2008

This study assessed oral health outcomes (perceived dental treatment need, untreated dental caries, gingival bleeding, periodontal pockets, and pain in teeth and gums), in relation to color/race inequalities among adolescents in each Brazilian region. The database included dental examination and interview of 16,833 15-19-year-old adolescents, surveyed by the Brazilian health authority, from May 2002 to October 2003, in accordance with international diagnostic criteria standardized by the World Health Organization. Prevalence ratios estimated by Poisson regression, and controlled by socioeconomic status and access to fluoridated piped water, assessed oral health differentials among color/race groups and country’s regions. Except for periodontal pockets, prevalence figures were higher in the North and Northeast: perceived dental treatment needs, untreated dental caries, gingival bleeding at probing and pain in teeth and gums varied between 80-83%, 75-76%, 38-43%, and 17-18%, respectively, in these regions. Adolescents living in the Southeast – the richest Brazilian region – presented a better general profile of oral health than their counterparts living in the remaining regions; they had a lower prevalence of untreated dental caries (54%) and unfavorable gingival status (29%). However, the Southeast presented color/ race inequalities in all oral health outcomes, with a poorer profile systematically affecting browns or blacks, depending on the oral health condition under consideration. These results reinforce the need for expanding the amplitude of health initiatives aimed at adolescent oral health. Socially appropriate health programs should concurrently aim at the reduction of levels of oral disease and its inequalities.

The incidence of dental caries in children and adolescents who have cerebral palsy and are participating in a dental program in Brazil

OBJETIVO: Avaliar a associacao de condicoes de saude gengival com a utilizacao de servico odontologico. METODOS: Realizou-se levantamento epidemiologico de saude bucal de 1.799 adolescentes, em 35 cidades do Estado de Sao Paulo, em 2002. A saude gengival foi avaliada pela prevalencia de sangramento na gengiva a sondagem e calculo dentario (indice periodontal comunitario) e oclusao dentaria (indice de estetica dentaria). A utilizacao de servicos odontologicos foi medida pelo indice de cuidado (O/CPO) para cada cidade. Analise multinivel de regressao logistica ajustou modelos explicativos para fatores associados aos desfechos de interesse. RESULTADOS: A prevalencia de sangramento gengival a sondagem foi 21,5%; de calculo dentario foi 19,4%. Os participantes do sexo masculino, negros e pardos, moradores em areas rurais, residentes em domicilios aglomerados e com atraso escolar apresentaram chance significantemente mais elevada para os agravos que seus respectivos pares de comparacao. Caracteristicas de oclusao dentaria tambem associaram com gengiva nao-saudavel: apinhamento dos segmentos incisais, mordida aberta vertical anterior, relacao molar antero-posterior. Cidades com maior utilizacao de servico odontologico tiveram menor proporcao de adolescentes com sangramento gengival e calculo. CONCLUSOES: A utilizacao de servicos odontologicos foi significativamente associada a melhores condicoes de saude gengival (sangramento e calculo). Essa associacao independeu das caracteristicas sociodemograficas individuais e contextuais, e de oclusao dentaria.OBJECTIVE To evaluate the association between gingival health conditions and dental service utilization. METHODS An epidemiological survey of the oral health of 1,799 adolescents was carried out in 35 cities of the state of São Paulo, in 2002. Gingival health was assessed through the prevalence of gingival bleeding on probing and dental calculus (community periodontal index), and dental occlusion was assessed through the dental aesthetic index. The utilization of dental services was measured by means of the dental care index (F/DMFT) for each city. Multilevel logistic regression analysis was used to adjust explanatory models to factors associated with the outcome variables of interest. RESULTS The prevalence of gingival bleeding on probing was 21.5%, whereas dental calculus was prevalent in 19.4%. Male participants, who were either black or dark-skinned, lived in crowded homes, in rural areas, and showed schooling delay, were at a significantly higher risk than their respective counterparts. The following dental occlusion characteristics were also associated with unhealthy gum: incisor segment crowding, vertical anterior open bite, and antero-posterior molar relationship. Cities with a higher utilization of dental services showed a smaller proportion of adolescents with gingival bleeding and dental calculus. CONCLUSIONS The utilization of dental services was significantly associated with better gingival health conditions (gingival bleeding and dental calculus). This association did not depend on contextual and individual sociodemographic characteristics or dental occlusion.