Anya Pimentel Gomes Fernandes Vieira

Child, neglect and oral health

BackgroundDespite advancements in oral health policies, dental caries still a problem. The lack of parents/caregiver’s care regarding child’s oral health, which characterizes neglect, may lead to a high prevalence of caries. Therefore, the objective of this study was to analyze the relation between dental caries and neglect in five year-old children.MethodsQuantitative study performed in two different moments. First, the children underwent oral examinations and physical inspection. Then, a semi-structured interview was performed with parents of children with high and low caries rate.ResultsIn all, 149 physical inspections and oral exams were performed. The number of decayed, missing and filled teeth – dmf-t was 2.75 (SD 2.83); 16 children had extremely high values (dmf-t ≥7), 85 intermediate values (1 ≤ dmf-t ≥ 6) and 48 extremely low (dmf-t = 0). Nearly all caregivers were female (96.7%; n = 29), mostly mothers (93.3%; n = 28). Associations were found between caries experience and reason of the last consultation (p = 0.011), decayed teeth and child’s oral health perception (p = 0.001). There was a trend towards a significant association between general health and decayed teeth (p = 0.079), general hygiene and caries experience (p = 0.083), and caries experience and number of times the child brushes the teeth (p = 0.086).ConclusionThere’s a relation between caries experience and children’s oral health perception by caregivers, as well as between caries experience and children’s access to dental care. There is a trend towards association between caries experience and risk factors suggestive of neglect.

ACESSO À SAÚDE BUCAL PÚBLICA PELO PACIENTE ESPECIAL: A ÓTICA DO CIRURGIÃO-DENTISTA

Objective: To examine, from the dentists’ perspective, the access of special needs patients (SNP) to oral health care in the Unified Health System. Methods: Cross-sectional and quantitative study, performed in 2011 by means of interviews based on semi-structured questionnaires, carried out with dental surgeons at family primary healthcare units of a capital city in Brazil’s northeast region. Study variables included sociodemographic factors, work conditions and data related to the access and utilization of dental care services by SNP. Data was analysed with proper statistics in SPSS 15. Results: Interviews were performed with 44 dentists, 36 (81.8%) of which regularly assisted SNP; 29 (65.9%) conducted only oral examination and oral hygiene instructions; and 5 (11.3%) conducted oral examination and referred the patients to specialties centers. Nine (20.5%) of them reported having attended a discipline, focused on that type of patient. The accessibility, caring and dental assistance offered to SNP were approved by 70% of the dentists. Conclusions: From the dentists’ perspective, special needs patients in the public network have access to oral health care; resolutivity, however, seems to be undermined, being necessary to refer those to other services.

Relação entre o gênero no acesso ao serviço odontológico e aos artigos de higiene bucal

Objective: Identify the influence of gender in the access to dental services and goods such as consultation, toothbrush, toothpaste and dental prostheses use. Methods: Cross-sectional, quantitative and population coverage study, with the population of Guaiuba municipality. Data were collected by Community Health Agents from 2007 to 2008. We used the Community Oral Health Indicator to verify the access to oral health services, oral hygiene, dental visit, use and need of dental prosthesis. Data were analyzed using SPSS 15.0 software, using the chi-square test and significance level of 5%. Results: 2581 people participated, with a mean age of 24.42 years (SD± 19, 365), predominance of females (n=1628; 63.1%). Among the interviewees, 2,341 (90.7%) had access to a toothbrush, 2272 (88.0%) to toothpaste, and 1175 (45.5%) to a dental appointment. The need for dental prosthesis was higher in women, 581 (35.7%) versus 221 (23.2%) men and their access [354 (60.9%)] versus [96 (43.4%)] with p<0.05. Conclusion: The access to health services and dental treatment presents gender as an influence factor. Women have most of the needs and benefits. doi: 10.5020/18061230.2014.p381

Structural Violence on Elderly People's Oral Health

To the Editor: Due to its subjectivity, violence can be defined in different ways. In this letter, structural violence is defined as a form of violence that occurs through institutional, relational, and cultural aspects over people’s historical, economical, and social vulnerability. In Brazil, this form of violence can be represented by 30 million edentulous people, almost 5 million aged between 65 and 74 years. Oral health (OH) problems extravasate the body and are constituted and determined beyond the biological sense, with a strong interaction with society and environment. Tooth loss spans the limits of dentistry, by interfering in self-esteem, dignity, social integration, influencing on people’s general health, well-being, and quality of life. The experience of oral problems among elders is higher in low-income countries due to the fact that elders who are exposed to social vulnerability are likely to suffer direct interference of social determinants in the health–disease process and need support from public policies and social support networks. To Minayo, the elderly population suffers from structural violence, which coincides with violence produced by existing social inequalities (cultural, economic, and formal education differences), a phenomenon that is also a consequence of the omission of public assistance by social institutions. Although a reality in the Brazilian society, tooth loss is not even remembered as a problem in daily life, nor even classified as a structural violence. However, all forms of marginalization that deprive people access to services and determine well-being can be considered structural violence. In this context, structural violence responds to the way human being is devalued in society, and the violent behavior can be identified by the neglect of care by social and health institutions, including lack of access to goods and services. Based on the above considerations, there was a need to research the three major national epidemiological surveys focusing on the OH conditions of the Brazilian elderly population in the last 24 years. This was done using secondary data from the national epidemiological surveys on OH conditions of Brazilian elders to compare number of decay, missing, and filled teeth (DMFT) scores in the years 1986, 2003, and 2010 –– the only official OH national surveys for the elderly Brazilian population. The 1986 survey only considered people aged 50 to 59 who lived in urban areas. This age group was set as representative for the elderly population due to the life expectancy at birth of Brazilians at that time. The 2003 and 2010 surveys included people 65 to 74 years old who lived in urban and rural areas. All surveys used the methodology adopted by the World Health Organization (WHO). Table 1 presents the DMFT values for the elderly population in 1986, 2003, and 2010. The most aggravating fact is that the components “decayed” and “filled” represented, together, only 2.9 (10.66%), 1.9 (7,36), and 2.2 (8.69%) of the DMFT in these surveys. The vast majority of this population had fewer than 20 teeth in the mouth, unlike the 50% target recommended by WHO/F ed eration Dentaire Internationale (World Dental Federation) for the year 2000. In fact, the OH condition of the Brazilian elderly population has not changed significantly over 24 years, with high numbers of extracted teeth, which, if properly treated (preventive and restorative care), were probably liable for conservation. This situation indicates the occurrence of a structural violence. Paradoxically, Brazil has a modern dentistry, a national health system (created in 1988) that aims to assure universal access to health care, as well as a National Oral Health Policy (from 2003) that recommends strategies to improve dental service access. Unfortunately, these strategies do not seem to be reaching the elderly population. The current scenario leads to the questioning of elements needed to change this epidemiological data. It is not clear what exactly needs to be done, but certainly, these elements shall be incisive public policies concerning the relation between OH and general and/or systemic health of the elderly population and also new strategies that spread the idea that OH is a right of every citizen and a duty of the public healthcare system. OH means much more than healthy teeth, considering that the mouth is both a cause and a reflection of the individual and population health and well-being. The condition found in the OH of Brazilian elders over the years indicates the occurrence of a structural violence, understood as a form of violence that occurs through institutional, relational, and cultural aspects over people’s historical, economical, and social vulnerability. The comprehension of this reality is the first step toward overcoming this problem, which is the main contribution of the present letter.

Saúde bucal do adolescente: necessidades odontológicas levantadas pelos agentes comunitários de saúde - doi: 10.5020/18061230.2012.p131

Objective: To present epidemiological data on adolescents oral health, collected by Community Health Agents (CHA) using Community Oral Health Indicator (COHI) in a city of Ceara State, Brazil. Methods: Cross-sectional study conducted in Guaiuba-CE from July, 2007 to February, 2008. Community health agents collected data using the COHI. The COHI evaluates the masticatory capacity (number of teeth); the need of restorative care (dental cavities and residual roots); presence of soft tissue injury; use and need of dental prosthesis. It allows giving priority care to the patients with greater needs by means of a list of signs related to oral health problems. A total of 743 adolescents were examined. Results: adolescents had 26.14 ± 3.61 teeth on average; 129 (17.4%) did not present cavities, 301 (40.5%) had one or two, 223 (30.0%), had three or more; 110 (14.8%) presented residual root, 121 (25.7%) tartar, 74 (10.0%) sore gums, 15 (2.0%) oral tissues injuries; 49 (6.6%) required prosthesis; 694 (93.4%) used toothbrush; and 281 (51.3%) had visited the dentist last year. It was detected an association between visit to the dentist in the last year and gender (p = 0, 0001), and between age below 12 and having three or more cavities (p = 0.023). Conclusion: Collected data demonstrated low oral health indicators among teenagers. It was noted that those aged under 12 present oral health indicators worse than the older ones, which demands public policies concerning such reality. Data suggests that COHI is suitable for epidemiological surveys.

Relação entre fluorose dental e a concentração de flúor no dente – um estudo em área endêmica - doi:10.5020/18061230.2011.p355

Objective: To determine the relationship between dental fluorosis (DF) severity and fluoride [F] concentration in tooth and water in DF endemic areas. Methods: Life-long residents from two DF endemic communities were studied. Forty-five extracted teeth were collected and analyzed for DF severity and tooth [F]. Thylstrup-Ferjeskov Index (TFI) was used to measure DF severity and instrumental neutron activation analysis (INAA) for tooth [F] concentration. Water from regional wells was also collected (n=9) and analyzed for F content using specific ion F electrode. Results: Water [F] varied between 0.2ppm and 4.7ppm. TFI scores ranged from 0 to 6; [F] from 120ppm to 2,140ppm in enamel and 304ppm to 4,800ppm in dentin. No correlation was found between DF severity and [F] in enamel (rs=0.22,p=0.15) and dentin (rs=-0.19,p=0.20), nor between water [F] and [F] in enamel (rs=-0.09,p=0.65) and dentin (rs=-0.11,p=0.56). Weak correlation between DF severity and water [F] (rs=0.38,p=0.04) was found. Linear regression analysis showed that TFI couldn?t be predicted from a linear combination of the independent variables (age, enamel and dentin [F]). When enamel, dentin and water [F] were used as independent variables in the linear regression (predict DF severity), only water [F] showed influence in DF severity (p=0.013;t=2.67). Conclusion: Even in areas of endemic DF, tooth [F] didn?t correlate with DF severity and the relationship between water [F] and DF severity was very weak. Therefore, tooth [F] may not be a good predictor/indicator of DF severity. Objetivo: Determinar a relacao entre severidade de fluorose dental (FD), e concentracao de fluor [F] no dente e agua em areas endemicas de FD. Metodos: Residentes de duas comunidades endemicas de FD foram estudados. 45 dentes foram coletados e analisados para severidade de FD e concentracao de fluor. O indice de Thylstrup-Ferjeskov (TFI) foi utilizado para medir a severidade de FD e analise por ativacao com neutrons (AAN) para concentracao de [F] dental. Aguas de pocos da regiao foram coletadas (n=9) e analisadas para [F], utilizando eletrodo especifico de fluor. Resultados: Concentracao de [F] da agua variou entre 0,2 e 4,7ppm. Os escores do TFI variaram entre 0 e 6; [F] no esmalte entre 120 e 2140ppm e na dentina entre 304 e 4800ppm. Nao se observou correlacao entre severidade de DF e [F] no esmalte (rs=0,22,p=0,15) e dentina (rs=-0,11,p=0,56). Encontrou-se correlacao fraca entre FD e [F] na agua (rs=0,38,p=0,04). Analise de regressao linear demonstrou que TFI nao podia ser predito por uma combinacao linear das variaveis (idade, e concentracao de fluor no esmalte e dentina). Quando a concentracao de fluor no esmalte, dentina e agua foram analisadas de forma independente na regressao linear, apenas fluor na aguademonstrou influencia na severidade de FD (p=0,013;t=2,67). Conclusao: Mesmo em areas endemicas de FD, concentracao de fluor dental nao se correlaciona com severidade de FD, e a relacao entre este e a concentracao de fluor nas aguas foi fraca. Assim, concentracao de fluor dental pode nao ser um bom preditor/indicador de severidade de FD.

P1-228 Decreased bone mass in women: importance of early diagnosis for healthy ageing

Objectives Presuming that osteoporosis begins in middle aged women, the present study had as an objective to identify the prevalence of osteopenia and osteoporosis in women whose ages vary from 45 to 59 and from 60 or more. Methodology The study analysed data from a gynaecologic outpatient clinic, related to patients files from 2000 to 2006. The following variables were analysed: age, the first and the last appointments dates, the result of the bones minerals density (DMO) classified by the categories: normal, osteopenia and osteoporosis. χ2 Test was used to verify associations between variables, considering p<0.05. Results Osteopororis was more frequent in the older age group (42.5% vs 5.6%, p<0.05), although osteopenia was more frequent in the younger group (55.0% vs 47.1%, p<0.05). Conclusion These findings suggest that an early screening for lost of bone mass should be done, allowing the beginning of adequate therapy, in order to assure life quality to middle aged and older women.

SP3-58 Teeth loss impact on elder people's quality of life

Introduction There are scientific evidences which show the health contribution of the quality of life. These measurements have not been well guided towards the free speech of the oral health in the peoples life. Objective This study aimed to investigate the impact of the teeth loss on the elder peoples quality of life. Material and Methods Qualitative investigation with descriptive features, which used random out sample as a result of the total edentulous elder peoples selection, who live in a institution of Fortaleza, Brazil. Within 250 residents screened: 72 elderly, completely edentulous, with ages varying from 60 to 79 years old were selected. A semi-structured questionnaire with closed and opened questions in which the last ones were used for the free flow of the interviewees speech. The content was analysed and codified according to Bardin. Results 84.7% had gone to the dentist in order to have exodontics. 81.9% reported difficulties after losing their teeth. Physical dimensions, characterised by the difficulties to be fed, and social dimensions, due to the interference in the communication with other people were obtained. Conclusion The tooth loss causes disorder in the individuals quality life, mainly when it affects his well-being and appearance.