Anya Pimentel Gomes Fernandes Vieira-Meyer

Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality

Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p≤0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly. Conclusions: No collaboration was observed between the Bolsa Família Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Família Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil.

Access to dental public services by disabled persons.

BackgroundAccording to the World Health Organization, one in every 10 people has a disability, and more than two-thirds of them do not receive any type of oral dental care. The Brazilian Constitution of 1988 guarantees all civilians including disabled people the right to healthcare, shaping the guidelines of the Brazilian National Health Care System (Sistema Único de Saúde – SUS). However, there is limited information about the true accessibility of dental services. This study evaluated the accessibility of public dental services to persons with disabilities in Fortaleza, Ceará, which has the third highest disability rate in Brazil.MethodsA cross-sectional quantitative study using structured questionnaires was administered to dentists (n = 89) and people with disabilities (n = 204) to evaluate the geographical, architectural, and organizational accessibility of health facilities, the communication between professionals and patients with disabilities, the demand for dental services, and factors influencing the use of dental services by people with motor, visual, and hearing impairments.Results43.1% of people with disabilities do not recognize their service as a priority of Basic Health Units (BHU), 52.5% do not usually seek dental care, and of those who do (n = 97), 76.3% find it difficult to receive care and 84.5% only seek care on an emergency basis. Forty-five percent are unaware of the services offered in the BHU. Of the dentists, 56.2% reported difficulty in communicating with deaf patients, and 97.8% desired interpreters stationed in the BHU. People with disabilities gave better accessibility ratings than dentists (p = 0.001). 37.3% of the patients and 43.8% of dentists reported inadequate physical access infrastructure (including doors, hallways, waiting rooms, and offices). Dentists (60%) reported unsafe environments and transportation difficulties as geographical barriers, while most people with disabilities did not report noticing these barriers.ConclusionsWhile access to dental services has increased in Fortaleza, the lack of accessibility of health units and their surroundings does not promote the treatment of people with disabilities. Cultural, organizational, architectural, geographical, and communication barriers constrain the demand for and use of oral dental care services by this social segment.

Atenção à saúde bucal das Pessoas que Vivem com HIV/Aids na perspectiva dos cirurgiões-dentistas

Este artigo descreve a dimensao do processo de atencao a saude bucal das Pessoas que Vivem com HIV/Aids em Fortaleza (CE), sob a otica dos dentistas. Estudo transversal quantitativo descritivo-analitico. A coleta de dados foi realizada aleatoriamente com 170 dentistas do Sistema Unico de Saude, Centros de Saude da Familia e Centros de Especialidades Odontologicas. Para a analise estatistica, calculou-se o teste Qui-quadrado de Pearson, T Independente e Correlacao de Spearman. O acesso, a estrutura fisica, a biosseguranca e a formacao profissional nao sao considerados satisfatorios para a atencao e influenciam na predisposicao dos profissionais em atender esses pacientes.

The association of the Bolsa Familia Program with children’s oral health in Brazil

BackgroundSeveral studies have demonstrated that Conditional Cash Transfer (CCT) programs reduce poverty/inequity and childhood mortality. However, none of these studies investigated the link between CCT programs and children’s oral health. This study examines the association between receiving the Brazilian conditional cash transfer, Bolsa Familia Program (BFP), and the oral health of five-year-old children in the Northeast of Brazil.MethodsWe conducted a cross-sectional study with 230 caregivers/children randomly selected in primary health care clinics in the city of Fortaleza in 2016. Interviews and oral health examinations were performed. Descriptive statistics and multiple logistic regression analyses were conducted to identify factors associated with dental caries among five-year-old children enrolled in the BFP.ResultsAround 40% of children enrolled in the BFP had dental caries. However, those who received Bolsa Familia (BF) for a period up to two years (OR = 0.13, 95% CI 0.05–0.35) had substantially lower adjusted odds of having dental caries than those who had never received BF. In addition, the association of BF and dental caries was more prominent among extremely poor families (OR = 0.05, 95% CI 0.01–0.28).ConclusionsAlthough initial enrolment in the BFP predicted low dental caries among five-year-old children, the prevalence of dental caries in this population is still high, thus, public health programs should target BF children’s oral health. An ongoing effort should be made to reduce oral health inequalities among children in Brazil.

Self-perceived oral health among the elderly: a household-based study

Objetivo: investigar a aupercepcao da saude bucal de idosos e sua relacao com medidas de autocuidado, uso de proteses e de servicos odontologicos, assim como queixas odontologicas e o impacto na vida cotidiana. Metodo: Estudo transversal analitico, de abordagem quantitativa, realizado em Fortaleza CE, baseado numa amostra de 95 idosos com 60 anos ou mais de idade, capacitados mentalmente conforme avaliacao pelo Miniexame de Estado Mental. Os parâmetros do estudo incluiram: sexo, grupo etario, raca, escolaridade, renda familiar, praticas de autocuidado, uso e necessidade de proteses, queixas odontologicas, impacto na vida cotidiana, acesso a servicos odontologicos e acesso a informacao. O parâmetro de desfecho foi a autopercepcao em saude bucal. Para testar a associacao entre os parâmetros do estudo e o parâmetro de desfecho calculou-se a razao de prevalencia e aplicaram-se os Testes qui-quadrado, exato de Fisher e Mann-Whitney, alem de regressao multivariadal. Resultado: A autopercecao de saude bucal otima/boa foi mais frequente entre mulheres que homens (p=0,044). A saude bucal tinha um impacto negativo sobre a vida cotidiana em quase um terco dos sujeitos (n=29; 30,5%). O numero mediano dos parâmetros queixas odontologicas e impacto na vida cotidiana foram significantemente menores em sujeitos com autopercepcao otima/boa do que em sujeitos com autopercepcao regular/ruim. Conclusao: Espera-se que os resultados deste estudo possam fortalecer a atencao odontologica em idosos, de modo que se possam manter as condicoes de saude bucal necessarias para que estes possam viver essa etapa da vida com qualidade.