Cláudia Helena Soares de Morais Freitas

Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde

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 countrys 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).

Perdas dentárias no Brasil: análise da Pesquisa Nacional de Saúde Bucal 2010

OBJECTIVE To estimate the mean number of missing teeth, lack of functional dentition and total tooth loss (edentulism) among adolescents, adults and the elderly in Brazil, comparing the results with those of 2003. METHODS Data from 5,445 adolescents aged 15-19, 9,779 adults aged 35-44 and 7,619 elderly individuals aged 65-74, participants in the Brazilian Oral Health Survey (SBBrasil) 2010, were analyzed. The mean missing teeth, proportion of lack of functional dentition (< 21 natural teeth) and proportion of edentulism (total tooth loss) were estimated for each age group, each state Capital and each macro region. Multivariable logistic regression (tooth loss) and Poisson (absence of functional dentition and edentulism) analyses were performed in order to identify socioeconomic factors and demographic characteristics associated with each outcome. RESULTS The prevalence of tooth loss among adolescents was 17.4% (38.9% in 2002-03) ranging from 8.1% among those earning higher income to almost 30% among those with less schooling. Among adolescents, females, those with black or brown skin and those with the lowest levels of income and schooling had a higher prevalence of tooth loss. Lack of functional dentition affected nearly ¼ of adults, it was higher among women, among those with black and brown skin and among those with the lowest levels of income and schooling. Mean missing teeth in adults decreased from 13.5 in 2002-03 to 7.4 in 2010. More than half of elderly is edentulous (similar to the 2002-03 findings); higher prevalence of edentulism was found among women and those with the lowest levels of income and schooling. Among adolescents the mean missing teeth ranged from 0.1 (in Curitiba, South Brazil and Vitória, Southeast Brazil) to 1.2 (in the North countryside). Among adults the lowest mean missing teeth was found in Vitória (4.2) and the highest in Rio Branco, North Brazil (13.6). CONCLUSIONS A remarkable reduction in tooth loss among adolescents and adults was identified between 2010 and 2003. Among the elderly, tooth loss figure remained the same. In spite of important achievements in tooth loss figures, social and regional inequalities persist.OBJETIVO: Analisar a perda dentaria com base em estimativas do numero medio de dentes perdidos, prevalencia de ausencia de denticao funcional e edentulismo em adolescentes, adultos e idosos brasileiros, comparando-a com resultados de 2003. METODOS: Os dados referem-se a Pesquisa Nacional de Saude Bucal (SBBrasil 2010): adolescentes de 15 a 19 anos (n = 5.445), adultos entre 35 e 44 anos (n = 9.779) e idosos entre 65 e 74 anos (n = 7.619). O numero de dentes perdidos, a prevalencia de individuos sem denticao funcional (< 21 dentes naturais) e de edentulismo (perda total dos dentes) foram estimados para cada grupo etario, capitais e macrorregioes brasileiras. Foram realizadas analises de regressao logistica (perdas dentarias) e de Poisson (ausencia de denticao funcional e edentulismo) multivariaveis para identificar fatores socioeconomicos e demograficos associados a cada desfecho. RESULTADOS: A prevalencia de perdas dentarias entre adolescentes foi de 17,4% (38,9% em 2002-3), variando de 8,1% entre os estratos de maior renda a quase 30% entre os menos escolarizados. Entre adolescentes, as mulheres, pardos e pretos, os de menor renda e escolaridade apresentaram maiores prevalencias de perdas. Ausencia de denticao funcional ocorreu em aproximadamente ¼ dos adultos, sendo superior nas mulheres, nos pretos e pardos, nos de menor renda e escolaridade. A media de dentes perdidos em adultos declinou de 13,5 em 2002-3 para 7,4 em 2010. Mais da metade da populacao idosa e edentula (similar em 2002-3); maiores prevalencias de edentulismo em idosos foram observadas em mulheres, nos de menores renda e escolaridade. A media de dentes perdidos em adolescentes variou de 0,1 (Curitiba e Vitoria) a 1,2 (interior da regiao Norte). Entre adultos, a menor media encontrada foi 4,2 (Vitoria) e a maior 13,6 (Rio Branco). CONCLUSOES: Houve importante reducao nas perdas dentarias em adolescentes e adultos em comparacao com dados de 2003, mas nao entre os idosos. As perdas dentarias apresentam marcadas desigualdades sociais e regionais.

Tooth loss in Brazil: analysis of the 2010 Brazilian Oral Health Survey

OBJECTIVE To estimate the mean number of missing teeth, lack of functional dentition and total tooth loss (edentulism) among adolescents, adults and the elderly in Brazil, comparing the results with those of 2003. METHODS Data from 5,445 adolescents aged 15-19, 9,779 adults aged 35-44 and 7,619 elderly individuals aged 65-74, participants in the Brazilian Oral Health Survey (SBBrasil) 2010, were analyzed. The mean missing teeth, proportion of lack of functional dentition (< 21 natural teeth) and proportion of edentulism (total tooth loss) were estimated for each age group, each state Capital and each macro region. Multivariable logistic regression (tooth loss) and Poisson (absence of functional dentition and edentulism) analyses were performed in order to identify socioeconomic factors and demographic characteristics associated with each outcome. RESULTS The prevalence of tooth loss among adolescents was 17.4% (38.9% in 2002-03) ranging from 8.1% among those earning higher income to almost 30% among those with less schooling. Among adolescents, females, those with black or brown skin and those with the lowest levels of income and schooling had a higher prevalence of tooth loss. Lack of functional dentition affected nearly ¼ of adults, it was higher among women, among those with black and brown skin and among those with the lowest levels of income and schooling. Mean missing teeth in adults decreased from 13.5 in 2002-03 to 7.4 in 2010. More than half of elderly is edentulous (similar to the 2002-03 findings); higher prevalence of edentulism was found among women and those with the lowest levels of income and schooling. Among adolescents the mean missing teeth ranged from 0.1 (in Curitiba, South Brazil and Vitória, Southeast Brazil) to 1.2 (in the North countryside). Among adults the lowest mean missing teeth was found in Vitória (4.2) and the highest in Rio Branco, North Brazil (13.6). CONCLUSIONS A remarkable reduction in tooth loss among adolescents and adults was identified between 2010 and 2003. Among the elderly, tooth loss figure remained the same. In spite of important achievements in tooth loss figures, social and regional inequalities persist.OBJETIVO: Analisar a perda dentaria com base em estimativas do numero medio de dentes perdidos, prevalencia de ausencia de denticao funcional e edentulismo em adolescentes, adultos e idosos brasileiros, comparando-a com resultados de 2003. METODOS: Os dados referem-se a Pesquisa Nacional de Saude Bucal (SBBrasil 2010): adolescentes de 15 a 19 anos (n = 5.445), adultos entre 35 e 44 anos (n = 9.779) e idosos entre 65 e 74 anos (n = 7.619). O numero de dentes perdidos, a prevalencia de individuos sem denticao funcional (< 21 dentes naturais) e de edentulismo (perda total dos dentes) foram estimados para cada grupo etario, capitais e macrorregioes brasileiras. Foram realizadas analises de regressao logistica (perdas dentarias) e de Poisson (ausencia de denticao funcional e edentulismo) multivariaveis para identificar fatores socioeconomicos e demograficos associados a cada desfecho. RESULTADOS: A prevalencia de perdas dentarias entre adolescentes foi de 17,4% (38,9% em 2002-3), variando de 8,1% entre os estratos de maior renda a quase 30% entre os menos escolarizados. Entre adolescentes, as mulheres, pardos e pretos, os de menor renda e escolaridade apresentaram maiores prevalencias de perdas. Ausencia de denticao funcional ocorreu em aproximadamente ¼ dos adultos, sendo superior nas mulheres, nos pretos e pardos, nos de menor renda e escolaridade. A media de dentes perdidos em adultos declinou de 13,5 em 2002-3 para 7,4 em 2010. Mais da metade da populacao idosa e edentula (similar em 2002-3); maiores prevalencias de edentulismo em idosos foram observadas em mulheres, nos de menores renda e escolaridade. A media de dentes perdidos em adolescentes variou de 0,1 (Curitiba e Vitoria) a 1,2 (interior da regiao Norte). Entre adultos, a menor media encontrada foi 4,2 (Vitoria) e a maior 13,6 (Rio Branco). CONCLUSOES: Houve importante reducao nas perdas dentarias em adolescentes e adultos em comparacao com dados de 2003, mas nao entre os idosos. As perdas dentarias apresentam marcadas desigualdades sociais e regionais.

Dental caries and treatment needs among indigenous people of the Potiguara Indian reservation in Brazil

OBJECTIVE The aim of this study was to assess the caries prevalence and treatment needs of Brazilian indigenous residents on an Indian reservation. METHODS This cross-sectional study comprised 1 461 individuals of ages 18-36 months and 5, 12, 15-19, 35-44, and 65-74 years living in the Potiguara Indian villages of Brazil. Decayed, missing, or filled permanent teeth (DMFT) and deciduous teeth (dmft) were determined by calibrated examiners using the methodology recommended by the World Health Organization. Treatment needs were assessed with the guidelines of the 2003 Brazilian Oral Health Survey. RESULTS Means + or - standard deviations (SD) for dmft of 18- to 36-month-old and 5-year-old children were 2.5 + or - 3.7 and 5.8 + or - 4.3, respectively. For the age groups 12, 15-19, 35-44, and 65-74 years, mean + or - SD values of DMFT were 3.6 + or - 3.1, 7.1 + or - 4.9, 16.4 + or - 7.5, and 22.8 + or - 8.6. The mean + or - SD number of deciduous teeth requiring treatment varied from 2.4 + or - 3.5 to 5.0 + or - 4.0 in the 18- to 36-month and 5-year-old age groups, respectively. Among adolescents and adults, it was observed that on average at least three permanent teeth required dental treatment such as fillings, crowns, endodontic treatment, and extractions. CONCLUSIONS High prevalence of caries and many teeth needing treatment were observed in all age groups of the Potiguara Indians.

Dilemas no exercício profissional da Odontologia: a autonomia em questão

El estudio busco comprender la dinamica y los cambios que afectan la profesion del odontologo, a partir de la categoria de la autonomia profesional y sus significados para el discurso profesional y las estrategias que se utilizan para mantener la autonomia profesional. Los pensamientos son fundamentados en la sociologia de las profesiones, sus conceptos de la autonomia, expertise e ideal de servicio. La investigacion revelo que la autonomia profesional sigue siendo un fuerte elemento para la identidad del grupo, no se ha alterado a pesar de los cambios observados en el mercado de trabajo.The study aimed to arrive at an understanding of th e dynamics and the changes faced by dentistry, using the professional autonomy category and its si gnificance to professional discourse and the strategies that are used to preserve professional a utonomy. The reflections are based on the sociology of professions, particularly the concepts of autono my, expertise and service ideal. The research revealed that professional autonomy is still a stro ng element with an important role to play in shapin g the identity of the group and that autonomy has not been affected in spite of changes in the labor mark et.O estudo buscou compreender a dinâmica e as mudancas que atingem a profissao de dentista, com base na categoria autonomia profissional e seus significados no discurso da profissao, e que estrategias sao utilizadas para preservar a autonomia profissional. As reflexoes sao fundamentadas na sociologia das profissoes, particularmente nos conceitos de autonomia, expertise e ideal de servico. A pesquisa revelou que a autonomia profissional continua a ser um forte elemento que conforma a identidade do grupo, nao estando abalada, apesar das mudancas do mercado de trabalho.

Sucrose concentration and pH in liquid oral pediatric medicines of long-term use for children

OBJECTIVES To determine the pH and sucrose concentrations (SC) of pediatric liquid drugs of long-term use by children in order to evaluate the potential risk for dental caries and dental erosion. METHODS After assessing the pH, we analyzed 71 aqueous medicine samples for sucrose by the Lane-Eynon general volumetric method. The pH and SC values (mean +/- standard deviation (SD) were calculated according to therapeutic action. RESULTS The highest and the lowest SC values (mean +/- SD) were found in respiratory (37.75% +/- 17.23%) and endocrine drugs (11.97% +/- 15.16%) (p < 0.01). The values for medicines prescribed for daily ingestion were 47.15% +/- 9.57%, whereas for twice daily and three or four times a day, these numbers were 24.42% +/- 18.03% and 34.43% +/- 14.83%, respectively (p < 0.01). The SC (mean +/- SD)) values were higher in syrups (36.32% +/- 17.62%) than in other formulations (p > 0.05). The overall pH (mean +/- SD) was 5.89 +/- 2.02 (range 2.3 +/- 0.01 to 10.6 +/- 0.02). In products with acidic pH, the SC (mean +/- SD) was significantly lower (22.14% +/- 15.72%) than in nonacidic medicines (39.22% +/- 15.82%) (p < 0.001). CONCLUSIONS It can be concluded that the pediatric medicines studied have a high SC and low pH, which vary according to therapeutic class, daily dose, and brand. Caution about dental caries, dental erosion, and systemic diseases such as diabetes mellitus is warranted when these medicines are ingested frequently.

Reflexões metodológicas sobre prevalência da fluorose dentária nos inquéritos de saúde bucal

OBJECTIVE To analyze the limitations of studying dental fluorosis in cross-sectional studies. METHODS Data from the Oral Health of the Brazilian Population (SBBrasil 2003) and the Brazilian Oral Health Survey (SBBrasil 2010) were used. Epidemiological trends for fluorosis in 12-year-old Brazilians, aspects of the reliability of the data as well as the accuracy of the estimates are assessed for these two studies. The distribution of prevalence of fluorosis was carried out according to the domains of the study (state capitals and regions) and the year in which the study took place. The confidence intervals (95%CI) were also shown for simple prevalence (without taking into account level of severity). RESULTS The prevalence of dental fluorosis showed considerable variation, between 0% and 61% in 2003 and 0% and 59% in 2010. Inconsistencies were observed in the data in individual terms (for year and for domain) and in the behavior of the trend. Considering the expected prevalence and the data available in the two studies, the minimum sample size should be 1,500 individuals in order to obtain 3.4% and 6.6% confidence intervals, considering the minimum coefficient of variation to be 15%. Given the subjectivity in its classification, examinations for dental fluorosis may show more variation than those for other oral health conditions. The power to establish differences between the domains of the study with the sample of the SBBrasil 2010 is quite limited. CONCLUSIONS Based on the 2003 and 2010 studies, it was not possible to analyze patterns of dental fluorosis in Brazil; these data are merely exploratory indicators of the prevalence of dental fluorosis. It was impossible to make comparisons due to different analysis models being used in the two surveys. Investigating dental fluorosis in population-based surveys is not even an economically viable technique, using localized epidemiological studies with a sampling plan would be more suitable [corrected].OBJETIVO: Analisar limitacoes do estudo de fluorose dentaria em inqueritos transversais. METODOS: Foram utilizados dados dos estudos Condicoes de Saude Bucal da Populacao Brasileira (SBBrasil 2003) e da Pesquisa Nacional de Saude Bucal (SBBrasil 2010). A estimativa de tendencia epidemiologica da fluorose na populacao de 12 anos, aspectos da confiabilidade dos dados, bem como a precisao das estimativas, foram avaliadas nessas duas pesquisas. A distribuicao da prevalencia de fluorose foi feita segundo os dominios de estudo (capitais e regioes) e o ano estudado. Foram expressos tambem os intervalos de confianca (IC95%) para a prevalencia simples (sem considerar os estagios de gravidade). RESULTADOS: A prevalencia da fluorose dentaria apresentou uma variacao consideravel, de 0% a 61% em 2003 e de 0% e 59% em 2010. Foram observadas inconsistencias nos dados em termos individuais (por ano e por dominio) e no comportamento da tendencia. Considerando a expectativa de prevalencia e os dados disponiveis nas duas pesquisas, o tamanho minimo da amostra deveria ser de 1.500 individuos para se obterem intervalos de 3,4% e 6,6% de confianca, considerando um coeficiente de variacao minimo de 15%. Dada a subjetividade na natureza de sua classificacao, exames de fluorose dentaria podem apresentar mais variacao do que aqueles realizados para outras condicoes de saude bucal. O poder para estabelecer diferencas entre os dominios do estudo com a amostra do SBBrasil 2010 e bastante limitado. CONCLUSOES: Nao foi possivel analisar a tendencia da fluorose dentaria no Brasil com base nos estudos de 2003 e 2010; esses dados sao apenas indicadores exploratorios da prevalencia de fluorose. A comparacao fica impossibilitada pelo fato de terem sido utilizados modelos de analise diferentes nos dois inqueritos. A investigacao da fluorose dentaria em inqueritos de base populacional nao e viavel tecnica nem economicamente, a realizacao de estudos epidemiologicos localizados com plano amostral e mais adequada.

Conflicts in the practice of Dentistry: the autonomy in question

El estudio busco comprender la dinamica y los cambios que afectan la profesion del odontologo, a partir de la categoria de la autonomia profesional y sus significados para el discurso profesional y las estrategias que se utilizan para mantener la autonomia profesional. Los pensamientos son fundamentados en la sociologia de las profesiones, sus conceptos de la autonomia, expertise e ideal de servicio. La investigacion revelo que la autonomia profesional sigue siendo un fuerte elemento para la identidad del grupo, no se ha alterado a pesar de los cambios observados en el mercado de trabajo.The study aimed to arrive at an understanding of th e dynamics and the changes faced by dentistry, using the professional autonomy category and its si gnificance to professional discourse and the strategies that are used to preserve professional a utonomy. The reflections are based on the sociology of professions, particularly the concepts of autono my, expertise and service ideal. The research revealed that professional autonomy is still a stro ng element with an important role to play in shapin g the identity of the group and that autonomy has not been affected in spite of changes in the labor mark et.O estudo buscou compreender a dinâmica e as mudancas que atingem a profissao de dentista, com base na categoria autonomia profissional e seus significados no discurso da profissao, e que estrategias sao utilizadas para preservar a autonomia profissional. As reflexoes sao fundamentadas na sociologia das profissoes, particularmente nos conceitos de autonomia, expertise e ideal de servico. A pesquisa revelou que a autonomia profissional continua a ser um forte elemento que conforma a identidade do grupo, nao estando abalada, apesar das mudancas do mercado de trabalho.

O PET-Saúde da Família e a formação de profissionais da saúde: a percepção de estudantes

Trata-se de estudo com abordagem qualitativa, cujo objetivo foi analisar a contribuicao do Programa de Educacao pelo Trabalho para a Saude (PET– Saude da Familia) para a formacao dos futuros profissionais de saude de uma universidade publica do Nordeste do Brasil. Foram utilizados dados secundarios do instrumento de avaliacao semestral do programa, respondido por 67 estudantes dos cursos de: Educacao Fisica, Enfermagem, Fisioterapia, Medicina, Nutricao e Odontologia. Os resultados foram sistematizados em duas categorias de analise: o trabalho interprofissional e a integracao ensino-servico. O estudo evidenciou: a importância do trabalho interprofissional e colaborativo, a integracao ensino-servico-comunidade, e a reflexao das praticas impulsionadas pelo PET-Saude da Familia para a mudanca no processo formativo em saude. Estrategias como essa sao essenciais para a formacao e o aperfeicoamento de profissionais para o Sistema Unico de Saude (SUS).

Saúde Bucal Infantil: Conhecimento e Interesse de Pais e Responsáveis

Objecti ves: To evaluate the knowledge of the parents/ caregivers about the oral health of children treated at the Clinic of Cariology of the Center of Healt...