Fabiana de Lima Vazquez

Association of breastfeeding, pacifier use, breathing pattern and malocclusions in preschoolers

OBJECTIVE To evaluate the association of breastfeeding duration, pacifier use and nasal air flow with occlusal disorders among children. METHODS This cross-sectional observational study included 138 children aged 4 and 5 years selected in all the daycare centers of the city of Campo Limpo Paulista, Brazil. Questionnaires were applied to mothers to identify total duration of exclusive breastfeeding and non-nutritive sucking. The independent variables were: Sucking (pacifier, bottle, finger), breastfeeding duration and nasal air flow. The dependent variables were: Open bite, crossbite, overjet, overbite, diastema and maxillary deficiency. Frequency distribution calculations were performed, a chi-square test, the Fisher exact test and, after that, stepwise logistic regression were used for statistical analysis, and the level of significance was set at 5%. RESULTS The use of a pacifier was the most deleterious factor and increased chances of having open bite in 33.3 times, marked overjet in 2.77 times and posterior crossbite in 5.26 times. CONCLUSION There was a significant association between non-nutritive sucking, particularly the use of a pacifier, and occlusal disorders. These findings are important to plan the treatment of preschoolers.

Individual and contextual factors related to dental caries in underprivileged Brazilian adolescents

BackgroundInvestigate the individual and contextual variables related to caries in underprivileged adolescents, and the disparity in distribution of the disease.MethodsCross-sectional analytical study, conducted in the city of Piracicaba, SP, Brazil, in 2012. The probabilistic sample was composed of 1,179 adolescents from 15–19 years of age, randomly selected from 21 state schools and 34 Primary Health Units – Family Health (PHU-FH). The dependent variables studied were number of decayed teeth and caries experience (DMFT). The independent variables were classified into individual (clinical, sociodemographic, psychosocial, self-perception, impact on oral health, access to services, and quality of life) and contextual (social exclusion index, total number of residents in suburb, literacy rate, and the following variables given in percentages: residences in the home ownership category, provision of domestic sewerage, trash collection, families with income of over 1 minimum wage per month, and families without monthly income) variables. The multilevel regression model was estimated by the PROC GLIMMIX (Generalized Linear Models-Mixed) procedure, considering the individual variables as Level 1 and the contextual variables of the suburbs as Level 2. Adjustment of the model was evaluated by -2 Res Log Likelihood with α = 0.05.ResultsAs regards the individual variables, adolescents who declared having a prison inmate in the Family and resided in homes with a larger number of persons, showed a higher number of decayed teeth. There were a larger number of decayed teeth, a higher DMFT value, and worse self-perception as regards the health of their teeth and mouth. Other variables, such as being of the female gender, age and time since last visit to the dentist were related to the DMFT index. As regards the contextual variables, the DMFT was lower in suburbs with greater access to domestic sewage, and the number of decayed teeth was higher in suburbs with the worst social exclusion indices.ConclusionIndividual and contextual variables were associated with the presence of caries and DMFT index in underprivileged adolescents, indicating that they must be taken into consideration in the formulation of policies directed towards oral health promotion and prevention activities in this group.

Referência e Contrarreferência na atenção Secundária em odontologia em Campinas, SP, Brasil

This article aims to evaluate the referencing of the demand for specialized care in oral health in Campinas in relation to the distribution of treatment and the influence of socio-economic variables in addition to the perception and information available to users in relation to counter-referencing. It is an observational exploratory study, selecting two Health Administrative Regions: one with a Center for Dental Specialties and one without, divided into two phases: 1) all referrals to secondary care were collected from all Oral Health teams as well as population and socio-economic data and distribution of referrals; 2) interview with 331 users, checking the counter-referencing, quality of service and reasons for absences or withdrawals. Regarding the counter-referencing, the majority of users who received the specialized treatments were well attended, and waited less than one month for appointment scheduling. The management model did not statistically influence access to secondary care in oral health. It was found that in a given Health Administrative Region the discrepancies were less evident and there was a correlation coefficient of demand attended with socio-economic variables, in addition to a lower percentage of non-attendance, demonstrating a greater commitment to integrity and fairness.This article aims to evaluate the referencing of the demand for specialized care in oral health in Campinas in relation to the distribution of treatment and the influence of socio-economic variables in addition to the perception and information available to users in relation to counter-referencing. It is an observational exploratory study, selecting two Health Administrative Regions: one with a Center for Dental Specialties and one without, divided into two phases: 1) all referrals to secondary care were collected from all Oral Health teams as well as population and socio-economic data and distribution of referrals; 2) interview with 331 users, checking the counter-referencing, quality of service and reasons for absences or withdrawals. Regarding the counter-referencing, the majority of users who received the specialized treatments were well attended, and waited less than one month for appointment scheduling. The management model did not statistically influence access to secondary care in oral health. It was found that in a given Health Administrative Region the discrepancies were less evident and there was a correlation coefficient of demand attended with socio-economic variables, in addition to a lower percentage of non-attendance, demonstrating a greater commitment to integrity and fairness.

Informações da atenção secundária em Odontologia para avaliação dos modelos de atenção à saúde

Introduction: secondary care may reflect the care-solving capacity of primary care, considering the principle of integrality and the construction of health care networks in the Unique System of Heatlh (USH), supporting the organization of activities and oral health services in the context of medium complexity. Objective: to evaluate models of primary care in oral health in the municipality of Marilia / SP using information related to secondary care in dentistry, according to the principle of integrity. Methodology: This is a retrospective study with a randomly selected sample of 6 Basic Health Units (BHU), characterized by the traditional model of care, and 11 Family Health Units (FHU) working with the perspective of the Family Health Model. Secondary data were collected in two places: a) Department of Evaluation, Control and Auditing, which reported the number of referrals scheduled for specialties, and b) Center for Dental Specialties (CDS) that pointed out the number of missing patients in the initial consultation and the number of patients who abandoned specialized treatment. The Department of Oral Health Coordination reported unmet demand specialty endodontics. CDS operation from 2007 to 2009 was considered for collecting data. We conducted exploratory data analysis, and Student t and Mann-Whitney tests were performed. Result: The highest number of referrals for endodontics was coming from BHU. The percentage of absense in the initial consultation, treatment dropout and care-solving capacity in the specialty showed no statistical difference in relation to the organizational model of primary care. Conclusion: We conclude that results from both organizational models are similar, except for endodontic indication for endodontic treatment, suggesting future studies, analysis of other variables mainly related to the user.

Individual and contextual factors associated with malocclusion in Brazilian children

OBJECTIVE To assess the association between the prevalence of malocclusion in Brazilian 12 years-olds with individual and contextual variables. METHODS A cross-sectional, analytical study was conducted with data from the Brazilian Oral Health Survey - SBBrazil 2010. The outcome studied was malocclusion, categorized as absent, set, severe and very severe. The independent variables were classified as individual and contextual. Data were analyzed using a multilevel model with a 5% significance level. RESULTS It was found that the prevalence of severe and very severe malocclusion in 12-year-olds did not differ between the Brazilian regions, although variation between the cities was significant (p < 0.001). Male children (p = 0.033), those on lower income (p = 0.051), those who had visited a dentist (p = 0.009), with lower levels of satisfaction with mouth and teeth (p < 0.001) and embarrassed to smile (p < 0.001) had more severe malocclusion. The characteristics of the cities also affected the severity of malocclusion; cities with more families on social benefits per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were significantly associated with malocclusion. CONCLUSION Significant associations between the presence and severity of malocclusion were observed at the individual and contextual level.OBJETIVO: Avaliar a associacao entre a prevalencia de ma oclusao em criancas aos 12 anos de idade com variaveis individuais e contextuais. METODOS: Foi realizado um estudo transversal analitico com dados da Pesquisa Nacional de Saude Bucal – SBBrasil 2010. O desfecho estudado foi a ma oclusao, categorizada em ausente, definida, severa e muito severa. As variaveis independentes foram classificadas em individuais e contextuais. Os dados foram analisados por meio de modelo multinivel, considerando nivel de 5% de significância. RESULTADOS: A prevalencia de ma oclusao severa e muito severa nas criancas com 12 anos de idade nao diferiu entre as regioes brasileiras, mas sim entre as cidades (p < 0,001). Criancas do sexo masculino (p = 0,033), de menor renda (p = 0,051), que consultaram o dentista (p = 0,009), com menor satisfacao com a boca e os dentes (p < 0,001) e com vergonha de sorrir (p < 0,001) apresentaram ma oclusao de maior gravidade. As caracteristicas das cidades tambem afetaram a gravidade da ma oclusao; cidades com mais familias com beneficio social por 1.000 habitantes, com menores notas do indice de desempenho do sistema de saude e menor renda per capita foram estatisticamente associadas com a ma oclusao. CONCLUSOES: Associacoes significativas entre a presenca e gravidade da ma oclusao foram observadas em nivel individual e contextual.

Fatores individuais e contextuais associados à má oclusão em crianças brasileiras

OBJECTIVE To assess the association between the prevalence of malocclusion in Brazilian 12 years-olds with individual and contextual variables. METHODS A cross-sectional, analytical study was conducted with data from the Brazilian Oral Health Survey - SBBrazil 2010. The outcome studied was malocclusion, categorized as absent, set, severe and very severe. The independent variables were classified as individual and contextual. Data were analyzed using a multilevel model with a 5% significance level. RESULTS It was found that the prevalence of severe and very severe malocclusion in 12-year-olds did not differ between the Brazilian regions, although variation between the cities was significant (p < 0.001). Male children (p = 0.033), those on lower income (p = 0.051), those who had visited a dentist (p = 0.009), with lower levels of satisfaction with mouth and teeth (p < 0.001) and embarrassed to smile (p < 0.001) had more severe malocclusion. The characteristics of the cities also affected the severity of malocclusion; cities with more families on social benefits per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were significantly associated with malocclusion. CONCLUSION Significant associations between the presence and severity of malocclusion were observed at the individual and contextual level.OBJETIVO: Avaliar a associacao entre a prevalencia de ma oclusao em criancas aos 12 anos de idade com variaveis individuais e contextuais. METODOS: Foi realizado um estudo transversal analitico com dados da Pesquisa Nacional de Saude Bucal – SBBrasil 2010. O desfecho estudado foi a ma oclusao, categorizada em ausente, definida, severa e muito severa. As variaveis independentes foram classificadas em individuais e contextuais. Os dados foram analisados por meio de modelo multinivel, considerando nivel de 5% de significância. RESULTADOS: A prevalencia de ma oclusao severa e muito severa nas criancas com 12 anos de idade nao diferiu entre as regioes brasileiras, mas sim entre as cidades (p < 0,001). Criancas do sexo masculino (p = 0,033), de menor renda (p = 0,051), que consultaram o dentista (p = 0,009), com menor satisfacao com a boca e os dentes (p < 0,001) e com vergonha de sorrir (p < 0,001) apresentaram ma oclusao de maior gravidade. As caracteristicas das cidades tambem afetaram a gravidade da ma oclusao; cidades com mais familias com beneficio social por 1.000 habitantes, com menores notas do indice de desempenho do sistema de saude e menor renda per capita foram estatisticamente associadas com a ma oclusao. CONCLUSOES: Associacoes significativas entre a presenca e gravidade da ma oclusao foram observadas em nivel individual e contextual.

Variables associated with the performance of Centers for Dental Specialties in Brazil

The aim of this study was to evaluate the performance of the Centers for Dental Specialties (CDS) in the country and associations with sociodemographic indicators of the municipalities, structural variables of services and primary health care organization in the years 2004-2009. The study used secondary data from procedures performed in the CDS to the specialties of periodontics, endodontics, surgery and primary care. Bivariate analysis by χ2 test was used to test the association between the dependent variable (performance of the CDS) with the independents. Then, Poisson regression analysis was performed. With regard to the overall achievement of targets, it was observed that the majority of CDS (69.25%) performance was considered poor/regular. The independent factors associated with poor/regular performance of CDS were: municipalities belonging to the Northeast, South and Southeast regions, with lower Human Development Index (HDI), lower population density, and reduced time to deployment. HDI and population density are important for the performance of the CDS in Brazil. Similarly, the peculiarities related to less populated areas as well as regional location and time of service implementation CDS should be taken into account in the planning of these services.

Variáveis de impacto na queda da mortalidade infantil no Estado de São Paulo, Brasil, no período de 1998 a 2008

This is an ecological, analytical and retrospective study comprising the 645 municipalities in the State of Sao Paulo, the scope of which was to determine the relationship between socioeconomic, demographic variables and the model of care in relation to infant mortality rates in the period from 1998 to 2008. The ratio of average annual change for each indicator per stratum coverage was calculated. Infant mortality was analyzed according to the model for repeated measures over time, adjusted for the following correction variables: the citys population, proportion of Family Health Programs (PSFs) deployed, proportion of Growth Acceleration Programs (PACs) deployed, per capita GDP and SPSRI (Sao Paulo social responsibility index). The analysis was performed by generalized linear models, considering the gamma distribution. Multiple comparisons were performed with the likelihood ratio with chi-square approximate distribution, considering a significance level of 5%. There was a decrease in infant mortality over the years (p 0.05). The proportion of PSFs deployed (p < 0.0001) and per capita GDP (p < 0.0001) were significant in the model. The decline of infant mortality in this period was influenced by the growth of per capita GDP and PSFs.This is an ecological, analytical and retrospective study comprising the 645 municipalities in the State of São Paulo, the scope of which was to determine the relationship between socioeconomic, demographic variables and the model of care in relation to infant mortality rates in the period from 1998 to 2008. The ratio of average annual change for each indicator per stratum coverage was calculated. Infant mortality was analyzed according to the model for repeated measures over time, adjusted for the following correction variables: the citys population, proportion of Family Health Programs (PSFs) deployed, proportion of Growth Acceleration Programs (PACs) deployed, per capita GDP and SPSRI (São Paulo social responsibility index). The analysis was performed by generalized linear models, considering the gamma distribution. Multiple comparisons were performed with the likelihood ratio with chi-square approximate distribution, considering a significance level of 5%. There was a decrease in infant mortality over the years (p < 0.05), with no significant difference from 2004 to 2008 (p > 0.05). The proportion of PSFs deployed (p < 0.0001) and per capita GDP (p < 0.0001) were significant in the model. The decline of infant mortality in this period was influenced by the growth of per capita GDP and PSFs.

A má oclusão e sua associação com variáveis socioeconômicas, hábitos e cuidados em crianças de cinco anos de idade

INTRODUCTION: The progressive increase in the rates of malocclusion has generated the need for knowledge of its prevalence, so that measures of health promotion and prevention can be developed. OBJECTIVE: To evaluate the association between malocclusion and socioeconomic, demographic, habits and care in five years old children. MATERIAL AND METHOD:The sample consisted of 441 children under five registered in nine family health units for eastern region of Sao Paulo city. Oral examinations were conducted and applied structured questionnaire to parents with questions about demographic characteristics, socioeconomic relating to family and home issues and habits, care and hospitalization of the child. Data analysis consisted of bivariate analysis using Chi-square test followed by multiple logistic regression model. RESULT: Malocclusion was found in 41.7% of children. Those who used a pacifier for up to 2 years were 1.24 times more likely to have malocclusion than those who did not. Children who used a pacifier for more than 2 years were 4.08 times more likely to have malocclusion than those who did not. The sleeping open-mouthed had 1.72 times more likely to have malocclusion. Allergies or bronchitis were associated to a higher chance to develop malocclusion. CONCLUSION: The malocclusion is strongly associated with harmful habits, especially the use of pacifiers, and affects similarly children of different socioeconomic levels.

Prevenção e detecção do câncer bucal: planejamento participativo como estratégia para ampliação da cobertura populacional em idosos

With respect to addressing oral cancer as a public health problem and the need to conduct early diagnosis to ensure a favorable prognosis for patients, the city of Marilia in the state of Sao Paulo stages an annual campaign for prevention and early detection of oral cancer. This study sets out to evaluate the participatory planning of the teams at health facilities, seeking to list the difficulties encountered and strategies adopted over a five-year period (2006-2011) by analyzing the coverage of oral examinations for prevention and detection of disease. Strategies for tackling difficulties, issues of epidemiological coordination and surveillance raised by dentists, generated an increase in the coverage of tests performed in the population (> 60 years) from 21% in 2006 to 62% in 2011. The conclusion is that the development of strategies with the participation of health teams produces quite encouraging results, ensuring that the lesions of oral cancer are diagnosed and treated early from the perspective of a more favorable prognosis.