Flávia Christiane de Azevedo Machado

Factors related to the performance of Specialized Dental Care Centers

The Specialized Dental Care Centers (SDCC) have the mission to expand access to public medium complexity dental care and support the primary health care actions at this level of complexity. However, it is necessary to ensure the quality of services and to evaluate such services continuously to identify weaknesses and strengths that support the processes of leadership/management. Nevertheless, there is a dearth of studies on the assessment of oral health in specialized care that may indicate which factors should be investigated. Therefore, this integrated literature review sought to explore the plethora of publications on the evaluation of SDCC in the LILACS and MEDLINE data bases in October 2013 to identify factors possibly related to the performance of such health services. Thus, 13 references were included in this review pointing to forms of organization and management of work processes related to the creation of healthcare networks (operation of regulation centers and setting up of health consortiums). They include the contextual characteristics of the places where SDCCs are located (population size, Family Health Strategy coverage, Municipal Human Development Index, governance, governing capacity) were factors that influenced the SDCCs performance.

Qualidade técnica e satisfação relacionadas às próteses totais

A perda dentaria e muito prevalente no Brasil, sobretudo entre idosos, onde mais de 3 milhoes precisam de protese total bimaxilar. Para mudar este quadro, o governo Federal instituiu os Centros de Especialidades Odontologicas (CEO). Assim, este estudo avaliou uma das atribuicoes desses Centros, a provisao de proteses totais convencionais (PTC) sob a otica da qualidade e satisfacao relacionadas a este produto. Para tanto, fez-se um estudo seccional com 149 individuos reabilitados em CEO do Rio Grande do Norte com tais proteses entre 2007 a 2009. Os dados foram obtidos por questionario e exame clinico da PTC quanto a sua retencao, estabilidade, estetica e fixacao. Das 233 PTC avaliadas; 52,7% das superiores e 9,5% das inferiores foram tecnicamente satisfatorias. Contudo, 69,1% (n = 103) dos entrevistados relataram satisfacao com suas proteses. Quanto a associacao entre qualidade tecnica e satisfacao, o teste Qui-quadrado indicou que PTC superiores tecnicamente adequadas (p = 0,041), sobretudo quanto a retencao (p = 0,002) e estabilidade (p = 0,000), estavam associados a satisfacao positiva do usuario. Assim, as proteses satisfizeram a populacao assistida, apesar dos deficits tecnicos. No entanto, essa satisfacao pode advir da reabilitacao em si e nao de sua funcionalidade.

Technical quality and satisfaction related to full conventional dentures

Tooth loss is highly prevalent in Brazil, especially among the elderly, where more than three million need bimaxillary dentures. The federal government instituted Specialized Dental Care Centers (SDCC) to remedy this situation. The scope of this study was to evaluate one attribute of these Centers, namely the provision of full conventional dentures (FCD) from the perspective of quality and satisfaction related to this product. A cross-sectional study was conducted with 149 individuals fitted with such dentures in SDCC of Rio Grande do Norte between 2007 and 2009. Data were obtained by questionnaire and clinical examination of FCD regarding its retention, stability, aesthetics, and fixation. From the 233 dentures evaluated, 52.7% of upper FCD and 9.5% of lower FCD were technically satisfactory. With respect to the association between technical quality and satisfaction, the chi-square test indicated that upper FCDs were technically adequate (p = 0.041), particularly in terms of retention (p = 0.002) and stability (p = 0.000) and were associated with patient satisfaction. Thus, the FCD satisfied the users, despite the technical defects. However, this satisfaction may come from the fitting itself rather than its functionality.

Dificuldades diárias associadas às próteses totais

The effectiveness of health services can be evaluated from the quality of life (QOL) standpoint. Thus, this study evaluated rehabilitation services using full conventional dentures (FCD) of Specialized Dental Care Centers (SDCC) in Rio Grande do Norte (RN) regarding daily difficulties associated with these dentures made between 2007 and 2009. A cross-sectional study was conducted with 138 users of these FCD, collecting data by clinical examination and a questionnaire based on the Oral Impacts on Daily Performances index. The Fisher and chi-square tests were used to test the association between the variables. The result was that 42% of users reported difficulties in executing oral activities due to FCDs. These difficulties were more frequent and intense in the activities of eating, speaking and smiling. In general, 58.7% of users did not have functional teeth. In relation to the clinical evaluation of FCDs, 57.2% of upper and 9.2% of lower FCDs were satisfactory. There was an association between difficulty and the absence of functional teeth, but not with inadequate FCDs. Thus, the SDCCs were effective in upper FCD rehabilitation, since the difficulties encountered are within the standard limitations of this type of rehabilitation. On the other hand, the cost-benefit of rehabilitation of lower FCDs must be evaluated.

As desigualdades sociais e a saúde bucal nas capitais brasileiras

Despite the improvement of the lives of Brazilians, still persists a panorama of iniquities in health in Brazil. This ecological study evaluated the relationship of socioeconomic conditions and public health policy with oral health conditions in Brazilian capitals. Factor analysis was performed with the socioeconomic indicators, revealing two common factors: economic deprivation and socio-sanitary condition. Then, was executed multiple linear regression analysis for the oral health indicators (average DMFT 12 years, mean missing teeth and rate of decay of free population) with two factors in common and fluoridation of water supply. Multiple linear regression analysis to the DMFT of the capitals was estimated by the socio-sanitary conditions and fluoridation, adjusted by economic deprivation; whereas the model for the average missing teeth was estimated only for flu-oridation and economic deprivation, and finally, the model for the rate of caries-free population in the Brazilian capitals was estimated by economic and sociosanitary condition set by fluoridated water supplies. Therefore, the results indicate the need for social actions that impact on peoples living conditions to reduce tooth decay.Despite the improvement of the lives of Brazilians, still persists a panorama of iniquities in health in Brazil. This ecological study evaluated the relationship of socioeconomic conditions and public health policy with oral health conditions in Brazilian capitals. Factor analysis was performed with the socioeconomic indicators, revealing two common factors: economic deprivation and socio-sanitary condition. Then, was executed multiple linear regression analysis for the oral health indicators (average DMFT 12 years, mean missing teeth and rate of decay of free population) with two factors in common and fluoridation of water supply. Multiple linear regression analysis to the DMFT of the capitals was estimated by the socio-sanitary conditions and fluoridation, adjusted by economic deprivation; whereas the model for the average missing teeth was estimated only for flu-oridation and economic deprivation, and finally, the model for the rate of caries-free population in the Brazilian capitals was estimated by economic and sociosanitary condition set by fluoridated water supplies. Therefore, the results indicate the need for social actions that impact on peoples living conditions to reduce tooth decay.

Proposição de indicadores para vigilância da saúde bucal de adolescentes

The existence of a few indicators that could guide the evaluation of oral health surveillance in the primary health care attention, mainly in adolescence life cycle, raised the realization of this study. To develop indicators to this end, it was conducted: document analysis to guide the development of a logic model and selection of data to compose indicators. This selection and validation of the logic model were performed by a group of four experts that, from the perspective of the modified Delphi method, analyzed if the model illustrated the activities, results and expected impact of a primary oral health service to enable the adolescents oral health surveillance and assigned points (0-10) to each data proposed. Then, those data judged important by the consensus of experts (média≥7; standard deviation <3) were used to construct indicators. After individual analysis and group discussions, the logical model and 36 of the 48 data, initially proposed, were consensually important, resulting in 26 indicators. The indicators matrix intends to be a situational diagnostic tool to assess, plan and manage health actions to adolescents, but it can be used in other life cycles by its adaptation.Resumo A existencia de poucos indicadores que pudessem orientar a avaliacao das acoes de vigilância a saude bucal da atencao basica em nivel local, sobretudo no ciclo da adolescencia, suscitou a realizacao deste estudo. Para desenvolver indicadores com este fim, procedeu-se: analise documental para guiar a elaboracao de um modelo logico e selecao de dados para compor indicadores. Esta selecao e validacao do modelo realizaram-se por um grupo de quatro experts que, sob a otica do metodo Delfos modificado, analisaram se o modelo ilustrava as atividades, os resultados e os impactos esperados de um servico primario de saude bucal para efetivar a vigilância da saude do adolescente e atribuiram pontos (0-10) a cada dado proposto de modo que os consensualmente importantes (media ≥ 7; desvio-padrao < 3) orientassem a construcao de indicadores. Apos analise individual e discussoes em grupo, o modelo logico e 36 dos 48 dados inicialmente propostos foram consensualmente importantes, resultando em 26 indicadores. A matriz de indicadores pretende constituir-se em ferramenta de diagnostico situacional para avaliar, planejar e gerenciar acoes em saude voltadas aos adolescentes, mas que com adaptacao podera englobar outros ciclos de vida.

Avaliação da Qualidade dos Tratamentos Endodônticos em Centros de Especialidades Odontológicas da Grande Natal-RN

Resumen pt: Objetivo: Avaliar a qualidade tecnica dos tratamentos endodonticos realizados em Centros de Especialidades Odontologicas (CEOs) da Grande Natal/RN no per...