Jaqueline Vilela Bulgareli

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.

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.

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.

A resolutividade em saude bucal na atencao basica como instrumento para avaliacao dos modelos de atencao

This study sought to evaluate which health system - either the Family Health Strategy (FHS) or the traditional model established in the Basic Health Units (BHU) - was more effective during the period between 2007 and 2009 in relation to the oral health needs of the population of the city of Marilia in the state of Sao Paulo. It involved a retrospective ecological study with a stratified random sample of 50% of the universe of the study area for the 12 BHU and 37% of the 29 Family Health Units (FHU) in the municipality, whereby 6 BHU and 11 FHS were randomly selected. The data collected for observation were gathered through the management reports of the SIAB and Oral Health Assessment Report information systems. Exploratory data analysis and the Student t test were performed in order to analyze the resolubility of different systems of health care. It was observed that the coefficients relating to Initial Dental Treatment were not statistically different, though with respect to the Completed Initial Treatment coefficient for the population greater than two years the values were 16.74 for the FHS model and 6.93 for the BHU model, with a statistically significant difference of 40.97% resolubility for the BHU in relation to 83.56% for the FHS (p < 0.05).

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.

Variables associated with the oral impact on daily performance of adults in the state of São Paulo: A population-based study

Objective: This study aimed to assess the oral impact on daily performance and its association with sociodemographic characteristics, tooth pain, need for prosthesis, and periodontal disease of adults in the state of São Paulo, Brazil. Methods: This was a cross-sectional epidemiological study with secondary data obtained from the Oral Health Conditions Project– 2015 conducted in 163 municipalities in the state of São Paulo with the participation of 17,560 individuals. This study evaluated adults in the age-range between 35–44 years (n = 5,855), selected by means of probabilistic cluster sampling in two stages. The outcome variable was the OIDP (Oral Impacts on Daily Performances), obtained by using this instrument to assess daily activities (eating, speaking, oral hygiene, relaxation, sports practice, smile, study/work, social contact, and sleep). The independent variables were collected and grouped into three blocks: Block 1 (sex, age group, and ethnic group); Block 2 (household income and education); and Block 3 (tooth pain, need for prosthesis, bleeding, calculus, and periodontal pockets). A hierarchical multiple logistic regression analysis was performed considering the complex cluster sampling plan. Each observation was assigned a specific weight, depending on the location, which resulted in weighted frequencies adjusted for the effect of outlining. Results: the female sex (p<0.0001), ethnic group black/mulatto (p<0.0001), low household income (p = 0.0112), up to 8 years of education (p<0.0001), tooth pain (p<0.0001), presence of bleeding (p<0.0001), and presence of periodontal pockets (p<0.0001) had greater oral impact on daily performance. Conclusion: sociodemographic characteristics, tooth pain, and presence of periodontal disease were associated with oral impact on daily performance of the adult population in the state of São Paulo, Brazil.

Influence of scheduling in clinical dental care on indicators of oral health

Objective: Assess the oral health indicators in the Family Health Units (Unidades de Saude da Familia - USFs) with scheduled demand in comparison with Family Health Units with spontaneous demand in oral health care, in Piracicaba.Methods: 10 Family Health Units located in Piracicaba, were randomly chosen: 5 Units with spontaneous demand and 5 Units with scheduled demand. Secondary data in daily production spreadsheets were collected from the information system, from February to September 2013. These were organized into indicators: 1) access; 2) resolutivity; 3) ratio of dental emergency per inhabitant; 4) mean number of individual preventive and curative dental procedures; 5) ratio of dental extraction per dental procedure; 6) ratio of dental extraction per inhabitant; 7) mean number of supervised toothbrushing sessions. Data were compared and statistically analyzed with the BioStat 5.0 program, by applying the Students-t test (p ≤ 0.05).Results: There were significant differences in the indicators of dental emergency, dental extraction per clinical procedure, and dental extractions per inhabitant, and these values were higher in Family Health Units with spontaneous demand.Conclusion: The model of scheduling the demand for dental care adopted by the USFs interferes in the number of users seeking dental emergency treatments and reasons for extractions.

Estudo qualitativo sobre as justificativas de adolescentes para a não adesão ao tratamento odontológico

The study aimed to reflect on adolescents’ speeches regarding their justifications for non-adherence to dental treatment. This is a qualitative research derived from a quantitative research aimed at adolescents from 15 to 19 years of public schools belonging to the area of 34 Primary Health Units – Family Health, in Piracicaba, SP, in 2012. The adolescents were evaluated, diagnosed and referred for dental treatment. One year after this intervention and with non-adherence to treatment, we used a qualitative method to deeply understand this phenomenon. We conducted 25 interviews with a semi-structured script, divided into three blocks: adopted or did not adopt actions recommended; arguments justifying the non-adherence of recommended actions; dimensions related to oral health importance. We adopted the thematic analysis and non-adherence was related to some aspects and grouped in: no priority; priority and change of priority. We concluded that the main reasons for non-adherence are related to different priorities, and orthodontic brace was a potent stimulator of interest and establishment of priorities in oral health care among adolescents.