José Leopoldo Ferreira Antunes

Cárie dentária no Brasil: declínio, polarização, iniqüidade e exclusão social

OBJETIVO: Analisar a evolucao da experiencia de carie dentaria entre escolares brasileiros no periodo de 1980 a 2003 e determinar a distribuicao da carie e o acesso dessa populacao ao tratamento da doenca. METODO: Foram utilizados dados secundarios produzidos no periodo de 1980 a 2003, empregando o indice dentes permanentes cariados, perdidos e restaurados (CPOD). Os estudos que deram origem aos dados variaram quanto ao tipo de investigacao, delineamento, plano amostral e criterio diagnostico para a doenca, mas produziram estimativas nacionais consideradas validas para os valores do indice CPOD, admitindo-se como possivel a presente analise de tendencia. RESULTADOS: Os valores de CPOD indicaram um nivel alto de carie dentaria nos anos 1980, declinando para um nivel moderado nos anos 1990. Em 2003, o valor do CPOD ainda era moderado (2,8). Entre 1980 e 2003, o declinio nos valores do CPOD foi de 61,7%. A porcentagem de escolares com CPOD igual a zero aumentou de 3,7% em 1986 para 31,1% em 2003. Por outro lado, enquanto no segmento menos atingido pela doenca (CPOD de 1 a 3), o indice de cuidados aumentou de 26,3% em 1986 para 34,7% em 2003, no segmento com CPOD de 4 a 5 o indice de cuidados caiu de 50,2% em 1986 para 39,3% em 2003. No segmento com CPOD de 6 ou mais, o indice de cuidados se manteve estavel (28.0%). Aproximadamente 20% da populacao passou a concentrar cerca de 60% da carga de doenca. CONCLUSAO: Um declinio relevante do CPOD foi observado no periodo do estudo, sendo a hipotese explicativa mais plausivel a elevacao no acesso a agua e creme dental fluorados e as mudancas nos programas de saude bucal coletiva. A despeito da melhora, a distribuicao da carie ainda e desigual. Os dentes atingidos por carie passaram a se concentrar numa proporcao menor de individuos. Ademais, nao se alterou a proporcao de dentes cariados nao tratados. A reducao das disparidades socioeconomicas e medidas de saude publica dirigidas aos grupos mais vulneraveis permanecem como um desafio para todos os que formulam e implementam as politicas publicas no Brasil.

Associação do índice CPO-D com indicadores sócio-econômicos e de provisão de serviços odontológicos no Estado do Paraná, Brasil

This ecological study investigated the associations between dental caries, socioeconomic indicators, and the supply of dental services in the State of Paraná, Brazil, for the year 1996. Two types of information were collected: (1) data on caries prevalence (DMFT at 12 years) for the municipalities (or counties) in the State; (2) data on socioeconomic conditions and the supply of dental services. Based on simple linear regression analysis, the study demonstrated a significant correlation between the caries index in municipalities and various social and dental services supply indicators. Results of the analysis of multiple linear regression showed that one indicator of income inequality remained significantly associated with dental caries, demonstrating that the worst oral health conditions cannot be dissociated from income disparities. A significant negative correlation was observed between DMFT and the proportion of the population that received fluoridated water, principally in the municipalities with the worst income inequality indicators. This highlights the importance of fluoridation for the reduction of caries rates, as well as to attenuate the impact of socioeconomic inequalities on the prevalence of dental caries.

Políticas de saúde bucal no Brasil e seu impacto sobre as desigualdades em saúde

This text systematizes available knowledge about the main dental health policies in Brazil in regards to their current degree of implementation and their impact on health inequalities. Although the fluoridation of publicly distributed water is legally mandated in Brazil, its implementation has been subject to marked regional inequalities. Data are presented about the extent of implementation for the intervention, and studies are reviewed that evaluate the interventions impact upon increasing inequality in the experience of dental caries. The provision of public dental services, which expanded considerably after the implementation of the National Unified Health Care System, is also discussed in relation to service provision and its impact on reducing inequality in access to dental treatment. The discussion of the differential effect of these interventions allowed for the proposal of targeted strategies (directing fluoridation to areas of greater need), aiming to reduce inequalities in the experience of dental caries in Brazil.Sistematiza-se o conhecimento disponivel sobre o estagio atual de efetivacao das principais politicas de saude bucal no Brasil e seu impacto sobre as desigualdades em saude. Embora a fluoretacao da agua de abastecimento publico no Brasil seja uma determinacao legal, sua implantacao tem sofrido marcantes desigualdades regionais. Sao apresentados dados sobre o grau de efetivacao da medida e sao revisados estudos que avaliaram seu impacto sobre a ampliacao da desigualdade na experiencia de carie dentaria. A oferta de atendimento publico odontologico, ampliada consideravelmente apos a implantacao do Sistema Unico de Saude, tambem e discutida em relacao a provisao do servico e seu impacto sobre a reducao da desigualdade no acesso a tratamento dentario. A discussao do efeito diferencial dessas medidas propiciou a proposicao de estrategias focais (direcionar a fluoretacao para as areas com maiores necessidades), visando a reduzir a desigualdade na experiencia de carie no Pais.

Trends and spatial distribution of oral cancer mortality in São Paulo, Brazil, 1980–1998

We assessed oral cancer mortality data in São Paulo to study trends of the disease and its distribution by areas of the city. We standardized death rates by gender and age group, and also supplied complementary information regarding oral cancer incidence. Oral cancer mortality remained stationary at high levels during the study period. Site-specific death rates revealed high figures for two categories of site: tongue and unspecified parts of mouth. Gum cancer death rates--the most easily diagnosed site-specific oral cancer at a routine dental examination--fell sharply, possibly as a consequence of the recent expansion in community dental health services in the city. In spite of this observation, the increase of death rates related to unspecified parts of the mouth points to the deficiencies of health services in detecting most of oral cancer cases early. Spatial data analysis enabled indication of areas and socio-economic factors associated with poorer profile in oral cancer mortality, important information for the targeting of health resources directed to the screening, prevention and education in oral cancer.

The association between socioeconomic development at the town level and the distribution of dental caries in Brazilian children

OBJECTIVE To investigate the association between dental caries among children in the state of São Paulo, Brazil, and town-level indices of socioeconomic development. METHODS We examined 15 385 oral-examination records from children aged 5 or 6 years old from 129 towns and cities in the state of São Paulo. We studied two outcomes: (1) the mean number of decayed, missing, and filled deciduous teeth (dmft index) and (2) the care index, which is the proportion of decayed teeth that have already been filled. The explanatory variables were the child development index, human development index, illiteracy rate among subjects older than 20 years, household income, Gini coefficient, insufficient income, fluoridated water supply, number of dentists per 10 000 inhabitants, number of dentists in the public service per 10 000 inhabitants, and number of weekly hours of dentist work in the public service per 10 000 inhabitants. Multiple linear regression models were fitted to the two outcome variables (dmft index and care index). RESULTS The multiple linear regression analysis showed that a higher dmft index was associated with a low child development index, a high illiteracy rate, and an unfluoridated water supply. The child development index was significantly associated with the care index, and the number of dentists in the public service per 10 000 inhabitants showed borderline statistical significance. CONCLUSIONS Our results indicate that town-level indices of socioeconomic status are significantly correlated with caries indices. Our results also emphasize the beneficial effect that fluoridating water has on reducing the prevalence of dental caries and the fact that strategies for treating and preventing oral diseases should be emphasized within the context of overall health promotion for children.

Determinantes individuais da utilização de serviços odontológicos por adultos e idosos de baixa renda

The utilization of dental care services results from the interaction of biological determinants with sociocultural, family and community variables, as well as from some characteristics of health systems. The objective of this study was to assess the individual factors associated with the use of dental care services among low-income adult and elderly individuals living in the catchment area of the Family Health Strategy, in Ponta Grossa, PR. The sample included 246 individuals, aged 35 years or over, who answered a questionnaire on socioeconomic conditions, perceived needs, and access to dental care services. Data analysis was performed according to a conceptual framework based on Andersens Behavioral Model. Non-recent use of dental care services was considered as the dependent variable in the logistic regression analysis models. There were high prevalences of self-reported oral health diseases and teeth loss. About 40% of the adults and 67% of the elderly had not made any dental visit in the past 3 years. Individuals without ownership of the family home, with inadequate oral hygiene habits and who wore complete dentures had higher odds of having gone to the dentist longer ago. The fact of having a regular source of dental care was identified as a protective factor in the analysis. The conceptual framework confirmed the presence of social and psychosocial inequalities in the use of dental services among low-income adult and elderly individuals.

Inequalities in the distribution of dental caries among 12-year-old Brazilian schoolchildren

We assessed the inequality in the distribution of dental caries and the association between indicators of socioeconomic status and caries experience in a representative sample of schoolchildren. This study followed a cross-sectional design, with a sample of 792 schoolchildren aged 12 years, representative of this age group in Santa Maria, RS, Brazil. Guardians answered questions on socioeconomic status and a dental examination provided information on the dental caries experience (DMF-T). Inequality in dental caries distribution was measured by the Gini coefficient and the Significant Caries Index (SiC). The assessment of association used Poisson regression models. Socioeconomic factors were associated with prevalence of dental caries for the whole sample and also for individuals with a high-caries level. Children from low-income households had the highest prevalence of dental caries. The Gini coefficient was 0.7 and the SiC Index 2.5. The percentage of caries prevalence was 39.3% (95% CI: 35.8%-42.8%) and the mean for DMF-T was 0.9 (± SD 1.5). Inequalities in the distribution of dental caries were observed and socioeconomic factors were found to be strong predictors of the prevalence of oral disease in children of this age group.

Correlação da presença de espécies de flebotomíneos (Diptera: Psychodidae) com registros de casos da leishmaniose tegumentar americana no Estado de São Paulo, Brasil

The study used environmental parameters associated with standardized coefficients incidence of American tegumentary leishmaniasis (ATL) in the State of Sao Paulo, Brazil, between 1986 and 1995. In the 140 municipalities with leishmaniasis transmission, the entomological collection of sandflies showed the most frequent species collected in the domestic environment: Lutzomyia intermedia was present in 87.7% of the surveyed municipalities, L. whitmani in 53.6%, L. migonei in 49.7%, L. pessoai in 28.5% and L. fischeri in 53.6%. It was found that the topographical relief and natural vegetation cover significantly influenced the mean values of standardized coefficients of accumulated incidence of ATL in the state (p < 0.001). Multivariable linear regression analysis showed that incidence of the disease was significantly associated with the presence of L. migonei (p = 0.029), in the municipalities of the Atlantic Plateau geomorphological region (p = 0.005) and those in which predominant vegetation cover was Type V forest (p < 0.001). This analysis reinforces the hypothesis that L. migonei is a vector for Leishmania in São Paulo State.

Cárie dentária e condições sócio-econômicas no Estado do Paraná, Brasil, 1996

The aim of this research was to determine the correlation between dental caries and socioeconomic conditions in the State of Parana, Brazil. Caries prevalence was estimated for each city in the State by gathering data on the DMFT index (in 12-year-old schoolchildren) supplied by the State Health Department. Official socioeconomic data for the municipalities were also presented. Ordinary least squares regression analysis was performed, and significant correlation coefficients were observed between the dental caries index and various social development indicators. Maps highlighting the overlapping areas with poor outcomes for most of these variables were presented. The results showed a significantly lower DMFT index in cities with fluoridated water supply and a negative correlation between the caries index and the proportion of households with running water in cities with fluoridated water supply. This observation highlights the importance of fluoridated drinking water for the prevention of dental caries and as a measure to reduce the impact of socioeconomic inequalities on the prevalence of tooth decay.

3-D volume rendering maxillofacial analysis of angular measurements by multislice CT.

OBJECTIVE This study was designed to determine the precision and accuracy of angular measurements using three-dimensional computed tomography (3D-CT) volume rendering by computer systems. STUDY DESIGN The study population consisted of 28 dried skulls that were scanned with a 64-row multislice CT, and 3D-CT images were generated. Angular measurements, (n = 6) based upon conventional craniometric anatomical landmarks (n = 9), were identified independently in 3D-CT images by 2 radiologists, twice each, and were then performed by 3D-CT imaging. Subsequently, physical measurements were made by a third examiner using a Beyond Crysta-C9168 series 900 device. RESULTS The results demonstrated no statistically significant difference between interexaminer and intraexaminer analysis. The mean difference between the physical and 3-D-based angular measurements was -1.18% and -0.89%, respectively, for both examiners, demonstrating high accuracy. CONCLUSION Maxillofacial analysis of angular measurements using 3D-CT volume rendering by 64-row multislice CT is established and can be used for orthodontic and dentofacial orthopedic applications.