Mara Vasconcelos

The severity of dental caries in adults aged 35 to 44 years residing in the metropolitan area of a large city in Brazil: a cross-sectional study.

BackgroundIn recent decades, studies in the field of public health have increasingly focused on social determinants that affect the health-illness process. The epidemiological perspective considers oral health to be a reflection of socioeconomic and environmental aspects, and it is particularly influenced by the social context. The aim of the present study was to assess the association between the severity of dental caries among adults aged 35 to 44 years and characteristics on the different levels at which the determinants of caries operate (individual, social structure and social context).MethodsA home-based, cross-sectional field study was carried out involving a sample of 1,150 adults (35 to 44 years of age) residing in metropolitan Belo Horizonte, Brazil. The DMFT (decayed, missing, filled tooth) index (≥14) was used to determine the severity of dental caries. Bivariate and multivariate analyses were carried out using the Poisson regression model with the level of significance set at 5% (p < 0.05) and 95% confidence intervals.ResultsThe majority of the participants (68.5%) had high caries severity. The rate of high-severity caries in the group between 40 and 44 years of age was 1.15-fold (CI: 1.04-1.26) greater than that among those aged 35 to 39 years. A greater prevalence of high caries severity was found among those who frequently visited the dentist (PR = 1.18; CI: 1.07-1.30), those with a lower income (PR = 1.11; CI: 1.01-1.23), those who reported that their neighborhood did not come together in the previous year to petition political leaders for benefits (PR = 1.16; CI: 1.05-1.28) and those who are unable to make decisions (without empowerment) (PR = 1.12; CI: 1.01-1.24).ConclusionsThe present study revealed high dental caries severity in adults, which was associated with individual characteristics, health-related behavior and social structure and contextual variables. These findings underscore the importance of considering social determinants involved in the health-illness process when carrying out epidemiological studies on dental caries.

Desigualdades na distribuição da cárie dentária no Brasil: uma abordagem bioética

Este artigo objetivou analisar a problematica da carie dentaria, enquanto uma questao de saude publica de relevância epidemiologica, tendo como suporte analitico a visao da Bioetica da Protecao. Trata-se de estudo de caso realizado a partir de analise documental dos inqueritos epidemiologicos em saude bucal, de base nacional, 1986, 2003 e 2010. Os levantamentos apontam desigualdades entre grupos populacionais. Essa desigualdade foi analisada, com relacao a reducao da doenca na populacao mais jovem, no acesso ao atendimento, e na perda dentaria, pior desfecho para a carie dentaria. Os bons resultados apresentados, nos levantamentos, nao atinge toda a populacao, apresentando desigualdades por renda familiar e regiao brasileira. Constatou-se a partir de 2003 intervencoes do Estado em acoes protetoras, como adocao de criterios de equidade na destinacao dos recursos na saude e inclusao de populacoes em vulneracao, contribuindo para reducao da carie. No entanto, considera-se necessario avancar mais nos modelos assistenciais em saude bucal usando a Epidemiologia como uma ferramenta estruturante, ja que as diferencas regionais ainda permaneceram marcantes, em interface com uma bioetica protetora e socialmente responsavel.

Inequalities in the distribution of dental caries in Brazil: a bioethical approach

The scope of this paper was to analyze the problem of dental caries as a public health issue of epidemiological relevance. It is a case study based on documentary analysis of national epidemiological surveys on oral health in the years 1986, 2003 and 2010, with the Bioethics of Protection as an analytical support. The surveys revealed inequalities between population groups; and such inequalities were analyzed with respect to the reduction of the disease in the younger population, access to oral health care, and tooth loss, which is the worst outcome for tooth decay. The good results presented in the surveys have not reached the whole population; data have shown inequalities regarding family income and Brazilian region. It was also found that from 2003 government interventions in protective actions such as the adoption of criteria of equity in the allocation of health resources and inclusion of vulnerable population have contributed to a reduction in caries. Nevertheless, it is considered necessary update oral health care models by using Epidemiology as a structuring tool, and an interface with socially responsible protective bioethics, since regional differences continued to be marked in the analysis.

High Dental Caries among Adults Aged 35 to 44 Years: Case-Control Study of Distal and Proximal Factors

The aim of this study was to determine whether a high degree of dental caries severity is associated with the distal and proximal determinants of caries in a group of Brazilian adults aged 35 to 44 years. A population-based case-control study was conducted using two groups—a case group with high caries severity (DMFT ≥ 14) and a control group without high caries severity (DMFT < 14). The sample comprised adults from metropolitan Belo Horizonte, Brazil (180 cases and 180 controls matched for gender and age). The exam was performed by calibrated dentists using the DMFT index. The statistical analysis used the Mann-Whitney test and bivariate and multivariate logistic regression (the conditional backward stepwise method). The mean DMFT was 8.4 ± 3.9 in the control group and 20.1 ± 4.5 in the case group. High caries severity was associated with regular visits to the dentist, low income, use of private/supplementary dental service and not petitioning the authorities for community benefits. The results of the study underscore the importance of considering distal and proximal factors in the assessment of the severity of dental caries. Greater caries severity persists among low-income families and among groups with a low degree of social cohesion.

Impacto da cárie dentária na qualidade de vida de adultos residentes no entorno de Belo Horizonte, MG, Brasil

This paper discusses the impact of dental carries on quality of life. The aim was to assess the quality of life of adults in greater Belo Horizonte (state of Minas Gerais, Brazil) in accordance with the prevalence and severity of dental caries. A domicile-based cross-sectional study was carried out with cluster sampling. Data collection involved the DMFT index and WHOQOL-BREF questionnaire. The prevalence of dental caries was defined based on the presence of at least one carious tooth (D > 1) and greater severity was defined as DMFT > 25. Among the 1138 adults studied, 461 had at least one carious tooth. Higher quality of life values were found among individuals without dental caries and those with lesser severity of caries. A greater number of carious teeth and higher DMFT index denoted a reduction in quality of life (p < 0.001). Negative correlations between dental caries and quality of life were determined in the psychological, social and environmental domains. In conclusion, dental caries exerts a negative impact on the quality of life of adults. Subjective indicators can contribute in qualifying clinical information on oral health.

A 15-Year Time-series Study of Tooth Extraction in Brazil

AbstractTooth loss is considered to be a public health problem. Time-series studies that assess the influence of social conditions and access to health services on tooth loss are scarce.This study aimed to examine the time-series of permanent tooth extraction in Brazil between 1998 and 2012 and to compare these series in municipalities with different Human Development Index (HDI) scores and with different access to distinct primary and secondary care.The time-series study was performed between 1998 and 2012, using data from the Brazilian National Health Information System. Time-series study was performed between 1998 and 2012. Two annual rates of tooth extraction were calculated and evaluated separately according to 3 parameters: the HDI, the presence of a Dental Specialty Center, and coverage by Oral Health Teams. The time-series was analyzed using a linear regression model.An overall decrease in the tooth-loss tendencies during this period was observed, particularly in the tooth-extraction rate during primary care procedures. In the municipalities with an HDI that was lower than the median, the average tooth-loss rates were higher than in the municipalities with a higher HDI. The municipalities with lower rates of Oral Health Team coverage also showed lower extraction rates than the municipalities with higher coverage rates.In general, Brazil has shown a decrease in the trend to extract permanent teeth during these 15 years. Increased human development and access to dental services have influenced tooth-extraction rates.

Dental caries and endemic dental fluorosis in rural communities, Minas Gerais, Brazil

It is observational, analytical and cross-sectional aimed to evaluate the association between severity and prevalence of fluorosis and dental caries in rural communities with endemic dental fluorosis in the north state of Minas Gerais, Brazil, with fluoride concentrations in water up to 4.8 mg/L. Data were collected by one examiner (intra-examiner kappa, 0.96 to 0,95 for caries and fluorosis) after toothbrushing. The study included 511 individuals aged 7 - 22 years, categorized according to age: 7 - 9 years (n = 227), 10 to 12 years (n = 153), 13 to 15 years (n = 92), 16 to 22 years (n = 39). For the diagnosis of dental caries used the criteria of the World Health Organization to measure indices DMFT. For fluorosis used the index Thylstrup and Fejerskov (TF), dichotomized according to prevalence (TF = 0 and TF > 0) and severity (TF < 4 and TF > 5). In the two younger groups, the DMFT and its decay component were higher in the group with more severe fluorosis (p < 0.001). This association was not found among adolescents and adults (p > 0.05). The association was found between the conditions more severe fluorosis and caries in individuals under 12 years.

Socioeconomic Factors and Caries in People between 19 and 60 Years of Age: An Update of a Systematic Review and Meta-Analysis of Observational Studies

This study is aimed to perform an update of a systematic review and meta-regression to evaluate the effect modification of the socioeconomic indicators on caries in adults. We included studies that associated social determinants with caries, with no restriction of year and language. The Newcastle-Ottawa Scale was used to evaluate the risk of bias. With regard to the meta-analysis, statistical heterogeneity was evaluated by I2, and the random effect model was used when it was high. A subgroup analysis was conducted for socioeconomic indicators, and a meta-regression was performed. Publication bias was assessed through Egger’s test. Sixty-one studies were included in the systematic review and 25 were included in the meta-analysis. All of the studies were published between 1975 and 2016. The most frequent socioeconomic indicators were schooling, income, and socioeconomic status (SES). In the quantitative analysis, the DMFT (decayed, missing, filled teeth) variation was attributed to the studies’ heterogeneity. The increase of 10.35 units in the proportion of people with lower SES was associated with an increase of one unit in DMFT, p = 0.050. The findings provide evidence that populations with the highest proportions of people with low SES are associated with a greater severity of caries. The results suggest the need for actions to reduce the inequalities in oral health (PROSPERO [CRD42017074434]).

Preenchimento da Caderneta de Saúde da Criança nos serviços de saúde em Belo Horizonte, Minas Gerais, Brasil

OBJECTIVE to describe the filling process of the Child Health Record (CHR) in health care services. METHODS descriptive study held in Belo Horizonte, Minas Gerais, Brazil; an interview was conducted with parents/guardians of children aged 3-5 years old; 21 essential items to child monitoring were observed in the CHR during the 2014 Multi-vaccination Day; fields that should be filled in maternity wards, Primary Health Care (PHC), and other services were assessed separately. RESULTS 367 children (96.1%) were included; 44.5% of CHR presented ≥60% of completeness; among the items that should be recorded in maternity wards, birth weight showed the highest proportion of completeness (64.5%); for those that should be filled in PHC/other services, records of vaccines (94.0%) presented the highest completeness; there was more filling in maternity wards than in PHC and other services (p<0.001). CONCLUSION a low proportion of filling was observed, especially in PHC and other services.

Avaliação do preenchimento da Caderneta de Saúde da Criança e qualidade do preenchimento segundo o tipo de serviço de saúde usado pela criança

Resumo Objetivou-se avaliar o preenchimento da Caderneta de Saude da Crianca (CSC) e a associacao entre qualidade do preenchimento e o tipo de servico usado para o acompanhamento da saude das criancas. Estudo transversal com amostra estratificada e proporcional aos 9 Distritos Sanitarios de Belo Horizonte, selecionada entre criancas de 3 a 5 anos, no Dia da Campanha de Vacinacao Infantil 2014. Realizou-se entrevista com os pais e observacao de 21 itens da CSC. A variavel dependente foi definida pela qualidade (satisfatoria/insatisfatoria) do preenchimento da CSC, sendo considerado satisfatorio o preenchimento > 60%. As variaveis independentes foram o tipo de servico para acompanhamento da saude da crianca, caracteristicas demograficas e condicoes de saude da mae e da crianca, e atencao em saude recebida pela crianca. Participaram 367 pais. A proporcao de preenchimento insatisfatorio foi 55,5%. Nao houve associacao significativa entre qualidade de preenchimento e tipo de servico de saude. O preenchimento insatisfatorio esteve associado a idade gestacional < 37 semanas, falta de acesso a informacoes sobre a CSC e ausencia de anotacoes dos pais na CSC. A CSC tem sido insatisfatoriamente empregada como um instrumento de vigilância da saude independentemente do tipo de servico usado pela crianca.The scope of this study was to assess the way Child Health Records (CHRs) are filled out and the association between the quality of entries and type of service used to monitor the health of children. It involved a cross-sectional study with a stratified sample - proportional for the nine Health Districts of Belo Horizonte, State of Minas Gerais - of 3- to 5-year-old children selected on Child Vaccination Campaign Day in 2014. Interviews with parents including observation of the 21 CHR items were conducted. The dependent variable was defined by the quality of the CHR entry (satisfactory/unsatisfactory), where satisfactory entries were > 60%. The independent variables were the type of service for monitoring child health, demographic and health conditions of the mother and child and healthcare treatment received by the child, with the participation of 367 (96.10%) parents. The prevalence of unsatisfactory entries was 55.5%. No significant association was found between quality of entry and type of healthcare. Unsatisfactory entries were associated with gestational age < 37 weeks, lack of access to information about the CHR and the absence of parental entries on the CHR. The CHR has been unsatisfactorily employed as a tool for monitoring health, irrespective of the type of service used by the child.