Maria Ângela Fernandes Ferreira

Mortalidade por câncer de boca e condição sócio-econômica no Brasil

As doencas cronico-degenerativas representam um grande problema de saude publica, necessitando de levantamento e controle mais efetivos destas enfermidades por parte dos orgaos publicos. O objetivo deste estudo foi correlacionar os indices de mortalidade por câncer oral nas capitais do Brasil no periodo de 1998 a 2002 com indicadores socio-economicos do Censo Demografico de 2000, por meio de um estudo do tipo ecologico. Os dados foram extraidos do Sistema de Informacao de Mortalidade (Ministerio da Saude/DATASUS), para os anos de 1998-2002. Os indicadores socio-economicos foram obtidos a partir do Atlas do Desenvolvimento Humano no Brasil. Apos coleta dos dados, a analise estatistica foi realizada usando-se o indice de correlacao de Pearson. Observaram-se correlacoes positivas e significativas entre os indicadores socio-economicos (Indice de Desenvolvimento Humano-Municipal - IDH-M, IDH-M renda, IDH-M educacao, IDH-M longevidade e renda per capita), e correlacao negativa e significante para os indicadores socio-economicos indice de Gini e mortalidade infantil. Apesar das limitacoes do estudo e da provavel problematica de sub-registros nas capitais menos desenvolvidas, o presente trabalho encontrou correlacoes estatisticamente significantes entre os indicadores socio-economicos selecionados e o indice de mortalidade por câncer oral.

Prevalence of orofacial clefts and social factors in Brazil

The aim of this study was to investigate the prevalence of orofacial clefts in live newborns from 1998 to 2002 in Brazilian state capitals and correlate their occurrence with a number of relevant socioeconomic factors collected in the 2000 census. Data was obtained from the Public Health Hospital Information System (SIH-SUS), Information System of Live Hospital Births (SINASC) and Atlases of Human Development in Brazil. The results showed that the mean prevalence of orofacial clefts in Brazil was 0.36 per 1,000 live births. Using Pearsons correlation coefficient, the correlation between cleft rate and social factors was not statistically significant (p > 0.05). Our study suggests that there is no correlation between the municipal economic factors and the prevalence of orofacial clefts, which is likely influenced by underrecording problems in the less developed municipalities.

Mandibular implant-supported removable partial denture with distal extension: a systematic review.

The aim of this article is to investigate patient satisfaction, survival rate of implants, and prosthetic complications or maintenance for rehabilitation with removable partial dentures associated with implants in mandibular Kennedy class I and II cases. A systematic literature review was conducted by three independent reviewers including articles published from January 1981 through September 2011. Medline and Cochrane Library electronic databases were used in addition to hand searching to assess clinical outcomes for mandibular implant-supported removable partial denture with distal extension. This review yielded 1751 records that were narrowed down to 5. The studies revealed implant survival rates ranging from 95% to 100% with one failure reported of 98 implants. The removable partial dentures associated with implant in mandibular free-end arches showed some complications and need of repair for relining, pitting of the healing abutment, replacement of resilient component of the attachment, damage in framework, screw loosening and damage in acrylic denture base. Patient satisfaction was evaluated through a five-point questionnaire, and results ranged between 4.12 and 5.0, considering 1 as the least favourable situation. The literature review showed increase in patient satisfaction and high survival rates of implants associated with mandibular removable partial dentures with distal extensions. However, some complications and need of prosthetic repair were reported. Although this treatment approach could represent a low-cost and beneficial rehabilitation for free-end mandibular ridges, the lack of controlled and randomised well-designed clinical trials suggests further studies with more representative samples to validate the outcomes of this treatment modality.

Saúde bucal no contexto do Programa Saúde da Família: práticas de prevenção orientadas ao indivíduo e ao coletivo

Professional practices reflect the structuring of health services and are related to the underlying principles of the prevailing health care model. This study focused on preventive and educational practices by dentists in the Family Health Program in Natal, Rio Grande do Norte State, Brazil. A structured interview was held with 80 dentists, in addition to analysis of documents from the Outpatient Database of the Unified National Health System (SIA-SUS) and the Primary Care Database. Individual activities involving orientation for oral hygiene and topical application of fluoride were reported by 87.5% and 95% of dentists, respectively. At the collective level, all the dentists that worked in schools (91.2%) performed topical fluoride application, while 86.2% conducted educational activities. According to SIA-SUS records, preventive activities accounted for 41% of all procedures. Among these, topical application of fluoride gel per sitting and supervised brushing accounted for 24.4% and 31%, respectively. As for educational activities, 57.4% were held in the health care unit and 42.6% in the community. The findings indicate that the preventive practices focus on dental caries, particularly in schoolchildren, and that they need to be expanded to include other oral health problems.

Os fatores associados à tuberculose pulmonar e a baciloscopia: uma contribuição ao diagnóstico nos serviços de saúde pública

OBJETIVO: Verificar os principais fatores associados a tuberculose pulmonar e os resultados da baciloscopia. DESENHO DO ESTUDO: Trata-se de um estudo seccional de base secundaria. METODOLOGIA: A coleta de dados foi realizada com 189 prontuarios de pacientes com idade acima de 25 anos atendidos no Hospital Giselda Trigueiro em Natal/RN, Brasil, no periodo de 2000 a 2002. Os fatores associados identificados e os resultado da baciloscopia foram apresentados atraves da distribuicao percentual. RESULTADOS: A media de idade dos pacientes variou entre 43,5 + 18,5 anos, sendo 73% do sexo masculino. Os principais fatores associados foram etilismo e tabagismo (20,6%), tabagismo (19,8%), etilismo (16,7%), contagio direto (10,3%), diabetes mellitus (8,7%), pneumonia nao tratada (6,3%), abandono de esquema (6,3%) e outros fatores (11,1%). A baciloscopia foi realizada em 84,1% dos pacientes. Em 44,7% deles, o diagnostico foi negativo, enquanto que em 55,3% foi positivo. CONCLUSAO: Os fatores associados contribuem para o diagnostico da tuberculose pulmonar na medida em que a baciloscopia apresenta uma baixa sensibilidade.

Counselling and self-management therapies for temporomandibular disorders: a systematic review

The aim of this review was to investigate the effectiveness of counselling and other self-management-based therapies on muscle and temporomandibular joint (TMJ) pain relief and increasing the functional abilities of patients with temporomandibular disorders (TMD). A systematic literature review was conducted by three independent reviewers and included articles published up to 2012. PubMed and Cochrane Library electronic databases were used in addition to hand-searching to assess clinical outcomes for counselling and self-management approaches for TMD treatment. The review yielded 581 records that were narrowed down to 7. All included studies were classified as blind-randomized controlled clinical trials. The selected articles analysed revealed that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches. Thus, counselling- and self-management-based therapies could be considered a conservative low-cost and beneficial treatment alternative for treating TMD to potentially improve psychological domains and remove harmful behaviours for the control of the signs and symptoms of TMD.

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.

Use of laser fluorescence (DIAGNOdentTM) for in vivo diagnosis of occlusal caries: a systematic review

This systematic review was conducted to assess the accuracy of laser fluorescence (DIAGNOdentTM) for diagnosis of occlusal caries in permanent teeth, using any sort of gold standard. The MEDLINE, LILACS, BBO and Cochrane library databases accessed by BIREME were searched for English, Spanish and Portuguese-language papers published between 1982 and 2003. Four works in English were selected. DIAGNOdentTM was found to be an accurate method for diagnosis of occlusal caries, mainly if employed simultaneously with visual inspection.

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.