Maximiano Ferreira Tovo

Capital Social e Sistema Único de Saúde (SUS) no Brasil

O objetivo principal deste artigo e construir um referencial teorico preliminar que possibilite a compreensao das razoes que podem determinar o desempenho satisfatorio das instituicoes de saude no Brasil, particularmente o do Sistema Unico de Saude (SUS). A hipotese teorica, a partir dos estudos de Putnam (2005), e de que o acumulo de Capital Social (CS) em determinada sociedade esta positivamente relacionado a capacidade de os governos atenderem e realizarem as demandas da populacao. Em outras palavras, os niveis de solidariedade e de confianca interpessoais e a existencia de organizacoes sociais sao elementos colaborativos para o desempenho das instituicoes politicas. O CS, na area da saude, funcionaria como elemento de impacto positivo, nao somente pelo fato de proporcionar uma vida mais saudavel para as populacoes, reduzindo a exclusao social e aumentando a longevidade e a autoestima, mas tambem por ter um papel fundamental no estimulo da participacao da comunidade tanto na formulacao de politicas publicas como no seu controle social, o que possibilitaria o melhor funcionamento das instituicoes. Nesse sentido, utilizamos os dados de pesquisa quantitativa aplicados em usuarios do SUS em duas cidades do Rio Grande do Sul (Caxias e Pelotas).

Evaluation of final-year dental students concerning therapeutic decision making for proximal caries

This cross-sectional study aimed to determine the radiographic criteria used by final-year dental students when defining the need for restorative treatment for proximal caries, as well as investigating potentially associated factors in this therapeutic decision. A questionnaire with two schematic diagrams presenting five levels of proximal lesion penetration was administered to students attending the six private and three public dental schools in the state of Rio Grande do Sul, Southern Brazil. Absolute and relative frequencies were described and inferential statistics involving Chi-square and McNemar tests and simple logistic regression were carried out to assess variations in therapeutic decisions related to patient dentition (deciduous/permanent) and gender, age and dental school (public/private). Of the 346 dental students assessed, 28.6% (99/346) indicated restorative treatment for lesions restricted to the enamel in deciduous teeth and 38.2% (132/346) indicated the same for permanent teeth, revealing a statistically significant difference (p = 0.001). Student gender and age were not associated with the therapeutic decision; however, a significant difference between dental schools was found when comparing restorative criteria in deciduous (p < 0.001) and permanent molars (p < 0.001). The odds of restorative decision in permanent teeth when the caries lesion was restricted to the enamel was 72% higher for students graduating from private schools compared to public schools (Odds Ratio: 1.72; 95% Confidence Interval: 1.03-2.90). These data demonstrate a large variation between the therapeutic decisions regarding proximal caries reported by final-year dental students and suggest that deep reflection is needed on the part of faculty in order to provide an evidence-based education.

Análise da produção ambulatorial em municípios com e sem centros de especialidades odontológicas no Brasil em 2010

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.O objetivo foi descrever a producao de servicos especializados em municipios brasileiros com e sem Centros de Especialidades Odontologicas (CEO) e estudar fatores associados. Para a coleta de dados, foram consultados: o Departamento de Informatica do SUS, dados do Atlas de Desenvolvimento Humano do Brasil e do Instituto Brasileiro de Geografia e Estatistica. Utilizou-se regressao binominal negativa inflada de zeros para modelar taxas de procedimentos de endodontia, atencao basica, periodontia e cirurgia. Apos controle por fatores sociodemograficos, os municipios com CEO apresentaram taxas maiores do que os sem, exceto para taxas de atencao basica. No modelo final, com variaveis de estrutura dos servicos, os municipios com CEO do tipo III tiveram uma taxa de procedimentos de endodontia 2,08 (IC95%: 1,26; 3,44) vezes maior que sem CEO. Das variaveis de estrutura, mais gastos em saude e maiores taxas de dentistas no SUS estavam consistentemente associados a maiores taxas de quaisquer procedimentos. Os CEO parecem ter um efeito positivo na producao municipal de procedimentos especializados, particularmente para a taxa de procedimentos de endodontia, e esse efeito nao e explicado por variaveis de estrutura.

Microleakage between two filling restorative techniques using glass ionomer cement in primary molars: comparative "in vitro " study

This study evaluate the marginal microleakage in deciduous molars cavities restored with ionomer cement modified by resin (Vitremer, 3 M) comparing two different techniques: the conventional (according to manufacturer instructions) and with the hybridization technique (acid phosphoric 37% and adhesive system Scotchbond Multi Pourpose , 3M). Proximal cavities were prepared in 20 sound deciduous molars, right after extraction. The samples were randomly divided in two groups. Group 1 consisted in teeth prepared with the conventional technique and in the group 2 teeth with etching by phosphoric acid and adhesive system. The teeth were submitted to termical cycle process (100 cycles, each one of 3 sub cycles of 5o C, 37o C and 55o C - by 60 Sec of bath immersion each one), after restorations. After that, the teeth were impermeable with nail polish and wax #7 keeping 2mm of area in the junction of the cervical restoration margin, and them immersed in methylen blue solution to 0,5% , seccionated and evaluated by one examiner, who established the microleakage degree. The data reveal the both techniques show the micro infiltration in different degree, but it has no statistical difference between techniques.This study evaluate the marginal microleakage in deciduous molars cavities restored with ionomer cement modified by resin (Vitremer, 3 M) comparing two different techniques: the conventional (according to manufacturer instructions) and with the hybridization technique (acid phosphoric 37% and adhesive system Scotchbond Multi Pourpose , 3M). Proximal cavities were prepared in 20 sound deciduous molars, right after extraction. The samples were randomly divided in two groups. Group 1 consisted in teeth prepared with the conventional technique and in the group 2 teeth with etching by phosphoric acid and adhesive system. The teeth were submitted to termical cycle process (100 cycles, each one of 3 sub cycles of 5o C, 37o C and 55o C - by 60 Sec of bath immersion each one), after restorations. After that, the teeth were impermeable with nail polish and wax #7 keeping 2mm of area in the junction of the cervical restoration margin, and them immersed in methylen blue solution to 0,5% , seccionated and evaluated by one examiner, who established the microleakage degree. The data reveal the both techniques show the micro infiltration in different degree, but it has no statistical difference between techniques.

Bibliometric analysis of scientific articles published in Brazilian and international orthodontic journals over a 10-year period

Objective This study aimed at describing the profiles of Brazilian and international studies published in orthodontic journals. Methods The sample comprised 635 articles selected from two scientific journals, i.e., Dental Press Journal of Orthodontics and American Journal of Orthodontics and Dentofacial Orthopedics, which were analyzed at three different intervals over a 10-year period (1999 - 2004 - 2009). Articles were described in terms of knowledge domain, study design, and country of origin (or state of origin for Brazilian papers). Results The most frequent study designs adopted in international studies were cohort (23.9%) and cross-sectional (21.7%) designs. Among Brazilian papers, cross-sectional studies (28.9%) and literature reviews (24.6%) showed greater frequency. The topics most often investigated were dental materials (17%) and treatment devices (12.4%) in international articles, with the latter topic being addressed by 16% of the Brazilian publications, followed by malocclusion, with 12.6%. In all cases, the most frequent countries of origin coincided with the countries of origin of each journal. Conclusions The majority of the studies analyzed featured a low level of scientific evidence. Moreover, the findings showed that journals tend to publish studies produced in their own country of origin, and that there are marked discrepancies in the number of papers published by different Brazilian states.

[Analysis of outpatient care in Brazilian municipalities with and without specialized dental clinics, 2010].

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.O objetivo foi descrever a producao de servicos especializados em municipios brasileiros com e sem Centros de Especialidades Odontologicas (CEO) e estudar fatores associados. Para a coleta de dados, foram consultados: o Departamento de Informatica do SUS, dados do Atlas de Desenvolvimento Humano do Brasil e do Instituto Brasileiro de Geografia e Estatistica. Utilizou-se regressao binominal negativa inflada de zeros para modelar taxas de procedimentos de endodontia, atencao basica, periodontia e cirurgia. Apos controle por fatores sociodemograficos, os municipios com CEO apresentaram taxas maiores do que os sem, exceto para taxas de atencao basica. No modelo final, com variaveis de estrutura dos servicos, os municipios com CEO do tipo III tiveram uma taxa de procedimentos de endodontia 2,08 (IC95%: 1,26; 3,44) vezes maior que sem CEO. Das variaveis de estrutura, mais gastos em saude e maiores taxas de dentistas no SUS estavam consistentemente associados a maiores taxas de quaisquer procedimentos. Os CEO parecem ter um efeito positivo na producao municipal de procedimentos especializados, particularmente para a taxa de procedimentos de endodontia, e esse efeito nao e explicado por variaveis de estrutura.

Root Resorption a 6-Year Follow-up Case Report

This paper describes the clinical course of a pediatric patient developing cervical external root resorption (CERR). An 11-year old male patient had sustained dental trauma and was diagnosed with crown fracture affecting the incisal and middle thirds of the maxillary right permanent central incisor and the maxillary right permanent lateral incisor with pulp exposure and CERR after 24 months. Diagnosis and treatment of CERR are a challenge for dental practitioners. In this case, preservation of natural dentition is shown as a successful treatment in a 6-year follow-up.

Análisis de la producción ambulatoria en municipios con y sin centros de especialidades dentales en Brasil, 2010

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.O objetivo foi descrever a producao de servicos especializados em municipios brasileiros com e sem Centros de Especialidades Odontologicas (CEO) e estudar fatores associados. Para a coleta de dados, foram consultados: o Departamento de Informatica do SUS, dados do Atlas de Desenvolvimento Humano do Brasil e do Instituto Brasileiro de Geografia e Estatistica. Utilizou-se regressao binominal negativa inflada de zeros para modelar taxas de procedimentos de endodontia, atencao basica, periodontia e cirurgia. Apos controle por fatores sociodemograficos, os municipios com CEO apresentaram taxas maiores do que os sem, exceto para taxas de atencao basica. No modelo final, com variaveis de estrutura dos servicos, os municipios com CEO do tipo III tiveram uma taxa de procedimentos de endodontia 2,08 (IC95%: 1,26; 3,44) vezes maior que sem CEO. Das variaveis de estrutura, mais gastos em saude e maiores taxas de dentistas no SUS estavam consistentemente associados a maiores taxas de quaisquer procedimentos. Os CEO parecem ter um efeito positivo na producao municipal de procedimentos especializados, particularmente para a taxa de procedimentos de endodontia, e esse efeito nao e explicado por variaveis de estrutura.

Utilização do sistema de anestesia computadorizada the wand® em odontopediatria

Resumen pt: Introducao: O comportamento positivo do paciente infantil depende, entre outras variaveis, do controle da dor com a anestesia local. Objetivo: Neste co...

Avaliação sobre o ensino e utilização de métodos radiográficos digitais na faculdades de odontologia do RS

This research evaluated the current stage of teaching and use of digital radiographic methods in Dentistry Schools in Rio Grande do Sul, Brazil. Professors of two different Dentistry specialties (pe- dodontologyand dental radiology) were invited to answer some ques- tions on digital radiographic me- thods. The results showed that only one school develops clinical/ laboratorial activities with digital systems. Theoretical activities are considered by five Radiology dis- ciplines and two Pediatric ones. The high cost of digital systems and the lack of a legal base to con- sider a digital image as a certified document were considered rea- sons for not using the systems. However, the majority of the in- quired professors affirmed that digital images show advantages, as the density and contrast post- processing; the reduction of the exposure time in relation to the conventional method and the eli- mination of chemical processing. ln conclusion, digital radiography is out of the current stage in den- tal education in Dentistry Scho- ols in the South ofBrazil. Key words: computerized diag- nosis, image diagnosis, pedodon- tology, radiology.